1. Diet therapy – table No. 2 (mechanically and chemically gentle diet);

2. Bed rest, then ward rest;

3. Drug therapy as prescribed by a doctor (dispensing drugs):

A. Eradication therapy:

· T. Pylorid 0.4 x 2 times a day at the end of meals;

· T. Clarithromycin 0.25 x 2 times a day;

· T. Metronidazole 0.5 x 2 times a day at the end of meals;

Within 7 days;

B. Antacids:

· Susp. Maalox – 15 ml. – 15 minutes after meals x 4 times a day, the last time at night;

B. Salnikov's mixture:

· Sol. Novocaini 0.25%-100.0

· S. Glucosae 5%-200.0

· Sol. Platyphyllini 0.2%-1.0

· Sol. No-Spani – 2.0

· Ins. – 2 units

IV drop x 1 time/day - No. 3;

D. Upon completion of eradication therapy:

· T. Pilorid 0.4 x 2 times a day at the end of meals - continue;

· R-r. Delargina 0.001 – IM – 1 time/day - No. 5.

4. Physiotherapy as prescribed by a doctor (assistance in carrying out procedures): SMT, ultrasound on the epigastrium, electrophoresis of novocaine.

5. Exercise therapy: Bed rest: At this time, static breathing exercises are indicated, which enhance inhibition processes in the cerebral cortex. Performed in the initial position lying on the back with relaxation of all muscle groups, these exercises are able to put the patient into a drowsy state, help reduce pain, eliminate dyspeptic disorders, and normalize sleep. Simple gymnastic exercises for small and medium muscle groups are also used, with a small number of repetitions in combination with breathing exercises and relaxation exercises, but exercises that increase intra-abdominal pressure are contraindicated. The duration of the classes is 12-15 minutes, the pace of the exercises is slow, the intensity is low. As the condition improves, when transferring to the ward mode: Household and household tasks are added to the tasks of the previous period. labor rehabilitation patient, restoration of correct posture when walking, improved coordination of movements. The second period of classes begins with a significant improvement in the patient’s condition. The exercises are performed in a lying position, sitting, on your knees, standing with gradually increasing effort for all muscle groups, still excluding the abdominal muscles. The most acceptable position is lying on your back: it allows you to increase the mobility of the diaphragm, has a gentle effect on the abdominal muscles and helps improve blood circulation in the abdominal cavity. Patients perform exercises for the abdominal muscles without tension, with a small number of repetitions. If the gastric evacuation function is slow, the LH complexes should include more exercises lying on the right side, and if it is moderate - on the left side. During this period, patients are also recommended massage, sedentary games, and walking. The average duration of a lesson in a ward mode is 15-20 minutes, the pace of exercise is slow, the intensity is low. Therapeutic gymnastics is carried out 1-2 times a day.

6. Collection of biological samples for analysis (blood, urine, etc.), assistance in implementation instrumental studies(FGS (FGS control - upon admission, within 10 days, before discharge), gastric intubation, X-ray examination of the stomach, etc.).

Contraindications to the use of exercise therapy:

1. Severe pain syndrome.

2. Bleeding.

3. Constant nausea.

4. Repeated vomiting.

Objectives of exercise therapy:

1. Normalization of the tone of nerve centers, activation of cortico-visceral relationships.

2. Improving the patient's emotional state.

3. Stimulation of trophic processes for the purpose of rapid and complete scarring of the ulcer.

4. Prevention of congestion in the digestive tract.

5. Normalization of the motor and secretory functions of the stomach and twelve duodenum.

In 1st period They use static breathing exercises in the starting position lying down, counting silently while inhaling and exhaling, and simple gymnastic exercises for small and medium muscle groups with a small number of repetitions in combination with breathing and relaxation exercises. Exercises that increase intra-abdominal pressure are contraindicated. The duration of the lesson is 12-15 minutes. The pace is slow, the intensity is low.

2nd period begins when the patient’s condition significantly improves and he is transferred to the ward mode.

Starting positions - lying, sitting, kneeling, standing. Use exercises for all muscle groups, excluding the abdominal muscles (at the end of the period you can, but without straining, with a small number of repetitions), breathing exercises. The lesson time is 15-20 minutes. The pace is slow, the intensity is low. Classes are held 1-2 times a day.

3rd period– use exercises for all muscle groups with limited load on the muscles of the abdominal wall, exercises with objects (1.-2 kg.), for coordination. The density of the lesson is average, duration is up to 30 minutes.

4th period(sanatorium conditions).

The volume and intensity of exercise therapy classes are increasing, health paths, walking, playing volleyball, skiing, skating, and swimming are widely used. Lesson duration 30 minutes

Physiotherapeutic treatment methods:

General impact procedures are used from the first days of stay on inpatient treatment. Local exposure methods are best used on days 7-8, and outpatient settings- in the stage of fading exacerbation.

General treatment procedures:

1. Galvanization using the galvanic collar method according to Shcherbak. The current strength is from 6 to 12 mA, the exposure time starts from 6 and is increased to 16 minutes. The procedure is carried out daily, the course of treatment is 10 procedures.

2. Electroanalgesia. The pulse repetition duration is 0.5 m/s, their repetition frequency is 300 – 800 Hz. Current strength is 2 mA. The duration of the procedure is 20-30 minutes. The course of treatment is 10 procedures.

3. Coniferous, oxygen, pearl baths, t 36 – 37 0 C. Course of treatment – ​​12-15 baths.

Local treatment procedures:

1. Amplipulse therapy on the stomach and duodenum. Current strength - 20-30 mA, daily or every other day. The course of treatment is 10-12 procedures.

2. EHF therapy for the epigastric region. Duration – 30-60 minutes. The course of treatment is 20-30 procedures.

3. Intragastric electrophoresis of no-shpa, aloe. The location of the electrodes is transverse: back, stomach. Current strength is 5-8 mA. Duration 20-30 minutes. The course of treatment is 10-12 procedures.

4. Laser therapy with infrared laser radiation Contact, scanning technique. Pulse mode, frequency 50-80 Hz. Duration 10-12 minutes, daily. The course of treatment is 10-12 procedures.

Page 17 of 18

Clinical examination and principles rehabilitation treatment patients with peptic ulcer disease at the stages of medical rehabilitation
The general direction of healthcare development in our country has been and remains preventive, providing for the creation of favorable healthy conditions life for the population, formation healthy image the life of each person and the entire society, active medical monitoring of the health of each person. The implementation of preventive tasks is associated with the successful solution of many socio-economic problems and, of course, with a radical restructuring of the activities of health authorities and institutions, primarily with the development and improvement of primary health care. This will make it possible to effectively and fully provide clinical examination of the population, to create a unified system for assessing and systematically monitoring the state of human health and the entire population as a whole.
Issues of medical examination require in-depth study and improvement, because its traditional methods are ineffective and do not allow for full-fledged early diagnosis of diseases, clearly identify groups of people for differentiated observation, and fully implement preventive and rehabilitation measures.
The methods of preparation and conduct need to be improved preventive examinations according to the program of general medical examination. Modern technical means make it possible to improve the diagnostic process by providing for the participation of the doctor only at the final stage - the stage of making a formed decision. This makes it possible to increase the efficiency of the prevention department and reduce the time of medical examination to a minimum.
We, together with E. I. Samsoi and co-authors (1986, 1988), M. Yu. Kolomoets, V. L. Tarallo (1989, 1990), have improved the technique early diagnosis diseases of the digestive system, including peptic ulcer, using computers and automated systems. Diagnostics consists of two stages - nonspecific and specific.
At the first stage (nonspecific) the primary expert review health status of those being examined, dividing them into two streams - healthy and subject to further examination. This stage is implemented by preliminary interviewing the population using an indicative questionnaire (0-1) * in preparation for a preventive examination. Those undergoing clinical examination, answering the questions of the indicative questionnaire (0-1), fill out the technological interview map (TKI-1). Then it is machine processed, based on the results of which individuals at risk are identified according to the pathology of individual nosological units.

