Medical encyclopedia - pathogenesis. General pathogenesis: term, definition of the concept

Pathogenesis is the mechanism of origin and development disease, its any individual manifestations. The pathogenesis can be considered different levels- from violations at the level of molecules to violations in the body as a whole. Studying the pathogenesis medical specialists determine how the disease progresses.

The development of the doctrine of pathogenesis is a particularly important part of the development of medicine in general. It was the description of pathogenetic processes and their various levels that made it possible to penetrate deeply into the causes of diseases, as well as to select the most effective therapy.

pathological physiology usually studies issues of pathogenesis. In addition to physiology, these issues are often dealt with by pathological anatomy, biochemistry, histology, as well as any other medical specialty. The number of typical processes of pathogenesis is limited, but their ratios of severity and combination, flows form unique clinical pictures characteristic of many diseases.

Knowledge of typical patterns of pathogenesis, their course, interaction with each other is the basis for prescribing the correct adequate treatment even in cases where it is not possible to install diagnosis diseases, but four clearly defined pathological changes that occur in the body.

Thus, stabilization of the patient's condition is ensured before the diagnosis is determined, as well as the start of etiotropic therapy.

The main link is a process that is necessary to determine the specificity of the disease. Timely elimination of the disease is based on pathogenetic treatment due to the lack of development of the disease.

Periods:

Latent period, that is, hidden
Expressed signs of the disease
Exodus

Etiopathogenesis is a relationship pathogenesis And etiology , which determines the totality of opinions about the mechanisms and causes of the development of the disease. Etiopathogenesis has not received wide distribution due to the fact that it led to a mixture of the cause and effect of the disease. However, there are 3 options for the relationship of pathogenesis and etiology:

Etiology initiates pathogenesis, and at the same time, it disappears itself, for example, with a burn;
Etiology and pathogenesis exist simultaneously, which is typical for most infections;
Etiology periodically initiates pathogenesis, for example, in malaria.

Pathogenesis can be roughly divided into specific And non-specific . The first type depends on the etiology, it determines the main properties of the disease, is the basis of its diagnosis. Nonspecific pathogenesis is a pathogenesis that is usually genetically determined.

Also, the phenomena of pathogenesis are primary local , which lead to general under appropriate conditions. Primary-general - manifested both in general and in local form, in this case refers to general, to local - diabetic foot, nephropathy, polyneuropathy, retinopathy and furunculosis.

Pathogenesis(pathogenesis; Greek pathos suffering, disease + genesis origin, origin) - a set of processes that determine the occurrence, course and outcome of diseases. The term "pathogenesis" also refers to the doctrine of the mechanisms of development of diseases and pathological processes. In this doctrine, general and particular P. are distinguished. The subject of general P. are the general patterns inherent in the main features of any disease process or individual categories of diseases (hereditary, infectious, endocrine, etc.). Private P. explores the mechanisms of development of specific nosological forms. Representations of general P. are formed on the basis of the study and generalization of data on the mechanisms of development of individual diseases, as well as on the basis of the theoretical development of philosophical and methodological problems. general pathology and medicine in general. At the same time, the doctrine of general P. is used in the study and interpretation of the mechanisms of development of individual specific diseases and the characteristics of their course.

P.'s study of the disease is based on the analysis of clinical data, the results of various laboratory, electrophysiological, optical, radiological, morphological and many other research methods, including various functional tests and mathematical methods of processing. Great importance to study both the general patterns of P. diseases and the mechanisms certain diseases and pathological processes have various forms pathology modeling on living and non-living objects, as well as mathematical and cybernetic modeling.

The pathogenesis largely depends on etiological factors. In some cases, the action of the etiological factor throughout the entire disease process decisively determines its P. (for example, in most infectious diseases, many intoxications, hereditary diseases, some endocrine disorders). In other cases, the primary impact of the etiological factor is only a trigger in the chain of causal relationships. Each link in this chain becomes, in turn, an etiological factor in the regular development of subsequent phenomena, i.e. pathogenesis of the disease process, even in the absence of its root cause. In some cases, P. is characterized by the appearance of the so-called vicious circle. So, hypoxia of any origin (for example, circulatory), having reached a certain degree, leads to a breakdown in other parts of the oxygen transport and utilization system (for example, respiratory center). The resulting alveolar hypoventilation aggravates the severity of the hypoxic state, which, in turn, causes further hemodynamic disorders, deepening hypoxia, and even greater respiratory. The specific structure of the vicious circle may be different, but once it has arisen, it usually seriously aggravates the course of the disease process, often creating life-threatening situations. The resulting vicious circle is often eliminated only with external intervention.

The nature and significance of etiological factors in the development of the disease at its various stages can change many times. Due to the presence of a dialectical relationship between the categories of etiology and a in medical literature the term "etiopathogenesis" appeared, but it did not receive widespread.

