Rehabilitation methods for peptic ulcer disease. Exercise therapy for stomach ulcers

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Treatment of peptic ulcer of the stomach and duodenum should be comprehensive. The main areas of therapy are:

Antihelicobacter therapy, because. the latest available data (Shcherbakov, Filin, 2003) indicate that with peptic ulcer of the stomach and duodenum, HP in sick children is determined in 94% of cases;

- suppression of gastric secretion and / or its neutralization in the lumen of the stomach (this disease is, according to the position adopted in gastroenterology, a classic "acid-dependent disease");

- protection of the mucous membrane from aggressive influences and stimulation of reparative processes in it;

- correction of the state of the nervous system and the mental sphere, the dysfunction of which has a significant impact on both the development of the disease and its recurrence;

– physiotherapeutic methods of treatment;

- rehabilitation.

In the section on the rehabilitation of children and adolescents with chronic gastritis (gastroduodenitis), we outlined in some detail the basic principles of the treatment of gastroduodenal diseases (see above). In the section on the medical aspects of the rehabilitation of patients with gastric and duodenal ulcers (see below), we focus doctors' attention on the most important aspects of rehabilitation programs for children and adolescents suffering from gastric and duodenal ulcers.

Dispensary observation

Patients with peptic ulcer of the stomach and duodenum are examined by a pediatrician every 3 months during 1 year of the disease and after an exacerbation, subsequently - 2 times a year. Examination by a gastroenterologist of these patients - 2 times a year, according to indications - more often. ENT doctor, dentist examine patients once a year. Psychotherapist and other specialists - according to indications.

During dynamic observation, special attention is paid to the presence or absence of manifestations of pain (duration, frequency, presence of pain on an empty stomach, night pain, "Moynigan's" rhythm of pain, connection with food intake, localization of pain), dyspeptic syndromes (decrease or increase in appetite, nausea, vomiting , belching sour, heartburn, diarrhea, constipation), general intoxication syndrome (headaches, dizziness, fatigue, lethargy, irritability).

Examination methods: blood test, urine test - 2 times a year, coprogram - 4 times a year. FGDS with biopsy, research on HP, intragastric pH-metry or fractional gastric sounding - 1 time per year. Ultrasound of the abdominal organs with the determination of the contractile function of the gallbladder - once, then according to indications.

Deregistration of patients with peptic ulcer of the stomach and duodenum is carried out with complete clinical and laboratory remission for 5 years.

Rehabilitation (medical, physical, psychological aspects)

Polyclinic stage (continuous rehabilitation)

The main tasks of medical rehabilitation of this contingent of patients:

1) ensuring the possible complete elimination of pathological changes in the state of the gastric mucosa and duodenum and thereby preventing the recurrence of the process, i.e. stable endoscopic remission and functional normalization of the stomach and duodenum;

2) prevention of combined lesions of the digestive system;

3) preventing the occurrence of complications of the underlying disease;

4) if possible, preventing disability or reducing it;

5) improving the quality of life of patients (returning the child to his usual living conditions, study, physical education and sports).

Clinical rehabilitation groups

KRG-1.2 –– patients with newly diagnosed gastric ulcer and duodenal ulcer of uncomplicated form;

KRG-2.1- Patients with a complicated form of peptic ulcer of the stomach and duodenum;

KRG-2.2- Patients with peptic ulcer of the stomach and duodenum with damage to other organs of the digestive system (dysfunction of the gallbladder and sphincter of Oddi, cholelithiasis, pancreatitis, chronic colitis).

Characterization and assessment of vital signs

Restriction Criteria vital activity child	Clinical rehabilitation groups
	KRG-1.2	KRG-2.1	KRG-2.2
Self service
Mobility (ability to move)
Communication
Ability to learn
Orientation
Controlling your behavior
A game

Medical aspect of rehabilitation

KRG-1.2

1. Gentle training mode, includes all the moments of the physiological age regimen with an extended time allotted for sleep. The sufficiency of rest and walks is strictly controlled, if necessary, an additional day off or shortened study days is introduced. Hardening without limits. The group of physical education classes is auxiliary without competition.

2. Feature of dietary nutrition. In children, ulcerative lesions are localized mainly in the duodenum and much less often in the stomach. With 1 or 2 stages of peptic ulcer, a strict diet is prescribed, which provides the most stringent mechanical and chemical sparing. So, table No. 1A is assigned at stage 1 for 7-10 days, at stage 2 - for 5-7 days. This table includes milk (if tolerated), fresh cottage cheese, jelly, jelly, mucous and pureed soups from cereals and milk, fish soufflé, salt in limited quantities.

The next stage of dietary measures is the appointment of table No. 1B: with stages 1 and 2 of PU for 14 days. Table No. 1B, in addition to table No. 1A, includes - crackers, meat, fish in the form of quenelles and soufflés, pureed cereals, soups from cereals in milk, salt in moderation. And only after 3 weeks from the start of the complex treatment of a newly diagnosed disease or its exacerbation, table No. 1 can be assigned, which includes a very large assortment of dishes, but subject to mechanical, chemical sparing.

In particular, table number 1 includes: white stale bread, dry biscuits, milk, cream, fresh cottage cheese, non-acidic sour cream, yogurt, eggs in the form of an omelet, vegetarian soups, pureed from vegetables, cereals; meat, chicken, fish - boiled or in the form of steam cutlets, doctor's sausage, cereals with milk and butter, noodles, pasta, vermicelli, vegetable puree or boiled vegetables, with the exception of sorrel and spinach, fruit and vegetable juices, sweet berries, fruits, boiled and pureed jelly, jelly, compotes. It is possible in a small amount of non-sharp varieties of cheese, low-fat ham. Salt - in the usual amount.

Table No. 1 is prescribed in the hospital and at home for 6-12 months. If the condition is satisfactory, after the specified time, "zigzags" are possible (with the expansion of nutrition and alternation with 1 table). Many authors recommend using table number 5 as well. It should be emphasized that in case of ulcer during the period of anti-relapse treatment, it is recommended to return to table No. 1.

3. Antihelicobacter therapy. If in chronic gastritis (gastroduodenitis) this type of treatment is carried out by HP-positive patients, then in the case of peptic ulcer, an algorithm for mandatory anti-Helicobacter treatment of all patients has been adopted. At the same time, preference in older children should be given to scheme 2 (standards of the Ministry of Health of the Republic of Belarus) with the inclusion of proton pump inhibitors (PPIs) - omeprazole. The Union of Pediatricians of Russia recommends the following HP eradication therapy regimens.

Triple therapy (at least 7 days): PPI or bismuth tripotassium dicitrate 2 times a day + clarithromycin 2 times a day + amoxicillin 2 times a day, or PPI 2 times a day + clarithromycin 2 times a day + metronidazole 2 times a day or nifuratel (Macmiror) 2 times a day.

Quadrotherapy (at least 7 days): PPI 2 times a day + bismuth tripotassium dicitrate 2 times a day + 2 antibiotics (or a combination of an antibiotic with nifuratel or metronidazole). Quadrotherapy is recommended for the eradication of antibiotic-resistant strains of HP when previous treatment has failed, or when pathogen susceptibility testing is not possible.

Feature of antisecretory therapy: With the ineffectiveness of eradication therapy in terms of healing of mucosal defects, frequent recurrence of the disease (3-4 times a year), complicated course of ulcerative disease, the presence of concomitant diseases requiring the use of NSAIDs, concomitant erosive and ulcerative esophagitis, maintenance therapy with antisecretory drugs is indicated (see section about gastroduodenitis) in a half dose.

Another option is “on demand” prophylactic therapy, which provides for the appearance of clinical symptoms of exacerbation (even in the absence of endoscopic signs of an ulcer), taking one of the antisecretory drugs in a full daily dose for 1-2 weeks, and then in a half dose for another 1-2 weeks.

Phytotherapy: like drug therapy, it is differentiated depending on the stage of the ulcer process. With an acute ulcer - chamomile, medicinal valerian, peppermint, common yarrow, dog rose are shown. In the stage of remission, calamus marsh, marshmallow officinalis, St. John's wort, large plantain, nettle are more appropriate. Thus, in patients with ulcerative disease, medicinal plants with anti-inflammatory, enveloping antispastic, hemostatic properties, as well as medicinal plants containing mucus and vitamins, are used.

In case of PU, the collection is effective: centaury grass (20.0), St. The decoction is taken 50-100 ml in the morning and in the evening 30-40 minutes before meals, it has a trophic, anti-inflammatory and anti-spastic effect. With neurotic reactions and long-term non-healing ulcers, a decoction of blue cyanosis is recommended, 10-20 ml 3-4 times a day between meals. With a tendency to bleeding, a collection is prescribed: chamomile (5.0), rhizome erect cinquefoil (20.0), St. John's wort (20.0). The decoction is used 10-20 ml 4-5 times a day for 40-60 minutes before meals.

Physiotherapy treatment: an alternating magnetic field (AMF) is a softly acting physical factor, which is considered one of the most effective in the treatment of chronic gastroduodenal pathology, including gastric and duodenal ulcer. The next effective method of physiotherapy is laser therapy with the impact on active points. In addition, at the stages of rehabilitation of patients with PU, pulsed low-frequency currents are widely used according to the method of electrosleep, galvanization and electrophoresis with drugs of various effects, microwave therapy of CMW or UHF, and inductothermy.

Internal use of mineral waters: for drinking treatment, mineral waters of low and medium mineralization are used. Mineral water, entering the stomach, binds hydrochloric acid, as a result of which the reaction of the gastric contents becomes closer to neutral, i.e. provides an antacid effect. In the duodenum, mineral water affects its interoreceptors, causing the so-called duodenal effect of reducing acid production. At the rehabilitation stage, mineral waters are used in the period of complete or incomplete remission. Of great importance in the effectiveness of treatment with mineral waters is their temperature. Warm water reduces the increased tone of the stomach and intestines, relieves spasm. Cold water, on the contrary, enhances the motor activity of the stomach and intestines and stimulates secretory activity. In case of ulcerative disease, it is recommended to use water at room temperature, 1-1.5 hours before meals, which enhances the duodenal effect of mineral water and, as a result, reduces acid production in the stomach. Mineral water is dosed at the rate of 3 ml per 1 kg of the required body weight. You can also use the working formula: "0" is assigned to the number of years. The resulting number indicates the amount of mineral water in ml needed by the child for 1 dose. The optimal course of treatment is 5-6 weeks, with peptic ulcer it is prolonged up to 7 weeks.

Other types of treatment: are set out in the section on the rehabilitation of children and adolescents with chronic gastritis (gastroduodenitis) (see above!).

KRG-2.1

The individual rehabilitation program is generally the same as for patients referred to in KRG-1.2.

However, additional important elements of the program should be pointed out. :

1. Optimization of the daily routine- an important condition for the successful rehabilitation of children. Due to the fact that children and adolescents with a complicated form of PU often have pronounced functional disorders of the central and autonomic nervous system, it is necessary to exclude from them activities and games that lead to overwork and overexcitation. Restrictions require watching TV shows, videos, visiting discos by schoolchildren.

The ratio of sleep and wakefulness during the day in children should approach 1:1, i.e. night sleep should be about 10 hours long and daytime sleep (1-2 hours) is obligatory or, depending on age, a quiet rest. Long walks in the fresh air are extremely important. In the presence of sleep disorders, other asthenoneurotic reactions, walks in the fresh air before going to bed, as well as taking sedative herbs (valerian or motherwort), are shown.

