Pathophysiology of pain. Physiological and pathological tests

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Bil is an important adaptation of the reaction to the body, which is important for the signal of triviality.

However, if it is old and chronic, it will involve its physiological significance and may take into account the pathology.

Bil є integrative functional organisms, mobile functional systems for the acquisition of a shrewd official. Vona manifest vegetative-somatic reactions and are characterized by singing psycho-social changes.

The term "bil" is the value of:

- a whole lot of psychophysiological camp, as a result of the infusion of overpowering and ruinous parasites, as well as organisation and functional degradation in the organism;
- in a big university sense bil (dolor) - it is sub'actively difficult to perceive, as a result of the infusion of strong values;
- bіl is a physiological phenomenon, which informs us about a lot of fluids, how we can think about it, or represent a potential security for the body.
In such a rank, bіl - yak is perjuval, so is the reaction.

International Association for the development of pain even when pain occurs (Merskey, Bogduk, 1994):

bіl - inadvertently and the emotional experience, the association with the effective and potential products of the fabric will not be able to be described in words of such striking.

The phenomenon of pain is not intertwined with organically or functionally destructed in the world of localization, but also infused into the efficiency of the organism as an individual. With a handful of rockets, the preachers described an uncountable number of uncomfortable physiological and psychological symptoms of pain.

Physiological inheritance of unhealed pain, be it localization, can include everything, fixing the function shlunkovo-intestinal tractі dichotomous systems and ending with improved metabolic processes, increased growth of fluff and metastasis, decreased immunity and increased terms of pregnancy, sleeplessness, increased loss of blood, second period of apathy.

Psychological inheritance of pain can manifest itself in the sight of anger, sexual activity, feeling of fear and anxiety, anxiety, loss of spirit, anger, depression, self-interest, loss of interest to life, loss of health to life and find out about euthanasia.

Psychological and emotional effects are often infused into the sub-active reaction of the patient, overreaching or applying the significance of the pain.

In addition, a singular role in the turn of psychological problems in pain can be reduced to self-control of pain and sickness by a patient, to the stages of psychosocial isolation, to the extent of social education, and to the causes of problems

It is practical for the lykary to be brought to the right by the mother with the manifestations of pain, emotions and behavior. This means that the effectiveness of diagnostics and treatment is not only due to the development of the pathogenetic mechanisms of the somatic become, which manifests itself in order to supervise the pain, or to the minds of the children who have problems with problems.

The number of robots, including monographs, has been assigned to the reasons for the diagnosis and pathogenesis of pain and pain syndromes.

Yak scientific phenomenon has been more than a hundred years old.

Development of physiological and pathological issues.

Physiological bile of winy at the time of withdrawal is seen by painful receptors, it is characterized by a small triviality and is in direct fallowness due to force and triviality, which is very common. Behavioral reaction with a lot of interruptions in the connection with the dzherel ear.

Pathological bile can be found in receptors, as well as in nerve fibers; the won is tied to trivial conquests and more ruinous through the potential contamination of the deterioration of the normal psychological and social awareness of the individual; Behavioral reaction in case of tsom - occurrence of anxiety, depression, impairment, as well as somatic pathology. Apply pathological pain: blistering pain, neuropathic pain, deafferentation pain, central pain.

Skin type of pathological pain key features They allow the recognition of the cause, mechanisms and localization.

tipi pain

first type- gostry bil, wiklikana pozhkodzhennyam fabrics, yak change in the world of її zagunnya. Gostry bil ma raptor cob, short triviality, readable localization, appears when an intensive mechanical, thermal abnormal factor is injected. You can get a wicked person for an infection, for a person who is sick or for a surgical entourage, for a long period of time for years or days, and often supervise with such signs as a quickened heart rate, piquity, lack of heart and soul.

We call it bile (or nociceptive), because it is tied to the activation of nociceptors for the tissue ear, which leads to a step of tissue reduction and triviality of the factors, and because of the increase in regression.

other type- a chronic bile develops as a result of a burned out or fired tissue or a nerve fiber;

It’s uncomfortable to fix the negative influx on the psychological, social and spiritual life of people.

With uninterrupted stimulation of pain receptors, the threshold of sensitivity decreases year by year, and non-pain impulses can fix the symptoms of pain. Development of chronic pain we are sick, Nagoloshuyuchi on the need for adequate її lіkuvannya.

The unhealed should not only be brought up to the materially assigned to the patient and the child's family, but the great vitality of the suspension and health protection system, including more trivial hospital terms, hospitalization unavailable help. Chronic bile is the most often overwhelmed reason for a trivial part of it or more inconsistency.

Isnu kіlka klassifіkatsіy pain, one of them divas. Table 1.

Table 1. Pathophysiological classification of chronic pain

Classification of pain

The somatic wine is in the case of small or stimulation of the skin, as well as in the case of larger large structures - mucous membranes, loops and cysts. Cystkovy metastases i surgical engagementє common causes of somatic pain in children who suffer from chills. Somatic bіl, as a rule, postіyna і to finish clearly surrounded; there is a description of yak bil pulsating, grize, etc.

Visceral Bill

Vona describe yak gliboka, scho siska, generalized and can go to school. Visceral bill, as a rule, post-life, it is important for the patient to establish localization. Neuropathic (aka deafferentation) bіl іs'a appear in case of reduced or subdivided nerves.

You can be persistently or nonstykoyu, ininodi strolyaє and dare to be described as a gostr, prickly, ryuchuy, baking, as it is inadvertently seen. Vzagal, at the feet were the most serious in terms of some types of pain, it is more important to give in to licks.

classically bil

The quality of the classification can be cinnamon for the cob therapy, protea, for now such a podil is uncomfortable through the next few days.

Nocigenic bill

Bile in case of small internal organs є inherited fast speed, spasm or stretching of smooth muzzles, fragments of the most smooth muzzles are insensitive to heat, cold, or distress.

Bіl from the internal organs, which may seem like a nice innerviation, can be seen in the singing zones on the surface of the floor (zone Zakhar'ina-Geda) - the price is displayed. Most likely, apply such a pain - a beat in the right shoulder and the right side of the shoulder with a severe cheekbone, a beat in the lower part of the back with an affliction sectional mikhuraі, nareshty, bіl in lіvіy rutsі and lіvіy halves breast cancer at heart disease. The neuroanatomical basis of the whole phenomenon is not a matter of intelligence.

Possibly an explanation of the fact that the segmental innervations of the internal organs and the distant areas of the surface of the body are segmental, however, I don’t explain the reason for the visualization of pain from the body to the surface of the body.

Nocigenny type of pain is therapeutically sensitive to morphine and other narcotic analgesics.

neurogenic bele

Neurogenic beads of little clinical forms.

Before them, it is possible to carry out actions of the peripheral nervous system, such as postherpetic neuralgia, diabetic neuropathy, not just the reduction of the peripheral nerve, especially the middle and lytic (reflexively sympathetic brachial dystrophy),

Neurogenic disease in the development of the central nervous system and in the development of such areas in these regions has been accompanied by a cerebrovascular catastrophe, which is usually called "thalamic syndrome" ...

A lot of pain є changes and clinically manifested nocigenic and neurogenic elements. For example, plump wicks and fabrics and compression of nerves; in case of diabetic nocigenic disease in case of peripheral vascular disease, and neurogenicity - in case of neuropathy; with grids mid-row disc, Compress the nerve root, pain syndrome, including a baking and shooting neurogenic element.

psychogenic bele

Vono is feasible in the hysterical features, and more accurately depicts the reality of the non-steroidal type of patients. Seemingly, people from young ethnic groups are looking for pain relief.

Patients of the European promenade by definition are less intense, less American negro or Latin American. They also have low pain intensity in Asian conditions, although the perceived value is no worse (Faucett et al., 1994). Deyakі people are more stiff to the development of neurogenic pain. Oskilki tsya tendencies maє vishchezgadanі ethnіchnіy cultural specialties, you will be built by nature. This is so attractive to the prospect of the dangers, directing to the joke of the localization and vision of the "pain gene" (Rappaport, 1996).

Be it chronically ill or unconscious, if you get sick, pouring into your emotions and behavior.

