Modern functional diagnostics: basics. functional diagnostician. What does this specialist do? What kind of research does it do? Methods of functional diagnostics in the clinic of internal diseases
Functional diagnostics doctor called a specialist who studies the condition of the patient's organs and reveals the presence of functional disorders even before the onset of anatomical changes in the body.
Responsibilities of a Functional Diagnostic Physician
- Constant control and organization of functional research by the staff of the department;
- Development of reasonable work schedules for yourself and for the nursing staff of the department;
- Managing the work of the nursing staff of the department;
- Control over the correctness of the ECG;
- Carrying out the analysis of the performed studies, as well as the development of conclusions on them;
- Organization and implementation of advanced training of department employees;
- Conducting functional diagnostics training for polyclinic doctors;
- Discussing, if necessary, the results of functional studies with the attending physicians of a medical institution and advising them on issues of functional diagnostics;
- Improving your own level of professional qualifications and theoretical knowledge;
- Carrying out a systematic analysis and generalization of the experience of the department;
- Ensuring proper maintenance of primary documentation in accordance with the approved forms;
- Proper organization of the labor activity of the department staff with the introduction of labor organization measures and the use of the experience of the best medical institutions;
- Timely familiarization of the department staff with all official documents (orders and instructions of the administration, methodological recommendations, etc.);
- Compliance with the principles of deontology.
What diseases does the Doctor of Functional Diagnostics treat?
The doctor of functional diagnostics does not deal with treatment and does not prescribe drug therapy, he has a different task. If the question arises what diseases the doctor treats, then it is more likely what organs and systems he examines. These can be the following types of surveys:
- Examination and evaluation of the functions of external respiration;
- Cardiological functional diagnostics;
- Functional diagnostics of the digestive organs;
- Endocrinological functional examination;
- Gynecological functional diagnostics;
- Neurological functional diagnostics;
The doctor of functional diagnostics conducts an examination in order to clarify, correct, confirm the preliminary diagnosis determined earlier. The diagnosis is made on the basis of an analysis of all the results, thus, a functional study is an aid in the diagnosis, and not a cure for the disease.
When should I contact a Functional Diagnostics Doctor?
Ideally, every reasonable person should understand the full value of his main resource - health, and regularly undergo medical examinations, including a comprehensive examination of the functions of organs and systems. If this is done, the question “when you should contact a doctor for functional diagnostics” simply will not arise. Unfortunately, most often patients get to the diagnostic room in the direction of the attending physician, that is, when the first symptoms of the disease already appear.
- Before you go on a long journey, especially to countries with an unusual climate for the body, conditions;
- In advance before various recreational activities - a trip to resorts, sanatoriums, and so on (often functional diagnostics and other studies are mandatory);
- , fitness;
- A comprehensive examination is necessary for those who adhere to conscious parenthood before conception.
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The main types of functional diagnostics studies carried out by the doctor
- electrocardiography;
- echocardiography;
- Electroencephalography;
- Spirometry;
- Daily monitoring of blood pressure and ECG;
- Veloegrometry (VEM);
- Impedancemetry;
- Tonal threshold audiometry;
- Examination of the functions of external respiration.
The advice of a doctor of functional diagnostics, first of all, concerns the well-known statement "Bene dignoscitur bene curatur", which means - well defined means well treated. A comprehensive study of the functions and resources of systems, the state of organs is necessary not only for those who have already fallen ill, but also for those who are in the category of relatively healthy people. Modern technologies, methods and advanced diagnostic equipment allow us to identify minimal, initial changes, disorders at the functional level with maximum accuracy, which means a unique opportunity for quick and effective treatment.
Functional diagnostics a section of diagnostics, the content of which is an objective assessment, the detection of deviations and the establishment of the degree of dysfunction of various organs and physiological systems of the body based on the measurement of physical, chemical or other objective indicators of their activity using instrumental or laboratory research methods. In a narrow sense, the concept of "" denotes a specialized area of modern diagnostics based only on instrumental functional diagnostic studies, which in clinics and hospitals is represented by an independent organizational structure in the form of functional diagnostic rooms or departments equipped with appropriate devices and devices with a staff of specially trained doctors and nursing staff. The most common methods used in these departments are phonocardiography, spirography, pneumotachometry, and in large consultative institutions, technically more complex methods for studying the functions of external respiration, blood circulation, and central scientific research are used. and others, incl. based on ultrasound diagnostics (Ultrasound diagnostics) .
They are not included in the structure of these subdivisions, but are widely used to study the functions of various organs and systems ,
Radionuclide diagnostics ,
sounding ,
Endoscopy ,
Laboratory diagnostics .
