Endocrine deficiency in the diagnosis. Enzyme deficiency

Lack of undershoot in children borrowing more than the position of the pathology of organs in the herbal tract, due to a variety of reasons and clinical manifestations. The smell is rich in what anatomical roztashuvannyam explains: zaliza zaymaє central camp in black wastes, Chastina її - retroperitoneally (retroperitoneally), the head of the thigh tight ligament with the twelve-fingered intestine, the tail of the swelling at the gates of the spleen.

Reasons for the appearance of pathology in the child

Pidshlunkova zloza is a single organ with a subordinate function - internal and external secretion:

• viroblya pancreatic sic, which reveals enzymes and biologically active speech;
• synthesis of insulin and glucagon, which take part in the carbohydrate exchange and inject into the microcirculation of their organs and systems.

In connection with the development of functions and the participation of the slurry formation in the processes in the body, the deterioration of the activity can be due to various reasons:

• the wrong mode of food і shkіdliva їzha;
• abdominal trauma;
• stress and chronic psychomotional overstrain;
• Infections (viruses and bacteria).

Uninvolved on for reasons When it comes to the destruction of the robotic slurry, there is a clinical picture in all types of symptoms: both during the ignition process, and if there is a lack of enzymes, not related to the ignition.

Pancreatic deficiency in children is primary and secondary.

First of all, the non-modifiable officials (they can't change any car, no patient). Cerebral disease of abnormal conditions:

• congenital obstruction of the posterior pancreatic duct;
• , Genetically speculative;
• lack of synthesis of deyakikh enzymes - deficiency of lipase or trypsin through dysfunction of the underworld.

In children, in the main, there is a secondary lack of zalosis (pancreatopathy, dispancreatism).

To the reasons I can see the child's sleep at the child:

• shkidliva їzha;
• pereїdannya;
• Timing of the decrease in the functions of the entry.

To the second disadvantage, to produce igniters for the seizure of suspicious herbal organs:

• gastroduodenitis;
• cholecystitis;
• dyskinesia of young people.

diagnostics come in

The robot is destroyed by pidshlunkovoy zalozi manifests itself in all typical symptoms: pain, tediousness, decreased appetite, carrying. For some people, it’s a trivial hour of great importance to show you can butt on the day. Ale, in a shabby tse, bring to the turns of the grass process.

Diagnostics of such stan_vs is difficult through the lack of manifestations and minor changes in functional methods of improvement.

It’s like a child to skarzhi on tediousness, to see from їzhі, a new pain in the stomach, blues, and the whole spectrum of symptomatic therapy is victorious.

Drug treatment

Medication for treatment of polyaga in the conducted. New drugs, direct to the list of functions, allow to live the necessary amount of fat, and the lack of lipase is compensated for by adequate dosage of urges. I will paint the nutritious status, it is important, the fragments of the childish organism are constantly growing.

The enzymatic preparation is taken up in place of new pancreatin, before the storage of which includes the main enzymes (lipase, amylase, protease). Pancreatin, Festal, Mezim-forte and іnshі are meant.

More effective є vikorystannya to Creon, which is released in the eyes of the capsules, and revenge microspheres in pH-sensitive shells. The producers of such innovative forms of microcapsules, for revealing the enzyme, repairing the breakdown of fat, in carbohydrates and twelve-fingered intestines, PH-style the shell does not allow hydrochloric acid into the slurry porous the integrity of the microspheres, the stench goes into the education of the two-fingered intestines of the non-smart. Only there will be given to the enzyme.

Childish vіk not contraindicated until Creon's sign. Schob maluk mg kovtati is a drug, a capsule is opened with a small amount of water and a microsphere vipity.

Until the change of the day enzyme preparations to be submitted:

• the possibility of storing in any business;
• visibility of side events;
• good portability.

The remaining point is especially important, and the reflections in deyakyh situations will be considered a therapy for all life. Children with an enzyme lack of the drug need to take from decile types to decile times.

Creon maє wide range showing, ale the smut of recognition - memorize an extraordinary shortfall of the pidshlunkovaya zalozi. The criterion for the correct dosage is the normalization of the style and the change in its frequency.

As soon as the poisoning of the organs of poisoning, which led to pancreatic slaughter, in parallel, it is recommended to take:

• antispasmodics (Duspatalin);
• prokinetics;
• Ingibitories of the proton pump.

All drugs are recognized only by a pediatrician or a gastroenterologist individually, in the patient's age.

folk methods

Due to the complexity of the problem, the triviality of using enzymes, the high speed of acceleration, it is categorically not to recommend pancreatic deficiency in children using folk methods. It can be provocative, as it becomes a shipment to the most basic manifestations in cases of asymptomatic transition of pathology.

Can you get better

If there are no recommendations, indicated by the drug, and the correct schedule of the day, including the obligatory hours of mixing in any products, do not step on. In general, the exocrine deficiency of the pancreatic cavity is manifested as a strong clinical symptomatology of pancreatitis and nadal podbaє chronic interruption from the sharpened ones, which require treatment in the stationary.

Diet in the period of ailments

Diet in case of tsy pathology - not a lot of part of the disease. Porushuvati cannot be found when receiving a different therapy.

Inodi fakhivtsi is a sign of intercourse in harchuvanny on a big and big price. However, do not get out of the way of getting rid of the ryvnovag, it is necessary to start the harvesting regime:

• mechanically and chemically merciful;
• temperature regime - she is guilty of being warm;
• shot shot (5-6 times per day) in small portions;
• obmezhennya zanadto fatty, greased, smoked and spicy;
• reception of a sufficient amount of rіdini (sampling of gas drinks, mint tea, kava);
• to catch the intervals between every hour and every hour.

Schab did not happen to lіkuvati and interconnect in the child, the fathers need to respectfully seek for the persecution of the little boy. Chance the beast to the fahivtsia and the elimination of pathological illnesses to outrun the development of chronic illnesses. Dotrimannya the regime of the day, the correct reception and help to eliminate problems for the health of children.

