1. Diet therapy - table number 2 (mechanically and chemically sparing diet);

2. Bed mode, then ward mode;

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

A. Eradication therapy:

· T. Pyloride 0.4 x 2 r / day at the end of the meal;

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 eating 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. – 2ED

In / in the cap x 1 time / day - No. 3;

D. Upon completion of eradication therapy:

· T. Pyloride 0.4 x 2 r / day at the end of the meal - continue;

· R-r. Delargin 0.001 - in / m - 1 time / day - No. 5.

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

5. Exercise therapy: Bed rest: At this time, static breathing exercises are shown, which enhance the processes of inhibition in the cerebral cortex. Performed in the initial position lying on the back with relaxation of all muscle groups, these exercises are able to bring 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 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 regime: To the tasks of the previous period, tasks of household and labor rehabilitation patient, restoring correct posture when walking, improving coordination of movements. The second period of classes begins with a significant improvement in the patient's condition. Exercises are performed in the prone position, sitting, kneeling, standing with gradually increasing effort for all muscle groups, still excluding the abdominal muscles. The most acceptable is the supine position: it allows you to increase the mobility of the diaphragm, has a gentle effect on the abdominal muscles and improves blood circulation in abdominal cavity. Patients perform exercises for the abdominal muscles without tension, with a small number of repetitions. With a slow evacuation function of the stomach, more exercises lying on the right side should be included in the LH complexes, with moderate - on the left side. During this period, patients are also recommended massage, sedentary games, walking. The average duration of a lesson in the ward mode is 15-20 minutes, the pace of the exercises is slow, the intensity is low. Therapeutic exercises are carried out 1-2 times a day.

6. Taking biological samples for analysis (blood, urine, etc.), assistance in the implementation instrumental research(FGS (FGS control - on admission, 10 days before discharge), gastric sounding, X-ray examination of the stomach, etc.).

Contraindications to the appointment of exercise therapy:

1. Severe pain syndrome.

2. Bleeding.

3. Constant nausea.

4. Repeated vomiting.

Tasks of exercise therapy:

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

2. Improving the emotional state of the patient.

3. Stimulation of trophic processes in order to speed up 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 duodenal ulcer.

In 1 period static breathing exercises are used in the initial lying position with counting to oneself on inhalation and exhalation 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.

2 period begins with a significant improvement in the patient's condition and transferring him to the ward regime.

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

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

4 period(sanatorium-resort conditions).

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

Physiotherapy treatments:

Procedures for general exposure are used from the first days of stay on inpatient treatment. Methods of local exposure are best applied on the 7-8th day, and in polyclinic conditions- in the stage of fading exacerbation.

General exposure procedures:

1. Galvanization by the method of galvanic collar according to Shcherbak. The current strength is from 6 to 12 mA, the exposure time starts from 6 and is adjusted 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 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. The course of treatment - 12-15 baths.

Local exposure procedures:

1. Amplipulse therapy for 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 on the epigastric region. Duration - 30-60 minutes. The course of treatment is 20-30 procedures.

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

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

Page 17 of 18

Medical examination and principles rehabilitation treatment patients with peptic ulcer at the stages of medical rehabilitation
The general direction of health care development in our country has been and remains preventive, providing for the creation of favorable healthy conditions life for the population, the formation healthy lifestyle the life of each person and the whole 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 effectively and fully ensure the medical examination of the population, create a unified system for assessing and systematic monitoring of the state of human health, the entire population as a whole.
Medical examination issues require deep study and improvement, because its traditional methods are ineffective and do not allow for a full-fledged early diagnosis of diseases, clearly identify groups of people for differentiated observation, and fully implement preventive and rehabilitation measures.
The methodology for preparing and conducting preventive examinations under the general health screening program. Modern technical means make it possible to improve the diagnostic process, providing for the participation of a doctor only at the final stage - the stage of making a formed decision. This makes it possible to increase the efficiency of the work of the prevention department, to reduce the time of medical examination to a minimum.
Together with E. I. Samsoi and co-authors (1986, 1988), M. Yu. Kolomoets, V. L. Tarallo (1989, 1990), we have improved the technique early diagnosis diseases of the digestive system, including peptic ulcer, using computers and automated systems. Diagnosis consists of two stages - non-specific and specific.
At the first stage (non-specific) the primary expert review the health status of those undergoing medical examination with their division into two streams - healthy and subject to further examination. This stage is implemented by preliminary interviewing the population according to the indicative questionnaire (0-1) * in preparation for a preventive examination. The prophylactic patients, answering the questions of the indicative questionnaire (0-1), fill out the technological interview card (TKI-1). Then its machine processing is carried out, according to the results of which individuals of risk groups are distinguished 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 micro-computer "Iskra-1256" of the RIVC of the Ministry of Health of Ukraine (1987) with the inclusion of specially developed methods for self-examination of the patient , additions and changes that ensure the conduct of mass self-interviewing of the population and filling out maps at home. The medical questionnaire is intended for territorial-district certification of the health of the population with the allocation of risk groups for diseases and lifestyle using a computer.

