Diseases, endocrinologists. MRI
About the site Contacts
Menu
Contacts
Site search

home Folk remedies How to stop bleeding stomach ulcers. General issues of treatment tactics. How is ulcer bleeding treated?

How to stop bleeding stomach ulcers. General issues of treatment tactics. How is ulcer bleeding treated?

One of serious complications A bleeding stomach ulcer is considered a peptic ulcer. It occurs when defects in the mucous membrane increase, which can lead to damage to blood vessels and bleeding. Against this background there is always sharp deterioration patient's condition.

Causes

Bleeding stomach ulcer and twelve duodenum always occurs against the background of deep ulceration. Internal bleeding begins when the lesion reaches the vessels and arteries.

There are a number of predisposing factors to bleeding from a stomach ulcer. First of all, the occurrence of such a complication is associated with the patient’s violation of the prescribed diet. In particular, the risk increases when the patient's diet includes:

  • Rough foods that can injure the ulcer.
  • Hot and cold foods that irritate wounds on the mucous membrane.
  • Alcoholic drinks, which are especially dangerous on an empty stomach.

Besides, perforated ulcer stomach often occurs:

  • After an abdominal injury.
  • Long term use medicines.
  • For cardiovascular pathologies.
  • For diabetes mellitus.


Increases the risk of bleeding from stomach ulcers poor clotting blood. Also, defects in the mucous membranes increase with stress, nervous strain and emotional breakdowns. Sometimes a dangerous pathology can occur during heavy physical exertion or sudden lifting of weight. The following can trigger bleeding in a patient:

  • Prolonged mental stress.
  • Avitaminosis.
  • Failure to comply with the work and rest schedule.

Sometimes doctors explain the development of a dangerous complication in a patient with a stomach ulcer by genetic predisposition. That is, if a bleeding ulcer was diagnosed in one of the parents, then there is a high probability of bleeding in children.

Symptoms

If hemorrhage is of a hidden form, then there may be no signs of bleeding. The patient's well-being changes slightly. As a rule, only weakness is observed. But even weak prolonged bleeding with a stomach ulcer it leads to oxygen starvation of tissues, which manifests itself in the patient:


In addition, if the ulcer has opened, black feces appear, and traces of blood may be observed in the belching. Symptoms of bleeding in peptic ulcer disease are more pronounced with massive blood loss.

In particular, the patient always experiences severe vomiting mixed with blood. It can be disposable or reusable, but after it there is never any relief. In this case, against the background of bleeding, the patient experiences such severe pain syndrome that a person may lose consciousness.

When the first serious signs, indicating severe internal bleeding, even if the body is not able to independently replenish the blood loss, in case of urgent medical care the consequences of severe hemorrhagic shock are still reversible.


Otherwise, if help is not provided, symptoms of multiple organ failure may develop. This means that the patient's blood pressure will drop to critical level, swelling of the brain tissue will occur, the functions of the heart and other internal organs. In this case, a bleeding stomach ulcer can be fatal.

First aid

When obvious symptoms appear that ulcerative bleeding has opened, it is necessary to urgently call ambulance. It is very important to accurately describe the symptoms that caused the emergency call.

While waiting for the arrival of specialists, it is necessary to ensure that the person is completely immobile. To do this, you need to lay it on a hard horizontal surface and place a pillow under your feet. This position will increase blood flow to the brain, which will reduce the risk of hypoxia.

First aid for gastrointestinal bleeding also involves cooling the stomach area to promote vasoconstriction. At home, you can use ice or frozen food from the freezer.


It is necessary to apply cold for a quarter of an hour, and then remove it. This will help, if not stop the bleeding, then to slow it down to a certain extent. And this is very important for stabilizing the condition of a bleeding stomach ulcer.

It is strictly forbidden to give water and food to a person when he has a stomach ulcer. This will increase gastric motility and increase blood circulation, which means blood loss will increase.

Do not give any painkillers during acute pain. You should also not try to sit the person down or lift them up if vomiting occurs. All you need to do is turn the person on their side to prevent vomit from entering the respiratory tract.

It is very important to be close to the person and constantly talk to him. We must strive to prevent him from losing consciousness. To do this, it is recommended to use ammonia before the ambulance arrives.

Diagnostics

An experienced ambulance specialist even during initial examination with low blood loss characteristic symptoms can determine that blood is leaking from the ulcer. But in order to determine the extent of the bleeding ulcer and the danger of the resulting complication, it is necessary to undergo tests and perform a number of studies:


  • General blood analysis. In it, the main indicators for confirming bleeding will be a decrease in the number of red blood cells and hemoglobin.
  • Coagulogram, which determines blood clotting.
  • Bilirubin test. The level of this substance always increases with perforation and perforation of the ulcer.
  • Ultrasound abdominal cavity.

If the patient’s condition allows, then after his admission to the hospital, diagnosis of a bleeding gastric ulcer is carried out using endoscopic examination. During the procedure, the mucous membrane of the digestive organ is examined using a special probe. This allows you to determine the exact location of the bleeding.

An open stomach ulcer often causes heavy bleeding. As a result, obvious symptoms arise that do not require additional diagnostics. In this case, measures are taken to stop the bleeding. Sometimes surgery is urgently required.

Treatment of bleeding from stomach ulcers

At the slightest suspicion of the presence of a bleeding ulcer, emergency hospitalization of the person is carried out. Treatment for bleeding gastric ulcers begins with strict bed rest and complete abstinence from food.


The goal of all procedures is to stop bleeding in the stomach. Therapeutic measures are carried out under the mandatory supervision of a doctor. The effectiveness of treatment for bleeding gastric ulcers is evidenced by the improvement in the patient's condition.

Treatment of gastric ulcers involves emergency hemostatic therapy. Once the patient's condition has stabilized, a strict special diet will be prescribed.

If a large loss of blood occurs during gastric bleeding, a blood transfusion will be required. This procedure is also necessary if the bleeding cannot be stopped in a short time.

Advice! It is unacceptable to conduct an examination and prescribe treatment to stop ulcer bleeding on an outpatient basis.

Drug therapy

To stop gastric bleeding, it is necessary to carry out drug therapy for the stomach. For this purpose, drugs are used that can stop bleeding. This:


  • Aminocaproic acid. It promotes vasoconstriction and increased blood clotting. The drug is also capable of suppressing specific allergic reactions. In addition, the drug helps remove toxins from the body.
  • Vikasol. This chemical analogue vitamin K, which normalizes blood clotting.
  • Calcium chloride. The drug reduces internal bleeding and can be used as an antiallergic agent.

Recovery water-salt balance For internal bleeding, special solutions are prescribed. The most famous are rheopolyglucin and trental.

Advice! In the process of treating a bleeding stomach ulcer, painkillers can be used, but they should be prescribed by a doctor taking into account the patient's condition.

Operation

Today, a large number of effective methods of endoscopic hemostasis have been developed to eliminate bleeding in the stomach. Most commonly used thermal effects, which involve cauterization of a bleeding ulcer. For this purpose the following is used:


  • Electrocoagulation.
  • Laser coagulation.
  • Argon plasma coagulation.
  • Radiofrequency coagulation.
  • Thermal probes.

Injection treatments using endoscopy involve the administration of various medications to deliver them directly to the lesion. It is also common to perform clipping or ligation of bleeding vessels during gastroduodenoscopy.

Hemostatic materials, such as biological glue and hemostatic powder, can be used. If conservative and endoscopic treatment methods are not effective, then surgical treatment is always considered.


Surgery is indicated for elderly patients who have experienced gastric bleeding. This is due to the fact that most drugs whose action is aimed at eliminating bleeding have age-related contraindications and their use can cause unpredictable consequences. Other indications for surgery are:

  • Massive bleeding.
  • Regular relapses.
  • The location of the defect is near large arteries.

The operation involves resection of the stomach under general anesthesia. In this case, the affected area is completely excised, and the walls of the stomach are stitched. After such an operation, long-term rehabilitation is required.

Diet

In the first 2-3 days with a bleeding stomach ulcer, you must completely stop eating. Extreme thirst can be relieved with ice cubes or a spoon of water. As a rule, after this period the condition can be stabilized.

Therefore, after bleeding, you can start eating small amounts of food. liquid consistency. The diet for stomach ulcers in this case involves the gradual inclusion of the following products in the diet:


  • Raw from soft-boiled.
  • Milk.
  • Milk and oatmeal jelly.
  • Not strong jelly.
  • Sweet diluted juice.

It is very important that all food is taken in small portions, but quite often. When the condition stabilizes, nutrition for stomach ulcers should become more varied. Others should appear in the menu dietary dishes. It can be:

  • Carrot and mashed potatoes.
  • Slimy soups.
  • Puree porridge.
  • Meatballs steamed from lean meat and fish.
  • Curd mousses and soufflés.
  • Cream.


It is allowed to season dishes with a small amount of butter and vegetable oil. It is very important to use fresh and high-quality products for preparing dishes. Sometimes you are allowed to drink weak tea with milk, as well as a decoction of rose hips and sweet compotes.

This diet should be followed long time to avoid relapses. It is strictly forbidden to consume alcoholic and carbonated drinks, any sour foods, dishes with added spices, strong tea and coffee.

Advice! Any changes in diet should be discussed with your doctor.

