chronic stomach pain
Introduction
Introduction Stomach pain is a common symptom in the clinic. It is more common in acute and chronic gastritis, stomach and duodenal ulcer disease, and gastric nervous system. Also seen in gastric mucosal prolapse, gastroptosis, pancreatitis, cholecystitis and cholelithiasis. Acute stomach pain is an acute onset, rapid change, and serious illness. The patient felt severe pain in the stomach, accompanied by snoring, flatulence, nausea, vomiting, diarrhea, chest tightness and other symptoms. Common causes of stomach pain are: cold seasons, improper diet (such as cold food, hunger and malnutrition, overeating, etc.), excessive drinking, overwork, emotional, irritating food or drugs. The above reasons stimulate the stomach, leading to smooth muscle spasm of the stomach wall, increased intragastric pressure, increased muscle fiber tension, and stimulation of nerve receptors and stomach pain.
Cause
Cause
Common causes of stomach pain are: cold seasons, improper diet (such as cold food, hunger and malnutrition, overeating, etc.), excessive drinking, overwork, emotional, irritating food or drugs. The above reasons stimulate the stomach, leading to smooth muscle spasm of the stomach wall, increased intragastric pressure, increased muscle fiber tension, and stimulation of nerve receptors and stomach pain.
Common causes of stomach pain include cold evil stomach, stomach injury, liver qi and stomach and weak spleen and stomach. The stomach is subject to the rotted water valley. If the cold sorcerer is in the stomach, the cold condenses and does not scatter, blocking the air machine, which can cause stomach discomfort and pain or due to unhealthy diet, hunger and satiety, or overeating, eating, eating Stagnant, gas machine blocked, stomach loss and drop caused by stomach pain; liver has a relief effect on the spleen and stomach, such as due to anger and depression, qi stagnation of the liver, liver loss, cross-counter stomach, stomach pain can also occur; Long-term illness, spleen and stomach weakness, or lack of endowment, Zhongyang deficiency, stomach loss of warmth, internal cold breeding, Zhongjiao cold and pain; also have qi stagnation for a long time, blood stasis, qi stagnation and blood stasis, hindering The coke machine, and the stomach pain episodes in short, the pathogenesis of stomach pain is divided into two sides of the virtual and real, the evidence is the air block, the pain is not; the deficiency is the stomach cramps lost in warm or support, the loss of pain.
First, because of anger and anger, liver dysfunction, and horizontal reversal caused by the stomach, the rule of law is to soothe the liver and qi.
First, the spleen is not healthy, the stomach loses and falls, and it is better to use Wentong and supplement the medium method to restore the function of the spleen and stomach.
There are many causes of stomach pain, including overworked tension, untimely food, work or exercise immediately after eating, excessive drinking, overeating, and frequent eating of indigestible foods. Stomach pain may have several factors, but most are caused by acid reflux. That is, the liquid originally intended to be in the stomach is reversed into the esophagus. These digestive juices contain hydrochloric acid (hydrochloric acid), a corrosive substance used in industry to clean metals. Although the stomach has a protective film to protect it from gastric acid, the esophagus lacks this protective layer.
Therefore, when stomach acid refluxes the human esophagus, it can cause burning, sometimes serious until you think it is a heart attack. The most common cause of stomach pain is eating and drinking, but this is not the only reason. Some people are not overeating, but they also suffer from stomach pain. In fact, stomach cramps have nothing to do with food. Most of them are caused by mental reasons. Angry, nervous, and stressed may cause stomach cramps.
The stomach is one of the important digestive organs in our body. Under normal conditions, it should be constantly squirming, and the food that is sent out of the esophagus is broken. If its peristalsis is not normal, it will hinder digestion and absorption, so that excess gas will accumulate and form stomach gas. Chinese medicine claims that this situation is "sluggish."
