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Clinico-Anamnestichesky features at children with SRK

For the purpose of revealing of features of clinical picture SRK at children we had been interrogated under specially developed questionnaire all patients and their parents. The clinical estimation has been spent on the basis of studying of complaints, the anamnesis of illness and objective survey.

For rising of objectivity of an estimation of clinical data we had been developed a mark estimation of symptoms (the Appendix 2 and 3).

By means of mark estimations the basic characteristics of a leading painful syndrome (a painful index), character of a chair, the abdominal distention characteristic (dispepsichesky an index) have been studied; features of the certificate of a defecation, character of disease are estimated.

Character of a painful syndrome and frequency of occurrence at the interrogated patients is presented in table 8.

Between various types SRK there were authentic differences in localisation of pains (/2=30,49; p 0,05).

Apparently from a drawing 10, in all investigated groups the painful index has averaged 11,60±0,56 (a median 11,0) a point. Authentic differences of size of a painful index at different types SRK was not (H=6,91; p=0,330).

Drawing 11. A painful index at SRK, depending on communication with the transferred infection

At comparison of a painful index at PI SRK and nepi SRK authentic differences also it is not found (the U-test: р=0,218), on the average it has made 11,60±0,17 (a median 12,0) a point (fig. 11).

Thus, for children with SRK a leading symptom are abdominal pains (100 %). Primary localisation of pains depends on type SRK: at SRK with a diarrhoeia in the bottom departments of a stomach (47,9 %), at SRK with a constipation and the admixed type a pain without accurate localisation (41,7 % and 50 % accordingly), at undifferentiated type in paraumbilical area (51,6 %). Pains more often aching and colicy character, with frequency 2-3 times a week and more often, arising both after food intake, and without communication with it, defecations weakening after the certificate and stopped independently or after reception spazmolitikov.


Frequent implication SRK is the feeling raspiranija in a stomach (inflation).

The characteristic of the given symptom is presented in table 10.

Table 10. The basic characteristics of an abdominal distention at various types SRK

The abdominal distention characteristic Type SRK
With a constipation

(n=15)

With a diarrhoeia

(n=33)

nedifferen - tsirovannnyj (n=12) The admixed

(n=3)

Communication with the defecation certificate (% =4,18; p=0,653)
Passes after a defecation 6 (40,0 %) 11 (33,3 %) 6 (50,0 %) 0 (0,0 %)
Decreases 8 (53,3 %) 16 (48,5 %) 4 (33,3 %) 2 (66,6 %)
Without changes 1 (6,6 %) 6 (18,2 %) 2 (16,6 %) 1 (33,3 %)
Expression degree (% =6,52; p=0,367)
The expressed 3 (20,0 %) 8 (24,2 %) 3 (25 %) 2 (66,6 %)
Moderately expressed 5 (33,3 %) 14 (42,4 %) 2 (16,6 %) 0 (0,0 %)
Weakly expressed 7 (46,6 %) 11 (33,3 %) 7 (58,3 %) 1 (33,3 %)
Occurrence time (% =5,48; p=0,484)
Morning 1 (6,6 %) 2 (6,1 %) 0 (0,0 %) 0 (0,0 %)
Evening 12 (80,0 %) 22 (66,6 %) 10 (83,3 %) 1 (33,3 %)
Within day 2 (13,3 %) 9 (27,3 %) 2 (16,6 %) 2 (66,6 %)
Communication with meal (х2=10,68; p=0,302)
Does not depend 13 (86,6 %) 21 (63,6 %) 10 (83,3 %) 2 (66,6 %)
Milk and milk

Products

1 (6,6 %) 9 (27,3 %) 1 (8,3 %) 0 (0,0 %)
Fat, fried 1 (6,6 %) 2 (6,1 %) 0 (0,0 %) 1 (33,3 %)
Fruit 0 (0,0 %) 1 (3,0 %) 1 (8,3 %) 0 (0,0 %)

Apparently from table 10, in our research the abdominal distention took place at 63 (52,1 %) children with SRK.

