Adenomyosis

More about the disease

Prevalence

Classification

The reasons

Clinical manifestations

Diagnostics

Treatment

Complications

Forecast

Prevention

Adenomyosis is a dyshormonal disease, which is based on the germination of the endometrium in the uterus muscle. It is clinically manifested by prolonged and abundant menstruation, periodic bleeding, the appearance of dark spotting before and after menstruation, pronounced premenstrual syndrome and pain syndrome (algomenorrhea, dyspareunia). The diagnosis is made after a gynecological examination, laboratory tests and instrumental examinations. Treatment may be conservative (hormone therapy), surgical or combined.

More about the disease

Adenomyosis (endometriosis of the uterus) is a form of endometriosis in which tissue begins to grow outside the uterine mucosa, in structure and function similar to endometrium. Pathology refers to internal endometriosis (external – endometriosis of the ovaries, cervix and other varieties). Adenomyosis is characterized by immunity (that is, in its development the state of immunity matters) and refers to genetically determined diseases (heredity plays the role). Since adenomyosis is endometriosis of the uterine body, it is incorrect to use the phrase “adenomyosis of the uterine body”. ICD 10 code: endometriosis of the uterus N88.0. Since pathology refers to hormone-dependent, adenomyosis in the female body can only develop with the onset of puberty, respectively, disappears on its own after menopause. Adenomyosis ranks third in the list of gynecological diseases (the first is inflammation of the appendages, the second is uterine fibroids). A marked increase in the incidence of uterine endometriosis in the last fewdecades, which is associated with an increase in the number of immune disorders and improved diagnostic methods.

Prevalence

Women of reproductive age, mainly 27 – 35 years, suffer from adenomyosis. Endometriosis is diagnosed in 10% of women, among them 15% of cases have adenomyosis. The frequency of nodular adenomyosis is 30%, the combination of this form with uterine myoma occurs in 60%.

Classification

Adenomyosis is systematized according to the depth of germination of the endometrium in the layers of the uterus by 4 degrees:

  • I degree – the pathological process is limited to the organ mucosa;
  • Grade II – germination of endometrioid cells until the middle of the myometrium;
  • Grade III – endometrial cells invaded the entire thickness of the muscle layer of the uterus, but did not come out in its serous membrane;
  • IV degree – the process captures the myometrium, serosa of the uterus and nearby organs.

Asymptomatic adenomyosis and with a pronounced clinical picture. Since endometriosis of the uterus does not apply to inflammatory diseases, such as endometritis (inflammation of the uterus), it is inappropriate to speak of acute or chronic adenomyosis.

There are several morphological forms of adenomyosis:

  • diffuse – refers to the common and is characterized by diffuse implantation of endometrial cells in the uterine layers, nodes and foci are not formed;
  • focal – characterized by local areas (foci) of endometriosis in the thickness of the uterus;
  • nodular – the formation of individual nodes (adenomyomas) in the muscular layer of an organ, similar to myomatous nodes, but unlike them have cavities with blood surrounded by connective tissue;
  • focal nodal – mixed form, combines the presence of nodes and foci of endometriosis.

The reasons

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The occurrence of endometriosis is explained by several theories, the main ones are considered:

  • implantation – based on the reflux (reflux) of menstrual blood from the uterus through the oviducts into the abdominal cavity;
  • metaplastic – explains the formation of endometrioid heterotopies from residues of embryonic tissues;
  • induction – the occurrence of endometrial foci under the action of exogenous and endogenous adverse factors.

Factors contributing to the development of pathology include:

  • heredity (there are relatives in the family with adenomyosis, uterine cancer, fibromyoma);
  • traumatization of the uterine lining (curettage of the uterus, hysteroscopy, hysterosalpingography, insertion / removal of the IUD, abortion, removal of uterine polyps);
  • long, complicated childbirth;
  • inflammatory processes in the uterus, organ surgery;
  • hormonal disorders (later menarche and onset of sexual activity, irregular cycle, treatment with hormonal drugs, COC use, obesity);
  • chronic pathology that weakens the immune system (diseases of the digestive tract, hypertension, allergic reactions, diseases of the thyroid gland);
  • frequent infectious diseases;
  • stress, intense exercise;
  • disturbed ecology, frequent climate change, long-term insolation, low social level;
  • late first childbirth, abandonment of pregnancies.

Clinical manifestations

Adenomyosis is characterized by a long, and in the absence of treatment, a progressive course. Spontaneous cure is possible only in postmenopause. The clinical picture of the disease on the extent of the spread of the process and form. Adenomyosis of 1 – 2 degrees is more often asymptomatic or with slightly pronounced manifestations. Pain is considered a constant and characteristic symptom of pathology. First of all, the disease should be excluded in adolescents in the case of existing algomenorrhea. The intensity of pain is also determined by the degree of germination of endometrial cells in the thickness of the uterus. When all layers of the organ are involved in the process, including its serous cover, the pain is almost always disturbing, increasing on the eve and on the days of menstruation. Adenomyosis is characterized by dyspareunia (pain during intercourse), which is noted on the eve of menstruation. During the germination of endometrial cells in the isthmus, pain can be transmitted to the perineum and lower extremities, and when uterine corners are affected, to the inguinal areas. The disease is often accompanied by severe premenstrual syndrome.

The third – the fourth degree of pathology is accompanied by hyperplasia of the myometrium and, during a gynecological examination, it is possible to palpate a round, painful, dense and enlarged uterus. Characterized by an increase in the size of the body on the eve of menstruation, and with a common process, its size can reach 8 – 10th pregnancy. In case of nodular adenomyosis, the surface of the uterus is bumpy, often a combination of the disease with myoma and / or endometrial hyperplasia is noted.

The second characteristic sign of adenomyosis is a disorder of the menstrual function. The appearance of brown spotting before and after menstruation, the occurrence of intermenstrual bleeding or spotting, lengthening and profusion of menstrual discharge are typical. Chronic blood loss leads to anemia (pallor of the skin, dry and brittle hair, weakness, fatigue, dizziness, possible fainting).

Adenomyosis is often accompanied by infertility due to adhesive and inflammatory processes in the uterus, endometrial structure disorders, and hormonal function of the ovaries. These factors interfere with fertilization of the egg and its subsequent implantation and ends with spontaneous abortion in the early stages.

The temperature increase for adenomyosis is not typical, since pathology does not apply to inflammatory diseases, and inflammation accompanying endometriosis (which causes adhesion formation) is always aseptic. When the temperature rises (especially regular, in the second phase of the cycle), latent sexually transmitted infections should be excluded.

Diagnostics

The preliminary diagnosis of adenomyosis is made on the basis of anamnesis, characteristic complaints and gynecological examination. The pathology is indicated by palpation of the spherical or bumpy enlarged uterus, polymenorrhea, pain syndrome and signs of anemia. The diagnosis is confirmed by conducting methods of instrumental examination:

  • Ultrasound of the pelvic organs. It is advisable to perform at the end of the menstrual cycle with a vaginal probe. Echo signs: the size of the uterus is larger than normal, the thickness of the walls is uneven, the echogenicity of the myometrium is increased, the presence of the “honeycomb” symptom: dense areas alternate with small cystic inclusions, the presence of strokes from the endometrium into the body. Adenomy cells are visualized as rounded areas of increased echogenicity without clear contours and capsules.
  • Hysterography The introduction of X-ray contrast into the uterine cavity reveals its enlargement, deformation and jagged edges of the contour in the pictures.
  • Hysteroscopy. Allows you to confirm adenomyosis and determine its degree. Grade 1 is characterized by a constant wall topography, the presence of endometrial moves (dark bluish “eyes” or open bleeding wounds). For grade 2 – the unevenness of the uterine walls, poor distensibility of the uterus, the presence of endometrial moves. For degree 3, protrusion into the uterine cavity without clear contours, rigidity of its walls, open / closed passages.
  • MRI Increase in the size of the uterus, thickening of its walls, impaired structure of the myometrium, endometrial passages.
  • Scraping the uterus and cervix. It is carried out after hysteroscopy, histological examination of the scraping allows to confirm the presence of endometrioid heterotopies, exclude / confirm hyperplasia, endometrial cancer.

From laboratory tests, OAK is assigned (confirms anemia), OAM, blood for sex hormones, and CA-125 tumor marker (its level increases with endometriosis).

