Anatomical and physiological features of the gastrointestinal tract in children. Enzymatic activity of saliva at an early age. How is the digestive process in children

Classification of diseases of the gastrointestinal tract A. Diseases of the esophagus: GER, GERD, Esophagitis u B. Diseases of the stomach and 12 - duodenal ulcer: Gastritis (gastroduodenitis), PU u C. Diseases of the biliary system: DGV, cholecystitis (cholecystocholangitis), cholelithiasis u D. Diseases of the pancreas: dyspancreatism, pancreatitis u E. Bowel diseases: IBS, UC, Crohn's disease 2 u

Features of diseases of the gastrointestinal tract in children 1. The prevalence of diseases of the digestive system in children: ● place in the structure of general morbidity ● the place of gastroduodenal pathology among diseases of the digestive system ● the degree of increase in incidence ● the causes of the increase in morbidity ● the prevalence of gastroenterological pathology depending on age 3

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

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

RISK FACTORS AND DEVELOPMENT OF CGD, PU I. Endogenous 1. Heredity u Markers of hereditary burden in PU u Blood group specificity u Gastrointestinal hyperreactivity u Type of higher nervous activity, personality traits, anthropometric indicators 6

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

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

CGD, PU Pathogenesis predisposition + prolonged exposure damaging factors violation of the ratio between the factors of defense and aggression Defense factors u Slime layer, Epithelial regeneration, Blood flow in CO, Local immunity factors of aggression u Hydrochloric acid, Pepsin, Bile acids, Medicines, Helicobacteria, Viruses 10

CHRONIC GASTRITIS, PUMP immune systems, u imbalance between local factors of "aggression" and "protection", u violation of regeneration u damage to the mucosa and 12-n intestine Prevalence!! u 11

CHRONIC GASTRITIS GASTRODUODENITIS Form classification 1. Endogenous autoimmune 2. Exogenous - infectious 3. Exo-endogenous Localization 1. Antral 2. Fundal 3. Pangastritis 12

CHRONIC GASTRITIS GASTRODUODENITIS Functionally u Normicid u Hyperacid 1. 2. Stages (phases) of the course Exacerbation Remission 13

CHRONIC GASTRITIS GASTRODUODENITIS Endoscopic stage of PU 1. fresh ulcer stage 2. Epithelialization stage 3. Scarring ulcer stage 4. Complete healing of the ulcer 14

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

CHRONIC GASTRITIS GASTRODUODENITIS 1. Clinical features Variety of complaints 2. Poor objective data 3. Clinical onset - coinciding with school entry (more often) 4. Early stage - symptoms of functional disorders 5. Before puberty 16 girls get sick more often

CHRONIC GASTRITIS GASTRODUODENITIS Ulcer-like CG Pain: aching, of varying intensity, on an empty stomach / 1.5 - 2 hours after eating / night Characteristic: disappearance or decrease in pain after eating Dyspeptic complaints: heartburn!!!, belching!! Vomit! Appetite is good!!! Palpation: pain in the epigastrium / pyloroduodenal zone (typical) General symptoms Secretory function: normal / EGDS: AH / bulbitis (typical) H. Pilory 17

CHRONIC GASTRITIS GASTRODUODENITIS Gastritis-like CG Pain: early, aching in the epigastrium, disappear after 1-1.5 hours. Fast saturation!!! Appetite lowered/selective!!! Dyspeptic complaints: belching with air!!!, nausea!!, vomiting of food! Palpation: diffuse tenderness Secretory function normal / EGDS: FG / Pangastritis Histology: atrophy, metaplasia 18

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

ULCER DISEASE Peculiarities of PUD in children For childhood, an atypical course of PUD is characteristic 1. There is no Moynigan rhythm, there is no recurrence and stereotyping of pain 2. Classical course -

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

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

CHD, PU Diagnosis 1. CLINIC + medical history 2. Endoscopy with biopsy of gastric mucosa and duodenum; with ulcerative disease detection of a peptic ulcer 3. Histologically: the degree of inflammation, dystrophy, dysregeneration 4. Secretory function of the stomach: fractional gastric intubation, intragastric r. Nmetric 5. motor function stomach: u EGDS: pathological refluxes, dysfunction of sphincters u Ultrasound of the stomach u EGG 6. X-ray with barium sulfate? 23 7. Diagnosis of HP

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

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

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

CHD, PU Correction of gastric hypersecretion 1. Non-absorbable antacids: almagel, maalox, phosphalugel 2. Antipeptics: venter, sucralfate 3. Gastroprotective drugs: de-nol, ventrisol, tribimol 4. H-2 histamine blockers III generation: ranitidine, famotidine 5. Proton pump inhibitors: omeprazole, pantoprazole, lansoprazole, rabeprazole 6. Mineral waters 27

CHD, PU Correction of motor disorders u antispasmodics of smooth muscles: noshpa, papaverine u anticholinergics with antispasmodic action: belloid, metacin, buscopan, platifillin u prokinetics: metoclopramide (syn. Cerucal), domperidone (syn. Motilium), coordinates in 30 min before meals. Course 10 -14 days. Correction of neurovegetative disorders u sedative therapy: valerian extract, motherwort infusion, peony infusion u tranquilizers (according to indications): rudotel, diazepam, meprobamate Stimulation metabolic processes, defensive forces organism, processes of CO regeneration u gastrofarm, riboxin, vit. U, methyluracil, pentoxyl, vitamins A, E, B, folic acid and others. Physiotherapy of "deep" impact on the organs of the upper section digestive tract u diadynamic currents, ultrasound, inductothermy, EHF 6. Therapeutic exercise 7. Herbal medicine 28 7. Sanatorium-resort treatment

CHD, PU Principles of antihelicobacter therapy Colloidal bismuth subcitrate (De-nol) 8 mg/kg; max -480 mg/s); Antibiotics: u amoxicillin (flemoxin-solutab, hiconcil-25 mg/kg; max 1 g/s), u azithromycin (sumamed-10 mg/kg; max-1 g/s), u clarithromycin (fromilid 7.5 mg/s). kg; max500 mg/s), u roxithromycin (rulid-5 -8 mg/kg; max-300 mg/s) 3. Macmiror -15 mg/kg, furazolidone-20 mg/kg, metronidazole -40 mg/kg 4 Omeprazole (losek-maps 1 mg/kg, rabeprazole 1 mg/kg) 29

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

CHD, PU Eradication therapy regimens in children B. Triple therapy with bismuth preparations: 1. Bismuth subcitrate + amoxicillin / clarithromycin / roxithromycin / azithromycin + macmiror / furazolidone 2. Bismuth subcitrate + clarithromycin (fromilid) / roxithromycin / azithromycin + camoxicillin C. : bismuth subcitrate + amoxicillin / roxithromycin / clarithromycin / azithromycin + macmiror / furazolidone + omeprazole (losek-maps) / ranitidine / rabeprazole 31

