{"id":884,"date":"2025-06-17T10:03:47","date_gmt":"2025-06-17T07:03:47","guid":{"rendered":"https:\/\/wiki.voka.io\/diseases\/uncategorized\/yazvennaya-bolezn-zheludka-i-dpk\/"},"modified":"2026-05-30T10:17:47","modified_gmt":"2026-05-30T07:17:47","slug":"ulcera-peptica-do-estomago-e-do-duodeno","status":"publish","type":"diseases_post","link":"https:\/\/wiki.voka.io\/pt\/doencas\/gastroenterologia\/ulceras-gastricas-e-duodenais\/","title":{"rendered":"\u00dalcera p\u00e9ptica do est\u00f4mago e do duodeno (\u00falceras gastroduodenais): Sintomas, etiologia, diagn\u00f3stico e tratamento"},"content":{"rendered":"<p><?xml encoding=\"UTF-8\" ?><\/p>\n<p class=\"wp-block-paragraph\">A \u00falcera gastroduodenal \u00e9 um defeito da parede do est\u00f4mago ou do duodeno, penetrando mais profundamente do que a camada submucosa.<\/p>\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/ru\/zkt\/yazvennaya-bolezn-zheludka-i-dvenadcatiperstnoy-kishki-gastroduodenalnye-yazvy\/yazva-lukovicy-dvenadcatiperstnoy-kishki.webp\" alt=\"\u00dalcera do bulbo duodenal\"><figcaption class=\"wp-element-caption\">\u00dalcera do bulbo duodenal \u2013 <a href=\"https:\/\/catalog.voka.io\/en\/models\/8b29e257-5d66-47fe-a26d-4f6e4b65959b\/0629cf84-6586-487c-970e-92d447990311\/7dec45da-b8cc-44d5-885a-cd23e1dc0685\/8e0e2015-f4f5-48e0-bd13-bebc8d0864cd\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">modelo 3D<\/a><\/figcaption><\/figure>\n<h2 id=\"relevancia\" class=\"wp-block-heading\">Relev\u00e2ncia<\/h2>\n<p class=\"wp-block-paragraph\">Nos pa\u00edses desenvolvidos, esta patologia \u00e9 identificada em 15% da popula\u00e7\u00e3o adulta. A maior mortalidade \u00e9 observada no Jap\u00e3o e em Portugal, a menor nos EUA e no Canad\u00e1.<\/p>\n<p class=\"wp-block-paragraph\">\u00dalceras duodenais ocorrem 5 a 7 vezes mais frequentemente do que \u00falceras g\u00e1stricas. A propor\u00e7\u00e3o entre homens e mulheres \u00e9 de 3 a 4:1.<\/p>\n<h2 id=\"anatomia\" class=\"wp-block-heading\">Anatomia<\/h2>\n<h3 id=\"estomago\" class=\"wp-block-heading\">Est\u00f4mago<\/h3>\n<p class=\"wp-block-paragraph\">O est\u00f4mago est\u00e1 localizado na parte superior da cavidade abdominal. \u00c9 mantido em posi\u00e7\u00e3o pela fixa\u00e7\u00e3o com o es\u00f4fago e o duodeno, bem como por ligamentos com o f\u00edgado, p\u00e2ncreas, ba\u00e7o e c\u00f3lon transverso. Na jun\u00e7\u00e3o do est\u00f4mago com o duodeno est\u00e1 o esf\u00edncter pil\u00f3rico.<\/p>\n<p class=\"wp-block-paragraph\">Na parede do est\u00f4mago, distinguem-se as camadas serosa, muscular, submucosa e mucosa. Na camada muscular, as fibras est\u00e3o dispostas em camadas de diversas dire\u00e7\u00f5es: longitudinal, obl\u00edqua, circular.<\/p>\n<p class=\"wp-block-paragraph\">A mucosa g\u00e1strica, com espessura de 0,5 a 1,5 mm, possui uma estrutura complexa (forma pregas e fov\u00e9olas g\u00e1stricas) e composi\u00e7\u00e3o (muc\u00f3citos, gl\u00e2ndulas tubulares).<\/p>\n<p class=\"wp-block-paragraph\">A estrutura das gl\u00e2ndulas g\u00e1stricas varia nas diferentes partes do \u00f3rg\u00e3o:<\/p>\n<ul class=\"wp-block-list\">\n<li><strong>regi\u00e3o c\u00e1rdica<\/strong> \u2014 c\u00e9lulas intermedi\u00e1rias, mucoides e argentafins;<\/li>\n<li><strong>corpo e fundo<\/strong> \u2014 c\u00e9lulas parietais (sintetizam \u00e1cido clor\u00eddrico), c\u00e9lulas principais (sintetizam pepsinog\u00eanio) e c\u00e9lulas adicionais (mucoides, sintetizam muco);<\/li>\n<li><strong>regi\u00e3o pil\u00f3rica<\/strong> \u2014 as gl\u00e2ndulas s\u00e3o compostas principalmente por c\u00e9lulas mucoides e parietais.<\/li>\n<\/ul>\n<p class=\"wp-block-paragraph\">C\u00e9lulas end\u00f3crinas est\u00e3o espalhadas por toda a mucosa g\u00e1strica. O epit\u00e9lio g\u00e1strico \u00e9 renovado constantemente (em m\u00e9dia a cada 3 a 5 dias).<\/p>\n<p class=\"wp-block-paragraph\">O suprimento sangu\u00edneo do est\u00f4mago \u00e9 feito a partir dos ramos do tronco cel\u00edaco:<\/p>\n<ul class=\"wp-block-list\">\n<li>art\u00e9rias g\u00e1stricas esquerda e direita;<\/li>\n<li>art\u00e9rias gastroepiploicas esquerda e direita;<\/li>\n<li>art\u00e9rias curtas do fundo g\u00e1strico.<\/li>\n<\/ul>\n<p class=\"wp-block-paragraph\">A inerva\u00e7\u00e3o \u00e9 realizada pelo nervo vago e pelos ramos do plexo solar. Na parede do est\u00f4mago, existem tr\u00eas plexos nervosos principais:<\/p>\n<ul class=\"wp-block-list\">\n<li>subseroso;<\/li>\n<li>intermuscular;<\/li>\n<li>submucoso.<\/li>\n<\/ul>\n<p class=\"wp-block-paragraph\">Diariamente, o est\u00f4mago produz at\u00e9 2 litros de suco g\u00e1strico, que, al\u00e9m de \u00e1cido clor\u00eddrico, cont\u00e9m enzimas proteol\u00edticas e muco.<\/p>\n<h3 id=\"duodeno\" class=\"wp-block-heading\">Duodeno<\/h3>\n<p class=\"wp-block-paragraph\">O duodeno (DPC) \u00e9 uma continua\u00e7\u00e3o do est\u00f4mago. Come\u00e7a no esf\u00edncter pil\u00f3rico e termina na flexura duodenojejunal (na regi\u00e3o do ligamento de Treitz).<\/p>\n<p class=\"wp-block-paragraph\">A parede do intestino \u00e9 composta por camadas:<\/p>\n<ul class=\"wp-block-list\">\n<li>serosa (nas \u00e1reas de localiza\u00e7\u00e3o mesoperitoneal);<\/li>\n<li>muscular;<\/li>\n<li>submucosa;<\/li>\n<li>mucosa.<\/li>\n<\/ul>\n<p class=\"wp-block-paragraph\">A camada muscular possui duas camadas:<\/p>\n<ul class=\"wp-block-list\">\n<li>externa longitudinal (continua\u00e7\u00e3o da camada g\u00e1strica, garantindo a continuidade da onda perist\u00e1ltica);<\/li>\n<li>interna circular.<\/li>\n<\/ul>\n<p class=\"wp-block-paragraph\">A mucosa do duodeno forma vilosidades intestinais (at\u00e9 40 vilosidades por 1 mm), cobertas por enter\u00f3citos. Al\u00e9m disso, na mucosa existem c\u00e9lulas caliciformes, que produzem mucina, e c\u00e9lulas end\u00f3crinas (distribu\u00eddas de forma difusa).<\/p>\n<p class=\"wp-block-paragraph\">No duodeno, s\u00e3o distinguidas as partes:<\/p>\n<ul class=\"wp-block-list\">\n<li>superior horizontal (bulbo duodenal);<\/li>\n<li>descendente;<\/li>\n<li>inferior horizontal;<\/li>\n<li>ascendente.<\/li>\n<\/ul>\n<p class=\"wp-block-paragraph\">Na por\u00e7\u00e3o descendente do duodeno, atrav\u00e9s da papila duodenal maior (ampola de Vater), abrem-se:<\/p>\n<ul class=\"wp-block-list\">\n<li>duto biliar comum;<\/li>\n<li>duto de Wirsung.<\/li>\n<\/ul>\n<p class=\"wp-block-paragraph\">Atrav\u00e9s da papila duodenal menor, abre-se o duto acess\u00f3rio do p\u00e2ncreas (duto de Santorini).<\/p>\n<p class=\"wp-block-paragraph\">O suprimento sangu\u00edneo do duodeno \u00e9 feito atrav\u00e9s dos ramos da art\u00e9ria mesent\u00e9rica superior:<\/p>\n<ul class=\"wp-block-list\">\n<li>art\u00e9ria pancreatoduodenal superior anterior;<\/li>\n<li>art\u00e9ria pancreatoduodenal superior posterior;<\/li>\n<li>art\u00e9ria pancreatoduodenal inferior anterior;<\/li>\n<li>art\u00e9ria pancreatoduodenal inferior posterior.