Differential diagnostics

Adenomyosis is differentiated with the following pathologies:

  • Uterine fibroids. Combination with adenomyosis reaches 85%. The symptoms of uterine fibroids and endometriosis of the uterus are similar. With a small size of fibroids, the pain syndrome is usually absent, menstrual disorders are more common with a submucosal location of the node. A gynecological examination allows you to identify an enlarged, dense uterus with nodes, its palpation is painless, mobility is preserved. In adenomyosis, the mobility of the organ is limited, there is pain on palpation and the relationship of the size of the uterus with the phase of the cycle. The final diagnosis confirms the conduct of instrumental methods of research.
  • Endometrial hyperplastic processes (hyperplasia, polyp). Pain, as a rule, is absent, there is a cycle disorder in the form of prolonged menstruation and an increase in the volume of blood loss, intermenstrual discharge. Pre- and postmenstrual discharge with polyp / endometrial hyperplasia is not characteristic. On ultrasound: the increase in the thickness of the M-echo diffuse (hyperplasia) or focal (polyp / polyposis), the contours of the uterus are even, the dimensions correspond to the norm.
  • Endometrial cancer. It is characterized by the occurrence of acyclic uterine bleeding and spotting, which are often accompanied by an unpleasant odor and discharge of pus. In the absence of bloody discharge, there is abundant watery leucorrhoea, sometimes with an admixture of blood in the color of “meat slop”. The pains are disturbing at the advanced stage, not related to the phase of the cycle. The diagnosis is confirmed by the performance of ultrasound, hysteroscopy, hysterography, curettage of the uterus.

Treatment

The gynecologist-endocrinologist deals with the treatment of adenomyosis. Pathology therapy can be conservative, operative and combination. When choosing a treatment strategy, consider:

  • age of the patient;
  • desire to preserve reproductive function;
  • the prevalence and severity of the process;
  • concomitant gynecological diseases.

Conservative therapy

Based on the admission or administration of hormonal drugs:

  • Oral combined contraceptives. Block cyclic processes in the endometrium and endometrioid heterotopies. With long-term use cause sclerosis and obliteration of endometrial moves. Use drugs of the new generation (Janine, logest, Vizanna, Marvelon and others).
  • Progestins (pure progestins). Contribute to the atrophy of endometrial foci (duphaston, norcolute, premalyut).
  • Androgens. Suppress ovulatory synthesis of gonadotropins. They block receptors of progesterone, estrogen, androgens, inhibit the growth of endometriod heterotopias and the formation of new (danazol).
  • Analogs Gonadoliberin. They block the production of gonadotropins, which reduces the production of sex hormones in the ovaries (gosererelin, buserilin).

In addition to hormone therapy, iron preparations are also prescribed for the treatment of chronic post-hemorrhagic anemia, NSAIDs (indomethacin, ibuprofen) for relieving a painful attack, vitamins, drugs that normalize the functioning of the liver, sedatives, and in severe psycho-emotional state disorders, antidepressants and tranquilizers. The introduction of the Mirena Navy (contains a gestagen) for a period of 5 years (reduces menstrual flow) is successfully applied.

Surgery

It is the only reliable way to get rid of the disease. There are mild and radical surgery. Surgical intervention is carried out with:

  • nodal forms;
  • a combination of diffuse adenomyosis and uterine fibroids;
  • high risk of malignancy;
  • 3 degree process.

For sparing techniques include electrocoagulation (endometrial ablation) of endometrial foci and intrauterine adhesions by an electrocoagulator during hysteroscopy. For radical operations – supravaginal amputation of the uterus, extirpation of the uterus, panhysterectomy. Before surgery, hormone therapy is carried out for several months, which stabilizes the course of adenomyosis, prevents the growth and formation of new endometriotic foci (combined treatment).

Pregnancy planning and management

Patients with established adenomyosis are advised to try to become pregnant no earlier than 6 months after the end of hormone therapy or endometrial coagulation. The indications for IVF are:

  • no pregnancy for a year;
  • obstruction of the pipe;
  • persistent anovulation.

Pregnancy is diagnosed in 30% of patients with 1 – 2 degrees of adenomyosis, in 14% with 3 – 4 degrees. In the first trimester of gestation, progestogens are prescribed (duphaston, utrogestan), subsequent hormone therapy is indicated (indications of interruption, low progesterone levels). Pregnancy has a positive effect on the course of the process, inhibiting the growth of endometrial foci.

Complications

Complications of endometriosis of the uterus include:

  • chronic post-hemorrhagic anemia (in 90-95%);
  • adhesive pelvic disease (3–4 degrees of the process);
  • obstruction of the pipe;
  • infertility (in 50 percent or more of cases);
  • habitual miscarriage;
  • psycho-emotional disorders (neurosis, depression) with severe disease.

Forecast

Adenomyosis does not belong to malignant processes, but its long existence in the absence of treatment can provoke the development of endometrial cancer due to hormonal imbalance. The prognosis for adenomyosis depends on the degree of spread of the process, its combination with another gynecological pathology and the treatment carried out, but generally favorable for life, doubtful for pregnancy. High risk of relapse after hormone therapy for 5 years in 2/3 patients. Performing radical operations allows you to get rid of the disease completely. Postmenopausal adenomyosis regresses.

Prevention

Specific methods for the prevention of adenomyosis is not developed. Non-specific preventive measures include: regular (every 6 months) visits to a gynecologist, normalization of the day and rest regimen, elimination of stressful situations, refusal of insolation and thermal procedures (visits to baths, saunas).

Peptic ulcer and 12 duodenal ulcer

Manifestations of peptic ulcer

Diagnostics

Treatment of gastric and duodenal ulcers

Peptic ulcer and 12 duodenal ulcer is a chronic disease, the main expression of which is recurrent gastric or duodenal ulcer arising on the background gastritis.

According to classical ideas, an ulcer is formed as a result of an imbalance between the aggressive and protective mechanisms of the gastrointestinal mucosa.

By aggressive factors include

  • hydrochloric acid
  • digestive enzymes
  • bile acids;

to protective –

  • mucus secretion
  • cell renewal of the epithelium,
  • adequate blood supply to the mucosa.

The causal value of H. pylori for chronic gastritis determines the most important place of the microorganism in the development of gastric ulcer and 12 duodenal ulcer. It turned out that H. pylori is closely associated with factors of aggression in peptic ulcer. The most important result of his destruction – reducing the frequency of relapses of the disease.

Manifestations of peptic ulcer

When duodenal ulcer pain occurs after an hour and a half after eating, there are nocturnal, hungry (that is, arising on an empty stomach) pain in the pancreas area or in the right hypochondrium, which pass after eating, taking antacid drugs, ranitidine, omeprazole .

Vomiting of acidic stomach contents may occur at a height of pain, after vomiting, the patient is relieved (some patients independently induce vomiting to reduce pain).

Pain occurring after 30 minutes – 1 hour after eating is more characteristic of the localization of an ulcer in the stomach.

Manifestations of peptic ulcer also include nausea, heartburn, belching.

Naturally, there are cases with atypical symptoms: the lack of a characteristic connection between pain syndrome and food intake, the lack of seasonality of exacerbations does not exclude this diagnosis. The so-called silent exacerbations of the disease are difficult to suspect and correctly recognize.

Diagnostics

The symptomatology of the disease is sufficiently bright, and the diagnosis is not difficult in a typical case. Be sure to conduct esophagogastroduodenoscopy.

A complete diagnosis of peptic ulcer disease should include objective information about the presence of H. pylori infection. Many laboratories perform a urea breath test with urea.

For analysis, only 2 samples of exhaled air are needed, the method allows you to monitor the success of the treatment.

A polymerase chain reaction (PCR) technique has been developed for determining H. pylori in feces. The method has sufficient sensitivity and specificity.

Treatment of gastric and duodenal ulcers

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Principles of treatment of peptic ulcer:

  • the same approach to the treatment of gastric and duodenal ulcers;
  • compulsory basic therapy that reduces acidity;
  • selection of an acidic lowering drug that supports intragastric acidity 3 about 18 hours per day;
  • the appointment of reducing the acidity of the drug in a strictly defined dose;
  • endoscopic control at 2-week intervals;
  • duration of therapy depending on the time of ulcer healing;
  • anti-helicobacter therapy according to indications;
  • mandatory monitoring of the effectiveness of therapy after 4-6 weeks;
  • repeated courses of therapy for its ineffectiveness;
  • supportive anti-relapse therapy.

