Rehabilitation therapy for chronic gastritis, peptic ulcer of the stomach and duodenum. Comprehensive physical rehabilitation of patients with peptic ulcer of the stomach and duodenum at the stationary stage Rehabilitation for peptic ulcer

Peptic ulcer is one of the most common ­ diseases of the digestive organs. The disease is characterized by a long course, a tendency to recurrence and exacerbation, which increases the degree of economic damage from this disease. peptic ulcer of the stomach and two ­ of the duodenum is a chronic, cyclically occurring, recurrent disease characterized by ulceration in the gastroduodenal zone.

Etipathogenesis of peptic ulcer disease is quite complicated and until now there is no single position on this issue. At the same time, it has been established that various lesions of the nervous system (acute psychotrauma, physical and especially mental overstrain, various nervous diseases) contribute to the development of peptic ulcer. It should also be noted the importance of the hormonal factor, in particular, a violation of the production of digestive hormones (gastrin, secretin, etc.), as well as a violation of the metabolism of histamine and serotonin, under the influence of which the activity of the acid-peptic factor increases. Of certain importance is the violation of the diet and the composition of the food. In recent years, an increasing place is given to the infectious (viral) nature of this disease. Hereditary and constitutional factors also play a certain role in the development of peptic ulcer.

Clinical manifestations peptic ulcer are very diverse. Its main symptom is pain, most often in the epigastric region, with an ulcer in the duodenum, pain is usually localized to the right of the midline of the abdomen. Depending on the localization of the ulcer, pain is early (0.5-1 hour after eating) and late (1.5-2 hours after eating). Sometimes there are pains on an empty stomach, as well as night pains. Quite common clinical symptoms in peptic ulcer disease is heartburn, which, like pain, can be rhythmic, often there is sour eructation and vomiting, also with acidic contents, usually after eating. During a peptic ulcer, four phases are distinguished: exacerbation, fading exacerbation, incomplete remission and complete remission. The most dangerous complication of peptic ulcer is perforation of the wall of the stomach, accompanied by acute "dagger" pain in the abdomen and signs of inflammation of the peritoneum. This requires immediate surgical intervention.

The complex of rehabilitation measures includes medicines, motor regimen, exercise therapy and other physical methods of treatment, massage, therapeutic nutrition. Exercise therapy and massage improve or normalize neuro-trophic processes and metabolism, helping to restore the secretory, motor, absorption and excretory functions of the digestive canal.

Exercise therapy for bed rest prescribed in the absence of contraindications (severe pain, ulcer bleeding). This usually coincides with 2-4 days after hospitalization. The tasks of this period include:

1 assistance in the regulation of the processes of excitation and inhibition in the cerebral cortex;

2 improvement of redox processes.

3 counteracting constipation and congestion in the intestines;

4 improve the functions of blood circulation and respiration.

The period runs for about two weeks. At this time, static breathing exercises are shown, which enhance the processes of inhibition in the cerebral cortex. Performed in the initial position lying on the back with relaxation of all muscle groups, these exercises are able to bring 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 classes is 12-15 minutes, the pace of the exercises is slow, the intensity is low.

Rehabilitation of the second period is assigned when the patient is transferred to ward regime. The tasks of the first period are supplemented with the tasks of everyday and labor rehabilitation of the patient, restoration of the correct posture when walking, 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. Exercises are performed in the prone position, sitting, kneeling, standing with gradually increasing effort for all muscle groups, still excluding the abdominal muscles (Fig. 26). The most acceptable is the supine position: it allows you to increase the mobility of the diaphragm, has a gentle effect on the abdominal muscles and improves blood circulation in the abdominal cavity. Patients perform exercises for the abdominal muscles without tension, with a small number of repetitions.

With a slow evacuation function of the stomach, more exercises lying on the right side should be included in the LH complexes, with moderate - on the left side. During this period, patients are also recommended massage, sedentary games, walking. The average duration of a lesson in the ward mode is 15-20 minutes, the pace of the exercises is slow, the intensity is low. Therapeutic exercises are carried out 1-2 times a day.

The tasks of the third period include: general strengthening and improvement of the patient's body; improvement of blood and lymph circulation in the abdominal cavity; restoration of household and labor skills. In the phase of incomplete and complete remission, in the absence of complaints and the general good condition of the patient, a free regimen is prescribed. Exercises are used for all muscle groups, exercises with light weights (up to 1.5-2 kg), for coordination, outdoor and sports games. The density of the lesson is average, the duration increases to 30 minutes.

In sanatorium conditions, the volume and intensity of exercise therapy increases, all means and methods of exercise therapy are shown. Recommended U GG in combination with hardening procedures; group classes of LG (ORU, DU, exercises with objects); dosed walking, walks (up to 4-5 km); sports and outdoor games; ski trips; occupational therapy. A therapeutic massage is also used: behind - segmental massage in the back from C 4 to D 9 on the left, in front - in the epigastric region, the location of the costal arches. Massage should be gentle at first. The intensity of the massage and the duration of the procedure gradually increase from 8-10 to 20-25 minutes by the end of the treatment.

Ulcers in the gastrointestinal tract are quite common. Physical rehabilitation for peptic ulcer disease consists of physical activity, exercise, proper nutrition, massage. Such therapy is prescribed to reduce pain, antiseptic effects, stop inflammation, regulate the motility of the digestive organs, and increase immunity.

The Benefits of Physical Rehabilitation

Stomach ulcer suppresses human motor activity, without which the body cannot function normally. Physical exercises in a dosed amount cause pleasant emotions that are needed in such a disease, since the mental state of the patient is not satisfactory. Physical activity is involved in the regulation of the digestive process and the functioning of the nervous system, which contributes to the normalization of spasmodic muscle contraction.

Thanks to systematic exercises, the following healing processes occur:

• the amount of energy increases;
• increases the creation of buffer compounds that protect the stomach from sudden changes in acid-base balance;
• organs are supplied with enzymes and vitamins;
• mental state is controlled;
• redox reactions are improved;
• accelerated scarring of the ulcer;
• stool disorders, loss of appetite, stagnant processes in the gastrointestinal tract are prevented.

The benefits of exercise therapy depend on its effectiveness and duration. Muscle tension of a moderate nature stimulates the functions of the digestive system, improves the secretory and motor functions of the stomach and duodenum. Methods of physical rehabilitation for peptic ulcer have a beneficial effect on blood circulation and respiration, which expands the body's ability to withstand negative factors.

With peptic ulcer of the stomach and other organs, physical exercises have a therapeutic and preventive focus, and also imply an individual approach.

Contraindications to physical activity

The main contraindications include:

• periods of exacerbation of stomach ulcers;
• open bleeding;
• the presence of stenosis (persistent narrowing of the lumen of anatomical structures);
• predisposition to bleeding or pathology exit outside the organ;
• the possibility of malignant transformation;
• paraprocesses during penetration (the spread of pathology outside the gastrointestinal tract).

Stages of physical rehabilitation

Rehabilitation for gastric ulcer takes place in stages:

1. Recovery during bed rest. Exercise therapy starts from 2-4 days of hospitalization in the absence of all contraindications.
2. During inpatient treatment, which are subject to patients with a newly diagnosed ulcer, as well as complications that have arisen.
3. During the period of weakening of the course of the disease, with the ending exacerbation or in the process of sanatorium treatment.

Early period

Physical rehabilitation is carried out if there are no contraindications. It lasts up to 14 days. Gymnastics is performed for proper breathing, which regulates the processes of inhibition in the cerebral cortex. Exercises are performed on the back, the muscles need to be completely relaxed. Gymnastics reduces the manifestation of pain symptoms, normalizes sleep.

In addition, simple exercises for small and medium muscles are used, which are repeated several times in combination with proper breathing and relaxing movements. Exercise therapy is prohibited, which entails intra-abdominal hypertension. Classes last a quarter of an hour, the exercises are performed slowly.

Second phase

Physiotherapy exercises are used while the patient is being treated in a hospital to develop the correct posture, improve coordination functions. Gymnastics is carried out with the onset of a significant improvement in the general well-being of the patient. Abdominal wall massage is recommended. The complex of exercises is designed to be performed in any position, while the efforts on the muscular system should increase gradually.

The muscles that make up the wall of the abdominal cavity cannot be used. To increase the agility of the abdominal barrier (diaphragm), sparing loads on the abdominal muscles are necessary. To normalize the movement of blood, the most convenient position for exercise is the supine position. Exercises should be performed without unnecessary overstrain, using a minimum of repetitions.

Introduction

Anatomical, physiological, pathophysiological and clinical features of the course of the disease

1 Etiology and pathogenesis of gastric ulcer

2 Classification

3 Clinical picture and preliminary diagnosis

Methods of rehabilitation of patients with gastric ulcer

1 Therapeutic exercise (LFK)

2 Acupuncture

3 point massage

4 Physiotherapy

5 Drinking mineral waters

6 Balneotherapy

7 Music therapy

8 Mud treatment

9 Diet therapy

10 Phytotherapy

Conclusion

List of used literature

Applications

Introduction

In recent years, there has been a tendency towards an increase in the incidence of the population, among which gastric ulcer has become widespread.

According to the traditional definition of the World Health Organization (WHO), peptic ulcer (ulcus ventriculi et duodenipepticum, morbus ulcerosus) is a common chronic relapsing disease, prone to progression, with a polycyclic course, the characteristic features of which are seasonal exacerbations, accompanied by the appearance of an ulcer in the mucous membrane, and the development of complications that threaten the life of the patient. A feature of the course of gastric ulcer is the involvement of other organs of the digestive apparatus in the pathological process, which requires timely diagnosis for the preparation of medical complexes for patients with peptic ulcer, taking into account concomitant diseases. Peptic ulcer of the stomach affects people of the most active, able-bodied age, causing temporary and sometimes permanent disability.

High morbidity, frequent relapses, long-term disability of patients, as a result of which significant economic losses - all this makes it possible to classify the problem of peptic ulcer as one of the most urgent in modern medicine.

A special place in the treatment of patients with peptic ulcer is rehabilitation. Rehabilitation is the restoration of health, functional state and ability to work, disturbed by diseases, injuries or physical, chemical and social factors. The World Health Organization (WHO) gives a very close definition of rehabilitation: “Rehabilitation is a set of activities designed to enable people with impaired functions as a result of illness, injury and birth defects to adapt to the new conditions of life in the society in which they live” .

According to WHO, rehabilitation is a process aimed at comprehensive assistance to the sick and disabled in order to achieve the maximum possible physical, mental, professional, social and economic usefulness for this disease.

Thus, rehabilitation should be considered as a complex socio-medical problem, which can be divided into several types or aspects: medical, physical, psychological, professional (labor) and socio-economic.

As part of this work, I consider it necessary to study the physical methods of rehabilitation for gastric ulcers, focusing on acupressure and music therapy, which determines the purpose of the study.

Object of study: gastric ulcer.

Subject of research: physical methods of rehabilitation of patients with gastric ulcer.

Tasks are directed to consideration:

-anatomical, physiological, pathophysiological and clinical features of the course of the disease;

-methods of rehabilitation of patients with gastric ulcer.

1. Anatomical, physiological, pathophysiological and clinical features of the course of the disease

.1 Etiology and pathogenesis of gastric ulcer

Gastric ulcer is characterized by the formation of an ulcer in the stomach due to a disorder of the general and local mechanisms of the nervous and humoral regulation of the main functions of the gastroduodenal system, trophic disorders and activation of proteolysis of the gastric mucosa and often the presence of Helicobacter pylori infection in it. At the final stage, an ulcer occurs as a result of a violation of the ratio between aggressive and protective factors with a predominance of the former and a decrease in the latter in the stomach cavity.

