Stomach ache

Introduction Abdominal pain is a common clinical symptom and a cause of patient visits. Abdominal pain is caused by a certain strong stimulation or injury to the intra-abdominal tissues or organs, and can also be caused by chest diseases and systemic diseases. In addition, abdominal pain is a subjective feeling. The nature and intensity of abdominal pain are not only affected by the condition of the lesion and the degree of stimulation, but also by factors such as nerve and psychology. That is, the sensitivity of the patient to pain stimuli is different, and the stimulation of the same lesion differs in nature, intensity, and duration of abdominal pain caused by different patients or different periods of the same patient. Therefore, only by analyzing the pathophysiology, neurophysiology, psychology and clinical aspects of the disease, it is possible to have a correct understanding of abdominal pain. Abdominal pain is often divided into acute and chronic clinical categories.

Cause

1. The cause of acute abdominal pain

(1) Abdominal organ diseases:

1 acute inflammation of abdominal organs: acute gastroenteritis, acute corrosive gastritis, acute cholecystitis, acute pancreatitis, acute appendicitis, acute cholangitis.

2 perforation or rupture of abdominal organs: perforation of gastric and duodenal ulcer, perforation of typhoid, liver rupture, rupture of spleen, renal rupture, rupture of ectopic pregnancy, rupture of ovary, etc.

3 abdominal organ obstruction or dilation: gastric mucosal prolapse, acute intestinal obstruction, inguinal hernia incarceration, intussusception, biliary ascariasis, cholelithiasis, kidney and ureteral stones.

4 abdominal organ torsion: acute gastric torsion, ovarian cyst torsion, omental torsion, intestinal torsion and so on.

5 intra-abdominal vascular obstruction: acute obstruction of mesenteric artery, acute portal vein thrombosis, dissecting abdominal aortic aneurysm.

(2) abdominal wall disease: abdominal wall contusion, abdominal wall abscess and abdominal wall banded sores.

(3) chest disease: acute myocardial infarction, acute pericarditis, angina pectoris, pneumonia and pulmonary infarction.

(4) systemic diseases and other: rheumatic fever, uremia, acute lead poisoning, hematoporphyria, abdominal allergic purpura, abdominal epilepsy.

2. The cause of chronic abdominal pain

(1) Abdominal organ diseases:

1 chronic inflammation: reflux esophagitis, chronic gastritis, chronic cholecystitis, chronic pancreatitis, tuberculous peritonitis, inflammatory bowel disease.

2 stomach, duodenal ulcer and gastrinoma.

3 torsion or obstruction of intra-abdominal organs: chronic gastrointestinal torsion, intestinal adhesions, omental adhesion syndrome.

4 organ capsule tension increased: liver congestion, hepatitis, liver abscess, liver cancer, splenomegaly and so on.

5 gastrointestinal dysfunction: gastroparesis, functional dyspepsia, hepatic flexion and splenic syndrome, irritable bowel syndrome.

6 tumor compression and infiltration: gastric cancer, pancreatic cancer, colorectal cancer.

(2) Poisoning and metabolic disorders: chronic lead poisoning, uremia, etc.

(3) chest and lumbar lesions: such as spinal tuberculosis, abscess and so on.

(4) organic neuropathy: spinal tuberculosis, spinal cord tumors, etc.

an examination

Related inspection

Endoscopy

Laboratory inspection

1. Blood, urine, feces routine, ketone body and serum amylase are the most commonly used laboratory tests.

The total number of white blood cells and the increase of neutrophils suggest that inflammatory lesions are almost all items that need to be examined in patients with abdominal pain. A large number of red blood cells in the urine suggest urinary stones, tumors or trauma. Proteinuria and white blood cells suggest a urinary system infection. Pus and blood will prompt intestinal infection, bloody stools suggest strangulated intestinal obstruction, mesenteric thromboembolism, hemorrhagic enteritis and so on.

Increased serum amylase is suggested to be pancreatitis, which is the most commonly used blood biochemical test for differential diagnosis of abdominal pain. The determination of blood sugar and blood ketone can be used for abdominal pain caused by diabetic ketosis. Increased serum bilirubin suggests biliary fatigue. Examination of liver and kidney function and electrolytes is also helpful in judging the condition.

