Peptic ulcer is the most common disease of the digestive system. It is characterized by a long course, prone to repetition and frequent exacerbation. Peptic ulcer of the stomach and duodenum is a chronic disease characterized by ulceration in the gastrointestinal tract.
An important role in the development of peptic ulcer is also played by heredity. 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 hour after eating) and late (1.0-2 hours after eating). Sometimes there are pains on an empty stomach, and also 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, dietary nutrition. Classes in therapeutic exercises on bed rest are prescribed in the absence of contraindications (acute pain, bleeding). It usually starts 2-4 days after hospitalization. Parkhotik 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 enhance the process of inhibition in the cerebral cortex. Performed lying on your back with relaxation of all muscle groups, these exercises help to relax, reduce pain, and normalize sleep. Simple physical exercises are also used, with a small number of repetitions, in conjunction with breathing exercises, but exercises that can increase intra-abdominal pressure are excluded. The duration of classes is 10-15 minutes, the pace of execution is slow or medium.
Physical rehabilitation of the 2nd period is applied during the transfer of the patient to the ward regime. The second period of classes begins when the patient's condition improves. Remedial gymnastics and massage of the abdominal wall 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 your back: in this position, the mobility of the diaphragm increases, positive effects on the abdominal muscles occur and blood supply to the abdominal organs improves. Exercises for the abdominal muscles are performed without tension, with a small number of repetitions.
The third period of physical rehabilitation is aimed at general strengthening and healing of the body; improvement of blood circulation in the abdominal cavity; restoration of psychological and physical skills. In the absence of complaints of pain, with a general satisfactory condition of the patient, a free regimen is prescribed. Exercises are used for all muscle groups, exercises with a small load (up to 1.5-2 kg), coordination exercises, sports games. The density of the lesson is average, the duration is allowed up to 30 minutes. The use of massage is shown. Massage must first be gentle. 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 peptic ulcer of the stomach and duodenum at the stationary stage, it is necessary to apply an integrated approach: drug therapy, therapeutic nutrition, herbal medicine, physiotherapy and psychotherapy, therapeutic physical culture, taking into account the observance of therapeutic and motor regimens. Parkhotik 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 regimen, can be recommended all means of therapeutic physical culture: physical exercises, natural factors of nature, motor modes, therapeutic massage, mechanotherapy and occupational therapy. From the forms of classes - morning hygienic gymnastics, therapeutic exercises, dosed therapeutic walking (on the territory of the hospital), training walking up the stairs, dosed swimming (if there is a pool), self-study. All these classes can be carried out by individual, small group (4-6 people) and group (12-15 people) methods.
Ulcers in the gastrointestinal tract are quite common. Physical rehabilitation for peptic ulcer disease consists of physical activity, exercise, proper nutrition, massage. Such therapy is prescribed to reduce pain, antiseptic effects, stop inflammation, regulate the motility of the digestive organs, and increase immunity.
The Benefits of Physical Rehabilitation
Stomach ulcer suppresses human motor activity, without which the body cannot function normally. Physical exercises in a dosed amount cause pleasant emotions that are needed in such a disease, since the mental state of the patient is not satisfactory. Physical activity is involved in the regulation of the digestive process and the functioning of the nervous system, which contributes to the normalization of spasmodic muscle contraction.
Thanks to systematic exercises, the following healing processes occur:
- the amount of energy increases;
- increases the creation of buffer compounds that protect the stomach from sudden changes in acid-base balance;
- organs are supplied with enzymes and vitamins;
- mental state is controlled;
- redox reactions are improved;
- accelerated scarring of the ulcer;
- stool disorders, loss of appetite, stagnant processes in the gastrointestinal tract are prevented.
Stimulation of muscle tissue speeds up the digestion process. The benefits of exercise therapy depend on its effectiveness and duration. Muscle tension of a moderate nature stimulates the functions of the digestive system, improves the secretory and motor functions of the stomach and duodenum. Methods of physical rehabilitation for peptic ulcer disease have a beneficial effect on blood circulation and respiration, thereby expanding the body's ability to withstand negative factors.
