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Exercise therapy for diseases of the digestive system. Exercise therapy for diseases of the gastrointestinal tract and digestive system. An approximate complex of therapeutic exercises for peptic ulcers of the stomach and duodenum

Diseases of the digestive system occupy a significant place in clinical medicine. Diseases of the digestive system often affect people of the most working age, causing a high rate of temporary disability and disability.

The location and general anatomy of the main parts of the digestive tract are shown below. The close anatomical and physiological connection between the digestive organs makes it impossible to separately treat one or another organ in case of its disease.

As a result of a violation of secretory function, gastritis, gastric and duodenal ulcers, etc. develop, and in case of motor function disorder, colitis, constipation, etc.

The main means of treating diseases of the digestive system are diet therapy, medications, massage, movements (physical therapy, moderate physical activity, etc.), physical and hydrotherapy procedures. Exercise therapy for this pathology has a general tonic effect, adjusts neurohumoral regulation, stimulates blood and lymph circulation in the abdominal organs, strengthens the abdominal muscles, helps normalize the evacuation and motor functions of the intestines, etc.

The result of the effects of physical exercise depends on its type, dosage, rhythm and tempo of implementation, on the stage of its application, the duration of the course, as well as on its combination with diet and other therapeutic agents.

Studies have shown that moderate physical exercise normalizes the secretory and evacuation functions of the stomach, while intense physical training, on the contrary, depresses it. The use of special exercises and segmental reflex massage helps to normalize impaired functions. Thus, exercises for the muscles of the abdominal wall and pelvic floor help well with chronic colitis, cholecystitis, dyskinesias, etc., and breathing exercises have a “massaging” effect on the internal organs, improving blood and lymph circulation in the abdominal cavity. At the same time, abdominal exercises, as studies have shown, sharply increase intra-abdominal pressure, so they are contraindicated in patients with exacerbation of gastric and duodenal ulcers, and spastic colitis. Such patients benefit from breathing exercises, relaxation exercises lying on the back with legs bent at the knees and hips, or in the knee-elbow position.

Thus, exercise therapy and massage have a positive effect on the abdominal organs and stimulate the regulatory mechanisms of the digestive system.

Gastritis
Exercise therapy for gastritis with reduced secretion
Exercise therapy for erosive gastritis
End of treatment
An approximate set of exercises for erosive gastritis for exercise at home

All this leaves a noticeable imprint on the frequency of occurrence and characteristics of the clinical course of diseases of the digestive system in elderly and old people.

Main symptoms of diseases.

Abdominal pain is one of the most common complaints caused by diseases of the digestive system. They can be sharp and dull, constant and periodic, associated and not associated with food intake, localized and diffuse. The localization of pain is of great importance, but in some cases it may not coincide with the topographic location of the affected organ. Sometimes abdominal pain is observed in diseases that have nothing to do with the digestive organs or the abdominal cavity in general. Pain in the epigastric region can be associated with irritation of the solar plexus, with diseases of the stomach, liver, pancreas, and with some others, for example, myocardial infarction with a diaphragmatic hernia. In the right upper abdomen they are characteristic of diseases of the liver, gall bladder, hepatic flexure or right curvature of the colon, and right kidney. Pain sometimes radiates to the same area in cases of right-sided diaphragmatic pleurisy, as well as diseases localized in the lower right part of the stomach. Pain in the left upper abdomen may also be characteristic of diseases of the stomach, pancreas, spleen, splenic flexure or left curvature of the large intestine, left stream.

In the right lower part of the abdomen they are more often found with appendicitis, damage to the cecum, right kidney and genital organs, and in the left lower part of the abdomen they are often associated with damage to the sigmoid colon and genital organs.

Stomach pain has a number of characteristics. In patients with gastritis and dyspepsia, they occur after eating, but do not differ in frequency, that is, these periods do not alternate with the so-called light intervals, which can last for months. In case of peptic ulcer (stomach and duodenal ulcer), pain is characterized by periodicity, seasonality, connection with food intake and localization in the epigastric region. For duodenal ulcers, it is typical that they occur at night and on an empty stomach; for intestinal diseases, they do not strictly depend on the time of food intake and are associated with the act of defecation. Such pain is usually relieved by a bowel movement or passing of gas. In diseases of the liver and biliary tract, pain is mainly localized in the right hypochondrium, often radiating to the right shoulder or interscapular space. They often occur after excessive eating, especially after fatty and spicy foods, and intensify with movement. In cases of damage to the pancreas, they are encircling in nature, radiating to the left half of the body (left hypochondrium, left shoulder blade, left shoulder, sometimes to the lower back).

Abdominal pain can be an important symptom of acute surgical diseases of the abdominal organs.

Therefore, even if the pain is very severe, the nurse should not give the patient any painkillers without a doctor’s prescription. Elimination or easing of pain after the use of these drugs, especially narcotics, may complicate the diagnosis, resulting in delayed surgical intervention. It should also be borne in mind that for a number of acute surgical diseases of the abdominal organs, heating pads, laxatives and enemas are contraindicated.

Nausea and vomiting are common symptoms of gastrointestinal diseases, but can also occur unrelated to them. They are based on a complex neuroreflex mechanism. They are typical for diseases of the stomach (gastritis, peptic ulcer, cancer), intestines (enteritis and colitis), liver and biliary tract (hepatitis, cholecystitis, cholelithiasis), acute surgical diseases of the abdominal organs, accompanied by irritation of the peritoneum (acute appendicitis, perforated ulcer stomach and duodenum, peritonitis, etc.), general intoxications (poisoning, infectious diseases, pulmonary tuberculosis, uremia, toxicosis of pregnant women, etc.), lesions of the brain and its membranes (meningitis, tumors, cerebral hemorrhages) .

The diseases listed above do not exhaust the causes of these symptoms. Nausea and vomiting also occur due to irritation of the root of the tongue, pharynx, pharynx and epiglottis; they can also be of conditioned reflex origin and occur with the smell of unpleasant food or the sight of an object that causes disgust.

The time of occurrence and the relationship of vomiting with food intake are of great importance for diagnosis; appearance and amount of vomit, presence and nature of impurities (mucus, blood, bile, pus). All these data, along with other signs, help the doctor understand the complex picture of the disease.

Gastric nausea and vomiting typically occurs after eating. Vomiting in this case usually brings relief. However, these symptoms can only be considered a manifestation of gastric pathology if there are other signs typical of stomach disease.

It should also be mentioned that nausea in gastric diseases, as in some other cases, precedes vomiting. The exception is cerebral vomiting, which occurs without previous nausea. It is also characterized by a combination with headache and sometimes with increased blood pressure.

It should also be remembered that vomiting is often a sign of acute surgical diseases of the abdominal organs, usually combined with symptoms of peritoneal irritation. Vomiting blood is a sign of massive gastric bleeding from the vessels of the stomach wall or dilated veins of the esophagus. The cause of profuse bloody vomiting is most often peptic ulcer and stomach cancer, sometimes - cirrhosis of the liver; if vomiting follows bleeding, the vomit consists of scarlet blood, and in cases where the blood has been in the stomach for some time, it has the appearance of coffee grounds. Copious, dirty-brown, foul-smelling vomit (called fecal vomit) is an important symptom of intestinal obstruction or gastrocolic fistula.

Stool disorders and changes in its character most often manifest themselves in the form of constipation and diarrhea and are accompanied by changes in the shape, consistency, color, and smell of stool. The nature of stool may change, however, even in the absence of a violation of its frequency.

Diarrhea occurs due to a violation of the motor and secretory functions of the intestine, which is observed during inflammatory processes in its mucosa (enteritis, colitis); mechanical irritation from rough food containing a lot of fiber; irritation of the mucous membrane with chemicals (poisoning with mercury, arsenic, etc.), endogenous, i.e., poisons formed in the body (release of nitrogenous products of protein metabolism into the intestinal lumen during uremia), and products of putrefaction or fermentation. There may be other causes of diarrhea. In some cases, they occur with excitement or fear due to neurogenic acceleration of peristalsis.

Diarrhea in older people is usually dangerous, as it leads to dehydration.