CGD, PU Clinical examination: CGD - 5 years? , PU - for life. Frequency of observation: In the 1st year after the exacerbation - 4 times, from the 2nd year - 2 times a year. The main methods of dynamic control: clinic + EGDS (?) + detection of HP 3-4 weeks 32

Diseases of the hepatobiliary system Structure: - biliary dyskinesia - 92.2% - chronic cholecystitis, cholecystocholangitis, cholelithiasis - 6.6% - chronic hepatitis - 1.1% . , forms Zh.P. partitions, constrictions, kinks Diagnostic methods: ultrasound (basic) 35

Dyskinesia of the biliary tract D F B P - violation and discoordination of the tone of the sphincter apparatus and / or u motility of the gallbladder and bile ducts u violation of the passage of bile into the intestine Provoking factors - inadequate level of physical and psycho-emotional stress - nutritional errors: especially fried and fatty food - diseases of the stomach, intestines, liver, etc. etc. 36

Biliary dyskinesia Classification J. V. P 1. Hypertonic-hyperkinetic increased tone and motility J. V. P. 2. Hypotonic-hypokinetic form reduced tone and motility J. V. P. More often in children - hypertensive and mixed form J. W. P. 37

Dyskinesia of the biliary tract Clinic 1. Hypertonic form CHARACTERISTIC AND KA B O L AND u paroxysmal!!! u stitching u connection with errors in diet u 30-40 minutes after ingestion cold food u physical activity: running, long walk u localization right hypochondrium u umbilical region - younger age u short-term - 5-15 minutes seasonality of exacerbation - autumn - spring 38

Dyskinesia of bile ducts 2. Hypotonic form H A R A K T E R I S T I K B O L I u aching!!! u stupid u connection with errors in diet u 1-1, 5 hours after eating - especially fatty u negative emotions u localization - right hypochondrium with family predisposition!!! seasonality of exacerbation - not typical 39

Dyskinesia of the biliary tract Dyspeptic complaints: u loss of appetite u nausea u vomiting (less often) u intolerance to fatty foods, u bitterness in the mouth (sometimes a sign of GHD) u unstable stool Objectively: u asthenovegetative reactions u positive s-we Kera, Ortner, Mussy, u moderate hepatomegaly (more than 70% of children) 40

Acute cholecystitis Predisposing conditions: stagnation of bile in Zh. P. Signs are characteristic: t 0 - b about l and cramping in the right half !!! intensify - on the right side; duration of pain attack - from several minutes to several hours - nausea, vomiting - jaundice (in 50% of cases) - symptoms of intoxication Objectively: bloating! , lag of the upper sections during breathing; muscle stiffness abdominal wall on the right Positive s-we Mendel, Ortner, Murphy, often see Shchetkin - Blumberg. KLA: leukocytes, ESR 41

Chronic cholecystitis is rare in children. Predisposing factors: JV anomalies, dyscholia. factors Often accompanies cholelithiasis and D. B. R. Characteristic features: - stereotypy, the presence of periods, signs of exacerbations with severe intoxication, subfebrile condition (possible) Syndromes: - pain (right-subcostal); - dyspeptic; inflammatory-intoxication; - astheno-vegetative; cholestatic Pain and paroxysmal (characteristic during exacerbation), occur h / s 1.5-2 hours after an error in the diet (fatty, fried foods), radiating (to the right shoulder and shoulder blade). Objectively: muscle resistance in the right hypochondrium!!!, s-m Objectively Ortner, Murphy, Mendel; soreness in Chauffara Laboratory research: - globulin, fibrinogen, leukocytes, ESR; possibly transaminases, bilirubin, lipoproteins 42

Cholelithiasis- dystrophic-dysmetabolic disease, with the formation of stones in the gallbladder or in bile ducts The reasons for the formation of cholelithiasis in children: - diseases that occur with hemolysis - familial hypercholesterolemia - hepatitis, inflammatory lesions of the biliary system - factors leading to the development of cholestasis - diabetes mellitus Pathogenesis: bile stasis, dyscholia, inflammation Clinical picture: cholelithiasis has a latent pattern for !!! Symptoms: cholecystitis, obstruction J. W. P. Symptoms Complications are rare! 43

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

PRINCIPLES OF THERAPY OF DISEASES OF THE HEPATOBILIARY SYSTEM Diet No. 5 according to Pevzner: nutrition 4-5 times; exclusion of fatty, fried foods; enrichment of the diet with fiber, vegetable oil. DZHVP Hypotonic hypokinetic form: 1. products of choleretic action: butter and vegetable oils, cream, sour cream, eggs, fruits, vegetables, black bread reflex stimulation of motility of Zh. 3 times a week 3. neurotropic antidepressants: phenibut, melipramine 4. thermal treatments: period of exacerbation 45

PRINCIPLES OF THERAPY FOR DISEASES OF THE HEPATOBILIARY SYSTEM Hypertonic - hyperkinetic form: 1. Choleretic: - allochol, cholenzyme, chologon - true choleretics, contain bile acids - plant origin - flamin, cholagogum of chemical synthesis - nicodine, oxafenamide, tsikvalon - hydrocholeretics - valerian, ginseng, corn silk, mineral water 2. Neurotropic drugs - tranquilizers: sibazon, nozepam 3. Antispasmodics: papaverine, nosh-pa, odeston 4. Cholinolytics - belladonna, bellataminal, metacin 46

Principles of therapy (continued) Acute cholecystitis (exacerbation): regimen!!!, hunger, plenty of fluids, antibiotics, antispasmodics, analgesics, infusion therapy, antienzymatic drugs. Surgical intervention: for complications biliary colic:!!! pain relief: inside 0.1% atropine (1/2 drops per year of life per reception) or belladonna extract (1 mg per year of life per reception), papaverine, no-shpa, spasmolitin, theophylline or theobromine. With inefficiency - in / m baralgin or platifillin, atropine sulfate, papaverine. With intractable colic - promedol or pantopon with atropine Chronic cholecystitis: diet (in acute period mechanically sparing, with restriction of salt, fats and proteins), JVP therapy; in the period of exacerbation - nikodin or oxafenamide, tsikvalon, furazolidone. Vitamin therapy (mandatory): in the acute period (Vit A, C, B 1, B 2, PP; later - courses of vitamins B 6, B 12, B 15, B 5, E) GSD: the principles of the above therapy + litholytic agents ( mainly with cholesterol gallstones) ursofalk (10 mg / kg), chenofalk (15 mg / kg), lithofalk (7 mg / kg) in courses of 6-24 months. With inefficiency - 47 cholecystectomy

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

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

PANCREATOPATHY Dyspancreatism: reversible dysfunction without morphological changes PAIN AND: unstable, diffuse Localization: epigastrium, hypochondrium, points and zone of the pancreas Dyspeptic disorders: nausea, flatulence, belching Coprogram: norm (m. b. Norm) Endoscopy: signs of duodenitis, papillitis 51

