Encyclopedia of Family Medicine

Chapter 45 Prevention of Common Diseases (6)
2.Premature beating: Refers to cardiac beating caused by premature impulses from ectopic pacemakers, the most common.It can be seen in normal people and is often related to mental stress, overwork, excessive smoking, drinking, drinking strong tea or coffee, etc.It can also be seen in various heart diseases, electrolyte disorders, drug effects, cardiac catheterization, etc.

3.Paroxysmal tachycardia: Symptoms such as palpitations, chest tightness, and dizziness often occur during attacks.

4.Flutter and tremor: When the ectopic rhythm point sends out an impulse, the frequency exceeds that of paroxysmal tachycardia, forming flutter and tremor.

5.Atrioventricular block: more common in coronary heart disease, rheumatic heart disease, myocarditis, digitalis poisoning, etc. Grade I is mostly asymptomatic; Grade II can cause symptoms such as palpitations, dizziness, and chest tightness; mild grade III can cause no symptoms or feel dizziness, heart palpitations, breathlessness, etc., and severe cases can cause syncope and convulsions.

General care for cardiac arrhythmias includes:

1.Psychological Nursing: Some arrhythmias can cause chest tightness, palpitations, and general discomfort, and they are prone to recurring attacks. Therefore, patients often have anxiety, fear, irritability, etc., and lack confidence in treatment. Their concerns should be eliminated.

2.Rest: Patients with paroxysmal tachycardia and Ⅰ, Ⅱ, Ⅲ degree atrioventricular block bradycardia should absolutely rest in bed and keep the surrounding environment quiet.For those with mild arrhythmia, pay attention to work and rest.

3.Diet: avoid oversatisfaction, irritating drinks (such as coffee, strong tea), smoking, alcoholism, etc. can be induced, let the patient eat small meals frequently, choose light, digestible, low-fat, and nutritious foods, and those with cardiac insufficiency should Limit sodium intake.Encourage those taking diuretics to eat more potassium-rich foods, such as oranges, bananas, etc., to avoid hypokalemia and induce arrhythmia.

4.Condition observation: monitor pulse, heart rate, heart rhythm, blood pressure, etc., pay attention to whether the patient has symptoms such as chest tightness, palpitations, dyspnea, angina pectoris, etc.

5.After leaving the hospital, the patient was insisted on taking the medicine and regularly reviewed.Try to avoid triggering factors, maintain an optimistic mood, and arrange your life reasonably.

Viral myocarditis
Viral myocarditis is an inflammatory lesion of the myocardium caused by various viruses (such as coxsackie virus A, B, echo virus, polio virus, influenza and herpes virus, etc.).

Patients often first have fever, general fatigue, so-called "cold"-like symptoms, or nausea, vomiting and other gastrointestinal symptoms, and then palpitations, chest pain, dyspnea, edema, and even A-Story syndrome.Signs include tachycardia that is not parallel to the degree of fever, various arrhythmias, and third heart sounds or murmurs can be heard.Or jugular varicose veins, pulmonary crackles, hepatomegaly and other signs of heart failure.Cardiogenic shock may occur in severe cases.

The patient should rest in bed and supplement nutrition. The treatment is mainly for heart failure. Digitalis should be used with caution because it is easy to be poisoned. The prognosis of acute myocarditis is usually good.Most of them can be completely cured, but patients may get worse rapidly in a short period of time or even die when they are overworked or sleep deprived.

1.Emphasize that early rest is important.Rest can reduce the burden on the heart and is conducive to the recovery of heart function.Patients in the acute phase must rest in bed, and those without complications can rest in bed for 1 month.Those with heart failure should rest for 6 to 12 months until the symptoms disappear and the heart size returns to normal.

2.Closely monitor heart rate, heart rhythm, blood pressure, respiration and symptom changes.

3.The vast majority of patients with viral myocarditis can be cured.Chronic patients should be treated in time to prevent repeated viral infections.

Acute gastroenteritis
The disease is an acute gastrointestinal symptom caused by physical and chemical factors, microbial infections or bacterial toxins.

Clinically, the disease is mostly caused by infection or bacterial toxins, and the onset is rapid. It occurs within hours to 24 hours after eating contaminated food, manifested as upper abdominal pain and discomfort, nausea, vomiting, anorexia, etc. Mild tenderness in the abdomen and umbilical cord, hyperactive bowel sounds.

