internal med sem 6 lect 1
TRANSCRIPT
Questioning and examination of Questioning and examination of patientspatients
with with gastrointestinal tract disordersgastrointestinal tract disorders
Propedeutic of internal medicine
PhD, assistant Zozuliak N.V.
Analysis of publications in recent years clearly shows that the incidence of the digestive system diseases increases, especially in developed countries. These trends are due to several reasons. First and foremost is the impact of such pathogenic factors such as chronic stress, allergy , the impact of negative factors, environmental factors (health and safety characteristics of water, air , eating canned food), and the resultant change in the body's immune properties of modern man. It was found that chronic gastritis wasdiagnosed in 50 % of the adult population, duodenitis in 70-90 % of patients with gastroenterological diseases.
1 2
3
Аnathomy of the GITAnatomical features of the digestive tract
Topographic anathomy of the abdomenAnatomical landmarks stomach
Horizontal topograhic lines
l. costarum – connects the lower edges of costal arches
l. spinarum – connects the front upper iliac bones
еpigastrium
mesogastrium
hypogastrium
Parts of the anterior abdominal wall(by M.D. Strazhesko)
regio iliaca dex.
regio epi-
gastrica
regio hypochondrica
dex.
regio paraumbilicalis
regio abdominalis
dex.
regio supra-pubica
regio hypochondrica sin.
regio abdominalis sin.
regio iliaca sin.
Pain
syndrome of gastric dyspepsia (disorders of appetite, bad taste in the mouth, bad breath, belching, nausea, heartburn, vomiting)
syndrome of intestinal dyspepsia (disorders of stool - diarrhea or constipation, bloating, rumbling, increased gas emission (meteorism), tenesmus)
complaints related to liver disfunction (jaundice, skin itching, etc.)
hemorrhagic syndrome
Complains during digestive tract disorders
Features of the pain: location, in spread pain - location of maximum pain
sensation
Irradiation
Character (burning, squeezing, knife-like)
Duration
provocation of the pain (food intake, changes in diet, hunger, some body position, weight lifting, jumping in after bumpy ride) and after how many minutes?
determine whether there is or not a growing pain in a certain body position, what relieves the pain, describe other symptoms that precede the pain, occur during or after the pain (nausea, vomiting, flatulence, defecation)
Topography of the abdominal organs lesions • stomach (large curvature) • spleen • tail of the pancreas • splenic angle of the colon • the upper pole of the left kidney
right hepatic lobe • gallbladder • hepatic angle of the colon transverse • the upper pole of the right kidney
liver (left lobe and small part of the right lobe) • stomach (body and pylorus) • upper half of duodenum • Pancreas • aorta
descending colon • part of the small intestine loops • lower pole of the left kidney
• ascending colon • small intestine • lover pole of the left kidney
sigmoid colon • loops of small intestine • left ureter • Left Ovary
* appendix • iliac intestine • cecum * The right ureter • The right ovary
lower horizontal part of the duodenum • transverse colon • cecum and ileum • right kidney (medial part) • aorta
8
loops of small intestine • bladder (upper half) • part of the sigmoid colon • uterus
7 9
6
32
5 4
1
Esophagus (acute inflammatory lesions of the mucous membrane, heartburns)
located along the course of the esophagus or behind the breastbone
irradiation to the shoulder, lower jaw, interscapular region
closely associated with the food intake
increases or decreases during swallowing
PAIN
Stomach: main reasons of the pain occurence
spasm strain disturbances in the motor function transition of the inflammation to the peritoneum
PAIN
Spastic contraction of the muscles of the stomach → periodic pain
Irritation of the nerves of the stomach → permanent pain Increased tone of the n. vagus - ↑ acidity of the stomach
juice. The pain occurs in different time period: early (30-40 min), late (1.5-2 h), night pain. Improvement after vomiting - release of acidic content.
Seasonality of pain - the occurence or exacerbation at autumn or spring.
Connection with food intake: Increased pain after taking spicy, salty food
Stomach pain irradiats to the back, shoulder, lower interscapular area, left hypochondrium.
