Anamnesis Wiktionary. History: what is it? Meaning and definition of the word, how is an anamnestic study carried out? Aggravated gynecological history: what are we talking about?

When a boil forms in the outer ear, unpleasant, painful sensations, which can bother you for quite a long time. In addition to pain, the abscess also causes psychological discomfort - after all, an abscess in the ear looks very unattractive.

Causes of formation and complications of pathology

There are many effective methods that can be used to treat boils. Ensuring careful ear care and using the correct medicines allows you to get rid of an annoying nuisance in just 6-7 days. If you start taking such measures at initial stage the onset of suppuration, then its growth will stop - the boil will resolve and will not have time to mature.

The outer part of the ear canal is lined with skin, which, like the entire surface of the skin of the human body, has hairs. A furuncle of the external auditory canal is formed due to the fact that hair follicles, sulfur or sweat glands penetrate pathogenic microorganisms- staphylococci and streptococci. Most often, a boil in the ear is formed as a result of mechanical stress, which leads to microtrauma.

The following factors increase the risk of pathology:

There are often cases when a person develops not one, but several boils in the ears. This condition is called furunculosis (extensive spread of ulcers throughout the body). The causes of furunculosis can be:

1. Impaired metabolism.
2. Defeat sebaceous gland or hair follicle pyogenic microorganisms.
3. Diabetes.
4. Hereditary predisposition.
5. Long-term damage to the body by infection.

As statistics show, this pathology leads to complications very rarely. But this does not mean at all that the problem can be treated dismissively. At first glance, such a harmless pathology as a boil of the external auditory canal can, although rarely, cause the development of serious complications.

The most favorable outcome is considered to be the opening of a boil and complete liquidation inflammation as a result of leakage of pus and removal of the necrotic core. But sometimes a boil in the ear leads to the infection of nearby hair follicles and the formation of new abscesses. With this development of the process, a persistent clinical course of furunculosis occurs, which is very difficult to treat. In addition, this situation becomes a threat of regional lymphadenitis, abscess, and infection entering the brain.

Symptoms of the disease

A furuncle in the auricle, unlike an abscess located on an open area of ​​skin, forms and matures in a closed space. Since there are many nerves in the ears, the pressure of the swelling on the pain receptors causes significant pain. The pain that occurs with this pathology is often more intense pain syndrome caused by acute non-perforative inflammatory process of the middle ear. Negative feelings manifest themselves as follows:

Otoscopy at the initial stage of the disease reveals a limited reddish bulge located in the external auditory canal. The increase in its size occurs quite quickly - in just a few hours. The growth of the abscess leads to blockage of the ear canal. A yellow-white “hood” begins to form on top of the bulge, under which pus accumulates. Sometimes it is possible to open the boil on your own - in this case, after removing the pus, the top of the infiltrate will take the form of a crater with a hole.

The presence of several ulcers is dangerous because the external ear canal may completely overlap. This causes aggravation clinical course and the occurrence of pastiness in the behind-the-ear area.

When examining a patient by palpation of a boil in the ear, symptoms may be as follows:

1. Touching your ear causes sharp pain, indicating the presence of an inflammatory process.
2. If the ear canal is affected, pain will be felt when pressing on the so-called tragus.
3. Painful sensations can also radiate behind the ear if the back wall of the auditory canal is affected.
4. If the boil is located at the bottom of the ear, during examination it usually hurts in the upper part of the earlobe.

Therapy methods

Depending on the severity of the disease, treatment for a boil in the ear can be carried out in a hospital or independently at home.

Drug and surgical treatment

When treating ears in a hospital, the patient is prescribed Erythromycin, Rulid or Tetracycline. Advanced forms of the disease require treatment with injections antibiotic drugs(Ceftriaxone, Amoxiclav).

Effective means are also:

The last three products are used as compresses. If the temperature increases significantly, antipyretic drugs (Nurofen, Nimesulide) are prescribed. Sometimes patients are prescribed vitamins and immunostimulants.

The method of treatment is selected depending on the stage of the disease:

1. Immediately when a developing boil is detected in the ear, it is recommended to apply alcohol-based compresses to it and conduct a course of UHF or ultraviolet radiation.
2. When opening an abscess, it is necessary to remove the pus from it. This is done using special narrow tampons, pre-soaked in pulling ointments.
3. The last stage of the disease is treated by washing the affected area. Boric Vaseline is used as a washing agent, the action of which is aimed at removing severe itching and inflammation.

In some cases, patients undergo autohemotherapy. This procedure is a course intramuscular injections the patient's own blood. These injections are given every 48 hours. To achieve greater effectiveness of therapy, it can be combined with taking antibiotic drugs.

