The Ministry of Health of the Republic of Uzbekistan Tashkent Medical Academy The department of internal diseases №3 of medical an Medical Pedagogical Faculty

It must be emphasized that the leading role in the diagnosis of various forms of dyspepsia is a correct assessment of anamnestic data and posistemny patient survey.

Heartburn and belching air, acid are the most common painful gastrointestinal symptoms in patients. We must always remember that they are not necessarily a manifestation of hyperacid condition and can be observed even in cancer patients with deep Akhil (lactic acid, bile, pancreatic juice). Epigastric discomfort may accompany diseases of the chest, retroperitoneum, spine, and in these cases timely ECG and radiographic examination to avoid rough diagnostic errors.

The method of "snowballs."

Objective: The involvement in the educational process of all students while controlling their knowledge of the topic under discussion.

The main provisions of methods.

Group 2-3 is divided into smaller subgroups kotoryeobsuzhdayut same problem or situation to set the highest number of correct answers. Each correct answer is recorded on the score of this group in the form of snowballs. Group receiving the highest number of points, give higher ratings.

1.Opredelenie chronic gastritis.

2. Diagnosis of chronic gastritis.

3. EradikatsiyaH.pylorici.

Answers:

1. Chronic gastritis - a chronic inflammation of the gastric mucosa in violation of the physiological regeneration and progressive atrophy of the specialized glandular epithelium with the development of intestinal metaplasia, dysplasia and later, and a violation of motor and secretory functions.

2. EFGDS + biopsy, fractional study of gastric juice, revealing H.pylorici (cytological and histological study, the degree of contamination of the mucous membranes, immunological).

3. First-line therapy in 7 days: omeprazole 20 mg 2 times / day + clarithromycin 500 mg 2 times / day. + Amoxicillin 1000 mg 2 times / day

+ Metronidazole 500 mg 2 times / day, second-line therapy 10 days of omeprazole 20 mg 2 times / day + bismuth subcitrate 120 mg 4 times / day + tetracycline 500 mg 4 times / day. + Metronidazole 500 mg 2 times / day

The evaluation criteria

Maximal score 20-19	18-17 point	16-15 point	14-13 point	12 point
Perfect	Good	Satisfactorily	Unsatisfactorily	bad
100%-86%	85%-73%	70-56%	53%-46%	43% and less

4. The analytical part of

4.1 Case Studies:

1. Male 20 years old at the reception GP notes epigastric pain, heartburn, nausea. The pain was after 20 minutes. after ingestion. From history revealed that the patient eats regularly, and enjoys rough and fried food. General state of moderate severity. On the part of the heart and lungs normal. Tongue coated white coating, wet, says teeth marks. The abdomen is involved in the act of breathing. When palpation diffuse epigastric tenderness. The chair is prone to constipation.

1. List at least four diseases in which the above symptoms are observed;

2. Your preliminary diagnosis;

3. Additional research is needed to confirm the diagnosis;

4. Tactics GPs. Treatment.
Aswers

№	Answers	point
1	a) irritable stomach, b) type B chronic gastritis with increased secretion, c) chronic gastritis type B with preserved secretion, d) a stomach ulcer.	15
2	chronic gastritis type B with an increased secretion.	25
3	EFGDS + biopsy, fractional study of gastric juice, revealing H.pylorici (cytological and histological study, the degree of contamination of the mucous membranes, immunological).	20
4	EradikatsiyaH.pylorici, anti-secretory drugs (ranitidine or omeprazole or gastrotsepin), antacids (Maalox), preparations protecting coolant (denol or sucralfate), correction of the impaired microcirculation (Actovegin).	20

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2. A patient 26 years old at the reception of the GP notes heaviness in the epigastric region, nausea, salivation, increasing the temperature to 38 ˚ C. From the history 2 days ago, he tried not benign food. Subsequently he observed vomiting and diarrhea. The general condition of the patient a heavy, moist skin, pale. Of the heart - tachycardia, heart rate 100 beats / min., Rhythmic. In the lungs, vesicular breathing. On palpation of the abdomen is soft, there is a slight pain in the epigastric region. Urine output is reduced.

