"Submit" The Pro-Rector on educational work, Professor Teshaev O. R
Contents classes 13.1. The theoretical part
Yüklə 43,87 Kb.
|
13. Contents classes13.1. The theoretical partThe Edemas - an output and accumulation экстрацеллюлярной to liquids in extracellular space with increase the volume fabric and reduction серозных cavities and breach to functions отечных organ. The Edemas become to be visible when increase the volume интерстициальной fabric on 15% and more.
- Increasing to capillary permeability. - "Block" in оттоке venous shelters, lymphs. - An Accumulation to liquids in тканях as a result of reductions онкотического pressures of the plasma shelters. Checking edema o account amount accepted and chosen liquids o Measurement of the volume of the belly( daily) o Vzveshivanie (daily) o Test Poppy-Klyura Test Poppy-Klyura o 0,2 ml 0,9% solution of the chloride sodium внутрикожно. o to define time рассасывания skin волдыря.
o Diseases of the cardiovascular system. o Diseases liver o Defeats вен o Endocrine disease o Medicinal edemas o Bezbelkovye edemas Patofiziologicheskie mechanisms edema o Reduction онкотическогодпавления plasmas o Increasing to vascular permeability o Increasing гидростатического pressures o Obstacles current lymphs o Other reasons Medicinal preparations, bring about development edema o Hormones oGipotenzivnye preparations o Nesteroidnyeпротивовоспалительные preparations o Other Local edemas: o Allergic o Arthritises o Phlebitises and others Reasons wide-spread edema o Positive water balance o Gipersekreciyaальдостерона o Breaches in симпатоадреналовой to system o Reduction онкртического pressures of the plasma. Positive water balance o Reinforcement реабсорбции sodium and plasmas in bud o Tkanevayaгиперосмия o Increase to secretions вазопрессина o Reinforcement реабсорбции water in bud Gipersekreciyaальдостерона o Gipovolemiya or increase the warmhearted surge o Increase to secretions ренина o Increase amount Angiotenzina-2 o Reinforcement to secretions альдостерона o Reinforcement реабсорбции water and sodium Simpatoadrenalovaya system o Promotes redistribution кровотока in bud o Discrepancy to velocities to circulations sodium in клубочках and реабсорбции in проксимальных and дистальныхканальцах Glomerulonefrity o group of the diseases, for which characteristic of presence иммунологических and clinic-morphological sign of the inflammation, bound first of all with клубочковым by defeat and secondary involvement in process канальцев and интерстиция bud. Primary гломерулонефрит,этиология o стрептококковая infection (нефритогенный streptococci gr But). o virus of the hepetitis V. o цитомегаловирусы. o malarial плазмодий o неинфекционные factors: oProf.privivki, entering the whey, cooling and etc. Patogenez GN. o Influence of the antigen o Formation antibody o Complex antigen +antibody (CIK) o Fiksaciya CIK on базальной to membrane клубочков bud o Liberation or activation biologically active material (гистамин, серотонин, кинины and others.) o Migration полинуклеаров from container o Activation комплемента o Liberation гидролизирующих and фибринолизирующих ferment o Damage capillary клубочковPatogenez GN o system Activation гемостаза o Local гицеркоагуляция o Defeat эндотелия capillary o Aggregation тромбоцитов o Capillary стаз o Breach микроциркуляции o system Activation of the rolling up o Depression фибринолиза o Postponing фибрина in bright spot клубочковых capsules. o DVS-syndrome Patogenez GN o Breach микроциркуляции- activation ренин -an ангиотензиновой of the system - GIPERTENZIYA. o Breach to permeability-loss squirrel, reduction онкотического and осмотического of the pressure- EDEMAS o URINARY SYNDROME Categorization primary GN. o Sharp GN o With нефритическим syndrome o With нефротическим syndrome o With edema,гипертензией and гематурией o Insulated urinary syndrome
