The main stages in the history of the development of pathological anatomy. Introduction Anatomical pathology

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Pathological anatomy is an integral part of pathology (from the Greek. pathos- disease), which is a broad field of biology and medicine that studies various aspects of disease. Pathological anatomy studies structural (material) basis of the disease. This study serves both medical theory and clinical practice, therefore pathological anatomy is scientific and applied discipline. The theoretical, scientific, significance of pathological anatomy is most fully revealed when studying the general patterns of development of cell pathology, pathological processes and diseases, i.e. general human pathology. General human pathology, primarily cell pathology and the morphology of general pathological processes, is the content of the course general pathological anatomy. The clinical, applied, significance of pathological anatomy lies in the study of the structural foundations of the entire variety of human diseases, the specifics of each disease, otherwise - in the creation anatomy of a sick person, or clinical anatomy. The course is dedicated to this section private pathological anatomy.

The study of general and specific pathological anatomy is inextricably linked, since general pathological processes in their various combinations are the content of both syndromes and human diseases. The study of the structural basis of syndromes and diseases is carried out in close connection with their clinical manifestations. Clinical and anatomical direction - this is a distinctive feature of domestic pathological anatomy.

In a disease, which should be considered as a violation of the normal vital functions of the body, as one of the forms of life, structural and functional changes are inextricably linked. There are no functional changes that are not caused by corresponding structural changes. Therefore, the study of pathological anatomy is based on principle of unity And structure pairing And functions.

When studying pathological processes and diseases, pathological anatomy is interested in the causes of their occurrence (etiology), development mechanisms (pathogenesis), the morphological basis of these mechanisms (morphogenesis), various outcomes of the disease, i.e. recovery and its mechanisms (sanogenesis), disability, complications, as well as death and death mechanisms (thanatogenesis). The task of pathological anatomy is also to develop the doctrine of diagnosis.

In recent years, pathological anatomy has paid special attention to the variability of diseases (pathomorphosis) and diseases arising in connection with the activities of a doctor (iatrogenics). Pathomorphosis - a broad concept that reflects, on the one hand, changes in the structure of morbidity and mortality associated with changes in human living conditions, i.e. changes in the general panorama of diseases, on the other hand, persistent changes in the clinical and morphological manifestations of a particular disease, but

zology - nosomorphosis, usually arising in connection with the use of medications (therapeutic pathomorphosis). Iatrogenesis (pathology of therapy), i.e. diseases and complications of diseases associated with medical manipulations (drug treatment, invasive diagnostic methods, surgical interventions) are very diverse and are often based on medical error. It should be noted that iatrogenicity has increased in recent decades.

Objects, methods and levels of research in pathological anatomy

Pathological anatomy obtains material for research during autopsies of corpses, surgical operations, biopsies and experiments.

At autopsies deceased - autopsy (from Greek autopsia- seeing with one’s own eyes) find both far-reaching changes that led the patient to death, and initial changes, which are often discovered only during microscopic examination. This made it possible to study the stages of development of many diseases. Organs and tissues taken at autopsy are studied using not only macroscopic, but also microscopic research methods. In this case, they mainly use light-optical examination, since cadaveric changes (autolysis) limit the use of more subtle methods of morphological analysis.

During the autopsy, the correctness of the clinical diagnosis is confirmed or a diagnostic error is revealed, the causes of death of the patient, the features of the course of the disease are established, the effectiveness of the use of medicinal drugs and diagnostic procedures is revealed, mortality and mortality statistics are developed, etc.

Operating material (removed organs and tissues) allows the pathologist to study the morphology of the disease at various stages of its development and use a variety of methods of morphological research.

Biopsy (from Greek bios- life and opsis- vision) - intravital tissue sampling for diagnostic purposes. The material obtained through biopsy is called biopsy. More than 100 years ago, as soon as the light microscope appeared, pathologists began to study biopsy material, supporting the clinical diagnosis with morphological examination. Currently, it is impossible to imagine a medical institution in which they would not resort to biopsies to clarify the diagnosis. In modern medical institutions, a biopsy is performed on every third patient, and there is no organ or tissue that is not available for biopsy examination.

