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Bauchschmerzen: Fachinternistischer Zugang/Differenzialdiagnostik 腹痛：专家内部介入/鉴别诊断
DoctorConsult - The Journal. Wissen für Klinik und Praxis Pub Date : 2011-04-01 Epub Date: 2011-03-23 DOI: 10.1016/j.dcjwkp.2011.03.002
Wolfram Domschke
{"title":"Bauchschmerzen: Fachinternistischer Zugang/Differenzialdiagnostik","authors":"Wolfram Domschke","doi":"10.1016/j.dcjwkp.2011.03.002","DOIUrl":"https://doi.org/10.1016/j.dcjwkp.2011.03.002","url":null,"abstract":"<div><p>This article presents differential diagnoses for abdominal pain in table form, according to the location of clinically relevant pain: right upper abdomen, epigastrium, left upper abdomen, central abdomen, right lower abdomen, central lower abdomen, left lower abdomen, flanks or the entire abdomen, including also the abdominal wall and the thorax, as abdominal pain can also radiate to these regions. Differential diagnoses, additional signs and symptoms and tests for confirming the diagnosis are specified for each pain location. We also distinguish between acute, subacute and chronic pain and, where relevant, between abdominal pain with and without abdominal tenderness.</p></div>","PeriodicalId":100380,"journal":{"name":"DoctorConsult - The Journal. Wissen für Klinik und Praxis","volume":"2 1","pages":"Pages 7-21"},"PeriodicalIF":0.0,"publicationDate":"2011-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.dcjwkp.2011.03.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72283240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Interpretation erhöhter Leberwerte 肝脏价值升高的解释
DoctorConsult - The Journal. Wissen für Klinik und Praxis Pub Date : 2011-04-01 Epub Date: 2011-03-23 DOI: 10.1016/j.dcjwkp.2011.03.004
Henryk Dancygier
{"title":"Interpretation erhöhter Leberwerte","authors":"Henryk Dancygier","doi":"10.1016/j.dcjwkp.2011.03.004","DOIUrl":"https://doi.org/10.1016/j.dcjwkp.2011.03.004","url":null,"abstract":"<div><p>Nowadays an abundance of fast and easily determinable biochemical parameters are available for the diagnostic investigation of hepatic diseases. In order to find a diagnosis with reasonable expenditure, the doctor needs to make a rational selection. The correct interpretation of altered biochemical parameters requires exact knowledge of the liver's structure and function, and can only be made together with thorough anamnesis<span> and physical examination. In this article the enzymological differential diagnosis of hepatic diseases will be discussed. In addition, the diagnostic relevance of a variety of autoantibodies in the serum in hepatobiliary diseases will briefly be mentioned.</span></p></div>","PeriodicalId":100380,"journal":{"name":"DoctorConsult - The Journal. Wissen für Klinik und Praxis","volume":"2 1","pages":"Pages 27-35"},"PeriodicalIF":0.0,"publicationDate":"2011-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.dcjwkp.2011.03.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72283243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Laparoskopische Aortenchirurgie 腹腔镜主动脉手术
DoctorConsult - The Journal. Wissen für Klinik und Praxis Pub Date : 2011-04-01 Epub Date: 2011-03-23 DOI: 10.1016/j.dcjwkp.2011.03.010
Ingo Flessenkämper
{"title":"Laparoskopische Aortenchirurgie","authors":"Ingo Flessenkämper","doi":"10.1016/j.dcjwkp.2011.03.010","DOIUrl":"https://doi.org/10.1016/j.dcjwkp.2011.03.010","url":null,"abstract":"<div><p>Outside Germany, laparoscopic techniques are more commonly used in aortic surgery<span><span> than in Germany, but some German centres have now adopted this technique as well. Particularly in high qualified centres laparoscopic surgery offers additional options in </span>treatment of aortic pathologies. This sophisticated technique is very advantageous for a strictly defined group of patients. Indications, preparations and complications of laparoscopy correspond to those of open aortic surgery. Extensive calcifications are considered as contraindications. An evaluation of calcifications is done by CT-scan. The correct positioning of the patient is vital for the success of the operation. Compared to open surgery patients recover faster after laparoscopy.</span></p></div>","PeriodicalId":100380,"journal":{"name":"DoctorConsult - The Journal. Wissen für Klinik und Praxis","volume":"2 1","pages":"Pages 63-67"},"PeriodicalIF":0.0,"publicationDate":"2011-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.dcjwkp.2011.03.010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136557047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Interpretation erhöhter Leberwerte 乐谱增加指数