List of Literature

1. Belmer S.V. Problems of herbal deficiency: viznachennya, viyavlennya, korekts_ya. Russian medical journal. 2003 r No. 3 T. 11 side. 119-121.
2. A.V. Netsvetaev Surgical pathology of fatigue in children (clinics, diagnostics, lykuvannya). Abstract of dissertation.
3. Korovina N.A., Zakharova I.M., Malova N.Y. Exocrine deficiencies in undershooting: problems and solutions (essential for patients). M. 2004 p
4. Korotko G.F. Secretion of the slurry layer. 2nd additional view. Vidavnitstvo Kuban Sovereign University 2005 r
5. Belmer S.V., Gasilina T.V., Zavalin P.A., Kovalenko A.A. Exocrine deficiency in children: methods of diagnostics and correction (methodical aspects). M. 2001 r

Pidshlunkov zalosa (PZh) is the most important exocrine organ of the herbal system and humans, so that it will not digest all the main components of the population: protein, fat, carbohydrates. In addition, there is no need to take revenge on the endocrine elements that were grouped in the island of Langerhans or diffusely change in all parenchyma. The main endocrine function of the pancreas is the regulation of carbohydrate metabolism through the secretion of insulin and glucagon, however, it also produces somatostatin, gastrin, vasoactive intestinal peptide and rich regulatory peptides.

The main components of the pancreas secretion are enzymes (Table 1 and Table 2), sodium bicarbonate and water.

Trypsin, chymotrypsin, elastase, and many others are introduced to the proteolytic enzymes of the pancreas. All the proteolytic enzymes of the pancreas are produced in an inactive view and are subsequently activated by trypsin. At the same time, trypsinogen activation occurs, it is seen in the twelve-fingered intestinal Enterokinase. In its own cell, the inactive enterokinase is activated by duodenase, and is also produced by cells of the twelve-fingered intestine.

The proteolytic effect of pancreatic secretion is accumulated by three endopeptidases - trypsin, chymotrypsin and elastase, which release bottles and polypeptides, when it comes from the slurry. Trypsin is specifically for peptide links, set with basic amino acids, chymotpsin - for linking with surpluses of uncharged amino acids, at that time, when elastase, in all its name, can be added to a wide specificity, , such as glucin, alanin and serine. Intestinal enterokinase, which activates trypsinogen, also proteolytic enzyme, which breaks down lysin peptide bonds into vitogens, vivifies malium polypeptide, which can be used to produce active trypsin until the molecule is expanded into active trypsin.

The human body can also be a forced system of proteolytic enzymes, up to which alpha 1 antitrypsin (alpha 1-AT) and alpha2-macroglobulin (alpha2-MG) are supplied. Alpha 1 AT (abo ingibitor alpha 1 protease) is synthesized by hepatocytes and the ingibitor of basic serine proteases. Win induces elastase of neutrophils, thrombin, plasma, factor of laryngeal blood and elastase of granulocytes. In case of ignition reactions, the speed of synthesis and growth instead of in the blood plasma increases, and the complex with proteases is quickly transferred to alpha2-MG. And alpha2-MG is a polyvalent ingibitor, tying all types of endopeptidases, including trypsin, chymotripsin, elastase, collagenase and many other enzymes. Vin is synthesized by hepatocytes, Kupffer cells, alveolar macrophages and fibroblasts.

Violation of the balance between the activity of the enzyme and of the ingibitors can be the reason for the development of such diseases as emphysema legeny, atherosclerosis, state of pancreatitis and in.

Z cym to bind the development of chronic recessive pancreatitis, which is not genetically root. In this hour, a number of mutations of decile genes have been established, which are indicative of the development of this disease. With one of these options, the disease is transmitted by an autosomal dominant type with 80% penetrance. In 1996, on chromosome 7q35, there was a gene that was associated with a cationic trypsinogen. At the moment, 8 mutations have been described in this gene. Mutations D22G, K23R, N29I, N29T, R122H and R122C produce up to an increase in autoactivity of trypsinogen, mutations N29T, R122H and R122C, stabilize trypsin on the basis of antibiotics. not a pathological effect. The R122H mutation saw the point of Arg122 autolysis, the D22G and K23R mutations induce the activation of Cathepsin B. Spasmodic pancreatitis manifests itself in the first rock of life, and in more adulthood, the appearance of overwhelming mutations is associated with a 50-fold increase in the development of pancreatic cancer. In addition to the trypsinogen gene, for the development of pancreatitis, there can also be enzymes in the gene of the inhibitor to trypsin (Serin Protease Inhibitor Kazal type 1 = SPINK1 or PSTI) on the 5th chromosome, which can also lead to the activation of the inhibitor to trypsin. In chicks, an autosomal recessive type of decay is transmitted.

Lipazi, the order of elastase-1, are sensitive markers of impairment of the exocrine function of the pancreas The stink is activated in the enlightenment of the two-fingered intestine with gum acids. Remain also emulsify fats, lodged by pouring lipases on them. The connection with the cym of the interaction of secretory processes in the liver and the pancreas is guiltyly synchronized, so that it takes care of all the regulatory systems.

Amilolytic activity (splitting of starch) of pancreatic secretion is initiated by amylase, a single enzyme, which is secreted immediately in active form.

An important mind-boggling interruption of over-etching processes є the optimal pH value in the enlightenment of the two-fingered intestine, close to neutral. Neutralization of sour in the place of coming from the slunk, taking care of the puddle secretion of the antrum from the slunk, twelve-fingered intestine, as well as bicarbonates of the gut and pancreatic secretion.

Regulation of the exocrine function of the pancreas will be provided with central ones, as well as micro-mechanisms They are both nervous and humoral. Central stimulation of exocrine pancreatic secretion is provided through parasympathetic viddil vegetative nervous system along the fibers of the bloating nerve.

