Ulcer

The code of gastric ulcer by ICD-10

see subheadings above

Included:

  • erosion (acute) of the stomach
  • ulcer (peptic):
    • pyloric part
    • stomach

If necessary, identify the drug that caused the lesion, use the additional code of external causes (class XX)

Excluded:

  • acute hemorrhagic erosive gastritis (K29.0)
  • peptic ulcer nodule (K27.-)

In Russia International Classification of Diseases 10th revision (ICD-10) adopted as a single regulatory document to account for the incidence, causes of public calls to medical institutions of all departments, causes of death.

ICD-10 introduced into the practice of health care throughout the territory of the Russian Federation in 1999 by order of the Ministry of Health of Russia dated May 27, 1997. №170

The release of the new revision (ICD-11) is planned by WHO in 2022.

ICD-10 classes

In Russia International Classification of Diseases 10th revision (ICD-10) adopted as a single regulatory document to account for the incidence, causes of public calls to medical institutions of all departments, causes of death.

ICD-10 introduced into the practice of health care throughout the territory of the Russian Federation in 1999 by order of the Ministry of Health of Russia dated May 27, 1997. №170

The release of a new revision (ICD-11) is planned by WHO in 2017 2018

Causes of breach of the integrity of the shell

Pathogenesis (mechanism of formation) depends largely on a complex number of reasons contributing to the imbalance in the body. The most dangerous form of the course of the disease is a perforated ulcer, the result of a significant preponderance of factors contributing to the intensification of an aggressive environment. The provocateurs of the disease include hydrochloric acid - a component of the gastric juice. Acids of the gallbladder flow from the liver to the duodenum, then to the stomach. The mucus protecting the inner surface is produced by mucous membrane cells. Normal blood circulation and cell regeneration of the cells of the membrane without delay are considered normal.

The disease occurs against the background of a disease initiated by the bacterium Helicobacter pylori. There are a number of other reasons predisposing the imbalance:

  • Prolonged time or periodically arising stressful state,
  • Changing the composition of gastric juice in the direction of increasing acidity,
  • Chronic gastritis, gastroduodenitis,
  • Failure to eat,
  • Nicotine addiction
  • Alcohol addiction,
  • Long-term treatment with certain medications, such as aspirin, butadion,
  • Predisposition embedded in the genetic code.

Symptoms of the disease

The main symptom of clinical exacerbation include strong pain. Spasms are localized mainly in the upper abdomen, pain is given in other departments, left hypochondrium and right, in the thoracic spine and lumbar spine. The duration of the attack, the flow time depends on the affected area of ​​the stomach and duodenum.

The pain that occurs after a meal indicates ulcerative changes in the upper part of the stomach. The ulcerative defect of the middle part contributes to the occurrence of a seizure at the expiration of one and a half hours after food enters the stomach. The ulcer of the 12th duodenal ulcer and the pyloric canal - the lower part of the stomach is accompanied by pain two or three hours after the meal. Such pains are called "hungry", occur on an empty stomach.

Concomitant symptoms are described, the analysis of which is important in drawing up the history of the disease. These include the appearance of belching, heartburn, vomiting, nausea, a tendency to difficult defecation.

Innovations in the description of diseases in the ICD-10

The International Congress Conference, held under the leadership of the World Health Organization in Geneva from September 25 to October 2, 1989, revised the classification of diseases.

A distinctive feature of the new revision was the innovation in the code for diseases. Now adopted a four-digit code consisting of one Latin letter and three digits. The letter U is left as a reserve. Coding of one hundred three-digit categories in one class, denoted by a letter, became possible.

The history of the unified international list of diseases

The classification of diseases began in the 17th century. The pioneer in the creation of the list was the Englishman John Graunt. The scientist carried out the first statistical processing of information, determining the proportion of live-born children who died before six years. Graunt managed to achieve a clear objectivity in estimating the percentage of mortality. The scientist used the method of selection for various diseases at an early age, having received the first list of diseases.

