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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 duodenal ulcers than stomach ones. • Type IV. High ulcers localized near the esophageal-gastric junction on the lesser curvature of the stomach. Despite the fact that they proceed as type I ulcers, they are allocated in a separate group, because they are prone to malignancy. Clinical picture • Pain in the epigastric region • With ulcers of the cardiac region and posterior wall of the stomach –appears immediately after ingestion, localized behind the sternum, may radiate to the left shoulder • With ulcers of lesser curvature, pain occurs 15-60 minutes after food • Dyspeptic symptoms - belching of air, food, nausea, heartburn, constipation • Asthenovegetative syndrome • Moderate local pain and muscle protection in the epigastric region • Laboratory tests • Analysis of peripheral blood uncomplicated course without changes • Analysis of feces for occult blood - Gregersen reaction. A positive reaction can serve as one of the indirect signs of an exacerbation of the process. Special studies • In the study of gastric secretion, normal or hypochlorhydria is common; hyperchlorhydria is rare. Analysis of gastric juice helps to differentiate benign and malignant ulcers. • Basal hydrochloric acid secretion in 1 hour: • Less than 2 mEq-norm, stomach ulcer, gastric cancer • 2-5 mEq-normal, stomach or duodenal ulcer • More than 5 mEq - usually a duodenal ulcer • Stimulated release of hydrochloric acid per hour (maximum histamine test): • 0 mEq - true achlorhydria, atrophic gastritis or gastric cancer • 1-20 mEq - normal, stomach ulcer, stomach cancer • 20-35 mEq - usually peptic ulcer • 35-60 mEq - duodenal ulcer, possible Zolling syndrome e-Ellison • More than 60 mEq - Zollinger-Ellison syndrome.
Roentgenoscopy of the upper gastrointestinal tract • Endoscopic examination - Advantages of the method: • Confirms or rejects the diagnosis • Detects a pathology of the mucous membrane of the upper digestive tract that is not available for the X-ray method • Targeted biopsy is possible • Local treatment of the ulcer defect is possible • Monitoring of mucous membrane regeneration or scar formation : exacerbation period • 1-2 weeks - diet No. 1a • 3-4 weeks - diet No. 16 • remission period - diet No. 1. Dairy products, caffeine and alcohol, smokers e have a stimulating effect on secretion and contraindication in acute cases. • Means that affect the acid-peptic factor • Antagonists of histamine H2 receptors (cimetidine, ranitidine, famotidine) reduce acidity for a long period of time and stimulate healing and reduce the frequency of relapses • Selective blockers of peripheral M1-choline receptors - gastrocepin. • Anti-Helicobacter therapy • Triple therapy • de-nol 120 mg 4 r / day for 28 days • metronidazole 200 mg 4 r / day for 10-14 days • tetracycline 500 mg 4 r / day for 10-14 days • Antacids (alfogel). Protective agents Colloidal bismuth preparations (promote healing of ulcers, inactivation of pepsin, elimination of H. pylori, but do not reduce acid production). Sucralfate has an antacid, adsorbing and enveloping effect. Misoprostol, an analogue of prostaglandin E2, is an effective treatment for peptic ulcer disease that is approved for the prevention of stomach ulcers while taking NSAIDs. • Carbenoxolone sodium - biogastron 100 mg 3 r / day for 1 week and 50 mg 3 r / day in the next 6-8 weeks; promotes the healing of peptic ulcers.
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65. DISEASES OF A ULCERAL STOMACH

  1. 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
  2. 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.
  3. 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.
  4. 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
  5. 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
  6. 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 the humoral mechanisms that regulate the secretory,
  7. 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
  8. NUTRITION FOR STOMACH ULCER DISEASES
    NUTRITION FOR ULCER DISEASES
  9. 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
  10. 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
  11. Bleeding in gastric ulcer as an example of bleeding from the upper gastrointestinal tract
    Gastric and duodenal ulcers cause about 50.% of cases of bleeding from the upper gastrointestinal tract (Table 9-2). Despite the introduction of new effective methods of treating peptic ulcer in the past 15 years, the frequency of bleeding with this pathology has not practically decreased. One of the reasons for this situation is the fact that often peptic ulcer
  12. 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
  13. Peptic ulcer
    Peptic ulcer - a chronic relapsing disease characterized by a defect in the mucous membrane and the formation of an ulcer in the stomach and / or in the duodenum. Along with peptic ulcer as an independent nosological form, it is now customary to distinguish secondary, symptomatic ulcers and gastroduodenal ulcers that occur when exposed to a known etiological
  14. Peptic ulcer
    Epidemiology Accurate epidemiological data on the incidence and prevalence of peptic ulcer are not available. According to various studies, in the USA, every 10th man and every 20th woman has a peptic ulcer throughout life. Apparently, the prevalence and frequency of the disease tend to decrease. In the past, peptic ulcer disease was more common in men than in women (4: 1).
  15. Peptic ulcer.
    Peptic ulcer is a chronic, cyclically ongoing disease, the main morphological expression of which is a chronic recurrent ulcer of the stomach or duodenum. In addition to ulcers, as manifestations of gastric and duodenal ulcers, there are so-called symptomatic ulcers, i.e. ulceration of the stomach and duodenum, which occur with
  16. Peptic ulcer
    Peptic ulcer is a group of heterogeneous diseases, the common manifestation of which is a local defect or erosion in the mucous membrane of the stomach and / or duodenum. This is a very common pathology, which, for example, in the USA, about 10% of men and 5% of women suffer throughout life. It should be borne in mind that the prevalence of gastrointestinal
  17. Peptic ulcer disease
    - a chronic disease of the stomach or duodenum, characterized by the occurrence of a peptic ulcer in the mucous membrane, proceeding cyclically and prone to progression. The main clinical manifestations of pain associated with eating and characterized by periodicity and seasonality; dyspeptic syndrome, manifested by nausea, vomiting, bringing
  18. Peptic ulcer and its features
    Statistics show that peptic ulcer disease is the most common disease of the digestive system. More often it affects men than women. Mostly people of working age fall ill. In case of improper behavior (smoking, alcohol abuse, neglect of the diet, etc.), peptic ulcer can be difficult, gives complications (bleeding, perforation
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