- •The approximate timing of classes
- •Practice work
- •Glossary
- •Office hours (2) Formation of practical skills on the theme «The subject, purposes and methods of pathological physiology”.
- •Case study
- •3. How can you experimentally check your presumptions about the nature of the pathologic process?
- •The approximate timing of classes
- •Practical work of students
- •Questions 1. What factors affect the mouse in this experiment?
- •2. Which of these factors could be considered the leading cause of the pathologic process - hypobaric hypoxia?
- •Pathogenesis of High altitude disease
- •Vicious circle in pathogenesis of High altitute disease
- •Office hours (2) Formation of practical skills on the theme «General etiology and pathogenesis. Effects of low barometric pressure on an organism”
- •Case Study Case 1. A group of tourists came under heavy rain. A day later, one of them developed pneumonia. Questions:
- •The approximate timing of classes
- •Glossary:
- •Office hours (2) Formation of practical skills on the theme «The role of reactivity of an organism in pathology”
- •The approximate timing of classes
- •Practical work of students
- •Explain the pathogenesis of hemolysis in tubes №№ 2-5 and the absence of hemolysis in tube number 1. Glossary
- •Office hours (2) Formation of practical skills on the theme “Cell injury”
- •Case Study
- •The approximate timing of classes
- •Practical work of students
- •I nfection, ischemia, traumas, tumors, burns, immune pathological processes, etc.
- •The significance of acute phase reactions for organism
- •Glossary
- •Types of fever on the basis of the extent of temperature elevation:
- •Types of fever on the basis of temperature fluctuation:
- •- Remittent (fluctuation 1-20c) (viral and bacterial infections, exudative pleuritis)
- •Control -test Office hours (2) Formation of practical skills on the theme “systemic organism’s response to damage. Fever”
- •Case Study
- •Control – conclusions on the cases
- •The approximate timing of class
- •Practical work of students
- •Glossary
- •Office hours (2) Formation of practical skills on the theme “Disorders of water and electrolyte metabolism”
- •The approximate timing of classes
- •Vasoconstriction Vasodilation of brain vessels High irritability of n. Vagus
- •Non respiratory (metabolic) alkalosis
- •Compensatory mechanisms at abb disorders
- •Glossary
- •Nongaseous acidosis (metabolic, exogenous, excretory) develops when there is accumulation of acidic products (metabolic disorders, acid intake from outside, diarrhea)
- •Office hours (2) Formation of practical skills on the theme “Acid-base disorders”
- •The approximate timing of classes
- •Practical work of students
- •Glossary
- •Control -test Office hours (2) Midterm control 1
- •The approximate timing of class
- •Practical work of students
- •Глоссарий
- •Office hours (2) Formation of practical skills on the theme “Disorders of carbohydrate metabolism”
- •The approximate timing of class
- •Case-study case 1
- •Control -test Office hours (2) Formation of practical skills on the theme “Disorders of protein and lipid metabolism”
Glossary
Acid-base balance is the ratio between the concentration of H+ and OH- ions in biological substances
КОС - кислотно-основное состояние – это- соотношение концентраций водородных (Н+) и гидроксильных (ОН) ионов в биологических средах.
pH is the negative logarithm of the H+ concentration. It is an integral indicator of acid-base status. The normal pH of arterial blood is 7.35-7.45, venous blood is 7,26-7,36.
рН - отрицательный десятичный логарифм концентрации водородных ионов, является интегральным показателем кислотно-основного состояния. В норме рН артериальной крови составляет 7,35-7,45, венозной - 7,26-7,36.
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Acidosis is absolute or relative increase in blood acids.
Ацидоз - абсолютное или относительное увеличение кислот в крови.
Alkalosis is absolute or relative increase in blood alkaline
Алкалоз – абсолютное или относительное увеличение оснований в крови
Compensated acidosis and alkalosis - arterial pH remains within the normal range
Компенсированные ацидозы и алкалозы - рН артериальной крови остается в пределах нормы
Decompensated acidosis and alkalosis occurs when arterial pH is less than 7.35 or more than 7.45
Декомпенсированные ацидозы и алкалозы - рН артериальной крови сдвигается за пределы нормальных значений
Gaseous (respiratory) acidosis occurs when acid-base balance disorders are caused by primary increase in pCO2 in biological fluids. Gaseous alkalosis - occurs when acid-base balance disorders are caused by primary decrease in pCO2 in biological fluids.
