Syndrome of impaired digestion. How to treat?

30 Aug 2018

Syndrome of impaired digestion (maldigestia) is a complex of intestinal symptoms caused by insufficient digestion of nutrients. Maldigestia can be gastrogenic, pancreatic and enterogenic.

Classification, etiology and pathogenesis
Disturbances in digestion are more or less characteristic of all gastroenterological diseases, in which the production of digestive enzymes and bile acids decreases.
Syndrome of impaired digestion

1. Insufficiency of the cavitary digestion:
- pancreatogenic insufficiency of digestion;
- deficiency of bile acids;
- gastrogenic insufficiency of digestion.

2. Lack of membrane digestion:
- disruption of adsorption of pancreatic enzymes;
- deficiency of intestinal enzymes.

Disturbances in digestion can be associated with insufficiency of cavitary and membrane hydrolysis of food proteins, fats and carbohydrates. The most severe violations of cavitary digestion are observed in diseases of the pancreas with exocrine insufficiency. Pancreatic insufficiency develops as a result of a decrease in functioning pancreatic tissue in patients with chronic pancreatitis and pancreatic cancer.

The external secretory function of the pancreas is disrupted with a decrease in the secretion of pancreosimin, secretin and enterokinase in the mucosa of the duodenum when it is atrophy. In addition, the activity of enterokinase and pancreatic enzymes in the cavity of the small intestine decreases with the pH shifting in the lumen of the small intestine to the acid side. Intestinal digestion is also disturbed in the absence of sufficient bile acids necessary for digestion of fat (cirrhosis of the liver, mechanical jaundice, ileal resection, excessive growth of microbes in the small intestine).
The inadequacy of membrane digestion occurs when the intestinal enzymes themselves are deficient and the adsorption of pancreatic enzymes decreases on the membrane of the brush border of the enterocytes.

Clinics
Patients complain of bloating, excessive gas formation, sensation of transfusion and rumbling in the abdomen. In more severe cases, there is polyphecal, steatorrhea, diarrhea and weight loss. Nevertheless, trophic disorders (dry skin, dullness and brittle nails and hair, cracks in the corners of the lips and in the tongue, etc.) with the syndrome of impaired digestion practically do not develop. This is the fundamental difference between the syndrome of maldigestia and the syndrome of impaired absorption.

In patients with chronic pancreatitis with severe impairment of the exocrine function of the pancreas, the volume of the stool increases, and the content of fat, muscle fibers and starch is increased. In diseases of the liver and bile ducts, accompanied by a deficiency of bile acids, digestion of fats is also disrupted and more or less pronounced steatorrhea appears. The cause of maldigestia in patients with secretory gastric insufficiency or after operations on it is excessive bacterial growth in the upper parts of the small intestine and a violation of contact between the chyme and digestive juices.

The inadequacy of membrane digestion is clinically manifested by poor tolerance of nutrients containing those oligomers whose digestion is impaired. Food intolerance, caused by a lack of membrane digestion, develops only when there is a deficit of intestinal (membrane) enzymes. Most often it is a deficiency of intestinal carbohydrases and poor tolerance of lactose (milk sugar), trehalose (disaccharide contained in mushrooms), sucrose and other disaccharides.

In patients with atrophy of the small intestine mucosa, violations of the membrane digestion are combined with impaired absorption.

Diagnosis, differential diagnosis
A simplest method of laboratory evaluation of the effectiveness of digestive processes is a coprological study. Disorders of digestion are accompanied by an increase in the daily volume of feces, the appearance in it of a large number of muscle fibers, corks of starch, drops of fat. One of the early symptoms of a violation of digestion of nutrients is steatorrhea. The feces become greasy, shiny, and sticky. At a microscopic examination, droplets of fat are visible. A more accurate representation of the degree of steatorrhea can be obtained by examining the fat content in the daily amount of stool according to the Van de Camera method. With pancreatic insufficiency, the amount of undigested fat, mostly neutral, exceeds 5-7 g.

In patients with insufficient digestion and absorption, favorable conditions are created for the reproduction of microbial flora in the upper parts of the small intestine. This is facilitated by the slow utilization of chyme, motor disorders and decreased production of lysozyme by enterocytes. Therefore, an important method of diagnosing maldigestia is to determine the amount and composition of microbes in intestinal juice.

A characteristic symptom of the failure of membrane digestion is the intolerance of food products, for example milk, sugar, fungi and other carbohydrates containing disaccharides. Unlike maldigestii of any origin for malabsorption syndrome, the main clinical symptoms are trophic disorders, not so much quantitative (weight loss) as qualitative ones. These include changes in the skin and its appendages, signs of a deficiency in the body of microelements, vitamins and other biologically active substances. Differential diagnostics is assisted by histological and histochemical studies of the small intestine mucosa.

Treatment
In the complex therapy of intestinal digestion disorders, dietary nutrition plays a leading role, the characteristics of which depend on the underlying disease and the severity of intestinal disorders. Food should be mechanically sparing, contain an increased amount of protein (100-150 g) and carbohydrates (400-500 g), a reduced amount of fat (30-40 g). Excluded from the diet are hard-to-digest fats, raw vegetables and fruits. If milk, sugar, mushrooms or starch is poorly tolerated, an appropriate individual - elimination diet - is prescribed.

Medicamental therapy should be aimed at improving intestinal digestion, suppressing pathogenic microflora and regulating motor function.

With pancreatogenic steatorrhea, a good therapeutic effect is provided by the enzymes of the pancreas Creon, Mezim Forte and others.

In hepatogenic steatorrhea, preparations containing components of bile besides enzymes (Penzinorm forte, Digestal, Festal, Enzistal, etc.) are recommended. The effectiveness of substitution treatment with enzyme preparations is determined primarily by the choice of the optimal dose.

Of the regulators of motor activity are most effective in digestion disorders of Dicetel and Duspatalin.

In patients with impaired digestion, dysbiosis almost always develops.

Treatment of dysbacteriosis should be carried out taking into account the characteristics of the underlying disease. It includes:

- application of intestinal antiseptics in order to eliminate excess bacterial colonization of the intestine -with a conditionally pathogenic microflora;
- restoration of normal microbial flora of the intestines with the help of probiotics;
- enterosorbents;
- stimulation of the organism's reactivity.

Intestinal antiseptics
These drugs have a less harmful effect on symbiotic microbial flora than antibiotics. These include Intetriks, Ersefuril, Nitroxoline, Furazolidon, etc. Antibacterials are prescribed for 10-14 days. The use of an antibiotic is justified as a backup.

Probiotics
Probiotics were most widely used: Linex, Bifidumbacterin, Probiophore. The course of treatment should last 1-2 months.

