Rehabilitation of gastric ulcer. Rehabilitation methods for patients with gastric ulcer. The psychological aspect of rehabilitation

Examination on physical rehabilitation Physical rehabilitation for gastric ulcer and duodenal ulcer

INTRODUCTION

peptic ulcer disease

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

Purpose of the work: to study the methods of physical rehabilitation for gastric ulcer and duodenal ulcer.

Research objectives:

1. To study the basic clinical data on gastric ulcer and duodenal ulcer.

2. To study the methods of physical rehabilitation for gastric ulcer and duodenal ulcer.

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

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

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

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

G Chapter 1. Basic clinical data on gastric ulcer and duodenal ulcer

1.1 Etiology and pathogenesis of gastric ulcer and duodenal ulcer colon

According to LS Khodasevich (2005), the term "peptic ulcer" is characterized by the formation of areas of destruction of the mucous membrane of the gastrointestinal tract. In the stomach it is localized more often on the lesser curvature, in the duodenum - in the bulb on the back wall. A.D. Ibatov believes that the factors contributing to the onset of ulcer are prolonged and / or repeated emotional stress, genetic predisposition, the presence of chronic gastritis and duodenitis, Helicobacter pylori ascertaining, eating disorders, smoking and drinking.

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

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

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

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

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

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

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

Pathogenesis of pyloroduodenal ulcers:

- violation of the motility of the stomach and duodenum;

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

- an increase in the level of adrenocorticotropic hormone of the pituitary gland and glucocorticoids of the adrenal glands;

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

Pathogenesis of stomach ulcers:

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

- weakening of the factors of protection of the mucous membrane

1.2 Clinical presentation, classification and complications of ulcer pain diseases of the stomach and duodenum

In the clinical picture of the disease, S.N. Popov notes pain syndrome, which depends on the localization of the ulcer, dyspeptic syndrome (nausea, vomiting, heartburn, changes in appetite), which, like pain, can have a rhythmic nature, signs of gastrointestinal bleeding can be observed or clinic of peritonitis with perforation of the ulcer.

The leading sign, according to S.N. Popov and L.S. duodenal ulcer, pain in which is usually localized to the right of the midline of the abdomen. Sometimes there are pains on an empty stomach, as well as night pains. Stomach ulcer is usually observed in patients over 35 years old, duodenal ulcer - in young people. The typical seasonality of spring exacerbations is traced. During ulcer S. N. Popov distinguishes four phases: exacerbation, fading exacerbation, incomplete remission and complete remission. The most dangerous complication of ulcer is perforation of the stomach wall, accompanied by acute "dagger" pain in the abdomen and signs of inflammation of the peritoneum. This requires immediate surgery.

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

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

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

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

- gastroduodenal - ulcer and duodenal ulcer;

- stomach - YABZH;

- perforated ulcer - stomach and duodenal ulcer, perforated into the free abdominal cavity.

P.F. Litvitsky and Yu.S. Popova give the classification of nuclear weapons:

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

- Stomach ulcers arising with duodenal ulcers.

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

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

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

S.N. Popov also distinguishes ulcers in the classification by type (single and multiple), by etiology (associated with Helicobacter pylori and not associated with N.R.), by clinical course (typical, atypical (with atypical pain syndrome, painless, but with other clinical manifestations, asymptomatic)), by the level of gastric secretion (with increased secretion, with normal secretion and with decreased secretion), by the nature of the course (newly diagnosed ulcer, recurrent course), by the stage of the disease (exacerbation or remission), by the presence of complications (bleeding , perforation, stenosis, malignancy).

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

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

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

- Penetration - violation of the integrity of the stomach when gastric contents are poured into the nearby pancreas, omentum, bowel loops or other organs. This happens when, as a result of inflammation, the wall of the stomach or duodenum fuses with the surrounding organs (adhesions are formed). The pain attacks are very severe and cannot be relieved with medication. Surgical intervention is required for treatment.

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

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

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

- Obstruction of the pyloric stomach (pyloric stenosis) - anatomical distortion and narrowing of the sphincter lumen resulting from scarring of the ulcer of the pyloric canal or the initial section of the duodenum. A similar phenomenon leads to difficulty or complete cessation of the evacuation of food from the stomach. Stenosis of the gatekeeper and associated digestive disorders lead to disorders of all types of metabolism, which leads to depletion of the body. The main method of treatment is surgery.

peptic ulcer rehabilitation

1.3 Diagnosis of gastric ulcer and duodenal ulcer

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

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

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

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

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

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

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

1.4 Treatment and prevention of gastric ulcer and twelve duodenal ulcer

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

S.N. Popov also argues that patients with exacerbation of uncomplicated ulcer, as a rule, are treated on an outpatient basis. Complex therapy is used, similar to the treatment of chronic gastritis, diet therapy, drug therapy, physiotherapy procedures, spa treatment (in remission), exercise therapy. Some authors believe that diet therapy, PH, massage, physiotherapy and hydrotherapy are used for treatment. In addition, Yu. S. Popova believes that it is important to create for the patient the calm psychological atmosphere he needs, to exclude nervous and physical overloads, and, if possible, negative emotions.

The causes, signs, diagnostic methods and possible complications of ulcer are somewhat different, depending on which particular part of the stomach or duodenum the exacerbation is localized, explains OV Kozyreva.