<\/li>\n<\/ul>\n<h2 id=\"classificacao-da-ulcera-peptica-do-estomago-e-do-duodeno\" class=\"wp-block-heading\">Classifica\u00e7\u00e3o da \u00falcera p\u00e9ptica do est\u00f4mago e do duodeno<\/h2>\n<h3 id=\"por-localizacao\" class=\"wp-block-heading\">Por localiza\u00e7\u00e3o<\/h3>\n<ul class=\"wp-block-list\">\n<li>\u00falcera g\u00e1strica \u2014 \u00falceras das regi\u00f5es c\u00e1rdica e subc\u00e1rdica, \u00falceras do corpo do est\u00f4mago (grandes e pequenas curvaturas), \u00falceras das regi\u00f5es pil\u00f3rica e antral);<\/li>\n<li>\u00falcera duodenal \u2014 \u00falceras do bulbo duodenal, \u00falceras p\u00f3s-bulbares.<\/li>\n<\/ul>\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/ru\/zkt\/yazvennaya-bolezn-zheludka-i-dvenadcatiperstnoy-kishki-gastroduodenalnye-yazvy\/ostrye-zalukovichnye-yazvy.webp\" alt=\"\u00dalceras agudas p\u00f3s-bulbares\"><figcaption class=\"wp-element-caption\">\u00dalceras agudas p\u00f3s-bulbares \u2013 <a href=\"https:\/\/catalog.voka.io\/en\/models\/8b29e257-5d66-47fe-a26d-4f6e4b65959b\/0629cf84-6586-487c-970e-92d447990311\/51f76b0d-dd44-4d80-a3a6-29b951287824\/ac48213e-0786-439d-b364-a88459bf852c\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">modelo 3D<\/a><\/figcaption><\/figure>\n<p class=\"wp-block-paragraph\"><strong>Por est\u00e1gio de desenvolvimento da \u00falcera<\/strong>:<\/p>\n<ul class=\"wp-block-list\">\n<li>est\u00e1gio ativo;<\/li>\n<li>est\u00e1gio de cicatriza\u00e7\u00e3o;<\/li>\n<li>est\u00e1gio de forma\u00e7\u00e3o de cicatriz (cicatriz vermelha, cicatriz branca).<\/li>\n<\/ul>\n<p class=\"wp-block-paragraph\"><strong>Por gravidade do curso<\/strong>:<\/p>\n<ul class=\"wp-block-list\">\n<li>latente;<\/li>\n<li>leve;<\/li>\n<li>moderada;<\/li>\n<li>grave.<\/li>\n<\/ul>\n<p class=\"wp-block-paragraph\"><strong>Por fator etiol\u00f3gico<\/strong>:<\/p>\n<ul class=\"wp-block-list\">\n<li>\u00falceras verdadeiras (associadas \u00e0 doen\u00e7a ulcerosa p\u00e9ptica);<\/li>\n<li>\u00falceras agudas (resultado de erro alimentar, uso de agentes agressivos);<\/li>\n<li>\u00falceras sintom\u00e1ticas (como resultado de outras condi\u00e7\u00f5es \u2014 aterosclerose, uremia, uso de AINEs, etc.).<\/li>\n<\/ul>\n<p class=\"wp-block-paragraph\"><strong>Por tamanho<\/strong>:<\/p>\n<ul class=\"wp-block-list\">\n<li>pequenas (at\u00e9 5 mm);<\/li>\n<li>m\u00e9dias (5\u201310 mm);<\/li>\n<li>grandes: para o est\u00f4mago \u2014 11\u201329 mm, para o duodeno \u2014 11\u201319 mm;<\/li>\n<li>gigantes: para o est\u00f4mago 30 mm ou mais, para o duodeno \u2014 20 mm ou mais.<\/li>\n<\/ul>\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/catalog.voka.io\/en\/models\/8b29e257-5d66-47fe-a26d-4f6e4b65959b\/0f21e01f-1165-4319-a5de-cf591733768b\/55039a91-d3f3-478c-9b8c-0b51bcf4adcc\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">Modelos 3D<\/a> de \u00falceras g\u00e1stricas por tamanho:<\/p>\n<div class=\"carousel-block\">\n<div class=\"swiper carousel-swiper carousel-swiper-block_6a34c97a53748\">\n<div class=\"swiper-wrapper\">\n<div class=\"swiper-slide image-carousel-slide\"><img decoding=\"async\" class=\"carousel-image\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/ru\/zkt\/yazvennaya-bolezn-zheludka-i-dvenadcatiperstnoy-kishki-gastroduodenalnye-yazvy\/malaya-yazva-tela-zheludka.webp\" alt=\"\u00dalcera pequena do corpo do est\u00f4mago\"><span class=\"small-text-article text-main-text-color\">\u00dalcera pequena do corpo do est\u00f4mago<\/span><\/div>\n<div class=\"swiper-slide image-carousel-slide\"><img decoding=\"async\" class=\"carousel-image\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/ru\/zkt\/yazvennaya-bolezn-zheludka-i-dvenadcatiperstnoy-kishki-gastroduodenalnye-yazvy\/yazva-srednih-razmerov-v-tele-zheludka.webp\" alt=\"\u00dalcera de tamanho m\u00e9dio no corpo do est\u00f4mago\"><span class=\"small-text-article text-main-text-color\">\u00dalcera de tamanho m\u00e9dio no corpo do est\u00f4mago<\/span><\/div>\n<div class=\"swiper-slide image-carousel-slide\"><img decoding=\"async\" class=\"carousel-image\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/ru\/zkt\/yazvennaya-bolezn-zheludka-i-dvenadcatiperstnoy-kishki-gastroduodenalnye-yazvy\/bolshaya-yazva-lukovicy-dvenadcatiperstnoy-kishki.webp\" alt=\"\u00dalcera grande do bulbo duodenal\"><span class=\"small-text-article text-main-text-color\">\u00dalcera grande do bulbo duodenal<\/span><\/div>\n<div class=\"swiper-slide image-carousel-slide\"><img decoding=\"async\" class=\"carousel-image\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/ru\/zkt\/yazvennaya-bolezn-zheludka-i-dvenadcatiperstnoy-kishki-gastroduodenalnye-yazvy\/gigantskaya-yazva-na-granitse-tela-i-antralnogo-otdela-zheludka.webp\" alt=\"\u00dalcera gigante na jun\u00e7\u00e3o do corpo e da regi\u00e3o antral do est\u00f4mago\"><span class=\"small-text-article text-main-text-color\">\u00dalcera gigante na jun\u00e7\u00e3o do corpo e da regi\u00e3o antral do est\u00f4mago<\/span><\/div>\n<\/div>\n<\/div>\n<div class=\"swiper-article-carousel__controls\">\n<div class=\"swiper-article-carousel__pagination-container swiper-article-carousel__pagination-container-block_6a34c97a53748\"><\/div>\n<div class=\"swiper-article-carousel__arrows\"><button class=\"swiper__arrow swiper__arrow--prev carousel-swiper-button-prev swiper__arrow swiper__arrow--prev carousel-swiper-button-prev-block_6a34c97a53748\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" 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14.999 20.1643 14.999 20C14.999 19.8357 15.0314 19.6731 15.0943 19.5213C15.1572 19.3696 15.2494 19.2317 15.3656 19.1156L21.6156 12.8656C21.7318 12.7495 21.8696 12.6574 22.0214 12.5945C22.1731 12.5317 22.3358 12.4993 22.5 12.4993C22.6643 12.4993 22.8269 12.5317 22.9786 12.5945C23.1304 12.6574 23.2682 12.7495 23.3844 12.8656C23.5005 12.9818 23.5926 13.1196 23.6555 13.2714C23.7184 13.4231 23.7507 13.5858 23.7507 13.75C23.7507 13.9142 23.7184 14.0769 23.6555 14.2286C23.5926 14.3804 23.5005 14.5182 23.3844 14.6344L18.0172 20L23.3844 25.3656Z\" fill=\"#B5C0CD\"><\/path><\/svg><\/button><button class=\"swiper__arrow swiper__arrow--next carousel-swiper-button-next swiper__arrow swiper__arrow--next carousel-swiper-button-next-block_6a34c97a53748\" tabindex=\"0\" aria-label=\"Next slide\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"40\" viewbox=\"0 0 40 40\" fill=\"none\"><path d=\"M20 3.75C16.7861 3.75 13.6443 4.70305 10.972 6.48862C8.29969 8.27419 6.21689 10.8121 4.98696 13.7814C3.75704 16.7507 3.43524 20.018 4.06225 23.1702C4.68926 26.3224 6.23692 29.2179 8.50952 31.4905C10.7821 33.7631 13.6776 35.3107 16.8298 35.9378C19.982 36.5648 23.2493 36.243 26.2186 35.013C29.1879 33.7831 31.7258 31.7003 33.5114 29.028C35.297 26.3557 36.25 23.2139 36.25 20C36.2455 15.6916 34.5319 11.561 31.4855 8.51454C28.439 5.46806 24.3084 3.75455 20 3.75ZM23.3844 25.3656C23.5005 25.4818 23.5926 25.6196 23.6555 25.7714C23.7184 25.9231 23.7507 26.0858 23.7507 26.25C23.7507 26.4142 23.7184 26.5769 23.6555 26.7286C23.5926 26.8804 23.5005 27.0182 23.3844 27.1344C23.2682 27.2505 23.1304 27.3426 22.9786 27.4055C22.8269 27.4683 22.6643 