Reference no: EM133219211

No. 1
A 32-year-old patient went to the doctor with complaints of "dull" pains in the epigastric region and behind the sternum, usually occurring after eating, and also when bending over when working. At the height of the pain attack, sometimes there is vomiting, a feeling of lack of air. Symptoms of the disease appeared 1/2 years ago, tend to progress.

On examination: The skin is pale pink, normal humidity. In the lungs, vesicular breathing is significantly weakened in the lower sections of the left lung. In the same place, intestinal noises are indistinctly auscultated. respiratory rate - 18 in 1 minute. Pulse - 76 in 1 minute, rhythmic. AD - 130/80 mm. rt. Art. Heart sounds are muffled, rhythmic. On the anterior abdominal wall there is a scar from a median laparotomy performed, according to the patient, a year ago for a stab wound penetrating into the abdominal cavity. The abdomen is not swollen, soft, painless on palpation in all departments. There are no symptoms of peritoneal irritation. Liver on the edge of the costal arch. The spleen is not palpable. The chair is regular, decorated. Urination free, painless.
1. What disease can you think of?
2. Classification of this disease?
3. Variability of the clinical picture depending on the differences in etiopathogenesis?
4. What research methods will confirm your diagnosis?
5. What complications can develop?
6. Methods of treatment of this disease?

2. A 37-year-old man was admitted 16 hours after the onset of the disease with complaints of sudden severe cramping pain in the upper abdomen, repeated vomiting of food eaten, and abdominal distention. From the anamnesis it is known that two years ago he was operated on for a penetrating wound of the abdominal cavity with damage to the liver and transverse colon. During the postoperative period, similar attacks were observed several times, which were effectively stopped by the use of antispasmodics. This time the attack is more difficult, the usual conservative measures are not effective.

Objectively: the state of moderate severity, the patient is restless, changes position. Pulse 90 per minute, blood pressure 110/70 mm Hg. Art. The tongue is somewhat dry, lined. The abdomen is evenly swollen, soft, more painful in the upper sections, peristalsis is auscultated, peritoneal symptoms are not determined. Hypertrophic scar on the anterior abdominal wall after median laparotomy. Days ago there was a normal chair. On rectal examination - traces of feces of normal color.
1. What is your preliminary diagnosis?
2. Plan for additional examination of the patient?
3. The role and scope of X-ray examination, data interpretation.
4. Etiology and pathogenesis of disorders developing in this pathology.
5. What is the volume of conservative therapeutic measures required for this patient?
6. Indications for surgery, options for surgical interventions?
7. Measures aimed at preventing the recurrence of the disease

Number 3

A 68-year-old patient was admitted to the surgical department on an emergency basis 3 days after the onset of the disease with complaints of persistent pain in all parts of the abdomen, repeated vomiting, stool retention and flatulence; for the presence in the right inguinal region of a painful, tumor-like protrusion; to rise t of the body up to 38 ° C.

The disease began with the appearance of a tumor-like, painful protrusion in the right inguinal region. Subsequently, the described symptom complex developed, the clinic of the disease progressed.

Objectively, the patient's condition is severe. The skin is pale pink. In the lungs, vesicular breathing, weakened in the lower sections. There are no wheezes. Pulse 100 in 1 minute, rhythmic, weak filling. BP -] 10/70. Heart sounds are muffled. Tongue dry, coated at the root with a brown coating. The abdomen is swollen, painful on palpation in all departments. Symptoms of peritoneal irritation are weakly positive. Single bowel sounds with a "metallic" tint are auscultated. "Splash noise" is defined. There was no stool for 2 days, gases do not go away.

In the right inguinal region, a tumor-like formation is determined up to

5 cm in diameter. The skin above it is hyperemic, edematous, skin t ° is increased. On palpation, the formation is sharply painful, densely elastic in texture, with softening in the center.
1. What diagnosis should be made in this case?
2. Etiopathogenesis of this pathology?
3. Classification of the disease?
4. The scope of the examination of the patient in this case?
5. Tactics of treatment of this disease?
6. The volume of medical care and features of the operational benefit in a particular case?
7. Postoperative management of the patient?