Thus, the development of peptic ulcer, according to modern concepts, is due to an imbalance between the impact of aggressive factors and defense mechanisms that ensure the integrity of the gastric mucosa.

Aggression factors include: an increase in the concentration of hydrogen ions and active pepsin (proteolytic activity); Helicobacter pylori infection, the presence of bile acids in the cavity of the stomach and duodenum.

The protective factors include: the amount of protective mucus proteins, especially insoluble and premucosal, the secretion of bicarbonates (“alkaline flush”); mucosal resistance: proliferative index of the gastroduodenal mucosa, local immunity of the mucosa of this zone (the amount of secretory IgA), the state of microcirculation and the level of prostaglandins in the gastric mucosa. With peptic ulcer and non-ulcer dyspepsia (gastritis B, pre-ulcerative condition), aggressive factors sharply increase and protective factors in the stomach cavity decrease.

Based on currently available data, the main and predisposing factors have been identified diseases.

The main factors include:

-violations of humoral and neurohormonal mechanisms that regulate digestion and tissue reproduction;

-disorders of local digestive mechanisms;

-changes in the structure of the mucous membrane of the stomach and duodenum.

Predisposing factors include:

-hereditary-constitutional factor. A number of genetic defects have been established that are realized in various links in the pathogenesis of this disease;

-Helicobacter pylori invasion. Some researchers in our country and abroad attribute Helicobacter pylori infection to the main cause of peptic ulcer;

-environmental conditions, primarily neuropsychic factors, nutrition, bad habits;

-medicinal effects.

From modern positions, some scientists consider peptic ulcer as a polyetiological multifactorial disease. . However, I would like to emphasize the traditional direction of the Kyiv and Moscow therapeutic schools, which believe that the central place in the etiology and pathogenesis of peptic ulcer belongs to disorders of the nervous system that occur in its central and vegetative departments under the influence of various influences (negative emotions, overstrain during mental and physical work , viscero-visceral reflexes, etc.).

There are a large number of works testifying to the etiological and pathogenetic role of the nervous system in the development of peptic ulcer. The spasmogenic or neurovegetative theory was first created .

Works by I.P. Pavlova about the role of the nervous system and its higher department - the cerebral cortex - in the regulation of all vital functions of the body (the ideas of nervism) are reflected in new views on the development of peptic ulcer: this is the cortico-visceral theory K.M. Bykova, I.T. Kurtsina (1949, 1952) and a number of works pointing to the etiological role of disorders of neurotrophic processes directly in the mucous membrane of the stomach and duodenum in peptic ulcer.

According to the cortico-visceral theory, peptic ulcer is the result of disturbances in the cortico-visceral relationship. Progressive in this theory is the evidence of a two-way connection between the central nervous system and internal organs, as well as the consideration of peptic ulcer from the point of view of a disease of the whole organism, in the development of which a violation of the nervous system plays a leading role. The disadvantage of the theory is that it does not explain why the stomach is affected when the cortical mechanisms are disturbed.

Currently, there are several fairly convincing facts showing that one of the main etiological factors in the development of peptic ulcer is a violation of nervous trophism. An ulcer arises and develops as a result of a disorder of biochemical processes that ensure the integrity and stability of living structures. The mucous membrane is most susceptible to dystrophies of neurogenic origin, which is probably due to the high regenerative capacity and anabolic processes in the gastric mucosa. The active protein-synthetic function is easily disturbed and may be an early sign of dystrophic processes aggravated by the aggressive peptic action of gastric juice.

It was noted that in gastric ulcer, the level of secretion of hydrochloric acid is close to normal or even reduced. In the pathogenesis of the disease, a decrease in the resistance of the mucous membrane is of greater importance, as well as the reflux of bile into the stomach cavity due to insufficiency of the pyloric sphincter.

A special role in the development of peptic ulcer is assigned to gastrin and cholinergic postganglionic fibers of the vagus nerve involved in the regulation of gastric secretion.

There is an assumption that histamine is involved in the implementation of the stimulating effect of gastrin and cholinergic mediators on the acid-forming function of parietal cells, which is confirmed by the therapeutic effect of histamine H2 receptor antagonists (cimetidine, ranitidine, etc.).

Prostaglandins play a central role in protecting the epithelium of the gastric mucosa from the action of aggressive factors. The key enzyme for prostaglandin synthesis is cyclooxygenase (COX), present in the body in two forms, COX-1 and COX-2.

COX-1 is found in the stomach, kidneys, platelets, endothelium. Induction of COX-2 occurs under the action of inflammation; the expression of this enzyme is carried out predominantly by inflammatory cells.

Thus, summarizing the above, we can conclude that the main links in the pathogenesis of peptic ulcer are neuroendocrine, vascular, immune factors, acid-peptic aggression, the protective muco-hydrocarbonate barrier of the gastric mucosa, helicobacteriosis and prostaglandins.

.2 Classification

Currently, there is no generally accepted classification of peptic ulcer disease. A large number of classifications based on various principles have been proposed. In foreign literature, the term "peptic ulcer" is more often used and a peptic ulcer of the stomach and duodenum is distinguished. The abundance of classifications emphasizes their imperfection.

According to the WHO classification of the IX revision, gastric ulcer (heading 531), duodenal ulcer (heading 532), ulcer of unspecified localization (heading 533) and, finally, gastrojejunal ulcer of the resected stomach (heading 534) are distinguished. The WHO International Classification should be used for the purpose of accounting and statistics, however, for use in clinical practice, it should be significantly expanded.

The following classification of peptic ulcer is proposed.. General characteristics of the disease (WHO nomenclature)

.Peptic ulcer (531)

2.Peptic ulcer of the duodenum (532)

.Peptic ulcer of unspecified location (533)

.Peptic gastrojejunal ulcer after gastric resection (534)

II. Clinical form

.Acute or newly diagnosed

III. Flow

.Latent

2.Mild or rarely recurrent

.Moderate or recurrent (1-2 relapses per year)

.Severe (3 or more relapses within a year) or continuously relapsing; development of complications.

IV. Phase

.Exacerbation (relapse)

2.Fading exacerbation (incomplete remission)

.Remission

v. Characterization of the morphological substrate of the disease

.Types of ulcers a) acute ulcer; b) chronic ulcer

Dimensions of the ulcer: a) small (less than 0.5 cm); b) medium (0.5-1 cm); c) large (1.1-3 cm); d) giant (more than 3 cm).

Stages of ulcer development: a) active; b) scarring; c) the stage of the "red" scar; d) the stage of the "white" scar; e) long-term scarring

Localization of the ulcer:

a) stomach: A: 1) cardia, 2) subcardial region, 3) body of the stomach, 4) antrum, 5) pyloric canal; B: 1) anterior wall, 2) posterior wall, 3) lesser curvature, 4) greater curvature.

b) duodenum: A: 1) bulb, 2) postbulbar part;

B: 1) anterior wall, 2) posterior wall, 3) lesser curvature, 4) greater curvature.. Characteristics of the functions of the gastroduodenal system (only pronounced violations of the secretory, motor and evacuation functions are indicated)

VII. Complications

1.Bleeding: a) mild, b) moderate, c) severe, d) extremely severe

2.Perforation

.penetration

.Stenosis: a) compensated, b) subcompensated, c) decompensated.

.Malignization

Based on the presented classification, the following formulation of the diagnosis can be suggested as an example: gastric ulcer, first detected, acute form, large (2 cm) ulcer of the lesser curvature of the body of the stomach, complicated by mild bleeding.

1.3 Clinical picture and provisional diagnosis

The judgment about the possibility of peptic ulcer should be based on the study of complaints, anamnestic data, physical examination of the patient, assessment of the functional state of the gastroduodenal system.

A typical clinical picture is characterized by a clear relationship between the occurrence of pain and food intake. There are early, late and "hungry" pains. Early pain appears 1/2-1 hour after eating, gradually increases in intensity, lasts 1 1/2-2 hours and subsides as the gastric contents are evacuated. Late pain occurs 1 1/2-2 hours after eating at the height of digestion, and "hungry" pain - after a significant period of time (6-7 hours), i.e. on an empty stomach, and stops after eating. Close to "hungry" night pain. The disappearance of pain after eating, taking antacids, anticholinergic and antispasmodic drugs, as well as the subsidence of pain during the first week of adequate treatment is a characteristic sign of the disease.

In addition to pain, a typical clinical picture of gastric ulcer includes various dyspeptic phenomena. Heartburn is a common symptom of the disease, occurs in 30-80% of patients. Heartburn may alternate with pain, precede it for a number of years, or be the only symptom of the disease. However, it should be borne in mind that heartburn is very often observed in other diseases of the digestive system and is one of the main signs of insufficiency of cardiac function. Nausea and vomiting are less common. Vomiting usually occurs at the height of pain, being a kind of culmination of the pain syndrome, and brings relief. Often, to eliminate pain, the patient himself artificially induces vomiting.

Constipation is observed in 50% of patients with gastric ulcer. They intensify during periods of exacerbation of the disease and are sometimes so persistent that they disturb the patient even more than pain.

A distinctive feature of peptic ulcer is the cyclical course. Periods of exacerbation, which usually last from several days to 6-8 weeks, are replaced by a remission phase. During remission, patients often feel practically healthy, even without following any diet. Exacerbations of the disease, as a rule, are seasonal in nature; for the middle zone, this is mainly the spring or autumn season.

A similar clinical picture in individuals with a previously undiagnosed diagnosis is more likely to suggest peptic ulcer disease.

Typical ulcer symptoms are more common when the ulcer is localized in the pyloric part of the stomach (pyloroduodenal form of peptic ulcer). However, it is often observed with an ulcer of the lesser curvature of the body of the stomach (mediogastric form of peptic ulcer). Nevertheless, in patients with mediogastric ulcers, the pain syndrome is less defined, pain can radiate to the left half of the chest, lumbar region, right and left hypochondrium. In some patients with mediogastric peptic ulcer, a decrease in appetite and weight loss are observed, which is not typical for pyloroduodenal ulcers.

The greatest clinical features occur in patients with localized ulcers in the cardiac or subcardial regions of the stomach.

Laboratory studies have a relative, indicative value in the recognition of peptic ulcer.

The study of gastric secretion is necessary not so much for the diagnosis of the disease, but for the detection of functional disorders of the stomach. Only a significant increase in acid production detected during fractional gastric sounding (rate of basal HCl secretion over 12 mmol/h, HCl rate after submaximal stimulation with histamine over 17 mmol/h and after maximum stimulation over 25 mmol/h) should be taken into account as a diagnostic sign of peptic ulcer .

Additional information can be obtained by examining intragastric pH. Peptic ulcer, especially pyloroduodenal localization, is characterized by pronounced hyperacidity in the body of the stomach (pH 0.6-1.5) with continuous acid formation and decompensation of alkalization of the medium in the antrum (pH 0.9-2.5). The establishment of true achlorhydria practically excludes this disease.

A clinical blood test in uncomplicated forms of peptic ulcer usually remains normal, only a number of patients have erythrocytosis due to increased erythropoiesis. Hypochromic anemia may indicate bleeding from gastroduodenal ulcers.

A positive reaction of feces to occult blood is often observed during exacerbations of peptic ulcer. However, it should be borne in mind that a positive reaction can be observed in many diseases (tumors of the gastrointestinal tract, nosebleeds, bleeding gums, hemorrhoids, etc.).

To date, it is possible to confirm the diagnosis of gastric ulcer using X-ray and endoscopic methods.

gastric ulcer acupressure music therapy

2. Methods of rehabilitation of patients with gastric ulcer

.1 Therapeutic exercise (LFK)

Physiotherapy exercises (exercise therapy) for peptic ulcer disease contributes to the regulation of excitation and inhibition processes in the cerebral cortex, improves digestion, blood circulation, respiration, redox processes, positively affects the patient's neuropsychic state.