Liquid and frequent stool mixed with mucus and blood is the main symptom of acute colitis of dysenteric and non-dysenteric origin. They are characterized by tenesmus, expressed in a painful and frequent urge to go down, accompanied by a feeling of pain in the rectum and anus. Diarrhea with vomiting is typical for toxic infections and cholera. Toxic infections are caused by salmonella and some other microorganisms, cholera is caused by Vibrio cholerae and its variety Vibrio El Tor. In cases of toxic infections, diarrhea is preceded by nausea and vomiting, and defecation is associated with paroxysmal abdominal pain, which decreases after stool. There is an increase in body temperature and chills. The first clinical manifestations of cholera are the urge to go down. Vomiting comes later.

Diarrhea occurs without pain, and the temperature reaction may be completely absent or a slight low-grade fever may be observed. As a result of profuse diarrhea and vomiting in cholera, severe dehydration occurs.

The cause of constipation is the slow movement of intestinal contents and its prolonged stay in the intestines. In this regard, increased absorption of the liquid part of stool occurs in the intestines, and they acquire an abnormally dense consistency.

Slower movement of intestinal contents may be associated with mechanical obstructions, impaired intestinal motility, and insufficient intestinal contents due to consumption of foods containing little plant fiber. There are other reasons for slow movement of intestinal contents.

In some cases, stool retention requires emergency care. One of these cases is the occurrence of a fecal impaction, i.e. the formation of hardened feces in the rectum, which, if not removed in a timely manner, can become fossilized. Their pressure on the wall of the rectum can cause the formation of bedsores. When a fecal impaction forms, mechanical removal of hardened feces is required. For this purpose, a bedpan is placed under the patient, and the nurse, wearing a glove, inserts an index finger lubricated with Vaseline oil into the rectum and removes the hardened feces in parts. After this, a cleansing enema is given. Stool retention can also be a symptom of a terrible condition - intestinal obstruction. In this case, constipation is combined with failure to pass gas, severe abdominal pain and severe general condition. Such patients require emergency surgical care.

Treatment of constipation can only be effective if its etiology is taken into account. An important link in treatment is a balanced diet, sports and therapeutic exercises. The systematic use of cleansing enemas and laxatives should be avoided. Taking mineral waters such as Batalinskaya and Essentuki No. 17 (1-1/2 glasses of water at room temperature in the morning and evening) has a beneficial effect.

Changes in stool color that are not associated with bowel movement disorders can be of great diagnostic importance. Thus, the discharge of discolored feces that look like whitish-gray clay indicates a blockage of the bile ducts (common bile and hepatic), as a result of which bile does not enter the intestines. Black tarry stools are observed with bleeding from stomach or duodenal ulcers, as well as with cancer of these organs.

However, it must be remembered that black stools also occur in patients taking iron supplements, Vikalin and activated carbon.

You should pay attention to the presence of various impurities in the stool. For example, a large number of connective tissue films in the stool indicates a decrease in the acidity of gastric juice and may indicate a complete absence of hydrochloric acid in it. The detection of undigested meat in the stool indicates a violation of the exocrine function of the pancreas.

A large amount of fat in the stool is observed in severe diseases of the pancreas and insufficient flow of bile into the intestines due to blockage of the hepatic or common bile duct.

DISEASES OF THE ESOPHAGUS

Esophagitis is an inflammation of the mucous membrane of the esophagus, which in old people is most often caused by the “throwing back” of peptically active gastric contents from the stomach. Conditions for gastric contents to enter the esophagus arise if the patient has a diaphragmatic hernia, impaired tone of the cardiac sphincter of the esophagus due to gastric ulcer or diseases of the biliary tract, as well as after surgical interventions. The cause of esophagitis can also be foreign bodies, stomatitis and candidiasis that has developed from antibiotic treatment.

Esophagitis is characterized by burning and pain in the chest, which intensifies while eating. The pain may radiate to the neck and back. Hypochromic anemia often develops as a result of hidden bleeding from the eroding surface of the inflamed mucous membrane of the esophagus.

Esophageal carcinoma. Men over 60 years of age are more often affected. Scars after a burn or injury to the esophagus, as well as diverticula and leukoplakia, predispose to the development of cancer.

Clinically, esophageal cancer is manifested by progressive difficulty swallowing, first solid and dry food, and then mushy and, finally, liquid. While eating, the patient may feel pain and burning behind the sternum. In the later stages of the process, when food stagnates above the narrowing of the esophagus and undergoes rotting, an unpleasant odor may emanate from the mouth. The patient gradually loses weight and becomes weaker. Severe general weakness, exhaustion and anemia develop.

Occasionally, in elderly patients, swallowing is slightly impaired. In these cases, the predominant symptoms are general weakness, exhaustion and anemia. Esophageal cancer metastasizes to the paraesophageal lymph nodes of the mediastinum, lungs and liver.

STOMACH DISEASES

Acute gastritis (acute gastric catarrh) is an acute inflammation of the gastric mucosa that occurs when it is exposed to poor quality food, chemicals, alcohol and other harmful substances. Acute gastritis can also be caused by overeating.

Patients complain of pain in the epigastric region, nausea and vomiting. Vomit contains remnants of recently eaten or stagnant, undigested food mixed with mucus or bile. The urge to vomit can be combined with cramping pain in the epigastric region. Severe general weakness develops. Dizziness, headache, sometimes an increase in body temperature up to 38°, and a complete aversion to food are noted.

Sometimes diarrhea occurs. In the latter case, phenomena of dehydration of the body may develop, expressed in a sharp deterioration in the general condition of the patient, adynamia, darkening of consciousness and other phenomena.

Chronic gastritis is quite common in the elderly and senile age. In old people, hypoacid and anacid forms predominate. This is explained by the fact that with age, structural changes occur in the nervous system and the vascular network of the stomach wall, as a result of which the prerequisites are created for the development of trophic changes on the part of various elements of the stomach wall and, in particular, the glandular apparatus.

Patients complain of a feeling of heaviness and fullness, as well as dull pain in the epigastric region that occurs or intensifies after eating. Appetite is reduced. Nausea occurs after eating. There is often belching of air, sometimes of rotten eggs. May cause pain in the mouth and tongue.

Peptic ulcer disease in old and senile age is not uncommon. Among patients with peptic ulcers, people over 60 years of age account for 20 to 25%.

Senile ulcers have a number of significant features. Its duration is usually small, its size is large, and its location in the stomach is higher. More often, an ulcer is combined with a low content or absence of hydrochloric acid in the contents of the stomach. Unlike peptic ulcer disease in young patients, it is not characterized by periodic exacerbations in spring and autumn.

The dependence of pain on food intake is also not expressed. Appetite is usually preserved. Vomiting with an uncomplicated ulcer is usually absent. The localization of pain is often atypical. Pain may be noted in the right half of the abdomen or in the left half of the chest. The latter is often perceived as a symptom of angina pectoris.

Frequent constipation. The older the patient, the more often the clinical course is characterized by extremely poor symptoms. Thus, the first manifestation of the disease may be profuse gastric bleeding or perforation. The diagnosis of gastric and duodenal ulcers is usually made on the basis of anamnesis, clinical data, X-ray examination and gastroscopy.

The most serious complications of gastric and duodenal ulcers: bleeding, perforation, degeneration into cancer, stenosis of the pylorus and duodenum.

Bleeding. Gastric bleeding is one of the dangerous complications of gastric and duodenal ulcers. Its frequency in elderly and senile patients is 2 times higher than in young people. With profuse gastric bleeding, severe general weakness, dizziness, pale skin, vomiting blood and tarry stools, severe thirst, tachycardia and a drop in blood pressure occur. If bleeding continues, collapse may occur. In this case, the patient loses consciousness.

The skin becomes covered with cold sweat, the pupils are dilated, the pulse is barely palpable (cannot be counted), the pressure decreases all the time and may not be detected.

Minor bleeding is characterized by mild general weakness, increased heart rate and a moderate decrease in blood pressure. Vomiting blood and tarry stools are sometimes absent. However, stool testing for occult blood in these cases gives a positive reaction.

A small amount of blood loss (150-200 ml) can cause only short-term weakness, subsequently manifesting itself in tarry stools.

