Задача №11.

Больной Ю., 47 лет, поступил в больницу на вторые сутки от начала заболевания с жалобами на резкую опоясывающую боль в верхней половине живота, увеличение живота в объеме, одышку, тошноту, рвоту, задержку стула и газов. Из анамнеза: заболевание связывает с употреблением значительного количества алкоголя, острой и жареной пищи.

При обследовании: общее состояние больного тяжелое, одышка в покое. Частота пульса 140 за 1 мин., дыхания - 27 за минуту. АД = 90/50 мм рт.ст. Лицо бледное, цианотичное. Живот вздут, передняя брюшная стенка не принимает участия в акте дыхания. На боковых поверхностях живота – умеренный цианоз. При пальпации - напружение и выраженная болезненность на всем протяжении живота, в эпигастральной области и левом подреберье пальпируется инфильтрат без четких контуров. Положительные симптомы Воскресенского, Чухриенко, Щеткина-Блюмберга. Перкуторно – притупление в отлогих местах и высокий тимпанит в эпигастрии. При аускультации живота – шумы перистальтики резко ослаблены.

Задача №12.

Больная С., 64 лет, обратилась к врачу с жалобами на постоянную боль в правой половине живота, тошноту, слабость, лихорадку, задержку стула и газов. Из анамнеза: боль возникла в эпигастральной области 6 суток тому назад, через несколько часов переместилась в правую подвздошную область, была однократная рвота. За медицинской помощью не обращалась, самостоятельно принимала спазмолитики. Через 4 суток состояние больной ухудшилось: повысилась температура тела до 37,8°С, появились тошнота, слабость, однако больная продолжала самолечение. На шестые сутки состояние больной значительно ухудшилось: усилилась боль и распространилась на всю правую половину живота, температура тела повысилась до 38,5°С, возникла задержка стула и газов.

При обследовании: общее состояние больной тяжелое, температура тела 38,3°С, пульс 120 уд. за 1 мин., АТ=100/60 мм рт.ст. Язык суховат, живот умеренно вздут в нижней половине, правая половина передней брюшной стенки не участвует в акте дыхания. При пальпации живот напряжен, болезненный на всем протяжении, но больше всего - в правой подвздошной области, где нечетко пальпируется инфильтрат розміром 10х8 см, резко болезненный, неподвижный. Перитонеальные симптомы (Щеткина-Блюмберга, Раздольского) положительные, більше в правой половине живота.

Acute inflammatory abdominal syndrome

Case# 1.

Patient B. male, 26 y.o., visited a doctor complaining of persistent pain in the right iliac region , nausea, weakness . Anamnesis : the pain appeared a day ago , for no apparent reason , initially localized in the epigastric region, and then moved a few hours in the right iliac region, was single vomiting . Stool is normal.

On examination : general condition is satisfactory, the usual skin color , body temperature 37,6 ° C, the pulse 94 bpm. Tongue moist , slightly swollen belly , the right half of the anterior abdominal wall is behind in breathing. Surface palpation revieled moderate pain in the right iliac area, deep palpation - tenderness is greatly enhanced . Positive signs Rovzing , Bartome - Michelson Voskresensky . Shchetkina-Blumberg sign is negative . Auscultation - weakened peristalsis sounds.

Case# 2.

Patient R. , male, 43 y.o., complains of persistent pain in the right part of the abdomen , and more - in the right upper quadrant , radiating to the right supraclavicular region ; nausea, fever, dryness and bitterness in the mouth. Anamnesis : 10 hours ago , the appearance of pain associated with consumption of fatty and fried foods ; pain arose sharply, accompanied by vomiting twice .

On examination : general condition of moderate severity, the patient is lying on his right side , mild pallor , body temperature 38,2 ° C, the pulse - 104 bpm. Tongue dry , covered with a brownish patina . Moderately distended abdomen , upper half does not participate in the act of breathing . On palpation determined soreness and tension in the abdominal wall verhnіy half bіlshe - in the right upper quadrant. Positive symptoms Grekov - Ortner , Murphy , Mussi . Auscultation - reduced peristalsis sound .

Case#3 .

Patient P. , 42 y.o., complains encircling sharp epigastric pain , which are periodically increased, accompanied by heartburn , vomiting, not bringing relief. Anamnesis:: get sick 5 hours ago , the appearance of pain is associated with alcohol and significant amount of fatty and spicy foods .