With peptic ulcer of the stomach and other organs, physical exercises have a therapeutic and preventive focus, and also imply an individual approach.
Contraindications to physical activity
The main contraindications include:
- periods of exacerbation of stomach ulcers;
- open bleeding;
- the presence of stenosis (persistent narrowing of the lumen of anatomical structures);
- predisposition to bleeding or pathology exit outside the organ;
- the possibility of malignant transformation;
- paraprocesses during penetration (the spread of pathology outside the gastrointestinal tract).
Stages of physical rehabilitation
The initial stage of therapy consists of a complex of respiratory gymnastics. Rehabilitation for gastric ulcer takes place in stages:
- Recovery during bed rest. Exercise therapy starts from 2-4 days of hospitalization in the absence of all contraindications.
- During inpatient treatment, which are subject to patients with a newly diagnosed ulcer, as well as complications that have arisen.
- During the period of weakening of the course of the disease, with the ending exacerbation or in the process of sanatorium treatment.
Early period
Physical rehabilitation is carried out if there are no contraindications. It lasts up to 14 days. Gymnastics is performed for proper breathing, which regulates the processes of inhibition in the cerebral cortex. Exercises are performed on the back, the muscles need to be completely relaxed. Gymnastics reduces the manifestation of pain symptoms, normalizes sleep.
In addition, simple exercises for small and medium muscles are used, which are repeated several times in combination with proper breathing and relaxing movements. Exercise therapy is prohibited, which entails intra-abdominal hypertension. Classes last a quarter of an hour, the exercises are performed slowly.
Second phase
The procedure normalizes intestinal peristalsis. Physiotherapy exercises are used while the patient is being treated in a hospital to develop the correct posture, improve coordination functions. Gymnastics is carried out with the onset of a significant improvement in the general well-being of the patient. Abdominal wall massage is recommended. The complex of exercises is designed to be performed in any position, while the efforts on the muscular system should increase gradually.
The muscles that make up the wall of the abdominal cavity cannot be used. To increase the agility of the abdominal barrier (diaphragm), sparing loads on the abdominal muscles are necessary. To normalize the movement of blood, the most convenient position for exercise is the supine position. Exercises should be performed without unnecessary overstrain, using a minimum of repetitions.
Introduction
Anatomical, physiological, pathophysiological and clinical features of the course of the disease
1 Etiology and pathogenesis of gastric ulcer
2 Classification
3 Clinical picture and preliminary diagnosis
Methods of rehabilitation of patients with gastric ulcer
1 Therapeutic exercise (LFK)
2 Acupuncture
3 point massage
4 Physiotherapy
5 Drinking mineral waters
6 Balneotherapy
7 Music therapy
8 Mud therapy
9 Diet therapy
10 Phytotherapy
Conclusion
List of used literature
Applications
Introduction
In recent years, there has been a tendency towards an increase in the incidence of the population, among which gastric ulcer has become widespread.
According to the traditional definition of the World Health Organization (WHO), peptic ulcer (ulcus ventriculi et duodenipepticum, morbus ulcerosus) is a common chronic relapsing disease, prone to progression, with a polycyclic course, the characteristic features of which are seasonal exacerbations, accompanied by the appearance of an ulcer in the mucous membrane, and the development of complications that threaten the life of the patient. A feature of the course of gastric ulcer is the involvement of other organs of the digestive apparatus in the pathological process, which requires timely diagnosis for the preparation of medical complexes for patients with peptic ulcer, taking into account concomitant diseases. Peptic ulcer of the stomach affects people of the most active, able-bodied age, causing temporary and sometimes permanent disability.
High morbidity, frequent relapses, long-term disability of patients, as a result of which significant economic losses - all this makes it possible to classify the problem of peptic ulcer as one of the most urgent in modern medicine.