Pain in the stomach
Stomach:Character of pain (feeling of tension,
overflow, heaviness, swelling, drilling, burning)
- Pulling pain - as a result of stretching. - Paroxysmal (colic) - spasm of the
pylorus. - During ulcer perforation is observed a
sharp pain (occurs suddenly, piercing the belly, “knife-like")
Pain
Stomach: More higher ulcer location is characterized by lesser time interval of pain occurrence after food intake
Ulcer of cardiac part of stomach and small curvature – pain occurs after 15-20 min;
Ulcer of the big curvature – pain occurs after 30-45 min; Ulcer of the antrum – after 1-1,5 hours; Ulcer of duodenum - 2 hours after food, often – in the
night.
Pain
Intestinal Pain differs from the stomach:
is independent from eating time There is connection with the act of defecation (increases before and
during defecation, decreasing after defecation)
Character Spastic pain - spasm - short-term Distensional pain - stretching – long-term
Location right iliac area - appendicitis, an inflammation of the cecum
(typhlitis) left iliac area - sigmoiditis, intestinal obstruction around the navel - enteritis. in the perineum - diseases of the rectum. irradiation depends on the part of the intestine
Pain
Pancreas
Head - the pain is localized in the epigastric region from the right Body - in the epigastric region from the left Tail - left upper quadrant The whole pancreas - encircling pain, upper abdominal pain
Features of the pain
intense, most pronounced in hemorrhagic pancreatitis, pancreatic edema
irradiating to the left half of the body - left upper quadrant, shoulder, arm, waist
due to stretching of the capsule, increased pressure in the duct, irritation of the parietal peritoneum that covers the pancreas
Pain
Печінка, жовчовивідні шляхи– ураження / розтягнення Гліссонової капсули – запалення жовчного міхура і жовчних протоків, а
також при їх розтягненні та спазміПатологічні процеси паренхіми можуть не даватибольових відчуттів
локалізується в правому підребер’ї, пов'язаний з вживанням їжі (жирної чи смаженої) та глибоким диханням.
особливо гострий біль при спазмі м’язів жовчного міхура, проток чи закупорці їх каменем (жовчна або печінкова коліка).
характер болю: колючий, ріжучий. іррадіює в ділянку правого плеча, праву лопатку, праву
половину шиї
БІЛЬLiver, Gallbladder
– Damage of the Glissons capsule – Inflammation of the gallbladder and bile ducts, and
during them distension or spasmN.B! Pathological processes in parenchyma do not cause
pain sensations
Features: Is localized in right hypochondrium, is connected with food intake в
(fat or fried food) and deep breathing. Especially acute pain occurs in case of gallbladder or it's ducts
spasm or stone formation (liver colic). Character of pain: piercing, knife-like. Irradiates to the right shoulder, right part of the neck
Pain
disorders of the swallowing act : can not to swallow or it is paintfull disturbed promotion of the food in the pharynx and along the esophagus discomfort feelings, associated with delayed food in the pharynx and esophagusOften patients should drink water after taking food.
Reasons:functional restriction - dysphagia occurs periodicallyorganic - increases gradually and progresses Paradoxical dysphagia – patient can eat solid food, and cannot - liquid food
Dysphagia
Burning sensation of the patients behind a sternum, in epigastric area.
Occurs due to the irritation of the esophagus by an acid stomach juice due to the reflux.
Heartburn (pyrosis)
discharge of air from the mouth, which was accumulated in the stomach (eructatio) or air with food (regurgitatio);
caused by contraction of the muscles of the stomach and simultaneous relaxation of the lower esophageal sphincter
The smell of rancid oil (due to oil and lactic acid ) due to the development of fermentation processes regurgitation with the smell of rotten eggs - gastritis with secretory failure;Rotten, putrid belching before food intake - pyloric stenosis ; regurgitation with unbearable odor occurs in a case of fistula formation between the stomach and colon ;Acidic regurgitation is observed in increased acid formation in stomach Bitter taste may be associated with throwing bile into the stomach (duodeno-gastral reflux).