Complications

If a bleeding ulcer is not completely cured, this means that the bleeding will not be completely eliminated. Against this background, there are high risks of relapse. Even minimal blood loss can significantly worsen the patient's condition and cause very dangerous complications.

If a bleeding ulcer is not treated properly, anemia may develop. This is a very dangerous condition, which leads to an increase in weakness, provokes dizziness and further total loss performance.


Symptoms developing anemia is, in addition to a deterioration in general well-being, the appearance of a grayish tint on the skin and blanching of the mucous membranes. Very often the patient experiences numbness in the lower extremities.

An increase in temperature may occur periodically. As a rule, due to increased weakness, the pulse increases significantly when moving. A complication of a bleeding ulcer can be a disorder of all body systems, in particular liver dysfunction.

This is very dangerous, as this results in toxic poisoning of the body and metabolic disorders. The most terrible complication of an untreated bleeding peptic ulcer due to constant blood loss is cerebral edema.

That's not all dangerous consequences, which can result from incorrect diagnosis and incorrect treatment. Statistics show that the mortality rate from hemorrhage is 10-15%, and in cases where massive bleeding occurs, 50-55% of patients cannot be helped.

Prevention

To prevent bleeding stomach ulcers, you should take care of your health. It is very important to prevent the occurrence of pathology. To do this, you need to treat any diseases in a timely manner. digestive system.


It is also important to eat right, avoid stress, minimize nervous tension, as well as eliminate increased mental and physical fatigue. It is important to learn how to properly organize your work and rest schedule. It is recommended to undergo regular medical examinations and if any pathological changes follow all doctor's instructions.

But even if a stomach ulcer is diagnosed, it is important not to get upset prematurely. Today there are many ways and methods successful treatment the most complex forms of the disease. It's important to keep leading active image life and follow a strict diet against the backdrop of complete refusal alcoholic drinks and smoking.

A positive prognosis for treatment of a bleeding stomach ulcer largely depends on the correct attitude of the patient. The main thing is to believe that you will be able to defeat the disease and do everything for this.

A bleeding stomach ulcer is one of the most severe and at the same time common complications of delayed treatment of ulcerative lesions of this organ. This pathology occurs in every tenth patient with a similar diagnosis. But statistics may be inaccurate, because a large number of cases of hemorrhage are masked by the symptoms of the underlying disease, which is why they are simply not recorded. The appearance of hidden hemorrhage has no restrictions on age group and gender.

It occurs suddenly, regardless of the severity of the underlying disease. In some situations, bleeding can be a sign of an illness, and in another - a consequence ineffective treatment. In any case, such a manifestation poses a danger to the patient’s life.

This disorder has its own symptoms, despite the fact that it is itself considered a symptom of the disease. In addition, there are several reasons for the occurrence of such a violation. The main ones are chronic course gastric ulcer, as well as progression inflammatory process near the site of ulceration.

The basis diagnostic measures constitute endoscopic procedures, in particular endoscopy. Treatment of open gastric ulcers in most cases is surgical, but with minor blood loss, the use of conservative methods of therapy is allowed. However, despite early diagnosis and timely treatment, mortality remains high - approximately 9% of all patients.

Etiology

Most often, a complication such as bleeding from a stomach ulcer occurs against the background of:

  • chronic course of peptic ulcer;
  • acute form of the disease, provided that the person has any pathology of the cardiovascular system;
  • ulcer defects that develop due to the use of glucocorticosteroids;
  • progression of the inflammatory process in the area of ​​the ulcer;
  • increasing capillary permeability;
  • defects in the blood clotting process;
  • a wide range of shell injuries;
  • physical stress or emotional shock;
  • vitamin deficiency in an organism weakened by peptic ulcer disease;
  • the formation of blood clots and neurotrophic lesions in the wall of this organ.

Bleeding often occurs in an eroded artery, and several times less often in small vessels that are located in the area of ​​the bottom of the ulcer.

Varieties

In gastroenterology, there are several stages of severity of blood loss:

  • initial, in which the patient loses no more than five percent of blood, his condition does not worsen, and all indicators remain within normal limits;
  • moderate severity– there is a blood deficiency of 5–15%, a slight manifestation of symptoms occurs, blood pressure and pulse indicators change;
  • severe – characterized by a loss of 15–30% of blood, which entails a more pronounced expression of symptoms and attacks of loss of consciousness;
  • complicated – more than a third of the total volume is lost. The patient’s condition is very serious, blood pressure is reduced to critical levels, and the heart rate is quite difficult to determine.

Symptoms

The severity of the symptoms of this pathological condition directly depends on the degree of blood loss and the duration of the hemorrhage. With a small or hidden hemorrhage, the clinical picture is almost always absent, and the patient’s condition and well-being do not worsen.

In cases heavy bleeding stomach will show signs such as:

  • dizziness, which can range from mild to severe;
  • increased fatigue;
  • pale skin;
  • decrease in blood pressure values;
  • attacks of nausea and vomiting. The vomit has the color and consistency of coffee grounds;
  • change in the shade of stool - they become black;
  • reduction in the volume of urine excreted per day;
  • increase in frequency heart rate and shortness of breath, even at rest, when a person is sitting or lying down;
  • increased anxiety and irritability.

With a blood loss of 30–50%, the above symptoms are joined by episodes of loss of consciousness, discharge large quantity cold and sticky sweat, thready pulse. In such cases, it is almost impossible to measure blood pressure. If you do not carry out emergency qualified assistance, then such a pathology will become irreversible, which is why, in most cases, death occurs.

Diagnostics

Consulting a gastroenterologist, with a thorough study of the life history and medical history, analysis of complaints and the presence of specific symptoms, allows the specialist to suspect the development of gastric bleeding even with minor blood loss. During the physical examination, the condition is studied skin, the presence of pain on palpation of the abdomen is determined, as well as the measurement of blood pressure, pulse and temperature.

Laboratory tests include:

  • general blood test - which will show the degree of anemia, changes in composition and clotting ability;
  • microscopic examination of stool for occult blood, which will objectively make it clear that a person has hemorrhage.

Endoscopy is considered a mandatory instrumental diagnostic technique. This is a diagnostic endoscopic procedure, which is carried out using special equipment, aimed at studying the internal surface of all organs gastrointestinal tract. This examination reveals the location of the bleeding site.

Diagnostic measures are aimed not only at establishing correct diagnosis, but also to carry out differential diagnosis open gastric ulcer with disorders such as the formation malignant neoplasm, polyp formation, Mallory-Weiss syndrome.

Treatment

Suspicion of an open ulcer is an indication for immediate hospitalization. While waiting for an ambulance, it is necessary to provide first aid to the victim. Rules emergency assistance are as follows:

  • providing complete peace to a person and horizontal position bodies on a flat and hard surface;
  • complete exclusion of food and liquid;
  • applying a cold compress to the projection of the stomach, i.e. top part belly;
  • complete refusal to lavage the stomach or consume any medications;
  • keeping the patient conscious until specialists arrive.

Upon arrival at medical institution appoint strict bed rest and complete hunger. The basis of treatment for a bleeding stomach ulcer is to ensure hemostasis - keeping the blood in a liquid state. This can be achieved in several ways:

  • conservatively - this involves the use of blood and plasma transfusions, intravenous administration medicinal substances, and oral administration aminocaproic acid. Indications for conservative therapy are: high-risk group of patients, for example, elderly age or the presence of concomitant pathology, as well as the occurrence of a gastric ulcer with bleeding at the initial stage of development;
  • operable - in most cases, therapeutic endoscopy is prescribed. Hemostasis is carried out in several ways: thermally - laser and electrocoagulation, injection - administration of drugs such as novocaine, adrenaline and saline, mechanically - stopping bleeding by clipping or ligating bleeding vessels. In addition, hemostatic materials such as biological glue or hemostatic powder can be used. Indications for this method of therapy are: severe forms the course of the pathology and the addition of complications.

Extensive medical interventions are carried out extremely rarely, often when the above methods are ineffective. Such operations include complete or partial resection of the stomach, suturing of an open ulcer and suturing of blood vessels.

After such a violation has been eliminated, patients are advised to follow a diet for stomach ulcers, which involves complete failure from:

  • fatty and fried foods;
  • pickles and smoked meats;
  • sour varieties of fruits and vegetables, as well as their consumption raw;
  • legumes and peas;
  • confectionery and bakery products;
  • alcoholic and carbonated drinks.

However, a gentle diet does not prohibit the use of:

  • dietary varieties of meat, poultry and fish, steamed, boiled or baked;
  • vegetable purees;
  • mucous first courses and cereals;
  • soft-boiled eggs;
  • jelly and compotes;
  • weak tea without sugar.

Following this diet will help rapid recovery patient.

Complications

If symptoms are ignored or therapy is not started in a timely manner, there is a possibility of developing the following consequences of a bleeding ulcer:

  • hypovolemic shock state;
  • development of heart failure;
  • orthostatic hypotension is a condition in which low blood pressure is observed;
  • formation of acute liver failure;
  • swelling of the brain;
  • poisoning by blood decomposition products;
  • development of MODS - multiple organ failure syndrome, in which there is a disruption in the functioning of all internal organs and systems.