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

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

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

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

1.4.2 Diet therapy Yu. S. Popova explains that nutritional therapy in ulcer should provide the gastric mucosa and duodenum maximum rest, it is important to exclude mechanical and thermal damage to the gastric mucosa. All food is mashed, the temperature of which is from 15 to 55 degrees. In addition, with an exacerbation of ulcer, it is unacceptable to consume foods that provoke increased secretion of gastric juice. Fractional meals - every 3-4 hours, in small portions. The diet should be complete, emphasis on vitamins A, B and C. The total amount of fat should not exceed 100-110 g per day.

1.4.3 Physiotherapy According to GN Ponomarenko, physiotherapy is prescribed in order to reduce pain and provide antispastic action, suppress the inflammatory process, stimulate regenerative processes, regulate the motor function of the gastrointestinal tract, and increase immunity. Local air cryotherapy is used, applying cold air to the back and abdomen for about 25-30 minutes; peloid therapy in the form of mud applications on the anterior abdominal cavity; radon and carbon dioxide baths; magnetotherapy, which has a positive effect on immune processes. Contraindications to physiotherapy are severe ulcer, bleeding, individual intolerance to physiotherapeutic methods, gastric polyposis, ulcer malignancy, general contraindications for physiotherapy.

1.4.4 Phytotherapy NP Petrushkina explains that phytotherapy is included in complex treatment later. In the process of phytotherapy of peptic ulcer and duodenal ulcer, with an increase in the activity of the acid-peptic factor, neutralizing, protecting and regenerating groups of drugs are used. For a long-term ulcer defect, antiulcer, herbal preparations are used (sea buckthorn oil, rosehip oil, carbenoxolone, alantone) ..

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

For the treatment of peptic ulcer and duodenal ulcer, the author also offers such collections of herbs as: fruits of fennel, marshmallow root, licorice, chamomile flowers; herb celandine, yarrow, St. John's wort and chamomile flowers. The infusion is usually taken before meals, at night, or to relieve heartburn.

1.4.5 Massage From remedies of exercise therapy for diseases of the abdominal cavity, massage is shown - therapeutic (and its varieties - reflex-segmental, vibration), says V.A.Epifanov. Massage in the complex treatment of chronic diseases of the gastrointestinal tract is prescribed to provide a normalizing effect on the neuroregulatory apparatus of the abdominal organs, in order to improve the function of the smooth muscles of the intestine and stomach, and strengthen the abdominal muscles.

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

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

1.4.6 Prevention To prevent exacerbations of ulcer, SN Popov offers two types of therapy (supportive therapy: antisecretory drugs in a half dose; preventive therapy: when symptoms of exacerbation of ulcer appear, antisecretory drugs are used for 2-3 days. Therapy is stopped when symptoms completely disappear) with the observance of general and motor regimes by patients, as well as a healthy lifestyle. Spa treatment is a very effective means of primary and secondary prevention of ulcer.

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

- sleep 6-8 hours;

- give up fatty, smoked, fried foods;

- during stomach pains, it is necessary to be examined by a specialist doctor;

- eat food 5-6 times a day, pureed, easily digestible: cereals, jelly, steam cutlets, sea fish, vegetables, omelet;

- treat aching teeth in order to chew food well;

- to avoid scandals, since after a nervous overstrain, pain in the stomach intensifies;

- do not eat food that is very hot or very cold, as this can contribute to the occurrence of esophageal cancer;

- do not smoke or abuse alcohol.

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

CHAPTER 2 Physical rehabilitation methods for gastric ulcer and duodenal ulcer

2.1 Physical rehabilitation at the inpatient stage of treatment

Hospitalization is subject, according to A.D. Ibatov, patients with newly diagnosed ulcer, with an exacerbation of ulcer and in the event of complications (bleeding, perforation, penetration, gatekeeper stenosis, malignancy). Considering that the traditional treatments for ulcer are warmth, rest and diet.

At the stationary stage, respectively, a semi-bed or bed rest is prescribed (with severe pain syndrome). Diet - table number 1a, 1b, 1 according to Pevzner - provides mechanical, chemical and thermal sparing of the stomach [Appendix B]. Eradication therapy is carried out (if Helicobacter pylori is detected): antibacterial therapy, antisecretory therapy, drugs that normalize gastric and duodenal motility. Physiotherapy includes electrosleep, sinusoidally modeled currents to the stomach area, UHF therapy, ultrasound to the epigastric region, and novocaine electrophoresis. With stomach ulcers, oncological alertness is necessary. Physiotherapy is contraindicated if malignancy is suspected. Exercise therapy is limited to UGG and LH in a sparing mode.

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

According to I.V. Milyukova, during exacerbations, a frequent change in rhythm, a fast pace of performing even simple exercises, muscle tension can cause or aggravate pain and worsen the general condition. During this period, monotonous exercises are used, performed at a slow pace, mainly in the SP lying down. In the remission phase, exercises are performed in the PI while standing, sitting and lying down; the range of motion increases, exercises with shells (weighing up to 1.5 kg) can be used.

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

2.2 Physical rehabilitation at the outpatient stage of treatment

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

2.3 Physical rehabilitation at the sanatorium stage of treatment

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

Treatment of patients takes place during the period of remission, the volume and intensity of LH training increases: they widely use OUU, DU, coordination exercises, allow outdoor and some sports games (badminton, table tennis,), relay races. Terrenkur is recommended, walks in winter - skiing (the route should exclude ups and downs with a steepness exceeding 15-20 degrees, the walking style is alternating). In the LH procedure, there are no strength, speed-strength exercises, static efforts and tensions, jumps and jumps, exercises at a fast pace. SP sitting and lying.