1. List at least three diseases in which the above symptoms are observed;

2. Your preliminary diagnosis;

3. Additional tests needed to confirm the diagnosis;

4. Specify the method of research, which is crucial for diagnosis and specific changes in this pathology;

5. Treatment. Tactics GPs._______________________________________________________________________________

3. A patient 48 years old at the reception of the GP complaining of heaviness, distension, dull epigastric pain, nausea, anorexia, bad taste in mouth, belching rotten, rumbling, bloating, diarrhea, hair loss. Objectively: the patient's general condition of moderate severity. Skin pale, dry, marked trophic nail changes. In the lungs, vesicular breathing. Heart sounds. Pulse 96 beats per 1 minute. BP 110/70 mmHg Tongue moist, coated with white bloom. The abdomen was soft, painful in the epigastric region. The liver and spleen were not enlarged. Stool occasionally diarrhea. Urination is free and painless.

Fluoroscopy tract: the relief of the mucous membrane is flattened, the tone and peristalsis weakened, gastric emptying accelerated. The study of gastric secretion: total acidity - 18 titr.ed.
1. List least 6 diseases which may be the above symptoms;

2. Your preliminary diagnosis;

3. What additional research is needed to clarify the diagnosis for the patient;

4. The most serious complication of the disease;

5. Please describe, drug and drug therapies (diet, drugs, indicating dose), Tactics GP

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4. Male 42 years appealed to the GP complaining of severe epigastric pain, nausea, heartburn. The pain occurs in 20-30 minutes after ingestion and is local. From history: last spring, there were also similar pains. The patient was not treated, the pain itself passed in a month. On-no: abdominal palpation there was a huge local tenderness in the epigastrium. Constipation.

1. 
   1. List at least four diseases which may be the above symptoms; Your preliminary diagnosis;
   
2. 
   2. What additional studies be carried out to confirm the diagnosis;
   
3. 
   3. What complications can occur with this disease;
   
4. 
   4. Please specify the scheme and the principles of conservative treatment of this disease.
   
5. 
   _________________________________________________________________________________
   
6. 
   5. The reception was at the GP 18 year old student complains of hunger and night pain in the abdomen, irradiruyuschie in the spine, occasionally heartburn, acid regurgitation. History of big brother is suffering a stomach ulcer 12 duodenal ulcer. Objectively: the patient malnutrition, skin and visible mucous membranes pale, tongue coated. On palpation of the abdomen there was a huge local pain in the epigastric region to the right. Constipation.
   
7. 
   1. List at least four diseases which may be the above symptoms;
   
8. 
   2. Your preliminary diagnosis;
   
9. 
   3. What additional studies be carried out to confirm the diagnosis;
   
10. 
    4. What are the causative factors of aggressive and are crucial to the emergence of this disease;
    
11. 
    5. Tactics GPs. Treatment.
    
12. 
    _______________________________________________________________________________
    
13. 
    6. A patient 21 years old, student, turned to the GP complaining of heartburn, acid regurgitation, the severity of pain and dull aching in the pit of stomach after eating, and constipation. Objectively: the patient's general condition is relatively satisfactory. Consciousness is clear. Position is activated. Skin is pale pink. In the lungs, vesicular breathing. Cardiac clear, rhythmic. Pulse 84 beats per 1 minute. BP 120/80 mm Hg Tongue moist, coated with white bloom. The abdomen was soft, painful in the epigastric region. The liver and spleen were not palpable. The chair is prone to constipation. Urination is free. The study of gastric secretion: the total acidity of fasting - 85 titr.ed. X-ray examination of the stomach: signs of hypersecretion, diffuse alteration of the relief of the mucous membrane, with thickening of the folds.
    
14. 
    
    
15. 
    1. List at least four diseases which may be the above symptoms;
    
16. 
    2. Your preliminary diagnosis;
    
17. 
    3. What additional studies be carried out to confirm the diagnosis;
    
18. 
    4. Describe in detail (in figures and indicating normal values), what changes are expected in the fractional study of gastric contents;
    
19. 
    5. Tactics GPs. Treatment.
    
20. 
    ________________________________________________________________________________
    
21. 
    7. A patient 42 years old, turned to the GP complaining of severe girdle pains at the epigastrium after a fatty meal, repeated nausea, vomiting bears no relief. From history: suffering for 10 years, peptic ulcer disease, occasionally worried about the pain associated with eating and recently changed the nature of pain, and there were complaints listed above. Objectively: general state of moderate severity, the patient malnutrition, sclera subikterichnost. Cor - the tones are muted, rhythmic. Pulse 80 beats. 1 min. BP -125 / 70 mm Hg In the lungs, vesicular breathing. The abdomen was soft, tension in the upper abdomen. The liver and spleen were not enlarged. Frenikus positive sign on the left. CBC - HB-120 g / l, 10 thousand white blood cells, erythrocyte sedimentation rate 20 mm / hour.
    
22. 
    