The protocol for the treatment of peptic ulcer disease involves primarily conducting basic therapy, the purpose of which is to eliminate pain syndrome and digestive disorders, as well as to achieve scarring of the ulcer defect as soon as possible.

Drug treatment involves the appointment of a drug that reduces the acidity of gastric juice, in a strictly defined dose. The duration of treatment depends on the results of endoscopic control, which is carried out at a two-week interval (i.e. after 4, 6, 8 weeks).

In each patient, a gastric ulcer or duodenal ulcer, in which N. Pylori is detected in the gastric mucosa, is carried out by one method or another (quick urease test, morphological method, using DNA determination by polymerase chain reaction, etc.). antimicrobial therapy. This therapy involves a combination of several antimicrobial agents.

Eradication therapy 2 lines

  • Proton pump blockers 2 times a day;
  • Bismuth colloid subcitrate 120 mg x 4 times;
  • Tetracycline 500 mg x 4 times;
  • Metronidazole 250 mg x 4 times;
  • The duration of treatment is 7 days.

As an alternative scheme, a combination of pyloride ( ranitidine ) at a dose of 400 mg 2 times a day with one of the antibiotics, clarithromycin (250 mg 4 times or 500 mg 2 times a day) or amoxicillin (at a dose of 500 mg 4 times a day) was proposed.

The protocol of eradication therapy involves mandatory monitoring of its effectiveness, which is carried out 4-6 weeks after its completion (during this period, the patient does not take antimicrobial drugs) using the respiratory test or polymerase chain reaction. While N. Pylori is preserved in the gastric mucosa, a second course of eradication therapy is carried out with the use of second-line therapy with subsequent monitoring of its effectiveness also after 4-6 weeks.

The ineffectiveness of the conservative treatment of patients with gastric or duodenal ulcer can manifest itself in two versions: a frequent recurrent ulcer (i.e., with an exacerbation frequency 2 times a year and above) and the formation of refractory gastroduodenal ulcers (ulcers that do not cicatrize for 12 weeks continuous treatment).

Factors determining the frequency of relapsing peptic ulcer are:

  • seeding of the mucous membrane of the stomach N. Pylori;
  • taking nonsteroidal anti-inflammatory drugs (diclofenac, ortofen, ibuprofen, etc.);
  • the presence of ulcerative bleeding and ulcer perforation in the past;
  • low compliance, i.e. lack of willingness of the patient to cooperate with the doctor, manifested in the refusal of patients to stop smoking and drinking alcohol, irregular medication.

Enteritis

Total information

The reasons

Kinds

Manifestations of enteritis

Diagnostics

Treatment of enteritis

Forecast

Enteritis is an acute or chronic inflammation in the small intestine, in which the basic functions of the intestine are disrupted (splitting and absorption of nutrients).

When enteritis is a change in the structure of the mucous membrane, which disrupts the normal synthesis of intestinal juice and the barrier function of the intestinal wall.

Total information

Enteritis can be of different origin, but acute and chronic forms can be distinguished by the flow.

Usually, acute enteritis occurs rapidly, with severe symptoms, and chronic ones are usually the outcome of an acute process, improperly treated or neglected. Enteritis occurs at any age, the acute form is more common in young children, chronic enteritis is more common in adults.

Usually acute enteritis is accompanied by the development gastritis (stomach inflammation) or colitis (inflammation of the colon).

Chronic enteritis is associated with diseases of the pancreas or biliary system, metabolic processes or autoimmune pathology, hereditary diseases.   

The reasons

The main causes of acute enteritis include:

  • infection with dangerous microbes (cholera bacillus, Salmonella, Escherichia, staphylococcus etc.),
  • infection with viral agents ( rotaviruses , enteroviruses),
  • allergenic damage to the food and drug plan,
  • poisoning by food poisoning (mushrooms, berries, etc.),
  • alcohol consumption,
  • exposure to heavy metals, chemicals,
  • abuse fatty, spicy, spicy, etc.

The main causes of chronic enteritis include:

  • intestinal damage by worms,
  • giardiasis intestines
  • overeating spicy, fatty, coarse foods,
  • bad habits (nicotine, alcohol),
  • industrial intoxication (heavy metals, chemical compounds, radiation exposure),
  • bowel damage due to taking certain medications,
  • autoimmune diseases
  • hereditary enteropathy and fermentopathy,
  • gut surgery.

The development of acute or chronic enteritis is promoted by unhealthy habits, a sedentary lifestyle, problems with the kidneys and blood circulation, abdominal trauma and surgery, adhesions.

Kinds

Localization share:

  • isolated enteritis,
  • gastroenteritis in combination with the defeat of the stomach,
  • enterocolitis in combination with the defeat of the colon,
  • gastroenterocolitis – damage to the stomach and intestines.

Also, according to the degree of spread of inflammation emit:

  • total enteritis,
  • jejunitis – inflammation of the jejunum,
  • ileitis is an inflammation of the ileum of the small intestine.

For reasons of formation can be identified:

  • parasitic enteritis,
  • infectious (viral and microbial) enteritis,
  • medicinal or drug,
  • food,
  • toxic (including radiation),
  • arising from congenital anomalies of the structure or operation of enzymes,
  • postoperative.

You can also divide:

  • primary enteritis arising as an independent pathology,
  • secondary, arising on the background or as complications of other diseases.

According to the features of the structure and operation of enzymes can be identified:

  • atrophic enteritis with focal or total changes,
  • non-atrophic enteritis.

By severity can be identified:

  • easy form
  • moderate form,
  • severe form, with or without complications.

Chronic enteritis can be:

  • in the acute stage,
  • in the stage of incomplete remission,
  • in complete remission.

Manifestations of enteritis

Acute enteritis usually progresses rapidly, but ends quickly.

Enteritis is manifested by the following symptoms:

  • loose stools from 1-2 to 10-20 or more times a day,
  • nausea and vomiting,
  • stomach ache,
  • bloating and rumbling in the stomach
  • temperature increase from 37 to 39 and more,
  • general malaise, headaches,
  • language,
  • in severe diarrhea, signs of dehydration – dry tongue and mucous membranes, weight loss, cramps.
  • in severe cases, coagulation, shock and coma disorders.

Chronic enteritis usually gives a variety of clinical symptoms, is not so acute, but sometimes lasts for months.

They are characterized by the following manifestations:

  • diarrhea after eating,
  • mild pain around navel
  • feeling of rumbling and bloating
  • increased stools, watery, yellow with food particles,
  • defecation can bring discomfort, pressure reduction,
  • gradual development   anemia ,   osteoporosis   due to impaired mineral absorption,
  • the tongue is coated with white bloom with imprints of teeth
  • there are signs of hypovitaminosis,
  • body weight gradually decreases, dystrophy occurs.

Diagnostics

The basis of the diagnosis are complaints and examination with palpation of the abdomen and the study of the nature of the chair. Complement the diagnosis:

  • coprogram , feces for intestinal group, virological study.
  • tests for hidden blood in feces, the presence   carbohydrates .
  • general blood analysis with the definition of acute infection, anemia, leukocytosis, acceleration ESR,
  • biochemistry blood with signs of protein starvation and micronutrient deficiencies,
  • endoscopy of the initial sections of the small intestine,
  • X-ray examination with contrast
  • Ultrasound of the pancreas and liver for the detection of combined pathology.

Treatment of enteritis

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Enteritis is mainly treated by infectious disease specialists and gastroenterologists, depending on the reason that caused them.

Acute treatment

Acute infectious enteritis is treated in the hospital. If it is a microbial intestinal infection, antibiotics are used, if viral is only a symptomatic treatment:

  • diet food – boiled, puree and non-irritating food,
  • fighting dehydration by infusing glucose and sodium chloride solutions,
  • the fight against toxicosis with hemodez, reopolyglukina,
  • enzyme therapy
  • sorbent, fixative therapy – smecta, enterosgel, rice water,
  • correction of microbial imbalance,
  • vitamins and immunotherapy.

In severe cases and in patients with concomitant diseases:

  • Norfloxacin 0.4 g 2 times a day for 5-7 days.
  • Ciprofloxacin 0.5 g 2 times a day for 5-7 days.
  • Ofloxacin 0.2 g 2 times a day for 5-7 days.
  • Ceftriaxone 1-2 g once a day for 5-7 days.

