Acute gastric distension

Introduction Acute gastric dilatation means that a large amount of contents in the stomach and duodenum cannot be discharged in a short period of time, and the extreme expansion occurs, resulting in repeated vomiting, and then water and electrolyte disorders, and even shock and death. The disease usually occurs after surgery, and can also be caused by overeating. Both children and adults can develop morbidity, which is more common in men. It is usually a serious complication of certain internal surgical diseases or anesthesia operations. In the early stage of the patient's onset, he felt abdominal fullness, pain in the upper abdomen or umbilicus, and generally sustained pain. He may have a paroxysmal aggravation, but it is not severe.

Cause

Some organic diseases and functional factors can be associated with acute gastric dilatation, which are commonly classified into three categories:

(1) Surgery

Trauma, anesthesia and surgery, especially abdominal, pelvic surgery and vagus nerve surgery, can directly stimulate the body or splanchnic nerve, causing autonomic dysfunction of the stomach, reflex inhibition of the stomach wall, causing gastric smooth muscle relaxation, and then expansion. Intubation of the trachea during anesthesia, postoperative oxygenation and gastric tube nasal feeding, can also make a large amount of gas into the stomach, forming an expansion.

(2) Disease status

Gastric torsion, incarcerated hiatal hernia and various causes of duodenal hoarding, duodenal tumor, foreign body, etc. can cause gastric retention and acute gastric dilatation; lesions near the pyloric, such as spinal deformity The ring-shaped pancreas, pancreatic cancer, etc. can even cause the acute gastric dilatation in the output channel of the stomach, and the so-called "cast syndrome" caused by the plaque on the body for 1 to 2 days may be excessive stretching of the spine. The duodenum is compressed by the superior mesenteric artery. Emotional stress, depression, and malnutrition can cause autonomic dysfunction, delaying gastric tension and delay in emptying, and application of diabetic neuropathy and anticholinergic drugs. Water, electrolyte metabolism disorders, severe infections (such as sepsis) can affect the tension of the stomach and emptying of the stomach, leading to acute gastric dilatation.

(3) Stress states caused by various traumas

Especially in the upper abdominal contusion or severe combined injury, its occurrence is related to the strong stimulation of the celiac plexus. Too much eating in a short period of time is also an occasional reason.

an examination

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.

Most of the onset is slow, and vagus nerve cuts often begin to enter the fluid diet after the second week after surgery. The main symptoms are bloating, upper abdominal or umbilical pain, nausea and persistent vomiting. The vomit is a turbid brown-green or brown liquid, and the symptoms are not alleviated after vomiting. As the condition worsens, the general condition deteriorates progressively. In severe cases, dehydration and alkalosis may occur, and irritability, shortness of breath, hand and foot convulsions, blood pressure drop, and shock may occur. The prominent signs are the expansion of the upper abdomen, which shows that there is no wriggling stomach contour, local tenderness, excessive percussion, and vibration. There is a localized mass on the right side of the umbilicus. The appearance is bulging, the touch is smooth and elastic, and the tenderness is light. The lower right border is clearer. This is the extremely dilated gastric antrum. It is called Giant sinus disease and is an acute stomach. The unique vital signs of expansion can be used as a strong evidence for clinical diagnosis.

Laboratory tests can reveal blood concentration, hypokalemia, hypochloremia and alkalosis. The abdomen X-ray film showed a large liquid level in the left upper abdomen and a large stomach shadow and a left iliac muscle elevation filled with the abdominal cavity.

Differential diagnosis

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. After taking the stomach contents, the patient will not have much benefit. X A plurality of stepped liquid levels can be seen in the flat sheet.

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