Emergency treatment for diseases of the digestive system. Diagnosis of digestive diseases at home

GASTROINTESTINAL BLEEDINGS

Gastrointestinal bleeding– asymptomatic or clinically significant blood loss through the gastrointestinal tract with feces and/or vomiting.

Etiology.

The causes of gastrointestinal bleeding are numerous and varied (Table 18). According to the literature, 52% of bleedings are ulcerative; for tumors of various localizations – 15%, for erosive gastritis – 10%; with dilated veins of the esophagus – 5%; for diverticula – 2% and for other diseases – 16%.

Table 18.

The most common causes of gastrointestinal bleeding.

For determining therapeutic tactics it is important to clarify the ulcerative or non-ulcerative nature of the bleeding. Probability surgical treatment with ulcerative bleeding is higher, bleeding of other origins can often be stopped with conservative methods.

Indications for surgical treatment:

• ongoing massive bleeding from a large vessel in the center of the ulcer, identified during endoscopic examination;
• urgent surgery in 1-2 days if the patient has stopped as a result conservative treatment bleeding (during endoscopy there is no active bleeding, the ulcer is covered with a blood clot, the bleeding vessel is thrombosed) in order to prevent re-bleeding due to the instability of the condition.

Ulcerative gastrointestinal bleeding is the most common and serious complication of gastroduodenal ulcers. It develops in 15-20% of patients with peptic ulcer disease. There is a high mortality rate for this complication - up to 10% or more. The ratio of bleeding gastric and duodenal ulcers is 1:4. Ulcer bleeding is equally common in men and women.

Bleeding can be arterial, venous and capillary. The source of bleeding is small and large eroded vessels located in the area of ​​the bottom or edges of the acute or chronic ulcers. Bleeding can also be diffuse against the background of inflammatory and destructive changes in the wall of the organ and erosive or hemorrhagic gastroduodenitis accompanying the ulcer. Most often, bleeding develops from ulcers of the lesser curvature of the stomach and the posteromedial surface of the duodenum, which is associated with the characteristics of the blood supply in these areas.

The patient's response to blood loss is determined by its volume and speed, the resulting deficiency of fluid and electrolytes, the patient's age, and the presence of concomitant diseases.

With blood loss up to 50-100 ml, there is no clinical bleeding, and its signs can only be detected by laboratory methods (examination of feces for occult blood in the Gregersen reaction). Such bleeding is often chronic, but over a period of time it can lead to massive blood loss and anemia in patients. In this regard, they are an indication for planned surgical treatment.

Acute bleeding, which occurs with rapid blood loss of 500 ml or more, is accompanied by characteristic clinical manifestations: hematemesis - vomiting with contents the color of “coffee grounds” and melena - the release of unformed, tarry feces. It is especially necessary to highlight profuse bleeding, when up to 1 liter of blood enters the lumen of the gastrointestinal tract at once and a characteristic symptom complex develops: vomiting blood, melena and hemorrhagic shock.

The compensatory mechanism for blood loss of 500 ml is the rapid redistribution of blood and interstitial fluid. Systemic vasoconstriction leads to the mobilization of blood from blood depots - the spleen, liver, and the release of antidiuretic hormone and aldosterone restores intravascular volume due to the entry of interstitial fluid into the vascular bed. These changes are accompanied by a decrease in hemoglobin and hematocrit levels, hypoproteinemia, decreased cardiac output, tachycardia, and systolic pressure remains normal or even increased.

With blood loss of more than 1 liter of blood, compensatory mechanisms may fail due to a significant discrepancy between the BCC and the volume of the vascular bed. This leads to the development of hemorrhagic shock immediately after blood loss or several hours after it.

Classification.

An accurate assessment of the severity of blood loss is of great importance for determining treatment tactics. IN surgical practice The severity of bleeding can be conveniently assessed based on clinical data and the results of a blood volume study.

There are three degrees of blood loss (according to A.A. Shalimov):

I degree (easy)- observed with a loss of up to 20% of circulating blood volume (up to 1000 ml in a patient weighing 70 kg). The general condition is satisfactory or moderate, the skin is pale (vascular spasm), moist; pulse 90-100 per minute, blood pressure 100-90/60 mm. rt. Art., anxiety gives way to slight retardation, consciousness is clear, breathing is somewhat rapid, reflexes are reduced, muscles are relaxed. In the analysis, leukocytosis with a shift of the leukocyte formula to the left, oliguria. Without compensation for blood loss, no significant circulatory disorders are observed.

II degree ( moderate)– observed with a loss of 20 to 30% of circulating blood volume (from 1000 to 1500 ml in a patient weighing 70 kg). The general condition is of moderate severity, the patient is inhibited, speaks in a low voice, slowly, marked pallor of the skin, sticky sweat, pulse 120-130 per minute, weak filling, blood pressure 90-80/50 mm. rt. Art., rapid shallow breathing, severe oliguria. Without compensation for blood loss, the patient can survive, but significant disturbances in blood circulation, metabolism and function of the kidneys, liver, and intestines remain.

III degree (heavy)– observed with a loss of more than 30% of the circulating blood volume (from 1500 to 2500 ml in a patient weighing 70 kg). The general condition is severe or very severe, the motor reaction is depressed, the skin and mucous membranes are pale cyanotic or spotted (vasospasm is replaced by dilatation). The patient answers questions slowly, in a whisper, often loses consciousness, the pulse is threadlike, 130-140 per minute, periodically cannot be counted or palpated, the maximum systolic blood pressure is from 0-60 to 50 mm. rt. Art., central venous pressure is low, breathing is shallow, rare, limbs and body are cold to the touch, body temperature is reduced. Oliguria gives way to anuria. Replenishment of blood loss can lead to rapid recovery of hemodynamics (labile form). If rapid improvement does not occur, this indicates damage to vital parenchymal organs (torpid form). Hemorrhagic phenomena are often observed, indicating widespread intravascular thrombus formation; blood oxygen saturation and arteriovenous difference decrease, the general condition worsens, and intoxication symptoms increase.

Without timely compensation for blood loss, patients die due to the death of cells in a number of organs, primarily the liver, kidneys, severe metabolic disorders, and a decrease in cardiac activity. Blood loss of 50-60% of the circulating blood volume causes rapid death from cardiac arrest due to insufficient blood supply to the heart muscle.

Clinic.

The examination plan for a patient with ulcerative bleeding includes studying the anamnesis, complaints, conducting an objective examination, laboratory tests, and emergency FGDS.

A significant number of patients have a history of symptoms typical of a peptic ulcer: pain after eating or hunger pain, heartburn, nausea and vomiting, seasonality - exacerbations in the spring-autumn period. Bleeding often occurs against the background of an exacerbation of peptic ulcer disease, but it can develop without it, with a generally satisfactory condition.

Even before the classic signs of bleeding from an ulcer appear - vomiting coffee grounds and melena, patients begin to complain of weakness, dizziness, increased sweating, flashing spots before the eyes, tinnitus, nausea, thirst, palpitations, drowsiness. In case of severe blood loss, its first manifestation is loss of consciousness, which often develops while the patient is moving or during physical activity, for example, after defecation. The appearance of vomiting coffee grounds indicates the presence of a source of bleeding in the stomach, and melena indicates the localization of the ulcer in the duodenum or more distal parts of the intestine.

The results of an objective examination of a patient with ulcerative bleeding depend on the intensity and degree of blood loss. The general condition of the patient varies from satisfactory with minor blood loss to comatose with severe blood loss. Common signs bleeding is marked pallor of the skin and visible mucous membranes, dry tongue, frequent thread-like pulse. Blood pressure initially increases and then tends to progressively decrease. Central venous pressure also decreases.

When examined, the abdomen participates in the act of breathing, is not tense, and is almost always painless on palpation. The disappearance of pain when bleeding from an ulcer occurs due to alkalization of acidic gastric contents by blood is one of the characteristic signs of this complication. A rectal examination reveals stool that is tarry in color and consistency.

Target: provide information about clinical and additional research methods and their significance in gastroenterology, diagnosis of main clinical syndromes and emergency care.

Educational-target questions

1. Main diseases of the digestive system.

2. Characteristic complaints of patients, their semiotics.

3. Features of the medical history (morbi et vitae), risk factors.

4. Clinical topography of the abdomen.

5. Examination of the abdomen (rules, methods), results and their interpretation.

6. Percussion of the abdomen (physical basis, rules, methodology), results and their interpretation.

7. Palpation of the abdomen (physical basis, rules, methodology), results and their interpretation.

8. Auscultation of the abdomen (physical basis, rules and technique), results and their interpretation.

9. The importance of additional research methods, their gradation.

9.1. Laboratory methods: list, interpretation.

9.2. Functional methods: list, meaning of results.

9.3. X-ray methods: types, interpretation of the data obtained.

9.4. Endoscopic methods: types, interpretation of results.

9.5. Ultrasound methods.

9.6. Aggressive (invasive) methods.

9.7. Other methods (puncture abdominal cavity).

10. Plan for a rational examination of a patient with the most common diseases of the digestive system.

11. Basic clinical syndromes in gastroenterology:

11.1. Acute abdomen.

11.2. Gastrointestinal bleeding (hemorrhagic).

11.3. Impaired evacuation of contents from the stomach.

11.4. Hypersecretory.

11.5. Hyposecretory.

11.6. Irritable bowel.

11.7. Malabsorption (impaired digestion and absorption).

1. Digestive diseases are studied in the branch of internal medicine called gastroenterology. The main and widespread diseases of the digestive system are peptic ulcers of the stomach and duodenum, gastritis and colitis.

2. K main symptoms diseases of the digestive system should include pain in the abdomen and dyspeptic symptoms.

Pain ( dolor). To better understand the cause of pain, this symptom must be decomposed into a number of components (signs): localization, nature, irradiation, duration, frequency, connection with food intake, how it is relieved.

First of all, it is necessary to establish the exact localization of abdominal pain, which suggests a particular disease. For example, pain caused by pathology of the esophagus is localized behind the sternum or in the interscapular space and occurs during swallowing, often accompanied by dysphagia. Pain in the right hypochondrium is characteristic of diseases of the liver, gall bladder, head of the pancreas, duodenum (postbulbar section), hepatic angle of the transverse colon, right kidney, right dome of the diaphragm; pain in the left hypochondrium - for diseases of the stomach, tail of the pancreas, spleen, splenic angle of the transverse colon, left kidney, left dome of the diaphragm; pain in the epigastric region - for diseases of the esophagus, stomach, duodenum, pancreas (especially if its body is damaged), hernia of the white line of the abdomen, pathology of the diaphragm; pain in umbilical region observed with umbilical hernias, damage to the small intestine, mesenteric lymph nodes, abdominal aorta. Pain in the right lateral abdomen (flank) is more often associated with diseases of the ascending colon, the appendix (if it is high), the right kidney and ureter, and the gall bladder (if it is low); pain in the left flank - the left kidney and ureter, descending colon. Pain in the pubic area is observed with pathology of the genitourinary area (cystitis, prostatitis); in the right inguinal region - the cecum, terminal ileum, right ovary, with appendicitis, inguinal hernia; in the left groin area - sigmoid colon, left ovary, with an inguinal hernia. Pain in diseases of the rectum is often localized in the perineal area. With pathology of the pancreas, intercostal neuralgia, neurosyphilis, girdle pain is observed; at intestinal obstruction, rupture of parenchymal organs, extensive adhesions, flatulence - spilled. In diseases of the esophagus and cardia of the stomach, pain is usually localized in the area of ​​the xiphoid process.

Undoubtedly, the nature of pain has a certain diagnostic significance. A burning sensation is noted in cases of changes in the mucous membrane (the effect of secretions, food, medications, inflammation, erosion, etc.); pressure, distension, colic, pain - with irritation of the muscular elements of hollow organs; drilling (strictly localized constant pain) – when the pathological process spreads to the serosa. Pains of spastic origin are, as a rule, cramping in nature, while pain caused by stretching of hollow organs is often dull, pulling, aching. Intense (sharp, “dagger-like”) pain is a consequence of complicated peptic ulcer disease (perforation), rupture of internal organs, cancer metastases and its growth into other organs (unbearable pain).

Determining irradiation also has diagnostic value. Thus, pain in diseases of the esophagus is carried out in the interscapular space, the region of the heart, behind the sternum; in case of stomach diseases, irradiation of pain may be observed in the back and lower part of the interscapular space (ulcer of the posterior wall of the stomach and duodenum), in the right hypochondrium and scapula (ulcers of the antrum and duodenum), in left half chest and substernum (cardiac ulcers); in case of pathology of the left parts of the colon - to the sacral area.

The duration of pain reflects to a greater extent the type of lesion than the disease of a particular organ (pain during a spasm lasts seconds or minutes; when passing a stone - hours; during inflammation or an ulcer - days, months). Assessing the rhythm of pain, i.e. the occurrence and cessation of pain during the day, one can judge the functional activity of a particular organ:

Pain with a regular rhythm - colic (bilious, renal, intestinal); pain dependent on food intake: diseases of the esophagus (esophagitis, ulcer), stomach (peptic ulcer), intestines (enteritis, colitis);

Pain with an irregular rhythm is characteristic of functional disorders (irritable bowel syndrome).

