Infectious diseases and pediatrics
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MINISTRY OF HEALTH OF THE REPUBLIC OF UZBEKISTAN
TASHKENT MEDICAL ACADEMY "INFECTIOUS DISEASES AND PEDIATRICS" CHAIR LECTURE ON THE SUBJECT: CHRONIC GASTRODUODENITA AT CHILDREN (for students of medical and medico-pedagogical faculties) TASHKENT – 2012 MINISTRY OF HEALTH OF THE REPUBLIC OF UZBEKISTAN TASHKENT MEDICAL ACADEMY "INFECTIOUS DISEASES AND PEDIATRICS" CHAIR I "CLAIM" dean of the medico-pedagogical faculty
professor Zufarov P. S. ___________________ ____ _____________ 2012 CHRONIC GASTRODUODENITA AT CHILDREN Lecturer: MD HALMATOV B. T. TECHNOLOGY OF TRAINING Number of students - 85-90 Time – 2 hours Form of educational occupation Lecture - visualization
2 . To train the student in criteria of diagnostics of HGD. 3 . To show the principles of carrying out differential diagnostics. 4 . To train students in the principles of treatment of HGD 5 . To train students in the principles of prevention of HGD 6 . To train students in scheduling of improving actions. Purpose of educational occupation: to acquaint students an etiology, patogenezy, prevalence, the principles of diagnostics, differential diagnostics, treatment, tactics of VOP and HGD prevention Tasks of the teacher: 1 . To fix and deepen knowledge of students about chronic гастродуоденитах 2 . To show clinical signs characteristic for chronic гастродуоденита 3 . To explain the principles of carrying out differential diagnostics 3 . To develop at students skills of independent adoption of reasonable decisions at appointment rehabilitation mero-priyatiya to children with chronic the gastroduodenity 4 . To acquaint students the principles of carrying out the pro of laktichesky actions Results of educational activity: The student has to: 1 . To give HGD definition; 2 . To give the characteristic of children with HGD; 3 . To list the clinical symptoms characterizing HGD; 4 . To carry out differential diagnostics; 6 . To appoint treatment at HGD 7 . To hold preventive events Methods and equipment of training Lecture – visualization, equipment: the quiz, focusing questions, equipment "not" Tutorials Laser projector, visual materials, information support Forms of education Collective Training conditions the Audience adapted for work with TSO TECHNOLOGICAL CARD OF LECTURE Stages, time Activity teacher of students 1 stage Introduction (5 min.) 1. Reports the subject name, the purpose, planned results of lecture and the plan of its carrying out 1. Listen 2 stage Updating of knowledge (20 min.) 2.1. With the purpose to staticize knowledge of students asks focusing questions: 1 . At children you know AFO of digestive organs? 2 . What factors promote HGD development? 3 . From what age children are ill HGD? Carries out a blitz poll. 2.2 . Displays and offers to examine the lecture purpose. Makes comments on the maintenance of a slide. Slide No. 1 2.3 . Displays a slide No. 2 2.1. Answer questions 2.2 . Study the maintenance of a slide No. 1 2.3 . Study the contents 3 stage
Informatsion ny (55 min.) 3.1. Consistently states a material of lecture on plan questions, uses visual materials and system of focusing questions: On 1 question of the plan: Give HGD definition On the 2nd question of the plan: What main diagnostic criteria of HGD at children? On the 3rd question of the plan: With what diseases it is necessary carries out the differential diagnosis of HGD? Focuses attention on the key moments of a subject, suggests them to write down. 3.1 . Discuss the maintenance of the offered materials, specify, ask questions. Write down the main thing
Zaklyuchitel- ny (10 min.) 4.1. Asks a question: 1 . What forms of gastritises you know? 2 . What complications can be at HGD? 4.2 . Gives a task for the most stoyatelny work: Gastroezofagalny reflux 4.1. Answer a question
Chronic гастродуодениты Chronic гастродуоденит it is characterized by nonspecific inflammatory restructuring of a mucous membrane of a stomach and a duodenal gut, and also sekretorny and motor эвакуаторными violations. At children, unlike the adults, isolated defeat of a stomach or a duodenal gut observe rather seldom – 10-15% of cases. Observe the combined defeat of these departments much more often. Duodenal gut, being gormonalno active body, has regulating impact on functional and evakuatorny activity of a stomach, a pancreas and zhelchevyvodyashchy ways. Etiologies and патогенез The leading etiologichesky role belongs to alimentary and psychogenic factors. The importance of these factors increases with hereditary predisposition to diseases of a gastroduodenal zone. Also long reception of medicines, food allergy and other factors reducing local specific and nonspecific protection of a mucous membrane matter. One of the main reasons for development of HGD – Helicobacter pylori infection. After detection at patients with chronic gastritis in a mucous membrane of