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Symptomatic gastroduodenal ulcers

Table of contents
Symptomatic gastroduodenal ulcers
Diagnosis
Separate types
Treatment

Symptomatic gastroduodenal ulcers are the heterogeneous group on the structure integrated by the general sign — formation of ulcer defect of a mucous membrane of a stomach and duodenum in response to influence of various ulcerogenic factors. Symptomatic ulcers arise in stressful situations, against other diseases or happen a consequence of the carried-out therapy. The merit in accurate differentiation of a peptic ulcer as independent disease and symptomatic gastroduodenal ulcers belongs to V. of X. Vasilenko (1972).

And a duodenum it is accepted to carry to symptomatic stomach ulcers:
1) stressful ulcers;
2) medicinal ulcers;
3) endocrine ulcers;
4) the ulcers arising at a number of diseases of internals.

Epidemiology
Frequency of developing of symptomatic gastroduodenal ulcers is closely connected with the reasons them caused and considerably differs depending on a type of ulcerations. So, the gastroduodenal ulcers which arose at stressful situations (widespread burns and injuries, extensive operations) are observed almost at 80% of patients, at hard proceeding diseases of internals (cardiovascular system, lungs, a liver, kidneys) — at 10 — 30%, and Zollinger's syndrome — Ellisona develops only at 1 — 4 on 1 million population a year.

Etiology and pathogeny
Unlike a peptic ulcer with its characteristic etiological factors (genetic predisposition, psychological overloads, alimentary errors, etc.). Symptomatic gastroduodenal ulcers pathogenetic are closely connected with other basic ("background") diseases or extreme influences.

For symptomatic gastroduodenal ulcers typically that one or the group of the pathogenetic factors breaking balance between factors of aggression and protection of a mucous membrane (see the Pathogeny of a peptic ulcer), become leaders in an ultserogeneza. So, the main role in development of stressful ulcers is played by disturbance of microcirculation in a mucous membrane of a digestive tract.

Gastroduodenal ulcers can arise at atherosclerotic defeat of belly department of an aorta owing to insufficiency of regional blood supply, direct damage of a protective mucous barrier by acetylsalicylic acid is the reason of formation of "aspirinovy" ulcers, and ulcers at Zollinger's syndrome — Ellisona are connected with sharp hyperproduction of NSL.

On the basis of research of 1149 patients origins of symptomatic gastroduodenal ulcers were studied and the system of an assessment of risk of their education is developed.

Risk of formation of symptomatic gastroduodenal ulcers

Reason of formation of symptomatic ulcers

Degree and risk factors of formation of symptomatic ulcers

low (1 point)

average (2 points)

high (3 points)

Diseases

Myocardial infarction

Acute disorders of cerebral circulation

The stenosing processes of visceral branches of a ventral aorta

Pseudorheumatism

Chronic nonspecific pulmonary diseases

Severe injuries, burns

Calculous cholecystitis

Cirrhosis

 

Chronic pancreatitis

Chronic diffusion diseases of kidneys
Peptic ulcer in the anamnesis

Acute surgical diseases of an abdominal cavity

Complications

 

Circulatory unefficiency of the II stage

Peritonitis Jaundice

Liver failure

Pulmonary insufficiency of II
degrees

Renal failure

Disturbances of mezenterialny blood circulation

Heart and cardiopulmonary failure of the III stage

Shock
Collapse

 

Secondary pneumonia

Septic complications

 

Hemorrhagic syndrome

 

Medicinal and stressful influences

Indometacin
Rheopyrinum
Butadionum
Prednisolonum

Acetylsalicylic acid

Operations on abdominal organs
Renal transplantation
Operations on a ventral aorta
Other extensive operations

According to the table the score for the patient at whom it is possible to assume development of symptomatic gastroduodenal ulcers is counted, and the judgment of a risk degree of their education is taken out. So, at the score equal 3, gastroduodenal ulcers find in 20% of patients, at equal 5 — in 35%, and at 10 — in 75% of cases.

Classification
The developed classification of symptomatic gastroduodenal ulcers is absent, only the type of an ulceration is usually allocated. We offer the following classification.

Classification of symptomatic gastroduodenal ulcers

I. Main types
1. Stressful
2. Medicinal
3. Endocrine
4. The symptomatic ulcers which arose against diseases of internals

II. Morphological characteristic of an ulceration
1. Erosion
2. Acute ulcer
3. Chronic ulcer

III. Number of defects of a mucous membrane
1. Single (1 — 3)
2. Multiple (more than 3)

IV. Sizes of ulcers (erosion)
1. Small (less than 0.5 cm)
2. Averages (0,5 — 1 cm)
3. Large (1,1 — 3 cm)
4. Huge (more than 3 cm)

V. Localization
1. A stomach — And: a) cardia, b) subkardnalny department, c) stomach body, d) antral department, e) peloric channel; Б: a) front wall, b) back wall, c) small curvature, d) big curvature

2. A duodenum — And: a) bulb, b) post-bulbar department; Б: a) front wall, b) back wall, c) small curvature (upper wall), d) big curvature (lower wall)

VI. Complications
1. Bleeding
2. Perforation
3. Penetration

At the formulation of the diagnosis before the diagnosis symptomatic gastroduodenal ulcers should be specified character of a disease and nature of defeat, it caused.

1. Acute calculous cholecystitis, cholecystectomia (date); the acute stressful multiple erosion and small acute ulcers of antral department of a stomach complicated by bleeding of moderate severity.
2. Pseudorheumatism; three large acute medicinal (steroid) ulcers of a front body wall of a stomach.
3. Atherosclerosis of a ventral aorta with sharply expressed stenosis of a celiac artery and a chronic abdominal ischemic syndrome; chronic huge (4,5 cm) the ulcer of small curvature of a body of a stomach penetrating in an omentulum.


 
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