xronicheskiy gastrit u detey

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xronicheskiy gastrit u detey. xronicheskiy gastrit u detey 1 opredelenie xronicheskiy gastrit (xg) – xronicheskoe retsidiviruyushee ochagovoe ili diffuznoe vospalenie slizistoy obolochki jeludka (soj) s narusheniem protsessov fiziologicheskoy regeneratsii, narushenie sekretornoy, motornoy, neredko inkretornoy funktsii jeludka, vozmojnostyu razvitiya atrofii, a takje nalichiem opredelennoy klinicheskoy simptomatiki. rasprostranennost xg v rossii sostavlyaet v srednem 100-150 sluchaev na 1000 detey. 2 etiologiya osnovnimi prichinami razvitiya xg u detey yavlyayutsya: infektsionniy faktor- helicobakter pylori (hp) medikamentozniy faktor – priem nesteroidnix protivovospalitelnix preparatov (npvp), kortikosteroidov, sulfanilamidov i dr. nalichie duodeno-gastralnogo reflyuksa (dgr) sochetanie vishe perechislennix faktorov dlitelnoe persistirovanie v organizme virusnix infektsiy : tsmvi, gepatita, vpg, veb v sochetanii s helicobacter pylori nekotorie zabolevaniya: bolezn krona, tseliakiya, tuberkulez dr. autoimmunniy faktor. 3 faktori riska xg: perinatalnaya gipoksiya; rannee iskusstvennoe vskarmlivanie; perenesennie v tyajeloy forme ostrie kishechnie infektsii: rotavirusnaya infektsiya, salmonellez, shigellez i drugie; nalichie ochagov xronicheskoy infektsii; allergicheskie zabolevaniya; narushenie motornoy funktsii jeludka i dvenadtsatiperstnoy …

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eyskaya klassifikatsiya) etiologiya: autoimmunniy; assotsiirovanniy s helicobacter pylori; reaktivniy (medikamentozniy, dgr); smeshanniy; idiopaticheskiy; osobie formi (granulomatozniy, limfotsitarniy, eozinofilniy). lokalizatsiya: antralniy; pangastrit; fundalniy; 7 endoskopiya (morfologiya): neatroficheskiy; atroficheskiy; aktivnost protsessa: aktivnaya faza; neaktivnaya faza. 8 diagnostika xg diagnoz stavyat na osnovanii: jalob, kotorie mojno ob'edinit v 3 sindroma: -bolevoy -dispepsicheskiy -astenovegetativniy anamnesticheskix dannix; ob'ektivnix dannix; dopolnitelnix metodov issledovaniya. 9 standart diagnostiki xg u detey laboratorno-instrumentalnie metodi: obshiy analiz krovi; bioximicheskoe issledovanie krovi (obshiy bilirubin i fraktsii, ast, alt, shelochnaya fosfotaza, amilaza, lipaza). issledovanie krovi na markeri gepatita; issledovanie krovi ifa na nalichie glistnoy invazii; issledovanie kala na nalichie kishechnoy infektsii; 10 issledovanie kala na yaytsa glistov; koprologicheskoe issledovanie kala; obshiy analiz mochi; uzi jelchevivodyashix putey (pecheni, jelchnogo puzirya s jelchegonnim zavtrakom), podjeludoch-noy jelezi; ezofagogastrofibroduodenoskopiya (efgds) s pritselnoy biopsiey soj; issledovanie na nr ne menee chem dvumya metodami; vnutrijeludochnaya rn-metriya; metod narujnoy elektrogastrografii (egg). 11 differentsialnaya diagnostika xg po lokalizatsii sindromi antralniy …

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cheskix usloviyax pri strogom soblyudenii vsex rekomendatsiy; 2 etap: lechenie v reabilitatsionnix tsentrax, sanatoriyax mestnogo znacheniya ili ambulatorno-poliklinicheskoe; 3 etap: dispansernoe nablyudenie gastroenterologa polikliniki. 13 pitanie pri xg lechebnoe pitanie naznachaetsya adekvatno tyajesti bolnogo- shadyashiy variant dieti do 30 dney: umerennoe ogranichenie ximicheskix i mexanicheskix razdrajiteley soj i retseptornogo apparata jkt, isklyuchaya ostrie zakuski, pripravi, pryanosti, ogranichivaya nacl. blyuda gotovyatsya v otvarnom vide ili na paru, temperatura pishi ot 15 do 60-650s. ob'yom jidkosti 1.0-1.5l. ritm pitaniya drobniy, 5-6 raz v den. 14 pitanie pri xg bolnim s povishennoy kislotoobrazuyushey funktsiey zapreshayut sokogonnie napitki (gazirovannie, cherniy kofe, krepkiy chay), a takje blyuda bogatie ekstraktivnimi veshestvami (navaristie supi, buloni, uxa). detyam s sekretornoy nedostatochnostyu rekomenduyut nekrepkie myasnie i ribnie buloni, ovoshnie otvari i supi na ix osnove (ovoshnie ili krupyanie),myaso, riba v rublenom vide ili kuskom, fruktovo-yagodnie soki, kiseli, jele, mussi. esli rebenok prinimaet preparati vismuta ili ingibitor protonnoy pompi(ipp), to …

