Transcript Кафедра подготовки ВОП с эндокринологией и аллергологией

The different diagnosis current
guidelines and prevention of
intestinal dysfunction
Relevamce
Intensial dysfunction is the most
common gastroenterological pathology
with which patient care treated on an
outpatients basis
 This is especially true for patients of
older age groups complain of delay
chair-constipation, and children, who
are mainly diarrhea.

Determination

Constipation-it labored A small amount
of dense feces. A rare chair , feeling of
incomplete emptying of the bowel after
a bowel movement less accurate
because soft stools every 2-3days-a
variant of the norm , as chair dense
even several times a day should be
considered constipation . complaints
constipation makes an average of 12
people in 1000 to address to doctors
Classification
Constipation is classified by duration into acute and chronic
on etiological and pathogenetic features-on the nutritiona
neurogenic (dyskinetic),
reflex, hypodynamic, inflammatory, proctogenic
mechanism consequence of an abnomality of the colon development
medication , endocrine , due to violations
of water-electrolyte metobolism
Cause
Constipation occurs in
depression
(Antiderpreassants further
enhances constipation)
and, in addition , he is one
of the most frequent
manifestations of
hypothyrodism,especially
in women , and
hypercalcemia of
hyperparathyrodism.
Diabetes mellitus is a rare
causes of constipation may
be cerebral palsy
,autonomic neuropathy
Cause of constipation

Constipation caused codeine , antacids
containing calcium salts and aluminum
,antidiarrheal , anti-Parkinsonian
agents, barbiturates, benzodiazepine
,H1-blocer , verapamil , ganglionic ,
monoamine oxidase inhibitors, clondine
muscle relaxants, nonsteroidal antiinflammatory drugsmiron oreoarations ,
bile acid sequestransts barium sulfate
thiazide and diuretics
Diagnostocs

Physical examination.The importance for
the diognosis of intestinaldysfunction has
physical examination .it is held with first
patient visit to a doctor and is available in
health facilities of any type . Particular
attention is paid to abdominal palpation and
rectal examination.
Diagnostics

When rectal examination note:the note of
the anal sphincter and the consistency of
the stool,pain –with procitis,diarrhea(with
anal fissure rectal examination is not
possible because-due to pain);seal the
rectal wall-at the crak of anus or chronic
paraprocities;volumetric education –a
bengin tumor has a soft consistency and a
smooth surface malignant is dense with a
rough surface
Laboratory and instrumental investigations
Determining the level of hemoglobin and ESR
.Issledovanie fecal occlt blood
Biohimicheskoe study blood calcium levels in
serum potassium levels in plasma
,determining carcinnoembryonic
antigen(marker of some cancers
Issledovanie levels of thyroid hormones
Rektoromanskopiya colonoscopy
Diagnostics

The most accessible method of endoscopic examination of
patients in a clinic is asigmoidoscopy.it is indicatd for
complaints on the allocation of blood and mucus from the
anus,suspected mass lesion of the rectum.in 60 percent of
cases, diverticula polyps and malignant tumors are located
at a distance of no more than 60 cm from the anal
margin.an important symptom is detected at endescopymelanosis colon
Diagnostics
Rectal manometry-denition of anal
sphincter tone and sensitivity
threshold tensile ampoule of the
rectum using an inflatable blloon;
Proktografiya defecation (bowel
movemnet reacel violations)
Rectal biopsy(receals agangiloz with
Hirschsprung`s disease)
Functional constipation
There are three types of functional constipation
The simple constipation
Zapor bowel hypomotilty
Zapor without hypokinesia intestine(irritable bowel syndrome)
The most comman simple aconstipation caused by poor
diet and sedenatary lefestyle
Alimentary constipation
The most commonly arises in
the use of food ,
with a smll-holding klechatki calcium
vitamins diet with violations.
Since every meal is gastrtsekalny
reflex spo-proper movement of the of the
chyme and feces,and irregular
eating hours inveitably erases
rit michnost-intestinal motility
motility.Foods rich in food
klechatkoy-black bran bread
vegetables herbs-provides the
right amount of stool and
accelerates molitiy and on the
contrary , an excess
of food slows-ing motoriku –rice white
bread strong tea cocoa potatoes
milk also food dry rations
to the restriction-chennym
amount of liquid -contribute
The reason is simple
constipation


Most nutritional factor combined with a sedentary
lifestyle .all these details are established medical
history.
The reason is simple constiption may be suppressing
the urge to defecate poor working conditions unusual
food during long trps.Constant supperession of urge
to defecate leading to diskhezii-state,when the rising
threshold to stretch the ampoule constipation
Neurogenic
(dyskinetic)Constipation
Disorders of the nervous regulation mechansim:suppressiontion of the physiologic urge vlesdstvii living conditions(the
rush,all in thhe batheoom).the lack of hyper-gieicheskih
skills, inaility tocoincide with the fact of DEF-cation to a
specific hour to the day,mmental perenap-maskers,conflict
situations ,dyskinetic disoeders largethenumber of functional
aand organic-cal diease system (neuriti myelitis
amyelotrophy)
Neurogenic constipation

