Bloating

Introduction Abdominal distension, name of the disease. Out of "Lingshu·Jade Edition", "Lingshu·Swelling" and other articles. That is, the abdomen is swollen or full. Can be a subjective feeling, feel a part of the abdomen or full abdomen full, usually accompanied by related symptoms, such as vomiting, diarrhea, belching, etc.; can also be an objective examination to see a part of the abdomen Or full abdomen bulging. Abdominal distension is a common digestive system symptom. The causes of abdominal distension are mainly seen in flatulence of the gastrointestinal tract, ascites caused by various causes, and abdominal tumors.

Cause

Classification of causes:

1. Stomach disease: It is one of the important causes of abdominal distension. It is found in chronic gastritis, chronic atrophic gastritis, peptic ulcer, gastric dilatation, gastric torsion, gastroptosis, pyloric obstruction and gastric cancer.

2. Intestinal diseases: It is also an important cause of abdominal distension. It is more common in acute and chronic intestinal infections (such as bacterial dysentery, amoebic enteritis, intestinal tuberculosis, Crohn's disease, ulcerative colitis, etc.). Sign, acute, chronic intestinal obstruction, pseudo-intestinal obstruction, intestinal diverticulosis, constipation caused by various reasons.

3. Gastrointestinal functional diseases: such as gassing, intractable hiccups, functional dyspepsia (non-ulcer dyspepsia), irritable bowel syndrome (IBS).

4. Liver disease: It is also an important cause of abdominal distension, more common in acute and chronic hepatitis, especially in severe hepatitis (abdominal swelling is one of the main and stubborn symptoms), cirrhosis (abdominal swelling is often the main symptom of early cirrhosis), Liver abscess, liver cancer and so on.

5. Biliary diseases: such as acute and chronic cholecystitis, cholelithiasis and biliary obstruction caused by various reasons.

6. Pancreatic diseases: such as acute and chronic pancreatitis, giant pancreatic cysts, pancreatic cancer, etc.

7. Peritoneal diseases: such as acute suppurative peritonitis, tuberculous peritonitis, peritoneal cancer, and the like.

8. Acute infectious diseases: such as shock pneumonia, typhoid fever, severe tuberculosis and sepsis.

9. Cardiovascular disease: seen in acute and chronic congestive heart failure (especially right heart dysfunction), mesenteric vascular embolism or thrombosis.

10. Other causes: such as chronic renal insufficiency, electrolyte and acid-base metabolism disorders, connective tissue diseases, diabetic gastroparesis, blood system diseases, central nervous system or spinal cord lesions, pleural effusion and ascites caused by various causes, etc. .

an examination

Related inspection

Li Fan, he tested chest and ascites, examined stool volume, abdominal plain film, abdominal perspective

Laboratory inspection

Blood routine examination of children is essential, such as increased white blood cell count and increased neutrophils, often suggesting that the child has systemic, intra-abdominal or intra-abdominal infections. Many urinary tract diseases can cause urinary tract infections. Urine routine examination can be found that leukocytosis intestinal infection can be diagnosed by routine stool examination. Patients with leukocytosis and ascites should first be identified as leakage or exudate by routine examination of ascites. Sometimes a small amount of fluid can be taken by abdominal puncture to diagnose inflammation, hemorrhage, digestive tract or biliary perforation in the peritoneal puncture of children with malignant tumor metastasis, and tumor cells may be found.

Various infections caused by abdominal distension have infectious blood, erythrocyte sedimentation rate increases blood culture positive acute phase protein increase and so on.

Auxiliary inspection

Can be used for B-ultrasound, sputum enema X-ray standing photos or fluoroscopy see the small intestine in multiple liquid level and contracture of the colon can be diagnosed as mechanical intestinal obstruction; paralytic intestinal obstruction can be seen in the colonic inflation; see intestinal tube floating in the ascites For the characteristics of ascites.