The misregulation of the pancreas function is ensured through the system of regulatory peptides, the most effective vivification of secretin and cholecystokinin.

Secretin is produced by S-cells of the mucous membrane of the duodenum intestine, and cholecystokinin (synonymic: pancreozymin) - by I-cells. The secretion of both peptides is mediatedly stimulated through the form of releasing peptides, which produce the mucous membrane clitins of the duodenum intestine in response to stimulation of intestinal education.

Stimulant of pancreatic secretion is also neurotensin (NT), modulator - motilin, inhibitor - somatostatin, peptide YY (PYY) and pancreatic polypeptide (PP).

Ailments of the flesh can develop in cases of spadkov, vrodzhene, and piddling, moreover, chronic illnesses (for example, pancreatitis) develop in the presence of anatomical or structural abnormalities of congenital malformations.

The working nomenclature of pancreatic disease in children is presented below.

Growth and decline

1. Morphological anomalies:

Ectopia PZh;

Annular hair loss with the presence of duodenal stenosis and without it;

Rozdvoєna zaliza.

2. Partial manifestation of exocrine pancreatic insufficiency:

Lack of lipase (Sheldon-Ray syndrome) is isolated;

Nstitutional decrease in amylase activity (pancreatic amylase deficiency);

Isolation of trypsinogen deficiency and intestinal enteropeptidase (enterokinase) deficiency.

3. Generalized natural exocrine pancreatic insufficiency (including Schwachman-Diamond syndrome, exocrine pancreatic insufficiency in cystic fibrosis, as well as developmental syndromes: Johanson-Blizzard syndrome, Pyrone syndrome)

podbani

1. Gostry pancreatitis:

Viruses infections with pancreatitis;

Lykarsky State University of Pancreatitis;

Traumatic pancreatitis;

Pancreatitis in Rey's syndrome;

Pancreatitis with ailments of Schönlein-Henoch;

Pancreatitis as a result of organisms' reaction to chippings;

Pancreatitis through nadmirne harchuvannya;

Juvenile tropical pancreatic syndrome.

2. Chronic and chronic recurrent pancreatitis:

Recession of pancreatitis;

Pancreatitis with anomalies in the development of bilious and pancreatic vivid ducts;

Pancreatitis in metabolic disorders (hyperparathyroidism, hyperlipidemia, lack of alpha 1 antitrypsin).

3. Zmіni zvnіshnosekretornoї function of the pancreas in case of bilkovo-energetic deficiency of harchuvannya (kwashiorkor).

Bagato zhvoryuvan PZh show itself, in the first place, signs of exocrine pancreatic insufficiency (EPN). Typical manifestations of the EPN turn є accelerations of kashkopodibny style of gray color with a fat blisk, polyfecal. In most important cases, it is more difficult to admit fat from the anal opening; As a touch of a damaged over-etching є a decrease in muscle mass, signs of hypo-taminosis, especially fatty vitamins, in children of an early age - introduced into psychomotor development. At the same hour, even more often EPN manifests itself in an erased form, not only without typical symptomatology, it is less likely to occur in laboratory conditions.

For the discovery of the damaged exocrine function of the pancreas, it is necessary to use the development methods of further development.

Naybilsh accessible є scatological dosage. The change to the change of neutral fat is directed to the destruction of the polypolytic function of the pancreas, the reduction of the meat fibers - to the disruption of the proteolytic processes, in which one would like to take part not only of the protease of the pancake, ale also the slurry in the over-etched starch, add sv_y additions as well as sludge amilase. Coprogram with accurate and competent conduct є to reach informative dosages, in a large amount of differential diagnostics and monitoring will become ill. More accurate indirect method, more folding and expensive є lipidogram feces.

We use a highly informative method for assessing the exocrine function of the pancreas є value in the feces of pancreatic elastasis-1. The norm is the value of elastasi-1 in the feces of 200 mcg / ml feces. More low values ​​will be included in the EPN. It is important that the test results do not infuse either the character of the patient's eating or the preparation of pancreatic enzymes.

At the same time, the method does not allow evaluating the turnover often to detect an obvious deficiency of the pancreas, showing it with a normal value. If there is no evidence of the results of indirect tests (coprograms or lipidograms of feces), it is possible to make a difference about the secondary nature of herbal deficiency. The fault is that it is the primary deficiency, if there is a rotated steatorrhea for the rakhunok triglycerides, the normal value of fecal elastasis-1 will be prevented.

Moreover, only the data of indirect methods for the improvement of the exocrine function of the pancreas allow to assess the adequacy of the particular therapy and to adjust the dose to the drug.

Exocrine deficiency of the pancreas can be primary and secondary (suput). Pervinna, the incidence of EPN is susceptible to congenital pancreatic hypoplasia (isolated or in the warehouse of numerical syndromes), cystic fibrosis, Schwachman-Diamond syndrome, congenital malignant deficiencies in children childish syndromes... Prior to the primary use of the EPN for chronic pancreatitis, as well as of the EPN for the resection of the pancreas.

Cystic fibrosis (CF) є to endure frequent monogenic autosomal recessive illnesses, mutation of the gene of the transmembrane conductivity regulator MV (CFTR). For CF, it is characteristic of practically all organs and systems of the body to be defeated, an important interruption and an unpleasant prognosis. In the meaning of the world, there can be a great deal of organization and etching. Characteristic for MV є of the risky step pivot (zvvychay important) ekzokrinna lack of pancreas. Diagnostic criteria for CF, critical donations, chlorine supplementation, as well as the results of genetic diagnosis.

Shvakhman-Diamond Syndrome - congenital syndrome, which is characterized by EPI (more importantly lipase) on the other pancreatic hypoplasia, hematologic disorders (often neutropenia, but it may also be possible to promote abnormalities of thrombocyte anemia) stegovyh kistokі colinny loams, moss clinodactyly, hypoplasia of phalanges, vuzka chest wall). key picture it is polymorphic and occurs as a perevazhny syndrome. In the case of the prevalence of pancreatic deficiencies, it is manifested in a fatty style and hypotrophic stage of turnover. Diagnosis is made on the basis of clinical and laboratory data.