At 16 children (25,4 %) the abdominal distention was expressed, at 21 (33,3 %) moderately expressed and at 26 children (41,3 %) weakly expressed. Arose in the evening - at 45 children (71,4 %) more often, is more rare within day - at 15 children (23,8 %), only at 3 children (4,8 %) in the morning. After the certificate of a defecation at 47,6 % of children abdominal distention reduction became perceptible, at 36,5 % the abdominal distention completely passed and at 15,9 % remains without changes. At 46 children (73 %) it is noted communications between occurrence of an abdominal distention and food intake, at 11 children (17,5 %) as provocation milk and milk products, at 4 children (6,3 %) the use of fat and-or fried nutrition served, at 2 (3,2 %) children communication with the use of fruit is noted.

Frequency of a chair was expressed in points (the Appendix 2). At SRK with a constipation frequency of a chair has made 2,21 points, at SRK with a diarrhoeia - 2,23 points, at undifferentiated SRK - 1,56 points, at admixed type SRK - 1,83 points. At all types SRK the morning chair - at 40 patients (33,05 %), evening at 12 persons (9,9 %), during morning and day time at 23 persons (19 %), at morning and evening o'clock at 28 persons (23,1 %), during day and evening time at 2 persons (1,7 %), within all day at 16 persons (13,2 %) is more often became perceptible.

Drawing 12. The Dispepsichesky index in investigated groups


dispepsichesky the index (a mark estimation of frequency of a chair, degree of expression of an abdominal distention) in investigated groups at all types SRK has made the general 3,04±0,14 (a median 3,0) a point (fig. 12 see).

At an estimation dispepsicheskogo an index significant difference between types SRK (H=21,40 has been shown; p=0,002): at SRK with a constipation, at nepi SRK with a diarrhoeia and PI SRK with a diarrhoeia dispepsicheskie the phenomena have more expressed character, than at nepi SRK undifferentiated type.

At comparison of a dyspeptic index at SRK, depending on communication with the transferred infection, it is not received authentic differences between groups (U - the test: p=0,970), results are presented in a drawing 13.

Drawing 13. The Dispepsichesky index at PI and nepi SRK

Children with SRK had certain features of the certificate of a defecation, depending on type SRK. Necessity natuzhivanija was at 41 patients (33,9 %): at 33 (91,6 %) at SRK with a constipation, at 6 (100 %) at the admixed type, at 2 (6,4 %) at undifferentiated type SRK. The manual grant was required to 14 patients (3,3 %): to 10 patients (27,7 %) with SRK with a constipation and to 4 patients (66,6 %) with SRK the admixed type. Imperative desires felt 28 persons (23,1 %): 3 (8,3 %) with SRK with a constipation, 23 (47,9 %) with SRK with a diarrhoeia and 2 (33,3 %) with SRK the admixed type. The feeling incomplete oporozhnenija an intestine (97 persons, 80,2 %) was the most frequent feature of the certificate of a defecation: at 33 (91,6 %) at SRK with a constipation, at 40 (83,3 %) with diarejnym, at 5 (83,3 %) with admixed and at 19 (61,3) with undifferentiated types SRK.


Thus, besides abdominal pains, 52 % of children with SRK complained of an abdominal distention, 100 % of children had certain features of the certificate of a defecation (at 33,9 % necessity natuzhivanija, at 3,3 % the manual grant, 23,1 % felt imperative desires, 97 % had a feeling incomplete oporozhnenija an intestine).

The analysis of anamnestic data has shown, that at the majority of children (68,5 %) duration of disease at all types SRK was 1-2 years. Short anamnesis SRK - from 6 till 11 months, was at 26 children (21,5 %), at 12 children (9,9 %) duration of disease was more than 2 years. The exacerbation and remission periods could not differentiate the majority of patients accurately and showed complaints on practically constant persistirovanie diseases. To track seasonal prevalence of exacerbations it was possible at 42 patients (34,7 %) which duration of disease has made more than 1,5 years. There were exacerbations at any time year, except summer: in the autumn and in the spring at 15 patients (35,7 %), in the autumn at 12 persons (9,9 %), in the autumn and in the winter at 11 persons (26,2 %), in the winter and in the spring at 4 persons (9,5 %). Almost all children (98,3 %) noted condition improvement in summertime of year. On seasonal prevalence of pains of authentic differences between types SRK it is not revealed (p> 0,05). The majority of children bound an exacerbation of disease to emotional experiences (35 children, 83,3 %), are more rare - with a margin error in a diet (7 children, 16,6 %).

