General Nosology – Definitions, Risk Factors, Etiology, Classification

According to General Nosology, Pathophysiology is a science that studies the vital activity of a sick organism, i.e. the main (general) patterns of emergence, innovation, development (pathogenesis), and outcome of the disease (recovery retirement, rehabilitation, or death). Knowledge of the above allows the practitioner to conduct a targeted search for specific signs of the disease, and, on their basis, make the correct diagnosis.

Pathophysiology can be divided into three parts.

  1. Nosology is a general teaching about the disease.
  2. Teaching about typical pathological processes (about the general patterns of processes underlying many diseases).
  3. Private pathophysiology – the doctrine of disorders in individual organs and systems.

According to General Nosology, The object of pathophysiological studies is a pathological process, the main goal is to establish the basic laws of the course of the latter, the mechanisms of its development, correction or elimination. Clinical pathophysiology is primarily a clinical diagnostic part of our science. Its task is to develop and use standard methods for diagnosing prodromal conditions and monitoring the course of the disease, as well as taking into account the influence (from the point of pathophysiology) of external factors on the human body.

 

MODERN METHODS USED IN THE EXPERIMENT (GENERAL NOSOLOGY)

With the help of a scientific experiment, specialists solve the following tasks:

  1. by isolating individual properties and aspects of the phenomenon under study, they penetrate into its essence, reveal its regularities;
  2. materializing this or that idea, expressed in theory, hypothesis or foresight, they find criteria for their truth, a form of manifestation of the general;
  3. receive and accumulate new scientific data, develop new hypotheses and theories;
  4. fix the “deviations” of real phenomena from the abstract-ideal image created on the basis of the well-known laws of science.

To carry out the experiment, you need the following.

  1. Formation of a working hypothesis.
  2. Determination of the purpose and objectives of the study.
  3. The choice of private techniques, adequate to the tasks.
  4. Carrying out an experiment (series of experiments with control).
  5. Fixation and analysis of experimental data.
  6. Discussion and conclusions.

The experimental method is the main method of pathophysiology, based on reproducing the disease in an animal, studying it and transferring the data obtained to the clinic.

The experiment is: acute – accompanied by vivisection (for example, reproduction of acute blood loss); chronic – implies long-term observation of the experimental animal (introduction of electrodes, transplantation).



 

EXPERIMENTAL TECHNIQUES (GENERAL NOSOLOGY)

  1. Shutdown – removal of a specific organ by surgical or any other means (heat, cold, radiation), the introduction of antibodies, pharmacological drugs.
  2. Irritations – stimulation of the primary structures for dysfunction of this or that organ.

 

 

DIFFERENT DEFINITIONS

“HEALTH”, “DISEASE”, “PRE-DISEASE”

Health is a state of complete physical, mental and social well-being, and not just the absence of disease or physical defects (from the WHO preamble).

Health is not only the absence of illness and disability, but also the presence of a full-fledged, harmoniously developed physical, mental and moral state of a person (B.V. Pet-

Rovsky).

Health is a highly stable state of sanogenetic mechanisms, an expression of not only biological essence, but also the social side (S.M. Pavlenko).

Health is the biological usefulness of an able-bodied individual (OS Glozman).

Health is the life of an able-bodied person, adapted to changes in the environment (I.R.Petrov).

 

The following is typical for a healthy human condition.

  1. Maintaining a stable imbalance between the environment and the body.
  2. Maintaining the integrity of the human body.
  3. Preservation of the ability to work.


According to General Nosology, The norm of health is the optimal state of a living system, which ensures maximum adaptability, i.e. adaptability to living conditions.

The norm of health is a form of the organism’s vital activity, which provides it with the best opportunity to function and adequate conditions for existence.

A pathological reaction is a short-term unusual reaction of the body to any stimulus, not accompanied by a prolonged and pronounced dysregulation of the functions of a person’s working capacity (for example, an increase or decrease in blood pressure under the influence of negative emotions).

The pathological reaction is an inadequate and biologically inappropriate (harmful or useless) response of the body or from-

it’s separate systems on exposure to ordinary or extreme (pathogenic) stimuli.

A pathological process is a regular sequence of phenomena that occur in the body when exposed to a pathogenic factor and includes (in various proportions) violations of the normal course of life processes and protective and adaptive reactions.

A pathological condition is a persistent deviation from the norm, which has a biologically negative significance for the body.

A pathological condition is a painful disorder with low dynamics, a slowly developing process or its consequences. In this case, the actual disease may not be due to the full compensation of the existing disorders (for example, with congenital deformities – clubfoot, organ hypoplasia, with a condition after limb amputation).

A pathological condition is an integral expression of a pathological process at any given moment.

