Задача 9
Больной Ю., 26 лет, жалуется на умеренную боль в правой половине живота, периодические поносы с примесью слизи и крови, тошноту, изредка – рвоту, исхудание, субфебрильную температуру тела. Из анамнеза: болеет на протяжении 2-х лет,когда стал замечать чередование запоров и поносов, ноющие боли в животе. В весенний и осенний периоды состояние ухудшается.
При обследовании: общее состояние средней тяжести, кожные покровы умеренно бледные. Температура тела 37,6С, пульс 90 уд/мин. Язык влажный, обложен. Живот умеренно вздут, передняя брюшная стенка принимает участие в акте дыхания. При пальпации – живот мягкий, умеренно болезненный в правой половине. В правой боковой области нечетко пальпируется умеренно болезненный инфильтрат без четких контуров. Перитонеальные симптомы отрицательные.
Задача 10
Больная Н., 26 лет, жалуется на резкую слабость, головокружение, мелькание мушек перед глазами, понос с выделением значительного количества малоизмененной крови. Из анамнеза: более месяца тому назад перенесла тяжелое нервное потрясение, после чего появился частый жидкий стул более 10 раз в сутки, кал с примесью слизи, гноя и крови. Периодически температура тела повышалась до 38,0-39,0°С. Три часа назад состояние резко ухудшилось, появился понос с выделением большого количества малоизмененной крови.
При обследовании: общее состояние больной тяжелое, выраженная бледность кожных покровов, пульс 120 уд/мин., АД=90/50 мм рт.ст. Живот умеренно вздут, передняя брюшная стенка принимает участие в акте дыхания. При пальпации – живот умеренно напряжен и болезненный в левой половине. Перитонеальные симптомы не определяются. При ректальном исследовании – на перчатке малоизмененная кровь.
Задача 11
Больная Ф., 30 лет, жалуется на резкую слабость, многократный (более 10 раз в сутки) жидкий стул с примесью слизи, гноя и крови, тенезмы, схваткообразные боли в левой половине живота, повышение температуры тела до 38.40С. Из анамнеза: болеет в течение недели, заболела остро, начало заболевания связывает с тяжелым нервным потрясением (смерть брата). До настоящего времени за медицинской помощью не обращалась, занималась самолечением.
При обследовании: общее состояние больной тяжелое, кожные покровы бледные, температура тела 38.40С, пульс 102 уд/мин., АД=110/60 мм рт.ст. Язык обложен, суховат. Живот симметричный, умеренно вздут, передняя брюшная стенка принимает участие в акте дыхания. При пальпации – умеренное напряжение и выраженная болезненность в левой половине живота (по ходу толстой кишки), перитонеальне симптомы отрицательные.
Задача 12
Больная К., 24 лет, жалуется на общую слабость, быструю утомляемость, исхудание, постоянную боль в левой половине живота и правом подреберье, чпстый жидкий стул до 15 раз в сутки с примесью слизи, гноя и крови, повышение температуры тела до 39,00С. Из анамнеза: болеет на протяжении года, периодически находится на стационарном лечении, последнее обострение возникло 10 дней назад.
При обследовании: общее состояние больной тяжелое, больная астениизирована, истощена. Пульс 112 уд/мин., АД=90/60 мм рт.ст. Язык обложен, сухо ват. Живот вздут, передняя брюшная стенка ограниченно принимает участие в акте дыхания. Ниже правой реберной дуги (+4см) пальпируется умеренно болезненная печень. Определяется выраженная болезненность в левой половине живота по ходу ободочной кишки. Перитонеальные симптомы отрицательные.
Diarrheal - inflammatory syndrome
CASE # 1
Patient B. , female, 25 y.o., complains of a constant dull pain in the right iliac region , nausea, diarrhea with mucus and blood in the stool , malaise, fever up to 38,0 ° C. Anamnesis: sick for a week, acute onset after stress , pain immediately appeared in the right iliac region . Never experienced these symptoms before. The patient’s mother has similar symptoms of the disease , about which she is a long time followed up by a gastroenterologist and proctologist .
