Acute suppurative gastritis

Introduction to acute suppurative gastritis Acute purulent gastritis (acutepurulent gastritis) refers to an acute infectious stomach disease caused by pyogenic bacteria, mainly submucosal lesions of the stomach wall, also known as acute cellulitis inflammatory gastritis or suppurative gastritis, first reported by Curveilher in 1862. basic knowledge The proportion of illness: 0.035% Susceptible people: no specific population Mode of infection: non-infectious Complications: acute peritonitis septic shock

Causes of acute suppurative gastritis

Mucosal damage (30%):

Gastric ulcer chronic gastritis, gastric diverticulum, gastric cancer, foreign body in the stomach, etc., damage the gastric mucosa, and the invading pathogen directly invades the stomach wall by the damaged mucosa. Drinking, malnutrition, old and frail, low stomach acid or no stomach acid, often the cause of this disease.

Pathogenic bacteria (30%):

When suffering from sepsis, bacterial endocarditis, scarlet fever, osteomyelitis and other diseases, pathogenic bacteria enter the stomach wall through the bloodstream. In the case of cholecystitis and peritonitis, pathogenic bacteria enter the stomach wall through the lymphatic system.

Septicum (30%):

Suppurative gastritis is caused by purulent invasion of the stomach wall. About 70% of the pathogens are hemolytic streptococcus, followed by Staphylococcus aureus, pneumococci and Escherichia coli.

Pathogenesis

1. Suppurative lesions at the site of the disease are common in the distal 1/2 of the stomach, but also throughout the stomach, but rarely exceed the pylorus or cardia. The lesion is mainly in the submucosal layer and spreads to the mucosa and serosal side, sometimes perforation.

2. Pathological changes are diffuse and limited depending on the extent of the lesion.

(1) diffuse type: clinically common, the stomach wall is dark red, diffuse thickening, pus outflow can be seen when the stomach wall is squeezed, but rarely exceeds the cardia or pylorus, in severe cases, gastric cavity dilatation, perforation of the stomach wall, etc.

(2) Localized type: more localized abscess formed in the antrum of the stomach. Visual observation shows that the gastric mucosa is congested, and there may be erosion, ulcer, necrosis and hemorrhage. Under the microscope, the blood vessels in the submucosa and the interstitial space may be congested. Fully fibrous mesh structure containing pus and a large amount of leukocyte infiltration.

Acute suppurative gastritis prevention

Active and effective treatment of gastric ulcer, chronic gastritis, gastric diverticulum, cholecystitis, peritonitis and sepsis are the key to prevent this disease.

Acute suppurative gastritis complications Complications acute peritonitis septic shock

Acute peritonitis and septic shock are common complications of this disease.

Acute suppurative gastritis symptoms Common symptoms Nausea chills bloating diarrhea nausea bowel pain abdominal pain upper abdominal pain acute abdomen shock

Often in the form of acute abdomen, sudden onset of upper abdominal pain, accompanied by fever, chills, nausea, vomiting, etc., abdominal pain can be progressively aggravated, the pain is relieved when sitting, the position is aggravated, this disease is specific to the disease Symptoms, with the development of the disease, the body temperature can be further increased, the vomit can be changed from purulent fluid to purulent fluid, abdominal distension, peritonitis signs and melena, but no diarrhea, there may be signs of shock in the later stages of the disease, and Bacterial toxins caused by infection poisoning and blood loss, loss of fluid, severe cases of early shock, poor prognosis, in addition to early signs of peritonitis, abdominal bulging, tenderness, rebound tenderness and muscle tension, above the abdomen, such as Inflammatory exudate is more, there may be inflammatory ascites, which is positive for mobile dullness, but rarely a large amount of ascites. The bowel sounds are hyperthyroidism in the early stage, and then gradually weaken or disappear.

Examination of acute suppurative gastritis

The number of white blood cells in peripheral blood increased, mostly above 1×1010/L, mainly neutrophils, and there was a phenomenon of left shift of the nucleus. Gastric juice, ascites, and blood bacterial culture could find pathogenic bacteria.

1. X-ray abdominal plain film shows gastric dilatation, there are bubbles in the stomach wall.

2. X-ray barium meal and gastroscopy should generally be classified as contraindications to avoid gastric perforation. Retrospective gastroscopy data shows that the gastric cavity is narrow, gastric mucosa is congested, thickened, and the mucosal surface is attached with empyema, which may be associated with multiple ulcers.

3. B-mode ultrasonography showed a significant thickening of the stomach wall.

Diagnosis and differentiation of acute suppurative gastritis

Diagnostic criteria

The disease lacks specific symptoms and signs, and there are few specific indicators for auxiliary examination. Therefore, the diagnosis is difficult. The key problem is to consider the possibility of suppurative gastritis in acute abdomen, and then consider the following points for diagnosis. Maybe it helps.

1. Often have chronic stomach problems or long-term stomach discomfort.

2. There are often unclean eating history or infectious diseases in other parts of the body.

3. Fever is often synchronized with abdominal pain, even before abdominal pain occurs.

4. In general peritonitis, patients do not like activities, and patients with this disease often move, the pain is lighter when sitting.

5. The vomit is mostly purulent, and may be pus and blood in the future.

Differential diagnosis

1. The initial perforation of ulcer disease is a sudden severe knife-like pain, which spreads to the whole abdomen, and the fever appears later. The abdominal muscles are plank-like and straight, the abdominal bulging is less frequent, the lung and liver dullness is reduced, and the abdominal cavity is The amount of liquid is large, often digestive juice, and the free gas can be seen under the abdomen.

2. Acute suppurative cholecystitis or cholangitis abdominal pain often affects the right shoulder and back, tenderness and muscle tension are often confined to the right upper abdomen, often accompanied by jaundice, sometimes in the abdomen can be swollen and swollen gallbladder, B-ultrasound has important value.

3. Acute pancreatitis often has a history of overeating or alcohol abuse. The abdominal pain is progressively aggravated, often involving the lower back. The fever appears later, and blood and urine amylase tests have special value.

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