Worsening right abdominal pain with anorexia and nausea
Introduction
Introduction Gradually aggravated right abdominal pain, accompanied by anorexia nausea is one of the clinical manifestations of idiopathic large omental segmental infarction.
Cause
Cause
(1) Causes of the disease
It is unclear that the occurrence of this disease is likely to be related to vascular disease of the greater omentum. Among the factors that can cause acute obstruction of the omental blood circulation, venous lesions are more than arterial lesions. Clinical data studies have shown that, in most cases, veins Lesions are the main cause of this disease.
1. Omental lesions of the greater omentum
Mainly manifested by various causes of damage to the omental venous intima, thrombosis, venous occlusion, reflux obstruction, and then affect the retinal arterial blood supply, these factors are:
(1) Sudden rise in intra-abdominal pressure: such as cough, vomiting, forced defecation, etc., so that the veins in the omentum are suddenly pulled or swayed.
(2) Abdominal closed injury: even a slight blunt injury, the greater omentum can also be affected by external forces, and may cause venous damage.
(3) Obesity: There is excessive fat deposition in the omentum of obese patients, which increases their volume, increases their weight, and increases the strength of pulling and moving the omentum during physical activity.
(4) Hypercoagulable state in the vein can promote the formation of thrombus.
(5) Heart failure, etc., affecting the reflow of the omental vein.
2. Omental arterial disease
Although atherosclerosis and nodular arteritis mainly occur in the aorta, it may affect the small omental arteries, causing the arterial lumen to stenosis and occlusion, eventually causing necrosis of the omentum.
(two) pathogenesis
Lesion
The omental idiopathic infarction mainly occurs in the right part of the greater omentum. Clinical data studies have found that the right half of the greater omental vascular variability is more than the left side, and fat deposition, hypertrophy is also more on the right side.
2. Lesion characteristics
The infarcted omentum is usually triangular, ranging from 2 to 20 cm in diameter, but more common in 6 to 8 cm. Localized edema, hemorrhage and necrosis, the appearance is dark red or dark purple, and the infarcted omentum is often associated with surrounding tissue. Extensive adhesion of organs, mainly with the right colon, duodenum and pelvic wall adhesion, a small amount of serous bloody exudation in the peritoneal cavity, longer course, exudate may be purulent, microscopic venous thrombosis Formation, inflammatory cell infiltration, the appearance of the omentum without torsion and external pressure phenomenon, can exclude the possibility of secondary omental necrosis.
Examine
an examination
Related inspection
Regression of hot spiral (BR) Hepatitis A antigen chest CT examination Hepatitis B antigen antibody detection Hepatitis B antigen antibody detection
Clinical manifestations: The disease can occur at any age but more in the middle and younger, and males are 2 to 3 times more likely than females. Obese people have more chances of getting sick. The disease resembles acute appendicitis and is extremely difficult to diagnose before surgery.
Abdominal pain
Acute abdominal pain cupping network is the primary symptom of patients seeking medical treatment. About 75% of patients have sudden right lower quadrant pain as persistent with paroxysmal aggravation, and the pain is more severe when changing position. Often accompanied by anorexia, nausea, but rarely vomiting, diarrhea or constipation, and sometimes low fever. The metastatic pain of the abdominal pain during the onset is not obvious, and there is no radioactivity. These symptoms are indistinguishable from acute appendicitis.
2. Abdominal signs
Peritoneal irritation occurs earlier in the lower right abdomen tenderness and tenderness in the right lower abdomen area and a large range of abdominal muscle tension. In some cases, careful palpation can still touch a mass with unclear borders and tenderness.
diagnosis:
History
Young and middle-aged men appear to gradually increase the right abdominal pain, accompanied by anorexia, nausea and fever.
2. Signs
The abdominal wall corresponding to the infarct area has tenderness, rebound tenderness, muscle tension, and sometimes abdominal and abdominal mass.
3. Auxiliary inspection
B ultrasound image can show that the uneven mass is located between the stomach and the transverse colon; the abdominal diagnostic puncture can have serous bloody exudate. In addition to common acute abdomen, it is necessary to determine whether there is retinal torsion, whether it is associated with cardiovascular disease or intra-abdominal related lesions and causes of secondary retinal torsion and infarction.
Diagnosis
Differential diagnosis
Gradually aggravated right abdominal pain, with differential diagnosis of anorexia nausea:
1, fever accompanied by abdominal pain, diarrhea, nausea, vomiting: fever accompanied by abdominal pain, diarrhea, nausea, vomiting refers to the body's abdominal pain, diarrhea, nausea, vomiting due to digestive diseases.
2, right lower quadrant pain with vomiting: typical clinical manifestations of acute appendicitis, gradually appearing pain in the upper abdomen or around the umbilicus, abdominal pain transferred to the right lower abdomen after a few hours. Often accompanied by loss of appetite, nausea or vomiting.
3, abdominal pain with nausea, vomiting: abdominal pain with nausea, vomiting is one of the clinical manifestations of acute pancreatitis.
