Before determining the gastric ulcer, several specialists must work at once. The diagnosis is made after the patient is examined by a therapist, endoskulist, radiologist, surgeon. The morphologist and the laboratory assistant help to recognize the stomach ulcer. The tasks of all specialists include:
- evaluation of the structure of the stomach;
- detection of ulcerative defects, their shape and magnitude;
- exclusion of other pathologies;
- learning functions;
- monitoring of the course of the disease.
When a stomach ulcer occurs, the definition of the pathology depends on the patient's complaints. The main signs are pain and dyspeptic syndromes. Guards doctor symptoms that occur several times a week. Patients complain of nausea, pain, heaviness in the stomach, heartburn, vomiting.
How to understand what exactly is a stomach ulcer in a patient? For accurate diagnosis, direct examination methods, instrumental and laboratory methods are used. An ulcer is determined during palpation, examination, listening and percussion. To know the stomach ulcer specialist can at a preliminary examination of the patient. Depending on the severity of the pathology, the patient may be in a forced position( on his side, pulling his legs or abdomen under his belly).If it is complicated by perforation, the patient lies, not moving on her back.
You can identify the stomach ulcer when examining the skin and mouth. Pale skin can indicate the development of anemia, which occurs with bleeding. The resulting exacerbations lead to weight loss and loss of skin elasticity. If the peptic ulcer of the stomach flows with perforation, the patient is marked by dryness of the tongue with pronounced bloom. Often noted the presence of diseases of the teeth and gums.
To detect a stomach ulcer, assays help. Blood indicators often indicate changes in the content of erythrocytes and the development of posthemorrhagic anemia. In uncomplicated flow, hemoglobin can be elevated. With complications, leukocytosis and high ESR are detected. Concentration in the serum of gastrin during acute exacerbation increases sharply. Stool analysis plays an important role in the diagnosis of the disease. Check the stomach ulcer by the presence in the stool of hidden blood.
Depending on the correct preparation for the examination, it depends whether the ulcer of the stomach will show an ultrasound or not. It is preferable to conduct ultrasound with a device that works in real time, as a qualitative image of the organ is obtained. Conduct an examination on an empty stomach in the morning. If there is a stomach ulcer, the ultrasound helps to identify the places of the greatest soreness( with the help of palpation under the control of the apparatus), determine the tone and peristalsis, and the evacuation capacity of the stomach. Particular attention during the examination is given to the condition of the walls of the stomach. In some cases, ultrasound shows a stomach ulcer, because the walls of the whole organ, its contours are evaluated.
FGDS for stomach ulcers helps to study the condition of the organ with an optical device that is equipped with flexible fiber optics. Thanks to this method, you can see the location of the ulcer, estimate its size, take tissue for a biopsy. It is also possible to evaluate the therapy. In 90% of the cases, thanks to the FGD, it is possible to make an accurate diagnosis, as well as to identify the concomitant pathology. Usually the method does not lead to complications and is practically safe.
Contraindications for its conduct are:
- heart failure( decompensated);
- acute stroke;
- myocardial infarction;
- narrowing of the esophagus;
- burns the esophagus;
- large aortic aneurysm;
- terminal states.
If a patient has a gastric ulcer, EGD( video) helps to see the mucosa, to clarify the deformity of the organ and the presence of motor disorders. Emergency GVHD is performed in order to exclude perforation of the ulcer or to establish the source of bleeding.
X-ray examination of
If it is not possible to perform an EGF, an X-ray examination is performed. This method allows you to diagnose gastrointestinal defects. The accuracy of this method is 80%.Radiologic signs of ulcers, radiologists are described as a "niche", opposite which are spasmodic muscles( "pointing finger").Most often, X-rays are shown to patients who have the following symptoms:
- gastric discomfort;
- sharp weight loss;
- seals in the abdomen;
- revealing hidden blood;
- violation of secretory function.
Identify the main methods of X-ray: traditional, urgent, two-phase, test and double contrast. Gastric ulcer on the x-ray is detected more often with the method of double contrasting( using contrast medium and air).Doctors study the motor function of the digestive tract, the compensatory possibility of the organ, in order to conduct adequate therapy in the future.
Helicobacter pylori test
There are invasive and non-invasive tests that help to identify a bacterium that causes an ulcer - Helicobacter pylori. Invasive tests include examining pieces of tissue that are taken during a vascular hypertension or a blood test. Examination of saliva, urine, feces, exhaled air - non-invasive tests. The peptic ulcer with the help of these tests is diagnosed and controlled by its healing. There are several non-invasive tests.
The stripped-down respiratory
The principle of the test is based on the fact that the bacterium Helicobacter is able to decompose urea, resulting in ammonia and CO2.On an empty stomach, 2 samples of exhaled air are taken, followed by a light breakfast and a special substrate that contains a urea solution with labeled carbon. After taking the test substrate, take samples of exhaled air every 15 minutes for an hour and determine the amount of labeled carbon on the special equipment. With the help of this test, in 98% of cases the presence of a bacterium is reliably determined. It should be noted that the method is absolutely safe. The test is not carried out if the stomach ulcer is bleeding.
Applicable in the event that it is impossible to conduct a breath test. The study is based on the fact that the bacterium Helicobacter causes immunological reactions, producing specific antibodies. They are found in saliva, urine, feces, blood.
A piece of tissue( biopsy) is required for the study, which is tested for the presence of bacteria using a special indicator containing urea and a reagent. The intensity of the reaction will depend on the number of bacteria in the biopsy.
This study is the most accurate and gives a 100% result. The test allows you to isolate a pure culture and study its properties and sensitivity to the drugs. To carry it out, special equipment and expensive reagents are needed. The biopsy study itself takes up to 7 days. For primary diagnosis, a reduced respiratory or immunological test is used. If the picture is clear, special express tests with immunological methods are used for clarification. In case of serious research, a reduced respiratory, stripped-down fast and bacteriological tests are used.
The role of biopsy in the diagnosis and treatment of
A biopsy with a stomach ulcer is carried out from a specific area of the mucosa. This study is of great importance for diagnosis. There are basic methods of sampling material: aspiration and gastroscopy. When aspiration biopsy material is taken with a probe. The role of biopsy, which is performed during endoscopic examination, is important, since it allows to determine ulceration in the mucosa. Sometimes a biopsy results in false negative results. This is due to the lack of material or the ingress of unwanted tissue( necrotic, granulation) into the biopsy. Errors can be associated with the patient's uneasy behavior during the study. To choose the right therapy tactics, the doctor should eliminate errors, perform the procedure carefully with a fence of at least 6 pieces of material.