CONCLUSION

YB ranks second in terms of morbidity in the population after IHD. Many cases of stomach and duodenal ulcers, gastritis, duodenitis, and possibly some cases of stomach cancer are etiologically associated with Helicobacter pylori infection. However, the majority (up to 90%) of infected H.P. no symptoms of disease are found. This suggests that ulcer is a neurogenic disease that developed against the background of prolonged psychoemotional overstrain. Statistics show that urban dwellers are more susceptible to PU than rural dwellers. A less significant factor in the onset of ulcer is malnutrition. I think everyone will agree with me that against the background of stress, emotional overload in work and life, people often, without noticing it, tend to tasty, not healthy food, and someone also abuses tobacco and alcohol. In my opinion, if the situation in the country was not tense, as at the moment, the incidence would be clearly lower. During the Great Patriotic War, soldiers were susceptible to various diseases of the gastrointestinal tract from martial law in the country, from malnutrition and tobacco abuse. The soldiers were also subject to hospitalization and rehabilitation. Seventy years later, the factors of the emergence of YB remained the same.

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

After the relapse stage has passed, the patient is transferred to a polyclinic for a gastroenterologist, undergoes observation for 6 years, with periodic treatments in sanatoriums or resorts to ensure a stable remission. In the sanatorium, patients are treated with mineral waters, various types of massage, skiing, cycling, swimming in open waters, games.

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

LIST OF ABBREVIATIONS

N.R. - Helicobacter pylori (Helicobacter pylori) UHF - decimetwave (therapy) Duodenum - duodenum DU - breathing exercises of the gastrointestinal tract - gastrointestinal tract ischemic heart disease - coronary heart disease PI - initial position of PH - therapeutic gymnastics exercise therapy - physiotherapy exercises NS - nervous system ORU - general developmental exercises OUU - general strengthening exercises SMV - centimeter wave (therapy) ESR - erythrocyte sedimentation rate FGS - fibrogastroscopy UHF - ultra-high-frequency (therapy) UGG - morning hygienic gymnastics heart rate - heart rate ECG - intestinal ulcerative disease - ulcer ulcer - peptic ulcer YABZh - gastric ulcer

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12. Physiotherapy: national guidance / ed. G. N. Ponomarenko. - M .: GEOTAR-Media, 2009 .-- 864 p.

13. Physiotherapy: textbook. manual / ed. A.R. Babaeva. - Rostov-on-Don: Phoenix, 2008 .-- 285 p.

14. Physical rehabilitation: textbook / under total. ed. S. N. Popova. - Ed. 2nd, rev. add. - Rostov-on-Don: Phoenix, 2004 .-- 603p.

15. Khodasevich, L.S. Lecture notes on the course of private pathology / L.S.

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

ANNEXES

Appendix A

Plan-outline of remedial gymnastics for ulcerative b diseases of the stomach and duodenum

The date of the: 11.11.11

Observed: full name., 32 years old Diagnosis: duodenal ulcer, gastroduodenitis, superficial gastritis;

Stage of the disease: relapse, subacute (damped exacerbation) Movement mode: extended bed rest Venue: ward Method of conducting: individual Duration of the lesson: 12 minutes Objectives of the lesson:

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

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

3. to ensure the prevention of complications and stagnation, to promote overall physical performance;

4. continue teaching diaphragmatic breathing, relaxation exercises, elements of auto-training;

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

Appendix Table

Parts of the lesson	Private tasks		Dosage	Organizational-method. directions
Introductory preparation of the body for the upcoming load	Checking heart rate and NPV	1) PI lying on the back. Measurement of heart rate and respiratory rate	Heart rate for 15 "" NPV for 30 ""	Show measurement area
	Teach diaphragmatic breathing	1) PI lying on your back, arms along the body, legs bent at the knees. Diaphragmatic breathing: 1. inhale - the abdominal wall rises, 2.exhale - retracts		The pace is slow Imagine the air coming out of the lungs
	Improve peripheral circulation.	2) PI lying on your back, arms along the body. Simultaneous flexion and extension of the feet and hands into a fist		Average tempo Breathing arbitrary
	Stimulate blood circulation in the lower extremities	3) PI lying on the back Alternate flexion of the legs without lifting the feet from the bed 1.exhalation - flexion, 2. inhalation - extension		The pace is slow
	Stimulate blood circulation in the upper limbs	4) IP lying on the back, arms along the body 1. inhale - spread your arms to the sides, 2. exhale - return to the IP		The pace is slow
Basic Solution for general and special tasks	Strengthen your abdominal and pelvic floor muscles	5) PI lying on your back, legs bent at the knees. 1.parse the knees to the sides, connecting the soles, 2.return to the IP
	Improve blood circulation in internal oraganes	6) SP sitting on the bed, legs lowered, hands on the belt. 1.exhale - turn the body to the right, arms to the sides, 2. inhale - return to IP, 3.exhale - turn the body to the left, arms to the sides, 4. inhale - return to PI		Pace slow Amplitude incomplete Spare the epigastric region
	Strengthen the pelvic floor muscles and improve emptying function	7) PI lying on your back. Slowly bend your legs and put your feet to the buttocks, leaning on your elbows and feet 1. raise your pelvis 2. return to the PI		Slow pace Do not hold breath
Concludes. decrease in load, recovery of heart rate and NPV	General relaxation	8) PI lying on your back. Relax all muscles		Eyes close Inclusion of auto-training elements
	Checking heart rate and NPV	1) PI lying on the back. Measurement of heart rate and respiratory rate	Heart rate for 15 "" NPV for 30 ""

