Methods and varieties of the study of the stomach. Digestion, its meaning

Part III. Examination of the contents of the stomach The gastrointestinal tract (GIT) is one of the body systems that provides mechanical and chemical processing of food. It consists of the proper digestive tube and accessory glands. Stomach, small intestine, part

Chapter 14 Microscopic examination of gastric contents After the gastric contents obtained on an empty stomach have settled or been centrifuged, sediment particles are examined under a microscope. Normally, such a sediment contains mainly squamous epithelium and

Ulcer of the stomach and duodenum Attention! Pain can be evidence of serious and dangerous diseases stomach, intestines and duodenum. Before trying to treat them with medicinal plants, consult a doctor! Rose hips 3

The study of intestinal contents Speaking "in Russian", we are talking about feces. Required Research? At the present time, its role has narrowed quite significantly. Today, feces are checked for helminth eggs and occult blood, as well as for bacterial composition (in the latter case

Chapter 3 Examination of saliva, contents of the stomach and duodenum Examination of saliva Examination of saliva is recommended to detect: gingivitis, dental caries, a comprehensive gastroenterological assessment of the digestive

Examination of the contents of the stomach Gastric contents (gastric juice) is a colorless clear liquid without a pronounced odor, with an acid reaction of the environment. The main components of gastric contents (normally) are hydrochloric acid,

Examination of the contents of the duodenum The contents of the duodenum are examined during duodenal sounding and are used to assess the composition of bile, if there is reason to assume damage to the biliary tract and gallbladder. Bile is a product

Examination of the stomach and duodenum? The essence of the method: radiography of the stomach allows you to clarify the position, size, contours, relief of the walls, mobility, functional state stomach, identify signs various pathologies in the stomach and its localization

Examination of the duodenum? The essence of the method: relaxation duodenography - contrast radiography of the duodenum in its relaxed state, artificially induced by drugs. The technique is informative for diagnosing various

The duodenum (duodenum) is part of the human intestine. It is located in the retroperitoneal space (retroperitoneally). What is a DPC? The duodenum looks like a tube that connects the stomach to the small intestine. It has a hole in the middle through which pancreatic enzymes enter. This is the initial and shortest segment of the intestine.

The duodenum got its name because of its length, which is approximately 30 cm, which corresponds to 12 fingers. The anatomy of the duodenum, like the stomach, includes a division into sections that differ in external coverage and length.

Where is the duodenum located? It is usually located at the level of the segment of the spine L2-L3. Depending on height, weight, type of human figure, it can move lower. It ends near the third lumbar vertebra. WPC has single system blood supply, and the outflow of lymph occurs through the walls of the head of the pancreas. Diseases of the duodenum is a common phenomenon in the modern world.

Structure and functions

The duodenum can be C-shaped, V-shaped, U-shaped. Each of them is a variant of the norm. Despite its small size, the anatomical structure of the duodenum includes 4 sections:

• upper horizontal (bulb) - 5-6 cm long, covered thin layer muscles, located on the border of the last thoracic and I lumbar vertebrae;
• descending - 7-12 cm long with pronounced circular folds, is detected to the right of the first 3 lumbar vertebrae;
• lower horizontal - 6-8 cm long, covered with a shell in front, located on level III lumbar vertebra;
• ascending - 4-5 cm long, located near II lumbar vertebra. Sometimes it can be vaguely expressed, creating the effect of absence.

The first section is located near the liver, from below it touches the kidney. Posteriorly, it contacts with retroperitoneal tissue. Diseases of the duodenum can affect any of its departments.

The wall of the duodenum has a complex structure, it consists, like the anatomy of the stomach, of several membranes:

• mucous - with circular folds, microscopic villi;
• submucosal - from loose connective tissue with collagen fibers and many blood vessels;
• muscle tissue - has smooth fibers, regulates muscle tone, helps to move chyme into the intestines;
• serous membrane - formed from squamous epithelium, prevents friction of the duodenum against other organs.

The duodenum is located at the junction of the stomach, gallbladder with bile ducts, pancreas, liver, and right kidney.

Functions of the duodenum:

• secretory - helps mixing food with digestive juices;
• reflex - with its help, a connection is maintained with the stomach, allowing you to open and close the gastric pylorus;
• motor secretion helps to move the food mass;
• regulatory - controls the production of food enzymes;
• protective function allows you to keep normal for the body alkaline level in chyme;
• the principle of the evacuation possibility is to move the chyme to other departments.

normal operation stomach and 12 duodenal process is needed for the smooth functioning of the whole organism.

Diseases and their prevention

Due to the influence of various external factors, heredity, infection with Helicobacter pylori, background pathologies, as well as age, changes appear that affect the work of the duodenum.

How does the affected area hurt? Discomfort is usually localized in the upper abdomen. Duodenal ailments are also manifested by other symptoms: heartburn, nausea, upset stool. The most common diseases of the stomach and duodenum:

• duodenitis - inflammation of the duodenal mucosa, disrupting its normal functioning;
• ulcer - the formation of a defect in the wall of the organ;
• gastritis - an inflammatory process of the gastric mucosa;
• cancer - the appearance of a malignant tumor.

To reduce the risk of developing duodenal disease, it is recommended to adhere to correct mode nutrition. It should consist of 5-6 daily meals. At the same time, food is consumed in small portions and chewed thoroughly. Prevention of peptic ulcer of the stomach and duodenum also provides for the rejection of bad habits since smoking and alcohol abuse are serious provoking factors.

It is better to cook dishes by steaming, stewing or baking methods. Carbonated drinks, strong tea and coffee should also not be consumed. Marinades, pickles, smoked meats, fatty, spicy dishes should be excluded.

The main prevention of duodenal ulcers is to minimize stress factors. Moderate physical activity will also benefit, and an annual medical checkup will help to identify pathologies in the early stages, which will greatly facilitate the treatment process and further predictions.

The duodenum is an important organ of the gastrointestinal tract, which has a complex structure and performs functions that contribute to normal digestion. Violations of its work affect the entire body, worsening the quality of human life. regular medical checkup, proper nutrition, sufficient physical activity helps control the health of the duodenum and prevent duodenal disease.

