#1
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Äåòñêèé âàðèàíò ïèëþëüêè
Óâ. ïåäèàòðû!
Íà ôîðóìå òåðàïåâòîâ åñòü ïèëþëüêà îò Íåñêó÷èíà. Ïðåäëàãàþ ó íàñ íà ôîðóìå åå äåòñêèé âàðèàíò. Äëÿ íà÷àëà âîò òàêîé âîïðîñ: A 17-year-old woman comes to the office complaining of a 3-month history of "crampy" abdominal pain along with alternating episodes of constipation and diarrhea. She reports that the pain has been worse recently since starting a new job, which she describes as "high stress." Pain also seems worse with eating fatty meals. Her temperature is 37.0 C (98.6F), blood pressure is 120/72 mm Hg, pulse is 63/min, and respirations are 10/min. Physical examination reveals a soft, non-tender, non-distended abdomen with normal bowel sounds and without organomegally. Her rectal exam reveals normal tone. The correct diagnosis would be supported by finding A. a biopsy with transmural intestinal inflammation B. fistula formation within the abdomen C. a history of bloody diarrhea D. a normal colonoscopy E. positive H. pylori antibody titers |
#2
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Äóìàþ, ÷òî ýòî ñèíäðîì ðàçäðàæåííîé òîëñòîé êèøêè, ò.å. D.
Ñ äðóãîé ñòîðîíû, íå âïîëíå ïîíÿòíà ëîêàëèçàöèÿ áîëåé. Ì.á. è ãàñòðèò èëè äóîäåíèò, òîãäà E. Íî âîîáùå ãîâîðÿ, äëÿ ãàñòðèòà õàðàêòåðíà áîëåçíåííîñòü ïðè ïàëüïàöèè. Íåò, âñå-òàêè D. |
#3
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Ïî-ìoåìó òîæå D.
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#5
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Íàñ÷åò ÍßÊà, ìåíÿ îñòàíîâèë ñîâåðøåííî ñïîêîéíûé æèâîò ïðè ïàëüïàöèè, äà è ïðè ðåêòàëüíîì îáñëåäîâàíèè âñå õîðîøî.
Íåìíîãî ñìóùàåò, ïðàâäà, òîò ôàêò, ÷òî åé êàæåòñÿ, ÷òî ïîõóæå îò æèðíîé ïèùè (ýòî âåäü òåñò, à â òåñòå, êàê â ñêàçêå ïðî Àëèñó, âñå íå ïðîñòî òàê), íî âñå ðàâíî ôèçèêàëüíî ïðè ÍßÊå ÷òî-òî äîëæíî íàõîäèòüñÿ... |
#6
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Òèì, òîæå âåðíî. Îäíàêî õàðàêòåð ó ìåíÿ äóðíîé - ñàìûé "íàïðàøèâàþùèéñÿ" âàðèàíò îòìåòàþ ñðàçó è èùó ïîäâîõ))) Êðîìå òîãî, ÷òî ïðè ïàëüïàöèè æèâîò ñïîêîéíûé è íîðìû ïðè ðåêòàëüíîì èññëåäîâàíèè, âñå îñòàëüíîå ïðè íàëè÷èè äèàðåè ñ êðîâüþ î÷åíü ïîõîæå íà ÍßÊ. Õîòÿ âïîëíå âîçìîæåí è âîñïàëèòåëüíûé ïðîöåññ.
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#7
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Explanation:The correct answer is D. This patient has irritable bowel syndrome (IBS). This is the most common functional GI disorder. It is characterized by abdominal pain with alternating diarrhea and constipation. It is often related to stress or exercise. Diagnosis is made by history and thoughtful exclusion of other organic diseases. Colonoscopy, if performed, should be normal. Indication for colonoscopy would be to differentiate irritable bowel syndrome from inflammatory bowel disease.
Transmural inflammation (choice A) and fistula formation (choice B) is typical of Crohn disease. Crohn disease is characterized by inflammation of any part of the gastrointestinal tract (mouth to anus). Patients often have lesions, which are not continuous, described as skip lesions. The inflammation is transmural, which means that it involves all layers of the mucosal wall contrary to UC. Patients typically present with non-bloody diarrhea, weight loss, and abdominal pain. Bloody diarrhea (choice C) is a finding in ulcerative colitis (UC). UC is characterized by inflammation limited to the colon and rectum and is typically described as continuous (as opposed to "skip" lesions). Bloody diarrhea is the typical presenting symptom. H. pylori (choice E) may be a cause of abdominal pain and its eradication is recommended if it is discovered incidentally, but routine serology checks in the work-up of abdominal pain is of unproved benefit. |
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#8
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Èðà, ôîòêè, ïðàâäà, ìåëêèå. Õàðàêòåð ñûïè êàêîé?
Èç áèîõèìèè òîëüêî ÑÐÁ äåëàëè? Èëè îñòàëüíîå (òðàíñàìèíàçû èíòåðåñóþò) â íîðìå? |
#9
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Äà, êàðòèíêè ìàëåíüêèå.
Ìîãó òîëüêî äîïîëíèòåëüíî äîáàâèòü, ÷òî ñûïü îïèñûâàåòñÿ, êàê âåçèêóëÿðíàÿ, ïðèâèâêè ñäåëàíû âñå ïî âîçðàñòó, â äîìå æèâåò ñîáàêà è êîøêà, íèêàêèõ äàëüíèõ ïîåçäîê â ïîñëåäíåå âðåìÿ íå áûëî. Âîò åùå ïðî ñûïü: The rash was found only on his extremities consists of papular lesions, with brownish-erythematous tops, some of which appeared to have a small central crust. There was no surrounding erythema, no vesicles seen, and no history of pruritus or evidence of excoriation. ---- Ýòî èç ñåðèè "çàäà÷åê", ïîýòîìó ïðåäïîëàãàåòñÿ, ÷òî èíôîðìàöèè, êîòîðàÿ âûëîæåíà, äîñòàòî÷íî äëÿ ïîñòàíîâêè äèàãíîçà. |
#10
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íà ñîîáùåíèå 223, åñëè áû áûë â îðäèíàòóðå,îòâåòèë áû À., ò.ê.,íà  íå ïîõîæå,D.ìîæåò âûçûâàòüñÿ è ïðè Ñ,à êàêèå òî with brownish-erythematous tops, some of which appeared to have a small central ïðè À. îïèñûâàþòñÿ, è çóäà íåò ÷àùå
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