2. Routine and biochemical examination of abdominal puncture fluid.

Abdominal puncture must be performed when the diagnosis of abdominal pain is unclear and abdominal fluid is found. The liquid obtained by puncture should be sent for routine and biochemical examination, and if necessary, bacterial culture is required. However, the visual observation of the puncture fluid has been helpful in the diagnosis of intra-abdominal hemorrhage and infection.

Auxiliary inspection

X-ray inspection

Abdominal X-ray examination is the most widely used in the diagnosis of abdominal pain. The free gas, gastrointestinal perforation found in the armpit is almost certain. Intestinal gas expansion, most fluids in the intestine can diagnose intestinal obstruction. Calcification of the sputum can prompt ureteral stones. Lumbar muscle shadows appear blurred or disappear, suggesting peritoneal inflammation or bleeding. X-ray barium meal imaging, or barium enema examination can find gastroduodenal ulcers, tumors and so on. Only in case of suspected intestinal obstruction, taboo meal should be contraindicated. Gallbladder, cholangiography, endoscopic retrograde cholangiopancreatography and percutaneous cholangiography are helpful for the differential diagnosis of biliary and pancreatic diseases.

When the diagnosis is difficult, suspected and chest and abdomen have lesions, it is feasible to see the chest and abdomen, the purpose is to observe the presence or absence of lesions in the chest, free air under the armpits, changes in diaphragmatic movement, presence or absence of intestinal gas and fluid level, etc. Regular filming. When suspected sigmoid torsion or low intussusception, barium enema examination is feasible. It is not advisable to have a barium meal examination for patients suspected of having intestinal obstruction, internal hemorrhoids or perforation.

2.B-ultrasound

Mainly used to check biliary and urinary calculi, bile duct dilatation, pancreas and hepatosplenomegaly. It also has a good diagnostic value for a small amount of effusion, intra-abdominal cysts and inflammatory masses in the abdominal cavity.

3. Endoscopy

Endoscopy has become an important means of finding the cause of abdominal pain. Retrograde cholangiopancreatography, cystoscopy, and laparoscopy can also be performed if the patient's condition permits. It can be used for the differential diagnosis of gastrointestinal diseases, which is often required in patients with chronic abdominal pain.

4. CT, magnetic resonance and radionuclide scanning

For intra-abdominal and retroperitoneal lesions, such as liver, spleen, pancreatic lesions and some intra-abdominal masses and abdominal abscesses, effusion, gas accumulation, etc. have a good diagnostic value, should be selected according to the condition.

5. ECG examination

For older patients, an electrocardiogram should be performed to understand the myocardial blood supply and to exclude myocardial infarction and angina pectoris.

Differential diagnosis

Differential diagnosis

There are many diseases that cause abdominal pain. The most common and more representative ones are as follows:

Acute abdominal pain

Acute abdominal pain is one of the common clinical symptoms, and its etiology is complex and diverse, but its common features are rapid onset, rapid change and serious illness. It is necessary to make rapid and accurate diagnosis and differential diagnosis.

(1) Acute inflammation of the abdominal organs:

1 acute gastroenteritis: can occur in any age group, mostly after eating unclean food or drinking contaminated water or overeating, persistent and paroxysmal abdominal pain, accompanied by nausea, vomiting, diarrhea, postprandial abdominal pain can be alleviated or relieved May be accompanied by chills and fever. Abdominal pain in the upper abdomen and umbilical cord was obvious, no rebound pain, and auscultation of bowel sounds. Laboratory tests for white blood cells and neutrophils can be increased.

2 cholecystitis, cholelithiasis: more common in women, the age of onset is 20 to 40 years old. Infected bacteria are mainly Escherichia coli. Mostly caused by eating fatty food or suffering from cold, the clinical manifestations of persistent upper right abdominal pain, intermittent aggravation, radiation to the right shoulder and right back, accompanied by chills, fever, nausea and vomiting, etc., 40% to 50% The patient developed yellow staining of the skin mucosa. Most patients have right upper quadrant tenderness and local muscle tension, and one-third of patients can reach the enlarged gallbladder under the right costal margin, and the Murphy sign is positive. Increased white blood cells and neutrophils, B-ultrasound and CT examination can be found to be diagnosed by swelling and gallbladder and stone signs filled with fluid.