When the stomach is sluggish, the food that is eaten cannot be ground and sent to the intestines in real time, so it is forced to stay in the stomach. The semi-treated food will be fermented and stinky, forming a sour odor, that is, a breath, and there will be Symptoms of bloating.
When the stomach is ulcerated, Helicobacter pylori will parasitize the wound, causing the ulcer to be often inflamed; that is, using the medicine to kill the bacteria, if the eating habits do not change, the ulcer will still feel pain after healing.
Examine
an examination
Related inspection
Electrogastrogram
Laboratory and other inspections
First, gastric juice analysis: Determination of basal gastric juice secretion (BAO) and increase of histamine or pentagastrin gastrin after the determination of large amount of acid (MAO) and peak acid secretion (PAO) to determine gastric acid function, there are Helps diagnose and guide clinical treatment of atrophic gastritis. Superficial gastritis is more normal gastric acid, and the extensive and severe atrophic gastritis is reduced in gastric acid, especially in gastric gastritis. Gastric sinusitis is normal or mild. Superficial, such as verrucous gastritis, may also have an increase in gastric acid.
Second, serological test: Chronic atrophic gastritis serum gastrin is often moderately elevated, which is due to gastric acid deficiency can not inhibit the secretion of G cells. If the lesion is serious, not only the secretion of gastric acid and pepsin is reduced, but also the secretion of internal factors is reduced, thus affecting the decrease of vitamin B12; serum PCA is often positive (more than 75%), and serum gastrin is decreased in chronic gastric antrum gastritis. It depends on the degree of G cell destruction; serum PCA also has a certain positive rate (about 30-40%).
Third, gastrointestinal X-ray barium meal examination: When the gastric mucosa double angiography shows the fine structure of the gastric mucosa, atrophic gastritis can appear relatively flat and reduced gastric mucosal folds. X-ray signs of gastric antrum gastritis are sinusoidal mucosa and sinus sinus, or anterior pyloric stenosis, and mucosal stenosis. X-ray meal characteristics of verrucous gastritis changed to nodular thick folds in the antrum of the stomach, and some of the folds in the center of the folds were ecchymosis.
4. Gastroscope and biopsy: It is the main method for diagnosing chronic gastritis. Superficial gastritis is often most obvious in the antrum of the stomach. Most of the mucous membranes on the surface of the diffuse gastric mucosa are increased. There are grayish white or yellowish white exudates. The mucosa of the lesion is red and white or plaque-like. It resembles measles-like changes and sometimes has erosion. The mucosa of atrophic gastritis is mostly pale or grayish white, and it can also be red and white, and the white area is depressed; the folds become thin or flat, and the mucosa becomes thinner and can be seen as a purple-blue submucosal blood vessel; the lesion can be diffuse or mainly in the stomach. The sinus, such as those with proliferative changes, has a mucosal surface that is granular or nodular.
The biopsy specimen should be used for pathology and Helicobacter pylori detection. A specimen can be placed in the phenol red-containing urea solution for the urease test. The test solution turns pink in 30-60 minutes, and the other specimen is set to special. The culture medium was cultured in a micro-oxygen environment, and another specimen was prepared into sections and stained with HE or Warthin-Starry or Gieemsa. On the slice, there are piles of micro-bone bacilli in the mucosa layer, which are arranged in a fish-like shape.
Diagnosis
Differential diagnosis
Differential diagnosis of chronic stomach pain:
1. Chronic stomach pain: Chronic stomach pain is common in chronic gastritis. Chronic gastritis refers to various chronic gastric mucosal inflammatory lesions caused by different causes. It is a common disease and one of the most common diseases of the army. Its incidence rate is in various stomach diseases. first place. Since the wide application of fiber endoscopy, the understanding of this disease has been significantly improved. Chronic gastritis often has a certain degree of atrophy (mucosal loss of function) and metaplasia, often involving the cardia, accompanied by loss of G cells and decreased secretion of gastrin, may also involve the body of the body, accompanied by loss of acid secretion glands, leading to stomach acid, Reduction of pepsin and endogenous factors.
