Lecture
Objective: to form students' knowledge of acute diseases of the digestive organs, metabolism, kidneys and urinary tract, and to familiarise them with types of first aid.
Diseases of the digestive system are among the most widespread among the population. Their incidence shows no tendency to decline; on the contrary, it is characterised by further growth, often depriving patients of their normal working capacity and leading to disability.
With diseases of the digestive organs, patients complain of abdominal pain, loss of appetite, belching, nausea, vomiting, flatulence, disturbance of bowel function, etc.
Pain in the abdominal cavity differs, with different diseases of the digestive organs, in its localisation, intensity, relation to food intake, its character, etc. In diseases of the stomach and duodenum, pain is localised in the epigastric region and is related to food intake. A feature of this pain is its periodicity, its appearance or intensification immediately after eating («early pain») or on an empty stomach («late pain», «hunger pain»). Constant pain, whose intensity does not change in relation to food intake, is encountered considerably less often. In diseases of the liver and biliary tract, pain is localised in the right hypochondrium.
Loss of appetite is largely related to the state of the secretory function of the stomach. Increased appetite is observed with increased gastric secretion, and decreased appetite - with reduced secretion. In chronic gastritis, and especially in stomach cancer, complete loss of appetite or its perversion is often encountered: for example, the patient experiences an aversion to meat or certain other foods.
Belching is the sudden involuntary release of gas from the stomach into the oral cavity, accompanied by the characteristic sound of air escaping through the mouth; with increased gastric secretion it may be accompanied by a sensation of acidity in the mouth, and with putrefactive processes in the stomach - by an unpleasant odour.
Heartburn is a sensation of heat or burning in the epigastric region and behind the sternum, occurring when the contents of the stomach enter the lower part of the oesophagus.
Nausea is an unpleasant sensation in the epigastric region combined with a feeling of pressure.
Vomiting is the involuntary expulsion of the contents of the stomach through the mouth, caused by spasmodic contractions of the musculature of the stomach, diaphragm and lower oesophagus. It may be caused by the intake of poor-quality food, or by stomach disease.
Flatulence is a sensation of bloating and distension of the abdomen, accompanied by increased passage of gas.
Disturbance of bowel function in the form of diarrhoea and constipation - is an important symptom of diseases of the digestive organs. Diarrhoea is loose stool with frequent bowel movements. Its causes may include increased intestinal peristalsis, inflammatory processes (dysentery), etc. Constipation is retention of faeces in the intestine for a period of more than two days. Functional and organic constipation are distinguished. The former is caused by a lack of fibre in the diet, inflammatory processes, insufficient intestinal peristalsis, or weakness of the abdominal muscles; the latter - by tumours of the intestine or its cicatricial narrowing.
Acute gastritis is an inflammatory disorder of the gastric mucosa.
The development of acute gastritis is caused by various factors: a disturbed diet (consumption of spicy, too hot, hard-to-digest or poor-quality food, alcohol abuse, irregular eating over a long period), medication-induced damage to the gastric mucosa, increased sensitivity of the stomach to certain foods, and consumption of food products infected with salmonella, staphylococci and other microbes.
Main symptoms. The manifestations of acute gastritis are that patients feel pain, heaviness and fullness in the epigastric region, nausea, and they develop vomiting, sometimes diarrhoea, salivation or dry mouth. The tongue is coated with a greyish-white coating.
Principles of treatment. The treatment of acute gastritis depends above all on its type. Thus, in simple acute gastritis caused by poisoning, it is necessary to immediately clear the stomach and intestines of food remnants by lavage. In milder cases this can be done by drinking water and artificially inducing vomiting.
For the first two days, patients should abstain from food, but at the same time should receive a sufficient amount of fluid. If vomiting has stopped, the patient is given tea, rosehip infusion, or rice or oat decoction.
Among the medicinal preparations prescribed are adsorbent substances (activated charcoal, etc.) and broad-spectrum antibiotics; in the case of pronounced pain, antispasmodics.
Therapeutic nutrition plays a major role in the treatment of acute gastritis: on days 2-3 - fat-free broth, mucous soup, mashed cereals, fruit jellies; on day 4 - meat or fish broth, mashed potato, rusks. The patient is then prescribed an appropriate diet, and after 7-8 days he switches to a normal diet.
Prevention of the development of acute gastritis consists in the strict observance of all rules of dietary hygiene, both public and individual. The former provides for constant monitoring of food products on their way to the consumer. Products consumed without prior heat treatment require special attention. Compliance with the rules of personal hygiene by the staff of catering establishments also plays a major role.
