1.) Make up questions to ask about patient`s complaints.

2.) Dramatize the dialogue.

Ask if patient has ever had jaundice.

Ask about occupational or other exposure to toxins.

Ask about recent travel or contact with a person who has traveled to areas where hepatic disease is epidemic.

Alcohol consumption, a significant factor in suspected hepatic disease.

Any recent blood transfusions, blood tests, tattoos.

If the patient take any drug that may cause liver damage.

If the patient's weight has fluctuated recently.

Ex 2. Study the text and speak on the diagnostic tests used for assessment of gallbladder disease. What data may be revealed by each of them?

Assessing for Gallbladder Disease

During physical examination of a patient with suspected gallbladder disease look for pain, jaundice (a result of blockage of the common bile duct), fever, chills, indigestion, nausea, and intolerance of fatty foods. Numerous tests are available to detect hepatic disease. Perhaps the most useful test is the liver function studies, which measures serum enzymes and other substances. Other useful diagnostic tests include: abdominal X-rays, barium studies, oral cholecystography, percutaneous transhepatic cholangiography, computed tomography scans, liver biopsy.

Ex. 3. Read the text” Hepatitis-Viral” and find in it the answers to the following questions:

1 .What is hepatitis?

2. What are the early signs of the disease?

3. Are these symptoms similar to signs of other diseases?

4. What are the late manifestations of the disease?

5. What types of hepatitis are recognized?

6. What are their causes?

7. Why is hepatitis considered to be a potentially serious disorder?

8. What are the main routs of transmission of hepatitis?

9. What should we know about prevention of hepatitis?

Hepatitis - Viral

Inflammation of the liver due to infection with one of the number of viruses known to cause them.

Symptoms: The early phases of hepatitis seem similar to any other viral illness including flu. There is fever, general aches and pains, nausea and vomiting, sometimes sore throat and headache. Loss of appetite is very severe, often way out of proportion to the amount of illness, and cigarettes taste especially bad. After about a week the fever falls, and jaundice appears along with abdominal discomfort, especially in the right upper abdomen. The stools may appear light in the color and the urine dark yellow or brown. There is profound fatigue and weakness, often accompanied by weight loss because of the loss of appetite and vomiting.

Cause: This type of hepatitis is caused by infection of the cells of the liver by certain viruses. There are several distinct types of hepatitis, based on both the course of the disease and the viruses that are found. Hepatitis A, previously called “infectious hepatitis", appears about two or six weeks after contact with someone who has it and lasts from several weeks to several months. Hepatitis B, previously called “serum hepatitis" appears six weeks to six months after contact and can last much longer, with a person carrying the virus from months to years. A recently recognized type of hepatitis, called non-A, non-B hepatitis is known to be caused by a virus, but not by the previously identified kinds. Hepatitis can also be caused by viruses that produce other diseases, such as infectious mononucleosis and cytomegalovirus disease.

Severity of problem: Hepatitis is always a potentially serious disease that can progress to chronic hepatitis or permanent liver damage. It is also a public health hazard, because it is quite contagious and it is often transmitted to others before a person knows he or she is ill.

Contagious? Yes, all forms of Viral Hepatitis are contagious. Hepatitis A virus is found in stool and urine and is passed by contact with contaminated food. It is contagious for as long as two weeks before a person is ill and for several weeks after that. Hepatitis B is most often passed from one person to another through blood transfusions or shared drugs but can also be transmitted through sexual contact and in saliva ( Hepatitis B is particularly difficult disease among male homosexuals). Hepatitis B is prevalent in certain groups of Orientals and can be passed from a carrier or infected mother to an unborn or newborn infant. Non-A, non-B Hepatitis is transmitted through blood transfusions and is the most common cause of post-transfusion Hepatitis.

Treatment: There is no specific treatment for viral Hepatitis. Rest, avoidance strenuous activity, a well-balanced, adequate diet and avoidance of substances that can further injure the liver (alcohol, certain drugs) are important.

Prevention: All forms of Viral Hepatitis are preventable by avoiding contact with persons who have the disease, especially by avoiding contact with their secretions. However, this is often not practical. While screening of donated blood will identify certain forms of hepatitis (hepatitis B), other forms cannot yet be identified. Injection of gamma globulin is helpful for people who have had known household exposure to someone with Hepatitis. There is a vaccine available (licensed in 1982) for use in people with particular risk for Hepatitis B.

Discussion: Hepatitis in infants and children (especially Hepatitis A) can be a “silent" illness - that is, the child may have what looks like intestinal flu (acute gastroenteritis) without ever becoming jaundiced. It is only when adults in the household become ill with jaundice that the real disease is identified. Hepatitis A is easily spread in group - care situations where babies are not yet toilet - trained.

Both pain and vomiting are common in gastric and duodenal disease.

Ex.4. Read the text “Cholecystitis-Acute” and complete the sentences using the information of it.

1. Acute cholecystitis is known to be …

2. The pain in cholecystitis is felt in …

3. Surgery is recommended if

4. The principal clinical signs of it are …

5 .Inflammation and infection of the gallbladder are associated with …

6. Severe pain and illness can result in …