General nosology

(substantiation of the provisional diagnosis)

1. Determine features of the present disease beginning (sudden, gradual) and its further current (acute, chronic — stable, progressing, calming down; paroxysmal (attack-like), recurrent, cyclic).

2. The symptoms that revealed during enquiry and objective examination, group according to each system — in the individual syndromes which are representing characteristic combination of symptoms, connected with general pathogenesis (syndrome of liquid accumulation in pleural cavity, bronchospastic, cardiac insufficiency, left, right ventricular, total; coronary, hypertension, dyspeptic, a portal hypertensia, edematic, uric, etc.); specify diagnostic value of them.

3. In clinical presentation of the given disease allocate the principal (dominating, prevailing) syndrome which is representing the main abnormality. Specify, what symptoms (syndromes) on the other part of bodies and systems are the components of the principal syndrome.

4. Determine the most probable character of a pathology, which based in conducting syndrome in this case (anatomic changes, inflammation, infection, blood supply disturbance of organ, metabolism, intoxication, tumors, functional disorder of the regulatory mechanisms etc.).

5. What circumstances could promote occurrence and development of disease in the current patient? (nervous or physical overloads, overcooling, infection, malnutrition, alcohol abuse, hereditary predisposition etc.).

6. Formulate are provisional (presumable) diagnosis: syndromic, and if it possibility — nosological diagnosis.

General nosology

General nosology (from the greek word "nosos" - disease) deals with the concept of disease and pathologic processes, the theory of the causes and conditions of their origin (etiology) and the mechanisms of their onset and development (pathogenesis). It also studies the organism's reactivity and its significance in pathology.

Concept of disease

One of the most important problems of pathologic physiology is to elaborate a scien­tific definition of disease. A correct view of disease helps to establish the general regularities of its onset and development, which is in its turn necessary for prevention and treatment of diseases. It is difficult, however, to find a definition of disease that would take in all of its main features.

The concept of disease was modified at each stage of the development of pathology, in keeping with the level of knowledge.

The following definitions are confirmed in modern medicine.

Definition of health.

According to definition supposed by experts of World Health Service Organization the health is the state of full physical, psychical and social well-being of person.

Disease is, a qualitatively new vital activity that is caused by special agent action and essentially has the following characteristics:

(i) functional and structural disturbances in different organs and organ-systems;

(ii) combination of mechanism of not only injury but also of defense, compensation and recovery;

(iii) impairment of adaptation of environment and reduced capacity for work and so­cially useful activity.

It should be stressed that two closely associated phenomena must be distinguished in the picture of any disease - the injury and the organism's counteraction to the injury, or the "physiologic measures" against it, i.e. defensive physiologic adjustments. In higher animals and man these adjustments are ensured by the activity of the central nervous system and lead to restoration of functions.

Often manifested as a complex of intensified or weakened physiologic processes the disease assumes a number of new qualitative aspects. It is qualitatively a new process. For example, the febrile process is conditioned by a quantitative disturbance in the ratio between heat loss and heat production, but the resultant fever is a specific process with specific fea­tures of metabolism and heat regulation. The peculiarities of heat regulation in a feverish pa­tient are manifested, for example, in a lowered capacity for adjustment to variations in exter­nal temperature.

The concept of disease includes the concepts of a pathologic reaction, pathologic proc­ess and pathologic state.

A pathologic reaction is the relatively short-term reaction of a separate functional sys-tem of organism in respose to unusial stimulation. This reaction oversteps the limits of physiological norm and may be manifestation of not only disorder but also of defensive and adaptive mechansms.

A pathologic process is the relatively long organism response to pathogenic action and is based on a disturbed function, and not infrequently, structure. It manifests in changes of all organism and includes pathologic and defensive reactions. Disease is a more complex phenomenoii including different pathologic processes and reactions as its constituents.

Thus, the pathologic process does not present a definite picture of disease and is only a constituent of a complex of phenomena characterizing a disease. For example, elevated arterial pressure in hypertensive vascular disease is one of the pathologic processes characteristic of this disease; the concept of hypertensive vascular disease includes, in addition to elevated arterial pressure, other changes in different organs and systems of the organism.

