WORK PROGRAM - library.tma.uzlibrary.tma.uz/uum2/uum-pediatrics-davolash-medped/02-umumiy-qis… · students of skills on dialogue with healthy and sick children of different age

MINISTRY OF HEALTH OF REPUBLIC UZBEKISTAN

THE TASHKENT MEDICAL ACADEMY

DEPARTMENT OF «INFECTIOUS DISEASES AND

PEDIATRICS»

WORK PROGRAM

On discipline “Children's illnesses” for students

IV - V courses of medical and medical-pedagogical

faculties

2

TASHKENT - 2012

MINISTRY OF HEALTH OF REPUBLIC UZBEKISTAN

THE TASHKENT MEDICAL ACADEMY

DEPARTMENT OF «INFECTIOUS DISEASES AND PEDIATRICS»

"ADOPTED"

The pro-rector

prof. Teshaev O.R.

Office of the head of studies

________________________

«____» ________ 2012

WORK PROGRAM

On discipline “Children's illnesses” for students IV - V courses of

medical and medical-pedagogical faculties

Field of knowledge - 720000 "Public health services"

Formation direction:

5720100 - Medicine

5140900 - Vocational training (5510100 - Medicine)

Labour input in hours - 180

Including:

Lectures - 24

Practical training - 96

Independent work - 60

Tashkent - 2012

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Composers:

1. Daminov Т.О., the head of department, PHD of medicine

2. Halmatova B.T., PHD of medicine

3. Kurbanova D.R., docent

4. Mirrahimova M. H, docent

Reviewers:

1. Karimdzhanov I.A. - PHD of medicine, head of department GP PEDIATRICS

2. Umarov R. H – PHD of medicine, the professor of chair GP-PEDIATRICS

Work program is made on the basis of the curriculum and the study program

for pediatrics, discussed and adopted on the Academic council of TMA, the report №

_____ from «____» ______________ 2012

The chairman of an academic council _______ associate professor Nurillaeva N.M. «_____» _____________ 2012

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1. Introduction.

In daily activity of the doctor of the general practice the basic place is occupied

with treatment and prophylactic medical examination of illnesses of children's age. In

this connection the section «Children's illnesses» is included in the program of

training of doctors of the general practice. In the given working program questions

AFI of children's age, aetiology and pathogenesis, the basic clinical symptoms of

children's illnesses, their diagnostics, differents-diagnostic aspects, rendering of

necessary medical assistance, and also a preventive maintenance and rehabilitation

basis are widely taken up. In the given program materials facilitating teaching of a

subject are presented students of treatment and mediko-pedagogical faculties.

The pediatrics studies the period of growth and development of the child. At

each age stage of a life for children special morphological, physiological and

psychological changes are peculiar. Therefore the knowledge of clinical anatomy and

physiology of children's age is a basis for understanding of an originality of methods

of research and an estimation of received results. Besides, the account of the basic

anatomo-physiological features allows defining the concrete organisation of

environment and a life mode. GP is in constant dialogue with the child and his

parents, therefore knowledge of ethics and deontology in pediatrics can help with

daily practical work. The children's organism sharply differs from the adult, the age

anatomo-physiological features.

1.1. The purposes and discipline problems

The training purpose of children's illnesses course is - development at

students of skills on dialogue with healthy and sick children of different age and their

parents, a technique of survey of children, carrying out of monitoring of physical

development of healthy children, to diagnostics, treatment, preventive maintenance

and rehabilitation of most often meeting diseases of children's age.

Learning tasks are - formation of knowledge on:

to dialogue with healthy and sick both children and their parents;

to definition of an essence of studied diseases, on their aetiology, pathogenesis,

classifications, to clinical displays, complications, the forecast, treatment

principles;

On scheduling of inspection, development of tactics GP and treatments;

to Principles of differential diagnostics and statement of the definitive diagnosis.

Rehabilitations and диспансерному to supervision of sick children.

1.2. Requirements to knowledge, abilities and practical skills.

According to the specified purposes and problems after the termination of

studying of discipline the student should know children's illnesses:

1. Anatomo-physiological features of bodies and systems at children;

2. Specifications of physical and psychomotor development of children of various

age groups;

3. Principles of feeding of healthy children of the first year of a life;

4. Principles of a food of healthy children are more senior 1 year.

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5. An aetiology, pathogenesis, clinical and differential diagnostics of the most

widespread diseases of children's age;

6. Principles of treatment of illnesses of children's age;

7. Indications to a direction on consultation of narrow experts;

8. Preventive maintenance of most often meeting diseases of children's age

9. Principles of improvement of often ill children

The student should be able:

1. To collect the anamnesis at sick children and their parents.

2. To inspect on bodies and systems

3. To estimate a state of health of children.

4. To spend food calculation to healthy and sick children;

5. To make the plan of carrying out of clinical, laboratory-tool inspection.

6. To prove the clinical diagnosis;

7. To develop the plan of rehabilitation actions;

8. To make out the case record of children in a hospital (F 003/at);

The student should have skills:

1. To carry out monitoring of physical development of children;

2. An estimation of a psychological condition of the healthy child;

3. Gathering of the anamnesis of disease;

4. Clinical inspection of patients on systems;

5. Revealing of the basic clinical and laboratory-tool criteria at studied diseases;

6. Drawing up of a food allowance to children.

7. Scheduling of preventive actions

2. Scheduling of preventive actions.

Labour input

Distribution of volume of an academic load by

kind’s auditorium employment (in hours)

IWS

In total Lectures Practical training

180 120 24 96 60

3. Lecture course

3.1. The thematic plan of lectures for students 4 courses

№ The name of themes Quantity

of hours

1. History of development of pediatrics. The childhood periods.

Monitoring of physical development.

2,0

2. Principles of feeding of children of early age 2,0

3. Rickets. 2,0

4. Protein-power insufficiency. 2,0

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5. Scarce anemias. 2,0

6. Features of a current of a pneumonia at children. 2,0

Total 12

3.2. The thematic plan of lectures for students 5 courses

№ The name of the themes

Quantity

of hours

1. Features of a current of a bronchial asthma at children. Tactics

GP

2,0

2. Features of a current of a sharp rheumatic fever at children.

Tactics GP.

2,0

3. Juvenile revmatoide arthritis. Tactics GP. 2,0

4. Features of a current of chronic gastritises and gastroduodenites

at children. Tactics GP

2,0

5. Features of a current chronic glomerulonephrites at children.

Tactics GP.

2,0

6. Features of a current of chronic hepatitises at children. Tactics

GP.

2,0

Total 12

3.2. The maintenance of a lecture material TOPIC 1. HISTORY OF DEVELOPMENT OF PEDIATRICS IN UZBEKISTAN.

THE PERIODS OF CHILDREN'S AGE. MONITORING OF PHYSICAL DEVELOPMENT

The lecture maintenance

The doctrine beginning about the child can be carried to IV century B.C. By

time of a writing of the book «About the nature of the child» the father of medicine

Gippocrat. After Gippocrat about children, about care of them and education write

Cels, Galen and Soran.

On the average a century in east states with calculation of social cultural

relations new opening have been created and doctoring moved ahead.

In 1066 in Bagdad, Damask, Hamadan, Bukhara, Samarkand hospitals have

been created. The well-known scientists who were engaged in doctoring, a science

have brought the contribution for science prosperity.

The first chair of children's illnesses at the Tashkent medical institute has been

based in 1920 г by the privat-senior lecturer of the Moscow State University

A.N.Ustinovym heading it till 1922 With 1922 on 1924 г by chair Vasily Ivanovich

Lysenko (1885-1946) - the doctor of medical sciences, the professor supervised.

In practical activities the individual approach, both to healthy and to sick

children with the account of the age anatomo-physiological features peculiar to each

period of children's age is necessary. According to it it is necessary to cancel, that

embrionnale the development stage (the first 11-12 weeks) is characterised by the

highest rates of a differentiation of fabrics, formation of bodies and systems, but

terms of their maximum development not similear. Depending on it those or other

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anomalies of a fruit are formed. The chest period is characterised by higher, than the

next years, rates of physical and mental development. The accurate organisation of a

mode, a food, alternation of the periods of a dream and wakefulness is necessary for

correct development of the child. In this period body proportions essentially vary,

static functions develop.

The prepreschool period (from 1 till 3 years - ясельный the period) - is

characterised already by some decrease in rates of physical development of children,

большей degree of a maturity of the basic physiological systems.

The school period (from 3 till 7 years). At this age growth process is a little

slowed down, but functionality of bodies and systems are actively improved.

The period of younger school age (from 7 till 12 years). In this period

perfection of functions of an organism of the child proceeds. At this age strenuously

develops and the muscular system and a skeleton gets stronger, the intelligence

increases. Discipline, independence develops.

The period of the senior school age proceeds from 12 till 16 years and is the

puberty period. It is characterised by the expressed reorganisation endocrine the

systems, the strengthened growth.

«Physical development» is understood as the term dynamic process of growth

(increase in length and weight of the body, separate parts of a body) during the

different periods of the childhood. The basic indicators of physical development are

the weight of a body, length of a body, a head and thorax circle. At an estimation of

physical development it is necessary to pay attention also to elasticity of a skin,

тургор of soft fabrics, a muscular tone, degree of development of bone system,

psychomotor development.

The literature:

B (basic) - 1,2,3,4,5.

A (additional) - 17,23,24,25,26,27,28,29,30.

TOPIC 2. FEEDING OF CHILDREN OF EARLY AGE

The lecture maintenance:

Natural feeding - feeding of the child by means of applying to a breast of its

biological mother. It represents the unique form of an adequate food for the child

after a birth and within 1-1,5 years of a life. Chest feeding should be exclusively

unique method of feeding of the child for the first time 6 months of a life.

The first applying of the newborn in maternity hospital is carried out

simultaneously with procedure of the first contact. Normal the child by the birth

moment has all successfully to suck a breast according to the congenital program of

search of a food during 102-150 mines after a birth: to a breast of mother,

coordination action of handles and a mouth in active search of a nipple with widely

open mouth, tenacious to a breast and vigorous saturation before a dream.

Chest feeding needs to be begun within the first hour after a birth, when both

reflexes of the child (search and sucing) and sensitivity of area of a nipple to tactile

stimulation at mother the highest. Skin contact after sorts should be to relatives - on a

stomach of mother after not complicated sorts.

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The literature: B (basic) - 1,2,3,4,5,6.

A (additional) - 17,20,23,24,25,26,27,28,29,30.

TOPIC 3. PROTEIN-POWER INSUFFICIENCY


Protein-power insufficiency (PPI) - chronic frustration of a food and tropical

the fabrics, breaking correct harmonious development of the child. In days of social

shocks the dystrophy can develop at any age, but especially children of the first 3

years of a life are subject to it. Disease is accompanied by considerable infringement

of exchange processes, immunity decrease, a delay physical, psychomotor, and

further and intellectual development.

PPI (hypotrophy) - the most widespread and significant kind of a dystrophy.