Not only the scope and methods of biopsy are expanding, but also the tasks that the clinic solves with its help. Through a biopsy, often repeated, the clinic receives objective data confirming

diagnosis, allowing one to judge the dynamics of the process, the nature of the course of the disease and prognosis, the feasibility of using and the effectiveness of a particular type of therapy, and the possible side effects of drugs. Thus, the pathologist, who came to be called clinical pathologist, becomes a full participant in diagnosis, therapeutic or surgical tactics and prognosis of the disease. Biopsies make it possible to study the most initial and subtle changes in cells and tissues using an electron microscope, histochemical, histoimmunochemical and enzymological methods, i.e. those initial changes in diseases, the clinical manifestations of which are still absent due to the consistency of compensatory-adaptive processes. In such cases, only the pathologist has the capabilities of early diagnosis. The same modern methods make it possible to give a functional assessment of structures changed during the disease, to gain an idea not only of the essence and pathogenesis of the developing process, but also of the degree of compensation for impaired functions. Thus, biopsy is now becoming one of the main objects of research in solving both practical and theoretical issues of pathological anatomy.

Experiment very important for elucidating the pathogenesis and morphogenesis of diseases. Although it is difficult to create an adequate model of human disease experimentally, models of many human diseases have been created and are being created; they help to better understand the pathogenesis and morphogenesis of diseases. Using models of human diseases, the effects of certain medications are studied and methods of surgical interventions are developed before they find clinical use. Thus, modern pathological anatomy has become clinical pathology.

The study of the structural basis of the disease is carried out at different levels: organismal, systemic, organ, tissue, cellular, subcellular, molecular.

Organismal level allows you to see the disease of an entire organism in its diverse manifestations, in the interconnection of all organs and systems.

System level- this is the level of study of any system of organs or tissues united by a common function (for example, the connective tissue system, blood system, digestive system, etc.).

Organ level allows you to detect changes in organs, which in some cases are clearly visible to the naked eye, in other cases, to detect them it is necessary to resort to microscopic examination.

Tissue and cellular levels- these are the levels of studying altered tissues, cells and intercellular substances using light-optical research methods.

Subcellular level allows you to observe using an electron microscope changes in cell ultrastructures and intercellular substance, which in most cases are the first morphological manifestations of the disease.

Molecular level studying the disease is possible using complex research methods involving electron microscopy, immunohistochemistry, cytochemistry, and autoradiography. As you can see, an in-depth morphological study of the disease requires the entire arsenal of modern methods - from macroscopic to electron microscopic, histocytoenzymatic and immunohistochemical.

So, the tasks that pathological anatomy is currently solving put it in a special position among medical disciplines: on the one hand, it is medical theory, which, revealing the material substrate of the disease, serves directly clinical practice; on the other hand, this clinical morphology to establish a diagnosis, serving the theory of medicine. It should be emphasized once again that teaching pathological anatomy is based on the principles of unity and conjugation of structure and function as a methodological basis for the study of pathology in general, as well as clinical and anatomical direction of domestic pathological anatomy. The first principle allows us to see the connections of pathological anatomy with other theoretical disciplines and the need to know, first of all, anatomy, histology, physiology and biochemistry to understand the fundamentals of pathology. The second principle - clinical anatomical direction - proves the need for knowledge of pathological anatomy to study other clinical disciplines and the practical activities of a doctor, regardless of the future specialty.

Brief historical data

Pathological anatomy is an integral part of theoretical and practical medicine and has its roots in ancient times. As an independent discipline, it developed slowly due to the fact that autopsy of the bodies of the dead was prohibited for a long time. Only in the 16th century did they begin to accumulate materials on the pathological anatomy of diseases obtained from autopsies of corpses. In 1761, the work of the Italian anatomist G. Morgagni (1682-1771) “On the location and causes of diseases identified by the anatomist” was published, based on the results of 700 autopsies, some of which were performed by the author personally. He tried to establish a connection between the described morphological changes and the clinical manifestations of diseases. Thanks to Morgagni’s work, the dogmatism of old schools was broken, new medicine appeared, and the place of pathological anatomy among clinical disciplines was determined.

