Physical rehabilitation for gastric ulcer and 12 duodenum.
Gastric ulcer (GUD) and duodenal ulcer are chronic recurrent diseases prone to progression, the main manifestation of which is the formation of a fairly persistent ulcerative defect in the stomach or duodenum.
Gastric ulcer is a fairly common disease, affecting 7-10% of the adult population. It should be noted a significant “rejuvenation” of the disease in last 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), ᴛ.ᴇ. An infectious theory of the origin of gastric and duodenal ulcers has emerged. 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 attack” on the mucous membrane.
Also “aggressive” influences include: bile acids, alcohol, nicotine, a number of medications (non-steroidal anti-inflammatory drugs, glucocorticoids, Heliobacter invasion).
Protective factors include gastric mucus, secretion of alkaline bicarbonate, 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, which 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 and personal factors play an important role in the etiology and pathogenesis of peptic ulcer disease.
Basic Clinical signs peptic ulcer (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 diseases of the gastrointestinal tract, age, degree of metabolic disorders, level secretion of gastric juice, etc.
The goal of antiulcer treatment is to restore the mucous membrane of the stomach and duodenum (ulcer scarring) and maintain a long-term relapse-free course of the disease.
To the complex rehabilitation measures includes: drug therapy, therapeutic nutrition, protective regime, exercise therapy, massage and physiotherapeutic methods of treatment.
Since peptic ulcer disease suppresses and disorganizes the patient’s motor activity, means and forms of exercise therapy are an important element in the treatment of the ulcerative process.
It is known that performing dosed physical exercises that are adequate to the state of the patient’s body improves cortical neurodynamics, thereby normalizing cortico-visceral relationships, which ultimately leads to an improvement in the psycho-emotional state of the patient.
Physical exercises, by 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 use therapeutic exercises and other forms of exercise therapy: fresh ulcer in the acute period; ulcer with periodic bleeding; threat of ulcer perforation; ulcer complicated by stenosis in the compensation stage; severe dyspeptic disorders; severe pain.
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. Improving 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 common innervation in the corresponding spinal segments as the affected organ; in this regard, according to Kirichinsky A.R. (1974) the choice and justification of the special physical exercises used are closely related to the segmental innervation of muscles and certain digestive organs.
In PH classes, in addition to general developmental exercises, special exercises are used to relax the abdominal muscles and pelvic floor, big number breathing exercises, both static and dynamic.
For diseases of the gastrointestinal tract, i.p. is important. during the exercises performed. The most favorable will be i.p. lying with legs bent 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 a 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 physical therapy classes 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.
For this reason, the following motor modes are preferred: gentle, gentle-training, training and general tonic (general strengthening) modes.
Gentle (mode with low motor activity). I.p. – lying on your back, on your right or left side, with your legs bent.
Initially, it is extremely important to teach the patient 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. Next, 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 added (monitor the patient’s reaction and pain sensations). The number of repetitions of each exercise is 2-4 times. In this mode, it is extremely important to instill autogenic training skills in the patient.
Forms of exercise therapy: UGG, LG, independent studies.
Monitoring the patient’s reaction based on heart rate and subjective sensations.
The duration of classes is from 8 to 15 minutes. The duration of the gentle motor regimen is about two weeks.
Balneo and physiotherapeutic procedures are also used. Gentle training mode (mode with average physical activity) designed for 10-12 days.
Goal: restoration of adaptation to physical activity, normalization vegetative functions, activation of redox processes in the body in general and in the abdominal cavity in particular, improvement of regeneration processes in the stomach and duodenum, 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 remote control to open source is 1:3. Exercises on the abdominal muscles are given limitedly and carefully (monitor pain and manifestations of dyspepsia). When slowing down the evacuation of food masses from the stomach, exercises should be used on the right side, and with moderate motor skills - on the left.
Dynamic breathing exercises are also widely used.
In addition to physical therapy exercises, measured walking and walking at a slow pace are used.
Forms of exercise therapy: LH, UGG, dosed walking, walking, independent exercise.
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) It is used upon completion of the scarring process of the ulcer and, in connection with this, is carried out either before discharge from the hospital, and more often in a sanatorium-resort setting.
The classes take on a training character, but with a pronounced rehabilitation focus. The range of LH exercises used is expanding, especially due to exercises on the abdominal and back muscles, and exercises with objects, on simulators, and in an aquatic environment are added.
In addition to LH, dosed walking, health paths, 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 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: gradualism and consistency in its increase, a combination of activity with rest and breathing exercises, a ratio to outdoor gear of 1:3, 1:4.
Other rehabilitation means include massage and physiotherapy (balneotherapy). The duration of classes is from 25 to 40 minutes.
General tonic (general strengthening) regime.
This regime pursues the goal: complete restoration of the patient’s performance, normalization of the secretory and motor functions of the gastrointestinal tract, increased adaptation of the body’s cardiovascular and respiratory systems 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, developing coordination of movements, and exercises to restore the patient’s strength capabilities. Massage (classical and segmental reflex) and balneotherapy are used.
During this period of rehabilitation, more attention is paid to cyclic exercises, in particular walking, as a means of increasing the body’s adaptation to physical activity.
Walking is increased to 5-6 km per day, the pace is variable, with pauses for breathing exercises and monitoring heart rate.
In order to create positive emotions, various relay races and ball exercises are used. The simplest sports games: volleyball, gorodki, croquet, etc.
Mineral waters.
Patients with gastric and duodenal ulcers with high acidity are prescribed low and moderately mineralized drinking mineral waters - carbonic and hydrocarbonate, sulfate and chloride waters (Borjomi, Jermuk, Slavyanskaya, Smirnovskaya, Moscow, Essentuki No. 4, Pyatigorsk Narzan), water tº 38Cº is taken 60-90 minutes before meals 3 times a day, 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 to the epigastric area. For patients with ulcers localized in the stomach, the number of applications is increased to 12-14 procedures.
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With pronounced pain syndrome SMT (sinusoidal modulated currents) is used. A high therapeutic effect is observed when using ultrasound.
Test questions and assignments:
1. Describe in general diseases of the digestive organs, violations of what functions digestive tract at the same time possible.
2. Therapeutic and restorative effect of physical exercises for gastrointestinal diseases.
3. Characteristics of gastritis, their types, causes.
4. Difference between gastritis based on secretory disorders in the stomach.
5. Objectives and methods of therapeutic exercises for decreased secretory function of the stomach.
6. Objectives and methods of therapeutic exercises for increased secretory function of the stomach.
7. Characteristics of gastric and duodenal ulcers, etiopathogenesis of the disease.
8. Aggressive and protective factors affecting the gastric mucosa.
9. Clinical course of gastric and duodenal ulcers and its outcomes.
10. Objectives of physical rehabilitation for gastric and duodenal ulcers.
11. Methods of therapeutic exercises in a gentle mode of physical activity.
12. Methods of therapeutic exercises in a gentle training mode.
13. Methods of therapeutic exercises in training mode.
14. Objectives and methods of exercise therapy with a general tonic regimen.
Physical rehabilitation for gastric and duodenal ulcers. - concept and types. Classification and features of the category "Physical rehabilitation for gastric and duodenal ulcers." 2017, 2018.
Peptic ulcer disease is one of the most common nious diseases of the digestive system. The disease is characterized by a long course, a tendency to relapse and exacerbation, which increases the degree of economic damage from this disease. Gastric ulcer and two duodenum is a chronic, cyclical, recurrent disease characterized by ulceration in the gastroduodenal zone.
The etipathogenesis of peptic ulcer disease is quite complex and until now there is no single position on this issue. At the same time, it has been established that the development of peptic ulcer disease is promoted by various lesions of the nervous system (acute psychological trauma, physical and especially mental overstrain, various nervous diseases). It should also be noted the importance hormonal factor, in particular, a violation of the production of digestive hormones (gastrin, secretin, etc.), as well as a violation of the metabolism of histamine and serotonin, under the influence of which the activity of the acid-peptic factor increases. Violation of diet and food composition is of certain importance. In recent years, more and more attention has been given to the infectious (viral) nature of this disease. Hereditary and constitutional factors also play a certain role in the development of peptic ulcer disease.
Clinical manifestations peptic ulcers are very diverse. Its main symptom is pain, most often in the epigastric region; with an ulcer in the duodenum, pain is usually localized to the right of midline belly. Depending on the location of the ulcer, pain can be early (0.5-1 hour after eating) and late (1.5-2 hours after eating). Sometimes there are pains on an empty stomach, as well as night pains. Quite common clinical symptoms of peptic ulcer disease are heartburn, which, like pain, can be rhythmic in nature; sour belching and vomiting, also with sour contents, are quite often observed, usually after eating. During a peptic ulcer there are four phases: exacerbation, fading exacerbation, incomplete remission And complete remission. Most dangerous complication peptic ulcer - perforation of the stomach wall, accompanied by acute “dagger” pain in the abdomen and signs of inflammation of the peritoneum. This requires immediate surgical intervention.
The complex of rehabilitation measures includes medications, motor regimen, exercise therapy and others. physical methods treatments, massage, therapeutic nutrition. Exercise therapy and massage improve or normalize neurotrophic processes and metabolism, helping to restore the secretory, motor, absorption and excretory functions of the digestive canal.
Exercise therapy classes at bed rest prescribed in the absence of contraindications (severe pain, ulcerative bleeding). This usually coincides with 2-4 days after hospitalization. The tasks of this period include:
1 assistance in regulating the processes of excitation and inhibition in the cerebral cortex;
2 improvement of redox processes.
3 counteracting constipation and congestion in the intestines;
4 improvement of circulatory and respiratory functions.
The period lasts about two weeks. At this time, static breathing exercises are indicated, which enhance inhibition processes in the cerebral cortex. Performed in the initial position lying on the back with relaxation of all muscle groups, these exercises are able to put the patient into a drowsy state, help reduce pain, eliminate dyspeptic disorders, and normalize sleep. Simple gymnastic exercises for small and medium muscle groups are also used, with a small number of repetitions in combination with breathing exercises and relaxation exercises, but exercises that increase intra-abdominal pressure are contraindicated. The duration of the classes is 12-15 minutes, the pace of the exercises is slow, the intensity is low.
Rehabilitation of the second period is prescribed when the patient is transferred to ward mode. The tasks of the first period include the tasks of household and work rehabilitation of the patient, restoration of correct posture when walking, and improvement of coordination of movements. The second period of classes begins with a significant improvement in the patient’s condition. UGG, LH, abdominal wall massage are recommended. The exercises are performed in a lying position, sitting, on the knees, standing with gradually increasing effort for all muscle groups, still excluding the abdominal muscles (Fig. 26). The most acceptable position is lying on your back: it allows you to increase the mobility of the diaphragm, has a gentle effect on the abdominal muscles and helps improve blood circulation in the abdominal cavity. Patients perform exercises for the abdominal muscles without tension, with a small number of repetitions.
If the gastric evacuation function is slow, the LH complexes should include more exercises lying on the right side, and if it is moderate - on the left side. During this period, patients are also recommended massage, sedentary games, and walking. The average duration of a lesson in a ward mode is 15-20 minutes, the pace of exercise is slow, the intensity is low. Therapeutic gymnastics is carried out 1-2 times a day.
The tasks of the third period include: general strengthening and healing of the patient’s body; improvement of blood and lymph circulation in the abdominal cavity; restoration of household and work skills. In the phase of incomplete and complete remission, in the absence of complaints and the general good condition of the patient, a free regimen is prescribed. Exercises are used for all muscle groups, exercises with light weights (up to 1.5-2 kg), coordination, outdoor and sports games. The density of the lesson is average, the duration increases to 30 minutes.
In sanatorium-resort conditions, the volume and intensity of exercise therapy classes increases, all means and methods of exercise therapy are shown. Recommended for GG in combination with hardening procedures; group classes of physical training (ORU, DU, exercises with objects); dosed walking, walks (up to 4-5 km); sports and outdoor games; skiing; occupational therapy. Therapeutic massage is also used: from behind - segmental massage in the back area from C 4 to D 9 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 increases from 8-10 to 20-25 minutes towards the end of the treatment.
Test
on physical rehabilitation
Physical rehabilitation for gastric and duodenal ulcers
INTRODUCTION
The problem of diseases of the gastrointestinal tract is the most pressing 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 methods of physical rehabilitation for peptic ulcer of the stomach and duodenum.
