bloating
Introduction
Introduction to bloating There is a certain amount (about 100 ~ 200ml) of gas in the gastrointestinal tract of normal people. The gas is mostly located in the stomach and colon. The gas in the small intestine is less. When excessive gas is accumulated in the gastrointestinal tract, it is called abdominal distension. Abbreviated as bloating. basic knowledge Sickness ratio: 100% Susceptible people: no special people. Mode of infection: non-infectious Complications: intestinal obstruction, acute gastroenteritis, gastric ulcer, duodenal ulcer
Cause
Cause of abdominal distension
Stomach, biliary tract disease (27%):
Gastric diseases are one of the important causes of abdominal distension. They are found in chronic gastritis, chronic atrophic gastritis, peptic ulcer, gastric dilatation, gastric torsion, gastroptosis, pyloric obstruction and gastric cancer. Biliary disease: such as acute, chronic cholecystitis, cholelithiasis and biliary obstruction caused by various reasons.
Intestinal disease (25%):
It is also an important cause of abdominal distension, more common in acute, chronic intestinal infections (such as bacterial dysentery, amoebic enteritis, intestinal tuberculosis, Crohn's disease, ulcerative colitis, etc.), malabsorption syndrome, acute, chronic intestine Obstruction, pseudo-intestinal obstruction, intestinal diverticulosis, constipation caused by various reasons.
Gastrointestinal function, pancreatic disease (15%):
Such as gassing, intractable hiccups, functional dyspepsia (non-ulcer dyspepsia), irritable bowel syndrome (IBS). Pancreatic diseases: such as acute, chronic pancreatitis, giant pancreatic cysts, pancreatic cancer, etc.
Liver disease (12%):
It is also an important cause of abdominal distension, more common in acute, chronic hepatitis, especially in severe hepatitis (abdominal swelling is one of the main and stubborn symptoms), cirrhosis (abdominal swelling is often the main symptom of early cirrhosis), liver abscess, liver cancer, etc. .
Peritoneal, acute infectious, cardiovascular disease (10%):
Peritoneal diseases: such as acute suppurative peritonitis, tuberculous peritonitis, and peritoneal cancer. Acute infectious diseases: such as shock pneumonia, typhoid fever, severe tuberculosis and sepsis. Cardiovascular disease: seen in acute, chronic congestive heart failure (especially right heart dysfunction), mesenteric vascular embolism or thrombosis.
Other causes (5%):
Such as chronic renal insufficiency, electrolyte and acid-base metabolism disorders, connective tissue diseases, diabetic gastroparesis, blood system diseases, central nervous or spinal cord lesions, pleural effusion and ascites caused by various reasons.
Pathogenesis
The increase of gas in the gastrointestinal tract is mainly due to an increase in the amount of gas entering the gastrointestinal tract from the outside, an increase in the amount of gas generated in the gastrointestinal tract, and a decrease in the amount of gas absorbed and discharged from the gastrointestinal tract.
1. Swallowing a large amount of gas: in patients with gassing or intractable hiccups, long-term nervousness, anxiety, often due to repeated belching, nausea or swallowing saliva, while swallowing a lot of air, in some pathological conditions, such as In the case of intestinal obstruction, the patient's abdominal breathing is weakened due to abdominal pain, so the breathing is accelerated, and a large amount of air enters the gastrointestinal tract through the mouth as the breathing speeds up.
2. Gastrointestinal obstruction: When there is obstructive lesion in the gastrointestinal tract (pyile obstruction, complete or incomplete intestinal obstruction, etc.), gas is trapped in the gastrointestinal tract due to the obstruction of gas from the anus.
3. Food fermentation:
(1) Ingest a large amount of foods containing more sugar (starch), such as hawthorn, potatoes, sweet potatoes, pumpkin, lotus root, corn and beans.
(2) When gastric emptying disorder or pyloric obstruction, the food is stored in the stomach, which can cause glycolysis of the food and produce too much gas, which is more significant in the absence of gastric acid.
(3) When bile, pancreatic enzyme or small intestinal peptidase is insufficiently secreted, it can affect the digestion and absorption of sugar and fat, and cause glycolysis of food, resulting in a large amount of gas.
