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Diagnosis: Chronic erosive gastroduodenitis in the stage of exacerbation

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Diagnosis: Chronic erosive gastroduodenitis in the stage of exacerbation.

Complaints on admission: Complaints of periodic painful nature in Mesogestria, which arose more often after eating, mostly in the morning after the first breakfast, at other times of the day pain appeared very rarely. The pain itself took place within 15-20 minutes. Other complaints at the time of admission did not show.

Complaints at the moment of curiae: The patient complains of persistent pain in the Mesogestria area, of a less intense nature, occurring much less often than on admission .

In the spring, there was again an exacerbation with the above described pain symptom . At the examination in April, 1999 Lamblias are found in the feces. Outpatient treatment trichoma. By the way, after treatment, control tests for the presence of lamblies are negative.

The last exacerbation began in early September this year. Again there was a sensation of pain in the morning after eating in 10-15 minutes, the duration of it did not change, but the pain became more intense. There were no other symptoms. During the autumn-spring exacerbations, in the words of the girl, a good appetite was maintained, the chair was observed once a day in the morning hours of normal coloring and consistency. The presence of nausea and vomiting during the entire illness of the child is denied. The parents of the girl turned to the district therapist for medical help, who directed the child to hospitalized in STD # 1 for the purpose of in-depth examination and subsequent treatment.

ANAMNESIS VITAE

Genera urgent first, in the fore form of the occipital predelia. Births proceeded without pathology. The child cried out immediately, at birth, had a mass of 3.200 g., Body length 51 cm, Apgar score of 8 points. The child was applied to the breast of the mother in 12 hours, active sucking movements were observed.

In the newborn period, a physiological jaundice was observed, which disappeared on the 7th day. The remainder of the umbilical ring disappeared for the third day, umbilical wound healed without complications. In the mother, lactation was sufficient, inflammation of the thoracic glands was not. From maternity home, mother and child were discharged on the 5th day. At discharge, the baby had a mass of 3.100 g.

On breastfeeding was up to 1 year 2 months. All supplements were introduced on time, preference was given to vegetable puree, fruit juices. The baby’s correction was carried out taking into account all the requirements. In the words of mother, the appetite at the child was good, the nutrition was rational and balanced on the amount of proteins, fats, carbohydrates.

Psychomotor and physical development of the child in the first year of life corresponded to the age. To keep a head the girl became in 1.5 months, to sit in 6 months, to stand in 8 months, and to walk in 9 months. By the year, the stock of words was 9.

The mental and physical development after the year of life corresponded to the age. By the year, the child had 8 teeth.

The mental and physical development of the girl after a year was equal to the age. Tuberculin tests are negative. According to the vaccine calendar, it has been preserved.

Hereditary history: a grandfather on the mother’s line a history of peptic ulcer. The health status of other children in the family of relatives does not suffer from the patient’s words.

Allergic history Not burdened.

Epidemiologic history: Fish families of carp, raw water does not consume food.

The social-household history. Relationships between parents and the child are good, kind. The main teacher of the child is the mother. Mom and girl live in a separate, well-appointed apartment, the girl has a separate room. Material and living conditions are satisfactory. The mode of life is correct. Asleep quickly, deep sleep. On the face of the public and educational load at school: the girl is engaged in high school, music school and dance, but the girl states that she can easily cope with the burden placed upon her, fulfilling all her educational duties with interest and desire, denying the presence of tiredness from the educational activity both in high school and in music and dance. At the same time, notes the presence of periodic headache in the evening, that the mother of the child in no way binds with increased training load. The girl easily finds a common language with her peers, communicative. Adequately perceives the criticism of the elderly, but is upset because of bad marks, which is due to increased demands on the progress of the parents. The father of the girl (doctor on education) does not live with the family due to divorce, often meets a child, showing great interest in her education, has a great influence on her. The separate living of parents is perceived by the child as a given, the girl herself reluctantly talks about relationships with both parents who, in words, are equally trusting and warm with their father and mother, conflicts almost do not arise.

Risk factors in the development of a child:

1) Parasitic infestation,

2) Transferred dysentery.

3) Irregular nutrition.

4) Excessive physical activity.

