Diseases of the digestive organs - a frequent pathology of children's age. The prevalence of these diseases does not have regional characteristics and is currently exceeding 100 cases per 1000 children's population. In recent years, the possibilities of early diagnosis and treatment of gastroy diseases have significantly expanded. This was facilitated by the development and widespread introduction into the practice of endoscopic and new radiation methods of diagnostics, which began in the 70-80s. XX century. Detection of a role Helicobacter pylori.in the etiology and pathogenesis of chronic gastritis, gastroduodenitis and ulcerative diseases of the stomach and duodenum made it possible to develop the most rational methods of treating these diseases. Children peak disease disease digestive system falls on 5-6 and 9-12 years. At the same time, with age, the frequency of functional disorders of the digestion system decreases and the proportion of organic diseases increases.

Diseases of the stomach and duodenum

Acute gastritis

Acute gastritis is an acute inflammation of the gastric mucosa, due to the impact of a strong stimulus entering (received) into the cavity of the stomach.

Etiology

The development of acute gastritis may be due to exogenous or endogenous factors. The following types of acute gastritis distinguish.

Acute primary (exogenous) gastritis: - alimentary;

Toxic-infectious.

Acute secondary gastritis, complicating severe infectious and somatic diseases.

Corrosive gastritis occurring in the stomach of concentrated acids, pitching and other caustic substances.

Acute phlegmosic gastritis (purulent inflammation of the stomach). The causes of the occurrence of acute exogenous and endogenous gastritis are presented in Table 16-1.

Table 16-1.Etheological factors causing acute gastritis

Pathogenesis

With an exogenous gastritis of alimentary origin, poor-quality food has a direct irritant effect on the gastric mucous membrane, violating the processes of digestion, separation of enzymes that are part of the gastric juice. In the food toxicoinfection (PT) on the gastric mucosa, the causative agent itself is provided (for example, salmonella) and its toxins. In case of endogenous gastritis, the inflammatory process in the stomach mucosa is developing due to the penetration of the etiological agent hematogenic way.

Clinical picture

The clinical picture of acute gastritis depends on its shape and etiology.

The first symptoms of acute exogenous gastritis of alimentary origin appear a few hours after the impact of the pathological agent. The duration of the disease averages 2-5 days. The main clinical manifestations are as follows. - Anxiety of a child, general ailment, abundant salivation, nausea, loss of appetite, feeling of "overflow" in the epigastric area.

Possible chills, then subfebrile fever.

Subsequently enhanced abdominal pain, repeated vomiting arises, in the vomit masses - the remnants of food eaten 4-6 h.

Objectively note the pallor of the skin, the abandonment of the tongue with white-yellow raid, flatulence, with palpation of the abdomen - the development of the epigastric region.

Diarrhea is possible.

Clinical manifestations of toxic-infectious acute exogenous gastritis resemble such with an alimentary gastritis. The peculiarities of toxic-infectious gastritis include:

The possibility of developing dehydration due to more frequent vomiting;

Localization of pain in the epigastric and paramilical areas;

Pronounced diarrhea;

Moderate neutrophilic leukocytosis in the analysis of peripheral blood.

It is very hard with acute phlegmonous gastritis, accompanied by purulent melting the wall of the stomach and the propagation of pus along the submucosal shell. Phlegmosic gastritis can develop during the injuries of the stomach or as a complication of peptic ulcer. It is characterized by a high fever, strong pain In the abdomen, the rapid deterioration of the state of the child, re-vomiting, sometimes with an admixture of pus. In the blood, neutrophilic leukocytosis is revealed with the shear of the leukocyte formula to the left, in the analysis of urine - leukocyteuria and albumin.

Diagnostics

The diagnosis is usually based on history and clinical manifestations. In dubious and hard cases, FEGDS is shown.

Treatment

Bed regime for 2-3 days. Hunger in the first 8-12 hours from the beginning of the disease. A rich frequency drink is shown in small portions (tea, a mixture of 0.9% sodium chloride solution with a 5% glucose solution). After 12 hours, fractional dietary food is prescribed: mucous membranes of puree, low-fat broths, crackers, kisins, porridges. By the 5-7th day of the child's illness, they are usually transferred to a regular table. According to the testimony (in the first hours of the disease), washing the stomach through the gastric probe was prescribed with a warm 0.5-1% sodium solution of hydrocarbonate or 0.9% solution of sodium chloride. With toxic-infectious gastritis prescribed anti-inflammatory therapy, enzymes

(Pancreatin), antispasmodic preparations (papaverine, drootaverine). Phlegmosic gastritis is treated in a surgical hospital.

Prevention

It is necessary to properly organize the nutrition of the child in accordance with its age, prevent overeating, avoid fatty, fried and sharp dishes. When admit some medicines (for example, acetylsalicylic acid, glucocorticoids) must be monitored for the state of the stomach mucosa, use antacid drugs.

Forecast

The prognosis of acute gastritis is in most cases a favorable - complete recovery.

Chronic gastritis

Chronic gastritis is a long-term inflammation of the mucous membrane of the stomach diffuse or focal nature with the gradual development of its atrophy and secretory insufficiency leading to digestion disorder.

Epidemiological studies indicate the emergency prevalence of this disease increasing with age. It should be noted that children chronic gastritis only in 10-15% of cases proceed as an isolated disease. Much more often chronic gastritis (usually anthral) is combined with the affection of the duodenum, biliary tract, pancreas.

Etiology and pathogenesis

Chronic gastritis is most often developing due to constantly existing rational nutrition disorders (both in quantitative and qualitative terms): non-compliance with the treatment regime, constant use of dry, poorly facing, too hot or cold, roasted, acute food, etc. Chronic gastritis can develop with prolonged use of some drugs (for example, glucocorticoids, NSAIDs, antibiotics, sulfanimamides). In recent years, the meaning of hereditary predisposition is given, as chronic gastritis is more often detected in children with a family history of grooves with a gastrointestinal history.

A significant role in the development of chronic gastritis plays Helicobacter pylori.This microorganism is often detected from others.

family members of the patient child. Helicobacter pylori.it is capable of splitting urea (using the ureaz enzyme), formed at the same time, ammonia strikes the surface epithelium of the stomach and destroys the protective barrier, opening with gastric juice access to the tissue, which contributes to the development of the gastritis and the ulcerative defect of the stomach wall.

Classification

The current classification of chronic gastritis (Sydney system) is based on the morphological features and etiology of chronic gastritis (Table 16-2).

Table 16-2.Modern classification of chronic gastritis *

Clinical picture

The main symptom of chronic gastritis - pain in the epigastric area: an empty stomach, 1.5-2 hours after reception of food, night, often associated with the error in the diet. The decrease in appetite, heartburn, exhaust air or sour, nausea, leaning to constipation is also characteristic. In case of examination of the patient, palpatorially determines pain in the epigastric region and the saworoduodenal zone. Subsequently, the meteorism appears, the rumbling and feeling of "transfusion" in the stomach.

Diagnostics

The diagnosis is made on the basis of a characteristic clinical picture, data of objective inspection and special research methods. From the latter, especially informative FEGDS, which allows to obtain several types of changes in the stomach mucosa: hypertrophic, subatrofic, erosive, sometimes hemorrhagic gastritis. Functional study of the gastric juice allows you to evaluate the secretory, acid and enzyme-forming function of the stomach. Pentagastrin, 0.1% hystamine solution is used as a stimulus of the ferrous apparatus. In this case, the pH and the proteolytic activity of the gastric juice, the amount of hydrochloric acid (flow rate) is estimated.

Treatment

Treatment of chronic gastritis should be differentiated, complex and individual, depending on the etiology, morphological changes, the flow of the process and the age of the child. The main components of chronic gastritis therapy are listed below.

With pronounced exacerbation, steady treatment is necessary.

Diet: Food should be mechanically and chemically gentle (mucous soups, fierce vegetables and meat, kisins, porridges, drenched cottage cheese). Everything needs to be used in warm form every 3 h (with the exception of the night break).

With increased gastric secretion, antisecretory preparations are prescribed - Blockers H 2 Histamine receptors (for example, ranitidine). Inhibitor H +, K + -ATF-AZA omeprazole is prescribed for 4-5 weeks.

Given the frequent presence Helicobacter pylori,the so-called three-component therapy is prescribed: bismuth tricia dicyrates for 2-3 weeks, amoxicillin for 1 week and metronidazole for 1 week, in age doses.

With hypermotor dyskinesia in the gastroduodenal zone, myotropic spasmolitics (papaverine, drootaverine), as well as Metoklopramid and Domperidon are used.

Polyefermen preparations are shown (for example, Pancreatin - "Poletrath", "Creon").

Out of exacerbation, patients need sanatorium-resort treatment.

Chronic gastroduodenit

Chronic gastroduodenitis is characterized by a non-specific inflammatory structural restructuring of the hemous membrane and duodenum, as well as secretory and motor-evacuation disorders.

In children, in contrast to adults, the isolated damage to the stomach or duodenum is observed relatively rarely - in 10-15% of cases. The combined defeat of these departments is observed much more often. The duodenum, being a hormonally active organ, has a regulatory effect on the functional and evacuator activity of the stomach, pancreas and biliary tract.

Etiology and pathogenesis

The leading etiological role belongs to an alimentary (irregular and defective nutrition, the abuse of acute food, the food "dryness") and psychogenic factors. The significance of these factors increases in the presence of a hereditary predisposition to diseases of the gastroduodenal zone. Psychotracting situations in the family, school, the circle of communication is often implemented in the form of SVD, affecting the secretion, motorcy, blood supply, regenerative processes and the synthesis of gastrointestinal hormones. The long-term reception of drugs (glucocorticoids, NSAIDs), food allergies and other factors that reduce the local specific and non-specific protection of the mucous membrane are also.

One of the main reasons for the development of chronic gastroduodenitis - infection Helicobacter pylori.Duodenitis develops against the background of gastritis caused by Helicobacter pylori,and metaplasia of the epithelium of the duodenum in the gastric, developing as a result of the discharge of acidic gastric content in the duodenum. Helicobacter pylori.settled on the plots of metaplazed epithelium and causes the same changes in them as in the stomach. The foci of the gastric metaplasia is unstable to the impact of content

the duodenum, which leads to erosions. Therefore, gastroduodenitis associated with Helicobacter pylori,more often is erosive.

The above-mentioned etiological factors have toxic-allergic effects and cause morphological changes in the mucous membrane of the duodenum. Under these conditions, the role of acid-peptic damage to the mucous membrane increases in the occurrence of evacuation and motor disorders and reducing the intraodeodenal pH. Damaging factors first cause irritation of the mucous membrane, and in the future - dystrophic and atrophic changes in it. At the same time, local immunity changes, autoimmune aggression develops, the synthesis of hormones governing the motor-secretory function of the pancreatoatobiliary system is disturbed. In the latter there are also inflammatory changes. This leads to a decrease in the synthesis of secretine and saturation by bicarbonate of the pancreas juice, which, in turn, reduces the octication of the contents of the intestine and contributes to the development of atrophic changes.

Classification

There is no generally accepted classification of chronic gastroduodenites. They are subdivided as follows:

Depending on the etiological factor - gastroduodenitis primary and secondary (accompanying);

On the endoscopic picture - surface, erosive, atrophic and hyperplastic;

According to histological data - gastroduodenites with a light, moderate and severe degree of inflammation, atrophy, gastric metaplasia;

On the basis of clinical manifestations, the phases of exacerbation, incomplete and complete remission are distinguished.

Clinical picture

Chronic gastroduodenitis is characterized by polymorphism of symptoms and is often combined with other diseases of the digestive organs, in connection with which it is not always possible to degrade the manifestations caused by the gastroduodenitis itself, from the symptoms caused by the concomitant pathology.

Gastroduodenitis in the exacerbation phase is manifested by a noving grapple-shaped pain in the epigastric region, occurring 1-2 hours after meals and often irradiating in the hypochondrium (more often, the right) and the communal region. Reception or antacids reduces or stop pain. Pain syndrome may be accompanied by

solving, cutting in the epigastric region, nausea, sowing. In the mechanism for the development of pain syndrome and dyspeptic phenomena, the main role belongs to the discsion of the twelve-rosewoman. As a result, a duodenogastral reflux, causing a bitter belch, sometimes vomiting with an admixture of yellow, less often heartburn.

When examining patients, pallhy skin Pokrovas well as low body weight. The language is covered with white and yellowish-white bell, often with fingerprints of teeth on the side surface. When palpation of the abdomen determine soreness in the saworoduodenal region, less often around the navel, in the epigastric region and hypochondrium. Characterized by the symptom of Mendel. In many patients, the symptoms of the Oder and Crara.

In children with chronic duodenitis, vegetative and psycho-emotional disorders often note: periodic headaches, dizziness, sleep disorder, fast fatigue, which is associated with a violation of the endocrine function of the duodenum. Vegetative disorders can manifest a clinical picture of dumping syndrome: weakness, sweating, drowsiness, reinforced intestinal peristalistic, occurring 2-3 hours after receiving food. With a long break between food receivers, signs of hypoglycemia may occur in the form of muscle weakness, trembling in the body, a sharply increased appetite.

Chronic gastroduodenitis has a cyclical flow: the exacerbation phase is replaced by remission. The exacerbations are more likely to occur in weight and autumn, associated with a violation of the power regime, the overload in school, various stressful situations, infectious and somatic diseases. The severity of exacerbation depends on the severity and duration of pain syndrome, dyspeptic phenomena and disorders of the general condition. Spontaneous pains pass on average after 7-10 days, palpactor pain persists 2-3 weeks. In general, the aggravation of chronic duodenitis lasts 1-2 months. Incomplete remission is characterized by the lack of complaints in the presence of moderate objective, endoscopic and morphological signs of duodenitis. In the remission stage, neither clinical nor endoscopic, nor morphological manifestations of inflammation in the duodenum.

Diagnostics

The diagnosis of chronic gastroduodenitis is based on clinical observation data, studying the functional state of the duodenum, endoscopic and histological (biopsy of the mucous membrane) of studies.

With functional duodenal sensing, changes are detected, characteristic of duodenitis: dystonia Sphinteer Oddi, pain and nausea at the moment of the introduction of an irritant in the intestine, inversely flowing through the magnesium sulfate solution due to the duodenal spasm. With microscopy of duodenal content, the intestinal epithelium of the intestines, non-discontinued and vegetative forms of giardia are found. To estimate the functional state of the duodenum, the activity of enzymes enterocinate and alkaline phosphatase in duodenal content is determined. The activity of these enzymes is raised in the early stages of the disease and decreases as the severity of the pathological process is aggravated.

It is important and learning the gastric secretion. Its indicators with acidopeptic duodenitis (bullbite) are usually elevated, and with a combination of duodenitis with atrophic gastritis and enteritis - lowered.

The most informative method for the diagnosis of gastroduodenitis - FEGDS (see the section "Chronic Gastritis").

X-ray study of the duodenum does not matter in the diagnosis of chronic duodenitis, but allows you to identify various motor-evacuation disorders related to the disease or caused its cause.

Treatment

Treatment in chronic gastroduodenis is carried out according to the same principles as in chronic gastritis.

In the acute period of the disease, bedding is shown for 7-8 days.

Of great importance is the diet. In the first days of illness recommended the table? 1, subsequently - the table? 5. During the remission, a full-fledged nutrition is shown.