The development of F. d. became a direct consequence and practical expression of the physiological direction, which was established in medicine thanks to the achievements of physiology and the work of major clinicians at the turn of the 19th and 20th centuries. It is known that the dysfunction of an organ is not always proportional to the volume of structural changes found in it. So, severe respiratory disorders in bronchial asthma or hemodynamics in hypertension are possible with relatively small morphological changes, while with significant structural lesions of the organ, for example, when a tumor replaces about 2/3 of the pancreas, clinical signs of its functional insufficiency in the normal load mode may be missing. Meanwhile, the limitations of vital activity in various diseases are directly related to disorders of the function of any organs or physiological systems and are proportional to the degree of these disorders. Therefore, along with the morphological, etiological and pathogenetic diagnosis of the disease, the identification and assessment of the degree of violations of a particular function is the most important part of the diagnosis (Diagnosis)
and is reflected in the formulated clinical Diagnosis of the disease. In healthy individuals, the study of the functional reserves of the body, primarily the respiratory and circulatory systems, is carried out in order to predict and control individual adaptation of a person to extreme environmental conditions (for example, in polar expeditions), sports loads, during professional selection and medical supervision of divers, divers , pilots, astronauts, etc., and in children and adolescents - in order to control the compliance of the development of physiological systems with age. The purpose of a functional diagnostic study is determined by clinical tasks, which are most often represented by the following types: identifying deviations in the specific function of an organ (for example, secretion of hydrochloric acid by the stomach) or the integral function of several organs that make up the physiological system (for example, blood pressure), or characterizing the function of the system in (for example, external respiration, circulation); study of the pathogenesis or immediate cause of established functional disorders (for example, the role of bronchospasm in violation of bronchial patency, venous hypotension in reducing cardiac output, etc.); quantitative assessment of the reserve of function to determine the degree of functional insufficiency of an organ or physiological system. A specific function under conditions of physiological rest or under other specified conditions is evaluated by measuring any of its indicators, which may be direct or indirect. Thus, the amount of hydrochloric acid per unit volume of gastric juice and its peptic acid are direct indicators of the secretory function of the stomach, and uropepsin in the urine is an indirect indicator. The study of the pathogenesis of functional disorders is usually multifaceted (for example, to identify only the hemodynamic nature of the increase, the total peripheral resistance to blood flow is also determined) and, as a rule, includes measuring the dynamics of impaired function under the influence of a specific and usually standardized load or targeted pharmacological effects, which allows us to evaluate the functional reserve . Most of the functional diagnostic studies are organizationally separated from the direct participation of the attending physician in them, and the conclusion on their results is given by specialists from the relevant departments of functional or laboratory diagnostics. However, a reasonable choice of method and assumptions regarding the study plan (stress tests, pharmacological tests, etc.) should come from the attending physician, who owns the right and responsibility for the final interpretation of the conclusions of certain specialists based on a comparison of the results of functional diagnostics with clinical manifestations. disease and data from other diagnostic studies. Therefore, one should know well not only the purpose of each of the used methods of F. d., but also the degree of their diagnostic specificity, as well as the principle of interpreting the results of the study, the possible reasons for their distortion, ambiguous or erroneous interpretation. For polyclinic doctors, these requirements relate primarily to the methods of F. d. available in the clinic, but at the same time, it is also absolutely necessary that both the local doctor and polyclinic specialists (cardiologist, neuropathologist, etc.) be fully informed about all the possibilities of F. d. according to the appropriate profile of pathology for a reasonable and rational selection of indications for referring the patient to the departments of F. d. consultative centers or hospitals. Study of the functions of external respiration in a polyclinic, it is mainly limited to measuring the vital capacity of the lungs (Vital capacity of the lungs) (), its constituent volumes (tidal volume, exhalation and inhalation reserves) and forced vital capacity of the lungs (Forced vital capacity of the lungs) () using spirography (Spirography) ,
as well as the maximum (peak) airflow velocity in the airways during forced exhalation and inhalation (the so-called expiratory and inspiratory power) using pneumotachometry. Deviations of these indicators from the proper values make it possible to identify ventilation respiratory failure (Respiratory failure) and guide the doctor in determining its predominant mechanisms (bronchial obstruction), and the study of the dynamics of the identified deviations (including pharmacological tests with bronchodilators, respiratory analeptics, etc.) used for pathogenetic analysis of respiratory disorders, selection and monitoring of the effectiveness of therapy. At the same time, the objectivity of spirography and pneumotachometry data is relative, because the value of the obtained indicative depends on the ability and correctness of the execution of the research procedure by the subject, i.e. on whether he really fulfilled the limit and exhalation when measuring VC and whether he really created the most forced exhalation when determining its power or FVC. In doubtful cases, the results should be checked for reproducibility (repeatability of the same maximum values at least twice in a row). They should be interpreted only in comparison with clinical data on the nature of the pathological process (lung parenchyma, in the pleural cavities, the presence of bronchitis or bronchial asthma, impaired diaphragm movements, etc.), and in the presence of shortness of breath (Shortness of breath) -