In both cases, the basis of therapy is based on therapy with highly effective preparations of pancreatic enzymes. In case of adequate correction of the damaged function of the pancreas, the prognosis can be remarkably friendly.

A probable lack of deficiency manifests itself in the people with a bold style and in all the laboratory signs. The versatility of the diagnosis of a disease is tied to the need to include all of the disease, as the EPN is manifested. In the meaning of the world, steatorrhea for the rakhunok triglycerides at normal performance rivnya elastazi-1 in cali.

Also described are the problems of congenital and isolated deficiency of amylasia, as it manifests itself in diarrhea with amilorrhea, as well as trypsin and enterokinase, which appear in diarrhea with creatorrhea, hypoprotein and hypotension. Tsіvoryuvannya іsrіchayuyutsya in the edge of a little, ale їх slіd vrahovuvati in the course of differential diagnostics.

A decrease in herbal activity of the pancreas can be prevented in case of problems with diseases shlunkovo-intestinal tract... In some cases, there is an absolute character and is tied to a decrease in the function of the lifespan, and in others, it is an absolute one. So, a transient decrease in function, linked to the breakdown of the regulation of pancreatic secretion, is promoted with celiac disease. There is a common drawback.

With a twisting ailment of the two-fingered intestine on aphids, it is possible to over-acidify the middle in the intestine, until the function of herbal enzymes is damaged, the optimum pH for which lies between 5-7. The most common mechanism is found in the case of Zollinger-Ellison syndrome, in case of any minor gastrinoma - puffin from gastrin-producing G-clitin, which can be localized in the pancreas, liver and other organs. Gypergastrinemia to produce the slurry hypersecretion with a light vialization in the slurry and the intestine, and also with malabsorption in the case of inactivation of pancreatic enzymes at low pH values.

In case of cholepathies due to lack of good gut in the intestine and / or damage to the storehouse, the function of pancreatic enzymes also deteriorates, in the first place, if there is a lack of fatty emulsion enzymes In addition, if there is a lack of gum acids, the processes of soaking fatty acids in the small intestine may deteriorate. Zaznachenі destructiveness is manifested by a syndrome of impaired intestinal moistening of a small character.

Loss of motility of the shlunkovo-intestinal tract of any kind, including Ch. functional breakdown Also, it can be superficially damaged by the deterioration of the growth stage as a result of an overwhelmingly swift, abo, navpaki, which relies on the passage of humus through the intestines.

Secondary deterioration of the exocrine function of the pancreas, not tied to the tissues of the acinar tissue, can be prevented when fiery ills intestines, celiac, food allergy. In cich vipadkah, it is also shown the sign of drugs in pancreatic enzymes.

The root of the herbal function of the pancreas is to blame for the inclusion of the main ailment, yake called for development, as well as symptomatic therapy, In t. Ch. Korektsіyu nutritive razladіv, up to which EPN can lead. An important aspect of the therapy of the group of illnesses is the nature of the therapy, the nature of which is due to the main illnesses. In connection with the cym, it means that the emergence of highly effective drugs in different therapy was made with earlier recommendations to reduce the reduction of fat loss. In a given hour, it is recommended to live in the week of birth, a quantity of fat, and a short amount of lipase to compensate for a specific dose of the drug. It is permissible to polish the nutritive status of a sick person, which is especially important for an adult child's body.

The emergence of highly effective mini-microspherical preparations in pancreatic enzymes with a pH-sensitive membrane has made its way to a revolution in approaches to the most beneficial therapy in EPN.

Visoka activity of cich drugs in the form of a start to the factors. Perche, the highest level of activity of the viral substrate (pancreatin), vicarious for all virobnits. In another way, a special form of cich preparations (mini microspheres with a size of 1-1.2 mm) will prevent efficient mixing with a slurry chamber and synchronously passing through the intestine in two digits. It is shown that the diameter of the mini-microsphere is 1.0-1.2 mm, which is optimal at all times, while the sphere with a diameter of 2 mm is more likely to be inserted into the slurry no less than 2 years before the slurry comes out of the slurry. By third, the pH-sensitive shell of minimicrospheres captures the enzyme from the slurry into the slurry and vivilnya in the twelve-fingered intestines. The viscosity of the earworm should be reduced to at least 90% of its activity. In addition, the very smallest microspheres are housed in gelatin capsules, which capture all of the early activation in mouthwashі in stravohodі, de, also like і in twelve-fingered intestines, in the middle, and lie down with the drug. In such a rank, the preparation in the capsules reaches the slurry, the capsules are decompressed, and the mini-microspheres are vivified and mixed with the slurry. In twelve-fingered intestines, at a pH value of close to 5.5, the pH-sensitive shell of the mini-microspheres grows and the enzymes repair their diet.

With all the overwhelming features of Volodya Creon®, a mini-microspherical capsule preparation of pancreatic enzymes. In one capsule, the Creon® 10000 preparation contains 150 mg of highly purified pancreatin, cut off from the pancreas of a pig and stored in lipase (10000 E), amylase (8000 E) and proteases (600 E) (E = one Ph. Eur.). Creon® 25000 should contain 300 mg of highly purified pancreatin with high activity of lipase (25000 E), amylase (18000 E) and proteases (1000 E). The drug should be taken for an hour and a half. The dose is taken individually and lie in the severity of exocrine pancreatic insufficiency. In pediatric practice, the capsule can be safely opened and taken out of the microsphere, not roasted, with a small amount of water. As soon as there is a small microsphere with a small one, then it’s wrong to accept it in a secret way: in the first place, there can be a bit of an entero-dissolving shell.

