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Acute abdomen and gastrointestinal bleedings

Table of contents
Acute abdomen and gastrointestinal bleedings
Clinic of an acute abdomen
Complaints of the patient - clinic of an acute abdomen
The anamnesis - clinic of an acute abdomen
Objective research - clinic of an acute abdomen
Laboratory diagnosis, researches - clinic of an acute abdomen
Acute appendicitis - clinic of an acute abdomen
Ruptured ulcer of a stomach and duodenum - clinic of an acute abdomen
Acute cholecystitis - clinic of an acute abdomen
Acute pancreatitis - clinic of an acute abdomen
Acute intestinal impassability - clinic of an acute abdomen
Thrombosis and embolism of mesenteric vessels - clinic of an acute abdomen
Seldom found diseases - clinic of an acute abdomen
Acute peritonitis - clinic of an acute abdomen
Diseases of a female genital - clinic of an acute abdomen
The diseases simulating a clinical picture
The diseases of a nervous system simulating a clinical picture of an acute abdomen
The diseases of bodies of a breast simulating a clinical picture of an acute abdomen
The pleurisy simulating a clinical picture of an acute abdomen
The stenocardia, myocardial infarction simulating a clinical picture of an acute abdomen
The abdominal type of a myocardial infarction simulating a clinical picture of an acute abdomen
The acute pancreatitis simulating a clinical picture of an acute abdomen
The heart diseases, endocarditises simulating a clinical picture of an acute abdomen
The diseases of vessels simulating a clinical picture of an acute abdomen
The rheumatism simulating a clinical picture of an acute abdomen
The hemorrhagic vasculitis simulating a clinical picture of an acute abdomen
The abdominal purpura simulating a clinical picture of an acute abdomen
The nodular periarteritis simulating a clinical picture of an acute abdomen
The aneurism of belly department of an aorta simulating a clinical picture of an acute abdomen
The diseases of abdominal organs simulating a clinical picture of an acute abdomen
The food toxicoinfections simulating a clinical picture of an acute abdomen
Enterita, an illness Krone, simulating a clinical picture of an acute abdomen
The colitis simulating a clinical picture of an acute abdomen
The helminthoses simulating a clinical picture of an acute abdomen
The hepatic colic simulating an acute abdomen
Dyskinesia of bilious ways, simulating an acute abdomen
The lambliasis simulating an acute abdomen
The spleen diseases simulating an acute abdomen
The pancreas diseases simulating an acute abdomen
The diseases of kidneys simulating an acute abdomen
The diseases of a female genital, periodic illness simulating an acute abdomen
The diseases of system of blood simulating an acute abdomen
The diseases of endocrine system and metabolism simulating an acute abdomen
Clinic of infectious diseases
Clinic of dysentery
Clinic of malaria
Clinic of a brucellosis
Clinic of an infectious disease
Clinic of tuberculosis of abdominal organs
Clinic of acute gastrointestinal bleedings
Reasons of acute gastrointestinal bleedings
Tool diagnosis of acute gastrointestinal bleedings
Peptic ulcer - pathology of acute gastrointestinal bleedings
Effect of some substances - pathology of acute gastrointestinal bleedings
Hemorrhagic gastritis - pathology of acute gastrointestinal bleedings
Duodenitis - pathology of acute gastrointestinal bleedings
Malignant tumors - pathology of acute gastrointestinal bleedings
Benign tumors - pathology of acute gastrointestinal bleedings
Hernia of an esophageal opening of a diaphragm - pathology of acute gastrointestinal bleedings
Portal hypertensia - pathology of acute gastrointestinal bleedings
Chronic hepatitises and cirrhoses of a liver - pathology of acute gastrointestinal bleedings
Tromboflebitichesky splenomegaly, Wilson's illness - pathology of acute gastrointestinal bleedings
Chronic cardial compression - pathology of acute gastrointestinal bleedings
Hemorrhagic capillary toxicosis - pathology of acute gastrointestinal bleedings
Scleroderma, hemorrhagic teleangiectasia - pathology of acute gastrointestinal bleedings
Rupture of an aorta - pathology of acute gastrointestinal bleedings
Myocardial infarction - pathology of acute gastrointestinal bleedings
Verlgof's illness - pathology of acute gastrointestinal bleedings
Hemophilia - pathology of acute gastrointestinal bleedings
Fibrinolysis - pathology of acute gastrointestinal bleedings
Paraproteinemic reticulosis, lymphogranulomatosis - pathology of acute gastrointestinal bleedings
Other diseases - pathology of acute gastrointestinal bleedings
Questions of tactics
Medicamentous means, groups of the choice
Literature

LIBRARY OF THE PRACTICAL DOCTOR
Acute abdomen and gastrointestinal bleedings in practice of the therapist and the surgeon
F. I . MOSQUITOES, V. A. LISOVSKY, V G BORISOV

 Own and literary data on frequency, structure and the reasons of diagnostic mistakes at an acute abdomen and gastrointestinal bleedings are provided to monographs.
Chapter 1 is devoted to a statement of questions of clinic, diagnosis and tactics of the doctor at a clinical picture of true "acute abdomen". Chapter 2 contains data on differential diagnosis of the therapeutic, neurologic and infectious diseases simulating a clinical picture of "acute abdomen". The chapter 3 contains data on clinic and differential diagnosis of atypically proceeding acute surgical diseases of abdominal organs and, in conclusion, in chapter 4 questions of differential diagnosis of bleedings from a digestive tract of both ulcer, and not ulcer character are discussed
Differential and diagnostic tables and reasons concerning the volume of laboratory and tool methods of research and medical tactics at various stages of medical evacuation are provided.

