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​Internal medicine​

 About our hospital's response to new coronavirus infections

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​General internal medicine

We diagnose acute diseases such as cold, bronchitis and hay fever, and chronic diseases such as hypertension, hyperlipidemia and diabetes.

For chronic diseases, vascular age is evaluated using carotid echo.

In addition, we can handle burns and emergency illnesses in general, so please contact us if you have any problems near you.

If the temperature is below 37.5 ° C, we can handle cold symptoms, so please contact us.

一般内科
table of contents
·cold
・ Fever, tremor
・ Night sweats, hot flashes
・ General malaise
·Weight loss
·headache
・ Chest pain
·stomach ache
·lower back pain
・ Joint pain / arthritis
·dizzy
・ Loss of consciousness
・ Numbness
·edema
・ Neck lump
・ Cough (chronic)
・ Dyspnea
・ Palpitations
・ Diarrhea / constipation
·rash
·dementia
・ The appearance of the elderly is strange

​Cold is a very common name of illness, but as a doctor, we treat various illnesses in mind.

If you list the names of the assumed diseases

・ Viral rhinitis

·allergic rhinitis

・ Viral pharyngitis

・ Viral bronchitis

・ Cough after cold + post-nasal drip

・ Acute bacterial sinusitis

・ Group A β-hemolytic streptococcal pharyngitis

・ Infectious mononucleosis

・ Subacute thyroiditis

・ Peritonsillar abscess

・ Acute epiglottitis

·pneumonia

・ Bacterial bronchitis

·pulmonary tuberculosis

·heart failure

・ Cough asthma

Etc. We will focus on the three symptoms of "cough," "nasal discharge," and "pharyngitis," and proceed with the diagnosis.

·cold
アンカー 1
発熱
・ Fever / tremor (chills / fighting)

I have a fever and the tremor doesn't stop. When I tremble, I am treating with the following diseases in mind. If a local infection affects the whole body, it is more likely to be severe. You need to have a solid understanding of your physical findings.

·influenza

·COVID-19 infection

・ Acute pyelonephritis

・ Acute prostatitis

・ Purulent cholangitis

・ Cholecystitis

・ Liver abscess

・ Acute viral hepatitis

​ ·pneumonia

・ Lung abscess

・ Meningitis

・ Soft tissue infections such as cellulitis

・ Fasciitis

・ Infective endocarditis

・ Myocarditis / epicarditis

​

​ It is necessary to systematically search for heat sources. It is necessary to check the fever + X of X in detail. Confirmation of X requires multidisciplinary clinical experience.

Pathological night sweats are sweating enough to change clothes during sleep, which means that you are sweating moistly even though it is not hot. It is distinguished from excessive sweating during the day and sweating due to the heat. Hot flashes, also referred to as hot flashes, are a transient symptom that is found in the upper body, often accompanied by sweating, and improves within minutes. The medical examination will be conducted assuming the following.

・ Infectious disease (acute)

・ Infectious diseases (chronic), especially tuberculosis

・ Menopause (male / female)

・ GERD (Gastroesophageal Reflux Disease)

・ Drug property

·Diabetes mellitus

・ Hypoglycemia

·hyperthyroidism

・ Hypothyroidism

・ Adrenal insufficiency

・ Hyperparathyroidism

・ Sleep apnea syndrome

・ Withdrawal symptoms

・ Mental illness (anxiety, depression)

・ Malignant tumors (especially malignant lymphoma and renal cell carcinoma)

・ HIV

・ Infective endocarditis

・ Deep abscess

・ Collagen disease

・ Dumping syndrome

・ Spinal cord disease

・ Independent neurological disorder

・ Pheochromocytoma

・ Carcinoid

​ Pay attention to physical findings and weight loss.

・ Night sweats / hot flashes
寝汗・ほてり
全身倦怠感
・ General malaise

General malaise means that your body is very tired. The examination is divided into physical illness, mental illness, and a combination of these. A detailed medical history and simple tests are enough to make a diagnosis in most cases. The following are assumed as diseases.

・ Infectious disease (acute)

・ Infectious diseases (subacute to chronic) (tuberculosis, HIV, infective endocarditis, etc.)

・ Mental illness (depression, somatization disorder, panic disorder, stress, bereavement of a loved one, etc.)

・ Irregular consumers

·Diabetes mellitus

・ Fulminant type 1 diabetes

·hyperthyroidism

​ ・ Hypothyroidism

・ Adrenal insufficiency

・ Hyperparathyroidism

・ Electrolyte imbalance, acidosis

・ Post-infection fatigue (sequelae of new coronavirus infection, etc.)

·anemia

​ ・ Organ failure

・ Drug-induced (drugs that cause drowsiness, drugs that cause muscle weakness, drugs that lower blood pressure and lightheadedness)

・ Iron deficiency without anemia

·Malignant tumor

・ Collagen disease (especially polymyalgia rheumatica)

・ Neuromuscular disease

·alcohol

・ Sleep apnea syndrome

·pregnancy

·menopause

・ Chronic fatigue syndrome

・ Fibromyalgia

・ Cerebrospinal fluid leakage (low cerebrospinal pressure syndrome)

体重減少
·Weight loss

First, make a clear check to see if you have unintentional weight loss or if you are on a diet and losing weight. Check specifically when and how many kilograms you have lost weight. If you are not sure, check your weight one month later. Check for appetite and fever. A weight loss of 5% or more of the original body weight in half a year is considered to be clinically important weight loss.

After that, we will distinguish the following diseases.

