Increased secretion. Violation of the secretory function of the stomach
Disturbances in the formation of hydrochloric acid and changes in the acidity of gastric juice:
- Hyperchlorhydria.
- Hypochlorhydria.
- Achlorhydria.
Gastric juice volume disorders:
- Hyposecretion.
- Hypersecretion.
- Ahilia.
Hypersecretion - a condition characterized by an increase in the volume of gastric juice and an increase in its acidity.
Causes:
Peptic ulcer;
Increased activity vagus nerve;
Hyperproduction of gastrin;
Hyperfunction of enterochromaffin cells;
Overdistension of the antrum of the stomach;
Pathogenesis:
Evacuation of the stomach contents is delayed, as its acidity is increased. It takes more time to alkalize the next portion of the contents coming from the stomach into the duodenum. The more acidic the contents of the stomach are, the more time it takes to alkalize it in the intestines, the longer the period when the pylorus is closed and the contents cannot leave the stomach.
Prolonged residence of the contents in the stomach, the presence of undigested carbohydrates in it, leads to the occurrence of fermentation processes.
As a result, CO 2 and organic acids accumulate. belching odorless (CO 2 leaves the stomach through the esophagus) and heartburn-an unpleasant subjective burning sensation in the epigastric region as a result of the reflux of acidic stomach contents into the esophagus
In addition, gastric hypersecretion leads to the development constipation. Due to the high acidity of gastric contents, when they enter the duodenum, the pylorus quickly slams shut. The contents enter the intestines in small portions and at long intervals. There is no sufficient stretching and, therefore, mechanical stimulation of the intestinal muscles; little peristalsis occurs.
The acidic contents promote the production of large quantities of intestinal hormones - secretin, cholecystokinin, etc. A lot of pancreatic hormones and bile are secreted, rapid and complete hydrolysis of food components and their absorption occurs. Consequently, chemical stimulation of peristalsis is also minimal.
Hyposecretion– a condition characterized by a decrease in the volume of gastric juice and a decrease in its acidity.
Causes:
Hypo- and atrophic gastritis;
Stomach tumor;
Insufficient formation of gastrin;
Neuroses that cause blockade of the vagus nerve;
Deficiency of proteins and vitamins;
Dehydration;
Impact medicines and etc.
Pathogenesis:
Hydrochloric acid stimulates gastric motility. Thus, hyposecretion is accompanied by a decrease in tone and peristalsis.
In the absence of hydrochloric acid, putrefactive flora multiplies in the stomach. This is facilitated by the fact that enzymatic hydrolysis of protein does not occur in the stomach (there is no pepsin and hydrochloric acid). The processes of decay are accompanied by the formation of foul-smelling sulfur-containing gases (hydrogen sulfide, mercaptans) and toxic products.
The belching in such patients is fetid with the smell of rotten eggs.
Nausea and vomiting are typical manifestations of hyposecretion and a hypoacid state.
The lack of hydrochloric acid leads to the fact that the pylorus in such patients is constantly open - “gaping”.
Evacuation disorders are possible in two versions.
1. If tone and peristalsis are preserved to some extent, then the food masses immediately, without lingering in the stomach, “fall through” into the intestines.
2. If achylia is combined with atony and the stomach is a stretched bag sagging into the pelvic cavity, the contents in such a “bag” may be retained long time, despite the open pylorus.
For the latter option, putrefactive processes are especially typical.
A decrease in gastric secretion is usually complicated by hypoacid and Achilles diarrhea.
The undigested contents of the stomach quickly pass through the gaping pylorus into the intestine, this is accompanied by significant stretching and mechanical stimulation of peristalsis. In the absence of hydrochloric acid, interstitial hormones are not produced twelve duodenum Consequently, the supply of pancreatic enzymes and bile secretion are reduced.
This leads to disruption of cavity digestion, the development of fermentation processes and especially putrefactive processes in the intestines and, consequently, fermentation and putrefactive dyspepsia. Chemical stimulation of peristalsis increases. If, even with an optimal diet, such a patient manages to avoid diarrhea, then the slightest violation of the diet leads to the resumption of diarrhea.