4. Drug effect: After taking excessive amounts of sodium bicarbonate, calcium carbonate and other drugs, it can produce carbon dioxide in the stomach and cause bloating. After applying a large amount of antibiotics, such as normal intestinal bacteria, the intestinal flora can be changed. Lead to food fermentation and excessive gas production.
5. Helicobacter pylori infection: intragastric infection of Helicobacter pylori (Hp), can affect the gastrointestinal motility, manifested as delayed gastric emptying and postprandial gastric contraction exercise, thus delaying gastro-intestinal gas excretion And bloating occurred.
6. Gastrointestinal motor function regulation disorder: Gastrointestinal motor function is usually regulated by the central nervous system, peripheral nervous system (sympathetic and parasympathetic) and enteric nervous system. When the above nervous system develops lesions or dysfunction, gastrointestinal motility Regulation is affected, such as Parkinson's disease, brain stem tumors and other neurological diseases can affect the cholinergic nerves in the intestinal nervous system, causing disturbances in intestinal movement, in addition, intestinal smooth muscle lesions (such as progressive systemic sclerosis) Symptoms, progressive myopathy, amyloidosis, etc.), intermuscular nerves from lesions (such as small bowel diverticulosis, intestinal dysplasia, etc.) can cause intestinal motor dysfunction, the cause of pseudo-intestinal obstruction and intestinal smooth muscle lesions, Intestinal myenteric plexus lesions are closely related. In addition, when intestinal smooth muscle and myenteric plexus lesions, intestinal mucosal absorption of gas is also significantly reduced.
7. The amount of gas diffused into the gastrointestinal tract from the blood: more common in the intestinal wall or mesenteric blood circulation disorders, such as mesenteric vascular embolism or thrombosis, congestive heart failure, etc., but also accompanied by intestinal mucosal absorption of gas barriers.
Prevention
Abdominal prophylaxis
1. Eat less high-fiber foods. Such as potatoes, pasta, beans and cabbage, cauliflower, onions, etc., are easy to produce gas in the stomach, and finally lead to bloating.
2. Do not eat food that is not easy to digest. Hard food such as fried beans and hard pancakes is not easy to digest, and it stays longer in the gastrointestinal tract, which may cause more gas to cause bloating.
3. Change the habit of gorging. Eating too fast, or eating while walking, it is easy to swallow a lot of air; drinking a drink with a straw often causes a lot of air to sneak into the stomach, causing bloating.
4. Overcome bad feelings. Unpleasant emotions such as anxiety, anxiety, sadness, depression, depression, etc. may weaken the digestive function or stimulate the stomach to produce too much stomach acid. As a result, the stomach gas increases and the abdominal distension increases.
5. Exercise properly. Holding an appropriate amount of exercise for about 1 hour a day can not only help overcome negative emotions, but also help the digestive system maintain normal function.
6, pay attention to certain diseases. For some diseases, bloating or aura, or one of the symptoms, including: allergic enteritis, ulcerative colitis, bladder tumors and so on.
Complication
Bloating complications Complications, intestinal obstruction, acute gastroenteritis, gastric ulcer, duodenal ulcer
Can be complicated by acute gastroenteritis, stomach, duodenal ulcer, intestinal obstruction.
Symptom
Abdominal swelling symptoms Common symptoms Exhaust abdominal pain accompanied by nausea, vomiting constipation, postoperative bloating
Generally speaking, abdominal distension has abdominal distension. The bulging of the upper abdomen is more common in the stomach or transverse colon. The abdominal distension of the small intestine can be confined to the middle abdomen. It can also be a full abdominal abdomen. The bulging can be limited to the lower abdomen or the left lower abdomen. When the pyloric obstruction is performed, the upper abdomen may have a stomach type and a peristaltic wave. When the intestinal obstruction is seen, the intestinal type and the peristaltic wave may be seen, the bowel sounds may be weakened or weakened, and the peritonitis may have tenderness and muscle tension. .
Examine
Bloating examination
1. stool examination: mucus pus and blood, microscopic cells see red blood cells, white blood cells, mostly intestinal inflammatory lesions; stool contains more indigestible food, microscopically seen muscle fibers, fat balls, more tips for digestion and malabsorption .