Research objectives:
.To study the basic clinical data on gastric and duodenal ulcers. 2.To study methods of physical rehabilitation for gastric and duodenal ulcers. At the present stage, the entire complex of rehabilitation measures gives excellent results in the recovery of patients with peptic ulcer disease. More and more methods are being included in the rehabilitation process from oriental medicine, alternative medicine and other fields. The best effect and lasting remission occurs after using psychoregulatory drugs and elements of auto-training. L.S. Khodasevich gives the following interpretation of peptic ulcer - it is a chronic disease characterized by dysfunction and the formation of an ulcerative defect in the wall of the stomach or duodenum. Research by L.S. 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; urban residents have a higher incidence than rural residents. Every year, 3 thousand people die from this disease and its complications. Peptic ulcer disease most often develops in men, mainly under the age of 50 years. S.N. Popov emphasizes that in Russia there are more than 10 million such patients with almost annual relapses of ulcers in approximately 33% of them. Peptic ulcer disease occurs in people of any age, but more often in men aged 30-50 years. I.A. Kalyuzhnova claims that most often this disease affects males. Localization of the ulcer in the duodenum is typical for young people. The urban population suffers from peptic ulcers more often than the rural population. L.S. Khodasevich cites the following possible complications of peptic ulcer disease: perforation (perforation) of the ulcer, penetration (into the pancreas, 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 gastric ulcer, combined complications. In the complex of rehabilitation measures, according to S.N. Popov, first of all, medications, motor regimen, exercise therapy and other physical methods of treatment, massage, and nutritional therapy should be used. Exercise therapy and massage improve or normalize neurotrophic processes and metabolism, helping to restore the secretory, motor, absorption and excretory functions of the digestive canal. Chapter 1. Basic clinical data on gastric and duodenal ulcers 1 Etiology and pathogenesis of gastric and duodenal ulcers According to Khodasevich L.S. (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 most often localized on the lesser curvature, in the duodenum - in the bulb on the back wall. HELL. Ibatov believes that factors contributing to the occurrence of ulcers are prolonged and/or repeated emotional stress, genetic predisposition, the presence of chronic gastritis and duodenitis, Helicobacter pylori contamination, poor diet, smoking and drinking alcohol. In the educational dictionary-reference book O.V. Kozyreva, A.A. Ivanov, the concept of “ulcer” is characterized as 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 ulcers is facilitated by various lesions of the nervous system (acute psychological trauma, physical and especially mental overstrain, 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 diet and food composition is also of certain importance. In recent years, more and more attention has been given to the infectious (viral) nature of this disease. Hereditary and constitutional factors also play a certain role in the development of ulcers. L.S. Khodasevich distinguishes two stages of the formation of a chronic ulcer: erosion - a surface defect formed as a result of necrosis of the mucous membrane; an acute ulcer is a deeper defect that involves not only the mucous membrane, but also other membranes of the stomach wall. S.N. Popov believes that currently the formation of gastric or duodenal ulcers occurs as a result of emerging changes in the ratio of local factors of “aggression” and “defense”; At the same time, there is a significant increase in “aggression” against the background of a decrease in “defense” factors. (decrease in the production of mucobacterial secretion, slowdown in the processes of physiological regeneration of the surface epithelium, decrease in blood circulation in the microvasculature 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 gastric ulcers and pyloroduodenal ulcers. Pathogenesis of pyloroduodenal ulcers: impaired motility of the stomach and duodenum; hypertonicity of the vagus nerve with increased activity of the acid-peptic factor; increased levels of adrenocorticotropic hormone of the pituitary gland and glucocorticoids of the adrenal glands; 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, decreased tone of the vagus nerve and activity of gastric secretion; weakening of mucosal protective factors 1.2 Clinical picture, classification and complications of gastric and duodenal ulcers In the clinical picture of the disease S.N. Popov notes a pain syndrome, which depends on the location of the ulcer, dyspeptic syndrome (nausea, vomiting, heartburn, change in appetite), which, like pain, can be rhythmic in nature; signs of gastrointestinal bleeding or clinical peritonitis may be observed when the ulcer is perforated. The leading feature, according to S.N. Popov and L.S. Khodasevich, is a dull, aching pain in the epigastric region, most often in the epigastric region, usually occurring 1-1.5 hours after eating with a stomach ulcer and after 3 hours with a duodenal ulcer, the 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. Gastric ulcers are usually observed in patients over 35 years of age, and duodenal ulcers in young people. There is a typical seasonality of spring exacerbations During YaB 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 surgical intervention. P.F. Litvitsky describes the manifestations of PU in more detail. PUD is manifested by pain in the epigastric region, dyspeptic symptoms (belching of 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, as well as ulcers can debut with perforation or bleeding. PUD is manifested by pain, predominant in 75% of patients, vomiting at the height of pain, bringing relief (reduction of pain), vague dyspeptic complaints (belching, heartburn, bloating, food intolerance in 40-70%, frequent constipation), upon palpation it is determined by pain in the epigastric region, sometimes some resistance of the abdominal muscles, asthenovegetative manifestations, and also periods of remission and exacerbation are noted, the latter lasting several weeks. In the educational dictionary-reference book O.V. Kozyreva, A.A. Ivanov distinguish ulcers: duodenal - duodenal ulcer. It occurs with periodic pain in the epigastric region, appearing for a long time after eating, on an empty stomach or at night. Vomiting does not occur (unless stenosis has developed), increased acidity of gastric juice and hemorrhages are very common; gastroduodenal - peptic ulcer and duodenum; stomach - ulcerative stomach; perforated ulcer - an ulcer of the stomach and duodenum that has perforated into the free abdominal cavity. P.F. Litvitsky and Yu.S. Popov gives a classification of nuclear weapons: Most type 1 ulcers 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 in this localization are heartburn, belching, nausea, vomiting, which brings relief, pain that occurs 10-30 minutes after eating, which can radiate to the back, in left hypochondrium, left half chest and/or behind the sternum. Antral ulcers are common in humans young. It manifests itself as “hungry” and night pain, heartburn, and less commonly, vomiting with a strong sour odor. Stomach ulcers that occur together with duodenal ulcers. Ulcers of the pyloric canal. In their course and manifestations, they are more similar to duodenal ulcers than gastric ulcers. The main symptoms of an ulcer are sharp pain in the epigastric region, constant or occurring randomly 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 surgery; High ulcers (subcardial), localized near the esophagogastric 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 area of the xiphoid process (under the ribs, where the sternum ends). Complications characteristic of such an ulcer are ulcerative bleeding and penetration. Often, in its treatment it is necessary to resort to surgical intervention; Duodenal ulcer. In 90% of cases, a duodenal ulcer is localized in the bulb (a thickening in its upper part). The main symptoms are heartburn, “hungry” and night pain, most often in the right side of the abdomen. S.N. Popov also classifies ulcers 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 (first diagnosed ulcer, recurrent course ), according to the stage of the disease (exacerbation or remission), according to the presence of complications (bleeding, perforation, stenosis, malignancy). The clinical course of ulcer, explains S.N. Popov, may be complicated by bleeding, perforation of the ulcer into the abdominal cavity, or narrowing of the pylorus. With a long course, cancerous degeneration of the ulcer may occur. In 24-28% of patients, ulcers can occur atypically - without pain or with pain resembling another disease (angina pectoris, osteochondrosis, etc.), and are discovered by chance. Peptic ulcer may 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 12pk), through which undigested food, along with acidic gastric juice, enters the abdominal cavity. Often, perforation of an ulcer occurs as a result of drinking alcohol, overeating or physical overexertion. Penetration is a violation of the integrity of the stomach when gastric contents spill into the nearby pancreas, omentum, intestinal loops or other organs. This happens when, as a result of inflammation, the wall of the stomach or duodenum becomes fused with surrounding organs (adhesions are formed). The attacks of pain are very severe and cannot be relieved with medications. For treatment it is necessary surgical intervention. Bleeding may occur during an exacerbation of ulcerative disease. It may be the beginning of an exacerbation or open at a time when other symptoms of an ulcer (pain, heartburn, etc.) have already appeared. It is important to note that ulcer bleeding can occur both in the presence of a severe, deep, advanced ulcer, and in a fresh, small ulcer. The main symptoms of ulcer bleeding are black stools and coffee-ground-colored vomit (or vomiting blood). In cases of extreme necessity, when the patient’s condition becomes dangerous, surgical intervention is performed in case of ulcer bleeding (the bleeding wound is sutured). Often, ulcer bleeding is 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 the period of exacerbation of ulcer as a result of perforation of the ulcer or spread of infection through the lymphatic system of the stomach or duodenum. Obstruction of the pyloric part of the stomach (pyloric stenosis) is an anatomical distortion and narrowing of the sphincter lumen that occurs as a result of scarring of an ulcer of the pyloric canal or the initial part of the duodenum. This phenomenon leads to difficulty or complete cessation of evacuation of food from the stomach. Pyloric stenosis and associated digestive disorders lead to disorders of all types of metabolism, which leads to exhaustion of the body. The main method of treatment is surgery. peptic ulcer disease rehabilitation 1.3 Diagnosis of gastric and duodenal ulcers The diagnosis of ulcer is made to patients most often during an exacerbation, says Yu.S. Popova. The first and main sign 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 the sternum). Ulcer pain is the so-called hunger pain, 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 exacerbation of peptic ulcer disease. These are heartburn, sour belching, vomiting (appears without preliminary nausea and brings temporary relief), increased appetite, general weakness, fast fatiguability, mental imbalance. It is also important to note that during exacerbation of peptic ulcer disease, 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 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 for examining a patient with a suspected ulcer - these are lab tests blood and feces. A moderate decrease in the level of hemoglobin and red blood cells in a clinical blood test allows the detection of hidden bleeding. Stool analysis "Examination of stool for occult blood"should reveal the presence of blood in it (from a bleeding ulcer). Gastric acidity in ulcerative disease is usually increased. In this regard, an important method for diagnosing ulcer disease is to study the acidity of gastric juice using Ph-metry, as well as by measuring the amount of hydrochloric acid in portions of gastric contents (gastric contents are obtained by intubation). The main method for diagnosing gastric ulcers is FGS. With the help of FGS, the doctor can not only verify the presence of an ulcer in the patient’s stomach, but also see how large it is, in which specific part of the stomach it is located, whether the ulcer is fresh or healing, whether it bleeds or not. In addition, FGS allows you to diagnose how well the stomach is working, as well as take a microscopic piece of the gastric mucosa affected by an ulcer for analysis (the latter allows, in particular, to determine whether the patient is affected by H.P.). Gastroscopy, as the most accurate research method, allows you to determine not only the presence of an ulcer, but also its size, and also helps to distinguish an ulcer from cancer and notice its degeneration into a tumor. Yu.S. Popova emphasizes that fluoroscopic examination of the stomach allows not only to diagnose the presence of an ulcer in the stomach, but also to evaluate its motor and excretory functions. Data on impaired motor abilities of the stomach can also be considered indirect signs of an ulcer. So, if there is an ulcer located in upper sections stomach, accelerated evacuation of food from the stomach is observed. If the ulcer is located low enough, food, on the contrary, stays in the stomach longer. 4 Treatment and prevention of gastric and duodenal ulcers In the complex of rehabilitation measures, according to S.N. Popov, first of all, medications, motor regimen, exercise therapy and other physical methods of treatment, massage, and nutritional therapy should be used. Exercise therapy and massage improve or normalize neurotrophic processes and metabolism, helping to restore the secretory, motor, absorption and excretory functions of the digestive canal. The causes, signs, diagnostic methods and possible complications of ulcer vary somewhat depending on which specific part of the stomach or duodenum the exacerbation is localized, explains O.V. Kozyreva. According to N.P. Petrushkina, 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, drug treatment is recommended. 