chronic ulcer
Introduction
Introduction Skin or mucosal defects combined with chronic infection, long-term non-healing of the wound is called chronic ulcer. Chronic ulcer refers to mucosal damage caused by digestive system such as stomach, duodenum, colon, etc. caused by various factors, such as genetic factors, infection, bacterial infection, psychological factors and improper diet, resulting in poor digestion. What's more, it is easy to cause bloody stools and cause anemia. The lower extremity is the most common site of ulcers, especially the upper side of the lower leg and the ankle. It is easy to prolong and heal, forming chronic ulcers of the lower extremities.
Cause
Cause
1. Genetic factors.
2. Chemical factors: long-term consumption of alcohol or long-term use of aspirin, corticosteroids and other drugs may cause this disease. In addition, long-term smoking and drinking tea also have a certain relationship with it.
3. Life factors: may be related to the law of diet. Excessive work can also induce chronic ulcers.
4. Mental factors: mental stress or anxiety, sentimentality, and excessive mental work are also chronic ulcer-inducing factors.
5. Infectious factors: Helicobacter pylori.
Examine
an examination
Related inspection
Blood test bacteriological test
Laboratory inspection
1. Analysis of gastric juice and determination of gastric acid: Gastric juice analysis and gastric acid determination are helpful for the diagnosis and treatment of gastroduodenal ulcer. The basal acid output (BAO)>5mmol/h may be duodenal ulcer, and BAO>7.5mmol/h should be treated surgically. BAO >20mmol/h maximum acid secretion (MAO) greater than 60mmol / h, or BAO / MAO > 0.6 may be gastrinoma, further gastrin determination.
2. Determination of serum gastrin and serum calcium: Determination of serum gastrin can help to rule out or diagnose gastrinoma, serum gastrin >20pg/ml consider gastrinoma; when gastrin >100pg /ml can be definitely a gastrinoma. Patients with hyperthyroidism are prone to peptic ulcer, so the determination of serum calcium is also helpful.
3. Fecal occult blood test: gastric ulcer with combined bleeding may be positive, but if the fecal occult blood test continues to be positive, gastric malignant lesions should be considered.
4. Related tests for bleeding with gastric ulcer: including hemoglobin, hematocrit, reticulocyte count, bleeding, and clotting time.
5. Schilling test: A Schilling test for the determination of vitamin B12 in patients with extensive atrophic gastritis.
6. Helicobacter pylori examination: Although this test is not the basis for the diagnosis of ulcer disease, it is closely related to the recurrence of ulcer disease, so it is of great significance in treatment. Anyone who is positive for this bacteria should be eradicated with an effective drug.
Other auxiliary inspection
1. Gastroscope plus biopsy: accuracy and sensitivity are better, and the diagnosis rate is high. Electron fiber gastroscope can accurately understand the size and location of gastric ulcer, whether there is bleeding, penetrating, active or stationary phase. According to the pathological morphology of ulcer, it can be roughly understood that it is benign and malignant, and pathological biopsy can clearly know whether it is benign or malignant. . At the same time, the gastroscope can also be combined with the detection of Helicobacter pylori to understand the presence or absence of Helicobacter pylori infection. The gastroscope can perform certain treatments, such as local hemostasis under the microscope.
2. Barium meal check: easy and easy, less painful. According to the general shape of the stomach, it can understand the peristalsis of the stomach and whether it is a leather bag. At the same time, benign or malignant can be identified according to changes in the shadow and mucous membrane. Benign ulcers are mostly located outside the stomach wall, and the surrounding mucosa is radially concentrated. Barium meals can also be seen in the duodenum and pylorus have deformation, stenosis, obstruction. But the barley meal has a certain false negative.
3. CT examination: It is not the first choice and routine examination of this disease, but it still has certain significance in the diagnosis and differential diagnosis of ulcer disease.
Diagnosis
Differential diagnosis
1, chronic gastric ulcer
1 Chronic menstruation, except for a small number of patients who have been treated earlier, the majority of the disease has been several years, ten years or more.
2 Periodicity: Except for a small number (about 10-15%), the patient does not relapse after the first episode, and most of the recurrent episodes occur during the course of the episode. It reflects the repeated process of the ulcer cycle of acute active period of ulcer, gradual healing and scar formation. The attack period can be several weeks or even months, and the remission period can be as long as several months or years. The frequency of seizures and the duration of seizures and remission periods vary with individual differences in patients and the development of ulcers and treatment effects and measures to consolidate efficacy.
3 rhythm: ulcer pain is related to gastric acid stimulation, and there is a typical rhythm between clinical pain and diet. Stomach ulcer pain occurs more than half an hour after a meal, lasts 1-2 hours, and gradually disappears until the next rule is repeated after the next meal.
4 The site of pain: The pain of gastric ulcer is mostly in the middle or left of the xiphoid process, and the duodenal ulcer is located in the middle or right side of the upper abdomen. The range of pain is generally limited, and there is local tenderness. The location of the visceral pain is blurred, and the ulcer site cannot be determined from the pain site. If the ulcer is deep into the serosa layer or is a penetrating ulcer, the pain may be released to the chest, the left upper abdomen, the right upper abdomen or the back due to the difference in the penetrating part.
5 The nature and extent of pain: The degree of ulcer pain varies, depending on the patient's pain threshold and individual differences. It can be described as hunger-like discomfort, dull pain, belching, pressure, burning or severe pain and tingling.
2, chronic duodenal ulcer
The rhythm of duodenal ulcer pain is: no pain in the morning, pain in the 2 - 3 hours after breakfast, relief after lunch, pain in the afternoon from 3 to 4 o'clock, and relief after dinner. Pain before bed or midnight is a prominent feature of duodenal ulcers.
3, chronic colon ulcer
The onset is slow and the condition is different. Symptoms are mainly diarrhea, excretion of feces containing blood, pus and mucus, often accompanied by paroxysmal colonic pain, and then urgency and weight, can be relieved after defecation.
diagnosis
1, local pain in the abdomen, the nature of the pain can be different.
2, through the collection of medical history, to understand whether the patient has improper diet or other psychological factors.
3, the pain occurs periodically, rhythmic changes, if there is blood, it should be more important.
