Download 3. gastroduodenitis

MINISTRY OF PUBLIC HEALTH REPUBLIC OF UZBEKISTAN
THE TASHKENT MEDICAL ACADEMY
"CONFIRM"
The pro-rector on study
professor Teshaev O.R.
___________________
____ ___________ 2012
Department: INFECTIOUS DISEASE AND PEDIATRICS
Subject: CHILDREN'S DISEASE
TECHNOLOGY TRAINING
On practical training on the topic:
CHRONIC GASTRODUODENITIS
Tashkent
Compiled by:
Khalmatova B.T. – Head of Department, Doctor of Medical Sciences
Mirrakhimova M. Kh. – docent, Ph.D.
Education technology approved:
At the faculty meeting report №
from «___ » ____________ 2012
Flow chart classes
№
1
2
Stage of learning
Form of learning
Lead-in teacher (Ad practice
session topics, goals, learning
outcomes, the characteristics of
the studies, indicators and
evaluation criteria)
Discussion of the topic of practical The
survey,
an
lessons, baseline assessment of explanation
students' knowledge with the use
of new educational technologies
3
Summing up the discussion
4
Supervision
on
patients,
performing skills
Hear and discuss students'
individual work
Determination of the degree of
achievement based on the lessons
mastered
the
theoretical
knowledge and the results of the
development of practical skills
The conclusion of the teacher in
this lesson. Assessing the students
on a 100 point system and its
announcement. Dacha job to the
next class
5
6
7
Duration
5
30
5
100
30
Oral
survey,
case
studies, discussion
45
Information. Questions
for self-training
5
Topic: Peculiarities of chronic gastritis, gastroduodenitis
children. Etiology, pathogenesis, clinical manifestations, diagnosis,
treatment and prevention. tactics GPs.
1. Location classes
- Department of Infectious Diseases and Pediatrics, Hospital.
2. Duration of study subjects
Number of hours– 6,0
3. Purpose of classes
To consolidate and deepen the students' knowledge about chronic gastritis and
gastroduodenitis, develop the skill of early diagnosis, differential diagnosis, treatment, and
tactics GPs on remediation and clinical examination.
4. Pedagogical Tasks:
- To teach students the criteria for diagnosis of chronic gastritis and gastro children.
- Demonstrate the principles of differential diagnosis.
- To show the principles of treatment of hepatitis and CGD
- Consider the criteria of possible complications CGD.
- Organization of specialized advice to the sick child with CGD.
- To teach students draw up a plan recreational activities.
- To introduce the hepatitis prevention and CGD children.
5. Outcome of learning
The student should know:
-Anatomical and physiological characteristics of the gastrointestinal tract in a different age.
-Etiopathogenesis, chronic gastritis, CGD in children;
-Criteria for diagnosis of chronic gastritis, CGD in children;
-Major complications of chronic gastritis, CGD in children;
-Principles of treatment and prevention of chronic gastritis, CGD in children;
-Indications for consultation gastroenterologist.
The student should be able to:
-That's right to collect medical history and complaints of the patient, to interpret them.
-Interpret the results of clinical, instrumental and radiographic studies on the disease.
-Inspect-child pathology of the gastrointestinal tract.
-Treat patient depending on the course of peptic ulcer, gastritis and biliary dyskinesia
-Make a plan of rehabilitation
6. Learning methods and techniques
Web method, case studies, engineering: Graphic Organizer - Table
7. Learning tools
Manuals, training materials, slides, video recordings, the patient on the history of the disease
8. Form of learning
Individual work, group work, team
9. Learning conditions
Auditorium, chamber
10. Monitoring and marking
Oral control: control issues, the implementation of learning tasks in groups, performing skills,
IWS.
11. Motivation
Knowing the characteristics of a CG and CGD children allow a GP to diagnose and choose the
tactics. Pay attention to the nature of gastrointestinal lesions, the nature of the disease (with a
mandatory evaluation premorbid background, presence of chronic foci of infection), pay
attention to the most characteristic symptoms of the disease, in the different character of the
disease, with or without complications.
