1. Diet therapy – table No. 2 (mechanically and chemically gentle diet);
2. Bed rest, then ward rest;
3. Drug therapy as prescribed by a doctor (dispensing drugs):
A. Eradication therapy:
· T. Pylorid 0.4 x 2 times a day at the end of meals;
· T. Clarithromycin 0.25 x 2 times a day;
· T. Metronidazole 0.5 x 2 times a day at the end of meals;
Within 7 days;
B. Antacids:
· Susp. Maalox – 15 ml. – 15 minutes after meals x 4 times a day, of which last time at night;
B. Salnikov's mixture:
· Sol. Novocaini 0.25%-100.0
· S. Glucosae 5%-200.0
· Sol. Platyphyllini 0.2%-1.0
· Sol. No-Spani – 2.0
· Ins. – 2 units
IV drop x 1 time/day - No. 3;
D. Upon completion of eradication therapy:
· T. Pilorid 0.4 x 2 times a day at the end of meals - continue;
· R-r. Delargina 0.001 – IM – 1 time/day - No. 5.
4. Physiotherapy as prescribed by a doctor (assistance in carrying out procedures): SMT, ultrasound on the epigastrium, novocaine electrophoresis.
5. Exercise therapy: Bed rest: 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. As the condition improves, when transferring to the ward mode: To the tasks of the previous period are added the tasks of household and work rehabilitation of the patient, restoration correct posture when walking, improving coordination of movements. The second period of classes begins with a significant improvement in the patient’s condition. 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. 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.
6. Taking biological samples for analysis (blood, urine, etc.), assistance in carrying out instrumental studies (FGS (FGS control - upon admission, within 10 days, before discharge), gastric intubation, X-ray examination of the stomach, etc.) .
Physical rehabilitation for peptic ulcer stomach 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 that there has been a significant “rejuvenation” of the disease in recent years.
Etiology and pathogenesis. In the last 1.5-2 decades, the point of view on the origin and causes of peptic ulcer disease has changed. The expression “no acid, no ulcer” was replaced by the discovery that the main cause of this disease is Helicobacter pylori (HP), 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 medicines(non-steroidal anti-inflammatory drugs, glucocorticoids, Heliobacter infection).
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.
In the etiology and pathogenesis of peptic ulcer important role psychological personal factors play a role.
The main clinical signs of peptic ulcer disease (pain, heartburn, belching, nausea, vomiting) are determined by the localization of the ulcer (cardiac and mesogastric, ulcers of the pyloric stomach, ulcers of the duodenal bulb and postbulbar ulcers), concomitant diseases of the gastrointestinal tract, age, degree of disorder metabolic processes, level of secretion gastric juice and 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.
The complex of 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 important element treatment of ulcerative process.
It is known that performing dosed physical exercises that are adequate to the condition of the patient’s body improves cortical neurodynamics, thereby normalizing cortico-visceral relationships, which ultimately leads to improvement psycho-emotional state sick.
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 prescription of therapeutic exercises and other forms of exercise therapy: a 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 and pelvic floor muscles, a large 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 physical 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 of autonomic 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. Protozoa sport 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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For severe pain, SMT (sinusoidal modulated currents) is used. High therapeutic effect observed when using ultrasound.
Control questions and tasks:
1. Describe diseases of the digestive organs in general and what functions of the digestive tract may be impaired.
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.
Page 17 of 18
Video: Algorithm for gastrointestinal rehabilitation at home
Clinical examination and principles rehabilitation treatment patients with peptic ulcer disease at the stages of medical rehabilitation
The general direction of health care development in our country has been and remains preventive, providing for the creation of favorable healthy living conditions for the population, the formation of a healthy lifestyle for each person and the entire society, and active medical monitoring of the health of each person. The implementation of preventive tasks is associated with the successful solution of many socio-economic problems and, of course, with a radical restructuring of the activities of health authorities and institutions, primarily with the development and improvement of primary health care. This will make it possible to effectively and fully provide clinical examination of the population, to create a unified system for assessing and systematically monitoring the state of human health and the entire population as a whole.
