Study of the role of a paramedic in the early diagnosis, treatment and prevention of cholelithiasis in a polyclinic. The role of the paramedic in the prevention of hypertension

Prevention of hypertension, which is a chronic progressive vascular pathology, is a difficult task.

Given its widespread prevalence, a special role in working with patients belongs to paramedical workers, in particular paramedics of the FAP and health centers. The most important prerequisite for effective treatment is thoughtful individual work with patients. First of all, it is necessary to instill in the patient the need for a systematic (and not only with an increase in blood pressure!) medicines for many years, and also, what is especially important, a decisive improvement of their lifestyle, i.e. elimination, if possible, of risk factors for arterial hypertension.
Prevention of hypertension is aimed at early detection of the disease by measuring blood pressure in people over 30-35 years of age during periodic medical examinations carried out at enterprises and institutions. People who have an increase in blood pressure should be taken under dispensary observation. The paramedic working at the paramedical station monitors the blood pressure of these people, actively visits them, monitors the action antihypertensive drugs.
Prevention of hypertension is of paramount importance in solving the problem of longevity, in maintaining mental and physical performance in adulthood. Thus, it is known that the presence of arterial hypertension shortens life expectancy by an average of 10 years (in the group of people older than 45 years). Such common complication hypertension, as a hypertensive crisis, causes a rather high mortality rate, a high percentage of temporary disability and disability. Huge labor losses are also caused by another complication - myocardial infarction. It is practically important that the prevention of hypertension and the prevention of coronary artery disease largely coincide.

The most promising is the identification of individuals with risk factors, i.e. those people in whom the development of hypertension is more likely (hereditary burden, abuse of table salt, animal fats, liquid and alcoholic beverages, improper work and rest, endocrine changes, intake oral contraceptives).

Primary prevention of hypertension should begin in childhood. Need to organize medical examination in children's institutions, schools, universities with regular measurement of blood pressure in children and young people 2-3 times a year. This should be given special attention at the FAP, in the pre-medical reception rooms of outpatient clinics, etc.
Primary prevention measures should take into account all risk factors. A rational muscular load is needed already in childhood, it is necessary to exclude unreasonable exemptions from physical education at school, overfeeding of children and adolescents is unacceptable, especially salt-eating (increased consumption of table salt). If mild hypertension does not cause pain, then only a wellness regimen should be recommended. These persons are contraindicated for work at night, as well as work associated with sharp nervous overload, tilting the head and torso, lifting weights. It is not recommended to sharply tilt the head, the body to a patient with hypertension, as this increases the pressure in cerebral vessels; the head should be kept as straight as possible or slightly pulled back. Overtime work is unacceptable, it is necessary to limit the impact of industrial and domestic noise wherever possible. It is contraindicated for many hours sitting at the TV, especially for elderly obese persons after eating. Recall that it causes thrombosis of small veins of the legs. It is necessary to combat hypokinesia.

Food that can increase vascular tone and irritate the nervous system (rich meat soups, fried meat, strong coffee, alcoholic beverages, spicy and spicy dishes) should be excluded from the diet. The fight against obesity is of great importance. Persons with overweight are recommended to periodically resort to unloading diets. Systematic control of body weight is a necessary prerequisite for a proper diet.
Persons predisposed to hypertension should accustom themselves to low-salt foods (no more than 4-5 g of table salt per day in total), to limit fluid intake; it is necessary to completely exclude the use of coffee, strong tea; The last meal and liquid should be at least 1 hour before bedtime. This is especially important on premenstrual days and during menopause. If, for any reason, the food regimen turned out to be disturbed, then the next day it is necessary to arrange a fasting day (rice, kefir, apple), perform an additional set of physical exercises - be sure to sweat. If an excess of fluid was taken the day before, it is recommended to take 0.02 g of brinaldix or 0.05 g of hypothiazide in the morning. It is advisable that the paramedic explain the usefulness of these dietary restrictions for all persons over 40-50 years of age.
Of great importance is the limitation of the possibility of prolonged neuropsychic overload at work and at home without subsequent physical relaxation. It is accompanied by stress erythrocytosis, thrombocytosis, i.e. risk factors for arterial hypertension. It has been proven that the nature of responses to external stimuli, including long-term, negative ones, is determined mainly by the reactivity of the organism at the time of the stressor. In particular, great value has the creation of a stable positive emotional background. The right choice of profession is also very important (work should bring satisfaction), and a friendly microclimate in the work team. However, a lot depends on a person's own culture, and on the sensitivity of the people around him.
Important have an exception of family conflicts, mutual understanding of spouses and children. Of undoubted importance for normal neuropsychic function is the harmony of sexual life, and the paramedic must take this aspect into account when conducting sanitary and educational work.
It is necessary to recommend hardening (a cool shower in the morning), the rational use of working time, the exclusion (if possible) of occupational hazards. According to a number of authors, the maintenance of indoor dogs and cats plays a certain “anti-stress” role.
Very important normal sleep. It has been established that for persons over 50 years of age, 7 hours of sleep at night is sufficient, but the depth of sleep, the absence of unpleasant emotions in case of sleep disturbances, are of decisive importance. The paramedic should explain that the fear of insomnia is more harmful than insomnia itself. It is better to avoid sleeping pills, in extreme cases, use herbal preparations - valerian root, peony tincture, etc. The speed of falling asleep is determined mainly by the depth of muscle relaxation and the degree of "disconnection" of consciousness from day cares.
Washing your feet with cool water and washing your feet is recommended to improve sleep. hot water(42...45 °С) before going to bed. A noticeable calming effect is exerted by foot massage (3-5 minutes) before going to bed using a special massage roller or rolling a round wooden stick. It is advisable not to read before going to bed while lying in bed.
Point self-massage according to Dineika helps to shorten the phase of falling asleep: by easy pressure massage the “anti-stress point” under the chin, points of muscle relaxation in the corners of the mouth, in the center upper lip and along the midline of the fronto-parietal zone. Self-massage can be supplemented with soothing breathing exercises: after a shallow breath (count up to 4), exhale as long as possible (count up to 12), after which they hold their breath for 2-3 seconds, actively causing yawning, and repeat such cycles without deep breaths during subsequent breathing.
A complex of autogenic training for falling asleep is useful. Recommended, for example, repeated repetition (in slow motion on a long exhalation) of phrases like: "I'm getting more and more sleepy" (pause). "The eyelids are getting heavy" (pause). "I'm falling asleep" or "My blood pressure is getting back to normal" (pause). "The heart is slow" (pause). “The heart works calmly,” etc. The text of self-hypnosis phrases is clarified by a psychotherapist; appropriate "sleeping pills" tape recordings may be used.
The bed should be hard enough, the pillow should be low 2, the legs should be slightly raised, the air in the room should be clean, cooled (but not below + 18 ° C). Sleep better head to North. The paramedic must explain the unconditional harm daytime sleep, especially after dense food or drinking alcohol. Such a dream is fraught with the risk of thrombosis and other circulatory disorders.
Particular attention should be paid to physical culture, as it is a kind of protective measure that trains the neurovascular apparatus and significantly reduces the effects of neuropsychic overload. Physical exercise can also stop harmful effects hypokinesia experienced by urban dwellers in economically developed countries. Physical education breaks between classes are recommended in schools and universities. Unfortunately, to reduce neuropsychic arousal, many resort to smoking or drinking alcohol. These bad habits should be weaned immediately and irrevocably. Gamabasin, reflex and psychotherapy help to quit smoking. The most physiological method of stopping negative emotions and nervous excitement are physical exercise performed at the appropriate pace.
Various warm-up exercises are recommended - sipping, rotation with the hands, turns and tilts of the body in combination with deep breathing through the nose, squats. They are performed in the evening, 1 "/g - 2 hours after eating and at least 1 -2 hours before bedtime for 30-40 minutes. The pace of movement is gradually increasing, the number of repetitions is determined by well-being (there should be a feeling of "filling "muscles," muscle joy "), pulse (in middle-aged persons, the pulse rate should not exceed 130-140 beats / min, the elderly - 100-110 beats / min) and breathing. Adequate physical activity should be accompanied by slight sweating. It is desirable that young people used weights (dumbbells, etc.) for this. Elderly people should first consult a doctor, an ECG study is required. It is not recommended to start intensive aerobics for people who have not trained before.
Persons of "sedentary" professions are especially shown exercises with a carpal expander and squats as they improve blood circulation in the joints of the hands and legs, where involutive changes occur early in persons of these professions. Systematic exercises for the abdominal muscles are very useful - rotational movements with straight legs lying on your back, imitation of cycling, etc.

After a warm-up, you need to wipe yourself with water to the waist or take a shower (the temperature of the water is gradually lowered) and firmly rub the skin (especially the back of the neck and spine) with a coarse towel, which has a normalizing effect on vascular tone.
In fact, after each stress, it is necessary to perform a set of exercises (squats, breathing exercises, movements with self-resistance, etc.) to utilize excess adrenaline, cholesterol, glucose, carbon dioxide and other biologically active substances released during stress. Outdoor sports games are shown - volleyball, tennis and table tennis, jogging (the speed and duration of running increase gradually!). It is advisable to walk 4-6 km daily at a fast pace (before sweating). With a properly constructed training regimen, there should be no weakness, insomnia, severe muscle pain after exercise.
Chess is contraindicated if it has an exciting effect, and losing leads to pronounced negative emotions.
Patients over 50 years of age, especially if they have not previously exercised therapeutic gymnastics, must strictly observe the following rules: torso tilts (especially forward and backward) are incomplete, avoid swinging movements of the arms and legs, after especially difficult body movements and squats, rest for 30-40 seconds while sitting, leaning back in a chair. It is useful to do morning exercises for 10-15 minutes, then, after resting for 2-3 minutes in a sitting position, proceed to water procedures (rubbing with water at room temperature with self-massage or a shower). On the 1st week of classes, the water should be heated (by 5 ... 6 ° C). After the water procedure, you need to dry the body soft towel, then proceed to self-massage.
Sitting on a chair, with a hard terry towel make circular movements on the chest, stomach; massage the back up and down, hands - in one direction from the hand to shoulder joint in circular motions. Massage to do at a calm pace, while not holding your breath, breathe evenly. The duration of self-massage is 5-7 minutes.
Persons with borderline hypertension should be under medical supervision. Their dispensary is obligatory. Exercise training is recommended. If within 6-12 months their blood pressure steadily normalizes or remains in the border zone, then the observation is continued for another year. When complaints (headache, insomnia, etc.) appear in risk groups, drug treatment is started, usually 6-blockers and sedatives are prescribed.

However, the paramedic must inspire each patient with hypertension that without eliminating risk factors drug treatment will give an incomplete and short-term effect. It is in the patients' misunderstanding of this circumstance, as well as in the irregularity of taking antihypertensive drugs, that the reasons for the relatively high incidence of hypertension and its complications, including lethal outcome(stroke, myocardial infarction). The experience of some foreign countries shows that persistent work with patients, individually selected and regular antihypertensive therapy can reduce the incidence of myocardial infarction and hemorrhagic strokes in the population by 20-30%.
So, in 1980, the results of the “total” treatment and prevention of hypertension in Finland were published, according to which it was possible to reduce its frequency in the population by 2 times (North Karelia Protocol).

Therefore, the paramedic should carry out preventive work with persons disposed to hypertension in order to reduce the risk of morbidity. Although with persons with hypertension, prevention is also necessary. Disease is easier to prevent than to cure! And the paramedic plays a huge role in this.

Introduction

Chapter 1. Theoretical part

1 Definition

2 Classification

3 Etiology

4 Pathogenesis

5 Risk factors

6 Clinic

7 Diagnostics

8 Treatment

9 Prevention

Chapter 2. Practical part

2.1 Studying risk factors in patients

2.2 Methods for diagnosing patients with hypertension

3 Analysis and evaluation of the results of the study of patients with hypertension

2.4 The role of the paramedic in organizing and conducting diagnostic, therapeutic and preventive measures to combat hypertension

Conclusion

Introduction

Relevance. Considering the problem of hypertension, we are faced with a paradox: with a significant prevalence of this pathology, public awareness of it is very low. According to statistics, only 37.1% of men know that they have hypertension, about 21.6% of them are treated, and only 5.7% are treated effectively. About 59% of women know that they have a disease, 45.7% of them are treated, and only 17.5% are treated effectively.

Currently, arterial hypertension is considered to be a multifactorial disease, in the development of which both hereditary predisposition and environmental factors are important. bad habits. Like no other disease, hypertension is a lifestyle disease. Clinical researches indicate the possibility of improving the life prognosis and quality of life of patients with adequate antihypertensive therapy, which is carried out differentially depending on the state of the target organs, comorbidities, and other characteristics of the patient.

Our country has a positive experience in conducting preventive programs. Thus, in the former USSR, the All-Union Cooperative Program for the Prevention of Arterial Hypertension was carried out. As a result of their implementation in the groups of program participants, there was a decrease in overall mortality by 17% and 21%, respectively, the frequency of cerebral stroke by 50% and 38%, and mortality from cardiovascular diseases by 41%. Participation in educational program forms a correct idea of the disease, risk factors for its occurrence and conditions for a progressive course, which allows the patient to more clearly follow a set of recommendations for a long time, forms an active life position the patients themselves and their loved ones in the further process of recovery.

Object Area-Therapy

The object of the study is hypertension

The subject of the study is Hypertension: an analysis of the prevalence, the role of a paramedic in the organization and implementation of diagnostic, therapeutic and preventive measures.

Purpose of the study: To study the role of a paramedic in the organization and implementation of diagnostic, therapeutic and preventive measures to combat hypertension.

Research objectives:

To reveal the concept and causes of the development of hypertension.

To study the classification and clinical picture of manifestations of hypertension.

Discuss factors in the development of hypertension.

4. Conduct a study aimed at studying risk factors in outpatient patients.

Process and analyze the results of the study.

6. Select methods for organizing and conducting diagnostic, therapeutic and preventive measures to combat hypertension.

Analyze the results of the study and formulate conclusions.

Research methods:

1. Theoretical (study of literary sources)

Empirical (questionnaire)

Chapter 1. Theoretical part

1 Definition

Hypertension (Greek hyper- + tonos tension; synonym: essential arterial hypertension, primary arterial hypertension) - a common disease unclear etiology, the main manifestations of which are high blood pressure in frequent combination with regional, mainly cerebral, disorders of vascular tone; staging in the development of symptoms; pronounced dependence of the flow on functional state nervous mechanisms regulation of blood pressure in the absence of a visible causal relationship of the disease with primary organic damage to any organs or systems. The latter circumstance distinguishes hypertension from symptomatic, or secondary, arterial hypertension.

The prevalence of hypertension in developed countries is high, and it is higher among residents of large cities than among the rural population. With age, the frequency of hypertension increases, and in people over 40 years of age it reaches 20-25% in these countries with a relatively even distribution among men and women (according to some reports, hypertension is more common in women).

In general, ideas about the etiology of hypertension are in the nature of hypotheses, therefore, the affiliation of hypertension to diseases of unknown etiology remains reasonable.

In the pathogenesis of hypertension, the leading disorder is higher nervous activity, which initially occurs under the influence of external stimuli and further leading to persistent excitation of autonomic pressor centers, which causes an increase in blood pressure.

2 Classification

Over the entire period of studying the disease, more than one classification of hypertension has been developed: according to appearance the patient, the reasons for the increase in pressure, etiology, the level of pressure and its stability, the degree of organ damage, the nature of the course. Some of them have lost their relevance, others continue to be used by physicians today, most often this is a classification by degree and stage.

There is no single systematization, but most often doctors use the classification that was recommended by WHO and the International Society for Hypertension (ISH) in 1999. According to WHO, hypertension is classified primarily by the degree of increase in blood pressure, which are divided into three:

1.The first degree - mild (borderline hypertension) - is characterized by pressure from 140/90 to 159/99 mm Hg. pillar.

2.In the second degree of hypertension - moderate - arterial hypertension is in the range from 160/100 to 179/109 mm Hg. pillar.

.In the third degree - severe - the pressure is 180/110 mm Hg. pillar and above.

You can find classifiers in which 4 degrees of hypertension are distinguished. In this case, the third form is characterized by pressure from 180/110 to 209/119 mm Hg. column, and the fourth - very heavy - from 210/110 mm Hg. pillar and above. The degree (mild, moderate, severe) indicates only the level of pressure, but not the severity of the course and the patient's condition.

In addition, physicians distinguish three stages of hypertension, which characterize the degree of organ damage. Classification by stages: stage. The increase in pressure is insignificant and unstable, the work of the cardiovascular system is not disturbed. Complaints in patients, as a rule, are absent. stage. Arterial pressure increased. There is an increase in the left ventricle. Usually there are no other changes, but local or generalized vasoconstriction of the retina of the eye may be noted. stage. There are signs of organ damage:

· heart failure, myocardial infarction, angina pectoris;

· chronic kidney failure;

· stroke, hypertensive encephalopathy, transient circulatory disorders of the brain;

· from the side of the fundus: hemorrhages, exudates, edema optic nerve;

· lesions of peripheral arteries, aortic aneurysm.

When classifying hypertension, options for increasing pressure are also taken into account. Allocate the following forms:

· systolic - only upper pressure is increased, lower - less than 90 mm Hg. pillar;

· diastolic - increased lower pressure, upper - from 140 mm Hg. pillar and below;

· systolic-diastolic;

· labile - pressure rises by a short time and normalizes itself, without drugs.

3 Etiology

The main cause of hypertension is repeated, as a rule, prolonged psycho-emotional stress. The stress reaction has a pronounced negative emotional character.

Risk factors for hypertension are divided into manageable and unmanageable.

Controlled risk factors include: smoking, alcohol consumption, stress, atherosclerosis, diabetes mellitus, excessive salt intake, physical inactivity, obesity.

The main factors involved in the development of hypertension are:

An excess of Na+ causes (among other things) several effects:

Increased transport of fluid into cells and their swelling. Swelling of the cells of the walls of blood vessels leads to their thickening, narrowing of their lumen, increased rigidity of the vessels and a decrease in their ability to vasodilate.

Disorders of the functions of membrane receptors that perceive neurotransmitters and other biologically active substances that regulate blood pressure. This creates a condition for the dominance of the effects of hypertensive factors.

Disturbances in the expression of genes that control the synthesis of vasodilator agents (nitric oxide, prostacyclin) by endothelial cells.

Studies have shown that salt intake in excess of the physiological norm leads to an increase in blood pressure.

It has been scientifically proven that regular consumption of more than 5 g of salt with food daily contributes to the occurrence of hypertension, especially if a person is predisposed to it. Excess salt in the body often leads to spasm of the arteries, fluid retention in the body and, as a result, to the development of hypertension.

environmental factors. Factors such as noise, pollution and water hardness are considered risk factors for hypertension.

Occupational hazards are of the greatest importance (for example, constant noise, the need for tension of attention); living conditions (including utilities); intoxication (especially alcohol, nicotine, drugs); brain injuries (bruises, concussions, electrical trauma, etc.).

individual characteristics of the body.

