Gastroenterology belongs to one of the leading branches of therapy. In the structure of diseases of the internal organs, diseases of the digestive system occupy a particularly important place due to their high prevalence, which increases with age. As a rule, these diseases have a chronic, progressive, recurrent course, which ultimately leads to severe disorders of the activity of many organs and systems of the body. The article presents the basic requirements for the formation of a clinical diagnosis of diseases of the gastrointestinal tract, which are most common in the practice of a family doctor.

The issue of gastrointestinal bleeding has been relevant for several decades, and the mortality rate as a result of this pathology ranges within 10 %. Against the background of the impossibility of timely surgical intervention or in the presence of serious contraindications to surgical treatment, an alternative may be to improve the methods of non-operative hemostasis, namely, the combination of endoscopic manipulations with medication. Endoscopic methods of stopping bleeding include thermal, mechanical and injection. Most often, physicians resort to the use of adrenaline (leading to a state of vasoconstriction), various sclerosing drugs (in particular, ethyl alcohol), the action of which is aimed at providing chemical coagulation, as well as thrombin and fibrin glue, leading to local thrombus formation, as medications. Therapeutic endoscopy for gastrointestinal bleeding has a fairly high efficiency and helps to stop bleeding, which in most cases allows preparing the patient for surgery and in some cases helps to prevent relapse and translates the need for surgical treatment into the category of planned operations. The use of thrombin in such practice is limited by the impossibility of carrying out hemostasis under conditions of bleeding from large vessels, the risk of transmission of blood-borne infections and the low availability of this drug.

Fatty degeneration of cells under the influence of various factors is called steatosis; most often this process is observed in the pancreas and liver. Steatosis of the liver refers to its fatty infiltration, in which fatty inclusions appear in the parenchyma of the organ, leading to dysfunction of hepatocytes. Steatosis can be focal and diffuse; in the latter case, fat cells are located over the entire surface of the liver. Until 1980, it was believed that only alcohol abuse can lead to steatosis, while fatty degeneration of the liver was noted in 90 % of alcohol abusers. Subsequently, it was found that alcoholism is not the only reason for the development of this pathological condition, after which it was proposed to divide steatosis into alcoholic and non-alcoholic. Most often, non-alcoholic steatosis develops in women over 45 years old against the background of obesity or diabetes mellitus. Also, the cause of the development of liver steatosis can be malnutrition and diseases of other digestive organs, leading to impaired absorption of nutrients, metabolic disorders, and hormonal disruptions.

Abdominal pain is one of the most common symptoms that family doctors have to deal with in their practice. In the vast majority of cases, the patient considers abdominal pain to be the sign of a disturbance in the digestive system; however, in fact, any organ — the spleen, bladder, organs of the genitourinary system, and sometimes even the heart — can be the «culprit» causing the pain syndrome. Therefore, the family doctor is often faced with a rather difficult task — to carry out a differential diagnosis of abdominal pain and choose the right tactics for further treatment. By its nature, the pain can be acute and chronic, associated or not associated with food intake, arising periodically, having a cramping character or constant. Depending on the localization, it is divided into pain in the epigastric region, pain in the middle and lower abdomen. Often it is the localization of pain that helps to make the correct diagnosis.

Salmonellosis is one of the most common intestinal infections with an established type of pathogen. It is caused by various subtypes of bacteria of the genus Salmonella, with domestic animals being the main source of infection. The infection can occur both through the contact with infected animals and by eating infected foods (eggs, cottage cheese, milk, sour cream, meat). Due to the immaturity of the immune system, the disease mainly affects children; more than half of the affected are preschoolers. Representatives of this age group are not yet fully aware of the need to observe the rules of personal hygiene and are inclined to taste everything; dirty hands, toys, and household items can serve as a source of infection. Newborns can become infected from adult carriers of Salmonella infection. There are frequent cases of mass infection by salmonellosis in organized children’s groups; the cause of the disease can be infected food products that have not undergone proper heat treatment, violation of sanitary and hygienic standards during the storage and preparation of products, as well as infected service personnel.

Along with Crohn’s disease, ulcerative colitis occupies one of the leading places among the most dangerous and severe diseases of the gastrointestinal tract. Persons aged 20–40, belonging to the most active and efficient group of the population, are most susceptible to this pathology. All over the world, there is a steady trend towards an increase in the incidence of ulcerative colitis, and the complexity and high cost of treatment to some extent transfer this problem from a number of purely medical to the category of socio-economic issues. The maximum mortality rates are recorded during the first year of the disease due to cases of extremely severe fulminant course of the disease, as well as 10 years after its onset due to the high probability of developing colorectal cancer. The first report on the surgical treatment of ulcerative colitis in Russia belongs to V. A. Oppel, who in 1907, at the meeting of the Society of Russian Physicians, made a report on the topic: «On the issue of surgical treatment of chronic ulcerative colitis». Since then, surgical intervention continues to be one of the most effective methods of treating this disease.

The article highlights the issues related to the development of dyscirculatory encephalopathy (DE), in particular, against the background of what diseases this pathology occurs and its social significance. The main issues of its pathogenesis are considered; the parts of the brain that are damaged in the first place and how this affects the manifestations of the disease and the rate of its development are described. The staging of DE development, the main symptoms and problems of its diagnosis are also considered. The basic principles of therapy are presented: the indications for inpatient and outpatient treatment, groups of drugs used to improve the patient’s condition and the mechanisms of their action.

At the present stage, the treatment of patients with pancreatic necrosis is one of the most urgent surgical tasks. Pancreatic necrosis is a destructive lesion of the pancreas, often leading to the development of multiple organ failure. The pathogenesis is based on a violation of the mechanism of counteraction to proteolytic enzymes produced by the pancreas. Pancreatic necrosis is a formidable complication of pancreatitis, with mortality ranging from 30 to 70 %. Today, in terms of the frequency of occurrence in surgical practice, this pathology ranks second after acute appendicitis. The leading role in the prevention of the development of pancreatic necrosis and the prevention of mortality is taken by early detection, timely hospitalization and the fastest possible start of therapeutic measures. A special place in the treatment of pancreatic necrosis is occupied by measures aimed at rehydration, optimization of hemodynamic parameters, the prescription of vasoactive drugs and prophylactic antibiotics in order to prevent the development of infectious complications.

The conducted research of the formation and development of surgery until the 19th century revealed that the accumulated experience in the development of surgery in the studies of Russian and foreign authors is relevant in the historical, methodological and organizational aspects. In the modern history of medicine and surgery, a significant segment is occupied by scientific analysis, which makes it possible to recognize the inner essence and connection of processes and phenomena in the formation and development of surgery, to understand the driving and controlling mechanisms. The identification of patterns and trends in the development of surgery, as well as the establishment of grounds for predictive analysis, must be implemented in further research in the history of medicine and surgery. Many medical workers who made a great contribution to the formation of Soviet surgery began their career in medicine directly as zemsky doctors. Zemsky surgery had a significant impact on the development of domestic medicine.

In a small rural cemetery not far from London, there is a modest grave, on which only the years of the life of the deceased — 1820–1910 — are inscribed, and the name is indicated — Florence Nightingale. Having received worldwide recognition even during her earthly existence, this heroic woman asked not to arrange a pompous funeral and not to make a cult from the place of her burial. A pioneer in organizing the nursing service, this aristocrat by birth walked through life with pride and dignity, fully devoting herself to the difficult task of providing medical care to all who needed it.