PATHOGENY

From Big Medical Encyclopedia

PATHOGENY (pathogenesis; Greek pathos suffering, a disease + genesis origin, an origin) — the doctrine about mechanisms of development, a current and outcomes of diseases. Distinguish the private and general Item. Private P. includes the analysis of mechanisms of development nozol, forms, napr, pneumonia, coronary heart disease, a typhoid. Despite a huge number nozol, forms, there are general mechanisms of development characteristic of various diseases (see). In the general P. the most general patterns of development and the course of diseases and their standard options are analyzed. Private and general P. are closely connected with each other since opening and generalization of the general patterns is possible only on the basis of the analysis of private forms of pathology, and the doctrine formulated on this basis about the general P. is used during the studying of mechanisms of development of various specific diseases and individual forms of their current.

The doctrine about P. is based on the general ideas of a disease, on the analysis of a role of a causative factor in pathology, a fundamental unit and the cause and effect relations, the general and local changes in reaction of a complete organism and is connected with philosophical aspects of medicine.

P.'s studying diseases is based on assessment a wedge, yielded, results biochemical and morfol, researches, on assessment of results various funkts, the tests allowing to define degree and the nature of disturbances of functions of bodies and systems. Its modeling in an experiment on animals is of great importance for the analysis of the general patterns of P. of a disease (see. Model of a disease ). However diseases of the person do not manage to be modelled fully in connection with essential specific features of reactivity and resistance of organisms of mammals. Therefore during the modeling of diseases the choice of experimental objects and P.'s studying of separate syndromes is of great importance.

Problems P. are closely connected with problems etiologies (see) since the disease arises under the influence of external or internal etiol, factors, to-rye cause the subsequent reactions and processes characteristic of P. V to medical literature it is possible to meet the term «etiopathogenesis», to-ry it is impossible to recognize successful since in most cases P. is defined not only action etiol, factors; in a course of a disease the large role is played developed in the course of evolution standard patol, processes and reactions, zakonokhmernost of development to-rykh are defined by the internal organization of fabrics, bodies and systems. The various methods allowing to estimate a role at P. etiol, a factor, the nature of damages of bodies, fabrics and disturbances of their functions, and also mechanisms of protective and compensatory processes are used. The importance belongs to assessment of a role of local and general disturbances, definition of a fundamental unit of P. — the cause and effect relations, and also to emergence of a vicious circle (see. Circulus vitiosus ). These issues shall be resolved taking into account reactivity of an organism.

The etiology of many diseases of the person cannot be understood without an important role of social factors, to-rye exert impact and on P. of diseases though in its basis and all-biological patterns lie.

Interaction etiol is frequent, a factor happens to an organism during a short time term, in the form of a releaser; e.g., action on an organism of the high temperature (boiled water, a flame) causing burns can continue fractions of a second or several seconds. However developing as a result of it patol, processes create a burn disease, edges the long span proceeds, and effects of burns need various methods of treatment. Similarly many others affect an organism etiol, factors. Cases of similar interaction meet often. The item at the same time is defined by the internal pathogenetic factors appearing at the time of interaction etiol, a factor with fabrics and bodies and also as a result of their destruction and formation of biologically active agents. The irritation of receptors and nervous conductors, allocation from the damaged fabrics of biologically active agents (a histamine, serotonin, adenylic nucleotides, etc.), influence on an organism of humoral factors response and not always proper response of neuroendocrinal system belongs to pathogenetic factors (accumulation of mediators of nervous excitement, glucocorticoids, catecholamines, etc.). In many cases the further course of process is defined by development of an inflammation and others standard patol, processes (fever, disbolism, a stress). This option of interaction etiol, a factor and an organism is characterized by the leading role of pathogenetic factors that defines treatment, a cut shall be preferential pathogenetic.

Interaction etiol, a factor and an organism, characterized significantly by a bigger role etiol, a factor in P.'s expansion is possible; e.g., at nek-ry intoxications toxins, blocking these or those enzymes, define development patol, process, and timely carried out antidotal therapy can interrupt its further current. However and at this option in the subsequent the large role is played for the second time by the arising disturbances of functions, to-rye at overdue use of antidotes define further development patol, process. The big role at many intoxications, and also at injuries is played by a hypoxia of different genesis.