Hereditary burden of hypertension is one of the most powerful risk factors for the development of this disease. There is a fairly close relationship between blood pressure levels in first-degree relatives (parents, brothers, sisters). The risk increases even more if two or more relatives had high blood pressure.

Since adolescence, the average level of pressure in men is higher than in women. Sex differences in blood pressure peak at young and middle age (35-55 years). In later life, these differences smooth out, and sometimes women may have a higher average level of pressure than men. This is due to the higher premature mortality of middle-aged men with high blood pressure, as well as the changes that occur in the body of women after menopause.

High blood pressure most often develops in people over 35 years of age, and the older the person, the higher the numbers of his blood pressure. In men aged 20-29 years, hypertension occurs in 9.4% of cases, and in 40-49 years old - already in 35% of cases. When they reach the age of 60-69, this figure rises to 50%. It should be noted that under the age of 40, men suffer from hypertension much more often than women, and then the ratio changes in the opposite direction.

Currently, hypertension has become much younger and increased blood pressure is increasingly being detected in young people and people of mature age.

The risk of developing hypertension increases in women during menopause. This is due to violation hormonal balance in the body during this period and exacerbation of nervous and emotional reactions. According to studies, hypertension develops in 60% of cases in women during the menopause. In the remaining 40%, during menopause, blood pressure is also steadily elevated, but these changes disappear as soon as the difficult time for women is left behind.

Stress is the body's response to a strong influence of environmental factors. There is evidence that various types of acute stress increase blood pressure. It is not known, however, whether prolonged stress to long-term high blood pressure regardless of other factors such as diet or socioeconomic factors. In general, there is not enough data to say with certainty about the causal relationship between stress and blood pressure or to calculate the quantitative contribution of this factor to the development of the disease.

It is difficult to find another such habit, about the dangers of which so much has been said and written. The fact that smoking can cause the development of many diseases has become so obvious that even a special term has appeared - “diseases associated with smoking”. The cardiovascular system also suffers from nicotine.

Diabetes is a reliable and significant risk factor for the development of atherosclerosis, hypertension and coronary heart disease. Diabetes leads to deep disorders metabolism, increase in cholesterol and lipoproteins in the blood, decrease in the level of protective lipoprotein factors in the blood.

Atherosclerosis is the main cause various lesions of cardio-vascular system. It is based on deposits in the walls of the arteries of fatty masses and the development of connective tissue, followed by thickening and deformation of the walls of the arteries. Ultimately, these changes lead to a narrowing of the lumen of the arteries and a decrease in the elasticity of their walls, which makes it difficult for blood to flow.

Mankind has long known about the beneficial effects of muscle activity on the state of the body. During physical activity, there is a sharp increase in energy consumption, this stimulates the activity of the cardiovascular system, trains the heart and blood vessels. Muscle load contributes to the mechanical massage of the walls of blood vessels, which has a beneficial effect on blood circulation. Exercise makes the heart work better blood vessels become more elastic, the level of cholesterol in the blood decreases. All this inhibits the development of atherosclerotic changes in the body.

Regular exercise in the open air, adequate to achieve an average level of fitness, is quite effective tool prevention and treatment of arterial hypertension.

Research data indicate that weight gain by 10 kg is accompanied by an increase in systolic pressure by 2-3 mmHg. and an increase in diastolic pressure by 1-3 mm Hg.

This is not surprising, since obesity is often associated with other factors listed - an abundance of animal fats in the body (which causes atherosclerosis), the use of salty foods, and low physical activity. In addition, with excess weight, the human body needs more oxygen. And oxygen, as you know, is carried by the blood, so an additional burden falls on the cardiovascular system, which often leads to hypertension.

IN scientific research established bad influence alcohol on the level of pressure, and this effect did not depend on obesity, smoking, physical activity, sex and age. It is estimated that the use of 20-30 ml. pure ethanol are accompanied by an increase in systolic pressure by about 1 mm Hg. and diastolic pressure by 0.5 mmHg.

In addition, there is an addiction, which is very difficult to fight. Alcohol abuse can lead to the development of heart failure, hypertension, acute disorder cerebral circulation.

4 Pathogenesis

A number of factors are involved in the mechanism of development of hypertension:

· nervous;

· reflex;

· hormonal;

· renal;

· hereditary.

It is believed that psycho-emotional overstrain (nervous factor) leads to the depletion of the centers of vascular regulation with the involvement of reflex and humoral factors in the pathogenetic mechanism. Among the reflex factors, one should take into account the possible shutdown of the depressor effects of the carotid sinus and aortic arch, as well as the activation of the sympathetic nervous system. Among hormonal factors, there is an increase in the pressor influences of the pituitary-diencephalic region (hyperplasia of cells of the posterior and anterior lobes of the pituitary gland), excessive release of catecholamines (hyperplasia of the adrenal medulla) and activation of the rening-hypertensive system as a result of increasing ischemia of the kidneys (hyperplasia and hypergranularity of cells of the juxtaglomerular apparatus, atrophy of the interstitial cells of the brain). kidney substances).

The renal factor in the pathogenesis of hypertension is given exceptional importance, since the excretion of sodium and water by the kidneys, the secretion of renin, kinins and prostaglandins by them is one of the main mechanisms for regulating blood pressure.

In the circulatory system, the kidney plays the role of a kind of regulator that determines the value of systolic blood pressure and ensures its long-term stabilization at a certain level (barostatic function of the kidney) by the feedback mechanism. Feedback in this system is carried out by nervous and endocrine mechanisms blood pressure regulation: autonomic nervous system with baro- and chemoreceptors and centers of vascular regulation in the brain stem, reninangiotensin system, neuroendocrine system (vasopressin, oxytocin), corticosteroids, natriuretic hormone and atrial natriuretic factor. Due to this prerequisite the development of chronic arterial hypertension becomes a shift in the curve of dependence of the excretory function of the kidney on the value of systolic blood pressure towards its higher values. This phenomenon is called “kidney switching”, which is accompanied by contraction of the afferent arterioles, inhibition of the countercurrent-multiplier system of the kidneys, and increased water reabsorption in the distal tubules.

Depending on the activity of the pressor systems of the kidneys, one speaks of vasoconstrictor hypertension with high renin activity in the blood plasma (the tendency to spasm of arterioles is pronounced) or hypervolemic hypertension with low renin activity (an increase in the mass of circulating blood). The level of arterial pressure is determined by the activity of not only pressor, but also depressor systems, including the kinin and prostaglandin systems of the kidneys, which are involved in the excretion of sodium and water.

The role of hereditary factors in the pathogenesis of hypertension is confirmed by the results of a number of experimental studies. It has been shown, for example, that the excretory and endocrine functions of the kidneys, which regulate the level of arterial pressure, can be genetically determined. In the experiment, animal lines with "spontaneous" arterial hypertension, which is based on defects in excretory and other kidney functions, were obtained. The “membrane theory” of primary hypertension is also convincing in this regard, according to which the primary link in the genesis of essential hypertension is a genetic defect in cell membranes in relation to the regulation of the distribution of intracellular calcium, which leads to a change in contractile properties. smooth muscles blood vessels, increased release of mediators by nerve endings, increased activity peripheral department the sympathetic nervous system and finally to the reduction of arterioles, which results in arterial hypertension and the inclusion of the renal factor (“kidney switch”). It is natural that hereditary pathology cell membranes does not play a role stressful situations, psycho-emotional stress in the development of hypertension. Membrane pathology of cells can only be a background against which other factors act favorably (Scheme XIX). It is important to emphasize the fact that the renal factor often closes the "vicious circle" of the pathogenesis of hypertension, since developing arteriolosclerosis and subsequent renal ischemia include the renin-angiotensin-aldosterone system.

1.5 Risk factors

The main cause of hypertension is repeated, as a rule, prolonged psycho-emotional stress. Stress - the reaction has a pronounced negative emotional character.

Risk factors for hypertension are divided into manageable and unmanageable.

Uncontrolled risk factors include: heredity, gender, age, menopause in women, environmental factors.

Controlled risk factors include: smoking, alcohol consumption, stress, atherosclerosis, diabetes mellitus, excessive salt intake, physical inactivity, obesity.

Too much Na+ in food.

Excess salt in the body often leads to spasm of the arteries, fluid retention in the body and, as a result, to the development of hypertension.

environmental factors. Factors such as noise, pollution and water hardness are considered risk factors for hypertension. Occupational hazards are of the greatest importance (constant noise, the need for tension of attention); living conditions (including utilities); intoxication (especially alcohol, nicotine, drugs); brain injuries (bruises, concussions, electrical trauma, etc.).

Hereditary burden of hypertension is one of the most powerful risk factors for the development of this disease. The risk increases even more if two or more relatives had high blood pressure.

High blood pressure most often develops in people over 35 years of age, and the older the person, the higher the numbers of his blood pressure. Currently, hypertension has become much younger and increased blood pressure is increasingly being detected in young people and people of mature age.

Stress is the body's response to environmental factors. There is evidence that various types of acute stress increase blood pressure.

Diabetes mellitus is a reliable and significant risk factor for the development of hypertension and leads to profound metabolic disorders, increased levels of cholesterol and lipoproteins in the blood, and a decrease in the level of protective lipoprotein blood factors.

Atherosclerosis is the main cause of various lesions of the cardiovascular system. It is based on deposits in the walls of the arteries of fatty masses and the development of connective tissue, followed by thickening and deformation of the walls of the arteries. Ultimately, these changes lead to a narrowing of the lumen of the arteries and a decrease in the elasticity of their walls, which makes it difficult for blood to flow.

Obesity. Research data indicate that weight gain by 10 kg is accompanied by an increase in systolic pressure by 2-3 mm. rt. Art. and an increase in diastolic pressure by 1-3 mm. rt. Art.

Alcohol. It is estimated that the use of 20-30 ml. pure ethanol are accompanied by an increase in systolic pressure of about 1 mm. rt. Art. and diastolic pressure by 0.5 mm. rt. Art.

Thus, acting simultaneously and for a long time, the factors described above lead to the development of hypertension (and other diseases). The impact of these factors on a person already suffering from hypertension contributes to the aggravation of the development of the disease and increases the risk of developing various complications.

1.6 Clinic

The clinic of hypertension in the early stages of the development of the disease is not clearly expressed, so there are certain difficulties in differentiating this disease from neurocirculatory dystonia. The borderline is considered to be systolic blood pressure of 140-159 mm Hg. Art. and diastolic - 90-94 mm Hg. Art. Patients complain of a headache of a certain localization (often in the temples, neck), accompanied by nausea, flashing before the eyes, dizziness. Symptoms worsen during a sharp rise in blood pressure (hypertensive crisis). Objectively, a deviation of the left borders of absolute and relative cardiac dullness to the left, an increase in blood pressure above the corresponding physiological (age, gender, etc.) norm, an increase (during a crisis) in the pulse rate and, accordingly, the heart rate, and often arrhythmia, accent II tone above the aorta, an increase in the diameter of the aorta. ECG shows signs of left ventricular hypertrophy. On x-ray examination<#"justify">In accordance with the recommendations of the WHO Expert Committee, there are 3 stages of hypertension. stage (mild) - periodic increase in blood pressure (diastolic pressure - more than 95 mm Hg) with possible normalization of hypertension without drug treatment. During a crisis, patients complain of headache, dizziness, sensation of noise in the head. The crisis may be resolved by copious urination. Objectively, only narrowing of arterioles, dilatation of veins and hemorrhages in the fundus without other organ pathology can be detected. Left ventricular myocardial hypertrophy no stage (moderate) - stable increase in blood pressure (diastolic pressure - from 105 to 114 mm Hg. Art.). The crisis develops against the background of high blood pressure, after the resolution of the crisis, the pressure does not normalize. Changes in the fundus are determined, signs of left ventricular myocardial hypertrophy, the degree of which can be indirectly assessed by X-ray and echocardiographic studies. Currently, an objective assessment of the thickness of the ventricular wall is possible using echocardiography. stage (severe) - a stable increase in blood pressure (diastolic pressure is more than 115 mm Hg). The crisis also develops against the background of high blood pressure, which does not normalize after the resolution of the crisis. Changes in the fundus compared with stage II are more pronounced, arterio- and arteriolosclerosis develops, cardiosclerosis joins left ventricular hypertrophy. There are secondary changes in other internal organs.

Taking into account the predominance of a specific mechanism for increasing blood pressure, the following forms of hypertension are conditionally distinguished: hyperadrenergic, hyporeinic and hyperreninous. The first form is manifested by pronounced autonomic disorders during a hypertensive crisis - a feeling of anxiety, flushing of the face, chills, tachycardia; the second - swelling of the face and (or) hands with periodic oliguria; the third - high diastolic pressure with severe increasing angiopathy. The latter form is rapidly progressive. The first and second forms most often cause hypertensive crises for I-II and II-III stages of the disease, respectively.

A hypertensive crisis is considered as an exacerbation of hypertension. Three types of crisis are distinguished depending on the state of central hemodynamics at the stage of its development: hyperkinetic (with an increase in the minute volume of blood or cardiac index), eukinetic (with normal values of cardiac output or cardiac index) and hypokinetic (with a decrease in cardiac output or cardiac index).

Complications of hypertension: heart failure, coronary heart disease, cerebrovascular accidents, up to ischemic or hemorrhagic stroke, chronic renal failure, etc. Acute heart failure, cerebrovascular accidents most often complicate hypertension during the development of a hypertensive crisis. Diagnosis is based on anamnestic and clinical data, the results of dynamic measurement of blood pressure, determination of the boundaries of the heart and the thickness (mass) of the wall of the left ventricle, examination of the vessels of the fundus, blood and urine ( general analysis). To determine the specific mechanism of arterial hypertension, it is advisable to study the humoral factors of pressure regulation.

Differential diagnosis. It is necessary to differentiate hypertension from symptomatic arterial hypertension, which is one of the syndromes in other diseases (kidney disease, skull trauma, endocrine diseases and etc.).

7 Diagnostics

Diagnosis of hypertension (AH) and examination of patients with arterial hypertension (AH) is carried out in strict sequence, meeting certain tasks: Determination of the stability of the increase in blood pressure (BP) and its degree. Exclusion of the secondary nature of hypertension or identification of its form.

Identification of the presence of other risk factors, CVD and clinical conditions that may affect the prognosis and treatment, as well as assigning the patient to one or another risk group. Determining the presence of POM and assessing their severity.

Determination of blood pressure stability and its degree

At the initial examination of the patient, the pressure on both hands should be measured. In the future, measurements are taken on the arm where blood pressure is higher. In patients over 65 years of age, patients with diabetes and receiving antihypertensive therapy, measure blood pressure while standing after 2 minutes. It is advisable to measure the pressure on the legs, especially in patients younger than 30 years. To diagnose the disease, at least two measurements must be taken with an interval of at least a week.

Ambulatory blood pressure monitoring (ABPM)

ABPM provides important information about the state of the mechanisms of cardiovascular regulation, in particular, reveals such phenomena as diurnal BP variability, nocturnal hypotension and hypertension, BP dynamics over time and uniformity hypotensive effect drugs. At the same time, the data of 24-hour blood pressure measurements have a greater prognostic value than one-time measurements.

The recommended ABPM program involves recording blood pressure at intervals of 15 minutes during wakefulness and 30 minutes during sleep. Approximate normal blood pressure values for the period of wakefulness are 135/85 mm Hg. Art., night sleep - 120/70 mm Hg. Art. with the degree of decrease at night 10-20%. The absence of a nocturnal decrease in blood pressure or the presence of an excessive decrease in blood pressure should attract the attention of a doctor, because. such conditions increase the risk of organ damage.

Possessing unconditional information, the SMAD method is not generally accepted today, mainly because of its high cost.

After the identification of stable hypertension, the patient should be examined to rule out symptomatic hypertension.

The survey includes 2 stages.

The first stage is mandatory studies that are carried out for each patient when AH is detected. This stage includes the assessment of POM, the diagnosis of concomitant clinical conditions that affect the risk of cardiovascular complications, and routine methods for excluding secondary hypertension.

Collection of anamnesis.

Laboratory and instrumental studies:

general urine analysis;

determination of blood levels of hemoglobin, hematocrit, potassium, calcium, glucose, creatinine;

determination of the blood lipid spectrum, including the level of HDL cholesterol, LDL and triglycerides (TG):

electrocardiogram (ECG);

chest x-ray;

examination of the fundus;

ultrasound examination (ultrasound) of the abdominal organs.

If at this stage of the examination the doctor has no reason to suspect the secondary nature of hypertension and the available data are sufficient to clearly determine the patient's risk group and, accordingly, treatment tactics, then the examination can be completed.

The second stage involves research to clarify the form of symptomatic hypertension, additional methods examinations to assess POM, identification of additional risk factors.

Special examinations to detect secondary hypertension.

Additional studies to evaluate concomitant risk factors and POM. They are performed in cases where they can affect the tactics of managing a patient, i.e. their results may lead to a change in the level of risk. So, for example, echocardiography, as the most exact method detection of LVH, if it is not detected by ECG, and its diagnosis will affect the definition of the risk group and, accordingly, the decision on the appointment of therapy.

Examples of diagnostic conclusions:

hypertension (or arterial hypertension) 3 degrees, 2 stages. Dyslipidemia. Left ventricular hypertrophy. Risk 3.

Hypertension 2 degrees, 3 stages. ischemic heart disease. Angina pectoris, 11 functional class. Risk 4.

Hypertension stage 2. Atherosclerosis of the aorta, carotid arteries. Risk 3.

Hypertension 1 degree, 3 stages. Atherosclerosis of the vessels of the lower extremities. Intermittent lameness. Risk 4.

Hypertension 1st degree, 1st stage. diabetes mellitus, type 2, medium degree severity, stage of compensation. Risk 3.

8 Treatment

Mode of work and rest, moderate physical activity, proper nutrition with restriction of consumption of table salt, animal fats, refined carbohydrates. It is recommended to refrain from taking alcoholic beverages.

Treatment is complex, taking into account the stages, clinical manifestations and complications of the disease. Use antihypertensive, sedative, diuretic and other drugs. Antihypertensive drugs used to treat hypertension can be conditionally divided into the following groups:

· drugs that affect the activity of the sympathetic-adrenal system - clonidine (clofelin, hemiton), reserpine (rausedil), raunatin (rauvazan), methyldopa (dopegyt, aldomet), guanethidine (isobarine, ismelin, octadine);

· beta-adrenergic receptor blockers (alprenolol, atenolol, acebutalol, trazikor, visken, anaprilin, timolol, etc.);

· alpha-adrenergic receptor blockers (labetolol, prazosin, etc.);

· arteriolar vasodilators (apressin, hyperstat, minoxidil);

· arteriolar and venous dilators (sodium vitroprusside);

· ganglion blockers (pentamine, benzohexonium, arfonad);

· calcium antagonists (nifedipine, corinfar, verapamil, isoptin, diltiazem);

· drugs that affect water and electrolyte balance(hypothiazide, cyclomethiazide, oxodoline, furosemide, veroshpiron, triamterene, amiloride);

· drugs that affect the activity of the renin-angiotensin system (captopril, enalapril);

· serotonin antagonists (ketanserin).

