How are acute gastrointestinal diseases treated?

Hospitalization is required for children with severe and complicated forms of disease, children of the first year of life, children with an unfavorable premorbid background, as well as ineffectiveness of outpatient treatment.

Mode. It is necessary to provide the child with thermal comfort, hygienic content, access to fresh air. Important isolation and compliance with sanitary epidemics in intestinal infections.

To conduct rehydration therapy, organize an individual post.

Diet. It is proved that even in severe forms of the disease, up to 70% of the absorptive capacity of the intestine is retained, and hungry diets slow down the repair process, significantly weaken the defenses of the organism and lead to the child's dystrophy. Restrictions in nutrition are allowed for a short time in the acute period of the disease. The child on natural feeding continues to be fed with breast milk, for 2-3 days canceling the lures. Children on artificial feeding with mild forms of acute gastrointestinal diseases reduce daily nutritional intake by 15-20% (by appetite), children older than a year are prescribed food with mechanical exclusion (table 4 "wiped") and inject additional dairy products 2 times a day . The normal volume of food is restored in 3-4 days.

For moderate and severe forms of the disease, it is recommended to reduce the amount of food to 50% and increase the frequency of feeding up to 7-8 times a day, with the restoration of the food volume after 5-7 days. Children who are mixed and formula-fed are given the usual formula for them, but preference should be given to adapted fermented milk mixtures (NAS, fermented milk, Agusha, Adalact). Children older than a year can be given dairy products, in which as a starter they use representatives of normal microflora - lactobacillus (actimel, vitalact, biolact) or bifidobacterin (bifilin, bifid, active). Children older than a year in the early days of the disease need to eat the mashed food (boiled rice, soups, puree from vegetables) with the restriction of fat and the addition of steamed meat and fish from the 3rd to 4th day.

In severe forms of acute gastrointestinal diseases (especially with dysentery and salmonellosis), a protein deficit may already occur in the acute period of the disease. These children are prescribed adapted mixtures enriched with protein, orally administered amino acid preparations (alvezin, aminone, levamine) at a rate of 10 ml / kg / day for 5-6 receptions during feeding.

In viral diarrhea with signs of lactase insufficiency (anxiety during feeding, regurgitation, flatulence, copious foamy stool with a sour smell), it is recommended to restrict or abolish milk formulas and the appointment of low-lactose or dairy-free soy mixtures. In the presence of breast milk, partial replacement (not more than 1/3) of low-lactose and lactose-free mixtures is permissible.

When the amount of food is limited in all cases, the child must be dosed to an age level with neutral solutions (water, tea, compote, carotene mixture) in a fraction.

Etiotropic therapy. Etiotropic therapy is prescribed only for bacterial infections of the gastrointestinal tract.

The drugs of choice for mild forms of intestinal infections are specific bacteriophages, biopreparations containing representatives of normal intestinal microflora, and biologics containing laboratory strains of bacteria that inhibit the growth of pathogenic and opportunistic flora.

Bacteriophages:

• staphylococcal;
• dysentery polyvalent;
• salmonella multivalent;
• coliprotein;
• klebsiellezy polyvalent;
• interstitophag (contains phagolysates of Escherichia coli, Shigella, Salmonella);
• Combined bacteriophage (a mixture of staphylococcal, streptococcal, coli, Pseudomonas aeruginosa, Proteus bacteriophage);
• polyvalent pyobacteriophage (a mixture of phagolysates of E. Coli, Klebsiella, Pseudomonas aeruginosa, staphylococci, streptococci, protea).

In case of moderate forms of acute intestinal infections, the following is indicated:

• derivatives of oxyquinoline (chlorinaldol, inte- trix, mexazate, intestopan, nitroxoline);
• nitrofuran preparations (furazolidone, ersefuril, furagin);
• sulfanilamide preparations (phthalazole, sulgin, phtazine);
• preparations of nalidixic acid (blacks, nevi-graham).

Indications for prescribing antibiotics are:

1. Severe forms of the disease.
2. Mikst-infection (viral-bacterial).
3. Presence of concomitant inflammatory foci or complicated course of the disease.

The starting drugs are "inhibitor-protected" penicillins (amoxicillin, amoxiclav, augmentin), aminoglycosides of the first generation (gentamicin, kanamycin), macrolides (midecamycin), levomycetin (with sensitive strains), polymeksins.

The preparations of the reserve are cephalosporins of III-IV generations, aminoglycosides II-III generations, rovamycin, rifampicin, vancomycin, carbenicillin.

After the termination of a course of antibiotics, the appointment of biologics is required to restore normal intestinal microflora.

Biopreparations.

1. Bifid-containing:
   • bifidumbacterin;
   • bifilin;
   • bifinorm.
2. Lactose-containing:
   • lactobacterin;
   • laminolact;
   • bibakton;
   • biofructolact.
3. Acidophilic flora containing:
   • Acipol;
   • acylact;
   • narine;
   • vitaflor.
4. Combined:
   • linex (lactobacterin + bifidobacteria);
   • bifidin (bifidobacteria + E. Coli);
   • primadofilus (bifidobacteria + lactobacterin);
   • bifikol (bifidobacteria + E. Coli);
   • bifacid (bifidobacteria + acidophilus flora).
5. Laboratory strains (do not live in the intestine, suppress the growth of pathogenic and conditionally pathogenic flora):
   • bactyzubtyl;
   • enterol;
   • sporobacterin;
   • biosporin;
   • bactisporin.

Pathogenetic therapy. The basis of pathogenetic therapy is rehydration, restoration of the water-electrolyte balance.

At present, preference is given to oral rehydration. It is effective in all cases of grade I and in 70-80% of cases of second-degree exsicosis.