12. Intra and interdisciplinary communication
Teaching of the subject is based on the knowledge of students the basics of anatomy, physiology,
pathophysiology, pathology, microbiology, biochemistry, internal medicine, propaedeutics
childhood diseases, clinical pharmacology. Acquired during the course knowledge will be used
during the passage of the GP - pediatrics and other clinical disciplines.
13. Contents classes
13.1. Theoretical part
Chronic gastritis (CG) is a chronic inflammatory disease of the mucous relapsing (GM)
and the submucosa of the stomach, which is accompanied by cellular infiltration, impaired
physiological regeneration. HCG with inadequate treatment is prone to progressive atrophy of
the glandular system and the progression of disorders of the secretory, motor and endocrine
functions of the stomach. In contrast to the practice of therapeutic hepatitis in children only 1015% is an isolated disease. Antral gastritis is more common in conjunction with duodenitis gastro.
Chronic gastro (CGD) - a chronic relapsing inflammatory disease that is accompanied by
non-specific restructuring of the mucosa and glandular apparatus of the stomach and duodenum
(degenerative, inflammatory and regenerative changes) with different secretory and motor
impairments.
CGD - the most common form of chronic gastroduodenal diseases. In the structure of
diseases of the stomach and duodenum is 58-74%. In the diagnosis should be considered risk
factors for CGD and hereditary predisposition. Clinic of the disease depends on the phase and
the inflammatory process, the state of the secretory function of the stomach, the motorevacuation disorders of the stomach and duodenum. CGD during exacerbation, as with peptic
ulcer disease, the following clinical syndromes: pain, dyspeptic and chronic nonspecific toxicity.
Characteristic color gives clinical comorbidities hepatobiliary, bowel and pancreas. The clinical
manifestations are similar to the symptoms of peptic ulcer disease, but often lack the seasonal
periodicity of pain, night pain are rare.
The prevalence of chronic gastritis (CG) is very large - they suffer from 30 to 50% of
the population. Diseases of the stomach and duodenum of the most common digestive diseases in
children and constitute 58-65%. in the structure of children and gastroenterological diseases
occur in 100-150 per 1000 children. Despite the fact that the show's leading role in the etiology
of chronic HP gastritis and peptic ulcer disease in children, it is necessary to consider the role of
risk factors that have contributed to the emergence of a pathological process, its further
implementation.
Exogenous risk factors of hepatitis:
• nutritional - food "in suhomyatku" abuse of acute and fried food, lack of protein and vitamins
in the diet, the use of food additives, food arrhythmias, etc.
• Psycho-emotional factor - stress, depression
• Environmental factors: the state of the atmosphere, the presence of nitrates in food, poor quality
of drinking water
• Medications - non-steroidal anti-inflammatory drugs (indomethacin, aspirin, corticosteroids,
etc.)
• Bad habits - smoking, alcohol
• Parasitic infections (especially giardiasis) Food allergies and intolerance to certain foods
• The poor state of dental system
• Hormonal dysfunction
Endogenous factors HCG
• HP-infection
• Bile reflux into the stomach
• Endocrine Disorders
The development of high-technology therapies, endoscopy, morphological study of secondary
school, some biochemical and bacteriological methods allowed in the following modes of
gastritis (Sydney classification) for the following types of self:
Gastritis type A (endogenous, autoimmune gastritis)
Gastritis is caused by endogenous production of autoantibodies to the parietal cells of the
stomach. Children rarely 1-3% of all cases of gastritis. For this type of gastritis is characterized
by atrophic changes in primary localized in the bottom and the stomach, decreased gastric
secretion, improving the content of gastrin in the blood.
Type B gastritis (bacterial)
HP - associated gastritis. In children, this form of gastritis is 80-85% of the
gastroduodenal pathology. Proved that in the pathogenesis of chronic gastritis type B is
persistent infection with HP, which is confirmed by the fact that the organism found in the
pyloric part of the overwhelming majority of patients. Oral route of infection from food or
endoscopic manipulation, sensing (pathogenesis of HP-infection, see a lecture on the ulcer
presented on a site in pediatrics).
