ACADEMIC RESEARCH IN MODERN SCIENCE
International scientific-online conference
62
IMPROVED EFFECTIVENESS IN TREATING PATIENTS WITH
ASCITS PERITONITIS CAN BE ACHIEVED THROUGH THE
CREATION OF AN ERGONOMIC ANTIBOETIC THERAPY PROGRAM.
Sh.T.Urokov
1
D.J.Komilov
2
1
Doctor of Medical Sciences, Associate Professor, Head of the Department;
Department of Surgical Diseases, Bukhara State Medical Institute named after
Abu Ali ibn Sina, Bukhara, Republic of Uzbekistan
2
Bukhara branch of the Republican Scientific Center for Emergency Medical
Care.
https://doi.org/10.5281/zenodo.15797279
Relevance:
A small intestine motility abnormality brought on by cirrhosis
increases the risk of intestinal bacterial overgrowth and translocation.
Furthermore, the fact that these patients use proton pump inhibitors often may
make this problem worse by decreasing stomach acidity and increasing
intestinal permeability, which encourages bacterial translocation and
colonization of mesenteric lymph nodes. The deterioration of the div's
defensive mechanisms also contributes to the subsequent infection of the fluid
in the peritoneal cavity. Additionally, bacteria that cause SBP can enter the
peritoneal cavity through the lymphatic or circulatory systems from extra-
gastrointestinal foci such the lungs, the urinary tract, dermatitis and
subcutaneous tissue, pharyngitis, and frequently disregarded odontogenic foci.
The diagnosis confirms the finding of > 250 polymorphonuclear cells
(PMNs) in a milliliter of ascitic fluid. If additionally the ascitic fluid culture is
positive, as is observed in approximately 40% of SBP cases, we can diagnose a
culture-positive SBP; otherwise the disease is called neutrocytic ascites. When
the ascitic fluid culture is positive and the number of PMNs is < 250 in a milliliter
of ascitic fluid the condition is called bacterascites. As cirrhosis is a condition of
immunosuppression, called cirrhosis-associated immune dysfunction (CAID),
the div’s response to infection may be poorly expressed. Therefore, in all
patients with liver cirrhosis and even mild ascites, in the case of sudden
deterioration of liver function, SBP should always be taken into account, even in
the absence of obvious clinical symptoms or deviations in laboratory tests.
We discuss the pathogenesis, diagnosis, and current clinical management of
ascites, with an emphasis on recent promising developments such as closed
transjugular intrahepatic portosystemic shunt. Spontaneous bacterial peritonitis
occurs in up to 10% of patients with ascites due to bacterial overgrowth with
translocation through increased permeability of the small intestinal wall and
disruption of protective mechanisms. Against the background of AP, liver failure
with nephrotic syndrome increases in 30% of patients.
ACADEMIC RESEARCH IN MODERN SCIENCE
International scientific-online conference
63
Primary ascites-peritonitis, or, according to foreign literature, spontaneous
bacterial peritonitis, causes difficulties in diagnosis. The cause of spontaneous
bacterial AP is the penetration of microorganisms through the intestinal wall
into the mesenteric lymph nodes and the peritoneal cavity.
Secondary AP in patients with cirrhosis occurs due to inflammatory
processes in the abdominal cavity and pelvis, perforation of hollow organs,
strangulated hernias, and surgical interventions. The effectiveness of treatment
for AP largely depends on its early diagnosis. According to the literature, today
diagnostic paracentesis with laboratory testing of AF is of decisive importance.
Determination of the number of polymorphonuclear leukocytes, protein content,
albumin and amylase concentrations is considered mandatory.
Objective Of The Study
— The effectiveness of treatment of patients with
AP can be improved by substantiating the optimal antibiotic therapy program in
combination with complex treatment of patients with cirrhosis.
Materials And Methods
The results of treatment of 23 patients with
cirrhosis complicated by AP were analyzed. There were 10 men (43.5%), 13
women (56.5%). The average age was 57.5 ± 11.4 years. According to the degree
of hepatic decompensation in accordance with the Child – Turcotte – Pugh
criteria, patients were distributed as follows: class B - 3 patients, class C - 20
patients. According to the nature of ascites, 8 patients had transient ascites, and
15 patients had resistant ascites.
Primary ascites-peritonitis was diagnosed in 16 patients. Secondary
bacterial peritonitis was detected in 7 patients: in 2 patients - as a consequence
of gangrenous calculous cholecystitis, in 1 - phlegmonous appendicitis. Four
patients diagnosed with secondary bacterial peritonitis had a history of invasive
manipulations accompanied by a violation of the integrity of the peritoneum:
laparocentesis in 2 patients, mesentericocaval-H anastomosis in one case, and
herneoplasty for an umbilical hernia in one case.
