Method (symptom) of Pasternatsky: we determine the pathology. Positive symptom of Pasternatsky Symptom of Pasternatsky is negative that

When identifying diseases of the urinary system and abdominal cavity, an important role is given to the identification of Pasternatsky's symptom. The name was fixed after the therapist Pasternatsky F.I. established the relationship between pain during tapping of the lumbar zone and the appearance of erythrocyturia in the urine. In modern medicine, when conducting an examination of persons with suspected pathologies of the kidneys and peritoneum, the definition of Pasternatsky's symptom is mandatory.

There are 3 options for identifying a symptom. The choice of the optimal technique for carrying out depends on the state of health, the well-being of the patient and the position in which he may be:

if the patient is able to sit or lie down, the examination technique is as follows: the doctor puts the palm of one hand on the lumbar area, makes several blows with his fist or the side of the second hand, without applying physical effort;
if the patient is able to take only a sitting position, the technique changes: the doctor makes tapping movements with his fingers in the border area between the lower ribs and the muscles of the lower back;
examination in the supine position: the patient lies on his back, the doctor brings his hand under the lumbar zone and makes several pushes.

After the manipulations, the patient is asked to urinate into a sterile container. If leached (without hemoglobin) erythrocytes are found in urine, this indicates a positive symptom of Pasternatsky. For the reliability of the study, all manipulations (tapping, tapping) are performed on both sides to identify reactions from the right and left kidneys.

When conducting an examination in children, all actions are replaced by light tapping with fingertips. In women during menstrual bleeding, the definition of Pasternatsky's symptom is not carried out. Pasternatsky's syndrome is not used as an independent diagnostic method due to insufficient information content. However, a significant advantage of the symptom is the possibility of using it in bedridden patients, when other complex diagnostic procedures are difficult or impossible.

Differentiation with the symptom of "tapping"

Many urologists confuse Pasternatsky's symptom and the effleurage symptom. The differences between these diagnostic methods are in the analysis of urine. For the correct definition of Pasternatsky's symptom, the key role is played by the combination of pain when tapping the lumbar region with the detection or increase in the number of red blood cells in urine.

Patient confirmation of pain is sufficient to determine the usual symptom of "tapping". Such a symptom during the examination appears in the area of the projection of the kidneys and may indicate:

consequences of injuries, bruises of the kidneys and spleen;
diseases of the digestive system (acute pancreatitis, cholecystitis, inflammatory bowel disease);
vascular ischemia with the formation of necrotic areas;
pathologies of musculoskeletal tissues (myositis, osteochondrosis, sciatica);
chronic gynecological diseases in women (endometriosis, metroendometritis, fibroids, ovarian cysts).

Deciphering the results

The disease is positive if, during the study, a person feels pain on the right, left, or both sides, in combination with erythrocyturia. A sharply positive symptom means an increase in pain during tapping or their provocation, which often indicates urolithiasis.

The interpretation of the symptom depends on the intensity and location of pain:

a weakly positive symptom - during the examination, the patient experiences vague sensations in the area of the projection of the kidneys;
a positive symptom - the patient feels pain, but it is moderate, tolerable;
sharply positive - the pain is severe, the patient may scream, wince;
Pasternatsky's symptom is positive on both sides - pain is felt on the right and left sides, which indicates a serious kidney injury, for example, with pyelonephritis;
Pasternatsky's symptom is negative on both sides - such an interpretation does not always indicate well-being in a state of health; if there are no red blood cells in the urine, the “tapping” symptom is positive, an extended diagnosis is required, the cause of the pain may not be in the urinary system.

If Pasternatsky's syndrome is negative on one or both sides, the reason sometimes lies in the prolapse of the kidneys. So, pain during examination by tapping will be absent even in the presence of confirmed renal pathologies, if the kidneys are displaced behind the lumbar region (pelvic dystopia).

What does it indicate?

