Respiratory System Disorders and Therapy From a New - Louis Bolk ...

from the mesoderm in the yolk sac via the liver to the bone marrow. During life, when there
is a need, the ability of the liver to contribute to erythropoiesis can be reactivated. This
is also possible in regard to the vascularization of different parts of the body. Normally,
the peritoneum is not vascularized. In appendicitis, a functional vascular system develops in
the peritoneum through vasculoneogenesis. It will disappear again once the peritonitis has
healed. In shock, people faint because there is an underfilling of the blood vessels to the
brain as a result of the opening of vascular beds elsewhere in the body which draws away a
large volume of blood. The infiltrate that is formed in pneumonia (and in other inflammatory
processes, such as sinusitis or otitis) results from an increased blood supply and from fluid
components and blood cells leaving the blood. There is a functional dislocation in these
cases.
Another instructive example is thrombosis. The fact that blood can clot is obviously of vital
importance for the organism. However, blood clotting in veins that are not injured is a
pathological process. Deep venous thrombosis is an example of this.
The above examples make it clear that the ability for functional dislocation is a dynamic
aspect that makes pathological processes recognizable as a healthy process in the wrong
place.
The Relation between Aeration and Vascularization of the Lung
In the healthy lung, the relation between ventilation and perfusion varies. In the lung
apex, aeration dominates vascularization and as a result there is more ventilation than
perfusion. In the middle segments, ventilation and perfusion keep each other in balance
and, at the base of the lung, perfusion dominates over ventilation.
The dynamic approach can identify three areas of function with differentiated relations
between ventilation and perfusion in the lung. The lung apex is ‘a bit asthmatic,’ and
the lung base is ‘a bit pneumonia-like.’ Shifts within these relations can be described as
a ‘dislocation’ in space. In asthma, COPD, and related diseases, the entire lung assumes
characteristics of the lung apex (fig.5.3.); in pneumonia and related diseases, it assumes
characteristics of the lung base (fig.5.2.).