a microorganism of Helicobacter pylori (HP) B. Marshall and J. Warren (1983) the new stage in development of ideas of an etiology and патогенезе and methods of treatment of diseases of a stomach and a duodenal gut began. However so far the role and the importance of NR in development of this pathology finally aren't found out. The concept about the leader, a dominating role of NR in development of defeats of a mucous membrane of a stomach and a duodenal gut some researchers consider as one of steady medical myths. The author emphasizes a saprofitichesky role of a microorganism, pointing to harm of the NR-concept. At the same time the leading role in an etiology and патогенезе diseases of a stomach and a duodenal gut of NR is emphasized in the majority of works, thus authors consider, in particular, "a duodenal ulcer" as manifestation of an infectious disease. Now it is established that the obsemenennost of a mucous membrane of a stomach of NR promotes development chronic гастродуоденита and stomach ulcer. The Gelikobakterny infection and its role in formation of gastroduodenal pathology at children cause interest in many researchers. It is caused by that still aren't found out and many mechanisms gastrito-and ульцерогенеза and their communication with the NR-infection aren't specified. Дуоденит develops against the gastritis caused by Helicobacter pylori, and a metaplaziya of an epithelium of a duodenal gut in gastric, developing as a result of dumping of sour gastric contents in a duodenal gut. Helicobacter pylori settles on sites of a metaplazirovanny epithelium of m causes in them the same changes, as in a stomach. The centers of a gastric metaplaziya are unstable to influence of contents of a duodenal gut that leads to emergence of erosion. Therefore гастродуоденит, associated with Helicobacter pylori, more often happens erosive. At the same time local immunity changes, autoimmune aggression develops, synthesis of the hormones regulating motor секреторную function of pankreato-biliarny system is broken. Classification The standard classification of HGD isn't present. Them subdivide as follows: • Depending on an etiologichesky factor – гастродуоденит primary and secondary • On an endoscopic picture – superficial, erosive, atrophic and hyper plastic • According to histologic data – гастродуодениты with easy, moderate and heavy degree of an inflammation, an atrophy, a gastric metaplaziya • On the basis of clinical manifestations allocate phases of an aggravation, incomplete and full remission. Chronic diseases of a stomach and duodenal gut often begin at preschool and school age; the recidivous course of disease leads to the expressed anatomic changes of body and further to disability and an invalidization of adult population. Morphological characteristic mucous stomach and duodenal gut Endoscopic Histologic Superficial gastritis (гастродуоденит) Superficial gastritis (гастродуоденит) "Hypertrophic gastritis" (гастродуоденит) Diffusion gastritis (гастродуоденит) Erosive gastritis (гастродуоденит) without an atrophy of glands Hemorrhagic gastritis (гастродуоденит) with an atrophy of glands Subatrophic (atrophic) gastritis (гастродуоденит) the huge hypertrophic Clinical picture HGD differs polymorphism of symptoms and is often combined with other diseases of digestive organs in this connection not always it is possible to delimit the manifestations caused gastroduodenity, from the symptoms caused by accompanying pathology. Гастродуоденит in a phase of an aggravation it is shown by aching skhvatkoobrazny pains in the epigastralny area, arising through 1-2 h after food and quite often irradiirushchy in podreberye and okolopupochny area. Meal or антацидов reduces or stops pain. The pain syndrome can be accompanied by heavy feeling, a raspiraniye in epigastralny area, nausea, a salivation. In the mechanism of development of a pain syndrome and the dispeptichesky phenomena the main role belongs to dyskinesia of a duodenal gut. Thereof amplifies the duodenogastralny reflux causing a bitter eructation, sometimes vomiting with bile impurity, is more rare heartburn. At survey of patients pallor of integuments, and also low mass of a body attracts attention. Language is imposed with a white and yellow-white raid, is frequent with prints of teeth on a lateral surface. At a palpation of a stomach define morbidity in piloroduodenalny area, is more rare round a navel, in epigastralny area and podreberye. Mendel's symptom is characteristic. Many patients have Ortner and Kerr's symptom. At children with HGD often note vegetative and psychoemotional frustration: periodic headaches, dizziness, dream violation, fast fatigue that is connected with violation of endocrine function of a duodenal gut. Vegetative frustration can be shown by a clinical picture a dumping syndrome: weakness, perspiration, the drowsiness, the strengthened vermicular movement of the intestines, arising