Peptic ulcer disease 12 duodenal ulcer - Disease of the duodenum chronic recurrent nature, accompanied by the formation of a defect in its mucosa and tissues located underneath. Manifested by severe pain in the left epigastric region, occurring 3-4 hours after a meal, attacks "hungry" and "night" pain, heartburn, belching acid, often vomiting. The most severe complications - bleeding, perforation of the ulcer and its malignant transformation.
Peptic ulcer 12P.intestine.
Helicobacter Pylori. This bacterial culture is sown with bacteriological study of gastric contents in 95% of patients with duodenal ulcer and 87% of patients with gastric ulcer.
However, H. pylori infection does not always lead to the development of the disease, in most cases, there is an asymptomatic carrier.
Factors contributing to the development of duodenal ulcer:
Duodenal ulcers resulting from medication or concomitant gastrinoma, are symptomatic and are not included in the concept of peptic ulcer.
peritonitis, occult bleeding and anemia.
The typical clinical picture of duodenal ulcer - a characteristic pain.
The pain is often mild, dull. Severity of pain depends on the severity of the disease. Localization, usually with epigastric, under the breastbone. Sometimes pain may be spilled in the upper abdomen. Often occurs at night (1-2 hours) and after long periods without meals when the stomach is empty. After a meal, milk, antacids relief occurs. But more often the pain resumes after gastric emptying. Pain can occur several times a day for several days (weeks), and then self-held. However, with the passage of time without proper treatment relapses become more frequent, and the intensity of the pain increases.
Typical seasonal recurrence: exacerbation occur more frequently in spring and autumn.
bleeding and narrowing of the intestinal lumen.
Ulcer bleeding occurs when the pathological process affects the blood vessels of the gastric wall. Bleeding can be hidden and shown only increasing anemia, and can be expressed, the blood can be found in the vomit and occur during defecation (black or streaked with bloody feces). In some cases, you can make a stop bleeding during endoscopy, when the source of bleeding is sometimes possible to cauterize. If the ulcer is deep and profuse bleeding - prescribe surgical treatment, in other cases treated conservatively correcting iron deficiency. When ulcer bleeding in patients prescribed a strict starvation, parenteral nutrition.
Perforation duodenal ulcers (usually the front wall) leads to penetration of its contents into the peritoneal cavity and peritoneal inflammation - peritonitis. When perforation of the intestinal wall normally there is a sharp cutting-stabbing epigastric pain, which quickly becomes diffuse, increases with the change, deep breathing body position. Determined symptoms of irritation of the peritoneum (Shchetkina-Bloomberg) - with pressure on the abdominal wall, and then abruptly released, the pain increases. Peritonitis is accompanied by hyperthermia.
This - the extra condition that no adequate medical treatment leads to the development of shock and death. Perforating ulcers - this reading for urgent surgery.
Penetration ulcer - a deep defect which affects the intestinal wall penetration into adjacent organs (liver and pancreas). Manifested intense stabbing pain character, which can be localized in the right or left upper quadrant, radiate to the back, depending on the location of penetration. When you change the position of the pain increases. Treatment depends on the severity of the conservative, or - in the absence of results - fast.
duodenal stenosis occurs in severe swelling or ulceration of the mucous formation of scar. When there is a narrowing of the lumen obstruction (complete or partial) of the duodenum. Often, it is characterized by repeated vomiting. The vomit is determined by food, adopted long before the attack. Also of symptoms characteristic of heaviness in the stomach (overflow), no stool, bloating. Regular vomiting helps to reduce body weight and metabolic disorders associated with deficiency of nutrients. In most cases conservative treatment is to reduce swelling and expansion of the walls of the lumen, but rough scarring stenosis may become permanent and require surgical intervention.
duodenal intubation receive status data duodenum environment.
The most informative method of diagnostics is gastroscopy - endoscopic examination of the mucous membranes of the stomach and duodenum. It gives detailed information on the localization of ulcer and its morphological characteristics, identify bleeding and scarring. If endoscopy is possible to produce a biopsy of the stomach and duodenum tissue for histological examination.
When X-ray examination with contrast medium duodenal ulcer appears as a wall defect (barium mixture penetrates into the ulcer and it can be seen on X-ray), revealed stenosis of bowel perforation and penetration of ulcers.
To detect Helicobacter infection used PCR diagnosis and urea breath test.
In a laboratory blood test can detect signs of anemia, which indicates the presence of internal bleeding. Occult blood were also examined stool.
Gastroenterologist, self-treatment is unacceptable in view of the fact that self-administration of drugs, helps get rid of the pain is stuhaniyu symptoms and the development of latent disease that threatens complications.
Drug therapy of duodenal ulcer include measures for the eradication of Helicobacter and healing ulcers (which helps decrease gastric acidity).
For suppression of H. pylori infection is used broad-spectrum antibiotics (metronidazole, amoxicillin, clarithromycin), carried out with antibiotics for 10-14 days. To reduce the secretory activity of the stomach optimal drugs are proton pump inhibitors - omeprazole, esomeprazole, lansoprazole, rabeprazole. For the same purpose use agents that block the histamine H2 receptors of the gastric mucosa: ranitidine, famotidine. As a means of lowering the acidity of gastric contents, use antacids: Maalox, Almagel, Aluminium phosphate gel, Gustav, Rennie. Gel antacids with anesthetics and effective as symptomatic drugs - relieve pain, enveloping the intestinal wall. To protect the mucous used gastroprotective agents: Venter, de-nol, Cytotec (misoprostol).
With the ineffectiveness of conservative treatment or in the case of dangerous complications resorting to surgery. Operation is excision or suturing duodenal ulcer. If necessary to reduce the secretion of conduct vagotomy.
Prevention of duodenal ulcer disease
Measures to prevent the development of duodenal ulcer:
Forecast at a peptic ulcer of the duodenum
Uncomplicated peptic ulcer disease with proper treatment and the recommendations on diet and lifestyle has a favorable prognosis, with high-quality eradication - ulcer healing and recovery. The development of complications of peptic ulcer during heavier and can lead to life-threatening.