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History of the disease by infectious diseases.

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History of the disease by the infectious diseases.

Diagnosis: Viral hepatitis A. Yellowish form. Medium severity.

Complaints On the yellowness of the skin and mucous membranes, dark urine color, nausea, urges for vomiting on blunt pains in the epigastrium and the right hypochondrium, dizziness, weakness, poor appetite.

Anamnesis of the disease:

She considers herself ill since November 6, 2003, when there were dull pains in the epigastrium and the right of the hypochondrium, general weakness, loss of appetite. He did not turn to the doctor because the beginning of the disease preceded the drinking of alcohol in large quantities and at first the patient thought that he had a hangover so .. Abdominal pain persisted. On the morning of November 7, 2004, the temperature rose (38.5C), took paracetamol and ferveyons, no effect, only a slight decrease in temperature. On November 14, 2004, skin jaundice and dark urine appeared, the patient was urgent and diagnosed: urinary tract infection on November 14, 2004 was delivered to the infectious department of 1 GKB of the city of Ivanovo.

Status at admission Complaints about blunt pains in epigastrium and right hypochondrium, dizziness, weakness, poor appetite, yellowness of the skin and mucous membranes, dark urine color, nausea, urges for vomiting. The general condition is satisfactory, the consciousness is clear, the position is active. Skin covers and visible mucous membranes of the jaundice, dry. Lymph nodes are not enlarged. With percussion on the lungs clear lung sounds. Breathing vesicular, no wheezing. The boundaries of the heart are not shifted. Tones of the heart are sound. There is no noise. Belly soft, palpation is painless. Urinary tract is regular, painless.

Epidemiologic history.

In the last 1.5 months, the acquaintance was ill with viral hepatitis, but with his words, he was not in contact with her, but his son was contacted by her son. Drinking water is consumed from under the tap. Sanitary and hygienic conditions are satisfactory. Lives in a two-room apartment, sanitary-hygienic conditions consider good, resides with his wife and son. In September this year was at the reception of a dentist. Vaccine did not do anything.

Anamnesis of life.

Born in the city of Ivanovo, he developed normally. I went to school with 7 years of studying well. Has transferred ORZ, SARS. Tuberculosis denies venereal diseases. Hepatitis did not get sick earlier, this disease is observed for the first time. Heredity is not burdened. In 1984, a trauma was a concussion of the brain with a fracture of the base of the skull. Over the past few years, he had nothing to do with his words.

There was no transfusion.

Allergic history

Allergic history: Medicines and allergens of other nature deny. Families, in the words of allergic reactions to allergens of various etiologies, denies. Chronic diseases that may cause allergenism are not revealed. All food products tolerate normally.

Status praesens.

The general condition is satisfactory, the consciousness is clear, the position is active. The body is correct, the constitution is normostenic. Temperature 36.6 С0. Skin and visible mucous membranes of the jaundice. The intensity of jaundice is weak. The color is yellowish-green. The skin is dry, elasticity is reduced. The development of subcutaneous fat is moderate, the distribution is uniform, in the male type. The thickness of the fold on the abdomen at the navel level is 2 cm. No fungus. The upper forward cervical lymphatic nodes are molded in size 1.0 * 0.6cm, axillary lymph nodes measuring 0.8 * 0.6cm, soft-elastic consistencies, painless, with the surrounding tissues are not soldered, the skin above them is not changed. The remaining lymph node groups are not palpated. Bone and muscular system without pathology.

Pathology from the respiratory system is not revealed.

Breathing is free, through the nose. Thoracic cage of cylindrical shape. The type of respiration is mixed. BH 20 per minute. With percussion on the lungs clear lung sounds. Breathing vesicular, no wheezing.

The limits of the heart are not displaced. Tone of the heart is sound, the rhythm is correct. The heart rate is 66 per minute. There is no noise. Pulse 66 per minute, identical, rhythmic, satisfactory filling and tension.

The language is covered with a whitish plaque. The stomach participates in the act of breathing. Belly soft, palpation is painless. The liver comes out from under the edges of the rib arch for 2 cm on the middle-clavicular line. The size of the liver by Kurlov 8.5 * 8.0 * 7.5 cm. The edge of the liver is rounded, smooth, elastic consistency, moderately painful. Ortner’s symptom is positive. The spleen is not palpable. Chair 1 time in 2-3 days, decorated, light, without pathological impurities.

Urinary tract is painless. The urine is dark. The symptom of Pasternak is negative on both sides.

Consciousness is clear, normal intellect, cramps, pathological symptoms are negative. Rumor and sight are satisfactory. Pulse 66 per minute. Blood Pressure 120/80 mmHg

Preliminary Diagnosis.

Viral Hepatitis. A typical form. Lightweight gravity.

