Functional reversible edema

Functional indigestion isimpairment of motor and / or secretory function, which occurs with the phenomena of gastric dyspepsia and pain syndrome, but there are no gastroscopic changes in the mucous membrane, and changes detected in morphological (especially histochemical and electron microscopic) studies are often reversible. Functional indigestion (FGR) is an independent disease or an early stage of chronic gastroduodenitis and peptic ulcer disease. It is generally accepted that gastric dysfunction occurs quite often. According to a number of researchers, more than a third of patients with complaints that occur in diseases of the digestive system can not detect any diseases. In practical activity, functional diseases of the digestive canal are noted in 18 of 1,000 children. ETIOLOGY. Functional disorders of the secretory and motor functions of the stomach can be primary and secondary, and by origin - exogenous and endogenous. Exogenous (more often - primary) functional disorders of the stomach are found in alimentary disorders: irregular eating, fast change of diet, fast food and dry food, overeating, abuse of carbohydrates, fats, coarse plant fiber, mushrooms, smoked foods, spices. Inadequate chewing food, eating too hot or cold food, food allergy, which most often occurs with the use of eggs, milk, certain types of fish, crabs, pork, honey, chocolate, mandarins, strawberries, strawberries, can also cause exogenous functional disorders of the stomach. Endogenous (more often - secondary) functional disorders of the stomach occur in diseases of other organs and systems: nervous, endocrine, digestive, cardiovascular, respiratory, urinary, hematopoietic. Especially often the cause of endogenous functional disorders of the stomach are diseases of the digestive system. It is noted that with intestinal diseases (chronic enterocolitis, dysentery), the gastric secretion first increases, and then sharply decreases, accompanied by inhibition of the motor function of the stomach. With chronic cholecystitis, both the secretory and motor functions of the stomach decrease, down to achlorhydria and hypotension. Multidirectional changes in the secretory activity of the stomach are observed in acute viral hepatitis. Diseases of the cardiovascular system are also often accompanied by functional disorders of the stomach. Quite often, there are abnormalities in the function of the stomach in chronic glomerulonephritis, even without uremia, manifested by gastric dyspepsia and pain in the epigastric region, increasing with chronic renal failure. Reduction of secretory and motor functions of the stomach is often found in anemia, iron deficiency. Diseases of the endocrine organs can also cause functional disorders of the stomach. PATHOGENESIS. It is caused by violations of the periodic activity of the stomach due to irritation of baro-and chemoreceptors, poorly ground food, extractive and toxic substances. A number of exogenous factors (ionizing radiation, burns), drugs (acetylsalicylic acid, indomethacin, corticosteroids, etc.) can lead to the development of functional disorders of the stomach - short-term hyperchlorhydria with subsequent development of secretory insufficiency. In these cases, the occurrence of functional disorders of the stomach is associated with the direct effect of damaging agents on the gastric mucosa or their effect on regulatory systems (cerebral cortex, hypothalamus, pituitary gland, vegetative centers, endocrine organs). The allocation of excess amount of gastrin leads first to gastric hypersecretion and hyperchlorhydria, and over time, if the etiological factor is not eliminated, to the depletion of the glandular apparatus of the stomach and the appearance of hypo- and achlorhydria. The coordinated activity of the sphincter of the stomach is violated, which promotes mixing of food and contact digestion. The pathogenesis of functional disorders of the stomach in diseases of other organs and systems is associated with viscer-visceral reflexes, as well as with violation of the neurohumoral regulation of the gastroduodenal system, caused, in particular, by the increase or decrease in the production of gastrointestinal hormones (gastrin, secretin, enterogastron, etc.), hormones of endocrine glands (insulin, somatostatin, calcitonin, etc.) and other biologically active substances (prostaglandins E and A). The alkalization of gastric juice in diseases of the hepatobiliary system and intestine can be associated with regurgitation of the contents of the duodenum containing the bile and secret of the pancreas into the stomach. Often violations of the secretory and motor functions of the stomach are observed in functional and organic diseases of the central nervous system: encephalitis, meningitis, brain tumors, skull injuries, hysteria, vegetoneurosis. Neuropsychiatric overexertion can lead to the development of dyspeptic disorders and pains of a spastic nature in the abdomen. The pathogenesis of functional disorders of the stomach in diseases of the central nervous system and other changes in the neuropsychic sphere is associated both with the direct involvement of the central nervous system in the implementation of interoceptive influences on the stomach and duodenum, and with the inclusion of the autonomic nervous system, hypothalamus, pituitary