pregnancy with peptic ulcer
Introduction
Introduction to pregnancy with peptic ulcer Peptic ulcer disease during pregnancy mainly refers to chronic ulcers of the stomach and duodenum, namely gastric ulcer and duodenal ulcer, referred to as ulcer disease. Clinically, young women with duodenal ulcers are more common, and the incidence of digestive ulcers during pregnancy is lower, but the exact incidence is not clear. basic knowledge Probability ratio: 0.5% incidence in a specific population Susceptible population: pregnant women Mode of infection: non-infectious Complications: upper gastrointestinal bleeding pyloric obstruction
Cause
Pregnancy with peptic ulcer
Causes:
Peptic ulcer is a disease caused by a variety of causes. It is generally believed that invasive factors that may damage the stomach and duodenal mucosa and the defense of the mucosa itself may be caused by long-term pathogenic factors in patients with gastric ulcer. Loss of balance leads to chronic gastritis, which delays gastric emptying and impairs the integrity of the gastric mucosal defense barrier. Studies over the past decade have shown that Helicobacter pylori (Hp) infection is the main cause of peptic ulcer, and Hp infection has changed. The balance between mucosal invasion factors and defensive factors induces local inflammation and immune response, impairs this balance mechanism, increases the secretion of pepsin and gastric acid, and enhances the invasive factors. Mucosal damage and ulcer formation, in addition to increased gastric acid secretion, increased pepsin activity, drug effects, acute stress and long-term mental stress anxiety, mood swings and improper diet are related to the pathogenesis of ulcer disease, which is an invasive factor of ulcer disease.
Pathogenesis:
Gastric and duodenal ulcers active during pregnancy are relatively rare, especially complications such as bleeding and perforation are rare. Clinical studies have found that most of the typical symptoms of peptic ulcer symptoms have improved or even disappeared after pregnancy; However, in the 3 months after delivery, half of the symptoms of recurrence of ulcers occurred. Almost all women had recurrence of ulcer disease 2 years after birth. Glar et al reported more than 300 cases of pregnancy after ulcer symptoms, and 88% of ulcer symptoms completely disappeared or significantly reduced. Not entirely clear, it may be related to the following enhancements:
1 During pregnancy, the secretion of gastric acid and pepsin is reduced due to the effects of hormones in the body.
2 during pregnancy, estrogen, progesterone increased, the former has a cytoprotective effect, the latter can delay the discharge of acidic gastric contents into the duodenum, reducing the damage of gastric acid on the duodenal mucosa.
3 Increased histamine in pregnancy, inactivate histamine and reduce gastric acid secretion.
4 prostaglandins have cytoprotective effects during pregnancy.
5 pregnant women generally work easily during pregnancy, feel comfortable, improve diet and quit smoking and alcohol, reducing the pathogenic factors associated with the onset of ulcer disease.
Prevention
Pregnancy with peptic ulcer prevention
Avoid fatigue and mental stimulation, and keep warm. During the onset of ulcer disease, you should pay attention to rest, and you should stay in bed when the pain is severe and the bleeding is combined. Because the onset of this disease has a lot to do with mental factors, long-term depression can cause damage to the gastric mucosa, so it is necessary to establish optimism and eliminate anxiety. Diet should be regular, eat less meals, eat four to six times a day, eat more liquid food, eat easily digestible and nutritious food, and ensure that you can eat enough vitamins and protein.
Complication
Pregnancy complicated with peptic ulcer complications Complications upper gastrointestinal bleeding pyloric obstruction
In the past decade or more, due to the continuous development of effective drugs for the treatment of peptic ulcer and the widespread development of anti-Hp treatment, the complications of peptic ulcer have been rare, especially in the pregnancy, because most patients have completely disappeared or significantly relieved the symptoms of ulcer disease. Clinically, ulcer bleeding occurs during pregnancy, and complications of perforation and pyloric obstruction are more rare. However, in the third trimester and puerperium, the symptoms of the patient may be aggravated due to changes in hormone levels in the body, and factors such as excessive fatigue, mental factors, and improper diet may occur. Complications can occur underneath.
Upper gastrointestinal bleeding
It is the most common complication of peptic ulcer disease, and its incidence rate is about 15% of patients with ulcer disease. It is more common with duodenal ulcer and blood. The amount of bleeding is related to the size of the eroded blood vessel. (Bleeding 50 ~ 100ml, you can appear black stool), severe cases of hematemesis, 1 more bleeding can have shock symptoms, abdominal signs are not typical, may have mild abdominal distension, upper abdominal ulcer bleeding site has mild tenderness, bowel If the blood is more than 30% of the total blood volume within 12 hours, it can endanger the life of the pregnant woman and the fetus.