The ratio and value of local and general processes in P. is variable. Yes, at inflammation caused by local damage tissue, the pathological process develops mainly in the area of damage and is aimed at limiting the focus of alteration, the destruction or removal of the damaging factor, the products of cell destruction and the compensation of the local tissue defect. General shifts in the body in most cases are relatively small. In other cases, small local disturbances through the receptor apparatus and neurogenic mechanisms or through the humoral route (as a result of a lack or excess of biologically active substances) cause pronounced generalized reactions.

Examples of this are gallstone and nephrolithiasis, - limited inflammatory process, which, as a result of strong pain irritation, entails a whole chain of reactions. The generalization of local processes can be associated with physiological significance damaged structures responsible for vital important features organism, such as the respiratory center or the conduction system of the heart. Along with this, local pathological changes in various bodies and systems can occur secondarily as a result of primary generalized processes (for example, kidney damage during general intoxication). The area of secondary local damage depends on many factors: the specific affinity of pathogenic agents to certain tissues, their excretion pathways, biological features damaged structures. Of great importance in the localization of pathological processes can be individual morphofunctional features organisms that depend on it constitution , previous diseases and other factors that determine body reactivity and its reactive properties individual bodies, tissues and systems.

With the development of any disease, as a rule, nonspecific and specific mechanisms of P. are found. Nonspecific mechanisms are typical pathological processes, such as inflammation, fever, as well as the so-called elementary processes, such as increased permeability biological membranes, changes in membrane potential, generation of reactive oxygen species, etc. An example of specific mechanisms is the activation of cellular and humoral immunity systems, hormone receptor interactions. However, an alternative distinction between the mechanisms of P.

on specific and non-specific cannot be carried out sequentially. So, inflammation and in each case can have a number of characteristic distinctive features, and at the same time, highly specific immune processes share a number of common features.

Among the various mechanisms of the development of diseases, the most significant, constantly occurring in this disease and determining its main features, are distinguished. These mechanisms are usually called the main links a. Such a main link, for example, for acute blood loss in initial stage, is a decrease in circulating blood volume and circulatory hypoxia. For more late stages, after replenishment of blood volume due to tissue fluid and renal water retention, hemodilution, accompanied by hypoproteinemia and hemic hypoxia, becomes the leading link in P.. After the restoration of blood proteins, hemodilutional erythropenia remains the main link in the posthemorrhagic state for some time. Thus, as the disease process develops, the leading links of P. may change. It often turns out to be impossible to single out from the multitude of patho genetic factors the only one is the main or leading one, even taking into account the stage of the disease.

The emergence, development and completion of the disease in the vast majority of cases consist of processes that are twofold in their biological essence and significance for the body. P. includes a direct consequence of the action of a pathogenic factor (primary damage or violation), structural and functional disorders secondary to the disease process and, simultaneously or with a certain time shift, emerging protective and adaptive (sanogenetic) reactions aimed at preventing or eliminating pathogenic effects and disturbances in the body. The trigger mechanisms of these reactions can be the pathogenic factor itself, as well as the primary and secondary results of its damaging effect.

Both primary and secondary disorders, and protective and adaptive reactions can be realized on various levels- from molecular to organismal, including behavioral responses.

When evaluating individual components P. quite often there is a divergence between their potential and real value for an organism. For example, the most important protective process in nature - inflammation under certain conditions can have harmful and even disastrous consequences for the body. The real significance of individual elements of inflammation may also be different - venous hyperemia, increased permeability blood vessels, exudations, etc. In some cases, the same reaction to the impact of a pathogenic factor simultaneously has both a positive and a negative value. Thus, spasm of the arterioles of the renal glomeruli in acute blood loss helps to maintain central hemodynamics and water retention in the body. However, at the same time it has a biologically negative meaning, because. violates excretory function; In addition, intense and long

Pathogenesis is the process of development of any disease. It is investigated on the basis of clinical test data. It also helps, for example, x-ray examination with diseases of the bones and joints; ultrasound - in case of illness internal organs, fluorographic - with lung damage and others. In other words, pathogenesis describes everything that happens to a person during a particular illness. If the doctor knows the mechanisms of pathogenesis, he will be able to prevent the development of more serious complications. The pathogenesis of the disease is always different. It will depend on the disease itself, its causes and pathogen. Consider the examples of the pathogenesis of diseases.

Diabetes

This disease has been known since ancient times. Even then, healers noticed that people who had sweet urine would soon die. But people did not know what kind of disease it was, how it was treated, so for many centuries diabetes was considered a death sentence.

Some time passed, scientists appeared who were able to understand the pathogenesis diabetes and develop a life-saving drug.

What happens in the body of a person with diabetes?

Diabetes mellitus is a disease in which the human body does not receive important hormone- insulin. Because of this, the patient's blood sugar rises. The person may die. There are two types of diabetes: insulin-dependent and non-insulin-dependent (types 1 and 2). The pathogenesis of diabetes mellitus in these cases is different, but first things first.

It usually occurs in children and adults under 35 years of age, it is inherited, but other causes are possible: severe stress, pancreatic injuries, infectious diseases. Any of the causes becomes an impetus for the development of the disease. The pancreas (more precisely, it begins to die. But it is she who secretes insulin. Soon, an absolute deficiency of this hormone develops in the body, and patients need saving injections.