The role and value etiol, a factor in a course of a disease can change. So, at nek-ry inf. diseases immunity is developed; the role of a contagium gradually weakens though it also can be present at an organism — quite often even after a wedge. recovery microorganisms are found in allocations of healthy bacilli carriers. Disease with constant participation in its P. etiol, a factor quite often gains wavy character, napr, at diphtheria, botulism.

The question of relationship of the phenomena of damage and protection is important for P.'s analysis. Lech. actions shall be directed to strengthening of protective adaptive processes and weakening of pathological. At the same time first of all the issue of primary damage, a cut is resolved can arise at the different levels. So, at hereditary diseases primary damage is localized in the genetic device at action on it mutagen factors of the environment, i.e. at molecular level therefore protein synthesis is broken, their fermental functions and the course of exchange processes changes, the structure and function of bodies and systems are broken. At such damages arise compensatory processes (see), leading, e.g., to a reparation of the genetic device. At recessive hereditary diseases defect of damage of genes can not be found due to functioning of similar dominant genes. However at the same time resistance of an organism goes down, and at the raised loads of this or that system there is pathology, specific to the damaged genes. At vegetative mutations, napr, in the course of a carcinogenesis, the large role in protection of an organism is played by cellular immunity (see), to-ry provides a lysis of mutant cells in certain conditions. Along with specific defense and compensatory reactions at the pathology which arose at molecular level nonspecific defense and compensatory reactions of bodies and systems join.

Primary damage can arise in the chromosomal device (see. Chromosomal diseases ). If such damage does not cause death of a fruit, then along with specific patol, the phenomena various adaptive reactions develop, to-rye provide life of an organism.

At damage at the cellular level compensatory reactions can be shown in the form of regeneration of surrounding cells as a result of effect of biologically active agents stimulating reproduction of cells; at the same time relative neutralization of action etiol is provided, a factor, and function of the damaged and died cells is compensated due to regeneration, their new population. In other cases connecting fabric mechanically replaces defect. Regeneration of intracellular structures, especially in the cells which do not have productive capacity is of great importance.

Primary damage can arise at the organ level, napr, at defects of valves of heart, at a pneumosclerosis, a nephrosis. Compensatory reactions and processes at the same time form at the level of body, system and a complete organism. At defects of valves of heart the department of heart experiencing the raised strain hypertrophies. At the same time there are changes of blood circulation and its regulation, peculiar for each type of defect, to-rye can provide compensation of the broken functions.

At primary damage at the system level there is a generalized loss or restriction of this or that function that especially clearly is observed at diseases of a nervous system, and also closed glands. At the same time there is a difficult reorganization of regulatory processes, a metabolism that in some cases allows an organism to keep life.

Finally primary damage always arises at the cellular and subcellular levels therefore function of cellular organellas and membranes is broken. However not at each damage of cells pathology since in bodies and systems there are functional and structural reserves develops. Hypofunction, e.g., of a liver is observed at defeat 2/3 all its fabrics. Therefore primary damage of a cell only to certain conditions leads to development of pathology.

Thus, level, on Krom occurs damage, defines specifics of relationship of destructive and compensatory processes. However many specific features of P. form at the level of a complete organism that defines also features of development nonspecific patol, processes.

The solution of a question of the destructive and adaptive phenomena in P. of a disease shall be specific since adaptive reactions and the processes developed in phylogenesis can in certain conditions be inadequate and inexpedient. So, in the analysis inflammations (see), participating in P. of a disease, it is schematically possible to allocate the phenomena of damage (primary and secondary alteration, a venous hyperemia, staz, hypostasis, disbolism in fabrics, education in them toxic products, etc.) and protective and compensatory processes (an arterial hyperemia, increase in a metabolism in fabrics, boundary with the center of an inflammation, emigration of leukocytes, phagocytes, regeneration of cellular elements). It is right in the all-pathological plan, but it can be insufficient or wrong in specific cases therefore the teleologic concept of L. Ashoff estimating an inflammation in general and its main components as the phenomena adaptive underwent fair criticism.