4.1 Treatment with medications 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 the ulcer is located, what it looks like, how long the patient has been suffering from ulcer). In any case, treatment of ulcers will always be comprehensive, says Yu.S. Popova. Since the causes of the disease are poor nutrition, infection of the stomach with a specific bacteria, and stress, then correct treatment should be aimed at neutralizing each of these factors. The use of medications during 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 motility of the stomach and duodenum, are combined with medications that stimulate the healing processes of ulcers and restoration of the mucous membrane. For severe pain, antispasmodics are used. In the presence of psychological disorders, stress, sedatives are prescribed. 4.2 Diet therapy Yu.S. Popova explains that therapeutic nutrition for ulcer should provide the gastric mucosa and duodenum with maximum rest; it is important to exclude mechanical and thermal damage to the gastric mucosa. All food is pureed, the temperature of which is from 15 to 55 degrees. In addition, during exacerbation of ulcerative disease, it is unacceptable to consume foods that provoke increased secretion of gastric juice. Meals are fractional - every 3-4 hours, in small portions. The diet should be complete, with an emphasis on vitamins A, B and C. The total amount of fat should not be more than 100-110 g per day. 4.3 Physiotherapy According to G.N. Ponomarenko, physiotherapy is prescribed to reduce pain and provide an antispastic effect, relieve the inflammatory process, stimulate regenerative processes, regulation of motor function of the gastrointestinal tract, increasing immunity. Local air cryotherapy is used, exposing the back and abdomen to cold air for about 25-30 minutes; peloidotherapy in the form of mud applications on the anterior abdominal cavity; radon and carbon dioxide baths; magnetic therapy, which has a positive effect on immune processes. Contraindications to physiotherapy are severe course Peptic ulcer, bleeding, individual intolerance to physiotherapeutic methods, gastric polyposis, malignancy of ulcers, general contraindications for physiotherapy. 1.4.4 Herbal medicine N.P. Petrushkina explains that herbal medicine is included in complex treatment later. In the process of herbal medicine of gastrointestinal tract and duodenum, neutralizing, protecting and regenerating groups of drugs are used to increase the activity of the acid-peptic factor. For long-term ulcerative defects, antiulcer drugs of plant origin are used (sea buckthorn oil, rosehip oil, carbenoxolone, alanton). However, it is better to add it to a treatment complex with herbs and a phytodiet. For peptic ulcer with increased secretory activity of the stomach, it is recommended to collect medicinal herbs: plantain leaves, chamomile flowers, cudweed grass, rose hips, yarrow herb, licorice roots. For the treatment of ulcers and duodenal ulcers, the author also offers herbal infusions such as: fennel fruits, 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. 4.5 Massage Among the means of exercise therapy for diseases of the abdominal organs, massage is indicated - therapeutic (and its varieties - reflex-segmental, vibration), says V.A. Epifanov. Massage in the complex treatment of chronic gastrointestinal diseases is prescribed to provide a normalizing effect on the neuroregulatory apparatus of the abdominal organs, to help improve the function of the smooth muscles of the intestines and stomach, and strengthen the abdominal muscles. According to V.A Epifanov, when carrying out the massage procedure, the paravertebral (Th-XI - Th-V and C-IV - C-III) and reflexogenic zones of the back, the area of the cervical sympathetic nodes, and the stomach should be affected. Massage is contraindicated in the acute stage of diseases of the internal organs, in diseases of the digestive organs with a tendency to bleeding, tuberculosis lesions, neoplasms of the abdominal organs, acute and subacute inflammatory processes female genital organs, pregnancy. 4.6 Prevention To prevent exacerbations of ulcerative disease, S.N. Popov offers two types of therapy (maintenance therapy: antisecretory drugs at half dose; preventive therapy: when symptoms of exacerbation of ulcer appear, antisecretory drugs are used for 2-3 days. Therapy is stopped when the symptoms completely disappear) with patients observing general and physical regimens, as well as a healthy lifestyle. A very effective means of primary and secondary prevention of ulcer disease is sanatorium treatment. To prevent the disease, Yu.S. Popova recommends observing the following rules: sleep 6-8 hours; give up fatty, smoked, fried foods; if you have stomach pain, you should be examined by a medical specialist; Take pureed, easily digestible food 5-6 times a day: porridge, jelly, steamed cutlets, sea fish, vegetables, omelette; treat bad teeth so you can chew food well; avoid scandals, as after a nervous overstrain the pain in the stomach intensifies; do not eat very hot or very cold food, as this may contribute to the development 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. Methods of physical rehabilitation for gastric and duodenal ulcers 1 Physical rehabilitation at the inpatient stage of treatment According to A.D., they are subject to hospitalization. Ibatova, patients with newly diagnosed ulcer, with exacerbation of ulcer and when complications occur (bleeding, perforation, penetration, pyloric stenosis, malignancy). Considering that traditional means Treatments for ulcer are warmth, rest and diet. At the inpatient stage, semi-bed or bed rest is prescribed, respectively (in case of severe pain). Diet - table No. 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, sinusoidal-modeled currents to the stomach area, UHF therapy, ultrasound to the epigastric area, novocaine electrophoresis. In case of a stomach ulcer, oncological alertness is necessary. If malignancy is suspected, physiotherapy is contraindicated. Exercise therapy is limited to UGG and LH in a gentle manner. V.A. Epifanov claims that LH is used after the acute period of the disease. Exercises should be performed with caution if they increase pain. Complaints often do not reflect the objective state; the ulcer can progress even with subjective well-being (disappearance of pain, etc.). You should spare the abdominal area and very carefully, gradually increase the load on the abdominal muscles. You can gradually expand the patient's motor mode by increasing the total load when performing most exercises, including diaphragmatic breathing, for the abdominal muscles. According to I.V. Milyukova, during exacerbations, frequent changes in rhythm, a fast pace of performing even simple exercises, and muscle tension can cause or aggravate painful sensations and worsen the general condition. During this period, monotonous exercises are used, performed at a slow pace, mainly in a prone position. In the remission phase, exercises are performed in the IP standing, sitting and lying down; The amplitude of movements increases, you can use exercises with apparatus (weighing up to 1.5 kg). When transferring a patient to a ward regime, A.D. states. Ibatov, rehabilitation of the second period is prescribed. The tasks of the first include the tasks of household and work rehabilitation of the patient, restoration of correct posture when walking, and improvement of coordination of movements. The second period of classes begins with a significant improvement in the patient’s condition. UGG, LH, abdominal wall massage are recommended. The exercises are performed in a lying position, sitting, on your knees, standing with gradually increasing effort for all muscle groups, still excluding the abdominal muscles. The most acceptable position is lying on your back: it allows you to increase the mobility of the diaphragm, has a gentle effect on the abdominal muscles and helps improve 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 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 IPs. Include exercises with dumbbells (0.5-2 kg), medicine balls (up to 2 kg), exercises on a gymnastic wall and bench. Diaphragmatic breathing maximum depth. Walking up to 2-3 km per day; walking up stairs up to 4-6 floors, outdoor walks are desirable. The duration of the LG session is 20-25 minutes. 2 Physical rehabilitation at the outpatient stage of treatment At the outpatient stage, patients are observed in the third group of dispensary registration. With ulcerative gastrointestinal tract, patients are examined 2 to 4 times a year by a therapist, gastroenterologist, surgeon, and oncologist. Every year, as well as during exacerbations, gastroscopy and biopsy are performed; fluoroscopy - according to indications, clinical analysis blood - 2-3 times a year, gastric juice analysis - 1 time every 2 years; stool analysis for occult blood, examination of the biliary system - according to indications. During examinations, the diet is adjusted, anti-relapse therapy is carried out if necessary, rational employment and indications for referral to sanatorium treatment are determined. With DU, the patient is invited for periodic examinations 2-4 times a year, depending on the frequency of exacerbations. In addition, patients undergo oral sanitation and dental prosthetics. Physiotherapeutic procedures include: electrosleep, microwave therapy for the stomach area, UHF therapy, ultrasound. 3 Physical rehabilitation at the sanatorium stage of treatment The indication for sanatorium-resort treatment is gastric ulcer and duodenum in the stage of 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-type resorts with mineral drinking waters (in the Caucasus, Udmurtia, Nizhneivkino, etc.) and mud resorts. Spa treatment includes therapeutic nutrition according to diet table No. 1 with a 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 administration is determined by the state of the secretory function of the stomach. They accept non-carbonated, low- and medium-mineralized mineral waters, mostly alkaline: “Borjomi”, “Smirnovskaya”, “Essentuki” No. 4. With preserved and increased secretion, water is taken 1-1.5 hours before meals. Balneological procedures include sodium chloride, radon, pine, pearl baths (every other day), heat therapy: mud and ozokerite applications, mud electrophoresis. In addition, sinusoidal-modeled currents, SMV therapy, UHF therapy, and diadynamic currents are prescribed. Exercise therapy is carried out according to a gentle tonic regimen using UGG, sedentary games, dosed walking, swimming in open reservoirs. Therapeutic massage is also used: from 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 increases from 8-10 to 20-25 minutes towards the end of the treatment. Treatment of patients takes place during a period of remission, the volume and intensity of PH exercises increases: OUU, remote control exercises, coordination exercises are widely used, outdoor and some sports games (badminton, table tennis,) and relay races are allowed. Health paths and walks in winter - skiing (the route should exclude ascents and descents with a steepness exceeding 15-20 degrees, alternating walking style) are recommended. In the LH procedure, there are no strength, speed-strength exercises, static efforts and tensions, jumps and leaps, or fast-paced exercises. IP sitting and lying down. CONCLUSION Peptic ulcer ranks second in terms of morbidity in the population after coronary artery disease. 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 carriers of H.P. no symptoms of disease are detected. This gives reason to believe that PU is a neurogenic disease that developed against the background of prolonged psycho-emotional stress. Statistics show that urban residents are more susceptible to PUBs than residents rural areas. A less significant factor for the occurrence of ulcers is poor nutrition. I think everyone will agree with me that against the backdrop of stress, emotional overload in work and life, people often, without noticing it, lean towards tasty rather than healthy food, and also someone abuses tobacco products and alcoholic drinks. In my opinion, if the situation in the country were not tense, as it is at the moment, the incidence would be clearly lower. During the Great Patriotic War, soldiers were susceptible to various gastrointestinal diseases from the martial law in the country, from poor nutrition and tobacco abuse. Soldiers were also subject to hospitalization and rehabilitation. Seventy years later, the factors causing ulcer disease remain the same. For the treatment of peptic ulcers, first of all, drug therapy is used to suppress the infectious factor (antibiotics), to stop bleeding (if necessary), nutritional therapy, to prevent complications, a motor regimen is used with the use of physical means of rehabilitation: UGG, LH, DU, relaxation exercises, which are special, and other forms of conducting classes. Physiotherapeutic procedures (electrosleep, novocaine electrophoresis, etc.) are also prescribed. It is very important that during the rehabilitation period the patient is in a state of rest, ensure silence if possible, limit watching TV to 1.5-2 hours a day, and walk outdoors 2-3 km a day. After the relapse stage, the patient is transferred to a clinic with a gastroenterologist and is observed for 6 years, with periodic treatments in sanatoriums or resorts to ensure stable remission. In the sanatorium, patients are treated with mineral waters, various types massage, skiing, cycling, swimming in open water, games. Physical rehabilitation for any disease plays an important role for the complete recovery of a person after illness. This allows you to save a person’s life, teach him to cope with stress, teach and instill 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 become ill again in the future. LIST OF ABBREVIATIONS N.R. - Helicobacter pylori (Helicobacter pylori) UHF - decimeter wave (therapy) Duodenum - duodenum DU - breathing exercises Gastrointestinal tract - gastrointestinal tract IHD - coronary heart disease IP - starting position LH - therapeutic exercises Exercise therapy - therapeutic physical culture NS - nervous system ORU - general developmental exercises OOU - general strengthening exercises SMV - centimeter wave (therapy) ESR - erythrocyte sedimentation rate FGS - fibrogastroscopy UHF - ultra high frequency (therapy) UGG - morning hygienic gymnastics HR - heart rate ECG - electrocardiography PU - peptic ulcer PUD - duodenal ulcer BIBLIOGRAPHICAL LIST 1. Belaya, N.A. Therapeutic exercise and massage: educational method. allowance for medical workers / N.A. White. - M.: Sov. Sport, 2001. - 272 p. 2. Gorelova, L.V. Short course of therapeutic physical culture and massage: textbook. allowance / L.V. Gorelova. - Rostov-on-Don: Phoenix, 2007. - 220 p. Epifanov, V.A. Therapeutic physical culture: textbook. allowance for medical universities / V.A. Epifanov. - M.: GEOTAR-Media, 2006. - 567 p. Epifanov, V.A. Therapeutic physical culture and sports medicine: textbook / V.A. Epifanov. - M.: Medicine, 2004. - 304 p. Ibatov, A.D. Fundamentals of rehabilitation: textbook. allowance / A.D. Ibatov, S.V. Pushkin. - M.: GEOTAR-Media, 2007. - 153 p. Kalyuzhnova, I.A. Therapeutic physical education / I.A. Kalyuzhnova, O.V. Perepelova. - Ed. 2nd - Rostov-on-Don: Phoenix, 2009. - 349 p. Kozyreva, O.V. Physical rehabilitation. Healing Fitness. Kinesitherapy: educational dictionary-reference book / O.V. Kozyreva, A.A. Ivanov. - M.: Sov. Sport, 2010. - 278 p. 8. Litvitsky, P.F. Pathophysiology: textbook for universities: 2 volumes / P.F. Litvitsky. - 3rd ed., rev. and additional - M.: GEOTAR-Media, 2006. - T. 2. - 2006. - 807 p. Milyukova, I.V. Great encyclopedia of health-improving gymnastics / I.V. Milyukova, T.A. Evdokimova; under general ed. T.A. Evdokimova. - M.: AST; St. Petersburg : Owl: , 2007. - 991 p. : ill. 10. Petrushkina, N.P. Herbal medicine and herbal prevention of internal diseases: textbook. manual for independent work / N.P. Petrushkina; UralGUFK. - Chelyabinsk: UralGUFK, 2010. - 148 p. Popova, Yu.S. Diseases of the stomach and intestines: diagnosis, treatment, prevention / Yu.S. Popova. - St. Petersburg. : Krylov, 2008. - 318 p. Physiotherapy: national guide / ed. G.N. Ponomarenko. - M.: GEOTAR-Media, 2009. - 864 p. Physiotherapy: textbook. manual / ed. A.R. Babaeva. - Rostov-on-Don: Phoenix, 2008. - 285 p. Physical rehabilitation: textbook / ed. ed. S.N. Popova. - Ed. 2nd, revised add. - Rostov-on-Don: Phoenix, 2004. - 603 p. Khodasevich, L.S. Lecture notes on the course of private pathology / L.S. Khodasevich, N.D. Goncharova.