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Special Propedeutics of Internal Diseases

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Special Propedeutics of Internal Diseases VITEBSK STATE MEDICAL UNIVERSITY DEPARTMENT OF PROPEDEUTICS OF INTERNAL DISEASES SPECIAL PROPEDEUTICS OF INTERNAL DISEASES LECTURE COURSE Compiled by L.M. Nemtsov, MD (2-е издание) Vitebsk, EI «VSMU» 2016 УДК 616.1/.4-07(07) ББК 54.1 С 71 Рецензенты: директор Белорусского государственного медицинского колледжа доктор медицинских наук И.И. Бураков; профессор кафедры общей и клинической фармакологии Витебского государственного медицинского университета доктор медицинских наук М.Р. Конорев Немцов Л.М. С 71 Special propedeutics of internal diseases : lecture course (Частная пропедевтика внутренних болезней : курс лекций (на английском языке) / Л.М. Немцов. – 2-е изд. – Витебск: ВГМУ, 2016. – 318 с. ISBN 978-985-466-822-2 Курс лекций «Частная пропедевтика внутренних болезней» составлен в соответствии с типовой учебной программой по пропедевтике внутренних болезней, утвержденной Министерством Здравоохранения Республики Беларусь в 1997 г., регистрационный № 08-14/5906, и рабочей учебной программой по пропедевтике внутренних болезней для студентов лечебно-профилактического факультета, утвержденной ВГМУ 29.08.2003 г. по специальности «Лечебное дело». УДК 616.1/.4-07(07) ББК 54.1 Первый выпуск в 2011 г. Немцов Л.М., 2016 УО «Витебский государственный медицинский университет», 2016 ISBN 978-985-466-822-2 CONTENT pp reface 5 Diseases of respiratory system Clinical, laboratory and instrumental methods of diagnostics 6 Basic clinical syndromes of pulmonary diseases 13 Respiratory insufficiency (failure) 18 Bronchitis 21 Pulmonary emphysema 25 Cor pulmonale (pulmonary heart) 27 Conception of chronic obstructive pulmonary disease (COPD) 29 Bronchial asthma 31 Pneumonia 36 Pleurisy 43 Diseases of blood circulatory system Clinical, laboratory and instrumental methods of diagnostics 48 Circulatory insufficiency 55 Clinical syndromes of arrhythmias 67 Acute rheumatic fever (Rheumatism) 68 Infective (bacterial, septic) endocarditis 75 Conception of non-rheumatic myocarditis, myocardial dystrophies, and cardiomyopathies 78 Acquired heart valves diseases: 82 mitral incompetence 83 mitral stenosis 85 aortic incompetence 87 aortic stenosis 90 tricuspid incompetence 91 Essential arterial hypertension 95 Conception of symptomatic (secondary) arterial hypertension 102 Ischemic heart disease: 104 angina pectoris (stenocardia) 105 myocardial infarction 111 conception of acute coronary syndrome 119 Diseases of digestive system Symptomatology and diagnostics of diseases of esophagus, stomach, and duodenum 120 Study of gastric secretion 126 Syndrome of dysphagia 129 Gastro-esophageal reflux disease (GERD) 130 Functional dyspepsia 133 Gastritis 136 Peptic ulcers of stomach and duodenum 139 3 Symptomatology and diagnostics of intestinal diseases 144 Coprology studies 147 Basic clinical syndromes of intestinal diseases 152 Irritable bowel syndrome 160 Cronh's disease 162 Non-specific ulcerative colitis 165 Clinical and laboratory examination in the liver and bile ducts diseases 167 Basic clinical syndromes of the hepatobiliary pathology 181 Biliary dysfunction (dysfunction of gallbladder and sphincter of Оddy) 188 Cholecystitis 190 Cholelithiasis 192 Cholangitis 194 Chronic hepatitis 195 Liver cirrhosis 198 Diseases of kidneys and urinary paths Clinical, laboratory and instrumental methods of diagnostics 203 Basic clinical syndromes of kidneys and urinary paths diseases 213 Acute glomerulonephritis 221 Chronic glomerulonephritis 224 Pyelonephritis 226 Diseases of blood Clinical, laboratory and instrumental methods of diagnostics 228 Basic clinical syndromes of the blood diseases 240 Anemia 246 Hemorrhagic diathesis 251 Leucosis 255 Diseases of endocrine system and metabolism Clinical, laboratory and instrumental methods of diagnostics 262 Goiter (goitre, struma) 269 Hyperthyroidism (thyrotoxicosis) 270 Diffuse toxic goitre (Basedov´s, or Grave´s disease) 273 Hypothyroidism (myxedema) 274 Diabetes mellitus 276 Obesity 284 Cachexia 287 Acute allergic diseases Conception of allergy (hypersensitivity) 292 Disorders of vasoactive mediators: Urticaria and angioedema 294 Acute anaphylaxis (Anaphylactic shock) 296 Symptomatology and diagnosis of HIV and AIDS 299 Supplement. Standards of laboratory tests 308 Literature 318 4 The lecture course of special propedeutics of internal diseases is designed basically for students of the faculty for the training of foreign citizens through the mediation of the English language during the course of studies. The lectures can be useful to teachers of therapeutic departments of medical universities while preparing for their classes with foreign students, to senior students, post-graduates and clinical residents. The lectures correspond to the basic educational thematic parts of the special propedeutics of internal diseases, according to Standard Educational Program of internal diseases propedeutics approved by Ministry of Public Health of Republic of Belarus in 1997 (registration number 08-14/5906) and the work program of internal diseases propedeutics for students of medical faculty approved by Vitebsk state medical university in 2003. The reference sources of the lectures are selected with regard for the modern level of internal medicine development. We ask to send all critical remarks and wishes to the department of propedeutics of internal diseases of Vitebsk state medical university. 