Restorative therapy for chronic gastritis, gastric and duodenal ulcers. Rehabilitation of children and adolescents with gastric ulcers in a clinic setting. Basic principles of therapy Rehabilitation of patients with peptic ulcer

Test

on physical rehabilitation

Physical rehabilitation for gastric and duodenal ulcers

INTRODUCTION

The problem of diseases of the gastrointestinal tract is the most pressing at the moment. Among all diseases of organs and systems, peptic ulcer disease ranks second after coronary heart disease.

Purpose of the work: to study methods of physical rehabilitation for peptic ulcer of the stomach and duodenum.

Research objectives:

.To study the basic clinical data on gastric and duodenal ulcers.

2.To study methods of physical rehabilitation for gastric and duodenal ulcers.

At the present stage, the entire complex of rehabilitation measures gives excellent results in the recovery of patients with peptic ulcer disease. More and more methods are being included in the rehabilitation process from oriental medicine, alternative medicine and other fields. The best effect and lasting remission occurs after using psychoregulatory drugs and elements of auto-training.

L.S. Khodasevich gives the following interpretation of peptic ulcer - it is a chronic disease characterized by dysfunction and the formation of an ulcerative defect in the wall of the stomach or duodenum.

Research by L.S. Khodasevich (2005) showed that peptic ulcer disease is one of the most common diseases of the digestive system. Up to 5% of the adult population suffers from peptic ulcer disease. The peak incidence is observed at the age of 40-60 years; urban residents have a higher incidence than rural residents. Every year, 3 thousand people die from this disease and its complications. Peptic ulcer disease most often develops in men, mainly under the age of 50 years. S.N. Popov emphasizes that in Russia there are more than 10 million such patients with almost annual relapses of ulcers in approximately 33% of them. Peptic ulcer disease occurs in people of any age, but more often in men aged 30-50 years. I.A. Kalyuzhnova claims that most often this disease affects males. Localization of the ulcer in the duodenum is typical for young people. The urban population suffers from peptic ulcers more often than the rural population.

L.S. Khodasevich cites the following possible complications of peptic ulcer disease: perforation (perforation) of the ulcer, penetration (into the pancreas, wall of the large intestine, liver), bleeding, periulcerous gastritis, perigastritis, periulcerous duodenitis, periduodenitis; stenosis of the inlet and outlet of the stomach, stenosis and deformation of the duodenal bulb, malignancy of gastric ulcer, combined complications.

In the complex of rehabilitation measures, according to S.N. Popov, first of all, medications, motor regimen, exercise therapy and other physical methods of treatment, massage, and nutritional therapy should be used. Exercise therapy and massage improve or normalize neurotrophic processes and metabolism, helping to restore the secretory, motor, absorption and excretory functions of the digestive canal.

Chapter 1. Basic clinical data on gastric and duodenal ulcers

1 Etiology and pathogenesis of gastric and duodenal ulcers

According to Khodasevich L.S. (2005), the term “peptic ulcer” is characterized by the formation of areas of destruction of the mucous membrane of the gastrointestinal tract. In the stomach it is most often localized on the lesser curvature, in the duodenum - in the bulb on the back wall. HELL. Ibatov believes that factors contributing to the occurrence of ulcers are prolonged and/or repeated emotional stress, genetic predisposition, the presence of chronic gastritis and duodenitis, Helicobacter pylori contamination, poor diet, smoking and drinking alcohol.

In the educational dictionary-reference book O.V. Kozyreva, A.A. Ivanov, the concept of “ulcer” is characterized as local loss of tissue on the surface of the skin or mucous membrane, destruction of their main layer, and a wound that heals slowly and is usually infected with foreign microorganisms.

S.N. Popov believes that the development of ulcers is facilitated by various lesions of the nervous system (acute psychological trauma, physical and especially mental overstrain, various nervous diseases). It should also be noted the importance of the hormonal factor and especially histamine and serotonin, under the influence of which the activity of the acid-peptic factor increases. Violation of diet and food composition is also of certain importance. In recent years, more and more attention has been given to the infectious (viral) nature of this disease. Hereditary and constitutional factors also play a certain role in the development of ulcers.

L.S. Khodasevich distinguishes two stages of the formation of a chronic ulcer:

erosion - a surface defect formed as a result of necrosis of the mucous membrane;

an acute ulcer is a deeper defect that involves not only the mucous membrane, but also other membranes of the stomach wall.

S.N. Popov believes that currently the formation of gastric or duodenal ulcers occurs as a result of emerging changes in the ratio of local factors of “aggression” and “defense”; At the same time, there is a significant increase in “aggression” against the background of a decrease in “defense” factors. (decrease in the production of mucobacterial secretion, slowdown in the processes of physiological regeneration of the surface epithelium, decrease in blood circulation in the microvasculature and nervous trophism of the mucous membrane; inhibition of the main mechanism of sanogenesis - the immune system, etc.).

L.S. Khodasevich cites the differences between the pathogenesis of gastric ulcers and pyloroduodenal ulcers.

Pathogenesis of pyloroduodenal ulcers:

impaired motility of the stomach and duodenum;

hypertonicity of the vagus nerve with increased activity of the acid-peptic factor;

increased levels of adrenocorticotropic hormone of the pituitary gland and glucocorticoids of the adrenal glands;

significant predominance of the acid-peptic factor of aggression over the protective factors of the mucous membrane.

Pathogenesis of stomach ulcers:

suppression of the functions of the hypothalamic-pituitary system, decreased tone of the vagus nerve and activity of gastric secretion;

weakening of mucosal protective factors

1.2 Clinical picture, classification and complications of gastric and duodenal ulcers

In the clinical picture of the disease S.N. Popov notes a pain syndrome, which depends on the location of the ulcer, dyspeptic syndrome (nausea, vomiting, heartburn, change in appetite), which, like pain, can be rhythmic in nature; signs of gastrointestinal bleeding or clinical peritonitis may be observed when the ulcer is perforated.

The leading feature, according to S.N. Popov and L.S. Khodasevich, is a dull, aching pain in the epigastric region, most often in the epigastric region, usually occurring 1-1.5 hours after eating with a stomach ulcer and after 3 hours with a duodenal ulcer, the pain in which is usually localized to the right of the midline of the abdomen. Sometimes there are pains on an empty stomach, as well as night pains. Gastric ulcers are usually observed in patients over 35 years of age, and duodenal ulcers in young people. There is a typical seasonality of spring exacerbations

During YaB S.N. Popov distinguishes four phases: exacerbation, fading exacerbation, incomplete remission and complete remission. The most dangerous complication of ulcer is perforation of the stomach wall, accompanied by acute “dagger” pain in the abdomen and signs of inflammation of the peritoneum. This requires immediate surgical intervention.

P.F. Litvitsky describes the manifestations of PU in more detail. PUD is manifested by pain in the epigastric region, dyspeptic symptoms (belching of air, food, nausea, heartburn, constipation), asthenovegetative manifestations in the form of decreased performance, weakness, tachycardia, arterial hypotension, moderate local pain and muscle protection in the epigastric region, as well as ulcers can debut with perforation or bleeding.

PUD is manifested by pain, predominant in 75% of patients, vomiting at the height of pain, bringing relief (reduction of pain), vague dyspeptic complaints (belching, heartburn, bloating, food intolerance in 40-70%, frequent constipation), upon palpation it is determined by pain in the epigastric region, sometimes some resistance of the abdominal muscles, asthenovegetative manifestations, and also periods of remission and exacerbation are noted, the latter lasting several weeks.

In the educational dictionary-reference book O.V. Kozyreva, A.A. Ivanov distinguish ulcers:

duodenal - duodenal ulcer. It occurs with periodic pain in the epigastric region, appearing for a long time after eating, on an empty stomach or at night. Vomiting does not occur (unless stenosis has developed), increased acidity of gastric juice and hemorrhages are very common;

gastroduodenal - peptic ulcer and duodenum;

stomach - ulcerative stomach;

perforated ulcer - an ulcer of the stomach and duodenum that has perforated into the free abdominal cavity.

P.F. Litvitsky and Yu.S. Popov gives a classification of nuclear weapons:

Most type 1 ulcers occur in the body of the stomach, namely in the area called the place of least resistance, the so-called transition zone, located between the body of the stomach and the antrum. The main symptoms of an ulcer in this localization are heartburn, belching, nausea, vomiting, which brings relief, pain that occurs 10-30 minutes after eating, which can radiate to the back, left hypochondrium, left half of the chest and/or behind the sternum. An ulcer of the antrum of the stomach is typical for young people. It manifests itself as “hungry” and night pain, heartburn, and less commonly, vomiting with a strong sour odor.

Stomach ulcers that occur together with duodenal ulcers.

Ulcers of the pyloric canal. In their course and manifestations, they are more similar to duodenal ulcers than gastric ulcers. The main symptoms of an ulcer are sharp pain in the epigastric region, constant or occurring randomly at any time of the day, and may be accompanied by frequent severe vomiting. Such an ulcer is fraught with all sorts of complications, primarily pyloric stenosis. Often, with such an ulcer, doctors are forced to resort to surgery;

High ulcers (subcardial), localized near the esophagogastric junction on the lesser curvature of the stomach. It is more common in older people over 50 years of age. The main symptom of such an ulcer is pain that occurs immediately after eating in the area of ​​the xiphoid process (under the ribs, where the sternum ends). Complications characteristic of such an ulcer are ulcerative bleeding and penetration. Often, in its treatment it is necessary to resort to surgical intervention;

Duodenal ulcer. In 90% of cases, a duodenal ulcer is localized in the bulb (a thickening in its upper part). The main symptoms are heartburn, “hungry” and night pain, most often in the right side of the abdomen.

S.N. Popov also classifies ulcers by type (single and multiple), by etiology (associated with Helicobacter pylori and not associated with N.R.), by clinical course (typical, atypical (with atypical pain syndrome, painless, but with other clinical manifestations, asymptomatic)), according to the level of gastric secretion (with increased secretion, with normal secretion and with decreased secretion), according to the nature of the course (newly diagnosed ulcer, recurrent course), according to the stage of the disease (exacerbation or remission), according to the presence of complications (bleeding , perforation, stenosis, malignancy).

The clinical course of ulcer, explains S.N. Popov, may be complicated by bleeding, perforation of the ulcer into the abdominal cavity, or narrowing of the pylorus. With a long course, cancerous degeneration of the ulcer may occur. In 24-28% of patients, ulcers can occur atypically - without pain or with pain resembling another disease (angina pectoris, osteochondrosis, etc.), and are discovered by chance. Peptic ulcer may also be accompanied by gastric and intestinal dyspepsia, asthenoneurotic syndrome.

Yu.S. Popova describes in more detail the possible complications of peptic ulcer disease:

Perforation (perforation) of an ulcer, that is, the formation of a through wound in the wall of the stomach (or 12pk), through which undigested food, along with acidic gastric juice, enters the abdominal cavity. Often, perforation of an ulcer occurs as a result of drinking alcohol, overeating or physical stress.

Penetration is a violation of the integrity of the stomach when gastric contents spill into the nearby pancreas, omentum, intestinal loops or other organs. This happens when, as a result of inflammation, the wall of the stomach or duodenum becomes fused with surrounding organs (adhesions are formed). The attacks of pain are very severe and cannot be relieved with medications. Treatment requires surgery.

Bleeding may occur during an exacerbation of ulcerative disease. It may be the beginning of an exacerbation or open at a time when other symptoms of an ulcer (pain, heartburn, etc.) have already appeared. It is important to note that ulcer bleeding can occur both in the presence of a severe, deep, advanced ulcer, and in a fresh, small ulcer. The main symptoms of ulcer bleeding are black stools and coffee-ground-colored vomit (or vomiting blood).

In cases of extreme necessity, when the patient’s condition becomes dangerous, surgical intervention is performed in case of ulcer bleeding (the bleeding wound is sutured). Often, ulcer bleeding is treated with medication.

A subphrenic abscess is a collection of pus between the diaphragm and adjacent organs. This complication of ulcer is very rare. It develops during the period of exacerbation of ulcer as a result of perforation of the ulcer or spread of infection through the lymphatic system of the stomach or duodenum.

Obstruction of the pyloric part of the stomach (pyloric stenosis) is an anatomical distortion and narrowing of the sphincter lumen that occurs as a result of scarring of an ulcer of the pyloric canal or the initial part of the duodenum. This phenomenon leads to difficulty or complete cessation of evacuation of food from the stomach. Pyloric stenosis and associated digestive disorders lead to disorders of all types of metabolism, which leads to exhaustion of the body. The main method of treatment is surgery.

peptic ulcer disease rehabilitation

1.3 Diagnosis of gastric and duodenal ulcers

The diagnosis of ulcer is made to patients most often during an exacerbation, says Yu.S. Popova. The first and main sign of an ulcer is severe spasmodic pain in the upper abdomen, in the epigastric region (above the navel, at the junction of the costal arches and the sternum). Ulcer pain is the so-called hunger pain, tormenting the patient on an empty stomach or at night. In some cases, pain may occur 30-40 minutes after eating. In addition to pain, there are other symptoms of exacerbation of peptic ulcer disease. These are heartburn, sour belching, vomiting (appears without preliminary nausea and brings temporary relief), increased appetite, general weakness, fatigue, mental imbalance. It is also important to note that during exacerbation of peptic ulcer disease, as a rule, the patient suffers from constipation.

The methods used by modern medicine to diagnose ulcers largely coincide with the methods for diagnosing chronic gastritis. X-ray and fibrogastroscopic studies determine anatomical changes in the organ, and also answer the question of what functions of the stomach are impaired.

