Perforated or bleeding ulcer

Introduction Gastric and duodenal ulcer perforation, such as ulcer erosive force, penetrate the serosa layer and reach the free abdominal cavity can cause acute perforation. If the ulcer penetrates and the adjacent organ tissue is dry, it is called penetrating ulcer or chronic perforation of ulcer. Subacute perforation is called when the posterior wall is perforated or perforated and only causes localized peritonitis. Acute perforation is the most serious complication of peptic ulcer and can die from peritonitis and sepsis. Symptoms of abdominal pain, cold pain or swelling and pain, tingling fixed, painful refuse to press or have hematemesis, melena, dark eyes, purple tongue, pulse string or late.

Cause

The disease is based on chronic stomach cramps, the actual pain and heat pain caused by disease and evil. From the beginning of the disease, from the spleen and stomach, after the liver and other organs. However, the basis of chronic stomach cramps, or by cold evil, food block; or liver gas guilty; or spleen and stomach cold; or blood stasis caused by different.

Perforation of gastric ulcer occurs mostly on the small curved side of the anterior wall of the stomach near the pylorus. The perforation is generally slightly larger than that of the duodenum, and the content of the stomach is more than that of the duodenum, so the acute peritoneal inflammation caused by it is often heavier. There is a long history of chronic ulcers, acute perforation, obvious scars in the ulcer, a few acute perforations without a history of ulcers, local ulcer and local intestinal wall close to normal, no significant thickening or inflammation.

After the perforation of the ulcer, food, gastric acid, duodenal juice, bile, pancreatic juice and other chemically stimulated gastric contents flow into the free abdominal cavity, causing chemical peritonitis, causing severe pain and a large amount of fluid exudation. After a few hours, the gastrointestinal secretion was inhibited, the leakage was reduced, the chemical irritant was diluted by the exudate, and the abdominal pain was alleviated. As the chemical turned to suppurative, the infectious disease and abdominal pain gradually worsened. The severity of the symptoms is related to the amount of leakage, the size and location of the perforation, perforation of the fasting or post-meal perforation, and the adhesion of the perforation to the surrounding tissue. Because of the severity of the disease, there are large differences with individuals.

an examination

Related inspection

Gastrointestinal CT examination of gastric ultrasound examination of gastric juice microscopy

The disease is rapidly onset and changes rapidly. Often under the influence of disease and evil, sudden abdominal pain starts from the stomach and sputum, and then extends to the whole abdomen. The disease is stagnation and stagnation for a long time. It shows various kinds of real fever, and it can be transferred to another card after treatment or for a long time. Therefore, it is good to use the syndrome to grasp the stage of the disease for syndrome differentiation and treatment.

1. Qi stagnation and blood stasis period (closed period): rapid onset, severe pain, from stomach cramps, rapid and full abdomen, abdominal muscles are tight, refused to refuse to move. The pain does not work, this is the image of qi and blood. The food does not follow the usual path, and it wears the gastrointestinal wall. It is smoldering in the abdomen, and the blood and blood are closed. Even more pale, cold limbs, cold sweat and shortness, pulse string tight or fine number of symptoms. This issue lasts for 1 to 2 days.

2. Toxic heat blizzard period ( heat period): three to five hours of onset of abdominal pain persists, from the stomach to the umbilical cord, the lower abdomen, lower abdomen, and even the whole abdomen. Fever, abdominal tight as a plate, constipation or closed, nausea and vomiting, short urine, yellow fur, pulse number, this is the disease and food and the food in the Yangming stomach sputum, stagnation heat, poison stagnation (intestinal paralysis), or heat evil smoldering Jin Wei, or heat into pus (suppurative peritonitis); or hot and humid bet, poly-formed (right lower abdomen or pelvic abscess); or hot deep sputum (toxic shock) ). Heat evil consumes Tianjin, conduction is lost, so constipation, polydipsia and drinking. The heat is forced to overflow from the sweat. The red, yellow, and pulse numbers are all images of real heat.

Differential diagnosis

1. Acute pancreatitis: It is also an acute abdomen caused by chemical stimulation. Clinical manifestations are similar to ulcer perforations. But the following characteristics can be identified:

1 Abdominal pain is more sudden, but not as rapid as perforation of the ulcer. The abdominal pain begins with a light and heavy process. The site is limited to the left abdomen and the back of the upper abdomen. The signs are relatively light compared with severe abdominal pain.

2 The amylase content of serum and peritoneal exudate can also be increased in the perforation of ulcers, but the increase is not enough to diagnose acute pancreatitis.

2. Cholelithiasis, acute cholecystitis: the onset of biliary colic is mainly paroxysmal, the tenderness is confined to the right upper abdomen, to a lesser extent, and the abdominal muscle tension is not as significant as the perforation. If serum bilirubin is increased, B-ultrasound can confirm the diagnosis.

3. Acute appendicitis: When the leakage of the perforated ulcer rises to the right sulcus of the colon or the root of the small mesenteric to the right lower abdomen, it can cause peritonitis of the right lower quadrant and resemble the symptoms and signs of perforation of appendicitis. However, the upper abdominal pain at the beginning of acute appendicitis is generally not very severe. When the abdominal pain is aggravated, the upper abdomen is not the main. The symptoms and signs of peritonitis are more obvious in the lower right abdomen than in the upper abdomen.

4. rupture of ectopic pregnancy and ovarian cyst torsion: When the leakage of ulcer perforation spreads to the pelvic cavity, it causes peritonitis of the lower abdomen and is similar to the symptoms and signs of rupture of ectopic pregnancy and torsion of ovarian cyst. However, the performance of the upper abdomen of the latter two is not prominent. There is a pregnancy manifestation and a mass in the lower abdomen in the medical history. After the pelvic pelvic puncture of the blood, the diagnosis is not difficult.

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