Gastrointestinal tract in children. How does the newborn's digestive system work?

It is rare that a child never has problems with the gastrointestinal tract during childhood. Newborns are tormented by gas and colic, older children are tormented by more serious diseases of the digestive system - gastoenteritis, and sometimes it comes to an intestinal disease such as an ulcer.

And if gas and colic are one of those diseases that a baby just needs to outgrow, then other diseases of the digestive tract do not go away so easily.

What are the most common gastrointestinal diseases in children?

According to statistics from the World Health Organization, one in ten children on the planet has a chronic gastrointestinal disease. Sad fact, is not it?

Important! That is why doctors now talk so much about the prevention of such diseases in children, about proper nutrition, and about the need for regular medical examinations of the digestive system in preschoolers and schoolchildren of all ages.

It is regular medical examinations that can promptly identify the onset of a disease in the child’s stomach or intestines and begin treatment on time, before the disease develops into chronic form.

What diseases of the gastrointestinal tract are most common in children? Below is a list of the most common gastrointestinal diseases in children:

• diarrhea and constipation;
• gastroenteritis;
• dyspepsia;
• pancreatitis;
• gastritis (acute and chronic);
• biliary dyskinesia;
• chronic enterocolitis;
• acute (or chronic) hepatitis.

The causes of such diseases in children

Similar pathological changes in the digestive organs of children can occur for the following reasons:

1. Unfavorable environmental conditions.
2. Frequent colds and other infectious diseases in children.
3. An unbalanced diet, eating too many fast foods - hamburgers, cheeseburgers, French fries, chips, etc.
4. Heavily carbonated and chilled drinks.
5. Failures in the immune system of children, leading to various types of allergies.
6. Nervous - mental factors, leading to the development of a number of gastrointestinal diseases.
7. The presence of neuroses of various etiologies in children.
8. Such diseases can be hereditary.

How does the digestive process occur in children?

Do not forget that the gastrointestinal intestinal tract The child is still far from perfect.

The gallbladder produces and stores bile, the pancreas produces gastric juice and a number of enzymes involved in the digestive process. All these components enter the child’s stomach and duodenum, which give a signal to the brain that the digestive organs are ready to eat food. And the child immediately feels hungry.

When the child has eaten, the food descends through the intestines into the stomach, where its primary processing occurs, in which gastric juice and a number of enzymes take part. Then the semi-digested food enters the duodenum, where the final digestion of the food occurs with the help of enzymes and bile.

As a result, all the elements, vitamins and other substances obtained during food processing enter the baby’s internal organs with the blood, and feces are formed from the residues, which come out during the act of defecation.

In an adult, all components involved in the digestive process enter the stomach and duodenum simultaneously. But a child’s internal organs do not always work harmoniously. It happens that gastric juice has already entered the stomach and begins the process of digesting food, but the bile has not yet reached the duodenum.

In this case, the food leaves the stomach, and no further processing occurs in the intestines. Food begins to ferment and rot. The resulting gases can cause pain in the intestines. And the remains of rotting food leave the body in the form of diarrhea.

It also happens the other way around - food has entered the stomach, but gastric juice has not yet arrived. In this case, undigested food enters the next section of the intestine for further processing. And bile and enzymes are not able to cope with so much unprocessed food. And some of the undigested food leaves the body with feces. As a result, the body does not receive the required amount of useful elements and vitamins.

It also happens that there is no food in the stomach yet, but gastric juice has already arrived, or the duodenum already has bile and the necessary enzymes, but there is nothing to digest - the food has not yet arrived. It is in this situation that diseases of the stomach and duodenum such as gastritis with increased acidity and ulcer.

Treatment of gastrointestinal diseases

Important! The specific treatment prescribed by the doctor depends on the disease that is diagnosed in the child.

Usually, drug therapy is carried out and an appropriate diet is prescribed, on careful adherence to which the child’s recovery process directly depends. It is necessary to restore normalcy in the family, except stressful situations from the life of the baby, do not give the child physical activity.

A child who has been diagnosed with some kind of gastrointestinal tract disease, even after complete recovery, should undergo regular medical examination by a gastroenterologist to avoid relapse of the disease.

Important! Such young patients are recommended to undergo sanatorium spa treatment.

Prevention of gastrointestinal diseases

What should be the prevention of diseases of the gastrointestinal tract in children?

First of all, it is necessary to conduct healthy image life for all family members. To avoid a recurrence of gastrointestinal diseases in a baby, doctors recommend adjusting his diet, changing his lifestyle so that the baby is not nervous, restoring immunity.

If the child has any chronic diseases digestive organs, then steps should be taken to prevent the exacerbation of these diseases.

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Functional gastrointestinal disorders in newborns and children of the first year of life are divided into the following types: diarrhea, abdominal pain, regurgitation. aerophagia.

This is not a complete list of gastrointestinal diseases in children. Diagnosis and treatment should be carried out pediatric gastroenterologist, and parents should know the main signs of these diseases, warning signs and first aid methods.

Functional disorders of the gastrointestinal tract in children are one of the most widespread problems, particularly among children in the first months of life. Distinctive feature of these conditions is the appearance of clinical symptoms in the absence of any organic changes in the gastrointestinal tract (structural abnormalities, inflammatory changes, infections or tumors) and metabolic abnormalities.

In infants, especially the first 6 months of life, the most common conditions are regurgitation, intestinal colic and functional constipation.

Causes of functional disorders of the gastrointestinal tract in children

The causes of functional disorders in children in the gastrointestinal tract can be divided into two groups: those associated with the mother and those associated with the child.

The first group of reasons include:

1. Complicated obstetric history.
2. Errors in nutrition in a nursing mother.
3. Violation of feeding technique and overfeeding during natural and artificial feeding.
4. Improper breeding of infant formula.
5. Woman smoking.

Child related reasons include:

1. Anatomical and functional immaturity of the digestive organs (short abdominal esophagus, sphincter insufficiency, reduced enzymatic activity, etc.).
2. Dysfunction of the regulation of the gastrointestinal tract due to the immaturity of the central and peripheral nervous system (intestines).
3. Features of the formation of intestinal microbiota.
4. Formation of sleep/wake rhythm.

Also, reasons that contribute to the development of gastrointestinal problems and pathologies in children include:

1. Unbalanced diet.
2. Unfavorable environmental situation.
3. Allergic reactions.
4. Neuroses.

In most cases, when such pathologies are identified, the heredity factor is confirmed.

Gastrointestinal problem in children: diarrhea

Diarrhea is an increase or thinning of the stool associated with indigestion. If in children of the first year of life the chair can be 3-5 times a day and have the consistency of thick sour cream, then after a year it should be regular and decorated.

Diarrhea is not a safe condition as it can interfere with GI functions such as motility and absorption useful substances. But diarrhea often leads to dehydration and nutrient deficiencies in the body. The reasons for its occurrence include:

1. Errors in nutrition.
2. Diet inappropriate for age.
3. Food poisoning.
4. Taking antibiotics.
5. Worms.
6. Intestinal infection.
7. Stress and negative emotions.
8. Lactose deficiency.

If diarrhea is accompanied by fever, loss of appetite, weakness and deterioration in the general condition of the child, then a visit to the doctor should be immediate.

It is necessary to implement a set of measures to provide emergency assistance, namely:

1. Don't feed.
2. Replenish fluid loss.
3. Monitor the patient's condition.

To compensate for the loss of fluid, electrolyte solutions are used, for example, Regidron. Drinking should be given in small sips so as not to induce vomiting, but often, every 3 to 5 minutes.

Further treatment is prescribed by a specialist, based on the results of laboratory tests. However, regardless of the tactics of therapy, its important stage should be the restoration intestinal microflora by taking lactobacilli, for example the drug "Acipola".

