Acute perforation of gastric and duodenal ulcers
Introduction
Brief introduction of acute perforation of stomach and duodenal ulcer Stomach, duodenal ulcer acute perforation is a common serious complication of gastric and duodenal ulcer, and duodenal ulcer is more common. When acute perforation, a large amount of contents in the stomach and duodenum suddenly flow into In the abdominal cavity, chemical peritonitis is caused first. After a few hours, the bacteria in the gastrointestinal tract that has flowed into the abdominal cavity begin to grow, and bacterial peritonitis gradually forms. In severe cases, the bacteria may be complicated by shock. Most patients have a history of ulcers and ulcer symptoms worsen a few days ago. Most of the perforations occur suddenly after fasting or eating at night. The typical symptoms are sudden upper abdominal pain, which is cut into a knife and can be radiated to the shoulders and quickly spread to the whole abdomen. Patients often have pale, cold sweat, cold limbs, fine pulse and other shock symptoms, accompanied by nausea and vomiting. Abdominal pain can be aggravated by secondary bacterial peritonitis. basic knowledge The proportion of illness: 0.1% - 0.3% Susceptible people: no specific population Mode of infection: non-infectious Complications: peritonitis toxic shock syndrome
Cause
Causes of acute perforation of gastric and duodenal ulcer
Application of non-steroidal anti-inflammatory drugs (20%):
Non-steroidal anti-inflammatory drugs are closely related to the perforation of GU and DU. Observations of patients treated with these drugs showed that non-steroidal anti-inflammatory drugs were a major contributor to DU perforation.
Overeating (20%):
Overeating can cause an increase in gastric acid and pepsin, and it is easy to induce gastric perforation. Perforation occurs seasonally, with perforations occurring most in winter. Ulcer patients can't eat fast, they should chew slowly, and they should not be hungry.
Tension and fatigue (20%):
Excessive tension or fatigue can increase the vagus nerve excitement and make the ulcers heavier and perforate.
Other factors (20%):
These include increased patient age, chronic obstructive pulmonary disease, trauma, extensive burns, and multiple organ failure.
Prevention
Prevention of acute perforation of stomach and duodenal ulcer
In order to prevent stomach and duodenal perforation, the following should be done:
1, life should be regular, pay attention to work and rest, keep a good mood, avoid overwork, mental stress, keep warm during the season change, quit smoking and alcohol, eat less or not eat irritating food.
2, try not to use or use drugs that are irritating to the gastric mucosa, such as hypertensive patients should try to avoid using blood and equal blood pressure drugs, such as arthritis and other diseases must take hormones or indomethacin and other non-steroidal anti-inflammatory drugs Should take gastric mucosal protective agents or drugs that inhibit gastric acid secretion (H2 receptor blockers, proton pump inhibitors, etc.), such as Thai stomach, it belongs to H2 receptor blocker, is a more common inhibition An acid agent that moderately inhibits gastric acid secretion with less side effects.
3, once the patient has upper abdominal pain, abdominal distension, nausea and other symptoms of dyspepsia, should go to the hospital in time, and carry out some necessary examinations, once you find peptic ulcer, you should follow the doctor's advice for regular treatment and regular review until the ulcer is fully healed until.
Complication
Complications of acute perforation of gastric and duodenal ulcer Complications peritonitis toxic shock syndrome
It is easy to be complicated by chemical peritonitis, bacterial peritonitis, and even toxic shock.
1. Peritonitis is inflammation of the peritoneal and visceral peritoneum of the abdominal wall. It can be caused by bacteria, chemical and physical damage. According to the pathogenesis, it can be divided into primary peritonitis and secondary peritonitis. Acute suppurative peritonitis involving the entire abdominal cavity is called acute diffuse peritonitis.
2, toxic shock is a syndrome caused by staphylococcal exotoxin, characterized by high fever, vomiting, diarrhea, confusion and rash, can quickly progress to severe and refractory shock. Mainly occurs in women who use vaginal tampon. The main symptoms are caused by toxins produced by S. aureus.