Prevention and prognosis

There is no specific prevention for such a pathology; it is only necessary to treat it in a timely manner. ulcerative lesion stomach, and chronic form during the course of the disease, undergo regular examination by a gastroenterologist.

It is not possible to establish an unambiguous forecast, since it depends on many factors. These include the age category of the patient, the degree of bleeding at which it was diagnosed, the presence of concomitant disorders and the amount of blood loss. The mortality rate is quite high; every tenth patient with this diagnosis dies.

They know what stomach bleeding is. Several milliliters of blood may leak from wounds every day. And this phenomenon is considered the norm. But it happens that the situation deteriorates, bleeding from a stomach ulcer becomes uncontrollable. At home, it becomes impossible to stop it on your own.

Problems often arise in stopping heavy gastric bleeding in a hospital setting. How to prevent the occurrence of pathology, and what measures should be taken when it appears? We'll tell you further.

A bleeding ulcer of the stomach and duodenum is a complication of peptic ulcer disease, in which blood begins to flow into the organ cavity from wounds. This phenomenon occurs in patients very often. This complication of peptic ulcer disease is divided into:

  • open;
  • hidden.

With hidden blood loss, the symptoms are almost invisible. The causes of bleeding in peptic ulcers are often very difficult to determine. It is not related to physical activity, injury to internal organs. The process most often begins unexpectedly due to a violation of the integrity of the veins.

Most often, stomach ulcers begin to bleed in people suffering from cardiovascular diseases.

Pathology can be caused by eating excessively hot foods. Abrupt change temperature damages the gastric mucosa and provokes bleeding.

If you have a stomach ulcer, it can cause blood loss. long-term use some types of medications.

Symptoms

When hidden bleeding occurs, there are practically no symptoms. The person does not feel any changes in well-being. If blood loss continues for a long time, patients begin to experience dizziness and severe fatigue. Patients become pale. You can suspect ulcer bleeding based on a decrease in blood pressure.

In order not to miss the beginning of the development of pathology and the onset severe consequences, it is necessary to regularly undergo tests for the Gregersen reaction. It helps detect even the smallest particles of blood in gastric juice.

With a chronic peptic ulcer, the bleeding will not stop on its own even for a short period. This is due to the fact that a scar forms at the site of the lesion, which cannot heal on its own. The wounds remain open until surgery is performed.

Acute ulcers of the stomach, like those of the duodenum, are characterized by intermittent bleeding. But contacting specialists cannot be postponed. The absence of medical intervention will lead to a large loss of blood; often a person with an advanced state of the disease can only be saved in intensive care.

The most obvious symptom of bleeding in the stomach is vomiting blood. As a rule, the reaction appears immediately. If there is severe bleeding, the blood in the vomit will be scarlet.

Heavy bleeding can be seen in the stool; it becomes black, sticky and liquid. If the pathology develops in mild form, the following symptoms will be observed:

  • pale skin;
  • low pressure;
  • cold extremities;
  • pulse quickens.

Bleeding of an average volume will manifest itself as follows:

The acute form of the disease, when severe bleeding occurs, manifests itself as follows:

  • chills, weakness, loss of consciousness;
  • black chair;
  • there is practically no pressure;
  • sticky sweat;
  • nausea and vomiting with blood.

Regular recurrence of bleeding within 1.5 weeks is very dangerous. Large blood losses can be fatal. First aid and treatment in such cases must be carried out as quickly as possible. The correct actions of specialists in case of duodenal ulcer with bleeding depends future life the patient and his general condition. The same applies to stomach ulcers with bleeding.

Complications

Anemia is the most basic complication that can cause duodenal bleeding and bleeding stomach ulcers. They always reduce hemoglobin levels.

The patient's general health deteriorates, his eyes darken, and his skin becomes pale.

Despite high level medicine, cases are very common deaths from ulcer bleeding. Most often this occurs in older people with severe blood loss accompanied by other pathologies. Also, deaths can occur due to delayed treatment or failure to provide first aid.

Note! Stomach bleeding is a very dangerous phenomenon. It cannot be ignored and treated with folk remedies.

Diagnosis and treatment

If bleeding occurs, first aid actions must be carried out as soon as possible. short time. Only under this condition will it be possible to save the patient’s life. If there is a stomach ulcer and symptoms of bleeding, it is necessary to competently help the patient.

  • If an open ulcer is bleeding, you should urgently call an ambulance.
  • The patient should be placed on his back and not allowed to move.
  • You can apply ice to your stomach.
  • The patient is prohibited from consuming liquids and food; he cannot even drink water. The patient can only lie still; he is transferred to the ambulance on a stretcher.

First aid consists of stopping a bleeding ulcer. This can be done through medication or physical means.

The ulcer can be cauterized using a laser, thermal or electrical method. Hemostatic agents used to stop bleeding. Stopping bleeding surgically is used only if drugs fail to do so.

If there is a stomach ulcer, bleeding, and then the symptoms disappear, you should not calm down. It is imperative to see a doctor for advice and treatment. Most often, a new exacerbation occurs soon.

Patients who experience severe and moderate bleeding are hospitalized in the department intensive care. This is necessary in order to compensate for blood loss.

For elderly people, blood transfusions are carried out with blood pressure monitoring. There are cases when the heart is not able to cope with the amount of fluid entering the body. When the body reacts in this way, doctors prescribe medications that stimulate the heart.

The following drugs are prescribed as treatment:

  • hemostatic agents;
  • drugs to improve blood clotting;
  • hemostatic agents.

For the treatment of bleeding from a duodenal ulcer the following are prescribed:

  • remedies for Helicobacter;
  • medications to stabilize acidity in the stomach;
  • strict diet.

If the bleeding can be stopped with medication, surgery is not performed. The possibility of resumption of bleeding is controlled using laboratory tests. Surgery is always considered as a last resort option to stop blood loss from ulcers in the intestines and stomach.

Method surgical intervention determined by doctors taking into account the severity of the disease. The simplest operation is gastric resection. This is an organ-saving operation.

In severely weakened patients, suturing of the defect is used. Both types of operation do not have technical difficulties, but precise definition is necessary anatomical location large vessels to avoid injury.

Duodenal ulcer with blood loss is treated with laser therapy. Very rarely, the area from which bleeding is observed is removed.

Prevention and diet

In case of acute ulcers of the stomach and duodenum, you need to be careful about your health and not aggravate the situation. Treatment must be combined with preventive measures.

First of all, you need to give up bad habits. Abuse of alcoholic beverages and cigarettes has a detrimental effect on the condition of stomach and duodenal ulcers.

It is necessary to reconsider your diet; it should consist only of “healthy” foods with plenty of vitamins.

Patients need:

  • kefir, cottage cheese;
  • sweet potatoes, apricots, apples, eggs, cheese, carrots;
  • ascorbic acid, which is found in cabbage, milk, pork, beef, seafood, yogurt, melon, beans;
  • vitamin E, which is found in peanuts, mangoes, kiwis, spinach, and egg yolks.
  • Black tea;
  • coffee;
  • bitter chocolate;
  • fried and fatty.

Maintaining healthy image life, giving up bad habits and paying attention to your health will be the key to eliminating the risk of developing dangerous pathologies. Timely detection of the first symptoms will help to begin treatment at the initial stage of the disease.

Peptic ulcers can be life-threatening and lead to complications such as gastrointestinal bleeding or perforation. However, with proton pump inhibitors and the ability to destroy the Helicobacter pylori bacterium, stomach ulcers (bleeding), the symptoms and manifestation of which are pain 3 hours after eating or fasting, do not produce such frequent consequences, so they are relatively less common. The main causes of bleeding are an open ulcer of the stomach or duodenum, which is possible in 35-50% of cases. The problem occurs in every 5 people.

Bleeding is a complication of gastric ulcer

Bleeding disease

Now treatment of stomach and duodenal ulcers is possible, since the pathology leads to a common complication, during which blood from damaged vessels enters the organ cavity. This pathology can be identified by the main symptoms:

  • vomiting with impurities;
  • hemodynamic disturbance;
  • tarry type stool;
  • hypovolemia.

Peptic ulcer of the stomach, bleeding of which is serious and dangerous complication, occurs in 10% of patients different ages, and also the problem is 50% of all possible defeats gastrointestinal organs. In the classification of medical diseases, pathology has ICD 10 code K25.

The patient vomits foreign matter

But the patient is not always diagnosed on time, because this process may not be extensive, so it is impossible to record it.

Irritating factors

The main cause of peptic ulcer disease is an imbalance between the protection of the mucous membrane and the processes of aggression. The latter include:

  • hydrochloric acid;
  • pepsin;
  • non-steroidal anti-inflammatory drugs;
  • stress;
  • Helicobacter Pylori, whose DNA multiplies rapidly in the mucosa.

Stress makes ulcers worse

This bacterium shows a special interest in the gastric epithelium, located under a protective layer of mucus. It produces urease, which allows it to survive in the very acidic pH environment of the stomach. If a patient has a stomach ulcer for a long time, he does not adhere to a diet and eat forbidden foods, then this threatens ulcer bleeding and perforation (development of a through hole).

Clinical picture

The symptom is often found among other pathologies of the digestive system. But sometimes the problem does not reveal itself with obvious symptoms, then the hidden problem is diagnosed using the following list of sensations:

  • the skin becomes pale;
  • vomit is colored the color of milky coffee grounds;
  • the patient complains of general weakness;
  • Frequent dizziness begins.