As it was already meant food, in Danish hour the most reliable method of detecting and assessing the level of exocrine pancreatic deficiency є determining the activity of elastasis-1 in calories. At the same hour, a dose of drugs for a different therapy is carried out under control (except for clinical donors) by means of lipidograms or coprograms. Criteria for the effectiveness of the reverse dose є normalization of the style, for example, the decrease in frequency, the increase, greater consistency, the visibility of visible fat), and also)

middle of merit special preparations pancreatic enzymes for side effects, Good tolerance and availability in all groups. If necessary, it can be signaled by stretching a trivial period of an hour.

For the suppression of the deterioration of the etching of Creon® in an individualized dose, it should be indicated at once. At the end of the day, the entire dose will increase in contact with the kharchovy chyme and will not be used for etching and galvanizing the pancreatic secretion. Yaksho Creon® is indicated for the relief of pain syndrome, then it is necessary to take proteases (for example, Creon® 25000 to replace 1000 OD of proteases) and a part of the dose is prescribed for 30-60 minutes before the intake of the intestine, so that in the interdigital, intestinal a drug for ruining the cholecystokin-releasing factor.

High activity of water is also microtabletable preparations Pancitrate. In cich preparations, pancreatin is placed in a microtablet envelope, placed in a capsule with a pH-sensitive envelope. Pantzitrate has been produced for a long time on the vichiznya pharmacological market. At the same hour, additional advances and detailed control of vip testing in accordance with the principles of modern evidence-based medicine are required.

Such a rank, means the versatility of getting sick from the slurry zone in a differentiated way to the point of getting involved, however, it’s a lot of problems to get involved in the development of the EPN.? An early identification of the EPN і deciphering the reasons її development allows the indication of adequate therapy, which will prevent the development and development of the child.

literature

Keller J., Layer P. Human pancreatic exocrine response to nutrients in health and disease // Gut. 2005. Vol. 54. Suppl. 6.P. 1-28.

Korotko G.F. M., 2002.224 p.

Teich N., Mossner J. Genetic aspects of chronic pancreatitis // Med Sci Monit. 2004. Vol. 10.P. 25-28.

Kapranov N.I. Successes and problems in the diagnosis and elimination of cystic fibrosis in Russia // Pulmonology. 2001. No. 3. P. 9-16.

Carroccio A. Pancreatic enzyme therapy in childhood celiac disease // Dig. Dis. Sci. 1995. Vol. 40. P. 2555-2560.

Whithead A. M. Study to compare the enzyme activity, acid resistance and dissolution characteristics of currently available pancreatic enzyme preparations // Pharm.Weekbe (Sci). Ed. 1998. Vol. 10.P. 12-16.

Khavkin A. I., Rachkova N.S., Zhikhareva N.S., Fomin D.K., Murashkin V.Yu. 2004. T. 12. No. 3. S. 156-157.

T.V. Gasilina, candidate of medical sciences
S. V. Belmer, Doctor of Medical Sciences, Professor

Russian State Medical University, Moscow

Contact information about authors for listing: [Email protected]

For a quote: Babayan M.L. Deterioration of the exocrine func- 2013. No. 2. P. 76

Pidshlunkova zalosa vikonuu dvi important functions in our body. On one side, the production of insulin and glucagon - the main hormones, which regulates carbohydrate metabolism, so that endocrine function. It is the most important exocrine organ of the herbal system of humans, which will prevent digestion of all the main components of the population: protein, fat and carbohydrates.

literature
1. Belousova E.A., Zlatkina A.R. Syndrome of malabsorption (pathophysiology, clinics, likuvannya) // Handbook for practical patients. - M., 1998 .-- 28 p.
2. Belmer S.V., Gasilina T.V. ruin herbal functions pidshlunkovoy zalozi in children: Initial-methodical book M., 2006. - 40 p.
3. Kapranov N. І. Successes and problems in diagnostics and elimination of cystic fibrosis in Russia // Pulmonology. - 2001. - No. 3. - C. 9-16.
4. Korninko O.O., Shabalov N.P., Erman L.V. Poisoning organs of etching // Children ailments. Izd. 5, T. 1. - SPb, 2002.- P.556-753.
5. Korovina N.A., Zakharova I.M., Malova N.Є. Exocrine deficiency of pidshlunkovoy zalozi // Nutrition of modern pediatrics. - 2003.- T.2, No. 5.
6. Gschwantler M. et al. The pancreas as a site of granulomatous inflammation in Crohn's disease // Gastroenterol. 1995. Vol. 108. P. 1246-1249.
7. Lankisch P. G., Schidt I., Konig H., et al. Vimiryuvannya pancreatic elastasis1 does not help in the diagnosis of chronic pancreatitis with mild and moderate degrees of lack of exocrine func- tion of fenestration // Gut. 1998. Vol. 42. P. 551-554.
8. Witt H., Luck W., Hennies H. C. et al. Mutations in the gene encoding the serine protease inhibitor, Kazal type 1 are assotiated with chronic pancreatitis // Nature Genet. 2000. Vol. 25. P.213-216.
9. Witt H., Becher M. Genetics of chronic pancreatitis // J. Ped. Gastr. Nutr. Hepat. 2002. Vol. 34. P.125-136.

Pidshlunkova zalosa is considered for the production of enzymes. These components additionally help in the over-etched and splitted to bols, fats and carbohydrates. As the process collapses, the people start to see inappropriate symptoms in viglyadі zduttya abdomen, pain in lіvu botsі, boring. Such a rank, is the lack of fodder burrow.

Whether a type of sickness is not a fault of its own accord. The whole process is dependent on the inflow of unwelcoming factors at the viglyad:

Whether the reason for this list can be led to a lack of organ. As soon as there is a small amount of pancreatic juice, the grub's breast is almost completely overtravelled. It’s done before that the skin clinker is inadequate to the body’s wake-up material in the eyes of the white people.

Varto and memory about those who have grown up zalosa are responsible for the viralization of two important hormones in the eyes of insulin and glucagon. The stench is needed for the processing of sugar and glucose at a normal level. If the process collapses, then the patient will grow seriously ill, yak cuckold diabet.

