stomach problems
Introduction
Introduction to stomach disease The so-called stomach disease is actually a general term for many diseases. They have similar symptoms, such as abdominal and abdominal discomfort, pain, fullness after meals, heating, acid reflux, and even nausea, vomiting, etc., clinically common stomach diseases include acute gastritis, chronic gastritis, gastric ulcer, twelve Finger ulcers, gastroduodenal complex ulcers, gastric polyps, stomach stones, benign and malignant tumors of the stomach, as well as gastric mucosal prolapse, acute gastric dilatation, pyloric obstruction and so on. Medication: Remove the cause, rest in bed, stop all diets and drugs that are irritating to the stomach. Short-term fasting, as appropriate, and then give a digestible, light, slag-free liquid diet that facilitates rest and healing of the stomach. basic knowledge The proportion of sickness: 0.2% Susceptible people: no specific population Mode of infection: non-infectious Complications: gastric ulcer acute gastritis chronic gastritis duodenal ulcer gastric and duodenal ulcer bleeding gastric polyps gastric mucosal prolapse acute gastric dilatation pyloric obstruction acute diffuse peritonitis gastric cancer
Cause
Cause of stomach disease
The cause of stomach disease
Lifestyle (30%):
Long-term drinking of spirits, strong tea, espresso, eating spicy and rough food, too cold, overheated food and drinks, smoking and other unreasonable living habits. Too rough food can stimulate the gastric mucosa and destroy the mucosal barrier.
Drug impact (20%):
Regularly take drugs that are harmful and irritating to the gastric mucosa, such as aspirin, indomethacin, glucocorticoids, anti-tumor drugs, etc. Aspirin and other drugs interfere with the synthesis of threose protein in gastric mucosal epithelial cells, which reduces gastric mucus and weakens the protective effect of lipoprotein membrane, resulting in gastric mucosal congestion, edema, erosion and hemorrhage. Prostaglandin synthesis is inhibited, and gastric mucosa is repaired. Also affected.
Chronic disease (20%):
Some chronic diseases, such as chronic nephritis, uremia, severe diabetes, etc.
Helicobacter pylori infection (10%):
Helicobacter pylori is a helical, gram-negative, microaerophilic bacterium. Almost half of the population is infected for life, and the infection is mainly in the stomach and the duodenal bulb.
Prevention
Stomach disease prevention
1. Stay away from chemical stimuli
Such as oral administration of certain drugs such as salicylates, reserpine and adrenocortical hormones, a large number of drinking spirits, strong tea, coffee, etc., can stimulate the gastric mucosa, causing gastric mucosal congestion, edema, and even bleeding, erosion, And the occurrence of acute simple gastritis.
2, avoiding the factors of bacteria
The cause of acute gastritis is usually acute gastritis caused by unclean diet. Common bacterial infections are staphylococcal exotoxin, botulinum toxin, salmonella endotoxin and acidophilus. Helicobacter pylori also develops acute gastritis during acute infection, and if it fails to eliminate it may turn into chronic active gastritis. Influenza viruses, enteroviruses, etc. are common in viral infection factors.
3. Other factors:
Neurological dysfunction, stress state, allergic reactions caused by various factors and certain systemic diseases. Chronic pulmonary heart disease, respiratory failure, vitamin deficiency, intestinal malabsorption and advanced cancer can be used as endogenous stimulating factors, causing acute inflammation of the gastric mucosa.
Complication
Gastric complications Complications gastric ulcer acute gastritis chronic gastritis duodenal ulcer stomach, duodenal ulcer hemorrhoids gastric polyps gastric mucosal prolapse acute gastric dilatation pyloric obstruction acute diffuse peritonitis gastric cancer
1, gastric ulcer: chronic gastritis is easy to complicated with ulcer disease, ulcers are generally occurring in gastritis, the incidence of gastric ulcer is related to diet, occupation, smoking, genetic and other factors, and pyloric sphincter dysfunction or bile reflux, etc. It can cause increased gastric acid secretion and damage the gastric mucosal barrier, and further form ulcers on the basis of gastritis.
2, upper gastrointestinal bleeding: upper gastrointestinal bleeding is the most common complication of peptic ulcer, peptic ulcer is also the most common cause of upper gastrointestinal bleeding, ulcer treatment is not timely, or overeating, alcoholism, overwork and Unreasonable medication can cause bleeding.
3, acute perforation: acute perforation refers to the ulcer deep into the muscular layer and serosal layer and suddenly pierced the stomach wall, causing the stomach or duodenal fluid to flow into the abdominal cavity, resulting in diffuse peritonitis.
