Diagnosis of gastric ulcer

How to identify a stomach ulcer? To diagnose pathology, the patient is assigned a series of studies, including the following items:

• clinical blood test;
• analysis of feces for available blood supplies;
• X-ray examination;
• ultrasound;
• ;
• biopsy( histological examination);
• tests for the presence of Helicobacter pylori.

Clinical blood test

A blood test is one of the mandatory tests assigned to a patient with suspected stomach ulcers. If the localization of the ulcer becomes pyloric stomach, then there is an increase in the level of erythrocytes and hemoglobin. The leukocyte formula remains unchanged in uncomplicated ulcers. In this case, minor lymphocytosis may occur.

If there is a disease in the results, there will be the following deviations. The ulcer, which proceeds without complications, does not cause significant changes in the composition of the blood. With the development of stenosis of the gatekeeper, changes in the acid-base balance, decrease in the number of electrolytes and total protein are noted.

A sign of perforated ulcer is the growth of indicators of ALT, gamma globulin, bilirubin. The increase in the level of urea is fixed during the development of peritonitis. On the degeneration of ulcers( malignancy) indicates progressive anemia. Additionally, there is a complete absence of hydrochloric acid, pepsin and the presence of lactic acid in the gastric juice composition, Boas-Osler ferment rods.

Study of feces for latent blood

Diagnosis of the stomach ulcers will help carry out an analysis of latent blood. Quite often, pathology is accompanied by the development of internal bleeding. After getting into the stomach, the blood gets black due to the oxidation of hemoglobin. Stool can contain its minimum volume, detected only by laboratory methods.

Radiography

To determine the stomach ulcer, it is possible with the help of X-ray study. The procedure can be appointed as an alternative to the EGF.The accuracy of the technique reaches 80%.There are direct x-ray signs of ulcer pathology. The main thing is a phenomenon such as "niche".Under the niche of the physicians understand the visually limited protrusion on the silhouette of the contrast filled stomach.

If the niche is defined on the front / back wall of the organ, then it looks like a stain on the relief background of the mucosa. It is surrounded by a pronounced marginal shaft caused by inflammation and edema. The size of the niche is variable. Depends on two factors:

• degree of damage to the gastric walls;
• the size of the inflammatory shaft.

Inflammatory shaft is able to visually extend the true size of the niche, as well as completely close it. The deepening itself is sometimes completely filled with remains of food, mucus, blood clots. That is why it can remain radioliologically invisible.

For chronic, recurring ulcers, as well as their callous forms, a modification of the relief of the gastric mucosa in the form of convergence of folds to a niche can be determined( cicatricial changes).Combined detection of the inflammatory shaft and cicatricial changes indicate the presence of gastric ulcer( JAW).

Niches come in different sizes - small, medium, large. The acute period of ulcer pathology is accompanied by the formation of a small depression. The most common size is 5 x 8 mm. Small niches, not exceeding the diameter of a pea, are localized in the bulb of the duodenum.

Large ulcer niches, the depth and diameter of which exceeds several centimeters, accompany chronic forms of the disease with pronounced symptoms. Formations of this size, in most cases, are penetrating ulcers. Penetriruyuschaya niche is a niche that extends beyond the stomach to the organ in the immediate vicinity.

It is three-layered - barium, liquid, air - and two-layer - barium and air layer. The presence of air bubbles on the X-ray is a clear indication of the penetration that occurred. The niche of ulcerous origin almost always has even walls. In the presence of defects, we can talk about bleeding or the beginning of the process of degeneration.

Ulcer can be located anywhere in the body of the

Indirect signs of the presence of sores, in which the patient is assigned a radiologic examination, are recognized:

• dysphagia;
• stomach discomfort;
• attacks of vomiting;
• sharp weight loss;
• pain syndrome;
• the presence of a palpation sensation in the abdomen;
• definition of occult blood;
• anemic conditions;
• violation of secretory function.

For a more accurate diagnosis of gastric ulcers, a double contrast technique is used - the use of contrast medium and air. After studying the motor function of the stomach and compensatory possibilities, the doctor prescribes an adequate treatment condition.