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, gastrit, aktivnaya faza. prokinetiki: domperidon (motilium) metaklopramid (tserukal) itoprid (ganaton) miotropnie spazmolitiki: drotaverin (no-shpa, spazmol) mebeverin (dyuspatalin) pinaverium bromid (ditsetel) 18 ingibitori protonnoy pompi (ipp) omez (omeprazol) lansoprazol pantoprazol ezomeprazol (neksium) rabeprazol (pariet) n2- gistaminoblokatori: ranitidin (zantag) famotidin (kvamatel) 19 blokatori m-xolinoretseptorov: pirenzepin (gastrotsepin) giostsina butilbromid (buskopan) prifiniya bromid (riabal) antatsidi: almagel-neo, maaloks, fosfalyugel, alyumag, gastal, gastrogel, geviston, megalak, rutatsid, topalkan. 20 tsitoprotektori pri erozivnix xg: - vismuta trikaliya ditsitrat (de-nol) - sukralfat prinimat za 30 minut do edi, de-nol ne zapivat molokom i nelzya prinimat odnovremenno s antatsidami. 21 fizioterapiya xg: lazerterapiya magnitno-lazernaya terapiya induktotermiya elektroforez i fonoforez na epigastralnuyu oblast. 22 2. xronicheskiy neatroficheskiy, assotsiirovanniy s helicobacter pylori, antralniy ili pangastrit, aktivnaya faza. v plane lecheniya, pri neobxodimosti, ostayutsya vse visheperechislennie preparati, dieta, oxranitelniy rejim, spazmolitiki, antatsidi, fizioterapiya, no obyazatelno doljna provoditsya antixelikobakternaya terapiya po rekomen-duemim standartam maastrixt 1(1996), 2 (2000), 3(2005), 4 (2010) , 5 (2015) …

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) + klaritromitsin. 25 terapiya vtoroy linii – chetirexkomponentnaya terapiya («kvadroterapiya») de-nol + amoksitsillin (flemoksin solyutab) + klaritromitsin + nifuratel (ili furazolidon) + ipp (omeprazol). kurs terapii – 10-14 dney. 26 3. xronicheskiy autoimmunniy atroficheskiy pangastrit. lechenie osnovnogo zabolevaniya: autoimmunniy tireoidit, saxarniy diabet, veb i dr. na osnove kotorix voznik xg. lechebnoe pitanie. miospazmolitiki. obvolakivayushie i vyajushie rastitelnie sredstva: - preparati podorojnika (plantaglyutsid ili sok podorojnika) - nastoi trav (tisyachelistnika, zveroboya, romashki). 27 s zamestitelnoy tselyu: -naturalniy jeludochniy sok -atsidin pepsin -pepsidil kompleks vitaminov gruppi v - v1, v2, v3, v5, v6, v12 - neyromultivit (v1, v6, v12 ) - folievaya kislota - vitamini a, e, i. 28 adaptogeni: - nastoyka jen-shenya - eleuterokokk biostimulyatori obmennix protsessov: - karnitina xlorida 20% rastvor - elkar (levokarnitin) - mildronat - apilak - propolis rebenok s xg podlejit snyatiyu s dispansernogo ucheta pri uslovii 5-letney polnoy kliniko- endoskopicheski- morfologicheskoy remissii. 29 image2.jpeg /docprops/thumbnail.wmf

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xronicheskiy gastrit u detey. xronicheskiy gastrit u detey 1 opredelenie xronicheskiy gastrit (xg) – xronicheskoe retsidiviruyushee ochagovoe ili diffuznoe vospalenie slizistoy obolochki jeludka (soj) s narusheniem protsessov fiziologicheskoy regeneratsii, narushenie sekretornoy, motornoy, neredko inkretornoy funktsii jeludka, vozmojnostyu razvitiya atrofii, a takje nalichiem opredelennoy klinicheskoy simptomatiki. rasprostranennost xg v rossii sostavlyaet v srednem 100-150 sluchaev na 1000 detey. 2 etiologiya osnovnimi prichinami razvitiya xg u detey yavlyayutsya: infektsionniy faktor- helicobakter pylori (hp) medikamentozniy faktor – priem nesteroidnix protivovospalitelnix preparatov (npvp), kortikosteroidov, sulfanilamidov i dr. nalichie duodeno-gastralnogo reflyuksa (dgr) sochetanie vi...

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