Surgical treatment consists of opening the abscess and removing the purulent contents. The operation is performed under local anesthesia on the 4th day after the onset of the inflammatory process. After the procedure, it is necessary to treat the injured area with turundas soaked hypertonic solution, and also treat the wound with tincture of iodine.

Traditional medicine

Many people successfully cure ear abscess using folk remedies. Most effective means traditional medicine are considered:

1. Baked onion– use both the juice for ear drops and the baked pulp as compresses.
2. Honey and rye flour– make small cakes and apply to the affected area.
3. Garlic juice - can be used to soak turundas or compresses.
4. Tea from string and lingonberries- taken orally.
5. Grated figs, grapes, mustard and honey– the mixture is used in the form of compresses.

If the boil is located on the earlobe, then it is more convenient to use compresses. They can be attached to the sore spot using an adhesive tape or bandage. To treat the inside of the ear, it is recommended to make turundas soaked in medicinal solutions. Turundas must be replaced with fresh ones every 3-4 hours.

Treatment of a boil in the external auditory canal must be carried out carefully due to the rather intense blood circulation in the head. When any type of infection enters the bloodstream, life-threatening complications can develop. Preventive measures which consists in compliance hygiene rules, strengthening the immune system, avoiding hypothermia, will help prevent the development of pathology.

A boil in the ear is an acute purulent inflammation. It can be localized in the area of ​​the hair follicle or involve the area of ​​the skin and subcutaneous retina. The location of the boil is the outer ear, i.e. areas of the concha and auditory canal. An abscess is not dangerous in itself, but it is evidence of a violation of the immune status, hormonal imbalance, and can also be fraught with unpleasant consequences.

Pathogens of furunculosis

Most often, the cause of the disease is the most common inhabitants of the skin - and. They are representatives of the so-called conditionally pathogenic flora. This means that bacteria can coexist peacefully with their host without leaving the skin until they have the opportunity to penetrate deep into the human body.

Usually this situation occurs due to a decrease in local immunity. This happens when the body is fighting a long-term infection (for example, chronic) or it lacks vitamins and nutrients. Microcracks on the surface of the skin of the ear can also provoke the aggressiveness of cocci. They often arise due to the incorrect use of cotton swabs or toothpicks.

Staphylococci and streptococci can be introduced into the cavity of the outer ear. This occurs as a result of contact with another carrier. The most dangerous strains (varieties) that grew in hospital conditions. Such bacteria are highly resistant to antibiotics and antiseptics and will be very difficult to get rid of.

Pathogenesis of the disease and characteristic symptoms

The disease begins with the introduction of bacteria into the hair follicle. As a result of the immune response, swelling and redness develop. Regional lymph nodes are enlarged. The main symptom of the disease is pain; it intensifies when pressing on the tragus or lower wall of the auricle, or when pulling the lobe, the sensation intensifies.

Staphylococci and streptococci release toxins into the blood that can cause fever. With extensive furunculosis, an increase in body temperature is observed, general weakness, chills Sometimes it is possible to develop sepsis (blood poisoning). This is indicated sharp jumps temperatures within 1-2 degrees. If the boil bursts on its own, its contents will gradually pour out of the ear. Pain and swelling gradually subside. The entire process usually takes about a week.

Important! If the boil has not opened during this period, you should not try to remove it yourself; only a specialist can do this correctly. Otherwise, the infection may spread. In addition, a scar often remains at the site of the boil. Treatment at home is the first step to the development of complications.

Diagnostics

ear diagnostics using an otoscope

The main method is to examine the auricle and canal. An otoscope is used for detailed examination. The examination can be painful, so the doctor uses the narrowest possible instrument and operates with extreme caution. The furuncle is a conical elevation, sometimes you can see the rod. It shines through thin skin. After opening, at the site of the boil, you can find a crater-shaped funnel from which pus oozes.

Furunculosis of the ear must be distinguished from. It is similar in symptoms. Main hallmark is hearing loss. Also, the pain is usually localized not in the area of ​​the auricle, but in deeper parts.

Furunculosis can be closely related to the intake of sugars into the body. Sometimes he develops with eating disorders, metabolic disorders or diabetes mellitus. Therefore, in case of recurrent furunculosis, the urine must be examined for the presence of glucose in it.

Also desirable precise definition pathogen. After its isolation in laboratory conditions you can check which antibiotic acts most effectively on it. This will allow you to correctly plan the course of treatment.

Treatment of furunculosis

Therapy of the disease is built in several directions:

• Measures against microorganisms.
• General strengthening treatment.
• Surgical opening of the boil.

