Stomach ulcer of 12 items of a gut
Stomach ulcer of 12 perstny guts - the disease of a duodenum of chronic recidivous character which is followed by formation of defect in her mucous membrane and the fabrics located under it. It is shown by the severe pains in the left epigastralny area arising in 3-4 hours after food, attacks of "hungry" and "night" pains, heartburn, an eructation acid frequent vomiting. The most terrible complications - bleeding, a perforation of an ulcer and its malignant regeneration.
Stomach ulcer of 12 items of a gut
Stomach ulcer of a duodenum is the chronic disease which is characterized by emergence of ulcer defects of mucous DPK. Proceeds it is long, alternating the remission periods to aggravations. Unlike erosive damages mucous, ulcers represent deeper defects getting into a submucous layer of a wall of a gut. Stomach ulcer of a duodenum occurs at 5-15 percent of citizens (the statistics fluctuates depending on the region of residence), to a bowl occurs at men. The duodenum ulcer by 4 times is more widespread, than stomach ulcer.
The modern theory of development of stomach ulcer considers a key factor in its emergence infectious damage of a stomach and duodenum Helicobacter Pylori bacteria. This bacterial culture is sowed at a bacteriological research of gastric contents at 95% of patients with an ulcer of a duodenum and at 87% of the patients having stomach ulcer of a stomach.
However infection with helikobakteriya not always leads to development of a disease, the asymptomatic carriage in most cases takes place.
The factors promoting development of stomach ulcer of a duodenum:
- alimentary violations – the improper, irregular feeding;
- frequent stresses;
- the increased secretion of gastric juice and the lowered activity of gastroprotektivny factors (gastric mukoprotein and bicarbonates);
- smoking, in particular on an empty stomach;
- long reception of the medicines having ultserogenny (yazvogeneriruyushchy) effect (most often it is medicines of group of nonsteroid resolvents – analginum, aspirin, diclofenac, etc.);
- gastrinprodutsiruyushchy tumor (gastrinoma).
The duodenum ulcers resulting from reception of medicines or accompanying a gastrinoma are symptomatic and do not enter a concept of stomach ulcer.
Classification of stomach ulcer
Stomach ulcer differs on localization:
- Stomach YaB (sebestens, subkardialny department, stomach body);
- peptic postrezektsionny ulcer of the pilorichesky channel (forward, back wall, small or big curvature);
- duodenum ulcer (bulbous and postbulbarny);
- ulcer of not specified localization.
In a clinical form distinguish sharp (for the first time revealed) and chronic stomach ulcer. On a phase allocate the periods of remission, an exacerbation (recurrence) and incomplete remission or the fading aggravation. Stomach ulcer can proceed latentno (without the expressed clinic), it is easy (with a rare recurrence), srednetyazhet (1-2 aggravations within a year) and it is heavy (with regular aggravations to 3kh and more once a year).
Directly the ulcer of a duodenum differs on a morphological picture: a sharp or chronic ulcer, small (to a polusantimetr), an average (to centimeter), large (from one to three centimeters) and huge (more than three centimeters) the size. Stages of development of an ulcer: active, cicatrizing, a "red" hem and a "white" hem. At the accompanying functional violations of gastroduodenal system also note their character: violations of motor, evakuatorny or sekretorny function.
Symptoms of stomach ulcer of a duodenum
Children and elderly people have a course of stomach ulcer sometimes almost asymptomatic or with insignificant manifestations. Such current is fraught with development of heavy complications, such as perforation of a wall of DPK with the subsequent peritonitis, the latent bleeding and anemia. The typical clinical picture of stomach ulcer of a duodenum is a characteristic pain syndrome.
Pain most often moderate, stupid. Expressiveness of pain depends on disease severity. Localization, as a rule, from an epigastriya, under a breast. Pain can sometimes be poured in the top half of a stomach. Arises often at night (at 1-2 o'clock) and after the long periods without meal when the stomach is empty. After meal, milk, antatsidny medicines there comes simplification. But most often pain renews after evacuation of contents of a stomach.
Pain can arise several times a day for several days (weeks) then independently to pass. However eventually without due therapy a recurrence becomes frequent, and intensity of a pain syndrome increases. Seasonality of a recurrence is characteristic: aggravations arise in the spring and in the fall more often.
Complications of stomach ulcer of a duodenum
The main complications of an ulcer of a duodenum are a penetration, perforation, bleeding and narrowing of a gleam of a gut. Ulcer bleeding arises when pathological process affects vessels of a gastric wall. Bleeding can be hidden and be shown only by the accruing anemia, and can be expressed, blood can be found in vomiting and be shown at defecation (black or with bloody streaks of kcal). In certain cases it is possible to make a bleeding stop during the endoscopic research when the bleeding source sometimes works well . If an ulcer deep and bleeding plentiful – appoint surgical treatment, in other cases treat conservatively, correcting zhelezodefitsit. At ulcer bleeding strict hunger, food parenteral is prescribed patients.