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Chapter VIII
Examination of the duodenum
A. Possibilities and methods of examination
Access to the duodenum is rather difficult, since it is located deep and covered by the parietal peritoneum, which in this area is partially fixed to the pancreas and back wall abdominal cavity. The descending branch (D2), the inferior horizontal branch (D3) and the ascending branch (D4) are crossed transversely by the base of the mesentery of the colon and in the sagittal plane by the mesentery of the small intestine.
It should also be emphasized that usually the examination of the duodenum during surgery is incomplete, limited only to the area above the mesentery of the colon, more accessible during conventional interventions (stomach, liver, biliary tract).
The subpyloric part (D1), surrounded by the peritoneum, is the only one that can be viewed from all sides without special techniques. In other cases, only the ventral semicircle of the wall can be seen and felt.
This difficulty is joined by the shape variants that change the size and ratio of different segments, and the different confluence of the mesentery of the transverse colon or the mesentery of the small intestine, which changes, depending on the case, access to different segments. Before proceeding to surgical treatment, these options should be carefully considered, guided by the anatomical location and adapted to each individual case.
To examine segment D1 and part of segment D2, located above the mesentery of the colon, it is necessary to move cranially the liver (after dissection of possible adhesions between the duodenum and gallbladder) and caudally the colon with the mesentery of the transverse colon. As for segment D2, located under the mesentery of the colon, as well as D3 and D4, to examine them, it is necessary to shift the omentum, colon and mesentery of the colon cranially, moving the initial part of the jejunum with the mesentery to the left or right.
If it is necessary to examine the dorsal (retroperitoneal) wall of the duodenum, additional abduction techniques are needed.
For D2, as well as for the terminal part of the choledochus or the dorsal surface of the pancreatic head, the classic abduction of the duodenum and pancreas (Kocher-Jourdan) is used, which consists in dissecting the parietal peritoneum in the dihedral angle, which is formed when it passes to the ventral branch of D2. Then, with the help of a dissecting tupfer or a finger, the horizontal and descending branches of the duodenum are mobilized.
In practice, mobilization can be small and extended. As Fruchaud (1960) points out, the usual mobilization of the duodenum and pancreas, which is limited to the dissection of the peritoneum along the outer edge of the segment D2, located above the mesentery of the colon, gives little visibility of this part and the terminal section of the common bile duct. In essence, this technique is reduced to the preparation of the preduodenal part, which is a continuation of the ligament of Treitz, and the dissection of the retroperitoneal space, which only lengthens the ligament of Treitz (Fig. 5a).

Rice. 5. Duodeno-pancreatic mobilization.
a - simple dissection of the peritoneum along the outer edge D2 - low mobilization; b - dissection of the parietal peritoneum in the right hypochondrium, retraction of the ascending and transverse colon down and medially allow to expose the entire segment D2 - the anterior surface of the common bile duct - extended mobilization (according to Fruchaud).
To completely expose the dorsal part of D2 and the lower part of the common bile duct, it is necessary to continue the incision of the peritoneum and dissect the duodeno-colonic ligaments (Fig. 5,6). The degree of mobilization of the pancreatoduodenal zone must be established depending on the conditions and characteristics of the given case, especially since this technique is not always distinguished by the simplicity and good quality that the authors of works on anatomy attribute to it. This technique is especially difficult during the adhesive process and significant amount newly formed vessels.
To examine D3, it is necessary to increase the mobilization of the duodenum and pancreas to the midline, to the level of the bend connecting it with D2, supplementing it in certain anatomical variants with an incision of the adjacent parietal peritoneum or the caudal leaf of the mesentery of the colon. As for the segment, it can be brought to the midline after an incision in the left sheet of the base of the mesentery and dissection of the ligament of Trade at the junction of it with the intestinal wall. Under these conditions, D4 can even be moved posterior and to the right of the mesenteric vessel trunk. All these techniques must be used carefully so as not to damage neighboring vessels (superior mesenteric vein and artery, inferior mesenteric vein, first arch of the jejunum).
To expose D3 and D4 widely without risk of vessel injury, Catell recommends retraction of the ascending colon in the plane of Toldt's fascia, to the left of the superior mesenteric artery.

Consistent application, depending on the case, of these techniques allows you to examine the entire circumference of the duodenum and, through the wall, its cavity, with the exception of the area adjacent to the pancreas. In this way, the nipple, a key landmark in biliary and pancreatic surgery, can be recognized by palpation through outer wall after the removal of the duodenum - the pancreas. It gives the feeling of a "grain of lead", usually located in the middle part. medial wall D2.
Under normal conditions, the recognition of the Vater nipple by external palpation is difficult, since it can be covered with folds of the mucous membrane, and its location is very different. Usually the nipple is within D2, in the zone starting at a distance of 2 cm from the upper knee and ending at a distance of 1 cm from the lower knee; in some cases it may be on D1 or D3 (Fig. 6). Given these differences, and the fact that under pathological conditions, retractile sclerosis can deform landmarks, the right way to recognize the location of the nipple (without duodenotomy), cholangiography remains during the operation.

Rice. 6. Operational cholangiography. Low confluence of the common bile duct into the duodenum.

Internal examination of the duodenal lumen can be performed under extraordinary conditions without duodenotomy, and also only partially. In this sense, we recall that by diagnostic gastrotomy or after dissection of the duodenum during gastrectomy, it is possible to visually examine the proximal part of the duodenal cavity, pushing back the walls with small valves using the optical apparatus Th. Firica or by palpation (insertion of a finger into the pylorus). In the same way, we make biopsies to recognize some tumors that are not detected by external palpation, sometimes we extract foreign bodies with tweezers. Usually, we systematically conduct a digital examination of the Vater nipple through the incision of the duodenum during the cold duct.
Apart from such exceptional cases, we resort to diagnostic duodenotomy, which can be done in any segment, but more often due to the need to examine the papilla, we choose the second part of the duodenum.
The first stage consists in retracting the duodenum - the pancreas, which facilitates both the examination itself and the suturing of the incision. For the same purpose, the mesentery of the colon should be separated whenever it empties higher into D2. The incision is made on the ventral side of D2 - it can be in the longitudinal direction (McBurney) or in the transverse direction (Kocher). In the first case, there is the advantage that the incision can be continued if necessary (low localization of the nipple); The disadvantage of such an incision is the possibility of developing stenosis. Both incisions are acceptable provided the correct technique is used. Given that it is usually possible to locate the nipple before duodenotomy, we use a transverse incision that spares the vessels.
After establishing the location of the papilla, the incision is oriented towards it. The incisions are small. To avoid further breaks in the wall, the edges of the incision must be strengthened with a seam. The duodenotomy wound can be sutured with a single- or double-row interrupted suture. Under these conditions, ninety-six diagnostic duodenotomies were performed, in two cases, their complications were fistulas, which closed spontaneously. In both cases, exploratory duodenotomy was followed by complex sphincterotomy.
Except in the case when we are guided by a guide probe inserted through the choledochus, the papilla must be carefully looked for among the contiguous mucosal folds that cover it and which should be straightened. To recognize the papilla, you can use various landmarks or techniques: palpation (a node like a "grain of lead"), cholangiography during surgery, compression of the gallbladder, possibly in combination with the introduction of a solution of methylene blue into its cavity. The papilla resembles a cone-shaped elevation covered cranially by a transverse fold of mucosa and caudally by a longitudinal fold of mucosa (the frenulum). At the end of the papilla, a pinhole can be seen opening into the ampulla, into which the common bile duct and the Wirsungian duct usually empty.
Through the opening of the nipple, we can insert a stylet or a thin plastic tube into the Wirsungian duct or into the common bile duct in order to examine these ducts, make cholangiography and, accordingly, Wirsungography. Experience has shown that the probe penetrates into the Wirsungian duct more easily than into the choledochus, the catheterization of which is much more difficult without sphincterotomy. This is due to the direction of both ducts (the Wirsungian duct is located caudally and runs in the transverse direction).
The small caruncle (the confluence of the santorini duct) has the form of a point, barely noticeable formation, the opening in which is located 2-3 cm ventral and cranial of the papilla of Vater. Finding this caruncle is very difficult.
If we don't find a nipple after thorough examination, we must either assume an abnormal location, or one of the morphological variants (absence of an ampulla, separate confluence of the common bile and Wirsungian ducts at the apex of the caruncle; confluence of the Wirsungian duct into the terminal segment of the common bile duct, etc.). The best ways to detect the nipple in such cases are cholangiography performed during surgery, or the introduction of a catheter into the choledochus (after choledochectomy).

