What is Girshprung disease? How does this disease manifest? How does it diagnose and treat this disease? Read in this article.
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Girshprung disease
Danish doctor Girshprung (H. HirschPrung) in 1887, described the clinical picture «New Disease» (congenital giant of colon), which later was assigned to his name.
Many years have passed before the essence of this pathology has been determined. According to modern ideas, the disease of the Girshprung disease lies a vilist for the development of the elements of the colon wall in the final department, the essence of which is reduced to the complete absence or shortage of nervous plexuses, which normally control its peristality. This area serves an obstacle to the normal passage of intestinal content, as a result of which the overlying gut departments are expanded.
Girshprung disease – Reparably common disease in children. Boys are getting 5 times more often than girls.
Manifestations of Girshprung disease
The main clinical symptoms of Girshprung disease are: constipation, gases delay, intestinal distention. In the part of the children of the early age, the manifestation of the disease can begin with diarrhea.
Chronic constipation in most cases is observed from a newborn period or appear somewhat later. The initial manifestations of constipation and their subsequent nature are largely dependent on the length of the segment, deprived of the nervous plexuses, the nature of feeding, compensatory intestinal opportunities. KSLi Modified segment is short enough, the delay of selection (original feces), and then the feces in newborns is limited to one - two days and is easily allowed by the cleansing enema. With a long flashes zone, the painting of intestinal obstruction is growing, which requires adoption of more energetic measures. Between those mentioned two extreme options meet others.
In any case, constipation progresses. It is less noticeable when the child is on breastfeeding because «Breast Chair» relatively easily overcomes the obstacle due to the compensatory efforts of healthy collapse of the colon. However, with the introduction of feeding or the transition to artificial feeding, when feces acquire a more dense consistency, the compensatory intestinal efforts become less effective, and constipation is noticeably enhanced. Parents increasingly have to resort to cleansing enemas. In older children, the duration of constipation varies and depends mainly from the care of the child and the regularity of conservative measures. Usually constipation lasts 2–4 days, and cases of a longer stool delay are mentioned in less often, as parents are making appropriate measures. However, part of the carte masses is delayed. Gradually accumulating and compacting, they form quite dense conglomerates of different types – The so-called cartoons, which are located in the departments, above the modified zone, sometimes reach large sizes and are determined through the front abdominal wall in the form of more or less clearly defined «tumors». Such stones can clog the intestinal lumen and cause acute intestinal obstruction.
The meteorism already in the first months of life causes an increase in the size and changing the configuration of the abdomen: the navel is smoothed or turned out and is located lower than usual; Displacement of the stretched intestine in one or the other side gives the abdomen asymmetric shape.
With a long-term latency of the chair due to intoxication or intestinal obstruction, vomiting may occur.
The older child or worse care for him, the more distinct the secondary changes arising due to chronic cartoons intoxication. So, many children identify anemia and hypotrophy. In the launched cases, the deformation of the chest, the lungs are fit, which creates conditions for bronchitis and pneumonia.
The severity of the clinical picture of Girshprung disease is in a certain dependence on the length of the zone, devoid of nervous plexuses.
Diagnosis of Girshprung disease
Mandatory is to carry out generally clinical examination and ultrasound for the diagnosis of concomitant pathology. The exclusive role is assigned to radiological methods for diagnosis, which are mandatory. Under the acute form of the disease in the period of the newborn, an overview radiography of the abdominal organs is carried out. The leading manipulation in the diagnosis of BG is an x-ray intestinal research – irrigography.
Important in the diagnosis is given to the conduct of biopsy wall of the rectum.
Treatment of Girshprung disease
Girshprung Disease Treatment Only Surgical.
An optimal term for the implementation of a radical surgery for Girshprung disease should be considered an age of 2 - 3 years. In the period preceding a radical operation, the conservative treatment is very important, which is usually carried out at home with the aim of regular intestinal emptying. Accordingly, the age is prescribed a relaxing diet with the inclusion of products that increase the intestinal peristalsis (oatmeal and buckwheat cereals, prunes, red beets, carrots, apples, honey and others.). Favorable effects are provided by lactic acid products (Prostokvash, Acidoofilin, fresh kefir). It is necessary to conduct a massage of the abdomen and a set of exercises to strengthen the muscles of the abdominal press. Parents must perform these uncomplicated manipulations daily within 10 - 15 minutes before each meal. In the conservative treatment of Girshprung disease, the leading place is occupied by various types of enema (ordinary cleaning, hypertensive, vaseline, siphon).
The dispensary observation after the transferred radical operation is carried out within 1 - 1.5 years. Parents instruct about proper nutrition and need to control the regularity of the chair. The complex of conservative measures during the rehabilitation period includes the electrostimulation of the rectum, regularly carrying out the cleaning enema at the same time, aimed at developing a conditional reflex to the act of defecation, prescribe prozerne, the training of anal sphincter, therapeutic gymnastics.
