Gastric Dyspepsia

2. syndrome gastric dyspepsia.

3. Dyspepsia - digestive disorders of different origin
s. There are gastric and intestinal dyspepsia. T
he term "gastric dyspepsia" combines symptom
s such as heartburn, belching, regurgitation, na
usea, vomiting, hiccups. They are observed not
only in various diseases of the stomach, but in
diseases of other organs and systems (central
nervous system, endocrine system, liver, biliary
tract, kidneys, and others.).

4. The organic reasons of dyspepsia:
• Gastritis;
• Stomach ulcer;
• Reflux- esophagitis;
• Stomach cancer;
• Cholelithiasis;
• Chronic pancreatitis.

5. Gastritis - inflammation of the mucous
membrane of the stomach wall.

6. common causes of gastritis.
The most common cause of gastritis is the
bacterium Helicobacter pylori, however, co
ntribute to the development of gastritis ma
y be poor nutrition, constant stress, smoki
ng, alcoholism, medications, error in nutriti
on.

7. types of gastritis.
etiological
• 1. Helicobacter pylori (associated with Helicoba
cter pylori)
• 2. Autoimmune
• 3. Reactive (due to duodenal reflux, bile reflux i
nto the stomach or taking drugs)
• 4. Special forms of gastritis (granulomatous, inc
luding Crohn's disease, sarcoidosis, tuberculosi
s, lymphocytic, eosinophilic)

8. types of gastritis.
on the course of the disease.
• acute gastritis
• chronic gastritis
topography
• 1. Gastritis antrum
• 2. The body of the stomach Gastritis
• 3. pangastritis

9. types of gastritis.
Endoscopic gastritis categories:
• 1. erythematous-exudative (surface), gastritis
• 2. atrophic gastritis
• 3. hemorrhagic gastritis
• 4. hyperplastic gastritis

10. Chronic H. pylori gastritis
In the early stages of the disease developing atr
ophic antral gastritis without secretory failure.
Ulcer-like symptoms:
• Pain in the epigastric 1-2 hours after a meal
• Hunger pain (fasting)
• Heartburn, acid regurgitation
• A healthy appetite
• The tendency to constipation

11. Objective clinical symptoms:
• Language clean or slightly coated from root
• Local tenderness in the area piloroduodenalnoy
• Normal border stomach

12. In the late stages of the disease devel
ops diffuse gastritis with atrophy of th
e gastric mucosa and the secretory de
ficiency.

13. Clinical symptoms:
• Poor appetite, nausea
• metallic taste in the mouth, dry mouth
• Belching air, food, sometimes rotten
• The feeling of heaviness in the epigastric
• Dull epigastric pain after eating
• Rumbling and flatulence
• Frequent loose stools

14. Objective symptoms
• Weight loss
• Language thickly coated
• Perleches in the corners of the mouth
• Moderate diffuse pain in the epigastric region
• Omission of the lower boundary of the stomach
• Rumbling palpation of the large intestine due to t
he pronounced flatulence

15. Perleches in the corners of the mouth

16. survey
X - ray examination of the stomach:
• Early stage (non-atrophic gastritis) - rough terrai
n mucosa in the antrum, pyloric spasm, segmen
ted peristalsis, disorderly evacuation of a contra
st agent.
• Late stage (pangastritis with atrophy) - relief of g
astric mucosa smoothed, hypotension, sluggish
perstaltika, fast evacuation of contrast material.

17. X - ray examination of the stomach

18. Gastroscopy
• Early stage (non-atrophic gastritis) - blotchy red
ness and swelling of the mucous membrane of t
he antrum, frequent submucosal hemorrhage, e
rosion, hyperplasia folds, exudation, antral spas
ms, stasis.
• Late stage (pangastritis with atrophy) - paleness
, thinning, flattening of the mucous membrane i
n the stomach and the antrum, blotchy flushing,
candling vascular hypotension, increased vulne
rability of the mucous, reflux of duodenal conten
ts.