The combination of erythrocyturia and pain when tapping (tapping) indicates the development of the following pathologies:

urolithiasis and nephrolithiasis with the formation of salt deposits in the ureters;
acute and chronic pyelonephritis - a catarrhal process that has engulfed the renal pelvis, calyx and parinchema, including with a purulent form of inflammation;
perinephritis and paranephritis - ailments associated with inflammation of the perirenal fat layer and fatty capsule;
malignant tumors of the kidney (carcinoma) and benign (adenoma, fibroma, cystic formations);
acute or chronic glomerulonephritis - an autoimmune process associated with damage to the renal tubules and glomeruli;
renal colic;
kidney injury.

Advanced Diagnostics

If a positive symptom of Pasternatsky is detected, an additional examination is necessary to establish a reliable diagnosis and prescribe appropriate therapy. An in-depth examination includes:

blood tests, general and biochemistry - tests for glucose, total protein, electrolyte concentration, alpha-amylase, creatinine;
general analysis of urine with the determination of the level of protein, leukocytes, erythrocytes, sugar, bilirubin, ketone bodies, flat cylinders, bacteria, specific gravity and density, microscopic examination of urinary sediment;
urinalysis according to Nechiporenko and Zimnitsky's test;
Ultrasound of the kidneys;
radiography with the introduction of contrast into the urinary tract;
cytoscopy with biopsy (in the presence of suspicious foci);
magnetic resonance imaging.

Such an examination allows you to establish the true cause of back pain and the presence of red blood cells in urine, to identify deviations in the functioning of the urinary system and abdominal cavity. Modern diagnostic methods (MRI, X-ray with contrast) allow you to visually assess the condition and internal structure of problematic organs.

Further tactics of the doctor's actions

After an extended examination of a patient with a positive symptom of Pasternatsky and establishing the cause of the deviations, complex treatment is carried out. The appointment of therapeutic measures depends on the diagnosis.

In urolithiasis, treatment is directed to the use of conservative methods, including taking medications that relieve painful spasms, dilate the ureters, increase urine output, and relieve inflammation. If the stones are uric, use agents with a dissolving effect. If the stones are large and there is a risk of blockage of the ureter, they resort to endoscopic methods of removal and surgical intervention.
In the course of acute catarrhal processes in the kidneys (purulent forms of pyelonephritis), they resort to intravenous or intramuscular infusion of antibiotics from the group of cephalosporins or penicillins. If the process is complicated by the formation of purulent cavities, they are opened, the contents are removed, the focus is washed with antiseptic solutions.
The disease often indicates kidney failure. Her treatment is reduced to the most sparing diet with the exclusion of salt and protein restriction, the normalization of metabolic processes. In severe cases (4-5 stages), hemodialysis is indicated to save life.
With oncological processes in the kidneys, the tactics of treatment depend on the type of tumor, stage, and the presence of metastases. If the neoplasm is benign, it is removed. In malignant tumors, surgery is indicated, followed by restorative therapy.

Pasternatsky's symptom allows you to identify obvious and hidden pathologies of the kidneys and urinary tract, neighboring organs. Some doctors consider the method outdated, but it does not lose its relevance and, in combination with more accurate diagnostic methods, is actively used to detect urolithiasis, various inflammatory diseases of the kidneys, and oncological processes.

Pasternatsky's symptom is used in the diagnosis of diseases of the urinary organs and serves to determine the inflammatory process and its localization. Most medical professionals confuse it with a symptom of tapping due to the similarity of both methods, which are based on the anatomical features of the ligamentous apparatus of the kidney. Due to its mobility, the inflamed organ reacts to the slightest fluctuations with severe pain and a change in the urine test.

Technique for carrying out the symptom of Pasternatsky

Pasternatsky's symptom is a standard research method used by doctors involved in the examination and treatment of patients with diseases of the urinary organs (urologists and nephrologists). The technique is simple and takes just a few seconds.

The patient is in an upright position (standing or sitting). The doctor puts the open palm of his hand on the lumbar region in the projection of the kidney and makes short blows to it with the second hand, clenched into a fist. If the manipulation is accompanied by severe pain on the side of inflammation, and the appearance or increase in the number of erythrocytes and leukocytes is determined in the urine test, the Pasternatsky test is positive, indicating the localization of the diseased kidney (right, left or both sides). The absence of any changes after the procedure means a negative result.