Given the large selection of antihypertensive drugs, it is advisable to determine the specific mechanism for increasing blood pressure in a patient.

In case of stage I hypertension, course treatment is aimed at normalizing and stabilizing normalized pressure. use sedatives(bromides, valerian, etc.), reserpine and reserpine-like drugs. The dose is selected individually. The drugs are given mainly at night. In crises with a hyperkinetic type of blood circulation, beta-adrenergic receptor blockers are prescribed (anaprilin, inderal, obzidan, trazikor, etc.).

In stage II-III it is recommended continuous treatment with the constant intake of antihypertensive drugs that ensure the maintenance of blood pressure as close as possible to the physiological level. Simultaneously combine several drugs with different mechanisms of action; include saluretics (hypothiazide, dichlothiazide, cyclomethiazide). Also used in combination dosage forms containing saluretics (Adelfan-Ezidrex, Sinepres, etc.). With a hyperkinetic type of blood circulation, beta-adrenergic receptor blockers are included in therapy. The use of peripheral vasodilators has been shown. A good effect is achieved when taking hemiton, clonidine, dopegyt (methyldopa). In the elderly with antihypertensive therapy, it is necessary to take into account the compensatory value of arterial hypertension due to the atherosclerotic process developing in them. You should not strive to ensure that blood pressure reaches the norm, it should exceed it.

At hypertensive crisis more decisive action is required. However, it must be remembered that a sharp decrease in blood pressure during the relief of a crisis is, in fact, a catastrophe for the relationship between the mechanisms of pressure regulation that has developed in a certain way in the patient. During a crisis, the dose of drugs used is increased and drugs with a different mechanism of action are additionally prescribed. IN emergency cases, with extremely high blood pressure, intravenous administration of drugs (dibazole, pentamine, etc.)

Inpatient treatment is indicated for patients with high diastolic pressure (more than 115 mm Hg), with severe hypertensive crisis and complications.

Treatment of complications is carried out in accordance with general principles treatment of the syndromes giving clinic of complications.

Patients are prescribed exercise therapy, electrosleep, in the first stage of the disease - physiotherapeutic methods. In stages 1 and 2, treatment is shown in local sanatoriums.

1.9 Prevention

The following facts testify to the role of nervous mechanisms in the origin of hypertension: in the vast majority of cases, patients can establish in the past, before the onset of the disease, the presence of strong nervous "shakes", frequent unrest, mental trauma. Experience shows that hypertension is much more common in people exposed to repeated and prolonged nervous strain. Thus, the huge role of disorders of the neuropsychic sphere in the development of hypertension is indisputable. Of course, personality traits and the reaction of the nervous system to external influences matter.

Heredity also plays a role in the occurrence of the disease. Under certain conditions, malnutrition can also contribute to the development of hypertension; gender, age matters. Thus, women during menopause (at 40-50 years old) suffer from hypertension more often than men of the same age. Elevations in blood pressure can occur in women during pregnancy, which can lead to serious complications during childbirth. Therefore, in this case medical measures should be aimed at eliminating toxicosis. Atherosclerosis of the cerebral vessels can contribute to the development of hypertension, especially if it affects certain departments that are in charge of the regulation of vascular tone.

The disruption of the kidneys is very important. Reducing the blood supply to the kidneys causes the production of a special substance - renin, which increases blood pressure. But the kidneys also have a so-called renoprival function, which consists in the fact that the medulla of the kidneys produces a substance that destroys compounds in the blood that increase blood pressure (pressor amines). If, for some reason, this so-called antihypertensive function of the kidneys is impaired, then blood pressure rising and stubbornly holding on high level despite comprehensive treatment modern means. In such cases, it is believed that the development of persistent hypertension is a consequence of a violation of the renoprival function of the kidneys.

Prevention of hypertension requires special attention to nutrition. It is recommended to avoid excessive consumption of meat and fats. The diet should be moderately high-calorie, with a restriction of protein, fat and cholesterol. This helps prevent the development of hypertension and atherosclerosis.

Overweight people should periodically resort to unloading diets. A known restriction in the diet should be consistent with the work activity. In addition, significant malnutrition contributes to the development of hypertension, causing a change in the reactivity of the higher parts of the central nervous system. Correct Mode nutrition without the formation of excess weight should be sufficient to prevent functional disorders higher nervous system. Systematic weight control is the best guarantee of a proper diet.

A person suffering from hypertension should be moderate in fluid intake. The normal daily water requirement is met by 1-1.5 liters of all water taken per day in the form of liquids, including liquid meals at lunch. About 1 liter of liquid, in addition, a person receives from the water that is part of the products. In the absence of heart failure, the patient can afford to take fluids in the range of 2-2.5 liters (preferably no more than 1-1.2 liters). It is necessary to distribute the drink evenly - you can not drink a lot at once. The fact is that the liquid is quickly absorbed from the intestines, flooding the blood, increasing its volume, which increases the load on the heart. It must move a larger than usual mass of blood until the excess fluid is removed through the kidneys, lungs, and skin.

Overfatigue of a diseased heart causes a tendency to edema, and an excess of fluid aggravates it all the more. The use of pickles should be excluded, table salt should be limited to 5 g per day. Overconsumption salt leads to a violation of water-salt metabolism, which contributes to hypertension. Alcoholic drinks, smoking also accelerate the development of the disease, so they should be strictly prohibited for patients with hypertension. Nicotine is a poison for blood vessels and nerves.

The appropriate distribution of hours of work and rest is of great importance. Prolonged and strenuous work, reading, mental fatigue, especially in persons predisposed to hypertension, contribute to its emergence and development.

Particular attention should be paid to physical culture. It is a kind of protective measure that trains the neurovascular apparatus of hypertensive patients, reduces the phenomena associated with disorders of the nervous system - headache, dizziness, noise and heaviness in the head, insomnia, general weakness. Exercises should be simple, rhythmic, performed at a calm pace. A particularly important role is played by regular morning hygienic gymnastics and constant walking, especially before going to bed, lasting at least an hour.

Very useful hours spent in nature, outside the city, in the country. It must be remembered, however, that summer residents should alternate hours of hard work with hours of relaxed, simple movement. Try to avoid prolonged loads in a bent state, try not to garden, but rather spend outdoor activities in the country<#"justify">Chapter I Conclusions

Hypertensive disease deserves the most serious attention, especially because it leads to a strong decrease, and sometimes to a loss of mental and physical performance in adulthood, when a person can bring maximum benefit to society. In addition, hypertension is one of the main obstacles to healthy longevity.

The following facts testify to the role of nervous mechanisms in the origin of hypertension: in the vast majority of cases, patients can establish in the past, before the onset of the disease, the presence of severe nervous stress, frequent unrest, and mental trauma. Experience shows that hypertension is much more common in people who are subject to repeated and prolonged nervous strain. Thus, the huge role of disorders of the neuropsychic sphere in the development of hypertension is indisputable. Of course, personality traits and the reaction of the nervous system to external influences matter.

Early detection of psychopathological disorders, their timely correction -important factors defining success rehabilitation activities in patients with hypertension.

In hypertensive patients with cardialgia, psychopathological symptoms are also more pronounced, mainly in the form of hypochondriacal, anxious and hysterical syndrome.

In persons with professional arterial hypertension and patients with hypertension most often reveal the following character traits: hyperthymia, sthenicity, demonstrativeness, psychasthenicity and less often introversion, cycloidism and rigidity.

Heredity also plays a role in the occurrence of the disease. Under certain conditions, malnutrition can also contribute to the development of hypertension; gender, age matters. Elevations in blood pressure can occur in women during pregnancy, which can lead to serious complications during childbirth. Atherosclerosis of the cerebral vessels can contribute to the development of hypertension, especially if it affects certain departments that are in charge of the regulation of vascular tone.

Thus, these factors need to be taken into account when building an individual plan for the primary prevention of hypertension and rehabilitation of patients.

Chapter 2. Practical part

1 Study of risk factors in patients

Having studied the literature on this topic, I decided to find out if visitors to the city's polyclinic have risk factors. I did a survey. The study involved 30 people of different ages.

Participants were asked to answer the following questions:

.Your age?

How do you rate your health level?

What, in your opinion, is the cause of the development of diseases of the cardiovascular system?

Do any of your relatives have heart disease?

Do you smoke?

Is your life stressful?

Do you tend to be overweight?

Do you do physical exercises?

Do you know your normal blood pressure numbers?

Summing up the results of the survey, we can conclude that many people do not follow the simplest norms of a healthy lifestyle. Some become victims of inactivity (physical inactivity), others overeat with the almost inevitable development of obesity, vascular sclerosis in these cases, and some have heart disease, others do not know how to relax, be distracted from industrial and domestic worries, are always restless, nervous, suffer from insomnia which ultimately leads to numerous diseases of the cardiovascular system. Almost all respondents (91%) smoke, which actively shortens their lives. Thus, the residents of the city have all the risk factors for cardiovascular diseases: smoking, overweight, physical inactivity, stress, hereditary factor, not being aware of your pressure.

This suggests that the medical assistants of the city pay little attention to primary prevention, they need to take this problem more seriously, because today the incidence of hypertension in people is very high.

2 Methods for diagnosing patients with hypertension

In order to solve the problems formulated in the work, a survey was conducted of patients of both sexes aged from 25 to 75 years. The study involved 30 people who were divided into two groups:

group 1 - control, which included 15 healthy subjects: 6 women and 9 men ( average age- 51.5 years). The group of healthy subjects included people who did not have chronic and acute somatic diseases and diseases of the nervous system, mental health and consented to participate in the study.

group 2 - the main one, which included 15 patients with hypertension: 6 women and 9 men (mean age - 48.9 years). In all patients, hypertension proceeded with crises. Among men, 2 were diagnosed with stage I hypertension, 2 with stage II hypertension, and 5 with stage III hypertension. Among women, stage I hypertension was present in 2, one had stage II hypertension, and 3 had stage III hypertension. All patients underwent a comprehensive clinical examination.

The layout of the experiment is shown in Table 1.

Table 1

Scheme of constructing an experiment in a group of patients with hypertension

Research methods Age Group of patients Healthy Typological questionnaire G.Yu. Eysenka 25-751515 Cattell's sixteen-factor personality questionnaire 25-751515 Diagnosis of the level of personal frustration (Boyko) 25-751515 Emotional burnout (Boyko) 25-751515 Social maladjustment Leary 25-751515

Statistical methods zM were used for statistical processing of the study results.

3 Analysis and evaluation of the results of the study of patients with hypertension

Clinical research methods included general clinical, cardiological and neurological examinations. History data, heredity, previous and concomitant diseases, the frequency of nervous stress, bad habits, pregnancy, adherence to the treatment of hypertension and control of blood pressure were taken into account. The study of the state of the cardiovascular system included the control of blood pressure.

Psychological research included:

Identification of extraversion-introversion, assessment of emotional stability-instability (neuroticism);

Assessment of individual psychological characteristics of a person;

Identification of the level of personal frustration and the level of manifestation of emotional burnout;

Study of the mechanisms of social maladaptation.

The most important component of hypertension are emotional disorders. In our work, we assessed the personality traits of patients with hypertension using the following components: extraversion-introversion (Eysenck's Questionnaire), individual psychological characteristics of the personality (Kettel's Questionnaire), identifying the level of personal frustration and the level of manifestation of emotional burnout (Boiko's Methods), studying the mechanisms of social maladjustment (Leary method).

Typological questionnaire G.Yu. Eysenck (EPI Questionnaire). The EPI questionnaire contains 57 questions, 24 of which are aimed at identifying extraversion-introversion, 24 others - at assessing emotional stability-instability (neuroticism), the remaining 9 form a control group of questions designed to assess the sincerity of the subject, his attitude to the examination and the reliability of the results.

Cattell's sixteen-factor personality questionnaire. The Cattell Questionnaire is one of the most common questionnaire methods for assessing the individual psychological characteristics of a person both abroad and in our country. It was developed under the direction of R.B. Kettel and is intended for writing a wide range of individual-personal relationships.

Diagnosis of the level of personal frustration (Boyko). The technique is aimed at a person's emotionally negative experience of any failure, failure, loss, collapse of hopes, accompanied by a sense of hopelessness, the futility of the efforts made.

Emotional burnout (Boyko). Measurement of the level of manifestation of emotional burnout - a psychological defense mechanism in the form of a complete or partial exclusion of emotions in response to selected psychotraumatic effects.

Leary's social maladaptation. The technique was created by T. Leary, G. Leforge, R. Sazek in 1954 and is designed to study the subject's ideas about himself and the ideal "I", as well as to study relationships in small groups. With the help of this technique, the predominant type of attitude towards people in self-esteem and mutual evaluation is revealed.

At the first stage, the subjects of the control and main groups underwent a clinical study.

An important stage of our study was the study of anamnesis, which allows us to assess the role of factors that take the most significant part in the formation of hypertension. The following indicators of anamnesis were taken into account: heredity, previous and concomitant diseases, the frequency of nervous stress, bad habits, pregnancy, adherence to the treatment of hypertension and control of blood pressure. The study of the state of the cardiovascular system included the control of blood pressure.

According to the results of the data collection of anamnesis, the following indicators were identified:

table 2

Comparative analysis of anamnestic data of healthy and hypertensive patients

Groups Heredity Past, concomitant diseases Nervous stress Bad habits Pregnancy Adherence to treatment of the disease Control of blood pressure levels 2%960.3%1280.4%853.6%213.4%1067%15100%

Comparison of the anamnestic data of the subjects of the main and control groups established a significantly higher degree of stress load. With statistical significance of differences (p<0,05) в группе гипертонических больных она составляла 80,4%, т. е. достоверно выше, чем у здоровых 46,9%. В 53,6% в основной группе, т. е. меньше, чем у здоровых 60,3% (p<0,05) был установлен факт вредных привычек. При исследовании наследственной предрасположенности было показано ее достоверное преобладание в группе больных гипертонической болезни (40,2%) по сравнению с соответствующими показателями у здоровых (наследственная предрасположенность 26,8%) (p<0,05).

When patients with hypertension were admitted to the emergency room of the hospital, the following indicators of blood pressure and the corresponding severity of the disease were noted in patients.

Table 3

Clinical assessment of disease severity

Severity of the disease Percentage Hypertensive disease 1 st.27.8 Hypertensive disease 2 st.

Table 4

Concomitant psychovegetative symptoms

Psycho-vegetative symptoms Percent Asthenia 26.8 Headaches 80.4 Psycho-emotional stress 53.6 Low mood 67 Depression 33.5

At the second stage, the subjects of the control and main groups underwent a psychological study.

Analyzing the results obtained, we came to the conclusion that in patients with hypertension, the level of social maladaptation is higher than in healthy subjects.

Thus, according to the study, we came to the conclusion that in order to normalize the psychological status of hypertensive patients, it is necessary to carry out psycho-correctional work among hypertensive patients.

2.4 The role of the paramedic in organizing and conducting diagnostic, therapeutic and preventive measures to combat hypertension

Prevention of hypertension, which is a chronic progressive vascular pathology, is not an easy task.

Given its widespread prevalence, a special role in working with patients belongs to paramedical workers, in particular paramedics. The most important prerequisite for effective treatment is thoughtful individual work with patients. First of all, it is necessary to instill in the patient the need for systematic (and not only with an increase in blood pressure) taking medications for many years, and also, most importantly, a decisive improvement in their lifestyle, i.e., eliminating, if possible, risk factors for arterial hypertension.

Prevention of hypertension is aimed at early detection of the disease by measuring blood pressure in people over 30-35 years of age during periodic medical examinations conducted at enterprises and institutions. People who have an increase in blood pressure should be taken under dispensary observation. The paramedic working at the paramedical station monitors the blood pressure of these people, actively visits them, monitors the action of antihypertensive drugs.

Prevention of hypertension is of paramount importance in solving the problem of longevity, in maintaining mental and physical performance in adulthood. Thus, it is known that the presence of arterial hypertension shortens life expectancy by an average of 10 years (in the group of people older than 45 years). Such a frequent complication of hypertension, such as a hypertensive crisis, causes a rather high mortality rate, a high percentage of temporary disability and disability. Huge labor losses are also caused by another complication - myocardial infarction. It is practically important that the prevention of hypertension and the prevention of coronary artery disease largely coincide.

Primary prevention of hypertension should begin in childhood. It is necessary to organize a medical examination in children's institutions, schools, universities with regular measurement of blood pressure in children and young people 2-3 times a year. This should be given special attention at the FAP, in the pre-medical reception rooms of outpatient clinics, etc.

Primary prevention measures should take into account all risk factors. A rational muscular load is necessary already in childhood, unreasonable exemptions from physical education at school must be excluded, overfeeding of children and adolescents is unacceptable, especially salt-eating (increased consumption of table salt). If moderate hypertension does not cause pain, then only a wellness regimen should be recommended. These persons are contraindicated for work at night, as well as work associated with sharp nervous overload, tilting the head and torso, lifting weights. It is not recommended to sharply tilt the head, the body to a patient with hypertension, as this increases the pressure in the cerebral vessels; the head should be kept as straight as possible or slightly pulled back. Overtime work is unacceptable, it is necessary to limit the impact of industrial and domestic noise wherever possible. It is contraindicated for many hours sitting at the TV, especially for elderly obese persons after eating. Recall that it causes thrombosis of small veins of the legs. It is necessary to combat hypokinesia.

Persons with borderline hypertension should be under medical supervision. Their dispensary is obligatory. Exercise training is recommended. If within 6-12 months their blood pressure steadily normalizes or remains in the border zone, then the observation is continued for another year. When complaints (headache, insomnia, etc.) appear in risk groups, drug treatment is started, usually 6-blockers and sedatives are prescribed.

However, the paramedic must instill in every patient with hypertension that without the elimination of risk factors, drug treatment will give an incomplete and short-lived effect. It is in the patients' misunderstanding of this circumstance, as well as in the irregularity of taking antihypertensive drugs, that the reasons for the relatively high incidence of hypertension and its complications, including those with a fatal outcome (strokes, myocardial infarctions), lie. The experience of some foreign countries shows that persistent work with patients, individually selected and regular antihypertensive therapy can reduce the incidence of myocardial infarction and hemorrhagic strokes in the population by 20-30%.

Chapter II Conclusions

On the basis of an empirical experiment, it can be concluded that hypertension has a great influence on the personality and largely determines the behavior of the subject.

The emotional sphere of hypertensive patients is characterized by high personal and reactive anxiety, emotional tension, low mood, irritability, the presence of depressive states, including masked ones.

Patients with hypertension are characterized by a higher level of accentuation in general and especially of emotive, anxious, pedantic, cyclothymic and distimic types.

Patients with hypertension had a higher level of alexithymia, which acts as an important pathogenetic factor in the formation of psychosomatic pathology.

