Prevention of gastritis and ulcers in adults and children. Methods for preventing gastritis Primary prevention of gastritis

At an appointment with a gastroenterologist

According to statistics from the Ministry of Health, 50–60 percent is observed gastritis in schoolchildren.

The reason is not the food from the school canteen, but the savings of children, the reluctance of parents to spend money on healthy food, and the desire to buy chips and hamburgers. No matter how mom and dad struggle with this problem, solving it is quite difficult and not always possible.

The reason why gastritis occurs in schoolchildren

The main cause of gastritis in schoolchildren is poor nutrition. Unfortunately, the rhythm of school life often violates the rule: eat at least five times a day, because this is the most acceptable pattern.

Another characteristic reason is children’s love for dishes that stimulate the production of gastric juice: sweets, crackers and chips with seasonings, juices from “boxes” that schoolchildren use to satisfy their hunger during recess.

And the main pest is chewing gum. A child’s body is very vulnerable, the immune system is just being formed, so a few weeks on “chips” is quite enough for the development of an inflammatory process or degenerative changes in the mucous membrane, that is, gastritis.

Symptoms of gastritis at school age

The first symptoms of gastritis are:

Proper nutrition

• discomfort in the stomach;
• heartburn;
• increased fatigue;
• exercise intolerance;
• irritability;
• drowsiness;
• loss of appetite;
• bruises under the eyes;
• coating on the tongue is gray, white or yellow.

Therefore, if you notice a complex of these symptoms in a child, you should not delay visiting a doctor. The sooner the examinations are carried out (they are needed, in particular, in order to determine the form of gastritis, since there are three of them) and the treatment prescribed, the less the risk that gastritis will become chronic and complications will appear.

Typically, stomach pain characteristic of gastritis first occurs in the afternoon, for example, after the last lesson. This is the so-called hunger pain, associated, in particular, with the reaction of the affected mucous membrane to an increase in the acidity of gastric juice. Therefore, children notice that the pain subsides if they eat something or simply drink sweet, warm tea.

With chronic gastritis, pain can occur immediately after eating, especially if the food is coarse or sour. Stomach pain can be accompanied by nausea during stress. Moreover, chronic stress itself can lead to the development of gastritis.

In any case, if gastritis in a schoolchild is not treated, it can lead to complications, such as erosion and even stomach ulcers. It is characterized by frequent heartburn, nausea after eating, and acute (stabbing) pain in the stomach. Then there is only one way out - call an ambulance. It is extremely important to follow the correct diet.

If gastritis occurs, a diet is required. To prevent attacks, you need to have breakfast before school. If a healthy child has no appetite in the morning, this means that he had dinner too late or ate too much, the food did not have time to be digested.

Dinner should be no later than 19:00, then the student will have time to get hungry before the morning. And the best breakfast is grain porridge (with butter, milk, fruits or vegetables). Thanks to the combination of proteins, fats and carbohydrates, the child will not feel either hungry or full by lunchtime.

Also, instead of sweet cookies or sweets, the child should be given a brown bread sandwich with cheese and fruit at school. Then the child will not have the desire to run for chips or candy during recess.

Prevention of gastritis involves a whole range of measures to prevent this disease. It includes eliminating the causes and factors contributing to the development of the disease, observing personal hygiene rules, and monitoring the quality of food.

What is gastritis

Gastritis is an inflammation of the gastric mucosa. This is a very common disease. Currently, there are different types of gastritis: with high and low acidity, erosive, allergic, etc.

The disease affects not only the mucous membrane. A number of other changes are taking place in the work of the body. The activity of the glands is disrupted, they cannot produce an adequate amount of juice: there is too much or too little. The secretion may contain an increased or decreased amount of hydrochloric acid. As a result, food absorption deteriorates and the stomach cannot cope with its digestion. Cell regeneration processes are also disrupted.

Why does he appear

To understand how to prevent gastritis from occurring, you first need to understand why it occurs. There are few main causes of inflammation of the gastric mucosa. Basically, they are all associated with poor nutrition or the use of any aggressive drugs or drugs. Thus, acute gastritis most often occurs after food poisoning or long-term use of medications.

The chronic form of the disease develops with constant nutritional disorders: overeating, consumption of low-quality foods, lack of a regimen, etc. In addition, the bacteria Helicobacter pylori can also be the cause.

There are a number of factors that contribute to the development of the disease, but not directly, but indirectly, for example, lack of daily routine, lack of sleep, low or excessive physical activity, smoking, etc.

Gastritis appears only in cases where the stomach is affected by any irritating factors. Therefore, it is necessary to minimize their impact. If the prevention of gastritis is carried out correctly, then the disease will not bother a person.

All prevention measures are divided into public and individual. The gastric mucosa comes into contact with air and ingested foods and drinks. Therefore, it is necessary to ensure that they do not contain certain irritants.

Public prevention

Public prevention measures are carried out at the state level. Authorized organizations monitor various areas of people's lives. Thus, the sanitary and epidemiological service monitors the quality of supplied water in cities, monitors the disinfection of wastewater, and checks food and public catering facilities.

Environmental monitoring laboratories take air samples. Thanks to these measures, it is possible to prevent mass diseases, especially those caused by toxic lesions of the mucous membrane or the spread of infections.

Individual prevention: general rules

But most of the concern for preventing gastritis lies with the person himself. The health of his gastrointestinal tract (GIT) depends entirely on himself. Individual preventive measures include the exclusion of potentially dangerous factors, as well as compliance with certain rules and requirements for hygiene and nutritional culture:

Prevention of acute gastritis

Prevention of acute gastritis is aimed at preventing the primary occurrence of the disease. Therefore, you need to avoid situations that could provoke its occurrence.