Routine radiology examination

(1) Abdominal plain film: Because there is physiological gas accumulation in the abdomen of normal newborns and small infants, no matter whether the gas increases or decreases, it may indicate that there may be lesions. Therefore, the diagnostic value of abdominal flat films in children is far greater than that of adults. And the younger the age, the more information you can provide. In addition to suggesting intestinal obstruction in different parts, it may also indicate the size and location of abdominal occupying lesions. Abdominal plain film is also easy to show the meridian peritonitis and neuroblastoma with different characteristics of calcification and teratoma skeletal shadow and suggest diagnosis. Abdominal plain film should be the first choice for the diagnosis of pneumoperitoneum.

Digestive tract angiography

1 meal: for the diagnosis of congenital hypertrophic pyloric stenosis and duodenal obstruction is very helpful, but in addition to chronic incomplete intestinal obstruction can sometimes be determined by barium meal, the position of the obstruction is generally low intestinal obstruction, do not make barium meal, sometimes by barium meal to determine The size and location of the lesions in the abdominal cavity.

2 enema: suspected colonic lesions often need to do barium enema examination, such as according to the colonic sputum, transition and expansion of the colon to diagnose congenital megacolon, according to the "fetal colon" diagnosis of intestinal atresia.

In children with intestinal obstruction, the presence or absence of gas in the colon can be determined by barium enema to determine whether the obstruction is a complete pelvic mass and rectal lesions may also be diagnosed by barium enema.

Urinary angiography

1 intravenous pyelography (IVP): commonly used to diagnose congenital malformations of the urinary system or tumors, such as hydronephrosis and diagnosis of nephroblastoma. IVP can also indicate the secretory function of the kidney. When other retroperitoneal masses are suspected, the renal or ureteral pressure is often detected by IVP examination to prompt diagnosis.

2 retrograde cystography: the most important for the diagnosis of urethral valve, ureteral cyst and bladder tumor.

CT examination

With the increasing use of medical instruments and devices, it is sometimes diagnostic for abdominal distension caused by abdominal masses or tumors. Through this examination, not only the size of the tumor can be measured, but also the mass of the tumor can be determined. The thickness of the cyst wall and the approximate trait of the capsule content can also be used to confirm that the tumor is derived from an organ or shows its The relationship between the surrounding organs but CT is a static image, and the display of functions is often inferior to B-mode. The price of this inspection is also high, and some small and medium medical units are still difficult to equip, and the application is limited. In addition, CT examination should be closely combined with clinical practice when the pediatric application time is short and the diagnostic experience and data accumulation are insufficient to determine the diagnosis.

B-ultrasound

B-ultrasound is easy to show soft tissue (such as liver and spleen) liquid (including ascites) and hydronephrosis cystic cysts such as cystic color Doppler can show the blood supply and vascular system morphology, and can indicate the direction of blood flow and Speed is unique compared to CT. This test is non-invasive and can be observed dynamically or repeatedly. The relatively inexpensive B-ultrasound has replaced some routine radiological examinations, such as the diagnosis of partial congenital hypertrophic pyloric stenosis and the positioning of the posterior urethral valve. And diagnosis of hydronephrosis. B-ultrasound is also gradually developed in the field of acute abdomen, such as intussusception and the diagnosis of acute appendicitis. Of course, any imaging examination results should be closely combined with the clinical, and mutual verification can continuously improve the diagnostic compliance rate and application value.

Differential diagnosis

Identification:

1. Normal people may have a small amount of gas in the gastrointestinal tract, about 150 ml (ml).

2, when swallowed into the stomach too much air or due to poor digestion and absorption function, the gas in the gastrointestinal tract is too much, and the gas in the intestine can not be excreted from the anus, it can cause abdominal distension.

3, the common clinical causes of gastrointestinal flatulence are gassing, acute gastric dilatation, pyloric obstruction, intestinal obstruction, intestinal paralysis, intractable constipation, hepatobiliary diseases and certain systemic diseases. Late pregnancy can also cause bloating, but it is physiological.

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