Generalized and non-localized abdominal pain
Introduction
Introduction Abdominal pain, abdominal pain, cramps, drill-like pain, dull pain and burning pain are all areas of abdominal pain and are 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.
Cause
Cause
The majority of tuberculous peritonitis is secondary to tuberculosis in other organs. The path of infection of this disease can be directly spread by intra-abdominal tuberculosis or disseminated by blood. The former is more common, such as intestinal tuberculosis, mesenteric lymphatic tuberculosis, tubal tuberculosis, etc., can be the direct primary lesion of the disease. More women than men may be due to retrograde infection of pelvic tuberculosis.
Examine
an examination
Related inspection
Abdominal perspective abdomen MRI examination abdominal plain film
1, blood, erythrocyte sedimentation rate and tuberculin test
Some patients have mild to moderate anemia, the latter is more common in patients with longer disease duration and disease activity, especially those with cheese type or complications. The white blood cell count is mostly normal or slightly high, and a few are low. The white blood cell count of patients with acute spread of abdominal tuberculosis or cheese type can be increased, and the erythrocyte sedimentation rate can be used as a simple indicator of disease activity. It generally increases in the active period of the disease, and the lesion gradually becomes normal when it is stationary. Those who are strongly positive in the tuberculin test may be helpful in diagnosing the disease, but may be negative in miliary tuberculosis or in critically ill patients.
2, ascites examination
The ascites is a yellowish exudate, which naturally solidifies after standing, and a few are bloody. Occasionally, chyle, the specific gravity is generally more than 1.016, the protein content is 30g / L, the white blood cell count exceeds 5 × 108 / L (500 / ul), mainly lymphocytes. However, sometimes due to hypoproteinemia, the nature of ascites can be close to the leakage, and must be combined with comprehensive analysis. In recent years, the judgment of infectious ascites should be increased by experimental diagnostic indicators. Ascites glucose <3.4mmol/L, pH <7.35, indicating bacterial infection, especially when ascites adenosine deaminase activity increases, suggesting tuberculous peritonitis. The general bacterial culture of the ascites of this disease is negative, the positive chance of finding tubercle bacillus is very small, and the positive rate of tuberculosis culture is also low, but the positive rate of ascites animal vaccination can reach more than 50%.
3, gastrointestinal X-ray examination
Barium meal examination, such as intestinal adhesions, intestinal tuberculosis, intestinal fistula, extraluminal mass, etc., have an auxiliary value for the diagnosis of this disease. Calcification is sometimes seen in the plain film of the abdomen, and the mesenteric lymph nodes are calcified.
4, laparoscopy
There are taboo examinations for people with extensive peritoneal adhesions. Generally suitable for patients with free ascites, can see the peritoneum, omentum, visceral surface scattered or concentrated gray-white nodules, serosal loss of normal luster, turbid rough, biopsy has a diagnostic value.
Diagnosis
Differential diagnosis
1. Identification of diseases with ascites
1 cirrhosis decompensation, patients with liver function abnormalities, portal hypertension, spleen hyperactivity, liver disease face and spider mites and other performance. Ascites is a leaking liquid. Typical cases are not difficult to identify, but patients with cirrhosis ascites may be complicated with tuberculous peritonitis; 2 cancerous ascites is mostly bloody ascites, repeated ascites examination can find tumor cells; 3 other constrictive pericarditis, hepatic vein obstruction Ascites can be produced, but both have corresponding pericardial and liver signs, and ascites is difficult to eliminate.
2. Identification of diseases with fever as the main performance
Tuberculous peritonitis needs to be differentiated from typhoid fever when there is heat retention. Typhoid fever often has apathy, relatively slow pulse, serum widal and reaction and blood culture positive.
3. Identification of diseases with abdominal pain as the main symptom
Should pay attention to the identification of diseases such as Crohn's disease, chronic cholecystitis, chronic appendicitis, peptic ulcer, ectopic pregnancy. When combined with intestinal obstruction, perforation and peritonitis, it should be differentiated from acute abdomen caused by other causes.
4. Identification of diseases with abdominal mass as the main sign
The disease is sometimes confused with malignant tumors such as ovarian cysts, colon cancer, and ovarian cancer, and attention should be paid to identification.