Gastritis type C (reactive chemical gastritis, reflux gastritis)
Determining role in the pathogenesis of gastritis C plays duodenogastric reflux with
reflux of bile acids, breaking and damaging coolant epithelium (reflux gastritis). Among other
reasons, this version of gastritis leading place of NSAIDs (aspirin, etc. Due to the influence of
antiprostoglandinovogo NSAIDs block the production of bicarbonate and mucus followed by the
formation of erosions, microcirculation disturbance.
Modern classification of hCG, which is used and recommended by pediatricians
Ukrainian Ministry of Health of Ukraine (2000) is primarily responsible, "the Sydney
classification" (1990)
Hepatitis in children usually occurs in the presence of hereditary tendency, and these risk
factors. Clinic chronic gastritis varied and depends on the nature of the violations secretion,
gastric evacuation function, age, and personality traits of the child. Are the following clinical
features of chronic gastritis in the exacerbation related to the state of acid secretion:
At an elevated (or normal) of hydrochloric acid (usually gastritis type B)
Pain syndrome: an intense and long associated with food intake. Early pain characteristic
of gastric fundus, and late pain for antral gastritis). Pain at night. There is no clear relation to the
time of year, violations of diet. In children older than age palpation indicated moderate epigastric
tenderness and pyloroduodenal zone.
Dyspeptic syndrome, "sour" belching, burping air, heartburn, nausea, tendency to
constipation.
Nonspecific toxicity syndrome is variable and asthenia. Draws attention to the autonomic
instability, irritability, rapid exhaustion in mental and physical loading.
With reduced acid secretion (usually gastritis type A)
Pain syndrome mild, characterized by blunt spilled epigastric pain. After the meal, a
feeling of heaviness and fullness in the upper abdomen, pain occur and amplified according to
the quality and quantity of food. On palpation minor "spilled" epigastric tenderness.
Dyspeptic syndrome predominates over pain. Observed food belching, nausea, a feeling
of bitterness in the mouth, loss of appetite, bloating, unstable chair. Gastritis with low secretory
activity there is a decrease in appetite, aversion to certain foods (cereals, dairy dishes, etc.).
Syndrome nonspecific toxicity significantly pronounced fatigue prevails. Sick - pale, body
weight decreased due to violation of the gastric phase of digestion and secondary disorders of the
pancreas, in severe cases of manifestations polyhypovitaminosis, anemia. In domestic pediatric
pay great attention to the definition of the state of acid-forming function of the stomach, which
affects not only the characteristics of clinical manifestations of gastroenterological diseases, but
also makes it possible to assign more justified antisecretory therapy and reparants.
The modern method of determining the acid-forming function of the stomach intragastric
pH meter. This method allows to determine the pH of the body and antrum. The normal pH of
the stomach body is fasting in children over 5 years of 1.7-2.5, and after the administration of
histamine - 1.5-2.5. Antrum, which provides neutralizing acid has a pH above 5. (Shabalov MP,
1999). That is the difference between the pH of the body and antrum of normal above 2 indicates
a compensated state. A reduction of this difference indicates a decrease in the neutralizing
properties of antral and duodenal acidification (decompensated state). In some hospitals, which
are unable to carry out intragastric pH meter we study the fractional method of gastric pH with a
variety of stimuli. The concept of hCG clinical and morphological. The most complete picture of
the stomach lesions provides a comprehensive study of antral biopsies, and the angle fundus of
the stomach. It should be emphasized that from the point of view of the leading
gastroenterologists without morphological study of the stomach gastritis diagnosis illegal. As a
preliminary diagnosis to the morphological study recommend to use the term non-ulcer
dyspepsia. Modern regimens HG depend on the type of gastritis, gastric secretory function, the
child's age, state of the autonomic nervous system and emotional state.
Given that a significant amount of abdominal pain in children is psychogenic in nature - a
clinical diagnosis of chronic gastritis should be verified endoscopically and histologically, and
only then begin therapy with the presence of concomitant gastrointestinal, somatic and
psychosomatic diseases.