with its clinical features (inspiratory, expiratory, etc.). Of the interpretation errors caused by the overestimation by the attending physicians of the diagnostic value of the decrease in VC, FVC and expiratory power, two are most often allowed. The first is the notion that the degree of decrease in FVC and expiratory power always directly reflects the degree of obstructive respiratory failure. This is not true. In some cases, a sharp decrease in these indicators is observed with minimal shortness of breath, which does not prevent the patient from performing moderate physical work. The discrepancy is explained by the valvular mechanism of obstruction, which occurs precisely during forced expiration (which is required by the research procedure), but is not very pronounced under physiological conditions during calm breathing and with a slight increase in its minute volume in response to the load. The correct interpretation of this phenomenon is helped by the obligatory measurement of inspiratory power, which decreases the less, the greater the importance of the valve mechanism in reducing FVC and expiratory power, and not other causes of obstruction. A decrease in FVC and expiratory power is also possible without violations of bronchial patency, for example, with damage to the respiratory muscles or their motor nerves. The second common mistake is to interpret a decrease in VC as a sign sufficient for the diagnosis of restrictive respiratory failure. In fact, a decrease in VC can be a manifestation of pulmonary emphysema, i.e. consequences of bronchial obstruction, and it is a sign of restriction only in cases where it reflects a decrease in the total lung capacity (), including, in addition to VC, the residual volume of the lungs. It is possible to assume a decrease in TRL (the main functional and diagnostic sign of restriction) if there are clinical and radiological signs of damage to the lung parenchyma, a high standing of the lower borders of the lungs according to percussion, a decrease in tidal volume, an increase in FVC up to 80% of VC and more (due to a decrease in VC in cases with normal bronchial patency). To measure the residual volume of the lungs and the REL, spirographs are used, equipped with special indicator gas analyzers (nitrogen, helium), they also determine the uneven ventilation of the alveoli (by the dilution time of the indicator gas in the REL, which is significantly lengthened with bronchial obstruction). These studies are usually carried out in large divisions of functional diagnostics, in particular, those available at pulmonological hospitals, where F. methods allow you to accurately determine respiratory failure (including diffusion, using a special device for studying diffusion lungs) and its degree. If necessary, they measure, for example, lung compliance and airway resistance using whole-body plethysmography (Pletysmography) or pneumotachography (Pneumotachography) with simultaneous measurement of intrathoracic (intraesophageal) pressure, oxygen uptake by blood (on specially adapted spirographs), the content of oxyhemoglobin in it (with using oximetry), tension in the blood plasma O 2 and CO 2, the concentration of CO 2 in the alveolar air (using capnometry, capnography). to the hospitalization of a patient for such studies usually occur with an unclear or combined pathogenesis of respiratory failure in patients with complex and severe chronic nonspecific lung diseases (granulomatosis and fibrosis of the lungs, a combination of damage to the lung parenchyma with bronchial asthma, etc.), the presence of possible causes of thoracodiaphragmatic or neuromuscular respiratory disorders. Study of kidney function largely based on clearance tests (see Clearance) , With which determine the renal plasma flow, glomerular filtration, secretion and reabsorption in the tubules of the kidneys (see Kidneys) .
These tests, as well as radionuclide and complex X-ray research methods used in nephrology and urology, as well as violations of the body's chemical homeostasis in renal failure, are used in hospitals. The polyclinic performs urine tests (Urine) With determining its density, acidity or alkalinity, studying the sediment (detection of salts, leukocyturia, cylindruria, etc.), plain radiography of the kidneys, sometimes urography (Urography) ,
cystoscopy and chromocystoscopy (see Cystoscopy) .
Of the functional diagnostic studies available to the outpatient doctor, the simplest and most informative are the measurement of daily diuresis and urine density (provided that the patient does not take), incl. Zimnitsky's test, urine concentration and dilution tests. For this, only a measuring container and are needed. The ratio of daily diuresis and urine density is considered normal if the sum of the last two digits in the urine density indicator and the first two digits of diuresis in ml is 30 (for example, 15 + 15 with a urine density of 1015 and diuresis of 1500 ml or 18 + 12 with urine density 1018 and diuresis 1200 ml). With osmotic polyuria (Polyuria) (for example, in patients with diabetes mellitus), this indicator is always higher than 30, and if the concentration function of the kidneys is impaired, for example, in patients with chronic pyelonephritis, it can be normal (osmotic substances with low-density urine are compensated by polyuria) and decreases by progression of renal failure. The Zimnitsky test (measuring the amount of urine and its density in portions collected every 3 hours during the day) allows you to set the range of fluctuations in the density of urine at different times of the day, compare them with hours of osmotic and water load, physical activity and rest, and identify such important symptoms of renal insufficiency, like isosthenuria and one of the early signs of a decrease in renal blood flow - nocturia (Nycturia) .
In simple tests with dry food and water load, the reserves of the ability of the kidneys to concentrate and dilute urine are determined. Interpretation of the results of measuring diuresis and urine density is carried out in comparison with changes in urine sediment (, cylindruria, etc.) and with the obligatory consideration of clinical data, because. changes in diuresis are observed not only in renal pathology, but also in violation of the regulation of kidney function by hormones (for example, in diabetes insipidus (Diabetes insipidus)) ,
heart failure (heart failure) ,
dehydration of the body (Dehydration of the body) of a different nature, a pathological decrease in blood pressure, paroxysms of autonomic dysfunction (for example, with supraventricular paroxysmal tachycardia (Paroxysmal tachycardia)) ,
the use of drugs that affect renal (caffeine, aminophylline, some, etc.) or tubular functions (diuretics, some hormonal drugs, etc.). If a kidney pathology is suspected, important additional information can be provided by x-ray examinations of the kidneys and urinary tract in the clinic and performed on an outpatient basis in a consultative center. Radionuclide renography .
