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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.