The issue of allocation of two streams of subjects (healthy and those in need of further examination) is decided on the basis of the conclusion of the computer on TKI-1 and the results of mandatory studies.
Persons in need of additional examination are sent for further examination under screening targeted programs. One such program is the Targeted Mass Medical Examination Program. early detection common diseases of the digestive system (including peptic ulcer and pre-ulcerative conditions). Clinical patients according to a specialized questionnaire (0-2 "p") fill out the technological card TKI-2 "p", after which they are automatically processed according to the same principle. The computer suggests a probable
diagnosis(s) and list additional methods studies of the digestive organs (laboratory, instrumental, radiological). 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 a preventive examination, a medical specialist is examined on the recommendation of a computer.
The questionnaires were tested by conducting preventive medical examinations of 4217 people. According to the results of machine processing, only 18.8% of the interviewees made a presumptive diagnosis of "healthy", the conclusion "needs further examination" - 80.9% (among them, 77% of those undergoing medical examinations needed consultations from therapeutic specialists). Analysis of the final results of preventive examinations showed that the computer gave a true positive response in 62.9% of cases, a true negative - in 29.1%, a false positive - in 2.4%, a false negative - in 5.8%.
When identifying gastroenterological pathology, the sensitivity of a specialized screening questionnaire turned out to be very high - 96.2% (with a predictive coefficient of the result of 0.9), because in specified percentage cases, the machine gives the correct answer with a positive decision “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 coefficient of conformity of the diagnostic conclusion is 92.1%, t. out of 100 people, in 8, the decision of the computer to identify gastroenterological pathology based on the survey data may be incorrect.
The data presented are convincing 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 you know, the order of the Ministry of Health of the USSR No. 770 dated May 30, 1986 provides for the allocation of three dispensary groups: healthy (DO; prophylactically healthy (Dg); patients in need of treatment (Dz). Our experience shows that, in relation to patients with peptic ulcer, their with pre-ulcerative conditions, as well as to 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 preventive and curative measures.
II group:
On - increased attention (persons who do not complain, without deviations from the norm according to the results of additional studies, but exposed to risk factors);
II b - persons with latent current pre-ulcerative conditions (no complaints, but having deviations from the norm in additional studies);
c - patients with obvious pre-ulcerative conditions, peptic ulcer who do not need treatment.
group:
IIIa - patients with obvious pre-ulcerative conditions in need of treatment;
III b - patients with uncomplicated peptic ulcer in need of treatment;
III c - patients with severe peptic ulcer disease, complications and (or) concomitant diseases.
Peptic ulcer is one of the diseases in the fight against which preventive rehabilitation measures are of decisive importance.
Without belittling the importance of the inpatient stage of treatment, it should be recognized that it is possible to achieve a stable and long-term remission, to prevent the recurrence of peptic ulcer disease through a long (at least 2 years) and successive restorative staged 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 distinguish the following stages of post-hospital rehabilitation treatment of patients with peptic ulcer:
a rehabilitation department for gastroenterological patients of a hospital for rehabilitation treatment (usually in a suburban area using natural healing factors);
a polyclinic (including a day hospital of a polyclinic, a department or an office for rehabilitation treatment of a polyclinic or a rehabilitation center at a polyclinic);
sanatorium-dispensary of industrial enterprises, institutions, collective farms, state farms, educational institutions;
Spa treatment.
We combine all of the above stages of post-hospital rehabilitation treatment in 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 recovery postoperative stages treatment);
- Dispensary observation in the clinic.
In the system of medical rehabilitation of patients with peptic ulcer, the polyclinic stage plays a decisive role, since it is in the polyclinic that continuous, consistent monitoring and treatment of the patient is carried out for a long time, and the continuity of rehabilitation is ensured. The effectiveness of the rehabilitation of patients in the clinic is due to the complex effect of various means and methods of rehabilitation 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 the organizational forms of rehabilitation of patients at the outpatient stage (OP Shchepin, 990). One of them is a polyclinic day hospital (DSP). An analysis of our observations on day hospitals at the polyclinics of the Central Republican Clinical Hospital of the Minsk region of Kiev, the polyclinic of the 3rd city hospital of Chernivtsi, as well as the data of A. M. Lushpa (1987), B. V. Zhalkovsky, L. I. Leibman (1990) show that that DSP is most effectively used for the rehabilitation of gastroenterological patients, constituting 70-80% of the total number of patients treated. Among patients with diseases of the digestive system, about half were patients with peptic ulcer. Based on the experience of the DSP, we determined the indications for referring patients with peptic ulcer 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 relief of pain.
Exacerbation of uncomplicated peptic ulcer disease without a peptic ulcer (from the beginning of an exacerbation), bypassing the stationary stage.
Long-term non-scarring ulcers in the absence of complications 3-4 weeks after the start of inpatient treatment.
Due to the rather long stay of patients in the DSP during the day (6-7 hours), we consider it appropriate to organize one or two meals a day (diet No. 1) in the DSP.
The duration of treatment of patients with peptic ulcer 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 a hospital - 20-30 days (or 14 days, followed by referral of the patient to a day hospital or a rehabilitation department for gastroenterological patients of a rehabilitation treatment hospital); in the rehabilitation department of a rehabilitation treatment hospital - 14 days; V day hospital- from 14 to 20 days; in the rehabilitation department of a polyclinic or rehabilitation center at the clinic - 14 days; in a sanatorium-dispensary - 24 days; in a sanatorium in a resort - 24-26 days.
In general, prolonged treatment should be continued for at least 2 years in the absence of new exacerbations and relapses. Practically healthy patient can be considered in those cases if within 5 years he had no exacerbations and relapses of peptic ulcer.
In conclusion, it should be noted that the problem of treating peptic ulcer goes far beyond the scope of medicine and is a socio-economic problem that requires the implementation of a set of measures on a nationwide scale, creating conditions for reducing psychogenic factors, normal nutrition, hygiene 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(LFK)