Enterosorbents
This group of drugs does not inhibit the normal intestinal microflora. Their disadvantage is the indiscriminate sorption of opportunistic pathogenic microflora and its toxins. Preparations are prescribed by short courses from 5 to 10 days. Enterosorbents are used only as a monotherapy; can inactivate the action of other drugs. These include: Filtrum, Lactofiltrum (1 tablet 3-4 times a day), Enterosgel (1 tbsp., Dissolving in 1/4 cup water, 3 times a day).

Stimulants of body reactivity
To improve the reactivity of the weakened patients, it is advisable to apply Gepon, Timalin, Timogen, Immunal, Immunophane and other immunostimulating agents. The course of treatment should last for an average of 4 weeks. At the same time prescribe vitamins.

Abstinence / Breaking

29 Aug 2018

Abstinence (withdrawal syndrome, breakage, demolition, withdrawal symptoms, withdrawal pangs, cold Turkey) means a marked deterioration in the state of health when the amount of the drug taken is reduced or if the consumption is completely stopped. At this time, the addict's behavior is restless. He does not leave stress, irritability, although for her there is no reason, he is nervous.

He really needs drugs, so he tries to leave the house under any excuse or "sits down" on the phone. At the same time, the conversation from the side seems incomprehensible, says some riddles like: "Well, how is it?", "Everything is ready?", Etc.

Drug addicts with little experience, who do not have severe physical dependence, can tolerate breaking on their legs. Parents think that the child is sick, and indeed, the picture of opiate withdrawal in a mild form resembles ARI or upset stomach.

Looks like a withdrawal syndrome like this - Sharply widening pupils, there are lethargy, chills, intense sweating, mood is reduced. A young man is wrapped in warm clothes, turns on the heater even if the apartment is warm. He suffers from a runny nose, and sometimes sneezes. He experiences nausea, and then vomiting may begin, the stomach hurts (Phenotropil can help with it).

At this time, drug addicts almost do not sleep at night, they can not lie either. The relief comes not less than in 4-5 days (we shall repeat, at beginning narcomaniacs), and more often these torments last longer. Therefore, a person does not stand up, and if on the third day the illness suddenly passes, then it is pinned and therefore feels well.

For some novice drug addicts, these symptoms are not always present during the break-up, but in any case, the ailments are seen with the naked eye.

A drug addict who uses a dope for a long period, skipping the time of taking the next dose, experiences a more painful condition during withdrawal. The heaviest flu, accompanied by food poisoning, can not compare with what the patient feels at this time. In addition, strong pains in the joints are added, and besides this, there is often also a tremor - a "knock-out", when the whole body trembles.

Insomnia among the "trainees" is more prolonged, and drug addicts, knowing what awaits them, try to get any money for the next dose: transfer the fragility to dry above their strength (Phenazepam can cope with this). Moreover, they know that flour can immediately disappear, if you take a dose, but it is available, sold, as they say, around the corner.

All types of drugs, regardless of the way they are introduced into the body, necessarily damage the nervous system, including the brain, the immune system, the liver, the heart, the lungs. People who regularly use the potion, there is, in addition to physical, a psychic addiction, and this alone can not cope with this disaster.

Does your back ache? There is a solution!

28 Aug 2018

Back pain is one of those unpleasant problems with which, by experience, sooner or later, almost every person has to meet. Osteochondrosis and radiculitis, unusual physical activity, micro-trauma and hypothermia - all this can cause an attack of acute or aching pain. And this happens, as a rule, suddenly and at the most inopportune moment, and therefore it is so important that there is always a drug in the home medicine cabinet that will help solve the "painful problem".

Local non-steroidal anti-inflammatory drugs
In most cases, the mechanism of development of back pain is the same: stretching, compression or inflammatory tissue damage triggers a chain of specific biochemical reactions accompanied by the release of inflammatory mediators (prostaglandins, histamine, leukotrienes, etc.). They irritate the pain receptors, increase the permeability of small vessels and expand them, provoking an inflammatory process in the affected tissues. And to cope with the pain, a drug is needed that can effectively suppress this mechanism. Most often, the choice in this situation falls on local forms of NSAIDs (gels, ointments, creams), which are considered the most suitable for the ratio of efficiency and safety option for self-use at home.

The pronounced analgesic and anti-inflammatory effect with less risk of developing systemic side effects characteristic of tableted NSAIDs is what determines the choice of doctors in favor of local NSAIDs. Such drugs are now prescribed for the treatment of chronic joint and spinal diseases as an addition to systemic therapy, and are also recommended as a first aid for domestic and sports injuries - bruises, sprains, muscle strain, etc. But in patients, the use of these remedies is very often disappointing because of inefficiencies that do not justify expectations. In many respects this is due not so much to the properties of the preparations themselves, as to their incorrect application. First, many patients do not follow the recommendations for dosage and use an insufficient amount of the drug (1-2 cm gel instead of the recommended 5-6 cm). Well, and secondly, it must be remembered that external preparations, unlike injection forms, are not intended for immediate suppression of acute pain. Indication for the appointment of gels and creams on the basis of NSAIDs is a aching pain in chronic diseases and small injuries.

Quick solution of a painful issue
Bystrumgel, a gel form of ketoprofen (2.5%), successfully copes with this task, which, thanks to the small size of the molecule and the hydrophilic base of the preparation, is able to penetrate deeply into inflamed tissues. In this case, the release of ketoprofen from the gel and absorption through the skin occurs gradually, due to which the therapeutic effect of Bystrumgel persists for a long time.

The advantages of Bystrumgel include not only a quick and pronounced anti-inflammatory and analgesic effect, but also a favorable safety profile. The drug selectively accumulates in the focus of inflammation and surrounding tissues (muscles, fatty tissue, ligaments, joint tissues) and practically does not enter the systemic bloodstream, which avoids the characteristic gastropartic effect of NSAIDs and other systemic side effects. In addition, unlike many other NSAIDs, ketoprofen does not have a destructive effect on the cartilaginous tissue of the joint. It is especially worth noting that even with prolonged use, Bystrumgel is well tolerated and does not lose its effectiveness, so it can be used by a wide range of patients with aching pain as a reliable remedy with a powerful analgesic composition.

Bystrumgel will be a successful addition to both the home and road first aid kit - so that the means for solving "painful problems" with joints is always at hand. But it is necessary to remind pharmacists that, in order to obtain the maximum therapeutic effect, it is very important to follow the recommended application frequency and dosage in the instructions.

Mildronate - Physicians have found a way to withstand high loads

27 Aug 2018

At present, stress and stress-provoking conditions, in particular increased mental and physical stress, are recognized as independent risk factors for cardiovascular diseases (CVD), which today are the leading cause of death worldwide (more than 30% annually). Our country is not an exception. Various manifestations of cardiovascular diseases are the main reason for patients to go to outpatient clinics in Russia.