On examination : general condition of the patient of moderate severity , skin is of palish color , pulse 94 bpm, blood pressure = 150/90 mmHg. Tongue moist, coated with gray patina . Distended stomach in the upper half , the abdominal wall is partially participates in the act of breathing , palpation determined moderate tension and soreness in the epigastrium and left upper quadrant . Pulsation of the abdominal aorta is not defined . Positive symptoms Kerte , Chuhrienko , Mayo-Robson , peritoneal signs are negative. Percussion: thympanitis in epigastric region . Auscultation of the abdomen - peristaltic sounds weakened.

Case# 4 .

Patient A. , 57 y.o. , admitted to the hospital for the 2nd day from the onset of illness with complaints of pain in sharp encircling pain in abdomen , bloating, shortness of breath, nausea, vomiting, stool retention and gases. Anamnesis: acutely get sick after receiving a significant amount of alcohol and eating spicy fatty foods. Initially he did not apply for the medical help and used self-medication (" washing " of the stomach , antispasmodics ) , due to the deterioration of the disease admit a hospital .

On examination : general condition of the patient is severe passive, position in the bed . Palish skin , acrocyanosis, emphasized cyanosis of side walls of the abdomen. Pulse rate of 140 bpm. , Respiratory rate - 27 per min. BP = 100/70 mmHg. Distended stomach in the upper half , the anterior abdominal wall above the navel does not participate in the act of breathing . On palpation - moderate tension and soreness in the epigastrium and left upper quadrant . Positive symptoms Kerte , Chuhrienko , Voskresensky, peritoneal signs questionable . Auscultation of the abdomen - peristalsis sounds are weakened.

Case#5 .

Patient D. , 36 y.o. , visited the doctor with complaint of persistent pain in the right iliac region , nausea, weakness , frequent painful urination . Anamnesis:: get sick 12 hours ago, pain first appeared in the epigastric region, then 2 hours later moved to the right iliac region, there was a single vomiting , frequent urination appeared . Stool is normal .

On examination : general condition of the patient is relatively satisfactory , body temperature 37,6 ° C, the pulse 104 bpm. Tongue moist , covered with whitish bloom at the root . Slightly swollen belly , the right half of the abdominal wall behind in the act of breathing. On palpation a moderate tension determined the anterior abdominal wall , and severe local pain in the right iliac region . Positive symptoms: Rovzing , Bartome – Michelson, Yaure, Rozanov. Peritoneal signs are negative. Auscultation – peristaltic sounds are somewhat weakened .

Case#6.

Patient B. female, 26 y.o. , went to the doctor complaining of persistent pain in the right iliac region and in suprapubic region , nausea, weakness . Anamnesis: get sick during the day, the pain first appeared in the upper abdomen , after 3-4 hours has moved in the right iliac and suprapubic region gradually intensified, there was single vomiting . The stool was the day before, of normal consistency , urination is without changes. Last menses were two weeks ago , in time .

On examination : general condition is satisfactory, the body temperature of 37,3 ° C, the pulse 94 bpm. Tongue moist, overlaid at the root. Moderately distended abdomen below the navel , the right half of the anterior abdominal wall is behind in the act of breathing . On palpation of moderate tension determined the anterior abdominal wall in the right iliac region. Marked local tenderness in the right iliac region . Positive symptoms: Rovzinga , Bartome -Michelson , Obraztsov . Peritoneal signs are negative.

Case#7.

Patient S. , 56 y.o. , went to the doctor complaining of persistent pain in the right iliac region , nausea, weakness , fever . Anamnesis: get sick 5 days ago, when on the background of the overall good health there was a pain in the upper abdomen , which moved through 4 hours in the right iliac region, there was a single vomiting . Medical care is not addressed, applied herbal tea . After 4 days the patient's condition deteriorated slightly: body temperature raised up to 37,5 ° C, nausea , weakness, and that led to consult a doctor .

On examination : general condition of moderate severity, body temperature 37,6 ° C, the pulse 94 bpm. , BP = 130/70 mmHg. Tongue moist, coated with a whitish bloom. Somewhat swollen belly in the lower half , the right half of the anterior abdominal wall behind in the act of breathing . On palpation the abdomen is soft , painless throughout , except for the right iliac region , where not clearly palpable tumor formation of size 6x8 cm , moderately painful , little mobility. Positive symptoms: Rovzing , Obraztsov . Peritoneal signs are negative.

Case#8.

Patient S., 48 y.o., complains of severe pain in the right part of the abdomen , more pronounced in the right upper quadrant , radiating to the right supraclavicular region and under the right scapula , increased body temperature , dry and bitter taste in the mouth. Anamnesis: get sick two days ago , a disease associated with consumption of fatty and fried foods . In the past, periodically appeared pain in the right upper quadrant after abuses in the food.

