Home Roses Dermoid cyst of the left ovary case history. Endometrioid cyst of the left ovary. Lower limits of the lungs

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Dermoid cyst of the left ovary case history. Endometrioid cyst of the left ovary. Lower limits of the lungs

I.Passport part.

Turenko Lyudmila Alekseevna

2. Age

3. Gender

4. Profession

accountant.

5. Home address

Art. Bryukhovetskaya st. Gerasimenko, 74.

6. Time of admission to the clinic

7. Diagnosis upon admission

Right ovarian cyst.

II... Subjective survey data

Patient complaints:

Irregular and very painful periods. The pains are localized in the lower abdomen and are intense.

Medical history:

Considers herself sick since December 1997, since the patient noted a violation of the menstrual cycle, which manifested itself in the fact that menstruation was delayed by a week or two, in the first days of menstruation there was very severe pain in the lower abdomen, the patient could even lose consciousness. 1.06.99. after the second time she lost consciousness (the first time in the previous menstruation), she was urgently admitted to the KKB, where she was diagnosed with a cyst of the right ovary. The doctor recommended surgical treatment. After relieving the pain, I sent him home and made an appointment for a consultation. During this time, menstruation should have passed. But when the patient arrived, he told her that there was no need for an operation, and a course of treatment with diclofenac for 10 days and “Duphaston” for 3 months was carried out. Menstruation was regular, painless during treatment, after discontinuation of the drug, the menstrual cycle was again disrupted, and intense pain appeared. I contacted the DEM for a consultation. From 10.03.99. until 26.03.99. completed a course of resorption therapy at the CMR hospital. Were prescribed: gentamicin, diclofenac, calcium gluconate, aloe, autohemotherapy, physiotherapy (electrophoresis with lidase). Operative treatment was recommended. 7.04.99. was admitted to the CMR for surgical treatment.

Anamnesis of life:

Heredity is not burdened.

Was born on time. Fed naturally. She grew and developed in accordance with gender and age. She began to walk at 11 months. In psychomotor development, she did not lag behind her peers.

Among childhood infections, she suffered chickenpox, mumps, and often had acute respiratory infections.

Denies hemotransfusion. There were no allergic reactions.

In 1990, appendectomy was performed, in 1990, and in 1993 - adenoidectomy, 1995 - alignment of the nasal septum. The operations took place without complications.

Mensis from 12 years old, irregular, duration 7 days, after 35 - 42 days, painful in the first 2 days from the first menstruation, profuse. Last menstruation 03/28/99.

Lives sexually since the age of 18 out of wedlock. From the beginning of sexual activity, menstrual and excretory functions have not changed. Contraceptives were not used.

There were no pregnancies.

12/23/97. an urgent operation was performed for rupture of the cyst of the left ovary, healing of the suture by secondary intention.

He denies tuberculosis, STDs, viral hepatitis, mental illness in himself and his relatives.

Has no bad habits.

Working and living conditions are good.

III... Objective research data.

General inspection.

The patient's condition is satisfactory . Active position. Consciousness is clear. Body temperature 36.7oС. The physique is correct, low nutrition. Height 165 cm, weight 50 kg. The skin is of a physiological color, clean, turgor is normal. There are no hemorrhages on the skin and mucous membranes. Subcutaneous fat is poorly developed, musculature is moderately developed. No edema. Lymph nodes are not palpable. The thyroid gland is not visualized. The joints are painless during active and passive movements, their configuration is not changed.

Respiratory system.

Breathing through the nose is not difficult. The breathing type is mixed. NPV 16 per minute. The shape of the chest is normosthenic, there are no deformities, painless on palpation. Percussion - clear pulmonary sound. Vesicular breathing is auscultated, no wheezing.

Lower limits of the lungs:


Parastenal	V intercostal space	V intercostal space
Mid-clavicular
Anterior axillary
Average axillary
Posterior axillary
Scapular
Paravertebral	Spinous process of the XI thoracic vertebra

The cardiovascular system.

There are no protrusions and pulsations of the carotid arteries. Palpation, the apical impulse is located in the V intercostal space 1.5 cm medially from the mid-clavicular line. The heart beat is not detected. The boundaries of relative and absolute cardiac dullness are not changed.

	Relative dullness	Absolute stupidity
	1 cm outward from the right sternum edges	Left edge of the sternum
	The upper edge of the III rib	IV rib cartilage
		1 cm medially from the mid-clavicular line

The diameter of the heart is 11 cm. The configuration of the heart is not changed.