Yu.S. Popova offers the first, simplest methods for examining a patient with a suspected ulcer - these are laboratory tests of blood and stool. A moderate decrease in the level of hemoglobin and red blood cells in a clinical blood test allows the detection of hidden bleeding. A stool test called a stool occult blood test should reveal the presence of blood (from a bleeding ulcer).

Gastric acidity in ulcerative disease is usually increased. In this regard, an important method for diagnosing ulcer disease is to study the acidity of gastric juice using Ph-metry, as well as by measuring the amount of hydrochloric acid in portions of gastric contents (gastric contents are obtained by intubation).

The main method for diagnosing gastric ulcers is FGS. With the help of FGS, the doctor can not only verify the presence of an ulcer in the patient’s stomach, but also see how large it is, in which specific part of the stomach it is located, whether the ulcer is fresh or healing, whether it bleeds or not. In addition, FGS allows you to diagnose how well the stomach is working, as well as take a microscopic piece of the gastric mucosa affected by an ulcer for analysis (the latter allows, in particular, to determine whether the patient is affected by H.P.).

Gastroscopy, as the most accurate research method, allows you to determine not only the presence of an ulcer, but also its size, and also helps to distinguish an ulcer from cancer and notice its degeneration into a tumor.

Yu.S. Popova emphasizes that fluoroscopic examination of the stomach allows not only to diagnose the presence of an ulcer in the stomach, but also to evaluate its motor and excretory functions. Data on impaired motor abilities of the stomach can also be considered indirect signs of an ulcer. So, if there is an ulcer located in the upper parts of the stomach, accelerated evacuation of food from the stomach is observed. If the ulcer is located low enough, food, on the contrary, stays in the stomach longer.

4 Treatment and prevention of gastric and duodenal ulcers

In the complex of rehabilitation measures, according to S.N. Popov, first of all, medications, motor regimen, exercise therapy and other physical methods of treatment, massage, and nutritional therapy should be used. Exercise therapy and massage improve or normalize neurotrophic processes and metabolism, helping to restore the secretory, motor, absorption and excretory functions of the digestive canal.

The causes, signs, diagnostic methods and possible complications of ulcer vary somewhat depending on which specific part of the stomach or duodenum the exacerbation is localized, explains O.V. Kozyreva.

According to N.P. Petrushkina, treatment of the disease should begin with a rational diet, diet and psychotherapy (to eliminate unfavorable pathogenetic factors). In the acute period, with severe pain, drug treatment is recommended.

4.1 Treatment with medications

Popova Yu.S. emphasizes that treatment is always prescribed by a doctor individually, taking into account many important factors. These include the characteristics of the patient’s body (age, general health, the presence of allergies, concomitant diseases), and the characteristics of the course of the disease itself (in which part of the stomach the ulcer is located, what it looks like, how long the patient has been suffering from ulcer).

In any case, treatment of ulcers will always be comprehensive, says Yu.S. Popova. Since the causes of the disease are poor nutrition, infection of the stomach with a specific bacteria, and stress, proper treatment should be aimed at neutralizing each of these factors.

The use of medications during exacerbation of peptic ulcer disease is necessary. Medicines that help reduce the acidity of gastric juice, protect the mucous membrane from the negative effects of acid (antacids), restore normal motility of the stomach and duodenum, are combined with medications that stimulate the healing processes of ulcers and restoration of the mucous membrane. For severe pain, antispasmodics are used. If there are psychological disorders or stress, sedatives are prescribed.

4.2 Diet therapy

Yu.S. Popova explains that therapeutic nutrition for ulcer should provide the gastric mucosa and duodenum with maximum rest; it is important to exclude mechanical and thermal damage to the gastric mucosa. All food is pureed, the temperature of which is from 15 to 55 degrees. In addition, during exacerbation of ulcerative disease, it is unacceptable to consume foods that provoke increased secretion of gastric juice. Meals are fractional - every 3-4 hours, in small portions. The diet should be complete, with an emphasis on vitamins A, B and C. The total amount of fat should not be more than 100-110 g per day.

4.3 Physiotherapy

According to G.N. Ponomarenko, physiotherapy is prescribed to reduce pain and provide an antispastic effect, relieve the inflammatory process, stimulate regenerative processes, regulate the motor function of the gastrointestinal tract, and increase immunity. Local air cryotherapy is used, exposing the back and abdomen to cold air for about 25-30 minutes; peloidotherapy in the form of mud applications on the anterior abdominal cavity; radon and carbon dioxide baths; magnetic therapy, which has a positive effect on immune processes. Contraindications to physiotherapy are severe ulcer disease, bleeding, individual intolerance to physiotherapeutic methods, gastric polyposis, malignancy of ulcers, general contraindications for physiotherapy.

1.4.4 Herbal medicine

N.P. Petrushkina explains that herbal medicine is included in complex treatment later. In the process of herbal medicine of gastrointestinal tract and duodenum, neutralizing, protecting and regenerating groups of drugs are used to increase the activity of the acid-peptic factor. For long-term ulcerative defects, antiulcer drugs of plant origin are used (sea buckthorn oil, rosehip oil, carbenoxolone, alantone). However, it is better to add it to a treatment complex with herbs and a phytodiet.

For peptic ulcer with increased secretory activity of the stomach, it is recommended to collect medicinal herbs: plantain leaves, chamomile flowers, cudweed grass, rose hips, yarrow herb, licorice roots.

For the treatment of ulcers and duodenal ulcers, the author also offers herbal infusions such as: fennel fruits, marshmallow root, licorice, chamomile flowers; herb celandine, yarrow, St. John's wort and chamomile flowers. The infusion is usually taken before meals, at night, or to relieve heartburn.

4.5 Massage

Among the means of exercise therapy for diseases of the abdominal organs, massage is indicated - therapeutic (and its varieties - reflex-segmental, vibration), says V.A. Epifanov. Massage in the complex treatment of chronic gastrointestinal diseases is prescribed to provide a normalizing effect on the neuroregulatory apparatus of the abdominal organs, to help improve the function of the smooth muscles of the intestines and stomach, and strengthen the abdominal muscles.

According to V.A Epifanov, when carrying out the massage procedure, the paravertebral (Th-XI - Th-V and C-IV - C-III) and reflexogenic zones of the back, the area of ​​the cervical sympathetic nodes, and the stomach should be affected.

Massage is contraindicated in the acute stage of diseases of the internal organs, in diseases of the digestive organs with a tendency to bleeding, tuberculosis lesions, neoplasms of the abdominal organs, acute and subacute inflammatory processes of the female genital organs, pregnancy.

4.6 Prevention

To prevent exacerbations of ulcerative disease, S.N. Popov offers two types of therapy (maintenance therapy: antisecretory drugs in half the dose; preventive therapy: when symptoms of exacerbation of ulcer appear, antisecretory drugs are used for 2-3 days. Therapy is stopped when the symptoms completely disappear) with patients observing general and motor regimens, and also a healthy lifestyle. A very effective means of primary and secondary prevention of ulcer disease is sanatorium treatment.

To prevent the disease, Yu.S. Popova recommends observing the following rules:

sleep 6-8 hours;

give up fatty, smoked, fried foods;

if you have stomach pain, you should be examined by a medical specialist;

Take pureed, easily digestible food 5-6 times a day: porridge, jelly, steamed cutlets, sea fish, vegetables, omelet;

treat bad teeth so you can chew food well;

avoid scandals, as after a nervous overstrain the pain in the stomach intensifies;

do not eat very hot or very cold food, as this may contribute to the development of esophageal cancer;

do not smoke or abuse alcohol.

To prevent stomach and duodenal ulcers, it is important to be able to cope with stress and maintain your mental health.

CHAPTER 2. Methods of physical rehabilitation for gastric and duodenal ulcers

1 Physical rehabilitation at the inpatient stage of treatment

According to A.D., they are subject to hospitalization. Ibatova, patients with newly diagnosed ulcer, with exacerbation of ulcer and when complications occur (bleeding, perforation, penetration, pyloric stenosis, malignancy). Considering that the traditional means of treating ulcer are heat, rest and diet.

At the inpatient stage, semi-bed or bed rest is prescribed, respectively (in case of severe pain). Diet - table No. 1a, 1b, 1 according to Pevzner - provides mechanical, chemical and thermal sparing of the stomach [Appendix B]. Eradication therapy is carried out (if Helicobacter pylori is detected): antibacterial therapy, antisecretory therapy, drugs that normalize gastric and duodenal motility. Physiotherapy includes electrosleep, sinusoidal-modeled currents to the stomach area, UHF therapy, ultrasound to the epigastric area, novocaine electrophoresis. In case of a stomach ulcer, oncological alertness is necessary. If malignancy is suspected, physiotherapy is contraindicated. Exercise therapy is limited to UGG and LH in a gentle manner.

V.A. Epifanov claims that LH is used after the acute period of the disease. Exercises should be performed with caution if they increase pain. Complaints often do not reflect the objective state; the ulcer can progress even with subjective well-being (disappearance of pain, etc.). You should spare the abdominal area and very carefully, gradually increase the load on the abdominal muscles. You can gradually expand the patient's motor mode by increasing the total load when performing most exercises, including diaphragmatic breathing, for the abdominal muscles.

According to I.V. Milyukova, during exacerbations, frequent changes in rhythm, a fast pace of performing even simple exercises, and muscle tension can cause or aggravate pain and worsen the general condition. During this period, monotonous exercises are used, performed at a slow pace, mainly in a prone position. In the remission phase, exercises are performed in the IP standing, sitting and lying down; The amplitude of movements increases, you can use exercises with apparatus (weighing up to 1.5 kg).

When transferring a patient to a ward regime, A.D. states. Ibatov, rehabilitation of the second period is prescribed. The tasks of the first include the tasks of household and work rehabilitation of the patient, restoration of correct posture when walking, and improvement of coordination of movements. The second period of classes begins with a significant improvement in the patient’s condition. UGG, LH, abdominal wall massage are recommended. The exercises are performed in a lying position, sitting, on your knees, standing with gradually increasing effort for all muscle groups, still excluding the abdominal muscles. The most acceptable position is lying on your back: it allows you to increase the mobility of the diaphragm, has a gentle effect on the abdominal muscles and helps improve blood circulation in the abdominal cavity. Patients perform exercises for the abdominal muscles without tension, with a small number of repetitions. After the disappearance of pain and other signs of exacerbation, in the absence of complaints and general satisfactory condition, a free regimen is prescribed, emphasizes V.A. Epifanov. In LH classes, exercises are used for all muscle groups (sparing the abdominal area and excluding sudden movements) with increasing effort from various IPs. Include exercises with dumbbells (0.5-2 kg), medicine balls (up to 2 kg), exercises on a gymnastic wall and bench. Diaphragmatic breathing of maximum depth. Walking up to 2-3 km per day; walking up stairs up to 4-6 floors, outdoor walks are desirable. The duration of the LG session is 20-25 minutes.

2 Physical rehabilitation at the outpatient stage of treatment

At the outpatient stage, patients are observed in the third group of dispensary registration. With ulcerative gastrointestinal tract, patients are examined 2 to 4 times a year by a therapist, gastroenterologist, surgeon, and oncologist. Every year, as well as during exacerbations, gastroscopy and biopsy are performed; fluoroscopy - according to indications, clinical blood test - 2-3 times a year, gastric juice analysis - 1 time in 2 years; stool analysis for occult blood, examination of the biliary system - according to indications. During examinations, the diet is adjusted, anti-relapse therapy is carried out if necessary, rational employment and indications for referral to sanatorium treatment are determined. With DU, the patient is invited for periodic examinations 2-4 times a year, depending on the frequency of exacerbations. In addition, patients undergo oral sanitation and dental prosthetics. Physiotherapeutic procedures include: electrosleep, microwave therapy for the stomach area, UHF therapy, ultrasound.

3 Physical rehabilitation at the sanatorium stage of treatment

The indication for sanatorium-resort treatment is gastric ulcer and duodenum in the stage of remission, incomplete remission or fading exacerbation, if there is no motor insufficiency of the stomach, a tendency to bleeding, penetration and suspicion of the possibility of malignant degeneration. Patients are sent to local specialized sanatoriums, to gastroenterological-type resorts with mineral drinking waters (in the Caucasus, Udmurtia, Nizhneivkino, etc.) and mud resorts. Sanatorium-resort treatment includes therapeutic nutrition according to diet table No. 1 with a transition to tables No. 2 and No. 5 [Appendix B]. Treatment is carried out with mineral waters, taken warm in portions of 50-100 ml 3 times a day, with a total volume of up to 200 ml. The time of administration is determined by the state of the secretory function of the stomach. They accept non-carbonated, low- and medium-mineralized mineral waters, mostly alkaline: “Borjomi”, “Smirnovskaya”, “Essentuki” No. 4. With preserved and increased secretion, water is taken 1-1.5 hours before meals. Balneological procedures include sodium chloride, radon, pine, pearl baths (every other day), heat therapy: mud and ozokerite applications, mud electrophoresis. In addition, sinusoidal-modeled currents, SMV therapy, UHF therapy, and diadynamic currents are prescribed. Exercise therapy is carried out according to a gentle tonic regimen using UGG, sedentary games, dosed walking, swimming in open reservoirs. Therapeutic massage is also used: from behind - segmental massage in the back from C-IV to D-IX on the left, in front - in the epigastric region, the location of the costal arches. The massage should be gentle at first. The intensity of the massage and the duration of the procedure gradually increases from 8-10 to 20-25 minutes towards the end of the treatment.