When performing physical exercises, the stomach area is spared. In the acute period of the disease in the presence of pain exercise therapy is not indicated. Physical exercises are prescribed 2-5 days after the cessation of acute pain.

During this period, the procedure of therapeutic exercises should not exceed 10-15 minutes. In the prone position, exercises for the arms and legs with a limited range of motion are performed. Exercises that actively involve the abdominal muscles and increase intra-abdominal pressure are excluded.

With the cessation of acute phenomena, physical activity is gradually increased. To avoid exacerbation, do it carefully, taking into account the patient's response to exercise. Exercises are performed in the initial position lying, sitting, standing.

To prevent adhesions against the background of general strengthening movements, exercises for the muscles of the anterior abdominal wall, diaphragmatic breathing, simple and complicated walking, rowing, skiing, outdoor and sports games are used.

Exercises should be done carefully if they aggravate the pain. Complaints often do not reflect the objective state, and the ulcer can progress with subjective well-being (disappearance of pain, etc.).

In this regard, in the treatment of patients, the abdominal area should be spared and very carefully, gradually increase the load on the abdominal muscles. It is possible to gradually expand the patient's motor mode by increasing the total load when performing most exercises, including exercises in diaphragmatic breathing and exercises for the abdominal muscles.

Contraindications to the appointment of exercise therapy are: bleeding; generating ulcer; acute perivisceritis (perigastritis, periduodenitis); chronic perivisceritis, subject to the occurrence of acute pain during exercise.

The exercise therapy complex for patients with gastric ulcer is presented in Appendix 1.

2.2 Acupuncture

Gastric ulcer in terms of its occurrence, development, as well as from the standpoint of the development of effective methods of treatment is a major problem. Scientific searches for reliable methods of treating peptic ulcer are due to the insufficient effectiveness of known methods of therapy.

Modern ideas about the mechanism of action of acupuncture are based on somato-visceral relationships, carried out both in the spinal cord and in the overlying parts of the nervous system. The therapeutic effect on the reflexogenic zones, where the acupuncture points are located, contributes to the normalization of the functional state of the central nervous system, the hypothalamus, maintaining homeostasis and faster normalization of the disturbed activity of organs and systems, stimulates oxidative processes, improves microcirculation (by synthesizing biologically active substances), blocks pain impulses. In addition, acupuncture increases the adaptive capacity of the body, eliminates prolonged excitation in various centers of the brain that control smooth muscles, blood pressure, etc.

The best effect is achieved if acupuncture points located in the zone of segmental innervation of the affected organs are irritated. Such zones for peptic ulcer disease are D4-7.

The study of the general condition of patients, the dynamics of indicators of laboratory, radiological, endoscopic studies give the right to objectively evaluate the applied method of acupuncture, its advantages, disadvantages, develop indications for differentiated treatment of patients with peptic ulcer. They showed a pronounced analgesic effect in patients with persistent pain symptoms.

An analysis of the parameters of the motor function of the stomach also revealed a clear positive effect of acupuncture on tone, peristalsis and evacuation of the stomach.

Acupuncture treatment of patients with gastric ulcer has a positive effect on the subjective and objective picture of the disease, relatively quickly eliminates pain and dyspepsia. When used in parallel with the achieved clinical effect, normalization of the secretory, acid-forming and motor functions of the stomach occurs.

2.3 Acupressure

Acupressure is used for gastritis and stomach ulcers. The acupressure is based on the same principle as when carrying out the method of acupuncture, moxibustion (zhen-jiu therapy) - with the only difference that BAT (biologically active points) are affected by a finger or brush.

To resolve the issue of the use of acupressure, a detailed examination and the establishment of an accurate diagnosis are necessary. This is especially important in chronic stomach ulcers due to the risk of malignant transformation. Acupressure is unacceptable for ulcerative bleeding and is possible no earlier than 6 months after its termination. A contraindication is also cicatricial narrowing of the outlet section of the stomach (pyloric stenosis) - a gross organic pathology, in which one does not have to wait for a therapeutic effect.

At peptic ulcer the following combination of points is recommended (the location of the points is presented in Appendix 2):

1st session: 20, 18, 31, 27, 38;

1st session: 22, 21, 33, 31, 27;

1st session: 24, 20, 31, 27, 33.

The first 5-7 sessions, especially during exacerbation, are carried out daily, the rest - after 1-2 days (12-15 procedures in total). Repeated courses are carried out according to clinical indications in 7-10 days. Before seasonal exacerbations of peptic ulcer, preventive courses of 5-7 sessions every other day are recommended.

With increased acidity of gastric juice with heartburn, points 22 and 9 should be included in the recipe.

With atony of the stomach, low acidity of gastric juice, poor appetite, after a mandatory x-ray or endoscopic examination, you can conduct a course of acupressure with the exciting method of points 27, 31, 37, combining it with massage with the inhibitory method of points 20, 22, 24, 33.

2.4 Physiotherapy

Physiotherapy - this is the use of natural and artificially generated physical factors for therapeutic and prophylactic purposes, such as: electric current, magnetic field, laser, ultrasound, etc. Various types of radiation are also used: infrared, ultraviolet, polarized light.

a) selection of soft operating procedures;

b) the use of small dosages;

c) a gradual increase in the intensity of exposure to physical factors;

d) their rational combination with other therapeutic measures.

As an active background therapy in order to influence the increased reactivity of the nervous system, methods such as:

-impulse currents of low frequency according to the method of electrosleep;

-central electroanalgesia by tranquilizing technique (with the help of LENAR devices);

-UHF on the collar zone; galvanic collar and bromoelectrophoresis.

Of the methods of local therapy (i.e., the effect on the epigastric and paravertebral zones), the most popular is galvanization in combination with the introduction of various medicinal substances by electrophoresis (novocaine, benzohexonium, platyfillin, zinc, dalargin, solcoseryl, etc.).

2.5 Drinking mineral waters

Drinking mineral waters of various chemical composition affect the regulation of the functional activity of the gastro-duodenal system.

It is known that the secretion of pancreatic juice, the secretion of bile under physiological conditions are carried out as a result of the induction of secretin and pancreozymin. From this it follows logically that mineral waters contribute to the stimulation of these intestinal hormones, which have a trophic effect. For the implementation of these processes, a certain time is needed - from 60 to 90 minutes, and therefore, in order to use all the healing properties inherent in mineral waters, it is advisable to prescribe them 1-1.5 hours before a meal. During this period, water can penetrate into the duodenum and have an inhibitory effect on the excited secretion of the stomach.

Warm (38-40 ° C) low-mineralized waters, which can relax the pylorus spasm and quickly evacuate into the duodenum, have a similar effect to a greater extent. When mineral waters are prescribed 30 minutes before a meal or at the height of digestion (30-40 minutes after a meal), their local antacid effect is mainly manifested and those processes that are associated with the effect of water on endocrine and nervous regulation do not have time to occur, thus, many aspects of the therapeutic effect of mineral waters are lost. This method of prescribing mineral waters is justified in a number of cases for patients with duodenal ulcer with a sharply increased acidity of gastric juice and severe dyspeptic syndrome in the phase of a fading exacerbation of the disease.

For patients with disorders of the motor-evacuation function of the stomach, mineral water is not indicated, since the water taken is retained in the stomach for a long time along with food and will have a juice effect instead of an inhibitory one.

Patients with peptic ulcer disease are recommended alkaline weakly and moderately mineralized waters (mineralization, respectively, 2-5 g / l and more than 5-10 g / l), carbonic bicarbonate-sodium, carbonate bicarbonate-sulfate sodium-calcium, carbonate bicarbonate-chloride, sodium-sulfate, magnesium-sodium, for example: Borjomi, Smirnovskaya, Slavyanovskaya, Essentuki No. 4, Essentuki new, Pyatigorsk Narzan, Berezovskaya, Moscow mineral water and others.

2.6 Balneotherapy

External application of mineral waters in the form of baths is an active background therapy for patients with gastric ulcer. They have a beneficial effect on the state of the central and autonomic nervous system, endocrine regulation, and the functional state of the digestive organs. In this case, baths from mineral waters available at the resort or from artificially created waters can be used. These include chloride, sodium, carbon dioxide, iodine-bromine, oxygen, etc.

Chloride, sodium baths are indicated for patients with gastric ulcer, any severity of the course of the disease in the phase of fading exacerbation, incomplete and complete remission of the disease.

Radon baths are also actively used. They are available at the resorts of the gastrointestinal profile (Pyatigorsk, Essentuki, etc.). For the treatment of this category of patients, radon baths are used at low concentrations - 20-40 nCi / l. They have a positive effect on the state of neurohumoral regulation in patients and on the functional state of the digestive organs. Radon baths with concentrations of 20 and 40 nCi/l are the most effective in terms of influencing trophic processes in the stomach. They are indicated at any stage of the disease, patients in the phase of fading exacerbation, incomplete and complete remission, concomitant lesions of the nervous system, blood vessels and other diseases in which radon therapy is indicated.

Patients with peptic ulcer disease with concomitant diseases of the joints of the central and peripheral nervous system, organs of the female genital area, especially with inflammatory processes and ovarian dysfunction, it is advisable to prescribe treatment with iodine-bromine baths, it is good to prescribe them to patients of an older age group. In nature, pure iodine-bromine water does not exist. Artificial iodine-bromine baths are used at a temperature of 36-37 ° C for a duration of 10-15 minutes, for a course of treatment 8-10 baths, released every other day, it is advisable to alternate with applications of peloids, or physiotherapy procedures, the choice of which is determined both by the general condition of patients and concomitant diseases gastrointestinal tract, cardiovascular and nervous systems.

2.7 Music therapy

It has been proven that music can do a lot. Calm and melodic, it will help you relax faster and better, recuperate; vigorous and rhythmic raises the tone, improves mood. Music will relieve irritation, nervous tension, activates thought processes and increases efficiency.

The healing properties of music have been known for a long time. In the VI century. BC. The great ancient Greek thinker Pythagoras used music for medicinal purposes. He preached that a healthy soul requires a healthy body, and both require constant musical influence, concentration in oneself and ascent to higher areas of being. Even more than 1000 years ago, Avicenna recommended diet, work, laughter and music as a treatment.

According to the physiological effect, melodies can be soothing, relaxing or tonic, invigorating.

The relaxing effect is useful for stomach ulcers.

For music to have a healing effect, it must be listened to in this way:

) lie down, relax, close your eyes and completely immerse yourself in the music;

) try to get rid of any thoughts expressed in words;

) remember only pleasant moments in life, and these memories should be figurative;

) a recorded musical program should last at least 20-30 minutes, but no more;

) should not fall asleep;

) after listening to the music program, it is recommended to do breathing exercises and some physical exercises.

.8 Mud treatment

Among the methods of therapy for gastric ulcer, mud therapy occupies one of the leading places. Therapeutic mud affects the metabolism and bioenergetic processes in the body, enhances the microcirculation of the stomach and liver, improves gastric motility, reduces duodenal acidification, stimulates reparative processes in the gastroduodenal mucosa, and activates the endocrine system. Mud therapy has an analgesic and anti-inflammatory effect, improves metabolism, changes the body's reactivity, its immunobiological properties.

Silt mud is used at temperatures of 38-40°C, peat mud at 40-42°C, the duration of the procedure is 10-15-20 minutes, every other day, for a course of 10-12 procedures.

This method of mud therapy is indicated for patients with gastric ulcer in the phase of fading exacerbation, incomplete and complete remission of the disease, with severe pain syndrome, with concomitant diseases, in which the use of physical factors on the collar region is indicated.

With a sharp pain syndrome, you can use the method of combining mud applications with reflexology (electropuncture). Where it is not possible to use mud therapy, you can use ozokerite and paraffin therapy.

