acute erosive gastritis
Introduction
Introduction to acute erosive gastritis Acute erosive gastritis (acuteerosivegastritis) is an acute gastritis characterized by multiple erosion of gastric mucosa, also known as acute gastric mucosal lesions or acute erosive hemorrhagic gastritis. In recent years, there has been an upward trend, and this disease has become one of the important causes of upper gastrointestinal bleeding, accounting for about 20% of upper gastrointestinal bleeding. The clinical symptoms are mostly dull pain or severe pain in the upper abdomen, accompanied by nausea and other symptoms. A small number of patients with heavier primary symptoms, manifested as hematemesis and (or) tar-like stools, bleeding often intermittent, some patients with acute massive bleeding, heavier conditions, hemorrhagic shock may occur. basic knowledge The proportion of illness: 0.24% Susceptible people: no special people Mode of infection: non-infectious Complications: hemorrhagic shock ulcer bleeding
Cause
Causes of acute erosive gastritis
Exogenous stimulation (35%):
Various exogenous stimulating factors causing acute simple gastritis, especially ethanol and non-steroidal anti-inflammatory drugs can destroy the gastric mucosal barrier, causing H and pepsin to diffuse into the mucosa and cause acute erosion of gastric mucosa.
Other diseases (27%):
However, some serious diseases, such as severe trauma, extensive burns, sepsis, intracranial lesions, shock and severe organ failure, are more common causes.
Hormone effects (16%):
During stress, norepinephrine and adrenocortical hormone secretion increased, visceral vasoconstriction, gastric blood flow decreased, and reverse-dispersed H+ could not be eliminated; hypoxia and norepinephrine reduced prostaglandin synthesis, and mucus secretion was insufficient, HCO3- Secretion is also reduced; gastrointestinal motility is slow during stress, pyloric dysfunction, causing bile reflux, bile salts further damage the ischemic gastric mucosal epithelium, causing damage to the gastric mucosal barrier, eventually leading to mucosal erosion and bleeding, and more lesions Found in the stomach and stomach, sometimes involving the antrum, gastric mucosa is multiple erosion, with a little flaky hemorrhage, sometimes see shallow ulcers, covered with white moss or yellow moss, histological examination see erosion at the surface epithelial cells The lesions are detached, the glands are distorted by edema and bleeding, and the lamina propria has infiltration of neutrophils and monocytes.
Prevention
Acute erosive gastritis prevention
Acid generator
An antacid such as aluminum hydroxide, magnesium hydroxide or bismuth subcarbonate (barium carbonate) is administered through the nasogastric tube to maintain the gastric pH value above 3.5 per hour, which can effectively prevent gastric mucosal bleeding. Hastings randomized 100 critically ill patients to antacids and placebo, resulting in bleeding in 2 of 51 patients treated with antacids, compared with 12 of 49 controls.
2.H2 receptor antagonist
Intravenous administration of H2 receptor antagonists is as effective as antacids in the prevention of stress-induced acute gastric mucosal lesions. Dammann reported that ranitidine 50 mg/6 h and famotidine 20 mg/12 h are effective in maintaining intragastric pH. The value is above 4.
3. Sucralfate
Sucralfate has mucosal protective effect, can resist the damage of pepsin, and can promote the release of endogenous prostaglandins. It can be given 1g of sucralfate and taken orally once every 6 hours.
Complication
Acute erosive gastritis complications Complications Hemorrhagic shock ulcer disease bleeding
Some patients showed acute massive hemorrhage, and the condition was heavier. Although the hemoglobin content was still difficult to increase rapidly after a large amount of blood transfusion, a few patients with this disease due to burns had only a rapid pulse and blood pressure caused by hypovolemia.
Symptom
Acute erosive gastritis symptoms common symptoms severe pain nausea upper gastrointestinal bleeding gastrointestinal symptoms repeated hematemesis shock gastrointestinal cold
Before the onset, there were non-steroidal anti-inflammatory analgesics, alcoholism and burns, major surgery, craniocerebral trauma, and important organ failure. The clinical symptoms were mostly pain or severe pain in the upper abdomen, accompanied by nausea. Symptoms, caused by drugs, also known as drug-induced gastritis, a small number of patients due to the primary symptoms of heavier, so the gastrointestinal symptoms before bleeding, such as abdominal pain and discomfort, burning sensation is often ignored or no obvious symptoms, often The above gastrointestinal bleeding is the first symptom, which is characterized by hematemesis and/or tar-like stool. The bleeding is often intermittent. Some patients show acute massive hemorrhage. The condition is heavier and hemorrhagic shock may occur.
Examine
Examination of acute erosive gastritis
When the patient presented with vomiting and/or tar-like stools and some patients with acute massive hemorrhage, the total amount of hemoglobin decreased, and stool and vomit occult blood tests were positive.
X-ray inspection
Gastrointestinal barium meal examination often can not find erosive lesions, and is not suitable for patients with acute active bleeding, because tincture can be applied to the mucosal surface, so that no endoscopic or angiographic examination can be performed in the near future; in the acute hemorrhage of the superior mesenteric artery Superselective angiography can make a localized diagnosis of bleeding, which is often negative during intermittent bleeding.
2. Emergency endoscopy
Emergency endoscopy was performed within 24 to 48 hours after hemorrhage. Acute gastric mucosal lesions characterized by multiple erosions and hemorrhagic foci were found to have a diagnostic value.
Diagnosis
Diagnosis and diagnosis of acute erosive gastritis
Diagnostic criteria
1. Clinical manifestations.
2. X-ray inspection.
3. Emergency endoscopy.
Differential diagnosis
1. Peptic ulcer and bleeding:
Peptic ulcer can be the first symptom of upper gastrointestinal bleeding, need to be differentiated from acute erosive gastritis, emergency gastroscopy can be identified.
2. Cirrhosis of esophageal varices:
Patients with a history of hepatitis, and liver function decline and portal hypertension, such as hypoproteinemia, ascites, collateral circulation, etc., combined with X-ray barium meal and gastroscopy, can be differentiated from acute erosive gastritis.
3. Other:
Acute erosive gastritis should also be differentiated from other diseases that cause upper gastrointestinal bleeding, such as gastric cancer, esophageal mucosal tear, biliary tract disease, etc., through the clinical manifestations of these primary diseases and endoscopy, B-ultrasound, CT, MRI and other auxiliary examinations Generally identifiable.
