Vinnytsya National Pirogov Memorial Medical University The Department of Children Infectious Diseases icon

Vinnytsya National Pirogov Memorial Medical University The Department of Children Infectious Diseases




НазваVinnytsya National Pirogov Memorial Medical University The Department of Children Infectious Diseases
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Vinnytsya National Pirogov Memorial Medical University

The Department of Children Infectious Diseases


Approved”

at sub-faculty meeting


“__”_____2012,

protocol №_____


Head of the Department

prof. _______I.I. Nezgoda


Study Guide for Practical Work for Students


Topic: “The differential diagnostics of acute viral hepatitis (A, B, C, D, E)”




Course VI

English-speaking Students

Medical Faculty

Duration of the class-6,6 hours.


Composed by assoc. prof., phD O.S. Onofriychuk


Vinnitsa



I. The theme urgency


Viral hepatitis is the most widespread infectious diseases of child's age. The hepatitis A virus (HAV) is the commonest cause of viral hepatitis, responsible for up to 40% of cases worldwide. It is spread by contaminated food. Vaccines are available against hepatitis A.

Hepatitis B, or serum hepatitis, is a highly contagious disease spread by blood products or in body fluids. It often culminates in liver failure, and is also associated with liver cancer, although only 10% of those infected suffer chronic liver damage. Hepatitis C is mostly seen in people in need frequent transfusions, 75% of infected with hepatitis C will go on to develop chronic liver infections. Vaccines are available against hepatitis B.


ІІ. Primary aims of the study

Students must know:

  1. Etiology and properties of causing factors of illness

  2. Epidemiology (source of infection, ways of transmission, age-old receptivity and morbidity).

  3. Pathogenesis of disease, pathomorphologic changes in the staggered organs.

  4. Classification of the illness.

  5. Clinical symptoms of pre-icteric, icteric and postichteric period of viral hepatitis

  6. Methods of laboratory research.

  7. Treatment of viral hepatitis

  8. Consequences and complications of viral hepatitis

  9. Measures of prophylaxis of viral hepatitis



Student must be able:

  1. To follow the basic rules of work near a bed sick with viral hepatitis.

  2. To take anamnesis with the estimation of epidemiology information

  3. To examine a patient and reveal the basic clinical signs of illness.

  4. To represent information of anamnesis and objective inspection in a hospital chart and formulate the preliminary diagnosis.

  5. To write the plan of examination.

  6. To write a clinical diagnosis (form of disease, type, severity, course of disease).

  7. To prescribe treatment taking into account age, severity of illness.

  8. To write out a prescription.

  9. To organize disease measures in the health of infection (to find out the source of infection, fill an urgent report in SES, to set a quarantine, to define the circle of contact persons, conduct them bacteriological inspection).

  10. To write epicrisis with the estimation of flow of illness, results of inspection, efficiency of treatment, prognosis, by recommendations for a subsequent supervision or treatment depending on the form of viral hepatitis.



^ III. Educational aims of the study

- forming the deontology presentations, skills of conduct with the patients

- to develop deontology presentations, be able to carry out deontology approach to the patient

- to develop the presentations of influence of ecological and socio-economic factors on the state of health

- to develop sence of responsibility for a timeliness and loyalty of professional actions

- to lay hands on ability to set psychological contact with a patient and his family


^ IV. Control materials for the preliminary and final stage for the lesson

Tests and tasks

1. A 6-year-old boy has been diagnosed as having mild form of viral hepatitis A. What is the most important in treatment?

A. Regimen and diet

B. Hepatoprotectors

C. Antiviral medications

D. Steroid hormones

E. Infusion therapy


2. A four-year child. Complaints are fever Т- 39оС, abdominal pains, vomiting. The 5th day: dark urine, acholic faeces, skin and mucous membranes are jaundiced. Tongue is covered with white coating. Liver is enlarged + 3,5 cm. Total bilirubin 127 (mk/mol/L), direct - 86, indirect - 41. ALT - 1,8 mmol/L/h, Prothrombine index – 78 %. What’s the primary diagnosis?

A. Viral hepatitis

B. Obstructive jaundice

C. Toxic hepatitis

D. Haemolytic anaemia Minkovski-Shoffar

E. Leptospyrosis


3. At the eldest group of the kinder garden in Kiev was a case of viral hepatitis A. 16 children didn’t have hepatitis A before. What do you prefer to use to prevent the viral hepatitis?

A. Immunoglobulin

B. Vaccination

C. Interferon

D. Remantadin

4. Should the patient with mild form of hepatitis A be hospitalized?

A. Yes

B. No


5. A three-month baby has been admitted with a low-grade fever, motor anxiety, anorexia, jaundice, hepatosplenomegaly, dark urine, acholic faeces. The baby had blood transfusion 2 month ago. What is the most probable diagnosis?