The upper section has round shape, and therefore it is also called an onion. Its length is 5-6 cm. The descending section, whose length is 7-12 cm, is located near lumbar spine. It is in this section that the ducts of the stomach and pancreas are removed. The length of the lower horizontal section is about 6-8 cm. It crosses the spine in the transverse direction and passes into ascending division. The ascending part is 4-5 cm long. It is located on the left side of the spinal column.

The duodenum is located within the 2-3 lumbar vertebrae. Depending on the age and weight of the person, the location of the intestine may vary.

The duodenum performs secretory, motor and evacuation functions. The secretory function is to mix the chyme with digestive juices that enter the intestine from the gallbladder and pancreas. The motor function is responsible for the movement of the food gruel. The principle of the evacuation function is to evacuate the chyme to the subsequent sections of the intestine.

2 Causes of pathology

Inflammation of the intestine, as a rule, occurs against the background of gastrointestinal disorders. Causative factors include a viral infection, inflammation of the lining of the stomach or gallbladder, diarrhea, and low blood flow to the intestines.

Inflammation of the intestine is often caused by an infection with Helicobacter pylori. This bacterium is in the stomach and does not manifest itself in any way. Its presence in the body leads to increased production of gastric acid, which further irritates the duodenal mucosa. Left untreated, the bacterium can cause intestinal ulcers.

Diseases of the duodenum can develop against the background severe stress or surgical intervention. In some cases, non-steroidal anti-inflammatory drugs (NSAIDs), smoking, or excessive alcohol consumption may be the underlying cause.

Inflammation of the duodenum 12 can be caused by food poisoning, eating spicy or fatty foods, as well as foreign object. It has been proven that some pathologies of the intestine can be hereditary. Pathogenic factors such as diabetes and gallstone disease.

Symptoms of duodenal disease have their own clinical picture and may differ from each other.

3 Peptic ulcer

A characteristic symptom of peptic ulcer is indigestion. The patient has frequent and liquid stool. Often, patients have a complete intolerance to dairy products and fruits. If the patient has sudden loss weight if available increased appetite, then this may indicate that the duodenum is inflamed.

If ulcers have affected an organ such as the duodenum, symptoms of the disease may appear in a characteristic yellow coating on the tongue. This is due to spasms of the bile ducts, which lead to stagnation of bile. In the advanced stages of the disease, pain appears in the right side and the skin acquires a yellow tint.

With a duodenal ulcer, there are cicatricial changes part of the stomach, which results in the evacuation of food. Congestion in the stomach leads to nausea and vomiting. Often, after vomiting, the general condition of the patient improves for a while.

Pain is a characteristic symptom of peptic ulcer disease. It can be aching or sharp, prolonged or paroxysmal. As a rule, the pain subsides after eating, which is why they are also called "hungry." This symptom occurs in 70-80% of patients. The pain is felt most often in the lumbar or thoracic region. In some cases, patients with duodenal ulcer may complain of pain in the collarbone.

4 Colon cancer and duodenitis

If a patient has been diagnosed with colon cancer, the symptoms of the disease may manifest as jaundice, fever, and itching. With first-degree cancer, there is pain. It occurs as a result of compression of the nerve fibers by the tumor or blockage of the bile duct. The pain syndrome is most often felt in the right hypochondrium, but in some cases the pain can spread to other organs.

One of the symptoms of the disease is itchy skin. It appears due to the high content of bilirubin in the blood and irritation of skin receptors with bile acids. Against the background of itching, the patient develops agitation and insomnia.

No less common disease of the duodenum is duodenitis. This ailment manifests itself in the form of distension of the stomach after eating, dull and constant pain, nausea, loss of appetite, vomiting. In patients with this diagnosis, palpation epigastric region painful.

5 Proper nutrition

For any of the diseases of the duodenum, the patient is prescribed diet food. The diet in combination with complex treatment eliminates exacerbations and significantly improves the general condition of the patient. If the duodenum is inflamed, then, first of all, foods that can stimulate the production of gastric acid are excluded from the diet. Such foods include sour fruits, fatty broths, fresh vegetables and fruit juices, mushrooms, smoked, salted, fried and pickled foods and spices. Sweet carbonated and alcoholic drinks are also prohibited.

The menu should contain easily digestible fats, such as vegetable oil, cream or margarine.

It is necessary to limit the intake of products that in any way irritate the mucous membrane. In order to avoid overloading the stomach and exacerbating the disease, it is not recommended to eat cold or hot dishes. Food should be at room temperature.

It is forbidden to eat foods that have mechanical irritation. These foods include raw vegetables and fruits, beans, peas, and whole grains. With inflammation of the duodenum, doctors recommend excluding mustard, vinegar, salt and other seasonings from the diet.

Meals should be frequent. You need to eat about 4-5 times a day. Between meals should be at least 3-4 hours. Preference should be given to dishes cooked in boiling water or steamed.

6 Treatment activities

Symptoms and treatment of duodenal pathologies are determined by the doctor after an appropriate examination. If the diagnosis confirmed peptic ulcer, then the patient is prescribed medication. To destroy the Helicobacter pylori bacteria, the patient is prescribed a course of antibiotics. These drugs include Erythromycin, Clarithromycin, Metronidazole and Ampiox.

To reduce production of hydrochloric acid doctors prescribe Omeprazole, De-Nol and Ranitidine.

These drugs provide bactericidal action. At severe pain doctors prescribe antacids.

Surgical treatment of duodenal ulcer is quite rare. Indications for surgery are complications of the disease. In this case, during the operation, the surgeon can remove the affected area of ​​​​the intestine, this helps to reduce the production of secretion and the level of hydrochloric acid.

Treatment of patients diagnosed with duodenal cancer is carried out using surgical intervention. The type of operation is chosen depending on where the malignant tumor is located and at what stage of development the disease is. A small tumor is removed laparoscopically, that is, through minimal punctures in the abdominal wall. If the tumor is large, then it is removed by extensive surgical operation. In this case, the doctor removes the outlet section of the stomach and the omentum adjacent to it, part of the duodenum, gallbladder and head of the pancreas.