Diet tables according to Pevzner

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

Table number 1a. Indications: exacerbation of gastric ulcer and duodenal ulcer in the first 10-14 days, acute gastritis in the first days of the disease, exacerbation of chronic gastritis (with preserved and high acidity) in the first days of the disease. Characteristics: physiological content of proteins and fats, restriction of carbohydrates, sharp restriction of chemical and mechanical irritants of the mucous membrane and the receptor apparatus of the gastrointestinal tract. Culinary processing: all products are boiled, wiped or steamed, dishes of a liquid or mushy consistency. Energy value: 1 800 kcal (7 536 kJ). Composition: proteins 80 g, fats 80 g, (of which 15-20 g are vegetable), carbohydrates 200 g, free liquid 1.5 liters, table salt 6-8 g. The mass of the daily diet is 2-2.5 kg. The diet is fractional (6-7 times a day). The temperature of hot dishes is 57-62 ° С, cold ones - not lower than 15 ° C.

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

Table No. 2. Indications: acute gastritis, enteritis and colitis during the recovery period, chronic gastritis with secretory insufficiency, enteritis, colitis during remission without concomitant diseases. General characteristics: a physiologically complete diet rich in extractives, with rational culinary processing of products. Excluded are foods and dishes that linger in the stomach for a long time, are difficult to digest, irritate the mucous membrane and the receptor apparatus of the gastrointestinal tract. The diet has a stimulating effect on the secretory apparatus of the stomach, improves the compensatory and adaptive reactions of the digestive system, and prevents the development of the disease. Culinary processing: dishes can be boiled, baked, stewed, and also fried without breading in breadcrumbs or flour and without the formation of a coarse crust. Energy value: 2800-3100 kcal. Ingredients: proteins 90-100 g, fats 90-100 g, carbohydrates 400-450 g, free liquid 1.5 liters, table salt up to 10-12 g. Daily ration weight - 3 kg. The diet is fractional (4-5 times a day). The temperature of hot dishes is 57-62? С, cold dishes - below 15 ° C.

Peptic ulcer disease is the most common disease of the digestive system. It is characterized by a long course, prone to repetition and frequent exacerbation. Peptic ulcer and duodenal ulcer is a chronic disease characterized by ulceration in the gastrointestinal tract.

An important role in the development of peptic ulcer disease is also played by heredity. The symptoms of peptic ulcer disease are very diverse. Its main symptom is pain, often in the epigastric region. Depending on the localization of the ulcer, pain is early (0.3-1 hours after eating) and late (1.0-2 hours after eating). Sometimes pain occurs on an empty stomach, as well as at night. Quite often, heartburn appears, sour belching is observed, vomiting also occurs with sour contents, and, as a rule, after eating.

The complex of therapeutic measures includes medicines, exercise therapy and other physical methods of treatment, massage, diet food. Therapeutic exercises on bed rest are prescribed in the absence of contraindications (acute pain, bleeding). Usually start 2-4 days after hospitalization. Parhotik I.I. Physical rehabilitation in diseases of the abdominal organs: Monograph. - Kiev: Olympic Literature, 2009 .-- 224 p.

The first period lasts about 15 days. At this time, static breathing exercises are used, which enhances the process of inhibition in the cerebral cortex. Performed lying on your back with relaxation of all muscle groups, these exercises contribute to relaxation, reduce pain, and normalize sleep. Simple physical exercises are also used, with a low number of repetitions in conjunction with breathing exercises, but exercises that can increase intra-abdominal pressure are excluded. The duration of the classes is 10-15 minutes, the pace of execution is slow or medium.

Physical rehabilitation of the 2nd period is used during the transfer of the patient to the ward mode. The second period of training begins when the patient's condition improves. Therapeutic exercises and abdominal wall massage are recommended. Gymnastic exercises are performed lying, sitting, standing with a gradually increasing effort of all muscle groups, also excluding exercises for the abdominal muscles. The most optimal position is lying on the back: in this position, the mobility of the diaphragm increases, there are positive effects on the abdominal muscles and the blood supply to the abdominal organs improves. Exercises for the abdominal muscles are performed without tension, with a low number of repetitions.

The third period of physical rehabilitation is aimed at general strengthening and improvement of the body; improving blood circulation in the abdominal cavity; restoration of psychological and physical skills. In the absence of complaints of painful sensations, with a general satisfactory condition of the patient, a free regimen is prescribed. Exercises for all muscle groups, exercises with a small load (up to 1.5-2 kg), coordination exercises, sports games are used. The density of the lesson is average, the duration is allowed up to 30 minutes. The application of massage is shown. The massage should be gentle at first. The intensity of the massage and its duration gradually increase from 10-12 to 25-30 minutes by the end of the treatment.

Thus, in the process of physical rehabilitation of gastric ulcer and duodenal ulcer at the stationary stage, it is necessary to apply an integrated approach: drug therapy, nutritional therapy, herbal medicine, physiotherapy and psychotherapeutic treatment, physical therapy, taking into account the observance of therapeutic and motor regimes. Parhotik I.I. Physical rehabilitation in diseases of the abdominal organs: Monograph. - Kiev: Olympic Literature, 2009 .-- 224 p.