One of the most complex and responsible problems of clinical medicine is differential diagnosis of so-called boundary diseases of abdominal organs, in particular the diseases which are followed by a symptom complex of "acute abdomen".
The term "acute abdomen" is the collective concept characterizing an acute belly syndrome which arises owing to the most various reasons. It is especially difficult to carry out differential diagnosis between the therapeutic diseases simulating "acute abdomen" and acute surgical diseases of abdominal organs. Certain diagnostic difficulties arise also at recognition of the reasons of gastrointestinal bleedings. The correct diagnosis in these cases predetermines the choice of a method of treatment surgical or conservative. On the contrary, an unjustified operative measure, for example at not recognizable myocardial infarction or pneumonia, the same as long waiting tactics at acute surgical diseases of abdominal organs, can be causes of death of patients.

Clinical experience and the relevant literary data demonstrate that diagnostic mistakes of this sort meet quite often not only in practice of polyclinic doctors, but also in the conditions of stationary medical institutions. So, for example, according to N. N. Samarin (1952), doctors of an extra hospital network mistakenly make the diagnosis of "acute abdomen" in 15% of cases. L. I. Garvin (1960) specifies that the number of diagnostic mistakes at an acute appendicitis reaches 25 — 35%. According to B. S. Rozanov (1950) data, among 1134 patients with profuse gastrointestinal bleedings at the 828th bleeding arose because of destructive changes mucous a stomach and at 306 patients bleedings of not ulcer character were established.

Complexity of differential diagnosis of the therapeutic diseases simulating a clinical picture of "acute abdomen" and acute surgical diseases of abdominal organs consists that perhaps atypical course of diseases, and also there is a similarity of some symptoms of therapeutic and surgical diseases. It is known that the acute appendicitis and acute cholecystitis at people of advanced age are characterized by the erased clinical current, insufficiently expressed local and general symptoms of a disease, and into the forefront symptoms of the diseases inherent to this age quite often act (atherosclerosis, stenocardia, an idiopathic hypertensia, etc.). On the other hand, such classical symptoms of "acute abdomen" as pains, tension of an abdominal wall, irritation of a peritoneum, can arise at pneumonia, phrenic pleurisy, a myocardial infarction and other diseases.
 N. N. Petrov points to the following basic reasons of diagnostic mistakes: a) mistakes from imperfection of knowledge (19%); b) corrected mistakes from non-compliance clinical trial (50%) and c) the mistakes depending on a serious condition of patients (30%).
One of the reasons of diagnostic mistakes is the insufficient awareness of therapists with clinic of acute surgical diseases, and surgeons — with the atypical course of the nervous, internal and infectious diseases simulating a clinical picture of "acute abdomen" or which are shown gastrointestinal bleedings.
It is possible to agree with M. M. Vikker (1936) opinion that identical competence of therapists and surgeons of a question of diagnosis and treatment of the so-called boundary diseases conditionally united in a syndrome of "acute abdomen" is necessary completely.
Questions of differential diagnosis of the therapeutic diseases simulating a clinical picture of "acute abdomen" and gastrointestinal bleedings of not ulcer character are insufficiently lit in medical literature. Separate supervision of diagnostic mistakes are published in the form of articles in periodic literature or in collections of the works devoted to errors of clinical diagnosis. In works M. M. Vikker (1939), G. Mondora (1939, 1940), N. N. Samarin (1952), N. N. Prokofiev (1950), N. I. Gurevich (1951), V. A. Batashev (1957), N. I. Krakovsky and Yu. Ya. Gritsman (1959), N. I. Blinova and G. A. Gomzyakova (1962), D. F. Skripnichenko (1966), A. Item. Podonenko-Bogdanova (1968), by Thorek (1943) and others differential diagnosis of acute surgical diseases of abdominal organs is discussed mainly from surgical positions, a little place is allocated to questions of differential diagnosis of the therapeutic diseases simulating "acute abdomen" or being the reason of gastrointestinal bleedings of not ulcer character, and many of diseases are not mentioned at all.
The present book intends for doctors of the ambulance and acute management, and also for therapists and surgeons of polyclinic and medical institutions.
Material for the monograph were case histories of two large hospitals of Leningrad, and also long-term experience of authors in the therapeutic and surgical clinics which are located on bases of these medical institutions.
Authors considered expedient chapter 1 of the monograph to devote to a statement of questions of clinic and diagnosis of "acute abdomen" at acute surgical diseases of abdominal organs. The following chapter of the monograph contains data on differential diagnosis of the therapeutic, neurologic and infectious diseases simulating a clinical picture of "acute abdomen". In a chapter 3 questions of differential diagnosis of bleedings from a digestive tract of ulcer and not ulcer character are discussed.
Questions of an etiology and pathogeny of the considered diseases are lit only so far as they are necessary for explanation of the reasons of an atipichesky course of diseases and diagnostic difficulties. That is why the present monograph cannot replace N. N. Samarin, N. I. Blinov, G. A. Gomzyakov, B. S. Rozanov's capital works and others, various aspects of the considered problem devoted to detailed analysis at all.
At last, the analysis of the reasons of diagnostic mistakes, and also reasons of rather differential diagnosis, volume of laboratory and tool methods of research and medical tactics is provided in final chapter of the monograph at the diseases proceeding with a syndrome of "acute abdomen" or with gastrointestinal bleedings.
Main goal of this monograph is improvement of quality of diagnosis of the diseases which are shown a picture of "acute abdomen" and gastrointestinal bleedings — diseases on which timely diagnosis decrease in a lethality substantially depends at them.



 
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