silent belly
Introduction
Introduction If the effusion in the peritoneal cavity exceeds 500 ml, the mobile voiced sound can be extracted. Auscultation of bowel sounds can disappear at the beginning, the so-called "silent belly." This symptom is caused by ulcerative perforation of the stomach. Acute perforation is one of the most common serious complications of gastric ulcer. Hospitalized cases of ulcer perforation account for about 20% of hospitalizations for ulcer disease. It has been reported that the mortality rate of gastric ulcer perforation is 27%. The older the patient, the higher the mortality rate, and the mortality rate over 80 years old can rise rapidly. The case fatality rate is related to the length of surgery after perforation. It is reported that after surgery for 6 hours after perforation, the postoperative mortality rate increases rapidly.
Cause
Cause
There are many factors leading to perforation of DU patients. The main risk factors are:
1. Excessive tension or fatigue in stress and exhaustion will increase the vagus nerve excitement and make the ulcers heavier and perforate.
2. Excessive diet overdose increases the pressure in the stomach and promotes perforation of the gastric ulcer.
3. Application of non-steroidal anti-inflammatory drugs Non-steroidal anti-inflammatory drugs are closely related to the perforation of GU and DU. Observations of patients treated with these drugs showed that non-steroidal anti-inflammatory drugs were a major contributor to DU perforation.
4. The use of immunosuppressive agents, especially in organ transplant patients, promotes the occurrence of DU perforation.
5. Other factors include increased patient age, chronic obstructive pulmonary disease, trauma, extensive burns, and multiple organ failure.
Examine
an examination
Related inspection
Abdominal plain abdominal puncture
70% of acute ulcer perforation cases have a history of ulcers, 15% have no history of ulcers, and 15% of cases have a short upper abdominal discomfort a few weeks before perforation. Patients with a history of ulcers often have a worsening course of general symptoms before perforation, but a small number of cases can occur during regular medical treatment, even during rest or sleep.
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.
Signs: The patient is seriously ill, forced to position, and superficially breathing. Abdominal tenderness, rebound tenderness, but the most obvious abdomen above, showing a "plate-like abdomen." After the stomach is perforated, the air in the stomach can enter the abdominal cavity. When standing or in a semi-recumbent position, the gas is located under the armpit, and the dullness of the liver is reduced or disappeared, that is, the so-called "pneumoperitoneum sign". If the effusion in the peritoneal cavity exceeds 500 ml, the mobile voiced sound can be extracted. Auscultation of bowel sounds can disappear at the beginning, the so-called "silent belly." Usually high heat.
According to the medical history, physical examination and abdominal wear, X-ray abdominal standing flat film, etc., can generally be diagnosed.
Diagnosis
Differential diagnosis
Acute gastric ulcer perforation needs to be differentiated from the following diseases:
1. Acute pancreatitis has severe pain in the upper abdomen, accompanied by nausea, vomiting, and peritoneal irritation. However, the pain of acute pancreatitis is often painful in the left upper abdomen and pain in the back. When the gastric perforation enters the small omentum cavity, there is also radiation pain in the back, which needs to be carefully identified. There is often a history of high-fat catastrophe before the onset of pancreatitis, and there is no pneumonia sign at the time of examination. Laboratory tests for blood and urine amylase are often elevated.
2. Acute appendicitis Gastric duodenal ulcer perforation Sometimes the stomach contents can flow along the right colon to the right lower abdomen, causing lower right abdominal pain. It is easy to be confused with appendicitis. Appendicitis begins with paroxysmal umbilical colic and gradually worsens later. The signs of peritonitis are most obvious in the right lower quadrant. Before perforation, the lower right abdomen is often fixed tenderness and rebound tenderness. After perforation, there may be total abdominal tenderness, rebound tenderness and muscle tension, but still in the right lower abdomen and lower abdomen, and gastric perforation. The above abdominal signs are most obvious. Appendicitis does not have a "pneumoperitoneum", nor is it accompanied by shock symptoms. In short, there is no serious stomach perforation. Abdominal wear and X-ray abdominal standing flat film can be used as a reference.
3. Gastric cancer perforation is rare. It is difficult to identify symptoms and signs alone, but the elderly patients with a short history of stomach should consider the possibility of this disease, and send a rapid pathological biopsy during surgery. In addition, biliary tract diseases such as necrotizing gallbladder perforation, as well as intestinal necrosis and intestinal obstruction should be differentiated.