At the stationary stage of rehabilitation, patients with this pathology, taking into account the capabilities of the medical institution and the prescribed motor regime, can be recommended all means of therapeutic physical culture: physical exercises, natural factors of nature, movement modes, therapeutic massage, mechanotherapy and occupational therapy. From the forms of classes - morning hygienic gymnastics, medical gymnastics, dosed therapeutic walking (on the territory of the hospital), training walking up the stairs, dosed swimming (if there is a pool), independent exercises. All these classes can be conducted by individual, small-group (4-6 people) and group (12-15 people) methods.

According to the WHO definition, rehabilitation is a combined and coordinated application of social, medical, pedagogical and professional measures in order to prepare and retrain an individual to achieve his optimal working capacity. "

Rehabilitation tasks:

• 1. Improve the general reactivity of the body;
• 2. Normalize the state of the central and vegetative systems;
• 3. Provide anesthetic, anti-inflammatory, trophic effect on the body;
• 4. Maximally prolong the period of remission of the disease.

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

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

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

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

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

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

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

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

The outpatient stage of medical rehabilitation must ensure the completion of the pathological process (Appendix D).

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

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

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

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

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

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

Areas of medical rehabilitation include medication and non-medication directions:

Medical direction of rehabilitation.

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

Reception before meals

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

Antiulcer drugs should be taken half an hour before meals - d-nol, gastrofarm. They should be taken with water (not milk).

Also, half an hour before meals, antacids (almagel, phosphalugel, etc.) and choleretic drugs should be taken.

Reception with meals

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

Along with food, you need to take preparations of gastric juice or digestive enzymes, as they help the stomach to digest food. These include pepsin, festal, enzistal, panzinorm.

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

Reception after meals

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

Immediately after meals, medications are mainly taken, which irritate the mucous membrane of the stomach and intestines. This recommendation applies to drug groups such as:

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

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

Aspirin or ascofen (caffeinated aspirin) is taken after meals, when the stomach has already begun to produce hydrochloric acid. Due to this, the acidic properties of acetylsalicylic acid (which provokes irritation of the gastric mucosa) will be suppressed. This should be borne in mind by those who take these pills for headaches or colds.

Regardless of food

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

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

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

Reception on an empty stomach

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

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

Patients often ignore the recommendations of doctors and pharmacists, forgetting to take the pill prescribed before meals, and reschedule it to the afternoon. If the rules are not followed, the effectiveness of drugs will inevitably decrease. To the greatest extent, if, contrary to the instructions, the drug is taken with food or immediately after it. This changes the rate at which drugs pass through the digestive tract and the rate at which they are absorbed into the bloodstream.

Some drugs can break down into their constituent parts. For example, in an acidic gastric environment, penicillin is destroyed. Aspirin (acetylsalicylic acid) breaks down into salicylic and acetic acids.

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

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

Day or night

Sleep medications should be taken 30 minutes before bedtime.

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

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

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

Emergency remedies are taken regardless of the time of day - if the temperature rises or colic begins. In such cases, adherence to the schedule is not essential.

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

Among the non-drug rehabilitation methods, the following are distinguished:

1. Diet correction:

The diet for gastric ulcer is used consistently as prescribed by the doctor; during surgery, it is recommended to start with a diet of 0.

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

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

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

Approximate set

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

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

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

Butter.

Tea (weak) with milk or cream.

Approximate one-day diet menu number 0

• 8 hours - fruit and berry juice.
• 10 hours - tea with milk or cream with sugar.
• 12 hours - fruit or berry jelly.
• 14 hours - a weak broth with butter.
• 16 hours - lemon jelly.
• 18 hours - rosehip decoction.
• 20 hours - tea with milk with sugar.
• 22 hours - rice water with cream.

Diet number 0A

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

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

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

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

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

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

Then there is an expansion of the diet.

Diet number 1a

Indications for diet number 1a

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

Purpose of diet number 1a

Reduction of reflex excitability of the stomach, reduction of interoceptive irritations emanating from the affected organ, restoration of the mucous membrane by maximally sparing the function of the stomach.

General characteristics of diet number 1a

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

The chemical composition of diet number 1a

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

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

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

Excluded foods and meals of diet number 1a

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

Diet number 1b

Indications for diet number 1b

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

Diet No. 1b is prescribed at the subsequent stages of treatment with the patient being kept in bed. The terms of adherence to diet No. 1b are very individual, but on average they range from 10 to 30 days. Diet No. 1b is also used subject to bed rest. The difference from diet number 1a is a gradual increase in the content of basic nutrients and calorie intake.

Bread is allowed in the form of dried (but not toasted) croutons (75 - 100 g). Mashed soups are introduced, replacing mucous membranes; milk porridge can be consumed more often. Homogenized fruit and vegetable canned baby food and beaten egg dishes are allowed. All recommended products and dishes from meat and fish are given in the form of a steam soufflé, dumplings, mashed potatoes, cutlets. After the products are boiled until soft, they are rubbed to a mushy state. Food should be warm. The rest of the recommendations are the same as for diet number 1a.

