WELCOME TO MONGOLIA

Welcome to school of medicine

MD, PhD B.Gantuya
Department of Gastroenterology, Mongolian National University of Medical Sciences
Endoscopy unit, Mongolia Japan Hospital of MNUMS
 ☆ 기초훈련(= 예비 훈련)
Clinic [설문지(subjective)와 신체검사
(objective)] only,
Paraclinic[구체적 진단법(by 장비 , 랩
분석)] 사용 X

▪ Propedeutics a word of the Greek origin and

means the preliminary training
▪ In medicine, the terms "propedeutic" specifically
refers to the preliminary collection of data about a
patient based on questionnaire and physical
examination without specialized diagnostic
procedures such as equipment or laboratory
analysis .
Propedeutic is the main methods of patient examination for all fields of
doctor! It is fundament of clinician.
 • We should obtain the ability of doctor’s technics
or methods of examination based on our own
natural ability (clinical) without using the
equipment (paraclinic*): Paraclinic*(additional) methods
• We should construct the diagnostic conclusions of patient’s examination:
on the ground of data of examinations Laboratory data: complete
blood analysis, urine analysis,
Clinical examination analysis of feces for worm ova
special: biochemical blood
Subjective examination – Objective examination – analysis, tests for estimation of
Questionnaire physical examination immune system, sputum
examination
a) Complaints a) Observation Instrumental: ecg, spirography,
b) Anamnesis morbi b) Palpation ultrasound, endoscopy,
c) Anamnesis vitae c) Percussion computer tomography, MRI etc.
d) Auscultation
• This method uses language as a
way of people, an exchange of
opinions and mutual understanding.
• Word is the powerful medical
diagnostic tool
• Questioning of a patient - the most
important method of examination of
the sick person, which
characteristic only for practical
medicine.
▪ General information about a patient (passport data)
▪ Patient’s problems which he is suffered for - patient’s complaints
▪ The main data about the disease, its onset duration - history of present
illness (anamnesis morbi)
▪ The main data about patient’s life in a short form - patient’s life history
(anamnesis vitae)
• Passport data • Education
• Surname, name, father’s name • Occupation
• Age • Place of employment
• Marital status • Profession (post)
• Sex • Address of close relatives
• Nationality • Date of admission
 ☆ 사람의 위점막에 기생하는 편모를 가진 나선형 세균
☆ 급성 &만성 위염, 위 & 십이지장 궤양, 위암, 위림프종 발생 주 원인

Helicobacter Pylori
infection
▪ The main complaints - in marked specific Protease

changes in internal organs (epigastric pain, epithelial

damage

nausea, bloody vomiting)

Muscularis mucosae

▪ The general complaints – nonspecific inflammation

symptoms such as fatigue, headache etc. Duodenal Ulcer

▪ The additional complaints – neck pain

▪ Onset of a disease
▪ Further course of a disease
▪ Performed diagnostical measures
▪ Treatment in the past, its efficiency
▪ Cause of the disease on patient’s own opinion
▪ Place of birth, living conditions in childhood, children’s diseases
▪ Profession
▪ Living and financial conditions
▪ Marital status at present time
▪ Diseases of the past
▪ Harmful habits
▪ Heredity concerning to father’s and mother’s lines
▪ Allergology anamnesis
 ☆ 후각 망울: 양쪽 대뇌 반구 전두엽 아래에 있는 화학 수용기 세포에서 신호를 받는 공모양 부분, 후각 신경이 그 속으로 들어간다
olfactory bulbs

nasal cavity Upper

Pharynx respiratory
tract
oral cavity
larynx
☆호흡부전: 폐에서 가스교환 X → 혈액 속 산소 감소, 이산화탄소 증가

trachea Lower
bronchi respiratory
bronchioles tract

aveoli
☆COPD: 호기 hard (= 만성 기류 폐색), 흡연 주원인 , 기침 & 호흡 곤란 유발

alveolar duct
☆ 폐색전증: 혈전이 폐혈관을 막은 상태

☆ 루게릭병: 근위축증 일종 , 근육 위축, 운동신경세포만 선택적으로 사멸

▪ Difficulty Breathing
▪ Stubborn Cough
☆벤조디아제핀: 신경안정제(향정신성의약품), 억제성 시냅스 후 표면의 GABA R에 결합하여 Nt
의 반응성 높임, 불안장애 & 발작&불면증 치료에 사용
▪ Breathing Noisily
▪ Lingering Chest Pain
▪ Chronic Mucus
▪ Coughing Up Blood
 ☆ 협심증: 고령/흡
연/고혈압/당뇨병/가
족력/비만 → 3개의