*The indicative questionnaire is based on the anamnestic questionnaire “Complex of Programs” (“Basic Examination”) for solving the problems of processing the results of mass dispensary screening examinations of the population using the Iskra-1256 microcomputer of the Regional Computer Science Center of the Ministry of Health of Ukraine (1987) with the inclusion of specially developed methods of patient self-examination , additions and changes to ensure the conduct of mass self-interviewing of the population and filling out cards at home. The medical questionnaire is intended for territorial-district certification of population health, identifying risk groups for diseases and lifestyle using a computer.

The issue of identifying two streams of subjects (healthy and those in need of further examination) is decided on the basis of the computer conclusion on TKI-1 and the results of mandatory studies.
Persons in need of further examination are referred for further examination according to targeted screening programs. One such program is the targeted mass medical examination program for early detection common diseases of the digestive system (including peptic ulcers and pre-ulcerative conditions). Those undergoing clinical examination according to a specialized questionnaire (0-2 “p”) fill out the technological map TKI-2 “p”, after which they are automatically processed according to the same principle. The computer assumes a probable
diagnosis(ies) and list additional methods studies of the digestive organs (laboratory, instrumental, x-ray). The participation of the general practitioner of the prevention department is provided for at the final stage of the preventive examination - the stage of making a formed decision, determining the group for dispensary observation. During the preventive examination, the person undergoing medical examination, on the recommendation of the computer, is examined by specialist doctors.
The questionnaires were tested through preventive medical examinations of 4217 people. According to the results of machine processing, a presumptive diagnosis of “healthy” was given to only 18.8% of those interviewed, the conclusion “needs further examination” was given to 80.9% (among them, 77% of those examined needed consultations with therapeutic specialists). Analysis of the final results of preventive examinations showed that the computer gave a true positive answer in 62.9% of cases, a true negative one in 29.1%, a false positive one in 2.4%, and a false negative one in 5.8%.
When identifying gastroenterological pathology, the sensitivity of a specialized screening questionnaire turned out to be very high - 96.2% (with a result prediction coefficient of 0.9), because in specified percentage cases, the machine gives the correct answer if the decision is positive, “sick.” At the same time, with a negative answer, the error is 15.6% (with a prediction coefficient of 0.9). As a result, the compliance rate of the diagnostic conclusion is 92.1%, i.e. Out of 100 people, in 8 cases the computer decision to identify gastroenterological pathology based on survey data may be incorrect.
The data presented convinces us of high degree reliability of the developed criteria and allow us to recommend a specialized questionnaire for widespread use in screening target program at the stage of preparation for a preventive medical examination.
As is known, the order of the USSR Ministry of Health No. 770 dated May 30, 1986 provides for the identification of three dispensary groups: healthy (DO; preventively healthy (Dg); patients in need of treatment (Dz). Our experience shows that in relation to patients with peptic ulcer disease, their with pre-ulcerative conditions, as well as for persons with risk factors for the occurrence of these diseases, a more differentiated division of those undergoing medical examination into the second and third health groups is justified (in each of them it is advisable to distinguish 3 subgroups) in order to ensure differentiated approach to carry out preventive and therapeutic measures.
Group II:
On - increased attention (persons who do not have complaints, without deviations from the norm according to the results of additional studies, but are exposed to risk factors);
II b - persons with latent current pre-ulcerative conditions (without complaints, but having deviations from the norm during additional studies);
c - patients with obvious pre-ulcerative conditions, peptic ulcer disease, who do not need treatment.
group:
III a - patients with obvious pre-ulcerative conditions in need of treatment;
III b - patients with uncomplicated peptic ulcer disease in need of treatment;
III c - patients with severe peptic ulcer disease, complications and (or) concomitant diseases.
Peptic ulcer disease is one of the diseases in the fight against which preventive rehabilitation measures are crucial.
Without detracting from the importance of the inpatient stage of treatment, it should be recognized that it is possible to achieve stable and long-term remission and prevent recurrence of peptic ulcer disease through long-term (at least 2 years) and continuous restorative stage treatment of the patient after discharge from the hospital. This is evidenced by our own research and the work of a number of authors (E. I. Samson, 1979; P. Ya. Grigoriev, 1986; G. A. Serebrina, 1989, etc.).
We highlight the following stages of post-hospital rehabilitation treatment of patients with peptic ulcer:
rehabilitation department for gastroenterological patients at a hospital for rehabilitation treatment (usually in a suburban area using natural healing factors);
polyclinic (including a day hospital of a polyclinic, department or rehabilitation treatment room of a polyclinic or a rehabilitation center at a polyclinic);
sanatorium-preventorium for industrial enterprises, institutions, collective farms, state farms, educational institutions;
Spa treatment.
We combine all of the above stages of post-hospital rehabilitation treatment into the period of late rehabilitation, and in general the process of medical rehabilitation can be divided into three periods:
- early rehabilitation (timely diagnosis in the clinic, early intensive treatment);
- late rehabilitation ( postoperative stages treatment);
- dispensary observation in the clinic.
In the system of medical rehabilitation of patients with peptic ulcer disease, the outpatient stage plays a decisive role, since it is in the outpatient clinic that continuous, consistent observation and treatment of the patient is carried out over a long period of time, and continuity of rehabilitation is ensured. The effectiveness of rehabilitation of patients in the clinic is due to the complex influence of various means and methods of restorative treatment, including therapeutic nutrition, herbal and physiotherapy, acupuncture, exercise therapy, balneotherapy, psychotherapy with very restrained, maximally differentiated and adequate pharmacotherapy (E. I. Samson, M Yu. Kolomoets, 1985; M, Yu. Kolomoets et al., 1988, etc.).
A correct assessment of the role and significance of the outpatient stage in the rehabilitation treatment of patients has contributed to the further improvement in recent years of organizational forms of rehabilitation of patients at the outpatient stage (O. P. Shchepin, 990). One of them is the day hospital of the clinic (DSP). Analysis of our observations on day hospitals at the clinics of the Central Regional Clinical Hospital of the Minsk district of Kiev, the clinic of the 3rd city hospital of Chernivtsi, as well as data from A. M. Lushpa (1987), B. V. Zhalkovsky, L. I. Leibman (1990) show that DSP is most effectively used for the rehabilitation of gastroenterological patients, who make up 70-80% of the total number of patients treated. Among patients with diseases of the digestive system, about half were patients with peptic ulcer disease. Based on the experience of the DSP, we determined the indications for referring patients with peptic ulcer disease to a day hospital. These include:
Uncomplicated peptic ulcer in the presence of a peptic ulcer 2 weeks after the start of treatment in a hospital after pain relief.
Exacerbation of uncomplicated peptic ulcer without ulcerative defect (from the beginning of exacerbation), bypassing the inpatient stage.
Long-term non-scarring ulcers in the absence of complications 3-4 weeks after the start of hospital treatment.
Due to the rather long stay of patients in the emergency room during the day (6-7 hours), we consider it advisable to organize one or two meals a day in the emergency room (diet No. 1).
The duration of treatment for patients with peptic ulcer disease at various stages of medical rehabilitation depends on the severity of the course, the presence of complications and concomitant diseases and a number of other clinical features in a particular patient. At the same time, our many years of experience allows us to recommend the following terms as optimal: in the hospital - 20-30 days (or 14 days with subsequent referral of the patient to a day hospital or rehabilitation department for gastroenterological patients at a rehabilitation hospital); in the rehabilitation department of a rehabilitation hospital - 14 days; V day hospital- from 14 to 20 days; in the rehabilitation treatment department of the clinic or rehabilitation center at the clinic - 14 days; in a sanatorium - 24 days; in a sanatorium at a resort - 24-26 days.
In general, prolonged treatment should continue for at least 2 years in the absence of new exacerbations and relapses. Practically healthy patient can be considered in cases where for 5 years he has not had exacerbations or relapses of peptic ulcer disease.
In conclusion, it should be noted that the problem of treating peptic ulcer disease goes far beyond the scope of medicine and is a socio-economic problem that requires the implementation of a set of measures on a national scale, creating conditions for reducing psychogenic factors, normal nutrition, hygienic conditions work, life, rest.