Provisions of I. V. Davydovsky considering a disease in general as adaptation of an organism to conditions of the environment are not standard.

A disease — process contradictory. It is known that after many postponed diseases resistance of an organism to a number of pathogenic factors increases, however in other cases the disease leads to disability and decrease in resistance of an organism, by death. Therefore the dialectic analysis of various processes P. Tak is necessary, the secondary alteration arising at fusion of fabrics proteolytic enzymes of pus around a foreign body has both destructive, and certain adaptive value as a way, with the help to-rogo an organism can tear away a foreign body. A number of researchers believes that at an inflammation the venous hyperemia has a certain adaptive value since at the same time reproduction of connective tissue cells is stimulated that is important at extensive defects of fabrics. On the other hand, the arterial hyperemia, napr, at an inflammation of covers and tissue of a brain, can cause hypertensia in vessels of a brain that is fraught with danger of hemorrhages; at incomplete phagocytosis the leukocytes containing contagiums can transfer them to other bodies and fabrics; excess regeneration of connecting fabric can promote formation of contractures. In the dialectic analysis of the similar contradictory phenomena consider a measure of this or that phenomenon in P.

Slozhny the question of relationship of the local and general phenomena in P. of a disease is. In a complete organism absolutely local patol. processes cannot be since in a varying degree all organism (is involved in P. see. Pathological process ). E.g., the pulpitis — limited inflammatory process, to-ry as a result of a pain syndrome involves the centers of a hypothalamus in reaction, and through them can cause difficult scale of various vegetative reactions. The same is observed, e.g., at a felon, cholelithiasis and other diseases. Nevertheless value of the local and general phenomena in P. is very variable. It is schematically possible to allocate the following main options. 1. Process begins with local damage of body or fabric as a result of influence external (e.g., thermal, mechanical) or internal (e.g., thrombosis, an embolism, atherosclerosis of vessels) factors. At the same time the adaptive reactions and processes directed to an otgranicheniye of the center of damage developed in phylogenesis join. It clearly is visible on the example of an inflammation (a granulyatsionny shaft, formation of the capsule, preferential current of liquid in the damaged fabrics, barrier function limf, nodes, etc.). As a rule, participation of an organism is limited to mobilization of local fabric adaptive mechanisms, and key parameters of a homeostasis (body temperature, quantity of leukocytes, ROE, a metabolism, etc.) significantly do not change. 2. Local process via the receptor device, and also as a result of receipt in blood of biologically active agents causes development of generalized reaction of an organism and certain shifts of parameters of a homeostasis. At the same time join adaptive and adaptive reactions (see), the development of the general directed to the prevention patol, changes and restriction of influence on an organism of the center of damage. 3. Generalization of local process at its heavy current differs in the maximum tension as adaptive and defense reactions and processes, and expressiveness patol, the phenomena at the level of an organism. Quite often there is general intoxication, sepsis. Parameters of a homeostasis change, part of them can be beyond changes, compatible to life. 4. Local patol, changes of bodies and systems can develop for the second time, on the basis of primary and generalized process. At inf. diseases localization of process is defined by a tropnost of activators to these or those fabrics (damage of a large intestine at dysentery, a meninx at meningitis, etc.), at nek-ry intoxications — ways of removal of toxins (a sublimate kidney, etc.). Localization patol, changes at generalized impact on an organism of a pathogenic factor (e.g., ionizing radiation) is defined also funkts, features of bodies and fabrics. At general irradiation the fabrics which are characterized by intensive proliferation of cellular elements more are surprised.

patol, processes at action same etiol, a factor various people can have an unequal localization that depends on the hereditary, constitutional and acquired in ontogenesis properties. The diseases postponed earlier resulting in relative inferiority of this or that body have a certain value. On this basis the place of the smallest resistance forms (see. Locus minoris resistentiae ). Anyway consider the general state and the general changes in an organism. So, it turned out that rather local patol, processes are defined by the general disturbances and need not only local, but also general treatment.