Nowadays, diabetes can be called incurable disease. In Russia and abroad, pancreas transplant operations are performed, but they are very expensive, not everyone can afford it.

It has a different pathogenesis of development. They suffer from older people, more often women who are prone to fullness. In their case, the pancreas has no problems. She, as expected, produces right amount insulin, but the tissues of the body do not feel this hormone, and it enters the blood in small quantities. Decreased sensitivity occurs due to age, excess weight And chronic diseases person. The body lacks insulin, which sends signals to the pancreas. She, in turn, begins to intensively produce a hormone, which still does not reach the goal. As a result, the body gets tired, with each time the production of insulin decreases. For normal tissue sensitivity to insulin, such people are prescribed tablet preparations that improve the above process. Sometimes this helps, and sometimes not, and then the patients are prescribed insulin injections.

The pathogenesis of pneumonia

Pneumonia develops when pathogenic bacteria enter the lungs. They can get in there. by airborne droplets- this is the most common option. By hematogenous route infection occurs with sepsis or other serious infectious diseases. Through the lymph, a person can become infected when the chest is wounded.

In any case, microbes enter the bronchi and begin to multiply there. The body reacts to such an invasion by raising the temperature, and, consequently, by launching immune system. With reduced immunity, a person quickly weakens, mucus begins to accumulate in the lungs, which will disrupt the patency of the bronchi. Predisposing factors in the formation of mucus include the following: smoking, drinking alcohol, working in hazardous industries, heart disease, and chronic illnesses. Microbes in the mucus feel very good and continue their pathogenic effect. For termination harmful effects on the body of pathogenic bacteria, the patient is prescribed special therapy and a complex of multivitamins to increase the body's defenses. The pathogenesis of pneumonia is very important for physicians. Knowing it, they will be able to prescribe the right treatment.

Arterial hypertension

The state in which there is an increase blood pressure in the arteries, called The causes of the problem are the following: increased cardiac output, increased resistance to arterial blood flow, or both. Pathogenesis arterial hypertension will depend on the reasons that caused it. For example, if a person is constantly stressed, his muscles are in a tense state. This is transmitted to the blood vessels, they narrow, thereby provoking an increase in pressure. Also, the causes of this problem can be diseases of the heart and other internal organs, for example, thyroid gland. In any case, if persistent arterial hypertension is detected, the patient must undergo a complete medical checkup for determining exact reason diseases.

The pathogenesis of gastric ulcer

in the gastric mucosa and duodenum identify aggressive and defensive factors. Peptic ulcer appears when there is an imbalance between them. Aggressive factors:

Bile acids;

Hydrochloric acid.

TO protective factors include the following:

Mucus production;

Renewal of the epithelium;

Proper blood supply;

Normal nutrition of nerve cells.

In addition, another important reason for the formation of ulcers is isolated - this is the bacterium Helicobacter pylori. At the end of the twentieth century, Australian scientists discovered it in the gastric mucosa of a person suffering from chronic gastritis. After a number of studies, it has been proven that Helicobacter pylori can affect the formation of ulcers. She does not die in the stomach and excretes harmful substances that damage its mucosa.

The bacterium attaches to the wall of the stomach, thereby causing inflammation of the mucous membrane. When a focus of inflammation appears, the body turns on defensive forces and with blood delivers leukocytes to the ulcer (they fight against infectious agents). But in this case, leukocytes begin to produce active form oxygen, which damages the epithelium and aggravates the course of the disease. The affected mucosa becomes sensitive to the effects of aggressive factors - this causes pain.

peptic ulcer requires emergency treatment because it gives many life-threatening complications. You must be aware of the risk of perforation of the ulcer (the formation of a through hole in the stomach). Untreated, an ulcer can turn into cancer. Therefore, if you suspect a considered ailment, you should consult a doctor.

Atherosclerosis

A disease in which the arteries of the elastic type are damaged is called atherosclerosis. With this disease, there is a change in the state of the walls of blood vessels and the formation atherosclerotic plaque. As the disease progresses, the patient's condition may worsen. But with timely application for medical care can be avoided dire consequences. The pathogenesis of atherosclerosis will depend on the causes that caused it. There are several hypotheses for the formation of atherosclerotic plaques.

Reasons for the formation of atherosclerotic plaques

The first reason is a violation of the integrity of the blood vessel wall. There are many factors that damage the endothelium. This includes smoking, including passive, increased arterial pressure, malnutrition, sedentary image life, frequent stress and emotional stress. In addition, various bacteria and viruses can cause integrity violations. Platelets begin to accumulate at the site of damage to the vessel. They are necessary to close the hole that has appeared. The problem is that platelets partially or completely block the lumen of the vessel. When large vessels are damaged, clinical symptoms complications of atherosclerosis: coronary disease heart - a condition in which the heart muscle does not have enough oxygen; myocardial infarction and other diseases.

