Transcript Colon is

Differential diagnosis of intestinal
dysfunctions. Goiter. Modern
principles of treatment and
prevention.
Professor M. Rustamova
Intestinal dysfunction is a violation of the
functions of the intestines
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The main function of the bowel:
Digestion
Induction
Secretory
Motor-èvakuator
Protective
Excretory
Colon is
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The cecum with appendix
Ascending colon
Transverse colon
Descending colon
Sigmoid
Anatomical structure of intestine
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A. small intestine-4 m
Duodenum
Jejunum
Ileal
B. large intestine – 1.5 m starts from
ileocekal′nogo and ends at the rectum and
anus, has two parts:
• Colon
• Rectum
• Pancreatic juice 1.5-2.5 l, intestinal
juice – up to 2.5 l, 0.7 l. -1.0 žel′či per
day.
• In the small intestine of acid chyme is
mixed with pankreatičeskim, intestinal
juice and žel′čû, Ito• GE formed monomers and oligo• measures that are easily absorbed.
• In the small intestine are the basic
substances
• for the body.
• Thanks to the motor
• the functions of the small intestine 1.52.5 l. chyme pass into the large
intestine.
Normal composition of intestinal bacteria
In the human intestine is from 400 to 500
types of microbes. Their number increases
in the distal direction, in the colon –
in 1 g of feces is bacteria 1011.
A. small intestine-4 m
1. duodenum: sterile
2. the jejunum: 0-104 in 1 g content
Anaeroba: none
Aerobic organism, Streptococcus, lactobacillus,
Enterobacteriaceae, Staphylococcus
3. ileal: 105-108 in 1 g contained
žimogo
Anaeroba: bakterioidy, Bifidobacterium longum
Aerobic organism, Streptococcus, lactobacillus,
staphylococci and enterococci, mushrooms
B. large intestine – 1.5 m, 1010-1012 bacteria in 1 g
content
Anaeroba: bakterioidy, Bifidobacterium longum,
eubacteria, Clostridium
Aerobic organism, Streptococcus, lactobacillus,
staphylococci, enterobacteria, mushrooms
The intestine is the largest
immune organ of man
In the intestinal mucosa located about
80% of the immuno-competent cells
25% of the intestinal mucosa consists
of immunologically active fabric
Each meter of the intestine contents of
1010 inhabitants of lymphocytes
The intestinal mucus barrier
• Preèpitelial′nyj protective barrier Protective
mucus
Immunoglobulin A1 and A2 of the glikoproteinami
mucus
• Epithelial (internal) protective barrier
Apical cell membranes, blocking passage into cell
macromolecules
Close the connection blocking intercellular,
intercellular passage into cell macromolecules
3. Postèpitelial′nyj barrier
• Network of blood capillaries and blood flow
to phagocytosis,
• humoral immune responses,
preèpitelial′nogo, epithelial barrier function
4. Intestinal lymphatic system
• vnutrièpitelial′nye t-lymphocytes, Pejerovy
(Peyer) plaque
• In intestinal diseases, intestinal
peristalsis may be speeding up-on or
slowed down.
• OK man defecates 1-2 times a day, CAL is
issued.
• When peristalsis of enhanced ispraž more
liquid, frequent stools, and when slowing
peristalsis-on the contrary.
Diarrhoea
• A painful condition in which there is
frequent or one-time bowel movements
with liquid faecal masses called diarrhoea
(diarrhea).
• Any diarrhea is the clinical aspectsof narušeniyâ suction of water and Electrolitov in the gut. Diarrhea is considered
chronic, if continues for more than 3
weeks. a chair with a mass exceeding 3
Causes of diarrhea may be:
• inflammation of the bowel infekcion-Neu
aetiology (Escherichia coli, ènte-rokokki,
Shigella, salmonella, etc.)
• inflammation of the bowel neinfekciinvestigation of etiology (yak, Crohn's
disease)
• chronic alcohol poisoning
• Venous Stasis in the blood (nutrients and
water is reduced or discontinued and bowel
movements remain liquid)
cause: the sequel
• čestvennaâ food containing poisonous
foods putrefaction of proteins – ptomainy,
botulizme).
• effect of inorganic poisons — arsenic is,
lead, etc.