For eradication Helicobacter pylori.three-component therapy is carried out: bismuth tricia dicyrates in combination with amoxicillin or macrolides and metronidazole for 7-10 days.

With increased acidity of the stomach, H 2-blocks of histamine receptors are recommended, as well as omeprazole for 3-4 weeks.

According to the indications, the means regulating motility (methoclopramide, domperidone, drochopramine) are used.

In the process of rehabilitation, physiotherapy, LFC, sanatorium-resort treatment are prescribed.

Prevention

In the disease of the gastroduodenal zone it is very important to observe the principles of age nutrition, to protect the child from physical and

emotional overloads. Secondary prophylaxis includes adequate and timely therapy, observation and regular consultations of the children's gastroenterologist.

Forecast

With irregular and ineffective treatment, chronic gastritis and gastroduodenitis recurverate and become the main pathology of adults, which reduces the quality of life of the patient, its ability to work.

Gastric ulcer and duodenal ulcer

A peptic disease is a chronic recurrent disease, accompanied by the formation of a ulcerative defect in the stomach and / or a duodenal intestine due to a balance of equilibrium between the factors of aggression and the protection of the gastroduodenal zone.

In recent years, cases of ulcerative disease in children have become more frequent, the disease is currently registered with a frequency of 1 case per 600 children (according to A.G. Commune, 1996). Also noted the "Ombudation" of the disease, an increase in the share of pathology with a difficult flow and reducing the effectiveness of therapy. In this regard, the peptic ulcer of the stomach and duodenal sector in children represents a serious problem of clinical medicine.

ETIOLOGY

The disease develops as a result of the impact on the body of several adverse factors, including the hereditary predisposition and emotional overloads in combination with permanent alimentary errors (irregular nutrition, abuse of sharp dishes, the food "dryness", etc.). The main reasons are the disorder of the nervous and hormonal mechanisms of activity of the stomach and duodenum, a violation of equilibrium between aggression factors (hydrochloric acid, pepsins, pancreatic enzymes, grained acids) and protection factors (mucus, bicarbonates, cell regeneration, PG synthesis). The ulcerative formation is associated with long-term hyperchloridehydrium and peptic proteolysis due to vagotone, hypergastrine and hyperplasia of the main yellowing of the stomach, as well as with gastroduodenal dispersion and long-term acidification of the anthropulbar zone.

An important role in the development of ulcer disease is played Helicobacter pylori,detected in 90-100% patients in the mucous membrane of the anthral gastric department.

PATHOGENESIS

Several mechanisms are distinguished leading to an increase in the secretion of hydrochloric acid and pepsins, a decrease in the products of the mucous membranes and a violation of the motor regulation of the gastroduodenal zone. An important role in this process is given to the CNS that has a double impact on the secretion and motorcycle of the stomach and duodenum (Fig. 16-1).

Fig. 16-1.The influence of the central nervous system on the secretion and motorcycle of the stomach and duodenum.

Pathological changes in the central and vegetative nervous system play an important role in violation of equilibrium between protective and aggressive factors, contributing to the formation of an ulcer defect.

CLASSIFICATION

The classification of gastric ulcer and duodenal disease is given in Table. 16-3.

Table 16-3.Classification of ulcerative disease in children *

* From: A.A. Baranov. Children's gastroenterology. M., 2002.

Clinical picture

The clinical picture depends on the localization of the process and the clinical endoscopic stage of the disease.

Stage I Stage (Fresh ulcer)

The leading clinical symptom is pain in the epigastric area and to the right of the midline, closer to the navel, the pain arise on an empty stomach or 2-3 hours after reception of food (late pain). Half children celebrate night pain. The clear "Moisnigam" rhythm of pain is noted: Hunger-pain-accepted food facilities. Expressed dyspeptic syndrome: heartburn (early and most frequent sign), belching, nausea, constipation. The superficial palpation of the abdomen is painful, deep and difficult due to the protective tension of the muscles of the front abdominal wall.

With endoscopic examination, on the background of pronounced inflammatory changes in the mucous membrane of the gastroduodenal zone, a defect (defects) of a rounded or oval shape, surrounded by an inflammatory roller, with a bottom coated with fibrin overlauses of gray-yellow or white color is detected.

In the stomach of ulcers are located mainly in the piloroantral department (they find more often in boys).

In the twelfth gauge, ulcers are localized on the front wall of the bulbs, as well as in the zone of the Bullboduodenal transition. Motor-

active disorders include duoden-gastric reflux and spastic deformation of the bulbs.

II. stage (beginning of the epithelization of the ulcer defect)

Most children keep late pain in the epigastric area, however, they arise preferably, and after eating there is a persistent relief. Pains become more stupid, noving. The stomach is well available to surface palpation, but with deeply saved muscle protection. Dyspeptic manifestations are expressed less.

In an endoscopic study, hyperemia of the mucous membrane is expressed weaker, reduced by the edema around the ulcerative defect and disappears the inflammatory shaft. The bottom of the defect begins to be cleaned of fibrin, the convergence of folds to the ulcer is planned, which reflects the healing process.

III stage (healing of ulcers)

Pain in this stage is preserved only on an empty stomach, at night their equivalent may have a feeling of hunger. The stomach becomes available deep palpation, soreness is saved. Dyspeptic disorders are practically not expressed.

When endoscopy at the site of the defect, traces of reparation in the form of red scars, having a different form - linear, circular, stars. It is possible to deformation of the wall of the stomach or duodenum. Signs of the inflammatory process of the stomach and duodenal mucosa are preserved, as well as motor-evacuation disorders.

IV stage (remission)

The general condition is satisfactory. No complaints. Palpation of abdomen is painless. Endoscopically mucous membrane of the stomach and duodenum is not changed. However, in 70-80% of cases, a persistent increase in the acid-forming function of the stomach is detected.

Complications

Complications of ulcerative disease are registered with 8-9% of children. Boys have complications 2 times more often than girls.

In the structure of complications, bleeding is dominated, and with a duodenal ulcer, they develop significantly more often than with a stomach ulcer.

Perforation of ulcers in children is more often occurring at the stomach ulcer. This complication is accompanied by an acute "dweller" pain in the epigastric area, a shock state is often developing.

Characteristically disappearance of liver stupidity at the percussion of the belly due to air in abdominal cavity.

Penetration (penetration of ulcers in neighboring organs) occurs rarely, against the background of a long heavy process and inadequate therapy. Clinically penetration is characterized by suddenly arising pain, irradiating in the back, and re-vomiting. The diagnosis is clarified using FEGDS.

DIAGNOSTICS

The diagnosis of peptic ulcer, in addition to the above clinical endoscopic substantiation, confirms the following methods:

Fractional sounding of the stomach with the determination of the acidity of the gastric juice, the flow rate of hydrochloric acid and pepsins. It is characterized by an increase in the pH of the gastric juice of an empty stomach and when using specific stimuli, increasing the content of pepsins.

X-ray study of the stomach and duodenal intestine with contrasting the barium mixture. Direct signs of ulcers - a symptom of a niche and a typical deformation of the duodenal bulb, indirect - spasm of the gatekeeper, dunk duodenal dyskinesia, gastric hypersecretion, etc.

Detection Helicobacter pylori.

Repeated definition of hidden blood in feces (Gregersen reaction).

TREATMENT

Treatment of patients with ulcer of the stomach and duodenum must be comprehensive, it is carried out in stages with the study of the clinical and endoscopic phase of the disease.

Stage I - the phase of exacerbation. Treatment in the hospital.

Stage II - phase of manifestation of manifestations, beginning of clinical remission. Dispensary observation and seasonal prevention.

III stage - phase of complete clinical and endoscopic remission. Sanatorium treatment.

I stage

Conservative treatment of ulcerative diseases start immediately after diagnosis. Many patients have healing of ulcers for 12-15 weeks.

Bed regime for 2-3 weeks.

Diet: chemically, thermally and mechanically gentle food. Therapeutic tables on Pevznera? 1a (1-2 weeks) ,? 1b (3-4 weeks) ,? 1 (during remission). Power must be fractional (5-6 times a day).

Reducing the damaging action of hydrochloric acid and pepsins.

Unseasonable antacids: algelfle + magnesium hydroxide, aluminum phosphate, simaldrat, etc.;

Antisecretory preparations: histamine antagonists H 2 -receptors (for example, Ranitidine) for 2-3 weeks; Inhibitor H + -, K + - Atphase omeprazole for 40 days.

Elimination of hypermotor dyskinesia in the gastroduodenal zone (papaverin, drootaverin, domperidon, metoclopramide).

In the presence of Helicobacter pylori.- three-component treatment for 1-3 weeks (bismuth tricia dicyrate, amoxicillin, metronidazole).

Taking into account the presence of disorders of digestion and suction - polyfe drugs (pancreatin).

Stage II

Treatment is carried out by a precinct pediatrician. He inspects the child 1 time in 2 months and conducts anti-inflicted treatment in autumn-winter and spring-winter periods (table? 1b, antacid therapy, visits within 1-2 weeks).

III stage

Sanatorium treatment is shown in 3-4 months after discharge from the hospital in local gastroenterological sanatoriums and on drinking balneological resorts (Zheleznovodsk, Essentuki).

Prevention

The exacerbations of ulcerative disease are usually a seasonal nature, therefore, with secondary prevention, a regular OSD is a pediatrician and the appointment of preventive therapy (antacid drugs), if necessary, a diet, the restriction of the school load (1-2 unloading days per week in the form of training at home). It is of great importance to ensure the house and school of a favorable psycho-emotional situation.

FORECAST

The course of ulcerative illness and the remote prediction depend on the timing of primary diagnosis, timely and adequate therapy. To a large extent, the success of treatment depends on the position of parents, understanding their seriousness of the situation. Permanent observation of the patient from a children's gastroenterologist, compliance with the rules for seasonal prevention of exacerbations, hospitalization into a specialized department with exacerbation to a large extent improve the disease forecast.

Diseases of fine and colon

Chronic noncommunicable diseases of thin and colon developing quite often, especially in children of preschool age. They represent a serious medical and social problem due to the large prevalence, the difficulties of diagnosis and with the severity of the consequences that violate the growth and development of the child. The basis of the intestinal diseases can be both functional and morphological changes, but they rarely succeed in the early period of the disease.

In early age children in connection with the anatomy-physiological characteristics of the digestion system in the pathological process, a thin and thick integer (enterocolitis) are often involved at the same time. For school-age children, more isolated lesions of the intestinal departments are characterized.

Chronic enteritis

Chronic enteritis is a chronic recurrent inflammatory-dystrophic disease of the small intestine, accompanied by a violation of its basic functions (digestion, suction) and, as a result, a violation of all types of metabolism.

In the structure of the pathology of the digestive organs, chronic enteritis as the main disease is registered in 4-5% of cases.

Etiology

Chronic enteritis is a polyethological disease that can be both primary and secondary.

Alimentary factors are given great importance: the food is dry, overeating, excess in the food of carbohydrates and fats with a lack of protein, vitamins and trace elements, early translation into artificial feeding, etc.

In recent years, such etiological factors as the impact of poisons, salts of heavy metals (lead, phosphorus, cadmium, etc.), drugs (salicylates, glucocorticoids, NSAIDs, immunosuppressants, cytostatics, some anti-

biotics, especially with long-term use), ionizing radiation (for example, with radiotherapy).

The emergence of diseases of the small intestine contributes to the events and acquired enzymopathy, malformations of the intestine, immunity disorders (both local and general), food allergies, operational interventions on the intestines, diseases of other digestive organs (primarily duodenal, pancreas, biliary tract ) and so on. When developing chronic enteritis, a child is usually difficult to distinguish one etiological factor. Most often, a combination of a number of factors both exogenous and endogenous nature is detected.

Pathogenesis

Under the influence of any of the factors listed above or their combinations in the mucous membrane of the small intestine, an emergency process develops, acquiring a chronic course due to the insufficiency of immune and compensatory-adaptive reactions. The enzymatic activity of intestinal glands is violated, the passage of chimuse is accelerated or slowed down, the conditions for the proliferation of the microbial flora are created, digestion and absorption of the main nutrients are disturbed.

Clinical picture

The clinical picture of chronic enteritrite is polymorph and depends on the prescription and phases of the disease, the degree of change in the functional state of the small intestine concomitant pathology. There are two main clinical syndrome - local and common.

Local intestinal (enteral) syndrome is due to a violation of the closed (membrane) and extension digestion. Watch meteorism, rumbling, abdominal pain, diarrhea. The feces are usually abundant, with slices of untapped food and mucus. Perhaps alternation of diarrhea and constipation. When palpation of the abdomen determine the soreness predominantly in the octopuspical region, the symptoms of exemplary and Porgyz are positive. In severe cases, pseudomassium phenomenon is possible. Intestinal symptoms More often occurs when receiving milk, raw vegetables and fruits, confectionery.

The total intestinal (enteral) syndrome is associated with water-electrolyte imbalance, absorption disorder of macro- and micronutrients and involvement in the pathological process of other organs (Malabsorption syndrome). Characteristic: Increased fatigue, irritability, headache, weakness, reduced body weight of varying degrees of severity. Mark skin dryness, change

nail, glossitis, gingivitis, snags, hair loss, twilight violation, increased vessel fragility, bleeding. The above symptoms are due to polyhypovitaminosis and trophic violations. In early age children (up to 3 years), anemia often identifies the metabolic dissemination, manifested by osteoporosis and bone rapidity, attacks of convulsion. The severity of the general and local enteral syndromes determines the severity of the disease.

Diagnostics is based on anamnesis data, clinical manifestations, results of laboratory and instrumental methods of the survey. Differentiated carbohydrate loads with mono- and disaccharides are carried out, sample with D-xylose. An informative is also an endoscopy with aiming biopsy and follow-up histological examination of a biopsy. The coprogram detects creature, steatore, amyloore.

Differential diagnosis is carried out with the most commonly developing hereditary and acquired diseases flowing with Malabsorption syndrome - acute enteritis, intestinal formation of fibrosis, gastrointestinal shape of food allergies, celiac disease, disaccharidase insufficiency, etc.

Treatment

See "Chronic Enterokolit" section.

Chronic enterocolit

Chronic enterocolitis is a polyethological inflammatory-sophisticated disease in which a thin and thick intersection is affected simultaneously.

Etiology

The disease occurs most often after transferring OKIs (salmonellosis, dysentery, escherihiosis, abdominal typhoid, viral diarrhea), helminthiasis, diseases caused by the simplest, errors in the food mode (long-term irregular, insufficient or excessive food), food allergic reactions. The development of the disease contributes to congenital and acquired enzymopathy, immunity defects, gastric diseases, liver, gorgeous pathways and pancreas, intestinal development anomalies, dysbacteriosis, vitamin failure, neurogenic, hormonal disorders, radiation impacts, irrational use of drugs, in particular antibiotics, etc. .

Pathogenesis

The pathogenesis is not clear. It is believed to, for example, that infectious agents can cause a violation of the integrity of tissue cells digestive tract, contributing to their destruction or morphological metaplasia. As a result, hypertension is formed, genetically alien organism, causing the development of autoimmune reactions. The accumulation of cytotoxic lymphocytes clones and the production of AT, directed against the AG structures of autologous tissues of the digestive tract. Press the value of the deficiency of secretory IgA, which prevents invasion of bacteria and allergens. The change in the normal intestinal microflora contributes to the formation of chronic enterocolitis, re-increasing the permeability of the intestinal mucosa for microbial allergens. On the other hand, dysbacteriosis is always accompanied by this disease. Chronic enterocolite can be secondary, when concerned other digestive organs.