Perforation. One of the most severe complications of gastric and duodenal ulcers is perforation (perforation) of the ulcer. The main symptom is sudden, extremely severe pain in the abdomen (in the figurative expression of patients - “like a blow from a dagger”). Initially it occurs in the epigastric region, then spreads to the right iliac region. The patient often takes a forced position - lying or sitting motionless with his legs brought to his stomach and bent at the knees. The most important objective signs of perforation include sharp tension in the muscles of the anterior abdominal wall, especially in the epigastric region. Palpation of the abdomen is painful.

The most severe pain occurs when the hand palpating the abdominal wall is suddenly removed (Shchetkin-Blumberg symptom). This is a very important symptom indicating irritation of the peritoneum. If the above symptoms are present, it is not difficult to make a diagnosis.

However, in elderly and senile patients, the clinical picture is not always so typical.

Often there is no symptom of the sudden onset of pain, tension in the abdominal wall is not so clearly expressed, and general phenomena predominate. In such cases, you should be especially attentive to subjective complaints and changes in general condition, so as not to miss such a formidable complication, since only an operation performed as early as possible can save the patient’s life.

Degeneration of a stomach ulcer into cancer. In elderly and senile people, this complication occurs in approximately 10% of cases, mainly with callous gastric ulcers, which are chronic persistent non-healing ulcers with calloused edges. Symptoms are usually very mild.

Stenosis of the pylorus and duodenum is a narrowing of the lumen of the outlet of the stomach due to scarring of an ulcer located at the outlet of the stomach or in the initial portion of the duodenum. In elderly and senile patients, this complication is relatively rare.

In severe cases, i.e. in the stage of decompensated stenosis, patients complain of a feeling of fullness and heaviness in the epigastric region, profuse vomiting of food eaten the day before, bloating and rotten belching; there is an unpleasant odor coming from the mouth. Patients with severely reduced nutrition. In the upper abdomen, gastric peristalsis is determined. Dehydration phenomena may occur. The amount of urine decreases until anuria occurs. The level of residual nitrogen in the blood increases. Occasionally, due to a significant disturbance in the electrolyte composition of the blood, convulsions are observed. X-ray reveals a large stomach, the lower pole of which is located in the pelvis.

Stomach cancer. Stomach cancer most often occurs between the ages of 40 and 70 years. After 70 years, its frequency decreases. Clinical manifestations of the disease, especially in the initial period, are usually mild. Patients complain of rapid fatigue, loss of appetite, aversion to certain types of food, a feeling of heaviness in the epigastric region, belching and regurgitation, periodic mild pain in the upper abdomen, and weight loss. Slight iron deficiency anemia and accelerated ROE may occur. In the later stages of the disease, a tumor is detected by palpation in the epigastric region, vomiting (in case of pyloric cancer) and impaired swallowing (in case of cardiac cancer), progressive emaciation, pain syndrome develops, and metastasis occurs in the cervical lymph nodes, liver, lungs, and bones.

GOW DISEASES

disease gastritis digestion physical therapy

Acute appendicitis is an acute inflammation of the appendix. In old people it occurs much less frequently than in young and mature people, and its clinical manifestations are much less pronounced. At the same time, it is characterized by a greater severity of pathological changes and a high frequency of complications. The disease often begins with diarrhea. Abdominal pain is not severe and its localization is not typical; often it is localized not in the right iliac region, but in the lower abdomen and is diffuse in nature. Protective muscle tension in the right iliac fossa is weak or absent. Body temperature usually does not exceed subfebrile levels. The increase in the number of leukocytes is usually insignificant, but there is a clear shift to the left with a noticeable increase in band forms. The deterioration of general condition and cardiac activity develops rapidly.

Chronic appendicitis. This disease is uncommon in older people. Its clinical course is sluggish. Subjective symptoms usually prevail over objective ones. Chronic appendicitis is often very difficult to distinguish from chronic intestinal diseases - chronic colitis and typhlitis, which often occur in old age.

Colitis is a disease of various etiologies that affects the entire colon or its individual sections. There are acute and chronic colitis.

Acute colitis. Of the acute colitis, dysentery is the most common. It is observed in people of older age groups as often as in young people.

Typical cases are characterized by an acute onset, paroxysmal abdominal pain (more in the lower parts), general weakness, dizziness, nausea, vomiting, increased body temperature, flatulence, loose stools with a fetid odor and an admixture of mucus and blood. Tenesmus may occur - a painful, fruitless urge to the bottom with the discharge of mucus, blood and pus. Recognition in typical cases does not present any particular difficulties. Often, however, the disease occurs in an erased form, which makes diagnosis much more difficult.

Colitis is chronic. Chronic colitis comes in various etiologies. The disease usually begins in young or middle age. After 60 years, its first symptoms are observed in approximately 5% of cases. The disease most often manifests itself as constipation, which sometimes alternates with diarrhea, less often with diarrhea alone, bloating and mild pain in the lower part of the abdomen. Constipation, flatulence and mild pain in the lower abdomen can also occur with purely age-related changes in the gastrointestinal tract, however, the diagnosis of senile constipation is valid only after excluding organic changes in the intestines and neighboring organs. To exclude these changes, a thorough X-ray examination of the gastrointestinal tract and sigmoidoscopy are necessary. Chronic colitis in elderly people is often combined with a decrease in the secretory function of the stomach, dysfunction of the liver and pancreas.

Ulcerative nonspecific colitis. Street people over 60 years of age are relatively rare. The impetus for its development may be infections, mental trauma, irritation of the gastrointestinal tract by certain medications (for example, 5-fluorouracil in the treatment of cancer) and other reasons. The disease is characterized by frequent exacerbations, accompanied by fever, diarrhea and abdominal pain. Diarrhea can lead to dehydration and disruption of electrolyte metabolism. The stool contains impurities of mucus, blood and sometimes pus. The disease may be complicated by bleeding from the ulcer or perforation of the intestinal wall. Elderly and old people sometimes develop colon cancer against the background of ulcerative colitis.

Hemorrhoids are varicose veins in the anus and lower rectum, resulting from impaired outflow of venous blood and decreased tone of the venous walls. Its development is promoted by chronic constipation, difficulty defecating due to anal fissure, a sedentary lifestyle, uterine fibroids and other factors leading to venous stagnation in the pelvis.

Subjective symptoms are discomfort and itching in the anus, pain during bowel movements. Often there are no complaints.

The most important objective symptom is periodic bleeding, usually at the end of defecation.

Hemorrhoidal bleeding often causes severe iron deficiency anemia. During bowel movements or when walking, hemorrhoids may fall out. They can become inflamed and pinched, complicated by paraproctitis and thrombophlebitis.

LIVER DISEASES

Hepatitis is an acute and chronic inflammatory disease of the liver of various etiologies.

The most common is Botkin's disease, which can occur in the form of acute and chronic epidemic hepatitis. Its causative agent is a virus, and the source of infection is a sick person. The virus is found in the blood, liver and other organs and is excreted in the feces. Infection occurs through the mouth with contaminated food, water, hands, as well as objects that have been in contact with the patient and contaminated with his secretions. If medical instruments are not properly sterilized, infection can also occur during vaccinations, blood transfusions, injections, etc. Botkin's disease is a very contagious disease. If during its epidemic spread young people are more likely to get sick, then vaccine forms equally often affect the population of all age groups.

