Die La Foix disease
Introduction
Introduction to Diola Fuwa disease Dieulafoy's disease (Dieulafoy's disease), also known as Dieulafoy's disease, is one of the causes of massive bleeding in the digestive tract, especially the upper digestive tract. It can occur in any part of the gastrointestinal tract, with the proximal stomach. Most seen. basic knowledge The proportion of sickness: 0.00001% Susceptible people: no specific people Mode of infection: non-infectious complication:
Cause
The cause of Diola Fuwa disease
(1) Causes of the disease
The pathogenesis of Diola Fuwa disease is not fully understood. In the past, Diola Fuwa disease was classified as a gastric aneurysm. It is believed that hemorrhage is caused by the expansion of the aneurysm and rupture. Recently, pathological examination revealed Diola. The disease of the Fuwa disease has the intima, middle and outer membranes, which excludes the possibility of aneurysms. It has also been considered that Diola Fuwa disease is a congenital arteriovenous malformation, but the existence of arteriovenous malformation was not found in the study. The blood supply to the lower stomach wall mainly comes from the short gastric artery. After entering the stomach wall, the branch gradually becomes thinner, and finally forms the capillary system in the gastric mucosa. However, the patient's short gastric artery branch enters the gastric mucosa muscle layer and maintains a constant diameter. Therefore, it is called a constant diameter artery. It is generally considered that the constant diameter artery is a congenital dysplasia. There is a special relationship between the constant diameter artery and the mucosa. Under normal conditions, the loose tissue under the submucosa makes the mucosa on the arterial surface move freely, and Diola Patients with Fuwa disease have a specific mucosal vulnerable area due to the fixation of arteries and mucosa by Wanken fiber bundles. The relationship between Wanken fiber bundles and arteries and mucosa may be congenital. In the vulnerable area of the membrane, mucosal damage occurs and the submucosal constant diameter artery ruptures under the stimulation of external factors. As the age increases, the diameter of the artery expands and the mucosa shrinks. This weak environment is more vulnerable. Therefore, Diola Fuwa lesions are composed of submucosal constant diameter arteries and superficial mucosal erosion. A variety of factors can promote gastric mucosal erosion and permanent diameter arteries rupture, such as heavy drinking, smoking, bile reflux can cause gastric mucosal erosion; gastric motility When the constant diameter artery is compressed, elongated, and the cutting force or mechanical damage caused by peristalsis can also cause the blood vessel to rupture, the constant diameter artery is not a sudden corrosion crack, but the tube wall is gradually thinned, and the expansion causes the fracture and rupture. There are often thrombosis in the past. Some studies have found that there are different degrees of arteriosclerosis in the blood vessels of Diola Fuwa, and the hardening of blood vessels is more prone to rupture. This phenomenon can explain the age of onset of Diola Fuwa disease.
(two) pathogenesis
The histopathology of Diola Fuval disease has two typical features: small lesions, mostly ovarian superficial erosion of 2 ~ 5mm, can reach the mucosal muscle layer, visible in the center of the mucosal lesion with a diameter of 1 ~ 3mm In the area of mucosal defect, there may be thrombus adhesion on the surface, and there is no inflammatory change in the mucosa around the lesion. Because of the small lesion, it is easy to be neglected by endoscopy; the location is special, and the Diolafuwa lesion is often located on the small curved side of the gastric cardia, reported by Zanten. 82% of the lesions were located within 6 cm of the esophagus and the stomach. 81% of the lesions were located on the small curved side of the stomach. There were also very few lesions located in the duodenum, jejunum and knots, and rectum.
The pathological features of the lesions of Dielaful disease under the microscope are:
1. Superficial focal defect of gastric mucosa accompanied by fibrous necrosis of the basement.
2. There is a large artery at the base of the defect, the wall of the artery is thickened; the muscular layer of the mucosa has a distorted, hyperplastic artery.
3. Thickening of the venous diameter associated with the mucosal myometrial artery.
Under high power microscope, there is mild inflammation in the ruptured arterial wall, fibrosis in the lumen, submucosal fibrosis in the arterial wall, thickening of the gastric mucosa, no inflammation in the mucosa around the lesion, and rupture of the artery by elastic fiber staining. The elastic fiber tissue around the wall was loosened, the arterial wall was free of tumor-like expansion, and there was no arteritis. Miko analyzed the histopathological difference between the bleeding artery and the normal artery in 24 cases of Diola Fuwa disease and found Diola Fuwa disease. The hemorrhagic artery has a normal tissue structure, which is composed of mucosa, muscular layer and adventitia. The submucosal artery has normal diameter. The thickening of the blood vessels is mainly manifested in the mucosal muscle layer. The artery is fixed to the mucosa by Wanken elastic fiber. Mucosal defects, accompanied by rupture of the veins.