oTranzitornoe increasing of the urea, креатинина, лейкоцитурия o Breach клубочковой to filtering o Breach to concentration function Sharp GN oNefriticheskiy syndrome-is characterized by round-robin current oNefroticheskiy syndrome-wave-like current o With edema, гипертензией, гематурией-затяжное current, steadfast breach to functions bud, HPN. The Categorization GN o Initial period (2-4 нед) o Period of the inverse development ( 2-4 knead.) o Recovery or transition in chronic process Chronic GN. o Gematuricheskaya form oNefroticheskaya form o Mixed form Chronic GN, нефротическая form o Edemas massive o Proteinuriya more than 2,5 gr./sutki o Hipo- and диспротеинемия o Giperholesterinemiya o Function bud is preserved by o Minimum morphological change o Current рецидивирующее o Positive effect from глюкокортикоидов. Chronic GN, mixed form o Edemas oNeselektivnayaпротеинурия o Gematuriya o Gipertenziya o Anemia o Restriction to functions bud o Denominated пролиферативно-мембранозныйгломерулит o HPN through 2-6 years oImmunosupressivnaya therapy little efficient. Chronic GN гематурическая form oХарактеризуется only urinary syndrome: oGematuriya before макрогематурии o Small протеинурия o HELL normal o Edema no o Function bud is preserved by o Sparingly denominated пролиферативный or пролиферативно-мембранозныйгломерулит. Podostryy malignant гломерулонефрит o Expressed гематурия o Proteinuriya massive o Edemas o Gipertenziya o Progressing fall to functions bud. o Terminal HPN during 1-2 knead. o Formation полулуний in capsule Ш-Б. o Treatment inefficient. Chronic GN,current o Period of the intensification o Clinical remission o Clinic-laboratory remission. The Estimation to functions bud o Normal or safe function o Parcialinoe breach to functions o HPN. Functions bud o Level креатинина and ureas o Factors of the SCYTHES o Value клубочковой to filtering o Concentration function o Compensation metabolic ацидоза. Level креатинина and ureas o Urea in whey -2,5- 8,3 ммоль/l o Kreatinin before 0,1 ммоль/l Test Reberga o Determination клубочковой to filtering on клиренсуэндогенногокреатинина o Child after matutinal urination is given 400 ml liquids, during the following two hours is conducted collection of the urine. The level креатинина is Defined in shelters and in collected to urine. Got given are inserted in formula Van-Slayka. Results: Klubochkovaya filitraciya-120 ml/mines Kanalicevayaреабсорбция -90-95% Concentration function bud o Test Zimnickogo (or her(its) modification) o Correlation DD : ND = 3:1, 2:1 o DD :ND= 1:1= никтурия o Relative density above 1018 = safe function bud on концентрированиюEkskretornayaурография o For estimation of the functional ability bud o In rate for 40 mines of the study is removed 27-33% incorporated contrast that corresponds to klub.filitracii 105-130 ml/mines of the Complication GN o OPN o Eklampsiya oQuiping warmhearted insufficiency OPN o Anuriya o Delay of water, азотистых slag, potassium. oGipergidrataciya o Metabolic ацидоз oDispepticheskie frustration (анорексия, sickness, retching, diarrhoea). oGemorragicheskiy syndrome o Anemia o Defeats CNS,SSS. oUremicheskaya coma Eklampsiya oAngiospasticheskayaэнцефалопатия: o is Conditioned by spasm container cerebrum, his(its) edema. o Tonic - an клонические of the crick o Consciousness is absent o Pupil of an eye do not on light o Skin and слизистыецианотичны o Hripyaschee breathing, spume изорта o Neproizvolinoe urination o Fit длится 2-5 mines o Palsies, paresises, breach speech. o Cerebral hemorrage o Lethal upshot. 