Localized or widespread tenderness, rebound tenderness in the abdomen
Introduction
Introduction Local or extensive tenderness in the abdomen, rebound tenderness is a clinical symptom of patients with non-occlusive mesenteric ischemia. Non-obliterative vascular ischemia of mesentery is an acute intestinal ischemia caused by superior mesenteric artery spasm, accounting for 20-30% of acute mesenteric ischemia, and the mortality rate is over 70%. The common cause is that the superior mesenteric artery spasm is the central link of non-occlusive mesenteric vascular ischemia. It has been found to be associated with sustained cardiac output reduction and hypoxic conditions, common in sepsis, congestive heart failure, arrhythmia, acute Myocardial infarction and severe blood loss are an end-stage manifestation of the above diseases.
Cause
Cause
(1) Causes of the disease
Superior mesenteric artery spasm is a central component of non-occlusive mesenteric ischemia. It has been associated with sustained cardiac output reduction and hypoxic conditions, common in sepsis, congestive heart failure, arrhythmia, acute myocardial infarction, and severe Blood loss, etc., is an end-stage manifestation of the above diseases.
(two) pathogenesis
The basis of non-occlusive mesenteric vascular ischemia is compensatory persistent contraction of visceral blood vessels, slowing of blood flow through small arteries, red blood cell condensation and blood stasis, resulting in intestinal hypoxia and infarction. The use of vasoconstrictor drugs in shock patients can prolong vasoconstriction and accelerate the occurrence of intestinal gangrene. In addition, most patients with non-obstructive mesenteric infarction have received digitalis. Animal experiments found that when the blood pressure of the straight blood vessels fell below 5.6 kPa (42 mmHg), the intestinal wall blood flow was less than 10 ml / 100 g, and lasted 8 h, irreversible intestinal infarction will occur. Because the mesenteric vasospasm is mainly microvessels, intestinal ischemia is flaky and confined to the mucosa. The pathological features are extensive ischemic necrosis of mucosa with ulcer formation, a large number of red blood cell deposits in the submucosal vasodilation, punctiform necrosis on the serosal surface, and perforation in the late stage.
Examine
an examination
Related inspection
Abdominal skin examination abdominal shape examination abdominal wall tension abdominal auscultation abdominal wall reflex
1, medical history
Those with the following medical history are at high risk of non-occlusive mesenteric ischemia:
1 acute myocardial infarction accompanied by shock, congestive heart failure, arrhythmia;
2 burns accompanied by a decrease in blood volume;
3 abscess, pancreatitis;
4 hemorrhagic shock;
5 Adrenalin alpha receptor agonists and digitalis drugs that have the function of contracting visceral blood vessels are being used.
2, clinical manifestations
Sudden onset of severe abdominal cramps, accompanied by watery diarrhea or bloody stools, fever, bowel sounds weakened or disappeared; partial or extensive abdominal tenderness, rebound tenderness and abdominal muscle tension.
1. Early manifestations: The superior mesenteric artery occlusion occurs slowly within a few days, during which there may be prodromal symptoms of fatigue and abdominal discomfort.
(1) Abdominal pain: Abdominal pain of non-occlusive mesenteric ischemia is milder than acute mesenteric artery embolization or thrombosis. The degree, nature and location of pain vary, and 20% to 25% of patients have no abdominal pain.
(2) bloating and gastrointestinal bleeding: bloating and gastrointestinal bleeding without obvious cause may be an early manifestation of non-occlusive mesenteric ischemia and intestinal necrosis.
2. Intestinal necrosis: sudden bowel pain and vomiting at the onset of intestinal infarction, followed by sudden drop in blood pressure and pulse rate. Common fever, watery diarrhea or bloody stools, the bowel sounds weaken, and disappear later. Local or extensive tenderness, rebound tenderness and abdominal muscle tension in the abdomen suggest a full-thickness of the intestinal wall and a poor prognosis.
If there is a disease with a decrease in visceral circulation, if there are unexplained abdominal symptoms and signs, the possibility of the disease should be highly suspected.
3. Auxiliary inspection
The superior mesenteric artery angiography revealed that the superior mesenteric artery had a narrow initial stenosis, an irregular shape of the intestine, and poor filling of the blood vessels in the intestinal wall.
Diagnosis
Differential diagnosis
Disease identification
1. Extensive and non-localized abdominal pain: abdominal pain, abdominal pain, cramps, drill-like pain, dull pain and burning pain are all areas of abdominal pain, which is a common clinical symptom. According to the degree of onset of the disease, it can be divided into acute abdominal pain and chronic abdominal pain. Chronic extensive and non-localized abdominal pain: common in tuberculous peritonitis, intestinal adhesions, intestinal ascariasis and neurosis.
2, gradually increased right abdominal pain, accompanied by anorexia nausea: gradually increased right abdominal pain, accompanied by anorexia nausea is one of the clinical manifestations of idiopathic large omental segmental infarction.
3, chronic abdominal pain: chronic abdominal pain is a relatively slow onset, long course of disease, or abdominal pain secondary to acute abdominal pain, its positioning is more accurate.
4, paroxysmal abdominal pain: abdominal pain, accompanied by diarrhea and other conditions, the symptoms are not like dysentery. Such abdominal pain and diarrhea symptoms can also be called summer paroxysmal abdominal pain. Also common in intestinal fistula, is the most common case of acute abdominal pain in children.
Disease diagnosis
History
Those with the following medical history are at high risk of non-occlusive mesenteric ischemia:
1 acute myocardial infarction accompanied by shock, congestive heart failure, arrhythmia;
2 burns accompanied by a decrease in blood volume;
3 abscess, pancreatitis;
4 hemorrhagic shock;
5 Adrenalin alpha receptor agonists and digitalis drugs that have the function of contracting visceral blood vessels are being used.
2. Clinical manifestations
Sudden onset of severe abdominal cramps, accompanied by watery diarrhea or bloody stools, fever, bowel sounds weakened or disappeared; partial or extensive abdominal tenderness, rebound tenderness and abdominal muscle tension.
3. Auxiliary inspection
The superior mesenteric artery angiography revealed that the superior mesenteric artery had a narrow initial stenosis, an irregular shape of the intestine, and poor filling of the blood vessels in the intestinal wall.