In acute epidemic hepatitis, the incubation period is 3-4 weeks for independent disease and 3-4 months for vaccination forms. In the clinical picture, preicteric and icteric stages can be distinguished. In the pre-icteric period, body temperature is normal or subfebrile. Patients complain of general weakness, headache, lack of appetite, bitterness in the mouth, nausea, stool retention or diarrhea, and joint pain. The color of the urine becomes dark yellow. The pulse slows down. Swelling of the liver and occasionally the spleen may occur. On the 5-7th day, and sometimes later, jaundice develops and itchy skin appears. The body temperature continues to remain normal or rises to low-grade levels, but the general condition of the patients worsens. General weakness increases. Apathy or irritability appears. The liver and sometimes the spleen enlarge. The amount of urine decreases. Its color becomes dark brown. The stool becomes discolored. The icteric period lasts 2-6 weeks, sometimes longer. Recovery occurs in approximately 43% of cases (S.M. Ryss and V.G. Smagin). In other cases, the disease becomes chronic. Complications may develop: acute toxic liver dystrophy, cholangitis and cholecystitis, liver cirrhosis, pneumonia, etc. The most severe of them is acute yellow liver dystrophy. It manifests itself as agitation of the patient, insomnia, severe headache, increased body temperature, tachycardia, mental disorder, a sharp decrease in the size of the liver, intense jaundice and bleeding. An unpleasant sweetish-putrid (“liver”) odor emanates from the patient’s mouth. Initially, minor disturbances of consciousness intensify. Consciousness becomes confused and then a deep unconscious state sets in - coma. In this case, the patient’s pupils are dilated and poorly responsive to light. Involuntary defecation and urination occur.

Chronic hepatitis is a common liver disease, which is characterized by a long-term relapsing course without significant progression.

It usually occurs as a result of the transition of acute epidemic hepatitis (Botkin's disease) to chronic, although this is not always clearly established. Symptoms during periods of exacerbation resemble acute epidemic hepatitis. Chronic epidemic hepatitis can cause the development of liver cirrhosis, angiocholitis, duodenitis, pancreatitis and some other complications.

Liver cirrhosis is the final stage of hepatitis and degenerative damage to liver tissue. It occurs mainly in people over 40 years of age.

Its highest frequency occurs at the age of 50-70 years; Men get sick more often. In almost 50% of cases it is the outcome of Botkin's disease. Among other reasons, the most important are alcoholism, insufficient and unhealthy nutrition, infectious diseases (malaria, brucellosis, etc.), toxic liver damage.

In the early period of the disease, patients usually complain of general weakness, fatigue, poor sleep, loss of appetite, nausea, vomiting, and a feeling of heaviness in the epigastric region. Constipation followed by diarrhea is often observed. Body temperature may periodically rise. Gradually the patient loses weight. Subictericity of the sclera appears. The skin becomes dry, wrinkled, and acquires a grayish-yellow color. These phenomena are accompanied by itching of the skin. On the face, cheeks, arms, in the shoulder girdle and other areas of the skin, “spider veins” are observed, which are small angiomas with a crown of dilated vessels. Redness of the skin of the palms is noted. It should, however, be remembered that this symptom, which is generally characteristic of liver cirrhosis, can be observed in elderly people without liver damage. Flatulence often occurs. The size of the liver varies and depends on the stage of the disease. Its lower edge is pointed and compacted. The surface of the liver may be uneven. The spleen is usually enlarged and dense. The patient continues to lose weight, and the second so-called ascitic period of the disease develops, when free fluid appears in the abdominal cavity. During this period, there is bleeding from the dilated veins of the esophagus. Anemia develops. Liver cirrhosis progresses slowly in older people. Death most often occurs from liver failure, exhaustion, bleeding from dilated veins of the esophagus.

Gallstone disease, cholecystitis, cholangitis. The frequency of these diseases increases with age. Mostly they are observed at the age of 50-70 years. Women predominate among the patients. However, after 70 years, men and women get sick equally often. There are acute and chronic cholecystitis. Due to the close anatomical and physiological relationship between the gallbladder and bile ducts, isolated cholecystitis is rare. It is usually combined with inflammation of the bile ducts - cholangitis (synonym - angiocholitis).

The symptoms of cholelithiasis and cholecystitis are basically similar, with the exception of the intensity of pain attacks, which is much more pronounced with the former. These diseases differ mainly in that in case of cholelithiasis, a mechanical factor is added to the main infectious component, which is often the cause of serious complications.

Acute cholecystitis is characterized by severe pain in the right hypochondrium, radiating to the right shoulder, neck and under the right shoulder blade. These pains are identical to hepatic colic due to cholelithiasis. In patients with acute cholecystitis, a more persistent increase in body temperature, leukocytosis with a shift to the left, and tachycardia are noted.

In both diseases, pain is accompanied by nausea and vomiting. Chest pain and pain in the heart area, heart rhythm disturbances, and shortness of breath are also common. If, following an attack of hepatic colic, icteric discoloration of the skin and sclera appears, and the stool becomes discolored and dark brown urine is discharged, this may indicate blockage of the common bile duct with a stone. In such cases, stagnation of bile inevitably occurs, which in turn leads to the development of an ascending infection of the extra- and intrahepatic bile ducts, i.e., to the development of cholangitis. In this case, multiple abscesses sometimes develop in the liver, as a result of which there is an increase in body temperature to 39-40° with stunning chills and profuse sweating.

It should be borne in mind that cholelithiasis and cholecystitis in the elderly and senile age often occur atypically, not accompanied by attacks of hepatic colic, so characteristic of younger people. Old patients more often complain of a feeling of pressure or slight pain in the right hypochondrium, poor appetite, bitterness in the mouth, nausea and vomiting, and bloating. The absence of attacks of hepatic colic in these cases is apparently associated with senile atony of the gallbladder.

Clinically, chronic cholecystitis can be expressed in pain of varying strength that occurs in the area of the right hypochondrium due to errors in diet, physical activity, or intercurrent infection. During the non-attack period, which can last months and years, mainly dyspeptic disorders are observed, manifested by heartburn, nausea, bloating, constipation, subicteric sclera and low-grade fever (37.2-37.6°), intolerance to fatty foods.

Liver cancer. There are primary and metastatic liver cancer. The first of them is extremely rare, the second accounts for about 50% of malignant tumors of the abdominal cavity. Patients complain of constant pain in the right hypochondrium. There is an enlargement of the liver, especially in the final stage of the disease. The liver is hard, its surface is nodular. Jaundice is often associated with these phenomena. Ascitic fluid may accumulate in the abdominal cavity.

DISEASES OF THE PANCREAS

Pancreatitis is a disease characterized by inflammation of the pancreas due to infection or stagnation of secretions in it. Their frequency increases with age. There are acute and chronic pancreatitis.

The first of them is one of the severe and dangerous diseases of the abdominal organs. Although progress has been made in its treatment, its mortality rate continues to be quite high, especially among elderly and senile patients. In them, acute pancreatitis often occurs in the form of pancreatic necrosis, i.e. in the most severe form. This is explained by the fact that with this disease, conditions are created to disrupt the outflow of pancreatic juice containing proteolytic enzymes and lipase, which under certain conditions cause self-digestion of the gland. Patients complain of severe girdle pain in the upper half of the abdomen, painful, frequent vomiting, and bloating in the epigastric region. Abdominal pain usually radiates to the left shoulder, the heart area and behind the sternum. Vomiting does not bring relief. Patients are restless. The skin is pale. In cases of compression of the common bile duct by the inflammatory infiltrate, jaundice occurs. Body temperature rises to 38-39°. Breathing speeds up to 28-30 per minute or more. Sometimes collaptoid states develop. Despite the severity of subjective complaints, the abdomen may be soft and painless or only slightly painful on palpation. Leukocytosis in some cases reaches high numbers, up to 20,000 leukocytes or more with a shift to the left, the content of urine diastase is several thousand units (normally 16-64 units).

With the development of pancreatic necrosis, the deterioration of the general condition and blood picture rapidly progresses, intoxication increases, abdominal pain intensifies, and muscle tension appears in the epigastric region. The urine diastase content can drop sharply within a few hours.

Pancreatic cancer is extremely rare in people under 40 years of age. Then its frequency increases. Among the patients, men predominate.

In the early period of the disease, heaviness in the epigastric region, deterioration or lack of appetite, nausea and vomiting are observed. Then these symptoms are accompanied by pain in one or another part of the upper abdomen. Their localization depends on which part of the pancreas is affected by the tumor. When the head of the gland is affected (the most common localization), they are observed to the right of the navel or in the right hypochondrium; when the body and tail of the gland are affected, they are observed in the pit of the stomach and in the left upper quadrant of the abdomen with irradiation to the lower back and spine. The pain is very intense, especially in cases of damage to the body and tail of the gland, and is difficult to relieve. If the head of the gland is affected, jaundice develops and Courvoisier's symptom appears (a distended gallbladder is palpated).