Two hundred years later, a sharp criticism of the principles of creating a statistical classification of diseases sounded in England. By 1899, the last version, dubbed “Classification of the causes of death of Bertillon,” by the name of the author, was voiced. In 1948, during the sixth classification adjustment, diseases were added that did not result in the death of the patient.

What is the global classification for?

Using a single code to indicate a particular disease erases the interlanguage borders. The international classification of diseases in the modern version is a normative document. Thanks to the ordered list, it became possible to ensure the unity of approaches in diagnostic methods.

From now on, a doctor in any country of the world, looking at the international four-digit code, will understand what is being said in the patient's history.

Gastrointestinal tract and its ulcerative deformities in ICD

Due to a profound change in the coding of the patient's painful conditions, a case of classifying an ulcer took into account several factors. For example, the use of an additional digit in the code indicates the course of the disease or the cause of it. When specifying the medication that caused the stomach, use an additional code of external causes. In the tenth revision, nine options are used to classify the ulcer subspecies. Acute hemorrhagic erosive gastritis and peptic ulcer of BDU are assigned separate numbers.

Perforation is one of a number of symptoms that is involved in determining the course of the disease. Perforation of the stomach wall or duodenum is a hole resulting from the impact of aggressive factors. Due to the imbalance of the protective forces and aggressive effects, the wall is thinning. Over time, a hole is formed through which the contents of the stomach pour into the abdominal cavity.

Gastric ulcer according to ICD-10 is expressed in the K25 code. The subspecies include four acute, four chronic and one unspecified. Acute and chronic forms are divided into diseases that occur with or without bleeding, with perforation or without. As an extra, numbers are added through the point 0,1,2,3,4,5,6,7,9.

The duodenal ulcer according to ICD-10 is denoted by the code K26. The principle of designating a subtype of the disease remains the same as the description of a stomach ulcer. There are 9 clarifications, which included 4 acute forms: K26.0 - with bleeding, K26.1 - with perforation, K26.2 - with bleeding and perforation, K26.3 - without them. 4 chronic or unspecified forms (K26.4, K26.5, K26.6, K26.7) are classified in a similar way. The ninth form - К26.9, comes as unspecified, acute or chronic, without bleeding or perforation.

Diagnosing

To determine the diagnosis using an integrated approach. The history of the disease, the patient's complaints are being studied. Conduct primary physical examination - a set of procedures, including inspection, palpation, percussion and auscultation. Later, specific methods are connected: x-rays, which help to reveal the niche of the ulcer, gastroduodenoscopy and intragastric measurement of the level of acidity.

After analyzing the results, the type of ulcer is determined. Depending on the diagnosis, the disease is assigned an ICD code. Diagnosis should be done on time. From this depends on the course of treatment, further predictions.

The initial stage of the diagnosis is carried out by the attending physician. Additional methods are included in the full examination. The patient is determined in the hospital, diagnosis and treatment are often carried out simultaneously.

In the acute form of the disease, urgent measures are taken. First, perform procedures aimed at restoring the patient, achieve stabilization of the state. Then connect in-depth diagnosis.

The treatment of peptic ulcer is prescribed and carried out only by a doctor. Modern methods include three to four components. The patient is prescribed one or two antibiotics. To drugs add the drug, neutralizing the hydrochloric acid contained in the gastric juice, medicines, forming a protective film on the surface of the gastric mucosa.

An important point is patient compliance with a special diet. A balanced diet helps to heal quickly and reduce the risk of recurrence. Recommend quitting smoking and drinking. The usual course lasts at least two to three weeks.

The surgical solution to the problem is chosen infrequently. This method refers to the cardinal methods of treatment.

Short description

Peptic ulcer - is a chronic recurrent disease occurring with alternating periods of exacerbation and remission, the main symptom of which is the formation of a defect (ulcer) in the wall of the stomach and duodenum. The main complications of peptic ulcer disease are bleeding, ulcer perforation, penetration, pyloric stenosis, malignancy, cicatricial deformity of the stomach and duodenum, periviscritis 8.