On time of occurrence it divide into three forms:

prenatal, developed till a birth of the child;

postnatal, arisen after a birth;

mixed, generated under the influence of the reasons operating on an organism of

the child intra-and newborn.

PPI (paratrophy) connect with excessively high caloric content of food and the

superfluous maintenance in it of fats and carbohydrates. To development paratrophy

contribute lymphohypoplastic diathesis and exudative diathesis.

Hypostatura apparently, it is caused by deep defeat neuroendocrine systems

(more often pre-natal).

Distinguish easy (I degree), moderate (II degree) and heavy (III degree) PPI.

Kvashiorkor - a variant of a dystrophy at children of 2-4th year of a life in the

tropical and subtropical countries. Arises after an excommunication from a breast at a

food by mainly vegetative food (albuminous starvation), accompanying infectious

diseases and other adverse factors.

The literature: B (basic) - 1, 2, 3,4,5,6.

A (additional) - 13,15,17,19,23,24,25,26,27,28,29,30.

TOPIC 4. THE RACHITIS


Rickets diseases of children - chest age with frustration, boneforming and

insufficiency of a mineralization of bones.

Leading pathogenetic link of rickets is deficiency of vitamin D and its active

metabolite in the most intensive growth of an organism.

Diseases distinctly comes to light at the age of 3-4 months though the first

symptoms can appear earlier - in 1-1,5 month: (anxiety, fearfulness, irritability, nape

baldness.) the rickets initial stage lasts from 1,5 weeks till 1 month, further diseases

passes in a heat with distinct changes from a skeleton, (kraniotabes, flet a nape,

asymmetry of a head, an Olympic forehead, rachitic "beads", arises "chicken" a

breast, rachitic bracelets, threads of pearls, a curvature of a backbone).

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During the reconvalescence period at the child signs of an active rickets

(symptoms of infringement of a condition of nervous system, softness of bones, a

muscular hypotonia, an anaemia disappear, etc.) concentration of phosphorus in

blood though level Са+ can be and lowered is normalised. The period of the residual

phenomena is diagnosed, as a rule, for children of 2-3 years, when there is no neither

signs of an active rickets, nor laboratory deviations from norm of indicators of a

mineral exchange though it is available consequences of transferred rickets II-III the

item

Rickets preventive maintenance

1. Antenatal. It can be specific and nonspecific. Nonspecific begins long before a

birth of the kid. The pregnant woman should observe a mode of day with sufficient rest

day and night. It is very important, that it not less than 2-4 hours daily, in any weather,

was on fresh air. The great value is given to a balanced diet: the daily use of the pregnant

woman not less than 180-200 gr meat, 1 00 gr fishes, 1 50 gr cottage cheese, 30 г cheese,

500 ml of milk or sour-milk products, enough macro- and microcells.

2. Postnatal. One of the important actions after a birth of the kid is the eutrophy

organisation. The best for the child of first two years of a life is chest feeding, the

reception of polyvitaminic preparations begun still during pregnancy, or special dairy

products.

In the absence of chest milk it is recommended the modern adapted substitutes of

the chest milk having balanced parity Са and Р (not less1:2) and containing

cholecalciferol (Vitamin Dз). And early introduction of feedings up is not recommended.

It is necessary to give special attention and to physical development of the child

and закаливанию: walks on fresh air, medical gymnastics, massage, water procedures

which should be spent systematically, regularly, it is long, with gradual uniform increase

in loading.

Specific preventive maintenance is spent by vitamin D, the minimum which

preventive dose for healthy newborn children of early age - 400-500 IU .


A (additional) - 17, 23, 24,25,26,27,28,29,30.

TOPIC 5. DEFICIENCY ANEMIAS AT CHILDREN


Anaemia - a condition characterised by reduction of number эритроцитов

below 3,5.10/l or decrease of level of haemoglobin in unit of volume of blood more

low 110 г/л for children early and 120 г/л-for children of advanced age.

Disease arises at infringement of an exchange of iron which in an organism of the

child is made very vigorously. A principal cause is the exhaustion of stocks of iron

when requirements for it, the increasing volume of blood and weight эритроцитов

exceed reception with food and всасывание. The newborn has iron total in an

organism about 240 mg, 75 % from which are necessary on a haemoglobin share.

Neonatal iron stocks are settled by 3-4 months at newborns and to 5-6. Sideropenie, it

especially long exists, breaks not only haemoglobin formation, but also myoglobine,

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and also variety of the fabric enzymes containing iron which provide transport of

oxygen and elektronics, destruction connections, oxidation-reduction processes in

cages, and also iron. The least value has latent deficiency of iron - long sideropenie at

which there is no decrease in level of haemoglobin of peripheral blood.

Preventive maintenance Consists in treatment of anaemia of pregnant women,

preventive maintenance newborn; rational feeding of children of all age, treatment of the

illnesses accompanied by infringement intestinal.


A (additional) - 1,17,23,24,25,26,27,28,29,30.

TOPIC 6. FEATURES OF THE CURRENT OF THE ACUTE PNEUMONIA AT

CHILDREN.


Pneumonia - the sharp infectious process developing in respiratory department

to respiratory system with inflammatory infiltration of a pulmonary fabric, filling of

alveoluses exudat and clinical showed by the general reaction of an organism to an

infection. Disease of pneumonia makes nearby 10-15 on 1000 children of 1-3 years

and nearby 5-6 on 1000 children is more senior 5 years in a year.

The nature of pneumonia at children more often the infectious. The most

frequent activators: streptococcus B, anaerobic, aureus, etc. staphilococcus,

pneumococcus, hemophilic bacteria, cytomegalovirus, the RS-virus, mycoplasmas,

aspiration, etc.

Contributing factors of development of a pneumonia at children are: GIE, a

syndrome of vomiting, artificial feeding, hypotrophy, congenital heart diseases,

mucoviscidosis, developmental anomalies of a lung, various hereditary

immunodeficiencies other.

For acute pneumonia are characteristic febril temperature (above 38%С and

more than 3 days), the expressed toxicosis. At sick of pneumonia, as a rule, there is

no appetite, are sharply changed behaviour (excitation, quite often apathy), a dream,

an emotional tone. At half of patients pallor of integuments is evident; in heavy cases

the skin has marble drawing, finitenesses cold. Shortening percussion sound more

often at massive defeats.By auscultation in lungs are listened local, damp rattles,

sometimes it are found out only at the very beginning of disease, then disappear and

again appear in process. Rattles can not be listened throughout all illness. More than

at 70 % of patients rigid or bronchial breath, more often the weakened breath on the

amazed site of a lung is listened. It is usually defined and bronchophony.

The acute pneumonia is diagnosed on the basis of local, clinical symptoms of

defeat of lungs, signs of a toxicosis and the respiratory insufficiency, accruing in

process of illness development; detection, segmentary or lobar infiltration shades at

X-ray, having positive dynamics against treatment; respiratory or mixed acidosis

Antibacterial therapy is urgent, is appointed at once after an establishment of the

diagnosis and spent not less than 10-14 days. At the heavy form an adverse current of

disease her spend repeated courses with change of preparations before clinical

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recover. The preference is given to that antibiotic to which the microflora allocated

from a bronchial secret of the patient is sensitive. However crops become not always

as its results are known not earlier than in 2-3 days; serologic diagnostics is spent

seldom. In this connection at the easy form of the illness, often caused by

pneumococcus 4 group, use 1 antibiotic, mainly penicillin or in a combination with

sulfanilamide. At heavy forms appoint preparations of a wide spectrum of action, or

2-3 antibiotics ("starting") are combined.


A (additional) - 3,9,16,17,23,24,25,26,27,28,29,30.

TOPIC 7. THE BRONCHIAL ASTHMA AT CHILDREN


Bronchial asthma - the disease characterised chronic recurrent obturation of

respiratory ways which clinical display is the asthma attack. The inflammation of a

mucous membrane caused immunological and not immunological by mechanisms,

promotes formation of the changed sensitivity and reactance of bronchial tubes to

various irreteitor.

The leading factor of formation of a bronchial asthma is the organism

sensitisation. Allocate groups of allergens: exogenic, getting into an organism from

environment, and endogenic formed in bodies and organism fabrics.

The forecast of a bronchial asthma depends on weight, the form, a functional

condition of internal bodies and the systems, spent therapy. The Infectious-allergic

and mixed bronchial asthma more often, than allergic, remains throughout the

childhood and adolescence, and to become disease of the adult. Timely revealing of

causally - significant allergens and a specific hyposensitization or promote recover of

the patient Proof functional infringements of internal bodies, formation of the chronic

centres of an infection burdens the forecast.

Preventive maintenance of a bronchial asthma.

The prevention of contact with exogenic allergens in a life, a balanced diet, restriction

of medicinal therapy by strict indications, timely sanation of the centres of a chronic infection

an active way of life with early inclusion of physical culture.


A (additional) - 17,23,24,25,26,27,28,29,30.

TOPIC 8. THE ACUTE RHEUMATIC FEVER


SRF - a sharp rheumatic fever - system inflammatory disease of a connecting

fabric with primary localisation of pathological process in cardiovascular to system

(CVS), developing at the persons predisposed to it, mainly, young age, in connection

with the transferred infection.

Frequent now latent and chronic forms SRF speak streptococcus

transformation in the forms which are not giving in fagozitosis and steady against

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action of antibiotics. SRF which fall ill only 0,2 - 0,3 % of the persons who have

transferred quinsy. It meets in families where with it parents and other children

already are ill is much more often. There was a concept «family SRF ».

Primary ARF. It is peculiar acute or subacute clinic course. In 2-3 weeks after

transferred quinsy there are first symptoms: temperature lifting, intoxication

symptoms, artpain or a polyarthritis, later carditis. Nesterov allocates brightly -

moderately – and ill-defined carditis.

Recurrent ARF.

At 20-50 % of patients repeated attack arises after an infection or paraallergic

influences. Again there is lifting of temperature, articulate a syndrome, relapse

trochees. Extracardial displays less bright, but all of them testify to the attack which

has arisen not earlier than in 10-12 months After 2 - 3 attacks at children the heart

disease in 100 % is formed.

ARF it is necessary to differentiate with diseases of heart, joints, CNS.

Diagnostics is helped by that all changes arise against a tonsillitis exacerbation (is not

present the latent interval), there are no symptoms of organic defeat of heart.

Treatment АRF at children should be early, complex, long (not less than 3-4

months), levelly (a hospital, rheumatic sanatorium, a clinic).

1 stage. Hospitalisation includes:

1. Creation to the child of a corresponding medical-impellent mode with

employment by medical gymnastics (functional rehabilitation).

2. Appointment of medicamentous therapy (pathogenetic treatment).

3. Sanation of the revealed chronic centres of an infection.

In branch the medical-impellent mode is defined. A confinement to bed

establish on 2-3 week. Or it is more. Further the child translate on a semiconfinement

to bed, and then on the training.