in 2-3 h after meal. At a long break between meals can arise and hypoglycemia signs in the form of muscular weakness, a shiver in a body, sharply increased appetite. HGD has a cyclic current: the phase of an aggravation is replaced by remission. Aggravations arise in the spring and in the fall more often, are connected with diet violation, an overload at school, various stressful situations, infectious and somatic diseases. Weight of an aggravation depends on expressiveness and duration of a pain syndrome, the dispeptichesky phenomena and violation of the general condition. Spontaneous pains pass on the average in 7-10 days, palpatorny morbidity remains 2-3 weeks. As a whole the aggravation of HGD proceeds 1-2 months. Incomplete remission is characterized by absence of complaints in the presence of moderate objective, endoscopic and morphological signs дуоденита. In a stage of remission don't find neither clinical, nor endoscopic, morphological manifestations of an inflammation in a duodenal gut. Diagnostics The diagnosis of HGD is based on data of clinical supervision, studying of a functional condition of a duodenal gut, endoscopic and histologic researches. HGD has a cyclic current: the phase of an aggravation is replaced by remission. Aggravations arise in the spring and in the fall more often, are connected with diet violation, an overload at school, various stressful situations, infectious and somatic diseases. Weight of an aggravation depends on expressiveness and duration of a pain syndrome, the dispeptichesky phenomena and violation of the general condition. Spontaneous pains pass on the average in 7-10 days, palpatorny morbidity remains 2-3 weeks. As a whole the aggravation of HGD proceeds 1-2 months. Incomplete remission is characterized by absence of complaints in the presence of moderate objective, endoscopic and morphological signs дуоденита. In a stage of remission don't find neither clinical, nor endoscopic, morphological manifestations of an inflammation in a duodenal gut. Diagnostics The diagnosis of HGD is based on data of clinical supervision, studying of a functional condition of a duodenal gut, endoscopic and histologic researches. Tool researches and criteria of diagnostics: • Fibroezofagogastroduodenoskopiya with an aim biopsy and carrying out the express of diagnostics of HP (at erosive HGD — double); • intragastric RN-metriya (or fractional research of gastric contents) — at a time; • Ultrasonography of abdominal organs — once for identification of accompanying pathology. If necessary: • radiological research of a stomach and DPK (motor эвакуаторные violations, anomalies of development); Laboratory criteria of an assessment of acid-forming function of a stomach are presented in the table. Tool researches and criteria of diagnostics: • Fibroezofagogastroduodenoskopiya with an aim biopsy and carrying out the express of diagnostics of HP (at erosive HGD — double); • intragastric RN-metriya (or fractional research of gastric contents) — at a time; • Ultrasonography of abdominal organs — once for identification of accompanying pathology. If necessary: • radiological research of a stomach and DPK (motor эвакуаторные violations, anomalies of development); Laboratory criteria of an assessment of acid-forming function of a stomach are presented in the table. Modern method of definition of acid-forming function of a stomach intragastric RN-metriya. This method allows to define RN of a body and antralny department of a stomach. Normal RN of a body of a stomach on an empty stomach makes at children is more senior than 5 years 1,7-2,5, and after histamine introduction — 1,5-2,5. The Antralny department of a stomach which carries out acid neutralization, has RN higher than 5. (Shabalov M.P., 1999). That is the difference between RN of a body and antralny department in norm higher than 2 testifies to the compensated condition. Reduction of this difference testifies to reduction of neutralized property of antralny department and acidulation of a duodenal gut (a dekompensirovanny condition). In some treatment-and-prophylactic establishments which are deprived of opportunity to spend intragastric RN-metriya stomach research RN by a fractional method with application of various irritants is conducted. Treatment Treatment at HGD carry out by the same principles, as at chronic gastritis. • In the sharp period of an illness the confinement to bed for 7-8 days is shown • The diet has great value. In the first days of an illness the table No. 1, in the subsequent – a table No. 5 is recommended. During remission the good nutrition is shown • At the increased acidity of a stomach recommend H1 blockers of retskptor of a histamine, and also омепразол during 3-4 weeks • According to indications apply the means regulating a motility (метоклопрамид, домперидон) • In the course of rehabilitation appoint physical therapy, LFK, sanatorium treatment.
