Tone I is strengthened because with mitral stenosis in the diastole, the left ventricle is not filled enough with blood, therefore, in the systole it will contract half-empty, and if so, it means that cardiomyocytes can be reduced by a larger percentage of their length, the tension of the muscle fibers during their reduction will be stronger. Those. everything goes to the fact that the strengthening of the muscle component of tone I, leads to an increase in the volume of the tone itself.
Tone II is accentuated in the second intercostal space to the left of the sternum because sounds are produced here when the three semilunar flaps of the pulmonary opening valve are closed, and with mitral stenosis they close more intensely. Why? The thing is that with mitral stenosis, the outflow of blood from the pulmonary circulation is disturbed, so a state of pulmonary hypertension is created.
TOMC is formed due to the fact that the mitral valve cusps open later than normal. Against this background, the phase of isovolumetric relaxation of the ventricles lengthens, recall that in the course of it the pressure in the ventricles normally decreases, which means that when it lengthens, the pressure in the left ventricle will drop below normal.
the tone is
sum of sound phenomena arising in
heart during systole. Therefore he
called systolic. He arises
as a result of fluctuations in tense
ventricular muscles (muscle component),
closed leaves of two- and tricuspid
valves (valve component), walls
aortic and pulmonary arteries in primary
the period in which they receive blood from
ventricles (vascular component),
atria during their contraction (atrial
Palpation of the abdomen. Surface
palpation, deep sliding
methodical topographic palpation
the abdomen according to the method of Obraztsov-Strazhesko.
Goals and objectives of palpation. Symptoms, their
pathogenesis and diagnostic value.
palpation of the abdomen should be observed
certain rules. The patient must
lie on your back in a hard bed with
low pillow, his legs and arms
should be stretched, the stomach is naked.
He should breathe smoothly and calmly, better
through the mouth. The explorer sits down on the right
side of the patient, facing him, on
level with the bed. His hands should
be warm and dry, nails short
the degree of tension is detected (judged
resistance) of the abdominal wall and its
soreness. Normally, it should be
soft, supple, painless.
Abdominal wall tension observed
mainly with inflammatory
processes in the abdominal cavity. At
superficial palpation can be detected
swelling of the skin of the abdomen
characteristic dents on the skin that
remain from the fingers after feeling.
With well-developed subcutaneous fat
fiber is not observed.
methodical palpation is carried out
by the method of Obraztsov — Strazhesko. Deep
she is called because fingers
the researcher penetrate deep into the abdominal
cavity sliding – because
organ fingers get in the moment
“Slipping” from him, methodical
– because it provides for palpation
abdominal organs in a certain
palpations examine the abdominal organs
cavities. Start with sigmoid
then alternately palpate the blind
with a process
the end of the ileum
and the descending part of the colon,
Then the kidneys are palpated.
Aortic valve insufficiency
malformation in which aortic leaflet
valves do not close aortic
hole during diastole, as a result
what happens the reverse flow of blood from
aorta in the left ventricle.
1) rheumatism (80%) 2) infectious endocarditis
3) syphilitic mesortitis 4) atherosclerosis
5) congenital malformation b) blunt trauma – (separation
sash) is very rare.
Reverse blood flow occurs
(regurgitation) from the aorta to the left ventricle,
causes its expansion – tonogenic
dilatation. In the wake of the hard work on
expulsion of blood, left ventricle
hypertrophied. Shortened diastole
unnecessarily due to reverse blood flow, pressure
in the left stomach. grows faster to
level required to open the aorta
In the left ventricle to the beginning
there is some amount of diastole left in the blood,
this makes it difficult for the left
atria, this leads to “mitralization
aortic defect. ”Develops
retrograde venous congestion in
small circle. As contractile contractility decreases
abilities of the right ventricle, right
atria leading to stagnation in
big circle, “bull’s heart” (Cor
with vague defects – no
complaints. And so – a heartbeat that is enhanced
throbbing, angina attacks,
dizziness, fainting, shortness of breath,
pallor of the skin, increased pulse
pressure – “dance carotid” (pulse
Corrigan), subclavian arteries and
Musset symptom (pulsatory concussion
head), stagnation in a big circle –
peripheral edema, severity, increase
liver (pressing bursting pain).
Blood pressure 200 mmHg / 0 mmHg, apical
push in 6-7 intercostal spaces outside of
midclavicular line, it is spilled,
tall, strong, domed,
resistant. The length is increased and
diameter, width of the vascular bundle.