Газовый (респираторный) ацидоз - нарушение КОС, обусловленное первичным увеличением напряжения СО2 в биологических жидкостях.
Газовый алкалоз - нарушение КОС, вызванные первичным снижением напряжения СО2 в биологических жидкостях.
Nongaseous acidosis (metabolic, exogenous, excretory) develops when there is accumulation of acidic products (metabolic disorders, acid intake from outside, diarrhea)
Nongaseous alkalosis (metabolic, exogenous, excretory) develops when there is accumulation of bicarbonate anion.
Негазовый ацидоз (метаболический, экзогенный, выделительный) формируется вследствие накопления в организме кислых продуктов (нарушение обмена, поступление кислот извне, почечная недостаточность, диарея)
Негазовый алкалоз (экзогенный, выделительный, метаболический) - нарушение КОС, обусловленное повышением концентрации аниона гидрокарбоната.
THE LIST OF LITERATURE:
The basic
Litvitsky P.F., Pirozhkov S.V., Tezikov E.B. Concise lectures and tests on pathophysiology E-tekstbook. – ГЭОТАР-Медиа, 2007
Additional
Textbook of pathology. Harsh Mohan. Body fluid and circulatory disturbances. 4rd edition, Delhi, 2004.- P 100-102 .
Textbook of medical physiology. Regulation of acid-base balance. A.C. Guyton, J.E. Hall., 9th edition, 1996.-P. 385-403
Control -test
Office hours (2) Formation of practical skills on the theme “Acid-base disorders”
The purpose of the office hour:
Development of practical skills of interpretation of clinical and laboratory data in solving clinical cases
Tasks of study: • To apply the theoretical knowledge in pathophysiological analysis of cases
The Method of office hour: case study
Case Study
Case 1.
A group of mountain-climbers in which a physician was included planned to climb a mountain peak of 6200 m. Climbing up to the level of 2900 m was successful, but at this altitude the physician, being an inexperienced climber, felt fatigue, muscle weakness, dizziness, buzzing in the ears (tinnitus). During a one-hour halt the physician collected samples of the capillary blood from himself (B1) and his mate (A1). Then the group continued the ascent. At the height of 5000 m the physician felt acute shortness of breath, severe weakness, heaviness in the body, vision disturbances, and became ataxic. For this reason he decided to stop climbing. The state of the experienced climbers was satisfactory. After the repeated withdrawal of blood samples (A2,B2) all the climbers returned to the camp at the level of 3000 m.
The results of laboratory tests of the blood samples are the following:
|
A1 |
A2 |
B1 |
B2 |
pH |
7.43 |
7.35 |
7.48 |
7.32 |
pCO2 (mm Hg) |
32 |
30 |
26 |
42 |
pO2 (mm Hg) |
74 |
48 |
70 |
38 |
SB (mmol/L) |
20.5 |
18.5 |
20.0 |
18.5 |
BE (mmol/L) |
+2.5 |
-3.6 |
+4.5 |
-5.5 |
Questions:
1. Are there any signs of hypoxia and acid-base disorders in the physician or his mate at the given altitudes? If you think there are, define the type of hypoxia and acid-base disorder and explain the cause of its development. Substantiate your answer by the given data.
2. What adaptive mechanisms, if any, were initiated in the body of the physician and the experienced climber when they were ascending? Were there any differencies in the pattern of adaptive mechanisms in the physician's and the climber's body?