Patients lose weight and exhaustion quickly sets in. An increase in the level of diastase in the blood and urine is observed in less than 50% of cases. Retroperitoneal pneumography in combination with tomo- or angiography of the pancreas helps make the diagnosis. Treatment is surgical.

THERAPEUTIC PHYSICAL ACTIVITY FOR DISEASES OF THE DIGESTIVE ORGANS

Therapeutic physical education is an integral part of general physical education and one of the most important methods of complex treatment of patients with peptic ulcer disease, as well as an effective means of preventing exacerbations with the correct structure of classes and the entire complex.

Let's start with physiology. Impulses from the receptors of internal organs enter the central nervous system, signaling the intensity of functioning and the condition of the organs. When the disease occurs, reflex regulation is disrupted, pathological dominants and vicious (pathological) reflexes arise, distorting the course of normal processes in the human body.

The disease suppresses and disorganizes motor activity - an indispensable condition for the normal formation and functioning of any living organism. Therefore, exercise therapy is a very important element in the treatment of ulcerative processes.

It is already known that performing dosed physical exercises, accompanied by positive changes in the functional state of the centers of the subcutaneous region and an increase in the level of basic life processes, causes positive emotions (the so-called psychogenic and conditioned reflex influence). This is especially applicable in cases of peptic ulcer disease, when the neuropsychic state of patients leaves much to be desired (normalization of the symptoms of dystonia expressed in patients from the nervous system. It should be noted the impact of physical activity on the nervous regulation of the digestive apparatus.

With regular exercise, as in the process of physical training, energy reserves gradually increase, the formation of buffer compounds increases, and the body is enriched with enzyme compounds, vitamins, potassium and calcium ions. This leads to the activation of redox processes and to an increase in the stability of the acid-base balance, which in turn has a beneficial effect on the scarring of the ulcerative defect (impact on the trophic and regenerative potency of the gastrointestinal tract tissues).

The effect of physical exercise is determined by its intensity and time of application. Small and moderate muscle tensions stimulate the basic functions of the gastrointestinal tract, while intense ones depress them.

There is a beneficial effect of exercise therapy on blood circulation and breathing, which also expands the functional capabilities of the body and increases its reactivity.

Depending on the clinical nature of the disease and the functionality of the patient, various forms and means are used. Since educational institutions usually use only the third (general developmental) health-improving set of exercises whenever possible, I will also stick to it.

Contraindications to classes include:

· Fresh ulcer in the acute period.

· Ulcer complicated by bleeding.

· Preperforative state.

· Ulcer complicated by stenosis in the stage of decompensation.

· Fresh massive paraprocesses during penetration.

When applied to patients suffering from peptic ulcers, exercise therapy has a beneficial effect in the following areas:

Influence the regulation of excitation and inhibition processes in the cerebral cortex; to strengthen cortico-visceral innervation and level out related disorders of autonomic innervation. Improve the coordinated functioning of the circulatory, respiratory and digestive systems.

By properly organizing the regime of movements, physical exercise and passive rest, influence the regulation of the patient’s neuropsychic sphere.

Improve redox processes in all organs, promote the normal course of trophic processes.

Counteract dysfunctions of the digestive system that occur with peptic ulcers (constipation, loss of appetite, congestion, etc.).

The principle of individualization when applying physical therapy for this disease is mandatory.

Physical therapy for gastritis

It is advisable to also include physical therapy in anti-relapse treatment. Physical education has a tonic effect on the entire body, improves metabolism, normalizes nervous reactions, changes intra-abdominal pressure, and improves blood circulation in the abdominal cavity.

Therapeutic exercise for patients with chronic gastritis occurring with secretory insufficiency should be moderate and aimed at strengthening the abdominal muscles, general strengthening. Walking, as well as dosed walking, are recommended.

In patients with increased secretion, the load during exercise should be significantly greater - at the level of submaximal work power, but the number of exercises for the abdominal muscles should be limited and they should be performed with a moderate load. When combining dietary nutrition, drinking mineral water and physical therapy, it is most advisable for chronic gastritis with increased secretion of the digestive glands to drink mineral water before physical exercise, and eat food 15-20 minutes after exercise.

For gastritis with reduced secretion, you should drink mineral water after physical exercise, 15-20 minutes before meals.

Maintaining a proper diet, combating smoking and alcohol abuse, identifying and treating other diseases of the digestive system, sanitation of the oral cavity - all these measures will prevent the occurrence and progression of chronic gastritis.

Running helps normalize the acidity of gastric juice. So, if the secretion of gastric juice is reduced, drink a glass of magnetized water before running - this will enhance the secretory function of the stomach. Run for at least 30 minutes and no more than an hour. When secretion is increased or normal, you can drink a glass of oatmeal or rolled oats before running to neutralize the increased acidity.

Bibliography

1) A.F. Chebotarev “Clinic of Internal Diseases” Ed. Health 1989

2) V.I. Boyko and D.F. Chebotarev “Care for elderly and senile patients” Publisher: “Health” 1995

3) Gishberg L.S. Clinical indications for the use of physical therapy for diseases of internal organs, SMOLGIZ, 1948

4) Moshkov V.N. Therapeutic exercise in the clinic of internal diseases, M., 1952

5) METHODOLOGICAL LETTER: Therapeutic physical education during inpatient treatment, M., 1962

6) Yakovleva L.A. Therapeutic exercise for chronic diseases of the abdominal organs, Kyiv 1968

THERAPEUTIC PHYSICAL ACTIVITY FOR DISEASES OF THE DIGESTIVE ORGANS. Diseases of the digestive system occupy a significant place in clinical medicine. Diseases of the digestive system often affect people of the most working age, causing a high rate of temporary disability and disability.

In diseases of the digestive system, changes in motor, secretory and absorption functions are observed. Pathological processes of the gastrointestinal tract are in close relationship with each other and are caused by a violation of nervous regulation. As a result of a violation of the secretory function, gastritis, gastric and duodenal ulcers, etc. develop, and in case of a disorder of motor function - colitis, constipation, etc. The main means of treating diseases of the digestive system are diet therapy, medications, massage, movements (physical therapy, moderate physical activity, etc. .), physio- and hydrotherapy procedures.

Exercise therapy for this pathology has a general tonic effect, adjusts neurohumoral regulation, stimulates blood and lymph circulation in the abdominal organs, strengthens the abdominal muscles, helps normalize the evacuation and motor functions of the intestines, etc. The result of physical exercise depends on its type, dosage, rhythm and the pace of implementation, the stage of their application, the duration of the course, as well as their combination with diet and other medications.

Such patients benefit from breathing exercises, relaxation exercises lying on the back with legs bent at the knees and hips, or in the knee-elbow position.

Massage facilitates the secretion of bile by increasing blood and lymph circulation in the liver and abdominal organs. Physical exercises help normalize impaired functions in dyskinesia of the gastrointestinal tract and biliary tract. Thus, exercise therapy and massage have a positive effect on the abdominal organs and stimulate the regulatory mechanisms of the digestive system.

Gastritis Gastritis is an inflammation of the gastric mucosa, which can be acute or chronic. Acute gastritis is most often the result of taking substances that irritate the mucous membrane, most often alcohol, eating poor quality or unusual food, certain medications, foodborne illnesses, and acute poisoning. During mass examinations of the population of industrialized countries, approximately 50% of people, many of whom did not complain of changes in the stomach, show signs of gastritis (V.Kh. Vasilenko, A.P. Grebnev; K. Villako et al., etc.). It has also been established that oxygen starvation of the body, being an important pathogenetic factor, has a great influence on the course and outcome of many internal diseases.

Another thing is known: the glands of the gastric mucosa are very sensitive to oxygen deficiency. Prolonged hypoxia leads to atrophy of the gastric mucosa with the development of enzymatic and secretory insufficiency.

