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Question 21: ULCER OF THE STOMACH AND TWELVE

—Chronic recurrent disease in which, as a result of disturbances in the nervous and humoral mechanisms that regulate secretory-trophic processes in the gastroduodenal zone, an ulcer forms in the stomach or duodenum (less often two or more ulcers).

Etiology, pathogenesis. Peptic ulcer is associated with a violation of the nervous, and then humoral mechanisms that regulate the secretory, motor functions of the stomach and duodenum, blood circulation in them, trophic mucous membranes. The formation of ulcers in the stomach or duodenum is only a consequence of disorders of the above functions.

Negative emotions, prolonged mental overstrain, pathological impulses from the affected internal organs in case of chronic appendicitis, chronic cholecystitis, gallstone disease, etc. are often the cause of the development of peptic ulcer.

Among hormonal factors, disorders of the pituitary-adrenal system and the function of sex hormones are important, as well as a violation of the production of digestive hormones (gastrin, secretin, enterogastron, cholecystokinin-pancreosimine, etc.), impaired histamine and serotonin metabolism, under the influence of which the activity of acid peptic factor. A certain role is played by hereditary constitutional factors (a hereditary predisposition occurs among patients with peptic ulcer in 15-40% of cases).

The direct formation of an ulcer occurs as a result of a disturbance in the physiological balance between “aggressive” (proteolytically active gastric juice, bile reflux) and “protective” factors (gastric and duodenal mucus, cellular regeneration, normal state of local blood flow, the protective effect of certain intestinal hormones, for example, secretin, enterogastron, as well as the alkaline reaction of saliva and pancreatic juice). In the formation of ulcers in the stomach, the decrease in the resistance of the mucous membrane and the weakening of its resistance to the damaging effects of acidic gastric juice are of the greatest importance. In the mechanism of development of ulcers in the output section of the stomach, and especially in the duodenum, on the contrary, the decisive factor is the increase in the aggressiveness of the acid-peptic factor. The formation of ulcers is preceded by ultrastructural changes and disorders in the tissue metabolism of the gastric mucosa.

Once it has arisen, the ulcer becomes a pathological focus, supporting the development and deepening of the disease as a whole and dystrophic changes in the mucous membrane of the gastroduodenal zone in particular, contributes to the chronic course of the disease, involving other organs and systems of the body in the pathological process. Predisposing factors are eating disorders, abuse of spicy, rough, irritating foods, constantly fast, hasty food, drinking strong drinks and their surrogates, smoking.

Symptoms, course. Pain, heartburn, and often vomiting of acidic gastric contents soon after eating at the height of pain are characteristic.
In the period of exacerbation, the pain is daily, it occurs on an empty stomach, after a meal it temporarily decreases or disappears and reappears (with a stomach ulcer after 0.5-1 hours, a duodenum - 1.5-2.5 hours). Often night pain. The pain is stopped by antacids, cholinergics, thermal procedures on the epigastric region. Often, duodenal ulcer is accompanied by constipation. On palpation, pain in the epigastric region is determined, sometimes some resistance of the abdominal muscles.

A coprological examination determines hidden bleeding. With the localization of an ulcer in the stomach, the acidity of the gastric juice is normal or slightly reduced, with an ulcer of the duodenum - increased. The presence of persistent histamine-resistant achlorhydria excludes peptic ulcer disease (cancer, trophic, tuberculous and other ulceration is possible).

The most reliable diagnostic method is gastroduodenoscopy, which allows you to detect an ulcer, determine its nature, and take a biopsy (for stomach ulcers).

The course is usually long with exacerbations in the spring-non-autumn period and under the influence of unfavorable factors (stressful situations, food inaccuracies, intake of strong alcoholic drinks, etc.).

The prognosis is relatively favorable, except when complications arise. Ability to work is preserved, but not all types of work associated with irregular nutrition, great emotional and physical overload are not shown.