If the organic disease of the nervous system in the
world bowel are expressed in resistant
kolokpazmath with intestinal colic reflex
neurovascular reactions the general neurosis
accompanied by changes in mental emotiona
crises complusions phobias increased irritability
and suspiciousness character changesinsomnia
Reflex constipation

Accompanies various diseases,mainly the
digestive and urogenital system:peptic
ulcer,chronic cholecystites appendicitis with
renal colic pelvic disase in women . A
characterictic feature of the reflex mechanism
of constipation is its again in the exacerbation
of the underlying disease,as well as
normalization of stool in remission.This
emphasizes the secondry nature of the
underlying disease zapora.Lechanie eliminates
reflex constipation
Endocrine
constipation observed
in hyperparthyoroidism
addison`s disease
pituiitary rsstroystvhl insufficiency of sexual
glands and nadpopechnikolv,plyurigalads
menopause.this alos applies
to constipation
in zhenschin normalizes
bowel movements when
beremennost of exchange
Endocrine
constipation
plyurigalads sometimes
diabetes menopause
Constipation in violation of
exchange

Constipation due to violations of water
–electrolyte metobolism occurs due to
loss of body fluids,with ascites cardiac
and real failurea, potassium deficiency
cholestasis.Treatment is aimed at
removing water and electrolyedisorders
and treatment of the underlying diseas
Inflammatory constipation

Arise from inflammotory disease of the small nad large
intestines.They suffer every fifth patient with chronic
enteritis and every srcond colitis.Along with constipation
observedd admixture of mucud pus and blood in the stool
pain and spasticity of the intestinal loops and pain from
the gas colic.Inflammatory factor causes constipation in
a number of infectious disease (toxic dyspepsia,iloeotifite
as tubeculous and non-specific)that occur with low-grade
fever abdomal pain constipation with symptoms of
intoxication
Proctogenic constipation

Proctogenic constipation occurs in patirnts with
anorectal disorders he called as disease of the
tectum and anus well as a reflex spasm of the
sphinter.prevalent complainet of a violation of the
act of defeation often accompained by piam in the
anuas as a result of the realase of red blood
scratches or cracks,loss of hemorrhoids or rectal
mucosa;cal is dealayed rectosigmoid department
kishki lechenie underlying disease anorectal the act
of defecation
Toxic constipation
Toxic constipation occurs in some
chronic occupational diasee,in
casee of poisoning
by nicotine in kurilishkov,the
abuse of food with a high
content of tannisn
Treatment zakyuchaetsya
in the appointment
of detoxificcation therapy
with a decrease
receving food
conataining tannin
Colon cancer
Colon cancer
The clinical picture is characterized by the apperance: the
impurity of blood and mucus in the stool;constipation and
sometimes diarrhea;sensation of incomplete emptying of
the bowel;abdomal discomfort or cramping pain
discomfort in the increasing anemia
Diarrhea. General provisions
Diarrhea
Diarrhea or diarrhea a
common abundant loose
or watery stool which is
frequently observred in
many dieases.
The main causes and symptoms
of diarrhea




Diarrhea usually passes qiuckly and the oatient does not go to the doctor.Usually
it is cauyse of intenstial luster and in disease of the lower divisons-lean brown
often mixed with blood and mucus texture may bedifferent
Diagnoz acute gastroenteritis put only after excluding other causes of diarrhea
To suit caauses of chronic diarrhea-protozol infections bacterial less for example
dysentery many antimicrobials violate the intestional microflora
For colondisaseas the patient has frequent and strong urge to defecate
The main causes and symotoms of
diarrhea
Diagnosis of acute gastroenteritis put only
after excluding other possible causes of
diarrhea
To suit causes of chronic diarrhea-protozoal
infections bacterial less for example dysentery
Many antimicrobias violate the intestinnal
microflora
For coloc disease the patient has frequent and
strong urge to defecate but the chair they
usually lean
Labortory and instrumental
research
Feces study: microscopy snowing
Blood research: overall analysis the level of iron
vitamin b12 electrolytez thyroid hormones and
antibodies to HIV
The reaction of no direct hemogglyutinization for
amoebiasis research absorption in the intestine
Endoscopic study rectomonoscopy, colonoscopy with
biopsy
Labarotory
and instrumental
researches
X-ray examination:X-ray of the
abdomen in
straight line projection and barium
enema with double contrast
passage of barium
through the small intenstine.
If unable to conduct the necessary
analysis in a clinic
a general practitioner should
send a patient
to a diagnostic center or
specialized agencies
Acute infectious diarrhea