Individual prevention comes down to a rational eating regimen, limiting the consumption of strong alcoholic drinks, and also preventing accidental consumption of acids, alkalis, etc.
Peptic ulcer disease of the stomach and duodenum is a chronic recurrent disease based on inflammation of the mucous membrane of the stomach and duodenum; in most cases it is caused by Helicobacter pylori, proceeds with impaired blood supply to the mucous membrane, and manifests as destruction of the mucous barrier and the formation of ulcers.
Among the many causes that can lead to the occurrence of peptic ulcer disease, the most significant are:
The main symptom of the disease in typical cases is paroxysmal pain, which is related to food intake and usually subsides after eating. At the height of the pain attack, a single episode of vomiting of acidic contents may occur, after which the patient's condition improves; heartburn and constipation are also observed. Peptic ulcer disease is characterised by seasonal exacerbations - in spring and autumn - as well as a connection with nervous, emotional and heavy physical strain, and the consumption of spicy, coarse food or alcohol. Increased fatigue, sleep disturbances and sweating are noted. The tongue is coated at the root. Among the various methods of diagnosing peptic ulcer disease, fibrogastroscopy and X-ray examination of the stomach occupy the leading place.
Principles of treatment. Two types of treatment for peptic ulcer disease are distinguished: conservative and surgical. The former is used for uncomplicated peptic ulcer disease, the latter - when bleeding or perforation (the formation of a hole in the wall of the stomach or duodenum) is suspected, etc.
Anti-ulcer therapy includes therapeutic nutrition, medication and physiotherapy. It provides for limiting physical activity and prescribing a diet and preparations that normalise the secretory and motor functions of the stomach and duodenum. Given the major role of the neuropsychological factor in the occurrence and course of peptic ulcer disease, procedures and agents that calm the nervous system are used.
Prevention. Primary prevention is aimed at preventing the disease. It includes proper nutrition, organisation of work and rest, abstention from smoking and alcohol, creating psychological comfort, engaging in physical exercise, etc. Primary prevention should be aimed at early diagnosis and treatment of the pre-ulcer state, functional disorders of the stomach and duodenum, and also at identifying other risk factors for the disease. Secondary prevention provides for preventing exacerbations of the disease. It is carried out through regular medical check-ups.
Acute hepatic colic is a typical symptom of gallstone disease - a disease characterised by the formation of stones in the gallbladder and bile ducts. A provoking role in the onset of an attack belongs to negative emotions, dietary irregularities, physical exertion, etc.
Main symptoms. Hepatic colic, as a rule, occurs suddenly, often at night, is localised in the right hypochondrium, and radiates to the right arm, shoulder and shoulder blade. The pain is, as a rule, severe, of a stabbing, tearing, cutting character, and may be accompanied by vomiting, chills and a rise in temperature. During an attack the abdomen is distended, the abdominal wall is tense, and there is pain over the projection of the gallbladder.
The duration of the pain attack in uncomplicated disease varies - from a few minutes to several hours or several days. In most cases, after the attack has ended, patients feel satisfactory.
Principles of treatment. During an attack of hepatic colic, a doctor must be called. Emergency therapeutic care for hepatic colic, regardless of its cause, begins with agents that relieve spasm. The presence of an inflammatory process requires the administration of broad-spectrum antibiotics.
For the prevention of hepatic colic, a general hygienic regimen, proper nutrition (consumption of vegetables, low-fat foods low in cholesterol and rich in protein, regular meals), combating obesity, infections, diseases and disorders of the digestive organs, timely elimination of bile stasis, absence of mental and physical overexertion, and systematic physical exercise and sports are all of great importance.
Acute cholecystitis
Acute cholecystitis is an acute inflammation of the walls of the gallbladder.
Etiology: The causative agents of the inflammation are Escherichia coli, staphylococci and streptococci. The predisposing factor is bile stasis.
Clinical picture: Clinically it presents with an acute onset: rise in body temperature, cramping pain in the right half of the abdomen radiating to the scapula and clavicle; nausea and vomiting are observed in half of patients; the pain intensifies when lying on the right side, the tongue is coated, appetite is absent, there is stool retention, and tachycardia. On examination and palpation the abdomen is distended, with rigidity of the muscles in the right half of the abdomen. Ortner's and Murphy's signs are positive, and the ESR is elevated.
Differential diagnosis: Differential diagnosis is made with appendicitis, exacerbation of chronic cholecystitis, and acute gastritis.
Treatment:Home regimen, antibiotics (Ampiox, Ceporin), antispasmodics, analgesics.