Features of adaptation in psychosomatic disorders are difficult due to the active use of non-adaptive psychological defense mechanisms such as denial, repression, hypercompensation and compensation, which do not contribute to the awareness of the presence and complexity of the disease, which leads to chronicity of the disease, as well as disharmonic personality development.

Thus, the residents of the city have all the risk factors for cardiovascular diseases: smoking, overweight, physical inactivity, stress, hereditary factor, lack of awareness of their pressure.

Conclusion

Measures to prevent hypertension are the subject of intensive and in-depth research. Hypertension, as observations have shown, is one of the most common cardiovascular diseases in many countries.

Patients with hypertension are more prone to atherosclerosis, especially the arteries of the brain, heart, kidneys. All this indicates the need for systematic measures of personal and social prevention of this disease, its timely treatment.

Epidemiological studies have shown that in a third of patients, hypertension is latent.

First of all, it is worth thinking about hypertension for everyone whose blood pressure is within the high or borderline norm. Everyone needs to have information about cases of hypertension in the family.

A person who may develop arterial hypertension, as a preventive measure, needs to reconsider his usual way of life and make the necessary amendments to it. This concerns an increase in physical activity, regular outdoor activities are necessary, especially those that, in addition to the nervous system, also strengthen the heart muscle: these are running, walking, swimming, skiing.

Nutrition should be complete and varied, include both vegetables and fruits, as well as cereals, lean meats, and fish. Eliminate large amounts of salt. You should also not get involved in alcoholic beverages and tobacco products.

A healthy lifestyle, a calm and benevolent atmosphere in the family and at work, regular preventive examinations by a cardiologist - that's all the prevention of hypertension and cardiovascular diseases.

In this work, I have:

.The literature on this topic was studied and analyzed, where I found out: risk factors for hypertension, the role of a paramedic in the primary prevention of arterial hypertension.

.A study aimed at studying the risk factors for cardiovascular diseases of the city residents was carried out.

.A memo for patients on the primary prevention of arterial hypertension has been developed. (Annex 1)

Having solved the tasks I have listed above, I can say that the goal of the thesis has been achieved, I have studied the role of the paramedic in the primary prevention of hypertension.

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26.Malysheva I.S. Hypertension. Home Encyclopedia. - M.: Vector, 2014. -208 p.

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28.Myasnikov A. L. Hypertension and atherosclerosis. - M: Medicine, 2015.

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30.Saikov D.V., Serafimovich E.N. Pressure. From high to normal. Hypertension therapy + treatment program. - M.: Trioleta, 2012. - 212 p.

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Annex 1

Memo "Prevention of hypertension"

The main functional duties of paramedics

An important section of the activity of paramedics is the provision of medical care to patients at home. The order of treatment of patients at home is determined by the doctors of the district hospital or the central district hospital (CRH) and only in some cases by the paramedic himself. Patients left at home should be monitored continuously until they recover. This is especially true for children. It is expedient to hospitalize patients from settlements remote from FAP; when leaving the patient at home, the paramedic informs the doctor of the rural medical district about this and monitors the patient.

In outpatient care for tuberculosis patients, the paramedic, being the direct executor of medical prescriptions, conducts immunochemoprophylaxis, medical examination, anti-epidemic measures in the foci of tuberculosis infection, work on hygiene education, etc.

A paramedic working at a FAP must master the simplest resuscitation techniques at the prehospital stage, especially in case of sudden cardiac or respiratory arrest, the causes of which can be severe injuries, blood loss, acute myocardial infarction, poisoning, drowning, electrical injury. Paramedics and obstetricians working independently are also entrusted with the provision of emergency medical care in case of acute illnesses and accidents. In case of an urgent call, the paramedic must have a suitcase with him, complete with medical instruments and medicines according to the packing list.

Paramedics play an important role in medical examination of the rural population. Its main goal is to implement a set of measures aimed at forming, maintaining and strengthening the health of the population, preventing the development of diseases, reducing morbidity, and increasing active creative longevity.

In order to conduct a general medical examination, a personal registration of the entire population living in the service area of the polyclinic, outpatient clinic and FAP is carried out in accordance with the “Instruction on the procedure for accounting for the annual medical examination of the entire population”. In rural areas, the lists of residents are average medical workers of the FAP.

For the personal account of each resident, paramedical workers fill out the “Medical examination record card” (educational form No. 131 / y - 86) and number it in accordance with the number of the outpatient medical card (registration form No. 025 / y). After clarifying the composition of the population, all "Medical examination records" are transferred to the file cabinet.

The paramedic or midwife makes sure that patients who need seasonal (autumn, spring) anti-relapse treatment receive it in a timely manner in a hospital or on an outpatient basis. The proper organization of the examination of temporary disability for FAP is important for reducing the incidence.

In accordance with the "Regulations on the head of the feldsher-obstetric station", the head of the FOP, the paramedic may have the right to issue sick leaves, certificates and other medical documents in the manner established by the Ministry of Health of the Russian Federation.

The basis for granting the right to issue sick leave to the paramedic is the petition of the chief physician of the district, which must indicate:

the remoteness of the FAP from the hospital (outpatient clinic) to which he is assigned;

the number of serviced settlements of the state farm and the number of workers in them;

state of communication routes;

the experience of the paramedic and the level of his qualifications;

knowledge and observance by the paramedic of the basics of examinations of temporary disability and the “Instructions on the procedure for issuing sick leave”.

The paramedic keeps records of the issued sick leave in the “Book of Registration of Disability Leaves” (form No. 036 / y) with the obligatory completion of all its columns.

Therapeutic and preventive care for women and children.

At each FLP, the paramedic (midwife) maintains a file of personal records of women starting from the age of 18, where they enter passport data, past illnesses, information about all pregnancies (years in which each pregnancy ended, complications). The medical assistant (midwife) begins the examination of each pregnant woman at the first visit with a general examination, measures the length and weight of the body, blood pressure on the common arms, determines the condition of the heart, lungs and other organs within her competence, examines the urine for protein. When monitoring pregnant women, the paramedic (midwife) of the FAP is obliged to show each of them to the doctor; in cases where a woman has the slightest deviation from the normal development of pregnancy, she should be immediately referred to a doctor.

One of the important sections of the activity of FAP paramedics is to carry out primary anti-epidemic measures in the event of outbreaks of infectious diseases, the timeliness and quality of which determine the effectiveness of preventing the spread of infection outside the outbreak. In this regard, the organization of the activities of FLP employees, aimed at identifying infectious diseases among the population, is of great importance.

When diagnosing an infectious disease (or suspecting it), the paramedical staff of the FAP should:

carry out primary anti-epidemic measures in the outbreak;

isolate the patient at home and organize ongoing disinfection before hospitalization of the patient;

identify all persons who have been in contact with the patient, take them into account and establish medical supervision over them;

to carry out (together with the doctor) quarantine measures in relation to persons who have been in contact with sick people, attending preschool institutions, schools or working at epidemically important facilities;

report at the place of work, study, preschool institutions, at the place of residence about the sick person and the persons who have been in contact with him;

at the direction of a pediatrician or epidemiologist, conduct gamma globulin prophylaxis for those who have been in contact with a patient with viral hepatitis A.

An infectious patient is hospitalized during the first day of the disease in a special transport. In its absence, the patient can be transported by any means of transport with subsequent disinfection. In the future, the medical worker of the FAP follows the instructions of the epidemiologist (assistant epidemiologist) and carries out:

collection of material from persons who have been in contact with patients for laboratory research in order to identify bacteria carriers;

vaccinations according to epidemiological indications and chemoprophylaxis;

dynamic monitoring of persons who have been in contact with patients during the incubation period of this infectious disease.

Paramedics and midwives of the FAP play an important role in health-improving activities, hygienic education of the rural population and promotion of a healthy lifestyle.In order to correctly assess the level of well-being of the object, paramedics are trained in the simplest laboratory tests, express methods and are provided with field express laboratories. With the help of such a laboratory, it is possible to determine residual amounts of chlorine in disinfectant solutions, on objects and surfaces (starch iodine method), residual amounts of detergents on tableware (phenolphthalein test).

The FAP paramedic often has to take part in the analysis of occupational injuries and the development of measures to reduce it, so he must be familiar with the main causes of injuries: technical, organizational and sanitary and hygienic. More than half of all victims turn to FAP, so the nursing staff is required to constantly improve their knowledge, in particular, in first aid for injuries. In addition to providing first aid to the victim, FAP paramedics register and record injuries; identify, study and analyze their causes depending on various factors; together with doctors, develop specific measures to eliminate the identified causes; monitor compliance with safety regulations; train agricultural workers in first aid.

When working as part of a medical team, the paramedic is completely subordinate to the doctor during the call. His task is to fulfill all assignments accurately and quickly. Responsibility for decisions made lies with the doctor.

The paramedic must be proficient in the technique of subcutaneous, intramuscular and intravenous injections and ECG recording, be able to quickly set up a drip system, measure blood pressure, count the pulse and number of respiratory movements, insert an airway, perform cardiopulmonary resuscitation, etc. He must also be able to apply a splint and a bandage, stop bleeding, know the rules for transporting patients.

In the case of independent work, the ambulance paramedic is fully responsible for everything, so he must fully master the methods of diagnosis at the prehospital stage. He needs knowledge in emergency therapy, surgery, traumatology, gynecology, pediatrics. He must know the basics of toxicology, be able to take birth on his own, assess the neurological and mental state of the patient, not only register, but also tentatively evaluate the ECG.

Appendix No. 10 to the order of the Ministry of Health of the Russian Federation No. 100 dated 03.26.99

Methods and means of sanitary and educational work of a paramedic

In organizing his health education work, the paramedic, along with traditional methods of educating the population on health issues (such as interviews, group discussions, lectures, theme evenings, question and answer evenings, round tables, oral journals, health schools, publications in press, conferences) also widely uses the methods of visual agitation: wall newspapers; health bulletins; exhibitions and corners of health; book exhibitions.

A health bulletin is an illustrated health-educational newspaper devoted to only one topic. Topics should be relevant and chosen taking into account the challenges facing modern healthcare, as well as the seasonality and epidemiological situation in the region. The title is in large print. The name should be interesting, intriguing, it is desirable not to mention the word "disease" and "prevention".

The newsletter consists of two parts - textual and illustrated. The text is placed on a standard sheet of drawing paper in the form of columns, 13-15 cm wide, typed on a typewriter or computer. It is allowed to write the text in calligraphic handwriting in black or purple ink. It is necessary to highlight the editorial or introduction, the rest of the text should be divided into subsections (headings) with subheadings, which state the essence of the issues and give practical advice. Noteworthy is the presentation of the material in the form of questions and answers. The text should be written in a language that is intelligible to the general public without medical terminology, with the obligatory use of local material, examples of proper hygienic behavior in relation to one's health, cases from medical practice. Artistic design: drawings, photographs, applications should illustrate the material, but not duplicate it. There can be one or more drawings, but one of them - the main one - should carry the main semantic load and attract attention. Text and artwork should not be bulky. The health bulletin ends with a slogan or appeal.

It is necessary to ensure the issuance of a sanitary bulletin at least 1-2 times a quarter.

Health corner.

The organization of the corner should be preceded by certain preparatory work: coordination with the leadership of this institution; determination of the list of works and necessary building materials (stands, strips, buttons, glue, fabric, etc.); choosing a place - one where there are constantly or often a lot of people; a selection of relevant illustrated material (posters, photo and literary exhibitions, transparencies, photographs, memos, leaflets, clippings from newspapers and magazines, drawings).

The leading theme of the health corner is various aspects of a healthy lifestyle. In the event of any infection or its threat in the area, appropriate prevention material should be placed in the corner. This may be a health bulletin, a leaflet prepared by the local sanitary and epidemiological surveillance authority, a brief memo, a clipping from a medical newspaper, etc. The health corner should have a question and answer board. Answers to questions should always be timely, efficient and useful.

oral journals.

In oral journals, in addition to health workers, traffic police officers, juvenile inspectors, and lawyers should participate. In their reports, they address issues not only of a medical nature, but also affecting legal, social and moral problems. Therefore, in oral journals, several topics can be considered at once.

Disputes and conferences. Dispute - a method of polemical discussion of any topical, moral or educational problem, a way of collective search, discussion and resolution of issues of concern to the population. A dispute is possible when it is well prepared, when not only specialists, but also (for example, at school) students and teachers participate in it. Collisions, struggle of opinions are associated with differences in people's views, life experience, inquiries, tastes, knowledge, in the ability to approach the analysis of phenomena. The purpose of the dispute is to support progressive opinion and convince everyone of the rightness.

A form of propaganda close to a dispute is a conference with a pre-designed program and fixed speeches by both specialists and the population itself.

Oral forms of health education propaganda also include themed evenings, round-table discussions, and question-and-answer evenings. Theater and entertainment events, mass sports events can play an important role in promoting a healthy lifestyle. The content of the work in carrying out various forms and methods of hygienic education of the population and promoting a healthy lifestyle at the FAP should be aimed at highlighting the basics of personal and public hygiene, hygiene of the village, town, housing, landscaping and gardening, maintenance of personal plots; to combat environmental pollution; prevention of diseases caused by exposure to unfavorable meteorological conditions (high humidity, high and low temperatures, etc.); on the introduction of physical culture into the life of every person. The range of topics of this activity also includes labor and professional orientation: the creation of healthy living and working conditions, the formation of a healthy lifestyle. Much attention should be paid to the prevention of infectious diseases, improvement of water supply and water use. One of the important tasks is the promotion of occupational health measures in agricultural work, the prevention of agricultural injuries and poisoning with pesticides, and the explanation of hygienic requirements for the delivery, purification and storage of water in the field.

A significant place should be occupied by anti-alcohol propaganda, an explanation of the dangers of smoking.

Smoking is one of the most common types of addiction. The work of a paramedic in anti-alcohol propaganda should be based on a certain system, including legal, biomedical and moral aspects.

Depending on gender and age, topics can be selected for better perception by listeners.

Sample lecture plans

1. For men: the effect of alcohol on all organs and systems of the body; alcohol and trauma; alcohol and sexually transmitted diseases; alcohol and mortality; alcohol and work capacity; alcohol and family; alcohol and heredity; economic damage caused to the state by persons who abuse alcohol.

2. For women: the effect of alcohol on a woman's body; the effect of alcohol on pregnancy; alcohol and children; the role of women in strengthening the family and overcoming drunkenness of men.

3. For teenagers: anatomical and physiological features of the teenager's body; the effect of alcohol on the body of a teenager; the effect of alcohol on a teenager's abilities; the effect of alcohol on offspring; alcohol and disorderly conduct; how to maintain mental health.

A large section of preventive work to promote a healthy lifestyle should be highlighted in pediatrics. Hygienic education and upbringing begins from early childhood, with antenatal protection of future offspring.

Education of a healthy lifestyle and prevention of various diseases should be carried out with pregnant women at prenatal care and group sessions in the form of individual conversations (for example, in the "School of Pregnant Women"). It is desirable to conduct conversations about the hygiene of a pregnant woman and the peculiarities of the newborn period ™ not only among women themselves, but also among their family members, especially husbands in the “School of Young Fathers”.

The need for extensive preventive measures in relation to the child population and youth, including primarily educational and sanitary-educational measures, is also increasing due to the fact that at this age basic behavioral attitudes, attitudes, skills, habits, etc. are formed, i.e. everything that further determines the way of life of a person. During this period, it is possible to prevent the emergence of bad habits, emotional incontinence, passive rest and poor nutrition, which in the future can become a risk factor for many diseases. It is relatively easy for children to cultivate the habit of physical activity, physical education and sports, a varied and moderate diet, and a rational regimen.

Sanitary and educational work at the FAP should be carried out according to a predetermined plan. Drawing up a plan for sanitary and educational work is carried out for the entire current year and for a month. The annual plan provides for the main tasks of protecting health and promoting a healthy lifestyle, and for each month they draw up a specific plan with the names of topics and methods for covering them. At the end of the month and at the end of the reporting year, the medical worker is obliged to report on the sanitary and educational work done.

Hygienic education of the population and promotion of a healthy lifestyle should contribute to early seeking medical care, improving obstetric care, reducing infant mortality, morbidity with temporary disability and injuries, timely hospitalization of patients, attracting the population to preventive examinations, increasing the level of sanitary culture of the population, improving conditions their work and life, the activation of the creative initiative of people in matters of preserving and strengthening health, increasing efficiency and creative longevity.

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The concept of anemia as an infectious disease, the causes of its occurrence in childhood, the types and degree of danger to the life and health of the child. Analysis of the number of anemias in children of primary and secondary school age, the role of a paramedic in their prevention.

STATE EDUCATIONAL INSTITUTION

SECONDARY VOCATIONAL EDUCATION

KASIMOV MEDICAL SCHOOL

SPECIALTY 060101 "MEDICAL BUSINESS"

FINAL QUALIFICATION WORK ON THE TOPIC:

"The role of the paramedic in the prevention of anemia in children of primary and secondary school age".

Performed:

group student 5f2

Konkina Svetlana
Sergeevna

Kasimov 2008

INTRODUCTION 3
CHAPTER 1. ANEMIA. 3

1.1. Iron deficiency anemia 3

1.1.1. Etiology 3
1.1.2. Pathogenesis 3
1.1.3. Clinic 3
1.1.4. Treatment 3

1.2. B 12 -deficiency anemia 3

1.2.1. Etiology 3
1.2.2. Clinic 3
1.2.3. Pathogenesis 3
1.2.4. Treatment 3

CHAPTER 2. Analysis of the number of anemia in children of primary and secondary school age. 3
CHAPTER 3

3.1. Prevention and dispensary observation for iron deficiency anemia 3
3.2. Dispensary observation of B12-deficiency anemia 3

CONCLUSION 3
USED LITERATURE 3

INTRODUCTION

Many anemias in children, despite the increased interest in them by diatricians, are still not well recognized, and pathogenetic methods of their treatment are poorly introduced into wide clinical practice. Meanwhile, the study of this pathology is of great practical importance. Some forms of anemia pose an immediate threat to life or are inevitably associated with defending children in physical and sometimes mental development. Over the past 10 years in the field of hematology in connection with the introduction of biochemical, immunological, cytological, molecular genetic and physiological methods of research, great progress has been made. Thanks to the creation of a method for cloning hematopoietic cells in the spleen of irradiated mice, chromosome analysis, and bone marrow transplantation, the role of stem cells as a fundamental unit of hematopoiesis has been proven. A major achievement is the fact of establishing a primary lesion of stem cells in aplastic anemia. It has been proven that the cause of hemolytic disease of the newborn can be not only group or Rh incompatibility of the blood of mother and child, but also incompatibility for other erythrocyte antigens. The number of carriers of hemoglobin anomalies and hereditary deficiency of glucose-6-phosphate dehydrogenase in the world is huge. Mutant variants of this enzyme have been identified. Among the Russian population, there are such hereditary anomalies as heterozygous?-thalassemia, hemolytic anemia caused by unstable hemoglobins, deficiencies of G-6-PD enzymes, pyruvate kinase, hexokinase, adenylate kinase, methemoglobinrectase in erythrocytes, etc. new data on the structure of the erythrocyte membrane, their enzymes, the role of membrane lipids and proteins in changing the shape of erythrocytes, mechanisms for eliminating defective erythrocytes. In connection with the foregoing, this topic seems to be very relevant.

