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- 1. Lecturer DR.HOSSAIN SYED AZFAR INTRODUCTION TO THERAPY IHSM, Bishkek, 2024-25 "gastric dyspepsia"
- 3. Dyspepsia - digestive disorders of different origins. There are gastric and intestinal dyspepsia. The term "gastric dyspepsia" combines symptoms such as heartburn, belching, regurgitation, nausea, vomiting, hiccups. They are observed not only in various diseases of the stomach, but in diseases of other organs and systems (central nervous system, endocrine system, liver, biliary tract, kidneys, and others.).
- 4. The organic reasons of dyspepsia: Gastritis; Stomach ulcer; Reflux- esophagitis; Stomach cancer; Cholelithiasis; Chronic pancreatitis.
- 5. Gastritis - inflammation of the mucous membrane of the stomach wall.
- 6. common causes of gastritis. The most common cause of gastritis is the bacterium Helicobacter pylori, however, contribute to the development of gastritis may be poor nutrition, constant stress, smoking, alcoholism, medications, error in nutrition.
- 7. types of gastritis. etiological 1. Helicobacter pylori (associated with Helicobacter pylori) 2. Autoimmune 3. Reactive (due to duodenal reflux, bile reflux into the stomach or taking drugs) 4. Special forms of gastritis (granulomatous, including Crohn's disease, sarcoidosis, tuberculosis, lymphocytic, eosinophilic)
- 8. types of gastritis. on the course of the disease. acute gastritis chronic gastritis topography 1. Gastritis antrum 2. The body of the stomach Gastritis 3. pangastritis
- 9. types of gastritis. Endoscopic gastritis categories: 1. erythematous-exudative (surface), gastritis 2. atrophic gastritis 3. hemorrhagic gastritis 4. hyperplastic gastritis
- 10. Chronic H. pylori gastritis In the early stages of the disease developing atrophic antral gastritis without secretory failure. Ulcer-like symptoms: Pain in the epigastric 1-2 hours after a meal Hunger pain (fasting) Heartburn, acid regurgitation A healthy appetite The tendency to constipation
- 11. Objective clinical symptoms: Language clean or slightly coated from root Local tenderness in the area piloroduodenalnoy Normal border stomach
- 12. In the late stages of the disease develops diffuse gastritis with atrophy of the gastric mucosa and the secretory deficiency.
- 13. Clinical symptoms: Poor appetite, nausea metallic taste in the mouth, dry mouth Belching air, food, sometimes rotten The feeling of heaviness in the epigastric Dull epigastric pain after eating Rumbling and flatulence Frequent loose stools
- 14. Objective symptoms Weight loss Language thickly coated Perleches in the corners of the mouth Moderate diffuse pain in the epigastric region Omission of the lower boundary of the stomach Rumbling palpation of the large intestine due to the pronounced flatulence
- 15. Perleches in the corners of the mouth
- 16. survey X - ray examination of the stomach: Early stage (non-atrophic gastritis) - rough terrain mucosa in the antrum, pyloric spasm, segmented peristalsis, disorderly evacuation of a contrast agent. Late stage (pangastritis with atrophy) - relief of gastric mucosa smoothed, hypotension, sluggish perstaltika, fast evacuation of contrast material.
- 17. X - ray examination of the stomach
- 18. Gastroscopy Early stage (non-atrophic gastritis) - blotchy redness and swelling of the mucous membrane of the antrum, frequent submucosal hemorrhage, erosion, hyperplasia folds, exudation, antral spasms, stasis. Late stage (pangastritis with atrophy) - paleness, thinning, flattening of the mucous membrane in the stomach and the antrum, blotchy flushing, candling vascular hypotension, increased vulnerability of the mucous, reflux of duodenal contents.
- 20. Gastroscopy
- 21. Gastroscopy
- 22. Mucosal erythema and edema consistent with acute gastritis.
- 23. Acute gastritis with superficial erosions.
- 24. Histopathological examination (biopsy taken at least 2 pieces of the antrum and the body (front and rear), always with a muscular plate): Early stage (non-atrophic gastritis) - pronounced active antral gastritis (infiltration own skin epithelial lymphocytes, plasmocytes, neutrophils), foci of intestinal metaplasia, a lot of helicobacter surface and mucous pits. Late stage (pangastritis with atrophy) - glandular epithelium atrophy, intestinal metaplasia, a small amount of helicobacter in gastric mucosa and antrum, the minimal activity of inflammation.
- 25. Diagnosis of Helicobacter pylory: Histological method for determining Helicobacter pylori is the gold standard of diagnosis: Thin slices of biopsy specimens stained by the method of Giemsa-Romanovsky, Helicobacter located in the mucus, have a spiral shape. There are three degrees of contamination Heliobacter pylory: Low () - 20 microbial cells in the s.v. Average (++) - up to 50 microbial cells in the s.v. High (+++) - more than 50 microbial cells in the s.v.