The chemical composition of diet No. 1b

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

The role of a nurse in dietary correction:

The dietary nurse monitors the work of the catering unit and the observance of the sanitary and hygienic regime, controls the implementation of dietary recommendations when the doctor changes the diet, checks the quality of the products when they arrive at the warehouse and kitchen, and controls the correct storage of food supplies. With the participation of the production manager (chef) and under the guidance of a dietitian, he compiles a daily layout menu in accordance with a card index of dishes. It periodically calculates the chemical composition and calorie content of diets, controls the chemical composition of actually prepared dishes and rations (protein, fat, carbohydrates, vitamins, minerals, energy value, etc.) by selectively sending individual dishes to the laboratory of the State Sanitary and Epidemiological Supervision Center. Supervises the laying of products and the delivery of dishes from the kitchen to the departments, according to the orders received, carries out the rejection of finished products. Carries out control over the sanitary condition of handouts and pantries at the offices, inventory, dishes, as well as over the fulfillment of the handout rules of personal hygiene by employees. Organizes training for nurses and kitchen staff on nutritional therapy. Carries out control over the timely conduct of preventive medical examinations of workers in the catering department and the prevention of persons who have not undergone a preliminary or periodic medical examination from work.

Diet number 1

General information

Indications for diet number 1

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

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

This diet helps to normalize the secretory and motor-evacuation functions of the stomach.

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

General characteristics of diet number 1

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

Diet with diet number 1 fractional, up to 6 times a day, in small portions. It is necessary that the break between meals should not be more than 4 hours, an hour before bedtime a light dinner is allowed. You can drink a glass of milk or cream at night. It is recommended to chew food thoroughly.

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

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

The chemical composition of diet number 1

Proteins 100 g (of which 60% of animal origin), fats 90 - 100 g (30% vegetable), carbohydrates 400 g, table salt 6 g, calories 2800 - 2900 kcal, ascorbic acid 100 mg, retinol 2 mg, thiamine 4 mg, riboflavin 4 mg, nicotinic acid 30 mg; calcium 0.8 g, phosphorus not less than 1.6 g, magnesium 0.5 g, iron 15 mg. The total amount of free liquid is 1.5 liters, the food temperature is normal. It is recommended to limit table salt.

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

Excluded foods and meals of diet number 1

You should exclude two food groups from your diet.

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

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

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

Peptic ulcer (PUD) and duodenal ulcer are chronic recurrent diseases prone to progression, the main manifestation of which is the formation of a fairly persistent ulcer in the stomach or duodenum.

Peptic ulcer is a fairly common disease that affects 7-10% of the adult population. It should be noted a significant "rejuvenation" of the disease in recent years.

Etiology and pathogenesis. In the last 1.5-2 decades, the point of view on the origin and causes of peptic ulcer disease has changed. The expression "no acid, no ulcer" was replaced by the discovery that the main cause of this disease is Helicobacter pylori (HP), i.e. there was an infectious theory of the origin of gastric ulcer and 12 duodenal ulcer. Moreover, the development and recurrence of the disease in 90% of cases is associated with Helicobacter pylori.

The pathogenesis of the disease is considered, first of all, as an imbalance between the "aggressive" and "protective" factors of the gastroduodenal zone.

The "aggressive" factors include the following: increased secretion of hydrochloric acid and pepsin; altered response of the glandular elements of the gastric mucosa to nervous and humoral influences; rapid evacuation of acidic contents into the duodenal bulb, accompanied by an "acid blow" on the mucous membrane.

Also, "aggressive" influences include: bile acids, alcohol, nicotine, a number of drugs (non-steroidal anti-inflammatory drugs, glucocorticoids, heliobacter invasion).

Protective factors include gastric mucus, alkaline bicorbanate secretion, tissue blood flow (microcirculation), and regeneration of cellular elements. The issues of sanogenesis are the main ones in the problem of peptic ulcer disease, in the tactics of its treatment, and especially in the prevention of relapses.

Peptic ulcer disease is a polyetiological and pathogenetically multifactorial disease that occurs cyclically with alternating periods of exacerbation and remission, is characterized by frequent recurrence, individual characteristics of clinical manifestations and often acquires a complicated course.

Psychological personality factors play an important role in the etiology and pathogenesis of peptic ulcer disease.

The main clinical signs of peptic ulcer disease (pain, heartburn, belching, nausea, vomiting) are determined by the localization of the ulcer (cardiac and mesogastric, ulcers of the pyloric stomach, ulcers of the duodenal bulb and postbulbar ulcers), concomitant gastrointestinal diseases, age, degree of metabolic disorders processes, the level of secretion of gastric juice, etc.

The purpose of antiulcer treatment is to restore the mucous membrane of the stomach and duodenum 12 (ulcer scarring) and maintain a long-term relapse-free course of the disease.

The complex of rehabilitation measures includes: drug therapy, medical nutrition, protective regime, exercise therapy, massage and physiotherapy methods of treatment.

Since peptic ulcer disease suppresses and disorganizes the patient's motor activity, the means and forms of exercise therapy are an important element in the treatment of the ulcerative process.

It is known that the implementation of metered, adequate to the state of the patient's body, physical exercises improves cortical neurodynamics, thereby normalizing the cortico-visceral relationship, which ultimately leads to an improvement in the psychoemotional state of the patient.

Physical exercises, activating and improving blood circulation in the abdominal cavity, stimulate redox processes, increase the stability of acid-base balance, which has a beneficial effect on scarring of the ulcer.

At the same time, there are contraindications to the appointment of remedial gymnastics and other forms of exercise therapy: fresh ulcer in the acute period; ulcer with intermittent bleeding; threat of perforation of the ulcer; an ulcer complicated by stenosis in the stage of compensation; severe dyspeptic disorders; severe pain.

The objectives of physical rehabilitation for peptic ulcer disease:

1. Normalization of the patient's neuropsychological status.

2. Improvement of redox processes in the abdominal cavity.

3. Improvement of the secretory and motor function of the stomach and duodenum 12.

4. Development of the necessary motor qualities, skills and abilities (muscle relaxation, rational breathing, elements of autogenic training, correct coordination of movements).