4, pyloric obstruction: duodenal or pyloric tube ulcer due to inflammation, edema, pyloric spasm, gastric mucosal sag or scar contraction caused by pyloric stenosis, food obstruction, known as pyloric obstruction.
5, bile reflux gastritis after gastrectomy: bile reflux gastritis after gastrectomy, refers to gastritis after gastrectomy, due to pyloric insufficiency and bile reflux.
6, cancer.
Symptom
Symptoms of stomach symptoms Common symptoms Acute stomach pain Stomach yin deficiency Stomach mucosa Congestion edema Abdominal discomfort Heart nest painful stomach rot diarrhea Appetite is not nausea Black stool
First, stomach, duodenal ulcer bleeding
1, a small amount of repeated bleeding, showing anemia, stool stable blood test positive.
2, a large amount of bleeding, hematemesis and black stools.
3, short-term bleeding volume> 400ml, there is a circulatory system compensation phenomenon, bleeding volume> 800ml, you can have shock.
Second, drug-induced stomach disease
The main condition for diagnosis is that during the course of medication, gastric symptoms appear and can be ruled out by other causes. Fiber gastroscopy shows extensive gastric congestion, multiple erosions, bleeding points, superficial ulcers, and sometimes activity in the stomach. The phenomenon of oozing, the lesions are mostly located in the corpus, a few involving the lower esophagus and duodenum, tissue biopsy of the lesion, often inflammatory cell infiltration, superficial mucosal necrosis, hemorrhage.
Third, antral vasodilation
The main clinical manifestations are long-term digestive tract recessive hemorrhage. The fecal occult blood test is persistently positive. The blood loss is as high as 100-200 ml per day, which may be accompanied by melena and hematemesis. The course of disease can last for several years to several decades. Due to long-term digestive tract blood loss, patients have severe iron deficiency anemia, hemoglobin is less than 70g / L is quite common. Most patients require repeated blood transfusions to improve severe anemia. Except for severe anemia, there were no abnormal findings in physical examination. Medical history, family history, physical examination, and laboratory tests also do not suggest evidence and manifestations of congenital vascular disease, such as hereditary telangiectasia. Some patients are associated with cirrhosis, chronic atrophic gastritis, systemic sclerosis and the like.
Fourth, portal hypertensive gastropathy
PHG is mostly mild and has no specific clinical symptoms and is often found during gastroscopy. Light PHG can evolve into a heavy-duty PHG over time. The clinical manifestations of severe PHG are mainly upper gastrointestinal bleeding. Most of them are a small amount of hematemesis, melena, may be associated with anemia, a small number of upper gastrointestinal bleeding, can cause hemorrhagic shock, and can induce hepatic encephalopathy, infection, liver and kidney syndrome and other complications. The rate of rebleeding after bleeding is high.
Five, esophageal varices and rupture of bleeding
1, the primary disease manifestations: 90% of portal hypertension is caused by cirrhosis, and patients with cirrhosis often fatigue, fatigue, loss of appetite, weight loss, 10% to 20% of patients have diarrhea. Visible skin dull or even dark or mild jaundice, subcutaneous or mucosal bleeding points, spider mites, liver palm, splenomegaly and endocrine disorders, such as sexual dysfunction, irregular menstruation (menopause or excessive) and male breast development.
2, portal hypertension manifestations: ascites and edema, abdominal varicose veins and varicose veins and splenomegaly.
3, bleeding and its secondary effects: cirrhosis, gingival, subcutaneous and mucosal bleeding are common symptoms.
Six, gastric ulcer perforation
The typical symptom of DU perforation is sudden onset of severe abdominal pain, which is cut into a knife and can be radiated to the shoulders and spread to the entire abdomen. Sometimes the digestive juice can flow down the right colon to the right lower abdomen, causing a pain in the lower right abdomen. Patients often have pale, cold sweat, cold limbs, fine pulse and other shock symptoms, accompanied by nausea and vomiting. The patient often remembers exactly the exact time of the sudden pain. After 2 to 6 hours, a large amount of exudate in the abdominal cavity dilutes the digestive juice, and the abdominal pain can be slightly relieved. Further, the symptoms gradually worsen due to the development of the bacterial peritonitis period.
