G. Demkin - General pathological anatomy: lecture notes for universities

Kolesnikova M. A.

PATHOLOGICAL

ANATOMY LECTURE NOTES

Kolesnikova M. A.

The lecture notes presented to your attention are intended to prepare students of medical universities for passing exams. The book includes a full course of lectures on pathological anatomy, is written in accessible language and will be an indispensable assistant for those who want to quickly prepare for the exam and pass it successfully.

LECTURE No. 1. Pathological anatomy

Pathological anatomy studies the structural changes that occur in the patient's body. It is divided into theoretical and practical. Structure of pathological anatomy: general part, specific pathological anatomy and clinical morphology. The general part studies general pathological processes, patterns of their occurrence in organs and tissues in various diseases. Pathological processes include: necrosis, circulatory disorders, inflammation, compensatory inflammatory processes, tumors, dystrophies, cell pathology. Particular pathological anatomy studies the material substrate of the disease, that is, it is the subject of nosology. But zology (the study of disease) provides knowledge of the etiology, pathogenesis, manifestation and nomenclature of diseases, their variability, as well as the construction of diagnosis, principles of treatment and prevention.

Objectives of pathological anatomy:

1) study of the etiology of the disease (causes and conditions of the disease);

2) study of the pathogenesis of the disease (mechanism of development);

3) study of the morphology of the disease, i.e. structural changes in the body and tissues;

4) study of the morphogenesis of the disease, i.e. diagnostic structural changes;

5) study of the pathomorphosis of the disease (persistent changes in cells and morphological diseases under the influence of drugs - drug metamorphosis, as well as under the influence of environmental conditions - natural metamorphosis);

6) the study of complications of diseases, the pathological processes of which are not obligatory manifestations of the disease, but arise and worsen it and often lead to death;

7) study of disease outcomes;

8) study of thanatogenesis (mechanism of death);

9) assessment of the functioning and condition of damaged organs.

Objectives of practical pathological anatomy:

1) control of the correctness and timeliness of clinical diagnosis (autopsy). The percentage of discrepancy between clinical and pathological diagnoses ranges from 12 to 19%. Causes: rare diseases with a blurred clinical or laboratory picture; late presentation of the patient to a medical institution. Timely diagnosis means that the diagnosis should be made within 3 days, in case of a serious condition of the patient - in the first hours;

2) advanced training of the attending physician (the attending physician is always present at the autopsy). For each case of discrepancy in diagnosis, the clinic holds a clinical-anatomical conference, where a specific analysis of the disease takes place;

3) direct participation in making a lifetime clinical diagnosis (by biopsy and examination of surgical material).

Methods for studying pathological anatomy:

1) autopsies of dead bodies;

2) biopsy (intravital histological examination carried out for the purpose of diagnosing and determining the prognosis of the disease).

The research material is called “biopsy”. Depending on the

The methods for obtaining biopsies are divided into closed and hidden. Closed biopsies:

1) puncture (in the liver, kidneys, mammary glands, thyroid gland, lymph nodes, etc.);

2) aspiration (by suction from the bronchial tree);

3) trepanation (from dense bone tissue and cartilage);

4) diagnostic curettage of the uterine cavity, i.e., obtaining endometrial scrapings (used in obstetrics and gynecology);

5) gastrobiopsy (using a gastrofibroscope, the gastric mucosa is taken).

Hidden biopsies:

1) examination of surgical material (all material is taken);

2) experimental modeling of the disease.

The structure of the biopsy material can be liquid, solid or soft. According to the timing, the biopsy is divided into planned (result on the 6-7th day) and urgent (result within 20 minutes, i.e. at the time of surgery).

Methods for studying pathological material:

1) light microscopy using special dyes;

2) electron microscopy;

3) luminescence microscopy;

4) radiography.

Levels of research: organismal, organ, systemic, tissue, cellular, subjective and molecular.

Briefly about the history of pathological anatomy.

IN In 1761, the Italian author G. Morgagni wrote the first work on pathological anatomy, “On the location and causes of diseases identified by the anatomist.”

The works of the French morphologists M. Bichat and J. Corvisart were of great importance for the development of pathological anatomy

And J. Cruvelier, who created the world's first color atlas on pathological anatomy. R. Bayle was the first author of a complete textbook on particular pathological anatomy, translated into Russian in 1826 by the doctor A.I. Kostomarov. K. Rokitansky was the first to systematize the pathological processes of body systems in various diseases, and also became the author of the first manual on pathological anatomy.

IN In Russia, autopsies began to be performed for the first time in 1706, when, by order of Peter I, medical hospital schools were organized. But the clergy prevented autopsies from being carried out. Only after the opening of the medical faculty at Moscow University in 1755, autopsies began to be carried out regularly.

IN In 1849, the first department of pathological anatomy in Russia was opened. They replaced each other as heads of the department: A. I. Polunin, I. F. Klein, M. N. Nikiforov, V. I. Kedrovsky, A. I. Abrikosov, A. I. Strukov, V. V. Serov.

LECTURE No. 2. General doctrine of dystrophies

Dystrophy is a pathological process that is a consequence of a violation of metabolic processes, with damage to cell structures and the appearance in the cells and tissues of the body of substances that are not normally detected.

Dystrophies are classified:

1) by scale of process prevalence: local (localized) and general (generalized);

2) by reason of occurrence: acquired and congenital. Congenital dystrophies have a genetic cause of the disease.

Hereditary dystrophies develop as a result of disorders

metabolism of proteins, carbohydrates, fats, in this case the genetic deficiency of one or another enzyme that is involved in the metabolism of proteins, fats or carbohydrates is important. Subsequently, incompletely converted products of carbohydrate, protein, and fat metabolism occur in the tissues. This process can develop in various tissues of the body, but damage to the tissue of the central nervous system always occurs. Such diseases are called storage diseases. Children with these diseases die in the 1st year of life. The greater the deficiency of the necessary enzyme, the faster the disease develops and the sooner death occurs.

Dystrophies are divided into:

1) according to the type of metabolism that was disrupted: protein, carbohydrate, fat, mineral, water, etc.;

2) by point of application (by localization of the process): cellular (parenchymatous), non-cellular (mesenchymal), which develop in connective tissue, as well as mixed (observed in both parenchyma and connective tissue).

There are four pathogenetic mechanisms.

1. Transformation is the ability of some substances to be transformed into others that have a similar structure and composition. For example, carbohydrates have this ability, transforming

into fats.

2. Infiltration is the ability of cells or tissues to be filled with an excess amount of various substances. There are two types of infiltration. Infiltration of the first type is characterized by the fact that a cell that participates in normal life activities receives an excess amount of a substance. After some time, a limit comes when the cell cannot process and assimilate this excess. Infiltration of the second type is characterized by a decrease in the level of vital activity of the cell; as a result, it cannot cope even with the normal amount of substance entering it.

3. Decomposition - characterized by the disintegration of intracellular and interstitial structures. There is a breakdown of protein-lipid complexes that are part of the membranes of organelles. In the membrane, proteins and lipids are in a bound state and are therefore not visible. But when membranes disintegrate, they form in cells and become visible under a microscope.

