Retrobulbar ulcer

Introduction Post-duodenal ulcer has symptoms of bulbar ulcer, but the pain is more dramatic, it can be radiated to the right shoulder, and bleeding and perforation are more likely to occur. Because of the lower part, the instrument examination is more likely to be missed. Post-duodenal ulcer is a rare type of peptic ulcer. It is characterized by severe symptoms, many complications, poor medical treatment and difficulty in preoperative diagnosis. Post-duodenal ulcers are often missed or misdiagnosed or delayed due to difficult diagnosis. Reported in the literature, the incidence of post-balloon ulcers accounted for 0.1% to 5.8% of the incidence of duodenal ulcers, while the necropsy diagnosis of 5% to 20%. The position of the ulcer is more common in the inner wall of the upper part of the duodenum, which is rare below the nipple. The age of onset of the patients was higher than that of duodenal bulb ulcers.

Cause

(1) Environmental factors: 1 Among environmental factors, the situation of diet is the first to bear the brunt. A more accepted view is that irregular diet may increase the risk of ulcer disease, and cold and stomach-stimulated food can often cause recurrence of ulcer disease. The different habits of 2 people are often associated with the onset of post-balloon ulcers. For example, the incidence of post-balloon ulcers in long-term smokers is significantly higher than that in non-smokers. 3 occupational high-stress occupational easy to cause post-ulcer ulcers, this is only a general impression, there is no definite evidence, but from the patient's treatment, the proportion of intellectuals suffering from post-ball ulcers is quite large. 4 It has been clarified that aspirin can destroy the self-regulating effect of gastric acid secretion and the gastric mucosal barrier, which can cause ulcer disease.

(2) Genetic factors: the incidence of post-balloon ulcers is closely related to genetic factors. From the study of genealogy, the relatives of chronic peptic ulcer patients have 2.5 to 3 times greater chance of suffering from ulcer disease than the general population. Moreover, the heritability of both gastric ulcer and post-balloon ulcer is irrelevant. Relatives and children of patients with post-balloon ulcers are prone to post-ball ulcers rather than gastric ulcers. vice versa. One of the identical twins, such as a stomach or post-ball ulcer, is susceptible to the same ulcer, which is not the case with fraternal twins. The identity of ulcers in identical twins suggests that genetic factors play an important role in the pathogenesis of ulcers. Post-balloon ulcers are associated with two genetic traits. ABO blood type and blood type substance ABH secretion state. People with a blood type of "O" are prone to post-ball ulcers, 1.4 times higher than those with a blood type of "A", "B" or "AB". In short, according to the understanding, the incidence of peptic ulcer has a certain relationship with heredity. Although it is not completely possible to explain all ulcer diseases by genetics, regardless of the cause, peptic ulcer seems to have a family tendency.

(3) Physical and mental factors: The relationship between mental factors and upper gastrointestinal diseases is well known. Long-term psychological stress or sustained high levels of mental stress are predisposed to peptic ulcer. However, the exact mechanism has not been confirmed, which may be related to long-term psychological (mental) stress, causing an increase in ulceration or a decrease in mucosal resistance. In view of the fact that psychological stress is a common phenomenon in society, only a few people have ulcer disease, so other pathogenic factors must be involved in addition to physical and mental factors.

Pathology of post-balloon ulcer

(1) Yu anger hurts the liver, liver qi guilty stomach: long-term anxiety and anger, poor feelings, liver qi stagnation, stagnation and dereliction of duty, cross-counter crimes, qi and blood stasis can not work, nowhere is pain. Because of the qi and blood, qi stagnation for a long time, can also lead to the production of blood stasis, blood stasis, its pain is severe, and can be seen vomiting blood, blood in the stool and other evidence.

(2) diet is not good, damage the spleen and stomach: overeating, hunger and satiety, the most vulnerable to spleen and stomach. Or overeating, cold, cold stomach, qi and blood stagnant, and causing stomach cold pain; or eating fat and spicy, overdrinking spirits, resulting in heat and heat, causing stomach heat pain.

(3) Insufficient endowment, spleen and stomach weakness: the body spleen and stomach weakness, or fatigue and internal injuries, or long-term illness, extended to the spleen and stomach, or improper medication, can damage the spleen and stomach. Deficiency of the spleen and stomach, Zhongyang does not transport, cold from the endogenous people are mostly cold and stomach pain, often due to cold and cold, eating and eating accidentally.

an examination

Related inspection

Abdominal vascular ultrasound examination of laparoscopic ascites

X-ray examination

X-ray examination, especially low-profile duodenal angiography, is helpful for diagnosis. The diagnosis was based on the discovery of stenosis and duodenal stenosis, local irritation and mucosal changes. However, in combination with clinical and comprehensive analysis of X-ray performance, we can draw conclusions. There is a technical difficulty in X-ray examination. The key is to try to expose the back of the ball and make the part have a good filling of the tincture. We understand: Radiological examination, whether standing, prone or supine, requires a combination of oblique fluoroscopy and close observation.

Fiber endoscopy

Fiberoptic endoscopy has diagnostic value for post-balloon ulcers, but the detection rate is low. Zhang Ziqi and other reports, 13509 cases of fiberoptic gastroscopy, found 3422 cases of duodenal ulcer, 31 cases of post-balloon ulcers, accounting for 0.91% of duodenal ulcer. The detection rate of fiber endoscopy is lower than that of autopsy and surgical detection, which is mainly due to insufficient understanding of the disease and insufficient attention. Recommendation: For patients with gastric and duodenal spheroid lesions that cannot be explained by fiberoptic endoscopy, the posterior ball should be examined routinely.

Differential diagnosis

Traditional Chinese medicine divides the post-balloon ulcer into cold type, qi stagnation type, stagnation type, phlegm-stasis type, deficient cold type, and yin deficiency type. The diet treatment needs to be treated according to different conditions.

Cold type

Mostly caused by gluttony and cold, when the stomach is in a hurry, the heat is relieved.

Blood type

Most of the pain is fixed, and even the hematemesis is black.

Deficiency type

Most of them are painful, like warm and happy, and easy to relapse after exertion.

Yin deficiency type

According to the doctor's syndrome, choose the therapeutic side.

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