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Gastrointestinal tract, kidneys and liver.

Changes in the gastrointestinal tract during pregnancy are associated mainly with its anatomical displacement by an increasing uterus. The axis of the stomach changes its position from vertical to horizontal, which leads to an increase in intragastric pressure and a change in the angle of connection of the stomach with the esophagus. This in turn leads to relative insufficiency of the esophageal sphincter. If non-pregnant women have an intragastric pressure of about 20 cm of water. century, and intraesophageal - only 2 cm of water. Art. and regurgitation of food masses is hampered by the efforts of the gastroesophageal sphincter, then in pregnant women in the third trimester, intragastric pressure is 6-7 cm of water. Art. higher, and sphincter pressure of 10 cm of water. Art. below normal, which contributes to the occurrence of gastroesophageal reflux. This explains the incidence of heartburn in healthy pregnant women. Slowing the evacuation of gastric contents and increasing activity of gastric secretion lead to an increase in the acidity of gastric juice. Thus, with a gestational age of 36 weeks or more, the tone of the gastroesophageal sphincter is set below the normal norm, and the acidity of the gastric contents, on the contrary, increases sharply, which creates conditions for the regurgitation of high acidity mucus and its aspiration (see 5.5). Pregnancy causes significant changes in the kidneys; renal blood flow and the rate of glomerular filtration begin to increase already during the first trimester, and subsequently, these functional indicators increase by 50-60% from the initial level. This occurs in parallel with an increase in bcc and cardiac output, as well as with interstitial hyperhydration of pregnant women. By the third trimester, the weight of the kidneys increases by 20% due to glomerular hypertrophy and they resemble working or vicar hypertrophy in people who have undergone unilateral nephrectomy. Enhanced glomerular filtration may exceed the ability to reabsorb; therefore, slight glycosuria or proteinuria may accompany normal pregnancy. From the 13th week of the metro massive release of progesterone reduces muscle cell tone and causes dilatation or atony of the renal pelvis and ureter.
In the III trimester, the uterus compresses the ureters in the pelvic cavity, exacerbating their expansion. Urinary stasis contributes to the occurrence or relapse of an infection in the kidneys. A decrease in reabsorption is manifested by an increase in the excretion of nicotinic, ascorbic and folic acids and vital trace elements.

Therefore, the kidneys during pregnancy work in an increased mode of glomerular filtration and undergo working hypertrophy. This is of great clinical importance in the further discussion of obstetric and somatic pathology of the kidneys and urinary tract in pregnant women. In addition to enhancing overall metabolism and oxygen consumption, significant changes are detected in the liver. Protein metabolism increases dramatically to meet the needs of the placenta and the fetus. Fat metabolism is characterized by an increase in the content of all lipid fractions in the blood, in particular high density lipoproteins, which is associated with increased synthesis of estrogens. However, the most significant changes occur in the metabolism of carbohydrates, since a pregnant woman is in conditions of additional glucose “starvation”. All the energy needs of the fetus are realized through the use of maternal glucose. Therefore, the level of glucose in the blood of a pregnant woman is within a narrow range - 4.5-5.5 mmol / L, and the clinical signs of hypoglycemia are determined already below the value of 3.3 mmol / L.

In a morphological plan, the liver of a pregnant woman has a normal lobule structure, but in some cases there is a moderate expansion of the bile tubules or signs of intrahepatic cholestasis, since the tone of the gallbladder is lowered and the evacuation of bile is difficult. In general, signs of tension or working hypertrophy of the hepatic lobules are detected. However, it is difficult to distinguish any morphological equivalents of the gestational effect in the liver, since they are blocked by other, more pronounced pathological reactions for any cause of the death of a woman (shock, DIC, etc.). Similar difficulties of treatment relate to gestational changes and other systems and organs of a pregnant woman.

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Gastrointestinal tract, kidneys and liver.