Clinical picture

Chronic enterocolitis is typical of the wave-like flow: the exacerbation of the disease is replaced by remission. During the exacerbation of the leading clinical symptoms, pain in the stomach and violation of the chair are becoming pain.

The nature and intensity of pain may be different. Children more often complain about pain in the navel area, at the bottom of the belly with right-hand or left-sided localization. Pains arise at any time of the day, but more often in the afternoon, sometimes 2 hours after receiving food, increase before defecation, when running, jumping, driving on transport, etc. Stupid painting pain More peculiar to the damage to the small intestine, intense - colon. Equivalents of pain: challenge chairs after eating or, especially in young children, rejection of food, the selectivity of taste.

Another most important symptom of chronic enterocolitis is a stool disorder in the form of a diarrhea alternation (with a predominant dedication of the small intestine) and constipation (with a colon damage). The frequent clarification for defecation (5-7 times per day) with small portions of the feces of different consistency (liquid with an admixture of undigested food, with mucus; gray, shiny, foam, fettered - with predominance of putrefactive processes). Often appears "sheep" or tanning feces. The discharge of solid roast masses can cause the formation of the cracks of the rear pass. In this case, a small amount of blood scales appears on the surface of the carts.

The permanent symptoms of chronic enterocolitis in children also include bloating and a feeling of resolving the abdomen, a rice and transfusion in the intestine, reinforced extinguishing of gases, etc. Sometimes in the clinical picture of the disease dominates the pillagetative syndrome: weakness develops, fast fatigue, poor sleep, irritability, headache. Complaints on the intestinal dysfunction are departed into the background. With a prolonged course of the disease, the delay in the increase in body weight, less often, anemia, signs of hypovitaminosis, metabolic disorder (protein, mineral) is noted.

Diagnosis and Differential Diagnostics

Chronic enterocolitis is diagnosed on the basis of anamnestic data, a clinical picture (a long intestinal dysfunction, accompanied by the development of dystrophy), laboratory surveys (anemia, hypo-and disproteinemia, hypoalbuminemia, decrease in cholesterol concentration, total lipids, β-lipoproteins, calcium, potassium, sodium in serum, detection in conalers of mucus, leukocytes, steatores, creators, amylorreals), results of instrumental research methods (rectoroscopy, colophybroscopy, radiological and morphological studies).

Chronic enterocolitis should be differentiated from protracted dysentery (see chapter "Acute intestinal infections"), congenital enzymopathy [fibrosis, celiac disease, disaccharidase deficiency, exudative enteropathy syndrome (see section "Congenital enzymopathy and exudative enteropathy")] and others.

Treatment

Treatment in chronic enteritis and chronic enterocolite is aimed at restoring disturbed intestinal functions and preventing exacerbations of the disease. The basis of the treatment of teraphutic measures is therapeutic nutrition (assign the table? 4 by svnery). Also prescribe polyvitamins, enzyme preparations (pancreatin), pre- and probiotics [bifidobacteria bifidum + activated carbon ("Probiofa"), "Linex", lactobacilli acidophilic + Kefir mushrooms ("acipol"), "Hilak-Forte"], enterosorbents ( Smoktitis dioctahedral), prokinetics (trimethelin, loperamide, furniture, etc.). According to strict indications, antibacterial drugs are prescribed: "Intetrix", nitrofurans, nanidixic acid, metronidazole, etc. Apply phytotherapy, symptomatic agents, physiotherapy, leaf. Sanatorium-resort treatment is shown no earlier than 3-6 months after exacerbation.

Forecast

With timely and adequate treatment at all stages of rehabilitation, the forecast is favorable.

Syndrome of irritable gut

Syndrome of an irritable intestine - a functional disorder of the gastrointestinal tract, manifested by a combination of violations of the act of defecation with pain syndrome in the absence of organic changes in the intestine.

At the international workshop of experts in Rome (1988), a single definition of the irritable intestine syndrome was developed ("Roman criteria") - a complex of functional disorders a duration of more than 3 months, including abdominal pain (as a rule, decreasing after the defecation act) and dyspeptic disorders (meteorism , rumbling, diarrhea, constipation or their alternation, a sense of incomplete intestinal emptying, imperative appeal for defecation).

In developed countries in an adult population, the irritably syndrome develops with a frequency of 14 to 48%. Women suffer from this disease 2 times more often than men. It is believed that 30-33% of children suffer functional intestinal disorders.

Etiology and pathogenesis

Syndrome of an irritable intestine - polyethological disease. An important place in its development is given to nervous psychic factors. It was established that in the syndrome of the irritable intestine, the evacuation function of both thin and colon is disturbed. The changes in the intestinal motor function can be associated with the fact that these patients have increased sensitivity of the receptors of the intestine of the intestine to stretching, as a result of which pain and dyspeptic disorders occur with them with a lower verge of excitability than in healthy people. A certain role in the formation of irritably syndrome in children play features of nutrition, in particular the lack of vegetation fiber. The loss is essential conditional reflex On the act of defecation and asinigration of muscle structures of the pelvic diaphragm, leading to disorders of the evacuation function of the intestine.

Syndrome of an irritable intestine can develop again with other diseases of the digestive system: gastritis, duodenites, ulcerative diseases of the stomach and duodenum, pancreatitis, etc. gynecological diseases In girls, the pathology of the urinary system.

Clinical picture

Depending on clinical manifestations, 3 variants of irritable intestinal syndrome are distinguished: mainly with diarrhea, constipation and stomach pains and flatulence.

In patients with the predominance of diarrhea, the main symptom is a liquid chair, sometimes with an admixture of mucus and remnants of undigested food, usually 4 times a day, more often in the morning, after breakfast, especially with emotional tension. Sometimes imperative urges for defecation, flatulence.

With the second version of the irritably syndrome, the stool delay (up to 1-2 times a week). In a number of children, the act of defecation is regular, but is accompanied by a long-term outset, a sense of incomplete intestinal emptying, a change in the shape and character of the chair (solid, dry, type of sheep and other). In some children, long constipation is replaced by diarrhea, followed by the resumption of constipation.

In patients with a third version of the irritable sink syndrome, grasp or stupid, gulp, driving abdominal pain, combined with his bloating. Pains occur or enhanced after meals, with stress, before defecation and pass after gases.

In addition to local manifestations, patients have frequent headaches, a feeling of lump in the throat when swallowing, vasomotor reactions, nausea, heartburn, belching, severity in the epigastric region, etc. A distinctive sign of the syndrome of the irritable intestine - the complaints of the complaints. The discrepancy between the duration of the disease, the diversity of complaints and good external species Sick children, physically well-developed.

Diagnosis and Differential Diagnostics

The diagnosis of irritable intestinal syndrome is based on the principle of excluding other intestinal diseases, often using functional, instrumental and morphological examination methods.

The differential diagnosis is carried out with endocrine diseases (hypothyroidism, hyperthyroidism - during constipation; with vipoma, gastride - with diarrhea), impaired intestinal suction syndrome (lactase insufficiency, celiac disease, etc.), gastrointestinal allergies, sharp and chronic constipation, etc.

Treatment

Treatment of patients with irritable intestinal syndrome is based on the normalization of the regime and nature of nutrition, psychotherapy, appointment

medicines. In order to normalize the state of the central and vegetative nervous system, as well as intestinal motorcycles prescribe LFC, massage, physiological and reflexology. Cepsis, Loperamide, Panoney Bromide, Mebavverin, etc., serve as selection of medicines.

In case of an irritable intestine with diarrhea, a dioctahedral effect has a positive effect, which has pronounced adsorption and cytoprotective properties. Pre- and probiotics are also used to restore normal microflora ["Enterol", bifidobacteria bifidum, bifidobacteria bifidum + activated carbon ("Probifa"), lactobacillia acidophilic + Kephyr's fungi ("acipol"), "Hilak-Forte", "Linex" and Dr.], antibacterial agents ("Intetrix", nifuroxazide, furazolidone, metronidazole et al.), Plant preparations [Lambs Leaves + Hypericum Grass + series three-part grass + Rosehip fruits ("Brusniser"), calendula flowers + daisies Flowers + licorice roots + Alternate grass + sage leaves + eucalyptus of a prudoid leaf (Eleasol)], reducing swelling, rumbling in the abdomen, the amount of mucus in the chair.

In the syndrome of the irritable intestine flowing with constipation, ballast substances are prescribed (bran, flax seed, lactulose, etc.).

According to the indications: antispasmodics (drootaverine, papaverine), cholinoblocators (bolromide hyoscin, bromide objination), drugs, normalizing the state of the central and vegetative nervous system (the choice of drug detected from the patient's affective disorders); Tranquilizers (diazepams, oxazepam), antidepressants (amitriptyline, pepophhesine), neuroleptics (thiuridazine) in combination with novotrops and vitamins of group B. Optimal treatment results can be obtained by joint observation of a patient with a pediatrician and a psychoneurologist.

Forecast

The forecast is favorable.

Congenital Enzymopathy and Exudative Enteropathy

The most common congenital entzimopathies of the GCT - celiac disease and insufficiency of disaccharidases.

Pathogenesis and clinical picture of celiac disease

Gluten enteropathy - a congenital disease due to insufficiency of enzymes, splitting gluten (protein of cereals)

to amino acids and accumulation of toxic products of its incomplete hydrolysis in the body. The disease is manifested more often since the administration of the adhesive (manna and oatmeal) In the form of a rich foam chair. Then join anorexia, vomiting, symptoms of dehydration, the picture of the false ascite. Heavy dystrophy develops.

With a radiological study of the intestine with the addition of flour to the barium suspension, there is a sharp hypersection, an accelerated peristaltics, a change in the intestinal tone and the relief of the mucous membrane (symptom of the "snow snowstorm").

Disaccharidase insufficiency

In early age children, it is more often a primary, due to the genetic defect (ρ) of the synthesis of enzymes that split lactose and sucrose. In this case, the intolerance to the lactose is manifested by diarrhea after the first feedings of breast milk, the intolerance to sucrose - from the moment of introducing the child of the sugar (sweet water, discomfort). Characterized by meteorism, a watery chair with sour smell, gradual development of hypotrophy. Chair, as a rule, is quickly normalized after the abolition of the corresponding disaccharide.

Exudative enteropathy syndrome

It is characterized by the loss of a large number of blood plasma proteins through the intestinal wall. As a result, children occur persistent hypoproteinemia, a tendency to the edema appears. The primary syndrome of exudative enteropathy is associated with an innate defect of the lymphatic vessels of the intestinal wall with the development of lymphangectasia detected during morphological examination. The secondary exudative enteropathy syndrome is observed with celiac disease, cystic disease, crown disease, nonspecific ulcerative colitis, liver cirrhosis and a number of other diseases.

DIAGNOSTICS

Diagnosis is based on the aggregate of clinical and laboratory data, the results of endoscopic and morphological studies. In diagnostics, load samples are used (for example, d-xylose suction test, etc.), immunological methods (definition of aggliadine at, etc.), as well as methods to determine the content of protein, carbohydrates, lipids in feces, blood.

Differential diagnosis

When conducting differential diagnosis, it is important to consider the age of the patient in which the first symptoms of the disease appeared.

In the period of newborn, the congenital lactase failure (alaktasia) is manifest; Congenital glucose-galactose malabsorption, innate lack of enterocinate, intolerance to the protein of cow's milk, soy, etc.

TREATMENT

The organization of individual therapeutic nutrition is crucial, in particular the purpose of eliminational diets, depending on the period of the disease, the general condition and age of the patient, the nature of enzyme failure. With celiac disease, the diet must be agglutaneous (exclude products rich in gluten, rye, wheat, barley, oatmeal) with the restriction of milk. In disaccharidase insufficiency, it is necessary to exclude the use of sugar, starch or fresh milk (with lactose intolerance). With exudative enteropathy, they prescribe a diet rich in proteins, with fats restriction (use mid-chain triglycerides). According to the testimony in severe cases, parenteral nutrition is prescribed. The enzyme preparations, probiotics, vitamins, symptomatic therapy are shown.

FORECAST

Forecast with strict observance of the elimination diet and thorough prophylaxis of relapses in patients with celiac disease, some enteropathies are generally favorable, only the achievement of clinical remission is possible with exudative enteropathy.

Prevention of diseases of fine and colon

Secondary prophylaxis includes: careful compliance with the power mode, full-fledged in composition; repeated courses of treated with vitamins, enzymes (under the control of the state of the chair), enterosorbents, prokinetics, therapeutic herbs, probiotics, as well as

non-level water (with a tendency to diarrhea, "Essentuki 4" are prescribed, heated to 40-50? C); Therapeutic gymnastics and abdomen massage; protecting the child from intercurrent diseases and injuries; Exception of bathing in open reservoirs.

In chronic enteritis and chronic enterocolitis in the resistant period, physical education and preventive vaccinations are allowed.

Child observation and their treatment during the remission period is carried out by district pediatricians and gastroenterologists of clinics in the first year of statement from the hospital quarterly. Sanatorium-resort treatment is shown no earlier than 3-6 months after exacerbation. The sanatorium therapeutic complex includes: gentle-training mode, dietary food, according to the testimony - drink heated weathered water, mud appliqués on the stomach and lower back, radon baths, oxygen cocktails, etc. The duration of the course of sanatorium treatment is 40-60 days.

Crohn's disease

Crohn's disease is chronic nonspecific progressive transmural granulomatous inflammation of the gastrointestinal tract.

It is more likely to be affected by the terminal department of the small intestine, so there are such synonyms of this disease, such as terminal Ileit, granulomatous Ileit, etc. In the pathological process, any department of the digestive tract from the root of the tongue to the rear-ground opening can be involved. The frequency of the intestinal departments decreases in the following order: terminal Ileit, colitis, Ileokolite, anorectal shape, etc. Alsame the focal, multicop and diffuse form. The course of Crohn's disease is wave-like, with exacerbations and remissions.

Crohn's disease detects all age groups. The peak of morbidity falls for 13-20 years. Among the sick ratio of boys and girls 1: 1,1.

Etiology and pathogenesis

Etiology and pathogenesis of the disease are unknown. Discuss the role of infection (mycobacteria, viruses), toxins, foods, some of the compositions considered as the starting moment of the development of acute inflammation. Immunological, dysbiotic, genetic factors attached great importance. There is a link between the HLA histocompatibility system and the Crohn disease in which DR1 and DRW5 locuses often detect.

Clinical picture

The clinical picture of the disease is distinguished by a great variety. The beginning of the disease is usually gradual, the flow of perennial with periodic exacerbations. Possible acute forms.

The main clinical symptom in children is a stubborn diarrhea (up to 10 times a day). The volume and frequency of the chair depend on the level of damage to the small intestine: what it is higher, the more often a chair, and, accordingly, a heavier disease. The lesion of the small intestine is accompanied by Mal Absorption syndrome. In the chair periodically appear blood impurities.

Abdominal pain is a mandatory symptom of all children. The intensity of pain varies from minor (at the beginning of the disease) to intense grabs associated with food and defecation. With the defeat of the stomach, they are accompanied by a feeling of gravity in the epigastric region, nausea, vomiting. In the later stages, pain is very intense, accompanied by bloating.