Auscultatory. Heart sounds are loud, rhythmic. Heart rate 70 beats per minute, abnormal murmurs are not heard.

Rhythmic pulse, weak filling and tension. BP - 120/70 mm Hg

Digestive system.

The tongue is moist and clean. The pharynx is normal in color. The shape of the abdomen is normal. There is no visible peristalsis.

With superficial palpation, the abdomen is soft, there are no areas of increased skin sensitivity; discrepancies of the rectus abdominis muscles, the phenomenon of "muscle protection" are absent; Shchetkin's symptom - Blumberg is negative.

In gynecology, ovarian cysts are quite common. Most often, their education process occurs at childbearing age. There are several reasons for the development of a cyst, but they all practically boil down to a violation of the hormonal background in a woman. An ovarian cyst is a hollow formation in or on the ovary wall that is filled with fluid or blood. Usually, this tumor is benign, but it is possible that in the absence of proper treatment, the cyst can degenerate into a malignant one. A timely visit to a gynecologist will prevent the risk of complications and significantly reduce the healing process.

Symptoms of the disease

Most patients whose pathological character is characterized by the following symptoms:

Aching pains in the lower abdomen, most often on one side. This pain may worsen with exercise or intercourse;
Painful and prolonged periods;
With the growth of the cyst, as well as its torsion, nausea, vomiting, loss of strength, short-term loss of consciousness are noted;
Abdominal enlargement, frequent urge to defecate appear due to tumor growth and compression of adjacent organs of the gastrointestinal tract;
Prolonged infertility occurs due to dysfunction of the ovaries.

At the first symptoms of malaise, it is recommended to contact a medical center, where you will be assisted by specialists. If women feel acute pain and a sharp drop in blood pressure, it is necessary to urgently call an ambulance and carry out emergency hospitalization.

Diagnosis of the disease

In order for the diagnosis to be accurate, and the treatment selected correctly, it is imperative to conduct a diagnostic examination. When you first contact a gynecologist, the doctor will listen to your complaints, conduct a gynecological examination in a chair and, if necessary, make an ultrasound diagnosis. During an ultrasound scan, the doctor will determine all the indicators of the pelvic organs in accordance with the day of the cycle, and also identify or exclude the presence of ovarian cysts.

In the presence of small cysts up to one centimeter and not posing a threat to the health of a woman, the doctor may decide to monitor this formation during subsequent cycles. Diagnosis of a disease is an important tool in making a diagnosis and choosing a method of treatment.

Treatment of the disease

After receiving all the diagnostic and laboratory tests, the doctor decides on the method of treatment. The conservative method of treatment is aimed at reducing and complete resorption of ovarian cysts by taking hormonal drugs. In the absence of effectiveness from treatment with hormones, as well as in the presence of non-functional ovarian cysts, surgical treatment is usually used. The main goal of surgery is to remove the ovarian cyst and maximize the preservation of the reproductive organs for the further planning of children.

In modern gynecology, one of the most effective methods of dealing with ovarian cysts is the laparoscopic method of treatment. The advantage of this method is minimal damage to soft tissues and a quick postoperative period. Instruments and a microscopic camera are introduced into the woman's uterus through small skin incisions of 1.5 cm. After a few months, not even a trace of the incisions will remain on the patient's skin. The aim of the operation is to preserve healthy ovarian tissue as much as possible.

The presence of ovarian cysts is of a different nature. In order to detect this disease in time, it is necessary to regularly visit a gynecologist. A timely visit to a doctor will help prevent the risk of complications, as well as preserve the woman's fertility. By contacting our medical center, you are guaranteed to receive qualified assistance from experienced doctors. Our gynecologists have extensive experience working with diseases of the female reproductive system. We will do everything that depends on us so that in your medical history of ovarian cyst remained in the past!

I. Passport part.

Turenko Lyudmila Alekseevna

2. Age

3. Gender

4. Profession

accountant.

5. Home address

Art. Bryukhovetskaya st. Gerasimenko, 74.

6. Time of admission to the clinic

7. Diagnosis upon admission

Right ovarian cyst.

II ... Subjective survey data

Patient complaints:

Irregular and very painful periods. The pains are localized in the lower abdomen and are intense.

Medical history:

Anamnesis of life:

Heredity is not burdened.

Was born on time. Fed naturally. She grew and developed in accordance with gender and age. She began to walk at 11 months. In psychomotor development, she did not lag behind her peers.