Issues of medical examination require in-depth study and improvement, because its traditional methods are ineffective and do not allow for full-fledged early diagnosis of diseases, clearly identify groups of people for differentiated observation, and fully implement preventive and rehabilitation measures.
The methods of preparation and conduct need to be improved preventive examinations by program general medical examination. Modern technical means make it possible to improve the diagnostic process, providing for the participation of a doctor only for final stage- stage of making a formed decision. This makes it possible to increase the efficiency of the prevention department and reduce the time of medical examination to a minimum.
We, together with E. I. Samsoi and co-authors (1986, 1988), M. Yu. Kolomoets, V. L. Tarallo (1989, 1990), have improved the technique early diagnosis diseases of the digestive system, including peptic ulcers, using computers and automated complexes. Diagnostics consists of two stages - nonspecific and specific.
At the first stage (nonspecific) the primary expert review health status of those being examined, dividing them into two streams - healthy and subject to further examination. This stage is implemented by preliminary interviewing the population using an indicative questionnaire (0-1) * in preparation for a preventive examination. Those undergoing clinical examination, answering the questions of the indicative questionnaire (0-1), fill out the technological interview map (TKI-1). Then it is machine processed, based on the results of which individuals at risk are identified according to the pathology of individual nosological units.
*The indicative questionnaire is based on the anamnestic questionnaire “Complex of Programs” (“Basic Examination”) for solving the problems of processing the results of mass dispensary screening examinations of the population using the Iskra-1256 microcomputer of the Regional Computer Science Center of the Ministry of Health of Ukraine (1987) with the inclusion of specially developed methods of patient self-examination , additions and changes to ensure the conduct of mass self-interviewing of the population and filling out cards at home. The medical questionnaire is intended for territorial-district certification of population health, identifying risk groups for diseases and lifestyle using a computer.
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The issue of identifying two streams of subjects (healthy and those in need of further examination) is decided on the basis of the computer conclusion on TKI-1 and the results of mandatory studies.
Persons in need of further examination are referred for further examination according to targeted screening programs. One such program is the targeted mass medical examination program for early detection common diseases of the digestive system (including peptic ulcers and pre-ulcerative conditions). Those undergoing clinical examination according to a specialized questionnaire (0-2 “p”) fill out the technological map TKI-2 “p”, after which they are automatically processed according to the same principle. The computer assumes a probable
diagnosis(ies) and list additional methods studies of the digestive organs (laboratory, instrumental, x-ray). The participation of the general practitioner of the prevention department is provided for at the final stage of the preventive examination - the stage of making a formed decision, determining the group for dispensary observation. During the preventive examination, the person undergoing medical examination, on the recommendation of the computer, is examined by specialist doctors.
The questionnaires were tested through preventive medical examinations 4217 people. According to the results of machine processing, a presumptive diagnosis of “healthy” was given to only 18.8% of those interviewed, the conclusion “needs further examination” was given to 80.9% (among them, 77% of those examined needed consultations with therapeutic specialists). Analysis of the final results of preventive examinations showed that the computer gave a true positive answer in 62.9% of cases, a true negative one in 29.1%, a false positive one in 2.4%, and a false negative one in 5.8%.
When identifying gastroenterological pathology, the sensitivity of the specialized screening questionnaire turned out to be very high - 96.2% (with a predictive coefficient of the result of 0.9), since in the specified percentage of cases the machine gives the correct answer with a positive decision “sick”. At the same time, with a negative answer, the error is 15.6% (with a prediction coefficient of 0.9). As a result, the compliance rate of the diagnostic conclusion is 92.1%, i.e. Out of 100 people, in 8 cases the computer decision to identify gastroenterological pathology based on survey data may be incorrect.
The presented data convinces of the high degree of reliability of the developed criteria and allows us to recommend a specialized questionnaire for widespread use in a targeted screening program at the stage of preparation for a preventive medical examination.