2. Analysis of gastric juice: Chronic atrophic gastritis, gastric cancer, gastric acid secretion is often reduced.
3. Liver function and serum enzymology: helpful for the diagnosis of hepatic biliary tract lesions.
4. Gastroscopic examination: Diagnostic value for gastric and duodenal diseases such as chronic gastritis, peptic ulcer and gastric cancer.
5. Colonoscopy: Diagnostic or diagnostic value for intestinal tuberculosis, Crohn's disease, ulcerative colitis, amoebic bowel disease, bacterial dysentery, colon cancer, colonic diverticulosis, etc.
6. X-ray examination: abdominal fluoroscopy or plain film examination can help the diagnosis of hepatic syndrome, splenic syndrome, perforation of ulcer disease, intestinal obstruction and other diseases; in addition to diagnosis of chronic gastritis, peptic ulcer and gastric cancer It is also conducive to the diagnosis of gastroptosis; barium enema examination can help diagnose colonic lesions.
7. B-ultrasound, CT or MIR examination: It has important diagnostic significance for liver, biliary and pancreatic diseases, and has auxiliary diagnostic value for tuberculous peritonitis or ascites caused by various causes.
Diagnosis
Diagnosis of abdominal distension
diagnosis
History
(1) Age: Adult abdominal distension is more common in liver, biliary and pancreatic diseases, and functional dyspepsia is also more common. Children and adolescents should consider dystrophic diseases such as intra-abdominal tuberculosis and B vitamin deficiency.
(2) Diet: Eating a large amount of foods containing sugar and overeating are prone to bloating.
(3) Past history: Patients should be asked whether they have previous history of gastritis, peptic ulcer, gastroptosis, pyloric obstruction or intestinal obstruction, history of tuberculosis, hepatitis, cirrhosis, pancreatitis, history of abdominal surgery, history of trauma.
2. Accompanying symptoms
(1) abdominal distension with abdominal pain: with acute abdominal pain should consider the possibility of acute cholecystitis, pancreatitis, intestinal obstruction, acute peritonitis, mesenteric vascular embolism or thrombosis, intestinal torsion, intussusception and other diseases.
(2) abdominal distension with vomiting: more common in pyloric obstruction, intestinal obstruction and other lesions, followed by liver biliary and pancreatic lesions. Functional dyspepsia and functional diseases such as gassing can sometimes cause vomiting.
(3) abdominal distension with hernia: common in gassing, functional dyspepsia, chronic atrophic gastritis, gastroptosis, ulcer disease and pyloric obstruction.
(4) abdominal distension with constipation: more common in habitual constipation, irritable bowel syndrome (constipation type), intestinal obstruction, left colon cancer.
(5) abdominal distension with diarrhea: more common in acute intestinal infection, cirrhosis, chronic cholecystitis, chronic pancreatitis, malabsorption syndrome.
(6) abdominal distension with anal exhaust increased: more common in food after intestinal fermentation, excessive gas in the colon, irritable bowel syndrome.
(7) abdominal distension with fever: more common in typhoid fever, acute intestinal inflammation, intestinal tuberculosis, tuberculous peritonitis and sepsis.
(8) abdominal distension with intestinal type or water sound: abdominal distension with intestinal type or abnormal peristaltic wave is more common in intestinal obstruction, such as the stomach has a water sound, more consideration for gastric retention or pyloric obstruction.
(9) abdominal distension: upper abdominal distension is more common in atrophic gastritis, functional dyspepsia, cirrhosis, pyloric obstruction, gastric dilatation or gastric cancer, pancreatic cancer, etc.; middle and upper abdominal distension is more common in liver and biliary tract lesions, hepatic syndrome The levy of the left upper abdomen is more common in gastric diseases, splenic syndrome, etc.; left lower abdominal swelling is more common in colonic flatulence (such as megacolon); full abdominal flatulence is more common in the small intestine or colon cavity, excessive gas, paralytic ileus Intestinal obstruction and so on.
Differential diagnosis:
Because of the many diseases that cause flatulence in the abdomen, only common diseases that cause abdominal distension are identified.