2. Ulcer perforation
The incidence rate is about 7% of ulcer disease, which can be divided into acute and chronic. When the perforation occurs, the patient has severe scalp under the scalp, and spreads rapidly to the whole abdomen, causing chemical peritonitis. The fluid flows down the right side of the uterus to the right lower abdomen and can cause pain in the right lower quadrant. It is often accompanied by nausea and vomiting. It may appear pale, cold sweat, cold limbs, rapid pulse and other shock symptoms. Mild pain, rebound tenderness, muscle tension and other symptoms of peritoneal inflammation, bowel sounds weakened, disappeared, such as delayed treatment can occur septic shock symptoms, in pregnant women standing or semi-recumbent, percussion liver dullness circle shrink or disappear, X-ray Or B-ultrasound see the free gas under the armpit, white blood cells and neutrophils increased, it should be emphasized that the clinical symptoms of digestive ulcers and perforators during pregnancy are often atypical, the peritoneal irritation is not obvious, and the mortality rate of patients is also Higher, the literature reported a group of 13 cases of pregnancy with gastrointestinal ulcer perforation, only 3 cases were diagnosed before death, should be emphasized.
3. Pyloric obstruction
Inflammatory hyperemia around the ulcer, edema or reflex caused by pyloric spasm, the main symptoms are abdominal pain and vomiting, the number of vomiting is not much, often 1 to 2 days, once a large amount of vomit, vomit contains more than 12h Digested food residue is acid odor, abdominal pain accompanied by obstructive symptoms, upper abdominal distension and paroxysmal gastric contraction pain, patients with loss of appetite, weight loss, chronic anemia, examination of upper abdominal bulging, early stomach examination According to the history of ulcer and vomiting characteristics, pyloric obstruction can be diagnosed. The amount of liquid residue in the fasting stomach tube can be diagnosed by pumping food residue>200ml.
Symptom
Pregnancy with peptic ulcer symptoms Common symptoms bowel nausea and peritoneal irritation sign abdominal pain bloating peptic ulcer hernia dull pain congestion
Symptom
(1) Upper abdominal pain: more than 90% of peptic ulcers have chronic upper abdominal pain, early pregnancy, mid-term due to decreased gastric acid secretion, weakened gastric motility, gastric mucosal congestion and other factors, most peptic ulcer symptoms can be alleviated, late pregnancy During childbirth and puerperium, due to the enhancement of adrenal cortex function, the formation and secretion of milk, the secretion of gastric juice increases or decreases, the content of hydrochloric acid and protease in gastric juice increases, about 12% of patients with gastric ulcer become worse, and even ulcer bleeding occurs. Or perforation, the pain has obvious rhythm, a periodic episode, the same as non-pregnancy, the pain is mostly burning or dull pain.
(2) Hernia, acid reflux, nausea, vomiting, and early pregnancy can be confused with pregnancy reactions.
2. Signs
Most patients have localized tenderness in the upper abdomen, and there may be corresponding signs when complications occur. However, the peritoneal irritation sign may not be obvious when perforating. Only mild abdominal distension is shown. The upper abdomen is equivalent to abdominal tenderness and bowel sounds. Advance, should attract attention.
Examine
Pregnancy with peptic ulcer examination
Patients with gastrointestinal bleeding may have anemia, fecal occult blood positive; non-invasive laboratory tests 13C-14C-urea breath test and Hp serological test can assist in diagnosis.
X-ray barium meal or upper gastrointestinal endoscopy has a diagnostic value for pregnancy with digestive ulcers, but the former has adverse effects on pregnant women and fetuses, and should not be used routinely. If the clinical symptoms are not typical or combined with upper gastrointestinal bleeding, you can use it first. After sedative or pharyngeal mucosal anesthesia, a clear diagnosis of gastric fibrosis can be used to relieve the pain of pregnant women. Combined with perforation, B-ultrasound can show the intra-abdominal gas and liquid echo, which is an indirect sign for diagnosing gastrointestinal perforation. Or particularly serious, the use of pediatric curved endoscopy for safe and confirmable diagnosis when antacids are ineffective or complicated with upper gastrointestinal bleeding.
Diagnosis
Diagnosis and differential diagnosis of pregnancy complicated with peptic ulcer
diagnosis
According to the patient's chronic course, periodic episodes, alternating episodes of abdominal pain, nighttime pain, and alleviation of available food or antacids, some patients may not only be diagnosed. The upper abdomen is painful and uncomfortable. The clinical diagnosis of pregnant women must first be differentiated from the symptoms of ulcer disease or normal pregnancy reaction or reflux esophageal symptoms.
Differential diagnosis
Surgical acute abdomen to be identified, such as: acute appendicitis, cholecystitis, cholelithiasis, pancreatitis, mesenteric thrombosis, etc. Generally speaking, the site of the pain or the most prominent site is often consistent with the site of the lesion, such as acute abdominal pain A little bit of the beginning and then spread to the whole abdomen is a substantial organ rupture or perforation of the hollow organs, biliary tract disease or pancreatitis often have radiation pain or pain, patients with ulcer bleeding, the symptoms of ulcers often relapse or aggravate before perforation, There are also induced factors such as emotional excitement, excessive fatigue, and overeating.