Treatment of patients takes place during a period of remission, the volume and intensity of PH exercises increases: OUU, remote control exercises, coordination exercises are widely used, outdoor and some sports games (badminton, table tennis,) and relay races are allowed. Health paths and walks in winter - skiing (the route should exclude ascents and descents with a steepness exceeding 15-20 degrees, alternating walking style) are recommended. In the LH procedure, there are no strength, speed-strength exercises, static efforts and tensions, jumps and leaps, or fast-paced exercises. IP sitting and lying down.

CONCLUSION

Peptic ulcer ranks second in terms of morbidity in the population after coronary artery disease. Many cases of stomach and duodenal ulcers, gastritis, duodenitis, and possibly some cases of stomach cancer are etiologically associated with Helicobacter pylori infection. However, the majority (up to 90%) of infected carriers of H.P. no symptoms of disease are detected. This gives reason to believe that PU is a neurogenic disease that developed against the background of prolonged psycho-emotional stress. Statistics show that urban residents are more susceptible to ulcers than rural residents. A less significant factor for the occurrence of ulcers is poor nutrition. I think everyone will agree with me that against the backdrop of stress, emotional overload in work and life, people often, without noticing it, lean toward tasty rather than healthy food, and some also abuse tobacco products and alcoholic beverages. In my opinion, if the situation in the country were not tense, as it is at the moment, the incidence would be clearly lower. During the Great Patriotic War, soldiers were susceptible to various gastrointestinal diseases from the martial law in the country, from poor nutrition and tobacco abuse. Soldiers were also subject to hospitalization and rehabilitation. Seventy years later, the factors causing ulcer disease remain the same.

For the treatment of peptic ulcers, first of all, drug therapy is used to suppress the infectious factor (antibiotics), to stop bleeding (if necessary), nutritional therapy, to prevent complications, a motor regimen is used with the use of physical means of rehabilitation: UGG, LH, DU, relaxation exercises, which are special, and other forms of conducting classes. Physiotherapeutic procedures (electrosleep, novocaine electrophoresis, etc.) are also prescribed. It is very important that during the rehabilitation period the patient is in a state of rest, ensure silence if possible, limit watching TV to 1.5-2 hours a day, and walk outdoors 2-3 km a day.

After the relapse stage, the patient is transferred to a clinic with a gastroenterologist and is observed for 6 years, with periodic treatments in sanatoriums or resorts to ensure stable remission. In the sanatorium, patients are treated with mineral waters, various types of massage, skiing, cycling, swimming in open water, and games.

Physical rehabilitation for any disease plays an important role for the complete recovery of a person after illness. This allows you to save a person’s life, teach him to cope with stress, teach and instill in him a conscious attitude in performing physical exercises in order to maintain his health, instill a stereotype about a healthy lifestyle, which helps a person not to become ill again in the future.

LIST OF ABBREVIATIONS

N.R. - Helicobacter pylori (Helicobacter pylori)

UHF - decimeter wave (therapy)

Duodenum - duodenum

DU - breathing exercises

Gastrointestinal tract - gastrointestinal tract

IHD - coronary heart disease

IP - starting position

LH - therapeutic exercises

Exercise therapy - therapeutic physical culture

NS - nervous system

ORU - general developmental exercises

OUU - general strengthening exercises

SMV - centimeter wave (therapy)

ESR - erythrocyte sedimentation rate

FGS - fibrogastroscopy

UHF - ultra high frequency (therapy)

UGG - morning hygienic gymnastics

HR - heart rate

ECG - electrocardiography

PU - peptic ulcer

PUD - duodenal ulcer

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APPLICATIONS

Appendix A

Outline of therapeutic exercises for peptic ulcers of the stomach and duodenum

Date: 11.11.11

Observed: Full name, 32 years old

Diagnosis: duodenal ulcer, gastroduodenitis, superficial gastritis;

Stage of the disease: relapse, subacute (fading exacerbation)

Motor mode: extended bed rest

Venue: Chamber

Method of implementation: individual

Lesson duration: 12 minutes

Lesson objectives:

.contribute to the regulation of nervous processes in the cerebral cortex, increasing the psycho-emotional state;

2.help improve digestive functions, redox processes, regeneration of the mucous membrane, improve respiratory and circulatory functions;

.ensure the prevention of complications and stagnation, help improve overall physical performance;

.continue training in diaphragmatic breathing, relaxation exercises, elements of auto-training;

.cultivate a conscious attitude towards performing special physical exercises at home in order to prevent relapse of the disease and prolong the period of remission.

Application

Parts of the lesson Particular tasks Contents of the lesson Dosage Organizational method. instructionsIntroductory preparation of the body for the upcoming load t = 3"Check heart rate and respiratory rate1) IP lying on your back.Measure heart rate and respiratory rateHR for 15""Respiratory rate for 30""Show measurement areaTeach diaphragmatic breathing1) IP lying on your back, arms along the torso, legs bent in the knees. Diaphragmatic breathing: 1. inhale - the abdominal wall rises, 2. exhale - retracts 6-8 times. Tempo is slow. Imagine how the air leaves the lungs. Improve peripheral blood circulation. 2) IP lying on your back, arms along the body. Simultaneous flexion and extension of the feet and hands into a fist 8-10 times Medium tempo Random breathing Stimulate blood circulation in the lower extremities 3) IP lying on your back Alternate bending of the legs without lifting your feet from the bed 1. exhale - flexion, 2. inhale - extension 5-7 times Slow tempo Stimulate blood circulation in the upper extremities 4) IP lying on your back, arms along the body 1. inhale - spread your arms to the sides, 2. exhale - return to IP 6-8 times Tempo is slowBasic Solution of general and special problems t = 6 "Strengthen the abdominal muscles and pelvic floor 5) IP lying on your back, legs bent at the knees. 1. spread your knees to the sides, connecting the soles, 2. return to IP 8-10 times. The pace is slow. Do not hold your breath. Improve blood circulation in the internal organs. 6) IP sitting on the bed, legs down, hands on the belt. 1. exhale - turn the torso to the right, arms to the sides, 2. inhale - return to IP, 3. exhale - turn the torso to the left, arms to the sides, 4. inhale - return to IP 3-4 times Tempo is slow Amplitude is incomplete Spare the epigastric area Strengthen the pelvic muscles bottom and improve the function of emptying 7) IP lying on your back. Slowly bend your legs and place your feet towards your buttocks, resting on your elbows and feet 1. raise your pelvis 2. return to IP 2-3 times. The pace is slow. Do not hold your breath. Conclude. reduction of load, restoration of heart rate and respiratory rate t = 3 "General relaxation 8) IP lying on your back. Relax all muscles 1" - rest Close your eyes Inclusion of autotraining elements Checking heart rate and respiratory rate 1) IP lying on your back. Measurement of heart rate and RRHR for 15"" RR for 30"" Ask the patient about his health Give recommendations for independent performance of physical exercises at home

Diet tables according to Pevzner

Table No. 1. Indications: peptic ulcer of the stomach and duodenum in the stage of subsiding exacerbation and in remission, chronic gastritis with preserved and increased secretion in the stage of subsiding exacerbation, acute gastritis in the stage of subsiding. Characteristics: physiological content of proteins, fats and carbohydrates, limitation of table salt, moderate limitation of mechanical and chemical irritants of the mucous membrane and the receptor apparatus of the gastrointestinal tract, stimulants of gastric secretion, substances that remain in the stomach for a long time. Culinary processing: all dishes are prepared boiled, pureed or steamed; some baked dishes are allowed. Energy value: 2,600-2,800 kcal (10,886-11,723 kJ). Ingredients: proteins 90-100 g, fats 90 g (of which 25 g are of plant origin), carbohydrates 300-400 g, free liquid 1.5 l, table salt 6-8 g. Daily ration weight 2.5-3 kg. The diet is divided (5-6 times a day). The temperature of hot dishes is 57-62 °C, cold dishes - not lower than 15 °C.

Table No. 1a. Indications: exacerbation of gastric and duodenal ulcers in the first 10-14 days, acute gastritis in the first days of the disease, exacerbation of chronic gastritis (with preserved and increased acidity) in the first days of the disease. Characteristics: physiological content of proteins and fats, limitation of carbohydrates, sharp limitation of chemical and mechanical irritants of the mucous membrane and the receptor apparatus of the gastrointestinal tract. Culinary processing: all products are boiled, pureed or steamed, dishes have a liquid or mushy consistency. Energy value: 1,800 kcal (7,536 kJ). Ingredients: proteins 80 g, fats 80 g (of which 15-20 g are vegetable), carbohydrates 200 g, free liquid 1.5 l, table salt 6-8 g. Daily ration weight - 2-2.5 kg. The diet is divided (6-7 times a day). The temperature of hot dishes is 57-62 °C, cold dishes - not lower than 15 °C.

Table No. 1b. Indications: exacerbation of gastric and duodenal ulcers in the next 10-14 days, acute gastritis and exacerbation of chronic gastritis in the next days. Characteristics: physiological content of proteins, fats and limitation of carbohydrates, chemical and mechanical irritants of the mucous membrane and the receptor apparatus of the gastrointestinal tract are significantly limited. Culinary processing: all dishes are prepared pureed, boiled or steamed, the consistency of the dishes is liquid or mushy. Energy value: 2,600 kcal (10,886 kJ). Ingredients: proteins 90 g, fats 90 g (of which 25 g vegetable fat), carbohydrates 300 g, free liquid 1.5 l, table salt 6-8 g. Daily ration weight - 2.5-3 kg. Diet: fractional (5-6 times a day). The temperature of hot dishes is 57-62 °C, cold dishes - not lower than 15 °C.

Table No. 2. Indications: acute gastritis, enteritis and colitis during the recovery period, chronic gastritis with secretory insufficiency, enteritis, colitis during remission without concomitant diseases. General characteristics: physiologically complete diet, rich in extractive substances, with rational culinary processing of products. Avoid foods and dishes that linger in the stomach for a long time, are difficult to digest, and irritate the mucous membrane and receptor apparatus of the gastrointestinal tract. The diet has a stimulating effect on the secretory apparatus of the stomach, helps improve the compensatory and adaptive reactions of the digestive system, and prevents the development of the disease. Culinary processing: dishes can be boiled, baked, stewed, and also fried without breading in breadcrumbs or flour and without forming a rough crust. Energy value: 2800-3100 kcal. Ingredients: proteins 90-100 g, fats 90-100 g, carbohydrates 400-450 g, free liquid 1.5 l, table salt up to 10-12 g. Daily ration weight - 3 kg. The diet is divided (4-5 times a day). The temperature of hot dishes is 57-62˚C, cold food is below 15°C.

Table No. 5. Indications: chronic hepatitis and cholecystitis in remission, cholelithiasis, acute hepatitis and cholecystitis during the recovery period. General characteristics: the amount of proteins, fats and carbohydrates is determined by the physiological needs of the body. Strong stimulants of gastric and pancreatic secretion (extractive substances, products rich in essential oils) are excluded; refractory fats; fried foods; foods rich in cholesterol and purines. Increased consumption of vegetables and fruits enhances the choleretic effect of other nutrients, intestinal motility, and ensures maximum cholesterol removal. Cooking technology: Dishes are boiled, less often - baked. Energy value: 2200-2500 kcal. Ingredients: proteins 80-90 g, fats 80-90 g, carbohydrates 300-350 g. Diet - 5-6 times a day. Only warm food is allowed, cold dishes are excluded.

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

Marina asks:

How is rehabilitation carried out after a stomach ulcer?

Currently, rehabilitation after a stomach ulcer is carried out using the following methods:

• Physiotherapy;
• Acupuncture;
• Acupressure;
• Sanatorium-resort treatment using mineral waters (balneotherapy);
• Mud therapy;
• Diet therapy;

The following exercises have an excellent rehabilitation effect:

• Rhythmic walking in place;
• Breathing exercises in a sitting position;
• Exercises for arms in a sitting position;
• Throwing and catching a sword in a standing position;
• Arm exercises in a lying position.

Acupressure represents the impact on various biologically active points with your fingers. The principle of acupressure is the same as that of acupuncture. Massage of active points should be carried out daily. Moreover, it is better to find out the necessary points from an acupuncturist and ask him to teach you how to massage them correctly.

Physiotherapy has a positive effect in rehabilitation after a stomach ulcer. The following methods are used for rehabilitation:

• Electricity;
• Ultrasound;
• Infrared, ultraviolet radiation;
• Polarized light;
• Electrophoresis on the epigastric region with Novocaine, Platiphylline, Zinc, Dalargin, Solcoseryl.

Mud therapy indicated during the period of attenuation of an exacerbation of a stomach ulcer. For treatment, silt mud is used at a temperature of 38-40 o C. The procedure is carried out at the beginning for 10 minutes, then extends to 20 minutes. The course of therapy consists of 10 – 12 procedures.

Diet therapy is based on compliance with table No. 1. Meals should be fractional (5 - 6 times a day) and in small portions. The diet must be based on lean meat and fish, from which cutlets, meatballs, soufflés, quenelles and steamed zrazy are prepared. Boiled sausages and sausages are also acceptable. In addition, the diet includes dishes made from cottage cheese (casseroles, souffles, cheesecakes, lazy dumplings) and other dairy products. Soups should be vegetarian, slimy, with a dressing of boiled pureed vegetables and well-cooked cereals. Porridges should be semi-liquid. Eggs can be boiled soft-boiled or in the form of a steam omelet. Fruits and berries are consumed in the form of purees, jelly, mousses, jellies, compotes, jam, etc. You should eat yesterday's bread made from white flour. Dry cookies, biscuits, and savory buns are also allowed.