Taking into account the frequency, there are several types of pain:

Paroxysmal – attacks of cholelithiasis, calculous pancreatitis (several hours or days);

Pain attack – repeated exacerbations of a chronic process during the year lasting several weeks or more (recurrent pancreatitis, ulcerative colitis);

Seasonal – relapses of the disease associated with a certain time of year (peptic ulcer);

Undulating – gradual onset of symptoms, the intensity of which is variable (functional disorders);

Constant – inherent in malignant neoplasms, chronic inflammatory processes ( painful form chronic pancreatitis);

Night – for duodenal ulcer.

Certain types of food excite or increase pain in many diseases of the digestive organs, as they are a natural stimulant of their functions. Therefore, it is important to assess the relationship between pain and food intake: the nature of the food that provokes pain (sharp, rough, fatty), its quantity, as well as diet. There are pains during eating, immediately after eating, early pain (30-60 minutes after eating), late (1.5-3 hours after eating), hungry (6-7 hours after eating) and night - equivalent to hunger pain (pain appears between 11 pm and 3 am).

Abdominal pain may also be associated with other factors: body position (with gastroptosis, pain intensifies in an upright position, with walking and physical activity, decreases in a lying position; with cardia insufficiency and hiatal hernia, pain intensifies when the torso is tilted forward and in horizontal position, and in a vertical position – decreases or passes; with cancer of the body of the pancreas, pain intensifies in a horizontal position and weakens when bending forward and in the knee-elbow position); the act of defecation (pain in diseases of the colon often intensifies before the act of defecation and decreases after bowel movement; with hemorrhoids and fissures in the anus, pain, on the contrary, usually occurs during the act of defecation, accompanied by tenesmus); sudden movements (with the development of adhesions, perigastritis and pericholecystitis, pain is provoked by shaking the body, movements, lifting heavy objects).

The way pain is relieved also has a certain diagnostic significance: with intestinal lesions, pain often disappears or decreases after defecation and the passage of gas; taking medications that affect pain is also important: spasmodic pain (hepatic, intestinal colic) disappears after using anticholinergic and antispasmodic drugs; peptic (burning) pain in patients with peptic ulcers and reflux esophagitis is relieved with antacid medications. It should be remembered that abdominal pain can be associated not only with diseases of the digestive system, but also with pathology of other organs of the abdominal cavity and retroperitoneal space, as well as the respiratory system (pneumonia, pleurisy) and circulatory system (myocardial infarction), abdominal wall (hernia) , peripheral nervous system and spine (neuritis, neuralgia, osteochondrosis), blood (porphyria, hemorrhagic vasculitis), with diffuse diseases connective tissue (periarteritis nodosa), endocrine ( diabetes) and muscular systems (myositis, myalgia), heavy metal poisoning, etc. The above indicates the need for careful detail and analysis pain syndrome in order to build the most accurate diagnostic hypothesis already at the questioning stage.

Pain in gastroenterological diseases can be accompanied by a variety of dyspeptic manifestations (dysphagia, heartburn, belching, nausea, vomiting, flatulence, loss of appetite, stool disorders). Dyspepsia is a term that includes most of the subjective manifestations of gastroenterological diseases caused by disturbances in the digestive processes.

Dysphagia. Organic or functional narrowing of the esophagus (dyskinesia, esophagitis, cancer, cicatricial stenosis, external compression by an aortic aneurysm, mediastinal tumor) may be accompanied by swallowing disorders. With angina, swallowing becomes painful, and in some cases (in case of cerebrovascular accident) - difficult or even completely impossible. Dysphagia may be constant or intermittent; find out what kind of food does not pass well through the esophagus (hard, soft, liquid). In case of cancer of the esophagus, cardial part of the stomach, cicatricial strictures of the esophagus, constant, usually progressive dysphagia is observed: first, the passage of solid food through the esophagus is difficult, then soft and liquid. Periodic (functional or paroxysmal) dysphagia is characteristic of patients with neuroses, dyskinesia of the esophagus, and often occurs with excitement; It is significant that liquid food passes through the esophagus worse than solid food.

Heartburn ( pyrosis) is associated with the reflux of gastric contents into the lower esophagus with a decrease in the tone of the lower esophageal sphincter (hiatal hernia, reflux esophagitis, gastritis, peptic ulcer, tumors of the esophagus, cardia, etc.), as well as with an increase in intragastric pressure (hypertonicity gatekeeper). The frequency of heartburn is determined (several times a day, episodically), the connection with taking certain food(sharp, rough, sour) or body position, duration - and those medications that take to relieve heartburn (usually antacids or food intake).

Belching ( eructatio) – release (throwing) of gases or pieces of food from the stomach into the oral cavity. Caused by contraction of the stomach muscles when the cardiac opening is open (with hiatal hernia, reflux esophagitis, dyskinetic insufficiency of the cardia). Belching with air is a consequence of aerophagia (with psychoneuroses); belching with the smell of rotten eggs is observed with pyloric stenosis; sour belching may appear during attacks of pain due to peptic ulcer; Bitter belching occurs when bile refluxes into the stomach from the duodenum.

Nausea ( nausea) occurs when the vomiting center of the medulla oblongata (central) or the vagus nerve (reflex nausea) is irritated, which determines the variety of its causes (damage to the central nervous system, intoxication, medications, reflex effects in diseases of the stomach, biliary tract, liver and other digestive organs, urinary system, etc.). Stomach nausea (its most common variant) appears after eating and often depends on the quality of food (fats, alcohol, etc.). If nausea is present, the time of its onset is recorded (on an empty stomach, after eating
etc.), duration (short-term, permanent), severity, what medications are used to relieve the specified complaint.

Vomit ( vomitus) is a dyspeptic manifestation, the act of involuntary release of the contents of the stomach or intestines through the esophagus and pharynx into the oral cavity and nasal passages. The reasons are the same as for nausea. Signs of diagnostic value include:

Time of appearance – on an empty stomach in diseases with portal hypertension; immediately or soon after eating - for acute gastritis, ulcers and cancer of the heart; 1-3 hours after eating - in patients with chronic gastritis type B, with antral and duodenal ulcers; at the end of the day – in case of disturbances in gastric evacuation (pyloric stenosis);

The smell of vomit - rancid oil (increased formation of fatty acids due to fermentation during hypo- and achlorhydria); rotten, putrefactive - in cases of decaying tumor or stagnation of food in the stomach; ammonia or urine-like odor – in patients with chronic renal failure; fecal – for gastrointestinal fistulas and intestinal obstruction;

Impurities in the vomit - mucus (gastritis), pus (gastric phlegmon), bile due to duodenogastric reflux with pyloric insufficiency (ulcer, antral cancer, chronic duodenal obstruction), streaks of blood - with strong repeated vomiting movements; abundant admixture and release of pure blood - with ulcers, cancer and other lesions of the stomach and esophagus. Bloody vomiting is usually accompanied by the appearance of tarry stools;

Preceding nausea - its dependence on the food taken in time and nature, duration, frequency, intensity, connection with pain.

Depending on the location, bleeding is divided into esophageal, gastric, intestinal and hemorrhoidal. Esophageal or gastric bleeding often manifests as bloody vomiting. In patients with a disintegrating tumor of the esophagus, an admixture of unchanged blood is noted in the vomit. When bleeding from varicose veins of the esophagus, the blood in the vomit takes on a dark cherry color. The color of “coffee grounds” is acquired by vomit in patients with gastric bleeding (with preserved production of hydrochloric acid, hydrochloric acid hematin is formed); in the absence of hydrochloric acid in the gastric juice, an admixture of unchanged blood may be present in the vomit. With profuse gastric bleeding, unchanged scarlet blood will be present in the vomit even with preserved gastric secretion.

Flatulence, or bloating, is a consequence of increased gas formation in the intestines due to dysbiosis; enzyme deficiency; excessive swallowing of gas and impaired absorption of gas by the intestinal wall; colonic obstruction (local flatulence, accompanied by difficult passage of gases). It is estimated that even digesting lunch produces about 15 liters of gas; Most of this gas is normally resorbed by the intestinal wall, and about 2 liters is excreted. If absorption is impaired, a significant amount of gas accumulates in the intestines, which leads to flatulence.

Appetite disturbances are a consequence not only of gastroenterological diseases, but also of infectious, mental and endocrine diseases, and vitamin deficiencies. There is a decrease in appetite (stomach and pancreatic cancer); cytophobia– refusal to eat for fear of provoking pain due to gastric ulcer with cardiac localization; anorexia – a complete lack of appetite with signs of aversion to certain foods (for example, meat), observed in the early stages of stomach cancer; increased appetite (up to the degree of “ravenous hunger”) – typical for patients with diabetes mellitus (polyphagia), peptic ulcer disease (we are talking not so much about a true increase in appetite, but about the need to eat frequently due to the presence of late and hunger pains) . During pregnancy, patients with Achilles gastritis experience a perversion of appetite (the desire to eat inedible substances). In addition, the nature of taste sensations requires clarification. In particular, dryness or an unpleasant taste in the mouth (“metallic”) is often detected in patients with chronic gastritis, bitterness in the mouth – when bile is thrown into the stomach, and a sour taste in the mouth – with gastroesophageal reflux. Increased salivation is observed with cicatricial strictures of the esophagus, cancer of the esophagus and the cardia of the stomach. It is necessary to explain whether food is chewed well and whether the patient does not experience pain when chewing - this is important in a number of dental diseases, lack of teeth, which may be one of the causes of diseases of the digestive system.

Stool disorders (diarrhea, constipation, unstable stool). Accelerated bowel movement with the release of liquid and mushy feces (diarrhea, or diarrhea), as a rule, is associated with damage to the small intestine (enteral) or large intestine (colitic). Enteral diarrhea is no different high frequency(2-3 times a day); significant volume of feces; the presence of signs of insufficient digestion and absorption of proteins, fats and carbohydrates.

If protein digestion is impaired, dark-colored stools appear, alkaline, with putrid smell containing pieces undigested food(putrefactive dyspepsia), and when the digestion and absorption of carbohydrates in the intestine is impaired, fermentative microflora is activated, which causes the appearance of foamy, mushy feces with an acidic reaction (fermentative dyspepsia). Colitic diarrhea is characterized by high frequency (up to 10 or more times a day), a small amount of feces mixed with mucus and blood.

Constipation – delay in bowel movement for up to 48 hours or more, with breaks between bowel movements often lasting 5-7 days; The consistency of stool is hard, its excretion is difficult, often in the form of small “nuts” (the so-called “sheep feces”). They are caused by a slowdown in intestinal motility, mechanical obstacles in it and nutritional factors. There are spastic, atonic and organic constipation. Spastic constipation occurs due to spasm of the smooth muscles of the intestinal wall: colitis, irritable bowel syndrome; viscero-visceral reflexes in peptic ulcers, cholecystitis, etc.; diseases of the rectum - hemorrhoids, anal fissures, proctitis; mercury and lead poisoning; psychogenic factors. Atonic - associated with a decrease in the tone of the intestinal muscles: poor nutrition, dry eating, intake of easily digestible food poor in plant fiber, improper nutritional rhythm - alimentary constipation; decreased tone of the colon wall in elderly people and weakened patients, sedentary individuals; violations nervous regulation motor function of the intestine and the act of defecation in patients with organic diseases of the central nervous system - strokes, tumors and brain injuries, meningitis; abuse of laxatives, antacids, sedatives, tranquilizers, anticholinergics, etc. Organic constipation is caused by a mechanical obstacle to the movement of feces through the intestines: intestinal tumors, scars, adhesions, megacolon, dolichosigma, etc., are accompanied by attacks of spastic pain with a specific localization.

It is important to remember that defeats small intestine(enteritis) are most often accompanied by diarrhea, and the large intestine (colitis) – by constipation. Detection of blood in the stool is regarded as an alarming symptom. The appearance of black, tarry stools indicates the localization of bleeding in the small intestine; unchanged blood, evenly mixed with feces and mucus, is usually associated with damage to the colon, especially its left parts.

3. B medical history clarify the first signs of the disease, the cause of the disease (diet violation, alcohol abuse, stress, etc.), the nature of the disease (seasonality of exacerbations in spring and autumn in patients with peptic ulcers, changes in the nature of pain when the ulcer transforms into cancer, bleeding or penetration), dynamics body weight (weight loss with pancreatitis, malignant tumors of the gastrointestinal tract), previous studies and their results (anemia is often the first manifestation of malignant tumors), treatment and its effectiveness.

IN life history first of all you should ask past diseases gastrointestinal tract and operations on the organs of the digestive and hepatobiliary systems, diseases of other organs, since medications taken often have an adverse effect on the mucous membrane of the gastrointestinal tract (anti-inflammatory, hormonal, analgesic, antibacterial, anti-tuberculosis); psychological situation at work and at home (peptic ulcer, irritable bowel syndrome); occupational hazards (intoxication with industrial poisons, pesticides, herbicides, nitrates); physical activity (hypokinesia can cause atonic constipation); nutrition of the patient with early childhood and to the present (regularity of meals, variety and nutritiousness of the diet, features of culinary processing of food, food preferences, nature of chewing food); indications of a hereditary predisposition to diseases of the digestive system, as well as oncological conditions; bad habits (alcohol abuse, smoking); allergic reactions, nature of nutrition and food tolerance; blood group – I (0) for peptic ulcer disease.