- M.: Physical culture, 2005.- 347 p. Private pathology: textbook. allowance / under general ed. S.N. Popova. - M.: Academy, 2004. - 255 p. APPLICATIONS Appendix A Outline of therapeutic exercises for peptic ulcers of the stomach and duodenum Date: 11.11.11 Observed: Full name, 32 years old Diagnosis: duodenal ulcer, gastroduodenitis, superficial gastritis; Stage of the disease: relapse, subacute (fading exacerbation) Motor mode: extended bed rest Venue: Chamber Method of implementation: individual Lesson duration: 12 minutes Lesson objectives: .contribute to the regulation of nervous processes in the cerebral cortex, increasing the psycho-emotional state; 2.help improve digestive functions, redox processes, regeneration of the mucous membrane, improve respiratory and circulatory functions; .ensure the prevention of complications and stagnation, help improve overall physical performance; .continue training in diaphragmatic breathing, relaxation exercises, elements of auto-training; .cultivate a conscious attitude towards performing special physical exercises at home in order to prevent relapse of the disease and prolong the period of remission. Application Parts of the lesson Particular tasks Contents of the lesson Dosage Organizational method. instructionsIntroductory preparation of the body for the upcoming load t = 3"Check heart rate and respiratory rate1) IP lying on your back.Measure heart rate and respiratory rateHR for 15""Respiratory rate for 30""Show measurement areaTeach diaphragmatic breathing1) IP lying on your back, arms along the torso, legs bent in the knees. Diaphragmatic breathing: 1. inhale - the abdominal wall rises, 2. exhale - retracts 6-8 times. Tempo is slow. Imagine how the air leaves the lungs. Improve peripheral blood circulation. 2) IP lying on your back, arms along the body. Simultaneous flexion and extension of the feet and hands into a fist 8-10 times Medium tempo Random breathing Stimulate blood circulation in the lower extremities 3) IP lying on your back Alternate bending of the legs without lifting your feet from the bed 1. exhale - flexion, 2. inhale - extension 5-7 times Slow tempo Stimulate blood circulation in the upper extremities 4) IP lying on your back, arms along the body 1. inhale - spread your arms to the sides, 2. exhale - return to IP 6-8 times Tempo is slowBasic Solution of general and special problems t = 6 "Strengthen the abdominal muscles and pelvic floor 5) IP lying on your back, legs bent at the knees. 1. spread your knees to the sides, connecting the soles, 2. return to IP 8-10 times. The pace is slow. Do not hold your breath. Improve blood circulation in the internal organs. 6) IP sitting on the bed, legs down, hands on the belt. 1. exhale - turn the torso to the right, arms to the sides, 2. inhale - return to IP, 3. exhale - turn the torso to the left, arms to the sides, 4. inhale - return to IP 3-4 times Tempo is slow Amplitude is incomplete Spare the epigastric area Strengthen the pelvic muscles bottom and improve the function of emptying 7) IP lying on your back. Slowly bend your legs and place your feet towards your buttocks, resting on your elbows and feet 1. raise your pelvis 2. return to IP 2-3 times. The pace is slow. Do not hold your breath. Conclude. reduction of load, restoration of heart rate and respiratory rate t = 3 "General relaxation 8) IP lying on your back. Relax all muscles 1" - rest Close your eyes Inclusion of autotraining elements Checking heart rate and respiratory rate 1) IP lying on your back. Measurement of heart rate and RRHR for 15"" RR for 30"" Ask the patient about his health Give recommendations for independent performance of physical exercises at home Diet tables according to Pevzner Table No. 1. Indications: peptic ulcer of the stomach and duodenum in the stage of subsiding exacerbation and in remission, chronic gastritis with preserved and increased secretion in the stage of subsiding exacerbation, acute gastritis in the stage of subsiding. Characteristics: physiological content of proteins, fats and carbohydrates, limitation of table salt, moderate limitation of mechanical and chemical irritants of the mucous membrane and the receptor apparatus of the gastrointestinal tract, stimulants of gastric secretion, substances that remain in the stomach for a long time. Culinary processing: all dishes are prepared boiled, pureed or steamed; some baked dishes are allowed. Energy value: 2,600-2,800 kcal (10,886-11,723 kJ). Ingredients: proteins 90-100 g, fats 90 g (of which 25 g are of plant origin), carbohydrates 300-400 g, free liquid 1.5 l, table salt 6-8 g. Daily ration weight 2.5-3 kg. The diet is divided (5-6 times a day). The temperature of hot dishes is 57-62 °C, cold dishes - not lower than 15 °C. Table No. 1a. Indications: exacerbation of gastric and duodenal ulcers in the first 10-14 days, acute gastritis in the first days of the disease, exacerbation of chronic gastritis (with preserved and increased acidity) in the first days of the disease. Characteristics: physiological content of proteins and fats, limitation of carbohydrates, sharp limitation of chemical and mechanical irritants of the mucous membrane and the receptor apparatus of the gastrointestinal tract. Culinary processing: all products are boiled, pureed or steamed, dishes have a liquid or mushy consistency. Energy value: 1,800 kcal (7,536 kJ). Ingredients: proteins 80 g, fats 80 g (of which 15-20 g are vegetable), carbohydrates 200 g, free liquid 1.5 l, table salt 6-8 g. Daily ration weight - 2-2.5 kg. The diet is divided (6-7 times a day). The temperature of hot dishes is 57-62 °C, cold dishes - not lower than 15 °C. Table No. 1b. Indications: exacerbation of gastric and duodenal ulcers in the next 10-14 days, acute gastritis and exacerbation of chronic gastritis in the next days. Characteristics: physiological content of proteins, fats and limitation 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 prepared pureed, boiled or steamed, the consistency of the dishes is liquid or mushy. Energy value: 2,600 kcal (10,886 kJ). Ingredients: proteins 90 g, fats 90 g (of which 25 g vegetable fat), carbohydrates 300 g, free liquid 1.5 l, table salt 6-8 g. Daily ration weight - 2.5-3 kg. Diet: fractional (5-6 times a day). The temperature of hot dishes is 57-62 °C, cold dishes - 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: physiologically complete diet, rich in extractive substances, with rational culinary processing of products. Avoid foods and dishes that linger in the stomach for a long time, are difficult to digest, and irritate the mucous membrane and receptor apparatus of the gastrointestinal tract. The diet has a stimulating effect on the secretory apparatus of the stomach, helps to improve compensatory and adaptive reactions digestive system, 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 forming a rough crust. Energy value: 2800-3100 kcal. Ingredients: proteins 90-100 g, fats 90-100 g, carbohydrates 400-450 g, free liquid 1.5 l, table salt up to 10-12 g. Daily ration weight - 3 kg. The diet is divided (4-5 times a day). The temperature of hot dishes is 57-62˚C, cold food is below 15°C. Table No. 5. Indications: chronic hepatitis and cholecystitis in remission, cholelithiasis, acute hepatitis and cholecystitis during the recovery period. General characteristics: the amount of proteins, fats and carbohydrates is determined physiological needs body. Strong stimulants of gastric and pancreatic secretion (extractive substances, products rich in essential oils) are excluded; refractory fats; fried foods; foods rich in cholesterol and purines. Increased consumption of vegetables and fruits enhances the choleretic effect of other nutrients, intestinal motility, and ensures maximum cholesterol removal. Cooking technology: Dishes are boiled, less often - baked. Energy value: 2200-2500 kcal. Ingredients: proteins 80-90 g, fats 80-90 g, carbohydrates 300-350 g. Diet - 5-6 times a day. Only warm food is allowed, cold dishes are excluded. Introduction Anatomical, physiological, pathophysiological and clinical features 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 Physical therapy (physical therapy) 2 Acupuncture 3 Acupressure 4 Physiotherapy 5 Drinking mineral waters 6 Balneotherapy 7 Music therapy 8 Mud therapy 9 Diet therapy 10 Herbal medicine 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 disease (ulcus ventriculi et duodenipepticum, morbus ulcerosus) is a general chronic relapsing disease prone to progression, with a polycyclic course, the characteristic features of which are seasonal exacerbations, accompanied by the appearance of an ulcerative defect in the mucous membrane, and the development of complications, life-threatening sick. A feature of the course of gastric ulcer is the involvement of other organs of the digestive system in the pathological process, which requires timely diagnosis to draw up medical complexes patients with peptic ulcer disease, taking into account concomitant diseases. Gastric ulcer affects people of the most active, working age, causing temporary and sometimes permanent loss of ability to work. High morbidity, frequent relapses, long-term disability of patients, resulting in significant economic losses - all this allows us to classify the problem of peptic ulcer disease as one of the most pressing in modern medicine. Rehabilitation occupies a special place in the treatment of patients with peptic ulcer disease. Rehabilitation is the restoration of health, functional status and ability to work, impaired by diseases, injuries or physical, chemical and social factors. The World Health Organization (WHO) gives a definition of rehabilitation very close to this: “Rehabilitation is a set of activities designed to ensure that persons with disabilities as a result of disease, injury and birth defects adapt to new living conditions in the society in which they live.” According to WHO, rehabilitation is a process aimed at comprehensive assistance to sick and disabled people so that they achieve the maximum possible physical, mental, professional, social and economic usefulness for a given 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 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. The tasks are aimed at 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 disease
.1 Etiology and pathogenesis of gastric ulcer
Gastric ulcer is characterized by the formation of ulcers in the stomach due to a disorder of the general and local mechanisms of the nervous and humoral regulation the main functions of the gastroduodenal system, disruption of trophism 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 relationship between aggressive and protective factors with a predominance of the former and a decrease in the latter in the gastric cavity. Thus, the development of peptic ulcer disease, according to modern concepts, is caused by an imbalance between the effects of aggressive factors and defense mechanisms that ensure the integrity of the gastric mucosa. Factors of aggression include: increased concentration hydrogen ions and active pepsin (proteolytic activity); Helicobacter pylori infection, presence bile acids in the cavity of the stomach and duodenum. The protective factors include: the amount of protective mucus proteins, especially insoluble and premucosal, secretion of bicarbonates (“alkaline tide”); resistance of the mucous membrane: proliferative index of the mucous membrane of the gastroduodenal zone, local immunity of the mucous membrane 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 gastric cavity decrease. Based on currently available data, the main and predisposing factors have been identified diseases. The main factors include: -disturbances of humoral and neurohormonal mechanisms regulating 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 identified that occur in certain stages of the pathogenesis of this disease; -Helicobacter pylori infestation. Some researchers in our country and abroad consider Helicobacter pylori infection to be the main cause of peptic ulcers; -conditions external environment, first of all, neuropsychic factors, nutrition, bad habits; -medicinal effects. From a modern point of view, some scientists consider peptic ulcer disease as a polyetiological multifactorial disease .
However, I would like to emphasize the traditional direction of the Kyiv and Moscow therapeutic schools, which believe that the central place in the etiology and pathogenesis of peptic ulcer disease belongs to disorders of the nervous system that arise in its central and vegetative sections under the influence of various influences (negative emotions, mental and physical work, viscero-visceral reflexes, etc.). There is a large number of works indicating the etiological and pathogenetic role of the nervous system in the development of peptic ulcer disease. The spasmogenic or neurovegetative theory was the first to be created .