All patients underwent puncture of the peritoneal cavity under ultrasound
guidance. In 11 (52.3%) patients, ultrasound of the abdominal cavity revealed
acoustic heterogeneity of the AF: floating fibrin threads, suspended protein
particles, and fibrinous deposits were visualized. However, their presence was
not strictly pathognomonic for AP.
The diagnosis of ascites-peritonitis was established when the total cytosis
in the AF increased over 800 cells in 1 μl and the number of neutrophil
leukocytes increased over 250 cells in 1 μl. To exclude infection of the AF, in
ACADEMIC RESEARCH IN MODERN SCIENCE
International scientific-online conference
64
each case, its bacteriological control was carried out by inoculating it on
enrichment media.
Results Of The Study
showed that the maximum concentration of
cefoperazone and sulbactam when administered intravenously is detected 1
hour after intravenous administration of the drug and decreases by 37% by 12
hours. The dynamics of drug concentrations in the AF were of a different nature:
Cmax in the AF reached values of 24.097 ± 3.375 μg/ml 1 hour after the start of
intravenous administration and decreased by half by 12 hours from the initial
level.
When comparing the concentrations of the antibacterial drug in the AF, it
was revealed that the concentration of cefoperazone and sulbactam in the
second group after 1 hour was significantly lower, but by 6 and 12 hours it
increased significantly and exceeded by 64% the concentration in the AF of the
first group.
When comparing the concentrations of the antibacterial drug in the AF, it
was revealed that the concentration of cefoperazone and sulbactam in the
second group after 1 hour was significantly lower, but by 6 and 12 hours it
increased significantly and exceeded by 64% the concentration in the AF of the
first group .
With endolymphatic administration of the antibiotic, its bioavailability in
ascitic fluid is significantly higher than with intravenous administration.
However, the effective concentration is achieved only 6 hours after
administration. When administered intravenously, within an hour the
concentration of cefoperazone is significantly higher (24.097 ± 3.375 μg/ml).
Taking into account the obtained data on the bioavailability of cefbactam in
the AF, 3 patients of the third group received combination antibacterial therapy.
After the diagnosis of AP was made, antibacterial therapy was started with
intravenous administration. Then, after inserting a catheter into the inguinal
lymph node, cefbactam at a dose of 1 gram was administered endolymphatically.
A study of the concentration of cefoperazone and sulbactam in AF was carried
out .
With combined antibacterial treatment, the effect of the antibiotic began
from the first hours of the start of therapy and persisted for 12 hours. On the
2nd day after the start of antibacterial therapy, all patients underwent repeated
cytological and microbiological examination of the AF.
ACADEMIC RESEARCH IN MODERN SCIENCE
International scientific-online conference
65
Conclusions
When diagnosing AP, it is necessary to begin timely
combination antibacterial therapy. It should include joint, simultaneous
intravenous and endolymphatic administration of cefbactam.
Literature:
1.
Латипов, И. И., & Хамроев, Х. Н. (2023). Улучшение Резултат
Диагностике Ультразвуковой Допплерографии Синдрома Хронической
Абдоминальной Ишемии. Central Asian Journal of Medical and Natural Science,
4(4), 522-525.
2.
Хамроев, Х. Н. (2022). Toxic liver damage in acute phase of ethanol
intoxication and its experimental correction with chelate zinc compound.
European journal of modern medicine and practice, 2(2).
3.
Xamroyev, X. N. (2022). The morphofunctional changes in internal organs
during alcohol intoxication. EUROPEAN JOURNAL OF MODERN MEDICINE AND
PRACTICE, 2(2), 9-11.
4.
Хамроев, Х. Н., & Туксанова, Н. Э. (2021). Сharacteristic of morphometric
parameters of internal organs in experimental chronic alcoholism. Тиббиётда
янги кун, 2, 34.
5.
Nutfilloyevich, K. K. (2024). NORMAL MORPHOMETRIC PARAMETERS OF
THE LIVER OF LABORATORY RATS. ОБРАЗОВАНИЕ НАУКА И
ИННОВАЦИОННЫЕ ИДЕИ В МИРЕ, 36(3), 104-113.
6.
Nutfilloevich, K. K., & Akhrorovna, K. D. (2024). MORPHOLOGICAL
CHANGES IN THE LIVER IN NORMAL AND CHRONIC ALCOHOL POISONING.
ОБРАЗОВАНИЕ НАУКА И ИННОВАЦИОННЫЕ ИДЕИ В МИРЕ, 36(3), 77-85.
7.
Kayumova, G. M., & Nutfilloyevich, K. K. (2023). Cause of perinatal loss
with premature rupture of amniotic fluid in women with anemia. AMALIY VA
TIBBIYOT FANLARI ILMIY JURNALI, 2(11), 131-136.
8.
