Digestive tract perforation

Introduction Gastric perforation is one of the most serious complications in patients with ulcer disease. The patient's gastric perforation is mainly caused by overeating. Overeating can cause an increase in gastric acid and pepsin, and it is easy to induce gastric perforation. Gastric perforation can be died if not treated in time. Ulcer patients can't eat fast, they should chew slowly, and they should not be hungry. Foods that are rough, too cold, too hot, and irritating, such as peppers, peppers, and strong teas, should be avoided, while smoking and alcohol are quit. When the pain is severe, you can eat soy milk or milk for a period of time, eat more meals, 5 to 8 times a day, after the condition improves, you can change the porridge and noodles, and gradually return to the normal diet.

Cause

The most common cause of gastric perforation is peptic ulcer. As the ulcer deepens, it penetrates the muscle layer, the serosal layer, and finally penetrates the stomach or the wall of the duodenum to cause perforation. Several different consequences can occur after perforation. For example, before the perforation, the ulcer base has adhered to adjacent organs such as pancreas and liver, forming a penetrating ulcer, which is a chronic perforation. In a few cases, the ulcer base adheres to the transverse colon, and the perforation forms a gastric colon fistula. Most of the above two cases occur in the stomach, and the duodenal ulcer is perforated in the posterior wall. If the ulcer is perforated and quickly adheres to the omentum or nearby organs, an abscess can be formed around the perforation.

an examination

Related inspection

Upper digestive tract X-ray meal upper gastrointestinal endoscopy

Abdominal pain

Sudden onset of severe abdominal pain is the most frequent and most important symptom of gastric perforation. Pain initially begins in the upper abdomen or perforated area, often with a knife-cut or burning-like pain, usually persistent, but also aggravated. The pain quickly spreads throughout the abdomen and can spread to the shoulders with a stinging or sore feeling.

2. In the early stage of perforation of shock symptoms, patients often have a certain degree of shock symptoms, and the disease progresses to bacterial peritonitis and intestinal paralysis. The patient may have toxic shock again.

3. Nausea, vomiting

About half of the patients have nausea and vomiting, which is not severe. The vomiting is aggravated during intestinal paralysis, and there are symptoms such as bloating and constipation.

4. Other symptoms

Fever, rapid pulse, increased white blood cells, etc., but generally appear several hours after perforation.

an examination

1. Physical examination: abdominal wall tenderness, rebound tenderness, muscle tension and peritonitis symptoms, liver dullness area shrinks or disappears.

2. Abdominal puncture to extract purulent fluid, the diagnosis is more clear.

3. X-ray, B-ultrasound, CT examination, diagnosis of disease.

Differential diagnosis

Need to be identified with the following symptoms:

Upper gastrointestinal bleeding: from the esophagus to the rectum called the digestive tract of the human body. The boundary between the duodenum and the jejunum is bounded by the upper digestive tract and the lower digestive tract below. Therefore, the upper digestive tract should include esophageal, gastric, duodenal and pancreatic, biliary bleeding, collectively referred to as upper gastrointestinal bleeding. Among them, ulcer disease accounts for about half, and esophageal and gastric varices account for 25%. In recent years, cases of acute hemorrhagic gastritis and erosive gastritis with blood have also increased, and about 5% of cases have not been confirmed, even if The laparotomy failed to find the cause of the bleeding. Its clinical manifestations are mainly hematemesis and black feces, often accompanied by clinical manifestations of hypovolemia, which is a common emergency.

Digestive tract stenosis: There are many causes of gastrointestinal stenosis, such as inflammatory stenosis, postoperative anastomotic stenosis, neoplastic stenosis, dysplasia, dysmotility (cardiac dysfunction) and acid-base burns. Clinically, the above digestive tract stenosis is the most common, so it often causes symptoms of dysphagia. In severe cases, it cannot be eaten. The treatment of the water sac, the balloon, the expansion of the Shah's probe or the placement of a metal stent can relieve the stenosis and ease the difficulty of eating.

Digestive tract irritation: digestive tract irritation, also known as irritable bowel syndrome. Refers to a group of clinical syndromes including abdominal pain, bloating, changes in bowel habits, abnormal stool characteristics, mucus, etc., persistent or recurrent, and examined to rule out organic diseases that can cause these symptoms. This disease is the most common type of functional bowel disease.

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