Goal of the work- study of the frequency of occurrence of anemia in children and the development of preventive measures to prevent them.

Work tasks:

Consider the theoretical foundations of this topic,

· To study the educational and methodical literature concerning both the diseases themselves and their prevention.

Analyze the incidence of anemia.

· Develop preventive measures for these diseases.

Object of study: children with iron deficiency anemia and B 12 deficiency anemia.

This work consists of three parts. The first part outlines the theoretical foundations for the occurrence of the course and complications of these anemias. The second part analyzes the incidence and the dynamics of its development over the past three years. The third part provides recommendations for the prevention of these diseases.

When writing this work, legal documents in the field of health care, educational and methodological literature were used.

CHAPTER 1. ANEMIA.

In childhood, all variants of anemia can occur or manifest, however, anemia associated with a deficiency of substances necessary for normal hematopoiesis, primarily iron, predominates (up to 90%). At the same time, individual clinical forms of anemia usually develop as a result of various influences and have a complex pathogenesis. In our country, anemia occurs on average in 40% of children under 3 years old, in 1/3 - at puberty, much less often - in other age periods.

This is due to the high intensity of growth of a child in the first years of life and a teenager, accompanied by a proportional increase in the number of formed elements and blood volume and high activity of erythropoiesis.

The entire bone marrow of the child is involved in the process of hematopoiesis, the body constantly requires a large amount of iron, high-grade protein, trace elements, and vitamins.

In this regard, even small violations of feeding, infectious effects, the use of drugs that depress the function of the bone marrow easily lead to anemia in children, especially in the second half of life, when neonatal iron stores are depleted.

Long-term sideration causes deep tissue and organ changes, the development of hypoxia and disorders of cellular metabolism.

In the presence of anemia, the growth of the child slows down, its harmonious development is disturbed, intercurrent diseases are more often observed, foci of chronic infection are formed, and the course of other pathological processes is aggravated.

1.1. Iron-deficiency anemia1.1.1. Etiology

The cause of iron deficiency is its imbalance in the direction of the predominance of iron expenditure over intake, observed in various physiological conditions or diseases.

Increased consumption of iron, causing the development of hyposiderosis, is most often associated with blood loss or with its increased use in certain physiological conditions (pregnancy, a period of rapid growth). In adults, iron deficiency develops, as a rule, due to blood loss. Most often, constant small blood loss and chronic occult bleeding (5-10 ml / day) lead to a negative iron balance. Sometimes iron deficiency can develop after a single massive loss of blood that exceeds the iron stores in the body, as well as due to repeated significant bleeding, after which the iron stores do not have time to recover.

Various types of blood loss, leading to the development of posthemorrhagic iron deficiency anemia, are distributed in frequency as follows: uterine bleeding is in the first place, then bleeding from the digestive canal. Rarely, siderhoea can develop after repeated nasal, pulmonary, renal, traumatic bleeding, bleeding after tooth extraction, and other types of blood loss. In some cases, iron deficiency, especially in women, can be caused by frequent blood donations from donors, therapeutic bloodletting for hypertension and erythremia.

There are iron deficiency anemias that develop as a result of bleeding into closed cavities with no subsequent iron recycling (hemosiderosis of the lungs, ectopic endometriosis, glomic tumors).

According to statistics, 20-30% of women of childbearing age have a latent iron deficiency, 8-10% have iron deficiency anemia. The main cause of hyposiderosis in women, in addition to pregnancy, is abnormal menstruation and uterine bleeding. Polymenorrhea can be the cause of a decrease in iron stores in the body and the development of latent iron deficiency, and then iron deficiency anemia. Uterine bleeding to the greatest extent increase the volume of blood loss in women and contribute to the occurrence of iron deficiency. There is an opinion that uterine fibroids, even in the absence of menstrual bleeding, can lead to the development of iron deficiency. But more often the cause of anemia in fibroids is increased blood loss.

The second place in frequency among the factors causing the development of posthemorrhagic iron deficiency anemia is occupied by blood loss from the digestive canal, which is often hidden and difficult to diagnose. In men, this is generally the main cause of sideritis. Such blood loss may be due to diseases of the digestive system and diseases of other organs.

Iron imbalances can accompany repeated acute erosive or hemorrhagic esophagitis and gastritis, peptic ulcer of the stomach and duodenum with repeated bleeding, chronic infectious and inflammatory diseases of the alimentary canal. With giant giertrophic gastritis (Menetrier's disease) and polyposis gastritis, the mucous membrane is easily vulnerable and often bleeds. A common cause of latent blood loss that is difficult to diagnose is a hernia of the alimentary opening of the diaphragm, varicose veins of the esophagus and rectum with portal hypertension, hemorrhoids, diverticula of the esophagus, stomach, intestines, Meckel duct, tumors. Pulmonary bleeding is a rare cause of iron deficiency. Bleeding from the kidneys and urinary tract can sometimes lead to the development of iron deficiency. Very often accompanied by hematuria giᴨȇrnefroma.

In some cases, blood loss of various localization, which is the cause of iron deficiency anemia, is associated with hematological diseases (coagulopathy, thrombocytosis and thrombocytopathy), as well as vascular damage in vasculitis, collagenoses, Rendu-Weber-Osler disease, hematomas.

Sometimes iron deficiency anemia due to blood loss develops in newborns and infants. Children are much more sensitive to blood loss than adults. In newborns, blood loss may be due to bleeding observed during placenta previa, its damage during cesarean section. Other hard-to-diagnose causes of blood loss in the neonatal period and infancy: bleeding from the alimentary canal in infectious diseases of the intestines, intussusception, from Meckel's diverticulum. (C) Information published on the website
Much less often, iron deficiency can occur when it is insufficiently supplied to the body.

Iron deficiency of alimentary origin can develop in children and adults with insufficient content in the diet, which is observed with chronic malnutrition and starvation, with limited nutrition for therapeutic purposes, with monotonous food with a predominant content of fats and sugars. In children, there may be insufficient intake of iron from the mother's body as a result of iron deficiency anemia during pregnancy, premature birth, with multiple pregnancies and prematurity, premature tying of the umbilical cord until the pulsation stops.

For a long time, the absence of hydrochloric acid in gastric juice was considered the main reason for the development of iron deficiency. Accordingly, gastrogenic or achlorhydric iron deficiency anemia was isolated. At present, it has been established that achilia can only have an additional significance in the violation of iron absorption in conditions of an increased need for it by the body. Atrophic gastritis with achilia occurs due to iron deficiency due to a decrease in enzyme activity and cellular respiration in the gastric mucosa.

Inflammatory, cicatricial or atrophic processes in the small intestine, resection of the small intestine can lead to impaired absorption of iron.

There are a number of physiological conditions in which the need for iron increases dramatically.

These include pregnancy and lactation, as well as periods of increased growth in children. During pregnancy, iron consumption rises sharply to meet the needs of the fetus and placenta, blood loss during childbirth and lactation.

The balance of iron in this period is on the verge of deficiency, and various factors that reduce the intake or increase the consumption of iron can lead to the development of iron deficiency anemia.

There are two periods in a child's life when there is an increased need for iron.

The first period is the first - the second year of life, when the child is growing rapidly.

The second period is the period of puberty, when the body develops rapidly again, girls have an additional consumption of iron due to menstrual bleeding.

Iron deficiency anemia sometimes, especially in infancy and old age, develops with infectious and inflammatory diseases, burns, tumors, due to a violation of iron metabolism while maintaining its total amount.

1.1.2. Pathogenesis

Iron deficiency anemia is associated with the physiological role of iron in the body and its participation in the processes of tissue respiration. It is part of the heme - a compound capable of reversibly binding oxygen. Heme is the prosthetic part of the hemoglobin and myoglobin molecule, which binds oxygen, which is necessary for contractile processes in muscles. In addition, heme is an integral part of tissue oxidative enzymes - cytochromes, catalase and ᴨȇroxidase. In the deposition of iron in the body, ferritin and hemosiderin are of primary importance. Transport of iron in the body is carried out by the protein transferrin (siderophilin).

The body can regulate the intake of iron from food only to a small extent and does not control its consumption. With a negative balance of iron metabolism, iron is first consumed from the depot (latent iron deficiency), then tissue iron deficiency occurs, manifested by a violation of enzymatic activity and respiratory function in tissues, and iron deficiency anemia develops only later.

1.1.3. Clinic

Iron deficiency states depend on the degree of iron deficiency and the rate of its development and include signs of anemia and tissue iron deficiency (siderosis). The phenomena of tissue iron deficiency are absent only in some iron deficiency anemias caused by a violation of iron utilization, when the depots are filled with iron. So, iron deficiency anemia in its course goes through two periods: the period of latent iron deficiency and the period of overt anemia caused by iron deficiency. In the period of latent iron deficiency, many subjective complaints and clinical signs appear that are characteristic of iron deficiency anemia, only less pronounced. Patients report general weakness, malaise, decreased performance. Already in this period, a perversion of taste, dryness and tingling of the tongue, a violation of swallowing with a sensation of a foreign body in the throat (Plummer-Vinson syndrome), palpitations, and shortness of breath can be observed.

An objective examination of patients reveals "small symptoms of iron deficiency": atrophy of the papillae of the tongue, cheilitis ("jam"), dry skin and hair, brittle nails, burning and itching of the vulva. All these signs of violation of the trophism of epithelial tissues are associated with tissue sideration and hypoxia.

Hidden iron deficiency may be the only sign of iron deficiency. Such cases include mild sideritis, developing over a long period of time in women of mature age due to repeated pregnancies, childbirth and abortions, in women - donors, in people of both sexes in a period of increased growth.

In most patients with continued iron deficiency, after the exhaustion of its tissue reserves, iron deficiency anemia develops, which is a sign of severe iron deficiency in the body.

Changes in the function of various organs and systems in iron deficiency anemia are not so much a consequence of anemia, but of tissue iron deficiency. The proof of this is the discrepancy between the severity of the clinical manifestations of the disease and the degree of anemia and their appearance already in the stage of latent iron deficiency.

Patients with iron deficiency anemia note general weakness, fatigue, difficulty concentrating, and sometimes drowsiness. Headache appears after fatigue, dizziness. With severe anemia, fainting is possible. These complaints, as a rule, do not depend on the degree of anemia, but on the duration of the disease and the age of the patients.

Iron deficiency anemia is characterized by changes in the skin, nails, and hair. The skin is usually pale, sometimes with a slight greenish tint (chlorosis) and with an easy blush of the cheeks, it becomes dry, flabby, flaky, cracks easily. Hair loses its luster, becomes gray, thinner, breaks easily, thins and turns gray early. Nail changes are significant: they become thin, matte, flatten, easily exfoliate and break, striation appears. With pronounced changes, the nails acquire a concave, spoon-shaped shape (koilonychia).

In patients with iron deficiency anemia, muscle weakness occurs, which is not observed in other types of anemia. It is attributed to the manifestations of tissue siderome. Atrophic changes occur in the mucous membranes of the digestive canal, respiratory organs, and genital organs. Damage to the mucous membrane of the digestive canal is a typical sign of iron deficiency conditions. In this regard, a misconception has arisen that the primary link in the pathogenesis of iron deficiency anemia is the defeat of the stomach with the subsequent development of iron deficiency.

In most patients with iron deficiency anemia, the appetite decreases. There is a need for sour, spicy, salty foods. In more severe cases, there are perversions of smell, taste (pica chlorotica): eating chalk, lime, raw cereals, pogophagy (an attraction to eating ice). Signs of tissue sideration quickly disappear after taking iron supplements.

In 25% of cases, glossitis and changes in the oral cavity are observed. In patients, taste sensations decrease, tingling, burning and a feeling of fullness in the tongue, especially its tip, appear. On examination, atrophic changes in the mucous membrane of the tongue are found, sometimes cracks at the tip and along the edges, in more severe cases, areas of redness of irregular shape ("geographic tongue") and aphthous changes. The atrophic process also captures the mucous membrane of the lips and oral cavity. There are cracks in the lips and seizures in the corners of the mouth (cheilosis), changes in tooth enamel.

It is characterized by sidereal dysphagia syndrome (Plummer-Vinson syndrome), which is manifested by difficulty in swallowing dry and dense food, a feeling of nausea and a feeling of having a foreign body in the throat. Some patients due to these manifestations take only liquid food. There are signs of a change in the function of the stomach: belching, feeling of heaviness in the abdomen after eating, nausea. They are due to the presence of atrophic gastritis and achylia, which are determined by morphological (gastrobiopsy of the mucous membrane) and functional (gastric secretion) studies. This disease occurs as a result of sideritis, and then progresses to the development of atrophic forms.

In patients with iron deficiency anemia, shortness of breath, palpitations, chest pain, and swelling are constantly observed. The expansion of the boundaries of cardiac dullness to the left, anemic systolic murmur at the apex and pulmonary artery, "top noise" at the jugular vein, tachycardia and hypotension are determined. The ECG shows changes that indicate the phase of repolarization. Iron deficiency anemia in severe cases in elderly patients can cause cardiovascular insufficiency.

A manifestation of iron deficiency is sometimes fever, the temperature usually does not exceed 37.5 ° C and disappears after iron treatment. Iron deficiency anemia has a chronic course with periodic exacerbations and remissions. In the absence of proper pathogenetic therapy, remissions are incomplete and are accompanied by permanent tissue iron deficiency.

1.1.4. Treatment

It includes the elimination of the causes that caused the disease, the organization of the correct daily routine and a rational balanced diet, the normalization of the secretion of the gastrointestinal tract, as well as the medicinal replenishment of the existing iron deficiency and the use of agents that contribute to its elimination. The mode is active, with sufficient exposure to fresh air. Young children are prescribed massage and gymnastics, older children - moderate sports, with the aim of improving the absorption of food products, stimulating metabolic processes.

The diet is shown depending on the severity of anemia: with mild and moderate anemia and satisfactory appetite - a varied, age-appropriate diet with the inclusion in the diet of foods rich in iron, protein, vitamins, microelements. In the first half of the year - an earlier introduction of grated apple, vegetable puree, egg yolk, oatmeal and buckwheat porridge, in the second - meat souffle, puree from ᴨȇcheni. You can use homogenized canned vegetables (puree) by adding meat products. In severe anemia, usually accompanied by anorexia and dystrophy, the threshold of food tolerance is first determined by prescribing gradually increasing amounts of breast milk or mixtures. Insufficient volume is replenished with juices, vegetable broths, in older children - with mineral water. Upon reaching the proper daily volume of food, its qualitative composition is gradually changed, enriching it with the substances necessary for hematopoiesis. Limit cereal products and cow's milk, since when they are consumed, insoluble phytates and iron phosphates are formed.

Pathogenetic therapy is carried out with iron drugs (ferroceron, resoferon, conferon, aktiferrin, ferroplex, orferon) and vitamins. Iron is most often prescribed orally in the form of ferrous salts, mainly ferrous sulfate, which is absorbed and absorbed most completely. Ferric chloride, lactate, ascorbate, gluconate and iron saccharate are also used. Medicines are made from iron salts in combination with organic substances (amino acids, malic, succinic, ascorbic, citric acids, sodium dioctylsulfosuccinate, etc.), which, in the acidic environment of the stomach, contribute to the formation of easily soluble complex iron compounds - chelates and its more complete absorption . It is recommended to take iron between meals or 1 hour before meals, as some food ingredients may form insoluble compounds with it. Fill preparations with fruit and vegetable juices, citrus juices are especially useful. For young children, the average therapeutic dose is prescribed at the rate of 4-6 mg of elemental iron per 1 kg of weight per day in 3 divided doses. Most of the preparations contain 20% elemental iron, in connection with this, the calculated dose is usually increased by 5 times. The individual dose per course of treatment is calculated in milligrams using the following formula:

Fe\u003d P x (78 - 0.35 xHb),

where P - body weight, kg; Hb - the actual level of hemoglobin in a child, g / l. The course of treatment is usually long, the full dose is prescribed until a stable normal hemoglobin content is reached, and over the next 2 to 4 months (up to 6 months in case of severe anemia of full-term and up to 2 years of life in preterm infants) a prophylactic dose is given (1/2 of the therapeutic dose 1 time per day). day) to accumulate iron in the depot and prevent recurrence of the disease. With poor iron tolerance, treatment begins with small doses, gradually increasing them, changing drugs. The effectiveness of treatment is determined by the increase in hemoglobin by (10 g / l, or 4-6 units per week), a decrease in microcytosis, a reticulocyte crisis on days 7-10 of iron supplementation, an increase in serum iron to 17 μmol / l or more , and the transferrin saturation coefficient - up to 30%. Parenteral iron preparations are prescribed with caution in severe anemia, intolerance to iron preparations when taken orally, peptic ulcer, malabsorption, lack of effect from enteral use, since children may develop hemosiderosis. The course dose is calculated according to the following formulas:

Fe(mg) \u003d (body weight (kg) x) / 20

ANDwhetherFe(mg) \u003d Px (78 - 0.35Hb),

where Fe (µg/l) is the iron content in the patient's serum; Hb - hemoglobin level of reference blood. The maximum daily single dose of parenteral iron preparations for body weight up to 5 kg is 0.5 ml, up to 10 kg - 1 ml, after 1 year - 2 ml, for adults - 4 ml. Iron sucrose is most often used, treatment with ferbitol (iron sorbitol), fercoven (2% iron sucrose with cobalt gluconate in carbohydrate solution) is effective. Iron preparations are administered orally simultaneously with digestive enzymes in order to normalize the acidity of the internal environment and stabilize it. For better assimilation and absorption, hydrochloric acid with ᴨȇpsin pancreatin with calcium, festal is prescribed. In addition, large doses of ascorbic acid and other vitamins in the age dosage inside are shown. Transfusion of whole blood and erythrocyte mass is performed only for vital indications (hemoglobin content below 60 g/l), since it creates the illusion of recovery only for a short time. Recently, it has been shown that blood transfusions suppress the activity of hemoglobin synthesis in normoblasts, and in some cases even cause a reduction in erythropoiesis.

1.2. B 12 deficiency anemia

For the first time, this kind of deficient anemia was described by Addison in 1849, and then in 1872 by Birmer, who called it "progressive critical" (fatal, malignant) anemia. The causes that cause the development of anemia of this type can be divided into two groups:

insufficient intake of vitamin B 12 in the body with food

Violation of the absorption of vitamin B 12 in the body

Megaloblastic anemia occurs when there is insufficient intake of vitamins B12 and / or folic acid. Deficiency of these vitamins leads to a disruption in the synthesis of DNA and RNA in cells, which causes impaired maturation and hemoglobin saturation of erythrocytes. Large cells - megaloblasts - appear in the bone marrow, and large erythrocytes (megalocytes and macrocytes) appear in the rhyme blood. The process of blood destruction prevails over hematopoiesis. Defective erythrocytes are less stable than normal ones and die faster.