A special place in the treatment of patients with peptic ulcer is rehabilitation. Rehabilitation is the restoration of health, functional state and ability to work, disturbed by diseases, injuries or physical, chemical and social factors. The World Health Organization (WHO) gives a very close definition of rehabilitation: “Rehabilitation is a set of activities designed to enable people with disabilities as a result of illness, injury and birth defects to adapt to the new conditions of life in the society in which they live” .
According to WHO, rehabilitation is a process aimed at comprehensive assistance to the sick and disabled in order to achieve the maximum possible physical, mental, professional, social and economic usefulness for this disease.
Thus, rehabilitation should be considered as a complex socio-medical problem, which can be divided into several types or aspects: medical, physical, psychological, professional (labor) and socio-economic.
As part of this work, I consider it necessary to study the physical methods of rehabilitation for gastric ulcers, focusing on acupressure and music therapy, which determines the purpose of the study.
Object of study: gastric ulcer.
Subject of research: physical methods of rehabilitation of patients with gastric ulcer.
Tasks are directed to consideration:
Anatomical, physiological, pathophysiological and clinical features of the course of the disease;
Methods of rehabilitation of patients with gastric ulcer.
1. Anatomical, physiological, pathophysiological and clinical features of the course of the disease
.1 Etiology and pathogenesis of gastric ulcer
Gastric ulcer is characterized by the formation of an ulcer in the stomach due to a disorder of the general and local mechanisms of the nervous and humoral regulation of the main functions of the gastroduodenal system, trophic disorders and activation of proteolysis of the gastric mucosa and often the presence of Helicobacter pylori infection in it. At the final stage, an ulcer occurs as a result of a violation of the ratio between aggressive and protective factors with a predominance of the former and a decrease in the latter in the stomach cavity.
Thus, the development of peptic ulcer, according to modern concepts, is due to an imbalance between the impact of aggressive factors and defense mechanisms that ensure the integrity of the gastric mucosa.
Aggression factors include: an increase in the concentration of hydrogen ions and active pepsin (proteolytic activity); Helicobacter pylori infection, the presence of bile acids in the cavity of the stomach and duodenum.
The protective factors include: the amount of protective mucus proteins, especially insoluble and premucosal, the secretion of bicarbonates (“alkaline flush”); mucosal resistance: proliferative index of the gastroduodenal mucosa, local immunity of the mucosa of this zone (the amount of secretory IgA), the state of microcirculation and the level of prostaglandins in the gastric mucosa. With peptic ulcer and non-ulcer dyspepsia (gastritis B, pre-ulcerative condition), aggressive factors sharply increase and protective factors in the stomach cavity decrease.
Based on currently available data, the main and predisposing factors of the disease have been identified.
The main factors include:
Violations of humoral and neurohormonal mechanisms that regulate digestion and tissue reproduction;
Disorders of local digestive mechanisms;
Changes in the structure of the mucous membrane of the stomach and duodenum.
Predisposing factors include:
Hereditary-constitutional factor. A number of genetic defects have been established that are realized in various links in the pathogenesis of this disease;
Helicobacter pylori invasion. Some researchers in our country and abroad attribute Helicobacter pylori infection to the main cause of peptic ulcer;
Environmental conditions, first of all, neuropsychic factors, nutrition, bad habits;
medicinal effects.
From modern positions, some scientists consider peptic ulcer as a polyetiological multifactorial disease. . However, I would like to emphasize the traditional direction of the Kiev and Moscow therapeutic schools, which believe that the central place in the etiology and pathogenesis of peptic ulcer belongs to disorders of the nervous system that occur in its central and vegetative departments under the influence of various influences (negative emotions, overstrain during mental and physical work , viscero-visceral reflexes, etc.).
There are a large number of works testifying to the etiological and pathogenetic role of the nervous system in the development of peptic ulcer. The spasmogenic or neurovegetative theory was first created .