As herbal medicine, you can use ready-made dosage forms from herbs: sanosan (a mixture of hop cones and valerian root extract), persena (capsules containing extracts of valerian, peppermint and lemon balm), altalex (a mixture of essential oils from 12 medicinal herbs, including lemon mint). These drugs have a calming effect, relieve irritation and normalize the child's sleep.

2. Limitation of physical activity and gaming activities. Group of physical education - exercise therapy.

3. Correction of motor disorders: antispasmodics against the background of increased peristalsis of the stomach and duodenum (drotaverine, papaverine, belloid, belataminal); in the presence of pathological refluxes - prokinetics (dommperidone 10 mg 2-3 times a day or cisapride 5-10 ml 2-4 times a day).

4. Improvement of metabolic processes in the mucous membrane: B vitamins, folic acid, multivitamin complexes with microelements (unicap, supradin, oligovit). Membrane stabilizing drugs are shown.

5. Administration of cytoprotectors and mucosal protection products - licorice root syrup, biogastron, sucralfate (venter), de-nol.

6. Strengthening reparative processes in coolant with the help of vegetable oils (sea buckthorn, rosehip, combined preparation "Kyzylmay").

KRG-2.2

In addition to the above rehabilitation measures:

1. Physical education group– exercise therapy (sparing complex)

2. With concomitant damage to the hepatobiliary system- hepatoprotectors and choleretic drugs (Essentiale 1 capsule 3 times a day, methionine 10-15 mg / kg / day, riboxin 1 table 3 times a day, allochol, hymecromon 50-200 mg 2-3 times a day ; with dysfunction of the gallbladder due to hypomotor dyskinesia - prokinetics for 10-14 days, 10% solution of sorbitol, 20-30 ml 2 times a day - courses of 10-14 days).

3. With concomitant damage to the pancreas- vitamin therapy in combination with enzymes (panreatin, festal, creon in age dosages).

4. With concomitant intestinal damage- exclusion from the diet of intolerable foods, milk; sedatives of plant origin (valerian extract, motherwort); enzymes (mezim-forte, etc.); biological products (bioflor, bifidum- and lactobacterin); vitamins with minerals for 3-4 weeks 2 times a year).

The psychological aspect of rehabilitation

Methods of psychological correction

KRG 1.2 – 2.2

Methods of psychological correction are applied when necessary, taking into account the available opportunities (availability of a specialist psychologist in the rehabilitation team). At the same time, individual approaches to patients are used, as well as group psychotherapy. Preliminary psychological testing is carried out with an analysis of the personal characteristics of patients according to the developed and approved methods.

Zhernosek V.F., Vasilevsky I.V., Kozharskaya L.G., Yushko V.D., Kabanova M.V., Popova O.V., Ruban A.P., Novikova M.E.

Test

for physical rehabilitation

Physical rehabilitation for peptic ulcer of the stomach and duodenum

INTRODUCTION

The problem of diseases of the gastrointestinal tract is the most relevant at the moment. Among all diseases of organs and systems, peptic ulcer ranks second after coronary heart disease.

The purpose of the work: to study the methods of physical rehabilitation for peptic ulcer of the stomach and duodenum.

Research objectives:

.To study the main clinical data on peptic ulcer of the stomach and duodenum.

2.To study methods of physical rehabilitation for peptic ulcer of the stomach and duodenum.

At the present stage, the whole complex of rehabilitation measures gives excellent results in the recovery of patients with peptic ulcer. More and more methods are included in the rehabilitation process from oriental medicine, alternative medicine and other industries. The best effect and stable remission occurs after the use of psychoregulatory agents and elements of auto-training.

L.S. Khodasevich gives the following interpretation of peptic ulcer - this is a chronic disease characterized by dysfunction and the formation of an ulcer in the wall of the stomach or duodenum.

Research L.S. Khodasevich (2005) showed that peptic ulcer is one of the most common diseases of the digestive system. Peptic ulcer affects up to 5% of the adult population. The peak incidence is observed at the age of 40-60 years, the incidence is higher among urban residents than among rural residents. Every year, 3,000 people die from this disease and its complications. Peptic ulcer develops more often in men, mainly under the age of 50 years. S.N. Popov emphasizes that in Russia there are more than 10 million such patients with almost annual recurrence of ulcers in approximately 33% of them. Peptic ulcer occurs in people of any age, but more often in men aged 30-50 years. I.A. Kalyuzhnova claims that most often this disease affects males. Localization of the ulcer in the duodenum is typical for young people. The urban population suffers from peptic ulcer disease more often than the rural population.

L.S. Khodasevich cites the following possible complications of peptic ulcer: perforation (perforation) of the ulcer, penetration (into the pancreas, the wall of the large intestine, liver), bleeding, periulcerous gastritis, perigastritis, periulcerous duodenitis, periduodenitis; stenosis of the inlet and outlet of the stomach, stenosis and deformity of the duodenal bulb, malignancy of the stomach ulcer, combined complications.

In the complex of rehabilitation measures, according to S.N. Popov, drugs, motor regimen, exercise therapy and other physical methods of treatment, massage, therapeutic nutrition should be used first of all. Exercise therapy and massage improve or normalize neuro-trophic processes and metabolism, helping to restore the secretory, motor, absorption and excretory functions of the digestive canal.

Chapter 1. Basic clinical data on peptic ulcer of the stomach and duodenum

1 Etiology and pathogenesis of peptic ulcer of the stomach and duodenum

According to Khodasevich L.S. (2005) the term "peptic ulcer" is characterized by the formation of sites of destruction of the mucous membrane of the digestive tract. In the stomach, it is localized more often on the lesser curvature, in the duodenum - in the bulb on the back wall. HELL. Ibatov believes that factors contributing to the onset of PU are prolonged and / or repetitive emotional stress, genetic predisposition, the presence of chronic gastritis and duodenitis, contamination of Helicobacter pylori, eating disorders, smoking and drinking alcohol.

In the educational dictionary-reference book O.V. Kozyreva, A.A. Ivanov's concept of "ulcer" is characterized as a local loss of tissue on the surface of the skin or mucous membrane, the destruction of their main layer, and a wound that heals slowly and is usually infected with foreign microorganisms.

S.N. Popov believes that various lesions of the NS (acute psychotraumas, physical and especially mental overstrain, various nervous diseases) contribute to the development of PU. It should also be noted the importance of the hormonal factor, and especially histamine and serotonin, under the influence of which the activity of the acid-peptic factor increases. Of certain importance is the violation of the diet and food composition. In recent years, an increasing place is given to the infectious (viral) nature of this disease. Hereditary and constitutional factors also play a certain role in the development of PU.

L.S. Khodasevich identifies two stages in the formation of a chronic ulcer:

erosion - a superficial defect resulting from necrosis of the mucous membrane;

acute ulcer - a deeper defect that captures not only the mucous membrane, but also other membranes of the stomach wall.

S.N. Popov believes that at present the formation of a stomach ulcer or duodenal ulcer occurs as a result of changes in the ratio of local factors of "aggression" and "protection"; at the same time, there is a significant increase in “aggression” against the background of a decrease in “protection” factors. (decrease in the production of mucobacterial secretion, slowing down the processes of physiological regeneration of the surface epithelium, a decrease in blood circulation in the microcirculatory bed and nervous trophism of the mucous membrane; inhibition of the main mechanism of sanogenesis - the immune system, etc.).

L.S. Khodasevich cites the differences between the pathogenesis of gastric ulcers and pyloroduodenal ulcers.

Pathogenesis of pyloroduodenal ulcers:

dysmotility of the stomach and duodenum;

hypertonicity of the vagus nerve with an increase in the activity of the acid-peptic factor;

increased levels of pituitary adrenocorticotropic hormone and adrenal glucocorticoids;

a significant predominance of the acid-peptic factor of aggression over the factors of protection of the mucous membrane.

The pathogenesis of gastric ulcer:

suppression of the functions of the hypothalamic-pituitary system, a decrease in the tone of the vagus nerve and the activity of gastric secretion;

weakening of mucosal protective factors

1.2 Clinical picture, classification and complications of peptic ulcer of the stomach and duodenum

In the clinical picture of the disease, S.N. Popov notes the pain syndrome, which depends on the location of the ulcer, dyspeptic syndrome (nausea, vomiting, heartburn, change in appetite), which, like pain, can be rhythmic, there may be signs of gastrointestinal bleeding or a peritonitis clinic when the ulcer is perforated.

The leading feature, according to S.N. Popova and L.S. Khodasevich, is a dull, aching pain in the epigastric region, most often in the epigastric region, usually occurring 1-1.5 hours after eating with a stomach ulcer and 3 hours later with a duodenal ulcer, the pain in which is usually localized to the right of the midline of the abdomen. Sometimes there are pains on an empty stomach, as well as night pains. Gastric ulcer is usually observed in patients older than 35 years, duodenal ulcer - in young people. There is a typical seasonality of spring exacerbations

During the YaB S.N. Popov distinguishes four phases: exacerbation, fading exacerbation, incomplete remission and complete remission. The most dangerous complication of PU is perforation of the stomach wall, accompanied by acute "dagger" pain in the abdomen and signs of inflammation of the peritoneum. This requires immediate surgical intervention.

P.F. Litvitsky describes in more detail the manifestations of PU. PUD is manifested by pain in the epigastric region, dyspeptic symptoms (belching with air, food, nausea, heartburn, constipation), asthenovegetative manifestations in the form of decreased performance, weakness, tachycardia, arterial hypotension, moderate local pain and muscle protection in the epigastric region, and ulcers can debut perforation or bleeding.

DU is manifested by pain prevailing in 75% of patients, vomiting at the height of pain, bringing relief (pain reduction), indefinite dyspeptic complaints (belching, heartburn, bloating, food intolerance in 40-70%, frequent constipation), palpation is determined by pain in epigastric region, sometimes with some resistance of the abdominal muscles, asthenovegetative manifestations, and also note periods of remission and exacerbation, the latter lasting several weeks.

In the educational dictionary-reference book O.V. Kozyreva, A.A. Ivanov distinguish an ulcer:

duodenal - duodenal ulcer. It proceeds with periodic pain in the epigastric region, appearing after a long time after eating, on an empty stomach or at night. Vomiting does not occur (if stenosis has not developed), very often there is increased acidity of gastric juice, hemorrhages;

gastroduodenal - GU and duodenal ulcer;

stomach - GU;

perforated ulcer - an ulcer of the stomach and duodenum, perforated into the free abdominal cavity.

P.F. Litvitsky and Yu.S. Popova give a classification of BU:

Most type 1 ulcers occur in the body of the stomach, namely in the area called the place of least resistance, the so-called transition zone, located between the body of the stomach and the antrum. The main symptoms of an ulcer of this localization are heartburn, belching, nausea, vomiting, which brings relief, pain that occurs 10-30 minutes after eating, which can radiate to the back, left hypochondrium, left half of the chest and / or behind the sternum. Ulcer of the antrum of the stomach is typical for young people. It is manifested by "hungry" and night pains, heartburn, less often - vomiting with a strong sour smell.

Gastric ulcers that occur together with a duodenal ulcer.

Ulcers of the pyloric canal. In their course and manifestations, they are more like duodenal ulcers than stomach ulcers. The main symptoms of an ulcer are sharp pains in the epigastric region, constant or occurring randomly at any time of the day, may be accompanied by frequent severe vomiting. Such an ulcer is fraught with all sorts of complications, primarily pyloric stenosis. Often, with such an ulcer, doctors are forced to resort to surgical intervention;

High ulcers (subcardial region), localized near the esophageal-gastric junction on the lesser curvature of the stomach. It is more common in older people over 50 years of age. The main symptom of such an ulcer is pain that occurs immediately after eating in the area of ​​​​the xiphoid process (under the ribs, where the sternum ends). Complications characteristic of such an ulcer are ulcerative bleeding and penetration. Often in its treatment it is necessary to resort to surgical intervention;

Duodenal ulcer. In 90% of cases, duodenal ulcer is localized in the bulb (thickening in its upper part). The main symptoms are heartburn, "hungry" and night pains, most often in the right side of the abdomen.