If a malignant tumor was diagnosed on late stage, which greatly complicates the operation. In this case, the surgeon removes not only the tumor, but also the affected lymph nodes and adjacent tissues.

In addition to surgical treatment, the patient is prescribed radiation and chemotherapy. Such treatment helps prevent relapses and prolongs the life of the patient.

Patients diagnosed with duodenitis are prescribed medication and physiotherapy. In acute or chronic duodenitis, doctors prescribe painkillers: Drotaverine, No-shpu and Papaverine. To reduce the level of acidity of gastric juice, antacid drugs are prescribed, such as Omeprazole or Almagel.

If duodenitis has developed against the background of helminthic invasion, then treatment is carried out with antibiotics. To normalize the work of the intestine, drugs are prescribed that enhance its peristalsis. These drugs include Maalox and Domperidone.

As an auxiliary treatment, physiotherapy is performed. Ultrasound, heating, paraffin applications and magnetotherapy. Physiotherapeutic procedures allow you to normalize the blood supply and lymph flow of the abdominal organs, relieve pain.

HOW to determine inflammation of the duodenum 12

You will need

• - referral of a gastroenterologist for examination.

Instruction

Symptoms of a disease of the duodenum can be similar to those of a disease of the stomach and colon. therefore appointed full examination gastrointestinal tract. Most often, inflammatory processes of the duodenum manifest themselves in the form of pain 1.5-2 hours after eating, as well as hunger pains, indigestion, which manifests itself in the form of constipation or diarrhea. These symptoms can be attributed to all diseases associated with damage or inflammation of the mucous membranes of the gastrointestinal tract.

The doctor necessarily prescribes an ultrasound, but this method does not always allow you to put accurate diagnosis, especially in obese patients, but helps to determine the location of all organs, the presence of foreign inclusions.

If you have been prescribed an irrigoscopy, then with the help of an enema they will introduce radiopaque agent and will diagnose using x-rays, which allows you to determine the patency of the duodenum.

During colonoscopy, a hardware examination of the duodenum is performed through the lumen. This allows you to make an accurate diagnosis of the mucosal lesion and determine the extent of the lesion.

During a barium x-ray, you will be given a drink of 500 mg of a solution that resembles dissolved chalk. If there are significant mucosal lesions, the x-ray will show the presence of niches.

Fibrogastroscopy allows you to determine the size of the lesions, allows you to get material for a biopsy. If the ulcers are deep and bleeding, then this method allows you to carry out medical manipulations and stop the bleeding.

Clinical manifestations of inflammatory diseases of the colon and small intestine are diverse. In the initial stage, the course of the disease is almost asymptomatic and is manifested by intestinal discomfort, delayed or increased stools, bloating, general malaise and discomfort. In order to make an accurate diagnosis in a timely manner, it is necessary to undergo a medical examination.

You will need

• - Referral for examination.

Instruction

Inflammatory diseases of the colon and small intestine always affect its inner lining. If you feel the listed symptoms, address to the doctor to the proctologist and the gastroenterologist. Examination must be carried out throughout the gastrointestinal tract, since the disease of one part of the intestine leads to disruption of the entire gastrointestinal tract.

Any doctor begins the examination by listening to the subjective complaints of the patient and examining with the help of palpation. In this case, the abdomen is palpated from all sides. A hardware examination is prescribed after collecting an anamnesis of the disease and after careful preparation of the patient.

Before any kind of hardware examination, you will be prescribed a diet for 10 days, daily enemas, laxative tablets.

Eliminate from the diet all indigestible foods, meat, cheese, legumes. Completely give up bread, alcohol, carbonated drinks, sweets. Eat mashed porridge on the water or mashed vegetables. Do an enema daily with Esmarch's mug.

Take an enema the day before the test. Do not eat 24 hours before the examination, no water for 6 hours.

Based on the examination, you will be given an accurate diagnosis and prescribed outpatient, inpatient or surgical treatment. TO inflammatory diseases intestines include: colitis, enteritis, proctitis, typhlitis, appendicitis, sigmoiditis. In severe cases of the disease, liquid pus or serous exudate may be discharged from the rectum. If deep ulcers are found, it threatens with perforation and peritonitis. Therefore, you must follow all the doctor's recommendations and complete the entire course of treatment prescribed.

We diagnose inflammation of the duodenum 12: symptoms

Inflammation of the duodenum is a disease that, depending on its cause, can be cured with proper diet and antibiotics. Often, however, this disease leads to consequences that are classified as peptic ulcer disease.

The most common symptoms are due to hyperacidity and the use of certain medications such as salicylates and antirheumatic agents, alcohol consumption. But a factor involved in the development of the disease can be acidity or even stress. The cause may also be bacteria, in particular Helicobacter pylori, which is also responsible for the occurrence of gastritis and stomach ulcers.

Inflammation often occurs as a result of dietary errors. The disease is associated with eating contaminated food or containing toxins or harmful chemicals.

All these factors cause damage to the mucous membrane that lines the duodenum, and therefore erosion occurs. Often, initial symptoms ignored by man. Due to not timely treatment erosion will increase over time. The disease then takes chronic form and soon leads to an ulcer. Therefore, it is very important to pay attention to the symptoms.

Symptoms of inflammation of the duodenum 12

With inflammation of the duodenum, the following symptoms are present:

• Pain different intensity in the epigastric region, burning or dull;
• Nausea and vomiting;
• Fever;
• Malaise;
• General weakness of the body;
• Diarrhea.

Pain in the abdomen, namely in the middle, can be especially severe in the morning.

How to diagnose inflammation of the duodenum 12

Currently, a doctor can make a more accurate diagnosis based on the results of endoscopy. Endoscopy upper divisions gastrointestinal tract and duodenum shows an accurate picture of the disease. To perform this test, a device called an endoscope or gastroscope is used. It is in the form of a thin and flexible hose that is inserted through the mouth or nose into the throat and then passed through the esophagus and stomach into the duodenum.

Inflammation and erosion of the duodenum: diet

The first step is to reduce your consumption food products strongly stimulating the secretion of gastric acid. This is primarily coffee and foods containing caffeine, strong tea, carbonated drinks, alcohol, rich broths, mushrooms, sour fruits, undiluted fruit and vegetable juices, pickled foods, smoked meats, fried and baked foods, spicy dishes, salty, too sour.

Include in the diet you need dietary products that inhibit the secretion of gastric acid and easily digestible fats, such as butter, cream, vegetable oils, olive oil, margarine.

It is necessary to limit products a) thermally b) mechanically and c) chemically irritating the gastric mucosa:

a) thermally irritating foods - foods that are too cold and too hot, they stimulate the peristalsis of the stomach and intestines and call for further overload and exacerbation of the disease.

b) mechanically irritating products - products with high content fiber, whole wheat, whole grains, raw fruits and vegetables, dry legumes.

c) chemically irritating foods: too sour fruits, undiluted juices, smoked foods, highly salty, spicy spices(pepper, paprika, chili pepper, mustard, ketchup, vinegar, salt).