4. Perverted Synthesis- formation of abnormal foreign substances occurs in the cell, which are not formed during the normal functioning of the body. For example, with amyloid dystrophy, an abnormal protein is synthesized in cells, from which amyloid is then formed. In patients with chronic alcoholism, the synthesis of foreign proteins begins to occur in liver cells (hepatocytes), from which the so-called alcoholic hyaline is subsequently formed.

Different types of dystrophies are characterized by their own dysfunction of tissue. In dystrophy, the disorder is twofold: quantitative, with a decrease in function, and qualitative, with a distortion of function, i.e., features appear that are unusual for a normal cell. An example of such a perverted function is the appearance of protein in the urine in kidney diseases, when there are dystrophic changes in the kidney, or changes in liver tests that appear in liver diseases, and in heart diseases - changes in heart sounds.

Parenchymal dystrophies are divided into protein, fat and carbohydrate.

Protein dystrophy is a dystrophy in which protein metabolism is disrupted. The process of dystrophy develops inside the cell. Among the protein parenchymal dystrophies, granular, hyaline droplet, and hydropic dystrophies are distinguished.

In granular dystrophy, during histological examination, protein grains can be seen in the cytoplasm of cells. Granular dystrophy affects parenchymal organs: kidneys, liver and heart. This dystrophy is called cloudy or dull swelling. This has a connection with macroscopic features. With this dystrophy, organs become slightly swollen, and the cut surface looks dull, cloudy, as if “scalded by boiling water.”

Several reasons contribute to the development of granular dystrophy, which can be divided into 2 groups: infections and intoxication. A kidney affected by granular dystrophy increases in size, becomes flabby, and a positive Schorr test can be determined (when the poles of the kidney are brought together, the kidney tissue is torn). On a section, the tissue is dull, the boundaries of the medulla and cortex are blurred or may not be distinguishable at all. With this type of dystrophy, the epithelium of the convoluted tubules of the kidney is affected. In normal kidney tubules, smooth lumens are observed, but in granular dystrophy, the apical section of the cytoplasm is destroyed, and the lumen becomes star-shaped. In the cytoplasm of the epithelium of the renal tubules there are numerous grains (pink).

Renal granular dystrophy ends in two variants. A favorable outcome is possible if the cause is eliminated; the tubular epithelium in this case returns to normal. An unfavorable outcome occurs with continued exposure to a pathological factor - the process becomes irreversible, dystrophy transforms into necrosis (often observed in cases of poisoning with kidney poisons).

The liver in granular dystrophy is also slightly enlarged. When cut, the fabric takes on the color of clay. The histological sign of granular liver dystrophy is the inconsistent presence of protein grains. It is necessary to pay attention - there is or time

beam structure collapsed. With this dystrophy, proteins are divided into separately located groups or separately lying hepatocytes, which is called discomplexation of the hepatic beams.

Cardiac granular dystrophy: the heart is also slightly enlarged in appearance, the myocardium becomes flabby, and when cut it resembles boiled meat. Macroscopically, no protein grains are observed.

In histological examination, the criterion for this dystrophy is basophilia. Myocardial fibers perceive hematoxylin and eosin differently. Some areas of the fibers are intensely stained lilac by hematoxylin, while others are intensely stained blue by eosin.

Hyaline droplet dystrophy develops in the kidneys (the epithelium of the convoluted tubules is affected). Occurs in kidney diseases such as chronic glomerulonephritis, chronic pyelonephritis, and poisoning. Droplets of a hyaline-like substance form in the cytoplasm of the cells. This dystrophy is characterized by significant impairment of renal filtration.

Hydropic dystrophy can occur in liver cells with viral hepatitis. In this case, large light droplets are formed in hepatocytes, often filling the cell.

Fatty degeneration. There are 2 types of fats. The amount of mobile (labile) fats changes throughout a person’s life; they are localized in fat depots. Stable (immobile) fats are included in the composition of cellular structures and membranes.

Fats perform a wide variety of functions - supporting, protective, etc.

Fats are determined using special dyes:

1) Sudan III has the ability to color fat orange-red;

2) sharlah paints red;

3) Sudan IV (osmic acid) turns fat black;

4) Nile blue has metachromasia: it colors neutral fats red, and all other fats under its influence become blue or light blue.

Immediately before dyeing, the starting material

processed using two methods: the first is alcohol

wiring, the second is freezing. To determine fats, freezing tissue sections is used, since fats dissolve in alcohols.

Fat metabolism disorders represent three pathologies:

1) actual fatty degeneration (cellular, parenchymal);

2) general obesity or obesity;

3) obesity of the interstitial substance of the walls of blood vessels (aorta and its branches).

Fatty degeneration itself is the basis of atherosclerosis

behind. The causes of fatty degeneration can be divided into two main groups: infections and intoxications. Nowadays, the main type of chronic intoxication is alcohol intoxication. Drug intoxications and endocrine intoxications, which develop in diabetes mellitus, can often be observed.

An example of an infection that provokes fatty degeneration is diphtheria, since diphtheria toxin can cause fatty degeneration of the myocardium. Fatty degeneration is observed in the same organs as protein degeneration - in the liver, kidneys and myocardium.

With fatty degeneration, the liver increases in size, it becomes dense, and on the cut it is dull and bright yellow. This type of liver is figuratively called “goose liver”.

Microscopic manifestations: fat droplets of small, medium and large sizes appear in the cytoplasm of hepatocytes. As a rule, they are located in the center of the hepatic lobule, but they can occupy it all.

There are several stages in the process of obesity:

1) simple obesity, when the drop occupies the entire hepatocyte, but when the influence of the pathological factor ceases (when the patient stops drinking alcohol), after 2 weeks the liver returns to normal levels;

2) necrosis - infiltration of leukocytes occurs around the focus of necrosis as a response to damage; the process at this stage is reversible;

3) fibrosis - scarring; the process enters an irreversible cirrhotic stage.

S. V. Akchurin, G. P. Demkin

General pathological anatomy. Lecture notes for universities

Lecture 1. Pathological anatomy

1. Objectives of pathological anatomy

4. Death and post-mortem changes, causes of death, thanatogenesis, clinical and biological death

5. Cadaveric changes, their differences from intravital pathological processes and significance for the diagnosis of the disease

1. Objectives of pathological anatomy

Pathological anatomy– the science of the occurrence and development of morphological changes in a sick body. It originated in an era when the study of painfully altered organs was carried out with the naked eye, i.e., using the same method used by anatomy, which studies the structure of a healthy organism.

Pathological anatomy is one of the most important disciplines in the system of veterinary education, in the scientific and practical activities of a doctor. She studies the structural, i.e., material basis of the disease. It is based on data from general biology, biochemistry, anatomy, histology, physiology and other sciences that study the general laws of life, metabolism, structure and functional functions of a healthy human and animal body in its interaction with the external environment.

Without knowing what morphological changes a disease causes in an animal’s body, it is impossible to have a correct understanding of its essence and mechanism of development, diagnosis and treatment.