1.Psychological Nursing: The onset of the disease is sudden, with abdominal pain, vomiting, and even diarrhea. Patients often have irritability and fear when there is peripheral circulation failure such as blood pressure drop, cold limbs, and sweating. Therefore, patients should be appeased.

2.Those with frequent vomiting and high fever should stay in bed to reduce physical exertion and keep warm.Mild cases can be self-healed by fasting for 1-2 meals; for severe cases, temporarily fast for 1-2 days, and give sugar and salt water to supplement nutrition and water.When you can eat, give high-calorie liquid food, and stop all drugs and food that are irritating to the stomach, and then gradually change from porridge to soft rice, and finally return to normal diet.Patients with vomiting should adopt a lateral or semi-recumbent position to reduce the risk of suffocation caused by vomitus inhalation into the trachea.

3.Observe the condition, pay attention to observe the body temperature, pulse, respiration, blood pressure, vomit, and stool, and record their properties and quantities.

Chronic gastritis

Chronic gastritis refers to chronic gastric mucosal lesions caused by various etiologies. The etiology is not fully understood. Possible factors include the continuation of acute gastritis, reflux of duodenal fluid, immune factors, and infection factors.

The course of chronic gastritis is protracted, and most of them have no obvious symptoms. Some of them have symptoms of dyspepsia such as epigastric fullness and discomfort (especially after meals), irregular abdominal pain, acid regurgitation, belching, nausea and vomiting, etc., which are non-specific.Gastric body gastritis has fewer gastrointestinal symptoms, but obvious anorexia and weight loss may occur, which may be accompanied by anemia, multilineage iron deficiency anemia, and a few pernicious anemia.Gastrointestinal symptoms of gastric antrum gastritis are more obvious, especially bile reflux; or patients with gallbladder stones, sometimes similar to peptic ulcer, may have repeated small amounts of upper gastrointestinal bleeding, or even hematemesis. Caused by acute erosion.

1.Ensure the regularity of life, pay attention to the balance between work and rest, avoid going to bed late or getting up late or overworked, keep the spirit happy, and rest in bed when acute attack or symptoms are obvious.

2.Life care: Provide patients with a quiet and comfortable environment, arrange recreational activities reasonably, and make patients happy.Do not eat food that is too cold or too hot, which is easy to ferment and produce gas, and develop the habit of chewing slowly, so that food and saliva are fully mixed to help digestion.Those with low gastric acid can be given foods that stimulate the secretion of gastric juice, such as chicken soup, broth, etc. For those with high gastric acid, acidic, fatty, irritating and sugary foods should be avoided.

3.Condition observation: Observe the changes in symptoms such as abdominal pain and abdominal distension. If the symptoms cannot be relieved but aggravated, blood in the stool or weight loss occurs, inspections should be carried out in time.

4.Instruct patients to strengthen dietary hygiene and dietary management, develop regular dietary habits, and avoid alcohol and tobacco.

Peptic ulcer

Peptic ulcer mainly refers to chronic ulcers that occur in the stomach and duodenal bulb. These ulcers are related to the digestion of gastric acid and pepsin, so they are also called peptic ulcers.Because more than 95% are located in the stomach and duodenum, it is also called gastroduodenal ulcer.

The clinical features are: ① chronic process; ② periodic attacks.Outbreak is seasonal, often occurs in autumn and winter or the turn of winter and spring.Women often experience remission during pregnancy.Mental factors, eating disorders and taking drugs related to ulcers are also predisposing factors; ③ rhythmic pain.When there are complications, the periodicity and rhythm disappear, and some patients have no symptoms although they have ulcers.

Symptoms: Mainly epigastric pain, which can be dull pain, burning pain, distending pain or severe pain, or just hunger and discomfort.A typical case is mild or moderate persistent pain, limited to the size of a palm, located in the upper abdomen under the xiphoid process, which can be relieved by antacids or food.More than half of patients with duodenal ulcer have rhythmic pain, no pain in the morning on an empty stomach, pain begins 2-3 hours after breakfast, relieves after lunch, pain resumes at 3-4 o'clock in the afternoon, and relieves after dinner .Pain also can occur before sleeping or midnight, claims nocturnal pain.Waking up painfully in the middle of the night often indicates a duodenal ulcer, and the pain can be relieved by itself.