Bіl often lead to the appearance of anxiety and spasms, as it is itself to relieve pain. I will explain the importance of psychotherapy in controlling pain. Biological ringing, relaxation training, behavioral therapy and hypnosis, how to become stagnant in the quality of psychological involvement, appear crimson in people who are inveterate, refractory to the liking of fallacies (Melzack, 1990, Wall, 1994)

Likuvannya is effective, as well as psychological and psychological. Systems (navkolishnє middle course, psychophysiology, behavioral reaction), which can be used to infuse sprinkles on the bolus (Cameron, 1982).

The discussion of the psychological factor of chronic pain is based on the theory of psychoanalysis, from behavioral, cognitive and psychophysiological positions (Gamsa, 1994).

G.I. Lysenko, V.I. Tkachenko

Mechanisms of regulation of pain sensitivity є emotional and include both nerves and humoral components. The laws that regulate the relationship between one and the same nerve centers are entirely fair and for everything that is tied to pain. The phenomenon of galvanizing is seen here, navpaki, enhancing the energy in the quiet structures of the nervous system, connected with pain, in case of failure to achieve intensive impulses from the lower neurons.

Ale especially more important in the regulation of painful sensitivity, humoral factors are played.

In the first place, there is already a guess of speech algogens (histamine, bradikinin, serotonin and in.), Nociceptive impulse, which is very well tolerated, form in the central nerve structures of a kind of reaction.

In other words, in the development of large reactions, the role of the game is so called speech π. There is a great number of things to take place in the neurons of the back horns spinal cordіn a decrease in algogens with an effect, lulling of the appearance of nociceptive neurons, of a deterioration of all high-threshold neurons in the dorsal horns of the spinal cord, so that the border of neurotransmitting (transmission) role in the neurotransmitter The axo-dendritic, axosomatic and axo-axonal synapses, and the terminals of these are revealed in the bulbs of the river π.

Thirdly, the nociception is attributed to such a galmic mediator of the central nervous system, such as γ-aminobutyric acid.

I, nareshti, quarterly, an extremely important role in the regulation of nociception of the Endogenous opioid system.

In experiments with radioactive morphine boules, the specific dilens were detected in the organisms. The morphine was named after the registration of the regions opioid receptors. Investigation of areas of localization showed that the detection of the number of receptors in the area of ​​thermal receptors of the primary afferent structures, the dramatic speech of the spinal cord, the hypogastric nucleus of the retinal nucleus of the thalamus, the hypochondriac Opiate receptors are widely represented not only in the central nervous system, but in peripheral views, In internal organs. It was taken into account that the analgesic effect of the morphine was accumulated because of the fact that it was used for the purchase of opioid receptors and for the change in the vision of algogenous mediators, and that it was carried out prior to blocking the medication. The discovery in the organisms of the nodules of the specialized opioid receptors was the reason for the rectification of the shocks of the endogenous morphine-like speech.

In 1975, the brain of tvarin buli vidіlenі oligopeptides, they tied the opioid receptor. I will name the speech endorphin_vі enkefalin_v. U 1976 p β-endorphin bulo seen from spinal cord people. In this hour, we see α-, β- and γ-endorphins, as well as methionin- and leucine-enkephalin. Hypothalamus and hypophysis are involved in the main areas of endorphism viroblasting. The majority of endogenous opioids will need to work on the analgesic action, and even the central nervous system may not have the same sensitivity to these factions. Suppose that enkephalin is also generally viroblyayut in hypothalamus. Endorphin terms are presented in the brain more intertwined with enkephalinovym. The recognition of five types of endogenous opioid is based on respect and the heterogeneity of the opioid receptors, which are seen only by five types that are not the same in the nervous solutions.

allow two mechanisms of endogenous opioid:

1. Through the activation of hypothalamic, and sometimes hypophyseal endorphins and systemic processes for widening with the flow of blood and spinal cord;

2. Through activation of the terminal. to take revenge on the offense of the fall, with a further inflow without a priori on the opioid receptor of the central nervous system and peripheral nerve structures.

Morphine and a large number of endogenous opiates block the conduct of nociceptive impulses on both somatic and visceral receptors. Zokrema, tsi speech, to lower in the middle of the ear to bradykinu, to block algogens efect of prostaglandins. On the back of the spinal cord, the depolarization of the primary afferent structures is affected, and presynaptic galvanization is activated in the somatic and visceral afferent systems.

The word bil ob'єdnu in sob is two super-articulate understanding. From one side, behind krilatim wislow old doctors: "bil is a watchdog of health", and on the other hand, there was an order of cinnamon, signaling function, so that organism is about security, victories a number of pathological effects, such as a difficult experience, damage the establishment, disregulation of the functions of organs and systems. May cause severe dysregulatory pathology and cause shock and death [Kukushkin M. L., Reshetnyak V. K., 2002].

Bіl є naybіlsh we will expand the acquaintance of bagatokh illnesses. Expert VOOZ vvazhayut, scho 90% of all illnesses are tied to pain. Patients with chronic pain five times more often suffer for medical aid, In some people in the population. Not a vague first breakdown of the fundamental 10-volume core of internal ailments, seen from the editorial board of T.R. Harrison (1993), assignments to describe the pathophysiological aspects of pain. It is usually sub-active, and it’s growing up due to the intensity, nature and localization of life, because of the nature of the life-threatening factor, because of the circumstances, in case of what the status of life, people, psychological standard

There were taken to be five components:

1. The perceptual component, which allows for the meaning of the message.
2. Emotional-affective component, which is a form of inappropriate psychomotional experience.
3. The vegetative component, which represents the reflexive changes of the robot and internal organs and the tone of the sympathoadrenal system.
4. Rukhovy component, straightening on the weakening of poppy stimuli.
5. The cognitive component, the form of sub-active putting before the test at the given moment of pain on the basis of accumulated evidence [Valdman A. V, Ignatov Y.D., 1976].

the main factors that pour on pain relief, Є:

1. Вік.
2. Constitution.
3. Vihovannya.
4. Early access.
5. Settings.
6. Ochіkuvannya pain.
7. Fear.
8. Race.
9. Nationality [Melzak R., 1991].

First, for all the pain relief, lie in the status of belonging to the individual. With the presentation of the same intensity of pain in women, an active indicator of pain (enlargement of the period) of rotations is stronger. With vicious positron tomography, it was revealed that the activation of the structures of the brain is significantly more pronounced in women during the hour of painful stimulation. A special pre-session, held on new-born women, showed that a female child shows a greater variety of reactions in the case of more teasing, not lads. It is also very important for pain relief. Clinical caution in a large number of cases is to indicate those, that the intensity of pain relief is decreasing in general. For example, the number of cases of painless infarctions grows in patients over 65 years old, and the number of cases of painless creep slopes also grows. However, the phenomenon can be explained by the different peculiarities of the pathological processes in the summer, and not the decrease in pain relief like this.

In case of a model pathological pain with a capsaicin on the skin in young and old people, there was more and more hyperalgesia of the same intensity. However, in people who have been kidnapped, the latency period to the ear most of the views and until the development of the maximum intensity of pain. People who are sick have a feeling of pain and hyperalgesia is more difficult than in young people. In the case of malignant changes, the plasticity of the central nervous system is reduced in people with abducted patients with trivial pain.

Clerical minds tend to show more common innovations and trivial painful sensitiveness written by fabrics [Reshetnyak V. K., Kukushkin M. L., 2003]... Seemingly, also that ethnic groups live in the private regions of the planet, it is easier to carry the beer in everyday life with the inhabitants of the day [Melzak R., 1981]... As it is already said vishche, bіl є a rich-component phenomenon і ї ї ї ї ї ї ї ї ї ї ї ї ї ї ї ї ї ї ї ї ї ї ї ї і і і і і і і bagatokh chinnikіv. To that date, it’s all-important. Naybіlsh popular viznachennya accepted in respect of the formulation, proponated by the group of experts of the International Association for the development of pain: "Bіl - it is not possible to see and not worry, because of the potential for such a given value to inform about those who see the pain can not only be done when the fabric is worn out, but in the minds of the person there is a lot of fabric, but it’s better to see it when there’s any kind of fabrication.