The study of the structural basis of the disease is carried out in close connection with its clinical manifestations. Clinical and anatomical direction is a distinctive feature of Russian pathological anatomy.

The study of the structural basis of the disease is carried out at different levels:

· the organismal level allows us to identify the disease of the entire organism in its manifestations, in the interrelation of all its organs and systems. From this level begins the study of a sick animal in clinics, a corpse in a dissection room or a cattle burial ground;

· the system level studies any system of organs and tissues (digestive system, etc.);

· the organ level allows you to determine changes in organs and tissues visible with the naked eye or under a microscope;

· tissue and cellular levels - these are the levels of studying altered tissues, cells and intercellular substance using a microscope;

· the subcellular level makes it possible to observe using an electron microscope changes in the ultrastructure of cells and intercellular substance, which in most cases were the first morphological manifestations of the disease;

· the molecular level of studying the disease is possible using complex research methods involving electron microscopy, cytochemistry, autoradiography, and immunohistochemistry.

Recognition of morphological changes at the organ and tissue levels is very difficult at the beginning of the disease, when these changes are insignificant. This is due to the fact that the disease began with changes in subcellular structures.

These levels of research make it possible to consider structural and functional disorders in their inextricable dialectical unity.

2. Objects of study and methods of pathological anatomy

Pathological anatomy deals with the study of structural disorders that arise at the very initial stages of the disease, during its development, up to the final and irreversible conditions or recovery. This is the morphogenesis of the disease.

Pathological anatomy studies deviations from the usual course of the disease, complications and outcomes of the disease, and necessarily reveals the causes, etiology, and pathogenesis.

Studying the etiology, pathogenesis, clinical picture, and morphology of the disease allows us to apply scientifically based measures for the treatment and prevention of the disease.

The results of observations in the clinic, studies of pathophysiology and pathological anatomy have shown that a healthy animal body has the ability to maintain a constant composition of the internal environment, a stable balance in response to external factors - homeostasis.

In case of illness, homeostasis is disrupted, vital activity proceeds differently than in a healthy body, which is manifested by structural and functional disorders characteristic of each disease. Disease is the life of an organism in changed conditions of both the external and internal environment.

Pathological anatomy also studies changes in the body. Under the influence of drugs, they can be positive and negative, causing side effects. This is the pathology of therapy.

So, pathological anatomy covers a wide range of issues. She sets herself the task of giving a clear idea of the material essence of the disease.

Pathological anatomy strives to use new, more subtle structural levels and the most complete functional assessment of the altered structure at equal levels of its organization.

Pathological anatomy obtains material about structural abnormalities in diseases through autopsies, surgeries, biopsies and experiments. In addition, in veterinary practice, for diagnostic or scientific purposes, forced slaughter of animals is carried out at different stages of the disease, which makes it possible to study the development of pathological processes and diseases at various stages. A great opportunity for pathological examination of numerous carcasses and organs is presented in meat processing plants during the slaughter of animals.

In clinical and pathomorphological practice, biopsies are of particular importance, i.e. intravital removal of pieces of tissue and organs, carried out for scientific and diagnostic purposes.

Particularly important for elucidating the pathogenesis and morphogenesis of diseases is their reproduction in experiment. The experimental method makes it possible to create disease models for accurate and detailed study, as well as for testing the effectiveness of therapeutic and preventive drugs.

The possibilities of pathological anatomy have expanded significantly with the use of numerous histological, histochemical, autoradiographic, luminescent methods, etc.

Based on the objectives, pathological anatomy is placed in a special position: on the one hand, it is a theory of veterinary medicine, which, by revealing the material substrate of the disease, serves clinical practice; on the other hand, it is clinical morphology for establishing a diagnosis, serving the theory of veterinary medicine.

3. Brief history of the development of pathological anatomy

The development of pathological anatomy as a science is inextricably linked with the dissection of human and animal corpses. According to literary sources in the 2nd century AD. e. The Roman physician Galen dissected the corpses of animals, studying their anatomy, physiology, and described some pathological and anatomical changes. In the Middle Ages, due to religious beliefs, autopsies of human corpses were prohibited, which somewhat halted the development of pathological anatomy as a science.

Lecture 1

PATHOLOGICAL ANATOMY AND ITS PLACE AMONG MEDICAL-BIOLOGICAL DISCIPLINES

Pathological anatomy is an integral part of pathology - a science that studies the patterns of occurrence and development of diseases, individual pathological processes and conditions.

In the history of the development of pathological anatomy, there are four main periods: anatomical (from antiquity to the beginning of the 19th century), microscopic (from the first third of the 19th century to the 50s of the 20th century), ultramicroscopic (after the 50s of the 19th century); the modern, fourth period of development of pathological anatomy can be characterized as the period of pathological anatomy of a living person.

The opportunity to study pathological changes in the organs of the human body appeared in the 15th-17th centuries thanks to the emergence and development of scientific anatomy. The most significant role in the creation of a method of anatomical research, description of the structure of all the most important organs and their relative positions was played in the middle of the 16th century by the works of A. Vesalius, G. Fallopius, R. Colombo and B. Eustachius.

Anatomical studies of the second half of the 16th - early 17th centuries not only strengthened the position of anatomy, but also contributed to the emergence of interest in anatomy among doctors. The philosopher F. Bacon and the anatomist W. Harvey had a significant influence on the development of anatomy during this period.

In 1676, T. Bonet made the first attempt, using significant material (3000 autopsies), to show the existence of a connection between the morphological changes discovered and the clinical manifestations of the disease.

In the 17th century, the richest anatomical museums appeared in Europe (Leiden), in which pathological and anatomical preparations were widely represented.

The most important event in the history of pathological anatomy, which determined its separation into an independent science, was the publication in 1761 of the main work of J.B. Morgani “On the location and causes of diseases identified by the anatomist.”

At the turn of the 18th and 19th centuries in France, J. Corvisart, R. La-ennec, G. Dupuytren, K. Lobstein, J. Buyot, J. Cruvelier widely introduced pathological anatomy into clinical practice; M.K. Bisha indicated the further path of its development - the study of damage at the tissue level. M.K.Bish's student F.Brousse created a doctrine that rejected the existence of diseases that do not have a material substrate. J. Cruvelier released in 1829-1835. The world's first color atlas on pathological anatomy.

In the middle of the 19th century, the greatest influence on the development of this branch of medicine was exerted by the works of K. Rokitansky, in which he not only presented changes in organs at various stages of disease development, but also clarified the description of pathological changes in many diseases. In 1844, K. Rokitansky founded the Department of Pathological Anatomy at the University of Vienna and created the world's largest pathological anatomical museum. The name of K. Rokitansky is associated with the final separation of pathological anatomy into an independent scientific discipline and medical specialty.

The turning point in the development of this discipline was the creation in 1855 of the theory of cellular pathology by R. Virchow.

In Russia, the first attempts to organize autopsy work date back to the 18th century. They are associated mainly with the activities of prominent health care organizers - I. Fisher and P. Z. Kondoidi. These attempts did not produce tangible results due to the low level of development of Russian medicine and the state of medical education, although already at that time separate autopsies were carried out for control, diagnostic and research purposes.

