In order to understand the diagnosis – duodenal ulcer, let us consider in more detail the anatomy of the human intestine.
Its total length in an adult living person is about 6 m, in a dead person it is more – about 8 m. there is no necessary tension (tone).
The intestine is anatomically subdivided into: the small intestine (Latin enterum) and the large intestine (Latin colon).
The small intestine originates from the stomach and is so called because, compared to the large intestine, its walls are thinner and not so strong. The small intestine is about 4 m long, and in men it is longer than in women. The diameter of the small intestine at the beginning and middle of the intestine is on average 4-6 cm, then gradually decreases to 2-3 cm. The wall of the small intestine is lined with the finest hairs – the epithelium, which takes the most active part in the process of cavity digestion.
In turn, the small intestine is conditionally subdivided into three parts:
jejunum (Latin jejunum);
ileum (Latin ileum).
Why does the duodenum have such a peculiar name?
The fact is that ancient scientists who studied the structure of human internal organs measured everything on the fingers, and in ancient Russia a finger was called a finger.
It is from the duodenum that the small intestine begins. Its length is about 21 cm, it has the shape of the letter “C”, because bends around the head of the pancreas. It opens the lumens of the common bile duct from the liver and the main pancreatic duct from the pancreas. Here, with the participation of enzymes, food breaks down to proteins, fats and carbohydrates, further splitting occurs already in the walls of the intestine. At the same time, a huge amount of various hormones (secretin, motilin, etc.) are synthesized by the intestinal cells.
The walls of the intestine are constantly exposed to powerful factors that contribute to the breakdown of food, therefore, when the protective function of the mucous membrane of the intestinal wall is weakened, it itself begins to be digested by the available enzymes. There is an eruption of the walls of the duodenum. This is where the disease begins. The disease usually occurs periodically: exacerbation alternates with sedation (sometimes long). At the same time, duodenal ulcer occurs in men 4 – 5 times more often than in women.
Hereditary factors, long-term psychoemotional stress, psychological trauma, anxiety, dietary habits with a violation of its rhythm and the frequent use of products that have a pronounced sokogonny effect contribute to the onset and development of the disease. In some cases, the role of mucosal exposure to drugs such as aspirin and long-term treatment with corticosteroids is evident. Of lesser importance, but still, there is a violation in the intestinal wall of blood circulation, which is usually associated not so much with organic changes in blood vessels (thickening, compaction, narrowing of the lumens, thrombosis), but with their functional disorders with a tendency to spasms.
The most characteristic symptoms of the disease are abdominal pain, unpleasant phenomena (nausea, vomiting, heartburn), sometimes bleeding. Pain in the abdomen can be given to the spine, usually they appear 1.5-2 hours after eating. Possible pain on an empty stomach, nighttime, relieving immediately after eating. Sometimes vomiting occurs against the background of pain, which brings relief. Heartburn usually occurs after eating, less often on an empty stomach and at night and is associated with the throwing of gastric juice into the lower esophagus. When palpating the abdomen, doctors determine the soreness and tension of the abdominal muscles slightly to the right and above the navel.
A person’s appetite persists, however, due to fear of pain, many people avoid eating. Sometimes during an exacerbation, patients lose weight, they have fear, anxiety, sweating, etc. Often, the disease can be asymptomatic for a long time, manifested by sudden bleeding with vomiting in the form of “coffee grounds”, tarry stools. Ulcer perforation may occur, which requires immediate hospitalization in the surgical department.
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In a laboratory study of gastric juice, high acidity is found. Ulcerative bleeding is determined by a special study of feces for occult blood. With the help of X-ray examination with exacerbation of peptic ulcer disease in the duodenum, a niche 0.5-4 cm in size and other signs characteristic of an ulcer are found – persistent deformation of the mucous membrane, groups of folds, spasm phenomena.
Exacerbations of the disease are usually observed in spring and autumn and can be followed by long-term remissions. In addition to bleeding and perforation of the ulcer, peptic ulcer disease can be complicated by the effect on the liver or pancreas.
The prevention of peptic ulcer disease consists, first of all, in finding out the causes of the disease, which lie in the factors that traumatize the psyche. It is necessary to carefully interview the patient to provide assistance to eliminate the negative impact on the psyche.
The usual treatment for peptic ulcer disease consists of adherence to a diet and a regular diet, smoking cessation, and exercise restrictions. It is especially important to observe these measures in spring and autumn.
Treatment for exacerbation of the disease provides for mandatory compliance with a rest regimen, including bed rest in a hospital for 2-4 weeks. The diet should be sufficient in terms of calories and not stimulate the motor and secretory functions of the stomach. You should eat 5-6 times a day. Exclude spicy and salty foods and seasonings, fried foods, bacon, smoked fish. Vegetarian mashed soups with the addition of cream, boiled lean meat, soft-boiled eggs, omelets, jelly, butter, fruit juices are recommended.
Gradually, the diet should be expanded, including the use of crackers and white bread, cereals, pasta, low-fat ham, cottage cheese, sour cream. Sharply limit salt intake. Alkalizing and astringent agents (for example, vikalin) are used. Almagel has a similar effect, as well as a mixture of Bourget, etc.
During the recovery period, in the absence of signs of latent bleeding, physiotherapy is performed (heating pads, warming compresses, later mud, paraffin applications). With a persistent course, as well as with complications of peptic ulcer disease (perforation, degeneration of an ulcer into cancer), surgical intervention is necessary. Apart from the exacerbation of peptic ulcer disease, spa treatment is indicated.