2 Acupuncture

3 point massage

4 Physiotherapy

5 Drinking mineral waters

6 Balneotherapy

7 Music therapy

8 Mud therapy

9 Diet therapy

10 Phytotherapy

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 (ulcus ventriculi et duodenipepticum, morbus ulcerosus) is a common chronic relapsing disease, prone to progression, with a polycyclic course, the characteristic features of which are seasonal exacerbations, accompanied by the appearance of an ulcer in the mucous membrane, and the development of complications that threaten the life of the patient. A feature of the course of gastric ulcer is the involvement in pathological process other organs of the digestive system, which requires timely diagnosis for the compilation medical complexes patients with peptic ulcer, taking into account concomitant diseases. Peptic ulcer of the stomach affects people of the most active, able-bodied age, causing temporary and sometimes permanent disability.

High morbidity, frequent relapses, long-term disability of patients, as a result of which significant economic losses - all this makes it possible to classify the problem of peptic ulcer as one of the most urgent in modern medicine.

A special place in the treatment of patients with peptic ulcer is rehabilitation. Rehabilitation is the restoration of health, functional state and ability to work, disturbed by diseases, injuries or physical, chemical and social factors. World Organization Health (WHO) gives a very close definition of rehabilitation: “Rehabilitation is a set of activities designed to enable people with impaired functions as a result of illness, injury and birth defects to adapt to the new conditions of life in the society in which they live” .

According to WHO, rehabilitation is a process aimed at comprehensive assistance to the sick and disabled in order to achieve the maximum possible physical, mental, professional, social and economic usefulness for this 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.

Tasks are directed to 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 course of the disease

.1 Etiology and pathogenesis of gastric ulcer

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

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

Aggression factors include: an increase in the 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, the secretion of bicarbonates (“alkaline flush”); mucosal resistance: proliferative index of the mucosa of the gastroduodenal zone, local immunity of the mucosa 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 stomach cavity decrease.