Regular food intake is necessary, between meals there should not be an interval of more than three hours.

It is important to eat 4-5 times a day. The day should start with good breakfast. This is the first meal after a long night break. The last meal should be consumed an hour before bedtime to prevent hunger pain at night. Meals should not be too heavy. You should eat slowly, without rushing, preferably at certain times of the day.

Use appropriate cooking techniques. Meals should be cooked in boiling water, steamed, steamed, baked in foil, sautéed.

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Signs of gastric and duodenal ulcers

According to statistics, about 5% of people annually seek help for peptic ulcer. In most patients, the clinic proceeds classically, but along with this, there are erased forms of gastric and duodenal ulcers.

Manifestation of pathology

Patients, as a rule, begin to sound the alarm when a severe pain syndrome appears. Depending on the location of the mucosal defect, pain can be early, hungry, nocturnal, late, and in some cases not at all associated with food intake. This is due to the direct action of chyme on the ulcer of the duodenum and stomach. The damaged mucosa is additionally irritated by the motility of the organs during the advancement of the food bolus.

Characteristics of the pain syndrome

Pain is described with different intensity and color. There may be cramping or constant discomfort from the epigastric zone of the abdomen. The feeling is described as something squeezing, stabbing, cutting, squeezing the epigastrium.

In the presence of an ulcer in the cardial part of the stomach, pain can radiate to the sternum, to the shoulder, to the left side of the chest, simulating angina pectoris. This localization of pathological changes is characterized by the development/intensification of symptoms no more than 30 minutes after saturation with food.

After 1-1.5 hours, signs of an ulcer of the antrum of the stomach and 12 duodenal ulcer appear, the symptoms may include vomiting at the peak of abdominal pain. The disease is accompanied by constipation. If a deep defect is located on the back wall of the stomach, pain may radiate to the back and lower back. In such a situation, women are suspected of problems in the gynecological field.

Ulcerative lesions of the duodenum in isolation are not so common. At the same time, the pain symptoms of the pathology of the bulbar and postbulbar regions differ. Signs of a duodenal ulcer in the region of the bulb are somewhat erased, pain does not depend on meals, can be permanent, localized in the right side of the epigastrium, radiating to umbilical region And chest on right. Ulceration of the mucosa outside the bulb can be determined due to the appearance of more intense pain after a couple of hours after eating and disappearing only after 20 minutes from satisfying hunger.

Additional signs of gastric and duodenal ulcers

Together with pain syndrome dyspeptic phenomena are of some importance:

• nausea;
• vomit;
• heartburn and belching;
• constipation.

How to test assumptions?

Diagnosis of gastric ulcer, bulbar and extrabulbar duodenal ulcers includes the collection of information about the prescription of the condition, heredity, examination by a specialist, instrumental and laboratory studies. The therapist or gastroenterologist, performing a manual examination of the abdomen, identifies areas of maximum pain, is determined with a preliminary diagnosis and further diagnostic search.

The main methods by which you can diagnose diseases of the duodenum and stomach include:

• endoscopy (FGDS);
• x-ray;

Fibrogastroduodenoscopy is a technique that allows you to visually examine the mucosa digestive organs the upper part of the abdominal cavity from the inside. This study is extremely important for diagnosis. Thanks to FGDS, the doctor can determine the length of the area covered with ulcers, take material for analysis for helicobacter pylori and biopsy. In addition, in the presence of bleeding, endoscopy can really be transferred to the category of medical manipulations (drug instillation, coagulation).

Important! Endoscopic diagnosis of gastric ulcers is strictly required for suspected malignant degeneration of cells. If malignancy is detected, the patient is examined and subsequently treated by an oncologist.

If it is impossible to conduct EGD, the patient is prescribed alternative methods diagnostics.

Beam methods

Fluoroscopy / radiography of the stomach and duodenum is performed using a contrast agent. Detected using X-ray the following signs this pathology:

• symptom of "niche" (due to filling the bottom of the ulcer with contrast);
• convergence of folds to the center of the defect;
• inflammatory shaft around the ulcer (due to tissue edema);
• increase in fluid volume;
• radiographic symptoms of pyloric stenosis, scarring;
• motor-evacuation dysfunction.

The advantage of ultrasound is the ability to make a conclusion regarding the state of the liver, morphology bile ducts and pancreas, which may be initially affected or secondary to the stomach and intestines. In such a case, along with manifestations of peptic ulcer, disorders of the glands are noted. digestive system.

Thus, the diagnosis of gastric ulcer is primarily based on the endoscopic picture of the disease and clinical symptoms. Ultrasound can differentiate some conditions and is helper method. X-ray of the stomach and duodenum confirms the diagnosis in case of contraindications to FGDS.

Laboratory methods

If a peptic ulcer is suspected or detected, the patient is prescribed blood tests (clinical, biochemical and for antibodies), urine, feces. The presence of anemia indirectly confirms the fact of bleeding. A positive Gregersen test indicates the presence of a bleeding vessel in the gastrointestinal tract.

For a complete diagnosis, it is possible to use various tests for Helicobacter pylori. The most famous is the breath test. The patient is given to drink a special solution with urea. Then, using an indicator in the exhaled air, the concentration of substances metabolized by Hp is estimated.

Complicated course

The formation of the adhesive process and the malignancy of the ulcer are chronic. In such cases, the symptoms progress gradually and for a long time. Dyspeptic manifestations are aggravated.

Diagnosis of duodenal ulcer should be carried out in as soon as possible with the development of a clinic of an acute abdomen, massive bleeding, vomiting of clotted blood of the color of "coffee grounds", black stools. The patient is urgently taken to the surgical hospital, where immediate treatment is carried out.

Diseases of the duodenum: symptoms, therapy, diagnostic methods

The human intestine consists of a thick and thin section. TO thin department the duodenum belongs - the symptoms of the disease of this organ are not always pronounced, therefore, diagnosis requires laboratory tests.

The length of the duodenum (duodenum) is only thirty centimeters. Its main functions are to transport food to the large intestine and assimilate vital important trace elements. If in the duodenum are detected pathological changes and it ceases to function normally, this negatively affects all organs of the digestive system and the human body as a whole.

Duodenum: causes of diseases of the organ

The most common pathologies of the duodenum, gastroenterologists call duodenitis, ulcers and cancer.

IN medical literature identify the following causes of these diseases:

Nowadays, diseases of the duodenum are increasingly being diagnosed in patients young age. This contributes sedentary image life, snacking on the run, drinking alcohol and smoking, going to nightclubs and other places of entertainment instead of a good rest. Let us consider in more detail the main diseases of the duodenum.

Treatment of duodenitis of the duodenum based on symptoms

Duodenitis is acute or chronic illness DPC, which is accompanied by inflammation of the mucous membrane of this organ.

