Задача № 12

Больной З., 64 лет, поступил в приемное отделение больницы с жалобами на схваткообразную боль в животе, задержку стула и газов, вздутие живота, тошноту. Из анамнеза: на протяжении последних 9-ти месяцев отмечает затруднение при акте дефекации, периодически в кале появлялась слизь и следы темной крови. За сутки до поступлення в больницу появилась умеренная схваткообразная боль в животе, перестали отходить газы и кал.

При обследовании: общее состояние больного средней тяжести. Пульс 86 уд. за 1 мин., АД=135/70 мм рт.ст. Язык суховат, обложен белым налетом. Живот умеренно вздут, симметричный. При пальпации – живот мягкий, умеренно болезненный ниже пупка слева, симптомов раздражения брюшины нет. При аускультации – выслушиваются усиленные шумы перистальтики. При пальцевом ректальном исследовании патологи не виявлено, ампула прямой кишки пустая.

Syndrome of acute intestinal obstruction

Case # 1

Patient N. female, 32 y.o. , was admitted to the hospital emergency room complaining of a sharp crampy abdominal pain, stool retention and gas , frequent vomiting, bears no relief. Anamnesis : sick for 6 hours , when there was a abdominal pain after meal, and then - vomiting, the symptoms began to grow .

On examination : general condition of the patient moderate , restless , moaning in pain , pulse 86 bpm , BP = 140/75 mmHg. Tongue is dry , moderately distended abdomen , anterior abdominal wall partially involved in the act of breathing. In the right iliac region - old atrophic postoperative scar . On palpation - the abdomen is soft , moderately painful in the right half . Positive signs: Sklyarov, Kivulya .Peristalsis is resonating .

OBJECTIVE number 2

Patient R. , 52 years old, complains of sharp crampy abdominal pain, stool retention and gas , frequent vomiting. Of history : the past three months had moderate pain in the right iliac region , periodic bloating, rumbling bowel strong , weakness , loss of appetite , low-grade temperature. Recently, there have constipation alternating with diarrhea mixed with blood in the stool . Night ago, abdominal pain increased significantly , began cramping stopped depart gases .

On examination : general condition of the patient of average weight , pulse 94 beats . for 1 min. , BP = 150/90 mmHg Language dryish , lined with a whitish bloom. Belly swollen, due to asymmetric bulge in the right half . On palpation - the abdomen is soft , tender in the right iliac region , where not clearly palpable tumor formation , sedentary . Positive symptoms Sklyarov Kivulya . Peritoneal signs are not defined . Laxation resonating . By digital rectal examination : empty vial , reduced sphincter tone .

OBJECTIVE number 3

Patient B. , 46 years old , complains of sharp crampy abdominal pain, stool retention and gas , frequent vomiting. From history : three years notes the protrusion at the navel . 5 hours before admission to hospital suddenly appeared cramping abdominal pain, stopped depart feces and gases , was vomiting .

On examination : general condition of the patient difficult , turbulent behavior , often changing position in bed , moaning . Pale skin , acrocyanosis . Pulse 110 beats . for 1 min. , BP = 90/60 mm Hg. Art. Tongue dry , coated with white bloom . Moderately distended stomach in the upper , anterior abdominal wall partially involved in the act of breathing. On palpation - the navel is defined oval plotnoelasticheskuyu education, 3x4 cm , painful , percussion over it thympanitis determined . Laxation resonating with metallic shade. Peritoneal signs questionable . Positive symptom Sklyarov .

OBJECTIVE number 4

Patient F. , 70 years old , complains of a dull paroxysmal pain in the lower abdomen , delay stool and gas . Of history : a long time suffer from constipation , a day before admission to hospital appeared to moderate pain in the lower abdomen , which after a time became paroxysmal stopped depart Ghazi , the chair was not 2 days .

On examination : general state of moderate severity , pulse 96 beats . for 1 min. , BP = 150/90 mmHg Language obklozhen white bloom , dryish . Belly asymmetric (right half of the abdomen swollen ) , palpation - soft, moderately painful in the left half , where palpable texture plotnoelasticheskoy education, measuring 10 x 8 cm , over which percussion dullness determined . Sklyarov positive symptom , symptoms of peritoneal irritation no peristalsis resonating . By digital rectal examination : the tone of the anal sphincter weakened ampoule rectum empty .

OBJECTIVE number 5

Patient P. , 62 years old, complains of moderate paroxysmal abdominal pain, stool retention and gases. Of history : the past 6 months notes difficulty in defecation , periodically appears mucus and traces of dark blood in the stool . One day before admission to hospital appeared paroxysmal abdominal pain, stopped depart gases chair was not 2 days.

On examination : general condition of the patient moderate , low Potanin . Pulse 86 beats . for 1 min. , BP = 140/80 mmHg Language dryish , lined with gray patina . Distended abdomen , visible through the abdominal wall peristalsis intestines. On palpation - the abdomen is soft , moderately painful below the navel. When balloting is determined by " splashing ". Reinforced peristaltic noises are heard . No symptoms of peritoneal irritation . When digital examination of the rectum to a depth of 10 cm revealed no pathology .