DoctorConsult - The Journal. Wissen für Klinik und Praxis Pub Date : 2011-04-01 DOI: 10.1016/J.DCJWKP.2011.03.004
H. Dancygier
{"title":"Interpretation erhöhter Leberwerte","authors":"H. Dancygier","doi":"10.1016/J.DCJWKP.2011.03.004","DOIUrl":"https://doi.org/10.1016/J.DCJWKP.2011.03.004","url":null,"abstract":"","PeriodicalId":100380,"journal":{"name":"DoctorConsult - The Journal. Wissen für Klinik und Praxis","volume":"63 1","pages":"27-35"},"PeriodicalIF":0.0,"publicationDate":"2011-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86076873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Therapie des zirrhotischen Aszites 脊椎动物治疗
DoctorConsult - The Journal. Wissen für Klinik und Praxis Pub Date : 2011-04-01 Epub Date: 2011-03-23 DOI: 10.1016/j.dcjwkp.2011.03.011
Henryk Dancygier
{"title":"Therapie des zirrhotischen Aszites","authors":"Henryk Dancygier","doi":"10.1016/j.dcjwkp.2011.03.011","DOIUrl":"https://doi.org/10.1016/j.dcjwkp.2011.03.011","url":null,"abstract":"<div><p>The development of ascites in the course of liver cirrhosis is very important for its prognosis and associated with a mortality of more than 50% 2 to 5<!--> <!-->years after the first episode of ascites occurred. The increase of creatinine concentration in the serum to<!--> <!-->&gt;<!--> <!-->1.5<!--> <!-->mg/dl is accompanied by a mortality of up to 80% within 6 to 12 months. Depending on whether the ascites can be washed out by salt restriction and treatment with diuretics alone or not, a distinction is made between uncomplicated and complicated ascites. Ascites treatment is a step-by-step therapy and starts with bedrest, salt and fluid restriction. In addition, aldosterone antagonists and loop diuretics may be applied. In therapy-refractory ascites paracentesis or transjugular intrahepatic portosystemic shunt (TIPS) may be administered. Therapy-refractory ascites occurs in 5-10% of patients. Its prognosis is very severe with a 1-year survival rate of<!--> <!-->&lt;<!--> <!-->50%.</p></div>","PeriodicalId":100380,"journal":{"name":"DoctorConsult - The Journal. Wissen für Klinik und Praxis","volume":"2 1","pages":"Pages 69-73"},"PeriodicalIF":0.0,"publicationDate":"2011-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.dcjwkp.2011.03.011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136557048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Akute Pankreatitis 急性Pankreatitis
DoctorConsult - The Journal. Wissen für Klinik und Praxis Pub Date : 2011-04-01 Epub Date: 2011-03-24 DOI: 10.1016/j.dcjwkp.2011.03.009
Peter Layer, Jutta Keller, Matthias Kahl, Ulrich Rosien
{"title":"Akute Pankreatitis","authors":"Peter Layer,&nbsp;Jutta Keller,&nbsp;Matthias Kahl,&nbsp;Ulrich Rosien","doi":"10.1016/j.dcjwkp.2011.03.009","DOIUrl":"https://doi.org/10.1016/j.dcjwkp.2011.03.009","url":null,"abstract":"<div><p>Manifestation of acute pancreatitis can range from a mild interstitial up to a life-threatening inflammation with necrosis inside and outside the pancreas and multiple organ failure.</p><p>Severe upper abdominal pain – often more pronounced on the left side with radiation to the shoulder and the back in a belt-like fashion – is a cardinal symptom, which – in combination with increased activity of pancreatic enzymes in the serum ≥<!--> <!-->3 times the upper limit of normal – leads to the diagnosis. So far, there is no specific therapy for acute pancreatitis. Treatment mainly consists of basic management, including problem-oriented measures to prevent or treat complications. Typical complications of acute pancreatitis include shock and electrolyte disorders, pleuropulmonary complications, diabetes mellitus, coagulation disorders, pseudocysts and infections. In biliary pancreatitis with concrements ERCP to remove stones should be the initial treatment. During follow-up, it is essential to identify and treat the causes of the pancreatitis.</p></div>","PeriodicalId":100380,"journal":{"name":"DoctorConsult - The Journal. Wissen für Klinik und Praxis","volume":"2 1","pages":"Pages 57-61"},"PeriodicalIF":0.0,"publicationDate":"2011-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.dcjwkp.2011.03.009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136557046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Morbus Crohn 克罗恩病
