Esophageal and Cardiac Mucosal Tearing Syndrome
Introduction
Introduction to esophageal and gastric mucosal tear syndrome Severe retching, vomiting, and other conditions that cause a sudden increase in intra-abdominal pressure, causing gastric cardia, distal mucosa and submucosal tears, and massive hemorrhage, called esophageal cardia mucosal tear syndrome (Mallory-Weiss synthesis) Expropriation). There are still few reports on this syndrome in China. In recent years, with the extensive use of fiber endoscopy and early examination of patients with upper gastrointestinal bleeding, it is more and more noted at home and abroad that this disease is important for upper gastrointestinal bleeding. one of the reasons. basic knowledge The proportion of illness: 0.005%-0.008% Susceptible people: no special people Mode of infection: non-infectious Complications: retching, nausea and vomiting, abdominal pain, shock
Cause
Causes of esophageal and gastric mucosal tear syndrome
(1) Causes of the disease
Abdominal pressure or sudden increase in intragastric pressure is the most basic cause of this disease. Atkinson et al. used air-expanded corpses to prove that when the intragastric pressure reaches 13.3-20.0 kPa (100-150 mmHg), mucosal tearing can occur. The most common cause of increased pressure in the stomach is severe retching and vomiting. In 1981, Chens report of the Chinese Journal of Internal Medicine reported that 17 cases in Beijing were all related to retching and vomiting. Weaver et al. reviewed the English literature from 1964 to 1968. In 108 cases, 98 cases were found to cause tearing due to vomiting, accounting for 90.7%. Atkinson et al. tested in healthy adults. The pressure in the stomach can rise to 16.0-21.2 kPa (120-160 mmHg) when vomiting, and the peak pressure can even be Up to 26.6 kPa (200 mmHg), and the internal esophageal pressure in the chest is generally only 6.6 kPa (50 mmHg). The stomach filled with food after a full meal can no longer withstand the increase of pressure, iatrogenic retching and vomiting, pregnancy vomiting, Esophagitis, acute gastroenteritis, active peptic ulcer, acute cholecystitis, acute pancreatitis, placement of gastric tube, endoscopy, diabetic acidosis, uremia, etc. are all causes of severe vomiting, but severe retching Vomiting In any case is not the only reason, the pressure increase could cause the stomach to Weiss actuator.
Including: severe cough, forced bowel movements, weight lifting, childbirth, severe hiccups during anesthesia, chest massage, wheezing state, seizures, abdominal blunt contusion, etc., some intra-abdominal diseases such as hiatal hernia, peptic ulcer, gastritis Esophagitis, cirrhosis, etc. often coincide with the Mallory-Weiss syndrome, which may play a role in promoting its pathogenesis, with esophageal hiatus being the most important, Atkinson believes that with esophageal hiatus hernia, The pressure at the junction of the gastroesophageal tract is greatly increased during vomiting, which may be the main cause of tearing of the esophageal hiatus. The esophageal hiatus is not only the cause of the Mallory-Weiss tear, but also the part of the mucosal laceration that occurs during vomiting. Watts pointed out that patients with esophageal hiatal hernia in a quiet state are mostly located in the cardia of the stomach. In patients without a hiatal hernia, the tear is mostly located at the distal end of the esophagus, usually without a hiatus and produces a vomiting. In patients with perforated hiatus hernia, the torsion rides across the junction of the esophagus and the stomach.
(two) pathogenesis
The main pathology is the longitudinal tear of the esophagus and stomach junction and the distal esophageal mucosa and submucosa. The laceration is mostly single, but it can also be multiple. The laceration is usually 3~20mm long and 2~3mm wide. The part is covered by blood clots and yellow necrotic tissue, the edge is clear, the mucous membrane is mildly edematous, the microscope is acute inflammatory ulcer, and penetrates the mucosa. The ulcer generally does not exceed the submucosa, and even the deep muscle layer, ulcer inside Contains blood and fibrous purulent exudate, the base of which is acutely inflammatory and edematous, usually with an expanded thin-walled vascular network visible in the surrounding submucosa.
Prevention
Esophageal cardia mucosal tear syndrome prevention
Severe cough, forced bowel movements, weight lifting, childbirth, wheezing, seizures, etc., causing intra-abdominal pressure or sudden increase in intragastric pressure are the basic causes of this disease. Therefore, prevention of intra-abdominal pressure or sudden increase in intragastric pressure is the key. .
Complication
Complications of esophageal cardia mucosal tear syndrome Complications, nausea, nausea, vomiting, abdominal pain, shock
Typical patients often have severe retching and vomiting, followed by hematemesis or melanosis, sometimes with mild abdominal pain, and hemorrhagic shock when the amount of bleeding is large.
Symptom
Esophageal cardia mucosal tear syndrome symptoms common symptoms repeated hematemesis nausea and vomiting black stool esophageal hemorrhagic shock
The typical medical history is retching or vomiting, followed by hematemesis. Compared with the spontaneous rupture of the esophagus, the pain in the heart is extremely inconspicuous. Most patients only show painless bleeding because of arterial bleeding. In severe cases, it can cause shock and death, but in some cases, there is very little bleeding, even if the vomit contains bloodshot or only black stool without hematemesis.
Examine
Examination of esophageal and gastric mucosal tear syndrome
When the disease is combined with major bleeding, the total number of red blood cells and total hemoglobin in the blood is reduced.
1. Gastroscopic examination: It is the most effective means to diagnose the disease. It is the first choice. The gastroscope should be performed within 24 hours of bleeding or bleeding. The endoscopic esophagus and stomach junction or the distal esophagus can be seen under the gastroscope. The tear is mostly single, and a few are multiple. The laceration is generally 3 to 20 mm long and 2 to 3 mm wide. The gastroscope can be divided into 5 categories:
1 active arterial effusion;
2 active vascular bleeding;
3 visible blood vessel exposure;
4 fresh bloody sputum adhered to the laceration;
5 simple laceration.
2. Tincture examination: The diagnostic value of the disease is small, only a few are expressed in the esophageal wall and stomach, and the detection rate is low.
3. Arterial angiography: The femoral artery can be selectively intubated to the left gastric artery, and the left gastric artery and its esophageal artery can be observed. The bleeding of the contrast agent can be seen in the active hemorrhage, and the bleeding speed must reach 0.5 ml/min or more.
Diagnosis
Diagnosis and differentiation of esophageal and gastric mucosal tear syndrome
1. The medical history is generally caused by severe vomiting according to various reasons. Following the hematemesis, the history of melena should be considered, especially in patients who drink alcohol, eat full meal or hiatal hernia.
2. Auxiliary inspection
(1) Gastroscope.
(2) Esophageal swallowing.
(3) Arteriography.