Ultrasound investigation

Diagnosis of stomach ulcers is impossible without an ultrasound examination of the stomach. On the screen of the monitor, the ultrasound picture of the disease looks like a wall defect penetrating deeper than the mucous and submucosal layer. Defeat can be focal or multiple. Chronic ulcers visually represent a defect of the gastric wall, one edge of which seems to hang over the surface of the mucosa.

FGD

Fibrogastroduodenoscopy( FGDS) - it is from advanced techniques, which allows to recognize peptic ulcer of stomach and intestines. The procedure is an endoscopic method of examining the stomach and duodenum with a fibroscope.

The EGF helps to obtain a detailed image of the gastric mucosa. The device allows you to assess the condition of the body: determine the location of ulcers, see the current size of education, get tissue for biopsy. The method of FGDS is used to evaluate the ongoing therapy. Approximately in 90% of all cases, the study helps confirm the diagnosis and cause associated pathologies.

The procedure is generally safe and has virtually no contraindications. But the examination of the stomach with a fibroscope will have to be abandoned in the presence of the following pathological conditions and diseases:

• heart failure in the stage of decompensation;
• acute stroke and post-stroke state;
• myocardial infarction;
• stenosis and esophagus burns;
• aortic aneurysm;
• terminal stages of chronic diseases.

Biopsy

Biopsy is used as a method of differential diagnosis. The study of the biopsy specimen makes it possible to distinguish the classic ulcerative defect from cancer. Peptic ulcer of the stomach and duodenum is initially regarded as a potentially possible cancerous formation. But the initial stages of cancer can be determined only by performing a histological examination of the living tissues of the stomach.

The preparation of the biomaterial is carried out during the endoscopy procedure. Deep ulcers are apparently capable of resembling cancerous areas, but in reality they are not. To confirm the diagnosis, multiple biopsies are carried out, i.e., the physician exercises the fences of the marginal and bottom tissues of each ulcerative element. Be sure to take the material of scar tissue, formed on the site of the healed damage. In addition, it is desirable to obtain tissue images from potentially hazardous areas.

For reliable diagnosis it is necessary to conduct a study of at least 6 samples obtained from different zones of damage. This is enough to make an accurate diagnosis. If you get samples of all affected areas of the mucosa did not work, then the patient is assigned to conduct a repeated biopsy.

Tests for the presence of Helicobacter pylori

The cause of ulcer disease in most cases is the bacterium Helicobacter pylori. There are invasive and non-invasive tests. The first group includes obtaining tissue for biopsy and a blood test. The second group includes the study of urine, saliva, stool and exhaled air. Non-invasive tests are conducted in several ways.

The stripped-down respiratory

The basis of the study is the ability of Helicobacteria to decompose urea. As a result of the reaction, ammonia and carbon dioxide are released. At the beginning of the test, the patient takes a double intake of exhaled air. After that, he must eat something. Then it painfully receives a special substrate containing a urea solution with labeled carbon.

After taking the test substance, the patient is sampled for exhaled air every 15 minutes for an hour. With the help of special equipment, the lab technician determines the amount of carbon labeled. The test is effective in 98%.The technique is safe. Contraindication becomes the bleeding ulcer.

Immunology

The procedure is used when it is not possible to carry out a breath test. The research is based on the immunological response to specific bodies. They are defined in the composition of urine, saliva, feces and blood.

Helicobacter - one of the causes of the development of the pathological condition

Fast stripped

For analysis, a piece of living tissue obtained as a result of a biopsy is used. For testing, a special indicator is used, in which urea and a reagent are present. The result depends on the intensity of the biopsy staining: the more bacteria present, the brighter and more saturated the color of the tissue.

Bacteriology

This is the most accurate option that determines the presence / absence of the bacterium pathogen. During the testing, the lab worker allocates a pure culture and conducts a study of its properties, as well as sensitivity to medicines. The average biopsy test takes a week. For the purposes of primary diagnosis, a reduced respiratory test or immunological examination is used.

If a more detailed study is needed, the patient is recommended to pass the following tests:

• reduced respiratory;
• stripped down fast;
• bacteriological.

Detection of the ulcer at the very beginning of its development significantly improves the prognosis of the disease. Learn about the presence of the disease will help the development of characteristic symptoms - recurring nausea, abscesses, often occurring at night, anorexia.