The patient reports regular dizziness

The profuse nature of bleeding can be recognized by single or repeated red vomiting. Somewhat less often, doctors record the release of a huge volume of scarlet blood from an artery with clots.

A bleeding stomach ulcer, the main symptoms of which is pain, appears approximately 3 hours after eating or fasting. If discomfort develops right side abdomen on an empty stomach, this is the first sign of a duodenal ulcer. Pain in the middle and left epigastric region most often occurs in the presence of pathological changes in the organ (bleeding gastric ulcer).

The symptom is accompanied by dyspeptic and reflexive symptoms, sudden weight loss. Conditions that require immediate medical attention include gastrointestinal bleeding such as black, tarry stools and coffee-colored vomit. They are often accompanied general weakness, pallor.

If you have black stools, you should seek immediate medical attention.

Signs of an open ulcer and stage

The main symptoms of lesions of the duodenum or stomach depend on the intensity and duration of blood loss. These include vomiting with clear melanesis, blood and loose, sometimes smooth, resinous stool. Patients with the first symptom account for 30% of cases, while the second symptom appears in only 20% of patients. They can form several days after the bleeding stops.

Usually the intensity of the phenomena increases 2-5 days before the onset of internal bleeding, and after this process clinical picture fades out. The most clear signs period:

  • palpation of the abdominal cavity is accompanied by pain;
  • thirst;
  • diuresis is reduced;
  • the skin becomes dry.

Heavy bleeding accompanied by thirst

How many signs and in what intensity the patient will feel depends on the severity. Life will be easier if a person immediately begins to treat the ulcer, and does not wait for complications to develop (opening of lesions), which can only be eliminated by surgery. But it all depends on the volume of blood lost. So, the following stages are distinguished:

  1. Less than 5%. The person feels almost normal, the hemodynamic pathology is disturbed in small degree. Blood pressure is unchanged, but the pulse is slightly higher.
  2. 5-10% - second degree. Symptoms: fainting, lethargy, increased heart rate, blood pressure less than 90.
  3. Up to 30% - the third stage. It is difficult to tolerate, the pulse becomes threadlike and frequent, blood pressure decreases (from 60), the skin turns pale.
  4. From 30% - fourth degree. A very serious condition with impaired consciousness and absence of pulse, blood pressure is reduced to fatal levels.

Internal bleeding may cause loss of consciousness

The treatment course should be prescribed at the earliest stages, when such serious damage and consequences can be avoided.

Danger of ulcers with hemorrhage

The accumulation of blood can lead to perforation. The patient experiences epigastric discomfort, an early feeling of fullness, and nausea, which passes and then recurs. Typically, patients tend to downplay the manifestations of pathology, attributing them to dietary errors. This leads to the fact that they do not want to do the necessary actions, and the time for therapy runs out.

The clinical picture becomes an early symptom of cancer, which develops as a consequence of an ulcer with hemorrhage.

Bleeding may be early sign stomach cancer

Diagnostic measures

The set of measures to establish gastrointestinal bleeding is usually small. There are typical clinical symptoms, facilitating the diagnosis. Further research is aimed at determining the source of bleeding.

To do this, it is necessary to conduct a long interview with the patient, paying attention to the symptoms that preceded and accompanied the bleeding, the history of past and concomitant pathologies, nutrition, and the use of medications, especially anticoagulant, painkillers, anti-inflammatory and alcoholic stimulants. The next step is a physical procedure in a hospital hospital and rectal manipulation.

Undoubtedly, biochemical additional research. For example, an image of red blood cells that informs the doctor about the intensity of bleeding and allows a decision to be made about the need for a transfusion. It must be remembered that in the first 6-8 hours after the occurrence of bleeding, changes in the level of hemoglobin, hematocrit and the number of red blood cells are usually not observed. But the first day is very important, so you shouldn’t lie at home and prolong the complication.

A rectal examination is performed to detect bleeding.

Health care

The disease is emergency in gastroenterology and requires intensive therapeutic treatment. If the hemorrhage is severe, a person loses up to 1 liter of blood in a short time. When discussing the most common causes of this process, it is necessary to distinguish between bleeding of the upper and lower gastrointestinal tract.

There are different clinical symptoms and the diagnosis of these conditions is different, so doctors will take different therapeutic measures. The pathology requires immediate hospitalization, since an open gastric ulcer with bleeding can lead to the death of the patient.

There is only one conclusion from here - ethnoscience at home using herbal infusions will in no way stop or replace blood loss.

The patient is urgently hospitalized

A course of treatment

Gastrointestinal bleeding sometimes stops spontaneously, and with peptic ulcer disease this percentage is 70-80% of cases. However, this does not relieve the doctor from the need to apply appropriate therapeutic manipulations, which should always be carried out in a hospital setting. The conservative course consists of the following points:

  • pharmacotherapy;
  • endoscopic treatment;
  • catheter therapy;
  • surgical intervention.

The drug regimen boils down to the use medicines against bleeding that reduces secretion: H2 blockers or proton pump inhibitors (PPI) and drugs for local hemorrhagic action.

An important aspect of treatment is the prevention of recurrent episodes. The eradication method of Helicobacter pylori, introduced over several years using antibiotics and PPIs, has shown promising results.

Methods for endoscopic bleeding control (acute form):

  • injection of decongestants (adrenaline);
  • thermal contact (thermal probe);
  • non-contact thermal variations (laser);
  • mechanical methods;
  • combined actions.

A patient is given an injection of adrenaline

Each of them reduces the speed rebleeding by approximately 75%, the number of operations per case urgent situation- by 60%, and mortality by 30%. The choice depends on the capabilities of the Center and the experience of the endoscopist. Some suggest combining the two methods to improve the effectiveness of treatment.

If bleeding cannot be controlled using conservative techniques, including endoscopic techniques, action must be taken quickly, as each delay increases the risk of death. Catheter therapy is performed, which is used to embolize bleeding. This method is recommended in case serious condition patient when surgical or endoscopic treatment carries a high risk. This task is undertaken only by hospitals with well-equipped radiology laboratories and experienced staff.

Endoscopic assessment of the state of the gastrointestinal tract occurs after hemodynamic stability. Such examination should be carried out within 24 hours unless the patient's condition is serious and therapeutic decisions have been made in advance.

The patient undergoes diathermocoagulation using the endoscopic method

The purpose of endoscopy is not only to determine the source of bleeding, but also to assess the prognosis and make appropriate local treatment attempts. It is recommended to use 2 endoscopic methods simultaneously. For example, the injection and thermal process will give a better effect than using one of them.

For injection of bleeding ulcers, epinephrine is usually used in a ratio of 1:10,000 with saline, concentrated sodium chloride or pure alcohol. The addition of obliterating drugs does not improve hemostasis results, and the importance of drugs (thrombin and fibrin glue) is uncertain.

From others endoscopic methods Clamps have gained a good reputation and can be used alone or in combination with various manipulations. The effectiveness of clamps is comparable to injection and thermal methods.

If the hemoglobin level is low, the manipulation is more difficult to tolerate

The effectiveness of endoscopy during the treatment of peptic ulcer bleeding is high and exceeds 90%. But after successful initial hemostasis, in approximately 20% of cases such episodes are a major cause of death. Factors that increase the risk of relapse:

  • low hemoglobin level;
  • active bleeding;
  • fresh blood in the stomach and ulcer diameter more than 2 cm.

To prevent relapse, try various methods pharmacotherapy. Research supports use high doses Omeprazole on the first day of treatment, as this is necessary to achieve an increase in gastric pH.

Chemotherapy is usually delayed until healing occurs.

Forecast and preventive measures

The further condition of perforated hemorrhage is improved by control endoscopy, performed 16-24 hours after hemostasis. If ulcer bleeding recurs after initial success, one of the endoscopic techniques should be used and the patient should not be referred to surgery, which poses a greater risk of complications and death. However, subsequent episodes require surgical treatment.

In patients with bleeding ulcers and Helicobacter pylori infection antibacterial therapy virtually eliminates relapse. It is now necessary to test all patients with bleeding for the presence of these bacteria.

Recurrent bleeding requires surgical treatment

The test should be performed during the first endoscopy, but on condition that there is not much blood in the stomach, since its presence causes a false negative result. During the same bleeding, histological examination using special staining techniques is more accurate than urease.

Perforated gastric ulcers can be prevented with nutrition and proton pump inhibitors in the morning on an empty stomach. Drinking alcohol is prohibited. It should be remembered that some drugs irritate the gastric mucosa, causing erosion. People diagnosed with peptic ulcer disease should use analgesics from the group of non-steroidal anti-inflammatory drugs with caution. There is also a hypothesis that consuming vitamin C helps combat the number of Helicobacter pylori bacteria.

What help is needed for stomach bleeding, see below:

Etiology and pathogenesis.

Bleeding of varying degrees of intensity can occur from arteries, veins and capillaries. There are hidden (occult) bleeding, manifested by secondary hypochromic anemia, and obvious bleeding.

Hidden bleeding is often chronic and occurs from the capillaries, accompanied by iron deficiency anemia, weakness, and decreased levels of hemoglobin and red blood cells. Hidden bleeding can be detected by examining stool or gastric contents for the presence of blood (benzidine or guaiac test).