Disruption of the gastrointestinal tract in children: symptoms and treatment of constipation

Constipation is a violation of the functions of the gastrointestinal tract in a child, which manifests itself in an increase in the intervals between bowel movements or systematic incomplete emptying intestines.

The reasons may be:

1. Improper bowel function.
2. Increased body temperature.
3. Taking antibiotics.

Changes in climate, water and diet can also cause constipation.

If not visible reasons for the occurrence of constipation, then with this symptom of disruption of the gastrointestinal tract, it is better to consult a specialist. If the reasons are obvious, then emergency assistance must be provided. It is recommended to put a microclyster, such as Microlax, and make sure that such situations do not recur:

1. Normalize your diet.
2. Eliminate dysbacteriosis.
3. Restore intestinal motility.

In addition, regular physical activity contributes to normal bowel movements. And with such a functional disorder in the work of the gastrointestinal tract in young children, you can massage the abdomen in a circular motion in a clockwise direction, regularly perform exercises that consist in raising the legs to the abdomen and with a slight pressure of the knees on it, and also introduce mashed potatoes with a probiotic into complementary foods. .

Abdominal pain due to gastrointestinal problems in a child

Abdominal pain in children can be a symptom of many diseases, including disorders of the gastrointestinal tract.

In infants, signs of pain look like:

1. Anxiety.
2. Breast refusal.
3. Cry.

The causes of such pain may be:

1. Gastritis.
2. Peptic ulcer disease.
3. Colic.
4. Binge eating.
5. Indigestion.
6. Constipation.

Pain may accompany food poisoning or a viral or bacterial infection.

Parents should understand that any pain in the abdomen that lasts more than half an hour should not be ignored.

If abdominal pain is caused by intestinal colic in infants, then this condition is accompanied by:

1. Bouts of crying for no apparent reason.
2. Pulling your legs towards your stomach.
3. Passage of gas during crying.

This condition is due to the immature digestive system and the accumulation of gases during feeding.

It is necessary to compare all the factors that cause concern, undergo a comprehensive examination and strictly follow the doctor's instructions.

With intestinal colic in infants, an important point in the treatment of disorders of the gastrointestinal tract is:

1. Diet compliance by a nursing mother.
2. Placing the baby on his stomach between feedings.
3. The use of the drug "Espumizan" with each feeding according to the instructions.

It is believed that colic begins at 3 weeks of age and ends at 3 months. When the colic finally passes, this will be evidence of the adaptation of the baby's body to the "adult" type of nutrition, that is, not through the umbilical cord, but through the stomach.

Regurgitation in a child due to gastrointestinal dysfunction

This is a very common phenomenon in children in the first months of life. A baby is born with a relatively small stomach, so some of the milk remains in the esophagus. And since the child very often swallows air together with milk (in violation of the feeding technique), the air comes out with the milk.

It is imperative to distinguish regurgitation from vomiting. When spitting up, the child does not worry. Milk flows out of the baby's mouth. When vomiting, the baby is very worried, the contents of the stomach “fly out” under pressure.

Regurgitation can be both a variant of the norm and evidence serious problems associated with the gastrointestinal tract.

Functional reasons, which are a variant of the norm:

• Overfeeding
• Flatulence.
• Inappropriate mix.
• Tight swaddling.

Causes of pathological regurgitation:

1. Infectious processes in the body.
2. Anomalies in the development of the gastrointestinal tract.
3. Kidney failure.
4. Heredity.

In addition, regurgitation in babies can be caused by food poisoning.

When feeding a child, it is necessary to follow the feeding rules - correctly attach the child to the breast or feed him from a bottle. After feeding, you need to hold the baby in vertical position(“column”) Usually this is enough.

In addition, regurgitation can be a consequence of a disruption in the digestion of food, a manifestation of increased excitability of the nervous system, etc. In these cases, regurgitation can negatively affect the child’s weight gain.

Typically, in infants, such disturbances in the gastrointestinal tract disappear as the body matures, usually by 3 months. If they last longer, then a specialist consultation is necessary.

Gastrointestinal dysfunction in children: symptoms and treatment of vomiting

Vomiting is one of the symptoms of a violation in the digestive tract. It can be both a sign of food poisoning and other, more serious pathologies. If vomiting occurs, be sure to provide first aid to the child, measure the body temperature and monitor his condition.

Causes of vomiting:

1. Overeating, especially in infants.
2. Inflammation of the gastric mucosa.
3. Taking medications.
4. Gastritis.
5. Intestinal infection.
6. Food poisoning.
7. Diseases of the central nervous system.

There can be many reasons, and therefore this condition in a child cannot be ignored.

What to do?

When the first signs appear, you should contact your local pediatrician. During a medical examination in a children's clinic, a pediatrician conducts a detailed medical history, examination, and appoints specialist doctors for consultations, additional methods examinations to rule out more serious illnesses.

Treatment is prescribed after a comprehensive examination of the child. As a rule, doctors prescribe antiemetic drugs, such as Cerucal. If necessary, antimicrobial and antivirals, for example "Novirin".

First aid:

1. Lay the patient on his side or wear in an upright position.
2. Drink often in small sips, a solution of Regidron is suitable.
3. Don't feed.
4. Wash your face and rinse your mouth between bouts of vomiting.

Also, for vomiting, sorbents are used in the treatment of gastrointestinal dysfunction in children; the drug “Smecta” has proven itself to be effective in reducing the effect of toxins on the body. In cases where vomiting is accompanied by pain or cramps in the abdomen, antispasmodics are used. To protect the irritated gastrointestinal mucosa, it is better to prescribe an antispasmodic in the form of rectal suppositories, for example Viburkol.

Aerophagia in case of gastrointestinal dysfunction in a child

Aerophagia is a functional disorder of the gastrointestinal tract in children, the cause of which is the swallowing of air, leading to repeated belching and flatulence. Moderate aerophagia is a common occurrence in children in the first months of life due to the immaturity of the nervous regulation of the swallowing process.

In infants, aerophagia can be caused by improper attachment to the breast or too much milk pressure.

What to do?

If aerophagia appears in a child, parents should contact their local pediatrician to find out and eliminate the causes of aerophagia.

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The functioning of the digestive organs at an early age has its own specific characteristics and therefore not every specialist who treats adult patients can accurately diagnose and choose the best method of treating gastrointestinal tract diseases in a child. Detects and treats diseases of the digestive system in children pediatric gastroenterologist. A highly qualified gastroenterologist can promptly recognize and prescribe a course of treatment for diseases of the gastrointestinal tract in a child, such as gastritis, sigmoiditis, esophagitis, hepatitis, peptic ulcers(ulcers of the duodenum, stomach), duodenitis, colitis and others.

The slightest concern about burning and pain in the gastrointestinal tract in a child should alert you - effective treatment without possible complications diseases of the digestive system depends on the timely detection of the disease at an early stage of development.

Pediatric gastroenterologist You should definitely examine your child if the following symptoms appear:
1. Vomiting, nausea, belching, heartburn
2. Disturbance in the process of defecation
3. Chronic pain in the abdomen
4. Decreased appetite
5. Bleeding from the digestive organs
6. Bad breath
7. Violation of the stool (diarrhea, constipation, unstable chair)
8. Weight loss

Pediatric gastroenterologist will examine the child, listen to complaints and collect an anamnesis about the child’s development, find out the features of possible previous treatment of diseases and features of the diet. Then the gastroenterologist will prescribe additional examinations and diagnostics: stool tests for scatology, dysbacteriosis, carbohydrates,
general blood analysis,
ultrasound examination of the digestive system,
If necessary, refer the child for examination by other specialists for a more accurate diagnosis.