2, neuropathic stomach pain: Some people, when subjected to greater mental stress, gastric acid will be secreted in large amounts, showing a state of hyperacidity, causing heartburn, septum, stomach pain and other symptoms. In addition, the work of the stomach is dominated by autonomic nerves. When the mental stress of the person is too large, the autonomic nervous system loses balance, and the stomach cannot work normally (secreting gastric acid, peristalsis, etc.), causing stomach discomfort and causing stomach pain. Furthermore, because of lack of sleep, diet, life, work, study and other reasons. Both may cause autonomic disorders, causing stomach pain, which is neuropathic stomach pain.
3, intermittent stomach pain: stomach pain refers to only the chronic ulcers in the contact area of the gastrointestinal tract and gastric juice, also known as ulcer disease, Chinese medicine said "stomach pain", "heartache", "stomach pain" category. Intermittent stomach pain is that the stomach pain is intermittent and there is no certain rule.
4, emotional stomach pain: psychological stomach pain belongs to mental function, mainly because people's nervousness, anxiety and other uneasy emotions are reflected to the stomach, leading to upper abdominal pain, symptoms include stomach cramps, bloating, usually relieve symptoms after anxiety is relieved. But what is disturbing is that psychological pain is sometimes difficult to have immediate relief of symptoms, and the degree of pain is unbearable. The more serious consequence is that the pressure will cause gastric acid secretion. Once the gastric acid is excessively secreted, it may cause gastritis, peptic ulcer and acid reflux.
symptom
Chronic gastritis lacks specific symptoms, and the severity of symptoms is not consistent with the degree of lesions in the gastric mucosa. Most patients often have asymptomatic or varying degrees of dyspepsia such as abdominal pain, loss of appetite, postprandial fullness, and acid reflux. Patients with atrophic gastritis may have anemia, water thinness, glossitis, diarrhea, etc. Individual patients with mucosal erosion have obvious upper abdominal pain and may have bleeding.
Upper abdominal pain, indigestion, hematemesis, melena. Frequent symptoms are recurrent episodes, irregular abdominal pain, pain often appear in the eating process or after meals and most of the upper abdomen, umbilical cord, part of the child is not fixed, light intermittent intermittent pain or blunt push, severe severe colic. Often accompanied by loss of appetite, nausea, vomiting, abdominal distension, continue to affect nutritional status and growth and development. Gastric mucosal erosion bleeding with hematemesis, melena.
Clinical manifestation
The disease progresses slowly, often recurrent, and has a good onset in middle age, and there is a tendency for the incidence to increase with age. Some patients may have no symptoms of chronic gastritis. Most patients may have different degrees of dyspepsia and the signs are not obvious. Each type of gastritis has different performances.
First, superficial gastritis: there may be chronic irregular upper abdominal pain, abdominal distension, belching, etc., especially in the case of improper diet, some patients may have acid reflux, upper gastrointestinal bleeding, such patients confirmed by sputum and sputum Most of the gastritis.
Second, atrophic gastritis: different types, different parts of the symptoms are not the same. Gastric gastritis generally has fewer gastrointestinal symptoms, and sometimes it can cause obvious anorexia, weight loss, glossitis, and atrophy of the tongue. Can be associated with anemia, rare in people with malignant anemia in China. Atrophic gastritis affects the gastrointestinal tract when the antrum is more obvious, especially in the case of bile reflux, often manifests as persistent upper abdominal pain, after eating, may be accompanied by bile-containing vomit and post-sternal pain and Burning sensation, sometimes there may be repeated small amount of upper gastrointestinal bleeding, and even hematemesis, this system of gastric mucosal barrier suffered damage and acute gastric mucosal erosion. Most of the chronic gastritis has no obvious signs, and sometimes there may be mild tenderness in the upper abdomen.