Works by I.P. Pavlova on the role of the nervous system and its higher department - the cerebral cortex - in the regulation of all vital functions organism (ideas of nervism) are reflected in new views on the process of development of peptic ulcer disease: this is the cortico-visceral theory K.M. Bykova, I.T. Kurtsina (1949, 1952) and a number of works indicating the etiological role of disruption of neurotrophic processes directly in the mucous membrane of the stomach and duodenum in peptic ulcer disease. According to the cortico-visceral theory, peptic ulcer disease is the result of disturbances in the cortico-visceral relationship. Progressive in this theory is the proof of two-way communication between the central nervous system and internal organs, as well as the consideration of peptic ulcer disease from the point of view of a disease of the whole organism, in the development of which a disorder 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 disrupted. Currently, there are several fairly convincing facts showing that one of the main etiological factors in the development of peptic ulcer disease is a violation of nerve trophism. An ulcer arises and develops as a result of a disorder in the 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 explained by the high regenerative ability and anabolic processes in the gastric mucosa. Active protein synthetic function is easily impaired and may be early sign dystrophic processes, aggravated by the aggressive peptic effect of gastric juice. It has been noted that in gastric ulcers the level of hydrochloric acid secretion is close to normal or even reduced. In the pathogenesis of the disease, a decrease in the resistance of the mucous membrane, as well as the reflux of bile into the gastric cavity due to insufficiency of the pyloric sphincter, is of greater importance. A special role in the development of peptic ulcer is assigned to gastrin and cholinergic postganglionic fibers of the vagus nerve, which are involved in the regulation of gastric secretion. There is an assumption that histamine is involved in the stimulating effect of gastrin and cholinergic mediators on the acid-forming function of parietal cells, which is confirmed therapeutic effect 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), present in the body in two forms COX-1 and COX-2. COX-1 is found in the stomach, kidneys, platelets, and endothelium. Induction of COX-2 occurs under the influence of inflammation; the expression of this enzyme is carried out predominantly by inflammatory cells. Thus, summarizing the above, we can come to the conclusion that the main links in the pathogenesis of peptic ulcer disease are neuroendocrine, vascular, immune factors, acid-peptic aggression, protective mucous-bicarbonate barrier of the gastric mucosa, helicobacteriosis and prostaglandins. .2 Classification
Currently, there is no generally accepted classification of peptic ulcer disease. A large number of classifications based on various principles are proposed. In foreign literature, the term “peptic ulcer” is more often used and a distinction is made between peptic ulcers of the stomach and duodenum. The abundance of classifications emphasizes their imperfection. According to the WHO classification of the IX revision, gastric ulcer (heading 531), duodenal ulcer (heading 532), ulcer of unspecified localization (heading 533) and, finally, gastrojejunal ulcer of the resected stomach (heading 534) are distinguished. International classification WHO should be used for accounting and statistical purposes, but for use in clinical practice it must be significantly expanded. The following classification of peptic ulcer disease is proposed.. General characteristics of the disease (WHO nomenclature) .Gastric ulcer (531) 2.Duodenal ulcer (532) .Peptic ulcer of unspecified localization (533) .Peptic gastrojejunal ulcer after gastrectomy (534) II. Clinical form .Acute or newly diagnosed III. Flow .Latent 2.Mild or rarely recurrent .Moderate or recurrent (1-2 relapses per year) .Severe (3 or more relapses within a year) or continuously relapsing; development of complications. IV. Phase .Exacerbation (relapse) 2.Fading exacerbation (incomplete remission) .Remission V. Characteristics of the morphological substrate of the disease .Types of ulcers a) acute ulcer; b) chronic ulcer Sizes of the ulcer: a) small (less than 0.5 cm); b) average (0.5-1 cm); c) large (1.1-3 cm); d) gigantic (more than 3 cm). Stages of ulcer development: a) active; b) scarring; c) “red” scar stage; d) “white” scar stage; e) long-term non-scarring Ulcer location: a) stomach: A: 1) cardia, 2) subcardial section, 3) body of the stomach, 4) antrum, 5) pyloric canal; B: 1) anterior wall, 2) posterior wall, 3) lesser curvature, 4) greater curvature. b) duodenum: A: 1) bulb, 2) postbulbar part; B: 1) anterior wall, 2) posterior wall, 3) lesser curvature, 4) greater curvature.. Characteristics of the functions of the gastroduodenal system (only indicated pronounced violations secretory, motor and evacuation functions) VII. Complications 1.Bleeding: a) mild, b) medium degree, c) severe, d) extremely severe 2.Perforation .Penetration .Stenosis: a) compensated, b) subcompensated, c) decompensated. .Malignancy Based on the presented classification, as an example, we can propose the following formulation of the diagnosis: gastric ulcer, newly diagnosed, acute form, large (2 cm) ulcer of the lesser curvature of the body of the stomach, complicated by mild bleeding. 1.3 Clinical picture and preliminary diagnosis
Judgment about the possibility of a peptic ulcer should be based on the study of complaints, anamnestic data, physical examination of the patient, and assessment of the functional state of the gastroduodenal system. The typical clinical picture is characterized by a clear connection between the occurrence of pain and food intake. There are early, late and “hunger” pains. Early pain appears 1/2-1 hour after eating, gradually increases in intensity, lasts 1 1/2-2 hours and subsides as gastric contents are evacuated. Late pain occurs 1 1/2-2 hours after eating at the height of digestion, and “hungry” pain occurs after a significant period of time (6-7 hours), i.e. on an empty stomach, and stops after eating. Night pain is close to “hungry”. The disappearance of pain after eating, taking antacids, anticholinergic and antispasmodic drugs, as well as the subsidence of pain during the first week of adequate treatment is a characteristic sign of the disease. In addition to pain, the typical clinical picture of gastric ulcer includes various dyspeptic symptoms. Heartburn is a common symptom of the disease, occurring in 30-80% of patients. Heartburn may alternate with pain, precede it for a number of years, or be the only symptom diseases. However, it should be borne in mind that heartburn is often observed in other diseases of the digestive system and is one of the main signs of insufficiency of cardiac function. Nausea and vomiting are less common. Vomiting usually occurs at the height of pain, being a kind of culmination of the pain syndrome, and brings relief. Often, to eliminate pain, the patient himself artificially induces vomiting. Constipation is observed in 50% of patients with gastric ulcer. They intensify during periods of exacerbation of the disease and are sometimes so persistent that they bother the patient even more than pain. A distinctive feature of peptic ulcer disease is its cyclical course. Periods of exacerbation, which usually last from several days to 6-8 weeks, are followed by a phase of remission. During remission, patients often feel practically healthy, even without following any diet. Exacerbations of the disease, as a rule, are seasonal; for the middle zone, this is mainly the spring or autumn season. A similar clinical picture in persons with no previously established diagnosis is more likely to suggest peptic ulcer disease. Typical ulcerative symptoms are more common when the ulcer is localized in the pyloric part of the stomach (pyloroduodenal form of peptic ulcer). However, it is often observed with an ulcer of the lesser curvature of the body of the stomach (mediogastric form of peptic ulcer). However, in patients with mediogastric ulcers, the pain syndrome is less defined, pain can radiate to the left half of the chest, lumbar region, right and left hypochondrium. Some patients with the mediogastric form of peptic ulcer experience a decrease in appetite and weight loss, which is not typical for pyloroduodenal ulcers. The greatest clinical features occur in patients with ulcers localized in the cardial or subcardial parts of the stomach. Laboratory tests have a relative, indicative value in recognizing peptic ulcer disease. The study of gastric secretion is necessary not so much for diagnosing the disease as for identifying functional disorders stomach. Only a significant increase in acid production detected during fractional probing of the stomach (basal HCl secretion rate over 12 mmol/h, HCl rate after submaximal stimulation with histamine over 17 mmol/h and after maximum stimulation over 25 mmol/h) should be taken into account as a diagnostic sign of peptic ulcer disease . Additional information can be obtained by examining intragastric pH. Peptic ulcer disease, especially pyloroduodenal localization, is characterized by pronounced hyperacidity in the body of the stomach (pH 0.6-1.5) with continuous acid formation and decompensation of alkalization of the environment in the antrum (pH 0.9-2.5). Establishing true achlorhydria practically eliminates this disease. Clinical blood tests in uncomplicated forms of peptic ulcer usually remain normal; only a number of patients have erythrocytosis due to increased erythropoiesis. Hypochromic anemia may indicate bleeding from gastroduodenal ulcers. A positive fecal reaction to occult blood is often observed during exacerbations of peptic ulcer disease. However, it should be kept in mind that positive reaction can be observed in many diseases (tumors of the gastrointestinal tract, nosebleeds, bleeding gums, hemorrhoids, etc.). Today, the diagnosis of gastric ulcer can be confirmed using x-ray and endoscopic methods. ulcerative stomach acupressure music therapy 2. Methods of rehabilitation of patients with gastric ulcer
.1 Physical therapy (physical therapy)
Physical therapy (physical therapy) for peptic ulcers helps regulate the processes of excitation and inhibition in the cerebral cortex, improves digestion, blood circulation, breathing, redox processes, and has a positive effect on the patient’s neuropsychic state. When performing physical exercises, spare the stomach area. In the acute period of the disease in the presence of pain, exercise therapy is not indicated. Physical exercises are prescribed 2-5 days after the cessation of acute pain. During this period, the therapeutic exercise procedure should not exceed 10-15 minutes. In a lying position, exercises are performed for the arms and legs with a limited range of motion. Avoid exercises that actively involve the abdominal muscles and increase intra-abdominal pressure. When the acute phenomena cease, physical activity is gradually increased. To avoid exacerbation, this is done carefully, taking into account the patient’s reaction to the exercises. Exercises are performed in the starting position lying, sitting, standing. To prevent adhesions against the background of general strengthening movements, exercises for the muscles of the anterior abdominal wall, diaphragmatic breathing, simple and complicated walking, rowing, skiing, outdoor and sports games are used. Exercises should be performed with caution if they increase pain. Complaints often do not reflect the objective condition, and the ulcer can progress with subjective well-being (disappearance of pain, etc.). In this regard, when treating patients, one should spare the abdominal area and very carefully, gradually increase the load on the abdominal muscles. You can gradually expand the patient’s motor mode by increasing the total load when performing most exercises, including diaphragmatic breathing exercises and exercises for the abdominal muscles. Contraindications to the use of exercise therapy include: bleeding; generating ulcer; acute perivisceritis (perigastritis, periduodenitis); chronic perivisceritis when acute pain occurs during exercise. A complex of exercise therapy for patients with gastric ulcers is presented in Appendix 1. 2.2 Acupuncture
Gastric ulcer from the point of view of its occurrence, development, as well as from the point of view of the development of effective treatment methods represents a major problem. Scientific search reliable methods of treating peptic ulcer due to lack of effectiveness known methods therapy Modern ideas about the mechanism of action of acupuncture are based on somato-visceral relationships, carried out both in spinal cord, and overlying parts of the nervous system. The therapeutic effect on reflexogenic zones where acupuncture points are located helps to normalize the functional state of the central nervous system, hypothalamus, maintain homeostasis and more quickly normalize the disturbed activity of organs and systems, stimulates oxidative processes, improves microcirculation (through the synthesis of biologically active substances), blocks pain impulses. In addition, acupuncture increases the body’s adaptive capabilities, eliminates prolonged excitation in various brain centers that control smooth muscles, blood pressure, etc. The best effect is achieved if acupuncture points located in the zone of segmental innervation of the affected organs are irritated. Such zones for peptic ulcer disease are D4-7. Study of the general condition of patients, dynamics of laboratory, radiological, endoscopic studies give the right to objectively evaluate the acupuncture method used, its advantages, disadvantages, and develop indications for differentiated treatment of patients with peptic ulcer. Showed a pronounced analgesic effect in patients with persistent pain symptom. Analysis of gastric motor function indicators also revealed a clear positive influence acupuncture for tone, peristalsis and gastric evacuation. Treatment of patients with gastric ulcer with acupuncture has a positive effect on the subjective and objective picture of the disease, and relatively quickly eliminates pain and dyspeptic symptoms. When used in parallel with the achieved clinical effect, normalization of the secretory, acid-forming and motor functions of the stomach occurs. 2.3 Acupressure
Acupressure is used for gastritis and stomach ulcers. Acupressure is based on the same principle as when carrying out the method of acupuncture, moxibustion (Zhen-Jiu therapy) - with the only difference that the BAP (biologically active points) are affected with a finger or brush. To resolve the issue of using acupressure, a detailed examination and establishment of an accurate diagnosis is necessary. This is especially important for chronic gastric ulcers due to the risk of malignant degeneration. Acupressure is unacceptable for ulcerative bleeding and is possible no earlier than 6 months after its cessation. A contraindication is also cicatricial narrowing of the gastric outlet (pyloric stenosis) - a gross organic pathology in which there is no expectation of a therapeutic effect. At peptic ulcer The following combination of points is recommended (the location of the points is presented in Appendix 2): 1st session: 20, 18, 31, 27, 38; Session 2: 22, 21, 33, 31, 27; 1st session: 24, 20, 31, 27, 33. The first 5-7 sessions, especially during an exacerbation, are carried out daily, the rest - after 1-2 days (12-15 procedures in total). Repeated courses are carried out according to clinical indications after 7-10 days. Before seasonal exacerbations of peptic ulcer disease, preventive courses of 5-7 sessions every other day are recommended. In case of increased acidity of gastric juice with heartburn, points 22 and 9 should be included in the recipe. In case of stomach atony, low acidity of gastric juice, poor appetite, after a mandatory X-ray or endoscopic examination, you can conduct a course of acupressure using the stimulating method of points 27, 31, 37, combining it with massage using the inhibitory method of points 20, 22, 24, 33. 2.4 Physiotherapy