Differences from tapping test

The difference between the Pasternatsky symptom and the tapping test is that with the latter, a laboratory study of urine is not carried out and only the patient's pain sensations are taken into account. The tapping test is more common, as it is much easier to perform, does not take much time, and does not require special equipment, which is especially true for ambulance workers, community physicians and outpatient services.

Diseases that are detected by both methods:

acute and chronic pyelonephritis;
urolithiasis in the acute stage;
glomerulonephritis;
nephroptosis;
kidney neoplasms.

A positive symptom of tapping may indicate diseases of other internal organs located in the vicinity of the kidney. And vice versa: sluggish inflammation of the kidney is not always accompanied by severe pain.

To confirm or refute a disease of the urinary system, at least a general urinalysis, biochemical tests and ultrasound of the kidneys are required, followed by a consultation with a urologist, nephrologist or therapist.

Pasternatsky's symptom is not a disease, but a diagnostic method. Thanks to this technique, many diseases of the urinary system can be diagnosed. With a positive result, we can talk about the presence of severe pain and the acute phase of the pathology.

What is Pasternatsky's symptom and how is it different from effleurage

Pasternatsky's symptom is one of the diagnostic methods. Sometimes this method is mistaken for "normal tapping". However, there are significant differences between them:

when carrying out the symptom of Pasternatsky, the patient is carried out with tapping in the lumbar region (on both sides), then it is necessary to pass urine for the possible presence of blood impurities in it;
when tapping, the doctor is limited to only light tapping without the use of laboratory diagnostic methods.

What diseases can be identified

Among many urological diseases, a positive result of this technique can be in such cases:

infectious and inflammatory processes (, inflammation of the pelvis and calyces);
the presence of pus in the kidneys, which is formed due to inflammatory processes in nearby organs;
(the presence of pus in the perirenal tissue);
(presence of mineral deposits);
benign and malignant formations;

Research methodology

There are three ways to carry out this technique:

The patient is sitting or standing, the doctor places one hand on the lower back from the side of one kidney and taps lightly with the other hand.
The patient takes a “sitting” position, the doctor lightly taps on the area between the lower back and the twelfth rib.
The patient lies on his back, puts his hand on one of the kidneys, the doctor at this time carries out small tremors.

It is important to note that the examination is carried out from two sides for a more reliable result.

Deciphering the analysis

The test result is considered positive if during the examination the patient feels severe pain, and the number of red blood cells in the urine analysis is increased. If only pain is noted, then additional studies will be required.

Depending on the severity of pain, the result can be mild, moderate and acute. In the first case, doctors believe that the result of the analysis is false positive and prescribe or other tests.

When the pain is very strong and during tapping, the patient must definitely say about it. In some cases, with congenital pathologies, the result of the analysis is negative. With a false positive result, pain may indicate the presence of other diseases (liver, spleen, etc.).

Complications

Do not confuse this method with simple tapping. If the patient feels pain during the examination, but the urine test is normal, then we can talk about the presence of such pathologies:

disorders of the gastrointestinal tract and intestines;
disorders in the musculoskeletal system.

Sometimes the pain can come from an injury to the back or kidneys. Therefore, to exclude other diseases, it is necessary to conduct additional diagnostics.

Secondary pyelonephritis (associated) is an inflammatory disease of the kidneys with lesions of the calyces and pelvis system, which develops against the background of already existing renal pathologies. This form of the disease occurs in most patients of the nephrology department. Some doctors believe that such a nosology as primary pyelonephritis does not exist. This is due to the fact that it is not always possible to establish the cause of the pathology using the available diagnostic methods.

Risk factors

The disease pyelonephritis is divided into obstructive and non-obstructive. This classification is based on the state of patency of the urinary tract.

Obstructive pyelonephritis occurs on the basis of a congenital or acquired pathology of the urinary system, in which there is difficulty in the outflow of urine. Congenital malformations include pyeloectasia, hydronephrosis, various anomalies of the urinary duct, vesicoureteral reflux, bladder diverticulum.