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

The main factors include:

-violations of humoral and neurohormonal mechanisms that regulate 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 established that are realized in various links in the pathogenesis of this disease;

-Helicobacter pylori invasion. Some researchers in our country and abroad attribute Helicobacter pylori infection to the main cause of peptic ulcer;

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

-medicinal effects.

From modern positions, some scientists consider peptic ulcer 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 belongs to disorders of the nervous system that occur in its central and vegetative sections under the influence of various influences (negative emotions, overstrain during mental and physical work , viscero-visceral reflexes, etc.).

There are a large number of works testifying to the etiological and pathogenetic role of the nervous system in the development of peptic ulcer. The spasmogenic or neurovegetative theory was first 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 (the ideas of nervism) are reflected in new views on the development of peptic ulcer: this is the cortico-visceral theory K.M. Bykova, I.T. Kurtsina (1949, 1952) and a number of works pointing to the etiological role of disorders of neurotrophic processes directly in the mucous membrane of the stomach and duodenum in peptic ulcer.

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

Currently, there are several fairly convincing facts showing that one of the main etiological factors in the development of peptic ulcer is a violation of nervous trophism. An ulcer arises and develops as a result of a disorder of 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 due to the high regenerative capacity and anabolic processes in the gastric mucosa. Active protein-synthetic function is easily disturbed and may be an early sign of dystrophic processes aggravated by aggressive peptic action. gastric juice.

It was noted that in gastric ulcer, the level of secretion of hydrochloric acid is close to normal or even reduced. In the pathogenesis of the disease greater value has a decrease in the resistance of the mucous membrane, as well as the reflux of bile into the stomach 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 involved in the regulation of gastric secretion.

There is an assumption that histamine is involved in the implementation of 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 for prostaglandin synthesis is cyclooxygenase (COX), present in the body in two forms, COX-1 and COX-2.

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

Thus, summarizing the above, we can conclude that the main links in the pathogenesis of peptic ulcer are neuroendocrine, vascular, immune factors, acid-peptic aggression, a protective muco-hydrocarbonate barrier of the gastric mucosa, helicobacter pylori and prostaglandins.

.2 Classification

Currently, there is no generally accepted classification of peptic ulcer disease. A large number of classifications have been proposed based on various principles. In foreign literature, the term "peptic ulcer" is more often used and a peptic ulcer of the stomach and duodenum is distinguished. 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 statistics purposes, but for use in clinical practice it should be significantly expanded.

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

.Peptic ulcer (531)

2.Peptic ulcer of the duodenum (532)

.Peptic ulcer of unspecified location (533)

.Peptic gastrojejunal ulcer after gastric resection (534)

II. Clinical form

.Acute or newly diagnosed

III. Flow

.Latent

2.Mild or rarely recurrent

.Medium or recurrent (1-2 relapses within a 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. Characterization of the morphological substrate of the disease

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

Dimensions of the ulcer: a) small (less than 0.5 cm); b) medium (0.5-1 cm); c) large (1.1-3 cm); d) giant (more than 3 cm).

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

Localization of the ulcer:

a) stomach: A: 1) cardia, 2) subcardial region, 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 violations of the 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.

.Malignization

Based on the presented classification, as an example, the following formulation of the diagnosis can be proposed: gastric ulcer, first detected, 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 provisional diagnosis

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

A typical clinical picture is characterized by a clear relationship between the occurrence of pain and food intake. There are early, late and "hungry" pains. Early pain appears 1/2-1 hour after eating, gradually increases in intensity, lasts 1 1/2-2 hours and subsides as the gastric contents are evacuated. Late pain occurs 1 1/2-2 hours after eating at the height of digestion, and "hungry" pain - after a significant period of time (6-7 hours), i.e. on an empty stomach, and stops after eating. Close to "hungry" night pain. 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, a typical clinical picture of gastric ulcer includes various dyspeptic phenomena. Heartburn is a common symptom of the disease, occurs in 30-80% of patients. Heartburn may alternate with pain, precede it for a number of years, or be the only symptom illness. However, it should be borne in mind that heartburn is very 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 disturb the patient even more than pain.

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

A similar clinical picture in individuals with a previously undiagnosed diagnosis is more likely to suggest peptic ulcer disease.