Bind the beginning of disease to the accurate reasons could not 16 (13,2 %) the person. 28 (23,1 %) patients noted occurrence of symptoms SRK after the transferred Oka, 77 (63,7 %) - after the transferred emotional stress. It is interesting, that all children at whom communication with Oka became perceptible, received concerning it a long course of an antibioticotherapia, even in cases of a virus aetiology
Diseases. Regular disturbance of a diet (quality of nutrition, a food out of the house, frequency rate of food intakes) was observed at the overwhelming majority - at 103 patients (85,1 %), without dependence from age. At the analysis of out-patient cards of patients the tendency to a wide prescription of antibiotics (at 61 % of patients) has been noted.

At an estimation of duration of thoracal feeding it has not been noted authentic differences between different types SRK (p> 0,05). Data are presented in table 11.

Table 11. Duration of thoracal feeding at patients with various types SRK

Duration of thoracal feeding Types SRK In total
With a constipation

(n=48)

With a diarrhoeia

(n=36)

nedifferenyotsirovannyj (n=31) The admixed.

(n=6)

To 1 month 12 (33,3 %) 14 (29,2 %) 15 (48,4 %) 4 (66,7 %) 45 (37,2 %)
To 3 months 12 (33,3 %) 17 (35,4 %) 9 (29 %) 1 (16,7 %) 39 (32,2 %)
To 6 months 8 (22,2 %) 11 (22,9 %) 7 (22,6 %) 1 (16,7 %) 27 (22,3 %)
Till 1 year 4 (11,1 %) 6 (2,5 %) 0 (0,0 %) 0 (0,0 %) 10 (8,3 %)

The note:/2=8,68; p=0,477

Duration of thoracal feeding at children of investigated groups: till 1 month - 37,2 %, till 3 months - 32,2 %, till 6 months - 22,3 %, till 1 year-8,3 % from total of children (tab. 11 see). By us it is not taped significant differences in a current of disease depending on duration of thoracal feeding, therefore it is impossible to confirm the assumption of adverse influence of early transfer into artificial feeding on development of functional disorders of an intestine further.

We have analysed character of an accompanying pathology (tab. 12).

Table 12. Frequency of an accompanying pathology of organs of digestion at different types SRK

Accompanying pathology of organs of digestion Types SRK
1 (n=48) 2 (n=36) 3 (n=31) 4 (n=6)
Hr. gastroduodenit (superficial),

Hp (-), n=51

21 (43,8 %) 12 (33,3 %) 16 (51,6 %) 2 (33,3 %)
Hr. gastroduodenit (poyoverhnostnyj), Hp (+), n=59 24 (50,0 %) 17 (47,2 %) 14 (45,2 %) 4 (66,7 %)
Hr. gastroduodenit (nodul. antr. A gastritis, poverhnostn. A duodenitis) Nr (+), n=11 3 (6,2 %) 7 (19,4 %) 1 (3,2 %) 0
Hr. gastroduodenit with a lymphostasis, n=24 9 (18,8 %) 6 (16,7 %) 9 (29,0 %) 0
Dyskinesias zhelchevyvodjashchih ways on hypomotor type, n=12 5 (10,4 %) 6 (16,7 %) 1 (3,2 %) 0
Dyskinesias zhelchevyvodja-shchih ways on the hypermotor th to type, n=20 10 (20,8 %) 8 (22,2 %) 1 (3,2 %) 1 (16,7 %)
Dysfunction of sphincter Oddi on pankreoticheskomu to type, n=31 9 (18,8 %) 5 (13,9 %) 15 (48,4 %) 2 (33,3 %)
Dysfunction of sphincter Oddi on vesical type, n=23 9 (18,8 %) 7 (19,4 %) 7 (22,6 %) 0
Dysfunction of sphincter Oddi on the admixed type, n=35 15 (31,3 %) 10 (27,8 %) 7 (22,6 %) 3 (50,0 %)
Laktaznaja insufficiency, n=33 24 (50,0 %) 3 (8,3 %) 4 (12,9 %) 2 (33,3 %)
Lambliasis, n=24 9 (18,8 6 (16,7 %) 9 (29,0 %) 0
Adiposity of 1st degree, n=15 5 (10,4 %) 2 (5,6 %) 5 (16,1 %) 3 (50,0 %)
Adiposity of 2nd degree, n=8 3 (6,2 %) 1 (2,8 %) 4 (12,9 %) 0
Belkovo-high-calorie insufficiency