Seven, portal vein sponge-like changes
In patients without primary portal hypertension, patients with primary CTPV may have no discomfort, and patients with secondary CTPV are mainly manifested by primary disease. After the formation of portal hypertension, mainly manifested as portal hypertension and secondary esophageal varices and/or portal hypertensive gastropathy, patients can repeatedly hematemesis and tar, accompanied by mild to moderate splenomegaly, The spleen is hyperactive, so the liver function of the patients is good, so ascites, jaundice and hepatic encephalopathy rarely occur. Occasionally, the cavernous degeneration of the collateral vessels can compress the common bile duct and cause obstructive jaundice.
Eight, portal hypertension
1. Opening of the collateral circulation: The opening of the collateral circulation is a unique manifestation of portal hypertension and an important basis for the diagnosis of portal hypertension. The main part of the collateral circulation is: 1 adjacent to the esophagus, causing esophageal varices. 2 periorbital veins, causing aortic varices. 3 Circumferential veins around the humeral ligament, umbilical or abdominal varicose veins. 4 retroperitoneal space vein. Varicose veins in different parts have different meanings. For example, esophageal varices has a diagnostic value for portal hypertension, and abdominal varicose veins, varicose veins, and retroperitoneal varices should be noted for other factors.
2, spleen enlargement and hypersplenism: splenomegaly is a necessary condition for portal hypertension, the liver of patients with portal cirrhosis is more and more narrow.
3, ascites and liver disease signs: ascites is one of the clinical manifestations of many diseases, but mainly caused by various liver diseases caused by portal hypertension (about 80%). Through the performance of the primary disease and laboratory tests, cirrhosis ascites can often be distinguished from other systemic diseases. Patients with advanced cirrhosis often have ascites and liver disease face, liver palm, spider mites, jaundice and other signs, liver sputum and nodules, late liver can be reduced.
Examine
Stomach check
1, commonly used laboratory tests include: blood, urine, feces three routine, as well as fecal occult blood test, parasites, microbiological examination, urinary bilirubin, urinary biliary examination, serum bilirubin, autoantigen or (and Antibodies, carcinoembryonic antigen, gastrin, secretin and the like.
2, morphological examination: X-ray barium meal examination, X-ray computed tomography (CT) and magnetic resonance imaging examination.
3, other: esophageal cavity measurement PH, pressure check, exfoliated cell examination and biopsy, endoscopy, ultrasound, radionuclide examination. Recently, genetic testing for stomach diseases has been carried out, especially in cancer, which can predict prognosis and observe efficacy.
Diagnosis
Diagnosis of gastric diseases
diagnosis
It can be diagnosed based on the patient's clinical symptoms and laboratory tests.
Differential diagnosis
People often refer to heart pain as stomach cramps. Most of the pain in this part comes from stomach and duodenal diseases. I don't know, except for the stomach and duodenum, gallbladder, pancreas, left lobe of the liver, common bile duct and heart. Organs are close to or close to the heart, and the appearance of these organs can also cause "stomach pain."
1. Cholelithiasis: The incidence of cholelithiasis is very high. Due to the stimulation of gallstones, gallbladder and bile ducts may have different degrees of inflammation. Patients often have irregular pain and discomfort in the heart socket (or right rib rib), sometimes There may be symptoms of stomach swelling, belching and other similar symptoms of stomach disease. The condition is often aggravated by improper diet or greasy food. Many patients have long been diagnosed by themselves or doctors misdiagnosed as stomach pain. Some cases are similar, such as a female patient. 50 years old, the heart has appeared irregular pain for 3 years, and there is suffocation, according to gastritis for several months, the effect is not obvious, a look at the B-ultrasound to know that she has to be gallstones with inflammation, simply not gastritis .
2, hepatobiliary malignant tumors: common hepatobiliary diseases, such as liver cancer (especially in the left lobe liver cancer), gallbladder cancer and total cholangiocarcinoma can be expressed as "stomach pain", and the upper abdomen is full, fatigue, Symptoms and signs such as anorexia and jaundice are easily misdiagnosed as stomach problems and lose early diagnosis and treatment opportunities.
3, pancreatic disease: patients with pancreatic head cancer or chronic pancreatitis also often have pain in the heart and nausea, vomiting and other symptoms, should be carefully examined to identify.
4, myocardial infarction: elderly patients with myocardial infarction may not have pre-chorionic colic, can only complain of "stomach pain" or heart discomfort, accompanied by nausea, vomiting, some patients will strongly require gastroscopy, if not identified Blind treatment according to stomach disease can easily lead to misdiagnosis or even accidents. It can be seen that many patients with "stomach pain" in the clinic are not necessarily stomach pains. The medical history should be carefully asked and combined with comprehensive physical and chemical examinations to find out the crux of the lesion.