Works by I.P. Pavlov about the role of the nervous system and its higher department - the cerebral cortex - in the regulation of all vital functions of the body (the ideas of nervism) are reflected in new views on the development of peptic ulcer: this is the cortico-visceral theory of K.M. Bykova, I.T. Kurtsina (1949, 1952) and a number of works pointing to the etiological role of disorders of neurotrophic processes directly in the mucous membrane of the stomach and duodenum in peptic ulcer.
According to the cortico-visceral theory, peptic ulcer is the result of disturbances in the cortico-visceral relationship. Progressive in this theory is the evidence of a two-way connection between the central nervous system and internal organs, as well as the consideration of peptic ulcer from the point of view of a disease of the whole organism, in the development of which a violation of the nervous system plays a leading role. The disadvantage of the theory is that it does not explain why the stomach is affected when the cortical mechanisms are disturbed.
Currently, there are several fairly convincing facts showing that one of the main etiological factors in the development of peptic ulcer is a violation of nervous trophism. An ulcer arises and develops as a result of a disorder of biochemical processes that ensure the integrity and stability of living structures. The mucous membrane is most susceptible to dystrophies of neurogenic origin, which is probably due to the high regenerative capacity and anabolic processes in the gastric mucosa. The active protein-synthetic function is easily disturbed and may be an early sign of dystrophic processes aggravated by the aggressive peptic action of gastric juice.
It was noted that in gastric ulcer, the level of secretion of hydrochloric acid is close to normal or even reduced. In the pathogenesis of the disease, a decrease in the resistance of the mucous membrane is of greater importance, as well as the reflux of bile into the stomach cavity due to insufficiency of the pyloric sphincter.
A special role in the development of peptic ulcer is assigned to gastrin and cholinergic postganglionic fibers of the vagus nerve involved in the regulation of gastric secretion.
There is an assumption that histamine is involved in the implementation of the stimulating effect of gastrin and cholinergic mediators on the acid-forming function of parietal cells, which is confirmed by the therapeutic effect of histamine H2 receptor antagonists (cimetidine, ranitidine, etc.).
Prostaglandins play a central role in protecting the epithelium of the gastric mucosa from the action of aggressive factors. The key enzyme in the synthesis of prostaglandins is cyclooxygenase (COX), with
Peptic ulcer of the stomach (PU) and 12 duodenal ulcers 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 of the stomach 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 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. an infectious theory of the origin of peptic ulcer of the stomach and duodenum appeared. At the same time, 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 strike" on the mucous membrane.
Also, "aggressive" effects include: bile acids, alcohol, nicotine, a number of drugs (non-steroidal anti-inflammatory drugs, glucocorticoids, heliobacter invasion).
Protective factors include gastric mucus, secretion of alkaline bicorbanate, tissue blood flow (microcirculation), regeneration of cellular elements. Questions of sanogenesis are the main ones in the problem of peptic ulcer, in the tactics of its treatment and especially in the prevention of relapses.
Peptic ulcer is a polyetiological and pathogenetically multifactorial disease that proceeds 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.
The main clinical signs of peptic ulcer (pain, heartburn, belching, nausea, vomiting) are determined by the localization of the ulcer (cardiac and mesogastric ulcers, pyloric gastric ulcers, duodenal ulcers and postbulbar ulcers), concomitant diseases of the gastrointestinal tract, age, degree of metabolic disorders processes, the level of secretion of gastric juice, etc.
The goal of antiulcer treatment is to restore the mucous membrane of the stomach and duodenum (scarring of the ulcer) and to maintain a long-term disease-free course.
The complex of rehabilitation measures includes: drug therapy, therapeutic nutrition, protective regimen, exercise therapy, massage and physiotherapeutic methods of treatment.
Since peptic ulcer suppresses and disorganizes the patient's motor activity, the means and forms of exercise therapy are an important element in the treatment of the ulcer process.
It is known that the implementation of dosed, adequate to the state of the patient's body, physical exercises improves cortical neurodynamics, thereby normalizing cortico-visceral relationships, which ultimately leads to an improvement in the patient's psycho-emotional state.