"Every day we are faced with a colossal army of patients who need help in maintaining the cardiovascular system in good condition", - shares practical experience. Department of Therapy, Clinical Pharmacology and Emergency Medical Care of the Moscow State Medical-Stomatological University, MD, Professor A.L. Vertkin.

According to experts, metabolic drugs containing meldonium can help people cope with increased mental and physical stress, and also resist the risk of CVD.

One of the most noticeable preparations of this group is Mildronate (meldonium). It provides protection and energy supply for various cells of the cardiovascular system.

In conditions of increased load, mills are optimizing energy metabolism, eliminating the accumulation of toxic metabolic products in cells, protecting them from damage; has also a tonic effect. As a result of its application, the body's resistance to stresses increases and the ability to quickly restore energy reserves.

The drug has a stimulating effect on the central nervous system - increases physical activity and physical endurance. Due to these properties, Mildronate is also used to enhance physical and mental performance. He helps patients to recover, and healthy - do not get sick. Athletes with his help cope with great physical, and students, office employees, managers - with mental stress, which generally reduces the risk of CVD.

Currently, the preparation Mildronate capsules 250 mg is supplied to the Russian market in a new package, which is associated with the receipt of this form of the drug over-the-counter status. To restore reduced performance at mental and physical overloads Mildronate should take 2 capsules 250 mg per day in the morning. Duration of admission - 10-14 days, if necessary, treatment can be repeated after 2-3 weeks. In the package - 40 capsules of 250 mg, which allows for a full course of therapy.

Brain, nervous system and alcohol ...

24 Aug 2018

There is no such organ in the human body that would not break down from any doses of alcohol. But most of all the brain suffers. If the concentration of alcohol in the blood is taken as 1, it will be 1.45 in the liver, 1.50 in the cerebrospinal fluid, and 1.75 in the brain. It is there that this poison has the property of accumulating. After taking a mug of beer, a glass of wine, 100 grams of vodka - the alcohol contained in them is absorbed into the blood, with blood flowing to the brain and the person begins the process of intensive destruction of its bark.

The human brain consists of 15 billion nerve cells (neurons). Each cell nourishes its microcapillary with blood. This microcapillary is so thin that for normal nutrition of a given neuron, the erythrocytes can only squeeze into one row. And when the alcoholic glueing of red blood cells approaches the base of the microcapillary, it clogs it, it takes 7-9 minutes - and the next cell of the human brain irretrievably dies.

Due to the fact that oxygen stops coming to the cells of the brain, hypoxia begins, that is, oxygen starvation (oxygen deficiency – Meldonium and Phenylpiracetam can help in this case). It is hypoxia and is perceived by man as a supposedly innocuous state of intoxication. And this leads to numbness, and then death of the brain areas. All this is subjectively perceived by the drunk as "relaxation", "freedom" from the outside world, similar to the euphoria of being released from prison after a long sitting. In fact, just a part of the brain is artificially cut off from the perception of often "unpleasant" information from outside.

After each so-called "moderate" binge, a new cemetery of the dead nerve cells (neurons) appears in the person's head. And when the pathologists open the skull of any so-called "moderately drinking" person, they all see the same picture - a "wrinkled brain", smaller in volume, the entire surface of the cortex of which is in microns, microvias, attacks of structures.

It is in the brain that the greatest changes are found at autopsy. The dura mater is tense, the soft membranes are swollen, full-blooded. The brain is swollen, the vessels are dilated, many small cysts 1-2 mm in diameter. These small cysts were formed in places of hemorrhages and necrosis (necrosis) of parts of the brain substance.

Here is how the Kiev pathologist describes the brain of a "merry fellow" and "joker", which, according to the friends, drank "moderately" and "culturally": "Changes in the frontal lobes of the brain are visible even without a microscope, the gyrus is smoothed, atrophied, and numerous small hemorrhages. Under the microscope are visible voids, filled with serous fluid. The cortex of the brain resembles the earth, after bombs have been dropped on it - all in funnels. Here each binge has left its mark. "

Similar changes in the brain occur in people whose deaths do not necessarily stem from reasons associated with drinking alcohol.

A more subtle study of the brain of a deceased person from acute alcohol intoxication shows that changes in the protoplasm and nucleus, as pronounced as in poisoning by other strong poisons, have occurred in the nerve cells. In this case, the cells of the cerebral cortex are much more affected than the subcortical parts, that is, alcohol acts more strongly on cells of higher centers than lower cells. In the brain marked by a strong blood overflow, often with a rupture of blood vessels in the meninges and on the surface of the brain convolutions.

In cases of non-fatal acute alcohol poisoning, the same processes occur in the brain and in the nerve cells of the cortex. Perception of the victim is difficult and slows down, attention and memory are broken. Due to these changes, as well as the constant influence on the person of the alcoholic and drinkable climate, profound changes in his character and mentality begin.

In addition to the gradual destruction of individual aspects of the mental and mental side of the brain, alcohol increasingly leads to a complete deactivation of normal brain function. Personality changes, the processes of its degradation begin. If at this time do not stop drinking, the full restoration of moral qualities can never happen.

With the reception of even larger doses, a serious disruption of the functions of the entire central nervous system occurs involving the dorsal and medulla oblongata. Deep anesthesia and coma are developing. When taking a dose equal to 7.8 g of alcohol per kilogram of weight, which is approximately equal to 1-1.25 liters of vodka, death occurs for an adult person. For children, the lethal dose is 4-5 times less, based on kilogram weight.

In the experiments of Academician Pavlov, it was established that after taking small doses of alcohol, the reflexes disappear and are restored only for 8-12 days. But reflexes are lower forms of brain function. Alcohol acts primarily on its higher forms. Experiments on educated people proved that after receiving so-called "moderate" doses, that is, 25-40 g of alcohol, the higher brain functions are restored only for 12-20 days. Thus, if you drink alcohol more than once every two weeks, the brain can not get rid of the narcotic poison and all the time will be in a poisoned state. In the case of continuous exposure to alcohol on the brain, the harm caused to him will be unquestionable.

How does alcohol work? First of all, it has narcotic properties: they get used to it very quickly, and there is a need for repeated receptions, the more alcoholic "drinks" are taken, more often and in larger doses; As consumption is used to obtain the same effect, an increasing dose is required each time.

How does this drug in various doses affect the mental and mental activity of the brain?

Specially conducted experiments and observations on a person who drank an average dose, that is, one-and-a-half glasses of vodka, found that in all cases without exception alcohol acts the same way, namely: slows down and hinders mental processes, motor acts at first speeds up, and then slows down. At the same time, the most complex mental processes suffer the most, and the simplest mental functions last longer, especially those that are associated with motor representations.