The works of the French morphologists M. Bichat (1771-1802), J. Corvisart (1755-1821) and J. Cruvelier (1791-1874), who created the world's first color atlas on pathological anatomy, were of great importance for the development of pathological anatomy. In the middle and end of the 18th century, major studies by R. Bright (1789-1858) and A. Bayle (1799-1858) appeared in England, which made a great contribution to the development of pathological anatomy. Bayle was the first author of the most complete textbook on private

pathological anatomy, translated into Russian in 1826 by doctor I.A. Kostomarov.

In the 19th century, pathological anatomy had already gained a strong position in medicine. Departments of pathological anatomy were opened in Berlin, Paris, Vienna, Moscow, and St. Petersburg. A representative of the Viennese school, K. Rokitansky (1804-1878), based on enormous personal experience (30,000 autopsies over 40 years of dissection work), created one of the best manuals on pathological anatomy at that time. K. Rokitansky was the last representative of the dominant for centuries theories of human humoral pathology, which had no scientific basis.

The creation in 1855 by the German scientist R. Virchow (1821-1902) can be considered a turning point in the development of pathological anatomy and all medicine. theories of cellular pathology. Using the discovery of the cellular structure of organisms by Schleiden and Schwann, he showed that the material substrate of the disease is cells. Pathologists and clinicians around the world saw great progress in the cellular theory of pathology and widely used it as the scientific and methodological basis of medicine. However, cellular pathology alone proved impossible to explain the complexity of the pathological processes that occur during the disease. Cellular pathology began to be opposed to the doctrine of the neurohumoral and hormonal regulatory systems of the body - this is how functional direction in medicine. However, it did not negate the role of the cell in pathology. Currently, the cell and its constituent elements (ultrastructures) are approached as integral components of the whole organism, under the continuous influence and control of its neurohumoral and hormonal systems.

In the 20th century, pathological anatomy began to develop rapidly, involving biochemistry and biophysics, immunology and genetics, molecular biology, electronics and computer science in solving its problems. In many countries, institutes of pathology were created, fundamental manuals and journals on pathological anatomy appeared; International, European and national scientific societies of pathologists were created.

In our country, autopsies began to be performed for the first time in 1706, when medical hospital schools were organized by decree of Peter I. However, the first organizers of the medical service in Russia, N. Bidloo, I. Fischer, and P. Kondoidi, had to overcome the stubborn resistance of the clergy, who in every possible way prevented autopsies. Only after the opening of the Faculty of Medicine at Moscow University in 1755, autopsies began to be carried out quite regularly.

The first pathologists were the heads of clinics F.F. Keresturi, E.O. Mukhin, A.I. Over et al.

In 1849, on the initiative of the therapist Professor I.V. Varvinsky, the first department of pathological anatomy in Russia was opened at the Faculty of Medicine of Moscow University. The head of this department was his student A.I. Polunin (1820-1888), who is the founder of the Moscow school of pathologists and the founder of the clinical-anatomical direction in pathological anatomy. Over the 140-year existence of the Department of Pathological Anatomy at Moscow University, and since 1930 at the First Moscow Medical Institute, the tradition has been firmly maintained: the cathedral staff is passed from the hands of the teacher to the hands of the student. All seven heads of the department, being representatives of the same school, have successively replaced each other from 1849 to the present: A.I. Polunin, I.F. Klein, M.N. Nikiforov, V.I. Kedrovsky, A.I. Abrikosov, A.I. Strukov, V.V. Serov.

M.N. occupied a special place in the Moscow school of pathologists. Nikiforov (1858-1915), who headed the department of pathological anatomy at Moscow University from 1897 to 1915. He not only performed valuable work on pathological anatomy, but created one of the best textbooks and trained a large number of students who later headed departments of pathological anatomy in various cities Russia. The most talented student M.N. Nikiforova was A.I. Abrikosov, who headed the Department of Pathological Anatomy at Moscow University from 1920 to 1952 and laid the scientific and organizational foundations of pathological anatomy in the USSR. He is rightfully considered the founder of Soviet pathological anatomy. A.I. Abrikosov has carried out outstanding research on the initial manifestations of pulmonary tuberculosis, myoblast tumors, oral pathology, kidney pathology and many other issues. He wrote a textbook for students, which went through 9 editions, created a multi-volume manual on pathological anatomy for doctors, and trained a large number of students. A.I. Abrikosov was awarded the title of Hero of Socialist Labor and State Prize laureate.