Achlorhydria– complete absence of hydrochloric acid in gastric juice.
Ahilia- a condition characterized by a complete absence of gastric secretion.
The amount of hydrogen and chlorine ions in the secretion of the stomach determines the acidity of the digestive juice. Hyperchlorhydria of the stomach is a shift in the pH of the environment inside the organ to the acidic side for various reasons. The pathology is accompanied by heartburn, sour taste in the mouth, belching, and nausea. Excessive stomach acidity can be neutralized with the help of medications, diet therapy, and physiotherapeutic techniques.
In case of gastrointestinal pathologies with high acidity of stomach juice, it is necessary to visit a doctor 1-2 times a year and undergo preventive examination to avoid deformation of the mucous layer of the organ and the formation of ulcers.
Causes of pathology
A shift in the balance between the production of acidic and alkaline compounds by gastric cells and a failure in the process of natural neutralization of excess acid causes a violation of the pH of the digestive juices of the organ. Hyperchlorhydria may indicate the need to adjust lifestyle and diet or signal serious impairment in activity digestive tract. In the first case, acidity is normalized when eliminating harmful factor, and gastrointestinal diseases will require complex treatment. List of probable causes of hyperchlorhydria:
- inflammation of the gastric walls;
- peptic ulcer;
- pancreatitis;
- cholecystitis;
- tumor formations of the gastrointestinal tract;
- neuroses and prolonged stress;
- poor nutrition, abundance acidic foods, carbonated drinks, coffee;
- alcohol abuse and smoking;
- prolonged fasting and unstable diet;
- taking medications.
Manifestations of increased acidity of the stomach
When reflux occurs, a person feels a burning sensation behind the breastbone. The severity of the symptoms of hyperchlorhydria depends on the severity of the disease that provoked it. The first and most common signs of pathology are a feeling of acidity in the mouth, which occurs after eating or on an empty stomach, as well as belching with a sour taste. At the moment of involuntary release of contents from the stomach into the esophagus, the patient suffers severe pain behind the sternum. Hyperchlorhydria may be accompanied by following symptoms:
- stomach ache;
- discomfort after eating;
- flatulence;
- nausea, vomiting.
Diagnostic measures
If you experience abdominal discomfort, heartburn, etc. pathological manifestations, you need to consult a gastroenterologist. The doctor will conduct a survey to determine the intensity, time of onset of symptoms, and their connection with food consumption. And you will also need information about the regime and characteristics of nutrition, lifestyle, condition nervous system patient. After the examination, the doctor will prescribe the following procedures to determine the level of acidity:
- Fractional intubation - obtaining gastric juice in small portions over 2-2.5 hours using a thin probe and syringe;
- pH-metry is a type of probing that lasts up to 3 hours or can be used as a method daily monitoring secretory activity of the stomach.
Diagnostic procedures for measuring gastric acidity must be carried out on an empty stomach, at least 12 hours after eating.
How is hyperchlorhydria treated?
Almagel is one of the drugs prescribed for elevated level hydrochloric acid in digestive organ. To eliminate it is necessary A complex approach. Therapy includes the use of medications, physiotherapy procedures, and diet selection. For hyperchlorhydria, the following groups of drugs are prescribed:
If a patient experiences severe nervous tension, he is recommended to have sessions with a psychotherapist, who, if necessary, can supplement the treatment regimen with psychotropic medications. It is also useful for patients with stomach diseases to master the auto-training technique for self-normalization emotional state. From physiotherapeutic methods for hyperchlorhydria positive action Baths with pine needles, applications of mud, ozokerite or paraffin, warm compresses, electrophoresis with drugs, galvanization will provide relief. It is mandatory to follow diet No. 1, and severe cases- No. 1A or No. 1B.
Achlorhydria refers to a condition characterized by a complete lack of production of hydrochloric acid by gastric cells. It is accompanied by significant digestive disorders and a noticeable deterioration in the well-being of patients. Therapeutic measures, unfortunately, are not sufficiently developed. Basically they come down to replacement therapy.