Diarrhea with severe signs of inflammation (presence of blood, pus, mucus in feces), accompanied by fever:

  • Norfloxacin 0.4 g 2 times a day for 3-5 days.
  • Ciprofloxacin 0.5 g 2 times a day for 3-5 days.
  • Ofloxacin 0.2 g 2 times a day for 3-5 days.

Chronic treatment

In the treatment of chronic enteritis tactics is somewhat different:

  • the basis of the treatment is the specific diet No. 4 (excluding acute, fatty, irritating, small portions, vegetable and milk table with protein and mineral enrichment, exclusion of coarse fiber),
  • further dieting up to life, especially for hereditary defects of the intestinal wall,
  • the appointment of enzyme preparations (festal, creon, digestal, sustak),
  • the appointment of motor correctors when bloating, nausea, gut hyperpulmonary (imodium, loperamide),
  • astringent herbal remedies for persistent diarrhea (cherry fruit, oak bark, St. John’s wort),
  • the use of probiotics and biologics (bifidus and lactobacterin, Narine),
  • multivitamins, additional appointment of mineral supplements.

Forecast

The prognosis for the correct treatment of acute enteritis is favorable; for chronic enteritis, the prognosis depends on the cause and degree of intestinal lesions. With a diet and regular treatment, exhaustion and adverse outcomes can be avoided.

With “watery” diarrhea, antibiotic therapy is not indicated. In this case, treatment is based on therapy aimed at maintaining water and electrolyte balance (drinking plenty of saline solution – for example, “rehydron”).

Scurvy

Symptoms of scurvy

Treatment

Complications of scurvy

Prevention

Scurvy or scurvy is caused by vitamin deficiency (vitamin C deficiency). An insufficient amount of ascorbic acid in the body or its complete absence becomes a cause of violations of collagen production. It is this protein that is responsible for the strength of the walls of blood vessels and the elasticity of connective tissues.As a result of a persistent lack of vitamin C, the structure of cartilage is disrupted, the tubular bones are destroyed, and bone marrow function is reduced.

With scurvy, the bone bed of the teeth atrophies. The disease often occurs against the background of other forms of vitamin deficiency. For example, simultaneously with rickets with a deficiency of vitamin B or with folic anemia with an insufficient amount of vitamin B12 in the body.

Symptoms of scurvy

The first clinical symptoms of scurvy appear 1-3 months after the development of an acute ascorbic acid deficiency in the body.

The patient feels weak, gets tired quickly, suffers from dizziness. He becomes irritable, drowsy, feels pain in the joints and calf muscles. These symptoms are not yet specific signs of scurvy and can only be suspected if there are cases of prolonged fasting, malnutrition or intestinal absorption in the patient’s medical history.

The progressive development of scurvy leads to changes in the tissue of the gums: specific pallor appears, then cyanosis of the mucous membranes. The condition of the interdental papillae also changes, bleeding occurs in the oral cavity. At the site of injury, dark-purple tissue seals are formed with signs of internal hemorrhage. Patients suffer from pain when chewing and feel discomfort due to increased salivation.

Treatment

The main role in the treatment of scurvy plays diet therapy. The food ration of the patient must necessarily include food – sources of vitamin C. Fresh vegetables, fruits, berries, juices and salads based on them should form the basis of therapeutic nutrition for scurvy.

In case of severe bleeding of tissues, drip or injection injection of ascorbic acid is prescribed. It is common to fight inflammation in the mouth with scurvy by rinsing with a weak solution of potassium permanganate, treating the mouth with hydrogen peroxide and an oil solution of vitamin A.

Physiotherapy is recommended for all patients with signs of limited articular mobility: remedial gymnastics, mud applications, massage, hydrotherapy. With concomitant anemia, iron and vitamin B12 preparations are prescribed.

Complications of scurvy

Late treatment of scurvy can lead to the accession of a secondary infection. The patient appears ulceration on the gums, bad breath. A gradual loosening of the teeth may result in their complete loss.

Patients with scurvy have a specific appearance: their skin is yellow-brown in color with a characteristic bumpy surface caused by small hemorrhages in the hair bags. Patients move with great difficulty due to severe joint and muscle pain.

Digestive disorders, triggered by scurvy, manifested in the oppression of gastric and intestinal motility, insufficient secretion of enzymes. Vitamin C hypovitaminosis also affects the heart. In patients with reduced blood pressure, quickens the pulse, weakens the power of heart pushes. Concomitant infectious diseases and other forms of avitaminosis lead to massive hemorrhages, bone fractures, patient disability, and sometimes death.

Prevention

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To prevent scurvy, nutrition is often sufficient. Special attention should be paid to the quality of food in winter and early spring time. The excellent prevention of scurvy is the constant use of fresh, canned or frozen vegetables and fruits. With an insufficient daily amount of vitamin C in the diet (less than 30 mg in children and 50 mg in adults) it is recommended to take complex vitamin preparations, such as undevit , roars . Prophylactic use of synthetic ascorbic acid in its pure form should not exceed 70-100 mg per day.

Functional dyspepsia

Functional dyspepsia: when and how to treat?

What is the relationship between these two diseases?

Treatment of PD is always complex

Functional dyspepsia: when and how to treat?

According to world statistics, the overall prevalence of dyspepsia symptoms is on average 25%. These numbers include both organic and functional dyspepsia.

Functional dyspepsia (PD) is characterized by the presence of symptoms such as pain, burning, early satiety, a feeling of fullness in the epigastrium after eating. Moreover, there are signs of PD in the absence of an organic lesion of the gastrointestinal tract.   The mechanism of occurrence of PD is not fully understood, but a violation of gastrointestinal motility, visceral sensitivity and increased secretion of hydrochloric acid is expected.

Despite the high prevalence of PD, such a diagnosis almost does not figure in Russian practice. Doctors prefer to use the term “chronic gastritis.”

What is the relationship between these two diseases?

Chronic gastritis – morphological diagnosis, characterizes the degree of damage to the gastric mucosa and is not necessarily accompanied by clinical manifestations. Functional dyspepsia – a diagnosis reflecting the presence of symptoms in a patient. At the same time, the clinical picture may not be combined with inflammatory changes in the mucous membrane.

According to the Rome criteria, PD diagnosis is made under the following conditions:

1. The patient experiences persistent or intermittent recurrent symptoms of dyspepsia ( epigastric pain, discomfort, etc.) for a total duration of at least 3 months in the last 6 months.

2. During examination of the patient (including the instrumental one), no organic disorders were detected, which could be the source of these symptoms.

Treatment of PD is always complex.

The main objectives of drug treatment of patients with PD are the elimination of the clinical symptoms of pathological changes in the gastric mucosa, reduction of the risk of recurrence of the disease, improving the quality of life of patients.

1. Pharmacotherapy is selected depending on the type of PD. If a patient suffers from an ulcer-like PD, he is primarily shown to receive acid-suppressant drugs and antacids. In the treatment of non-ulcer PD, the picture is different – even high doses of antacid drugs improve well-being in 35-80% of patients, which looks quite modest against the background of placebo intake (30-60% of improvements). However, due to the safety of the intake, antacids retain their popularity in the treatment of PD. Acid – suppressive drugs, unlike neutralizing acids that have already been released by the chemical reaction of antacids, directly affect the process of acid production. Histamine H2 receptor antagonists are more commonly used in the treatment of PD, although their effectiveness is lower than that of few inhibitors used in the treatment of PD proton pumps. Last recommendations of the Russian Gastroenterological Association indicate the feasibility of receiving rabeprazole in the treatment of PD

2. With dyskinetic PD, prokinetics reception comes to the fore. Products- prokinetiki most studies show a significantly higher efficacy than placebo (by an average of 40-45%) prokinetic increase the intensity of peristaltic contractions of the esophagus, stomach, duodenum. Reductions are synchronized, thereby reducing the amount of reflux from the stomach into the esophagus, accelerating gastric emptying and the passage of food masses through the duodenum.

