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clinical features of disease depending on character of its current.

Under our observation there were 66 children with an acute delay of a chair among which 32 children (48,5 %) have addressed for medical aid in the first 7 days, within the first month - 25 children (37,9 %) and on 2-3 month from occurrence of the first symptoms of disease - 9 children (13,6 %) (fig.

3.1.1)

Fig. 3.1.1 Terms of the reference in medical institution of children with an acute constipation (%).

From 139 children with HZ duration of disease from 3 till 6 months had 23 children (16,5 %), from 7 months till 1 year - 32 children (23,0 %) from 1 till 3 years - 44 children (31,7 %) and more than 3 years - 40 children (28,8 %) (fig. 3.1.2).

Fig. 3.1.2 Duration of disease by a chronic constipation (%).


Interest represents the comparative analysis of the basic symptom of disease - duration of intervals between certificates of a defecation at the moment of inspection depending on character of a current of disease (tab. 3.1.1).

Table 3.1.1

Duration of intervals between certificates of a defecation depending on

Character of a current of disease

Character of disease Quantity of children
Duration of intervals between defecations
From 1 till 2 days 3-4 days 5 and more days
Acute constipation abs 31 27 8
% 47 % 40,9 % 12,1 %
Chronic constipation abs 20 57 62
% 14,4 % 41 % 44,6 %

Apparently from the table, about half of children with OZ (47 %) had a delay of a chair duration from 1 till 2 days, are a little bit less (40,9 %) - from 3 till 4 days and only at 12,1 % of children duration of intervals between defecation certificates has made 5 and more days. The return picture took place at children with HZ at which almost at half of children (44,6 %) duration of a delay of a chair was 5 and more days and only at 14,4 % of children it has made from 1 till 2 days. Thus, at children with OZ the delay of a chair from 2 till 4 days while in group with HZ at a larger part of children duration of intervals between defecation certificates has made 5 and more days prevailed. The received differences were statistically significant (p.0.01).

We have analysed frequency of complaints at children surveyed by us depending on a disease current.

By us it has been taped, that more than half of children with an acute constipation besides a chair delay showed complaints to presence in fecal masses of pathological impurity (53 %), from them at 18 children (27,3 %) slime, at 17 children (25,8 %) - blood in a chair became perceptible.

Also the most frequent complaints at children with OZ were: abdominal pains mainly in paraumbilical and ileal areas (57,6 %), a meteorism (56 %), feeling incomplete oporozhnenija an intestine (48,5 %). Less often at patients with an acute constipation complaints on long intensive natuzhivanie with the condensed beginning of the fecal cylinder (27,3 %), abdominal pains became perceptible at a defecation (25,8 %), the "sheep" chair (19,7 %) and emiction increase (19,7 %). Complaints to a chair of the big diameter (10,6 %) and kalomazanie (10,6 %) even less often took place. At 9 children (14,8 %) the chair after a delay was the speeded up poor portions.

In turn, practically all children with HZ (93,5 %) showed complaints to abdominal pains, thus at 78 of them (56,1 %) became perceptible abdominal pains during a defecation, and 17 children (12,2 %) disturbed pains before oporozhneniem an intestine. At 35 children (25,2 %) pains have not been bound to the certificate of a defecation and localised mainly in ileal areas. Widespread complaints at children with HZ were episodes a feces incontience - kalomazanie (54,7 %), sensation incomplete oporozhnenija an intestine (48,2 %), long natuzhivanie during the defecation certificate (43,9 %) and a meteorism (43,2 %). Complaints to the sheep chair and a chair of the big diameter also took place at children with HZ (44,6 % and 30,2 %) is more often. Attracted attention, that at 35 children (25,2 %) character of a chair has not been changed. Presence in fecal masses of pathological impurity at children with HZ took place a little bit less often, than at children with OZ (27,4 %), thus at 17,3 % from them slime, and at 10,1 % - blood in a chair became perceptible. Complaints to abdominal pains after a defecation was not at one of surveyed children with HZ.

Comparative data on frequency of complaints at children with an acute and chronic constipation are resulted in a drawing 3.1.3

Fig. 3.1.3 Comparative data on frequency of complaints at children with an acute and chronic constipation (%).