Acute duodenitis occurs when food poisoning or trauma to the mucous membrane of a foreign body. Risk factors for the transition of the disease to the chronic stage are malnutrition, alcohol consumption and smoking.

There are such symptoms of duodenitis:

• cramping or dull pain in the upper abdomen;
• heaviness in the stomach;
• feeling of overeating;
• nausea;
• belching;
• vomit;
• heartburn;
• constipation.

Treatment of duodenitis includes the appointment of a special diet. In the first ten days after acute attack you need to abandon the use of alcohol, canned food, smoked meats, as well as spicy, fried and sour dishes. The basis of the diet should be steamed food. It should be taken in small portions six times a day.

To restore the functions of the duodenum with duodenitis, use the following products:

• yesterday's wheat bread;
• buckwheat, rice and semolina porridge;
• small pasta;
• egg white omelet;
• dry biscuit;
• dairy products;
• boiled vegetables ( cauliflower, broccoli, potatoes, carrots, pumpkin, beets, zucchini).

During the period of treatment of duodenitis, the following products should be abandoned:

• barley and millet porridge;
• legumes;
• pasta;
• eggs (fried and hard boiled);
• fatty dairy products;
• carbonated drinks;
• sweets;
• fresh bread.

Such a diet must be followed for life, but in acute period diseases, it should be especially strict.

To improve the effectiveness of medications, treatment is supplemented with physiotherapy procedures.

Apply electrophoresis with novocaine, magnetotherapy and galvanization. In sanatorium-resort conditions, natural mud applications are used.

How to beat peptic ulcer?

A duodenal ulcer is a chronic disease that manifests itself in the formation of ulcerative defects on the mucous membrane. Peptic ulcer is a complication of gastritis, duodenitis and other inflammatory processes. Its exacerbations occur in autumn and spring.

For a long time, the symptoms of peptic ulcer appear in the form of mild digestive disorders, which quickly pass. Most people limit themselves to taking painkillers. However, such actions bring only temporary relief, while the duodenal ulcer progresses more and more. If treatment is not started on time, the disease can go into an acute stage.

The leading role in the appearance of duodenal ulcers is played by infection of the mucous membrane with the bacterium Helicobacter pylori. It is very important to recognize the symptoms of the disease in time.

Most often, at the appointment with a gastroenterologist, the patient makes the following complaints:

• pain in the epigastric region on the right, subsiding after eating;
• cramps in the abdomen, which sometimes radiate to the shoulder blade or back;
• nausea;
• yellow coating on the tongue;
• bloating;
• decrease in performance.

Ulcerative duodenal disease rarely develops on its own. As a rule, the patient is simultaneously diagnosed with cholecystitis and gastritis. The list of symptoms of an ulcer can be expanded due to the influence of certain pathological processes.

Treatment of peptic ulcer medications aimed at healing the ulcer, relieving pain and preventing complications.

The most commonly used drugs are:

• Esomeprazole, Omeprazole, Lansoprazole, Rabeprazole and Pantoprazole reduce stomach acid;
• Cimetidine, Nizatidine, Famotidine and Ranitidine reduce acid production;
• Metronidazole in combination with omeprazole is prescribed when the bacterium Helicobacter pylori is detected.

If conservative therapy turned out to be ineffective or a complication such as severe bleeding appeared, surgical treatment is performed.

Duodenal cancer: do not miss the first symptoms

How independent disease duodenal cancer is uncommon and early stage does not appear at all. As the tumor grows, the symptoms may be the same as with duodenitis and ulcers.

But it also adds other features:

• pain in the right hypochondrium;
• itching - this symptom is associated with skin irritation with bile acids;
• rapid weight loss;
• severe weakness.

Cancer treatment should focus on surgical intervention. During the operation, the part of the duodenum affected by the tumor and part of the lymph nodes, which may contain cancer cells, are removed.

With an extensive cancerous lesion during surgery, part of the stomach, pancreas and gallbladder may be affected.

After the operation, courses of chemical and radiation therapy are carried out. The use of these treatments reduces the risk of postoperative recurrence.

The duodenum: how to identify the pathology of the organ?

To diagnose diseases of the duodenum, the following examination methods are used:

• Gastroscopy is a study in which the patient's organs are examined with an endoscope. This diagnostic method determines the presence of a peptic ulcer or other damage to the duodenum, and also evaluates changes in the mucous membrane;
• Clinical blood test. This study allows you to identify the inflammatory process, signs of anemia and other disorders;
• Biopsy - microscopic examination a small piece of intestinal mucosa;
• A blood test for the bacterium Helicobacter pylori;
• Analysis of feces for occult blood. This examination method is necessary to detect intestinal bleeding;
• Magnetic resonance imaging is a modern diagnostic method, which is used when difficulties arise with the diagnosis.

In almost all diseases of the duodenum, it is necessary to observe therapeutic diet. At the initial stage of the development of diseases of the duodenum, conservative treatment is indicated, and when serious complications surgical method is used.

How to check the intestines for diseases?

If various diseases are suspected, an examination of the intestine is required. It involves examining the mucous membrane and determining peristalsis. Distinguish between small and large intestine. Inspection of the initial sections is difficult. Instrumental diagnostic methods are supplemented by laboratory tests, palpation and questioning of a sick person.

Instrumental examination of the intestine

Intestinal examination is performed according to certain indications. Patients can be both adults and children. There are endoscopic and non-endoscopic techniques. In the first case, the mucous membrane is examined from the inside using a camera. This is the most informative way to identify various diseases. It is necessary to examine a person if he has the following symptoms:

• constant or periodic pain in a stomach;
• violation of the stool by the type of constipation or diarrhea;
• vomiting of feces;
• bloating;
• the presence of blood or other pathological impurities in the feces.

The following studies are most often organized:

• fibroesophagogastroduodenoscopy;
• colonoscopy;
• sigmoidoscopy;
• anoscopy;
• irrigoscopy;
• computed or magnetic resonance imaging;
• capsule colonoscopy;
• radionuclide research;
• radiography.

Sometimes a laparoscopy is performed. Therapeutic and diagnostic procedure, in which the organs of the abdominal cavity are examined from the outside. During the examination of patients, the following diseases can be detected:

• benign and malignant tumors;
• ulcerative colitis;
• Crohn's disease;
• diverticula;
• polyps;
• duodenal ulcer;
• duodenitis;
• enterocolitis;
• proctitis;
• haemorrhoids;
• anal fissures;
• condylomatosis;
• paraproctitis.

Endoscopic examination of the duodenum

FEGDS allows you to check the condition of the duodenum. This is an endoscopic method for examining patients. It allows you to examine only the initial section of the small intestine. FEGDS is often performed for therapeutic purposes. During the study, you can stop the bleeding or remove the foreign body. There are planned and urgent FEGDS.