Hypoxia of the gastric mucosa is aggravated by blood redistribution during heavy physical activity. The main portion of blood is sent to vital organs (brain, heart, liver, as well as to muscles), while the exchange blood flow in the abdominal organs is reduced. Thus, hypoxia is the cause of chronic atrophic gastritis. Chronic gastritis is an inflammatory change in the gastric mucosa of an endogenous or exogenous nature. Characteristic signs of chronic gastritis are: unpleasant taste in the mouth, sour belching, nausea, especially in the morning, heaviness in the epigastrium, flatulence and pain resembling ulcers; with gastritis with secretory insufficiency, diarrhea is possible.

A major role in the occurrence of chronic gastritis is played by alcohol abuse, smoking, drugs, poor nutrition (chronic lack of animal proteins in food, vitamins B, A, C, E) and irregularity (dietary disorder) of food intake. Chronic gastritis is often caused by intense physical activity, including sports.

Gastritis is divided (taking into account the secretory function of the stomach) into gastritis with secretory insufficiency; gastritis with increased secretion and acidity; gastritis with normal secretory function. Athletes often experience gastritis with increased secretion and acidity, which often develops into peptic ulcer disease.

Most often, chronic gastritis with high acidity occurs in men. Symptoms: heartburn, sour belching, burning sensation, pressure and heaviness in the epigastric region. When palpating the abdomen, moderate pain is noted; Sometimes a neurasthenic syndrome is observed (increased irritability, poor sleep, fatigue, etc.). Diet therapy, drug therapy, vitamins and other means are used for treatment. Exercise therapy, walking, skiing, swimming, and cycling are recommended.

During sanatorium-resort treatment: swimming, walking and running along the seashore, games on the seashore, diet, taking an oxygen cocktail, exercise therapy, etc. PH includes general developmental and breathing exercises, relaxation exercises. For pain symptoms, cryomassage of the abdominal wall is indicated. However, exercises for the abdominal muscles are contraindicated. Walking, contrast showers, lying down exercises (breathing exercises, exercises for the distal parts of the lower extremities) are useful. Objectives of massage: to provide an analgesic effect; normalize the secretory and motor functions of the stomach; activate blood and lymph circulation; eliminate the usually existing venous congestion; stimulate intestinal function.

Massage technique. Abdominal massage is performed with maximum relaxation of the abdominal wall muscles. Planar stroking, rubbing, kneading the muscles of the abdominal wall, oblique abdominal muscles, and vibration are used. Then, along the course of the large intestine (starting from its ascending part), stroking is carried out with the fingertips of the right hand. Stroking techniques are repeated 4-6 times, after which several superficial circular strokes are made to give the abdominal wall a rest, and then tapping with the fingertips along the intestine and shaking it is carried out to influence its wall.

Finish the massage of the abdominal wall with planar stroking and diaphragmatic breathing. Duration of massage is 10-15 minutes. Biliary dyskinesia Biliary dyskinesia is characterized by a disorder of the motor function of individual parts of the biliary system, including the sphincter of Oddi. This is facilitated by various autonomic nervous disorders.

Biliary dyskinesia is the initial stage in the pathogenesis of other diseases of the biliary tract, contributing to the formation of gallstones and the development of infection. It is often combined with other functional disorders - duodenal dyskinesia, changes in the function of the stomach, intestines, and pancreas. With a spastic, or hyperkinetic, gallbladder, short-term pain is noted in the right hypochondrium and epigastric region.

An atonic, or hypokinetic, gallbladder is characterized by dull, prolonged pain after eating, which intensifies when the patient sits for a long time. Evacuation of bile is slowed down. Dyskinesias are quite common in athletes (cyclists, cross-country skiers, long distance runners, etc.). The hyperkinetic form of dyskinesia is characterized by paroxysmal pain (biliary colic), which occurs after physical exertion (overload) and is often accompanied by nausea, vomiting, bowel dysfunction, as well as irritability, headache, and deterioration of the general condition.

Hypokinetic dyskinesia is manifested by periodically occurring pain and a feeling of fullness in the right hypochondrium, sometimes by dyspeptic symptoms and deterioration of the general condition. Complex treatment includes massage, physical therapy, diet therapy, drinking mineral waters, physiotherapy and hydrotherapy, drug therapy, herbal medicine and other remedies.

LH consists of general developmental and breathing exercises; The choice of starting position is of great importance. The best conditions for blood circulation in the liver, formation and secretion of bile are created in a lying position. To enhance the influence of the diaphragm, you can use breathing exercises while lying on your right side, since this increases the excursion of its right dome. In addition, LH is also performed while standing on the knees, as well as knee-elbow, which help relax the abdominal press and unload the spine, allowing you to perform exercises with raising and adducting the legs without sudden changes in intra-abdominal pressure.

In the hypokinetic form of dyskinesia, PH is performed lying on the back, on the left and right side, kneeling, kneeling with hands resting on the floor, sitting and standing. Perform general developmental and breathing exercises with gradually increasing amplitude and tempo of movements. The LH complex also includes abdominal exercises, walking; “belly breathing” helps reduce (or eliminate) pain.

Duration of classes is 20-30 minutes. During the period of complete remission, games, skiing, rowing, skating, cycling, swimming, etc. are recommended. In the hyperkinetic form of dyskinesia, PH is performed lying on the back, right and left side. Includes general developmental, breathing and relaxation exercises. Abdominal exercises, exercises with equipment (dumbbells, medicine balls), as well as straining and holding your breath are not recommended.

The pace of the exercises is slow and medium. Duration of classes is 15-20 minutes. During the period of complete remission - dosed walking, skiing, swimming, occupational therapy, ice skating, etc. The objectives of massage: normalization of the psycho-emotional state and function of the biliary tract, analgesic effect, elimination of congestion in the gallbladder. Massage technique. First, massage is performed on the collar area and back (segmental zones of the VIII-X thoracic and I-II lumbar vertebrae, especially on the right) using segmental techniques.

The massage is carried out in a sitting position. Then, while lying on your back, massage your stomach and oblique abdominal muscles. The procedure is completed by squeezing the lower segments of the lungs (as the patient exhales). Repeat 3-5 times, then ask the patient to “breathe with the stomach” for 1-2 minutes (legs are bent at the knees and hip joints). The following techniques are excluded: chopping, tapping and deep kneading (especially in the area of the right hypochondrium). The duration of the procedure is 8-12 minutes. A course of 10-15 procedures.

End of work -

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Performing dosed physical exercises, accompanied by positive changes in the functional state and an increase in the level of basic life processes, evokes positive emotions. This is especially applicable in case of peptic ulcer disease, when the neuropsychic state of patients leaves much to be desired (normalization of the symptoms of dystonia expressed in patients from the nervous system). It should be noted the impact of physical activity on the nervous regulation of the digestive system.

With regular exercise, as in the process of physical training, energy reserves gradually increase, the body is enriched with enzyme compounds, vitamins, potassium and calcium ions. This has a beneficial effect on the scarring of the ulcerative defect (impact on the trophic and regenerative potency of the tissues of the gastrointestinal tract).

Complex treatment of diseases of the stomach and duodenum must necessarily include means that help improve blood circulation both in the abdominal cavity and in the body in general. This allows you to more effectively combat the manifestations of the inflammatory process and, in addition, contribute to the normalization of metabolic processes in tissues, without which it is impossible to achieve rapid scarring of the ulcer and improvement of impaired stomach functions.

An equally important task is the selection of means to normalize the impaired nervous regulation of the functions of these organs. One of the multifaceted and effective methods of treating diseases of the stomach and duodenum is physical therapy with all its arsenal that affects the body, and in particular, therapeutic exercises.

Numerous studies show that physical exercises for diseases of the stomach and duodenum help to normalize the nervous regulation of stomach functions, primarily motor and evacuation, as well as acid-forming and enzymatic, improve blood circulation, help normalize intra-abdominal pressure, and all together improves tissue nutrition and metabolism in them , which helps reduce the inflammatory process, accelerate ulcer scarring, and normalize the functioning of the stomach and duodenum.

There is a beneficial effect of exercise therapy on blood circulation and breathing, which also expands the functional capabilities of the body and increases its reactivity.

Depending on the clinical nature of the disease and the functionality of the patient, various forms and means are used.

Contraindications to classes include:

· Fresh ulcer in the acute period.

· Ulcer complicated by bleeding.

· Preperforative state.