S.N. Popov also classifies ulcers by type (single and multiple), by etiology (associated with Helicobacter pylori and not associated with H.R.), by clinical course (typical, atypical (with atypical pain syndrome, painless, but with other clinical manifestations, asymptomatic)), by the level of gastric secretion (with increased secretion, with normal secretion and with reduced secretion), by the nature of the course (for the first time detected PU, recurrent course), by the stage of the disease (exacerbation or remission), by the presence of complications (bleeding , perforation, stenosis, malignancy).

The clinical course of PU, explains S.N. Popov, may be complicated by bleeding, perforation of an ulcer into the abdominal cavity, narrowing of the pylorus. With a long course, cancerous degeneration of the ulcer may occur. In 24-28% of patients, ulcers can proceed atypically - without pain or with pain resembling another disease (angina pectoris, osteochondrosis, etc.), and is detected by chance. PU can also be accompanied by gastric and intestinal dyspepsia, asthenoneurotic syndrome.

Yu.S. Popova describes in more detail the possible complications of peptic ulcer:

Perforation (perforation) of an ulcer, that is, the formation of a through wound in the wall of the stomach (or 12 PC), through which undigested food, together with acidic gastric juice, enters the abdominal cavity. Often the perforation of the ulcer occurs as a result of drinking alcohol, overeating or physical overexertion.

Penetration is a violation of the integrity of the stomach, when the gastric contents spill into the nearby pancreas, omentum, intestinal loops or other organs. This happens when, as a result of inflammation, the wall of the stomach or duodenum fuses with the surrounding organs (adhesions form). Attacks of pain are very strong and are not removed with the help of medications. Treatment requires surgery.

Bleeding may occur during an exacerbation of the ulcer. It may be the beginning of an exacerbation or open at a time when other symptoms of an ulcer (pain, heartburn, etc.) have already appeared. It is important to note that ulcer bleeding can occur both in the presence of a severe, deep, advanced ulcer, and in a fresh, small ulcer. The main symptoms of bleeding ulcers are black stools and coffee grounds-colored vomit (or vomit of blood).

In case of emergency, when the patient's condition becomes dangerous, with ulcerative bleeding, surgical intervention is undertaken (a bleeding wound is sutured). Often, ulcer bleeding is treated with medication.

A subdiaphragmatic abscess is a collection of pus between the diaphragm and adjacent organs. This complication of PU is very rare. It develops during the period of exacerbation of PU as a result of perforation of the ulcer or the spread of infection through the lymphatic system of the stomach or duodenum.

Obstruction of the pyloric part of the stomach (pyloric stenosis) is an anatomical distortion and narrowing of the sphincter lumen resulting from scarring of the ulcer of the pyloric canal or the initial part of the duodenum. This phenomenon leads to difficulty or complete cessation of the evacuation of food from the stomach. Pyloric stenosis and related disorders of the digestive process lead to disorders of all types of metabolism, which leads to depletion of the body. The main method of treatment is surgery.

peptic ulcer rehabilitation

1.3 Diagnosis of peptic ulcer of the stomach and duodenum

The diagnosis of PU is made to patients most often during the period of exacerbation, says Yu.S. Popova. The first and main symptom of an ulcer is severe spasmodic pain in the upper abdomen, in the epigastric region (above the navel, at the junction of the costal arches and the sternum). Pain with an ulcer - the so-called hungry, tormenting the patient on an empty stomach or at night. In some cases, pain may occur 30-40 minutes after eating. In addition to pain, there are other symptoms of an exacerbation of peptic ulcer. These are heartburn, sour belching, vomiting (appears without prior nausea and brings temporary relief), increased appetite, general weakness, fatigue, mental imbalance. It is also important to note that during an exacerbation of peptic ulcer, as a rule, the patient suffers from constipation.

The methods used by modern medicine to diagnose ulcers largely coincide with the methods for diagnosing chronic gastritis. X-ray and fibrogastroscopic studies determine the anatomical changes in the organ, and also answer the question of which functions of the stomach are impaired.

Yu.S. Popova offers the first, simplest methods for examining a patient with a suspected ulcer - these are laboratory tests of blood and feces. A moderate decrease in the level of hemoglobin and erythrocytes in a clinical blood test reveals hidden bleeding. Fecal analysis "Stool occult blood test" should reveal the presence of blood in it (from a bleeding ulcer).

Gastric acidity in PU is usually increased. In this regard, an important method for diagnosing PU is the study of the acidity of gastric juice by Ph-metry, as well as by measuring the amount of hydrochloric acid in portions of gastric contents (gastric contents are obtained by probing).

The main method for diagnosing stomach ulcers is FGS. With the help of FGS, the doctor can not only verify the presence of an ulcer in the patient's stomach, but also see how large it is, in which particular section of the stomach it is located, whether it is a fresh or healing ulcer, whether it bleeds or not. In addition, FGS allows diagnosing how well the stomach works, as well as taking a microscopic piece of the gastric mucosa affected by an ulcer for analysis (the latter allows, in particular, to establish whether the patient is affected by H.P.).

Gastroscopy, as the most accurate research method, allows you to establish not only the presence of an ulcer, but also its size, and also helps to distinguish an ulcer from cancer, to notice its degeneration into a tumor.

Yu.S. Popova emphasizes that fluoroscopic examination of the stomach allows not only diagnosing the presence of an ulcer in the stomach, but also assessing its motor and excretory functions. Data on the violation of the motor abilities of the stomach can also be considered indirect signs of an ulcer. So, if there is an ulcer located in the upper parts of the stomach, there is an accelerated evacuation of food from the stomach. If the ulcer is located low enough, food, on the contrary, lingers in the stomach longer.

4 Treatment and prevention of peptic ulcer of the stomach and duodenum

In the complex of rehabilitation measures, according to S.N. Popov, drugs, motor regimen, exercise therapy and other physical methods of treatment, massage, therapeutic nutrition should be used first of all. Exercise therapy and massage improve or normalize neuro-trophic processes and metabolism, helping to restore the secretory, motor, absorption and excretory functions of the digestive canal.

The causes, signs, methods of diagnosis and possible complications of PU are somewhat different, depending on which particular section of the stomach or duodenum the exacerbation is localized, explains O.V. Kozyrev.

According to N.P. Petrushkina, the treatment of the disease should begin with a rational diet, diet and psychotherapy (to eliminate adverse pathogenetic factors). In the acute period, with severe pain syndrome, drug treatment is recommended.

4.1 Medical treatment

Popova Yu.S. emphasizes that the treatment is always prescribed by the doctor individually, taking into account many important factors. These include the characteristics of the patient's body (age, general health, the presence of allergies, concomitant diseases), and the characteristics of the course of the disease itself (in which part of the stomach the ulcer is located, what it looks like, how long the patient has been suffering from PUD).

In any case, the treatment of ulcers will always be complex, Yu.S. Popova. Since the causes of the disease are malnutrition, infection of the stomach with a specific bacterium, and stress, the correct treatment should be aimed at neutralizing each of these factors.

The use of medications for exacerbation of peptic ulcer is necessary. Medicines that help reduce the acidity of gastric juice, protect the mucous membrane from the negative effects of acid (antacids), restore normal motility of the stomach and duodenum, are combined with medicines that stimulate the healing of ulcers and restore the mucous membrane. For severe pain, antispasmodics are used. In the presence of psychological disorders, stress, sedatives are prescribed.

4.2 Diet therapy

Yu.S. Popova explains that therapeutic nutrition for PU should provide the gastric mucosa and duodenum with maximum rest, it is important to exclude mechanical and thermal damage to the gastric mucosa. All food is pureed, the temperature of which is from 15 to 55 degrees. In addition, during an exacerbation of PU, the use of products that provoke an increased secretion of gastric juice is unacceptable. Fractional nutrition - every 3-4 hours, in small portions. The diet should be complete, focus on vitamins A, B and C. The total amount of fat should not be more than 100-110 g per day.

4.3 Physiotherapy

According to G.N. Ponomarenko, physiotherapy is prescribed to reduce pain and provide an antispastic effect, stop the inflammatory process, stimulate regenerative processes, regulate the motor function of the gastrointestinal tract, and increase immunity. Local air cryotherapy is used, influencing cold air on the back, abdomen for about 25-30 minutes; pelotherapy in the form of mud applications on the anterior abdominal cavity; radon and carbonic baths; magnetotherapy, which affects the immune processes positively. Contraindications to physiotherapy are severe ulcerative disease, bleeding, individual intolerance to physiotherapy methods, gastric polyposis, ulcer malignancy, and general contraindications for physiotherapy.

1.4.4 Phytotherapy

N.P. Petrushkina explains that phytotherapy is added to complex treatment later. In the process of phytotherapy of GU and DPC, with an increase in the activity of the acid-peptic factor, neutralizing, protecting and regenerating groups of drugs are used. With a long-term ulcerative defect, antiulcer, herbal preparations are used (sea buckthorn oil, rosehip oil, carbenoxolone, alanton). However, it is better to add to the treatment complex with the collection of herbs, phyto-diet.

In case of YABZH with increased secretory activity of the stomach, it is recommended to collect medicinal herbs: plantain leaves, chamomile flowers, cudweed grass, rose hips, yarrow grass, licorice roots.

For the treatment of GU and DPC, the author also suggests such herbal preparations as: fennel fruits, marshmallow root, licorice, chamomile flowers; herb celandine, yarrow, St. John's wort and chamomile flowers. The infusion is usually taken before meals, at night, or to relieve heartburn.

4.5 Massage

Of the means of exercise therapy for diseases of the abdominal organs, massage is indicated - therapeutic (and its varieties - reflex-segmental, vibrational), says V.A. Epifanov. Massage in the complex treatment of chronic diseases of the gastrointestinal tract is prescribed to have a normalizing effect on the neuroregulatory apparatus of the abdominal organs in order to help improve the function of the smooth muscles of the intestines and stomach, and strengthen the abdominal muscles.

According to V.A. Epifanov, during the massage procedure, one should act on the paravertebral (Th-XI - Th-V and C-IV - C-III) and reflexogenic zones of the back, the region of the cervical sympathetic nodes, and the stomach.

Massage is contraindicated in the acute stage of diseases of the internal organs, in diseases of the digestive system with a tendency to bleeding, tuberculous lesions, neoplasms of the abdominal organs, acute and subacute inflammatory processes of the female genital organs, pregnancy.

4.6 Prevention

For the prevention of exacerbations of PU, S.N. Popov offers two types of therapy (maintenance therapy: half-dose antisecretory drugs; prophylactic therapy: when symptoms of exacerbation of PU appear, antisecretory drugs are used for 2-3 days. The therapy is stopped when the symptoms completely disappear) with patients observing the general and motor regimens, and also a healthy lifestyle. A very effective means of primary and secondary prevention of PU is sanatorium treatment.

For the prevention of the disease, Yu.S. Popova recommends following the rules:

sleep 6-8 hours;

refuse fatty, smoked, fried foods;

during pain in the stomach, it is necessary to be examined by a specialist doctor;

take mashed, easily digestible food 5-6 times a day: cereals, kissels, steam cutlets, sea fish, vegetables, scrambled eggs;

treat bad teeth in order to chew food well;

avoid scandals, because after a nervous strain, pain in the stomach intensifies;

do not eat very hot or very cold food, as this can contribute to esophageal cancer;

do not smoke or abuse alcohol.