Below is information about the main diseases of the digestive system in children, which are detected pediatric gastroenterologist and then prescribes a course of treatment:

How to recognize the symptoms of gastrointestinal diseases in an infant?
Pain in the tummy in an infant is manifested by twisting of the legs, frequent restlessness, bending of the legs towards the stomach, and strong crying. The baby's tummy may be dense, noticeably swollen, and make specific sounds: transfusion and rumbling. At the same time, the baby makes an effort, blushes strongly, groans.
Pain in the baby's tummy can appear due to the accumulation of gases, severe colic (spontaneous intestinal spasms), which leads to sleep disturbances and loss of appetite.

An experienced pediatric gastroenterologist will determine the causes of symptoms of digestive diseases in an infant. The reasons can be very different:
1. General immaturity of the digestive system in an infant, characteristic of any infant at an early age (frequent colic and accumulation of gases are quite normal for completely healthy children under 4 one month old)
2. Intestinal dysbiosis
3. Lactase deficiency due to imperfect enzymatic systems in the child’s body
Lactose intolerance is a fairly common phenomenon for children under 1 year of age. Lactose (or milk sugar) is found in dairy products. products, breast milk, cow's milk and infant formula. A deficiency of the enzyme that breaks down lactose (lactase) in the baby’s body leads to poor tolerance to dairy foods and poor absorption of lactose (lactose intolerance).
Lactase deficiency in an infant can develop both due to a hereditary predisposition and against the background of intestinal dysbiosis or general enzymatic immaturity. Symptoms of lactose intolerance in infant: tummy pain during or after feeding, frequent loose (and even foamy) stools (more than 10 times a day), bloating and weight loss. After examining the baby, the pediatric gastroenterologist may give a referral for a stool test for carbohydrates to confirm the diagnosis.

When the balance of intestinal microflora is disturbed with the developing dominance of pathogenic bacteria in the gastrointestinal tract, the functioning of the digestive system is disrupted and dysbiosis begins in children. Analysis of stool for dysbacteriosis (study of intestinal microflora) allows you to accurately establish a diagnosis and prescribe appropriate treatment to correct the intestinal microflora and restore the functionality of the child’s digestive system.

Often to a pediatric gastroenterologist They bring children with periodically occurring acute abdominal pain that is not associated with diseases of the digestive system. The child complains of abdominal pain after suffering shocks and psycho-emotional stress. These are the so-called neurotic pains in children. After the examination, the gastroenterologist may advise you to consult a pediatric neurologist. a child psychologist and also with a cardiologist - pain in the abdominal area may be part of vegetative-vascular dystonia.

Why does the child have a stomachache? The most common causes of digestive system dysfunction in children encountered pediatric gastroenterologist in your medical practice:

1. Overeating
Often found in very young children. Do you never deny your child a supplement? Do not be surprised if, some time after overeating, the child begins to complain of pain in the tummy, he develops lethargy, apathy, and mild nausea.
If this happens, put the baby to bed and if he vomits, give him some water to drink. Enzyme preparations can significantly alleviate the condition, but they can only be given after consultation with a pediatrician!
And most importantly, try to teach your child to eat in moderation!

2. Colic (spontaneous intestinal spasms)
If the child is very small (several months old), then colic is usually provoked by air collecting in the intestines.
Manifestations of colic in a child - the baby cries a lot for a long time after eating.
What you need to do - if you are breastfeeding your baby, make sure that he grasps not only the nipple with his mouth, but also the areola around it. Try to eat only easily digestible foods. And if your baby is on artificial nutrition, then consult with your pediatrician in order to choose the appropriate baby food (formula) for the baby.
Prevention: Hold the baby upright for some time after feeding, until excess air is released from the intestines.

3. Constipation
You should be wary of your child having bowel movements that are too infrequent (only a few times a week), as well as the appearance of periodic abdominal pain and frequent flatulence.
What you need to do: Be sure to take your child for examination to a pediatric gastroenterologist. Constipation may be a consequence of functional disorders of the pancreas or thyroid gland, as well as the liver. But such reasons are not common and in most cases it is enough to change the child’s lifestyle and diet. Give your child more foods that perfectly activate the intestines, maintaining the balance of microflora - acidophilus milk, yogurt with bifidobacteria, kefir, as well as dried fruits (dried apricots, prunes, raisins) and raw and cooked vegetables (carrots, beets, apples, tomatoes) .
Constipation in a child can also be a consequence of dehydration - give the baby as much liquid as possible (juices, fruit drinks, compote).
The best way to combat constipation in a child is to eat a nutritious diet, drink as much fluid as possible and walk more in the fresh air.

4. Pathogenic bacteria
Some of the most common bacteria that cause diseases of the digestive system are salmonella and shigella.
Symptoms of salmonellosis in a child are high fever, diarrhea, diarrhea, vomiting, abdominal pain.
What to do? Be sure to show the child pediatrician to clarify the diagnosis. A course of antibiotic treatment is usually prescribed. Treatment begins with the use of sorbents - activated carbon, sillard, smecta.
With shigellosis (dysentery) in a child, the child’s body temperature rises to 38-39 degrees, watery stools mixed with mucus and blood, and a painful urge to defecate appear.
What to do? Be sure to take your child to the pediatrician for examination. For dysentery, treatment is usually prescribed antibacterial drugs. It is imperative to give a glucose-saline solution, and when the baby gets better, replace it with a weak solution of unsweetened tea. Diet for dysentery - steamed cutlets, porridge, baked apples. Give more fruits, berries and vegetables (wash them thoroughly).

5. Viral diseases
A fairly diverse group of pathogenic microorganisms - enteroviruses lead to stomach upset in a child.
Enteroviral diarrhea. Absolutely any child can get sick by putting a dirty toy in their mouth or interacting with an infected peer. Typically, enteroviral diarrhea affects children under 4 years of age. Symptoms: fever up to 38 degrees, cough, stuffy nose, sore throat. If you have symptoms of diarrhea, check with your pediatrician about the dosage of cold medications and treatment regimen. Let your child drink as much fluid as possible. Build your child's immunity.
Another disease caused a certain type enteroviruses - Hepatitis A in a child. The infection is transmitted through personal hygiene items, infected dishes, tap water (if the child drank raw water). Symptoms: the temperature rises sharply, the child suffers from nausea and acute abdominal pain. The stool becomes discolored and the urine turns dark yellow. Yellowness of the whites of the eyes appears, then the face and then the whole body (signs of infectious jaundice).
With hepatitis A, the child will have to stay in the hospital for some time. Diet for hepatitis A - vegetable soups, dietary meat (rabbit, turkey, chicken), dishes from stewed, boiled and raw vegetables.
The best cure for hepatitis A is vaccination. Teach your child to eat only washed fruits and to wash their hands thoroughly before eating.

6. Acetonomic crisis
Reasons for occurrence - poor nutrition, frequent overwork, long trips - severe stress for the child’s body, leading to excess production ketone bodies in the blood (acetoneacetic acid and acetone).
Symptoms - the child often vomits undigested food mixed with bile. The temperature rises and severe abdominal pain appears. The child's breath smells like acetone.
Be sure to take your child for examination see a pediatric gastroenterologist to clarify the diagnosis. Every five minutes, give your child a teaspoon of a solution of rehydron or alkaline mineral water without gas. Do an enema to cleanse the intestines (2 teaspoons of soda per 200 grams of water). Give your child a sorbent (polysorb, smecta, sillard). Diet - for several days, give your baby porridge, crackers, pureed vegetable soups.
A nutritious diet and the elimination of stressful situations will prevent a recurrence of the child’s acetone crisis.

Tests and diagnostics prescribed pediatric gastroenterologist :
1. Stool tests for carbohydrates, dysbacteriosis, scatology
2. Biochemical blood test
3. Diagnosis of the pancreas and liver
4. Gamma-glutamyltransferase, aspartate aminotransferase, proteinogram (protein fractions), alpha-1-acid glycoprotein, total bilirubin, antitrypsin, cholinesterase, etc.
5. Ultrasound examination (ultrasound) of the abdominal cavity

According to statistics, recently, disruptions and pathologies of the gastrointestinal tract occupy a leading place among other diseases. Residents of large cities are especially susceptible to them. The reason for this is an unhealthy lifestyle and constant stress. Therefore, by the age of 30, every fourth person suffers from gastrointestinal diseases.

