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Syndrome of intestinal dyspepsia

2020-07-07

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Cause	Acute inflammatory intestinal diseases: acute enterocolitis, ulcerative colitis (nonspecific, parasitic), acute diverticulitis (with segmental stenosis, perforation, bleeding); adhesive disease of abdominal cavity; intestinal obstruction (obstructive, strangulation); mesenteric intestinal thrombosis, etc.
Questioning	Complaints of abdominal pain, bloating and feeling of fullness, violation of stool and gas outflate, nausea and vomiting, loss of appetite, weight loss, weakness, dizziness, loss of work capacity, swelling. In the localization of pathology in the small intestine, pains are more often in the umbilical area, with diarrhea, abundant stools with remnants of undigested food without pathological impurities, usually no more than 3-4 times a day. If in colon, the pain is more often localized along the colon, constipation is common or frequent (10-15 times a day), scanty stool with pathological impurities (blood, mucus), there may be tenesmi, pain during defecation or relief after defecation and gas discharge.
General inspection	In pains in colon - the patient may be forced to lay on the side of lesion. In some cases, asymmetry of the abdomen, visible peristalsis against a background of cachexia, pallor, swelling, signs of dehydration are possible.
Systems	Physical signs of gastrointestinal disease: tender palpation, detection of a tumor-like lump, distended/spasmodic bowel, increased pneumatization, auscultatory signs of increased/weakened peristalsis, splashing noise. In prolonged vomiting, diarrhea, hypotension, tachycardia may occur, in severe cases - signs of hemodynamic disorders.
Instrumental study	Sigmoidoscopy, irrigoscopy, colonoscopy, ultrasound, endoscopy, general radiography of the abdomen, barium passage through the gastrointestinal tract help to make the final diagnosis.
Lab data	Changes in the leukocyte blood count (leukocytosis with a shift to the left), anemia, symptoms of water-electrolyte disturbances - increased hematocrit, oliguria, urinary syndrome, etc.), in the study of feces - pathological impurities in the feces, steatorrhea, creatorrhea.

5.4. Shock

Cause	Syndromically similar pathological conditions characterized by the critical decrease of blood flow in tissues: hypovolemic (hemorrhagic, burn, traumatic); cardiogenic; vascular (septic, anaphylactic).
Questioning	Complaints of weakness, dizziness, breathlessness, "darkening" and "flickering" of flies in the eyes. A history of the appropriate diseases. Possible episodes of loss of consciousness, thirst, vomiting.
General inspection	Characterized by adynamia, impaired consciousness to coma. Pale, cold and wet skin, a symptom of a "pale spot", body temperature is often decreased. Dyspnoea. In hypovolemia - dry skin and mucous membranes, including the tongue, decreased turgor, decreased tone of the eyeballs. In joined DIC, hemorrhagic rashes, with hyperkalemia, muscle hypertonus, etc.
Systems	Signs of impaired systemic hemodynamics: most often a decrease in cardiac output, systolic and pulse BP, CV and CVP, in severe cases, BP cannot be taken by Korotkov’s method, no pulse on the peripheral arteries. RR and heart rate are significantly increased. The shock index is above 1, with severe shock - above 1.5. Arrhythmias are possible. Oligouria/anuria.
Lab data	Decrease of pH, increase in lactate concentration, first decrease, then increase in РСО₂. Deviations of water-electrolyte balance parameters - more often increase of potassium, sodium, osmolarity. Hypercoagulation, followed by hypocoagulation. Increased urine density, the appearance of protein, cylinders, RBC in urine. In renal failure - the increse of creatinine, urea, etc.