2.9 Diet therapy

Dietary nutrition is the main background of any antiulcer therapy. The principle of fractional (4-6 meals a day) must be observed regardless of the phase of the disease.

Basic principles of therapeutic nutrition (principles of the "first tables" according to the classification of the Institute of Nutrition): 1. good nutrition; 2. observance of the rhythm of food intake; 3. mechanical; 4. chemical; 5. thermal sparing of the gastroduodenal mucosa; 6. gradual expansion of the diet.

The approach to diet therapy for peptic ulcer disease is currently marked by a move away from strict to sparing diets. Mainly mashed and non-mashed diet options No. 1 are used.

The composition of diet No. 1 includes the following products: meat (veal, beef, rabbit), fish (perch, pike, carp, etc.) in the form of steam cutlets, quenelles, soufflé, beef sausages, boiled sausage, occasionally - low-fat ham, soaked herring (the taste and nutritional properties of herring increase if it is soaked in whole cow's milk), as well as milk and dairy products (whole milk, powdered, condensed milk, fresh non-acidic cream, sour cream and cottage cheese). With good tolerance, yogurt, acidophilic milk can be recommended. Eggs and dishes from them (soft-boiled eggs, steam scrambled eggs) - no more than 2 pieces per day. Raw eggs are not recommended, as they contain avidin, which irritates the stomach lining. Fats - unsalted butter (50-70 g), olive or sunflower (30-40 g). Sauces - dairy, snacks - mild cheese, grated. Soups - vegetarian from cereals, vegetables (except cabbage), milk soups with vermicelli, noodles, pasta (well cooked). Salt food should be moderate (8-10 g of salt per day).

Fruits, berries (sweet varieties) are given in the form of mashed potatoes, jelly, with tolerance compotes and jelly, sugar, honey, jam. Non-acidic vegetable, fruit, berry juices are shown. Grapes and grape juices are not well tolerated and can cause heartburn. In case of poor tolerance, juices should be added to cereals, jelly or diluted with boiled water.

Not recommended: pork, lamb, duck, goose, strong broths, meat soups, vegetable and especially mushroom broths, undercooked, fried, fatty and dried meats, smoked meats, salted fish, hard-boiled eggs or scrambled eggs, skimmed milk, strong tea, coffee, cocoa, kvass, all alcoholic drinks, carbonated water, pepper, mustard, horseradish, onion, garlic, bay leaf, etc.

Cranberry juice should be avoided. From drinks, weak tea, tea with milk or cream can be recommended.

.10 Phytotherapy

For most patients suffering from gastric ulcer, it is advisable to include decoctions and infusions of medicinal herbs, as well as special anti-ulcer preparations consisting of many medicinal plants in the complex treatment. Fees and folk recipes used for stomach ulcers:

Collection: Chamomile flowers - 10 gr.; fennel fruits - 10 gr.; marshmallow root - 10 gr.; wheatgrass root - 10 gr.; licorice root - 10 gr. 2 teaspoons of the mixture to 1 cup of boiling water. Insist, wrapped, strain. Take one glass of infusion at night.

Collection: Fireweed leaves - 20 gr.; lime blossom - 20 gr.; chamomile flowers - 10 gr.; fennel fruits - 10 gr. 2 teaspoons of the mixture per cup of boiling water. Insist wrapped, strain. Take 1 to 3 glasses throughout the day.

Collection: Cancer necks, roots - 1 part; plantain, leaf - 1 part; horsetail - 1 part; St. John's wort - 1 part; valerian root - 1 part; chamomile - 1 part. A tablespoon of the mixture in a glass of boiling water. Steam 1 hour. Take 3 times a day before meals.

Collection:: Series -100 gr.; celandine -100 gr.; St. John's wort -100 gr.; plantain -200 gr. A tablespoon of the mixture in a glass of boiling water. Insist wrapped for 2 hours, strain. Take 1 tablespoon 3-4 times a day, one hour before or 1.5 hours after meals.

Freshly squeezed juice from the leaves of garden cabbage, when taken regularly, cures chronic gastritis and ulcers better than all medications. Making juice at home and taking it: the leaves are passed through a juicer, filtered and squeezed out the juice. Take in a warm form, 1/2-1 cup 3-5 times a day before meals.

Conclusion

So, in the course of work, I found out that:

List of used literature

1.Abdurakhmanov, A.A. Peptic ulcer of the stomach and duodenum. - Tashkent, 1973. - 329 p.

2.Alabaster A.P., Butov M.A. Possibilities of alternative non-drug therapy of gastric ulcer. // Clinical medicine, 2005. - No. 11. - P. 32 -26.

.Baranovsky A.Yu. Rehabilitation of gastroenterological patients in the work of a therapist and family doctor. - St. Petersburg: Folio, 2001. - 231 p.

.Belaya N.A. Massotherapy. Teaching aid. - M.: Progress, 2001. - 297 p.

.Biryukov A.A. Therapeutic massage: Textbook for universities. - M.: Academy, 2002. - 199 p.

.Vasilenko V.Kh., Grebnev A.L. Diseases of the stomach and duodenum. - M.: Medicine, 2003. - 326 p.

.Vasilenko V.Kh., Grebenev A.L., Sheptulin A.A. Ulcer disease. - M.: Medicine, 2000. - 294 p.

.Virsaladze K.S. Epidemiology of peptic ulcer of the stomach and duodenum // Clinical Medicine, 2000. - No. 10. - P. 33-35.

.Gaichenko P.I. Treatment of stomach ulcers. - Dushanbe: 2000. - 193 p.

10.Degtyareva I.I., Kharchenko N.V. Ulcer disease. - K .: Healthy I, 2001. - 395 p.

11.Epifanov V.A. Therapeutic physical culture and massage. - M.: Academy, 2004.- 389 p.

.Ivanchenko V.A. natural medicine. - M.: Project, 2004. - 384 p.

.Kaurov, A.F. Some materials on the epidemiology of peptic ulcer. - Irkutsk, 2001. - 295 p.

.Kokurkin G.V. Reflexology of peptic ulcer of the stomach and duodenum. - Cheboksary, 2000. - 132 p.

.Komarov F.I. Treatment of peptic ulcer.- M.: Ter. archive, 1978. - No. 18. - S. 138 - 143.

.Kulikov A.G. The role of physical factors in the treatment of inflammatory and erosive and ulcerative diseases of the stomach and duodenum // Physiotherapy, balneology and rehabilitation, 2007. - No. 6. - C.3 - 8.

.Leporsky A.A. Therapeutic exercise for diseases of the digestive system. - M.: Progress, 2003. - 234 p.

.Physiotherapy exercises in the system of medical rehabilitation / Ed. A.F. Kaptelina, I.P. Lebedeva.- M.: Medicine, 1995. - 196 p.

.Physiotherapy exercises and medical control / Ed. IN AND. Ilyinich. - M.: Academy, 2003. - 284 p.

.Physiotherapy exercises and medical control / Ed. V.A. Epifanova, G.A. Apanasenko. - M.: Medicine, 2004. - 277 p.

.Loginov A.S. Identification of a risk group and a new level of disease prevention \\ Active issues of gastroenterology, 1997.- No. 10. - P. 122-128.

.Loginov A.S. Questions of practical gastroenterology. - Tallinn. 1997.- 93 p.

.Lebedeva R.P. Genetic factors and some clinical aspects of peptic ulcer \\ Topical issues of gastroenterology, 2002.- No. 9. - P. 35-37.

.Lebedeva, R.P. Treatment of peptic ulcer \\ Topical issues of gastroenterology, 2002.- No. 3. - S. 39-41

.Lapina T.L. Erosive and ulcerative lesions of the stomach \\ Russian Medical Journal, 2001 - No. 13. - pp. 15-21

.Lapina T.L. Treatment of erosive and ulcerative lesions of the stomach and duodenum \\ Russian Medical Journal, 2001 - No. 14 - S. 12-18

.Magzumov B.X. Socio-genetic aspects of studying the incidence of peptic ulcer of the stomach and duodenum. - Tashkent: Sov. health care, 1979.- No. 2. - S. 33-43.

.Minushkin O.N. Peptic ulcer of the stomach and its treatment \\ Russian Medical Journal. - 2002. - No. 15. - S. 16 - 25

.Rastaporov A.A. Treatment of peptic ulcer of the stomach and duodenum 12 \\ Russian Medical Journal. - 2003. - No. 8 - S. 25 - 27

.Nikitin Z.N. Gastroenterology - rational methods of treatment of ulcerative lesions of the stomach and duodenum \\ Russian Medical Journal. - 2006 - No. 6. - pp. 16-21

.Parkhotik I.I. Physical rehabilitation in diseases of the abdominal organs: Monograph. - Kyiv: Olympic Literature, 2003. - 295 p.

.Ponomarenko G.N., Vorobyov M.G. Guide to Physiotherapy. - St. Petersburg, Baltika, 2005. - 148 p.

.Rezvanova P.D. Physiotherapy.- M.: Medicine, 2004. - 185 p.

.Samson E.I., Trinyak N.G. Therapeutic exercise for diseases of the stomach and intestines. - K .: Health, 2003. - 183 p.

.Safonov A.G. Status and prospects for the development of gastroenterological care for the population. - M.: Ter. archive, 1973.- No. 4. - S. 3-8.

.Stoyanovskiy D.V. Acupuncture. - M.: Medicine, 2001. - 251 p.

.Timerbulatov V.M. Diseases of the digestive system. - Ufa. Health care of Bashkortostan. 2001.- 185 p.

.Troim N.F. Ulcer disease. Medical business - M .: Progress, 2001. - 283 p.

.Uspensky V.M. Pre-ulcerative state as the initial stage of peptic ulcer disease (pathogenesis, clinic, diagnosis, treatment, prevention). - M.: Medicine, 2001. - 89 p.

.Ushakov A.A. Practical physiotherapy. - 2nd ed., corrected. and additional - M .: Medical Information Agency, 2009. - 292 p.

.Physical rehabilitation / Ed. S.N. Popov. - Rostov n / a: Phoenix, 2003. - 158 p.

.Fisher A.A. Ulcer disease. - M.: Medicine, 2002. - 194 p.

.Frolkis A.V., Somova E.P. Some questions of the inheritance of the disease. - M.: Academy, 2001. - 209 p.

.Chernin V.V. Diseases of the esophagus, stomach and duodenum (a guide for physicians). - M.: Medical Information Agency, 2010. - 111 p.

.Shcherbakov P.L. Treatment of gastric ulcer // Russian Medical Journal, 2004 - No. 12. - S. 26-32

.Shcherbakov P.L. Peptic ulcer of the stomach // Russian Medical Journal, 2001 - No. 1 - S. 32-45.

.Shcheglova N.D. Peptic ulcer of the stomach and duodenum. - Dushanbe, 1995.- S. 17-19.

.Elyptein N.V. Diseases of the digestive system. - M.: Academy, 2002. - 215 p.

.Efendieva M.T. Physiotherapy of gastroesophageal reflux disease. // Issues of balneology, physiotherapy and therapeutic physical culture. 2002. - No. 4. - S. 53 - 54.

Attachment 1

Exercise therapy procedure for patients with gastric ulcer (V. A. Epifanov, 2004)

No. of the section Contents Dosage, min Tasks of the section, procedures 1 Walking simple and complicated, rhythmic, at a calm pace 3-4 Gradual retraction into the load, development of coordination 2 Exercises for arms and legs in combination with movements of the body, breathing exercises in a sitting position 5-6 Periodic increase in intra-abdominal pressure, increased blood circulation in the abdominal cavity 3 Standing exercises in throwing and catching the ball, throwing a medicine ball (up to 2 kg), relay races, alternating with breathing exercises 6-7 General physiological load, creating positive emotions, developing the function of full breathing 4 Exercises on the gymnastic wall like mixed hangs 7-8 General toning effect on the central nervous system, development of static-dynamic stability5 Elementary lying exercises for the limbs in combination with deep breathing4-5 Reducing the load, developing full breathing

An integrated approach with the obligatory consideration of the individual characteristics of the course of the process is an unshakable principle for the treatment and rehabilitation of peptic ulcer. The most effective method of treating any disease is the one that most effectively eliminates the cause that causes it. In other words, we are talking about a targeted impact on those changes in the body that are responsible for the development of an ulcerative defect in the mucous membrane of the stomach and duodenum.