Preventive measures are similar to those presented in the paragraph above. They include following a diet, monitoring food quality, excluding irritating foods from the diet, potent medications, etc.

In addition, you need to follow safety precautions when working with chemicals: use personal protective equipment, minimize contact with aggressive substances.

Prevention of chronic gastritis

To avoid exacerbation of chronic gastritis, you must follow several rules:

• maintain a diet;
• adhere to a gentle diet;
• reduce or eliminate smoking and alcohol consumption;
• eliminate helminthic infestations;
• do not eat foods of questionable quality, as well as food that can damage the gastric mucosa;
• avoid occupational hazards: contact with dust, vapors of acids and alkalis, etc.;
• regularly brush your teeth and monitor the condition of the oral cavity, sanitize in a timely manner;
• reduce the use of medications that irritate the stomach;
• promptly treat diseases of the nervous, endocrine and cardiovascular systems.

The main task that the prevention of chronic gastritis must solve is to prevent exacerbations of the disease.

Prevention of gastritis in children

The most difficult thing to avoid is gastritis in children. The child wants to eat something unusual, tasty, interesting. In this case, children, as a rule, do not know the measures, and the ability to resist temptation is not yet fully developed. Therefore, it is the parents who must monitor the diet of their child, compose and think through it. There are several rules that must be followed:

If a child develops an acute illness for the first time, you need to consult a doctor promptly. With proper and timely treatment, gastritis will not become chronic.

Folk remedies

Some folk remedies can be an excellent prevention option.

For example, you can prepare a decoction of strawberry leaves. It soothes the stomach and stabilizes the production of gastric juice. Chamomile tea has a similar effect.

Other herbal infusions and teas will also help to avoid the onset of the disease. But you should avoid alcohol tinctures, since alcohol has an aggressive effect on the mucous membrane.

Currently, it is possible to treat gastritis at any stage. However, the more advanced the disease, the more difficult it is to fight it. Therefore, it is easier to engage in prevention and think about your health in a timely manner.

Unfortunately, today's children are becoming victims of the food industry. Fast food, chips, crackers and carbonated drinks are becoming common food for preschoolers and schoolchildren. Regular dishes for children (soups and purees) fade into the background. All this leads to a breakdown in the digestive system and occurs at an early age. Prevention is necessary to prevent the harmful effects of eating the wrong foods.

Nowadays, pathology of the gastrointestinal tract is often found among children. At the same time, chronic forms of diseases prevail over acute processes. Over the past 10–15 years, gastritis and gastroduodenitis have become detected 2 times more often. According to medical statistics, every 4th child has a disease of the digestive system. Unfortunately, the percentage of severe and disabling forms has increased.

The likelihood of gastrointestinal pathology increases as the child grows up. This is due to a large number of risk factors. But even at early ages, high incidence peaks are possible.

Pathology of the digestive organs can also negatively affect the development of other body systems. Thus, nervous diseases occur in 80–90% of children with damage to the gastrointestinal tract, in 40% of cases the nasopharynx (chronic tonsillitis) is affected, and in 50% -.

To avoid unpleasant consequences, parents should pay attention to prevention. Preventing a disease is always easier than treating it.

Main types of prevention of pathology of the digestive system

The main type of prevention is primary. That is, preventing the development of diseases. The most important thing here is to form the child’s habit of eating right.

1. Primary.

This type of prevention is aimed at creating a healthy lifestyle and preventing the emergence of risk factors.

1. Secondary.

This type of prevention is aimed at identifying children at risk for gastrointestinal pathology to exclude the development of the disease. This is where nutrition and lifestyle adjustments are made.

1. Tertiary.

Prevention is aimed at preventing exacerbations of digestive diseases in chronic patients.

The main objectives of preventive measures

1. Prevention and control of risk factors.
2. Active and healthy lifestyle.
3. Timely identification of the initial symptoms of the disease, before the pathology becomes a chronic irreversible process.
4. Clinical examination (observation under medical supervision) and rehabilitation (recovery after illness) of children with a diagnosable disease of the gastrointestinal tract.
5. Timely treatment of exacerbations (relapses) of diseases of the digestive system.

Risk factors for the development of pathology of the digestive system

A risk factor is not the direct cause of the disease, but increases the likelihood of its occurrence.

Classification of risk factors:

1. Controllable factors, i.e. controllable:

Nutrition Features:

• A decrease in the quality of traditional baby food products leads to an increase in the proportion of “contaminated food” in the diet, i.e. containing. They can also reach store shelves from environmentally unfavorable areas.
• Deficiency of vitamins and microelements is accompanied by depletion of the digestive system.
• Suboptimal diet, especially at school age (dry food, long intervals between meals, consumption of carbonated drinks, crackers, chips during meals).
• The predominance of refined products that are industrially processed and lose beneficial substances (vegetable oil, premium flour, white rice, etc.). A deficiency in the diet (vegetables, fruits, greens) leads to disruption of the normal functioning of the intestines and its biocenosis (opportunistic and pathogenic flora begins to predominate).
• in the first year of life, especially with low-adapted mixtures, disrupts the physiological functioning of the digestive system.

Environmental risk factors:

• Chemical contamination of food products (agricultural poisons - pesticides, heavy metal ions - mercury, lead, tin, zinc, iron, etc., radioactive isotopes, nitrates, etc.) and drinking water (phenols, chlorine and its compounds, iron and etc.). All these factors suppress the activity of digestive enzymes and impair digestion processes. Normal peristalsis is disrupted. Due to the suppression of local immunity, bacteria and viruses freely penetrate the gastrointestinal barrier.