In adults, urolithiasis, strictures of the ureter, and various malignant neoplasms most often become the cause of difficulty urinating. A rather large risk group is made up of older and older men who suffer from prostate adenoma.

In pregnant women, especially for long periods, the growth and enlargement of the fetus contributes to the compression of the internal organs and, in particular, the ureters. In turn, this leads to a violation of the evacuation function.

Non-obstructive pyelonephritis occurs against the background of metabolic failures and various systemic diseases. With this form of pathology, there is no obstacle for urine, but metabolic processes are disturbed, which leads to a decrease in local and general immunity. Risk factors for the development of non-obstructive pyelonephritis are diabetes mellitus of the first and second types, arterial hypertension, atherosclerosis, long-term or chronic inflammatory diseases.

Etiology

The most common cause of pyelonephritis is Escherichia coli. Escherichia coli enters the kidneys from the anus via the ascending route through the urethra and ureters. And in case of violation of the passage of urine, favorable conditions are created for the development of the inflammatory process.

In women, pyelonephritis is more common than in men, which is explained by the peculiarities of the anatomical structure. The female urethra is wider and shorter than the male urethra and is located much closer to the anus. Therefore, in case of violations of the rules of personal hygiene, it is possible for E. coli to enter those organs and systems where it should not be normal.

But not only Escherichia coli causes secondary pyelonephritis. Against the background of existing pathologies of the urinary tract or diseases of other systems, proteas, Pseudomonas aeruginosa, staphylococci and streptococci can provoke inflammatory processes.

Symptoms

The symptoms of secondary pyelonephritis largely depend on the initial pathology that caused the inflammation and on the type of course of the disease (acute or chronic). For an accurate diagnosis, not only the symptoms are important, but also the data of laboratory tests.

Clinical picture

This form of the disease is characterized by an abrupt onset and severe symptoms of intoxication. Acute pyelonephritis debuts with a high temperature (38-39 ° C). The patient's condition deteriorates sharply, he complains of severe weakness, severe headache, dry mouth, nausea. At the same time, he is pale, cold sweat may appear, and the heart rate rises. In adults, the high temperature lasts all day. And in children, there are periods of its increase and decrease, within 24 hours.

If the cause of acute secondary pyelonephritis was obstruction in urolithiasis, then the patient complains of severe, paroxysmal pain in the lumbar region. With pain syndrome, a person is restless, rushing about. It is treated by taking antispasmodics or a hot bath.

If acute pyelonephritis is non-obstructive, then the pain syndrome is not so pronounced. Patients complain of aching, dull, sometimes pressing pain.

Informative in this clinical picture is the symptom of tapping, with the help of which the doctor checks the patient's sensations in the lumbar region and along the ureter. To do this, you need to put one palm on the projection of the kidney from the side of the lower back, and with the other hand? clenched into a fist lightly beat on it. With pyelonephritis, the patient will feel severe pain in the region of the kidney and below, along the ureter. Sometimes, on palpation on the side of the lesion, muscle soreness is noted.

The severity of symptoms largely depends on the form of the disease. Allocate:

Exacerbation, in which signs of intoxication are pronounced, body temperature exceeds 39 degrees. The overall clinical picture is in many ways reminiscent of sepsis.
Acute form with predominantly moderate intoxication and mild dehydration.
Subacute, in which local manifestations of pyelonephritis (back pain and changes in laboratory tests) are more pronounced than signs of intoxication.
Latent form, in which there are no symptoms. This is dangerous because more often than others it becomes chronic.

Manifestations of chronic secondary pyelonephritis

Secondary chronic pyelonephritis usually occurs after an acute form. Chronization of the process occurs due to insufficiently effective treatment or high resistance of bacteria and viruses, which caused the disease.

Chronic pyelonephritis is characterized by a blurred clinical picture. When taking an anamnesis, the patient notes moderate weakness, headache, chills, chilliness. The pain syndrome is not as pronounced as in the acute form. The temperature rises to 38 degrees.