Belch (відрижка)
shows involvement in the pathological process of the phrenic nerve
Reflector hyper function (n. vagus )Salivatory glands due to the esophageal receptors irritation
Hiccup
Hypersalivation
reflex associated with n.vagus irritation
- Shows an unpleasant feeling of pressure in the epigastric region, general weakness, increased salivation and sweating, dizziness, decreased blood pressure, pale skin
- Often precedes vomiting, but can occur without it
- - Nausea often observed in diseases of the biliary tract
- Nausea can be caused by toxic drugs, toxins produced in the body in uremia, diabetes, burns
- - Reflex nausea may occur during stimulation of the tongue, throat, pharynx, trachea, vomiting center in the brain
Nausea
complex reflex due to excitation of the vomiting center, during which occures release of stomach contents through the esophagus, throat, mouth, sometimesnasal cavity
Reasons of the vomiting central haematogenic-toxic visceral or reflectory
Vomiting which is not connected with the stomach diseases: - is not associated with food intake - is not preceded by nausea - is repeated and do not brings relief Reasons: medicines, infectious diseases, pregnancy, brain tumor
Vomiting, (emesis)
morning vomiting with a lot of mucus and saliva - chronic gastritis
a few minutes after eating - narrowing of the esophagus, ulcer of the stomach cardia
2-3 hours. after eating - chronic gastritis, peptic ulcer disease, gastric atony of muscles
stagnant vomiting, in vomit mass there is a residues of 1-2 days ago food – pylorus stenosis
a small amount of vomiting - stomach neurosis.
Acid vomiting mass - hypersecretionputrid smell - the disintegration of the tumorammonia smell - uremic gastritis, renal failureAlcohol odor - acute alcohol poisoningfecal vomiting - during intestinal obstruction
Vomiting (emesis)
Impurities in the vomiting mass, mucus (gastritis), bile (reflux from the duodenum to the stomach), pus (abscess), blood, worms.
Blood in vomiting mass
- Bloody vomiting (haematemesis, "coffee grounds") due to the formation of chloride hematin, which has a brown color and is formed by the interaction of hemoglobin with HCl- With hypo- and anacid blood is not changed in vomiting mass - Vomiting by the not changed blood due to the esophageal bleeding in a case of portal hypertension (cirrhosis)- An admixture of blood can be in the case of ingestion in cases of bleeding from the gums, nose
Vomiting (emesis)
Порушення апетиту
anorexia – loss of appetite due to decreased excitability of food center
loss of appetite can be selective - aversion to meat dishes - during gastric secretory function reducing
forced refusal of food: citofobia - refusal to eat food because of fear of pain (pancreatitis)
increased appetite bulimia (bulimia means: bus - buffalo, limos - hunger)
distortion of appetite, passion to chalk, graphite, coal – at anemia, pregnancy, hysteria . This condition is called pica or parorexia
Apetite disorders
desire to defecate, accompanied by sharp pain and spasms in the rectum, whicjh are completed by incomplete release of intestinal contents or without defecation.
During tenesmus occurs spastic contraction of the smooth muscle of the colon (rectum and sigmoid).
Tnesmus (teino - strain, stretch; tenesmus - unsuccessful desire to defecate; colica rectalis)
Meteorism is a medical condition in which excess gas accumulates in the gastrointestinal tract and causes abdominal distension
The digestive tract always contains a large amount of air and gases: an average amount is 900 cm3, under certain conditions, this number increases
Flatulence occurs in a case of:
- enhanced gas production in the intestine in the use of products that contain high amounts of fiber and starch (beans, cabbage, potatoes, black bread)
- excessive swallowing air (aerophagia)
- violating of the gas emission from intestine (atony, ileus)
- digestive disorders in the intestine due to insufficient enzyme production, violation of the intestinal microflora (dysbiosis)
- hysteria (psychogenic flatulence).
it is sounds in the stomach, they can be heard at a distance from the patient that occur during the passage of gas through relatively narrowed intestine.
Diagnostic value of grumbling is that it points on a combination of flatulence with difficulty of fecal passage through the intestines - spastic character.