DoctorConsult - The Journal. Wissen für Klinik und Praxis Pub Date : 2011-04-01 Epub Date: 2011-03-23 DOI: 10.1016/j.dcjwkp.2011.03.006
Ulrike Melle , Ulrich Rosien , Peter Layer , Volker Groß
{"title":"Morbus Crohn","authors":"Ulrike Melle ,&nbsp;Ulrich Rosien ,&nbsp;Peter Layer ,&nbsp;Volker Groß","doi":"10.1016/j.dcjwkp.2011.03.006","DOIUrl":"https://doi.org/10.1016/j.dcjwkp.2011.03.006","url":null,"abstract":"<div><p>Crohn's disease is a chronic inflammatory disease of the gastrointestinal tract which is characterized by the cardinal symptoms of abdominal pain and diarrhea. Furthermore, fever, weight loss, bleeding, symptoms of malnutrition and abnormal gastrointestinal motility as well as fistulae, fissures, ulcerations and abscesses can occur. Extraintestinal symptoms and associated diseases include arthritis, aphthous stomatitis, erythema nodosum, pyoderma gangraenosum and primary sclerosing cholangitis. The diagnosis is based on ileocolonoscopy, esophagogastroduodenoscopy as well as one or several procedures for examining the small intestine; stool cultures and a blood picture are also required. CT and MRT are used in case of endoscopically impassable colon stenoses and for the examination of the small intestine. The disease activity can be determined based on clinical and laboratory parameters; the most commonly used index is the Crohn's Disease Activity Index. Conservative therapy options include budesonide, prednisone, salazosulfapyridine, 5-ASA, ciprofloxacine and metronidazole. Long-lasting immunosuppressive therapy with azathioprine, 6-mercaptopurine or infliximab is indicated in steroid-refractory disease. Surgery can be carried out in case of isolated symptomatic affection of the ileocecal region; otherwise, a surgical intervention is only indicated for complications, severe exacerbations with sepsis or treatment refractoriness. Potential complications include intestinal stenoses, perforation, fistulae, abscesses, toxic megacolon, hemorrhage, thromboembolic complications, osteoporosis, CMV superinfection, amyloidosis, colon carcinoma, secondary amenorrhea or – in children and adolescents – developmental disorders.</p></div>","PeriodicalId":100380,"journal":{"name":"DoctorConsult - The Journal. Wissen für Klinik und Praxis","volume":"2 1","pages":"Pages 37-41"},"PeriodicalIF":0.0,"publicationDate":"2011-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.dcjwkp.2011.03.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72283244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Bauchschmerzen in der hausärztlichen Praxis 糟了
DoctorConsult - The Journal. Wissen für Klinik und Praxis Pub Date : 2011-04-01 Epub Date: 2011-03-23 DOI: 10.1016/j.dcjwkp.2011.03.001
Anne Breetholt , Jörg Schelling
{"title":"Bauchschmerzen in der hausärztlichen Praxis","authors":"Anne Breetholt ,&nbsp;Jörg Schelling","doi":"10.1016/j.dcjwkp.2011.03.001","DOIUrl":"10.1016/j.dcjwkp.2011.03.001","url":null,"abstract":"<div><p>This article focuses on the special situation of the general practitioner, starting with the ’red flags’ which require immediate action, such as a sudden onset of pain, signs of shock<span> and compliance problems. With regard to the conditions in a GP's practice, the article describes palpation and auscultation<span> of the abdomen, emergency blood tests and sonography on which the initial diagnosis is based. Relevant differential diagnoses are specified, with special focus on diagnoses requiring referral to a clinic. The article also provides a list of practical measures that can be taken until the ambulance arrives and critically analyzes therapeutic possibilities and constraints in a GP's practice.</span></span></p></div>","PeriodicalId":100380,"journal":{"name":"DoctorConsult - The Journal. Wissen für Klinik und Praxis","volume":"2 1","pages":"Pages 3-5"},"PeriodicalIF":0.0,"publicationDate":"2011-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.dcjwkp.2011.03.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77509559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Bauchschmerzen: Chirurgischer Zugang/Akutes Abdomen 腹痛：手术入路/急腹症