· Ulcer complicated by stenosis in the stage of decompensation.

· Fresh massive paraprocesses during penetration.

· Severe dyspeptic disorders.

· Severe pain.

· General contraindications.

The principle of individualization when applying physical therapy for this disease is mandatory.

Therapeutic exercises for prolapse of abdominal organs are aimed at general strengthening of the body, normalization of intra-abdominal pressure, stimulation of the motor and secretory functions of the stomach and intestines. And most importantly, regular and dosed training with special physical exercises in combination with subsequent hydrotherapeutic procedures (rubbing, showering) strengthens the muscles of the abdominal press, pelvic floor, and back, which gradually helps to establish the abdominal organs in a normal anatomical position. It must be said that this method is one of the most effective means of helping patients with prolapse of the abdominal organs.

Students with chronic diseases need to introduce elements of a health regime: reducing the academic load, exercise therapy according to a special program, compulsory daily morning exercises, walks before and after classes. As a therapeutic and health factor - 5-6 meals a day. In a comprehensive plan for the rehabilitation of patients with diseases of the digestive system at all stages, the differentiated, pathogenetically substantiated use of physical therapy ensures an increase in the effectiveness of treatment, helps restore performance and maintain it at the required level. Exercise affects digestive functions through the central nervous system.

Morning hygienic gymnastics pursues the goals of general development and strengthening of health, increasing efficiency, and helps hardening, promotes a more complete transition from an inhibited state to an alert one. Morning hygienic exercises use a small (8-10) number of exercises covering the main muscle groups; physical exercise should be simple.

Objectives of exercise therapy:

· General improvement and strengthening of the patient’s body.

· Impact on the neurohumoral regulation of digestive processes.

· Improving blood circulation in the abdominal cavity and pelvis, preventing adhesions and congestion.

· Strengthening the abdominal muscles and stimulating the motor function of the digestive system.

· Improved breathing function.

· Increased emotional tone.

Morning hygienic gymnastics, therapeutic exercises, walks, health path, outdoor games, elements of sports and applied exercises, cycling, swimming, rowing, skiing, ray therapy. In addition, massage and self-massage of the abdomen are used.

Therapeutic gymnastics (TG) is one of the main forms of exercise therapy.

The therapeutic effect of LH will be significantly higher if special physical exercises are performed by muscle groups that receive innervation from the same segments of the spinal cord as the affected organ. These are exercises involving the muscles of the neck, trapezius, levator scapulae, rhomboid major and minor, diaphragm, intercostal muscles, anterior abdominal wall, iliopsoas, obturator, foot and calf muscles.

In diseases of the digestive organs, the effectiveness of LH largely depends on the choice of starting positions that allow differentiated regulation of intra-abdominal pressure.

Special exercises include:

· breathing exercises, especially diaphragmatic breathing, which, rhythmically changing intra-abdominal pressure, has a massaging effect on the liver, stomach, and intestines. As a result, bile secretion, peristalsis of the stomach and intestines increase, venous outflow improves, and congestion in the digestive organs decreases.

· relaxation exercises: reduce the increased tone of the central nervous system, reflexively lower the tone of the muscles of the stomach and intestines, and are effective for relieving spasms of the pylorus and sphincters.

· exercises for the abdominal muscles.

· exercises for the pelvic floor muscles. When the abdominal muscles relax and contract, the pressure in the abdominal cavity either increases or decreases, exerting a massaging effect on the internal organs. Actively acting muscles of the abdominal press, back and pelvis increase blood flow to the abdominal organs, and this helps eliminate inflammatory processes, normalize blood circulation in the liver, kidneys, eliminate stagnation of venous blood in the pelvic area, and also increases oxidative processes and metabolism substances. Strengthening the abdominal muscles and pelvic floor helps normalize the position of the digestive organs, especially when the internal organs prolapse.

· exercises that promote the flow of bile from the gallbladder. Various starting positions are used: standing, kneeling, sitting, lying, knee-elbow, knee-wrist. Lying on your back with bent legs and on all fours achieves the best relaxation of the abdominal organs. To improve the outflow of bile, the best starting position is lying on the left side (the movement of bile is facilitated by the contraction of the walls of the gallbladder, the gravity of the bile), as well as on all fours. Lying on the right side improves blood supply to the liver and provides liver massage by increasing the excursion of the right dome of the diaphragm. Starting position: lying on your back with the foot end of the couch raised, as well as the knee-elbow position are used for splanchnoptosis. In various starting positions, movements of the torso and legs are performed with a large amplitude in combination with breathing.

Indications for prescribing exercise therapy:

· chronic gastritis with normal, increased and decreased secretion;

· peptic ulcer of the stomach and duodenum;

· biliary dyskinesia and chronic cholecystitis;

· chronic hepatitis;

· chronic colitis, mainly with a tendency to constipation;

hiatal hernia;

· splanchnoptosis (prolapse of internal organs).

Contraindications for prescribing exercise therapy:

· period of exacerbation of the disease with severe pain, repeated vomiting and nausea;

· complicated course of the disease: bleeding due to gastric and duodenal ulcers, ulcerative colitis, perforation of the ulcer, acute perivisceritis (perigastritis, periduodenitis).

The classes also have an educational value: patients get used to systematically performing physical exercises, this becomes their daily habit. Exercise therapy classes turn into general physical education classes and become a human need even after recovery.

Thus, we found out that the state educational program involves physical education classes for students with diseases of the gastrointestinal tract and digestive system in a special group. In this work, we focused our attention on subgroup “B”, which is recommended for students who have significant deviations in their health status caused by serious chronic diseases. Such students are admitted to theoretical classes and classes on the rehabilitation of their own health.

In our work, we considered the limitations of physical activity of students with diagnoses such as celiac disease, peptic ulcer, splanchnoptosis, GERD, gastroduodenitis. Until recently, adolescents with similar diagnoses were completely exempt from sports; exercise therapy was not developed for them.

Due to the fact that in recent decades there has been a significant increase in gastrointestinal diseases, the amount of popular medical literature and scientific works on such rare diseases as celiac disease, GERD has increased, and exercise therapy programs are widely represented.

In our work, we presented an approximate complex of exercise therapy, presented in the work of V.N. Moshkov. During the study, we were able to find out that for some diseases of the gastrointestinal tract, fitness classes, dancing, swimming, and cycling are acceptable.

It is believed that only medications and diet are prescribed to treat diseases of the gastrointestinal tract. Most people with a similar pathology limit themselves to these two points, not knowing about the existence of another effective therapeutic technique. We are talking about exercise therapy recommended for diseases of the digestive system.

Types of exercises for improving the gastrointestinal tract (GIT)

Treatment of one or another abdominal organ with the help of gymnastics also affects its neighbors due to their anatomical and functional unity. However, there are also narrowly targeted techniques used for specific pathologies. There are special workouts that stimulate motility and secretion of the gastrointestinal tract, while other types of gymnastics, on the contrary, “calm” the digestive tract and suppress its excessive activity.

The type of training is also determined by the general condition of the patient and the stage of the disease. If it is necessary to adhere to bed rest, in case of exacerbation of the chronic process, minimal respiratory and muscle stress is possible. After you feel better, exercise in a sitting position is allowed. At the recovery stage, it is already allowed to exercise while standing; in addition, activities include jogging, sports, skiing, etc.

Exercise therapy for chronic gastritis: a set of physical exercises for stomach pain

In a lying position, pull the thigh of the bent leg towards the chest, exhaling. Then straighten it and inhale. Duplicate with the other leg.
Standing on all fours, alternately perform backward swings with straightened legs.
Perform an exercise similar to the previous one, but extend your opposite arms together with your leg. For example, left with right.
Sit on a stool, place your hands on your waist. Smoothly tilt your body forward and rotate your torso first to the right and then to the left.
Stand up straight, spread your feet wider, spread your arms out to the sides parallel to the floor. Lean forward, reaching the fingers of one hand to the opposite foot, and at this time place the other hand behind your back.

Perform 8-10 times

A set of exercises for gastrointestinal diseases and gastritis with high acidity

Such exercises help reduce the acidity of gastric juice, therefore they are recommended to prevent ulcerative processes in the stomach and duodenum and for hyperacid gastritis.