Perforation of an ulcer of a duodenum (as a rule, a forward wall) leads to penetration of its contents into an abdominal cavity and a peritoneum inflammation – peritonitis. At a gut wall perforation usually there is a sharp rezhushche-pricking pain in an epigastriya which quickly becomes poured, amplifies when changing position of a body, deep breath. Symptoms of irritation of a peritoneum (Shchetkin-Blyumberg) – are defined when pressing on a belly wall, and then a sharp otpuskaniye pain amplifies. Peritonitis is followed by a hyperthermia.
It is the emergency state which without due medical care leads to development of shock and death. Perforation of an ulcer is an indication to urgent surgery.
The penetration of an ulcer is the deep defect striking a gut wall with penetration into adjacent bodies (a liver or a pancreas). It is shown by intensive pain of the pricking character which can be localized in the right or left podreberye, irradiate in a back depending on a penetration location. At change of situation pain amplifies. Treatment depending on weight conservative, or – in the absence of result – quick.
The stenosis of a duodenum arises at the expressed hypostasis izjyazvlenny mucous or formation of a hem. When narrowing a gleam there is an impassability (full or partial) a duodenum. Often it is characterized by repeated vomiting. In emetic masses food eaten long before an attack is defined. Also from symptomatology weight in a stomach is characteristic (overflow), lack of a chair, an abdominal distension. Regular vomiting promotes the decrease in body weight and exchange violations connected with insufficiency of nutrients. Most often conservative treatment leads to reduction of puffiness of walls and expansion of a gleam, but at rough cicatricial changes the stenosis can gain constant character and demand surgery.
Diagnosis of stomach ulcer of a duodenum
At poll character of a pain syndrome, its communication with meals, seasonality of attacks, the accompanying symptomatology comes to light. At duodenal sounding obtain data on a condition of the DPK environment.
The most informative method of diagnostics is gastroscopy – an endoscopic research of mucous membranes of a stomach and duodenum. It gives detailed information on localization of an ulcer and its morphological features, reveals bleeding and cicatricial changes. At an endoscopic research it is possible to make a biopsy of tissues of stomach and DPK for a histologic research.
At radiological inspection with contrast substance stomach ulcer of a duodenum is shown as defect of a wall (baric mix gets into an ulcer and it is visible on the roentgenogram), the stenosis of a gut, perforation and a penetration of ulcers is found. Helikobakteriya apply PTsR-diagnostics and the ureazny respiratory test to detection of contamination. At laboratory blood test it is possible to find symptoms of anemia which speaks about existence of internal bleeding. On the hidden blood investigate also kalovy masses.
Treatment of stomach ulcer of a duodenum
Treatment of an ulcer of a duodenum is carried out strictly to destination the gastroenterologist, self-treatment is inadmissible because independent administration of drugs, promoting disposal of pain conducts to a stukhaniye of symptomatology and latent development of a disease that threatens with complications. Medicamentous therapy of stomach ulcer of a duodenum includes measures for an eradikation of Helicobacter and healing of ulcer defects (what is promoted by decrease in acidity of gastric juice).
Apply antibiotics of a broad spectrum of activity to suppression of a helikobakterny infection (metronidazole, amoxicillin, ), carry out antibiotic treatment about a current of 10-14 days. For decrease in sekretorny activity of a stomach optimum medicines are inhibitors of a proton pomp – , , , . With the same purpose apply the means blocking H2-histamine receptors mucous a stomach: ranitidine, . As the means lowering acidity of gastric contents apply antatsida. Gel antatsida with anesthetics are effective and as symptomatic medicines – relieve pain, enveloping a gut wall. Mucous apply gastroprotektivny means to protection: , bismuth medicines, .
At inefficiency of conservative treatment or in case of development of dangerous complications resort to expeditious treatment. Operation consists in excision or an ushivaniye of an ulcer of a duodenum. If necessary for decrease in secretion carry out a vagotomiya.
Prevention and forecast of stomach ulcer of a duodenum
Measures of prevention of development of stomach ulcer of a duodenum:
- timely detection and treatment of a helikobakterny infection;
- normalization of the mode and character of food;
- refusal of smoking and abuse of alcohol;
- control of the accepted medicines;
- harmonious psychological situation, avoiding of stressful situations.
Uncomplicated stomach ulcer at due treatment and observance of recommendations about a diet and a way of life has the favorable forecast, at a qualitative eradikation – healing of ulcers and treatment. Development of complications at stomach ulcer makes heavier a current and can conduct to life-endangering states.