The emergence of pathological anatomy as a scientific discipline began only in the first quarter of the 19th century and coincided with the improvement of the teaching of normal anatomy at universities. One of the first anatomists to draw students' attention to pathological changes in organs during dissection was E.O. Mukhin.

For the first time, the question of the need to include pathological anatomy among the compulsory teaching subjects at the medical faculty of Moscow University was raised in 1805 by M.Ya. Mudrov in a letter to the university trustee M.N. Muravyov. At the suggestion of Yu.H. Loder, the teaching of pathological anatomy in the form of a course at the department of normal anatomy was reflected in the university charter of 1835. In accordance with this charter, the teaching of an independent course of pathological anatomy was started in 1837 by prof. L.S. Sev-hand at the Department of Normal Anatomy. Professors G.I. Sokolsky and A.I. Over began to use the latest pathological and anatomical information in teaching therapeutic disciplines, and F.I. Inozemtsev and A.I. Pol - when giving lectures on surgery courses.

In 1841, in connection with the creation of a new medical faculty in Kiev, N.I. Pirogov raised the question of the need to open a department for teaching pathology at the University of St. Vladimir. In accordance with the charter of this university (1842), the opening of the department of pathological anatomy and pathological physiology was provided for, which began to function in 1845: it was headed by N.I. Pirogov’s student N.I. Kozlov.

On December 7, 1845, the “Additional Decree on the Medical Faculty of the Imperial Moscow University” was adopted, which provided for the creation of the department of pathological anatomy and pathological physiology. In 1846, Yu. Dietrich, an adjunct of the faculty therapeutic clinic, headed by A.I. Over, was appointed professor of this department. After the death of J. Dietrich, four adjuncts from the therapeutic clinics of Moscow University took part in the competition to fill the vacant position - Samson von Gimmelyptern, N.S. Toporov, A.I. Polunin and K.Ya. Mlodzievsky. In May 1849, A.I. Polunin, an adjunct at the hospital therapeutic clinic of I.V. Varvinsky, was elected professor of the department of pathological anatomy and pathological physiology.

Modern medicine is characterized by a constant search for the most objective material criteria for diagnosis and knowledge of the essence of the disease. Among these criteria, morphological acquires exceptional importance as the most reliable.

Modern pathological anatomy widely uses the achievements of other medical and biological disciplines, summarizing the actual data of biochemical, morphological, genetic, pathophysiological and other studies in order to establish patterns relating to the work of a particular organ or system in various diseases.

Thanks to the problems that pathological anatomy is currently solving, it occupies a special place among medical disciplines. On the one hand, pathological anatomy is a theory of medicine, which, by revealing the material substrate of the disease, directly serves clinical practice, on the other hand, it is clinical morphology for diagnosis, which provides the material substrate for the theory of medicine - general and specific human pathology [Serov V.V., 1982].

Under general pathology understand the most general ones, i.e. characteristic of all diseases, patterns of their occurrence, development and outcomes. Having its roots in the particular manifestations of various diseases and based on these particulars, general pathology simultaneously synthesizes them and gives an idea of the typical processes characteristic of a particular disease.

As a result of the progress of medical and biological disciplines (physiology, biochemistry, genetics, immunology) and the convergence of classical morphology with them, it became obvious that there is a single material substrate for the manifestations of life activity, including the entire range of levels of organization - from molecular to organismal, and no, not even insignificant, functional disorders can arise and disappear without being reflected in the corresponding structural changes at the molecular or ultrastructural level. Thus, the further progress of general pathology cannot be made dependent on the development of any one discipline or group of them, since general pathology today represents the concentrated experience of all branches of medicine, assessed from a broad biological perspective.

Each of the modern medical and biomedical disciplines makes its contribution to the construction of the theory of medicine. Biochemistry, endocrinology and pharmacology reveal the subtle mechanisms of vital processes at the molecular level; in pathological studies, the laws of general pathology receive a morphological interpretation; pathological physiology gives their functional characteristics; microbiology and virology are the most important sources for the development of etiological and immunological aspects of general pathology; genetics reveals the secrets of the individuality of the body's reactions and the principles of their intracellular regulation; clinical medicine completes the formulation of the laws of general human pathology on the basis of its own rich experience and the final assessment of the experimental data obtained from the point of view of psychological, social and other factors. So, general pathology implies an approach to the assessment of observed phenomena, which is characterized by their broad medical and biological analysis.

The modern stage of development of medicine is characterized by the fact that disciplines that were previously predominantly or even exclusively experimental (genetics, immunology, biochemistry, endocrinology, pathological physiology, etc.) are becoming equally clinical.

Thus, modern general pathology includes:

▲ synthesis of evidence obtained using research methods used in various biomedical disciplines;

▲ study of typical pathological processes (see lecture 2); and the development of problems of etiology, pathogenesis, morphogenesis of human diseases;

▲ development of philosophical and methodological aspects of biology and medicine (problems of expediency, the relationship between structure and function, part and whole, internal and external, social and biological, determinism, integrity of the body, nervism, etc.) based on understanding the totality of facts obtained in various fields of medicine; and the formation of the theory of medicine in general and the doctrine of disease in particular.

The rapid development of clinical physiology, clinical morphology, clinical immunology, clinical biochemistry and pharmacology, medical genetics, fundamentally new methods of X-ray examination, endoscopy, echography, etc. has enormously enriched our knowledge of the actual details and general patterns of the development of human diseases. The increasingly widespread use of non-invasive research methods (computed tomography, ultrasound diagnostics, endoscopic methods, etc.) makes it possible to visually determine the localization, size and even to a certain extent the nature of the pathological process, which essentially opens the way for the development of intravital pathological anatomy - clinical morphology, which is dedicated to course of private pathological anatomy.

The scope of application of morphological analysis in the clinic is constantly expanding due to the ever-increasing surgical activity and advances in medical technology, as well as due to the improvement of the methodological capabilities of morphology. The improvement of medical instruments has led to the fact that there are practically no areas of the human body that are inaccessible to a doctor. At the same time, endoscopy is of particular importance for improving clinical morphology, allowing the clinician to engage in a morphological study of the disease at the macroscopic (organ) level. Endoscopic examinations also serve the purpose of biopsy, with the help of which the pathologist obtains material for morphological examination and becomes a full participant in resolving issues of diagnosis, therapeutic or surgical tactics and prognosis of the disease. Using biopsy material, the pathologist also solves many theoretical issues of pathology. Therefore, the biopsy becomes the main object of research when solving practical and theoretical issues of pathological anatomy.

The methodological capabilities of modern morphology satisfy the pathologist's aspirations for ever-increasing accuracy of morphological analysis of disturbed vital processes and an increasingly complete and accurate functional assessment of structural changes. Modern methodological possibilities of morphology are enormous. They make it possible to study pathological processes and diseases at the level of the organism, system, organ, tissue, cell, cellular organelle and macromolecule. These are macroscopic and light-optical (microscopic), electron microscopic, cyto- and histochemical, immunohistochemical and autoradiographic methods. There is a tendency to integrate a number of traditional methods of morphological research, as a result of which electron microscopic histochemistry, electron microscopic immunocytochemistry, and electron microscopic autoradiography emerged, which significantly expanded the capabilities of the pathologist in diagnosing and understanding the essence of diseases.