4. Clinical topography of the abdomen. To localize pathological changes, in particular, pain, and the projection of the boundaries of the internal organs onto the anterior abdominal wall, the paramedic must use common landmarks and know the clinical topography of the abdomen. Topographic lines and the areas they form are determined by the natural identifying elements of the human body. These identification points are horizontal and vertical lines. Horizontal lines (bicostal, or l. bicostalis, connecting the lower ends of the costal arches, and biiliac l. biiliaca, connecting the upper anterior iliac spines) divide the anterior abdominal wall into 3 floors: epigastric, mesogastric, hypogastric. Two vertical lines running along the outer edges of the rectus abdominis muscles divide the surface of the abdomen into 9 regions: epigastric - regio epigastrica- the upper middle part of the anterior abdominal surface, limited from above by converging to xiphoid process costal arches; subcostal areas - regio hypochondrica dex. et sin. – bordering the epigastric on the right and left; mesogastric, or umbilical - regio mesogastrica– located in the middle part of the abdomen, around the navel; lateral areas of the abdomen - regio abdomialis dex. et sin. – abdominal areas to the right and left of the umbilical region; suprapubic – regio suprapubica– lower middle part abdomen, limited below by the pubic joint; iliac regions - regio iliaca dex. et sin. – to the right and left of the suprapubic region.

5. Objective examination of the digestive organs includes examination of the oral cavity, pharynx, examination of the abdominal organs: inspection, percussion, palpation and auscultation of the abdomen.

During a general examination of a patient with gastrointestinal pathology, one can detect: impaired consciousness; features of the constitutional type (in persons with an asthenic physique - peptic ulcer); forced position (with a perforated ulcer on the back with legs brought to the stomach, on the stomach - with pancreatic cancer); a characteristic facial expression, for example, “the face of Hippocrates” - a pale gray face with pointed features, a pained expression, drops of cold sweat - in patients with acute severe diseases of the abdominal organs, peritonitis; changes in the skin, nails, hair - (pallor during bleeding, dryness, peeling, cracks in the corners of the mouth, brittle hair, nails - with impaired absorption of vitamins and microelements; weight loss up to cachexia - with advanced pyloric stenosis, neoplasms; enlarged lymph nodes (“Virchow’s gland”) – for stomach cancer.

An examination of the oral cavity includes an assessment of the odor in the air exhaled from the mouth: bad breath can be caused by various diseases of the teeth, gums, tonsils, and oral mucosa; putrid odor from the mouth can be observed during the disintegration of a malignant tumor of the esophagus and stomach; condition of the mucous membrane of the inner surface of the lips, cheeks, hard and soft palate(color, humidity, presence of any rashes, aphthae, leukoplakia); teeth (missing and carious teeth can lead to functional and inflammatory diseases of the stomach and intestines); gum conditions (bleeding, gingivitis); tongue (shape, size, color, moisture, severity of filiform and mushroom-shaped papillae, the presence of imprints, cracks, ulcerations, plaques): a bright red tongue with a smooth shiny surface due to atrophy of the taste buds is called “varnished” and is observed in stomach cancer, some vitamin deficiencies; dry tongue with peritonitis; pharynx (color, smoothness of contours, presence of plaque); tonsils (size, surface, presence of purulent contents); Normally, in adults, the tonsils do not protrude beyond the palatine arches; posterior wall of the pharynx (color, surface, moisture).

Examination of the abdomen, as a rule, is carried out in horizontal and vertical positions, paying attention to the shape of the abdomen, which to a certain extent depends on the patient’s physique; protrusion of the abdomen can be general (symmetrical) and local (asymmetrical), the former occurs with obesity, flatulence, ascites, pregnancy, the latter is observed with an enlargement of some abdominal organs (liver, spleen), large cysts(pancreas, ovary), tumors, intestinal obstruction; reduction (retraction) of the abdomen, as a pathological phenomenon, is recorded less frequently, and for the most part it accompanies general emaciation in various serious diseases (malignant neoplasms) and diarrhea (debilitating). In persons with poor muscle development abdominals, especially with splanchnoptosis, the abdomen becomes saggy. With ascites, along with an enlarged abdomen, protrusion of the navel and expansion of the saphenous veins on the abdominal wall are often observed; a change in the shape of the abdomen is characteristic when the patient changes position: flattening of the peri-umbilical region, protrusion of the flanks in a horizontal position and drooping of the abdomen in a vertical position. The abdominal circumference is measured at the level of the navel (in dynamics it allows one to evaluate the effectiveness of diuretic therapy in patients with ascites); skin of the abdomen (coloring, presence of rashes, postoperative scars, stretch marks, condition of the venous network); purple-pink stripes are observed with Cushing's syndrome, dilatation of the saphenous veins - with cirrhosis of the liver or obstruction of the inferior vena cava; visible peristalsis associated with increased gastric peristalsis - in patients with pyloric stenosis, with intestinal obstruction; pulsation in the epigastric region - with an aortic aneurysm or increased pulse pressure; participation of the abdominal wall muscles in the act of breathing (complete lack of respiratory mobility of the entire abdomen during peritonitis).

6. Percussion of the abdomen pursues two goals: 1) to identify areas of dull percussion sound due to the presence of fluid in the abdominal cavity, tumors, accumulation of feces and 2) to determine the boundaries of the stomach. Due to the predominance of gases in the digestive tract, a tympanic sound is noted over most of the surface of the abdominal wall, usually lower over the stomach and higher over the intestines. With flatulence, the percussion sound becomes louder, and when fluid accumulates in the abdominal cavity, a dull sound appears. The causes of dullness of percussion sound may be the uterus during pregnancy, tumor of the intestine, ovary, full bladder, enlarged liver, spleen. Shortening of the percussion sound in the lateral abdomen requires further investigation for the presence of ascites.

7. Palpation of the abdomen– the most informative physical research method that allows you to study the position and physical properties of the abdominal organs and the anterior abdominal wall. For effective palpation, a number of rules must be followed. First, the patient must take comfortable position– on the back with a low headboard and legs slightly bent at the knees, the patient’s arms should be extended along the body or folded on the chest, breathing should be even and shallow. Secondly, the position of the doctor is important: he should be positioned to the right of the patient so that the seat of the chair is approximately at the same level as the bed; The doctor's hands must be warm. And finally, before starting palpation, it is necessary to ask the patient to indicate the location of the pain, since the site of pain is palpated last.

There are two types of palpation: superficial indicative and methodical deep sliding according to Obraztsov-Strazhesko. Superficial indicative palpation of the abdomen allows you to assess the presence of pain, tension in the muscles of the anterior abdominal wall, discrepancy of the rectus abdominis muscles, hernial formations (linea alba and umbilical ring, inguinal, postoperative hernias), determine a significant increase in abdominal organs, superficially located tumors and cysts large sizes. Deep sliding palpation of the abdominal organs according to Obraztsov-Strazhesko is the most important way to study the abdominal organs and physical properties (localization, position, shape, size, nature of the surface, pain, presence of pathological formations). This type of palpation is called deep, because during it the hand penetrates deep into the abdominal cavity; sliding – since various properties of palpated organs are assessed by sliding palpating fingers over their surface; and methodological, since it is carried out according to a set plan and in a certain sequence, which reflects the increasing difficulty of the study. Most often, the procedure proposed by N.D. is used. Strazhesko: sigmoid colon(palpable in 90-95% of healthy people), cecum (in 80-85%) and appendix, terminal part of the ileum (in 80-85%), ascending and descending colon (in 70-80%), transverse colon(in 60-70%), greater curvature of the stomach (in 50-60%), the pylorus of the stomach (in 20-25%), liver (in 88%) and then organs that are usually not palpable in healthy people - the gallbladder, spleen, pancreas and kidneys.

8. Auscultation of the abdomen allows you to evaluate motor function intestines (the absence of peristaltic noise may be a sign of intestinal paresis during peritonitis, a sharp increase in peristalsis appears with mechanical intestinal obstruction, loud rumbling - with narrowing of the intestine, inflammatory processes, diarrhea); identify peritoneal friction noise during peritonitis; systolic murmur with stenosis of the aorta, renal artery; determine the lower border of the stomach.

9. Additional methods for studying patients with diseases of the gastrointestinal tract. Additional examination is carried out in cases where there is not enough questioning and physical examination data to make a diagnosis. Additional examination should always be rational, comprehensive and systematic, meeting the principles: from simple to complex, with a minimum of costs - maximum information. It is important to know and remember: the risk of additional examination should not exceed the risk of the disease itself.

9.1. TO laboratory methods studies in gastroenterology include: scatological examination, stool analysis for occult blood, bacteriological examination of stool (to identify intestinal dysbiosis). Chemical examination of stool is essential to detect hidden gastric bleeding. For this purpose, tests based on the peroxidase action of hemoglobin are used: with benzidine (Gregersen reaction), pyramidon, guaiac resin (Weber reaction). The most sensitive is the benzidine test (detects 0.2% of blood), and the least sensitive is the reaction with guaiac resin (5% of blood). The Gregersen test is so sensitive that it can be positive when eating meat products, fish, and green plants (especially if the secretory function of the stomach is reduced). These foods should be excluded from the patient’s diet three days before the study (and for constipation - 7-8 days). In addition, it is necessary to exclude foods containing iron from the patient’s diet, and not to perform dental procedures 3 days before the study.

9.2. TO functional methods studies include the study of gastric secretion, duodenal intubation, balloon-kymographic method, electrogastrography. The study of gastric secretion is important not so much for diagnosing the disease as for identifying functional disorders of the stomach. The study of gastric secretion can be divided into two groups: probe methods - one-step method - extraction of gastric contents with a thick probe; fractional method - extraction of gastric contents with a thin probe; probeless – ion exchange methods, gastroacid tests, radiotelemetry method, determination of uropepsin.

Probe research methods. The one-step method gives only an approximate idea of ​​the functional state of the stomach and has now practically lost its significance. Fractional study of gastric contents allows you to obtain pure gastric juice and study gastric digestion in dynamics, evaluate the function of the stomach on an empty stomach, the secretory, partly evacuation, and acid-forming function of the stomach. Probeless methods are used in cases where sounding is contraindicated or undesirable (heart defects, hypertension, coronary heart disease, circulatory failure, cirrhosis of the liver with esophageal varices, mental illness, childhood and old age patients). Assessment of the acid-forming function of the stomach using gastrotest, acidotest, gastroglaze and similar drugs is based on the ability of hydrochloric acid to split off the dye contained in it from the ingested substance, which is excreted in the urine. The color intensity is compared with a standard scale, and ion exchange resins are also used, combined with quinine or azure II, which are replaced by hydrogen ions and excreted in the urine. The amount of secreted substance correlates with the level of acidity of gastric juice. The accuracy of probeless methods is low. They give only an approximate (qualitative) idea of ​​acid formation in the stomach. The study of gastric secretion makes it possible to distinguish its functional inhibition from organic secretory insufficiency, manifested by hypo- and achlorhydria. Functional disorders secretions are characterized by temporary inhibition of acid formation while the glandular apparatus of the stomach is preserved (nervous-psychic stress, acute intoxication, etc.), and organic hypo- and achlorhydria are caused by varying degrees of atrophy of the gastric glands ( chronic gastritis type A, stomach cancer, atrophic gastritis with diabetes, hypothyroidism). The study of the motor function of the stomach is carried out using the balloon-kymographic method and using electrogastrography. The state of motor function is characterized by the rhythm, amplitude of gastric contractions, the number of peristaltic waves per unit of time and their grouping on a gastrokymogram or the frequency and amplitude of electrogastrogram potentials.

9.3. X-ray methods studies allow us to most fully study the pathology of the gastrointestinal tract. X-ray examination of the stomach is currently carried out mainly using two main techniques: standard and double contrast. Advantages of the method compared to endoscopy:
V better diagnostics complications of stomach and duodenal ulcers (stenosis, penetration, perforation), peri-processes, diseases of neighboring organs, functional state of the stomach (tone, peristalsis, emptying). X-ray examination becomes the main thing in conditions where gastroscopy is impossible (severe stenosis, deformations of the esophagus and stomach, concomitant diseases). It has no contraindications and provides accurate information about the relationship with neighboring organs, anatomical structure, state of tone and peristalsis. To determine a hiatal hernia, cardia insufficiency, prolapse of the gastric mucosa into the esophagus, esophagospasm, it is necessary X-ray examination the patient not only in a vertical, but also in a horizontal position.

Computed tomography is indicated to determine the shape and size, structural changes of the pancreas. It is of paramount importance for the diagnosis of focal lesions of the gland (tumors, cysts). Angiography, depending on the method of administration of the contrast agent, is divided into celiacography and mesentericography (selective contrasting of the branches of the celiac or superior mesenteric arteries). The advantages of this method are the diagnosis of small cysts, tumors and hormonally active neoplasms characterized by hypervascularity (gastrinoma, VIPoma).