gland, adrenal glands and other endocrine organs in the pathological process through their hormones. Patients of this category clearly trace the relationship of the occurrence of "gastric complaints" with mental trauma, stressful situation, chronic overwork. CLINICAL MANIFESTATIONS. The most characteristic sign of the FRG in children is pain in the epigastric region, in the right upper quadrant, near the navel (without clear localization). In addition, the localization of pain may change within one or several days and not be related to the reception and character of the food. The pain is constant, aching or pressing, as well as acute, cramping-like colic. Pain in the epigastric region can be accompanied by a feeling of heaviness, raspiraniya, pressure, especially with secondary disorders viscero-visceral reflexes, with diseases of other organs (intestines, gall bladder, etc.). Anti-peristaltic contractions of the stomach, especially when cardia is deficient, lead to regurgitation of acidic gastric contents into the esophagus, irritation of its lower segment, the appearance of heartburn, and with severe stomach contractions - belching, acid, bitter. Possible aerophagia, in which there is a very loud belch. Perhaps the emergence of a "rotten" belch in violation of the evacuation of food from the stomach (pyloripasms, atony of the stomach, gastroptosis), when due to rotting of the products of incomplete protein breakdown hydrogen sulphide enters the oral cavity. With motor and secretory disorders of the stomach, nausea may appear due to irritation of the vagus nerve, which is often accompanied by pain and pain in the epigastric region, drooling, unpleasant taste in the mouth, dizziness, general weakness. When you take a large amount of food (especially unusual, but quite benign) after a few hours there is a feeling of heaviness in the epigastric region or abdominal pain. There is a profuse vomiting that brings relief, the pain disappears. With food allergies several minutes after the contact of the food allergen with the mucous membrane of the stomach (due to a hypersensitivity reaction of the immediate type), the peristalsis of the stomach becomes worse, spastic contractions of it and spasms of the pylorus appear, there are anti-peristaltic waves, tenderness in palpation of the epigastric or pyloroduodenal region. All this is accompanied by nausea, abundant salivation, severe abdominal pain, severe weakness, blanching, cold sweat, tachycardia, sometimes dizziness and ends with vomiting, which usually brings relief. Endoscopically or radiologically outside the attack, it is not possible to detect changes. In the WHD, the secretory function of the stomach and the acid activity of the gastric juice are moderately elevated, the proteolytic is usually unchanged or slightly elevated. The indicator of the alkaline component is normal. Radiography sometimes reveals cardiopathism or pyloroduodenospasm, accelerated or delayed evacuation. The clinic of functional disorders depends on their nature. Thus, with hyperchlorhydria and increased motor function of the stomach, it is more often observed that the belching is acidic, heartburn, vomiting, often abundant acidic contents, severe pain, which does not have a definite localization, in combination with vegetative disorders. X-ray examination reveals an increased peristalsis of the stomach, spasm of the pylorus, delay in the evacuation of gastric contents. When gastroscopy reveals profuse secretion, spasmodic contractions of the stomach, increasing its tone, which leads to frequent regurgitation of the introduced air. With hypo- and achlorhydria, anorexia predominates, regurgitation of food, belching of the air, bitterness in the mouth, nausea, sometimes vomiting with an admixture of bile and mucus, a feeling of heaviness and pressing dull pain in the epigastric region, more often immediately after eating. Functional intestinal disorders are often associated; there is an unstable stool with prevalence of diarrhea. The tongue is covered, edematous, with the impressions of the teeth along the edges, the smoothed papillae, the hyperemic tip, in which the burning and tingling sensation is felt. When x-ray examinations are found, flaccid peristalsis, gastroptosis, the gaping gatekeeper and rapid gastric emptying, i.e. signs of a decrease in his tone. Sometimes, with a significant decrease in the tone of the stomach, evacuation slows down. When gastroscopy mucous membrane without pronounced changes, sometimes paler, in the stomach a large amount of thick mucus; an admixture of bile is possible. DIFFERENTIAL DIAGNOSIS. Specific markers of functional disorders of the stomach, as well as other organs, is not established. Pain in the epigastric region and gastric dyspepsia occur not only with functional disorders of the stomach, but also in other diseases. Therefore, it is necessary to carefully collect the history taking into account previous violations of the regime, the quantity and quality of nutrition, neuropsychic and physical overloads, concomitant diseases. The lack of a clear connection of pain in the epigastric region and the phenomena of gastric dyspepsia with food intake, their dependence on stressful situations, agitation or exacerbation of any diseases of other organs and systems testify to the functional disorders of the stomach.