In the end mechanism of pain diagnosisє psycho-social camp of people (manifestation of depression, іsterії or psychosis). In other words, the interpretation of a person's painful perception, their emotional reaction and behavior may not be correct due to the harshness of the problem. ... More can be broken down: on the somatic surface (in the case of small curves), on the somatic surface (in the case of the cyst-type system) and visceral. More can be found in the case of distorted structures of the peripheral and / or central nervous systems, to take part in the analysis of pain signals. Neuropathic pain is called bіl, which is called viny with decreased peripheral nerves, and with decreased CNS structures - central pain [Reshetnyak V. K., 1985]... A special group is composed of psychogenic pains, which occur independently of somatic, visceral or neuronal ears, and are based on psychological and social factors. For the hourly parameters, they see the GOST and the chronicle.

Gostry bil- the price is new, recently bіl, unreasonably tied to the wikklicks її ї її і ї і, as a rule, є a symptom of some kind of ill health. Such a bіl znika in the case of usunenny poshkojennya [Kalyuzhny L. V., 1984].chronic bile Often the status of an independent ailment swells up, a trivial period of time, and the reason why it has gone up in a number of cases may not start. The International Association for the Vyvchennya Pain Viznacha її yak "bil, what progress is going on over the normal period of start". The head form of chronic pain from acute is not a time factor, but obviously neurophysiological, biochemical, psychological and clinical sports. Formation of chronic pain is often found in a complex of psychological officials. Chronic bile є by the beloved mask of the admitted depression. The strong link of depression with chronic pain is explained by the out-of-the-box biochemical mechanisms ... Pain relief is taken care of by a complexly organized nociceptive system, which includes a special group of peripheral receptors and central neurons, which are rooted in the structures of the central nervous system and react to a slow life. Intraarchical, complex organization of the nociceptive system, and the type of neuropsychological findings about the dynamic localization of the brain functions and about the perception of the "pain center", which is specific to the structure of morphology pain syndrome.

Dan is sure to be supported by the number of key warnings, to inform about those who are neurosurgical, be it from nociceptive structures in ailments, as they suffer from chronic painful syndromes, to bring half of the quiet time. More syndromes occur in cases of activation of nociceptive receptors in case of trauma, inflammation, ischemia, stretching of tissues, and can lead to somatogenic pain syndromes. Clinically, somatogenic pain syndromes are manifested in the manifestation of persistent ailment and / or an increase in pain sensitivity in the zone of weakness or heat. Patients, as a rule, easily locate such pains, clearly start their intensity and character. In this case, the zone of increased pain sensitivity can be expanded and moved beyond the boundaries of the tissues. Delianas with increased pain sensitivity to ear stimuli are called hyperalgesia zones.

See primary and secondary hyperalgesia. The primary hyperalgesia is found in pockets of tissue, the secondary hyperalgesia is localized in the posture zone of the ear. Psychophysically, the area of ​​primary school hyperalgesia is characterized by lower pain thresholds and higher tolerance up to mechanical and thermal stimuli.

Zones of secondary hyperalgesia may cause a normal pain tolerance and a decrease in pain tolerance only to mechanical stimuli. The pathophysiological basis of primordial hyperalgesia is sensitization (sensitization) of nociceptors - A- and C-fibers to the ear for ear stimuli. Sensitization of nociceptors is manifested by a decrease in the threshold of activation, an increase in receptive fields, an increase in the frequency and triviality of discharges in nerve fibers, so that the afferent nociceptive flow becomes stronger. [Wall P. D., Melzack R., 1994]... Exogenous or endogenous launching of a cascade of pathophysiological processes that consume the entire nociceptive system (from tissue receptors to circulating neurons), as well as a number of other regulatory systems to the body. Exogenous or endogenous pozdogennya to produce vasoneuroactic speech, which is to produce before development. Ci vaseneuroactive speeches, because the so-called mediators fired up are not just types of fiery reactions, including the painful reaction, or the sensitivity of the nociceptors before the teasing comes. Razr_znyayut decilka types of mediators zapalennya.

I. Plasma media fired

1. Callikrin-kininova system: bradikinin, kallidin
2. Components to the complement: C2-C4, C3a, C5 - anaphylotoxin, C3v - anti-lo, C5-C9 - membrane attack complex
3. System of hemostasis and fibrinolysis: XII factor (Hageman factor), thrombin, fibrinogen, Fibrinopeptides, plasmin and in.

II. Klіtinnі medіatori zapalennya

1. Biogenic amin: histamine, serotonin, catecholamini
2. Possible arachidonic acids: - prostaglandins (PGE1, PGE2, PGF2 ?, Tromboxane A2, prostacyclin I2), - leukotroeni (LTV4, MRS (A) - commonly reactive substances of anaphylaxis), - chemotherapy
3. Granulocyte factors: cationic proteins, neutral and acidic proteases, lysosomal enzymes
4. Chemotaxis factor: neutrophil chemotactic factor, chemotactic factor eosinophiliv and іn.
5. Acid radicals: O2-superoxide, H2O2, NO, OH-hydroxyl group
6. Adhesive molecules: selectini, integrarini
7. Cytokines: IL-1, IL-6, factor of necrosis of chickens, chemokin, interferon, colony-stimulating factor and in.
8. Nucleotides and nucleosides: ATP, ADP, adenosine
9. Neurotransmitters and neuropeptides: substance P, calcitonin gene-spore peptide, neurokinin A, glutamate, aspartate, norepinephrine, acetylcholine.

In this hour, I see 30 neurochemical studies taking part in the mechanisms of stimulating and galvanizing nociceptive neurons in the central nervous systems. Among the numerical group of neurotransmitters, neurohormones and neuromodulators, which lead to the advancement of nociceptive signals, there are simple molecules - zbudzhuyuchі amino acids - VAK(Glutamate, aspartate), as well as folding high molecular weight (substance P, neurokinin A, calcitonin gene-spore peptide, etc.).

VAK plays an important role in the mechanisms of nociception. Glutamate is found more and more in half of the neurons in the dorsal ganglia and in vivialization before the number of nociceptive impulses. VAK interacts with decilcoma with different types of glutamate receptors. Price for all ionotropic receptors: NMDA receptor (N-methyl-D-aspartate) and AMPA-receptor (? -Amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid), as well as metalobolotropic glutamate receptor .

With the activation of these receptors, there is an intensive supply of Ca 2+ ions in the cell and the change in functional activity. Formation of a stiffness of neuronal hyperextension and hyperalgesia. It is necessary to admit that the sensitization of nociceptive neurons is possible for more than a year or more days because of the improvement of the proper nociceptive impulses from the periphery. In other words, if the hyperactivation of nociceptive neurons has already become, then it will not require additional activation by impulses from the moment of operation. For the most part, the alarming effect of nociceptive neurons will be linked to the activation of the genetic apparatus - express early, inaccurately reacting genes, such as c-fos, c-jun, junB and others. Zokrem, a positive correlation between the number of fos-positive neurons and the degree of pain was demonstrated. In the mechanisms of activation of proto-oncogenes, the role of the introduction of Ca 2+ ions is important. When the concentration of Ca 2+ ions in the cytoplasm is increased, as soon as the membrane enters through the regulation of the Ca channel by NMDA receptors, the expression of s-fos, s-jun is used, and the products of these cells take part in the regulation ... It remains for an hour more important in the mechanisms of sensitization of nociceptive neurons to suck nitrogen oxide (NO), which is the role of an atypical extra-naptic mediator in the brain of a vicon.

The small size and visibility of the charge allows NO to penetrate through the plasma membrane and take part in the signal transmission, functionally transferring post- and presynaptic neurons. NO is established with L-arginine in neurons, so that it replaces the enzyme NO-synthetase. NO is seen from clitin during NMDA-induction of destruction and interconnection with presynaptic terminals of C-afferents; [Kukushkin M. L. et al., 2002; Shumata V. B. ta in., 2002]... Nitrogen oxide has a key role in ignition processes. locally introducedіngіbіtorіv NO synthase in the joint is effective in blocking nociceptive transmission and firing.