The peptic ulcer treatment program includes a complex of diverse activities, the ultimate goal of which is the normalization of gastric digestion and the correction of the activity of regulatory mechanisms responsible for the disorganization of the secretory and motor functions of the stomach. This approach to the treatment of the disease provides a radical elimination of the changes that have occurred in the body. Treatment of patients with peptic ulcer should be complex and strictly individualized. During the period of exacerbation, treatment is carried out in a hospital.

Comprehensive treatment and rehabilitation patients with peptic ulcer of the stomach and duodenum include: drug treatment, diet therapy, physiotherapy and hydrotherapy, drinking mineral water, exercise therapy, therapeutic massage and other therapeutic agents. The antiulcer course also includes the elimination of factors contributing to the recurrence of the disease, provides for the optimization of working and living conditions, the categorical prohibition of smoking and alcohol consumption, and the prohibition of taking medications with an ulcerogenic effect.

Drug therapy has as its purpose:

1. Suppression of excess production of hydrochloric acid and pepsin or their neutralization and adsorption.

2. Restoration of the motor-evacuation function of the stomach and duodenum.

3. Protection of the mucous membrane of the stomach and duodenum and treatment of helicobacteriosis.

4. Stimulation of the processes of regeneration of cellular elements of the mucous membrane and relief of inflammatory-dystrophic changes in it.

The basis of drug treatment of exacerbations of peptic ulcer is the use of anticholinergics, ganglioblockers and antacids, with the help of which the effect on the main pathogenetic factors is achieved (decrease in pathological nervous impulses, inhibitory effect on the pituitary-adrenal system, decrease in gastric secretion, inhibition of the motor function of the stomach and duodenum, etc. .).

Alkalizing agents (antacids) are widely included in the medical complex and are divided into two large groups: soluble and insoluble. Soluble antacids include: sodium bicarbonate, as well as magnesia oxide and calcium carbonate (which react with hydrochloric acid of gastric juice and form soluble salts). Alkaline mineral waters (Borjomi, Jermuk springs, etc.) are widely used for the same purpose. Reception of antacids should be regular and repeated during the day. The frequency and timing of admission are determined by the nature of the violation of the secretory function of the stomach, the presence and time of occurrence of heartburn and pain. Most often, antacids are prescribed an hour before a meal and 45-60 minutes after a meal. The disadvantages of these antacids include the possibility of changing the acid-base state with prolonged use in large doses.

An important therapeutic measure is diet therapy. Therapeutic nutrition in patients with gastric ulcer must be strictly differentiated depending on the stage of the process, its clinical manifestations and associated complications. The basis of dietary nutrition in patients with peptic ulcer of the stomach and duodenum is the principle of sparing the stomach, that is, creating maximum rest for the ulcerated mucosa. It is advisable to use products that are weak causative agents of juice secretion, quickly leave the stomach and slightly irritate its mucous membrane.

Currently, special anti-ulcer rations for therapeutic nutrition have been developed. The diet must be followed for a long time and after discharge from the hospital. During the period of exacerbation, products that neutralize hydrochloric acid are prescribed. Therefore, at the beginning of treatment, a protein-fat diet, restriction of carbohydrates is needed.

Meals should be fractional and frequent (5-6 times a day); diet - complete, balanced, chemically and mechanically sparing. Diet food consists of three successive cycles lasting 10-12 days (diet No. 1a, 16, 1). With severe neuro-vegetative disorders, hypo- and hyperglycemic syndromes, the amount of carbohydrates in the diet is limited (up to 250-300 g), with trophic disorders, concomitant pancreatitis, the amount of protein increases to 150-160 g, with severe acidism, preference is given to products with antacid properties : milk, cream, soft-boiled eggs, etc.

Diet number 1a - the most sparing, rich in milk. Diet No. 1a includes: whole milk, cream, cottage cheese steam soufflé, egg dishes, butter. As well as fruits, berries, sweets, kissels and jelly from sweet berries and fruits, sugar, honey, sweet berry and fruit juices mixed with water and sugar. Sauces, spices and appetizers are excluded. Drinks - rosehip broth.

Being on a diet number 1a, the patient must comply with bed rest. She is kept for 10 - 12 days, then they switch to a more stressful diet No. 1b. On this diet, all dishes are cooked pureed, boiled in water or steamed. Food is liquid or mushy. It contains various fats, chemical and mechanical irritants of the gastric mucosa are significantly limited. Diet No. 1b is prescribed for 10-12 days, and the patient is transferred to diet No. 1, which contains proteins, fats and carbohydrates. Dishes that stimulate gastric secretion and chemically irritate the gastric mucosa are excluded. All dishes are prepared boiled, mashed and steamed. Diet No. 1 for a patient with a stomach ulcer should receive a long time. You can switch to a varied diet only with the permission of a doctor.

Application of mineral waters occupies a leading place in the complex therapy of diseases of the digestive system, including peptic ulcer.

Drinking treatment is practically indicated for all patients with peptic ulcer in remission or unstable remission, without a sharp pain syndrome, in the absence of a tendency to bleeding and in the absence of persistent narrowing of the pylorus.

Assign mineral waters of low and medium mineralization (but not higher than 10-12 g / l), containing no more than 2.5 g / l of carbon dioxide, bicarbonate sodium, bicarbonate-sulphate sodium water, as well as water with a predominance of these ingredients, but more complex cationic composition, pH from 6 to 7.5.

Drinking treatment should be started already from the first days of the patient's admission to the hospital, however, the amount of mineral water for admission during the first 2-3 days should not exceed 100 ml. In the future, with good tolerance, the dose can be increased to 200 ml 3 times a day. With increased or normal secretory and normal evacuation function of the stomach, water is taken in a warm form 1.5 hours before meals, with reduced secretion - 40 minutes -1 hour before meals, with a slowdown in evacuation from the stomach 1 hour 45 minutes - 2 hours before food.

In the presence of pronounced dyspeptic symptoms, mineral water, especially hydrocarbonate, can be used more often, for example 6-8 times a day: 3 times a day 1 hour 30 minutes before meals, then after meals (after about 45 minutes) at the height of dyspeptic symptoms and, Finally, before bed.

In some cases, when taking mineral water before meals, heartburn intensifies in patients, and pain appears. Such patients sometimes well tolerate the intake of mineral water 45 minutes after a meal.

Often, this method of drinking treatment has to be resorted to only in the first days of the patient's admission, in the future, many patients switch to taking mineral water before meals.

Persons with peptic ulcer in the stage of remission or unstable remission of the disease, in the presence of dyskinesia and concomitant inflammatory phenomena from the large intestine are shown: microclysters and cleansing enemas from mineral water, intestinal douches, siphon lavages of the intestines.

Gastric lavage is prescribed only according to indications, for example, in the presence of pronounced phenomena of concomitant gastritis. Various types of mineral and gas baths are widely used in the treatment of patients with peptic ulcer. The method of choice is oxygen, iodine-bromine and mineral baths. Carbonic baths are contraindicated for patients with peptic ulcer disease with severe symptoms of vegetative dyskinesia. One of the methods of treatment of patients with peptic ulcer in remission is pelotherapy.

The most effective types of mud therapy include mud applications on the anterior abdominal wall and lumbar region (temperature 40°C, exposure 20 minutes), every other day, alternating with baths. The course of treatment is 10-12 mud applications. With contraindications to mud applications, diathermo mud or galvanic mud on the epigastric region is recommended.

Various methods are widely used psychotherapy - hypnotherapy, autogenic training, suggestion and self-hypnosis. With the help of these methods, it is possible to influence psychopathological disorders - asthenia, depression, as well as neurovegetative and neurosomatic functional-dynamic disorders of the stomach.

During the hospital period of rehabilitation, exercise therapy, therapeutic massage, and physiotherapy are used.

Therapeutic physical culture prescribed after the subsidence of acute manifestations of the disease.

Tasks of exercise therapy:

Normalization of the tone of the central nervous system and cortico-visceral relationships,

Improvement of the psycho-emotional state;

Activation of blood and lymph circulation, metabolic and trophic processes in the stomach, duodenum and other digestive organs;

Stimulation of regenerative processes and acceleration of ulcer healing;

Reducing spasm of the muscles of the stomach; normalization of secretory and motor functions of the stomach and intestines;

Prevention of congestion and adhesive processes in the abdominal void.

Massotherapy prescribed to reduce the excitation of the central nervous system, improve the function of the autonomic nervous system, normalize the motor and secretory activity of the stomach and other parts of the gastrointestinal tract; strengthening the abdominal muscles, strengthening the body. Apply segmental-reflex and classical massage. They act on the paravertebral zones D9-D5, C7-C3. At the same time, in patients with gastric ulcer, these zones are massaged only on the left, and with duodenal ulcer - on both sides. The area of ​​the collar zone D2-C4, belly is also massaged.

Physiotherapy prescribed from the first days of the patient's stay in the hospital, its tasks:

Decreased excitability of the central nervous system, - improvement of the regulatory function of the autonomic nervous system;

Elimination or reduction of pain, motor and secretory disorders;

Activation of blood and lymph circulation, trophic and regenerative processes in the stomach, stimulation of ulcer scarring.

First, medical electrophoresis, electrosleep, solux, UHF therapy, ultrasound are used, and when the exacerbation process subsides, diadynamic therapy, microwave therapy, magnetotherapy, UV radiation, paraffin-ozokerite applications, coniferous, radon baths, circular showers, aeroionotherapy.

The post-hospital period of rehabilitation is carried out in a clinic or sanatorium. Apply exercise therapy, therapeutic massage, physiotherapy, occupational therapy.

Recommended sanatorium treatment (Crimea, etc.), during which: walks, swimming, games; in winter - skiing, skating, etc.; diet therapy, drinking mineral water, taking vitamins, UV radiation, contrast shower.

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Introduction

peptic ulcer physical rehabilitation

Among diseases of the internal organs, diseases of the digestive system are the most common. In most cases, they are chronic and have a tendency to periodically exacerbate. They worsen the functional state of all body systems, cause metabolic disorders, and reduce the ability to work. A number of diseases (gastric and duodenal ulcer, chronic hepatitis, etc.) can lead to premature disability.

The causes of diseases of the digestive system are complex and diverse, although the main place is occupied by an infectious factor. Transferred acute intestinal infections entail long-term disorders of the digestive system. The second place among these reasons is occupied by the food factor, i.e. food poisoning, low-quality products, ingestion of harmful elements with food. The chemical factor as one of the causes of diseases of the digestive system is associated with poisoning with household chemicals, pesticides, chronic intoxication caused by the abuse of alcoholic beverages, their surrogates and uncontrolled medication during self-medication. Mental stress, stressful situations, i.e. neuropsychogenic factor, create a favorable background for the impact of these harmful factors on the gastrointestinal tract, and often serve as a direct cause of a number of diseases. And, finally, in a number of cases, a family-hereditary predisposition to diseases of the digestive system can be traced, i.e. hereditary factor.

Of the numerous diseases of the stomach, a stomach ulcer is quite common.

Long-term, systematic treatment gives good results in the chronic course of the disease with a stomach ulcer. In complex treatment, along with properly organized dietary nutrition, the mode of work and life, as well as therapeutic physical culture, are of no small importance.

