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Diagnosis - Functional gastric disturbances

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Functional gastric disturbances
Diagnosis
Forms
Treatment

Functional diagnosis. Is followed functional gastric disturbances various secretory and motor evakuatornymi by disturbances.
Gastric secretion is investigated by means of fractional sounding or method of an intragastralny rn-metriya.

At fractional sounding for stimulation of secretion the submaximum histamine test (under skin enter histamine dihydrochloride in a dose of 0,008 mg/kg of body weight) is usually used or enter 6 mg/kg of Pentagastrinum under skin, than the maximum stimulation is reached. Trial breakfasts (5% alcohol solution, cabbage broth, a beef-infusion broth, etc.) in connection with their weak sokogonny effect and instability of the received results apply seldom now.

At fractional research within an hour with a 15-minute interval receive 4 portions (a basal secret); after introduction under skin of a histamine or Pentagastrinum — take 4 portions of a gastric juice with an interval of 15 min. In each taken portion determine the volume of a gastric juice, the general acidity, free and connected NSL. In an assessment of secretory function of a stomach in a basal and stimulated phase the leading value has calculation an output hour, i.e. products of NSL for 1 h.

The main standards of indicators of gastric secretion are provided in the table.
The main lack of a titratsionny method — low sensitivity of reactants indicators by means of which reveal only acidity with rn lower than 2,5 and at rn within 2,5 — 6,9 it is defined as anacidity. An opportunity to establish rn within 2,5 — 6,9 and more — the leading advantage of a rn-metriya.

At an intragastralny rn-metriya, by means of a zone with two sensors it is possible to register a kislotoobrazovaniye in a body of a stomach and to obtain data on an alkaline reserve in peloric department; to conduct long research of a kislotoobrazovaniye using activators or blockers of secretion; to define, the achlorhydria of the true, i.e. caused by sharp reduction obkladochny cells in a mucous membrane of a stomach is, or false, connected with functional braking of the obkladochny cells which are available in enough.

According to the accepted criteria of a kislotoobrazovaniye in a stomach body on an empty stomach is defined as follows: rn 0,9 — 1,5 — hyperacidity; rn 1,6 — 2 — a normatsidnost; rn 2,1 — 5 — a gipatsidnost; rn more than 6 — an achlorhydria.
In peloric department of a stomach rn usually is registered higher than 2,5. The expressed hyperacidity in a stomach body (rn 0,6 — 1,5) at insufficient alkalization in peloric department (rn 0,9 — 2,5) testifies to a so-called dekompensirovanny acid stomach.

At high intensity of a kislotoobrazovaniye the irritant is not applied. The alkaline test and the test with atropine is carried out. The alkaline test is carried out as follows. Through an opening on the end of a probe the syringe enter 1 g of the hydrosodium carbonate dissolved in 30 ml of the distilled water. Upon termination of administration of drug each 5 min. for 20 min. register rn. Return rn to initial indicators on average happens for 17 ± 3,2 min. Reduction of time of alkalization testifies to a decompensation of neutralized function. For implementation of the atropinic test to the patient under skin enter 1 ml of 0,1% of solution of atropine and during 1 h change rn. Sharply positive reaction is characterized by increase rn more than on 4, at atropinorezistentny hyperacidity rn changes less than on 0,5.

At a kislotoobrazovaniye of the average and lowered intensity or an achlorhydria secretion stimulation is carried out by a histamine or Pentagastrinum. Registration of indicators rn after stimulation is carried out before their stabilization usually within 30 — 60 min. Data rn stomach bodies after stimulation are estimated as follows: rn 0,9 — 1,2 — hyperacidity; rn 1,2 — 2 — a normatsidnost; rn 2 — 3 — a moderate gipatsidnost; rn 3 — 5 — the expressed gipatsidnost; rn more than 6 — a true achlorhydria.

It is possible to refer impossibility to investigate volume indicators and, therefore, to study such important indicator as a secretion output hour to a lack of a method.

Research of motive function of a stomach is conducted by means of radiological and elektrogastrografichesky methods.

X-ray inspection of motor function of a stomach includes an assessment of a tone, a vermicular movement, activity of the gatekeeper and evacuation of contents of a stomach. Disturbances of motive function can be hyper motor (a stomach hyper tone, the segmenting peristaltics, a pylorospasm) or hypomotor type (stomach hypotonia, a ventroptosis, a sluggish peristaltics, the slowed-down evacuation).

The Elektrogastrografichesky method consists in selective record of biocurrents of a stomach which are registered by means of an elektrogastrograf EGS-4m in the frequency range of 0,03 — 0,07 Hz. The device allows to register biocurrents from a surface of an abdominal wall in a stomach projection. Similar results receive at record of biopotentials from extremities in assignment "the right forearm — the right shin".

At interpretation elektrogastrogramm (EGG) pay attention to the general character of a curve, amplitude, frequency and a rhythm of teeth. At healthy people amplitude makes 0,1 — 0,4 mV, a rhythm usually correct — 3 fluctuations a minute.

The greatest information on a physical activity of a stomach can be obtained at repeated records EGG in the course of use of medicamentous means and food loadings. Most of all amplitude of teeth (from 0,02 to 1 mV) changes, the frequency of reductions is usually poorly subject to fluctuations.

It is accepted to allocate two extreme types of consensual disturbance secretory and motor evakuatornoy to function of a stomach:
1) hypersthenic,
2) hypo - and asthenic.

The hypersthenic type of a functional gastric disturbance is characterized by a combination of hypersecretion of a gastric juice, hyper motility of a stomach, increase of a tone of a stomach and periodic spasms of muscles, especially cardial and peloric sphincters.

At 70% of patients with functional gastric disturbances of hypersthenic type stomach contents on an empty stomach exceed 50 ml, and indicators of free NSL on an empty stomach make more than 20 mmol/l. At 80 — 90% of patients reveal NSL hypersecretion in a stimulated phase. At hypersthenic type of functional gastric disturbances on an elektrogastrogramma chaotic waves are registered, at X-ray inspection reveal the segmenting peristaltics, kardio-and piloroduodenospazma, a duodenogastralny reflux.

Hypo - and asthenic type of functional gastric disturbances represents combinations of hyposecretion (achlorhydria) of a gastric juice to lowering of a tone and hypomotility of a stomach. Decrease in secretion of NSL usually has non-constant character. At research of a gastric juice in these cases decides on trial breakfasts hypo - and even an achlorhydria. However indicators of a kislotoobrazovaniye are normal and even raised at the submaximum and maximum histamine stimulation. In some cases it is possible to establish existence of an acid gastric juice only at an intragastric rn-metriya with use of an adequate secretagogue (a histamine, Pentagastrinum).

Disturbance of motility of an elektrogastrograficheska is shown by the low amplitude of peristaltic waves, and at X-ray inspection — a sluggish peristaltics, a gastroptosis, duodenospazmy.


 
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