20. Gastroscopy

21. Gastroscopy

22. Mucosal erythema and edema co
nsistent with acute gastritis.

23. Acute gastritis with superficial ero
sions.

24. Histopathological examination (biopsy taken at least
2 pieces of the antrum and the body (front and rear), a
lways with a muscular plate):
• Early stage (non-atrophic gastritis) - pronounced active
antral gastritis (infiltration own skin epithelial lymphocy
tes, plasmocytes, neutrophils), foci of intestinal metapl
asia, a lot of helicobacter surface and mucous pits.
• Late stage (pangastritis with atrophy) - glandular epithe
lium atrophy, intestinal metaplasia, a small amount of
helicobacter in gastric mucosa and antrum, the minim
al activity of inflammation.

25. Diagnosis of Helicobacter pylory:
Histological method for determining Helicobacter
pylori is the gold standard of diagnosis:
• Thin slices of biopsy specimens stained by the
method of Giemsa-Romanovsky, Helicobacter l
ocated in the mucus, have a spiral shape.
There are three degrees of contamination Helioba
cter pylory:
• Low () - 20 microbial cells in the s.v.
• Average (++) - up to 50 microbial cells in the s.v
.
• High (+++) - more than 50 microbial cells in the
s.v.

26. Chronic autoimmune gastritis.
Chronic autoimmune gastritis is chara
cterized by lesions of the gastric fund
us, atrophy of the gastric mucosa and
the secretory deficiency.

27. Subjective symptoms
• feeling of heaviness and fullness after eating
• Belching air, rotten, food sedennoy
• metallic taste in the mouth
• Poor appetite
• Rumbling transfusions and stomach, unstable st
ool
• severe weakness, dizziness, sweating (function
al dumping syndrome)

28. Objective symptoms
• Weight Loss
• pale skin (anemia), hair loss, brittle nails
• Dry skin, hyperpigmentation (gipokortitsizm)
• Signs gipopolivitaminoza (dry skin, blurred vision, blee
ding of gums and loosening, Zayed corners of mouth,
dermatitis, diarrhea)
• coated tongue
• Sore epigastrii
• Morbidity and rumbling in the umbilical and the ileocec
al region
• Omission of the greater curvature of the stomach

29. X-ray examination of the stomach
Improvement in the folds of the stomach lining

30. Gastroscopy
• The folds of the gastric mucosa are reduced in v
olume, in advanced cases of atrophy, they can
be absent
• stomach lining thinned, atrophic, pale, clearly vi
sible vascular pattern, an excessive amount of
mucus
• hiatus gatekeeper, throw the stomach contents
of 12 duodenal ulcer, gastric motility sluggish
• antrum is not changed

31. Histopathological examination
• atrophy of the mucous membrane of the fundus
of the stomach with the replacement of speciali
zed glands psevdopiloric glands and intestinal e
pithelium.

32. Immunological blood tests
• The presence of autoantibodies to parietal cells
and gastromukoproteinu.

33. Special forms of gastritis.
Hypertrophic gastritis (Menetries disease).
Subjective symptoms:
• Intense epigastric pain occurring after meals, he
artburn, regurgitation, air and food
• Frequent vomiting with blood
• Anorexia
• Weight loss, swelling of the feet and hands
• Diarrhea
• Hypoproteinemia

34. Special forms of gastritis.
Hypertrophic gastritis (Menetries disease).
Gastroscopy:
• Hypertrophy of the mucous membrane in the for
m of giant folds, covered with lots of sticky muc
us.
Histopathological examination:
• The sharp thickening of the gastric mucosa, ext
ension and expansion of the gastric pits

35. Hypertrophic gastritis (illness Menet
ries).

36. treatment

37. treatment
1. Sparing diet. Vegetables boiled, steamed zucc
hini, potatoes, carrots, cabbage, beans, beets,
dairy products, fruit and berry juices, sauces,
spices, snacks, tea, coffee and black with milk
, broth hips, black currant). Excluded are indig
estible, long linger in the stomach and dishes.
Fractional meals 4-5 times a day.