Mushrooms, broths, fatty meats and fish, poorly cooked lean meats, anything fried, strong tea, coffee, carbonated water, hot seasonings (mustard, horseradish, onions, garlic) and raw vegetables with coarse fiber (cabbage, turnips, etc.) are excluded from the diet. radish, bell pepper, etc.). You should also not eat anything smoked, canned, spicy, fatty, pickled or pickled.

Phytotherapy helps accelerate the onset of remission or prevent exacerbation of stomach ulcers. Cabbage and potato juice has an excellent effect. Cabbage juice is taken 1 glass 3 times a day, before meals. Take half a glass of potato juice 20 minutes before meals.

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According to the WHO definition, rehabilitation is the combined and coordinated use of social, medical, pedagogical and professional measures with the aim of preparing and retraining an individual to achieve his optimal working capacity.”

Rehabilitation objectives:

• 1. Improve the overall reactivity of the body;
• 2. Normalize the state of the central and autonomic systems;
• 3. Provide painkillers, anti-inflammatory, trophic effects on the body;
• 4. Maximize the period of remission of the disease.

Comprehensive medical rehabilitation is carried out in the system of hospital, sanatorium, dispensary and polyclinic stages. An important condition for the successful functioning of a staged rehabilitation system is the early start of rehabilitation measures, the continuity of stages ensured by the continuity of information, the unity of understanding of the pathogenetic essence of pathological processes and the fundamentals of their pathogenetic therapy. The sequence of stages may vary depending on the course of the disease.

An objective assessment of the results of rehabilitation is very important. It is necessary for the ongoing correction of rehabilitation programs, prevention and overcoming of unwanted side reactions, and the final assessment of the effect when moving to a new stage.

Thus, considering medical rehabilitation as a set of measures aimed at eliminating changes in the body that lead to a disease or contribute to its development, and taking into account the knowledge gained about pathogenetic disorders in asymptomatic periods of the disease, 5 stages of medical rehabilitation are distinguished.

The preventive stage aims to prevent the development of clinical manifestations of the disease by correcting metabolic disorders (Appendix B).

Activities at this stage have two main directions: elimination of identified metabolic and immune disorders through dietary correction, the use of mineral waters, pectins from marine and terrestrial plants, natural and reformed physical factors; combating risk factors that can significantly provoke the progression of metabolic disorders and the development of clinical manifestations of the disease. You can count on the effectiveness of preventive rehabilitation only by backing up the measures of the first direction by optimizing the living environment (improving the microclimate, reducing dust and gas pollution, leveling the harmful effects of geochemical and biogenic nature, etc.), combating physical inactivity, excess body weight, smoking and others bad habits.

Inpatient stage of medical rehabilitation, in addition to the first most important task:

• 1. Saving the patient’s life (involves measures to ensure minimal tissue death as a result of exposure to a pathogenic agent);
• 2. Prevention of complications of the disease;
• 3. Ensuring the optimal course of reparative processes (Appendix D).

This is achieved by replenishing the deficit of circulating blood volume, normalizing microcirculation, preventing tissue swelling, conducting detoxification, antihypoxic and antioxidant therapy, normalizing electrolyte disturbances, using anabolic steroids and adaptogens, and physiotherapy. In case of microbial aggression, antibacterial therapy is prescribed and immunocorrection is carried out.

The outpatient stage of medical rehabilitation should ensure the completion of the pathological process (Appendix D).

For this purpose, therapeutic measures are continued aimed at eliminating residual effects of intoxication, microcirculation disorders, and restoring the functional activity of body systems. During this period, it is necessary to continue therapy to ensure the optimal course of the restitution process (anabolic agents, adaptogens, vitamins, physiotherapy) and develop principles of dietary correction depending on the characteristics of the course of the disease. A major role at this stage is played by targeted physical culture in a mode of increasing intensity.

The sanatorium-resort stage of medical rehabilitation completes the stage of incomplete clinical remission (Appendix G). Treatment measures should be aimed at preventing relapses of the disease, as well as its progression. To achieve these goals, predominantly natural therapeutic factors are used to normalize microcirculation, increase cardiorespiratory reserves, stabilize the functioning of the nervous, endocrine and immune systems, gastrointestinal tract and urinary excretion.

The metabolic stage includes conditions for the normalization of structural and metabolic disorders that existed after completion of the clinical stage (Appendix E).

This is achieved through long-term dietary correction, the use of mineral waters, pectins, climatotherapy, therapeutic physical training, and balneotherapy courses.

The results of the implementation of the principles of the proposed medical rehabilitation scheme are predicted by the authors to be more effective compared to the traditional one:

• -- highlighting the stage of preventive rehabilitation makes it possible to form risk groups and develop preventive programs;
• - identifying the stage of metabolic remission and implementing measures at this stage will make it possible to reduce the number of relapses, prevent progression and chronicity of the pathological process;
• -- staged medical rehabilitation including independent stages of preventive and metabolic remission will reduce morbidity and increase the level of health of the population.

Areas of medical rehabilitation include medicinal and non-medicinal areas:

Medicinal direction of rehabilitation.

Drug therapy in rehabilitation is prescribed taking into account the nosological form and the state of the secretory function of the stomach.

Take before meals

Most medications are taken 30-40 minutes before meals, when they are best absorbed. Sometimes - 15 minutes before a meal, not earlier.

Half an hour before meals you should take anti-ulcer drugs - d-nol, gastrofarm. They should be washed down with water (not milk).

Also, half an hour before meals you should take antacids (Almagel, phosphalugel, etc.) and choleretic drugs.

Take with meals

During meals, the acidity of gastric juice is very high, and therefore significantly affects the stability of drugs and their absorption into the blood. In an acidic environment, the effect of erythromycin, lincomycin hydrochloride and other antibiotics is partially reduced.

Gastric acid preparations or digestive enzymes should be taken with food, as they help the stomach digest food. These include pepsin, festal, enzistal, panzinorm.

It is advisable to take laxatives that can be digested with food. These are senna, buckthorn bark, rhubarb root and joster fruit.

Take after meals

If the medicine is prescribed after a meal, wait at least two hours to get the best therapeutic effect.

Immediately after eating, they take mainly medications that irritate the mucous membrane of the stomach and intestines. This recommendation applies to such groups of drugs as:

• - painkillers (non-steroidal) anti-inflammatory drugs - Butadione, aspirin, aspirin cardio, voltaren, ibuprofen, askofen, citramon (only after meals);
• - acute drugs are components of bile - allohol, lyobil, etc.); Taking after meals is a prerequisite for these drugs to “work.”

There are so-called antacid agents, the intake of which should be timed to coincide with the moment when the stomach is empty and hydrochloric acid continues to be released, that is, an hour or two after finishing a meal - magnesium oxide, vikalin, vikair.

Aspirin or askofen (aspirin with caffeine) is taken after meals, when the stomach has already begun to produce hydrochloric acid. Thanks to this, the acidic properties of acetylsalicylic acid (which causes irritation of the gastric mucosa) will be suppressed. This should be remembered by those who take these tablets for headaches or colds.

Regardless of food

Regardless of when you sit down at the table, take:

Antibiotics are usually taken regardless of food, but fermented milk products must also be present in your diet. Along with antibiotics, they also take nystatin, and at the end of the course, complex vitamins (for example, supradin).

Antacids (Gastal, Almagel, Maalox, Taltsid, Relzer, Phosphalugel) and antidiarrheals (Imodium, Intetrix, Smecta, Neointestopan) - half an hour before meals or one and a half to two hours after. Please note that antacids taken on an empty stomach last for about half an hour, and those taken 1 hour after a meal last for 3 to 4 hours.

Take on an empty stomach

Taking the medicine on an empty stomach is usually in the morning 20-40 minutes before breakfast.

Medicines taken on an empty stomach are absorbed and absorbed much faster. Otherwise, the acidic gastric juice will have a destructive effect on them, and the medications will be of little use.

Patients often ignore the recommendations of doctors and pharmacists, forgetting to take a pill prescribed before meals and rescheduling it for the afternoon. If the rules are not followed, the effectiveness of the drugs will inevitably decrease. To the greatest extent if, contrary to the instructions, the drug is taken during or immediately after meals. This changes how quickly drugs pass through the digestive tract and how quickly they are absorbed into the blood.

Some drugs may break down into their component parts. For example, penicillin is destroyed in an acidic stomach environment. Aspirin (acetylsalicylic acid) breaks down into salicylic and acetic acids.

Taking 2 - 3 times a day, if the instructions indicate “three times a day”, this does not mean breakfast - lunch - dinner. The medicine must be taken every eight hours to maintain its concentration in the blood evenly. It is better to take the medicine with plain boiled water. Tea and juices are not the best remedy.

If it is necessary to resort to cleansing the body (for example, in case of poisoning, alcohol intoxication), sorbents are usually used: activated carbon, polyphepane or enterosgel. They collect toxins “on themselves” and remove them through the intestines. They should be taken twice a day between meals. At the same time, you need to increase your fluid intake. It is good to add herbs that have a diuretic effect to your drink.

Day or night

Drugs with a hypnotic effect should be taken 30 minutes before bedtime.

Laxatives - bisacodyl, senade, glaxena, regulax, gutalax, forlax - are usually taken before bed and half an hour before breakfast.

Ulcer medications are taken early in the morning and late in the evening to prevent hunger pangs.

After inserting the suppositories, you need to lie down, so they are prescribed at night.

Emergency medications are taken regardless of the time of day - if the temperature rises or colic begins. In such cases, adherence to the schedule is not important.

The key role of the ward nurse is the timely and accurate delivery of medications to patients in accordance with the prescriptions of the attending physician, informing the patient about medications, and monitoring their intake.

Non-drug rehabilitation methods include the following:

1. Diet correction:

The diet for gastric ulcers is used as prescribed by the doctor sequentially; during surgery, it is recommended to start with diet - 0.

Goal: Maximum sparing of the mucous membrane of the esophagus and stomach - protection from mechanical, chemical, thermal factors of food damage. Providing an anti-inflammatory effect and preventing the progression of the process, preventing fermentation disorders in the intestines.

Diet characteristics. This diet requires a minimal amount of food. Since it is difficult to take in solid form, food consists of liquid and jelly-like dishes. The number of meals is at least 6 times a day, if necessary - around the clock every 2-2.5 hours.

Chemical composition and calorie content. Protein 15 g, fat 15 g, carbohydrates 200 g, calorie content - about 1000 kcal. Table salt 5 g. The total weight of the diet is no more than 2 kg. The food temperature is normal.

Sample set

Fruit juices - apple, plum, apricot, cherry. Berry juices - strawberry, raspberry, blackcurrant. Broths are weak, made from lean meats (beef, veal, chicken, rabbit) and fish (pike perch, bream, carp, etc.).

Cereal decoctions - rice, oatmeal, buckwheat, corn flakes.

Kissels made from various fruits, berries, their juices, and dried fruits (with the addition of a small amount of starch).

Butter.

Tea (weak) with milk or cream.

Sample one-day diet menu No. 0

• 8 hours - fruit and berry juice.
• 10 o'clock - tea with milk or cream and sugar.
• 12 hours - fruit or berry jelly.
• 14 hours - weak broth with butter.
• 16 hours - lemon jelly.
• 18 o'clock - rosehip decoction.
• 20 o'clock - tea with milk and sugar.
• 22 hours - rice water with cream.

Diet No. 0A

It is prescribed, as a rule, for 2-3 days. The food consists of liquid and jelly-like dishes. The diet contains 5 g of protein, 15-20 g of fat, 150 g of carbohydrates, energy value 3.1-3.3 MJ (750-800 kcal); table salt 1 g, free liquid 1.8-2.2 l. Food temperature should not exceed 45 °C. Up to 200 g of vitamin C is added to the diet; other vitamins are added as prescribed by the doctor. Meals 7 - 8 times a day, for 1 meal give no more than 200 - 300 g.

• - Allowed: weak low-fat meat broth, rice broth with cream or butter, strained compote, liquid berry jelly, rosehip broth with sugar, fruit jelly, tea with lemon and sugar, freshly prepared fruit and berry juices, diluted 2-3 times sweet water (up to 50 ml per appointment). If the condition improves, on the 3rd day add: a soft-boiled egg, 10 g of butter, 50 ml of cream.
• - Excluded: any dense and pureed foods, whole milk and cream, sour cream, grape and vegetable juices, carbonated drinks.

Diet No. 0B (No. 1A surgical)

It is prescribed for 2-4 days after diet No. 0-a, from which diet No. 0-b differs in the addition of liquid pureed porridge from rice, buckwheat, rolled oats, cooked in meat broth or water. The diet contains 40-50 g of protein, 40-50 g of fat, 250 g of carbohydrates, energy value 6.5 - 6.9 MJ (1550-1650 kcal); 4-5 g of sodium chloride, up to 2 liters of free liquid. Food is given 6 times a day, no more than 350-400 g per meal.

Diet No. 0B (No. 1B surgical)

It serves as a continuation of the expansion of the diet and the transition to physiologically nutritious nutrition. The diet includes puree soups and cream soups, steamed dishes from pureed boiled meat, chicken or fish, fresh cottage cheese, pureed with cream or milk to the consistency of thick sour cream, steamed dishes from cottage cheese, fermented milk drinks, baked apples, well-mashed fruit and vegetable purees, up to 100 g of white crackers. Milk is added to tea; They give you milk porridge. The diet contains 80 - 90 g of protein, 65-70 g of fat, 320 - 350 g of carbohydrates, energy value 9.2-9.6 MJ (2200-2300 kcal); sodium chloride 6-7 g. Food is given 6 times a day. The temperature of hot dishes is not higher than 50 °C, cold - not less than 20 °C.