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 the scarring of the ulcer.
At the same time, there are contraindications to the appointment of therapeutic exercises and other forms of exercise therapy: a fresh ulcer in the acute period; ulcer with periodic bleeding; the threat of perforation of the ulcer; an ulcer complicated by stenosis in the stage of compensation; severe dyspeptic disorders; severe pain.
Tasks of physical rehabilitation for peptic ulcer disease:
1. Normalization of the neuropsychological status of the patient.
2. Improvement of redox processes in the abdominal cavity.
3. Improvement of the secretory and motor function of the stomach and duodenum.
4. Development of the necessary motor qualities, skills and abilities (muscle relaxation, rational breathing, elements of autogenic training, proper 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 Kirichinsky A.R. (1974) the choice and justification of the applied special physical exercises are closely related to the segmental innervation of the muscles and certain digestive organs.
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, i.p. during exercise. 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 on all fours is used to limit the impact on the abdominal muscles.
Since in the clinical course of peptic ulcer there are periods of exacerbation, subsiding exacerbation, a period of scarring of the ulcer, a period of remission (possibly short-term) and a period of long-term remission, it is rational to carry out physiotherapy exercises taking into account these periods. The names of motor modes accepted in most diseases (bed, ward, free) do not always correspond to the condition of a patient with peptic ulcer.
Therefore, the following motor modes are preferable: sparing, sparing training, training and general tonic (general strengthening) modes.
Gentle (mode with low physical 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 a slight 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 a 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 his pain sensations). 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 autogenic training.
Forms of exercise therapy: UGG, LG, self-study.
Monitoring the patient's response to heart rate and subjective sensations.
The duration of the lessons is from 8 to 15 minutes. The duration of the sparing motor regimen is about two weeks.
Balneo and physiotherapy procedures are also used. Gentle-training mode (mode with medium physical activity) calculated for 10-12 days.
Purpose: restoration of adaptation to physical activity, normalization of vegetative functions, activation of redox processes in the body as a whole and in the abdominal cavity in particular, improvement of regeneration processes in the stomach and duodenum, fight against congestion.
I.p. - lying on your back, on your side, standing 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 control to ORU is 1:3. Exercises for the abdominal muscles are limited and cautious (monitor pain and manifestations of dyspepsia). When slowing down the evacuation of food masses from the stomach, exercises on the right side should be used, with moderate motor skills - on the left.
Breathing exercises of a dynamic nature are also widely used.
In addition to LH classes, 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.
Training mode (high physical activity mode) is used at the end of the process of scarring of the ulcer and therefore is carried out either before discharge from the hospital, and more often in sanatorium-resort conditions.
Classes acquire a training character, but with a pronounced rehabilitation orientation. The range of used exercises of the LH is expanding, especially due to exercises on the muscles of the abdominal press and back, exercises with objects, on simulators, in the aquatic environment are added.
In addition to LH, dosed walking, health path, therapeutic swimming, outdoor games, elements of sports games are used.
Along with the expansion of the motor regimen, control over exercise tolerance and the state of the body and gastrointestinal tract should also improve through medical and pedagogical observations and functional studies.
It is necessary to strictly adhere to the basic methodological rules when increasing physical activity: gradualness and consistency in its increase, combination of exercise with rest and breathing exercises, ratio to ORU 1:3, 1:4.
Of the other rehabilitation means, massage and physiotherapy (balneotherapy) are used. The duration of the lessons is from 25 to 40 minutes.
General toning (general strengthening) mode.
This mode is aimed at: complete restoration of the patient's working capacity, normalization of the secretory and motor functions of the gastrointestinal tract, increased adaptation of the cardiovascular and respiratory systems of the body to physical exertion.
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 strength of the patient. Massage is used (classical and segmental-reflex), balneotherapy.
More attention in this period of rehabilitation is given 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, exercises with the ball are used. The simplest sports games: volleyball, towns, croquet, etc.
Mineral water.