Numerous discussions concerning provisions cellular pathology (see) have generally historical interest. It is obvious that idea of a disease cannot be reduced only to the local processes taking a part of cells at the same time integrative systems of an organism are inevitably involved. However R. Virkhov's appeal to look for at a disease the broken or changed material substrate remains progressive. Methods of light microscopy which R. Virkhov used could not provide the solution of this question in some cases. There were offers to allocate purely functional diseases. By many researchers it is shown that at functional pathology it is possible to find certain changes at the subcellular or molecular levels. Therefore often understand rather easily reversible processes as the term «functional diseases».

At pathology direct quantitative relationship between local and general, structural and functional disturbances is not always found. Quite often rather small on the area and volume of disturbance of structure cause heavy, and in some cases the disturbances of functions leading to death if they are localized in the vital educations (respiratory, sosudodviga-telnokhm the center, the carrying-out system of heart, etc.). Sometimes massive destructive changes of fabrics are compensated for the account of a hypertrophy of surrounding cells or pair body.

Specific and nonspecific mechanisms P. are found at development of any disease. Nonspecific mechanisms are defined by inclusion in P. standard patol, the processes which are characterized by the natural, rather stereotypic, genetically predetermined expansion in time of various reactions. Standard patol, processes (inflammation, fever, change of microcirculation, metabolism, etc.) are the nonspecific response of an organism to action of any etiol, a factor. Then the system of cellular and humoral immunity providing specific protection and fight against the alien object which got into an organism and caused damage is activated. Participation standard patol. processes in P. dictates need of use for therapy along with specific and nonspecific means. However accurate and invariable differentiation of specific and nonspecific mechanisms does not exist.

Distinguish a fundamental unit of P. and a chain of the cause and effect relations from various displays of a disease. The fundamental unit of P. is understood as such phenomenon, a cut defines development of process with characteristic features, specific to it. So, the arterial hyperemia arises because of expansion of arterioles, a fundamental unit of an arterial hyperemia, as a result to-rogo the blood stream accelerates, reddening of fabric, increase in volume of body, increase in its temperature and a metabolism is observed. At a venous hyperemia a fundamental unit of P. is disturbance of outflow of blood on veins. It is much more difficult to allocate a fundamental unit of G1. at system disturbances, to-rye have certain dynamics. So, at massive blood loss in an initial stage of process a fundamental unit of P. is the reduction of the volume of the circulating blood (VCB) leading to development of a circulator hypoxia, disbolism, accumulation of nedookislen-ny products, and also to disturbance of functions of a nervous system and other bodies and systems. Timely completion of volume of the circulating blood transfusion of blood substitutes or blood usually stops further development of process. At long hypotension the important role in P. belongs to centralization of blood circulation. The organ blood stream at the same time is distributed in favor of vitals (a brain, heart, closed glands) at the expense of bodies went. - kish. path, liver, skin, skeletal muscles, etc. Thanks to it the organism can independently cope with effects of massive blood loss since rather good blood supply of vitals provides time necessary for mobilization of the deposited blood and an intercellular lymph and partial or full elimination of deficit of OTsK. However at insufficiency of these adaptive mechanisms, or excessive centralization of blood circulation, centralization of blood circulation becomes patol, the phenomenon, turning into a fundamental unit of irreversible states as «somatic death». At this stage of process administration of blood or blood substitutes does not normalize microcirculation of many bodies, the hypoxia to-rykh at the same time progresses. Therefore use of the means reducing a spasm of arterioles is necessary. In the following stage of hypotension exchange processes in fabrics as a result of a long hypoxia, reduction of energy resources in cells and disturbances of fermental systems are sharply broken that gains character of a fundamental unit of the Item. The positive effect can be reached by addition to the specified therapy of enzymes, hormones and other drugs. On the example of blood loss it is possible to see a peculiar relay of the major pathogenetic factors. Therefore definition of a fundamental unit of P. in development patol, process without its stages can be insufficient.

In P.'s analysis of a disease consider mechanisms of maintenance homeostasis (see). In the conditions of norm parameters of a homeostasis differ in the certain specific features which are not beyond the fluctuations characteristic for the sake of appearances. At a disease etiological, and then and pathogenetic factors are the revolting agents shifting these parameters for limits of norm. At the same time, on the one hand, feedback mechanisms join, and to another — there is a change of adjusting levels of parameters of a homeostasis as adaptation of an organism to new conditions (body temperature, metabolic rate, etc.). So, at fever exogenous and endogenous pyrogens excite the centers of thermal control of a medial preoptichesky kernel of a hypothalamus therefore mechanisms of thermal control are adjusted on maintenance of body temperature at the new level, to-ry provides increase in exchange processes, activation of activity of reticuloendothelial system, strengthening of phagocytosis and increase in activity of other adaptive systems.