3. If a patient has been diagnosed with H. pylori, he is shown anti-helicobacter therapy in addition to other methods of treating PD. More recently, there was no consensus about the feasibility of H. pylori eradication in PD. Recommendations from the National Institutes of Health of the USA from 1994 indicated that anti-Helicobacter therapy in patients with PD leads to the elimination of dyspeptic phenomena only in 25% of cases, and therefore there is no need for it. At the moment, it is known that H. pylori has a inhibitory effect on gastric motility due to the action of cytokines IL-1b, IL-6, IL-8 and tumor necrosis factor TNF-alpha. Considering these data, in 2005 the III Maastricht consensus was developed , according to which patients with FD are subject to mandatory testing for H. pylori and, if it is revealed, they need eradication therapy.

4. In the treatment of PD for the relief of postprandial distress syndrome, antiemetic agents are prescribed, which are based on blocking central dopamine receptors. So, as a result of taking the drug Motilak patient can get rid of nausea, belching, heartburn. Blocking the dopamine receptors in the antrum of the stomach improves its peristalsis, which helps with early satiety and heaviness in the stomach. Taking the drug reduces the time of contact of the mucous membrane of the esophagus with the contents of the stomach, increases the pressure of the lower esophageal sphincter and accelerates gastric emptying. Stimulation of dopaminereceptors in the duodenum increases its peristalsis, which helps with bloating. A significant advantage is that domperidone – the active ingredient of the drug Motilak – the safest prokinetic with a wide evidence base . Unlike metoclopramide, known for its relatively frequent side effects in the form of extrapyramidal effects, domperidone provokes such phenomena extremely rarely – in no more than 0.05% of cases. Prolactinemia is one of the side effects of domperidone , manifests itself in no more than 1.3% of patients when prescribing the drug in the maximum daily dosage. Other adverse reactions (dry mouth, diarrhea, headache, skin rashes) when taking Motilaka rarely occur.

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5. In the presence of refractoriness to the therapy being conducted, borderline mental disorders require antidepressants, which can improve the quality of life of patients by analogy with the treatment of patients with ulcerative colitis and other serious chronic diseases of the gastrointestinal tract. For the successful treatment of PD, the patient must be configured for long-term therapy, the course of which is usually 6-8 weeks.

6. In some cases, enzyme preparations that stimulate digestion and improve the quality of life of the patient are used as an auxiliary treatment of PD. The researchers note that the combined enzyme preparations, which include sorbents, eliminate flatulence, which often worries patients with FD, are more effective .

The causes of functional dyspepsia, issues of its diagnosis and treatment, possible complications and prognosis continue to be studied. But already now in the arsenal of doctors there are enough funds to significantly improve the quality of life of patients with FD.

Irritable Bowel Syndrome

Manifestations of irritable bowel syndrome

Diagnostics

Treatment of constipation and diarrhea syndrome

Forecast

Irritable bowel syndrome is a dysfunction of the intestines, manifested by abdominal pain and / or defecation disorders. Irritable bowel syndrome develops as a result of psychological and other effects on the over-reacting bowel.

Irritable bowel syndrome is the most common disease of the internal organs. It can occur at any age, including in children. In women, the disease occurs 2-3 times more often.

Despite the extreme prevalence of irritable bowel syndrome, approximately 75% of the adult population do not consider themselves ill and do not seek medical help.

In the occurrence and development of the disease have psycho-emotional disorders.

Manifestations of irritable bowel syndrome

The leading manifestations of irritable bowel syndrome are pain, abdominal discomfort and abnormal stool. Often in the feces you can see a large amount of mucus. A spasm of various parts of the intestine is observed non-permanently and may change localization on different days.

Patients with irritable bowel syndrome have many extra-intestinal symptoms, some of which are associated with dysfunction of other digestive organs, and the other with disorders of the nervous system and psychological status. The latter cause rapid fatigue, weakness, headaches, decreased appetite, sleep disturbances , palpitations, sweating, “lack of air” attacks, frequent urination, a slight increase in temperature, etc.

In irritable bowel syndrome, there is often a shortage of body weight, but it is not associated with impaired digestion of nutrients, but with features of neuropsychological status or with poor appetite.

High-quality eating disorders are manifested by dryness and flaking of the skin, a change in its color (a peculiar dirty-gray tint), the appearance of pigment spots on the face, hands and legs.

There are three main types of irritable bowel syndrome: with a predominance constipation , with a predominance of diarrhea and with a predominance of pain.

Abdominal pain, diarrhea, constipation, flatulence, bloating …

All these symptoms can be a single problem – irritable bowels. If the symptoms change the usual rhythm of a person’s life, it may help ….

Diagnostics

The diagnosis of irritable bowel syndrome can be made on the basis of typical manifestations in the absence of other bowel diseases, which are excluded during additional studies.

At present, the “Roman criteria-II (2000)” is used to diagnose irritable bowel syndrome in adults: for at least 12 weeks (not necessarily following one after the other), in the last 12 months there is abdominal discomfort or pain, which have at least two of the following three characteristics:

  • decrease after bowel movement;
  • the onset is associated with a change in stool frequency;
  • the beginning is associated with a change in the shape of the chair

Irritable bowel syndrome is diagnosed only if there is a connection between pain and discomfort in the abdomen with the stool. Pains appear in front of the stool and subside after bowel movements, and there is a dependence on changes in the regularity or consistency of the stool.

A number of signs not characteristic of irritable bowel syndrome, which may indicate the presence of other diseases.

  • Rectal hemorrhage
  • Weight loss
  • Chronic   diarrhea
  • Anemia
  • Fever
  • Onset of the disease in persons over 50 years
  • Burdened heredity (cancer and inflammatory bowel disease in parents)
  • The appearance of pain and diarrhea at night

Rectal bleeding can be due to hemorrhoids; decrease in body weight and low-grade fever – manifestations depressed or hypochondriac syndrome.

Treatment of constipation and diarrhea syndrome

Treatment of irritable bowel syndrome should be comprehensive.

Diet for syndrome

With the prevalence of constipation shown diet with the addition of wheat bran.

In the case of the prevalence of diarrhea, it is recommended to limit foods rich in fiber (vegetables, fruits, bran).

Everyone, without exception, patients with irritable bowel syndrome are advised to follow an exception diet that does not contain caffeine, lactose, fructose, sorbitol, vinegar, alcohol, pepper, smoked foods, as well as products that cause excessive gas formation – milk, fermented milk products.

Correction of psycho-emotional disorders

The complex of measures aimed at improving the functions of the central nervous system and the correction of autonomic disorders includes psychotropic drugs, rational psychotherapy. In an optimal way, a psycho-neurologist or psychotherapist should be engaged in the diagnosis of psycho-emotional disorders and their elimination.

Antibacterial and bacterial drugs

Indications for the use of antibacterial drugs for irritable bowel syndrome are diarrhea, flatulence and abdominal pain.

Apply antibacterial drugs courses of 7-10-14 days. Recommended

  • Furazolidone,
  • ersefuril,
  • metronidazole ( trihopol ),
  • as well as intrix, nitroxoline and nevigramone.

After antibacterial therapy, long-term (up to 1.5-2 months) administration of bacterial preparations (probiotics) is recommended: bifidum – and lactobacterin, bifiform, hilaka -forte, etc.

With diarrhea, imodium ( loperamide ) and alosetron have an effect.

With the prevalence of constipation shown tsuercal and motilium .

With persistent pain, Ditsetel and Duspatalin ( Mebeverin ) have a good effect .

All patients with irritable bowel syndrome with exacerbation of diarrhea prescribe astringent drugs: smectu , dermatol , tanalbin , white clay, as well as decoctions of herbs of similar action (chamomile, peppermint, St. John’s wort, alder cones, blueberries and bird cherry). With the same purpose, you can use some antacid drugs ( almagel , phosphalugel , maalox) and preparations containing bismuth ( venter ).

In irritable bowel syndrome with a predominance of constipation, it is necessary to develop a lost morning reflex to defecation and an increase in the amount of dietary fiber in the diet by introducing wheat bran into it. To stimulate defecation at the first stage of the development of a lost reflex,dufalac (lactulose), 1-2 teaspoonful spoons, should be administered overnight . Train yourself to empty your bowels every morning.

Forecast

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The condition of patients with irritable bowel syndrome, the effectiveness of treatment and the prognosis largely depend on the severity of related disorders of the nervous system. In achieving recovery, it is often crucial to overcome the conflicts that cause the formation of neurosis in a patient.

