The article identifies the features of the pathology of the gastrointestinal tract in patients with gastroesophageal reflux disease on the background of hypothyroidism. The frequency of gastroesophageal reflux disease and the severity of this disease increase with age and the presence of comorbid pathology. In the elderly, the frequency of the typical esophageal manifestations decreases, and the erosive esophagitis with atypical symptoms is more common. The growing number of cases of combined thyroid dysfunction with gastropathology requires in-depth study of the reasons for the relationship between these processes. Pathological changes in the gastrointestinal tract in these patients make their condition severer, contributing to the development and progression of metabolic disorders. An important aggravating effect on the regulatory mechanisms of esophageal kinetics has a pathological functioning of the thyroid gland on the background of iodine deficiency. Results and discussion. In patients with gastroesophageal reflux disease with hypothyroidism, all changes in gastric and duodenal function are associated with a decrease in the acid-forming function of the gastric mucosa, due to its atrophy, decreased tone and contractility of the stomach. This in turn leads to a slowing of gastric and duodenal evacuation, dysfunction of the closing capacity of the cardia and, as a consequence, the development of duodenogastroesophageal reflux. The esophageal contents are not so pronounced, so patients with non-erosive forms of esophagitis predominate (46.2%) against 16% of patients in the second group (patients with gastroesophageal reflux disease). At the same time, erosive forms predominate among patients in the control group with predominant acid reflux. It should be noted that there is a clear relationship between the frequency of erosive changes in the esophageal mucosa and the duration of the disease. Thus, among patients of the main group with a 5-year history of the disease, the number of erosive forms of gastroesophageal reflux disease was minimal. The number of erosive changes in the esophageal mucosa increased sharply in patients with a 10-year history and reached its maximum after 15 years from the onset of the disease. Conclusion. The delay in gastric evacuation is more pronounced in patients with gastroesophageal reflux disease on the background of hypothyroidism. It can be explained by a decrease in gastric motility and the presence of duodenostasis. The slowing of gastric evacuation was more pronounced in patients with gastroesophageal reflux disease on the background of reduced thyroid function. In patients with gastroesophageal reflux disease on the background of hypothyroidism there is an alkaline duodenogastroesophageal reflux as a consequence of reduced acid-forming function of the gastric mucosa and reduced contractility of the stomach and duodenum
The purpose of the work was to study the clinical course of gastroesophageal reflux disease with acid and alkaline refluxes, to investigate the psychosomatic state, the features of endoscopic changes in the esophageal mucosa, changes in pH-measurement and gastric motility in patients with gastroesophageal reflux disease depending on the type of reflux. Materials and methods. A study of 60 patients with gastroesophageal reflux disease aged 24-65 years (mean age 44.5±5.3 years) was carried out. The main group consisted of 35 patients with gastroesophageal reflux disease with concomitant acid reflux, and the comparison group included 25 patients with verified alkaline reflux. Control group consisted of 20 practically healthy people. The groups were representative by age and sex. All patients underwent a comprehensive diagnostic program, which included a careful collection of life and medical history, questionnaires, clinical examinations, anthropometric studies, laboratory and instrumental studies. Results and discussion. Among the examined patients with gastroesophageal reflux disease with acid reflux, men predominated (60%). In contrast, the patients with alkaline reflux were dominated by female patients –76%. Most patients with alkaline reflux were overweight and had obesity of I and II degree. Тhe abdominal type of the obesity prevailed in the patients with alkaline reflux (64%). In the main group of the patients there was an increase in the number of acid reflux per day – 125±2.6, alkaline – 60±2.1 in the comparison group – 113±44.2 (p <0.01). In the control group, weakly acidic reflux, which coincided with clinical manifestations, was registered less frequently – the average daily rate was 155±24.3. The average daily number of refluxes over 5 minutes in patients with acid reflux was 19.7±3.5, with alkaline – 16.8±3.3. The erosive form of gastroesophageal reflux disease was observed more often with alkaline refluxes in 14 (66.7%) people: reflux esophagitis grade A (38.1%), grade B (19.1%), grade C (9.5%) patients. However, the non-erosive form was more observed in patients with acid reflux (59.3%). Delayed gastric evacuation is more pronounced in patients with gastroesophageal reflux disease with alkaline reflux, which can be explained by slowing of motility of the stomach and the presence of duodenostasis. In the vast majority of patients in this group, complete evacuation of contrast from the stomach occurred in a period of 3 hours or more. This allows us to conclude that the violation of the contractile ability of the stomach is one of the main factors that slows gastric evacuation, increases intragastric pressure and contributes