Along with a qualitative assessment of the observed processes and phenomena, it became possible to make a quantitative assessment using the latest methods of morphological analysis. Morphometry gave researchers the opportunity to use electronic technology and mathematics to judge the reliability of the results and the validity of the interpretation of the identified patterns.

Using modern research methods, a pathologist can detect not only morphological changes characteristic of a detailed picture of a particular disease, but also initial changes in diseases, the clinical manifestations of which are still absent due to the consistency of compensatory-adaptive processes [Sarkisov D.S., 1988]. Consequently, the initial changes (preclinical period of the disease) are ahead of their early clinical manifestations (clinical period of the disease). Therefore, the main guideline in diagnosing the initial stages of the disease is the morphological changes in cells and tissues.

Pathological anatomy, having modern technical and methodological capabilities, is designed to solve problems of both clinical diagnostic and research nature.

The importance of the experimental direction is growing, when both the clinician and the pathologist are looking for answers to complex questions of the etiology and pathogenesis of diseases. The experiment is used primarily to model pathological processes and diseases, with its help new treatment methods are developed and tested. However, morphological data obtained in an experimental disease model must be correlated with similar data from the same disease in humans.

Despite the fact that in recent years in all countries the number of autopsies has been steadily decreasing, pathological examination remains one of the main methods of scientific knowledge of the disease. With its help, an examination of the correctness of diagnosis and treatment is carried out, and the causes of death are established. In this regard, an autopsy as the final stage of diagnosis is necessary not only for the clinician and pathologist, but also for the medical statistician and health care organizer. This method is the basis for scientific research, teaching fundamental and applied medical disciplines, and a school for doctors of any specialty. Analysis of autopsy results plays an important role in solving a number of major scientific and practical problems, for example, the problem of variability, or pathomorphosis, of diseases. The importance of this problem is constantly increasing, since more and more often the clinician and pathologist are faced with the question: where does the pathomorphosis end and where does the pathology of therapy begin?

Lecture 2

About 70 years ago, the outstanding Russian pathologist I.V. Davydovsky wrote: “... modern medicine has gone almost entirely into analysis; synthesis is lagging behind, generalizing ideas are lagging behind, on which alone a more or less coherent doctrine of diseases can be built.” These words are perhaps even more significant in our time. However, I.V. Davydovsky not only called for the creation of a harmonious doctrine of diseases, but he himself built this doctrine, the name of which is “general human pathology.” He did what they strived for, but what outstanding pathologists of the past were never able to accomplish.

Even V.V. Pashutin (1878) saw in pathology that branch of knowledge that should concentrate everything that has been developed by various medical sciences and that “can serve to understand pathological processes in their entirety,” and “with more philosophical goals,” therefore, he believed that “generalizing flights of the mind in the field of pathological phenomena are absolutely necessary.” L.A. Tarasevich (1917) believed that general pathology as a natural completion of medical education is “the unification of disparate knowledge and facts into one harmonious whole to establish a connection between this whole and general biology, to establish a single and integral biological worldview.” V.K. Lindeman (1910) looked at general pathology even more broadly; he believed that general pathology “concerns the phenomena of the entire organic world,” its ultimate goal is “the establishment of the fundamental laws of life.”

I.V. Davydovsky believed that the time had come to oppose the dispersal of modern medicine with an attempt to create its theoretical foundations, paying special attention to the general patterns underlying pathological processes. When creating these theoretical foundations, he proceeded from the position that pathological processes and diseases are “nothing more than private manifestations of general, namely biological, laws”, that pathology as an integral part of biology can shed light on many fundamental issues of life. At the same time, general pathology should be based primarily on the pathology of man as a being who stands at the height of evolutionary development and who has refracted within himself all the complexity of the relationship of the animal world with the external environment. Developing these provisions of I.V. Davydovsky, D.S. Sarkisov believes that the further progress of general pathology cannot be made dependent on the development of any one discipline or even a group of them. General pathology, he writes, represents the concentrated experience of all branches of medicine, assessed from a broad biological perspective.

I.V. Davydovsky formulates a number of general provisions that define the methodology for studying general human pathology.

1. Man should be studied primarily as a representative of the animal kingdom, i.e. as an organism, and then as a social personality, and the study of man as a social personality should not overshadow the study of the biology of the human body and its specific ecology. This requirement follows at least from the fact that the patterns characterizing human pathology are general biological, since they are inherent in all higher mammals.

2. The cardinal properties of all living systems essentially reflect the widest range of adaptive capabilities of the living body; all its structures and functions ultimately reflect this range. Therefore, “everything that we call physiological or pathological is an endless series of “plus” and “minus” variants of adaptive acts.”

3. Variability is essentially adaptability, i.e. the law of evolution, to which all life processes, physiological and pathological, are subject.

4. The unity of structure (form) and function implies their fundamental indivisibility. Form is a natural and necessary expression of a function: if a function forms a form, then the form also forms a given function, stabilizes and hereditarily consolidates it. It should be emphasized that this thesis was defended by outstanding Russian clinicians, pathologists, physiologists and philosophers of both the past - A.I. Polunin (1849), M.M. Rudnev (1873), and the present - I.P. Pavlov (1952), N.N.Burdenko (1957), A.I.Strukov (1978). The issue of combining structure and function is currently being resolved on the basis of the principle of structure, if structure is considered as a genetically determined property of life, as one of the universal objective properties of material systems and processes. And yet, one can still often find, especially among clinicians, a discussion of so-called functional diseases.

5. Theoretical thought cannot passively follow empirical knowledge. “The pragmatic bias in science, which actually rejects the study of the general laws of natural phenomena, emasculates the ideological content of science and closes the path to knowledge of objective truth,” wrote I.V. Davydovsky.

The methodology for studying general pathology determines the following tasks currently facing it: a generalization of factual data from biological, pathophysiological, genetic, morphological and other studies to form ideas about the patterns of functioning of an organ, system and organism in various diseases; and further study of typical general pathological processes;

and the development of general problems of the etiology and pathogenesis of human diseases;

and deepening the doctrine of nosology;

and further development of philosophical and methodological aspects of biology and medicine: the relationship between structure and function, part and whole, internal and external, determinism, integrity of the organism, etc.; and development of issues in the history of medicine; and the formation of the doctrine of disease and the theory of medicine as the ultimate goal of general pathology.

If, based on the tasks and ultimate goal of general pathology, we try to define it, then we can say that general pathology- this is the doctrine of the most general laws of pa-

tological processes that underlie any syndrome and any disease, regardless of the cause that causes them, the individual characteristics of the organism, environmental conditions, etc. These processes constitute the essence of general pathological processes.

General pathological processes are unusually diverse, since they embrace the entire pathology of man. Among them, the following groups are distinguished: damage, disorders of blood and lymph circulation, dystrophy, necrosis, inflammation, immunopathological processes, regeneration, adaptation and compensation processes, sclerosis, tumors.