The benefits of this study are:

• rapidity;
• information content;
• good tolerance;
• safety;
• low invasiveness;
• painlessness;
• the possibility of implementation within the walls of the clinic;
• availability.

The disadvantages include discomfort during the introduction of the probe and discomfort during the withdrawal of anesthesia. FEGDS is performed if the following pathology is suspected:

Before FEGDS preparation is required. It includes not eating immediately before the procedure and following a diet for several days. Spicy foods, nuts, seeds, chocolate, coffee and alcoholic beverages should be excluded from the diet 2-3 days before the study. Dinner on the eve should be no later than 18 pm.

In the morning you can not eat breakfast and brush your teeth. It is necessary to examine the duodenum and stomach in the supine position on the left side with the knees pressed to the body. A thin tube with a camera is inserted through the patient's mouth. Held local anesthesia. This ensures a painless procedure. During the examination, the person should not talk. Saliva should be swallowed only with the permission of a doctor. You can eat only 2 hours after the study.

Contraindications for FEGDS are:

• curvature of the spinal column;
• atherosclerosis;
• neoplasms of the mediastinum;
• a history of stroke;
• hemophilia;
• cirrhosis;
• myocardial infarction;
• narrowing of the lumen of the esophagus;
• bronchial asthma in the acute phase.

Relative limitations include severe hypertension, angina pectoris, lymphadenopathy, acute inflammation tonsils, mental disorders, inflammation of the pharynx and larynx.

Performing an intestinal colonoscopy

The main instrumental method for diagnosing diseases of the colon in women and men is colonoscopy. It is classic and capsule. In the first case, a fibrocolonoscope is used. This is a flexible tube that is inserted into the intestine through anus.

The possibilities of colonoscopy are:

• extraction of foreign objects;
• restoration of intestinal patency;
• stop bleeding;
• biopsy;
• removal of tumors.

How you can prepare for this procedure, not everyone knows. The main goal is to cleanse the intestines. For this, enemas or special laxatives are used. In case of constipation, an additional Castor oil. An enema is performed when a bowel movement is delayed. To carry it out, you will need a mug of Esmarch and 1.5 liters of water.

Within 2-3 days you need to follow a slag-free diet. It is forbidden to use fresh vegetables, fruits, greens, smoked meats, pickles, marinades, Rye bread, chocolate, peanuts, chips, seeds, milk and coffee. On the evening before the procedure, it is required to clean the intestines. Used drugs such as Lavacol, Endofalk and Fortrans.

Colonoscopy is performed under local anesthesia. The procedure is less pleasant than FEGDS. A probe with a camera at the end is inserted into the rectum. The doctor examines all parts of the large intestine, starting with the rectum. The expansion of the intestine occurs due to the injection of air. This study lasts minutes. The following complications are possible with an incorrectly performed colonoscopy:

If the general condition worsens after the procedure, you should visit a doctor. Normally, in a healthy person, the mucosa of the large intestine pale pink. It is shiny, without ulcerative defects, protrusions and outgrowths, smooth with slight striation. The vascular pattern is uniform. Seals, pus, blood, fibrin deposits and necrotic masses are not determined. Absolute contraindications to colonoscopy are peritonitis, severe heart and respiratory failure, heart attack, severe ischemic stroke and pregnancy.

X-ray examination of the intestine

Methods for examining the intestines include irrigoscopy. This is a type of radiography that uses a dye. This study allows you to determine the pathological changes in the mucosa. The bowel relief is assessed in detail. Contrasting is simple and double. In the first case, barium sulfate is used. In the second, air is additionally introduced.

The advantages of irrigoscopy are:

• safety;
• painlessness;
• availability;
• information content;

The condition of the colon (ascending, transverse and descending), sigmoid and rectum is assessed. It is recommended to inject contrast not through the mouth, but through the rectum using an enema. During the examination, the patient is on his side with his upper leg pressed to his stomach. A rectal tube is installed through which a barium solution is injected.

Then an overview photo is taken. After that, the examined person empties the intestines. Next, a second photo is taken. There are the following indications for irrigoscopy:

• suspicion of a tumor;
• blood in the stool;
• the presence of stool with pus;
• pain during bowel movements;
• bloating with stool retention;
• chronic constipation and diarrhea.

There are 3 main methods of preparation for the procedure:

• cleansing enemas;
• taking the drug Fortrans;
• carrying out hydrocolonotherapy.

A conclusion is drawn from the picture. Irritable bowel syndrome can be suspected if uneven folds-gaustras, areas of narrowing of the intestine in combination with incomplete excretion of contrast during defecation are detected. If during the examination an uneven diameter of the colon, a narrowing of the lumen against a background of spasm, and areas of asymmetric contraction are found, this indicates ulcerative colitis. Barium enema should not be performed in pregnant women, with intestinal perforation, diverticulitis, ulcers, and severe heart failure.

Conducting a capsule study

Modern methods of examining the intestines include capsule colonoscopy. Its difference is that nothing is introduced into the anus of the patient. It is enough to take one capsule, equipped with two chambers. The advantages of this study are:

• safety;
• simplicity;
• no need for anesthesia;
• no radiation exposure;
• minimally invasive;
• the possibility of examining the intestine without a cleansing enema.

The disadvantages include the inconvenience of processing the received data and the difficulty of swallowing. A picture of the intestine with a capsule is recorded on a special device that is worn on a belt. This study is of limited use. It is costly. A capsule examination is performed when it is impossible to carry out colonoscopy and barium enema.

Complications include a delay in the removal of the capsule. Some patients develop allergic reactions. The study is being carried out in outpatient settings. The person does not need to be in the hospital. After swallowing the capsule, you can exercise daily affairs. Preparation includes the use of laxatives.

Examination with a sigmoidoscope

To examine the final sections of the intestine, sigmoidoscopy is often organized. The procedure is performed using a sigmoidoscope. It is a lighting device with a metal tube. The thickness of the latter is different. Using a sigmoidoscope, you can examine the mucosa of the sigmoid and rectum at a distance of up to 35 cm from the anus.

• pain in the anus during bowel movements and at rest;
• persistent constipation;
• unstable chair;
• bleeding from the rectum;
• the presence of mucus or pus in the feces;
• feeling of a foreign body.

The study is carried out in chronic hemorrhoids and inflammation of the colon. Sigmoidoscopy is contraindicated in acute anal fissure, narrowing of the intestine, massive bleeding, acute paraproctitis, peritonitis, cardiac and lung failure. The preparation is similar to that for a colonoscopy.

Immediately before the introduction of the tube of the sigmoidoscope into the anus, it is lubricated with petroleum jelly. The advancement of the device is carried out during attempts. To straighten the folds of the intestine, air is pumped. In the presence of a large amount of pus or blood, an electric pump can be used. If necessary, material is taken for histological analysis.

Other research methods

Magnetic resonance imaging is a modern method for diagnosing bowel diseases. It can be done with double contrast. The dye is administered intravenously and through the mouth. This method cannot replace a colonoscopy. He is supportive. The advantages of MRI are painlessness, information content and the absence of radiation exposure.