It is not worth treating furunculosis at home; only a doctor, after a series of tests, can choose the best therapeutic method.

Antibacterial and antiseptic drugs

Depending on the degree of damage, they can be used:

1. Topically in the form of solutions and emulsions;
2. As part of general therapy;
3. In the form of injections for severe cases.

Turundas soaked in boric alcohol are inserted into the ear canal. The drug destroys the proteins of the bacterial cell, causing its death. It also inhibits the growth and development of microorganisms. After opening the boil, an emulsion, streptomycin or 1% chloramphenicol, is instilled into the ear.

Antibiotics are taken in tablet form, active against staphylococci and streptococci. Recommended regimens vary greatly depending on the individual physician and regional studies, regarding coccal flora. Can be written:

Opening a boil

If the disease was detected before the boil resolved spontaneously, it is better to do this in a hospital setting. Before the operation, local anesthesia is performed. After this, an incision is made and all the pus and the core of the boil are removed. The resulting cavity is lubricated with 5% iodine.

If there are no complications, the patient is discharged. At home, he needs to insert turundas soaked in alcohol or saline solution into his ear twice a day. This will allow fluid to drain and prevent infection until the wound heals.

General restorative therapy

Such measures include:

1. Autohemotherapy. To stimulate local immunity, injections of the patient's own venous blood are performed.
2. Taking vitamin complexes.
3. Taking immunostimulating drugs. This measure is appropriate for chronic furunculosis.
4. Immunization staphylococcal toxoid. When inserted of this substance The patient develops specific antibodies. When a bacterial infection occurs, the immune system already “recognizes” them, which helps fight the infection without allowing inflammation to develop.

Possible complications

The most important danger of ear furunculosis is the spread of suppuration. The risk of such an outcome is higher in childhood. In a child, due to the close location of all organs, the infection easily spreads to neighboring tissues. Inflammation can spread to the perichondrium, The lymph nodes, salivary glands. In some cases, sepsis – blood poisoning – may develop.

In all these cases, prompt consultation with a specialist is necessary, possibly hospitalization. You should consult a doctor immediately if:

• After opening the boil does not go away pain symptom, swelling
• Body temperature is above 37°.
• Hearing has worsened.

Preventing the disease and preventing relapses

Collateral healthy condition ear is normal immunity. This means that it is necessary:

1. Avoid chronic diseases.
2. Follow a daily routine and eat right.
3. Avoid stress and overwork.

Furunculosis can be associated with a number of serious disorders. To prevent relapses, it is advisable to find out exactly what your hormonal levels, check immune status. Sometimes the reason may be helminthic infestation or thyroid dysfunction.

Furunculosis of the ear occurs as a result of various factors, ranging from poor hygiene to serious problems in the functioning of the body. Healthy image life and timely visits to specialist doctors will help reduce the risk of developing this unpleasant disease.

Video: how to get rid of boils - Dr. Komarovsky

A boil in the ear is very unpleasant problem. This inflammation of the hair follicle and the adjacent sebaceous gland may be accompanied by severe pain and increased temperature, which negatively affects performance and well-being.

Causes of a boil in the ear

Possible reasons:

• non-compliance elementary rules hygiene;
• mechanical damage various kinds(scratching) and subsequent infection with staphylococcus;
• acute respiratory infections due to hypothermia;
• prolonged use of antibiotics and, as a result, decreased immunity;
• endocrine disruptions.

The abscess leads to swelling of the ear canal and compression nerve fibers, which provokes severe discomfort.

Symptoms and signs of boils

Stages of the disease:

1. Initial. Maturation of the abscess (takes 1-2 days). At this stage, its development can be prevented. Accompanied by redness and itching.
2. Necrosis. Inflammation is localized in a specific place. This occurs approximately 3-4 days. A dense purulent core is formed.
3. Maturation. The pus comes out, there is a general improvement in well-being and a subsidence of the inflammatory process.
4. Recovery. Typically, this process takes 7-10 days.

Important! At elevated temperature Be sure to prescribe medications to reduce it.

At home, it is quite possible to cure a boil within a week. Special narrow tampons with ointments and antiseptics that draw out pus are often applied to an already opened boil. Washing with boric petroleum jelly is also often used, which helps remove annoying itching during the recovery stage.

Surgery

Long-maturing boils large sizes it is often recommended to remove surgically. Surgery is also used in cases where the prescribed treatment does not help for some reason. The patient is given local anesthesia and the inflammation that has formed in the outer ear is opened. The purulent core is removed along with the affected cells. After removing the pus, antibiotic ointments and immunomodulators are often prescribed. If the rehabilitation process goes according to plan, the patient is quickly discharged from the hospital.