Typical ulcer 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 body of the stomach (mediogastric form of peptic ulcer). Nevertheless, 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. In some patients with mediogastric peptic ulcer, a decrease in appetite and weight loss are observed, which is not typical for pyloroduodenal ulcers.

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

Laboratory studies have a relative, indicative value in the recognition of peptic ulcer.

The study of gastric secretion is necessary not so much to diagnose the disease, but to identify functional disorders stomach. Only a significant increase in acid production detected during fractional gastric probing (the rate of basal secretion of HCl over 12 mmol/h, the rate of HCl 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 .

Additional information can be obtained by examining intragastric pH. Peptic ulcer, 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 medium in the antrum (pH 0.9-2.5). The establishment of true achlorhydria practically excludes this disease.

A clinical blood test in uncomplicated forms of peptic ulcer usually remains normal, only a number of patients have erythrocytosis due to increased erythropoiesis. Hypochromic anemia may indicate bleeding from gastroduodenal ulcers.

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

To date, it is possible to confirm the diagnosis of gastric ulcer with the help of X-ray and endoscopic method.

gastric ulcer acupressure music therapy

2. Methods of rehabilitation of patients with gastric ulcer

.1 Therapeutic exercise (LFK)

Physiotherapy exercises (exercise therapy) for peptic ulcer disease contributes to the regulation of excitation and inhibition processes in the cerebral cortex, improves digestion, blood circulation, respiration, redox processes, positively affects the neuro- mental condition sick .

When performing physical exercises, the stomach area is spared. 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 procedure of therapeutic exercises should not exceed 10-15 minutes. In the prone position, exercises for the arms and legs with a limited range of motion are performed. Exercises that actively involve the abdominal muscles and increase intra-abdominal pressure are excluded.

With the cessation of acute events physical activity gradually increase. To avoid exacerbation, do it carefully, taking into account the patient's response to exercise. Exercises are performed in the initial position lying, sitting, standing.

For a 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 done carefully if they aggravate the pain. Complaints often do not reflect the objective state, and the ulcer can progress with subjective well-being (disappearance of pain, etc.).

In this regard, in the treatment of patients, the abdominal area should be spared and very carefully, gradually increase the load on the abdominal muscles. It is possible to gradually expand the patient's motor mode by increasing the total load when performing most exercises, including exercises in diaphragmatic breathing and exercises for the abdominal muscles.

Contraindications to the appointment of exercise therapy are: bleeding; generating ulcer; acute perivisceritis (perigastritis, periduodenitis); chronic perivisceritis, subject to the occurrence of acute pain during exercise.

The exercise therapy complex for patients with gastric ulcer is presented in Appendix 1.

2.2 Acupuncture

Gastric ulcer from the point of view of its occurrence, development, as well as from the standpoint of the development of effective methods of treatment is a major problem. Scientific search for reliable methods of treating peptic ulcer due to lack of effectiveness known ways 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 the reflexogenic zones, where the acupuncture points are located, contributes to the normalization of the functional state of the central nervous system, the hypothalamus, maintaining homeostasis and faster normalization of the disturbed activity of organs and systems, stimulates oxidative processes, improves microcirculation (by synthesizing biologically active substances), blocks pain impulses. In addition, acupuncture increases the adaptive capacity of the body, eliminates prolonged excitation in various centers of the brain 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 indicators of laboratory, radiological, endoscopic studies give the right to objectively evaluate the applied method of acupuncture, its advantages, disadvantages, develop indications for differentiated treatment of patients with peptic ulcer. They showed a pronounced analgesic effect in patients with persistent pain symptoms.

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

Acupuncture treatment of patients with gastric ulcer has a positive effect on the subjective and objective picture of the disease, relatively quickly eliminates pain and dyspepsia. 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, cauterization (zhen-jiu-therapy) - with the only difference that on BAP (biologically active points) act with a finger or a brush.

To resolve the issue of the use of acupressure, a detailed examination and the establishment of an accurate diagnosis are necessary. This is especially important in chronic stomach ulcers due to the risk of malignant transformation. Acupressure is unacceptable for ulcerative bleeding and is possible no earlier than 6 months after its termination. A contraindication is also cicatricial narrowing of the outlet section of the stomach (pyloric stenosis) - a gross organic pathology, in which one does not have to wait for 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;

1st session: 22, 21, 33, 31, 27;

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

The first 5-7 sessions, especially during 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 in 7-10 days. Before seasonal exacerbations of peptic ulcer, preventive courses of 5-7 sessions every other day are recommended.