- 26. Chronic autoimmune gastritis. Chronic autoimmune gastritis is characterized by lesions of the gastric fundus, atrophy of the gastric mucosa and the secretory deficiency.
- 27. Subjective symptoms feeling of heaviness and fullness after eating Belching air, rotten, food sedennoy metallic taste in the mouth Poor appetite Rumbling transfusions and stomach, unstable stool severe weakness, dizziness, sweating (functional dumping syndrome)
- 28. Objective symptoms Weight Loss pale skin (anemia), hair loss, brittle nails Dry skin, hyperpigmentation (gipokortitsizm) Signs gipopolivitaminoza (dry skin, blurred vision, bleeding of gums and loosening, Zayed corners of mouth, dermatitis, diarrhea) coated tongue Sore epigastrii Morbidity and rumbling in the umbilical and the ileocecal region Omission of the greater curvature of the stomach
- 29. X-ray examination of the stomach Improvement in the folds of the stomach lining
- 30. Gastroscopy The folds of the gastric mucosa are reduced in volume, in advanced cases of atrophy, they can be absent stomach lining thinned, atrophic, pale, clearly visible vascular pattern, an excessive amount of mucus hiatus gatekeeper, throw the stomach contents of 12 duodenal ulcer, gastric motility sluggish antrum is not changed
- 31. Histopathological examination atrophy of the mucous membrane of the fundus of the stomach with the replacement of specialized glands psevdopiloric glands and intestinal epithelium.
- 32. Immunological blood tests The presence of autoantibodies to parietal cells and gastromukoproteinu.
- 33. Special forms of gastritis. Hypertrophic gastritis (Menetries disease). Subjective symptoms: Intense epigastric pain occurring after meals, heartburn, regurgitation, air and food Frequent vomiting with blood Anorexia Weight loss, swelling of the feet and hands Diarrhea Hypoproteinemia
- 34. Special forms of gastritis. Hypertrophic gastritis (Menetries disease). Gastroscopy: Hypertrophy of the mucous membrane in the form of giant folds, covered with lots of sticky mucus. Histopathological examination: The sharp thickening of the gastric mucosa, extension and expansion of the gastric pits
- 36. treatment
- 37. treatment 1. Sparing diet. Vegetables boiled, steamed zucchini, potatoes, carrots, cabbage, beans, beets, dairy products, fruit and berry juices, sauces, spices, snacks, tea, coffee and black with milk, broth hips, black currant). Excluded are indigestible, long linger in the stomach and dishes. Fractional meals 4-5 times a day.
- 38. treatment Anti-inflammatory therapy Sucralfate (Venter) Tablets (1 g) 1 tab four times daily (for 1 hour before meals and at bedtime) or 2 g in the morning and evening. The course of treatment 2-4 weeks or De-nol (colloidal bismuth subcitrate) Tablets (120 mg) 1 tablet three times a day 30 minutes before meals and at bedtime. The course of treatment 4 - 8 weeks. For 30 minutes before and after taking the drug should not take antacids, milk, beverages, solid food.
- 39. treatment Cementing and enveloping substance Allonton (drug inula) Tablets (0.1) 1 tab. 2-4 times for 30 min. before meals or Kaleflon (extract from marigold flowers) Tablets (0.1) Table 1-2. 3 times per day after meals
- 40. treatment Stimulators of gastric secretion Trental (metabolic drug in combination with the improvement of microcirculation) 100 mg 1-2 tab. 3 times for 30 min. before meals for 1-2 months. or Pentagastrin (synthetic analog of histamine) Ampoule 0.025% -1.0 s/c before meal 1-2 times a day for two weeks
- 41. treatment replacement therapy drugs. Gastric juice natural vials of 1-2 tablespoons into 遜 cup of water through a straw while eating or Citric acid powder on the tip of a knife into 村 cup of water with meals or Atsidin-pepsin tablets (0.5) Table 1. dissolved in 遜 cup of water with meals
- 42. treatment prokinetics. Metoclopramide (raglan, Reglan) Tablets (0.01) Ampules (1 ml-0.005) 10-20 mg 3-4 times a day for 15-30 minutes before meal, maximum daily dose of 60 mg or Motilium (domperidone) Tablets 0.01 mg 10-20 3-4 times a day for 15-30 minutes before meals, daily dose - 60 mg
- 43. treatment Pancreatin Tablets 0.5-1.0 The enzyme preparation from the pancreas of beef cattle. Table 1-2. before meals 3-4 times or Mezim forte preparation containing pancreatic enzymes 1-2 tab. 3 times daily before or during meals
- 44. treatment Antibiotics to treat Helicobacter pylori
- 45. Peptic ulcer
- 46. Peptic ulcer - an independent (primary) chronic relapsing disease gastroduodenal region with the formation of ulcers of the stomach and duodenum.