• abuse of laxatives (castor oil, rhubarb,
phenolphthalein) and klizmami, especially
cold
continued
• diarrhea can be protective and prisposobibased reaction (for quick removal from the
body of toxic products)
• irregular meals, occasional meals, rough,
out-razževan food
• Diarrhea is a symptom of a number of
diseases, the diagnosis should be based:
• data on medical history,
• physical research
• macro-and microscopic examination of
feces:
1. consistency, volume, smell,
It blood, pus, mucus, fat, starch
2. parasitic disease-eggs GFIS, the simplest
is there or not
continued
• the instrumental studies
rectoromanoscopy, irrigoskopii, columnskopii, x-ray
small intestine (inflammation, erosion and
ulcers, tumors, etc.)
• bacteriological analysis of feces
• Constipation is bowel movements less
than three times a week, with a mass of
stool less than 35 g/day.
Constipation is vsledstviem reducing
peristalsis (atonic)
Cause of sluggish peristalsis is:
the weakening of the intestinal muscles, atony
intestines and abdominal muscles
-This could be a weakness at malokrovnyh and
exhausted,-easy good digestible foods (meat,
eggs, dairy products) is not irritating to the
intestine, it is slow work, weakening of intestinal
muscles and constipation.
• Atonic constipation, also suffers from
spastic constipation caused by Tony-based
abridgements of circular muscle of the
intestine.
• Causes of constipation: sedentary lifestyle
contributes to constipation
• It should be noted the so-called habitual
constipation when people constantly
suppresses normal reflex for bowel
movements (rush, employment, shyness).
• pererazdraženie autonomic nervous system
• When the inflammatory events in the intestine
(with chronic colitis)
• mechanical obstructions: scarry narrow
clearance, tumours, haemorrhoids, increased
during pregnancy, the uterus
• irregular meals, occasional meals, chronic
alcohol poisoning
• Venous Stasis ulcers (SN, CPU)
• in depression, schizophrenia
• When miksedeme, diabetes, sklero-dermii
• medicines (bismuth, opiates, antidepres.)
• Diagnosis: collect complaints, medical history,
objective data, survey data (feces analysis,
recto-romanoskopiâ, barium enema,
colonoscopy, CT)
• Differential diagnosis: If there is no stool a few
days – acute constipation, If the stool less likely
3 times a week. with the mass of stool
less than 35 g/day is chronic.
• Secondary lock – you need to find out the basic
by disease or clarify officinalis history-if not, it
will be necessary to proceed to inves the facilities
of the DIGESTIVE TRACT (rectum).
• Functional diarrhea and
constipation, appearing in the
absence of morphological changes of
the intestinal mucosa, often recover
without the use of drugs by
eliminating the reasons causing them.
• Enteritis, both acute and from
chronic, rare isolated. More often
they combine with colitis and
chronic gastritis.
• When fermentation has enteritises
in thin intestines and ferment
diarrheas.
The symptoms and course of illness
• The main symptom is diarrhea,
• defecation abundant and mixed with
mucus, stool is not very frequent,
• enteritis accompanied by fermentative
dyspepsia-typical frothy stools (due to
formation of large quantities of gases)
without much flavor.
Colitis (colon, Qatar):
• stool frequent bowel movements, are
scarce, the mucus is removed with the
Ark. acute colitis is often gnilost-Naya
neuralgia: bowel movements have a
putrid, rotten smell. In acute
inflammation, often at the same time is
amazed and thin, and thick guts
Department.
• Is poured around the stomach pain,
usually a small, sometimes violent,
resulting in bouts of intestinal cramps
(caused by spasms of the intestinal
muscles)
• When flatulence too m.b. sharp pain
• body temperature rises to 39-40°. The
patient had no appetite, nausea,
headache, malaise, and weakness.
Dysbacteriosis of the intestine
include
• Changing the quantitative and qualitative
composition of the microflora in different biotopes
(thin and large intestine)
• Appearance optional strains outside the resident
microflora: Proteus, Morganella, Klebsiella,
Enterobacter, Citrobacter, Hafnia, e. coli with
enzyme insufficiency, gemoliziruûŝimi properties,
Pseudomonas, etc.