Then there is an expansion of the diet.

Diet No. 1a

Indications for diet No. 1a

This diet is recommended for maximum limitation of mechanical, chemical and thermal aggression on the stomach. This diet is prescribed for exacerbation of peptic ulcer disease, bleeding, acute gastritis and other diseases that require maximum sparing of the stomach.

Purpose of diet No. 1a

Reducing the reflex excitability of the stomach, reducing interoceptive irritations emanating from the affected organ, restoring the mucous membrane by maximally sparing the function of the stomach.

General characteristics of diet No. 1a

Exclusion of substances that are strong secretion stimulants, as well as mechanical, chemical and thermal irritants. Food is prepared only in liquid and mushy form. Steamed, boiled, mashed, pureed dishes in a liquid or mushy consistency. In Diet No. 1a for patients who have undergone cholecystectomy, only mucous soups and eggs are used in the form of steamed protein omelettes. Calories are reduced primarily through carbohydrates. The amount of food taken at one time is limited, the frequency of intake is at least 6 times.

Chemical composition of diet No. 1a

Diet No. 1a is characterized by a decrease in the content of proteins and fats to the lower limit of the physiological norm, and a strict limitation of the effects of various chemical and mechanical irritants on the upper parts of the gastrointestinal tract. This diet also limits carbohydrates and table salt.

Proteins 80 g, fats 80 - 90 g, carbohydrates 200 g, table salt 16 g, calorie content 1800 - 1900 kcal; retinol 2 mg, thiamine 4 mg, riboflavin 4 mg, nicotinic acid 30 mg, ascorbic acid 100 mg; calcium 0.8 g, phosphorus 1.6 g, magnesium 0.5 g, iron 0.015 g. The temperature of hot dishes is not higher than 50 - 55 ° C, cold dishes - not lower than 15 - 20 ° C.

• - Slimy soups made from semolina, oatmeal, rice, pearl barley with the addition of egg-milk mixture, cream, butter.
• - Meat and poultry dishes in the form of puree or steam soufflé (meat cleaned of tendons, fascia and skin is passed through a meat grinder 2-3 times).
• - Fish dishes in the form of steam soufflé from low-fat varieties.
• - Dairy products - milk, cream, steam soufflé from freshly prepared pureed cottage cheese; Fermented milk drinks, cheese, sour cream, and regular cottage cheese are excluded. If well tolerated, whole milk is drunk up to 2-4 times a day.
• - Soft-boiled eggs or in the form of a steam omelet, no more than 2 per day.
• - Cereal dishes in the form of liquid porridge with milk, porridge made from cereal (buckwheat, oatmeal) flour with the addition of milk or cream. Almost all cereals can be used, with the exception of pearl barley and millet. Add butter to the finished porridge.
• - Sweet dishes - jelly and jellies from sweet berries and fruits, sugar, honey. You can also make juices from berries and fruits by diluting them with boiled water before drinking in a 1:1 ratio.
• - Fats - fresh butter and vegetable oil added to dishes.
• - Drinks: weak tea with milk or cream, juices from fresh berries, fruits, diluted with water. Among the drinks, decoctions of rose hips and wheat bran are especially useful.

Excluded foods and dishes of diet No. 1a

Bread and bakery products; broths; fried foods; mushrooms; smoked meats; fatty and spicy foods; vegetable dishes; various snacks; coffee, cocoa, strong tea; vegetable juices, concentrated fruit juices; fermented milk and carbonated drinks; sauces (ketchup, vinegar, mayonnaise) and spices.

Diet No. 1b

Indications for diet No. 1b

Indications and intended purpose are the same as for diet No. 1a. The diet is fractional (6 times a day). This table is for less severe, in comparison with table No. 1a, limitation of mechanical, chemical and temperature aggression on the stomach. This diet is indicated for mild exacerbation of gastric ulcer, in the stage of subsidence of this process, for chronic gastritis.

Diet No. 1b is prescribed at subsequent stages of treatment while the patient remains in bed rest. The duration of diet No. 1b is very individual, but on average it ranges from 10 to 30 days. Diet No. 1b is also used during bed rest. The difference from diet No. 1a is a gradual increase in the content of basic nutrients and caloric content of the diet.

Bread in the form of dried (but not toasted) crackers (75 - 100 g) is allowed. Pureed soups are introduced, replacing mucous membranes; Milk porridge can be consumed more often. Homogenized canned baby food made from vegetables and fruits and dishes made from beaten eggs are allowed. All recommended products and dishes from meat and fish are given in the form of steam soufflé, quenelles, mashed potatoes, and cutlets. After the products are boiled until soft, they are rubbed to a mushy state. The food should be warm. The rest of the recommendations are the same as for diet No. 1a.

Chemical composition of diet No. 1b

Proteins up to 100 g, fats up to 100 g (30 g vegetable), carbohydrates 300 g, calorie content 2300 - 2500 kcal, table salt 6 g; retinol 2 mg, thiamine 4 mg, riboflavin 4 mg, nicotinic acid 30 mg, ascorbic acid 100 mg; calcium 0.8 g, phosphorus 1.2 g, magnesium 0.5 g, iron 15 mg. The total amount of free liquid is 2 liters. The temperature of hot dishes is up to 55 - 60°C, cold - not lower than 15 - 20°C.

The role of the nurse in dietary correction:

The nutritionist monitors the operation of the catering unit and compliance with the sanitary and hygienic regime, monitors the implementation of dietary recommendations when the doctor changes the diet, checks the quality of products when they arrive at the warehouse and kitchen, and monitors the correct storage of food supplies. With the participation of the production manager (chef) and under the guidance of a nutritionist, he compiles a daily menu layout in accordance with the dish card index. Performs periodic calculations of the chemical composition and calorie content of diets, monitoring the chemical composition of actually prepared dishes and diets (content of protein, fat, carbohydrates, vitamins, minerals, energy value, etc.) by selectively sending individual dishes to the laboratory of the State Sanitary and Epidemiological Supervision Center. Controls the stocking of products and the release of dishes from the kitchen to the departments, according to received orders, and carries out rejecting of finished products. Monitors the sanitary condition of dispensing and canteens at the departments, equipment, utensils, as well as the observance of personal hygiene rules by dispensing employees. Organizes training sessions with paramedics and kitchen staff on clinical nutrition. Monitors the timely conduct of preventive medical examinations of catering workers and prevents persons from working who have not undergone a preliminary or periodic medical examination.

Diet No. 1

General information

Indications for diet No. 1

Gastric ulcer in the stage of fading exacerbation, during the period of recovery and remission (duration of dietary treatment 3 - 5 months).

The purpose of diet No. 1 is to accelerate the processes of repair of ulcers and erosions, further reduce or prevent inflammation of the gastric mucosa.

This diet helps normalize the secretory and motor-evacuation functions of the stomach.

Diet No. 1 is designed to meet the physiological needs of the body for nutrients in inpatient settings or in outpatient settings during work that is not associated with physical activity.

General characteristics of diet No. 1

The use of diet No. 1 is aimed at providing moderate sparing of the stomach from mechanical, chemical and temperature aggression with a restriction in the diet of foods that have a pronounced irritant effect on the walls and receptor apparatus of the upper gastrointestinal tract, as well as difficult-to-digest foods. Avoid foods that are strong secretion stimulants and chemically irritating to the gastric mucosa. Both very hot and very cold foods are excluded from the diet.

The diet for diet No. 1 is fractional, up to 6 times a day, in small portions. It is necessary that the break between meals should not be more than 4 hours; a light dinner is allowed an hour before bedtime. At night you can drink a glass of milk or cream. It is recommended to chew food thoroughly.

Food is liquid, mushy and has a denser consistency when boiled and mostly pureed. Since the consistency of food is very important during dietary nutrition, the amount of foods rich in fiber (such as turnips, radishes, radishes, asparagus, beans, peas), fruits with skin and unripe berries with rough skin (such as gooseberries, currants, grapes) is reduced. , dates), bread made from wholemeal flour, products containing rough connective tissue (such as cartilage, poultry and fish skin, stringy meat).

Dishes are prepared boiled or steamed. After this, they are crushed to a pasty state. Fish and lean meats can be eaten whole. Some dishes can be baked, but without a crust.

Chemical composition of diet No. 1

Protein 100 g (of which 60% animal origin), fat 90 - 100 g (30% vegetable), carbohydrates 400 g, table salt 6 g, calorie content 2800 - 2900 kcal, ascorbic acid 100 mg, retinol 2 mg, thiamine 4 mg, riboflavin 4 mg, nicotinic acid 30 mg; calcium 0.8 g, phosphorus at least 1.6 g, magnesium 0.5 g, iron 15 mg. The total amount of free liquid is 1.5 l, the food temperature is normal. It is recommended to limit table salt.

• - Wheat bread made from premium flour, freshly baked or dried; rye bread and any fresh bread, products made from butter and puff pastry are excluded.
• - Vegetable broth soups from pureed and well-cooked cereals, milk soups, pureed vegetable soups, seasoned with butter, egg-milk mixture, cream; Meat and fish broths, mushroom and strong vegetable broths, cabbage soup, borscht, and okroshka are excluded.
• - Meat dishes - steamed and boiled from beef, young lean lamb, trimmed pork, chicken, turkey; Fatty and stringy varieties of meat, poultry, duck, goose, canned meat, and smoked meats are excluded.
• - Fish dishes are usually low-fat varieties, without skin, in pieces or in the form of cutlets; cooked with water or steam.
• - Dairy products - milk, cream, non-acidic kefir, yogurt, cottage cheese in the form of soufflé, lazy dumplings, pudding; Dairy products with high acidity are excluded.
• - Porridges made from semolina, buckwheat, rice, cooked in water, milk, semi-viscous, mashed; millet, pearl barley and barley cereals, legumes, and pasta are excluded.
• - Vegetables - potatoes, carrots, beets, cauliflower, boiled in water or steam, in the form of souffles, purees, steam puddings.
• - Appetizers - salad of boiled vegetables, boiled tongue, doctor's sausage, milk sausage, diet sausage, jellied fish in vegetable broth.
• - Sweet dishes - fruit puree, jelly, jelly, pureed compotes, sugar, honey.
• - Drinks - weak tea with milk, cream, sweet juices from fruits and berries.
• - Fats - butter and refined sunflower oil added to dishes.

Excluded foods and dishes of diet No. 1

There are two food groups you should eliminate from your diet.

• - Products that cause or increase pain. These include: drinks - strong tea, coffee, carbonated drinks; tomatoes, etc.
• - Products that strongly stimulate the secretion of the stomach and intestines. These include: concentrated meat and fish broths, mushroom decoctions; fried foods; meat and fish stewed in their own juice; meat, fish, tomato and mushroom sauces; salted or smoked fish and meat products; canned meat and fish; salted, pickled vegetables and fruits; spices and seasonings (mustard, horseradish).

In addition, the following are excluded: rye and any fresh bread, pastry products; high acidity dairy products; millet, pearl barley, barley and corn cereals, legumes; white cabbage, radish, sorrel, onions, cucumbers; salted, pickled and pickled vegetables, mushrooms; sour and fiber-rich fruits and berries.

It is necessary to focus on the patient’s feelings. If, when eating a certain product, the patient feels discomfort in the epigastric region, and even more so nausea and vomiting, then this product should be abandoned.

Gastric ulcer (GUD) and duodenal ulcer are chronic recurrent diseases prone to progression, the main manifestation of which is the formation of a fairly persistent ulcerative defect in the stomach or duodenum.

Gastric ulcer is a fairly common disease, affecting 7-10% of the adult population. It should be noted that the disease has significantly “rejuvenated” in recent years.

Etiology and pathogenesis. In the last 1.5-2 decades, the point of view on the origin and causes of peptic ulcer disease has changed. The expression “no acid, no ulcer” has been replaced by the discovery that the main cause of this disease is Helicobacter pylori (HP), i.e. An infectious theory of the origin of gastric and duodenal ulcers has emerged. Moreover, the development and recurrence of the disease in 90% of cases is associated with Helicobacter pylori.

The pathogenesis of the disease is considered, first of all, as an imbalance between the “aggressive” and “protective” factors of the gastroduodenal zone.

“Aggressive” factors include the following: increased secretion of hydrochloric acid and pepsin; altered response of the glandular elements of the gastric mucosa to nervous and humoral influences; rapid evacuation of acidic contents into the duodenal bulb, accompanied by an “acid shock” to the mucous membrane.

Also “aggressive” effects include: bile acids, alcohol, nicotine, a number of medications (non-steroidal anti-inflammatory drugs, glucocorticoids, Heliobacter invasion).

Protective factors include gastric mucus, secretion of alkaline bicarbonate, tissue blood flow (microcirculation), and regeneration of cellular elements. The issues of sanogenesis are the main ones in the problem of peptic ulcer disease, in the tactics of its treatment and especially in the prevention of relapses.

Peptic ulcer disease is a polyetiological and pathogenetically multifactorial disease that occurs cyclically with alternating periods of exacerbation and remission, is characterized by frequent recurrence, individual characteristics of clinical manifestations and often acquires a complicated course.

Psychological and personal factors play an important role in the etiology and pathogenesis of peptic ulcer disease.