Хамроев, Х. Н., & Уроков, Ш. Т. (2019). ВЛИЯНИЕ ДИФФУЗНЫХ
ЗАБОЛЕВАНИЙ ПЕЧЕНИ НА ТЕЧЕНИЕ И ПРОГНОЗ МЕХАНИЧЕСКОЙ
ЖЕЛТУХИ. Новый день в медицине, (3), 275-278.
9.
Хамроев, Х. Н., & Ганжиев, Ф. Х. (2023). Динамика структурно-
функциональных нарушение печени крыс при экспериментальном
алгоколние циррозе. Рr oblemsofmodernsurgery, 6.
10.
Хамроев, Х. Н., & Хасанова, Д. А. (2023). Жигар морфометрик
кўрсаткичларининг меъёрда ва экспериментал сурункали алкоголизмда
қиёсий таснифи. Журнал гуманитарных и естественных наук, (2), 103-109.
11.
Хамроев, Х. Н., Хасанова, Д. А., Ганжиев, Ф. Х., & Мусоев, Т. Я. (2023).
Шошилинч тиббий ёрдам ташкил қилишнинг долзарб муаммолари:
ACADEMIC RESEARCH IN MODERN SCIENCE
International scientific-online conference
66
Политравма ва ўткир юрак-қон томир касалликларида ёрдам кўрсатиш
масалалари. XVIII Республика илмий-амалий анжумани, 12.
12.
Хамроев, Х. Н., & Тухсанова, Н. Э. (2022). НОВЫЙ ДЕНЬ В МЕДИЦИНЕ.
НОВЫЙ ДЕНЬ В МЕДИЦИНЕ Учредители: Бухарский государственный
медицинский институт, ООО" Новый день в медицине",(1), 233-239.
13.
Хамроев, Х. Н. (2022). Toxic liver damage in acute phase of ethanol
intoxication and its experimental correction with chelate zinc compound.
European journal of modern medicine and practice, 2(2).
14.
Kayumova, G. M., & Hamroyev, X. N. (2023). Significance of the femoflor
test in assessing the state of vaginal microbiocenosis in preterm vaginal
discharge. International Journal of Medical Sciences And Clinical Research,
3(02), 58-63.
15.
Каюмова, Г. М., Хамроев, Х. Н., & Ихтиярова, Г. А. (2021). Причины
риска развития преждевременных родов в период пандемии организм и
среда жизни к 207-летию со дня рождения Карла Францевича Рулье:
сборник
материалов
IV-ой
Международной
научнопрактической
конференции (Кемерово, 26 февраля 2021 г.). ISBN 978-5-8151-0158-6.139-
148.
16.
Каюмова, Г. М., Мухторова, Ю. М., & Хамроев, Х. Н. (2022). Определить
особенности течения беременности и родов при дородовом излитии
околоплодных вод. Scientific and innovative therapy. Научный журнал по
научный и инновационный терапии, 58-59.
17.
Уроков, Ш. Т., & Хамроев, Х. Н. (2018). Клинико-диагностические
аспекты механической желтухи, сочетающейся с хроническими
диффузными заболеваниями печени (обзор литературы). Достижения
науки и образования, (12 (34)), 56-64.
18.
Nutfilloevich, H. K., & Akhrorovna, K. D. (2023). COMPARATIVE
CLASSIFICATION OF LIVER MORPHOMETRIC PARAMETERS IN THE LIVER AND
IN EXPERIMENTAL CHRONIC ALCOHOLISM. International Journal of Cognitive
Neuroscience and Psychology, 1(1), 23-29.
19.
Уроков, Ш. Т., & Хамроев, Х. Н. (2019). Influe of diffusion diseases of the
liver on the current and forecfst of obstructive jaundice. Тиббиётда янги кун, 1,
30.
20.
Каюмова, Г. М., Мухторова, Ю. М., & Хамроев, Х. Н. (2022). Причина
преждевременных родов. Scientific and innovative therapy. Научный журнал
по научный и инновационный терапии, 57-58.
ACADEMIC RESEARCH IN MODERN SCIENCE
International scientific-online conference
67
21.
Хамроев, Х. Н., & Хасанова, Д. А. (2023). Сравнительная
характеристика морфометрических показателей печени.
Журнал
Проблемы биологии и медицины ПБиМ, 5.
22.
Хамроев, Х. Н., Тешаев, Ш. Ж., & Туксанова, Н. Э. (2021). Influence of
environmental factors on the morphometric parameters of the small intestine of
rats in postnatal ontogenesis. International Journal of Pharmaceutical Research,
13.
23.
Уроков, Ш. Т., Холиков, Ф. Й., Кенжаев, Л. Р., & Хамроев, Х. Н. (2023,
December). СОВРЕМЕННАЯ ДИАГНОСТИКА И ТАКТИКА ЛЕЧЕНИЯ ПРИ
ОСТРЫХ КОЛЕЦИСТИТАХ И.