Prominent representatives of the Moscow school of pathologists are M.A. Skvortsov (1876-1963), who created the pathological anatomy of childhood diseases, and I.V. Davydovsky (1887-1968), known for his work on general pathology, infectious pathology, gerontology and combat trauma, and research on the philosophical foundations of biology and medicine. On his initiative, pathological anatomy began to be taught according to the nosological principle. I.V. Davydovsky was awarded the title of Hero of Socialist Labor and Lenin Prize laureate. Among the employees of the Department of Pathological Anatomy of the First Moscow Medical Institute - students of A.I. Abrikosov, a great contribution to the development of pathological anatomy was made by S.S. Weil (1898-1979), who later worked in Leningrad, V.T. Talalaev (1886-1947), N.A. Kraevsky (1905-1985).

The Department of Pathological Anatomy in St. Petersburg was created in 1859 on the initiative of N.I. Pirogov. Here is the glory of Russian pathological

anatomy was created by M.M. Rudnev (1837-1878), G.V. Shore (1872-1948), N.N. Anichkov (1885-1964), M.F. Glazunov (1896-1967), F.F. Sysoev (1875-1930), V.G. Garshin (1877-1956), V.D. Zinzerling (1891-1960). They trained a large number of students, many of whom headed departments at Leningrad medical institutes: A.N. Chistovich (1905-1970) - at the Military Medical Academy named after S.M. Kirova, M.A. Zakharyevskaya (1889-1977) - at the Leningrad Medical Institute named after I.P. Pavlova, P.V. Sipovsky (1906-1963) - at the State Institute for Advanced Training of Doctors named after. CM. Kirov.

In the second half of the 19th and early 20th centuries, departments of pathological anatomy were opened in medical institutes of Kazan, Kharkov, Kyiv, Tomsk, Odessa, Saratov, Perm and other cities. After the October Revolution, departments of pathological anatomy were created in medical institutes of all union and autonomous republics, and many regional centers of the RSFSR. Schools of pathologists grew up here, whose representatives developed and continue to develop Soviet pathological anatomy: M.P. Mirolyubov (1870-1947) and I.V. Toroptsev in Tomsk, I.F. Pozharisky (1875-1919) and Sh.I.

During the years of Soviet power, pathologists launched scientific research in various areas of medicine, in particular infectious diseases. These works provided great assistance to Soviet healthcare in eliminating a number of infections (smallpox, plague, typhus, etc.). Subsequently, pathologists developed and continue to develop issues of early diagnosis of tumors, paying a lot of attention to the study of cardiovascular and many other diseases, issues of geographic and regional pathology. Experimental pathology is developing successfully.

Created in the country pathological service. Each hospital has a pathology department, headed by a pathologist. In large cities, central pathological laboratories have been created that organize the work of pathologists. All deaths in hospitals or clinics of medical institutes are subject to a pathological autopsy. It helps to establish the correctness of the clinical diagnosis, identify defects in the examination and treatment of the patient. To discuss medical errors identified during a pathological autopsy and develop measures to eliminate shortcomings in medical work, clinical and anatomical conferences. The materials of pathological conferences are summarized and contribute to the improvement of the qualifications of doctors, both clinicians and pathologists.

The work of pathologists is regulated by regulations and orders of the Ministry of Health of the Russian Federation and is controlled by the chief pathologist of the country.

Soviet pathologists are united by the All-Union Scientific Society, which regularly convenes all-Union conferences, plenums and congresses devoted to topical issues of pathological anatomy. A multi-volume manual on pathological anatomy has been created. Since 1935, the journal “Archive of Pathology” has been published. Its first editor was A.I. Abrikosov. Since 1976, the publication of the abstract journal “General Issues of Pathological Anatomy” began.

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.

In the 16th century in a number of countries in Western Europe, doctors were again given the right to perform autopsies on human corpses. This circumstance contributed to the further improvement of knowledge in the field of anatomy and the accumulation of pathological and anatomical materials for various diseases.