1.2.2. Clinic

In the bone marrow, more or less megaloblasts with a diameter of more than (15 microns), as well as megalocaryocytes, are found. Megaloblasts are characterized by desynchronization of the maturation of the nucleus and cytoplasm. The rapid formation of hemoglobin (already in megaloblasts) is combined with a slow differentiation of the nucleus. These changes in erythron cells are combined with impaired differentiation of other myeloid cells: megakaryoblasts, myelocytes, metamyelocytes, stab and segmented leukocytes are also enlarged in size, their nuclei have a more delicate chromatin structure than normal. In the rhyme blood, the number of red blood cells is significantly reduced, sometimes to 0.7 - 0.8 x 10 12 / l. They are large - up to 10 - 12 microns, often oval in shape, without central enlightenment. As a rule, megaloblasts meet. In many erythrocytes, remnants of the nuclear substance (Jolly bodies) and nucleolemms (Cabot rings) are found. Anisocytosis (macro- and megalocytes predominate), poikilocytosis, polychromatophilia, and basophilic puncture of the erythrocyte cytoplasm are characteristic. Erythrocytes are oversaturated with hemoglobin. The color index is usually more than 1.1 - 1.3. However, the total content of hemoglobin in the blood is significantly reduced due to a significant decrease in the number of red blood cells. The number of reticulocytes is usually reduced, less often - normal. As a rule, leukemia (due to neutrophils) is observed, combined with the presence of polysegmented giant neutrophils, as well as thrombocytosis. In connection with the increased hemolysis of erythrocytes (mainly in the bone marrow), bilirubinemia develops. In 12 - deficiency anemia is usually accompanied by other signs of beriberi: changes in the gastrointestinal tract due to the violation of division (in this case, signs of atypical mitosis are revealed) and maturation of cells (the presence of megalocytes), especially in the mucous membrane. There is glossitis, the formation of a "polished" tongue (due to atrophy of its papillae); stomatitis; gastroenterocolitis, which aggravates the course of anemia due to impaired absorption of vitamin B 12; a neurological syndrome that develops as a result of changes in neurons. These deviations are mainly the result of a violation of the metabolism of higher fatty acids. The latter is due to the fact that another metabolically active form of vitamin B12 - 5 - deoxyadenosylcobalamin (in addition to methylcobalamin) regulates the synthesis of fatty acids, catalyzing the formation of succinic acid from methylmalonic acid. Deficiency of 5-deoxyadenosylcobalamin causes a violation of myelin formation, has a direct damaging effect on the neurons of the brain and spinal cord (especially its posterior and lateral columns), which is manifested by mental disorders (delusions, hallucinations), signs of funicular myelosis (staggering gait, paresthesia, pain, limb numbness, etc. ).

This type of megaloblastic anemia is a violation of the formation of compounds involved in the biosynthesis of DNA, in particular thymidine phosphate, uridine phosphate, orotic acid. As a result, the structure of DNA and the information contained in it on the synthesis of polypeptides are violated, which leads to the transformation of the normoblastic type of erythropoiesis into megaloblastic. The manifestations of these anemias are for the most part the same as in vitamin B12 - deficiency anemia.

The development of megaloblastic anemia is possible not only due to a deficiency of vitamin B 12 and (or) folic acid, but also as a result of a violation of the synthesis of purine or pyrimidine bases necessary for the synthesis of nucleic acids. The cause of these anemias is usually an inherited (usually recessive) disorder of the activity of enzymes necessary for the synthesis of folic, orotic, adenylic, guanylic, and possibly some other acids.

1.2.3. Pathogenesis

A lack of vitamin B 12 in the body of any origin causes a violation of the synthesis of nucleic acids in erythrokaryocytes, as well as the metabolism of fatty acids in them and cells of other tissues. Vitamin B 12 has two coenzyme forms: methylcobalamin and 5 - deoxyadenosylcobalamin. Methylcobalamin is involved in ensuring normal, erythroblastic, hematopoiesis. Tetrahydrofolic acid, formed with the participation of methylcobalamin, is necessary for the synthesis of 5, 10 - methyltetrahydrofolic acid (a coenzymatic form of folic acid), which is involved in the formation of thymidine phosphate. The latter is included in the DNA of erythrokaryocytes and other rapidly dividing cells. The lack of thymidine phosphate, combined with a violation of the inclusion of uridine and orotic acid in DNA, causes a violation of the synthesis and structure of DNA, which leads to a breakdown in the processes of division and maturation of erythrocytes. They increase in size (megaloblasts and megalocytes), and therefore resemble erythrokaryocytes and megalocytes in the embryo. However, this similarity is only superficial. The erythrocytes of the embryo fully provide the oxygen transport function. Erythrocytes, on the other hand, formed in conditions of vitamin B 12 deficiency, are the result of pathological megaloblastic erythropoiesis. They are characterized by low mitotic activity and low resistance, short life span. Most of them (up to 50%, normally about 20%) are destroyed in the bone marrow. In this regard, the number of erythrocytes in the rhyme blood also significantly decreases.

1.2.4. Treatment

A complex of therapeutic measures for B 12 - deficiency anemia should be carried out taking into account the etiology, severity of anemia and the presence of neurological disorders. When treating, you should focus on the following provisions:

An indispensable condition for the treatment of B 12 - deficiency anemia with helminthic invasion is deworming (to expel a wide tapeworm, fenasal is prescribed according to a certain scheme or male fern extract).

In case of organic bowel diseases and diarrhea, enzyme preparations (panzinorm, festal, pancreatin) should be used, as well as fixing agents (calcium carbonate in combination with dermatol).

Normalization of the intestinal flora is achieved by taking enzyme preparations (panzinorm, festal, pancreatin), as well as by choosing a diet that helps to eliminate the syndromes of putrefactive or fermentative dyspsia.

· A balanced diet with a sufficient content of vitamins, protein, an unconditional prohibition of alcohol is an indispensable condition for the treatment of B 12 and folic deficiency anemia.

Pathogenetic therapy is carried out using parenteral administration of vitamin B12 (cyanocobalamin), as well as normalization of altered central hemodynamic parameters and neutralization of antibodies to gastromucoprotein ("intrinsic factor") or gastromucoprotein + vitamin B12 complex (corticosteroid therapy).

Blood transfusions are carried out only with a significant decrease in hemoglobin and the manifestation of symptoms of a coma. It is recommended to enter erythrocyte mass in 250 - 300 ml (5 - 6 transfusions).

CHAPTER 2. Analysis of the number of anemia in children of primary and secondary school age.

In the period from 2005 to 2007, 53 cases of anemia were registered in children of primary and secondary school age in the city of Kasimov and the Kasimov district.

Table 1

Statistical data on the incidence of anemia in Kasimov and Kasimov district among children for 2005-2007

Diagram 1

table 2

The ratio of the incidence of iron deficiency B12-deficiency anemia among children in 2005-2007.

Diagram 2

The ratio of the incidence of iron deficiency and B 12 deficiency anemia among children in 2005-2007.

From this material it is clearly seen that the incidence of anemia in children of primary and secondary school age is growing every year. This is due to the lack of awareness of parents about the proper rational nutrition of the child and their late treatment in medical institutions, as well as unfavorable conditions of both the environment and the social environment. The data also show that despite the increase in the incidence of iron deficiency anemia, the incidence rate is higher than that of B 12 deficiency anemia, this is due to the environmental characteristics of the area in which the population lives.

CHAPTER 3 3.1. Prevention and dispensary observation for iron deficiency anemia

Primary prevention consists in the use of products containing a lot of iron (meat, ᴨȇchen, cheeses, cottage cheese, buckwheat and wheat groats, wheat bran, soybeans, egg yolk, dried apricots, prunes, dried rose hips). It is carried out among people at risk (for example, those who have had oᴨȇrations on the gastrointestinal tract, with malabsorption syndrome, regular donors, pregnant women, women with polymenorrhea).

Secondary prevention indicated after completion of a course of treatment for iron deficiency anemia. After the normalization of the Hb content (especially with poor tolerance of iron preparations), the therapeutic dose is reduced to prophylactic (30-60 mg of ionized ferrous iron per day). With continued loss of iron (for example, heavy menstruation, constant donation of erythrocytes), prophylactic administration of iron preparations is carried out for 6 months or more after the normalization of the level of Hb in the blood. Monitoring of the Hb content in the blood is carried out monthly for 6 months after the normalization of the Hb level and serum iron concentration. Then control tests are carried out once a year (in the absence of clinical signs of anemia).

Prevention of iron deficiency anemia comes down to good nutrition with the consumption of animal proteins, meat, fish, control of possible diseases, which is mentioned above. An indicator of the well-being of the state is the cause of iron deficiency anemia: for the rich, it is post-hemorrhagic in nature, and for the poor, it is alimentary.

3.2. Dispensary observation of B 12 deficiency anemia

Dispensary supervision - lifelong. Supportive therapy (prevention of relapses) is carried out under the control of the level of Hb and the content of erythrocytes, for this purpose cyanocobalamin is used in courses of 25 injections 1 time per year (during remission) throughout life. Once every six months, an endoscopic examination of the stomach with a biopsy is required to exclude stomach cancer.

An important role in the prevention of anemia is played by proper rational nutrition of the child. The paramedic should explain to the parents of the child what foods should be given to him at his age, that the composition of the products must include iron, since a lack of iron leads to the development of anemia. The paramedic should conduct sanitary and educational work on the prevention of anemia. If anemia is suspected, the paramedic should refer the child to a ᴨȇdiatrist so that he can begin timely treatment of anemia. So, in addition to sanitary and educational work, early diagnosis of the disease plays a huge role.

CONCLUSION

Anemia (anemia) - a decrease in the number of red blood cells and (or) a decrease in hemoglobin content per unit volume of blood. Anemia can be both an independent disease and a syndrome that accompanies the course of another pathological process.

With anemia, not only quantitative, but also qualitative changes in erythrocytes are observed: their size (anisocytosis), shape (poikilocytosis), color (hypo- and hyrchromia, polychromatophilia).

The classification of anemia is difficult. It is based on the distribution of anemia into three groups according to the causes and mechanisms of the development of the disease: anemia due to blood loss (posthemorrhagic anemia); anemia due to violations of the formation of hemoglobin or hematopoietic processes; anemia caused by increased breakdown of red blood cells in the body (hemolytic).

From the statistical data it is clearly seen that the incidence of anemia in children of primary and secondary school age is growing every year. This is due to the lack of awareness of parents about the proper rational nutrition of the child and their late treatment in medical institutions, as well as unfavorable conditions of both the environment and the social environment. The data also show that despite the increase in the incidence of iron deficiency anemia, the incidence rate is higher than that of B 12 deficiency anemia, this is due to the environmental characteristics of the area in which the population lives.

The role of the paramedic is to carry out sanitary and educational work on the prevention of anemia in children. If anemia is suspected, the paramedic should refer the child to a ᴨȇdiatrist so that he can begin timely treatment of anemia. So, in addition to sanitary and educational work, early diagnosis of the disease plays a huge role.

REFERENCES

1. Anemia in children: diagnosis and treatment. A practical guide for doctors / Ed. A. G. Rumyantseva, Yu. N. Tokareva. M: MAKS-Press, 2000.

2. Volkova S. Anemia and other blood diseases. Prevention and methods of treatment. Publisher: Tsentrpoligraf. 2005 - 162 p.

3. Gogin E. Patient management protocol. "Iron-deficiency anemia". Publisher: Newdiamed. 2005 - 76 p.

4. Ivanov V. Iron deficiency anemia in pregnancy. Tutorial. Ed. N-L. 2002 - 16 p.

5. Kazyukova T.V., Kalashnikova G.V., Fallukh A. et al. New possibilities of ferrotherapy for iron deficiency anemia// Clinical pharmacology and therapy. 2000. No. 9 (2). pp. 88-92.

6. Kalinicheva V. N. Anemia in children. M.: Medicine, 1983.

7. Kalmanova V.P. Indicators of erythropoietic activity and iron metabolism in hemolytic disease of the fetus and newborn and intrauterine transfusions of erythrocytes: Dis ... cand. honey. Sciences. M., 2000.

8. Korovina N. A., Zaplatnikov A. L., Zakharova I. N. Iron deficiency anemia in children. M., 1999.

9. Miroshnikova K. Anemia. Treatment with folk remedies. Publisher: FEIX. 2007 - 256 p.

10. Mikhailova G. Diseases of children from 7 to 17 years old. Gastritis, anemia, influenza, appendicitis, vegetovascular dystonia, neurosis, etc. Ed.: VES. 2005 - 128 p.

11. Ellard K. Anemia. Causes and treatment. Publisher: Norint. 2002 - 64 p.

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discipline

SBEI SPO "Krasnodar Regional Basic Medical College" of the Ministry of Health of the Krasnodar Territory

Cycle Commission "Medicine"

GRADUATE WORK

ON THE TOPIC: "Research of the role of a paramedic in the early diagnosis, treatment and prevention of gallstone disease in a polyclinic"

Students Lezhneva Tatyana Vladimirovna

Specialty "Medicine"

Krasnodar 2015

ANNOTATION

INTRODUCTION

CHAPTER 1. GALLSTONE DISEASE AS ONE OF THE COMMON DISEASES OF THE DIGESTIVE ORGANS

2 Etiology and pathogenesis

3 Risk factors for gallstone disease

4 Clinical picture

4.1 Physico-chemical stage of gallstone disease

4.2 Latent stage of the disease

4.3 Clinically pronounced stage of gallstone disease

5 Diagnostics

6 Treatment

7 Complications of gallstone disease

8 Prevention of the development of the disease

CONCLUSIONS ON CHAPTER 1

CHAPTER 2

1. Early diagnosis of cholelithiasis at the prehospital stage

2 Paramedic emergency care at the prehospital stage

3 Analysis of the incidence of cholelithiasis based on the Dinskaya CRP

3.1 Statistical data on the village of Dinskaya for 2014

3.2 Identification of the frequency of occurrence of cholelithiasis among patients of the Dinskaya CRP

4 Patient survey

5 The activities of the paramedic for the prevention of cholelithiasis in the conditions of the Dinskaya CRP

CONCLUSIONS ON CHAPTER 2

GENERAL CONCLUSIONS

CONCLUSION

BIBLIOGRAPHY

APPENDIX №1

APPENDIX №2

APPENDIX No. 3

ANNOTATION

In the thesis work, a study was made of the role of a paramedic in the early diagnosis, treatment and prevention of gallstone disease in a polyclinic. In the available literature, there is not enough information that reveals the variety of relationships between biochemical changes, clinical, psycho-emotional changes in the human body in diseases of the biliary system, and approaches are not sufficiently developed and ways to correct the developed imbalance are not sufficiently developed. In this regard, the optimization of diagnostics and therapeutic and preventive measures in the activities of a paramedic in people of different ages with biliary pathology is important and necessary. This determined the relevance of the study.

The hypothesis of the study was the assumption that the high-quality sanitary and educational work carried out by the paramedic and preventive measures at the outpatient stage will lead to an increase in the knowledge of patients at risk about this pathology, which, in turn, improves the quality of life and the psycho-emotional status of patients.

The structure of the thesis consists of an introduction, two chapters, conclusions by chapters, a general conclusion, a conclusion, a list of references and an appendix. The total volume of the thesis was 75 pages of typewritten text, including applications. The work contains 6 figures, 3 tables. The list of used literature includes 25 titles.

INTRODUCTION

Currently, diseases of the gallbladder and biliary tract are an acute problem for modern medicine, and occupies one of the leading places among all diseases of the gastrointestinal tract. Therefore, the introduction of educational programs is an urgent issue.

Early diagnosis and treatment of pathologies of the hepatobiliary system is of great clinical importance due to the transformation of functional disorders of the biliary system into organic pathology. It develops due to a violation of the colloidal stability of bile and the addition of an inflammatory process.

In Russia, the incidence of gallstone disease is at the level of the European average (about 10%), however, it has been established that in the second half of the 20th century, the frequency of detection of stones in the gallbladder among the population of the country doubled every decade. Over the age of 60, almost every second person experiences excruciating attacks of biliary colic, and women are especially affected.

Cholelithiasis belongs to those diseases whose frequency is decreasing with the development of medical science and improvement of well-being. In recent decades, throughout the world, despite certain successes associated with the appearance on the market of new effective pharmacological agents for the correction of functional disorders of the digestive system, there has been a clear upward trend in the incidence of the biliary system.

And it is connected with the fact that there is a sharp decline in the quality of nutrition, people lead a sedentary lifestyle, many have bad habits.

Modern methods of treatment of gallstone disease, if used on time, can achieve complete recovery in 85-95% of cases. The overall mortality after all such operations is 0.5-0.8% and, as a rule, in cases with the development of complications that increase the severity of the operation itself, especially among the elderly.

For high-quality medical care, it is necessary to ensure the continuity of the diagnostic and treatment process at all stages of treatment. Here, a clear division of functions at each stage of medical care becomes important. The activity of a paramedic is an important link in the health care system in our country. To confirm this statement, I want to consider the activities of a paramedic in the early diagnosis, treatment and prevention of diseases, using the example of cholelithiasis in a polyclinic.

In the available literature, there is not enough information that reveals the variety of relationships between biochemical changes, clinical, psycho-emotional changes in the human body in diseases of the biliary system, and approaches are not sufficiently developed and ways to correct the developed imbalance are not sufficiently developed.

In this regard, the optimization of diagnostics and therapeutic and preventive measures in the activities of a paramedic in people of different ages with biliary pathology is important and necessary. .

An acute problem in clinical gastroenterology are diseases of the hepatobiliary system, which tend to grow. Literature data indicate an annual increase in the number of patients with diseases of the hepatobiliary system by 15-30%. In this regard, the problem of diseases of the liver and biliary tract is becoming increasingly relevant.

Field of study: activity of a paramedic in a polyclinic.

Object of study: professional activity of a paramedic in cholelithiasis.

Subject of study: statistical data of the Central District Hospital of the village of Dinskaya; outpatient cards; survey results.

Hypothesis: high-quality sanitary and educational work carried out by the paramedic and preventive measures at the outpatient stage will lead to an increase in the knowledge of patients at risk about this pathology, which, in turn, improves the quality of life and the psycho-emotional status of patients.

The purpose of the study: to analyze the impact of preventive measures of the activity of a paramedic on the effectiveness of early diagnosis, treatment and prevention of this disease in a polyclinic.

Perform an analysis of the literature on the research topic; to identify risk factors that provoke the development of gallstone disease.

To expand and deepen the knowledge of patients on the features of the course of gallstone disease;

To conduct a study among patients of the Dinskaya CRP with pathology of the hepatobiliary system;

Develop a questionnaire and conduct a survey among identified patients with cholelithiasis; perform analysis of the obtained results;

Develop a memo for patients with cholelithiasis and sanitation to expand knowledge about this disease.

