Академический Документы
Профессиональный Документы
Культура Документы
chronic digestive
disorders.
Syndrome
of regurgitation and
vomiting
( ).
, ,
Vomiting
Physiological gag occurs when stimulation of the
gastric mucosa (Irritation of the gastric mucosa)
(intolerance substance or overflow of the
stomach).
In pathological conditions, the gag reflex occurs
during stimulation of the labyrinth of the brain,
stomach, brain, and as a result of circulating
toxins and metabolites (metabolic products).
:
(5-30 ) 30-60
.
:
():
,
(50-100 ,
). .
( ):
50 , 30
; .
.
,
.
.
,
,
.
( ).
.
.
()
.
- -,
.
,
(
)
,
( 50% ).
.
- ,
.
,
.
(
, , ,
).
Patogenesis
Inappropriate relaxation of the lower
esophageal sphincter associated with
failure or underdevelopment of intramural
sympathetic ganglion cells.
Contributes to improving the appearance
of gastric reflux and intra-abdominal
pressure (flatulence, constipation, obesity,
spasm of the pylorus). Occurrence of
reflux contributes to increased intragastric
and intra-abdominal pressure (for
flatulence, constipation, obesity, spasm of
the pylorus).
,
(
)
Other factors
.
,
.
,
.
,
, .
Clinical signs
Regurgitation - the most common
symptom in infants - it is stress-free and
painless. Regurgitation occurs soon after few
hours of meal in the form of multiple episodes
of leakage from the mouth in small
amounts of milk curds. There is
reflux of stomach contents, especially with a
deep breath and low position of the upper
torso.
Vomiting - usually without any admixture
of bile flow or leakage of food.
. Complications
:
- (
,
,
, ,
,
).
Complications
Reflux esophagitis
(manifested by
irritability, strong cry, refusal of
food within a few minutes after
the feeding of infants, pain,
localized behind the
sternum and the
epigastrium, in older children).
bleeding from esophageal
:
()
(
)
(
)
Systems complications:
- delay in physical
development (malnutrition)
- anemia (due to blood loss and iron
deficiency)
- hypoproteinemia (protein loss due
to damage in the esophageal
mucosa)
:
, ,
,
.
Respiratory complications:
- aspiration with the development
of nocturnal cough, bronchospasm,
microaspiration syndrome, recurrent
pneumonia
- episodes of apnea and
bradycardia due
to laryngospasm, reflections from
the vagusnerve.
:
. -
.
,
.
( )
( ).
Diagnostics
- X-ray study of the gastrointestinal
tract with barium. The water-siphon test in
the positionTrandelenburg.
It can be seen as a radiopaque
substance numb from the stomach into
the lower esophagus.
Oesophageal angle (the angle
of His) larger (normally hot).
- Fibrogastroscopy
(chalasia)
-
The water-siphon test
.
10 , 2
20-30
.
.
. ,
10% .
Treatment
Diet.
- Frequent feeding of up to 10 times a
day, every 2 hours.
- After feeding for 20-30 minutes, keep
the baby upright for the elimination of the
consequences aerofagii.
- When chalasia long to keep upright.
antireflux FRISOVOM mixture. If not, then a
teaspoon of cream of 10% in cereal before
feeding.
, - 60
.
.
-:
-
,
.
,
.
Pilorospasm
Pilorospasm - inconstant pyloric obstruction
due to spasm.
The reason is a violation
of pylorospasm regulatory functions of the
central nervous system and
its autonomic division, which is more
common in children with birth injury of the
central nervous system, and
after intrauterine hypoxia.
.
. , ,
.
.
:
, ,
.
-
:
,
,
Complications
Hypotrophy (malnutrition)
reflux esophagitis,
bronchopulmonary disease:
microaspiration syndrome,
recurrent pneumonia,
bronchial obstruction
(10 , 2
).
.
,
.
20-30 .
30-45
.
.
Treatment
- Frequent feeding (10 times a day,every 2
hours).
- Anti-reflux mixture. You can alternate with
breastfeeding
- Drinking a fraction, considering the water
needs of a spoon.
- After feeding a baby to hold in an upright
position for 20-30 minutes.
raise the head end of bed to 30-45 degrees.
- Watch the baby to prevent aspiration of vomit.
:
2,5% (),
1.5 //. 3
.
0,25%
3 20-30
+
,
:
To reduce muscle
spasm pyloric neurons vegetoblockard
remedy:
2,5% solution of diprazina (Pipolphenum),
a daily dose of 1,5 mg / kg / day. 3 times a
day intramuscularly.
0,25% solution of
novocaine to teaspoon 3 times a day for
20-30 minutes before meals
+ Treatment of
existing syndromes, perinatal encephalopa
thy, as the main causes of pilorospasm:
,
.
- 2 - 3
, 7
.
,
.
.
Congenital pylorostenosis
This is a congenital malformation, manifested
in the narrowing of the pyloric canal due to
thickening of the walls of the pylorus.
Pyloric stenosis - a disease the first 2 3 months of life, the boys affected 7
times more often.
This disease has a definite tendency,
as observed in familial cases. The disease is
inherited in an autosomal recessive trait
.
3-, 4- .
, ,
.
.
,
.
Symptom hourglass
1. -
.
2. ( ),
( ).
3. .
4.
,
.
5.
.
6.
( )
:
,
,
-
.
Diagnosis
In the presence of three
clinical symptoms: vomiting a
fountain, visible peristalsis of the
stomach, pylorus probing packed
-leaves no doubt about the
diagnosis.