Achlorhydria, or hypochlorhydria (a significant decrease in the production of hydrochloric acid), affects the performance of many organs. After all, such an aggressive chemical compound does not just form in our body.
The role of hydrochloric acid
Achlorhydria can be caused by the bacteria Helicobacter pylori existing in the stomach for a long time.Wise nature provides for the presence of special cells in the gastric mucosa - parietal cells, which are located in the glands of the body of the stomach and synthesize hydrochloric acid. Her presence is necessary because she:
- activates gastric juice enzymes (pepsinogen, etc.), which are initially produced in an inactive state and therefore are not able to break down food proteins;
- provides an acidic environment in the stomach, which is necessary for the action of gastric enzymes;
- prepares food proteins for digestion;
- creates conditions unfavorable for most microbes to live;
- stimulates production;
- promotes timely and coordinated evacuation of food from the stomach to the duodenum.
Causes
Various processes can lead to disruption of hydrochloric acid synthesis:
The resulting achlorhydria can be either functional (reversible) or organic (due to irreversible cell damage).
Symptoms
Achlorhydria, as a rule, does not appear all at once, so its symptoms arise gradually. They are associated with insufficient digestion of protein components of food. Such patients are often concerned about:
- aching mild or moderate pain localized in the epigastric (epigastric) zone;
- feeling of a stomach full of food;
- belching;
- bloating;
- nausea.
Sometimes achlorhydria does not manifest itself at all, and its presence is detected during an examination of the stomach, which is prescribed for completely different reasons (preparation for surgery, liver disease, etc.).
Diagnostics
One of the symptoms of achlorhydria is heaviness, feeling full stomach. After talking with the patient, the doctor (gastroenterologist or therapist) can recommend a number of examinations. Their volume depends on the individual clinical situation. Without them, unfortunately, it is impossible to verify achlorhydria, determine its causes and prescribe correct treatment. After all, the same clinical manifestations are present in many other ailments (peptic ulcer, diseases of the esophagus, gallbladder, intestines, pancreas, poisoning, etc.).
If you suspect the development of achlorhydria, doctors may prescribe:
- analysis for the content of pepsinogens and gastrin in the blood (atrophy is accompanied by a decrease in pepsinogens, combined with an increase in gastrin);
- test for specific antibodies (to Helicobacter pylori, to parietal cells);
- assessment of the content of antigens of Helicobacter pylori bacteria in feces;
- fibrogastroduodenoscopy - examination of the stomach with a special device - an endoscope, reveals indirect evidence of atrophy: thinning and pallor of the gastric mucosa, loss of its luster, and provides the opportunity to take biopsy specimens - samples of gastric tissue);
- chromogastroscopy with Congo-mouth dye - a dye is injected through an endoscope, which helps to evaluate the ability of the parietal cells of the gastric mucosa to produce hydrochloric acid;
- direct detection of Helicobacter pylori bacteria in biopsy samples (various tests are used for this: histological, molecular genetic, cytological, rapid urease, cytoimmunochemical, etc.);
- histological (under a microscope) examination of gastric tissue (reveals atrophy, contamination with Helicobacter pylori microorganisms).
Treatment
Unfortunately, an exact treatment algorithm for achlorhydria has not yet been developed. The main therapeutic measures are aimed at replenishing the deficiency of hydrochloric acid and stimulating the remaining parietal cells. It is advisable that the doctor develop individual program treatment. This may include:
- special diet;
- medications;
- physiotherapeutic procedures;
- medicinal plants.
Diet
In addition to the usual recommendations aimed at ensuring sufficient stomach sparing, patients with achlorhydria are advised to include in their diet foods that are mild stimulants of gastric secretion. They are diluted lemon, cabbage, cranberry, tomato juice, weak coffee, rosehip infusion, cocoa, herbs, fish soup, vegetable soups. This diet can be supplemented with some therapeutic mineral waters(“Mirgorodskaya”, “Narzan”, “Arzni”, “Slavyanovskaya”, “Essentuki” No. 17 and No. 4), which should definitely be drunk warm.