I. INTRODUCTORY PART

Protocol name: Gastric and duodenal ulcer and gastroenteroanastomosis complicated by bleeding
Protocol code:

ICD code 10:
K25 - Gastric ulcer
K25.0 - Acute with bleeding
K25.4 - Chronic or unspecified with bleeding
K26 - Duodenal Ulcer
K26.0 - Acute with bleeding
K26.4 - Chronic or unspecified with bleeding
K28 - Gastrojejunal ulcer
K28.0 - Acute with bleeding
K28.4 - Chronic or unspecified with bleeding

Abbreviations used in the protocol:
GSH - hemorrhagic shock
DIC - disseminated intravascular coagulation
Duodenal ulcer
IPP - proton pump inhibitors
ITT - infusion-transfusion therapy
INR - international normalized attitude
NSAIDs - nonsteroidal anti-inflammatory drugs
BCC - circulating blood volume
PTI - prothrombin index
SPV - selective proximal vagotomy
LNG - portal hypertension syndrome
STV - stem vagotomy
CA - level of evidence
Ultrasound - ultrasound
CVP - central venous pressure
BH - respiratory rate
ECG - electrocardiography
EFGDS - esophagogastroduodenoscopy
YAB - peptic ulcer
Hb - hemoglobin
Ht - hematocrit

Protocol development date: year 2014.

Patient category: adults.

Protocol users: surgeons, anaesthesiologists and resuscitators, gastroenterologists, local physicians, general practitioners, emergency and emergency doctors, paramedics, functional diagnostics doctors (endoscopists).

Evaluation of the evidence of recommendations given4.
The scale of the level of evidence:

Classification

Clinical classification of peptic ulcer1

Depending on the location, there are:

Combined ulcers: gastric and duodenal ulcer

• the stage of scarring (red scar, white scar).

Complications:

• Latent, mild, moderate, severe

Classification of gastroduodenal bleeding

I By localization:

• FIII - no stigma bleeding in the ulcer crater,

Diagnostics

Ii. METHODS, APPROACHES AND PROCEDURES FOR DIAGNOSTICS AND TREATMENT

The minimum list of examinations that must be carried out when referring for planned hospitalization: not carried out.

Basic (mandatory) diagnostic examinations conducted at the hospital level (in case of emergency hospitalization, diagnostic tests are carried out not carried out on an outpatient basis):

Relative contraindications: an extremely serious condition with low blood pressure below 90 mm Hg (EFGDS should be performed after correcting the patient's condition in OR and T conditions and increasing systolic blood pressure not less than 100 mm Hg) 7 (UD-C).
Absolute contraindications: agonal condition of the patient, acute myocardial infarction, stroke. one

Additional diagnostic examinations conducted at the hospital level (in case of emergency hospitalization, diagnostic tests are carried out not carried out on an outpatient basis):

• physical examination (pulse count, heart rate, BH count, measure blood pressure, assess the nature of vomit, digital rectal examination).

Diagnostic criteria (description of reliable signs of the disease, depending on the severity of the process)

Complaints: Clinical signs of bleeding: vomiting of scarlet (fresh) blood or coffee grounds, tarry stools or loose stools with little-altered blood. Clinical signs of blood loss: weakness, dizziness, cold, sticky sweat, tinnitus, rapid heartbeat, short-term loss of consciousness, thirst.

Medical history of the disease:

• Signs of hemocoagulation syndrome (DIC).

Laboratory research:
General blood analysis: decrease in the content of red blood cells, hemoglobin and hematocrit levels.
Blood chemistry: increase in blood sugar, AST, ALT, bilirubin, residual nitrogen, urea, cretinin, reduced total protein.
Coagulogram: reduction of PTI, fibrinogen, increased INR, lengthening of clotting time.
Tactics of treatment is determined in accordance with the degree of blood loss and BCC deficiency (Appendix 1).