Common symptoms of the disease: general weakness, weight loss, fever. With a significant lesion of the small intestine, the suction and metabolism of proteins, carbohydrates, fats, vitamin B 12, folic acid, electrolytes, iron, magnesium, zinc, and other hypoproteinemia is clinically manifested by edema. It is characterized by a delay in growth and sexual development.

The most common extortiece manifestations of Crohn's disease: arthralgia, monoarthritis, sacroileit, nodal erythema, aphodnye stomatitis, iridocyclite, injeve, episclerite, pericholangitis, cholestasis, vascular disorders.

Complicationsin case of crown, the most often associated with the formation of fistula and abscesses of various localization, purification of intestine, peritonitis. Possible intestinal obstruction, acute toxic dilatation of colon.

In general blood test, anemia (decrease in erythrocytes, Hb, hematocrit), reticulocytosis, leukocytosis, an increase in ESP is detected. With biochemical analysis of blood, hypoproteinemia, hypoalbuminemia, hypocalemia, reduction of the content of trace elements, increase the level of alkaline phosphatase, and 2-Globulin and C-reactive protein are detected. The degree of severity of biochemical changes correlates with the severity of the disease.

An endoscopic picture in Crohn's disease is distinguished by a large polymorphism and depends on the stage and length of the inflammatory process. Endoscopically distinguishes 3 phases of the disease: infiltration, ulcers-cracks, scarring.

In the infiltration phase (the process is localized in the submucosal shell) the mucous membrane has the appearance of a "steam blanket" with a matte surface, the vascular pattern is not visible. In the future, erosion appears in the AFT type with separate surface ulcers and fibrinous overlays.

In the phase of ulcers-cracks, individual or multiple deep longitudinal ulcerative defects are detected, affecting the muscular layer of the intestinal wall. The crossing of the crack gives the mucous membrane the appearance of the "cobblestone pavement". Due to the significant subtle shell, as well as the damage to the deep layers of the intestinal wall, the intestinal lumen is narrowed.

In the scarring phase, areas of irreversible intestine stenosis are found.

Characteristic X-ray signs (the study is usually carried out with double contrast): segmentality of lesions, wavy and uneven intestines of the intestine. In the colon, it is determined non-removal and ulcerations along the upper edge of the segment while maintaining a gustration along the bottom. In the stage of the ulcers-cracks - the view of the "cobblestone pavement".

Diagnosis and Differential Diagnostics

The diagnosis is established on the basis of clinical and history data and the results of laboratory, instrumental, morphological studies.

The differential diagnosis of crown disease is carried out with acute and protracted intestinal infections of bacterial and viral etiology, diseases caused by the simplest, gloves, mallabsorption syndrome, tumors, nonspecific ulcerative colitis (Table 16-4), etc.

Table 16-4.Differential diagnosis of intestinal inflammatory diseases *

* On Kanchina O.A., 1999.

Treatment

The mode during the exacerbation period is bedding, then gentle. Healing food - table? 4 by svnery. The character of the diet is significantly depends on the localization and length of the intestinal lesion, the phase of the course of the disease.

The most effective drugs consider the preparations of aminoalcyl acid (Mesalazin), sulfasalazine. At the same time, it is necessary to take folic acid and polyvitamins with trace elements according to the age dose. In the acute phase of the disease and under heavy complications (anemia, cachexia, lesions of the joints, erythem, etc.) are prescribed glucocorticoids (hydrocortisone, prednisone, dexamethasone), less often immunosuppressants (azatioprine, cyclosporine).

In addition, antibiotics of a wide range of action, metronidazole, probiotics, enzymes (pancreatin) are used to treat patients with crown disease, enterosorbents (diotic dioctahedral), anti-pharya preparations (for example, loperamide), symptomatic agents. In case of severe the course of the disease, with the development of hypoproteinemia, electrolyte disorders, intravenous infusion of amino acid solutions, albumin, plasma, electrolytes are carried out. According to the testimony, surgical treatment is carried out - the removal of the affected departments of the intestine, excision of fistulas, the imposition of anastomosis to restore the passability.

Prevention

Forecast

The forecast for recovery is unfavorable, the forecast for life depends on the severity of the disease, the nature of its flow, the presence of complications. It is possible to achieve a long clinical remission.

Nonspecific ulcerative colitis

Nonspecific ulcerative colitis is a chronic inflammatory-sophisticated colon disease with a recurrent or continuous flow, local and systemic complications.

Nonspecific ulcerative colitis is prevalent mainly among the population of industrialized countries (distributed

adults among adults - 40-117: 100 000). In children, it develops relatively rare, making up 8-15% of the incidence of adults. In the past two decades, the number of patients with non-prescribed ulcerative colitis are observed both among adults and among children of all age groups. Debut of the disease may occur even at the breast. The floor distribution is 1: 1, and at an early age, boys sick, in adolescence - girls.

Etiology and pathogenesis

Despite the long-term study, the etiology of the disease remains unexplained. Among the various theories of the development of non-specific ulcerative colitis, infectious, psychogenic and immunological was obtained the greatest distribution. The search for some kind of reason for the occurrence of the ulcer process in the colon is still unsuccessful. The etiological factors involve viruses, bacteria, toxins, some ingredients of food capable, as triggers, cause the beginning of a pathological reaction, resulting in damage to the intestinal mucosa. The state of the neuroendocrine system, local immune protection of the intestinal mucosa, genetic predisposition, unfavorable factors of the external environment, psychological stress, non-drug-based environmental impacts is attached. In nonspecific ulcerative colitis there is a cascade of self-sustaining pathological processes: first nonspecific, then autoimmune, damaging target bodies.

Classification

The modern classification of nonspecific ulcerative colitis takes into account the length of the process, the severity of clinical symptoms, the presence of relapses, endoscopic signs (Table 16-5).

Table 16-5.Working classification of nonspecific ulcerative colitis *

Extra case manifestations and complications

* Nizhny Novgorod Research Institute of Children's Gastroenterology.

Clinical picture

The clinical picture is represented by three leading symptoms: diarrhea, blood release with chair, stomach pain. Almost half of the cases, the disease begins to be treated. With a lung colitis, single streams of blood in the chair are noticeable, with a heavy mixture of it. Sometimes a chair acquires the form of a slicer liquid bloody mass. Most patients develop diarrhea, the frequency of the chair varies from 4-8 to 16-20 times or more. In a liquid chair, in addition to the blood, it is contained in a large amount of mucus and pus. The diarrhea with blood admixture is accompanied, and sometimes preceded by her, abdominal pain - more often during meals or before defecation. Picky pain, localized in the bottom of the abdomen, in the left ileal region or around the navel. Occasionally develops a dysentery of the disease. It is very characteristic of heavy nonspecific ulcerative colitis an increase in body temperature (usually not higher than 38? C), a decrease in appetite, a total weakness, a decrease in body weight, anemia, a delay of sexual development.

Complicationsnonspecific ulcerative colitis are systemic and local.

System complications are diverse: arthritis and arthralgia, hepatitis, sclerosing cholangitis, pancreatitis, heavy lesions of the skin, mucous membranes (noded erythema, pyodermia, trophic ulcers, grinding inflammation, thomatite, pneumonia, sepsis) and eye (uveit, episcler).

Local complications in children are rarely developing. These include: profuse intestinal bleeding, purification of the intestine, acute toxic dilatation or stricture of colon, the defeat of the anorectal region (cracks, fistula, abscesses, hemorrhoids, weakness of the sphincter with incontinence of feces and gases); Colon cancer.

Laboratory and instrumental research

When analyzing the blood, leukocytosis with neutrophilysis and a leukocyte formula shift to the left, decrease in the content of eritrocytes, Hb, whey iron, common protein, disproteinemia with a decrease in albumin concentration and increase - γ-globulins; Disorders of blood electrolyte composition are possible. Accordingly, the utensils and the concentration of C-reactive protein increases the utensils and phase of the disease.

Endoscopic research methods play a decisive role in the diagnosis of non-specific ulcerative colitis. With colonoscopy in the initial period of the disease, the mucous membrane is hyperemic, extinguished, easy to view. In the future, a picture of typical

oral-ulcer process. During the period of manifest manifestations, the circular folds of the mucous membrane thicken, the activities of the colon sphincters are disturbed. With a long-term course of the disease, folding disappears, the intestinal lumen becomes tube, its walls - rigid, the anatomical bends are smoothed. Hyperemia and the edema of the mucous membrane are growing, its grain appears. The vascular pattern is not determined, the contact bleeding is expressed, erosion, ulcers, microabscesses, pseudopolyps are found.

X-ray detects a disturbance of the gustral pattern: asymmetry, deformation or its full disappearance. The intestinal lumen has the kind of hose, with thickened walls, rooted departments, smoothed by anatomical bends.

Diagnosis and Differential Diagnostics

The diagnosis is established on the basis of clinical and laboratory data, the results of rectoroscopy, sigmo- and colonoscopy, irrigography, as well as histological research of the biopsy material.

Differential diagnosis is carried out with Crohn's disease, celiac disease, diverticulitis, tumors and colon polyps, intestinal tuberculosis, Whipple's disease, etc.

Treatment

The greatest importance in the treatment of nonspecific ulcerative colitis in children give the diet. Are you prescribed a silent table? 4 According to the Pessner, enriched with protein at the expense of meat and fish products, eggs.

The basis of basic drug therapy is sulfasalazine and aminosalcyl acid preparations (Mesalazin). They can be administered orally and introduce into the form of a healing enema or candle into the rectum. Dose of preparations and the duration of treatment are determined individually. In case of heavy the flow of nonspecific ulcerative colitis, glucocorticoids are appointed. According to strict indications, immunosuppressants are used (Azatioprin). Symptomatic therapy and local treatment (microclisms) are also carried out.

An alternative to conservative treatment is the operational - subtotal resection of the intestine with the imposition of ilectal anasomose.

Prevention

Prevention is aimed primarily on the prevention of relapses. After discharge from the hospital, all patients should

message courses of support and anti-inflicted treatment, including basic drug therapy, diet and security-recovery mode. Patients with nonspecific ulcerative colitis are subject to mandatory dispensary observation. Preventive vaccination is carried out only by epidemias, weakened vaccine drugs. Children free from exams, physical exertion (physical education classes, labor camps, etc.). Training is advisable to spend at home.

Forecast

The forecast for recovery is unfavorable for life - depends on the severity of the disease, the nature of the flow, the presence of complications. The regular monitoring of changes in the semicircle mucosa is shown due to the possibility of its dysplasia.

Diseases of the biliary system

Etiology and pathogenesis

The formation of the pathology of the biliary system in children contributes to high-quality and quantitative disorders of the nutritional mode: an increase in the intervals between food receptions, early introduction into the diet of greasy and sharp dishes, overeating, excess sweetness, a sedentary lifestyle. The development of the pathology of the biliary system in children predispose disorders of the psycho-emotional sphere, perinatal encephalopathy, SVD, stressful situations. A significant role is played by concomitant diseases of the stomach and duodenum, plaque invasions, giardiasis, anomalies for the development of an aging bubble and bustling system, food, food

allergies, bacterial infections. Among bacteria causing inflammatory processes in the horizontal bubble and raging stals prevail E. coliand a variety of cocci; Anaerobic microorganisms becomes less likely. Hereditary predisposition is of great importance.

Various lesions of biliary tract are closely related to each other and have a lot in common at all stages of pathogenesis. The disease usually begins with the development of dyskinesia of biliary tract, i.e. Functional disorders of the horizontal bubble, raw strokes, Lutcens sphincters, Oddi and Miritzzi. Against this background, there is a change in the physicochemical properties of yellow, leading to the formation of bilirubin crystals, cholesterol, etc. As a result, it is possible to develop organic inflammatory lesions of the gully bubble and horizontal ducts, as well as the formation of gallstone disease.

Dyskinesia biliary tract

In the occurrence of dyskinesium of biliary lines, the functional state of the stomach and duodenalist plays an important role. Violation of the activities of sphincters, duodenostasis, edema and spasm of a large duodenal nipple lead to hypertension in the biliary system and disruption of bore. There are different mechanisms leading to violation of the Passage of Hals. Two possible variants of such mechanisms are shown in Fig. 16-2.

Clinical picture and diagnostics

Hypotonic (hypokinetic) and hypertonic (hyperkinetic) types of disknesium are isolated. A mixed form is also possible.

Dyskinesia hypotonic type

The main signs of the hypotonic type dyskinesia: a decrease in the tone of the muscles of the yeast bubble, its weak reduction, an increase in the volume of the horizontal bubble. Clinically, this option is accompanied by noving pains in the right hypochondrium or around the navel, total weakness, fast fatigue. Sometimes it is possible to pinch a large atonic yellow bubble. With ultrasound, the increased, sometimes an elongated horizontal bubble with a normal or slow emptying is detected. When accepting the stimulus (egg yolk), the transverse size of the horizontal bubble is usually reduced by less than 40% (normally 50%). With fractional duodenal sensing, an increase in the volume of portions in with normal or high

Fig. 16-2.Mechanisms of violation of the Passage of Yellow.

the speed of the outflow of bubble glands, if the tone of the bubble is still saved. The decrease in the tone is accompanied by a decrease in the volume of this portion.

Discower hypertensive type

The main signs of a hypertonic type dyskinesia: a decrease in the size of the gulb bubble, accelerating its emptying. Clinically, this option is characterized by short-term, but more intense attacks of pain with localization in the field of right hypochondrium or around the navel, sometimes dyspepsia. With ultrasound, the reduction in the transverse size of the gulb bubble after a choleretic breakfast is more than 50%. With fractional duodenal sounding, a decrease in the amount of portion in with an increase in the rate of outflow of the boots is revealed.

TREATMENT

Treatment can be carried out both in the hospital and at home. When prescribing treatment, you should consider the type of diskinesia.

Healing nutrition:

Table? 5 with a full content of proteins, fats and carbohydrates;

Unloading days, such as fruit-sugar and kefiro-curds (for the purpose of disintellation);

Fruit and vegetable juices, vegetable oil, eggs (for the natural amplification of the outflow of yellow).

Choleretic means. Choleretic therapy must be carried out for long, intermittent courses.

Choleretics (stimulating greyhi form) - Bile + Caucas + nettle Leaves + Activated coal ("Allohol"), Blue + powder made of Pancreas and a small intestine mucous membrane ("Holenzim"), hydroxymethylnicotinicamide, osalmid, cyciscoval, rosehip fruits extract ( "HOLOSAS"); Plants (mint, nettle, chamomile, St. John's wort and others).

Holes (contributing to the release of yellow) - increasing the tone of the horizontal bubble (for example, the preparations of barberry ordinary, sorbitol, xylitol, egg yolk), reduce the tone of the gorgeous paths (for example, papaverine, platifilin, belladonny extract).

To eliminate cholestasis recommended Tuba in GS Demyanov with mineral water or sorbitol. In the morning, the patient is given to drink an empty stomach of a glass of mineral water (warm, without gases), then for 20-40 minutes, the patient lies on the right side on a warm heating floor without a pillow. The tubaz is carried out 1-2 times a week for 3-6 months. Another version of the tubaz: After receiving a glass of mineral water, the patient makes 15 deep breaths with the participation of the diaphragm (the position of the body is vertical). The procedure is carried out daily within a month.

Acute cholecystitis

Acute cholecystitis - acute inflammation of the wall of the yeast bubble.

Pathogenesis.The enzymes of microorganisms affect the dehydroxylation of gully acids, enhance the lunch of the epithelium,

they are on a neuromuscular apparatus and sphincters of a rash bubble and biliary tract.