A pathologic state is the steady irreversible change of structure and function of an organ and tissue. As a rule it is a consequence of the previous pathologic process or disease. A pathologic state develops very slowly or does not develop at all.

For example, a transition of the pathologic process to a pathologic state is observed in the change of the active progressive form of pulmonary tuberculosis to the fibroid form.

A disturbance in the adaptation of the organism to its environment (for example, in cases of excessive functional load or infection) may lead to a change of a pathologic state to a pathologic process again.

Manifestations of disease.

Disease, pathologic process and pathologic state are characterized by certain manifes­tations. The following types of these manifestations are distinguished in accordance with their characteristics:

1. with their origin: subjective and objective;

2. with their character and diagnostic significance: speficic, pathognomonic, non-specific;

3. with their significance in disease development: cardinal (guiding), assident, and impend­ing;

4. to the spreading of change: focal and general.

1) Objective manifestation of disease are registered by investigator or with registering in­struments; subjective ones are the patient's sensations and complaints.

2) Specific manifestations of disease are caused by specific action of nosopoietic agent. They define the character of disease and allow to diagnosticate it.

Specific sign that is met with alone concrete disease is called pathognomonic sign. For example, multiple tophi are the pathognomonic sign of gout. The tophus is a tissue node, contaiting crystals of sodium urate.

Non-specific manifestations are found in different diseases. They usually deal with nervous and hormonal regularities of defensive and compensatory reactions ensuring limiting and elimination of lesions.

Combination of signs and symtoms characterizing the given concrete disease is called symptom complex. For example, tachicardia, heightened basal metabolism, irritability, exophthalmia each taken separately may be met with different diseases but their association characterizes thyrotoxicosis.

Combination of the interdependent in their development changes in two or more organs or systems of organism is called syndrom. For example, cardiopulmonary syndrome may be met with the diseases in the heart and lungs. An another example is a hepatolienal syndrome. Some disease were described by investigators as syndromes and keep their names.

Periods and duration of disease.

The following principal periods in the course of disease may be distinguished:

1) latent, 2) prodromal, 3) period of marked manifestations and 4) outcome.

Such development of disease is called typical and usually appears in infectious disease.

The latent period lasts from the begining of the action or entrance of the infective agent to the manifestations of the organism's reaction in the form of detectable morbid phenomena or symptoms. In infectious disease this period is known as the incubation period. The latent period varies in its duration from several minutes to several months and even years. It is ap­parently determined by the organism's reaction to the action of the causative agent, its ability to overcome the resultant disturbances by means of its defence mechanisms. (Intoxication oc­curs almost instantly or within several minutes only after the action of powerful poisons). As­certainment of the latent period is of great practical importance for the prevention and treat­ment of the disease.

The prodromal period (from the Greek word "prodromes" - running before) lasts from discovery of the first sings of the disease to its complete manifestation. For example, the on­set of infectious disease is often characterized by indefinite manifestations, such as general indisposition, sometimes chills, headache, inappetence, rise in temperature, etc.

The period of marked manifestations usually follows the prodromal period. It is the pe­riod of development of all the principal morbid phenomena. Some diseases, especially infec­tious diseases, run a rather definite course. (For example, typhus usually lasts 13-16 days, measles - 8-10 days). Other diseases, particularly chronic disease, do not have a definite du­ration.

Outcome of disease.

In some cases the disease ends in restoration of functions and complete recovery. How­ever, complete restoration may only be imaginary. Thus, after infection the properties of the host alter just the same; the host acquires a state of immunity to the given infection (for ex­ample, smallpox, scarlet fever, typhoid fever) or, on the contrary, becomes more susceptible to it (for instance, erysipelas).

If the functional disturbances caused by the disease have not completely disappeared the cure is incomplete. Sometimes structural and functional changes persist; for example, the heart valves retain lesions after inflammation, or a joint remains immobile as a result of a tu­berculous process in it.

If the organism cannot adjust itself to the altered conditions of existence, its adaptation mechanisms become exhausted, further vital activity becomes impossible, and the third pos­sible outcome of the disease - death - ensues.

Date: 2015-01-02; view: 1482