Peptic ulcer disease occurs with destructive changes in the mucous membrane of the body when its protective function is reduced. This leads to an increase in the pathological focus and without therapy. completely destroys the gastric wall. When under action physical, bacterial or chemical irritant occurs the lumen in the wall of the stomach – a perforated ulcer develops, which can be fatal.
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Causes of perforated ulcers and risk factors
Прободение язвы желудка или duodenal ulcer – это chronic disease resulting from complications of chronic diseases of these organs. Provoking factor can be following points:
- Filling an increased volume of food of the stomach.
- Exacerbation of chronic ulcers.
- Sharp physical activity.
- Alcohol intake, fatty or spicy foods.
- Increased acidity of the stomach.
All of these causes of perforated gastric ulcer are valid if a peptic ulcer caused by a bacterium Helicobacterpylori. Although 50% is infected with this microorganism population, not all get sick. Activates pathogenic effect bacteria are any violation of the protective functions of our body. TO risk factors for peptic ulcer include:
- sleep disturbance;
- prolonged stress;
- reduced immunity;
- uncontrolled NSAIDs;
- smoking;
- alcohol consumption;
- violation of the quality of food;
- наличие гастрита или других патологий ЖTOТ;
- heredity.
Symptoms and signs of the disease
Лечение прободной язвы желудка (код по МБTO 10) зависит от стадии inflammatory process. The disease is provoked from falling into abdominal contents of the stomach. Next begins the first period development of perforated ulcers – chemical peritonitis. It lasts from 3 to 6 hours, accompanied by acute pain in the right hypochondrium or umbilical segment, later covering the entire abdomen. Have the patient increases sweating, the skin turns pale, arterial pressure decreases, breathing becomes rapid, sometimes appears vomiting, gastrointestinal bleeding.
If untreated, after 6 hours, bacterial peritonitis when sharp pains disappear. This phase rises temperature, rapid pulse, intoxication of the body increases. The patient begins to feel relief, becomes uncritical. your condition. If no assistance is provided during this period, then the patient goes to the most severe stage of the perforated ulcer.
The period of acute intoxication begins after 12 hours from onset of illness and is characterized by constant vomiting, which is quickly causes the body to dehydrate. Characteristic perforated symptoms ulcers 3 stages: the skin becomes dry, increased body temperature drops to 36 degrees, blood pressure decreases below normal, the process of urination stops, patient’s response to external stimuli is slowed down. To the patient Reached this phase, life is no longer possible to save.
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TOлассификация прободной язвы
Прободная язва duodenal ulcer и желудка classified by clinical course of disease, by localization hearth (stomach or duodenum 12) and by the pathological-anatomical featured. The disease proceeds in two forms: typical, when stomach contents enter the abdominal region and atypical when the contents get into the stuffing box or flows into the retroperitoneal fiber.
Pathological and anatomical signs of perforated ulcer:
- Perforation of acute ulcers.
- Complications of chronic gastric disease.
- Perforation during infection with parasites.
- Perforation with the defeat of the stomach tumor formation.
- Impaired blood circulation.
Diagnostics
Diagnosis begins with a thorough survey of patient complaints, studying the history of the disease, physical and laboratory studies, use of x-ray and endoscopic method. For perforated (perforative) ulcer is characterized by painful attack, therefore The first thing a doctor resorts to is a palpation examination. on the left side and x-rays. With the help of the main radiological method is determined by the presence of a through defect, air in the abdominal cavities under the diaphragm and intestinal airiness characteristic of perforated ulcers.
Additional research methods to clarify the diagnosis:
- Endoscopy. It is performed if a perforated ulcer is suspected, but X-ray examination gave a negative result.
- Electrocardiogram. It is done to assess the heart activity, scarring of the heart, determining the violation rhythm С помощью ЭTOГ исключается инфаркт миокарда.
- HaveЗИ. Confirms the presence of gas in the intestine, revealed the focus lesions of the stomach wall and the size of the perforated circumference holes.
- Blood test (general). Shows the presence of increased content leukocytes.
- Laparoscopy. Helps quantitative and qualitative analysis accumulation of effusion in the abdomen.
Лечение прободной язвы желудка и duodenal ulcer
Impact perforated ulcers are treated only with surgical intervention. Preoperative preparation for gastrectomy is to restore blood pressure and output gastric contents. The specialists take into account the onset of the attack in time, the size and localization of the ulcer, the age of the patient, the presence of other pathologies, and then the technique of the operation is determined.
Surgery for a perforated ulcer can be of two types: suturing, in which the organ is preserved during surgery and resection is a radical excision of the ulcer, which leads to the loss of a large part of the stomach, and after the patient receives a disability. Haveшивание показано при распространенном перитоните, а техника заключается в иссечении края язвы и последующем сшивании части желудка. Resection is done in the presence of large chronic ulcers, suspected oncology, purulent peritonitis. < P>
Emergency aid in case of sudden acute pain < / h2>
In case of any suspicion of a perforated ulcer attack, the patient should be given first aid, which consists of his urgent delivery to the hospital. An accurate history of the disease can be made only by a qualified doctor, and the sooner this happens, the better. Do not think that emergency care for perforated gastric ulcer is taking narcotic analgesics, since these drugs will only ease the symptoms, which will disorient the doctor and hinder the proper organization of the nursing process.
Diet after perforated ulcer surgery < / h2>
Nutrition during the recovery period after excision of a perforated ulcer plays a very important role. The diet is aimed at restoring peristaltic and secretory functions, so the diet should be complete and balanced. It should consist of daily carbohydrates (420 g), fat (100 g), proteins (100 g). You can eat salt no more than 12 g / day, and drink at least 1.5 liters / day of water. TOалорийность ежедневного меню не должна быть выше 3000 ккал.
Food after surgery should be fractional 5-6 times / day and in small portions. The break between meals should not be done for more than 4 hours. As for prohibited foods, you should not include in the diet baked pastries, coarsely ground bread and any freshly baked products. We’ll have to abandon the mushroom and meat broths, fatty meats, fried foods, smoked meats, canned and dairy products.
Prohibited products after the operation of perforated ulcer: hard-boiled eggs, corn, beans, millet, pearl barley, cabbage, radishes, spinach, cucumbers, mushrooms, seasonings, savory snacks, kvass, coffee, soda, alcohol.
What you can eat: a sample menu for the day < / h2>
Despite multiple taboos, the menu after removing a perforated ulcer can be very diverse. Immediately after surgery for 1-2 days give only water, weak tea. Gradually introduced pureed soups, cereals, vegetable purees.
If, on the 10th day after the operation, it does not feel sick, there is no pain, belching and other unpleasant symptoms, then it is allowed to use non-rubbed food. Approximate menu for the day after rehabilitation:
- Breakfast – soft-boiled egg, non-sour cottage cheese, butter sandwich, cocoa. < / li>
- Lunch – pumpkin, baked with honey. < / li>
- Snack – cracker, yogurt. < / li>
- Lunch – vegetable soup, chicken fillet, steamed. < / li>
- Snack – boiled rice, steam cutlet, milk kissel. < / li>
- Haveжин — запеченная рыба, морковное пюре.
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Possible complications of the disease and prognosis < / h2>
The most important consequence of a perforated ulcer is peritonitis. In the abdominal cavity accumulates the contents of the stomach, which has leaked out, which provokes the occurrence of pus. If the operation is not performed in time, the person will live for 2-3 days. The absence of surgical treatment of perforated ulcers – 100% death in all cases. Postoperative mortality is 5-8% of the occurrence of complications, age and the presence of concomitant pathologies of the patient.