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Peptic ulcer of a stomach and duodenum
The peptic ulcer of a stomach and duodenum is an illness of recurrent type which has chronic character. At the same time in a stomach and/or a duodenum ulcer defect appears. As a result, there is a considerable disturbance of balance between protective properties of a gastroduodenal zone and factors of aggression.
This illness is considered to be as the most often found defeat of bodies of a gastrointestinal tract. The statistics demonstrates that about 10% of all population suffer from a peptic ulcer. As a rule, the illness affects both young people, and people of middle age. More often the peptic ulcer is diagnosed for men. Today doctors note characteristic "rejuvenation" of an illness, and also more frequent manifestation of a severe form of an illness and lowering of efficiency of treatment.
Reasons of a peptic ulcer
As a rule, the illness develops as a result of influence on a human body of several contributing factors. As the reasons of development of this illness define errors in activity of hormonal and nervous mechanisms which regulate activity of a stomach and duodenum, and also lack of due balance between impact on the specified bodies of hydrochloric acid, enzymes, pepsins, etc. also protective factors to which bicarbonates, slime, cell regeneration belong. In particular, the peptic ulcer develops at the people having a hereditary favor to its manifestation and also at those who regularly experience emotional strain, does not follow the rules of healthy food.
The reasons of a peptic ulcer can be subdivided on contributing and implementing. The contributing reasons include a genetic factor. Some people have genetically caused increased quantity of the cells of a stomach producing hydrochloric acid. As a result, the person suffers from a hyperoxemia. Besides, there are also other genetic features which influence development of a peptic ulcer. There are also researches which demonstrate that the peptic ulcer is more characteristic of the people having the first blood group.
Important factor are certain features of a psychological state. Diseases are more subject those who suffer from disturbances of functioning of a vegetative nervous system.
Also food factor is considered. Development of a peptic ulcer can be promoted by the continuous use of spicy food, irregular food, absence in a diet of full-fledged hot dishes. But till today exact proofs of direct impact of this factor on manifestation of a peptic ulcer do not exist.
Prolonged treatment by certain medicamentous drugs can also provoke stomach ulcer. To such medicines aspirin, nonsteroid drugs treats with antiinflammatory action, synthetic adrenal hormones. Reception of these drugs can negatively affect a condition of a mucous membrane of a stomach and duodenum. Besides, they activate aggression of a gastric juice and at the same time reduce protective function. If the person has a chronic ulcer, then these means can provoke an exacerbation of an illness.
Existence of addictions can also lead to manifestations of a peptic ulcer. Hard alcoholic drinks can damage mucous, besides alcohol promotes increase of secretion in a stomach. If to take alcoholic drinks regularly and the long period, then at the person chronic gastritis can develop.
Not to exchange also smoking as nicotine, as well as alcohol, increases gastric secretion is dangerous. At the same time supply of a stomach with blood worsens. But, as well as the food factor, this reason still is not considered proved.
As the implementing reason of display of stomach ulcer and a duodenum define existence at the person of a helikobakterny infection. Infection can happen at the use of dirty food, and also owing to use of badly sterilized medical tools.
Helicobakter pylori develops tsitotoksinva – substances which damage cells mucous that as a result can become the reason of development of an erosion and a peptic ulcer of a stomach. Even if these substances are not produced by helikobakteriya, then at the person chronic gastritis develops.
Symptoms of a peptic ulcer
Generally peptic ulcer of a duodenum and stomach is shown, first of all, by pain at the top of a stomach (that is "in the pit of the stomach"). Most often pain becomes intensive when the person feels hunger, it is mainly shown between meals. Sometimes attacks of pain disturb the patient during the night period. At such attacks the person should get up to take medicine or food. In such situation help is given by those drugs which reduce secretion of hydrochloric acid in a stomach or completely neutralize it. As a rule, approximately in half an hour after acceptance of food or the specified medicines pain becomes less intensive and gradually abates. Besides, as symptoms of a peptic ulcer periodic nausea, feelings of strong overflow of a stomach and feeling of strong weight in it at once after meal can be shown. In more exceptional cases of the patient suffers from vomiting attacks after which the feeling of simplification appears. Sometimes at the person body weight owing to deterioration in appetite considerably decreases.
In general manifestation of symptoms of an illness and its overall clinical picture directly depends on that, pathological process and what stage of an illness takes place is localized where exactly.
The state at which the fresh ulcer of a duodenum or stomach is formed is considered the first stage. In this case the main symptom is display of pain in epigastric area which becomes stronger if the person is hungry, and also can be shown several hours later after the person accepted food. At this stage night pains, the expressed manifestations of a dispepsichesky syndrome (an eructation, heartburn, a lock, nausea) are shown. The patient notes morbidity at a stomach palpation.
The second stage of an illness is the period of initial epithelization of ulcer defect. Pain in epigastric area at this stage arises generally in the afternoon. After meal of people feels noticeable simplification. During this period dispepsichesky manifestations are much more less expressed.