Patients with peptic ulcer of the stomach and duodenum with high acidity are prescribed low and medium mineralized drinking mineral waters - carbonic and bicarbonate, sulfate and chloride waters (Borjomi, Jermuk, Slavic, Smirnovskaya, Moscow, Essentuki No. 4, Pyatigorsk Narzan), water tº 38Cº is taken 60-90 minutes before meals 3 times a day for ½ and ¾ cups a day, for 21-24 days.
Physiotherapeutic agents.
Baths are prescribed - sodium chloride (hydrochloric), carbonic, radon, iodine-bromine, it is advisable to alternate them every other day with applications of peloids to the epigastric region. For patients with localized ulcers in the stomach, the number of applications is increased to 12-14 procedures. With severe pain syndrome, SMT (sinusoidal modulated currents) is used. A high therapeutic effect is observed when using ultrasound.
Control questions and tasks:
1. Describe in general diseases of the digestive system, violations of which functions of the digestive tract are possible in this case.
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 secretory disorders in the stomach.
5. Tasks and methods of therapeutic exercises in case of reduced secretory function of the stomach.
6. Tasks and methods of therapeutic exercises 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 and duodenal ulcer and its outcomes.
10. Tasks of physical rehabilitation in gastric and duodenal ulcers.
11. The method of therapeutic gymnastics in a sparing mode of physical activity.
12. The technique of therapeutic exercises in a gentle training mode.
13. The method of therapeutic gymnastics in training mode.
14. Tasks and methods of exercise therapy in general tonic mode.
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Video: Algorithm for the rehabilitation of the gastrointestinal tract at home
Clinical examination and principles of rehabilitation treatment of patients with peptic ulcer at the stages of medical rehabilitation
The general direction of healthcare development in our country has been and remains preventive, providing for the creation of favorable healthy living conditions for the population, the formation of a healthy lifestyle for each person and the whole society, and active medical monitoring of the health of each person. The implementation of preventive tasks is associated with the successful solution of many socio-economic problems and, of course, with a radical restructuring of the activities of health authorities and institutions, primarily with the development and improvement of primary health care. This will effectively and fully ensure the medical examination of the population, create a unified system for assessing and systematic monitoring of the state of human health, the entire population as a whole.
Medical examination issues require deep study and improvement, because its traditional methods are ineffective and do not allow for a full-fledged early diagnosis of diseases, clearly identify groups of people for differentiated observation, and fully implement preventive and rehabilitation measures.
The methodology for preparing and conducting preventive examinations under the program of general medical examination needs to be improved. Modern technical means make it possible to improve the diagnostic process, providing for the participation of a doctor only at the final stage - the stage of making a formed decision. This makes it possible to increase the efficiency of the work of the prevention department, to reduce the time of medical examination to a minimum.
Together with E. I. Samsoi and co-authors (1986, 1988), M. Yu. Kolomoets, V. L. Tarallo (1989, 1990), we have improved the method of early diagnosis of diseases of the digestive system, including peptic ulcer, using automated complexes. Diagnosis consists of two stages - non-specific and specific.
At the first stage (non-specific), an initial expert assessment of the health status of those undergoing medical examination is given, dividing them into two streams - healthy and subject to further examination. This stage is implemented by preliminary interviewing the population according to the indicative questionnaire (0-1) * in preparation for a preventive examination. The prophylactic patients, answering the questions of the indicative questionnaire (0-1), fill out the technological interview card (TKI-1). Then its machine processing is carried out, according to the results of which individuals of risk groups are distinguished according to the pathology of individual nosological units.
* The indicative questionnaire is based on the anamnestic questionnaire "Complex of programs" ("Basic examination") for solving the problems of processing the results of mass dispensary screening examinations of the population using the microcomputer "Iskra-1256" of the RIVC of the Ministry of Health of Ukraine (1987) with the inclusion of specially developed methods for self-examination of the patient , additions and changes that ensure the conduct of mass self-interviewing of the population and filling out maps at home. The medical questionnaire is intended for territorial-district certification of the health of the population with the allocation of risk groups for diseases and lifestyle using a computer.