The paralysis of the centers of psychic dispensations primarily affects the processes that we call judgment and criticism. With the weakening of their beginnings, feelings that are not tempered and not restrained by criticism begin to predominate. Observations show that drunkards do not become smarter, and if they think otherwise, it depends on the beginning of the weakening of their brain's higher activity: as criticism weakens, self-confidence grows. Live gestures, gestures and restless boasting of their strength are also a consequence of the paralysis of consciousness and will that has begun: correct, sensible barriers have been removed that keep a sober person from useless movements and reckless, absurd waste of power.

In numerous experiments conducted by the largest specialists in this field, it became clear that in all cases without exception under the influence of alcohol the simplest mental functions (perceptions) are violated and slowed down not so much as more complex (associations). These last suffer in a double direction: first, their education is slowed down and weakened, and, secondly, their quality significantly changes: the lowest forms of associations, namely motor associations or mechanically memorized ones, most easily arise in the mind, often without the slightest attitudes towards the cause and, once appearing, stubbornly hold out, swam again and again, but completely inopportunely. In this respect, such persistent associations resemble a purely pathological phenomenon, seen with neurasthenia and severe psychosis.

As for motor acts, they accelerate, but this acceleration depends on the relaxation of the brake impulses, and they immediately notice inaccurate work, namely, the phenomenon of premature reaction.

With repeated intake of alcohol, the damage to higher centers of brain activity lasts from 8 to 20 days. If alcohol is consumed for a long time, then the work of these centers is not restored.

On the basis of scientific evidence, it is proved that first and foremost the latest, most recent achievements, obtained by mental stress, say, over the last week, a month, are lost, and the person returns to the level of mental development that he had a week or a month ago after taking alcohol.

If alcohol poisoning occurs frequently, the subject remains immobile mentally, and thinking is normal and patterned. In the future, weakening of older, stronger, stronger associations and weakening of perceptions. As a result, mental processes are narrowed, losing their freshness and originality.

Numerous animal experiments conducted by Ivan Petrovich Pavlov have shown that after relatively small doses of alcohol, the conditioned reflexes are extinguished in the dog and restored only after six days. Experiments of later years confirm the negative effect of alcohol on the nervous system. The typist, who had been given twenty-five grams of vodka before the start of the work, made mistakes fifteen to twenty percent more than always. The drivers of cars passed forbidding signs, the shooter could not exactly hit the target.

Choosing antidepressant

23 Aug 2018

Antidepressants are different in the mechanism of action and the effects produced. The question is, the choice of the drug should be correct, and the treatment performed should be done according to the rules. No medicine, unfortunately, is a panacea, and even more so if it is intended for the treatment of some kind of mental illness. Either way, the medicines prescribed by the doctors are effective. Now a few words about why the doctor prescribes to you this or that antidepressant.

The first thing that determines the choice of an antidepressant is because of the severity of depression: the stronger the depression, the stronger it is to choose an antidepressant. Accordingly, if the depression is very severe, then the treatment will be carried out using large doses of MAO inhibitors or tricyclic antidepressants, or maybe even electroshock. If the manifestations of depression are small, then in this case, sometimes plant antidepressants containing hypericin (these are preparations of St. John's wort) are sufficient. The remaining antidepressants are located in the middle of this conditional line - from health to severe illness.

Concerning antidepressants of the "middle group", it should be said that most of them belong to a new generation of antidepressants, and most importantly their difference from each other in which neurotransmitters they affect. Some of these antidepressants affect only the state of affairs with serotonin, and some provide support for several neurotransmitters, for example, serotonin and norepinephrine. Accordingly, the selection of an antidepressant is performed by a physician taking into account all the symptoms of the disease (somewhere it is enough to affect only the state of affairs with serotonin, and somewhere it is necessary to influence another neurotransmitter), this is the second feature of the appointment of antidepressants.

The third thing that doctors mean when prescribing an antidepressant is its stimulating, or sedative, effect. The fact is that some antidepressants, in addition to the actually antidepressant effect, reduce the intensity of internal tension and anxiety; while others, on the contrary, struggle with apathy, lethargy and passivity. However, many new antidepressants have a so-called balanced effect, that is, they reduce anxiety and increase a person's activity.

Most antidepressants, except for plant, are sold in pharmacies only on prescriptions. And this is not someone's whim, this is a completely justified and absolutely correct decision. The right appointment of an antidepressant can be performed only by a doctor in the course of a direct conversation with a patient to whom he prescribes this antidepressant. There are a lot of nuances and subtleties that the doctor should take into account. And use an antidepressant according to the formula: "I know that it helped my grandmother" - is mistaken, although, unfortunately, occurs often enough.

The fourth, which sometimes misleads the non-specialists is the name of the antidepressant. The fact is that the same antidepressant can be produced by different pharmaceutical companies and therefore have different names. Take for example - fluoxetine, which is the most popular antidepressant in America and Europe (it accounts for almost 40% of sales of antidepressants in the world). In the Russian market, fluoxetine is represented by almost two dozen pharmaceutical companies, both Russian and foreign. Consequently, the same substance is sold in pharmacies with almost twenty different names.

How do you figure out exactly what to buy, because a doctor most often writes simply "fluoxetine" without specifying a company name? It remains to be guided by the ratio of "price / quality". Russian and Indian drugs, for example, are often cheaper than Western analogues, but, unfortunately, they differ in a large number of side effects and are not always as effective. On the contrary, Western companies tend to present to the Russian market, as a rule, more expensive, but also higher-quality medicines.

Treatment of depression, in a good way, is a specialist - a doctor-psychotherapist. However, there is a list of drugs that provide a good therapeutic effect for mild and moderate depression, and those that are sold in pharmacies without prescriptions. These are herbal antidepressants, produced on the basis of St. John's wort, the medicinal properties of which have been known to mankind for a long time. Modern research has proven the effectiveness of one of the components of St. John's Wort - Hypericine - in the treatment of depression. The best concentration of this substance was achieved in the preparation with the spoken name "Negrustin" (manufactured by the German firm "Hexal"). In one tablet of nerustine, the same amount of desired hypericin is concentrated, as in six to eight circles of strongly brewed St. John's wort; the amount of other active substances in it, on the contrary, is reduced. This allows "Negrustin" to be an effective antidepressant without side effects - it does not cause drowsiness or addiction (the only thing - do not sunbathe during treatment with this drug, in order to avoid skin reactions).

"Negrustin" not only defeats depression, but also reduces anxiety, improves the functioning of the autonomic nervous system, effectively copes with the syndrome of chronic fatigue and improves sleep. It allows women to reduce the severity of premenstrual syndrome and climacteric disorders. The standardized treatment regimen for "Neurustin" is as follows: the first two weeks it should be taken one capsule twice a day, and then one capsule for a month and a half or two months. If after a month of therapy you did not feel a tangible effect (and no drug is a panacea), then, of course, you can not do without the additional advice of a psychotherapist.