II stage. Treatment is spent to sanatoria not earlier than in 7-10 months after

attack. Efficiency of sanatorium treatment above at a direction of the patient in

sanatorium directly from hospital. The sanatorium problem includes achievement of

Full remission, restoration of functional ability СVS.

III stage. Dispansery supervision. From sanatorium the child arrives under

supervision of the local pediatrist and cardioreumotology. It is examined by 2 times a

year, direct on consultation to other experts, spend instrumental and laboratory

inspections.

The forecast. Last decades has considerably improved thanks to effectual

measures of struggle against a streptococcal infection and effective pathogenetic

therapy. Mortality has decreased from 11-12 %/ju 0,4-0,1 %. Primary reumocardit

leads to formation valve a heart disease at 10-15 % of patients, whereas returnable -

at 40 % of patients.

Preventive maintenance. Patients with long and it are continuous-

retsidivirujushchim a current, with heart diseases are observed cardioreumotology up

to proof remission then they pass under supervision of the local doctor and the

control cardioreumotology. Preventive maintenance happens primary and secondary.

The literature:

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B (basic) - 1,2,3,4,5.

A (additional) - 17,23,24,25,26,27,28,29,30.

TOPIC 9. JUVENILE REUMOTHOID ARTHRITIS


JRA - chronic, progressing symmetric polysinovites, gradually leading destraction

joints, and in some cases and to out joints to defeats.

Prevalence universal. Affects people in any age. Annual disease incidence - 0,02

%. Prevalence JRA (till 16 years) - 0, 01-0,001 % to bowl ЮРА develops at children of

1-3th years.

The etiology is insufficiently studied. The known role belongs bacterial infection

and also to viruses and mycoplasmas. Contributing factors: a cystitis, a tonsillitis,

cholecystitises, and pyelonephritises.

In any case, underlie of RA at adults and children the changes in reactivity of

patients, supersensitivity to various factors of environment lay. Pathogenesis: Modern

concepts: In 1948г has been opened reumothoid the factor appearing autobone to own

IgG, and it has formed a basis for understanding РА, as autoimmune diseases.

Syndrome Stil’s – articular-visceral form JRA: a fever with the daily cheeks, a

tremendous fever. Against a fever: a rash - roseole character.

Laboratory changes: the RF is defined in blood whey, but is not authentic as

falsepositive the result can be received at SLE, diseases of connective tissue. For RA it is

characteristic: hypochromic (НЬ - 80 г/л - 100-110 г/л) because of raised capture Fе 2+

an anaemia, high СОЭ, high sharply faze indicator of an inflammation. Rarely at

outjoints displays at patient’s JRA is it possible to find out LЕ - cell.

Primary specific preventive maintenance - is not present.

The nonspecific: sanitation of the centres of a chronic infection, medical

supervision over children with the changed reactance. For the relapse prevention - it is

recommended regular medical check-up over children suffering JRA.

The literature: B (basic) - 1,2,3,4,5.

A (additional) - 17,23,24,25,26,27,28,29,30.

TOPIC 10. GLOMERULONEPHRITIS AT CHILDREN


GN - disease of the infectious-allergic nature or the established nature in which

basis lays bilateral diffusion or cenrtre not purulent inflammation balles the device of

kidneys with characteristic nephritic and outkidneys symptoms.

Nephritogenous streptococcus contain a certain antigene. Sharp GN arises in 7-

14 days after a pharyngitis or for 14-21 day after pyoderms, caused beta-

gemoliticheskim a streptococcus of group and, also SGN arises after the transferred

virus infection, i.e. during the postinfluenzal period.

There are three forms CGN:

1) Nephrotic. It is shown by hypostases of various degree of expressiveness,

proteinuria from above 2,5 g/sut, dysproteinemia, gyperlepidemia.

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Morphological - the minimum changes in glomerule. Hematuria and the

hypertensia is not observed.

2) Mixed. It is clinically characterised by a combination nefritic and hematuric

syndromes. There is an infringement balles filtrations and concentration functions of

kidneys. In a kidney reveals diffusion mesangioproliferative, mesangiocapillaris or

fibroplastic glomerulites.

3) Hematuric.

It is shown only by a uric syndrome in hematuria form - from micro to macro.

It can be combined with insignificant proteinuria (to 1 g/sut). Functions of kidneys

are kept, the arterial pressure the normal. In a kidney reveal central, is rarer diffusion

dystrophic changes epitelial challes, central a sclerosis interstisiales than a fabric.

AGN differentiate with relapse CGN, with secondary GN, developed against SLE,

with GN, developed at congenital developmental anomalies of kidneys of type dysplasia;

with a pyelonephritis.

Acute diffusion GN it is necessary to differentiate with toxic defeats of kidneys, a

sharp pyelonephritis, DIC - a syndrome or the pathological condition connected with it -

a hemolytic-uremic syndrome, exacerbation of CGN, a hereditary nephrite.

The literature:

B (basic) - 1, 2,3,4,5.

A (additional) - 17, 23, 24,25,26,27,28,29,30.

TOPIC 11. CHRONIC GASTRODUODENITES AT CHILDREN. FEATURES OF

THE CLINICAL COURSE.


Chronic gastroduodenites (CG) is chronic inflammatory residive disease

mucous and submucous covers of a stomach which is accompanied cellular

infiltration, infringements of physiological regeneration. CG at inadequate treatment

it is inclined to gradual development of an atrophy of the ferruterous device and

progressing of infringements secretor, motor and incretor stomach functions. Unlike

therapeutic practice CG at children only in 10-15 % happens the isolated disease.

Meets antral gastritis in a combination with duodenit - gastroduodenites is more

often.

Leading clinical sign at patients with chronic gastroduodenites is pains in a

stomach. The pain is localised in epigastral and pyloroduodenal areas and has ulcer-

like character: attack, fight, sharp before meal, are quite often localised in right or in

left underedge. At objective survey of patients it is marked clinical signs

gypopolyvitaminos and angiodystonia, as occurrence by a chronic intoxication.

Palpation: morbidity in pyloroduodenal areas, epigastral round a navel, a swelling of

the top right small square of a stomach, pressure of direct muscles.

Radiological segmentation of defeat 12 finger guts, quite often, are observed

at a pathology of a stomach, disease hepatobiliar system and a pancreatitis.

CG differentiate from a sharp, chronic pancreatitis, inflammatory diseases of

bilious ways. Secretor and impellent diarrheas.

15

Primary preventive maintenance of chronic diseases gastroduodenal provides

systems to preserve the child against physical and emotional overloads, observance of

the principles, the increased physiological food, timely revealing and sanitation of the

centres chronic to infections, timely treatment of other defeats of system of digestion.

Secondary preventive maintenance is stated above.

The literature: B (basic) - 1, 2,3,4,5.

A (additional) - 17, 23, 24,25,26,27,28,29,30.

TOPIC 12. CHRONIC HEPATITES AT CHILDREN


Chronic hepatites - this group of illnesses of the liver caused by the different

reasons, with various degree of expressiveness of morphological changes throughout

pathological process, with conditional border of synchronisation of 6 months.

The chronic virus hepatitis is caused by viruses. In, with and D (HBV, HCV

and HDV) more often. Kliniko-morphological changes at it are caused direct sitopatic

by action on cages, outliver replication viruses, immonological infringements and

immunopathological changes of bodies and fabrics.

Development CH is caused persistention a virus, its insufficient ability

elimenation from a liver.

Chronic medicinal hepatitis - the inflammatory disease of a liver caused by

toxic action of medicines, entered under medical indications in the therapeutic doses

provided for each medicine by or an idiosyncrasy to them.

Chronic criptogenй hepatitis - disease of a liver with characteristic for a

hepatitis morphological change - is established at an exception virus, autoimmun and

a medicinal aetiology.

In clinic it is marked:

Hepatomegaly - the liver dense, has a rough surface, its bottom edge sharp.

Splenomegaly - at some patients the bottom pole of a spleen reaches a navel

and even a crest bones.

Skin change - dryness, pellagres brownish sites alternate with depigmentation

whitish specks, заеды in mouth corners, hepatic palms, vascular asterisks, rashes,

стрии, hypostases. Hairs are rare, dry, dim.

Portal hypertensia - stomach increase in volume, puffiness of the forward belly

wall, the expanded network of hypodermic veins on a breast and a stomach.

Dispepsia - the lowered appetite, a periodic nausea and the vomiting, an

unstable chair, meteorism.

Generalized dystrophic symptoms - weakness, fast fatigue, a muscular

hypotonia and reduction of weight of muscles, sweat, sometimes subfebril, artalgia.

Complications of cirrhosis at children:

Cardiac insufficiency - is typical hepatogenis myocardiodystrofia. Quite often

patients have arterio-venous shunts in lungs.

Gastrointestinal tract: atrofic a gastritis, a dyskinesia of bilious ways and

cholecystitises, a stomach ulcer.

16

Kidneys affection. At heavy cirrhoses of a liver function of kidneys, filtrational

ability balles and secretor function channel are broken urea allocation. The uraemia is

a consequence sharp channel‘s necrosis, nefrosclerosis.

Raised bleeding sickness related liver cirrhoses it is caused by hypocoagulation

owing to decrease in synthesis of factors of curling of blood by the amazed liver,

level increase fibrenolis, strengthening of permeability of a wall, a thrombocytopenia.

Neurologic complications unite the term a portal system encephalopathy which

includes is more often: mentality frustration, a nervously-muscular pathology.

Hepatic coma. As the starting mechanism of a hepatic coma consider sharply

developing gypocsia a liver. In phathogenesis a coma the great value is given by

intoxications of a brain products of the broken albuminous exchange and, first of all,

ammonium. On the foreground in a clinical picture of a hepatic coma frustration of

activity ЦНС act: apathy, drowsiness, confusion of consciousness, anxiety, delirium,

disorientation, unconsciousness.

The literature:

B (basic) - 1, 2,3,4,5.

A (additional) - 17, 23, 24,25,26,27,28,29,30.

4. Practical training

4.1. The them’s plans of a practical training for students

4 courses

№ The name of themes Hours

1. Acquaintance to the organisation and principles of work of children's

hospital and WMP. Features of gathering of the anamnesis at children

and their parents. The periods of children's age. Monitoring of physical

development of healthy children.

4,8

2. A food of the healthy child. Natural feeding of children till 1 year.

The artificial and mixed feeding of children till 1 year. Rules of

introduction of a feeding up. A food of children is more senior 1 year

4,8

3. AFF nervous system and sense organs. Features of a technique of

research. Semiotics of infringements. AFI skin and hypodermically

fatty клетчатки, lymph nodes. Semiotics of defeats.

4,8

4. Anomalies of the constitution. Modern representations about a

diathesis. An aetiology, pathogenesis, clinic, diagnostics, differential

diagnostics and treatment methods, preventive maintenance. A

problem of a food of children with a diathesis. Tactics GP

4,8

5. AFF musculoskeletal system. Semiotics of defeats. A rickets and

spasmophilya. Social aspects of a problem. Aetiology, pathogenesis,

clinic, diagnostics, the differential diagnosis, treatment and preventive

maintenance. A food of children at a rickets and спазмофилии.