3. Why did the adaptive mechanisms fail in the physician?
Case 2
A patient is in a coma. pH 7.17 pCO2 of 50 mm Hg. SB 15,0 mmol / l BB 38.0 mmol / l -13 BE mmol / l Ketone bodies - 250 micromoles (normal 140-200mkmol / l) Titratable acidity - 270 ml / day (normal 70-100 ml / day)
Questions:
1. Rate the pH of arterial blood, indicate its degree (compensated, decompensated) 2. Make a conclusion about a type of ABB, justify the answer 3. Rate the value of indicators of ABB. 4. Explain compensatory mechanisms of ABB disorders of the patient
Case 3. A patient has a concussion, accompanied by uncontrollable vomiting and shortness of breath. Describe the violation of ABB of the patient. Explain the pathogenesis of changes.
pH 7.56 pCO2 of 26 mm Hg. Art. SB 24,0 mmol / l AB 17.0 mmol / l BE 4.0 mmol / l
Questions:
1. Rate the pH of arterial blood, indicate its degree (compensated, decompensated) 2. Make a conclusion about a type of ABB, justify the answer 3. Rate the value of indicators of ABB. What is the cause of AB disorders 4. Explain compensatory mechanisms of ABB disorders of the patient
Case 4.
Patient has diffuse glomerulonephritis. Describe the violation of ABB of the patient. pH 7.23 pCO2 of 34 mm Hg. Art. SB 16,0 mmol / l AB 13.0 mmol / l EE - 11.0 mmol / l Titratable acidity of urine: 8 ml of caustic (normally 70-100 ml / day) Urine Ammonia: 8 mmol / l (normal range 20-50 mmol / l)
Questions:
1. Rate the pH of arterial blood, indicate its degree (compensated, decompensated) 2. Make a conclusion about a type of ABB, justify the answer 3. Rate the value of indicators of ABB. What is the cause of AB disorders 4. Explain compensatory mechanisms of ABB disorders of the patient
Case 5.
Surgery of a patient is performed with the use of mechanical ventilation. Describe the violation of ABB of the patient. Explain the pathogenesis of changes. pH 7.24 pCO2 69 mm Hg. Art. SB 18,5 mmol / l AB 28.0 mmol / l BE -8.0 mmol / l
Questions:
1. Rate the pH of arterial blood, indicate its degree (compensated, decompensated) 2. Make a conclusion about a type of ABB, justify the answer 3. Rate the value of indicators of ABB. What is the cause of AB disorders 4. Explain compensatory mechanisms of ABB disorders of the patient
Hand-outs: cases, lecture, multimedia presentation
Control – conclusions on cases
8. THEME: |
«HYPOXIA» |
The purposes of the class:
Formation of knowledge of the main issues of the theme
Formation of skills of analysis of experimental data and creation of pathogenetic schemes
Formation of communicative skills for discussion of the problem
Tasks of study: • To learn the main issues of the theme • To develop the skills to use the glossary in three languages for discussion of the theoretical material • To apply the theoretical knowledge in solving of clinical cases
• To form communicative skills for discussion of the theoretical material Questions for the theme
1. Definition of hypoxia and its classification
2. Exogenous hypoxia: causes, types and typical changes of PaO2, PvO2, Pa-vO2, oxygen blood capacity, PaCO2 and pH in the given type of hypoxia
3. Respiratory hypoxia: causes, types and typical changes of PaO2, PvO2, Pa-vO2, oxygen blood capacity, PaCO2 and pH in the given type of hypoxia
4. Anemic hypoxia: causes, types and typical changes of PaO2, PvO2, Pa-vO2, oxygen blood capacity, PaCO2 and pH in the given type of hypoxia
5. Circulatory hypoxia: causes, types and typical changes of PaO2, PvO2, Pa-vO2, oxygen blood capacity, PaCO2 and pH in the given type of hypoxia
6. Histotoxic and substrate types of hypoxia: causes, types and typical changes of PaO2, PvO2, Pa-vO2, blood oxygencapacity, PaCO2 and pH in the given type of hypoxia
7. Overutilization hypoxia: causes, types and typical changes of PaO2, PvO2, Pa-vO2, oxygen blood capacity, PaCO2 and pH in the given type of hypoxia
8. Conditions that determine the susceptibility of cells to hypoxia.
9. Signs of acute hypoxia.
10. Adaptive reactions in acute hypoxia.
11. Mechanisms of long-term adaptation to hypoxia.
Methods of teaching
Discussion the major issues under the supervision of a teacher, discussion pathogenetic schemes, analysis of experimental data
Methods of control
Oral questioning, checking pathogenetic schemes, testing