Rhythmic pain can also occur in gastric ulcer, but it appears earlier after a meal, about 1/2 to 1 hour after a meal, and disappears before the next meal. Midnight pain is rare; some patients only have stomach pain after eating, and the pyloric tube Especially noticeable with ulcers.Pyloric ulcer can cause pyloric obstruction due to mucosal edema or scar formation, manifested as upper abdominal fullness and discomfort after meals or nausea and vomiting.

Some patients do not have the above-mentioned typical pain, but present as irregular and vague pain, accompanied by upper abdominal fullness, loss of appetite, belching, acid reflux and other symptoms, which are generally called indigestion, and gastric ulcer is more common than duodenal ulcer.Dyspepsia is also common in patients without ulcer disease, called non-ulcer or functional dyspepsia.When the ulcer is located on the posterior wall and penetrates, it also presents as atypical abdominal pain. At this time, the pain is severe and radiates to the back.

2.Clinical manifestations of special types of ulcers: symptoms of retrobulbar ulcers, such as duodenal ulcers, are severe and persistent, common nocturnal pain, easy to bleed, and poor medical efficacy.The condition of pyloric ulcer generally develops quickly, and pain occurs soon after meals. The effect of antacids is poor, vomiting occurs frequently and early, and the curative effect of internal medicine is poor.

General care for peptic ulcers includes:

1.Rest: The environment should be comfortable and quiet, make the patient happy, and ensure adequate sleep and rest.For mild cases, the workload should be appropriately reduced, and treatment should be given at the same time. When the pain occurs during the active period, it should be completely rested for about 1 to 6 weeks.

2.Diet should master five principles:

(1) Eating regularly and eating small amounts frequently can not only reduce the burden on the stomach and avoid unfavorable factors, but also regularly keep food in the stomach, which can dilute gastric juice and neutralize gastric acid, which is conducive to ulcer healing.

(2) Chew more and avoid fast food.

(3) The food should be warm and soft, easy to digest, avoid eating too cold, hot or rough food, so as to reduce the physical stimulation to the ulcer.

(4) It is rich in nutrition and ensures calories. The diet should be mainly protein and fatty acids, and it is advisable to consume more milk.

(5) Avoid stimulating diet to reduce gastric acid secretion, such as alcohol, strong tea, coffee, chili, spices, vinegar, meat, fish soup and fried food.

3.Ulcers are more common in winter and spring. In the cold season, cotton pads or stomach protectors can be used to keep the upper abdomen warm.

4.Condition observation: closely observe the relationship between the time and nature of pain and diet.

Cirrhosis

Liver cirrhosis is diffuse liver damage caused by long-term or repeated effects of viral hepatitis, schistosomiasis, alcoholism, industrial poisons or drugs, cholestasis, intestinal infection or inflammation, metabolic disorders, nutritional disorders, and other unknown causes.

The onset and course of liver cirrhosis are mostly slow and insidious.Clinically, it is divided into liver function compensation period and liver function decompensation period.

Compensatory period: There may be fatigue, loss of appetite, nausea, upper abdominal discomfort, upper abdominal pain and diarrhea, etc., mostly intermittent, appearing due to fatigue or accompanying diseases, and relieved after rest or treatment.

The nutritional status of the patient is average, the liver is mildly enlarged, the texture is hard, no or mild tenderness, and the spleen is mild and moderately enlarged.Liver function test results were normal or slightly abnormal.

Decompensated stage: mainly two types of clinical manifestations caused by decreased liver function and portal hypertension, and may have systemic multi-system manifestations, with prominent and prominent symptoms.

1.Clinical manifestations of liver dysfunction:
(1) Systemic symptoms: general condition is poor, weight loss, fatigue, poor spirit, severe cases are weak and bedridden, dry skin, gray complexion, irregular low-grade fever, glossitis, angular stomatitis, night blindness, edema, etc.

(2) Gastrointestinal symptoms: anorexia or even anorexia, epigastric fullness and discomfort, nausea, vomiting, and greasy disgust.

