Duodenal hyperdilatation

Introduction One of the clinical symptoms of acute jejunal input sputum obstruction in the high jejunal sputum syndrome is one of the causes of acute gastric dilatation. The duodenum is between the stomach and the jejunum. The length of the adult is 20-25 cm, the diameter of the tube is 4-5 cm, and it is close to the posterior wall of the abdomen. It is the shortest length of the small intestine, the largest diameter, the deepest position and the most fixed. Small intestine segment. Both the pancreatic duct and the common bile duct open in the duodenum. Therefore, it accepts both gastric juice and pancreatic juice and bile injection, so the digestive function of the duodenum is very important. The shape of the duodenum is "C" shape, which covers the head of the pancreas and can be divided into four parts: the upper part, the lower part, the horizontal part and the ascending part.

Cause

Disease status Duodenal hoarding, duodenal tumor, foreign body, etc. caused by certain diseases such as gastric torsion, incarcerated esophageal hiatal hernia, etc. can cause gastric dilatation. Pathological changes of tissues and organs around the pylorus, such as spinal deformity, annular pancreas, pancreatic cancer, etc., if the output channel of the stomach is compressed, can cause acute gastric dilatation. Long-term bedridden patients with chronic diseases, as well as post-spinal extension, body plaster model fixation, can also occur gastric and duodenal dilatation, may be related to duodenal compression of the superior mesenteric artery. Various causes of autonomic dysfunction, diabetic neuropathy, severe infections (such as sepsis), the use of anticholinergic drugs, and potassium and water imbalances in the balance of water and electrolytes can affect gastric tension and gastric tract Empty leads to acute gastric dilatation.

The stomach and duodenum are highly dilated, the stomach wall may be thinned due to excessive stretching, the surface of the stomach is dilated and hyperemia, and there are bleeding in various layers of the stomach wall. Individual blood vessels may have thrombosis, or necrosis and perforation due to blood circulation disorder. . The stomach wall thickens when there is inflammatory edema. In most patients, the duodenal transverse is compressed by the superior mesenteric artery, and even the duodenal wall may have compression ulcers. In the advanced stage, there are small erosion points on the gastric mucosa. Peritonitis can be caused when the stomach wall is necrotic and perforated.

an examination

Related inspection

Duodenal drainage microscopy for blood routine

According to the history and physical signs, combined with laboratory tests and abdominal X-ray signs, the diagnosis is generally not difficult. Gastric dilatation that occurs after surgery is often misdiagnosed due to atypical symptoms and confusion with general postoperative gastrointestinal symptoms. In addition, it should be differentiated from intestinal obstruction and intestinal paralysis. Intestinal obstruction and intestinal paralysis mainly involve the small intestine. The abdominal distension is obvious in the middle of the abdomen. There is no large amount of fluid and gas in the stomach. The patient will not have much benefit after evacuating the stomach contents. The X-ray film can be seen in a plurality of stepped liquid levels.

1. Early, long-term bed rest or over-satisfaction after surgery, there is swelling of the upper abdomen, accompanied by symptoms of involuntary and powerless vomiting of stomach contents.

2. X-ray abdominal plain film can be seen in the dilated and gas-filled stomach cavity, which has a huge intragastric fluid-liquid level, and most of them occupy most of the abdominal cavity.

3. Pyloric obstruction, high mechanical intestinal obstruction and acute gastroenteritis should be excluded.

Differential diagnosis

Should be noted with diffuse peritonitis, high mechanical intestinal obstruction and pyloric obstruction. Diffuse peritonitis often has a history of intestinal perforation or acute inflammation of the abdominal organs, with signs of peritoneal irritation, loss of bowel sounds, and elevated body temperature and white blood cell count. High intestinal mechanical obstruction in the small intestine, often with paroxysmal colic, hyperthyroidism, vomit is the content of the small intestine, swelling is not obvious, X-ray examination can be seen a number of stepped liquid level. Pyloric obstruction often has a history of chronic stomach and duodenal ulcer. The stomach type and gastric peristalsis wave are visible. The degree of gastric dilatation is very light. The content of vomiting is food and gastric juice.

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