PANCREATOPATHY Reactive pancreatitis: interstitial pancreatitis against the background of gastroduodenal or biliary diseases P O L I: intense, above the navel, irradiation to the left and to the back Pain: Chauffard zone, t. diarrhea!! Coprogram: normal or non-permanent steatorrhea Blood and urine amylase: ultrasound: pancreas, fuzzy contours, echogenicity EGDS: signs of duodenitis, papillitis 52

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

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

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

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

Classification of colitis According to the ICD X revision, chronic IBD includes u Crohn's disease [regional enteritis] (K 50) u Ulcerative colitis (non-specific) (K 51) Crohn's disease [regional enteritis] (K 50) u Crohn's disease of the small intestine (K 50. 0) u Crohn's disease of the colon (K 50.1) u Other varieties of Crohn's disease (K 50.8) 57

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

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

Inflammatory bowel disease (IBD) Clinical picture Variants of the onset of the disease: acute (not typical; the development of the clinical picture within 1-3 days); gradual (characteristic; basic symptoms - blood and mucus in a mushy or shaped stool - develops within 1-3 months or over several years) Course: 1. Acute (uncharacteristic; observed in 12% of patients, more often in children under 11-10 years old) 2. Chronic (typical for of all age groups; 88% of patients; has periods of exacerbation and remission) 2. 1. chronic relapsing (remission is achieved within 6 months after the first attack and lasts more than 4 months; in 36% of patients) 2. 2. chronic continuous course (after 6 months after the first attack, there is no remission and there is a progressive, 60

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

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

Inflammatory bowel disease (IBD) Endoscopic classification of UC activity: 0 - degree of activity (remission) - pale CO, visible vessels 1st degree (mild act) - erythema, slightly granular surface, weakening (loss) of the vascular pattern 2nd degree (died act.) - solitary ulcers, velvety SO, contact and spontaneous bleeding 3rd degree (high act) - pus, spontaneous bleeding, multiple ulcerations The most informative EGDS signs in children: contact bleeding of the mucosa from minimal to the symptom dew", absence of vascular pattern, erosion or traces of small healed erosions Histological signs: - lymphoplasmacytic and eosinophilic 63 infiltration, and - violation of the crypt architectonics and - reduction

Inflammatory bowel disease (IBD) Crohn's disease is a non-specific chronic progressive disease characterized by transmural granulomatous inflammation of various parts of the gastrointestinal tract, clinically manifested by pain and diarrheal syndromes. The incidence of CD is 30-35 cases per 100,000 population. The peak of the disease is 15-35 years (they can get sick at any age). When defeated terminal departments the ileum predominantly suffers from vitamin B12 and bile acid absorption and bile acid-associated fat absorption; absorption of zinc, vit. A, E 64

Inflammatory bowel disease (IBD) Causes of diarrhea in CD: resorptive capacity of the inflamed intestinal mucosa, insufficiency of its enzymatic activity, activity of pancreatic enzymes The severity of diarrhea depends on the prevalence and level of damage to the small intestine: the higher it is, the more severe the course of the disease Hemocolitis joins in 40% of cases , usually in the later stages, and does not depend on the localization of the process Pain syndrome (): at the beginning of the disease - local (irritation of the peritoneum due to excessive gas formation), later diffuse - intense paroxysmal pain (due to stasis of intestinal contents, complete or partial obstruction) CD in young children: rapid development of dehydration, muscle hypotension, tachycardia, arterial hypotension; Objectively: abdominal distension, dilated intestinal loops are palpable. With the progression of the process, protein-free 65 edema, fatty degeneration of the liver, nephropathy are added.

Inflammatory bowel disease (IBD) Extraintestinal manifestations u Most common: arthritis (similar to the RA clinic of symmetrical joint lesions and morning stiffness), arthralgia, erythema nodosum, pyoderma, aphthous stomatitis; u Possible: damage to the eyes (iridocyclitis, uveitis, episcleritis), biliary tract (pericholangitis, cholestasis), reactive hepatitis, amyloidosis of various organs Complications: Local - caused directly by inflammation of the CO: intestinal strictures (the most common complication), perforation of intestinal ulcers in the abdominal cavity (rare), fistulas (external, with access to the skin, and internal - open into the loops of neighboring intestines and hollow organs), abscesses (near rectal), persistent anal fissures, toxic dilatation of the colon. Systemic - extraintestinal manifestations of CD 66

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

Inflammatory bowel disease (IBD) Diet - with the exception of dairy products, carbohydrate restriction, enriched with proteins The main groups of drugs for the treatment of IBD in the acute phase: 1. Drugs that directly release 5-aminosalicylic acid (mesalazine), or drugs in which 5-aminosalicylic acid acid is formed in the process of splitting the active substance already in the intestine (sulfasalazine - for children of the first years of life!) 2. Topical (budesonide) or systemic corticosteroids (prednisolone) 3. Immunosuppressants (azathioprine, mercaptopurine) Antimicrobial drugs - for sanitation of the intestine from pathogenic and conditionally - pathogenic flora Enzymatic deficiency: pancreatin, mezim forte, creon Exhausting diarrhea - imodium. Enteral nutrition (according to indications). Surgical treatment 68

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

NUC. Ulcerative polypoid stage u a. Inflamed, ulcerated mucous membrane covered with purulent exudate. u b. Mucosal outgrowths (inflammatory polyps or "pseudopolyposis"). 75

BK. Ulcerative stage. Deep linear ulcers located on the edematous mucous membrane in the form of a "cobblestone pavement" 76

List of gastrointestinal diseases in children

The formation of the work of the gastrointestinal tract () occurs in the first year of a child's life. It is during this period that almost all babies suffer from functional disorders associated with the immaturity of the digestive system. Such disorders bring a lot of worries, but usually when a child reaches 3- one month old, they disappear.

There are also birth defects systems of the gastrointestinal tract that require surgical intervention. It is important to notice suspicious symptoms in time, and contact a specialist.

In this article, we will consider the main diseases of the gastrointestinal tract of a child that any young mother may encounter.

stomach cramps

The most common problem is stomach cramps and excess gas. This disorder is a completely natural process due to insufficient maturity of the microflora of the stomach. There are many reasons that provoke this phenomenon from the outside. So, if the mother is not breastfeeding, the mixture may not suit the baby. Also important role plays feeding baby. Excessive swallowing of air provokes gas formation, causing discomfort to the baby.

Colic goes away on its own as soon as the baby's digestive system gets a little stronger. A properly organized feeding process, the diet of a nursing mother, massage, dry heat, and the use of symbiotics will help speed up and facilitate this process.

Vomit

A fairly common symptom that can indicate a number of diseases, but can also be a physiological process.

If vomiting is frequent, with a "fountain", while the child's skin is pale, the temperature rises - this is a reason to consult a doctor. Such symptoms appear with viral diseases, intestinal infections, injuries of the abdominal organs.

Single vomiting after eating may be the result of overfeeding. It should be remembered that immediately after feeding the child can not be laid.

regurgitation

The physiological process due to the capture of large volumes of air during feeding, as well as the anatomical and physiological characteristics of the child's stomach. Regurgitation does not cause autonomic disorders and changes in the mood of the child. To solve the problem, it is necessary to reconsider the tactics of feeding, to exclude overfeeding.

