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3 Warning method perinatal HIV transmission to disseminate information on the prevention of HIV transmission through health care, including counseling of women with HIV and chemoprophylaxis 200mg take cheap capsule celebrex cost of buy price 400 400mg 50mg how 100mg.

4 organization of medical care and social support to HIV patients, their families and others

Chapter 1: The choice of birth control

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Has the analgesic effect and the specific anti-inflammatory effect. Physiotherapy some reduce the activity of several proteolytic enzymes and kinin system. Physiotherapy in remission from acute and painful form of chronic pancreatitis. Physiotherapy appointed to the projection of the pancreas: electrophoresis 5-10% solution of novocaine; Corrientes dd; modulated sinusoidal currents; Ultrasonic therapy. . To improve on the testimony used inductothermy pancreas, diathermy 2 times a year


Used tinctures, decoctions and positions of the following herbs: chamomile, St. John's wort, pink wild banana leaves, corn grain, calendula, celandine, Helichrysum.

spa treatment

The most important therapeutic factors of the stations are healthy foods, bottled water, physiotherapy, balneotherapy, physiotherapy. Physical therapy is very important in the rehabilitation of a person with chronic pancreatitis. They are not specially selected complex exercises in physical therapy for a person suffering from chronic pancreatitis, which contribute to the stimulation of metabolic and trophic processes, improve blood circulation in the abdominal organs, accelerate the passage of intestinal contents and eliminate constipation The empty gallbladder and overall body tone. Recommended 6 months after the exacerbation. Mineral water with low salinity (Essentuki No. 4, Borjomi, Slavic)

dispensary observation of patients with acute pancreatitis - 3 years

The indications for hospitalization: ..

1) The lack of effect of therapeutic interventions in the home;

2) frequent relapses ,.

3) concomitant diseases of the gastrointestinal tract during exacerbations


Preventing exacerbations and success of treatment depends on the elimination of concomitant diseases of the gastrointestinal tract and focus of chronic infection

Chronic pancreatitis

Chronic pancreatitis -. a progressive inflammatory disease characterized by progressive progressive sclerosis (replacement connective tissue of the gland tissue) and focal, segmental or diffuse exocrine tissue destruction

The reasons that lead to the development of chronic pancreatitis. a genetic predisposition, prolonged obstruction of the pancreas in diseases of the gallbladder and bile ducts; Duodenal factors (oddit papilla sclerosis parapapillyarnye diverticula, tumors of the papilla and pancreatic duct, duodenal papilla main pollipoz); Hemochromatosis (combination diabetes and chronic liver disease, exocrine pancreatic insufficiency); dysmetabolic disorders (hyperparathyroidism, hyperlipidemia); systemic diseases (cystic fibrosis, renal failure, systemic lupus erythematosus); Vascular injuries.


1 After :. origin Second primary and secondary

form :.

1) recurrent,

2) with constant pain,

3) latency

the third period of the disease.

1) Tightening;

2) remission

4 clinical course: Linear

1) separated by severity: mild, moderate, severe,

a) pankreatopechenochny;

b) of the brain;

c) renal syndrome, and others.

3) the stage of the disease. Final initial manifestations work

4) State of the pancreas:

a) the state of the external secretion of:

b) no evidence of exocrine insufficiency,

c) with symptoms of exogenous failure;

5) The state of internal secretion;

6), without altering the internal secretion ;.

7) with internal secretion disorders (hyper-and hypo-function insular apparatus)

5 pancreatic complications

The mechanisms of disease

The aetiology of the disease the following :.

1) leads to blockage of the pressure increase in the pancreatic duct and the expansion;

2) dysmetabolic disorders :. waiting for the return of the mass of the protein in the small ducts of the pancreas developed fibrous tissue, small canal stenosis with cyst formation,

3) immunopathological mechanisms

Symptoms of the disease

pain syndrome, dyspeptic syndrome, caused toxicity following errors in your diet. The pain is caused by the bitter taste in the mouth, nausea accompanied

An objective examination :. Under the gaze of blue gray skin, sometimes subikterichnost hypovitaminosis phenomena - dry, scaly skin, cracks in the corners of the mouth; the power is reduced; swollen belly; positive symptoms Mayo - Robson, Kacha, Desjardins, Chauffard grotto (atrophy of the fatty tissue of the anterior abdominal wall in the left upper quadrant)

After the meal, there are signs of exocrine insufficiency. Frequency and stool softener, polifekaliya in neutral fat steatorrhea Coprogram

