Ulkus/en: Unterschied zwischen den Versionen

Version vom 16. April 2019, 22:32 Uhr

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By an ulcer of the stomach or duodenum we generally mean a circumscribed substance defect of the mucous membrane, which also affects deeper layers beyond the actual mucous membrane.

Gastric or duodenal ulcers are circumscribed mucous membrane defects that reach the deeper layers of the stomach and intestinal wall and whose diameter can range from a few millimetres to more than three centimetres. They usually result from an inflammation of the gastric mucosa, the so-called chronic gastritis, which lasts for weeks, months or even years and is always accompanied by a loss of tissue substance.

The main cause of gastroduodenal ulcer disease is considered to be a disturbed balance between aggressive factors and protective mechanisms of the mucous membrane. Aggressive factors include hydrochloric acid, digestive enzymes of the stomach and bile acids. The production of mucus in the stomach, good blood circulation in the gastric mucosa and sufficient regeneration of the upper cell layers of the gastric and duodenal mucosa are regarded as protective factors.

Important influencing factors which can impair the finely tuned interplay of these mechanisms are stress and smoking, but also certain pharmaceuticals as well as colonisation of the stomach lining with the bacterium Helicobacter pylori ' (especially painkillers which are frequently used in joint diseases - for example acetylsalicylic acid, diclofenac and cortisone preparations - can lead to ulcers. Therefore, when prescribing these drugs, usually a protective drug is prescribed at the same time).

Approximately half of the ulcers heal within four to eight weeks even without specific therapies. However, recurrences often occur (with drug therapy, over 90% of the ulcers heal in the same period. Very often, however, recurrences occur after completion of therapy, in up to 70% of patients within the first year).

Complications of gastroduodenal ulcers often occur acutely and without any precursors. A sometimes life-threatening complication is the bleeding from the ulcer with subsequent tar stool (It is noticeable by blood vomiting or black coloration of the stool, so-called tar stool and occurs in up to 20% of all ulcer patients. Also highest life-threatening danger exists if the ulcer breaks through into the free abdominal cavity. Such a perforation, in about 5% of all ulcer patients, suddenly leads to severe permanent pain and irritation of the peritoneum. Here, the patient usually indicates a dull permanent pain with radiation in the back. All three complications require surgical treatment, which must be performed immediately, especially in the case of severe bleeding or perforation).

Weiterhin kann das Ulkus in Nachbarorgane einbrechen, es kommt zur Penetration, insbesondere der Bauchspeicheldrüse.

Bei langdauernder Ulkuskrankheit kann es zu Spätkomplikationen kommen. Dies sind beispielsweise entzündlich-narbige Verengungen im Bereich der Ulzerationen, die zu Entleerungsstörungen des Magens führen können. Die Patienten leiden unter Völlegefühl, Erbrechen und Gewichtsabnahme. Außerdem kann ein chronisches Ulcus ventriculi in etwa 3% der Fälle karzinomatös entarten, Ulzera des Duodenums entarten dagegen praktisch nie.

Das Bakterium Helicobacter pylori findet sich bei 95% der Patienten mit Ulcus duodeni und bei 70% der Patienten mit Ulcus ventriculi. Aber auch gesunde Erwachsene über 50 Jahre sind zu etwa 50% Träger von Heliobacter pylori.

https://de.wikipedia.org/wiki/Ulcus _{(Wikipedia CC-by-sa-3.0)}

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 Approximately half of the ulcers heal within four to eight weeks even without specific therapies. However, recurrences often occur (''with drug therapy, over 90% of the ulcers heal in the same period. Very often, however, recurrences occur after completion of therapy, in up to 70% of patients within the first year'').
-Komplikationen der gastroduodenalen Ulzera treten oft akut und ohne Vorboten in Erscheinung. Eine mitunter auch lebensbedrohliche Komplikation ist die Blutung aus dem Geschwür mit nachfolgendem Teerstuhl (''Sie macht sich durch Bluterbrechen oder Schwarzfärbung des Stuhls, sogenannter [[Teerstuhl]] bemerkbar und tritt bei bis zu 20% aller Ulkuspatienten auf. Ebenfalls höchste Lebensgefahr besteht, wenn das Ulkus in die freie Bauchhöhle durchbricht. Bei einer solchen Perforation, bei ca. 5% aller Ulkuspatienten, kommt es plötzlich zu heftigsten Dauerschmerzen und aufgrund der Reizung des Bauchfells. Hier gibt der Patient meist einen dumpfen Dauerschmerz mit Ausstrahlung in den Rücken an. Alle drei genannten Komplikationen bedürfen einer operativen Therapie, die vor allem bei schwerer Blutung oder Perforation unverzüglich durchgeführt werden muss'').
+Complications of gastroduodenal ulcers often occur acutely and without any precursors. A sometimes life-threatening complication is the bleeding from the ulcer with subsequent tar stool (''It is noticeable by blood vomiting or black coloration of the stool, so-called [[tar stool]] and occurs in up to 20% of all ulcer patients. Also highest life-threatening danger exists if the ulcer breaks through into the free abdominal cavity. Such a perforation, in about 5% of all ulcer patients, suddenly leads to severe permanent pain and irritation of the peritoneum. Here, the patient usually indicates a dull permanent pain with radiation in the back. All three complications require surgical treatment, which must be performed immediately, especially in the case of severe bleeding or perforation'').
 Weiterhin kann das Ulkus in Nachbarorgane einbrechen, es kommt zur Penetration, insbesondere der [[Bauchspeicheldrüse]].