The most serious complication of gastric and duodenal ulcers is a perforated stomach ulcer or perforation. If you do not immediately provide emergency care, a person faces peritonitis and even death. In most cases, the disease in men, because women are protected by the body's estrogen, protecting the mucous.
Causes of perforation of the ulcer
There can not be a perforation of a stomach ulcer on an equal place, there are always preconditions for this. Its probability is high in those who suffer from peptic ulcer disease for more than three years, in patients with gastritis who rarely consult a doctor. Calling perforation can:
- strong, sharp load;
- frequent overeating;
- high acidity of gastric juice;
- misuse of spices;
- non-compliance with sleep and wakefulness, night shifts at work, lack of sleep;
- both long-term and short-term use of drugs of certain drugs;
- non-compliance with diet, refusal of liquid food, abuse of fried and smoked products;
- regular use of alcohol and smoking:
- hereditary predisposition.
Perforated ulcer of the stomach - symptoms
Any strong pain in the epigastric region may lead to the idea of ​​perforation of the stomach ulcer, the symptoms of which are characteristic and eloquent. Perforated ulcer or perforation of the stomach is classified by:
- etiology;
- location (localization);
- place of outflow;
- periods (clinical phases).
The first signs of a perforated ulcer
At the very beginning of the disease, in the first period, when the perforation of the ulcer has not yet been diagnosed, the symptoms are characteristic and clear. Knowing them, there is the possibility of unerringly understanding the cause of poor health. There are three phases:
- Chemical peritonitis, which lasts 3-6 hours. At this time there are severe pain in the navel and on the right side of the abdomen. Depending on the location, the perforated ulcer of the stomach can cause atypical pain in the left forearm. Gradually, the pain becomes blurred and felt throughout the stomach, the pressure is lowered. The skin becomes pale and sticky, and the stomach swells due to the accumulation of gases. This is the best time when a patient should be taken to a hospital.
- Bacterial peritonitis does not occur immediately, but after 6 hours from the time when the first signs of perforation of the stomach ulcer were seen. Gradually, the organism becomes intoxicated and the patient's condition worsens, although it does not know the gravity of the situation. This is a period of euphoria, when the signs of perforation of the ulcer become weaker, the pain recedes and the person feels well. By this time, the pressure rises, like the body temperature, the peristalsis is broken, the tongue is covered with a gray coating.
- Acute intoxication occurs after 12 hours from the onset of the disease. The temperature drops, the skin becomes dry, vomiting and dehydration begin. Gassing in the abdomen leads to the fact that the stomach becomes hard and swollen due to gases and decomposition products trapped in the peritoneum. There is a patient's indifference to what is happening, a breakdown, urinary output stops. At this stage the perforated ulcer of the stomach becomes lethal and it is almost impossible to save the patient.
Perforated ulcer - X-ray
Noticing the first signs of a perforated stomach ulcer, a person should immediately be sent to a hospital for diagnosis. With this disease, any delay is very dangerous. Diagnosis is carried out in several ways:
- making an anamnesis of the patient;
- X-ray and laboratory examination;
- endoscopic examination.
In 80% of cases, the X-ray at a perforation of the stomach gives a positive result. Its conduct reveals gas in the abdominal cavity, which falls during the breakdown of the gastric wall. If its quantity is small and the diagnosis is in doubt, the X-ray is repeated, after the patient has had a little carbonated liquid. After that, the gas freely leaves the peritoneum and becomes visible in X-rays.
Perforation of an ulcer - complications
Like other complicated diseases, perforation of the stomach ulcer has its complications:
- internal fistulas (intestinal and gallbladder);
- abscess;
- pneumothorax with ruptured abscess;
- peritonitis .
How to treat a perforated stomach ulcer?
When a perforated stomach ulcer is diagnosed in a person, treatment is likely to be prompt. This is the best way out of the situation when it is possible to sew a hole, and in some cases, to carry out a stomach resection. Only in exceptional cases can conservative treatment be prescribed if the patient refuses surgery. Then, pumping the liquid out of the peritoneum with a probe is used, in a certain way for a few days the patient is laid down, medicines for anti-inflammatory therapy are prescribed.
Perforated stomach ulcer - emergency aid
To minimize the risk of a lethal outcome to a minimum, urgent care is required in the perforation of gastric ulcers in the first hours of the disease, which must be provided by physicians. Do not self-medicate. It is rendered in the following order:
- The patient is laid with a slightly raised head and slightly bent knees.
- Suck the contents of the stomach through the probe.
- To remove the shock (if any), introduce cardiac drugs;
- An infusion of saline and glucose is made as a preparatory stage before the operation.
Perforated ulcer of stomach - operation
In 99% of cases, a perforated ulcer of the stomach is sutured. Depending on the location of the ulcer and the severity of the patient's condition, such surgical interventions are appropriate:
- suturing;
- excision and drainage;
- resection of the stomach ;
- economical resection and vagotomy (dissection of nerves responsible for the production of hydrochloric acid to avoid relapses);
- drainage and vagotomy.
Perforated stomach ulcer - postoperative period
Perforation of an ulcer means an operative solution to the problem. The recovery period is not easy and long. From the correct behavior at this time depends the future health of the operated. Much attention is paid to diet and motor activity. After surgery for 3-4 days the patient remains in bed, after which he is allowed to get up. Do this with an assistant and very slowly, since the body is weakened after surgery. Lying without movement is also not recommended because of the high likelihood of adhesive process.
Diet after a perforated stomach ulcer operation
To reduce complications from surgery to zero, you will need a strict diet after a perforated stomach ulcer. The first 3-4 days the patient is not fed, so that the stomach is used to a new state. The food is delivered via a dropper, using a glucose solution. On the fifth day the patient can start to drink a little bit of jelly and a decoction of dogrose , but the liquid is banned in large quantities, just like salt. By the end of the week in the diet are introduced unsalted rubbed rice soups / porridge and soft-boiled eggs. The ration for the near future after surgery includes:
- boiled eggs;
- steam cutlets and boiled meat of turkey, rabbit, chicken;
- lean sea fish boiled or steamed;
- vegetable purees;
- berry jelly;
- rice, oatmeal, buckwheat;
- bananas, pears;
- low-fat cottage cheese, milk, acidophilus kefir;
- crackers of their yesterday's bread.
Unfortunately, the list of allowed products is very small, in contrast to the list of prohibitions. They will have to adhere to throughout life or make rare exceptions, 2-3 years after the operation:
- smoked products;
- sausages;
- carbonated drinks;
- cucumbers, tomatoes, cabbage, mushrooms;
- onion garlic;
- beans;
- soda, alcohol, coffee, kvass;
- chocolate, desserts, ice cream, buns.