Prízaky a sydróy v edicíe - FMED UK - Zóna · – Effort (heart/lung disease/anemia) – Breathing – Meal (GIT) – Urination Stool – Sleep (any organ system) Sexual activities

6. 10. 2016

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Symptoms and syndromes in medicine

Tomáš Koller

Príznaky a syndrómy v medicíne

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Osnova / Outline

1. Roles in medicine/hospital

2. Nomenclature / terminology

3. Most frequent symptoms in medicine

4. Symptom analysis

5. Clinical signs

6. Clinical diagnosis making

7. Most frequent syndromes/clinical pictures

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Osnova / Outline

1. Roles in medicine/hospital

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V hlavnej úlohe Leading roles

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Vzťahy medzi rolami Role relations

Student / young doctor

patient

Senior doctor

Language is different !

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The patient

patient

„....je mi nejako zle“ „....neviem sa nadýchnúť“ „bolí ma .....“ „...neviem prehĺtať“

„i feel unwel...“ „i can´t breathe ...“ „ I feel pain in ...“ „ i can´t eat ...“

- Reč pacienta je laická - Závisí od úrovne vzdelania/intelektu - Od úrovne analýzy príznakov samotným pacientom - Od závažnosti stavu pacienta

- The talk of the patient is unfamiliar with medical terminology - Depends on the level of education/intelect/language - On the analysis of the symptoms by the patients him/herself - On the severity of the disease

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The student / junior doctor

Cieľ: akú má pacient diagnózu ? Goal: what is the diagnosis ? Prostriedok: klinické vyšetrenie – anamnéza, fyzikálne vyšetrenie Modality: clinical exam – full medical history and full physical exam Cesta/Path: 1. Komunikáciou identifikuj hlavné symptómy pacienta (TO) 2. V prípade nejasností otázky opakuj inými slovami

1. Communicating with the patient identify main symptoms 2. When unclear, repeat questions with different words

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Senior doctor

„Tell me about the patient“ Expecting to hear: 1. Principle symptoms of the patient 2. Possible connection to the previous medical history/or therapy 3. Principle physical exam findings 4. Clinical diagnosis hypotheses 5. Differential diagnosis hypotheses

„Povedzte mi o pacientovi“ Chce počuť: 1. Hlavné príznaky pacienta 2. Ich možnú súvislosť s OA a liečbou 3. Relevatné nálezy pri fyzikálnom vyšetrení 4. Hypotézy klinickej diagnózy 5. Hypotézy diff. dg.

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Osnova / Outline

2. Nomenclature / terminology

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nomenclature 1. a system of names used in the classification of an art or science or other field or subject.

Názvoslovie symtómov Symptom nomeclature

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Klinický / clinical

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slex.sk

Príznak/symptom

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Symptom nomenclature

• Is internationally standardized

• May have some small regional differences – With regard to the most common

diseases

– With regard to the history of particular school of medicine • Anglo-american, German, French,

Indian, Chinese ...

• Is an alphabet of medicine and medical communication and documentation

• Je medzinárodne štandardizovaná

• Môže mať malé regionálne rozdiely – Kvôli odlišnostiam v

najčastejších chorobách

– Vzhľadom na históriu danej medicínskej školy

• Je abecedou medicíny a medicínskej komunikácie a dokumentácie

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Symptoms

• No official list of all symptoms

• Usually organ system specific – But can overlap /dyspnea,

fatigue .../

• ICD 10 – WHO • Evolve with time

– New diseases – New knowledge – New investigations

• Neexistuje oficálny úplný zoznam prízakov a syndrómov

• Často sú špecifické pre orgánové systémy – Ale môžu sa prelínať

• Dyspnoe, únava ....