All the way to reduce, how the nitrogen oxide is established in the ignited slopes ... Кініни є one of the most difficult algogenic modulators. The stench is quick to admit when the tissue is too thin and there are more effects that are more likely to occur when ignited: vasodilatation, increased judgment, extravasation of plasma, mitigation, hyperemia. The stench activates C-fibers, producing neurogenic firing for the rakhunok vikida from the nerve terminals of substance P, calcitonin of the gene-spore peptide and other neurotransmitters.

Direct zbudlivy efekt bradikіnіnu on chutlivі nervovі zakіnchennya oposeredkovuєtsya B2-receptor pov'yazany i z aktivatsієyu membrannoї fosfolіpazi C. Indirect zbudlivu dіyu bradikіnіnu on zakіnchennya nervovih afferents obumovleno Yogo vplivom on rіznі tkaninnі Elements (endotelіalnі klіtini, fіbroblasti, ogryadnі klіtini, macrophages neytrofіli i) and stimulating the awareness of mediators in them, which, in conjunction with the receptors on the nerve ends, activate the membrane of adenylate cyclase. In its own cell, adenylate cyclase and phospholipase C stimulate the establishment of enzymes, phosphorylation of the ionic channels.

The result of phosphorylation of the ionic channels is a change in the penetration of the membrane for the ions, which is susceptible to the malaise of the nerve end and health of the generation of nerve impulses. Bradykinin, acting through the B2-receptor, stimulates the administration of arachidonic acid with the additional administration of prostaglandins, prostacyclin, thromboxanes and leukotroins. The speech, volodyuchal self-styled algogens, in their own way, potentiate the health of histamine, serotonin and bradykinin sensitize the nerves of the end. As a result of non-melanized C-afferents, the wikid of tachikinins (substance P and neurokinin A), which increases the permeability of the brain, increases the concentration of medication. [Reshetnyak V. K., Kukushkin M. L., 2001].

Stagnation of glucocorticoids in the transmucosal state of the intake of arachidonic acid for the inhibition of the inhibition of the activity of phospholipase A2. Into my own house, non-steroidal anti-inflammatory drugs (NSAP) change the approval of cyclic endoperoxides, zokrem, prostaglandins. Under the name of the oil refinery plant, we will agree on the chemistry of the buzz words, as they make the injection for cyclooxygenase. All oil refineries in this world may have an anti-firing, fever-lowering and analgesic effect. It's a pity, practically all oil refineries with a trivial stasis of bends bit by bit... Stink viklikayut dyspepsia, peptic infections and slunk-intestinal bleeding. It may also be inevitable that the glomerular filtration rate is irreversibly reduced. interstitial nephritis and guests nirkova lack... NPZP produce a negative effect on microcirculation, may cause bronchospasm [Filatova Є. G., Wayne A. M., 1999; Chichasova N.V., 2001; Nasonov E. L., 2001].

In the Danish hour, there are two types of cyclooxygenases. Cyclooxygenase-1 (COX-1) is approved in the minds of the norms, and cyclooxygenase-2 (COX-2) is approved in the process of ignition. In this day, the development of effective refineries is aimed at the stem of the vibrating іngіbіtorіv COG-2, as for the view of the nonselectiveіngіbіtorіv volodіyut signicantly less pivoting by the sideways. In addition to the fact that the preparations with the "balanced" anti-inflammatory activity in relation to the reduction to COX-1 and COX-2 may be more pronounced against the apical and analgesic activity in patients [Nasonov E. L., 2001].

The order of the preparation of drugs, which can be used to bring COX-1 and COX-2, is conducted on the basis of fundamentally new analgesic drugs. Transmission is carried out for chronic firing of the B1 receptor. Antagonism of cich receptors signi fi cantly reduce the manifestation of heat. In addition, bradykinin takes over the fate of the viroblency of diacylglycerol and activation of protein C, which, in its own way, by virtue of the sensitization of nerve cells.

Proteinase The role in nociception is even more important; ... In addition to the synthesis and wikidum of mediators firing, hyperactivity of the spinal nociceptive neurons and the strengthening of the afferent flow, which is found in the central structure of the brain, the main role is the activity of the sympathetic nervous system. It has been established that the adjustment of the sensitivity of the terminals of nociceptive afferents during the activation of post-ganglionic sympathetic fibers is mediated by two paths. In the first place, for the reduction of the permeability of the vessel in the zone of the reduction of the membrane and the improvement of the concentration of the mediators in the heat (indirect path) and, in other words, for the reduction of the direct injection of neurotransmitter of the adherent sympathetic nervous system - the neurotransmitter When ignited, the activation of the so-called "movable" nociceptive neurons is seen, as for the daytime, the activation does not appear to be of a different kind of nociceptive development.

The order of the strength of the afferent nociceptive flow when ignited is the strength of the decay control ... It can be seen as a result of the activation of the antinociceptive system. Vona activate, if a large signal reaches the antinociceptive structures of the stovbur brain, thalamus and great measles in the brain [Reshetnyak V. K., Kukushkin M. L., 2001]... Activation of the near-water conduit speech and the great nucleus of the suture vyklicaє vivilennye endorphins and enkephalin, which link to the receptors, triggering a series of physical and chemical changes, which changed to change. There are three main types of opiate receptors: - ,? - i? receptor. What is the greatest number of vicarious analgesics who use their own dietary methods? receptors. Until recently, it has been accepted that it is important that it affects the nervous system and an analgesic effect because of its interaction with opioid receptors localized in the brain and spinal cord. However, the opiate receptor and ligandi are detected on the immune cells , In peripheral nerves , In fiery fabrics ... In the given hour, 70% of receptors are up to endorphin and enkephalin rostosis in the presynaptic membrane of nociceptors, and most often a large signal is triggered (before reaching the back horns of the spinal cord).

Dynorphin active? receptor and insertion of neurons, which leads to the vivification of GABA, as well as hyperpolarization of the clin of the posterior horn, and the transmission of the signal ... Opioid receptors grow in the spinal cord by the head near the terminal of C-fibers in the I plate of the dorsal horns ... The stench is synthesized in the small cells of the dorsal ganglia and transported proximally and distally along the axon ... Opioid receptors are inactive in non-inflamed tissues, when the cob is ignited and the receptor is activated for several years ... The synthesis of opiate receptors in the neurons of the ganglion of the dorsal horns also grows in case of firing, ale, the process, including an hour of transport along axons, to become a few days ... Clinical preliminaries brought in 1 mg morphine in a colony slope for a visible change and a trivial analgesic effect ... Nadal bulo showed the presence of opiate receptors in the fired synovial tissue .

Slid to mean, wow opiates vicious muscle analgesic effect in the case of їkh aplіkatsії on the fabric of the ball was described as early as the XVIII century. So, the English drug Heberden in 1774 published the robot, in which he described the positive effect of the aplication of the opiate extract in the treatment of hemorrhoidal pain ... Indications good analgesic effect diamorphin when you locally apply for bedsores and for small children of shkiri , With the visible teeth in the minds of the swiveled firing of the knitted fabric ... Antinociceptive efficacy (as a result of a stretch of decimals of subtilization due to the fallout) to lie down for all the blockade of increased potential for children, as well as as a result of the change in the wake of stimulating, nervous mediators, . Morphin is disgustingly absorbed through a normal shkіra and kindly get wet through the fire. To that, the aplication of morphine on the school gives only a local analgesic effect and not systemically.

In the rest of the rock, more and more authors are repaired talk about the completeness of storing balanced analgesia, tobto one-hour consumption of oil refineries and opiate analgesics So yes, there is the possibility of lowering the dose and probably the bitter effects of the first, as well as others [Ignatov Y.D., Zaitsev A.A., 2001; Osipova N.A., 1994; Filatova Є. G., Wayne A. M., 1999; Nasonov E. L., 2001]. Find out more and more often to fix problems with arthritic pain [Ignatov Y.D., Zaitsev A.A., 2001]... Zokrema, in Danish hour a bolus form of tramadol is vikorized. Tsey drug є agonist-antagonist [Mashkovsky M. D., 1993] Moreover, the rate of detection of physical debris in the presence of adequate doses is not high. Seemingly, when opioid, how to be referred to the group of agony-antagonists, in a significantly smaller world, there is a physical fallowness in the case of true opiates [Filatova Є. G., Wayne A. M., 1999].