Acute pancreatitis
Acute pancreatitis is an acute inflammatory disease accompanied by autolysis (due to activation of the gland's own enzymes) and dystrophy of the pancreatic tissue.
Etiology
The causes may include viral infections, blunt abdominal trauma, allergic reactions, dietary disorders (excess of fatty, carbohydrate-rich food), biliary tract disease, obstruction of the pancreatic duct, vascular pathology (atherosclerosis, severe hypotension), renal failure, diabetes, medications (glucocorticoids, estrogens), and parasitic diseases.
Classification
The classification is as follows.
I. Form:
1) interstitial;
2) haemorrhagic;
3) pancreatonecrotic;
4) purulent.
II. Period of the disease:
1) acute attack (onset);
2) reparative.
III. Clinical course:
1) type: acute, subacute, recurrent;
2) severity: mild, moderate, severe;
3) syndromic characteristics: pancreatic-hepatic, cerebral, cardiac syndromes and others.
IV. State of pancreatic function.
V. Complications and their nature: on the part of the gland: pseudocyst, abscess, diabetes; on the part of other organs: haemorrhage, dysfunction of the cardiovascular system, liver, kidneys, and central nervous system.
Clinical picture
The clinical picture consists of the following syndromes.
1. Pain syndrome is characterised by intense pain in the epigastrium radiating to the left, of a girdling (belt-like) nature.
2. Dyspeptic syndrome is characterised by nausea, vomiting that brings no relief, constipation or maldigestion.
3. Intoxication syndrome – rise in body temperature, headache, weakness, malaise, acute vascular insufficiency, disseminated intravascular coagulation (DIC) syndrome.
On examination the tongue is coated with a white or yellowish coating, the abdomen is distended, with muscular defence; Halstead's sign (cyanosis of individual areas of the anterior abdominal wall), Grey Turner's sign (pigmentation on the lateral areas of the abdomen), Grunwald's sign (petechiae around the umbilicus), Mondor's sign (purple spots on the face and trunk), Korte's sign – tenderness in the area of the transverse abdominal muscle above the umbilicus in the projection of the pancreas (5–7 cm above the umbilicus), the Chauffard zone, the Mayo-Robson point, the Desjardins point – tenderness on palpation; Voskresensky's sign (absence of pulsation of the abdominal aorta on pressure in the epigastrium).
Diagnosis
The complete blood count shows leukocytosis with a left shift of neutrophils. Urine amylase levels are high. Blood biochemistry shows dysproteinaemia, elevated amylase, lipase, transaminases, alkaline phosphatase, and bilirubin (in cases of secondary liver involvement).
Ultrasound shows enlargement of the gland with tissue oedema.
Differential diagnosis
Differential diagnosis is made with appendicitis, perforated ulcer, high intestinal volvulus, splenic infarction, pleurisy, acute cholecystitis, nephrolithiasis, acute gynaecological diseases, aortic aneurysm, and diabetic or hepatic coma.
Diabetes mellitus is a disease of the endocrine system characterised by a disorder of carbohydrate and other types of metabolism due to an absolute or relative deficiency of insulin production by the pancreas. The essence of the disease lies in the insufficient uptake by the body's cells of carbohydrates coming in with food, which is related to insufficient production of insulin by the pancreas. Under normal conditions dietary carbohydrates (sugar, bread, cereals, vegetables) are converted in the human intestine into the simplest form of sugar – glucose, which is one of the main sources of nutrition for the body. In diabetes mellitus, because of the cells' insufficient uptake of glucose, it accumulates in the blood in large quantities. A lack of insulin also leads to a disorder of water metabolism, as a result of which the tissues fail to retain water. Water not absorbed by the tissues is excreted from the body in large quantities in the urine.
Factors contributing to the development of diabetes mellitus may include hypertension, atherosclerosis, obesity, alcohol abuse, diseases of the liver and pancreas, heredity, and others.
Insulin-dependent and non-insulin-dependent types of diabetes mellitus are distinguished, and by severity – mild, moderate and severe forms. Insulin-dependent diabetes mellitus is more common in young people and begins quite acutely. The leading symptoms of the initial period of this type of diabetes are thirst, dry mouth, frequent urination, weight loss, and gradually increasing weakness. The main laboratory signs of diabetes are an elevated blood glucose level and impaired utilisation of glucose by peripheral tissues.
Non-insulin-dependent diabetes mellitus occurs more often in people over 40 years of age with excess body weight. This type of diabetes is characterised by a gradual and slowly progressing onset. Patients may be troubled by slight thirst, weakness, weight loss, periodontal disease and other symptoms. The first signs of the disease (dry mouth, increased need for fluids, etc.) appear several months or years after the onset of the disease.