27.5007 22.5 27.5007C22.3358 27.5007 22.1731 27.4683 22.0214 27.4055C21.8696 27.3426 21.7318 27.2505 21.6156 27.1344L15.3656 20.8844C15.2494 20.7683 15.1572 20.6304 15.0943 20.4787C15.0314 20.3269 14.999 20.1643 14.999 20C14.999 19.8357 15.0314 19.6731 15.0943 19.5213C15.1572 19.3696 15.2494 19.2317 15.3656 19.1156L21.6156 12.8656C21.7318 12.7495 21.8696 12.6574 22.0214 12.5945C22.1731 12.5317 22.3358 12.4993 22.5 12.4993C22.6643 12.4993 22.8269 12.5317 22.9786 12.5945C23.1304 12.6574 23.2682 12.7495 23.3844 12.8656C23.5005 12.9818 23.5926 13.1196 23.6555 13.2714C23.7184 13.4231 23.7507 13.5858 23.7507 13.75C23.7507 13.9142 23.7184 14.0769 23.6555 14.2286C23.5926 14.3804 23.5005 14.5182 23.3844 14.6344L18.0172 20L23.3844 25.3656Z\" fill=\"#B5C0CD\"><\/path><\/svg><\/button><\/div>\n<\/div>\n<\/div>\n<p><script defer>\n    document.addEventListener('DOMContentLoaded', function() {\n        const imagesCarouselSwiper = new Swiper('.carousel-swiper-block_6a34c97a53748', {\n            slidesPerView: 1,\n            spaceBetween: 20,\n            loop: true,\n            pagination: {\n                el: '.swiper-article-carousel__pagination-container-block_6a34c97a53748',\n                clickable: true,\n            },\n            navigation: {\n                nextEl: '.carousel-swiper-button-next-block_6a34c97a53748',\n                prevEl: '.carousel-swiper-button-prev-block_6a34c97a53748',\n            },\n        })\n    })\n<\/script><\/p>\n<h3 id=\"por-numero\" class=\"wp-block-heading\">Por n\u00famero<\/h3>\n<ul class=\"wp-block-list\">\n<li>isoladas;<\/li>\n<li>m\u00faltiplo.<\/li>\n<\/ul>\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/ru\/zkt\/yazvennaya-bolezn-zheludka-i-dvenadcatiperstnoy-kishki-gastroduodenalnye-yazvy\/mnozhestvennye-yazvy-tela-i-antralnogo-otdela-zheludka.webp\" alt=\"M\u00faltiplas \u00falceras do corpo e da regi\u00e3o antral do est\u00f4mago\"><figcaption class=\"wp-element-caption\">M\u00faltiplas \u00falceras do corpo e da regi\u00e3o antral do est\u00f4mago \u2013 <a href=\"https:\/\/catalog.voka.io\/en\/models\/8b29e257-5d66-47fe-a26d-4f6e4b65959b\/0f21e01f-1165-4319-a5de-cf591733768b\/c27e1458-5f11-41d0-800a-9080f09b6d9a\/3db0267d-9c11-4882-836a-e7e923561c03\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">modelo 3D<\/a><\/figcaption><\/figure>\n<figure class=\"wp-block-video\" id=\"animacao-3d-multiplas-ulceras-gastricas\"><video controls><source data-src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/en\/gastrointestinal-tract\/peptic-ulcer-disease\/multiple-gastric-ulcers.webm\" type=\"video\/webm\"><\/source><\/video><figcaption class=\"wp-element-caption\">Anima\u00e7\u00e3o 3D \u2013 m\u00faltiplas \u00falceras g\u00e1stricas<\/figcaption><\/figure>\n<p class=\"wp-block-paragraph\" id=\"h-\"><strong>Classifica\u00e7\u00e3o de A.G. Johnson (1990)<\/strong>:<\/p>\n<ul class=\"wp-block-list\">\n<li><strong>Tipo I<\/strong> \u2014 \u00falceras cr\u00f4nicas da pequena curvatura;<\/li>\n<li><strong>Tipo II<\/strong> \u2014 \u00falceras cr\u00f4nicas associadas \u00e0 \u00falcera duodenal (incluindo \u00falcera duodenal cicatrizada);<\/li>\n<li><strong>Tipo III<\/strong> \u2014 \u00falceras cr\u00f4nicas prepiloricas;<\/li>\n<li><strong>Tipo IV <\/strong>\u2014 \u00falceras cr\u00f4nicas superficiais agudas;<\/li>\n<li><strong>Tipo V<\/strong> \u2014 \u00falceras cr\u00f4nicas devido \u00e0 s\u00edndrome de Zollinger-Ellison.<\/li>\n<\/ul>\n<p class=\"wp-block-paragraph\" id=\"h-\"><strong>Classifica\u00e7\u00e3o de Forrest<\/strong>:<\/p>\n<ul class=\"wp-block-list\">\n<li><strong>Tipo FI<\/strong> \u2014 hemorragia ativa:\n<ul class=\"wp-block-list\">\n<li>Ia \u2013 jato puls\u00e1til;<\/li>\n<li>Ib \u2013 fluxo cont\u00ednuo.<\/li>\n<\/ul>\n<\/li>\n<li><strong>Tipo FII<\/strong> \u2014 sinais de hemorragia recente:\n<ul class=\"wp-block-list\">\n<li>IIa \u2013 vaso vis\u00edvel (n\u00e3o sangrante);<\/li>\n<li>IIb \u2013 trombo fixo;<\/li>\n<li>IIc \u2013 mancha preta plana (fundo da \u00falcera negro).<\/li>\n<\/ul>\n<\/li>\n<li><strong>Tipo FIII<\/strong> \u2014 \u00falcera com fundo limpo (branco).<\/li>\n<\/ul>\n<h2 id=\"fatores-de-desenvolvimento-da-ulcera-peptica\" class=\"wp-block-heading\">Fatores de desenvolvimento da \u00falcera p\u00e9ptica<\/h2>\n<p class=\"wp-block-paragraph\">Os fatores que contribuem para o desenvolvimento da \u00falcera p\u00e9ptica incluem:<\/p>\n<ul class=\"wp-block-list\">\n<li><strong>Hereditariedade<\/strong>: predisposi\u00e7\u00e3o transmitida principalmente pela linha masculina; a frequ\u00eancia de desenvolvimento em descendentes de primeira linha \u00e9 3 vezes maior do que em indiv\u00edduos sem hereditariedade pesada.<\/li>\n<li><strong>\u00c1lcool<\/strong>: em altas concentra\u00e7\u00f5es, causa danos diretos, altera a camada de prote\u00e7\u00e3o mucinosa e estimula a atividade das gl\u00e2ndulas g\u00e1stricas, aumentando assim a produ\u00e7\u00e3o de \u00e1cido clor\u00eddrico.<\/li>\n<li><strong>Tabagismo<\/strong>: a nicotina causa vasoconstri\u00e7\u00e3o no est\u00f4mago, estimula a produ\u00e7\u00e3o de \u00e1cido clor\u00eddrico e provoca o refluxo gastroduodenal, reduzindo a secre\u00e7\u00e3o de bicarbonatos (piorando as propriedades protetoras da mucosa).<\/li>\n<li><strong>Caracter\u00edsticas alimentares<\/strong>: alimentos picantes, excessivamente quentes ou frios, assim como alimentos muito fibrosos, podem fisicamente danificar a parede do trato gastrointestinal.<\/li>\n<li><strong>Alimenta\u00e7\u00e3o irregular<\/strong>: hipersecre\u00e7\u00e3o em jejum e les\u00e3o \u00e1cido-pept\u00edgica da mucosa.<\/li>\n<li><strong>Uso de certos medicamentos<\/strong>: anti-inflamat\u00f3rios n\u00e3o esteroides (AINEs), glicocorticoides, anticoagulantes, aspirina, alendronato.<\/li>\n<li><strong>Estresse prolongado ou regular<\/strong>: desenvolvimento de \u00falceras de estresse.<\/li>\n<\/ul>\n<h2 id=\"etiologia-das-ulceras\" class=\"wp-block-heading\">Etiologia das \u00falceras<\/h2>\n<p class=\"wp-block-paragraph\">No desenvolvimento de \u00falceras gastroduodenais, o principal mecanismo patogen\u00e9tico \u00e9 o predom\u00ednio dos fatores de agress\u00e3o sobre as propriedades protetoras da mucosa g\u00e1strica e do duodeno. Com o tempo, isso leva \u00e0 forma\u00e7\u00e3o de um defeito na mucosa, e na aus\u00eancia de tratamento, ao desenvolvimento de complica\u00e7\u00f5es (o chamado \u201cbalan\u00e7o de Shoy\u201d).