Literature

1. Internal diseases an introductory course. - Vasilenko V., Grebenev A. - M.: Mir . Publishers, 1990. - 647 p

2. Propedeutics to internal medicine. Part 1.-Vinnytsya: NOVA KNYHA, 2006.- 424 p.

3. Propedeutics to internal medicine. Part 2.-Vinnytsya: NOVA KNYHA, 2007.- 264 p.

4. Introduction to the course of internal diseases. Book 1. Diagnosis: [Textbook/Zh.D. Semidotskaya, O.S. Bilchenko, et al.].-Kharkiv: KSMU, 2005. -312p.

5. Michael Swash Hutchison’s clinical methods / XIX edition. ELBS, 1989. -618p.

6. Mark H., Beers M.D., Robert Berkow The Merck Manual of diagnosis and therapy / XVII edition.- Published by Merk research laboratories, 1999.- 2833 p.

7. Harrison΄s principles off internal medicine / Fauci, Braunwald, Isselbacher and al.-XIV edition. - Vol. 1 and 2. - International edition, 1998.

Topic 11. Basic Symptoms and Syndroms in Biliary Diseases: Chronic Cholecystitis, Cholangitis, Cholelithiasis.

Class lasts: 3 hours

Chronological class structure:

Control of initial standard of knowledges- 20 min.

Teacher′s demonstration of practical skills - 60 min.

Sudents′ independent work: - 30 min.

Control of ultimate standard of knowledges- 15 min.

Sum up of the class, homework- 10 min.

Questions for theoretical preparation:Definition and modern classifications of chronic cholecystitis and cholangitis. Biliary duct dyskinesia and its tapes. Main complaints of the patients with cholecystitis and cholangitis. Clinical, instrumental and laboratory examination of the patients for biliary disease. Study of duodenal contents and to analyze the results. Cholelithiasis.: main complaints and clinical features. Biliary pain (“biliary colic“). Jaundice and cholestasis, them laboratory findings.

Syndrome of bile ducts dyskinesia (dysfunctional bile tract disorders)

The syndrome of bile ducts dyskinesia is the complex of clinical symptoms which developing connects with moto-tonic dysfunction of gallbladder, bile ducts and sphincters. Dysfunctional bile tract disorders include not coordinated, untimely, insufficient or excessive reduction of a gallbladder and sphincters (Oddy, Lutkensa and Mirricy).

Classification

Depending on the etiological factor, localization and functional state there are the next forms of dysfunctional bile tract disorders:

I. According to the etiology:

1. Primary dysfunctional bile tract disorders (hereditary decrease of muscular tone, decrease of receptors apparatus sensitivity to neurohumoral stimulation).

2. Secondary dysfunctional bile tract disorders.

II. According to the localization:

1. Dysfunction of the gall bladder.

2. Dysfunction of the Oddy's sphincter.

III. According to the functional state:

1. Hyperfunction.

2. Hypofunction.

In hyperkinetic form of the gall bladder or/and bile ducts dysfunction the main complaints are: acute pain in the abdomen and clinical signs of neurotic syndrome.

Pain in the abdomen - is periodic, recurrent, colic like, localized in the right hypochondrial region with radiation to the back, right scapulae and right shoulder, aggravated more frequent at night-time after improper feeding, alcohol, augment physical or psychical activity.

In hypokinetic form of the gall bladder or/and bile ducts dysfunction the main complaints are: dull pain in the abdomen, clinical signs of neurotic and dyspeptic syndromes.