Intestinal growl (borborigmus)
- the presence of bright red blood in the stool - ulcerative colitis, intestinal tumors, fissures, hemorrhoids (bleading from the lower part of intestines)
- Black stool - melena - bleeding from the stomach, upper parts of intestine
- The allocation of a large number of bright red blood - bleeding below the left colon flexure
Intestinal bleading
is rapid (more than 2 times per day) bowel movement with the release of liquid or soft excrements.
Diarrhea is a symptom of many diseases of internal organs:
- intestinal infections (dysentery, cholera) - inflammatory bowel disease (enteritis, colitis) - other diseases of the digestive system (chronic pancreatitis, hepatitis and liver cirrhosis, disease of the biliary ways) worms, - poisoning by salts or heavy metals (mercury, lead and others.) - endogenous intoxication (chronic renal failure) - endocrine diseases (hyperthyroidism, insufficiency of adrenal glands) - vitamins insufficienty, - food allergies.
Diarrhea (diarrhoea)
The mechanism of diarrhea occurrence is complex and includes several pathogenetic parts:
- increasing osmolarity of intestinal content (for example, during taking laxatives)- increased secretion of water and electrolytes by epithelial cells of the small intestine (in case of cholera)- disturbance of digestion and absorption in the intestine (especially after extensive resection of the small intestine)- disorders of motor function of the intestine with the acceleration passage of intestinal contents- inflammatory changes of the intestinal mucosa
Diarrhea (diarrhoea)
There are such types of diarrhea- enteric - colitical
Enteral diarrhea have next features:
- lower frequency (not more than 4-5 times a day)- a significant volume of stool- is a manifestation of maldigestione syndrome (impaired digestion in the wall and cavity) and malabsorption (malabsorption) that occurs in various diseases of internal organs
Colical type of diarrhea is characterized by : - greater frequency (10 times or more per day)
- the release of a small amount of feces (often mixed with mucus and blood)- usually accompanied by cramping abdominal pain and tenesmus
Diarrhea (diarrhoea)
In a case of violating of the splitting and absorption of proteins occurs liquid stool dark color with alkaline reaction (due to the formation of ammonia) containing particles of undigested food with disgusting putrid smell, muscle fibers (creatorrhea) and connective tissue - putrefactive dyspepsia. In addition to intestinal methane also are formed hydrogen sulfide, indole, skatole and other products.
In a case of violating of the splitting and absorption of carbohydrates in combination with the activation of gut fermentation appear frothy mushy stool with acidic reaction, containing a significant amount of starch grains (amylorrhea) and iodinophilic microflora - fermentation dyspepsia. Stool is light yellow, defecation is not more than 5-6 times a day. Pain arise long before a bowel movement, are dull and not very intense, accompanied by rumbling. Flatulence is marked with a large amount of gas.
In a case of violating of the splitting and absorption of fats occurs their active excretion in the feces (steatorrhea) - fatty dyspepsia. Patients complain of bloating, rumbling, frequent liquid stools. Stool is usually light, with neutral or alkaline reaction.
Diarrhea (diarrhoea)
slowing of the intestinal emptying more than 2 days (in severe cases 5-7days). The water content in the stool decreases, it becomes harder, looks like "Sheep feces."
Constipation can be caused by various reasons:- alimentary - deficient fiber, liquid content in diet; fasting- so-called "conventional" constipation are associated with the weakening of the fefecation reflex - in a case of sedentary lifestyle, prolonged supine position, with the weakening of the abdominal muscles- neural – occurs in a case of spastic colon (or hyperkinetic or spastic constipation) or reducing of its motility (hypokinetic or atonic constipation)- proctogenic constipation - patients suffering from hemorrhoids- when taking certain medications (antacids)- endocrine diseases (myxedema)- constipation associated with organic diseases of the intestine, abnormal development (dolichosygma, megacolon), tumors of colon, diverticuls, intestinal obstruction due to adhesive process of the intestines (after surgery)
Obstipation (obstipatio)
Through history should be taking by common scheme, it is necessary to clarify:
- how disease began (acute, gradually);- the sequence in which complains appeared;- connection with food intake, the act of defecation;- tolerance of certain food products;- how patient nutrition affect the condition of the patient;- check the medical records – data of ultrasound (presence of stones in the gall bladder), previous endoscopic, radiologic studies;- Previous use of drugs (prolonged use of antibiotics can cause diarrhea and bloating, NSAIDs cause erosive lesions of the digestive tract, hormonal contraceptives cause biliary dyskinesia)- the nature of the treatment, its effectiveness.
