A case from the practical medicine

Today we discussed the case of a 22-year-old white man who was in good health prior to two days ago, when he began to have an abdominal pain. This pain was sporadic and colicky in nature. It began in the epigastrium and has since migrated to the right lower quadrant. The patient has had three episodes of vomiting associated with the pain. He has been anorectic and feverish. He has no bowel movements for two days. He reported no diarrhea, coughing with expectoration or short of breath. He has no past history or family history of abdominal pain or any other disease. The pertinent physical findings are related to the abdomen. There is extreme tenderness to palpation, especially over McBumey's point, Guarding, muscle rigidity and rebound tenderness are all present. Bowel sounds are absent. There is a difference between the axillary and thc rectal temperature. His urinalysis, hemoglobin and hematocrit are within normal limits. Nevertheless, both white blood count and red rate are elevated. His chest film is clear, but in the abdominal film we

observed the psoas line absent.

We established the differential diagnosis with acute pancreatitis, acute cholecystitis, myocardial infarction, gastroduodenal ulcer and perforation of an ulcer, finally, we decided the definitive diagnosis is acute appendicitis. Among the possible complications to consider are perforation, ne-

48                         AHI'ÄHÜCKHÜ R3b1K MeÅRUMHCKHX KOMeAxeÜ H

crosis peritonitis. Therefore, the prognosis is anceps. The only possible treatment is surgical: appendectomy. (Berman H. S. Medicine. Practical Surgery. London: Macmillian)

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Onpeðenume: Cuunm0Mb1 KŒoeo 3a60neeaH11H onucarw g ÈHHOJU cnyqae?

3

A CASE

Patient Orlov caiied in a physician from the polyclinic. He could not go to the polyclinic himself because his temperature was about 38⁰C. Soon doctor Smitnova, an experienced therapeutist, came to the call.

Doctor Smirnova wanted to know the patient's complains. The patient said that a short, painful, dry cough associated with rapied respiration had developed two days before, The patient complained of the pain in the throat and behind the breastbone. Doctor Smirnova listened to the heart and lung^s and then measured the patients's blood pressure. The blo^od pressure and the heart sounds were normal. But dry and moi^st rales were heard in the lungs. The respiratory rate was coⁿsiderably increased. The amount of the discharge from ^the bronchial mucous membrane was large.

On the basis of all the findings the doctor made ^the  diagnosis of (acute bronchitis, acatarrh, a cold).

                                                                                   Pa3ge.,Y 2.                                                           49

Notes

l) a physician — Bpaq 2) complaint xan06a

3) to be associated — 6b1Tb      C3E.M-1H60

4) breastbone — rpyAHHa

5) moist rales — ßJ1aXHb1e xpørlbl

6) considerably 3Ha^t1HTeÄbHO

7) discharge — BblAeJ1eHHe

Cocmaome ðuanoe Meonðy mopoM CMupnogoÜ.

17poqumaùme u nepeeeðume ðuanoe.

Ilepegucnume OCU08Hb1e eonpocbl, Komopbže 6b1nu 3aðaHb1 60flbHOMY.