The latter makes it possible to distinguish between predominant disorders of renal blood flow and excretory function of the kidneys, as well as to assess the symmetry of these disorders, which is important for diagnosing the underlying disease (for example, with diffuse glomerulonephritis, the disorders are usually symmetrical, and with pyelonephritis they usually differ markedly on the renograms of the left and right kidneys ). If necessary, in-depth F. d. and in diagnostically unclear cases are completed in a hospital. Study of the functions of the endocrine glands It is carried out mainly by methods of laboratory diagnostics by direct determination of the concentration in the blood or excretion in the urine of a particular hormone or a substance that is regulated by this hormone. To assess the function of the gonads, semen, vaginal smears are additionally examined; in the diagnosis of diseases of the adrenal glands, the thyroid gland is often used radionuclide, scintigraphy. In some cases, pharmacological tests are used to study the dynamics of a function after the administration of a hormonal drug that affects it, for example, diuresis under the influence of pituitrin, secretion of 17-ketosteroids and 17-hydroxycorticosteroids after the administration of dexamethasone, or the dynamics of the number of eosinophils in the blood after the administration of synthetic analogues. Most studies of the function of the endocrine glands are carried out in a hospital. At the same time, many clinical symptoms of endocrine diseases directly reflect the insufficiency or excess production of a certain hormone, and the dynamics of the severity of these symptoms is used by doctors in hospitals and clinics as an indicator of changes in the function of the gland during treatment. With thyroid diseases and diabetes mellitus (the most common forms of endocrine pathology in the practice of a polyclinic doctor), this approach can significantly reduce the frequency of proper endocrinological functional diagnostic studies. So, for example, after establishing the diagnosis of hypo- or hyperfunction of the thyroid gland by examining the concentration of triiodothyronine (T 3) and thyroxine (T 4) in the blood, monitoring the effectiveness of the prescribed therapy can be carried out for quite a long time by the dynamics of the pulse rate, temperature and body weight, sweating, tremor ( with thyrotoxicosis), edema (with hypothyroidism), etc. diabetes mellitus is based on the detection of an increased concentration of glucose in the blood on an empty stomach and at different hours of the day, and in case of latent diabetes mellitus - on the study of curves of the concentration of glucose in the blood after a load of glucose (see. Sugar diabetes) .
These studies, as well as the determination of glucose in the urine, are carried out in the clinic, and in the presence of express tests ("", etc.), the patient himself can evaluate glucosuria. At the same time, with an established diagnosis, decompensation and compensation for diabetes mellitus reflects the dynamics of such clinical symptoms as, polyuria, skin, with which the results of laboratory tests should be compared. Functional diagnostics in neurology is based on the use of electrophysiological methods for studying the brain (Electroencephalography) and peripheral nerves (Electromyography) ,
direct measurement of cerebrospinal fluid pressure and indirect assessment of intracranial hypertension (according to X-ray studies and echoencephalography), the study of the blood supply to the brain by radionuclide methods, using dopplerography of the vertebral and branches of the carotid arteries, rheoencephalography (Rheoencephalography) ,
orbital plethysmography (plethysmography) ,
various ways to study the function of maintaining balance (, nystagmography, etc.), vegetative functions (tremorography, sweating, etc.). To identify structural changes in the central nervous system, in addition to echoencephalography, cerebral angiography, radionuclide methods, computer methods are increasingly being used. In the functional diagnostic rooms of polyclinics, electroencephalography, rheoencephalography, echoencephalography (Echoencephalography) are more often used .
Electroencephalography with evoked potentials of the brain (visual, somatosensory, auditory, in the test with hyperventilation) helps to diagnose epilepsy, multiple sclerosis, parkinsonism and some other diseases of the nervous system. used to recognize brain tumors, hydrocephalus, lesions of the posterior cranial fossa, hemorrhagic stroke. With the help of rheoencephalography, changes in the pulse blood filling of the head are assessed, incl. in the process of pharmacological tests with drugs that affect the vessels. necessary in the differential diagnosis of damage to muscles and peripheral nerves. Taking into account the clinical signs of the disease, this method helps to recognize myopathies, polymyositis, polyradiculoneuritis. Indications for a functional diagnostic study determines. Bibliography: Belousov D.S. Differential diagnosis of digestive diseases, M., 1984; Zenkov L.R., Ronkin M.D. nervous diseases, M., 1982; bibliography; Instrumental methods for studying the cardiovascular system, ed. G.S. Vinogradova. M., 1986; Sokolov L.K., Minushkin O.N., Savrasov V.M., Ternovoy S.K. Clinical and instrumental diagnosis of diseases of the organs of the hepatopancreatoduodenal zone, M., 1987. 1. Small medical encyclopedia. - M.: Medical Encyclopedia. 1991-96 2. First aid. - M.: Great Russian Encyclopedia. 1994 3. Encyclopedic dictionary of medical terms. - M.: Soviet Encyclopedia. - 1982-1984.
- Adaptive physical culture. Concise Encyclopedic Dictionary
Despite the fact that today any physician - an emergency doctor, therapist or narrow specialist must have the skills to study and identify the main types of disorders in the functioning of organs and systems in the human body, the allocation of the field of functional diagnostics to a separate medical specialization is fully justified. After all, the work of the human body is a complex interrelated process, and if there are violations in the work of one organ, this inevitably affects the functioning of all other systems, and general well-being. That is why the activity of the doctor, aimed at clarifying the functional and adaptive capabilities of each organ, as well as determining the mechanism for the development of pathologies, is an independent area of medical science, which is called functional diagnostics. A doctor of functional diagnostics or a functional diagnostician is a medical worker with a higher education who has completed postgraduate training (internship, residency) in the relevant specialty.
What does a functional diagnostician do?
The Diagnostic Specialist is responsible for examining the systems of the human body: respiratory, cardiovascular, nervous, endocrine, digestive, reproductive, urinary. In the process of studying and analyzing their performance indicators, the doctor collects information about the presence or absence of changes and deviations from the norm. The doctor not only directly diagnoses with the help of special instruments and devices, but also carries out a clinical interpretation of the data obtained, and can also periodically monitor the dynamics of the effectiveness of the prescribed treatment. Based on the information received, interpreted and systematized by the functional diagnostician, narrow specialists, for example, cardiologists, gastroenterologists, endocrinologists, neurologists, can treat the patient.