38. treatment
Anti-inflammatory therapy
• Sucralfate (Venter) Tablets (1 g) 1 tab four time
s daily (for 1 hour before meals and at bedtime)
or 2 g in the morning and evening. The course
of treatment 2-4 weeks
or
• De-nol (colloidal bismuth subcitrate) Tablets (12
0 mg) 1 tablet three times a day 30 minutes bef
ore meals and at bedtime. The course of treatm
ent 4 - 8 weeks. For 30 minutes before and afte
r taking the drug should not take antacids, milk,
beverages, solid food.

39. treatment
Cementing and enveloping substance
• Allonton (drug inula) Tablets (0.1) 1 tab. 2-4 tim
es for 30 min. before meals
or
• Kaleflon (extract from marigold flowers) Tablets
(0.1) Table 1-2. 3 times per day after meals

40. treatment
Stimulators of gastric secretion
• Trental (metabolic drug in combination with the i
mprovement of microcirculation) 100 mg 1-2 tab
. 3 times for 30 min. before meals for 1-2 month
s.
or
• Pentagastrin (synthetic analog of histamine) Am
poule 0.025% -1.0 s/c before meal 1-2 times a
day for two weeks

41. treatment
replacement therapy drugs.
• Gastric juice natural vials of 1-2 tablespoons int
o ½ cup of water through a straw while eating
or
• Citric acid powder on the tip of a knife into ¼ cu
p of water with meals
or
• Atsidin-pepsin tablets (0.5) Table 1. dissolved in
½ cup of water with meals

42. treatment
prokinetics.
• Metoclopramide (raglan, Reglan) Tablets (0.01)
Ampules (1 ml-0.005) 10-20 mg 3-4 times a day
for 15-30 minutes before meal, maximum daily
dose of 60 mg
or
• Motilium (domperidone) Tablets 0.01 mg 10-20
3-4 times a day for 15-30 minutes before meals,
daily dose - 60 mg

43. treatment
• Pancreatin Tablets 0.5-1.0 The enzyme prepara
tion from the pancreas of beef cattle. Table 1-2.
before meals 3-4 times
or
• Mezim forte preparation containing pancreatic e
nzymes 1-2 tab. 3 times daily before or during
meals

44. treatment
Antibiotics to treat Helicobacter pylori

45. Peptic ulcer

46. Peptic ulcer - an independent (primary) chronic
relapsing disease gastroduodenal region with th
e formation of ulcers of the stomach and duode
num.

47. Peptic ulcer
Peptic ulcer duodenal bulb (PUD) occurs 4 time
s more often than gastric ulcer (GU).
Peptic ulcer duodenal bulb - is more common in t
he age range 25-75 years (rarely less than 15 y
ears).
GU - occurs more often aged 55-65 (rarely young
er than 40 years).

48. The criteria for early diagnosis.
• epigastric pain - in the center or left of the midlin
e at a stomach ulcer, epigastric right of the midli
ne - duodenal ulcer and prepiloric area with ga
stric cardia of the stomach - in the sternum.
• Early pain (30 minutes - 1 hour after a meal) - at
the top of the stomach ulcer, recent pain (1.5 -
2 hours after a meal), night and hungry (after 6-
7 hours after eating) - ulcer antral department a
nd duodenal ulcer.

49. The criteria for early diagnosis.
• Dumb nature of pain can be aching, boring
• The frequency of pain
• Relief of pain - after antacids, milk, food, of
ten after vomiting
• Seasonality pain - spring, autumn, charact
erized more for duodenal ulcer
• Heartburn

50. The criteria for early diagnosis.
• Belching, often occurs in the localization fi
eld mesogastric
• Nausea – characteristic for mediogastral ul
cers, but not characteristic of ulcer 12 duo
denal ulcer
• Vomiting - at an altitude of pain
• Appetite - kept, good

52. The criteria for early diagnosis.
objective:
• Asthenia
• The tendency to bradycardia
• Tendency to hypertension
• Moderate or severe pain in the epigastric in acut
e: gastric ulcer - midline or left, ulcer 12 duoden
al ulcer over the right
• percussion tenderness over the area of the ulcer
- a symptom of Mendel
• Local protective tension anterior abdominal wall