Complete information about the condition of the colon is provided by an x-ray method called irrigography, or irrigoscopy (from the Latin irrigatio - irrigation, washing, Greek skoreo - examining), in which a barium suspension is introduced into the large intestine through the anus using an enema (200 g of barium and 10 g of tannin per 1 liter of water). The method makes it possible to detect segmental and diffuse lesions of the colon: changes in motility, contours and relief of the mucous membrane - disturbances in tone, haustral segmentation, bulging of the intestinal wall, filling defects.

9.4. Endoscopic method research of hollow organs and cavities of the human body today is one of the main highly informative methods diagnostics The endoscopic method is most widely used in gastroenterology. It allows you to diagnose various diseases of the digestive system, conduct targeted biopsies of various parts of the gastrointestinal tract, identify the source of hematemesis, determine the prevalence of the pathological process and the degree of its severity. This method is not limited to diagnostic capabilities; it allows for various endoscopic operations, such as polypectomy, papillotomy, removal of foreign bodies, stopping bleeding, sclerosis of dilated veins of the esophagus. Advantages over x-ray examination methods: diagnosing small, flat, focal lesions; conducting targeted and stepwise biopsies, various endoscopic operations (polypectomy, papillotomy, removal of foreign bodies, stopping bleeding, sclerosis of dilated veins of the esophagus, etc.); opportunity to avoid X-ray exposure both the patient and the medical worker participating in the study. Targeted biopsy in cases that are difficult to diagnose should be multiple (up to 5-7 pieces) and repeated. Fibroesophagogastroduodenoscopy (FEGDS) is an endoscopic method for examining the upper parts of the digestive tract: esophagus, stomach, duodenum. Absolute contraindications: stroke, myocardial infarction, aortic aneurysm, decompensated heart defects, bronchial asthma, hemophilia, deformation of the cervical and thoracic spine, mental illness. Relative contraindications: acute respiratory viral diseases, tracheobronchitis, acute diseases of the esophagus and stomach with sharp pain and frequent vomiting; varicose veins of the esophagus preclude the use of devices with lateral optics for esophagoscopy. The possibilities of the endoscopic method of examining the stomach are not limited only to visual inspection of its cavity and taking biopsies; there are a number of additional methods that are used together with endoscopy: chromogastroscopy, transendoscopic pH-metry. Chromogastroscopy is a method for studying the structure and function of the stomach, based on the introduction of various dyes into the stomach that can stain a particular tissue. The technique is used to identify foci of intestinal metaplasia and cancer cells, and to determine the boundaries of the acid-forming zone. Using transendoscopic pH-metry, it is possible to establish pH in various parts of the gastric mucosa, which in some cases allows one to avoid the cumbersome method of fractional study of gastric secretion and obtain sufficient information about the patient in one study.

Sigmoidoscopy is a simple, accessible method endoscopic diagnostics pathological changes in the distal colon. Using sigmoidoscopy, you can detect tumors, inflammatory processes, ulcerations, atrophy of the mucous membrane, hemorrhoids, foreign bodies, conduct a targeted biopsy with subsequent histological examination of biopsy samples, and perform therapeutic manipulations. Colonoscopy is an endoscopic method for examining the colon using flexible endoscopes with fiber optics.

9.5. Ultrasound methods research. Ultrasound is a modern method, highly informative, accessible, simple and harmless, and therefore has virtually no contraindications. It is inferior in terms of information content to computed tomography, but is less complex, more accessible, not burdensome and harmless to the patient. Ultrasound allows visualization of inflammatory and volumetric formations abdominal cavity.

9.6. Morphological methods research. Histological examination of biopsy samples of the gastrointestinal mucosa is necessary to distinguish between benign and malignant ulcers and tumors, identify precancerous changes and early cancer (tumors within the mucosa), the morphological variant of the neoplasm, chronic gastritis, and diagnosis of Helicobacter pylori. The frequency of Helicobacter pylori infection in patients with gastric ulcers is 50-70%, and in patients with duodenal ulcers – 80-100%. Cytological examination is an effective way to diagnose esophageal tumors (75-95% positive results). Material for research is obtained by washing (exfoliative method) or scraping (abrasive method) from the affected or suspicious area of ​​the esophageal mucosa.

9.7. Abdominal puncture carried out for diagnostic and therapeutic purposes.

10. Plan for a rational examination of a patient with the most common diseases of the digestive system

Laboratory methods: blood group and Rh factor, blood electrolytes, serum iron, proteinogram, lipidogram, scatological examination, stool tests for dysbacteriosis and occult blood.

Functional methods: study of gastric secretion, balloon-kymographic study of gastric motor function.

X-ray methods: radiography of the stomach, irrigography.

Endoscopic: FEGDS with targeted biopsy, colonoscopy, sigmoidoscopy, laparoscopy.

Ultrasound methods – ultrasound of the abdominal organs.

Other methods (abdominal puncture).

11. Main clinical syndromes in gastroenterology – « acute stomach", gastrointestinal bleeding, hypersecretory, hyposecretory syndromes, disturbances in the evacuation of contents from the stomach, irritable bowel, malabsorption.

11.1. Acute abdomen syndrome develops as a result of acute diseases or injuries of the abdominal organs, which require or may require emergency surgical care. There are 5 large groups of diseases that can manifest as “acute abdomen” syndrome:

Acute inflammatory diseases of the abdominal and pelvic organs without perforation of a hollow organ: acute appendicitis, cholecystitis, pancreatitis, cholangitis, intestinal infarction, acute salpingo-oophoritis, etc.;

Acute inflammatory diseases of the abdominal organs with perforation of a hollow organ: acute perforated appendicitis, cholecystitis, perforated gastroduodenal ulcer, perforation of a tumor of the gastrointestinal tract, etc.;

Diseases of the abdominal organs that cause obstruction: adhesive and tumor intestinal obstruction, strangulated hernias, intussusception, etc.;

Internal bleeding into the abdominal cavity;

Abdominal injuries.

Acute surgical diseases of the abdominal organs must be differentiated from pseudo-abdominal syndrome and non-surgical pathology, accompanied by the clinical picture of an “acute abdomen”. The causes of pseudoabdominal syndrome can be: acute infections (influenza, mumps, infectious mononucleosis, brucellosis, scarlet fever); neurological diseases(radiculitis, tabes dorsalis, tetanus); metabolic disorders (diabetes mellitus, uremia, hypercalcemia, hypokalemia); blood diseases and a number of other pathological conditions.

Complaints of abdominal pain, nausea, vomiting, flatulence, stool retention; in the anamnesis it is necessary to clarify the possible cause (diseases of the gastrointestinal, hepatobiliary, urinary systems, blood, gynecological diseases), pay attention to the suddenness of the onset of symptoms and the rate of progression; on examination - “Hippocratic face”, dry tongue, absence or limitation of excursion of the abdominal wall during breathing; percussion of the abdomen reveals the disappearance of hepatic dullness due to perforation of a hollow organ and high tympanitis due to obstruction; upon palpation - tension in the abdominal muscles ( defense muscles), positive Shchetkin–Blumberg symptom; during auscultation - increased peristaltic sounds, splashing noise in case of intestinal obstruction, absence of peristaltic sounds - in case of intestinal paresis in the case of peritonitis, thrombosis of mesenteric vessels; digital examination of the rectum - it is possible to detect narrowings, intussusceptions, blood, pus, mucus; inflammatory infiltrates or tumors located in the lower abdominal cavity.

Additional research methods: laboratory methods (determining the levels of sugar, urea, amylase and trypsin in the blood, urine diastase, electrolytes, acid-base status, volume of circulating blood and plasma, blood clotting, hematocrit allows you to objectively assess the severity of pathological changes in the body and determine the degree of anemia , inflammation, metabolic and water and electrolyte disturbances); X-ray (detect the presence of perforation of a hollow organ, fluid with peritonitis or bleeding, fluid levels with pneumatosis intestinalis (Kloiber cups) with intestinal obstruction); computed x-ray tomography and magnetic resonance imaging are used whenever possible; Ultrasound will allow you to study the structures and their changes in the anterior abdominal wall, in the abdominal cavity, retroperitoneal space, identify pathological formations (infiltrates, ulcers, tumors), signs of intestinal obstruction, inflammatory changes in the organs of the pancreaticobiliary zone, pelvis, kidneys, pathology large vessels; FEGDS is used in the diagnosis of covered perforations of gastroduodenal ulcers; sigmoidoscopy and colonoscopy are prescribed to diagnose some forms of intestinal obstruction.

The paramedic’s tactics are an ice pack on the abdominal area, if possible, without the use of analgesics and narcotic drugs; immediate hospitalization in a surgical hospital, and in case of threat of development state of shock– relief (reduction) of pain and hospitalization.

11.2. Gastrointestinal bleeding syndrome– a pathological condition that is a serious complication of many diseases, requiring urgent diagnostic and therapeutic measures.

The causes are peptic ulcer, benign and malignant tumors, acute erosions and ulcers of the esophagus, stomach and duodenum, including those caused by taking non-steroidal anti-inflammatory drugs, varicose veins of the esophagus and cardia of the stomach, Mallory-Weiss syndrome (narrow linear tears of the gastric mucosa in the cardia), nonspecific ulcerative colitis, Crohn's disease, specific lesions of the digestive tract (tuberculosis, syphilis), vascular lesions (angiodysplasia), disorders of the blood coagulation system (Werlhof's disease, polycythemia vera, hemophilia, etc.), damage to the digestive tract (knife and gunshot wounds, blunt abdominal trauma, foreign bodies).

Complaints of vomiting blood (hematomesis), black tar-like stool (melena), discharge of scarlet blood in feces (hematochezia), general weakness, dizziness, sensation of noise or ringing in the ears, “flickering spots” before the eyes, pallor of the skin, shortness of breath, palpitations, drop in blood pressure until collapse, loss of consciousness. From the anamnesis you can obtain information about the possible cause, source and severity of bleeding. Examination reveals pallor of the skin; Auscultation – tachycardia, hypotension.

Additional research methods make it possible to judge the severity of bleeding in the first hours after its development: the deficit in circulating blood volume is determined by the value of the shock index, which is calculated using the Algover method by dividing the pulse rate by the value of systolic pressure. Shock index values ​​corresponding to 0.5 indicate a deficiency of 15% of the circulating blood volume, 1.0 - 30% of the circulating blood volume, 2.0 -
70% of circulating blood volume. There are 3 degrees of severity of acute gastrointestinal bleeding:

I degree – with blood loss of 1-1.5 liters and a deficit of circulating blood volume of up to 20%;

II degree – with blood loss of 1.5-2.5 liters and a deficit of circulating blood volume of 20-40%;

III degree – with blood loss of more than 2.5 liters and a deficit of circulating blood volume of 40-70%.

In parallel with monitoring laboratory parameters (complete blood count, coagulogram, blood group, feces for occult blood, occult bleeding), endoscopic research methods are used to clarify the source of the suspected bleeding: FEGDS, sigmoidoscopy, selective angiography and scintigraphy.

Urgent Care. Bleeding is an absolute indication for hospitalization. When transporting on a stretcher, first aid is provided - cold on the stomach, administration of hemostatic drugs (calcium chloride, vikasol, aminocaproic acid, dicinone). One of the primary tasks is fast recovery volume of circulating blood (massive infusion therapy, transfusion of red blood cells; in the presence of blood clotting disorders - transfusion of fresh frozen plasma and platelet mass).

11.3. Gastric Evacuation Syndrome– a pathological process characterized by impaired gastric emptying.

Delayed gastric emptying is caused by many acute and chronic diseases, metabolic disorders (hypokalemia, hyper- and hypocalcemia, acute hyperglycemia) and drugs (tricyclic antidepressants, narcotic analgesics and anticholinergic drugs). Chronic disruption of evacuation is often caused by gastric paresis due to long-term diabetes mellitus type I, scleroderma and after vagotomy. In addition, the causes of this syndrome can be bezoars (conglomerates of undigested substances retained by the pylorus), diverticula and gastric torsions. Among diseases of the gastrointestinal tract, gastric emptying syndrome is most often caused by mechanical obstruction due to duodenal ulcer and pyloric stenosis.

Complaints of a feeling of heaviness and fullness in the epigastric region that occurs immediately after eating, rapid satiety, rotten belching, nausea, vomiting in the afternoon and evening (in the vomit there are remnants of food eaten the day before), bringing relief, loss of appetite, progressive weight loss. Objectively during general examination: lack of body weight, dry skin and mucous membranes, decreased turgor and elasticity of the skin; When examining the abdomen, visible convulsive peristalsis is revealed; percussion - “splashing noise” in the epigastrium on an empty stomach and several hours after eating. Palpation is uninformative; pain in the epigastrium and pyloroduodenal area is possible. Auscultation can detect prolapse of the stomach (greater curvature).

Additional research methods. Lab tests allow to detect blood thickening, hypochloremia, hypocalcemia, alkalosis, and increased urea content. X-rays reveal slow gastric emptying, its expansion, and a large secretory layer on an empty stomach. FEGDS is of decisive importance in diagnosis. In case of decompensated stenosis, the endoscopic picture is characterized by a sharp depression of the motor function of the stomach, active pangastritis, rough relief of the mucous membrane, and cicatricial ulcerative pyloric stenosis.