To prevent gastric and duodenal ulcers, it is important to be able to cope with stress and maintain your mental health.

CHAPTER 2. Methods of physical rehabilitation for peptic ulcer of the stomach and duodenum

1 Physical rehabilitation at the inpatient stage of treatment

Hospitalizations are subject, according to A.D. Ibatova, patients with newly diagnosed PU, with exacerbation of PU and in the event of complications (bleeding, perforation, penetration, pyloric stenosis, malignancy). Given that the traditional means of treating PU are warmth, rest and diet.

At the stationary stage, half-bed or bed rest is prescribed, respectively (with severe pain syndrome). Diet - table No. 1a, 1b, 1 according to Pevzner - provides mechanical, chemical and thermal sparing of the stomach [Appendix B]. Eradication therapy is carried out (if Helicobacter pylori is detected): antibiotic therapy, antisecretory therapy, agents that normalize gastric and duodenal motility. Physiotherapy includes electrosleep, sinusoidal-modeled currents on the stomach area, UHF therapy, ultrasound on the epigastric area, novocaine electrophoresis. With a stomach ulcer, oncological alertness is necessary. If malignancy is suspected, physiotherapy is contraindicated. Exercise therapy is limited to UGG and LH in a gentle mode.

V.A. Epifanov claims that LH is used after the acute period of the disease. Exercises should be done carefully if they aggravate the pain. Complaints often do not reflect the objective state, an ulcer can progress even with subjective well-being (disappearance of pain, etc.). You should spare the abdominal area and very carefully, gradually increase the load on the abdominal muscles. It is possible to gradually expand the patient's motor mode by increasing the total load when performing most exercises, including diaphragmatic breathing, for the abdominal muscles.

According to I.V. Milyukova, during exacerbations, frequent changes in rhythm, a fast pace of even simple exercises, muscle tension can cause or aggravate pain and worsen the general condition. During this period, monotonous exercises are used, performed at a slow pace, mainly in the lying position. In the remission phase, exercises are performed in the IP standing, sitting and lying down; the amplitude of movements increases, you can use exercises with shells (weighing up to 1.5 kg).

When transferring a patient to a ward regimen, A.D. Ibatov, rehabilitation of the second period is assigned. The tasks of the first are added to the tasks of household and labor rehabilitation of the patient, restoring the correct posture when walking, improving coordination of movements. The second period of classes begins with a significant improvement in the patient's condition. UGG, LH, abdominal wall massage are recommended. Exercises are performed in the prone position, sitting, kneeling, standing with gradually increasing effort for all muscle groups, still excluding the abdominal muscles. The most acceptable is the supine position: it allows you to increase the mobility of the diaphragm, has a gentle effect on the abdominal muscles and improves blood circulation in the abdominal cavity. Patients perform exercises for the abdominal muscles without tension, with a small number of repetitions. After the disappearance of pain and other signs of exacerbation, in the absence of complaints and in general satisfactory condition, a free regimen is prescribed, emphasizes V.A. Epifanov. In LH classes, exercises are used for all muscle groups (sparing the abdominal area and excluding sudden movements) with increasing effort from various IPs. They include exercises with dumbbells (0.5-2 kg), stuffed balls (up to 2 kg), exercises on the gymnastic wall and bench. Diaphragmatic breathing of maximum depth. Walking up to 2-3 km per day; walking up stairs up to 4-6 floors, outdoor walks are desirable. The duration of the LH class is 20-25 minutes.

2 Physical rehabilitation at the outpatient stage of treatment

At the polyclinic stage, patients are monitored according to the third group of dispensary registration. With YABZh, patients are examined from 2 to 4 times a year by a general practitioner, gastroenterologist, surgeon, and oncologist. Annually, as well as during exacerbation, gastroscopy and biopsy are performed; fluoroscopy - according to indications, clinical blood test - 2-3 times a year, analysis of gastric juice - 1 time in 2 years; analysis of feces for occult blood, examination of the biliary system - according to indications. During examinations, the diet is corrected, if necessary, anti-relapse therapy is carried out, rational employment and indications for referral to sanatorium treatment are determined. With PUD, the patient is invited for periodic examinations 2-4 times a year, depending on the frequency of exacerbations. In addition, patients undergo oral cavity sanitation, dental prosthetics. Physiotherapeutic procedures include: electrosleep, microwave therapy on the stomach area, UHF therapy, ultrasound.

3 Physical rehabilitation at the sanatorium stage of treatment

An indication for spa treatment is gastric ulcer and duodenal ulcer in remission, incomplete remission or fading exacerbation, if there is no motor insufficiency of the stomach, a tendency to bleeding, penetration and suspicion of the possibility of malignant degeneration. Patients are sent to local specialized sanatoriums, gastroenterological resorts with mineral drinking water (to the Caucasus, Udmurtia, Nizhneivkino, etc.) and mud resorts. Sanatorium-resort treatment includes therapeutic nutrition according to the diet table No. 1 with the transition to tables No. 2 and No. 5 [Appendix B]. Treatment is carried out with mineral waters taken warm in portions of 50-100 ml 3 times a day, with a total volume of up to 200 ml. The time of admission is determined by the state of the secretory function of the stomach. They accept non-carbonated low- and medium-mineralized mineral waters, mostly alkaline: "Borjomi", "Smirnovskaya", "Essentuki" No. 4. With preserved and increased secretion, water is taken 1-1.5 hours before meals. Balneological procedures include sodium chloride, radon, coniferous, pearl baths (every other day), thermotherapy: mud and ozocerite applications, mud electrophoresis. In addition, sinusoidally simulated currents, CMW therapy, UHF therapy, and diadynamic currents are prescribed. Exercise therapy is carried out according to a gentle tonic regimen using UGG, sedentary games, dosed walking, swimming in open water. A therapeutic massage is also used: behind - segmental massage in the back from C-IV to D-IX on the left, in front - in the epigastric region, the location of the costal arches. Massage should be gentle at first. The intensity of the massage and the duration of the procedure gradually increase from 8-10 to 20-25 minutes by the end of the treatment.

Patients are treated during the period of remission, the volume and intensity of PH training increases: they widely use OUU, DU, coordination exercises, allow outdoor and some sports games (badminton, table tennis,), relay races. Health paths are recommended, walks in winter - skiing (the route should exclude ascents and descents with a steepness exceeding 15-20 degrees, the walking style is alternate). There are no power, speed-strength exercises, static efforts and tensions, jumps and hops, exercises at a fast pace in the LH procedure. IP sitting and lying down.

CONCLUSION

PU takes the second place in the incidence of the population after coronary artery disease. Many cases of gastric and duodenal ulcers, gastritis, duodenitis, and possibly some cases of gastric cancer are etiologically associated with Helicobacter pylori infection. However, the majority (up to 90%) of infected carriers of H.P. no symptoms of disease are found. This gives reason to believe that PU is a neurogenic disease that has developed against the background of prolonged psycho-emotional overstrain. Statistics show that urban residents are more prone to PU than rural residents. A less significant factor in the occurrence of PU is malnutrition. I think everyone will agree with me that against the backdrop of stress, emotional overload in work and life, people often, without noticing it, tend to tasty, not healthy food, and someone abuses tobacco products and alcohol. In my opinion, if the situation in the country had not been tense, as it is at the moment, then the incidence would be clearly lower. During the Great Patriotic War, soldiers were subject to various diseases of the gastrointestinal tract from martial law in the country, from malnutrition and tobacco abuse. The soldiers were also subject to hospitalization and rehabilitation. Seventy years later, the factors for the occurrence of PU have remained the same.

For the treatment of peptic ulcer, first of all, drug therapy is used to suppress the infectious factor (antibiotics), to stop bleeding (if necessary), therapeutic nutrition, to prevent complications, a motor mode is used with the use of physical means of rehabilitation: UGG, LH, DU, relaxation exercises, which are special, and other forms of conducting classes. Physiotherapeutic procedures are also prescribed (electrosleep, novocaine electrophoresis, etc.). It is very important that during the rehabilitation period the patient be at rest, if possible, ensure silence, limit TV viewing to 1.5-2 hours a day, walk in the open air 2-3 km per day.

After the relapse stage, the patient is transferred to a gastroenterologist's clinic, followed up for 6 years, with periodic treatments in sanatoriums or resorts to ensure stable remission. In the sanatorium, patients are treated with mineral waters, various types of massage, skiing, cycling, swimming in open water, games.

Physical rehabilitation for any disease plays an important role for the full recovery of a person after an illness. This allows you to save a person's life, teach him to cope with stress, teach and educate him in a conscious attitude in doing physical exercises in order to maintain his health, instill a stereotype about a healthy lifestyle, which helps a person not to be ill again in the future.

LIST OF ABBREVIATIONS

N.R. - Helicobacter pylori (Helicobacter pylori)

UHF - decimeter wave (therapy)

duodenum - duodenum

DU - breathing exercises

GIT - gastrointestinal tract

IHD - ischemic heart disease

IP - starting position

LG - therapeutic gymnastics

Exercise therapy - therapeutic physical culture

NS - nervous system

ORU - general developmental exercises

OUU - general strengthening exercises

SMW - centimeter wave (therapy)

ESR - erythrocyte sedimentation rate

FGS - fibrogastroscopy

UHF - ultrahigh frequency (therapy)

UGG - morning hygienic gymnastics

HR - heart rate

ECG - electrocardiography

PU - peptic ulcer

DU - duodenal ulcer

REFERENCES

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Epifanov, V.A. Therapeutic physical culture: textbook. allowance for medical universities / V.A. Epifanov. - M. : GEOTAR-Media, 2006. - 567 p.

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Ibatov, A.D. Fundamentals of rehabilitation: textbook. allowance / A.D. Ibatov, S.V. Pushkin. - M. : GEOTAR-Media, 2007. - 153 p.

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Milyukova, I.V. Big encyclopedia of health gymnastics / I.V. Milyukova, T.A. Evdokimova; under total ed. T.A. Evdokimova. - M.: AST; SPb. : Owl:, 2007. - 991 p. : ill.

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Popova, Yu.S. Diseases of the stomach and intestines: diagnosis, treatment, prevention / Yu.S. Popov. - St. Petersburg. : Krylov, 2008. - 318 p.

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Private pathology: textbook. allowance / under total. ed. S.N. Popov. - M.: Academy, 2004. - 255 p.

APPS

Annex A

Outline of therapeutic exercises for peptic ulcer of the stomach and duodenum

Date: 11/11/11

Observed: Full name., 32 years old

Diagnosis: duodenal ulcer, gastroduodenitis, superficial gastritis;

Stage of the disease: relapse, subacute (fading exacerbation)

Motor mode: extended bed rest

Venue: ward

Method of carrying out: individual

Lesson duration: 12 minutes

Lesson objectives:

.contribute to the regulation of nervous processes in the cerebral cortex, increase the psycho-emotional state;

2.contribute to the improvement of the functions of digestion, redox processes, regeneration of the mucous membrane, improvement of the functions of respiration and blood circulation;

.to ensure the prevention of complications and congestion, to improve overall physical performance;

.continue learning diaphragmatic breathing, relaxation exercises, auto-training elements;

.to cultivate a conscious attitude to the implementation of special physical exercises at home in order to prevent the recurrence of the disease and prolong the period of remission.