Introduction

Anatomical-physiological, pathophysiological and clinical features course of the disease

1 Etiology and pathogenesis of gastric ulcer

2 Classification

3 Clinical picture and preliminary diagnosis

Methods of rehabilitation of patients with gastric ulcer

1 Physiotherapy(physical therapy)

2 Acupuncture

3 Acupressure

4 Physiotherapy

5 Drinking mineral waters

6 Balneotherapy

7 Music therapy

8 Mud therapy

9 Diet therapy

10 Herbal medicine

Conclusion

List of used literature

Applications

Introduction

In recent years, there has been a tendency towards an increase in the incidence of the population, among which gastric ulcer has become widespread.

According to the traditional definition of the World Health Organization (WHO), peptic ulcer disease (ulcus ventriculi et duodenipepticum, morbus ulcerosus) is a general chronic relapsing disease prone to progression, with a polycyclic course, the characteristic features of which are seasonal exacerbations, accompanied by the appearance of an ulcerative defect in the mucous membrane, and the development of complications that threaten the patient’s life. A feature of the course of gastric ulcer is its involvement in pathological process other organs of the digestive system, which requires timely diagnosis to draw up medical complexes patients with peptic ulcer disease, taking into account concomitant diseases. Gastric ulcer affects people of the most active, working age, causing temporary and sometimes permanent loss of ability to work.

High morbidity, frequent relapses, long-term disability of patients, resulting in significant economic losses - all this allows us to classify the problem of peptic ulcer disease as one of the most pressing in modern medicine.

Rehabilitation occupies a special place in the treatment of patients with peptic ulcer disease. Rehabilitation is the restoration of health, functional status and ability to work, impaired by diseases, injuries or physical, chemical and social factors. World organization Health Care (WHO) gives a definition of rehabilitation very close to this: “Rehabilitation is a set of activities designed to ensure that persons with disabilities as a result of illness, injury and birth defects adapt to new living conditions in the society in which they live.”

According to WHO, rehabilitation is a process aimed at comprehensive assistance to sick and disabled people so that they achieve the maximum possible physical, mental, professional, social and economic usefulness for a given disease.

Thus, rehabilitation should be considered as a complex socio-medical problem, which can be divided into several types or aspects: medical, physical, psychological, professional (labor) and socio-economic.

As part of this work, I consider it necessary to study physical methods rehabilitation for gastric ulcer, focusing on acupressure and music therapy, which determines the purpose of the study.

Object of study: gastric ulcer.

Subject of research: physical methods of rehabilitation of patients with gastric ulcer.

The tasks are aimed at consideration:

-anatomical, physiological, pathophysiological and clinical features of the course of the disease;

-methods of rehabilitation of patients with gastric ulcer.

1. Anatomical, physiological, pathophysiological and clinical features of the disease

.1 Etiology and pathogenesis of gastric ulcer

Gastric ulcer is characterized by the formation of ulcers in the stomach due to a disorder of the general and local mechanisms of nervous and humoral regulation of the main functions of the gastroduodenal system, disruption of trophism and activation of proteolysis of the gastric mucosa and often the presence of Helicobacter pylori infection. At the final stage, an ulcer occurs as a result of a violation of the relationship between aggressive and protective factors with a predominance of the former and a decrease in the latter in the gastric cavity.

Thus, the development of peptic ulcer disease, according to modern concepts, is caused by an imbalance between the effects of aggressive factors and defense mechanisms that ensure the integrity of the gastric mucosa.

Factors of aggression include: increased concentration of hydrogen ions and active pepsin (proteolytic activity); Helicobacter pylori infection, the presence of bile acids in the stomach cavity and duodenum.

The protective factors include: the amount of protective mucus proteins, especially insoluble and premucosal, secretion of bicarbonates (“alkaline tide”); resistance of the mucous membrane: proliferative index of the mucous membrane of the gastroduodenal zone, local immunity of the mucous membrane of this zone (the amount of secretory IgA), the state of microcirculation and the level of prostaglandins in the gastric mucosa. With peptic ulcer and non-ulcer dyspepsia (gastritis B, pre-ulcerative condition), aggressive factors sharply increase and protective factors in the gastric cavity decrease.

Based on currently available data, the main and predisposing factors have been identified diseases.

The main factors include:

-disturbances of humoral and neurohormonal mechanisms regulating digestion and tissue reproduction;

-disorders of local digestive mechanisms;

-changes in the structure of the mucous membrane of the stomach and duodenum.

Predisposing factors include:

-hereditary constitutional factor. A number of genetic defects have been identified that occur in certain stages of the pathogenesis of this disease;

-Helicobacter pylori infestation. Some researchers in our country and abroad consider Helicobacter pylori infection to be the main cause of peptic ulcers;

-conditions external environment, first of all, neuropsychic factors, nutrition, bad habits;

-medicinal effects.

From a modern point of view, some scientists consider peptic ulcer disease as a polyetiological multifactorial disease . However, I would like to emphasize the traditional direction of the Kiev and Moscow therapeutic schools, which believe that the central place in the etiology and pathogenesis of peptic ulcer disease belongs to disorders of the nervous system that arise in its central and autonomic parts under the influence of various influences (negative emotions, overexertion during mental and physical work , viscero-visceral reflexes, etc.).

