THE MAIN METHODS THE MAIN METHODS OF DIAGNOSISOF DIAGNOSISIN THE CLINIC IN THE CLINIC OF INTERNAL OF INTERNAL

DISEASESDISEASES

Bakalets Olena Valeriivna

PLANPLAN1. 1. The notion of "functional diagnosis“The notion of "functional diagnosis“2. 2. Classification of methods of functional Classification of methods of functional

diagnosticsdiagnostics3. 3. Methods of functional diagnostics in Methods of functional diagnostics in

pulmonologypulmonology 33.1..1. Studies function of external respiration Studies function of external respiration 33.2. .2. Studies of gas exchange functionStudies of gas exchange function 4. Methods of functional diagnostics in 4. Methods of functional diagnostics in

gastroenterologygastroenterology 4.1. 4.1. Studies of secretory functionStudies of secretory function 4.2. 4.2. Studies of motor function Studies of motor function 5. 5. Combined methods of functional diagnosticsCombined methods of functional diagnostics

DDiagnosticiagnosticssfrom the Greek - diagnosis

= διαγνώσις = «cognition»

is in Ukrainian diagnostics;

is in German Diagnostik;

is in French le diagnostic 

Functional diagnosticsFunctional diagnostics  —  —

is a complex analytical and is a complex analytical and methodological approaches methodological approaches

to the definition and to the definition and evaluation of the functional evaluation of the functional state of organs and body state of organs and body

systems.systems.

the methods (means)the methods (means)of diagnosticsof diagnostics – –

of structural diagnostics

(X-ray,(X-ray, ultrasound, ultrasound, and others.)and others.)

of functional diagnostics

(ECG, (ECG, pphonocardiography, honocardiography,

spirometry et al.)spirometry et al.)

The The functional diagnosticsfunctional diagnostics –– is based on the measurementis based on the measurement of of ::

physical parameters

(speed, volume, pressure, (speed, volume, pressure, electric potential, etc.). electric potential, etc.).

Chemicals parameters

(рН, (рН, gas composition, gas composition, etc.).etc.).

The functional diagnosticsThe functional diagnostics Determination of functional reservesDetermination of functional reserves Determining the type and degree of Determining the type and degree of

functional disordersfunctional disorders Monitoring of the rate of disease Monitoring of the rate of disease

progressionprogression Evaluating the effectiveness of a course Evaluating the effectiveness of a course

of treatmentof treatment Differential diagnosisDifferential diagnosis Expert evaluation disability, military, Expert evaluation disability, military,

sports, etc.sports, etc.

Objective

CardiovascularCardiovascularsystemsystem

RespiratoryRespiratorysystemsystem

DigestiveDigestivesystemsystem

Musculo-Musculo-skeletalskeletalsystemsystem

EndocrineEndocrinesystemsystem

UrinaryUrinary systemsystem

The functional diagnostics

NervousNervoussystemsystem SensorySensory

systemsystem

ReproductiveReproductive

Methods Methods of functional of functional diagnostics diagnostics

in pulmonologyin pulmonology

Spirography from the Latin spiro - to breathe, from the Greek grapho - to write, to depict

method of graphic registration method of graphic registration

of changes of lung volumes during performance of changes of lung volumes during performance of natural respiratory movements of natural respiratory movements

and volitional forced respiratory maneuvers.and volitional forced respiratory maneuvers.

The aims of monitoring PEFThe aims of monitoring PEF::

treatment planning of obstructive pulmonary treatment planning of obstructive pulmonary diseasedisease

evaluation of the effectiveness of treatment evaluation of the effectiveness of treatment with bronchodilators and inhaled steroidswith bronchodilators and inhaled steroids

predicting predicting thethe asthma exacerbations asthma exacerbations determining the reversibility of bronchial determining the reversibility of bronchial

obstructionobstruction determining the professional asthmadetermining the professional asthma identification of mechanisms that provoke identification of mechanisms that provoke

bronchospasmbronchospasm

Indications for the spirography

Determining the type and degree of Determining the type and degree of pulmonary insufficiencypulmonary insufficiency

Monitoring of lung ventilation indexesMonitoring of lung ventilation indexes to to determine the extent and rate of disease determine the extent and rate of disease progressionprogression

Evaluating the effectiveness of a treatment Evaluating the effectiveness of a treatment course of bronchial obstruction with course of bronchial obstruction with bronchodilatorsbronchodilators ( (β2-agonist short and long-β2-agonist short and long-acting, anticholinergic, inhaled acting, anticholinergic, inhaled corticosteroids and membrane stabilizerscorticosteroids and membrane stabilizers))

Indications for the spirography

Detecting early signs of ventilatory failure in Detecting early signs of ventilatory failure in patients prone to develop lung diseasespatients prone to develop lung diseases or or persons working in conditions of influence persons working in conditions of influence harmful factors.harmful factors.

Examination working capacity and military Examination working capacity and military expertise - based pulmonary ventilation expertise - based pulmonary ventilation function in conjunction with clinical function in conjunction with clinical parametersparameters..

For differential diagnosisFor differential diagnosis between between pulmonary and cardiac failure in pulmonary and cardiac failure in combination with other research methodscombination with other research methods..