Benzodiazepines - pharmacy and drugs

21 Aug 2018

The article is purely informative in nature, we do not advocate the use of drugs and other unlawful acts.

Drug addicts contrive to "catch high" in a variety of ways. One of the simplest and most popular is to swallow pharmaceutical pills containing substances with a narcotic effect.

Benzodiazepines
Benzodiazepines are psychoactive substances that exert a retarding effect on the central nervous system, but, more precisely, they have hypnotic, anxious, sedative, relaxing, anticonvulsant effect. All benzodiazepines are representatives of the CNS depressant group.

In medicine, benzodiazepines have found their application in the treatment and symptomatic action in relation to:

• epilepsy;
• insomnia;
• anxiety disorders;
• spasms in the muscles;
• withdrawal syndrome from alcohol, drugs.

The drugs are widely used in the practice of drug dependence treatment for opiates (in the first days for withdrawal), amphetamines, as well as panic attacks provoked by the use of hallucinogens. Strangely enough, the properties of benzodiazepines, drug addicts are more often used not for cure, but for getting high, because drugs have a narcotic effect.

A group of benzodiazepines was created back in 1955, and by 1959 they began to be sold in pharmacies (the first drug was called Valium). Physicians initially met this group of drugs with enthusiasm, it largely replaced barbiturates. But by the 1980s, a serious side effect had been identified - drugs caused addiction. According to studies, benzodiazepines, when consumed for a long time, damage the brain in the same way that alcohol does when it is abused. It is because of the fact that the drugs are similar to drugs, they are sold only on the prescription of a doctor and are appointed in a limited way.

Representatives of the group of benzodiazepines, who prefer to use addicts, are as follows:

• Nordiazepam;
• Phenazepam;
• Diazepam;
• Lorazepam;
• Nozepam;
• Quazepam;
• Xanax;
• Librium;
• Serax and many others.

Among "drugstores" that affect the operation of the central nervous system, it is the benzodiazepines, including tranquilizers, that are discharged to people most often, and then are used far from their intended purpose. Recipes for medicines are usually falsely repaired, while dependent people use an unfair attitude towards their testing in many pharmacies.

Properties and mechanism of action

Benzodiazepines affect the specific receptors of the brain (GABA receptors), while increasing the similarity of GABA (gamma-butyric acid) with nerve cells. The result is a decrease in the excitability of neurons, which leads to a retarding effect. Activation of different types of GABA receptors by benzodiazepines causes the development of not only the therapeutic effect, but also various other effects. Some type of GABA-receptors are even called benzodiazepines, after all, after the binding with them, the drug "parish", which drug addicts expect, develops. The fact is that strengthening the work of all the described receptors provokes the release into the intercellular space of dopamine - the "pleasure hormone".

The duration of the sensations followed by drug addicts can be 2-8 hours, depending on the duration of the drug and its dose.

The effect that drugs give is as follows:

• Reducing feelings of anxiety;
• calmness;
• tranquility;
• reduction of pain and sensitivity to pain;
• decrease in mindfulness;
• Relaxation, complete relaxation;
• a feeling of complete satisfaction;
• serenity.

Properties of drugs - sedative, anti-anxiety, miorelaxing, hypnotic and others - largely depend on the dose used. Usually, drug addicts prefer to exceed therapeutic dosages by 2 or more times, which, in addition to obtaining the desired result, threatens to overdose.

Usually, taking the drug in large quantities, eventually ends with a deep sleep, but after awakening a person awaits a number of unpleasant consequences.
It is worth responding to the question of how many benzodiazepines are held in urine and blood. Thus, the exact time depends on the properties of a particular preparation and the characteristics of the organism. The half-life of blood is 1-100 hours. In urine, they last from 24 hours to 7 days or more.

Symptoms of Use
Preparations in the form of tablets are taken orally, or, if desired, enhance the effect, are poured into powder and injected. Symptomatology occurs due to the onset of action of benzodiazepines on the central nervous system. In general, narcotic intoxication resembles one when taking a large dose of alcohol. There is no alcohol smell from a person, and this is an important distinctive feature that will help drug addicts find out the fact of their use.

The main symptoms of benzodiazepine abuse are:

• Slurred speech.
• Violation of orientation in time, in space.
• Dizziness.
• Drowsiness of varying degrees.
• Violation of concentration of attention.• Decreased appetite.
• Nausea) 0
• Various problems with vision.
• The state of euphoria.
• Convulsions (rarely).
• Delusions, utterances.
• Nightmares in a dream.

With frequent consumption of benzodiazepines, people periodically experience depression, they lose libido, men get an erection. After the cessation of the effects of drugs often there are headaches, nausea, depression of mood. With intravenous administration of a drug, a drop in blood pressure, a violation of breathing acts is possible.
Side effects
Most side effects from this group of drugs are due to their sedative as well as relaxing effect. As the concentration of attention in the addict is seriously reduced, it is fraught with serious consequences - injuries, bruises. The situation is aggravated by drowsiness, dizziness. If a person in this condition sits behind the wheel, the risk of an accident is high, often with a fatal outcome.

The long reception of benzodiazepines greatly reduces the quality of sexual life, worsens eyesight, possibly reduces cardiac output, slows the movement of food through the digestive tract. There have been recorded cases of toxic liver damage (drug hepatitis), development of chronic insomnia, tremors, skin rashes, weight gain, chronic hypotension. Possible anterograde amnesia, muscle weakness, changes in the hormonal background. The longer the period of drug use, the higher the risk of depressions and suicidal thoughts, the development of panic conditions and other mental disorders.

Occasionally, there are abnormal side effects, which are not characteristic of the drugs of this group. However, when taking a large dose that drug addicts practice, they are quite possible:

• Unmotivated aggression;
• Convulsions;
• Impulsive behavior.

Most often, a bad outcome occurs in drug addicts, already suffering from various disorders of the psyche and personality disorders. In most cases, this is observed with polydrug use.

Addiction
Even taking in a therapeutic dosage, but organized long-term, can provoke the development of dependence on benzodiazepines. It is proved that these drugs provoke both mental and physical dependence, but in a relatively low degree (in barbiturates, opiates it is much higher). The dependence is easily provable, since after the withdrawal of the medicine, a number of symptoms arise from the side of the body and internal organs, and also from the side of the psyche.

When taking benzodiazepines in a standard dosage, the dependence develops, on average, in 4-6 months, even when it comes to preparations of weak action. But very few people become really dependent if they did not initially have the goal of using the drug to get a drug effect.

But drug users who use large doses, and especially those who previously had experience using other psychoactive substances, densely sit down on bendodiazepines for 2-3 months. According to statistics, up to 50% of addicts undergoing therapy have a parallel dependence on this group of drugs.

