Gastric distension

Introduction Gastric dilatation refers to a group of syndromes caused by a large amount of gas and fluid accumulation in the stomach and duodenum in a short period of time, or food retention, resulting in a high degree of expansion of the upper part of the stomach and duodenum. Mainly due to some postoperative complications, overeating, long-term supine patients and the elderly with debilitating disease, the disease is mainly caused by acute gastric dilatation. Early symptoms are not obvious, only the upper abdomen is full and nausea. Subsequent persistent pain in the upper abdomen or umbilical cord, paroxysmal aggravation, severe abdominal pain if accompanied by gastric perforation.

Cause

The etiology and pathogenesis are not fully understood. Most are considered to be associated with gastric neuromodulation disorders, overeating, long-term supine position, ridge forward, body plaster fixation, severe pain, abdominal trauma, stomach and adjacent organs, systemic or local infections, neurological diseases (such as diabetes) Sexual neuropathy), metabolic diseases (such as hypokalemia, hypocalcemia), emotional stress, post-vagus nerve ablation, excessive use of anticholinergics, etc. may also be associated with the disease. It may also cause a large amount of gas to enter the stomach due to the secretion of the upper digestive tract secretion and the gas in the stomach, duodenum, or due to anesthesia, oxygen supply technology is incorrect, so as to aggravate acute gastric dilatation. Acute gastric dilatation often pushes the small intestine downward, pulling the small mesenteric and superior mesenteric artery, thus pressing the duodenum to the third, causing bile and facial fluid to flow back into the stomach. The stomach and duodenum are extremely dilated, occupying most of the abdominal cavity, and the local wall circulation disorder occurs due to expansion of the stomach wall, which can lead to gastric bleeding, necrosis and perforation. A large loss of water and electrolytes, imbalance of acid-base balance, compression of the inferior vena cava, reflex visceral vasodilation caused by dilatation of the gastroduodenum, and complicated pulmonary infection all reduce the effective circulating blood volume and cardiac output. Shock occurred.

an examination

Related inspection

Gastrointestinal dysfunction, gastrointestinal examination, ultrasound examination, gastric ultrasound, electronic gastroscope

The onset is urgent. The main clinical manifestations are persistent pain or dull pain in the upper abdomen or umbilical cord, which may have paroxysmal aggravation; followed by abdominal distension and vomiting. Frequent vomiting is a prominent symptom. It starts with a small mouth reflux, and the amount of vomiting increases gradually. The vomit is dark green or brown turbid liquid, sometimes coffee, and the occult blood test is positive. Examination revealed that the abdomen was highly bulging, especially the abdomen was obvious; the abdominal wall was generally soft and the tenderness was very light; the abdominal percussion showed obvious drum sounds and there was a sound of water; the bowel sounds weakened or disappeared. In the later stage, there are obvious water, electrolyte imbalances and acid-base balance disorders until shock occurs.

The x-ray examination showed that the abdomen was diffuse and uniform in shadow, and the thick surface of the stomach bubble was obviously widened. A large amount of gastroduodenal effusion could be aspirated through the gastric tube to aid diagnosis. The disease must be differentiated from diffuse peritonitis and acute intestinal obstruction.

Differential diagnosis

Need to be identified with the following symptoms:

Acute gastric dilatation: Acute gastric dilatation refers to a syndrome caused by a large amount of gas and fluid accumulation in the short term, and a high degree of expansion of the upper part of the stomach and duodenum. It is usually a serious complication of certain internal surgical diseases or anesthesia operations.

Gastric shift: The volvulus of stomach is a fixed mechanism of the normal position of the stomach or its adjacent organ lesions cause gastric displacement.

Gastric duplication: Gastric duplication is a form of repeated malformation of the gastrointestinal tract.

The onset is urgent. The main clinical manifestations are persistent pain or dull pain in the upper abdomen or umbilical cord, which may have paroxysmal aggravation; followed by abdominal distension and vomiting. Frequent vomiting is a prominent symptom. It starts with a small mouth reflux, and the amount of vomiting increases gradually. The vomit is dark green or brown turbid liquid, sometimes coffee, and the occult blood test is positive. Examination revealed that the abdomen was highly bulging, especially the abdomen was obvious; the abdominal wall was generally soft and the tenderness was very light; the abdominal percussion showed obvious drum sounds and there was a sound of water; the bowel sounds weakened or disappeared. In the later stage, there are obvious water, electrolyte imbalances and acid-base balance disorders until shock occurs.

The x-ray examination showed that the abdomen was diffuse and uniform in shadow, and the concentrated plane of the gastric bubble was obviously widened, and a large amount of gastroduodenal effusion was aspirated through the gastric tube. The disease must be differentiated from diffuse peritonitis and acute intestinal obstruction.

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