case history
Doctor have to find out : regime and the nature of food intake use of a large number of fatty meat in combination with alcohol -
the risk of acute pancreatitis ; stress - important in the development of peptic ulcer ; Smoking - promotes diseases of stomach and duodenum ; hereditary factor ( cholelithiasis , peptic ulcer, hereditary
disease - congenital benign hyperbilirubinemia ); pay attention to surgery on abdominal organs, previous
diseases, helminths; contact with patients with jaundice in the last month or a history
of parenteral interventions over the last six months ; Occupation of the patient can also help in establishing the
diagnosis : the drivers are prone to diseases of the stomach and duodenum, is due to irregular eating and stressful nature of the work;
Professional intoxication ( lead, arsenic, mercury, gasoline vapors);
use of chemical and herbal poisons ( alcohol substitutes, mushrooms).
Anamnesis of the life
- pale skin indicates cancer, anemia (after bleeding, iron malabsorption or insufficient production of hematopoietic factors by gastric glands)- signs of itching- jaundice (icterus)
General view of the patient
Skin and mucous membrane
cahexia
Patients with gallbladder disease often have cholesterol deposits on the eyelids (xanthelasma) and skin (xanthoma).
At the review can also be noted the presence of: -Telangiectasia - spider navi - Hyperaemia of the tenar (palmar erythema or "liver palms“)-in men can be observed, gynecomastia (breast enlargement) These are all symptoms associated with hyperestrogenemia.
Skin and mucous membrane
gynecomastiaTelangiectasia
Palmar erythema
spider navi
Is performed in a vertical and horizontal position of the patient
Doctor should pay attention to:
condition of skindevelopment of subcutaneous veinsstate of the navelthe shape of the abdomensymmetrysize, presence and character of the rash on the skinthe presence of postoperative scarsvisible pulsations
Examination of the abdomen
-
Striae Scars
Ascitis Caput Medusae
caput Medusae
Gastric dyspepsia: nausea, vomiting, heartburn, regurgitation, distortion appetite.
Intestinal dyspepsia, flatulence, disorders stool (diarrhea, constipation).
Liver and biliary tract diseases are characterized by fatty indigestion (or soap) depends on fat digestion disorders. One of its causes is the rapid transition of food through the small intestine, lack of lipolytic pancreatic function, and violation of the flow of bile into the intestine.
Syndrome fermentation dyspepsia - indigestion in the colon. In the analysis, mushy stool, yellow color, with acidic reaction, a small amount of soaps and fatty acids; planty of starch, digested fiber and iodinophillic flora
Syndrome putrefactive dyspepsia - indigestion in the colon. In the fecal analysis, mushy stool with alkaline reaction and putrefactive smell; increased amount of fiber; increased ammonia content
Main syndromes
Malabsorption syndrome - clinical syndrome caused by malabsorption through the mucous membrane of the small intestine of one or more nutrients.
Maldigestion syndrome - clinical syndrome caused by indigestion of food particles required for absorption, which leads to malabsorption in the intestines through the intestinal wall
Main syndromes
jaundice syndrome
Hemorrhagic syndrome: bleeding gums, nosebleeds, skin hemorrhages.
Cholestatic syndrome: persistent have itching, jaundice, skin pigmentation, ksantelazms.
Intrahepatic cholestasis - lesions of hepatocytes.
Extrahepatic cholestasis, compression or inflammation of the liver ducts from inside by stone or from outside (tumor of the pancreas).
Hypersplenism syndrome, liver enlargement, anemia.