'Quiping warmhearted insufficiency o Appears seldom o Increase the sizes heart o Systolic noise o Deaf tones o Bradikardiya o гепатомегалия Differential diagnosis o интерстициальный nephritis o system васкулиты o амилоидоз oгеморрагическийваскулит o токсическийнефроз o secondary нефротический syndrome o HPN Differential diagnosis o Defeats of the cardiovascular system: Rheumatism, innate vices, breach кровообращения (the anemias, тиреотоксикоз, beriberi, pneumonia). o Liver problem: :cirrhosis, thrombosis liver vein. o Consequences of the using medicinal preparation :эстрогены, диазоксид, quick introduction fiz.r-ra and his(its) analogue. The Differential diagnosis o disease of the endocrine system: oGipotireoidizm, excess минералкортикоидов, sugar diabetes, o Syndrome to inadequate secretion ADG Differential diagnosis oBezbelkovye edemas at syndrome "broken suction". o Edemas newborn o Allergozy. o Round-robin идиопатические edemas Treatment o Bed mode o Dietoterapiya o Antibakterialinaya therapy o Vitaminoterapiya o Gipotenzivnye preparations o Diuretiki oPatogeneticheskaya therapy. Bed mode o Promotes removing the spasm container, is a facility maximum щажения struck organ. Dietoterapiya oBessolevoy table with restriction animal squirrel and liquids at sharp period o Gipohloridnyy table with дозированным by acceptance to liquids o Sugar-fruit discharge days Antibakterialinaya therapy. oPenicilin or полусинтетическиеpenicilins o Sharp GN (all sick) o Chronic GN: the chronic centres to infections massive гормонотерапия. Vitaminoterapiya o Ascorbic acid, routines o Vitamins of the group In o Antioksidashy: Vitamin А, E. o Lipotropnye: Vitamin In 15 o Folic acid o Vitamin D. Gipotenzivnye facility. o Becalming facility of the central origin: valerian, пустырник, bromine, phenobarbital. o Small and greater tranquillizers o Antiadrenergicheskie facility: o preparations раувольфии, гемитон, обзидан, анаприлен and others Diureticheskie facility oGipotiazid, лазикс, фуросемид, бринальдикс, этакриновая acid. o Antagonists альдостерона -верошпирон o Osmodiuretiki - an маннитол, полиглюкин, albumin and others Patogeneticheskaya therapy o Glyukokortikoidy o Antikoagulyanty o Antiagreganty o CitostatikiGlyukokortikoidy o Possess the expressed противовоспалительным and десенсибилизирующим effect. o Suppress the possibility of the formation иммунных complex, prevent their оседанию on territory клубочков bud. o Prednizolon-1,0-1,5 mg/kgs 3-4 not d. o Gradual reduction (on 0,5 mg) o Intermittent course 6-8 knead. Antikoagulyanty oPotenciruyut action hormone o Possess the противовоспалительными and десенсибилизирующим characteristic o Immunosupressivnyy effect o Diureticheskiy effect in combination with albumin o Geparin-150-200 ME/kgs 3 нед. Antiagreganty o Promote the improvement an микроциркуляции o Reduce the spasm small container o Hold up агре;гациютромбоцитов o Kurantil 3 mg/kgs (3 knead). Citostatiki o Hlorbutin o Leykeran o Azatioprin o 6-меркаптопурин o метатрексат Preparations 4-аминохинолинового of the row o are Accumulated in hutch RES o Block formation an antibody o Delagil o Plakvenil 5 -10 mg/kgsIndometacin o Expressed противовоспалительное characteristic o Immunodepressant o 3 mg/kgs in day Methods внепочечного of the defogging shelters o At rack breach to functions bud o Gemodializ o Gemosorbciya o Plazmaferez o is Used not only for removing slag, electrolyte, but also иммунных complex. Forecast