The heart of the aortic configuration. I
(at the top) and II
tone (on the aorta) weakened.
atherosclerosis – accent of the 2nd tone,
metallic tone due to compaction
aortic walls! Diastolic murmur in the 5th
and 2nd point after II
tones, timbre of noise – soft, blowing,
“Pouring”. ECG: left hypertrophy
ventricle – increase in amplitude R
in the left leads I,
ST segment decline
negative tooth T.
3. Mechanical jaundice: causes, clinical manifestations. The role of additional methods in the diagnosis.
joint group of liver diseases
which is caused by various reasons
varying degrees of inflammation
and hepatic cell necrosis.
Flowing without improvement during b
month And more. Chron. Viral hepatitis
etiology – viruses B, C, B Basics. way before.
parenterally. Clia. manifest latent
complaint weakness increased
fatigue. Asthenia. X-dull dull pain
in the right hypochondrium. Nausea of pain in
epigaster. Areas. Muscle pain and
joints. Jaundice, discolored. Feces dark
urine. “Small hepatic symptoms” –
Telangiectasias – spider veins;
palmar erythema; xanthomas and
xanthelasma. hemorrhagic syndrome with the appearance
petechiae. Wedge. Manifested.
Depend on the degree
activity inflamed. Process.H.G not
viral etiol. – drugs (chlorpromazine, isoniazid
etc) gene, Wilson Konovalov’s disease
copper deposition; enzymatic abnormalities. -deficit
A1 antitrepsin ;. Clinically they x-x
syndromes of parenchitis. jaundice and cytolysis
with increased transaminase activity.
gradual progression of neurotics.
Struct. Rev. Liver: the appearance of sclerosis,
regenerative nodes. That leads to
cirrhosis. D-Ki-Viral methods
etc; Biochemical analysis AST.ALT. Histological
percussion of the lungs. Tasks
lower borders of the lungs;
upper borders of the lungs, or height
standing of the tops of the lungs, as well as their
width (Krenig fields);
mobility of the lower edge of the lungs.
periosternal line-5 intercostal space, along
midclavicular line 6 intercostal space,
along the front axillary line-7, along
middle axillary line-8, on the back
axillary line-9, along the scapular
line-10, – along the paravertebral line – on
level 11 thoracic vertebra
certain diseases (emphysema
lungs, bronchial asthma in phase
exacerbations) in connection with the expansion of the alveoli
lower edge offset may be noted
lung down. In other cases, note
lifting up the lower border of the lungs,
for example, wrinkling of the lungs
(chronic pneumonia, abscess and
pulmonary tuberculosis) or with compression
them (exudative pleurisy, hydrothorax)
tricuspid valve (insufficientiavalvuletricupidalis)
most often relative as
the result of myogenic expansion of the cavity
right ventricle with mitral defects
heart, especially with mitral stenosis.
tricuspid valve developing
as a result of rheumatic endocarditis,
very rare (in 5% of all
this vice does not come complete closure
right ventricular systole time and blood
comes back from the ventricle to the right
atrium. Due to the increase
the amount entering the right
the atrium of the blood, it expands, and
then hypertrophies. Developing
stagnation of blood in the veins of a large circle
blood circulation slows down
blood flow, severe disruption
in tissues, vascular permeability and in
ultimately to the formation of edema.
As a result,
increased load on the right ventricle
(due to the increase in mass located in
blood) comes its expansion and
hypertrophy. Patients complain of
weakness, palpitations, sometimes on
recurrent heart pain, severity and
pain in the right hypochondrium, increase
abdomen, swelling in the legs, dyspeptic
violations. Shortness of breath is not significant,
but increases with hydrothorax and ascites.
examination marked cyanosis
integuments and mucous membranes. Skin
integument sometimes with icteric shade.
Often an extension and
pulsation of the cervical veins (systolic
throbbing jugular veins).
is a positive venous pulse,
those. pulse synchronous with arterial.
It is clearly visible in the jugular veins and
due to backpropagation
blood waves from the right atrium to
large veins during systole right
ventricle. Develop rather early
swelling and ascites.
When palpating the region of the heart, it is detected
heart beat in the lower sternum
and pulsation of hypertrophied right
ventricle of the xiphoid process. Highly
a symptom characteristic of this defect
is the pulsation of an enlarged liver.