Clinical picture. Acute catarrhal cholecystitis is usually manifested by pain, dyspeptic disorders and intoxication.

Pains wear an approached character with localization in the right hypochondrium, epigastric area and around the navel, the duration of pain syndrome varies from a few minutes to several hours. Occasionally pain irradiate to the lower angle area of \u200b\u200bthe right blade, right-hand-screw area or right half of the neck. More often, pain occurs after receiving oily, sharp or spicy food, as well as emotional experiences.

Disps syndrome is manifested by nausea and vomiting, sometimes constipation.

The main manifestations of intoxication syndrome - febrile fever, chills, weakness, sweating, etc.

When the abdominal palpation is determined, the voltage of the anterior abdominal wall, positive symptoms of Crara, Murphy, Ortner and de Mushi-Georgievsky (Fragenic Symptom). It is possible to increase the liver. It is less likely that jaundice is possible due to the obstruction of the overall grade duct (due to the eath or councils).

Diagnostics.The diagnosis is made on the basis of a clinical picture and data ultrasound (thickening and heterogeneity of the walls of the gulb bubble, the negrogeneity of the contents of its cavity).

Treatment.Catarial acute cholecystitis is usually treated in hospital or at home.

Bed mode (duration depends on the state of the patient).

Diet - table? 5. Unloading Days: Fruit and sugar, kefiro-curd, apple - to remove intoxication.

A large amount of liquid (1-1.5 l / day) in the form of tea, horses, horseradish beam.

Natural choleretic agents (fruit and vegetable juices, vegetable oil, eggs).

Antispasmodic preparations.

Antibiotics in order to suppress infection (semi-synthetic penicillins, erythromycin rate of 7-10 days).

Forecast.In most cases, the prognosis is favorable. However, approximately 1/3 of patients with acute cholecystitis are transformed into a chronic form.

Chronic non-calculous cholecystitis

Chronic cholecystitis - chronic polyethological inflammatory disease of the gulb bubble, accompanied by

hals outflow and changes in the physicochemical and biochemical properties.

Etiology.The etiology of chronic cholecystitis is complex and is substantially related to the state of the biliary system, duodenum and stomach. Violation of the activities of sphincter apparatus, duodenostasis, edema and spasm of a large duodenal nipple lead to hypertension in a biliary system, violation of the pensal of yellow and hypocomotor dyskinesia of the yeast bubble. Also, as in the development of acute cholecystitis, a certain role is played by an infectious process (more often bacterial), which contributes to the formation of cholesterol crystals.

Pathogenesis.Allergic factors have a certain meaning in the formation of chronic cholecystitis. Bacterial toxins, chemical and drug effects exacerbate diskinetic disorders. The role of intestinal dysbacteriosis is noted. Simplified pathogenesis of chronic cholecystitis is presented in Fig. 16-3.

Clinical picture. The disease is manifested by recurrent parcel pain In the epigastric region, the right hypochondrium and around the navel, often irradiating to the right blade. During the period of exacerbation of chronic cholecystitis, the clinical picture is made up of several components due not only to the pathology of the gully bubble, but also a secondary violation

Fig. 16-3.Pathogenesis of chronic cholecystitis.

functions of other internal organs. Thus, insufficiency or complete cessation (aholia) of the existence of yellow in the intestine leads to a violation of the digestion and intestinal peristals, changes in the evacuation and motor and secretory functions of the stomach and duodenum, a decrease in the secretion of pancreatic enzymes, the occurrence of fermentation, and sometimes pending processes in the intestine, The appearance of dyspeptic disorders (nausea, bitterness in the mouth, reducing appetite, meteorism, constipation or liquid chair). As a result, signs of chronic intoxication appear: weakness, subfebrile temperature Body, dizziness, headache. The body weight is reduced, children can fall behind in physical development. The skin and sclera can be somewhat written as a result of cholestasis. The language is covered, sometimes collapsed, with fingerprints in the edges. When palpation, the abdomen determine the pain in the right hypochondrium and the epigastric region.

Diagnostics.During the period of exacerbation in peripheral blood, moderate leukocytosis with neutrophilosis is determined, an increase in ESR may increase the concentration of bilirubin, alkaline phosphatase activity (due to cholestasis). The diagnosis is established on the basis of anamnesis and clinical and instrumental research. When ultrasound, the walls of the horizontal bubble reveal, the increase in its volume, in the lumen of the bubble, is often determined by a thick secret, after a test breakfast, the gorgeous bubble is completely emptied. Bubble can purchase a spherical shape.

Differential diagnosis. Acute I. chronic cholecystitis Differentiate with other diseases of the gastroduodenal zone - chronic gastroduodenitis, dyskinesia of biliary tract, hepatitis, chronic pancreatitis, etc.

Treatmentchronic cholecystitis in the period of exacerbation build on the same principles as the treatment of acute cholecystitis: bedding, diet? 5 and? 5A with the ratio of proteins, fats and carbohydrates 1: 1: 4, lots of fruits and vegetables, fractional food. Table? 5 for 2 years recommended during remission. After the second year of observation, the diet can be expanded. With a serious exacerbation of chronic cholecystitis, disinfecting therapy is shown - the introduction of intravenously glucose, saline solutions. Otherwise, medication therapy is the same as when acute cholecystitis.

Prevention.In the threat of the development of chronic cholecystitis, prevention is strictly observing the food regime, the use of choleretic agents, including choleretic tea, restriction of physical activity (including physical education classes in school), reducing emotional stresses.

Forecast.Recurrences of the disease can lead to the development of anatomical and functional disorders (for example, thickening of the wall of the behaft bubble, the appearance of the climbing stagnation, the possible formation of gall stones).

Chronic calculous cholecystitis

Chronic calculose cholecystitis in pediatric practice is considered rare. But in recent years (apparently, due to the use of ultrasound), it is revealed in children more often than before, especially in adolescent girls with various types of exchange disorders.

Etiology and pathogenesis. At the heart of the formation of choletiasis is the onset stagnation of yellow, the inflammatory process in the biliary paths and changes in the chemical composition of the hydraulic composition in connection with the metabolic disorders. Under the action of these factors, there is a precipitate of cholesterol, calcium, bilirubin, especially in the ridicule layer, followed by the formation of stones. In early age children, pigment stones are more often formed (yellow colors consisting of bilirubin, a small amount of cholesterol and calcium salts), and cholesterol stones are usually found (dark cholesterol crystals).

Clinical picture. There are two options for the clinical picture of calculatory cholecystitis in children. More often, the disease proceeds without typical attacks of stomach pain, only the mischievous pains, the severity in the upper half of the abdomen, bitterness in the mouth and belching are noted. Less often observe a typical course with repeated attacks sharp pain In the area of \u200b\u200bthe right hypochondrium (grained colic). Pains can repeat repeatedly at certain time intervals. Colic is often accompanied by nausea, vomiting, cold sweat. The passage of the stone can cause the temporary blockage of the gully duct, the appearance of an acute obtaceous jaundice and a achering chair. If the stone is small and passed through the raging paths, pain and jaundice are bought.

Diagnostics.The diagnosis is established on the basis of clinical data and special research methods: ultrasound and x-ray (cholecystography). With an ultrasound of an abnormal bubble and raging paths, dense education detects in them. In cholecystography, multiple or solitary defects of the horizontal bubble filling are fixed.

Treatment.Perhaps both medicinal and operational treatment. There are preparations, softening and dissolving pigment and cholesterol stones of small diameter (0.2-0.3 cm). But,

given the general exchange disorders and chronic disorders of the biliary function, it is possible to repeated stones. The radical method should be considered cholecystectomy - removal of the bearded bubble. Currently, an endoscopic method is widely distributed - laparoscopic cholecystectomy.

Diseases of the pancreas

Of all diseases of the pancreas in children, pancreatitis are most often diagnosed. Pancreatitis is the disease of the pancreas due to the activation of pancreatic enzymes and enzymatic toxemia.

Acute pancreatitis

Acute pancreatitis can be represented by an acute edema of the gland, hemorrhagic lesion, sharp fatty necrosis and purulent inflammation.

Etiology

The main etiological factors of acute pancreatitis are as follows.

Acute viral diseases (for example, epidemic vapotitis, viral hepatitis).

Bacterial infections (for example, dysentery, sepsis).

Traumatic pancreatic damage.

Pathology of the stomach and duodenum.

Diseases of raging paths.

Heavy allergic reaction.

Pathogenesis

The simplified scheme of the pathogenesis of acute pancreatitis is presented in Fig. 16-4.

When entering blood and lymph, pancreatic enzymes, the products of enzymatic cleavage of proteins and lipids are activated by the kinine and plasminine systems and cause toxemia, which is reflected in the functions of the CNS, hemodynamics and the state of parenchymal organs. For most children, as a result of the impact of inhibiting systems, the process can be interrupted at the stage of the pancreas edema, then pancreatitis undergoes reverse development.

Classification

The clinical and morphological classification of acute pancreatitis includes the wound form, fatty pancreatic and hemorrhagic

Fig. 16-4.The mechanism for the development of acute pancreatitis.

cue pancreonenecosis. Depending on the clinical picture, acute ethylene (interstitial), hemorrhagic and purulent pancreatitis is distinguished.

Clinical picture

Symptoms of the disease largely depend on its clinical form and the age of the child (Table 16-6).

Table 16-6.Clinical picture and treatment of acute pancreatitis *

* From: Baranov A.A. et al. Children's gastroenterology. M., 2002.

Diagnostics

The diagnosis is established on the basis of a clinical picture and data of laboratory and instrumental studies.

In general blood test, leukocytosis is detected with a leukocyte formula shift to the left, increase in hematocrit.

In biochemical analysis, an increased content of amylase is noted. For early diagnosis of the disease, repeated (after 6-12 h) studies of the activity of amylase in the blood and urine are used. However, its content does not serve as a criterion for the severity of the process. So, moderately expressed fatty pancreatitis may be accompanied by high content Amylases, and heavy hemorrhagic - minimal. In case of pancreaticosis, its concentration in the blood falls.

With ultrasound, an increase in the size of the pancreas is detected, its seal and soloity.

Differential diagnosis

The differential diagnosis of acute pancreatitis is carried out with a peptic ulcer of the stomach and duodenum, acute cholestitis (see the relevant sections), choledocholiticiasis, sharp appendicitis, etc.

Treatment

Treatment as well as the clinical picture depends on the form of the disease and age of the child (see Table 16-6).

Chronic pancreatitis

Chronic pancreatitis is a polyethic disease of the pancreas with progressive flow, degenerative and destructive changes in the focal fabric of a focal or diffuse nature, a decrease in the exocrine and endocrine function of the organ.

Etiology

In most children, chronic pancreatitis has a secondary nature and is associated with diseases of other digestive organs (gastroduodenitis, the pathology of the biliary system). As a primary disease, chronic pancreatitis develops in children only in 14% of cases, most often due to enzymes or acute abdomen injury. It is impossible to exclude the toxic effect of drugs.

Pathogenesis

The mechanism for the development of the disease may be due to two factors: the difficulty of outflow of pancreatic enzymes and the causes acting directly on the glands. Just as in acute pancreatitis, the pathological process in ducts and the pancreas parenchyma leads to an edema, necrosis, and with a long flow - to sclerosis and fibrosis of the body tissue. Powerful inhibitory systems and protective factors of glands are able to stop the pathological process at the stage of the edema, which occurs in most cases of reactive pancreatitis.

* From: Baranov A.A. et al. Children's gastroenterology. M., 2002.

The main clinical manifestation of chronic pancreatitis is painful syndrome. The pain is more often the paroxy, localized in the upper half of the abdomen - in the epigastric region, the right and left hypochondrium. Sometimes they become minimizing, intensify after reception of food and in the afternoon. Most often, the appearance of pain is associated with errors in the diet (use of oily, roasted, cold, sweet food). Sometimes the attack can be triggered by a significant physical activity or infectious disease. The duration of pain is different - from 1-2 hours to several days. Pains are often irradiating in the back, the right or left half of the chest, in the sitting position weaken, especially when tilting the body forward. The most typically for a patient with chronic pancreatitis a knee-urban position (with it, the pancreas is as it were in the "suspended" state).

From pathological symptoms during the exacerbation of the disease, the symptoms of Meio-Robson, Kacha, de Musseigorgievsky, Grotta are often found. Most children can put a dense and painful head of the pancreas.

Chronic pancreatitically dyspeptic disorders: decrease in appetite, nausea, vomiting arising from height

painful attack, belching, heartburn. More than a third of the patients note constipation, changing diarrhea when aggravating the disease.

General symptoms of chronic pancreatitis: loss of body weight, asthenovegetative disorders (fatigue, emotional instability, irritability).

The severity of clinical symptoms is associated with the severity of the disease. Allow the course of the process of related orientation changes in the duodenum (duodenostasis, diverticulus) and biliary system (chronic cholecystitis, bile disease).

Diagnostics

The diagnosis is based on clinical and laboratory and instrumental data.

In the study of the content of pancreativity and secretine, pathological types of pancreatic secretion are found.

Provocative tests with glucose, neostigmine methyl sulfate, pancreatimine reveal changes in the content of amylase, trypsin.

With the help of ultrasound, the structure of the gland is determined. If necessary, use CT and endoscopic retrograde pancreaticolangiography.

Treatment

The basis of the treatment of chronic pancreatitis is a diet that reduces pancreatic and gastric secretion. In the nutrition of the patient there should be a sufficient amount of protein when limiting fats (55-70 g) and carbohydrates (250-300 g). Drozerin, Papaverin, Beziclan are prescribed to relieve pain syndrome.

The negative effect of the effects of hydrochloric acid is neutralized by the appointment of antisecretory preparations - histamine H 2-receptor blockers, as well as other drugs of this series (for example, omeprazole). Given the violation of the motility of the duodenum and dyskinesia of biliary tract, prescribe metoclopramide, Domperidon.

During the exacerbation of chronic pancreatitis, the first 3-4 days are recommended for hunger, disassembled tea, alkaline mineral waters, roshovnik decoction. Pathogenetic therapy means are inhibitors of proteolytic enzymes (for example, apricin). Preparations are injected drip intravenously in 200-300 ml of 0.9% sodium chloride solution. Doses are selected individually.

Recently, somatostatin (octreotide) has been proposed to suppress pancreatic secretion. It has a multifaceted effect on the gastrointestinal tract: reduces abdominal pain, liquidates the intestinal paresis, normalizes the activity of amylase, lipase, tripsin in the blood and urine.

Also replacement therapy for enzyme preparations (Pancreatin, etc.) is also important. The testimony for their application is the signs of the exocrine deficiency of the pancreas. If the exacerbation of chronic pancreatitis is accompanied by an increase in body temperature, an increase in ESR, a neutrophilic shift of the leukocyte formula to the left, prescribed antibiotics of a wide range of action.

After extracting from the hospital, patients with chronic pancreatitis are subject to dispensary observation, they are conducted by anti-inflicted treatment courses. Sanatorium treatment is recommended in Zheleznovodsk, Essentuki, Borjomi, etc.

Chronic hepatitis

Chronic hepatitis is a diffuse inflammatory process in the liver flowing without improving at least 6 months.

The classification of chronic hepatitis adopted at the International Congress of Gastroenterologists (Los Angeles, 1994) is presented in Table. 16-8.