Among childhood infections, she suffered chickenpox, mumps, and often had acute respiratory infections.

Denies hemotransfusion. There were no allergic reactions.

In 1990, appendectomy was performed, in 1990, and in 1993 - adenoidectomy, 1995 - alignment of the nasal septum. The operations took place without complications.

Mensis from 12 years old, irregular, duration 7 days, after 35 - 42 days, painful in the first 2 days from the first menstruation, profuse. Last menstruation 03/28/99.

Lives sexually since the age of 18 out of wedlock. From the beginning of sexual activity, menstrual and excretory functions have not changed. Contraceptives were not used.

There were no pregnancies.

12/23/97. an urgent operation was performed for rupture of the cyst of the left ovary, healing of the suture by secondary intention.

He denies tuberculosis, STDs, viral hepatitis, mental illness in himself and his relatives.

Has no bad habits.

Working and living conditions are good.

III. Objective research data.

General inspection.

The patient's condition is satisfactory . Active position. Consciousness is clear. Body temperature 36.7 o C. Correct physique, low nutrition. Height 165 cm, weight 50 kg. The skin is of a physiological color, clean, turgor is normal. There are no hemorrhages on the skin and mucous membranes. Subcutaneous fat is poorly developed, musculature is moderately developed. No edema. Lymph nodes are not palpable. The thyroid gland is not visualized. The joints are painless during active and passive movements, their configuration is not changed.

Respiratory system.

Lower limits of the lungs:

The cardiovascular system .

The diameter of the heart is 11 cm. The configuration of the heart is not changed.

Auscultatory... Heart sounds are loud, rhythmic. Heart rate 70 beats per minute, abnormal murmurs are not heard.

Rhythmic pulse, weak filling and tension. BP - 120/70 mm Hg

Digestive system.

The tongue is moist and clean. The pharynx is normal in color. The shape of the abdomen is normal. There is no visible peristalsis.

With deep methodical palpation: the sigmoid colon is palpated in the form of a rumbling roller, painless; the cecum is palpable in the form of a cylinder 2 fingers thick, painless; the ileum hums; the transverse colon moves easily up and down. There are no infiltrates, no tumors.

The liver is palpable at the edge of the costal arch: the edge is sharp, the surface is smooth, painless. The size of the liver according to Kurlov is 9cm-8cm-7cm.

The gallbladder is not palpable.

The pancreas and spleen are not palpable.

The chair was unremarkable.

Genitourinary organs.

On examination of the lumbar region, redness and swelling were not detected. There is no tension in the lumbar muscles. The tingling symptom is negative on both sides. The bladder is not palpable. There are no dysuric disorders.

Endocrine system.

The thyroid gland is not visualized on examination. Secondary sex characteristics correspond to age and sex. Female pattern hair growth.

Nervous system.

Consciousness is clear oriented in place, time and situation. Attention is stable, memory for current and past events is preserved. Thinking is logical, speech is consistent. Meningeal symptoms are negative. No pathology on the part of FMN, sensory and motor spheres was revealed.

Gynecological examination.

The external genitals are well developed. Pubic hair growth is female, large lips cover the labia minora, there are no scars or deformities. The mucous membrane of the entrance to the vagina is white-pink, the urethra is not changed. Bartholin's and paraurethral glands were unremarkable.

In the mirrors: the vaginal mucosa is clean, pink in color, the folds of the mucous membrane are preserved. The discharge is mucous. The cervix is conical, the mucous membrane is clear, pink in color. The external pharynx is punctate.

Bimanual vaginal-abdominal examination: the vaginal mucosa is folded, the walls are extensible, there are no cicatricial changes. Uterus in anteflexio, normal size and shape, dense, limited mobility, painless. The appendages on the left are heavy, on the right and behind the uterus there is a tumor-like formation 6x5 cm of tight-elastic consistency, painless. The vaults are free.

Preliminary diagnosis and its justification.