(3) Bleeding tendency and anemia: Epistaxis, gingival bleeding, skin purpura, and gastrointestinal mucosal erosion and bleeding are often present.

(4) Endocrine disorders: the inactivation of estrogen, aldosterone and antidiuretic hormone by the liver is weakened, resulting in their accumulation in the body and the reduction of androgens, which may include loss of libido, testicular atrophy, hair loss and breast development in men; women have menstruation Disorders, amenorrhea, infertility, etc.The patient's face, neck, chest, back and upper extremities appeared spider nevus and telangiectasia, and erythema (liver palm) at the end of the fingers. If the liver function damage is serious, the number of spider nevus will increase and decrease, and vice versa.

Increased vasopressin from aldosterone can cause decreased urine output and edema, involvement of the adrenal cortex, and hyperpigmentation in exposed areas of the body in some patients.

2.Clinical manifestations of portal hypertension:
(1) Splenomegaly: Enlarged due to congestion, most of which are mild to moderate, and some may extend below the navel, and may temporarily shrink when upper gastrointestinal bleeding occurs. When perisplenitis occurs, there may be dull pain or distending pain in the left upper abdomen.Late hypersplenism.

(2) Establishment and opening of collateral circulation: clinically there may be massive bleeding due to rupture of esophageal and gastric varices, and symptoms such as hematemesis, blood in stool, melena and shock, abdominal wall and periumbilical varicose veins; hemorrhoid formation, rupture can cause blood in stool .

(3) Ascites: It is the most prominent clinical manifestation of liver cirrhosis.

Liver palpation: generally large first and then small, hard texture, smooth surface in early stage, nodular or granular in late stage.

Complications of cirrhosis include upper gastrointestinal bleeding, infection, hepatic coma, primary liver cancer, functional kidney failure (hepatorenal syndrome), and disturbances in electrolyte and acid-base balance.

General care for cirrhosis includes:

1.Rest: During the liver function compensation period, in order to reduce the metabolic burden of the liver and improve the blood circulation of the liver, activities should be reduced to avoid fatigue, but light work or half-day work can be performed.In the decompensated period, the patient should rest in bed. The hepatic blood flow increases in the supine position than in the upright position, which is conducive to the recovery of liver cells.To live a regular life, get enough sleep.

2.Diet: High calorie, high protein, high vitamin, and moderate fat should be the principle.The food should be fresh and delicious, soft and easy to digest, non-irritating, and eat small meals frequently, and strictly prohibit alcohol.In the event of hepatic coma or increased blood ammonia, protein intake should be reduced.Cereals, beans, fresh vegetables, fruits, meat, eggs, and milk are rich in B vitamins and vitamins C, D, E, A, and K should account for a certain proportion in the diet.

3.Others: Patients with liver cirrhosis have low resistance and many concurrent infections, especially those with edema should pay attention to the prevention of bedsores, and actively prevent and treat oral, respiratory, urinary tract or intestinal infections.

People with ascites should not eat high-sodium diets such as bacon, kimchi, soy sauce, and sodium-containing monosodium glutamate. Eggs and milk have moderate sodium content, while fruits and vegetables are low in sodium. Bananas, oranges, tomatoes, and apples are rich in potassium and can be Choose as appropriate, pay attention to oral and skin cleanliness, prevent colds, prevent infection, regular review, and timely medical treatment if the condition changes.

Acute glomerulonephritis
Acute glomerulonephritis, referred to as acute nephritis, is more common after streptococcal infection, and can also be caused by other infections such as staphylococcus, pneumococcus, typhoid bacillus, diphtheria bacillus, virus, and plasmodium.

The onset is 1 to 3 weeks after the prodromal infection, and the onset is relatively rapid, showing the following manifestations of acute nephritic syndrome:
1.Gross hematuria: occurs in about 40%, often as the first manifestation.It is like meat washing water or soy sauce (acid urine), which can disappear within a few days.

2. Less urine.

3.Edema: It is often the first manifestation of the disease, manifested as edema of the eyelids in the morning, showing the appearance of nephritis, and can spread throughout the body in severe cases.

4.Hypertension: mostly transient, moderately elevated, occasionally severe hypertension with retinal hemorrhage, exudation, papilledema, and even hypertensive encephalopathy.