Bleeding from a peptic ulcer is a dangerous complication. It occurs due to arrosion of the branches of the gastric arteries (right or left). With a duodenal ulcer, the source of bleeding is aa. pancreaticoduodenales in the area of ​​the bottom of the ulcer.

In case of acute minor bleeding (˂ 50 ml), the formed stools are black in color. General state the patient remains satisfactory. Obvious signs of profuse bleeding include bloody vomiting and bloody stools. Bloody vomiting (hematemesis) - the release of unchanged or changed (the color of coffee grounds) blood with vomit, observed with bleeding from the stomach, esophagus, duodenum. Melena - secretion of altered blood from feces(tarry stools), observed with bleeding from the duodenum and massive gastric bleeding with blood loss reaching 500 ml or more.

The reaction of the patient’s body depends on the volume and rate of blood loss, the degree of loss of fluid and electrolytes, the patient’s age, and concomitant diseases, especially cardiovascular diseases.

A loss of about 500 ml of blood (10-15% of the blood volume) is usually not accompanied by a noticeable reaction from the cardiovascular system. A loss of 25% of bcc causes a decrease in systolic blood pressure to 90-85 mm Hg, diastolic blood pressure to 45-40 mm Hg. Massive bleeding with such significant blood loss can cause: 1) hypovolemic shock; 2) acute renal failure caused by decreased filtration, hypoxia, necrosis of the convoluted tubules of the kidneys; 3) liver failure due to a decrease in hepatic blood flow, hypoxia, and degeneration of hepatocytes; 4) heart failure caused by oxygen starvation of the myocardium; 5) cerebral edema due to hypoxia; 6) disseminated intravascular coagulation; 7) intoxication with hydrolysis products of blood poured into the intestines. All these signs mean that the patient has developed multiple organ failure.

Clinical picture and diagnosis.

Early signs of acute massive blood loss are sudden weakness, dizziness, tachycardia, hypotension, and sometimes fainting. Later, bloody vomiting occurs (when the stomach is full of blood), and then melena. The nature of the vomit (scarlet blood, dark cherry-colored clots, or gastric contents the color of coffee grounds) depends on the conversion of hemoglobin (Hb) under the influence of of hydrochloric acid into hydrochloric acid hematin. Repeated bloody vomiting and the subsequent appearance of melena are observed with massive bleeding. Vomiting repeated at short intervals indicates ongoing bleeding; repeated vomiting of blood after a long period of time is a sign of renewed bleeding. With heavy bleeding, blood promotes rapid opening of the pylorus, acceleration of intestinal motility and excretion of feces in the form of “cherry jelly” or an admixture of slightly changed blood.

The source of bleeding that occurs during an exacerbation is often a duodenal ulcer in young people, and a gastric ulcer in patients over 40 years of age. Before bleeding, the pain often intensifies, and from the moment the bleeding begins, it decreases or disappears (Bergmann's symptom). The reduction or cessation of peptic pain is due to the fact that the blood neutralizes hydrochloric acid.

Bleeding may be the first sign of a stomach or duodenal ulcer, which was previously asymptomatic (about 15-20%), or a manifestation of an acute ulcer (stress ulcer).

During examination, the patient's fear and anxiety are noticed. The skin is pale or cyanotic, moist, cold. Pulse is increased; Blood pressure may be normal or low. Breathing is rapid. With significant blood loss, the patient feels thirsty and notes dryness of the mucous membranes of the oral cavity.

An approximate assessment of the severity of blood loss is possible based on the external clinical manifestations of bleeding, by heart rate (HR), blood pressure, the amount of blood released through vomiting and loose stools, as well as during aspiration of contents from the stomach.

A frequently used indicator of blood loss is the Algover shock index, which is calculated as the ratio of pulse to systolic blood pressure. Normally this ratio is 0.5. A shock index of 1 corresponds to approximately 30% deficit of blood volume (pulse - 100 per minute, systolic blood pressure - 100 mm Hg). A shock index of 2 allows one to suspect a BCC deficiency of about 70% (pulse - 120 per minute, systolic blood pressure - 60 mm Hg).

Indicators of Hb, hematocrit, central venous pressure (CVP), blood volume, and hourly diuresis allow a more accurate assessment of the severity of blood loss and the effectiveness of treatment. When examining blood early (several hours) after the onset of acute bleeding, the number of red blood cells and Hb content may remain at normal levels. This is due to the fact that during the first hours red blood cells are released from the depot.

There are 4 degrees of severity of blood loss:

    I degree – chronic occult (hidden) bleeding, the Hb content in the blood is slightly reduced, there are no signs of hemodynamic disturbances.

    Stage II – acute minor bleeding, heart rate and blood pressure are stable, Hb content is 100 g/l or more.

    III degree – acute blood loss of moderate severity (tachycardia, slight decrease in blood pressure, shock index ˃ 1, Hb content ˂ 100 g/l).

    IV degree - massive severe bleeding (BP below 80 mm Hg, heart rate ˃ 120 per minute, shock index about 1.5; Hb content ˂ 80 g/l, hematocrit ˂ 30, oliguria - diuresis ˂ 40 ml/h) .

Examination and treatment of patients with acute bleeding is carried out in the intensive care unit, where the following priority measures are carried out:

    catheterization of the subclavian vein or several peripheral veins to quickly replenish the deficit of blood volume, measurement of central venous pressure (CVP);

    gastric lavage to prepare for emergency endoscopic examination;

    emergency endoscopy to verify the source of bleeding and perform endoscopic hemostasis;

    constant catheterization of the bladder to control diuresis (it should be at least 50-60 ml/h);

    determination of the degree of blood loss;

    oxygen therapy;

    hemostatic therapy;

    cleansing enemas to remove blood spilled into the intestines.

Gastric lavage is performed ice water(in which pieces of ice float) with the addition of a solution of adrenaline (1: 1000). This allows not only to wash the gastric mucosa from blood, but also to reduce the intensity of bleeding and the degree of hyperemia of the mucous membrane, which significantly improves the visibility of the source of bleeding and the effectiveness of endoscopic manipulations.

EGDS is the most informative method for diagnosing bleeding. According to endoscopic examination, there are 3 stages of ulcer bleeding (according to the classification of J. Forrest, 1974), with important in the algorithm for choosing a treatment method:

    FIA stage – active arterial bleeding;

    FIB stage – leakage of blood from under the clot;

    Stage FIIA - signs of stopped fresh bleeding, thrombosed vessels are visible at the bottom of the ulcer or blood clot, covering the ulcer, as well as remaining blood in the stomach or duodenum;

    FIIB stage – small fixed blood clots and hematin on the surface of the ulcer;

    Stage FIII - the ulcer is covered with fibrin, but there are traces of hematin in the stomach. Gastrointestinal bleeding should be differentiated from pulmonary bleeding, in which bloody vomiting is foamy in nature, accompanied by a cough, and moist rales of various sizes are often heard in the lungs.

Treatment.

When choosing a treatment method, it is necessary to take into account endoscopy data (bleeding stage at the time of endoscopy according to Forrest), the intensity of bleeding, its duration, relapses, general condition and age of the patient.

Therapeutic and diagnostic endoscopy against the background of anti-shock measures and correction of blood loss plays a major role at the 1st stage of treatment. It allows you to identify the source of bleeding, perform endoscopic hemostasis and assess the likelihood of recurrent bleeding depending on the location and size of the ulcer, as well as the Forrest stage.

Endoscopic hemostasis is carried out by physical impact on the source of bleeding (diathermo-, laser-, argon plasma and thermocoagulation), mechanical compression of the bleeding vessel (introduction of ethanol, adrenaline and other osmotically active solutions into the area of ​​the ulcer, clipping). Endoscopic hemostasis is performed not only when bleeding continues, but also when bleeding has stopped, when the risk of recurrence is high (FIIA). The effectiveness of final bleeding control using instrumental hemostasis exceeds 90%.

Conservative measures should be aimed at the prevention and treatment of shock, suppression of HCl and pepsin production by intravenous administration of H2 receptor blockers - ranitidine (and its analogues - histak, ranital), famotidine (quamatel) or blockers proton pump(losek). In most cases (about 90%), acute bleeding can be stopped with conservative measures.

Infusion therapy is carried out to normalize hemodynamics and ensure adequate tissue perfusion. It includes replenishing blood volume, improving microcirculation, preventing intravascular aggregation, microthrombosis, maintaining plasma oncotic pressure, correcting water-electrolyte balance and acid-base status, and detoxification.

With infusion therapy, they strive to achieve moderate hemodilution (Hb should be at least 100 g/l, and hematocrit should fluctuate within 30%), which improves the rheological properties of blood, microcirculation, reduces peripheral vascular resistance to blood flow, and facilitates the work of the heart.

Infusion therapy should begin with the transfusion of rheological solutions that improve microcirculation. For mild blood loss, an infusion of rheopolyglucin and hemodez is performed in a volume of up to 400-600 ml with the addition of saline and glucose-containing solutions.

In case of moderate blood loss, plasma-substituting solutions and components of donor blood are administered. The total volume of infusions should be 30-40 ml per 1 kg of patient body weight. The ratio of plasma-substituting solutions and blood in this case should be 2: 1. Prescribe polyglucin and reopolyglucin (up to 800 ml), increase the dose of saline and glucose-containing solutions.