Medications
Patients with achlorhydria differ from each other. That's why drug regimens Doctors formulate individually, including the following drugs:
- stimulants of gastric secretion (Pentagastrin, Plantaglucid, Limontar, Eufillin, Etimizol, insulin, Lipamide, calcium preparations, etc.);
- replacement drugs (3% hydrochloric acid, Pepsidil, Abomin, Acidin-pepsin, etc.);
- polyenzymes that correct impaired digestion (Enzistal, Digestal, Festal, etc.);
- stimulants for the restoration of the gastric mucosa (Carnitine, Befungin, Retabolil, sodium nucleinate, sea buckthorn oil, vitamins, Etaden, etc.);
- corticosteroid hormones (sometimes recommended for autoimmune gastritis with high level antibodies).
Physiotherapeutic procedures
In case of moderate deficiency of hydrochloric acid, its production can be slightly increased using hyperbaric oxygenation, peloid therapy, electrophoresis with calcium chloride, intragastric electrophoresis of cobamamide and inductothermy.
Medicinal plants
Some medicinal plants, in particular calendula flowers, stimulate the secretion of hydrochloric acid by stomach cells. In case of decreased secretory function of the stomach, patients can be advised to infusions, tinctures, decoctions and herbal applications from the collections of the following stimulant plants:
- plantain;
- parsley;
- wormwood;
- fennel;
- thyme;
- centaury;
- caraway;
- calendula;
- horseradish root;
- tansy;
- hops
However, it is better to use them together with other treatment methods, and not as monotherapy.
The stomach on an empty stomach appears to be almost completely empty and that the acidity of the gastric contents an hour after a test breakfast gives approximately 55-65. Research recent years have shown, however, that there are numerous individual exceptions to this rule, which should in no way be considered, without reservation, as pathological.
Along with people whose stomachs almost completely do not separate free hydrochloric acid, there are also people - and apparently the number of them is quite significant - in whom even on an empty stomach one can constantly find clear traces of HCl in the stomach and whose acidity after a test breakfast is much higher. expressed in figures of 80-100 and even more.
Some of these persons have no dyspeptic disorders at all, so that their unusually high secretion of HCL should be considered only as an individual, and not as a morbid feature. In other cases, these states of increased secretion of HCl occur in persons suffering from severe gastric disorders and in such a form that a direct dependence of these disorders on the increased production of acid seems without further adoubt to be highly probable.
These conditions are designated as dyspepsia acida, and, as has also been mentioned, a distinction is made between superaciditas, that is, abnormally large quantities of hydrochloric acid during digestion, from supersecretio, that is, the continuous secretion of gastric juice and outside the digestive period, therefore, on an empty stomach or after the end gastric emptying.
Supersecretion is almost always associated with increased acidity, but not vice versa. Otherwise, in practice, a strict clinical distinction between these two conditions is not always possible. It seems very important, also from a practical point of view, to make a sharp and definitive distinction between symptomatic increased acidity and supersecretion (occurs, perhaps, with known forms gastritis and above all, almost without exception, with ulcus ventriculi) from essential dyspepsia acida.
True, in practice, as we will soon see, it is often hardly possible to completely reliably carry out differential diagnosis between ulcer and supersecretion. This, however, should not prevent us from establishing the necessary basic differences between the two states. Actually, only those cases in which there is an increased secretion of HCl without the formation of an ulcer should be designated as “essential” supersecretion.
If we consider supersecretion as possible reason formation of an ulcer, then the latter should be designated as a complication of supersecretion. Unfortunately, we still know almost nothing about the causes of ordinary increased acidity and supersecretion. Anatomical studies mucous membranes in typical cases were almost never performed.
Currently usually taken nervous reason supersecretion, which really seems to be evidenced by the frequent connection of supersecretion with other nervous conditions (general neurasthenia, migraines, etc.). We will talk about this circumstance in more detail later.