Differential diagnosis

• stabilization of hemostasis (drug correction, endoscopic hemostasis, surgical treatment)

Treatment tactics***

Non-drug treatment
Diet of patients with YAB must have a weak sokogonnym action: drinking water, alkaline water, deprived of carbon dioxide, fatty milk, cream, egg white, boiled meat, boiled fish, vegetable puree, soups from different cereals. Food and dishes that have a strong sokogonnym action are excluded from the diet: broths, strong Navara from vegetables, alcoholic drinks, fried and smoked dishes, pickles, alcoholic drinks, etc.
Diet therapy for peptic ulcer disease consists of three cycles (diets No. 1a, No. 1b, and No. 1 with a duration of 10–12 days each during the exacerbation period. Later, in the absence of a sharp exacerbation and conducting anti-relapse therapy, a non-wiped version of diet No. 1 may be prescribed. Anti-ulcer diet should contain juices of raw vegetables and fruits rich in vitamins (especially cabbage juice), rosehip broth.
Food for ulcer complicated by bleeding, the patient does not give food for 1-3 days, and he is on parenteral nutrition. After stopping or significant reduction of bleeding, they give liquid and semi-liquid cooled food in tablespoons every 2 hours to 1.5-2 glasses per day (milk, cream, slimy soup, sparse jelly, jelly, fruit juices, dogrose broth Malengracht table). Then the amount of food is gradually increased at the expense of soft-boiled eggs, meat and fish soufflé, butter, liquid semolina, carefully grated fruits and vegetables.
Diet - every 2 hours in small portions. In the future, the patient is transferred first to diet No. 1a, and then to No. 1b with an increase in the content of animal proteins in them (meat, fish, and curd steam dishes, protein omelets).
It is advisable to use enpitov, in particular protein and antianemic. The patient is on diet No. 1a until complete cessation of bleeding, and on diet No. 1b - 10-12 days. Next, for 2-3 months prescribed pureed diet number 1.

Drug treatment

ITT with mild blood loss:

complex of amino acids for parenteral nutrition) in the ratio of 3: 1 with a total volume of 300% of the volume of blood loss (2.5-4.5 liters),

ITT with severe blood loss 7 (UD-A):

The critical level of hemoglobin parameters is 65-70 g / l, hematocrit 25-28%. (to adhere to the order number 501 of 2012 on the transfusion of blood components),

• Perftoran in a dose of 10-15 ml per 1 kg of patient weight, the speed of administration is 100-120 drops per minute. But it must be remembered that perftoran does not replace hemoplasmotransfusion,

In the “quadrotherapy" scheme: tetracycline 500 mg 4 times a day, metronidazole 500 mg 2 times a day, bismuth tri-potassium dicitrate 120 mg 4 times a day. In regions with resistance> 20%, sequential therapy is recommended as an alternative to quadrotherapy in first-line therapy to overcome clarithromycin resistance: IPP + amoxicillin (5 days), then IPI + clarithromycin + metronidazole (5 days).

• Metamizole sodium 50% 2 ml / m

• Neostigmine 0.5 mg 1 ml as required

Drug treatment provided at the outpatient level

The list of additional drugs (less than 100% probability of use): Sodium chloride 0.9% 400 ml IV.

Gastric ulcer and its types according to ICD 10

According to ICD 10, gastric ulcer has a code K 25, its varieties are classified into phases and symptoms:

  • K 25.0 - acute form with bleeding,
  • K 25.1 - acute form with perforation,
  • K 25.2 - acute form, accompanied by bleeding and perforation,
  • K 25.3 - acute period without perforation and bleeding,
  • K 25.4 - unspecified ulcer with bleeding,
  • K 25.5 - unspecified ulcer with perforation,
  • K 25.6 - unspecified with bleeding and perforation,
  • K 25.7 - a chronic period without bleeding and perforation,
  • K 25.8 - Unidentified without bleeding and perforation.

A stomach ulcer has many different complications, but in ICD 10 only perforation is fixed, the others have different classification codes and belong to other sections. The assignment of codes to diseases greatly facilitates the work of doctors, the surgeon of any country will immediately understand that K 25.1 is an ulcer with perforation in acute form.

Causes of development

A gastric ulcer with a common ICD 10 K 25 code usually occurs on the background of gastritis and the main cause of the disease is Helicobacter pylori. Almost 50% of the adult population is infected with Helicobacter, it occurs in the everyday life of the family through dishes, saliva and hygiene items.

