Text a. Peritonitis

Peritonitis is known to be general or localized, acute or chronic, primary or secondary.

Acute general purulent peritonitis is believed to be due to perforation of one of the hollow abdominal organs. The most frequent causes are perforating appendicitis, inflammatory conditions of the female sex organs and perforating gastric or duodenal ulcers.

The main symptoms of this condition are vomiting, pain and tenderness in the abdomen, it being considerably enlarged due to the presence of fluid there. The temperature is known to be moderately elevated, the pulse rate being considerably changed. The blood analysis usually reveals leucocytosis.

This condition is extremely dangerous to the patient’s life, an emergency surgery being performed to save the patient. During the operation the primary focus of peritonitis is to be removed, the danger for the patient being eliminated.

Emergency operative treatment is known to be followed by a course of antibiotic treatment, which greatly contributes to the recovery.

Class assignments Revision

6. Replace each part of the Complex Subject given in bold type by the corresponding word or word combination given below:

1 2

The female patient was known to complain of skin irritation.

1. the nurse; the physician; the surgeon; the male patient

2. to suffer from continuous bleeding; to perform an emergency surgery; to give blood and serum transfusion; to reveal digestion disturbances

6. Finish the sentences:

1. Acute cholecystitis is known... (a) to be characterized by pain radiating to the breastbone and lumbar area; 6) to be accompanied by profuse external bleeding) 2. Irregular diet as well as an emotional overstrain have been found ... (a) to result in the disturbances of peripheral blood circulation; 6) to contribute to the development of gastric and duodenal ulcers) 3. Clinical manifestations of gastric carcinoma prove... (a) to vary with the stage of its development, location and spread through the lymphatic nodes and other inner organs; 6) to be associated with the lesions of the central nervous system)

6. 1. Translate the sentences. 2. Find the subject in the main clause and the word acting as a subject in the Absolute Participle Construction:

1. Digestion disturbances having been present for a long period of time, the patient was prescribed a strict diet not containing any fat. 2. The patient suffering from a continuous bleeding, severe anaemia developed. 3. There being no characteristic clinical manifestations of gastritis, the patient was allowed to vary his diet. 4. Tumour cells being spread with the blood flow, metastases may appear in various organs.

6. Supply extended answer to the following questions:

1. Who of Soviet scientists proved the existence of association between a lesion of the central and peripheral nervous systems and the development of ulcer? 2. What do you know about the corticovisceral theory of ulcers? 3. Give the characteristic clinical manifestations of gastritis. 4. What factors contribute to the development of gastric cancer? 5. What is the development of acute appendicitis accompanied by? 6. What did the prominent Russian scientist S. Botkin prove? 7. What pathologic changes does hepatitis produce in the human body? 8. What three forms of cholecystitis are there? 9. What treatment is indicated in purulent and gangrenous forms of cholecystitis? 10. What diseases may be accompanied by jaundice?

6. Say what diseases are spoken about in the following statements:

1. This disease is treated surgically. The operation is performed not under general but under local anaesthesia. The operation must be performed immediately to prevent the development of peritonitis.

2. Ibis disease is most commonly observed in nervous persons. Such factors as mental and emotional overstrain contribute considerably to its development. The incidence of this disease is higher in men than in women. This disease is characterized by a chronic cyclic course.

3. When the physician examines the patient with this disease he reveals severe tenderness in the right upper part of the abdomen and in the umbilical area. The physician also notes slight jaundice of sclerae. The patient complains of dryness in the mouth, vomiting, nausea and constipation.

6. 1. Read Text B. 2. Say what the doctor must pay particular attention to while examining a patient whose condition is suggestive of liver or bile duct disease:

   Text B. Symptoms of Diseases of the Liver and Bile Ducts

When the physician is taking the patient’s medical history he must pay attention to the patient’s working and living conditions, the diet which the patient follows, the history of past diseases, particularly of those of the alimentary tract, and the condition of the nervous and endocrine systems, because a hepatic disease is often directly associated with these factors.

For example, overeating, particularly of fatty foods, alcoholism may sometimes suggest the diagnosis of the fatty degeneration of the liver. A persistent lesion of the liver may be observed after Botkin’s disease and in chronic infections. Involvement of the liver and bile ducts is often found after gastrointestinal diseases, gastritis being one of them.

The patient’s complaints of loss of weight, pain in the right hypochondrium and abdominal enlargement may contribute to the proper diagnosis of the diseases of the liver and bile ducts. Among the characteristic symptoms of a hepatic disease are a yellowish colour of the skin, sclerae and of the mucous membranes of the oral cavity, dilatation of the veins in the umbilical area, tenderness in the left and right hypochondrium.

Palpation and percussion of the liver and spleen may supply important evidence for a diagnosis. The size of the liver may be enlarged or contracted, it may be soft or firm, its surface may be nodular, the lower border may be sharp

• all these findings enable the physician not to doubt an adequate diagnosis.