o Sharp GN-recovery 85% Dispanserizaciya oDispansernoe observation for 5 years o Urinalysis o Blood test o Biochemistry shelters o Estimation of the functional condition bud o Dietoterapiya o Occupations by physical culture in spec.gruppah o Sanaciya chronic centre to infections o Supporting therapy o Prof.privivki on evidences 6.2. Analytical part Used on given occupation to new pedagogical technologies: The Play: "find its half" Purpose: checking source level knowledges on subject "Edemas". The Main positions of the method "find its half". Beforehand prepare the cards with names of the diseases (on one половинки) and clinical sign (on the second) of the card раздаются all student. The Student beside which card with name disease must find the second half with clinical sign of this disease (beside the other student). If половинки coincide, that answer correct. The Questions: 1. The Wide-spread edemas, mechanism of the development. 2. The Local edemas, enumerate. 3. Sharp гломерулонефрит, clinical forms. 4. Chronic гломерулонефрит, periods. 5. The Functional condition bud, methods of the estimation. 6. The Methods of the checking edema. Situational problems:
1. Your diagnosis: A. sharp гломерулонефрит* B. chronic гломерулонефрит V. hereditary nephritis интерстициальный nephritis D. .пиелонефрит II. What studies necessary to conduct: A. general urinalysis B. general blood test V. biochemical blood test biochemical urinalysis D. all enumerated* III. In urine протеинурия. For what forms disease characteristic of: A. нефротическая* B. нефритическая V. mixed G.otnositsya to urinary system
I. Your diagnosis: A. sharp гломерулонефрит* B. chronic гломерулонефрит V. hereditary nephritis интерстициальный nephritis D. пиелонефрит P. The Tactics of the further examination: А. THE TIE bud* B. коагулограмма V. biochemical blood test biochemical urinalysis D. all enumerated III. What form GN possible development in this age: A. подострый, heavy гломерулонефрит* B. sharp гломерулонефрит, mixed form. V. chronic гломерулонефрит.
I. Your diagnosis: A. sharp гломерулонефрит, нефритический syndrome B. chronic гломерулонефрит V. sharp гломерулонефрит, нефротический syndrome* интерстициальный nephritis D. sharp пиелонефрит II. The Plan of the examination: A. general urinalysis B. general blood test V. biochemical blood test G. The Biochemical urinalysis D. all enumerated * III. Patogeneticheskoe treatment гломерунефрита with нефротическим syndrome: A.gormony* B.antibiotiki V. diuretic гипосенсибилизирующие Preparations
I. As his(its) mechanism: A.snizhenieонкотического and осмотического of the pressure B. reduction гидростатического pressures V. increasing онкотического pressures increasing гидростатического pressures* D. breach to permeability capillary. P.V treatment edema in the first place beside given sick is shown: A. warmhearted гликозиды* B. диуретикиV.belkovye preparations G.sredstva, reducing permeability capillary D. antibiotics 6.3. Practical part
1. The Test Poppy-KlyuraOldricha (for determination hidden edema). 2. Interpretation laboratory data. 3. The Estimation of the functional condition bud. Test Poppy-KlyuraOldricha (for determination hidden edema) Actions of No answer Full answer 1 Prepares fiz.solution and инсулиновый syringe 0 15 2 Ispytuemyy must be in suitable position, sitting. 0 15 3 0,2 ml fiz. solution are entered внутрикожно on lower one third of the forearm (in the manner of "lemon корочки"). 0 15 4 Are Defined time рассасывания skin волдыря 0 15 5 Quick рассасываниеволдыря, test negative that is to say no hidden edema. 0 20 6 Slowрассасываниеволдыря, for 30 minutes, points to presence hidden edema. 0 20 Hiccupped: 0 100 14. Forms of the checking the knowledges, skill and skills - spoken; - писменный; - a decision of the situational problems; - a demonstration masterred practical skill.