Infectious factor:

Psychosomatic factor:

• In 40–50% of children, diseases of the digestive system develop due to mental overload, emotional stress, etc.

Provoking factors from the nervous system:

1. Perinatal encephalopathy is damage to the child’s brain in the prenatal period or during childbirth.
2. Hypoxia is oxygen starvation of the brain and all body systems of a newborn in the prenatal or postpartum period.
3. Autonomic dysfunction is a violation of the neurohumoral regulation of organs;
4. Injuries to the central nervous system and spine.
5. Early artificial feeding after the birth of a child.

Social factors:

• Financial security of the family (low income – poor nutrition).
• (as a rule, meals are inadequate in terms of time intervals).
• The living conditions of the child (failure to maintain order, cleanliness and hygiene contribute to the spread of infectious diseases).
• Moral and psychological climate of the family (trouble provokes a stressful environment).

Medication factor:

• Salicylic acid (aspirin), large doses of ascorbic acid, sulfonamides, drugs from the group of nonsteroidal anti-inflammatory drugs (analgin, Nurofen, Nise, indomethacin, etc.) cause irritation of the gastrointestinal mucosa and, with prolonged use, provoke the appearance of erosive and ulcerative processes.
• Limitation of physical activity (hypodynamia) leads to weakening of muscles and deterioration of the motor-evacuation function of the stomach.

Sensitizing factor:

• , accompanied by damage to the gastrointestinal tract, increases the likelihood of Helicobacter pylori infection by 100 times.

Medical and organizational factor:

• Doctors' focus on acute infectious diseases of the gastrointestinal tract with clear symptoms (mild forms of pathology with minor manifestations are missed).
• Lack of regular medical monitoring of children at risk for digestive diseases.
• Limitation of availability of functional diagnostic methods for a modern doctor (long waiting times).
• Lack of control over the educational, psycho-emotional and physical load of schoolchildren.

1. Uncontrollable factors, i.e. uncontrollable:

Hereditary factor (inheritance rate for diseases of the gastrointestinal tract is 30%):

• Most often, family predisposition extends to gastroesophageal reflux in children (reflux of acidic gastric contents into the esophagus due to sphincter failure) and excess production of hydrochloric acid (increased acid-forming function of the stomach).

Psychological factor (personality type):

• A labile psyche, impressionability, touchiness, irritability, etc. contribute to the development of pathology of the digestive system.

Gender factor:

• Girls get sick more often than boys.

Age factor:

• The main peaks of incidence occur at 4–5 years, 6–7 years and .

1. Specific factors (increase the likelihood of Helicobacter pylori infection):

• Children with a hereditary history of gastric and duodenal ulcers and gastric adenocarcinoma.
• Children with malabsorption syndrome (impaired intestinal absorption).
• Children with social burdens (difficult living conditions, alcoholism or drug addiction of parents, etc.).
• Frequently ill children with.
• The presence of gastroesophageal reflux in children after 3 months of age provokes the development of persistent digestive pathology in older age: heartburn, belching, hiccups, unpleasant taste in the mouth in the morning, sensation of a lump behind the sternum.

Preventive actions

The infectious factor, in particular the bacterium Helicobacter pylori, is one of the leading risk factors for the development of diseases of the digestive system in both adults and children.

For children at risk of developing gastrointestinal tract diseases - family nutrition analysis.

• regular and timely meals at least 4–5 times a day;
• increasing the share of animal protein (at least 50% of the total diet), vegetable protein - no more than 50%;
• eating easily digestible foods (), excluding fatty and difficult to digest foods (duck, goose, lamb, fatty pork);
• cheese only from 4 years old;
• fruits and vegetables daily (remove heavy metal salts, bacterial toxins, improve intestinal motility, reduce stomach acidity).

Prevention of school gastritis:

• (by proteins, fats, carbohydrates and kilocalories);
• alternating physical activity and meals (physical education should be before the second breakfast, 2-3rd lesson depending on the class);
• for dinner, easily digestible foods (vegetables, fruits, fermented milk foods);
• fatty, fried, salty and spicy foods are not allowed;
• exclusion of psychotraumatic situations at school - use of safe sedatives (tinctures of motherwort, valerian, Tenoten for children) and drugs that improve brain function (Glycine) before stress (exam, test, etc.), work with a psychologist on management emotions;

Protection of the gastric mucosa when prescribing drug therapy (non-steroidal anti-inflammatory drugs, sulfonamides, etc.) through the use of coating agents (Phosphalugel, Maalox, Gaviscon, Almagel, etc.).

For children at risk for Helicobacter pylori infection:

• improvement of intestinal biocenosis with the help of biological products that normalize microflora and improve peristalsis (“Linex”, “Bifiform”, “Acipol”, “Bifidumbacterin”, etc.);
• cleansing the body of toxins, toxins, allergens, a gentle detoxification agent is prescribed (Smecta - 2-3 courses per year for 3 weeks);
• separation of household items in a family with a risk of Helicobacter pylori infection (relatives have gastric or duodenal ulcers, gastric adenocarcinoma, etc.) - the child must have individual dishes, a towel, and hygiene products.

For children at risk for gastroesophageal reflux disease (GERD):

• Nutrition Features:

1. During meals it is necessary to drink it with water (the acidity of the stomach decreases), but after meals it is not recommended.
2. After breakfast, lunch and dinner, you should not lie down, run or jump - the child must sit at the table for 10 minutes (to avoid reflux).
3. 2 hours before bedtime, it is recommended to use the following foods and dishes in your diet: cottage cheese, fermented milk food, porridge, omelet, vegetables.