OBJECTIVE STUDY

General state The patient is closer to satisfactory. Consciousness is complete, facial expression is calm, skin covers of physiological color. Eyes are wide open, shiny. The pupils are the same, the reaction to the light is alive, friendly. Behavior of the child during inspection is calm. The body of the child is correct. Genetic stigma is absent.

Output: 9 b Microsomototype, disharmonious development.

Skin covers are pale pink, without pigmentation, moderate humidity, elastic. The type of fatness is female. Mucous membranes of lips, mouth, conjunctiva eyes pink. The subcutaneous fat layer is developed moderately and uniformly, the thickness of the skin folds at the level of the 2nd intercostal space is 1.5 cm, at the level of the umbilicus of 2 cm.

Lymph nodes with palpation are painless, elastic, not conjugated with the surrounding fiber. The occipital and submaxillary salivary glands are not enlarged, painless. The thyroid gland is not palpable. The degree of development of the muscular system is average, the muscle tone is normal, muscle strength is good.

The proportions of the brain and the facial part of the skull are preserved. Chest is normostenic, symmetrical and non-deformed. When examining the spine, deformities have not been detected, the posture is correct. The extremities are proportional, tubular bones without visible bending. Pathological changes in the bones are visual and palpation is not observed. Joints without visible deformations. Skin covers over the joints of physiological color, local increase of temperature is not detected by palpation. The volume of active and passive movements is preserved, close to the physiological.

Breathing organs: Nasal breathing is free. Type of breathing chest. The breath is deep, rhythmic. ChDD 18 per minute. Both halves of the chest are equally symmetrically involved in the act of breathing. When palpation, the thorax is elastic, pain in the course of intervertebral nerves and muscles is not present. Voice shaking is the same on symmetrical places. Percussion is determined by clear lung sounds across all the lungs fields.

With topographic percussion:

Topographic line Right light Left lung || | 300
L. parasternalis 4m / p
L. mediaclavicularis 5m / p
L. axilaris anterior 6m / p 6 m / p
L. axilaris media 7 m / p 7 m / p
L. axilaris posterior 8 m / p 8 m / p
L. scapularis 9 m / p 9 m / p
L. paravertebralis 10 m / p 10 m / p

Auccultatively determined vesicular breathing over all the lung fields, pathological respiratory no noise.

Cardiovascular system: When examining the cardiovascular system, pathological pulsations were not detected. The pulse is the same on both hands, rhythmic, moderate filling. Vertex impulse is not visually determined.

When listening, the tone of the heart is clear rhythmic.

AD = 120/80 mm. ht Art. At palpation, the apical impulse is localized in the fifth intercostal space along the median-key line, normal characteristics, the limits of relative cardiac dullness correspond to norm.

Digestive system and organs of the abdominal cavity: The appetite is elevated. Dyspepsia is not observed. There is a periodic, painful, low-intensity character appearing in the morning after the first breakfast in the right and left ilium and just above the navel. Pain sensations go on their own, without the use of medicines, after 15-20 minutes and do not appear more during the day after eating food for lunch and dinner.

Tonsils of normal anatomical sizes. The abdomen is slightly protruded, the right half is symmetrical to the left. Subcutaneous veins are not visible. The navel is slightly retracted. Diastase of the direct muscles of the abdomen, hernial protrusions is not detected palpated. The stomach participates in the act of breathing. Peristaltic movements of the intestines are not visible.

When surface (orientated) palpation of the abdomen, the zone of perineal hyperesthesia of Zakharyin-Geda is not determined. In deep palpation of the large intestine, the sigmoid colon, the blind, transverse-abdominal, are within its normal anatomical position. With palpation of the stomach, pancreas, mesenteric lymph nodes, no noticeable changes are observed, except for insignificant pain in the region of the stomach, sigmoid and rectum. The morbidity at the point of Kerah, the Schoffar zone is determined. The positive symptom of Mendel, the symptom of Ortner, the Boas symptom, Murphy is determined. When palpation of the liver, the edge of the liver does not protrude from the edge of the edentulus. The lower edge of the liver is moderately dense, painless, with a smooth surface. Percussion of the liver: ordinates of Kurlov: 9 ‘8’ 7 cm.

The genitourinary system: In the examination of the genitourinary system of pathological changes, revealed There is no pain in palpation of ureters, the Pasternatsky’s symptom is negative. Urinary tract is painless.