Table 16-8.Classification of chronic hepatitis

The prevalence of chronic hepatitis is not accurate due to the large number of anticipated and asymptomatic forms and the lack of population studies. Most often, chronic viral hepatitis are detected due to persistence in the body of hepatitis B and C. viruses

Chronic viral hepatitis

Chronic viral hepatitis - chronic infectious diseases caused by hepatotropic viruses and characterize

the clinical and morphological picture of the diffuse inflammation of the liver is a duration of more than 6 months and a symptom complex of extrahepatic lesions.

Chronic hepatitis in etiology and pathogenesis

The causative agent of the disease is a DNA virus (hepatitis B virus). The main way of transfer is parenteral. It is believed that chronic hepatitis B is the disease primary chronic or arising after the coated or subclinical form of acute infection. The transition of acute hepatitis B into chronic is noted in 2-10% of cases, mainly with light or latent forms of the disease. The overwhelming majority of patients with chronic hepatitis do not have a history of instructions on transferring acute hepatitis.

It is assumed that the cause of the development of chronic hepatitis B may be the insufficiency of the immune response, due to genetic causes or the immaturity of the body (infection of the fetus, a newborn or child of young age). Infection of the child in the perinatal period and in the first year of life in 90% of cases ends with the formation of chronic hepatitis in or carrier of hepatitis virus V. Chronic hepatitis B and HB S AG is often recorded in diseases associated with impaired immune system functions: immunodeficiency states, chronic diseases kidneys, chronic lympholoicosis, etc.

Chronic hepatitis B has several phases: initial (immune tolerance); immune response (replicative) flowing with severe clinical and laboratory activity; integrative, HB S AG. The process usually remains active for 1-4 years and is replaced by the phase of the integration of the hepatitis V virus in the hepatocyte genome, which coincides with the clinical remission of the disease. The process may end with the development of carriage or cirrhosis.

The hepatitis B virus itself, apparently, does not cause cytolysis. Damage to hepatocytes is associated with immune reactions that occur in response to virus circulating in the blood (Hb S Ag, Hb ^ G) and liver ag. In the virus replication phase, all three hpatitis B viruses are expressed, immune aggression is more pronounced, which causes massive necrosis of the liver parenchyma and a virus mutation. As a result of the mutation of the virus, the composition of serum ags, therefore, the replication of the virus and the destruction of hepatocytes occur for a long time.

The replication of the virus is possible and outside the liver - in the cells of the bone marrow, mononuclears, thyroid and salivary glands than, apparently, and are due to the abstract manifestations of the disease.

Clinical picture

The clinical picture of chronic hepatitis in is associated with the phase of the replication of the virus and polysindroma.

Almost all patients note a minor intoxication syndrome with asthenovegetative manifestations (irritability, weakness, fatigue, sleep disorder, headaches, sweating, subfebilitation).

Jaundice is possible, although most often the patients detect subcomktericity or light ictericity.

Hemorrhagic syndrome, correlating with the severity of the process, is registered in approximately 50% of patients, it is expressed in non-nasal bleeding, phetechial rash on face and neck, hemorrhages on the skin of the limbs.

Vascular manifestations (so-called extraordinary signs) meet in 70% of patients. They include teleangectasses ("vascular stars") on the face, neck and shoulders, as well as palmar erythoma - symmetrical redness of the palms ("liver palms") and stop.

Dyspeptic syndrome (bloating, flatulence, nausea, increasing after eating and reception of medicines, belching, anorexia, intolerance of fatty dishes, the feeling of gravity in the right hypochondrium and epigastric area, unstable stools) is associated both with the functional inferiority of the liver and with a concomitant lesion Handwood, pancreas, gastroduodenal zone.

Hepatomegaly - the main and sometimes single clinical symptom of chronic hepatitis V. The dimensions of both liver shares are increased both percussion and palpator. Sometimes the liver performs at 6-8 cm from under the edge of the refinery arc, has a density consistency, a rounded or pointed edge, a smooth surface. Palpation is painful. Signs of liver damage are more pronounced with an active process. Patients often complain about permanent huming pain In the right hypochondrium, increasing during exercise. When a decrease in activity, a decrease in the size of the liver is reduced, palpation becomes less painful, the pain in the field of liver is worried about the child less.

A pronounced increase in spleen is detected with high hepatitis activity.

Endocrine disorders are possible - disorders of the menstrual cycle in girls, strlica on the bemps, acne, girsutism, etc.

Extrached systemic manifestations include nervous ticks, erythematous spots on the skin, urticaria, a narrow erythoma, transient arthralgia.

In general blood test, in the active period, and during the serious course of chronic hepatitis B, anemia, leukopenia, thrombocytopenia, lymphopinge and an increase in ESP are detected. In the serum, an increase in aminotransferase activity was 2-5 times or more, hyperbilirubinemia (an increase in the concentration of associated bilirubin), hypoalbumine, hypoprothrombinemia, an increase in cholesterol content, alkaline phosphatase (3 times or more) and γ-globulins. With the help of ELISA, reef, DNA hybridization and PCR, reveal hepatitis B virus replication markers (HB E AG, anti-Hb E AG-IgM, viral DNA).

Chronic hepatitis C.

Etiology.The causative agent of the disease is a RNA virus (hepatitis C virus). Transmission paths are similar to those in chronic hepatitis B.

Pathogenesis.Chronic viral hepatitis C is the outcome of the acute geatitis C (in 50-80% of cases). The hepatitis C virus has a direct cytopathic effect on hepatocytes. As a result, the replication of the virus and its persistence in the body is associated with the activity and progression of hepatitis.

Clinical picture. Clinical manifestations of chronic hepatitis C are usually expressed moderately or absent. Patients are bothering fatigue, weakness, dyspeptic disorders. In case of inspection, hepatomegaly, teleangectas, palky erythoma. The course of the disease is wave-like and long. With biochemical analysis of blood, an increase in the activity of Alaninotransferase (ALT) is detected. The diagnosis is based on the discovery of specific markers of chronic hepatitis C - RNA virus and AT to it (in the absence of markers of the hepatitis B virus).

Chronic hepatitis Delta

Etiology.The causative agent is a small defective RNA virus (hepatitis D virus); Contacious only when infected with the hepatitis B virus (since, due to the incomplete genome, the proteins of the hepatitis B virus uses proteins. The main way of transfer is parenteral.

Pathogenesis.Chronic viral hepatitis D is always the outcome of its acute shape that occurred as superinfection or a coinfection in patients with acute or chronic hepatitis V. The hepatitis D virus has a cytopathogenic effect on hepatocytes, supports activity and promotes the progression of the process in the liver.

Clinical picture. Clinically detect symptoms of liver failure (pronounced weakness, drowsiness Day, insomnia at night, bleeding, dystrophy). Most patients expressed jaundice and skin itch, Extraked systemic manifestations, increase and sealing liver. Chronic hepatitis D is characterized by severe flow. In the blood, the markers of chronic hepatitis D - DNA of the virus and AT to its ag are detected in the blood. The hepatina virus replication is suppressed as the liver cirrhosis is rapidly.

DIAGNOSTICS

The diagnosis of chronic viral hepatitis is based on anamorestic, clinical (intoxication, hemorrhagic syndrome, increasing and sealing of the liver, extracticular signs), bio-chemical (increase in ALT, thymol sample, disproteinemia, hyperbilirubinemia, etc.), immunological (signs of immune inflammation, specific markers ) and morphological data.

Differential diagnosis

TREATMENT

Treatment of chronic viral hepatitis includes primarily the basic, then symptomatic and (according to indications) disinfect and antiviral therapy.

The basic therapy includes the mode and diet, the purpose of vitamins.

The regime of patients with chronic hepatitis should be as gentle as possible, in the active period of the disease - semi-by-step. Limit physical and emotional loads.

When appointing a diet, the individual tastes and the habits of the patient, the tolerance of individual products and related diseases of the gastrointestinal tract are taken into account. Use predominantly dairy and vegetable products, 50% of fats should be plant origin. Exclude fat, fried, smoked dishes, ice cream, coffee, chocolate, carbonated drinks. Limit meat and fish broths, as well as the amount of raw fruit. Food should be fractional (4-5 times a day).

To normalize metabolic processes and the vitamin balance, vitamin C is prescribed (up to 1000 mg / day), multivitamin preparations.

Symptomatic therapy refer to the appointment of mineral waters, choleretic and antispasmodic agents, enzyme preparations and probiotics for the treatment of associated dysfunctions of the biliary system and the gastrointestinal tract.

With pronounced intoxication, drip needed intravenous administration Povidone + sodium chloride + potassium chloride + calcium chloride + magnesium chloride + sodium hydrocarbonate ("hemodesa"), 5% glucose solution for 2-3 days.

In the active phase of the disease (the phase of the replication of the virus), therapy is carried out by interferon preparations (interferon alpha-2, subcutaneously 3 times a week for 6 months in a dose of 3 million IU / M 2 of the body surface; Alpha-2A interferon is used; interferon alpha-p1 ) and other antiviral drugs. The effectiveness of treatment is 20-60%. Chronic viral hepatitis D is resistant to interferon therapy. With the ineffectiveness of antiviral therapy, a combination of interferon alpha with antiviral drugs is possible (for example, with ribavirin). With chronic hepatitis, lamivudine therapy is also carried out.

Prevention

Primary prevention is not designed. Secondary prophylaxis is in early recognition and adequate treatment of patients with acute viral hepatitis. Children moved acute viral hepatitis B, C, D, G, should consist of a dispensary accounting for at least one year. In the period of the dispensary observation, in addition to inspection with the determination of the size of the liver, conduct a biochemical test of serum blood (total bilirubin, transaminase activity, sedimentary samples, specific markers, etc.). Disposal from medical vaccinations, restriction of physical exertion, strict adherence to a diet, spa treatment (outside exacerbation). The widespread introduction of vaccination against hepatitis A and B will solve the problem not only acute, but also chronic hepatitis.

FORECAST

The probability of complete recovery is insignificant. As the process progressing, liver cirrhosis and hepatocellular carcinoma are developing.

Autimmune hepatitis

An autoimmune hepatitis is a progressive hepatocellular inflammation of unclear etiology, characterized by the presence of periportal hepatitis, hypergammaglobulinemia, and associated serum autoantibodies and a positive effect of immunosuppressive therapy.

The prevalence of autoimmune hepatitis in European countries is 0.69 cases per 100,000 population. In structure chronic diseases The liver The proportion of autoimmune hepatitis in adult patients is 10-20%, in children - 2%.

Etiology and pathogenesis

The etiology of autoimmune hepatitis is not known, and the pathogenesis is not studied enough. It is assumed that autoimmune hepatitis develops due to the primary caused impaired immune response. As possible launchers (trigger) factors contributing to the occurrence of the disease, indicate viruses (EPstainabarrr, measles, hepatitis A and C) and some drugs (for example, interferon).

In the presence of an appropriate genetic predisposition under the influence of trigger factors or without them there is a violation of immune regulation, manifested by the defect of the function of the Super T-cells admired the HLA A1-B8-DR3 haplotype in the White population in Europe and North America, or the HLA DR4 allele, more common in Japan and other countries of Southeast Asia). As a result, an uncontrollable synthesis in cells AT class IgG, destroying the membranes of normal hepatocytes, arises. In the collapse of Allel DR3 and / or DR4, they reveal in 80-85% of patients with autoimmune hepatitis. Currently, autoimmune hepatitis I, II and III types is distinguished.

I Type is a classic option, its share accounts for about 90% of all cases of illness. The role of the main autoantignen with an autoimmune hepatitis I type belongs to the liver protein Liver Specific ProteinLSP). Antinuclear whey is found in blood serum Antinuclear AntibodiesAna) and / or anti-thunder (Smooth Muscle Antibody,SMA) AT in the title more than 1:80 in adults and more than 1:20 in children. In 65-93% of patients with this type of hepatitis, perinuclear neutrophilic cytoplasmic (PANCA) also detect.

An autoimmune hepatitis II type is about 3-4% of all cases, most of the patients are children from 2 to 14 years. The main autoantigen with autoimmune hepatitis II type - AG liver micros

and kidney i type Liver Kidney Microsomes,LKM-1). With autoimmune hepatitis II type II in serum, AT to microsmams of liver cells and epithelial cells of the teaser of the kidney I type (anti-LKM-!) Are found.

An autoimmune hepatitis III type is isolated, characterized by the presence of AT to soluble liver ag (Soluble Liver Antigen)anti-SLA in the absence of anA or anti-KLM-1 in patients with type III diseases often detect SMA (35%), antimicochondrial AT (22%), rheumatoid factor (22%) and AT to AG liver membrane (anti-LMA) (26%).

Clinical picture

The clinical picture in children in 50-65% of cases is characterized by the sudden appearance of symptoms similar to those with viral hepatitis. In some cases, the disease begins unnoticed with aspectative disorders, pain in the field of right hypochondrium, minor jaundice. The latter often appears in the later stages of the disease, it is non-permanent and enhanced during the period of exacerbations. Characterized by the appearance of teleangectasis (on the face, neck, hands) and palky erythema. The liver is sealed and protrudes from under the edge of the refinery arc by 3-5 cm, the spleen is almost always increased. Often, autoimmune hepatitis is accompanied by amenorrhea and infertility, gynecomastia can develop in boys. It is possible to develop an acute recurrent migratory polyarthritis with the involvement of large joints without their deformations. One of the options for the beginning of the disease is a fever in combination with extra-erase manifestations.

Laboratory research

When analyzing the blood, hypergammaglobulinemia is found, an increase in IgG concentration, a decrease in the concentration of common protein, a sharp increase in ESP. Leukopenia and thrombocytopenia are detected in patients with hyperplanism and portal hypertension syndrome. In the serum, autoantibodes against liver cells are found.

Diagnosis and Differential Diagnostics

The autoimmune hepatitis is distinguished by "certain" and "probable".

The "determined" diagnosis of autoimmune hepatitis involves the presence of a number of indicators: periportal hepatitis, hypergammaglobulinemia, autoantaitel in blood serum, increased activity of serum transaminases at normal concentration of ceruloplasmin, copper and 1 -anttripsin. In this case, the concentration of serum γ-globulins exceeds the upper limit of the norm by more than 1.5 times, and the Titres AT (ANA, SMA and Anti-LKM-1) are not

less than 1:80 in adults and 1:20 in children. In addition, there are no viral markers in blood serum, damage to gall ducts, copper deposition in the liver tissue and other histological changes implied by other etiology of the process, as well as there are no information about the hemotransphus and the use of hepatotoxic drugs. "Probable" diagnosis is justified when the available symptoms allow you to think about autoimmune hepatitis, but insufficient for the formulation of a "defined" diagnosis.

In the absence of vehicles in the blood (about 20% of patients), the disease is diagnosed on the basis of an increase in the activity of transaminases in the blood, pronounced hypergammaglobulinemia, which is erected in serum blood content of IgG content, typical histological signs and a certain immunological background (identification of other autoimmune diseases in a patient child or his relatives) with the obligatory exclusion of other possible causes of liver damage. Some diagnostic signs Different types of autoimmune hepatitis are shown in Table. 16-9.

Table 16-9.Diagnostic criteria for different types of autoimmune hepatitis

Differential diagnosis is carried out with chronic viral hepatitis, insufficiency A 1 -anttripsin, Wilsonkonov's disease.