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

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

2.4 Physiotherapy

Physiotherapy - this is the use 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 soft operating procedures;

b) the use of small dosages;

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

d) their rational combination with others therapeutic measures.

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

-impulse currents of low frequency according to the method of electrosleep;

-central electroanalgesia by tranquilizing technique (with the help of LENAR devices);

-UHF on the collar zone; galvanic collar and bromoelectrophoresis.

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

2.5 Drinking mineral waters

Drinking mineral waters of various 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. From this it follows logically that mineral waters contribute to the stimulation of these intestinal hormones, which have a trophic effect. For the implementation of these processes, a certain time is needed - from 60 to 90 minutes, and therefore, in order to use all the healing properties inherent in mineral waters, it is advisable to prescribe them 1-1.5 hours before a meal. During this period, water can penetrate into the duodenum and have an inhibitory effect on the excited secretion of the stomach.

Warm (38-40 ° C) low-mineralized waters have a similar effect, which can relax the pylorus spasm and quickly evacuate into the duodenum. When appointed 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 effect 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 some cases for patients with duodenal ulcer with a sharp hyperacidity gastric juice and severe dyspeptic syndrome in the phase of fading exacerbation of the disease.

Patients with disorders of the motor-evacuation function of the stomach do not take mineral waters, since accepted water for a long time lingers in the stomach along with food and will have a juice effect instead of an inhibitory one.

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

2.6 Balneotherapy

External application of mineral waters in the form of baths is an active background therapy for patients with gastric ulcer. 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, sodium baths are indicated for patients with gastric ulcer, any severity of the course of the disease in the phase of fading exacerbation, incomplete and complete remission of the disease.

Radon baths are also actively used. They are available at the resorts of the gastrointestinal profile (Pyatigorsk, Essentuki, etc.). For the treatment of this category of patients, radon baths are used at low concentrations - 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. Radon baths with concentrations of 20 and 40 nCi/l are the most effective in terms of influencing trophic processes in the stomach. They are indicated at any stage of the disease, patients in the phase of fading exacerbation, incomplete and complete remission, concomitant lesions of the nervous system, blood vessels and other diseases in which radon therapy is indicated.

Patients with peptic ulcer disease with concomitant diseases of the joints of the central and peripheral nervous system, organs of the female genital area, especially in 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. In nature, pure iodine-bromine water does not exist. Artificial iodine-bromine baths are used at a temperature of 36-37 ° C for a duration of 10-15 minutes, for a course of treatment 8-10 baths, released every other day, it is advisable to alternate with applications of peloids, or physiotherapy procedures, the choice of which is determined both by the general condition of 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, recuperate; vigorous and rhythmic raises the tone, improves mood. Music will relieve irritation, nervous tension, activates thought processes and increases efficiency.

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 higher areas of being. Even more than 1000 years ago, Avicenna recommended diet, work, laughter and music as a treatment.

By physiological action melodies can be soothing, relaxing or invigorating, 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;

) a recorded musical program should 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 exercise.

.8 Mud therapy

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

Silt mud is used at temperatures 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 method of mud therapy 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 comorbidities, in which the use of physical factors on the collar region is shown.

With a sharp pain syndrome, 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) must be observed regardless of the phase of the disease.

Basic principles medical nutrition(principles of the "first tables" according to the classification of the Institute of Nutrition): 1. good nutrition; 2. observance of the rhythm of food intake; 3. mechanical; 4. chemical; 5. thermal sparing of the gastroduodenal mucosa; 6. gradual expansion of the diet.

The approach to diet therapy for peptic ulcer disease is currently marked by a move away from strict to sparing diets. Mainly mashed and non-mashed diet options No. 1 are used.

The composition of diet No. 1 includes the following products: meat (veal, beef, rabbit), fish (perch, pike, carp, etc.) in the form of steam cutlets, quenelles, soufflé, beef sausages, boiled sausage, occasionally - low-fat 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, powdered, condensed milk, fresh non-acidic cream, sour cream and cottage cheese). With good tolerance, yogurt, acidophilic milk can be recommended. Eggs and dishes from them (soft-boiled eggs, steam scrambled eggs) - no more than 2 pieces per day. Raw eggs are not recommended, as they contain avidin, which irritates the stomach lining. Fats - unsalted butter (50-70 g), olive or sunflower (30-40 g). Sauces - dairy, snacks - mild cheese, grated. Soups - vegetarian from cereals, vegetables (except cabbage), milk soups with vermicelli, noodles, pasta (well cooked). Salt food should be moderate (8-10 g of salt per day).