The main clinical signs of peptic ulcer disease (pain, heartburn, belching, nausea, vomiting) are determined by the localization of the ulcer (cardiac and mesogastric, ulcers of the pyloric stomach, ulcers of the duodenal bulb and postbulbar ulcers), concomitant diseases of the gastrointestinal tract, age, degree of metabolic disorders processes, the level of gastric juice secretion, etc.

The goal of antiulcer treatment is to restore the mucous membrane of the stomach and duodenum (ulcer scarring) and maintain a long-term relapse-free course of the disease.

The complex of rehabilitation measures includes: drug therapy, therapeutic nutrition, protective regime, exercise therapy, massage and physiotherapeutic methods of treatment.

Since peptic ulcer disease suppresses and disorganizes the patient’s motor activity, means and forms of exercise therapy are an important element in the treatment of the ulcerative process.

It is known that performing dosed physical exercises that are adequate to the state of the patient’s body improves cortical neurodynamics, thereby normalizing cortico-visceral relationships, which ultimately leads to an improvement in the psycho-emotional state of the patient.

Physical exercises, by activating and improving blood circulation in the abdominal cavity, stimulate redox processes, increase the stability of acid-base balance, which has a beneficial effect on the scarring of the ulcer.

At the same time, there are contraindications to the prescription of therapeutic exercises and other forms of exercise therapy: a fresh ulcer in the acute period; ulcer with periodic bleeding; threat of ulcer perforation; ulcer complicated by stenosis in the compensation stage; severe dyspeptic disorders; severe pain.

Objectives of physical rehabilitation for peptic ulcer disease:

1. Normalization of the patient’s neuropsychological status.

2. Improvement of redox processes in the abdominal cavity.

3. Improving the secretory and motor function of the stomach and duodenum.

4. Development of the necessary motor qualities, skills and abilities (muscle relaxation, rational breathing, elements of autogenic training, proper coordination of movements).

The therapeutic and restorative effect of physical exercises will be higher if special physical exercises are performed by those muscle groups that have common innervation in the corresponding spinal segments as the affected organ; therefore, according to Kirichinsky A.R. (1974) the choice and justification of the special physical exercises used are closely related to the segmental innervation of muscles and certain digestive organs.

In PH classes, in addition to general developmental exercises, special exercises are used to relax the abdominal and pelvic floor muscles, and a large number of breathing exercises, both static and dynamic.

For diseases of the gastrointestinal tract, i.p. is important. during the exercises performed. The most favorable will be i.p. lying with legs bent in three positions (on the left, on the right side and on the back), kneeling, standing on all fours, less often - standing and sitting. The starting position on all fours is used to limit the impact on the abdominal muscles.

Since in the clinical course of a peptic ulcer there are periods of exacerbation, subsiding exacerbation, a period of scarring of the ulcer, a period of remission (possibly short-term) and a period of long-term remission, it is rational to carry out physical therapy classes taking into account these periods. The names of motor modes accepted in most diseases (bed, ward, free) do not always correspond to the condition of a patient with peptic ulcer.

Therefore, the following motor modes are preferable: gentle, gentle-training, training and general tonic (general strengthening) modes.

Gentle (mode with low physical activity). I.p. - lying on your back, on your right or left side, with your legs bent.

First, the patient must be taught the abdominal type of breathing with a slight amplitude of movement of the abdominal wall. Muscle relaxation exercises are also used to achieve complete relaxation. Then exercises are given for the small muscles of the foot (in all planes), followed by exercises for the hands and fingers. All exercises are combined with breathing exercises in a ratio of 2:1 and 3:1 and massage of the muscle groups involved in the exercises. After 2-3 sessions, exercises for medium muscle groups are added (monitor the patient’s reaction and pain sensations). The number of repetitions of each exercise is 2-4 times. In this mode, it is necessary for the patient to instill the skills of autogenic training.

Forms of exercise therapy: UGG, LG, independent studies.

Monitoring the patient’s reaction based on heart rate and subjective sensations.

The duration of classes is from 8 to 15 minutes. The duration of the gentle motor regimen is about two weeks.

Balneo and physiotherapeutic procedures are also used. Gentle training mode (mode with average physical activity) designed for 10-12 days.

Goal: restoration of adaptation to physical activity, normalization of autonomic functions, activation of redox processes in the body in general and in the abdominal cavity in particular, improvement of regeneration processes in the stomach and duodenum, combating congestion.

I.p. – lying on your back, on your side, on all fours, standing.

In LH classes, exercises are used for all muscle groups, the amplitude is moderate, the number of repetitions is 4-6 times, the pace is slow, the ratio of remote control to open-ended exercise is 1:3. Exercises on the abdominal muscles are given limitedly and carefully (monitor pain and manifestations of dyspepsia). When slowing down the evacuation of food masses from the stomach, exercises should be used on the right side, and with moderate motor skills - on the left.

Dynamic breathing exercises are also widely used.

In addition to physical therapy exercises, measured walking and walking at a slow pace are used.

Forms of exercise therapy: LH, UGG, dosed walking, walking, independent exercise.

A relaxing massage is also used after exercises on the abdominal muscles. The duration of the lesson is 15-25 minutes.

Training mode (high physical activity mode) It is used upon completion of the scarring process of the ulcer and is therefore carried out either before discharge from the hospital, and more often in a sanatorium-resort setting.

The classes take on a training character, but with a pronounced rehabilitation focus. The range of LH exercises used is expanding, especially due to exercises on the abdominal and back muscles, and exercises with objects, on simulators, and in an aquatic environment are added.

In addition to LH, dosed walking, health paths, therapeutic swimming, outdoor games, and elements of sports games are used.

Along with the expansion of the motor regime, control over load tolerance and the state of the body and gastrointestinal tract should also improve through medical and pedagogical observations and functional studies.

It is necessary to strictly adhere to the basic methodological rules when increasing physical activity: gradualism and consistency in its increase, combination of activity with rest and breathing exercises, ratio to open-air training 1:3, 1:4.

Other rehabilitation means include massage and physiotherapy (balneotherapy). The duration of classes is from 25 to 40 minutes.

General tonic (general strengthening) regimen.

This regime pursues the goal: complete restoration of the patient’s performance, normalization of the secretory and motor functions of the gastrointestinal tract, increased adaptation of the body’s cardiovascular and respiratory systems to physical activity.

This motor mode is used both at the sanatorium and at the outpatient stages of rehabilitation.

The following forms of exercise therapy are used: UGG and LH, in which the emphasis is on strengthening the muscles of the trunk and pelvis, developing coordination of movements, and exercises to restore the patient’s strength capabilities. Massage (classical and segmental reflex) and balneotherapy are used.

During this period of rehabilitation, more attention is paid to cyclic exercises, in particular walking, as a means of increasing the body’s adaptation to physical activity.

Walking is increased to 5-6 km per day, the pace is variable, with pauses for breathing exercises and monitoring heart rate.

In order to create positive emotions, various relay races and ball exercises are used. The simplest sports games: volleyball, gorodki, croquet, etc.

Mineral water.

Patients with gastric and duodenal ulcers with high acidity are prescribed low and moderately mineralized drinking mineral waters - carbonic and bicarbonate, sulfate and chloride waters (Borjomi, Jermuk, Slavyanskaya, Smirnovskaya, Moscow, Essentuki No. 4, Pyatigorsk Narzan), water tº 38Cº is taken 60-90 minutes before meals 3 times a day, ½ and ¾ glasses a day, for 21-24 days.

Physiotherapeutic agents.

Baths are prescribed - sodium chloride (salt), carbon dioxide, radon, iodine-bromine, it is advisable to alternate them every other day with applications of peloids to the epigastric area. For patients with ulcers localized in the stomach, the number of applications is increased to 12-14 procedures. For severe pain, SMT (sinusoidal modulated currents) is used. A high therapeutic effect is observed when using ultrasound.

Test questions and assignments:

1. Describe diseases of the digestive organs in general and what functions of the digestive tract may be impaired.

2. Therapeutic and restorative effect of physical exercises for gastrointestinal diseases.

3. Characteristics of gastritis, their types, causes.

4. Differences in gastritis depending on secretory disorders in the stomach.

5. Objectives and methods of therapeutic exercises for decreased secretory function of the stomach.

6. Objectives and methods of therapeutic exercises for increased secretory function of the stomach.

7. Characteristics of gastric and duodenal ulcers, etiopathogenesis of the disease.

8. Aggressive and protective factors affecting the gastric mucosa.

9. Clinical course of gastric and duodenal ulcers and its outcomes.

10. Objectives of physical rehabilitation for gastric and duodenal ulcers.

11. Methods of therapeutic exercises in a gentle mode of physical activity.

12. Methods of therapeutic exercises in a gentle training mode.

13. Methods of therapeutic exercises in training mode.

14. Objectives and methods of exercise therapy with a general tonic regimen.

Exercise therapy for gastric ulcers

1. Clinic for peptic ulcer disease

peptic ulcer disease physical therapy

Peptic ulcer is a chronic, cyclical disease with a varied clinical picture and ulceration of the gastric or duodenal mucosa during periods of exacerbation.

The leading symptom in the clinical picture of peptic ulcer disease is pain. Its distinctive features should be considered periodicity (alternating periods of exacerbations and remissions), rhythm (the connection of pain with food intake), seasonality (exacerbation in spring and autumn, and in some patients - in winter and summer), the increasing nature of pain as the disease develops, changes and disappearance of pain after eating, antacids; use of heat, anticholinergics, after vomiting.

According to the time of onset of pain after eating, they are divided into early, occurring soon after eating, late (after 1.5 - 2 hours) and night. Early pain is characteristic of ulcers located in the upper part of the stomach. Ulcers of the antrum and duodenal ulcers are characterized by late and night pain, which can also be “hungry”, as it decreases or stops after eating.

Pain in peptic ulcers reaches its maximum intensity at the height of digestion and only “hunger” pains disappear after eating. In the presence of perigastritis or periduodenitis, the pain intensifies with physical stress. Reduction or cessation of pain after accidental vomiting leads to the fact that patients, when pain appears, induce vomiting artificially. No less typical for peptic ulcer disease is the lightning cessation of pain after taking alkalis. No wonder I.P. Pavlov compared their effect with the effect of nitroglycerin in angina pectoris.

Vomiting during a peptic ulcer occurs without previous nausea, at the height of pain in the midst of digestion, and with different localization of the ulcerative process, its frequency varies. The release of active gastric juice on an empty stomach is often accompanied by vomiting. Frequent morning vomiting with the remains of food eaten the day before indicates a violation of the evacuation function of the stomach.

Of the dyspeptic phenomena in peptic ulcers, heartburn occurs most often (in 60-80% of all patients with peptic ulcers). From a diagnostic point of view, it is important that it is noted not only during periods of exacerbations, but can precede them for a number of years and has the same typical features as pain (frequency, seasonality). Heartburn is associated with impaired motor function of the esophagus and stomach, and not with secretory function, as previously thought. When inflating the esophagus, stomach, or duodenum with a rubber balloon, you can cause a burning sensation of varying degrees, up to the sensation of a “burning cramp.”

Appetite in case of peptic ulcer is not only preserved, but sometimes even sharply increased. Since pain is usually associated with eating, sometimes patients develop a fear of food. Some people suffering from peptic ulcer periodically experience increased salivation, which is preceded by nausea. There is often a feeling of heavy pressure in the epigastric region. These phenomena are characterized by the same patterns as pain.

Constipation is often observed during an exacerbation. They are caused by the nature of the patients’ diet, bed rest and mainly by neuromuscular dystonia of the colon of vagal origin. The general nutrition of patients with peptic ulcer is not affected. Weight loss can be observed during an exacerbation of the disease, when the patient limits food intake due to fear of pain. With superficial palpation of the abdomen, tension in the right rectus muscle can be detected, which decreases as the pathological process subsides.

According to the clinical course, acute, chronic and atypical ulcers are distinguished. Not every acute ulcer is a sign of peptic ulcer disease.

The typical chronic form of peptic ulcer disease is characterized by a gradual onset, an increase in symptoms and a periodic (cyclical) course.

The first stage is the prelude of an ulcer, characterized by pronounced disturbances in the activity of the autonomic nervous system and functional disorders of the stomach and duodenum, the second by the appearance of organic changes initially in the form of structural changes in the mucous membrane with the development of gastroduodenitis, the third by the formation of an ulcerative defect in the stomach or duodenum, the fourth by development of complications.

The duration of periods of remission for peptic ulcer disease ranges from several months to many years. Relapse of the disease can be caused by mental and physical stress, infection, vaccination, trauma, taking medications (salicylates, corticosteroids, etc.), and insolation.

Causes of occurrence: damage to the nervous system (acute psychological trauma, physical and mental fatigue, nervous diseases), hormonal factor (impaired production of digestive hormones - gastrin, secretin, etc., impaired histamine and serotonin metabolism, under the influence of which the activity of the acid-peptic factor increases) .

2. Treatment of peptic ulcer

The complex of rehabilitation measures includes medications, motor regimen, exercise therapy and other physical methods of treatment, massage, and nutritional therapy. Exercise therapy and massage improve or normalize neurotrophic processes and metabolism, helping to restore the secretory, motor, absorption and excretory functions of the digestive canal.

Conservative treatment of peptic ulcer is always complex, differentiated taking into account factors contributing to the disease, pathogenesis, localization of the peptic ulcer, the nature of clinical manifestations, the degree of dysfunction of the gastroduodenal system, complications and concomitant diseases

During the period of exacerbation, patients should be hospitalized as early as possible, since it has been established that with the same treatment method, the duration of remission is longer in patients treated in a hospital. Treatment in a hospital should be carried out until the ulcer is completely scarred. However, by this time gastritis and duodenitis still persist, and therefore treatment should be continued for another 3 months on an outpatient basis.

