Canker perforation

Introduction to perforation of ulcer disease The stomach and duodenal ulcer develop to the deep, and can penetrate the stomach or the duodenal wall. It is a common complication of ulcer disease, but it is less than half of the bleeding, accounting for about 20% to 30% of hospitalized patients with ulcer disease. The diameter of the perforation is more than 3 to 6 mm, the smallest is like the tip of the needle, and the number is more than 10 mm. It is located on the small curved side near the pylorus. The higher the position of the gastric ulcer, the worse the prognosis, the perforation of the ulcer under the cardia, and the mortality rate. Up to 80%. basic knowledge The proportion of illness: 0.0006% Susceptible people: no specific population Mode of infection: non-infectious Complications: shock acute peritonitis

Cause of perforation of ulcer disease

Mental state (35%):

When the task is completed in wartime or assault, due to excessive work, the ulcer can be worsened and perforation occurs. If the diet is too full or engaged in heavy physical labor, the pressure in the stomach may suddenly increase, causing the weak stomach to wear.

Drug effects (25%):

Long-term use of aspirin, salicylic acid preparations or hormones, often cause acute exacerbation of ulcer disease and development to perforation, insomnia, fatigue can increase the tension of the vagus nerve, thereby making the ulcer disease worse.

Smoking and drinking (25%):

Smoke can directly stimulate the gastric mucosa, alcohol can reduce the resistance of the mucous membrane to gastric acid erosion, promote perforation, car drivers, soldiers and surgeons on the battlefield, etc., easily stimulate ulcer perforation.

Ulcer perforation prevention

1, must adhere to long-term medication: because gastric ulcer is a chronic disease, and easy to relapse, to make it completely heal, must adhere to long-term medication.

2, to avoid mental stress: mental stress, emotional excitement, or excessive anxiety on the cerebral cortex to produce bad stimulation, so that the regulation of the hypothalamic central weakening or loss, causing autonomic dysfunction, is not conducive to food digestion and ulcer healing.

Ulcer perforation complications Complications, shock, acute peritonitis

Shock

Severe chemical stimulation after perforation can cause shock symptoms, patients with irritability, shortness of breath, rapid pulse, unstable blood pressure, etc., as the degree of abdominal pain is reduced, the situation can be stabilized, after which, with the increase of bacterial peritonitis The condition is worsening, and in severe cases, infection (poisoning) shock can occur.

2. Acute peritonitis

The whole abdomen is tense like a plate, and the tenderness is remarkable. If you refuse to press it, the whole abdomen can cause rebound tenderness.

Perforated symptoms of ulcer disease Common symptoms Anxiety Sustained pain Stomach pain Nausea pale pale abdominal pain Reversing pulse fast and weak blood pressure Drop eyeball retraction

A few days before the perforation, the stomach pain is often aggravated, but about 10% of the patients can have no pain. This is not a rapid development of the ulcer, but it is already existing. There is no clinical symptom in the clinic. Another 15% of patients have a history of ulcer disease. Therefore, only 3/4 of the patients can indicate the possibility of perforation of ulcer disease from the medical history. Once the ulcer is suddenly worn, the patient feels pain in the upper abdomen, is unbearable, and is forced to stay in bed, so the patient can clearly recall The time and place of the attack and the situation at the time, the pain can be released to the back or right shoulder. According to the amount and direction of the gastrointestinal contents in the abdominal cavity, the top of the diaphragm is stimulated. The patient feels sore shoulder and stimulates the back of the gallbladder. The diaphragm and peritoneum, the patient feels pain under the right scapula, stimulates the small omentum cavity, the patient only feels the corresponding lower back pain, when the gastrointestinal content is diffused to the whole abdomen, it causes persistent abdominal pain, due to a large amount of gastrointestinal content It is along the right colon to the right axilla, so the symptoms here are particularly obvious, easily misdiagnosed as appendicitis, after the onset of pain, accompanied by nausea and vomiting, if the spit has blood, Off perforated ulcer disease prompted significance.

Examination of perforation of ulcer disease

1. It can be seen that white blood cells are increased. In general cases of acute perforation, the white blood cell count is between 15,000 and 20,000/mm3, the neutrophils are increased, and the hemoglobin and red blood cell counts are also increased due to different degrees of dehydration.

2. Exploratory abdominal puncture, the liquid is taken for microscopic examination, such as seeing white blood cells or pus balls in full field, which is indicated as inflammatory ascites, which is evidence for diagnosis of peritonitis. It can also determine the content of ammonia, if it exceeds 3g/ml, There are gastrointestinal perforations.

3. X-ray standing plain film examination, about 80% of patients can see underarm gas accumulation, B-ultrasound can be found in abdominal abscess lesions.

Diagnosis and diagnosis of perforation of ulcer disease

Typical cases are relatively easy to diagnose, but some patients may have less perforation, and the performance is not typical. For example, the abdominal pain is more limited, the muscle tension and the underarm gas are not obvious, and other similarities should be excluded in combination with the medical history. Diagnosis after the disease, when the peritoneal effusion is more, it can also be used for smear microscopy by abdominal puncture, and if the food residue is found, it can assist in diagnosis.

Differential diagnosis

In the diagnosis of ulcer perforation should pay attention to the identification of acute appendicitis, acute pancreatitis, cholecystitis and other surgical diseases.

Acute appendicitis

Metastatic pain is a typical manifestation, but sometimes it is difficult to distinguish from gastric perforation of gastric contents to the right lower abdomen. The lesion of appendicitis is located in the right lower abdomen, so the fixed tender point is in the right lower abdomen, and more localized peritonitis, gastric perforation patients On the upper and lower abdomen, there is tenderness, and the above abdominal pain is significant. The peritoneal irritation sign is more diffuse than appendicitis. The anal examination can sometimes touch the tenderness on the right side of the rectum and also contribute to the diagnosis of appendicitis.

2. Acute pancreatitis

Abdominal pain can be left in the upper abdomen, radiating to the back, sometimes it is difficult to distinguish from ulcer perforation, blood should be used, urine amylase determination, although the perforation of ulcer can also have amylase increase, but mostly moderate increase, if more than The 700Somogyi unit can exclude perforation of ulcer disease, and can also measure amylase by abdominal puncture. When pancreatitis is used, the puncture fluid is often brown, and there is no food residue. X-ray examination of pancreatitis without free gas under the armpit.

3. Cholecystitis

The right upper quadrant radiates to the right shoulder and can touch the swollen gallbladder. B-ultrasound can often find cholecystitis or combined gallstones. There is no free gas accumulation under the armpits. In addition, it should be differentiated from diseases such as pleurisy and ectopic pregnancy.

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