▪ Chest pain, chest tightness, 관상동맥 중 하나라

도 급성 /만성 협착
chest pressure and chest → 혈류공급 감소 at
discomfort (angina) 심장 → 산소/영양 공
급감소→ 심장 근육
▪ Shortness of breath. 이차적 허혈 상태
① 혈전증 ② 동맥 경
▪ Pain, numbness, weakness or 화증 ③ 변이형 협심
coldness in your legs or arms if 증 (by 혈관의 급성
the blood vessels in those parts 연축 /수축)
of your body are narrowed.
☆ 허혈: 혈류 감소/
▪ Pain in the neck, jaw, throat, 부족 → 산소 수요》
upper abdomen or back. 공급
 transverse colon

duodenum

☆ 소장= 십이지장+공장+회장 stomach

☆ 대장= 맹장+ 충수+ 결장 +직장
jejunum

ascending colon descending colon

appendix
sigmoid colon
ileum

rectum
 ☆ 담석: 담석증 원인, [담낭결석]담낭관 폐쇄 →산통발작 (only pain) , [총담관결석] 총담관
폐쇄→ 황달,
• 종류: ①콜레스테롤 결석 ② 빌리루빈 결석 (담즙색소 주) ③혼합형 ⇒ 서양인(지방 섭취
多) : ① , 동양인 : ② &③

☆hepatic: 간의

☆ bile: 담즙

☆ Sphincter :괄약근

☆ 간경변증: 만성적인 염증으로 인해 정상적 간 조직이 재생결절(regenerative nodules; 작은 덩어리화) 등의 섬유화 조직으로 바 쉼→ 간 기능 저하
 ☆ 청색증: 조직에 탈산소화된 Hb 증가 or 제 기능 X Hb 유도체 증가
• 중심성 청색증: 산소 포화도 저하되는 심질환/폐질환, 비정상 Hb 질병
• 말초성 청색증: 혈액순환 원활 X but 정상 산소포화도 ex) 심부전, 추위노출, 혈관 막힘
• 청색증+곤봉지: 선천성 심질환 (심기형)
• only 청색증 : 말초성 or sudden 중심성
•Upper abdominal pain.
•Abdominal pain that radiates to your back.
•Abdominal pain that feels worse after eating.
•Fever.
•Rapid pulse.
•Nausea.
•Vomiting.
•Tenderness when touching the abdomen.
▪ Swelling, warmth, and tenderness in the joints.
▪ Unexplained weight loss.
▪ Fever.
▪ Fatigue.
▪ Joint pain and inflammation.
 ☆ polycystic ovary syndrome: 만성 무배란, 고안드로겐혈증 (남성 호르몬 과다), 초음파상 다낭성 난소 형태, 비만, 인슐린 저항성

Hair Loss Hirsutism Pelvic Pain

▪ weight loss and poor appetite. Infertility Overweight Irregular Periods

▪ tiredness.
▪ blood in your pee (urine)
Fatigue High Testosterone Acene
▪ itchy skin. Levels
☆ 버섯증후군: 목뒤쪽 아랫부분이 혹처럼 돌출, 연부 조직이 과섬유화

☆ 서맥: 심장 박동이 늦음 (60회

이하), 느린 심박으로 인해 몸에 충
☆ 빈맥: 심장 박동수가 분당 100회 이상으로 빨라짐 (정상 : 56/60~ 100회) 분한 피를 내보내지 X, 호흡곤란과
☆ 심계항진: 비정상/불규칙/빠른 심장박동, 어지러움, 흉부통증, 메슥거림 졸도 유발

☆ 타리변: 흑색, 타리모양 변, 십이지장/공장/ 회장으로부터 대량 출

열→ 혈액이 장관내 변화 (암적갈색 or 흑색), 대장하부로부터 출혈
시 선홍색 혈액 그대로

☆ 부신 급성발증: 부신 호르몬(코티솔) 분비의 결핍,

▪ Caused by a disease - a disease is unknown or rare, symptoms are
absent, clinical pattern resembles other diseases
▪ Caused by a patient - when it is not possible to take anamnesis,
anamnesis is wrong or distorted because of simulation, when it is not
possible to perform objective examination, presence of concomitant
diseases
▪ Caused by a doctor – insufficient knowledges, inattentiveness,
excessive confidence, overestimation of data of examination
▪ Caused by circumstances - noise, insufficient lighting, the room is not
adopted for examination of patients
What Doctors Wear Really Does Matter to Patients
THANK YOU FOR YOUR ATTENTION