Fruits, berries (sweet varieties) are given in the form of mashed potatoes, jelly, with tolerance compotes and jelly, sugar, honey, jam. Non-acidic vegetable, fruit, berry juices are shown. Grapes and grape juices are not well tolerated and can cause heartburn. In case of poor tolerance, 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 meats, smoked meats, salty fish, hard-boiled eggs or scrambled eggs, skim milk, strong tea, coffee, cocoa, kvass, all alcoholic drinks, carbonated water, pepper, mustard, horseradish, onion, garlic, Bay leaf and etc.

Cranberry juice should be avoided. From drinks, weak tea, tea with milk or cream can be recommended.

.10 Phytotherapy

For most patients suffering from gastric ulcer, it is advisable to include decoctions and infusions of medicinal herbs in the complex treatment, as well as special anti-ulcer preparations consisting of many medicinal plants. Fees and folk recipes used for stomach ulcers:

Collection: Chamomile flowers - 10 gr.; fennel fruits - 10 gr.; marshmallow root - 10 gr.; wheatgrass root - 10 gr.; licorice root - 10 gr. 2 teaspoons of the mixture to 1 cup of boiling water. Insist, wrapped, 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 cup of boiling water. Insist wrapped, strain. Take 1 to 3 glasses throughout the day.

Collection: Cancer cervix, 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 in a glass of boiling water. Steam 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 in a glass of boiling water. Insist wrapped for 2 hours, strain. Take 1 tablespoon 3-4 times a day, one 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. Making juice at home and taking it: the leaves are passed through a juicer, filtered and squeezed out the juice. Take in a warm form, 1/2-1 cup 3-5 times a day before meals.

Conclusion

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

List of used literature

1.Abdurakhmanov, A.A. Peptic ulcer of the stomach and duodenum. - Tashkent, 1973. - 329 p.

2.Alabaster A.P., Butov M.A. Possibilities of alternative non-drug therapy of gastric ulcer. // Clinical Medicine, 2005. - No. 11. - S. 32 -26.

.Baranovsky A.Yu. Rehabilitation of gastroenterological patients in the work of a therapist and family doctor. - St. Petersburg: Folio, 2001. - 231 p.

.Belaya N.A. Massotherapy. Teaching aid. - M.: Progress, 2001. - 297 p.

.Biryukov A.A. Therapeutic massage: Textbook for universities. - M.: Academy, 2002. - 199 p.

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.Vasilenko V.Kh., Grebenev A.L., Sheptulin A.A. Ulcer disease. - M.: Medicine, 2000. - 294 p.

.Virsaladze K.S. Epidemiology of peptic ulcer of the stomach and duodenum // Clinical Medicine, 2000. - No. 10. - P. 33-35.

.Gaichenko P.I. Treatment of stomach ulcers. - Dushanbe: 2000. - 193 p.

10.Degtyareva I.I., Kharchenko N.V. Ulcer disease. - K .: Healthy I, 2001. - 395 p.

11.Epifanov V.A. Therapeutic Physical Culture and massage. - M.: Academy, 2004.- 389 p.

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Annex 1

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

No. section Contents Dosage, min Tasks of the section, procedures 1 Walking simple and complicated, rhythmic, at a calm pace 3-4 Gradual retraction into 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 the 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 the gymnastic wall like mixed hangs 7-8 General toning effect on the central nervous system, development of static-dynamic stability5 Elementary lying exercises for the limbs in combination with deep breathing4-5 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 in Peptic Ulcer".

Fulfilled

Student gr.XXXXXX

Checked:

Teacher

Simonova T.A.

Tula, 2006.

Ulcer disease. Facts. Manifestations.

Treatment of peptic ulcer.

Physical rehabilitation for peptic ulcer and complexes of gymnastic exercises.

List of used literature.

1) Peptic ulcer. Data. Manifestations.