Portal hypertension – caput medusae
Main syndromes
INSTRUMENTAL METHODS OF gastrointestinal tract and kidneys
investigation
X-ray examination of the stomach Plain radiograph of the abdomen Іrrigoscopy Computer tomography
Gastric probing PH metryDuodenal probing
INSTRUMENTAL METHODS OF THE GASTROINTESTINAL TRACT ARE divided into:
Endoscopic:
EsophagogastroduodenoscopySigmoidoscopyFibrokolonoscopy
X- ray:
Probe methods: Sonographic:
Ultrasound of the abdomen
Fibroezophagogastroduodenoscopy
a review of the mucous membrane of the esophagus, stomach and duodenum using an endoscope, which is administered to the patient after anesthesia of the pharynx
Research of the mucosa membraine
Determination of pH Biopsy → morphological
study (diagnosis of the forms of chronic gastritis, gastric cancer)
Possibility of introducing drugs
Opportunity to stop the bleeding in the stomach or duodenum
Fibroezophagogastroduodenoscopy
OBJECTIVE:
- Fibrogastroduodenoscopy is performed at the morning on an empty stomach, emergency - at any time
- - At first anestesia of the throat and esophagus is performed by 3% solution of dicaine
- -The patient is placed on the left side- -Inserted into the mouth and injected sterile mouthpiece probe
- Before examining the patient for 2 hours should not eat, drink, smoke, and
- if biopsy was performed, patient can not eat that day a hot meal
Prepare patient for examination
Normal mucous membrane
Rectoromanoscopy (RRS)
With rectoromanoscop can be examined the colon mucosa to a depth of 30-35 cm from the anus.
Method of the endoscopic examination of the rectum and distal sigmoid, investigation of their inner surface with rectoromanoskop introduced through the anus.
Indications:- pain in the anus- discharge of blood, mucus or pus- violation of stool (constipation, diarrhea)- suspected cancer of rectum or sigmoid
Contraindications:No absolute contraindications.Relative contraindications are: - cardiac decompensation - severe general condition - narrowing of the rectum - acute inflammation of the anus - stenosing tumor of the anal canal
Rectoromanoscopy (RRS)
Preparing to RRS
An important condition for RSS is a thorough colon cleanse from the content. At the evening before investigation diet is prescribed - just tea is allowed . Investigation is performed on an empty stomach.- In the evening and 2 hours before investigation cleaning enemas are used.
Rectoromanoscopy (RRS)
Normal mucous membrane
РЕКТОРОМАНОСКОПІЯ (RRS)
RRS зазвичай виконується в колінно-ліктьовому положенні пацієнта. При виражених болях в області заднього проходу RRS проводять під місцевою або загальною анестезією.У анальний канал вводять ректоскоп і поступово просувають його вперед при подачі повітря для розправлення просвіту кишки.Після видалення обтуратора ректоскопа під контролем зору його проводять вгору до сигмоподібної кишки.При RRS можна провести біопсію для гістологічного дослідження. Показання до біопсії є: наявність поліпів, пухлини, виразок, інфільтратів.
Colonoscopy
Method of endoscopic investigation of colon
Colonoscopy is the most informative method of early diagnosis of benign and malignant tumors of the colon, ulcerative colitis, Crohn's disease allows to inspect 80-90% of the colon.It is possible also to perform various therapeutic manipulation - removal of benign tumors, stop the bleeding, extracting of the foreign bodies, recanalisation of bowel stenosisПоказання:підозра на пухлинузапальні захворюваннях товстої кишки (особливо неспецифічний виразковий коліт, хвороба Крона)кишкові кровотечікишкова непрохідністьнаявність сторонніх тіл
Протипоказання:гострі інфекційні хворобиперитонітпізні стадії серцевої та легеневої недостатностівиражені порушення згортання кровіважкі форми виразкового та ішемічного коліту
The success of the research depends on correct preparation for the procedure.At the evening before research should be performed two cleansing enemasIn the morning before study should be done the same two enemas3-4 days before investigation should be prescribed a diet, excluding from the diet fresh fruits and vegetables, brown bread, cabbage in any form
ColonoscopyPreparation
Colonoscopy
Normal mucous membrane
X-ray investigation of stomach
Indications:
- Dysphagia- Complaints: heartburn, belching, loss of appetite, abdominal pain, nausea, vomiting- stomach ulcers or tumors- weight loss- The presence of seals abdominal palpation- ascites- anemia of unknown ethiology
- the presence of occult blood in the stool
makes it possible to investigate the shape, size, position, mobility of stomach, ulcer, localization of tumors, relief of the stomach, damage or lack of folds, a symptom of "niche" (ulcers), "filling defect" in a case of tumors.