If regurgitation is accompanied by vomiting, and the child is not gaining weight well, this may be a reason to contact a specialist.

Violation of the patency of the gastrointestinal tract

Due to the insufficient development of the child's digestive tract (esophagus, intestines, etc.). The process of food processing slows down, the stool becomes irregular, which leads to pain, gas, bloating, and other troubles.

Cardiospasm. An anomaly of the esophagus, characterized by the presence of spasms at the site of its transition to the stomach. In children, it is manifested by vomiting, "pressure" during meals.

Pylorospasm. Disorder of the pyloric part of the stomach. It is characterized by vomiting "fountain", frequent regurgitation, disorders of the baby's nervous system.

These diseases necessarily require careful diagnosis (including radiography). In case of violation of the work of organs, but the physiological norm, conservative treatment is prescribed.

Congenital obstruction of the digestive tract

It is characterized by a violation of the passage of food through the digestive tract due to the presence of malformations of their location. After a thorough diagnosis, urgent surgical intervention is required. For example, with bowel obstruction, feces cannot pass naturally, thereby releasing toxins into the blood. This condition is dangerous for the life of the baby.

The main symptoms of this disease are problems with stool, vomiting, pale skin color of the child.

Dysbacteriosis - a state of deficiency in the intestines beneficial microflora. It is characterized by acute intestinal disorders, bloating, loose stools, poor weight gain. Treatment includes introducing mixtures with beneficial bacteria into the baby's diet (if breastfeeding is not possible). Special preparations are prescribed to suppress the growth of opportunistic microorganisms, with a further population of the intestinal microflora by bacteriophages.

Alimentary dyspepsia - indigestion due to malnutrition. Overfeeding, non-compliance with the rules for the preparation and storage of mixtures, a quick transition to artificial nutrition, improper selection of the mixture - all these factors cause dyspeptic disorders.

Prevention of diseases of the digestive tract in newborns

It is necessary to monitor the condition of the child, and not to miss important symptoms. Whenever possible, the mother should breastfeed her baby. Milk contains all the necessary elements for the population of the child's sterile intestines with beneficial bacteria. This is an excellent prevention of dysbacteriosis and intestinal infections, which can be easily "caught" even in the hospital.

A young mother needs to follow the correct feeding regimen for a child. It is easy for mothers who are breastfeeding to observe it - the child himself will give up the breast when he is full. For mothers of babies artificial feeding It is worth remembering - it is better to underfeed than overfeed. Overeating will not bring the baby any benefit, but it will add problems. Also, do not supplement a child under the age of 6 months with sweet tea or juice. Artificial babies can be given some water in between feedings. Babies don't need anything other than breast milk.

The work of the digestive organs at an early age has its own specific features and therefore, not every specialist in the treatment of adult patients can accurately diagnose and choose the best way to treat diseases of the gastrointestinal tract in a child. Is engaged in the identification and treatment of diseases of the digestive system in a child pediatric gastroenterologist. A highly qualified gastroenterologist can recognize and prescribe a course of treatment for such diseases of the gastrointestinal tract in a child as gastritis, sigmoiditis, esophagitis, hepatitis, peptic ulcers (duodenal ulcers, stomach ulcers), duodenitis, colitis and others.

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

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

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

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

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

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

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

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

Why does the child have a stomachache? The most common causes of digestive disorders in children that are encountered pediatric gastroenterologist in my medical practice:

1. Overeating
It often occurs in very young children. Do you ever refuse your child a supplement? Do not be surprised if, after some time after overeating, the child begins to complain of pain in the tummy, he develops lethargy, apathy, slight nausea.
If this happens, put the baby to bed and if he vomited, let him drink some water. Enzyme preparations can significantly alleviate the condition, but they can be given only after consulting a pediatrician!
And most importantly - try to teach your child to eat in moderation!

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

3. Constipation
You should be alerted by too rare bowel movements in a child (only a few times a week), as well as the appearance of periodic pain in the tummy and frequent flatulence.
What to do: Be sure to take the child to the examination to a pediatric gastroenterologist. Constipation can be the result of functional disorders of the pancreas or thyroid gland, as well as the liver. But similar reasons are not common and in most cases it is enough to change the lifestyle and diet of the child. Give your child more foods that perfectly activate the work of the intestines, maintaining the balance of microflora - acidophilus milk, yogurts with bifidobacteria, kefir, as well as dried fruits (dried apricots, prunes, raisins) and raw and boiled vegetables (carrots, beets, apples, tomatoes) .
Constipation in a child can also be the result of dehydration - give the baby as much liquid as possible (juices, fruit drinks, compote).
The best way to deal with constipation in a child is to eat a nutritious diet, drink plenty of fluids and walk more in the fresh air.

4. Pathogenic bacteria
One of the most common disease causing bacteria digestive system are salmonella and shigella.
Symptoms of salmonellosis in a child are fever, diarrhea, diarrhea, vomiting, abdominal cramps.
What to do? Be sure to show the child to the pediatrician to clarify the diagnosis. Usually a course of antibiotics is prescribed. Treatment begins with the use of sorbents - activated carbon, sillard, smectite.
With shigellosis (dysentery) in a child, the child's body temperature rises to 38-39 degrees, watery stools appear mixed with mucus and blood, painful urge to defecate.
What to do? Be sure to take the child to the pediatrician for examination. Treatment for dysentery is usually antibacterial drugs. Be sure to give a glucose-salt solution, and when the baby gets better, replace it with a weak solution of unsweetened tea. Diet for dysentery - steam cutlets, cereals, baked apples. Give more fruits, berries and vegetables (wash them thoroughly).

5. Viral diseases
A fairly diverse group of pathogens - enteroviruses lead to indigestion in a child.
Enteroviral diarrhea. Absolutely any child can get sick by taking a dirty toy in his mouth or talking with an infected peer. Usually enterovirus diarrhea affects children under the age of 4 years. Symptoms - fever up to 38 degrees, cough, stuffy nose, sore throat. For symptoms of diarrhea, check with your pediatrician for the dosage of cold medicines and the treatment regimen. Let your child drink as much liquid as possible. Engage in boosting your child's immunity.
Another disease caused a certain kind enteroviruses - Hepatitis A in a child. The infection is transmitted through personal hygiene items, contaminated dishes, tap water (if the child drank raw water). Symptoms - the temperature rises sharply, the child is tormented by nausea and sharp pains in a stomach. The stool becomes discolored, and the urine becomes dark yellow. Yellowness of the whites of the eyes appears, then the face and then the whole body (signs of infectious jaundice).
With hepatitis A, the child will have to lie down for some time in the hospital. Diet for hepatitis A - vegetable soups, dietary meat (rabbit, turkey, chicken meat), stewed, boiled and raw vegetables.
The best cure for hepatitis A is vaccination. Encourage your child to eat only washed fruits and to wash their hands thoroughly before eating.