• MKCH 10 – WHO • V čase sa môže meniť

– Nové choroby – Nové poznatky o chorobách – Nové vyšetrovacie metódy

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Standardized nomenclature

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ICD-10

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Osnova / Outline

3. Most frequent symptoms in medicine

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Celkové príznaky

• Horúčka

• Triaška

• Slabosť/únava

• Kŕče

• Šok

• Zväčšené lymfatické uzliny

• Nadmerné potenie

• Generalizované opuchy

• Kachexia

General symptoms

• Fever

• Chills

• Fatigue/exhaustion

• Seizures

• Shock

• Lymphadenopathy

• Sweating

• Generalized oedema

• Cachexia

Časté príznaky / common symptoms

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Heart and vascular disease

• Chest pain

• Syncope

• Malaise

• Palpitations

• Fatigue

• Dysnea

• Edema

• Claudication

Choroby srdca a ciev

• Bolesti na hrudníku

• Synkopa

• Mdloba

• Palpitácie

• Únava

• Dyspnoe

• Opuchy

• Klaudikácie

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Choroby pľúc a pleury

• Bolesť na hrudníku

• Kašeľ

• Expektorácia

• Hemoptýza

• Dyspnoe

• Zachrípnutosť

• Čkanie - singultus

Pulmonary and pleural diseases

• Chest pain

• Cough

• Expectoration

• Hemoptysis

• Dyspnea

• Voice alterations

• Hiccups


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Choroby tráviaceho traktu • Nechutenstvo • Anorexia • Bulímia • Dysfágia/odynofágia • Regurgitácia • Pálenie záhy • Nauzea • Vracanie • Hemateméza • Meléna/hematochézia • Zápcha • Hnačka • Ikterus

Digestive tract disease • Loss of apetite • Anorexia • Bulimia • Dysphagia/odynophagia • Regurgitation • Pyrosis • Nausea • Vomiting • Haematemesis • Melaena/hematochezia • Constipation • Diarrhea • Jaundice


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Urologicko-nefrologické

• Polakizúria

• Dyzúria

• Nyktúria

• Anúria

• Retencia moča

• Inkontinencia moča

• Pálenie pri močení

• Hematúria

• Bolesti v lumbálnej oblasti

• Opuchy

Uro-nephrologic

• Pollakisuria

• Dysuria

• Nycturia

• Anuria

• Urine retention

• Urine incontinence

• Haematuria

• Lumbar pain

• Edema


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Kostno-kĺbový aparát

• Bolesť kĺbov

• Bolesť chrbice

• Opuch kĺbov

• Haemarthros

• Pyartros

• Hydrarthros

Osteoarticular

• Joint pain

• Back pain

• Joint edema

• Haemarthros

• Pyarthros

• Hydrarthros


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Osnova / Outline

4. Symptom analysis

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Analysis of symptoms

• Should be thorough - exhaustively complete – Should take time and patience

• Friendly relatioship with the patient • But considering the urgency of the situation

– Should be focused on the main symptom (or two) for which the patient is being evaluated • All principle findings should be re-checked – confirmed

during the talk (in other words)

• Should always be followed by brief other organ

system function screening questions – Not to miss important impact on other organ systems

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Symptom analysis

• Evolution with time: – Since when? – How often? – Character of onset – seconds, minutes, hours, days, months – Duration? – Similar symptoms in the past? – Evolution with time? (more severe/stable), more often/less often)

• Circumstances at which the symptom appears and goes away

• Relation to physiological activities:

– Effort (heart/lung disease/anemia) – Breathing – Meal (GIT) – Urination – Stool – Sleep (any organ system) – Sexual activities

days/months

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Symptom analysis

• Exact location (will guide the focused physical examination) – Pain – Itching – Burning – Skin lesions

• Severity scale – 0-10 for pain – Solid food/liquid food

• Character of the symptom

– Pain – sharp, dull, burning, throbbing, pressing....

