acute simple gastritis
Introduction
Introduction to acute simple gastritis Acute gastritis (acutegastritis) refers to acute extensive or localized acute inflammation of the gastric mucosa caused by various extrinsic and intrinsic factors. If combined with intestinal inflammation, it is called acute gastroenteritis. The clinical manifestations of acute gastritis vary from disease to cause, and their causes are diverse, including acute stress, drugs, ischemia, bile reflux, and infection. At present, acute gastritis is divided into acute simple gastritis, acute erosive gastritis, acute suppurative gastritis, acute corrosive gastritis. The former two are more common, acute simple gastritis (acutesimplegastritis) is a common clinical frequently-occurring disease. Generally, it can be cured in the short term, and a few can have sequelae. basic knowledge The proportion of illness: 0.3%-0.5% Susceptible people: no specific population Mode of infection: non-infectious Complications: shock peritonitis
Cause
Cause of acute simple gastritis
Causes
Chemical factors (25%):
Aspirin and other drugs interfere with the synthesis of threose protein in gastric mucosal epithelial cells, which reduces gastric mucus and weakens the protective effect of lipoprotein membrane, resulting in gastric mucosal congestion, edema, erosion and hemorrhage. Prostaglandin synthesis is inhibited, and gastric mucosa is repaired. Also affected.
Biological factors (25%):
Bacteria and their toxins. Common pathogens are Salmonella, halophilic bacteria, pathogenic Escherichia coli, etc. Common toxins are Staphylococcus aureus or toxin bacilli, especially in the former. Gastroenteritis or a combination of enteritis and acute gastroenteritis can occur after eating food contaminated with bacteria or toxins for several hours. Staphylococcus and its toxins can also be combined with enteritis, and the onset is faster. In recent years, the number of patients with this disease has increased due to viral infection.
Physical factors (20%):
Too cold, overheated foods and beverages, strong tea, coffee, spirits, irritating condiments, and too rough food can stimulate the gastric mucosa and destroy the mucosal barrier.
Mental and neurological factors (15%):
Mental and neurological disorders, critical conditions of acute and severe illness, and abnormal (allergic) reactions in the body can cause acute inflammatory damage to the gastric mucosa.
Exogenous stimulation (10%):
Foreign body gas or stomach stone, stomach area radiation therapy can be used as an exogenous stimulus, leading to this disease.
Pathogenesis
Chemical substances, such as non-steroidal anti-inflammatory drugs such as aspirin, inhibit oxidative phosphorylation in the mitochondria of cells, thereby inhibiting Na-K-ATPase and active transport systems on the cell membrane, resulting in increased permeability of the mucosa, intracellular water and sodium. Detention, cell swelling and shedding; can also block the synthesis of endogenous prostaglandins E2 and I2 by inhibiting epoxidase, the secretion of sodium bicarbonate and mucus secreted by the epithelium is reduced, H is dispersed, thereby destroying the gastric mucosal barrier, Rehmannia, reserpine and certain anticancer drugs can stimulate the gastric mucosa and damage the gastric mucosal barrier.
Gastric mucosa congestion, edema, increased mucus secretion, surface covered with white or yellow secretions, common spotted hemorrhage and/or mild erosion on mucosal folds, microscopic surface epithelial cell shedding, necrotic vascular damage caused by hemorrhage and plasma Extravasation, with a large amount of neutrophil infiltration.
Prevention
Acute simple gastritis prevention
If acute gastritis is not treated in time, or if the treatment is not thorough, it will be easily converted into chronic gastritis. Eating too fast on weekdays, food chewing is not enough, often eating cold or overheated food, long-term consumption of irritating condiments, excessive drinking, Chronic gastritis can occur, resulting in indigestion, loss of appetite, abdominal pain after a meal, nausea and even vomiting.
To prevent the occurrence of gastritis:
First, pay attention to food hygiene, especially in the summer and autumn seasons, do not eat unclean food.
Second, on weekdays, avoid eating foods that are too irritating to the stomach, eat more easily digestible foods, and chew them thoroughly.
Third, smoking, alcohol, especially those who have stomach problems, should stop smoking and drinking.
Complication
Complications of acute simple gastritis Complications, shock peritonitis
The disease is a limited pathological process, the course of disease is short, and the disease can be self-healed after removing the pathogenic factors, so the general prognosis is good except for hemorrhagic shock and peritonitis which may occur in a large amount of hemorrhage.
