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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. At different ages, gastroduodenal ulcer occurs in 4-5% of the population. In young people, duodenal ulcers are 4 times more likely than mediastric ulcers. In the elderly, gastric ulcers are recorded 2-3 times more often than duodenal ulcers. At a young age, peptic ulcer disease is a sad privilege of men who are sick 2-5 times more often than women. After 40 years, age differences disappear.

Often people with certain professions suffer from peptic ulcer: urban transport drivers, dispatchers, operators, workers of hot shops, teachers, creative workers, managers, surgeons.

Etiological factors:

• hereditary predisposition (peptic ulcer in blood relatives, 0 (1) blood type, deficiency of a-1 antitrypsin, a-2 macroglobulin, deficiency of fucoglycoprotein in the gastric mucus, increased mass of parietal cells, high activity of the “ulcerogenic” fraction of peptides -synogen, characteristic data of dermatoglyphics, the ability to taste phenylthiocarbamide);

• infection of the gastric mucosa and (or) the duodenum with the pyloric helicobacter;

• taking medications (non-steroidal anti-inflammatory drugs, etc.).

Risk factors: occupational hazards (noise), violation of the nutritional stereotype, smoking, physiological desynchronosis - the transition from biological summer to biological winter and vice versa, psychoemotional stress in people with low stress tolerance (increased rates on the scales of anxiety, egocentrism, claims, demonstrative ™ , vegetative provision of emotions).

In the pathogenesis of duodenal ulcers, greater importance is attached to the predominance of “aggressive” ulcerogenic factors: acid peptic (low pH values ​​of the gastric contents with a high rate of hydrochloric acid) in combination with a high activity of the pepsin-1 fraction, as well as full-duodenal dyskinesia with excessive evacuation from the stomach into the duodenum, gels for bacteriosis. The pathogenesis of gastric ulcers is dominated by “weakness” of protective and gastroprotective factors: the mucosal bicarbonate barrier of the stomach and duodenum (low protein content in the corner of water complexes in mucus, bicarbonates), poor regeneration of the epithelium, poorly developed microcirculation pools, insufficient to neutralize the acidic gastric contents the amount of bicarbonates in the duodenum 12.

The more frequent localization of gastric ulcers on the lesser curvature is explained by the weak development of the arterial network, worse microcirculation conditions.

The predominance of onion ulcers of the duodenum over extracellular ulcers is a consequence of impaired motility in the bulb, creating conditions for stagnation and poor neutralization of acidic gastric contents.

The healing of gastroduodenal ulcers passes through the mechanisms of immune inflammation with the change of cell cooperations, the production of collagen structures and their maturation.

After the healing of a chronic ulcer, an “unreliable" balance is established between the factors of aggression and defense. The failure of adaptation is due to the weakness of self-regulation at different levels: it occurs during biological desynchronosis, psychoemotional distress, etc.
Therefore, gastroduodenal ulcers are prone to recurrence.

Clinic. The leading symptom is epigastric pain. "Visceral" pain with an ulcer within the mucosa is dull, oppressive, aching; has a clear frequency (0.5-1.5 hours after eating with a stomach ulcer, 2-3 hours after eating and at night with a duodenal ulcer); localized throughout the epigastrium; there is no irradiation of pain (P.Ya. Grigoriev). Mendel's symptom is negative. There is no local muscle tension. With deep palpation, the pain is strictly local, corresponds to the projection of the ulcer on the abdominal wall. Soreness on palpation does not coincide with the subjective localization of pain. With an ulcer within the wall of the organ with a periprocess, the pain in the epigastrium is dull, gradually increasing, at the height of the pain it is acute. Frequency is poorly expressed. The stopping effect of antacids is reduced. The pain radiates to the left and upward with ulcers of the cardiac section of the stomach, to the right - with pyloric and duodenal ulcers.

Mendel's symptom is positive. With superficial palpation, local muscle tension is determined (on the left in the epigastrium - with a stomach ulcer, right - with a duodenal ulcer). With deep palpation, a clear local pain, coinciding with the subjective localization of pain. Cutaneous hyperesthesia in the zones of Za-Kharyin-Ged (points of Boas, Openkhovsky).

Other symptoms of peptic ulcer are vomiting at the height of pain, which relieves pain, without prior nausea. Constipation

The duodenal ulcer is characterized by the predominant occurrence of the disease in young men with frequent hereditary burden; seasonality of exacerbations; high level of gastric secretion; radiologically - a niche, a large layer of liquid above a barium suspension, enhanced gastric motility, hypermobility of the duodenum 12; characteristic endoscopic and morphological picture.

Gastric ulcer is characterized by a predominant occurrence at the age of over 35 with a rare hereditary burden; level of gastric secretion, close to normal; characteristic x-ray picture; typical changes in endoscopic and morphological studies.

Possibilities and limits of paraclinical methods. X-ray gives information about the topic, the depth of the ulcer, the severity of the "ulcer shaft", motor function. The resolution of the method is not higher than 60-65% for intermediate radiologists, 80-85% - for highly qualified radiologists.

Gastroduodenofibroscopy is indicated for the initial diagnosis of the disease. Hazards: the possibility of infection with hepatitis B, C, HIV; trauma of the esophagus, stomach, duodenum. Relative contraindications: arrhythmias, myocardial infarction, chronic heart failure 2B-3 tbsp., Decompensated pulmonary heart. The resolution of the method in the diagnosis of gastric and duodenal ulcers is high. The main advantage over x-ray diagnostic methods is the possibility of multiple biopsies for the differential diagnosis of the primary ulcerative form of gastric cancer and gastric ulcer. The method helps in establishing the source of gastric or duodenal bleeding.

Gastric secretion. It is desirable to determine it during gastroduodenofibroscopy (parietal pH-metry). An in-depth study of gastric secretion (basal, pentagastrin-induced maximum acid production, debit-hour of hydrochloric acid and pepsin in the basal and stimulated phase of secretion) is carried out in gastroenterological clinics to select the method of surgical intervention.
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Peptic ulcer of the stomach and duodenum (ciphers K 25; K 26)

  1. 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.
    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
    —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,
  4. 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
  5. Gastric ulcer and 12 duodenal ulcer without bleeding and perforation
    Protocol code: 06-070а Profile: pediatric Stage: hospital Purpose of stage: Eradication of H. pylori. Healing of a peptic ulcer, “stopping” (suppressing) active inflammation in the mucous membrane of the stomach and duodenum. The disappearance of pain and dyspeptic syndromes, the prevention of complications and the occurrence of relapses of the disease. Duration of treatment (days): 21 ICD code:
  6. 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
  7. 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
  8. 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
  9. 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
  10. 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.
    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
  12. 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 soldered 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
  14. 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
  15. 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; ¦
  16. 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
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