On palpation of a heart beat and
swinging movement is felt in the liver
– while in the area of the right heart
retraction is felt as a result
ventricular systole in the liver
reverse movement occurs – expansion
due to overflow of the liver with blood.
right border of relative cardiac
dullness extended to the right, sometimes to
right mid-clavicular line, in connection
with an increase in the right atrium and
right ventricle. Absolute stupidity
the heart shifts outward from the right
the edges of the sternum. Hepatic Cardiac Angle
1 tone at the apex and at the xiphoid process
sternum weakened due to lack of
the period of complete closure of the tricuspid
valve. 2 tons on the pulmonary artery
weakens. In the lower part of the sternum
soft blowing systolic is heard
noise of diminishing nature which
held to the right collarbone.
pressure rises to 200-350 mm of water. Art.
Blood flow velocity in a large circle
blood circulation slows down to 30-40 seconds.
study reveals an increase
hearts to the right due to the right atrium
and the right ventricle. Stagnation
in the lungs are not detected.
The electrical axis of the heart is deflected
to the right. In I
standard lead is low
and deep S wave,
and in III
standard lead high R wave
and mild tooth S.
Atrial enlargement noted
complex – tooth R. The tooth T happens
negative in III
At the base of the sternum is recorded
attenuation of the amplitude of 1 tone. After
the first tone is systolic
noise of diminishing nature.
Complaints made by patients with
no appetite due to impaired activity
– the desire to constantly eat
pain behind the sternum of a pressing nature,
dysphagia (passage of food through the esophagus);
in the epigastrium proper – crushing,
separated by time (depending
from localization in the digestive tract); spilled in the area
abdomen – functional / inflammatory
lesions, bloating. In the umbilical
and left hypochondrium – girdle,
after eating fried, plentiful
food – p / f. The syndrome of the “alarm” –
dysphagia (violation of swallowing, hiccups)
dyspeptic symptoms (belching, heartburn,
diarrhea (with intestinal infections, functional
(organic and functional)
abdomen (shift in bowel function, decreased
(vomiting, with clots of blood dark cherry
(“Coffee grounds” for ulcers, tumors)
(black tarry stool, etc.
ulcers, tumors, hemorrhoids)
respiratory function with
spirometer. The spirometer will record
pulmonary volume curve
relative to the time axis when the patient
breathes calmly, produces maximum
deep breath and then breathe air
as fast and strong as possible (test typhno)
the maximum air volume that
may be expelled from the lungs following
tidal volume – air volume
inhaled in one breath while calm
breathing. Part of subsidiaries participating in
gas exchange, called alveolar
volume, remainder – “dead space”,
in which they understand first of all
“Anatomical” residual capacity
volume of air that can be expelled
and lungs with the highest possible for
examined by force and speed after
air that can be expelled with
maximum effort during the first
seconds after a deep breath, i.e. part
FVC exhaled for 1 sec. FEV1 reflects
condition of large respiratory tract. OFV1 / FZHEL (
Typhno index) is expressed as a percentage. is he
increases with increasing inspiratory effort.
If only FEV1 decreases
indicates obstruction if
FVC — This indicates restriction.
Is an infectious pneumonia
parenchyma, namely parts
localized distally with respect
to end bronchioles, including
bronchioles, alveolar passages and alveolar
bags with alveoli.
bacterial, viral, ornithic,
rickettsial, mycoplasma, fungal,
allergic, infectious and allergic,
rarely, with diseases of the gastrointestinal
tract, wide tape infestation, severe
dysbiosis and is always accompanied
impaired folic acid metabolism.
folic acid and vitamin B12 upsets
synthesis of amino acids and DNA slows down
normal maturation of all blood cells
in the bone marrow. Folic acid deficiency
and vitamin B12 violates not only function
bone marrow but also cellular metabolism
all growing and proliferating tissues.
picture. Are characteristic
weakness, asthenia, anorexia,
older children – paresthesia, pallor
with a lemon yellow tint, subictericity
sclera, glossitis, stomatitis, changes
dyspeptic cardiovascular system
disorders, hepatomegaly. In analysis
blood – hyper- or normochromic
anemia, megaloblastosis, Jolly body and
Kebot rings in red blood cells.
(subhepatic) jaundice due to
high blood conjugated
bilirubin in connection with its regurgitation
in blood. Main reasons
bile into the duodenum 12, which is observed
with: 1-blockage or hepatic pressure
or bile duct stone or
a tumor, including a tumor or
tumor metastases in the gates of the liver.
2- compression of the mouth of the bile duct
a tumor in the head of the pancreas.
3-sclerotic biliary change
ducts with sclerotic cholangitis.
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