Postoperative reflux gastritis
Introduction
Introduction to reflux gastritis after surgery After the stomach surgery, the patient's upper abdomen burns like pain. The food with nausea and vomiting mixed with bile is called postoperative reflux gastritis. The patient often suffers from increased pain in the upper abdomen after the meal. The pain cannot be relieved after vomiting. The food intake is reduced, resulting in weight loss. And anemia. basic knowledge Sickness ratio: 0.001%-0.005% Susceptible people: no special people Mode of infection: non-infectious Complications: chronic laryngitis, chronic cough, pneumonia
Cause
Causes of reflux gastritis after surgery
(1) Causes of the disease
Reflux gastritis after surgery is caused by surgical injury. There is a layer of mucus on the surface of normal gastric mucosa, which has a shielding effect on hydrogen ions, so that gastric acid only stays in the stomach cavity. When the pyloric defense against bile reflux mechanism is abnormal, bile flows back into the stomach and even enters the esophagus, and the bile acid that flows into the stomach is destroyed. The mucus layer function on the surface of gastric mucosa, the mucus layer on the cell surface of gastric mucosa no longer has a functional barrier function of shielding hydrogen ions from reverse diffusion and sodium ion inflow. The result is: bile acid causes histamine release from gastric mucosa, gastric mucosa Increased permeability, hydrogen ions in the gastric mucosa, increased reverse diffusion of sodium ions, mucosal edema, mucosal acidosis, mucosal trophic ischemia, and reflux gastritis.
(two) pathogenesis
There is a layer of mucus on the surface of normal gastric mucosa, which has a shielding effect on hydrogen ions, so that gastric acid only stays in the stomach cavity. When the pyloric defense against bile reflux mechanism is abnormal, bile flows back into the stomach and even enters the esophagus, and the bile acid that flows into the stomach is destroyed. The mucus layer function on the surface of gastric mucosa, the mucus layer on the cell surface of gastric mucosa no longer has a functional barrier function of shielding hydrogen ions from reverse diffusion and sodium ion inflow. The result is: bile acid causes histamine release from gastric mucosa, gastric mucosa Increased permeability, hydrogen ions in the gastric mucosa, increased reverse diffusion of sodium ions, mucosal edema, mucosal acidosis, gastric mucosal nutrient ischemia, reflux gastritis, duodenal juice on the stomach Mucosal damage is stronger than simple bile. Phospholipase A in pancreatic juice hydrolyzes lecithin (lyciectin) in bile to produce lysed lecithin. Bile acid and trypsin activate this reaction, and lysolecithin is hydrolyzed by phospholipase to produce Glyceryl phosphoryl choline and fatty acids, this reaction is inhibited by bile acids, hemolytic egg phosphorus Lipid has high cytotoxicity and gastric mucosal barrier damage. In gastric juice, recurrent gastric ulcer, stress ulcer, stomach juice of patients after gastric resection, the concentration of lysolecithin is higher than that of normal gastric juice. It is 10 times higher, so lysolecithin may play an important role in the pathogenesis of reflux gastritis.
Prevention
Prevention of reflux gastritis after surgery
The use of Bi-type or Roux-y-type gastric resection for the prevention and treatment of bile reflux gastritis has a certain effect on reducing the occurrence of residual gastric cancer.
Complication
Complications of reflux gastritis after surgery Complications chronic laryngitis chronic cough pneumonia
1. Some patients may cause throat symptoms due to frequent reflux of stomach contents to the throat: chronic laryngitis, difficulty in pronunciation, sore throat, periodontitis, etc.
2. Reflux can cause many lung diseases: bronchitis, chronic cough, aspiration pneumonia, etc.
Symptom
Symptoms of reflux gastritis after surgery Common symptoms Heartburn, weight loss, abdominal pain, postprandial episodes of abdominal pain, vomiting, bile reflux
Two common symptoms of reflux gastritis: upper abdominal pain and bilious vomiting.
1.2 common clinical symptoms: upper abdominal pain and bilious vomiting.
2. Gastroscopic examination: Gastric mucosal pathological biopsy is the most important step in the diagnosis of reflux gastritis.
3. Gastric-esophageal scintigraphy.
Examine
Examination of reflux gastritis after surgery
Gastric-esophageal scintigraphy can detect reflux of radiolabeled meals with a sensitivity and specificity of approximately 90%.
1. Gastroscopic examination of gastric mucosal pathological biopsy is the most important diagnostic procedure for the diagnosis of reflux gastritis. The gastroscope of reflux gastritis shows red color of gastric or residual gastric mucosa, congestion and edema, weak tissue, easy bleeding, rapid superficial ulcer, gastroscope Under the submucosal vasospasm can be seen.
2. Specimen microscopic examination of parietal cells is rare, superficial ulcer formation, hemorrhage, mucosal atrophy, chronic inflammation with lymphocytic infiltration.
Diagnosis
Diagnosis and diagnosis of reflux gastritis after operation
It can be diagnosed according to symptoms and examinations.
Similar to chronic enterosis syndrome, it must be identified, but the two syndromes can coexist.