Layered pictures of the organ are taken. The doctor receives a three-dimensional image on the screen. Tomography is based on the use of magnetic fields. The latter are reflected from the nuclei of tissue hydrogen ions. Before an MRI, you need to clean the intestines and follow a diet for several days. The procedure takes about 40 minutes. Pictures are taken while the patient is holding his breath.

The patient is placed on the platform and the body is fixed with straps. The methods of examination of patients include anoscopy. With it, you can examine the final section of the intestinal tube. An anoscope is required. This is a device that consists of an obturator, a tube and a light handle.

Anoscopy often requires a finger test before anoscopy. rectal examination. This is done in order to assess the patency of the intestine. If necessary, an anesthetic ointment is used. Thus, if you suspect intestinal pathology necessarily carried out instrumental research. It is impossible to make a diagnosis on the basis of a survey, examination and palpation.

Examination of patients with diseases of the gastroduodenal region begins with questioning. Most often, these patients complain of pain in the epigastric region, nausea, belching, vomiting, change in appetite. However, these complaints are quite common in the pathology of other organs and therefore are of little specificity. The data of the physical examination of patients (examination, palpation of the abdomen) are usually uninformative. Due to this crucial in the diagnosis of diseases have additional research methods, primarily gastroduodenoscopy and X-ray examination.

questioning

Complaints. pain in the abdomen, caused by the pathology of the stomach, are usually localized in the epigastric region and can be both permanent and paroxysmal. The most characteristic are paroxysmal pains associated with eating, which occur shortly after eating after a certain period of time or disappear after eating. Patients may complain of a vague painful feeling of pressure or tension in the epigastric region associated with gastric overflow and bloating. Pain associated with stomach disease occurs as a result of disorders motor function this organ (with spasm or stretching of the smooth muscle fibers of its wall).

Heartburn- a burning sensation in the esophagus, due to the reflux of gastric contents.

Nausea - discomfort in the epigastric region. In diseases of the stomach, it is usually combined with pain.

Vomit- paroxysmal ejection of the contents of the stomach into the esophagus and further into the oral cavity as a result of contractions of the abdominal press, movements respiratory muscles when the pylorus is closed, it is often combined with nausea, abdominal pain. In patients with gastric disease, pain usually subsides after vomiting.

Belching- sudden release into the oral cavity of a small portion of gastric contents due to compression of the stomach between the diaphragm, abdominal wall and bloated bowels or pyloric spasm.

Change in appetite- its decline is widespread. Lack of appetite - anorexia- common symptom stomach cancer.

Disease history. The onset of the disease can be acute (gastritis after an error in the diet) and gradual. There are frequent exacerbations and long periods remission (with peptic ulcer). The progression of the disease is characteristic of gastric cancer. It is always important to clarify the relationship of stomach disease with taking medicines such as non-steroidal anti-inflammatory drugs.

Physical research methods

A general examination of the patient reveals weight loss (up to fco cachexia), pallor of the skin associated with anemia, and a white-coated tongue.

Superficial palpation of the abdomen often reveals pain in the epigastric region and slight tension in the abdominal muscles, usually associated with peptic ulcer or gastritis.

Deep sliding palpation only occasionally allows you to feel the small and large curvature and pyloric parts of the stomach, and even less often - a tumor of the stomach. Percussion and auscultation of the stomach, as a rule, are not significant.

Additional research methods

X-ray examination. First of all, it is necessary to prepare the patient for the study. To this end, the night before and in the morning on the day of the study, his intestines are cleansed with enemas, with persistent constipation, laxatives are prescribed. The study is carried out on an empty stomach, in vertical position sick. Barium sulphate is used as a contrast. The study begins with determining the relief of the gastric mucosa, the folds of which have great variations and often change depending on the stage of the digestion process, becoming either more prominent and distinct, or flattening. If their course is interrupted, they assume the presence in this place pathological process. It is important to study the contours of the stomach. The persistent protrusion of its shadow is designated as a niche, which is a typical symptom of gastric ulcer. Lack of filling of the stomach area with a contrast mass is called a filling defect and is important symptom neoplasms.

Gastroduodenoscopy. With the use of fiber optics, gastroduodenoscopy has been intensively developed and has become the most effective and rapidly applied method. Simultaneous biopsy and morphological examination made this method the most effective diagnostic method. The main indication for gastroduodenoscopy is upper gastrointestinal bleeding and epigastric pain. The great importance of this method lies also in the possibility of using local treatment with continued bleeding. The advantage of gastroscopy is the ability to detect superficial changes in the mucous membranes that are not detected radiographically. In the presence of a stomach ulcer found on x-ray, endoscopy is also usually required to visually and histologically rule out an ulcerated tumor. For any suspicion of a tumor of the stomach, including the presence of symptoms such as weight loss, anemia, an endoscopic examination is necessary.

Biopsy of the gastric mucosa and cytological examination. This method is used to exclude or confirm the presence of a tumor. In this case, tissue for research is taken in several (preferably 6-8) places, the accuracy of the diagnosis in this case reaches 80-90%. It should be noted that both false positive and false negative results are possible.

Examination of gastric juice. The study is carried out using a thin probe, the introduction of which requires the active assistance of the subject. A portion of gastric contents is obtained on an empty stomach and then every 15 minutes after the introduction of the stimulus. The acidity of gastric contents can be determined by titrating it with 0.1 mmol/l NaOH solution in the presence of dimethylaminoazobenzene and phenolphthalein (or phenol red) indicators to pH 7.0 while neutralizing the acidic contents with alkali.

Basal acid secretion is the total amount of hydrochloric acid secreted in the stomach over four 15-minute time intervals and expressed in mmol/h. This indicator ranges normally from 0 to 12 mmol / h, on average 2-3 mmol / h.

Study of stimulated secretion of hydrochloric acid. The strongest irritants of gastric secretion are histamine and pentagastrin. Since the latter has less side effect, it is being used more and more frequently. To determine basal acid secretion, pentagastrin or histamine is injected subcutaneously and gastric contents are collected over four 15-minute periods. As a result, the maximum secretion of acid is determined, which is the sum of the maximum consecutive values ​​of secretion for 15 minutes of collection of gastric juice.

Basal and maximum acid secretion is higher in patients with localization of the ulcer in the duodenum, with the location of the ulcer in the stomach, acid secretion in patients is less than in healthy ones. Benign gastric ulcers rarely occur in patients with achlorhydria.

The study of gastrin in blood serum. The determination of the content of gastrin in serum is carried out by radioimmunoassay and may have diagnostic value in diseases of the gastroduodenal zone. Normal values this indicator on an empty stomach is 100-200 ng / l. An increase in the content of gastrin over 600 ng/l (severe hypergastrinemia) is observed in Zollinger-Ellison syndrome and pernicious anemia.