A typical (typical) pathological process is characterized by the general patterns of its development, fixed evolutionarily, independent of the causes of the process, its localization and the type of living organism.

Examples: inflammation, edema, fever, microcirculation disorders, hypoxia, etc.

According to General Nosology, The disease is a special type of suffering caused by damage to the body, its individual systems by various damaging factors; with it, there are dysregulation and adaptation, decreased working capacity (WHO).

The disease is a complex reaction of the body to the action of a pathogenic agent, a qualitatively new process that arises as a result of a disorder of the body’s relationship with the environment and is characterized by a violation of its functions and adaptability, limitation of working capacity and socially useful activity (D.E. Alpern).

The disease is a qualitatively new process of life that arises as a result of exposure to an extreme stimulus on the body, characterized, on the one hand, by dysfunction of individual links of the nervous-regulatory apparatus, and on the other, by reflex activation of protective and adaptive mechanisms of recovery (S.M. Pavlenko).

A disease is a complex, qualitatively new reaction of the body to extreme stimuli, arising from a disorder of its interaction with the environment. In case of illness, the following are noted:

  • dysfunctions and morphological structures of the body, regulation of vital functions;
  • decreased adaptability;
  • limitation of working capacity and socially useful activities.

Pre – illness – the state of the body with the weakening of some sanogenetic mechanisms and their complexes (S.M. Pavlenko).

Pre-illness (i.e., the transition from health to illness) is a decrease in the functional activity of some sanogenetic mechanisms or their complexes, leading to a disorder of self-regulation and a weakening of the body’s resistance.

Pre-illness is formed under the influence of environmental factors, but in some cases indirectly, through the internal environment of the body. In the development of a pre-disease, some common pathogenetic variants can be distinguished.

  1. The condition of pre-disease is hereditary (congenital);
  2. Quite often the organism begins to be influenced by a pathogenic factor, which, due to the low intensity and (or) the sufficiency of the organism’s defenses, is unable to cause the development of the disease. However, with prolonged exposure, for example, dustiness, gas pollution, vibration, a gradual weakening of sanogenetic mechanisms is likely.
  3. More often the state of pre-illness is due to one causal factor (N1), which limits the possibilities of compensatory-adaptive reactions; against this background, some other factor (N2) can lead to the development of a certain disease.

Chronic stress often reduces the activity or disintegrates the immune surveillance system (a state of pre-illness); in such a situation, the formation of various diseases (infections, tumors, autoimmune diseases) is not excluded.

The premorbid stage is characterized by the appearance of specific, usually isolated symptoms that make it possible to determine the general direction of future pathology – cardiological, pulmonological, gastroenterological.

The prenosological condition is manifested by the aggravation of the disorders of the affected organ, which leads to an increase in the number of specific syndromes; their combination indicates a presumptive nosological diagnosis.



RISK FACTORS (GENERAL NOSOLOGY)

I. ACCESSORY

  1. Social and production (material security, social discomfort, noise, vibration, physical and mental stress, monotony and monotony of operations, dustiness, microclimate of working premises, night shifts, etc.).
  2. Family and household (living conditions, interpersonal relationships in the family, religious and educational and sanitary and hygienic features, bad habits, violations of the rest regime, diet, etc.).
  3. Environmental (environmental pollution, radioactive background, meteorological and geomagnetic effects).

II. ON THE MECHANISM OF ACTION

  1. Neurogenic.
  2. Alimentary.
  3. Infectious and toxic.
  4. Allergic.

 



ETIOLOGY (GENERAL NOSOLOGY)

According to General Nosology, Etiology (from the Greek. Aetia – cause, logos – doctrine) is the definition of the causes and conditions of the disease. Diseases arise when, under the influence of appropriate causes and conditions, the balance between the internal environment of the body and the external environment is disturbed, i.e. when the fitness of the latter becomes insufficient. Consequently, etiology is understood as the process of a complex, unusual interaction of an organism with a pathogenic factor and a complex of various influences.

The cause of the disease is the factor that causes the disease and gives it specific features.

There are three main types of action of the causal factor.

  1. The causal factor acts throughout the course of the disease and determines its development and course (acute poisoning, etc.).
  2. The causal factor acts only as an impetus, triggering the process, further developing under the influence of pathogenetic factors (burns, radiation sickness, etc.).
  3. The causal factor acts and persists throughout the disease, but plays a different role at different stages.

Human health is determined by the external environment (social, geographic, etc.) and the internal environment of the body, i.e. the conditions for the existence of its various organs and systems, individual cells and extracellular formations.