Treatment

The basis of treatment is immunosuppressive therapy. Prescribed prednisolone, azathioprin or their combination. Combined therapy is recommended to reduce the likelihood of the development of adverse reactions from the use of glucocorticoids: prednisone is prescribed in a smaller dose than with monotherapy. A positive answer to such therapy is one of the criteria for the diagnosis of autoimmune hepatitis. However, in the absence of effect, it is impossible to completely eliminate this diagnosis, since it is possible to break the patient of the treatment of drugs or insufficient dosage. The purpose of the treatment is to achieve full remission. Under the remission implies the absence of biochemical signs of inflammation [activity of aspartataminotransferase (AST) above the norm no more than 2 times] and histological data indicating the activity of the process.

Therapy with prednisolone or a combination of prednisolone with azatiotric allows you to achieve clinical, biochemical and histological remission in 65% of patients for 3 years. The average duration of treatment until remission is 22 months. Patients with histologically confirmed cirrhosis of the liver respond to therapy as well as patients without signs of cirrhosis: 10-year survival of patients with cirrhosis or without liver cirrhosis Against the background of therapy, almost does not differ and is 89 and 90%, respectively. The prednisone is prescribed at a dose of 2 mg / kg (maximum dose of 60 mg / day) with its subsequent decrease by 5-10 mg every 2 weeks under the weekly control of biochemical indicators. When the transaminase content is normalized, the prednisolone dose is reduced to the lowest possible support (usually 5 mg / day). If during the first 6-8 weeks therapy does not normate the liver samples, additionally prescribed anosatioprine in the initial dose of 0.5 mg / kg. In the absence of signs of toxic action, increase the dose of the drug to 2 mg / day. Although the decrease in the activity of transaminases by 80% of the initial occurs during the first 6 weeks in most patients, the complete normalization of the concentration of enzymes occurs only in a few months (after 6 months with an autoimmune hepatitis I type, after 9 months at the II type). Recurrences Against therapy arise in 40% of cases, while temporarily increase the dose of prednisolone. After 1 year from the beginning of the remission, it is recommended to try to cancel immunosuppressive therapy, but only after conducting the control puncture biopsy of the liver. At the same time, the morphological study should indicate the absence or minimum severity of inflammatory changes. However, completely cancel immunosuppressive therapy in most cases is not possible. With a repeated recurrence of autoimmune hepatitis after the abolition of immunosuppressive drugs are prescribed

lifetime supporting therapy prednisone (5-10 mg / day) or azatioprope (25-50 mg / day). Prolonged immunosuppressive therapy causes adverse reactions in 70% of children. With the ineffectiveness of glucocorticoid therapy, cyclosporine, cycular phosphamide, are used.

In 5-14% of patients with a confirmed diagnosis of autoimmune hepatitis, primary treatment resistance are observed. This small group of patients can be clearly allocated after 14 days after the start of treatment: they do not improve liver samples, and subjective well-being remains the same or even deteriorating. Mortality among patients with this group is high. They are subject to mandatory consultation in liver transplant centers, like those patients who, against the background of treatment or after its completion, develops relapse resistant to therapy. Medicia treatment Such patients usually turn out to be ineffective, the continuation of the reception of glucocorticoids in high doses leads only to the loss of precious time.

Prevention

Primary prevention is not designed. The secondary lies in regular dispensary observation of patients, periodically determining the activity of liver enzymes, the content of γ-globulin and autoantibodies for the timely diagnosis of recurrence and enhancing immunosuppressive therapy. Important moments: Compliance with the regime of the day, restriction of physical and emotional loads, diet, discharge from vaccination, minimal reception of medicines. Periodic courses of hepatoprotectors and maintenance therapy with glucocorticoids are shown.

Forecast

The disease without treatment continuously progresses and does not have spontaneous remissions. Improving well-being is short-term, the normalization of biochemical indicators does not occur. In the outcome of autoimmune hepatitis, cirrhosis of the liver of macronodular or micronodular type is formed. Adjustable prognosis in children with primary treatment resistance. With the ineffectiveness of immunosuppressive therapy, the patient is shown liver transplantation. After liver transplantation, 5-year survival in patients with autoimmune hepatitis is more than 90%.

Causes of diseases of the digestive

For each disease of the digestive organs, there are specific causes, but among them it is possible to distinguish those that are characteristic of most diseases of the digestive system. All these reasons can be divided into external and internal.

These are, of course, external causes. To them, first of all, it is necessary to attribute food, liquids, drugs:

Unbalanced nutrition (disadvantage or excess proteins, fats, carbohydrates) irregular nutrition (every day in different time), frequent use of "aggressive" components (acute, salted, hot, etc.), the quality of the products themselves (various additives such as preservatives) - all these are the main causes of the diseases of the stomach and intestines and often the only reason for these digestive disorders as constipation, diarrhea, increased gas formation and other digestive disorders.

From liquids, primarily diseases of the digestive organs are able to cause alcohol and its surrogates, carbonated and other drinks containing preservatives and dyes.

And, of course, medicines. Almost all of them to varying degrees have a negative effect on the gastric mucous membrane.

Also, to the external reasons for diseases of the digestive organs include microorganisms (viruses, bacteria and simplests that cause specific and non-specific diseases), worms (losers, ribbon worms, round worms), which come mainly with food or water.

Smoking, independent cause of the stomach and intestines and intestines, it is infrequent, but it, together with an insufficient oral hygiene, causes diseases of the oral cavity (gingivitis, stomatitis, periodontalosis, lip cancer).

Even the external reasons for the diseases of the stomach and intestines include frequent stresses, negative emotions, and experiences for any reasons.

The internal reasons of the diseases of the digestive organs include genetic - this is a predisposition (that is, the presence of a disease of the digestive system in previous generations), disorders of the intrauterine development (mutations in the genetic apparatus), autoimmune (when the body for one or another reasons begins to attack its bodies).

The main symptom for diseases of the digestive organs is pain in the course of the digestive tract. This symptom is present in almost every disease of the stomach or intestines, but depending on the disease will have one or another. In terms of localization, pain may occur in the right (cholecystitis) or left hypochondrium, concerning (pancreatitis), without a specific localization, in the course of the esophagus, often pain may irradiate (give) between the blades (esophagus inflammation), in the region of the heart, etc. constant or, on the contrary, at some point is very strong (the perforation of the stomach ulcers), and over time to pass, appear during palpation, tapping (cholecystitis). May be related to food intakes or not, or when taking some particular food (for example, fat like in chronic pancreatitis or cholecystitis), or, on the contrary, when taking some foods to pass (for example, a milk with hyperacid gastritis), or Arrive when you do not eat anything (ulcerative illness of the stomach). For diseases of the rectum, pain may occur with the act of defecation.

In the diseases of the stomach often occurs as a symptom as dyspepsia. It can be divided into the upper and lower. To the top there are such symptoms as heartburn (sensation of burning sternum or in the upper part of the abdomen during gastritis), belching (acidic in the diseases of the stomach, bitter with damage to the gallbladder), nausea, vomiting (peptic disease), feeling of completeness and pressure in the epigastric Areas (with disorders of the evacuation function of the stomach), dysphagia (dysfunction of swallowing for diseases of the esophagus), anorexia (loss of appetite).

The lower dyspepsia includes a feeling of completeness and cutting in the abdomen, meteorism (excess accumulation of gases in the intestine in disabilities of digestion processes), diarrhea (infectious diseases), constipation (irritable bowel syndrome).

From other symptoms there are a change in the color of the chair (bleaching during hepatitis, melan - a tar-shaped chair in gastric bleeding, "raspberry jelly" during amoebiase, green with salmonellosis, allay blood in feces).

There are also various changes on the skin, as the manifestations of the symptoms of various diseases of the organs of the digestive system (rash - infectious diseases, vascular stars and skin color changes in the diseases of the liver).

Diagnosis of diseases of the digestive

Prevention of diseases of the stomach and intestines.

The main and most important prevention of diseases of the digestive organs, and not only them, is to keep a healthy lifestyle. This includes a refusal of bad habits (smoking, alcohol and others), regular physical culture classes, the exclusion of hypodynamine (lead the movable lifestyle), compliance with labor and recreation regimes, full sleep and more. It is very important to be a complete, balanced, regular nutrition, which provides admission to the body of the necessary substances (proteins, fats, carbohydrates, minerals, microelements, vitamins), observation of the body mass index.

Also, the prophylactic measures include annual medical examinations, even if nothing bothers. After 40 years, it is recommended annually ultrasound procedure Abdominal organs and esophagogastroduodenoscopy. And in no case cannot be launched a disease, when symptoms appear to see the doctor, and not engage in self-medication or only folk medicine.

Compliance with these measures will help to avoid or reveal and timely start treating diseases not only the digestive system, but also the body as a whole.

Nutrition for diseases of the stomach and intestines.

Nutrition for diseases of the digestive system should be special. In this regard, in our country at one time of the Russian Academy Medical Sciences Special diets have been developed that are suitable not only for diseases of the digestive organs, but also other systems, too (diets are indicated in articles on the treatment of certain diseases). A specially selected diet is necessary in the treatment of diseases of the digestive organs and is the key to successful treatment.

With the impossibility of conventional enteral nutrition, parenteral is prescribed, that is, when the necessary organisms of the substance come immediately into the blood, a mine digestive system. Indications for the purpose of this nutrition are: complete esophageal dysphagia, intestinal obstruction, acute pancreatitis and a number of other diseases. The main ingredients of parenteral nutrition - amino acids (polyamine, aminoofusine), fats (lipofundine), carbohydrates (glucose solutions). Also introduced electrolytes and vitamins, taking into account the daily need of the body.

Diseases of the digestive organs include:

Oral diseases, salivary glands and jaws
Diseases of the esophagus, stomach and duodenum
Cases of Appendix [Cherched Ground]
Gryzhi
Noncommunicability enteritis and colitis
Other sickness of the intestine
Diseases of peritoneum
Diseases of the liver
Diseases of the gallbladder, biliary tract and pancreas
Other digestive diseases

Read more about the diseases of the digestive system:

To maintain its livelihoods, the human body must regularly receive vitamins, trace elements and other nutrients. The digestion system is responsible for this process, the functioning of which depends on the state of many organs. Any failure in their work can violate the well-established mechanism, therefore diseases of the digestive organs need to be treated in a timely manner.

How does the digestive system work?

When a person sends food to his mouth, he is not thinking about her further fate. Meanwhile, bypassing the oral cavity, the food then passes through the throat, the esophagus and enters the stomach. In this organ, food is split under the action of gastric juice containing hydrochloric acid. Then the primary recycled food moves to the initial division of the intestine - the duodenum. For its splitting in this body, bile is responsible. The final intestine is engaged in the final recycling, where suction is absorbed into the blood of the useful substances. Finally, untapped food residues are sent to a large intestine and under the influence of its motor functions are removed from the body. It should be noted that the liver and pancreas are also involved in the digestion.

Diseases

If the work is disturbed by at least one of the above-listed organs, the digestive system can no longer function normally. People develop various diseases, and in recent times it happens quite often. There are a great many diseases of the digestive system. The most common diseases are, the ulcer of the stomach and, colitis, gastroduodenitis, reflux-esophagitis, dyskinesia of the gastrointestinal tract, intestinal obstruction, cholecystitis, pancreatitis, constipation, diarrhea.

Causes

The development of diseases of the digestive system depends on many factors. There are a variety of specific and provoking factors, but doctors identify the external and internal causes of pathologies. First of all, external reasons are negatively affected by the digestive organs: the use of poor-quality food, excessive, smoking, stressful situations, long-term reception of drugs.

The internal reasons for diseases of the digestive system include autoimmune processes in the human body, malformations of intrauterine development, hereditary predisposition. Sometimes the consequence of the development of a single disease is the presence of two or more predisposing factors.

Symptoms

Painful syndrome of varying severity - the main symptom characteristic of most diseases digestive organs. However, pain is manifested in different ways. It may be nullifying or intense and sharp, as with the exacerbation of the stomach ulcers. In case of pancreatitis, pain is hazardous, gives under the blades or in the region of the heart. Cholecystitis is accompanied by pain, which are localized in the area of \u200b\u200bthe right or left hypochondrium. An important role in the development of pain syndrome plays meals. In particular, with ulcerative disease, pain occurs mainly on an empty stomach, and with pancreatitis or cholecystitis after consuming oily food.

Another common symptom signaling about the presence of problems in the gastrointestinal tract is dyspepsia. It happens two varieties. Upper dyspepsia is an exterior, heartburn, loss of appetite, feeling of overcrowding in the field of epigastria, nausea, vomiting. Lower dyspepsia is manifested in (meteorism), diarrhea or constipation. The manifestations of one or another dyspepsia depends on the particular disease of the digestive organs.

Treatment and prevention

Treatment of diseases of the digestion system is to take appropriate drugs and compliance with diet nutrition. The main thing is to properly diagnose the emerging ailment and try to avoid the transition of the existing disease in chronic form.

Problems associated with the work of the stomach or intestines cause discomfort from any person. Therefore, the prevention of diseases of the digestive organs is played. It is necessary to take care of a balanced diet, exercise physical activity, to rest fully rest, throw bad habits, learn how to deal with stress. And upon reaching the age of 40, an ultrasound study of the abdominal organs should be held regularly. Take care of your health!

Diseases of digestive organs - This group of diseases occupies one of the leading places among the diseases of the internal organs. The fact is that various factors of the external environment are constantly affected by the digestive system - the nature of nutrition, working conditions and life.

In addition to structural changes of the digestive system, functional disorders may also occur. The domestic digestive organs includes esophagus, stomach, intestines, liver, pancreas. In digestion, gallways also participate.

Diseases of digestive organs are widespread. Most often, these are various inflammatory processes associated with the presence of an infection or disruption of the internal secretion glands. Any of these diseases in the acute stage requires immediate treatment, since when switching it to a chronic form, operational intervention may be required.

Diseases of digestive organs

The diseases of the organs of the digestive tract are distinguished by the variety of their clinical and morphological signs.

They include independent primary diseases that studies science, which is named gastroenterology, as well as other secondary, which are a manifestation of a number of diseases of infectious and noncommunicable nature, acquired or hereditary origin.

At the heart of these diseases, various common community processes may lie, such as alteration, inflammation, hyper- and dysplastic processes, autoimmune disorders and, finally, tumors.

Descriptions of digestive diseases

Causes of diseases of the digestive

The reasons of the disorder of the digestion system are:

Exogenous, endogenous, as well as genetic factors can provoke diseases of digestion.

Exogenous

Such primary reasons of the disease include:

• eating dryness
• eating very hot dishes,
• abuse of various spices and spices
• excessive alcohol consumption
• smoking,
• upholstery of poor-quality foods,
• no power mode
• hurry meal,
• clamp defects man,
• uncontrolled medication
• an unfavorable environmental situation.

Diseases caused by exogenous factors include gastritis and enteritis, colitis, ulcer of the stomach and duodenum, bile disease, and dyskinesia and liver cirrhosis.

Endogenic

Secondary (or endogenous) causes of gastrointestinal diseases are such diseases as diabetes and anemia, obesity and hypovitaminosis, various diseases of the kidneys and lungs, stress. Diseases provoked by endogenous factors are hepatitis and cholecystitis, pancreatitis and enterobiosis.

Genetic

This group includes genetic factors, as well as developmental anomalies, among which malforms of the esophagus and benign tumors (and esophagus, and stomach), diagnosed abnormal development of the pancreas (for example, cystic fibrosis directly pancreas), as well as congenital pancreatic hypoplasics .