Based on the patient's complaints (about irregular and very painful menstruation), anamnesis of the disease (considers himself sick since December 1997, when menstruation became very painful and irregular, during which the patient could lose consciousness, felt weakness, dizziness, mood swings. 1.06. 99. was urgently admitted to the KKB, where she was diagnosed with a cyst of the right ovary. Was treated with diclofenac, prescribed "Duphaston" for 3 months. Intense pain. I consulted at the CMR. From 03/10/99 to 03/26/99, underwent a course of resorption therapy at the CMR hospital. Were prescribed: gentamicin, diclofenac, calcium gluconate, aloe, autohemotherapy, physiotherapy (electrophoresis with lidase). It was recommended surgical treatment), life history (mensis from 12 years old, irregular, duration 7 days, after 35 - 42 days, illness nna in the first 2 days from the first menstruation, abundant; 12/23/97. an urgent operation was performed for rupture of the cyst of the left ovary, healing of the suture by secondary intention), the results of gynecological examination (the appendages on the left are tympanic, on the right and behind the uterus a tumor-like formation of 6x5 cm of tight elastic consistency, painless is determined), a preliminary diagnosis can be made: CYST OF THE RIGHT OVARIAN.

Anamnesis... Heredity is not burdened. I had flu and pneumonia. Menstrual function was normal. The last menstruation was 6/21/1986 Sex life from 20 years.
There were three pregnancies, of which two ended in urgent labor and one ended in an induced abortion without complications. Denies gynecological diseases.
History of the present disease. The patient considered herself pregnant due to delayed menstruation. She did not seek medical help. She fell ill acutely at 18.9 at 16 o'clock, when, after lifting the weight, sharp pains appeared in the lower abdomen and in the right iliac region; vomiting twice. Body temperature rose to 38 ° C. The patient's husband called an ambulance, which took her to the hospital.
General and obstetric examination.On admission, the patient's condition is moderate. The skin is pale. Body temperature 38.2 ° C, pulse 110 per minute, rhythmic, satisfactory filling. BP 110/70 mm Hg. Art. The tongue is coated with a whitish bloom, rather dry. The abdomen participates in the act of breathing only in the upper sections. On superficial palpation in the right iliac region, there is a pronounced tension in the muscles of the anterior abdominal wall and soreness. Shchetkin's symptom is positive in the lower abdomen, more on the right. Intestinal motility is heard well, active. The chair was in the morning. Pasternatsky's symptom is negative on both sides. There are no dysuric disorders.
Vaginal examination.The external genitals are developed correctly, the vagina of a woman giving birth, the cervix is cylindrical, the pharynx is closed. The uterus is in the correct position, enlarged, respectively, of an 11-week pregnancy, softened, rounded, painful when displaced. Symptoms of Gorvits-Gegar and Snegirev are positive. The left uterine appendages are not palpable, their area is slightly sensitive. To the right and posterior to the uterus, a tumor-like formation measuring 8X10 cm, rounded, with a tight-elastic consistency, limited in mobility, sharply painful on palpation and displacement, is determined. When viewed in the mirrors - cyanosis of the mucous membranes of the vagina and the vaginal part of the cervix.
Blood test: Hb - 113 r / l, leukocytosis 12.6-109 / l. CO E 25 mm / h. No pathological changes were found in the urine.

What is the diagnosis?

When diagnosing, you need to pay attention to two important circumstances - the presence of obvious signs of uterine pregnancy in the patient, and in the area of the right uterine appendages - a cystic formation, sharply painful when moving and causing peritoneal symptoms. Such phenomena are often caused by torsion of the leg of the ovarian cyst.

The frequency of combination of pregnancy with ovarian cystic formations ranges from 0.02 to 0.46%. Ovarian cysts during pregnancy usually occur in young women. According to R.L.Shub and F.E. Petersburgsky, the average age of primiparous women with ovarian cysts and cysts was 27 years, and those of repeated pregnant women - 28.5 years.

In most patients, ovarian cysts are asymptomatic, do not cause dysfunction and fertility, and in some cases do not have a negative effect on pregnancy, childbirth and the postpartum period. However, often with a combination of ovarian cysts and pregnancy, a number of serious complications are observed. One of them is premature termination of pregnancy (in 17-25%). In addition, during childbirth, the ovarian cyst can pinch in the pelvis and rupture. Cyst rupture is a very serious complication, the danger of which is increased if the contents of the cyst become infected.

During pregnancy, twisting of the cyst leg is especially common (10-12%) due to the fact that as pregnancy progresses, the uterus extends beyond the pelvis, and this entails the displacement of the cyst. Twisting of the cyst leg, which can be facilitated by sharp rotational movements of the pregnant woman's body, lifting of weight, etc., leads to compression of the venous and arterial trunks located in the ligamentous apparatus of the ovaries. Slow torsion of the leg in the range of 90-120 ° usually does not disturb the nutrition of the ovary and may be asymptomatic. Twisting the leg by 180 ° or more leads to compression of thin-walled veins, as a result of which the blood flow in them sharply slows down or stops altogether. Through the arteries, which have a more elastic wall, blood flow continues. As a result of this, venous stasis develops, the cyst increases in size, hemorrhages occur in its capsule. In a particularly severe form, the cyst may rupture with severe bleeding into the abdominal cavity. With a complete cessation of blood flow in the cyst, necrotic changes usually occur, which threatens the patient with the development of severe peritonitis.