Principles of treatment and emergency care. Diet therapy (exception fatty foods and foods rich in fiber), drug treatment: prokinetics (Coordinax, Motilium), in the case of decompensated stenosis - surgical treatment or endoscopic balloon dilatation with a preliminary full course of antiulcer therapy.

11.4. Hypersecretory syndrome gastric dysfunction is a pathological process based on an increase in the secretory function of the stomach, often combined with an increase in the acidity of gastric juice.

It is observed with gastritis with increased secretory and motor functions, type B gastritis, duodenal ulcer and sometimes with gastric ulcer, pancreatic tumors.

Clinical picture. Complaints of pain in the epigastric region of varying intensity and frequency, heartburn, sour belching, vomiting at the height of pain, bringing relief, sometimes “hungry” and night pain, a tendency to constipation. Inspection, percussion and auscultation are usually uninformative. Palpation reveals local pain in the pyloroduodenal area.

Additional research methods. Functional studies reveal gastric hypersecretion; X-ray – hypertonic or horn-shaped stomach with rough relief, accelerated peristalsis, large amounts of fluid on an empty stomach; FEGDS - spotty hyperemia, swelling of the gastric mucosa, submucosal hemorrhages, single erosions, ulcers, pyloric spasm, duodenogastric reflux; histological examination of biopsy specimens - various variants of chronic gastritis, often Helicobacter pylori in the antrum.

Principles of treatment and emergency therapy. Elimination of stressful influences, the use of medications that irritate the gastric mucosa, giving up bad habits, following a diet, diet therapy, prescribing medications that regulate stomach functions (antacids, histamine H2 receptor antagonists, H+, K+ - ATPase inhibitors, anticholinergics, etc.), antibacterial drugs (if the gastric mucosa is infected with Helicobacter pylori).

11.5. Hyposecretory syndrome disorders of the stomach - a pathological process, which is based on a decrease in the secretory activity of the stomach of functional or organic origin.

The causes and conditions for the occurrence of the syndrome are different: intoxication, hypovitaminosis, possible congenital failure of the secretory apparatus of the stomach. Hypo- and anacid state can be observed in patients with diffuse toxic goiter, diabetes mellitus; it is also characteristic of type A gastritis (autoimmune).

Clinical picture. Complaints of a feeling of heaviness, pressure, fullness in the epigastrium, dull, low-intensity pain, usually diffuse, without clear localization and irradiation, which does not subside, as a rule, after taking antispasmodics (distension pain); dyspeptic manifestations: nausea, belching after eating, loss of appetite, poor tolerance of certain types of food (milk), tendency to diarrhea. Inspection, percussion and auscultation are usually uninformative. Palpation - diffuse pain in the epigastric region.

Additional methods. A study of gastric secretion reveals hypoacidity up to anacidity (achlorhydria); X-ray – stomach in the form of a sharp hook with a thin, smoothed relief, severe hypotension, rare peristalsis, accelerated evacuation of contrast; FEGDS – pyloric gaping, rare superficial peristalsis, signs of mucosal atrophy; histological examination of biopsy specimens – atrophy of the glandular epithelium, intestinal metaplasia, minimal activity inflammation.

You should know that hyposecretion and achlorhydria are regarded as a precancerous condition.

The principles of treatment and emergency therapy involve eliminating stressful influences, giving up bad habits, following a diet, and diet therapy. Non-drug methods are combined with the prescription of replacement therapy (natural gastric juice, acidin-pepsin, pepsidil, etc.), drugs that stimulate the secretory function of the stomach (insulin, calcium preparations) and affect tissue metabolism, trophism and regeneration processes (vitamins, combined enzymes) .

11.6. Irritable bowel syndrome(irritable colon) – a complex of functional (not associated with organic damage) disorders of the colon lasting more than 3 months.

The causes and mechanisms of development of irritable bowel syndrome remain unknown. The most proven etiological factors are the following: neuropsychic factors and psycho-emotional stressful situations, disturbances in the usual diet, insufficient content of ballast substances, plant fiber in the diet (contributes to the development of a variant of irritable bowel syndrome, manifested by constipation), sedentary lifestyle life, lack of proper sanitary and hygienic condition of the toilet (contributes to the suppression of the urge to defecate and the development of constipation), gynecological diseases (cause reflex disorders of the motor function of the colon), endocrine disorders - menopause, dysmenorrhea, premenstrual syndrome, obesity, hypothyroidism, diabetes mellitus, etc., acute intestinal infections with subsequent dysbacteriosis.

In the pathogenesis, the leading role is played by a disorder of neurohumoral regulation of the functional state of the intestine and gastrointestinal endocrine system and an imbalance in the production of hormones that affect the motor activity of the large intestine. There are three main variants of irritable bowel syndrome: a) occurring with a predominance of diarrhea, b) occurring with a predominance of constipation, c) occurring with a predominance of abdominal pain and flatulence.

Complaints of abdominal pain or discomfort that are relieved by defecation or are accompanied by a change in stool frequency, or are accompanied by a change in stool consistency in combination with at least two of the following: changes in stool frequency (> 3 times per week), stool shape, and stool passage (tension, urgency, feeling incomplete emptying intestines), mucus secretion, bloating, neurotic manifestations(migraine-type headache), sensation of a lump when swallowing, dissatisfaction with inhalation (feeling of lack of air), sometimes rapid painful urination. From the anamnesis in favor of irritable bowel syndrome - the duration of the disease, the variable nature of complaints, the absence of progression of the disease, the connection of the deterioration of the condition with psycho-emotional factors and stressful situations, the absence of pathological changes in blood tests (clinical and biochemical), as well as organic changes in endoscopic studies, including histological picture of a biopsy specimen of the colon mucosa. Inspection, percussion and auscultation are uninformative. On palpation, the pain is diffuse or local, spastically contracted areas of the large intestine (usually the sigmoid colon).

Additional methods: a) laboratory - general blood and urine tests, biochemical blood tests without significant changes; scatological analysis - a large amount of mucus is often detected; b) X-ray - examination of the large intestine reveals signs of dyskinesia, uneven filling and emptying, alternation of spastically contracted and dilated sections of the intestine; c) endoscopic - colonoscopy and sigmoidoscopy usually do not record characteristic pathological symptoms, but often record accumulation of mucus and a tendency to intestinal spasms.

Emergency assistance is usually not required. We can recommend normalization of lifestyle, nutrition, physical therapy, psychotherapeutic and informational influence. For pain and flatulence, they begin with the use of antispasmodics - hyoscine butyl bromide 2 tablets 3 times a day, for severe flatulence - simethicone 1 capsule 3 times a day or the combined drug meteospasmin (alverine + simethicone) 1 capsule 2-3 times before meals.

11.7. Malabsorption syndrome (or malabsorption syndrome) is a symptom complex caused by impaired digestion (maldigestion) and actual absorption (malabsorption) in the small intestine of one or more nutrients. There are primary and secondary malabsorption syndromes.

The causes of primary malabsorption syndrome include: congenital or hereditary deficiency of disaccharidases and peptidases of the brush border of the small intestine, enterokinase deficiency, monosaccharide intolerance, malabsorption of amino acids, vitamins, cystic fibrosis. The causes of secondary (acquired) malabsorption syndrome are diseases of the digestive, hepatobiliary, endocrine systems, intoxication and drug effects (alcohol, uremia, poisoning with heavy metal salts, antibiotics, cytostatics and immunosuppressants, non-steroidal anti-inflammatory drugs, tuberculostatics, quinidine, digitalis, colchicine, etc. ), systemic diseases(scleroderma, amyloidosis, vasculitis). In the pathogenesis of malabsorption syndrome, depending on the cause, there is a violation of cavity and membrane digestion, the processes of absorption and transport of nutrients through the intestinal wall.

Complaints of diarrhea, copious “fatty” stools, flatulence, progressive weight loss; examination - lack of body weight, trophic disorders of the skin and mucous membranes, swelling of the lower extremities.

Additional research methods. It is necessary to conduct a scatological study to determine the degree of steatorrhea (neutral fat), creatorrhoea (muscle fibers), amilorrhea (starch) of feces; studies of the microflora of feces and stool for protozoa, occult blood, blood group and Rh factor, blood electrolytes, serum iron, proteinogram, lipidogram, gastric secretion, balloon kymography, radiography of the stomach, irrigography, FEGDS with targeted biopsy, colonoscopy, sigmoidoscopy, laparoscopy, ultrasound of the abdominal organs.

Lecture 5

• Prevention of emergency conditions in gastoenterology
• Which doctors should you contact if you have a gastoenterological emergency?

What are Emergency Conditions in Gastroenterology

"Emergencies"- a conventional term that combines various acute diseases of the digestive system and pathophysiological changes that threaten the patient’s life and require emergency treatment measures or in which it is necessary to as soon as possible alleviate the patient's condition.

A feature of emergency conditions is the need for accurate diagnosis in the shortest possible time and, based on the expected diagnosis, the determination of treatment tactics. The problem of emergency conditions for gastroenterology as the most important branch of internal medicine and surgery is especially important both in view of the very high prevalence of diseases of the digestive system (it is known that such diseases occupy third place among diseases of internal organs), and taking into account the huge variety of nosological forms encountered (including and numerous rare ones). Emergency conditions in gastroenterology cause great difficulties for diagnosis and treatment, they require special methods and special preparedness medical institutions and medical personnel to provide appropriate assistance. These conditions can arise as a result of acute diseases and injuries of the digestive organs, exacerbation of chronic diseases, or as a result of complications.

Symptoms of Emergency Conditions in Gastroenterology

Emergency conditions occur with diseases and lesions of any organ of the digestive system. Thus, diseases and lesions of the esophagus can cause more than 30 types of emergency conditions. These are acute arterial esophageal bleeding with peptic ulcers and erosions of the esophagus, venous bleeding with varicose veins, as well as various foreign bodies, which in 80-85% of cases, when accidentally or intentionally (during suicide attempts) ingestion, are retained in the esophagus (it has been established that that if a foreign body has passed the esophagus, it very rarely lingers in other parts of the digestive tract). Relatively rarely (according to various sources, in one case per 10,000-80,000 population) severe forms of acute inflammatory diseases of the esophagus (abscess and phlegmon of the esophagus, periesophagitis) occur. Serious problems arise with the formation of a tracheoesophageal fistula.

Among a large group of diseases of the stomach and duodenum, the most common and require emergency care are: serious complications, such as acute gastric or duodenal bleeding or perforation of the wall of these organs. Acute bleeding from gastroduodenal ulcers is observed, according to various authors, in 15-20% of cases. Perforation of peptic ulcers occurs in approximately 5% of cases. If we take into account the prevalence of peptic ulcer disease (in various regions of our country among the adult population, peptic ulcer disease occurs in 4-8% of cases in men and 2-3% in women), then the total number of patients with peptic ulcer disease who experience these complications requiring emergency diagnostic and therapeutic measures turns out to be very large. It should be taken into account that in approximately 10% of cases, acute gastroduodenal bleeding occurs against the background of an asymptomatic course of a peptic ulcer, as well as a number of other diseases of the stomach and duodenum.

There is a separate problem of symptomatic gastroduodenal ulcers: medicinal, stress, endocrine, etc. Moreover, the clinical picture of such ulcers is usually masked by the underlying disease; they are often not recognized in time, and the diagnosis is established only when complications associated with them occur (mainly acute bleeding) or already on the section table, and in approximately 5-8% of cases (especially drug-induced and stress ulcers) they are the cause of death of patients.

Gastroduodenal ulcerations and erosions, which also give serious complications, often occur with so-called collagen diseases, in particular with rheumatism, rheumatoid arthritis, etc. In this case, the cause of their occurrence and the development of complications can be both the disease itself and the therapy with prednisone, non-steroidal anti-inflammatory (NSAID) drugs, which are known to have ulcerogenic side effects.

Currently, NSAIDs occupy an important place in the treatment of many diseases. In addition to a pronounced anti-inflammatory effect, these drugs, to a greater or lesser extent, have an analytical, hypothermic (in febrile conditions) and sedative effect. The subsidence of the inflammatory process and the reduction of pain (especially in joint diseases) under the influence of NSAID treatment are largely explained by the suppression of prostaglandin synthesis by these drugs.

The specialized medical literature provides data on the very wide use of NSAIDs. It is believed that about 30-60 million people in all countries of the world systematically take these drugs to treat various diseases manifested by inflammatory reactions and pain. First of all, these are various diseases of the joints (rheumatoid arthritis, osteoarthritis, deforming spondylosis, etc.), neuritis and neuralgia and other diseases from the group of so-called collagenoses, etc. Small doses acetylsalicylic acid(0.5-0.25 g 2-3 times a day), which has antiaggregation and anticoagulant properties, is widely and long-term prescribed by doctors to prevent the formation of blood clots in coronary heart disease, thrombophlebitis and other diseases and conditions that may be complicated by thrombosis and embolism . In reality, however, the population takes these drugs (sometimes in significant doses and more or less constantly, often systematically over a number of years), much more often for various reasons: for headaches, migraines, radiculoneuralgia, febrile states and etc. It is impossible to list such widespread cases of NSAID use, especially since in such cases these drugs are usually taken without a doctor’s prescription.