The important mechanism of a course of a disease is disturbance of regulation of a homeostasis and especially disturbance of the mechanism of functioning of feed-backs that is the cornerstone of formation of vicious circles of P. when arisen patol, a deviation of level of functioning of body or systems begins to support and strengthen itself as a result of emergence of a positive feed-back. So, at blood loss patol, deposition of blood, an exit of its liquid part from a vascular bed increase deficit of OTsK, hypotension accrues, edges, in turn, through baroreceptors activates sympathoadrenal system, strengthens vasoconstriction, centralization of blood circulation and, finally, patol, deposition of blood and further reduction of OTsK — as a result patol, process progresses.

At an idiopathic hypertensia development of atherosclerosis usually accelerates that leads to dysfunction of baroreceptors and decrease in their sensitivity to changes of the ABP, a cut as a result remains steadily at a high level. The vasospasm of kidneys causes a hypoxia and inclusion of a reninangio-tenzinovy complex that conducts to a further vasospasm and increase in the ABP. At heart failure the tone of veins reflex raises and inflow of blood to the weakened heart increases, strengthening its decompensation. Increase in secretion of Aldosteronum at a hypoxia of kidneys causes a delay of sodium and water that leads to increase in OTsK. Formation of vicious circles of P. makes heavier disease. Timely diagnosis of initial modes of formation of a vicious circle and the prevention of its formation is of great importance for successful treatment of a disease.

The outcome of a disease depends on a ratio of adaptive and compensatory mechanisms with patol. the phenomena caused by the destroying action etiol, a factor, inadequacy, inexpediency of responses of an organism; there are hyper reactions exhausting an organism or vicious circles of P., elimination become isolated to-rykh it is usually possible only during the performing complex treatment. In many cases pathology is aggravated owing to too active and inadequate reaction of an organism, napr, at allergic reactions, painful shock. The strong irritation of sensory nerves causes their certain local destruction, not life-threatening, the organism can die from painful shock. The local anesthesia or the general anesthesia prevents development of painful shock that is widely used during the performing surgeries. Thus, emergence and disease in many respects depend on reaction of an organism. Therefore problem reactivity of an organism (see) has direct value for the analysis of questions of the general

P. V a wedge, to practice of pattern P. of a disease are modified depending on specific features of the patient. It is known that it is necessary to treat not only a disease, and first of all the sick person. The analysis of specific features of response of various people to pathogenic factors to lay down. means shall provide assessment of hereditary qualities, to-rye together with influence of the environment in ontogenesis create the constitution of an organism and its reactivity. Besides, reactivity of an organism and its resistance (see. Resistance of an organism ) can change in certain limits under the influence of the environmental factors operating on an organism shortly before its contact with the pathogenic agent. Various adverse environmental factors (mental injuries, an emotional stress, physical overfatigue, defective food, the postponed cooling or overheating) with other things being equal lower resistance of an organism, e.g., to an injury, blood loss, burns, to-rye at the same time proceed hard and more difficultly give in to usual methods of treatment.

The leading role in definition of features of reactivity of an organism is played by nervous, endocrine, reticuloendothelial systems, limf, nodes, marrow, blood, connecting fabric. At pathology it is important to estimate not only the general reactivity of an organism as whole, edges can be quantitatively it (is raised, lowered) and qualitatively changed (e.g., inadequate reactions to usual irritants). Studying of reactivity of systems and bodies in relation to certain irritants is represented important. So, at coronary heart disease as a result of a hypoxia, injury of a myocardium and the carrying-out predserd-but-ventricular system reaction of heart of a caret on fiziol, loadings, and on pharmaceuticals changes; at traumatic shock reactivity cardiovascular and limf, systems significantly changes, at a radial illness — systems of blood etc. Assessment of reactivity of various bodies and systems at pathology is of great importance for the characteristic of features of reactivity of an organism as whole. So, without definition of a state and reactivity of a thyroid gland it is impossible to understand changes of reactivity and resistance of an organism and its nervous system at a hyperthyroidism. It is known also that at a hyperthyroidism the lowered function of bark of adrenal glands defines low resistance of an organism to operational and accidental injuries.