Tactics GP.

4,8

6. AFF breath system. A research technique. Semiotics of defeats. 4,8

17

Bronchitis. Aetiology, pathogenesis, clinic, diagnostics, the

differential diagnosis, treatment and preventive maintenance. Tactics

GP

7. AFF blood circulation system. Features of pre-natal blood circulation.

Research methods. Semiotics of defeats. Congenital heart disease.

Haemodynamic changes at CHD. Tactics GP.

4,8

8. AFF digestion system. Defeat semiotics. Functional frustration GIT.

Proteino-power insufficiency. Tactics GP.

4,8

9 AFF urinoformation and urinations system. Research methods.

Semiotics of defeats. Infections urino ways. Tactics GP.

4,8

10 AFF hematopoetic organs. Specifications of peripheral blood of

children of different age. Semiotics of defeats. Insufficiency anemias

at children. Aetiology, pathogenesis, clinic, diagnostics, the

differential diagnosis, treatment and preventive maintenance. A food

of children with scarce anemias. Tactics GP

4,8

Total 48

4.1. The thematic plan of a practical training for students 5 courses

№ The name of the themes

Hours

1. Features of a current of a sharp pneumonia at children.

Aetiology, pathogenesis, clinic, diagnostics, the differential

diagnosis, treatment and preventive maintenance. Tactics GP.

6

2. Features of a current of a bronchial asthma at children.



6

3. Nonreumatic carditis. An aetiology, pathogenesis, clinic,

diagnostics, treatment and preventive maintenance. Tactics GP.

6

4. Features of a current of a sharp rheumatic fever at children.


diagnosis treatment and preventive maintenance. Tactics GP.

6

5. Juvenile rheumatoid arthritis. Aetiology, pathogenesis, clinic,

diagnostics, the differential diagnosis, treatment and preventive

maintenance. Tactics GP.

6

6. Features of a current gastroduodenal pathologies at children.



6

7. Features of a current of diseases hepatobiliar systems at children.



6

8. Features of a current of diseases of kidneys at children. 6

18



Total 48

4.2. The maintenance that of a practical training for students 4 courses

№ з

of

less

on

s

№ o

f le

ctu

re The name of the themes practical employment and their

summary with instructions of used new pedagogical

technologies

refe

ren

ce

to l

iter

atu

re

1 1 Acquaintance to the organisation and principles of work of

children's hospital and WMP. Features of gathering of the anamnesis

at children and their parents. Question’s ethics and deontological in

pediatrics. The periods of children's age. Monitoring of physical

development of healthy children.

The summary. The pediatrics studies the period of growth and

development of the child, those at each age stage of the life special

morphological, physiological and psychological qualities are peculiar to

the child. The knowledge of clinical anatomy of children is a basis for

understanding of an originality of methods of research and an estimation

of received results. The account of the basic anatomo-physiological

features allows defining the concrete organisation of environment and a

life mode. GP is in constant dialogue with the child and his parents. The

children's doctor should be the good psychologist and the teacher. As the organism of the child fragile, gentle, infringement,

leaving rules leads to its frequent diseases. The child becomes

whimsical, whining does not allow to us to examine itself. But we

should examine and make carefully the correct diagnosis and treat. The children's organism sharply differs from the adult, the age

anatomo-physiological features. The propaedeutic of children’s illnesses is the pediatrics

beginning. On propaedeutics of children's illnesses it is studied:

Anatomo-physiological features of children on age and leaving

rules. Survey of the child and anamnesis studying the General semiotics of sick children. to the Technician of feeding of healthy children depending on age,

cooking and drawing up of a diet for healthy children. The period внеутробного developments of the child shares for

following periods: the Period новорожденности in till 3-4 weeks; the Period of chest age or younger the age, proceeds from 3-4

weeks till 1 year. - with 12 till 17-18 years.

Younger school age - from 7 till 11 years.

B-1,2,3, 4,5

A-27,28,

29,30,

31,32,33.

19

the Senior school age (pubertal period) - with 12 till 17-18 years.

Deontological is a doctrine about professional both moral duties

and rules of the medical worker, mainly in relation to the patient.

Dialogue with the patient demands a certain psychological spirit.

Professional work of the doctor appears on a joint between medicine

and rhetoric as art of professional dialogue of the doctor with the

patient. At a meeting with the patient it is necessary to greet and ask of

the permission to conversation, first of all. It is always expedient to be

presented. It is necessary to try to arrange the patient to dialogue and to

lead conversation in pleasant aspect for the patient (to take an interest in

state of health, appetite, and rhythmics of a dream to ask, on what the

patient complains). The aspiration to listen always has to a direct talk.

The future medical worker should seize art to listen to the patient.

Physical development of the person is understood as set of

morphological and functional signs of an organism in their interrelation.

Intensively proceeding processes of growth and maturing of a children's

organism define its special sensitivity to environment conditions.

Features of a climate are considerably reflected in physical development

of children, domestic conditions, a mode of day, character of a food, and

also the transferred diseases. Rates of physical development are

influenced also by hereditary factors, constitution type, intensity of a

metabolism, эндокринный an organism background, activity of

enzymes of blood and secrets of digestive glands. In this connection it is

considered to be level of physical development of children an authentic

indicator of their health.

Carrying out of business game: Cluster 2 2 A food of the healthy child. Natural feeding of children till 1 year.

The artificial and mixed feeding of children till 1 year. Rules of

introduction of a feeding up. A food of children is more senior 1

year.

The summary. Natural feeding - feeding of the child by means

of applying to a breast of its biological mother. It represents the unique

form адкватного a food for the child after a birth and within 1-1,5 years

of a life. Chest feeding should be exclusively unique method of feeding

of the child in the first 6 months of a life.

The first applying of the newborn in maternity hospital is carried

out simultaneously with procedure of the first contact. Normal newborn

the child by the birth moment has all successfully to suck a breast

according to the congenital program of search of a food during 102-150

mines after a birth: to a breast of mother, coordintionе action of handles

and a mouth in active search of a nipple with widely open mouth,

tenacious to a breast and vigorous saturation before a dream.

Chest feeding needs to be begun within the first hour after a

birth, when both reflexes of the child (search and suck) and sensitivity

of area of a nipple to tactile stimulation at mother the highest. Skin

contact after sorts should be to relatives - on a stomach of mother after

not complicated sorts.

Colostrum - a sticky dense liquid of yellow or grey-yellow

colour which is allocated in the end of pregnancy and in the first 3 days

after sorts. At heating it is easy. In colostrum there is more than fiber,

vitamin A, carotin, ascorbic acid, vitamins В12, Е, salts, than in mature

milk. Albumin and globuline fractions prevail over casein. Casein

B-1,2,3, 4,5,

A-27,28,

29,30,

31,32,33.

20

appears only from 4th day of lactation, its quantity gradually increases.

Before applying of the child to a breast in colostrum IgA. And dairy

sugar in colostrum it is less than fat, than in mature milk.

Fibers of colostrum are soaked up in not changed kind owing to

identity to fibers of whey of the child.

The colostrum is the intermediate form of a food between the

period’s hematrophic and amniotrophic a food and the beginning

lactotrof a food. Power value of colostrum in the first day makes 1500

kcal/l, in 2nd - 1100 kcal/l, in 3rd - 800 kcal/l.

Mature milk is the milk developed in some days, its quantity

accrues, breasts are filled, bulk up and become heavy. This process

name «milk arrival».

Early milk is the milk developed in the beginning of feeding.

Later milk is the milk made in the end of feeding. On colour it

more white, than early because in it there are more than fats. This fat is

the basic energy source at chest feeding.

Early milk has a bluish shade in comparison with the late. It is

developed in great volume and provides the child with enough of fibers,

lactose and other components.

The child does not need additional drink in the first 6 months of

a life, even in a hot climate. If it satisfies thirst with water will consume

less than chest milk.

Carrying out of business game: Cluster

3. AFF nervous system and sense organs. Features of a technique of

research. Semiotics of infringements. AFF skin and hypodermically

fatty, lymph nodes. Semiotics of defeats.

The summary. Development of nervous system proceeds after a birth up to

пубертатного the period. The most intensive growth and brain

development are observed in first two years of a life. In postnatal the

period different departments of nervous system finish development in

different terms. In the first half of the year the differentiation of a

striped kernel, pyramidals ways comes to an end. In this connection

disappears regides muscles, spontaneous movements are replaced with

the any. The cerebellum intensively grows and develops in the second

half of the year; its development comes to an end by two years. With

cerebellum development coordination of movements is formed. One of

criteria НПР of the child is development any coordinations movements.

From the moment of a birth newborn the child has a number

congenital, or unconditional, reflexes. Swallowing, a blinking, cough, a

sneezing, certificates concern them urea let out, defecation and some

other. They carry out the organism adaptation to environment and till

the end of the first year of a life are exposed to essential evolution.

Congenital reactions in the form of unconditioned reflexes quite provide

existence of the child only in the first days of a life.

Development of the higher nervous activity, i.e. Acquisition of

conditioned reflexes, on the first year of a life goes fast rates. The child

is much easier, than the adult, forms conditional communications with

environment, and they at the child are steadier. Rather quickly children

get habits, skills of behaviour which in the subsequent remain for all

life.

B-1,2,3, 4,5,

A - 7,27,28,

29,30,

31,32,33.

21

The skin of the child on the structure and in the functional

relation in many respects differs from a skin of the adult. The skin is

pawned in the pre-natal period on 5th week. The skin is the age

indicator in the pre-natal period. Skin furrows on a sole appear on 32

34th week in the top part of a sole and go cross-section. About 37th

week of a furrow occupy 2/3 areas of foot in the top departments. By

40th week all foot drown furrows. The skin, as well as at the adult,

consists from epidermis and derma. Epidermis very gentle, thin consists

of 2 3 layers of the become horny cages. Epidermis includes constantly

torn away epitheliala layer and actively expanding basic, germinal layer.

Derma, actually the skin, consists from reticular layers in which the

soedinitelno-woven basis and muscular fibres are poorly developed.

Hypodermic fatty cletchatka it starts to be formed on 5th month of

a pre-natal life, but it is as much as possible postponed on 8- 9th month.

At children of early age makes 12 % from weight of a body, at adults -

only 8 %. The structure of fat acids at the child of chest age is close to

structure of fats of chest milk.

Carrying out of business game Cluster

4. Anomalies of the constitution. Modern representations about a

diathesis. An aetiology, pathogenesis, clinic, diagnostics, differential

diagnostics and treatment methods, preventive maintenance. A

problem of a food of children with a diathesis. Tactics GP.

The summary. A diathesis (diatheses: греч. diathesis

predisposition, propensity to something) - the anomalies of the

constitution characterised predraspo - ложенностью to some illnesses

and certain type of inadequate reactions on usual irretation.

The essence of the term "constitution" during centuries varied.