Application

Parts of the lessonParticular tasksContent of the lessonDosageOrganization-method. instructionsIntroductory preparation of the body for the upcoming load t \u003d 3 "Checking heart rate and respiratory rate 1) PI lying on your back. Measuring heart rate and respiratory rate for 15"" respiratory rate for 30"" Show the measurement areaTrain diaphragmatic breathing1) IP lying on your back, arms along the body, legs bent in the knees Diaphragmatic breathing: 1. inhale - the abdominal wall rises, 2. exhale - retracts 6-8 times Slow pace Imagine how the air comes out of the lungs Improve peripheral blood circulation 2) IP lying on the back, arms along the body Simultaneous flexion and extension of the feet and hands in a fist 8-10 times Average pace Breathing is voluntary Stimulate blood circulation in the lower extremities 3) IP lying on the back Alternate bending of the legs without taking the feet off the bed 1. exhale - flexion, 2. inhale - extension 5-7 times Slow pace Stimulate blood circulation in the upper limbs arms along the body 1. inhale - spread your arms to the sides, 2. exhale - return to IP 6-8 times. The pace is slow. 1. spread your knees to the sides, connecting the soles, 2. return to PI 8-10 times. The pace is slow. Do not hold your breath. Improve blood circulation in the internal organs. 6) IP sitting on the bed, legs lowered, hands on the belt. 1. exhale - turn the body to the right, arms to the sides, 2. inhale - return to the PI, 3. exhale - turn the body to the left, arms to the sides, 4. inhale - return to the PI 3-4 times The pace is slow The amplitude is incomplete Spare the epigastric region Strengthen the muscles of the pelvic bottom and improve emptying function7) PI lying on the back. Slowly bend your legs and put your feet to the buttocks, leaning on your elbows and feet 1. raise the pelvis 2. return to SP 2-3 times The pace is slow Do not hold your breath. load reduction, restoration of heart rate and respiratory rate t \u003d 3 "General relaxation 8) IP lying on your back. Relax all muscles 1" - rest Eyes close Switching on auto-training elements Checking heart rate and respiratory rate 1) IP lying on your back. Measurement of heart rate and HRHR for 15"" RR for 30""Ask the patient about his state of health Give recommendations on self-execution of FU at home

Diet tables according to Pevzner

Table number 1. Indications: peptic ulcer of the stomach and duodenum in the stage of subsiding exacerbation and in remission, chronic gastritis with preserved and increased secretion in the stage of subsiding exacerbation, acute gastritis in the subsiding stage. Characteristics: physiological content of proteins, fats and carbohydrates, salt restriction, moderate restriction of mechanical and chemical irritants of the mucous membrane and the gastrointestinal tract receptor apparatus, stimulants of gastric secretion, substances that linger in the stomach for a long time. Culinary processing: all dishes are cooked in boiled, mashed or steamed form, individual dishes are allowed in baked form. Energy value: 2,600-2,800 kcal (10,886-11,723 kJ). Composition: proteins 90-100 g, fats 90 g (of which 25 g of plant origin), carbohydrates 300-400 g, free liquid 1.5 l, sodium chloride 6-8 g. Daily ration weight 2.5-3 kg. Diet - fractional (5-6 times a day). Temperature of hot dishes - 57-62 °С, cold - not lower than 15 °С.

Table number 1a. Indications: exacerbation of peptic ulcer of the stomach and duodenum in the first 10-14 days, acute gastritis in the first days of the disease, exacerbation of chronic gastritis (with preserved and increased acidity) in the first days of the disease. Characteristics: the physiological content of proteins and fats, the restriction of carbohydrates, a sharp restriction of chemical and mechanical stimuli of the mucous membrane and the receptor apparatus of the gastrointestinal tract. Culinary processing: all products are boiled, rubbed or steamed, dishes of liquid or mushy consistency. Energy value: 1,800 kcal (7,536 kJ). Composition: proteins 80 g, fats 80 g (of which 15-20 g are vegetable), carbohydrates 200 g, free liquid 1.5 l, common salt 6-8 g. Daily ration weight - 2-2.5 kg. Diet - fractional (6-7 times a day). The temperature of hot dishes - 57-62 ° C, cold - not lower than 15 ° C.

Table number 1b. Indications: exacerbation of peptic ulcer of the stomach and duodenum in the next 10-14 days, acute gastritis and exacerbation of chronic gastritis in the following days. Characteristics: the physiological content of proteins, fats and restriction of carbohydrates, chemical and mechanical irritants of the mucous membrane and the receptor apparatus of the gastrointestinal tract are significantly limited. Culinary processing: all dishes are cooked boiled or steamed, the consistency of the dishes is liquid or mushy. Energy value: 2,600 kcal (10,886 kJ). Composition: proteins 90 g, fats 90 g (of which 25 g vegetable fat), carbohydrates 300 g, free liquid 1.5 l, table salt 6-8 g. Daily ration weight - 2.5-3 kg. Diet: fractional (5-6 times a day). The temperature of hot dishes - 57-62 ° C, cold - not lower than 15 ° C.

Table number 2. Indications: acute gastritis, enteritis and colitis during the recovery period, chronic gastritis with secretory insufficiency, enteritis, colitis during remission without concomitant diseases. General characteristics: physiologically complete diet, rich in extractive substances, with rational culinary processing of products. Excluded are foods and dishes that linger in the stomach for a long time, are difficult to digest, irritate the mucous membrane and the receptor apparatus of the gastrointestinal tract. The diet has a stimulating effect on the secretory apparatus of the stomach, improves the compensatory-adaptive reactions of the digestive system, and prevents the development of the disease. Culinary processing: dishes can be boiled, baked, stewed, and also fried without breadcrumbs in breadcrumbs or flour and without forming a rough crust. Energy value: 2800-3100 kcal. Composition: proteins 90-100 g, fats 90-100 g, carbohydrates 400-450 g, free liquid 1.5 l, common salt up to 10-12 g. Daily ration weight - 3 kg. The diet is fractional (4-5 times a day). The temperature of hot dishes is 57-62˚С, cold ones are below 15 °С.

Table number 5. Indications: chronic hepatitis and cholecystitis in remission, cholelithiasis, acute hepatitis and cholecystitis in the recovery period. General characteristics: the amount of proteins, fats and carbohydrates is determined by the physiological needs of the body. Strong stimulants of the secretion of the stomach and pancreas are excluded (extractive substances, products rich in essential oils); refractory fats; fried foods; foods rich in cholesterol, purines. Increased consumption of vegetables and fruits enhances the choleretic effect of other nutrients, intestinal motility, and ensures maximum excretion of cholesterol. Cooking technology: Boiled dishes, rarely baked. Energy value: 2200-2500 kcal. Composition: proteins 80-90 g, fats 80-90 g, carbohydrates 300-350 g. Diet - 5-6 times a day. Only warm food is allowed, cold dishes are excluded.

Federal Agency for Education

State educational institution

Higher professional education.

Tula State University

Department of Physical Education and Sports.

Essay

Subject:

"Physical Rehabilitation in Peptic Ulcer".

Fulfilled

Student gr.XXXXXX

Checked:

Teacher

Simonova T.A.

Tula, 2006.

Ulcer disease. Facts. Manifestations.

Treatment of peptic ulcer.

Physical rehabilitation for peptic ulcer and complexes of gymnastic exercises.

List of used literature.

1) Peptic ulcer. Data. Manifestations.

Peptic ulcer disease (gastric ulcer, duodenal ulcer) is a disease, the main manifestation of which is the presence of an ulcer in the stomach or duodenum.

Among the population, the spread of peptic ulcer reaches 7-10%. The ratio of stomach ulcers and duodenal ulcers is 1:4. It is more common in men aged 25 - 50 years.

Etiology and pathogenesis

It is not possible to name any single cause of peptic ulcer disease.

Nevertheless, in the etiology, as recently considered, the following main factors play a role:

1. Neuropsychic stress and physical overload.

2. Malnutrition.

3. Biological defects inherited at birth.

4. Some drugs.

5. Smoking and alcohol.

The role of hereditary predisposition is undoubted.

Duodenal ulcers occur predominantly at a young age. Gastric ulcers - in the older.

There is a violation of the secretory and motor function of the stomach. Violation of nervous regulation is essential.

There are substances that also inhibit the function of parietal cells - gastrin and secretin.

These substances are of great importance in the recovery period after peptic ulcer. A large role is also given to the acid factor: an increase in the secretion of hydrochloric acid, which acts aggressively on the mucous membrane. An ulcer does not form without an increase in hydrochloric acid: if there is an ulcer, but there is no hydrochloric acid, it is practically cancer. But the normal mucosa is quite resistant to the action of damaging factors. Therefore, in the pathogenesis, it is also necessary to take into account the protective mechanisms that protect the mucosa from the formation of ulcers. Therefore, in the presence of etiological factors, an ulcer does not form in everyone.

External contributing factors:

1. Alimentary. Negative erosive effect on the mucosa and food that stimulates the active secretion of gastric juice (normally, mucosal injuries heal in 5 days). Spicy, spicy, smoked foods, fresh pastries (pies, pancakes), a large amount of food, most likely cold food, irregular meals, dry food, refined foods, coffee and various hard-to-digest foods that cause irritation of the gastric mucosa.

In general, irregular food intake (at different hours, at long intervals), disrupting the process of digestion in the stomach, can contribute to the development of peptic ulcer, since this excludes the neutralization of the acidic environment of the stomach by food.

2. Smoking - significantly contributes to the development of ulcers. In addition, nicotine causes vasospasm and impaired blood supply to the gastric mucosa.

Alcohol. Although the direct effect of alcohol has not been proven, it has a powerful cocaine effect.

Factors affecting pathogenesis

1. Acid - increased secretion of hydrochloric acid.

2. Reducing the intake of alkaline juice.

3. Violation of coordination between the secretion of gastric juice and alkaline contents.

4. Disturbed composition of the mucous membrane of the epithelium of the stomach (mucoglycoproteins that promote the repair of the mucosa. This substance covers the mucosa with a continuous layer, protecting it from burns).

Ulcer symptoms.

The main complaint of a patient with peptic ulcer is pain in the epigastric region, the appearance of which is associated with food intake: in some cases, pain occurs after half an hour - an hour, in others - 1.5 - 2 hours after eating or on an empty stomach. "Hungry" pains are especially characteristic of duodenal ulcers. They usually disappear after taking, sometimes even a small amount of food. The intensity of pain can be different; often the pain radiates to the back, or up into the chest. In addition to pain, patients are often worried about excruciating heartburn 2-3 hours after eating, due to the throwing of acidic stomach contents into the lower esophagus. Usually heartburn subsides after taking alkaline solutions and milk. Sometimes patients complain of belching, nausea, vomiting; vomiting usually brings relief. All these unpleasant sensations are also associated with eating. When the ulcer is located in the duodenum, "night" pains and constipation are characteristic.

Exacerbations of ulcers and the course of the disease.