But peptic ulcer disease may have other causes:

  • violation of the diet and diet,
  • emotional and mental experiences
  • heredity,
  • other diseases of the digestive system (gastritis),
  • taking alcohol in large quantities, smoking,
  • long-term drug therapy
  • occupational intoxication.

The process of ulceration on the walls of the stomach occurs due to increased release of hydrochloric acid, bile and digestive enzymes.

Symptoms of the disease

The course of a peptic ulcer and its symptoms depend on the complexity and localization of the pathology:

  • severe pain
  • constant heartburn
  • unpleasant belching,
  • nausea with vomiting
  • bleeding,
  • loss of consciousness,
  • Weight loss,
  • peritonitis.

Pain is most often associated with eating, heartburn always accompanies the ulcer.

Perforated ulcer

Perforated or perforated gastric ulcer code K 25.1, K 25.2, K 25.5 or K 25.6 according to ICD 10, depending on the complexity of the process and its localization. This form of peptic ulcer is life-threatening; if perforated through the perforation, food from the stomach can get into the abdominal cavity and cause the development of peritonitis. With exacerbation, the pathology develops quickly and if you do not provide timely assistance in the form of qualified treatment, the prognosis will be poor.

The reason for the activation of pathology can be:

  • breaking the diet
  • binge eating,
  • physical overload
  • reduced immunity
  • exacerbation of the inflammatory process around the ulcerative focus.

Perforation of the stomach walls and accompanying complications are classified in the following order:

  • the severity of the disease,
  • the degree of development of peritonitis,
  • localization of the hearth,
  • characteristic pathological features.

Symptoms perforated ulcer is divided into three degrees.

First degree

The most characteristic feature of this stage of the disease is a strong, intensely increasing pain in the stomach area, radiating to the right, can capture the right shoulder blade and shoulder. The pain is so severe that the patient can only be in one position - bend your knees to the stomach. At the slightest movement, the pain pierces so much that a person's face turns pale, breathing becomes faster and the pulse decreases.

The abdominal muscles are toned, the abdomen is swollen due to the large accumulation of gas. Vomiting is usually absent.

Second degree

The most dangerous stage during which peritonitis usually develops. Acute pain recedes and one may think that relief has come, and the attack of aggravation has passed. At this point, the tongue seems dry and a raid appears on it. Often these symptoms are confused with the development of appendicitis and do not provide appropriate assistance.

Third degree

Development of purulent peritonitis with the rapid deterioration of the patient. At this point from the beginning of the attack of pain passes about 12 hours. At this stage, frequent vomiting occurs, contributing to dehydration. The skin and mucous membranes become dry, the coating on the tongue becomes brown.

When pus spills in the abdominal cavity, the temperature rises, the pulse becomes frequent, the blood pressure is greatly reduced, bloating is observed. In this stage, urgent operational assistance is required. It often happens that it is already impossible to help the patient.

Content

The normal functioning of the gastric mucosa occurs under the influence of two groups of factors on the mucosa:

  1. protective factors
  2. aggressive, destructive factors.

The factors of the 1st group include: mucus produced by the gastric mucosa, this mucus prevents the back diffusion of protons to the mucous membrane.

The factors of the 2nd group include: gastric juice (containing hydrochloric acid and pepsin - an enzyme that digests protein compounds), which is an aggressive agent for cells and an infectious factor - microbe Helicobacter - Helicobacter pylori (in case of infection with it). The occurrence of an ulcer occurs when the destructive effect on the gastric mucosa of aggressive factors begins to prevail over the action of protective factors. A noticeable number of gastric ulcers associated with infection by a microorganism Helicobacter pylori, a spiral acidophilic bacterium that lives in the acidic contents of the stomach and in its mucosa. However, only a small number of infected carriers of Helicobacter pylori develop a clinically pronounced gastric or duodenal ulcer or gastritis with high acidity. The reasons for the fact that a smaller part of those infected with this microorganism falls ill are not clear: apparently, the state of general and local immunity, nonspecific protective factors of the gastric mucosa (bicarbonate secretion, protective mucus), the initial (before infection) acidity and the enzymatic activity of the gastric contents etc.