In the middle of the 18th century. The book of the Italian doctor Morgagni “On the localization and causes of diseases identified by the anatomist” was published, where the scattered pathological and anatomical data of his predecessors were systematized and his own experience was generalized. The book describes changes in organs in various diseases, which facilitated their diagnosis and contributed to the promotion of the role of pathological and anatomical research in establishing a diagnosis.

In the first half of the 19th century. in pathology, the humoral direction dominated, whose supporters saw the essence of the disease in changes in the blood and juices of the body. It was believed that first there was a qualitative disturbance of the blood and juices, followed by the rejection of “pathogenic matter” in the organs. This teaching was based on fantastic ideas.

The development of optical technology, normal anatomy and histology created the prerequisites for the emergence and development of cell theory (Virchow R., 1958). The pathological changes observed in a particular disease, according to Virchow, are a simple sum of the diseased state of the cells themselves. This is the metaphysical nature of R. Virchow’s teaching, since the idea of the integrity of the organism and its relationship with the environment was alien to him. However, Virchow's teaching served as an incentive for in-depth scientific study of diseases through pathological-anatomical, histological, clinical and experimental research.

In the second half of the 19th and early 20th centuries. In Germany, major pathologists Kip and Jost worked, authors of fundamental manuals on pathological anatomy. German pathologists conducted extensive research on equine infectious anemia, tuberculosis, foot and mouth disease, swine fever, etc.

The beginning of the development of domestic veterinary pathological anatomy dates back to the middle of the 19th century. The first veterinary pathologists were professors of the veterinary department of the St. Petersburg Medical-Surgical Academy I. I. Ravich and A. A. Raevsky.

Since the end of the 19th century, domestic pathanatomy has received its further development within the walls of the Kazan Veterinary Institute, where since 1899 the department was headed by Professor K. G. Bol. He is the author of a large number of works on general and specific pathological anatomy.

The research conducted by domestic scientists is of great scientific and practical importance. A number of important studies have been carried out in the field of studying theoretical and practical issues of pathology of farm and commercial animals. These works made a valuable contribution to the development of veterinary science and animal husbandry.

4. Death and post-mortem changes

Death is the irreversible cessation of the vital functions of the body. This is the inevitable end of life, which occurs as a result of illness or violence.

The process of dying is called agony. Depending on the cause, the agony can be very brief or last up to several hours.

Distinguish clinical and biological death. Conventionally, the moment of clinical death is considered to be the cessation of cardiac activity. But after this, other organs and tissues with varying durations still retain vital activity: intestinal motility continues, gland secretion continues, and muscle excitability remains. After the cessation of all vital functions of the body, biological death occurs. Postmortem changes occur. Studying these changes is important for understanding the mechanism of death in various diseases.

For practical activities, the differences in morphological changes that occurred intravital and postmortem are of great importance. This helps to establish the correct diagnosis and is also important for forensic veterinary examination.

5. Cadaveric changes

· Cooling the corpse. Depending on the conditions, after various periods of time, the temperature of the corpse is equalized with the temperature of the external environment. At 18–20°C, the corpse cools by one degree every hour.

· Rigor mortis. 2–4 hours (sometimes earlier) after clinical death, smooth and striated muscles contract somewhat and become dense. The process begins with the jaw muscles, then spreads to the neck, forelimbs, chest, belly and hind limbs. The greatest degree of rigor is observed after 24 hours and persists for 1–2 days. Then the rigor disappears in the same sequence as it appears. Rigor of the heart muscle occurs 1–2 hours after death.

The mechanism of rigor mortis has not yet been sufficiently studied. But the importance of two factors has been clearly established. During the post-mortem breakdown of glycogen, a large amount of lactic acid is formed, which changes the chemistry of muscle fiber and promotes rigor. The amount of adenosine triphosphoric acid decreases, and this causes the loss of elastic properties of the muscles.

· Cadaveric spots arise due to changes in the state of the blood and its redistribution after death. As a result of post-mortem contraction of the arteries, a significant amount of blood passes into the veins and accumulates in the cavities of the right ventricle and atria. Post-mortem blood clotting occurs, but sometimes it remains liquid (depending on the cause of death). In death from asphyxia, blood does not clot. There are two stages in the development of cadaveric spots.