Physiotherapy - this is the use for therapeutic and preventive purposes of natural and artificially generated physical factors, such as: electric current, magnetic field, laser, ultrasound, etc. Various types of radiation are also used: infrared, ultraviolet, polarized light. a) selection of mild procedures; b) use of small dosages; c) gradual increase in the intensity of exposure to physical factors; d) rational combination of them with other therapeutic measures. As active background therapy to influence the increased reactivity of the nervous system, methods such as: -low-frequency pulse currents using the electrosleep technique; -central electroanalgesia using a tranquilizing technique (using LENAR devices); -UHF on the collar zone; galvanic collar and bromine electrophoresis. Of the methods of local therapy (i.e., exposure to the epigastric and paravertebral zones), the most popular remains galvanization in combination with the introduction of various medicinal substances by electrophoresis (novocaine, benzohexonium, platiphylline, zinc, dalargin, solcoseryl, etc.). 2.5 Drinking mineral waters
Drinking mineral waters of various chemical compositions affect the regulation of the functional activity of the gastro-duodenal system. It is known that the secretion of pancreatic juice and the secretion of bile under physiological conditions are carried out as a result of the induction of secretin and pancreozymin. It logically follows that mineral waters help stimulate these intestinal hormones, which have a trophic effect. To carry out these processes, a certain time is required - from 60 to 90 minutes, and therefore, in order to use all the medicinal properties inherent in mineral waters, it is advisable to prescribe them 1-1.5 hours before meals. During this period, water can penetrate the duodenum and have an inhibitory effect on the excited secretion of the stomach. Warm (38-40° C) low-mineralized waters, which can relax the spasm of the pylorus and quickly evacuate into the duodenum, have a similar effect. When mineral waters are prescribed 30 minutes before a meal or at the height of digestion (30-40 minutes after a meal), their local effect is manifested mainly antacid effect and those processes that are associated with the influence of water on the endocrine and nervous regulation, thereby losing many aspects of the healing effect of mineral waters. This method of prescribing mineral waters is justified in a number of cases for patients with duodenal ulcer with sharply increased acidity of gastric juice and severe dyspeptic syndrome in the phase of a fading exacerbation of the disease. For patients with impaired motor-evacuation function of the stomach, the intake of mineral waters is not indicated, since the taken water long time is retained in the stomach along with food and will have a sokogonny effect instead of an inhibitory one. For patients with peptic ulcers, alkaline weakly and moderately mineralized waters are recommended (mineralization, respectively, 2-5 g/l and more than 5-10 g/l), sodium bicarbonate carbonate, sodium-calcium carbonate bicarbonate-sulfate, bicarbonate-chloride carbonate, sodium sulfate, magnesium-sodium, for example: Borjomi, Smirnovskaya, Slavyanovskaya, Essentuki No. 4, Essentuki Novaya, Pyatigorsk Narzan, Berezovskaya, Moscow mineral water and others. 2.6 Balneotherapy
External use of mineral waters in the form of baths is an active background therapy for patients with gastric ulcers. They have a beneficial effect on the state of the central and autonomic nervous systems, endocrine regulation, and the functional state of the digestive organs. In this case, baths from mineral waters available at the resort or from artificially created waters can be used. These include chloride, sodium, carbon dioxide, iodine-bromine, oxygen, etc. Chloride and sodium baths are indicated for patients with gastric ulcers, any severity of the disease in the phase of a fading exacerbation, incomplete and complete remission of the disease. Radon baths are also actively used. They are available at gastrointestinal resorts (Pyatigorsk, Essentuki, etc.). To treat this category of patients, radon baths of low concentrations are used - 20-40 nCi/l. They have a positive effect on the state of neurohumoral regulation in patients and on the functional state of the digestive organs. The most effective in influencing trophic processes in the stomach are radon baths at concentrations of 20 and 40 nCi/l. They are indicated for any stage of the disease, for patients in the phase of fading exacerbation, incomplete and complete remission, concomitant lesions of the nervous system, blood vessels and other diseases for which radon therapy is indicated. For patients with peptic ulcer disease with concomitant diseases of the joints of the central and peripheral nervous system, female genital organs, especially with inflammatory processes and ovarian dysfunction, it is advisable to prescribe treatment with iodine-bromine baths; it is good to prescribe them to patients of an older age group. Pure iodine-bromine waters do not exist in nature. Use artificial iodine-bromine baths at a temperature of 36-37°C for 10-15 minutes, for a course of treatment 8-10 baths, released every other day, it is advisable to alternate with peloid applications, or physiotherapeutic procedures, the choice of which is determined by both the general condition of the patients and concomitant diseases gastrointestinal tract, cardiovascular and nervous systems. 2.7 Music therapy
It has been proven that music can do a lot. Calm and melodic, it will help you relax faster and better, and restore strength; cheerful and rhythmic raises tone and improves mood. Music will relieve irritation, nervous tension, and activate thought processes and improves performance. The healing properties of music have been known for a long time. In the VI century. BC. The great ancient Greek thinker Pythagoras used music for medicinal purposes. He preached that a healthy soul requires healthy body, and both - constant musical influence, concentration in oneself and ascension to higher areas being. More than 1000 years ago, Avicenna recommended diet, work, laughter and music as treatments. According to their physiological effect, melodies can be soothing, relaxing or tonic, invigorating. The relaxing effect is useful for stomach ulcers. For music to have a healing effect, it must be listened to in this way: ) lie down, relax, close your eyes and completely immerse yourself in the music; ) try to get rid of any thoughts expressed in words; ) remember only pleasant moments in life, and these memories should be figurative in nature; ) a recorded musical program must last at least 20-30 minutes, but no more; ) should not fall asleep; ) after listening to a music program, it is recommended to do breathing exercises and several physical exercises. .8 Mud therapy
Among the methods of treating gastric ulcers, mud therapy occupies one of the leading places. Therapeutic mud affects metabolism and bioenergetic processes in the body, enhances microcirculation of the stomach and liver, improves gastric motility, reduces acidification of the duodenum, stimulates the reparative processes of the gastroduodenal mucosa, and activates the activity of the endocrine system. Mud therapy has an analgesic and anti-inflammatory effect, improves metabolism, changes the reactivity of the body, its immunobiological properties. Silt mud is used at a temperature of 38-40°C, peat mud at 40-42°C, the duration of the procedure is 10-15-20 minutes, every other day, for a course of 10-12 procedures. This mud therapy technique is indicated for patients with gastric ulcer in the phase of fading exacerbation, incomplete and complete remission of the disease, with severe pain syndrome, with concomitant diseases in which the use of physical factors on the collar area is indicated. In case of severe pain, you can use the method of combining mud applications with reflexology (electropuncture). Where it is not possible to use mud therapy, you can use ozokerite and paraffin therapy. 2.9 Diet therapy
Diet food is the main background of any antiulcer therapy. The principle of fractional (4-6 meals a day) meals must be observed regardless of the phase of the disease. Basic principles of therapeutic nutrition (principles of “first tables” according to the classification of the Institute of Nutrition): 1. good nutrition; 2. maintaining the rhythm of eating; 3. mechanical; 4. chemical; 5. thermal sparing of the gastroduodenal mucosa; 6. gradual expansion of the diet. The approach to dietary therapy for peptic ulcer disease is currently marked by a departure from strict to gentle diets. Mainly pureed and non-mashed versions of diet No. 1 are used. Diet No. 1 includes the following products: meat (veal, beef, rabbit), fish (pike perch, pike, carp, etc.) in the form of steamed cutlets, quenelles, soufflés, beef sausages, boiled sausage, occasionally - lean ham, soaked herring (the taste and nutritional properties of herring increase if it is soaked in whole cow's milk), as well as milk and dairy products (whole milk, dry, condensed milk, fresh non-sour cream, sour cream and cottage cheese). If tolerated well, yogurt and acidophilus milk can be recommended. Eggs and dishes made from them (soft-boiled eggs, steam omelette) - no more than 2 pieces per day. Raw eggs are not recommended, as they contain avidin, which irritates the gastric mucosa. Fats - unsalted butter (50-70 g), olive or sunflower (30-40 g). Sauces - milk, snacks - mild, grated cheese. Soups - vegetarian from cereals, vegetables (except cabbage), milk soups with vermicelli, noodles, pasta (well boiled). You need to salt food in moderation (8-10 g of salt per day). Fruits, berries (sweet varieties) are given in the form of puree, jelly, if tolerated, compotes and jelly, sugar, honey, jam. Non-acidic vegetable, fruit, and berry juices are indicated. Grapes and grape juices are poorly tolerated and can cause heartburn. If tolerance is poor, juices should be added to cereals, jelly or diluted with boiled water. Not recommended: pork, lamb, duck, goose, strong broths, meat soups, vegetable and especially mushroom broths, undercooked, fried, fatty and dried meats, smoked meats, salted fish, hard-boiled eggs or scrambled eggs, skim milk, strong tea, coffee, cocoa, kvass, all alcoholic drinks, carbonated water, pepper, mustard, horseradish, onions, garlic, bay leaves, etc. You should abstain from cranberry juice. For drinks, we can recommend weak tea, tea with milk or cream. .10 Herbal medicine
For most patients suffering from gastric ulcers, it is advisable to include in complex treatment decoctions and infusions of medicinal herbs, as well as special antiulcer mixtures consisting of many medicinal plants. Herbs and folk recipes used for stomach ulcers: Collection: Chamomile flowers - 10 g; fennel fruits - 10 gr.; marshmallow root - 10 g; wheatgrass root - 10 g; licorice root - 10 gr. 2 teaspoons of the mixture per 1 cup of boiling water. Infuse, wrap, strain. Take one glass of infusion at night. Collection: Fireweed leaves - 20 gr.; linden blossom - 20 gr.; chamomile flowers - 10 gr.; fennel fruits - 10 gr. 2 teaspoons of the mixture per glass of boiling water. Leave it wrapped and strain. Take 1 to 3 glasses throughout the day. Collection: Crayfish necks, roots - 1 part; plantain, leaf - 1 part; horsetail - 1 part; St. John's wort - 1 part; valerian root - 1 part; chamomile - 1 part. A tablespoon of the mixture per glass of boiling water. Steam for 1 hour. Take 3 times a day before meals. Collection:: Series -100 gr.; celandine -100 gr.; St. John's wort -100 gr.; plantain -200 gr. A tablespoon of the mixture per glass of boiling water. Leave covered for 2 hours, strain. Take 1 tablespoon 3-4 times a day, an hour before or 1.5 hours after meals. Freshly squeezed juice from cabbage leaves, when taken regularly, cures chronic gastritis and ulcers best of all. medications. Preparing juice at home and taking it: the leaves are passed through a juicer, filtered and the juice is squeezed out. Take 1/2-1 glass warmed 3-5 times a day before meals. Conclusion
So, in the course of my work I found out that: List of used literature
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Exercise therapy procedure for patients with gastric ulcer (V. A. Epifanov, 2004) No. Section content Dosage, min Section objectives, procedures 1 Simple and complicated walking, rhythmic, at a calm pace 3-4 Gradual involvement in the load, development of coordination 2 Exercises for arms and legs in combination with body movements, breathing exercises in a sitting position 5-6 Periodic increase in intra-abdominal pressure, increased blood circulation in the abdominal cavity 3 Standing exercises in throwing and catching a ball, throwing a medicine ball (up to 2 kg), relay races, alternating with breathing exercises 6-7 General physiological load, creating positive emotions, developing the function of full breathing 4 Exercises on a gymnastic wall such as mixed hangs 7-8 General tonic effect on the central nervous system, development of static-dynamic stability 5 Elementary lying exercises for the limbs in combination with deep breathing 4-5 Reducing the load, developing full breathing Test on physical rehabilitation Physical rehabilitation for gastric and duodenal ulcers INTRODUCTION peptic ulcer disease rehabilitation The problem of diseases of the gastrointestinal tract is the most pressing 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 methods of physical rehabilitation for peptic ulcer of the stomach and duodenum. Research objectives: 1. Study the basic clinical data on gastric and duodenal ulcers. 2. To study methods of physical rehabilitation for peptic ulcer of the stomach and duodenum. At the present stage, the entire complex of rehabilitation measures gives excellent results in the recovery of patients with peptic ulcer disease. More and more methods are being included in the rehabilitation process from oriental medicine, alternative medicine and other fields. The best effect and lasting remission occurs after using psychoregulatory drugs and elements of auto-training. L.S. Khodasevich gives the following interpretation of peptic ulcer - it is a chronic disease characterized by dysfunction and the formation of an ulcerative defect in the wall of the stomach or duodenum. Research by L. S. 