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Pathological Anatomy / ответы для экзамена ЕМ (1).docx
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  1. Calcium metabolism:

1. Calcium absorption begins in the initial part of the small intestine at pH < 7 with the participation of vitamin D and fatty acids in the form of calcium phosphates.

2. Calcium phosphates enter the liver, and then into the general bloodstream (blood calcium concentration 0.25-0.30 mmol / m), then deposited in bone tissue (in the form of hydroxyapatites)

3. If necessary, calcium is disposed of from the spongy substance of metaphyses and epiphyses in two ways: a. lacunar resorption by osteoclasts b. axillary resorption (smooth resorption) - dissolution of bone without the participation of cells to form "liquid bone".

4. Calcium circulating in the blood is excreted from the body through a. colon (65%) b. kidneys (30%) c. bile (5%)

5. Normally, the intake of calcium is equal to its excretion.

Regulation of calcium metabolism:

1. parathyroid hormone: utilization of calcium from bones

2. Thyroid calcitonin: deposition of calcium from the blood into the bones

3. Vitamin D: necessary for the absorption of calcium in the small intestine

The outcomes of calcification:

a) metastatic calcification: with lung damage, respiratory failure is possible; with massive nephrocalcinosis, renal failure is possible; with myocardial damage, the formation of chronic heart failure is possible

b) dystrophic calcification: the formation of a heart defect with calcification of valves; coronary artery disease with atherocalcinosis of the coronary arteries, etc.

c) metabolic calcification: usually an unfavorable outcome, since the precipitated lime practically does not dissolve.

The mechanism of development. Depending on the predominance of general or local factors in the development of calcification, three forms of calcification are distinguished: metastatic, dystrophic and metabolic.

  1. Dystrophic calcification: definition, causes, mechanisms of development. Macro- and microscopic changes in organs, clinical significance. Disease examples.

Etiology of dystrophic calcification (petrification): topically with necrosis, dystrophy, sclerosis under conditions of alkalinization of the medium and increased activity of phosphatases released from damaged tissue.

Dystrophic calcification is local in nature and is not accompanied by hypercalcemia. The main cause of dystrophic calcification is the physico-chemical changes in tissues that ensure the absorption of lime from the blood and tissues of the liquid. The greatest importance is attached to the alkalinization of the medium and the increased activity of phosphatases released from necrotic tissues.

Morphologically: the foci of dystrophic calcification are pertificates; in this case, both individual necrotic cells (psammoma corpuscles) and large areas of necrosis are petrified.

The most common are:

a. petrifications in the lungs during the healing of foci of caseous necrosis in tuberculosis: foci of white color, stony density, surrounded by a connective tissue capsule (are a favorable sign).

b. calcified atherosclerotic plaques (atherocalcinosis).

c. scar tissue of the valves.

d. dead parasites, dead fetus (lithopedion).

Outcome: the formation of a heart defect with calcification of valves; coronary artery disease with atherocalcinosis of the coronary arteries, etc..