Symptom
Acute simple gastritis symptoms common symptoms diarrhea bile reflux upper abdominal discomfort nausea appetite reduction retirement gram blood in the stool indigestion lower abdominal cramps bowel
Clinically, acute simple gastritis caused by infection or eating food contaminated with bacterial toxins is common. Generally, the onset is more urgent. After eating contaminated food for several hours to 24 hours, the symptoms are different. Upper abdominal discomfort, pain, and even severe abdominal cramps, anorexia, nausea, vomiting, diarrhea often accompanied by enteritis, stool water, severe cases may have fever, hematemesis and / or blood in the stool, dehydration, shock and Symptoms such as acidosis, acute simple gastritis caused by alcohol, irritating foods and drugs are manifested as upper abdominal discomfort, pain, loss of appetite, nausea, vomiting and other symptoms of dyspepsia, symptoms vary, with enteritis There are fever, middle and lower abdominal cramps, diarrhea and other symptoms, physical examination has upper abdominal or umbilical tenderness, bowel sounds hyperthyroidism.
Examine
Examination of acute simple gastritis
Infected factors caused by peripheral white blood cell counts generally increased slightly, the proportion of neutrophils increased; with intestinal inflammation, stool examination showed a small amount of mucus and red, white blood cells, stool culture can detect pathogens.
Endoscopy showed visible hyperemia of the gastric mucosa, edema, sometimes see erosion and bleeding points, the mucosal surface covered with thick inflammatory exudate and mucus, but endoscopy did not have to be routinely examined.
Diagnosis
Diagnosis and diagnosis of acute simple gastritis
diagnosis
1. Clinical manifestations.
2. Laboratory examination.
3. Endoscopy.
Differential diagnosis
According to the history and symptoms, the signs can generally be diagnosed, but if accompanied by upper gastrointestinal bleeding, especially for alcohol or salicylate preparations, the possibility of acute erosive gastritis should be considered. The above symptoms should be considered as the main symptoms. It is differentiated from acute pancreatitis, cholecystitis, cholelithiasis and other diseases.
1, acute cholecystitis: the disease is characterized by persistent upper or upper abdominal pain or colic, paroxysmal aggravation, can be radiated to the right shoulder, Murphy (Murphy) positive, abdominal B-ultrasound, CT or MRI and other images The examination can establish a diagnosis.
2, acute pancreatitis: often history of overeating or biliary calculi, sudden upper abdominal pain, severe knife-like pain, with persistent bloating and nausea, vomiting; blood urease amylase increased in early, severe The amylase content in the ascites of patients is significantly increased. B-ultrasound, CT and other auxiliary examinations can be found that diffuse or localized enlargement of the pancreas is conducive to diagnosis.
3, hollow organ perforation: patients with more rapid onset, manifested as severe abdominal pain, physical examination has tenderness and rebound tenderness, abdominal muscle tension is plate-like, percussion liver dullness circle shrinks or disappears, X-ray or plain film The free gas under the armpit can be seen.
4, intestinal obstruction: intestinal obstruction showed persistent abdominal pain, paroxysmal aggravation, accompanied by severe vomiting, anal stop defecation and excretion, early abdominal auscultation can smell sorghum bowel sounds or gas over water, late bowel sounds weakened or Disappeared, the abdominal X-ray film can be seen in the inflatable bowel and multiple liquid levels.
5, acute corrosive stomach : have a strong acid (sulphuric acid, hydrochloric acid, nitric acid), strong alkali (sodium hydroxide, potassium hydroxide) or come to Sur, and other history, after the service caused by digestive tract burns, the mouth, throat, sternum And severe pain in the upper abdomen, accompanied by swallowing pain, difficulty in swallowing, frequent nausea, vomiting, severe vomiting of blood, vomiting of mucous membranes with blood, prolapse, shock or symptoms of esophagus, gastric perforation, mouth, throat Inflammation at the site of contact, congestion, edema, erosion, necrotic mucosal exfoliation, ulceration or visible black, white sputum.
6, acute appendicitis: the early stage of the disease may have upper abdominal pain, nausea, vomiting, but as the disease progresses, the pain gradually turns to the right lower abdomen, and there is fixed tenderness and rebound tenderness, more with fever, white blood cells, neutral White blood cells are significantly increased.
7, other lobar pneumonia: myocardial infarction and other early stages of the disease may have varying degrees of abdominal pain, nausea, vomiting, such as detailed history, physical examination and necessary auxiliary examination, it is not difficult to identify.