3 acute pancreatitis: acute onset, more alcohol, overeating, high-fat meal and mental agitation and other incentives, the main clinical manifestations of persistent upper abdomen or left upper abdomen pain, and to the left back waist. Pain is relieved when bending over or sitting forward, accompanied by fever, nausea, vomiting, and vomiting occurs soon after the onset of abdominal pain, which is more intense but not persistent. A few have jaundice. Severe cases of respiratory and circulatory failure. Upper abdominal tenderness, rebound tenderness and localized muscle tension are obvious in the left upper abdomen, sometimes with mobile dullness. Blood leukocytes and neutrophils are elevated, and serum and urinary amylase are elevated. In addition, blood sugar increased, blood calcium decreased, B-ultrasound CT examination showed pancreatic enlargement, sometimes abdominal puncture can extract yellow or bloody ascites, ascites amylase increased, etc. can be helpful in diagnosis. Gastric and duodenal ulcer perforation, intestinal obstruction, cholecystitis, cholelithiasis, etc., may also have mild blood and urine amylase increase, while blood calcium and blood sugar are not changed. Repeated detection of urinary amylase can be differentiated from the above diseases.

4 acute appendicitis: can be seen at any age, but more common in 20 to 50 years old, clinical manifestations of umbilical or mid-abdominal pain, gradually worsening, and transferred to the right lower abdomen, persistent or paroxysmal aggravation or sudden all Pain in the abdomen, accompanied by nausea and vomiting, diarrhea or constipation. In severe cases, fever may occur. Physical examination: Mai's point tenderness, rebound tenderness and local abdominal muscle tension, colon aeration test positive; if the appendix is cecal, the psoas muscle test may be positive, white blood cells and neutrophils increased. Acute appendicitis needs to be differentiated from acute non-specific appendicitis, because its clinical manifestations are similar to acute appendicitis; female acute appendicitis also needs acute right salpingitis, right ectopic pregnancy rupture, ovarian cyst torsion, ovarian corpus luteum or follicular rupture, etc. Identification.

5 acute hemorrhagic necrotizing enterocolitis: mostly children and adolescents, acute onset, the cause is still unclear, may be related to the production of B-toxin C-type Clostridium perfringens infection. Clinical manifestations of sudden acute abdominal pain, pain in the umbilical and upper abdomen, can spread to the whole abdomen, mostly persistent paroxysmal aggravation, with fever, nausea, vomiting, diarrhea and bloody stools. Severe cases can occur toxic shock, intestinal paralysis, intestinal perforation and so on. Abdominal bulging, abdominal muscle tension, umbilical and upper abdominal tenderness were obvious, no rebound pain, early bowel sounds hyperthyroidism, and late bowel sounds decreased. The total number of white blood cells was significantly increased, reaching (2 ~ 30) × 109 / L, fecal occult blood positive or bloody stool. Abdominal X-ray shows small intestine flatulence, liquid level or small intestinal wall thickening, irregular mucosa and so on.

6 acute mesenteric lymphadenitis: can occur in any age group, but more common in children aged 8 to 12 years old, some people think it is caused by viral infection. Clinical manifestations: Abdominal pain often occurs with upper respiratory tract infections, mostly persistent right lower quadrant or umbilical pain. Short-term abdominal pain can be alleviated or disappeared, accompanied by fever, nausea and vomiting, and some patients have diarrhea or constipation. There are tenderness, rebound tenderness and mild muscle tension in the lower abdomen. The tender points are more extensive and not fixed. The total number of white blood cells is slightly increased. The disease needs to be differentiated from acute appendicitis.

(2) rupture and perforation of abdominal organs:

1 Acute perforation of gastroduodenal ulcer: a history of gastroduodenal ulcer or a history of recurrent episodes of stomach pain. The vast majority of pain occurs suddenly, and the nature of the pain is inconsistent. It usually manifests as sudden and severe upper abdominal pain, followed by persistent abdominal pain with persistent or paroxysmal aggravation, accompanied by nausea and vomiting, pale complexion, cold limbs, palpitation, weak pulse, Blood pressure drops or is in a state of shock. Physical examination of total abdominal tenderness, rebound tenderness and platy abdomen, with the upper abdomen or right upper abdomen as the weight, the abdomen may have mobile dullness. The total number of white blood cells and neutrophils were elevated. Abdominal radiographs and fluoroscopy showed free gas under the armpits. For patients with suspected disease and unclear diagnosis, abdominal puncture can be performed.