6. Acetonomic Crisis
Causes of occurrence - malnutrition, frequent overwork, long trips - severe stress for the child's body, leading to excessive production ketone bodies in the blood (acetoneacetic acid and acetone).
Symptoms - the child often vomits undigested food mixed with bile. The temperature rises, there are severe pains in the abdomen. From the mouth of the child smells of acetone.
Be sure to take the child to the examination to a pediatric gastroenterologist to clarify the diagnosis. Every five minutes, give your child a teaspoon of a solution of rehydron or alkaline mineral water without gas. Make an enema to cleanse the intestines (2 teaspoons of soda per 200 grams of water). Give the child a sorbent (Polysorb, Smecta, Sillard). Diet - for several days, give the baby cereals, crackers, mashed vegetable soups.
A complete diet and the exclusion of stressful situations will prevent the recurrence of the child's illness with an acetone crisis.

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

Obstruction of the gastrointestinal tract - what is it? Obstruction of the gastrointestinal tract (GIT) is a syndrome characterized by a violation of the movement of intestinal contents due to a mechanical obstruction or functional impairment motility.

Diseases of the gastrointestinal tract (gastrointestinal tract)

Diseases of the gastrointestinal tract (GIT) are becoming more and more common. The active way of life of a modern person often does not leave time for the calm consumption of wholesome food. Fast food snacking has reached the level of a significant problem.

Stress and ecology, regular use of antibiotics followed by dysbacteriosis complete what was started by malnutrition, and as a result, a person begins to get sick: the organs cannot withstand the harsh attack of adverse factors.

Diseases of the gastrointestinal tract significantly rejuvenated. Gastritis has become a mass phenomenon even in primary and secondary school, a significant part of children of different ages suffer from dysbacteriosis. As a result, such serious diseases of the digestive tract as colitis of various origins develop, problems with the pancreas begin, which leads to a predisposition to diabetes mellitus.

That is why diseases of the gastrointestinal tract should be detected and treated in time before they begin to take a chronic form.

Symptoms and treatment of diseases of the gastrointestinal tract

Knowing the symptoms of gastrointestinal diseases, and you can think about treatment. The symptoms are quite rich, paying attention to its features, you can not only confidently contact doctors, but also take care of more proper nutrition, mode and other therapeutic and preventive measures.

Symptoms of housing diseases include:

The "top" of the abdomen is occupied epigastric region and hypochondrium (right and left, respectively). This is a kind of arc, the pain on which is characteristic of colitis, an inflammatory process in lower esophagus, fundic gastritis, gastric dilatation and initial stage food poisoning.

If vomiting also joins this symptom, then it is appropriate to assume that this is an ulcer, but in the stomach or in duodenum difficult to determine. In addition, it is also characteristic of intestinal obstruction.

In the right hypochondrium is the liver and, located under it, the gallbladder. Strong pain and colic usually come just from them. A similar feeling on the left is inherent in gastritis (especially in tandem with nausea and its consequences), acute pancreatitis and other digestive diseases.

The middle of the abdomen is reserved for mesogastrium. In the umbilical region, the concentration of pain is associated with
intestinal dysfunctions. This may be inflammation of the small intestine, enteritis, Crohn's disease, etc.

At the same level, only on the right, pain is assigned to hepatitis, and on the left - ulcerative colitis, inflammation of polyps and problems with the colon.

Hypogastrium, he is the lowest "level" of the abdomen. Pain in his area rarely indicates diseases of the gastrointestinal tract. More often it comes from the bladder or genitals. But on the right is appendicitis, it can make itself felt in this place, as well as intestinal infections with diseases of the caecum. The left iliac space contains the sigmoid colon, which can become inflamed and painful. It is also appropriate to assume dysentery.

  1. Symptoms of diseases of the gastrointestinal tract help to make the correct diagnosis.
  2. During the initial examination, palpation and listening to the patient, percussion (tapping) are performed.
  3. The history of the disease itself is not enough. Having established, according to the patient, the symptoms of housing and communal services, treatment does not begin without various kinds laboratory and instrumental research(probing, pH-metry, gastrography and manometry). At the same time, it is important not only to determine the disease, but also its root cause, since only its elimination can completely restore the health of the patient.
  4. Radiation diagnostics - ultrasound, X-ray, scintigraphy, is used by a doctor to clarify the diagnosis.

The treatment itself, depending on the result, can be conservative or surgical. At conservative treatment diseases of the gastrointestinal tract, drug treatment is provided, the appointment of various diets, physiotherapy exercises, homeopathic methods can be used.

Sometimes the disease requires surgery. In such cases, the patient is prepared for surgery by restricting food and drink, and if necessary, enemas are given. After an operable intervention, a recovery course is carried out, the main methods of which are the use of antiseptics and antibiotics and strict adherence to prescribed diets.

Features of the treatment of certain diseases of the housing and communal services

Separately, chronic diseases of the gastrointestinal tract, their symptoms and treatment are singled out, since such diseases are neglected and require a long-term serious approach from the doctor and the patient himself.

Common among patients are:

  • Chronic colitis and enterocolitis.
  • Chronic cholecystitis.
  • Chronic pancreatitis.
  • Chronic gastritis and peptic ulcer.

Infectious diseases of the gastrointestinal tract require the attention of a gastroenterologist, an infectious disease specialist. In addition, they very often proceed similarly to other, non-infectious diseases.

Common triggers are:

  1. Bacteria:
  • Typhoid fever.
  • Salmonella.
  • Cholera.
  • Bacterial toxin - botulism.
  • Staphylococcus.
  • Viruses:
    • Rotavirus.
    • Enterovirus.

    The treatment of such diseases is not only the task of destroying the infection, but also the elimination of dehydration of the body, and later a long work to restore the natural microflora.

    Diseases of the gastrointestinal tract in children are different acute course and severe tolerance. They are usually accompanied by severe weakness, rapid dehydration, high fever, and extreme nervousness.

    Often the disease is accompanied by blurred symptoms. According to statistics, the incidence is characterized by bursts of two age peaks, which depend on age and occur at 5-6 years old, 10-11 years old, and are explained by physiological and social distinctive features of age.

    Can hurt:


    Diet for diseases of the gastrointestinal tract

    Diet in diseases of the housing and communal services is almost crucial during the recovery period and important during treatment.

    Its violations can provoke a relapse of the violation.

    1. No. 1. Diet for diseases of the gastrointestinal tract during exacerbation peptic ulcer, chronic gastritis and recovery after acute gastritis. Allows you to normalize the activity of the stomach, its peristalsis, protecting the mucous membranes and providing normal nutrition for the body.
    2. The food includes yesterday's bread (white), soups with heavily boiled cereals seasoned with butter or a mixture of milk and eggs. Meat, fish must be obtained in a ground form - steam cutlets, meatballs are suitable, it is possible to bake with vegetables. Boil or bake vegetables, use non-acidic dairy products fat-free. Drink lightly brewed tea, juices, cocoa, rose hips.
    3. No. 1a) for the same diseases is indicated for the first four days of treatment. A sparing diet for diseases of the gastrointestinal tract allows you to quickly heal ulcers, resist inflammatory processes, is indicated if you have to comply bed rest. All food is consumed grated, liquid or gruel, pre-boiled or steamed. There are temperature restrictions: + 60-15 degrees. Feeding process according to the crushed principle, the last feed is warm milk. Excluded dairy products, vegetables, but cereals, eggs and meat without fat are suitable. Berries as part of decoctions, juices, jelly or jellies.