There is a large number of works indicating the etiological and pathogenetic role of the nervous system in the development of peptic ulcer disease. The spasmogenic or neurovegetative theory was the first to be created .

Works by I.P. Pavlova on the role of the nervous system and its higher department - the cortex big brain- in the regulation of all vital functions of the body (ideas of nervism) are reflected in new views on the process of development of peptic ulcer disease: this is the cortico-visceral theory K.M. Bykova, I.T. Kurtsina (1949, 1952) and a number of works indicating the etiological role of disruption of neurotrophic processes directly in the mucous membrane of the stomach and duodenum in peptic ulcer disease.

According to the cortico-visceral theory, peptic ulcer disease is the result of disturbances in the cortico-visceral relationship. Progressive in this theory is the evidence of two-way communication between the central nervous system and internal organs, as well as consideration of peptic ulcer disease from the point of view of a disease of the whole organism, in the development of which a leading role is played by a disorder of the nervous system. The disadvantage of the theory is that it does not explain why the stomach is affected when the cortical mechanisms are disrupted.

Currently, there are several fairly convincing facts showing that one of the main etiological factors in the development of peptic ulcer disease is a violation of nerve trophism. An ulcer arises and develops as a result of a disorder in the biochemical processes that ensure the integrity and stability of living structures. The mucous membrane is most susceptible to dystrophies of neurogenic origin, which is probably explained by the high regenerative ability and anabolic processes in the gastric mucosa. Active protein-synthetic function is easily disrupted and can be an early sign of degenerative processes, aggravated by aggressive peptic action gastric juice.

It has been noted that with gastric ulcer the level of hydrochloric acid secretion is close to normal or even reduced. In the pathogenesis of the disease higher value has a decrease in the resistance of the mucous membrane, as well as the reflux of bile into the gastric cavity due to insufficiency of the pyloric sphincter.

A special role in the development of peptic ulcer is assigned to gastrin and cholinergic postganglionic fibers of the vagus nerve, which are involved in the regulation of gastric secretion.

There is an assumption that histamine is involved in the stimulating effect of gastrin and cholinergic mediators on the acid-forming function of parietal cells, which is confirmed by the therapeutic effect of histamine H2 receptor antagonists (cimetidine, ranitidine, etc.).

Prostaglandins play a central role in protecting the epithelium of the gastric mucosa from the action of aggressive factors. The key enzyme in the synthesis of prostaglandins is cyclooxygenase (COX), present in the body in two forms COX-1 and COX-2.

COX-1 is found in the stomach, kidneys, platelets, and endothelium. Induction of COX-2 occurs under the influence of inflammation; the expression of this enzyme is carried out predominantly by inflammatory cells.

Thus, summarizing the above, we can come to the conclusion that the main links in the pathogenesis of peptic ulcer are neuroendocrine, vascular, immune factors, acid-peptic aggression, protective mucous-hydrocarbonate barrier of the gastric mucosa, helicobacteriosis and prostaglandins.

.2 Classification

Currently, there is no generally accepted classification of peptic ulcer disease. A large number of classifications based on different principles. In foreign literature, the term “peptic ulcer” is more often used and a distinction is made between peptic ulcers of the stomach and duodenum. The abundance of classifications emphasizes their imperfection.

According to the WHO classification of the IX revision, gastric ulcer (heading 531), duodenal ulcer (heading 532), ulcer of unspecified localization (heading 533) and, finally, gastrojejunal ulcer of the resected stomach (heading 534) are distinguished. International classification WHO should be used for accounting and statistical purposes, but for use in clinical practice it must be significantly expanded.

The following classification of peptic ulcer disease is proposed.. General characteristics of the disease (WHO nomenclature)

.Gastric ulcer (531)

2.Duodenal ulcer (532)

.Peptic ulcer of unspecified localization (533)

.Peptic gastrojejunal ulcer after gastrectomy (534)

II. Clinical form

.Acute or newly diagnosed

III. Flow

.Latent

2.Mild or rarely recurrent

.Moderate or recurrent (1-2 relapses per year)

.Severe (3 or more relapses within a year) or continuously relapsing; development of complications.

IV. Phase

.Exacerbation (relapse)

2.Fading exacerbation (incomplete remission)

.Remission

V. Characteristics of the morphological substrate of the disease

.Types of ulcers a) acute ulcer; b) chronic ulcer

Sizes of the ulcer: a) small (less than 0.5 cm); b) average (0.5-1 cm); c) large (1.1-3 cm); d) gigantic (more than 3 cm).

Stages of ulcer development: a) active; b) scarring; c) “red” scar stage; d) “white” scar stage; e) long-term non-scarring

Ulcer location:

a) stomach: A: 1) cardia, 2) subcardial section, 3) body of the stomach, 4) antrum, 5) pyloric canal; B: 1) anterior wall, 2) posterior wall, 3) lesser curvature, 4) greater curvature.

b) duodenum: A: 1) bulb, 2) postbulbar part;

B: 1) anterior wall, 2) posterior wall, 3) lesser curvature, 4) greater curvature.. Characteristics of the functions of the gastroduodenal system (only pronounced disorders of secretory, motor and evacuation functions are indicated)

VII. Complications

1.Bleeding: a) mild, b) moderate, c) severe, d) extremely severe

2.Perforation

.Penetration

.Stenosis: a) compensated, b) subcompensated, c) decompensated.

.Malignancy

Based on the presented classification, as an example, we can propose the following formulation of the diagnosis: gastric ulcer, newly diagnosed, acute form, large (2 cm) ulcer of the lesser curvature of the body of the stomach, complicated by mild bleeding.

1.3 Clinical picture and preliminary diagnosis

Judgment about the possibility of a peptic ulcer should be based on the study of complaints, anamnestic data, physical examination of the patient, and assessment of the functional state of the gastroduodenal system.

The typical clinical picture is characterized by a clear connection between the occurrence of pain and food intake. There are early, late and “hunger” pains. Early pain appears 1/2-1 hour after eating, gradually increases in intensity, lasts 1 1/2-2 hours and subsides as gastric contents are evacuated. Late pain occurs 1 1/2-2 hours after eating at the height of digestion, and “hungry” pain occurs after a significant period of time (6-7 hours), i.e. on an empty stomach, and stops after eating. Night pain is close to “hungry”. The disappearance of pain after eating, taking antacids, anticholinergic and antispasmodic drugs, as well as the subsidence of pain during the first week of adequate treatment is a characteristic sign of the disease.

In addition to pain, the typical clinical picture of gastric ulcer includes various dyspeptic symptoms. Heartburn is a common symptom of the disease, occurring in 30-80% of patients. Heartburn may alternate with pain, precede it for a number of years, or be the only symptom diseases. However, it should be borne in mind that heartburn is often observed in other diseases of the digestive system and is one of the main signs of insufficiency of cardiac function. Nausea and vomiting are less common. Vomiting usually occurs at the height of pain, being a kind of culmination of the pain syndrome, and brings relief. Often, to eliminate pain, the patient himself artificially induces vomiting.