Video: Rehabilitation after a stroke. Doctor I...
The issue of allocation of two streams of subjects (healthy and those in need of additional examination) is decided on the basis of the conclusion of the computer on TKI-1 and the results of mandatory studies.
Persons in need of additional examination are sent for further examination under screening targeted programs. One of these programs is the targeted mass medical examination program for the early detection of common diseases of the digestive system (including peptic ulcer and pre-ulcerative conditions). Clinical patients according to a specialized questionnaire (0-2 "p") fill out the TKI-2 "p" technological card, after which they are automatically processed according to the same principle. The computer suggests a probable
diagnosis (diagnoses) and a list of additional methods for examining the digestive organs (laboratory, instrumental, radiological). The participation of the general practitioner of the prevention department is provided for at the final stage of the preventive examination - the stage of making a formed decision, determining the group for dispensary observation. During a preventive examination, a medical specialist is examined on the recommendation of a computer.
The questionnaires were tested by conducting preventive medical examinations of 4217 people. According to the results of machine processing, only 18.8% of the interviewees made a presumptive diagnosis of "healthy", the conclusion "needs further examination" - 80.9% (among them, 77% of those undergoing medical examinations needed consultations from therapeutic specialists). Analysis of the final results of preventive examinations showed that the computer gave a true positive response in 62.9% of cases, a true negative - in 29.1%, a false positive - in 2.4%, a false negative - in 5.8%.
When identifying gastroenterological pathology, the sensitivity of the specialized screening questionnaire turned out to be very high - 96.2% (with a predictive coefficient of the result of 0.9), since in the indicated percentage of cases the machine gives the correct answer with a positive decision "sick". At the same time, with a negative answer, the error is 15.6% (with a prediction coefficient of 0.9). As a result, the coefficient of conformity of the diagnostic conclusion is 92.1%, t. out of 100 people, in 8, the decision of the computer to identify gastroenterological pathology based on the survey data may be incorrect.
The given data convinces of a high degree of reliability of the developed criteria and allows us to recommend a specialized questionnaire for widespread use in a screening target program at the stage of preparation for a preventive medical examination.
As you know, the order of the Ministry of Health of the USSR No. 770 dated May 30, 1986 provides for the allocation of three dispensary groups: healthy (DO - prophylactically healthy (Dg) - patients in need of treatment (Dz). Our experience shows that, in relation to patients with peptic ulcer, their with pre-ulcerative conditions, as well as to persons with risk factors for these diseases, a more differentiated division of those undergoing medical examination into the second and third health groups is justified (in each of them it is advisable to single out 3 subgroups) in order to ensure a differentiated approach to preventive and therapeutic measures.
II group:
On - increased attention (persons who do not complain, without deviations from the norm according to the results of additional studies, but exposed to risk factors) -
II b - persons with latent current pre-ulcerative conditions (no complaints, but having deviations from the norm in additional studies) -
c - patients with obvious pre-ulcerative conditions, peptic ulcer who do not need treatment.
group:
III a - patients with obvious pre-ulcerative conditions in need of treatment;
III b - patients with uncomplicated peptic ulcer in need of treatment;
III c - patients with severe peptic ulcer disease, complications and (or) concomitant diseases.
Peptic ulcer is one of the diseases in the fight against which preventive rehabilitation measures are of decisive importance.
Without belittling the importance of the inpatient stage of treatment, it should be recognized that it is possible to achieve a stable and long-term remission, to prevent the recurrence of peptic ulcer disease through a long (at least 2 years) and successive restorative staged treatment of the patient after discharge from the hospital. This is evidenced by our own research and the work of a number of authors (E. I. Samson, 1979; P. Ya. Grigoriev, 1986; G. A. Serebrina, 1989, etc.).