• Sleeping features: when putting the child to sleep, it is necessary to raise the head end of the bed by 10–15 cm.

Rehabilitation of children with chronic pathology of the gastrointestinal tract

Main goals:

1. Prevention of disease progression.
2. Increasing the duration of remission (no exacerbations), preventing relapses (reducing the number of acute clinical periods).
3. Psychological and pedagogical work to reduce morbidity: changing the child’s lifestyle, conversations with parents, improving (if possible) family conditions, a positive attitude towards health.

All children are divided into dispensary registration groups based on health status:

Group I – healthy children (no diseases, no functional abnormalities, normal physical and neuropsychic development);

Group II – healthy children with any functional abnormalities in the development of organs or body systems, frequently ill children, no chronic pathology;

Group III - children with chronic diseases in the compensation stage (no complaints, changes in well-being, laboratory remission), exacerbations are rare (1-2 times a year in a mild form);

Group IV - children with chronic diseases in the subcompensation stage (well-being is slightly impaired, there may be complaints and morphofunctional changes in internal organs and body systems), exacerbations are more frequent (3-4 times a year in moderate and severe forms);

Group V – children with chronic diseases in the stage of decompensation (constant relapses, progressive course with pronounced changes in internal organs and body systems).

Features of dispensary observation of children with pathology of the digestive system

Children suffering from chronic diseases of the digestive tract are subject to dispensary registration. Periodically, they need to come to the pediatrician for an appointment and undergo a series of examinations.

Children with group V are treated until their condition improves (transition of the disease from the stage of decompensation to subcompensation), then they are observed in group IV.

IV group of dispensary registration:

• Once a quarter examination by a pediatrician and gastroenterologist;
• for gastroduodenitis associated with Helicobacter pylori (with normal and increased acidity of the stomach), examination for infection is carried out 6-8 weeks after treatment;
• fibroesophagogastroduodenoscopy (FEGDS - an endoscopic procedure for examining the esophagus, stomach and duodenum) - 2 times a year, for gastritis with secretory insufficiency - 1 time a year;
• pH-metry (method for determining stomach acidity) – once a year;
• General blood test according to indications.

III group of dispensary registration:

• 2 times a year examination by a pediatrician and gastroenterologist;
• FEGDS and pH-metry - once a year according to indications, for gastritis with secretory insufficiency - once a year is mandatory.

II group of dispensary registration:

• Examination by a pediatrician and gastroenterologist once a year;
• for gastroduodenitis associated with Helicobacter pylori (with normal and increased acidity of the stomach), examination for infection is carried out once a year;
• FEGDS and pH-metry - once a year only for medical reasons.

Rehabilitation measures

ichtherapeutic and protective regime:

• consultation with a psychologist on managing emotions, motivation for recovery;
• limitation of physical activity: children with group IV engage in physical therapy, and at school - in a special medical group; Children in group III are assigned to the preparatory physical education group, and those in group II are assigned to the main group.

• frequent split meals (5–6 times a day);
• children with group IV - with normal and high acidity, table No. 1 according to Pevzner, with low acidity - table No. 2;
• children with group III - for normal and high acidity, table No. 2 according to Pevzner, for gastritis with secretory insufficiency - table No. 15;
• children with group II - table No. 15 according to Pevzner;
• long-term diet is not recommended.

Drug therapy:

• children with group IV - anti-relapse treatment 1-2 times a year for 1.5-2 months; for normal and high acidity, antacids (Phosphalugel, Maalox, Gaviscon, Almagel, etc.) and antisecretory drugs (Ranitidine, Famotidine, Omeprazole, etc.) are prescribed; for gastritis with secretory insufficiency, enzymes (Festal, Abomin, etc.) and stimulants of gastric secretion (natural gastric juice, Plantaglucid) are prescribed;
• children with group III – anti-relapse treatment once a year for 3–4 weeks;
• children with group II - treatment only for medical reasons.

Phytotherapy:

• children with group IV with normal and high acidity are allowed to use soothing herbs (valerian and motherwort);
• for gastritis with secretory deficiency, regardless of the group, yarrow, wormwood and trefoil leaves are used.

• used with low and medium mineralization;
• For children with group IV with normal and high acidity, it is used in a warmed, degassed (release gases before use) form 3 times a day, the required volume is 2–3 ml per 1 kg of the child’s weight. Mineral water is used 1–1.5 hours before meals in courses 2–3 times a year, for gastritis with secretory deficiency - 20–30 minutes before meals for 1–1.5 months;
• children with group III–II with normal and high acidity are prescribed 1 time per year (Borjomi, “Slavyanovskaya”, “Smirnovskaya”, “Arzni”, etc.), for gastritis with secretory insufficiency - 1–2 times a year ( “Arzni”, “Izhevskaya”, “Mirgorodskaya”, “Minskaya”, etc.).

Spa treatment:

• recommended 3–6 months after an exacerbation (stable remission);
• sanatoriums: “Big Salts” (Nekrasovskoye village, Yaroslavl region), “Anapa” (Krasnodar region), “Belokurikha” (Altai region), “Sestroretsky resort” (St. Petersburg), “Staraya Russa” (Novgorod region), “Ozero” Shira" (Krasnoyarsk Territory), sanatoriums of Pyatigorsk (Karelia).