Seven-day threefold therapy with bismuth preparations: 1 . Bismuth subcitrate + Antibiotic + Nitrofuranovy preparation 2 . Bismuth subcitrate + Antibiotik-makrolid + Amoksitsillin Seven-day threefold therapy with blockers of the proton pump: 1 . Omeprazol +Антибиотик + Nitrofuranovy preparation. 2 . Omeprazol + Antibiotik-makrolid +Амоксициллин.
1 . Bismuth subcitrate + Antibiotic + Nitrofuranovy preparation + омепразол Bismuth preparations: colloidal subcitrate of bismuth (de zero) - 4¼ú/kg 2 times a day. Antisekretornye of means: Omeprazol (Losek) of 1 mg/kg/days. Antibiotics: Amoksitsillin – 25-30 mg/kg/days (max of 1,0 g/days) in 2 receptions; Klaritromitsin (кларомин) –15 mg/kg/days (max 500mg/sut) in 2 receptions; Nitrofuranovye preparations: Furasolidone – 6-8мг/кг/сут (max 400mg/sut) in 3-4 receptions, a nifuratel (Makmiror) – on 15 mg/kg. At other forms of gastritis, гастродуоденита symptomatic treatment with use of the following combinations of preparations is carried out: At a yazvennopodobny dispepsiya: H2 blockers (ranitidine 300mg/sut in day, or гастросидин on 150 mg of 1 time a day, or фамосан 150 mg of 1 time a day) At a diskinetichesky dispepsiya: Metoklopramid (церукал or a raglan) 10 mg 3-4 times a day before food Motilium (домперидон) on 1 mg/kg per day. In 10-15 min. prior to food. In a stage of an exacerbation of a disease physical methods of treatment — electrotreatment, heattreatment are applied. Motor эвакуаторной stomach and increase functions traffic SOZH is applied to normalization laser and magnito-laser therapy. Among not medicamentous methods of treatment are applied reflexotherapy. In a stage of clinical remission: phytotherapy, balneoterapiya, physiotreatment, LFK, not medicamentous nonconventional therapy. Terms of stay in a hospital on the average 21 days (at erosive HGD — till 28 days). Prevention At a disease of a gastroduodenal zone it is very important to observe the principles of an age food, to preserve the child against physical and emotional overloads. Secondary prevention includes adequate and timely therapy, supervision and regular consultations of the children's gastroenterologist. Literature: 1 . Children's diseases, under the editorship of P. Shabalov's N, 2010 2 . Children's diseases, under the editorship of A.A.Baranova, 2010 3 . Children's diseases, T.O.Daminov, B.T.Halmatova, U.R.Babayev, 2012 4 . Diseases of digestive organs at children, V.A.Mazurin, 1994, 5 . Denisov M. Yu. Practical gastroenterology for the pediatrician. M, 2001. 6 . Clinical medicine. Directory of the practical doctor. M, 1997, T.1 7 . Nazirov F.G. Denisov I.N. Ulumbekova E.G. Directory of the practical doctor. 2000 8 . Pathology of children of advanced age – under. Yüklə 66,5 Kb. Dostları ilə paylaş:
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