The working capacity of patients with irritable bowel syndrome and the prognosis for this disease largely depend on the severity of concomitant psycho-emotional disorders.

Sigmoiditis

The reasons

Kinds

Symptoms of sigmoiditis

Diagnostics

Sigmoiditis treatment

Prognosis and complications

Sigmoiditis is an isolated inflammation of the sigmoid colon (the penultimate part of the large intestine), which can be either an independent process or a manifestation of other diseases.   

The reasons

Most of the reasons for the development of sigmoiditis as an independent disease are embedded in the anatomical and physiological features of the sigmoid colon.

First, the main function of the sigmoid colon is the final formation of fecal masses, which can irritate the intestinal mucosa, contributing to the development of microdamages, and therefore creating the prerequisites for the occurrence of inflammation.

Secondly, unlike other parts of the large intestine, the sigmoid colon has a curved shape, which delays the passage through it of the intestinal contents. This feature of the structure increases the duration of irritation of the mucous membranes, which increases the likelihood of inflammation.   

In addition, the reasons also include:

  • intestinal infections like dysentery and amebiasis. The bacteria that cause these infections produce toxins that destroy intestinal cells, forming erosions or ulcers. Due to the characteristics of the sigmoid colon, with such lesions, it is most vulnerable to the inflammatory process.
  • intestinal dysbiosis. In addition, the microflora in the intestinal lumen performs a protective function. In dysbacteriosis, the natural microbial environment is disturbed, which creates conditions for the reproduction of aggressive bacteria, and, consequently, for the development of inflammation.   
  • non-specific ulcerative diseases of the intestines, for example, Crohn’s disease or ulcerative colitis. These diseases are caused by allergic factors, and can cause ulceration, similar to that of intestinal infections.
  • circulatory disorders of the intestine (intestinal ischemia). The most common cause of such damage is atherosclerosis . With atherosclerosis, plaques form in the lumen of the vessels, reducing the amount of blood that is passed, thereby interfering with the feeding of organs and tissues. In the intestine, under the influence of ischemia, necrosis (necrosis) areas appear, which become the primary foci of inflammation.
  • exposure to ionizing radiation – radiation sickness. Under the influence of radiation, some cell structures are destroyed, and free radicals appear – toxic compounds that can damage healthy cells of the body.

Kinds

Like most inflammatory diseases, sigmoiditis can be acute or chronic. In addition, there are the following types of it, which differ in the nature of damage to the intestine:

  • Catarrhal sigmoiditis. The mildest form in which only the upper layer of the intestinal epithelium is damaged.
  • Erosive sigmoiditis. It is a continuation of untreated catarrhal and is characterized by destruction of the intestinal epithelium with the formation of erosions on it – open unprotected sections of the mucous membrane.
  • Ulcerative sigmoiditis. This form appears, with prolonged irritation of erosions on the intestinal surface, as a result of which they turn into ulcers – deeper defects of the mucous membrane.
  • Perisigmoiditis. It is the most severe form of the disease. Through the ulcer surface, inflammation penetrates into the deep sections of the intestinal wall, reduces its mobility, and the adhesions begin in the abdominal cavity (the process of connecting the intestinal loops together).

Symptoms of sigmoiditis

Due to the variety of forms and causes of sigmoiditis, symptoms can vary greatly, but there are three main manifestations characteristic of any type of disease:

Pain in the left iliac region (lower left corner of the abdomen). The pain is intense in nature, can often give up the leg or lower back. It should be remembered that the sigmoid colon initially has a high mobility, resulting in a change in the localization of pain closer to the center line of the abdomen, or higher, towards the diaphragm.

Change the frequency and nature of the chair. Most often there is diarrhea, constipation occurs somewhat less frequently. For sigmoiditis is characterized by an increase in the frequency of desire to defecate, which is explained by irritation of the intestine. Fecal masses most often liquid, have a sharp, unpleasant smell, you can see blood, mucus or pus in them.

Deterioration of the patient’s general condition. Since during a long-term course of the disease, the human body is depleted, it is possible the loss of body weight, reduced efficiency and general well-being, various sleep disorders .

Diagnostics

Diagnostics and treatment of sigmoiditis can be done by a general practitioner, a gastroenterologist, an infectious diseases specialist, a surgeon.

The main task in making a diagnosis is to conduct a differential diagnosis with other inflammatory diseases of the intestines and abdominal organs, such as paraproctitis, ulcerative colitis, as well as infectious diseases, for example dysentery, cholera, intestinal dysbiosis.

For diagnosis, the results of the following studies are used:

  • Survey and examination of the patient, palpation of the abdominal organs. Conducting these studies, the doctor will be able to establish the exact localization of the lesion, and to conclude which part of the intestine is involved in the inflammatory process.
  • General analysis of blood and feces. These studies will help to accurately determine the severity and nature of the inflammatory process.
  • Rectoromanoscopy conducted for the direct study of the mucous membrane of the large intestine. Based on the results of the study, we can conclude about the form of the disease and the area of ​​the lesion, as well as to exclude cancer.
  • Radiography is carried out in order to differentiate sigmoiditis with impaired intestinal patency.
  • In women, data from a gynecological examination, in order to exclude gynecological pathologies, such as endometriosis, adnexitis, tubal pregnancy and some others capable of giving a similar clinical picture.

After collecting all the information, the doctor establishes the final diagnosis and prescribes treatment.

Sigmoiditis treatment

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Treatment is prescribed depending on the cause of the sigmoiditis.

1. For the treatment of sigmoiditis caused by intestinal infections, antibiotic therapy is prescribed (Biseptol, Tetracycline, Ampicillin, Cefran), covered with bacterial preparations, to protect against dysbiosis (Lactobacterin, Bifidobak and others).

Also, in the chronic course, intestinal antiseptics are prescribed, such as Intetrix or Smecta.

2. For the treatment of sigmoiditis caused by nonspecific inflammatory bowel diseases, anti-inflammatory drugs are used that eliminate the underlying disease: Salazoperidazin, Prednisolone, Sulfasalazin.

To combat general intoxication processes, infusion therapy is used with solutions of glucose, blood plasma and iron preparations (for the treatment of anemia ). Also, bacterial preparations are prescribed to normalize the intestinal microflora.

3. For the treatment of ischemic sigmoiditis, the same regimens are used as in the treatment of sigmoiditis caused by non-specific diseases. In some cases, in case of failure of such therapy, an operation on plastic surgery of vessels supplying the intestines may be indicated.

In addition, as with any diseases of the gastrointestinal tract, a special diet number 4 is appointed, which involves the elimination of spicy, fried, smoked food, alcohol, and the maximum reduction in the diet of fats, carbohydrates and salt, as well as showing the preliminary grinding of food before by use.  

The treatment of sigmoiditis is long, in most cases it is necessary to conduct 1-2 courses of therapy for recovery, the duration is from 1 to 3 months.  

Prognosis and complications

With the proper treatment of sigmoiditis, in most cases, it is possible to achieve complete recovery, but it should be understood that the treatment process is long and is accompanied by a lot of restrictions on the part of the diet.

In the absence of treatment, it is possible to spread inflammation to adjacent segments of the intestine, most often to the rectum (proctitis).

Also, with the progression of inflammation, the tightness of the intestine may be disturbed, resulting in peritonitis – inflammation of the abdominal cavity, requiring extensive surgical intervention.

Reflux esophagitis

The reasons

Degrees of reflux

Manifestations

Diagnosis of reflux esophagitis

Treatment

Reflux esophagitis is the development of an inflammatory lesion of the esophagus due to repeated reflux of gastric contents into the esophagus.

Manifestations of the disease are detected in almost half of the adult population, endoscopic signs – in more than 10% of individuals subjected to endoscopic examination. Berrett’s esophagus develops in 20% of patients with reflux esophagitis (0.4% of the population).

