Educational literature o f TSMU
PATHOPHYSIOLOGY:
GENERAL NOSOLOGY
Tutorial
Training manual
ISBN 978-5-98301-223-3
9 7 8 5 9 8 3
01 2 2 3 3
Publishing house «Medicina DV»
690600, Vladivostok, 4 Ostryakova ave
Тел.: (423) 245-56-49. E-mail: medicinaDV@mail.ru
Medicina DV
2021
Vladivostok
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Federal State Budgetary Educational Institution
Pacific State Medical University
Ministry of Public Health o f Russia
(FSBEI HE PSMU of Ministry of Public Health of Russia)
PATHOPHYSIOLOGY:
GENERAL NOSOLOGY
Tutorial
Training manual
Рекомендовано Координационным советом по области образования
«Здравоохранение и медицинские науки» в качестве учебного пособия
для использования в образовательных учреждениях, реализующих
основные профессиональные образовательные программы высшего
образования уровня специалитета по направлению подготовки
31.05.01 «Лечебное дело»
Vladivostok
Medicina DV
2021
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UDC 616-092:811.111(025.8)
BBK 52.52 я 73
Р 32
It is recommended by the Editorial and Publishing Board o f
Pacific State Medical University
Reviewers:
M. V. Osikov - Dr. habil. med., professor, head o f the Pathological Physiology
Department o f FSBEIHPE «South Ural State Medical University»
o f Ministry o f Public Health o f the Russian Federation
T.A. Batalova - Dr. biological sciences, associate professor,
head o f the Department o f Normal Physiology and Pathophysiology o f FSBEI
HE «Amur State Medical Academy» o f Ministry o f Public Health
o f the Russian Federation
Authors:
В.Е. Krasnikov, E.A. Chagina, E.V Markelova, A.Yu Shubina
Р 32
Pathophysiology, clinical pathophysiology: general nosology: training
manual / V. E. Krasnikov, E. A. Chagina, E. V. Markelova and other authors. -
Vladivostok: Medicina DV, 2021, - p. 156, Table 4, Figure 8, Bibliography: 13
items.
ISBN 978-5-98301-223-3
TThe manual was prepared in accordance with the requirements o f FSES and
modern programs on the pathophysiology o f medical universities.
The manual contains materials on the subject, goals and objectives of
pathophysiology, its significance and place in educational training o f students. A
modern interpretation of general nosology and its categories is given (health, norm,
pre-disease, disease, pathological process, typical pathological process, etc.). The role
of reactivity, resistance and constitution of the organism, their positive and negative
sides in pathology are considered. The manual is illustrated (drawings, tables), sufficient
in volume for the development of the basis of the competence of the doctor to solve
their professionalproblems. The manual is intended for students o f medical schools,
may be useful to interns, residents, graduate students and doctors of various specialties.
The tutorial is compiled on “Pathophysiology, clinical pathophysiology” discipline,
in accordance with the requirements of the Federal State Educational Standards and
is intended for students pursuing specialist’s programs «General Medicine» as a
study guide for use in educational institutions that implement the main professional
educational programs of higher education at the level of a specialty for the training
program 31.05.01 «General Medicine».
UDC 616-092:811.111(025.8)
BBK 52.52 я 73
ISBN 978-5-98301-223-3
© Team of authors, 2021
© Medicina DV, 2021
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Ta b l e o f c o n t en t s
Preface.......................................................................................................................................................5
Chapter 1. Introduction to the subject............................................................................................ 7
1.1. The definition of «pathophysiology»...........................................................................7
1.2. The subject, purpose and objectives of pathophysiology....................................8
1.3. The structure (content) of pathophysiology............................................................ 9
1.4. The relationship of pathophysiology with other medical disciplines..............11
1.5. Method for the study of pathophysiology.............................................................. 13
Task for self-control of knowledge............................................................................ 17
Chapter 2. General doctrine on disease........................................................................................20
2.1. Basic concepts and categories of nosology
(health, norm, pre-disease, disease).........................................................................20
2.2. Other concepts of nosology (pathological process, typical pathological
process, pathological condition, etc.)...................................................................... 28
2.3. Principles of classification and nomenclature of diseases..................................35
2.4. Forms and periods (stages) of the development of diseases............................. 36
Task for self-control of knowledge.......................................................................... 40
Chapter 3. General ethiology........................................................................................................... 44
3.1. Description of the concept of «etiology»................................................................ 44
3.2. Previous theories and modern general principles of etiology........................ 45
3.3. Characterization of etiological factors (causes) of the disease.........................47
3.4. Description of the conditions of the disease.......................................................... 51
3.5. Modern theories of causality in human pathology............................................ 53
3.6. The basics of etiotropic prevention and therapy...................................................56
Tasks for self-control of knowledge.......................................................................... 57
Chapter 4. General pathogenesis..................................................................................................... 61
4.1. Description of the concept of «pathogenesis».......................................................61
4.2. The main provisions of the general pathogenesis................................................62
4.3. Fundamentals of pathogenetic therapy and prevention.....................................79
Tasks for self-control of knowledge...........................................................................80
Chapter 5. Role of reactivity and resistance of the organism in pathology........................85
5.1. Characteristics of the concept of «body reactivity»............................................. 85
5.2. Types and forms of reactivity.................................................................................... 87
5.3. Resistance of an organism, general characteristic, types..................................100
5.4. The relationship between reactivity and resistance............................................103
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5.5. Relative expediency and potential pathogenicity of protective and adaptive
mechanisms (reactivity mechanisms)....................................................................105
5.6. Implementation of reactivity mechanisms at various structural and
functional sublevels of an organism........................................................................109
Task for self-control of knowledge.......................................................................... 113
Chapter 6. The role of the organism constitution in pathology.........................................117
6.1. Description of the concept of «constitution of the body.»..............................117
6.2. Classification (types) of constitutional types...................................................... 119
6.3. Molecular (serological) markers of the constitution......................................... 131
6.4. The doctrine of diathesis............................................................................................135
Conclusion...........................................................................................................................................140
Responses to tasks for self-control of knowledge....................................................................146
Appendix.............................................................................................................................................147
List of references............................................................................................................................... 153
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PREFACE
General nosology is one of the main sections of pathophysiology.
