1. THE MAIN METHODS OF DIAGNOSIS IN THE CLINIC OF INTERNAL DISEASES Bakalets Olena Valeriivna

2. PLAN 1. The notion of "functional diagnosis“ 2. Classification of methods of functional diagnostics 3. Methods of functional diagnostics in pulmonology 3.1. Studies function of external respiration 3.1. Studies function of external respiration 3.2. Studies of gas exchange function 3.2. Studies of gas exchange function 4. Methods of functional diagnostics in gastroenterology 4.1. Studies of secretory function 4.1. Studies of secretory function 4.2. Studies of motor function 4.2. Studies of motor function 5. Combined methods of functional diagnostics

3. Diagnostics from the Greek - diagnosis = διαγνώσις = «cognition» is in Ukrainian diagnostics; is in German Diagnostik; is in French le diagnostic

4. Functional diagnostics — is a complex analytical and methodological approaches to the definition and evaluation of the functional state of organs and body systems.

5. the methods (means) of diagnostics– of diagnostics – of structural diagnostics (X-ray, ultrasound, ultrasound, and others.) of functional diagnostics (ECG, phonocardiography, spirometry et al.)

6. The functional diagnostics – is based on the measurement of: is based on the measurement of : physical parameters (speed, volume, pressure, electric potential, etc.). Chemicals parameters (рН, gas composition, etc.).

7. The functional diagnostics  Determination of functional reserves  Determining the type and degree of functional disorders  Monitoring of the rate of disease progression  Evaluating the effectiveness of a course of treatment  Differential diagnosis  Expert evaluation disability, military, sports, etc. ObjectiveObjective

8. Cardiovascularsystem Respiratorysystem Digestivesystem Musculo-skeletalsystem Endocrinesystem Urinary system The functional diagnostics Nervoussystem Sensorysystem Reproductiv e

9. Methods of functional diagnostics in pulmonology

10. 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 natural respiratory movements and volitional forced respiratory maneuvers.

11. The aims of monitoring PEF:  treatment planning of obstructive pulmonary disease  evaluation of the effectiveness of treatment with bronchodilators and inhaled steroids  predicting the asthma exacerbations  determining the reversibility of bronchial obstruction  determining the professional asthma  identification of mechanisms that provoke bronchospasm

12. Indications for the spirography  Determining the type and degree of pulmonary insufficiency  Monitoring of lung ventilation indexes to determine the extent and rate of disease progression  Evaluating the effectiveness of a treatment course of bronchial obstruction with bronchodilators (β2-agonist short and long- acting, anticholinergic, inhaled corticosteroids and membrane stabilizers)

13. Indications for the spirography  Detecting early signs of ventilatory failure in patients prone to develop lung diseases or persons working in conditions of influence harmful factors.  Examination working capacity and military expertise - based pulmonary ventilation function in conjunction with clinical parameters.  For differential diagnosis between pulmonary and cardiac failure in combination with other research methods.

14. Indications for the spirography  Reversibility testing with a beta2-adrenergic bronchodilator  Conducting inhalation provocation tests for the detection of bronchial hyperreactivity (methacholine, histamine, hyperventilation, exercise testing)

15. Contraindication for the spirography  severe general condition of the patient  severe pulmonary insufficiency, which does not allow making breathing maneuvers  progressive angina  myocardial infarction  malignant hypertension, hypertensive crisis  circulatory failure IIB and III stage  acute cerebrovascular accident  toxaemia of pregnancy  the second half of pregnancy

16. Spirogram a tracing or graph of respiratory movements

17. Static indicators

18. Dynamics of Respiratory Minute Volume depending on the activity of human RMV=TVхBR

19. Dynamic indicators

21. Characteristic changes in lung function N – norm; R – at rest; L – at load. ↓ - decrease ↑ - increase * DA CO – 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

22. Algorithm of spirogram analysis

23. Bronchodilator Reversibility Testing

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

25. According to the recommendations According to the recommendations European Respiratory Society (ERS)and American Thoracic Society (АТS) calculations of spirometric indices are carried out according to the values ​​ that depend on the anthropometric: calculations of spirometric indices are carried out according to the values ​​ that depend on the anthropometric: on the height, gender and age

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

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

28. Peak flow metry is method of monitoring peak expiratory flow (PEF), which measured in liters per 1 sec.

29. The technique of Peak flow metry 1st stage Take 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 scale.

30. 2nd stage At the beginning of testing to breathe calmly and evenly. and evenly. Then make the maximal deep inspiration. The technique of Peak flow metry

31. 3 stage Need to keep pеак flow meter horizontally. To take mouthpiece of appliance in the mouth tightly clasp the its his lips and quickly to exhale air in device without blocking the hole mouthpiece by tongue. The technique of Peak flow metry

32. The 4 Stage Determine the result – the result – a number, on which indicates the Arrow device. Indices of PEF is recorded on a scale of device The technique of Peak flow metry

33. 5 stage Highest of the 3 measurements is fixed and written in diary The technique of Peak flow metry

34. Every morning, before taking medications, Repeat this in evening and it should be noted best indicator in column to record best indicator in column “М“ – Morning ‘Е' - Еvening The technique of Peak flow metry

35. Evaluation of PEF

36. Pulse oximetry - a method of monitoring the oxyhemoglobin percentage.

37. Capnometry Capnometry - this measurement and digital reflection of concentration or partial pressure of carbon dioxide in inhaled and exhaled gas during the patient's respiratory cycle. this measurement and digital reflection of concentration or partial pressure of carbon dioxide in inhaled and exhaled gas during the patient's respiratory cycle.

38. Capnography Capnography - this measurement and graphical reflection of concentration or partial pressure of carbon dioxide in inhaled and exhaled gas during the patient's respiratory cycle. this measurement and graphical reflection of concentration or partial pressure of carbon dioxide in inhaled and exhaled gas during the patient's respiratory cycle.

39. Thank you!