It should be noted that most often the disease of the gastrointestinal tract occurs when combined as endogenous and exogenous factors.

Symptoms of digestive diseases

Symptoms of diseases of the digestive system are diverse, but there are always the main signs of the presence of the disease:

• nausea;
• frequent challenge of the chair;
• belching;
• vomiting;
• flatulence;
• disruption of appetite;
• fast fatiguability;
• reducing body weight;
• pain in the stomach of various locations;
• insomnia.

Rest characteristic symptoms Different and depend on the type of disease. In many cases, digestion disease is accompanied by rashes on the skin.

Diagnosis of diseases of the digestive

Initially, when suspected the development of diseases of the digestive system, the doctor necessarily conducts a thorough examination of the patient. In the process of inspection, palpation is practiced, percussion, auscultation. It is necessary to ask about complaints, learn anamnesis.

As a rule, under diseases of this type, laboratory research is assigned to the patient:

• common and biochemical blood tests,
• conducting a general urine analysis,
• cala analysis.

Wide in the diagnostic process, radiation research methods are also practiced. An informative method is an ultrasound study of the abdominal organs, the conduct of radiography, radioscopy with the use of contrast substances, CT, MRI.

Depending on the disease, procedures can also be assigned to estimate the state of the internal organs of the digestive system and at the same time receive a biopsy material:

• colonoscopy
• ezophagogastroduodenoscopy,
• rectorOnoscopy,
• laparoscopy.

In order to survey the stomach, the use of functional tests is practiced to obtain detailed information on the acid secretion of the stomach, its motor function, as well as the state of the pancreas, the small intestine.

Treatment of diseases of the digestive

The treatment method is determined after diagnosis. In infectious and inflammatory pathologies, antibacterial therapy is required. The following drugs are used: M "Ciprofloxacin", "Cefazolin", "Metranduazol".

For the treatment of enzyme failure, Mezim, Pancreatin preparations are used. Also use anti-inflammatory and antisecretory agents. Surgery It is to eliminate the intestinal obstruction, the removal of concretions, tumor formations, the stroke of the ulcerative defect, etc.

Nutrition for diseases of the digestive

Nutrition for diseases of the digestive system should be special. In this regard, in our country, at one time the Russian Academy of Medical Sciences developed special diets that are suitable not only for diseases of the digestive organs, but also other systems, too (diet are indicated in the articles on the treatment of certain diseases). A specially selected diet is necessary in the treatment of diseases of the digestive organs and is the key to successful treatment.

With the impossibility of conventional enteral nutrition, parenteral is prescribed, that is, when the necessary organisms of the substance come immediately into the blood, a mine digestive system. Indications for the purpose of this nutrition are: complete esophageal dysphagia, intestinal obstruction, acute pancreatitis and a number of other diseases.

The main ingredients of parenteral nutrition - amino acids (polyamine, aminoofusine), fats (lipofundine), carbohydrates (glucose solutions). Also introduced electrolytes and vitamins, taking into account the daily need of the body.

Prevention of diseases of the digestive

The main and most important prevention of diseases of the digestive organs, and not only them, is to keep a healthy lifestyle.

This includes a refusal of bad habits (smoking, alcohol and others), regular physical culture classes, the exclusion of hypodynamine (lead the movable lifestyle), compliance with labor and recreation regimes, full sleep and more.

It is very important to be a complete, balanced, regular nutrition, which provides admission to the body of the necessary substances (proteins, fats, carbohydrates, minerals, microelements, vitamins), observation of the body mass index.

Also, the prophylactic measures include annual medical examinations, even if nothing bothers. After 40 years, it is recommended annually to conduct an ultrasound study of the abdominal organs and esophagastroduodenoscopy.

And in no case cannot be launched a disease, when symptoms appear to see the doctor, and not engage in self-medication or only folk medicine.

Questions and answers on the topic "Diseases of the digestive organs"

Question: Having attempted to go to bed and burst in the throat and in the mouth.

Answer: Binding in the mouth and throat is considered a manifestation of many diseases of various types: from otolaryngological and dental pathologies to violations in the operation of the digestive tract. The most likely cause of the feeling of bitterness in the throat is a violation in the work of biliary tract. You need a full-time consultation doctor for examination.

Question: Hello! I'm 52 years old. Somewhere in the 2000th year was at the examination from the doctor, the diagnosis was put by gastritis and hernia of the esophagus, pancreatitis, cholecystitis, in general, a whole bouquet of diseases. There were pebbles in the bustle bubble. I saw the preparations of various, bums from herbs, and then ceased to be treated. But for many years it suffers from heartburn, there are pains in the area of \u200b\u200bthe stomach, liver. I take various preparations from heartburn, and during the year, after each meal, I feel the gravity in the stomach and after a while it is constantly cloning to sleep and again frequent heartburn. I almost always saves antacid agents. Tell me please why, after meals, I begin to clone to sleep and is it harmful to the frequent use of Renni and Almagel eh?

Answer: First of all, it is necessary to decide on the stones in the bustling bubble. If you are presented, all your problems will only be exacerbated. It is necessary to examine the gastroenterologist.

Medical statistics noted that in the past decades of the pathology of the gastrointestinal tract, in the list of diseases leading place. Specialists confirm that most urban residents, to some extent, suffer from food disorders.

Modern rhythm of life, rich in constant stress, poor ecology, improper and irrational nutrition leads to the fact that by the 30s each fourth of a person has one of the diseases of the gastrointestinal tract. Which of them are most common, what is the cause of pathological conditions and how to deal with the diseases of the digestive tract?

Everyone knows that a person cannot live without food, with her he gets the necessary proteins, carbohydrates, fats, vitamins and trace elements for the livelihoods. They are the source of energy and the main building material for new cells. And it helps to get this energy from the incoming gastrointestinal tract of a person.

The digestive system itself consists of the following main departments: oral cavity, throat, esophagus, stomach. Next follow lower departments: Thin and fat intestines, straight intestine. Each of these departments performs a specific function of processing and assimilation of the incoming food.

Under the influence of adverse factors, faults arise in the work of the tract, leading to various diseases. What reasons most often become a trigger mechanism of disease?

Causes of intestinal diseases

Diseases of the digestive system may provoke the following factors:

The list of adverse factors is quite extensive and the risk of developing the pathology of the digestive system is great for each person. Therefore, with special attention should be treated with the slightest signs of unfavorable to avoid the development of severe and dangerous diseases. What symptoms need to pay attention to?

Symptoms of intestinal diseases

The main symptoms of intestinal diseases are known to many. But the nature of the manifestations in each case is individual, and the severity of symptoms depends on the affected organ and stage of the disease.

In addition to these basic symptoms, there are a number of characteristic features indicating the defeat of the digestive system:

Most of these symptoms do not represent much danger, but significantly reduce the quality of life of the patient and affect its performance. When ignoring the symptoms and late appeal to the medical assistance of the digestive system, they go into a chronic form, their exacerbation may have serious consequences for the patient.

All diseases of the digestive tract in nature are divided into two large groups:

1. Infectious
2. Non-heel

The localization of the pathological process is distinguished by diseases of the following organs:

• Stomach
• Esophagus
• Intestines (thin and thick)
• Biliary tract
• Liver

In addition, the gastrointestinal diseases are acquired and hereditary, sharp and chronic.

Acute intestinal diseases Basically have bacterial-infectious nature and develop against the background of poisoning, allergic reactions or some pathological conditions (viral hepatitis, esophagitis).

Chronic inflammatory processes such as gastritis, colitis, cholecystitis are developed against the background of a long disorders of the power mode, use of low-quality and harmful products. Moreover, such chronic diseases rarely proceed insulated, in most cases the entire digestive tract is involved in the inflammatory process. Consider in more detail the most common pathological states of the gastrointestinal tract.

A brief list of the most common gastrointestinal diseases:

The list of diseases of the gastrointestinal tract is sufficiently extensive and the above-mentioned diseases constitute only a small part of them. Treatment of intestinal diseases requires a competent approach, proper and timely diagnosis and timely appeal to the doctor in the appearance of disadvantaged symptoms.

Diagnosis of diseases of the gastrointestinal tract

Methods of physical and instrumental examination are used to diagnose diseases of the digestive system.

Physical examination

For a start, the doctor will conduct a patient survey, will collect anamnesis, asking for complaints, well-being, power, heredity, the presence of chronic diseases. Then it will begin to examine the patient using such diagnostic methods like palpation, auscultation and percussion.

1. It implies the tack of internal organs through the abdominal cavity. The method is based on tactile sensations and allows the fingers to explore the position of the organs, their shape, consistency, mobility and soreness.
2. Auscultation - This is listening to internal organs using a phoneneoscope or stethoscope.
3. Percussion - A method that allows you to determine the physical condition and topography of the internal organs by tapping in different parts of the body.

Instrumental examination

The basis of many diseases of the tract of the tract is the violation of the secretion and motor activity of various departments of the digestive tract. Therefore, in the first place there are methods of studying the acidity of gastric juice, such as intragastric, daily and endoscopic pH-metry.

For the study of Motoric, the gasts apply the methods of pressure gauge and gastrography. In order to visually inspect the inner surface of the esophagus, the stomach and intestines use endoscopic methods.

If it is necessary to inspect the internal organ as a whole, to identify pathological flaws, use x-ray methods, laparoscopy, MRI (magnetic resonance tomography), CT (computed tomography) and ultrasound (ultrasound research). In some cases, diagnoses with the use of radioactive substances (scintigraphy).

In addition, use laboratory methods Diagnostics, carry out a histological examination of tissue samples poaching with biopsy, are carried out cytological and microbilic studies.

Treatment of intestinal diseases

The therapy of intestinal diseases is beginning after a thorough examination and clarification of the diagnosis. The course of treatment will depend on the specific disease, the stage of its development, the overall condition and well-being of the patient. In most cases, methods of conservative drug therapy are used. In a number of acute cases, there is a need for surgical intervention.

Therapist or gastroenterologist is engaged in the treatment of GAST diseases. If any adverse symptoms associated with the digestive bodies are important in a timely manner for medical assistance and diagnosis. It is unacceptable to engage in self-treatment and postpone the visit to the doctor, it can turn into serious complications or states threatening the patient's life.

Tactics of treatment in each case will be selected individually, based on the survey results. In a complex with medication therapy, many use folk remedies: champs and infusions of medicinal plants. They give a good medicinal effect, but they can only be applied after consulting with the attending physician and under its control.

Recently, there has been a significant increase in the number of diseases of the digestive system in children. This is facilitated by many factors:

1. bad ecology,
2. unbalanced food
3. heredity.

Harological harm to the children's body is applied so favorite sweets and confectionery with a great content of preservatives and artificial dyes, fast food, carbonated drinks. The role of allergic reactions, neuropsychiatric factors, neurosis increases. Doctors note that intestinal diseases in children have two age peaks: in 5-6 years and in 9-11 years. The main pathological conditions are:

• , diarrhea
• Chronic and sharp gastritis and gastroenteritis
• Chronic enterocolit
• Gastric ulcer and duodenal ulcer
• Chronic cholecystitis
• Chronic pancreatitis
• Diseases of biliary tract
• Chronic and sharp hepatitis

Large importance in the occurrence and development of gastrointestinal diseases plays the insufficient ability of the children's body to resist infections, since the child's immunity is still weak. The formation of immunity is greatly influenced by proper feeding in the first months of life.

The best option is breast milk with which protective bodies are transferred from the mother to the child, which increase the ability to resist various infections. Children fed by artificially mixtures are more often susceptible to various diseases and have a weakened immunity. The cause of violations in the operation of the digestive system can be irregular feeding or throwing a child, early introduction of the feeding, non-compliance with hygienic standards.

A separate group is sharp intestinal diseases in children (dysentery, salmonellosis). Their main clinical manifestations are dyspeptic disorders, dehydration (dehydration) of the organism and symptoms of intoxication. Such manifestations are very dangerous and require immediate hospitalization of a sick child.

Intestinal infections are particularly often diagnosed in childhood, this is due to the imperfection of protective mechanisms, the physiological characteristics of the digestive organs and the absence of sanitary skills in children. Especially negatively acute intestinal infections affect early children and can lead to a significant decrease in immunity, delay in physical development, attachment to complications.

Their principle is accompanied by characteristic features: a sharp increase in temperature, pain in the abdomen, diarrhea, vomiting, loss of appetite. The child becomes restless, or opposite sluggish and inhibited. The clinical picture depends largely on which intestinal deposits are amazed. In any case, the child needs emergency medical care and antibacterial therapy.

The treatment of diseases of the digestive system in the kids is engaged in a children's gastroenterologist, it is necessary to contact him when disadvantaged symptoms appear.

Diet and Features of Nutrition for Gastrointestinal Diseases

The diseases of the tract are so different that to give any specific recommendations that are impossible to give any patient without exception. The adjustment of the diet in each particular case is made by the doctor individually, taking into account all the peculiarities of the patient and its diagnosis. We can consider only the principles of healthy nutrition, which must be observed that all patients suffering from the pathologies of the digestive system.

Diet with intestinal diseases It assumes fractional food, in small portions, this allows not to overload the stomach and prevent overeating. It is necessary to eat 5-6 times a day, preferably at the same time. Be sure to comply with the drinking regime. On the day of the patient should drink 1.5-2 liters of fluid and the form of water, juices, compotes, fastening tea (better than herbal or green). Carbonated drinks are excluded.

Food should be the most gentle, not irritating the mucous membrane of the stomach and intestines. Preferably use:

• porridge cooked on water
• non-fat meat and fish broths,
• omelets,
• puree
• souffle.

The meat is better to prepare in the form of a kitlet, bokings, nodes. All products are better to boil, bake or cook for a couple, from fried dishes it is necessary to refuse. Temperature regime should be observed when applying finished dishes. You can't eat too hot or cold food. Dishes must be fed warm.

Vegetables are better to cook or make a mashed potature, fruit can be grate or baked (baked apples). Vegetables with coarse fiber, causing in the stomach of fermentation processes and excessive gas formation is not recommended. This cabbage, all kinds of legumes, radishes, corn, radish, turnip.

It should be limited or minimized by the use of flour and confectionery, sweets, strong coffee, tea, to be from fast food. It is strictly forbidden to use alcohol, oily, fried, salty, sharp, pickled food. From the diet, it is better to exclude:

• seasonings
• sauces
• semi-finished products
• canned food and all other products containing artificial dyes and preservatives.

Food should be fresh, easy to absorb and contribute to the normalization of the work of the gastrointestinal tract. The smaller the refined food in the diet, and more products containing fiber and nutritional fibers, the better the operation of the digestive system will be.

Prevention

Prevention of intestinal diseases primarily includes measures to ensure balanced and healthy nutrition. Observe personal hygiene measures and sanitary requirements when preparing dishes. By this you will protect yourself from food infections.

Eat more fruits and vegetables, choose the proper methods of heat treatment of products (cooking, quenching). Fit fractionally, do not overeat, give up snacks on the go and fast food. Nutrition should be balanced and diverse, with the right ratio of nutrients (proteins, fats, carbohydrates, vitamins).

Try to move more, lead an active lifestyle, go on sports, walk more on foot, perform the sink exercise, run, swim.

Burn with stress and psychological stress, for this you can take natural sedatives (mother-in-law, Valerian).

In the event of any adverse symptoms associated with the work of the digestive tract, in a timely manner, do not engage in self-medication. Only so you can avoid the transition of the disease into the chronic stage and achieve recovery.