The first stage is the formation of cadaveric hypostases, which occur 3–5 hours after death. The blood, due to gravity, moves to the underlying parts of the body and seeps through the vessels and capillaries. Spots form, visible in the subcutaneous tissue after removing the skin, and in the internal organs - upon opening.

The second stage is hypostatic imbibition (impregnation).

In this case, interstitial fluid and lymph penetrate into the vessels, thinning the blood and increasing hemolysis. The diluted blood again seeps out of the vessels, first onto the underside of the corpse, and then everywhere. The spots have indistinct outlines, and when cut, it is not blood that flows out, but sanguineous tissue fluid (different from hemorrhages).

· Cadaveric decomposition and rotting. In dead organs and tissues, autolytic processes develop, called decomposition and caused by the action of the dead organism’s own enzymes. Tissue disintegration (or melting) occurs. These processes develop most early and intensively in organs rich in proteolytic enzymes (stomach, pancreas, liver).

Decomposition is then joined by rotting of the corpse, caused by the action of microorganisms that are constantly present in the body during life, especially in the intestines.

Rotting occurs first in the digestive organs, but then spreads to the entire body. During the putrefactive process, various gases are formed, mainly hydrogen sulfide, and a very unpleasant odor occurs. Hydrogen sulfide reacts with hemoglobin to form iron sulfide. A dirty greenish color appears in the cadaveric spots. The soft tissues swell, soften and turn into a gray-green mass, often riddled with gas bubbles (cadaveric emphysema).

Putrefactive processes develop faster at higher temperatures and higher humidity of the environment.

Lecture 2. Necrosis

2. Pathomorphological characteristics of necrosis. Their importance for diagnosing diseases

1. Definition, etiology and classification of necrosis

Necrosis– necrosis of individual cells, areas of tissue and organs. The essence of necrosis is the complete and irreversible cessation of vital activity, but not in the entire body, but only in some limited area (local death).

Depending on the cause and various conditions, necrosis can occur very quickly or over a period of very variable duration. With slow death, dystrophic changes occur, which increase and reach a state of irreversibility. This process is called necrobiosis.

Necrosis and necrobiosis are observed not only as a pathological phenomenon, but also occur as a constant process under physiological conditions. In the body, a certain number of cells constantly die and are replaced by others, this is especially clearly noticeable on the cells of the integumentary and glandular epithelium, as well as on the blood cells.

The causes of necrosis are very diverse: the action of chemical and physical factors, viruses and microbes; damage to the nervous system; disturbance of blood supply.

Necrosis that occurs directly at the site of application of harmful agents is called direct.

If they occur at a distance from the place of exposure to a harmful factor, they are called indirect. These include:

· angiogenic necrosis, which is formed as a result of cessation of blood flow. Under these conditions, oxygen starvation of the tissue develops, leading to cell death. The central nervous system is especially sensitive to hypoxia;

· neurogenic, caused by damage to the central and peripheral nervous system. When neurotrophic function is disturbed, dystrophic, necrobiotic and necrotic processes occur in tissues;

· allergic necrosis, which is observed in tissues and organs with altered sensitivity to a harmful agent that acts repeatedly. Skin necrosis in the chronic form of pig erysipelas, according to the mechanism of their formation, is also a manifestation of an allergic organism that is sensitized to the causative agent of this disease.

2. Pathomorphological characteristics of necrosis

The sizes of dead areas vary: microscopic, macroscopically visible from barely visible to very large. Sometimes entire organs or individual parts die.

The appearance of necrosis varies depending on many conditions: the cause of necrosis, the mechanism of development, the state of blood circulation, the structure and reactivity of the tissue, etc.

The following types of necrosis are distinguished according to macroscopic signs.

A. Dry (coagulative) necrosis

Occurs when moisture is released into the environment. The reasons may be cessation of blood flow, the action of certain microbial toxins, etc. In this case, coagulation (clotting) of proteins in cells and interstitial matter occurs. Necrotic areas have a dense consistency, whitish-gray or grayish-yellow color. The cut surface is dry, the tissue pattern is erased.

An example of dry necrosis can be anemic infarctions - areas of organ necrosis that occur when the flow of arterial blood is stopped; dead muscles - with paralytic hemoglobinemia of horses, white muscle disease and bedsores. The affected muscles are dull, swollen, and reddish-gray in color. Sometimes it resembles wax in appearance; This is where waxy, or Zenker's, necrosis occurs. Dry necrosis includes the so-called caseous (cheesy) necrosis, in which the dead tissue is a dry crumbling mass of yellowish-gray color.

