Тиббиётнинг долизарб муаммоси

HEPATO – LIENAL SYSTEM
Complaints (has or hasn’t): pains in the right subcostal area: “character” (permanent, attack-like, length, severety). Irradiation of pains to the right shoulder-blade, back, etc. Causes: appearing pain, aggravating or ceasing pain. Appearance of jaundice or becoming yellow after pain attack.Association of pains with vomiting and elevation of temperature.Has the patient ever had jaundice and how long it lasted. Pharynx: of normal staining, flamed up. Mucous membrane – dry, granular, bright.


Examination of the organs of abdominal cavity


Examination of abdomen:
Liver: percussion – the detection of the upper liver border is conducted by Kurlov’s method of percussion; upper and lower liver borders (3 dimensions identifying 5 points); palpation of liver by Obrazcov-Strajesko: consistence, surface (smooth, hummocky, rough), the edge (pointed, rounded), morbidity.
Cholecyst: palpation-painfulness, the presence of circular elastic lump and sensitiveness to a certain extent (an enlarged) cholecyst or a denser conglomerate (swelling) in this area is defined. It is also necessary to define painful points and zones (phrenicus symptom, Znaharyin-Mendel’s, Obrazcov-Murphy’s, Ortner’s symptoms).
Spleen: palpation - it’s defined weather it is palpable, if in case of a positive result the border of sickliness and consistence are identified; percussion – at first the upper and lower borders of the diameter indicating ribs between which the spleen is placed are defined. The length of the longitudinal axis and diameter of the spleen are given in cm.


Examination of the pancreas
At first the surface palpation of the pancreas area is fulfilled using Obrazcov-Otrajevko’s method. Palpability, consistence of bundles are identified.


The Secretion system
Complaints (yes, no) Urination

1. 
   painfull, painless;
   
2. 
   urination rate especially at night (nocturia)
   
3. 
   the amount of urine output in 24 hours (diuresis); difficult urination
   
4. 
   an anomalous urination;
   
5. 
   colic, burning, pains at the urination (at the beginning and at the end); false urination urges;
   
6. 
   pains in lumbar region (constant, attack-like, intensity, length, irradiation);
   
7. 
   colour of urine: normal (straw-coloured), dark (beer-coloured), bloody etc. examination of lumbar region: without changes, smoothing of contour outline, bulging, hyperemi.
   

The swelling of renal region. The palpability of kidneys and their
removability the points of tenderness of kidneys, ureters. The sickliness at the tapotement of the renal region from behind (the symptom of tapotement), Pasternackiy’s symptom. The urinary bladder palpation and percussion data.