Gyppocrat as «the good constitution» understood harmony of four

liquids of an organism. Galen spoke about a different condition

«pneumo», penetrating a body of the person. From definition of a

diathesis follows, that these conditions should not be regarded at all as

illness. Most likely, is more competent to treat a diathesis as anomalies

of the human constitution or the adaptation infringement, capable to be

transformed to disease only at adverse confluence of many external and

internal factors - an irrational mode of day of the child, errors in a food,

defects of leaving, chronic infectious and emotional dystress.

Exudative diathesis - peculiar to children of early age and characterised

by predisposition to repeating infiltrativno-deskvamativnym to defeats

of a skin and mucous membranes, development of allergic reactions and

a long current of inflammatory processes, and also to infringement of a

vodno-salt exchange and lymphoid gyperplasya. Approximately at 30-

50 % of children of early age mark usually short-term signs

ekssudative-catarale a diathesis. At the majority of children in

pathogenesisе ekssudative-catarale a diathesis the raised permeability of

the gastroenteric path, insufficient stability of membranes of the

corpulent cages, the lowered activity of the enzymes splitting biogene

амины, and the fibers connecting them have crucial importance. Allergic diathesis - anomaly of the constitution, characterised

predisposition to (1984) and I.M.Vorontsov (1985) depending on

features immunological reactions following variants of an allergic

diathesis suggest to allocate J.E.Veltishchev: atopic, autoimmun,

B-1,2,3, 4,5

A- 7, 20,

23,24,

25,27,28,29,

30,31,32,33.

22

infectious-allergic.

Lymphohypoplastic diathesis- children of the first 7 years of the life,

characterised common and proof increase in lymph nodes and

вилочковой glands, dysfunction endocrin systems (hypofunction of

adrenal glands, simpatiko-adrenalovoj systems) with the lowered

adaptation to environment changes, propensity to frequent infectious

diseases and allergic reactions. In formation of this diathesis crucial

importance have toksiko-infectious and long gypoxic influences in the

pre-natal period and in the first week’s outwombs lives.

Arthritism diathesis- the anomaly of the constitution characterised by

predisposition to to a diabetes, and to exchange, that is caused basically

by infringements of an exchange of uric acid and accumulation purins in

an organism, to a lesser degree infringements lipides and carbohydrate

exchanges. Polygene inheritance nervously-artriticheskogo a diathesis is

proved.

Carrying out of business game: Case technology

5 3 AFF musculoskeletal system. Semiotics of defeats. A rickets and

spasmophilia. Social aspects of a problem. Aetiology, pathogenesis,

clinic, diagnostics, the differential diagnosis, treatment and

preventive maintenance. A food of children at a rickets and

spasmophilia. Tactics GP

The summary. Anatomic features of bone system at children:

By the birth moment диафизы tubular bones are already presented by a

bone fabric;

The-majority epiphys, all spongy bones of a brush and a part of spongy

bones of foot consist from fabrics;

- Growth of tubular bones at length before occurrence in э epiphys

ossification points is carried out at the expense of development fabrics;

-In the first months and years of a life reorganisation of structure of a

bone fabric occurs from a coarse-fibered structure to lamellar with

secondary structures;

The-bone fabric is very sensitive to adverse influences of an

environment, and especially to infringements of a food, an impellent

mode of the child, a condition of a muscular tone and and so on;

-Intensive osteogenesis and remodelling is accompanied by reduction of

density and hardness of a bone fabric at children of early age with

simultaneous increase in flexibility of bones;

The-big maintenance of water;

-Intensive blood supply of a bone fabric;

The-big thickness and functional activity надкостницы, cross-section

growth of bones occurs for the account over bone;

-Volumes of intrabone cavities are rather insignificant and is formed

with the years;

-Bone ledges are made out and extended as become stronger and

muscles start to function;

The-external structure and histologic differentiation of a bone fabric

come nearer to characteristics of a bone of the adult person by 12 years.

Anatomico-physiologicalfeatures of a muscular fabric. The weight of

muscles in relation to weight of a body at children is much less, than at

adults. Feature of newborns is considerable prevalence of a tone of

muscles-sgibatelej.

B-1,2,3, 4,5,

A- 3, 23,

24,25,

27,28,

29,30,

31,32,33.

23

Development of muscles in children goes non-uniformly. Large

muscles of a shoulder, a forearm, later - muscles of a brush of hands

first of all develop. Till 6 years thin work as fingers is not possible to

children. At the age of 6-7 years the child can be engaged already

successfully in such works, as weaving, a moulding etc.

From 8-9 years at children sheaves become stronger, muscular

development amplifies, the considerable gain of volume of muscles is

marked. In the end of the puberty period there is a gain of muscles not

only hands, but also muscles of a back, a humeral belt and feet.

After 15 years also small muscles intensively develop, accuracy

and coordination of small movements is improved.

Rickets - polyaetiological the exchange disease caused by

discrepancy between high requirement of the growing organism in salts

of phosphorus and calcium and insufficiency of systems, providing their

transport and inclusion in a metabolism. The rickets is characterised by

the bone infringements caused by an insufficient mineralization

остеоида (formed intercellular matrix bones). At children is more

senior 1 year and adults a similar condition name osteomalation and an

osteoporosis.

Spasmophilia till now it is considered as independent disease

though tetania as the basic clinical display spasmophylia can be various

aetiology and have different pathogenetic mechanisms. Communication

of rickets with спазмофилией is known. It is considered, that

pathogenetic спазмофилия and a rickets - two various phases of

frustration of an exchange of calcium and phosphorus which develop as

a result of a lack of vitamin D of an organism.

Carrying out of business game: Problem training

6 6 AFF respiratory system. A research technique. Semiotics of defeats.

Bronchitis. An aetiology, pathogenesis, clinic, diagnostics, the

differential diagnosis, treatment and preventive maintenance.

Tactics GP.

The summary. Bodies of breath at children have rather smaller

sizes and differ incompleteness of anatomo-histologic development. The

nose of the child of early age is rather small, nasal courses overthroat

narrow; the bottom nasal course is absent. The nose mucous membrane

gentle, rather dry, is rich with blood vessels. Owing to narrowness of

nasal courses and plentiful blood supply of their mucous membrane

even the insignificant inflammation causes in small children difficulty

of breath through a nose. Breath through a mouth at children of the first

half of the year of a life is impossible, as the big language pushes aside

overthroat behind. At children of early age the exit from a nose - choan

is especially narrow, that often is the reason of long infringement at

them nasal breath.

Bronchitis - inflammatory disease of bronchial tubes of various

aetiology (infectious, allergic, physical and chemical and др). Allocate

following forms of a bronchitis at children:

1. Acute simple bronchitis (ASB)

2. Acute obstructive a bronchitis (AOB)

3. Acute broncholites (AB)

4. Reccurent a bronchitis

B-1,2,3, 4,5

A- 3,7,9,16,

23,24,25

27,28,29,30,

31,32,33.

24

5. Reccurent obstructive bronchitis

All forms of bronchitis diagnose at clinical symptoms of an

inflammation of bronchial tubes without pneumonia signs.

Acute simple bronchitis - a bronchitis proceeding without

пизнаков of obstruction of bronchial tubes.

Etiologic factors ASB are viruses (a paraflu I and II types, Rs-

viruses, аденовирусы, flu viruses, a cytomegalovirus). The bronchitis,

as a rule, arises in the course of a current of such children's infections,

as a whooping cough and measles. At children of advanced age frequent

aethiological the factor can be Mycoplasma pneumonia, Chlamydia

pneumonia.

Sharp obstructive bronchitis - a bronchitis proceeding with a

syndrome of obstruction of bronchial tubes. Arises at children much

more often also proceeds more hard, than at adults.

Sharp broncholites on modern representations concerns to AOB

with defeat of small bronchial tubes and bronchiolis usually virus

aetiology. Sharp broncholites children of the first 2 years of a life are ill

basically.


7. AFF blood circulation bodies. Features of pre-natal blood

circulation. Research methods. Semiotics of defeats. CHD.

Haemodynamic changes at CHD. Tactics GP.

The summary. The heart bookmark begins on 2nd week of pre-

natal development from two independent warm rudiments which then

merge in one tube located in the field of a neck. It is fixed above by

arterial trunks, below - developing venous sine. Owing to fast growth at

length on 3rd week the tube starts to be bent in the form of letter S, thus

a primitive auricle and the arterial channel, were in the beginning on the

ends of a warm tube, approach, and inflow and outflow ways are closed.

On 4th week heart becomes two-chamber (as at fishes) with valves

between a venous sine and an auricle. On 5th week there is a formation

межпредсердной partitions, and heart becomes three-chambered (as

amphibians), on 6-7th week have a division of the general arterial trunk

into a pulmonary artery and an aorta, and stomach- on right and left.

At newborns heart rather big also makes 0,8 % from weight of a

body (nearby 22), and at adults - 0,4 %. Right and left stomachs are

approximately equal; the thickness of their walls makes 5 mm. With the

years there is an increase of weight of heart: to 8 мес the weight

doubles, by 3 years - trebles, by 6 years increases in 11 times.

Especially intensively in connection with bigs loading on it the left

heart, a thickness of a wall left stomach grows reaches by 14 years

almost 10 mm (right - 6 mm). Both auricles big, a thickness of their

walls of 2 mm. Simultaneously there is a fabric differentiation.

Congenital heart disease - the pathological condition

characterised by those or other defects of development of heart and the

main vessels, resulted influence on an embryo and a fruit of various

harmful factors.

Frequency of congenital heart diseases is sufficient is high. At

different authors the estimation of frequency of occurrence fluctuates,

but, on the average, it makes 0,8 - 1,2 % from all newborns. From

among all meeting developmental anomalies it makes to 30 %. Principal

B-1,2,3, 4, 5

A- 2,12, 23,

24,25,26,

27,28,29,30,

31,32,33.

25

causes of a birth of children with CHD are: chromosomal infringements

- 5 %; a mutation of 1st gene - 2-3 %; influence of external factors (an

alcoholism of parents, reception of the medical products, the transferred

virus infections during pregnancy etc.) - 1-2 %; poligenno-multifocal

inheritance - 90 %.

Besides aethiological, allocate risk factors of a birth of the child

with ВПС. They concern: age of mother, endocrin diseases of spouses, a

toxicosis and threat of interruption of I trimester of pregnancy, deadborn

in the anamnesis, presence of children with congenital developmental

anomalies at close relatives.

Quantitatively estimate risk of a birth of the child with CHD in a

family can only генетик, but give the preliminary forecast and direct

parents on medical and biologic consultation each doctor can. Meets

more than 90 variants CHD and set of their combinations.


8. 4 AFF digestion system. Defeat semiotics. Functional frustration ЖКТ.

Belkovo-power insufficiency. Tactics GP.

The summary. Formation of bodies of digestion begins from 3-

4th week embrional the period when from entodermal plates the primary

gut is formed. On its forward end on 4th week there is an oral aperture,

and a little later on opposite the end appears anal an aperture.