to the development of pathological dumping of gastric contents into the esophagus. Conclusion. The combined course of gastroesophageal reflux disease with acid and alkaline reflux is characterized by specific etiopathogenetic mechanisms of development, polymorphism of clinical symptoms, which worsens the psychosomatic state and quality of life of patients. In patients with gastroesophageal reflux disease with alkaline refluxes, concomitant lesions of the pancreato-biliary system were more often diagnosed. The erosive form of gastroesophageal reflux disease was observed more often with alkaline refluxes (66.7%) patients. However, the non-erosive form was more observed in patients with acid reflux (59.3%). A hiatal hernia was found in patients with acidic (22.9%) and alkaline reflux (28.1%). Insufficiency of the lower esophageal sphincter was observed in 40% of patients with alkaline reflux, in 34.2% of patients with acid reflux with normal body weight. In gastroesophageal reflux disease with acid reflux, persistent delay in gastric evacuation is caused by persistent pylorospasm
The purpose of the study was to determine the feasibility of using the Case study method in teaching clinical disciplines to students of a medical university, its advantages, problems and the value of using it in an online format. Results and discussion. Studying in medical higher education institutions has always been quite challenging and requires the involvement of various student reserves. The COVID-19 pandemic and martial law in Ukraine has brought many changes to the life of society in general and the educational process in particular. Medical students lost the opportunity to gain clinical experience, as the entire educational process was transferred to an online format. The Case study method in teaching clinical disciplines has become extremely effective in this situation. The Case study method or method of situational exercises makes it possible to bring the learning process closer to the real practical activities of specialists. The Case study method is based on the concept of developing mental abilities. The essence of the method is the use of specific cases (clinical situations, disease histories, the texts of which are called “cases”) for joint analysis, discussion or decision-making by students from a certain section of training in the discipline “Internal Medicine” or “Surgery”. The value of the Case study method lies in the fact that it simultaneously reflects not only a practical problem, but also actualizes a certain set of knowledge that must be mastered when solving this problem, and also successfully combines educational and analytical activities. The educational tasks of the Case study method consist in acquiring the skills of using theoretical material to analyze practical problems; in the formation of skills for assessing the situation, choosing and organizing the search for basic information for formulating a clinical diagnosis; in the development of the ability to formulate questions and requests; in the development of skills to develop multivariate approaches to the implementation of an action plan for diagnosis and treatment; in the formation of the ability to independently make decisions in conditions of uncertainty; forecasting ways of development of clinical situations. For the effective use of the Case study method, it is necessary to create special conditions: ensuring a sufficiently high complexity of the clinical problem that students need to solve; creation by the teacher of a logical series of questions that motivate students to search for the truth; creation of an atmosphere of psychological comfort in the classroom, which should facilitate students' free expression of their thoughts without fear of making mistakes; devoting special time to thinking about ways to solve the problem. A student who is preparing to discuss a case in the classroom must study the facts, draw conclusions from these facts, evaluate alternatives for actions in a given situation and make a choice in favor of one or another plan of action. Conclusion. Changes in life in the modern world also require changes in the purpose of modern education. The value of the Case study method is that it simultaneously reflects not only a practical problem, but also actualizes a certain set of knowledge that must be mastered when solving this problem
Вищий державни й навчальний заклад України «Буковинський державний медичний університет», м. Чернівці Резюме. У статті висвітлені клінічні прояви гастроезофагеальної рефлюксної хвороби, зумовлені супутньою патологією щитоподібної залози. Порушення вторинної перистальтики стравоходу, що трапляються в більшості хворих на гіпотиреоз, сприяють більш тяжкому перебігу захворювання.Ключові слова: гастроезофагеальна рефлюксна хвороба, гіпотиреоз, клінічний перебіг.
Вивчено динаміку локальних морфологічних змін при синдромі діабетичної стопи (СДС) у 215 хворих за умови адекватного місцевого лікування за розробленими стандартами. За даними гістологічних досліджень, відзначали зменшення набряку, клітинної інфільтрації, мікроциркуляторних розладів в крайовій зоні рани в динаміці лікування. Через 1 тиж від початку лікування у біоптатах виявляли молоду грануляційну тканину з великою кількістю петель судин, орієнтованих перпендикулярно рановій поверхні, і численних тяжів фібробластів. Через 2 тиж спостерігали активну епітелізацію ранового дефекту в декілька шарів. З боку збереженої шкіри наповзав пласт, що вкрива в ранову поверхню.
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