Damage is represented by cell pathology, tissue degeneration and necrosis.

Circulatory disorders include plethora, anemia, bleeding, plasmorrhagia, stasis, thrombosis, embolism, and lymph circulation disorders include various types of insufficiency of the lymphatic system (mechanical, dynamic, resorption).

Among the dystrophies, parenchymal (protein, fat, carbohydrate), stromal-vascular (protein and fat) and mixed (metabolism disorders of chromoproteins, nucleoproteins and minerals) are distinguished.

The forms of necrosis are varied; this applies to both etiological and clinical-morphological forms.

Inflammation as a complex local vascular-mesenchymal reaction to damage is extremely diverse, and this diversity depends not only on the causative factor and structural and functional characteristics of the organs and tissues where inflammation develops, but also on the characteristics of the reactivity of the human body and hereditary predisposition.

Immunopathological processes are represented by both hypersensitivity reactions and autoimmunization and immunodeficiency syndromes.

Regeneration in human pathology can be both reparative and adaptive; it also includes wound healing.

Adaptation in human pathology is manifested by hypertrophy (hyperplasia) and atrophy, organization, tissue restructuring, metaplasia and dysplasia, while compensation is most often manifested by hypertrophic processes.

Sclerosis is the proliferation of connective tissue, which completes many pathological processes associated with tissue destruction.

Tumors combine all issues of tumor growth (morphogenesis, histogenesis, tumor progression, antitumor protection), as well as structural features and classification of all neoplasms found in humans.

Recently, an attempt has been made to revise this classical scheme for systematizing general pathological processes (D.V. Sarkisov). It is proposed to consider general pathological processes from one angle - whether they are involved in the injury (damage) or in the reaction to this injury, i.e. to compensatory-adaptive reactions, and these latter are considered in terms of their “absolute” or “relative” purposefulness. However, the attribution of general pathological processes to damage or compensatory-adaptive reactions does not always have a sufficiently strong justification. For example, among circulatory disorders, plethora (apparently venous) is proposed to be attributed to damage, and thrombosis to compensatory-adaptive reactions. Thrombosis is considered as a reaction to damage to the inner lining (intima) of a vessel, which is why it is a compensatory-adaptive reaction, but we should not forget that thrombosis is associated with the development of tissue necrosis (infarction), which cannot be called either an adaptation or compensation. The author also considers venous congestion as a reaction to damage to a vein or heart, leading to impaired blood outflow. But venous congestion, classified as damage, can be the cause of processes such as edema, stasis, bleeding, atrophy, dystrophy, necrosis, which are also classified as tissue damage. There is no reason to classify inflammation as a compensatory-adaptive process, which is impossible without alteration (damage) and is often the basis of often fatal diseases. In the proposed classification scheme, compensatory-adaptive reactions (reactions to damage), in addition to thrombosis and inflammation, also include immunity, which, as is known, reflects the body’s immunity to various agents and substances with antigenic properties. The question arises: can “immunity” respond to damage? Apparently it can't. Immunity can only prevent damage.

It seems that the division of all general pathological processes into damage and compensatory-adaptive reactions resolves the issues of pathology too straightforwardly and excludes the dialectic of “good and evil”, so clearly expressed in various diseases. The recommended renaming of typical general pathological processes into “typical protective, compensatory and adaptive reactions of the body” (D.S. Sarkisov) is not justified.

Lecture 1 General information about pathological anatomy.

Dystrophies. Parenchymal dystrophies.

Pathological anatomy is a science that studies the morphological changes that occur in organs and tissues during diseases and pathological processes.

As a branch of medicine, pathological anatomy is closely related to histology, pathological physiology, and underlies forensic medicine.

And is the foundation of clinical disciplines.

IN The pathological anatomy course has two sections:

1). General pathological anatomy studies the morphological changes that occur when general pathological processes: dystrophy; necrosis;

disorders of blood and lymph circulation; inflammation; adaptation processes;

immunopathological processes; tumor growth.

2). Particular pathological anatomy studies the morphological changes that occur in organs and tissues during specific diseases.

In addition, private pathological anatomy is engaged in the development of nomenclature and classification of diseases, the study of the main complications, outcomes and pathomorphism of diseases.

Pathological anatomy, like any other science, uses a number of research methods.

Methods of pathological anatomy:

1) Autopsy (autopsy). The main purpose of an autopsy is to determine the cause of death. Based on the autopsy results, a comparison of clinical and pathological diagnoses is made, the course of the disease and its complications are analyzed, and the adequacy of the treatment is assessed. Dissection has important educational value for students and clinicians.

2) Biopsy - intravital taking of pieces of organs and tissues (biopsy specimens) for histological examination in order to establish an accurate diagnosis.

Based on the time of preparation of pathohistological preparations, urgent biopsies (cito-diagnosis) are distinguished, which are carried out as

usually during surgical interventions, and are prepared within 15-20 minutes.

Scheduled biopsies are carried out to study biopsy and surgical material in a planned manner. within 3-5 days.

The method of taking a biopsy sample is determined by the localization of the pathological process. The following methods are used:

- puncture biopsy, if the organ is not accessible to non-invasive methods (liver, kidneys, heart, lungs, bone marrow, synovial membranes, lymph nodes, brain.)

- endoscopic biopsy (brochoscopy, sigmoidoscopy, fibrogastroduodenoscopy, etc.)

- scrapings from mucous membranes (vagina, cervix, endometrium and

3) Light microscopy– is one of the main diagnostic methods in modern practical pathological anatomy.

4) Histochemical and immunohistochemical research methods-

examination of organs and tissues using special staining methods and is an additional diagnostic method (detection of tumor markers).

5) Electron microscopy- study of the morphology of pathological processes at the subcellular level (changes in the structure of cell organelles).

6) Experimental method – used to model diseases and various pathological processes in experimental animals in order to study their pathogenesis, morphological changes, and pathomorphosis.

General information about dystrophies.

Dystrophy is a pathological process based on metabolic disorders leading to structural changes in organs and tissues.

Dystrophies, along with necrosis, are a manifestation of the process of alteration - damage to cells, organs and tissues in a living organism.

The modern classification of dystrophies adheres to the following principles:

I. According to the localization of the pathological process, the following are distinguished:

1) parenchymal (intracellular)

2) mesenchymal (stromal - vascular)

3) mixed

II. By predominant metabolic disorder: 1) Protein (dysproteinosis)

2) Fatty (lipidoses)

3) Carbohydrates

4) Mineral

III. According to the influence of the genetic factor: 1) Hereditary 2) Acquired

IV. According to the prevalence of the process:

1) local

2) general (system)

Morphogenetic mechanisms of development of dystrophies:

1) Infiltration - impregnation or accumulation of substances in cells, organs and tissues. For example, with atherosclerosis, proteins and lipids accumulate in the walls of blood vessels.

2) Perverted synthesis is the synthesis of pathological, abnormal, substances not normally found. For example, the synthesis of the pathological hemoglobinogenic pigment hemomelanin, the pathological amyloid protein.

3) Transformation - the synthesis of substances of one class from common initial products of substances of other classes. For example, with excess carbohydrate consumption, the synthesis of neutral lipids is enhanced.