As is known, the order of the Ministry of Health of the USSR No. 770 dated May 30, 1986 provides for the identification of three dispensary groups: healthy (DO - preventively healthy (Dg) - patients in need of treatment (Dz). Our experience shows that in relation to patients with peptic ulcer their with pre-ulcerative conditions, as well as for persons with risk factors for the occurrence of these diseases, a more differentiated division of those undergoing medical examination into the second and third health groups is justified (in each of them it is advisable to distinguish 3 subgroups) in order to ensure a differentiated approach to the implementation of preventive and therapeutic measures.
Group II:
On - increased attention (persons who do not complain, without deviations from the norm according to the results of additional studies, but exposed to risk factors) -
II b - persons with latent current pre-ulcerative conditions (without complaints, but having deviations from the norm during additional studies) -
c - patients with obvious pre-ulcerative conditions, peptic ulcer disease, who do not need treatment.
group:
III a - patients with obvious pre-ulcerative conditions in need of treatment -
III b - patients with uncomplicated peptic ulcer disease in need of treatment -
III c - patients with severe peptic ulcer disease, complications and (or) concomitant diseases.
Peptic ulcer disease is one of the diseases in the fight against which preventive rehabilitation measures are crucial.
Without detracting from the importance of the inpatient stage of treatment, it should be recognized that it is possible to achieve stable and long-term remission and prevent recurrence of peptic ulcer disease through long-term (at least 2 years) and continuous restorative stage treatment of the patient after discharge from the hospital. This is evidenced by our own research and the work of a number of authors (E. I. Samson, 1979 - P. Ya. Grigoriev, 1986 - G. A. Serebrina, 1989, etc.).
We highlight the following stages of post-hospital rehabilitation treatment of patients with peptic ulcer:
rehabilitation department for gastroenterological patients of a hospital for rehabilitation treatment (usually in a suburban area using natural healing factors) -
polyclinic (including a day hospital of a polyclinic, department or rehabilitation treatment room of a polyclinic or a rehabilitation center at a polyclinic) -
sanatorium-preventorium of industrial enterprises, institutions, collective farms, state farms, educational institutions -
Spa treatment.
We combine all of the above stages of post-hospital rehabilitation treatment into the period of late rehabilitation, and in general the process of medical rehabilitation can be divided into three periods:
- early rehabilitation ( timely diagnosis in the clinic, early intensive treatment) -
- late rehabilitation (postoperative stages of treatment) -
- dispensary observation in the clinic.
In the system of medical rehabilitation of patients with peptic ulcer disease, the outpatient stage plays a decisive role, since it is in the outpatient clinic that continuous, consistent observation and treatment of the patient is carried out over a long period of time, and continuity of rehabilitation is ensured. The effectiveness of rehabilitation of patients in the clinic is due to the complex impact various means and methods of restorative treatment, including therapeutic nutrition, herbal and physiotherapy, acupuncture, exercise therapy, balneotherapy, psychotherapy with very restrained, maximally differentiated and adequate pharmacotherapy (E. I. Samson, M. Yu. Kolomoets, 1985- M, Yu Kolomoets et al., 1988, etc.).
A correct assessment of the role and significance of the outpatient stage in the rehabilitation treatment of patients has contributed to the further improvement in recent years of organizational forms of rehabilitation of patients at the outpatient stage (O. P. Shchepin, 990). One of them is the day hospital of the clinic (DSP). Analysis of our observations on day hospitals at the clinics of the Central Regional Clinical Hospital of the Minsk district of Kiev, the clinic of the 3rd city hospital of Chernivtsi, as well as data from A. M. Lushpa (1987), B. V. Zhalkovsky, L. I. Leibman (1990) show that DSP is most effectively used for the rehabilitation of gastroenterological patients, who make up 70-80% of the total number of patients treated. Among patients with diseases of the digestive system, about half were patients with peptic ulcer disease. Based on the experience of the DSP, we determined the indications for referring patients with peptic ulcer disease to a day hospital. These include:
Uncomplicated peptic ulcer in the presence of a peptic ulcer 2 weeks after the start of treatment in a hospital after pain relief.
Exacerbation of uncomplicated peptic ulcer without ulcerative defect (from the beginning of exacerbation), bypassing the inpatient stage.
Long-term non-scarring ulcers in the absence of complications 3-4 weeks after the start of hospital treatment.