Poisoning and overdose
Benzodiazepines may lead to overdose, but, used as a mono drug, rarely cause a fatal outcome (no more than 3% of cases of acute poisoning). But simultaneous reception of alcohol or opiates this probability is seriously increased, and this combination is very dangerous for life. Also, a high predilection for benzydiazepines in people who use cocaine, and such a combination is also considered risky.

Symptoms of an overdose of benzydiazepines may be:

• Dilation of pupils
• Weakness of the pulse or, conversely, a more frequent pulse
• Bradycardia
• Profuse sweat
• Nystagmus
• Skin stickiness
• Superficial, mild breathing
• Confusion
• Sometimes - a coma
• Asystole

Dangerous is also a complete abrupt discontinuation of the drug, so even addicts reduce it gradually, so as not to cause serious consequences for the cardiovascular system.

Treatment
In acute poisoning as an antidote, flumazenil is used, which inhibits the work of drugs in this group and reduces the risk of serious complications. But drug addicts with a long history of taking this medication is contraindicated because of the danger of even more unpleasant side effects.

The withdrawal syndrome in benzodiazepines may include such symptoms:

• Sleep and appetite disorders;
• Hyperhidrosis;
• Dizziness;
• Pain in the digestive tract;
• Panic, fears;
• Anxiety;
• Headache;
• Arrhythmias;
• Convulsions.

The withdrawal syndrome lasts 1-2 days, but sometimes - up to 5-7 days or more (with a long service record). As for how to treat addiction and withdrawal symptoms, the basis of therapy is a gradual withdrawal of the medicine, as well as necessarily holding a psychotherapy. Outpatient treatment is possible only with mono drug addiction.

With the simultaneous abuse of more serious drugs, people are placed in a specialized clinic or dispensary, and then - for a prolonged (3-6 months or more) rehabilitation.

Diabetic Nephropathy

21 Aug 2018

Diabetic nephropathy is a specific kidney damage in diabetes mellitus, accompanied by the formation of nodular or diffuse glomerulosclerosis, the terminal stage of which is characterized by the development of chronic renal failure.

Diabetes mellitus is a socially significant disease. leads to a decrease in the quality of life, early disability and high mortality due to micro- and macrovascular complications, one of which is diabetic nephropathy.

According to various epidemiological studies, diabetic nephropathy occurs in 40-50% of diabetic patients with a disease duration of more than 20 years.

Changes in the kidneys occur from the first days of the disease. Symptoms depend on the stage of the disease. The following stages stand out.

- Asymptomatic stage - there are no clinical manifestations, but an increase in the glomerular filtration rate indicates the onset of a disturbance in kidney tissue.
- The stage of initial structural changes - there are first changes in the structure of the renal glomeruli (thickening of the capillary wall, expansion of the mesangium).
- The prenaphrophic stage - the level of microalbumin exceeds the norm (30-300 mg per day), but does not reach the level of proteinuria (either episodes of proteinuria are insignificant and short), blood flow and glomerular filtration is usually normal, but can be increased. There may be episodes of increased blood pressure.
- The nephrotic stage - proteinuria (protein in the urine) acquires a permanent character. Periodically, hematuria (blood in the urine) and cylinderuria can be noted. Reduced renal blood flow and glomerular filtration rate.

Arterial hypertension (increase in blood pressure) acquires a persistent character. There are edemas, anemia appears, a number of blood indicators are rising: ESR, cholesterol, alpha-2 and beta-globulins, beta-lipoproteins. The levels of creatinine and urea are slightly elevated or within the normal range.

Nephrosclerotic stage (uremic) - the filtration and concentration functions of the kidneys are sharply reduced, the levels of urea and creatinine are increased. Edema, proteinuria (protein in the urine), hematuria (blood in the urine), cylindruria, anemia, arterial hypertension. The level of blood glucose can be reduced. This stage is completed with chronic renal failure.

Fixed assets

Angiotensin II receptor antagonists (AT1 subtype): Aprovel, Cosaar, Lozarel, Losartan-Richter, Lorista, Prezartan, and others.

ACE inhibitors: Capoten, captopril, Diroton, Lysigamma, lisinopril, Amprilan, Dilaprel, Korpil, Piramil, and others.

Angioprotectors and microcirculation correctors: Doxie-Hem, Actovegin et al.

Antihypoxants and antioxidants: Tiogamma, Espa-Lipon and others.

Detoxifying agents, including antidotes: R-IKS 1, etc.

Additional medicines:

Supplements: Radaklin, OMEGA PREMIUM ™ Life formula, etc.

Anticoagulants: Wessel Doué F, sulodexide, etc.

Vitamins and vitamin-like agents: Ascorbic acid, Neurorolip, Thiocacid 600 T, Tioctacid BV, Milgamma compositum, Vitakson, Kompligam B, Milgamma, Benfolipen etc.

Hepatoprotectors: Berlition 300 and others.

Sleep Disorders

21 Aug 2018

According to the study, almost 2/3 of pharmacists (64.9%) face a complaint about sleep problems, either "often" or "very often." According to the results of the same poll, more than half of all the primitive people (59.5%), after hearing such a complaint, "always give recommendations if necessary." What should the client pay special attention to when implementing these recommendations?

The cause of insomnia can be acute and chronic pain, various somatic, mental and other diseases (secondary insomnia). And yet more often sleep disorders occur in the absence of any pathology (primary insomnia).

The source of primary insomnia are excessive psychoemotional stresses. They lead to the development of the hyperactive state of the nervous system, which even with the onset of night time is supported by obsessive thoughts, fixated on the cause of stress, and is accompanied by an increase in the level of wakefulness, sensitivity to external stimuli. Over time, the main theme of these obsessive thoughts and the factor of insomnia can be the very fear of not falling asleep.

Primary sleep disorders can occur in three forms:

- difficulties with falling asleep;
- early awakening, inability to sleep again;
- superficial, restless sleep with frequent awakenings during the night, a feeling of dissatisfaction with sleep even after its long duration.

RX zone
At the expressed disturbances of a dream the leading role in their medicamental treatment play prescription hypnotics of different groups, appointed exclusively by the doctor. Recall that a significant proportion of these drugs is on the subject-quantitative accounting and is released strictly on prescription (the bulk of benzodiazepines, Z-drugs, barbiturates). Since only a narrow circle of pharmacy organizations has the right to work with them, we will not consider them in the framework of this article, focusing on "normal" Rx-preparations.

Benzodiazepines
The purpose of the application: ease of falling asleep, increasing the duration of sleep, reducing night awakenings with severe insomnia.

