pyloric cicatricial stenosis
Introduction
Introduction The pylorus is the narrowest part of the digestive tract, and the normal diameter is about 1.5 cm, so it is prone to obstruction. As the pylorus passes through the obstacle, the contents of the stomach cannot enter the intestine smoothly, but a large amount of retention in the stomach leads to hypertrophy of the muscular layer of the stomach wall, scar formation of the pylorus, enlargement of the gastric cavity and inflammation of the gastric mucosa, edema and erosion. Clinically, due to long-term failure of patients to eat normally, and a large number of vomiting, leading to severe malnutrition, hypoproteinemia and anemia, and severe water dehydration, low potassium and alkali poisoning and other water and electrolyte disorders. Scar pyloric stenosis is more common. Submucosal fibrosis caused by chronic ulcers, the pyloric passage caused by scarring stenosis is blocked, and food and gastric juice cannot pass smoothly.
Cause
Cause
The cause of pyloric scarring stenosis:
Ulcers located near the pylorus or pylorus may be due to mucosal edema, or reflex pyloric ring muscle contraction due to ulcers. The more common cause is submucosal fibrosis caused by chronic ulcers, scarring stenosis, pyloric obstruction caused by ulcer disease About 10%. In addition, adults can also develop pyloric muscle hypertrophy and produce pyloric obstruction. The onset or exacerbation of pyloric fistula is often paroxysmal, and the obstruction can be relieved by itself; mucosal edema can be resolved with the reduction of inflammation. However, the pyloric stenosis caused by scar contracture can not be alleviated. And constantly increasing. The pyloric fistula is purely functional, and the rest are all organic lesions. Pyloric edema is associated with inflammation of the stomach. Although it is an organic disease, it can heal itself. Only scarring stenosis can not be solved by surgery. The occurrence of pyloric obstruction is often not a single factor, but a combination of multiple factors. See Obstruction due to tumors can be found in gastric cancer.
1. sacral pyloric stenosis: ulcers located near the pylorus or pylorus, may be due to mucosal edema or ulceration caused by reflex pyloric ring muscle contraction, resulting in pyloric passage through the barrier, the obstruction is intermittent.
2. Edema pyloric stenosis: due to ulcer activity, mucosal inflammation and edema, the pylorus can be blocked, but the inflammation and edema can be relieved, this obstruction is temporary.
3. Scar pyloric stenosis is more common. Submucosal fibrosis caused by chronic ulcers, the pyloric passage caused by scarring stenosis is blocked, so that food and gastric juice can not pass smoothly. This obstruction is permanent and often requires surgery.
Examine
an examination
Related inspection
Gastrointestinal CT examination, fiberoptic examination, gastric ultrasonography
Examination and diagnosis of pyloric scar stenosis:
1. The general patient has a history of longer ulcers. As the disease progresses, the stomach pain gradually worsens, and there are symptoms such as hernia and nausea. Patients often get anorexia due to bloating, and antacids are becoming ineffective. Because the stomach is unbearable, the patient himself uses his fingers to reach the pharynx to induce vomiting. The spit is usually a diet that was taken a few hours ago and contains no bile and is sour and sour. Gradually vomiting frequently, the patient was afraid of eating because of fear of bloating, but he still spit out all the food during the day, and then felt comfortable. The stomach gradually expands, the upper abdomen is full and complains of a moving mass. The patient himself and his family can see that due to the increased number of vomiting, the dehydration day is severe and the weight is reduced. The patient feels headache, fatigue, thirst, but is afraid of food, and severe cases can collapse. Due to excessive loss of gastric juice, hand, foot and ankle can occur, even convulsions. The amount of urine is decreasing. Finally, a coma can occur.
2, signs: patients are thin, burnout, dry skin, loss of elasticity, and can appear signs of vitamin deficiency, dry lips, dry tongue, moss, eyeball retraction. The upper abdomen swells significantly, and the stomach type and the gastric peristaltic wave moving from left to right can be seen. Percussion of the upper abdomen drum sound, the water sound is obvious. I can hear the sound of gas, but it is rare. Chvostek and Trousseau were positive.
3, the course of disease is longer, the patient gradually appears to be weak, losing weight, losing weight, oliguria, constipation, sometimes mental symptoms and hand, foot and ankle.
Diagnosis
Differential diagnosis
Symptoms of pyloric scarring stenosis:
1. Active pyloric spasm caused by ulcers and edema: patients often have ulcer pain symptoms, obstruction is intermittent, although vomiting is very intense, but the stomach does not expand, vomit does not contain food. Medical treatment of obstruction and pain symptoms can be alleviated or alleviated.
2. Pyloric obstruction caused by gastric cancer: the patient's course of disease is shorter, the degree of gastric dilatation is lighter, and gastric peristalsis is rare. The upper abdomen can reach the mass. X-ray barium meal examination showed filling defects in the antrum of the stomach, and biopsy can be confirmed by gastroscopy.
3. Duodenal ampulla obstructive lesions: such as duodenal tumor, annular pancreas, duodenal stasis can cause duodenal obstruction, accompanied by vomiting, gastric dilatation and retention, but its The vomit contains more bile. X-ray barium meal or endoscopy can determine the nature and location of the obstruction.
1. The general patient has a history of longer ulcers. As the disease progresses, the stomach pain gradually worsens, and there are symptoms such as hernia and nausea. Patients often get anorexia due to bloating, and antacids are becoming ineffective. Because the stomach is unbearable, the patient himself uses his fingers to reach the pharynx to induce vomiting. The spit is usually a diet that was taken a few hours ago and contains no bile and is sour and sour. Gradually vomiting frequently, the patient was afraid of eating because of fear of bloating, but he still spit out all the food during the day, and then felt comfortable. The stomach gradually expands, the upper abdomen is full and complains of a moving mass. The patient himself and his family can see that due to the increased number of vomiting, the dehydration day is severe and the weight is reduced. The patient feels headache, fatigue, thirst, but is afraid of food, and severe cases can collapse. Due to excessive loss of gastric juice, hand, foot and ankle can occur, even convulsions. The amount of urine is decreasing. Finally, a coma can occur.
2, signs: patients are thin, burnout, dry skin, loss of elasticity, and can appear signs of vitamin deficiency, dry lips, dry tongue, moss, eyeball retraction. The upper abdomen swells significantly, and the stomach type and the gastric peristaltic wave moving from left to right can be seen. Percussion of the upper abdomen drum sound, the water sound is obvious. I can hear the sound of gas, but it is rare. Chvostek and Trousseau were positive.
3, the course of disease is longer, the patient gradually appears to be weak, losing weight, losing weight, oliguria, constipation, sometimes mental symptoms and hand, foot and ankle.