Treatment during an exacerbation is carried out in a hospital. In the first 2-3 weeks, bed rest, then ward. The food is fractional and frequent (4-6 times a day), the diet is full, balanced, chemically and mechanically sparing (No. 1 a, 1 b, then No. 1). Prescribe antacids (almagel, magnesium oxide, calcium carbonate, etc.), enveloping, astringents (basic bismuth nitrate, 0.06% silver nitrate solution), as well as anticholinergic (atropine sulfate, etc.), antispasmodic (papaverine hydrochloride, but- Shpa, etc.) drugs or ganglion blockers. To relieve emotional stress, bromine preparations and other sedative drugs, tranquilizers are used. Prescribe vitamins (U, A, group B), methandrostenolone (0.01 g), retabolil (0.025-0.05 g im 1 time per allotment), methyl uracil (0.5-1 g), pentoxyl ( 0.25 g), biogenic stimulants (PhiBS, aloe extract, etc.), acting on metabolic and reparative processes. Physiotherapy is widely used (diathermy, UHF therapy, mud therapy, paraffin and ozocerite applications).

Prevention: compliance with hygiene standards of work, life and nutrition,

abstinence from smoking and drinking alcohol.

Patients should be under clinical supervision with active anti-relapse treatment courses (in spring, autumn).

Preventive treatment, even without severe exacerbations of the disease, should be carried out for 3-5 years
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Question 21: ULCER OF THE STOMACH AND TWELVE

