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Before talking of ulcer and diet that we
have to be taken, it's a right way tospeak and describe the organs involvedin this disease:
- The Stomach - The Duodenum
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The Stomach
The stomach is a muscular,
hollow, dilated part of the
alimentary canal which
functions as an importantorgan of the digestive tract. It
is involved in the second
phase of digestion, following
mastication (chewing). Thestomach is located between
the oesophagus and the small
intestine.
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mucosa
The first main layer. This consists of the epithelium and the lamina propria
(composed of loose connective tissue), with a thin layer of smooth muscle
called the muscularis mucosae separating it from the submucosa beneath.
submucosa
This layer lies over the mucosa and consists of fibrous connective tissue,separating the mucosa from the next layer. The Meissner's plexus is in this
layer.
muscularis externa
Over the submucosa, the muscularis externa in the stomach has three layers
of smooth muscle
inner oblique layer
middle circular layer
outer longitudinal layer
serosa
This layer is over the muscularis externa, consisting of layers of connective
tissue continuous with the peritoneum.
The Stomach wall
The stomach walls are made of the following layers, from inside to outside
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Glands of Stomach
Cardiac glands
(at cardia)
Pyloric glands
(at pylorus)
Fundic glands
(at fundus)
The epithelium of the stomach forms deep pits. The glands at these
locations are named for the corresponding part of the stomach:
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The Stomach Glands Cell and their
Secretions
Layer of stomach Name Secretion Region of stomach
Isthmus of gland Mucous and mucoid
cells
mucus gel layer Fundic, cardiac, pyloric
Body of gland parietal (oxyntic)
cells
gastric acid and
intrinsic factor
Fundic, cardiac, pyloric
Base of gland chief (zymogenic)
cells
pepsinogen Fundic only
Base of gland enteroendocrine(APUD) cells
hormones gastrin,histamine,
endorphins,
serotonin,
cholecystokinin and
somatostatin
Fundic, cardiac, pyloric
Different types of cells are found at the different layers of these glands:
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GASTRIC Juice
Hydrochloric acid
PepsinIntrinsic factor
1.1. Mucosal cellsMucosal cells
2.2. MucoidMucoid cellscells
3.3. Parietal cellsParietal cells4.4. Chief cellChief cell
GASTRICGASTRIC
GLANDGLAND
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The Duodenum
The duodenum is the first
section of the small intestine.
The duodenum precedes the jejunum and ileum and is the
shortest part of the small
intestine, where most chemical
digestion takes place.
In humans, the duodenum is ahollow jointed tube about 1012 inch long connecting the
stomach to the jejunum. It begins with the duodenal bulb and
ends at the ligament of Treitz.
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Duodenum parts
First part (superior) begins as a continuation of theduodenal end of the pylorus. Then 5cm
it curves inferiorly into the superior
duodenal flexure (the end of the
superior part).
Second part (descending) begins at the superior duodenal
flexure. At the end turn medially into
the inferior duodenal flexure (the end
of the descending part).
Third part (inferior/horizontal) begins at the inferior duodenal flexure
and passes transversely to the left,
crossing the right ureter.
Fourth part (ascending) reaches the inferior border of the body
of the pancreas. Then, it curves
anteriorly and terminates at the
duodenojejunal flexure where it joins
the jejunum. The duodenojejunal
flexure is surrounded by a peritoneal
fold containing muscle fibres: the
ligament of Treitz.
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Ulcer
Destructive process of the
mucous membranes and
underlying layers,
common in the stomach
and duodenum, caused by
the damaging action of
chloride-peptic secretion
Definition
Other locations: distal esophagus, post-anastomotic jejunal loop, Meckel's diverticulum
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Positions of Ulcers
STOMACH: on top of small
curvature, inintermediate portion between
the body and pyloric antrum
DUODENUM: commonly in the
bulb, immediate
near the pylorus
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Most common causes of
Ulcers
Infection by Helicobacter
Pylori (After 1980)
Gastric acid
hypersecretion
Stress
Smoke
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almost every time, an acute gastric
mucosal lesions is caused by theuse or abuse of anti-inflammatory
drugs, including aspirin, that is
acetylsalicylic acid or other
(indomethacin, ibuprofen,naproxen, tolmetin, sulindac,
piroxicam, fenoprofen).