B. Wet (colliquation) necrosis occurs in tissues rich in moisture (for example, the brain), and also provided that the area of necrosis does not dry out. Examples: necrosis in the substance of the brain, death of the fetus in the uterus. Sometimes foci of dry necrosis (secondary colliquation) may liquefy.

B. Gangrene is one of the necroses, but is characterized by the fact that it may not occur in the entire body, but only in areas in contact with the external environment, under conditions of exposure to air, thermal influences, moisture, infection, etc. (lungs, gastrointestinal tract, uterus, skin).

In dead areas, changes in hemoglobin occur under the influence of air. Iron sulfide is formed, and dead tissue becomes dark, gray-brown or even black.

Dry gangrene (mummification) is observed on the skin. Dead areas are dry and dense, brown or black in color. This process can occur due to frostbite, ergot poisoning, and certain infections (erysipelas, leptospirosis, pigs, etc.).

Wet gangrene (putrefactive or septic) is caused by the action of putrefactive microorganisms on dead tissue, resulting in liquefaction of dead materials. Affected areas are soft, decaying, dirty gray, dirty green or black in color, with a foul odor. Some putrefactive microbes produce a lot of gases that accumulate in the form of bubbles in dead tissue (gas, or noisy, gangrene).

Microscopic changes in the cell during necrosis

Changes in the nucleus have three types: – karyopyknosis – wrinkling; – karyorrhexis – decay or rupture; – karyolysis – dissolution.

With karyopyknosis, a decrease in nuclear volume occurs due to chromatin compaction; it wrinkles and therefore becomes more intensely colored.

Karyorrhexis is characterized by the accumulation of chromatin clumps of various sizes, which then separate and penetrate the damaged nuclear envelope. Remnants of chromatin remain scattered in the protoplasm.

During karyolysis, voids (vacuoles) are formed in the nucleus at the sites of chromatin dissolution. These voids merge into one large cavity, the chromatin disappears completely, the nucleus does not stain and dies.

Changes in the cytoplasm. At the beginning, coagulation (clotting) of proteins occurs due to the action of enzymes. The cytoplasm becomes more dense. This is referred to as plasmopyknosis, or hyalinization. Later, the cytoplasm breaks up into separate clumps and grains (plasmorhexis).

When there is a large amount of moisture in the tissues, liquefaction processes predominate. Vacuoles are formed and merge; the cells take the form of balloons filled with liquid, and the cytoplasm dissolves (plasmolysis).

Changes in the interstitial substance. Collagen, elastic and reticular fibers lose their outlines, become basophilically stained and fragmented, and later liquefy. Sometimes the dead interstitial substance becomes similar to fibrin fibers (fibrinoid transformation).

When the epithelium becomes necrotic, the soldering (cementing) substance liquefies. Epithelial cells become separated and sloughed off from the basement membrane: cell discomplexation and desquamation or sloughing.

Outcomes of necrosis. In areas of necrosis, tissue decay products (detritus) accumulate, which have an irritating effect on surrounding living tissues; inflammation develops in them.

A red stripe called a demarcation line forms at the boundary between living tissue and dead material.

During the process of inflammation, proteolytic enzymes act on dead materials, which are liquefied and absorbed by polynuclear cells and macrophages; thus, decomposition products are removed.

At the site of necrosis, granulation tissue forms, from which a scar is formed. The replacement of necrosis by connective tissue is called organization.

Calcium salts are easily deposited in dead material, which is called calcification or petrification.

If dead tissue is not liquefied and replaced, a connective tissue capsule forms around it - encapsulation occurs. When a capsule forms around the area of wet necrosis, a cyst is formed - a cavity with liquid contents.

If, during demarcation inflammation, increased emigration of leukocytes occurs, purulent softening occurs, leading to the delimitation of the necrotic focus from the surrounding tissues. This is called sequestration, and the isolated dead area is called sequestration. Granulation tissue develops around the sequester, from which a capsule is formed.

