Cardiac mucosa tear syndrome
Introduction
Introduction to cardia mucosal tear syndrome Cardiacmucosallacerationsyndrome is a syndrome characterized by massive hematemesis, uncoordinated vomiting and longitudinal tearing of the esophagogastric junction. It was first reported by Mallory and Weiss in 1929, hence the name Mallory. -Weiss syndrome. In the past, this disease was considered to be rare, but the widespread use of fiber esophagoscopy made the diagnosis of this disease easier, and the reports of large groups of cases were increasing. The incidence of this disease in the literature accounted for 3% of cases of upper gastrointestinal bleeding. ~15%. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: blood in the stool
Cause
The cause of gastric mucosal tear syndrome
(1) Causes of the disease
Cardiac mucosal tear syndrome often occurs after severe vomiting. Alcohol abuse is a common cause. Many other diseases, such as ulcer disease, intestinal obstruction caused by digestive tract malignant tumor, uremia, atrophic gastritis, severe vomiting during pregnancy, childbirth, severe Exercise, migraine, forced bowel movements, etc. are also associated with Mallory-Weiss syndrome, especially with hiatal hernia, which is reported to be as high as 91% in cases reported by Sato et al. (1989), and it is believed that hiatus is occurring in Mallory- One of the susceptibility factors of Weiss syndrome, it has also been found that such patients often have coagulation disorders.
(two) pathogenesis
1. The mechanism of pathogenesis of gastric mucosal tear is not fully understood. It is generally believed that when vomiting, the contents of the stomach enter the esophageal sputum, and the diaphragm contraction causes the pressure in the distal esophagus to increase sharply and cause the mucosal tear of the cardia. Some people used cadaveric research. When the intragastric pressure continues to 150mmHg and the esophagus is blocked, it can cause tearing of the esophagogastric junction. It is found that the normal intragastric pressure of the healthy adult can reach 200mmHg, which many people think occurs. The mechanism of gastric mucosal tear syndrome is similar to spontaneous esophageal rupture. It can be a full-thickness of the esophagus and cause perforation of the esophagus. It can also be only a hematoma in the esophageal wall or only a mucosal tear.
2. Most of the pathological and staging tears are at the end of the esophagus or across the esophagogastric junction. Most of them are linear single tears, but there are also two or more tears. The tear is mostly in the interstitial fold of the mucosa. According to a group of 224 cases of Mallory-Weiss syndrome, 83% of the tears were located on the small curved side of the esophagogastric junction. Active hemorrhage was observed early, or there was blood clot or cellulose block coverage.
(1) Bleeding period: bleeding, within 24 hours after the illness.
(2) Open period: the wound is split and the edge is raised, 48h to 7 days.
(3) Linear phase: The crack is linear, close to closure, with white moss attached, lasting 1 to 2 weeks.
(4) Scar stage: white moss disappears and scar formation occurs for 2 to 3 weeks.
Prevention
Prevention of gastric mucosal tear syndrome
Avoid excessive drinking and try to relieve vomiting and coughing as soon as possible.
Complication
Complications of gastric mucosal tear syndrome Complications
The most common complication is bleeding (blood loss), if hematemesis or blood in the stool should be treated immediately.
Symptom
Symptoms of gastric mucosal tear syndrome Common symptoms Nausea left upper abdominal mass accompanied by... Upper gastrointestinal bleeding, abdominal pain, reversal arterial hemorrhage, shock, venous bleeding, varicose veins
1. Vomiting or nausea According to a large number of reports in the literature, almost all patients with Mallory-Weiss syndrome have vomiting or nausea onset, and some patients have vomiting, but the Mallory-Weiss syndrome can also occur, showing the severity of vomiting. It is not a causal relationship or a parallel relationship with the occurrence of this syndrome, but about 9% of patients are caused by nausea and causes other than vomiting. For example, patients who have undergone surgery for other diseases may also have a hiccup during anesthesia. The Mallory-Weiss syndrome occurred.
2. Hematemesis or hoarsemic hemorrhage or melena is the second important clinical symptom of patients with Mallory-Weiss syndrome. The interval between vomiting and hematemesis varies from patient to patient, and some patients may have hematemesis after vomiting. Some patients have hematemesis or melena after a few days of severe vomiting.
An important clue to the diagnosis of Mallory-Weiss syndrome is that patients often have a history of hematemesis or a large amount of melena after vomiting once or several times of normal stomach contents. However, some patients present with a large amount of hematemesis at one onset, and none Painful hematemesis, a large amount of bright red blood, if not treated in time, the patient died of hemorrhagic shock.