The combination of these complaints with changesautonomic nervous system (sweating, tremor of fingers, eyelids, tip of tongue, persistent diffuse red or white dermographism, rapid exhaustion of the abdominal and an increase in tendon reflexes) confirms this assumption. When palpation of the abdomen is determined by soreness, which has no clear localization. It can be in the epigastric region, right and left hypochondria, around the navel, in the region of the transverse colon, sometimes migrating to the same patient. Perhaps percussion and auscultatory change of the boundaries of the stomach with its atony. The change in gastric secretion can not serve as a reliable criterion for functional disorders of the stomach, since the secretion variables vary within fairly wide limits and in healthy individuals, depending on the nature of nutrition, the type of nervous activity, environmental conditions; with functional disorders of the stomach possible heterochyroidism in the same patient, which can be an additional diagnostic criterion only with dynamic observation in conjunction with other symptoms. Quite informative in the diagnosis of functional disorders of the stomach is the X-ray method of investigation, which allows to identify such motor disorders as spastic contractions or atony of the stomach, strengthening or weakening of peristalsis, gastroptosis, gastric contents into the esophagus and duodenal into the stomach, cardiac spasm and insufficiency of the cardiac sphincter, pilorospazm and atony of the pylorus. Helps diagnose and gastroscopy, in which thickening of the folds of the unmodified mucous membrane can be detected due to spasmodic contractions, rapid regurgitation of the introduced air, stomach pain and vomiting, even with a small amount of it, gastro-spasm due to irritation of the vagus nerve, characterized by sharp cramping pains in the epigastric vomiting or regurgitation of stomach contents, vegetative disorders (cold sticky sweat, pallor, bradycardia, hypotension). Fibroscopy allows for intragastric tonometry, recording of hypotension and dilatation of the stomach. In cases where the WFD occurs after taking an abundant amount of food, it must be differentiated from a food toxico- * infection that develops violently, the general condition is violated, the body temperature rises, and a loose stool appears. In severe cases, dehydration and toxicosis develop, there is a loss of consciousness, delirium, cramps. Usually, several children are ill. FGR, accompanied by abdominal pain and vomiting, should be differentiated from acute surgical diseases: intestinal obstruction, appendicitis, peritonitis, croupous pneumonia, helminthic invasion, mezadenitis, meningitis, dysentery, etc. TREATMENT. It should be comprehensive and include the elimination of the causes of the disease. The main attention should be directed to the normalization of the diet, timely treatment of diseases of other organs and systems, the exclusion of allergens, toxic effects, therapeutic nutrition. With an increase in the functional activity of the stomach, diet variants No. 1 are prescribed depending on the severity of hypersecretory disorders. With functional disorders of the stomach, the hypo and asthenic type is prescribed diet No. 2. When a combination of secretory deficiency with chronic cholecystitis is prescribed diet number 5. When taking a large amount of food accompanied by excessive vomiting, you should wash the stomach with warm boiled water, 1% solution of sodium bicarbonate or induce vomiting by pressing on the root of the tongue, giving pre-1 / 2-1-2 glasses of warm water. The child should be laid in bed, warmed, give warm sweet tea, put a hot-water bottle on the stomach. The first 1-2 days show a gentle diet. With food allergies - immediately eliminate food from the food allergen, rinse the stomach, give a salt laxative, antihistamines, symptomatic drugs. Of the fortifying agents, vitamins are prescribed primarily, and with hyperfunction of the stomach, preference should be given to vitamins B6, B2, C, and in case of hypofunction - B. P, PP, B | 2, folic acid, with severe asthenia and intestinal dysfunction - in conjunction with the appointment anabolic steroids, protein hydrolysates. Neuro- and psychotropic drugs affect the disturbed regulation of the functions of the gastroduodenal system, including cortical processes, and stop the pain syndrome. With hyperchlorhydria and increased gastric motility, it is preferable to prescribe M-cholinolytics of peripheral and sight-cell action (metacin, gastrocepin, etc.) that inhibit gastric secretion, eliminate motor disorders and, consequently, pain sensations, as well as other antisecretory drugs - H blockers, -receptor histamine (ranitidine, famotidine), which can not be corrected by M-holinolitics and antacids in combination with psychotropic drugs. With a decrease in secretion and motility, it is