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Diagnostics and Treatment of Internal Diseases in the Elderly

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Diagnostics and Treatment of Internal Diseases in the Elderly MINISTRY OF HEALTH OF UKRAINE ZAPORIZHZHIA STATE MEDICAL UNIVERSITY Department of Internal Diseases -1 and Simulation Medicine V. D. Syvolap, T. V. Bogoslav DIAGNOSTICS AND TREATMENT OF INTERNAL DISEASES IN THE ELDERLY (gastroenterology, pulmonology, hematology) Training manual Zaporizhzhia 2020 1 UDC 616.1/3-053.9(075.8) S98 Ratified on meeting of the Central methodical committee of Zaporizhzhia State Medical University (protocol № 4 from 28.05. 2020) and it is recommended for the use in educational process for foreign students. Authors: V. D. Syvolap - MD, PhD, professor of Department of Internal Diseases -1 and Simulation Medicine of Zaporizhzhia State Medical University. Т. V. Bogoslav - PhD, docent of Department of Internal Diseases -1 and Simulation Medicine of Zaporizhzhia State Medical University. Reviewers: S. Y. Docenko - MD, PhD, Head of Department of Internal Diseases-3 of Zaporizhzhia State Medical University. V. V. Syvolap - Professor, Doctor of Medicine, Head of Department of Propedeutics of Internal Diseases, radiation diagnostics and radiation therapy of ZSMU. S98 Syvolap V. D. Diagnostics and treatment of internal diseases in the elderly (gastroenterology, pulmonology, hematology): training manual / V. D. Syvolap, T.V. Bogoslav. - Zaporizhzhia: ZSMU, 2020. - 116p. The training manual was prepared in accordance with the requirements of the new program of the discipline "Internal Medicine" for higher medical schools of III-IV levels of accreditation, approved by the Ministry of Health of Ukraine (2016). The manual contains training materials on the topic "Diagnostics and treatment of internal diseases in the elderly." The physiological changes in the aging digestive, respiratory, blood and blood-forming organs, the features of diagnostics and treatment in the elderly, the pharmacokinetics and pharmacodynamics of medications are highlighted. The methodological and educational materials presented in the manual will allow students not only to learn the basic gerontological aspects in the clinic of internal diseases, but also to gain practical skills in the supervision in elderly patients. UDC 616.1/3-053.9(075.8) © Syvolap V. D., Bogoslav T.V. 2020. © Zaporizhzhia State Medical University, 2020 2 CONTENT Introduction……………………………………………………………… 4 1. Actuality ................................................................................................ 5 2. Learning objectives ................................................................................ 6 3. Materials for classroom self-study work 8 ................................................... 3.1. List of basic terms and characteristics that student must acquire.......... 8 3.2. Content of the topic............................................................................... 9 3.3. List of recommended literature ............................................................ 40 3.4. Materials for student self-assesment at the classroom stage ................ 44 4. Materials for classroom self-study work.................................................. 56 4.1. Practical assignments students carry out on practical training .............. 56 4.2. Methodological support for self-study work of students at the stages of practical training....................................................................................... 58 5. Tasks and materials for extracurricular self-study work .......................... 58 Annex 1. Abbreviations used in the results of laboratory and instrumental studies............................................................................................................ 59 Annex 2. Main laboratory values and their interpretation............................ 62 Annex 3. Schemes of describing the main instrumental studies................... 84 Annex 4. Examples of interpretation of laboratory and instrumental studies ........................................................................................................... 91 Annex 5. Examples of situational tasks and rationales for their solving .......................................................................................................... 101 3 INTRODUCTION The expediency of preparing the training manual is due to the need to make changes to the organization of the educational process in accordance with the requirements of the new curriculum discipline “Internal Medicine”, approved by the Ministry of Health of Ukraine in 2016. The main component of these changes in the program is the addition to the content module-5 the topic of etiology, pathogenesis, and features of the clinical manifestations of the main internal diseases in the elderly, assuming students are to master theoretical knowledge, to acquire skills of supervision, physical examination of elderly patients, interpreting laboratory results and instrumental studies, methods of differential diagnosis and rationale for the clinical diagnosis, prevention and treatment of the elderly patients based on the principles of evidence-based medicine, and to acquire knowledge on issues of medical ethics and deontology. 4 1. Actuality The planet’s population is rapidly aging. According to the WHO, by 2050 the number of elderly people in the world will increase to 38% and times, when such people prevail in the general population, will quickly come. In EU countries, the life expectancy of men is 74 - 77 years, women 80 - 82 years. The level of health and especially morbidity in the elderly are due to an increase in the number of chronic diseases [1-2]. According to the WHO, more than 40% of people aged 50- 65 have 4-5 diseases, and 66% of people over 75 have more than 5. The sickness rate in the elderly (60-74 years) is almost 2 times higher , and in senile (75 years and older) - 6 times higher than in young people [3]. Ukraine belongs to the demographically old countries of the world. The proportion of the population, who are 60 years and older, is 20.3%. According to WHO, by the middle of this century, this percentage is expected to increase in Ukraine to 38.1%, and the proportion of people who are 80 years and older will increase by 3.5 times. Aging of the population is closely related to an increase in the prevalence of age-dependent pathology, especially circulatory system diseases, which take first place in prevalence, which determine more than half of all deaths and a third of cases of disability. The purpose of the publication of this manual is to help students study the aging process, age-related physiological changes in organs and systems, the characteristics of the course of diseases, and acquire skills for diagnostics and treatment in the elderly and senile patients. 5 2. Learning objectives: Students will learn the features of development, course, symptoms, clinic, diagnostics and treatment of diseases in the elderly. Students will acquire skills of history taking in the elderly and senile patients. To teach students to interpret the results of objective examination, laboratory and instrumental studies in the elderly and senile patients. Students will understand features of pharmacodynamics in patients of older age groups. Students will study the principles of drug therapy in elderly patients. Student must know: • Physiological characteristics of the elderly. • Features of pathology in the elderly. • Features of comorbid pathology in the elderly • Psychological features of the geriatric patient • Features of the development, course, symptoms, clinic, diagnostics and treatment of diseases in the elderly. • Features of the collection of anamnesis in elderly patients • Interpretation of the results of objective examination, laboratory and instrumental studies in the elderly patients. • Features of pharmacodynamics in patients of older age groups. • Features of the effect of drugs on the body of an elderly person. • Principles of drug therapy in the treatment of the elderly. • Emergency care algorithms for the elderly patients. Student must be able to: Take history, perform physical examination in the elderly patinets and diagnose the most common diseases of the digestive, respiratory, blood and blood-forming organs. 6 Identify a typical clinical picture of the most common diseases of the internal organs in the elderly. Identify types of the course and complications of the most common internal diseases in the elderly. Make a preliminary diagnosis for the most common diseases of the internal organs in the elderly. Draw up an examination plan, justify the need for use, determine indications and contraindications, possible complications when performing invasive and non-invasive diagnostic methods in elderly patients. Interpret laboratory and instrumental studies in elderly patients. Make differential diagnosis based on analysis of the results of clinical, laboratory and instrumental examination. To reason and formulate a diagnosis for the most common diseases of the internal organs in the elderly. Prescribe treatment, carry out primary and secondary prevention of the most common diseases of the internal organs in the elderly. Assess the prognosis and performance for the most common diseases in the elderly. Diagnose and provide medical care in emergency situations for the most common diseases in the elderly. Perform medical manipulations according to the topic of practical training. Obtain medical records in accordance with the requirements of the discipline program. Demonstrate knowledge of the moral and ethical principles of a medical specialist and the principles of professional subordination.
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