• Functional impact on daily acitivities – Work – Self-care – Eating – Drinking – Sleeping – Walking

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Symptom analysis

• All other associated symptoms

– General

– Localized

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Osnova / Outline

5. Clinical signs

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Klinický znak/clinical sign

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syndrome

Syndróm sa skladá minimálne 1 z: Syndrome consists of one or more of: Príznakov Symptoms Znakov Clinical signs (Laboratórny nález) (Labs) (Zobrazovací nález) (Imaging)

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Osnova / Outline

6. Clinical diagnosis making

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Basic terms

• Clinical diagnosis – Diagnosis suggested by the symptom analysis and observed

clinical signs » E.g. progressive dyphagia for liquids, then solids with severe

malnutrition

• Differential diagnosis

– All possible diseases with similar clinical picture » E.g. oesophageal cancer, achalasia, large goiter, mediastinal mass ....

• Etiological diagnosis

– The disease (one) that caused the current condition of the patient

» E.g. Proximal squamous oesophageal carcinoma T3N1M0 » Using upper endoscopy, histology, CT scan

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What is it?

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Príznak/symptom 1.

Klinický znak/clinical sign 1.

Etiologická diagnóza/etiological diagnosis

Príznak/symptom 2.

Príznak/symptom 3.



Diferenciálna diagnóza/differencial diagnosis

Čas/time Easy case

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Príznak/symptom 1.



Príznak/symptom 2.

Príznak/symptom 3.




Čas/time Uneasy case

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Príznak/symptom 1.



Príznak/symptom 2.

Príznak/symptom 3.




Čas/time

Laboratory result 1.

Laboratory result 2.

Imaging 2.

Confirmatiory exams

Imaging 1.

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More pieces of the puzzle

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Etiological diagnosis

• Can be synthetized from a mosaic of indices – Clinical diagnosis – symptoms + signs – Risk factors – Personal history – Lab results and imaging

OR

• a diagnostic test

– Test that confirms the diagnosis – Is defined and interpreted exactly (e.g. troponin, histology) – Not all diagnoses have one (rheumatological dis.)

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Etiological diagnosis

• When the disease begins – Only few indices pointing to the

disease are detectable

BUT

– Disease more likey curative

• More the disease progresses – More indices pointing to it are

detectable

BUT

– Less likely the therapy will be curative (cancer)

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Osnova / Outline

7. Most frequent syndromes/clinical pictures

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Heart failure

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Angina pectoris

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Variants of angina pectoris

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Pulmonary embolism

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Chronic Obstructive Pulmonary Dis.

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Pulmonary malignancy

Superior vena cava syndrome Pancoast syndrome

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Biliary pain

Torsion, spasm

Continuous

Paroxysmal aggravation

Very strong

Rapidly progressive

Hours, night

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Colic pain

Paroxysmal

Strong

Spasms, distention

Short – minutes

Diarhea

Gas

Fever

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Small intestine – obstructional syndrome

Spasms

Quick installation

Repeating waves of

pain of short duration

Minutes

Not maximal

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Gastro-oesophageal reflux pain

Burning

Seconds, minutes

After meals

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Peptic ulcer pain

Spasm, torsion like

Hunger like

Minutes, hours

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Tearing pain

Spasms

Very strong

Continuous

After meal

Pancreatic pain

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Ascites – portal hypertension

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Hypothyroidism

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Acromegaly Growth hormone overproduction

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Cachexia

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Nephrotic syndrome

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Pre-eclampsia

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Summary

• Symptoms and signs – alphabet of medicine

• absolutely

• Clinical diagnosis – By the bed of the patient

• Differential diagnosis – All possible conditions

possibly causing the clinical diagnosis

• Etiological diagnosis – The disease that caused the

current problem

– Chapters in medical books

• Symptom analysis a physical examination makes the clinical diagnosis and most of the etiological diagnosis – Cornerstone of your clinical

teaching

– Takes time and patience

– Requires appropriate language (Slovak too!)

– Should never be ommited when managing any patient at any situation

– Improves with practice all your carrier

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Documents

Prízaky a sydróy v edicíe - FMED UK - Zóna · – Effort (heart/lung disease/anemia) – Breathing – Meal (GIT) – Urination Stool – Sleep (any organ system) Sexual activities