    
23. 
    1. List at least three diseases and at least two events at which the above signs and symptoms;
    
24. 
    2. Preliminary diagnosis (main complication);
    
25. 
    3.Informativnye survey methods;
    
26. 
    4.Taktika GP;
    
27. 
    _________________________________________________________________________________
    
28. 
    8. Patient K., 33 years old, turned to the GP complaining of unbearable heartburn, hunger pains in the epigastric region, nausea, diarrhea with abundant liquid feces. In the history of repeatedly treated in gastroenterology hospital for peptic ulcer disease 12 sc, and there have been episodes of ulcer bleeding. On examination - peripheral lymph nodes were not enlarged. In the lungs, vesicular breathing. Cor - high tones sonorities, rhythmic. Pulse 90 beats. 1 min. BP -100 / 70 mm Hg. Abdomen soft, painful on palpation in the gastro-duodenal area. The liver and spleen were not enlarged.
    
29. 
    In the study of gastric juice: basal acid output -18mekv/chas with histamine load flow rate figures revealed total acidity 60 mEq / hour, total acidity of 100 units., Free hydrochloric acid in the basal phase of 80 units. EGDFS 4 ulcers (stomach 1 and 3 s.c. 12) coated with fibrin coating.
    
30. 
    1. List at least chyteryzabolevany at which the above signs and symptoms;
    
31. 
    2. The preliminary diagnosis;
    
32. 
    3. Informative survey methods;
    
33. 
    4. What changes are in the U.S.; 5. Tactics GPs.
    
34. 
    _________________________________________________________________________________
    
35. 
    9. Patient V., 32, appealed to the GP complaining of a sudden appeared last night, severe weakness, dizziness, nausea and retching, but no vomiting occurred. From history: for many years, often in the spring and autumn are concerned heartburn, recurrent epigastric pain occurring within 1.5-2 hours after eating. Last night was awakened by the urgency to bottom, and then there was a black liquid stools. On-no: the patient malnutrition, skin and mucous membranes are pale and clean. Cor-tones are muffled, rhythmic. Pulse of 100 beats. 1 min. BP 95/65 mm Hg In the lungs auscultated vesicular breathing. Tongue coated with white bloom at the root of the teeth along the edges of the prints. The abdomen was soft, sensitive in the epigastric region. The liver and spleen were not enlarged.
    
36. 
    1. List at least five diseases and at least two events at which the above signs and symptoms;
    
37. 
    2. Preliminary diagnosis (main complication);
    
38. 
    3. . Informative survey methods;
    
39. 
    4. The tactics of the GP;
    
40. 
    5. Formulations used for the first order of the patient;
    
41. 
    _________________________________________________________________________________
    
42. 
    10. Patient M., 21, turned to the GP with complaints of epigastric pain after 1 -1.5 hours after a meal, the emergence of feelings of fullness in the epigastrium, belching with the smell of "rotten eggs", nausea, vomiting of food eaten the day before, after vomiting patient feels relieved. From history: epigastric pain, heartburn, constipation, disturbed in the spring and autumn for the past 4-5 years. Objectively: the patient malnutrition, the skin is pale, clean, dry, flaky, in the corners of the mouth binding. Cor-high tones sonorities, rhythmic. Pulse 90 beats. 1 min. Blood pressure 100/70 mm Hg The tongue is coated with a grayish bloom. The abdomen was soft, painful epigastric auscultation, "splashing". The liver and spleen were not zoom. Chair - a tendency to constipation.
    
43. 
    1. List at least four diseases and at least two complications are observed above signs and symptoms;
    
44. 
    2. Preliminary diagnosis (main complication);
    
45. 
    3. Informative survey methods;
    
46. 
    4. The tactics of the GP;
    
47. 
    ________________________________________________________________________________
    
48. 
    11. In the SVP to see a GP patient appealed 30 years complained of heartburn and pain in the midline between the xiphoid process breastbone and the navel, characterized by frequency, seasonality, decreased after vomiting, weakness. In the words of the patient, the above complaints concerned about the age of 7. Bad habits: smoking, loves hearty, sour, salty food.
    
49. 
    Objectively: general condition of the patient at the time of inspection is relatively satisfactory, skin and visible mucous membranes pale, tongue coated. On palpation revealed tenderness in the epigastric region. BP 120/80 mm.rt. Art., pulse 76 beats per minute.
    
50. 
    
    
51. 
    Objects of the 20-step principles.
    
52. 
    
