Functional diseases of the gastrointestinal tract tract - diseases of the gastrointestinal tract that are not associated with organic lesions and include a number of individual idiopathic disorders affecting various parts of the gastrointestinal tract, associated with visceral hypersensitivity and impaired motor function.
The aim of the study was to investigate the features of clinical course and diagnostics of pathologies of upper sections of gastro-intestinal tract in patients with connective tissue dysplasia to develop the system of management of patients at the level of primary health care. In the study it was revealed that patients with gastrointestinal tract pathology associated with CTD had early onset of disease and higher frequency of exacerbations, prevalence of dyspeptic and asthenic complaints, as well as impaired motor and evacuatory function of the gastroduodenal zone. Manifestation terms, frequency of exacerbations of gastroduodenal diseases are interrelated with the severity of connective tissue disorders.
In the structure of the pathology of the biliary tract, there is a significant increase in both dysfunctional disorders and diseases of an metabolic-inflammatory nature. At the same time, the proportion of cholelithiasis in children with an upward trend is increasing (1). A certain role in the formation of the pathology of the biliary tract is played by congenital anomalies of the gallbladder and biliary tract.
The studies carried out indicate the frequency of lesions of the biliary tract in school-age children. Comparative analysis of the data obtained in a comprehensive study allows differentiating the pathology of the biliary tract, but with a clinical manifestation, and also confirms the informative value of X-ray and ultrasound studies to clarify the diagnosis.
Target. То study the structure of nosology, demonstrated by the syndrome of recurrent vomiting, for timely assistance in primary health care. Materials and methods. The study included 176 sick children with recurrent vomiting symptoms. Verification of clinical diagnoses were carried out based on clinical, laboratory and instrumental research methods, including: clinical anamnestic methods,biochemical blood analysis, ultrasound examination, EGDS, X-ray contrast method for the study of the gastrointestinal tract.
Result. The symptom of recurrent vomiting in preschool children, regardless of the sex of patients, occurs most often in functional and organic diseases of the gastrointestinal tract (83.5%), in metabolic disorders - in 14.2% and in pathology of the central system - in 2.27 % of cases.
Conclusion. The most common causes of vomiting in children are diseases of the gastrointestinal tract (GIT), both functional and organic. Vomiting can also be caused by both congenital metabolic defects and endocrine disorders.
Subjects of the inquiry: patients with acute intestinal obstruction.
The aim of the inquiry: improvement of treatment results of the patients with acute bowel obstruction by means of the perfection of the methods of intestinal decompression and enteral correction of metabolic disturbance of the organism with nutritive blend “Perative”.
Methods of inquiry: general clinical laboratory investigations, roentgenological studies, statistical technologies, clcctrocntcrography.
Novelty of inquiry: In complex treatment of the patients with acute bowel obstruction the improved intestinal tube has been used for intraoperative decompression of the gastrointestinal tract and it has been demonstrated of its effectiveness. The active intra- and postoperative decompression of the gastrointestinal tract, gut lavage, enteral [tube] feeding effectiveness in complex treatment of the patients with acute bowel obstruction has been proved. The necessity of addition of the complex treatment of the patients with acute bowel obstruction the enteral correction of metabolic disturbance of the organism has been proved and the balanced nutritive blend “Perative” efficacy has been defined.
Practical value: The application of the improved intestinal tube allowed accomplishing of the adequate evacuation of the toxic contents of the gastrointestinal tract and reducing of the enteric pressure. It has contributed to earlier recovery of the all gastrointestinal tract function and it has created the favourable conditions for enteral [tube] feeding. Carrying out of the enteral [tube] feeding with semi - substrate nutritive blend “Perative” has promoted to earlier replacement of the loss of power and plastic material needs. Clinical application of the developed patients management with acute bowel obstruction has promoted to the reduction of the complications rate (from 33,9% to 6,0%) and mortality (10,7% to 0%).
Degree of embed and economical effectivity: The main regulations of the dissertation have been applied in practical work of the urgent surgical department of the second clinic of the Second Tashkent State Medical Institute and it is used in process of 4-6 years students teaching in the Second Tashkent State Medical Institute.
Sphere of usage: urgent surgical help.
Currently, the structure of morbidity in children is characterized by the predominance of chronic non-epidemic diseases, among which one of the first places is occupied by chronic diseases of the gastrointestinal tract. Gastrointestinal niche allergy is an important medical and social problem. According to scientific sources, the prevalence of this pathology is very contradictory. Thus, according to a number of researchers, at least 20-30% of the population are convinced that they have certain manifestations of food allergies.
Polypoid rhinosinusitis is quite common, but oddly enough, poorly understood pathology of the nasal cavity and paranasal sinuses. The very name "polyp" (from the Greek poly - many and pus -leg) is a collective term used to refer to pathological formations of various origins, towering above the surface of the mucous membranes of the gastrointestinal tract, respiratory and urinary tract, and uterus. Polyps represent a rather variegated picture of a wide variety of diseases, far from homogeneous in etiological, pathogenetic and morphological terms from benign tumors to hyperplastic formations of an allergic or inflammatory nature. Therefore, it makes no sense to look for any analogies in the etiology and pathogenesis of polyps of the paranasal sinuses and, for example,the gastrointestinal tract or urinary tract. Polypoid rhinosinusitis is a completely independent disease, in no way associated with polyps of other localizations, neither etiologically, nor morphologically, nor pathogenetically. Polyps of the nasal cavity and paranasal sinuses have nothing to do with the group of benign tumors, although sometimes they are mistakenly placed in the textbooks in the section "Benign nasal tumors". In the presence of a large number of polyps, the term "polyposis" is used, although the border between the concepts "multiple polyps" and "polyposis" is arbitrary. According to most researchers, the term "polyposis" should be used when the number of polyps is more than 10 - 20. Sometimes you can find the term "polyposis of the nose", which is not entirely correct grammatically or "nasal polyposis", like tracing paper with "nasal polyposis", the most the designation of this disease common in the English-language literature. But still, from our point of view, the most legitimate name for this etiopathogenetic form will be "polyposis rhinosinusitis", since it is the paranasal sinuses and, first of all, the cells of the ethmoid labyrinth that are the place of localization of this process.
