Artificial lung

Several predisposing clinical conditions has deleterious effects on individual links in the protective mucosal barrier. Any disease process that breaks the balance of these factors leads to the development of gastroduodenal erosions and ulcers. It is commonly observed in patients undergoing episodes of shock in multiple trauma, severe acute respiratory syndrome adults with acute renal failure and sepsis. The principal trigger mechanisms are the reduction of blood flow and change splanhnicheskogo vnutritprosvetnoy gastric acidity [10, 46].

In animal experiments established that the barrier function of the small intestine is damaged in 5 minutes after application of burn injuries, while the permeability of mucous membrane reaches a maximum after 4 h, remaining high for 21 days postburns period [33].

According to D. Metz [41], the most important brand viagra online damaging factor in such situations is the increased gastric secretion. Stress ulcers occur only in the presence of acid, while intragastric pH 7,0. AS Ermolov et al. [7] during endoscopic intragastric pH-metry revealed giperhlorgidriyu in one or more of the stomach in 35 (92.1%) patients, and 12 patients with erosive and ulcerative hemorrhage was most pronounced (mean basal pH of less than 1,2) . According to IS Osipov [15], the peak increase of acid secretion and intragastric proteolysis accounts for the 2-3rd day after the injury - it is most likely during the formation of stress ulcers.

However, other authors believe that the hydrochloric acid does not play a major role in ulcer formation [45]. This view is generic viagra confirmed by the fact that acute ulcer detected not only in the stomach and duodenum, but also in the esophagus, small intestine and large intestine, gall bladder, where there is no acid-peptic factor, with acute ulcers develop in a wide range of intracavitary pH up to achlorhydria, as well as atrophy of the mucosa and after vagotomy. In addition, mucosal defects healed at constant acidity, and the frequency of bleeding from acute ulcers increases with age, when gastric secretion is quenched [12, 13, 31].

Not all acute erosions and ulcers complicated by bleeding, often they may occur without any clinical symptoms. But early brand name levitra detection and effective treatment of ulcers - this is the best prevention of bleeding from upper gastrointestinal patients in critical condition [1, 7, 48].

Stress-related bleeding from upper gastrointestinal usually develops by 7 to 10 days after the initial injury, but may occur earlier. Bleeding from acute erosions and ulcers usually do not go intense and rarely progresses to the point of threatening the life of [46, 48].

In contrast to patients with peptic ulcer complicated by hemorrhage, the severity of which is mainly determined by the degree of blood loss, the severity of the burnt is due primarily to the burn disease and OPA against shock, toxemia, septikotoksemii [6]. Noted that the starting point of bleeding from acute erosions or ulcers, as well as the formation of new defects mucosa can serve as a traumatic dressings and surgical interventions. In this case, bleeding occurs more often after 12-36 h after injury, the majority of cases it precedes the development of paresis of the intestine [34].

The negative dynamics of the state of endoscopic upper GI have burned is correlated with the change of the overall inflammatory response and the condition of the blood coagulation system. This is reflected in increasing the total number of cialis without prescription leukocytes, leukocyte formula shift to the left, reducing the number of lymphocytes, abrupt changes in fibrinogen levels with decreased fibrinolysis, when fibrinogen degradation products. Swings observed in platelet count [34].

Artificial lung ventilation (ALV) for over 48 hours and coagulopathy are two important and independent risk factors for gastrointestinal bleeding in patients treated in the ICU [39, 45, 47].

Early diagnosis of acute erosions and ulcers is difficult because of the absence or weak expression of clinical signs [2, 43, 50]. However, RN Kadyrov [10] notes that in the first hours after burn injury in victims often have dyspeptic symptoms and sometimes pain in the abdomen. But the main role in the diagnosis of erosive and ulcerative lesions and bleeding from upper GIT have burned playing esophagogastroduodenoscopy (endoscopy), introduction of a generic levitra significantly increased incidence of acute erosions and ulcers in such patients [2, 14, 50].

According to SV Volkov et al. [3], out of 58 surveyed endoscopically affected by thermal burns II-IIIA, B - IV grade lesions with an area of more than 20% of body clinical signs of bleeding were only 9 (15,5%), while at the same time, the dynamic endoscopy bleeding from multiple sources was diagnosed in 26 (44.2%) patients.

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