The antiulcer course includes: 1) elimination of factors contributing to the relapse of the disease; 2) therapeutic nutrition; 3) drug therapy; 4) physical methods of treatment (physiotherapy, hyperbaric oxygenation, acupuncture, laser therapy, magnetic therapy).

Elimination of factors contributing to the relapse of the disease involves organizing regular meals, optimizing working and living conditions, strictly prohibiting smoking and drinking alcohol, and prohibiting the use of medications that have an ulcerogenic effect.

Drug therapy aims to: a) suppress the excess production of hydrochloric acid and foam or their neutralization and adsorption; b) restoration of motor-evacuation function of the stomach and duodenum; c) protection of the mucous membrane of the stomach and duodenum and treatment of helicobacteriosis; d) stimulation of regeneration processes of cellular elements of the mucous membrane and relief of inflammatory-dystrophic changes in it.

Physical methods of treatment - thermal procedures during the period of subsiding of the exacerbation (application of paraffin, ozokerite) with an uncomplicated course of the disease and no signs of hidden bleeding.

For long-term non-scarring ulcers, especially in elderly and senile patients, irradiation of the ulcerative defect with a laser (through a fiber gastroscope) is used; 7-10 irradiation sessions significantly shorten the time of scarring.

In some cases, there is a need for surgical treatment. Surgical treatment is indicated for patients with peptic ulcer disease with frequent relapses with continuous therapy with maintenance doses of antiulcer drugs.

During the period of remission of a peptic ulcer, it is necessary: ​​1) exclusion of ulcerogenic factors (cessation of smoking, consumption of alcohol, strong tea and coffee, drugs from the group of salicylates and pyrazolone derivatives); 2) compliance with the work and rest regime, diet; 3) spa treatment; 4) clinical observation with secondary prevention

Patients with newly diagnosed or rarely recurrent peptic ulcers should undergo seasonal (spring-autumn) preventive courses of treatment lasting 1-2 months.

Prevention

There are primary and secondary prevention of peptic ulcers. Primary prevention is aimed at active early detection and treatment of pre-ulcerative conditions (functional indigestion of the hypersthenic type, antral gastritis, duodenitis, gastroduodenitis), identification and elimination of increased risk factors for the disease. This prevention includes sanitary-hygienic and sanitary-educational measures for the organization and promotion of rational nutrition, especially among people working on night shifts, transport drivers, teenagers and students, to combat smoking and alcohol consumption, to create favorable psychological relationships in the work team and at home, explaining the benefits of physical education, hardening and organized recreation.

The task of secondary prevention is to prevent exacerbation and relapse of the disease. The main form of preventing exacerbation is medical examination. It includes: registration of people with peptic ulcer disease in the clinic, constant medical supervision of them, prolonged treatment after discharge from the hospital, as well as spring-autumn courses of anti-relapse therapy and, if necessary, year-round treatment and rehabilitation.

Therapeutic physical training is prescribed after the acute manifestations of the disease have subsided.

Objectives of exercise therapy:

normalization of central nervous system tone and cortico-visceral relationships,

improvement of psycho-emotional state;

activation of blood and lymph circulation, metabolic and trophic processes in the stomach, duodenum and other digestive organs;

stimulation of regenerative processes and acceleration of ulcer healing;

reducing stomach muscle spasms; normalization of the secretory and motor functions of the stomach and intestines;

prevention of stagnation and adhesions in the abdominal cavity.

Therapeutic massage is prescribed to reduce central nervous system excitation, improve the function of the autonomic nervous system, normalize the motor and secretory activity of the stomach and other parts of the gastrointestinal tract; strengthening the abdominal muscles, strengthening the body. Segmental reflex and classical massage are used. Act on paravertebral zones. In this case, in patients with gastric ulcer, these areas are massaged only on the left, and in patients with duodenal ulcer - on both sides. The area of ​​the collar area is also massaged.

Physiotherapy is prescribed from the first days of the patient’s stay in the hospital; its objectives are:

reducing the excitability of the central nervous system, - improving the regulatory function of the autonomic nervous system;

elimination or reduction of pain, motor and secretory disorders;

activation of blood and lymph circulation, trophic and regenerative processes in the stomach, stimulation of ulcer scarring.

First, drug electrophoresis, electrosleep, sollux, UHF therapy, ultrasound are used, and when the exacerbation process subsides, diadynamic therapy, microwave therapy, magnetic therapy, ultraviolet irradiation, paraffin-ozokerite applications, pine baths, radon baths, circular showers, aeroion therapy.

The post-hospital rehabilitation period is carried out in a clinic or sanatorium. Exercise therapy, therapeutic massage, physiotherapy, and occupational therapy are used.

Spa treatment is recommended, during which: walks, swimming, games; in winter - skiing, ice skating, etc.; diet therapy, drinking mineral water, taking vitamins, ultraviolet radiation, contrast shower.

The main forms of exercise therapy that are used at the inpatient stage of physical rehabilitation:

.Morning hygienic exercises.

.Physiotherapy.

.Independent studies.

.Walks in the open air.

.Therapeutic walking.

LH classes are first carried out in relation to bed motor rest.

The tasks of this motor mode include:

promoting the regulation of excitation and inhibition processes in the cerebral cortex;

improvement of redox processes.

counteracting constipation and stagnation in the intestines;

improvement of circulatory and respiratory functions.

In the first lessons, it is necessary to teach the patient abdominal breathing with a small amplitude of vibrations of the abdominal wall. These exercises, causing minor changes in intra-abdominal pressure, help improve blood circulation and gentle massage of the abdominal organs, reduce spastic phenomena and normalize peristalsis. Movements in large joints of the limbs are first performed with a shortened lever and a small amplitude. You can use exercises in static tension of the muscles of the upper limbs, abdominals and lower limbs. It is necessary to turn over in bed and move to a sitting position calmly, without significant tension. Duration of LG classes is 8-12 minutes.

Complex 1

Preparatory part

Same. Free breathing 2-3 times Slow

Lying on your back, arms along your body. Take the right (left) note to the side - inhale, return to i. p. - exhale. 2-3 times Slow Do not hold your breath

The same, hands below in the “lock” Raise your hands up, stretch - inhale, return to i. p. - exhale. 2-3 times Slow Do not hold your breath

The same Raise your arms up through your sides, inhale through your nose for 4 s, then slowly lower your arms - exhale for 4 seconds

2-3 times Slow 6. Lying on your left (right) side Take your left leg to the side - inhale, lower it - exhale, do the same on the other side 4-5 times Medium Don’t hold your breath

Lying on your back Relaxation exercises 30-40 s

Main part

Sitting on a chair, leaning your back against the back of the chair, hands - left on the chest, right on the stomach Diaphragmatic breathing: inhale - lasting 4 s, pause - 8 s, exhale - 6 s 2-3 times Slow

Sitting, legs straight, shoulder width apart Raise your arms up - inhale, bend towards your left leg - exhale, do the same for the other leg 2-3 times Slow Do not hold your breath

Sitting, resting your back against the back of the chair Hands across the sides (pulling your shoulders back) forward - inhale, bringing your palms together, pressing your fingers together, hold your breath for 8 seconds, lowering your arms relax - active exhalation 2-3 times Slow after each exercise free inhalation and exhalation

Sitting on the edge of a chair, hands resting behind you Raise your right (left) leg up, bend, straighten and lower 4-5 times Slow Breathing is arbitrary

The same, hands on the waist Turn the body to the right (left), reaching the back of the chair with your elbow 2-3 times Slow Breathing is arbitrary

The same, arms down. Tilt to the left, left hand down, right hand in the armpit; the same in the other direction 3-4 times Slow Breathing is arbitrary

Standing behind the chair, leaning your hands on the back Alternate swinging movements of the legs to the side, crossing 3-4 times Medium Breathing is arbitrary

Standing, left hand on chest, right hand on stomach Diaphragmatic breathing: inhale - 4 s, hold on inhalation - 8 s and exhale - 6 s 2-3 times Slow

Standing, rubbing your hands against the back of the chair, head back, legs together Press firmly with your hands on the back of the chair, straining the muscles of your legs and core for 8 s, relax by lowering your arms down 2-3 times Slow Breathing is arbitrary

Standing, bend your arms in front of your chest, legs shoulder-width apart Move your elbows to the sides with jerks, then straight arms to the sides with your palms up 2-3 times Slow Breathing is arbitrary

StandingWalking: inhale for 4 steps, hold your breath for 8 steps and exhale for 6 steps. Pause on exhalation 2 - 3 steps 2-3 times Slow Breathing is arbitrary

Final part

Sitting, hands to shoulders Rotations in the shoulder joints forward and backward 3-4 times in each direction Medium Breathing is arbitrary

The same: Squeeze and unclench your fingers, while simultaneously raising and lowering your feet 4-6 times. Medium Breathing is arbitrary

Same. Bring your hands to your shoulders, raise your arms up, lower your hands to your shoulders, lower your arms and relax 2-3 times. Medium Breathing is arbitrary

The same, hands on the hips. Palms up - inhale, palms down, relaxed - exhale 4-5 times. Average.

The same Close your eyes, relax the muscles of the whole body for 30-40 s. Slow. Breathing is calm

When performing exercises with isometric muscle tension at this stage of treatment, it is necessary to pay patients’ attention to rhythmic breathing without holding it. In the future, we can recommend breathing exercises aimed at increasing the duration of the respiratory phases and the intervals between them. The volume of static exercises should not exceed 10-15% of the total physical activity.

At the second and third stages (rehabilitation department - clinic, dispensary), the optimal duration of isometric tension increases until a submaximal time of volitional breath holding is achieved.

With a noticeable subsidence of pain and other exacerbation phenomena, the disappearance or reduction of rigidity of the abdominal wall, a decrease in pain and an improvement in general condition, a ward motor regimen is prescribed (about 2 weeks after admission to the hospital).

In addition to the tasks of the ward motor regime, the tasks of household and work rehabilitation of the patient, restoration of correct posture when walking, and improvement of coordination of movements are added.

Exercises from I.p. lying, sitting, standing, kneeling, with a gradually increasing effort for all muscle groups (except for the abdominal muscles), with incomplete amplitude, at a slow and medium pace. Short-term moderate tension of the abdominal muscles in a supine position is allowed. Diaphragmatic breathing gradually deepens. Duration of LG classes is 15-18 minutes.

If the gastric evacuation function is slow, the LH complexes should include more exercises lying on the right side, and if it is moderate - on the left side. During this period, patients are also recommended massage, sedentary games, and walking. The average duration of a lesson in a ward mode is 15-20 minutes, the pace of exercise is slow, the intensity is low. Therapeutic gymnastics is carried out 1-2 times a day.

Complex 2.

Preparatory part

Lying on your back, left hand on your chest, right hand on your stomach. Counting your pulse. Diaphragmatic breathing 5-6 times Slow Breathing evenly

The same Free breathing 2-3 times Slow. Standing Combined walking (on toes, on heels, cross step, etc.) with movements for the upper and lower 2-3 minutes Slow Do not hold your breath

3. Standing Slow walking: 4 steps - inhale, 6 steps - exhale 30-40 Slow

Standing, feet shoulder-width apart, raising your arms up through your sides - inhale 4 sec. Rise on your toes, inhale for 8 seconds, then exhale sharply, lowering your arms 2-3 times Slow While holding your breath while inhaling, perform isometric tension on the torso muscles

Standing Raise your catching hand to the side, right up, turn your torso to the left - inhale, return to i. p. - exhale 3-4 times Medium Do not hold your breath

The same, legs together, arms forward with palms down Raise your right leg with a swing, reaching for your left hand, lower the leg 5-6 times Medium Don’t hold your breath 8. Same, arms down Raise your arms up, left leg back on your toes - inhale, return to i. p. - exhale 3-4 times Slow Do not hold your breath

Main part

Standing on your knees Raise your hands up - inhale, sit on your heels - exhale 3-4 times Slow Do not hold your breath

The same Raise your arms up - inhale, sit to the right on the floor - exhale; the same to the left 3-4 times Slow Do not hold your breath

Standing on all fours, reach with your right knee (without lifting it from the floor) your left hand, return to i. p. 3-4 times Medium Do not hold your breath

10. The same, hands inward Inhale - bend over, touching your chest to the floor, exhale 3-4 times Medium

11. The same, hands forward Take a deep breath for 6 s, lean back, sit on your heels without lifting your hands from the floor - exhale slowly for 8 s 3-4 times Average

12.Lying on your stomach, head down on your hands, raise your right (left) leg up, return to i. p.2-3 times Medium Breathing is arbitrary

13. Same with your right knee, turning it to the side, reach your right elbow, return to i. p.2-3 times Medium Breathing is arbitrary

14. Lying on your left (right) side Take your leg back - inhale, protruding the abdominal wall forward, bend your leg at the knee joint, press it to your stomach - exhale 2-3 times Slow Breathing is arbitrary

15. Lying on your back, hands - left on your chest, right - on your stomach, feet on you Diaphragmatic breathing: inhale for 6 s, inhale pause - 12 s, exhale for 6 s 2-3 times Slow

16.Lying on the slip, arms along the body. Take a deep breath, hold your breath for 12 with simultaneous jerks, pressing your right (left) knee to your stomach - exhale 2-3 times Slow

17. Lying on blue, hands behind head Flexion and extension of legs at the hip, knee, ankle joints alternately - imitation of riding a bicycle 40-50 s Medium Breathing is arbitrary

The same, arms along the body Raise your arms up - inhale, relax your elbows down - exhale, relax 2-3 times Slow Breathing is arbitrary

The same Raise your legs up, spread your legs apart and cross (“scissors”). 20-30 sec. Slow Breathing is arbitrary

20. Same thing, legs apart Raise your arms up - inhale, lower them relaxed to the left to the floor - exhale, do the same in the other direction 2-3 times Slow Breathing is arbitrary

21.Kneeling, hands behind back Take a deep breath 6 s, bend forward - exhale 8 s 2-3 times Slow

Final part

22.Standing, arms down. Walking as usual, walking with arms moving up - inhale, lower arms down with muscle relaxation - exhale 1-2 minutes Slow Breathing is arbitrary

23. Same While walking, swinging arms with relaxation 30-40 s Slow Breathing voluntary

24. Same Alternately rocking the shin with muscle relaxation 1 min Slow Breathing voluntary

After the disappearance of pain and other signs of exacerbation, in the absence of complaints and general satisfactory condition, a free motor regimen is prescribed.