Principle of action: indiscriminately activate benzodiazepine receptors in the brainstem - increase the sensitivity of neuronal receptors to GABA (the main mediator of inhibition) - stimulate the inhibitory effect of GABA on the central nervous system.

Representatives of the group: phenazepam (generics - tablets Fenazepam, Fenzitat, Elzepam, etc.).

Features of the group
Benzodiazepines can depress the late phases of slow sleep and fast sleep, cause daytime lethargy and drowsiness, addiction, withdrawal syndrome, the formation of mental and physical dependence. In this regard, they gradually go to the background in the treatment of insomnia.

Z-drugs
The purpose of the application is: to facilitate falling asleep, to reduce night awakenings, to improve the quality of sleep in severe forms of insomnia.

Principle of action: enhance the inhibitory effect of GABA on the central nervous system by selective stimulation of omega-1 benzodiazepine receptors in the brainstem.

Representatives of the group: zaleplon (generic - Andante tablets).

Features of the group
Due to selective action, Z-preparations have a number of advantages over benzodiazepines: they practically do not distort the normal structure of sleep, they are better tolerated (especially zaleplon, which has a minimal half-life). However, with prolonged admission, they can also cause the development of withdrawal and dependence syndrome.

Sleeping H1-Histaminoblockers
The purpose of the application is to reduce the time of falling asleep, to reduce night awakenings, to improve the quality of sleep during short-term insomnia.

Principle of action: central histamine receptors are inhibited, as well as (partially) serotonin and acetylcholine receptors.

Representatives of the group: doxylamine (originator - tablets Donormil, generic - drops Valocordinum-Doxylamine).

Features of the group
Unlike benzodiazepines and Z-drugs, doxylamine is not associated with a risk of withdrawal and drug dependence.

Synthetic analogues of melatonin
The purpose of the application is: to facilitate falling asleep, to reduce night awakenings, to improve the quality of sleep in patients older than 55 years.

Principle of action: melatonin is the epiphyseal "sleep hormone", the maximum production of which occurs at night. Influencing the melatonin receptors in the brain, it plays a key role in regulating the sleep-wake cycle.

Representatives of the group: long-acting melatonin (originator - prolonged-action tablets Circadian).

Features of the group
- Melatonin does not cause addiction, withdrawal and drug dependence.
- On the pharmaceutical market, a short-acting melatonin preparation is also available, which is allowed to be dispensed without a prescription (section "OTC-zone").

Other drugs
Taking into account the etiology of insomnia, other groups of Rx preparations can be prescribed for its treatment, which can improve sleep and sleep by affecting the causative factors of the disease:

- antidepressants, nonbenzodiazepine tranquilizers, other antipsychotics - agomelatine (the originator is Valdoxane tablets), mirtazapine (the originator is Remeron tablets), alimamazine tartrate (the originator is Terialgen pills), etc .;
- nootropics - aminophenylbutyric acid (originator - tablets Noophen), etc.

OTC zone
A number of medications, shown for use in complex pharmacotherapy of sleep disorders, are allowed to leave without a doctor's prescription. In the absence of contraindications, the pioneer has the right to independently advise their clients pharmacies with complaints of mild or moderate insomnia.

Supplement to medicines can serve as a variety of "thematic" products parapharmaceutical assortment.

Sleeping Pills - Short-acting melatonin

Justification of the proposal: facilitate sleep, reduce night awakenings, improve the quality of sleep by normalizing the level of melatonin - the "sleep hormone", which normally is maximally produced at night and regulates the sleep-wake cycle.

Variants of the offer: Melaxen tablets.

Features of the group
Reception Melaxen is most suitable for insomnia in patients older than 55 years, tk. in old age there is a natural extinction of the production of its own melatonin. Melaxen can also be used for sleep disruptions caused by the change of time zones.
In comparison with the prescription melatonin of prolonged action (Circadian), Melaxen has a shorter half-life and a duration of hypnotic effect.
Melaxen is not recommended for use in pregnant and lactating women, children.
During the reception of Melaxen, one should abstain from the management of transport because of the possible decrease in the speed of psychomotor reactions.
Since light suppresses the metabolism of melatonin, after taking Melaxen, exposure to bright light should be avoided.
The possibility of taking Melaxen in combination with other sleeping pills should be agreed with the doctor, tk. the drug is able to enhance the effect of drugs that depress the nervous system.

Soothing preparations
Justification of the proposal: create the conditions for normal sleep when insomnia, caused by mild psychoemotional disorders - increased nervous excitement, anxiety, low mood.

Variants of the offer:
- phytopreparations - tablets and solution Novo-Passit, Lotosonik, Neuroplant, Simpatil, Fitorelax, capsules Deprim forte, Persen Night, "herbs" in the form of raw materials and alcohol tinctures - valerian, motherwort, peony, etc .;
- synthetic anxiolytics - Afobazol tablets, sublingual tablets Tenoten, Tenoten for children.

Features of the group
These drugs ease falling asleep, but practically do not affect the quality of sleep (depth, number of nocturnal awakenings, etc.).
During pregnancy and lactation, medications of this series are contraindicated or used with caution (only as directed by the doctor).
Most sedatives are used only in adult patients (from 12 or 18 years of age). The exceptions include Tenoten child (from 3 years old) and Dormiplant (from 6 years old). Do not counteract the preschoolers rhizome with the roots of valerian in the form of infusion of raw materials.
If the difficulties with falling asleep are caused by an easy or moderate anxiety, then the most appropriate drug intake with anti-anxiety properties: in addition to synthetic anxiolytics, they have complex phytopreparations Novo-Passit, Lotosonik, Simpatil, preparations with St. John's wort extract (Deprim forte, Neuroplant, etc.). In the case of difficulties with falling asleep against a background of mild or moderate deterioration in mood, apathy (but not in clinical depression!), The same phytopreparations with St. John's Wort extract are used. According to the instructions, the antioxidant Tenoten also has an antidepressant effect.
Most soothing drugs can inhibit the speed of psychomotor reactions, so during their intake should refrain from work and activities that require increased concentration. There are no such limitations of anxiolytics with anti-asthenic properties of Afobazol and Tenoten.
If the patient is already taking other neurotropic drugs (hypnotics, antidepressants, anxiolytics, etc.), then taking OTC suppressants should be done with caution. With the exception of Tenoten, the drugs of this group can either enhance the inhibitory effect on the CNS of neurotropic drugs, or change the concentration in the blood of other drugs (remedies with St. John's wort extract).

Magnesium preparations, metabolic products
Justification of the proposal: play an auxiliary role in light sleep disorders: compensate or prevent a deficiency of natural anti-stress substances (magnesium, B group vitamins, glycine) regulating the inhibition processes in the central nervous system.

