IMPROVEMENT OF THE QUALITY OF CORRECTION OF ANEMIC SYNDROME IN PREGNANT WOMAN WITH GASTROENTEROLOGIC DISEASES

O.A. GUBKINA, E.Y. NEMSTSVERIDZE, E.A. YENENKOVA, S.N. PETROSOV,

A.S. YURIKOV, K.I. KASAPOV

“CM-Clinic”, Moscow, RUSSIA

Introduction: In case of significant increase in the number of pregnant women with anemic syndrome, mainly iron-deficient, rarely B12 – folic deficient and anemia in the result of chr. diseases. The reason - inconformity between increased need in microelements and their intake, due to malabsorption from GIT and blood loss. Recovery of iron, folic and Vit. B12 deficiency in pregnant women with GIT pathology, which is exacerbated by concomitant preeclampsia, uterine pressure, directivity on preserving “slender” figure etc.

Purpose: Improvement of the quality of medical care for pregnant women, with GIT pathologies.

Materials and methods: The study included 45 pregnant women aged between 18-40 years, with different degrees of anemic syndrome and GIT pathologies. An algorithm of the examination, including: common blood analysis with reticulocytes, identification of serum iron, ferritin levels, transferrin, transferrin coupling ratio, exchange of vit. B12 and folic acid, conc. of erythropoietin in blood serum, coprogram, fecal analysis for the detection of occult blood and helminthes, hapto and hemoglobin in feces. Anemia were: iron-deficient - 80%, B12 and folic deficient 10%, and the rest - anemia after chr. diseases and “false” anemia (dilutional anemia). The structure of GIT pathologies: irritable bowel syndrome with constipations - 12 persons (26.6%), GERD-8 persons (17.7%), chronic gastritis (exacer.) - 10 (22.2%), bile tract disk. - 3 (6.6%) pers., rectal fissures, 7 persons (15.5%), hemorrhoid (exacer.) - 4 persons (9.2%), helminthiasis -1 per. (2.2%). Indications for parenteral therapy (iron supplements, cyanocobalamin) were: severe hypoxic syndrome, intolerance to and ineffectiveness of oral drugs within 2 months., active inflammatory diseases of GIT. Hypoxia was assessed according to the level of endogenous erythropoietin and corr. with clinical picture of the disease.

Results: The algorithm of investigation of patients with anemic syndrome was developed, the structure of GIT diseases in pregnant women was presented, the dependence of the level of endogenous erythropoietin on the degree of anemia was revealed.

Conclusions: 1 GIT pathology in pregnant women is the most common cause of anemia syndrome. 2 Parenteral therapy is a preferred method of administration of drugs in pregnant women with gastroenterological pathologies. 3. The level of endogenous erythropoietin correlates with the degree of hypoxia and serves as the criterion of treatment.

GASTROINTESTINAL BLEEDINGS IN THE POLYCLINICS PRACTICE

L.V. GUSEVA, E.G. BURDINA, A.A. SAVENKOV, I.N. CHEREZOVA, A.M. JUCHKOV, O.N. MINUSHKIN

PolyclinicsNo 3,2» MA of the President of RF, Moscow, RUSSIA

Introduction: acute gastrointestinal bleedings (AGIB) may be complications of a number of diseases, according to different authors, their frequency constitutes 50-150 cases per 100 thousand population per year. In men AGIB occur 2.5-3 times more often than in women.

Objective: Analysis of the causes of gastrointestinal bleedings in outpatient practice.

Materials and methods: We analyzedhospital cards of 110 patients (men – 69, women – 41, 1.7:1 ratio, average age 69,6±4,7 years) of patients with symptoms of AGIB for the period of 2006-2010. thatconstituted 0.2% of the average number of attached contingent. In addition to the analysis of clinical and anamnestic data, all patients were performed endoscopicinvestigation of the stomach with morphological study if gastric biopsy samples and diagnosis of H. pyloriinfection, or colonoscopy, ultrasound examination of the abdominal cavity, general clinical and biochemical blood tests, serologic diagnosis of H.pylori, fecal analysis for occult blood, according to, - CT, MRT and capsule endoscopy in the hospital.

Results: The reasons of AGIB were divided in the following way – duodenal and gastric ulcers in 31,8% (n = 35) and 25,5% (n = 28) of patients, respectively, Mallory-Weiss syndrome - in 8,2% (n = 9), esophageal varices - 5,5% (n = 6), diverticular disease - 4,5% (n = 5), the early period after polypectomy - in 4,5% (n = 5), gastric cancer - 4,5% (n = 5), undefined source - in 2,7% (n = 3), gastrojejunostomiculcer - 2,7% (n = 3), esophagealulcer - 2,7% (n = 3), colonic cancer - 2,7% (n = 3), nonspecific ulcerative colitis - 2,7% (n = 3), haemorrhoidal bleeding - 1,8% (n = 2). The main precipitating factor of AGIB was intake of ulcerogenic drugs (aspirin, NSAID, indirect anticoagulants, corticosteroids) - 71,8% (n = 79). In the remaining patients progression of the underlying diseasecaused bleeding.

Conclusions: The incidence of gastrointestinal bleeding, for average of 5 years constituted 0.2% of the average annual number of attached population, mostly from the upper segments of the gastrointestinal tract (85.5%), of them drug injuries constituted 71.8%, which requires preventive antisecretory therapy in this category of patients.

Date: 2014-12-28; view: 796