Indications for the spirography Reversibility Reversibility testingtesting with a beta2-adrenergic with a beta2-adrenergic

bronchodilatorbronchodilator Conducting inhalation provocation tests for Conducting inhalation provocation tests for

the detection of bronchial hyperreactivitythe detection of bronchial hyperreactivity ((methacholinemethacholine, , histaminehistamine, , hyperventilationhyperventilation, , exercise testing)exercise testing)

Contraindication for the spirography

severe general condition of the patientsevere general condition of the patient severe pulmonary insufficiency, which does severe pulmonary insufficiency, which does

not allow making breathing maneuversnot allow making breathing maneuvers progressive angina progressive angina myocardial myocardial infarctioninfarction malignant hypertension, hypertensive crisismalignant hypertension, hypertensive crisis circulatory failure IIB and III stagecirculatory failure IIB and III stage acute cerebrovascular accidentacute cerebrovascular accident toxaemia of pregnancytoxaemia of pregnancy the second half of pregnancythe second half of pregnancy

Spirogram

a tracing or graph of respiratory movements a tracing or graph of respiratory movements

Static indicatorsStatic indicators

Dynamics of Dynamics of Respiratory Minute VolumeRespiratory Minute Volume

depending on the activity of humandepending on the activity of human

RMVRMV==TVTVххBRBR

Dynamic indicatorsDynamic indicators

Dynamic indicatorsDynamic indicators

Characteristic changes in lung functionCharacteristic changes in lung functionN – norm; R – at rest; L – at load.↓ - decrease↑ - increase

* DACO– diffusion ability of lungs characterizes the gas exchange through the alveolar-capillary membrane and is defined as the rate of transfer of substances through the membrane when gradient partial pressure of the gas on the membrane is 1 mm Hg

Algorithm of spirogram analysisAlgorithm of spirogram analysis

Bronchodilator Reversibility TestingBronchodilator Reversibility Testing

PneumotachoPneumotachographygraphy

is research method function of external is research method function of external respiration, which is a graphical respiration, which is a graphical registration of airflow speed registration of airflow speed (Curve "flow (Curve "flow - volume")- volume") during quiet breathing patientduring quiet breathing patient and during the performance of certain and during the performance of certain breathing maneuversbreathing maneuvers..

According to the recommendationsAccording to the recommendationsEuropean Respiratory SocietyEuropean Respiratory Society

(ERS) (ERS)

andand

American Thoracic SocietyAmerican Thoracic Society

(АТS) (АТS)

calculations of spirometric indices are calculations of spirometric indices are carried out according to the values that carried out according to the values that depend on the anthropometricdepend on the anthropometric::

on the on the heightheight, gender and age, gender and age

The normal curve of ratio volume to airflow speed The normal curve of ratio volume to airflow speed during max. inspiration and expirationduring max. inspiration and expiration::

The Changes of Curve "flow - volume"The Changes of Curve "flow - volume"::

Peak flow metryPeak flow metry

is method of monitoring is method of monitoring

peak expiratory flow (PEF), peak expiratory flow (PEF),

which measured in liters per 1 sec.which measured in liters per 1 sec.

TheThe technique technique ofof Peak flow metryPeak flow metry

1st stage1st stage

Take pikfloumetr the hand so that the finger doTake pikfloumetr the hand so that the finger do not blocked the slit where the is moving arrow.not blocked the slit where the is moving arrow.Arrow must be led out on the beginning of the scaleArrow must be led out on the beginning of the scale..

2nd stage2nd stage

At the beginning of testing to breathe calmly At the beginning of testing to breathe calmly and evenly.and evenly.Then make the maximal deep Then make the maximal deep inspirationinspiration..

TheThe technique of technique of Peak flow metryPeak flow metry

3 stage3 stage

Need to keep pеак floNeed to keep pеак floww met meteer horizontally. To take r horizontally. To take mouthpiece of appliance in the mouth tightly clasp mouthpiece of appliance in the mouth tightly clasp the its his lips and quickly to exhale air in device the its his lips and quickly to exhale air in device without blocking the hole mouthpiece by tongue.without blocking the hole mouthpiece by tongue.

TheThe technique of technique of Peak flow metryPeak flow metry

The 4 StageThe 4 Stage

DetermineDetermine the result – the result – a number, a number, on which on which indicates indicates the Arrow the Arrow

device.device.

Indices of PEF is recorded on a scale of deviceIndices of PEF is recorded on a scale of device

TheThe technique of technique of Peak flow metryPeak flow metry

5 stage5 stage

Highest of the 3 measurements is fixed Highest of the 3 measurements is fixed and written in diaryand written in diary

TheThe technique of technique of Peak flow metryPeak flow metry

Every morning, before taking medications, Every morning, before taking medications, Repeat this in evening andRepeat this in evening and

it should be noted best indicator init should be noted best indicator in column column to record best indicator in column to record best indicator in column

““ММ““ – – Morning Morning ‘‘ЕЕ' ' - Е- Еveningvening

TheThe technique of technique of Peak flow metryPeak flow metry

Evaluation of PEFEvaluation of PEF

Pulse oximetryPulse oximetry -- a method of monitoring the oxyhemoglobin a method of monitoring the oxyhemoglobin

percentage.percentage.

CapnometryCapnometry - this measurement and this measurement and digital digital reflection of reflection of

concentration or partial pressure of carbon concentration or partial pressure of carbon dioxide in inhaled and exhaled gas during the dioxide in inhaled and exhaled gas during the patient's respiratory cycle.patient's respiratory cycle.

CapnographyCapnography - this measurement and this measurement and graphicalgraphical reflection of reflection of

concentration or partial pressure of carbon concentration or partial pressure of carbon dioxide in inhaled and exhaled gas during the dioxide in inhaled and exhaled gas during the patient's respiratory cycle.patient's respiratory cycle.

Thank Thank you!you!