Research methods:

scientific and theoretical analysis of medical literature on this topic;

sociological (questionnaire, conversation);

empirical (observation, additional research methods);

statistical (calculation of percentages).

Practical significance: in the course of the study, knowledge of bile -stone disease. The significance of the influence of the activity of a paramedic in early diagnosis, on the effectiveness of treatment and prevention of gallstone disease in a polyclinic has been confirmed. The results of the study can be used in the educational process of preparing students in the specialty "Medicine" when studying PM.02.01. "Treatment of therapeutic and geriatric patients".

CHAPTER 1. GALLSTONE DISEASE AS ONE OF THE COMMON AND SEVERE DIGESTIVE DISEASES

1 Gallstone disease. Concept. Classification

biliary disease paramedic medical

Gallstone disease (syn. calculous cholecystitis) is a chronic metabolic disease of the hepatobiliary system, characterized by the formation of gallstones in the gallbladder (cholecystolithiasis, chronic calculous cholecystitis), in the common bile duct (choledocholithiasis), in the hepatic bile ducts (intrahepatic cholelithiasis).

Classification of gallstone disease

The modern concept of gallstone disease distinguishes the following forms of the disease:

Symptomatic cholelithiasis is a condition accompanied by the occurrence of biliary colic. Biliary colic is intense or severe pain in the epigastrium or right hypochondrium, lasting about 30 minutes. Biliary colic may be accompanied by nausea, vomiting, and headache.

Asymptomatic gallstone disease is a form of the disease that does not cause biliary colic.

Gallbladder stones may also be present in the common bile duct rather than in the gallbladder itself. This condition is called choledocholithiasis.

Secondary stones of the common bile duct. In most cases, common bile duct stones initially form in the gallbladder and travel into the common bile duct. Therefore, they are called secondary stones. Secondary choledocholithiasis occurs in about 10% of patients with gallstones.

Primary stones of the common bile duct. Less commonly, stones form in the common bile duct itself (called primary stones). They tend to be of the brown pigmented type and are more likely to cause infection than secondary gallstones.

Acalculous disease of the gallbladder. This condition is called acalculous gallbladder disease. In this condition, the person has symptoms of gallstones, but there is no evidence of stones in the gallbladder itself or the biliary tract. It can be acute or chronic. Acute acalculous gallbladder disease usually occurs in patients with comorbidities. In these cases, inflammation occurs in the gallbladder. This inflammation usually results from a decrease in blood supply or an inability of the gallbladder to contract properly and clear its bile.

Chronic acalculous disease of the gallbladder, also called biliary dyskinesia, which is caused by muscle defects, interferes with the natural contractions needed to release bile.

Classification of gallstones and the mechanism of their formation

Two main substances are involved in the formation of gallstones: cholesterol and calcium bilirubinate.

Cholesterol gallstones.

More than 80% of gallstones contain cholesterol as the main component. Liver cells secrete cholesterol into bile, as well as phospholipids (lecithin) in the form of small spherical membrane vesicles called unilamellar vesicles. Liver cells also secrete bile salts, which are powerful agents needed for the digestion and absorption of dietary fats. Bile salts in bile dissolve unilamellar vesicles, forming soluble aggregates called mixed micelles. This occurs mainly in the gallbladder, where bile is concentrated to absorb electrolytes and water.

Compared to bubbles (which can hold up to 1 cholesterol molecule for every lecithin molecule), mixed micelles have a lower cholesterol carrying capacity (about 1 cholesterol molecule for every 3 lecithin molecules). If bile contains a relatively high percentage of cholesterol in the blood to begin with, then as the concentration of bile increases, the progressive dissolution of the vesicles can lead to a condition in which cholesterol accumulates due to reduced micelle permeability and residual vesicles. As a result, bile is supersaturated with cholesterol, and the formation of cholesterol monohydrate crystals begins.

Thus, the main factors that determine the formation of cholesterol gallstones are:

the amount of cholesterol secreted by liver cells in relation to lecithin and bile salts. The liver produces too much cholesterol in bile.

The degree of concentration and degree of stagnation of bile in the gallbladder.

The gallbladder is unable to contract normally, so the bile stagnates. The cells lining the gallbladder are unable to effectively absorb cholesterol and fat from bile.

Calcium, bilirubin and pigment gallstones.

Bilirubin is a substance normally formed from the breakdown of hemoglobin in red blood cells. It is excreted from the body with bile. Most bilirubin is found in bile in the form of glucuronide conjugates (direct bilirubin), which are quite water-soluble and stable, but a small part consists of indirect bilirubin. Free bilirubin, such as fatty acids, phosphates, carbonates, and other anions, tends to form insoluble precipitates with calcium. Calcium enters bile passively along with other electrolytes.

The calcium bilirubinate can then crystallize out of solution and eventually form stones. Over time, various oxidations cause a change in the color of the bilirubin deposits, the stones become pitch black. These stones are called black pigment gallstones. Black pigment stones represent 10-20% of all gallstones. They are more likely to develop in people with hemolytic anemia, an anemia in which red blood cells are destroyed at an abnormally high rate.

Bile is usually sterile, but in some unusual circumstances it can become colonized by bacteria. Bacteria hydrolyze bilirubin, and as a result of an increase in indirect bilirubin, calcium bilirubinate crystals can precipitate. Bacteria can also hydrolyze lecithin to release fatty acids, which can also bind calcium that precipitates out of bile solution. As a result, the stones have a clay-like consistency and are called brown pigment stones. Unlike cholesterol or black pigmented gallstones, which form almost exclusively in the gallbladder, brown pigmented gallstones often form deposits in the bile ducts. They contain more cholesterol and calcium than black pigment stones. Infection plays an important role in the development of these stones.

Brown pigment stones are more common in Asian countries.

Mixed gallstones.

Mixed stones are a mixture of pigment and cholesterol stones. Cholesterol gallstones can become infected with bacteria, which in turn can cause inflammation of the lining of the gallbladder. As a result, over time, cholesterol stones can accumulate a significant amount of calcium bilirubinate, enzymes from bacteria and leukocytes, fatty acids and other salts, forming mixed gallstones. Large stones may develop with a calcium rim on a shell-like surface, and may be visible on conventional x-ray films.

Clinical features of the forms of cholelithiasis depending on the localization of the stone. .

Cholecystolithiasis (stone in the gallbladder). Clinical symptoms are fully consistent with the above. The most characteristic of the severe form of the disease is pain syndrome (biliary colic).

) Biliary colic is a consequence of spastic contractions of the muscles of the gallbladder, aimed at pushing the stone into the cystic and further into the common bile duct. Sometimes the stone actually comes out of the gallbladder and can be detected by careful examination of the feces. However, most often, after the elimination of spasm in the vesicocervical region (spontaneously or under the influence of antispasmodics), the stone slips back into the so-called "silent" zone (the body of the gallbladder). After stopping the attack, vomiting stops, body temperature returns to normal, pain gradually disappears. However, for several days, general weakness, weakness, poor appetite, non-intense dull pain in the right hypochondrium of a permanent nature may persist. In some patients, an enlarged gallbladder can be felt during an attack. However, this is most often observed during the period of remission of the disease with obstruction of the cystic duct by a stone (hydrocele of the gallbladder develops). In this case, the remnants of bile are absorbed, the cavity of the bladder is filled with a mucus-like liquid, the gallbladder is palpated in the form of a painful tumor-like smooth formation, which, with a deep breath, can move down along with the liver. The lower pole of the enlarged gallbladder is mobile and shifts inward and outward. Hydrocele of the gallbladder may disappear on its own if the stone manages to exit the cystic duct into the ductuscholedochus or return back to the gallbladder and, therefore, the outflow of bile will be restored. However, often the gallbladder shrinks, its cavity disappears (“disabled gallbladder”). One should also be aware of the atypical equivalents of biliary colic. These include: periodic pain in the right shoulder, under the right shoulder blade, in the right elbow joint and forearm, in the epigastrium (in this case, pain in the epigastric region is combined with dyspeptic symptoms - nausea, belching, heartburn and mimic "gastric disease"). In all cases of atypical equivalents, pain in the projection of the gallbladder is little pronounced or even completely absent.

) Choledocholithiasis (a stone in the common bile duct). According to Gloucal (1967), stones in the common bile duct are observed in 10-25% of patients with cholecystolithiasis. In most cases, stones enter the common bile duct from the gallbladder. This is facilitated by the presence of infection and obstruction of the outflow of bile into the duodenum 12. Autochthonous calculi consist of calcium bilirubinate, have a brownish tint and, as a rule, are located in the distal segment of the common bile duct. Quite often, there is an accumulation of putty-like masses and calcium bilirubinate crystals (in the form of grains), while the common bile duct and intrahepatic bile ducts are dilated. The clinical picture of choledocholithiasis depends on the location of the stone in the common bile duct. A stone in the supraduodenal segment of the ductuscholedochus may not be clinically manifested due to the absence of obstruction and bile stasis, especially if the common bile duct is dilated. Infringement of the stone in the final distal segment of the common bile duct causes significant clinical manifestations.

There are the following clinical forms of choledocholithiasis:

) latent,

) dyspeptic,

) clinically expressed (fully developed),

) cholangitis.

The latent form of choledocholithiasis is characterized by an almost complete absence of complaints, only occasionally there are dull pains in the right hypochondrium.

Dyspeptic form. With this form, dyspeptic manifestations come to the fore in the clinical picture - nausea, belching, bitterness and dryness in the mouth, loss of appetite. Perhaps a feeling of pressing pain, and sometimes short-term attacks of acute pain in the right hypochondrium, which may be due to transient infringement of the stone in the peri-papillary region. In this case, short-term jaundice is observed. Spasm and swelling of the mucous membrane of the common bile duct are quickly eliminated, pain and jaundice disappear.

Latent and dyspeptic forms of choledocholithiasis are of great clinical importance, since the mild symptoms of the disease do not attract close attention of patients and doctors, and meanwhile, due to chronic stagnation of bile and infection in the biliary tract, significant liver damage is gradually formed.

The clinically pronounced (fully developed form) is characterized by Villar's triad (biliary colic, fever, jaundice), as well as an enlarged liver.

Gallbladder colic is a consequence of spastic contractions of the muscles of the gallbladder, aimed at pushing the stone into the cystic and further into the common bile duct. The pains are paroxysmal, very pronounced, intense, localized in the right hypochondrium, radiating to the right and to the back. When the stone is localized in the region of the papilla of Vater, pain is felt in the region of the XI thoracic vertebra, and when the stone is infringed in the papilla, in the left epigastric region. Very often, pain in choledocholithiasis is accompanied by nausea and vomiting.

Fever in choledocholithiasis usually indicates the development of cholangitis and is usually accompanied by chills. With a sudden and complete blockage of the choledochus, there is no infection and the body temperature is normal.

Jaundice is the most important clinical sign of choledocholithiasis. It is mechanical in nature and appears due to obstruction of the common bile duct. Jaundice usually appears 12-24 hours after the onset of pain and may last from several hours or days to several weeks. In this case, jaundice is accompanied by skin itching, urine becomes dark in color, contains bilirubin and does not contain urobilin. The chair is aholic. At first, jaundice has a copper tint, and with prolonged existence it acquires a greenish tint. With choledocholithiasis, jaundice is observed in 50% of patients, blockage of the common bile duct is not always complete. Persistent complete obturation of the common choledochus is observed only in 8-10% of patients (with infringement of a stone in the ampulla above the papilla of Vater). In the elderly, complete obstructive jaundice with choledocholithiasis can develop gradually, and there is no pronounced pain syndrome in the preicteric period. In this case, a thorough differential diagnosis should be carried out with cancer of the pancreatic head or tumor metastases to regional lymph nodes that compress the ductus choledochus.

In some cases, there may be a valve stone in the common bile duct, which can periodically change its position, opening an outlet for bile into the duodenum. In this regard, jaundice disappears after a few days, but later reappears.

) The cholangitis form is characterized by the development of cholangitis and has the following symptoms:

body temperature is elevated, often to high numbers, accompanied by chills; it should be noted that with choledocholithiasis, the infection and, therefore, cholangitis develops with incomplete or intermittent blockage of the common bile duct (in this case, conditions are created for the penetration of infection from the intestine in an ascending way);

fever is accompanied by jaundice with typical manifestations of a mechanical (subhepatic) type; jaundice is intermittent. In some patients, jaundice is absent or mild (subicterus);

skin itching is observed;

pain in the right hypochondrium is usually not intense, due to the gradual stretching of the common bile duct;

characterized by an increase in the liver, with prolonged existence of cholestasis, it becomes dense;

often there is an increase in the spleen;

with incomplete but prolonged obstruction of the common bile duct and repeated episodes of cholangitis, secondary biliary cirrhosis may form.

2 Etiology and pathogenesis

This is a polyetiological disease: only the interaction of various factors contributes to the formation of stones. The inflammatory process in the wall of the gallbladder can be caused not only by a microorganism, but also by a certain composition of food, allergological and autoimmune processes. At the same time, the integumentary epithelium is rebuilt into goblet and mucous membranes, which produce a large amount of mucus, the cylindrical epithelium flattens, microvilli are lost, and absorption processes are disrupted. In the niches of the mucosa, water and electrolytes are absorbed, and colloidal solutions of mucus turn into a gel. Lumps of the gel, when the bladder contracts, slip out of the niches and stick together, forming the beginnings of gallstones. Then the stones grow and impregnate the center with pigment.

The focus is on infection. Pathogenic microorganisms can enter the bladder in three ways: hematogenous, lymphogenous, enterogenic. More often, the following organisms are found in the gallbladder: E. coli, Staphilococcus, Streptococcus.

The second reason for the development of the inflammatory process in the gallbladder is a violation of the outflow of bile and its stagnation. In this case, mechanical factors play a role - the kinks of the elongated and tortuous cystic duct, its narrowing. Against the background of cholelithiasis, according to statistics, up to 85-90% of cases of acute cholecystitis occur. If sclerosis or atrophy develops in the wall of the bladder, the contractile and drainage functions of the gallbladder suffer, which leads to a more severe course of cholecystitis with deep morphological disorders.

The development of gallstone disease is also promoted by hypovitaminosis, including endogenous and exogenous origin, as well as a hereditary factor. The main factors leading to the development of cholelithiasis are inflammation of the biliary tract (chronic cholecystitis, cholangitis, inflammation of the common cystic and common bile ducts), metabolic disorders and bile stasis. An important role is played by metabolic disorders, primarily bilirubin and cholesterol - both components of bile, which are poorly soluble in water and are retained in solution under the influence of the emulsifying action of bile acids. When the normal concentration of cholesterol or bilirubin in the bile is exceeded, conditions are created for the formation of stones. Cholesterol metabolism disorders and hypercholesterolemia are observed in obesity, diabetes mellitus, atherosclerosis, hyperlipoproteinemias IIA, IIB, III, IV types, gout.

Congenital hemolytic anemia (hereditary microspherocytosis) contributes to hyperbilirubinemia and the formation of pigment stones. Of great importance is the violation of rational nutrition - excessive consumption of fat-rich foods. The development of gallstone disease is promoted by hypovitaminosis A of exogenous and endogenous origin, as well as a hereditary factor.

According to A. M. Nogaller, the following predispose to the development of gallstone disease:

pregnancy (in 77.5% of all sick women),

irregular meals (53.4% of all patients),

sedentary lifestyle (48.5%),

overweight (37.8%),

heredity burdened with metabolic diseases (32.1%),

previous typhoid fever or salmonellosis (31.396),

malaria (20.8%),

viral hepatitis (6.5%),

rich in fats or overnutrition (20%),

Of great importance is the chronic violation of duodenal patency (HNDP). With CNDP, a high degree of duodenal hypertension develops, under these conditions, due to excessive obstruction of the outflow of bile from the gallbladder, cholestasis develops, and then stones form.

Also, stones in the gallbladder are formed due to precipitation and crystallization of the main components of bile. This process is facilitated by dyscholia (changes in the composition of bile), inflammation, stagnation of bile. Most often, stones form in the gallbladder, less often - in the bile and hepatic ducts and intrahepatic bile ducts.

Modern ideas about the mechanism of formation of gallstones are as follows:

) oversaturation of bile with cholesterol;

) activation of lipid peroxidation processes in it;

) a decrease in the content of protein substances in bile; shift of the reaction of bile to the acid side);

) a sharp decrease or complete absence of the lipid complex in bile. This complex provides colloidal stability of bile, preventing the crystallization of cholesterol and the formation of stones. The composition of the lipid complex includes bile salts, phospholipids and cholesterol, electrolytes;

) under the influence of initiating factors (food imbalance, allergies, autoantibodies, microflora), inflammation develops and mucus containing glycoprotein is secreted by the wall of the gallbladder;

) in lumps of mucus, cholesterol is deposited, which is facilitated by the appearance of positively charged mucoid and protein substances in bile;

) the merging and growth of lumps leads to the formation of cholesterol gallstones, and subsequent recrystallization processes are accompanied by the formation of micro- and then macrocracks, through which pigments enter the stone, forming its core. The inner layers of the stone increase by an average of 0.2 cm3, and the outer layers by 0.9 cm3 per year, the growth rate is 2.6 mm per year (N. Mok, 1986).

1.3 Risk factors for gallstone disease

genetic predisposition. Up to one-third of gallstone cases may be due to genetic factors. A mutation in the ABCG8 gene significantly increases the risk of gallstones. This gene controls the level of cholesterol carried from the liver to the bile duct. This mutation can lead to a high rate of cholesterol transfer. Defects in the transport of proteins involved in bile lipid secretion predispose some people to gallstone disease, but this by itself is not sufficient for gallstone formation. Research suggests that disease is complex and may result from interactions between genetics and the environment.

Racial affiliation. Gallstones are associated with diet, especially fat intake. The incidence of gallstone disease varies between countries and regions. For example, Hispanics and Northern Europeans have a higher risk for gallstones than those of Asian and African ancestry. People of Asian descent suffer from brown pigment stones.

Floor. The ratio of women to men is 2-3 women to 1 man. Women have an increased risk because estrogen stimulates the liver to remove cholesterol from the blood and send it to bile. Estrogen also raises levels of triglycerides, substances that increase the risk of developing cholesterol stones. Therefore, replacement therapy can also contribute to stone formation.

Pregnancy. During pregnancy, the risk of developing gallstones increases. Surgery should be delayed until after the baby is born, if possible. If surgery is urgently needed, laparoscopy is the safest approach.

Age. Gallstone disease in children is relatively rare. When gallstones occur in this age group, they are more likely to be pigment stones. Patients over 60 years of age and those who have had multiple bowel surgeries (particularly in the small and large intestine) are at particularly high risk.

Obesity and drastic weight changes. Being overweight is a significant risk factor for the development of gallstones. The liver produces supersaturated cholesterol, which enters the bile and settles in the form of cholesterol crystals. Rapid weight loss, diets, stimulate a further increase in the production of cholesterol in the liver, which leads to its supersaturation and increases the risk of gallstones by 12% after 8 -16 weeks of a restricted diet and a risk of more than 30% within 12 - 18 months after surgery gastric bypass. The risk of gallstone disease is highest with the following diets and weight fluctuations:

Loss of more than 24% of your weight. More than 1.5 kg per week.