15. Criteria of the estimation of the current checking Progress in % Estimation Level knowledges of the student 1 96-100% Fine "5" Full correct answer to questions on этиологии, патогенезу, categorizations, clinics and treatment. Takes stock of and comes to a conclusion, creative imaginative, by itself analyses. The Situational problems solves it is correct, with full motivation of the answer. Actively, creative participates in интерактивныхplay, it is correct takes the motivated decisions and takes stock of. The Recipes is drawn in accordance with medicinal form and with faithfull instruction of the dose and evidences to using. 2 91-95% Fine "5" Full correct answer to questions Onэтиологии, патогенезу, categorizations, clinics and treatment. Takes stock of and comes to a conclusion, creative imaginative, by itself analyses. The Situational problems solves it is correct, with full motivation of the answer. Actively, creative participates in интерактивныхplay, it is correct takes the motivated decisions and takes stock of. The Recipes is drawn there is 1 grammatical mistake in accordance with medicinal form. 3 86-90% Fine "5" Full correct answer to questions on этиологии, патогенезу, categorizations, clinics and treatment, but there is 1-2 inexactnesses in answer. By itself analyses. The Inexactnesses at decisions of the situational problems, but under correct approach. Actively, creative participates in интерактивныхplay, it is correct takes the motivated decisions and takes stock of. Recipes is drawn in accordance with medicinal form, but there are 2-3 grammatical mistakes 4 81-85% Well "4" Full correct answer to questions on этиологии, патогенезу, categorizations, clinics and treatment, but there is 2-3 inexactnesses in answer. By itself analyses. The Situational problems are solved it is correct, but motivations of the answer it is not enough packed. Actively, creative participates in интерактивныхplay, it is correct takes the motivated decisions and takes stock of. The Recipes is drawn in accordance with medicinal form, but there are 2-3 grammatical mistakes. 5 76-80% Well "4" Correct, but not full illumination of the question. The Student knows the categorization, evidences to using preparation, but неполностью understands in mechanism of the action and development side effect. Understands the essence of the question, tells certain, has an exact presentations. Actively, creative participates in интерактивныхplay, it is correct takes the motivated decisions and takes stock of. The Recipes is drawn in accordance with medicinal form, but not are completely given evidences to using. 6 71 75 % Well "4" Correct, but not full illumination of the question. The Student knows the categorization, evidences to using preparation, but неполностью understands in mechanism of the action and development side effect. Understands the essence of the question, tells certain. On situational problems gives not full decisions. The Recipes is drawn in accordance with medicinal form, but not are completely given evidences to using, there is 2-3 grammatical mistakes. 7 66-70% Satisfactorily "3" Student knows to categorizations, not packed enumerates the evidences to using preparation, the main characteristic, but bad understands in mechanism of the action. Understands the essence of the question, tells certain, has an exact presentations on separate questions of the subject only. The Situational problems are solved faithfully, but no motivations of the answer. The Recipes is drawn with correct instruction of the dose, but not are completely given evidences to using and there is mistakes in instruction of the form of the issue. 8 61-65% Satisfactorily "3" Correct answer to half of the put(deliver)ed questions. The Mistakes in categorizations, mistakes in evidence to using preparation. Tells not certain, has an exact presentations on separate questions of the subject only. Allows the mistakes at decision of the situational problems. The Recipes is drawn with grammatical mistake. 9 55-60% Satisfactorily "3" Correct answer to half of the put(deliver)ed questions. The Mistakes in categorizations, mistakes in evidence to using preparation. Tells not certain, has a partial presentations on subject. The Situational problems are solved not faithfully. The Recipes is drawn with grammatical mistake. 10 50-54% Neudовлетворительно "2" On questions does not give the answer. The Student does not know the categorization, characteristic preparation. Does Not know the mechanisms of the action and side effect preparation. The Situational problems are solved not faithfully. Will Not die to draw the recipes.