<\/p>\n<p class=\"wp-block-paragraph\">Fatores de agress\u00e3o incluem:<\/p>\n<ul class=\"wp-block-list\">\n<li><strong>produ\u00e7\u00e3o excessiva de \u00e1cido clor\u00eddrico<\/strong>: atividade aumentada das c\u00e9lulas parietais das gl\u00e2ndulas g\u00e1stricas, hipertonia do nervo vago, aumento da secre\u00e7\u00e3o de gastrina;<\/li>\n<li><em><strong>Helicobacter pylori<\/strong><\/em>: o microrganismo libera a enzima mucinase, que altera as propriedades protetoras da mucosa; libera catalase e urease, que levam diretamente \u00e0 morte dos epiteli\u00f3citos. A presen\u00e7a da bact\u00e9ria no submucosa em si provoca uma rea\u00e7\u00e3o inflamat\u00f3ria na parede do est\u00f4mago;<\/li>\n<\/ul>\n<figure class=\"wp-block-video\" id=\"animacao-3d-ulcera-gastrica-aguda-com-sangramento\"><video controls><source data-src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/en\/gastrointestinal-tract\/peptic-ulcer-disease\/acute-gastric-ulcer-with-bleeding.webm\" type=\"video\/webm\"><\/source><\/video><figcaption class=\"wp-element-caption\">Anima\u00e7\u00e3o 3D \u2013 \u00falcera g\u00e1strica aguda com sangramento<\/figcaption><\/figure>\n<ul class=\"wp-block-list\">\n<li><strong>refluxo gastroduodenal<\/strong>: a bile e o suco pancre\u00e1tico regurgitados nesse estado destroem a camada protetora da parede g\u00e1strica e levam a danos diretos nas c\u00e9lulas da mucosa;<\/li>\n<li><strong>hipergastrinemia<\/strong> (s\u00edndrome de Zollinger-Ellison);<\/li>\n<li><strong>infec\u00e7\u00e3o por citomegalov\u00edrus<\/strong>;<\/li>\n<li><strong>radioterapia e quimioterapia<\/strong>;<\/li>\n<li><strong>doen\u00e7a de Crohn<\/strong>.<\/li>\n<\/ul>\n<p class=\"wp-block-paragraph\">Os fatores de prote\u00e7\u00e3o incluem:<\/p>\n<ul class=\"wp-block-list\">\n<li><strong>barreira mucosa (mucinosa)<\/strong>: localizada diretamente na camada mucosa e intimamente associada a ela. \u00c9 composta por mucopolissacar\u00eddeos e glicoprote\u00ednas, impedindo a penetra\u00e7\u00e3o dos fatores de agress\u00e3o nas c\u00e9lulas epiteliais;<\/li>\n<li><strong>regenera\u00e7\u00e3o epitelial constantemente ativa<\/strong>: como mencionado acima, as c\u00e9lulas da mucosa g\u00e1strica s\u00e3o renovadas a cada 3\u20135 dias, o que ajuda na r\u00e1pida recupera\u00e7\u00e3o de les\u00f5es da mucosa.<\/li>\n<\/ul>\n<h2 id=\"apresentacao-clinica\" class=\"wp-block-heading\">Apresenta\u00e7\u00e3o cl\u00ednica<\/h2>\n<ul class=\"wp-block-list\">\n<li><strong>S\u00edndrome da dor<\/strong>. Localiza-se nas regi\u00f5es superiores do abd\u00f4men: no epig\u00e1strio \u00e0 direita \u2014 com \u00falcera duodenal ou pil\u00f3rica; no epig\u00e1strio \u00e0 esquerda ou por tr\u00e1s do esterno \u2014 com \u00falcera card\u00edaca; com \u00falcera p\u00f3s-bulbar, a dor irradia para as costas. A dor \u00e9 causada por irrita\u00e7\u00e3o direta das termina\u00e7\u00f5es nervosas pelo conte\u00fado \u00e1cido, bem como por espasmo das camadas musculares da parede g\u00e1strica. As \u00falceras g\u00e1stricas caracterizam-se por dores \u201cde fome\u201d, que diminuem ap\u00f3s a ingest\u00e3o de alimentos ou de um medicamento anti\u00e1cido.<\/li>\n<li><strong>Azia<\/strong>. Apresenta-se como queima\u00e7\u00e3o retroesternal devido ao refluxo do conte\u00fado \u00e1cido do est\u00f4mago para o es\u00f4fago. Este refluxo \u00e9 causado por dist\u00farbios na motilidade g\u00e1strica devido ao efeito irritante das \u00falceras na parede muscular do \u00f3rg\u00e3o.<\/li>\n<li><strong>N\u00e1useas e v\u00f4mitos<\/strong>. Ocorrem devido \u00e0 irrita\u00e7\u00e3o reflexa e contra\u00e7\u00e3o do est\u00f4mago. Tamb\u00e9m podem resultar do desenvolvimento de estenose da sa\u00edda g\u00e1strica.<\/li>\n<li><strong>Redu\u00e7\u00e3o ou aus\u00eancia de apetite<\/strong> (de g\u00eanese reflexa).<\/li>\n<li><strong>Sensibilidade abdominal \u00e0 palpa\u00e7\u00e3o<\/strong>. \u00c9 determinada na proje\u00e7\u00e3o da \u00falcera, onde tamb\u00e9m pode ser observado defesa muscular da parede abdominal anterior. Na percuss\u00e3o abdominal na proje\u00e7\u00e3o da \u00falcera, a sensibilidade pode ser detectada \u2014 sintoma de Mendel.<\/li>\n<\/ul>\n<p class=\"wp-block-paragraph\">\u00c9 importante notar a possibilidade de evolu\u00e7\u00e3o assintom\u00e1tica da \u00falcera p\u00e9ptica (segundo alguns autores, at\u00e9 30% dos casos).<\/p>\n<h2 id=\"diagnostico-de-ulcera-peptica-gastrica-e-duodenal\" class=\"wp-block-heading\">Diagn\u00f3stico de \u00falcera p\u00e9ptica g\u00e1strica e duodenal<\/h2>\n<ul class=\"wp-block-list\">\n<li><strong>Estudo da secre\u00e7\u00e3o g\u00e1strica<\/strong> (produ\u00e7\u00e3o \u00e1cida basal e produ\u00e7\u00e3o \u00e1cida m\u00e1xima). A produ\u00e7\u00e3o \u00e1cida m\u00e1xima \u00e9 determinada ap\u00f3s estimula\u00e7\u00e3o da secre\u00e7\u00e3o g\u00e1strica (histamina, pentagastrina).<\/li>\n<li><strong>pH-metria<\/strong>. Normalmente, a acidez do conte\u00fado g\u00e1strico \u00e9 1,6\u20132,0. A \u00falcera duodenal \u00e9 caracterizada por acidez elevada no canal pil\u00f3rico e no duodeno.<\/li>\n<li><strong>Diagn\u00f3stico de infec\u00e7\u00e3o por Helicobacter pylori<\/strong> (teste respirat\u00f3rio, an\u00e1lise de sangue, an\u00e1lise de fezes).<\/li>\n<li>Radiografia \u2014 m\u00e9todo diagn\u00f3stico principal na confirma\u00e7\u00e3o da \u00falcera perfurada \u2014 detec\u00e7\u00e3o de g\u00e1s livre sob a c\u00fapula do diafragma.<\/li>\n<li><strong>Fluoroscopia<\/strong>. Sintoma principal \u2014 sintoma \u201cdo nicho\u201d: ao preencher a cavidade da \u00falcera com contraste, aparece um rebaixamento caracter\u00edstico (\u201cnicho\u201d). Sintoma de converg\u00eancia das dobras \u2014 pregas g\u00e1stricas dispostas radialmente com \u00falcera situada no centro. Tamb\u00e9m \u00e9 frequentemente detectada a disfun\u00e7\u00e3o da motilidade g\u00e1strica, retorno retr\u00f3grado de alimentos para o es\u00f4fago. A efic\u00e1cia deste m\u00e9todo \u00e9 m\u00e1xima no diagn\u00f3stico de disfun\u00e7\u00e3o evacuadora e no desenvolvimento de estenose da sa\u00edda g\u00e1strica. Para o diagn\u00f3stico de patologias duodenais, utiliza-se a duodenoscopia de relaxamento (antes do exame, alcan\u00e7a-se o m\u00e1ximo relaxamento e expans\u00e3o dos m\u00fasculos do duodeno com o aux\u00edlio de metacina, aerona, etc.) para completo preenchimento de todas as divis\u00f5es e visualiza\u00e7\u00e3o dos seus contornos.<\/li>\n<li><strong>Exame endosc\u00f3pico (FEGDS)<\/strong> \u2014 padr\u00e3o ouro de diagn\u00f3stico na etapa atual. O m\u00e9todo permite:\n<ul class=\"wp-block-list\">\n<li>visualizar o defeito ulceroso;<\/li>\n<li>determinar o est\u00e1gio do processo e a localiza\u00e7\u00e3o da \u00falcera;<\/li>\n<li>detectar complica\u00e7\u00f5es;<\/li>\n<li>realizar bi\u00f3psia;<\/li>\n<li>realizar diagn\u00f3stico de infec\u00e7\u00e3o por Helicobacter pylori;<\/li>\n<li>realizar manipula\u00e7\u00f5es endosc\u00f3picas em caso de complica\u00e7\u00f5es (hemostasia, clipagem de defeitos, coagula\u00e7\u00e3o por plasma de arg\u00f4nio, suturas endosc\u00f3picas).<\/li>\n<\/ul>\n<\/li>\n<li><strong>Ultrassom<\/strong>. No n\u00edvel atual de desenvolvimento desta tecnologia, \u00e9 poss\u00edvel detectar infiltra\u00e7\u00e3o ulcerosa e defeito da parede g\u00e1strica, bem como a presen\u00e7a de complica\u00e7\u00f5es da \u00falcera p\u00e9ptica (estenose, perfura\u00e7\u00e3o, c\u00e2ncer).