Diets low in fat, low calorie diets.

Diabetes. People with diabetes have a higher risk of developing gallstones. Gallbladder disease may progress more rapidly in diabetic patients, who are already usually complicated by infections.

Long-term intravenous nutrition. Long-term intravenous nutrition reduces the flow of bile and increases the risk of gallstones. Approximately 40% of patients on intravenous nutrition develop gallstones.

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Figure #1. Separation of men and women by types of labor activity.

Results.

The examined patients underwent ultrasound of the abdominal organs, regardless of subjective data (the presence of complaints or their absence) and a number of standard studies (complete blood count, urine; biochemical blood test). Cholecystoliasis was diagnosed in 22 people, 21 studied had acute cholecystitis, and the remaining 47 people were diagnosed with dyskinesia.

Figure No. 2. The result of the examination of 90 patients with pathology of the hepatobiliary system

If we divide the 90 patients studied by gender, then gallbladder stones were detected in 15 out of 42 women, which is 35% and in 7 out of 48 men, which is 14%.

Figure No. 3. The incidence of cholelithiasis in the examined women among all diseases of the hepatobiliary system

Figure No. 4. The incidence of cholelithiasis in the examined men among all diseases of the hepatobiliary system

I have carried out the diagnosis of the ratio of "men-women" in different age categories: at the age of 21-30 years 1:0.8; at 31-40 - 1:1.7; at 41-50 years old - 1: 2.5; at the age of 51-60 years 1:3.3.

Table No. 1. Diagnostics of the ratios of the incidence of cholelithiasis between "men - women", in different age groups

Age Male-Female Ratio21-30 years 1:0.831-40 years 1:1.741-50 years 1:2.551-60 years 1:3.3 Average 1:2

Single gallbladder calculi were identified in 4 (19%) of 22 identified patients (1 female and 3 male). Multiple cholecystolithiasis was observed in the remaining 18 subjects (15 women and 3 men).

Figure No. 5. Percentage of diagnosed single and multiple calculi.

Figure No. 6. The absolute index of multiple and single cholecystolithiasis in men and women

The incidence of cholelithiasis in patients engaged in physical and mental labor. Out of 6 patients involved in physical labor activity: 4 women (67%) and 2 men (33%), and out of 16 people involved in mental activity, 12 women (87.5%) and 4 men (12.5%).

Table No. 2 The number of identified patients with cholelithiasis by type of their activity

data fieldIntellectual laborPhysical laborTotal Number of detectedPercent of detectedTotal Number of detectedPercent of detectedfemale 16 1275% 6 4 67%male 425% 2 33%

3 Questioning patients

To test knowledge about this pathology and assess the health education of the paramedic in the Dinskaya polyclinic, I developed a questionnaire (see Appendix No. 1) and conducted a survey among 22 patients with cholelithiasis (15 women and 7 men). The questionnaire included 18 questions.

Table No. 3. The results of the survey.

Answer options Question numberCorrectDon't know the answerIncorrect119 86%2 9%1 5%217 73%3 14%2 9%321 95%1 5%-415 68%-7 32%516 73%4 18%2 9%615 68% 5 22%2 10%722 100%--821 95%1 5%-918 82%- 4 18%1020 90%-2 10%1117 77%4 18%1 5%1222 100%--1322 100%- -1415 68%2 10%5 22%1515 68%3 14%4 18%1622 100%--1718 82%4 18%-1822 100%--Total320 81%43 11%30 8%

Of the 393 answers, 320 were correct, which is 81% of the total. Based on the results of the survey, it can be said that the interviewed patients are highly aware of cholelithiasis and the work of the paramedic of the Dinskaya CRP is good.

4. The activities of the paramedic for the prevention of gallstone disease in the conditions of the Dinskaya CRP

Due to the high proportion of gallstone disease in the structure of the disease and the large number of asymptomatic carriage, the main activity of the paramedic is, first of all, early diagnosis and prevention of development, especially in people with risk factors. If this pathology is suspected, timely appointment of additional methods diagnostics, for accurate diagnosis (OAC; BHC, ultrasound; radiography; oral cholecystography; cholegraphy; ERCP; hepatobiliary scintigraphy; computed tomography of the gallbladder; MRI).

For patients, for clarity, I developed handouts, booklets and a memo to increase the knowledge of the population of the village of Dinskaya about this pathology (see Appendix No. 2) (see Appendix No. 3).

The booklet on "Cholelithiasis" presents risk factors and measures to correct them.

Gallstone disease (GSD) is a disease caused by the formation and presence of stones (calculi) in the gallbladder and

bile ducts. The proportion of cholelithiasis in the overall structure of diseases of the digestive system is constantly growing. Every year, 1 million patients with cholelithiasis are diagnosed in the world.

Risk factors for the development of cholelithiasis: 1. Gallstone disease is more common in women. 2. Irregular meals. The risk group includes people who skip breakfast, lunch, or dinner. (too long intervals between meals (especially at night, when the digestive tract "rests" for more than 12 hours) lead to stagnation of bile in the gallbladder and its ducts. And stagnation of bile is one of the reasons that provoke stone formation). A sedentary lifestyle also contributes to congestion in the gallbladder and its ducts, which leads to a decrease in the contractile function of the gallbladder. 4. Pregnancy. The lumen of the duct during pregnancy is narrowed for all 9 months. Which also leads to stagnant processes and stone formation.

Prevention measures are disclosed: 1. A complete, balanced diet 4-6 times a day. It is necessary to eat according to the therapeutic diet "TABLE No. 5". You should exclude from your diet: smoked meats, sausages and irritating seasonings. Animal fats should be replaced with vegetable fats, with a limit on their quantity. 2. Timely intake of enzyme preparations. 3. Lead a healthy, active lifestyle (do gymnastics, swimming, hiking). 4. Don't do herbal medicine on your own. Cholagogue fees are like a whip for a diseased organ: they constantly irritate, spur the liver and gallbladder. If they are taken, then only as directed by a doctor.

Measures for controlling the state of the gallbladder are disclosed. It is enough to regularly undergo a medical examination once a year, where the therapist or gastroenterologist will prescribe the necessary examination for you.

Chapter 2 Conclusions

In the practical part of the work, an analysis of the incidence of gallstone disease according to Art. Dinskaya for 2013-2014, a questionnaire was developed and a survey was conducted among identified patients with cholelithiasis, and booklets were developed with information on the prevention of gallstone disease for the population living in st. Dinskaya. From this it emerged:

Analysis of the dynamics of the incidence of gallstone disease according to Art. Dinskaya for 2013-2014 showed an increase in the number of patients by 4%.

According to the analysis of the results of the study, it was established:

cholelithiasis more often affects women, with the exception of the age interval from 21 to 30 years;

the number of women with multiple calculi prevails over the number of men;

in men, multiple and single stones in the gallbladder and its ducts occur with the same frequency.

people engaged in mental work are more likely to develop this disease;

in women, among all diseases of the hepatobiliary system, cholelithiasis was detected in 35% of cases; among men, this figure is 14%.

According to the analysis of the conducted survey, it was revealed:

the percentage of correct answers is 81%;

high knowledge of patients about their disease;

high quality of preventive paramedical work in the village of Dinskaya with registered people.

GENERAL CONCLUSIONS

In order to achieve an increase in knowledge about gallstone disease, in the first chapter, I conducted a theoretical analysis of the medical literature on this topic in full. In the second chapter, I developed a questionnaire and conducted a survey in patients with gallstone disease. From what it follows:

Gallstone disease is one of the most common diseases of the gastrointestinal tract. Literature data indicate that in Russia the incidence of gallstone disease is at the level of the European average (about 10%), however, it was found that in the second half of the twentieth century, the frequency of detection of stones in the gallbladder among the population of the country doubled every decade. Over the age of 60, almost every second person experiences excruciating attacks of biliary colic, and women are especially affected, indicating a high percentage of patients in all countries. Up to 20% of the adult population suffers from this disease throughout their lives.

This disease has a high tendency to increase the population of Art. Dinskaya. A comparative analysis of the incidence of gallstone disease for the period from 2013 to 2014 showed that the rate increased by 4%.

The basis for the prevention of gallstone disease is, first of all, taking into account risk factors and their constant correction. Risk factors for the development of peptic ulcer include: hereditary predisposition; irrational and not regular nutrition (fatty, too hot food); low physical activity; the presence of bad habits (smoking, alcohol addiction). Corrective measures include: developing eating habits, eating quality foods, giving up bad habits, increasing the level of physical activity.

CONCLUSION

During the work, the theoretical aspects of gallstone disease were investigated, a questionnaire was developed, and a survey of patients was completed.

The hypothesis was confirmed that high-quality sanitary and educational work and preventive measures carried out by the paramedic at the outpatient stage will lead to an increase in the knowledge of patients at risk about this pathology, which, in turn, will improve the quality of life and the psycho-emotional status of patients.

The purpose and objectives of the study were fulfilled.

The result of my thesis work was the compilation of leaflets for patients on the topic: "Diet for patients with cholelithiasis."

The results of the study can be used in the educational process of the college when students of the specialty "Medicine" study professional modules in accordance with the training program.

BIBLIOGRAPHY

1.Abasov I.T., Iof I.M., Gidayatov A.A. The prevalence of diseases of the biliary tract // Soviet health care, 1983. - No. 1. P. 22-26.

Baranovsky A.Yu. Diseases of the upper gastrointestinal tract in the elderly and senile age // New St. Petersburg Medical Gazette. -1999. No. 2. - S. 29-35.

Batskov S.S. Ultrasonic research method in gastroenterology. -SPb., 1995.-S. 183.

Batskov S.S., Gordienko A.V., Tkachenko E.I. Cholelithiasis. Therapeutic aspects, problems. SPb., 1996. - S. 26.

Batskov S.S., Inozemtsev S.A., Tkachenko E.I. Diseases of the gallbladder and pancreas. St. Petersburg: Stroylespechat, 1996. - P. 95.

Belashkin I.I. Clinic and diagnosis of cholelithiasis 1988.

Boger M.M., Mordvov S.A. Ultrasonic diagnostics in gastroenterology. Novosibirsk: Nauka, 1988.-S. 159.

Bulatov A.N., Chernyakhovskaya N.E., Erokhin P.G., Rozikov Yu.N. X-ray semiotics of cholelithiasis with direct contrasting of the biliary tract // Vesti radiology. - 1982. -№ 5.-S. 36-39.

Burkov S.G., Grebnev A.JI. Risk factors for the development of gallstone disease. Statistical data // Klin.med. 1994. - No. 3. - S. 5962.

Velikoretsky A.N. Cholelithiasis and cholecystitis (etiology, pathogenesis and classification) // Paramedic and midwife. 1979. - No. 4. - S. 16-11. Vetshev P.S., Shkrob O.S., Beltsevich D.G. Cholelithiasis. -M.: "Medical newspaper", 1998. S. 159.

Vinogradov V.V., Lapikin K.V., Bragin F.A. Direct ante- and retrograde cholangiography in the diagnosis of biliary obstruction. ways//Surgery. 1983.-№8.-S. 121-125.

Vorotyntsev A. S. Modern ideas about the diagnosis and treatment of gallstone disease and chronic calculous cholecystitis

Grigoriev K. I. Perfilyev G. M. "Nurse" 2 2011

Ilchenko A.A. classification of gallstone disease // Expir. and clinical gastroenterology.- 2010.-№1.-131s

Maev I.V. Cholelithiasis / I.V. Maev.- M.- GOU VUNMTS MOH and RF, 2009

As a Manuscript Podolskaya M.N. Professional Role of a Paramedic in Modern Russia, 2009.

Marakhovsky Yu. Kh. Cholelithiasis, 2003.

Sherlock I. Diseases of the liver and biliary tract, 1999.

APPENDIX №1

) What is gallstone disease?

A) is inflammation. gallbladder .

B) This is the formation of stones (calculi) in the gallbladder , bile ducts.

C) This is a violation of the motility of the biliary tract.

) Is surgical treatment always indicated for cholelithiasis?

C) I don't know.

) Can heredity influence the formation of gallstones?

C) I don't know.

) To prevent the development of gallstone disease, how many servings should you divide your daily diet into?

C) Arrange fasting days (hunger strikes) 1-2 times a month.

) Is it possible to periodically use choleretic drugs to prevent the formation of stones in the gallbladder?

C) I don't know.

) Complaints about heaviness in the epigastric region after eating, bloating, sometimes belching, can it indicate a latent form of cholelithiasis?

C) I don't know.

) Do you know what tubazh is?

) Is it useful to carry out tubage in case of cholelithiasis?

C) I don't know.

) What is preferable to use on the area of the projection of the gallbladder in pain syndrome of gallstone disease?

B) acupuncture.

Who is more likely to develop gallstone disease?

A) women.

B) men.

C) I don't know.

) Can gallstones not cause pain?

C) I don't know.

) Is it possible to detect stones in the gallbladder and its ducts only by computer or magnetic resonance imaging?

C) I don't know.

) Can the pain radiate ("irradiate") to the back on the right?

C) I don't know.

) Can the pain syndrome in cholelithiasis radiate behind the sternum and mimic an attack of angina pectoris?

C) I don't know.

) Name the symptoms that are not related to gallstone disease.

A) pain in the right hypochondrium, bitterness in the mouth, nausea;

B) belching, heartburn, flatulence;

C) vomiting, jaundice (rarely);

D) back pain, pain when urinating, pain in the groin.

) Is it possible to stop an attack of gallstone colic by taking analgesics with antispasmodics?

C) I don't know.

) Is it necessary to go to the clinic in case of acute pain in the right hypochondrium?

C) I don't know.

APPENDIX №2

REMINDER FOR THE PATIENT

DIET FOR PATIENTS

with gallstone disease

Diet number 5

SPECIAL PURPOSE. Contribute to the normalization of impaired functions of the biliary tract, stimulate bile secretion and intestinal motility.

GENERAL CHARACTERISTICS. A diet full of energy value with an optimal content of proteins, fats and carbohydrates, with the exception of foods rich in purines, cholesterol, oxalic acid, essential oils, fat oxidation products (acroleins, aldehydes) formed during the frying process. The diet is enriched with lipotropic substances (choline, methionine, lecithin) and contains a significant amount of fiber and fluid.

Energy value 10 467-12 142 kJ (2500-2900 kcal).

Chemical composition, g: proteins - 90-100 (60% of animals), fats - 80-100 (30% of vegetable), carbohydrates - 350-400 (70-90 g of sugar), sodium chloride - 10; free liquid - 1.8-2.5 liters.

DIET. Food is taken 5 times a day in a warm form.

RECOMMENDED AND EXCLUDED FOOD AND DISHES BREAD AND FLOUR PRODUCTS. Recommended: wheat and rye bread, baked yesterday or dried. Uncooked dough products. Excluded: fresh bread, fried, pastry products, cream cakes. MEAT AND POULTRY. Recommended: low-fat varieties of poultry meat (beef, rabbit, chickens, turkeys); in boiled, baked form with preliminary boiling, a piece or chopped, low-fat ham, doctor's and dietary sausages. Excluded: fatty meat products (goose, duck, game, brains, liver, kidneys, canned food, smoked meats), fried foods. FISH. Recommended: low-fat types of fish; in boiled or baked spinach, turnips, garlic, mushrooms, pickled vegetables. DAIRY AND FERROUS MILK PRODUCTS. Recommended: milk, kefir, curdled milk, sour cream as a seasoning for dishes, cottage cheese and dishes from it (pudding, casserole, lazy dumplings), mild cheese. non-acid varieties, compotes, kissels, jelly, mousses from them, snowballs, meringues. Excluded: cream. SAUCES AND SPICES. Recommended: dairy, sour cream, vegetable, fruit and berry sauces. Parsley, dill, cinnamon, vanillin. Excluded: spicy sauces, on meat and fish broth, mushroom broth; forbidden pepper, mustard, horseradish. form with pre-boiling, jellied fish (on vegetable broth), stuffed. Excluded: fatty smoked, salted types of fish products; canned food. FATS. Recommended: butter in its natural form and vegetable oil: sunflower, olive, corn. Excluded: ghee; pork, beef, lamb fat, margarine. GRAINS. Recommended: a full range of cereals (especially oatmeal and buckwheat) in the form of cereals, baked puddings with the addition of cottage cheese, carrots, dried fruits, pilaf with vegetables or fruits. VEGETABLES. Recommended: raw, boiled, stewed and baked; onions only after boiling, non-sour sauerkraut is also allowed. Excluded: radish, radish, sorrel, SOUPS. Recommended: dairy, on a vegetable broth with cereals, vermicelli, noodles, fruit, borscht and vegetarian cabbage soup. Flour and vegetables for dressing are not fried. Excluded: soups on meat and fish broth, mushroom soup, green cabbage soup, okroshka. FRUITS, BERRIES. BEVERAGES. Recommended: tea with lemon, coffee with milk, vegetable, fruit and berry juices, rosehip broth. Excluded: coffee, cocoa, cold drinks. Recommended: fruits and berries Excluded: sour fruits.

APPENDIX No. 3

"Your health is in your hands!"

CHOLELITHIASIS

Risk factors

prevention

SAY NO JCB!!

Cholelithiasis

(GSD) - a disease caused by the formation and presence of stones (calculi) in the gallbladder and

bile ducts. Every year, 1 million patients with cholelithiasis are diagnosed in the world. Operations on the gallbladder

occupy the 2nd place in frequency after removal of the appendix.

The proportion of cholelithiasis in the overall structure of diseases of the digestive system is constantly growing.

Risk factors for the development of cholelithiasis:

Gallstone disease is more common in women.

Irregular meals. The risk group includes people who skip breakfast, lunch, or dinner. (too long intervals between meals (especially at night, when the digestive tract

“rests” for more than 12 hours) lead to stagnation of bile in the gallbladder and its ducts. And stagnation of bile is one of the reasons that provoke stone formation)

A sedentary lifestyle also contributes to congestion in the gallbladder and its ducts, which leads to a decrease in the contractile function of the gallbladder.

Pregnancy. The lumen of the duct during pregnancy is narrowed for all 9 months. Which also leads to stagnant processes and stone formation.

Prevention.

A complete, balanced diet 4-6 times a day. It is necessary to eat according to the therapeutic diet "TABLE No. 5".

Exclude: smoked meats, sausages and irritating seasonings. Animal fats should be replaced with vegetable fats, with a limit on their quantity.

Timely intake of enzyme preparations.

Lead a healthy, active lifestyle (do gymnastics, swimming, hiking).

Cholagogue fees are like a whip for a diseased organ: they constantly irritate, spur the liver and gallbladder. If they are taken, then only as directed by a doctor.

Control of the gallbladder.

To do this, it is enough to regularly undergo DISPANSERIZATION once a year, where the therapist or gastroenterologist will prescribe the necessary examination for you.

"DO PREVENTION TODAY TO BE HEALTHY TOMORROW"