Characteristics of the digestive system

It's no secret that the digestive tract plays a very important role important role in the life of the body. With its help we get vitamins, microelements, proteins, fats, carbohydrates, fiber and useful acids. Some of them serve as building material for cells and provide us with energy. Other substances contribute to the smooth functioning of organs and systems. Therefore, gastrointestinal diseases can not only disrupt the normal rhythm of a person’s life, affecting his health, but in some cases lead to death.

The gastrointestinal tract consists of the following components: the oral cavity, pharynx, esophagus, stomach and intestines, which includes the thin, thick and straight sections. The main functions of all these organs: breakdown of food, removal of its remains from the body, production of useful enzymes that contribute to proper digestion and absorption of necessary substances. Without normal functioning In the gastrointestinal tract, a person feels discomfort, he feels unwell, which, due to lack of treatment, can become chronic.

Causes of diseases

There are a lot of them and most of them relate to the wrong lifestyle. The main causes of gastrointestinal diseases are as follows:

1. Unbalanced diet: constant dieting, overeating, unhealthy snacks and chewing on the go, regular visits to establishments selling fast food, lack of healthy fiber, instead, the predominance of animal fats and hard-to-digest carbohydrates in the diet.
2. Ecology: low quality of drinking water, the presence of large amounts of nitrates and pesticides in vegetables, antibiotics and preservatives in meat products.

Acute and chronic gastrointestinal diseases have a number of signs that make it easy to determine whether you have problems with this part of the body. These include the following symptoms:

• Abdominal pain. With ulcers it is sharp, with frequent localization, in the case of appendicitis and hernia - strong, pulsating, when a person has colic - cramping.
• Heartburn. Painful sensations are typical for it with an ulcer, intensification - with a hernia.
• Belching. Sour indicates indigestion, with the smell of rotten eggs - a pathological retention of food in the stomach and intestines.

Symptoms also include vomiting and nausea, which are more typical of chronic diseases. For example, for gastritis. If the vomit contains bloody discharge and clots, it may be an open ulcer or stomach cancer. If a patient regularly suffers from flatulence, he may be diagnosed with dysbiosis, pancreatic secretory insufficiency, or complete or partial intestinal obstruction.

Other signs

Gastrointestinal diseases have less severe symptoms which indicate damage to the digestive system: bad breath, a feeling of bitterness, the appearance of a white coating on the tongue, poor appetite (especially aversion to meat products), constant thirst, increased salivation, a sharp decrease in body weight, the development of anemia, pallor, dizziness, weakness, a feeling of heaviness in the abdomen, prolonged stool disorder (constipation or diarrhea), as well as the appearance of stool bloody discharge.

These symptoms in themselves are not dangerous, but can disrupt the normal rhythm of life, affect its quality, and also indicate the development of pathology. Therefore, the sooner you see a doctor, the faster and easier the treatment will be, the therapy will work effectively and the result will be complete healing. If the disease is not detected on early stage and is not cured, it can cause serious complications or will regularly worsen for the rest of your life.

Major diseases

They are typical for a larger percentage of patients who seek medical help. Firstly, it is gastritis, the development of which is provoked by bacteria Helicobacter pylori, as well as errors in nutrition, the presence bad habits and constant neuroses. With gastritis, the mucous membrane of the gastric walls suffers, which is why a person feels pain and suffers from indigestion. Secondly, it is a stomach and duodenal ulcer. Among other things, it is characterized by painful sensations, heartburn, and problems with digestion of food. An ulcer is formed when the gastrointestinal tract is damaged and the integrity of the tissue is damaged, and this can lead to life-threatening complications.

Third, most frequent illness Gastrointestinal tract, is colitis. Occurs under the influence of pathogenic bacteria, against the background of infection. Localized in the intestinal mucosa and carries inflammatory nature. Nonspecific colitis causes ulcerative lesions, which cause peritonitis, intestinal bleeding, malignant tumors and obstruction.

Other diseases

Their list is huge. What gastrointestinal diseases are most common among patients? First of all, it is pancreatitis and dysbacteriosis. The first refers to inflammatory diseases of the pancreas, which is characterized by vomiting, nausea, indigestion and pain. The second is the consequences of changes in the natural state of the intestinal microflora, as a result of which its full functioning is disrupted, problems arise with the digestibility of food and its normal excretion from the body.

The most common diseases of the gastrointestinal tract include the following ailments: cholecystitis - inflammation of the gallbladder, which is accompanied by bitterness in the mouth, nausea, pain, problems with stool and dyspeptic symptoms; cirrhosis of the liver - a deadly disease in which large-scale damage to the cells of the organ occurs. Digestive diseases are also called hemorrhoids and appendicitis.

Clinical picture in children

Unfortunately, recently there has been an increase in cases of digestive pathologies in children. Gastrointestinal diseases in children occur due to several factors: poor environment, heredity and poor nutrition. As for the latter, it manifests itself in the uncontrolled consumption by minors of carbonated drinks, fast food products, and sweets that contain emulsifiers, dyes and preservatives. Doctors say that intestinal diseases in children most often manifest themselves at 5-6 and 9-11 years old. The clinical picture is as follows: the baby has a stomach ache, feels nauseous or vomits, and complains of diarrhea or constipation.

Even babies are not protected from illnesses. They often suffer from so-called colic. The reason is artificial feeding. Therefore, doctors never tire of insisting that breast milk - better food for the youngest children. It not only has a beneficial effect on the stomach, but also helps strengthen the immune system. The organism that receives sufficient quantity natural vitamins, microelements and antibodies from mother's milk, can also provide adequate resistance to various bacteria that cause gastrointestinal tract diseases.

Intestinal diseases in children

Acute intestinal diseases of children are classified as a separate group of gastrointestinal diseases. These are salmonellosis and dysentery, which cause intoxication, dehydration and various dyspeptic disorders. Such symptoms are very dangerous and require immediate hospitalization. Interestingly, it is children who most often suffer from intestinal infections. This is due to the fact that in babies the body’s defense mechanisms still work imperfectly. The reasons are also children’s ignorance of sanitary standards and the physiological characteristics of their gastrointestinal tract.

Acute infectious diseases The gastrointestinal tract can provoke delayed physical development, “kill” the immune system and cause a number of other serious complications and irreversible consequences. They are usually accompanied complete absence loss of appetite, fever, pain in the abdomen, diarrhea, nausea and vomiting. The baby complains of weakness and fatigue, he is lethargic and lethargic. Such a child needs medical attention: antibacterial therapy prescribed by a pediatric gastroenterologist.

Treatment

First you need to contact a specialized doctor - a gastroenterologist. Only after passing necessary tests and conducting examinations, he will make an accurate diagnosis. Treatment of gastrointestinal diseases, its duration and intensity will depend on the specific disease, the form and stage of its development, the degree of neglect, and the general condition of the patient. Drug therapy is usually used, but in some cases surgical intervention is urgently required.

Tactics are selected individually. The following drugs are usually prescribed:

• Antacids - neutralize gastric juice.
• Alginates - normalize acidity.
• Prokinetics - stimulate gastrointestinal motility.
• Antispasmodics - relieve spasms of smooth muscles.
• Antibiotics and probiotics.
• Enterosorbents - against intoxication.
• Antimicrobial agents.
• Enzymatic digestive drugs etc.

In combination with drug treatment Traditional medicine is also used: infusions and decoctions of medicinal plants. For example, immortelle, nettle, yarrow, lemon balm. They are very effective, but you can only take them under the supervision of your doctor.