1. Swallowing: Patients often have mental stress, emotional instability or depression. The main symptoms of the digestive tract are hernia or hiccups (more frequent sputum in front of the doctor). The patient feels comfortable after being suffocated, actually While swallowing a large amount of air, the upper abdomen has a feeling of swelling or fullness. There are no obvious organic lesions on X-ray barium or gastroscopy. Psychotherapy is used to apply drugs that accelerate gastric emptying (Domperidone). , mosapride or Shu Li Qi Neng, etc.) and anti-anxiety or anti-depression and other drug treatments are effective.
2. Chronic atrophic gastritis: more common in middle-aged patients, the main symptoms are upper abdominal pain, abdominal distension, loss of appetite and weight loss, anemia and other symptoms, gastroscopy and mucosal biopsy histopathological examination can establish a diagnosis.
3. Gastroptosis: occurs in lean, weak body type, the elderly with abdominal wall relaxation and maternal or chronic wasting disease, abdominal distension is generally lighter in the morning to get up, standing too late to afternoon, the symptoms worsened at night, in addition, Can also be accompanied by loss of appetite, nausea, belching, limb weakness and other symptoms, X-ray barium meal examination shows that the position of the stomach is significantly moved down, the stomach contour is moved below the bilateral ridge ridge line, the stomach is weak, is conducive to gastric ptosis diagnosis.
4. Gastric cancer: more common in male patients over 40 years old, but in recent years young people with gastric cancer is not uncommon, the main symptoms are anorexia, upper abdominal pain, abdominal distension, nausea, vomiting and weight loss, anemia, etc., a small number of patients can be seen in the upper abdomen Blocks, X-ray barium meal and gastroscopy can establish a diagnosis.
5. Liver cirrhosis: abdominal distension is the only symptom of early cirrhosis, to the stage of decompensation, in addition to abdominal distension, the patient also has loss of appetite, spider disease, liver palm, skin pigmentation, splenomegaly, jaundice, ascites and lower limbs Symptoms and signs such as edema, gastroscopic examination of esophageal varices, liver function damage, and B-ultrasound found typical signs of cirrhosis have diagnostic value.
6. Chronic pancreatitis: In addition to abdominal distension, patients often have loss of appetite, upper abdominal pain, diarrhea (especially steatorrhea), weight loss and other symptoms, pancreatic exocrine function test, abdominal B-ultrasound, CT or MRI can make a diagnosis.
7. Intestinal obstruction: the lower the obstruction site, the more obvious the abdominal distension of the patient. When the paralytic ileus is obstructed, it shows full abdominal distension, nausea, vomiting, no deflation, no bowel sounds, weakened or disappeared; mechanical intestinal obstruction, The bowel sounds are hyperthyroidized or metallic, and X-ray fluoroscopy or abdominal plain film examination can be seen in the intestinal lumen to facilitate the diagnosis.
8. Functional dyspepsia: It is a common functional disease. The main symptoms of the digestive tract include bloating, early satiety, loss of appetite, nausea, pain in the upper abdomen or burning, and a few patients may have acid reflux symptoms. In addition, patients may also With mental stress, anxiety or depression, X-ray barium meal or gastroscopy is conducive to the diagnosis of this disease after the elimination of organic diseases.
9. Irritable Bowel Syndrome (IBS): It is a common intestinal functional disease. It can be divided into diarrhea type, constipation type or diarrhea constipation. The main symptoms of patients are abdominal distension, abdominal pain, diarrhea or constipation, and abdominal pain. Relieved after the stool, but the patient's bloating feeling disappeared slowly, the disease is also related to mental factors, X-ray barium enema or colonoscopy without obvious organic lesions, sometimes see intestinal irritation or sputum signs are helpful for diagnosis .
10. Sugar indigestion: After eating a large amount of sugar (starch) food, the main symptoms of the patient are bloating, belching, anal discharge of a large amount of gas without obvious odor, accompanied by mild abdominal pain, diarrhea (more stools Symptoms, foam and sour smell), when the anus discharges a lot of gas or stool, the symptoms can be alleviated or alleviated. If you eat too much sugary food again, the symptoms can recur; the stool can be seen with indigestible food. Residues, stools are acidic, and X-ray barium enema and other tests are helpful for diagnosis.