In these cases in the patient, since
the drug is absorbed throughbackscattering in the gastric
mucosa, there are superficial antral
erosions with bleeding.
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The most common sintoms
difficulty in swallowing food;
nausea and vomiting;
vomiting of blood coagulation;
loss of weight;
tiredness;
severe abdominal pain.
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Gastric Ulcers
the ulcer was confirmed by endoscopic examination and
radiological
very important is the differential diagnosis with stomach cancer
the first symptom is commonly
represented by epigastric pain.
antacids provide prompt relief,
while food, after a temporary
wellness, can induce growth.
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Duodenal Ulcer
The pain typically appears from
1 ½ to 3 hours after a meal
(late)
An ingestion of food results in
a resolution of pain in a short
time
A typical seasonal increase inspring and autumn
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Clinical Differences
STOMACH:
-older age
- decreased motility
- reduced secretion at rest
-DUODENUM:
- more sensitive to the resting
basal stimulus
- regress with food
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Complications of Ulcers
Hemorrhage
Perforation (the most
common site duodenum)
Pyloric stenosis
M alignant degeneration
(1-5% of gastric cases
caused by Helicobacter
Pylori)
Malignant ulcer: endoscopic
view of cancer
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TherapyBefore talking about the diet in case of ulcer, shown the severity of the disease, is right
to say a word about medical treatments, which are much more timely and useful
ME DICAL TH ER APY
In about ¾ of patients with ulcer, medical treatment (antacids, histamine H2
receptor antagonists, proton pump inhibitors, somatostatin) is sufficient tostop the bleeding and stabilize the condition.
The placement of a nasogastric tube of large caliber allows flushing of the
stomach, the aspiration of blood clots, and monitoring any resumption of
bleeding.
The electrocoagulation, a lasercoagulation, tissue adhesives, fibrin glue,
collagen can be useful sometimes decisive.
In patients infected by Helicobacter pylori will be associated an antibiotic antibiotic therapy.therapy.
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Surgical Therapy25% of patients with an acute ulcer still requires the use of
emergency surgery.
The surgery is aimed first of all to identify and arrest (by
suturing / or ligation) the source of hemorrhage.
After, it's possible to proceed to one of the surgical
treatment valid for ulcer:Vagotomy simple
Vagotomy + antrectomy (with Reset of gastrointestinal
continuity).
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Diet for Ulcera
Gastric ulcer belongs to a
category of diseases for
which it described a diet
that reduces the secretion
of stomach acid and avoidexcessive mechanical
distension of the stomach
wall.
There are many herbal and homeopathic remedies for thetreatment of peptic ulcer. But if the disease is not treated, it can
give serious complications. So they should be taken under
medical supervision.
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The diet in case of ulcer is a diet low in vitamins B1, C, calcium and iron. It
can be used in case of gastric and duodenal ulcer, bleeding or healing
phase). In general, the diet for an ulcer is governed by the following
points:
eat at regular intervals,
variety of foods,
exclude irritant and stimulants foods for of the secretions of thestomach.
Other suggestions:
Eat slowly, chewing carefully
Have a snack between main meals and before bedtime
Avoid heavy meals (with the ulcer is better to eat little but often)
Avoid tea, coffee, alcohol, fried foods, fatty cheeses, fatty meats, spices
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Ulcers: The "Good" foods
Bread toasted, dry, crust of bread, crackers, bread sticks, rusks,
biscuits, rice, pasta, semolina, corn, cream of vegetables and
legumes, pasta with olive oil and fresh tomatoes)
drinking milk or in various foods (mashed potatoes, cakes, cream,
white sauce ...).
Unfermented fresh cheese (mascarpone, mozzarella, smoked
cheese, crescenza), boiled eggs, poached, even as an ingredient in
other preparations, but not fried.
Lean veal, chicken, rabbit, pork, lean, leg of lamb, and ham.
Fresh fish lean boiled or grilled or baked (sole, trout, perch and
hake, sea bass, sea bream) never fried.