Isnu dumka, what opioid, like vikoristoyutsya in correct doses, more safe, less traditional oil refinery [Ignatov Y.D., Zaitsev A.A., 2001]... One of the most important factors in the chronicity of pain is depression. On the thought of the authors, in case of chronic pain, it is necessary to take antidepressant medications, regardless of the pathogenesis [Filatova Є. G., Wayne A. M., 1999].

antipolitical effect antidepressants reach for the rakhunok three mechanisms. First - a change in depressive symptoms. The other is antidepressants to activate the serotonic and noradrenergic antinociceptive systems. The third mechanism of polyagion is in the fact that amitriptyline and tricyclic antidepressants act as antagonism of NMDA receptors and interactions with the endogenous adenosine system. Thus, in the pathogenesis of pain syndromes, which occurs when ignited, the fate of a great number of new neurophysiological and neurochemical mechanisms, which will inevitably lead to changes in the psychophysiological status of the patient. To that order with anti-inflammatory and analgesic drugs for carrying out complex pathogenetically primed therapy, as a rule, it is necessary to start antidepressant therapy.

literature

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Bil - it is the form of a complex psychophysiological camp of people, which includes in itself: 1) no pain; 2) singing vegetative reactions (tachycardia, changes in the arterial grip); 3) emotional component (negative emotions: sthenic and asthenic (depression, fear, tightness); 4) manifest motor (unique reflex - waking up of the hand); 5) volovі zusilla (psychogenic setting of lowering the degree of visibility of pain).

Classification of pain:

I. For walking:

• A) "Fiziologicheskaya" - a wicked call with a singing call;
• - to lay down on the strength of the character of the child (adequate to you);
• - mobilization of organisms;
• - є with a signal of insecurity (the possibility of pozhkogennya).
• B) Pathologic = neuropathic - viclikana to the nerve. systems;
• - not adequate to the singing inflow;
• - Chi does not mobilize to organisms
• - є signal of pathology, characteristic of the nervous system.

II. For the localization of nociceptors and the nature of painful reactions:

• 1. Somatic:
  • a) surface:
    • - Epikriticheskaya (early, shvidka);
    • - protopathic (piznya, povilna).
  • b) gliboka.
• 2. Visceral: (tied to the zones of Zakhar'ina-Ged)
• a) reference;
• b) is visualized.

The somatic bill is tied with the shkiri, m'yaziv, ODA as a whole.

Superficial bile of vinikє with subdivided nociceptors of the shkiri,

Epikriticheskaya (early) bіl is called a shvidkoy that, scho:

vinikaє through parts of a second;

MAє short latency period;

accurately localize;

pass quickly;

gostre shvidke minusche vidchuttya.

Protopathic (piznya) bіl is characterized by:

more trivial latent period (number of seconds);

more diffuse;

more trivial;

supravodzhutsya unacceptable big visions.

Such a pod_l of dressings for carrying out zabudzhennya - according to the fibers A (shvidka b_l); on non-melinic fibers C (bulk).

Fibers of group A - tovsti mієlіnovі fibers (Vprov. 50-140 m / s).

Fibers of group B - small diameter, B1 and B2 (Vprov. 15-30; 10-15 m / s).

Fibers C - bezmelinovie - smaller diameter (V = 0.6-2 m / s).

Without more fiber:

• - up to hypoxia (to that the activity of metabolism is reduced);
• - shvidshe regenerate;
• - are characterized by a greater diffuse rosin of fibers in the zone of innervation.

When nerve fibers are compressed into the perch, muscle fibers are shielded, the anesthetic during anesthesia is more likely to be non-melanic.

Gliboka b_l is tied to the subset of receptors in glyboky tissues (tendons, cysts, oysters).

The nature of the pain: - dull;

• - niyuchi;
• - trivial;
• - diffuse;
• - schilny to irradiation.

Causes of pain:

• - stretching fabric;
• - strong grip on the fabric;
• - ischemia;
• - a series of cheeky teens.

Visceral bill - winy with subdivided receptors in internal organs.

The nature of the pain: - dull;

• - niyuchi;
• - more;
• - trivial;
• - the building of the building is up to the date.

Causes of visceral pain:

• - stretching empty organs;
• - spastic speed of empty organs;
• - spasticity (spastic speed of blood-bearing organs);
• - ischemia;
• - Chemically teasing shells of organs (with VC);
• - Stronger fasting organs (fasting intestines).

The main mechanisms for the formation of pain.

Bil is the result of the interaction of two systems: bolovy (algicheskim, nociceptive), protivolyovy (analgesic; antinociceptive).

The Bolova system includes 3 lanes:

Receptor.

Providnikove lanka.

Central Lanka.

Recipe: Згідно happy news- special, highly differentiated receptors for the development of different modalities.

Groups of pain receptors:

mechanic

Specially for sprinkling quick ears, you can use stimuli (for example, gostrich objects), create an epicritical ball, tied with A fibers, less than 3 fibers.

When we go to the subject, we will stretch the receptor to activate the ionic channels in the Na receptor energized.

polymodal

• - tied with 3 fibers, less than Avoloknam, with a variety of options in more than 1 modality with a high level of energy:
  • a) mechanical teasers, scho ushkodzhu meaning (vise);
  • b) nagrіvannya, scho ushkozhu meaning;
  • c) deyakі chіmіchnі razdratuvannya (capsaicin - the word of red pepper, bradikinin).

Mechanism of activation of dressing receptors, both with the activation of the second channels, as well as with the activation of the second in the middle.

heat receptor

• - tied with 3 fibers, activates special cation channels, adjusted to the temperature of gradation; warm and cold cold weather.
• 4) move the receptor
• - in vychaynyh minds do not get lost before the process, become active during the ignition process. For example: bradykinin, Pg - to increase the sensitivity of receptors, which, when heated, will be susceptible to - a phenomenon of peripheral sensitization.

As of today, I see 2 mechanics

activity of nociceptors:

First of all - to go to the school of education in connection with the time, to the end of the reception of the client to the end of the day When the role of mediators in pain is ignited, it can also be affected by LT, IL-1, IL-8, TNL.

Secondary - the impulse from the nerve is carried out not only in the central nervous system, but in parallel, behind the other terminals, retrograde (tobto back in the moment of the transmission). At the end of the cich terminals, one can see the speech of R.

Yogo Efekti:

Expansion of the Sudin;

Activation of obese cells in the formation of histamine release of nociceptors;

Activation of blood platelets of serotonin activation of nociceptors.

Providnikova part - stimulates the sensible fibers in the rear horns, de-energizing the transition to another neuron on the way.

There are 2 options for conducting:

With normal, not even more frequent, impulses, in the end, glutamate appears, which activates the propionate receptor 2 of the neuron shvidka bl.

Frequent impulses along the afferent path of vision of neutrotransmitters - glutamate and speech and activation to avenge the aspartate receptor 2 of the neuron is more common and strong (which is a sign of central pain sensitization).

Zorovi gorby - 3 neuron to the way sensory zone measles to the brain. The activation of the form is necessary to detect the form of pain. Collaterals of the pain path appear in the structure of the limb system and emotional pain relief.

The destruction of the cortical zone is necessary for the understanding of pain and precise localization.

The persistence of pain - non-meaningfulness, non-differentiation, or even more severe. Winikak zavdyaki damaged nuclei of healthy humps - thalamic bile between green hillocks and cortical zone, for the inclusion of nonspecific thalamic nuclei, circulations are generated = reverberation.

Antinociceptive system (AS)

includes 2 views:

Singing center of the brain with a low antinociceptive path;

Segmental mechanisms or mechanisms of sensory pain flow at the entrance (gate mechanisms).

A.S., yes, spadniy shlyakh, maє centri - the center of the seam, which will drain the Silvia water supply (near-conduit sera of the flute), the core of the seam; Syra rechovina, which lies down to the stems of the III lingo and the middle anterior-cerebral bundle in the central part of the hypothalamus.