Diagnostics

To make a correct diagnosis, the doctor must collect an accurate history, as well as correctly plan the examination plan. Of the laboratory methods, the most important are general urine and blood tests, according to Zimnitsky and Nechiporenko. And from instrumental - ultrasound examination of the kidneys, excretory urography with contrast, cystography and cystoscopy.

With pyelonephritis, leukocytes, casts and, most importantly, bacteria are found in the urine. These changes are characteristic and make it highly likely to suspect pyelonephritis. Urine analysis according to Nechiporenko is carried out to more accurately determine the number of leukocytes (a marker of the inflammatory process), erythrocytes and cylinders.

In the blood, the level of leukocytes rises, the ESR increases sharply (more than 25 mmh). In a biochemical blood test, creatinine and urea are important, as they are markers of the proper functioning of the kidneys.

If you suspect the presence of secondary pyelonephritis, it is important to identify the root cause of the disease. Plain radiography allows you to detect stones, determine the size of the kidney, the presence of cavities or pathological narrowing. On cystography, you can see tumors, pathological "niches" and other structural changes in the bladder. Ultrasound examination is necessary to determine the size of the kidneys, the structure of their walls and the pyelocaliceal system. With the help of ultrasound, stones and even sand are clearly visible with urolithiasis.

Therapy Methods

Treatment of all forms of secondary pyelonephritis is carried out in the conditions of the nephrology department. This allows you to monitor the dynamics of the process and adjust the prescribed treatment in time. The doctor warns about the need for bed rest and diet. During an exacerbation, you need to limit the intake of salt and protein, but at the same time increase the calorie content of meals. It is necessary to exclude canned foods, spices, meat, mushroom and fish broths, alcohol, strong tea and coffee. When the condition improves, the diet is gradually expanded, but it is possible to return to the previous diet only when complete remission is achieved.

Antibiotic therapy is prescribed in accordance with the causative agent of the disease. The selected drug should have a bactericidal effect and not affect the functioning of the kidneys.

In secondary pyelonephritis, a competent combination of etiotropic therapy with the restoration of evacuation function is important. To do this, it is necessary to eliminate the pathology that has become the root cause of inflammation. If the outflow of urine is disturbed due to urolithiasis, then the method of treatment depends on the size and number of stones. The doctor makes a choice between conservative, instrumental and surgical treatment. With congenital pathologies of the urinary system, in many cases, they resort to surgery.

Symptom of Pasternatsky

The symptom of Pasternatsky was fixed in the name after the identification of a special sign by the Russian therapist F.I. Pasternatsky when studying the manifestations of urolithiasis. He first noted the relationship of pain when tapping on the lower back and the subsequent increase in the number of erythrocytes in the urine with renal colic.

Modern diagnostics includes the mandatory determination of Pasternatsky's symptom in the scheme of primary examination of patients with suspected diseases of the kidneys, abdominal cavity. This method is used by doctors in differential diagnosis.

Of course, this method alone is not enough for a final diagnosis. A complete examination includes laboratory and instrumental, x-ray and ultrasound, magnetic resonance and even radioisotope studies. But in the practice of a doctor, it is rarely possible to use them at the patient's bedside.

symptom detection technique

if the patient can stand or sit, then the doctor is recommended to put the palm of one hand on the lumbar region and make several gentle blows with the fist or the edge of the palm of the other hand on the back of the hand;
if the patient is only sitting, then the doctor can tap with his fingers on the projection zone of the kidneys (on the border of the lower rib and lumbar muscles);
with the position of the person under study on the back, the doctor should bring his hand under the lumbar region and make several pushes.

All options include mandatory double-sided application. This allows you to identify differences in the response from each kidney. When examining children, tapping is carried out with a light finger tapping.

Interpretation of results

A positive symptom of Pasternatsky is detected when painful sensations appear on the right or left in the tapping zone. It is considered sharply positive if the pain increases significantly, is provoked by the research method. This result is most often found in urolithiasis.

We must not forget about the classic description of the procedure. This means that it is necessary to take a urine sample from the patient before and after the manipulation, to compare the content of erythrocytes. If an increase in hematuria is detected, then this sign is counted as a positive symptom.