According to the latest updated data, 38% of gastric ulcers worldwide are associated with infection. H. pylori. The second particular reason for the formation of gastric ulcers is the use of nonsteroidal anti-inflammatory drugs. More rare causes include adenocarcinoma, carcinoid, tumor penetration of neighboring organs, sarcoma, leiomyoma, foreign bodies, diabetes mellitus, Crohn's disease, lymphoma, syphilis, tuberculosis, HIV infection. one

The emergence of gastric ulcers can also be promoted by smoking, alcohol abuse (especially strong alcoholic drinks), coffee and other caffeine-containing drinks, psychological overstrain, stress, depression, and anxiety, when increased secretion of the gastric juice (so called “stress ulcer”), acute pains with severe injuries, burns, accompanied by the development of traumatic shock (the so-called “shock ulcer”), unsystematic nutrition, nutrition dry food, abuse of convenience foods and concentrates, spices, sour, spicy, pepper, salted, smoked, fried, too hot, too cold or otherwise thermally, chemically or mechanically irritating food, carbonated drinks. In some patients, exacerbation of symptoms also causes the use of large quantities of sweet or muffin, apparently due to increased insulin secretion and a concomitant increase in acidity and pepsin secretion.

The symptoms of peptic ulcer disease depend on the location of the ulcer, the duration of the disease, the individual sensitivity of the patient to pain.

Epigastric pain is the main symptom of an ulcer. With the localization of ulcers in the stomach, pain usually occurs after eating, with the localization of ulcers in the duodenum, on the contrary, there are so-called “hungry pains” in which pain occurs on an empty stomach, and eating helps relieve pain.

Other symptoms of a peptic ulcer may include:

A clinical analysis of blood in an uncomplicated course of a peptic ulcer most often remains without significant changes. Sometimes there is a slight increase in hemoglobin and red blood cells, but anemia may be detected, indicating obvious or hidden bleeding. Leukocytosis and the acceleration of ESR are found in complicated forms of peptic ulcer.

  • Analysis of fecal occult blood.
  • The study of the acid-forming function of the stomach, which is carried out using pH-metry (in recent years - using daily monitoring of intragastric pH).

In case of ulcers of the body of the stomach and the subcardial part, normal or reduced indicators of acid production are usually noted.

A radiological examination with a double tight contrasting barium reveals a direct sign of a peptic ulcer - a “niche” on the contour or on the relief of the mucous membrane and indirect signs of the disease.

The most informative in the diagnosis of gastric ulcer and 12 duodenal ulcer is endoscopy, which visually confirms the presence of an ulcer defect, allows you to specify its localization, depth, shape, size, allows you to assess the condition of the bottom and edges of the ulcer, to identify related changes in the mucous membrane. When conducting endoscopic examinations, it is possible to perform an aimed biopsy - “pinching off” a piece of tissue from the edges or bottom of the ulcer defect using special tools. Thus obtained biopsy (piece of tissue) is sent for histological examination, which allows to identify the possible cancerous nature of the detected ulcer defect (ulcerative form of gastric cancer).

  • Biopsy followed by histological examination of the material obtained.

This study makes it possible to eliminate the malignant nature of the ulcerative lesion.

  • Studies of the presence in the gastric mucosa Helicobacter pylori.
  • Electrogastroenterography and antroduodenal manometry make it possible to identify violations of gastroduodenal motility.

For more than 10 years, the basis of therapy is the eradication of Helicobacter pylori in case of its detection. The patient's condition may improve after taking antacid medications, but most ulcers can be treated with antisecretory drugs 2.

Suppression of the secretion of hydrochloric acid in the stomach with the help of drugs leads to a decrease in the acidity of gastric juice. The dose of antisecretory agents was always selected individually, because inadequate amount of the drug in one case leads to ineffective therapy and long-term existence of the ulcer (as is known, the longer the ulcer defect remains open, the greater the likelihood of complications, the scarring causes more severe deformities and ulceration of the ulcer is very significantly increased), in another case (overdose) - to a deep and long-lasting suppression of the secretory function of the stomach and, as a result, to enhance the pr fermentation processes, impaired normal digestion and microflora alteration (dysbacteriosis).