The principles of treatment of gastritis type A
Ongoing replacement therapy aimed at restoring conditions for the functioning of the
stomach close to normal compensation atrophic processes in the coolant.
The basic method of treatment - health food. In the acute phase is assigned diet number
1a, which provides functional, mechanical, thermal and chemical schazhenie coolant and 5 to 6
meals a day. Excluded from the diet meals that can irritate coolant (salted, smoked, rich soups,
pickles, hot spices, grilled meat and fish). Given the fact that patients often do not tolerate whole
milk, grape juice, sour cream, it is desirable to exclude them from the diet. Limited use of salt,
strong tea and coffee, their surrogates. With the elimination of inflammation is shown gradually
increasing functional stimulation of fundic glands. For this purpose, a diet prescribed number 2 if
even number 15. It is necessary to limit the amount of fatty meats and fish, refractory animal
fats, fried potatoes, pancakes, canned foods, smoked meat and spices. Milk is replaced by fresh
dairy products (yogurt, kefir, cottage cheese, cheese is not sharp). Limited and fresh brown
bread, sweet dough, cream, sour cream, cabbage, grapes, which causes flatulence.
Anticholinergics and antacids for gastritis type A are not appointed. In the presence of
pain and dyspeptic syndromes good effect is achieved when the value of the reception or i / m
injection of metoclopramide, sulpiride, shpy, butilskopolaminbromida (Buscopan).
Widely prescribed cathartic and astringent herbal remedies: the infusion of plantain
leaves, granules plantaglyutsida, yarrow, chamomile, peppermint, St. John's wort, valerian root.
Herbal infusions are inside of 1/3 1/2 cup 4-5 times a day before meals for 2-4 weeks.
In order to stimulate the secretory function of the stomach can be used herbal
combination of drugs, which stimulate secretion: gerbogastrin, stomach drops gerbion, plantain
and its products (plantaglyutsid).
In order to use replacement solution of hydrochloric acid, pepsin and other drugs. To
improve the trophic coolant used tools that enhance microcirculation, protein synthesis and
repair processes: drugs niacin, vitamin B and C inside and injections metiluratsil solkoseril. With
concomitant megaloblastic anemia appoint additional injections of vitamin B12. In acute stage
subsides possible to apply methods of physiotherapy, spa treatments. Without exacerbation of
the disease patients recommended spa treatment.
The principles of treatment of gastritis type B
Given that the overwhelming number of cases of type B gastritis caused by HP, the basis
for treating this form of gastritis is eradication of H. pylori infection. Schema therapy of H.
pylori (see lecture on peptic ulcer disease). At the same time, has not lost its role in the initial
stages of treatment diet.
Assigned diet N1, which moderately reduces the mechanical and chemical effects on
coolant. Number of meals increases to 4-6 times a day. In the period of exacerbation with
significant pain syndrome may additionally appointed antispasmodics - drotaverine (drotaverineKMP, no-spa, but-x-spa), galidor, papaverine. In some cases the effective anticholinergic
atropine, Buscopan. At high rates of gastric acid antisecretory agents appointed from the group
of selective M holinolitikov - pirenzepine (gastrotsepin) for up to 4 weeks. Dose in children of
preschool age in the form of tablets 12.5 mg 2 times a day, and students 25 mg 2 times a day.
Blockers H2 - receptor antagonists (famotidine, ranitidine) for 2 weeks. Children older
than 10 liters. famotidine administered in a dose 0.02-0.04 g bedtime. After completing the
course of antisecretory therapy uses a comprehensive type Fosfalyugel antacids or medications
that contain algedrat with magnesium hydroxide (almagel, almol, Maalox). You can assign
diosmektit (smectite) in the dose for children over 2 liters. - 9.6 g / day in the form of an aqueous
solution at several stages. At the end of treatment to confirm the effectiveness of eradikatsonnoy
therapy, especially with residual pain and dyspeptic symptoms may prescribe a course
cytoprotectors - sucralfate (ankrusal, Venter). The dose of sucralfate in children 0.5 g - 1.0 g 4
times per reception (in the long run one time at night) for a month.