Diet for gastrointestinal diseases

All diseases from this series are so different that specific recommendations can be given only after a detailed study of the diagnosis. The diet is subject to adjustment in each individual case. But there are also general requirements for the patient’s diet. Firstly, you need to eat often - 6 times a day. Portions should not be large; it is best if the dish is rare or crushed. This way you won't overload your stomach and intestines. Secondly, the patient needs to drink 2 liters of water per day.

The diet for gastrointestinal diseases must be gentle. Preference should be given to soufflés, purees, omelettes, low-fat fish and meat broths. Fried, smoked, canned, pickled, salted - under strict ban. You should also give up various sauces, semi-finished products, seasonings and spices. It is also better to exclude vegetables that cause fermentation processes. These are all legumes, corn, peas, cabbage, turnips and radishes. Other vegetables must be thoroughly boiled or stewed. Food should be fresh and easy to digest. The more fiber in the diet and the less refined food, the better the gastrointestinal tract will function.

Prevention

First of all, it’s still the same balanced and proper nutrition. Prevention of gastrointestinal diseases includes the following measures: compliance with the rules of sanitary food preparation and personal hygiene. This way you will protect yourself and your family from intestinal infections. Eat only healthy foods: vegetables, fruits, herbs, low-fat dairy products, fish and meat. Try to daily diet proteins, fats and carbohydrates were in the correct ratio.

Gastrointestinal diseases “love” passive people very much. Therefore, try to move more, play sports, and spend a lot of time outdoors. Great option There will be swimming, light running, aerobics and even walking. Give up bad habits - they provoke disruptions in the functioning of the intestines and stomach. Try to protect yourself from stress, don’t be too nervous, take natural sedatives: valerian or motherwort. When the first alarming symptoms Contact your doctor immediately - this way you will avoid the progression of the disease and prevent it from becoming chronic, and, of course, achieve a complete recovery.

Classification of gastrointestinal diseases A. Diseases of the esophagus: GER, GERD, Esophagitis and B. Diseases of the stomach and 12 - duodenum: Gastritis (gastroduodenitis), ulcer u B. Diseases of the biliary system: bile duct, cholecystitis (cholecystocholangitis), cholelithiasis u G. Diseases of the pancreas: dyspancreatism, pancreatitis u D. Intestinal diseases: IBS, UC, Crohn's disease 2 u

Features of gastrointestinal diseases in children 1. Prevalence of digestive diseases in children: ●place in the structure of general morbidity ●place of gastroduodenal pathology among diseases of the digestive organs ●degree of increase in incidence ●reasons for increase in incidence ●prevalence of gastroenterological pathology depending on age 3

Features of gastrointestinal diseases in children ● At what age does gastroduodenal pathology most often debut in children? ●At what age is the most striking clinical picture in children? ●Which characteristic changes Are they more common in preschoolers and schoolchildren? ● What are the features of the course of gastroduodenal pathology in children? ● What clinical and examination features cause late diagnosis of organic changes in diseases of the gastroduodenal zone in children? 4

Factors predisposing to the early development of gastrointestinal diseases in children 1. Imperfect motor function of the gastrointestinal tract 2. Low enzymatic activity of saliva gastric juice 3. High permeability of intestinal CO 4. Insufficiently formed protective properties of CO, low activity of digestive juices, imperfect intestinal microflora 5

RISK FACTORS AND DEVELOPMENT OF CGD, PUDS I. Endogenous 1. Heredity u Markers of hereditary burden in PUDS u Group specificity of blood u Gastrointestinal hyperreactivity u Type of highest nervous activity, personality traits, anthropometric indicators 6

RISK FACTORS AND DEVELOPMENT OF CGD, UD II. Exogenous 1. Nutritional: irrational feeding u for infants and young children u for schoolchildren 2. Neuropsychic stress, external functional factors, astheno-neurotic reactions, vegetative dystonia, hyperreactivity syndrome 7

RISK FACTORS AND DEVELOPMENT OF CGD, PUDS u u u u PATHOGENICITY FACTORS -NR High mobility High adhesiveness of HP to epithelial cells of the coolant Ability to produce and release a large number of enzymes Ability to release toxins: vacuolating -Vac. A and the cytotoxin associated Cag. A Routes of infection Frequency of HP infection depending on nosology Frequency of HP infection depending on age 9

CGD, PU Pathogenesis predisposition + long-term exposure to damaging factors violation of the relationship between protective and aggressive factors Protective factors u Mucous layer, Epithelial regeneration, Blood flow in CO, Local immunity aggression factors u Hydrochloric acid, Pepsin, Bile acids, Medicines, Helicobacteria, Viruses 10

CHRONIC GASTRITIS, PUD Multifactorial, heterogeneous diseases caused by a violation of the neuroendocrine and immune systems, an imbalance between local factors of “aggression” and “defense”, a violation of regeneration, and damage to the coolant and 12-p of the intestine Prevalence!! u 11

CHRONIC GASTRITIS GASTRODUODENITIS Classification FORMS 1. Endogenous autoimmune 2. Exogenous - infectious 3. Exo-endogenous By localization 1. Antral 2. Fundal 3. Pangastritis 12

CHRONIC GASTRITIS GASTRODUODENIT By functional characteristic u Normacid u Hyperacid 1. 2. Stages (phases) of the course Exacerbation Remission 13

CHRONIC GASTRITIS GASTRODUODENITIS Endoscopic stage of ulcer 1. stage of fresh ulcer 2. Stage of beginning of epithelialization 3. Stage of scarring ulcer 4. Complete healing of the ulcer 14

CHRONIC GASTRITIS GASTRODUODENITIS Characteristics inflammation of the stomach u Duration of periods of exacerbation up to 2-3 weeks u Stereotypic clinical manifestations u Relationship of symptoms to the nature of food u Seasonality of exacerbations 15

CHRONIC GASTRITIS GASTRODUODENITIS 1. Features of the clinic Variety of complaints 2. Scarce objective data 3. The onset of the clinic coincides with admission to school (more often) 4. Early stage - symptoms of functional disorders 5. Before puberty 16 girls get sick more often

CHRONIC GASTRITIS GASTRODUODENITIS Ulcer-like CG Pain: aching, of varying intensity, on an empty stomach/1.5 - 2 hours after meals/at night Characteristic: disappearance or reduction of pain after eating Dyspeptic complaints: heartburn!!!, belching!! Vomit! Good appetite!!! Palpation: pain in the epigastrium/pyloroduodenal area (typical) General symptoms Secretory function: normal/EGD: AG/bulbit (characteristic) H. Pilory 17

CHRONIC GASTRITIS GASTRODUODENITIS Gastritis-like hCG Pain: early, aching in the epigastrium, passes after 1-1.5 hours. Rapid saturation!!! Reduced/selective appetite!!! Dyspeptic complaints: belching with air!!!, nausea!!, vomiting food! Palpation: diffuse pain Secretory function is normal/EGD: FG/Pangastritis Histology: atrophy, metaplasia 18

ULCER DISEASE Clinic Pain u Hungry, often at night!!! u Persistent, paroxysmal, stabbing!!! u Localization!!! Irradiation!! u After eating, antacids or antispasmodics!!! Appetite!!! Dyspeptic complaints: vomiting!!! heartburn!!!, belching!! Constipation!!! Seasonality!!! VSD of vagotonic type!! 19

ULCER DISEASE Features of PU in children For childhood, an atypical course of PU is characteristic 1. There is no Moynihan rhythm, there is no recurrence and stereotypy of pain 2. Classic course -

ULCER DISEASE 1. Mild course: ulcer healing up to 1 month, remission for more than a year 2. Moderate severe course: ulcer healing for more than 1 month, remission less than a year (short remission) 3. Severe course: presence of complications, frequent relapses (more than 2 exacerbations per year), combined and multiple ulcers, long healing time 21