2 acute intestinal perforation: acute intestinal perforation can occur in intestinal ulcers, intestinal necrosis, trauma, typhoid fever, inflammatory bowel disease, acute hemorrhagic necrotic enteritis and amoebic bowel disease. Acute intestinal perforation often occurs suddenly, abdominal pain is persistent knife-like pain, mostly in the lower abdomen or affecting the whole abdomen, the pain is often intolerable, and is exacerbated during deep breathing and coughing, often accompanied by fever, bloating and toxic shock . Physical examination Abdominal respiratory movement weakened or disappeared, total abdominal tenderness and rebound tenderness, abdominal muscle tension, may have mobile dullness, bowel sounds weakened or disappeared. The total number of white blood cells and neutrophils were elevated, and free blood was found under the axillary X-ray or fluoroscopy.

3 liver rupture: more occurs under the inducement of increased abdominal pressure or trauma, manifested as sudden severe abdominal pain, from the right upper abdomen to the full abdomen, showing persistent pain. If the traumatic liver rupture or hepatic hemangioma rupture, it is often accompanied by hemorrhagic shock symptoms, such as pale, rapid pulse, blood pressure and so on. Hepatic rupture also has manifestations of hemorrhagic shock. Physical examination of abdominal muscle tension, total abdominal tenderness, rebound tenderness, abdominal breathing restriction, abdominal dullness. The total number of red blood cells and hemoglobin decreased, and the total number of white blood cells increased. Abdominal X-ray examination of left ankle elevation, limited movement, abdominal puncture and extraction of blood and bile. Peritoneal puncture found that bloody ascites is beneficial to the differentiation of gastrointestinal perforation. Sometimes surgical exploration is required to determine if there is a liver rupture.

4 spleen rupture: rupture of the spleen occurs on the basis of splenomegaly, and trauma is the direct cause. It is characterized by severe abdominal pain, spread from the left upper abdomen to the whole abdomen, and sometimes to the left shoulder, accompanied by symptoms of hemorrhagic shock such as nausea, vomiting, bloating, palpitation, sweating, and pale complexion. Physical examination of total abdominal tenderness, rebound tenderness, abdominal muscle tension, percussion with mobile dullness. The total number of red blood cells and hemoglobin decreased. Abdominal X-ray examination of the left iliac muscle elevation, limited movement. Abdominal puncture to extract non-coagulated blood is helpful for diagnosis.

5 ectopic pregnancy rupture: the age of onset is more than 26 to 35 years old, about 80% of ectopic pregnancy rupture occurs within 2 months of pregnancy, the main symptoms are abdominal pain, vaginal bleeding and menopause, mostly for one side of the lower abdomen Severe pain, then spread to the entire abdomen, showing persistent pain, sometimes tearing pain. About 80% of patients have irregular vaginal bleeding, most of them are small, dark brown, drip-like, lasting for a long time, accompanied by signs of shock such as palpitation, sweating, pale complexion. Some patients may have a feeling of swelling at the anus. Abdominal examination of the lower abdomen or the whole abdomen has tenderness, rebound tenderness, abdominal muscle tension, abdominal muscle tension can be absent when the amount of bleeding is large, percussion has mobile dullness. The vaginal examination revealed that the posterior iliac crest was full and bulging, and the tenderness was obvious. Positive pregnancy test, abdominal or posterior iliac puncture can extract non-coagulated blood. Abdominal B-ultrasound, endometrial disease and laparoscopy are helpful for diagnosis.

6 ovarian rupture: more than 14 to 30 years old women, mostly due to extrusion, sexual intercourse, puncture and other factors. It is characterized by sudden onset of severe pain in the lower abdomen and spread to the whole abdomen, accompanied by nausea and vomiting, irritability, and severe shock, but less common. Abdominal examination of the lower abdomen has tenderness, rebound tenderness and muscle tension, some patients may have no abdominal muscle tension, one side attachment tenderness is obvious, there may be mobile dullness. A vaginal examination revealed a firm cervix, no tenderness, and a negative pregnancy test. The disease must be differentiated from acute appendicitis, rupture of ectopic pregnancy and other diseases.