Principles of treatment. Modern treatment of diabetes mellitus is aimed at the maximum regulation of the disturbed metabolic processes that occur in the body due to an absolute or relative deficiency of insulin. Rational treatment of patients with diabetes mellitus is based on diet therapy, the administration of insulin, and tablet forms of drugs that lower blood sugar levels and normalise metabolic processes. Insulin is administered by injection, since when taken orally it is destroyed by digestive enzymes.
Comatose states in diabetes mellitus are divided, depending on their cause, into hyperglycaemic (diabetic) and hypoglycaemic (associated with insulin overdose) forms. Diabetic coma occurs with insulin deficiency. Its development is promoted by insufficiently consistent treatment of diabetes, dietary disorders, inflammatory processes, injuries, and others. The comatose state develops gradually over several hours or days. It is preceded by weakness, dry mouth, thirst, abdominal pain, drowsiness, and others. The skin of the face is pinkish, the lips and tongue are dry, breathing is noisy, and there is a smell of acetone on the breath. Muscle tone is reduced, blood pressure is lowered, the pulse is weak, and blood and urine sugar levels are elevated.
Treatment of diabetic coma is aimed at eliminating insulin deficiency, normalising water-salt metabolism, and eliminating infections or other causes that led to the development of the coma.
Hypoglycaemic coma occurs with a rapid drop in blood sugar (insulin overdose, dietary disorders, physical and mental strain, etc.). Its clinical signs develop very quickly: pallor and moist skin, headaches, weakness, palpitations, increased muscle tone, increased reflexes, convulsions, agitation, and impaired consciousness are observed. Treatment of the coma is carried out with easily absorbed carbohydrates (sugar, sweet tea). In severe cases, 40–100 ml of 40% glucose solution and other medicinal products are administered intravenously.
Patient care. Caring for patients suffering from diabetes mellitus requires the thorough carrying out of general care measures and includes a number of special issues related to the particularities of treating such patients.
In patients with diabetes mellitus, various skin changes are often observed against a background of severe itching and reduced resistance to pathogenic microorganisms. In this connection, careful skin hygiene is necessary.
Against a background of low resistance of the body, patients often develop inflammatory diseases of the gums (gingivitis) and of the oral mucosa (stomatitis). Prevention of such complications requires systematic oral care and timely sanitation.
Patients with diabetes mellitus often have concomitant diseases of the respiratory organs, cardiovascular system, digestive tract, and others. All this necessitates constant monitoring of the state of the respiratory and cardiovascular systems, counting the respiratory rate and identifying pulse characteristics, measuring blood pressure, monitoring bowel function, and others.
Prevention. The main preventive measures include rational nutrition, physical activity, and the prevention and treatment of obesity. When signs of carbohydrate metabolism disorder appear, foods containing easily absorbed carbohydrates (sugar, etc.) and foods rich in animal fat should be excluded from the diet. Dietary restriction should be maintained by older people regardless of the severity of atherosclerotic disorders, especially with increased body weight.
Prevention of decompensation in existing diabetes mellitus (secondary prevention) consists of strict adherence to a rational work and rest regimen, avoidance of emotional and physical strain, prescription of an appropriate diet, timely meals, and adequate treatment of the disease.
In kidney diseases, the treatment of the patient largely depends on timely and accurate diagnosis. The most characteristic symptoms of kidney damage are oedema, disorders of urine output and urination, changes in urine composition, and elevated blood pressure.
Oedema in kidney disease varies in severity, location, and persistence. Most often oedema appears in the morning on the face. With a more pronounced oedematous syndrome it appears on the lower limbs (mainly on the shins). In some cases the oedema reaches a large size.
Changes in urine output are a frequent symptom of diseases of the genitourinary system. Oedema is usually combined with a decrease in urine output.
Disorders of urination – painful and frequent urination – are mainly associated with inflammatory processes of the urinary tract (cystitis, urethritis, prostatitis), but may also occur when a stone passes through the ureter.
A change in urine colour is most often due to the presence of blood (macrohaematuria). Macrohaematuria occurring after renal colic indicates the presence of urolithiasis. When it is detected, urological examination and determination of the underlying disease are needed first of all. Painless, suddenly developing, profuse macrohaematuria requires ruling out a tumour process in the kidneys.
Changes in urine composition are established by laboratory testing. In kidney diseases, increased excretion of erythrocytes and protein in the urine, and the presence of leukocytes in the urine, are found.
Pain in the lumbar region may be caused by inflammatory processes in the kidneys, or be due to a stone, a blood clot, a tumour, and other causes. Severe paroxysmal pain in the lower back with the typical radiation downward is a characteristic symptom of urolithiasis.