<\/li>\n<li><strong>TC de abd\u00f4men<\/strong> \u2014 combina as vantagens da fluoroscopia e do ultrassom. \u00c9 poss\u00edvel diagnosticar tanto o pr\u00f3prio defeito ulceroso quanto o desenvolvimento de complica\u00e7\u00f5es (perfura\u00e7\u00e3o, estenose, penetra\u00e7\u00e3o, c\u00e2ncer).<\/li>\n<\/ul>\n<h2 id=\"complicacoes-e-tratamento-da-ulcera-peptica-gastrica-e-duodenal\" class=\"wp-block-heading\">Complica\u00e7\u00f5es e tratamento da \u00falcera p\u00e9ptica g\u00e1strica e duodenal<\/h2>\n<h3 id=\"perfuracao-perfuracao\" class=\"wp-block-heading\"><strong>Perfura\u00e7\u00e3o (perfura\u00e7\u00e3o)<\/strong><\/h3>\n<p class=\"wp-block-paragraph\">De acordo com v\u00e1rias fontes, esta complica\u00e7\u00e3o representa de 3 a 30% de todas as complica\u00e7\u00f5es das \u00falceras gastroduodenais. Entre os pacientes, 95% s\u00e3o homens. <\/p>\n<p class=\"wp-block-paragraph\">As \u00falceras piloroduodenais ocorrem em 75% dos casos. A combina\u00e7\u00e3o de \u00falcera perfurada e hemorragia atinge 10%.<\/p>\n<p class=\"wp-block-paragraph\">No quadro cl\u00ednico da \u00falcera perfurada s\u00e3o identificados 3 per\u00edodos:<\/p>\n<ul class=\"wp-block-list\">\n<li>primeiras 4\u20136 horas \u2014 choque abdominal prim\u00e1rio;<\/li>\n<li>6\u201312 horas \u2014 per\u00edodo de bem-estar ilus\u00f3rio;<\/li>\n<li>mais de 12 horas \u2014 est\u00e1gio de peritonite.<\/li>\n<\/ul>\n<p class=\"wp-block-paragraph\">Durante a perfura\u00e7\u00e3o, a dor \u00e9 aguda e s\u00fabita (\u201cdor em punhal\u201d). Nas primeiras horas, localiza-se nos quadrantes superiores do abd\u00f4men e, em seguida, se espalha pelo canal lateral direito e por toda a cavidade abdominal.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Nas primeiras horas ap\u00f3s a perfura\u00e7\u00e3o, observam-se<\/strong>:<\/p>\n<ul class=\"wp-block-list\">\n<li>bradicardia (devido \u00e0 irrita\u00e7\u00e3o do nervo vago);<\/li>\n<li>secura da l\u00edngua;<\/li>\n<li>poss\u00edvel s\u00edndrome de fr\u00eanico (irradia\u00e7\u00e3o da dor para a clav\u00edcula direita e esc\u00e1pula devido \u00e0 irrita\u00e7\u00e3o do nervo fr\u00eanico direito);<\/li>\n<li>na percuss\u00e3o pode n\u00e3o haver macicez hep\u00e1tica (devido \u00e0 presen\u00e7a de g\u00e1s livre na cavidade abdominal);<\/li>\n<li>sensibilidade \u00e0 palpa\u00e7\u00e3o durante o exame retal (sintoma de Kulenkampff).<\/li>\n<\/ul>\n<p class=\"wp-block-paragraph\">Como mencionado anteriormente, na radiografia detecta-se g\u00e1s livre (em 70-80% dos casos). Para esclarecer o diagn\u00f3stico, \u00e9 poss\u00edvel realizar uma endoscopia digestiva alta, e em caso de d\u00favida persistente sobre a perfura\u00e7\u00e3o, uma radiografia de repeti\u00e7\u00e3o para detectar g\u00e1s livre (neste caso, a utilidade diagn\u00f3stica \u00e9 maior).<\/p>\n<p class=\"wp-block-paragraph\">Com o progresso cont\u00ednuo da doen\u00e7a, os principais sintomas tornam-se intoxica\u00e7\u00e3o e peritonite:<\/p>\n<ul class=\"wp-block-list\">\n<li>taquicardia;<\/li>\n<li>queda da press\u00e3o arterial;<\/li>\n<li>distens\u00e3o abdominal;<\/li>\n<li>paresia intestinal;<\/li>\n<li>leucocitose progressiva.<\/li>\n<\/ul>\n<p class=\"wp-block-paragraph\">Formas at\u00edpicas de perfura\u00e7\u00e3o (at\u00e9 4-6% dos casos) incluem:<\/p>\n<ul class=\"wp-block-list\">\n<li>perfura\u00e7\u00e3o da parede posterior do est\u00f4mago (para o saco omental);<\/li>\n<li>perfura\u00e7\u00e3o da parede posterior do duodeno (para o espa\u00e7o retroperitoneal);<\/li>\n<li>perfura\u00e7\u00e3o de \u00falceras elevadas na regi\u00e3o card\u00edaca do est\u00f4mago na fronteira com o es\u00f4fago;<\/li>\n<li>perfura\u00e7\u00f5es cobertas.<\/li>\n<\/ul>\n<p class=\"wp-block-paragraph\">Nestes casos, o curso do quadro cl\u00ednico \u00e9 pouco caracter\u00edstico, sem sintomas principais marcantes.<br \/>O tratamento das \u00falceras perfuradas \u00e9 exclusivamente cir\u00fargico (sutura da \u00falcera, ressec\u00e7\u00e3o g\u00e1strica).<\/p>\n<p class=\"wp-block-paragraph\">Na maioria das vezes, realiza-se a sutura da \u00falcera:<\/p>\n<ul class=\"wp-block-list\">\n<li>sutura simples com pontos em U;<\/li>\n<li>sutura por tamponamento omental segundo Oppel-Polikarpov (realizada na presen\u00e7a de grande orif\u00edcio perfurativo e impossibilidade de ressec\u00e7\u00e3o);<\/li>\n<li>ressec\u00e7\u00e3o da \u00falcera com piloroduodenoplastia.<\/li>\n<\/ul>\n<p class=\"wp-block-paragraph\">As indica\u00e7\u00f5es para ressec\u00e7\u00e3o do est\u00f4mago s\u00e3o:<\/p>\n<ul class=\"wp-block-list\">\n<li>\u00falcera calosa;<\/li>\n<li>\u00falceras g\u00e1stricas;<\/li>\n<li>perfura\u00e7\u00e3o de m\u00faltiplas \u00falceras;<\/li>\n<li>combina\u00e7\u00e3o de perfura\u00e7\u00e3o e estenose da sa\u00edda g\u00e1strica.<\/li>\n<\/ul>\n<p class=\"wp-block-paragraph\">Os seguintes tipos de ressec\u00e7\u00f5es s\u00e3o mais aplic\u00e1veis:<\/p>\n<ul class=\"wp-block-list\">\n<li>ressec\u00e7\u00e3o segundo Billroth I e Billroth II (na modifica\u00e7\u00e3o de Hofmeister-Finsterer);<\/li>\n<li>ressec\u00e7\u00e3o \u00e0 Rux;<\/li>\n<li>ressec\u00e7\u00e3o \u00e0 Balfour.<\/li>\n<\/ul>\n<p class=\"wp-block-paragraph\">Ap\u00f3s tratamento cir\u00fargico de \u00falcera perfurada, \u00e9 mandat\u00f3rio um curso completo de tratamento anti-\u00falcera.<\/p>\n<h3 id=\"sangra\" class=\"wp-block-heading\"><strong>Sangra<\/strong><\/h3>\n<p class=\"wp-block-paragraph\">Esta complica\u00e7\u00e3o desenvolve-se em 10-15% dos pacientes. Os homens representam at\u00e9 70%. \u00dalceras duodenais ocorrem em at\u00e9 80% dos casos. A letalidade nesta patologia atinge 7\u201310%.<\/p>\n<p class=\"wp-block-paragraph\">O sangramento ocorre devido \u00e0 eros\u00e3o (destrui\u00e7\u00e3o) da parede de um grande vaso no fundo da \u00falcera no contexto do progresso da doen\u00e7a. A gravidade do quadro cl\u00ednico \u00e9 caracterizada pelo volume de perda de sangue \u2013 desde leve (menos de 20% do volume sangu\u00edneo circulante) at\u00e9 grave (mais de 40% do VBC).<\/p>\n<figure class=\"wp-block-video\" id=\"animacao-3d-ulcera-pos-bulbar-do-duodeno-complicada-por-penetracao-e-sangramento\"><video controls><source data-src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/en\/gastrointestinal-tract\/peptic-ulcer-disease\/postbulbar-duodenal-ulcer-with-penetration-and-bleeding.webm\" type=\"video\/webm\"><\/source><\/video><figcaption class=\"wp-element-caption\">Anima\u00e7\u00e3o 3D \u2013 \u00falcera p\u00f3s-bulbar do duodeno complicada por penetra\u00e7\u00e3o e sangramento.<\/figcaption><\/figure>\n<p class=\"wp-block-paragraph\">A variabilidade das manifesta\u00e7\u00f5es cl\u00ednicas depende da gravidade do sangramento:<\/p>\n<ul class=\"wp-block-list\">\n<li>taquicardia;<\/li>\n<li>taquipneia;<\/li>\n<li>hipotens\u00e3o;<\/li>\n<li>redu\u00e7\u00e3o da diurese;<\/li>\n<li>altera\u00e7\u00e3o do n\u00edvel de consci\u00eancia;<\/li>\n<li>sintomas psiconeurol\u00f3gicos (ansiedade, agita\u00e7\u00e3o, alucina\u00e7\u00f5es, del\u00edrios);<\/li>\n<li>palidez da pele.