Another hypothesis for the appearance of the disease is malnutrition. At frequent use fatty and fried foods retain a large amount of fat in the blood. They adversely affect the walls of blood vessels and cause damage to them. Further, the picture is similar to the previous one. Platelets rush to the site of injury, but their activity is too high. A thrombus forms on the wall of the vessel, which clogs the lumen of the vessel and causes complications. In addition, a thrombus can break away from the wall of the damaged vessel and block any other one, such as the aorta or pulmonary artery. In this case, instant death occurs.

As can be seen, both hypotheses have almost the same pathogenesis. This is a matter of controversy, but scientists around the world believe that both causes of atherosclerosis have a right to exist. More than that, they complement each other. There are currently a number of medicines that can reduce the risk of developing plaques. In order to find out if you are at risk of developing this disease, you need to consult a doctor. If necessary, he will prescribe treatment for you.

Edema

Everyone knows what edema is. The pathogenesis of their appearance depends on the causes. And the latter has great amount. But first things first.

Edema in heart disease

Normally, the fluid that goes through arterial vessels, has more high pressure than that available in tissues. IN venous system it's the other way around. Thus, it happens normal exchange fluids in the body. But with pathology, the pressure in the venous vessels increases, fluid retention occurs in the body - edema appears. The problem may be due to or heart failure.

Edema in the inflammatory process

The pathogenesis of the disease is also associated with fluid retention in the body. Inflammation provokes venous congestion - this is a condition in which there is stagnation of blood in the organs due to difficulty venous outflow. The pressure in the veins increases, while the fluid is retained in the body.

Swelling with an allergic reaction

Allergy is the body's reaction to antigenic factors. With such a problem, the body releases histamine, which causes vasodilation and increases permeability. vascular wall. Because of this, fluid begins to flow intensively into the tissues, resulting in edema.

hungry edema

Normally, it is the same in blood and tissues. But during starvation, the breakdown of proteins begins in the body, which the body begins to consume. First of all, it is taken for blood plasma proteins. Because of this, blood pressure drops sharply, and the fluid goes to the side high blood pressure i.e. in tissue.

Edema associated with inflammation of the kidneys

With inflammation of the kidney, compression of the renal vessels occurs. This is followed by a violation of the circulation of the specified organ and irritation of the cells that stimulate the release of renin. The latter stimulates the adrenal glands, which begin to produce aldosterone. It inhibits the excretion of sodium from the body. This element irritates tissue osmoreceptors, which increase activity. It, in turn, slows down the excretion of fluid from the body, and it begins to accumulate in the tissues.

The pathogenesis of diseases that cause edema is almost the same, but each case has its own nuances. Therefore, for proper treatment disease is not enough just to independently read the pathogenesis. It can only hurt. Therapy must be prescribed by a doctor.

Conclusion

In the article, we tried to describe the pathogenesis various ailments understandable words to make it easier for you to understand the essence of the problem. Pathogenesis is a mechanism for the development of diseases. Information about it is used to prescribe the correct treatment.

And some of its manifestations. It is considered at various levels - from molecular disorders to the organism as a whole. By studying the pathogenesis, physicians reveal how the disease develops.

The evolution of the doctrine of pathogenesis is an extremely important part of the development of medicine in general. It was the presence of a description of pathogenetic processes, at various levels, that made it possible to penetrate deeper into the causes of the development of diseases and to select more and more effective therapy for them. Issues of pathogenesis are studied by pathological physiology, pathological anatomy, histology and biochemistry, any medical specialty cannot do without considering the issues of pathogenesis. And although the number of typical pathogenetic processes is limited, their combinations and the ratio of the severity of their course form unique clinical pictures for many known diseases.

Knowing typical pathogenetic reactions, their course and interaction with each other, it becomes possible appointment adequate therapy, even in cases where the diagnosis of the disease has not yet been established, but the pathological changes occurring in the body are clearly defined. Thus, it became possible to stabilize the patient's condition until the diagnosis was established and etiotropic therapy began.

General information

Main link

This is the process necessary for the deployment of the rest and determines the specificity of the disease. Pathogenetic treatment is based on its timely elimination, since the disease will not develop in this case.

Periods

Etiopathogenesis

Due to the relationship between etiology and pathogenesis, the term "etiopathogenesis" (aetiopathogenesis, from the Greek. αἰτία - cause), which determines the totality of ideas about the causes and mechanisms of the development of the disease, but since it contributed to the confusion of the concepts of cause and effect in pathology, it was not widely used. However, there are 3 generally accepted options for the connection of etiology and pathogenesis:

The etiological factor initiates pathogenesis, while disappearing itself (burn);
Etiological factor and pathogenesis coexist (most infections);
The etiological factor persists, periodically initiating pathogenesis (malaria).

In addition, the dependence of pathogenesis on etiology can be demonstrated by the example of causal relationships:

"Direct line": use a large number fat → atherosclerosis → insufficiency of coronary circulation → myocardial infarction → cardiogenic shock → death.
Branched types (divergence and convergence).