CLASSIFICATION OF CAUSAL FACTORS (GENERAL NOSOLOGY)

According to General Nosology, The causes of the disease can be divided into: exo- and endogenous; physical (mechanical, electrical, thermal, radiation); chemical; biological; in humans – psychogenic.

PRINCIPLES FOR CLASSIFICATION OF CAUSES

  1. Potential pathogenic factors:
    1. mechanical,
    2. physical,
    3. chemical,
    4. biological,
    5. psychogenic,
    6. genetic.
  2. Unconditional pathogenic factors.

 

P.D. classification Gorizontova

Stimulus type

condition reactivity of organism

Type of response of organism

Pathogenic

Modified or not changed

Unconditionally reflexive

“Indifferent”

Changed

Unconditionally reflexive

“Indifferent”

Changed

Conditioned reflex

Psychogenic

Modified or not changed

Violation of higher nervous activity or function of internal organs

Under the terms of understanding the circumstances or effects, are not in themselves capable of causing the disease, but weaken, reinforcing or modifying the action of pathogenic factors.

Conditions are divided into several groups.

  1. Conditions affecting the reactivity of the organism (favorable and unfavorable).
  2. Conditions affecting the cause of the disease (favorable and unfavorable).

 

 

PATHOGENESIS (GENERAL NOSOLOGY)

According to General Nosology, Pathogenesis (from the Greek patos – suffering, genesis – origin) – the doctrine of the mechanisms of development and outcome of the disease.

CM. Pavlenko defines pathogenesis as a dynamic complex of disorders of the body’s self-regulation, developing on the basis of functional and structural damage by an extreme stimulus to the corresponding reflex apparatuses. It is precisely two cardinal indicators (violation of self-regulation of the body and damage to its reflex apparatus) that reveal the inner essence of pathogenesis, creating the opportunity to purposefully influence the process of pathogenesis at different periods of its development.

According to General Nosology, Pathogenetic factors are pathological changes that occur during the interaction of an organism with an etiological factor. There is a cause-and-effect relationship between etiological and pathogenetic factors. Pathogenetic factors play an important role in the development of the disease, especially when the etiological factor acts for a short time, and the disease subsequently proceeds for a long time (for example, after a single exposure, etc.).

The main link in pathogenesis is a phenomenon or process that is absolutely necessary for the deployment of all links of pathogenesis and preceding it (for example, expansion of arterioles for arterial hyperemia in pneumothorax; acute oxygen starvation occurs, the main link is a violation of the tightness of the pleural cavity and the appearance of positive pressure there). Determination of the main link in pathogenesis is necessary for choosing the tactics of the essence of the disease and for choosing the tactics of pathogenetic therapy.

The leading pathogenetic factors of the pathological process are the factors that determine the cause-and-effect relationship, the main chain of phenomena in the disease. Some leading factors of pathogenesis are common to many diseases (oxygen starvation, metabolic disorders, etc.). In the development of the disease, it is important to determine the sequence of the entire chain of phenomena, the proportion and importance of the main link and pathogenetic factors.

Causal relationships. The disease, having arisen, develops further according to its internal laws as a result of various phenomena connected by cause-and-effect relationships. Each disease is characterized by a certain, typical course for it in time, certain changes in respiration, blood circulation, body temperature, peripheral blood, etc .; they reflect complex and interrelated processes taking place in the body. Knowledge of causal relationships in pathogenesis allows you to purposefully intervene in the mechanisms of disease development.

“Vicious circle”. Often, the chain of phenomena during illness closes in a vicious circle, as a result of which the body cannot get out of an unhealthy state without outside help (postoperative flatulence, hypoxia and anemia after blood loss, etc.).

Pathological system. The pathological process is characterized by damage and destruction of biological structures and functional systems. Along with destructive phenomena, new relationships are being formed between various structures, both damaged and undamaged, secondary endogenous (pathogenetic) mechanisms of the development of the pathological process inherent in the altered formations themselves arise. In their totality, these new relationships and mechanisms form a pathological system, the activity of which has a biologically negative significance for the organism. The pathological system is formed under the influence of the pathological determinant of the leading link, which determines the nature of the system’s activity.

Pathological dominant. A pathological dominant can be any structure out of control with an overly enhanced function (a stably expressed, uncontrolled gene, an unmodulated ion channel, an intensely functioning block, a hyperactive nerve center, etc.).

 



SANOGENESIS (GENERAL NOSOLOGY)

According to General Nosology, Sanogenesis (Latin sanitas – health, Greek genesis – origin, the process of education) means “development of health”. Sano

genesis – the doctrine of the mechanisms of maintaining health and recovery from illness.