    
53. 
    The evaluation criteria
    

Maximal score 20-19	18-17 point	16-15 point	14-13 point	12 point
perfect	Good	satisfactorily	unsatisfactorily	bad
100%-86%	85%-73%	70-56%	53%-46%	43% and less

TESTS.

Tests with two or more correct answers.

1. The appearance of bloody vomiting and black liquid stool in a patient may be due to:

a) chronic gastritis

b) ulcer duodenum 12

c) esophageal varices

r) drug administration of bismuth

e) syndrome Mallory - Weiss

e) irritable bowel syndrome

2. What are the three main factors in the development of peptic ulcer?

a) nervous and mental strain

b) the metabolism of cholesterol

c) chronic gastritis and duodenitis

d) non-compliance with hygiene

e) jetlag food
3. What are the three main places of localization ulcer in the stomach:

a) small curvature

b) in the antral

c) on the sphincter

g) in the bulb

e) in the cardiac department

e) in the fundal
4. 3 Specify the characteristic symptoms for 12 duodenal ulcer?

a) constipation

b) heartburn

c) night pain

d) diarrhea

e) pain on an empty stomach
5. What are the three characteristics of pain in 12 duodenal ulcer:

a) increased at night

b) the gain on an empty stomach

c) increased after ingestion

d) seasonality

d) seasonality is not typical

e) has no connection with the meal
6. What are the 3 main X-ray signs of ulcers:

a) enhanced evacuation of barium

b) scar deformity

c) hypersecretion on an empty stomach

d) a symptom of a niche

e) there is no right answer
7. Enter the 3 main events for ulcer bleeding from the stomach:

a) glucocorticoid

b) sodium etamzilat

c) aminokapronku

d) Vitamins

e) cytostatics

e) peace

8. What are the 3 main diagnostic methods in peptic ulcer disease:

a) EGDFS

b) X-ray

c) scatoscopy

g) liver ultrasound

d) analysis of gastric juice

e) sigmoidoscopy

9. What are the 3 groups antiskretornyh funds used for the treatment of peptic ulcer disease:

a) Antibiotics

b) N2gistaminoblokatory

c) gastrin receptor blockers

d) anti-

e) sulfonamides

e) M holinoblokatory
10. 3 morphological forms of gastritis:

a) polypoid

b) Chronic

c) Hypertrophic

g) hemorrhagic

e) Hereditary

e) acute

11. In the clinic the prevalence of chronic gastritis syndrome consists of the following 3

a) gastric dyspepsia

b) epigastric pain

c) The neurotic

g) of diarrheal

e) intestinal dyspepsia

e) jaundice
12. Intestinal dyspepsia exacerbation of chronic gastritis characterized by three symptoms

a) pain in the belly button

b) borborygmus c) Breach of the chair

g) Flatulence

e) pain along the large intestine

e) melena

13. Highlight 3 morphological forms of chronic duodenitis:

a) Surface

b) Hypertrophic

c) purulent

g) Autoimunnyj

d) Fibrous

e) Atrophic

c) evidence of a pheochromocytoma

d) The tendency to allergic reactions

e) astenonevroticheskih syndrome

e) hypertrophic gastritis

14. For peptic ulcer, 12 duodenal ulcer is characterized by all of the following complications, except for:

a) pyloric stenosis

b) diarrhea

c) haemorrhage

d) penetration

e) the deterioration of the intestinal conductivity

e) malignancy

The evaluation criteria

Max score 20-19	18-17 point	16-15 point	14-13 point	12 point
perfect	good	Satisfactorily	Unsatisfactorily	bad
100%-86%	85%-73%	70-56%	53%-46%	43% and less

6.Grafichesky organizer "fishbone".

The purpose of the scheme "fishbone" to describe the whole range of field problems and try to solve it, develops and activates the system, creative, analytical thinking.

Progress chart: students get acquainted with the rules of construction of the scheme. Individually or in pairs to write down the top bone wording of sub-problems and on the bottom - the facts prove that these problems exist.

Together in a mini group, compare and complement your scheme.

Next, conduct a presentation of the results. Presentation of the completed scheme to demonstrate the relationship of sub. Their comprehensive.
                                         worn similar latency simulation

                                        clinical symptoms of the disease

dyspepsia

    diagnostics-------------------------------------------------------------------------------------------------------------------------------

Lack of patient shortage of economic

                            Lack of laboratory equipment in time

                                                            Do not come

Doctor doctor doctor doctor

                             Illiterate inattentive careless nonprogressive

dyspepsia

diagnostics

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Nurse Nurse Nurse

                            Careless illiterate non-executive