    4. No. 2b) with the subsidence of the course of peptic ulcer and chronic gastritis with high acidity. Less strict than #1a), it allows non-acid grated cottage cheese, white breadcrumbs, thinly sliced, grated vegetables.
    5. No. 2 is shown at chronic colitis, enterocolitis and gastritis with high acidity. In addition, with concomitant diseases of the pancreas, biliary tract and liver. Temperature-limiting products are excluded; fried products are suitable if a hard crust has not formed after such processing. Yesterday's bread, inedible pastries, meat and fish are not fatty, vegetables and fruits are ripe even at the end of the heat treatment.
    6. No. 3 is designed to improve the activity of the intestines during its chronic problems. Food is fractional, 5-6 times daily. In the morning on an empty stomach 1 tbsp. l. honey with a glass of water. For the evening, dried fruits, kefir. Any bread, but yesterday's baking. Food will heal by boiling or steaming, vegetables are allowed raw. Weak tea, instant coffee, all other drinks are allowed, except for alcoholic and sweet waters.
    7. No. 4 - a diet for diseases of the housing and communal services, with diarrhea. The task is to reduce the number of inflammatory processes, to reduce the development of fermentation and putrefaction in the organs of the housing and communal services. For this purpose, chemical and physical components that can affect the mucous membrane are limited: grated, boiled or steamed food, white bread, can be slightly dried. Meat and fish low-fat varieties passed through a meat grinder several times. Soups and broths, non-acidic cottage cheese, immediately after cooking. Eggs can occasionally be soft-boiled. Cereals - buckwheat, rice, oatmeal. Drink decoctions of quince, dogwood, bird cherry, tea and black coffee.
    8. No. 4b) is prescribed after exacerbation of chronic intestinal diseases, improvement of acute diseases. Recipes for dietary nutrition for diseases of the gastrointestinal tract in such cases include minced meat and fish without fat, fermented milk (without strong acid) products, rice, buckwheat, oatmeal in a well-boiled version. From vegetables, potatoes, pumpkin, zucchini, carrots and cauliflower. Drinks according to the diet option number 1. All food is boiled or cooked in a double boiler, grated or chopped.

    9. No. 4c) - a diet for diseases of the housing and communal services, the purpose of which is to ensure sufficient nutrition of the body with incomplete functioning of the intestinal tract. It is used for recovery after acute intestinal diseases and a period of remission after an exacerbation of chronic diseases. Eat food in 5-6 sittings. Yesterday's bread can be dried fresh, but a small amount of dry cookies is allowed. Baking without muffin, no more than a couple of uses per week. Soups, meat with a minimum amount of fat, are allowed not only chopped, but also a whole piece. All dairy products with a limited amount of fat, mild cheeses. oatmeal, rice, buckwheat dissolve well. Raw fruits - apples, pears, watermelon, oranges and grapes, peeled. Vegetables on diet No. 4b). Drink diluted juices in half with cooled boiling water, milk is added to the usual drinks, but not cream.
    10. Dietary table No. 5 for diseases of the gastrointestinal tract is intended during the recovery period after an exacerbation in chronic cholecystitis and hepatitis, recovery after acute cholecystitis and hepatitis, gallstones, and cirrhosis of the liver. Recipes for such diseases of the gastrointestinal tract include food from a double boiler, boiled, stewed and baked. Only high-fiber foods and tough meats are ground. Nasty pastries with various savory and not spicy fillings. Soups with milk, vegetables, cereals, pasta. Baked meat is allowed without a crust. The dairy group is represented by low-fat cottage cheese and milk. Raw vegetables and fruits are allowed, as long as they are not acidic. The patient prefers sweet dishes, then sweeteners are used instead of part of the sugar. Diet drinks No. 4c).

    Prevention of gastrointestinal diseases

    It is much easier and painless to avoid the disease instead of treating it. Prevention of diseases of the gastrointestinal tract includes elementary rules healthy way life:


    Prevention of gastrointestinal diseases in children follows the same rules, but more attention is paid to the diet and the quality of the dishes prepared. In addition to fried foods, children are limited to the consumption of spicy, too hot or cold foods, sour and sweet.

    It is very important to teach children to always wash their hands before eating, not to eat unwashed vegetables and fruits, to spend money on school breakfasts in the canteen, and not on hot dogs. In addition, categorically exclude products that contain harmful dyes and preservatives, sweet water, unnatural seasonings.

    Exercise therapy for diseases of the gastrointestinal tract

    During the rehabilitation period for diseases of the housing and communal services, physiotherapy exercises (LCF) and herbal medicine are widely used. Exercise therapy for diseases of the gastrointestinal tract helps to improve blood circulation, restore motor functionality, strengthen the muscles of the press and improve the body in general.

    Indications for exercise are diseases:

    • Chronic gastritis and peptic ulcers
    • Colitis and enterocolitis
    • Splanchnoptosis
    • Diaphragm hernia
    • Biliary dyskinesia.

    Exercises consist of tilts in different directions, turns, work of the press and legs. In particular, the legs work in the prone position for extension, flexion, crossing, lifting, breeding.

    With colitis with a tendency to constipation, there are many relaxation exercises, in the case of intestinal atony - with a greater load and the use of power complexes.

    A prerequisite for performing exercises is the state of 2 hours after eating. In addition, calm walking on level ground, swimming and bathing are recommended. Loads are carefully dosed, raised gradually. For some diseases, a special massage is prescribed, capturing certain areas.

    Separate exercise therapy for diseases of the gastrointestinal tract uses breathing exercises, which help not only restore the body as a whole, but also organize proper blood circulation in all problem areas human body.

    In order to get advice or join a group on therapeutic gymnastics, you need to contact a physiotherapist, a specialist in the recovery of patients after diseases of the housing and communal services or a trainer in treated gymnastics.

    If the patient is going to use any complex on their own, it is necessary to first consult a specialist who will take into account not only general diagnosis patient. But also his current state.

    Herbal medicine for diseases of the gastrointestinal tract is indicated, since the patient's body is usually weakened, and freely selected fees can quickly fill human organs with nutrients without damaging the painful areas of the housing and communal services.

    Various infusions, decoctions and juices will help you quickly get rid of beriberi, anemia, they are instantly absorbed and at the same time additionally treat diseases, acting gently and accurately.

    Diseases of the gastrointestinal tract respond well enough to treatment, and even the most difficult problems can often be cured. This is possible only if the patient and the doctor actively cooperate, the patient strictly follows the doctor's recommendations and fulfills all prescriptions even after the disappearance of unpleasant symptoms.