(3) Abdominal organ obstruction, torsion and vascular disease:

1 acute intestinal obstruction: acute intestinal obstruction is divided into three types: mechanical, paralytic and spontaneous; from the local pathological changes are divided into two types: simple and strangulated. Only those with poor intestinal lumen and no blood supply disorder are simple. If there is a blood supply disorder, it is strangulated. Clinically, acute mechanical intestinal obstruction is the most common. The main reasons are: torsion, intussusception, mites, tumors, tuberculosis, sputum incarceration, etc., among which intestinal adhesions are the most common. The main clinical manifestations of acute mechanical intestinal obstruction are persistent abdominal pain and paroxysmal colic, accompanied by bloating, nausea and vomiting, constipation or cessation of exhaust. Abdominal examination is often the contour of the inflated intestine, and even the intestinal type is visible, sometimes the whole abdomen is tender, the bowel sounds are hyperthyroidism, and the bowel movement sounds in the flatulence of the intestines are high-pitched metal sounds. Abdominal X-ray examination is helpful for diagnosis. Patients with mechanical intestinal obstruction should consider stenotic intestinal obstruction in the following cases:

A. Abdominal pain is acute and intense, with persistent paroxysmal aggravation and persistent vomiting.

B. The course of disease progresses rapidly, and early symptoms of shock occur, and the treatment effect is not good.

C. There is obvious peritoneal irritation, asymmetry on both sides of the abdomen, palpation of the abdomen or anal fingering touches a tender mass, and the body temperature, pulse, and white blood cells tend to increase. X-ray examination revealed that the intestinal fistula was persistent and swelled separately.

D. vomiting or discharge of bloody fluid from the anus, abdominal hemorrhagic fluid by diagnostic puncture, treated by gastrointestinal decompression, etc., although abdominal distension is reduced, but abdominal pain is not significantly improved.

2 ovarian cyst pedicle torsion: the most common in 20 to 50 years old, mostly in small cysts, large mobility, long pedicle cysts, body position changes as its incentive. The clinical manifestation is a sudden onset of severe pain in the lower abdomen, which is persistent, accompanied by nausea and vomiting, and sometimes a swollen abdominal mass. Abdominal examination of the affected side of the abdominal tenderness, abdominal muscle tension. A vaginal examination can be used to reach a round, smooth, active, painful mass, sometimes with a taut and twisted pedicle that is definitive for diagnosis. B super visible on the side of the uterus is a circular liquid dark area with a smooth border. CT examination, laparoscopy, etc. are helpful for diagnosis.

3 biliary mites: more common in children and adolescents, mites into the biliary tract is the cause of this disease. The clinical manifestations are sudden onset of paroxysmal cramps in the upper abdomen or xiphoid, accompanied by nausea and vomiting, fever, jaundice and other symptoms. Intermittent pain is completely relieved. Some patients have a history of fecal discharge of mites. Abdominal examination: the abdomen is soft, the tenderness under the xiphoid is mild, and there is no rebound pain. B-ultrasound, X-ray venography and ERCP examination are helpful for diagnosis. Duodenal bile drainage examination found that aphid body yellow stains or ring indentations were found in the eggs and feces of the mites, which are evidence that the mites had drilled into the biliary tract.

4 kidney, ureteral stones: more common in 20 to 40 years old and young adults, its occurrence and urinary tract infections, obstruction, foreign body, diet, fungus, high calcium urine, high oxalic acid urine. The clinical manifestations are persistent dull pain or paroxysmal cramps in the affected side of the abdomen, upper abdomen or lower abdomen, often radiating to the lower abdomen or genital area, accompanied by nausea and vomiting, frequent urination, urgency, dysuria, hematuria, pyuria and fever. . Physical examination of the affected side of the kidney area, ureteral area has tenderness and sputum pain. X-ray examination can be found in the kidney area or ureteral stone shadow, B-ultrasound can be found in the X-ray can not show positive stones, urography can be found in the stone site and hydronephrosis. Diagnosis can be confirmed if there is a stone shadow in the kidney or ureteral area.

(4) Chest disease:

1 acute myocardial infarction: a small number of patients with acute myocardial infarction only showed upper abdominal pain, accompanied by nausea, vomiting, and even abdominal muscle tension, upper abdominal tenderness. Such patients are easily misdiagnosed, so the elderly, especially those with hypertension, atherosclerosis or past history of angina pectoris should be highly valued, electrocardiogram, echocardiography, serum enzymology examination has a diagnostic value.