According to the World Health Organization, in recent years there has been an increase in the incidence of acute respiratory viral infection. In this regard, the attention of pediatricians and otolaryngologists is attracted by acute stenosing -laryngotracheitis (ASLT). According to the data of many years of research, the number of patients with ASLT ranges from 0.1 to 0.4% of all children hospitalized with a diagnosis of acute respiratory viral infection. The development of stenosing laryngotracheitis in acute respiratory viral infection (AR.VI) dramatically aggravates the condition of sick children, and sometimes the life of a child depends on its attachment to the underlying disease.
Since the first days of independence , large-scale reforms have been consistently implemented in our country in order to improve the quality of medical care for the population . Thus, effective medical care for children ensured timely detection, early diagnosis and treatment of patients with ASLT, which made it possible to reduce the duration of their treatment in the hospital by 3-4 days.
Despite numerous scientific studies devoted to the study of the patterns of the infectious process in stenosing laryngotracheitis, the role of dysbiocenosis of the mucous membranes of the upper respiratory tract, the process of endogenous intoxication (El), which develops as a result of illness in children and its relationship with the course of the disease, as well as the state of the system of local and general immunity dictate the need to improve the methods of their correction in the light of modern requirements. At the same time, the causes of recurrence of acute stenosing laryngotracheitis have not been fully determined; an important task is to develop prognostic criteria for assessing the outcomes of OSLT.
Given the dissertation research to a certain extent serves to solve the problems provided for in the resolutions of the President of the Republic of Uzbekistan No. PP-2133 dated February 19, 2014 “On the State Program" The Year of a Healthy Child ’’and No. PP-2221 dated August 1, 2014 “On the State Program for Further Strengthening reproductive health of the population, protection of the health of mothers, children and adolescents in Uzbekistan for the period 2014-2018”, as well as in other legal documents adopted in this area.
Scientific research aimed at improving the methods of complex diagnostics, treatment and prevention of stenosing laryngotracheitis in children was carried out in many leading medical centers, such as the Schneider Children's Medical Center (Israel), Giessen University Hospital (Germany), St. Mary's Children's Clinic (Germany), Center of Innovative Medicine Interbalkan (Greece), Generale Clinic (Switzerland), Royal Clinic (Great Britain), Queens Medical Center (Great Britain), IDIBAPS Clinic (Spain), St. Luke's Hospital (Japan), Federal Scientific and Clinical Center of Otorhinolaryngology FMBA of Russia (Russia) , as well as the Tashkent Pediatric Medical Institute and the Republican Specialized Scientific and Practical Medical Center for Pediatrics (Uzbekistan).
As a result of the studies, criteria for assessing the risk of occurrence and recurrent course of OSLT were developed, the mechanisms that determine the sensitivity of the respiratory tract were identified (Freiburg Clinic, Germany); established endocrine dysfunction in children with primary and recurrent acute stenosing laryngotracheitis (Children's Hospital, Ireland); the influence of the composition of the microflora of the main loci of the body, connective tissue dysplasia, regulatory systems on the function of external respiration, the formation of threshold sensitivity and reactivity of the respiratory tract in children with recurrent stenosing laryngotracheitis (RSLT) was proved (Melbourne University, Australia).
At present, the goal of many studies in the world is to further determine at the immunomolecular level the role of specific and non-specific factors of immune protection in the pathogenesis of acute stenosing laryngotracheitis; assessment of the state of non-specific protection during OSLT; study of significant changes in the cellular link of immunity, changes in T-suppressors and partially B-lymphocytes; as well as the prevention of relapses and the improvement of methods for diagnosing and treating the disease.
As the analysis of special literature showed, a number of researchers studied the role of the allergic component and the autonomic nervous system in the pathogenesis of the development of primary and recurrent OSLT. According to the results obtained, more than 90% of sick children in the pathogenesis of primary and recurrent acute stenosing laryngotracheitis is dominated by allergic component with the identification of common and allergen-specific IgE . In addition, it has been proven that the development of OSLT in parainfluenza infection is associated with a significant increase in IgE titer and specific IgA in nasopharyngeal secretions in children with ARVI. The mechanisms of OSLT recurrence based on a significant change in the immunological reactivity of the body, which are associated with its allergization by both infectious and non-infectious agents, including adverse environmental, seasonal, meteorological and even social conditions, have been studied. It has been proven that OSLT proceeds with vegetative disorders, which, in turn, have a significant impact on the course and outcome of the underlying disease. An improved treatment of OSLT at the height of the disease is proposed, based on the use of drags, taking into account the type of initial vegetative tone of the body.
Despite numerous works devoted to the study of acute stenosing laryngotracheitis, its diagnosis and methods of treatment, the trend towards an increase in the recurrence of the disease persists, which dictates the need to study the general patterns of the infectious process in stenosing laryngotracheitis, assess the significance of the microbiocenosis of the mucous membranes of the upper respiratory tract, disorders of the immune and interferon statuses and development of ways to correct them, predict the disease on the basis of a prognostic map, as well as improve the effectiveness of treatment and preventive measures.