advisable to prescribe caffeine, papaverine, euphyllin, enhancing the formation of cAMP, with pronounced atony - small doses of proserine. To a certain extent stimulate the secretion and tone of the stomach preparations of potassium and calcium (panangin, potassium chloride, calcium gluconate). Sedation funds are prescribed taking into account personal characteristics and manifestation of vegetative changes. With hyperfunction of the stomach apply belloid, bellaspon, tazepam, elenium, seduxen, with hypofunction - valerian, rudotel, grandaxin. An obligatory component of therapeutic measures should be psychotherapy, which in patients with neurotic disorders of the functions of the stomach is the main, and sometimes the only method of treatment. The allocation of funds that affect the basic functions of the stomach is to a certain extent conditional, since neuro- and psychotropic drugs have a similar effect on the functional state of the stomach. So, for elimination of dyskinesia of cardiac and pyloric sphincters of the stomach, motilium (domperidone) is used, which, being an antagonist of peripheral and central dopamine receptors, increases the duration of peristaltic contractions of the antral part of the stomach and duodenum, raises the tone of the lower esophageal sphincter, and exerts an antiemetic effect. The drug is administered as a suspension at the rate of 2.5-5 ml per 10 kg of body weight 3 times a day. You can also use sulpiride (eglonil), but-shpu, halidor and cerulek (raglan, ephedrine, metoclopramide). But cerucal should be prescribed to children over 3 years of age and for a short time, since side effects (headaches, dizziness, increased intestinal peristalsis, etc.) are possible. With hypersecretion and hyperchlorhydria, antacids are prescribed (vikalin, magnesium oxide, diamond, phosphalugel, maalox, gelusil) 1 to 1.5 hours after eating. The alkalinizing action of antacids can be strengthened by applying them in combination with cholinolytics (in the absence of gastroesophageal and duodenogastric reflux), which, while slowing evacuation from the stomach, prolong the action of the alkalinizing factor. Substitution therapy is prescribed for patients with hypo- and asthenic type of functional disorders of the stomach. The means of this group include abdomin, acid-pepsin, natural gastric juice, preparations containing pancreatic enzymes (creon, pancreatin, panzinorm, festal, digestal, etc.), which are especially indicated in cases of intestinal dyspepsia, pancreatic dysfunction. With concomitant chronic cholecystitis, it is advisable to prescribe cholagogue and anti-inflammatory drugs (flamin, choleretic tea, nicodine, etc.). From physiotherapeutic procedures, warming compresses, electrophoresis with novocaine, papaverine, diathermy, mud applications, ozocerite, paraffin, coniferous baths, general galvanization with bromine according to Vermel, galvanic collar with calcium chloride over the Scherbak are effective from hyperventilation of the stomach. With hypofunction, it is expedient to prescribe Bernard's currents, amplipulse therapy, circular shower, pearl-oxygen baths. Sanatorium treatment is indicated during remission. Depending on the type of functional disorder, the appropriate drinking regime is prescribed: with increased secretion, mineral water (Borzhomi, Smirnovskaya, Slavyanovskaya, Essentuki No. 4, Izhevskaya, Arzni) is recommended warmly, without gas, 1.5-2 hours before meals; at a reduced room temperature - 30 minutes before meals. Patients with functional disorders of the stomach are subject to follow-up and periodic examination 1-2 times a year, since with a long course of this pathology (more than 2 years), deep destructive changes in the gastric mucosa may develop and develop either chronic anthra- phic gastritis with increased secretory function patients with hyper- and normostenic type), or in hypo- and asthenic type - chronic diffuse gastritis with secretory insufficiency. In addition, functional indigestion is often the initial stage of gastritis and peptic ulcer. Timely diagnosis contributes to targeted treatment, which leads to the recovery and prevention of chronic gastroduodenal diseases. PREVENTION. Is in the timely treatment of diseases! organs of digestion and other systems, sanitation of the oral cavity, adherence to the diet (regular meals, the exclusion of food in the dry), the use of sharp and rich in coarse vegetal fiber. Observance of the regime of the day, morning exercises, water procedures, auto-training (in older children) contribute to the strengthening of the nervous system and, therefore, can be considered as measures to prevent functional disorders of the stomach. This is facilitated by the diet for 2-6 months after acute infectious diseases (dysentery, viral hepatitis, salmonellosis), nephritis, helminthic and protozoal invasions, operations, primarily on the organs of the abdominal cavity.