Peptic ulcer is characterized by a chronic course with alternating periods of exacerbations and improvements (remissions). Exacerbations often occur in spring and autumn, usually last 1-2 months and are manifested by an increase in the described signs of the disease, often depriving the patient of his ability to work, and in some cases lead to complications:

* Bleeding - the most frequent and serious complications; occurs on average in 15-20% of patients with peptic ulcer and is the cause of almost half of all deaths in this disease. It occurs predominantly in young men. More often with peptic ulcer, so-called small bleeding occurs, massive bleeding is less common. Sometimes sudden massive bleeding is the first manifestation of the disease. Small bleeding is characterized by pallor of the skin, dizziness, weakness; with severe bleeding, melena is noted, single or repeated vomiting, vomit resembles coffee grounds;

* Perforation is one of the most severe and dangerous complications, which occurs in approximately 7% of peptic ulcer cases. It is more often observed with a duodenal ulcer. However, this complication of gastric ulcer is accompanied by higher mortality and a higher rate of postoperative complications. The vast majority of perforations of gastric and duodenal ulcers are so-called free perforations into the abdominal cavity. Often occurs after eating a large meal. It is manifested by a sudden sharp (dagger) pain in the upper abdomen. The suddenness and intensity of the pain is not so pronounced in any other condition. The patient takes a forced position with knees pulled up to the stomach, tries not to move;

* Penetrations are characterized by the penetration of an ulcer into the organs in contact with the stomach or duodenal bulb - the liver, pancreas, lesser omentum. The clinical picture in the acute period resembles perforation, but the pain is less intense. Soon, signs of damage to the organ into which the penetration occurred (girdle pain and vomiting with damage to the pancreas, pain in the right shoulder and in the back during penetration into the liver, etc.) join. In some cases, penetration occurs gradually;

* Stenosis of the gastrointestinal tract (as a result of cicatricial deformity);

* Degeneration into a malignant tumor or malignancy - observed almost exclusively in the localization of ulcers in the stomach, malignancy of duodenal ulcers is very rare. With malignancy of the ulcer, pain becomes constant, loses connection with food intake, appetite decreases, exhaustion increases, nausea and vomiting become more frequent.

In this case, a change in the nature of pain can be a sign of the development of complications.

Peptic ulcer in adolescents and young adults usually occurs against the background of a pre-ulcerative condition (gastritis, gastroduodenitis), is characterized by more pronounced symptoms, a high level of acidity, increased motor activity of the stomach and duodenum, often the first sign of the disease is gastrointestinal bleeding.

Peptic ulcer in the elderly and senile age occurs against the background of an increasing decrease in the functions of the gastric mucosa, especially due to impaired blood circulation in the vessels. It is often preceded by chronic inflammatory processes in the stomach and duodenum. Ulcers in elderly and senile people are more often localized in the stomach. In persons older than 60 years, gastric localization of the ulcer occurs 3 times more often than in young and middle-aged patients.

Gastric ulcers that have arisen in the elderly and senile age are of considerable size (giant ulcers are often found), a shallow bottom covered with a gray-yellow coating, fuzzy and bleeding edges, edema, and slow healing of the ulcer.

Peptic ulcer disease in people in the elderly and senile age often proceeds according to the type of gastritis and is characterized by short duration, mild pain syndrome, and the absence of its clear connection with food intake. Patients complain of a feeling of heaviness, fullness in the stomach, diffuse aching pain in the epigastric region without a clear localization, radiating to the right and left hypochondrium, to the sternum, to the lower abdomen. Disorders are manifested by belching, nausea; heartburn and vomiting are less common. Characterized by constipation, loss of appetite and weight loss. The tongue is heavily coated. The course of the disease is characterized by monotony, the absence of a clear periodicity and seasonal exacerbation; in most patients, it is aggravated by other chronic diseases of the digestive system - cholecystitis, hepatitis, pancreatitis, enterocolitis, as well as chronic coronary heart disease, hypertension, atherosclerosis, cardiovascular insufficiency and pulmonary heart failure. In elderly and senile patients, there is a slowdown in the duration of ulcer scarring, and the frequency of complications increases. Bleeding occurs most frequently; perforation are much less common, and malignancy of the ulcer is much more common than in young and middle-aged people.

Some differences between gastric ulcer and duodenal ulcer.

Clinical signs

Duodenal ulcer

Over 40 years old

Male predominate

No gender differences

Night, hungry

Immediately after eating

normal, elevated

Anorexia

Body mass

Therapeutic physical culture is currently an integral part of complex treatment, a means of primary and, especially, secondary prevention of gastric ulcer and duodenal ulcer. Without exercise therapy, a full-fledged rehabilitation of patients is impossible. The use of exercise therapy at various stages of treatment of patients with various conditions requires the constant use of various control methods. These methods can only conditionally be called methods for evaluating the effectiveness of exercise therapy, since they provide much more information. With their help, the functional state of the patient at the moment, the adequacy of exercise therapy in terms of physical activity and specific orientation, and in combination with other therapeutic measures, are determined. Methods for evaluating the effectiveness of exercise therapy, having multilateral characteristics, largely contribute to the disclosure of the mechanisms of influence of the physical exercises themselves and thus are the basis of a scientific approach to exercise therapy.

To determine the effectiveness of exercise therapy, constant monitoring of the patient is carried out, determining his condition, the impact of the exercises used, a separate lesson, a certain period of treatment. Special studies of the functional state are also important, which give an objective assessment of the patient, his individual characteristics, and adaptation to physical activity.

Knowledge and application of methods for studying the functions of the body increases the effectiveness of therapeutic physical education. An assessment of the functional state of the patient before the start of physical therapy classes is necessary for the distribution of patients into homogeneous groups according to the functional state, the correct planning and dosage of physical activity. Current examinations during the course of treatment and the study of the impact of a one-time session make it possible to evaluate the effectiveness of an individual session, make timely changes to the treatment plan (for example, expanding the motor regimen) and the training methodology. Accounting for effectiveness at the end of treatment sums up the course of studies.

Improvement in the condition of patients with peptic ulcer in the phase of fading exacerbation is noted with relief of pain and dyspepsia, the absence of pain on palpation, improvement, well-being, refusal of medications, expansion of the dietary regimen, restoration of the motor function of the stomach and improvement of the autonomic regulation of the functions of internal organs according to ortho- and clinostatic samples Endoscopically, it is verified by a decrease in the inflammatory reaction of the mucous membrane around the ulcer, cleansing of the bottom of the ulcer, and a tendency to scarring. Persistent improvement is determined by a change in the type of course (rhythm of exacerbations): the absence of recurrence during the year with previously frequent recurrence, the formation of a scar and the elimination of inflammation in its area according to endoscopy, or the disappearance of the “niche”, confirmed by X-ray.

Determination of the effectiveness of treatment in the application of exercise therapy procedures is based on data on the well-being of patients; the functional state of the digestive system (indicators of the secretory and motor functions of the stomach, data from X-ray and endoscopic studies); reactions of the cardiovascular and respiratory systems to physical activity; state of excitability of the autonomic nervous system; shortening the duration of treatment; reducing the frequency and duration of complications; restoration of performance.

To take into account the effectiveness of exercise therapy for peptic ulcer can be used:

A survey regarding the existing subjective sensations: heartburn, belching, bloating, abdominal pain, the nature of the stool (constipation, diarrhea).

Pulse and blood pressure control;

Breath tests of Stange and Genchi;

Dynamic control of body weight. Body weight is determined by weighing on a medical scale.

With the positive effect of physical exercise, subjective sensations disappear, appetite and stool normalize, the pulse tends to slow down, the time of the Stange test lengthens, and the body weight of patients stabilizes.

In assessing the effectiveness of LH, the patient's well-being plays a very important role. With the appearance of insomnia, deterioration of appetite, the appearance of pain in the abdomen, dysfunction of the intestines, it is necessary to carefully examine the patient for a more correct differentiated choice of means and forms of exercise therapy.

To determine the effectiveness of a particular lesson, medical and pedagogical observations are carried out. The most important thing is to determine how therapeutic problems are solved in this lesson, whether physical activity corresponds to the patient's capabilities, what are his individual reactions to exercise therapy.

To clarify these issues, a physiological curve and the density of the lesson are determined in the exercise therapy session by changing the pulse rate.

During observations, attention is drawn to the external signs of fatigue, the appearance of pain, the ability to perform exercises. Based on observations, you should change the method of training, for example, reduce the dosage of physical activity. In most cases, physical exercise should cause slight fatigue, which is characterized by reddening of the skin with perspiration, increased breathing. It is impossible to allow the appearance of pain and overwork, accompanied by noisy shortness of breath, severe weakness, impaired coordination and balance, dizziness, and a change in the structure of physical exercise.

In exercise therapy classes, the study of the pulse rate should be carried out 3 times, before the lesson, in the middle of the lesson (after the most difficult exercise) and after the end of the lesson.

To assess the distribution of physical activity in parts of exercise therapy, multiple pulse counts should be performed and a physiological curve should be built.

To assess the effectiveness of exercise therapy during the entire course of treatment, it is necessary to study the patient's condition even before starting classes with him. During the initial examination of the patient, complaints, features of the course of the disease, objective data, the state of physical development and functionality, and clinical data are determined and recorded in the exercise therapy card. Repeated (through certain periods) and final examinations reveal the dynamics of these indicators, which allows us to draw conclusions about the effectiveness of exercise therapy.

The study of the characteristics of the course of the disease is carried out according to the history of the disease and anamnesis. Attention is drawn to the duration of the disease, the presence of exacerbations, methods of treatment and the results achieved, physical activity before and during the disease.

Physical development is determined by anthropometric measurements.

Much attention should be paid to the definition of functionality. For this purpose, various tests with dosed physical activity are used. These tests also help to determine the body's reserve capabilities, its adaptation to physical activity, justify the appointment and transition from one motor mode to another. The nature of the load in functional tests is selected depending on the motor mode on which the patient is located.

The analysis of the self-control map helps to evaluate the effectiveness of exercise therapy, in which the dynamics of the patient's well-being, sleep, appetite, objective research data (height, body weight, chest circumference, waist circumference, pulse rate, blood pressure, duration of holding the breath on inspiration) are noted quarterly and annually. and exhalation, indicators of spirometry, dynamometry).

Along with this, in the evaluation of the results of exercise therapy, one of the main roles is given to the analysis of a special map of the physical rehabilitation room. It contains information about the patient, the main and concomitant diagnosis of the disease, brief clinical and functional data. Since the differentiated choice of exercise therapy procedures is determined by the original; the functional state of the digestive system, the map separately highlights the characteristics of the secretory and motor functions of the stomach, intestinal motility (constipation, diarrhea). It also contains anthropometric data, indicators of individual functional tests, doctor's guidelines.

The appointment of forms and means of exercise therapy is made only after determining the response of the cardiovascular and respiratory systems to physical activity (Martinet-Kushelevsky test). Studies are carried out no earlier than 1.5 hours after a meal. Clothing should be light, not hindering movement and not interfering with heat transfer. The optimum ambient temperature should be 18-20 °C.

An improvement in the condition of patients with peptic ulcer in the remission phase is evidenced by an improvement in the general condition, a decrease in the severity of neurotic disorders, the possibility of further expanding the dietary regimen, an improvement in the autonomic regulation of the functions of internal organs according to ortho- and clinostatic tests, and a change in the rhythm of recurrence with no recurrence throughout the year - about sustainable improvement. On the contrary, the appearance of pain, heartburn, recurrence of ulcers or erosions according to endoscopic or X-ray studies confirm the deterioration of the patients' condition.

According to the WHO definition, rehabilitation is the combined and coordinated application of social, medical, pedagogical and professional activities with the aim of preparing and retraining the individual to achieve his optimal ability to work.

Rehabilitation tasks:

• 1. Improve the overall reactivity of the body;
• 2. Normalize the state of the central and autonomic systems;
• 3. Provide analgesic, anti-inflammatory, trophic effect on the body;
• 4. Maximize the period of remission of the disease.

Comprehensive medical rehabilitation is carried out in the system of hospital, sanatorium, dispensary and polyclinic stages. An important condition for the successful functioning of a staged rehabilitation system is the early start of rehabilitation measures, the continuity of stages, provided by the continuity of information, the unity of understanding the pathogenetic essence of pathological processes and the foundations of their pathogenetic therapy. The sequence of stages can be different depending on the course of the disease.

An objective assessment of the results of rehabilitation is very important. It is necessary for the current correction of rehabilitation programs, the prevention and overcoming of unwanted side effects, the final assessment of the effect when moving to a new stage.