5 Diseases of respiratory system Clinical, laboratory and instrumental methods of diagnostics Diagnosis and management of pulmonary disorders requires a history, a physical examination, and usually chest x-rays. Laboratory examinations, such as common blood count, analysis of sputum, pulmonary function testing, arterial blood gas analysis, chemical or microbiologic tests, and other special studies (e.g. bronchoscopy) may be needed. Subjective examination (inquiry) in diseases of respiratory system Complaints The basic complaints are typical for the respiratory system: - dyspnea (character – inspiratory, expiratory, mixed; persistent, progressive, periodical); - cough (dry, wet; character of sputum); - bloody expectorations (hemoptysis); - pain in the chest (localization; relationship to cough, respiratory phase, position of the patient); - fever (character and level of body temperature). History of the present disease gives answers about: - beginning of diseases (acute, gradual); - contact with infections patient (in tuberculosis, influenza, other acute respiratory infections, AIDS) - exposure to environmental allergens (dust mites, pet dander, or cockroach allergens in the home or allergens in the outdoor environment such as pollen and ragweed) or occupational allergens (in bronchial asthma); - course of disease (acute, prolonged, chronic, persistent, periodical exacerbations); - chilling and cooling (in acute bronchitis, pneumonia, chronic bronchitis); - previous (before hospitalization of the patient) examinations and treatment (the medical preparations, their effectiveness) of present disease. History of past life includes questions of: - smoking history (the number of years of smoking, the intensity, passive smoking); - occupational hazards (coal, silica, asbestos dusts; cold and wet working conditions); - living conditions; - allergy (polinosis, inhalant allergy- hay fever, house dust allergy, medications); - frequent respiratory infections; 6 - others predisposing diseases and factors (tuberculosis, diabetes mellitus, various chronic purulent diseases, acute and chronic heart, shock, disorders of nutrition); - family history (bronchial asthma, cystic fibrosis, a1-antitrypsin deficiency). Objective examination in diseases of respiratory system Physical examination follows history taking in importance. The sequence of inspection, palpation, percussion, and auscultation should be followed when examining the lungs. General inspection (survey) may detect typical symptoms of respiratory system diseases: Position of patient - active, passive, forced lateral recumbent (in pneumonia, tuberculosis, exudative and dry pleurisy, pulmonary abscess or gangrene, bronchiectases), forced sitting (pneumothorax, an attack of bronchial asthma, emphysema). Colour of skin: - “facies febrilis“ is characterized by hyperemic skin, sparkling eyes and excited expression; feverish redness in acute lobar pneumonia is more pronounced on the side of the affected lung; - cyanosis - central cyanosis in respiratory failure (various degrees of blueness from moderate cyanosis of the face up to diffuse cyanosis); - peripheral cyanosis is associated with stasis of circulation (blueness of distal parts of extremities, prominent parts of nose, cheeks, ears and tip of tongue). Drumstick (clubbed, Hippocratic) fingers - enlargement of the terminal digital phalanges with loss of the nail bed angle (“watch glass nails”) in prolonged suppurative processes in lungs (abscesses and gangrene), emphysema, tumours of mediastinum and lungs, bronchoectatic disease, chronic circulatory insufficiency, liver cirrhosis. Inspection of chest Static survey estimates the shape of the chest at quiet respiration. Pathological chest: emphysematous (barrel-like), paralytic chest, rachitic (keeled or pigeon chest), funnel, foveated, kyphoscoliotic. Asymmetric expansion of the chest is usually due to an asymmetric process affecting the lungs, such as endobronchial obstruction of a large airway, unilateral parenchymal or pleural disease, or unilateral phrenic nerve paralysis. Visible abnormalities of the thoracic cage include kyphoscoliosis and ankylosing spondylitis, either of which can alter compliance
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