The first eferent fibers (enkephalic-secreting fibers) descend from the old speech, the stench ends in the nuclei of the seam. An offensive neuron - (2) - a neuron of the suture nuclei (serotoninergic) - a fiber end in rear horns the spinal cord on the 3rd neuron of the decay path (enkephalinergic), the 3rd neuron set up synapses on the presynaptic terminals of the afferent neuron.

Efekti enkefaliniv:

Changing the amplitude of the potential on the presynaptic membranes.

Reducing the secretion of the mediator of the pain path (-glutamate, speech R).

Galmuvannya / blocking of bolovy impulses for the preparation of presynaptic galmuvannya.

Segmental mechanisms of pain:

The basis of the gate mechanism of regulation of pain flow is the interaction between painful impulses and impulses along the paths of tactile, temperature feeling through neurons (SG) gelatinous substance.

The neurons are stimulated by the flow of temperature and tactile sensitivity and the presynaptic galvanization of another neuron of the pain path.

Sered neurons A.S. abundant neurons secreting opioid peptides (enkephalini, lei-i meth-) and endorphin (29-31 AA).

Earlier, buli opened an opiate receptor, tobto a receptor, which interacts with morphine (alien alkaloid).

Opioid peptides and receptors to them are distributed in the other regions of the brain (hypothalamus, lambic system, the cortex of the great spirits).

Basic effects of opioid peptides:

Play the role of neutrotransmitters A.S.

Zbudzhuyut the center is pleased, wiklyayut to see her.

Є modulators (predisposing organism).

Є components of anti-stress systems and stress-limiting systems.

Especially see the pain:

projectuati bil

When you have a nervous breakdown, you see pain in the appearance of a delay in the surface of your body, if you want to avoid getting sick.

Mechanism: the articulation of the rigidly fixed in the picture of the representative by the scheme of the body.

neuralgia

• - pains, tied with the ears of the nerve stubbury.
• 3) causalgia
• - large, stiff pains, which occur when the sensory fibers of the nerve stems are not completely damaged, which include nice nerve fibers. The breakdown of painful fibers is often attributed to the mechanism of piece synapses (epapses) - not only the earning of nerve stumps and the appearance of strumming.
• 4) Phantom pain
• - pain in the amputated picture.
• 2 hypotheses for development:
• 1. Strengthened pulsation from the kuksi overreacted abnormally rosied nerve in the form of a projection in the cortex of any zone.
• 2. Stike of the circulation is generated between the thalamus and the cortical zone - the projection of the amputated part of the body is generated.
• 5) See the pain
• - zoni Zakhar'ina-Geda.

Mechanism: The principle of innervating the cutaneous segment of the body from the spinal segment of the spinal cord is based on the principle.

• 2 hypotheses:
• 1. The hypothesis of convergence of gentry.
• -the basis is the occurrence of sumatism on the second neuron.
• 2. The hypothesis of lodging.

Topic 3. Pathology of motor functions of the central nervous system

Classification:

Weakening of motor functions right up to the bottom (paresis, paralysis).

Strengthening motor function (hyperkinesia).

Ataxies (the destruction of the coordination of rukhiv in peace and in rusi).

Paresis is either paralleled in the presence of a paralytic system, which will prevent accurate, finely coordinated ruchs, incl. and dribbles of rukhovi navichki (sheet).

Central parallels develop when:

customized tila piradi.

single fibers kirkovykhklitin.

Peripheral parallels develop when:

posed tila -Motoneurons.

single fibers.

Signs of the central parallels:

The loss of considerable ruins on the protele ship floor.

Hypertonicity in common sounds.

Clonus is a rhythmically fast kintzivka with a sharp raptus rattle.

Preservation and strengthening of tendon reflexes on one side.

Nemaє destruction of the trophy of myaziv.

Weakening of abnormal superficial reflexes.

There are 2 main regulatory systems:

• 1) Paramidal system.
• 2) the extrapiracy system.

Saving hypertonicity and tendon reflexes is due to the fact that the tendon reflexes are spinal, and the arch of the spinal reflex is saved, which smells at central parallels. Dystrophies and atrophies of the mucous membranes are not, therefore, the nerve of the mucous membranes is not damaged, the r-motor neuron is an innervular element of the intrafusal fiber.

Mechanisms for strengthening the tendon reflex:

Strengthening the growth of the spinal cord motoneuron due to the reduction of the lower supraspinal infusion, the more galvanizing the reduction of the quicker muscle elements of the intrafusal fiber

Clonus is the result of the strengthening of tendon reflexes with the strength of the effects of adduction.

The weakening of the school's reflexes is the result of the reduction of sensory neurons, the development of motor measles, and also the reduction of the sensory zone.

Babinsky's reflex is the result of a breakdown of the supraspinal injections (fan-shaped spread of the toes at the edges of the dash).

Signs of peripheral parallels:

The prevalence of significant ruins in the vicinity of the cinema, in the same ear segment.

Visibility of tendon reflexes, which causes a reflex arc to appear.

Hypotonia of myasis as a result of the loss of infusion from the proprioceptors of the myasoma spindles.

Atrophy / dystrophy of the musculoskeletal system as a result of denervation and destruction of the connection with the trophic centers.

the snake m'yazovoy fabric, incl. the destruction of the electrical malaise of fabric

Brown-Séquard Syndrome:

(When cutting the right or left half of the spinal cord).

Razlad large and temperature sensitiveness on the other side.

Rozlad glibokoi and see dots on the sides of the game.

Rukhovi rozladi by the type of central parallels on the sides of the spinal cord.

Hyperkinesi.

Overwhelmed, the rapists, who do not accept the will of the people, who are not private, are chimeras.

Classification (in terms of fallowness):

Spinal cord.

Pіramіdnі.

Extrapіramіdnі.

• 1. Spinomozkovykh (sudomi) - posmikuvannya (fastsіlyatsіі) m'yazіv. The stench is not supervised by the collapse of the picture as a whole.
• 2. Pіramіdnі (sudomi):

For character: - clone;

Tonichny.

Clonic - characterized by a quick change in speed and weakness of groups of musculoskeletons, it is possible to suffer from a point dot to the motor zone of measles.

Tonichny - are the fastest growing groups of music and parts of the body, and you can only catch it in an unprecedented position, in conjunction with the one-hour fast communication-antagonisms. Vvazhayut, that fine judgments are found as a result of the destruction of cortical infusions on the pediatric light, on the basal ganglion, tobto on the element of the extrapiracy system.

Judge by themselves not painful, not the symptoms, which occur with small ailments, which supervise the damaged functions and interactions of the cerebral structures.

Sudami buys first (idiopathic; genuinic epilepsy) and second (when dear ones: Lichomaniac in children, alkalosis, infectious and igneous diseases of the brain, injuries> illumination of glial scars> diagnosis of post-traumatic epilepsy).

General mechanisms of pathogenesis by the court:

Disruption of neurotransmitter balance.

Directly destroying neurons when a scar is established.

Weakening galmuvannya in the central nervous system.

Change to the balance of electricity.

The main link to the pathogenesis is the education of the population of hyperactive neurons.

Individual scholarship until the court grows.

• 3.Extrapiramidal (sudomi).
• a) Chorea.
• b) Athetosis.
• c) Khvoroba Parkinson.
• d) score.

Tied to the lesions of the extrapiracytic system (EPC).

EPC is a great system of kernels and paths.

• 1) Basal ganglia: Striopallidal system - caudal nucleus; putamen (pillow); blidiy kulu.
• 2) Chorna substance.
• 3) Luis core.
• 4) Chervone core.
• 5) Reticular formation of the stovbur to the brain.
• 6) Vestibular nuclei.

The slope of the show by the slopes:

Reticulospinal.

Rubrospinalny.

Vestibulospinalny.

• a) Chorea.
• 1) Vinnikє in case of decreased neostriatum of GABA secretion, reduction of black substance (SN), increased production of dopamine, galvanization of neostriatum hypotonia.
• 2) Shrinking the caudal nucleus and putamen (pillows) opening the ring of the ring of the ring of the ring of the premotor zone and measles hyperkinesi.