In order to improve trophic coolant can be used sea buckthorn oil, multivitamin
preparations for a period of 3-4 weeks. In the treatment justified appointment 2-3 weeks
tranquilizers - diazepam (seduksen, sibazon) tazepam etc. efficacy of herbal sedatives - an
extract of valerian, Percy.
The principles of treatment of gastritis type C
In the treatment of gastritis type C (reflux gastritis) occurs with impaired motility,
duodenogastric and gastroesophageal reflux, shows the assignment of metoclopramide (Reglan,
Reglan), which normalizes the closing function of the cardia. Metoclopramide also reduces
gastro-esophageal reflux disease, accelerates gastric emptying and increases the resistance of
coolant to damage. Occasionally possible side effects such as hyperkinetic phenomena,
drowsiness, tinnitus, dry mucous membranes in the mouth.
Normalizes gastric motility domperidone (Motilium). This drug acts softer than Reglan,
rarely has side effects. When gastroesophageal reflux promising application of selective
cholinomimetic cisapride (used with caution in disorders of the conduction system of the heart).
In order to neutralize the aggressive action of bile on coolant appoint Aluminium phosphate gel,
which in addition to the antacid action adsorb bile acids and has an enveloping effect. Good
cytoprotective effect has sucralfate (ankrusal, Venter, ulgastran, sukreyz). The mechanism of
action of the drug in reflux gastritis is the formation of complexes with proteins in the damaged
tissues of the mucous membranes. Sucralfate adsorbs pepsin and bile acids, increases the
resistance of the mucosa to acid-peptic factor. Cytoprotective action has diosmektit (smectite).
The most effective cytoprotectors synthetic analogues of prostaglandins, misoprostol
(Cytotec, arboprostil etc.). In the operation, they can be promising for use in children, as it
reduces both basal and stimulated gastric secretion, stimulate repair processes. However, these
drugs often cause dyspepsia, a number of undesirable effects on the reproductive system, allergic
reactions, and can therefore only be used in adolescents with erosive gastritis. Isolated chronic
gastritis or duo denitis in children are rare, most often we meet with gastro duo denitis. From the
point of view of the leading pediatric CGD in children with a history of gastroenterological
diseases by history is post ulcerative state.
Chronic gastro (CGD) — chronic relapsing inflammatory disease that is accompanied by
non-specific restructuring of the mucous membrane and glandular apparatus of the stomach and
duodenum (degenerative, inflammatory and regenerative changes) with different secretory and
motor impairments.
CGD - the most common form of chronic gastroduodenal diseases. In the structure of
diseases of the stomach and duodenum is 58-74%. In the diagnosis should be considered risk
factors for CGD and hereditary predisposition. Clinic of the disease depends on the phase and
the inflammatory process, the state of the secretory function of the stomach, the motorevacuation disorders of the stomach and duodenum. CGD during exacerbation, as with peptic
ulcer disease, the following clinical syndromes: pain, dyspeptic and chronic nonspecific toxicity.
Characteristic color gives clinical comorbidities hepatobiliary, bowel and pancreas. The clinical
manifestations are similar to the symptoms of peptic ulcer disease, but often lack the seasonal
periodicity of pain, night pain are rarely.
Pain syndrome: Most characteristic of abdominal pain - aching, prolonged that arise in
the morning on an empty stomach and at 1, 5-2 hours after a meal. There is often a sharp, shortlived nature of the attacks of pain, which is localized in the epigastrium, right upper quadrant,
around the navel. The pain is worse after eating and physical loading.
With erosive giperatsidnom CGD - combined hungry late at night and pain. Palpable
marked diffuse epigastric tenderness, positive symptom Mendel pyloroduodenal area with
erosion - perhaps a local muscle tension.
Dyspeptic syndrome: frequent belching, heartburn, prolonged nausea, heaviness after
eating, feeling of bitterness in the mouth, bloating, constipation, more rarely - unstable chair.