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; urban residents have a higher incidence than rural residents. Every year, 3 thousand people die from this disease and its complications. Peptic ulcer disease most often develops in men, mainly under the age of 50 years. S. N. Popov emphasizes that in Russia there are more than 10 million such patients with almost annual relapses of ulcers in approximately 33% of them. Peptic ulcer disease occurs in people of any age, but more often in men aged 30−50 years. I. A. Kalyuzhnova claims that most often this disease affects males. Localization of the ulcer in the duodenum is typical for young people. The urban population suffers from peptic ulcers more often than the rural population. L.S. Khodasevich cites the following possible complications of peptic ulcer disease: perforation (perforation) of the ulcer, penetration (into the pancreas, 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 gastric ulcer, combined complications. G Chapter 1. Basic clinical data on gastric and duodenal ulcers 1.1 Etiology and pathogenesis of gastric and duodenal ulcers colon According to Khodasevich L.S. (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 most often localized on the lesser curvature, in the duodenum - in the bulb on the back wall. A.D. Ibatov believes that factors contributing to the occurrence of ulcers are prolonged and/or repeated emotional stress, genetic predisposition, the presence of chronic gastritis and duodenitis, Helicobacter pylori contamination, poor diet, smoking and drinking alcohol. In the educational dictionary-reference book by O. V. Kozyreva, A. A. Ivanov, the concept of “ulcer” is characterized as 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 ulcers is facilitated by various lesions of the nervous system (acute psychological trauma, physical and especially mental overstrain, 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 diet and food composition is also of certain importance. In recent years, more and more attention has been given to the infectious (viral) nature of this disease. Hereditary and constitutional factors also play a certain role in the development of ulcers. L.S. Khodasevich distinguishes two stages of the formation of a chronic ulcer: - erosion - a surface defect formed as a result of necrosis of the mucous membrane; - acute ulcer - a deeper defect that involves not only the mucous membrane, but also other membranes of the stomach wall. S.N. Popov believes that currently the formation of gastric or duodenal ulcers occurs as a result of emerging changes in the ratio of local factors of “aggression” and “defense”; At the same time, there is a significant increase in “aggression” against the background of a decrease in “defense” factors. (decrease in the production of mucobacterial secretion, slowdown in the processes of physiological regeneration of the surface epithelium, decrease in blood circulation of the microvasculature 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 gastric ulcers and pyloroduodenal ulcers. Pathogenesis of pyloroduodenal ulcers: - impaired motility of the stomach and duodenum; — hypertonicity of the vagus nerve with increased activity of the acid-peptic factor; - increased levels of adrenocorticotropic hormone of the pituitary gland and glucocorticoids of the adrenal glands; - 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, decreased tone of the vagus nerve and activity of gastric secretion; - weakening of mucosal protective factors 1.2 Clinical picture, classification and complications of ulcerative pain knowledge of the stomach and duodenum In the clinical picture of the disease, S. N. Popov notes a pain syndrome, which depends on the location of the ulcer, dyspeptic syndrome (nausea, vomiting, heartburn, changes in appetite), which, like pain, can be rhythmic in nature, signs of gastrointestinal bleeding may be observed or clinic of peritonitis when an ulcer is perforated. The leading symptom, according to S. N. Popov and L. S. Khodasevich, is a dull, aching pain in the epigastric, most often in the epigastric region, usually occurring 1-1.5 hours after eating with a stomach ulcer and 3 hours with 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. Gastric ulcers are usually observed in patients over 35 years of age, and duodenal ulcers in young people. A typical seasonality of spring exacerbations can be traced. During a 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 surgical intervention. P.F. Litvitsky describes the manifestations of PU in more detail. PUD is manifested by pain in the epigastric region, dyspeptic symptoms (belching of 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, as well as ulcers can debut with perforation or bleeding. PUD is manifested by pain, predominant in 75% of patients, vomiting at a height of pain that brings relief (reduction of pain), vague dyspeptic complaints (belching, heartburn, bloating, food intolerance in 40−70%, frequent constipation), upon palpation it is determined by pain in the epigastric region, sometimes some resistance of the abdominal muscles, asthenovegetative manifestations, and also periods of remission and exacerbation are noted, the latter lasting several weeks. In the educational dictionary-reference book by O. V. Kozyreva and A. A. Ivanov, an ulcer is distinguished: - duodenal - duodenal ulcer. It occurs with periodic pain in the epigastric region, appearing for a long time after eating, on an empty stomach or at night. Vomiting does not occur (unless stenosis has developed), increased acidity of gastric juice and hemorrhages are very common; — gastroduodenal - ulcer and duodenum; - stomach - ulcerative stomach; - perforated ulcer - an ulcer of the stomach and duodenum that has perforated into the free abdominal cavity. P.F. Litvitsky and Yu. S. Popova give a classification of nuclear weapons: - Most type 1 ulcers 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 in this localization are heartburn, belching, nausea, vomiting, which brings relief, pain that occurs 10-30 minutes after eating, which can radiate to the back, left hypochondrium, left half of the chest and/or behind the sternum. An ulcer of the antrum of the stomach is typical for young people. It manifests itself as “hungry” and night pain, heartburn, and less commonly, vomiting with a strong sour odor. - Stomach ulcers that occur together with duodenal ulcers. - Ulcers of the pyloric canal. In their course and manifestations, they are more similar to duodenal ulcers than gastric ulcers. The main symptoms of an ulcer are sharp pain in the epigastric region, constant or occurring randomly 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 surgery; — 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 area of the xiphoid process (under the ribs, where the sternum ends). Complications characteristic of such an ulcer are ulcerative bleeding and penetration. Often, in its treatment it is necessary to resort to surgical intervention; - Duodenal ulcer. In 90% of cases, a duodenal ulcer is localized in the bulb (a thickening in its upper part). The main symptoms are heartburn, “hungry” and night pain, most often in the right side of the abdomen. S.N. Popov also classifies ulcers 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)), according to the level of gastric secretion (with increased secretion, with normal secretion and with decreased secretion), according to the nature of the course (newly diagnosed ulcer, recurrent course), according to the stage of the disease (exacerbation or remission), according to the presence of complications (bleeding , perforation, stenosis, malignancy). The clinical course of ulcer, explains S. N. Popov, can be complicated by bleeding, perforation of the ulcer into the abdominal cavity, and narrowing of the pylorus. With a long course, cancerous degeneration of the ulcer may occur. In 24−28% of patients, ulcers can occur atypically - without pain or with pain resembling another disease (angina pectoris, osteochondrosis, etc.), and are discovered by chance. Peptic ulcer may 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 12pk), through which undigested food, along with acidic gastric juice, enters the abdominal cavity. Often, perforation of an ulcer occurs as a result of drinking alcohol, overeating or physical stress. — Penetration is a violation of the integrity of the stomach, when gastric contents spill into the nearby pancreas, omentum, intestinal loops or other organs. This happens when, as a result of inflammation, the wall of the stomach or duodenum becomes fused with surrounding organs (adhesions are formed). The attacks of pain are very severe and cannot be relieved with medications. Treatment requires surgery. — Bleeding may occur during an exacerbation of ulcerative disease. It may be the beginning of an exacerbation or open at a time when other symptoms of an ulcer (pain, heartburn, etc.) have already appeared. It is important to note that ulcer bleeding can occur both in the presence of a severe, deep, advanced ulcer, and in a fresh, small ulcer. The main symptoms of ulcer bleeding are black stools and coffee-ground-colored vomit (or vomiting blood). In cases of extreme necessity, when the patient’s condition becomes dangerous, surgical intervention is performed in case of ulcer bleeding (the bleeding wound is sutured). Often, ulcer bleeding is treated with medication. — A subdiaphragmatic abscess is an accumulation of pus between the diaphragm and the organs adjacent to it. This complication of ulcer is very rare. It develops during the period of exacerbation of ulcer as a result of perforation of the ulcer or spread of infection through the lymphatic system of the stomach or duodenum. — Obstruction of the pyloric part of the stomach (pyloric stenosis) is an anatomical distortion and narrowing of the sphincter lumen, resulting from scarring of an ulcer of the pyloric canal or the initial part of the duodenum. This phenomenon leads to difficulty or complete cessation of evacuation of food from the stomach. Pyloric stenosis and associated digestive disorders lead to disorders of all types of metabolism, which leads to exhaustion of the body. The main method of treatment is surgery. peptic ulcer disease rehabilitation 1.3 Diagnosis of gastric and duodenal ulcers The diagnosis of ulcer is made to patients most often during an exacerbation, says Yu. S. Popova. The first and main sign 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 the sternum). Ulcer pain is the so-called hunger pain, 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 exacerbation of peptic ulcer disease. These are heartburn, sour belching, vomiting (appears without preliminary nausea and brings temporary relief), increased appetite, general weakness, fatigue, mental imbalance. It is also important to note that during exacerbation of peptic ulcer disease, 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 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 for examining a patient with a suspected ulcer - these are laboratory tests of blood and stool. A moderate decrease in the level of hemoglobin and red blood cells in a clinical blood test allows the detection of hidden bleeding. A stool test called a stool occult blood test should reveal the presence of blood (from a bleeding ulcer). Gastric acidity in ulcerative disease is usually increased. In this regard, an important method for diagnosing ulcer disease is to study the acidity of gastric juice using Ph-metry, as well as by measuring the amount of hydrochloric acid in portions of gastric contents (gastric contents are obtained by intubation). The main method for diagnosing gastric ulcers is FGS. With the help of FGS, the doctor can not only verify the presence of an ulcer in the patient’s stomach, but also see how large it is, in which specific part of the stomach it is located, whether the ulcer is fresh or healing, whether it bleeds or not. In addition, FGS allows you to diagnose how well the stomach is working, as well as take a microscopic piece of the gastric mucosa affected by an ulcer for analysis (the latter allows, in particular, to determine whether the patient is affected by H.P.). Gastroscopy, as the most accurate research method, allows you to determine not only the presence of an ulcer, but also its size, and also helps to distinguish an ulcer from cancer and notice its degeneration into a tumor. Yu.S. Popova emphasizes that fluoroscopic examination of the stomach allows not only to diagnose the presence of an ulcer in the stomach, but also to evaluate its motor and excretory functions. Data on impaired motor abilities 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, accelerated evacuation of food from the stomach is observed. If the ulcer is located low enough, food, on the contrary, stays in the stomach longer. 1.4 Treatment and prevention of gastric ulcer and twelve duodenum In the complex of rehabilitation measures, according to S. N. Popov, medications, motor regimen, exercise therapy and other physical methods of treatment, massage, and nutritional therapy should be used first of all. Exercise therapy and massage improve or normalize neurotrophic processes and metabolism, helping to restore the secretory, motor, absorption and excretory functions of the digestive canal. S.N. Popov also states that patients with exacerbation of uncomplicated ulcer are usually treated on an outpatient basis. Applicable complex therapy, similar to the treatment of chronic gastritis, diet therapy, drug therapy, physiotherapeutic procedures, sanatorium-resort treatment (in remission), exercise therapy. Some authors believe that diet therapy, LH, 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 eliminate nervous and physical overload, and, if possible, negative emotions. The causes, signs, diagnostic methods and possible complications of ulcer vary somewhat depending on which specific part of the stomach or duodenum the exacerbation is localized, explains O. V. Kozyreva. According to N.P. Petrushkina, 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, drug treatment is recommended. 1.4.1 Treatment with medications 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 the ulcer is located, what it looks like, how long the patient has been suffering from ulcer). In any case, treatment of ulcers will always be comprehensive, says Yu. S. Popova. Since the causes of the disease are poor nutrition, infection of the stomach with a specific bacteria, and stress, proper treatment should be aimed at neutralizing each of these factors. The use of medications during 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 motility of the stomach and duodenum, are combined with medications that stimulate the healing processes of ulcers and restoration of the mucous membrane. For severe pain, antispasmodics are used. If there are psychological disorders or stress, sedatives are prescribed. 1.4.2 Diet therapy Yu. S. Popova explains that therapeutic nutrition for ulcer should provide the gastric mucosa and duodenum with maximum rest; it is important to exclude mechanical and thermal damage to the gastric mucosa. All food is pureed, the temperature of which is from 15 to 55 degrees. In addition, during exacerbation of ulcerative disease, it is unacceptable to consume foods that provoke increased secretion of gastric juice. Meals are fractional - every 3-4 hours, in small portions. The diet should be complete, with an emphasis on vitamins A, B and C. The total amount of fat should not be more than 100−110 g per day. 1.4.3 Physiotherapy According to G.N. Ponomarenko, physiotherapy is prescribed to reduce pain and provide an antispastic effect, relieve the inflammatory process, stimulate regenerative processes, regulate the motor function of the gastrointestinal tract, and increase immunity. Local air cryotherapy is used, exposing the back and abdomen to cold air for about 25-30 minutes; peloidotherapy in the form of mud applications on the anterior abdominal cavity; radon and carbon dioxide baths; magnetic therapy, which has a positive effect on immune processes. Contraindications to physiotherapy are severe ulcer disease, bleeding, individual intolerance to physiotherapeutic methods, gastric polyposis, malignancy of ulcers, general contraindications for physiotherapy. 1.4.4 Herbal medicine N.P. Petrushkina explains that herbal medicine is included in complex treatment later. In the process of herbal medicine of gastrointestinal tract and duodenum, neutralizing, protecting and regenerating groups of drugs are used to increase the activity of the acid-peptic factor. For long-term ulcerative defects, antiulcer drugs of plant origin are used (sea buckthorn oil, rosehip oil, carbenoxolone, alanton). For peptic ulcer with increased secretory activity of the stomach, it is recommended to collect medicinal herbs: plantain leaves, chamomile flowers, cudweed grass, rose hips, yarrow herb, licorice roots. For the treatment of ulcers and duodenal ulcers, the author also offers herbal infusions such as: fennel fruits, 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 Among the means of exercise therapy for diseases of the abdominal organs, massage is indicated - therapeutic (and its varieties - reflex-segmental, vibration), says V. A. Epifanov. Massage in the complex treatment of chronic gastrointestinal diseases is prescribed to provide a normalizing effect on the neuroregulatory apparatus of the abdominal organs, to help improve the function of the smooth muscles of the intestines and stomach, and strengthen the abdominal muscles. According to V. A Epifanov, when carrying out the massage procedure, the paravertebral (Th-XI - Th-V and C-IV - C-III) and reflexogenic zones of the back, the area of the cervical sympathetic nodes, and the stomach should be affected. Massage is contraindicated in the acute stage of diseases of the internal organs, in diseases of the digestive organs with a tendency to bleeding, tuberculosis 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, S.N. Popov suggests two types of therapy (maintenance therapy: antisecretory drugs in half the dose; preventive therapy: when symptoms of exacerbation of ulcer appear, antisecretory drugs are used for 2-3 days. Therapy is stopped when symptoms disappear completely) with patient compliance with general and physical regimens, as well as a healthy lifestyle. A very effective means of primary and secondary prevention of ulcer disease is sanatorium treatment. To prevent the disease, Yu. S. Popova recommends following the following rules: - sleep 6-8 hours; - give up fatty, smoked, fried foods; - if you have stomach pain, you should be examined by a medical specialist; - take pureed, easily digestible food 5-6 times a day: porridge, jelly, steamed cutlets, sea fish, vegetables, omelet; - treat bad teeth so that you can chew food well; - avoid scandals, as after a nervous overstrain the pain in the stomach intensifies; - do not eat very hot or very cold food, as this can contribute to the development 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 Methods of physical rehabilitation for gastric and duodenal ulcers 2.1 Physical rehabilitation at the inpatient stage of treatment According to A.D. Ibatov, patients with newly diagnosed ulcers, with exacerbation of ulcers and when complications occur (bleeding, perforation, penetration, pyloric stenosis, malignancy) are subject to hospitalization. Considering that the traditional means of treating ulcer are heat, rest and diet. At the inpatient stage, semi-bed or bed rest is prescribed, respectively (in case of severe pain). Diet - table No. 