Specific and non-specific mechanisms

Local and general phenomena

Literature

Zaichik A. Sh., Churilov L. P. Mechanisms of development of diseases and syndromes // Pathophysiology. - St. Petersburg: ELBI-SPb, 2002. - T. I. - S. 63-79. - 240 s. - 90,000 copies.;
Ataman A.V. Mechanisms of development of diseases and syndromes // Pathological physiology in questions and answers. - 2nd, supplemented and revised. - Vinnitsa : New Book (ukr.) Russian , 2008. - S. 27-31. - 544 p. - 2000 copies. - ISBN 978-966-382-121-4;
Vorobyov A. I., Moroz B. B., Smirnov A. N. Pathogenesis// Great Soviet Encyclopedia .

Notes

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Synonyms:

See what "Pathogeny" is in other dictionaries:

Pathogenesis ... Spelling Dictionary

PATHOGENESIS- PATHOGENESIS. Content: general characteristics pathogenetic mechanisms and their occurrence .......... 96 The significance of pathogenesis data for therapy and prevention .................. 98 The problem of “local and general” and pathogenesis .. .. 99… … Big Medical Encyclopedia

Origin, causes of diseases. Dictionary foreign words included in the Russian language. Chudinov A.N., 1910. pathogenesis (gr. pathos suffering + ... genesis) a section of pathology that studies all biological (physiological, biochemical, etc.) ... ... Dictionary of foreign words of the Russian language

AND PATHOGENESIS, pathogenesis, pl. no, husband. (from the Greek pathos disease and genesis birth) (med.). The sequence in the development of some kind of pathological (painful) process. Pathogenesis typhoid fever. Dictionary Ushakov. D.N. Ushakov. ... ... Ushakov's Explanatory Dictionary Technical Translator's Handbook

pathogenesis- pathological genesis

Federal State Autonomous Educational Institution of Higher Professional Education "Ural Federal University named after the first President of Russia B.N. Yeltsin"

GENERAL CONCEPTS OF ETIOLOGY, PATHOLOGY, PATHOGENESIS, PATHOLOGICAL PROCESSES AND SYMPTOMS

Head V.V. Filimonov

Student FKM-100206 M.A. Klevtsova

Specialty 032100

Ekaterinburg

1 Etiology: term, definition, concept. Cause classification

The term "etiology" comes from the Greek. aetia - cause + logos - teaching. It was introduced by the ancient Greek materialist philosopher Democritus (about 470–460 BC), the founder of the causal trend in medicine.

Etiology - This is the doctrine of the causes and conditions for the emergence and development of diseases. In a narrower sense, the term "etiology" refers to the cause of a disease or pathological process. Studying the etiology, we answer the question: why, for what reasons and conditions did the disease arise. According to the breadth of coverage of the phenomenon under study, etiology is divided into:

general studying the general patterns of the origin of entire groups of diseases (infectious, allergic, oncological, cardiovascular, etc.);

private, which studies the causes of certain diseases (nosological forms) - diabetes mellitus, pneumonia, myocardial infarction. Private etiology is studied by clinicians.

Under cause or etiological factor they understand such an object or phenomenon that, directly affecting the body, causes one or another consequence under certain conditions, i.e. disease and give it specific features.

Classification of causes (principles).

Origin All etiological factors are divided into two groups:

a) external or exogenous;

b) internal, or endogenous.

External (exogenous) etiological factors:

mechanical - the impact of phenomena or objects that have a large supply of kinetic energy, capable of causing a fracture, stretching, crushing, etc. at the moment of contact with the body;

physical - impact various kinds energy;

chemical - exposure to acids, alkalis, poisons of organic and inorganic nature, salts heavy metals, hormones, etc.;

biological - viruses, bacteria, helminths;

psychogenic - the point of application of these factors is the cerebral cortex.

To "internal" include hereditary and constitutional factors. The word internal is put in quotation marks, because in the end it is also external factors.

2. According to the intensity of action (classification by I.P. Pavlov) distinguish the following etiological factors:

extraordinary, or unusual, extreme etiological factors ( large doses poison, the impact of lightning, electric current high voltage, falling from a great height, virulent microorganisms, ionizing radiation, etc.);

ordinary, but acting in unusual quantities and sizes, i.e. ordinary in nature, but going beyond the range of physiological adaptive capabilities of the organism (insufficient oxygen content in the air, acute psycho-emotional overload, exposure to excessively high or low temperatures and etc.);

indifferent - factors that do not cause diseases in most people, but in some, under certain conditions, can cause disease.

Condition(lat. - conditio) - this is a factor, circumstance or a combination of them, which, acting on the body, cannot cause a disease by themselves, but they affect the occurrence, development and course of the disease. For example, Mycobacterium tuberculosis does not cause disease in all people, but only in the presence of adverse conditions. Conditions by origin are divided into external and internal, and according to the effect on the body - into favorable and unfavorable.

Unfavorable conditions deepen the relationship between cause and effect and contribute to the onset of the disease (fatigue, malnutrition, poor living conditions, emotional and mental stress, etc.), while favorable ones, on the contrary, break the cause-and-effect relationship and prevent the onset of the disease (good nutrition, healthy lifestyle life, hardening) by increasing the body's resistance.