- 47. Peptic ulcer Peptic ulcer duodenal bulb (PUD) occurs 4 times more often than gastric ulcer (GU). Peptic ulcer duodenal bulb - is more common in the age range 25-75 years (rarely less than 15 years). GU - occurs more often aged 55-65 (rarely younger than 40 years).
- 48. The criteria for early diagnosis. epigastric pain - in the center or left of the midline at a stomach ulcer, epigastric right of the midline - duodenal ulcer and prepiloric area with gastric cardia of the stomach - in the sternum. Early pain (30 minutes - 1 hour after a meal) - at the top of the stomach ulcer, recent pain (1.5 - 2 hours after a meal), night and hungry (after 6- 7 hours after eating) - ulcer antral department and duodenal ulcer.
- 49. The criteria for early diagnosis. Dumb nature of pain can be aching, boring The frequency of pain Relief of pain - after antacids, milk, food, often after vomiting Seasonality pain - spring, autumn, characterized more for duodenal ulcer Heartburn
- 50. The criteria for early diagnosis. Belching, often occurs in the localization field mesogastric Nausea characteristic for mediogastral ulcers, but not characteristic of ulcer 12 duodenal ulcer Vomiting - at an altitude of pain Appetite - kept, good
- 52. The criteria for early diagnosis. objective: Asthenia The tendency to bradycardia Tendency to hypertension Moderate or severe pain in the epigastric in acute: gastric ulcer - midline or left, ulcer 12 duodenal ulcer over the right percussion tenderness over the area of the ulcer - a symptom of Mendel Local protective tension anterior abdominal wall
- 53. The criteria for early diagnosis. Laboratory research: CBC - a slight increase in red blood cells and hemoglobin Fecal occult blood test (reaction Gregersen) - positive for bleeding from the ulcer
- 54. The criteria for early diagnosis. Endoscopy: Ulcers round, polygonal or slit form Borders ulcers crisp, edge bloodshot, swollen Undermining the ulcer edge (facing the cardiac department), the distal end flat The bottom of the ulcer is covered with fibrin
- 58. Gastric ulcer with punched-out ulcer base with whitish fibrinoid exudates.
- 59. Gastric ulcer (lesser curvature) with punched-out ulcer base with whitish exudate.
- 60. The criteria for early diagnosis. X-rays: Direct indication of the "niche" Indirect signs: Delay barium mass at the site of the ulcer (contrast stain resistant) Delayed or accelerated passage of barium sulfate of stomach Duodenalnogastralny reflux Convergence folds at locations ulcers Lack of cardia, gastroesophageal reflux Local stomach cramps or 12 duodenal ulcer Symptom De Quervain - circular retraction of the muscles on the opposite side of the stomach ulcer - deformation of the stomach and duodenum
- 61. X-rays
- 62. Determination Helicobacter pylori urease breath test - identifying exhaled C13 isotopes which are formed in the stomach during digestion drunk labeled urea by the action of urease HP histological methods - detection of HP in biopsies stained by the method of Giemsa urease biopsy test - determination of urease activity of HP in biopsies The bacteriological test - the growth of HP biopsy Immunological methods - determination of antibodies in the blood to HP, HP detection of antigen in stool
- 63. Required laboratory tests Complete blood count - once (In the event of repeated study of 1 every 10 days) Blood type Fecal occult blood test
- 64. The severity of the ulcer Mild - is characterized by the following features: Exacerbations 1 time in 1-3 years Pain syndrome moderate pain stoped for 4-7 days shallow ulcer The remission disabled preserved
- 65. The severity of the ulcer moderate severity: Relapse 2 times a year Pain syndrome pronounced pain stoped in the hospital for 10-14 days Characterized dyspepsia Ulcers deep, often bleeds, accompanied by phenomena perigastritis, periduodenitis
- 66. The severity of the ulcer Severe: Relapse 2-3 times a year and more Pain and pronounced cropped in the hospital for 2 weeks or more Sharply expressed dyspeptic symptoms and weight loss The ulcer is often complicated by bleeding, development of pyloric stenosis, perigastritis, periduodenitis
- 67. Complications of peptic ulcer disease. Peptic ulcer bleeding is observed in 15-25% of patients with peptic ulcer disease, often with stomach ulcers localization Ulcer perforation occurs in 5% of patients with peptic ulcer disease, more common in men. Penetration - penetration of gastric ulcer or duodenal ulcer in the surrounding tissues: the pancreas, a small gland, gall bladder, and others. Perivistserit - adhesive process that evolves with ulcers between the stomach or duodenum and adjacent organs (pancreas, liver, gall bladder). duodenum.