These include diarrhea when tiphoparathyfozy
diseases. Diarrhea is observed in 2-3 weeks after the
onest of the disease it is recognized on the basis of
characteristic clinical epidemiological and laboratory
data. Typhoid fever begins with increasing
temperature apethetic indifferent expression on the
face which in the presence of bradycardia typical
language enlarged spleen and leukoenia are the
basis of the diagnosis which is confirmed by
bacteriological and serological testing
Chronic diarrhea
Irritable bowel syndrome is a functional bowel disorder that is
more common in women aged 20-24 years.Clinic patients
complain of cramping pain in the navel,the right or left iliac
region , which decreases after passing flatus.Diarrhea
alternating constipations.Diarrhea often occurs after a meal
usually after lunch .if there is constpation stool takes the form
o small beads or ribbons.There are also flatulance and
rumbing
Chronic enteritis

CHE
ischaracterized
by
thpresrnce
of
lical
(intestinal)symotons of the disease and imparied general
condition rasrojstvo all exchnge due to improper digestion
and food.Local syndrome manifested flatulence a dull pain
rumbing and splashing on palpation of the cecum , soreness
on the left above the navel.Scatlogical study indentifies
polifekauliya,steattorrha,creator,amiloreyu,the presence of
soaps and mucus,intestinal dysbiosis.The mamount of faces
increased:the more secere thr patients`s condition the more
shrply expressed polifekaliya
Ulcerative colitis
Ulcerative
colitis
Ulcerative
colitis
The disease is more common in developed
countries. Age of onset varies from 15 to 40
years. Affects only the colon often the disease
begins with the dstruction of the rectum
Clinic patients complain of diarrhea
with blood sometimes with pus and
mucus fever weakness weight loss
mild pian in the abdomen
Crohn`s Disease
The age of onset of the disease 20-40 years.
Clinic patients often complain of pain in the navel
and right iliac region.Worried diarrhea mixed with
blood and mucus in the stool,as well as fever
,weight loss weakness. They can see crack , rectal
fistula abscess ishirektany.the defeat of the often
limited.In the 30%of patients struck only the distial
rectum 25% of the entire colon.if colonoscopy
reveals that looks slimy cobbles
Cystic fibrosis
Refers to hereditary disease.The first
symptoms appear soon after
birth.Characterized by frequent respiratory
infevtions,developmental
delay,malasscorption syndrome .to explore
the diagnostic trypsin activity in feces.
 Treatment:assiging preaparations containing
pancreatic juice components,treatment of
respiratory tract infections

Celiac disease(gluten
enteropathy)
From diet completely exclude food
containing gluten:yeast bread
pasta crackers cakes wheat and
oats rye flour prducts wheat bran
ber fish fried in breadcrumbs,
both
It occurs in both children and
adults but the diagnosis is usualyy
made in childhood
Treatment
Diagnostic criteria are based on
increasing the excretion of fat in
the faces and study of rhe boipsy
of the small intesting-identifying
gross changes vaillous atrophy of
glandular epithelium.
The syndrome of malabsoption..
The causes malabsorption syndrome are:celic
disease,sprue,lectase deficiency,crohn`s
disease,protozl infections, giardiasis.To it are
also operations on the gastrointestial
tract,systematic sclerosis,pancreatic disease.
 For the syndrome of malabsoprtion is
characterized by a ,light frothy stool with
greasy lister poorly washed off the toilet
weight loss. In children thereis a delay of
physical development high levels of fat in the
feces collected over 3 days avitominoosis
A,D,E,K sore tongue

Pseudomembranous colitis
PC is usually caused by taking the
antimicrobial agents,most often
ampiclian ,cephalosporins.Antimicrobial
agents distrup the intestinal microflora
which leads to excessive growth of the
payhological flora toxins which cause
psedomembranous colitics.Chracterized
by abundant stools ,abdominal pain
tenesmus and sometimes fever
 The diagnosis is confiemed
rektomanskopiey and snowing feces

Chronic violation of mesenteric
circulation

It is sometimes also cause diarhea,which often develops as a result of
atherosclerosis mesenteric artery and ischemic colitis. Ischemic colitis
in the initial stage is manifested by pain in the abdomen,usually in the
ileoceacal region, and angles rektosigmoidalnogo connection his
bloating diarrhea tensmus and rektorragiyami with fever and
leukocytosis .With the devlelopment of gangrene of the colon there re
signs of acute diffuse peritonitis and septic.In the process of endocopy
in the lumen of rectum and sigmoid intestine visible blood mucous
membrance in ischemic swelling sometimes ulcerated with polypod
masses.