Rehydration is carried out with salt-balanced preparations. To this end, a number of glucose-saline solutions (regidron, oralite, glucosolan, citroglucosolan, gastrolit) are used that contain, in addition to glucose, sodium and potassium salts in ratios adequate for those with fluid loss with vomiting and diarrhea.

Calculation of the volume of the solution for the I stage of oral rehydration

The patient's weight at hospitalization	Age of the patient	Degree of dehydration
		Easy	Medium gravity
3-4 kg	1-2 months	120-200 ml	300-400 ml
5-6 kg	3-4 months	200-300 ml	500-600 ml
7-8 kg	6-9 months	300-400 ml	700-800 ml
9-10 kg	1-2 year	400-500 ml	900-1000 ml
11-12 kg	2-3 years	450-600 ml	1000-1100 ml

Solutions for the II stage of oral rehydration

Bicarbonate mixture	Citrate mixture
Sodium chloride 3,5	Sodium chloride 3,5
Sodium bicarbonate 2.5	Sodium citrate 2.5
Potassium chloride 1,5	Potassium chloride 1,5
Glucose 20.0	Glucose 20.0
Boiled water 1 liter	Boiled water 1 liter

Oral rehydration is carried out in 2 stages:

1. Primary rehydration is aimed at correcting water-salt deficiency, available at the time of treatment. Calculated for 4-6 hours. The volume of glucose-salt solutions for the first stage is calculated by the mass deficit, depending on the degree of exsicosis: in case of grade I exciseosis - 50 ml / kg of mass, with grade II exciseosis - 60-90 ml / kg of mass.
2. Supportive rehydration is aimed at compensating for the continued loss of water and salts and providing additional fluid demand. It is carried out until the diarrhea syndrome stops and the water-salt balance is restored. For each subsequent 6 hours, enter as much solution as the patient lost for the previous 6 hours from the calculation: for each loss with vomiting or stool to children under 2 years old, 50-100 ml of solution must be drunk, for children over 2 years - 100-200 ml.

To drink it is necessary fractional for 2-3 teaspoons every 3-5 minutes or from a horn, but no more than 100 ml for 20 minutes. If vomiting occurs, the solution is stopped for 5-10 minutes, and then resumed according to the usual method. It is possible to inject the solution through the nose with a gastric probe at 10-20 ml / kg for 1 hour.

Signs of sufficient rehydration: a decrease in the volume of fluid loss, an increase in body weight by 6-7% per day, the normalization of diuresis, the disappearance of clinical signs of dehydration, improvement in the general condition of the child, normalization of the pulse rate and its filling.

It is necessary to examine children during oral rehydration every 3-6 hours.

The need for parenteral rehydration occurs in 5-10% of patients with acute gastrointestinal diseases. Indications for intravenous administration of solutions are:

• excisiousness of the third degree;
• coma;
• indomitable vomiting;
• oliguria (absence of urination more than 8 hours);
• ineffectiveness of oral rehydration.

The volume of fluid for the infusion therapy consists of the following components:

1. Providing the physiological needs of the body in the fluid necessary for normal life.
2. Compensation for the initial deficiency of fluid and electrolytes.
3. Compensation of pathological losses of fluid and electrolytes as a result of ongoing vomiting, diarrhea, dyspnea, hyperthermia - the so-called pathological losses.
4. Correction of violations of CBS and osmolarity.

Detoxification implies the additional administration of fluid inside or parenterally, more often in the volume of age diuresis.

If careful accounting of losses is not carried out, the following scheme can be used: to compensate losses with vomiting and liquid stool, an additional 20-40 ml / kg / day is prescribed; at a dyspnea - on 10 breaths above norm or rate - 10 ml / kg / day, at a hyperthermia - on each degree above 37 With - 10 ml / kg / sut.

Enter 5% or 10% glucose solution, Ringer's solution, for detoxification - hemodez, reopolyglucin (10-15 ml / kg), to restore the volume of circulating blood - polyglucin, polyvinol, gelatin.

All solutions except glucose contain sodium ions and are combined under the name crystalloids.

The ratio of glucose and crystalloids for infusion should correspond to the type of axiocosis:

• water-deficient type of exsicosis - 4 (3) glucose solution: 1 crystalloids;
• salt-deficient type of exsicosis - 1: 1;
• isotonic type of exsicosis - 2: 1.

Volemic solutions are especially indicated in the salt-deficient (hypotonic) type of exsicosis for the recovery of bcc.

A dropper is placed for at least 8-12 hours, prolonged according to the indications after the examination of the child, with the specification of the amount of liquid administered to the needs at the time of the examination.

For all children with acute gastrointestinal disease, as the diet is expanding, the appointment of enzyme preparations containing pancreatic or combination enzymes is indicated .

Enterosorbents are given to children of early age carefully, preference is given to coal or natural sorbents.

Enterosorbents.

Coal:

• Activated carbon;
• carbolong (activated stone);
• vaulen (fibrous carbon sorbent);
• microsorb II.

Polyvalent:

• lignin-polyphepan;
• bilignin;
• lignosorb.

Natural:

• smect;
• rich in pectin vegetables and fruits (carrots, apples, bananas).

The appointment of astringent medicines (decoctions of St. John's wort, co-occurrence of alder, calgary, blueberry) is shown.

In the period of reparation, vitamins, methyluracil, are prescribed; children who have had colitis - enemas with a solution of chamomile, vinyl, sea buckthorn oil, rosehip oil.

Criteria for recovery: persistent normalization of the stool, negative results of feces on the intestinal group of pathogenic bacteria.

The child after an acute gastrointestinal disease is subject to follow-up and must follow the diet for one month.

Prevention (as recommended by WHO)

1. Struggle for natural feeding.
2. Rational nutrition, the correct introduction of new products.
3. Use of clean water.
4. Sanitary and hygienic skills in the family.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10]