Thus, considering medical rehabilitation as a set of measures aimed at eliminating changes in the body that lead to a disease or contribute to its development, and taking into account the knowledge gained about pathogenetic disorders in asymptomatic periods of the disease, 5 stages of medical rehabilitation are distinguished.

The preventive stage aims to prevent the development of clinical manifestations of the disease by correcting metabolic disorders (Appendix B).

The activities of this stage have two main directions: elimination of the identified metabolic and immune disorders by dietary correction, the use of mineral waters, pectins of marine and terrestrial plants, natural and reshaped physical factors; the fight against risk factors that can largely provoke the progression of metabolic disorders and the development of clinical manifestations of the disease. It is possible to count on the effectiveness of preventive rehabilitation only by supporting the measures of the first direction with the optimization of the habitat (improving the microclimate, reducing dust and gas content in the air, leveling the harmful effects of geochemical and biogenic nature, etc.), combating hypodynamia, overweight, smoking, and others. bad habits.

Stationary stage of medical rehabilitation, except for the first important task:

• 1. Saving the patient's life (provides for measures to ensure minimal tissue death as a result of exposure to a pathogenic agent);
• 2. Prevention of disease complications;
• 3. Ensuring the optimal course of reparative processes (Appendix D).

This is achieved by replenishing with a deficit in circulating blood volume, normalizing microcirculation, preventing tissue swelling, conducting detoxification, antihypoxant and antioxidant therapy, normalizing electrolyte disturbances, using anabolics and adaptogens, and physiotherapy. With microbial aggression, antibiotic therapy is prescribed, immunocorrection is carried out.

The polyclinic stage of medical rehabilitation should ensure the completion of the pathological process (Appendix E).

For this, therapeutic measures are continued aimed at eliminating the residual effects of intoxication, microcirculation disorders, and restoring the functional activity of body systems. During this period, it is necessary to continue therapy to ensure the optimal course of the restitution process (anabolic agents, adaptogens, vitamins, physiotherapy) and develop the principles of dietary correction, depending on the characteristics of the course of the disease. An important role at this stage is played by purposeful physical culture in the mode of increasing intensity.

The sanatorium-and-spa stage of medical rehabilitation completes the stage of incomplete clinical remission (Appendix G). Therapeutic measures should be aimed at preventing the recurrence of the disease, as well as its progression. To implement these tasks, predominantly natural therapeutic factors are used to normalize microcirculation, increase cardiorespiratory reserves, stabilize the functioning of the nervous, endocrine and immune systems, organs of the gastrointestinal tract and urinary excretion.

The metabolic stage includes conditions for the normalization of structural and metabolic disorders that existed after the completion of the clinical stage (Appendix E).

This is achieved with the help of long-term dietary correction, the use of mineral waters, pectins, climatotherapy, therapeutic physical culture, and balneotherapy courses.

The results of the implementation of the principles of the proposed scheme of medical rehabilitation by the authors are predicted to be more effective than the traditional one:

• - the allocation of the stage of preventive rehabilitation allows the formation of risk groups and the development of preventive programs;
• - the allocation of the stage of metabolic remission and the implementation of measures of this stage will make it possible to reduce the number of relapses, prevent the progression and chronicity of the pathological process;
• -- staged medical rehabilitation with the inclusion of independent stages of preventive and metabolic remission will reduce the incidence and improve the health of the population.

Directions of medical rehabilitation include drug and non-drug directions:

Medical direction of rehabilitation.

Drug therapy in rehabilitation is prescribed taking into account the nosological form and the state of the secretory function of the stomach.

Take before meals

Most medications are taken 30 to 40 minutes before a meal, when they are best absorbed. Sometimes - 15 minutes before a meal, not earlier.

Half an hour before meals, you should take antiulcer drugs - d-nol, gastrofarm. They should be taken with water (not milk).

Also, half an hour before meals, you should take antacids (almagel, phosphalugel, etc.) and choleretic agents.

Reception at mealtime

During meals, the acidity of gastric juice is very high, and therefore significantly affects the stability of drugs and their absorption into the blood. In an acidic environment, the effect of erythromycin, lincomycin hydrochloride and other antibiotics is partially reduced.

You should take gastric juice preparations or digestive enzymes with food, as they help the stomach digest food. These include pepsin, festal, enzistal, panzinorm.

Along with food, it is advisable to take laxatives to be digested. These are senna, buckthorn bark, rhubarb root and joster fruits.

Reception after meals

If the medicine is prescribed after a meal, wait at least two hours to obtain the best therapeutic effect.

Immediately after eating, they take mainly drugs that irritate the mucous membrane of the stomach and intestines. This recommendation applies to drug groups such as:

• - painkillers (non-steroidal) anti-inflammatory drugs - Butadion, aspirin, aspirin cardio, voltaren, ibuprofen, askofen, citramon (only after meals);
• - acute agents are components of bile - allochol, lyobil, etc.); taking after meals is a prerequisite for these drugs to “work”.

There are so-called anti-acid drugs, the intake of which should be timed to coincide with the moment when the stomach is empty, and hydrochloric acid continues to be released, that is, an hour or two after the end of the meal - magnesium oxide, vikalin, vikair.

Aspirin or askofen (aspirin with caffeine) is taken after a meal, when the stomach has already begun to produce hydrochloric acid. Due to this, the acidic properties of acetylsalicylic acid (which provokes irritation of the gastric mucosa) will be suppressed. This should be remembered by those who take these pills for headaches or colds.

Regardless of food

Regardless of when you sit down at the table, take:

Antibiotics are usually taken regardless of food, but dairy products must also be present in your diet. Along with antibiotics, nystatin is also taken, and at the end of the course, complex vitamins (for example, supradin).

Antacids (gastal, almagel, maalox, talcid, relzer, phosphalugel) and antidiarrheals (imodium, intetrix, smecta, neointestopan) - half an hour before meals or one and a half to two hours after. At the same time, keep in mind that antacids taken on an empty stomach act for about half an hour, and taken 1 hour after eating - for 3-4 hours.

Fasting

Taking the medicine on an empty stomach is usually in the morning 20-40 minutes before breakfast.

Medicines taken on an empty stomach are absorbed and absorbed much faster. Otherwise, acidic gastric juice will have a destructive effect on them, and there will be little use from medicines.

Patients often ignore the recommendations of doctors and pharmacists, forgetting to take a pill prescribed before meals, and transferring it to the afternoon. If the rules are not followed, the effectiveness of drugs inevitably decreases. To the greatest extent, if, contrary to the instructions, the drug is taken during meals or immediately after it. This changes the rate of passage of drugs through the digestive tract and the rate of their absorption into the blood.

Some drugs may break down into their component parts. For example, penicillin is destroyed in an acidic gastric environment. Breaks down into salicylic and acetic acids aspirin (acetylsalicylic acid).

Reception 2 - 3 times a day if the instructions indicate "three times a day", this does not mean breakfast - lunch - dinner at all. The medicine must be taken every eight hours so that its concentration in the blood is evenly maintained. It is better to drink the medicine with plain boiled water. Tea and juices are not the best remedy.

If it is necessary to resort to cleansing the body (for example, in case of poisoning, alcohol intoxication), sorbents are usually used: activated carbon, polyphepan or enterosgel. They collect toxins "on themselves" and remove them through the intestines. They should be taken twice a day between meals. At the same time, fluid intake should be increased. It is good to add herbs with a diuretic effect to the drink.

Day or night

Sleeping pills should be taken 30 minutes before bedtime.

Laxatives - bisacodyl, senade, glaxena, regulax, gutalax, forlax - are usually taken at bedtime and half an hour before breakfast.

Ulcer remedies are taken early in the morning and late in the evening to prevent hunger pains.

After the introduction of the candle, you need to lie down, so they are prescribed for the night.

Emergency funds are taken regardless of the time of day - if the temperature has risen or colic has begun. In such cases, adherence to the schedule is not essential.

The key role of the ward nurse is the timely and accurate delivery of medicines to patients in accordance with the prescriptions of the attending physician, informing the patient about medicines, and monitoring their intake.

Among the non-drug methods of rehabilitation are the following:

1. Diet correction:

The diet for gastric ulcer is used as prescribed by the doctor sequentially, with surgical intervention it is recommended to start with a diet - 0.

Purpose: Maximum sparing of the mucous membrane of the esophagus, stomach - protection from mechanical, chemical, thermal factors of food damage. Providing an anti-inflammatory effect and preventing the progression of the process, preventing fermentation disorders in the intestines.

characteristics of the diet. This diet provides a minimum amount of food. Since it is difficult to take it in a dense form, food consists of liquid and jelly-like dishes. The number of meals is at least 6 times a day, if necessary - around the clock every 2-2.5 hours.

Chemical composition and calorie content. Proteins 15 g, fats 15 g, carbohydrates 200 g, calories - about 1000 kcal. Table salt 5 g. The total weight of the diet is not more than 2 kg. Food temperature is normal.

Sample set

Fruit juices - apple, plum, apricot, cherry. Berry juices - strawberry, raspberry, blackcurrant. Broths - weak from lean meats (beef, veal, chicken, rabbit) and fish (perch, bream, carp, etc.).

Cereal broths - rice, oatmeal, buckwheat, corn flakes.

Kissels from various fruits, berries, their juices, from dried fruits (with the addition of a small amount of starch).

Butter.

Tea (weak) with milk or cream.

Approximate one-day diet menu number 0

• 8 hours - fruit and berry juice.
• 10 o'clock - tea with milk or cream with sugar.
• 12 hours - fruit or berry jelly.
• 14 hours - a weak broth with butter.
• 4 p.m. - lemon jelly.
• 6 p.m. - rosehip decoction.
• 20:00 - tea with milk and sugar.
• 22 hours - rice water with cream.

Diet number 0A

It is prescribed, as a rule, for 2-3 days. Food consists of liquid and jelly-like dishes. In the diet 5 g of protein, 15-20 g of fat, 150 g of carbohydrates, energy value 3.1-3.3 MJ (750-800 kcal); table salt 1 g, free liquid 1.8-2.2 liters. The food temperature is not higher than 45 °C. Up to 200 g of vitamin C is introduced into the diet; other vitamins are added as prescribed by the doctor. Eating 7 - 8 times a day, for 1 meal they give no more than 200 - 300 g.

• - Allowed: low-fat meat broth, rice broth with cream or butter, strained compote, liquid berry jelly, rosehip broth with sugar, fruit jelly, tea with lemon and sugar, freshly prepared fruit and berry juices diluted 2-3 times sweet water (up to 50 ml per reception). When the condition improves on the 3rd day, add: soft-boiled egg, 10 g of butter, 50 ml of cream.
• - Excluded: any dense and puree-like dishes, whole milk and cream, sour cream, grape and vegetable juices, carbonated drinks.

Diet No. 0B (No. 1A surgical)

It is prescribed for 2-4 days after diet No. 0-a, from which diet No. 0-b differs in addition in the form of liquid pureed cereals from rice, buckwheat, oatmeal, boiled in meat broth or water. In the diet 40-50 g of protein, 40-50 g of fat, 250 g of carbohydrates, energy value 6.5 - 6.9 MJ (1550-1650 kcal); 4-5 g sodium chloride, up to 2 liters of free liquid. Food is given 6 times a day, no more than 350-400 g per reception.