External conditions are divided into domestic, social, natural. External adverse conditions include malnutrition, improper organization of the daily routine, heat, dampness, cold, etc.

To internal, i.e. associated with the organism itself, adverse conditions include: hereditary predisposition, early childhood, senile age, pathological constitution.

Internal conditions can be formed in extrauterine life (for example, a decrease in the body's resistance after suffering measles, pneumonia, diphtheria), affect the fetus during intrauterine life (alcoholism, smoking, drug addiction in the mother during pregnancy), and also be hereditary in nature (for example , predisposition to mental illness, hypertension, diabetes mellitus, gout, etc.).

2 Pathology: term, definition, concept

Pathology(from the Greek παθος - suffering, pain, illness and λογος - study) - deviation from the normal state or development process. Pathology explores the processes of deviation from the norm, processes that violate homeostasis, diseases, dysfunctions.

Pathology is a field of theoretical medicine that studies the patterns of occurrence, course and outcome of diseases. Based on the factual material of various biomedical disciplines ( clinical medicine, pathological anatomy and pathological physiology, histology and biochemistry, microbiology, genetics, etc.). It is customary to distinguish between general and private pathology. General pathology studies the general patterns inherent in the main features of any disease process or certain categories of diseases: hereditary, infectious, endocrine, etc. It gives an idea of typical pathological processes - inflammation, atrophy, dystrophy, regeneration, etc. In the tasks of general pathology includes the development of theoretical aspects of the etiology and pathogenesis of human diseases, compensation for impaired functions. Particular pathology explores the morphological foundations and mechanisms of development of specific forms of diseases (historically, it has developed within the framework of clinical medicine as a specific pathology and therapy of internal diseases, since in the 1st half of the 19th century pathological anatomy was taught at clinical departments). There is also a comparative, or evolutionary, pathology, which studies, in a comparative aspect, diseases, pathological processes and conditions in animals at different stages of evolutionary development.

3 Pathogenesis: term, definition and classification. Damage. The main link of pathogenesis. The course of diseases. Disease outcomes

The term "pathogenesis" comes from two words: Greek. pathos - suffering (according to Aristotle, pathos - damage) and genesis - origin, development. Pathogenesis - this is the doctrine of the mechanisms of development, course and outcome of diseases, pathological processes and pathological conditions. Studying the pathogenesis, we answer the question: how, how did the disease arise, i.e. we find out the mechanisms of the development of the disease and deal mainly with internal factors.

The following definition most fully reflects the content of the concept of "pathogenesis". Pathogenesis – this is a set of mechanisms that are activated in the body when it is exposed to harmful (pathogenic) factors and manifested in the dynamic stereotypical deployment of a number of functional, biochemical and morphological reactions of the body that determine the occurrence, development and outcome of the disease.

The scope of the concept is revealed through the classification of pathogenesis. According to the breadth of coverage of the studied issues, there are:

A) private pathogenesis, which studies the mechanisms of individual pathological reactions, processes, conditions and diseases (nosological units). Private pathogenesis is studied by clinicians, revealing the mechanism of specific diseases in specific patients (for example, the pathogenesis of diabetes mellitus, pneumonia, peptic ulcer stomach, etc.). Private pathogenesis refers to specific nosological forms.

b) general pathogenesis involves the study of the mechanisms most general patterns underlying typical pathological processes or certain categories of diseases (hereditary, oncological, infectious, endocrine, etc.). General pathogenesis is concerned with the study of mechanisms leading to the functional failure of any organ or system. For example, general pathogenesis studies the mechanisms of development of heart failure in patients with pathology of the cardiovascular system: with heart defects, myocardial infarction, coronary heart disease, lung diseases with pulmonary hypertension.

General and particular pathogenesis are closely related to each other, since the opening and generalization of general patterns is possible only on the basis of an analysis of particular forms of pathology, and the doctrine of general pathogenesis created on this basis is used to reveal the mechanisms of specific diseases and individual forms of their course.

The study of pathogenesis is reduced to the study of the so-called pathogenetic factors, those. those changes in the body that occur in response to the influence of an etiological factor and in the future play the role of a cause in the development of the disease. The pathogenetic factor causes the emergence of new disorders of life in the development of the pathological process, disease.

The trigger mechanism (link) of any pathological process, disease is damage, arising under the influence of a harmful factor.

Damage can be:

primary; they are caused by the direct action of the pathogenic factor on the body - these are damages at the molecular level,

secondary; they are a consequence of the influence of primary damage on tissues and organs, accompanied by the release of biologically active substances (BAS), proteolysis, acidosis, hypoxia, impaired microcirculation, microthrombosis, etc.

The nature of the damage depends on the nature of the irritant (pathogenic factor), species and individual properties of the living organism. Damage levels can be different: molecular, cellular, tissue, organ and organism. The same stimulus can cause damage at various levels.

Simultaneously with damage, protective and compensatory processes are activated at the same levels - molecular, cellular, tissue, organ and organism.