2 acute pericarditis: acute pericarditis is more common in young adults, the reasons are non-specific, rheumatic, suppurative, tuberculous and malignant tumors, myocardial infarction sequelae. Clinically, there may be abdominal pain, abdominal muscle tension, tenderness, sweating, and paleness. Abdominal pain is persistent or paroxysmal, mostly in the middle and upper abdomen, sometimes in the right lower abdomen or the whole abdomen. Physical examination: jugular vein engorgement, hepatomegaly, odd pulse, pericardial friction sound and heart sound distant. The laboratory examined the increase in the total number of white blood cells and increased erythrocyte sedimentation rate. X-ray examination of the heart is triangular or trapezoidal. Echocardiography suggests pericardial effusion. Pericardial puncture and liquid extraction and pericardoscopy are helpful for diagnosis.

3 pneumococcal pneumonia: more common in young adults, the above respiratory infections, fatigue, rain and so on as incentives. The clinical manifestations are persistent pain in the upper abdomen, radiating to the affected side of the shoulder, accompanied by high fever, chills, cough, chest pain, difficulty breathing, and coughing rust. Physical examination: the respiratory movement of the affected side is weakened, the vocal fibrosis is enhanced, and the pathological breath sounds can be heard. The abdomen may have tenderness and abdominal muscle tension. The total number of white blood cells and neutrophils are elevated, and sputum and blood smears and culture can determine pathogenic bacteria. X-ray examination of the early stage of the lesion is the shadow of the distribution of the lung segment, and later a large piece of uniform and dense shadow can be confirmed.

2. Chronic abdominal pain

Chronic abdominal pain is slow onset, long course of disease, pain is mostly intermittent or delayed abdominal pain after acute onset, pain is mostly dull or painful, and there is also burning or cramping. The cause of chronic abdominal pain is more complicated, often intersecting with the cause of acute abdominal pain, causing difficulties in diagnosis and differential diagnosis.

(1) Esophageal hiatus: The incidence of hiatal hiatus hernia increases with age, more common after 30 years old, the main causes include late pregnancy, obesity, severe cough, tight belt, frequent vomiting, massive ascites, huge abdomen Internal tumors, chronic constipation, esophagitis, esophageal ulcers, etc. The main clinical manifestations are discomfort or burning in the upper and lower abdomen, and the pain is radiated to the shoulders and back, accompanied by symptoms such as hernia, acid reflux and anti-feeding. Post-food position is easy to induce symptoms, especially before bedtime, and walking after eating can relieve symptoms. The diagnosis of this disease mainly relies on X-ray barium meal examination and gastroscopy in special position.

(2) Lower esophageal cancer: It is more common in middle-aged and elderly people. The pathogenesis of the disease is still unclear. It is mainly caused by pain in the back of the sternum or under the xiphoid during early eating. It is burning, acupuncture or pulling. Like, accompanied by nausea and vomiting, loss of appetite, fatigue. Late dysphagia, hematemesis, black feces, etc. Physical examination: In the case of advanced cases, the upper abdomen can often be sputum and hard, fixed, uneven surface and tender mass. X-ray barium examination, esophageal mucosal exfoliative cytology, gastroscope and biopsy at the lesion showed that the cancer cells had a definite diagnosis value.

(3) peptic ulcer: upper abdominal pain is the most prominent symptom of ulcer disease, characterized by: chronic upper abdominal pain, repeated periodic attacks, obvious rhythm, gastric ulcer pain located in the middle or left of the upper abdomen, 0.5 after meal ~1h occurs, until the next meal is relieved. Duodenal ulcer pain is mostly located in the middle and upper abdomen or right side. It occurs 2 to 3 hours after a meal, showing hunger pain or nighttime pain. The pain of re-feeding can be alleviated. With acid reflux, nausea, vomiting, and suffocation, if there is no complication, the general condition has no obvious effect. Physical examination: gastric ulcer has tenderness in the middle and upper abdomen, and duodenal ulcer has tenderness in the right upper quadrant. There is no rebound pain and muscle tension. Gastric fluid analysis and fecal occult blood tests are helpful for diagnosis. X-ray barium meal examination or gastroscopy revealed that the ulcer has a definite diagnosis value.

(4) Chronic gastritis: Helicobacter pylori infection, smoking, drinking, duodenal reflux is the main cause of chronic gastritis. Its clinical manifestations are upper abdominal discomfort or dull pain, fullness after eating, and no obvious rhythm of pain. Accompanied by nausea and vomiting, loss of appetite, bloating, diarrhea, weight loss, and even anemia. The diagnosis of this disease is mainly based on gastroscopy and direct biopsy of gastric mucosa. Other auxiliary examinations, such as gastric acid determination, Hp examination, and serum gastrin content determination, help to understand the functional status of the stomach and establish the cause.