Unfortunately, in the latest editions of textbooks on our discipline, this
section is not fully disclosed, sometimes thesisally. This makes it difficult for
students to master a number of fundamental categories of general pathology
and medicine.
The purpose of this manual was a broader, based on modern material,
discussion of the provisions of nosology and their significance for clinical
medicine.
The presentation of the material begins with the chapter “Introduction
to the subject”, which shows the goals and objectives of pathophysiology,
its sections, research methods. A detailed description of the stages of the
pathophysiological experiment is given. The subsequent sections of the
manual (5 chapters) are devoted directly to general nosology.
The chapter “General doctrine of the disease” discusses the
characteristics of the main categories of medicine - “disease”, “health” and
the main criteria for their assessment. Attention is drawn to the concepts of
“norm”, “pre-illness”, their significance for the doctor’s activity is noted. Such
nosology concepts as “pathological process”, “typical pathological process”,
“pathological condition”, etc. are also presented, their properties and role in
pathology are noted.
The chapter “General etiology” introduces theories of causality in
pathology (previous and modern), the main groups of causes and conditions
of the onset of diseases and the nature of their interaction with the body. The
principles of etiotropic prevention and therapy are considered.
The issues of general pathogenesis are discussed in the fourth chapter,
which describes the characteristics of pathological changes (“breakdown”)
in the mechanisms of disease development, as well as protective and adaptive
reactions of the body aimed at recovery (mechanisms of sanogenesis). The
principles of pathogenetic prophylaxis and therapy are presented.
Preface
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The content of the fifth chapter “The role of the reactivity and resistance
of the organism in pathology” includes a description of the concepts
of “reactivity” and “resistance” of the organism, their types and forms.
Emphasis is placed on the similarities and differences between them. The
relative pathogenicity of reactivity mechanisms (protective and adaptive
reactions) is emphasized.
The significance of the constitution of an organism in pathology is
described in the last chapter, which presents various classifications of
constitutional types with a detailed description of them. It is emphasized
that the relationship between constitutional types can be traced not only
with certain diseases, but also with professional inclinations.
For each chapter (section), a graphological structure and tasks for selfmonitoring
with response standards have been developed
Level of training - specialty, areas: medical business, pediatrics, medical
and preventive care, dentistry, medical biochemistry, pharmacy.
As a result of studying the discipline of pathophysiology, students
should:
to know - the basic concepts of general nosology, the role of causes
and conditions in the emergence of typical pathological processes (clinical
syndromes), diseases; the role of reactivity, resistance and constitution of the
body in pathology; typical pathological processes (main clinical syndromes),
causes and mechanisms of their development, outcomes; principles of
etiotropic and pathogenetic prevention, diagnosis, treatment.
to be able to - conduct a pathophysiological analysis between various
typical pathological processes (clinical syndromes), taking into account
the results of laboratory and instrumental data and the symptoms of their
manifestation in the clinic; substantiate pathogenetically correct principles
of diagnosis, etiotropic and pathogenetically justified methods of prevention,
therapy and rehabilitation.
to own - modern methods of assessing laboratory and instrumental
methods of research in the clinic, the basics of medical thinking
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Preface
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Ch a p t e r
1
INTRODUCTION TO THE SUBJECT
1.1. THE DEFINITION OF “PATHOPHYSIOLOGY”
“Pathophysiology arose as an experimental science in connection
with the need for an accurate, natural-scientific study o f the
mechanisms of the emergence, development, and elimination of
pathological processes” (Kryzhanovsky G.N., 1997). Currently, it is
one of the fundamental, integrating disciplines in higher medical school.
Pathophysiology is the theoretical basis of the doctor’s training system, the
formation of the foundations of his clinical thinking. “Pathophysiology -
the basis o f professional medical intelligence” (experts of WHO(World
Health Organization)).