In case of severe blood loss and hemorrhagic shock, the ratio of transfused solutions and blood is 1: 1 or 1: 2. The total dose of infusion therapy should exceed the amount of lost blood by an average of 200-250%.

To maintain oncotic blood pressure, intravenous administration of albumin, protein, and plasma is used. The approximate volume of infusions can be determined by the value of central venous pressure and hourly diuresis (after therapy it should be ˃ 50 ml/h). Correction of hypovolemia improves central hemodynamics and adequate tissue perfusion, provided that the deficiency in blood oxygen capacity is eliminated.

Surgical treatment of bleeding ulcers.

Emergency surgery is indicated for patients with active bleeding (Forrest I), which cannot be controlled by endoscopic methods. In case of hemorrhagic shock and ongoing bleeding, the operation is performed against the background of massive blood transfusion, plasma-substituting solutions and other anti-shock measures.

Urgent surgery is indicated for patients after endoscopic control of active bleeding and after endoscopic hemostasis of stage FIIA, in whom conservative measures did not allow stabilization of the condition.

After stopping the bleeding (Forrest II-III), surgery is indicated for patients with a long history of ulcers, recurrent bleeding, callous and stenosing ulcers and the patient’s age is over 50 years. It is necessary to decide on the choice of surgical option taking into account concomitant diseases, which can increase the risk of both early and late surgical intervention.

For a bleeding gastric ulcer, the following operations are recommended: in weakened patients, a low-traumatic operation is preferable - truncal vagotomy, gastrotomy with excision of the ulcer and pyloroplasty. In extremely severe general conditions, gastrotomy with suturing of a bleeding vessel or excision of an ulcer followed by suturing is acceptable. The risk of performing gastric resection at the height of bleeding is very high.

For a bleeding duodenal ulcer, one of the vagotomy options is performed with suturing of the bleeding vessels and pyloroplasty or duodenoplasty.

Patients with a low risk of recurrent bleeding are operated on routinely after preoperative preparation carried out for 2-4 weeks in order to heal the ulcer or reduce periulcerative inflammation. Mortality after emergency operations ranges from 5 to 15%.

EDUCATIONAL AND METHODOLOGICAL MATERIAL

Tables, slides, photographs, radiographs, gastroscopes.

TASKS IN TEST FORM FOR EACH PART OF THE TOPIC

SITUATIONAL TASKS

A 39-year-old patient, about 12 hours ago, suddenly developed severe pain in the epigastric region, quickly spreading throughout the abdomen, and severe weakness. It is known that the patient has been suffering from duodenal ulcer for 5 years.

The patient's condition is moderate. The skin is pale. Pulse – 100 per minute. Blood pressure – 110/60 mm Hg. The tongue is dry. The abdomen is retracted and participates in the act of breathing to a limited extent. Muscle tension and a positive Shchetkin-Blumberg sign are determined by palpation. Hepatic dullness is not determined by percussion.

What is your diagnosis?

What research methods can confirm the diagnosis?

What are the treatment tactics?

Perforated duodenal ulcer.

The diagnosis can be confirmed with a plain abdominal x-ray.

The patient is shown emergency surgery. Due to the long-standing history of ulcer perforation and the development of diffuse peritonitis, suturing of the perforated hole, sanitation and drainage of the abdominal cavity are indicated.

A 39-year-old patient, suffering for many years from a duodenal ulcer, developed a feeling of heaviness in the stomach after eating, belching rotten food, and daily vomiting of food eaten the day before. The patient's condition is satisfactory. The stomach is soft. On an empty stomach, a splashing noise is detected. Fluoroscopy revealed that the stomach is of considerable size, evacuation is slowed down, the pyloroduodenal section is narrowed, in the duodenal bulb there is back wall a “depot” of barium suspension was discovered. After 12 hours, a significant part of the barium mass remains in the stomach.

Make a diagnosis.

What are the treatment tactics?

Duodenal ulcer complicated by subcompensated pyloric stenosis.

The patient is indicated for surgery - selective proximal vagotomy with drainage surgery.

A 70-year-old patient was observed for 5 years for a gastric ulcer located in the antrum. From surgical treatment the patient refused. Over the past 3 months, pain in the epigastric region has become permanent, an aversion to meat products has appeared, the patient’s performance has decreased, and the patient’s weight has decreased.

What complication of the disease can you think about?

How to make an accurate diagnosis?

What are the treatment tactics?

You should think about the malignancy of a stomach ulcer.

An accurate diagnosis can be established through gastroscopy with targeted biopsy.

For a malignant gastric ulcer, the surgical tactics are the same as for gastric cancer - subtotal resection of the stomach, removal of the greater and lesser omentum.

TEST CONTROL ON ALL TOPIC MATERIAL

1. FOR CHRONIC GASTRODUODENAL ULCERS DO NOT

CHARACTERISTIC:

a) tight edges

b) the ability to penetrate deep into the wall

c) different sizes (from 0.3 to 6-8 cm or more) of the ulcerative defect

d) lack of convergence of folds of the mucous membrane to the edges of the ulcer

e) the possibility of developing various complications

2. NOT CHARACTERISTIC FOR DUMIDUM ULCER

GUTS IS:

a) high prevalence of the disease

b) more frequent development in men

c) preferential education at a young age

d) more persistent than with stomach ulcer, current

e) extremely rare malignant transformation

3. GASTRIC ULCER IS NOT CHARACTERISTIC:

a) clearer nosological isolation

b) the presence of gastritis with pronounced antrocardial expansion

c) reduction of gastric glands

with a shift of the anthro-fundal junction towards the cardia

d) the predominance of the hormonal nature of acid formation

e) preferential education after 40 years

4. FOR STOMACH ULCER:

a) much more often than with duodenal ulcers,

surgical treatment is used

b) increased motor function of the stomach during the interdigestive period

c) low pH values ​​in the antrum

d) more rare than with a duodenal ulcer, degeneration into cancer

e) gastritis is less pronounced than with a duodenal ulcer

5. ENDOCRINE ULCEROGENIC FACTORS CANNOT:

a) lead to the development of peptic ulcers

b) cause the formation of symptomatic ulcers

c) inhibit the regenerative abilities of the mucous membrane

d) reduce duodenal acid neutralization

e) stimulate the acid-producing function of the gastric glands

6. ULCEROGENIC FACTORS

(EACH INDIVIDUALLY OR IN VARIOUS COMBINATIONS)

YOU CAN DIRECTLY:

a) lead to the development of peptic ulcers

b) cause the formation of a symptomatic ulcer

c) cause the formation of acute ulcers

d) cause the development of pre-ulcerative conditions

e) activate general and local pathogenetic mechanisms,

capable of causing damage to the mucous membrane

gastroduodenal zone

7. THE MOST PROBABLE CAUSE OF THE REDUCTION

RESISTANCE OF THE GASTRIC MUCOSA,

LEADING TO THE DEVELOPMENT OF AN ULCER IS:

a) deficiency of cells necessary for reproduction

plastic substances and biochemically active substances

b) metabolic changes in the body

c) local ischemia of the gastroduodenal mucosa

d) chronic gastritis

d) hormonal changes in the body

8. THE PATHOGENESIS OF DUODEN ULCER IS NOT IN THE PATHOGENESIS

a) intense continuous acid formation

b) the state of the antral acid brake

c) duodenal acid brake

d) decompensated acid stomach

e) hyperproduction of antral gastrin

9. INHIBITION OF GASTRIC ACID FORMATION

OCCURS AT INTRADUODENAL pH:

e) 2.5 and below

10. INTRADUODENAL BRAKE EFFECT ON

ACID FORMATION IS REALIZED THROUGH:

a) inhibition of pancreatic secretion

b) increased bile production

c) increased pancreatic secretion

d) increased secretin production

e) duodenogastric reflux

11. THE INITIAL PROCESS OF ULCER FORMATION IS RELATED TO:

a) with reverse diffusion of hydrogen ions

b) with decompensation of antral acid-neutralizing function

c) with a violation of the acid-neutralizing function of the duodenum

d) with mechanisms that disrupt the balance between protective factors

and aggression of the gastroduodenal zone

e) with a decrease in the secretory function of the pancreas

12. OPERATION OF CHOICE FOR PULDER DISEASE WITH DISRUPTION

DUODENAL PASSABILITY IS:

a) gastric resection (antrumectomy) with vagotomy according to Billroth-1

b) gastric resection (antrumectomy) with vagotomy according to Roux

c) gastric resection (antrumectomy) with vagotomy

according to Hofmeister-Finsterer

d) PPV with duodenojejunostomy

e) PWV without special correction of impaired duodenal

cross-country ability

13. ABSOLUTE INDICATION FOR OPERATION FOR ULCER

DISEASES ARE:

a) penetrating ulcer

with the formation of an interorgan pathological fistula

b) large pyloric ulcer,

threatening the development of stenosis during healing

c) combination of giant ulcers of the stomach and duodenum

d) the presence of a genetic predisposition to peptic ulcer disease

e) persistent duodenogastric reflux with gastritis and ulcers

14. RELATIVE INDICATIONS FOR SURGICAL TREATMENT

Peptic ulcer disease is diagnosed when:

a) pyloric stenosis

b) recurrence of ulcer bleeding

after endoscopic stop

c) low subbulb ulcers

d) malignant degeneration of an ulcer

e) atypical perforation of the ulcer

15. INDICATIONS FOR SURGERY FOR Peptic Ulcer DISEASE NOT

ARE RELATIVE:

a) upon detection of cell atypia

b) with systematic seasonal annual exacerbations

peptic ulcer complicated by bleeding

c) with a peptic ulcer, previously complicated by perforation

and after suturing prone to frequent exacerbations

d) with multiple annual exacerbations

with an almost continuous course of the disease

e) with giant penetrating callous ulcers

16. WHEN DETERMINING INDICATIONS FOR SURGICAL

TREATMENT OF Peptic Ulcer DISEASE DOES NOT CONSIDER:

a) duration of the disease

b) frequency of exacerbations and severity of their manifestations

c) the effectiveness of conservative therapy

d) duration of remissions

e) severity of the periprocess

in the area of ​​the pylorus and duodenum

17. WHEN DETERMINING INDICATIONS FOR OPERATION FOR ULCER

DISEASES NO NEED TO KNOW:

a) about the nature of the disease

b) about the complications of peptic ulcer that have occurred

c) about predisposition to dumping syndrome

d) about the nature of gastric secretion

e) about duodenogastric reflux, its severity and nature

18. DETERMINING INDICATIONS FOR SURGICAL TREATMENT

Peptic ULCER DISEASE, IT IS NECESSARY TO CONSIDER:

a) data from endoscopic assessment of the ulcer and its localization

b) indications of an x-ray examination of the stomach

and duodenum

c) motor-evacuation function of the stomach and duodenum

d) functional state of the gastrin-producing system

e) true dimensions of the antrum of the stomach

19. PLANNING SURGERY FOR A DUODENAL ULCER,

IT IS OPTIONAL TO DO:

a) endoscopic examination of the upper sections

gastrointestinal tract

c) study of the secretory function of the pancreas

d) X-ray examination of the stomach

e) study of the functional state of the duodenum

20. FOR SUCCESSFUL SURGICAL TREATMENT OF DUODENAL

ULCERS NOT NECESSARILY:

a) study of duodenal patency

b) study of gastric secretion

c) assessment of the gatekeeper’s condition

d) determination of serum gastrin

e) determination of the nature (type) and level of antral gastrin

21. CARRYING OUT A FRACTIONAL STUDY OF THE GASTRIC

SECRETION CANNOT BE DETERMINED:

a) acid-forming function of the stomach

during the interdigestive period

b) basal acid production

c) stimulated acid formation

d) maximum reaction of the gastric glands

e) decompensated sour stomach

22. ESOPHAGOGASTRODUODENOSCOPY DOES NOT ALLOW:

a) assess the condition of the cardiac sphincter and pylorus

b) give a comprehensive assessment of the ulcerative defect

and determine its location

c) assess the condition of the mucous membrane of the esophagus, stomach and duodenum

d) determine the severity of duodenogastric reflux

e) conduct an electrometric study

basal acid formation

23. DETERMINATION OF THE BOUNDARIES OF THE ANTRAL SECTION OF THE STOMACH

NECESSARY FOR:

a) precise installation of pH probe electrodes

b) performing etiopathogenetically justified gastrectomy

with duodenal ulcer

c) determining the level of vagal denervation of the stomach

with selective vagotomy

d) performing a true anthrumectomy

e) determining the distal border of the intermedial zone of the stomach

24. STUDYING THE PATHOGENESIS OF DUMPING SYNDROME ALLOWS

CLAIM THAT HE IS:

a) the body’s reaction to rapid emptying of the gastric stump

and overdistension of the initial part of the jejunum

b) the result of intraintestinal hyperosmosis

c) a consequence of hormonal changes occurring after surgery

d) a kind of psycho-neurotic manifestation

e) genetically determined reaction of the body

for certain foods

25. INCREASED ACID PRODUCTION IN DUODENAL DISEASE

AN ULCER IS THE RESULT OF:

a) increased release of gastrin by G-cells

b) weakening of the antral acid brake

c) decreased acid-neutralizing ability of the stomach

d) disturbances of duodenal acid neutralization

e) development of ulcers in persons with excitable and asthenic type

gastric secretion

26. HEALTHY PERSONS DO NOT HAVE A TYPE OF GASTRIC

SECRETIONS:

a) normal

b) excitable

c) asthenic

d) inert

e) brake

27. ETHIOPATHOGENETICALLY BASED METHOD

OPERATIONS FOR UNCOMPLICATED DUODENAL ULCERS

IS:

a) SPV (selective proximal vagotomy)

b) ideal anthrumectomy

c) combination of anthrumectomy with vagotomy

d) high (2/3 or more) gastrectomy

e) stem or selective vagotomy

28. IN DECOMPENSATED PYLORODUODENAL

STENOSIS INDICATED APPLICATION:

a) PPV with pyloroplasty

b) truncal vagotomy with gastroduodenoanastomosis

c) selective vagotomy with gastroenteroanastomosis

d) economical gastrectomy with PPV

e) economical gastrectomy

with trunk or selective vagotomy

29. BEST FUNCTIONAL RESULTS AT LOW

DUODENAL STENOSIS RESULTS FROM:

a) pyloroplasty according to Heineke-Mikulich

in combination with selective vagotomy

b) combination of PPV with gastroduodenoanastomosis according to Dzhabulei

c) combinations of SPV with duodenoplasty

d) gastroenteroanastomosis with truncal vagotomy

e) economical gastrectomy with selective vagotomy

30. THE MOST PHYSIOLOGICAL METHOD OF GASTRIC RESECTION

COUNTS:

a) Billroth-2 in the Hoffmeister–Finsterer modification

b) resection in modification of Roux

c) Billroth-1

d) Balfour modification

e) resection according to Reichel - Polya

31. THE BEST METHOD OF INTRAOPERATIVE CONTROL FOR

COMPLETENESS OF VAGOTOMY IS RECOGNIZED:

a) intragastric pH-metry with a special pH probe

b) endoscopic pH-metry

c) chromogastroscopy with Congo mouth

d) determination of intragastric pH through the gastrotomy opening

e) combination of chromogastroscopy with transillumination

32. FOR COMPENSATED PYLORODUODENAL

STENOSIS IS CHARACTERISTIC:

a) serious condition of patients, exhaustion, dehydration, adynamia

b) profuse daily, sometimes repeated, often foul-smelling vomiting

c) thirst, decreased diuresis, constipation, and sometimes diarrhea

d) constant painful belching with an unpleasant odor

e) hunger pain in the epigastric region

33. IN DUODENAL ULCER COMPLICATED WITH STENOSIS,

SELECTIVE PROXIMAL VAGOTOMY CAN

APPLY TO ALL OPERATIONS EXCEPT:

a) ideal anthrumectomy

b) duodenoplasty

c) pyloroplasty

d) gastroduodenoanastomosis according to Dzhabulei

e) gastroenteroanastomosis

34. PATIENTS WITH COMPENSATED PYLORODUODENAL

STENOSIS WITHOUT SIGNS OF ACTIVE ULCER:

a) do not require surgical treatment

b) subject to surgical treatment

in case of exacerbation of peptic ulcer

c) surgery is performed only in case of progression of stenosis

d) require mandatory surgical treatment

e) operated after a 2-month course

intensive antiulcer therapy

35. OF THE PROVISIONS PRESENTED, THE CORRECT IS

STATEMENT ACCORDING TO WHICH:

a) a leading role in the pathogenesis of gastroduodenal ulcers

belongs to stimulated, not basal acid production

b) the more distal the ulcer is located in the gastroduodenal zone,

the higher the level of aggressive factors and the lower the protective

gastric mucin

c) the nature of ulcers does not depend on their localization in the gastroduodenal zone

d) with pyloroduodenal stenosis, hypersecretion and hyperproduction

acid-peptic factor is 1.5-2 times lower than those

with duodenal ulcer without stenosis

e) restoration or disruption of patency in the area of ​​stenosis

accompanied by a significant increase in the level

gastric secretion

36. THE HIGHEST ACIDITY NUMBERS ARE OBSERVED

FOR AN ULCER:

a) fundus of the stomach

b) antrum

c) pyloric canal

e) cardia of the stomach

37. FOR BLEEDING ULCERS OF THE BODY OF THE STOMACH AND SMALL DEGREE

OPERATIONAL RISK SHOWN:

a) wedge-shaped excision of a bleeding ulcer

b) resection of the stomach with a bleeding ulcer

c) wedge-shaped excision of a bleeding ulcer with spv

d) suturing a bleeding ulcer

with pyloroplasty and truncal vagotomy

d) excision of the ulcer

38. THE MOST INFORMATIVE DIAGNOSTIC METHOD

PERFORATIVE ULCERS ARE:

a) esophagogastroduodenoscopy

c) laparocentesis

d) laparoscopy

e) survey fluoroscopy

39. GASTRIC RESECTION IS NOT INDICATED FOR:

a) perforation of chronic callous ulcers with a long history

b) combined ulcers - stomach and duodenum

c) repeated perforations

d) perforation of prepyloric ulcers

e) repeated massive gastroduodenal ulcerative bleeding

in the anamnesis

40. VAGOTOMY IS INDICATED IN PERFORATION:

a) prepyloric ulcers and ulcers of the pyloric canal

b) acute ulcers of any nature

c) fresh ulcers without signs of a chronic process in history

d) mediogastric ulcers

e) duodenal ulcers in Zollinger-Ellison syndrome

41. IF A DUODENAL ULCER IS SUSPECTED FOR THE FIRST TIME

THE QUEUE IS HELD:

a) study of gastric secretion

b) determination of serum gastrin level

c) cholecystography

d) general fluoroscopy of the abdominal organs

e) esophagogastroduodenoscopy

42. ENDOSCOPIC EXAMINATION DOES NOT ALLOW

DIAGNOSE:

a) type of gastritis

b) Mallory-Weiss syndrome

c) early stomach cancer

d) Zollinger-Ellison syndrome

e) degree of pyloric stenosis

43. THE MOST COMMON COMPLICATION OF ANTERIOR WALL ULCER

THE DIDUM IS:

a) perforation

b) bleeding

c) penetration into the head of the pancreas

d) malignancy

d) everything is wrong

44. EXTREMELY RARE COMPLICATION OF DUDOMAL ULCER

IS:

a) perforation

b) malignancy

c) bleeding

d) penetration

e) cicatricial deformation of the intestine

45. RELIABLE X-RAY SIGN

PERFORATION OF A GASTRODUODENAL ULCER IS:

a) high diaphragm position

b) the presence of free gas in the abdominal cavity

c) intestinal pneumatization

d) Kloiber's "bowls"

d) enlarged gas bubble of the stomach

46. ​​RETURNING FOAMY BLOOD OF BRIGHT RED COLOR,

WORSE WITH COUGHING, CHARACTERISTIC FOR:

a) bleeding stomach ulcer

b) tumors of the cardia

c) Mallory-Weiss syndrome

d) pulmonary hemorrhage

e) Randu-Osler syndrome

47. FOR PERFORATIVE GASTRODUODENAL ULCERS

CHARACTERISTIC:

a) sudden onset with sharp pain in the epigastrium

b) gradual increase in pain syndrome

c) cramping sharp pain

d) excessive repeated vomiting

d) rapidly increasing weakness, dizziness

48. FOR A PERFORMED STOMACH ULCER, DO NOT IN THE FIRST 6 HOURS

CHARACTERISTIC:

a) sharp pain in the abdomen

b) plank belly

c) disappearance of liver dullness

d) bloating

e) “sickle” of gas under the diaphragm dome

49. IF A PERFORATIVE GASTRIC ULCER IS SUSPECTED

THE FIRST RESEARCH SHOULD BE:

a) fluoroscopy of the stomach with barium suspension

b) plain radiography of the abdominal cavity

c) emergency esophagogastroduodenoscopy

d) angiography (selective celiac artery)

d) laparoscopy

50. ESTABLISH THE SOURCE OF GASTRODUODENAL

BLEEDING ALLOWS:

a) X-ray examination of the stomach

b) laparoscopy

c) nasogastric tube

e) repeated determination of hemoglobin and hematocrit

51. DISAPPEARANCE OF PAIN AND APPEARANCE OF “MELENA” WITH

DUODENAL ULCER IS CHARACTERISTIC FOR:

a) pyloroduodenal stenosis

b) perforation of the ulcer

c) malignancy of the ulcer

d) bleeding

e) penetration into the pancreas

52. MALLORY-WEISS SYNDROME IS:

a) varicose veins of the esophagus and cardia,

complicated by bleeding

b) bleeding ulcer of Meckel's diverticulum

c) bleeding from the mucous membranes due to hemorrhagic angiomatosis

(Randu-Osler disease)

d) cracks in the cardiac part of the stomach with bleeding

e) hemorrhagic erosive gastroduodenitis

53. THEORETICAL BACKGROUND OF THE MEULENGRAFT DIET

BASED ON:

a) on mechanical sparing of the gastric mucosa

b) to suppress the secretion of gastric juice

c) providing high-calorie nutrition

d) all of the above are true

d) everything is wrong

54. THE MOST COMMON COMPLICATION OF PENETRATING ULCERS

THE STOMACH IS:

a) development of pyloric stenosis

b) malignancy of the ulcer

c) formation of an interorgan fistula

d) profuse bleeding

e) perforation

55. NATURE OF OPERATIVE INTERVENTION IN PERFORMANCE

STOMACH ULCER DETERMINES:

a) age of the patient

b) localization of the perforation hole

c) severity of peritonitis

d) period from the moment of perforation

d) all of the above

PERFECTION OF DUODENAL ULCER IS EXPLAINED BY:

a) reflex connections through the spinal nerves

b) the flow of air into the abdominal cavity

c) flow of gastric contents into the right lateral canal

d) development of diffuse peritonitis

e) viscero-visceral connections with the appendix

57. SURGERY FOR DUODENAL ULCERS IS NOT INDICATED IF:

a) hormonal nature of the disease

b) massive bleeding

c) development of stenosis

d) the occurrence of ulcers during treatment with ulcerogenic drugs

e) lack of effect from conservative therapy

58. IN case of duodenal ulcer, do not

CHARACTERISTIC:

a) predominant development at the age of 20-40 years

b) increased tone of the parasympathetic nervous system

c) high concentration of antral gastrin

d) seasonal exacerbations

e) continuous acid formation

59. CONSERVATIVE THERAPY FOR A PERFORMED ULCER

ALLOWED ONLY IF:

a) the patient does not have a history of ulcers

b) elderly patients

c) absence of conditions for fulfillment

emergency surgery

d) extremely high degree of operational risk

e) combination of gastric ulcer and duodenal ulcer

60. FORCED POSITION OF A PATIENT WITH RESULTS

TO THE ABDOMEN WITH LEGS AND BOARD-SHAPED MUSCLE TENSION

ABDOMEN IS CHARACTERISTIC FOR:

a) hemorrhagic pancreatic necrosis

b) volvulus

c) perforated ulcer

d) renal colic

e) mesenteric thrombosis

61. WHEN SURGERY IS ONE HOUR AFTER CALLOSIS PERECURATION

STOMACH ULCERS SHOWN:

a) true anthrumectomy

b) classic resection of 2/3 of the stomach

c) suturing a perforated ulcer

e) any of the above operations

62. FOR DECOMPENSITED pyloric stenosis, do not

CHARACTERISTIC:

a) vomiting food eaten the day before

b) tension in the abdominal wall muscles

c) oliguria

d) “splashing noise” in the stomach on an empty stomach

e) retention of barium in the stomach for more than 24 hours

63. FOR A BLEEDING DUDOMAL ULCER DO NOT

CHARACTERISTIC:

a) vomit the color of coffee grounds

b) increased abdominal pain

c) drop in hemoglobin

d) melena

e) decrease in BCC

64. THE MOST RATIONAL OPERATION FOR STOMACH ULCERS

IS:

a) classic resection of at least 2/3 of the stomach

b) ideal (true) anthrumectomy with removal of the ulcer

c) selective proximal vagotomy

d) truncal vagotomy with pyloroplasty

d) excision of the ulcer

65. OPERATION OF CHOICE FOR SUBCOMPENSED STENOSIS

THE GATEKEEPER IS:

a) PPV with pyloroplasty

b) gastroduodenostomy

c) gastric resection

d) gastroenterostomy

e) any of the above operations

66. GUARANTEE AGAINST RECURRENCE DURING SURGERY FOR

DUMIDAL ULCER IS:

a) selective proximal vagotomy

b) truncal vagotomy with pyloroplasty

c) true anthrumectomy

d) anthrumectomy with selective vagotomy

e) resection of at least 2/3 of the stomach

67. IN RECURRENCE OF GASTRODUODENAL ULCER

BLEEDING INDICATED:

a) emergency surgery

b) urgent surgery

c) endovascular selective hemostatic therapy

d) repeated endoscopic hemostatic therapy

e) intensive conservative hemostatic therapy

68. IN THE THREAT OF RECURRENCE OF GASTRODUODENAL ULCER

a) exclusively conservative therapy

b) emergency surgery

c) urgent surgery

d) systematic endoscopic control

e) surgical treatment as planned

69. SELECTIVE PROXIMAL VAGOTOMY IS ALLOWED

WITH EVERYTHING EXCEPT:

a) duodenal ulcer with symptoms of subcompensated stenosis

b) perforated duodenal ulcer

c) uncomplicated duodenal ulcer

d) duodenal ulcer complicated by bleeding

e) combined ulcer of the stomach and duodenum

70. OPERATION OF CHOICE FOR A PERFORMED STOMACH ULCER IN

THE CONDITIONS OF PURULENT PERITONITIS ARE:

a) gastric resection

b) excision of the ulcer with truncal vagotomy and pyloroplasty

c) suturing the perforation

d) PPV with suturing of perforation

e) true anthrumectomy

spbtr.ru - Diseases, endocrinologists. MRI

Certificate of registration of mass media EL No. FS 77 - 57771 dated 04/18/2014.
Copyright © 2006-2017. All materials are protected by copyright
The media outlet "BusinessGarant" is registered by the Federal Service for Supervision of Communications, Information Technologies and Mass Communications