Also for treatment stomach ulcers Vitamin preparations are used: vitamin B5 (pantothenic acid) and U (methylmethionine sulfonium chloride).

Pantothenic acid (vitamin B5) has a powerful reparative effect on mucous membranes. A lack of pantothenic acid in the body leads to the formation of an excess of hydrochloric acid in the stomach. Increased doses of pantothenic acid, on the contrary, inhibits gastric secretory function. Pantothenic acid also stimulates intestinal peristalsis. 3

Vitamin U (methylmethionine sulfonium chloride) helps to reduce gastric secretion and causes anesthetic effect. This is achieved due to the fact that vitamin U is involved in the methylation reactions of biogenic amines. For example, by methylation of histamine, vitamin U turns it into an inactive N-methylhistamine. four

Salo, salted fish, sausage are not recommended even during remission. Fat is a heavy product for the stomach. Patients are wondering if the jelly is allowed in peptic ulcer disease. During the period of exacerbation the dish is contraindicated. It is necessary to consider in detail that you can not take in food with a stomach ulcer. The following is a list of prohibited foods.

  1. In the diet of the ulcer should not appear raw vegetables with coarse fiber, irritating the mucosa mechanically and chemically. In the acute period do not eat tomatoes, garlic, turnips, onions, raw cabbage, vinaigrette.
  2. Contraindicated in duodenal ulcer grapes, has a high content of sugar and active acids. Juice from grapes to drink during exacerbation of the ulcer is not recommended. In the acute period, pomegranate is excluded, the fruit is sour, which negatively affects the condition of the mucous membrane. In remission, it is permissible to drink diluted pomegranate juice to restore hemoglobin. Cranberries in case of stomach ulcers are harmful, just like lemon.
  3. It is categorically contraindicated in case of a stomach ulcer fatty heavy meals - dumplings, kebabs, fried pork cutlets, lamb, liver and lard are prohibited.
  4. Nuts and seeds irritably mechanically affect the wall of the stomach, is strictly contraindicated in intestinal ulcers and stomach. Walnuts are not recommended to use categorically.
  5. Mushrooms are extremely heavy for the stomach, not recommended for use even in remission.
  6. Strong condiments, such as garlic, ginger, pepper, are strictly contraindicated. Herbs are full of irritating properties, stimulate gastric juice. Tomato and nut sauce are contraindicated.
  7. In the acute period of an ulcer it is impossible to try dried fruits. Dried apricots or prunes are harmful, injuring a weakened mucous membrane. But during remission, prunes with honey prevents constipation, restores the body tone.
  8. In case of a stomach disease, fatty foods, sausages, liver, caviar, lard are excluded. Butter can be used in small doses for dressing soups or porridge. five

The prognosis of the disease is conditionally favorable, with adequate timely treatment, the quality of life does not suffer, the ability to work is fully restored. However, it is possible to develop a number of life-threatening complications, such as bleeding from an ulcerous defect, or ulcer perforation, and, as a consequence, the development of peritonitis.

Medical examination in the military commissariat in the presence of an ulcer is carried out in accordance with Article 58 of the Schedule of Diseases 6. Depending on the degree of functional disorders caused by peptic ulcer, the recruit can be assigned the category of fitness "D" (not suitable) or "B" (partially suitable).

Exemption from conscription under category “D” occurs when a conscript has:

  • gastric ulcer, complicated by penetration, stenosis of the pylorobulbar zone, accompanied by malnutrition (BMI 18.5 - 19.0 or less), if there are contraindications to surgical treatment or refusal of it,
  • ulcer disease, complicated by massive gastroduodenal bleeding, during the first year after the specified complication.

With other forms of manifestation of the disease, the draft board approves the category of “B”. The exception is the aggravation of peptic ulcer at the time of passage of activities related to the call. In this case, a young person may be temporarily released from military service in the category of "G" 7. According to the results of the second medical examination conducted after the expiration of the grace period, the final decision on the appeal.

Watch the video: ICD-10-CM Coding Guidelines Understanding Gastrointestinal Ulcers (February 2020).