Download Practical session №4 Theme: "Edematous syndrome. Differential

Practical session №4
Theme: "Edematous syndrome. Differential diagnosis of edema of various etiologies (local - allergic,
cardiovascular, inflammatory, general - circulatory insufficiency, renal, endocrine). Tactics GPs."
Case studies:
1. Go to the GP patient appealed, 50 years old, of cases of acute (sick 2 days), with complaints of marked
edema of the right leg and foot, pain and heaviness in it, raising the temperature to 39oS, chills. For many
years, noticed the expansion and bulging veins on the left leg, her swelling after exercise. When viewed otek right shin, skin cyanotic, palpation -boleznennye seal along the vein, pain when pressure in the
gastrocnemius muscle. Cardio-vascular and respiratory systems revealed no pathology. Blood pressure of
130/80 mm Hg -100 Pulse beats. min. Chair and regular diuresis.
In an. blood - leucocytes 15h109 / l, ESR -32 mm / h.
1. List at least four diseases in which the above symptoms are observed;
2. A presumptive diagnosis;
3. Informative research methods;
4. List and describe in detail the sample, allowing to judge the state of the superficial veins;
5. Tactics GPs with detailed management of patients (medical and non-medicated);
2. The patient, 31 years old, he turned to the GP complaining of facial swelling, abdomen, extremities,
pain and heaviness in the lumbar region. First noticed swelling 4 years ago, after hypothermia, which took
place independently. After quinsy health deteriorated sharply. At the time of inspection: severe facial
swelling, lower limbs, hands, abdomen. BP 140/80 mm. Hg. Art.
Urinalysis: relative density-1006, 6.65% protein, leukocytes -5-6 / 1, erythrocytes 10-17 / 1, hyaline
cylinders -2-4 / 1, grainy 1-2 / 1.
The patient was hospitalized in a specialized department, where he was diagnosed with chronic
glomerulonephritis with nephrotic syndrome a high degree of activity. Got patogeniticheskoe and
symptomatic treatment. Write out of the hospital in satisfactory condition and has been recommended
prodalzhat receiving maintenance doses of pathogenetic therapy. However, the patient stopped voluntarily
supplementation and your doctor did not address. Two months later reappeared swelling, join nausea,
vomiting, abdominal pain of various localization, painful migratory erythema rozhepodobnye in the
abdomen. Decreased blood pressure.
1. What is the complication developed in a patient;
2. List at least four more possible complications that threaten this patient;
3. At what more disease on the background of nephrotic syndrome likelihood of developing these
complications is high;
3. What should be the strategy of GPs with this case;
3. Patient L., aged 28, appealed to the GP with complaints of weakness, headache, pain in the lumbar
region, the temperature rise of 37.6 0C, frequent urination. In the anamnesis: frequent colds. Considers
herself sick for 3 years. Link their disease with a cold during pregnancy, received a course of penicillin,
nevigramon. The effect was negligible. On examination, the general condition is satisfactory. Pale skin,
pastoznost face. BP 150/90 mm Hg Pulse 82 beats / min., The heart - left ventricular hypertrophy, accent
II tone of the aorta. In the lungs showed no abnormality. Positive sign of a beating from 2 sides. Common
en. blood: HB - 105 g / l; er. - 2.6 h1012, l - 9,5 h109; ESR - 34 mm / h; obsch.belok - 68.5; blood sugar 4.5 mmol / l. Obsch.an.mochi: ud.ves - 1015; Protein - 0.09%; Erith. - 3-4 / 1; l - 40-50 / 1; epitope. - B /
c; salt - oxalates in large quantities.
1.Perechislite least four diseases in which there is the above mentioned symptoms;
2. A presumptive diagnosis;
3.Informativnye research methods;
4. How opredelaetsya and above what numbers will be renal-cortical index in this patient;
5. Tactics GPs;
4. Patient 57 years old and has 5 children, asked the GP complaining of a sharp deterioration of general
condition, marked swelling and redness of the right tibia, chilling, pain and distension in the area of
edema. From history: in a few years time to time notes nagging pain in his leg, edema of the right lower
leg. On examination: varicose veins and swelling of the right lower leg, tenderness, hot to the touch
compared to the left. Body temperature -37,8oS. On the part of the lung and heart disease have been
identified.
General analysis of blood: HB-120 g / L-eritr. 3,8h1012 / L, WBC-14h109 / l p / -5% s / I 80%
lymphocytes, 10% monocytes, 5% basophils -0, ESR 25 mm / h.
1. List at least four diseases in which the above symptoms are observed;
2. A presumptive diagnosis;
3. Informative research methods;
4. List at least three indirect thrombin inhibitors and indicators for monitoring the application of these
drugs
5. Tactics GPs with detailed management of patients (medical and non-medicated)
5. Patient H. 8 years treated by a nephrologist about xp. glomerulonephritis. In the last 2 years monthly
hemodialysis. A few days ago (before hospitalization) were long-term pain in the heart, increases with
inspiration, palpitations, headaches, nausea, vomiting, weakness. Objectively: the patient malnutrition,
puffy face, pale skin, dry, there are traces of scratching and bruising. Tion over the light vezikular breath,
wheezing not. Cardiac sounds are muffled, rhythmic, listens pericardial rub. Heart rate of 110 bpm. 1
min. BP 190/130 mm Hg The abdomen was soft, painful in the epigastric region. The liver and spleen
were not palpable. OAM: beats. w-1005 protein 4 g / day, leukocyte-6-8 / 1, modified RBCs-12-18 / 1,
not modified 4-5 / 1 tsilindiry-4-8 / 1. Glomerular filtration of 20 ml / min.
1. Your full preliminary diagnosis;
2. Plan of the survey;
3. Identify the reasons for pain in the heart;
4. Tactics GPs.
6. Patient K., 32 years old, married 6 years, no children. Was at the gynecologist several times, taking a
course of anti-inflammatory therapy (about endometritis), 2 times was a miscarriage. 1.5 months after
miscarriage appeared to rise in temperature 37,80S, pain in the right lumbar region, fever, frequent
urination. On examination: general condition is satisfactory. Pale skin, clean, peripheral lymph nodes
were not enlarged. Cardiac sounds are muffled, rhythmic. Pulse 80 beats / min, blood pressure 100/80
mm Hg Language lightly coated with white bloom. Symptom effleurage on the right is positive.
An.krovi: HB-84 g / l; er.-3.2 million .; n- 9500; ESR - 27 mm / hour.
An.mochi: ud.ves - 1017; l - in bolsh.kol Island, epitope. - B / Number. Erit.- 1-3 / 1, Lake 15-20, protein
- 0.033%.
1.Perechislite least four diseases in which there is the above mentioned symptoms;
2. A presumptive diagnosis;
3. Informative research methods;
4. Describe the signs of symptom Hodson (which normalno indicators of this syndrome) possibly having
this patient with excretory urography;
5. Tactics GPs;