Symptoms of pyloric obstruction cannot be ignored!

Pyloric obstruction is a type of pyloric ulcer or submucosal fibrosis disease, which can cause stomach diseases and symptoms such as stomach pain, stomach acid, nausea, and regurgitation. It can also easily cause a feeling of fullness and vomiting, and can easily cause patients to feel general fatigue and dizziness.

Causes

Ulcers located at or near the pylorus may be caused by mucosal edema or by reflex contraction of the pyloric circular muscle caused by the ulcer. A more common cause is submucosal fibrosis caused by chronic ulcers, which forms scar stenosis. The onset or aggravation of pyloric spasm is often paroxysmal and can relieve the obstruction on its own. Mucosal edema may subside as inflammation decreases. Pyloric stenosis caused by scar contracture cannot be relieved and continues to worsen. Pylorospasm is functional, while the rest are organic diseases.

Clinical manifestations

Generally, patients have a long history of ulcers. As the disease progresses, stomach pain gradually worsens, and there are symptoms such as belching and nausea. Patients often suffer from anorexia due to bloating, and antacids gradually become ineffective. The stomach gradually expands, the upper abdomen is full, and there is a mobile mass. As the vomiting increases, dehydration becomes more severe and weight loss occurs. Patients suffer from headache, fatigue, thirst, but are afraid of eating. In severe cases, they may collapse. Due to excessive loss of gastric juice, tetany and even convulsions may occur. The amount of urine decreases gradually, and finally coma may occur.

Signs: Weight loss, fatigue, dry skin with loss of elasticity, signs of vitamin deficiency, dry lips and mouth, dry and coated tongue, and sunken eyes. The upper abdomen is significantly distended, and the stomach shape and gastric peristaltic waves moving from left to right can be seen. Percussion of the upper abdomen revealed obvious tympanic and gurgling sounds. You can hear the sound of air passing through water, but it's very rare.

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1. Laboratory examination

A routine blood test can reveal mild anemia caused by malnutrition. Blood biochemistry shows that sodium, potassium, and chloride are all lower than normal, the carbon dioxide binding capacity and pH value are increased, and the carbon dioxide partial pressure is also high, showing hypokalemic alkali poisoning. Non-protein nitrogen or urea nitrogen is also higher than normal due to oliguria. Hypoproteinemia may occur due to long-term hunger. If anemia is severe and stool occult blood is positive, the possibility of malignant ulcer should be considered. Gastric juice examination shows that the gastric juice acidity is high in benign ulcer disease. If there is a lack of hydrochloric acid in the gastric juice, further cytology and other tests are required to rule out tumors.

2. Other auxiliary examinations

(1) In addition to the giant gastric bubble that can be seen under fluoroscopy, X-ray barium gastrointestinal angiography should be performed after gastric lavage. The enlarged stomach and difficulty emptying are clearly seen. If it is pyloric spasm, temporary discharge of gastric contents can be seen when the pylorus relaxes during a longer observation period. Generally, pyloric relaxation can be observed after injection of atropine or scopolamine (654-2), so it is easy to identify. However, pyloric stenosis caused by mucosal edema and scar contracture is difficult to distinguish on X-rays. After a period of medical treatment, angiography is performed again. If the pyloric obstruction improves, it may indicate the presence of edema.

(2) Gastroscopy Fiberoptic gastroscopy can detect different pathological changes such as pyloric spasm, mucosal edema or mucosal prolapse, and scar stenosis, and can also determine the size, location and shape of the ulcer. In cases of suspected malignancy, a biopsy is required.

(3) Saline load test: First, the contents stored in the stomach are aspirated out, and then 700 ml of normal saline is injected within 3 to 5 minutes. After 30 minutes, the saline in the stomach is aspirated out again. If less than 200 ml is drawn out, it means there is no pyloric obstruction; if more than 350 ml is drawn out, it is considered that obstruction exists.