The reasons

  • Surgical interventions on or near the esophageal opening of the diaphragm (vagotomy, resection of the cardial section of the stomach, esophagogastrostomy, resection of the stomach, gastrectomy)
  • Hernias of the esophageal opening of the diaphragm
  • Peptic ulcer and duodenal ulcer
  • Pilorospasm or pyloroduodenal stenosis
  • Scleroderma
  • Smoking
  • Alcohol
  • Pregnancy
  • Drugs that can reduce the tone of the lower esophageal sphincter
  • Sphincter insufficiency with obesity
  • Gastritis associated with Helicobacter pylori

Degrees of reflux

  • Grade A – one (or more) lesion of the mucous membrane less than 5 mm, limited to the limits of the fold of the mucous membrane
  • Grade B – one (or more) lesion of the mucous membrane more than 5 mm, limited to the limits of the fold of the mucous membrane
  • Grade C – one (or more) lesion of the mucous membrane, extending over 2 or more folds of the mucous membrane, but occupying less than 75% of the circumference of the esophagus
  • Grade D – one (or more) lesion of the mucous membrane, extends to 75% or more of the circumference of the esophagus.

Manifestations

  • Heartburn is the most characteristic symptom of reflux esophagitis (experiencing 83% of patients), resulting from prolonged contact of the acidic gastric contents with the mucous membrane of the esophagus. Heartburn increases with errors in diet, alcohol intake, carbonated beverages, physical exertion, inclinations and in a horizontal position.
  • Belching, worse after eating, taking carbonated drinks
  • Regurgitation of food, aggravated by physical exertion
  • Swallowing disorder
  • Pain in the epigastric region or behind the sternum – appear shortly after eating, aggravated by bending the body, in a horizontal position
  • Less commonly, there is a feeling of a coma in the throat when swallowing, pain in the ear and lower jaw, chest pain that can be provoked by physical exertion.

Extraesophageal manifestations – chronic cough, pneumonia , hoarseness, caries teeth, etc.

Diagnosis of reflux esophagitis

  • X-ray examination lying on the back or upright with a strong patient tilting anteriorly: throwing barium sulfate into the esophagus
  • Endoscopic examination with biopsy
  • Esophagotonography (manometry)
  • Daily pH-metry – the main method of monitoring the effectiveness of treatment.
  • Bilimetry is performed to identify alkaline (biliary) reflux.
  • Scintigraphy is shown to identify motor-evacuation disorders of the esophagus
  • Omeprazol test
  • Bernstein test

Treatment

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In the treatment of reflux esophagitis, complex therapy gives good results, which consists not only in taking medications, but also in keeping to a diet, in the quest for general improvement of the body.

  • Smoking cessation
  • Normalization of body weight
  • Raise the head end of the bed
  • Avoiding loads on the abdominal muscles, working with the torso, wearing tight belts, belts
  • Undesirable medications that reduce the tone of the esophageal sphincter (nitrates, calcium antagonists, theophylline, progesterone, antidepressants)

Diet in the treatment of reflux esophagitis

Diet includes

  • restriction of products that enhance gas formation;
  • avoid spicy, very hot or cold foods;
  • avoidance of alcohol, foods that reduce the tone of the lower esophageal sphincter (onions, garlic, pepper, coffee, chocolate, etc.);
  • avoiding overeating, the last meal – no later than 3-4 hours before bedtime.

Drug therapy

Drug therapy is carried out for at least 8-12 weeks, followed by maintenance therapy for 6-12 months.

Apply

  • proton pump inhibitors (omeprazole, lansoprazole, rabeprazole) in usual or double dosage,
  • antacids (almagel, phosphalugel, maalox, gelusil varnish, etc.) are usually prescribed 1.5–2 hours after meals and at night,
  • prokinetics – domperidone, metoclopramide.

Surgery

Indications for surgical treatment:

  • complications of reflux esophagitis (esophageal strictures, repeated bleeding, Berrett’s esophagus),
  • the ineffectiveness of drug therapy (for 6 months) in young patients,
  • combination with bronchial asthma.

Pneumatosis

The reasons

Kinds

Manifestations of intestinal pneumatosis

Diagnostics

Pneumatosis treatment

Complications and prognosis

Pneumatosis is a pathological condition of the digestive system (the walls of the intestine or stomach are more often involved), in which cavities (cysts) are formed in the wall that are filled with air or gases.

As pneumatosis progresses, it can move to the area of ​​the mesentery, lymph nodes or into the peritoneum.

Pneumatosis often occurs in young children after intestinal infections, which is found during surgeries for intestinal obstruction.

The reasons

The basis of intestinal pneumatosis is a pathological accumulation of gases, which are usually formed in the intestine, in its mucous membranes. Gases accumulate, forming air cavities and cysts, instead of being absorbed into the bloodstream and excreted.

The main reasons for the formation of pneumatosis include:

  • the early age of children with their low mobility,
  • violation of peristaltic bowel movements,
  • increased abdominal pressure, bowel spasms,
  • signs of intestinal obstruction,
  • violation of the discharge of gases through the anus,
  • severe intestinal infections with lesions of the small and large intestine, as a result of which gas, as a metabolic product of microbes, accumulates in the damaged intestinal walls (E. coli, proteus).

An additional factor in the development of intestinal pneumatosis is air penetration from the stomach with its penetration into the intestinal wall. A violation of the development of lymphatic capillaries in the intestinal wall is also of some importance.

Kinds

Intestinal pneumosis may be limited or spread to the small intestine or the entire intestine.

Most often there is pneumatosis of the ileal part of the intestine and the ileocecal zone. In this case, the intestine may resemble in appearance bunches of grapes or soap foam, in rare cases, air cysts occur singly.

Manifestations of intestinal pneumatosis

There are no typical and typical complaints for pneumatosis, all complaints are due to the processes that occur in the abdominal cavity.

Cystic pneumatosis or simply pneumatosis of the intestines is a rare disease and there are few observations on it to accurately describe the clinical picture of the disease.

The severity and severity of intestinal and extraintestinal manifestations depend on the length and progression of the process.

First of all, the main complaints of intestinal pneumatosis are manifestations flatulence , in the intestine is formed an excessive amount of gases, which strongly stretch the intestinal wall, causing severe discomfort in the abdomen, a feeling of distention, pressure, soreness.

The passage of peristaltic bowel waves may be accompanied by cramping or   colicky pains , there may often be problems with the stool, and these may be diarrhea ( diarrhea, loose stools) or constipation, lasting up to several days.

Severe pneumatic bowel can lead to intestinal obstruction due to the closure of the intestinal lumen swollen air cysts. Often, the pressure of the gas inside the intestine increases too much, as a result, gas cysts break, with the penetration of the intestinal contents and gases into the abdominal cavity with symptoms  peritonitis.

Also signs of pneumatosis can be heaviness in the abdomen, belching with air, a feeling of overflowing of the intestine with air, discharge of gas, pain in the abdomen along the intestine, relief of pain after stool, nausea, and even vomiting.

With the development of peritonitis, the state is sharply disturbed, there is pallor, abdominal pain and “dumb abdomen” with no signs of peristalsis, a decrease in pressure, a shock.

Diagnostics

The basis of the diagnosis is complaints by the patient that are so non-specific that they can occur in almost any bowel disease of both infectious and non-infectious genesis.

Inspection data may show signs of bloating and rumbling in the abdomen, a feeling of gas rolling under the arms in the gut.

An experienced surgeon can detect air cysts in the wall of the intestine when probing the intestinal wall, if their size is large enough. Cysts are arranged in groups, chains, similar to a bunch of grapes.

Confirm the diagnosis can only methods of endoscopy – with them visually visible gas bubbles along the intestine.

X-ray diagnostic methods can also be used with or without contrast.

Pneumatosis treatment

Usually pneumatoz is considered as a secondary process, therefore, the therapy of those diseases and conditions that caused the defeat of the intestinal wall is mainly carried out.

First of all, it is the treatment of intestinal infections in young children with intestinal antiseptics and rational antibiotics according to the results of seeding.

With the development of intestinal obstruction, an urgent operation is needed, with constipation – the normalization of nutrition and the intake of laxatives, with the spasmodic processes of the intestine – the reception of antispasmodics.

In pneumatosis, symptomatic treatment is also indicated:

  • carminative drugs (against the formation of gases),
  • antispasmodic drugs (baralgin no-shpa),
  • antidiarrheal drugs (tsirukal, motilium),
  • laxative drugs series.

If symptoms of peritonitis appear, immediate surgery and drainage of the abdominal cavity are necessary.

Complications and prognosis

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The main and most dangerous complication of pneumatosis may be intestinal obstruction with necrosis of part of the intestine and the development of peritonitis.

The prognosis for life is favorable with the timely start of treatment.