The numerous individual options of a course of the same disease which are characterized by nek-ry features P. Tak can meet, experience of studying of experimental traumatic shock showed existence of a large number of specific features of reactivity and resistance of experimental animals. The size of the injury which caused shock at different animals fluctuates in wide limits (a difference in 10 and even by 20 times between sensitive and resistant individuals), life expectancy of animals after development of the shock caused in the same conditions of influence made of 20 min. to 8 hours; specific features of change of body temperature, pulse, breath and other indicators are noted. The analysis of these data allowed to allocate three options of a course of process, to-rye can be characterized by hyperreactivity, hyporeactivity or the intermediate course of process. The same options are observed at action on an organism, e.g., of ionizing radiation, blood loss, toxins, etc. At action on an organism of a mechanical injury, air hunger, blood loss and other factors animals with insufficient or overreactions since at them there comes exhaustion of compensatory mechanisms earlier differ in especially low resistance and quickly there are vicious circles of the Item. Preliminary introduction by such animal of drugs removes overreactions and increases duration of their life.

In pathology of the person the large role is played by social factors, to-rye can be the important reason or a condition of emergence of a number of diseases and leave a certain mark on P. at various forms of pathology. In industrially developed countries the quantity of factors increases, to-rye in certain conditions can be pathogenic. Treat them: the environmental pollution leading, in particular, to increase in contents in it various oncogenous substances; wide use of pesticides, to-rye together with food and water can get into a human body; the development of the motor transport leading to environmental pollution and growth of transport traumatism; influence of unfavorable working conditions, etc. System of social and medical actions in the socialist countries (environmental control, prevention of diseases, timely and free treatment etc.) is decisive the condition providing the prevention or reduction of influence of pathogenic factors by an organism. In the capitalist countries where the pursuit of profit is the dominating motive of a ruling class, etiol, factors of production activity of the person exert greater pathogenic influence. Unemployment, inflation, poor housing conditions at a considerable part of the population of the capitalist countries which is below «poverty line», defective food, mental injuries and emotional pressure as a result of fierce fight for existence considerably influence reactivity of an organism, lower its resistance. In industrially developed capitalist countries in the presence of medical shots and institutions medical aid because of its high cost becomes unavailable to workers. In the countries which are recently freed from colonial domination, but did not overcome economic dependence on capitalist countries, the leading role in P. of diseases is played by starvation, a lack of vitamins, insanitary conditions that is aggravated with a lack of medical shots and means for rendering medical aid.

Many social factors not only promote action on an organism of pathogenic environmental factors, lower resistance of an organism (mental injuries, an emotional stress, defective food, etc.), but also can in itself be the reason of diseases (neurosises, mental diseases, so-called psychosomatic diseases, etc.). Existence hron, unemployment and periodic economic crises cause in people uncertainty in tomorrow. According to Hallidey (J. L. Halliday, 1949), unemployment does the person to patients; he called all capitalist society sick society.

The extensive area of military pathology is also connected with social factors. During the war in the warring countries the work-rest schedule of people changes. The psychological and physical tension, mental injuries change reactivity and resistance of an organism, as a result the disease proceeds more hard. During war diseases, unusual to peace time, as a result of closer contact of people with the natural centers of infections or use of unknown before weapons of destruction can develop; the structure of diseases changes — the specific weight of injuries, burns increases. Sovr, means of mass defeat, as we know, cause the beam and combined damages.