Conclusion

Thus, the prevention of diseases of the digestive system plays a significant role in the prevention of pathology of the gastrointestinal tract. It is important that children understand from an early age the need to observe rules of hygiene and hygiene. This will help protect them from many digestive problems. Of course, no one has canceled heredity. A family in which parents (or one of the parents) has a gastric ulcer or chronic gastritis associated with Helicobacter pylori can become a source of infection for the child, which will result in the disease. Despite this, moms and dads should not get upset ahead of time. With the correct behavior of parents (compliance with daily hygiene procedures, dividing household items into individual ones for each family member, fractional high-quality meals) and excluding the harmful effects of risk factors for gastrointestinal pathology in a child, it can be avoided.

If this does not happen and the child still gets sick, then it is necessary to contact a pediatrician or gastroenterologist in a timely manner. Early diagnosis and treatment help to completely stop the acute period and prevent chronicity of the process. If the parents contact them late (the child complains for a long time of nausea, heartburn, belching, periodic abdominal pain, etc.), the pathology becomes irreversible. In such situations, rehabilitation measures aimed at restoring the function of the affected organ and preventing relapses help.

Parents should always take care of their child's health and never self-medicate. Let prevention come first!

Peritonitis is a process of inflammation of the peritoneum. With peritonitis, organ functioning is disrupted due to severe intoxication of the body. The connective tissue of the peritoneum envelops all the internal organs of the abdominal cavity and serves as a limiter between the internal environment of the abdominal cavity and the abdominal muscles.

When exposed to pathogenic microorganisms or chemical agents on the surface of the peritoneum, it is capable of releasing special substances that stop this process. If the number of pathogenic factors is large, then the peritoneum becomes involved in inflammation and peritonitis occurs. Peritonitis is a very life-threatening condition. If it occurs, emergency medical attention and urgent treatment are required, otherwise death is possible.

Causes of peritonitis

Peritonitis is classified as primary or secondary. In primary peritonitis, the causative agent is microorganisms that entered the peritoneum along with the blood flow from the infectious focus in the body. At the same time, the integrity of the peritoneum is preserved.

Primary peritonitis is classified as:

• spontaneous childhood primary peritonitis (usually girls under 7 years of age);
• spontaneous adult primary peritonitis (due to ascites, side effect of hemodialysis);
• primary peritonitis in persons suffering from active tuberculosis.

Secondary peritonitis is accompanied by damage or rupture of all layers of the peritoneum as a result of penetrating trauma to the abdomen or a violation of the integrity of one of the internal organs.

Secondary peritonitis is classified into:

1. peritonitis caused by a violation of the integrity of internal organs;
2. peritonitis caused by penetrating or blunt abdominal trauma;
3. peritonitis, which developed in the postoperative period.

There is tertiary peritonitis, which develops in the abdominal cavity after peritonitis has already occurred. That is, in essence, this is a relapse of peritonitis. Fortunately, it is rare. Its peculiarity is an erased course, severe intoxication and failure of almost all internal organs. It occurs when the body's defenses are severely depleted. Such peritonitis often does not respond to therapy and ends in the death of the patient.

Bacterial etiology of peritonitis

The intestines are home to a great variety of microorganisms, but exposure to only some of them can lead to peritonitis. This happens because some of them die in an oxygen environment, that is, they are strict anaerobes. Another part is subject to controlled death due to the anti-infective ability of the peritoneum.

Depending on the conditions in which peritonitis occurred, there are 2 forms:

• hospital;
• out-of-hospital.

The process of development of peritonitis

The speed and severity of the development of peritonitis symptoms largely depends on the state of the body, on the pathogenicity of microbes, and on the presence of provoking factors.

The main points in the development of peritonitis are as follows:

1. Intestinal paresis, as a result of which the absorption function is impaired, and the body loses a large amount of water and electrolytes.
2. Dehydration and decreased pressure in blood vessels leads to strong heartbeat and shortness of breath.
3. The rate of development of peritonitis and the severity of damage to the peritoneum depends on the number of pathogenic bacteria and the magnitude of intoxication.
4. Autointoxication is added to intoxication caused by microbes. In response to the aggression of microorganisms, antibodies are released in the blood that attack the lipopolysaccharide wall of the bacterium. The compliment system is activated and many active substances are released, the effect of which is manifested by intoxication.

If the human body is weakened or the microorganism is highly pathogenic, then peritonitis is not limited, but becomes diffuse or widespread. The spread is especially facilitated by increased peristalsis, as well as blood and exudate in the abdominal cavity.

Clinical manifestations of peritonitis

Symptoms depend on the cause of the disease, so the initial signs can be very varied. But there are several successive stages, depending on the time of onset of symptoms.

Reactive stage

Develops in the first day. Severe pain occurs, the patient can clearly determine the location. If the cause of peritonitis is perforation of a hollow organ, then this pain is described as dagger-like. For example, perforation of a stomach ulcer is described as severe sharp pain in the epigastric region, rupture of the appendix is ​​described as pain in the right iliac region.

The pain gradually spreads to other areas of the abdomen. Sometimes, after it occurs, the pain becomes less intense and does not bother the patient as much. This is how a symptom of imaginary well-being manifests itself. After some time, the pain returns.

The face of a patient with peritonitis is very typical. It is pale, sometimes even with an earthy tint. Covered with drops of sweat when pain occurs. Facial features become sharp due to dehydration. Severe pain forces the patient to take a comfortable position in order to somehow alleviate it. More often, a person lies on his side with his legs bent, sparing his stomach in every possible way, trying not to strain it.

When examining such a patient, tense abdominal muscles are found - a plank-shaped abdomen. The Shchetkin-Blumberg symptom is pronounced, in which a sharp removal of the hand from the surface of the abdomen at the time of palpation leads to increased pain.

