gastric diverticulum
Introduction
Introduction to stomach chamber Gastric diverticulum (gastricdiverticulum) refers to the localized bag-like dilatation or cystic protrusion of the stomach wall. The detection rate in barium meal imaging is 0.04%-0.1%, and the gastroscope detection rate is 0.03%-0.3%. Most of them are single shots. basic knowledge The proportion of illness: the incidence rate is about 0.004% - 0.008% Susceptible people: no special people Mode of infection: non-infectious Complications: upper gastrointestinal bleeding gastric perforation
Cause
Gastric diverticulum
Extragastric traction (20%):
Mostly located in the anterior pyloric area, due to increased pressure in the stomach, such as pyloric obstruction, the diverticulum is also called the internal pressure gastric diverticulum, such as due to adhesion around the stomach, also known as traction diverticulum, gastric fundus, gastric diverticulum Relatively rare, due to extragastric traction, the occurrence of gastric diverticulum has nothing to do with the diverticulum in other parts of the digestive tract.
Pathogenesis (30%):
The true diverticulum includes various layers of the stomach wall, namely the gastric mucosa layer, the muscular layer and the serosal layer. The shape is in the shape of a bag protruding from the stomach wall. The touch is soft, the diameter is 2 to 4 cm, and the diameter is 9 to 10 cm. The mucosa of the gastric diverticulum is normal. There may be congestion, erosion, bleeding, thickening of the diverticulum wall due to inflammation, or adhesion to surrounding tissues, perforation is rare, diverticulum can also occur mucosal necrosis and cancerous but rare, a few sputum indoor ectopic pancreatic tissue makes the mucosa irregular, It should be classified as a congenital diverticulum, which is more common in the small curvature of the stomach and the anterior pyloric region. The pseudo-dip chamber has only gastric mucosa and serosal layer. If the mucosal layer is embedded in the muscular layer and the surface of the gastric serosa is not abnormal, it is called the diverticulum in the stomach wall.
Ulcer, granuloma, tumor, surgery and other factors (25%):
Congenital gastric diverticulum is generally located within 2 to 3 cm below the small curved side of the esophagus and stomach junction near the posterior wall of the stomach. Most of them are true diverticulum, accounting for about 70% of the gastric diverticulum. Usually there is no ulcer, granuloma or tumor. The longitudinal muscles are weak and formed. The secondary gastric diverticulum has both true and false diverticulum, mostly caused by ulcers, granuloma, tumors, surgery and other factors.
Prevention
Gastric diverticulosis prevention
1, to maintain the law of life, regular diet, easy to digest, eat slowly, not easy to eat too much, avoid cold and irritating food. Develop good habits, eat regularly, quantitatively, chew slowly, avoid hunger and fullness, eat more easily digestible food, moderate exercise to increase gastrointestinal motility and promote digestion.
2, the use of ordinary drugs: such as gastric motility drugs, intestinal flora regulators, digestive drugs, regulation of gastric autonomic dysfunction drugs, etc., however, such drugs, there are great side effects, can not be used, should be in the doctor Under the guidance of the guidance, it is best to have an understanding of its side effects and contraindications.
Complication
Gastric diverticulum complications Complications upper gastrointestinal bleeding gastric perforation
Patients may have upper gastrointestinal bleeding or perforation when the diverticulum is combined with inflammation.
Symptom
Gastric diverticulum symptoms common symptoms pain, dull pain, nausea, difficulty swallowing
Most patients are asymptomatic. Only when they have a stomach barium meal examination or a gastroscope, some patients with gastric diverticulum can also have other gastrointestinal lesions at the same time. Therefore, the symptoms are not necessarily caused by the gastric diverticulum. It is characterized by dull pain, pain and burning sensation in the upper abdomen sword, or a paroxysmal aggravation, which may be accompanied by nausea, vomiting and even difficulty swallowing. It occurs in the dull pain within 1 to 2 hours after the sword, and the lying position is aggravated. The standing position or sitting position relieves the characteristics of the disease. The symptoms may be caused by the expansion of the food into the chamber. When a certain position is conducive to the emptying of the diverticulum, the pain may be relieved. Some people think that the symptoms are caused by food or The retention of gastric juice in the diverticulum cavity causes inflammation of the diverticulum. Therefore, the small diverticulum is prone to symptoms, and sometimes the symptoms are similar to ulcer disease or gallbladder disease.
Examine
Gastric diverticulum examination
Biopsy examination helps identify true, pseudo-diverticulum.
1. X-ray examination of the gastric cavity mainly relies on X-ray barium angiography examination, if the diverticulum is too small or not careful enough to check, it is easy to miss, take the supine right anterior oblique position for examination, the expectorant is easy to concentrate on the fundus, at the same time Avoid diverticulum shadow and fundus overlap, easy to find, the true diverticulum in the Tuen Mun area has characteristic X-ray barium angiography: the diverticulum is mostly cystic, 3 ~ 4cm in diameter, smooth edge, protruding outside the stomach, a narrow length The neck is connected to the stomach. When standing, the liquid surface can appear in the sputum. In most cases, mucosal folds can be seen from the stomach through the neck into the sputum. In some cases, there are other changes in the sputum that have ulcers or mucous membranes. The tincture is drained slowly. When the stomach is drained, the tincture remains in the chamber.
The fundus diverticulum is saclike, with a narrow neck and a gastric mucosa extending into the sacral cavity. It is easy to differentiate from small curved ulcers at the fundus, but there are often ectopic pancreatic tissues in the diverticulum or anterior pyloric region. Make the mucosa in the sputum irregular, easy to mistake the tumor, need to be diagnosed by gastroscopy.
2. Gastroscopic examination of gastroscope for the diagnosis of gastric diverticulum has a certain help, as seen by gastroscope, the entrance of the diverticulum is round, the edge rules are clear, the surrounding mucosa is completely normal without infiltration, and the mucosal folds can be seen directly into the capsule, and Regular contractions are seen at the mouth of the diverticulum. The size of the mouth can be changed. Sometimes the mouth is completely closed. The mucosa in the sputum is generally normal, sometimes with inflammation and ulceration.
Diagnosis
Gastric diverticulum diagnosis
The gastroenteritis was diagnosed by fiberoptic gastroscopy and X-ray barium meal. From the symptoms should be noted with the esophageal hiatus hernia, perforation ulcers, malignant lesions.