Constipation is observed in 50% of patients with gastric ulcer. They intensify during periods of exacerbation of the disease and are sometimes so persistent that they bother the patient even more than pain.

A distinctive feature of peptic ulcer disease is its cyclical course. Periods of exacerbation, which usually last from several days to 6-8 weeks, are followed by a phase of remission. During remission, patients often feel practically healthy, even without following any diet. Exacerbations of the disease, as a rule, are seasonal; for the middle zone, this is mainly the spring or autumn season.

A similar clinical picture in persons with no previously established diagnosis is more likely to suggest peptic ulcer disease.

Typical ulcerative symptoms are more common when the ulcer is localized in the pyloric part of the stomach (pyloroduodenal form of peptic ulcer). However, it is often observed with an ulcer of the lesser curvature of the stomach (mediogastric form of peptic ulcer). However, in patients with mediogastric ulcers, the pain syndrome is less defined, pain can radiate to the left half of the chest, lumbar region, right and left hypochondrium. Some patients with the mediogastric form of peptic ulcer experience a decrease in appetite and weight loss, which is not typical for pyloroduodenal ulcers.

The greatest clinical features occur in patients with ulcers localized in the cardial or subcardial parts of the stomach.

Laboratory tests have a relative, indicative value in recognizing peptic ulcer disease.

The study of gastric secretion is necessary not so much for diagnosing the disease as for identifying functional disorders stomach. Only a significant increase in acid production detected during fractional probing of the stomach (basal HCl secretion rate over 12 mmol/h, HCl rate after submaximal stimulation with histamine over 17 mmol/h and after maximum stimulation over 25 mmol/h) should be taken into account as a diagnostic sign of peptic ulcer disease .

Additional information can be obtained by examining intragastric pH. Peptic ulcer disease, especially pyloroduodenal localization, is characterized by pronounced hyperacidity in the body of the stomach (pH 0.6-1.5) with continuous acid formation and decompensation of alkalization of the environment in the antrum (pH 0.9-2.5). Establishing true achlorhydria practically eliminates this disease.

Clinical blood tests in uncomplicated forms of peptic ulcer usually remain normal; only a number of patients have erythrocytosis due to increased erythropoiesis. Hypochromic anemia may indicate bleeding from gastroduodenal ulcers.

A positive fecal reaction to occult blood is often observed during exacerbations of peptic ulcer disease. However, it should be kept in mind that positive reaction can be observed in many diseases (tumors gastrointestinal tract, nosebleeds, bleeding gums, hemorrhoids, etc.).

Today, the diagnosis of gastric ulcer can be confirmed using X-ray and endoscopic method.

ulcerative stomach acupressure music therapy

2. Methods of rehabilitation of patients with gastric ulcer

.1 Physical therapy (physical therapy)

Physical therapy (physical therapy) for peptic ulcers helps regulate the processes of excitation and inhibition in the cerebral cortex, improves digestion, blood circulation, breathing, redox processes, and has a positive effect on the nervous system. mental condition sick

When performing physical exercises, spare the stomach area. In the acute period of the disease in the presence of pain, exercise therapy is not indicated. Physical exercises are prescribed 2-5 days after the cessation of acute pain.

During this period, the therapeutic exercise procedure should not exceed 10-15 minutes. In a lying position, exercises are performed for the arms and legs with a limited range of motion. Avoid exercises that actively involve the abdominal muscles and increase intra-abdominal pressure.

Upon cessation of acute symptoms physical activity gradually increase. To avoid exacerbation, this is done carefully, taking into account the patient’s reaction to the exercises. Exercises are performed in the starting position lying, sitting, standing.

For warning adhesive process against the background of general strengthening movements, exercises for the muscles of the anterior abdominal wall, diaphragmatic breathing, simple and complicated walking, rowing, skiing, outdoor and sports games are used.

Exercises should be performed with caution if they increase pain. Complaints often do not reflect the objective condition, and the ulcer can progress with subjective well-being (disappearance of pain, etc.).

In this regard, when treating patients, one should spare the abdominal area and very carefully, gradually increase the load on the abdominal muscles. You can gradually expand the patient’s motor mode by increasing the total load when performing most exercises, including diaphragmatic breathing exercises and exercises for the abdominal muscles.

Contraindications to the use of exercise therapy include: bleeding; generating ulcer; acute perivisceritis (perigastritis, periduodenitis); chronic perivisceritis when acute pain occurs during exercise.

A complex of exercise therapy for patients with gastric ulcers is presented in Appendix 1.

2.2 Acupuncture

Gastric ulcer from the point of view of its occurrence, development, as well as from the point of view of the development of effective treatment methods represents a major problem. The scientific search for reliable methods of treating peptic ulcer disease is due to insufficient effectiveness known methods therapy

Modern ideas about the mechanism of action of acupuncture are based on somato-visceral relationships, carried out both in the spinal cord and in the overlying parts of the nervous system. The therapeutic effect on reflexogenic zones where acupuncture points are located helps normalize the functional state of the central nervous system, hypothalamus, maintain homeostasis and more quickly normalize the disturbed activity of organs and systems, stimulates oxidative processes, improves microcirculation (through the synthesis of biologically active substances), blocks pain impulses. In addition, acupuncture increases the body’s adaptive capabilities, eliminates prolonged excitation in various brain centers that control smooth muscles, blood pressure and etc.

Best effect is achieved if acupuncture points located in the zone of segmental innervation of the affected organs are irritated. Such zones for peptic ulcer disease are D4-7.

The study of the general condition of patients, the dynamics of laboratory, radiological, and endoscopic examinations give the right to objectively evaluate the acupuncture method used, its advantages and disadvantages, and to develop indications for differentiated treatment of patients with peptic ulcer disease. They showed a pronounced analgesic effect in patients with persistent pain symptoms.

Analysis of gastric motor function indicators also revealed a clear positive influence acupuncture for tone, peristalsis and gastric evacuation.

Treatment of patients with gastric ulcer with acupuncture has a positive effect on the subjective and objective picture of the disease, and relatively quickly eliminates pain and dyspeptic symptoms. When used in parallel with the achieved clinical effect normalization of the secretory, acid-forming and motor functions of the stomach occurs.

2.3 Acupressure

Acupressure is used for gastritis and stomach ulcers. The basis acupressure The same principle is laid down as when carrying out the method of acupuncture, moxibustion (Zhen-ju therapy) - with the only difference that on BAP (biologically active points) act with a finger or brush.

To resolve the issue of using acupressure, a detailed examination and establishment of an accurate diagnosis is necessary. This is especially important for chronic gastric ulcers due to the risk of malignant degeneration. Acupressure is unacceptable for ulcerative bleeding and is possible no earlier than 6 months after its cessation. A contraindication is also cicatricial narrowing of the gastric outlet (pyloric stenosis) - a gross organic pathology in which there is no expectation of a therapeutic effect.

At peptic ulcer The following combination of points is recommended (the location of the points is presented in Appendix 2):

1st session: 20, 18, 31, 27, 38;

Session 2: 22, 21, 33, 31, 27;

1st session: 24, 20, 31, 27, 33.