ULCER DISEASE Complications 1. Bleeding: hematemesis, melena, symptoms of acute blood loss, disappearance of pain Hidden bleeding: positive Gregersen reaction Management tactics: emergency hospitalization and endoscopy 2. Pyloroduodenal stenosis and cicatricial and inflammatory-spastic (functional) 22

CGD, PU Diagnostics 1. CLINIC + anamnesis 2. EGDS with biopsy of the stomach and duodenum; in case of ulcerative disease, detection of an ulcerative defect 3. Histologically: degree of inflammation, dystrophy, dysregeneration 4. Secretory function of the stomach: fractional gastric intubation, intragastric r. Nmetry 5. Motor function of the stomach: u EGDS: pathological refluxes, dysfunction of the sphincters u Ultrasound of the stomach u EGG 6. X-ray with barium sulfate? 23 7. Diagnosis of HP

CGD, PU Diagnosis of HP invasive u Histological, bacteriological immunohistochemical, rapid urease test, PCR non-invasive 1. urease breath test (UDT) 2. immunological methods: u antibodies to HP immunoglobulin class A, M, G in the blood, quantitative determination of HP antigen in feces u PCR diagnostics of HP in feces 24

CGD, PU Primary diagnosis of HP infection bacteriological, histological, urease tests Control of eradication therapy 1. Timing of control 2. Control methods 25

CGD, PUD 1. 2. 3. Principles of therapy Exacerbation period Bed rest Fractional meals(5-6 times) Diet therapy. Eliminate!!! Diet depending on the secretory function of the stomach: 1. Hyperacid stomach: table No. 1 2. Hypacid stomach: table No. 2 3. Table No. 5 26

CGD, PU Correction of gastric hypersecretion 1. Non-absorbing antacids: Almagel, Maalox, phosphalugel 2. Antipeptics: Venter, sucralfate 3. Gastroprotective drugs: de-nol, ventrisol, tribimol 4. H-2 histamine blockers III generation: ranitidine, famotidine 5. Inhibitors proton pump: omeprazole, pantoprazole, lansoprazole, rabeprazole 6. Mineral waters 27

CGD, PU Correction of motor disorders and smooth muscle antispasmodics: but-shpa, papaverine u anticholinergics with antispasmodic action: belloid, metacin, buscopan, platifillin u prokinetics: metoclopramide (syn. Cerucal), domperidone (syn. Motilium), coordinax 30 minutes before meals. Course 10-14 days. Correction of neuro-autonomic disorders u sedative therapy: valerian extract, motherwort infusion, peony infusion u tranquilizers (according to indications): rudotel, diazepam, meprobamate Stimulation of metabolic processes, protective forces body, regeneration processes CO u gastrofarm, riboxin, vit. U, methyluracil, pentoxyl, vitamins A, E, B, folic acid and others. Physiotherapy procedures for “deep” effects on the organs of the upper digestive tract and diadynamic currents, ultrasound, inductothermy, EHF 6. Physiotherapy 7. Herbal medicine 28 7. Sanatorium and resort treatment

CGD, BU Principles of anti-Helicobacter therapy Colloidal bismuth subcitrate (De-nol) 8 mg/kg; max -480 mg/s); Antibiotics: u amoxicillin (flemoxin-solutab, hiconcil-25 mg/kg; max 1 g/s), u azithromycin (sumamed-10 mg/kg; max-1 g/s), u clarithromycin (fromilid 7.5 mg/s kg; max 500 mg/s), u roxithromycin (rulid-5 -8 mg/kg; max-300 mg/s) 3. Macmiror -15 mg/kg, furazolidone-20 mg/kg, metronidazole -40 mg/kg 4 Omeprazole (losec-maps 1 mg/kg, rabeprazole 1 mg/kg) 29

CGD, PU Schemes of eradication therapy in children A. First-line therapy: triple therapy with H+K+-ATPase blockers: 1. Omeprazole (losec-maps), rabeprazole + clarithromycin (fromilid) / roxithromycin / azithromycin + amoxicillin 2. Omeprazole ( losec-maps), rabeprazole + roxithromycin / clarithromycin / azithromycin + makmiror / furazolidone 30

CGD, PU Schemes of eradication therapy in children B. Triple therapy with bismuth preparations: 1. Bismuth subcitrate + amoxicillin / clarithromycin / roxithromycin / azithromycin + makmiror / furazolidone 2. Bismuth subcitrate + clarithromycin (fromilid) / roxithromycin / azithromycin + amoxicillin B. Quad therapy : bismuth subcitrate + amoxicillin / roxithromycin / clarithromycin / azithromycin + makmiror / furazolidone + omeprazole (losec-maps) / ranitidine / rabeprazole 31

CGD, JB Clinical examination: CGD - 5 years? , PU – lifelong Frequency of observation: In the 1st year after an exacerbation - 4 times, from the 2nd year - 2 times a year Basic methods of dynamic control: clinic + EGDS (?) + detection of HP Anti-relapse treatment: 2 times a year, 3-4 weeks 32

Diseases of the hepatobiliary system Structure: - biliary dyskinesia - 92.2% - chronic cholecystitis, cholecystocholangitis, cholelithiasis - 6.6% - chronic hepatitis - 1.1% Anomalies of the gallbladder: anomalies in quantity - doubling, agenesis, position of the intrahepatic bladder, etc. . , forms of gastrointestinal tract, partitions, constrictions, kinks Diagnostic methods: Ultrasound (main) 35

Dyskinesia of the biliary tract D G H P - disturbance and discoordination of the tone of the sphincter apparatus and/or motility of the biliary tract and bile ducts and disruption of the passage of bile into the intestines Provoking factors - inadequate level of physical and psycho-emotional stress - food errors: especially fried and fatty foods food - diseases of the stomach, intestines, liver, etc. etc. 36

Dyskinesia of the biliary tract Classification D. G. V. P. 1. Hypertonic-hyperkinetic increased tone and motility G. V. P. 2. Hypotonic - hypokinetic form decreased tone and motility G. V. P. More often in children - hypertonic and mixed form D. J. V. P. 37

Biliary dyskinesia Clinic 1. Hypertensive form CH A R A C T E R I S T I C A B O L I u paroxysmal!!! u stabbing u connection with errors in diet u 30-40 minutes after eating cold food u physical activity: running, long walking u localization right hypochondrium u periumbilical region- younger age u short-term - 5 -15 min family predisposition!!! Season of exacerbation - autumn - spring 38

Biliary dyskinesia 2. Hypotonic form CHARACTERISTICS AND ACHING!!! u dull u connection with errors in diet u 1-1.5 hours after eating food - especially fatty food u negative emotions u localization - right hypochondrium family predisposition!!! Seasonality of exacerbation - not typical 39

Biliary dyskinesia Dyspeptic complaints: u loss of appetite u nausea u vomiting (less often) u intolerance to fatty foods, u bitterness in the mouth (sometimes a sign of GHD) u unstable stool Objectively: u asthenovegetative reactions u positive comments from Kehr, Ortner, Mussi, u moderate hepatomegaly (more than 70% of children) 40

Acute cholecystitis Predisposing conditions: stagnation of bile in the gastrointestinal tract. Characteristic signs: t 0 - pain and cramping in right half!!!, all over my stomach! intensified - on the right side; duration of pain attack - from several minutes to several hours - nausea, vomiting - jaundice (in 50% of cases) - symptoms of intoxication Objectively: bloating! , lag upper sections when breathing; rigidity of the abdominal wall muscles on the right. Positive comments from Mendel, Ortner, Murphy, often see Shchetkin - Bloomberg. CBC: leukocytes, ESR 41

