"Interview a patient with therapeutic pathology"

Scenario: Chronic autoimmune hepatitis

Algorithm Necessary questions
Greeted and introduced himself
Identified the patient
Asked permission to conduct the survey
Asked complaints
Singled out the main complaint - a discomfort in the right hypochondrium
Asked "What is the discomfort in the right hypochondrium related to and
how?
Asked "How long does the discomfort in the right hypochondrium last?"
Asked about the nature of the fever
Asked "How long does the jaundice last?"
Asked about recent weight loss
Asked "When did you get sick?"
Asked “How did you get sick?
Asked “What do you associate the occurrence of your disease with?”
Asked "Have you had concomitant diseases?"
Asked “Do you take drugs for concomitant diseases regularly? If so, which
ones?”
Asked "Have you noticed any side effects?"
Asked "Have you had a previous surgical intervention?"
Asked about the hereditary predisposition to same diseases in the family
Asked "Have you had bad habits?"
Asked "Does the patient have a question?", thanked for the information
provided.
 ALGORITHM FOR PERFORMING PRACTICAL SKILLS
at the OSCЕ-2 station
"Physical examination of the patient"
Scenario "Chronic autoimmune hepatitis": deep sliding palpation of the liver.

1. Say hello, introduce yourself to the patient.

2. Obtain consent for the examination.
3. Offer the patient to undress to the waist and lie down on the couch, ask if the
patient is comfortable.
4. Take a classical (academic) position by the patient's bed: sit to the right of the
patient at the level of the patient's pelvis, facing the patient.
5. The liver is palpated bimanually. When palpating the liver, 3 moments of
palpation are performed:
correct topographical location of the hand;
immersion in the abdominal cavity;
sliding palpation movement, in which the hand does not slide over the organ, but the
organ (liver) slides over the hand.
6. Before starting the palpation of the liver, it is necessary to percussively determine
the position of its lower edge along the lin. medioclavicularis dextra.
7. Put the patient's hands (forearms and hands) on the chest.
8. With his left hand, the doctor covers and fixes the lower part of the chest in such
a way that 4 fingers (2-5) go along the back surface at the level of the last 2 ribs
(perpendicular to the spine), and the thumb is located along the edge of the costal
arch in front.
9. The doctor's right hand with extended fingers (2-5) is placed flat on the stomach
in the right hypochondrium. The middle finger is slightly bent to form one palpable
line. The position of the hand in the right hypochondrium should be such that it is
located 2-3 cm below the percussively determined lower edge of the liver, and lin.
medioclavicularis dextra divided the hand in half.
10. On exhalation, do not dip your hand deeply (up to 2 cm) into the abdominal
cavity.
11. Ask the patient to take a deep breath through his stomach.
12. At the moment of sliding the edge of the liver over the fingers, assess: the
localization of the lower edge of the liver, the nature of the lower edge (shape and
consistency), the nature of the surface, soreness.
Сontrol questions
Obtaining consent to the survey
The student washed hands or treated with antiseptic
It is suggested to undress to the waist
It is suggested to lie down on a couch
Provide instructions on the position on the couch
Classical (academic) position at the patient's bedside
Determination of the lower edge of liver
Correct performance of percussion
Determination of the percussive border of the lower edge of the liver
Carrying out deep sliding palpation of the liver
Correct fixation of the lower part of the chest
The hands are correctly topographically located (1st moment of palpation)
Correctly performed penetration into the abdominal cavity (2nd moment of
palpation)
Correctly executed palpation movement (3rd moment of palpation)
Report the results of deep sliding palpation of the liver
Make conclusions
Thank the patient
Analyze the proposed results of deep sliding palpation of the liver

ANALYZE THE DATA OF DEEP SLIDING PALPATION OF THE LIVER: (EXAMPLE)

Deep sliding palpation of the liver revealed its lower edge 4 cm below the
costal arch and its painfull.
"Interpretation of laboratory and instrumental research methods, diagnosis,
examination plan"
Scenario: Chronic autoimmune hepatitis

ALGORITHM
Interpretation of the examination result:
Made a conclusion about the presence of cytolysis syndrome
Determined the degree of cytolysis syndrome activity
Determined an increase in the level of total bilirubin and γ-globulins
Determined an increase in ANA, SMA titers
Established the diagnosis: chronic hepatitis
Formulated the diagnosis: Chronic autoimmune hepatitis of type 1,
moderately active, with extrahepatic manifestations (AIT, arthralgias)
Appointed mandatory laboratory and instrumental methods of examination
to confirm the diagnosis:
Liver biopsy
Ultrasound examination of abdominal organs
Antimitochondrial antibodies (AMA)
C-reactive protein
The student did not choose inappropriate research methods
 "Treatment of a patient with therapeutic pathology"
Scenario: Chronic autoimmune hepatitis
Algorithm

Inpatient treatment
Recommendations for lifestyle modification:
Mode of reduced physical activity
Recommendation to avoid excessive sun exposure
Recommendation to avoid taking non-recommended medicines
Medical treatment:
Prescribed Prednisolone
Prescribed Azathioprine
Correctly written drugs and stated the dose and frequency of use of drugs
(drugs may be different than those listed below)
Prednisolonum 5 mg in a dose of 60 mg/day
Azathioprine 50 mg in a dose of 100 mg/day