Thus, at children with OZ, besides a chair delay, authentically complaints to pains in paraumbilical and ileal areas (r-0.01) and presence of pathological impurity (slime and blood in a chair) (р0.01) while children with HZ authentically showed complaints on kalomazanie рО.01 is more often), abdominal pains is more often became perceptible at a defecation (r 0.0) 1, the "sheep" chair (р0.01), a chair of the big diameter (р0.01), long natuzhivanie at a defecation (р0.01). With identical frequency at children with OZ and HZ complaints to a meteorism and feeling incomplete oporozhnenija an intestine after a defecation were taped.

Besides the complaints set forth above at observable children a number of the clinical symptoms which expression was defined by character of a current of disease has been taped.

At objective survey pallor of integuments became perceptible only at 4 children with OZ while oblozhennost tongue by grey scurf it has been taped at 48 children with OZ (72,7 %). Also for the majority of children with OZ (68,2 %) were characteristic an abdominal distention owing to a delay of fecal masses and a meteorism. At 26 (39,4 %) children at a stomach palpation moderate morbidity in epigastric area, at 23 children (34,9 %) - in right hypochondrium, at 51 children (77,3 %) in points of a projection of a head and a pancreas tail was defined. The painful, sigmoid intestine enlarged in size overflowed in dense fecal masses has been taped at 54 children with OZ (83,3 %), and rumbling on a course spazmirovannyh colon loops - at 42,4 % of patients. At survey of proctal area of children with OZ at 12,1 % from them cracks in the field of a fundament, caused by passage of a fecal column of the big diameter became perceptible, at 7 (10,6 %) children with kalomazaniem took place pollution of proctal area in fecal masses, and at 1 child with OZ at survey of proctal area hemorrhoidal knots have been taped.


At objective survey at children with HZ pallor of integuments (10 %) in comparison with children from the LAKE At the majority of children with HZ (84,8 %), also was a little bit more often taped as well as with OZ, at oral cavity survey it became perceptible oblozhennost tongue grey scurf, and an abdominal distention - at 69,1 % of children that took place and at children from the LAKE However at children with HZ moderate morbidity in epigastric and piloroduodenalnyh areas (59 %), by the right hypochondrium (43,2 %) and pancreas projections (85,6 %) was more often defined. The painful, sigmoid intestine enlarged in size overflowed in dense fecal masses has been taped at 121 children with HZ (87,1 %), that Rumbling on a colon course coincides with frequency of the given symptom among children with the LAKE was observed at 43,2 % of patients with HZ.

Attracts attention that fact, that at 72 (51,8 %) children with HZ unlike children with OZ took place implications of a long fecal intoxication in a kind: delicacies, irritability - at 48 children (34,5 %), appetite depression - at 72 children (51,7 %), fast fatigability - at 56 (40,3 %), and also concentration and attention disturbances - at 35 patients (25,2 %). At survey of proctal area of children with HZ fundament cracks were taped with the same frequency, as at
Patients with OZ also were made by 10,1 %. Thus kalomazanie it became perceptible much more often at HZ - 38 children (37,3 %), also as well as hemorrhoidal knots - 12 children (8,6 %).

Comparative data on frequency of clinical symptoms of disease at children with an acute and chronic constipation are resulted in a drawing 3.1.4

Fig. 3.1.4 Comparative data on frequency of clinical symptoms at children with an acute and chronic constipation (%).

Thus, at children with HZ, authentically morbidity is more often became perceptible at a palpation in epigastric area (р0.01), kalomazanie (r ' 0.01), hemorrhoidal knots (р0.01).sleduet to notice, that more than at half of children with HZ (51,7 %) took place symptoms of a chronic fecal intoxication, unlike children with OZ (r 0.01).

Laboratory indicators of clinical and biochemical analyses of blood at the majority of observable children were within referential value: both at OZ, and at HZ with identical frequency in the biochemical analysis of blood
There was a rising of level of an alkaline phosphatase on the average to 687 yo 56 mmol/l (6,1 % and 8,6 %).

Considering, that at the majority of children with OZ disease demonstrated after reception of antibacterial preparations or the transferred intestinal infection, to all children with OZ for the purpose of an estimation a condition of a microflora of a colon microbiological research of a feces has been carried out. At 56 children with OZ (84,8 %) have been taped disturbance of a microbiocenosis of an intestine, at the expense of depression laktobatsill (average value have made 5,1 yo 0,61 105 WHICH/G feces) and the raised level hemolyzing E.coli (average value have made 3,4 yo 0,74 108) and yeast mushrooms and mushrooms of sort Candida (average value have made 4,4 yo 0,56 105). At children with HZ disturbances of a microbiocenosis of an intestine became perceptible much less often (46 %), basically at the expense of depression laktobatsill. On the basis of the received data it is possible to assume, that in development of an acute constipation the essential role is played by disturbance of a microbiocenosis of an intestine.