The factors causing damage to the intestinal
barrier and translocation of intestinal
microflora
• Microorganisms and their toxins: quality and number of
channel-based changes of normal microflora, rise of
conditionally pathogenic strains with reduced kolonizaoperating resistance mucous membrane
• Taking NSAIDS, violating the basic mechanisms of
preèpitelial′noj protection
• Acceptance of SSC, drugs, is break immunolo-biological
link safety barrier
• Salts of bilious acids, providing detergentnyj effect on the
mucous membrane
• Violation of blood flow (abdominal ischemia, portalhypertension)
Principles of treatment of patients with
dysfunction of the bowel dysbacteriosis
• Treatment of the underlying disease (etiotreatment)
• Restoration of normal composition of intestinal
microflora
• Restoration of intestinal mucous barrier
Restoration of normal microflora,
mucous barrier and functions
1. Diet, depending on the type of dysfunction
and disease If you have diarrhea (specify
with) – diet number 4 aglûtenovaâ,
alaktoznaâ
For constipation-diet number 3, wheat bran
The fermentative dyspepsia: for 7-10 days to
limit vegetables, fruits, legumes, milk
When putrefactive dyspepsia: between obostreof food with vegetables and mixed fruits per-Tov in
culinary processing
продолжение
2. The use of probiotics and/or Prebiotics
3. Motor Control: If you have diarrhea is Imodium
(loperamide) 1 caps (2 mg) after each Act urinating
(8 capsules per day) for constipation – prokinetiki
(with gipomotor function) metoclopramide, motilium,
cizaprid; in spastic-m-holinorecepto-blockers
moat (atropine, buscopan, metazin), Spa, proserin;
4. Laxatives for constipation – normaze, forlaks,
bisacodyl, guttalaks, lactulose and sorbitol
5. According to the course of antimicrobial therapy
INDICATIONS FOR ANTIBIOTIC DECONTAMINATION
BOWEL
1. the presence of excessive bacterial growth in
the small and large intestine
2. the presence of inflammatory processes in the
gut
3. identification of conditionally pathogenic flora
gut
4. lack of effect of treatment without dekontaminacii
Antibacterial drugs used for decontamination
bowel
Mainly for decontamination
Drugs,
daily dose per os
The
small
intestine
The
The
large
biliary
intestine system
Semisynthetic Penicillins
(ampicillin, amoxicillin) 0.25 4Rs/day
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Cephalosporins (conventional dose)
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Tetracycline -0.5 4Rs 0.3/day
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+
Erythromycin 4Rs/day 0.2
+
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+
+/-
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+
Aminoglikozida 0.25 4Rs/day
Levomicetin 4Rs/day 0.25
Drugs,
daily dose per os
For decontamination
The small
intestine
The large
intestine
The biliary
system
Sulphonamides
Biceptol, etc. 480-960mg 2 p/day
Sulgin, ftalazol -0.5 4Rs 0.25/day
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Nitrofurans
Furazolidone 0.1 3 p/day
Èrsefuril 0.2 3-4 p/day
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Fluoroquinolones
Ciprofloxacin 250 mg 2/day
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+
Metronidazole 250 mg-RS/day
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+
Intetriks 1 caps 4 p/day
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Nalidiksova to-Ta 0.5 3 p/day
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-
Biological bacterial preparations (with
diarrhea)
Well as bactisubtil 1 caps. 2-4 p/day
Ènterol 1 2-4 of the CBSA p/day
Bifidumbacterin, bificol, lacto-bakterin,
linex, normaflor, Chilak-f
Adsorbents: thistle extract,
neointestopan
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Probiotics
• Pathology of small intestine-prepara-Ty
containing aerobic flora (colibacterin,
lactobacterin)
• Pathology of small intestine-prepara-Ty
containing anaerobic Flora
(bifidumbacterin)
• Combined preparations (Bificol, Bifiform
)
Tactics of patients with dysfunction and
dysbacteriosis
• If there are indications for antibiotic therapy:
• the 2-3 courses of antibiotic therapy with the change
of the drug in the ordinary course
• duration of the treatment course 5-7 days
• For example: 1-course-25 g x 0 ciprofloxacin 2 times
+ metronidazole 0, 5 g x 2 times within 5 days
• 2-course-intetriks 1 caps x 4 times a day for 5 days
• the subsequent appointment of probiotics for
2 or more weeks. Are drugs, revitalising small
and large bowel microflora-BIFIFORM on 1
capsule 2 times daily up to 1 -2 months.
• at the same time are:
Intestinal adsorbents, enzyme preparations,
preparations, normalizing bowel motility
• Vitamins B1, B2, B6, pp, etc. (Multi-tabs, bcomplex)
THANK YOU FOR YOUR
ATTENTION