Chronic cholecystitis is rare in children. Predisposing factors: anomalies of the gastrointestinal tract, dyscholia. factors Often accompanies cholelithiasis and D.B.R. Characteristic signs: - stereotypy, presence of periods, signs of exacerbations with severe intoxication, low-grade fever (possible) Syndromes: - pain (right hypochondrium); - dyspeptic; inflammatory-intoxication; - astheno-vegetative; cholestatic Pain and paroxysmal (characteristic during exacerbation), occur within 1.5-2 hours after an error in diet (fatty, fried foods), radiating (in right shoulder and spatula). Objectively: muscle resistance in the right hypochondrium!!!, objectively from Ortner, Murphy, Mendel; soreness in the s. Shoffara Laboratory tests: - globulin, fibrinogen, leukocyte studies, ESR; possibly transaminases, bilirubin, lipoproteins 42

Cholelithiasis- dystrophic-dismetabolic disease, with the formation of stones in the gall bladder or bile ducts Causes of cholelithiasis in children: - diseases occurring with hemolysis - familial hypercholesterolemia - hepatitis, inflammatory lesions of the biliary system - factors leading to the development of cholestasis - diabetes mellitus Pathogenesis: stagnation bile, dyscholia, inflammation Clinical picture: cholelithiasis has a latent course!!! Symptoms: cholecystitis, obstruction of the gastrointestinal tract. V. P. Symptoms Complications are rare! 43

The main methods for diagnosing DISEASES OF THE HEPATOBILLIARY SYSTEM: ultrasound using functional test with cholekinetics: neocholex, egg yolk, sorbitol: sphincter dysfunction, speed of bladder contraction Duodenal intubation (less physiological) Bile microscopy: detection of cholesterol and bilirubin crystals (signs of dyscholia) CHOLECYSTITIS: Ultrasound thickening (more than 2 mm), layering, hyperechogenicity of the gland wall. P., heterogeneity of bile Biochemical analysis of bile: - arachidonic and oleic acid, pentadecanoic and cuprous fatty ones; - concentrations of immunoglobulins G and A, R-proteins, C-reactive protein; enzymes (5-nucleotidase and alkaline phosphatase); - lysozyme of the cholelithiasis: ultrasound, x-ray cholecystography, CT, B/C analysis of bile to clarify the composition of stones 44

PRINCIPLES OF THERAPY FOR DISEASES OF THE HEPATOBILIARY SYSTEM Diet No. 5 according to Pevzner: meals 4-5 times, exclusion of fatty, fried foods, enrichment of the diet with fiber, vegetable oil. JVP Hypotonic hypokinetic form: 1. products choleretic action: creamy and vegetable oil, cream, sour cream, eggs, fruits, vegetables, black bread reflex stimulation motility of the gastrointestinal tract, intestines 2. choleretic – cholekinetics: sorbitol, xylitol, tubazhi 2-3 times per week 3. neurotropic – antidepressants: phenibut, melipramine 4. thermal procedures: exacerbation period 45

The principles of therapy of diseases of the hepatobiliary system hypertension - hyperkinetic form: 1. choleretic: - allochol, cholenzim, idle hollow, contain bile acids - vegetable origin, chegogue of chemical synthesis, oxaphinamide, cyclolon - hydrocholenetics - water -watering, chewing, corn, corn stigma, mineral water 2. Neurotropic drugs - tranquilizers: sibazon, nozepam 3. Antispasmodic drugs: papaverine, nosh-pa, odeston 4. Anticholinergics - belladonna, bellataminal, metacin 46

Principles of therapy (continued) Acute cholecystitis (exacerbation): regimen!!!, hunger, plenty of fluids, antibiotics, antispasmodics, analgesics, infusion therapy, antienzyme drugs. Surgical intervention: for complications Biliary colic: !!! relief of pain: orally 0.1% atropine (1/2 drop per year of life per dose) or belladonna extract (1 mg per year of life per dose), papaverine, no-spa, antispasmodic, theophylline or theobromine. If ineffective - IM baralgin or platyphylline, atropine sulfate, papaverine. For intractable colic - promedol or pantopon with atropine. Chronic cholecystitis: diet (in the acute period, mechanically sparing, with limited salt, fats and proteins), therapy with diarrhea; during an exacerbation - nicodine or oxafenamide, cyclone, furazolidone. Vitamin therapy (mandatory): in the acute period (vitamins A, C, B 1, B 2, PP; later - courses of vitamins B 6, B 12, B 15, B 5, E) GSD: principles of the above therapy + litholytic agents ( mainly for cholesterol gallstones) ursofalk (10 mg/kg), henofalk (15 mg/kg), lithopalk (7 mg/kg) in courses of 6-24 months. If ineffective - 47 cholecystectomy

child, 5 years old, acute cholecystitis. A significant, uneven thickening of the gallbladder wall, a dispersed component in the lumen, a perifocal zone of decreased echogenicity, corresponding to an edematous change in the peri-vesical tissues, are determined; 49

R. 13 l. , Gallbladder calculus (echo-dense inclusion in the lumen with a clear acoustic shadow) 50

PANCREATOPATHIES Dyspancreatism: reversible dysfunction without morphological changes PAIN: unstable, diffuse Localization: epigastrium, hypochondrium, points and area of ​​the pancreas Dyspeptic disorders: nausea, flatulence, belching Coprogram: normal Blood and urine amylase: variable Ultrasound: size of parts of the pancreas (m.b. Norm) EGDS: signs of duodenitis, papillitis 51

PANCREATOPATHIES Reactive pancreatitis: interstitial AP against the background of gastroduodenal or biliary diseases PAIN: intense, above the navel, irradiation to the left and to the back Pain: Chauffar's area, t.t. Kacha, Mayo Robson Dyspeptic disorders: nausea, vomiting, flatulence, short-term diarrhea!! Coprogram: normal or unstable steatorrhea Blood and urine amylase: Ultrasound: pancreas, unclear contours, echogenicity EGD: signs of duodenitis, papillitis 52

PANCREATOPATHIES Principles of therapy Exacerbation: Diet: Table No. 5 P according to Pevzner Drug therapy: u elimination of pain: antispasmodics - papaverine, no-shpa u decrease in the functional activity of the pancreas: antacids - almagel, maalox, phosphalugel, etc. u antisecretory agents: ranitidine, famotidine u proton pump inhibitors - omeprazole u replacement therapy: pancreatin, creon, pancitrate Remission: Diet. Min. water - weak 53 mineralization. Sanatorium-resort

Sonographic picture of a normal pancreas. 1 liver; 2 - head of the pancreas; 3 - body of the pancreas; 4 - Wirsung duct; 5 - tail of the pancreas; 6 - superior mesenteric artery; 7 inferior vena cava; 8 - aorta; 9 - splenic vein; 10 - gallbladder; 11 - spine. Oblique scanning in the epigastric region. 54

Sonographic picture chronic pancreatitis with pronounced fibrous tissue changes. The contours of the gland are uneven and clear. The echostructure of the tissue is diffusely heterogeneous, echogenicity and sound absorption are significantly increased. There is a weak acoustic shadow behind the gland. 55

IBD is a chronically ongoing, recurrent inflammation of the gastrointestinal tract, leading to an irreversible destructive process of its structure and function. Similarities - some pathogenetic mechanisms, common genetic mechanisms, common approaches to drug therapy. Differences - in localization of lesions, morphological changes in the intestine, clinical features 56

Classification of colitis According to the ICD X revision, chronic IBD includes u Crohn's disease [regional enteritis] (K 50) u Ulcerative colitis(non-specific) (K 51) Crohn's disease [regional enteritis] (K 50) u Crohn's disease of the small intestine (K 50. 0) u Crohn's disease of the large intestine (K 50. 1) u Other types of Crohn's disease (K 50. 8) 57

Inflammatory diseases intestines Predisposing factors 1) endogenous: u constitutional-genetic family predisposition, u food allergy, intolerance to cow's milk proteins, u identification of HLA types characteristic of autoimmune and systemic diseases (B 5, 7, 8, 21, CW 1) 2) exogenous u chronic stress u environmental u iatrogenic u infectious factors 58