At ultrasonic research of organs of an abdominal cavity at children with HZ pathological changes of organs of digestion were a little bit more often taped. So, at HZ a lesion zhelchevyvodjashchih ways (anomaly of development of a cholic bubble, its augmentation in sizes, the thickening of its wall, disturbance sokratitelnoj abilities, bile of the raised echo-density in a kind pristenochnogo a deposit) was taped at 56 children (40,3 %), echo-signs of a lesion of a pancreas (local or diffusive augmentation of the sizes, giperehogennost parenchyma, roughness of contours) - at 119 children (85,6 %) and augmentation of the sizes of a liver - at 18 children (13 %). While at OZ the pathology zhelchevyvodjashchih ways has been taped a little bit less often - at 23 children (34,8 %), and echo-signs of a lesion of a pancreas almost with the same frequency, as at HZ - at 54 children (81,8 %). However the augmentation of the sizes of a liver authentically more often p 0.01) was taped at children with OZ (78 %) (a drawing 3.1.5), that can be caused that at 43,4 % of children have served as manifestation OZ the transferred
Intestinal infection or medicamental therapy concerning those or other infectious diseases (47,5 %).

Fig. 3.1.5 Comparative data of results of ultrasonic research of organs of an abdominal cavity at children with an acute and chronic constipation (%).

Ultrasonic research of a colon is spent to 16 children with OZ which against spent therapy did not have the positive clinical dynamics, allowed to tap at 4 of them a dolichosigma, and at 12 children any pathological changes were absent.

The torpid current of disease at treatment OZ at 7 children has demanded hospitalisation in a specialised hospital where they have been surveyed rentgenologicheski (irrigoscopy) and endoscopically (proctosigmoidoscope). At carrying out of a proctosigmoidoscope at 3 children cracks of a proctal aperture, at 1 child - hemorrhoidal knots are taped, and at 3 children it was not revealed any pathological changes of distal departments of a colon. On an irrigoscopy at 3 from 7 children, and the dolichosigma is diagnosed for 1 child - a megarectum.

The proctosigmoidoscope spent to 24 children with HZ, has allowed to establish at 14 of them cracks of a proctal aperture, and at 12 children - hemorrhoidal knots. For the purpose of specification of the reason of a hemocolitis to 2 children the colonoscopy on which have been excluded VZK has been spent, and blood in a chair has been caused by presence of a crack of a rectum and hemorrhoidal knots.

Thus, at carrying out of a proctosigmoidoscope at children with HZ fundament cracks (10 %) and hemorrhoidal knots (8,6 %) are a little bit more often taped, than at
Children with OZ (4,5 % and 1,5 %, accordingly). However the received differences were not statistically significant.

For an exception of anomaly of development of a colon to all children with a long current of disease the irrigoscopy has been spent. The organic pathology of a colon by results of an irrigoscopy has been excluded at all surveyed children, the dolichosigma has been diagnosed for 97 children (69,8 %) (elongation of a sigmoid intestine, presence of additional loops), at other children (30,2 %) have not been taped anatomic features of a colon. Thus, among children with HZ in 2,3 times there were children a dolichosigma is more often.

At carrying out of an irrigoscopy peristalsis retardation is established at 61 (70 %) the child, a smoothness of haustrations - at 16 children (11,5 %) that testifies to depression of a motility of a colon. Haustration intensifying has been taped at 32 children (23 %), depression of a tonus of a sigmoid intestine became perceptible at 2 children (1,4 %), expansion of an ampoule of a rectum - at 73 (52,5 %) children. At 23 (16,5 %) patients were taped incomplete oporozhnenie a colon that specified in retardation evakuatornoj functions at rectum level. TSekoilealnyj the reflux took place at 23 children (16,5 %), and at 16 children with incomplete oporozhneniem an intestine (11,5 %) within several days - othozhdenie barium with fecal masses that testified to the slowed down transit on a colon. At 63 % of children after oporozhnenija the spastic stricture of a sigmoid intestine became perceptible.

