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Approved at the Meeting of Department of Pediatrics №2 Minutes № 21 " 05 " 06 2020 Head of the Department MD, Prof

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Approved at the Meeting of Department of Pediatrics №2 Minutes № 21 MINISTRY OF HEALTH OF UKRAINE UKRAINIAN MEDICAL STOMATOLOGICAL ACADEMY Approved at the meeting of department of Pediatrics №2 Minutes № 21 " 05 " 06 2020 Head of the department MD, Prof. Kryuchko T.O. _____________________ METHODICAL RECOMMENDATIONS INDIVIDUAL WORK OF STUDENTS IN PREPARATION FOR THE PRACTICAL (SEMINARS) CLASS Academic discipline Pediatrics Module № 1 The most common somatic diseases in children Topic of the lesson Functional gastrointestinal disorder in children of the early age. Course 4 Faculty Medical Poltava-2020 1. Relevance of the topic: The question of functional disorders of the digestive system in pediatric gastroenterology is now one of the most pressing. Most often, parents consult a pediatrician for abdominal pain localized in the umbilical region, bloating, poor appetite or refusal to eat. These complaints can occur in both functional and organic lesions of the digestive tract. Functional disorders are often found in the structure of pathology of the digestive system. According to a number of researchers, more than a third of patients with complaints of diseases of the digestive system, no organic disorders are detected. Namely, abdominal pain is functional in 90-95% of children, in 20% of cases diarrhea in children is also due to functional disorders. 2. Specific objectives: - To analyze the etiological and pathogenetic factors of the most common functional gastrointestinal disorders in children: cyclic vomiting syndrome, colic, functional dyspepsia, functional constipation. -Explain the principles of treatment, rehabilitation and prevention of functional gastrointestinal disorders in children: cyclic vomiting syndrome, colic, functional dyspepsia and functional constipation in young children. -To offer a differential diagnosis and make a preliminary diagnosis of cyclic vomiting, functional dyspepsia, colic and functional constipation in young children. - To classify and analyze the typical clinical picture of the most common functional gastrointestinal disorders in children: cyclic vomiting syndrome, colic, functional dyspepsia, functional constipation. -Treat to analyze the data of laboratory and instrumental examinations in the typical course of the most common functional gastrointestinal disorders in children: general clinical blood and urine tests, biochemical blood tests, coprogram, study of intestinal microflora, ultrasound of internal organs, fibroesophageal gastroduodenum. -Analyze the prognosis of life in functional gastrointestinal disorders in children: the syndrome of cyclic vomiting, colic, functional dyspepsia and functional constipation in young children. - Diagnose and provide emergency care for colic in young children. 3. Basic knowledge, skills, abilities necessary for studying the topic (interdisciplinary integration): № Names of previous Acquired skills disciplines 1. Normal anatomy Know the anatomical features of the gastrointestinal tract in children 2. Normal physiology Have an idea of the physiological processes that occur in the digestive tract in children. 3. Pathological physiology Identify pathophysiological processes that occur in the gastrointestinal tract on the basis of symptoms 4. Microbiology with virology Have knowledge of the normal composition of the intestinal and immunology microflora of newborns and young children. 5. Patient care and nursing Demonstrate skills in caring for young children with functional practice disorders of the gastrointestinal tract and providing pre-medical care. 6. Propaedeutic pediatrics To have knowledge about the main clinical symptoms of functional gastrointestinal disorders in young children, to have an idea of laboratory and instrumental methods of examination. 7. Social medicine and health Apply knowledge about the structure of health care for children care organization for the proper use of resources of the health care system in terms of treatment and prevention of functional disorders of the gastrointestinal tract. 8. Pharmacology Have knowledge of the main groups of drugs used in the treatment of functional gastrointestinal disorders in young children. 4. Tasks for independent work in preparation for the lesson. 4.1. The list of the basic terms, parameters, characteristics which the student should master at preparation for employment № Term Definition 1. Functional gastrointestinal It is a diverse combination of gastrointestinal symptoms disorders without structural or biochemical abnormalities. 2. Cyclic vomiting syndrome The disease is predominantly childhood, manifested by (CVS) stereotyped recurrent episodes of vomiting, followed by symptoms of complete well-being. 