- 69. Complications of peptic ulcer disease. Pyloric stenosis usually formulated after ulcer healing located in the pyloric channel or the initial part of the duodenum, is found in 5% of patients. The risk of malignancy (adenocarcinoma development) benign ulcers when infected with HP 9 times more likely than uninfected patients.
- 70. treatment 1. Medical treatment - mental and physical rest, not strict bed rest for 7-10 days, then free. 2. Diet - table 1 a, 1 b for 2-3 days, then the table 1. The food is cooked, but not shabby, eat 5-6 times a day are not recommended sharp, pickled, smoked food. The optimum amount of protein in the diet of 120-125 g / day. 3. Giving up smoking. 4. Pharmacotherapy.
- 71. treatment H. pylori therapy First-line therapy (triple therapy) for 7 days Omeprazole 20 mg 2 times a day, or Lansoprazole 30 mg 2 times a day, or Pantoprozol 40 mg 2 times a day + Clarithromycin 500 mg 2 times a day + Amoxicillin 1000 mg 2 times a day or Clarithromycin 500 mg 2 times a day + Metronidazole 500 mg 2 times a day
- 72. treatment H. pylori therapy First-line therapy (triple therapy) for 7 days Omeprazole 20 mg 2 times a day, Clarithromycin 500 mg 2 times a day Amoxicillin 1000 mg 2 times a day
- 73. treatment H. pylori therapy Second-line therapy (quadruple) for 7 days Omeprazole 20 mg 2 times a day, or Lansoprazole 30 mg 2 times a day, or Pantoprozol 40 mg 2 times a day + Bismuth subsalicylate 120 mg four times a day + Metronidazole 500 mg three times a day + Tetracycline 500 mg four times a day
- 74. treatment H. pylori therapy Second-line therapy (quadruple) for 7 days Omeprazole 20 mg 2 times a day, Bismuth subsalicylate 120 mg four times a day Metronidazole 500 mg three times a day Tetracycline 500 mg four times a day
- 75. stomach cancer
- 76. stomach cancer Stomach cancer - a malignant tumor growing from the epithelial cells of the mucosa (inner) membrane of the stomach. Swelling can occur in different parts of the stomach: at the top, where it connects with the esophagus, in the main part (body) of the stomach or in the bottom where the stomach is connected to the intestines.
- 77. stomach cancer Risk factors for gastric cancer Genetic predisposition - if someone in the family diagnosed with stomach cancer, then all the other relatives (blood) relatives likely to develop increased by 20%; eating habits - overreliance smoked, spicy, salty, fried (overcooked) and canned food, long stored foods containing nitrates, significantly increases the risk of stomach cancer; long-existing diseases of the stomach: gastritis (with low acidity), ulcers and polyps of the stomach; gastric surgery increases the risk of gastric cancer development is 2.5 times;
- 78. stomach cancer Risk factors for gastric cancer the presence of the stomach bacterium Helicobacter pylori: In 1994 the World Health Organization (WHO) has recognized the link between Helicobacter Pylori and stomach cancer and the bacteria brought it into the category of carcinogens of the first class; Work with asbestos and nickel; deficiency of vitamin B12, and C; primary and secondary (e.g., AIDS), immunodeficiency states; 20 times more common in gastric cancer patients with pernicious (malignant) anemia; Some viruses, such as Epstein-Barr virus; alcoholism and smoking.
- 79. stomach cancer clinical picture decreased appetite; changes in eating habits, for example, they feel an aversion to meat, fish and etc .; rise in temperature (usually 37-38 属 C); anemia (decreased hemoglobin).
- 80. stomach cancer clinical picture With the growth of stomach cancer, new symptoms: a feeling of heaviness in the stomach after eating, nausea and vomiting, fast saturation; violation stool (diarrhea, constipation); pain in the upper abdomen, girdle pain, smack in the back (in the propagation of the tumor in the pancreas); increasing the size of the stomach, fluid accumulation in the abdomen (ascites); weight loss; the destruction of tumor blood vessels may develop gastrointestinal bleeding.
- 81. Physical examination Objective methods of inspection (survey, palpation, percussion) allow revealing a stomach cancer only at late stages of disease.
- 82. TOOL METHODS of INVESTIGATION gastroscopy with biopsies. computed tomography US x-ray study.
- 83. Gastric cancer. Note the irregular heaped up overhanging margins.
- 84. Gastric cancer with ulcerated mass.
- 85. Thank you for the attention.