Atypical course of acute appendicitis

1. In the elderly: muscle tension, symptoms of peritoneal irritation, pain are less pronounced than in young people. Patients often present already with peritonitis.

2. In pregnant women: the cecum is mixed up, which makes it difficult to diagnose. Vomiting and nausea are mistakenly regarded as toxicosis.

3. In children under 4 years of age, it is rare, but the course is stormy, with severe intoxication, often complicated by diffuse peritonitis.

If acute appendicitis is suspected, laxatives, enemas, painkillers, hot water bottles should not be used.


1. Hospitalization. Treatment promptly.

Renal colic

This is a syndrome that occurs when there is an acute violation of the outflow of urine due to blockage of the urinary tract by a stone, a blood clot, as a result of an inflection of the ureter or a spasm of the renal pelvis or ureter.


They appear suddenly, the pain is very intense, radiates to the inguinal region, patients rush about without finding a place for themselves, urination becomes more frequent.

PMP in renal colic.

1. Antispasmodics (baralgin, no-shpa, papaverine)

2. Urgent hospitalization

Guidelines for independent work of students

1. When working in pairs: determine the signs of an “acute abdomen” and render PMP on the phantom; determine the signs of renal colic and render PMP on the phantom.

2. In pair work, solve a situational problem using reference literature (compose a written answer in a notebook).

3. Prepare to check the completed task.

Situational tasks

Task #1

A 42-year-old patient suffering from urolithiasis developed sharp pains in the lumbar region. The pains radiate to the lower abdomen and to the inguinal region, their intensity is such that the patient sometimes “darkens in the eyes.” The pain is accompanied by frequent painful urination.

Solve the problem by answering the questions.

1. What about the patient?

2. What is the main symptom of this condition?

3. What is the cause of the main symptom of the disease?

4. What are the immediate actions?

5. Is hospitalization of the patient in a medical facility necessary?

Task #2

A young worker, 25 years old, went to the health center: at night at home, she developed slight pains in the upper abdomen, nausea. By morning, the nausea had passed, the woman went to work. Currently complains of pain in the lower abdomen, urge to stool. On examination: the abdomen is tense, especially in the right iliac region, a weakly positive symptom of Shchetkin-Blumberg in this area is also determined there. Pulse 96 per minute.

Solve the problem by answering the questions.

  1. What disease can be assumed in a woman?
  2. On what grounds did you assume this?
  3. What is the main symptom of this disease?
  4. In which area of the abdomen is this symptom most often felt?
  5. What is the first aid strategy?

Task number 3

A young patient with a long history of ulcers developed melena several times a day, decreased blood pressure100/60, pulse 110 beats. per minute, general weakness, dizziness, vomiting of the color of coffee grounds.

Solve the problem by answering the questions.

1. What complication of peptic ulcer developed in the patient?

2. What symptoms characterize this complication?

3. What is melena?

4. What are the first aid measures?

5. In what position should the patient be transported?

Task number 4

A young woman, a day ago, suddenly had severe pain in the right iliac region. The general condition of the patient is satisfactory, the temperature is 37.8 C, the pulse is 100 beats/min. The tongue is wet. The abdomen is not swollen, participates in the act of breathing: in the right iliac region it is tense, sharply painful. Positive symptoms of Shchetkin – Blumberg, Rovsing, Sitkovsky.

Solve the problem by answering the questions.

1. What disease does the woman have?

2. What symptoms are typical for it?

3. The reason for the development of this complication?

4. What is the tactics in providing first aid?

5. Why can’t I take painkillers?

Task number 5

A young woman complained of severe weakness, dizziness, nausea, moderate abdominal pain. The woman is very pale, the pulse is over 120 per minute, weak. The abdomen is moderately swollen, painful on palpation in all departments, with a sudden withdrawal of the hand from the abdomen, the pain increases sharply.

Solve the problem by answering the questions.

1. What disease should you think about?

2. What is the cause of this disease?

3. Is this disease dangerous?

4. What is the tactics of providing first aid?

5. Do you need urgent transportation of the patient to the hospital?

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