OBJECTIVE number 6

Patient R. , 48 years old , appealed to the hospital emergency department with complaints of crampy abdominal pain, gas and stool retention , nausea, vomiting . Of history : the patient previously suffered three operative intervention on the abdominal organs with drainage , and then often had bouts of abdominal pain, bloating, nausea, intermittent constipation and gas . Five hours before admission to the hospital , after taking large quantities of food , there was paroxysmal abdominal pain, nausea, vomiting twice had appeared constipation and gas

On examination : general condition of patients with severe , pulse 122 for 1 min. , BP = 90/60 mmHg , pale skin . Tongue dry , coated with white bloom . Belly swollen, asymmetric : right at the navel defined broad, flat protrusion plotnoelasticheskoy consistency in proektsii MDM determined "splashing " and percussion on it - thympanitis . In the left half - sunken belly , soft. Peritoneal signs are not defined . By digital rectal examination : empty vial .

OBJECTIVE number 7

Patient G. , 36 years old , is being treated in the surgical department , where three days ago was operated on for perforated gastric ulcer was made suturing perforated holes and drainage of the abdominal cavity. On the third day after the operation continues to disturb the constant abdominal pain, nausea, periodically - vomiting .

On examination : general condition of the patient of average weight , pulse 100 beats per 1 min. , BP = 100/70 mm Hg. Art. Tongue dry , coated with white bloom . Uniformly swollen abdomen , anterior abdominal wall weakly participates in the act of breathing . On palpation - the abdomen is soft in all departments , moderately painful , peritoneal signs are not expressed on auscultation - sharply weakened peristalsis , peristaltic waves unit . Through a tube inserted into the stomach to 1.5 saw stagnant content.

OBJECTIVE number 8

Patient G. , 26 years old , was admitted to the hospital emergency room complaining of a sharp crampy abdominal pain, stool retention and gas , frequent vomiting , bloating . From history : p'yat years ago was operated on for acute appendicitis , these complaints appeared 6 hours before admission to the hospital after eating a large amount of food gradually increased .

On examination : general condition of the patient moderate , restless , moaning in pain , pulse 90 beats . for 1 min. , BP = 110/70 mmHg Language dryish , lined with gray patina . Abdomen moderately swollen, slightly anterior abdominal wall is involved in the act of breathing . In the right iliac region - old atrophic postoperative scar . On palpation - the abdomen is soft , moderately painful to the right of the navel, is determined by " splashing ". Peritoneal signs are negative. Laxation resonating .

OBJECTIVE number 9

Patient D. , aged 58 , was admitted to a hospital emergency department with complaints of cramping pain in the lower abdomen , delay stool and gas , bloating . Of history : in the last four months the patient appeared periodically moderate pain in the right part of the abdomen , bloating , increased intestinal rumbling , increasing weakness , loss of appetite . A month ago, there were constipation, which alternated with diarrhea , said admixture of mucus and dark blood in the stool . Two days ago, abdominal pain increased significantly , began cramping , no longer depart gases .

On examination : general condition of the patient of average weight , pulse 96 beats . for 1 min. ; BP = 140/80 mmHg Language dryish , lined with gray patina . Belly swollen , symmetrical, anterior abdominal wall slightly participates in the act of breathing . On palpation - the abdomen is soft , moderately tender in the left iliac region , where not clearly palpable tumor formation size 6x5 cm Symptoms of peritoneal irritation not determined . In mezogastralnoy area determined " splashing ". Peristalsis of the intestines resonating . By digital rectal examination : decreased sphincter tone , ampoule rectum empty .

TASK № 10

Patient G. , 42 years old , was admitted to a hospital emergency department with complaints of crampy abdominal pain, stool retention and gas , bloating , dry mouth . From history : 5 hours before admission to the hospital for no apparent reason appeared cramping abdominal pain, stopped depart gases was repeated vomiting .

On examination : general condition of the patient heavy, restless , often change position in bed , sonnet , skin is pale , acrocyanosis . Pulse 110 beats . for 1 min. , BP = 90/60 mm. Hg. Art. Tongue dry , lined with gray patina . Moderately distended belly . In the right pane mezogastralnoy navel palpated plotnoelasticheskuyu education, oval , painful , percussion over it determined thympanitis s metal shade . Peristalsis of the intestines resonating , peritoneal signs questionable . By digital rectal examination : ampoule rectum empty .

TASK № 11

Patient R. , 67 years old , complains of mild cramping abdominal pain, stool retention and gases. From history : for several months suffer from constipation , take a laxative. 2 days prior to arrival at the hospital appeared to moderate pain in the lower abdomen , which has become a day cramping stopped depart gases .

On examination : general condition of the patient of moderate severity. Pulse 98 beats . for 1 min. , BP = 145/80 mmHg Tongue coated with white bloom , dryish . Belly asymmetrical , the right side of the abdomen is swollen , the left - sunken . On palpation - the abdomen is soft , moderately painful right where palpiruєtsya education plotnoelasticheskoy consistency , size 8h9 see positive symptom Sklyarov . Peritoneal signs are negative. Auscultation - peristalsis weakened. By digital rectal examination : weakened sphincter tone , ampoule blank .

TASK № 12

Patient Z. , 64 years old , was admitted to a hospital emergency department with complaints of crampy abdominal pain, stool retention and gas , bloating, nausea. Of history : the past 9 months notes difficulty in defecation , periodically appeared in the stool mucus and traces of dark blood . One day before admission to hospital appeared moderate cramping abdominal pain, stopped depart gases and feces .

On examination : general condition of the patient of moderate severity. Pulse 86 beats . for 1 min. , BP = 135/70 mmHg Language dryish , coated with white bloom . Abdomen moderately swollen, symmetrical . On palpation - the abdomen is soft , moderately painful left below the navel , no symptoms of peritoneal irritation . Auscultation - amplified noises are heard peristalsis. Digital rectal examination not viyavleno pathologists , ampoule rectum empty .