In exocrine insufficiency -. bold, bright, badly washed polifekaliya chair, insufficient growth

Chronic pancreatitis with chronic pain manifest indolent course .. complaints of slack in constant pain, worse after errors in diet, in the projection pancreas. If palpation tenderness in the left upper quadrant, and the point of the pancreas

The diagnosis of the disease

Survey program:

1) count,

2) Urinalysis

3) the biochemical blood;

4) amylase curve with a double glucose load;

5) Coprogram chair;

6) exhibits: ultrasound;

7) X-ray examination (duodenography, ERCP, angiography, computed tomography),

8) ultrasound;

9) scintigraphy,

10) biopsy of the pancreas;

11) Laparoscopy,

12) splenoportography, oral pankreatoholangioskopiya.

Treatment Basics

in the acute phase (see above acute pancreatitis.)

without problems :. diet (Table No. 5), antispasmodic (papaverine Nospanum), vitamins, anabolic steroids (Nerobolum, Retabolil); . Pancreatic enzymes

Phytotherapy (birch leaves, calendula, licorice root)

Biological. enteroseptol or intestopan; Physiotherapy and spa treatment

The indications for surgical treatment.

- pancreatic cysts,

- organic duodenospaz,

- narrowing or clogging of the bile duct,

-. cicatricial narrowing of the main duodenal papilla

biliary dyskinesia

biliary dyskinesia - a functional motility disorders of the gallbladder and biliary tract, manifested. Pain in the right upper quadrant, resulting in violation of the outflow of bile into the duodenum

Classification of biliary tract diseases:

1), dyskinesia ducts Gallbladder and bile ducts:

a) gipermotornaya - high blood pressure, giperkeneziya;

b) engine hiccups - hypotonia, akinesia,

c) mixed;

2) gallbladder dyskinesia;

3) inflammatory disease (cholecystitis holongit, holetsistoholangit) Power: acute, chronic; Stage of disease: exacerbation, remission,

4) congenital malformations of the gallbladder and bile ducts;

5) cholelithiasis;

6) parasitic diseases (opistorhoz, ehinokokkokoz, helminths) ;.

7) tumors

The reasons that lead to the development of the disease

dyskinesia is primary, including changes in neurohormonal mechanisms develop shared with drunkenness Incidental and secondary allergic diseases, endocrine and hormonal diseases, neurosis, which reflexively by type of visceral visceral reflexes occur in diseases of the abdominal cavity, joining holetsistoholangitu chronic cholelithiasis.

Mechanisms of disease development

The appearance of motility disorders of the bile ducts and biliary hypertension results in a change in normal blood flow in ducts gallbladder and bile ducts, resulting in hypoxia followed by changes the permeability of cell membranes and biochemical processes in the cells of the mucosa of the gallbladder and the liver.


manifests with abdominal pain, especially in the right upper quadrant. Pain or cramping in nature accompanied by gastrointestinal symptoms (nausea, vomiting, bitter taste in the mouth, intolerance to fatty foods, unstable chair), is a characteristic feature of the relationship of pain to mental and physical overload nerve.

The pain syndrome in hypertensive dyskinesia characterized by pain paroxysmal character (cramps, punctures, cuts), is associated with emotional and physical problems over-exertion, radiating to the right shoulder area of ​​the upper abdomen and navel

complications.:. development of chronic cholecystitis, cholelithiasis

The diagnosis of the disease

Survey program:

1) count,

2) urinalysis,

3) Blood chemistry

4) Break the duodenal intubation, microscopic and biochemical study of bile;

5) US-cholecystography;

6) ultrasound of the liver and gallbladder, there are signs of stagnation of bile from the gallbladder abnormalities

Treatment Basics

Diet Therapy

table number. 5 - the power mechanically, chemically, thermally soft. Morning and afternoon must contain dairy products. Exclude diet meal extracts, essential oils, peppers, onions, garlic, sausage, biscuits, chocolate, coffee.

If dyskinesia gipomotornoy show choleretic effect products (butter and vegetable oil, eggs, cream, sour cream, bread, vegetables and fruit).

When dyskinesia hyper engine can not eat rye bread, peas, cold drinks, ice cream.

The choleretic therapy

applied drugs that stimulate galls (holagol, holenzim); The formulations containing bile acids (Allohol, liobil); Drugs that increase the tone of the bile duct (sorbitol, xylitol, magnesium sulfate) to perform; herbal medicines (dandelion, rose, mint, corn). Mineral water dyskinesia gipomotornoy high and medium mineralization, as "Essentuki" Used cause

25 May, 2016