Children with HZ, arrived in a hospital repeatedly in connection with small efficiency of the previous treatment (53 children - 38,1 %), have been in addition advised by the psychologist who has taped at them a number of psychological features:

• High level of uneasiness became perceptible at 13 children (9,4 %);

• higher level of emotional instability - at 22 children (15,8 %);

• Depression - at 5 children (3,6 %);

Also features in communicatively-interpersonal are noted

Mutual relations:

• Suspiciousness - at 9 children (6,5 %)

• Inactivity of thinking - at 8 children (5,8 %);

• Care - at 4 children (2,9 %);

• Absence of profound perception of a problem and sensation of any trouble - at 17 children (12,2 %).

At 31 children (22,3 %) disturbances of mechanisms of integration of a family took place: bad contact more often mothers (22 children) and is more rare - the father (9 children) with the child, expressed in superficial interest to problems of the child, ignoring of its point of view, hyperguardianship with suppression of will and responsibility for the acts, the raised insistence to successes of the child to employment at school.

Bad adaptation of the child in collective, a conflictness with contemporaries and teachers is noted at 18 children (13 %).

Thus, having analysed data of the anamnesis, complaints, clinical survey and laboratory-tool methods of inspection, have been taped statistically significant differences at children observed by us depending on duration of a current of disease. At a larger part of children with OZ (47 %) duration of intervals between defecation certificates has made from 2 till 4 days while in group with HZ children (44,6 %) with a delay of a chair of 5 and more days (r ~ prevailed. 0.01). Complaints to abdominal pains mainly in paraumbilical and ileal areas (р0.01) and presence of pathological impurity (slime and blood in a chair) (r-0.01) authentically became perceptible at children with OZ while children with HZ authentically complained on kalomazanie (r.0.01 is more often), abdominal pains at a defecation (the river 0.01), the "sheep" chair (the river 0.01), a chair of the big diameter (the river 0.01), long natuzhivanie at a defecation (r ~ is more often. 0.01). At clinical survey at children with HZ unlike children with OZ, authentically morbidity is more often became perceptible at a palpation in epigastric area (the river 0.01), kalomazanie

(The river 0.01), hemorrhoidal knots (the river 0.01). It is necessary to notice, that more than at half of children with HZ (51,7 %) took place symptoms of a chronic fecal intoxication, unlike children with OZ at which the given symptoms were absent (r 0.01). In turn laboratory indicators of clinical and biochemical analyses of blood have not taped authentic differences at children with OZ and HZ.

At carrying out of ultrasonic research of organs of an abdominal cavity at children with OZ and HZ with identical frequency ultrasonic changes in a kind of a lesion of a pancreas (81,8 % and 85,6 %, accordingly) and pathologies zhelchevyvodjashchih ways (34,8 % and 40,3 %, accordingly) were taped. However the augmentation of the sizes of a liver authentically was more often taped at children with OZ р0.01).

It is necessary to notice, that at 53 children with HZ (38,1 %) which have repeatedly arrived in a hospital and are advised by the psychologist, changes of the psychological status have been taped, from them at 31 children (22,3 %) took place disturbances of detsko-parent relations.

The received results testify, that children with OZ and HZ demand the differentiated approach in observation and treatment taking into account duration of disease and features of clinico-tool researches. At an inefficiency of treatment of children with OZ it is necessary to hospitalise and survey in due time for specification of a condition of a colon. Relapsing current HZ demands consultation of the psychologist for an exception of psychological problems from the child with the subsequent correction of its psychosomatic status.

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Scientific source IPATOV ANDREY ALEKSANDROVICH. EFFICIENCY of ACUPUNCTURE In COMPLEX TREATMENT of CHILDREN With the CONSTIPATION SYNDROME. The DISSERTATION on competition of a scientific degree of the candidate of medical sciences. Moscow - 2014. 2014

Other medical related information clinical features of disease depending on character of its current.:

  1. INTRODUCTION
  2. INTRODUCTION
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  4. THE LITERATURE LIST
  5. THE TABLE OF CONTENTS
  6. INTRODUCTION
  7. clinical features of disease depending on character of its current.
  8. THE CONCLUSION
  9. modern representations about a syndrome of a dysplasia of a connecting tissue
  10. THE LITERATURE LIST
  11. THE LITERATURE LIST
  12. THE CONCLUSION
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  16. structure assotsiirovannyh with a syndrome of Down of diseases. Features of implication, diagnostic and therapeutic approaches.
  17. THE DISSERTATION GENERAL CHARACTERISTIC