<\/li>\n<\/ul>\n<p class=\"wp-block-paragraph\">Dos sintomas desta complica\u00e7\u00e3o, os mais frequentemente encontrados s\u00e3o:<\/p>\n<ul class=\"wp-block-list\">\n<li><strong>v\u00f4mitos<\/strong> \u2014 v\u00f4mitos de sangue (hemat\u00eamese) ou v\u00f4mitos tipo \u201cborra de caf\u00e9\u201d (a hematina resultante oxida a hemoglobina com \u00e1cido clor\u00eddrico g\u00e1strico, dando uma cor marrom-escuro ao conte\u00fado vomitado);<\/li>\n<li><strong>fezes alcatroadas (melena)<\/strong> \u2014 fezes de cor negro-acastanhada e consist\u00eancia n\u00e3o moldada; tal cor \u00e9 obtida devido \u00e0 a\u00e7\u00e3o de fermentos digestivos e microrganismos sobre a hemoglobina, seguida de degrada\u00e7\u00e3o e mudan\u00e7a de cor do sangue extravasado.<\/li>\n<\/ul>\n<p class=\"wp-block-paragraph\">\u00c9 caracter\u00edstico o <strong>sintoma de Bergman<\/strong> \u2014 redu\u00e7\u00e3o das dores ulcerosas no in\u00edcio do epis\u00f3dio de sangramento.<\/p>\n<p class=\"wp-block-paragraph\">O padr\u00e3o ouro no diagn\u00f3stico \u00e9 a endoscopia digestiva alta. A patologia exige hospitaliza\u00e7\u00e3o obrigat\u00f3ria em unidade cir\u00fargica hospitalar.<\/p>\n<p class=\"wp-block-paragraph\">Em casos de perda de sangue de grau moderado a grave, os pacientes s\u00e3o levados para a sala de cirurgia, onde s\u00e3o realizadas todas as manipula\u00e7\u00f5es diagn\u00f3sticas e terapia intensiva.<\/p>\n<p class=\"wp-block-paragraph\">O tratamento conservador inclui:<\/p>\n<ul class=\"wp-block-list\">\n<li>plasma fresco congelado;<\/li>\n<li>crioprecipitado ou tromboconcentrado;<\/li>\n<li>ativadores de forma\u00e7\u00e3o de tromboplastina (etamzilato);<\/li>\n<li>inibidores da fibrin\u00f3lise (\u00e1cido aminocaproico, \u00e1cido tranex\u00e2mico);<\/li>\n<li>vitamina K (fitomenadiona);<\/li>\n<li>cloreto de c\u00e1lcio;<\/li>\n<li>hipotermia local;<\/li>\n<li>corre\u00e7\u00e3o da anemia (massa eritrocit\u00e1ria);<\/li>\n<li>corre\u00e7\u00e3o da hipovolemia (solu\u00e7\u00f5es cristal\u00f3ides);<\/li>\n<li>tratamento anti-\u00falcera (inibidores da bomba de pr\u00f3tons, bloqueadores de H\u2082-histamina, anti\u00e1cidos);<\/li>\n<li>tratamento sintom\u00e1tico.<\/li>\n<\/ul>\n<p class=\"wp-block-paragraph\">Durante o tratamento, realiza-se urgentemente endoscopia digestiva alta para detalhar a localiza\u00e7\u00e3o da \u00falcera e realizar hemostasia endosc\u00f3pica.<\/p>\n<p class=\"wp-block-paragraph\">Se as medidas realizadas forem ineficazes e o sangramento continuar, \u00e9 realizada interven\u00e7\u00e3o cir\u00fargica. O tipo de interven\u00e7\u00e3o cir\u00fargica \u00e9 determinado de acordo com a localiza\u00e7\u00e3o e natureza da \u00falcera, bem como o estado do paciente.<\/p>\n<p class=\"wp-block-paragraph\">O procedimento mais justific\u00e1vel do ponto de vista patogen\u00e9tico \u00e9 a ressec\u00e7\u00e3o de 2\/3 do est\u00f4mago (elimina\u00e7\u00e3o da \u00falcera e hipersecre\u00e7\u00e3o de \u00e1cido clor\u00eddrico). No entanto, devido \u00e0 gravidade do estado, idade e comorbidades, nem todos os pacientes podem tolerar tal volume de cirurgia \u2014 em tais situa\u00e7\u00f5es, realiza-se um procedimento de menor porte:<\/p>\n<ul class=\"wp-block-list\">\n<li>ressec\u00e7\u00e3o da \u00falcera com pl\u00e1stica g\u00e1strica ou duodenal;<\/li>\n<li>em casos de gravidade extrema do paciente, limita-se \u00e0 sutura do defeito ulceroso para parar o sangramento.<\/li>\n<\/ul>\n<h3 id=\"obstrucao-gastrointestinal\" class=\"wp-block-heading\"><strong>Obstru\u00e7\u00e3o gastrointestinal<\/strong><\/h3>\n<p class=\"wp-block-paragraph\">A obstru\u00e7\u00e3o gastrointestinal (estenose da sa\u00edda g\u00e1strica, estenose piloroduodenal) pode ser compensada, subcompensada ou descompensada.<\/p>\n<p class=\"wp-block-paragraph\">Esta complica\u00e7\u00e3o pode ter:<\/p>\n<ul class=\"wp-block-list\">\n<li>car\u00e1ter tempor\u00e1rio (durante a exacerba\u00e7\u00e3o da \u00falcera devido a edema e infiltra\u00e7\u00e3o do tecido com desenvolvimento de estenose do l\u00famen gastrointestinal);<\/li>\n<li>car\u00e1ter permanente (devido \u00e0 deforma\u00e7\u00e3o cicatricial ap\u00f3s cicatriza\u00e7\u00e3o das \u00falceras).<\/li>\n<\/ul>\n<p class=\"wp-block-paragraph\">Devido \u00e0 sa\u00edda obstru\u00edda do conte\u00fado g\u00e1strico, o est\u00f4mago dilata-se e aumenta de volume, a comida estagna nele e ocorre regurgita\u00e7\u00e3o do conte\u00fado. Em consequ\u00eancia do patog\u00eanese descrito, desenvolve-se o principal quadro cl\u00ednico da doen\u00e7a:<\/p>\n<ul class=\"wp-block-list\">\n<li>arroto com cheiro f\u00e9tido;<\/li>\n<li>v\u00f4mito de alimentos \u201cn\u00e3o digeridos\u201d (traz al\u00edvio);<\/li>\n<li>dores peri\u00f3dicas nos quadrantes superiores do abd\u00f4men e sensa\u00e7\u00e3o de plenitude g\u00e1strica mesmo ap\u00f3s leve ingest\u00e3o de alimentos;<\/li>\n<li>perda de peso progressiva (devido \u00e0 falta de entrada de nutrientes no intestino);<\/li>\n<li>obstipa\u00e7\u00e3o.<\/li>\n<\/ul>\n<p class=\"wp-block-paragraph\">Com o progresso cont\u00ednuo da doen\u00e7a e falta de tratamento, as disfun\u00e7\u00f5es eletrol\u00edticas aumentam, levando a:<\/p>\n<ul class=\"wp-block-list\">\n<li>dist\u00farbios neurol\u00f3gicos;<\/li>\n<li>disfun\u00e7\u00e3o muscular;<\/li>\n<li>coma hipoclor\u00eamica.<\/li>\n<\/ul>\n<p class=\"wp-block-paragraph\">O padr\u00e3o ouro para diagnosticar essa patologia \u00e9 a fluoroscopia. Ela permite determinar o grau de estenose.<\/p>\n<p class=\"wp-block-paragraph\">Realizando uma endoscopia digestiva alta, tamb\u00e9m \u00e9 poss\u00edvel detectar a presen\u00e7a de estenose, mas \u00e9 extremamente dif\u00edcil determinar o grau de compensa\u00e7\u00e3o; s\u00f3 se pode avaliar indiretamente \u2014 pela permeabilidade do estreitamento ao endosc\u00f3pio:<\/p>\n<ul class=\"wp-block-list\">\n<li>o di\u00e2metro normalmente \u00e9 de 2,5 cm;<\/li>\n<li>com estenose compensada \u2014 1,5 cm;<\/li>\n<li>na fase subcompensada \u2014 0,5\u20131,5 cm;<\/li>\n<li>na descompensa\u00e7\u00e3o \u2014 menos de 0,5 cm.<\/li>\n<\/ul>\n<p class=\"wp-block-paragraph\">O tratamento nos est\u00e1gios iniciais \u00e9 conservador com o objetivo de diferenciar a restri\u00e7\u00e3o tempor\u00e1ria da cicatricial. Durante o tratamento conservador por 7\u201310 dias, com a cicatriza\u00e7\u00e3o do defeito ulceroso e a resolu\u00e7\u00e3o da rea\u00e7\u00e3o inflamat\u00f3ria na estenose tempor\u00e1ria, a passagem da parte de sa\u00edda do est\u00f4mago \u00e9 restaurada, enquanto que na restri\u00e7\u00e3o cicatricial org\u00e2nica n\u00e3o ocorre melhora.<\/p>\n<p class=\"wp-block-paragraph\">Na estenose permanente, o tratamento \u00e9 exclusivamente cir\u00fargico. Ap\u00f3s a prepara\u00e7\u00e3o pr\u00e9-operat\u00f3ria para corrigir os dist\u00farbios eletrol\u00edticos e proteicos, \u00e9 realizada a ressec\u00e7\u00e3o do est\u00f4mago (geralmente 2\/3 do est\u00f4mago).