The therapeutic and restorative effect of physical exercises will be higher if special physical exercises are performed by those muscle groups that have a common innervation in the corresponding spinal segments as the affected organ; therefore, according to A.R. Kirichinsky. (1974) the choice and justification of the used special physical exercises are closely related to the segmental innervation of muscles and certain organs of the digestive system.

In LH classes, in addition to general developmental exercises, special exercises are used to relax the abdominal and pelvic floor muscles, a large number of breathing exercises, both static and dynamic.

In diseases of the gastrointestinal tract, it matters. with the exercises performed. The most favorable will be i.p. lying with bent legs in three positions (on the left, on the right side and on the back), kneeling, standing on all fours, less often standing and sitting. The starting position of standing on all fours is used to limit the impact on the abdominal muscles.

Since the clinical course of peptic ulcer disease distinguishes between periods of exacerbation, subsiding exacerbation, a period of scarring of an ulcer, a period of remission (possibly short-lived) and a period of long-term remission, it is rational to carry out exercise therapy taking into account these periods. The names of motor regimes adopted in most diseases (bed, ward, free) do not always correspond to the condition of a patient with peptic ulcer disease.

Therefore, the following motor modes are preferable: gentle, gentle training, training and general tonic (restorative) modes.

Gentle (mode with low motor activity). I. p. - lying on your back, on the right, left side, with bent legs.

First, the patient must be taught the abdominal type of breathing with an insignificant amplitude of movement of the abdominal wall. Muscle relaxation exercises are also used to achieve complete relaxation. Then exercises are given for the small muscles of the foot (in all planes), followed by exercises for the hands and fingers. All exercises are combined with breathing exercises in the ratio of 2: 1 and 3: 1 and massage of the muscle groups involved in the exercises. After 2-3 sessions, exercises for medium muscle groups are connected (monitor the patient's reaction and pain). The number of repetitions of each exercise is 2-4 times. In this mode, it is necessary for the patient to instill the skills of autogenous training.

Forms of exercise therapy: UGG, LH, independent studies.

Control over the patient's response by heart rate and subjective sensations.

Duration of classes is from 8 to 15 minutes. The duration of the gentle motor regimen is about two weeks.

They also use balneo and physiotherapy procedures. Gentle training mode (mode with medium motor activity) designed for 10-12 days.

Purpose: restoration of adaptation to physical activity, normalization of autonomic functions, activation of oxidation-reduction processes in the body as a whole and in the abdominal cavity in particular, improvement of regeneration processes in the stomach and duodenum 12, combating congestion.

I. p. - lying on your back, on your side, on all fours, standing.

In LH classes, exercises are used for all muscle groups, the amplitude is moderate, the number of repetitions is 4-6 times, the pace is slow, the ratio of DU to ORU is 1: 3. Exercises on the abdominal muscles are given in a limited and careful manner (monitor pain and manifestations of dyspepsia). When the evacuation of food masses from the stomach is slowed down, exercises on the right side should be used, with moderate motor skills - on the left.

Dynamic breathing exercises are also widely used.

In addition to LH exercises, dosed walking and walking at a slow pace are used.

Forms of exercise therapy: LH, UGG, dosed walking, walking, self-study.

A relaxing massage is also used after exercises on the abdominal muscles. The duration of the lesson is 15-25 minutes.

Exercise mode (vigorous activity mode) it is used at the end of the ulcer scarring process and therefore is carried out either before discharge from the hospital, and more often in a sanatorium-resort environment.

Classes acquire a training character, but with a pronounced rehabilitation orientation. The range of LH exercises used is expanding, especially due to exercises on the abdominal and back muscles, exercises with objects, on simulators, in the aquatic environment are added.

In addition to LH, dosed walking, health path, therapeutic swimming, outdoor games, and elements of sports games are used.

Along with the expansion of the motor regime, control over load tolerance and the state of the body and the gastrointestinal tract should also improve through medical and pedagogical observations and functional research.

It is necessary to strictly adhere to the basic methodological rules when increasing physical activity: gradualness and consistency in its increase, a combination of load with rest and breathing exercises, the ratio to ORU is 1: 3, 1: 4.

Other rehabilitation means include massage and physiotherapy (balneotherapy). Duration of classes is from 25 to 40 minutes.

General tonic (restorative) regimen.

This mode pursues the goal: complete restoration of the patient's working capacity, normalization of the secretory and motor function of the gastrointestinal tract, increased adaptation of the cardiovascular and respiratory systems of the body to physical activity.

This motor mode is used both at the sanatorium and at the outpatient stages of rehabilitation.

The following forms of exercise therapy are used: UGG and LH, in which the emphasis is on strengthening the muscles of the trunk and pelvis, on the development of coordination of movements, exercises to restore the patient's strength capabilities. Massage (classical and segmental-reflex), balneotherapy are used.

More attention in this period of rehabilitation is paid to cyclic exercises, in particular - walking as a means of increasing the body's adaptation to physical activity.

Walking is brought up to 5-6 km per day, the pace is variable, with pauses for breathing exercises and heart rate control.

In order to create positive emotions, various relay races and ball exercises are used. The simplest sports games: volleyball, towns, croquet, etc.

Mineral water.