3. Upper abdominal pain Patients with Mallory-Weiss syndrome sometimes have upper abdominal pain, but in most cases there is no abdominal pain. Upper abdominal pain can occur soon after hematemesis. It can also appear before hematemesis. Some patients are sick. Before vomiting, there was tearing pain in the upper abdomen, which was persistent; some patients felt that the position of abdominal pain was deep. According to Freeark et al. (1964), this patient found extensive bleeding under the mucosa of the cardia during laparotomy. In cases of complete tearing of individual esophageal and gastric mucosa, upper abdominal pain is a prominent clinical symptom. Because of its severe abdominal pain, the upper gastrointestinal bleeding is easily overlooked, which is one of the causes of misdiagnosis.
4. A large number of hematemesis in shock patients can cause hemorrhagic shock and threaten their life safety. Most patients with Mallory-Weiss syndrome have mild to moderate bleeding, and only a small number of patients have major bleeding, slow and persistent hematemesis or intermittent hematemesis. It can also cause hemorrhagic shock in patients. Most patients with Mallory-Weiss syndrome have symptoms of upper gastrointestinal bleeding that can be stopped by themselves. No surgical treatment is required. Less than 10% of upper gastrointestinal active arterial bleeding or massive venous bleeding It is caused by long-term portal hypertension and rupture of esophageal varices. Pay attention to this situation when diagnosing Mallory-Weiss syndrome, and carefully diagnose it.
Among the 23 patients reported by Miller and Hirschowitz (1970), 1 patient with hematemesis was treated with conservative medical treatment, the patient died of cardiac arrest, and 6 of the surgically treated patients were all cured. Therefore, surgical treatment is needed. Patients with Mallory-Weiss syndrome cannot delay the timing of surgery.
Examine
Examination of gastric mucosal tear syndrome
1. Gastroscopic examination Mallory-Weiss lesions are mostly located in the esophagus-gastric junction, so the diagnostic value of gastroscopy is better than esophagoscopy.
Of the 23 Mallory-Weiss syndromes reported by Millet and Hirschowitz (1970), 19 were diagnosed by gastroscopy, 12 of which showed a longitudinal laceration of the gastroesophageal junction mucosa under endoscopy, accounting for 55%; Case (30%) showed no obvious damage to the esophagus and gastric mucosa under endoscopy, but bleeding was still seen from the esophagus-gastric junction; 3 cases were filled with blood in the stomach during gastroscopy, and the examination was not satisfactory and could not be made. Diagnosis; 1 case was not performed by gastroscopy, and the lower esophageal mucosa was torn and blood was found during surgical exploration. This shows 23 cases reported by Miller and Hirschowitz: 85% (19/23) of Mallory-Weiss syndrome are transgastroscopy The diagnosis is made after the examination. The diagnosis of this syndrome by gastroscopy has the diagnostic value that cannot be replaced by other examinations. As long as there is no contraindication, the gastroscopy should be done first.
2. Upper gastrointestinal barium meal angiography upper gastrointestinal barium meal examination for Mallory-Weiss syndrome can not show the esophageal cardia mucosal tearing lesions, its main role is to rule out upper gastrointestinal bleeding caused by other causes, but also Some authors report that when the mucosal tear of the esophageal cardia is severe, the contrast of the upper gastrointestinal sputum can show the lesion, which is characterized by the filling of the mucosa at the mucosal tear.
3. Selective celiac angiography According to reports in the literature, some authors used selective celiac angiography to show the specific site of upper gastrointestinal bleeding, making the diagnosis of Mallory-Weiss syndrome.
A large number of clinical practice has shown that many patients with unexplained upper gastrointestinal hemorrhage were diagnosed as Mallory-Weiss syndrome when they were surgically inspected because of conservative medical treatment. According to some authors' retrospective analysis, some patients were considered to be Preoperatively, the clinical features of the typical Mallory-Weiss syndrome can be diagnosed as Mallory-Weiss syndrome, and the vast majority of these patients have undergone surgical exploration. The specific part of the bleeding is defined after the incision of the anterior wall of the stomach. .
Diagnosis
Diagnosis and differentiation of gastric mucosal tear syndrome
Alcoholism, pregnancy, peptic ulcer, cirrhosis, intestinal obstruction, stop taking antacids or food poisoning patients should consider the possibility of upper gastrointestinal bleeding after vomiting. Gastroscope should be performed within 24 hours after onset. See the gastroesophageal junction mucosa with longitudinal laceration, or no obvious esophageal and gastric mucosal damage, but bleeding from the esophagus-gastric junction can be diagnosed.
Because of the many causes of upper gastrointestinal bleeding, and such patients are often accompanied by superficial gastritis, hiatal hernia, duodenitis or other stomach, duodenal diseases, and therefore must be clearly identified.