Due to the rather long stay of patients in the emergency room during the day (6-7 hours), we consider it advisable to organize one or two meals a day in the emergency room (diet No. 1).
The duration of treatment for patients with peptic ulcer disease at various stages of medical rehabilitation depends on the severity of the course, the presence of complications and concomitant diseases, and a number of others. clinical features for a specific patient. At the same time, our many years of experience allows us to recommend the following terms as optimal: in the hospital - 20-30 days (or 14 days with subsequent referral of the patient to a day hospital or the rehabilitation department for gastroenterological patients of the hospital for rehabilitation treatment) - in the rehabilitation department of the hospital for rehabilitation treatment - 14 days - in a day hospital - from 14 to 20 days - in the rehabilitation treatment department of a polyclinic or rehabilitation center at a polyclinic - 14 days - in a sanatorium - 24 days - in a sanatorium at a resort - 24-26 days.
In general, prolonged treatment should continue for at least 2 years in the absence of new exacerbations and relapses. A patient can be considered practically healthy if he has had no exacerbations or relapses of peptic ulcer disease for 5 years.
In conclusion, it should be noted that the problem of treating peptic ulcer disease goes far beyond the scope of medicine and is a socio-economic problem that requires the implementation of a set of measures on a national scale, creating conditions for reducing psychogenic factors, normal nutrition, hygienic working conditions, living conditions, and rest.
Therapeutic physical culture is currently an integral part of complex treatment, a means of primary and, especially, secondary prevention of gastric and duodenal ulcers. Without exercise therapy, full rehabilitation of patients is impossible. The use of exercise therapy at various stages of treatment of patients with different condition requires constant use various methods control. These methods can only conditionally be called methods for assessing the effectiveness of exercise therapy, since they provide much more information. With their help, the functional state of the patient at the moment is determined, the adequacy of exercise therapy in terms of physical activity and specific focus and in combination with other therapeutic measures. Methods for assessing the effectiveness of exercise therapy, having multifaceted characteristics, largely contribute to the disclosure of the mechanisms of influence of physical exercises themselves and thereby form the basis of a scientific approach to exercise therapy.
To determine the effectiveness of exercise therapy, constant observations of the patient are carried out, determining his condition, the impact of the exercises used, a separate lesson, and a certain period of treatment. Special studies of the functional state are also important, which give an objective assessment of the patient, his individual characteristics, adaptation to physical activity.
Knowledge and application of methods for studying body functions increases the effectiveness of therapeutic physical education classes. Assessing the patient’s functional state before starting physical therapy exercises is necessary to distribute patients into homogeneous groups according to their functional state, and to correctly plan and dosage physical activity. Ongoing examinations during the course of treatment and research into the impact of a single session make it possible to evaluate the effectiveness of a single session, make timely changes to the treatment plan (for example, expanding the motor mode) and training methods. Taking into account the effectiveness at the end of treatment sums up the course of training.
Improvement in the condition of patients with peptic ulcer disease in the phase of fading exacerbation is noted with the relief of pain and dyspepsia, the absence of pain on palpation, improvement, well-being, refusal of medications, expansion of the dietary regimen, restoration of motor function of the stomach and improvement of the autonomic regulation of the functions of internal organs according to ortho- and clinostatic samples It is verified endoscopically by a decrease in inflammatory reaction mucous membrane around the ulcer, cleansing the bottom of the ulcer, and a tendency to scarring. Persistent improvement is determined by a change in the type of course (rhythm of exacerbations): the absence of relapse within a year with previously frequent recurrences, the formation of a scar and the elimination of inflammation in its area according to endoscopy, or the disappearance of a “niche” confirmed by x-ray.
Determination of the effectiveness of treatment when applying exercise therapy procedures is carried out on the basis of data on the well-being of patients; functional state of the digestive system (indicators of secretory and motor function of the stomach, data from X-ray and endoscopic examinations); reactions of the cardiovascular and respiratory systems to physical activity; state of vegetative excitability nervous system; reducing the treatment period; reducing the frequency and duration of complications; restoration of performance.