In the USA and other capitalist countries the psychosomatic medicine which adopted original positions 3 was widely adopted. Freida. According to representatives of psychosomatic medicine, P.'s basis of the majority of diseases are the «sincere» conflicts caused by impossibility in the conditions of social life with its restrictions of satisfaction of inborn instincts. These conflicts can arise at children's or youthful age. Then they are implemented in the form of various diseases and patol, states (bronchial asthma, a peptic ulcer of a stomach, dyskinesia of intestines, disturbance of sexual function, ischemia of a myocardium, an idiopathic hypertensia, etc.). The main method of a research and diagnosis in psychosomatic medicine is psychoanalysis (see), on the basis to-rogo the attempt to define character of the «sincere» conflict becomes, the recommendations about its permission ignoring the social factors of the environment leading in some cases to a disease express. Proceeding from the analysis of real-life diseases, to-rykh primary dysfunction of a nervous system under the influence of various environmental factors, psychosomatic medicine is the cornerstone (see. Psychosomatic medicine ) carries out this analysis, being guided only on psikhol, methods of a research, and in the ideological relation — by idealistic concepts 3. Freida.

The question of a role of a nervous system in P. of diseases drew attention of a number of researchers since developing of many diseases is connected with insufficiency of its diverse functions. I. M. Sechenov's researches showed a big role of the reflex mechanism in regulation of functions, I. P. Pavlov opened the main patterns of function of bark of a great brain and mechanisms of formation of neurosis in an experiment. Analyzing P. of a disease, it is necessary to consider mechanisms of formation patol, reflexes. By data A. D. Speransky (1935, 1953), patol, structural changes and functions of bodies can arise at action of pathogenic factors on the receptors and nervous conductors located in the remote bodies and fabrics. Inadequacy of reflex reactions can be caused by the disturbances which arose in various departments of a reflex arc, and also in system of direct and return ring bonds across Anokhin (see. functional systems ). Patol, a reflex is characterized by development negative biol, the reaction limiting adaptability of an organism to the changing conditions of the environment. Quite often the mechanism of a dominant described by A. A. Ukhtomsky (1927) is its cornerstone. Normal the nervous system provides mobilization of defense and compensatory reactions and processes at action on an organism of pathogenic factors of surrounding and internal environment.

In 60 — the 70th 20 century the great influence rendered the doctrine on ideas of the general P. A Selye about the general and local adaptation syndrome (see). The main idea of this doctrine consisting that in P. of a disease specific and nonspecific reactions closely intertwine is, certainly, fruitful. From various scale of nonspecific reactions of an organism of G. Xie of league the gipotalamo-hypophysis-adrena-lovoy of system (GGAS) excreted reaction, edges plays a large role in adaptation of an organism to action of various conditional and unconditional and pathogenic factors (stress factors). However nonspecific adaptive reaction of an organism is more difficult and multicomponent. Participates in it neuroendocrinal and cardiovascular systems, system of connecting fabric, blood, etc. Therefore as P. D. Gorizontov believes, the characteristic of an adaptation syndrome cannot be limited only to the description of reaction of GGAS. Besides, there were data allowing to consider that within reaction of GGAS to various pathogenic factors of the environment it is possible to find nek-ry specific elements if to consider quantitative and qualitative features of this reaction and its dynamics. Apparently, the leagues of an adaptation disease described by G. Xie resulting from inadequate secretion glyuko-and mineralokortikoid, have more difficult genesis. Therefore in general idea of the general adaptation syndrome needs further development.

Pathogenetic therapy is of great importance in medicine, and its main objective is the choice of methods and means, to-rye can eliminate or weaken action of a fundamental unit and major factors of P. and strengthen compensatory and protective processes in an organism. Holding the actions increasing the general resistance of an organism, and also replacement and corrective therapy is necessary. During the development of pathogenetic therapy patterns of a current standard patol are considered, processes and the corresponding correction is carried out them. So, at various inflammatory diseases the thermal and physiotherapeutic procedures activating an arterial hyperemia and eliminating the phenomena of a venous hyperemia and a staz as important pathogenetic factors standard patol are widely used. process. At the sluggish course of diseases quite often apply pyrogens to activation of feverish reaction and those processes at it, to-rye increase nonspecific and specific resistance of an organism. With the same purpose the stimulating therapy is used. At many diseases, in P. to-rykh a big role plays air hunger, use various methods of oxygen therapy. The combination of causal and pathogenetic treatment is very important for successful treatment of many diseases.

See also Disease .



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B. K, Kulagin.

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