Nervous system: Consciousness is clear, the response to the surrounding is adequate, the room in the clinic responds calmly. Common cerebral symptoms of central nervous system lesions are absent. Meningeal symptoms are negative. CHM without pathology. Violations of sensitivity are not observed. The motor sphere is unchanged: reflexes with upper limbs, knee, achilles without distinct side differences, coordination of movements is not disturbed, abdominal reflexes are symmetrical. Vegetative-trophic sphere without pathology. The development of higher cortical functions corresponds to age. Thinking active. No visible memory impairment. Speech is free, vocabulary exceeds age parameters. The overall emotional tone is positive. The behavior of the child is adequate to the age. Sleep deep, not less than 9 -10 hours a day.

Sense organs: Pathological changes from the sensory organs were not detected. There is no hearing and vision impairment.

Preliminary diagnosis: Chronic erosive gastroduodenitis in the stage of exacerbation.

Survey plan: 1) General blood test.

  • General urine analysis.
  • Kal on eggs worm
  • X-ray of the chest || | 432

The results of the survey conducted: OAC: Er = 4,3’10 / l, Nb = 142 g / l, CP = 0,9,

L = 7,6’10 \ l, E 1, P 1, C 39, L 53, M 6. COE = 20 mm \ h.

Conclusion: According to annыm KLA observed otnosytelnыy no absolute lymphocytosis, uskorenye Speed ​​osedanyya background of red blood cells to normal (the upper limit for blyzhe norms) Quantity of general leykotsytov. Such a pattern of peripheral blood is characteristic of a child who has undergone a recent infection with the virus (ARVI, influenza).

Bilirubin straight: 1,1 μmol \ l – ¯N;

Indirect: 11 μmol \ n – N;

a-amylase -11, 7g \ l – N;

AST, ALT-0.40 μmol \ l – N;

b-LP 40ed – N;

Timolatum sample 3.1 units – N;

Cholesterol 3.6 μmol \ l – ¯N;

Alkaline phosphatase 20.4 units (N = 0.14-0.36 μmol / L);

Serumcoid – negative – N

CRP- negative – N. || | 503

Conclusion: According to the biochemical examination of blood, normal indices are revealed.

ECG: Vertical position of the electric axis of the heart, sinus arrhythmia of heart rate 70, left ventricular overload – (unreliable).

Analysis of feces on eggs worms from 23.09.99: Yay The worm is not found.

FGS: Conclusion: Chronic gastroduodenitis, exacerbation, (erosion of the gatekeeper).

Bile analysis: 1 portion: light yellow, clear, L-0-1 -1, flat epithelium-0-1-1, mucus + +; 2 portions of olive color, clear, L single, mucus +.

Conclusion: According to bile analysis, the parameters are within the normal range.

Microscopic examination of feces: muscle fibers – 1-2- 2, neutral fat – no, LCD no, non-digivable cellulose 1-2-1, no mucus, L-1-2-2 in the field of vision, the simplest were not found.

Conclusion: Coprologic data About research within the normal range.

Clinical diagnosis:

Major: Chronic erosive gastroduodenitis. Exacerbation.

Clinical diagnosis of the disease is based on the following data:

1) Complaints for periodic in mesogestria arising after a meal . Pains are resting on their own. The intensity of the pain is associated with seasonality.

2) From the anamnesis: The pain arose after dysentery in 1998, and after parasitic infestation, lambliosis. Of the predisposing factors, there is an irregular diet and an excessive physical activity.

3) In addition, with Objective examination, it was revealed pain in palpation of the abdomen in mesogastry , i.e. Kera, Shafar zone.

4) From Instrumental methods Diagnosis studies confirm data of FGS.

For ulcer disease there is a more pronounced pain syndh Om: paroxysmal pain, rezhuschye. There is a definite type of pain: hunger – pain – relief after eating. All this can be accompanied by vomiting, nausea, burning sensation. In objective study, pronounced muscle tension and pain in deep palpation in the pyloroduodenal zone. The instrumental methods allow to reveal a defect of the mucous membrane (acute ulcer, in the phase of scarring or in the epithelial phase). At the X-ray examination, the symptom of the niche is detected.