On the other hand, it is possible that functional disorders in the activity of the cells themselves lead to an increase in secretion. I myself am inclined to equate some cases of supersecretion with known cases increased sweating (sweating hands, feet), saliva formation, etc. Abnormal nervous circumstances do not always have to be present here.
With such a lack of accurate information about the essence of the process, we must for now take a purely clinical point of view and describe painful pictures as they occur in practice. I will only note that this is partly about conditions that are far from rare.
The only thing that is difficult is often their exact interpretation and in particular the question of which of the existing disorders should actually be attributed to supersecretion and which to due to other anomalies that often occur simultaneously (general nervousness, gastroptosis, chlorosis, etc.). For greater clarity, several forms of dyspepsia acida are distinguished, however, we must once again especially note that no sharp distinction is possible between increased acidity and supersecretion.
Dyspepsia with increased acidity (hyperchlorhydria)
Conditions related to this are most often found in at a young age among women. Very often they are associated with signs of chlorosis, general nervousness, etc. But dyspepsia acida is also observed in older people of both sexes. Hyperchlorhydria can also be caused by well-known diet errors (hot, spicy foods, then especially strong coffee).
Dyspeptic conditions with hyperchlorhydria were also often observed in immoderate smokers. The disorders appear to be quite characteristic. They occur mainly after eating and sometimes only after certain foods and consist first of a feeling of heaviness in the stomach, which, however, can sometimes reach the level of real stomach pain.
Usually these pains occur only 2-3 hours after eating, therefore, at a time when the stomach is already empty, a significant separation of acid is still ongoing. Some of the patients then made the observation that they could reduce their pain by introducing new foods or drinking liquids, which is easily understandable.
Very often, during strong acid formation, sour belching appears, causing a clear sensation of heartburn. Vomiting of acidic stomach contents also occurs, although not particularly often. When the stomach is completely empty, patients again feel quite satisfactory.
Since the appetite is usually not impaired, the nutritional status, as a rule, remains quite good. The general course of the disease is, however, chronic, but very variable. Sometimes, especially under the influence of mental factors (sorrow, anxiety) or as a result of an unreasonable lifestyle, painful phenomena become more pronounced, and sometimes they completely disappear.
The diagnosis of hyperchlorhydria can be assumed based on the above-mentioned symptoms; it can only be established precisely by examining it with a probe. External examination of the stomach does not reveal anything special, except for the occasional mild diffuse sensitivity to pressure.
The fact that gastric prolapse often occurs simultaneously does not matter (see next chapter). If the stomach is examined on an empty stomach, then with pure hyperchlorhydria it turns out to be empty or almost empty. The amount of acid after a test breakfast, on the contrary, is very high (70-100 or more), the digestive power of gastric juice is increased. According to this, it's already 3-4 hours,
After a test meal, the stomach is usually found to be completely empty, which indicates good motor power of the stomach. Usually there is still hydrochloric acid present. Digestion of starch is difficult due to the abundant HCl content.
From the above relationships, the diagnosis of hyperchlorhydria as such is clear without further explanation. The only question that seems difficult is whether we are dealing with an ordinary functional increase in secretion or with symptomatic increased acidity in the presence of a stomach ulcer.
If characteristic symptoms If there are no ulcers (stomach bleeding, limited pain with pressure, etc.), then this issue can only be resolved with a certain probability. It seems characteristic that in ordinary hyperchlorhydria, pain improves with administration; food, with an existing stomach ulcer, on the contrary, worsens.
The presence of clearly expressed general nervous symptoms usually definitely indicates a “nervous” increase in acidity. Finally, the success of treatment may have an impact on the diagnosis (see below). We will talk about treatment methods at the same time as treating supersecretion.
Dyspepsia with supersecretion of gastric juice (continuous leakage of gastric juice).