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Ulcers: The "Good" foods
Vegetables: vegetable soups in general, potatoes (not fried), lettuce,
artichoke hearts, cooked carrots, red beets, small peas cooked and
mashed, beans, tomatoes (skinned and seeded), finely chopped
celery.
Fruit cooked and mashed
fresh fruit ripe, peeled and seeded.
Beverage: barley coffee and only after meals, non-carbonated water,
various teas, non-acidic fruit juices diluted with water.
Sweets: sugar, fruit cakes, meringue, candy, dry biscuits, fruit jellies,
butter, olive oil, aromatic herbs, lemon juice instead of vinegar.
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Ulcers: The "Good" foods
The main Property of the extracts of
liquorice root is its cytoprotective, anti-inflammatory and healing activity on
gastric and duodenal mucosa. All this is
due in particular to the glycyrrhizin, which
acts by direct contact with the lesion, and
with an indirect stimulus to production of
mucus by the cells of the gastric wall.Liquorice is very specified in the
prevention and treatment of gastric and
duodenal ulcers, gastritis and ulcer caused
by drugs (NSAIDs, steroids).
Liquorice
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Ulcers: The "Good" foods
Cabbage Fights gastric
ulcer, duodenal ulcerand intestinal ulcers
Cabbage
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Ulcers: The "Good" foods
Kohlrabi fights gastric
ulcer, duodenal ulcerand intestinal ulcers
K ohlrabi
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Ulcers: The "Good" foods
This juice is precious
for its properties:
It is efficient for cases
of gastric and
duodenal ulcer.
Potatoes Juice
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A new Discovery!
A recent study, published on the
world-magazine of
gastroenterology, discovered
the protective effects of arugula
about gastric and duodenal
ulcer in an animal model
(mouse).
Although the prickly taste, the
arugula protected the mice's
stomach from damage, inducedby alcohol and indomethacin.
The results are very good, and
certainly should be detailed on
man before take conclusions.
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Ulcers: The Bad foods
Fresh bread: soft part or undercooked bread , rye bread, wholemeal flour, fat soups
or whit whole vegetables, soups with fried, soup with meat broth, seasoned pasta
too much seasoned with sauces and spices.
Condensed milk, cold milk, cheese or spicy fermented.
Fried eggs, omelet fried.
Fatty meats and meats served with sauces, preserved in salt, smoked, not cooked,
fried, stews, casseroles, roasts, fat pork, mutton, venison, goose, duck, turkey,salami, Bologna sausage, sausages.
Fatty fish: sardines, herring, anchovies, eel, salmon, cod.
All preparations fried, smoked, dried, salted
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Ulcers: The Bad foods
All nuts, figs, bananas, chestnuts, oranges, tangerines, grapes, dates, walnuts,
almonds, hazelnuts, sour fruit, all just ripe fruit.
Pure wine, beer, all carbonated drinks, carbonated water, tea, concentrated
coffee, especially with empty stomach, liqueurs and alcoholic drinks, all the
frozen drinks, all liquids are too hot, acidic fruit juices (lemon, grapefruit, orange,
apricot).
fried Sweet, stuffed, made with puff pastry, with cream, cocoa, chocolate, ice
cream, sorbets.
All cooked fat, especially if cooked longer, fried foods, lard, all the spices,
mustard, vinegar.
All stored and fermented food.
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Breakfast200 ml of milk or yogurt or barley coffee with one packet of sugar
2 slices toast with honey or 30 grams. bread
Lunch
60 gr. rice or pasta, or semolina or cream of rice cooked in milk with a knob of butter
140 gr. veal or grilled scallops, or 140 gr. chicken in the oven or 210gr. sole in white or 2
eggs
200 gr. zucchini (or carrots or green beans), steamed
30 gr. unsalted bread
150 gr. baked apples or pears or fresh fruit ripe
Break
2 slices with 30 gr. of jam and a cup of decaffeinated tea or coffee barley
Dinner
35 gr. rice or noodles in vegetable broth or cream of rice milk (200 ml)
60 gr. of mozzarella cheese or soft cheese or 2 eggs or 120 grams. of ricotta cheese
Mashed potatoes and carrots
2 slices bread or bread sticks
An example of 1600 calorie diet for Ulcers
Recommended