With acute twisting of the leg of the ovarian cyst, the patient suddenly develops severe abdominal pain (especially in its lower parts), accompanied by nausea, vomiting, increased heart rate, and fever up to 38 ° C. The anterior abdominal wall is usually tense and painful, the Shchetkin-Blumberg symptom is positive. A sharp pain syndrome may be accompanied by signs of shock (pallor of the skin and mucous membranes, cold extremities, rapid pulse, decreased blood pressure, etc.). It should be noted that the symptoms of peritonitis and shock can be not only when the legs of the cyst are twisted, but also when the capsule of the cystic formation ruptures with the outflow of the contents into the abdominal cavity.

Anamnesis and clinical data in our patient allow us to diagnose - uterine pregnancy for a period of 11 weeks and torsion of the leg of the cyst of the right ovary. The diagnosis of uterine pregnancy is confirmed primarily by the correspondence of the size of the uterus to the duration of the delay in menstruation, the presence of cyanosis of the mucous membrane of the vagina and the vaginal part of the cervix, signs of Snegirev, Gorvits-Gegara. An ovarian cyst is indicated by the presence of a rounded formation with a smooth surface, elastic consistency, located posterior to and to the right of the uterus. This arrangement is common in most ovarian tumors. The sudden onset of the disease after physical exertion, pronounced pain in the lower abdomen, vomiting, fever and peritoneal symptoms certainly indicate a torsion of the cyst leg.

With what diseases is it necessary to differentiate torsion of the leg of the ovarian cyst in a patient with a uterine pregnancy for a period of 11 weeks?

A similar clinical picture can be observed with ovarian apoplexy, interrupted ectopic pregnancy, twisting of the hydrosalpinx and subserbial node of uterine fibroids, acute inflammatory process of the uterine appendages, acute appendicitis, hepatic colic and acute intestinal obstruction.

Ovarian apoplexy is more often observed in the middle of the menstrual cycle (at the time of ovulation) and is accompanied by acute intra-abdominal bleeding. An ectopic pregnancy is usually terminated at 4-6 or 8 weeks of gestation. These patients often have a history of infantilism, inflammatory diseases of the uterine appendages and secondary infertility. With an ectopic pregnancy, symptoms of internal bleeding and collapse predominate, and not irritation of the peritoneum. It is necessary to pay attention to the nature of the pains and their irradiation. When a tube ruptures, they are sharp, cutting, and with a tubal abortion, they are cramping. Pain almost always radiates to the rectum and external genitalia. The temperature is usually normal or slightly elevated, the pulse is frequent and weak filling, the blood pressure drops significantly. During a vaginal examination in the area of the uterine appendages, a dough formation of an ovoid shape is palpated, and not a rounded elastic cyst, as it was in our patient. A characteristic symptom of an ectopic pregnancy is smeared dark spotting from the genital tract. However, in the absence of these secretions, the presence of a disturbed ectopic pregnancy cannot be completely denied.

The clinical picture of the torsion of the hydrosalpinx is almost similar to that of the torsion of the cyst leg. In this case, anamnestic indications of a former chronic inflammatory process of the uterine appendages are of great importance. The subserous node of myoma differs from the ovarian cyst in its dense consistency. In addition, it is rarely isolated and is often associated with interstitial nodes.

Acute inflammation of the uterine appendages of gonorrheal etiology is often bilateral and is usually combined with other manifestations of this infection (urethritis, cervicitis, etc.). With inflammation of the uterine appendages of septic etiology, it is always possible to establish a connection with previous abortions, childbirth, diagnostic curettage or with any other intrauterine intervention.

Differential diagnosis of torsion of the pedicle of the ovarian cyst and acute appendicitis presents certain difficulties. With the latter, pain begins in the epigastrium or in the navel and only later is localized in the right iliac region; during vaginal examination, the appendages are not changed.