The problem of widespread use of NSAIDs would not be so relevant if these very valuable drugs, in addition to their therapeutic effect, did not cause a number of serious side effects, among which one of the first places is their damaging effect on the mucous membrane of the stomach and duodenum with the development of inflammatory dystrophic changes, erosions and gastroduodenal ulcers and their complications - bleeding and perforation. A huge number of works are devoted to this problem, the problem of medicinal gastroduodenal ulcers.

Based on large statistical data, scientists noted that patients with rheumatoid arthritis who received NSAIDs were 1/4 times more likely to be hospitalized due to gastrointestinal complications compared to patients who did not receive these drugs. Moreover, it has been found that among patients with rheumatoid arthritis, death from serious gastrointestinal complications occurs 2 times more often than in the general population. About 10% of patients treated with NSAIDs for a long time and hospitalized due to gastrointestinal complications die. The authors believe that gastropathy, accompanying treatment NSAIDs are responsible for the death of at least 2,600 people and the reason for hospitalization in 20,000 patients (these estimates were carried out only for patients with rheumatoid arthritis).

Data about frequent occurrence gastropathy and gastroduodenal erosions and ulcers in the treatment of NSAIDs, as indicated, are very numerous, and the frequency of identified gastrointestinal lesions, although it varies quite significantly according to the results of studies and observations cited by different authors, is in all cases very high.

Clinically, damage to the mucous membrane of the stomach and duodenum is manifested by dyspepsia, heartburn, and pain in the stomach. But often even the formation of gastroduodenal erosions and ulcers is not accompanied by any obvious symptoms and for the first time it manifests itself with severe, life-threatening complications: acute gastroduodenal bleeding or perforation of ulcers into the free abdominal cavity. Such an “asymptomatic” (up to a certain time) course of medicinal gastroduodenal ulcers is typical with long-term use of NSAIDs. This is explained, firstly, by the direct properties of this group of drugs, in which, as is known, one of the main mechanisms of action is the inhibition of prostaglandin synthesis, which contributes to both the subsidence of inflammatory phenomena and the reduction of pain, and secondly, against the background of the underlying disease , manifested either by severe pain (arthritis, arthrosis, etc.) or other difficult to tolerate severe symptoms (severe shortness of breath, swelling of the legs, ascites in heart failure in patients with rheumatic heart disease); dyspeptic disorders and pain in the epigastric region in cases of gastroduodenal ulcers seem to “fade into the background” or are simply not perceived by patients. In some cases, these patients with much more severe illnesses simply do not attach much importance to these symptoms. There are other possible explanations for the mechanisms of “low-symptomatic” or even “asymptomatic” medicinal gastroduodenal ulcers.

The risk of developing gastroduodenal erosions and ulcers, as well as their complications (ulcerative bleeding, perforations), increases significantly in the following cases.

• With a significant duration of taking NSAIDs.
• When taken in large doses.
• At long-term treatment several (2-3) NSAIDs or concurrent use of corticosteroid hormones,
• In the presence of concurrent (or previous) serious diseases.
• In elderly and senile patients (the older, the greater the danger).
• If there is a history of peptic ulcer disease or in close relatives (hereditary predisposition).

Relatively often, an emergency condition is the first manifestation of a previously asymptomatic disease of the stomach, duodenum or other parts of the digestive system

When analyzing the archive for 10 years (6742 sectional cards), it was found that in 61 cases, ulcerative lesions of the stomach or duodenum were not detected during life (24.9% of the total number - 245 patients with peptic ulcer), and 13 of them (21 .3%) died from newly revealed complications of peptic ulcer - acute bleeding or perforation.

It was found that acute gastric bleeding occurred in 26.6% of cases, according to a pathological study, in patients who died from severe circulatory failure (NB stage III), and in 13.2% of patients observed in different years in the clinic. It was important to establish the fact that against the background of severe somatic disorder erosive and ulcerative lesions of the stomach and duodenum are often asymptomatic, or these symptoms are “overshadowed” by more vivid and pronounced symptoms of the underlying disease (heart disease, circulatory failure) and for the first time clinically manifest themselves as complications. In congestive heart failure in patients with rheumatic heart disease, a relatively common but peculiar complication is the perforation of peptic ulcers (including medicinal ones caused by the need for long-term use of antirheumatic drugs) into the free abdominal cavity filled with ascitic fluid. Symptoms of perforation of the ulcer in these cases are significantly “shadowed”, they do not appear as clearly as in classical cases, and sometimes the time of perforation can only be determined very approximately. This is explained by the fact that the acidic contents of the stomach are significantly dissolved in the ascitic fluid and the acidic, proteolytically active gastric juice does not have such a strong (as in classical cases) irritating effect on the peritoneum.

The list of emergency conditions caused by gastroenterological diseases is unusually diverse. Thus, over the course of about 20 years, we observed 4 cases of gastric volvulus.

A large group of acute complications is associated with polyps and polyposis of the digestive tract (torsion of the polyp leg, necrosis and bleeding from a benign or malignant tumor, intestinal obstruction). It must be borne in mind that, in addition to acquired ones, there is a large group of hereditary forms of such polyposis - Peutz-Jeghers-Touraine syndrome, etc.

Big problems arise with acute cholecystitis and cholelithiasis. Gallbladder diseases are currently one of the most common pathologies of the digestive system. Often, gallstone disease continues throughout the patient’s life or is asymptomatic for some period. However, violations of diet, diet and some other factors known to us can cause an attack of biliary colic or acute cholecystitis.

Acute pancreatitis accounts for 6-8% of all diseases of the pancreas. In 35-70% of cases, it is caused by nutritional disorders and diseases of the biliary system; in men, the main etiological factor is the use of strong alcoholic drinks. Acute pankeratitis, as a rule, is very severe and in 40-60% of cases ends in death.

Acute liver lesions, as a rule, are of a viral or toxic nature, so such patients end up in infectious diseases hospitals or poison control centers. However, the outcome of chronic liver disease (mainly cirrhosis) is liver failure, which, according to many authors, is observed in 6-8% of patients and requires urgent measures.

A very serious condition develops in patients with intestinal obstruction, which can be a consequence of a large number of intestinal diseases, peritonitis (however, these patients are hospitalized in surgical hospitals). More than 1 million people were hospitalized in hospitals in LIC territories due to acute appendicitis. Relatively rare but serious pathologies are vascular diseases of the intestine and lesions of the liver vessels. It should be noted that against the background of a long, relatively benign course of ulcerative colitis and Crohn's disease, complications occur relatively often: bleeding, perforation of the intestinal wall. Finally, tumor lesions of the digestive system often cause a wide variety of emergency conditions: acute bleeding, intestinal obstruction, etc.

It often turns out that the cause of an emergency in certain specific cases may be the action of several factors simultaneously. It is often also necessary to state that the immediate cause (or causes) of the emergency condition cannot be established with the most careful analysis. In some cases, apparently, an emergency condition arises as a result of the natural development of the pathological process (in chronic diseases), due to the accumulation of certain quantitative changes(for example, the sudden occurrence of gastric bleeding during an exacerbation of a peptic ulcer at some stage of an increase in the size of the ulcer). Thus, the causes of emergency conditions are numerous and extremely diverse.

The range of emergency conditions caused by damage to the digestive system can be roughly reduced to the following pathological disorders.

• Acute inflammatory diseases (acute cholecystitis, pancreatitis, phlegmon of the stomach wall, acute peritonitis resulting from various causes, etc.) or exacerbation of chronic inflammatory diseases (exacerbation of chronic cholecystitis, appendicitis, pancreatitis, etc.)
• Bleeding from the digestive system.
• Traumatic lesions: bruises, violation of the integrity of an organ or its wall, etc.
• Formation of messages from a hollow organ into the peritoneal cavity (for example, perforation of an ulcer during peptic ulcer disease, etc.)
• Dystrophic (even necrotic) changes; superficial (with chemical or thermal burns mucous membrane) or diffuse (for example, toxic liver damage, etc.).
• Acute disorders of the digestive tract (obstructive, intussusception and strangulation types of obstruction). This also includes attacks of biliary colic, which usually involves strangulation of a stone in the bile ducts.
• Disorders of blood supply (thrombosis, embolism) to the intestinal wall or liver tissue, pancreas. This also includes disturbances in the blood supply, for example in the area of ​​the intestinal wall due to a strangulated hernia. Often these pathological changes are of a combined nature (trauma and circulatory disorders, strangulation of the hernia and circulatory disorders in the hernia formation, etc.).
• Emergency conditions caused by medical diagnostic and therapeutic measures are relatively rare. For example, during esophagogastroduodenoscopy, perforations (mainly the esophagus) and severe bleeding from those areas of the mucous membrane from which the biopsy was performed, according to various sources, occur in 1 in 4000-10,000 cases. It is possible to develop myocardial infarction during endoscopy or immediately after it (we know of one such case).

Severe and even fatal bleeding after a puncture biopsy of the liver is very rare. Retrograde cholangiopancreatography in approximately 1% of cases leads to exacerbation of pancreatitis and even ends in death. Even a routine X-ray examination of the stomach with contrast agent(a suspension of barium sulfate) in people with persistent constipation (especially in the elderly) can lead to intestinal obstruction. Reception large quantities insoluble antacids in some cases can also be the cause of intestinal obstruction (we came across 6 such descriptions in the specialized medical literature). It is well known that with the sudden withdrawal of Hg-blockers of histamine receptors, for example cimetidine, a sharp exacerbation of peptic ulcer disease, etc. may occur. Therefore, doctors must be very responsible in prescribing complex diagnostic procedures to patients, as well as medications, taking into account all indications and possible contraindications in each specific case.

Diagnosis of emergency conditions in gastoenterology

Diagnosis of emergency conditions in gastroenterology is associated with great difficulties. At the same time, it is absolutely obvious that no delays in both making a diagnosis and providing first aid and transportation to the appropriate hospital or hospital department are impossible. The first task that is posed to the doctor is to recognize an emergency condition, in this case an emergency condition caused by damage to the digestive organs. Moreover, the severity of the patient’s condition and the need for emergency medical events often do not allow the doctor to question the patient in detail and examine him in detail, even using physical methods.

At the first, initial stage, the basis for recognizing an emergency condition can be some typical complaints of patients, anamnesis data, and the results of a direct examination of the patient. The most typical signs are:

• acute repeated episodes of vomiting;
• sharp abdominal pain;
• symptoms of peritoneal irritation, signs of “acute abdomen”;
• signs of acute bleeding from the digestive tract (coffee-ground-colored vomit, melena, vascular collapse);
• signs of acute intoxication (indicating or suspecting the entry of a toxic substance into the body through the digestive tract);
• indication of a swallowed foreign body (especially in combination with chest pain or abdominal pain, signs of a fever);

Signs of external injury (or indications of such) in the abdomen, neck or perineum in combination with sharp pain in the esophagus, in the abdomen, symptoms of vascular collapse, and increased body temperature.

Anamnestic data on the presence of a chronic disease of the digestive system (ulcerative, cholelithiasis, etc.) are of some importance for diagnosis, but they should not be overestimated.

The appearance of signs of an emergency condition in a patient with established diagnosis some disease of the digestive system, in which acute complications may occur (for example, bleeding, perforation in a peptic ulcer), usually in the presence of corresponding symptoms, leads the doctor to believe that the cause of the emergency is a complication of this disease. But this is not always observed. According to various authors, for example, the cause of acute bleeding from the digestive tract in 15-35% of cases or more is a previously unknown disease, which could serve as a potential source of bleeding, and other causes.

Patients with these conditions should be urgently hospitalized in hospitals, depending on the preliminary diagnosis: mainly surgical, less often in intensive care units of therapeutic hospitals, toxicology centers or infectious diseases hospitals.

Thus, the doctor must:

• be able to recognize a patient’s emergency condition or suspect it;
• determine the need and nature of emergency treatment measures (mostly symptomatic, but in some cases aimed at eliminating the etiological factor, for example, in acute poisoning);
• correctly resolve the issue of hospitalization of the patient in the appropriate medical institution and urgently organize hospitalization.

All this requires high professional medical erudition and responsibility, starting from the very first stages, that is, when the doctor first meets a patient who has some kind of “catastrophe” associated with the digestive system.

At the hospital stage, to determine treatment tactics, an accurate diagnosis of the disease that caused the emergency is necessary.

Currently diagnostic capabilities emergency conditions have expanded. For this purpose, according to appropriate indications, emergency X-ray and endoscopic examination (esophagogastroduodenoscopy, colonoscopy, laparoscopy), ultrasound examination of the abdominal organs, and a set of laboratory tests are widely used.