This doctor must have many general medical skills, knowledge and skills, for example, understand the legal framework governing medical activities in general and the work of a particular medical institution; understand the paragenetic mechanism and etiology of the appearance and development of pathological processes, the clinical features of their manifestation, the specifics of the course of various diseases; own methods for identifying common and specific symptoms of various ailments; have an understanding of the general principles of complex therapy of diseases and pathologies.
Specific knowledge that a doctor of functional diagnostics should have:
- fundamental principles, methods and methods of clinical, instrumental and laboratory diagnostics of the human body;
- metrological characteristics of the equipment used in the process of diagnostics;
- rules for organizing work and instrumental support of the diagnostic department or office.
The powers and responsibilities of this specialist include:
- organization and control over the process of implementation of the relevant functional research by the staff of the cabinet or department subordinate to him;
- checking the correctness of data taking during the ECG procedure;
- analysis of the performed studies, giving conclusions on them;
- organization of information sessions on functional diagnostics with doctors of the relevant medical institution;
- discussion of the data obtained as a result of diagnostics with other physicians, their consultation on functional diagnostics;
- ensuring the maintenance of primary medical records.
As for direct interaction with patients, the doctor gradually performs the following functions:
- preventive examinations of patients at risk to identify possible diseases in the early stages;
- identification and evaluation of functional and anatomical pathologies and deviations of internal organs and systems;
- surveys to identify the dynamics of changes in the body in the process of medical therapy;
- implementation of drug, functional and stress testing to select the most appropriate therapy option;
- analysis of the effectiveness of the prescribed and conducted therapy;
- examinations in a dispensary, preoperative and postoperative examinations;
- preparation and issuance of advisory opinions.
What is the difference between a functional diagnostician and a therapist
Many patients are confused by the situation when the attending physician, the therapist sends him to the doctor of functional diagnostics for examinations. This fact usually causes bewilderment, since, in fact, the therapist himself must be a diagnostician, he identifies and fixes the presence of various diseases. In addition, a functional diagnostician, like a therapist, specializes in the health of the entire human body as a single system.
However, there are serious differences in their qualifications and methods of work. Firstly, a diagnostician can be considered as such only after additional training and practice (residency) in this specialty, in addition to higher medical education. Secondly, this doctor, unlike the therapist, does not prescribe treatment. Specifically, his “element” is precisely the study of the functional features of the body, analysis and clinical interpretation of the data obtained, giving conclusions on them. The diagnostician can consult the attending physician and take part in the development of a treatment regimen. Thirdly, the diagnostician not only determines the methods and procedure for examining a particular patient, but can also independently carry out certain types of diagnostics using special medical equipment. In addition, the knowledge of a diagnostician in the field of applied technologies for examining a patient is deeper and more specific.
The doctor, depending on the available merits, knowledge and skills, can be assigned qualification categories:
- second;
- first;
- higher.
What organs and parts of the body are studied by the doctor, what diseases are determined
It is important to understand that the doctor of functional diagnostics is not directly involved in the treatment of pathologies and disorders in the functioning of organs and systems. The scope of his activity is the study of the state of the whole organism in the complex, and its individual parts:
- respiratory organs;
- gastrointestinal tract;
- endocrine system;
- heart and blood vessels;
- nervous system;
- reproductive and urinary organs.
Most often, patients sent there by the attending physician get to the functional diagnostics room. In this case, although the doctor has doubts about the diagnosis, there are already certain suspicions that need to be confirmed or refuted. Thus, the specialist has to deal with the symptoms, manifestations and indicators of diseases of almost any etiology and nature. Some illnesses, for example, oncological or psychiatric diseases, are studied and diagnosed by specialized specialists.
In what cases and for what symptoms it is necessary to visit a doctor of functional diagnostics
This specialist mainly works with patients who are referred to him by his colleagues - in such cases we are talking about situations where the attending physician cannot independently determine the current diagnosis.
Other reasons for visiting a doctor include routine check-ups and preventive diagnostics. Children and adults can undergo regular comprehensive examinations by a diagnostician, regardless of whether they are being treated by any specialist or not.
- before long and long journeys, especially to countries with unusual climate or epidemiological conditions;
- before planning pregnancy;
- before carrying out complex recreational activities: before visiting sanatoriums, medical resorts;
- before starting active sports.
The appearance of disturbing and unusual symptoms, a general deterioration in well-being, ailments of unknown origin is also the basis for consulting a functional diagnostician, although it would be more advisable to first contact a therapist.
What examination methods does the doctor use in his work?
The main activity of this specialist is the diagnosis of any pathological conditions and deviations in the work of the human body. In his work, he uses all the modern achievements of medical science, computer technology, biology, anatomy, chemistry, radiology, and physics.
If the attending general practitioner or narrow specialist has not previously prescribed any examinations, you should prepare before visiting the doctor. For example, it is recommended to take a general blood test with a mandatory determination of the level of hemoglobin, undergo electrocardiography and echocardiography procedures, do fluorography and fibrogastroduodenoscopy. Such analyzes and examinations can also be given in parallel with the process of conducting functional diagnostics.
Special preparation and preliminary testing is not required before ultrasound of the thyroid gland, lymph nodes and salivary glands, echocardiography, duplex ultrasound scanning of the vessels of the extremities.