This includes those cases of dyspepsia in which studies of the stomach on an empty stomach reveal the presence of large quantities of fluid with a significant content of HCl, without this supersecretion being considered as a consequence of a gastric ulcer. The disease is much less common than ordinary hyperchlorhydria.
It seems to occur somewhat more often in men than in women. Of the special causal factors, the biggest one can be named: prolonged mental stress and unrest. Often no definite causes can be found.
Symptoms
Symptoms, as with hyperchlorhydria, include pain in the stomach, sour belching, heartburn and often vomiting. Pain occurs when empty stomach, often also at night. Vomiting only rarely produces minor food residues, but for the most part only a cloudy, sometimes bile-colored, strongly acidic liquid with a strong taste, causing a burning pain in the pharynx.
The appetite usually remains good, and sufferers know from experience that by drinking tea (to dilute the gastric juice) or by introducing food they can improve their suffering. The feeling of thirst is also often increased. Stools are usually retained, urine is usually slightly acidic and cloudy due to precipitation of phosphates. The pulse is often slow. In some cases, accompanying general neurasthenic symptoms clearly appear.
An accurate diagnosis, again, can only be made by examining the gastric contents. The decisive symptom is the presence in the stomach on an empty stomach of a large amount of liquid that does not contain any food residues and with high content HCl. It should be especially noted that sometimes, even under normal conditions, small amounts (several cubic centimeters) of gastric contents containing HCl can be found in the stomach.
You can talk about super secretion only when you can get approximately 50-100 cm from an empty stomach without much difficulty? very acidic liquid. Along with supersecretion, there is usually hyperchlorhydria. An hour after the test breakfast, therefore, high acidity figures are found.
If you give a test meal, then after 3 hours the meat has already disappeared, while starch digestion is significantly slowed down due to increased acidity. 7 hours after the test meal, the stomach no longer contains any food residues, but even larger amounts of sour secretion can again be found.
If you inflate the stomach or examine it under an X-ray screen, then sometimes it is found to be drooping (gastroptosis), which, however, indicates only an accidental complication; it is never very expanded. Each stronger dilation of the stomach should raise suspicion of narrowing of the pylorus.
The latter can then usually be easily diagnosed, mainly by identifying difficult gastric emptying. In all cases, where in an empty stomach 7-8 hours after a test meal there is not only copious amount HCl, but along with this there are also abundant food residues; this is not about ordinary supersecretion, but about ulcerative narrowing of the pylorus associated with supersecretion.
This takes on a completely different state. clinical significance. I consider the assumption that the existing supersecretion may be supplemented by a greater slowdown in gastric emptying due to a purely functional pyloric spasm questionable.
In all my cases of supersecretion and severe disturbance of gastric emptying, it was eventually determined with certainty, although at first they were inclined to assume a purely functional supersecretion. It is much more difficult to accurately differentiate supersecretion from gastric ulcers that are not accompanied by judgment. In this case, the narrowing can be alleviated only by the general course of the disease, accompanying nervous phenomena, careful attention to all individual symptoms and, above all, x-ray examination (see above).
The general course of dyspepsia acida with supersecretion is chronic, but very variable. The prognosis is favorable, and correct treatment, possible, however, only on the basis precise research, very often gives good results.
When treating both dyspepsia acida and ordinary hyperchlorhydria or supersecretion, the circumstance that primarily interferes with this treatment is usually the impossibility of completely excluding a gastric ulcer. Rest, a non-irritating diet and the administration of alkalis are, of course, advisable here too. Added to this is the fact that in very rare cases, methodically carried out treatment sometimes has a beneficial suggestive effect on patients with a fearful, hypochondriacal mood.
But precisely this aforementioned combination of dyspepsia acida with a pronounced neuro-hypochondriacal state can, on the other hand, make this effect of strict treatment of ulcers unfavorable. If we are talking about patients who have long been tormented by fear of stomach ulcers, who have therefore already spent so much time treatment courses and those who follow an overly cautious, insufficient diet, as a result of which they become weak and exhausted, then carrying out a new strict treatment of the ulcer may sometimes be useless. It rather strengthens the fears of the sick and makes them even weaker and more unhappy.