The connection of pain with increased hematuria is important, since pain during effleurage can occur not only with an inflammatory process in the kidney, perinephric tissue, but also in cases of pancreatic pathology, with myositis, osteochondrosis of the lumbar spine.

If Pasternatsky's symptom is negative on both sides, one should not calm down and stop research on renal pathology. The cause may be anomalies in the localization of the kidneys or a latent stage of a chronic inflammatory process.

When is a positive symptom detected?

The result is defined as positive in the following diseases:

urolithiasis or nephrolithiasis with the formation of salt stones in the urinary tract;
acute or chronic pyelonephritis, when inflammation captures the pelvis, calyx and passes to the kidney parenchyma;
apostematous form of acute pyelonephritis, with a severe purulent course of the disease, the cause of which is often distant chronic foci of infection;
perinephritis and paranephritis - if inflammation passes to the capsule and perirenal fatty tissue;
kidney tumors, both with a benign course (cyst, angiolipoma, adenoma, fibroma), and with malignant growth (renal cell carcinoma, adenocarcinoma);
acute glomerulonephritis, less often in the chronic form of the disease, when autoimmune inflammation captures the renal glomeruli, the main structural units of the organ.

Features of diagnostics

In practice, doctors distinguish between the symptoms of Pasternatsky and "effleurage", when there is no increase in the number of red blood cells in the urine.

A positive symptom of "effleurage" can be with such pathologies as:

injuries of renal structures with bruises, wounds;
vascular ischemia with separation of necrotic tissues;
pathology of the perirenal tissue (paranephritis);
diseases of the musculoskeletal system;
diseases of the digestive system (especially the intestines);
in women with chronic inflammation of the appendages, cystic ovaries.

An in-depth diagnosis is required to confirm the connection of the “tapping” or Pasternatsky symptom with specific diseases. It includes:

complete history taking;
general blood test, biochemical tests for sugar, protein, nitrogenous substances, electrolytes, pancreatic and liver enzymes;
urine tests, including general examination, sediment microscopy, testing according to Nechiporenko and Zimnitsky, determination of protein, sugar, bilirubin;
ultrasound scanning of the abdominal cavity and kidneys;
X-ray techniques with survey pictures, tomograms, contrasting of the urinary tract;
cystoscopy;
magnetic resonance and computer research;
biopsy of suspicious tissue areas to exclude malignant growth.

These studies are evaluated in aggregate and provide more reliable information about the condition of the kidneys and other urinary structures, their functions, and the presence of pathology in neighboring organs.

Tactics of the doctor after the detection of a positive symptom of Pasternatsky

After detecting a positive symptom of Pasternatsky, the doctor prescribes an additional examination and, having received their results, makes a diagnosis and prescribes treatment.

In the treatment of urolithiasis are used:

conservative methods, which include relief of pain in renal colic, expansion of the ureters and forced diuresis to expel the stone, prophylactic administration of anti-inflammatory drugs to prevent pyelonephritis;
with stones formed from urate salts, it is possible to use drugs with a dissolving effect;
endoscopic methods of extracting stones;
shock wave lithotripsy method;
surgical treatment for complications (anuria, blockage of the urinary tract, renal bleeding).

Inflammatory and purulent processes in the kidneys and perirenal tissue require the immediate use of strong antibiotics of the group:

penicillins,
cephalosporins,
fluoroquinolones.

You may need to open the abscess with washing the cavity with antiseptic solutions. With autoimmune inflammation (glomerulonephritis) appoint:

preparations of the cytostatic group;
high doses of corticosteroids.

The initial manifestations of renal failure are treated with a strictly restrictive diet (minimum protein, no salt), compensation of the electrolyte and acid-base composition of the blood. It is necessary to make a timely decision on the use of hemodialysis. The method allows to save the life of patients.

The tactical approach to the treatment of kidney tumors depends on their origin and the results of the biopsy. Small benign neoplasms that do not tend to grow rapidly are simply observed. If the tumor is cancerous, then it should be removed as soon as possible. The volume of surgical intervention depends on the damage to the kidney, the degree of prevalence of the process in the lymph nodes and surrounding organs.