Folk remedies

You need to be very careful with folk remedies. Various douching is strictly prohibited! IN sore ear Under no circumstances should any liquid enter. Scratching and squeezing out an abscess that has not yet matured is also not allowed.

At home, an emerging abscess can be heated, but this should not be done too often. A quarter of an hour a day is enough. To do this, just lie down with your sore ear on a pleasantly warm heating pad wrapped in a soft towel.

Boils can be lubricated with self-prepared ointment: 0.5 tbsp. l. crushed calendula, take 15 g of petroleum jelly, mix and use as directed several times a day.

A good effect is achieved by using baked onions, which are used as a compress. But if the inflammation is localized directly in the ear canal, it is difficult to use this method.

People also treat boils with a mixture of fried onions and garlic. You can simply moisten the turunda in liquid and place it in your ear.

Opening purulent abscess can happen at any time, so you should always sleep on the side of the inflamed ear, so that the pus that leaks out during sleep does not get inside and cause worsening.

Complications and prognosis

The rules are very simple:

1. Try not to let water get into your ear when washing your hair or taking a shower. This is especially true for people with sensitive skin.
2. Clean your ears correctly. Cotton buds Not intended for cleaning the ear canal. The passage itself needs to be cleaned with a cotton swab dipped in peroxide, simply placing it in the ear for 5 minutes.
3. Don't get too cold. In windy and cold weather, wear a hat that covers your ears.
4. Treat diseases in a timely manner, preventing them from becoming chronic.
5. Treat scratches promptly with special antiseptic agents.

A progressive boil in the ear blocks the ear canal, is fraught with serious health complications, and requires immediate treatment. At the initial stage characteristic neoplasm can be eliminated using medicinal methods, however, as it grows, one cannot do without surgical intervention. If an abscess in the ear is not treated in time, potential complications include the opening of pus with further blood poisoning. At the first symptom, you need to promptly consult a specialist and undergo an examination.

What is a boil in the ear

This is an acute purulent inflammation concentrated in the area of ​​the hair follicle or subcutaneous retina. The areas of the auricle and auditory canal become foci of pathology, which once again proves the seriousness of the prevailing clinical picture– deafness or progressive ear abscess cannot be ruled out. The abscess itself is not dangerous; its accidental opening can lead to consequences. The disease is associated with weak immunity, and as a result of extensive infection in the body in pathological process many may be involved internal organs, systems.

Causes

A furuncle of the external auditory canal is dangerous due to its complications, therefore effective treatment should follow immediately after diagnosis. For intensive therapy to be successful, the first step is to determine pathogenic factor and eliminate it from the life of a clinical patient. Besides weak immunity The causes of boils in the ear may be:

• painful inflammation of the outer ear;
• acute pain in the earlobe;
• consequence improper hygiene;
• discomfort with swelling of the ear canal;
• violation of cleaning rules ear canal;
• increased body temperature;
• mechanical damage to the ear;
• complication colds;
• addition of a secondary infection;
• progressive otitis of the ear;
• reduced immune response of the body.

Symptoms of a boil in the ear

A characteristic ailment on early stage accompanied by itching and discomfort in the area of ​​the auricle and ear canal, however, it is difficult to differentiate furunculosis based on this criterion. Unpleasant and even painful symptoms appear when a boil on the earlobe has completely formed. Eloquent manifestations of this disease, which require special attention, are presented in detail below:

• a feeling of dryness and burning in the ear canal;
• visible manifestation of swelling of the pathological focus;
• appearance acute pain focus of pathology;
• hyperemia of the skin, ear;
• enlarged parotid lymph nodes;
• acute attacks of migraine, pain in the temples;
• partial or complete deafness.

If the boil is concentrated directly in the ear canal, it is not visible, but the patient notices a sharp decline hearing acuity and more. As a result of inflammation hair follicles the skin turns red, it hurts to touch the ear, and it’s even more painful to lie on the side of the pathology. Over time, the abscess in the ear turns into an abscess, which some patients squeeze out on their own. This is strictly forbidden. A boil behind the ear or on the lobe is visible to the naked eye, so conservative treatment should not be delayed.

Furuncle in the ear of a child

If characteristic disease develops in childhood, the first thing that alarmed parents notice is increased nervousness and the tearfulness of your own child. The baby constantly cries and touches sore ear, sleeps poorly, does not make contact with adults. In addition, other, no less eloquent symptoms of a boil in childhood cannot be ruled out:

• visible abscess in the ear;
• violation temperature regime;
• visible purulent core;
• the appearance of purulent masses that begin to flow moderately from the ear canal;
• acute attack boil pain.