The third stage is the period of healing of an ulcer. At this time the patient can feel pain only during manifestation of feeling of hunger, at the same time dispepsichesky manifestations are not observed.
At the fourth stage of a disease which remission is the person feels rather normally and does not state complaints. At a palpation of a stomach of morbidity it is not felt.
Complications of a peptic ulcer
There are data of specialists that complications of a peptic ulcer of a stomach and a duodenum are more often shown at males. Bleeding is considered the most often found complication of a disease. Much more often bleedings develop at people with a duodenum ulcer.
If the ulcer gradually increases, then as a result there can be an exposure of a vascular wall which is destroyed afterwards by acid. After that internal bleeding is shown. Depending on what volumes of a loss of blood, at the patient are shown certain symptoms. But the main signs of developing of bleeding is the feeling of sudden strong weakness, a syncope, display of vomiting at which the scarlet or turned blood, sharp lowering of arterial pressure is emitted. The patient at bleeding will have a liquid chair tar-like.
It is important to consider that it is possible to treat bleeding only in surgical department of a hospital. To define, the bleeding point is located where exactly, to the patient conduct gastroscopic research. At the time of carrying out gastroscopy a wound is stopped with use of specially prepared solutions. Also a vessel which bleeds it is possible to stitch the paper clips which are specially used for this purpose. Intravenously sick administer the drugs which lower a producing hydrochloric acid.
Even after the termination of bleeding some more days are shown to the patient to be in a hospital under fixed control of the doctor. If the stop of bleeding is impossible without surgery, to the patient surgical intervention which type the specialist defines in an individual order is made.
At development of stomach ulcer there is a risk of manifestation of perforation of an ulcer. Emergence of a through opening in a wall of the body affected with an ulcer is characteristic of this state which is also called a perforation of the ulcer. Owing to formation of such opening the part of contents of a duodenum or stomach appears in an abdominal cavity. As a result there is a development of peritonitis.
At such complication of an illness of the patient feels an acute pain in epigastric area. These feelings on intensity can be compared with blow of a knife in a stomach. Pain is so strong that threatens with development of a depressed case. Then there is a gradual distribution of pain to one of lateral departments of a stomach. At the same time the person owing to so strong pain turns pale, becomes covered then, at him the consciousness can grow dull. At such bad attack it is forced to remain in motionless lying situation – a so-called pose of "embryo". At it body temperature increases, dryness of language is shown.
This state is shown at the patient in three stages: initially there comes shock, the period of imaginary wellbeing then the progressing peritonitis develops follows further. One more distinctive symptom of this state is the tension of muscles of a front abdominal wall.
Perforation of an ulcer arises as a result of progressing of a peptic ulcer. More often perforation is diagnosed for men at efficient age. It is very important to hospitalize quickly the patient with such complication as without surgery the patient is threatened by death. Without operation it is impossible to cure perforation.
Also cases of the covered ruptured ulcer at which after perforation approximately in one hour the opening covers body, nearby are noted. But the opening unsteadily therefore peritonitis nevertheless develops is, as a rule, covered.
Its one complication of a peptic ulcer — an ulcer penetration. At such state there is also an emergence of an opening in a wall of a duodenum or stomach. But at the same time such opening will open not in an abdominal cavity, and in those bodies which are located nearby. Symptoms of such complication are shown at the patient depending on about what body there is a speech.
However there are also characteristic general symptoms. In particular, it is severe pain which only becomes over time more intensive and is shown already constantly. Such pain cannot be appeased drugs antacids. Increase of body temperature is characteristic. It is possible to treat this pathology only in the surgical way.
At a pyloric stenosis and a duodenum (this state is called also impassability of peloric department of a stomach) the food from a stomach gets into intestines with considerable difficulties which arise as an effect of scarring of an ulcer which developed or in initial department of a duodenum, or in final department of a stomach. If such narrowing is insignificant, then it can be expressed by manifestation of heavy feeling throughout some time after consumption of food. Periodically sick vomiting after which he notes simplification can overcome. If the stenosis develops further, then the part of food is already late in a stomach which, in turn, stretches. The person notes manifestation of a putrefactive smell from a mouth, constant desires to vomiting, strong pain in a stomach. After a while disturbance in the course of digestion progresses, and the person is considerably exhausted, his organism is dehydrated.
Diagnosis of a peptic ulcer
For establishment of the correct diagnosis the doctor has to study the anamnesis for the purpose of studying of evolution of an illness. When collecting the anamnesis it is important to consider information on whether the patient has a digestive disturbance. Sometimes the ulcer proceeds without manifestation of visible symptoms, in that case symptoms of a disease are found only when complication of an illness is shown.
In the course of establishment of the diagnosis inspection of the patient is also performed. At the same time it is considered whether the body weight of the person is reduced, whether there is pain at epigastric area.
After that various paraclinic methods of research are applied. The simplest research is X-ray inspection by means of which it is also possible to find certain complications of a disease.
But if the patient has signs of complication of a peptic ulcer, then to it make radio graphic research without contrast, a fibrogastroduodenoskopiya. To exclude cancer, the histologic analysis of samples which are selected for a biopsy is made.