To take into account the effectiveness of exercise therapy for peptic ulcer disease, the following can be used:
A survey regarding existing subjective sensations: heartburn, belching, bloating, abdominal pain, bowel habits (constipation, diarrhea).
Monitoring pulse and blood pressure;
Breathing tests by Stange and Genchi;
Dynamic control of body weight. Body weight is determined by weighing on a medical scale.
With the positive effects of exercise subjective feelings disappear, appetite and stool normalize, pulse tends to slow down, the time of the Stange test lengthens, and the body weight of patients stabilizes.
In assessing the effectiveness of LH, the patient’s well-being plays a very important role. If insomnia, loss of appetite, pain in the abdomen, or dysfunction of the intestines occurs, it is necessary to carefully examine the patient for a more correct differentiated choice of means and forms of exercise therapy.
To determine the effectiveness of a particular lesson, medical and pedagogical observations are carried out. The most important thing is to determine how the treatment problems are solved in this session, whether the physical activity corresponds to the patient’s capabilities, and what his individual reactions to exercise therapy are.
To clarify these issues, during a physical therapy session, the physiological curve and density of the session are determined by changing the pulse rate.
During observations, attention is paid to external signs of fatigue, the appearance of pain, and the ability to perform exercises. Based on observations, you should change the training method, for example, reduce the dosage of physical activity. In most cases, physical exercise should cause slight fatigue, which is characterized by redness of the skin, perspiration, and increased breathing. The appearance of pain and fatigue, accompanied by noisy shortness of breath, severe weakness, loss of coordination and balance, dizziness, and changes in the structure of physical exercise, should not be allowed.
During exercise therapy classes, the pulse rate should be examined 3 times, before the class, in the middle of the class (after the most difficult exercise) and after the end of the class.
To assess the distribution of physical activity in parts exercise therapy classes The pulse should be counted multiple times and a physiological curve should be constructed.
To assess the effectiveness of exercise therapy during the entire course of treatment, it is necessary to study the patient’s condition before starting classes with him. During the initial examination of the patient, complaints, features of the course of the disease, objective data, condition are determined and recorded in the exercise therapy card. physical development and functionality, clinical data. Repeated (after certain periods) and final examinations reveal the dynamics of these indicators, which allows us to draw conclusions about the effectiveness of exercise therapy.
The study of the characteristics of the course of the disease is carried out according to the medical history and anamnesis. Attention is drawn to the duration of the disease, the presence of exacerbations, treatment methods and results achieved, physical activity before and during the disease.
Physical development is determined by anthropometric measurements.
Great care should be taken to define functionality. For this purpose, various tests with dosed physical activity are used. These tests also help determine the reserve capabilities of the body, its adaptation to physical activity, and justify the purpose and transition from one motor mode to another. The nature of the load in functional tests ah is selected depending on the motor mode in which the patient is.
The analysis of a self-monitoring card helps to assess the effectiveness of exercise therapy, in which quarterly and annually the dynamics of the patient’s well-being, sleep, appetite, objective research data (height, body weight, chest circumference, waist circumference, pulse rate, blood pressure, duration of breath holding during inhalation) are noted and exhalation, spirometry, dynamometry indicators).
Along with this, in assessing the results of exercise therapy, one of the main roles is given to the analysis of a special map of the physical rehabilitation room. It contains information about the patient, the main and concomitant diagnosis of the disease, and brief clinical and functional data. Since the differentiated choice of exercise therapy procedures is determined by the initial one; functional state digestive system, the map separately highlights the characteristics of the secretory and motor functions of the stomach, intestinal motility (constipation, diarrhea). It also contains anthropometric data, indicators of individual functional tests, and doctor’s guidelines.
The prescription of forms and means of exercise therapy is made only after determining the reaction of the cardiovascular and respiratory systems to physical activity (Martine-Kushelevsky test). Studies are carried out no earlier than 1.5 hours after eating. Clothing should be light, not interfere with movement and not interfere with heat transfer. The optimal ambient temperature should be 18-20 °C.