    Diets and LCF can only be a good help in recovery, and not an opportunity for self-treatment.

    Among the most common diseases of the gastrointestinal tract in infants are called astroesophageal reflux, dyspepsia, diarrhea and enterocolitis. Some of them are directly related to the imperfection of the digestive system, others are provoked by hereditary factors or intrauterine failures. But there are also diseases of the digestive system in young children (for example, dystrophy or paratrophy), which appear due to malnutrition.

    Disease of the digestive system in young children

    it fungal infection mucous membrane of the oral cavity, often occurring in infants. The disease is registered in 4-5% of all newborns. The most susceptible to thrush are premature babies, newborns with a weakened immune system, infants who are underperformed. hygiene care, and babies who, for one reason or another, take antibiotics.

    The cause of the disease. This disease of the digestive system in young children causes a fungus of the genus Candida. Frequent regurgitation provokes the development of the fungus.

    Signs of the disease. White spots appear on the mucous membrane of the mouth and cheeks, resembling curdled milk. Sometimes these points merge with each other, forming a continuous film of white-gray color. With a massive lesion, these plaques spread to the mucous membrane of the esophagus, stomach and respiratory tract.

    Treatment. In mild cases, irrigation of the mucous membrane with a 2% solution of sodium bicarbonate or a 10-20% solution of borax in glycerin is sufficient. It is possible to use 1-2% solutions of aniline dyes (methyl violet, gentian violet, methylene blue), a solution of nystatin in milk or water (500 thousand units / ml). The mucosa is treated every 3-4 hours, alternating the means used.

    In severe cases, in addition to local treatment of this disease of the gastrointestinal tract in young children, the child is given orally nystatin at 75 thousand U / kg 3 times a day for 3-5 days or levorin at 25 mg / kg 3-4 times a day for the same period.

    Malformation of the gastrointestinal tract of newborns pyloric stenosis

    pyloric stenosis- a malformation of the upper muscular sphincter of the stomach, associated with the excessive development of its muscles and narrowing of the entrance to the stomach. Boys get sick more often.

    Causes of the disease. The disease occurs as a result of a violation of the innervation of the stomach.

    Signs of the disease. The first signs of this gastrointestinal malformation in newborns appear on the 2nd-3rd week of life, rarely earlier. Occurs in a strong fountain 15-GO minutes after eating. Over time, the weight of the child drops sharply, up to dystrophy, anemia and dehydration develop. Little urine and feces are excreted, constipation appears.

    The duration of the disease is from 4 weeks to 2-3 months.

    For diagnostic purposes, ultrasound, fibrogastroscopy, X-ray gastrography are performed.

    Treatment. Treatment is operative. In the postoperative period, dosed feeding is carried out with the addition of glucose and saline solutions.

    Gastrointestinal disease in infants neonatal reflux

    gastroesophageal reflux newborns is an involuntary throwing of gastric contents into the esophagus with an increase in the tone of the lower and middle esophageal sphincters.

    Causes of the disease. This pathology of the gastrointestinal tract in newborns often occurs against the background of encephalopathy, congenital hernia of the esophagus, with constant overeating.

    Signs of the disease. After feeding, the newborn spits up profusely, after which he vomits. The child is excited and restless.

    Treatment. Switch to feeding with a thick milk formula in an upright position. After eating, the child should be in an upright position for another 5-10 minutes. The last feeding is carried out 2-3 hours before bedtime. To treat this digestive problem in newborns, antacid preparations are prescribed: Almagel 0.5 teaspoon per meal before meals, Maalox 5 ml suspension per meal before meals.

    Pathology of the gastrointestinal tract in newborns dyspepsia

    Dyspepsia simple (functional dyspepsia)- functional disorders of the gastrointestinal tract, manifested by a violation of the function of digestion of food, without pronounced changes in the gastrointestinal tract.

    Causes of the disease. Cause this disorder digestion in young children are errors in the diet, overfeeding or underfeeding the baby.

    Signs of the disease. Children have regurgitation. With the predominant involvement of the stomach in the process after feeding, ordinary vomiting occurs, with the predominant involvement of the intestine - in the form of chopped eggs. In the latter case, frequent stools up to 6-10 times a day are also characteristic. The child may experience painful colic, passing after the passage of gases.

    Treatment. Treatment is based on the elimination of the causes that caused dyspepsia.

    In a mild case, the currents skip 1-2 feedings, liquid is given instead (tea, rehydron, glucosolan, 5% glucose solution).

    In the case of artificial feeding with this disease of the digestive system in young children, a water-tea diet is prescribed for 8-10 hours. The amount of liquid is calculated based on the weight of the child. Liquid is given in small portions. After a water-tea diet, the amount of food is distributed for feeding and is 1/3 of the total need per day. In the following days, 100-200 ml per day is added, by the 4th day gradually recovering to a normal volume. With loose stools, smecta is prescribed.

    Digestive disorders in young children: diarrhea and milk intolerance

    Antibiotic-induced diarrhea- This is a digestive disorder in young children who take antibacterial drugs for a long time.

    Signs of the disease. The disease is characterized by vomiting, lack of appetite, frequent copious watery stools with mucus.

    Treatment. After antibiotics are discontinued, diarrhea is treated.

    Intolerance to cow's milk proteins can occur at any age and occur after consumption of cow's milk-based products.

    Causes of the disease. The child does not have an enzyme that breaks down milk proteins, or there is a very strong allergization of the body to milk components.

    Signs of the disease. The disease begins from the first days of using cow's milk or mixtures prepared on its basis. The greater the volume of milk entering the body, the brighter the intolerance manifests itself. With this disease of the gastrointestinal tract, the newborn is restless, and since he experiences constant pain in the abdomen (colic) - screaming loudly. Flatulence, watery, frothy stools with cloudy mucus are characteristic. In severe cases, the baby vomits immediately after feeding. Bloating, various skin rashes are possible.

    Children lose weight dramatically, their growth and development are delayed, neuropsychiatric disorders appear.

    Treatment. Natural feeding is the best way to protect the child from this pathology, and in the absence of breast milk and the appearance of its intolerance, they switch to special mixtures such as NAN H.A. These are hypoallergenic formulas containing whey protein other than standard cow's milk protein.

    NAN H.A 1 is prescribed in the first half of life, in the second half of the year NAN H.A 2 is shown, which has a higher content of iron, zinc and iodine, meets all the needs of children from 6 months of age.

    Digestive disorders in newborns: celiac disease in infants

    celiac disease occurs as a result of a violation of the digestion of cereal protein - gluten.

    Causes of the disease. Pathology is genetic in nature.

    Signs of the disease. The disease is detected in the first two years of life when you start eating white wheat and black rye bread, as well as dishes made from wheat and rye flour (i.e., foods containing rye, wheat, oats, barley).