4) Decomposition (phanerosis)- This is the breakdown of complex biochemical substances into their component components. For example, the breakdown of lipoproteins that make up cell membranes into lipids and proteins.

Parenchymal dystrophies

Parenchymal dystrophies are dystrophies in which the pathological process is localized in the parenchyma of organs, that is, inside the cells.

This type of dystrophy develops mainly in parenchymal organs - liver, kidneys, myocardium, lungs, pancreas.

Parenchyma is a collection of cells of organs and tissues that perform the main function.

Classification of parenchymal dystrophies:

1) Protein (dysproteinoses)

a) granular, b) hyaline-droplet,

c) vacuolar (hydropic or hydropic), d) horny.

2) Fatty (lipidoses)

3) Carbohydrates

a) associated with impaired glycogen metabolism, b) associated with impaired glycoprotein metabolism.

Parenchymal dysproteinoses associated with disruption of predominantly protein metabolism. The causes of the development of this pathological process are diseases that are accompanied by intoxication and fever. This leads to the acceleration of metabolic processes, denaturation and coagulation of proteins in the cytoplasm of cells and the disintegration of biological membranes.

Granular dystrophy- characterized by the accumulation of protein inside cells in the form of grains. Most often found in the kidneys, liver, and myocardium. Protein, accumulating inside the cells, leads to an increase in cell volume, that is, the organ increases in size, and when cut, the organ tissue becomes dull (turbid swelling). Recently, many pathologists believe that with granular dystrophy, hyperplasia and hypertrophy of organelles occur in cells, which resemble granular protein inclusions.

a) restoration of membrane structure and normalization of organs, since granular dystrophy is characterized by superficial and reversible protein denaturation; b) further progression of the pathological process with the development

hyaline droplet dystrophy; c) in some cases with severe infectious diseases

(diphtheria myocarditis) cell necrosis is possible.

Hyaline droplet dystrophy- characterized by the accumulation of protein inside cells in the form of hyaline-like droplets. More often it develops in the kidneys with glomerulonephritis, amyloidosis, nephrotic syndrome, in the liver with alcoholic and viral hepatitis, cirrhosis.

The external macroscopic picture of the organ is determined by the cause of this pathological process. Since hyaline-droplet dystrophy is based on deep and irreversible protein denaturation, the result is focal (partial) coagulation necrosis of the cell or a transition to vacuolar (hydropic) dystrophy.

Vacuolar dystrophy- characterized by the accumulation of fluid-filled vacuoles inside cells. It is found in skin epithelial cells during edema, smallpox, in the epithelium of convoluted tubules of the kidneys during nephrotic syndrome, in hepatocytes during viral and alcoholic hepatitis, in cells of the adrenal cortex during sepsis, and in the cells of some tumors. As the process progresses, the vacuoles increase in size,

which leads to the destruction of organelles and cell nuclei. The extreme degree of vacuolar dystrophy is balloon dystrophy, in which cells turn into “balloons” filled with liquid, while all cell organelles undergo decay. The outcome of this form of dystrophy is always unfavorable - wet, liquefied cell necrosis.

Horny dystrophy is an independent pathological process, which is characterized by excessive accumulation of horny substance in those tissues where it is normally synthesized (integumentary epithelium), or synthesis of horny substance in those organs and tissues where it is normally absent (stratified squamous non-keratinizing epithelium). In the surface epithelium, this can manifest itself as hyperkeratosis and ichthyosis.

Hyperkeratosis is an acquired excessive keratinization of the surface epithelium of various etiologies (callus formation, senile hyperkeratosis, hyperkeratosis due to hypovitaminosis and various skin diseases).

Ichthyosis is a hereditary disease characterized by a diffuse disorder of keratinization such as hyperkeratosis (skin in the form of fish scales), in some forms (fetal ichthyosis), skin manifestations of the disease are combined with multiple malformations (deformation of the limbs, contractures, defects of internal organs).

Synthesis of horny substance can develop on mucous membranes lined with stratified squamous non-keratinizing epithelium (oral cavity, esophagus, vaginal part of the cervix, cornea of the eye).

Macroscopically, the foci of keratinization have a whitish color, so this pathology is called leukoplakia. If the outcome is favorable, the process ends with the restoration of normal epithelium. With long-existing foci of leukoplakia, malignancy (malignancy) is possible, with the development of squamous cell carcinoma. In this regard, leukoplakia has important functional significance and is considered as an optional precancer.

Parenchymal fatty degenerations – lipidoses - characterized by a predominant disturbance of lipid metabolism and the accumulation of neutral fats in the cells of parenchymal organs. Most often develop in the kidneys, liver, and myocardium.

The causes of the development of parenchymal lipidoses are:

1) diseases and pathological processes accompanied by decreased activity redox processes or tissue hypoxia. These include chronic alcoholism, tuberculosis, chronic pulmonary and heart failure.

2) severe infectious diseases accompanied by fever, prolonged intoxication, massive breakdown of lipoprotein complexes: diphtheria, typhus and typhoid fever, sepsis and septic conditions, etc.

3) chronic poisoning with certain toxic substances: phosphorus, arsenic, chloroform.

4) anemia of various origins.

Fatty degeneration of the myocardium develops in chronic myocarditis and heart defects, accompanied by chronic cardiovascular failure. Microscopically, the process is characterized by the accumulation of lipids inside cardiomyocytes in the form of tiny droplets (pulverized obesity). The accumulation of lipids is observed mainly in groups of muscle cells that are located along the venous bed. Macroscopically, the appearance of the heart depends on the degree of fatty degeneration. With a pronounced form, the heart is enlarged, in size, the myocardium has a flabby consistency, on a section it is dull, clay-yellow, the cavities of the heart are expanded. From the side of the endocardium, a yellow-white striation is visible (the so-called “tiger heart”). The outcome depends on the severity of the process.

Fatty liver degeneration develops with chronic intoxication with hepatotropic poisons. Microscopically, lipids can accumulate inside hepatocytes in the form of small granules (pulverized obesity), small droplets, which later merge into large ones (small-droplet obesity). More often the process begins from the periphery of the lobules. Macroscopically, the liver has a characteristic appearance: it is enlarged, flabby, the edge is rounded. The color of the liver is yellow-brown with a clayey tint.

Fatty kidney disease is characterized by the accumulation of lipids in the epithelial cells of the convoluted tubules. Mainly develops with lipoid nephrosis, with general obesity of the body. Microscopically, accumulation of lipids is observed in the basal parts of the tubular epithelium. Macroscopically, the kidneys are enlarged and flabby. On a section, the cortex is swollen, gray with yellow speckles.

Parenchymal carbohydrate dystrophies characterized by impaired metabolism of glycogen and glycoproteins.

Carbohydrate dystrophies associated with impaired glycogen metabolism are most clearly manifested in diabetes mellitus and hereditary carbohydrate dystrophies - glycogenosis. Diabetes mellitus is a disease associated with pathology of β cells of the pancreatic islets. It is manifested by the following clinical and morphological symptoms: hyperglycemia, glycosuria, reduction and complete disappearance of glycogen granules in hepatocytes with the development of fatty liver. Glycogen accumulation is noted in the convoluted tubule epithelium.