This shows how it is necessary to individualize treatment for dyspepsia acida and, above all, what attention should be paid, along with dyspeptic symptoms, to the general condition of patients. It is often recommended to begin with the usual course of an anti-ulcer diet, and then, as soon as the complaints cease, to move more quickly than with an ulcer to more nutritious foods and other methods of treatment.
The more one comes to the conclusion that one is dealing with ordinary nervous supersecretion, and not with an ulcer, the sooner one can neglect dietary treatment. Then it is best to offer patients mainly food rich in proteins (meat, fish, eggs, milk), along with brown bread and butter and light vegetables. Administration should be limited as much as possible. alcoholic drinks, strong coffee, all spices and acids, then flour dishes and mealy vegetables.
True, even in this case one should be guided not only by theoretical reasoning, but also personal experience sick. As for medicines, of course, alkalis are mainly used. Depending on the circumstances of each individual case, Natrium bicarbonicum or another similar powder is prescribed several times a day, especially after meals (for example, Natrii bicarbon., Magnes. ustae ana 20.0, or Natrii bicarbon. 30.0, Bismuthi subn . 5.0, etc.) on the tip of the knife.
If there is supersecretion, then early in the morning, on an empty stomach, 1/2 liter of warmed Carlsbad water or artificial Carlsbad salt dissolved in warm water. In severe cases of supersecretion, regular gastric lavage is advisable, best done early in the morning. For rinsing, you can use a 1% solution of Natrium bicarbonicum.
Atropine and narcotics (morphine and codeine) are recommended as medications that can reduce the secretion of gastric glands. We have also successfully used belladonna (eg Extr. Belladonnae 0.3, Aq. Amygd.amar. 30.0, 3 times a day 15-20 drops after meals) and atropine, but must caution against excessive drug use.
It is very important to simultaneously general treatment, especially in all cases associated with neurasthenic symptoms. In this regard, treatment courses with mineral waters in Carlsbad, Tarasp and other resorts have a very beneficial effect in connection with the general relaxation possible there, with prolonged exposure to the air, with baths, cold rubs, etc. home treatment these healing factors are also accompanied by success.
Periodic (intermittent) supersecretion (gastroxynsis).
The condition here described is that in persons who otherwise feel quite well and have no gastric disturbances, after shorter or longer intervals, sometimes after some inducement, and sometimes apparently without any reason, quite suddenly severe stomach pains, sour belching and vomiting appear. Vomiting voids a large number of watery, sharply acidic liquid containing HCl.
The general state of health of patients during these attacks is very painful, they have a pale appearance, their pulse is small and accelerated. Very often there are extremely severe headaches at the same time. Such an attack lasts several hours, and sometimes also 2-3 days in a row. Often it stops quite suddenly, so that later, after wellness lasting a week, month or more large quantity time, to resume again.
The causes of this amazing disease are still completely unknown. It seems that what really matters here is states of irritation emanating from the nervous system. It seems to me indisputable that there is a close connection between gastroxynsis and real migraine (see the chapter on migraine).
It is also very important to know that a very similar symptom complex (though often without an increase in juice secretion) appears with tabes dorsalis (see the corresponding chapter) and is designated as “gastric crisis.” Therefore, in each case it is necessary to examine tendon reflexes, pupils, etc.
Seizures can also occur with ulcerative narrowing of the pylorus, which may initially give rise to confusion with gastroxynsis on nervous soil. In any case, an x-ray examination of the stomach is necessary every time. Nevertheless, it seems to me indisputable that a pure nervous form, although suffering in a clearly defined form is quite rare.
If possible, gastric secretions should be examined outside of attacks. It seems that some cases of periodic gastroxynsis represent only an exacerbation of constant supersecretion. Then, even in the intervals, there are mild dyspeptic symptoms, and careful treatment of the latter (gastric lavage, alkali, Carlsbad water) has a very beneficial effect on seizures.