When there is necrosis in the external parts of the body, they can be completely rejected from the body - mutilation.

The significance of necrosis is that the dead areas cease to function.

Necrosis in the heart and brain often leads to death. Absorption of tissue decay products causes poisoning of the body (autointoxication). In this case, very severe disruptions to the body’s vital functions and even death can occur.

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

Read:

II. The period of scientific anatomy (starts from the time of Andrei Vesalius - 16th century AD and continues to the present day).
Anatomy and its place among biological disciplines. The importance of anatomy for medicine. Methods of anatomical research.
Anomalies of the skull bones, their significance in anatomy and practical medicine.
Certification and pedagogical measuring materials on pathological anatomy for the specialty "pediatrics"
CHAPTER 1 BRIEF HISTORICAL OVERVIEW OF THE DEVELOPMENT OF RADIOLOGY DIAGNOSTICS

UDC 616-091-057.875

Yu.V.Krylov

SHORT COURSE OF PATHOLOGICAL ANATOMY

GUIDE FOR FOREIGN STUDENTS

MEDICAL INSTITUTIONS

“A short course in pathological anatomy” is an introduction to pathological anatomy and is intended for foreign students of medical institutes. It covers the main sections of modern pathological anatomy and is presented in the form of three separate parts: general and specific pathological anatomy, as well as examples of pathological diagnoses. Read the manual before starting the study the subject will facilitate the study of pathological anatomy using a basic textbook.

Reviewer: Doctor of Medical Sciences, Professor, Head. Department of Pathological Anatomy of the Smolensk Medical Academy Dorosevich A.E.

“A short course in pathological anatomy” is published on the basis of the decision of the Academic Council of the Vitebsk Medical Institute, protocol No. 9 of June 18, 1997.

Preface__________________________________________________________3

Introduction________________________________________________________________3

Part I. General pathological anatomy _________________________4

Dystrophies_________________________________________________________ 4

Parenchymal dystrophies________________________________________________5

Mesenchymal dystrophies__________________________________________6

Mixed dystrophies ________________________________________________9

Disturbance of mineral metabolism______________________________12

Necrosis. Overall death_______________________________________________13

Death ____________________________________________________15

Circulatory disorders__________________________________________16

Arterial plethora__________________________________________16

Venous congestion_______________________________________________16

Anemia ________________________________________________18

Staz_______________________________________________________________18

Bleeding_______________________________________________18

Heart attack ___________________________________________________19

Thrombosis_________________________________________________________21

Embolism ___________________________________________________22

Shock ________________________________________________________________23

Inflammation ___________________________________________________24

Immunopathological processes________________________________29

Autoimmunization and autoimmune diseases______________________________31

Immunodeficiency syndromes ________________________________32

Compensation and adaptation processes ______________________________33

Regeneration of individual tissues and organs ________________________________34

Hypertrophy and hyperplasia__________________________________________35

Atrophy______________________________________________________________36

Tissue restructuring_______________________________________________37

Tumors______________________________________________________________38

Mesenchymal tumors_____________________________________________42

Epidermal tumors_______________________________________________43

Tumors of the central nervous system ________________________________________________47

Tumors of the blood system_______________________________________________48

Part II. Particular pathological anatomy_ ______________________51

Anemia_______________________________________________________________53

Diseases of the heart and blood vessels_______________________________________________54

Atherosclerosis ________________________________________________54

Hypertension _____________________________________56

Coronary artery disease (IHD) ___________________________________57

Rheumatic diseases_____________________________________________58

Rheumatism _________________________________________________59

Rheumatoid arthritis______________________________________________61

Systemic lupus erythematosus________________________________________________61

Periarteritis nodosa _____________________________________62

Systemic scleroderma_____________________________________________63

Dermatomyositis _____________________________________________63

Lung diseases_______________________________________________63

Lobar pneumonia _____________________________________________63

understanding of structure and function in pathology.

Unlike pathological Physiology, pathological anatomy is a clinical discipline. Medical pathologists perform two main tasks. Firstly, they monitor the quality of diagnostic and treatment work in medical institutions by comparing autopsy results and medical history data.

Secondly, they are directly involved in diagnosis through the response of biopsies. A biopsy is an intravital morphological examination of pieces of a patient’s organs.

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