Transcript 01. The main methods of diagnosis in the clinic of internal diseases

THE MAIN METHODS
OF DIAGNOSIS
IN THE CLINIC
OF INTERNAL
DISEASES
Bakalets Olena Valeriivna
PLAN
1. The notion of "functional diagnosis“
2. Classification of methods of functional
diagnostics
3. Methods of functional diagnostics in
pulmonology
3.1. Studies function of external respiration
3.2. Studies of gas exchange function
4. Methods of functional diagnostics in
gastroenterology
4.1. Studies of secretory function
4.2. Studies of motor function
5. Combined methods of functional diagnostics
Diagnostics
from the Greek - diagnosis
= διαγνώσις = «cognition»
is in Ukrainian
is in German
is in French
diagnostics;
Diagnostik;
le diagnostic
Functional diagnostics
—
is a complex analytical and
methodological approaches
to the definition and
evaluation of the functional
state of organs and body
systems.
the methods (means)
of diagnostics –
of structural
diagnostics
(X-ray,
ultrasound,
and others.)
of functional
diagnostics
(ECG,
phonocardiography,
spirometry et al.)
The functional diagnostics –
is based on the measurement of :
physical parameters
Chemicals
parameters
(speed, volume, pressure,
electric potential, etc.).
(рН, gas composition,
etc.).
The functional diagnostics
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Determination of functional reserves
Determining the type and degree of
functional disorders
Monitoring of the rate of disease
progression
Evaluating the effectiveness of a course
of treatment
Differential diagnosis
Expert evaluation disability, military,
sports, etc.
Nervous
system
The functional
diagnostics
Respiratory
system
Cardiovascular
system
Endocrine
system
Digestive
system
Musculoskeletal
system
Sensory
system
Urinary
system
Reproductiv
e
Methods
of functional
diagnostics
in pulmonology
Spirography
from the Latin spiro - to breathe, from the Greek grapho - to write, to depic
method of graphic registration
of changes of lung volumes during performance
of natural respiratory movements
and volitional forced respiratory maneuvers.
The aims of monitoring PEF:
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treatment planning of obstructive pulmonary
disease
evaluation of the effectiveness of treatment
with bronchodilators and inhaled steroids
predicting the asthma exacerbations
determining the reversibility of bronchial
obstruction
determining the professional asthma
identification of mechanisms that provoke
bronchospasm
Indications for the spirography
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Determining the type and degree of
pulmonary insufficiency
Monitoring of lung ventilation indexes to
determine the extent and rate of disease
progression
Evaluating the effectiveness of a treatment
course of bronchial obstruction with
bronchodilators (β2-agonist short and longacting, anticholinergic, inhaled
corticosteroids and membrane stabilizers)
Indications for the spirography
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Detecting early signs of ventilatory failure in
patients prone to develop lung diseases or
persons working in conditions of influence
harmful factors.
Examination working capacity and military
expertise - based pulmonary ventilation
function in conjunction with clinical
parameters.
For
differential
diagnosis
between
pulmonary
and
cardiac
failure
in
combination with other research methods.
Indications for the spirography
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Reversibility testing with a beta2-adrenergic
bronchodilator
Conducting inhalation provocation tests for
the detection of bronchial hyperreactivity
(methacholine, histamine, hyperventilation,
exercise testing)
Contraindication for the
spirography
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severe general condition of the patient
severe pulmonary insufficiency, which does
not allow making breathing maneuvers
progressive angina
myocardial infarction
malignant hypertension, hypertensive crisis
circulatory failure IIB and III stage
acute cerebrovascular accident
toxaemia of pregnancy
the second half of pregnancy
Spirogram
a tracing or graph of respiratory movements
Static indicators
Dynamics of
Respiratory Minute Volume
depending on the activity of human
RMV=TVхBR
Dynamic indicators
Dynamic indicators
Characteristic changes in lung function
N – norm;
R – at rest;
L – at load.
↓ - decrease
↑ - increase
* DACO– diffusion
ability of lungs
characterizes the
gas exchange
through the
alveolar-capillary
membrane and
is defined as the
rate of transfer of
substances
through the
membrane when
gradient partial
pressure of the
gas on the
membrane is 1
mm Hg
Algorithm of spirogram analysis
Bronchodilator Reversibility Testing
Pneumotachography
is research method function of external
respiration, which is a graphical
registration of airflow speed (Curve "flow
- volume") during quiet breathing patient
and during the performance of certain
breathing maneuvers.
According to the recommendations
European Respiratory Society
(ERS)
and
American Thoracic Society
(АТS)
calculations of spirometric indices are
carried out according to the values ​that
depend on the anthropometric:
on the height, gender and age
The normal curve of ratio volume to airflow speed
during max. inspiration and expiration:
The Changes of Curve "flow - volume":
Peak flow metry
is method of monitoring
peak expiratory flow (PEF),
which measured in liters per 1 sec.
The technique of Peak flow metry
1st stage
Take pikfloumetr the hand so that the finger do
not blocked the slit where the is moving arrow.
Arrow must be led out on the beginning of the scale.
The technique of Peak flow metry
2nd stage
At the beginning of testing to breathe calmly
and evenly.
Then make the maximal deep inspiration.
The technique of Peak flow metry
3 stage
Need to keep pеак flow meter horizontally. To take
mouthpiece of appliance in the mouth tightly clasp
the its his lips and quickly to exhale air in device
without blocking the hole mouthpiece by tongue.
The technique of Peak flow metry
The 4 Stage
Determine
the result –
a number,
on which
indicates
the Arrow
device.
Indices of PEF is recorded on a scale of device
The technique of Peak flow metry
5 stage
Highest of the 3 measurements is fixed
and written in diary
The technique of Peak flow metry
Every morning, before taking medications,
it should be noted best indicator in column
“М“ – Morning
Repeat this in evening and
to record best indicator in column
‘Е' - Еvening
Evaluation of PEF
Pulse oximetry a method of monitoring the oxyhemoglobin
percentage.
Capnometry this measurement and digital reflection of
concentration or partial pressure of carbon
dioxide in inhaled and exhaled gas during the
patient's respiratory cycle.
Capnography this measurement and graphical reflection of
concentration or partial pressure of carbon
dioxide in inhaled and exhaled gas during the
patient's respiratory cycle.
Thank you!