Complications

An ear boil in itself is not dangerous to health. Serious threat the body is ensured by its pathogenic growth, which is accompanied by increased risk opening the abscess does not exclude blood poisoning. The patient may even need to be urgently hospitalized to further remove the pus. As the boil matures potential threat health is only growing, since among potential complications doctors identify:

• ear abscess;
• meningitis;
• transition of suppuration to the perichondrium, lymph nodes, salivary glands;
• development of sepsis.

Diagnosis of the disease

Until a boil bursts in the ear, a timely examination of the source of pathology is required, resuscitation measures and conservative treatment. A correct diagnosis is half the success on the path to speedy recovery. Mandatory laboratory research and clinical examinations in a hospital setting are presented below:

• examination of the auricle and canal with an otoscope;
• urine test for glucose;
• radiography and ultrasound for complicated clinical pictures.

Treatment at home

After diagnosis, it is necessary to immediately begin conservative treatment home environment. Many patients actively use boric alcohol and instill it into blocked ear canals. The method is questionable, since it can provoke irritation and hyperemia of the pathological focus. It is better to treat the inflamed passage with peroxide, and then use other medications. However, before talking about conservative treatment, needs to be studied general recommendations specialists:

1. It is important to carefully observe the rules of personal hygiene, promptly clean the ear canals, and avoid injury.
2. At excessive accumulation sulfur, it is necessary to rinse the ear canals in the hospital, and then use local antiseptics.
3. Iodine relieves inflammation, but it is important to make sure there is no allergy to this component.
4. Methods alternative medicine can only be implemented on the recommendation of the attending physician; home self-medication is completely excluded.

Drug therapy

The photo of a boil is scary, so when the first symptoms of the disease appear, patients immediately resort to help drug therapy. The approach to a health problem is comprehensive, and if there is bacterial infection Otolaryngologists compulsorily prescribe antibiotics. For boils, it is appropriate to use representatives of the following pharmacological groups:

• antibacterial drugs penicillin series: Amoxiclav, Dicloxacillin;
• macrolide antibiotics: Erythromycin, Azithromycin;
• cephalosporins: Ciprofloxacin, Cefaclor;
• antibiotics of the rifamycin group: Rifabutin, Rifampin;
• local antiseptics: boric alcohol, hydrogen peroxide, chloramphenicol and streptomycin emulsion;
• vitamin therapy.

Separately, it is worth clarifying that a boil can be cured with the help of immunomodulatory therapy and autohemotherapy. In the first case we are talking about oral administration medical supplies for increase protective forces body. In the second: the patient is injected with his own venous blood with a view to the most as soon as possible stimulate local immunity to fight pathogenic infection.

Antibacterial ointments

Representatives of this pharmacological group act externally. Patients place a portion of the medicinal ointment into the sore ear, thereby providing a local effect directly on the source of the pathology. Must pass full course, otherwise the relief will be temporary, and you will still not be able to completely get rid of the boil. Here effective antibiotics in the form of an ointment with brief description therapeutic effect:

1. Tetracycline. This medicine in ointment form must be used externally. Apply to small quantity on the affected areas 1 – 2 times daily, but first rinse and dry skin. Course – 10 – 14 days.
2. Levomycetin. Presented not only with an antibiotic solution, but also medicinal ointment, intended for external use. Foci of pathology need to be lubricated in the morning and evening during the course intensive care- 2 weeks. Additionally, you can use Vishnevsky ointment.

Antiseptic drugs

Such therapeutic agents have a drying, bactericidal and antiseptic effect, while they have a local effect directly on the site of pathology. List of contraindications and side effects minimal, limited to local and allergic reactions with hypersensitivity body to synthetic components. If there are none, here effective medicines when boils appear:

1. Boric alcohol. With such medicinal composition It is required to perform cotton turundas in the morning and evening for 10 – 14 days. As an alternative, you can use homemade compresses.
2. Hydrogen peroxide. Proven local antiseptic. The ear canal must be treated with peroxide until the hissing in the ear disappears. Only after this can the medicinal ointment be applied.

Self-dissection

Squeezing out an abscess at home is strictly prohibited. You need to wait until it ripens and opens on its own. In this case, it is important to exclude the addition of a secondary infection, and to do this, act in accordance with the following instructions:

1. Rinse the ear canal with hydrogen peroxide until the pus is completely released.
2. Apply cotton wool pads with a few drops of iodine at home.
3. Place a portion of Vishnevsky ointment into the dried ear canal.