See the shortcomings of the slurry

In the medical field, there are fewer enzymes in the slurry zone, it is taken into 4 main groups. The skin of them has its own particularity and a classic picture.

Judge:

• exocrine form;
• ekzokrinny form;
• enzyme form;
• endocrine form.

First of all, you need to go to bed with the sick and restore symptoms with symptoms.

Secretary deficiency

This secretory deficiency was earlier diagnosed in people older than 50 years. But at the last hour, such a form of becoming ill can be found in children at 20-30 years of age. The price is developing on the other hand, the number of cell structures for the formation of a secret has been greatly reduced.

The reasons for the pathological manifestation are scolded in the offensive:

• lowered mass of parenchyma of pidshlunkovoy zalozi through endocrine malaise;
• damage to the flow instead of into the lumen of the small intestine;
• devilish reprocessing of old-fashioned speeches.

Symptoms of deficiency of the supra-slurry zone:

• sickness in the stomach;
• fatty and salty food sales;
• to see the importance in the slurry emptying;
• diarrhea;
• swelling of the abdomen;
• the appearance of a ring of a sick, sickly feeling in the cyst fabrics;
• frequent sertsebitty;
• development of a sudoma syndrome;
• zadishka;
• broken blood loss;
• dry and sverbinnyh nodding;
• tedious and blunt poses.

These symptoms indicate fat deficiency.

To renew the secretory function, it is necessary to learn more about it. Vono gruntutsya on the same deyakikh recommendations.

1. Correctly grunt. Ports of guilt are not large, but at the same time, they are often needed.
2. The menu includes fat and grease.
3. The rest of the reception will be brought to 6-7 years of the evening. I will turn on nichni snacks.
4. Drink alcohol and drink from the fence.
5. The list of permitted products is designated only as a medicine for individual indications.

An important point in case of external secretary deficiencies is those who need to change food for roslinna. Vona is guilty of becoming 70-80% of the entire menu.

So, as the body cannot vibrate, there is a need for a number of enzymes and not to remove fat, it will be quickly consumed in carbohydrates. Before products that are rich in wickedness, bring confectionery and boroshnia virobi. Ale the stench podralyayut under the fence. It is recommended to replace it with vegetables and fruits. Ale also the menu can be unpleasantly familiar with the robotic organisms - we will react to the decisions of the gases. Ale change yogo add help hanging.

The enzyme deficiency in the subshlunkovaya zolozi is compensated for by taking medications:

1. mezim,
2. Creon,
3. pancreatin,
4. Festal.

I will first introduce you correct lіkuvannyaє Normalization of style and detection of any unacceptable symptoms.

Exocrine deficiencies in breeders are characterized by a deterioration in the formulation of herbal juice for the processing of grub breast.

Likar see some of the main reasons for such a phenomenon in viglyad:

• slaughter in robotic slurry;
• zhvoryuvan shlunkovaya empty;
• ailment of the ruminant mikhur;
• problematic stun of a twelve-fingered intestine;
• unbalanced eating;
• chronic alcoholism;
• tricky hunger.

Symptoms of unstable enzymes in the slurry zone are characterized by:

• we will rot to the wicked ones;
• we will advise the approval of the gas;
• difficult with a stile;
• tediousness and bloating poses;
• in the belly.

Exocrine type of damage can only be confirmed for help laboratory diagnostics Obligatory analysis for such pathology is the conversion of sugar in the blood, as well as the condition of the diagnosis of sugar diabetes.

Lіkuvannya will be on the usuned pershoprinja. Even before the deterioration of the pancreatic juice, the alcohol called for alcohol, then the patient should look over his life principle. Monodiety and trivial hunger leads to unstable important elements: bile, fat and carbohydrates. The whole process is unpleasantly perceived not only on the lump, but on the whole organism as a whole.

The ratsion is guilty of buty with vitamins in the presence of ascorbic acid, alpha-tocopherol, retinol. The stench itself may sound positive on equal organ... In some people, the doctor signifies benzimi.

enzyme deficiency

Enzyme failure supravodzhutsya persistent pain syndrome. Serious enzyme deficiency is caused in this vypadku.

The reasons for the pathological process are:

• overwhelmingly vzhivannya lykarsky zasobіv;
• falling ill of infectious type;
• trauma to the duct of the pidshlunkovaya zalozi;
• the manifestation of congenital pathologies in the underworld;
• intestinal dysbiosis.

The most frequent enzymatic failure to manifest itself, such as gastric or chronic pancreatitis. The clearest picture of the tsikh is of the same kind and is supervised:

• irregular style. Most of the paciєnti skarzhshayutsya to carry. Kalovi masi have a stinking odor;
• vіdsutnіstyu or sharpened appetite;
• zalous weakened;
• zdutty abdomen on the smallest large number of gases;
• lower vagi;
• ailments in the stomach.

Naygirshe such a process is recognized in children. Children are important to take advantage of the childish regime. The waste of vagi can lead to serious problems in the development. It’s uniqueness, it’s necessary to add some information about the race. Guilty of the high-calorie. More lіkuvannya is based on the use of piece enzymes.

endocrine deficiency

Pidshlunkova zloza does not only have a robotic grass tract, but it does not help the endocrine system. In the middle organ, regular supply of insulin, glucagon and lipocaine is observed. Such components are considered for the replacement of blood in the blood.

1. Insulin lowering the level of glucose.
2. Glucagon is necessary for the production of zukru.
3. Lipocaine. Galmu іnіknennya fatty іnfіltratsії in the oven and stimulates the infusion of lipotropic ovaries.

As the process of viroblasting collapses, it can develop unpleasant inheritances. The problem in the first place is the islands of Langerhans, as the stench is caused by hormones.