1st degrees, n=23

9 (18,8 %) 7 (19,4 %) 6 (19,4 %) 1 (16,7 %)
Belkovo-high-calorie nedoyostatochnost 2nd degrees, n=13 5 (10,4 %) 6 (16,7 %) 2 (6,4 %) 0
Gastroezofagealnyj a reflux (GER), n=33 12 (25,0 %) 8 (22,2 %) 10 (32,3 %) 3 (50,0 %)
Duodenogastralnyj a reflux (DGR),

n=19

7 (14,6 4 (11,1 %) 7 (22,6 %) 1 (16,7 %)
Allergic diseases, n=27 7 (14,6 %) 8 (22,2 %) 11 (35,5 %) 1 (16,7 %)
Cloelithiasis, n=2 0 1 (2,8 %) 0 1 (16,7 %)
Chronic cholecystitis, n=2 0 1 (2,8 %) 0 1 (16,7 %)
Illness ZHilbera, n=5 4 (8,3 %) 1 (2,8 %) 0 0
Anomaly of the form of a cholic bubble, n=8 5 (10,4 %) 2 (5,6 %) 1 (3,2 %) 0
Intolerance of fructose, n=6 4 (8,3 %) 0 1 (3,2 %) 1 (16,7 %)

The note: designations of types SRK: 1 - with a constipation, 2 - with a diarrhoeia, 3 - undifferentiated, 4 - admixed

The accompanying pathology met at all children with SRK (100 %). At all children it is endoscopically confirmed chronic gastroduodenit but at anybody it is not taped a peptic ulcer and erosive lesions of the top departments GASTROINTESTINAL TRACT. Chronic gastroduodenit, assotsiirovannyj with a Hp-infection, met at 70 children (57,9 %), including the superficial widespread was taped at 59 persons (84,3 %), and noduljarnyj an antral gastritis with a superficial duodenitis at 11 persons (15,7 %); neassotsiirovannyj a Hp-infection met at 51 patients (42,1 %). The duodenitis with a lymphostasis was diagnosed for 24 persons (19,8 %) at whom the lambliasis has been taped. Also at all children functional disorders biliarnoj systems (dyskinesias zhelchevyvodjashchih ways, more often dysfunctions of sphincter Oddi were taped - 73,6 %), anomaly of the form of a cholic bubble is taped at 8 children (6,6 %), illness ZHilbera at 5 (4,1 %). The intolerance of carbohydrates has been taped at 39 persons (32,2 %): Intolerance of lactose at 33 (84,6 %), intolerance of fructose at 6 (15,4 %) children with prevailing diarejnym type SRK. There were children as a lot of mass of a body, and its deficiency: adiposity of 1 degree at 15 children (12,4 %) and 2 degrees at 8 (6,6 %), BKN 1 degrees at 23 (19 %) and 2 degrees at 13 (10,7 %). Motor disturbances gastroduodenalnoj zones met in 43 % of cases: GER at 33 persons (27,3 %) and DGR at 19 persons (15,7 %). Allergic diseases 27 patients (22,3 %) suffered, in a sensibilization spectrum the food allergy prevailed. In group SRK with a constipation and admixed type SRK single instances of a cloelithiasis with a chronic cholecystitis in a remission stage (1,7 %) are noted. The mark estimation of an accompanying pathology of organs of digestion has not taped authentic differences between types SRK (p> 0,05).

At comparison of a painful index at children with this or that accompanying pathology, authentic differences have been received: in the presence of dysfunction of sphincter Oddi on the admixed type (the U-test: р=0,023) and-or DZHVP on hypertensive type (the U-test: p

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Scientific source TIPIKINA Maria Jurevna. ESTIMATION of the ROLE of INFLAMMATORY And MICROBIOLOGICAL CHANGES AT the SYNDROME of the ANGRY INTESTINE At CHILDREN. The dissertation on competition of a scientific degree of the candidate of medical sciences. St.-Petersburg - 2014. 2014

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Other medical related information Clinico-Anamnestichesky features at children with SRK:

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  3. Clinico-Anamnestichesky features at children with SRK