All of the above leads to relevance topics of this course.

general characteristicswork

Target. To improve the function of the digestive system of patients with gastric ulcer by developing a comprehensive program of physical rehabilitation based on the analysis of scientific and methodological literature.

Tasks:

1. Based on the analysis of scientific and methodological literature, to identify the main means of physical rehabilitation for gastric ulcer.

2. Develop a comprehensive rehabilitation program for patients with gastric ulcer.

Object of study. The process of rehabilitation of patients with gastric ulcer.

Position to be defended. A comprehensive program of physical rehabilitation for patients with gastric ulcer.

The structure of the course work. The following sections are presented in the course work: introduction, general characteristics of the work, chapter 1 "Analysis of scientific and methodological literature", chapter 2 "Comprehensive program of physical rehabilitation for gastric ulcer", conclusion, list of sources used.

The results of the study are presented in three tables, three figures. Course work is done on 40 pages of computer text using 31 literary sources.

1. Analysis scientifically-methodicalliterature

1.1 Anatomy-physiological characteristicstomach

Stomach(lat. ventriculus, gaster) is a hollow organ of the digestive tract, in which food is accumulated and partially digested.

The stomach is located in the epigastric region, most of it (5/6) is contained to the left of the midline.

The structure of the stomach

In the stomach, the following parts are distinguished: the place of entry of the esophagus into the stomach is ostium cardiacum, the part of the stomach adjacent to it is pars cardiaca, the place of exit from the stomach is pylorus, its opening is ostium pyloricum, the part adjacent to it is pars pylorica, the domed part of the stomach to the left of ostium cardiacum is called the bottom - fundus, or the vault - fornix. The body of the stomach is located between the cardial part and the bottom, on the one hand, and the antral part, on the other. The boundary between the antrum and the body of the stomach runs along the intermediate groove, which corresponds to an angular notch on the lesser curvature.

The wall of the stomach is made up of three layers:

1) tunica mucosa - a mucous membrane with a developed submucosal layer (tela submucosa);

2) tunica muscularis - muscular membrane;

3) tunica serosa - serous membrane.

The blood supply to the stomach comes from the branches of the abdominal trunk and the splenic artery. On the lesser curvature, there is an anastomosis between the left gastric artery and the right gastric artery, along the greater curvature - aa.gastroepiploicaе sinistraе with a.lienalis and aа.gastroepiploicaе Dextor with a.gastroduodenalis. Short arteries from the splenic approach the bottom of the stomach.

The veins of the stomach correspond to the arteries of the same name, flow into the portal vein. The innervation of the stomach is carried out by branches of the vagus nerve (n.vagus) and the sympathetic trunk (tr.sympathicus). N.vagus enhances peristalsis and secretion of its glands, relaxes m.sphincter pylori, conveys a feeling of nausea and hunger. The sympathetic nerves of the stomach weaken peristalsis, cause a contraction of m. sphincter pylori, constrict blood vessels, transmit a feeling of pain.

In the area of ​​​​the body and fundus of the stomach, the main number of main (pepsinogen secrete) and obkladovye (HCl secrete) cells, as well as additional (mucoid) cells that produce mucin, mucopolysaccharides, gastromucoprotein, Castle factor, are located.

Gastrin is produced in the antrum of the stomach.

The main functions of the stomach are: chemical and mechanical processing of food, its deposition and evacuation to the intestines. The stomach is also involved in intermediate metabolism, hematopoiesis, water-salt metabolism and maintaining acid-base balance (CLR).

The actual digestive function of the stomach is provided by gastric juice, which is secreted by the glands. Cells of the gastric glands secrete 8 fractions of pepsinogen, which constitute two immunologically heterogeneous groups. Pepsinogens of the first group are secreted by fundic glands, pepsinogens of the second group are secreted by antral glands. Gastric juice has proteolytic activity in a wide pH range with two optimal points: at pH 1.5-2.0 and 3.2-3.5. At the first pH optimum, proteolysis is carried out by pepsin, at the second - by gastrixin, which differs in amino acid composition, molecular weight, and a number of other properties. The ratio of pepsin and gastrixin under physiological conditions ranges from 1:1.5 to 1:6. Pepsin and gastrixin provide 95% of the proteolytic activity of gastric juice. Gastric juice also has a slight lipo-and aminolytic activity.

The chief cells of the gastric glands are mainly stimulated by the vagus nerves through acetylcholine. Reflex stimulation of gastric enzyme secretion also mediated by gastrin. Cholinergic influence increases the reactivity of chief cells to gastrin. Histamine enhances enzyme secretion, but weaker than gastrin and vagus nerves. Secretin, suppressing the secretion of hydrochloric acid stimulated by gastrin, increases enzyme secretion. A similar effect has cholecystokinin, pancreozymin.

Parietal cells secrete hydrochloric acid, which is involved in the activation of pepsinogen and the creation of an optimal pH for the action of gastric enzymes. Stimulation of parietal cells under physiological conditions is carried out through cholinergic nerve fibers by gastrin and histamine, and inhibition is carried out by secretin and cholecystokinin (pancreozymin). The secretory activity of the gastric glands is regulated by reflex and humoral mechanisms. According to the mechanisms of stimulation of the gastric glands, the folding-reflex and neurohumoral phases are distinguished. However, it has now been established that there is no fundamental difference between them, since reflex stimulation is also carried out through the humoral link (histamine, gastrin), and the nervous mechanisms change the sensitivity of the gastric glands to humoral agents. The main conductor of the central influence on the gastric glands is the vagus nerve. Gastrin is released from the gastrin-producing cells of the mucous membrane of the antrum, both as a result of central influence (through the vagus nerves) and as a result of the effect on the mechano- and chemoreceptors of the products of hydrolysis of extractive substances: meat, ethanol, caffeine, etc. When the mucous membrane of the antrum is exposed to acidic solutions inhibits the release of gastrin in proportion to the increase in acidity (at pH 1.0, the release of gastrin completely stops). After the gastric chyme passes into the duodenum, hormones are formed in it, which are of great importance in regulating the activity of the hepatobiliary system, pancreas, stomach and intestines. The secretion phase, which is regulated by the duodenum and small intestine, is called intestinal. The exclusion of the transit of gastric contents into the duodenum increases the secretory response of the gastric glands to numerous stimulants. The main inhibitors of gastric acid secretion are secretin and cholecystokinin (pancreozymin). However, a number of other gastrointestinal hormones are involved in this process.

The motor activity of the stomach ensures the deposition of food, mixing it with gastric juice and portionwise evacuation of chyme into the duodenum. The reservoir function is carried out mainly by the body and fundus of the stomach, the evacuation function is carried out by its pyloric section.

The regulation of gastric motility is provided by nervous and humoral mechanisms. Irritation of the vagus nerves increases the motor activity of the stomach, irritation of the sympathetic nerves reduces it (adrenaline has a similar effect). The leading role in the regulation of the evacuation function of the stomach is played by the enterogastric reflex: irritation of the mechano- and chemoreceptors of the duodenum and small intestine inhibits gastric motility and evacuation.

Thus, the secretory and motor functions of the stomach are closely interconnected, have a complex system of regulation and self-regulation in the form of feedback and provide optimal conditions for the gastric phase of digestion in close interaction with the neuro-reflex and intestinal phases.

This must be taken into account when choosing a method of treatment and means of rehabilitation for peptic ulcer.

1.2 Etiologyand pathogenesis

stomach ulcer - This is a chronic relapsing disease in which an ulcer is formed on the basis of secretory-trophic disorders in the mucous membrane of the gastroduodenal zone.

Quite often, an ulcer is complicated by perforation, bleeding, penetration, malignancy, cicatricial and ulcerative deformity (stenosis of the gastric outlet, less often duodenal stenosis). Perforation and bleeding are an immediate danger to life.

Etipathogenesis stomach ulcers is quite complicated and so far there is no single position on this issue.

In the occurrence of peptic ulcer, genetic, alimentary, neuropsychic, drug, infectious factors matter.

With the greatest reliability, the value of the hereditary factor in the occurrence of peptic ulcer was established (30-38%). At the same time, a reduced reactivity of the mucous membrane of the stomach and duodenum to the damaging effect of gastric juice, increased acidity due to the excessive development of the glandular apparatus of its mucous membrane is inherited.

Alimentary factors (consumption of rough and spicy foods, spices, smoked meats, excessive consumption of coffee and refined carbohydrates), which can cause mechanical trauma to the mucous membrane or increase secretion and gastric motility, are somewhat less important. Pronounced functional disorders of the gastric glands are also caused by irregular nutrition. Fasting secretions can also cause acid-peptic damage to the stomach and duodenum. A certain importance is attached to bad habits - smoking, alcohol abuse. Nicotine, like alcohol, can cause gastric vasospasm, especially when combined with qualitative and quantitative malnutrition.

In some cases, ulcer formation is promoted by the intake of certain drugs (salicylates, glucocorticoids), which can cause a decrease in the secretion of gastric mucus and regeneration of the epithelium of the gastric mucosa, spasm of the stomach vessels.

At the same time, it has been established that various lesions of the nervous system (acute psychotraumas, physical and especially mental overstrain, various nervous diseases) contribute to the development of this disease. It should also be noted the importance of the hormonal factor, in particular, a violation of the production of digestive hormones (gastrin, secretin, etc.), as well as a violation of the metabolism of histamine and serotonin, under the influence of which the activity of the acid-peptic factor increases. Of certain importance is the violation of the diet and food composition. In recent years, an increasing place is given to the infectious (viral) nature of this disease. A certain role in the development of gastric ulcers is also played by hereditary and constitutional factors.

1. 3 Clinic

The main symptom of gastric ulcer is severe pain in the epigastric region, most often in spring and autumn. Periods of exacerbation alternate with periods of calm. During the period of exacerbation, pain associated with food intake occurs in 15-20 minutes. after eating or on an empty stomach ("hungry" pains). Vomiting, which often accompanies pain, brings relief. In cases where gastric ulcer is accompanied by increased secretion of the stomach, the patient is worried about heartburn.

In typical cases, an exacerbation of peptic ulcer is accompanied by a sharp pain in the abdomen some time after eating. Sometimes an attack of severe pain ends with profuse sour vomiting. In other cases, after reaching maximum strength, the pain gradually subsides. Night pain, pain on an empty stomach, weakening after eating, are possible.

More often the pain is localized in the epigastric region, less often in the right or left hypochondrium. It radiates to the lower back, less often to the chest, even more rarely to the lower abdomen.

Pain in the abdomen increases with physical exertion, decreases in a motionless, bent position with legs drawn to the stomach, as well as when pressing on the stomach with hands.

Constant pain in the abdomen is characteristic of ulcers penetrating the pancreas, complicated by perivisceritis.

The pain of peptic ulcer disease is often combined with heartburn, vomiting, which brings relief. Appetite in patients is usually preserved, but there is a fear of eating due to fear of increased pain.

With an exacerbation of the disease, there is tension in the anterior abdominal wall, percussion pain in a limited area in the epigastric region. With the help of deep palpation, pain in the pyloroduodenal region is revealed. The diagnosis is facilitated by the presence of a characteristic ulcer history - the seasonality of the exacerbation of the disease, the double frequency of pain.

According to the clinical course, acute, chronic and atypical ulcers are distinguished. Not every acute ulcer is a sign of a peptic ulcer.

A typical chronic form of peptic ulcer is characterized by a gradual onset, an increase in symptoms and a periodic (cyclic) course.

The first stage - the prelude of an ulcer, is characterized by pronounced disturbances in the activity of the autonomic nervous system and functional disorders of the stomach, the second - by the appearance of organic changes at first in the form of a structural reorganization of the mucous membrane with the development of gastritis, the third - by the formation of an ulcer in the stomach, the fourth - by the development of complications.