For functional disorders of the stomach is characterized by irregular pain syndrome, there is no clear connection with the intake and the nature of the food. Objectively sometimes it is possible to reveal a tenderness in an epigastrium which passes quickly. The endoscopic mucous membrane of the stomach is usually not altered, although in some cases there may be some hyperemia, which is a manifestation of irritated stomach, but is not confirmed by histological signs of chronic inflammation. According to the ultrasound, violations of the motor evacuation function may occur.

TREATMENT

 

1) General mode. The main focus should be on the food intake mode (5 times a day in small portions every 3-4 hours).

2) Diet # 1. This diet excludes substances that excite gastric secretion (strong broths of meat, fish, fried greasy foods, black bread, coffee, snacks, black bread, vegetable fiber, unprocessed vegetables). The food is given predominantly by sweating, boiled or steamed. Milk-sour products, especially boiled porridges, are widely used. The diet implies a normal amount of calories and a normal ratio of proteins, fats and carbohydrates, with high levels of vitamins B and C. The salt is restricted. In accordance with the daily requirement for basic nutrients and energy for girls ages 11 to 13, the following norms are recommended (Ministry of Health of the USSR, No. 5786-91):

 

Energy, kcal / day

2500

& nbsp;

squirrels, all-day, g / day

82

Proteins%

Animals

49

Proteins%

Vegetable 84

Carbohydrates

g / day

355

   
             

Vitamins:

B1,

mg

1,3

B2,

mg

1.5

B6,

mg

1,6

B12,

mg

3,0

РР,

mg

17

C,

mg

70

A,

Мкг

800

E,

mg

10

D,

mg

2,5

folacin,

μg

200

& nbsp;

& nbsp; & nbsp; & nbsp; || | 765   & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp;

Mineral substances:

Ca,

mg

1200

P,

mg

1800

Mg,

mg

300

Fe,

mg

18

Zn

мг

12

I,

mg

0,1 || | 831

           
                     

Based on the recommended dietary requirements and, given the nature of diet number 1, an approximate daily menu (menus) products for girls 11-13 years looks like this (according to AA Pokrovskii, 1972):

1st breakfast 8-00: porridge oatmeal – 200 g, butter -20 g, cocoa, oatmeal cookies.

2nd breakfast 11 – 30: cheesecake with sour cream – 150 g, apple juice – 200 ml.

Lunch 14 – 30: vegetable soup, 200 g beef broth, 100 g potato pancakes, 100 g potatoes, 150 g potatoes, bread wheat (grain) – 50 g, dried fruit compote – 100 g.

half past 17 – 30: carrot juice – 50 ml., “plasma” cookie – 50 g.

DAY OF DISEASE

  • The state is satisfactory. Consciousness is clear. Emotional background is positive. Complaints on low-intensity pain in the morning after the first meal, which lasted for 15 minutes. There are no other complaints. The appetite is good. Dispepsia was not observed. Chair daily 1 time per day, well-formed, normal color. Sleep deep 9 hours a day. Skin covers are clean, physiologically colored. Mucous membranes of the mouth are bluish-white color, without pathological changes. Breathing vesicular, conducted in all fields, no side-breathing noises. ChDD 18 per minute. The heart tones are muffled, the rhythm is correct, heart rate 80 per minute. AD = 120/90 mm. ht Art. The abdomen is soft, slightly painful in mesogastry, slightly swollen. A slight soreness is observed in the area of ​​the projection of the blind and sigmoid colon. The treatment is received regularly in accordance with the appointment letter.
  • The condition is satisfactory. No complaints. There is a positive emotional background. The appetite is good. The chair is 1 time in the morning, without features. Skin covers are pure physiological coloring. Mucus oral cavity unchanged. Breathing vesicular, no wheezing. ChDD 18 per minute. The heart tones are muffled, the rhythm is correct, heart rate 78 per minute. AD = 130/80 mm. ht Art. The abdomen is soft, painless in mesogastry, as well as in the course of the blind and sigmoid colon.

2.10.99 The condition is satisfactory. No complaints. There is a positive emotional background. The appetite is good. The chair is 1 time in the morning, without features. Skin covers are pure physiological coloring. Mucus oral cavity unchanged. Breathing vesicular, no wheezing. PDA 16 per minute. The tones of the heart are muffled, the rhythm is correct, heart rate of 75 per minute. AD = 120/80 mm. ht Art. Belly soft, painless in mesogastry, as well as in the course of the blind and sigmoid colon.

 
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