<\/p>\n<figure class=\"wp-block-video\" id=\"animacao-3d-ulcera-cronica-do-duodeno-com-formacao-de-estenose-descompensada\"><video controls><source data-src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/en\/gastrointestinal-tract\/peptic-ulcer-disease\/chronic-duodenal-ulcer-with-decompensated-stenosis.webm\" type=\"video\/webm\"><\/source><\/video><figcaption class=\"wp-element-caption\">Anima\u00e7\u00e3o 3D \u2013 \u00falcera cr\u00f4nica do duodeno com forma\u00e7\u00e3o de estenose descompensada<\/figcaption><\/figure>\n<h3 id=\"penetracao-da-ulcera\" class=\"wp-block-heading\"><strong>Penetra\u00e7\u00e3o da \u00falcera<\/strong><\/h3>\n<p class=\"wp-block-paragraph\">A penetra\u00e7\u00e3o da \u00falcera \u00e9 a invas\u00e3o do fundo do defeito ulceroso em \u00f3rg\u00e3os vizinhos (ligamento hepatoduodenal, f\u00edgado, p\u00e2ncreas, raramente no mesent\u00e9rio, parede do c\u00f3lon, ves\u00edcula biliar, ep\u00edploo menor).<\/p>\n<p class=\"wp-block-paragraph\">A principal caracter\u00edstica desta complica\u00e7\u00e3o no quadro cl\u00ednico \u00e9 a altera\u00e7\u00e3o do car\u00e1ter do s\u00edndrome doloroso: as dores tornam-se localizadas, constante sem rela\u00e7\u00e3o com as refei\u00e7\u00f5es.<\/p>\n<p class=\"wp-block-paragraph\">Pode surgir um quadro cl\u00ednico de comprometimento do \u00f3rg\u00e3o no qual ocorreu a penetra\u00e7\u00e3o:<\/p>\n<ul class=\"wp-block-list\">\n<li>pancreatite;<\/li>\n<li>colecistite;<\/li>\n<li>hepatite reativa;<\/li>\n<li>icter\u00edcia mec\u00e2nica;<\/li>\n<li>omentite;<\/li>\n<li>forma\u00e7\u00e3o de infiltra\u00e7\u00f5es inflamat\u00f3rias na cavidade abdominal.<\/li>\n<\/ul>\n<p class=\"wp-block-paragraph\">O diagn\u00f3stico \u00e9 feito utilizando os m\u00e9todos descritos anteriormente:<\/p>\n<ul class=\"wp-block-list\">\n<li><strong>Esofagogastroduodenoscopia<\/strong>\u2014 uma \u00falcera profunda com bordas elevadas \u00e9 detectada; no fundo, \u00e0s vezes \u00e9 poss\u00edvel visualizar o \u00f3rg\u00e3o penetrado.<\/li>\n<li><strong>Radiografia<\/strong> \u2014 uma \u201cnicha\u201d profunda, fixada, que n\u00e3o se desloca com a mudan\u00e7a de posi\u00e7\u00e3o do corpo \u00e9 determinada.<\/li>\n<li><strong>Ultrassonografia<\/strong> \u2013 vizualizam-se infiltra\u00e7\u00f5es, sinais de inflama\u00e7\u00e3o dos \u00f3rg\u00e3os adjacentes.<\/li>\n<li><strong>Tomografia Computadorizada dos \u00f3rg\u00e3os abdominais (TC OB)<\/strong> \u2013 facilita a visualiza\u00e7\u00e3o da \u00falcera e da infiltra\u00e7\u00e3o.<\/li>\n<\/ul>\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/ru\/zkt\/yazvennaya-bolezn-zheludka-i-dvenadcatiperstnoy-kishki-gastroduodenalnye-yazvy\/penetraciya-yazvy-dvenadcatiperstnoy-kishki-v-golovku-podjeludochnoj-jelezy.webp\" alt=\"Penetra\u00e7\u00e3o da \u00falcera do duodeno na cabe\u00e7a do p\u00e2ncreas\"><figcaption class=\"wp-element-caption\">Penetra\u00e7\u00e3o da \u00falcera do duodeno na cabe\u00e7a do p\u00e2ncreas \u2013 <a href=\"https:\/\/catalog.voka.io\/en\/models\/8b29e257-5d66-47fe-a26d-4f6e4b65959b\/0629cf84-6586-487c-970e-92d447990311\/7dec45da-b8cc-44d5-885a-cd23e1dc0685\/dee8ba27-7de2-4f8b-9d71-4c5481080ff5\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">modelo 3D<\/a><\/figcaption><\/figure>\n<div class=\"social-banner-block\">\n<div class=\"social-banner-content\">\n<p class=\"h5-title text-black\">Encontra mais conte\u00fados cientificamente exactos nas nossas redes sociais<\/p>\n<p><span class=\"social-banner-text text-grey\">Subscreve e n\u00e3o percas os recursos mais recentes<\/span><\/p>\n<div class=\"social-links-wrapper\"><a class=\"social-icon-link\" href=\"https:\/\/www.facebook.com\/VOKA3DAnatomyAndPathology\/\" target=\"_blank\" rel=\"nofollow noopener\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/Social%20Icons\/facebook.svg\" alt=\"social link\"><\/a><a class=\"social-icon-link\" href=\"https:\/\/www.instagram.com\/voka.io\/\" target=\"_blank\" rel=\"nofollow noopener\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/Social%20Icons\/insta.svg\" alt=\"social link\"><\/a><a class=\"social-icon-link\" href=\"https:\/\/www.linkedin.com\/company\/voka-io\/posts\/?feedView=all\" target=\"_blank\" rel=\"nofollow noopener\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/Social%20Icons\/linkedin.svg\" alt=\"social link\"><\/a><a class=\"social-icon-link\" href=\"https:\/\/www.youtube.com\/@vokaio\" target=\"_blank\" rel=\"nofollow noopener\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/Social%20Icons\/youtube.svg\" alt=\"social link\"><\/a><a class=\"social-icon-link\" href=\"https:\/\/www.pinterest.com\/voka3danatomyandpathology\/\" target=\"_blank\" rel=\"nofollow noopener\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/Social%20Icons\/pinterest.svg\" alt=\"social link\"><\/a><a class=\"social-icon-link\" href=\"https:\/\/www.tiktok.com\/@voka.io\" target=\"_blank\" rel=\"nofollow noopener\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/Social%20Icons\/tiktok.svg\" alt=\"social link\"><\/a><a class=\"social-icon-link\" href=\"https:\/\/discord.gg\/7ejUpq8DRR\" target=\"_blank\" rel=\"nofollow noopener\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/Social%20Icons\/discord.svg\" alt=\"social link\"><\/a><\/div>\n<\/div>\n<p><img decoding=\"async\" class=\"social-banner-image\" loading=\"lazy\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/social-media-banner-mobile-image.webp\" alt=\"Banner background\"><\/div>\n<h3 id=\"malignizacao\" class=\"wp-block-heading\"><strong>Maligniza\u00e7\u00e3o<\/strong><\/h3>\n<p class=\"wp-block-paragraph\">No contexto de um processo inflamat\u00f3rio cr\u00f4nico prolongado, ocorre displasia das c\u00e9lulas do epit\u00e9lio com desenvolvimento de transforma\u00e7\u00e3o maligna e forma\u00e7\u00e3o de tumor.<\/p>\n<p class=\"wp-block-paragraph\">Diagn\u00f3stico:<\/p>\n<ul class=\"wp-block-list\">\n<li>Esofagogastroduodenoscopia com visualiza\u00e7\u00e3o do processo e realiza\u00e7\u00e3o de bi\u00f3psia;<\/li>\n<li>tomografia computadorizada dos \u00f3rg\u00e3os abdominais (TC OB).<\/li>\n<\/ul>\n<p class=\"wp-block-paragraph\">O tratamento \u00e9 apenas cir\u00fargico seguido de tratamento oncol\u00f3gico espec\u00edfico.<\/p>\n<div>\n<h2 class=\"faq-title h2-article\" id=\"faq\">FAQ<\/h2>\n<div class=\"faq-section\">\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">1. O que \u00e9 doen\u00e7a ulcerosa?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">A doen\u00e7a ulcerosa \u00e9 uma doen\u00e7a cr\u00f4nica em que se formam defeitos da parede do \u00f3rg\u00e3o em \u00e1reas variadas da mucosa do est\u00f4mago ou duodeno.<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">2. Quais s\u00e3o as causas da doen\u00e7a ulcerosa g\u00e1strica?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">As causas da doen\u00e7a s\u00e3o acidez g\u00e1strica aumentada, infec\u00e7\u00e3o por <em>Helicobacter pylori<\/em>, uso prolongado de antiinflamat\u00f3rios n\u00e3o esteroides, estresse, m\u00e1 alimenta\u00e7\u00e3o e predisposi\u00e7\u00e3o gen\u00e9tica.