The duration of periods of remission in peptic ulcer disease ranges from several months to many years. The recurrence of the disease can be caused by mental and physical stress, infection, vaccination, trauma, medication (salicylates, corticosteroids, etc.), insolation.

1. 4 Means of rehabilitation

Physiotherapy

Therapeutic gymnastics pursues the tasks of general strengthening of the patient's condition. Physical exercises, increasing the tone of the body, contribute to the activation of its defenses. The stimulation of the functioning of all body systems by physical exercises has a favorable effect on the general condition of the patient.

The use of therapeutic physical culture in diseases of the stomach ulcer primarily pursues the task of improving the nervous processes in the central nervous system. In diseases of the stomach from pathologically altered organs, perverted impulses enter the central nervous system, which create foci of congestive excitation or inhibition, disrupt the course of neurodynamic processes and the relationship between the cerebral cortex, the reticular formation and the subcortex. Excitation of the motor centers of the brain, which occurs during exercise, has a normalizing effect on the foci of congestive pathological excitation and inhibition associated with disease processes. At the same time, by increasing the excitatory tone of the cerebral cortex, physical exercises improve its interaction with the subcortex. An increase in the flow of impulses from the musculoskeletal system suppresses the altered impulses from the affected organs.

The most important task of therapeutic exercises is to improve the trophic processes of gastric ulcers: accelerate regeneration, slow down and reverse the development of dystrophic and atrophic processes. Physical exercise activates the metabolism in stomach ulcers, improves blood circulation in the abdominal cavity, reduces congestion and increases the blood supply to pathologically altered tissues. The activation of hormones and enzymes during muscular work enhances tissue metabolism, at the same time, the sensitivity of tissues and organs to the action of hormones increases due to improved nervous regulation. All this accelerates the recovery and plastic processes in altered tissues: inflammation subsides, ulcer scarring is stimulated.

Therapeutic exercises contribute to the improvement of impaired functions. Using specially selected exercises, it is possible to selectively influence the various functions of the resulting processes in gastric ulcers. For example, to enhance the motor function of the smooth muscles of the stomach and intestines, reduce the tone of the spasmodic muscles of the pylorus and sphincters, increase the secretion of the stomach, improve the outflow of bile from the liver and gallbladder, and evacuate the contents of the large intestine. Strengthening the muscles of the pelvic floor, the anterior and lateral walls of the abdomen improves the functions of the intestine and stomach, especially when the internal organs are prolapsed, and helps to normalize the position of digestion.

Remedial gymnastics combines general strengthening and special exercises.

Restorative exercises for various muscle groups help to increase the tone of the central nervous system, improve the functions of internal organs and the musculoskeletal system. According to the mechanism of motor-visceral reflexes, they have an effect on the function of digestion in case of a stomach ulcer, moreover, against their background, the effect of special exercises is more effective.

Morning hygienic gymnastics

This is a necessary component of the correct regimen of the day. The transition from the state of sleep to the state of wakefulness occurs gradually. Immediately after awakening, the predominance of inhibitory processes in the nervous system remains, a person has reduced mental and physical performance, almost all types of sensitivity, and the speed of reactions is significantly reduced.

The inhibited state of the central nervous system can persist for several tens of minutes or even several hours. This largely depends on the quality of sleep and the degree of general fatigue of the body.

Such a long transition from the state of sleep to the state of wakefulness is not only not convenient in modern life, but also harmful to the health of the body, which, after waking up, is subjected to significant mental and intellectual stress, when the nervous system is not yet ready to perceive them.

Therefore, it is extremely important to take measures to help facilitate the process of transition to a state of wakefulness after sleep.

Systematic morning exercises stimulate the development of muscles, develop the respiratory and circulatory organs, and improve metabolism. Taking air baths during exercises and water procedures after a gymnast hardens the body.

Therapeutic swimming

Therapeutic swimming is one of the forms of therapeutic physical culture, a feature of which is the simultaneous effect on the human body of water and active (rarely passive) movements. Dosed muscular work in special, unusual for a person, conditions of the aquatic environment is an important component of the effect of the procedure on the patient. The mechanical effect of the aquatic environment is due to its significantly higher density compared to air. As a result, for the implementation of motor skills acquired by a person in an air environment, it is necessary to master new mechanisms of movement. In addition, overcoming the resistance of a medium denser than air requires a lot of effort. Thus, facilitation (by reducing body weight) of static positions, as well as slow, smooth movements in the water, is combined with significant force stress to overcome the increased resistance of the environment during fast movements. The influence of water temperature, which is the main factor in various hydrotherapy procedures, is also of great importance for creating optimal conditions for conducting physical exercises in the water. With a variety of movements, the patient can tolerate lower water temperatures (hardening effect). Conducting classes in warmer water (close to body temperature) contributes to a significant decrease in reflex excitability and muscle spasticity, as well as a decrease in pain. The chemical action of the aquatic environment is also important, especially when conducting classes in pools with mineral and sea water. For the correct and differentiated use of therapeutic swimming. it is necessary to take into account the complex influence of all these factors on the body as a whole, as well as on its organs and systems.

The main indications for therapeutic swimming. are: damage and diseases of the nervous system; injuries and diseases of the musculoskeletal system, conditions after surgical interventions; diseases of the cardiovascular system, diseases of the respiratory system, digestion, endocrine diseases, metabolic disorders, etc. With indications for the therapeutic use of physical exercises in water, the issues of choosing one or another technique and the permissible level of load are decided individually, taking into account the nature of the disease, the age of the patient , his general condition, the level of physical fitness, in particular the ability to stay on the water. However, if the patient does not know how to swim, this is not a contraindication for the appointment of procedures in the pool.

Contraindications to physical exercises in water are the presence of open wounds, granulating surfaces, trophic ulcers; skin diseases (eczema, fungal and infectious lesions); eye diseases (conjunctivitis, blepharitis, keratitis) and ENT organs (purulent otitis media, etc.); conditions after infectious diseases and chronic infection; trichomoniasis; radicular pain syndromes, plexitis, neuralgia, neuritis in the acute stage; acute respiratory viral infections; incontinence of urine and feces, the presence of fistulas with purulent discharge, copious sputum; pulmonary tuberculosis in the active stage; rheumatic heart disease in the acute stage; decompensated diseases of the cardiovascular system, etc.

Dosed walking

Being the most natural form of physical therapy, this type of treatment is prescribed to patients at the stage of rehabilitation in order to improve and increase the functionality of the body, develop adaptive mechanisms of the cardiovascular system. During the walk, the processes of metabolism, blood circulation and respiration are stimulated, the patient's neuropsychic state improves.

When walking, there is a rhythmic alternation of tension and relaxation of the muscles of the lower extremities, which has a positive effect on blood and lymph circulation, counteracting the occurrence of congestion. Dosed walking is the most habitual load; it is advisable to use it in the rehabilitation treatment of debilitated patients. Physical activity is increased gradually, lengthening the distance, accelerating the pace of walking; in this case, it is necessary to take into account the terrain.

Dosed walking walks are carried out on a flat area, starting from a route with a length of 1000 m, then along a route with a length of up to 2000 m and only then up to 3000 m. -5 days, you should increase the distance by 500-1000 m, while accelerating the pace of walking and, accordingly, reducing the number of pauses for rest and their duration.

Very slow - 60-70 steps per minute, or 2.5-3 km / h;

Slow - 70-90 steps per minute, or 3-3.5 km / h;

Average - 90-120 steps per minute, or 4-5.6 km / h;

Fast -120-140 steps per minute, or 5.6-6.4 km / h;

Very fast - more than 140 steps per minute, or over 6.5 km / h.

Massage

Massage It is a way to treat and prevent diseases. Massage is scientifically substantiated, proven by many years of practice, the most physiological health remedy for the human body. It is used both for preventive purposes - for general strengthening of the body, and in various fields of medicine: surgery, orthopedics, gynecology, therapy, neurology, etc.

Depending on the purpose for which massage is used, it can be divided into several types: sports, therapeutic, hygienic, cosmetic. In addition, there are various forms of massage, depending on the area of ​​influence of massage techniques (general and local), as well as on who is performing the massage (massage performed by a masseur, mutual massage or self-massage). There are also different methods of massage (foot, manual, hardware and combined).

Therapeutic massage can be used as an independent method, and can be used in combination with other methods of treatment. But you can use massage for therapeutic purposes only as prescribed by a doctor.

Massage contraindications:

1. Exacerbation of the disease.

2. Bleeding.

3. Acute cholecystitis.

4. Inflammatory processes in the genitals in women.

5. Tuberculosis.

6. Pregnancy and postpartum period, post-abortion period (within 2 months).

7. General contraindications.

It is necessary to perform massage techniques in the following sequence:

1. Massage of the back muscles.

2. Massage of the neck and trapezius muscles.

3. Massage the chest muscles.

4. Massage the abdominal muscles.

Back muscle massage

1. Stroking.

2. Squeezing.

3. Kneading the long muscles of the back:

a) circular with the pad of the thumb;

b) circular pads of four fingers;

d) "forceps";

e) circular with the pads of the thumbs.

Particular attention should be paid to zones D7-D9, D10-L1 on the left and D9-D12-L1 on the right, because they are associated with the affected organs. 4. Kneading the latissimus dorsi:

a) ordinary;

b) double neck;

c) double ring;

d) circular phalanges of bent fingers.

5. Rubbing the fascia of the trapezius muscle, interscapular region, supraspinous and infraspinatus regions:

a) rectilinear pad and tubercle of the thumb;

b) circular edge of the thumb;

c) circular tubercle of the thumb.

Neck and trapezius muscle massage

1. Stroking.

2. Squeezing.

3. Kneading:

a) ordinary;

b) double ring;

c) phalanges of bent fingers;

d) the radial side of the brush.

Massage of the abdominal muscles

Techniques should be performed on the rectus and oblique muscles of the abdomen, in areas that are directly related to the stomach and duodenum.

1. Circular stroking.

2. Kneading on the rectus abdominis muscles:

a) ordinary;

b) double ring;

c) circular phalanges of bent fingers with one and both hands alternately;

3. Kneading on the oblique muscles of the abdomen:

a) ordinary;

b) double ring;

c) circular phalanges of bent fingers;

d) round-shaped beak-shaped.

It is necessary to carry out 12-14 massage sessions.

Physiotherapy

Physiotherapy treatment is contraindicated for complications of peptic ulcer and suspected malignancy of the ulcer.

Among the physiotherapeutic procedures used in the treatment of peptic ulcer of the stomach and duodenum, the following are most often used.

diadynamic therapy(DDT) is one of the effective physiotherapeutic methods used in the complex treatment of patients. DDT has a pronounced analgesic effect in patients with exacerbation of peptic ulcer and a normalizing effect on the main functions of the stomach.

Ultrasound Therapy produces micromassage of tissues, enhances metabolic processes in them, has an anti-inflammatory effect. As a result of this therapy, the pain syndrome is quickly stopped, the secretion of gastric juice decreases, but acid formation does not change significantly.

Magnetotherapy. As a result of exposure to a magnetic field, pain syndrome and dyspeptic disorders are stopped faster, there is a tendency to reduce the acidity of gastric juice, normalize the motor function of the stomach, and heal ulcers.

electrosleep- a modern method of pulsed electrotherapy. As a result of treatment, the functional state of the central and autonomic nervous system is normalized, and the healing of ulcers is accelerated.

The effectiveness of antiulcer therapy depends on the timeliness of its implementation, the correct combination of diet, pharmacological agents and physiotherapy.

One of the leading places, especially in sanatorium conditions, is occupied by mud treatment. Mud and peat treatment is shown in the phase of fading exacerbation. Muds of low temperatures reduce hypersecretion, normalize motor function, improve blood circulation, and normalize the reduced activity of the sympathoadrenal system.