The first 5-7 sessions, especially during an exacerbation, are carried out daily, the rest - after 1-2 days (12-15 procedures in total). Repeated courses are carried out according to clinical indications after 7-10 days. Before seasonal exacerbations of peptic ulcer disease, preventive courses of 5-7 sessions every other day are recommended.

In case of increased acidity of gastric juice with heartburn, points 22 and 9 should be included in the recipe.

In case of stomach atony, low acidity of gastric juice, poor appetite, after a mandatory X-ray or endoscopic examination, you can conduct a course of acupressure using the exciting method of points 27, 31, 37, combining it with massage using the inhibitory method of points 20, 22, 24, 33.

2.4 Physiotherapy

Physiotherapy - this is the use for therapeutic and prophylactic purposes of natural and artificially generated physical factors, such as: electricity, magnetic field, laser, ultrasound, etc. are used and different kinds radiation: infrared, ultraviolet, polarized light.

a) selection of mild procedures;

b) use of small dosages;

c) gradual increase in the intensity of exposure to physical factors;

d) rational combination of them with others therapeutic measures.

As active background therapy to influence the increased reactivity of the nervous system, methods such as:

-low-frequency pulse currents using the electrosleep technique;

-central electroanalgesia using a tranquilizing technique (using LENAR devices);

-UHF on the collar zone; galvanic collar and bromine electrophoresis.

Of the methods of local therapy (i.e., effects on the epigastric and paravertebral zones), the most popular remains galvanization in combination with the introduction of various medicinal substances by electrophoresis (novocaine, benzohexonium, platiphylline, zinc, dalargin, solcoseryl, etc.).

2.5 Drinking mineral waters

Drinking mineral waters of various types chemical composition affect the regulation of the functional activity of the gastro-duodenal system.

It is known that the secretion of pancreatic juice, the secretion of bile in physiological conditions are carried out as a result of the induction of secretin and pancreozymin. It logically follows that mineral waters help stimulate these intestinal hormones, which have a trophic effect. To carry out these processes, a certain time is required - from 60 to 90 minutes, and therefore, in order to use all the medicinal properties inherent in mineral waters, it is advisable to prescribe them 1-1.5 hours before meals. During this period, water can penetrate the duodenum and have an inhibitory effect on the excited secretion of the stomach.

Warm (38-40° C) low-mineralized waters, which can relax the spasm of the pylorus and quickly evacuate into the duodenum, have a similar effect. Upon appointment mineral waters 30 minutes before a meal or at the height of digestion (30-40 minutes after a meal), their local antacid effect is mainly manifested and those processes that are associated with the influence of water on endocrine and nervous regulation do not have time to occur, thereby losing many aspects of the therapeutic effect of mineral waters. This method of prescribing mineral waters is justified in a number of cases for patients with duodenal ulcer with severe increased acidity gastric juice and severe dyspeptic syndrome in the phase of fading exacerbation of the disease.

For patients with impaired motor-evacuation function of the stomach, taking mineral waters is not indicated, since accepted water it stays in the stomach for a long time along with food and will have a sokogonny effect instead of an inhibitory one.

For patients with peptic ulcers, alkaline weakly and moderately mineralized waters are recommended (mineralization, respectively, 2-5 g/l and more than 5-10 g/l), sodium bicarbonate carbonate, sodium-calcium carbonate bicarbonate-sulfate, bicarbonate-chloride carbonate, sodium sulfate, magnesium-sodium, for example: Borjomi, Smirnovskaya, Slavyanovskaya, Essentuki No. 4, Essentuki Novaya, Pyatigorsk Narzan, Berezovskaya, Moscow mineral water and others.

2.6 Balneotherapy

External use of mineral waters in the form of baths is an active background therapy for patients with gastric ulcers. They have a beneficial effect on the state of the central and autonomic nervous system, endocrine regulation, functional state digestive organs. In this case, baths from mineral waters available at the resort or from artificially created waters can be used. These include chloride, sodium, carbon dioxide, iodine-bromine, oxygen, etc.

Chloride and sodium baths are indicated for patients with gastric ulcers, any severity of the disease in the phase of a fading exacerbation, incomplete and complete remission of the disease.

Radon baths are also actively used. They are available at gastrointestinal resorts (Pyatigorsk, Essentuki, etc.). To treat this category of patients, radon baths of low concentrations are used - 20-40 nCi/l. They have a positive effect on the state of neurohumoral regulation in patients and on the functional state of the digestive organs. The most effective in influencing trophic processes in the stomach are radon baths at concentrations of 20 and 40 nCi/l. They are indicated for any stage of the disease, for patients in the phase of fading exacerbation, incomplete and complete remission, concomitant lesions of the nervous system, blood vessels and other diseases for which radon therapy is indicated.

For patients with peptic ulcer disease with concomitant diseases of the joints of the central and peripheral nervous system, female genital organs, especially with inflammatory processes and ovarian dysfunction, it is advisable to prescribe treatment with iodine-bromine baths; it is good to prescribe them to patients of an older age group. Pure iodine-bromine waters do not exist in nature. Use artificial iodine-bromine baths at a temperature of 36-37°C for 10-15 minutes, for a course of treatment 8-10 baths, released every other day, it is advisable to alternate with peloid applications, or physiotherapeutic procedures, the choice of which is determined by both the general condition of the patients and concomitant diseases gastrointestinal tract, cardiovascular and nervous systems.

2.7 Music therapy

It has been proven that music can do a lot. Calm and melodic, it will help you relax faster and better, and restore strength; cheerful and rhythmic raises tone and improves mood. Music will relieve irritation and nervous tension, activate thought processes and increase performance.

ABOUT medicinal properties music has been known for a long time. In the VI century. BC. The great ancient Greek thinker Pythagoras used music for medicinal purposes. He preached that a healthy soul requires a healthy body, and both require constant musical influence, concentration in oneself and ascent to the highest regions of existence. More than 1000 years ago, Avicenna recommended diet, work, laughter and music as treatments.

By physiological effect melodies can be soothing, relaxing or tonic, invigorating.

The relaxing effect is useful for stomach ulcers.

For music to have a healing effect, it must be listened to in this way:

) lie down, relax, close your eyes and completely immerse yourself in the music;

) try to get rid of any thoughts expressed in words;

) remember only pleasant moments in life, and these memories should be figurative in nature;

) a recorded musical program must last at least 20-30 minutes, but no more;

) should not fall asleep;

) after listening to a music program, it is recommended to do breathing exercises and some physical exercises.

.8 Mud therapy

Among the methods of treating gastric ulcers, mud therapy occupies one of the leading places. Therapeutic mud affects metabolism and bioenergetic processes in the body, enhances microcirculation of the stomach and liver, improves gastric motility, reduces acidification of the duodenum, stimulates the reparative processes of the gastroduodenal mucosa, and activates the activity of the endocrine system. Mud therapy has an analgesic and anti-inflammatory effect, improves metabolism, changes the body's reactivity, and its immunobiological properties.