16. Hronologicheskaya card of the occupation Stages of the occupation of the Form of the occupation Prodolжительность in mines. 270
1 Introductory word of the teacher (motivation of the subject) 10 2 Discussions of the subject, use new pedagogical technology, as well as checking the source knowledges student, use the visual aidses (slides, audio and video cassette, муляжи, phantoms, EKG, x-rays and others) questioning, explanation 60 3 Podvedenie total of the discussion 15 4 Grantings student tasks for performing the practical part of occupation.Independent курация. 45 5 Assimilations practical skill by student by means of teacher (курация thematic sick). The History disease, business plays clinical situational problems 50 6 Analysises result laboratory, instrumental studies thematic sick, differential diagnostics, sheduling the plan of the treatment and drawing recipe. Work with clinical laboratory instrument 30 7 Discussions degree achievements to purposes of the occupation on the grounds of masterred theoretical knowledges and on result of the practical functioning(working) the student and with provision for this estimation of activity of the group. Spoken questioning, test, debates, discussion result practical work 40 8 Conclusions of the teacher on given occupation. The Estimation of the knowledges student on 100 балльной to system and her(its) оглашение. The Datcha of the task student on the following occupation. Information, kit of the questions for independent training 20
17. Checking questions 1. Enumerate the diseases running with syndrome edemas. 2. The Algorithm of the diagnostics edema. 3. Rasprostranenye edemas. 4. The Local edemas. 5. Bezbelkovye edemas. 6. The Edemas at disease of the cardiovascular system. 7. The Edemas at disease liver. 8. The Edemas at disease bud. 9. The Estimation of the functional condition bud. 10. The Modern methods of the treatment and preventive maintenances GN beside детей. Tests 1. For mixed form chronic гломерулонефрита typical: A. expressed edemas* B. гематурия* V. hypertension* гиперлипидемия D. болевой syndrome 2.Патогенетическое treatment chronic гломерулонефрита includes: A. антикоагулянты * B. антиагреганты* V. глкжокортикоиды* антигистаминные D. нейролептики 3. The Clinical forms chronic гломерулонефрита: A. гематурическая* B. нефротическая* V. mixed* олигурическая D. Gipertonicheskaya 4.0страя kidney insufficiency is characterized: A. олигурией * B. анурией* V. азотемией * anemia D. гипербилирубинемией 5.Исходы sharp kidney insufficiency: A. lethal upshot * B. development интерстициального nephritis * V. recovery* G. HPN* D. development гломерулонефритаb.TheLeadinging biochemical factor under HPN are: A. increased level of the urea * B. low клиренс on эндогенномукреатинину* V. increased level креатина* гиперурикемия D. гипермагнезиемия 7. What studies necessary to conduct for stating the diagnosis sharp GN: A. general urinalysis, general protein of the whey shelters* B.bak sowing of the urine V.biohimicheskie studies shelters* G.ekskretornayaурографияD.angiografiya ' 8. A following features have Atнефротическом syndrome гломерулонефрита edemas: A. wide-spread* B. "soft"* V. develop with upper half of the body* thick D. Limited 9.Методы checking edema:; A.sutochnyyдиурез* B.The Measurement of the volume of the belly* В. Daily взвешивание* G. The Test Zimnicskogo D. Test Reberga 10. To reason wide-spread edema it pertains: A. diseases SSS* B.The Medicinal edemas* В. Bezbelkovye edemas* G. The Allergic edemas D. Phlebitises 11. To medicinal preparation, bring about development edema, pertains: A. hormones* B. Gipotenzivnye preparations* В. NPVS* G. The Antibiotics D. Antigistaminnye preparations 12. The Mechanism of the development kidney edema: A. positive water balance* B. The Reduction онкотическогр pressures* V. Gipersekreciyaальдостерона* G. Increasing гидростатического pressures D. Prepyatsvie current of the lymph. 13. The Mechanism of the development "warmhearted edema": A. increasing гидростатического pressures* B. Increasing to permeability capillary* В. Expressed протеинурия G. The Reinforcement to secretions альдостерона D. The Reduction онкотического pressures of the plasma. 14. Generalizovannye edemas typical of the following forms гломерулонефрита: A. нефротическая* B. Mixed* В. Podostryy malignant* G. Gematuricheskaya D. Nefriticheskiy syndrome. 15. To осмодиуретикам it pertains: A. маннитол* B.The Urea* V. Albumin* G. Furosemid. D. Verashpiron. About
1 .Детские disease.Red.N.P.SHABALOV,M.,2000. 2.Болезнидетей of the early age.Red.A.A.BARANOV,1998. 3.Неотложные conditions in pediatrics.Red. A.A.BARANOV, 1998.4.Материалы lecture. 5. Internet
1. Nefrologiya baby age in scheme and table. M. V. Erman. 1997 S.-PT. 2. The Clinical lectures on pediatrics. Red.Aleksandrova A. and others 2004. 3. The Nursery нефрология YU. E. Velitischev, M. S. Ignatova. Moscow 2000 Yüklə 43,87 Kb. Dostları ilə paylaş:
|