Carrying out a diagnostic laparoscopy which sometimes passes into a laparotomy is sometimes reasonable. As a result, operation at which the causes of complication of an ulcer are removed can be performed.
In the course of diagnosis it is also important to define existence in an organism of a helikobakterny infection. The special blood analysis of the patient is for this purpose made. During establishment of the diagnosis it is necessary to differentiate an ulcer from other illnesses.
Treatment of a peptic ulcer
It is important that treatment of a peptic ulcer of a stomach and duodenum was made in a complex and on certain stages. At a stage of an exacerbation of a disease its therapy is without fail carried out in a hospital. Treatment begins at once after carrying out diagnosis. Initially several days of the patient has to adhere to a bed rest, strictly observe the principles of a diet. Complex therapy includes treatment by nonabsorbed antacids, anti-secretory drugs. Besides, by means of some drugs (Drotaverinum, Metoclopramidum, a papaverine a hydrochloride, domperidon is applied) hyper motor dyskinesia in a gastroduodenal zone is eliminated. If Helicobacter pylori is found in the patient, then the special ternary technique of therapy which proceeds several weeks is applied.
At the second stage periodic antirecurrent therapy is carried out, the diet is kept, treatment is made by vitamin complexes.
At the third stage it is desirable to conduct a course of a sanatorium therapy which is appointed to the patient approximately in four months after therapy in a hospital.
At treatment of a peptic ulcer it is important to adhere to some general principles which are extremely important for recovery. First of all, it is important to patient to refuse smoking completely. Such step will promote more active scarring of ulcers, will reduce quantity of aggravations. Also it is necessary to reduce the use of alcoholic beverages to a minimum. It is whenever possible recommended to refrain from use of nonsteroid antiinflammatory medicines, and also steroids. If it is impossible, then it is necessary to reduce a drug dose as much as possible.
It is necessary to adhere to the principles of dietary food. The diet at a peptic ulcer can reduce considerably frequency manifestation of attacks of illness. It is the most important not to use those products after which symptoms of a peptic ulcer become more intensive.
At treatment of a peptic ulcer rather effective impact is made by phytotherapy. Some grass broths and infusions provide reliable protection to a mucous membrane, making the knitting and enveloping impact. Besides, they eliminate pain, promote faster healing of fabrics, have antiinflammatory effect.
Making collecting herbs for treatment of a peptic ulcer, it is necessary to consider the level of acidity of the specific patient surely. In treatment of an ulcer collecting from a camomile, roots of an acorus, a glycyrrhiza, a bergenia, a mallow, fruits of fennel, plantain leaves is used. Effectively also treatment by broth of a grass of a St. John's Wort, root of a valerian, chicory, etc. Impact effective obvolakivayushche is made on a mucous membrane of a stomach and a duodenum by broth of seeds of flax. Broths of herbs need to be accepted every day several times. The general course of treatment to last not less than two months.
Medical foods at a peptic ulcer
Till today doctors claim that the healthy nutrition at a peptic ulcer promotes more active treatment. It is important that sick, especially those at whom the ulcer proceeds it is long, surely considered this moment and followed the rules of healthy food at a peptic ulcer. In view of the fact that the main damages, both in a stomach, and in a duodenum appear under the influence of hydrochloric acid, it is necessary to reduce surely in a diet quantity of products which excite secretion of a gastric juice. Whenever possible it is better not to use them at all. Dietary food has to contain without fail enough proteins, fats, vitamins. It is desirable to use those dishes which poorly stimulate secretion of a stomach. These are milk and vegetable soups, boiled fish, the meat which is previously well boiled down. Also it is recommended to include in the menu dairy products, eggs, white loaf of yesterday's pastries, porridge on milk, rather weak tea. At the same time very strongly excite secretion in a stomach alcoholic and carbonated drinks, canned food, all spicy products, strong tea and coffee, rich meat, fish, mushrooms broths. Therefore food at a peptic ulcer should not include the specified dishes and drinks. Besides, those are blown which irritate mucous mechanically, it is also undesirable to use. It is about a radish, turnip, an asparagus, bean, and also unripe fruit and fruit with too firm peel. It is also not necessary to eat dishes from products in which there is a rough connecting fabric – too sinewy meat, skin, cartilages.
Prevention of a peptic ulcer
Most often manifestation of a peptic ulcer at the person is noted in autumn or spring time. To avoid aggravations, and also to completely prevent manifestation of a peptic ulcer, it is necessary to provide surely a full-fledged dream – not less than 6-8 hours a day, not to use too often fried, smoked and fat food. At the first symptoms of a disease of a gastrointestinal tract it is necessary to pass full inspection, having visited the specialist. It is not less important to watch carefully over health of teeth, not to allow a nerve strain. The disease can provoke alcohol intake and smoking therefore it is important to get rid of such addictions in time. In general both active lifestyle and the correct attitude towards own health is important for prevention of a peptic ulcer healthy.