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ANSWERS ON QUESTIONS
Main part
A 35-year-old man turned to a general practitioner
intense pain after eating in the epigastric region after 30-60 minutes and
passing after 1-2 hours, heartburn, nausea, single vomiting at the height of pain,
bringing relief.
Considers himself ill for about 15 years, when there were non-intense pain in
pit of stomach, arising after eating.
Chronic superficial gastritis was diagnosed as outpatient. Pain
lasted 2-3 weeks, after which they passed.
Later they arose annually in the autumn-spring period.
When pH-metry revealed an increase in the acidity of the gastric contents.
He was treated on an outpatient basis, tried to follow a diet.
For pain, he took Ranitidine (30 mg per day).
This exacerbation began in March, lasting 3 weeks.
Smokes for 8 years at 15 cigarettes per day.
On palpation, local pain in the epigastric region is determined,
positive symptom of Openkhovsky (pain when striking the spinous processes of VII-
XII vertebrae).
Questions:
1. State the most probable preliminary diagnosis.
2. With what diseases of the stomach is it necessary to conduct differential
diagnosis?
3. What additional studies can be performed to confirm and
clarification of the diagnosis?
4. What is the standard treatment for this disease (indicating doses and multiplicity
introduction)?
5. What are the possible complications of this disease?
Situational task 192 [K002055]
Instructions: READ THE SITUATION AND GIVE EXPLAINED
ANSWERS ON QUESTIONS
Main part
A 40-year-old patient went to the polyclinic to a general practitioner
complaints of abdominal pain, flatulence, mushy, sometimes watery, frothy
stool, which sometimes alternates with constipation, also notes general weakness.
He associates his condition with milk intake, although he did not notice such a thing in childhood.
Symptoms appeared after cholecystectomy for gangrenous
cholecystitis, with the development in the postoperative period of dynamic intestinal
obstruction, for which a small bowel resection was performed. HELL - 110/60 mm
Hg. senior, PS - 89 beats per minute, NPV - 18 per minute, body temperature - 36.7 ° C.
Questions:
1. State the most probable preliminary diagnosis.
2. List the methods of laboratory diagnosis of this disease.
3. What are the basic principles for treating this disease?
4. What diseases should be used for differential diagnosis?
5. List the main causes of this condition.
Situational task 193 [K002056]
Instructions: READ THE SITUATION AND GIVE EXPLAINED
ANSWERS ON QUESTIONS
Main part
Patient A., 38 years old, turned to the local GP with complaints of
bitterness in the mouth, which occurs mainly in the morning, discomfort
in the epigastric region, a feeling of rapid satiety; after errors in diet
worried about nausea, flatulence.
From the anamnesis it is known that 2 years ago she underwent cholecystectomy about
chronic calculous cholecystitis.
Such complaints are worrying throughout the year.
An objective examination: the condition is satisfactory. Integuments and
visible mucous membranes of normal color, clean. From the cardiovascular
respiratory systems without features. The tongue is moist, yellowish coated with
root. The abdomen is of normal shape, palpation is soft, slightly painful in
epigastric region.
In a clinical blood test: red blood cells - 4.2 × 10 12 / l, hemoglobin - 135 g / l,
color indicator - 0.96, platelets - 347 × 10 9 / l, white blood cells - 8.7 × 10 9 / l, ESR - 12 mm / h.
In the biochemical analysis of blood: ALT - 28 U / L, AST - 25 U / L, amylase - 77 U / L,
alkaline phosphatase - 80 units / liter.
FGDS performed: the gastric mucosa is moderately edematous, hyperemic in
antrum. Active peristalsis. The stomach expands well.
The gatekeeper is yawning. A small amount of bile is detected in the lumen of the stomach.
Questions:
1. State the most probable preliminary diagnosis.
2. What is the pathogenesis of the described manifestations?
3. With which diseases is it necessary to make a differential diagnosis?
4. What additional research methods are needed to confirm
the diagnosis?
5. Formulate a treatment plan.
Situational task 194 [K002057]
Дата: 2019-12-10, просмотров: 285.