<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">3. Quais s\u00e3o os sintomas da doen\u00e7a ulcerosa g\u00e1strica e duodenal?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">Os sintomas principais incluem dor no abd\u00f4men superior (frequentemente relacionada \u00e0 alimenta\u00e7\u00e3o), azia, n\u00e1useas e v\u00f4mitos. A perda de apetite e de peso tamb\u00e9m pode ser observada. Com o desenvolvimento de complica\u00e7\u00f5es aparecem sintomas caracter\u00edsticos \u2013 hemorragia (manifestada por v\u00f4mito com sangue ou fezes escurecidas), perfura\u00e7\u00e3o (manifestada por peritonite), estenose (disfun\u00e7\u00e3o do tr\u00e2nsito pelo tr\u00e2nsito gastrointestinal).<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">4. Quais s\u00e3o as queixas na doen\u00e7a ulcerosa g\u00e1strica?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">Os pacientes queixam-se de dor ardente ou cortante na parte superior do abd\u00f4men, azia, n\u00e1useas, eructa\u00e7\u00e3o, ocasionalmente v\u00f4mito, bem como uma sensa\u00e7\u00e3o de peso ou plenitude ap\u00f3s as refei\u00e7\u00f5es. Com o desenvolvimento de complica\u00e7\u00f5es, surgem queixas caracter\u00edsticas: na hemorragia \u2013 v\u00f4mito com sangue e fezes pretas, na perfura\u00e7\u00e3o \u2013 dores agudas em todo o abd\u00f4men, na estenose \u2013 perda de peso e v\u00f4mito frequente e abundante.<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">5. Como a doen\u00e7a ulcerosa g\u00e1strica e duodenal se manifesta em crian\u00e7as?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">Em crian\u00e7as, a doen\u00e7a ulcerosa \u00e9 menos comum, mas pode se desenvolver devido a infec\u00e7\u00e3o por <em>Helicobacter pylori<\/em>, fatores heredit\u00e1rios, doen\u00e7as cr\u00f4nicas do trato gastrointestinal, al\u00e9m de estresse e m\u00e1 alimenta\u00e7\u00e3o. Os sintomas em crian\u00e7as s\u00e3o semelhantes aos dos adultos.<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"sources-list-block sources-list-hidden\" id=\"referencias\">\n<div class=\"sources-list-content\">\n<div class=\"sources-list-title\">\n<p class=\"small-text-bold text-black sources-list-title-text\">Refer\u00eancias<\/p>\n<div class=\"sources-expand-button-wrapper-mobile\">\n<div class=\"sources-expand-button\"><svg width=\"32\" height=\"32\" viewbox=\"0 0 32 32\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M8 12L16 20L24 12\" stroke=\"#8C9AAB\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\"><\/path><\/svg><\/div>\n<\/div>\n<\/div>\n<div class=\"sources-list-items\">\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">1.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>VOKA 3D Anatomy & Pathology \u2013 Complete Anatomy and Pathology 3D Atlas (VOKA 3D Anatomia e Patologia \u2013 Atlas 3D completo de anatomia e patologia) [Internet]. VOKA 3D Anatomy & Pathology [VOKA 3D Anatomia & Patologia]. <\/cite><\/p>\n<p><span class=\"small-text-medium text-grey\">Dispon\u00edvel em: https:\/\/catalog.voka.io\/<\/span><\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">2.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Ndidi K. \u00dalceras g\u00e1stricas: causas, sintomas, tratamento e preven\u00e7\u00e3o. J Wetenschap Health. 2020;1(1):1-4.<\/cite><\/p>\n<\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">3.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Naidu K. Doen\u00e7a ulcerosa p\u00e9ptica. Em: Cirurgia de emerg\u00eancia para regi\u00f5es com poucos recursos. Cham: Springer Nature Switzerland AG; 2021. p. 179-183. 85.<\/cite><\/p>\n<\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">4.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Sidzenka VM. Doen\u00e7a ulcerosa p\u00e9ptica. Minsk: Universidade Estatal M\u00e9dica da Bielorr\u00fassia; 2019. 24 p. [Em russo.]<\/cite><\/p>\n<\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">5.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Sipponen P, Maaroos HI. Gastrite cr\u00f4nica. Scand J Gastroenterol. 2015;50(6).<\/cite><\/p>\n<\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">6.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Weber DG, Bendinelli C. Cirurgia de controle de danos para cirurgia geral de emerg\u00eancia. Em: Manual de cirurgia de cuidados agudos. Vol. 1. Cham: Springer International Publishing AG; 2017. p. 179-183. 397-398.<\/cite><\/p>\n<\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">7.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Grigoriev PY. Gastroenterologia cl\u00ednica. Moscou; 2001. 681 p. [Em russo.]<\/cite><\/p>\n<\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">8.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Zavada NV. Cirurgia de emerg\u00eancia dos \u00f3rg\u00e3os abdominais. Minsk: Bielorr\u00fassia; 2005. 117 p. [Em russo.]<\/cite><\/p>\n<\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">9.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Kozyrev MA. \u00dalceras gastroduodenais. Minsk: Bielorr\u00fassia; 2007. 139 p. [Em russo.]<\/cite><\/p>\n<\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">10.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Rylyuk AF. Anatomia topogr\u00e1fica e cirurgia dos \u00f3rg\u00e3os abdominais. Minsk; 2003. 418 p. [Em russo.]<\/cite><\/p>\n<\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">11.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Shott AV, Leonovich SI, Kondratenko GG. Hemoragia de \u00falcera gastroduodenal. Minsk: Bielorr\u00fassia; 2003. 140 p. [Em russo.]<\/cite><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"sources-expand-button-wrapper\">\n<div class=\"sources-expand-button\"><svg width=\"32\" height=\"32\" viewbox=\"0 0 32 32\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M8 12L16 20L24 12\" stroke=\"#8C9AAB\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\"><\/path><\/svg><\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>A \u00falcera gastroduodenal \u00e9 um defeito da parede do est\u00f4mago ou do duodeno, penetrando mais profundamente do que a camada submucosa. Relev\u00e2ncia Nos pa\u00edses desenvolvidos, esta patologia \u00e9 identificada em 15% da popula\u00e7\u00e3o adulta. A maior mortalidade \u00e9 observada no Jap\u00e3o e em Portugal, a menor nos EUA e no Canad\u00e1. \u00dalceras duodenais ocorrem 5 [&hellip;]<\/p>\n","protected":false},"author":13,"featured_media":0,"template":"","diseases_category":[296],"class_list":["post-884","diseases_post","type-diseases_post","status-publish","hentry","diseases_category-gastroenterologia"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v25.0 (Yoast SEO v27.8) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>\u00dalcera p\u00e9ptica do est\u00f4mago e do duodeno: sintomas, etiologia, cl\u00ednica, diagn\u00f3stico e tratamento.<\/title>\n<meta name=\"description\" content=\"A \u00falcera gastroduodenal \u00e9 um defeito da parede do est\u00f4mago ou do duodeno. 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