    Usually this violation of the gastrointestinal tract in newborns manifests itself with the introduction of complementary foods with cereals. The child develops vomiting, rumbling in the intestines, flatulence, the stomach increases. The stool brightens, becomes plentiful, frothy, sometimes fetid, which indicates a lack of absorption of fat. There is a halt in growth and weight, mental development slows down.

    Treatment. The baby is assigned a gluten-free diet with the complete exclusion of products containing flour and grains cereal crops. Dishes containing flour, pastes, minced meat products, sausages, boiled sausages, sauces, cereal soups are prohibited. During a diet with this digestive problem in infants, buckwheat, rice, soy, vegetables, and fruits are allowed. In the diet, increase the amount of products containing milk, additionally give cottage cheese, cheese, eggs, fish, poultry meat. Of fats, corn is preferable, sunflower oil, from sweets - jam, compotes, jams, honey.

    Violation of the gastrointestinal tract in newborns enterocolitis

    Ulcerative necrotic enterocolitis occurs in children of the first year of life as an independent pathology or intestinal damage may accompany other ailments.

    Causes of the disease. Most often, independent enterocolitis develops in children infected with one or another microorganism in the womb, the process develops against the background of dysbacteriosis, long-term use of antibiotics, sepsis, etc.

    Signs of the disease. There are no typical manifestations of the disease. The child becomes lethargic, eats poorly, after feeding he has constant regurgitation, vomiting often occurs, sometimes with an admixture of bile. At this violation digestion in newborns, the stool is watery, the stool becomes greenish tint. Over time, the abdomen swells, and the venous network becomes clearly visible on its skin.

    If left untreated, the disease can lead to the death of the baby due to perforation of intestinal wall ulcers.

    Treatment. It is recommended that the child be fed only with mother's milk, if breastfeeding is not possible, it is transferred to sour mixtures. Of the medications, lactobacterin or bifidumbacterin are used at 3-9 biodoses per day. If the baby is severely tormented by vomiting, the stomach is washed with a 2% solution of sodium bicarbonate before each feeding. Be sure to introduce vitamins B1, B6, B12, P, PP, C. UHF is done on the solar plexus area.

    Digestive problems in newborns: malnutrition disorders in infants

    Chronic eating disorders are most common in young children and are characterized by:

    • underweight, lagging behind growth norms (hypotrophy);
    • a uniform lag in increasing body weight and height;
    • overweight and height, the predominance of body weight over height.

    Dystrophy- This is a violation of the digestion of the baby, characterized by pathologically low body weight.

    Causes of the disease. Exist alimentary reasons diseases - qualitative and quantitative malnutrition, lack of vitamins. This indigestion in infants can occur with long-term infectious and non-infectious diseases, care defects, due to constitutional reasons, with prematurity.

    With mixed and artificial feeding, especially with unadapted mixtures, quantitative malnutrition occurs, and the level of metabolism decreases.

    Intrauterine malnutrition occurs as a result of impaired fetal development, slowing down its physical development.

    Signs of the disease. With malnutrition I degree thinning fatty tissue in the groin, on the abdomen, under the armpits. Weight loss is 10-15%.

    With malnutrition II degrees subcutaneous fat disappears on the trunk, limbs, its amount on the face decreases. Weight loss is 20-30%.

    With malnutrition III degree(atrophy) subcutaneous fat disappears on the face, weight loss is over 30%. The skin turns gray, the face takes on an senile expression with a reproachful look. Anxiety is replaced by apathy. The mucous membrane of the mouth turns red, the muscles lose their tone, the body temperature is below normal. The child's food endurance decreases, regurgitation, vomiting appear, the stool may be normal or constipation alternates with diarrhea.

    With congenital (intrauterine) hypotrophy in newborns, there is a lack of mass; decrease in tissue elasticity; paleness and peeling of the skin; multiple functional disorders; long-term physiological jaundice.

    Treatment. Treatment of malnutrition is carried out taking into account the causes that caused it, as well as the severity of the disease, the age of the child.

    In a child with any degree of malnutrition, the daily amount of food should be equal to 1/5 of his body weight. At the beginning of treatment, 1/3 or 1/2 of the daily volume of food is prescribed. Within 5-10 days, the volume is adjusted to 1/5 of body weight. The best nutrition is mother's milk or adapted age formulas.

    Nutrition up to the daily volume is supplemented with tea, vegetable broth, rehydron, oralit. The number of feedings is increased by one. A child during this period should receive 80-100 kcal per 1 kg of weight per day. This stage of diet therapy is called the minimum nutrition, when the volume of food is brought to 2/3 of the required, enlites, protein milk are added. When fed with human milk, it is added skim cheese, the amount of drink is reduced by the corresponding volume.

    At the next stage of intermediate nutrition, an increase in the amount of proteins, fats and carbohydrates consumed is required; the daily allowance is made up of 2/3 of the main food and 1/3 of the corrective one. This period lasts up to 3 weeks.

    The period of withdrawal from dystrophy is called optimal nutrition. The child is transferred to physiological nutrition age appropriate.

    As drug treatment infusion therapy is carried out (albumin, etc.), donor gamma globulin is introduced. Enzyme therapy is prescribed during the period of intermediate nutrition for 2-3 weeks (pancreatin, abomin, etc.). Held active treatment dysbacteriosis, complex vitamin preparations are shown.

    In severe cases, anabolic hormones (nerobol, retabolil) are used in age doses.

    Paratrophy is an indigestion infants characterized by overweight.

    Causes of the disease. Excess body weight appears as a result of overfeeding or with excess protein or carbohydrate nutrition, as well as with excessive carbohydrate intake of a pregnant woman.

    Signs of the disease. There are 3 degrees of paratrophy.

    • I degree - weight exceeds age norm by 10-20%.
    • II degree - weight exceeds the age norm by 20-30%.
    • III degree - weight exceeds the age norm by 30-40%.

    In any case, the disease is accompanied by a violation of protein, fat and carbohydrate metabolism.

    Protein eating disorders occur when excessive introduction of cottage cheese into the baby's diet in the 2nd half of life, protein mixtures. The stool becomes dry, acquires White color contains large amounts of calcium. Gradually, the appetite decreases, the child begins to lose weight, anemia occurs.

    With excessive carbohydrate nutrition with a lack of protein, excessive deposition of fat and water retention in the body occur. In this case, the elasticity of tissues usually decreases. The child looks obese. Indicators of physical development by weight are usually above average.

    Treatment. With paratrophy in the first months of life, it is recommended to eliminate night feeding, streamline other meals. Children with carbohydrate overfeeding are limited easily digestible carbohydrates. For protein eating disorders, do not use mixtures enriched with protein. Feeding is given in the form vegetable puree, enzymes and vitamins B1, B2, B6, B12 are additionally used.

    Control over height and weight indicators in children with dystrophies is carried out 1 time in 2 weeks, while nutrition is calculated.

    Massage, gymnastics, long walks in the fresh air are prescribed.

    In older children, the need for carbohydrates is satisfied by vegetable dishes, fruits, vegetable oils, proteins and vitamins are additionally introduced into the diet.

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