In the case of an inoperable stage, symptomatic agents are prescribed. As you can see, the detection of Pasternatsky's symptom is still important in the diagnosis and organization of subsequent treatment.

Is it possible to delay menstruation due to cystitis?

When the menstrual cycle is disturbed, this may indicate pregnancy or pathology of the genital organs. But if the test is negative, and there are no pathologies, then we can talk about cystitis. It can be caused by hypothermia or inflammation.

Is it possible?

Cystitis appears mainly due to pathogenic bacteria entering the bladder, which multiply rapidly and cause inflammation of the appendages, including the ovaries. For this reason, there is a delay in menstruation due to cystitis. The mechanism looks like this:

The female hormone estrogen affects the functioning of the bladder, and when its level drops, it weakens.
As a result, infections can easily enter the body.
This causes cystitis, and a hormonal imbalance can disrupt the menstrual cycle.

The absence of menstruation is not directly affected by cystitis itself, but by problems with hormones. For this reason, menstruation may not occur even after recovery.

What is considered a delay?

Even with cystitis, pregnancy cannot be ruled out. If the test is negative, then against the background of the disease, menstruation can be delayed both by 5 days and up to 2 weeks. But with high-quality complex treatment, the cycle will be restored.

Causes

Cystitis can occur due to hypothermia, the addition of infections against the background of a deterioration in immunity, as well as sexually transmitted diseases. Often it develops simultaneously with thrush. Risk factors include antibiotics, climate change, poor personal hygiene, and certain diseases.

Violations of the cyclicity of menstruation occur due to the fact that the pathology of the ovaries passes to the walls of the bladder. The cycle may not immediately recover even after the end of therapy.

Pregnancy with cystitis

Most girls know that a missed period is the first sign of pregnancy. But even if the test confirms this, sometimes cystitis, together with thrush, can accompany it both in the early stages and throughout the entire period. Most of all, cystitis during pregnancy affects girls who previously had it. If the disease has already become chronic by the beginning of pregnancy, its symptoms may worsen.

Negative test at delay

When there is a failure in the cycle, and the test shows a negative result, then you need to pay attention to the following symptoms:

frequent urination;
feeling of an empty bladder;
cramps during urination;
false urge to urinate;
blood in the urine and the appearance of pus;
sharp pains in the lower abdomen.

All of them indicate the onset of cystitis, which must be cured in time so that it does not become chronic.

What to do?

It is necessary to treat the disease depending on the cause of its occurrence. First, if you are late, you need to do a pregnancy test. Then be sure to visit a doctor.

He prescribes antibiotics aimed at eliminating the inflammatory process in the appendages. In addition, drug treatment may include taking such groups of drugs as:

antiseptics against infection;
antispasmodics;
painkillers.

To restore the menstrual cycle, drugs are also prescribed to restore hormonal balance. Their specialist selects, based on the age of the patient and the characteristics of her body.

You need to follow the right lifestyle and diet. This will restore the functioning of the organs, and drinking plenty of drinks based on natural ingredients will help cleanse the bladder of infectious agents.

Examination for the detection of cystitis includes the following activities:

gynecological examination - it determines the state of the pelvic organs, and also confirms or excludes pregnancy;
taking a smear from the vagina and cervical canal to identify the cause of infection;
blood test for hormones;
urinalysis according to Nechiporenko;
Ultrasound of the pelvic organs;
sowing on bacteriological flora.

What is dangerous?

Cystitis itself, with proper treatment, is not dangerous. But the presence of disruptions in the cycle may indicate adhesions in the fallopian tubes, the uterus itself or the ovaries. This can have dire consequences.

The consequence of the appearance of adhesions can be infertility, a woman can conceive and bear a child only as a result of the intervention of a surgeon or laparoscopy. It is impossible to ignore and refuse to treat cystitis, even in the mildest form.

Sometimes it occurs as a complication against the background of sexually transmitted diseases:

chlamydia;
genital herpes;
gonorrhea;
trichomoniasis, etc.

Most of these diseases negatively affect not only the functioning of the bladder, but also the female genital organs. If complications occur simultaneously, then against the background of cystitis, menstrual cycle failures are observed, and the symptoms appear more clearly.