5.5. Respiratory distress-syndrome of adults (RDSA)

Cause	Conditions characterized by sudden impairment of pulmonary perfusion, alveolar ventilation, and surfactant system: shock, sepsis, MODS, acute pancreatitis, toxic effects of high oxygen concentration, smoke poisoning, DICS, aspiration of fluid (vomit), fat embolism, contusion of lung etc.
Questioning	Complaints of severe breathlessness, cough, possible headaches, thirst, vomiting, decreased urine output. A history of the appropriate disease.
General inspection	Pallor/cyanosis. Excitation, later – adynamia, possible muscles hypertonus, misconsciouness.
Systems	Shown progress of RR and PR, decrease of BP, arrhythmia. Phisycal features of pulmonary swelling.
Instrumental study	Strengthening the vascular pattern, reducing transparency of the lung tissue against the background of multiple focal-like shadows, then signs of alveolar edema and diffuse infiltration.
Lab data	РаО₂ below 50 mm.m.с. even in concentrated oxygen inhalation, increase of РСО₂, decreased рH, increased potassium, sodium, osmolarity.

5.6. Syndrome of acute liver failure

Cause	Conditions leading to acute damage of hepatocytes with further impairment of their function: acute and chronic hepatitis, cirrhosis, primary and metastatic liver tumors, echinococcosis; complicated by cholestasis: choledocholithiasis, strictures of the bile ducts, tumors of the hepatic and common bile duct, pancreatic head, ligation/damage to the common bile duct during surgery; poisoning with hepatotropic poisons: dichlorethane, phenol, alcohol, chlorpromazine, etc.; impaired hepatic blood flow - portal vein thrombosis.
Questioning	Complaints of weakness, itching, dark urine. Possible breathlessness, dizziness, thirst, vomiting. A history of the appropriate disease.
General inspection	Характерна заторможенность, адинамия, в тяжелых случаях делирий, кома с дыханием Куссмауля, «печеночный запах». Бледность или желтушное окрашивание кожи и слизистых, геморрагические высыпания, отеки, на верхней половине туловища возникает эритема в виде звездчатых ангиом, мышечный гипертонус. Inhibition, adynamia, in severe cases, delirium, coma with Kussmaul breathing, and “hepatic odor” are characteristic. Pallor/icteric skin and mucous membranes, hemorrhagic rashes, swelling, erythema in the form of stellate angiomas, muscle hypertonus on the upper half of the body.
Systems	Decreased BP, arrhythmias. Painful, sometimes enlarged liver, splenomegaly, high hyperthermia, oliguria/anuria. Signs of hydrothorax and ascites.
Lab data	Both direct and indirect fractions of blood bilirubin are increased. Increased LDG, ALT, AST. Dysproteinemia, decreased concentration of albumin, glucose, ceruloplasmin, prothrombin, fibrinogen, cholesterol, phospholipids, lipoproteins. Signs of hypocoagulation, decrease of pH, and PCO2, increased concentration of ketone bodies, potassium, sodium, and osmolarity. In urine, bilirubin and urobilin.

5.7. Syndrome of acute blood loss

Cause	Acute bleeding in violation of the integrity of vascular wall of a large vessel (fractures, dislocations, wounds, bleeding from gastrointestinal ulcers, diverticula, polyps, decaying tumors, etc.).
Degrees of severity	Clinical data	Blood data	Coagulogram	CV shortage (%)
Light	Features absent			Appr. 10% (500-600 ml)
Mild	Pulse up to 100 beats/min; BP 90-100 mm.m.с. CVP 3-6 mm.m.с; Skin is cool, pale, dry; Diuresis above 30 ml/hr	Hb – 80-90 g/l; Ht – 38-32 g/l; CI – 0,8 – 1,2.	Fibrinogen, thrombin time, fibrinolytic activity normal/a little bit increased	15–20% (1,0–1,5 l)
Severe	Pulse 120 beats/min; АД 75-85 mm.m.с. CVP 3-4 mm.m.с; Excitation, cool sweat; Diuresis below 25–30 ml/hr	Hb – 70-80 g/l; Ht – 32-30 g/l; CI – 1,3 – 2,0.	Fibrinogen, thrombin time, fibrinolytic activity increased	25–30% (1,5–2,0 l)
Massive	Pulse above 120 beatrs/in; sBPbelow 70 mm.m.с. CVP below 3 mm.m.с; Stupor Sharp pallor, sticky sweat, Anuria	Hb below 70 g/l; Ht below 22 g/l; ЦП above 2,0.	Fibrinogen, thrombin time, fibrinolytic activity decreased. Hypercoagulation changed with fibrinolysis	Above 35% (above 2,0 l)

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