The patient is bothered by repeated vomiting, after which there is no improvement. First it is vomiting water, then bile. Body temperature rises to febrile levels, fever often occurs with chills. On examination, the mucous membranes are dry due to dehydration, and thirst is a concern. The amount of urine excreted decreases.

Toxic stage

Develops on the second or third day. The patient's general condition worsens. Peritoneal symptoms are less pronounced. Microcirculation is disrupted. Outwardly, this is manifested by a cyanotic appearance of the nose, earlobes, fingers and toes. The patient is very pale. Severe dehydration leads to impaired brain function. Consciousness is depressed, the patient is indifferent to what is happening. Sometimes, on the contrary, he may be excited and delirious. Upon examination, palpation of the abdomen does not give any reaction.

Vomiting of bile continues, and in advanced cases, intestinal contents. Little urine is produced, maybe none at all. Fever reaches high numbers, up to 42 degrees. Worried about severe shortness of breath and palpitations. The pulse becomes threadlike.

Terminal stage

It is also called irreversible. If the patient’s condition does not improve by the third day, then the disease is irreversible and most often ends in the death of the person. The patient is in very serious condition. Dehydration is expressed to the maximum. In this case, facial features become so sharp that it becomes difficult to recognize the person. For a long time, such a face was called the face of Hippocrates: pale, with a bluish tint, sunken eye sockets with dark circles under the eyes.

Palpation of the abdomen does not provide objective data. The patient does not respond to palpation of the abdomen. Breathing is impaired and artificial support for lung function is often required. There is no pulse in the peripheral arteries. Such a patient requires intensive treatment and resuscitation care.

Methods for diagnosing peritonitis

In order to make a diagnosis of peritonitis, the doctor must rely on clinical data from the disease, medical history, external symptoms, and examination data of the patient.

Blood test and instrumental data are important.

Changes in the hemogram are aimed at increasing the number of white blood cells, shifting the formula to the left, and increasing ESR. These are universal signs of inflammation. Hemoglobin falls, the number of red blood cells decreases. Due to blood thickening, its clotting is impaired.

The main role is played by ultrasound of the abdominal cavity. It shows the primary localization of peritonitis, the affected organ and the degree of spread of the process throughout the peritoneum. The sooner a person with symptoms of peritonitis seeks help, the greater his chances of recovery. Therefore, if you have a disease that is accompanied by fever, uncontrollable vomiting, or abdominal pain, you must call a doctor. If he suspects peritonitis, he will urgently refer such a patient to the hospital.

Treatment methods for peritonitis

Peritonitis is treated surgically. The operation is prescribed urgently, after appropriate preparation of the patient. The surgeon will open the abdominal cavity, eliminate the cause of peritonitis, suture the diseased organ, perform an inspection, and wash the internal organs and peritoneum with an antiseptic and saline solution. If peritonitis has affected a large part of the peritoneum, the wound is not tightly sutured, but additional lavage of the abdominal cavity is performed on the second and third days.

Antibacterial therapy and correction of water and electrolyte balance are actively carried out.

The problem of treating peritonitis occupied many outstanding minds from Hippocrates to S.I. Spasokukotsky. At the beginning of the 20th century, the latter identified the connection between the speed of surgical care and the outcome of the disease. The sooner such a patient got to the operating table, the more likely his recovery was.

The reactive stage is not yet so severe, the disorders can be corrected, the body is not exhausted by the disease. The second stage, toxic, already leads to significant changes in the internal environment of the body and recovery is doubtful. In the third terminal stage, multiple organ failure develops and will end in death.

Preoperative preparation and monitoring

• For successful surgical intervention, it is necessary to carry out preoperative preparation.
• The patient must have a peripheral and central vein and bladder catheterized and premedicated.
• Midazolam (5 mg) and 10–20 mg of cerucal are administered on the operating table. Atropine administration is contraindicated, as there is a high probability of developing bradycardia.
• Medicines are administered that help reduce the acidity of gastric juice (about 40 mg of omeprazole or famotidine/ranitidine 50 mg into a vein).
• During the operation, infusion therapy is carried out in an amount of at least 1.5 liters of physiological solution, and plasma and blood products are added if necessary.
• Perform artificial ventilation and administer oxygen.

In the case when the patient lies on the operating table and there is more than 25 ml of contents in the stomach, there is a real threat of aspiration. This is the name for the entry of stomach contents into the lumen of the bronchial tree. Gastric juice can cause a burn to the mucous membrane of the bronchi and trachea. Complications of aspiration include multiple pulmonary atelectasis, bronchospasm, respiratory failure, and pulmonary edema.

Aspiration of small amounts of gastric juice can subsequently lead to aspiration pneumonia.

Therefore, in anesthesiological practice in patients with peritonitis, ganglioblockers and anticholinergics - drugs that can reduce the tone of the lower esophageal sphincter - are not used.

Antibacterial therapy is carried out with a combination of antibiotics that act on both Gram-plus and Gram-minus bacteria. For community-acquired peritonitis, this is intravenous administration of cefotaxime and metronidazole. For in-hospital use - cefepime and metronidazole. If peritonitis develops in the hospital during antibiotic therapy, carbapenems are used.

Postoperative period

In the postoperative period, some problems may arise related to the normal functioning of the intestines, severe pain, and the development of purulent complications. Recommended:

• observation of the patient, hourly assessment of respiratory rate, pulse, diuresis, central venous pressure, drainage discharge;
• infusion therapy with colloid and crystalloid solutions is carried out;
• to warm patients, infusion media are heated to body temperature;
• the lungs are ventilated for 72 hours to ensure sufficient oxygen supply to organs and tissues;
• a glucose solution is administered through a nasogastric tube;
• early restoration of intestinal motility;
• prevention of pain syndrome. Narcotic analgesics are used in combination with non-steroidal anti-inflammatory drugs. Fentanyl, morphine, ketorolac are used.