Diabetes mellitus is characterized by micro- and macroangiopathy. Diabetic glomerulosclerosis develops in the kidneys. Atherosclerotic plaques appear in elastic and muscular elastic arteries.

Glycogenosis is caused by insufficiency or absence of enzymes involved in glycogen metabolism.

Carbohydrate dystrophies associated with impaired glycoprotein metabolism are manifested by excessive accumulation of mucins and mucoids. In this regard, this type of dystrophy is called “mucosal dystrophy”.

Mucous dystrophy develops in a number of diseases and pathological processes:

Catarrhal inflammation - characterized by the accumulation of catarrhal exudate, which includes desquamated epithelial cells, microorganisms, leukocytes and a large amount of mucus. Microscopically, hyperfunction of goblet cells is observed, manifested by the accumulation of excess mucus in the cytoplasm of the cells, followed by its secretion. Catarrhal inflammation of the mucous membranes of the respiratory tract (nasal cavity, trachea, bronchi), in particular, chronic obstructive mucopurulent bronchitis, is of great clinical importance.

- colloid goiter - develops with hyperfunction of the thyroid gland. Microscopically, it is manifested by the accumulation of colloid in the cells of the follicular epithelium and in the lumen of the follicles.

- colloid (mucosal) cancers - in this case, tumor cells are capable of synthesizing mucus. Microscopically, the formation of the so-called “ring-shaped” cells, the cytoplasm of which is filled with mucus, and the nucleus is pushed to the periphery. Mucous cancers are often found in the lungs, stomach, and intestines.

The outcome of mucous dystrophy is determined by the cause of the disease.

Lecture 2 Stromal-vascular (mesenchymal) dystrophies

Stromal vascular dystrophies develop when metabolic processes in connective tissue are disrupted and are detected in the stroma of organs and in the walls of blood vessels.

The structure of connective tissue includes a basic substance, which includes glycosaminoglycans (chondroitinsulfuric and hyaluronic acids), fibrous structures (collagen, elastic and reticular fibers), cellular elements (fibroblasts, mast cells, histiocytes, etc.). Stromal-vascular dystrophies are based on processes of connective tissue disorganization.

Classification:

1) Protein dystrophies (dysproteinoses): a) mucoid swelling b) fibrinoid swelling c) hyalinosis d) amyloidosis

2) Fatty degenerations (lipidoses):

a) associated with a disorder of neutral fat metabolism b) associated with a disorder of cholesterol metabolism

3) Carbohydrate dystrophies:

a) associated with a disorder of glycosaminoglycon metabolism b) associated with a disorder of glycoprotein metabolism

Mucoid swelling

The causes of the development of mucoid swelling are allergic reactions, infectious-allergic diseases, rheumatic diseases, hypoxia, etc.

The pathological process is based on superficial and reversible disorganization of connective tissue. When exposed to a damaging factor, a redistribution of glycosaminoglycones occurs in the main substance and walls of blood vessels with an increase in the content of hyaluronic and chondroitinsulfuric acids. These substances have pronounced hydrophilic properties, which leads to increased vascular and

tissue permeability. This leads to the penetration of the liquid part of the blood plasma and tissue fluid into the pathological focus.

Collagen fibers and the ground substance are saturated with tissue fluid and plasma, increase in size and swell, while maintaining their structure. This pathological process is called mucoid swelling. Lymphohistiocytic infiltrates (manifestation of immune reactions) can form in the affected tissue.

Mucoid swelling is characterized by the phenomenon of metachromasia - the phenomenon of a different, pathological staining of the tissue. With this phenomenon, normal and pathologically altered tissues, when stained with the same dye, acquire different colors. Metachromasia is based on the accumulation of chromotropic substances in the stroma of organs. For example, when stained with picrofuchsin, connective tissue is normally colored pink, but with metachromasia it is yellow.

Outcomes of mucoid swelling:

1) normalization, since it is based on superficial and reversible disorganization of connective tissue.

2) as the process progresses, fibrinoid swelling develops.Fibrinoid swelling characterized by deep and irreversible

disorganization of connective tissue.

With this pathological process, an increase in vascular and tissue permeability progresses, as a result of which, following the liquid part, blood plasma proteins, including fibrinogen, penetrate into the stroma. Destruction of collagen fibers is observed. A pathological protein, fibrinoid, is synthesized in the stroma of organs. The composition of fibrinoid includes connective tissue components, blood plasma proteins, mainly fibrin, immunoglobulins, complement components, lipids.

The predominance of fibrin protein in the fibrinoid composition explains the name - fibrinoid swelling. This pathological process is also characterized by the phenomenon of metachromasia.

Most often, fibrinoid swelling is observed in rheumatic diseases.

Due to the deep disorganization of connective tissue, affecting both collagen fibers and the ground substance, the outcome is irreversible: the development of fibrinoid necrosis, sclerosis and hyalinosis.

Fibrinoid necrosis manifested by the breakdown of all components that make up the fibrinoid. Proliferation around masses of fibrinoid necrosis of cellular elements underlies the formation of rheumatic granuloma (Aschoff - Talalaevsky nodules).

Sclerosis is the formation of connective tissue in place of fibrinoid masses.

Hyalinosis is the next stage of systemic disorganization of connective tissue and is characterized by destruction of collagen fibers and basic substance, plasmorrhagia, precipitation of plasma proteins and the formation of pathological protein hyaline. The process of hyaline formation is accompanied by homogenization and compaction of plasma proteins and connective tissue components, resulting in the formation of dense, translucent masses that are bluish in color and resemble hyaline cartilage in structure.

Hyalinosis is characterized by the synthesis of an abnormal protein - hyaline. Externally, it is translucent, bluish, similar to hyaline cartilage. Composition of hyaline: connective tissue components, plasma proteins, lipids, immune complexes. Hyalinosis occurs as a result of the following processes:

a) plasmatic impregnation b) fibrinoid swelling.

c) sclerosis d) necrosis

a) - occurs in the walls of blood vessels, when, due to increased vascular permeability, the walls are impregnated with plasma and then with proteins. These proteins settle on the walls of blood vessels, then homogenize (homogeneous

view) - hyaline begins to be synthesized. Blood vessels become similar - to glass tubes - this underlies hypertension b) fibrinoid masses are homogenized, lipids, immune

complexes and hyaline is synthesized. Hyalinosis as a result of fibrinoid swelling can be systemic in nature (rheumatism, scleroderma, rheumatoid arthritis) and local in nature (in the bottom of a chronic gastric ulcer and 12 p.c. in the wall of the appendix in chronic appendicitis, in foci of chronic inflammation).

c) - is local in nature. Sclerotic processes are replaced by masses of hyaline. For example: in connective tissue scars, in connective tissue adhesions

serous cavities, in the walls of the aorta during atherosclerosis, in the walls of blood vessels during the organization (that is, when replacing connective tissue) of blood clots d) - is local in nature. Bears necrotic lesions, replaced by masses of hyaline