The improvement in the condition of patients with peptic ulcer disease in the remission phase is evidenced by an improvement in the general condition, a decrease in the severity neurotic disorders, the possibility of further expansion of the dietary regimen, improvement of the autonomic regulation of the functions of internal organs according to ortho- and clinostatic tests, and a change in the rhythm of relapse with the absence of relapse throughout the year indicates a stable improvement. On the contrary, the appearance of pain, heartburn, recurrence of ulcers or erosions according to endoscopic or x-ray examination confirm the deterioration of the patients' condition.
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 industries. 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. Urban population suffers from peptic ulcers more often than rural ones. L.S. Khodasevich gives the following possible complications peptic ulcer: 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. Popova, medications, motor regimen, exercise therapy and others should be used first of all 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. 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 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 clinical picture diseases 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, left hypochondrium, left half of the 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 pains in the epigastric region, constant or occurring randomly at any time of the day, 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)), according to the level of gastric secretion (with increased secretion, with normal secretion and with decreased secretion), by the nature of the course (newly diagnosed ulcer, recurrent course), by the stage of the disease (exacerbation or remission), by the presence of complications (bleeding, perforation, stenosis, malignancy). The clinical course of ulcer, explains 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 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 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 throughout lymphatic system stomach or duodenal infection. 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, 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. 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 exact method research allows us to establish 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. 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 state health, the presence of allergies, concomitant diseases), and features 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. 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, 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 ulcerative stomach and duodenum, with an increase in the activity of the acid-peptic factor, neutralizing, protecting and regenerating groups are used medicines. For long-term ulcerative defects, antiulcer drugs of plant origin are used (sea buckthorn oil, rosehip oil, carbenoxolone, alantone). However, it is better to add it to a treatment complex with herbs and a phytodiet. For gastric ulcers with increased secretory activity of the stomach, it is recommended to collect medicinal herbs: plantain leaves, chamomile flowers, dried herb, 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 complex treatment chronic gastrointestinal diseases are prescribed to provide a normalizing effect on the neuroregulatory apparatus of the abdominal organs in order 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 acute stage diseases of internal organs, diseases of the digestive system with a tendency to bleeding, tuberculosis lesions, neoplasms of the abdominal organs, acute and subacute inflammatory processes of the 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 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 the symptoms completely disappear) with patients observing general and motor regimens, and also a healthy lifestyle. A very effective means of primary and secondary prevention of ulcer disease is sanatorium-resort 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, omelet; treat bad teeth so you can chew food well; avoid scandals, because after nervous overstrain stomach pain 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 there is a frequent change of rhythm, a fast pace of execution even simple exercises, muscle tension may cause or aggravate pain and worsen 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 of 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 blood test - 2-3 times a year, gastric juice analysis - 1 time in 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. 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 being carried out 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, measured walking, swimming in open waters. Also used massotherapy: behind - segmental massage in the back from C-IV to D-IX on the left, in front - in the epigastric region, 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. The LH procedure does not include strength, speed-strength exercises, static efforts and tensions, jumps and jumps, 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 exposed to various diseases Gastrointestinal tract 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) UHF - decimeter wave (therapy) Duodenum - duodenum DU - breathing exercises Gastrointestinal tract - gastrointestinal tract IHD - ischemic disease hearts IP - starting position LH - 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 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. 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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: .promote a settlement nervous processes in the cerebral cortex, increasing 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 slowBasic Solution of general and special tasks t = 6 "Strengthen the abdominal and pelvic floor muscles5) IP lying on your back, legs bent at the knees. 1. spread your knees to the sides, bringing the soles together, 2. return to IP 8-10 times. Tempo is slow. Do not hold your breath. Improve blood circulation in the internal organs6) 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 IP3 -4 times Tempo is slow Amplitude is incomplete Spare the epigastric area Strengthen the pelvic floor muscles and improve the function of emptying 7) IP lying on your back Slowly bend your legs and place your feet to your buttocks, resting on your elbows and feet 1. raise the pelvis 2. return to IP 2-3 times Tempo slow Breathing do not delay Final 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 Incorporate 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" "Respiratory rate for 30" "Ask the patient about his well-being 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 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 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 by the physiological needs of the 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.