X-ray of stomach
Pefformed on an empty stomach2 - 3 daysbefore investigation should be removed from the patient's diet foods that cause flatulence (beans, cabbage, potatoes, black bread)Dinner before the test should be light, not later than 20:00.Immediately before the test patient drink 200 ml of a mixture of barium
Preparing
Normal
symptom of "niche“ULCER
CANCER
IrrigoscopyX-ray examination of rectum and colon, allows to determine the localization of the pathological process, the presence of diverticuls
and evaluate the functional capacity of the intestine.
Indications:
bloatingdiarrheaconstipation blood in the stoolweight loss
Preparing – cleaning enema, diet
Normal
Cancer
рН-metryThe method of gastric secretion determination
The clinical significance of pH metery: it is the best diagnostic method of functional disorders, acid-dependent diseases, in the digestive tract diseases, allowing in all cases, especially when combined pathologies develop an adequate treatment strategy and monitor the progress of treatment
рН Stomach
body
рН Antral part
hyperacidity < 1,6 < 2,1
Normoacidity 1,6-2,3 2,1-3,0
Hypoacidity > 2,3 > 5,9-6,0
рН-metry
Duodenal probingDuodenal probingResearch of duodenal content that is performed to investigate the bile to detect lesions of the biliary tract and gall bladder
The patient is siting with opened mouthThe probe is introduced that olive was at the root of the tongue, and we offer the patient to swallowWhen the probe, according to the marks, must be in the stomach, its position shoud be checked by aspirating of gastric content by syringe: muddy liquid with acid reaction. The liquid may be yellow in the case of throwing to the stomach contents of the duodenum, but the reaction should be acidicWhen the probe is in the stomach, the patient is placed on the right side that olive was mooved to pylorusThen the patient continues to swallow slowly probe till mark 70 cm, then expect the olive passage in the duodenum, which is due to 1-1,5 hours. If the olive is in the duodenum, the tube starts flowing with yellow liquid with alkaline reaction
Duodenal probingDuodenal probing
Phase duration volume characteristic
portion
І Choledochus 10-15 min. 15-20 ml Light yellow duodenal content “А”
ІІ Closed Oddi’s sphincter 2-3 min. - - -
ІІІ Bile excretion from bile duct 3-6 min. 3-5 ml Light yellow bile
ІV Bile excretion from gallbladder
20-30 min. 30-50 ml Dark brown bile “В”
V Bile excretion from liver duct
20-30 min. 10-30 ml Light yellow bile “С”
Duodenal probingDuodenal probing
Ultrasound Review subject: Liver, spleenPortal, spleen and splenic veingallbladderpancreasretroperitoneal lymph nodes kidneys
Ultrasound is performed on an empty stomach. For the patient with increased gas production is recommended for 2-3 days before the test use a diet, excluding from the diet raw vegetables, foods rich in fiber, milk, black bread, beans, sweets. It is advisable to take during this time enzymes and enterosorbents.
Preparing
Computer tomography
Excretory urography - one of the leading X-ray techniques to study the morphology and function of the kidneys and urinary tract. It is based on the physiological ability of the kidneys to capture from the blood iodinated organic compounds, excreting them with urine and contrast porous system of the kidneys, ureters and bladder.
Contrast is introduced i.v.
Ascending (retrograde) pyelography - a method that helps to clarify the status of renal pelvis system
Investigation is carried out on an empty stomach, after cleaning the bowel. In aseptic conditions, using a special cystoscope at first examine the bladder wall, than through the ureter in the renal pelvis is introduced the X-ray catheter. Than in the bowl slowly is injected 8-10 ml of 20-30% solution of sterile contrast agent.
Computer tomography