Silt mud is used at a temperature of 38-40°C, peat mud at 40-42°C, the duration of the procedure is 10-15-20 minutes, every other day, for a course of 10-12 procedures.

This mud therapy technique is indicated for patients with gastric ulcer in the phase of fading exacerbation, incomplete and complete remission of the disease, with severe pain syndrome, with concomitant diseases, in which the use of physical factors on the collar area is indicated.

In case of severe pain, you can use the method of combining mud applications with reflexology (electropuncture). Where it is not possible to use mud therapy, you can use ozokerite and paraffin therapy.

2.9 Diet therapy

Diet food is the main background of any antiulcer therapy. The principle of fractional (4-6 meals a day) meals must be observed regardless of the phase of the disease.

Basic principles therapeutic nutrition(principles of the “first tables” according to the classification of the Institute of Nutrition): 1. good nutrition; 2. maintaining the rhythm of eating; 3. mechanical; 4. chemical; 5. thermal sparing of the gastroduodenal mucosa; 6. gradual expansion of the diet.

The approach to dietary therapy for peptic ulcer disease is currently marked by a departure from strict to gentle diets. Mainly pureed and non-mashed versions of diet No. 1 are used.

Diet No. 1 includes the following products: meat (veal, beef, rabbit), fish (pike perch, pike, carp, etc.) in the form of steamed cutlets, quenelles, soufflés, beef sausages, boiled sausage, occasionally - lean ham, soaked herring (the taste and nutritional properties of herring increase if it is soaked in whole cow's milk), as well as milk and dairy products (whole milk, dry, condensed milk, fresh non-sour cream, sour cream and cottage cheese). If tolerated well, yogurt and acidophilus milk can be recommended. Eggs and dishes made from them (soft-boiled eggs, steam omelette) - no more than 2 pieces per day. Raw eggs are not recommended, as they contain avidin, which irritates the gastric mucosa. Fats - unsalted butter (50-70 g), olive or sunflower (30-40 g). Sauces - milk, snacks - mild, grated cheese. Soups - vegetarian from cereals, vegetables (except cabbage), milk soups with vermicelli, noodles, pasta (well boiled). You need to salt food in moderation (8-10 g of salt per day).

Fruits, berries (sweet varieties) are given in the form of puree, jelly, if tolerated, compotes and jelly, sugar, honey, jam. Non-acidic vegetable, fruit, and berry juices are indicated. Grapes and grape juices are poorly tolerated and can cause heartburn. If tolerance is poor, juices should be added to cereals, jelly or diluted with boiled water.

Not recommended: pork, lamb, duck, goose, strong broths, meat soups, vegetable and especially mushroom broths, undercooked, fried, fatty and dried meat, smoked meats, salty fish, hard-boiled eggs or scrambled eggs, skim milk, strong tea, coffee, cocoa, kvass, all alcoholic drinks, sparkling water, pepper, mustard, horseradish, onions, garlic, Bay leaf and etc.

You should abstain from cranberry juice. For drinks, we can recommend weak tea, tea with milk or cream.

.10 Herbal medicine

For most patients suffering from gastric ulcers, it is advisable to include in complex treatment decoctions and infusions of medicinal herbs, as well as special antiulcer mixtures consisting of many medicinal plants. Herbs and folk recipes used for stomach ulcers:

Collection: Chamomile flowers - 10 g; fennel fruits - 10 gr.; marshmallow root - 10 g; wheatgrass root - 10 g; licorice root - 10 gr. 2 teaspoons of the mixture per 1 cup of boiling water. Infuse, wrap, strain. Take one glass of infusion at night.

Collection: Fireweed leaves - 20 gr.; Linden blossom- 20 gr.; chamomile flowers - 10 gr.; fennel fruits - 10 gr. 2 teaspoons of the mixture per glass of boiling water. Leave it wrapped and strain. Take 1 to 3 glasses throughout the day.

Collection: Cancerous cervixes, roots - 1 part; plantain, leaf - 1 part; horsetail - 1 part; St. John's wort - 1 part; valerian root - 1 part; chamomile - 1 part. A tablespoon of the mixture per glass of boiling water. Steam for 1 hour. Take 3 times a day before meals.

Collection:: Series -100 gr.; celandine -100 gr.; St. John's wort -100 gr.; plantain -200 gr. A tablespoon of the mixture per glass of boiling water. Leave covered for 2 hours, strain. Take 1 tablespoon 3-4 times a day, an hour before or 1.5 hours after meals.

Freshly squeezed juice from cabbage leaves, when taken regularly, cures chronic gastritis and ulcers best of all. medications. Preparing juice at home and taking it: the leaves are passed through a juicer, filtered and the juice is squeezed out. Take 1/2-1 glass warmed 3-5 times a day before meals.

Conclusion

So, in the course of my work I found out that:

List of used literature

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Annex 1

Exercise therapy procedure for patients with gastric ulcer (V. A. Epifanov, 2004)

No. Section content Dosage, min Section objectives, procedures 1 Simple and complicated walking, rhythmic, at a calm pace 3-4 Gradual involvement in the load, development of coordination 2 Exercises for arms and legs in combination with body movements, breathing exercises in a sitting position 5-6 Periodic increase in intra-abdominal pressure, increased blood circulation in the abdominal cavity 3 Standing exercises in throwing and catching a ball, throwing a medicine ball (up to 2 kg), relay races, alternating with breathing exercises 6-7 General physiological load, creating positive emotions, developing the function of full breathing 4 Exercises on a gymnastic wall such as mixed hangs 7-8 General tonic effect on the central nervous system, development of static-dynamic stability 5 Elementary lying exercises for the limbs in combination with deep breathing 4-5 Reducing the load, developing full breathing

Federal Agency for Education

State educational institution

Higher professional education.

Tula State University

Department of Physical Education and Sports.

Essay

Subject:

"Physical rehabilitation for peptic ulcer disease."

Completed

Student gr.XXXXXX

Checked:

Teacher

Simonova T.A.

Tula, 2006.

Peptic ulcer disease. Facts. Manifestations.

Treatment of peptic ulcer.

Physical rehabilitation for peptic ulcers and sets of gymnastic exercises.

List of used literature.

1) Peptic ulcer. Data. Manifestations.

Peptic ulcer (stomach ulcer, duodenal ulcer) is a disease the main manifestation of which is the presence of an ulcer1 in the stomach or duodenum.

Among the population, the prevalence of peptic ulcer disease reaches 7-10%. The ratio of gastric ulcers and duodenal ulcers is 1:4. It is more common in men aged 25 - 50 years.

Etiology and pathogenesis

It is not possible to name any single cause of peptic ulcer disease.

Nevertheless, the following main factors have recently been thought to play a role in etiology:

1. Neuropsychic stress and physical overload.

2. Eating disorder.

3. Biological defects inherited at birth.

4. Certain medications.

5. Smoking and alcohol.

The role of hereditary predisposition is undoubted.

Duodenal ulcers occur predominantly at a young age. Stomach ulcers - in older people.

There is a violation of the secretory and motor functions of the stomach. Dysfunction of nervous regulation is essential.