()
Diagnosis can
be virtually errorfree at endoscopy
(fibrogastroscopy) or X-ray
examination of the
gastrointestinal tract
with barium
30
12
:
,
()
(
, .
,
, ,
,
,
metabolic
alkalosis
hypokalemia
hyponatremia
The delay in
the barium
stomach more than 9
hours
No symptoms
viralization
metabolic
acidosis
hyperkalemia
hyponatremia
No delay in barium
symptoms
viralization
expressed
ECG changes
-,
.
2
10 ,
4 10 2 10
.
.
Pilorotomy Fredet-Weber-Bamstedt
The operation involves the dissection of seromuscular layer of pyloric stomach.
Upper, mid-right ad rectal cut 3-5 cm layers
reveal the abdominal cavity. Liver blunt hook
is pulled up and right and extract the
gatekeeper.
Fixing his fingers of his left hand, cut
longitudinally and serous and muscle pylorus.
After that, the grooved director peeled lining
up to its bulging into the wound.
:
2 - 20 2
3 30 2
4 40 2
5 50 2
6 60-70 2.5 8
10
.
:
(
),
,
,
,
( ),
( ).
Chronic diarrhea
They are:
intolerance to lactose (milk sugar),
intolerance to cow's milk proteins,
intolerance of disaccharidases,
exudative enteropathy,
celiac disease (gluten enteropathy)
cystic fibrosis (intestinal form).
.
,
.
.
,
3.8-5.0.
,
0.5%
Intolerance to lactose
Reduced activity of lactase, which is most
often secondary.
No part of metabolized carbohydrates enters
the large intestine and undergoes
fermentation.
Hence - flatulence, intestinal colic
Reduced fecal pH to 3.8-5.0.
Hence - a frequent sour, watery stools
In feces carbohydrates more than 0.5%
(
0.5%)
,
( .ALL 110),
(, ,
- )
Treatment
Preparations of lactase (lower level of
carbohydrates in feces is less than 0.5%)
If there is no effect, part of the breast
milk is replaced by a mixture of Low
Lactose(bebilak ALL 110), based on soy
protein (Humana, Humana SL, Nutri-soya,
etc)
Domestic milk mixture
.
( )
(
)
Intolerance of cow's
milk proteins
Develops in the appointment of artificial mixtures
based on cow's milk
Involve all sections of the intestine
Rapidly developing malnutrition (protein deficiency)
Unstable stool mixed with blood and
mucus (differentiated from intestinal infection)
Is the main cause of atopic dermatitis in infants
Often - Iron deficiency anemia
e, ( )
.
:
(, ),
, .
:
, , ,
( ),
:
.
Treatment
Pregestimil, Alfare (Nestle Company) and
others.
As foods are used:
porridge with water (rice, buckwheat)
potatoes, cabbage puree.
As a source of protein in the form of puree:
lean pork, turkey, rabbit, horse
meat (best tolerability)
As a source of fat:
vegetable oils.
.
-
,
Intolerance of disaccharidases.
Hereditary disease
Deficiency of sucrase-isomaltase
Appears when you turn on the
diet products containing sucrose
With chronic diarrhea
Moderate malnutrition
.
,
(,
,
).
Exudative enteropathy
Often develops secondarily, for
any damage of oesophageal epithelium
(infection,intolerance to cow's milk
protein, disaccharidase deficiency).
Severe diarrhea with great loss of
protein
Hence - the hypoproteinemia
Often associated with malabsorption of
carbohydrates
(, ,
.)
:
5-8%
(, ,
, , )
Treatment
Parenteral nutrition
(aminoacids, intralipid,protein hydrolysates,
etc.)
Diet against total parenteral
nutrition gradually, rice water, or 5-8% of rice
porridge with added fructose
Vegetable oil droplets
Individually selected type of meat
Carbohydrates are introduced to fruits and
vegetables (zucchini, pumpkin, potatoes,
cabbage, bananas)
(
)
,
(, , ,
)
(
) (
).
-
(,
, ),
Pathogenesis
Gluten protein causes atrophy of
the intestinal mucosa in violation of
the intestinal
absorption (proteins, fats,
carbohydrates) and micronutrients
In the biopsy of the intestine show
a shortening of the villi,
increased crypt
develop hypoproteinemia
,
,,
(
200-300 )
, ,
, .
There
is a profuse diarrhea, greasy, frothy, foulsmelling stool (feces daily volume may
reach 200-300 g)
developing malnutrition
Very often this is combined with rickets,
vitamin deficiencies, anemia
Marked growth retardation
Clinical and morphological characteristics of
the disease disappear against the
background of a gluten-free diet
and resumed after eating foods
containing gluten.
, ,
,
, ,
( )
. 1:2000
.
-.
(,
, ).
,
(, ).
(
),
( ,
),
(
),
.
, (
)
,
(CF)
2 (2 degrees of malnutrition)
.
.
,
( 60 \
Diagnosis
The main method available
to diagnose cystic fibrosis sweat test
with a pilokarpinom. To
stimulate sweating electrophoresed with
pilocarpine.
Next, the concentration
of sodium chloride and allocated per unit
of time (greater than 60mEq \ L pathology
(,
.)
,
Treatment
Pancreatin, Creon in
the individually selected dose
Special mixtures
of infants (Pregestimil, ,
Portagen)
The complex vitamins, calcium