Prevention of peritonitis development

It consists of informing the population of the main symptoms of peritonitis and its consequences. It is necessary that everyone knows how to act if peritonitis is suspected and, if there are reliable signs, immediately call an ambulance. Prevention of primary peritonitis consists of timely treatment of existing chronic foci of infection.

Peritonitis as a surgical complication:

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Prevention of gastritis

It is known that it is easier to prevent a disease than to treat it later. Activities carried out to prevent the development of the disease are based on the statement.

Prevention, as a part of medicine, is:

• Primary, aimed at preventing the disease;
• Secondary, characterized by eliminating risk factors for an existing disease and preventing exacerbations.

Chronic gastritis is a disease worthy of preventive measures. There are several reasons given:

• Affects the patient's quality of life;
• Leads to ulceration;
• Impaired absorption of nutrients and vitamins;
• The risk of complications is bleeding and stomach cancer.

To understand preventive measures for gastritis, it is necessary to find out the causes of development. Depending on the type of chronic gastritis, the causes are:

Prevention of chronic gastritis can be public and individual.

Public prevention is based on carrying out measures to protect the population from consuming low-quality products. Government organizations supervise public catering establishments and places where food products are sold. The correctness of food preparation, hygiene of the workplace and the employee himself are monitored.

This especially applies to children's organizations to prevent damage to the stomach and digestive tract due to non-compliance with the rules for storing and preparing food.

Individual prevention concerns each person personally and depends on a number of factors:

• The reason for the development of gastritis;
• Presence of concomitant pathology;
• Family members have gastritis.

Prevention of acute gastritis

Chronic gastritis is the result of lack of treatment or poor treatment of acute gastritis. The most important preventative measure will be to consult a doctor on time and follow treatment recommendations.

Prevention of Helicobacter pylori infection

The research work of scientists B. Marshall and J. Warren was demonstrated in 1983. It was the first to talk about the bacterium Helicobacter pylori as a causative agent of gastritis. The mentioned work changed the way medicine thinks about chronic gastritis.

Helicobacter is transmitted by contact, you will need to follow the following measures:

• mandatory hand washing before eating;
• do not share unwashed dishes, do not taste food from the same spoon, do not drink from the same cup;
• Personal hygiene products are provided individually for each family member.

If an infection is detected in a family member, it is recommended that everyone undergo an examination and, if necessary, take medications.

It is recommended to carry out activities aimed at restoring and improving the functioning of the immune system.

Nutrition

The importance of nutrition in the prevention of gastritis cannot be overestimated.

Diet

The correct percentage of meals: breakfast is dense, rich in nutritional components, dinner – on the contrary, light.

Prevention of gastritis involves limiting salt intake, due to the fact that the foods consumed contain a sufficient amount of sodium chloride for the body.

Drink water in the prescribed amount. Juice, compote, soup, tea and coffee are not water; a bowl of soup cannot replace a glass of water. Moisture is vital for the proper functioning of the body and the fight against an aggressive environment.

Consuming the right fats. You cannot give up fats; lipids are involved in many metabolic processes, for example, in the synthesis of sex hormones. It is necessary to differentiate the consumption of fats: increase the amount of polyunsaturated fats contained in sea fish, limit the consumption of unsaturated fats found in meat, eggs, and butter. Both types of fats should be present in the diet.

You will have to sharply limit or abandon the consumption of foods that strongly irritate the gastric mucosa. This includes fried foods, half-baked foods, excess smoked meats, marinades and spices.

The diet should include and alternate cooking methods of different consistency. Excess dry food will prepare the mucous membrane for the development of gastritis.

Treatment of gastritis is accompanied by similar nutritional recommendations.

Food quality

Monitoring the quality properties of products is necessary to prevent gastritis and many other diseases of the digestive tract. The main thing is freshness, eliminating doubts about the quality of food. If doubts arise, the only correct decision is to refuse to use the product for food.

Mode

Regular meals in small portions will prevent chronic gastritis and help activate metabolic processes. This is true for people who are prone to obesity.

Between meals, make small snacks: not chocolate bars and chips, but an apple, grapefruit, low-fat cottage cheese, nuts and dried fruits.

To prevent overstretching of the stomach and damage to the mucous membrane, simultaneous intake of large amounts of food is unacceptable!

Nutrition process

Absorption of food is carried out consciously; rushing and swallowing unchewed portions are not allowed. Chewing makes the stomach's work easier; the organ is not adapted to grinding food. Watching TV or the computer while eating food will not help normalize digestion.

Alcohol consumption

Regular consumption of alcoholic beverages and its substitutes leads to the development of atrophic gastritis. Any alcohol has a toxic effect on the cells of the gastric mucosa, especially if consumption becomes excessive.

Alcohol substitutes can cause severe damage to the esophagus, stomach, liver, and pancreas even with one-time use. This leads to irreparable consequences.

Smoking

Tobacco smoke affects the stomach in several ways:

• Smoking stimulates salivation; when saliva saturated with tobacco smoke products is swallowed, the mucous membrane is damaged and chronic gastritis develops;
• A small amount of nicotine enters the stomach in gaseous form when inhaled;
• The effect of nicotine on the centers regulating appetite and satiety in the brain;
• Once in the blood, nicotine is integrated into the body's metabolic processes and becomes necessary.