Folk remedies

Alternative medicine methods for the appearance of boils are more auxiliary intensive care measures. Before you choose for further treatment proven recipe, you must first consult with an otolaryngologist to exclude the occurrence of allergic reaction. Here are the ones tested in practice folk remedies when a boil appears in the ear:

1. Prepare a puree from the onion and garlic in the ratio of the indicated ingredients 1:1. Fry the prepared pulp in vegetable oil and use it as a compress directly on the site of pathology. It is advisable to perform the procedure before bedtime for 3 to 5 days.
2. You need to combine honey and rye flour until it reaches the consistency of thick sour cream, then make a flat cake. Apply warm to the pathology site and secure with bandages. Conduct the session at night for 5 days. The heated flatbread promotes the breakthrough of the abscess.

Surgery

If conservative methods Treatments for boils have proven to be ineffective in practice; the attending physician performs the operation in a hospital setting using local anesthesia. The essence of the procedure is as follows: a small incision is made directly at the site of pathology with a scalpel, through which the core of the boil and accumulated suppuration are removed. Then the injured surface is treated with a local antiseptic, for example, iodine.

Prevention

The photo of a boil appearing in the ear frightens all potential patients. To avoid this disease, you need to take timely care preventive measures. Among these, doctors focus on the following recommendations:

• exclude chronic diseases ENT organs;
• follow a routine and eat right;
• eliminate stress and overwork;
• strengthen immunity;
• avoid injury to the ear canal.

Video

Anamnesis(anamnesis; Greek anamnē sis memory) - a set of information about the patient and his disease, obtained by interviewing the patient himself and (or) people who know him and used to establish a diagnosis, prognosis of the disease, choice optimal methods its treatment and prevention. Anamnesis as a process of obtaining this information is one of the main methods of clinical examination of the patient.

The method of interviewing a patient was purposefully developed and introduced into clinical practice by the classics of Russian medicine M.Ya. Mudrov, G. A. Zakharyin, A. A. Ostroumov. In modern clinical medicine, anamnesis continues to play a significant role in understanding the patient and the disease. It is of paramount importance in the diagnosis of mental illness and a number of forms of somatic pathology. Thus, for the diagnosis of angina pectoris, the anamnesis is more informative than many other methods of studying the heart.

Using the anamnestic method, the doctor is obliged to follow the rules of deontology (see. Medical deontology). During the collection of anamnesis, mutual understanding and trust must be achieved between the doctor and the patient, and medical confidentiality is guaranteed. Anamnesis is taken in the absence of other patients. It is necessary to first listen to the patient himself - everything that he considers necessary to tell the doctor, and then ask questions without imposing his own description of the symptoms and without suggesting the possible course of the disease. It is important to achieve reliable information, which is possible if the patient has an adequate attitude towards his illness. Sometimes dissimulation, aggravation or simulation are possible on the part of the patient; The ability to recognize these deviations and find out their motivation depends on the doctor’s experience. When examining patients who are in an extremely serious or unconscious state, as well as deaf-mutes, information obtained from the patient’s relatives and other people who know him is used. In the case of cancer, venereal disease, tuberculosis, as well as during an expert examination, the anamnesis must be supplemented with medical documentation data.

The main sections of the medical history are the medical history and the life history, each of them is collected according to a specific plan.

Anamnesis illnesses(anamnesis morbi) - information about the occurrence and course of the disease. The time and sequence of occurrence of complaints and the nature of the onset of the disease are established. It must be borne in mind that sometimes a disease, after the appearance of certain symptoms, may then not manifest itself for a long time, and in the future a complication arises that is mistakenly taken for the onset of the disease. Determine the causative and contributing factors to the development of the disease, the reason for the first visit to the doctor, the results of the studies and established diagnosis. Next, the course of the disease, changes in subjective and objective signs diseases during periods of exacerbations, duration of remissions. A short medical history gives reason to suspect acute illness or a malignant process, and a relapsing course is a chronic process, more often than an inflammatory or allergic nature. The nature and sequence of appearance of new symptoms, complications, and the dynamics of the patient’s ability to work are established. Find out which medical institutions the patient applied, what treatment methods were used, their effectiveness. If possible, identify the name and dose of the drugs used, evaluate their adequacy, effect, tolerability, manifestation side effects(pharmacological history). This information ensures continuity of treatment at a new stage of the disease.