Food poisoning

The reasons

The easiest to poison

How to identify hazardous products

Symptoms of food poisoning

Diagnostics

Food poisoning treatment

Prevention

Food poisoning is a collective term that implies a clinic of acute indigestion (nausea,vomiting, diarrhea ), sometimes in combination with other symptoms resulting from the use of substandard food or liquids.

Food poisoning classification

Food poisoning can be divided into:

  • infectious (caused by microbes, viruses or protozoa, or their metabolic products), these types of poisoning are more properly called foodborne toxicoinfections (PTI).
  • non-infectious or toxic poisoning (due to ingestion of chemical toxins, heavy metals, poisons, eating herbs, plants, or inedible fungi).

The reasons

Food toxic poisoning occurs as a result of the consumption of food or water, which contains chemical, vegetable or animal poisons:

  • inedible mushrooms, or mushrooms collected along the routes, near chemical plants and accumulated in themselves harmful compounds,
  • poisonous plants (nightshade, wolfberry, henbane),
  • chemicals (toxins, heavy metal salts, preservatives, dyes).

Foodborne diseases result from eating spoiled food or food contaminated with harmful microbes.

These include:

  • salmonellosis, listeriosis, botulism, proteus, clostridiosis,
  • conditionally pathogenic flora (staphylococcus, E. coli),
  • viruses (rotavirus, enterovirus).

The easiest to poison

The most dangerous products in terms of the development of food toxic poisoning are:

  • milk products,
  • eggs, especially raw,
  • meat dishes,
  • fish dishes, especially raw fish,
  • pastry with protein cream,
  • home canned food and pickles in violation of the technology of conservation,
  • perishable foods that require cold storage,
  • products with packaging integrity and shelf life,
  • catering products in violation of sanitary rules in their preparation.

How to identify hazardous products

Foods that have been stored for some time after cooking are potentially dangerous, although freshly prepared foods can also cause poisoning.

There are several signs:

  • the product has expired or will expire soon,
  • its packaging is broken or has defects (dents, abrasions, color fuzziness),
  • the product has an uncharacteristic smell
  • the taste and color of the product is changed,
  • consistency is heterogeneous, layered,
  • when stirring or heating gas bubbles appear,
  • there is sediment at the bottom, if the product is liquid, the transparency is disturbed.

Characteristic features of food poisoning

The peculiarity of food toxicoinfection and toxic poisoning is a short period of incubation, about 2-6 hours and rapidly developing manifestations.

In addition, these diseases are usually dangerous to others, occur in the form of outbreaks in the family or team, all or almost all used these products.

Even if the product is normal in appearance and taste, poisoning can occur, as it could be seeded with dangerous microbes as a result of preparation from a sick person, but the microbes have not yet had time to multiply and spoil the dish.

Symptoms of food poisoning

The first symptoms of poisoning can occur in the period from 1-2 to 6-8 hours, gradually in the next 1-2 days they progress, and without assistance can significantly harm health.

The characteristics of clinical manifestations depend on many conditions – the type of microbe or toxin, the amount of food taken, the state of the body, and other conditions. However, a number of typical signs of poisoning stand out:

  • temperature, from low in 37-37.5 to 39-40C,
  • loss of appetite, malaise,
  • upset stool and abdominal pain cramping
  • bloating
  • nausea and vomiting,
  • cold sweat, lowering pressure,
  • signs of dehydration due to loss of fluid from the stool and vomit (dry mucous membranes, decreased urine volume and its concentration, weight loss).

In severe cases or when exposed to neurotoxic poisons occur:

  • visual impairment, double vision,
  • muscle tone disorders
  • loss of consciousness
  • strong salivation (hypersalivation),
  • disorders of the brain (hallucinations, delusions, coma) or the peripheral nervous system (paresis and paralysis).

Most dangerous salmonella, listeriosis and botulism, especially for pregnant, lactating and young children, as well as the elderly – they can be fatal.

First signs of salmonellosis

Salmonellosis develops on average in 12-24 hours.

Its characteristic features are:

  • temperature increase to 38-39C,
  • headache,
  • cramping abdominal pain, nausea and vomiting.

The chair is liquid, watery, frothy, fetid, greenish in color from 5 to 10 times a day. On the 2-3rd day of the disease in some patients an admixture of mucus is found in the stool.

First signs of listeriosis

The incubation period of listeriosis is 2-4 weeks.

Symptoms depend on the form of the disease, below are the most characteristic:

  • prolonged temperature rise
  • redness and sore throat,
  • swollen lymph nodes
  • puffiness and redness of the eyelids, purulent discharge (when infection gets through the conjunctiva of the eye),
  • rash on body with typhoid form.

The first signs of botulism

Botulism develops over a period of several hours to 5 days. Symptom development is very fast!

It is necessary to immediately seek help for the following symptoms:

  • no fever or slight fever,
  • nausea, vomiting, loose stools without impurities – these symptoms last for about a day,
  • a characteristic early sign of botulism – visual impairment – fog, “flies”, double vision,
  • swallowing disorders – feeling of a lump in the throat, pain when swallowing
  • at the beginning of the second day, neurological symptoms appear: headaches, dizziness, weakness,
  • One of the most dangerous signs of botulism is respiratory failure: feeling of lack of air, shallow breathing. It is respiratory failure that is the cause of death in botulism.

Diagnostics

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The basis for the diagnosis of food poisoning is a typical clinical picture, the defeat of several people at once and an indication of the use of the same products.

To identify a specific pathogen, crops are administered:

  • blood
  • feces
  • vomit,
  • food that ate infected.

If a viral nature of the infection is suspected, a rapid analysis is performed to detect the virus in the blood.

If toxic damage is suspected, a blood test for toxins and an examination of samples of products that have been consumed are performed.

Food poisoning treatment

If you suspect food poisoning, you need to call an ambulance, and before her arrival provide first aid.

First aid for food poisoning

These actions apply to both adults and children:

  • washing the stomach with soda solutions until the water is clear, without food impurities,
  • then reception of enterosorbents is necessary

* At the first symptoms of poisoning enteral detoxification with Enterosgel enterosorbent is necessarily used as first aid. After ingestion, Enterosgel moves along the gastrointestinal tract and collects toxins and harmful bacteria as a porous sponge. Unlike other sorbents that need to be carefully diluted with water, Enterosgel is completely ready for use and is a gentle gel-like paste that does not injure the mucous, but envelops and contributes to its restoration. This is important because the poisoning is often accompanied by an exacerbation of gastritis, because of which the mucous membrane of the stomach and intestines becomes inflamed.

  • if vomiting occurs on the reception of a large volume of liquid, the sorbents are dissolved in water and take a sip every 5-10 minutes,
  • take a cool liquid to prevent dehydration (screaming, rehydron, if not, then sweet tea with lemon alternating it with saline),
  • create peace for the body, temporarily refuse to eat.

How to prepare an analogue of rehydron

It is necessary to dilute 9g of salt (a tablespoon with a slide) in 1l of water.

Water should be either bottled or boiled – this is especially important in food poisoning. It is not recommended to take water passed through a household filter without boiling.

It is strictly forbidden to take without strong prescription in case of severe food poisoning:

  • antibiotics
  • sulfa drugs (streptocid, biseptol, sulfasalazine),
  • Linex, biological products,
  • antiemetic and antidiarrheal drugs,
  • traditional medicine in the form of decoctions and tinctures of various plants (oak bark, pomegranate peels),
  • alcohol and alcohol solutions.

At the hospital, further measures are being taken to eliminate toxins from the body and fight infection, dehydration and damage to the nervous system. With the timely start of treatment, the symptoms of poisoning disappear without a trace in 3-7 days.

Prevention

To prevent or minimize the risk of food poisoning, you must follow basic rules:

  • prepare food only in the kitchen, regularly clean the cooking and eating areas,
  • strictly observe the rules of cooking food, cooking technology,
  • use only benign products, check expiration dates,
  • If possible, do not store perishable foodstuffs, or store them in a refrigerator for no more than 6-12 hours,
  • Be wary of foods with raw ingredients, especially in catering,
  • always visually and on smell to check the quality of products,
  • do not eat home-made canned food purchased in markets
  • wash hands and dishes thoroughly
  • fight with flies and other insects in the house, and especially in the kitchen,
  • do not eat unfamiliar foods or dishes, especially in public places,
  • Always boil or filter the water.
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