Inflammatory bowel diseases (IBD) UC is a chronic, continuous (solid) purulent hemorrhagic, non-infectious inflammation of the colon, almost always starting in the rectum, with the development of local and systemic complications. The incidence of UC in children in Europe is 1.5 - 2 children per 100,000 population per year; in Great Britain, the incidence is 6.8 per 100,000 children per year n occurs in all age groups n the peak incidence is adolescence and young adulthood (up to 30% of patients become ill at the age of 10-19 years) Features of the course of UC in children: a tendency towards an increase in the incidence of onset of UC at an early age, an increase in the proportion of total forms of UC (total damage to the colon in 76%; left-sided - in 10% of patients; distal - in 14%); distal colitis that began in childhood, has a high degree of spread in the proximal direction, is difficult and late diagnosis UC, especially at 7-10 years of age (minimal symptoms of the clinical picture (lack of blood in the stool - the leading symptom of the disease) 59 retardation in growth and sexual development (only in children)

Inflammatory bowel diseases (IBD) Clinical picture Variants of onset of the disease: acute (not typical; development of the clinical picture within 1-3 days); gradual (characteristic; the main symptoms are blood and mucus in mushy or formed stools; develops over 1-3 months or several years) Course: 1. Acute (uncharacteristic; observed in 12% of patients, more often in children under 11-10 years) 2. Chronic (typical for all age groups; 88% of patients; has periods of exacerbation and remission) 2. 1. chronic recurrent (remission is achieved within 6 months after the first attack and lasts more than 4 months; in 36% of patients) 2 2. chronic continuous course (6 months after the first attack, remission does not occur and a progressive course is observed, 60

Inflammatory bowel diseases (IBD) Clinical picture Criteria for assessing the severity of UC: stool frequency, presence of blood in stool, endoscopic activity, extent of lesion, ESR, general state, including extraintestinal manifestations Classification of UC by activity: Mild course Severe course Stool frequency 4 10 Mild continuous bleeding No fever 38.8 Hemoglobin 100 g/l Moderate course 6 profuse 37.5 100 g/l 61

Inflammatory bowel diseases (IBD) Clinical picture of UC: Intestinal manifestations: Colitic syndrome - diarrhea with discharge of blood, mucus and/or pus, spontaneous spasmodic pain, often in the left lower quadrant abdomen (leading clinical manifestations), anal fissures, anal fistulas Extraintestinal manifestations: symptoms of intoxication (weakness, malaise, fever), weight loss, delayed sexual development, anemia, erythema nodosum, liver damage (sclerosing cholangitis), joints (arthralgia, ankylosing spondylitis), eyes (uveitis, iridocyclitis), thrombohemorrhagic syndrome In children, the most informative are: hemocolitis, weight loss and abdominal pain Complications of UC: intestinal (toxic dilatation of the colon, intestinal bleeding), infectious (sepsis, pneumonia, adnexitis, erysipelas, aphthous stomatitis, etc.) 62 Laboratory indicators: nonspecific signs activity

Inflammatory bowel diseases (IBD) Endoscopic classification of UC activity: 0 - degree of activity (remission) - pale SB, visible vessels 1st degree (mild act.) - erythema, slightly granular surface, weakening (loss) of the vascular pattern. 2nd degree (moderate act.) - single ulcers, velvety CO, contact and spontaneous bleeding. 3rd degree (high act.) ) - pus, spontaneous bleeding, multiple ulcerations The most informative EGD signs in children: contact bleeding of the mucous membrane from minimal to the symptom of “bloody dew”, absence of a vascular pattern, erosions or traces of small healed erosions Histological signs: - lymphoplasmacytic and eosinophilic 63 infiltration, and - violation of the architectonics of the crypts and - decrease

Inflammatory bowel diseases (IBD) Crohn's disease is a nonspecific chronic progressive disease characterized by transmural granulomatous inflammation various departments Gastrointestinal tract, clinically manifested by pain and diarrhea syndromes. The incidence rate of CD is 30 - 35 cases per 100,000 population. Peak of the disease - 15 - 35 years (can get sick at any age) Clinical picture of the onset / or exacerbation of CD: persistent increase in temperature to febrile levels, severe weakness, anorexia, loose stools Malabsorption syndrome (with small intestinal localization). With damage to the terminal sections ileum the absorption of vitamin B 12 and bile acids and the absorption of fats associated with bile acids are predominantly affected; absorption of zinc, vit. A, E 64

Inflammatory bowel diseases (IBD) Causes of diarrhea in CD: resorptive capacity of the inflamed intestinal mucus, insufficiency of its enzymatic activity, activity of pancreatic enzymes The severity of diarrhea depends on the prevalence and level of damage to the small intestine: the higher it is, the more severe the course of the disease Hemocolitis occurs in 40% of cases , usually in late stages, and does not depend on the localization of the process Pain syndrome (): at the beginning of the disease - local (irritation of the peritoneum due to excess gas formation), later diffuse - intense paroxysmal pain (caused by stasis of intestinal contents, complete or partial obstruction) CD in young children: fast development dehydration, muscle hypotension, tachycardia, arterial hypotension; Objectively: abdominal distension, dilated intestinal loops are palpable. As the process progresses, protein-free edema appears, fatty degeneration liver, nephropathy

Inflammatory bowel diseases (IBD) Extraintestinal manifestations u The most common: arthritis (reminiscent of RA clinic symmetrical joint damage and morning stiffness), arthralgia, erythema nodosum, pyoderma, aphthous stomatitis; u Possible: eye damage (iridocyclitis, uveitis, episcleritis), biliary tract (pericholangitis, cholestasis), reactive hepatitis, amyloidosis various organs Complications: Local - caused directly by inflammation of the mucous membrane: intestinal strictures (most common complication), perforation of intestinal ulcers in abdominal cavity(rare), fistulas (external, with an exit on the skin, and internal - opening into the loops of neighboring intestines and hollow organs), abscesses (peri-rectal), persistent anal fissures, toxic dilatation of the colon. Systemic - extraintestinal manifestations of CD 66

Inflammatory bowel diseases (IBD) Laboratory indicators: anemia, leukocytosis, reticulocytosis, increased ESR, hypoproteinemia, hypoalbuminemia, CRP, serum iron, magnesium, zinc Endoscopic picture: asymmetric transmural inflammation, deeper layers are more affected. The severity of the disease does not always correlate with endoscopic and histological features or laboratory data Crohn's Disease Activity Index - to assess disease activity and prescription adequate therapy 67

Inflammatory bowel diseases (IBD) Diet - excluding dairy products, limiting carbohydrates, enriched with proteins The main groups of drugs for the treatment of IBD in the acute phase: 1. Drugs that directly release 5-aminosalicylic acid (mesalazine), or drugs in which 5-aminosalicylic acid acid is formed during the breakdown of the active substance already in the intestines (sulfasalazine - for children in the first years of life!) 2. Topical (budesonide) or systemic corticosteroids (prednisolone) 3. Immunosuppressants (azathioprine, mercaptopurine) Antimicrobial drugs - for sanitation of the intestines from pathogenic and conditionally - pathogenic flora Enzyme deficiency: pancreatin, mezim forte, creon Debilitating diarrhea - imodium. Enteral nutrition (as indicated). Surgical treatment 68

cryptabscesses polyps UC. Ulcerative-polypoid stage On the inflamed, vulnerable mucous membrane there are many cryptabscesses and polypoid formations of various sizes and shapes, the so-called. , inflammatory polyps or “pseudopolyps”. 74

UC. Ulcerative-polypoid stage u a. Inflamed, ulcerated mucous membrane covered purulent exudate. u b. Outgrowths of the mucous membrane (inflammatory polyps or “pseudopolyposis”). 75

BK. Ulcerative stage. Deep linear ulcers located on the edematous mucous membrane in the form of a “cobblestone street” 76