Along with the actual pathological changes and mechanisms of pathological development, (pathogenesis), pathophysiology studies the mechanisms of preventing the emergence and development of a pathological process, the mechanisms of its elimination, compensation, restoration of impaired functions and recovery. Sanogenesis is a dynamic complex of protective and adaptive mechanisms of a physiological and pathological nature that develops as a result of exposure to the body of an extreme stimulus, functioning throughout the entire pathological process (from pre-illness to recovery) and aimed at restoring the impaired self-regulation of the body (S.M. Pavlenko).

CLASSIFICATION OF SANOGENETIC MECHANISMS

  1. Primary (adaptive, protective, compensatory).
  2. Secondary (protective, compensatory, terminal).

The primary (physiological) mechanisms of sanogenesis exist in a healthy organism and begin to play the role of sanogenetic mechanisms when the body is exposed to an extreme stimulus.

Secondary sanogenetic mechanisms arise in the development of pathology, they are formed on the basis of the “sex” formed in the body.

Sanogenesis includes the following mechanisms:

  • protection;
  • compensation;
  • adaptation (in evolutionary terms).

In sanogenetic reactions, according to their specific content, one can distinguish:

  • barrier;
  • eliminator;
  • the mechanism of destruction (phagocytosis, detoxification);
  • buffer;
  • insulating;
  • compensatory;
  • regenerative;
  • adaptive.

Recovery is not a consequence, but the very process of eliminating pathological changes. It is carried out according to certain patterns by appropriate mechanisms.

Recovery is the final stage of the painful process.

According to General Nosology, Pathological reactions occur in response to an extreme stimulus. They cause a violation of the integrity of a complex organism, “sex”, perversion of coordinating harmonious relations in the activity of individual organs and systems, imbalance between the internal environment of the organism and the environment, a decrease in its adaptive capabilities. In a purely isolated form, pathological reactions do not exist. Each time, their appearance gives rise to protective and compensatory-adaptive reactions.

Compensatory reactions arise in response to signals about a defect in functions, structures, and metabolic processes. Compensatory reactions – reactions of the whole organism, for they are aimed at restoring harmonious coordinated relations of organs and systems, to maintain and maintain a balance between the internal

and the external environment – their main purpose. Compensatory reactions are a kind of adaptive reactions. Any adaptive reaction proceeds according to the principle of the formation of functional systems of the body.

The functional system according to P.K. Anokhin includes: afferent synthesis, an action acceptor (functional apparatus), action formation, reverse afferentation about its results (for example, a functional system for regulating the body’s respiratory function).

 

ROLE OF REACTIVITY IN THE DEVELOPMENT OF THE PATHOLOGICAL PROCESS

According to General Nosology, Reactivity is the ability of the organism as a whole, as well as its organs and cells, to respond with adequate changes in vital activity to the effects of the environment.

The following types of reactivity are distinguished. (GENERAL NOSOLOGY)

  1. Increased – hyperergia.
  2. Decreased – hypergia.
  3. Perverted – dysergy.

 

Reactivity is manifested in the following forms.

A.

  1. Unchanged, or primary form.
  2. Modified under the influence of external or internal influences, or a secondary form.

B.

  1. Non-specific form.
  2. Specific shape.

IN.

  1. General reactivity.
  2. Local reactivity.

 

Classification of reactivity according to A.D. Ado (GENERAL NOSOLOGY)

  1. Biological or species reactivity.
  2. Group (typical) reactivity.
  3. Individual reactivity (heredity, constitution, gender, age, environmental influences):
    1. physiological:
      1. immunological or specific;
      2. non-specific;
    2. pathological:
      1. specific;
      2. non-specific

 

Reactivity must be distinguished from the following concepts.

  1. Irritability – the property of a cell to change the intensity of its metabolism in response to exposure.
  2. Excitability – the ability to arousal and its spread.
  3. Sensitivity – the ability to feel, ie. to determine the characteristics, strength and localization of the stimulus.
  4. Reaction – the ability to respond to irritation.

According to General Nosology, Resistance is the property of the body to withstand various influences or immunity to the effects of damaging environmental factors.

 

The following forms of resistance are distinguished. (GENERAL NOSOLOGY)

A.

  1. Absolute.
  2. Relative.

B.

  1. Passive, associated with the anatomical and physiological characteristics of the body.
  2. Active, associated, on the one hand, with the stability of the biological system, on the other hand, with the ability to rebuild when external conditions change (lability), which is carried out thanks to the mechanisms of active adaptation.

IN.

  1. Primary or hereditary.
  2. Secondary, acquired or modified.

G.

  1. Specific – resistance to the action of a single agent.
  2. Non-specific – resistance to many influences.

D.

  1. General – the stability of the whole organism.
  2. Local – the stability of individual parts of organs or body systems.