(5) Gastric cancer: more common in men over 40 years of age, the etiology and pathogenesis of the disease is not very clear. Its clinical manifestations are early pain or discomfort in the upper abdomen, severe pain in the late stage, irregular pain and rhythm, accompanied by fatigue, loss of appetite, abdominal distension, weight loss and fever, anemia. Physical examination: upper abdominal tenderness, 1/3 of patients can touch hard, irregular, tender mass, diagnosis based on gastroscopy and biopsy. Found that cancer cells have a definite value.

(6) Functional dyspepsia: Indigestion is a group of symptoms such as acid reflux, hernia, anorexia, nausea and vomiting, upper abdominal discomfort and pain, and B-ultrasound, X-ray barium meal, endoscopy, CT, etc. Symptoms of sexual lesions. In addition, patients are often accompanied by dizziness, headache, insomnia, palpitations, chest tightness, inattention and other symptoms. Physical examination: There is tenderness in the upper abdomen, but the site is not fixed. Diagnosis mainly relies on B-ultrasound, barium meal, gastroscope and other examinations to exclude organic lesions.

(7) Intestinal tuberculosis: more common in people under 40 years old, can be caused by tuberculosis, miliary tuberculosis, tuberculous peritonitis, tuberculous annexitis, divided into ulcer type and proliferative type. The main clinical manifestations are abdominal pain, diarrhea, constipation or diarrhea, constipation alternately, abdominal pain in the right lower abdomen or umbilical circumference, dull pain, dull pain or paroxysmal pain, can be aggravated by eating, accompanied by low fever, night sweats, weight loss, Bloating, anemia, poor appetite, etc. Proliferative type can show intestinal obstruction. Physical examination: There is tenderness in the lower abdomen, no rebound pain and muscle tension, proliferative type can be licked and mass. The erythrocyte sedimentation rate is obviously increased, and the stool acid-fast bacilli examination and the tuberculin test are helpful for diagnosis. X-ray barium meal examination can establish the lesion. Colonoscopy and mucosal biopsy at the lesion are useful for diagnosis and differential diagnosis.

(8) Crohn's disease (segmental enteritis): is a chronic, recurrent, granulomatous enteritis, the incidence of more than 21 to 40 years old. The main clinical manifestations are abdominal pain, diarrhea, abdominal mass, abdominal pain often occurs after meals, located in the right lower abdomen or umbilical circumference, usually spastic pain, sometimes persistent abdominal pain. Initially intermittent, followed by persistence, about 2 to 6 times a day, a paste-like stool, often without pus or mucus, may be associated with fever, nausea, vomiting, loss of appetite, fatigue, weight loss, bloating, anemia, etc. . Abdominal examination: There is tenderness in the whole abdomen or right lower abdomen, no rebound tenderness and abdominal muscle tension. When there is intestinal obstruction and fistula formation, the right lower abdomen can have a tender mass. Gastrointestinal X-ray barium meal or barium enema shows:

1 The intestinal stenosis and the X-ray showed a line-like sign.

2 There is a normal bowel between the diseased intestines.

3 The contour of the diseased intestine is asymmetrical, one side is stiff and the other side is inflated.

4 multiple nodular lesions and cobblestone signs.

5 fistula or sinus sacral shadows are helpful for diagnosis. Colonoscopy performance:

A. Longitudinal fissure ulcers.

B. The surrounding mucosa is normal or paving stone is uneven.

C. The intestines disappear and flatten into a water-tubular, narrow, and pseudopolyp.

D. The lesions are segmentally distributed. Tissue biopsy found non-caseous necrotizing granuloma and a large number of lymphocyte aggregates have diagnostic value.

(9) Ulcerative colitis: The etiology and pathogenesis of ulcerative colitis have not yet been fully elucidated. The age of predilection is 20 to 30 years old, and the number of men is slightly more than that of women. The clinical manifestations are abdominal pain, diarrhea, diarrhea as early symptoms, repeated attacks, long-term unhealed, several times to dozens of times a day, more often accompanied by urgency, or diarrhea and constipation alternately, feces have pus and mucus. Abdominal pain is often located in the left lower abdomen or lower abdomen with paroxysmal spasm, relieved after defecation, increased abdominal pain during the attack period, no abdominal pain or mild abdominal pain during remission, may be associated with weight loss, anemia, physical decline. Abdominal examination has left lower abdomen or total abdominal tenderness, no rebound pain and abdominal muscle tension. Blood routine examination of hemoglobin is reduced. The feces are routinely blood, pus and mucus. X-ray barium enema examination: In the early stage, the mucosa was found to have a granular change, and in the later stage, the intestinal tube was lead-like, stiff and short, and the colonic bag disappeared. Colonoscopy can determine the extent and severity of the lesion. Mucosal biopsy has diagnostic value.