When a patient first gets an appointment with a functional diagnostician, the doctor first conducts a survey and examination of the patient, during which, using his own knowledge, experience and skills, he studies and analyzes the information received. During the interview, he manages to find out the subjective manifestations of the disease, which became the reason for going to the doctor, while during the examination he receives objective information about the symptoms of the disease (changes in heart rate, temperature, test results, and other factors). Examining the patient, the doctor pays attention to the appearance of the skin and mucous membranes, examines the condition of the oral cavity and eyes, feels the abdominal cavity, lymph nodes.
The main diagnostic methods used by a doctor can be divided into the following types: clinical electrocardiography (it includes stress tests, vectorcardiography, phonocardiography and some other techniques); study of the functional state of external respiration, which consists in conducting inhalation provocative tests, assessing the degree of airway obstruction and the functional state of the lungs; assessment and analysis of the state of the nervous system - for this, the patient undergoes an electroencephalogram, electromyography, functional tests, transcranial magnetic stimulation; echocardiography; study of the state of the vascular system through rheography, oscillography, dopplerography, phlebography, the method of stress tests.
There are more specific methods of examination, for example, dopplerography of the heart, transesophageal pacing, variational pulsometry, pneumotachometry, reopletismography, endoradio sounding.
Many of these techniques are completely unfamiliar to the layman, and even therapists and narrow specialists cannot always say for sure when they should be performed. This is the value of a doctor of functional diagnostics - he knows exactly what examinations can be used to obtain information, for example, on the level of vascular tone, phases of the cardiac cycle, venous and arterial pressure, and how to dispose of it later for the benefit of the patient who applied.
Functional diagnostics is a branch of medicine that is responsible for the study of pathological conditions of organs and systems in the human body, features and disorders in their work. The information obtained in the process of applying the practical principles and methods of this medical industry is of great importance for the entire treatment process, because the diagnosis is often based on the data of the diagnostic examination. That is why the importance of the medical activity of a functional diagnostician is difficult to overestimate.
Functional diagnostics - a section of diagnostics, the content of which is an objective assessment, the detection of deviations and the establishment of the degree of dysfunction of various organs and physiological systems of the body based on the measurement of physical, chemical or other objective indicators of their activity using instrumental or laboratory research methods.
In a narrow sense, the concept of "functional diagnostics" means a specialized area of modern diagnostics based only on instrumental functional diagnostic studies, which in polyclinics and hospitals is represented by an independent organizational structure in the form of rooms or departments of functional diagnostics equipped with appropriate devices and devices with a staff of specially trained doctors and secondary medical staff.
Studies conducted in the Department of Functional Diagnostics
The department uses the equipment of leading foreign and domestic companies. Most of the diagnostic devices belong to the expert class devices. The following types of research are being carried out:
1. Heart examination:
1.1. Electrocardiography (ECG) in 12 leads
1.2. Holter monitoring - 24-hour continuous ECG recording using a portable device in order to detect latent myocardial ischemia, arrhythmias, life-threatening arrhythmic episodes accompanied by loss of consciousness, as well as to identify the cause of complaints of pain in the heart, interruptions,
1.3. daily monitoring of blood pressure - for the purpose of early detection of arterial hypertension, selection of drugs, detection of hypotensive conditions,
1.4. bicycle ergometry (examination of ECG with exercise in order to detect latent myocardial ischemia, as well as to determine exercise tolerance, degree of fitness),
1.5. echocardiography (EchoCG) - ultrasound examination of the heart, including all types of Doppler analysis for diagnosing heart diseases, identifying the causes of complaints of "interruptions" and pain in the heart area,
2. Examination of vessels:
2.1. ultrasonic dopplerography (USDG) of vessels:
2.2. Doppler ultrasound of the cerebral vessels (UZDG MAG) (main arteries of the head).
2.3.. Ultrasound of the arteries of the upper and lower extremities
2.4. Duplex and triplex scanning of cerebral vessels, arteries and veins of the upper and lower extremities - in order to identify the severity of atherosclerosis, the degree of vascular stenosis, disruption of the valves of the veins, etc.
2.5. Evaluation of elastic properties of blood vessels - express diagnostics of early stages of atherosclerosis.
3. Examination of the function of external respiration:
3.1 spirometry.
3.2 conducting drug tests with the selection of effective bronchodilators,
3.3. peak flow monitoring for the purpose of early detection and control of violations of the function of external respiration in bronchial asthma.
4. Examination of the nervous system:
4.1. electroencephalography (EEG), including computer EEG with mapping of pathological brain foci,
Preparation for research
Special preparation for research is not required.
When conducting daily ECG monitoring, patients should observe the following recommendations:
- throughout the day it is necessary to fill out the patient's diary;
- it is necessary to describe in the column the activity that you did, with the obligatory indication of the time: waking up, resting, walking, transport, watching TV, reading, eating, walking, running, climbing stairs, sleeping, night awakenings, etc., indicating the time in first column;
- it is necessary to mark periods of rest in a horizontal position during the day and specify those moments when he dozed off;
- be sure to mark symptoms in the column: pain in the heart, headache, etc .;
- be sure to mark in the column medication, taking all medications.
Before stress tests (treadmill test, bicycle ergometry):
- It is necessary to cancel (or adjust therapy individually) the following drugs before the study:
- beta-blockers - cancel 48-72 hours before the study;
- nitrates eazoactive drugs - cancellation on the day of the study;
- antiegregants - control therapy.