·Malignant tumor​

·depression

・ Alcoholism

​ ·hyperthyroidism

·Diabetes mellitus

・ Gastrointestinal ulcer

・ Drug property

・ After dementia and cerebral infarction

・ Advanced heart failure, COPD, renal failure

・ Malabsorption syndrome (Crohn's disease, chronic pancreatitis)

・ Adrenal insufficiency

・ Hypercalcemia

​ ·tuberculosis

・ Abscess (liver / kidney / anus circumference)

・ Infective endocarditis

・ HIV

・ Malignant lymphoma

・ Polymyalgia rheumatica

・ Nervous anorexia

For example, to confirm alcohol dependence, screening using the CAGA score is performed. C ut down: one is that you feel must reduce their alcohol intake. A nnoyed by criticism: Have you ever troubled been criticized their alcohol consumption until now to the people around. G uilty feeling: or thought that is not good about his drinking, have you felt the guilt. E ye opener: Have you the the Asazake. If you meet two or more items, you are more likely to be alcoholic.

頭痛
·headache

We will proceed with the diagnosis by checking whether the headache is repeated, the degree of the headache, and the neurological symptoms. We will distinguish the following diseases.

・ Tension headache

·Migraine

・ Cluster headache

・ Sinus headache

・ Neuralgia (trigeminal nerve, glossopharyngeal nerve, occipital nerve)

・ Headache associated with acute infections (cold, pneumonia, urinary tract infections, etc.)

·depression

・ Drug-induced headache due to withdrawal

・ Headache due to head and neck disease (toothache, temporomandibular joint disease, cervical spondylosis)

·subarachnoid hemorrhage

·cerebral hemorrhage

・ Meningitis / encephalitis

・ Vertebral artery dissection, internal carotid artery dissection

・ Intracranial occupying lesions (abscess, hematoma, tumor)

・ Glaucoma attack

・ Hypertensive encephalopathy (PRES: posterior reversible encephalopathy syndrome)

・ Cavernous sinus thrombosis

・ Temporal arteritis

・ Cerebrospinal fluid leakage (low cerebrospinal fluid pressure syndrome)

・ Internal carotid artery cavernous sinus fistula

・ Idiopathic increased intracranial pressure

​ Symptoms of headache suspected of subarachnoid hemorrhage include: 1. Sudden onset, 2. Painful headache that has never been experienced, 3. Unusual headache, 4. Increasing frequency and severity of headache, 5.50 These include the first headache after age, 6. headache with neurological loss and visual impairment, and 7. headache with closed eyes and quiet endurance. On rare occasions, some patients walked to the emergency department and were diagnosed with subarachnoid hemorrhage by CT examination. If you have any of the above symptoms, please call an ambulance.

・胸痛

　診断には病歴の聴取・判断が最も有用です。病歴で診断する気構えを持って話を聞きます。重症度の判断はバイタルサインを重要視します。下記を念頭に置いて診療しています。

・肋軟骨炎

・剣状突起痛

・肋骨骨折

・胸壁の単神経炎

・帯状疱疹

・Tietze症候群

・胸壁の血栓性静脈炎（Mondor病）

・胸鎖関節炎

・頚椎症

・胸壁の筋肉痛

・ウイルス性胸膜炎

・気胸

・肺炎

・パニック症候群、うつ病、過換気症候群

・GERD、消化性潰瘍

・食堂攣縮症

・その他の機能性食道障害

・胆石症

・急性冠症候群

・急性大動脈解離

・肺塞栓症

・異型狭心症

・心筋・心外膜炎

・たこつぼ心筋症

・特発性食道破裂

・急性白血病での胸骨痛（骨髄の膨張によって）

​　問診の一つのテクニックとしていつから胸痛を自覚しているかが大事です。くも膜下出血と同様に重症度が高いほど、発症時の状況を良く覚えていることが多いです。冷や汗​、脂汗を自覚するような初めて体験するような胸痛は重症度と緊急度が高い疾患の可能性があります。症状が辛く自ら病院へ受診するのが難しいと判断したら、迷わず救急車を呼んで下さい。（それでも迷う場合は7119に連絡し救急車を呼ぶかどうか確認して下さい）

胸痛

　バイタルサイン、病歴、身体所見より総合的に判断します。腹部にある臓器は多数あり、診療医の経験が試されます。基幹病院に紹介してでも確定診断が必要な症状かどうかを判断する必要があります。以下の疾患を想定して診察いたします。

・急性胃腸炎

・蠕動痛

・消化性潰瘍

・過敏性腸症候群

・胆石症

・虫垂炎

・憩室炎

・肋骨・肋軟骨・剣状突起痛

・尿管結石

・膀胱炎

・急性冠症候群（心筋梗塞）

・大動脈解離

・腸間膜動脈（静脈）血栓症

・糖尿病性ケトアシドーシス

・子宮外妊娠・卵巣茎捻転

・腸閉塞（大腿ヘルニア、内ヘルニアも含め）

・腸重積

・急性膵炎

・腎盂腎炎

・炎症性腸疾患

・悪性腫瘍（胃癌、肝臓癌、大腸癌、膵臓癌、腎癌、悪性リンパ腫）

・副腎不全

​　腹痛は検査しないと鑑別つかない場合を多く経験します。まさに後医は名医の症例（ケース）がゴロゴロする症状です。町医者としては確定診断を間違えても患者様の不利益にならぬように慎重に対応する必要があります。虫垂炎一つをとっても初期症状は典型的なMcBurney点の圧痛ではなく心窩部痛を自覚する場合があるなど症状が多彩です。

・腹痛
腹痛
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