At the same time, even in a hospital setting, specifically identifying the cause of an emergency condition is associated with great difficulties and is not always possible. This is due to the following main reasons: The need to establish an accurate diagnosis in an extremely short time frame, the impossibility of dynamic observation and repeated studies if the diagnosis is unclear during the initial examination of the patient. Limited diagnostic capabilities to a certain extent instrumental methods research. Yes, even complex application X-ray and gastroduodenoscopic examination, which gives the most good results in identifying the causes of acute gastroduodenal bleeding, according to one of our very experienced employees, it turned out to be ineffective in 2.8% of patients. An extremely limited range of laboratory rapid diagnostic methods. In some cases, an emergency condition may be caused by not one, but two or even more reasons (for example, acute cholecystitis and ulcer bleeding, myocardial infarction and acute stress peptic ulcer of the stomach, complicated by gastric bleeding, etc.). 5. The erased “asymptomatic” course of acute gastroenterological diseases in elderly and senile patients, in persons with severe diseases of the heart, lungs, renal failure, as well as during treatment with certain medications (in particular, corticosteroids, immunosuppressants, etc.) , in persons who have undergone radiation exposure (for example, as a result of radiation therapy for a tumor disease). In all these cases, pain is usually mild (even with perforation of the hollow organs of the abdominal cavity and the development of peritonitis), symptoms of peritoneal irritation, and a temperature reaction is absent or slightly expressed. 6. A serious problem that complicates the accurate diagnosis of the causes of emergency conditions is the wide variety of options for the clinical course of diseases of the digestive system and very big number rare diseases.

Difficulties in diagnosis aggravated by the fact that there are numerous diseases and conditions not related to the digestive system, in which, as with an “acute abdomen,” acute abdominal pain can occur - the so-called false acute abdomen.

Treatment of Emergency Conditions in Gastroenterology

In recent years, new treatments for many emergency conditions have been developed. Thus, in case of acute gastroduodenal bleeding, endoscopy is urgently performed with exposure to the source of bleeding with a helium-neon or argon laser beam, electrocoagulation is performed or the bottom of the ulcer is treated with medicinal substances that prevent bleeding, and hemostatic films are glued. Thanks to such esophagogastroduodenoscopes, it became possible to remove foreign bodies of the esophagus, stomach and duodenum, and with the help of a colonoscope it is possible to remove bleeding polyps and foreign bodies of the colon. In the treatment of emergency conditions associated primarily with acute liver diseases and liver failure, plasmapheresis and the method of hyperbaric oxygenation have become widely used.

Year of issue: 1997

Genre: gastroenterology

Format: DjVu

Quality: Scanned pages

Description: Judging by the success of the first edition, the manual was received positively. The first edition was awarded the M. P. Konchalovsky Prize of the USSR Academy of Medical Sciences for best book on internal diseases in 1991 (resolution No. 130 from P.P.91 of the Presidium of the USSR Academy of Medical Sciences). In the second edition, the authors introduced the latest advances in understanding the etiology and pathogenesis of gastroenterological diseases and their complications, the possibility of their diagnosis and treatment, and included separate sections relating to ultrasonography, diagnosis and treatment of acute gastrointestinal bleeding using angiography.

GENERAL ISSUES IN EMERGENCY GASTROENTEROLOGY
Chapter 1. Organizational matters (V. A. Mikhailovich)
Emergency care, intensive care and resuscitation in gastroenterology
Organization of emergency care, intensive care and resuscitation
Interaction between a gastroenterologist and doctors of other specialties
Chapter 2. Intensive Observation Techniques and Techniques (A. A. Krylov, A. G. Zemlyanoy)
Objective examination of the abdomen
General principles of intensive surveillance
Emergency endoscopy
Abdominal puncture
Ultrasonography in emergency gastroenterology(E.F. Onishchenko)
Emergency x-ray diagnostics (L. N. Kondrashova)
Chapter 3. Symptoms and syndromes of gastroenterological diseases requiring emergency care (A. A. Krylov, A. I. Ivanov)
Symptoms and syndromes of acute diseases of the digestive system
Abdominal pain
Vomit
Hiccups
Heartburn
Dysphagia
Upset stool
Jaundice
Changes in other organs and systems
The cardiovascular system
Respiratory system
Kidneys
Nervous system
Fever
Chapter 4. Techniques and methods of intensive care (V. A. Mikhailovich)
Disturbances and correction of water-electrolyte balance
Water balance
Electrolyte balance
Disorders and correction of acid-base status
Biochemical buffer systems
physiological buffer systems
Metabolic acidosis
Metabolic alkalosis
Gas acidosis
Gas alkalosis
Parenteral nutrition
Application of enpits (V.V. Shchedrupov)
Hyperbaric oxygenation
Hemosorption
SPECIAL ISSUES IN EMERGENCY GASTROENTEROLOGY
Chapter 5. Acute gastrointestinal bleeding (A. G. Zemlyanoy)
Ulcerative gastroduodenal bleeding
Acute stomach ulcers
Acute hemorrhagic gastritis
Mallory-Weiss syndrome
Bleeding from stomach cancer
The use of angiography in the diagnosis and treatment of gastrointestinal bleeding (N. A. Borisova, V. S. Verkhovsky)
Bleeding from the upper digestive tract
Bleeding from the lower digestive tract
Treatment of massive gastrointestinal bleeding using x-ray endovascular interventions
Treatment of esophagogastric bleeding in portal hypertension
Chapter 6. Diseases of the esophagus (L. I. Ivanov, A. S. Kiselev)
Acute esophagitis
Chemical burns of the esophagus
Damage to the esophagus
Foreign gel of the esophagus
Esophageal spasm
Achalasia cardia
Chapter 7. Diverticula of the digestive tract (A. G. Zemlyanoy)
Esophageal diverticula
Gastric diverticula
Duodenal diverticula
Small intestinal diverticula
Ileal diverticulum (Meckel's)
Colon diverticula
Chapter 8. Stomach diseases (A. A. Krylov, L. G. Zemlyanoy)
Acute gastritis
Cellulitis of the stomach
Peptic ulcer of the stomach and duodenum
Symptomatic ulcers of the stomach and duodenum
Acute gastric dilatation
Prolapse of the gastric mucosa into the duodenum (Schmieden syndrome)

Pathological syndromes after gastrectomy and vagotomy
Chapter 9 Diseases of the liver, biliary tract, pancreas and spleen (L. I. Ivanov, L. G. Zemlyanoy)
Hepatitis and cirrhosis of the liver
Liver failure
Biliary (hepatic) colic
Acute cholecystitis
Pathological syndromes after cholecystectomy
Liver abscesses
Acute pancreatitis
Splenic rupture
Splenic infarction
Spleen abscess
Chapter 10. Intestinal diseases (A. A. Krylov, L. G. Zemlyanoy, A. I. Ivanov)
Duodenostasis
Acute gastroenteritis and enterocolitis
Acute abdominal allergic syndromes
Granulomatous enterocolitis (Crohn's disease)
Intestinal phlegmon
Nonspecific ulcerative colitis
Acute appendicitis
Acute intestinal obstruction
Digestive and malabsorption syndromes
Chapter 11. Vascular diseases of the abdominal organs (A. I. Ivanov, L. G. Zemlyanoy, L. F. Gulo)
Hepatic artery occlusion
Portal hypertension
Chiari disease and Budd-Chiari syndrome
Extrahepatic portal venous obstruction
Purulent pylephlebitis
abdominal toad
Throm6osis of mesenteric arteries
Mesenteric artery embolism
Ischemic colitis
Periarteritis nodosa
Non-infectious necrotizing granulomatosis
Chapter 12. Diseases of the diaphragm, peritoneum and anterior abdominal wall (A. G. Zemlyanoy)
Hiatal hernia
Acute peritonitis
Adhesions and adhesive disease
Strangulated hernias
Chapter 13. Acute abdominal syndromes in diseases of other organs and systems (A. A. Krylov)
Diseases of the cardiovascular system
Respiratory diseases
Kidney diseases
Gynecological diseases
Diseases of the blood system
Diseases of the endocrine system and metabolism
Connective tissue diseases
Other diseases

Send your good work in the knowledge base is simple. Use the form below

Students, graduate students, young scientists who use the knowledge base in their studies and work will be very grateful to you.

Posted on http://allbest.ru

GBOU SPO Tolyatti Medical College

Specialty Nursing (basic level) (FSES SPO)

Professional module “Participation in treatment, diagnostic and rehabilitation processes”

Interdisciplinary course “Nursing care for various diseases and conditions ( Nursing assistance in case of health problems)"

Section “Nursing assistance in therapy”

Course - 3, full-time study

"Nursing care for emergency conditions in gastroenterology"

Performed:

student of group C - 301

Grudko Anastasia

Checked by the teacher:

Ryazantseva V. N

Tolyatti 2014

Introduction

The digestive system is a system of organs where food enters and where food is broken down, followed by the absorption of substances necessary for the functioning of the body, as well as the removal of remnants of digested food.

Diseases of the gastrointestinal tract are a complex of characteristic, constant or periodically occurring symptoms that signal disturbances in the functioning of the digestive system or a separate organ of this system, which have a certain dependence on exogenous, endogenous and genetic factors. A separate branch of medical science, gastroenterology, studies diseases of the digestive system.

According to statistics, diseases of the gastrointestinal tract occupy the second place in terms of incidence in Russia. Among the causes of these diseases, poor nutrition and stress should be particularly highlighted.

Nutrition determines the length and quality of a person’s life.

The modern rhythm of life: “snacks” on the run, “fast food”, alcohol abuse and constant stress at work and at home can lead to the development of both acute processes and chronic diseases.

Life in modern society dictates its own rules, and our body tries to adapt to these rules; accordingly, one of the following suffers first. critical systems The body is the digestive system. When the digestive system suffers, an interconnected disruption occurs in the functioning of other body systems, which means a disruption of homeostasis.

Maintaining Consistency internal environment The body is the most important condition for normal metabolism in the body, and therefore health and the associated quality of human life.

The clinical picture of diseases of the digestive system varies in its course in different age groups, but thanks to various studies and the introduction of new technologies in the diagnosis of diseases of the gastrointestinal tract, it is possible to make the most accurate diagnosis and provide competent medical care.

Modern pharmaceuticals allow you to get maximum effect and minimum side effects in the treatment of diseases of the gastrointestinal tract.

The detection and timely treatment of diseases of the gastrointestinal tract is supported by preventive measures.

These activities involve medical and preventive institutions that have an approved system of conducting preventive examinations, as well as if it is necessary to provide outpatient treatment.

Etiology of diseases of the digestive system

The causes of diseases of the gastrointestinal tract are exogenous, endogenous and genetic factors. The primary causes of the disease are: nutritional factor, which includes: dry food (fast food), very hot dishes, rough food, abuse of spices and spices, alcohol and smoking, poor quality food, hasty eating, defects of the masticatory apparatus, uncontrolled use of medications (especially salicylates, hormones, the drug rauwolfin), pollutants (ecology).

Diseases caused by exogenous factors include: acute and chronic gastritis with both high and low acidity, gastroenteritis, enteritis, acute colitis, chronic spastic colitis, peptic ulcer of the stomach and duodenum, malignant tumors of the stomach, cholelithiasis, biliary dyskinesia, alcoholic hepatitis and cirrhosis of the liver.

Secondary or endogenous causes are the presence of antral Helicobacter (Campillobacter), diabetes mellitus, thyrotoxicosis, anemia, obesity, hypovitaminosis, kidney disease, infections, lung diseases that occur with signs of tissue hypoxia, stress. Such diseases include hepatitis, gastritis caused by helicobacter pylory, chronic cholecystitis, pancreatitis, mucous colic, SPRU, intestinal tuberculosis, helminthiasis (ascariasis, enterobiasis, trichuriasis, hookworm disease, strongyloidiasis).

Enterobiasis is caused by pinworms, a small nematode 10-12 mm long (female) and 2-2.5 mm (male).

Enterobiasis affects children more often preschool age, since infection occurs by ingestion of mature eggs entering through dirty hands. When eggs enter the stomach and intestines, larvae appear, grown-up individuals adhere to the intestinal walls, and mature females descend into the rectum and at night crawl out into the area of ​​the perianal folds to lay eggs, thereby causing itching in this area.

The third group of causes includes genetic and developmental anomalies. These are malformations of the esophagus, benign tumors of the esophagus and stomach, abnormalities of the pancreas (cystic fibrosis of the pancreas), congenital hypoplasia of the pancreas (isolated pancreatic lipase deficiency or Shwachman-Bodian syndrome).

More often, diseases of the gastrointestinal tract occur due to a combination of endogenous and exogenous factors.

Syndromes and symptoms

In the clinical picture of diseases of the digestive system, one can identify symptoms and syndromes that are characteristic of all diseases of the digestive system, and that are characteristic only of a specific disease. The most common symptom of any digestive disease is pain.

By nature, the following types are distinguished:

Visceral pain - constant dull pain with diffuse distribution throughout midline belly;

Somatic pain is an acute, local pain that occurs as a result of acute processes in the abdominal cavity affecting the peritoneum; radiating pain.

Constant (aching pain is caused by irritation of nerve elements embedded in the mucous membrane and submucosal layer during inflammatory processes);

Periodic, at certain hours - for example, pain on an empty stomach, night pain and pain - due to hypersecretion of gastric juice, pyloric spasm;

Cramping pain occurs with spastic contractions of the smooth muscles of the hollow organs;

Seasonal pain;

The relationship of pain with food intake (decreased, increased, no change), antacids and antispasmodics, with anxiety and physical stress.