In a lying position, pull your legs towards your buttocks and cross them at the ankle joints. Turn your buttocks and lower limbs in one direction, and your head and shoulder girdle in the opposite direction.
Sit down, stretch your arms in front of you, spread your legs wider. First, reach with your hands to your left foot, then to the space between your legs, and then to your right foot.
Stand straight, keep your arms parallel to your body. As you inhale, extend your arms straight toward the ceiling, pause for a few seconds, then exhale and lower them.
From the previous position, inhaling, stretch your arms up, exhaling, bend forward and down, reaching your fingers to the floor.
While in a similar position, stretch your arms towards the ceiling, arch your back forward, move one leg back a little - inhale. Stand up straight again - exhale. Repeat with the other leg.

Repeat 10-12 times.

Attention!

In the presence of gastroesophageal reflux (return of food from the stomach cavity into the esophagus), all gymnastic elements accompanied by bending and tensing the muscles of the anterior abdominal wall are contraindicated.

Complex exercise therapy for gastric ulcers: physical exercises for ulcers without perforation

The therapeutic and health complex for ulcer formation and the presence of erosions differs from exercise therapy for various inflammatory diseases of the gastrointestinal tract in a more gentle regime and a smooth pace of implementation.

You need to lie on the floor, stretch your limbs, connect your legs and thighs. As you inhale, clench your fingers into fists, and as you exhale, slowly relax your hands.
Now turn your head alternately to the right and then to the left.
From the previous position, raise your forearms at a right angle upward, pressing your elbows to the floor. At the same time, make mirror rotational movements with your right and left hand, alternately clockwise and counterclockwise.
Still lying down, pull the toe of your right foot toward the floor, the toe of your left foot toward you, then change the position of your feet.
Bring your feet closer to your buttocks. Spread your knees to the right and left, pressing your soles firmly to the horizontal surface.

Do 8-10 times each exercise.

Physical therapy for dyskinesia

Dyskinesia of the digestive system is understood as a disorder of the motor function of the stomach and intestines, as well as organs that ensure the outflow of bile. This condition can be triggered by gastrointestinal diseases due to gastric or intestinal inflammation, or it can occur without signs of digestive tract disease.

In some patients, phenomena are discovered - this is a violation of the nervous regulation of the gastrointestinal tract, in which there is no coordination in the functioning of all its departments.

There are hypomotor (hypotonic) and hypermotor (hypertonic) dyskinesias. In the first case, gastrointestinal motility slows down, constipation appears, the evacuation of food masses from the stomach is disrupted, which is accompanied by nausea and heaviness in the upper abdomen. The secretion of bile from the gallbladder also suffers, which causes pain and swelling under the ribs on the right. With the hypertensive type, motility accelerates, the patient experiences diarrhea, absorption of nutrients is impaired, spasms of the intestines and bile ducts cause unpleasant painful sensations.

Effects of exercise therapy for dyskinesia

Exercise therapy performed for biliary dyskinesia (BD) and other abdominal organs can solve several problems at once:

Relax or, conversely, tone the smooth muscle layer of the hollow organs;
Reduce pain;
Slow down or speed up;
Regulate digestive processes.

It should also be noted that it has a general tonic effect on the body: therapeutic exercises are used to restore normal nervous regulation of digestion and adapt the nervous system to adverse external influences.

This is interesting!

It is known for certain that neuropsychic and prolonged emotional stress lead to digestive dysfunction. In such situations, to restore normal functioning of the gastrointestinal tract, psychotherapy and relaxing therapeutic practices are sufficient: massage,.

Contraindications for physical therapy complex

In case of diseases of the digestive system, it should be limited in the following cases:

Presence of stones in the biliary tract;
Development of complications after cholecystectomy;
Tumors located in the abdominal cavity;
Acute processes or exacerbation of chronic diseases of the gastrointestinal tract;
Risk of bleeding from the gastrointestinal tract;
Infectious pathologies in the acute phase;
Severe disorders of the cardiovascular system.

In any case, before starting classes, a consultation with a gastroenterologist or therapist is necessary to identify possible contraindications and adequate gymnastic complexes.

Useful video - Exercises for the gastrointestinal tract - for diseases of the liver, stomach, gall bladder

A set of exercises for JVP

Physical activity affects the nature of the mobility of the biliary tract, therefore, for bile ducts, gymnastics are selected in accordance with the type of motor disorders. Exercises for any type of biliary dyskinesia should be preceded by a short warm-up so that stimulation of the gastrointestinal tract does not cause a sharp muscle spasm.

Exercises for hypertensive dyskinesia

In a horizontal position, extend your arms along the body and place them palms down, bend your legs slightly at the knees, and press your lower back to the horizontal plane. While inhaling, move your knee joints to the right and left, without lifting your feet from the floor. As you exhale, connect again.
Lie straight. Stretch your right arm up and pull your left leg towards your pelvis, sliding your feet along the floor. Repeat with opposite limbs.
Turn onto your right side. Place your straightened right hand under your head, and extend your left hand parallel to the body. As you exhale, press your left thigh to your chest, while inhaling, return to its original position.
Turn over to the other side. Raise your right limbs to the ceiling - inhale. Pull your knee and elbow towards each other, press your chin to your chest - exhale.
Take a knee-elbow position, do not arch your lower back, tighten your abdominal muscles only slightly. While exhaling, pull the left thigh towards the ribs, and when inhaling, put it back in place. Double with your right foot.

Exercises for hypotonic dyskinesia

Lie with your back on the floor, pressing your lower back tightly to it, pull your bent legs towards your chest, place your arms loosely parallel to your body. While inhaling, straighten your legs, but keep them slightly suspended, without touching the floor. Exhaling, press your hips to your chest again. When performed correctly, the exercise also helps to train the abdominal muscles.
Lie flat, place your palms on your waist. Exhaling, raise your head and shoulder girdle so that you can see your feet. As you inhale, relax.
In the knee-elbow position, alternately move your legs bent at the knees back and up, tensing your abs.
Get on all fours, when you inhale, throw your head back and bend your spine down, when you exhale, lower your head and arch your back up.
Next, you need to get to your feet, place your feet shoulder-width apart, extend your arms straight in front of your chest and clasp your hands. As you inhale, turn your body and arms to the right, and as you exhale, turn your body and arms to the left. Then vice versa.

Repeat all exercises from 6 to 10 times.

Video - Healing yoga for the gastrointestinal tract

Self-massage and breathing

Massage also expands the functionality of the digestive tract, normalizing its tone and preventing spasms. You can perform a massage yourself at home, only with caution and smooth movements.

The simplest self-massage technique consists of circular movements of the palm around the navel, alternately clockwise and counterclockwise. In this case, you need to lie on your back, slightly bend your knees and relax your stomach. Next, you can move on to massage the right half of the abdomen to normalize the functioning of the bile reservoirs. The hand should be placed in the right iliac region (below and to the right of the navel) and light massaging movements should be made, gradually moving the hand to the hypochondrium.

Breathing exercise for digestive problems is aimed at balancing gastrointestinal motility. This is achieved by changing intra-abdominal pressure against the background of alternating thoracic and abdominal breathing.

First we train chest breathing. In a standing position, press your straight arms to your torso and hips, straighten your back. Gradually inhale through your nose, drawing in your stomach and expanding the spaces. This is followed by a quick exhalation and relaxation of the abdominal muscles.
Now let's move on to abdominal breathing. In the previous position, exhale completely, drawing in the front wall of the abdomen. Pause for a couple of seconds, then inhale, expanding your belly.
In the end, it is optimal to resort to a meditative, calming technique. Sit cross-legged on the floor cross-legged. Place your hands on your knee joints, straighten your back. Take a deep breath and relax. Hold your breath for a couple of seconds, exhale slowly. On your own or with someone's help, make sure that your back remains straight at all times, and remember to hold your breath after each inhalation.

Massage and physical therapy are excellent helpers in restoring normal gastrointestinal motility and regulation. With an adequate combination of physical activity with a balanced diet and drug therapy, long-term, stable remission can be achieved and possible complications can be avoided.

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