Syndrome nonspecific toxicity: emotional instability, frequent headaches, irritability,
fatigue, and asthenia.
In the treatment of patients with CH and CGD in modern conditions for adequate
diagnosis and treatment must perform the required volume paraclinical methods of examination:
Laboratory studies:
a) Mandatory (disposable)
• CBC;
• Clinical analysis of urine;
• Total protein and protein fractions of blood;
• Tests for Helicobacter pylori (rapid urease, bacteriological, respiratory urease test,
serological (ELISA), ELISA analysis of the concentration of antigen in stool HP, PCR);
b) If necessary:
• Fecal occult blood test (Gregersen reaction);
• Histological (cytology) biopsies using histological method for diagnosing Helicobacter
pylori - "gold standard";
• Immune gram;
Instrumental studies and diagnostic criteria:
Necessary:
• фиброэзофагогастродуоденоскопия with biopsy, and the rapid diagnosis of HP (with erosive
CGD - double);
• intragastric pH meter (or fractional study of gastric contents) - at a time;
• Ultrasound of the abdomen - once to identify comorbidities.
If needed:
• X-rays of the stomach and duodenum (motor-evacuation disorders, developmental
abnormalities);
• Rheography;
• Other activities according to the background and comorbidity
Basic principles of treatment are mainly responsible principles and hCG therapy depend
on the period of the disease, the nature of clinical and endoscopic changes, the state of gastric
secretory function and disorders of motor-evacuation function of the stomach and duodenum.
When exacerbation to define the conditions of treatment (inpatient or outpatient), the mode of
physical activity. Assign dietary activities with the patient (table number 1 or number 5).
A comprehensive treatment includes:
• With HP: anti-HP eradication therapy (usually within 7 days);
• antisecretory drugs: blockers of histamine H2-receptor for 2-3 weeks, M1-selective
anticholinergics (pirenzepine to 4 weeks). If necessary, add a cytoprotective drugs antacids and
sorption effect for 10-14 days. Smectite 1 envelope 3-4 times a day;
• prokinetics (domperidone) designate the presence of reflux and duodenostasis - for
10days.
• antispasmodics (drotaverine, papaverine, metatsin) - for 7-10 days;
• Sedative drugs and tranquilizers, sedatives plant.
After the abolition of antisecretory agents appointed reparants - smectite, sucralfate,
likviriton, sea buckthorn oil for a period of 4-6 weeks. Simultaneously, treatment of comorbidity
pancreatic enzyme preparations appointment. Teenagers may appoint intestinal antispasmodics
(ditsetel, pinavery bromide), constipation drugs act as a laxative (macrogol) and others.
In the acute stage of the disease are applied physical treatments - electrotherapy,
thermotherapy. To normalize the motor-evacuation function of the stomach and increasing
trophic coolant employs a laser and magnetic-laser therapy. Among non-drug treatments are used
reflexology.
In clinical remission: phytotherapy, balneotherapy, physiotherapy, exercise therapy, not
alternative drug therapy. Duration of stay in the hospital an average of 21 days (erosive CGD up to 28 days).
Inpatient treatment is desirable to continue at a local children's gastroenterology nursing
home. Direction for domestic spas in Mirgorod, Truskavets, Morshyn and others performed at a
sufficiently persistent clinical remission.
Clinical supervision in CG and CGD is five years since the last exacerbation, frequency
inspections at least twice a year.
Patients were examined by a doctor, a pediatrician 1 time in 6 months and a pediatric
gastroenterologist at one time a year. Fibrogastroduodenoscopy carried out at least 1 time a year.
With erosive CGD multiplicity surveys increases to 3 times a year, endoscopy - 2 times a year).
CGD patient child or HCG is subject to removal from the dispensary subject to a 5 - year
clinical and endoscopic remission.
USING "WEB" METHOD
This method will allow the teacher in the beginning of class to determine the level of
preparedness of the student to the subject by theoretical questions asked students to each - other.
methodology:
1.Predvaritelno students are given time to prepare questions on the passed occupation.
2.Uchastniki sit in a circle.