Oral cavity of the newborn of the insignificant sizes. The

threshold is delimited from an oral cavity so-called gum by edge,

instead of alveolar shoots. A lip thick, the mucous membrane is

covered, on an internal surface of lips there are cross-section platens.

Language at the newborn wide, short, thick, inactive. It occupies all oral

cavities. At the closed mouth it leaves for edges of gums and reaches

cheeks. Ahead language acts between the top and bottom jaws in a

threshold of a mouth, which at the newborn very small. Nipples

language are expressed, it is developed poorly.

Belkovo-power insufficiency - chronic frustration of a food and

trofic the fabrics, breaking correct harmonious development of the

child. In days of social shocks the dystrophy can develop at any age, but

especially children of the first 3 years of a life are subject to it. Disease

is accompanied by considerable infringement of exchange processes,

immunity decrease, a delay physical, psychomotor, and further and

intellectual development.

On time of occurrence it divide into three forms:

prenatal, developed till a birth of the child;

postnatal, arisen after a birth;

mixed, generated under the influence of the reasons operating on

an organism of the child intra-and outwombs.

The reasons of dystrophies. Pre-natal the dystrophy is caused by

adverse conditions and the various factors breaking correct development

of a fruit.

Young (till 20 years) or elderly (after 40 years) age of the

pregnant woman.

Infectious and somatic diseases of the pregnant woman.

Gestosis in any trimester of pregnancy.

Adverse social conditions, nervous stresses, an irrational food and

bad habits.

B-1,2,3,4, 5

A-4,6,

19,23,

24,25,

27,28,

29,30,

31,32,33.

26

Professional harm at both parents.

a placenta Pathology (reveal in most cases if all factors set forth

above are excluded, and the dystrophy is diagnosed for the child

prenatal).

Postnatal the dystrophy can be connected both with exogen

influences and with endogen the factors causing a secondary dystrophy.

the Basic exogen factors postnatal dystrophies:

o the alimentary: the proteino-power insufficiency caused

quantitatively or qualitatively unbalanced food, deficiency of microcells

(zinc, copper, selenium, etc.);

o the infectious: intestinal infections, repeated SRI, especially

complicated an otitis;

o the social.

To endogen aethiological to factors postnatal dystrophies carry:

o developmental anomalies and chromosomal diseases;

o anomalies of the constitution;

o immunodefisit conditions.


9 AFF urinoformation and urinations system. Research methods.

Semiotics of defeats. Infections urino ways. Tactics GP.

The summary. At newborns and children of chest age a kidney

roundish, its surface hilly at the expense of a lobular structure that is

connected with insufficient development substances at this age. The

lobular structure of a kidney remains till 2-3 years. The length of a

kidney at the newborn makes 4,2 sm, and weight - 12 At chest age the

sizes of a kidney increase approximately in 1,5 times, and the weight

reaches 37г. In the first childhood the length of a kidney is equal on the

average 7,9 sm, and weight-56 Growth of kidneys occurs basically on

the first year of a life of the child. During the period with 5 - 9 years and

especially in 16 - 19 years the sizes of a kidney increase at the expense

of development substance which proceeds up to the termination

пубертатного the period; growth of brain substance stops by 12 years.

The weight substance of kidneys increases thanks to growth at length

and width curve channels and an ascending part of a loop nefron.

Nephritic at the newborn wide, ampulliform. The fibrous capsule of a

kidney becomes life of the child well appreciable to 5 years, and to 10 -

to 14 years on the structure it is close to a fibrous capsule of the adult

person.

The infection of urinary system at children takes a leading place

in structure of diseases of children's age after a sharp respiratory virus

infection. To 7-year-old age of 7-9 % of girls and 1,6-2 % of boys have,

at least, one episode UWI confirmed bacteriological. It is necessary to

notice, that beginning UWI more often, it is necessary for the first year

of a life irrespective of a floor, and, as a rule, proceeds in the form of a

sharp pyelonephritis. If at this age the correct diagnosis is not made to

the child and corresponding treatment the probability reccurent clinic

course with the subsequent formation of the centres nefrosklerosis is

very high is not spent. So, 30 % of girls within a year and 50 % - within

5 years transfer an aggravation of a sharp pyelonephritis. At boys

B-1,2,3,4, 5

A-21,23,24,

25,27,28,

29,30,

31,32,33.

27

frequency of relapses UWI within a year a little bit more low - 15-20 %.

Further for them development of an aggravation of a pyelonephritis is

not characteristic. Obstructive urophathia meet in 2 % of cases UWS at

girls and in 10 % - at boys. Clinical displays of a sharp cystitis meet,

basically, at girls of 2-6 years.

Carrying out of business game a case technology

10 5 AFF hemopoietic organs. Specifications of peripheral blood of

children of different age. Semiotics of defeats. Scarce anemias at

children. Aetiology, pathogenesis, clinic, diagnostics, the differential

diagnosis, treatment and preventive maintenance. A food of

children with scarce anemias. Tactics GP.

The summary. At early stages of development of an embryo (on

3rd week) the centres bloods appear in so-called blood islets -

congestions mesenximal the cages located in a wall желточного of a

bag. On 4-5th week embrional come to light primitive bloods cages.

During this period of development of a germ of the person bloods

occurs in vessels and is called as a stage angioblast.

In the beginning of 4th month when the bone fabric and a bone

brain develop, arises a marrowy blood which gradually starts to star. In

prenatal the period the bone brain is red, with 3-4-yaers age it is

replaced on yellow in some bones.

In outwombs the bone brain produces lives eritrocytes, the

granulated leukocytes, trombocytes and monocytes; in lymph nodes, a

spleen, follicles, peyer plaques of intestines and others lymfs formations

are produced lymfocytes.

Iron deficiency an anaemia (IDA) - an extreme variant of display

of deficiency of iron, characterised by reduction of concentration of

haemoglobin in unit of volume of blood and in erytrocyte; microcytosis,

anysocytosis; a low colour indicator; the low maintenance of iron and

ferretin blood whey; low saturation transferrin iron; increase iron

linkage abilities

IDA is the most frequent kind of anaemia at children's age. It is

more often observed at early age with the maximum frequency at

children of the second half of the year of a life and in the teenage

period. It is preceded by the period of latent deficiency of iron, meeting

approximately in 1,5-2 times more often, than IDA.

Reasons IDA:

1. Low stocks of iron at a birth.

2. Superfluous losses or iron consumption.

At deficiency of iron the first changes occur in fabrics - fabric

stocks that finds reflexion in level decrease feretin in whey decrease,

saturation transferrin iron further decreases, but the general raises iron

lincage ability of whey and level free - predecessors gems. All specified

changes develop at the child even before decrease in level of iron in

whey of blood and concentration of haemoglobin, volume erytrocytes,

that is before anaemia development.

Depending on degree of decrease in haemoglobin distinguish lungs

(haemoglobin 90-110 г/л), average (haemoglobin 60-80 г/л) and heavy

(haemoglobin more low 60 г/л).

Carrying out of business game a case technology

B-1,2,3, 4,5

A-1,7,23,24

27,28,29,30,

31,32,33.

The intermediate control

28

4.3. The maintenance that of a practical training for students 5 courses

№

less

on

s

№ l

ectu

res

The name of the themes practical employment and their

summary with instructions of used new pedagogical

technologies

Ref

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o

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1 6 Features of a clinic coure of acute pneumonia at children. Aetiology,

pathogenesis, clinic, diagnostics, the differential diagnosis,

treatment and preventive maintenance. Tactics GP.

The summary. Pneumonia - inflammatory process in respiratory

departments of the lung, arising as independent illness or complication

of any disease. Disease of pneumonia makes nearby 10-15 on 1000

children of the first year of a life, 15-20 on 1000 children of 1-3 years

and nearby 5-6 on 1000 children is more senior 5 years in a year.

The most frequent activators of pneumonia at children at the age

from 6 months till 5 years which were ill in house conditions are

Streptococcus pneumonia and hemophyl a stick - Haemophylus

influenzae b. In 60-70th years on the first place among the reasons of a

pneumonia at children left golden stafilicoccus.

At pre-natal infection is diagnosed chlamidya pneumonia more

often. In rare instances at children born before term, it is similar

proceeds pneumocyctos; at deep newborn children a pneumonia caused

by an ureaplasma and Mycoplasma hominis is described also.

Bronchopneumonia- most often meeting type of a pneumonia

proceeding with some distinctions at children of early age and at

preschool children, schoolboys.

At children of preschool and school age the clinic central

pneumonia develops of "pulmonary" complaints, symptoms of

intoxication, signs local fisical changes.

The disease beginning can be as gradual, with slow development

of characteristic semiology in the end to 1st 2nd week of illness, and

sudden at which already in the first 3 days the clinical picture allows to

diagnose a pneumonia.

Segmentary pneumonia. Centrals a pneumonia which occupy a

segment or some segments are called as segmentary. Three variants of a

current of a segmentary pneumonia are described. A clinical current at

the first variant the good-quality. Quite often they at all do not diagnose,

for focal changes keep all some days, and respiratory insufficiency,

intoxication, sometimes even at patients is not present cough.

Croupous pneumonia. The typical current crupous pneumonia is

observed at children of preschool and school age, is rare - at the age of

1-3 years and as an exception - on the first year of a life. In

pathogenesisе crupous to a pneumonia the important role belongs to

allergic reactance which develops in sensibilitation pneumococcus an

organism inclined to hyperergic to reactions. The rarity crupous

pneumonia on the first year of a life speaks absence of a sensitisation at

children of this age to pneumococcus.

B-1,2,3, 4,5

A- 9,14,16,

23,24,25,

27,28,29,30,

31,32,33.

29

Interstitial pneumonia. In 1946 г R.Lenk from group of a sharp

pneumonia has allocated a pneumonia characterised X-ray by following

lines:

1. Change of pulmonary drawing on type proceeding from the

expanded root, the consisting from rough or gently outlined strips in

which basis lays peribronchial infiltration and, probably, filling of

bronchial tubes exudat.

2. Mesh pulmonary drawing in a zone of defeat with various on

size. Against these two kinds of changes at development atelectasis

appears small spotty.

3. Extended accurately outlined shades with signs of narrowing

of a bronchial tube


2 1 Features of clinical course of a bronchial asthma at children.

Etiology, pathogenesis, clinic, diagnostics, the differential diagnosis,

treatment and preventive maintenance. Tactics GP. The summary. A bronchial asthma (BА) - chronic inflammatory

disease of respiratory ways which is shown: the full or partial reversible

obstruction of respiratory ways arising owing to a spasm of smooth

muscles of bronchial tubes, a mucous membrane hypostasis, infiltration

under mucous covers inflammatory cages, hypersecretions of slime, a

thickening basal membranes; by episodes of the cough, whistling rattles,

a short wind, feeling of constraint in breast which, as a rule, happen are

connected with influence of specific trigger factors and arise mainly at

night or early in the morning; hyperreactance of respiratory ways. BА is one of the most widespread chronic diseases of children's

age. In structure bronchopulmonare pathologies the asthma makes 50-

60 %. On pathogenesis the bronchial asthma can be divided into two

variants: immunophathological and not immune. At some children

symptoms БА are provoked only by physical activity. In this group

carrying out of the loading test (the 6-minute report of loading run) is

useful. The primary help at an out-patient stage at easy attack БА

includes inhalations β2-adrenomimetika fast action from a dosing out

aerosol inhaler. At averge and heavy attacks use β2-adrenomimetik

repeatedly with an interval of 20-30 mines within an hour, then

everyone 4 ч (necessarily). Preferences give nebulaysers therapies.