  1. Differential diagnosis
    Differential diagnosis of chronicgastritis is most often carried out with peptic ulcer, stomach cancer and functional disorders of the stomach. With gastritis, in contrast to stomach ulcers, the pains are not so intense and regular, their appearance at night is not typical; with palpation, tenderness in epigastric obolost is insignificant; There is no ulcerative niche for radiology and
    1. In the clinic of chronic intoxication with inorganic phosphorus compounds, one of the central places is the pathology of the nervous system and higher mental functions, which are early signs of damage to the nervous system. 2. Neurologic manifestations of HINSF are characterized by the development of asthenoneurotic syndrome and the syndrome of vegetative dystonia in combination with dysfunction of median
    In the previous lecture, we considered methodsthe provision of first aid in emergency situations due to various injuries, in this - due to diseases or functional disorders. These urgent conditions include: immediate life-threatening pathological conditions; pathological conditions that at the moment do not threaten life, but the lack of timely
  4. Definition
    NDC - polyethyological functionala neurogenic disease of the cardiovascular system, which is based on disorders of neuroendocrine regulation with multiple and diverse clinical symptoms that arise or are aggravated against a background of stressful influences, characterized by a benign course and a favorable prognosis. The term NDC is proposed by N.N. Savitsky (1948) and G.F.
  5. Epidemiology
    Functional disabilitiescardiovascular system is extremely widespread, especially among young and middle-aged people. According to numerous epidemiological studies in the population, vegetative disorders are noted in 25-80% of observations. In the general structure of cardiovascular diseases, NDC, which is based on vegetative disorders, is
  6. Relationship of the skin with the central nervous system and int. bodies
    The receptor field of the skin is functionallyinteracts with the central and autonomic nervous systems, constantly acting dermoneurotropic, dermovisceral connections. The skin reacts continuously to a variety of irritations coming from the environment, as well as the central nervous system and internal organs. It is logical to imagine that the skin is, as it were, a screen on which functional and
    Circulatory disorders are associated with changesfunction of the heart, arteries, microvessels, veins, disturbances in the rheological properties of the blood flowing through them, the permeability of the histohematological barrier or neurohumoral regulation. Individual links of the cardiovascular system function in close interconnection, therefore, the changes occurring in one of them affect the function of all the others. Wherein
  8. Diseases of the autonomic nervous system
    The autonomic nervous system is represented in the cortexa large brain, a hypothalamic region, a brain stem, a spinal cord; there are also peripheral parts of the vegetative system. The presence of a pathological process in any of these structures, as well as a functional disruption of the connection between them, can cause the appearance of vegetative
  9. Nosocial psychiatric disorders
    As a result of deterministic generalizationpathogenetic mechanisms of mental trauma, specific specific deficit symptoms develop. At this pathological level, mental disorders are not only syndromic, but also nosologically structured and fit within the framework of well-known nosological forms with a peculiar pathoplastic framing of their clinical picture. TO
  10. Justification of the expediency of developing new technology
    The expediency of developing an improveddevice is determined by its role and importance for medical institutions. It is important that this device is cost effective and of high quality. The quality depends on the functional and technical characteristics, and its change is estimated by the technical level index of the developed device. To determine the technical level index
  11. General concept of disease
    Definitions of the concept of the disease set: disruption of normal life activity, adaptation to the environment (disadaptation), the functions of the organism or its parts, the body's connections with the external environment, homeostasis (the constancy of the internal environment of the body), the inability to fully exercise human functions. According to the classification of the World Health Organization (WHO), the disease is a violation
  12. Criteria of the disease
    An important criterion of the disease are complaints of the patient(malaise, pain, various functional disorders, etc.), which, however, do not always reflect objectively the state of the organism. In some cases, people with increased suspiciousness and superficial awareness of certain signs of a disease and the causes that cause it can misinform the doctor telling them about their
  13. The concept of normotrophy and dystrophy
    Normotrophy is normalfunctional and morphological state of the organism. Implies the following: a child with a clean, pink, velvety skin, a normal turgor, a uniform distribution of subcutaneous fat, without signs of violation of internal organs and systems, normal indices of physical, motor, mental development, rarely sick,