The root of the endocrine function of the pidshlunkovaya zalozi is characterized by the following signs in the view:

• detection of gases and unpleasant odor;
• tediousness and bluesy positives;
• stinky reddened style;
• increase the amount of viporozhnen for doba;
• swelling of the abdomen;
• destruction of blood indicators. The stench can be lower or lower because of the presence of a robotic hormone;
• weakness;
• znevodnennya organizmu.

Likuvannya will be on the same recommendations.

1. Dotrimannya suvoroi children. The races include fatty and greased, food and salt sprays. Go to the fence to eat delicious malt, zukor, kava, smoked meats, pickles.
2. Continuously controlling blood supply. The patient needs to add a special attachment, which will help you to get rid of the tsukru. Vin is called a glucometer. Carrying out the manipulation is necessary in the heart and in order to receive it.
3. Taking pills for normalization of blood sugar.

If the robot does not go into the normal range, it means that there is no diabetes. One of the most serious ill-gotten sick... Along with it, life can be found. In important cases, the patient is marked with the introduction of an insulin, in which everything will end with a fatal result.

oduzhannya forecast

Likuvannya primed on the use of medications and prescription drugs. Have the first days, if you want to pain syndrome, More beautifully, I see it from the reception. Allowed to drink only purified water.

Yak tilki bіl decline (at the end of 1-2 days), it is possible to expand the races. The menu includes low-fat soups and bouilloni, compotes, herbs and black tea without zucru, porridge on water. Harchuvatisya often more beautifully, ale to giblets. Ports of guilt are small - 100-150 g.

Nagolos timid on vegetables and fruits. Tilki їkh is more beautiful to live not in new viglyad, And stewed, made or added. Before going to bed, categorically zaboronyatsya ust. You can drink a bottle of kefir or yogurt for normalization of microflori.

Even after 3-4 days, the race will expand to a tasty meal. In order to help you get rid of fat in the presence of fermented enzymes, it is recommended to take special preparations based on pancreatin. The drug course is not more than 1 month. As soon as you don’t need to do it, you need to go through a thorough analysis and create an analysis.

If all recommendations are met, the forecast will be only positive. In 80% of cases of recurrence and transition of ailments, the shape of the disease is unique. Reshta vipadk_v will end summarily. Ale all lie in the most ailing and living image. At the first signs of the varto it is not safe to see the doctor.

Poisonousness, to which one can lead to the lack of a slurry deposit

At the outset of the daily visits of the patient of the check, the development of serious acceleration.

When enzymes are not stable, they develop:

• pancreatitis. Win buvah two kinds: we are hospitable and chronic. It is characterized by the ignition process in the slurry zone;
• will cover pseudocysts. All the middle information can be known in the city. If the cyst formation is burst, then the sick person will not be able to identify the serious acceleration;
• pancreatic necrosis. Characterized by tissue necrosis є expedited severe pancreatitis... Veda to multiple organ failure;
• diabetics. Defects in glucose uptake. Submitted before serious pathologies I do not care for the life of the sick;
• the establishment of fistulas in the slurry zone, the slurry emptying in the intestinal canal.

It is possible to get a diagnosis of ailment as soon as symptoms and symptoms appear.

Whether it’s a snake over-etching їzhі wiklikє, the deterioration of the eating, which can lead to a deficiency, or the accumulation of excess vagi. Regarding the overtreatment of the disease, called dyspepsia, supravodzhuyuvannya slung-intestinal tract and other organs, and that often occurs in the CLINIC PRACTICE.

Dyspepsia is most often unbalanced for an even greater amount of carbohydrates or fat. When the processes are damaged, the etching of the guarded enzyme system, and in the first place - the pidshlunkov zolose.

Rise primary and secondary pancreatic deficiency.

The primary pancreatic deficiency of the pancreatic disease is in case of important diseases of the pancreatic cavity - cystic fibrosis of the pancreatic cavity, impaired pancreatic duct disease, chronic pancreatitis, etc.

In the classroom practice, it is often the case that it’s second, for it’s obvious, the lack of green space, as a rule, it’s a good idea, as a rule, because of the non-random life, because of the overwhelming function of the rose.

The pancreatic lack of intertwining the development of life and can lead to the collapse of the processes of wetting. key manifestations destructiveness of robotic podshlunkovoy zolozi є change to appetite, nudity, blues, gurgling in the stomach, flatulence, steatorrhea.

If there is a lack of slurry, the growth becomes stagnant. lykarski zasobi, Scho revenge ferment. It is traditionally for tsyo vikoristovuyutsya pancreatin - a drug, preparations from a slurry of homemade foods. The history of pancreatic stasis can be carried to the ear of the ninth century, if we are sick with a powder, we can prepare for the great horny thinness. In the sinks of an intensive acid-dissolution, a second part of an inactivation occurred in the slunker, and the drug did not appear to have a good elimination effect.

Given the development of the pharmaceutical industry and knowledge about the mechanism of etching processes, a new formulation of preparations has appeared to replace pancreatin from tablets, dragees, granules from a clotted shell and microspheres, placed in a capsule.

In the present hour, enzyme preparations, which are used in clinical practice, are responsible for the diagnosis of vimogamy: non-toxic; good portability; visibility of the side reactions; the optimum in the range of pH 5-7; strength up to hydrochloric acid, pepsin and other proteases; zm_st sufficient amount of active herbal enzymes; mother trivialy term zberigannya.

Enzyme preparations can be divided into several groups according to their storage: by speech such as pepsin (abomin, adinpepsin). Pancreatic enzymes, represented by amylase, lipase and trypsin (pancreatin, pancitrate, mezim-forte, creon). Combined enzymes, which replace pancreatin from the combination with components of milk, hemicellulosis and other additional components (digestal, festal, panzinorm-forte, benzistal).

All ci lykarsky rechovinys Revenge the ferments of the podshlunkovoy zalozi, ale the stench is not mutually interchangeable. Rіznі groups of cich preparations can be readily and rigorously indicated before being consumed. In case of broken ciches, the indication of the rules may not only fail to reach the desired result, but also the victorious side reactions.