A. Viral hepatitis B

B. Hemolytic anemia

C. Viral hepatitis A

D. Atresia of bile-duct

E. Conjugation jaundice


6. A two-year baby. Complaints: malaise, loss appetite. The 5th day: dark urine, acholic faeces. The 6th day: jaundice of skin and sclera, Т - 37,4о С, repeated vomiting. Liver enlarged + 7 cm, lien +2,5 cm. Heart sounds are muted, bradycardia. Child is not active. He has sleeping disturbances. Total bilirubin - 220 mmol/L, direct - 176. Prothrombine index - 60%. ALT - 6,4 mmol/L/h,. НВS Ag is founded. In age 1,5 years child have had pneumonia, have got treatment in the hospital. What is the primary diagnosis:

A. Viral hepatitis В

B. Haemolytic anaemia

C. Viral hepatitis А

D. Toxic hepatitis

E. Obstructive jaundice


5. A five-year child. The disease started with loss appetite and vomiting, Т- 37,8°С. 5th day – dark urine, acholic faeces, sclera and skin are jaundice, liver on 4 cm lower than rib arch, painful. Blood test: ALT- 2,7 mmol/L, total bilirubin 150 mkmol/L, direct - 110, indirect - 40. What is the primary diagnosis?


A. Viral hepatitis

B. Haemolytic anaemia

C. Viral hepatitis А

D. Toxic hepatitis

E. Obstructive jaundice

Task 1

A six-year child is ill over 5 days. Among the symptoms are: lost of appetite; nausea, discomfort in the right subcostal region, dark colour of urine.

Physical Examination: The child has jaundice of the skin and scleras. The hepar enlarge (+3 cm from the costal arch).

The findings of the biochemical analyses of the blood are as follows:

  1. total bilirubinum – 68,9 mkmol/l, direct bilirubinum – 50,8 mkmol/l, indirect bilirubinum – 18,1 mkmol/l;

  2. PT index – 90%;

  1. ALT 2,25 mkmol/l, AST 1,5 mkmol/l;

  2. Thymol test 7 un.;

  3. Choleric pigment is founded in the urine;

  4. Anti-HAV IgM are determined in the blood.

Questions:

1.What is your primary diagnosis?

2.Estimate the date of the laboratory findings?


Task 2

An eight-year child is ill for five days. He has jaundice of the skin and scleras, recurrent vomiting, the temperature rises up 38,30 C. The stools are acholic, the urine is dark.

Physical Examination: the child is flaccid, adynamic. He is vomiting. Hepar +4 cm is from the costal arch, tenderness of the hepar with painful palpation.

The findings of the biochemical analyses of the blood are as follows:

  1. total bilirubinum – 208,3 mkmol/l, direct bilirubinum – 185,1 mkmol/l, underect bilirubinum – 23,2 mkmol/l;

  2. PT index – 40%;

  3. ALT 4,00 mkmol/l, AST 2,5 mkmol/l;

  4. Sublimate test 1,5ml;

The findings of the IFA are as follows: HBsAg (+)

Questions:

1.What is your primary diagnosis?

2.Estimate the date of the laboratory findings?


Task 3

A five-year child has complaints of malaise, lost of appetite, temperature 37,20C. Hepar +1,5 cm is from the costal arch.

The findings of the biochemical analyses of the blood are as follows:

  1. total bilirubinum – 30 mkmol/l, direct bilirubinum – 25 mkmol/l, indirect bilirubinum – 5 mkmol/l;

  2. Thymol test 6 un.;

  3. Sublimate test 2,2 ml.;

  4. Anti-HAV IgM are determined in the blood.

Questions:

1.What is your primary diagnosis?

2.Estimate the date of the laboratory findings?


Task 4

A thirteen-year child has malaise, lost of appetite, pain in the right subcostal region. He has jaundice of the skin and scleras.

The findings of the biochemical analyses of the blood are as follows:

        1. total bilirubinum – 62 mkmol/l, direct bilirubinum – 44 mkmol/l, indirect bilirubinum – 18 mkmol/l;

        2. ALT 2,6 mkmol/l, AST 1,2 mkmol/l;

        3. PT index – 85%;

The findings of the IFA are as follows: Anti-HCV IgM (+)

Questions:

1.What is your primary diagnosis?

2.Estimate the date of the laboratory findings?

V. Literature

  1. Mikhailova A.M., Minkov I.P., Savchuk A.I. Infection diseases in children.- Odessa, 2003.- 236 p.

  2. Kuznetcov S.V., Olchovskaya O.N., Tatarkina A.N. Selected lectures in children’s infectious diseases for English medical students. – Kharkov: KSMU, 2006. – 164 p.

  3. Nelson textbooks of pediatrics. / Edited by Richard E. Behrman, Robert M. Kliegman, Ann M. Arvin.; senior editor, Waldo E. Nelson. – 1996.

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