Diet No. 0B (No. 1B surgical)

It serves as a continuation of the expansion of the diet and the transition to physiologically complete nutrition. Puree soups and cream soups, steamed dishes of mashed boiled meat, chicken or fish, fresh cottage cheese mashed with cream or milk to the consistency of thick sour cream, steamed cottage cheese dishes, sour-milk drinks, baked apples, well-mashed fruit and vegetable purees, up to 100 g of white crackers. Milk is added to tea; give milk porridge. In the diet 80-90 g of protein, 65-70 g of fat, 320-350 g of carbohydrates, energy value 9.2-9.6 MJ (2200-2300 kcal); sodium chloride 6-7 g. Food is given 6 times a day. The temperature of hot dishes is not higher than 50 °С, cold - not less than 20 °С.

Then there is an expansion of the diet.

Diet number 1a

Indications for diet No. 1a

This diet is recommended for the maximum limitation of mechanical, chemical and thermal aggression on the stomach. This diet is prescribed for exacerbation of peptic ulcer, bleeding, acute gastritis and other diseases that require maximum sparing of the stomach.

Purpose of diet No. 1a

Reducing the reflex excitability of the stomach, reducing interoceptive irritations emanating from the affected organ, restoring the mucous membrane by sparing the function of the stomach as much as possible.

General characteristics of diet No. 1a

Exclusion of substances that are strong causative agents of secretion, as well as mechanical, chemical and thermal irritants. Food is cooked only in liquid and mushy form. Steamed, boiled, pureed, pureed dishes in a liquid or mushy consistency. In Diet No. 1a for patients who have undergone cholecystectomy, only mucous soups, eggs in the form of steam protein omelettes are used. Calorie content is reduced mainly due to carbohydrates. The amount of food taken at a time is limited, the frequency of intake is at least 6 times.

The chemical composition of diet No. 1a

Diet No. 1a is characterized by a decrease in the content of proteins and fats to the lower limit of the physiological norm, a strict limitation of the impact of various chemical and mechanical stimuli on the upper gastrointestinal tract. With this diet, carbohydrates and salt are also limited.

Proteins 80 g, fats 80 - 90 g, carbohydrates 200 g, table salt 16 g, calories 1800 - 1900 kcal; retinol 2 mg, thiamine 4 mg, riboflavin 4 mg, nicotinic acid 30 mg, ascorbic acid 100 mg; calcium 0.8 g, phosphorus 1.6 g, magnesium 0.5 g, iron 0.015 g. The temperature of hot dishes is not higher than 50-55 ° C, cold - not lower than 15-20 ° C.

• - Mucous soups from semolina, oatmeal, rice, pearl barley with the addition of egg-milk mixture, cream, butter.
• - Meat and poultry dishes in the form of mashed potatoes or steam soufflé (meat cleaned from tendons, fascia and skin is passed through a meat grinder 2-3 times).
• - Fish dishes in the form of a steam soufflé from low-fat varieties.
• - Dairy products - milk, cream, steamed soufflé from freshly prepared grated cottage cheese; fermented milk drinks, cheese, sour cream, ordinary cottage cheese are excluded. Whole milk with good tolerance is drunk up to 2-4 times a day.
• - Soft-boiled eggs or in the form of a steam omelette, no more than 2 per day.
• - Dishes from cereals in the form of liquid porridge in milk, porridge from cereal (buckwheat, oatmeal) flour with the addition of milk or cream. You can use almost all cereals, with the exception of barley and millet. Butter is added to the finished porridge.
• - Sweet dishes - kissels and jelly from sweet berries and fruits, sugar, honey. You can also make juices from berries and fruits, diluting them with boiled water in a 1: 1 ratio before drinking.
• - Fats - fresh butter and vegetable oil added to dishes.
• - Drinks: weak tea with milk or cream, juices from fresh berries, fruits, diluted with water. Of the drinks, decoctions of wild rose and wheat bran are especially useful.

Excluded foods and dishes of diet No. 1a

Bread and bakery products; broths; fried foods; mushrooms; smoked meats; fatty and spicy dishes; vegetable dishes; various snacks; coffee, cocoa, strong tea; vegetable juices, concentrated fruit juices; fermented milk and carbonated drinks; sauces (ketchup, vinegar, mayonnaise) and spices.

Diet number 1b

Indications for diet No. 1b

Indications and purpose as for diet No. 1a. The diet is fractional (6 times a day). This table is for less sharp, in comparison with table No. 1a, limitation of mechanical, chemical and thermal aggression on the stomach. This diet is indicated for mild exacerbation of gastric ulcer, in the stage of remission of this process, with chronic gastritis.

Diet No. 1b is prescribed at subsequent stages of treatment with the patient remaining in bed. The timing of diet No. 1b is very individual, but on average they range from 10 to 30 days. Diet number 1b is also used subject to bed rest. The difference from diet number 1a is a gradual increase in the content of essential nutrients and caloric content of the diet.

Bread is allowed in the form of dried (but not toasted) crackers (75-100 g). Pureed soups are introduced, replacing mucous membranes; milk porridge can be consumed more often. Homogenized canned food for baby food from vegetables and fruits and dishes from beaten eggs are allowed. All recommended products and dishes from meat and fish are given in the form of steam soufflé, quenelles, mashed potatoes, cutlets. After the products are boiled to softness, they are rubbed to a mushy state. Food must be warm. The rest of the recommendations are the same as for diet No. 1a.

The chemical composition of diet No. 1b

Proteins up to 100 g, fats up to 100 g (30 g vegetable), carbohydrates 300 g, calories 2300 - 2500 kcal, salt 6 g; retinol 2 mg, thiamine 4 mg, riboflavin 4 mg, nicotinic acid 30 mg, ascorbic acid 100 mg; calcium 0.8 g, phosphorus 1.2 g, magnesium 0.5 g, iron 15 mg. The total amount of free liquid is 2 liters. The temperature of hot dishes is up to 55 - 60 ° C, cold - not lower than 15 - 20 ° C.

The role of a nurse in dietary correction:

The dietitian monitors the work of the catering department and compliance with the sanitary and hygienic regime, monitors the implementation of dietary recommendations when the doctor changes the diet, checks the quality of the products when they arrive at the warehouse and kitchen, and controls the correct storage of the food supply. With the participation of the head of production (chef) and under the guidance of a dietitian, draws up a daily menu-layout in accordance with the card file of dishes. Carries out periodic calculation of the chemical composition and calorie content of diets, control of the chemical composition of actually prepared dishes and diets (protein, fat, carbohydrates, vitamins, minerals, energy value, etc.) by selectively sending individual dishes to the laboratory of the State Sanitary and Epidemiological Supervision Center. Controls the bookmarking of products and the release of dishes from the kitchen to the departments, according to the orders received, carries out the grading of finished products. Carries out control over the sanitary condition of dispensing and canteens at departments, inventory, utensils, as well as the implementation of distributing rules of personal hygiene by employees. Organizes classes with paramedical workers and kitchen staff on therapeutic nutrition. Controls the timely conduct of preventive medical examinations of catering workers and the exclusion from work of persons who have not passed a preliminary or periodic medical examination.

Diet number 1

General information

Indications for diet number 1

Peptic ulcer of the stomach in the stage of fading exacerbation, during the period of recovery and remission (the duration of dietary treatment is 3-5 months).

The purpose of diet No. 1 is to accelerate the processes of reparation of ulcers and erosions, further reduce or prevent inflammation of the gastric mucosa.

This diet contributes to the normalization of the secretory and motor-evacuation function of the stomach.

Diet No. 1 is designed to meet the physiological needs of the body for nutrients in stationary conditions or in outpatient conditions during work that is not associated with physical activity.

General characteristics of diet No. 1

The use of diet No. 1 is aimed at providing a moderate sparing of the stomach from mechanical, chemical and thermal aggression with a restriction in the diet of dishes that have a pronounced irritating effect on the walls and receptor apparatus of the upper gastrointestinal tract, as well as indigestible foods. Exclude dishes that are strong causative agents of secretion and chemically irritate the gastric mucosa. Both very hot and very cold dishes are excluded from the diet.

The diet for diet No. 1 is fractional, up to 6 times a day, in small portions. It is necessary that the break between meals should not be more than 4 hours, a light dinner is allowed an hour before bedtime. At night, you can drink a glass of milk or cream. Food is recommended to chew thoroughly.

The food is liquid, mushy and denser in boiled and mostly pureed form. Since the consistency of food is very important in dietary nutrition, they reduce the amount of foods rich in fiber (such as turnips, radishes, radishes, asparagus, beans, peas), fruits with skins and unripe berries with rough skins (such as gooseberries, currants, grapes). , dates), bread made from wholemeal flour, foods containing coarse connective tissue (such as cartilage, poultry and fish skin, sinewy meat).

Dishes are cooked boiled or steamed. After that, they are crushed to a mushy state. Fish and coarse meats can be eaten whole. Some dishes can be baked, but without a crust.

The chemical composition of diet No. 1

Proteins 100 g (of which 60% of animal origin), fats 90-100 g (30% vegetable), carbohydrates 400 g, table salt 6 g, calories 2800-2900 kcal, ascorbic acid 100 mg, retinol 2 mg, thiamine 4 mg, riboflavin 4 mg, nicotinic acid 30 mg; calcium 0.8 g, phosphorus at least 1.6 g, magnesium 0.5 g, iron 15 mg. The total amount of free fluid is 1.5 liters, food temperature is normal. Salt is recommended to be limited.

• - Wheat bread from the highest grade flour of yesterday's baking or dried; rye bread and any fresh bread, pastry and puff pastry products are excluded.
• - Soups on vegetable broth from mashed and well-boiled cereals, dairy, vegetable puree soups seasoned with butter, egg-milk mixture, cream; meat and fish broths, mushroom and strong vegetable broths, cabbage soup, borscht, okroshka are excluded.
• - Meat dishes - steamed and boiled from beef, young low-fat lamb, trimmed pork, chickens, turkeys; fatty and sinewy varieties of meat, poultry, duck, goose, canned meat, smoked meats are excluded.
• - Fish dishes are usually low-fat varieties, without skin, in pieces or in the form of cutlets; cooked with water or steam.
• - Dairy products - milk, cream, non-acidic kefir, yogurt, cottage cheese in the form of a soufflé, lazy dumplings, pudding; dairy products with high acidity are excluded.
• - Cereals from semolina, buckwheat, rice, boiled in water, milk, semi-viscous, mashed; millet, barley and barley groats, legumes, pasta are excluded.
• - Vegetables - potatoes, carrots, beets, cauliflower, boiled in water or steam, in the form of soufflé, mashed potatoes, steam puddings.
• - Appetizers - boiled vegetable salad, boiled tongue, doctor's sausage, dairy, dietary, aspic fish on vegetable broth.
• - Sweet dishes - fruit puree, kissels, jelly, pureed compotes, sugar, honey.
• - Drinks - weak tea with milk, cream, sweet juices from fruits and berries.
• - Fats - butter and refined sunflower oil added to dishes.

Excluded foods and dishes of diet No. 1

Two food groups should be excluded from your diet.

• - Foods that cause or increase pain. These include: drinks - strong tea, coffee, carbonated drinks; tomatoes, etc.
• - Products that strongly stimulate the secretion of the stomach and intestines. These include: concentrated meat and fish broths, decoctions of mushrooms; fried foods; meat and fish stewed in own juice; meat, fish, tomato and mushroom sauces; salted or smoked fish and meat products; meat and fish canned food; salted, pickled vegetables and fruits; spices and seasonings (mustard, horseradish).

In addition, the following are excluded: rye and any fresh bread, pastry products; dairy products with high acidity; millet, barley, barley and corn grits, legumes; white cabbage, radish, sorrel, onion, cucumbers; salted, pickled and pickled vegetables, mushrooms; sour and fiber-rich fruits and berries.

It is necessary to focus on the feelings of the patient. If, when eating a certain product, the patient feels discomfort in the epigastric region, and even more so nausea, vomiting, then this product should be discarded.