Stressful ulcers

Description:

Stressful gastroduodenal ulcers call usually acute, the superficial and multiple cankers of a stomach and duodenum arising at some extreme states are more often.

Frequency of stressful ulcers is estimated in literature ambiguously and fluctuates, for example, at widespread burns (an ulcer of Kurlinga) from 11 to 78%, at neurosurgical operations and craniocereberal injuries (Cushing's ulcer) - from 14 to 15%. The given distinctions in estimates are connected, most likely, with quite often asymptomatic course of such defeats when they are for the first time distinguished only on opening.

Stressful ulcers are most often localized in a stomach body (including it is not so rare on big curvature), is more rare - in its antral department and a bulb of a duodenum.

Pathogeny of stressful ulcers:

The pathogeny of stressful gastroduodenal ulcers is rather difficult and includes many various links.

First of all against the background of a stress owing to activation of a hypothalamus there is an increase in development of AKTG to the subsequent increase in products of corticosteroids in cortical substance of adrenal glands. Corticosteroid hormones in turn reduce products of gastric slime and worsen its qualitative structure, reducing the content of sialic acids, and lead thereby to damage of a protective mucous barrier. Besides, corticosteroids break regeneration of epithelial cells of a mucous membrane of a stomach, promote the increased formation of a histamine from a histidine (due to histidinedecarboxylase enzyme activation).

Corticosteroids, and also catecholamines which are allocated in a large number against the background of a stress worsen microcirculation processes, causing ischemia of a mucous membrane of a stomach. Deterioration in blood circulation in a stomach is promoted also by other heavy disturbances (hypovolemic shock, плазмопотеря) which are observed, for example, at extensive burns.

Increase in functional activity of a hypothalamus as a result of a stress is followed also by increase in a tone of a vagus nerve that leads to strengthening of an acid and peptic factor of a yazvoobrazovaniye. Increase of acid products is in addition promoted by increase in development of a histamine and the catecholamines stimulating production of gastrin.

In a pathogeny of stressful ulcers also disturbances of gastroduodenal motility (stomach paresis, strengthening of a duodenogastralny reflux of bile) have a certain value. Contribute to development of stressful ulcers, perhaps, and disturbances of protein metabolism. As a result of a stress activity of digestive enzymes is braked that leads to insufficient receipt in an organism of amino acids and to negative nitrogenous balance.

Symptoms of stressful ulcers:

The clinical picture of stressful ulcers is characterized, on the one hand, by a malosimptomnost of manifestations (in particular, a rarity of a pain syndrome), and on the other hand - frequent bent to gastrointestinal bleedings which frequency at stressful gastroduodenal ulcers fluctuates, according to different authors, from 11 - 12 to 69-75%, averaging 39-47%. At 3-6% of patients with stressful cankers the perforation of the ulcer is observed.

The lethality at stressful gastroduodenal ulcers fluctuates, according to literature, from 6 to 87,5% also are caused often by a current and the forecast of a basic disease against the background of which there were stressful ulcers.

Treatment of stressful ulcers:

At stressful stomach ulcers and a duodenum treatment has to be directed to the basic disease which was the reason of their development first of all. Purely antiulcerous therapy of stressful ulcers essentially does not differ from treatment of a peptic ulcer, however has to include the most effective antiulcerous remedies (blockers Ng-retseptorov of a histamine, etc.). Surgical ways of treatment should be applied at stressful ulcers only according to strict indications as the postoperative lethality in such cases (considering weight of a basic disease) reaches 50%.

Prevention of stressful ulcers:

Prevention of developing of stressful stomach ulcers and duodenum comes down first of all to timely and careful treatment of a basic disease, maintenance of normal volume of blood, ensuring functions of breath and blood circulation, correction of BRAIDS and electrolytic balance, fight against infectious complications. In the preventive purposes purpose of antiacid and anti-secretory drugs is shown to patients with high risk of developing of stressful ulcers.