The nature of hyperkeys:

• - quickness of the proximal parts of the pictures and the minuscule words, grimacing, buvay pribane (rheumatism in childish) I spadkov (vrodzhene - Gutchington's chorea).
• b) Athetosis.

Winikak in case of lateral visualization of the child. Hyperkinesis have the character of worm-like mucus and tulubs, as a result of the rapid masses-antagonisms of distal groups of muses and elements of plastic tone.

c) ballism.

It is characterized by the collapse of the type of threshing (zginannya, rozginnya).

d) Khvoroba Parkinson.

Winikє with the primary posed black substance (SN).

• 1. Possibility of SN reduction in the appearance of dopamine in the growth of striopallidal system and in the strengthening of low-grade infusions on the motor neurons;
• 2. Symptom "toothed wheel".
• 3. Akinesia is manifested as a special foldability of repairing the ruch, the ruin of the pooled from the outside of the day before the ruh in rukh complexes.
• 4. a mask-like person.
• 5. Tremor (tremulous parallel). Vyavlyayetsya in tranquility, characterized as a shydoguvannya m'yaziv-antagonistv in distal viddilah.

The tremor is based on the strength of the stimulation of the striopallidal system, which will ease the galaxies in the water, instead of the active corks in the inflow, the emergence of the stimulation in the premotor zone of measles, and the growth of the stimulation through the inertia.

Cerebral tremor is dynamic.

The loss of the coordination of ruffles during standing and walking.

See ataxia:

• 1) Spinal - impaired afferentation of the proprioreceptors.
• 2) Cerebral (lobova) - with cortical obstructions.
• 3) Cerebellar.
• 4) Labyrinth - in case of impaired control of the level.

Ataxia buva is static (when standing) or dynamic (when walking).

Topic 4. Pathophysiology of GNI

VND is the behavior of the newly-born people, which is the same as the behavior of behavior (instinct) and science.

To base the VND on the vital functions of the brain:

Sleepyattya.

Uvaga.

Zdibnosti until navchannya.

Mova. vegetative nervous breakdown

The pathology of VND is based on the destruction of vital functions of the brain and subcortical structures.

Destruction of GNI can be the result functional arrangements(dynamics nerve processes in singing messages to the brain); They can be organic, as a result of increasing the growth of the brain.

Classic butt of functional poles.

Neurosis is a psychogenic, neuropsychic disagreement, as a result of the destruction of the relationship between people and the callous middle-class, since in the name of the young middle-class it overturns the power of people and manifests itself in singers key symptoms, Ale without psychotic problems (without symptoms).

Neurosis is an ailment of specialness, which is a result of the confrontation between people and the last middle-class.

Ethiology:

Overwhelming neuropsychic overstrain:

• a) socially unfavorable,
• b) a particular problem (vyrobnichya activity),
• c) insensitive (unhappy love),
• d) extremal stanu (wines, earthlings).

There are 3 concepts of walking neuroses, quilting the links between specific circumstances and the result of overworldly stress.

Theories of neuroses:

Biological (Petro Kuzmich Anokhin).

The reason for the psycho-emotional stress of the people is the lack of good fortune between the planned achievements and the real result. Chim important є meta, the motive of the dei, tim bolsha vpruga viklikє tse nezgozhenist.

II. Information (Pavlo Vasilovich Simonov).

The main reason for the overwhelming stress is the lack of necessary information, especially on the overwhelming, new information.

Formula for the step of neuropsychic stress:

n - necessary: ​​information, hour, energy;

h - information: information, hour, energy.

What is more important is the death meta and what is more difference between the real and necessary minds, the more steps of nervous overstrain.

Stages of neuropsychiatric stress:

Mobilization of respect, activity of people and the promotion of RS.

Growing spasms before the appearance of an emotional supportive (there are active stenic negative emotions - gniv, fierce, aggression).

Development of asthenic negative emotions (fear, depression, tightness).

There are 3 steps of neuropsychic stress of werewolves, and in case of a psycho-traumatic situation, everything comes back to normal.

Determination of neurosis, as well as vimag of special treatment.

Sh. Theory of deficiency of adaptive energy - volovy energy = deficiency of social development in the course of the formation of people.

Sick to neurosis - children who grow in the minds of isolation from one-sided.

Factors of risk of development of neuroses:

Vіk (yunaki, lіtnі people - the adjustment of asthenizatsion of the nervous system in conjunction with endocrine worms).

Kharchuvannya (there is a sufficient number of bricks in the country, especially in the first three years of life, there is a shortage of bricks in the brain and VND).

Hypodynamics (reduction of anxiety and activity in the brain, because:

• a) reduction of impulses in the brain, activation through the reticular formation of the stovbur to the brain;
• b) obmezhennya blood supply to the brain through detraining of the myocardium;
• c) hypoxia to the brain).
• 4) Kurinnya, alcohol.
• 5) Robot people, tied up with overworked people (people are rosy).
• 6) Zmіna of minds of life (urbanization of the population).
• 7) Singing type of VND (і biological and especially human).

The type of VND - the characteristic of people is very important in nature, it is based on the power of nervous processes.

Principles of classification of GNI:

Alignment of nerve processes and powers:

strength - timeliness - ruggedness

First, the mind-reflex method (the activation of nerve processes) has propelled I.P. Pavlov:

Seen the main type 4, which can be derived from the classification of temperaments of Hippocrates.

Temperament - the characteristic of the people is naturally summed up, including the dynamic power of the psyche, which is manifested in all reactions of the people.

Temperament pіznіshe buv descriptions by Kant, Galen.

• * 1 type according to Pavlov - a strong neurological impairment type with impairment (choleric after Hippocrates).
• 2 type according to Pavlov - strong, level, ruhlivy (sanguinik).
• 3 type according to Pavlov - strong, level, inert (phlegmatic).
• * 4 type according to Pavlov - weak type (melancholy).
• * - decline in mental capacity to neurosis.
• 2) Vlasne human tipi VND.
• Principle 1 - general biological typi.

People's tipi - the image of a person's callous light, like to lay down from 1 and 2 of the signaling system.

• a) sensory - garnishing development of 1 signaling system, imagery, redness of the target of people.
• b) abstract - garnishing development of the 2 signaling system, in the misinterpretation there is a widespread understanding of the apparatus.

Signal systems 1 and 2 are shown as follows:

• 1) artistic (artistic type).
• 2) pink (abstract type).
• 3) hesitation (middle type).

If the mental capacity to develop neuroses lies in the natural, biological type, then the key form is to lie in the specific human type of GNI.

Basic clinical forms of neuroses:

Neurasthenia.

Obsessive-compulsive neurosis.

It develops in people of a wicked type, tied with trivial and repeated mental traumatization.

• 1. Hypersthenic - increased reactivity, responsiveness (fast sleepy, fast sleep).
• 2. hiposthenic - a decrease in the strength of nerve processes.
• 3. Asthenic - weakening of nervous processes, administrative, etc.

Vinikak in people of the artistic type is reduced by intellect. It is characterized by the increased vigor of the people up to the midst of the middle, demonstrative behavior; sensory impairments to the point of more slap and deafness; motor injuries; vegetative reactions from the side of the heart vascular system (arrhythmias, arterial vices).

Winning people with understandable misinterpretations. A whole neurosis is manifested by phobias, anxiety, ritual actions; nosophobia.

Pathophysiological aspects of VND damage in neuroses:

Destruction of the processes of development.

Destruction of galvanized processes.

See neuroses.

There are 2 types of debris from damage to processes: 1) damage, 2) galvanization and 3) failure of nerve processes.

Reasons for rejecting neuroses:

Zasosuvannya overworldly podraznikiv.

Mechanism: overexertion of the processes of development.

Strengthening the soul of galvanized razdratuvannya.

Mechanism: overexertion of galvanizing processes.

Overexertion of the collapse of the nervous processes (overloading of the signal value of the patient).

Immediately stagnation of positive and negative simulations of the "fixing" of nervous processes, breakdown of decay and temporality of processes.

Vibrating folding differentiation

Pathogenesis of neuroses:

Asthenization of nerve cells - a decrease in MS.

Changing the strength of galvanizing and stimulating processes.

Destruction of the timing of the processes.