Anamnesis life(anamnesis vitae) - information characterizing the physical, mental and social development of the subject, presented in a certain sequence. The scope of this information varies depending on the conditions in which the patient receives medical care. IN urgent situation Only the main points necessary for diagnosis and treatment are clarified. In general, the more detailed the life history is collected, the more the doctor understands the patient with his individual characteristics, knowledge of which helps to clarify the diagnosis and prognosis of the disease, treatment tactics, and preventive recommendations. The necessary sections of the life history are: physical and mental development in childhood and adolescence; family life and living conditions; bad habits; professional history; past illnesses; allergy history; heredity. Obstetrics are also collected from women. anamnesis.

Assessment of physical and mental development patient in childhood, his ethnicity, place of birth make it possible to suspect some congenital and endemic diseases. To assess the patient’s mental development, it is important to clarify at what age he started going to school, what his academic performance was, and how many classes he completed. Essential for understanding the patient is information about his sexual development, onset and characteristics family life. Living conditions are clarified: characteristics of the home; material security; nutritional adequacy (nature of food, regularity of its intake, periods of malnutrition); duration and regularity of rest; physical education and sports. They clarify in which areas the person being examined lived or visited during his life (climatic anamnesis). Actively find out the presence and nature of bad habits: smoking, drinking alcohol, drugs, tonics or toxic substances; at what age and in what quantity does the patient use them.

Professional history includes information about all stages of work activity, service in the army (branch of the military); about the age at which the patient began working, acquired professions, position; whether there is a disability, its cause, group. It is necessary to get an idea of ​​the labor process and work regime, physical, chemical and bacteriological occupational hazards, and the sanitary condition of the premises. It is important to find out the patient’s opinion about the connection of the disease with one or another harmful factor, its influence on work ability. The elderly are asked about their participation in the Great Patriotic War, at what age they retired, and whether they are involved in public work.

Past illnesses, as well as injuries, operations, concussions, wounds are identified in chronological order, starting from childhood, their severity and complications are noted. An analysis of the possible connection of the present disease with a previously suffered disease or its treatment is necessary.

The allergy history includes information about the presence of allergic diseases in the patient and his relatives. Be sure to clarify the manifestations of allergies (urticaria, Quincke's edema, anaphylactoid reactions, shock, swelling of the nasal mucous membranes, vocal cords, broncho-obstructive syndrome, etc.), if possible, find out the allergen or assume its relation to any group of substances (medicine, volatile substances, food products, vaccines, serums, etc.).

When determining the role of heredity in the development of a disease, the presence of the same disease or similar diseases in blood relatives is established. They find out the age and causes of death of deceased relatives in previous generations, and the health of the patient’s children. The presence of similar diseases on the line of only one or both parents is clarified.

Obstetric history concerns reproductive function women. The cyclicity and nature of menstruation, the number of pregnancies, abortions, childbirth, the peculiarities of their course, complications, past gynecological diseases, and the age of menopause are determined. During pregnancy and childbirth, a woman is examined comprehensively, and then hidden diseases are often revealed for the first time (for example, heart defects, pyelonephritis, diabetes and etc.).

A new direction in the development of the anamnestic method is the introduction into practice of a programmed survey in various specific sections (allergies, chest pain, acute stomach etc.), carried out by filling out a questionnaire, the data of which can be entered into programs for machine diagnostics. However, when filling out questionnaires, a direct impression of the patient’s personality, which is very important for the doctor, is missing and the feeling of confidence in the patient’s personality, which is often important for the patient, is not realized. correct understanding doctor for his illness.

The reliability of the anamnesis is assessed by comparison with data from an objective examination and medical documentation.

Anamnesis in children collected mainly by interviewing the mother, father and people around the child. Some questions need to be asked to a child of preschool and school age in order to establish proper contact with him, but the child’s answers should be assessed with caution, because Children are easily suggestible and do not sufficiently differentiate their sensations. When listening to the mother's complaints, one must tactfully and skillfully give them the desired direction. It is necessary to clarify the time of onset of the disease, the characteristics of its onset and course, changes in body temperature, manifestations on the part of individual organs and systems, what treatment was carried out, its results, and the presence of reactions to medications.