53. The criteria for early diagnosis.
Laboratory research:
• CBC - a slight increase in red blood cells and h
emoglobin
• Fecal occult blood test (reaction Gregersen) - p
ositive for bleeding from the ulcer

54. The criteria for early diagnosis.
Endoscopy:
• Ulcers round, polygonal or slit form
• Borders ulcers crisp, edge bloodshot, swollen
• Undermining the ulcer edge (facing the cardiac
department), the distal end flat
• The bottom of the ulcer is covered with fibrin

55. Gastroscopy procedure

58. Gastric ulcer with punched-out ulcer
base with whitish fibrinoid exudates.

59. Gastric ulcer (lesser curvature) with punched
-out ulcer base with whitish exudate.

60. The criteria for early diagnosis.
X-rays:
Direct indication of the "niche"
Indirect signs:
• Delay barium mass at the site of the ulcer (contrast stai
n resistant)
• Delayed or accelerated passage of barium sulfate of st
omach
• Duodenalnogastralny reflux
• Convergence folds at locations ulcers
• Lack of cardia, gastroesophageal reflux
• Local stomach cramps or 12 duodenal ulcer
• Symptom De Quervain - circular retraction of the muscl
es on the opposite side of the stomach ulcer - deforma
tion of the stomach and duodenum

61. X-rays

62. Determination Helicobacter pylori
• urease breath test - identifying exhaled C13 isotopes w
hich are formed in the stomach during digestion drunk
labeled urea by the action of urease HP
• histological methods - detection of HP in biopsies stain
ed by the method of Giemsa
• urease biopsy test - determination of urease activity of
HP in biopsies
• The bacteriological test - the growth of HP biopsy
• Immunological methods - determination of antibodies in
the blood to HP, HP detection of antigen in stool

63. Required laboratory tests
• Complete blood count - once (In the event of rep
eated study of 1 every 10 days)
• Blood type
• Fecal occult blood test

64. The severity of the ulcer
Mild - is characterized by the following features:
• Exacerbations 1 time in 1-3 years
• Pain syndrome moderate pain stoped for 4-7 da
ys
• shallow ulcer
• The remission disabled preserved

65. The severity of the ulcer
moderate severity:
• Relapse 2 times a year
• Pain syndrome pronounced pain stoped in the h
ospital for 10-14 days
• Characterized dyspepsia
• Ulcers deep, often bleeds, accompanied by phe
nomena perigastritis, periduodenitis

66. The severity of the ulcer
Severe:
• Relapse 2-3 times a year and more
• Pain and pronounced cropped in the hospital for
2 weeks or more
• Sharply expressed dyspeptic symptoms and wei
ght loss
• The ulcer is often complicated by bleeding, deve
lopment of pyloric stenosis, perigastritis, peridu
odenitis

67. Complications of peptic ulcer disease.
• Peptic ulcer bleeding is observed in 15-25% of patie
nts with peptic ulcer disease, often with stomach ulcer
s localization
• Ulcer perforation occurs in 5% of patients with peptic
ulcer disease, more common in men.
• Penetration - penetration of gastric ulcer or duodenal
ulcer in the surrounding tissues: the pancreas, a small
gland, gall bladder, and others.
• Perivistserit - adhesive process that evolves with ulce
rs between the stomach or duodenum and adjacent or
gans (pancreas, liver, gall bladder). duodenum.

68. Ulcer emergencies

69. Complications of peptic ulcer disease.
• Pyloric stenosis usually formulated after ulc
er healing located in the pyloric channel or the i
nitial part of the duodenum, is found in 5% of pa
tients.
• The risk of malignancy (adenocarcinoma devel
opment) benign ulcers when infected with HP 9
times more likely than uninfected patients.

70. treatment
1. Medical treatment - mental and physical rest, n
ot strict bed rest for 7-10 days, then free.
2. Diet - table 1 a, 1 b for 2-3 days, then the table
1. The food is cooked, but not shabby, eat 5-6 ti
mes a day are not recommended sharp, pickled
, smoked food. The optimum amount of protein i
n the diet of 120-125 g / day.
3. Giving up smoking.
4. Pharmacotherapy.