- The patient must take with him to the study all the constantly taken medications. Adequate correction of blood pressure indicators against the background of temporary withdrawal of beta-blockers is a prerequisite.
- do not take blood tests;
- do not smoke or drink coffee 2 hours before the examination;
- light breakfast - no later than 2 hours before the study;
- for men with intense hairline, it is advisable to shave their chest;
- take sports pants, socks, sports shoes.
- The study is carried out on an empty stomach or not earlier than 1.5-2 hours after a light breakfast.
- The patient should not smoke or drink coffee 2 hours before the examination.
- Before the study, do not use inhalers: short-acting inhalers (used up to 4 times a day) are canceled 6 hours before the study; medium-acting inhalers (usually used 2 times a day, morning and evening) are canceled 12 hours before the study; long-acting inhalers (used once a day) are canceled 24 hours before the study.
- Before the study, the patient should avoid intense physical activity.
- The patient must come to the study 15-20 minutes before the start in order to be able to rest a bit.
- It is advisable for the patient to get enough sleep, give up morning exercises, take a shower and not apply lotions and creams to the body.
- Light breakfast, without coffee, tea and energy drinks 1.5-2 hours before the study.
- Not later than 1.5-2 hours before the study, exclude smoking and physical activity
- Not later than 1.5-2 hours before the study - eating without coffee, tea, energy drinks,
- 1.5-2 hours before the study, the patient is advised not to smoke and not to exercise.
- The patient must take all medications without changes.
On the day of the study:
Before examining the function of external respiration:
Before ECG:
Before ECHO-KG:
ECG during hypoxia
ECG hypoxia is detected quite simply. As a rule, oxygen deficiency of the heart muscle immediately affects its work. An electrocardiogram is able to reveal in which area and how strongly the pathological process has developed. Read about the dangers of hypoxia and what deviations an ECG can show in this article.
ECHO KG of the child's heart - purpose, interpretation, precautions
ECHO KG is a method for diagnosing the work of the cardiovascular system using specialized devices that allow ultrasound to determine the work of the heart and valvular apparatus. In this article we will talk in more detail about echo kg in children.
Ultrasound of the bronchi - indications, preparation, interpretation
One of the most comfortable, simple and painless studies is bronchial ultrasound. This procedure allows you to identify certain problems with the respiratory system. Ultrasound of the lungs and bronchi is not a fairly common medical study. In terms of popularity, it is significantly inferior to conventional x-ray diagnostics. Most often, ultrasound of the bronchi is prescribed as an addition to other types of studies. Its significant advantage is the fact that it can be administered to both adults and children. Including babies.
Ultrasound of the brain in children
Ultrasound of the brain in children is the most modern, reliable and safe method for obtaining data on the structure and processes occurring in the subcortical structures of the brain, which are located in the cranium. This research method is widely used in the diagnosis of childhood diseases in newborns. When conducting neurosonography, a specialist is given the opportunity to observe the state of the brain, the volumes of its individual parts and identify a number of pathologies, if any.
Ultrasound at 32 weeks pregnant
Ultrasound at 32 weeks of pregnancy can tell a lot about both the condition of the fetus and the degree of its compliance with developmental standards, and the mother's readiness for childbirth. The main outcome of the survey is to identify the tactics of childbirth. In this article you will find information about what an ultrasound of the 32nd week is and how to decipher the result, as well as the norms for the development of the organs of the child and mother.
When and where to do ultrasound of the mammary glands - doctor's recommendations
Many women have heard that it is necessary to regularly visit a mammologist and do an ultrasound of the mammary glands. What is it and why is it needed? What problems can be solved by ultrasound examination? Is it harmless and who can do an ultrasound of the mammary glands? What problems will such research help to avoid?
Echo kg fetus during pregnancy
From this article, you will learn about the most popular cutting-edge method for examining pregnant women - fetal echocardiography. This method allows you to get the most detailed information about the presence or absence of any abnormalities in the baby's heart long before his birth. For the echo of a kg of fetus, thousands of saved lives of newborns are worth.
Ultrasound of the pelvis in women
In what cases do doctors prescribe an ultrasound of the pelvic organs. Diagnostic capabilities and principle of operation of ultrasound. Preparation for abdominal and obstetric ultrasound. Vaginal ultrasound. Survey technique.
What can not be done with Holter monitoring?
In this article, the reader will find information about the effectiveness of the Holter study in detecting pathologies of the cardiovascular system. Find out when it is prescribed, whether it is harmful to health, and what should not be done during Holter monitoring for a patient. We hope that the information will be useful.
How is an ultrasound of the prostate performed?
Ultrasound of the prostate gland is a method of functional diagnostics that allows you to determine the condition of the prostate in men and adjacent tissues. When and for what purpose the procedure is prescribed, how it is carried out and what it shows, read in this article.
Modern functional diagnostics: basics
Thanks to this direction, it is possible to identify various pathologies and dysfunctions of organs in the initial stages and take the necessary measures. We will consider the basics of functional diagnostics in this article.
You can read more about hormonal studies. If you are interested in female diagnostics, check out this article.
Blood tests, ultrasound, X-ray examinations are already well-known and even routine procedures for everyone. But modern medicine has much wider possibilities.