The life history of children under 3 years of age begins with information about the mother. It is necessary to find out: from what pregnancy and birth the child was born; the course of pregnancy, the regime and nutrition of the pregnant woman; mother’s health (if she was sick, then with what and during what stages of pregnancy, how she was treated), how long before the birth she went on vacation, the presence of bad habits. Next, they find out whether the pregnancy ended at term, prematurely or post-term; characteristics of labor (quick, prolonged), whether obstetric aid was used and what kind; the child cried immediately after birth or after resuscitation measures were taken; his weight and height; on what day the baby was brought to the mother for feeding, how he took the breast for the first time and the following days; when the remainder of the umbilical cord fell off; what was and when the physiological loss of body weight was restored; diseases in the neonatal period (what they are and their treatment); on what day and with what body weight the child was discharged from the maternity hospital. Great importance have data on the nature of feeding (natural, mixed, artificial), whether it was carried out hourly or randomly, when and what supplementary feeding, complementary feeding, and vitamins were introduced; when the baby is weaned; at artificial feeding- at what age and what was the child fed, in what quantity and in what sequence; what kind of food was there after a year and later, features of taste and appetite. To assess the physical and psychomotor development of a child, they find out: an increase in the child’s body weight and height in the first year of life and after one year; when I began to hold my head up, sit, stand, walk, pronounce the first words, phrases, vocabulary; sleep, its features and duration; walks, hardening; when the first teeth erupted and the order in which they erupted. The medical history must include information about previous diseases (their course, whether the child was under medical supervision), preventive vaccinations, reactions to them; about the result of the tuberculin test when it was carried out; about contact with infectious patients.

By collecting an anamnesis of the lives of older children, they find out what age the child is, how he developed during the period early childhood; what is the behavior at home and in the team, performance at school; what diseases you have suffered, preventive vaccinations; when was the tuberculin test performed and what was its result; whether there was contact with infectious patients.

The family history should contain information about the age of the parents, their profession, and financial security; when and what diseases did you suffer from? about other children in the family, their age and development, health (if they died, then from what reasons); about visiting children's institutions, schools, observing the daily routine, nutrition, for schoolchildren - about academic performance, additional workloads. Special attention focus on identifying hereditary diseases.

During the examination and treatment of the patient, the anamnesis data is clarified with additional information.

Anamnesis mentally ill. Influence mental illness on the patient’s memories and his attitude to the past makes it necessary to distinguish between subjective history and objective anamnesis, each of which is important for understanding the characteristics and course of the disease. When establishing the first signs of the disease, it should be taken into account that the patient, who is in pathological condition, often interprets the past under the influence of certain disorders that determine the patient’s condition (delusional interpretation, confabulation, etc.). By interviewing both the patient and those close to him, it is necessary to carefully examine hereditary burden, the condition of the mother during pregnancy, the characteristics of childbirth, early development child, physical and mental trauma. Of particular importance is the study of the child’s character, changes in his qualities and properties, developmental features in critical age periods. It is necessary to find out whether the patient had a delay in physical and mental development, to clarify what exactly it was. It is important to determine the characteristics of contacts with others in childhood, adolescence and adulthood. Particular attention should be paid to puberty, youthful hobbies, and a tendency to use alcohol or drugs. Subsequently, it is necessary to carefully question the patient about his studies, family life, professional activities, because a number of difficulties, failures, difficulties can be explained by the disease, which often develops gradually. At the same time, it is necessary to find out the appearance of fears and obsessions in the child, clarify their nature, changes in their manifestations, and ask about impulsive actions.

Obvious signs of the disease must be examined in detail, because often it is by their characteristics that the nature and genesis of the disease are determined. You should be careful about the history data about the significance of various hazards that preceded or supposedly preceded the disease. Often harmful effects are not the true causes, but factors that provoke the disease and put a certain shade on it.

If due to mental state it is not possible to collect subjective anamnestic information from the patient; only objective information is collected anamnesis. It is necessary to obtain from those giving information an unbiased description of the characteristics and changes in the patient’s personality, behavior at home, at work, and contacts with others. In this case, you should especially pay attention to the nature of the patient’s thinking, erroneous judgments, incomprehensible actions, strange (unjustified) actions. Recommended with great caution treat the attempts of loved ones and relatives to interpret in a philistine way the pathologically alarming actions and actions of patients

Bibliography: Botkin S.P. Course of the clinic of internal diseases and clinical lectures, vol. 1, M., 1950; Mazurin A.V. and Vorontsov I.M. Propaedeutics of childhood diseases, p. 416, M., 1985; Guide to Pediatrics, ed. R.E. Berman and V.K. Vaughan, trans. from English, book. 1, p. 148, M., 1987; Guide to Psychiatry, ed. G.V. Morozova, vol. 1, p. 212, M., 1988; Guide to Psychiatry, ed. A. V. Snezhnevsky, vol. 1, p. 187, M., 1983; Handbook of Psychiatry, ed. A. V. Snezhnevsky, p. 9, M., 1985; Tur A.F. Propaedeutics of childhood diseases, p. 231, L., 1971; Shelagurov A. A. Research methods in the clinic of internal diseases, M., 1964; Shklyar B.S. Diagnosis of internal diseases, p. 12, Kyiv, 1971.