The term “pathological physiology” was first used in the 17th century
by J. Varandes, according to other sources - Galiot, who in 1819 published a
textbook entitled “General Pathology and Pathological Physiology”.
One of the founders of Russian pathological physiology as a science
and academic discipline is Viktor Vasilyevich Pashutin. He created the first
department of pathological physiology at Kazan University in Russia in
1874.
In modern literature, both in scientific and in educational, instead
of the phrase “pathological physiology” it is customary to use the
term “pathophysiology”(from Greek “pathos” - suffering; “physis” -
nature, essence; “logos” - teaching, science), and relatively recently -
“pathophysiology, clinical pathophysiology” (see below).
This terminology is a priority in Russia. In the West, in particular in
French-speaking countries, “clinical physiology” is more often used, and in
English-speaking countries it is a “general pathology”.
What is pathophysiology, what kind of science is it, what does it study?
Despite some discrepancy in terminology, the issues that are addressed by
this science, regardless of the nationality of scientists, are one.
Introduction to the subject
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Pathophysiology is a science that studies the most general patterns
o f the occurrence, development, and outcomes of pathological processes,
typical pathological processes and diseases. If translated literally - this is
the science of the vital activity of a sick organism. But this does not at all
follow that a healthy organism is out of sight of pathophysiologists.
Such important pathophysiological concepts as resistance, constitution,
stress, diathesis and a number of others belong to a healthy body. N.N.
Anichkov once said: “... that normal mechanisms can be known only when they
become dependent on abnormal reactions.” Under the influence of various
pathogenic factors, making maximum use of its adaptive mechanisms,
a healthy organism reveals its own genetically determined capabilities
more fully, functions outside the narrow ranges inherent in a quiet
existence.
The definition of the concept of “pathophysiology” can be approached
on the other hand. Each organism has a peculiar program of life, which
has developed in the process of evolution and is encoded in the genetic
apparatus. According to this program, the nucleation, development and
manifestations of various forms of activity of the body occur. Therefore, all
the activities of the body, the optimal characteristics of its functioning are
genetically determined. A.M. Ugolev defined physiology as the science of
the technology of living systems, implying by this a way to solve a particular
problem by various body systems. So the technological task of the external
respiration system is the optimal oxygen saturation of red blood cells with
a minimum expenditure of energy, urinary - removal of various metabolic
products and the preservation of substances useful for the body, etc. Based
on this, pathophysiology can be “defined as the science of technological
errors and technological defects in the functioning of living systems, a kind
of biological defectology” (Churilov L.P., 2015).
1.2. THE SUBJECT, PURPOSE AND OBJECTIVES
OF PATHOPHYSIOLOGY
Science, in contrast to “not science,” according to J.J. Thomson,
should have a subject and method of research. The subject (object) of
the study of pathophysiology is, sadly, a human disease. The main goal
of pathophysiology is to establish the most general patterns by which a
pathological process, a disease develops.
In accordance with the goal, the objectives of our science are:
• study of the general laws of specific mechanisms (underlying the body’s
resistance) of the occurrence, development and completion of pathological
processes and diseases;
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Chapter 1
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• study of typical pathological processes (stereotypical combinations
of phenomena), a different combination of which determines the clinical
picture of human diseases;
• study of typical forms of violation and restoration of functions of
individual organs and systems of the body;
• study of transition states between health and illness (pre-illness);
• systematization and analytical-synthetic processing of factual material;
• the creation of new methods for modeling pathological processes and
diseases;
• on the basis of theoretical and applied knowledge to contribute to the
formation of the clinical thinking of the doctor, i.e. not only to transmit
modern knowledge to the student, but also to teach them how to find and
use them in order to be able to build a chain of the phenomena studied in
their future practical activity into a logical system.
1.3. THE STRUCTURE (CONTENT) OF
PATHOPHYSIOLOGY
Pathophysiology, as a science and academic discipline, consists of three
main sections with several subsections:
I. General nosology (nosos-disease + logos-teaching)
1. General doctrine of the disease:
a) the basic concepts and categories of pathology;
b) classification and nomenclature of diseases;
c) social aspects of pathology.
2. General etiology (aithia-cause):
a) the general properties of pathogenic factors;
b) the main categories of pathogenic factors;
c) the importance of conditions in the occurrence of diseases;
d) the principles of etiotropic prevention and therapy.
3. General pathogenesis (pathos + genesis - origin):
a) mechanisms of the body’s resistance to pathogenic factors;
b) general mechanisms of disease development;
c) mechanisms of recovery;
d) mechanisms of dying;
e) the principles of pathogenetic prophylaxis and therapy.
4. The doctrine of reactivity, resistance and constitution of organism
II. The study of typical pathological processes: pathology of the cell,
peripheral blood circulation and microcirculation, hypoxia, inflammation,
tumor growth, allergies, metabolic disorders, etc. those processes that are
often found in various combinations for many diseases.
Introduction to the subject
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