There are substances that also inhibit the function of parietal cells - gastrin and secretin.

These substances are of great importance during the recovery period after a peptic ulcer. An important role is also given to the acid factor: increased secretion of hydrochloric acid, which has an aggressive effect on the mucous membrane. An ulcer does not form without an increase in hydrochloric acid: if there is an ulcer, but there is no hydrochloric acid, it is practically cancer. But normal mucosa is quite resistant to damaging factors. Therefore, in pathogenesis it is also necessary to take into account protective mechanisms that protect the mucous membrane from the formation of ulcers. Therefore, in the presence of etiological factors, not everyone develops an ulcer.

External contributing factors:

1. Nutritional. Negative erosive effect on the mucous membrane and food that stimulates active secretion of gastric juice (normally, mucosal injuries heal in 5 days). Hot, spicy, smoked foods, fresh baked goods (pies, pancakes), large amounts of food, most likely cold food, irregular meals, dry meals, refined foods, coffee and various difficult-to-digest foods that cause irritation of the gastric mucosa.

In general, irregular meals (at different hours, with large intervals), disrupting the digestion process in the stomach, can contribute to the development of peptic ulcers, since this eliminates the neutralization of the acidic environment of the stomach with food.

2. Smoking significantly contributes to the development of ulcers. In addition, nicotine causes vasospasm and impaired blood supply to the gastric mucosa.

Alcohol. Although the direct effect of alcohol has not been proven, it has a powerful socogenic effect.

Factors influencing pathogenesis

1. Acid - increased secretion of hydrochloric acid.

2. Reduced intake of alkaline juice.

3. Impaired coordination between the secretion of gastric juice and alkaline contents.

4. Disturbed composition of the mucous coating of the gastric epithelium (mucoglycoproteins that promote repair of the mucosa. This substance covers the mucosa with a continuous layer, protecting it from burns).

Ulcer symptoms.

The main complaint of a patient with peptic ulcer is pain in the epigastric region, the appearance of which is associated with food intake: in some cases, pain occurs after half an hour - an hour, in others - 1.5 - 2 hours after eating or on an empty stomach. “Hungry” pain is especially characteristic of duodenal ulcers. They usually disappear after eating, sometimes even a small amount of food. The intensity of pain may vary; often the pain radiates to the back, or upwards, in chest. In addition to pain, patients are often bothered by painful heartburn 2-3 hours after eating, caused by the reflux of acidic stomach contents into the lower esophagus. Heartburn usually subsides after taking alkaline solutions and milk. Sometimes patients complain of belching, nausea, vomiting; vomiting usually brings relief. All these unpleasant sensations are also associated with food intake. When the ulcer is located in the duodenum, “night” pain and constipation are typical.

Exacerbations of ulcers and the course of the disease.

Peptic ulcer disease is characterized by a chronic course with alternating periods of exacerbations and improvements (remissions). Exacerbations more often occur in spring and autumn, usually last 1-2 months and are manifested by an increase in the described symptoms of the disease, often depriving the patient of his ability to work, and in some cases lead to complications:

* Bleeding - the most common and serious complications; occurs on average in 15-20% of patients with peptic ulcer and is the cause of almost half of all deaths in this disease. It is observed mainly in young men. More often with peptic ulcers, so-called minor bleeding occurs, massive bleeding is less common. Sometimes sudden massive bleeding is the first manifestation of the disease. Minor bleeding is characterized by pale skin, dizziness, weakness; with severe bleeding, melena, single or repeated vomiting is noted, the vomit resembles coffee grounds;

* Perforation is one of the most severe and dangerous complications, which occurs in approximately 7% of cases of peptic ulcer. More often observed with duodenal ulcers. However, this complication of gastric ulcer is associated with higher mortality and a higher incidence of postoperative complications. The overwhelming majority of perforation of stomach and duodenal ulcers are so-called free perforations into the abdominal cavity. Often occurs after eating a large meal. It manifests itself as a sudden sharp (dagger) pain in the upper abdomen. The suddenness and intensity of pain is not so pronounced in any other condition. The patient takes a forced position with his knees pulled up to his stomach, trying not to move;

* Penetrations are characterized by the penetration of an ulcer into organs in contact with the stomach or duodenal bulb - the liver, pancreas, and lesser omentum. The clinical picture in the acute period resembles perforation, but the pain is less intense. Soon signs of damage to the organ into which penetration occurred (girdling pain and vomiting with damage to the pancreas, pain in the right shoulder and back with penetration into the liver, etc.). In some cases, penetration occurs gradually;

* Stenosis of the gastrointestinal tract (as a result of cicatricial deformation);

* Degeneration into a malignant tumor or malignancy - observed almost exclusively when the ulcer is localized in the stomach; malignancy of duodenal ulcers is very rare. When ulcers become malignant, pain becomes constant, they lose connection with food intake, appetite decreases, exhaustion increases, nausea and vomiting become more frequent.

In this case, a change in the nature of pain may be a sign of the development of complications.

Peptic ulcer disease in adolescents and young adults usually occurs against the background of a pre-ulcerative condition (gastritis, gastroduodenitis), is characterized by more pronounced symptoms, high levels of acidity, increased motor activity of the stomach and duodenum, often the first sign of the disease is gastrointestinal bleeding.

Peptic ulcer disease in the elderly and old age occurs against the background of an increasing decline in the functions of the gastric mucosa, especially due to impaired blood circulation in the vessels. It is often preceded by chronic inflammatory processes in the stomach and duodenum. Ulcers in elderly and senile people are more often localized in the stomach. In persons over 60 years of age, gastric ulcer localization occurs 3 times more often than in young and middle-aged patients.

Stomach ulcers that occur in the elderly and senile age are distinguished by their significant size (giant ulcers are often found), a shallow bottom covered with a gray-yellow coating, blurred and bleeding edges, swelling, and slow healing of the ulcer.

Peptic ulcer disease in elderly and senile people often occurs as gastritis and is characterized by short duration, mild pain, and the absence of a clear connection with food intake. Patients complain of a feeling of heaviness, fullness in the stomach, diffuse aching pain in the epigastric region without clear localization, radiating to the right and left hypochondrium, to the sternum, to the lower abdomen. Disorders are manifested by belching, nausea; heartburn and vomiting are observed less frequently. Characterized by constipation, loss of appetite and weight loss. The tongue is thickly coated. The course of the disease is characterized by monotony, lack of clear periodicity and seasonality of exacerbation; in most patients it is aggravated by other chronic diseases of the digestive system - cholecystitis, hepatitis, pancreatitis, enterocolitis, as well as chronic coronary heart disease, hypertension, atherosclerosis, cardiovascular failure and pulmonary heart failure. In elderly and senile people, there is a slowdown in the time of ulcer scarring, and the frequency of complications increases. Bleeding occurs most frequently; perforation is much less common, and malignancy of ulcers is much more common than in young and middle-aged people.

Some differences between gastric and duodenal ulcers.

Clinical signs

Duodenal ulcer

Over 40 years old

Male predominant

No differences by gender

Nocturnal, "hungry"

Immediately after eating

Normal, increased

Anorexia

Body mass