71. treatment
H. pylori therapy
• First-line therapy (triple therapy) for 7 days
Omeprazole 20 mg 2 times a day, or
Lansoprazole 30 mg 2 times a day, or
Pantoprozol 40 mg 2 times a day
+
Clarithromycin 500 mg 2 times a day
+
Amoxicillin 1000 mg 2 times a day
or
Clarithromycin 500 mg 2 times a day
+
Metronidazole 500 mg 2 times a day

72. treatment
H. pylori therapy
• First-line therapy (triple therapy) for 7 days
Omeprazole 20 mg 2 times a day,
Clarithromycin 500 mg 2 times a day
Amoxicillin 1000 mg 2 times a day

73. treatment
H. pylori therapy
Second-line therapy (quadruple) for 7 days
Omeprazole 20 mg 2 times a day, or
Lansoprazole 30 mg 2 times a day, or
Pantoprozol 40 mg 2 times a day
+
Bismuth subsalicylate 120 mg four times a day
+
Metronidazole 500 mg three times a day
+
Tetracycline 500 mg four times a day

74. treatment
H. pylori therapy
Second-line therapy (quadruple) for 7 days
Omeprazole 20 mg 2 times a day,
Bismuth subsalicylate 120 mg four times a day
Metronidazole 500 mg three times a day
Tetracycline 500 mg four times a day

75. stomach cancer

76. stomach cancer
Stomach cancer - a malignant tumor growing fro
m the epithelial cells of the mucosa (inner) mem
brane of the stomach. Swelling can occur in diff
erent parts of the stomach: at the top, where it c
onnects with the esophagus, in the main part (b
ody) of the stomach or in the bottom where the
stomach is connected to the intestines.

77. stomach cancer
Risk factors for gastric cancer
• Genetic predisposition - if someone in the family d
iagnosed with stomach cancer, then all the other r
elatives (blood) relatives likely to develop increase
d by 20%;
• eating habits - overreliance smoked, spicy, salty, f
ried (overcooked) and canned food, long stored fo
ods containing nitrates, significantly increases the
risk of stomach cancer;
• long-existing diseases of the stomach: gastritis (w
ith low acidity), ulcers and polyps of the stomach;
• gastric surgery increases the risk of gastric cance
r development is 2.5 times;

78. stomach cancer
Risk factors for gastric cancer
• the presence of the stomach bacterium Helicobact
er pylori: In 1994 the World Health Organization (W
HO) has recognized the link between Helicobacter
Pylori and stomach cancer and the bacteria broug
ht it into the category of carcinogens of the first cl
ass;
• Work with asbestos and nickel;
• deficiency of vitamin B12, and C;
• primary and secondary (e.g., AIDS), immunodefici
ency states;
• 20 times more common in gastric cancer patients
with pernicious (malignant) anemia;
• Some viruses, such as Epstein-Barr virus;
• alcoholism and smoking.

79. stomach cancer
clinical picture
• decreased appetite;
• changes in eating habits, for example, they feel
an aversion to meat, fish and etc .;
• rise in temperature (usually 37-38 ° C);
• anemia (decreased hemoglobin).

80. stomach cancer
clinical picture
With the growth of stomach cancer, new symptoms:
• a feeling of heaviness in the stomach after eating, nau
sea and vomiting, fast saturation;
• violation stool (diarrhea, constipation);
• pain in the upper abdomen, girdle pain, smack in the b
ack (in the propagation of the tumor in the pancreas);
• increasing the size of the stomach, fluid accumulation i
n the abdomen (ascites);
• weight loss;
• the destruction of tumor blood vessels may develop ga
strointestinal bleeding.

81. Physical examination
Objective methods of inspection (survey, pa
lpation, percussion) allow revealing a stom
ach cancer only at late stages of disease.

82. TOOL METHODS of INVESTIGATION
• gastroscopy with biopsies.
• computed tomography
• US
• x-ray study.

83. Gastric cancer. Note the irregul
ar heaped up overhanging margi
ns.

84. Gastric cancer with ulcerated ma
ss.

85. Thank you for the attention.