The first group of enzymes is straightened, in the main, to compensate for the deterioration of the mucous membrane of the slunk. Pepsin, cathepsin, peptidazi are installed in their warehouses practically all natural bottles. The drug is viciously difficult for hypoacid gastritis; It is not meant to be recognized in case of sickness, tied with acid-alleviation.

A large number of drugs, including up to a group of pancreatic enzymes and regulating the function of the pancreatic zone, can be used for poisoning (in case of significant damage to the process of etching and illumination of pancreatic juice). Navigate within the framework of one group of drugs are sold at a few warehouse of all components.

The development of the structure of the pancreatic enzymes is the basis for the development of the structure of the clinics. Included in the amilase complex is starch and pectin to simple candies - sucrose and maltose. Before pouring lipase into the hydrolysis of fats, proteases accelerate the process of splitting of proteins and peptides. Before entering the store of proteases, trypsinogen injected with Enterokinase small intestine become active in trypsin. With the infusion of active trypsin in the upper dilation of the small intestine, retro-inguvannya of the secretion of the lactic acidosis is promoted (galvanization for the "feedback" type). As a result, there is no pain in pancreatin preparations.

Highly active enzymes (Creon®) often become stagnant in case of swelling lesions of the flesh zone, systemic ills, For the treatment of secondary pancreatic deficiencies, as well as cystic fibrosis. The drug mezim-forte®, to avenge 4200 OD of amylase, 3500 OD of lipase and 250 OD of proteases, is often indicated for the correction of short-term and minor dysfunctions of the midges, the most widespread in most common.

Pigulka mezim-forte is covered with a special glaze shell, which is used to protect the preparation in the form of an aggressive infusion of the sour middle of the slunk.

In the classroom practice, most often they start to "come close" - the destructiveness of the pidshlunkovaya zalozi, which supervises rіznі ailing the upper forms of the herbal tract (VOPT), or it can be detected in case of errors in the grain, the transfer. With a wide range of ailments, they present sub-active skargi on the deyak nezduzhannya, the child is boring, the importance in the belly of the message. Some symptoms are found in case of re-transmission, in case of unwitting, "not knowing". Especially often people try to find out where they are to be found far away from the most ancient places of living. Nova dyeta, a new mineral warehouse of water and products for the destruction of pickling processes. After 20-30 minutes. If you get it, you can take a short hour to press the beat in the umbilical area. In addition, there may be a short-time breakdown of style at the viglyadi of this growth, there is a flatulence. However, in case of an active clinical and laboratory routine, there are some abnormal changes, as a rule, do not start. Itself in cich vipadki and it is necessary to conserve medium-active pancreatic enzymes. Victory of medium-active pancreatic forms, for example, mezim-forte, is fully justified in basic situations, the effect is from all the implantation of the development of secondary effects.

In the case of ailments, such as stagnation of high doses of pancreatic enzymes, the prevention of changes in the place of sech acid. Hyper-ypikozypia spriy of the precipitation of sech acid in the tubular apparatus of the nirka, wash the form for the development of sechoam ailment. In people suffering from cystic fibrosis, it takes a trivial hour to pick up high doses of pancreatic enzymes, a high level of development of interstitial fibrosis.

Experimental robots on creatures are used to induce intratubular deposition of sechic acid crystals and can lead to obstruction of nyrcoval tubules, depletion of the basal membrane. It can persist for an hour and lead to progressive sclerosis of tissue nirok.

The fact of the possibility of developing hyperuricosis is necessary in case of other illnesses, if enzyme preparations are used, especially in pediatric practice. During the period of manifestation of celiac, with atrophy of the mucous membrane of the small intestine in the blood of ailments, there is a rapid change in the exchange of purine bases with the accumulated high concentrations of seic acid and increased levels of ecstasy. In the cich umovah, the preparation of the high-volume enzymes can be used to develop the supplementary nyrcovine ears. In general, there is a good effect of normalization of empty etching of withdrawals in case of stagnant mezim-forte in the same period of time.

Combined preparations to replace the components of gum and hemicellulase (festal®), create an optimal mind for rapid and repeated splitting of bins, fats and carbohydrates in two empty guts... Hemicellulase, before entering the warehouse of the festal, spraying the splinter cells in the lumen of the small intestine, normalizing the intestinal microflora.

The drugs are indicated in case of a lack of func- tionality of the baby's lick in some pathology of the liver, of the gut system, in the case of impaired juvenile function, a little deafness in the way of life, short-term loss of life. From the side, after a fight of organs, etching is surrounded by a wide range of cich combined preparations... So, in patients with a hypercritical type of dyskinesis of the dysfunctional paths from the hypofunctional dysplasia, duodenogastric reflux, the component of enzyme preparations, which may be stored in their own A whole group of drugs is also not possible to recognize the disease with the help of bilirubin in blood, signs intestinal imperfections... Wrong and not primed signs of the festival among the children with the accelerated style can provoke development of the diarea.

The availability in the warehouse of the combined preparations in the core of the enzymes from the slurry deposit of the components in the gum, pepsin and hydrochlorides of amino acids (Panzinorm®) will prevent the normalization of the etching processes in the ailments of the hypochondria. In cichs with ailments, as a rule, they suffer from the function of a creeping hole, chewing and chewing. However, the patients with the added acid-dissolving function of the slurry are not valid for the purpose of the preparation. shlunk juice... Vikoristannya panzіnorma® with hyperacid gastritis, swollen ailments, the activity of proteolytic enzymes, altering the acidity of the slurry, but clinically can be manifested by such a visible symptom, such as a furnace.

In such a rank, the skin group of enzyme preparations is strictly indicated for vicarystanny. Stagnation and prescription of drugs for indicators in the boundaries of the frame to normalize the processes of etching and polishing the sick person. It is not correct to check out different groups of enzymes to discredit these drugs, in the absence of a positive effect or to make the patient die.