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Gee's disease - Diseases of digestive organs at children

Table of contents
Diseases of digestive organs at children
Oral cavity
Diseases of teeth
Malformations of the sky and soft tissues of an oral cavity
Diseases of a mucous membrane of an oral cavity and gums
Diseases of lips and language
Sialadens
Digestive tract
Basic reasons of gastrointestinal frustration
Gullet
Atresia and esophageal and tracheal fistula
Guttural and tracheal and esophageal crevice, inborn stenosis of a gullet
Other diseases of a gullet
Stomach and intestines
Peptic ulcer
Inborn hypertrophic pyloric stenosis
Inborn impassability of intestines
Inborn impassability of a duodenum
Disturbances of turn of intestines
Inborn impassability of a small bowel
Inborn megacolon
Diverticulums and duplikatura
The acquired impassability of intestines
Intestines invagination
Foreign bodys of a stomach and intestines
Motive frustration. stomach and intestines
Anomalies of a structure of anorectal area
Infectious diseases of intestines
Nonspecific ulcer colitis
Illness Krone
Necrotic coloenteritis of newborns
The coloenteritis connected with treatment by antibiotics
Gastrointestinal symptoms of anaphylactoid purpura, gemolitiko-uraemic syndrome
Intolerance of food proteins
Eosinophilic gastroenteritis
Absorption disturbance syndromes
Malabsorption
Immunodeficiency and intestines
Syndrome of "a congestive loop"
Syndrome of a short small bowel
Gee's disease
Sprue after acute enteritis
Tropical to a spr
Whipple's illness, intestines lymphangiectasia, Uolmap's illness, idiopathic diffusion defeat of mucous
Enzymopathies and disturbances of mechanisms of transport of nutrients
Irritable colon
Acute appendicitis
Diseases of an anus, direct and large intestine
Tumors of a digestive tract at children
Hernias of a digestive tract at children
Exocrine part of a pancreas
Pancreatitis
Embryonic development of structure and function of a liver
Diagnosis of diseases of a liver
Cholestatic states at babies
Parenchymatous jaundices at children of chest age
Disturbances of a metabolism of a liver and zhelchevydelitelny system
Anomalies of a structure of bilious ways
Cysts of bilious channels
Cholestasia and diseases of a liver connected with completely parenteral food
Medicinal damage of a liver
Ray's syndrome
Chronic hepatitis
Wilson's illness — Konovalova
Indian juvenile cirrhosis
Damages of a liver at chronic colitis
Cirrhosis and chronic liver failure
Portal hypertensia and varicosity of a gullet
Fatty infiltration of a liver
Cholecystitis
Peritoneum diseases
Peritonitis
Peritoneum hernias
GLUTEN ILLNESS (GEE'S DISEASE)

Inability to acquire the gluten which is in cereals for the first time was described by Dicke in 1950 as the important reason of a chronic intestinal disease at children. Its frequency fluctuates from 1: 300 (in the west of Ireland) to 1: 2000; there are no exact data on incidence of a Gee's disease in North America, but it is known that in one areas frequency makes 1:200, and in others is much lower.
Damage of intestines arises owing to resistant intolerance of gliadinovy fraction of gluten — the protein which is contained in grains of wheat and rye. There are inconsistent data on similar properties of proteins of oats and barley, however most of patients well transfer them at moderate consumption. It agrees one of hypotheses, inborn defect of fermental system because of which undigested toxic components of gluten accumulate in a mucous membrane is the cornerstone of a pathogeny. Other hypothesis says that injury of intestines is caused by immune responses.
Predisposition to a gluten illness is descended; transfer type — dominant with incomplete penetrance. About 80% of patients are HLA-B8 antigen carriers (among healthy faces — only 22%). The Gee's disease and a diabetes mellitus considerably meet among the immediate family of patients more often, than in control group.
Clinical manifestations. Range of clinical displays of a gluten illness fluctuates from generalized heavy malabsorption to normal or almost a health normality.
Table 12-1Z Symptoms of a gluten illness in an aggravation stage (42 cases)


Symptoms

Number
patients

Delay of mental development

36

Diarrhea

30

Instability of health

30

Vomiting

24

Anorexia

24

Putrefactive chair

21

Abdominal pains

8

The increased appetite

6

Prolapse of the rectum

3

Lag in growth more than for 25%

30

The deficit of body weight exceeding 25%

37

Weakness of muscles

40

Increase in a stomach

33

Hypostases

14

Fingers in the form of "drum sticks"

11

The main clinical symptoms are provided to tab. 12-12. Irritability, anorexia and chronic diarrhea which arises at the end of the first year of life belong to the most typical manifestations. Fecal masses is decoloured and fetid. The child lags behind in the weight and growth; the muscular hypotrophy, especially proximal groups of muscles is noted. Among other symptoms of an illness it is necessary to call afta in oral cavities, the "varnished" language, multiple hypodermic hemorrhages, "drum" fingers and peripheral hypostases. The circle of clinical manifestations of a Gee's disease is extremely wide and therefore "student's" symptoms can be observed not always. At least 30% have patients neither irritability, nor anorexia; at many patients vomitings and ponosa, and at some — locks are noted. The most constant signs — a growth inhibition and increases of body weight during all childhood, sometimes even without obvious gastrointestinal frustration. At the same time at other patients with the same diagnosis the good health remains and typical symptoms develop only in many years.
Datas of laboratory. Anemia is often observed, and the iron deficiency type prevails, however decrease in level of folic acid in a blood plasma is possible. The hypovitaminosis of B12 is shown only in hard chronic cases. The hypoalbuminemia and a hypogammaglobulinemia result from insufficient consumption of food, its bad absorption and excessive losses of protein with a stake.
Most of sick children after the use of the food saturated with fats has a steatorrhea. The fat excretion exceeding 10% of the entered quantity (in the analysis a calla, it is built go within 4 days), indicates a steatorrhea (at children 6 months are more senior).
Microscopic examination the calla usually reveals a significant amount of crystals of fatty acids. Carotene level in the plasma taken on an empty stomach is reduced (less than 0,5 g/l); content of vitamin D - 25-OH, calcium and vitamin A is also reduced; the prothrombin time is increased. These indicators can be normal, despite existence of a steatorrhea and other signs of a Gee's disea