Each pathological process, disease is considered as a long chain of cause-and-effect relationships, which spreads like a chain reaction. The primary link in this long chain is damage that occurs under the influence of a pathogenic factor, and which becomes the cause of secondary damage that causes tertiary, etc. (Impact mechanical factor- trauma - blood loss - centralization of blood circulation - hypoxia - acidosis - toxemia, septicemia - etc.).

In this complex chain of cause-and-effect relationships, there are always basic(synonyms: main, leading) link. Under the main (main) link of pathogenesis understand such a phenomenon that determines the development of a process with specific features characteristic of it. For example, arterial hyperemia is based on the expansion of arterioles (this is the main link), which causes an acceleration of blood flow, redness, an increase in the temperature of the hyperemic area, an increase in its volume and an increase in metabolism. The main link in the pathogenesis of acute blood loss is the deficiency of circulating blood volume (BCV), which causes a decrease in blood pressure, centralization of blood circulation, shunting of blood flow, acidosis, hypoxia, etc. When the main link is eliminated, recovery occurs.

Untimely elimination of the main link leads to a violation of homeostasis and the formation vicious circles pathogenesis. They arise when a deviation in the level of functioning of an organ or system begins to support and strengthen itself as a result of the formation positive feedback.

The formation of vicious circles aggravates the course of the disease. Timely diagnosis of the initial stages of the formation of vicious circles, prevention of their formation and elimination of the main link of pathogenesis is a guarantee successful treatment sick.

In a complex chain of cause-and-effect relationships, local and general changes are distinguished. The question of the relationship between local and common phenomena in the pathogenesis of the disease, the pathological process remains quite complex. There are no absolutely local processes in a whole organism. In the pathological process, the disease involves the entire body. As you know, with any pathology: pulpitis, stomatitis, local burn, furuncle, pituitary adenoma - the whole body suffers. Nevertheless, the significance of local and general phenomena in pathogenesis is very variable.

Knowledge of the mechanisms of pathogenesis ensures reliable treatment of the patient and prevention of the disease. Pathogenetic principles of therapy include symptomatic therapy, detoxification and immunosuppressive therapy; treatment aimed at increasing the body's resistance; desensitization and therapy of typical pathological processes.

The modern understanding of the essence of the disease is pathogenetic. Only by studying the pathogenesis, one can understand the essence of the disease and develop effective preventive and treatment measures on this basis. Knowledge of pathogenesis allows you to correctly diagnose, treat, predict and prevent the disease.

Regarding such a section of pathogenesis as flow diseases, the question of acute And chronic processes.

Traditionally, one of the criteria for an acute or chronic course is temporary. If a pathogenic agent (or information about it recorded by the immune or nervous system) persists in the body, the disease acquires a protracted course, which is clinically referred to as subacute, and after a certain period - chronic.

Many acute processes are very long - and do not become chronic because of this.

Many chronic processes are comparable in duration to the longest acute ones, which, however, does not turn them into acute ones.

Contrary to popular belief outside of medicine, not all acute pathologies in the world become chronic over time, just as not all chronic originates from acute. Acute sinusitis may become chronic over time, but has been shown to acute gastritis and chronic gastritis have different etiology and pathogenesis and do not pass into each other. It is certainly true that for the prospect of a transition to chronic form both the causative factor (for example, the ability of the pathogen to inhibit the completion of phagocytosis and survive inside phagocytes) and the reactivity of the organism (immunity tension, aggressiveness of anti-inflammatory and etiotropic therapy) are important.

An acute process, no matter how long it lasts, always has a relatively more autochthonous character (see the next section), while a chronic process often requires not a starting, but a continuing action of a causative factor.

outcomes diseases in the general pathogenesis is full recovery(for example, after an acute process in an organ that has an excess reserve of structural elements, say, in the kidney), incomplete recovery leaving structural changes and functional limitations in organs (focal and diffuse cardiosclerosis after a heart attack, myocardium), death. Incomplete recovery can be expressed in relapses after periods remissions(recurrence of the same disease after some interval of relief or absence of symptoms - an example would be the course endogenous psychoses), in the transition of the disease into a chronic form (for example, with bronchitis), in complications(transition to new disease or the addition of a process that is not an obligate element of the primary disease, for example, the appearance of immunocomplex glomerulonephritis after scarlet fever). Incomplete recovery can lead to the development of disability (for example, due to amputation of a limb after an anaerobic infection).

4 The concept of the pathological process, syndrome and symptom

The pathological process a sequence of reactions naturally arising in the body to the damaging effect of a pathogenic factor. The same pathological process can be caused by various etiological factors and be a component of various diseases, while retaining its essential distinctive features. For example, inflammation can be caused by the action of mechanical, physical, chemical, biological factors. Taking into account the nature of the etiological factor, conditions and reactivity of the body, inflammation is very diverse, however, despite this, in all cases, inflammation remains a holistic, standard vascular-mesenchymal response to damage to tissue structures and includes alteration, impaired microcirculation, exudation with emigration, increased vascular permeability, phagocytosis and proliferation.