The objectives of this regime include: general strengthening and healing of the patient’s body; improvement of blood and lymph circulation in the abdominal cavity; restoration of household and work skills.

In LH classes, exercises are used for all muscle groups (sparing the abdominal area and excluding sudden movements) with increasing effort from various starting positions. Include exercises with dumbbells (0.5 - 2 kg), medicine balls (up to 2 kg), exercises on a gymnastic wall and bench. Diaphragmatic breathing is carried out with maximum depth. Walking is up to 2-3 km per day, walking up stairs - up to 4-6 floors, outdoor walks are desirable. The duration of the LG session is 20-25 minutes.

Complex 3.

Preparatory part

1. Standing, counting your pulse. Diaphragmatic breathing 5-6 times Slow Breathing evenly

2. Standing Combined walking (on toes, on heels, cross step, etc.) with movements for the upper and lower extremities 3-5 minutes Medium Do not hold your breath

3. The same Dosed walking, inhale for 6 steps, hold your breath for 12, exhale for 8. 1-2 minutes Medium Do not hold your breath

4. The same, right hand at the top, left hand at the bottom. Jerks the arms back, the same, changing hands. 5-6 times. Medium. Breathing is arbitrary.

5.O. c. Raise your arms up - inhale, sit down, arms forward - exhale 5-6 times Medium Breathing is arbitrary

6.O. c. Hands to the left, right leg to the side on the toe; swing your arms to the right, at the same time swing your right leg to the left, return to i. p. 3-4 times with each leg Fast Breathing is arbitrary

7. Standing Diaphragmatic breathing: inhale - 6 s. exhale - 8 s5-6 times Average

Main part

8. Standing, stick below Raise the stick up - inhale, return to i. p. - exhale 5-6 times Medium Breathing is arbitrary

9.Standing, stick forward Turn the torso and head to the right, return to i. p., the same in the other direction. 3-4 times in each direction Medium Breathing is arbitrary

10. Standing, stick down Stick up - inhale, hold your breath for 8 s, simultaneously bend 2 times to the right (left), then exhale sharply 2-3 times Slow After each exercise, take a deep breath and exhale

11.Standing, stick forward. Alternately, swing your legs to reach the stick 4-5 times with each leg. Fast. Breathing is arbitrary.

12.Standing, stick on stomach Deep diaphragmatic breathing with protrusion of the abdominal wall forward - inhale, press the stick and draw in the abdominal wall - exhale 2-3 times Slow

13.Standing, stick forward Spring squats 3-4 times Fast Voluntary breathing

14. Standing on your knees Raise the stick up - inhale 6 s, hold your breath for 12 s, exhale sharply, sit on your heels 1-2 times Slow

15.Lying on your back, put the stick next to you. Raise your arms up - inhale, hold your breath for 8 seconds, while simultaneously pressing your knee (left, right) to your stomach, return to i. p.1-2 times with each leg Slow

16. The same Alternate abduction of legs by sliding on the carpet 3-4 times Medium Breathing is arbitrary

17. Lying down, legs bent at the knee joints, hands under the head. Inhale, lower your bent knees to the right to the floor - exhale, inhale - return to i. p., lower your knees to the left - exhale 3-4 times Medium Breathing is arbitrary

18.Lying on your back, hands under your head Raise your torso up, return to i. p.3-4 times Medium Breathing is arbitrary

19. Same: Raise your legs, bend them, straighten them, lower them 3-4 times. Medium. Don’t hold your breath.

20.Lying on your back. Raise your arms up - inhale, lower your elbows down relaxed - exhale 4-5 times Slow

21. Lying on your side Swing movements, legs forward, backward, the same on the other side. 3-4 times Medium Do not hold your breath

22.Lying on your stomach, hands under your chest Raise your shoulders up, straightening your arms, bend over - inhale, return to i. p. - exhale, relax for 1-2 s3-4 times Medium Do not hold your breath

23.Standing on all fours Raise your right (left) leg up, bending, return to i. p. 4-5 times with each leg Medium Breathing is arbitrary

24.The same Raise your right (straight) leg to the side, look at the toe, return to i. p. 4-5 times with each leg Medium Breathing is arbitrary

25. The same, reach the left hand with your right knee by sliding it along the carpet, return to i. p. 3-4 times with each leg Medium Breathing is arbitrary

26.Kneeling, stick below Raise the stick up - inhale, return to i. p. - exhale 3-4 times Slow Do not hold your breath

27.Standing, feet shoulder-width apart, stick perpendicular to the floor. Bend your left leg at the knee joint, return to i. p., bend your right leg, return to i. p. 3-4 times Medium Do not hold your breath

28. Standing, ball in hands Stand in a circle and, on command, pass the ball to a friend on the left, and the same to the right. 3-4 times Medium Do not hold your breath

29. The same Pass the ball to the right (left) by hitting the floor 3-4 times Fast Don’t hold your breath

30. Same Raise the ball up - inhale, lower - exhale 2-3 times Slow

Final part

31. Standing Raise your arms up - inhale 6 s, lower your arms - exhale 8 s 2-3 times Slow

32. Same: Slow walking, relaxation exercises, breathing exercises. Sit down, relax, count your pulse and breathing

Breathing exercises must be included in the LH complex. In this case, the task is to teach the patient to correctly perform deep diaphragmatic breathing, to teach volitional control of respiratory movements aimed at increasing the duration of the respiratory phases and the intervals between them, which contribute to the activation of redox processes and increasing the tone of the whole organism.

Diaphragmatic breathing has a massaging effect on the abdominal organs, improves lymph and blood circulation, as well as intestinal motility and prevents the development of constipation. Based on this, there is a need for an individual dosage of breathing exercises in relation to general developmental exercises.

Thus, at the inpatient stage of rehabilitation treatment in bed motor mode, the ratio of breathing and general developmental exercises should be 1:2, 1:3, 1:4. When expanding motor activity in the ward and free motor modes, this ratio is also determined individually and is 1:5, 1:6, 1:7.

Dosed therapeutic walking has a positive effect on the functional state of the digestive system, stimulates metabolism, blood circulation, breathing and muscles of the whole body.

Therapeutic dosed walking can be prescribed at all stages of rehabilitation treatment after the pain has disappeared, indicating in the prescription the route number, walking pace, and intensity of physical activity. The degree of physical activity is consistent with the nature of the disease, the functional state of the digestive organs and the body as a whole.

There are different types of therapeutic walking: subsidized walking, subsidized walking, tourism at close distances (10-20 km), walking along special routes (health path), and in winter - skiing. For patients with peptic ulcers, walking at a slow pace (60-80 steps per minute) and walking at an average pace (80-100 steps per minute) is recommended.

Treatment using dosed walking is prescribed by a doctor and carried out under the supervision of a physical therapy instructor. Therapeutic walking is indicated in the morning and early evening; in winter it is better to do it in the middle of the day. Clothing should be light and appropriate for the seasonal air temperature. Each patient must be taught proper breathing while walking. Measured walking on level ground is combined with rhythmic breathing: inhale through the nose for 2-4 steps: exhale through the nose or mouth (lips pursed) for 4-5 or 6-7 steps.

The success of treatment largely depends on a gradual increase in physical activity. Therefore, when prescribing subsidized walking, one should take into account the severity of the disease, the duration of remission, the initial background of the secretory and motor functions of the stomach, as well as gastrofibroscopy and radiography data.

Peptic ulcer of the stomach and duodenum is a common disease of the gastrointestinal tract. Literary data indicate a high percentage of patients in all countries. Over the course of a lifetime, up to 20% of the adult population suffers from this disease. In industrialized countries, 6-10% of the adult population suffers from peptic ulcers, with duodenal ulcers predominating compared to gastric ulcers.

Factors contributing to the occurrence of peptic ulcer disease are various disorders of the nervous system, infection with Helicobacter; for some patients, hereditary predisposition may be important, as well as neuropsychic stress, dietary errors, alcohol abuse, spicy foods, chronic diseases of the gastrointestinal tract and other factors.

Currently, it is generally accepted that peptic ulcer of the stomach and duodenum develops as a result of an imbalance between the aggressive factors of gastric juice and the protective factors of the mucous membrane of the stomach and duodenum towards the predominance of aggressive factors. Under the influence of various etiological factors, a violation of the neuroendocrine regulation of the secretory, motor, and endocrine functions of the stomach and duodenum occurs with an increase in the activity of the parasympathetic division of the autonomic nervous system.

Complex treatment and rehabilitation of patients with gastric and duodenal ulcers include: drug treatment, diet therapy, physical and hydrotherapy, drinking mineral water, exercise therapy, therapeutic massage and other therapeutic agents. The anti-ulcer course also includes the elimination of factors contributing to the relapse of the disease, provides for the optimization of working and living conditions, a categorical prohibition of smoking and drinking alcohol, and a prohibition of taking medications that have an ulcerogenic effect.

The use of physical exercises for diseases of the gastrointestinal tract allows the use of all four mechanisms of their therapeutic action: tonic effect, trophic effect, formation of compensation and normalization of functions. Exercise therapy improves or normalizes neurotrophic processes and metabolism, helping to restore the secretory, motor, absorption and excretory functions of the digestive canal.

An important therapeutic measure is diet therapy. Therapeutic nutrition in patients with gastric ulcers must be strictly differentiated depending on the stage of the process, its clinical manifestation and associated complications. The basis of dietary nutrition for patients with gastric and duodenal ulcers is the principle of a gentle regime for the stomach, that is, creating maximum rest for the ulcerated mucous membrane.

To determine the effectiveness of exercise therapy, medical and pedagogical observations of the patient are carried out, determining his condition, the impact of the exercises used, a separate lesson, and a certain period of treatment. Special studies of the functional state are also of great importance, which provide an objective assessment of the patient, his individual characteristics, and adaptation to physical activity.

The main forms of exercise therapy that are used at the inpatient stage of physical rehabilitation: morning hygienic gymnastics, therapeutic exercises, independent exercises, walks in the fresh air, therapeutic walking. Exercise therapy is used in three motor modes: bed, ward and free.

In the first lessons (bed locomotor mode), it is necessary to teach the patient abdominal breathing with a small amplitude of oscillations of the abdominal wall. Movements in large joints of the limbs are performed first with a shortened lever and a small amplitude. You can use exercises in static tension of the muscles of the upper limbs, abdominals and lower limbs. It is necessary to turn over in bed and move to a sitting position calmly, without significant tension. Duration of LG classes is 8-12 minutes.

In the ward motor mode, exercises from i.p. lying, sitting, standing, kneeling, with a gradually increasing effort for all muscle groups (except for the abdominal muscles), with incomplete amplitude, at a slow and medium pace. Short-term moderate tension of the abdominal muscles in a supine position is allowed. Diaphragmatic breathing gradually deepens. Duration of LG classes is 15-18 minutes.

If the gastric evacuation function is slow, the LH complexes should include more exercises lying on the right side, and if it is moderate - on the left side. During this period, patients are also recommended massage, sedentary games, and walking. The average duration of a lesson in a ward mode is 15-20 minutes, the pace of exercise is slow, the intensity is low. Therapeutic gymnastics is carried out 1-2 times a day.

In the free motor mode, LH classes use exercises for all muscle groups (sparing the abdominal area and excluding sudden movements) with increasing effort from various starting positions. Diaphragmatic breathing is carried out with maximum depth. Walking is up to 2-3 km per day, walking up stairs - up to 4-6 floors, outdoor walks are desirable. The duration of the LG session is 20-25 minutes.

Therapeutic massage is prescribed to reduce central nervous system excitation, improve the function of the autonomic nervous system, normalize the motor and secretory activity of the stomach and other parts of the gastrointestinal tract; strengthening the abdominal muscles, strengthening the body. Segmental reflex and classical massage are used. Act on paravertebral zones. At the same time, in patients with gastric ulcer, the named zones are massaged only on the left, and in patients with duodenal ulcer - on both sides. The collar area and abdomen are also massaged.

Physiotherapy is prescribed from the first days of the patient's stay in the hospital. First, drug electrophoresis, electrosleep, sollux, UHF therapy, ultrasound are used, and when the exacerbation process subsides, diadynamic therapy, microwave therapy, magnetic therapy, ultraviolet irradiation, paraffin-ozokerite applications, pine baths, radon baths, circular showers, aeroion therapy.

The data we obtained can be used in the practical activities of physical rehabilitation specialists and exercise therapy instructors in various medical institutions, as well as used in physical education universities in the process of training in the discipline “Physical rehabilitation for diseases of internal organs.”

Bibliography

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