On examination : moderate general condition, body temperature 37,7 ° C. Tongue moist, obducted. Abdomen is symmetrical, anterior abdominal wall is involved in the act of breathing . On palpation - moderate tension and soreness in the right iliac region , here is palpable movable moderately painful infiltration , 5x5 cm. Rousing , Voskresensky, the Michelson - Bartome signs are negative. Peritoneal signs are negative.
CASE # 2
Patient T. , 30 y.o., complains of moderate dull pain in the right part of the abdomen , nausea, periodic diarrhea with mucus and blood , weight loss . Anamnesis: more than one year , the disease gradually emerged , the appearance of his patient connects with repeated stressful situations .
On examination : general condition of the patient is relatively satisfactory , malnutrition , skin palish body temperature 37,2 ° C. Tongue moist, coated at the root. Abdomen symmetrical, anterior abdominal wall is involved in the act of breathing . On palpation - moderate pain in the right part of the abdomen , to the right and below the navel palpable dense formation , movable, size 6x4 cm , painful . Peritoneal signs are negative.
CASE # 3
Patient S., 35 years old, complains of periodic dull pain in the left side of the abdomen, loose stools up to 5 times a day with mucus and sometimes - streaked with blood , intermittent fever up to 37,5 C, malaise. Anamnesis: illness began six weeks ago , after a severe nervous shock. In the past, ill enterocolitis , was treated by a gastroenterologist .
On examination : general condition is satisfactory, clear consciousness , skin of normal color , body temperature 37.50 C. Tongue moist, coated on the edges. Abdomen symmetrical anterior abdominal wall is involved in the act of breathing . On palpation - moderate pain in the left half of the course of the colon. In the left iliac region palpable spasm , moderately painful sigmoid colon . Peritoneal signs are negative.
CASE # 4
Patient D. , aged 30, complains of a constant dull pain in the left half of the abdomen , bloating, rumbling in the stomach , loose stools up to 10 times a day with mucus , pus and blood , fever up to 38.0 C. Anamnesis: sick for two years , periods of exacerbation in spring and autumn periods . Is followed up by a gastroenterologist.
On examination : general state of moderate severity. Patient of asthenic constitution , skin pale . The body temperature of 37.9 ° C. Tongue moist, coated . Abdomen moderately swollen, anterior abdominal wall is involved in the act of breathing. On palpation - moderate tension and soreness in the projection of the colon , and more - in the left iliac region . Peritoneal signs are negative.
CASE # 5
Patient B. , 25 y.o., complains of general weakness, fatigue, weight loss , persistent pain in the left side of the abdomen, loose stools up to 15 times a day with mucus , pus, blood , fever up to 39,0 ° C . Anamnesis: sick during the year , when periodically , usually in spring and autumn , there were episodes of watery stools several times a day . A month ago , after a severe nervous shock condition deteriorated .
On examination : general condition issevere. Skin and visible mucous membranes are pale . The body temperature of 38,8 ° C, the pulse 110 bpm. Tongue is dryish , coated. Distended abdomen , anterior abdominal wall partially participates in the act of breathing. On palpation - belly moderately tense and painful all over, but more in the left half . Peritoneal signs left side - doubtful .
CASE # 6
Patient S., 34 years old, complains of general weakness, fatigue, weight loss , constant dull pain in the left side of the abdomen, loose stools up to 10 times a day with mucus , pus and blood , fever up to 38,0 ° C . In addition, patient suffers from sore in knee and elbow joints , which worsened by motion. Anamnesis: is ill for 1.5 years , periodically is hospitalized , the recent aggravation arose a week ago .
On examination : general condition of patients is severe , the patient is asthenic, significantly reduced body weight . Skin and visible mucous membranes are pale . The body temperature of 37,9 ° C. Contours of the knee and elbow joints smoothed motion in joints limited painful. Distended abdomen , anterior abdominal wall is involved in the act of breathing. On palpation - moderate tension and soreness in the left half of the abdomen . Peritoneal signs negative.
CASE # 7
Patient G. , 32 years old, complains of constant pain in the abdomen, but on the left , nausea, vomiting , stool retention and gases. Anamnesis: for two years suffers from the pain in the left half of the abdomen , diarrhea up to 10 times a day with mucus , pus, blood , emaciation . 5 hours ago abdominal pain increased dramatically , there was vomiting, bloating, constipation and gas retention .