Functional diagnostics is one of the branches of medicine. Modern functional diagnostics of the body includes a whole range of diagnostic procedures that allow you to evaluate all the functional capabilities of the systems and organs of the body. This is the true key to understanding how the disease develops. Warning signs can appear even when tests and analyzes show that everything is normal. This is where functional diagnostics comes to the rescue. Functional diagnostics should not be underestimated, because a timely study will allow the doctor to prescribe the necessary treatment and avoid many of the consequences of the disease.
Functional diagnostics includes the following methods:
- Electrocardiogram;
- Holter electrocardiogram monitoring;
- Treadmill test (this is a cardiographic study that is carried out under load);
- Duplex and triplex color scanning of blood vessels;
- Electroencephalogram. Assessment of external respiration and the study of the ventilation properties of the lungs.
Let's talk about what is included in functional diagnostics in more detail.
This is a well-known and widespread method, which is one of the main ones in this branch of medicine. The electrocardiograph registers and fixes the indicators of the electrical activity of the heart on electronic or paper media, thanks to which a specialist in functional diagnostics, in the course of deciphering the information, can identify all kinds of health problems in a patient, if any. Existing rhythm and conduction disturbances are also detected. The specialist has the opportunity to evaluate the work of the myocardium, even at an early stage to diagnose all kinds of ischemic changes, including such a serious pathology as myocardial infarction. The process of taking an electrocardiogram is absolutely painless and safe for the patient. Modern equipment that records ECG is capable, in addition to the study itself, of accumulating a huge amount of data in memory and, on their basis, monitoring the quality of treatment courses passed by patients.
This method is also called treadmill tests of the functional diagnostics of the body. The peculiarity of this study is that an electrocardiographic study is carried out not in a supine state, but when the patient receives physical activity on a special treadmill. With the help of a treadmill test, data is obtained:
- how tolerant the subject's body is to stress;
- about the reaction of the human cardiovascular system to physical activity;
- whether there are cardiac arrhythmias during exercise;
- whether the quality of the blood supply to the heart muscle worsens (this happens with ischemia, especially its painless forms);
- how the patient's condition was affected by anti-ischemic, hypotensive or antiarrhythmic therapy.
Hotler monitoring
Functional diagnostics includes this method, which is used to assess the work of the subject's heart for a whole day. A study is being carried out in the Department of Functional Diagnostics. Holter monitoring makes it possible to detect any kind of arrhythmia (especially those that occur occasionally and last a short time) and the early stages of the development of coronary heart disease. This type of functional diagnostics is used to determine indications for coronary angiography, cardiac surgery, and correction of drug therapy.
This method of measuring blood pressure is used, probably, by every department of functional diagnostics. It is used to evaluate the effectiveness of drug correction of blood pressure. A portable device is connected to the patient for a day, which records changes in blood pressure levels during the patient's usual life. It is this method that often allows you to identify the level of pressure in a person by eliminating situational hypertension that occurs in response to stress. Such stress may well arise when visiting a medical institution. In addition, 24-hour monitoring makes it possible to identify such an unfavorable sign in terms of prognosis as nocturnal hypertension.
This technique is very important for identifying the features of the functioning and structure of the heart, as well as the main vessels. Echocardiography allows:
- identify congenital and acquired malformations of the heart;
- evaluate the operation and structure of the valves;
- determine the functioning of the myocardium and its thickness in coronary disease, hypertension and other lesions of the cardiovascular system.
Allows you to assess the state of the patient's brain based on its bioelectrical activity. Functional diagnosis of the brain is necessary if there is a suspicion of neurological pathologies (frequent fainting, encephalopathy, epilepsy, oncology, etc.)
This is the most informative and perfect method for studying blood vessels. It allows you to see both the vessels and the tissues surrounding them, as with a conventional ultrasound. In addition, the method makes it possible to study blood flow using spectral analysis, as well as color mapping. It is based on the Doppler effect. Color scanning consists of the following methods of functional diagnostics:
- scanning of brachiocephalic arteries (their extracranial sections). Using this method, they examine the vessels designed to supply blood to the brain and identify;
- the degree of narrowing of the lumen of blood vessels;
- the presence of atherosclerosis and the nature of atherosclerotic plaques;
- condition and course of the vertebral arteries;
- squeezing of vessels in cervical osteochondrosis;
- condition of the subclavian and carotid arteries.
The indications for the scan are hypertension, headaches, dizziness, symptoms of impaired blood supply to the brain. The method of scanning the arteries of the extremities allows you to assess the condition of their walls, determine changes caused by atherosclerosis, the degree of vascular lumen and the nature of blood flow. This is the optimal technique for detecting obliterating atherosclerosis, Raynaud's syndrome, during surgical interventions. Scanning of the veins of the extremities is an informative method for determining the early signs of varicose veins, thrombophlebitis, and assessing the need for surgical intervention. This technique allows you to determine thrombosis and the state of the deep-lying venous network. In addition, a scrupulous study of the state of the veins of the extremities is necessary in preparing the patient for abdominal operations.
For a more detailed idea of this section of medicine, you can see pictures of functional diagnostics on the Internet.
The method serves to accurately assess blood flow in the vessels that are located at the base of the brain. Thanks to this diagnostic procedure, it became possible to determine the main causes of blood flow disorders and their degree, as well as prescribe the necessary and correct treatment.
Thus, modern functional diagnostics has a wide range of studies that allow you to detect disorders at an early stage, when they are easiest to cure, and prevent negative consequences. Thanks to the rapid development of technology today, this is possible, so that functional diagnostics, one might say, is the future of medicine.