(10) Colorectal cancer: The age of onset is 40 to 50 years old. The etiology and pathogenesis are still unclear. The main clinical manifestations are persistent pain in the left lower abdomen or right lower abdomen, which is aggravated after eating and relieved after defecation. If an intestinal obstruction or perforation occurs, it can cause acute abdominal pain. Some patients have diarrhea or constipation, or alternating between the two, the stool with blood or mucus. Rectal cancer is accompanied by urgency and so on. Often accompanied by loss of appetite, abdominal distension, weight loss, anemia, ascites, cachexia and so on. There is no obvious positive sign in the early stage of abdominal examination, and the mass can be touched in the late stage. The mass is hard, fixed and tender. There is a screening value for the determination of intestinal cancer-associated antigens such as serum carcinoembryonic antigen and CAl9-9. X-ray barium enema can detect the extent of the lesion and its relationship with the surrounding organs. Colonoscopy and biopsy have found that cancer cells have a definite value.

(11) Chronic appendicitis: Mostly caused by recurrent episodes of leftovers after remission of acute appendicitis, it may also be caused by foreign bodies such as stomach (intestine) stones, grains, and eggs in the appendix cavity. Clinical manifestations of intermittent or persistent pain in the lower right abdomen, often caused by severe exercise, improper diet or aggravation, accompanied by upper abdominal discomfort, indigestion, loss of appetite, abdominal distension, diarrhea or constipation. Abdominal examination of the right lower abdomen has localized, fixed tenderness. Blood routine, total white blood cell count and neutrophil increase during acute attack are helpful for diagnosis.

(12) chronic pancreatitis: more than 30 to 50 years old, mostly by biliary calculi, biliary ascariasis combined with biliary tract infection leading to recurrent episodes of pancreatitis, can also be caused by acute pancreatic acute pancreatitis. Its main clinical manifestations are related to eating, repeated episodes of dull pain, pain or cramps in the upper abdomen, which can be radiated to the lower back and shoulders, accompanied by hernia, nausea and vomiting, steatorrhea, and sometimes jaundice. Touched the lump. Patients may be asymptomatic during remission, or only have general dyspepsia symptoms. X-ray abdominal plain film examination can find pancreatic stones and pancreatic calcification shadows. X-ray examination of gastrointestinal barium can detect the displacement and degeneration of adjacent organs. B-ultrasound can show pancreatic enlargement and pancreatic duct protection. The diagnosis of chronic pancreatitis is mainly based on repeated episodes of abdominal pain and evidence of pancreatic endocrine and exocrine insufficiency such as diabetes and steatorrhea. In addition, pancreatic calcification or calculus is seen in the plain X-ray. B-ultrasound and ERCP examinations are very helpful for diagnosis.

(13) Pancreatic cancer: Most occur in people aged 40 to 60 years. The etiology and pathogenesis are still unclear. The main clinical manifestations are persistent dull pain or paroxysmal severe pain in the upper abdomen, and radiate to the lower back, the front chest and the right shoulder. The night and the lying position are aggravated, and the sitting position and the forward tilt position are alleviated, often accompanied by fatigue. Loss of appetite, nausea, vomiting, diarrhea, bloating, weight loss, etc. Those with jaundice are more common in pancreatic head cancer, and most of them are progressive deepening. Abdominal physical examination may have liver and gallbladder enlargement (Courvoisier sign), upper abdominal tenderness, partial body, tail cancer compression of splenic artery or abdominal aorta, vascular murmur can be heard in the left upper abdomen or umbilical cord, the sign suggests pancreatic body tail cancer. B-ultrasound is the most ideal method for examination. Percutaneous fine needle positioning and cytological examination under the guidance of B-ultrasound can improve the diagnostic accuracy. X-ray barium meal imaging is an indirect reflection of the location, size and gastrointestinal pressure of the cancer. ERCP, CT, and endoscopic ultrasound are all helpful for diagnosis.

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