Balneotherapy

Balneotherapy is a prevention and treatment using natural or artificially prepared mineral waters.

Mineral waters can be used externally (baths, pools), for drinking, inhalation, washing-irrigation of the intestines, etc. Mineral waters are characterized by a high content of mineral and organic components, have specific physical and chemical properties, on which their therapeutic effect on the human body is based . Each type of mineral water has a certain effect on the body, mainly due to the presence of leading chemical elements in it.

Natural mineral water (especially thermal springs) has a more versatile effect than its artificial counterparts. In addition, the effect of natural mineral waters is enhanced by the powerful influence of other resort factors (climatic, landscape, motor, psychological).

Ingestion of mineral water.

The action of mineral water when taken orally differs significantly from its action when taken externally in the form of baths. Here, first of all, its influence on the digestive organs is manifested.

Drinking mineral water normalizes the functions of the stomach, intestines, gallbladder, pancreas, which improves digestion and assimilation of food. However, their action does not end there. The chemical substances that make up mineral water are easily absorbed in the digestive tract and are carried through the blood vessels throughout the body, improving metabolic processes, strengthening the body's defenses, and restoring impaired functions.

When drinking treatment, the temperature of the mineral water taken, its composition and the time of intake (on an empty stomach, along with a meal) are important.

Drinking treatment at the resort gives a much greater effect than outside the resort environment. Water taken directly from the source, relaxation in a favorable environment, regimen, and other health procedures enhance the therapeutic effect of drinking mineral waters.

Sodium chloride mineral waters are used for chronic gastritis without exacerbation, peptic ulcer of the stomach and duodenum without exacerbation, chronic inflammatory diseases of the intestines, liver, cholelithiasis.

Baths with mineral water

In balneological procedures, various kinds of baths are most widely used, filled with mineral water with and without hydromassage, mineral-pearl, with chromotherapy, with underwater massage shower (procedures in these baths are described in the thalassotherapy - hydrotherapy section).

The action of baths is based on the influence of water of different temperatures on numerous nerve endings located in the skin.

When taking hot baths, the blood supply to the skin and chronic inflammatory foci increases, which leads to an increase in the intensity of oxidative processes, the oxidation of pathological products in inflammatory foci, and their removal from the body, and acceleration of recovery processes. The process of sweating and thickening of the blood intensifies, as a result of which there is an effective removal of toxins from the body.

When taking cold baths, first there is a rapid narrowing of the blood vessels, which is soon replaced by their expansion, which improves blood circulation, there is an increase in muscle tone and nervous system, there is a surge of additional energy. These baths have a tonic effect.

Baths of indifferent temperatures (close to body temperature) reduce the increased excitability of the nervous system, have a relaxing effect. They are used in the treatment of hypertension, hypersthenic neurosis, with a tendency to vascular and muscle spasms, disorders of motor functions.

Contraindications are all diseases in the acute stage, infectious diseases, blood diseases, malignant neoplasms.

The mechanism of action of mineral water baths consists of the influence of temperature, hydrostatic, mechanical, chemical and (or) radioactive factors. The effect of the first three factors is common to mineral water baths of all types.

When using showers or bathing in pools with mineral water, its specific effects are supplemented by the influence on the body of physical exercises or mechanical irritation of the skin, muscles and tendons, and therefore, the effect of the procedure on blood circulation and other body systems is significantly enhanced. Differences in the properties of mineral waters cause differentiated indications and contraindications for the appointment of such baths.

Diet

The anti-ulcer course of treatment includes therapeutic nutrition, elimination of damaging factors, primarily smoking, taking alcohol and drugs such as acetylsalicylic acid, butadione, reserpine and other drugs, especially on an empty stomach and at bedtime, creating mental and physical rest for the patient, treatment with physical factors, pharmacotherapy.

When prescribing therapeutic nutrition, one should take into account the presence of concomitant diseases of the digestive system and the individual tolerance of certain foods, such as milk. Food is taken fractionally, in small portions, every 2-3 hours. The diet should be rich in proteins, since the therapeutic effect comes faster, the healing of ulcers and the subsidence of the inflammatory process are accelerated. From the first days of exacerbation, patients are recommended three times a day meat and fish dishes, dishes from eggs, freshly prepared cottage cheese, butter, vegetable, berry sweet juices, rosehip infusion.

Very hot and cold drinks, ice cream are prohibited. The diet should be sparing. Foods that strongly stimulate gastric secretion are excluded from the diet: strong meat, vegetable, mushroom broths, fried foods, strong tea and coffee, salted and smoked meat and fish, pepper, mustard, onion, garlic.

With a combination of peptic ulcer with cholecystitis, fractional nutrition without any correction of the diet is shown according to the hypokinetic type, and food with restriction of fats and egg yolks according to the hyperkinetic type.

With a combination of peptic ulcer with hepatitis, the diet includes foods containing lipotropic substances (cottage cheese, oatmeal, rice) and vitamins.

Peptic ulcer is often accompanied by reactive pancreatitis. In these cases, you should limit your fat intake and increase your protein intake.

1. 5 Assessment of the functional state of the digestive system

Examination of the digestive system (Fig. 1.3) includes:

Analysis of complaints;

Physical examination;

paraclinical methods.

Digestive system:

1 - stomach; 2 - duodenum; 3 - jejunum; 4 - ileum, 5 - ileocecal valve; 6 - cecum, 7 - appendix; 8 - ascending section of the transverse colon; 9 - descending section of the transverse colon; 10 - sigmoid colon; 11 - rectum

Main complaints. Diseases of the digestive system are characterized by:

*gastrointestinal pathology -intestinal tract: dysphagia (impaired passage of food through the esophagus), regurgitation (returning part of the food taken back into the oral cavity), heartburn (a kind of painful burning sensation behind the sternum associated with throwing gastric contents into the lower esophagus), bad breath, belching (sudden and sometimes a sonorous exit through the mouth of air accumulated in the stomach or esophagus), loss of appetite, taste perversion, pain in various parts of the abdomen, a feeling of severe stomach fullness, nausea, vomiting, bloating, constipation or diarrhea, stomach and intestinal bleeding;

* pathology of the liver and biliary tract: pain in the right hypochondrium, sometimes in the epigastric region, belching, heartburn, nausea, vomiting, a feeling of severe stomach fullness after eating, jaundice, skin itching, an increase in the size of the abdomen, fever;

*pathology of the pancreas: pain in the epigastric region, right or left hypochondrium, girdle pain, dyspepsia, jaundice, general weakness and weight loss.

Physical examination methods allow you to determine the location, size, shape and consistency of the abdominal organs, the degree of tension of the abdominal wall, its soreness in a particular area, the presence of formations in the skin or subcutaneous tissue, the presence of hernias, intestinal motility.

Main paraclinical methods diagnosis of diseases of the digestive system:

- contrast radiography (esophagus, stomach, duodenum, large intestine, gallbladder);

- endoscopy(esophagus, stomach, duodenum, large intestine);

- ultrasound procedure(liver, gallbladder, pancreas);

- laboratory methods: study of gastric juice, the contents of the duodenum and feces.

Basic diagnostic method stomach ulcers - endoscopy of the stomach. This method can reveal small ulcers - 0.3-0.4 cm. You can also take a biopsy from the edge of the ulcer, from the bottom of the ulcer (ulcerative detritus - destroyed muscle, elastic fibers, epithelium, blood cells - erythrocytes, leukocytes). You can define and +/- N.r. morphologically (in the Republic of Belarus, the diagnosis of N.r. is exclusively morphological). Very small ulcers (less than 0.3-0.4 cm) are not visible and cannot be biopsied.

The X-ray method is used in the diagnosis of ulcers in 2 cases: 1) contraindications to EGD (myocardial infarction, stroke, decompensation of all diseases, status asthmaticus), 2) if clinical signs suggest a violation of the evacuation of contents from the stomach and duodenum. The method of studying the secretory function of the stomach - pH-metry. It is possible to carry out daily monitoring of intragastric pH, as well as fractional sounding. The diagnosis of gastric ulcer is confirmed by x-ray examination, which reveals a wall defect (niche) or deformation of the stomach as a result of cicatricial changes.

Peptic ulcer of the stomach can give severe complications: bleeding, which causes bloody vomiting in stomach ulcers; perforation (perforation) of the stomach wall, leading to peritonitis - inflammation of the peritoneum; narrowing of the exit from the stomach (pyloric stenosis) due to cicatricial processes. The possibility of degeneration of an ulcer and the formation of cancer is dangerous. Complications and a long course of peptic ulcer, not amenable to conservative treatment, require surgical intervention.

1. 6 Preventive measures for the disease

Many factors in the occurrence of stomach ulcers can be avoided, which means that such a serious illness as gastric ulcer can be avoided. For this, the following requirements must be met:

Sleep 6 - 8 hours;

Refuse fatty, smoked, fried foods;

During pain in the stomach, it is necessary to be examined and take 5-6 times a day pureed, easily digestible food: cereals, kissels, steam cutlets, sea fish, vegetables, scrambled eggs;

Treat bad teeth so that food can be chewed well;

Avoid scandals, because after a nervous strain, pain in the stomach intensifies;

Do not eat very hot or very cold food, as this can contribute to esophageal cancer;

Do not smoke;

Do not abuse alcohol.

It must be remembered that gastric ulcer is not only local damage to the stomach. This is a painful disease of the whole organism, which is easier to prevent than to adapt and treat for a lifetime.

A stomach ulcer is a chronic relapsing disease in which an ulcer forms on the basis of secretory-trophic disorders in the mucous membrane of the gastroduodenal zone.

The complex of rehabilitation measures includes medicines, motor regimen, exercise therapy and other physical methods of treatment, massage, therapeutic nutrition. Exercise therapy and massage improve or normalize neuro-trophic processes and metabolism, helping to restore the secretory, motor, absorption and excretory functions of the digestive canal.

Thus, we came to the conclusion that the processes occurring in the cerebral cortex affect the secretion and motor functions of the gastrointestinal tract. Muscular activity also has a great influence. The use of physical exercises is especially effective in diseases that are based on functional disorders. Physical exercise is also effective in the treatment of residual effects after inflammatory processes of duodenal ulcers. The treatment of such patients is most effective in a sanatorium-resort environment, where a complex of influences, including physical exercises, provides the necessary changes in the central nervous system and in the function of the gastrointestinal tract.

Treatment is most effective when combined with therapeutic gymnastics, balneotherapy and massage, especially in specialized medical institutions and resorts. To obtain the best therapeutic effect, it is necessary that the patient independently repeat the exercises for the affected digestive tracts 10-15 times during the day (as prescribed by the doctor). Occupational therapy is also good for training movements and substitution skills.

2. Integratedphysical rehabilitation program for stomach ulcers

Based on the analysis of scientific and methodological literature on the problem of physical rehabilitation of patients with gastric ulcer, a comprehensive rehabilitation program was developed.

When developing a physical rehabilitation program, we proceeded from the analysis of the prevailing ideas about restorative measures after gastric ulcer, the use of modern methods of rehabilitation.

A comprehensive program of physical rehabilitation is designed for 1 month and includes the following basic procedures: therapeutic exercises; morning hygienic gymnastics; dosed walking; swimming; massage; physiotherapy procedures (table 2.1).

Comprehensive physical rehabilitation program for patients with gastric ulcer

In the first week of rehabilitation, only the LH complex No. 1, massage, physiotherapy procedures are used. From the second week until the end of the rehabilitation program, the LH complex No. 2, the UGG complex, massage, dosed walking, swimming, physiotherapy procedures are used.

Therapeutic gymnastics complex №1

Therapeutic gymnastics complex №2

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