  1. GASTRIC AND TWELVE ULCER DISEASES
    Since about 200 years ago, Crewellier attracted the attention of doctors to stomach ulcers, interest in this disease has been progressively increasing. Approximately the same applies to duodenal ulcer described in detail much later (Moynihan, 1913). Peptic ulcer is now understood as a common, chronic, recurring, cyclically occurring disease in which
  2. Nutrition for peptic ulcer of the stomach and duodenum
    In order to create maximum peace of the stomach and duodenum, you need to eat 5-6 times a day. Take food in small portions, slowly, without rushing. At night, it is best to slowly drink a glass of warm milk. In order to eliminate pain and neutralize the gastric juice, which irritates the gastric mucosa, you must also drink a glass of warm milk and eat
  3. Sample menu for a week with peptic ulcer of the stomach and duodenum (diet 16)
    This therapeutic nutrition is recommended for patients with peptic ulcer of the stomach and duodenum, acute gastritis and chronic gastritis with preserved secretion after cancellation of diet 1a. MONDAY First breakfast: porridge, rice, milky mucous membrane, omelette, milk. Second breakfast: milk, curd cream or yogurt cream. Lunch: oatmeal soup, boiled meat soufflé, mashed potatoes
  4. Sample menu for a week with peptic ulcer of the stomach and duodenum (diet 1a)
    MONDAY First breakfast: mucous rice porridge, scrambled eggs, milk. Second breakfast: milk. Lunch: milk oatmeal soup, boiled meat soufflé, dried fruit compote. Snack: milk, soft-boiled egg. Dinner: buckwheat porridge, milk mucous, soft-boiled egg, milk. At night: milk. TUESDAY First breakfast: milk semolina, scrambled eggs, milk. Second breakfast: milk. Lunch: rice soup
  5. Nutrition for diabetes mellitus with diseases of the gastrointestinal tract (gastritis, peptic ulcer of the stomach or duodenum)
    In the diet for diabetes with diseases of the gastrointestinal tract, it is necessary to comply with all the requirements for the nutrition of a diabetic. However, it is necessary to spare the gastric mucosa. In order to avoid its mechanical, chemical, and thermal irritation, all dishes are cooked in a boiled and steamed form. The fractional diet is 5-6 times a day. RECOMMENDED
  6. Peptic ulcer of the stomach and duodenum
    Questions for repetition: 1. Methods of examination of children with diseases of the stomach and 12 duodenal ulcer. 2. Fractional study of gastric secretion in children. Test questions: 1. Modern views on the etiopathogenesis of peptic ulcer. 2. Classification of peptic ulcer. 3. Clinical manifestations of duodenal ulcer: 3.1. pain syndrome 3.2. dyspeptic syndrome 3.3.
  7. Peptic ulcer of the stomach and duodenum (ciphers K 25; K 26)
    Definition Peptic ulcer of the stomach and (or) duodenal ulcer (essential mediogastric and duodenal ulcer) - a heterogeneous disease with a lot? actor etiology, complex pathogenesis, chronic relapsing course, morphological equivalent in the form of a mucosal and submucosal defect with an outcome in the connective tissue scar. Statistics. In different age periods
  8. Perforated ulcer of the stomach and duodenum
    Perforated (perforated) ulcer of the stomach or duodenum - the formation of an opening in the wall of the stomach or duodenum in a pre-existing ulcerative defect and the entry of gastrointestinal contents into the abdominal cavity. ETIOLOGY AND PATHOGENESIS A perforated ulcer is preceded by an exacerbation of a peptic ulcer or the development of an acute ulcer. Perforations contribute to: ¦ alcohol intake; ¦
  9. Perforated gastric or duodenal ulcer
    Perforation (perforation) is a difficult and frequent complication of peptic ulcer of the stomach or duodenum. The “perforated” peritonitis progressing at the same time proceeds so quickly that a belated or incorrect diagnosis is equivalent to a death sentence with negligible chances of salvation. Perforation of ulcers, as well as their exacerbation, is more often observed in winter and spring. Often for
  10. Perforated ulcer of the stomach and duodenum
    There are perforations of chronic and acute ulcers. By localization, ulcers of the stomach (lesser curvature, anterior and posterior walls, cardiac, pyloric) and duodenal ulcer (bulbar, postbulbar) are found. Perforation can be typical - in the free abdominal cavity or atypical - covered, in an omental bursa, in retroperitoneal fiber. D - ka: There are 3 stages during
  11. Perforated ulcer of the stomach and duodenum
    There are perforations of chronic and acute ulcers. Perforation can be typical - in the free abdominal cavity or atypical - covered, in an omental bursa, in retroperitoneal fiber. DIAGNOSTICS There are 3 stages during a perforated ulcer. · The stage of shock (the first 6 hours) is characterized by sharp pain in the epigastric region, which suddenly appeared as a “dagger strike”. Possible vomiting. Celebrate
  12. Stomach ulcer
    Peptic ulcer is a chronic recurrent disease characterized by the development of peptic ulcer of the mucous membrane of the stomach or duodenum. The prevalence of peptic ulcer in the structure of gastroenterological pathology is from 3.6 to 14.8%. Boys and girls get sick equally often, only after 14 years the number of patients among young men is greater.
  13. Stomach disease. Gastritis. Peptic ulcer. Tumors of the stomach.
    1. In acute gastritis, gastric mucosa develops 1. enterolization 2. coagulation necrosis 3. productive inflammation 4. exudative inflammation 5. proliferation of integumentary epithelium 2. Intestinal metaplasia of the epithelium can develop in chronic gastritis 1. superficial 3. atrophic 2. productive 4 Catarrhal 3. Macroscopic characteristics of acute gastric ulcer 1. edge
  14. PUNCHING GASTRIC OR TWELVE ULCER (first 6 hours after perforation)
    The choice of antimicrobial drugs. Drugs of choice: cefazolin, cefuroxime. Alternative drugs: amoxicillin / clavulanate, ampicillin / sulbactam, cefotaxime, ceftriaxone, ampicillin + gentamicin. Duration of therapy: in the absence of risk factors and manifestations of a systemic inflammatory reaction - 48-72 hours. In the presence of risk factors for infectious complications, depending on the specific
  15. 65. DISEASES OF A ULCERAL STOMACH
    Classification • Type I. Most type I ulcers occur in the body of the stomach, namely in the area called the place of least resistance, ie. transitional zone located between the body of the stomach and the antrum. • Type II. Gastric ulcers that occur along with a duodenal ulcer. • Type III. Ulcers of the pyloric canal. In their course and clinical manifestations, they are more like ulcers
  16. Bowel disease. Infectious enterocolitis (dysentery, typhoid fever, cholera). Nonspecific ulcerative colitis. Crohn's disease. Coronary bowel disease. Appendicitis. Colon cancer
    1. Macroscopic characteristics of the small intestine with cholera enteritis 1. a gray-yellow film tightly adhered to the wall 2. ulceration of the mucous membrane 3. multiple hemorrhages 4. wall sclerosis 2. Elements of the pathogenesis of typhoid fever 1. bacteremia 2. bacteriocholia 3. cerebral swelling 4. exudative inflammation 5. hypersensitivity reaction in the lymphoid apparatus 3. Modern
  17. NUTRITION FOR STOMACH ULCER DISEASES
    NUTRITION FOR ULCER DISEASES
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