Elevated body temperature may be a sign of infection in patients with kidney disease (acute or chronic pyelonephritis, etc.), kidney tumours, and others.
Acute pyelonephritis is inflammation of the kidney and its pelvis. Pyelonephritis is among the most common diseases in general and kidney diseases in particular.
The main cause of acute pyelonephritis is infection: most often Escherichia coli, somewhat less often staphylococcus, enterococcus, streptococcus, and others. The onset and development of pyelonephritis are promoted by a decrease in the body's resistance to infection as a result of hypothermia, overexertion, previous severe inflammatory urogenital diseases, and others.
Main symptoms. The disease presents with general and local symptoms. A triad of symptoms is characteristic: chills followed by a rise in temperature, frequent urination, and lower back pain. Local symptoms in acute pyelonephritis are characterised by pain and tension of the back and abdominal muscles. The onset of the disease is acute: a high temperature – up to 40°C – and chills appear. Patients complain of malaise, thirst, severe headache, joint pain, nausea, and vomiting. Protein, erythrocytes and a large number of leukocytes appear in the urine.
Principles of treatment and patient care. Treatment measures for acute pyelonephritis are determined mainly by its form and stage.
Antibacterial therapy is of greatest importance. It is carried out according to the results of testing the sensitivity of the urinary infection to antibiotics, as well as on the basis of individual tolerance.
In the acute period of the disease, especially with elevated body temperature and pain, the patient is prescribed bed rest. Drinking large amounts of fluid in the form of juices, fruit drinks, mineral water, tea, and infusions of diuretic herbs is indicated. The patient's diet should be sufficient to provide the necessary number of calories. Food should not contain irritating components; dairy and plant-based dishes are preferable.
After the condition improves, the diet is gradually expanded. For pain in the kidney area, heat treatments are recommended – heating pads, warming compresses, and others.
Prevention of pyelonephritis consists of the timely sanitation of foci of infection, especially chronic inflammatory diseases of the genital organs and the lower urinary tract, as well as the prevention of severe hypothermia.
Renal colic is a manifestation of urolithiasis, which is characterised by the formation of urinary stones in the kidneys and urinary tract as a result of metabolic disorders and changes in the urinary organs. It develops when an obstruction suddenly arises in the path of urine outflow. Most often colic occurs when a stone moves through the ureter, which is blocked by blood clots, a tumour, or has impaired patency as a result of inflammatory processes.
Main symptoms. The attack begins suddenly. It most often occurs after physical exertion or drinking a significant amount of fluid, but it can also occur at rest, at night during sleep. The pain is sharp, cutting, with periods of easing and worsening. Patients are restless in bed, searching for a comfortable position that would help reduce the pain. As a rule, the pain begins in the lumbar region and spreads along the ureter toward the bladder, the groin area, and the genitals; it may radiate to the hypochondrium and abdomen. Severe pain is accompanied by frequent urges to urinate. The patient is pale, and the skin is covered with cold, clammy sweat. Reflex nausea and vomiting, and urges to defecate, are observed. The pain may be very intense and accompanied by loss of consciousness.
Principles of treatment and patient care. Emergency care is usually limited to the administration of antispasmodics and painkillers. If these measures are ineffective, the patient is hospitalised.
Acute cystitis is inflammation of the mucous membrane of the bladder. It occurs when infection penetrates the bladder (Escherichia coli, enterococcus, streptococcus, and others). The bladder can also be affected by a number of sexually transmitted infections. The development of the disease is promoted by factors that irritate the bladder mucosa: hypothermia of the body, frequent consumption of spices and alcoholic beverages, and also constipation.
Main symptoms. Acute cystitis is characterised by painful, frequent urination in small amounts (sometimes every 5-10 min). The pain varies: burning, cutting, dull, and it intensifies at the end of urination. Acute cystitis is characterised by heaviness in the lower abdomen and perineum. In severe cases of the disease, a slight rise in body temperature is possible.
Principles of treatment and patient care. Antibacterial therapy is of leading importance in treatment, in order to prevent the disease from becoming chronic. Bed rest is indicated in the acute period; canned food, spicy sauces, seasonings, smoked food, and alcoholic beverages should be excluded from the diet, and bowel function should be monitored.
Measures for the prevention of acute cystitis include hardening of the body, treatment of concomitant diseases, and observance of genital and personal hygiene. It is advisable to avoid hypothermia, wearing clothing unsuited to the season, and frequent consumption of canned food, alcohol, and other such things.
Comments