Both high blood pressure and edema were relieved with more urine output.

5.Systemic manifestations: often fatigue, anorexia, nausea, vomiting, dull pain in the waist and headache.

Chronic glomerulonephritis
Chronic nephritis, referred to as chronic nephritis, is a long course of disease (one to several decades) caused by a variety of primary glomerular diseases, with proteinuria, hematuria, edema, and hypertension as clinical manifestations.

Patients showed varying degrees of edema, hypertension, non-selective proteinuria, dysmorphic erythrocytes, and renal dysfunction.

According to the characteristics of clinical manifestations, it can be divided into the following four types:
1.Ordinary type: moderate proteinuria (+~++, 1~3g/d) and mild microscopic hematuria, mild edema, moderately increased blood pressure, a certain degree of renal dysfunction with increased urine output and increased nocturia.

2.Nephrotic type: the primary nephrotic syndrome type Ⅱ.

3.Hypertensive type: It has the general manifestations of the ordinary type, but is characterized by a sustained increase in blood pressure (especially diastolic blood pressure) to a moderate or higher level, and renal function further deteriorates due to renal vasospasm.

4.Acute-onset type: The patient develops aggravation of nephritic syndrome within a few days after infection or exertion, often accompanied by abrupt deterioration of renal function.

Nephrotic syndrome

A syndrome characterized by massive proteinuria, high edema, hypoalbuminemia, and hypercholesterolemia.

It usually occurs after infection (tonsillitis, pharyngitis, or general upper respiratory tract infection), or after cold or exertion.The onset process can be acute or slow, and there are also insidious onset.Systemic, orthostatic, pitting edema, with varying degrees of severity, severe pleural effusion, or even mediastinal edema, often accompanied by oliguria, and may have varying degrees of hypertension or circulating blood volume depletion: body position hypotension, low pulse pressure, weak pulse, thirst, etc.

The clinical course can be alleviated naturally or through treatment, but it is prone to repeated attacks and exacerbations.

Pyelonephritis
Infectious inflammation of the renal pelvis and calices mucosa, renal tubules, and renal interstitium caused by bacteria (very few can be caused by fungi, protozoa, and viruses) through ascending infection, blood infection, lymphatic infection, and direct infection.Infection is prone to occur under the influence of the following adverse factors:

1.Poor urinary tract flow: such as urinary tract stones, tumors, enlarged prostate, bladder neck obstruction, urethral stricture, phimosis, etc.

2.Urinary tract malformations or functional defects: such as renal hypoplasia, polycystic kidney disease, medullary cystic disease, iron-hoofed kidney, etc.

3.The body's resistance is reduced.

4.Other factors: such as inflammatory lesions in the urethra or near the urethral opening, catheterization and urinary tract device examination.

The clinical manifestations of pyelonephritis are:

1.Clinical manifestations of acute pyelonephritis: Depending on the degree of inflammation, the clinical symptoms are quite different and can be divided into three aspects:
(1) Systemic manifestations: the onset is usually abrupt, with chills or chills, fever (body temperature above 39°C), general malaise, headache, fatigue, loss of appetite, and sometimes nausea and vomiting. Symptoms are similar to those of a cold.Mild patients may have little or no systemic manifestations.

(2) Urinary system symptoms: At the same time or later when systemic symptoms appear, most patients have low back pain or discomfort in the kidney area.Physical examination showed tenderness at upper ureteral point or rib lumbar point, and percussion pain in kidney area was positive.Patients often have urinary tract irritation such as frequent urination, urgency, painful urination, and tenderness in the bladder area.

(3) Urinary changes: There are obvious abnormalities in urine tests.

Acute pyelonephritis usually resolves spontaneously after a few days, but bacteriuria often continues to be positive, and it is easy to recur in the future.

2.Clinical manifestations of chronic pyelonephritis: Similar to the acute phase, there are also systemic manifestations, urinary system symptoms, and urinary changes.Some clinical manifestations are occult, without urinary symptoms or only occasionally have low-grade fever, fatigue and other general manifestations, but the urine bacterial culture (repeated 2-3 times) is all positive, and they are of the same strain, which is called "asymptomatic bacteriuria" .

(End of this chapter)