Особливості лікувальної тактики при хронічному панкреатиті у поєднанні з хронічним обструктивним захворюванням легень Резюме Метою роботи стало висвітлення особливостей стратегії та тактики лікування хронічного панкреатиту за умов коморбідності з хронічним обструктивним захворюванням легень. Автори акцентували увагу на виконанні рекомендацій уніфікованих протоколів, які затверджені наказами Міністерства охорони здоров'я для лікування кожної хвороби, а також уніфікованих Європейських клінічних рекомендацій з діагностики та лікування ХП (2017 р.) і рекомендацій GOLD (2018 р.) щодо лікування хронічного обструктивного захворювання легень. Підкреслюється значення препаратів, які спрямовуються на ліквідацію абдомінального болю, зовнішньосекреторної недостатності підшлункової залози, оптимальності застосування бронхолітичної терапії, особливостей призначення кортикостероїдів та показань для використання антибіотикотерапії.
The aim of this article is to draw attention of gastroenterologists, surgeons and primary care physicians to the features of the course of pancreatitis complications, which tend to have an acute course and are a complex process that causes medical errors and life tragedies.
The importance of complications of pancreatitis such as cysts, pseudocysts, fistulas, cholestatic syndrome, portal hypertension syndrome, bleeding from varicose veins of the esophagus, stomach and erosive-ulcerative secondary gastroduodenal processes is emphasized.
Attention is focused on the mechanisms of development of these complications, features of the clinical course, management tactics of such patients, depending on the location of the complications, which is important for the treatment strategy (conservative or surgical). The peculiarities of the clinical picture of the syndrome of compression of neighboring organs, thrombosis of the hepatic and splenic veins, biliodigestive bleeding, including hemobilia, bleeding from the large and small duodenal papilla, are directly related to the analytical approach regarding the diagnosis of these complications. Angiographic techniques are considered to be the most effective diagnostic techniques, which include celiacography, upper mesentericography, percutaneous and transhepatic portography. It is indicated that on their basis, techniques for stopping bleeding have been developed, namely endovascular catheter hemostasis.
The aim: To examine the features of the clinical course of osteoarthritis in combination with type 2 diabetes on the background of obesity and hypertension.
Materials and methods: 116 patients who were in the inpatient stage of treatment in the rheumatology department of the Chernivtsi Regional Clinical Hospital during 2015-2017 were examined. The epidemiological and clinical features of osteoarthritis in patients with type 2 diabetes mellitus were also analyzed.
Results: It was found that the course of osteoarthritis is extremely severe with limited range of motion in the joints, their deformation and significant deteri¬oration of functional capacity, duration of pain, periodic prolonged exacerbations, the predominance of knee and hip injuries (64.8%) and 14.8 persons - small joints. This showed the progression and generalization of processes in various joints, aggravation of the course and prognosis of osteoarthritis, especially in women. Their prevalence was registered at II radiological stage (59.27% and 74.0%, respectively).
Conclusions: The authors emphasize that such a clinical course indicates the worst prognosis. This multimorbidity of diseases requires treatment, observation and consultation with a traumatologist, rheumatologist and endocrinologist, due to the multisystem approach to the treatment and rehabilitation of such patients with an emphasis on individual clinical features (including gender) and the course of comorbidities or syndromes.
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