Prevention
Diola Fuwa disease prevention
Prevention: Early detection, early diagnosis and effective treatment are essential. Health products inquiry Breakline Diola Fuwa disease Chinese medicine treatment method No relevant information Chinese herbal medicine inquiry Breakline Diola Fuwa disease Western medicine treatment method Diola Fuwa disease has a high mortality rate, the main cause of death is blood loss Shock and multiple organ failure. Early diagnosis and effective treatment are essential. Endoscopic treatment, selective left gastric embolization, and surgery are available.
Complication
Diela Fuval disease complications Complication
The main clinical manifestations of Diola Fuwa disease are recurrent hematemesis and tar-like stools, and severe cases may have hemorrhagic shock.
Symptom
Symrasian disease symptoms common symptoms tar will be repeated hematemesis
The main clinical manifestations of Diela Fuval disease are recurrent hematemesis and tar-like stools. In severe cases, hemorrhagic shock can occur. There is no obvious upper abdominal discomfort and pain before hemorrhage, and there is no history of digestive ulcers and family history.
Due to the lack of specificity in the clinical manifestations of Diola Fuval disease, endoscopic, selective angiography, radionuclide tracing and other methods are helpful for preoperative diagnosis of Diola Fuval disease and provide important for surgical treatment. According to some patients, the diagnosis can be obtained when the laparotomy and autopsy pathological examination.
Examine
Inspection of Diola Fuwa disease
1. Fecal occult blood test can be positive.
2. Blood routine examination of the total amount of hemoglobin decreased.
3. The diagnosis of endoscopic endoscopy depends on the examiner's understanding and experience of Diola Fuwa disease. Diola Fuwa disease has different performance under endoscopy. The main features are: focal adhesion of gastric mucosa in the Tuen Mun area. The defect is accompanied by jet-like hemorrhage; the gastric mucosa is superficially depressed, the blood vessel is walking in the middle of the defect, and the blood clot is attached on the surface; occasionally, the small blood vessel protrudes from the surface of the normal mucosa, and there is pulsatile bleeding, and the endoscope is on Dier Lafu There is a certain difficulty in the diagnosis of the disease. It has been reported that the diagnosis rate is only 37%. In the active bleeding of the lesion, a large amount of blood or blood clot in the stomach cavity covers the bleeding point, and it is difficult to find the lesion by endoscopy; even if the bleeding stops, Small lesions are also easy to ignore.
4. Selective angiography has a diagnosis rate of 20% to 30% for Diola Fuval disease. Burham reported 9 patients who underwent selective celiac angiography before surgery. Only 3 patients were diagnosed. Diola Fuwa disease The angiographic features are: the contrast agent passes through the left gastric artery into the proximal end of the stomach, and rapidly enters the gastric cavity from the punctate area of the mucosa. The arterial morphology is normal, there is no aneurysm formation or the presence of arteriovenous shunt, but the selective celiac artery The angiography must be successful in indicating the location of the bleeding. If the bleeding stops, consider placing the catheter in the blood vessel for 24 hours. Once there is bleeding, the angiography is expected to be diagnosed. It is generally believed that patients with Diola Fuwa disease After repeated endoscopy, the patient was still negative, and selective celiac angiography was used to confirm the diagnosis.
5. Nuclide examination has been successfully reported by 99Tc-red blood cell tracer in the diagnosis of Diola Fuwa disease. 99Tc-erythrocyte examination is helpful to find out when no bleeding point is found in endoscopic and selective celiac angiography. Bleeding point.
Diagnosis
Diagnosis and diagnosis of Diola Fuwa disease
Intraoperative diagnosis: most of Diola Fuwa disease is diagnosed during emergency surgery exploration. During the operation, the morphological appearance of the stomach surface is normal. If no pathological causes such as digestive ulcer or portal hypertensive esophageal varices are found, gastric mucosa should be considered. Hemorrhage caused by lesions, cut the stomach wall along the large curved side of the stomach, aspirate a large amount of blood and blood clots in the gastric cavity, and carefully check whether there is a hemorrhagic lesion in the gastric mucosa. If no obvious lesions such as hemangioma are found in the gastric mucosa, attention should be paid. Check the gastric mucosa in the Tuen Mun area. Under normal circumstances, the patient's gastric mucosa is normal, there is no varicose vein on the mucosal surface, and only active bleeding points can be seen on the small curved side of the gastric cardia area. Careful observation shows that the gastric mucosa has a needle point. Superficial erosion or mucosal defect or rash-like bulge, sweaty oozing or jet-like bleeding on the surface, normal mucosa around the lesion; if bleeding stops, blood clots may adhere to the mucosal surface, rubbed with absorbent gelatin sponge In addition to blood clots, bleeding spots can be found; some lesions show that the central part of the superficial gastric mucosa has a small artery protruding from the stomach cavity and active bleeding; Film superficial localized foci of infection associated with active bleeding, can be considered as Dieulafoy disease, as long as the special position and fully understand the pathological features of Dieulafoy disease, intraoperative exploration to obtain a clear diagnosis.
Attention should be paid to the identification of Malloy-Weiss tear and hemorrhagic gastric vasodilation in the diagnosis of Diola Fuval disease.