3.Odnomu participant is given a skein yarn, and he asks his prepared question (which itself needs
to know the full answer), hold the thread end and throwing the ball of any student.
4.Student, received a skein, answers the question (the party who asked him, says the answer),
and passes the baton to the issue further. Participants continue to ask questions and to answer
them, until everything will be in the web.
5.What Once all the students have finished asking questions, the student holding the coil, returns
to a participant, from whom he received the question, while asking the question, and so on, until
the "unwinding".
12. Analytical part (on the subject developed a case study).
13.3. Practical Part
In this lesson, students should master the inspection and palpation of the abdomen, the division
into zones. Superficial and deep palpation of the abdomen, recognizing pain points.
14. Control forms of knowledge, skills and abilities
- Oral
- Decision of situational problems
- Demonstration of practical skills
- IWS
15. The evaluation criteria of the current control
№
1
Progress in (%) and points
96-100
Mark
Excellent
«5»
The level of knowledge of the student
Depending on situations can take the
correct decision and leads the total.
When preparing additional literature
uses to practical occupation (both on
родном, and on English) By itself
analyses essence of the problem chronic
gastroduodentа. By itself can examine
sick and it is correct puts diagnosis
(chronic gastroduodent), fix plan of the
treatment and preventive maintenances
chronic gastroduodentа Shows high
activity, creative approach when
undertaking интерактивных plays it is
Correct solves situational problems with
full motivation of the answer During
discussion SRS will actively assign
questions, does additions Practical skill
2
91-95
3
86-90
4
76-80
executes certain, understands essence.
When preparing additional literature
uses to practical occupation (both on
родном, and on English)
By itself analyses essence of the
problem chronic gastroduodentа. By
itself can examine sick and it is correct
puts
the
diagnosis
(chronic
gastroduodent), fix the plan of the
treatment and preventive maintenances
chronic gastroduodentа. Shows the high
activity, creative approach when
undertaking интерактивных plays. It is
Correct solves the situational problems
with full motivation of the answer.
During discussion SRS will actively
assign the questions, does the additions.
Practical
skill
executes
certain,
understands essence
By itself analyses essence of the
problem chronic gastroduodentа.
Shows the high activity, creative
approach
when
undertaking
интерактивных plays.
It is Correct solves the situational
problems, motivates the treatment,
forms the plan preventive action. Knows
chronic gastroduodent, tells certain. Has
an exact presentations on этиологии,
патогенезу, clinic, can conduct the
differential
diagnostics,
fix
the
treatment, can conduct the preventive
maintenance chronic gastroduodentа.
Practical
skill
executes
certain,
understands essence
It is Correct collects анамнез, examines
sick, and puts the preliminary diagnosis.
Can interpret the given laboratory
studies. Actively participates in
discussion SRS.
Shows the high activity when
undertaking интерактивных plays.
It is Correct solves the situational
problems, but cannot fix the concrete
treatment, muddles the dosages a
preparation.
Knows
chronic
gastroduodent, tells certain. Has exact
presentations
on
этиологии,
патогенезу, and clinic, can conduct the
differential
diagnostics,
fix
the
treatment, but cannot conduct the
preventive
maintenance
chronic
Good
«4»
6
71-75
7
66-70
8
61-65
9
55-60
10
54 -30
gastroduodentа.
Practical skill executes on step
It is Correct collects анамнез, examines
sick, and puts the preliminary diagnosis.
Can interpret the given laboratory study.
Actively participates in discussion SRS.
It is Correct solves the situational
problems, will die to put the clinical
diagnosis on categorizations, but cannot
fix the plan of the treatment and
preventive action.
Knows chronic gastroduodent, tells
certain.
Has an exact presentations on
этиологии, патогенезу, clinic and
conduct the differential diagnostics, but
cannot fix the treatment Practical skill
executes, but muddles the steps.
It is Correct collects анамнез, examines
sick, and puts the preliminary diagnosis.
Can interpret the given laboratory study.
Actively participates in discussion SRS.