Diagnosis of acute intestinal obstruction and renal colic does not cause great difficulties. In acute intestinal obstruction, severe abdominal cramping, vomiting (with high obstruction), flatulence, gas and stool retention are noted. The clinical diagnosis is confirmed by X-ray (fluid level in the intestinal loops). With renal colic, there is always a positive Pasternatsky symptom and characteristic changes in urine.

What is the therapy for torsion of the peduncle of an ovarian cyst during pregnancy?

An urgent operation is indicated - removal of the cyst, leaving the uterus and appendages of the second side, if they are not changed. You should not untwist the leg of the cyst because of the danger of embolism when blood clots are torn off.

In the postoperative period, patients may have premature termination of pregnancy due to mechanical impact on the uterus during the operation and the likelihood of removal of the corpus luteum in the affected ovary. Therefore, it is necessary to take all measures to prevent spontaneous abortion (rest, suppositories with papaverine, antispasmodics, turinal, etc.)

Obstetric seminar, Kiryushchenkov A.P., Saburov H.S., 1992

Turenko Lyudmila Alekseevna

Profession

accountant.

Home address

Art. Bryukhovetskaya st. Gerasimenko, 74.

Time of admission to the clinic

Diagnosis on admission

Right ovarian cyst.

II. Subjective survey data

Patient complaints:

Irregular and very painful periods. The pains are localized in the lower abdomen and are intense.

Medical history:

Anamnesis of life:

Heredity is not burdened.

Was born on time. Fed naturally. She grew and developed in accordance with gender and age. She began to walk at 11 months. In psychomotor development, she did not lag behind her peers.

Among childhood infections, she suffered chickenpox, mumps, and often had acute respiratory infections.

Denies hemotransfusion. There were no allergic reactions.

In 1990, an appendectomy was performed, in 1990 and in 1993 adenoidectomy, in 1995 - alignment of the nasal septum. The operations took place without complications.

Mensis from 12 years old, irregular, duration 7 days, after 35 to 42 days, painful in the first 2 days from the first menses, profuse. Last menstruation 03/28/99.

Lives sexually since the age of 18 out of wedlock. From the beginning of sexual activity, menstrual and excretory functions have not changed. Contraceptives were not used.

There were no pregnancies.

12/23/97. an urgent operation was performed for rupture of the cyst of the left ovary, healing of the suture by secondary intention.

He denies tuberculosis, STDs, viral hepatitis, mental illness in himself and his relatives.

Has no bad habits.

Working and living conditions are good.

III. Objective research data.

General inspection.

The patient's condition is satisfactory . Active position. Consciousness is clear. Body temperature 36.7C. The physique is correct, low nutrition. Height 165 cm, weight 50 kg. The skin is of a physiological color, clean, turgor is normal. There are no hemorrhages on the skin and mucous membranes. Subcutaneous fat is poorly developed, musculature is moderately developed. No edema. Lymph nodes are not palpable. The thyroid gland is not visualized. The joints are painless during active and passive movements, their configuration is not changed.

Respiratory system.

Lower limits of the lungs:

Lines Right Left Parastenal V intercostal space V intercostal space Midclavicular VI rib VI rib Anterior axillary VII rib VII rib Medium axillary VIII rib VIII rib Posterior axillary IX rib IX rib Scapular X rib X vertebral vertebral column XI Spinal bone

The cardiovascular system .

Border relative dullness absolute dullness Right 1 cm outward from right

edges of the sternum Left edge of the sternum Upper upper edge of the III rib Cartilage of the IV rib Left 1 cm medially from the mid-clavicular line 1 cm medially from the mid-clavicular line

The diameter of the heart is 11 cm. The configuration of the heart is not changed.

Auscultatory... Heart sounds are loud, rhythmic. Heart rate 70 beats per minute, abnormal murmurs are not heard.

Rhythmic pulse, weak filling and tension. BP - 120/70 mm Hg

Digestive system.

The tongue is moist and clean. The pharynx is normal in color. The shape of the abdomen is normal. There is no visible peristalsis.

The liver is palpable at the edge of the costal arch: the edge is sharp, the surface is smooth, painless. The size of the liver according to Kurlov is 9cm-8cm-7cm.

The gallbladder is not palpable.

The pancreas and spleen are not palpable.

The chair was unremarkable.

Genitourinary organs.

Endocrine system.

The thyroid gland is not visualized on examination. Secondary sex characteristics correspond to age and sex. Female pattern hair growth.

Nervous system.

Gynecological examination.

Preliminary diagnosis and its justification.