Bronchodilatation the effect can be strengthened addition bromide. If

the effect is insufficient, appoint prednisolone inside (till 1 year of 1-2

mg/kg/sut, in 1-5 years of 10-20 mg) or parenteral. For treatment of

aggravation BА suspension budesonid is effective, it is possible to

dilute it with a physiological solution, and also to mix with solutions

broncholitecs. The dose at children makes 0,25-0,5 mg (to 1 mg) 2

times a day. Carrying out of business game: Case technology

B-1,2,3, 4,5

A-9,10,11,

18,23,24,25,

27,28,29,30,

31,32,33.

3 Nonrevmatic cardites. An etiology, pathogenesis, clinic, diagnostics,


The summary. Nonrevmatic cardites - defeat of a muscle of the

heart, caused by development of nonspecific changes of inflammatory

character. Frequency cardite considerably increases during epidemics of

B-1,2,3, 4,5

A- 2,3,12,

23,24,25,

27,28,29,30,

30

virus infections.

Cardites any infectious disease irrespective of its activator can

become complicated. However in most cases not rheumatic cardites

arise at children with a sharp virus infection. The greatest value in their

occurrence is given to viruses kocsaci, especially groups And and In,

and ECHO. To another aethiological to factors carry viruses of flu and a

paraflu, measles, a parotitis, a cytomegalovirus, etc. Njnrevmatic

cardites can be caused bacteria, mushrooms and other infectious agents.

Last years hereditary factors draw to themselves attention at not

rheumatic cardites. Cardites in such cases It is not enough symptoms,

with development of warm insufficiency only in the ending. In a basis,

possibly, genetically determined defect antiviral immunity lies.

Pathogenesis sharp and chronic cardites, possibly, it is

distinguished. At sharp cardites have values influence of the infectious

factor, allocation mediators’ inflammations, occurrence of reaction of

hypersensitivity of immediate type with increase of vascular

permeability and cellular infiltration; it is frequent with damage of a

wall of vessels. At a chronic current the activator does not play a main

role and at the heart of disease lay autoimmune infringements. Thus

there is an interaction autoantigen (anticardial antibodies) and-or with

autoallergens against the changed immune tolerance. In reply to

secondary autoantigenes (only damaged own fabric of heart or a

combination of such damage to a virus antigene) are formed anticardial

antibodies, usually aggressive. The reason of such condition is lowered

formation T-supressorov that leads to activation helps influences and

hyperstimulations V-limfotsitov. Features chronic кардитов (self-

supporting process, system character, malignant and resedive a current,

resistant to therapy) allow thinking about autoimmun the mechanism as

to a basis of their formation.

At sharp not rheumatic cardites laboratory data contain the small

information. In blood analyses - increase SSE, increase of level ά2 and

γ-globulin, S-jet fiber - is reflected a current virus infection. The most

reliable acknowledgement of the diagnosis is allocation of a virus from

blood, Nasopharynx slime, and excrements.

Carrying out of business game: Ccase technology

31,32,33.

4 2 Features of clinical course of a acute rheumatic fever at children.

Etiology, pathogenesis, clinic, diagnostics, the differential diagnosis


The summary. Rheumatism (a rheumatic fever) - system

inflammatory defeat of a connecting fabric with primary localisation of

process in cardio vascular system and the support-impellent device. At

rheumatism any bodies and systems can be amazed: the brain, kidneys,

a liver, etc. Primary attack of rheumatism arises mainly in children's (7-

15 years) and young age. The rheumatism takes the important place in

the general structure of disease cardio vascular illnesses and death rates

from them. Disease of rheumatism in economically developed countries

makes now less than 5 on 100000 population. Results of

epidemiological data, clinical supervision, and microbiological,

immunological and experimental researches convincingly show

communication streptococcal nasopharynx to an infection (β-

gemoliticheskogo a group streptococcus) with rheumatism.

B-1,2,3, 4,5

A- 2,3,12,

23,24,25,

27,28,29,30,

31,32,33.

31

Acknowledgement of a streptococcal aetiology of rheumatism are:

previous rheumatism attack a streptococcal infection (quinsy, a

pharyngitis); increase in disease of rheumatism during flashes ОРЗ,

caused β-gemoliticheskim a streptococcus of group And; increase of a

caption of streptococcal antibodies; possibility of sharp decrease in

disease of rheumatism and its relapses as a result antistreptococcus

preventive maintenance and active treatment of the streptococcal centres

of an infection. The streptococcal aetiology of rheumatism is

characteristic for its "classical" forms proceeding sharply, with

involving in process of joints. Communication between a streptococcal

infection and long is not caught almost, latent or is frequent resedive a

rheumatism current. At last forms of a current of rheumatism there is no

increase of a caption of streptococcal antibodies, is not effective

bisillino preventive care rheumatism relapses. In this connection many

researchers call into question a role of a streptococcal infection in

development latent, long and resedive rheumatism forms. Pathogenesis

rheumatism it is combined and in many respects it is not clear. Essential

value in its development is given to an allergy. The affinity of kliniko-

anatomic displays of rheumatism testifies to it, whey illness and an

experimental allergy, resedive illnesses under the influence of a number

of nonspecific factors, antirheumatic effect from antiallergic means. In

the subsequent in process join autoallergic mechanisms. The

rheumatism prognosis depends on character of a current of pathological

process and involving in process of those or other bodies and systems.

Now the most proved is three stage the system of treatment of

rheumatism: the first stage - long (4-6 week) hospitalisation in an active

phase; the second stage - sanatorium or sanatorium treatment in after

hospital the period, the third stage - dispanser supervision in the

conditions of a polyclinic with bisilino medicamentosis treatment.

Rheumatism treatment should be whenever possible early (during the

first hours or days - till 3 days from the disease beginning), as in this

stage of change of a connecting fabric of heart and other bodies (a phase

mucoide swellings) are still reversible; complex, adequate and strictly

individual. In an active phase of rheumatism of the patient it is

necessary to hospitalise. If it cannot be made, it should observe a

confinement to bed in house conditions. The medical-guarding and

impellent mode, a balanced diet, medicamentous and physiotherapeutic

means enter into a treatment complex.


5 3 Juvenile reumatoid arthritis. Etiology, pathogenesis, clinic,

diagnostics, the differential diagnosis, treatment and preventive

maintenance. Tactics GP.

The Summary. Juvenile reumatoid arthritis (JRA) - chronic

inflammatory disease of joints of the unknown aetiology, characterised

difficult autoimmun pathogenesis, steadily progressing current, possible

involving in process of internal bodies and frequent development of

physical inability in children. Disease in which clinical picture prevail a

fever, a rash, hepatosplenomegalya, hyperleucositosis in a combination

with artpain, but without a proof arthritis, is considered in quality

rheumo diseases (pseudo-sepsis Visslera-Fankoni). Reumatoid the

arthritis is characterised by a chronic not purulent inflammation

B-1,2,3, 4,5

A- 2,3,12,

23,24,25,22

27,28,29,30,

31,32,33.

32

sinoveal covers. The raised secretion of an articulate liquid leads to

formation intraarticulate. Which act in a joint cavity; the cover at JRA

extends on a surface of an articulate cartilage and is accustomed to

drinking with it (formation pannus). Proof damages of an articulate

cartilage at JRA arise later, than at reumatoid arthritis of adults; at many

children with JRA proof defeat of joints never arises, despite is long

preceding sinovit. Destraction articulate structures arises at children

with positive on reumatoid to the factor form JRA or with the form

which begins with system displays is more often.


6 4 Features of clinical course gastroduodenal pathologies at children.

Etiology, pathogenesis, clinic, diagnostics, the differential diagnosis,

treatment and preventive maintenance. Tactics GP. The summary. Chronic gastroduodenites (CG) - chronic

disease of inflammatory character, which is accompanied by not

specific structural reorganisation of a mucous membrane and the

ferruterous device of a stomach and a duodenal gut (dystrophic,

inflammatory and regeneratore changes) with different secretor and

motor infringements. CGD - the most widespread form chronic gastroduodenals

diseases. In structure of illnesses of a stomach and a duodenal gut

makes 58-74 %. At diagnostics it is necessary to consider presence of

risk factors of development CGD and hereditary predisposition. The

disease clinic depends on a phase and expressiveness of inflammatory

process, a condition secretor stomach functions, motor-evakuatore

infringements of a stomach and 12IJ. At aggravation CGD, as well as at

a stomach ulcer, following clinical syndromes take place: painful,

dyspeptic and a chronic nonspecific intoxication. Characteristic

colouring the accompanying pathology hepatobiliars gives to a clinical

picture systems, an intestines, a pancreas. Clinical symptoms are similar

to stomach ulcer displays, but often there is no seasonal periodicity of a

painful syndrome, night pains happen infrequently. At treatment of patients CG and CGD in modern conditions for carrying

out of adequate diagnostics and treatment it is necessary to execute

necessary volume of paraclinical methods of inspection. Laboratory

researches share on obligatory and if necessary Tool researches and criteria of diagnostics: • EGDS with aim biopsya and carrying out the express train of

diagnostics HP (at erozive CGD - double); • intragastric rN-metrija (or fractional research of gastric contents) - at a

time; • Ultrasonic of bodies of a belly cavity - unitary for revealing of an

accompanying pathology. If necessary: • radiological research of a stomach and 12IJ (motor-evakuatore

infringements, anomalies of development); • reografi; • others according to character background and combination

pathologies Main principles of treatment basically answer principles of

therapy CG and conditions secretor functions of a stomach and

B-1,2,3, 4,5

A- 4,19,

23,24,25,

27,28,29,30,

31,32,33.

33

infringements motor-evakuators functions of a stomach and a duodenal

gut depend on the period of disease, character kliniko-endoskopic

changes. At an aggravation it is necessary to define treatment conditions

(stationary or out-patient), a mode of physical activity. To appoint

dietary actions taking into account a condition of the patient (a table №

1 or № 5).


7 5 Features of clinical course of diseases hepatobiliary system at

children. Aetiology, pathogenesis, clinic, diagnostics, the differential


The summary. A dyskinesia bilededucing ways at children is the

most widespread pathology biliar systems. A dyskinesia bilededucin

ways - frustration reduction functions of various bodies bilededucin

systems, mainly a bilious bubble and outliver the bilious ways, leading

to infringement bilededucin.