Symptom
Symptoms of acute perforation of stomach and duodenal ulcers Common symptoms Abdominal pain, severe pain, abdominal pain, shock, hunger, upper abdominal pain, nausea, bloating, blood pressure, pale face, cold sweat, high fever
1, symptoms
1 Most patients have a history of ulcer disease, and the symptoms of ulcer disease are aggravated in the near future;
2 The upper abdominal knife cuts the pain, gradually affects the whole abdomen, and sometimes the pain radiates to the shoulders and back;
More than 3 with nausea and vomiting.
2, signs
1 full abdominal tenderness, muscle tension, especially in the right upper abdomen;
2 liver dullness circles shrink or disappear;
3 The bowel sounds weaken or disappear.
3. Auxiliary inspection
1X line and abdominal fluoroscopy see free gas under the armpit;
2 The abdominal pelvic puncture obtained a yellow turbid liquid, and the litmus paper showed an acidic reaction.
Most patients have a history of stomach and duodenal ulcers. Suddenly there is persistent severe pain in the upper abdomen. They do not dare to move their position due to abdominal pain. They may also be accompanied by nausea, vomiting, abdominal muscle tension, and can be stiff. There is obvious tenderness and rebound tenderness. The body temperature of the early patients is not elevated. Due to the strong chemical stimulation of the stomach and duodenal juice after perforation, the patient may have pale complexion, cold sweat, cold limbs, rapid pulse, blood pressure. Symptoms such as decline, late infection due to intestinal bacteria entering the abdominal cavity, patients with high fever, intestinal paralysis, abdominal distension and other symptoms, due to gastrointestinal gas into the abdominal cavity, X-ray examination showed that there is free gas under the armpit.
Examine
Examination of acute perforation of stomach and duodenal ulcer
1, total abdominal tenderness, muscle tension, especially in the right upper abdomen, liver dullness shrinks or disappears, bowel sounds weaken or disappear.
2, X-ray film and abdominal fluoroscopy see the free gas under the armpit, the belly wears a yellow turbid liquid.
3, blood routine examination
(1) White blood cell count: The white blood cell count is mostly at (15-20)×109/L, mainly due to neutrophil enlargement.
(2) Hemoglobin and red blood cells: often due to dehydration, blood concentration and increase.
4, serum amylase
It can be moderately elevated, but the serum amylase creatinine clearance ratio (CAM/CCr) is within the normal range.
Diagnosis
Diagnosis and diagnosis of acute perforation of gastric and duodenal ulcer
diagnosis
According to the history, symptoms and auxiliary examination results can be diagnosed.
Differential diagnosis
Should pay attention to the identification of acute appendicitis, acute pancreatitis, gastric cancer perforation and other diseases.
1, acute appendicitis is a common surgical disease, ranking first in various acute abdomen. Metastatic right lower abdominal pain and appendical tenderness and rebound tenderness are common clinical manifestations, but the condition of acute appendicitis is highly variable.
2, acute pancreatitis (AP) is a common acute abdomen, the incidence of which accounts for the third to fifth place of acute abdomen. More than 80% of the patients have milder conditions, that is, acute edematous pancreatitis, which can be cured by non-surgery, which is basically a medical disease. About 10% of patients belong to severe pancreatitis, that is, acute hemorrhagic necrotizing pancreatitis. The inflammation of the pancreas is irreversible or self-limiting. It is often treated with surgery and should be regarded as a surgical disease.
3, gastric cancer can occur in any part of the stomach, but more common in the antrum of the stomach, especially the small curved side of the stomach, according to the depth of invasion of cancer tissue is divided into early gastric cancer and advanced gastric cancer (medium and advanced gastric cancer). Early symptoms of gastric cancer are often not obvious, such as unpredictable upper abdominal discomfort, dull pain, belching, pantothenic acid, loss of appetite, mild anemia, etc., some resemble gastroduodenal ulcer or chronic gastritis, some patients take painkillers, anti-ulcer Pain or relief after drug or diet adjustment is often overlooked without further examination. As the disease progresses, the symptoms of the stomach gradually turn, and there is pain in the upper abdomen, loss of appetite, weight loss, weight loss and anemia. In the later stage, there are often cancer metastasis, abdominal mass, enlarged lymph nodes on the left supraclavicular bone, melena, ascites and severe malnutrition.