We distinguish the following stages of post-hospital rehabilitation treatment of patients with peptic ulcer:
rehabilitation department for gastroenterological patients of a hospital for rehabilitation treatment (usually in a suburban area using natural healing factors) -
polyclinic (including a day hospital of a polyclinic, a department or an office for rehabilitation treatment of a polyclinic or a rehabilitation center at a polyclinic) -
sanatorium-dispensary of industrial enterprises, institutions, collective farms, state farms, educational institutions -
Spa treatment.
We combine all of the above stages of post-hospital rehabilitation treatment in the period of late rehabilitation, and in general, the process of medical rehabilitation can be divided into three periods:
- early rehabilitation (timely diagnosis in the clinic, early intensive treatment) -
- late rehabilitation (postoperative stages of treatment) -
- Dispensary observation in the clinic.
In the system of medical rehabilitation of patients with peptic ulcer, the polyclinic stage plays a decisive role, since it is in the polyclinic that continuous, consistent monitoring and treatment of the patient is carried out for a long time, and the continuity of rehabilitation is ensured. The effectiveness of the rehabilitation of patients in the clinic is due to the complex effect of various means and methods of restorative treatment, including therapeutic nutrition, herbal and physiotherapy, acupuncture, exercise therapy, balneotherapy, psychotherapy with very restrained, maximally differentiated and adequate pharmacotherapy (E. I. Samson, M Yu. Kolomoets, 1985 - M, Yu. Kolomoets et al., 1988, etc.).
A correct assessment of the role and importance of the outpatient stage in the rehabilitation treatment of patients has contributed to the further improvement in recent years of the organizational forms of rehabilitation of patients at the outpatient stage (OP Shchepin, 990). One of them is a polyclinic day hospital (DSP). An analysis of our observations on day hospitals at the polyclinics of the Central Republican Clinical Hospital of the Minsk region of Kiev, the polyclinic of the 3rd city hospital of Chernivtsi, as well as the data of A. M. Lushpa (1987), B. V. Zhalkovsky, L. I. Leibman (1990) show that that DSP is most effectively used for the rehabilitation of gastroenterological patients, constituting 70-80% of the total number of patients treated. Among patients with diseases of the digestive system, about half were patients with peptic ulcer. Based on the experience of the DSP, we determined the indications for referring patients with peptic ulcer to a day hospital. These include:
Uncomplicated peptic ulcer in the presence of a peptic ulcer 2 weeks after the start of treatment in a hospital after relief of pain.
Exacerbation of uncomplicated peptic ulcer disease without a peptic ulcer (from the beginning of an exacerbation), bypassing the stationary stage.
Long-term non-scarring ulcers in the absence of complications 3-4 weeks after the start of inpatient treatment.
Due to the rather long stay of patients in the DSP during the day (6-7 hours), we consider it appropriate to organize one or two meals a day (diet No. 1) in the DSP.
The duration of treatment of patients with peptic ulcer at various stages of medical rehabilitation depends on the severity of the course, the presence of complications and concomitant diseases, and a number of other clinical features in a particular patient. At the same time, our long-term experience allows us to recommend the following terms as optimal: in a hospital - 20-30 days (or 14 days, followed by referral of a patient to a day hospital or a rehabilitation department for gastroenterological patients of a rehabilitation hospital) - in the rehabilitation department of a rehabilitation hospital - 14 days - in a day hospital - from 14 to 20 days - in the rehabilitation department of a polyclinic or a rehabilitation center at a polyclinic - 14 days - in a sanatorium-dispensary - 24 days - in a sanatorium at a resort - 24-26 days.
In general, prolonged treatment should be continued for at least 2 years in the absence of new exacerbations and relapses. A practically healthy patient can be considered in those cases if within 5 years he had no exacerbations and relapses of peptic ulcer.
In conclusion, it should be noted that the problem of treating peptic ulcer goes far beyond the scope of medicine and is a socio-economic problem that requires the implementation of a set of measures on a nationwide scale, creating conditions for reducing psychogenic factors, normal nutrition, hygienic working conditions, life, rest.
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