Laboratory and instrumental examination plan

  1. General blood test
  2. General urine analysis
  3. Biochemical blood test
  4. Virological examination:

А. Immunogenic method (for detection of VGA-Ag)

  1. Serologic methods of investigation: IMF (for detection in IgM-antigens in the growing titer)

 

Summary:

Based on the data of the performed laboratory and instrumental methods the research can be confidently put the final diagnosis, as from the general analysis of blood, we found: neutropenia, relative lymphocytosis, accelerated ESR; which is characteristic of viral hepatitis A; from OAM revealed: changes in color of urine, proteinuria, cholururia, urobilinuria; these changes are characteristic of viral hepatitis; From B / X: an increase in total bilirubin predominantly due to a direct fraction, an increase in ALT, an increase in the thyme sample rate is characteristic of viral hepatitis A, of moderate severity; from the reaction to Hbs Ag: a positive result. All data suggest in favor of viral hepatitis A.

 

Differential diagnosis

     Differential diagnosis of hepatitis A is carried out in the prodromal period with influenza and other OCD, enterovirus infection. Unlike hepatitis A, in cases of influenza, the predominance of catarrhal and toxic syndromes, changes in functional liver tests and hepatomegaly is not typical. When adenoviral, enterovirus infection accompanied by an increase in the liver, catarrhal processes of the upper respiratory tract, myalgia are commonly expressed. Differentiate VHF with Vasiliev-Weyl’s disease

With VHA, gradual, headaches, muscle pains, kidney damage are rare, leptospiros in the urine and blood are not detected, the reaction of agglutination and lysis is negative. When expressed jaundice, it is necessary to differentiate from a mechanical jaundice caused by stones of the gallbladder or a tumor with mechanical jaundice, a painful syndrome is sharply expressed and a positive reaction to Hbs Ag is not revealed.

Clinical diagnosis and its justification | || 301

This diagnosis is based on anamnesis, objective research, laboratory-instrumental examination methods. From anamnesis, namely from an epidemic. Anamnesis acquaintance was ill with viral hepatitis, which is a predisposing factor for the development of this disease, although the patient also denies having been in contact with her. In September of this year, the patient was on the treatment at the dentist, this can also be a factor in the development of this pathology. From the objective examination of the lung, we revealed the yolk coloration of the mucous membranes and sclera, the language is deposited with a whitish plaque. With percutaneous determination of the borders of the liver by Kurlov, hepatomegaly is detected, the edge of the liver extends from the edge of the edge arch by 2 cm, the edge of the liver is rounded, smooth, elastic consistency, moderately painful. From laboratory methods of research: from the general analysis of blood we have revealed: neutropenia, relative lymphocytosis, accelerated ESR; which is characteristic of viral hepatitis A; from OAM revealed: changes in color of urine, proteinuria, cholururia, urobilinuria; these changes are characteristic of viral hepatitis; From B / X: an increase in total bilirubin predominantly due to a direct fraction, an increase in ALT, an increase in the thyme sample rate is characteristic of viral hepatitis A, of moderate severity; from reaction to Hbs Ag: positive result.

Pathogenesis of clinical symptoms.

1. Dyspepsia syndrome consists of a number of symptoms:

A. Lower appetite

B. Nausea

V. Requests for vomiting

Pathogenesis: when the pathogen passes into the digestive tract, it penetrates into the blood and lymph, virussemia occurs and a general toxic effect develops both on the liver and on the digestive tract, the depression of the gastric secretion occurs, as a result, a decrease in appetite occurs. As a result of accumulating the virus of the virus in the digestive tract and increasing the toxic effect, nausea and urges for vomiting arise.

  1. Intoxication syndrome which includes the following symptoms:

А. Fever

B Muscular weakness.

V. Adynamia

Pathogenesis: When a pathogen passes into the blood through the gastrointestinal tract, virussemia develops; activation of the protective systems of the organism occurs as a result of the development of fever. Adynamia and muscle weakness develop as a result of violations of water-salt metabolism and energy metabolism.

  1. Yellow fever syndrome includes:

A. Yellowness of the skin and mucous membranes

B. dark urine color

V. Skin pains

The pathogenesis is associated with the pathogen coming into the hepatic tissue and the subsequent development of inflammatory and noncrobotic changes, resulting in disturbed bilirubin exchange, hepatocytes can not cope with a large amount of indirect bilirubin and it enters the bloodstream, then it begins deposited in the tissues and mucous membranes, resulting in yellowness of the skin and mucous membranes and itching of the skin. Since part of the bilirubin is filtered by the kidneys and is excreted in the urine, a dark color of the urine arises.

Treatment

Treatment of the patient:.

  1. Mode of half-life
  2. Diet № 5 by Pevsner plus abundant alkaline drink
  3. Infusion therapy:

Rp. Sol Glucose 5% – 200ml

Sol. Ac Ascorbinici 5% – 2 ml

D.t.d.N1

  1. S. Inject intravenously 1 time per day

Rp Sol. Ringer 200 ml

D.t.d.N1

  1. S. Administer intravenously drip 1 time per day
  2. Cholagogic drugs Hologon 1 tablet 3 times a day

Treatment of this nosological form:

All of the above items 1, 2,3,4 but in addition to this:

  1. Vitamin therapy: Vitrum, multivitamins take one capsule 2 times a day.
  2. Plasma solutions are prescribed to stimulate the liver and reduce intoxication, amino acids mixtures.
  3. Vitamin B12 intramuscularly 1 time per day at a dose of 500 mg.
 
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