DoctorConsult - The Journal. Wissen für Klinik und Praxis Pub Date : 2011-04-01 Epub Date: 2011-03-24 DOI: 10.1016/j.dcjwkp.2011.03.003
Kia Homayounfar
{"title":"Bauchschmerzen: Chirurgischer Zugang/Akutes Abdomen","authors":"Kia Homayounfar","doi":"10.1016/j.dcjwkp.2011.03.003","DOIUrl":"https://doi.org/10.1016/j.dcjwkp.2011.03.003","url":null,"abstract":"<div><p>Appropriate disease management of acute abdominal pain is essential. The main causes of death are hypocolemic or septic shock. Therefore, it is vital to establish a differential diagnosis on the basis of the history, the physical examination, specific tests and laboratory medicine. The principal therapeutic measures are emergency laparotomy if neccessary after initial cardiocirculatory stabilization on an intensive care unit. This article specifies the important symptom complexes for different clinical manifestations of acute abdominal pain, including differential diagnoses and implications for the treatment: traumatic acute abdominal pain, hypovolemic shock due to bleeding, diffuse peritonitis and localized peritonitis.</p></div>","PeriodicalId":100380,"journal":{"name":"DoctorConsult - The Journal. Wissen für Klinik und Praxis","volume":"2 1","pages":"Pages 23-25"},"PeriodicalIF":0.0,"publicationDate":"2011-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.dcjwkp.2011.03.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72283239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Akute Verschlüsse der Viszeralgefäße 急性性血管缝合
DoctorConsult - The Journal. Wissen für Klinik und Praxis Pub Date : 2011-04-01 Epub Date: 2011-03-24 DOI: 10.1016/j.dcjwkp.2011.03.008
Helmut Kogel
{"title":"Akute Verschlüsse der Viszeralgefäße","authors":"Helmut Kogel","doi":"10.1016/j.dcjwkp.2011.03.008","DOIUrl":"10.1016/j.dcjwkp.2011.03.008","url":null,"abstract":"<div><p>Acute occlusions of the visceral vessels are rare findings but most often occur in visceral arteries due to thromboembolism in patients with atrial fibrillation. Symptoms can range from abdominal discomfort, increased transaminases, gastrointestinal bleeding to segmental splenic infarctions. Massive thrombosis of the hepatic arteries has often a grim prognosis. Occlusion of the mesenteric artery leads to an ischemic syndrome with abdominal pain and leukocytosis often associated with a history of heart disease. After a silent period (7-12<!--> <!-->h), aggravating shock symptoms, peritonitis and paralytic ileus develop. Often segmental embolisation can result in later intestinal stenosis. Emboli can develop in aneurysms, in patients with arteritis and after an accident. A non-occlusion disease can occur due to functional or angiospastic ischemias which can be induced by several drugs (ergotism, digitalis, catecholamines), heart insufficiency or during shock. Only angiographic imaging, e.g. angio-CT or DSA can prove visceral vessel occlusions in the early phase. Treatment can be done by catheter lysis or surgical in more severe cases. Embolectomy with a Fogarty catheter is sometimes possible in case of embolic occlusion, infarcted areas need to be resected.</p></div>","PeriodicalId":100380,"journal":{"name":"DoctorConsult - The Journal. Wissen für Klinik und Praxis","volume":"2 1","pages":"Pages 49-56"},"PeriodicalIF":0.0,"publicationDate":"2011-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.dcjwkp.2011.03.008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75468204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
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