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

Among the population, the spread of peptic ulcer reaches 7-10%. The ratio of stomach 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, in the etiology, as recently considered, the following main factors play a role:

1. Neuropsychic stress and physical overload.

2. Malnutrition.

3. Biological defects inherited at birth.

4. Some drugs.

5. Smoking and alcohol.

The role of hereditary predisposition is undoubted.

Duodenal ulcers occur predominantly at a young age. Gastric ulcers - in the older.

There is a violation of the secretory and motor function of the stomach. Violation 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 in the recovery period after peptic ulcer. A large role is also given to the acid factor: an increase in the secretion of hydrochloric acid, which acts aggressively 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 the normal mucosa is quite resistant to the action of damaging factors. Therefore, in the pathogenesis, it is also necessary to take into account the protective mechanisms that protect the mucosa from the formation of ulcers. Therefore, in the presence of etiological factors, an ulcer does not form in everyone.

External contributing factors:

1. Alimentary. Negative erosive effect on the mucosa and food that stimulates the active secretion of gastric juice (normally, mucosal injuries heal in 5 days). Spicy, spicy, smoked foods, fresh pastries (pies, pancakes), a large amount of food, most likely cold food, irregular meals, dry food, refined foods, coffee and various hard-to-digest foods that cause irritation of the gastric mucosa.

In general, irregular food intake (at different hours, at long intervals), disrupting the process of digestion in the stomach, can contribute to the development of peptic ulcer, since this excludes the neutralization of the acidic environment of the stomach by 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 cocaine effect.

Factors affecting pathogenesis

1. Acid - increased secretion of hydrochloric acid.

2. Reducing the intake of alkaline juice.

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

4. Disturbed composition of the mucous membrane of the epithelium of the stomach (mucoglycoproteins that promote the 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" pains are especially characteristic of duodenal ulcers. They usually disappear after taking, sometimes even a small amount of food. The intensity of pain can be different; often the pain radiates to the back, or up, to chest. In addition to pain, patients are often worried about excruciating heartburn 2-3 hours after eating, due to the throwing of acidic stomach contents into the lower esophagus. Usually heartburn 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 eating. When the ulcer is located in the duodenum, "night" pains and constipation are characteristic.

Exacerbations of ulcers and the course of the disease.

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

* Bleeding - the most frequent 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 occurs predominantly in young men. More often with peptic ulcer, so-called small bleeding occurs, massive bleeding is less common. Sometimes sudden massive bleeding is the first manifestation of the disease. Small bleeding is characterized by pallor of the skin, dizziness, weakness; with severe bleeding, melena is noted, single or repeated vomiting, vomit resembles coffee grounds;

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

* Penetrations are characterized by the penetration of an ulcer into the organs in contact with the stomach or duodenal bulb - the liver, pancreas, 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 the penetration occurred (girdle pain and vomiting with damage to the pancreas, pain in the right shoulder and in the back during penetration into the liver, etc.) join. In some cases, penetration occurs gradually;

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

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

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

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

peptic ulcer in the elderly old age occurs against the background of an increasing decrease 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 older than 60 years, gastric localization of the ulcer occurs 3 times more often than in young and middle-aged patients.

Gastric ulcers that have arisen in the elderly and senile age are of considerable size (giant ulcers are often found), a shallow bottom covered with a gray-yellow coating, fuzzy and bleeding edges, edema, and slow healing of the ulcer.

Peptic ulcer in people in the elderly and senile age often proceeds according to the type of gastritis and is characterized by short duration, mild pain syndrome, and the absence of its clear connection with food intake. Patients complain of a feeling of heaviness, fullness in the stomach, diffuse aching pain in the epigastric region without a 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 less common. Characterized by constipation, loss of appetite and weight loss. The tongue is heavily coated. The course of the disease is characterized by monotony, the absence of a clear periodicity and seasonal 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 insufficiency and pulmonary heart failure. In elderly and senile patients, there is a slowdown in the duration of ulcer scarring, and the frequency of complications increases. Bleeding occurs most frequently; perforation are much less common, and malignancy of the ulcer is much more common than in young and middle-aged people.

Some differences between gastric ulcer and duodenal ulcer.

Clinical signs

Duodenal ulcer

Over 40 years old

Male predominate

No gender differences

Night, hungry

Immediately after eating

normal, elevated

Anorexia

Body mass