Examples of pathological processes are inflammation lung tissue with pneumonia, hypoxia with obliterating endarteritis, inflammation of the heart muscle with myocardial infarction, fever with typhoid fever, etc.

The totality of pathological processes determines pathogenesis of diseases. But disease is not a simple sum of pathological processes. Croupous pneumonia is not the sum of such pathological processes as inflammation, fever, hypoxia, acidosis. Only in the interconnection of all these components and their internal unity lies the specific content and their nosological certainty. Characteristic features of pathological processes:

Pathological processes can act as early stage development of the disease (deposition of cholesterol as a manifestation of impaired lipid metabolism, thrombosis of the coronary arteries as a manifestation of impaired microcirculation - myocardial infarction).

Pathological processes at a certain stage of development can acquire new qualities - the qualities of a disease as a nosological form: the deposition of cholesterol in the coronary vessels - IHD, although it is conditional and sometimes difficult to distinguish between a pathological process and a disease.

Some diseases are essentially a pathological process - mountain and altitude sickness, decompression sickness.

Pathological processes are different nature and different biological significance:

a) some of them are a direct consequence of the action of the etiological factor and a manifestation of the damage caused by them (hypoxia),

b) other typical pathological processes developed in the course of evolution as biologically beneficial reactions of the body to damage caused by a pathogenic factor (inflammation, fever, thrombosis), but under certain circumstances they can also have a detrimental effect.

Pathological condition – this is a persistent deviation of the structure and function of an organ (tissue) from the norm, which has a biologically negative value for the body; violations that change little over time. Pathological conditions can be genetically determined (polydactyly, defect upper lip and hard palate, etc.) and may be a consequence of earlier past illness or a pathological process: the consequences of injuries - scars, loss of a limb, ankylosis, lameness, false joints; tuberculosis of the spine - hump; rickets - deformation of the skeleton).

Examples of pathological conditions are also a stump (after amputation of a limb), cicatricial changes in tissues after a thermal burn, atrophy of the alveolar processes of the jaw due to the removal or loss of teeth, an acquired defect in the valvular apparatus of the heart.

Usually, pathological conditions do not contain immediate prerequisites for noticeable dynamics and are mainly subject to age-related changes: decreased visual acuity, hearing loss, muscle atrophy, tooth loss. At the same time, a pathological condition can lead to the emergence of secondary more or less developing pathological processes or diseases. For example, the removal or loss of teeth causes atrophy of the alveolar processes of the jaw and leads to indigestion; persistent cicatricial narrowing of the esophagus causes significant digestive disorders.

Sometimes, under the influence of various additional influences, a pathological condition can turn into a rapidly developing pathological process: a birthmark after repeated exposure to UV rays turns into a melanosarcoma (malignant tumor).

Pathological reaction- a simple mosaic element of the pathological process, showing both relative adequacy and potential pathogenicity.

In the clinic, the concept of a pathological process most often corresponds to the term syndrome(for example, the pathological process referred to as "progressive nephrosclerosis" correlates with chronic renal failure syndrome), and the pathological reaction can sometimes (though not in all cases) be correlated with the corresponding symptom(for example, Babinsky's symptom, as a manifestation of pyramidal insufficiency). The combination of mosaic elements into a disease is not a simple summation. They are combined according to the stochastic probabilistic principle, on the basis of the archive of program responses and the selection trend that are present in the individual reactivity of a particular patient. Therefore, diseases have individual variations and the doctor, according to S.P. Botkin, should “treat not the disease, but the patient.”

Symptom(from Greekσύμπτομα - case, coincidence, sign) - one separate sign, a particular manifestation of some diseases, pathological condition or violation of any process vital activity, one separate specific complaint sick.

In some cases, when the cause of a symptom in a patient is unknown and it is not possible to establish and classify the disease causing this symptom, this symptom is called "idiopathic" or "essential", and is isolated into a separate independent disease. For example, this is how "essential tremor" or "idiopathic headache" is distinguished.

A set of symptoms that often occur together in several specific diseases is called syndrome(with their common pathogenesis), symptoms or symptom complex. For example, this is exactly what they say about the “flu-like syndrome” (headache, weakness, fever, etc.) with many infections, about the “depressive syndrome” with various mental and somatic diseases, etc.

The symptoms are divided into specific(special) - inherent in only one disease, and non-specific- attendants whole line diseases.

Syndrome (Greek σύνδρομον, σύνδρομο - equally, in agreement)- aggregate symptoms with a common pathogenesis.

In medicine and psychology, the term syndrome refers to the association of a number of clinically recognizable symptoms (features, phenomena, or characteristics) that often occur together, such that the presence of one feature alerts the clinician to the presence of the others. In recent decades, the term has also been used outside of medicine to describe similar phenomena.

In technical medical parlance, a syndrome concerns only a set of detectable characteristics. A particular disease, condition, or disorder may be identified as the underlying cause. As soon as physical cause been identified, the word "syndrome" sometimes remains in the name of the disease.

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