Taking medications

Groups of drugs that require careful monitoring of the stomach condition and prescribing gastroprotectors:

• Nonsteroidal anti-inflammatory drugs are medications that should be taken with caution and follow the instructions. These include Aspirin (acetylsalicylic acid), Ibuprofen, Ketoprofen, Indomethacin, Diclofenac.
• Sulfonamides contribute to the development of erosive gastritis. Antibiotics act on the gastric mucosa as toxic substances and allergens;
• Medicines used to treat tuberculosis;
• Anticoagulants such as heparin require differentiated administration, especially when combined with other medications;
• Cytostatics;
• Anticholinergics reduce intestinal motility, thereby promoting stagnation of food, overstretching of the stomach, and the development of gastritis;
• Iron supplements.

When prescribing drugs that have a detrimental effect on the stomach, the attending physician will recommend medications to protect the mucous membrane or reduce the negative effect. You should not self-medicate or take medications uncontrollably.

Occupational hazards

Precautionary measures must be taken if professional activities involve the production or use of toxic substances. The use of personal safety equipment is required: masks, respirators, protective suits.

Chronic infections

Here we talk about infections of the digestive system, specific infectious processes affecting the stomach, and chronic lesions.

When the body is infected with Mycobacterium tuberculosis or the causative agent of syphilis, the gastric mucosa undergoes changes: granulomatous gastritis develops. Prevention is the early diagnosis and treatment of specific infections.

Chronic infections of the oral cavity contribute to the development of gastritis.

Prevention of gastritis in childhood

Gastritis of the stomach in a child develops for reasons different from those in adults.

Features of the development of gastritis in children:

• Physiologically low motor function of the stomach;
• The amount of bacterial agent required for the development of infectious gastritis is significantly less;
• Self-healing often occurs.

Maintaining a daily routine: adequate sleep, walks in the fresh air, meals at a time. For a child, the regime is a kind of confidence, calmness and, accordingly, the absence of personal experiences.

The family environment should be friendly. This concerns the relationship with the child and the connection between parents.

Breastfeeding plays a major role in the formation of good protective factors in the stomach, and subsequently the correct introduction of complementary foods.

It is imperative to monitor what the child eats, especially if the family lives outside the city, because all unripe berries and fruits contain acids that irritate the mucous membranes and prepare the stomach for inflammation. It is necessary to monitor the condition of the oral cavity, sanitize chronic foci of infection: treat teeth, throat and inflammation of the tonsils.

If allergic manifestations occur on the skin, a mandatory consultation with an allergist is necessary to prescribe adequate treatment. Allergic gastritis of the stomach often accompanies skin manifestations.

If any disease develops, parents should not try to cope with it on their own. An examination by a pediatrician is necessary to prevent uncontrolled prescription of medications, which contribute to an even greater tendency of the child’s body to allergies.

If someone in the family is diagnosed with Helicobacter, then the child can become infected easily. Therefore, adults should take their treatment seriously: take pills regularly and observe personal hygiene rules.

Parents must be responsible for the health of their child.

Secondary prevention of gastritis

This is prevention aimed at preventing exacerbation of existing chronic gastritis.

To do this, all the rules of primary prevention are followed, which are accompanied by mandatory medical examination and prescription of medications.

How to avoid relapse of peptic ulcer? Prevention of duodenal ulcers

Ulcerative formations in the duodenum are a chronic, relapsing disease that affects the walls of the small intestine. When the disease worsens, the pathological process can spread to the stomach.

For patients, the spring-autumn period is especially dangerous. At this time, the digestive organs are most vulnerable, since a weakened immune system cannot always suppress pathogenic microorganisms.

Gastroenterologists are confident that preventive measures can prevent damage to the intestinal mucosa both in the absence of disease and in the case of an ulcer diagnosis, significantly lengthening the period of remission.

Prevention of duodenal ulcers is divided into three phases:

• Primary - consists of measures to prevent the development of the disease;
• Secondary - reduces the risk of relapse and exacerbations;
• Tertiary - reduces the likelihood of complications;

Primary prevention of duodenal ulcer

A set of measures that reduces the risk of developing a defect in the intestinal mucosa consists of:

• Preventing infection by Helicobacter pylori bacteria. It is this type of microorganism that causes ulcers. If at least one family member is infected with Helicobacter pylori, strictly follow the rules of hygiene, separate dishes, and do not use towels or personal belongings of the sick person. This will help reduce the risk of infection.
• Ban on smoking and strong alcoholic drinks.
• Proper nutrition. The daily dietary menu should be age- and energy-appropriate. For quick absorption and easy digestion of food, limit yourself to spicy, fatty and smoked foods, carbonated drinks and caffeine.
• Regular visits to the dentist and treatment of caries.
• Psychological comfort. Nervous breakdowns and stress primarily affect the functioning of the digestive system, especially the stomach and duodenum.

Prevention of recurrence of duodenal ulcer

The secondary and tertiary preventive complex is aimed at reducing pain and the risk of repeated exacerbations of the disease, which may result in a complication in the form of perforation of the ulcer.

• Anti-relapse treatment prescribed by a gastroenterologist. The course includes physiotherapeutic procedures, herbal medicine, medication and mineral water.
• In the autumn-spring period, sanatorium-resort prevention of peptic ulcer disease in specialized institutions is required.
• Rehabilitation of chronic diseases. Any exacerbation of old foci of infection can provoke new ones.
• Strict adherence to the dietary menu.
• Regular monitoring of changes in the course of the disease using laboratory and instrumental examinations.

To summarize what has been said, it is necessary to pay attention to the fact that disease prevention should not be neglected. After all, timely measures taken will be able to prevent the appearance of ulcers, and in the case of already formed lesions of the duodenal mucosa, they will reduce the risk of complications.