anastomotic ulcer
Introduction
Introduction to anastomotic ulcer Anastomotic ulcer refers to ulceration in the anastomosis or a nearby mucosa after gastric jejunostomy, also known as recurrent peptic ulcer. Have a history of peptic ulcer gastrectomy. Perforation, obstruction, bleeding and other complications are prone to occur. basic knowledge The proportion of illness: 0.0065% Susceptible people: no specific population Mode of infection: non-infectious Complications: acute diffuse peritonitis
Cause
Cause of anastomotic ulcer
Have a history of peptic ulcer gastrectomy. In the stomach cavity, gastric acid and pepsin are important digestive substances in gastric juice.
Gastric acid is a strong acid substance and is highly aggressive; pepsin has the function of hydrolyzing proteins and can destroy proteins on the stomach wall. However, in the presence of these erosion factors, the gastrointestinal tract can still resist and maintain mucosal integrity. And its own function, mainly because the stomach, duodenal mucosa also has a series of defense and repair mechanisms. We call the harmful erosion of gastric acid and pepsin the damage mechanism, and the defense and repair mechanism of the gastrointestinal tract itself is called the protection mechanism.
It is currently believed that the protective mechanism of the gastric duodenal mucosa of normal people is sufficient to resist the erosion of gastric acid and pepsin. However, when certain factors impair a certain part of the protective mechanism, gastric acid and protease may erode the mucosa and cause ulcer formation. Excessive gastric acid secretion far exceeds the defense and repair of the mucosa and may also cause ulceration. Recent studies have shown that Helicobacter pylori and non-steroidal anti-inflammatory drugs are the most common cause of ulcer damage caused by gastrointestinal protective mechanisms, and gastric acid plays a key role in ulcer formation. In addition, drugs, stress, hormones can also lead to the emergence of ulcers, a variety of psychological factors and poor eating habits can induce the emergence of ulcers.
Prevention
Anastomotic ulcer prevention
This disease should pay attention to prevent stomach diseases, reasonable diet, moderate thickness, and appropriate physical exercise should be carried out to strengthen their own immunity.
Complication
Anastomotic ulcer complications Complications, acute diffuse peritonitis
Perforation, obstruction, bleeding and other complications are prone to occur.
1, bleeding
Bleeding is caused by the ulcer eroding to a certain extent and rupturing the blood vessels around the ulcer. The amount of bleeding and the degree of damage to the patient's life depends on the size of the damaged blood vessel. When the ulcer is damaged by the capillaries, it is generally less harmful to the patient and is not easy to be found. It is only in the case of fecal occult blood test. It is found; when the larger blood vessels are damaged, hematemesis or black stools may appear. In general, patients may experience aggravation of various gastrointestinal symptoms before hemorrhage, but when the bleeding stops, the upper abdominal pain may be reduced or even disappeared.
2. Perforation
The general ulcer injury is in the mucosal muscle layer of the gastrointestinal tract. When the ulcer continues to progress deep into the serosal layer of the gastrointestinal tract, only the outermost layer is similar to a thin piece of paper, and the acute gastrointestinal tract can occur at any time. After perforation, the contents of the gastrointestinal tract flow into the abdominal cavity after perforation, resulting in acute diffuse peritonitis. Sudden abdominal pain, nausea, vomiting, abdominal plate, obvious tenderness and rebound tenderness, liver dullness and bowel sounds disappeared, abdominal fluoroscopy sees free gas under the armpit, some patients are in shock state, in In this situation, the patient should be treated immediately by emergency surgery, otherwise life is at risk. Of course, with the current medical conditions and timely visits to patients, the incidence of perforation is not very high, clinically can be divided into acute, subacute and chronic three, only acute perforation requires surgery.
Symptom
Anastomotic ulcer symptoms Common symptoms Abdominal pain Abdominal tenderness Nausea abdominal muscles Peptic ulcer Anorexia weight loss
symptom:
There is a history of peptic ulcer gastrectomy. The symptoms are similar to those before peptic ulcer. The most common abdominal pain is episodes. The nighttime pain is significant. It is often radiated to it. The abdominal pain is longer and the remission period is longer. Shorter, eating or antacids can temporarily relieve, anorexia, nausea, vomiting and weight loss are more common, some patients can be complicated by perforation, obstruction and bleeding.
Physical examination found:
Abdominal tenderness is often consistent with abdominal pain. Abdominal muscles may sometimes have abdominal muscle tension. In elderly patients, the abdominal mass may touch the mass.
Examine
Anastomotic ulcer examination
Fecal occult blood: Sustainability is positive when ulcers are active.
Endoscopy: common ulcers are located in the small intestine of the anastomosis, most of which are single ulcers, with mucosal erosion and congestion, edema, biopsy can exclude malignant ulcers.
Gastric acid test: showed an increase in BAO, MAO was significantly elevated by pentagastrin gastrin or augmented histamine method, serum gastrin measurement could be increased, and anastomotic malformation, stenosis, sputum can be seen in about half of X-ray barium meal examinations. Residues, shadows and local tenderness.
Diagnosis
Diagnosis and differentiation of anastomotic ulcer
It can be diagnosed based on medical history, clinical symptoms and laboratory tests.
Pay attention to the identification of other ulcers, stomach diseases and other diseases.