  1. The main manifestations in the oral cavity of the pathology of the liver and gastrointestinal tract
    In diseases of the liver, accompanied by jaundice, the ictericity of the mucous membrane in the area of ​​the border of the hard and soft palate appears long before it appears in other parts of the body (sclera, skin, etc.). Chronic liver failure is manifested by a specific “liver odor” from the mouth (foetor hepaticum). The cause of “hepatic odor” from the mouth is the release of mercaptan due to
    Saponin glycosides are hemolytic as well as irritating to the gastrointestinal tract. By their chemical nature, saponins are derivatives of triterpenes, however, steroid compounds are also found among them. In plants, they are contained from negligible amounts up to 30-50% (A. D. Turova et al., 1965). Plants containing saponins are widely distributed in the plant world.
  3. Gastrointestinal bleeding
    Gastrointestinal bleeding is a problem that doctors in the USA often encounter (300 thousand hospitalizations annually). The degree of hemorrhage varies from small slow bleeding to life-threatening conditions that contribute to the development of iron deficiency anemia. Mortality from upper gastrointestinal tract in the USA is 8%. This indicator has not changed much.
  4. Gastrointestinal Lymphoma
    In systemic dissemination of non-Hodgkin lymphoma (see chapter 13), any segment of the gastrointestinal tract may be involved again. However, up to 40% of lymphomas develop not in the lymph nodes, but in other organs, among which the intestine is the most frequent localization. By the time of recognition of the primary lymphoma of the gastrointestinal tract, the tumor process does not affect either the liver or
  5. Gastrointestinal metabolism
    Liquid and electrolytes are excreted in large quantities with digestive secretions in the gastrointestinal tract, but under normal conditions they are mostly reabsorbed (Fig. 20). Fig. 20. Secretion of water and electrolyte (meq / l of the amount of secretion indicated in the table) (Geigy). Potassium is excreted in the intestines (especially in the large intestine), and it is replaced during the exchange process with sodium (Gooptu with
  6. Gastrointestinal Tumors
    In the organs of the gastrointestinal tract (hollow organs, pancreas, liver, biliary tree), various types of tumors are much more common than in other systems of the body, and such patients have a much higher degree of probability of death. However, there is no single simple explanation for the etiology of tumors of the gastrointestinal tract. International studies
  7. Gastrointestinal tract
    More than half of pregnant women have an increase in appetite, weight gain can reach 400 g per week, and by the end of pregnancy is 12 kg. Such a change in the regulation of feelings of hunger and satiety provides increased needs of the mother's body for energy and plastic materials. Often there are taste perversions and whims associated with a change in the secretory function of the gastrointestinal tract.
  8. Gastrointestinal diseases
    Conditions leading to dysphagia Causes: • tumor esophageal stricture; • ???? achalasia; • ???? diffuse spasm of the esophagus; • ???? medicinal esophagitis; • ???? hiatal hernia; • ???? collagenoses; • ???? chemical burn of the esophagus; • ???? diverticulum of the esophagus; • ???? esophageal infections (candidiasis). Features of anesthesia: • preoperative preparation is needed
  9. Gastrointestinal diseases
    ANATOMICAL FEATURES OF THE GASTROINTESTINAL TRACT Features of the gastrointestinal tract determine the specifics of the clinical picture in pathological conditions. The oral cavity in the newborn is poorly developed, the mucous membrane is well vascularized, but relatively dry due to a small amount of saliva. The saliva of the newborn does not play a significant role in digestion, since it practically does not contain enzymes and
    SURVEY ALGORITHM {foto29} Fig. 16. Algorithm for examination of the gastrointestinal tract. Examination of the gastrointestinal tract consists of examination, palpation, percussion and auscultation (Fig. 16). From the anamnesis we learn about the nature of food intake, diet, dependence of pain on the time of eating, etc. The main manifestations are bitterness in the mouth, bad breath. Swallowing (free,
  11. Acute and chronic bleeding from the gastrointestinal tract
    There are many causes of gastrointestinal bleeding. Bleeding develops according to one of two primary mechanisms: 1. Violation of the integrity of the mucous membrane, leading to exposure of deep vessels, their erosion. For example, bleeding from a stomach ulcer, bleeding from the intestines during infectious or idiopathic processes, from the small and large intestines during ischemia. 2.
    Loss of juice in surgery plays a large role (vomiting, intestinal obstruction, fistula of the gastrointestinal canal, diarrhea, exudation, etc.). In this case, a wide variety of violations occur (Table 18). If a pathological loss of juice occurred before admission to the hospital and targeted treatment, then the violations are eliminated in accordance with the principles set out in the chapter “The therapeutic plan
  13. Bleeding from the upper gastrointestinal tract
    It is customary to talk about bleeding from the upper gastrointestinal tract (GIT) in cases where the source of bleeding is located either in the esophagus, or in the stomach, or in the duodenum (duodenum). Pathophysiology The most common causes of bleeding in adults are: duodenal ulcer; erosion of the stomach and duodenum; varicose veins
  14. Digestion disorders in the gastrointestinal tract
    Protein digestion disorders can occur at the stage of gastric, intestinal, parietal digestion. In the stomach, peptide hydrolases cleave peptide bonds between aromatic and dicarboxylic amino acids. Protein digestion sharply slows down in hypoacid conditions, especially with achilia and total gastric resection (if the pH does not reach at least 5.0 units). Without
  15. Practical recommendations for the normalization of the gastrointestinal tract
    Now, having gotten a little acquainted with the technology of the gastrointestinal tract, one should act in accordance with it. So, practical recommendations. Do not drink plenty of fluids before meals. Enzymes are diluted and washed off into the underlying sections of the gastrointestinal tract. Do not drink plenty of fluids immediately after eating. Drinking liquid will not only dilute the digestive juices of the small intestine, but also wash it off
  16. Gastrointestinal nutrition and cancer
    Cancer of the transverse colon and rectum Many theories have been put forward about the role of nutrition in the development of colon cancer. The human diet includes a large number of substances with mutagenic and carcinogenic properties, as well as antagonists and blockers of these compounds. Therefore, it is very difficult to determine which of them has a damaging effect. Carcinogens that damage the upper sections
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