To protect yourself from cystitis, you need to follow preventive measures: defecate on time, drink plenty of fluids and monitor the hygiene of the genitals. We must not forget that hypothermia is often the cause of cystitis, so you should always dress according to the weather, especially the appendages. After all, it is much better to wear warm trousers instead of a short skirt in the cold than to take antibiotics for a long time and be treated by other methods.

Percussion over the region of the kidneys, covered in front by intestinal loops, normally gives a tympanic sound. However, with a significant increase in the kidney, it moves the intestinal loops away, as a result of which a dull sound may appear above it during percussion.

In the diagnosis of many kidney diseases, the tapping method is used - the definition of Pasternatsky's symptom. Assessing this symptom, the doctor puts his left hand on the area of \u200b\u200bthe XII rib to the right and left of the spine and with the edge of the palm (or the tips of bent fingers) of the right hand inflicts short, gentle blows on it. Pasternatsky's symptom is usually determined in the patient's standing or sitting position, however, if necessary, it can also be checked in the patient's lying position, putting his hands under the lumbar region and applying them with jolts.

Depending on whether the patient has pain at the time of the blows and how intense they are, Pasternatsky's symptom is regarded as negative, weakly positive, positive and sharply positive. A positive symptom of Pasternatsky is noted in urolithiasis (especially at the time of renal colic), acute pyelonephritis, paranephritis, etc. However, it should be borne in mind that a positive symptom of Pasternatsky can be observed in osteochondrosis of the spine with severe radicular syndrome, diseases of the ribs, lumbar muscles, and sometimes in diseases of the abdominal organs (gall bladder, pancreas, etc.).

The percussion method is also used to determine the position of the upper border of the bladder. At the same time, placing the finger-plessimeter horizontally, percussion is carried out along the midline in the direction from top to bottom, starting approximately from the level of the navel. In cases where the bladder is empty, the tympanic sound persists up to the pubic symphysis. When the bladder is full, percussion in the region of its upper border, a transition of a tympanic sound into a dull one is detected. The protrusion of the upper border of the bladder above the pubis is noted in cm.

Description of the results of the study of the urinary system in the history of the disease in the absence of any pathological changes is usually quite brief: Pasternatsky's symptom is negative on both sides. The bladder percussion does not protrude above the pubic symphysis.

Section 3. Auscultation Auscultation. Question history.

Auscultation (from the Latin auscultatio - listening) is listening to phenomena in the body perceived by our ear or directly applied to the body, or with the help of tools: a stethoscope, phonendoscope, etc. Thus, auscultation deals with sounds that are formed in the body on their own, in contrast to percussion, where the doctor studies sounds that he specifically caused.

Auscultation was known in ancient times. So, already Hippocrates heard the sound of splashing during a concussion of the chest - succussio Hippocratis. In the future, auscultation is mentioned in the writings of the Greek physician Areteus; in the 17th century it was handled by Hooke; however, it was René Laennec who first developed this method in detail and scientifically. That is why the history of auscultation, as a scientifically based clinical method for examining a person, dates back to 1818, when the work of Laennec entitled "Traite de l'auscultation mediate et des poumons et du coeur" appeared.

There are two types of auscultation: direct, by attaching the ear to the body, and mediocre - using devices of various types and types, collectively called stethoscopes.

For the first time, Laennec began to use a stethoscope, and his first model was a tube made of rolled paper. Laennec himself believed that the stethoscope not only conducts sound, but also amplifies it. When it became known that an ordinary stethoscope is only a conductor of sound, stethoscopes began to be made that amplify sound by resonance. Such stethoscopes with resonators in the form of a hollow capsule with an amplifying membrane, which is applied to the body of the subject, are called phonendoscopes.

The question of which auscultation to give preference to - mediocre or direct was repeatedly discussed. Obviously, it is necessary to give preference to the first, because, firstly, it is more hygienic, in particular in patients who are contagious and untidy; secondly, it makes it possible to accurately localize auscultatory phenomena; finally, not all places can be heard directly with the ear, such as the pulmonary apices.