1. Concepts of symptoms and syndromes

During the study of the patient, one or other signs or symptoms of the disease can be identified.

Distinguish between objective and subjective symptoms:

Objective signs can be detected with the help of sensory organs (for example, changes in color, texture, shape and size of a part of the body), special equipment (ECG, radiography) or measured with special techniques.

Subjective signs are the sensations of the examined people about whom they talk (pain, nausea) or which can be guessed by their behavior, motor, clinical, vegetative-vascular reactions.

By diagnostic value, there are: pathognomonic, specific and nonspecific symptoms. Pathognomonic symptoms occur only with any one disease. For example, vomiting pus with purulent gastritis, gouty cones with gout. At the same time, diseases with pathognomonic symptoms are comparatively few, and not all patients with these diseases have pathognomonic symptoms. Therefore, an accurate diagnosis on one basis is difficult to establish.

Specific symptoms make it possible to suspect a lesion of one organ. For example, cough indicates damage to the respiratory system, jaundice - damage to the liver.

Nonspecific or general symptoms indicate that a person is sick, but does not allow a specific judgment on the nature of the disease. For example, chills, emaciation, leukocytosis. At the same time, the severity of general symptoms characterizes the severity of the disease and largely determines the prognosis.

The next step in the diagnostic process is a logical analysis of the symptoms and their grouping into syndromes.

Syndrome is a set of symptoms combined by a common pathogenesis and characterizing a certain pathological condition of the body.

The basis of the development of the syndrome can be:

1. Structural changes in the body - for example, valvular heart disease (these are anatomical syndromes);

2. Functional changes - for example, arterial hypertension syndrome (these are functional syndromes);

3. Some pathological conditions of the whole organism - for example, fever, syndrome of an infectious-inflammatory process (these are common syndromes);

There are also simple and complex, large syndromes. Large syndromes are a complex of pathogenetically related symptoms and syndromes. For example, the syndrome of chronic renal failure (uremia) includes more than 10 syndromes, such as anemic, polyserositis, neurological, etc. All of them are determined by one mechanism - self-poisoning of the body by nitrogenous slags that are not excreted by the affected kidneys.

Eponymous symptoms and syndromes are also distinguished (signs that got their name from the proper names of researchers, who first described them, literary or mythological characters, etc.). We presented some of them in our methodological guide.

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2. Pulmonology

1. Syndrome of compaction of lung tissue (decrease in airiness)

REASONS: inflammatory infiltration (pneumonia, tuberculosis, non-infectious pneumonitis), pulmonary infarction, pneumosclerosis, carnification, tumors, parasitic cysts, etc. SYMPTOMS (for lung tissue infiltration):

1. Shortness of breath of an inspiratory character.

2. Unilateral reduction (restriction) of the respiratory excursion of the chest;

3. Strengthening of voice trembling as a result of the best conduct of oscillatory movements of the densified lung tissue;

4. Shortening or complete dullness of percussion sound over the sealed portion of the lung, depending on the degree of compaction;

5. The appearance of bronchial breathing over the background of blunting with extensive compaction: (depending on the size of the compaction, the amount of normal alveolar tissue surrounding it, options for bronchovascular, weakened vesicular and unchanged vesicular breathing are possible).

For a clear bronchial breathing, two conditions are necessary: - a sufficiently extensive surface focus of compaction;

- patency of the bronchus in the lesion.

6. Strengthening bronchophony;

7. Radiological - dimming or lowering the transparency of the lung tissue.

8. Acute alveolar consolidation has 2 main characteristic ultrasonic features:

1. Tissue-like sign (tissue sign). Normally, lung tissue during ultrasound is not visible, only the echogenic pleural line with artifacts extending from it is visualized. In pneumonia, the inflamed and edematous tissue of the lung, rich in fluid, becomes visible by ultrasound. Ultrasound examinations of the lung have a tissue-like sign. At the same time, the visualized lung tissue ultrasonographically resembles liver tissue (ultrasound ―hepatization‖ of lung tissue).

2. Shred sign (sign of uneven, torn border). The surface border of subpleural consolidation is the pleural line, most often represented by a flat line, while the deep (lower) border of consolidation is represented by an uneven ragged line. This ragged line (shred line) has a hyperechoic appearance, as it outlines the consolidation zone at the border with healthy aerated lung tissue.

Pic 2.1 Focal pneumonia

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