acute gastric distension
Introduction
Introduction to acute gastric dilatation Acute gastric dilatation (acutegastricdilatation) refers to a syndrome caused by a large amount of gas and fluid accumulation in the short term, and the upper part of the stomach and duodenum is highly expanded. It is usually a serious complication of certain internal surgical diseases or anesthesia operations. basic knowledge The proportion of illness: 0.015% Susceptible people: no special people Mode of infection: non-infectious Complications: peritonitis
Cause
Cause of acute gastric dilatation
Surgery (30%):
Trauma, anesthesia and surgery, especially abdominal cavity, pelvic surgery and vagus nerve surgery, can directly stimulate the body or splanchnic nerve, causing autonomic dysfunction of the stomach, reflex inhibition of the stomach wall, causing gastric smooth muscle relaxation, and then expansion. Intubation of the trachea during anesthesia, postoperative oxygenation and gastric tube nasal feeding, can also make a large amount of gas into the stomach, forming an expansion.
Disease status (30%):
Gastric torsion, incarcerated hiatal hernia and various causes of duodenal hoarding, duodenal tumors, foreign bodies, etc. can cause gastric retention and acute gastric dilatation. Lesions near the pylorus, such as spinal deformity, annular pancreas, pancreatic cancer, etc., can even compress the output of the stomach causing acute gastric dilatation. The so-called "cast syndrome" caused by the plaque on the body for 1 to 2 days may be caused by excessive stretching of the spine and compression of the duodenum by the superior mesenteric artery. Emotional stress, depression, and malnutrition can cause autonomic dysfunction, delaying gastric tension and delaying emptying. Diabetic neuropathy, the use of anticholinergic drugs, water, electrolyte metabolism disorders, severe infections (such as sepsis) can affect the gastric tension and gastric emptying, leading to acute gastric dilatation.
Stress status caused by various traumas (10%):
Especially in the upper abdominal contusion or severe combined injury, its occurrence is related to the strong stimulation of the celiac plexus.
Too much eating in a short period of time is also an occasional reason.
Prevention
Acute gastric dilatation prevention
Strengthen preventive measures to prevent acute gastric dilatation. From the above pathogenesis analysis, the main causes of this disease are vagus nerve cutting and partial gastric resection, mental factors, anemia, hypoproteinemia, water and electrolyte disorders. Therefore, surgical patients with the above-mentioned high-risk factors should improve the nutritional status of patients in the perioperative period, and those with gastrointestinal bleeding should correct anemia in time before and after surgery. In order to prevent their occurrence, patients should be relieved of their nervousness. Gastrointestinal decompression before operation, early promotion of intestinal peristalsis recovery, and more can be avoided, when the proximal end of the stomach is resected, plus pyloric angioplasty, it is helpful to prevent this disease.
Complication
Acute gastric dilatation complications Complications peritonitis
The disease can cause acute gastric perforation and acute peritonitis due to necrosis of the stomach wall. When the stomach expands to a certain extent, the muscle tension of the stomach wall is weakened, causing an acute angle between the esophagus and the cardia, the junction of the stomach and the duodenum, hindering the discharge of the contents of the stomach, and the enlarged stomach can press the duodenum and the mesentery And the small intestine is squeezed into the pelvic cavity. Therefore, the superior mesenteric artery is stretched to press the duodenum, causing obstruction at the distal end of the pylorus. The secretion of saliva, gastroduodenal juice, pancreatic juice and intestinal fluid can cause a large amount of fluid to accumulate. In the stomach, the stomach is aggravated. The dilated stomach can also mechanically compress the portal vein, causing blood to stagnate in the abdominal cavity, or compressing the inferior vena cava, reducing the amount of blood returning to the heart, and finally leading to peripheral circulatory failure. Due to massive vomiting, fasting and gastrointestinal decompression drainage can cause water and electrolyte disturbances.
Symptom
Acute gastric dilatation symptoms Common symptoms Acute gastric dilatation Stomach shift Peritonitis Shortness of breath, irritability, restless palsy, nausea, dehydration, hypokalemia
Most of the onset is slow, vagus nerve cuts often begin to enter the fluid diet after the second week after surgery, the main symptoms are bloating, upper abdominal or umbilical pain, nausea and persistent vomiting, vomit is turbid brown green or brown Liquid, vomiting symptoms are not alleviated, with the worsening of the disease, the general condition deteriorates, severe cases can occur dehydration, alkalosis, and manifested as irritability, shortness of breath, hand and foot convulsions, blood pressure drop and shock, prominent signs For the upper abdomen, it can be seen that there is no peristaltic stomach contour, local tenderness, excessive percussion, sound of water, and a limited mass on the right side of the umbilicus. The appearance is bulging, the touch is smooth and elastic, and the tenderness is tender. The lower right border is relatively clear, this is the extremely dilated gastric antrum, called "Giant sinus disease", which is an important sign of acute gastric dilatation, which can be used as a strong evidence for clinical diagnosis.
The disease can cause acute gastric perforation and acute peritonitis due to necrosis of the stomach wall.
Laboratory tests can find blood concentration, hypokalemia, hypochloremia and alkalosis. The abdominal X-ray film shows a large liquid level in the left upper abdomen and an extra-stomach large stomach shadow and left iliac muscle elevation.
Examine
Acute gastric dilatation examination
1, blood routine
The total number of white blood cells is often not high, but white blood cells can be significantly increased and left nucleus after gastric perforation. Hemoglobin and red blood cell counts increase due to a large amount of fluid loss leading to blood concentration.
2, serum electrolytes
Blood potassium, sodium, and chlorine are reduced.
3, blood gas analysis
Severe alkalosis can be found and carbon dioxide binding can be increased.
4, blood biochemistry
Non-protein nitrogen is elevated.
5, urine routine
The specific gravity of the urine increases, and proteins and casts may appear.
6, X-ray inspection
(1) The flat abdomen of the standing position shows uniform shadows in the upper abdomen, a large flat surface of the gastric cavity, a stomach shadow filled with the abdominal cavity, and an elevation of the left diaphragm.
(2) Sparse sputum angiography showed that the sputum entered the dilated gastric cavity, and the enlarged contour of the stomach and duodenum was observed. Duodenal obstruction was also found, and the expectorant could not enter.
7, abdominal B-ultrasound
It can be seen that the stomach is dilated, the stomach wall is thinned, and if there is a large amount of fluid retention in the stomach, the amount of fluid and its body surface projection can be measured.
Diagnosis
Diagnosis of acute gastric dilatation
diagnosis
According to the medical history, physical signs, combined with laboratory examination and abdominal X-ray signs, the diagnosis is generally not difficult. The gastric dilatation that occurs after surgery is often misdiagnosed due to the atypical symptoms and the general postoperative gastrointestinal symptoms. In addition, it should be complicated with intestinal obstruction. Identification of intestinal paralysis, intestinal obstruction and intestinal paralysis mainly affect the small intestine, abdominal distension is obvious in the middle of the abdomen, there will be no large amount of fluid and gas in the stomach, and the patient will not have much benefit after taking the stomach contents. The X-ray film is visible. Multiple stepped liquid levels.
Differential diagnosis
It should be differentiated from intestinal obstruction and intestinal paralysis. Intestinal obstruction and intestinal paralysis mainly involve the small intestine. The abdominal distension is obvious in the middle of the abdomen. There is no large amount of fluid and gas in the stomach. After taking the stomach contents, the patient will not have much benefit. X A plurality of stepped liquid levels can be seen in the flat sheet.