On examination : general state of moderate severity , the patient lies on his back , the body temperature 37,9 ° C, the pulse 94 bpm , BP = 150 /80 mm Hg. Tongue moist , coated with yellowish coating on the edges . Moderately distended stomach , the upper half of the abdominal wall behind in the act of breathing . On palpation - defined moderate tension and soreness in the right upper quadrant . Positive symptoms: Grekov - Ortner , Kehr , Mussi . Peritoneal signs are negative.

Case#9.

Patient F. , aged 68, complains of persistent pain in the right upper quadrant radiating to the right supraclavicular region, dryness and bitterness in the mouth, icteric staining of the skin. Anamnesis:: ill two days ago, the onset of pain associated with consumption of fatty and fried foods . Initially, there was pain in the epigastric region , twice was vomiting, then the pain localized in the right upper quadrant , aggravated by movement. At the end of the first day of the disease noticed icteric staining of the skin and sclera . In the past, periodically had pain in the right upper quadrant after errors in the food.

On examination : general condition of the patient of average weight , body temperature 38,2 ° C, the pulse 94 beats . bpm. , BP = 135/75 mmHg Skin and sclera subikterichnost . Tongue moist, coated yellowish coating . Moderately distended abdomen , upper half behind in the act of breathing . On palpation - moderate tension and soreness in the right podrebereї . Positive symptoms Grekova - Ortner , Kera , Musso George's . Peritoneal signs are negative.

Case#10 .

Patient D. , 72 y.o., complains of pain in the right postoyanku abdomen , dryness and bitterness in Horta , nausea, vomiting . Anamnesis:: acutely ill two days ago, the onset of pain associated with consumption of fatty and fried foods . Pain occurred in the right upper quadrant and epigastric pain , radiate to the right shoulder , was twice vomiting . Medical care is not addressed , self- hosted antispasmodics , but the condition gradually worsened , the pain spread down the right flank , increased body temperature . In the past, periodically poznikali pain in the right upper quadrant after pogrіshnostey nutrition .

On examination : general condition of patients with severe , lies on the right side , the body temperature 39,2 ° C, the pulse 114 beats . bpm. , BP = 130/65 mmHg Pale skin . Tongue dry , lined with a brownish patina . Distended abdomen , anterior abdominal wall does not participate in the act of breathing . On palpation - dramatic tension and soreness of the right half of the abdomen. Positive symptoms Grekova - Ortner , Musso George's . Peritoneal signs ( Shchetkina - Blumberg , Razdolsky ) positive in the right part of the abdomen .

Case#11.

Patient Yu , 47 y.o. , was admitted to the hospital on the second day of onset with complaints encircling sharp pain in the upper abdomen , abdominal distension , shortness of breath , nausea, vomiting , stool retention and gases. Of history : the disease is associated with the use of a significant amount of alcohol, spicy and fried foods .

On examination : general condition of patients with severe , shortness of breath at rest . Pulse rate of 140 bpm. , Breathing - 27 per minute. BP = 90/50 mmHg Face pale , cyanotic. Distended abdomen , anterior abdominal wall does not participate in the act of breathing . On the sides of the abdomen - moderate cyanosis . On palpation - napruzhenie and soreness all over the abdomen, epigastric and left upper quadrant palpable infiltration without precise contours . Positive symptoms of the Resurrection , Chuhrienko , Shchetkina - Blumberg . Percussion - blunting in sloping areas and high thympanitis epigastric . Auscultation of the abdomen - noise peristalsis weakened sharply .

Case#12.

Patient S. , 64 y.o., went to the doctor complaining of persistent pain in the right part of the abdomen , nausea, weakness , fever, stool retention and gases. Of history : the pain originated in the epigastric region 6 days ago, a few hours later moved to the right iliac region, was single vomiting . Medical care is not addressed , self- hosted antispasmodics . After 4 days the patient's condition worsened: increased body temperature to 37,8 ° C, developed nausea , weakness, but the patient continued self . On the sixth day the patient's condition has deteriorated significantly : increased pain and spread to the entire right half of the abdomen , the body temperature rose to 38,5 ° C, there was a delay stool and gas .

On examination : general condition of patients with severe , body temperature 38,3 ° C, the pulse 120 beats . bpm. , AT = 100/60 mmHg Language dryish , abdomen moderately distended in the lower half , the right half of the anterior abdominal wall is not involved in the act of breathing . On palpation the abdomen tense, painful all over, but most of all - in the right iliac region , where not clearly palpable infiltration rozmіrom 10x8 cm, sharply painful , immobile . Peritoneal signs ( Shchetkina - Blumberg , Razdolsky ) positive bіlshe in the right half of the abdomen.