It is Correct solves situational problems,
but cannot motivate clinical diagnosis
Knows chronic gastroduodent, tells
certain
Has exact presentations on этиологии,
Satisfactorily
патогенезу and clinic, but cannot
«3»
conduct the differential diagnostics and
fix the treatment.
It is Correct collects анамнез, examines
sick, but cannot value gravity of the
condition. Partly can interpret the given
laboratory study. Actively participates
in discussion SRS.
Allows the mistakes at decision of the
situational problems (cannot expose the
diagnosis on categorizations) Knows the
clinic chronic gastroduodentа, tells not
certain Has an exact presentations on
этиологии chronic gastroduodentа, but
cannot the clinic with патогенезом
Collection анамнеза not goal-directed,
checkup not on scheme.
Can Not interpret the given laboratory
studies. Passive when discussing SRS
Has a general beliefs about chronic
gastroduodentе, tells not certain
Muddles
the
clinic
chronic
gastroduodentа.
Unsatisfactorily Has Not an exact belief about chronic
«2»
gastroduodentе does Not know the
11
20-30
clinics chronic gastroduodentа.
For the presence of the student in class,
Unsatisfactorily
in due form, have a notebook,
«2»
stethoscope
16. Flow chart classes
№
1
2
3
4
5
6
7
Learning Stages
Lead-in teacher (Ad practice session
topics, goals, learning outcomes, the
characteristics of the studies, indicators
and evaluation criteria)
Discussion of the topic practically
anyone classes, baseline assessment of
students' knowledge with the use of new
teaching technologies transformations
Summing up the discussion
Supervision on patients, performing
skills
Hearing and discussion students'
individual work
Determination of the degree of
achievement based on the lessons
mastered the theoretical knowledge and
the results of the development of
practical skills
The conclusion of the teacher in this
lesson. Assessing the students on a 100
point system and its announcement.
Distribution of jobs to the next class
Learning Form
Duration in min.
5
Опрос, объяснение
30
5
100
30
Oral survey, case studies,
discussion discussion
45
Information. Questions for
self-training
5
Overall 270 min – 45= 235 – 15 = 220 min duration of classes
17. Test questions
1. Etiopathogenesis of chronic gastritis, gastroduodenitis.
2. Classification of chronic gastritis, gastroduodenitis children.
4. Clinic of chronic gastritis and DG children.
5. Diagnosis and diff.diagnostika chronic gastritis and DG children.
6. The idea of modern concepts of the etiology and pathogenesis of the disease.
7. Tell modern classification of HCG and CGD.
8. Give the main clinical manifestations of the disease to be diagnosed.
9. With what diseases differential diagnosis of chronic enterocolitis in children?
10. Modern approaches of treatment and prevention of hepatitis and CGD children.
11. Tactics GPs in chronic gastritis, gastroduodenitis children.
18. Recommended Reading
Main
1. Childhood diseases, ed. H. P. Shabalova, 2010
2. Childhood diseases, ed. A.A. Baranova, 2010
3. Childhood diseases T. O. Daminov, B. T. Khalmatova, U. R. Babaeva, 2012
Extra
1. Denisov M. Practical Gastroenterology for the pediatrician. Moscow, 2001.
2.
Rations WL, Hackel SB, Herman L. Pediatric gastroenterology in diagrams and tables:
Reference Manual. SPb., 1998.
3.
Pathology older children - edited A. A. Baranova, M, -1998
4.
Directory GP. Edited by Acad. RAMS. N. R. Paleeva. EKSMO 2002
5.
Reference pediatrician. St. Petersburg, Moscow, 2004
6.
7.
8.
"Directory of the family doctor" (Pediatrics) - Minsk, 2000 - s.390-398, 417-420.
The five Minute child Health Advisor/ - M. William Schwartz, MD., - 1998, USA
A therapist’s guide to pediatric assessment, - Linda King-Thomas, Bonnie J. Hacker, 1987,
USA
9. Pediatrics, - Margaret C. Heagarty., William J. Moss, -1997, USA
10. www.tma.uz
11. www.medlincs.ru
12. www.medbook.ru