Passage of food in the stomach
Introduction
Introduction The obstacle to the passage of food in the stomach is due to lesions such as ulcers or cancer. It can be divided into two categories: incomplete obstruction and complete obstruction. Pyloric obstruction is one of the common complications of gastric and duodenal ulcers, which can occur in the short-term (ie, active) or advanced stages of ulcer disease.
Cause
Cause
The pylorus is the narrowest part of the digestive tract, and the normal diameter is about 1.5 cm, so it is prone to obstruction. As the pylorus passes through the obstacle, the contents of the stomach cannot enter the intestine smoothly, but a large amount of retention in the stomach leads to hypertrophy of the muscular layer of the stomach wall, enlargement of the gastric cavity and inflammation of the gastric mucosa, edema and erosion. Clinically, due to long-term failure of patients to eat normally, and a large number of vomiting, leading to severe malnutrition, hypoproteinemia and anemia, and severe water dehydration, low potassium and alkali poisoning and other water and electrolyte disorders.
Examine
an examination
Related inspection
Determination of lactic acid in gastric juice by gastroscopy
First, the diagnosis:
Based on the history of the ulcer, typical symptoms, and X-ray and gastroscopy results, it is not difficult to make a diagnosis. However, the cause and severity of the disease should be further clarified for treatment.
Second, laboratory inspection:
Blood routine examination can find mild anemia caused by malnutrition. Blood chemistry shows that sodium, potassium and chlorine are lower than normal, carbon dioxide binding capacity and pH value are increased, and carbon dioxide partial pressure is also high, showing low potassium alkalosis. Non-protein nitrogen or urea nitrogen is also higher than normal due to less urine. Hypoproteinemia can occur due to chronic hunger. If the anemia is severe and the fecal occult blood is positive, the possibility of malignant ulcer should be considered. Gastric fluid examination, gastric acidity of benign ulcer disease is high, generally in the range of 50 ~ l00mmol / h. If there is a lack of hydrochloric acid in the gastric juice, further cytological examination and other tests should be performed to exclude the tumor.
Third, other auxiliary inspections:
1. X-ray examination: In addition to seeing a large stomach bubble under fluoroscopy, X-ray gastrointestinal angiography should be performed after gastric lavage. The enlarged stomach and difficulty in emptying can be clearly seen. If it is a pyloric fistula, the temporary discharge of the stomach contents when the pylorus is relaxed can be seen during a long observation. Pylorus relaxation is usually observed after injection of atropine or 654-2, so it is easy to identify, but pyloric stenosis caused by mucosal edema and scar contracture is difficult to distinguish on X-ray photographs. After a period of medical treatment, and then angiography, such as pyloric obstruction improved, it can be said that there are factors of edema. In addition, you can see the shadow of the ulcer or the deformation of the abdomen of the duodenum. It is also 80% to 85% reliable for the identification of benign or malignant ulcers.
2. Gastroscopic examination: Fiberoptic gastroscopy can see different pathological changes such as pyloric palsy, mucosal edema or mucosal prolapse, and scarring stenosis, and the size, location and morphology of the ulcer can be seen. For cases of suspected malignancy, a biopsy is required. Therefore, gastroscopy can provide an accurate diagnosis for the cause of pyloric obstruction.
3. Saline load test: firstly absorb the contents of the gastric memory, then inject 700ml of normal saline within 3 to 5 minutes, and then aspirate the saline in the stomach after 30 minutes. If the extraction is less than 200ml, it means there is no pyloric obstruction; if it is more than 350ml, it is considered to have obstruction.
Diagnosis
Differential diagnosis
Differential diagnosis of food in the stomach through obstacles:
1. Active pyloric spasm caused by ulcers and edema: patients often have ulcer pain symptoms, obstruction is intermittent, although vomiting is very intense, but the stomach does not expand, vomit does not contain food. Medical treatment of obstruction and pain symptoms can be alleviated or alleviated.
2. Pyloric obstruction caused by gastric cancer: the patient's course of disease is shorter, the degree of gastric dilatation is lighter, and gastric peristalsis is rare. The upper abdomen can reach the mass. X-ray barium meal examination showed filling defects in the antrum of the stomach, and biopsy can be confirmed by gastroscopy.
3. Duodenal ampulla obstructive lesions: such as duodenal tumor, annular pancreas, duodenal stasis can cause duodenal obstruction, accompanied by vomiting, gastric dilatation and retention, but its The vomit contains more bile. X-ray barium meal or endoscopy can determine the nature and location of the obstruction.