Damage to decay of nerve processes:

• a) from the adjustment of the collapse (the adjustment of the lability of the processes);
• b) due to the decrease in decay (increased inertness).
• 5) Development of phasic manifestations (div. Parabiosis).
• 6) Vegetative damage (damage from the side of the heart-vascular system).

Lіkuvannya neurosis.

Suck down psychic traumatization.

Medication for the correction of nervous processes (tranquilization, sedation, sleep).

The correct regime is correct and correct.

Secondary neurosis (somatogenic) - neurosis, which is diagnosed in the presence of somatic diseases.

Mechanism of development of somatogenic neuroses:

Unwelcoming inflow of the self-ailment (psychogenic).

The afferent pulsation of the affected organs is unavoidable (pain pulsation and chronic pain).

Disruption of delivery to the tissue of the brain of the necessary living words, O2 hypoxia, damage to the harvest.

Topic 5. Pathology of the autonomic nervous system

The nervous system is nice (senior researcher);

The nervous system is parasympathetic (psi).

The nervous system is sympathetic - it is energotropic, so it is sympathetic to the activation of a healthy universesal catabolic action, to the preservation of the energy-saving activity of the organism, and to the effective control of energy.

VNS - 2 neurons, neurons are digested in vegetative ganglia.

Preganglial fibers are short, postganglial fibers are the more diffuse nature of the generalized reaction of the fibers. The secreting features of the preganglial nerve fibers are all cholinergic.

Postganglial fibers in their greater adrenergic vision of norepinephrine, in addition to sweaty hairs and small vertebral membranes (cholinergic).

Efekti senior researcher:

• - stimulation of the heart-vascular system,
• - enlargement of bronchial tubes і t. D.

The parasympathetic nervous system is trophotropic, which stimulates the processes of anabolism and the restoration of reserves and the establishment of a depot of lively rivers.

Preganglionic fibers (from craniobulbar and sacral viddiliv) in organs switch to intramural ganglia, postganglionic fibers, short> parasympathetic local reactions (cholinergic).

Efekti p. S. N.S.:

Protylezhny Senior Researcher

If you are sympathetic and parasympathetic in the form of the nervous system, it is intertwined with the flow.

The nervous system is nicely activated

parasympathetic through such mechanisms:

Central.

Reflexive.

Peripheral.

• a) strengthening the energy exchange in all nerve centers;
• b) adjusting the activity of cholinesterase;
• c) the addition of Ca2 + in the blood to the activation of the ps. center

The improvement of the arterial grip is a nice effect of the strengthening of the development of the baroreceptors, the improvement of the tone of the bloating nerves.

Basically: stifling activity of cholinesterazi ruinuvannya ACH.

The nervous system is parasympathetic with activation

nice to see through the following mechanisms:

Reflex activation from reflexogenic zones.

Peripheral mechanisms of surplus of ions K +.

Vvazhayut, what products exchange A and HA (adrenochrome) may cause vagotropic activity.

The interconnection of systems is a safe balance of sympathetic and parasympathetic effects, and the balance can be broken down into the background of this system.

The list of VNS functions include:

Functional rosary, knitted from the changing center.

Peripheral rosters - the reduction of nerve fibers.

Tsentrogenno razladi (reduction of diencephalic areas to the brain).

Div. Pidruchnik Zayko.

See the adjustment to the tone of the vegetative centers and the deterioration of the awfulness (tone).

Main damage to tone:

Sympathotony is to improve the tone of the sympathetic centers, to supervise the improvement of the effective impulses and massive visions of mediators. When the synthesis of mediators is improved, the synthesis of mediators does not lead to an increase in the synthesis of those enzymes in the prolonged development of mediators.

Vagotonia is a stimulation of the tone of parasympathetic centers.

Amphotonia - adjusting the tone of both centers.

Sympathoergy - an increase in the alertness of a sympathetic response to a stronger response, albeit for a short time, which makes the synthesis of a mediator more powerful than the advancement of the synthesis of enzymes that inactivate it. (ON INACTIVE MAO, OAT).

Vagoergia - an increase in the awkwardness of a parasympathetic viddilu. Bagato AtsX, bagato cholinesterasi.

Amphoergy is an increase in the anxiety of both forms of the autonomic nervous system.

Peripheral syndromes manifest themselves most beautifully on the surface of the body and tied with bundles of pretty nerve fibers, including:

Syndrome of sympathy with sympathy:

• a) fixing the dryness of the skin;
• b) loss of the pilomotor reflex;
• c) after the first 10 days - hyperaemia as a result of paralytic arterial hypertension, in which cyanosis appears as a result of arterial spasm and a decrease in blood flow.

Teasing syndrome:

• a) hyperhidrosis as a result of the activation of sweat zones;
• b) strengthening the pilomotor reflex;
• c) change of shkirnykh pokriviv - sweeping, peeling of shkiri, approval of “rubbish”, “kigtepodibni” nigtiv;
• d) sympathy;
• e) the adoption of razor-sharp movements, which can lead to the development of a razdratuvannya syndrome.

Denervation hypersensitivity syndrome.

• a) convulsive spasm. Mechanism: adjusting the sensitivity of denervation tissue (її recipes) to humoral stimuli;
• b) sensitivity adjustment. Mechanism: an increase in the number of vilny types of interaction with ligand receptors, an increase in the number of receptors.

Trofika. Dystrophies.

Trofikas - the essence of the processes, which will ensure:

pidtrimannya metabolism of cellini;

adjustment of the structural and morphological organization of cellini;

securing the optimal efficiency of the cell.

The number of processes involved includes:

the hopefulness of living talk and gas into the cell,

by disposing of the clutter,

balancing the processes of assimilation and dissemination,

synthesis of macromolecules and plastic materials,

vivedennya from cells of products to metabolism.

Normally, the trophic camp of the clitini is neutrophia.

See the destruction of the trophy:

Кілкісні: - hypertrophy;

• - hypotrophy;
• - atrophy.

Yakisnі: - dystrophy.

Dystrophy - damage to the trophism, as a result of damage to the metabolism of cellini; the ruin of the authorities of the clitinnyh devices (membranes); to the ruin of the powers of mitochondria. Change of the cellin genome and antigenic powers of the cellin.

The overwhelming result is the destruction of the building of the cell to self-improvement and self-improvement.

Mechanisms of trophic regulation:

Humoral, including endocrine.

Tse mіzhklіtinnі vzaєmodії.

Nervous control - to live according to the reflex principle and the afferent and the eferent nerves take their fate.

Mechanisms of nervous control:

Metabolic effects of mediators, the stench is the most demonstrative in case of healthy tonic uninterrupted impulses, like a quantum vision of mediators. Phase impulses = discrete, tied to a specific reaction of the effectors. Mediators in small quantities can stimulate the metabolism of the cell, which is beyond the reach of the difference to the organ.

Sudinny is the serpent of blood supply to the body.

Increased penetration of gistogematic bars.

Afferent nerves come through trophic inflows into the nerve zone through the antidromic current of axoplasms, so that the axoplasm collapses into the receptor side.

Endocrine control - infusion on metabolism.

Dystrophies, diseases of the nervous system - neurogenic dystrophies.

4 groups of neurogenic dystrophies are seen, according to

with the nature of the shkodzhennya:

Poshkogennya afferent fibers.

Shkokogennya eferent fibers.

Increased adrenergic fibers.

Poshkozhennya nerve centers - centrogenic dystrophy.

Features of centrogenic dystrophy:

A quick development of degeneration of afferent fibers.

Preservation of current injections.

Zmіna adrenergic injections.

A vision of neurohormones.

Pathogenesis of centrogenic dystrophies:

Applying afferent impulses to the centers, tissue anesthesia

Strengthened pulsation to the nerve centers as a result of the expansion of the proximal end of the nerve nerve.

Traumatization of the denervated organ has been increased.

Uninvolved impulses along the eferent fibers.

The change of a / g tissue power to the inclusion of autoimmune processes.

The sensitivity of the effector is indispensable.

Show centrogenic dystrophy:

dedifferentiation of tissues, bending of combined elements (loss of health before regeneration);

early death of klin;

approval of virazok;

Immune and autoimmune tissue tissue and leukocyte infiltration.