Patients with gastric ulcer and duodenal ulcer with high acidity are prescribed low and medium mineralized drinking mineral waters - carbonic and hydrocarbonate, sulfate and chloride waters (Borjomi, Jermuk, Slavic, Smirnov, Moscow, Essentuki No. water tº 38Cº is taken 60-90 minutes before meals 3 times a day for ½ and ¾ glasses a day, for 21-24 days.

Physiotherapeutic agents.

Baths are prescribed - sodium chloride (salt), carbon dioxide, radon, iodine-bromine, it is advisable to alternate them every other day with applications of peloids on the epigastric region. For patients with gastric ulcer localization, the number of applications is increased to 12-14 procedures. With severe pain syndrome, CMT (sinusoidal modulated currents) is used. A high therapeutic effect is observed when using ultrasound.

Control questions and tasks:

1. Describe in general the diseases of the digestive tract, violations of which functions of the digestive tract are possible.

2. Therapeutic and restorative effect of physical exercises in diseases of the gastrointestinal tract.

3. Characteristics of gastritis, their types, causes.

4. The difference between gastritis depending on the secretory disorders in the stomach.

5. Tasks and methods of medical gymnastics with reduced gastric secretory function.

6. Tasks and methods of medical gymnastics with increased secretory function of the stomach.

7. Characteristics of gastric ulcer and duodenal ulcer, etiopathogenesis of the disease.

8. Aggressive and protective factors affecting the gastric mucosa.

9. Clinical course of gastric ulcer and duodenal ulcer and its outcomes.

10. Tasks of physical rehabilitation for gastric ulcer and duodenal ulcer.

11. The technique of therapeutic gymnastics in a sparing mode of physical activity.

12. The technique of remedial gymnastics in a gentle training mode.

13. The technique of remedial gymnastics in a training mode.

14. Tasks and methods of exercise therapy in general tonic regime.

The site provides background information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. A specialist consultation is required!

Marina asks:

How is rehabilitation after a stomach ulcer carried out?

Currently, rehabilitation after a stomach ulcer is carried out using the following methods:

• Physiotherapy;
• Acupuncture;
• Acupressure;
• Spa treatment using mineral waters (balneotherapy);
• Mud therapy;
• Diet therapy;

Physiotherapy helps to speed up recovery, activates metabolic processes and normalizes the general condition. Physical exercises begin to be performed 2 - 3 days after the severe pain subsides. The whole set of exercises is performed within 15 minutes.

The following exercises have an excellent rehabilitation effect:

• Rhythmic walking in place;
• Respiratory exercises in a sitting position;
• Exercises for hands in a sitting position;
• Throwing and catching a sword in a standing position;
• Exercises on the arms while lying down.

Acupuncture performed by a doctor, and allows you to quickly relieve pain and normalize the digestion process. Reflexogenic zones that should be affected to treat ulcers are D4-7.

Acupressure is an impact on various biologically active points with the fingers. The principle of acupressure is the same as that of acupuncture. Hot spot massage should be done daily. Moreover, it is better to find out the necessary points from an acupuncturist and ask him to teach them how to massage them correctly.

Physiotherapy has a positive effect in rehabilitation after stomach ulcers. The following methods are used for rehabilitation:

• Electricity;
• Ultrasound;
• Infrared, ultraviolet radiation;
• Polarized light;
• Electrophoresis on the epigastric region with Novocaine, Platyphyllin, Zinc, Dalargin, Solcoseryl.

Spa treatment carried out no earlier than 3 months after exacerbation. The balneological resorts of Arzni, Borjomi, Dorokhove, Druskininkai, Essentuki, Zheleznovodsk, Krainka, Mirgorod, Morshin, Truskavets, etc. are optimal for rehabilitation after stomach ulcers. At these resorts, treatment is carried out by taking mineral water inside, as well as mineral baths and other procedures.

Mud therapy indicated in the period of attenuation of exacerbation of stomach ulcers. For treatment, silt mud is used at a temperature of 38-40 o C. The procedure is carried out at the beginning of 10 minutes, then it lasts up to 20 minutes. The course of therapy consists of 10 - 12 procedures.

Diet therapy based on the observance of table number 1. Meals should be fractional (5 - 6 times a day) and in small portions. The diet must be based on lean meat and fish, from which cutlets, meatballs, soufflés, dumplings and steamed zrazy are prepared. Cooked sausages and sausages are also acceptable. In addition, the diet includes dishes from cottage cheese (casseroles, soufflés, cheese cakes, lazy dumplings) and other dairy products. Soups should be vegetarian, slimy, with a dressing of boiled mashed vegetables and well-boiled cereals. Porridge should be semi-liquid. Eggs are allowed boiled soft-boiled or in the form of a steam omelet. Fruits and berries are consumed in the form of mashed potatoes, jelly, mousse, jelly, compotes, preserves, etc. Yesterday's white flour bread should be eaten. Also allowed are dry biscuits, biscuits, uncooked buns.

Mushrooms, broths, fatty meat and fish, poorly cooked lean meat, everything fried, strong tea, coffee, carbonated water, hot spices (mustard, horseradish, onion, garlic) and raw vegetables with coarse fiber (cabbage, turnips, radish, bell pepper, etc.). Also, you can not eat anything smoked, canned food, spicy, fatty, soaked and pickled.

Phytotherapy helps to speed up the onset of remission or prevent exacerbation of stomach ulcers. Cabbage and potato juice has an excellent effect. Cabbage juice is taken 1 glass 3 times a day, before meals. Potato juice is taken in half a glass 20 minutes before meals.

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