If there are general neurasthenic symptoms at the same time, then, of course, you should pay attention to general treatment. Treating the seizures themselves rarely has much success. Work best large doses sodium bromide.
You should also try chloral, belladonna chloroform, codeine, antipyrine, coryphine (6-10 drops). A warm scarf or hot poultice should be applied externally to the abdominal area. In case of very severe pain, subcutaneous injections of morphine sometimes cannot be avoided, although they should be avoided if possible.
characteristic of the localization of the ulcer:
A. esophagus
B. lesser curvature of the stomach
C. body of stomach
D. 12 duodenum
245. Required method examination of gastric ulcer and duodenal ulcer is:
A. colonoscopy
B. study of Helicobacter pylori
C. Ultrasound internal organs
D. irrigoscopy
246. What research method is used for stomach diseases?
A. rectoscopy
B. colonoscopy
C. gastroscopy
D. esophagoscopy
247. Vomiting 10-15 minutes after eating is typical for:
A. ulcers of the cardial part of the stomach
B. ulcers of the body of the stomach
C. ulcers of the antrum of the stomach
D. pyloric stenosis
248. Early pain (30 minutes after eating) is characteristic of:
A. esophagitis
B. gastric ulcer
C. duodenal ulcer
D. inflammation of the gallbladder
249. The following provisions are true for gastric bleeding:
A.always accompanied pain syndrome
B. manifests itself as bloody vomiting
S. observed in esophagitis
D. acholic stool
250. Causes of anemia in peptic ulcer disease:
A. vitamin B-6 deficiency
B. deficiency folic acid
C. vitamin B-12 deficiency
D. bleeding
251. On X-ray examination, pyloric stenosis is characterized by:
A. “niche” symptom
B. defect in the filling of the pylorus
C. Kloiber bowls
252. On X-ray examination, gastric ulcers are characterized by:
A. filling defect
B. “niche” symptom
C. Kloiber bowls
D. retention of barium in the stomach for 12 hours or more
253. X-ray examination stomach determines:
A. shape and size of the stomach, its mobility
B. pH of gastric juice
C. color of the gastric mucosa
D. intragastric pressure
254. Clinical symptoms peptic ulcer:
A. pain characterized by periodicity, seasonality
B. vomiting without nausea
C. weight gain
D. Mendel's symptom is negative
255. Functional status stomach with duodenal ulcer is characterized by:
A. hyposecretion
B. pH above 2.1
C. hyperacidity
D. achlorhydria
256. The most informative and common research methods for peptic ulcer syndrome:
A. irrigoscopy
B. cholangiography
C. esophagogastroduodenoscopy
257. Signs of gastric bleeding in peptic ulcer disease are:
A. acholic feces
B. increase blood pressure
D. vomiting scarlet blood or “coffee grounds”
258. X-ray sign of a stomach ulcer:
A. filling defect
B. lack of peristalsis in the affected area
C. reduction in stomach size
D. presence of a “niche” symptom
259. Helicobacter pylori infection is the main cause of the development of:
A. gastric ulcer and duodenal ulcer
C. cirrhosis of the liver
260. Helicobacter pylori:
A. main cause of reflux-esophagitis
B. is a gram-negative bacterium that persists for a long time in the gastric mucosa
C. is the cause of hepatitis
D. is the main cause of pancreatitis
261. Causes of black stool:
A. hepatic jaundice
B. bleeding from upper section gastrointestinal tract
C. bleeding from the rectum
D. suprahepatic jaundice
262. Which condition is a contraindication to esophagogastroduodenoscopy:
A. esophagogastric bleeding
B. narrowing of the esophagus
C. gastric ulcer
D. peptic ulcer of the esophagus
263. The first signs of bleeding during peptic ulcer stomach:
A. vomiting blood, weakness, dizziness, palpitations
B. acholic stool
C. palpitations and increased blood pressure
D. sudden dagger pain
264. The following symptoms are characteristic of stomach diseases:
A. pain in the left iliac region
B. pain in the right iliac region
C. pain around the navel
D. pain in the epigastric region