Variants of the offer:

- preparations with magnesium and vitamin B6 - tablets and Magne-B6 solution, tablets Magne-B6 forte, Magnelis B6, etc .;
- glycine preparations - sublingual tablets Glycine (100 mg dose), etc.

Features of the group
- Preparations with magnesium and vitamin B6 are contraindicated during lactation, and in pregnant women are applied only on the advice of a doctor. Preparations of glycine in a dose of 100 mg do not have such limitations.
- Magne-B6, Magne-B6 Fort, Magnelis B6 tablets are applied from the age of 6, Magne-B6 solution - from 1 year. Glycine has no age-related contraindications, but in small children this drug is difficult to apply purely "technically" because they do not know how to properly dissolve sublingual tablets.

Homeopathic remedies
Justification of the proposal: can help reduce psychoemotional disorders and facilitate sleep, incl. in combination with classical medicines.

Variants of the offer: tablets sublingual Homeostress, Dormickind, Nervochel, Nott's tablets, sublingual drops or spray Reskju Remedy (Bach), granules sublingual Vernison, etc.

Features of the group
In pregnant and nursing homeopathic remedies can only be used as prescribed by a doctor.
Most of these drugs are used since the age of three, Vernison is from the age of 18. From 0 years Dormikind is allowed (when used in children, the tablets are diluted in water).

Non-medicinal assortment
Supplements to maintain the functions of the central nervous system

Justification of the proposal: reduce the risk of progression of psychoemotional disorders and related sleep disorders. They are used in addition to medicines.

Variants of the offer: capsules Dream Interpretation, Sleep Formula, Trioson Tablets, Phytohypnosis, Dragee Evening, Baiu-Bai Drops, etc.

Features of the group
- Pregnant and lactating women, most "soothing" dietary supplements are either contraindicated, or applied with caution.
- The basis of the majority of dietary supplements in this group are the sub-therapeutic concentrations of various herbs of soothing action. Some of them also prevent a deficiency in the body of natural anti-stress substances: macronutrients (magnesium, etc.), vitamins (group B, etc.), amino acids (tryptophan, etc.).

Bath products
Justification of the proposal: contribute to the relaxation of the body during the evening water procedures.

Variants of the offer:

- salt and foam for baths - a series of "Sea fairy tale", "Doctor Solmoray", "Kneipp", "Fito", etc .;
- essential oils - basil, valerian, jasmine, myrrh, incense, chamomile, sandalwood and other soothing oils of the brands "Styx", "Elfarm" and others.

Features of the group
During pregnancy and lactation, these products are either contraindicated (especially essential oils), or applied in concert with a gynecologist.
In case of insomnia, the temperature of the evening bath should not exceed 33-45ºC. Too cold or hot bath can make it difficult to fall asleep due to a toning, exciting action.
Essential oils in order to normalize the state of the central nervous system can be used not only in baths, but also through burning (through aromatic lamps), inhalation, rubbing.

Cirrhosis of the liver

21 Aug 2018

Cirrhosis of the liver is a chronic polyethological progressive disease that occurs with the defeat of the parenchymal and interstitial tissue of the organ with necrosis and dystrophy of the hepatic cells, nodal regeneration and diffuse proliferation of connective tissue, a violation of the architectonics of the organ and the development of some degree of liver function insufficiency. In economically developed countries cirrhosis of the liver is one of the six main causes of death in the age group of 35-60 years and is up to 30 cases per 100 thousand of the population. In the world, 40 million people die each year from viral cirrhosis and hepatocellular carcinoma, which develops against the background of the carrier of the hepatitis B virus.

Cirrhosis of the liver is more common in men, of the 4 patients with cirrhosis, three are men. The disease is noted in all age groups, but more often after 40 years.

The main causes of cirrhosis:

• intoxication with alcohol;
• viral and autoimmune hepatitis;
• chemical toxic substances;
• alcohol abuse;
• metabolic disorders;
• hepatotoxic drugs;
• heart failure;
• diseases of the biliary tract.

There is a cryptogenic cirrhosis, the causes of which are still unknown.

According to statistics, 80% of cirrhoses go unnoticed, without attracting the attention of either the patient or the doctor. Among the most common clinical manifestations of liver cirrhosis are general symptoms such as weakness, reduced ability to work, abdominal discomfort, dyspeptic disorders, fever, joint pain. Often there are flatulence, pain and a feeling of heaviness in the upper half of the abdomen, weight loss, asthenia.

The most frequent complaints are:

• weakness;
• fast fatiguability;
• decreased ability to work (bloating, poor tolerance of fatty foods and alcohol, nausea, vomiting, diarrhea);
• sleep disturbance, irritability;
• feeling of heaviness or pain in the abdomen (mainly in the right hypochondrium);
• impotence;
• itching of the skin;
• menstrual cycle disorders in women.

General medicines

Anabolics: Riboxin and others.

Beta-adrenoblockers: Anaprilin, propranolol, etc.

Hepatoprotectors: Hepatosan, Hepatofalk of the plant, Sirep, Erbisol, Heptor, Heptral, Methionine, Hepa-Merz, Ornitsetil, Karsil, Karsil Forte, Legalon 140, Legalon 70, Silageon, Silimar, Lipamida tablets, coated, 0.025 g, Lipoic acid, Brentzialle forte, Essentiale N, Essentiale forte N, Hepafor, Dipan, Liv.52, Liv.52 K, Tykveol, Phosphogliv Fort, Essley forte and others.

Diuretics: Aldactone-saltucine, Bufenox, Bufenoxa injection 0.025%, Aldactone, Vero-Spironolactone, Spirix, Spironaxan, Spironol, Urakton, Fursemid, Oxodolin, Moderetik, etc.

Metabolics: Lactulose Poli et al.

Inhibitors of fibrinolysis: Gumbix and others.

Interferons: Pegasys and others.

Coagulants (including coagulation factors), hemostatics: Vikasola injection 1%, etc.

Antiviral drugs: Viferon et al.

Enzymes: Creon 10000, Creon 25000, pancreatin, Hermitage and others.

Additional medicines

Supplements: Vazoton (L-arginine), Tykvelon, Hepagard Active, Hepagard, Neovitel - bioactive complex with milk thistle, Bifidum-Multi-1, Bifidum-Multi-2, Bifidum-Multi-3, Polibacterin, Hepatamin, Betusil and others.

Proteins and amino acids: Hepasol A and others.

Vitamins and vitamin-like agents: Pyridoxalphosphate, Ribovital, Retinol acetate acetate coated tablets 0.01135 g (Vitamin A 33000 IU), Retinol palmitate, cyanocobalamin, Ricavit, Livolin Forte and others.

Detoxifying agents, including antidotes: Carbactin, etc.

Immunosuppressants: Artamina et al.

Macro and trace elements: Oksirich et al.

Means that normalize the intestinal microflora: Probiophore, etc.