Chronic virus hepatitis - it is long proceeding (more than 6

months) dystrophic, proliferative, inflammatory process in a liver,

clinically shown by a rack hepatosplenomegalya, hyperenzyme-emiej

and dysproteinemiea, quite often having progridients, progress-

sirujushchee a current up to cirrhosis formation.

Chronic virus hepatitises - one of the most actual socially

medical problems of pediatrics.

It is caused by considerable increase of frequency of their

formation already at early children's age, absence of effective therapy

and unpredictability of the prognosis. The reasons of growth and

эaethiological structure of chronic diseases of a liver in various regions;

the world are various. They are connected with a various ecological

situation, character of a food, high prevalence infectious gastrointestinal

and other diseases, but first of all, virus hepatitises.

Basic element of defeat of a liver at chronic virus hepatitis In is

interaction immunocompetens systems of a virus with hepatocytes.

Persistens a hepatitis virus In it is caused by absence of the adequate

immune answer of an organism of the owner, sharp oppression

interferonogenesis. It is established, that the sharp hepatitis With

proceeds, as a rule, latents, and in 5-10 years at the patient the chronic

hepatitis comes to light. In this connection the hepatitis With is named

"the tender murderer". The majority researcher underline, that the sharp

hepatitis With at (60-75 %) considerable number of patients, comes to

an end with formation of a chronic hepatitis and at 20 % - cirrhosis.

Hence, formation of chronic forms of illnesses of a liver of virus

aetiology occurs at a combination of virus hepatitis In with delta an

infection or, at revealing of virus hepatitis With.

In 1994 the group of the American researchers has allocated a

new virus of a hepatitis With which is found out at a sharp and chronic

hepatitis And, neither In, nor With, is frequent in a combination with

hepatitis viruses In and With, and also at persons from risk group

(addicts and the patients receiving of many haemotransfusions).

Thus, progress in a science has allowed formulating new

classification, substantially aethiologic. Allocate following forms of a

chronic hepatitis.The chronic virus hepatitis with instructions of the

virus which has caused it (In, delta, With, About,) or is noticed, that the

B-1,2,3, 4,5

A- 4,19,

23,24,25,

27,28,29,30,

31,32,33.

34

virus is not identified.

Carrying out of business game: Case technology 8 6 Features of a current of diseases of kidneys at children. Aetiology,

pathogenesis, clinic, diagnostics, the differential diagnosis,

treatment and preventive maintenance. Tactics DGP.

The Summary. Acute glomerulonefritis (AG) - glomerulonefrite with

rather fast current shown in expressed cases by a triad of symptoms -

hypostases, a hypertensia and gematuria, but sometimes only changes of

structure of urine. Frequency AGN - 6-20 on 10 000 children. Boys are

more often are ill. Peak of disease - in the end of summer and in the

autumn. The aetiology of primary forms SG is connected with

nefritogen stams beta-gemoliticheskogo a streptococcus of group of

A.Istochnikom the streptococcal infection of the top respiratory ways or

integuments is. Chronic glomerulonefritis (CGN) - group primary

glomerulopathye, characterised persistens progressing immunno-

inflammatory, sclerous and destructive defeats нефронов with the

subsequent tubulointerstisial a sclerosis and frequent development of

chronic nephritic insufficiency. CGN, as a rule, is initially chronic

illness, disease with hereditary predisposition. As trigger factors can

play a role: 1) irrational medicinal therapy; 2) the chronic centres of an

infection; 3) persistens virus infections; 4) excessive antigene loadings.

Quickly progressing glomerulonefritis, before called subsharp,

characterises quickly developing and nephritic insufficiency with

firmness keeping at usual therapy with development of a terminal

uraemia in terms from several weeks about several months. At the heart

of disease - autoimmun defeats at which or are synthesised highlyaffine

to basal to a membrane аutoantitels, or are formed the big immune

complexes with an abundance compliment and development

membranozno-proliferativnogo glomerulonefritis.


B-1,2,3, 4,5

A- 18,21

23,24,25,

27,28,29,30,

31,32,33.

9 OSCE

6. Independent works for students

6.1. Thematic plans of independent work for students 4 courses

№

The name of the themes IWS Hours

1. Methods temper healthy and often ill children 3

2. Often ill child 3

3.

4.

Features of a current of a dysbacteriosis at children. 3

4. Pylorospasm and pylorostenosis 3

5. The chronic centres of an infection 3

6. Dyskinesia bileddeducing ways 3

7. Hypo and avitaminosises. 3

8. Enuresis, neurogenicbladder dysfunction 3

9. As Rickets diseases 3

10. Dismetabolic nephropathy 3

35

6.2. Thematic plans of independent work for students 5 courses

№

The name of the themesы IWS Hours

1. Atypical pneumonia at children 3

2. Reactive arthritises at children 3

3.

4.

Kartageners syndrome 3

4. Rei’s Syndrome. 3

5. System diseases at children 3

6. Gastroesophageal reflux 3

7. Mitral valve prolapse 3

8. Chronic enterocolit 3

9. Cirrhosis 3

10. Hereditary nephrites 3

7. The list of practical skills

For students 4 courses 1. An estimation of physical development of the child.

2. Technics of delimitation of relative dullness of heart at children.

3. Technics of definition of the sizes of a liver at children.

4. Urgent help at laryngospasm at children.

For students 5 courses 1. Technics of measurement of arterial pressure at children.

2. Picfloumetrria at children.

3. Urgent help at anafilaxsis a shock

8. The rating control and criteria of an estimation of knowledge, skills on discipline

The basic criterion of quality of readiness of the student is its rating developing of a current

estimation, an estimation of the intermediate control and an estimation of the total control.

100 points as a whole on discipline are distributed as follows:

№ Control kind The maximum point Factor Lowest passing

score 1. The current control

taking into account

IWS

50 0,5 27,5

2. The intermediate

control 20 0,2 11,0

3. The total control

(ОSCE + the test) 30 0,3 16,5

TOTAL 100 1 55,0

36

On semestre points are distributed depending on duration of studying of a subject.

Criterion оценивания a practical training is the current estimation developing of the control of

readiness of the student to employment and estimations of quality of performance of the task.

Criteria of an estimation of knowledge of students under the current control

cоставлены on 18 employment separately (Appendices №1), and also criteria of estimation IWS

(the appendix №2)

Criteria of an estimation of the intermediate control (the appendix №3).

100-86 points - are excellent

85,9-71 points - it is good

70,9-55 points - are satisfactory

54,9 and more low - it is unsatisfactory

Criteria of an estimation of the total control (the appendix №4).

100-86 points - are excellent

85,9-71 points - it is good

70,9-55 points - are satisfactory

54,9 and more low - it is unsatisfactory.

Criteria of an estimation of practical skills

Practical skills are estimated on 100 ball system. Are provided from 5 to 10 steps, for ease

of mastering by students (the appendix №5).

9. Information-methodical maintenance

Use of multimedia presentation of lectures, the educational films, new pedagogical

technologies, computer testing.

10. The literature

The basic:

1. Children's illnesses, under the editorship of L.A.Isaevoj. 1994.

2. Propaedeutics of children's illnesses, A.V.Mazurin, I.M.Vorontsov, 1995

3. Children's illnesses, under the editorship of Н P.Shabalova, 2002

4. Children's illnesses, under the editorship of Н P.Shabalova, 2010

5. Children's illnesses, under the editorship of A.A.Baranova, 2010

6. Children's illnesses, T.O.Daminov, B.T.Halmatova, U.R.Babaeva, 2012

The additional:

1. Anemias at children, V.I.Kalinicheva, 2000,

2. Belokon N.A., Kuberger M. B. Illnesses of heart and vessels at children. M. 1987, s.303-338.

3. Belozerov JU.M.nurser cardiology. M. 2004. 597 with.

4. «Illnesses of children of early age», - a management for doctors under A.A.Baranova's edition, -

Moscow-Ivanov, 1998,-s.241-257.

37

5. Illnesses of bodies of digestion at children, V.A.Mazurin, 1994,

6. A bronchial asthma at children and its classification. In books.: Under the editorship of

S.J.Koganova. M: Medicine 1999;

7. Denisov M. JU. Practical gastroenterology for the pediatrist. М, 2001.

8. Clinical medicine. The directory of the practical doctor. М, 1997, T.1

9. Clinical immunology of children's age, D.V.Stefani, J.E.Veltishchev, 1996

10. Korovina N.A., Zaplatnikov A.L., Захарова I.N.cough at children. The grant for doctors. - М:

2000.

11. Коганов S.JU.bronchial an asthma at children. Moscow: Medicine 2002;

12. Lasitsa O. I, Ласица T.S.bronchial asthma in practice of the family doctor. - Kiev: Joint-Stock

Company «Атлант UMS». - 2001. - 263 with.

13. Moshchich P. S, V.M.Sidelnikova, D.J.Krivchenja. «Cardiology of children's age». Moscow,

2004

14. Неонатология N.P.Shabalova, М, 1998

15. The urgent help in pediatrics, I.M.Sinelnikov, 2000

16. Nazirov F.G., Denisov I.N., Улумбекова Э.Г. The Directory of the practical doctor. 2000

17. A sharp pneumonia at children, under V.K.Tatochenko's edition, 1994

18. Pediatrics - a management for doctors under R.E.Bermana, V.K.Vogana's edition. The book 6,

TH, 1989

19. A pathology of children of advanced age - under A.A.Baranova's edition, M,-1998

20. Rations of Century Л, Hatskel S.B., Эрман L.V.gastroenterolog of children's age in schemes

and tables: the Help management. SPb, 1998.

21. Parijsky Т.В. The Directory of the pediatrist. ЭКСМО. Moscow 2004

22. A management on children's nephrology, M.S.Ignatova, J.E.Veltishchev, 1995

23. A management on a nursery артрологии. Under ред.акад. АМН the USSR M.J.Studenikina

and порф. A.A.Jakovlevoj. - l. 1987. - 162 170.

24. The directory of the doctor of the general practice. Under edition акад. The Russian Academy

of Medical Science. N.R.Paleeva. ЭКСМО 2002 г

25. The directory of the doctor of the general practice. ЭКСМО, Under edition акад. Russian

Academy of Medical Science N.R. Палеева. 2002

26. The directory of the pediatrist. St.-Petersburg, Moscow, 2004

27. «The directory of the family doctor» (Pediatrics), - Minsk, 2000, - s.390-398, 417-420.

28. The five Minute child Health Advisor/-M. William Schwartz, MD., - 1998, USA

29. A therapist’s guide to pediatric assessment, - Linda King-Thomas, Bonnie J. Hacker, 1987,

USA

30. Pediatrics, - Margaret C. Heagarty., William J. Moss,-1997, USA

31. www.tma.uz

32. www.medlincs.ru

33. www.medbook.ru

34. www.medafarm.ru

Documents

WORK PROGRAM - library.tma.uzlibrary.tma.uz/uum2/uum-pediatrics-davolash-medped/02-umumiy-qis… · students of skills on dialogue with healthy and sick children of different age