Symptomatic gastric and duodenal ulcers is to occur under the influence of yazvoprovotsiruyuschego factor. They are distinguished from peptic ulcer disease that is always possible to identify the precipitating factor, and an ulcer if you remove this factor, ulcer healing and recovery is fairly quick.
Symptomatic ulcers are:
stressful
drugs
endocrine
arising on a background of diseases of other organs.
Stress ulcers. Acute stress ulcers occur when symptomatic severe trauma, with severe acute diseases of various organs after complicated surgery. In these cases, stressful situations are considered for the body shock, collapse (the sharp drop in blood pressure), oxygen starvation of body tissues, acute failure of the liver or kidneys. Under the influence of several of these factors together the risk of ulcers increases dramatically.
The mechanism for the development of ulcers in this case is considered a violation of the interaction of the factors of aggression and defense factors of gastric mucosa and duodenal ulcers. Aggression factors begin to predominate over protective factors. The mechanism of development of ulcers include blood in the release of stress hormones glucocorticoids and catecholamines, which stimulate the release of hydrochloric acid, reduce gastric mucus production, contribute to disruption of blood microcirculation in the wall of the stomach and duodenum.
As a consequence of disturbance of microcirculation (blood flow in small vessels) occur in the mucous membrane bleeding. Bleeding may be small or large. Then, in place of hemorrhage in a reduced protection of the mucous membrane is destroyed surface layer of mucous membrane - Erosion is formed. Erosion gradually deepens and, reaching the muscular layer of the stomach or duodenum, turned into an ulcer. Most of these are symptomatic stress ulcers are formed on the bottom of the mucosa of the stomach and body, at least in the duodenum.
There are different types of stress ulcers:
Curling's ulcer. This type of ulcer occurs in patients with extensive or deep burns, the burn disease.
Cushing's ulcer. In patients with severe diseases of the central nervous system: severe traumatic brain injury, hemorrhagic stroke (bleeding in the brain), surgery on the brain.
Ulcers in the other major surgery.
Ulcers in myocardial miokrada.
Ulcers with severe injuries.
Erosions and ulcers are found in more than 50% of patients with the above conditions. But not always, these ulcers are diagnosed. Quite often they have cured themselves in the stabilization of the patient and treating the underlying disease. The risk of stress ulcers is the possibility of life-threatening complications of massive bleeding from ulcers or perforation of the ulcer with the development of inflammation of the peritoneum (peritonitis).
Medication or drug ulcers. This ulceration of the stomach and duodenal ulcers, which occur under the influence of ulcerogenic (ulcer causing) drugs. The mechanism of development of these ulcers may be different, some drugs inhibit the formation of protective hormones (certain types of tissue hormones - prostaglandins) in the gastric mucosa and reduces the production of gastric mucus (aspirin, nonsteroidal anti-inflammatory drugs - diklofenka, brufen, indomethacin, etc.).
Other drugs directly damage the gastric mucosa - potassium chloride, sulfonamides, nonsteroidal anti-inflammatory drugs. Such drugs as caffeine, synthetic adrenal cortex hormones - glucocorticoids, reserpine stimulate the formation of hydrochloric acid increased parietal cells of the stomach. Steroids other than that stimulate the secretion of gastrin and pepsin, which further increases the aggressiveness of gastric contents.
Contribute to the formation of ulcers anticoagulants, digitalis preparations, nitrofuranovogo drugs. The most common drug ulcers occur in the stomach. Enough in a lot of cases they are multiple and combined with erosion. These ulcers usually heal quickly after discontinuation of the drug. However, the risk of ulcer drugs is the possibility of complications - bleeding ulcers and perforation of the stomach wall. If the patient has a peptic ulcer, all these drugs may lead to its aggravation.
Ulcers with hyperparathyroidism. Hyperparathyroidism - a disease in which the parathyroid glands is the excess production of parathyroid hormone, or parathyrin regulating calcium metabolism. At the same time he parathyroid hormone increases the production of hydrochloric acid in the stomach. In addition, excessive amounts of calcium in the blood also stimulates the secretion of hydrochloric acid and gastrin. Ulcers in the giperparatiroze formed mostly on the duodenal mucosa. For such ulcers are usually difficult: there are long-term ulcers, poorly respond to treatment, accompanied by severe pain and are prone to complications (perforation, bleeding) and frequent relapses.
Ulcers are also formed with other diseases of the digestive system (liver cirrhosis, chronic pancreatitis), chronic lung disease, chronic renal failure and diabetes.