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, sinusoidal-modeled currents to the stomach area, UHF therapy, ultrasound to the epigastric area, novocaine electrophoresis. In case of a stomach ulcer, oncological alertness is necessary. If malignancy is suspected, physiotherapy is contraindicated. Exercise therapy is limited to UGG and LH in a gentle manner. V.A. Epifanov claims that LH is used after the acute period of the disease. Exercises should be performed with caution if they increase pain. Complaints often do not reflect the objective state; the ulcer can progress even with subjective well-being (disappearance of pain, etc.). You should spare the abdominal area and very carefully, gradually increase the load on the abdominal muscles. You can gradually expand the patient's motor mode by increasing the total load when performing most exercises, including diaphragmatic breathing, for the abdominal muscles. According to I.V. Milyukova, during exacerbations, frequent changes in rhythm, a fast pace of performing even simple exercises, and 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 a prone position. In the remission phase, exercises are performed in the IP standing, sitting and lying down; The amplitude of movements increases, you can use exercises with apparatus (weighing up to 1.5 kg). When transferring a patient to a ward regime, says A.D. Ibatov, rehabilitation of the second period is prescribed. The tasks of the first include the tasks of household and work rehabilitation of the patient, restoration of correct posture when walking, and improvement of coordination of movements. The second period of classes begins with a significant improvement in the patient’s condition. UGG, LH, abdominal wall massage are recommended. The exercises are performed in a lying position, sitting, on your knees, standing with gradually increasing effort for all muscle groups, still excluding the abdominal muscles. The most acceptable position is lying on your back: it allows you to increase the mobility of the diaphragm, has a gentle effect on the abdominal muscles and helps improve 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 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 IPs. Include exercises with dumbbells (0.5-2 kg), medicine balls (up to 2 kg), exercises on a gymnastic wall and bench. Diaphragmatic breathing of maximum depth. Walking up to 2−3 km per day; walking up stairs up to 4-6 floors, outdoor walks are desirable. LH session duration is 20−25 minutes. 2.2 Physical rehabilitation at the outpatient stage of treatment At the outpatient stage, patients are observed in the third group of dispensary registration. With ulcerative gastrointestinal tract, patients are examined 2 to 4 times a year by a therapist, gastroenterologist, surgeon, and oncologist. Every year, as well as during exacerbations, gastroscopy and biopsy are performed; fluoroscopy - according to indications, clinical blood test - 2-3 times a year, gastric juice analysis - once every 2 years; stool analysis for occult blood, examination of the biliary system - according to indications. During examinations, the diet is adjusted, anti-relapse therapy is carried out if necessary, rational employment and indications for referral to sanatorium treatment are determined. With DU, the patient is invited for periodic examinations 2-4 times a year, depending on the frequency of exacerbations. In addition, patients undergo oral sanitation and dental prosthetics. Physiotherapeutic procedures include: electrosleep, microwave therapy for the stomach area, UHF therapy, ultrasound. 2.3 Physical rehabilitation at the sanatorium stage of treatment The indication for sanatorium-resort treatment is gastric ulcer and duodenum in the stage of 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-type resorts with mineral drinking waters (in the Caucasus, Udmurtia, Nizhneivkino, etc.) and mud resorts. Sanatorium-resort treatment includes therapeutic nutrition according to diet table No. 1 with a 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 administration is determined by the state of the secretory function of the stomach. Take non-carbonated, low- and medium-mineralized mineral waters, mostly alkaline: “Borjomi”, “Smirnovskaya”, “Essentuki” No. 4. If secretion is preserved and increased, water is taken 1-1.5 hours before meals. Balneological procedures include sodium chloride, radon, pine, pearl baths (every other day), heat therapy: mud and ozokerite applications, mud electrophoresis. In addition, sinusoidal-modeled currents, SMV therapy, UHF therapy, and diadynamic currents are prescribed. Exercise therapy is carried out according to a gentle tonic regimen using UGG, sedentary games, dosed walking, swimming in open reservoirs. Therapeutic massage is also used: from 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 increases from 8-10 to 20-25 minutes towards the end of the treatment. Treatment of patients takes place during a period of remission, the volume and intensity of PH exercises increases: OUU, remote control exercises, coordination exercises are widely used, outdoor and some sports games (badminton, table tennis,) and relay races are allowed. We recommend a health path, walks in winter - skiing (the route should exclude ascents and descents 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 leaps, or fast-paced exercises. IP sitting and lying down. CONCLUSION Peptic ulcer ranks second in terms of morbidity in the population after coronary artery disease. 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 carriers of H.P. no symptoms of disease are detected. This gives reason to believe that PU is a neurogenic disease that developed against the background of prolonged psycho-emotional stress. Statistics show that urban residents are more susceptible to ulcers than rural residents. A less significant factor for the occurrence of ulcers is poor nutrition. I think everyone will agree with me that against the backdrop of stress, emotional overload in work and life, people often, without noticing it, lean toward tasty rather than healthy food, and some also abuse tobacco products and alcoholic beverages. In my opinion, if the situation in the country were not tense, as it is at the moment, the incidence would be clearly lower. During the Great Patriotic War, soldiers were susceptible to various gastrointestinal diseases from the martial law in the country, from poor nutrition and tobacco abuse. Soldiers were also subject to hospitalization and rehabilitation. Seventy years later, the factors causing ulcer disease remain the same. For the treatment of peptic ulcers, first of all, drug therapy is used to suppress the infectious factor (antibiotics), to stop bleeding (if necessary), nutritional therapy, to prevent complications, a motor regimen is used with the use of physical means of rehabilitation: UGG, LH, DU, relaxation exercises, which are special, and other forms of conducting classes. Physiotherapeutic procedures (electrosleep, novocaine electrophoresis, etc.) are also prescribed. It is very important that during the rehabilitation period the patient is in a state of rest, ensure silence if possible, limit watching TV to 1.5-2 hours a day, and walk outdoors 2-3 km a day. After the relapse stage, the patient is transferred to a clinic with a gastroenterologist and is observed for 6 years, with periodic treatments in sanatoriums or resorts to ensure stable remission. In the sanatorium, patients are treated with mineral waters, various types of massage, skiing, cycling, swimming in open water, and games. Physical rehabilitation for any disease plays an important role for the complete recovery of a person after illness. This allows you to save a person’s life, teach him to cope with stress, teach and instill 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 become ill again in the future. LIST OF ABBREVIATIONS N.R. - Helicobacter pylori (Helicobacter pylori) DMV - decimeter wave (therapy) duodenum - duodenum DU - breathing exercises Gastrointestinal tract - gastrointestinal tract IHD - coronary heart disease IP - initial position PH - therapeutic exercises exercise therapy - therapeutic physical culture 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 exercises HR - heart rate ECG - electrocardiography PUD - peptic ulcer PUD - duodenal ulcer PUD - gastric ulcer BIBLIOGRAPHICAL LIST 1.
Belaya, N. A. Therapeutic physical education and massage: educational method. allowance for medical workers / N. A. Belaya. - M.: Sov. Sport, 2001. - 272 p. 2. Gorelova, L. V. Short course of therapeutic physical culture and massage: textbook. allowance / L. V. Gorelova. - Rostov-on-Don: Phoenix, 2007. - 220 p. 3. Epifanov, V. A. Therapeutic physical culture: textbook. allowance for medical universities / V. A. Epifanov. - M.: GEOTAR-Media, 2006. - 567 p. 4. Epifanov, V. A. Therapeutic physical culture and sports medicine: textbook / V. A. Epifanov. - M.: Medicine, 2004. - 304 p. 5. Ibatov, A. D. Fundamentals of rehabilitation: textbook. allowance / A. D. Ibatov, S. V. Pushkina. - M.: GEOTAR-Media, 2007. - 153 p. 6. Kalyuzhnova, I. A. Therapeutic physical education / I. A. Kalyuzhnova, O. V. Perepelova. - Ed. 2nd - Rostov-on-Don: Phoenix, 2009. - 349 p. 7. Kozyreva, O. V. Physical rehabilitation. Healing Fitness. Kinesitherapy: educational dictionary-reference book / O. V. 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APPLICATIONS Appendix A Outline of therapeutic exercises 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 (fading exacerbation) Motor mode: extended bed rest Location: ward Method of delivery: individual Lesson duration: 12 minutes Lesson objectives: 1. contribute to the regulation of nervous processes in the cerebral cortex, increasing the psycho-emotional state; 2. help improve digestive functions, redox processes, regeneration of the mucous membrane, improve respiratory and circulatory functions; 3. ensure the prevention of complications and stagnation, help improve overall physical performance; 4. continue training in diaphragmatic breathing, relaxation exercises, elements of auto-training; 5. cultivate a conscious attitude towards performing special physical exercises at home in order to prevent relapse of the disease and prolong the period of remission. Appendix Table Parts of the lesson Particular problems Dosage Organizational method. instructions Introductory preparation of the body for the upcoming load Checking heart rate and respiratory rate 1) IP lying on your back. Measuring heart rate and respiratory rate Heart rate for 15"" NPV for 30"" Show measurement area Teach diaphragmatic breathing 1) IP 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 leaving your lungs Improve peripheral blood circulation. 2) IP lying on your back, arms along the body. Simultaneous flexion and extension of the feet and hands into a fist Average tempo Breathing is arbitrary Stimulate blood circulation in the lower extremities 3) IP lying on your back Alternately bending the legs without lifting the feet from the bed 1. exhale - flexion, 2. inhale - extension The tempo is slow Stimulate blood circulation in the upper limbs 4) IP lying on your back, arms along the body 1. inhale - spread your arms to the sides, 2. exhale - return to IP The tempo is slow Main Solution of general and special problems Strengthen your abdominal and pelvic floor muscles 5) IP lying on your back, legs bent at the knees. 1. spread your knees to the sides, connecting the soles, 2. return to IP Improve blood circulation in internal organs 6) IP sitting on the bed, legs down, hands on the belt. 1. exhale - turn the torso to the right, arms to the sides, 2. inhale - return to IP, 3. exhale - turn the torso to the left, arms to the sides, 4. inhale - return to IP Tempo is slow Amplitude is incomplete Spare the epigastric area Strengthen the pelvic floor muscles and improve bowel function 7) IP lying on your back. Slowly bend your legs and place your feet towards your buttocks, resting on your elbows and feet 1. raise your pelvis 2. return to the IP The pace is slow. Do not hold your breath. Concludes. reduction of load, restoration of heart rate and respiratory rate General relaxation 8) IP lying on your back. Relax all muscles Close your eyes Inclusion of elements of auto-training Checking heart rate and respiratory rate 1) IP lying on your back. Measuring heart rate and respiratory rate Heart rate for 15"" NPV for 30"" Diet tables according to Pevzner Table No. 1. Indications: peptic ulcer of the stomach and duodenum in the stage of subsiding exacerbation and in remission, chronic gastritis with preserved and increased secretion in the stage of subsiding exacerbation, acute gastritis in the stage of subsiding. Characteristics: physiological content of proteins, fats and carbohydrates, limitation of table salt, moderate limitation of mechanical and chemical irritants of the mucous membrane and the receptor apparatus of the gastrointestinal tract, stimulants of gastric secretion, substances that remain in the stomach for a long time. Culinary processing: all dishes are prepared boiled, pureed or steamed; some baked dishes are allowed. Energy value: 2,600−2,800 kcal (10,886−11,723 kJ). Ingredients: proteins 90−100 g, fats 90 g (of which 25 g are of plant origin), carbohydrates 300−400 g, free liquid 1.5 l, table salt 6−8 g. Daily ration weight 2.5−3 kg. Diet - fractional (5-6 times a day). The temperature of hot dishes is 57−62 °C, cold dishes - not lower than 15 °C. Table No. 1a. Indications: exacerbation of gastric and duodenal ulcers in the first 10-14 days, acute gastritis in the first days of the disease, exacerbation of chronic gastritis (with preserved and increased acidity) in the first days of the disease. Characteristics: physiological content of proteins and fats, limitation of carbohydrates, sharp limitation of chemical and mechanical irritants of the mucous membrane and the receptor apparatus of the gastrointestinal tract. Culinary processing: all products are boiled, pureed or steamed, dishes have a liquid or mushy consistency. Energy value: 1,800 kcal (7,536 kJ). Ingredients: proteins 80 g, fats 80 g (of which 15−20 g are vegetable), carbohydrates 200 g, free liquid 1.5 l, table salt 6−8 g. Daily ration weight - 2−2.5 kg. The diet is fractional (6-7 times a day). The temperature of hot dishes is 57−62 °C, cold dishes - not lower than 15 °C. Table No. 1b. Indications: exacerbation of gastric and duodenal ulcers in the next 10-14 days, acute gastritis and exacerbation of chronic gastritis in the next days. Characteristics: physiological content of proteins, fats and limitation 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 prepared pureed, boiled or steamed, the consistency of the dishes is liquid or mushy. Energy value: 2,600 kcal (10,886 kJ). Ingredients: proteins 90 g, fats 90 g (of which 25 g vegetable fat), carbohydrates 300 g, free liquid 1.5 l, table salt 6-8 g. Daily ration weight - 2.5-3 kg. Diet: fractional (5-6 times a day). The temperature of hot dishes is 57−62 °C, cold dishes - 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 the period of remission without concomitant diseases. General characteristics: physiologically complete diet, rich in extractive substances, with rational culinary processing of products. Avoid foods and dishes that linger in the stomach for a long time, are difficult to digest, and irritate the mucous membrane and receptor apparatus of the gastrointestinal tract. The diet has a stimulating effect on the secretory apparatus of the stomach, helps improve 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 forming a rough crust. Energy value: 2800−3100 kcal. Ingredients: proteins 90−100 g, fats 90−100 g, carbohydrates 400−450 g, free liquid 1.5 l, table salt up to 10−12 g. Daily ration weight - 3 kg. The diet is divided (4−5 times a day). The temperature of hot dishes is 57−62? C, cold dishes are below 15 ° C.
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