In case of pathology of the abdominal wall, the main complaints will be pain in certain places, the presence of hernial protrusions, pain in them, unstable stools, the presence of dilated veins, the presence of wounds, bruises. In case of abdominal pathology, complaints of abdominal pain, weakness, malaise, nausea, vomiting, stool retention or diarrhea, dry mouth, bloating, ascites, weight loss, palpitations.

Gastroenteral pathology is characterized by pain and a feeling of heaviness in the epigastrium, right hypochondrium, heartburn, nausea, vomiting, dyspepsia associated with meals, intolerance to certain foods, weakness, weight loss.

Gastroduodenal syndrome can be acute or chronic. Acute gastroduodenal syndrome occurs with a clinical picture of food toxic infection: nausea, vomiting of food masses without bile, headache, weakness, malaise, hypotension and tachycardia.

On palpation of the abdomen, moderate tension of the abdominal wall is observed in the upper floor of the abdominal cavity, without symptoms of peritoneal irritation, pain in the epigastrium and right hypochondrium (pain symptoms of Kocher, Boas, Oppenhowsky).

There are painful diagnostic points in the chest and abdomen, the so-called paravertebral Boas points at the level of 10-12 thoracic vertebrae and Openkhovsky points in the area of ​​the spinous processes of 8-10 thoracic vertebrae - for peptic ulcers, cancer and other pathologies of the stomach.

Anterior Boas point at the intersection of the rectus abdominis muscle and the right costal arch - with cholecystitis and duodenal ulcer. McBurney's points are 2 cm below the navel and 1-2 cm to the right with mesadenitis and reflex solaritis, more often with appendicitis; at the intersection of the line between the navel and the wing of the ilium with the rectus abdominis muscle - with appendicitis.

Ortner's point, along the lower edge of the costal arch on the right - for diseases of the liver and gall bladder; Mussi's point above the collarbone, between the legs of the sternocleidomastoid muscle, cholecystitis, subphrenic abscess. Herbst's point at the transverse process of the third lumbar vertebra on the left - with gastric ulcer. Lanz's point at a distance of 5 cm from the right anterior - superior iliac spine on the line connecting both spines - with appendicitis. Mayo-Robson point anterior-internal surface of the lower third of the left leg - with acute pancreatitis, increased pain in the epigastrium is noted.

From a practical point of view, there are three main forms of damage to the biliary tract: dysfunctional disorders of the biliary tract, cholecystitis, cholelithiasis.

With pathology of the biliodigestive system, the following are detected: pain and a feeling of heaviness in the right hypochondrium, radiating to the neck, right arm and under the scapula; pain in the epigastrium and left hypochondrium, radiating to the navel and back; bitterness in the mouth, nausea, vomiting, dyspepsia, itching, scleral icterus or jaundice, loss of appetite, weight loss, ascites. The main complaints for colon-rectal pathology are: constant or paroxysmal abdominal pain, bloating, stool disorders, tenesmus, mucus, blood, black stools, painful bowel movements.

Methods of clinical examination of the patient

Methods of clinical examination of a patient include: patient interview, general examination, X-ray examination, radioisotope research methods, laboratory methods research - research blood, urine, feces. When interviewing a patient to determine the pathology of the digestive system, they find out:

1.Appetite: increased, decreased, elevated, perverted (aversion to a certain type food).

2. Satiety: normal, fast, constant feeling of hunger, fullness in the stomach.

3. Thirst: absent, periodic, dry mouth - constant with quenching up to how many liters per day or periodic.

4.Taste in the mouth: normal, bitter, sour, metallic, loss of taste.

5. Heartburn: no or yes, associated with food intake or not, what foods cause it, frequency, whether it happens at night, how it is relieved.

6. Nausea, if present: constant or periodic, time of occurrence, whether it is associated with food intake, is resolved by vomiting.

7. Vomiting, if any: is it associated with nausea or not, the time of its occurrence - before eating, during eating, after eating, how long after eating. The nature of the vomit - stagnant or ingested food, “coffee grounds”, “meat slop”, streaks of blood, blood clots; does it bring relief?

8.Pain syndrome: time of occurrence, nature of pain, localization, connection with food intake.

9. Character of stool: normal, constipation, loose stool, how many times, color, presence of impurities - mucus, blood, pieces of undigested food, if there is bleeding - before or after stool, volume, type of blood.

The main laboratory methods for studying blood for diseases of the gastrointestinal tract are a general blood test, a biochemical blood test, serological test for the diagnosis of infectious diseases of the digestive system, bacteriological research(seeding is carried out on several media simultaneously).

A general urine test is prescribed for almost any disease. Biochemical analysis urine is more often prescribed for diseases of the biliodigestive system (hepatitis, cholecystitis, liver cirrhosis, pancreatitis).

Instrumental research methods represent a section of a comprehensive examination of patients with diseases of the digestive system. They include X-ray, endoscopic, ultrasound, electrographic and electrometric methods for examining patients.

Depending on the nature of the disease, the doctor prescribes a specific examination that is most informative in this particular case. Instrumental research methods make it possible to characterize specific features of the morphology or function of the organ being studied. The appointment of several instrumental research methods in a program for diagnosing diseases in one patient makes it possible to reveal all aspects of the numerous processes occurring in the formation of diseases of the system under study, to identify the nature of its functional and morphological relationships with other organs and tissues.

Emergency conditions and emergency assistance

As a rule, emergency care is based on syndromic care, that is, not making a final diagnosis, but identifying syndromes characteristic of a particular disease and making a preliminary diagnosis.

The main syndromes requiring emergency care for diseases of the digestive system are: hemorrhagic syndrome (bleeding from dilated veins of the esophagus, gastrointestinal bleeding); syndrome of comatose states in hepatic coma, which can be due to viral hepatitis, liver cirrhosis, poisoning; diarrhea syndrome non-infectious origin; abdominal pain syndrome or “acute abdomen”, occurs with appendicitis, acute intestinal obstruction, acute pancreatitis, strangulated hernia, acute cholecystitis, perforated gastric and duodenal ulcers, thromboembolism of mesenteric vessels; jaundice syndrome; abdominal organ injury syndrome closed injury abdomen with damage to hollow organs, closed abdominal injury with damage to parenchymal organs.

Emergency care for gastrointestinal bleeding

Position the patient lying on his back, in case of large blood loss, raise his legs, cold on the stomach, IV or IM etamsylate 12.5% ​​2-4 ml, adroxone 0.025% 1-2 ml IM, children 0.3-0 .5 ml, aminocaproic acid orally, 1 tablespoon repeatedly. Mandatory hospitalization.

To combat hypovolemia, plasma-substituting solutions are used: polyglucin, reopolyglucin. Symptoms of bleeding from dilated veins of the esophagus: dilated vessels on the anterior wall of the chest and abdomen, bleeding from the mouth, jaundice, telangiectasia on the skin, ascites, enlarged spleen. liver.

For bleeding from dilated veins of the esophagus, use etamsylate 12.5% ​​IV, aminocaproic acid 5% 100 ml IV, call a special resuscitation team to stop the bleeding with a special probe with an inflatable balloon. With a closed abdominal injury, the general condition is severe, frequent vomiting mixed with blood due to ruptures of the stomach and duodenum, the abdomen is of a normal shape, sharply painful on palpation, board-like tension of the abdominal muscles, weakening of bowel sounds. It is necessary to transport the patient on a stretcher to the trauma department.

A condition requiring emergency care is hepatic coma. Its symptoms are lethargy or agitation, convulsions, yellowness of the sclera and skin. dark urine, enlarged or decreased liver, increased vascular pattern on the anterior abdominal wall, ascites, nosebleeds, Kussmaul breathing, bradycardia, decreased blood pressure.

The tactic is hospitalization in the intensive care unit. Another emergency is perforated ulcer stomach and duodenum, characterized by sharp pain in the epigastrium or right hypochondrium, pain radiating to the subclavian region, scapula, spreading throughout the abdomen. Vomiting may occur when peritonitis develops. Emergency hospitalization to the surgical department is indicated.

It is important to remember that in the event of any emergency conditions, urgent hospitalization is indicated.

Prevention and treatment principles

The principles of treatment of the digestive system organs are reduced to eliminating causes and risk factors or reducing their influence, as well as eliminating their consequences.

Treatment of gastroenterological pathology is always long-term and systematic. Alcohol and smoking are prohibited and food intake must be observed.

A diet is prescribed depending on the disease. Developed special diets for various diseases, the so-called medical treatment tables. When treating gastric and duodenal ulcers, table No. 1, 1a, 1b is prescribed; for chronic acute gastritis, enteritis table No. 2 is shown; for constipation, table No. 3; for intestinal diseases with diarrhea, table No. 4; for diseases of the liver and biliary tract, table No. 5. In the treatment of gastric and duodenal ulcers and erosive esophagitis, a high-tech group of proton pump inhibitor drugs is used. They are prescribed to eliminate pain and dyspeptic symptoms. These drugs include rabeprazole, lansoprazole.

H2 receptor blockers (ranitidine), antibiotics, and bismuth subsalicylate are also used in the treatment of diseases of the gastrointestinal tract. Prevention of diseases of the digestive system includes, first of all, adherence to a diet and exclusion of fatty, spicy, smoked, highly salted, fried foods.

For existing chronic diseases, outpatient observation, examination by a therapist 1-2 times a year and preventive treatment in a sanatorium. Of course, routine medical examinations play an important role in identifying various pathologies.

Medical and social assistance in teenage rooms, conversations with teenagers on the topic of a healthy lifestyle and giving up bad habits are also used in the disease prevention system.

digestive ulcerative gastritis

Conclusion

The topic of digestive diseases is very relevant in the modern world.

Knowing the etiology of diseases and the resulting changes in the body, diagnostic methods have been developed, and various clinical researches medications for the highest quality therapy in gastroenterology.

Thanks to new modern knowledge and diagnostic methods, the most effective preventive work is carried out with the population to reduce the occurrence of diseases of the gastrointestinal tract, as well as to identify these diseases in the early stages of their development.

List of used literature

1. Gromnatsky N.I. Internal diseases.-M.: MIA, 2010-688p.

2. Gromnatsky N.I. Diagnosis and treatment of internal diseases.-M.: MIA, 2006-522p.

3. Eliseev Yu.Yu. Internal diseases.-M.: Kron-Press, 1999.- 848 p.

4. Eliseev Yu.Yu., Berezhnova I.A. Directory of the local therapist.-M.: Saratov, 2003-809p.

5. http://bibliofond.ru

Posted on Allbest.ru

Similar documents

Characteristics of the basic principles and rules of herbal medicine for diseases of the gastrointestinal tract: gastritis, gastric ulcer and duodenal ulcer. Medicinal plants used: large plantain, smooth licorice, cordate linden.

course work, added 10/29/2013


General characteristics of diseases of the stomach, intestines and duodenum. Clinical symptoms of gastritis, peptic ulcer and stomach cancer. Major diseases of the liver and pancreas. Caring for patients with diseases of the digestive system.

presentation, added 02/11/2014


Etiology of diseases of the digestive system, symptoms and syndromes. Forms of damage to the biliary tract, methods of clinical examination of the patient. Emergency conditions and emergency care for diseases, prevention and principles of their treatment.

abstract, added 11/24/2010


Causes, course, diagnosis and treatment of diseases of the digestive system. Localization of pain in diseases of the liver and biliary tract. Help with biliary colic, vomiting. Gastric lavage, duodenal intubation. Endoscopic research methods.

abstract, added 12/23/2013


Main symptoms for diseases of the gastrointestinal tract. Causes and specific treatment of vomiting. Signs, diagnosis and treatment features of gastritis, hepatitis, cholelithiasis, cirrhosis of the liver and ulcers of the stomach and duodenum.

abstract, added 11/29/2009


Classification, pathogenesis, clinical picture and complications of gastric and duodenal ulcers. Diagnosis and treatment of peptic ulcer. The effect of alcohol on the secretory and motor functions of the stomach. Emergency care for gastrointestinal bleeding.

course work, added 03/11/2015


Endoscopy of the gastrointestinal tract, its essence and features. Esophagogastroduodenoscopy and gastroscopy, their role and significance for examining the esophagus and stomach. Preparing patients for endoscopic examinations of the gastrointestinal tract.

course work, added 05/31/2014


Classification of diseases united by the concept of "acute abdomen". Clinical picture, nursing care, symptoms and treatment of acute appendicitis, pancreatitis, cholecystitis, perforation of ulcers, gastrointestinal bleeding. Stages of the nursing process.

presentation, added 12/04/2016


Duodenal ulcer, heartburn, acute and chronic gastritis. Main symptoms of the disease, complications, therapeutic nutrition. Types of enteritis, treatment. Causes and prevention of stomach ulcers. Spicy and chronic colitis, treatment.

abstract, added 06/02/2015


Consideration of the problem of preventing diseases of the gastrointestinal tract - gastritis and ulcers of the stomach and duodenum. The use of plantain, licorice and cordate linden as phytotherapeutic agents for the treatment of diseases.