On examination : the patient's conditionis severe, forced position in the bed – lays on his left side with knees given to the stomach down. The body temperature of 38,7 ° C, the pulse 108 bpm , BP = 110/60 mmHg Tongue dry , swollen abdomen , anterior abdominal wall does not participate in the act of breathing . On palpation - abdomen tense, sharply painful in all parts , but more - to the left , positive symptom Shchetkin - Blumberg . Peristalsis does not auscultated .
CASE # 8
Patient Ch , 30 y.o., complains of persistent pain in the right iliac region , nausea, single vomiting, diarrhea with mucus and blood streaks . Anamnesis: previously this condition was not, but periodically had constipation alternating with diarrhea. A few hours ago , at night there was acute pain in the right part of the abdomen , nausea .
On examination : general condition of the patient of average weight , body temperature 37,6 ° C , pulse 92 bpm . Tongue coated , wet. Abdomen moderately swollen, anterior abdominal wall is involved in the act of breathing . On palpation - the right side and the right iliac areas defined moderate tension and soreness , here clearly palpable formation of size 8x5 cm, without clear contours , movable, moderately painful . Peritoneal signs negative.
CASE # 9
Patient Yu , 26 y.o., complains of mild pain in the right part of the abdomen , periodic diarrhea with mucus and blood , nausea, occasionally - vomiting, emaciation , subfertil body temperature. Anamnesis: sick for two years , when he began to notice the alternating constipation and diarrhea , aching pain in the abdomen. In spring and autumn the condition worsens .
On examination : general condition of moderate , moderately pale skin . The body temperature of 37.6 C , pulse 90 beats / min. Tongue moist, overlaid . Abdomen moderately swollen, anterior abdominal wall is involved in the act of breathing . On palpation - the abdomen is soft , moderately painful in the right half . In the right side pane clearly palpable moderately painful infiltration without precise contours . Peritoneal signs are negative.
CASE # 10
Patient N. , 26 y.o., complains of severe weakness , dizziness , flickering before the eyes of flies , diarrhea with a significant amount of blood maloizmenennoy . Anamnesis: more than a month ago suffered a serious nervous breakdown , and then came loose stools more than 10 times a day , stool with mucus , pus and blood . Periodically, the body temperature rises to 38,0-39,0 ° C. Three hours ago, the state has deteriorated sharply , diarrhea appeared with the release of large amounts of blood maloizmenennoy .
On examination : general condition of patients with severe , severe pallor , pulse 120 beats / min. , BP = 90/50 mmHg Abdomen moderately swollen, anterior abdominal wall is involved in the act of breathing . On palpation - belly moderately tense and painful in the left half . Peritoneal signs are not defined . At rectal examination - on the glove maloizmenennaya blood.
CASE # 11
F. Patient , 30 y.o., complains of severe weakness , multiple (more than 10 times per day) loose stools with mucus , pus and blood , tenesmus , cramping pain in the left side of the abdomen, fever up 38.40S . Anamnesis: sick for a week, ill acute onset of the disease is associated with severe nervous shock ( brother's death ) . Until now, medical care is not addressed, to self-medicate .
On examination : general condition of patients with severe , pale skin , body temperature 38.40S , pulse 102 beats / min. , BP = 110/60 mmHg Tongue coated , dryish . Abdomen symmetrical , moderately swollen, anterior abdominal wall is involved in the act of breathing . On palpation - moderate tension and soreness in the left half of the abdomen ( in the course of the colon) , peritoneal signs are negative.
CASE # 12
Patient K. , 24 years old, complains of general weakness, fatigue, loss of weight , persistent pain in the left half and the right upper quadrant of the abdomen , chpsty loose stools up to 15 times a day with mucus , pus and blood , fever up to 39,00 C . Anamnesis: sick during the year , periodically is hospitalized , the recent aggravation occurred 10 days ago.
On examination : general condition of patients with severe , the patient asteniizirovana , exhausted. Pulse 112 beats / min. , BP = 90/60 mmHg Tongue coated , dry vat . Distended abdomen , anterior abdominal wall partially participates in the act of breathing. Below the right costal arch ( 4 cm) moderately painful palpable liver. Determined soreness in the left half of the abdomen during the colon. Peritoneal signs are negative.