3. Functional dyspepsia according to Roman criteria III is defined as the presence of signs of dyspepsia originating from the gastroduodenal region in the absence of any organic, systemic or metabolic diseases that could explain these signs. 4. Functional constipation Delayed bowel movements, which is accompanied by difficulty in defecation in the absence of organic pathology. 4.2. Theoretical questions for the lesson: 1. Define the concepts: functional gastrointestinal disorders, cyclic vomiting syndrome, functional constipation, functional dyspepsia. 2. Causes of functional gastrointestinal disorders in children. 3. Classification of functional gastrointestinal disorders in children according to Roman criteria III-IV. 4. Pathogenesis of functional gastrointestinal disorders in children. 5. Clinic of cyclic vomiting syndrome. 6. Criteria for the diagnosis of cyclic vomiting syndrome. 7. Diagnostic criteria for functional dyspepsia in children. 8. The main symptoms of functional dyspepsia in children. 9. Mechanisms of symptoms of functional dyspepsia. 10. Clinic and diagnosis of colic in young children. 11. Clinic and diagnosis of functional constipation in young children. 12. Treatment, prevention and prognosis of functional gastrointestinal disorders in young children. 4.3. Practical work (tasks) performed in class: 1. Work with test tasks. 2. Work of students in the wards at the bedside of children with functional gastrointestinal disorders: A) Collection of complaints, medical history; B) Objective examination of children; C) Formulation of the diagnosis according to the modern classification; D) Make a plan for the examination of a sick child; E) Make a treatment plan for a sick child. 3. Clinical analysis of an indicative case. 4. Solving situational tasks. 5. Contents of the topic: Definition:Functional gastrointestinal disorders are disorders of the interaction between the intestine and the brain (Drossman, 2016). This group of diseases is associated with any combination of disorders of the following gastrointestinal functions: motility, visceral hypersensitivity, mucosal disorders and its immune functions (mucosal homeostasis), changes in the composition of the intestinal microbiota, combined with changes in the central nervous system (CNS). Etiopathogenesis: today formed a new integrated biopsychosocial model of development of functional gastrointestinal disorders, which explains the development of these disorders as a result of interaction of biological, psychological and social subsystems at different levels and determine the degree of manifestation of various symptoms in gastrointestinal tract (functional disorders of the gastrointestinal tract). and those around her. The biopsychosocial model considers some infectious and non-infectious factors that are part of these subsystems as comorbid. At an early age, genetics, sociocultural environmental factors can negatively affect psychosocial development in terms of personal qualities, propensity to life stress, psychological state, as well as cognition and coping skills. These factors also affect the degree of sensitivity to intestinal dysfunction: altered motility or sensitivity, altered immune dysfunction of the mucosa or inflammation, a certain microbial environment and the influx of food and nutrients. In addition, all factors of connection between the brain and intestines interact with the degree of excitability of the CNS. Although psychosocial factors are not required for diagnosis, they affect the physiological functioning of the gastrointestinal tract through the axis "brain - intestine" (motility, sensitivity, barrier function) and are modulators of pain and symptoms of patient behavior, and ultimately affect treatment choices and clinical results. Classification. The classification of functional gastrointestinal disorders in infants and children is based on the age of the child (taking into account certain anatomical and physiological features of infants and the symptom that predominates in the complaints with which patients seek medical attention. Classification of functional gastrointestinal disorders in infants and children (Roman diagnostic criteria IV) Pediatric functional gastrointestinal disorders: Newborns / young children G1. Infant Regurgitation or pediatric regurgitation G2. Infant Rumination Syndrome G3. Cyclic Vomiting Syndrome G4. Colic in infants (or - InfantColic) G5. Functional diarrhea G6. InfantDyschezia G7. Functional constipation Children's functional gastrointestinal disorders (FGD): Children / Adolescents H1. Disorders accompanied by nausea and vomiting H1a. Cyclic vomit syndrome (CVS) H1b. Functional nausea and functional vomiting H1c. Rumination syndrome H1d.Aerophagia H2. Functional abdominal pain disorders H2a. Functional dyspepsia · H2a1 Postpranidal distress syndrome · H2a2 Epigastric pain syndrome H2b. Irritable bowel syndrome H2c. Abdominal migraine
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