Traumatic injuries of the stomach are observed with: a) wounds of the abdomen, b) blunt bruises of the abdomen (subcutaneous injury to the stomach), c) when the stomach is perforated from the inside. All these injuries are characterized by symptoms that depend both on damage to the hollow abdominal organ and on bleeding from damaged vessels, especially with injuries in the region of greater or lesser curvature. In connection with the development of shock, the patient turns pale, he develops cold sweat, shallow breathing, increased heart rate; when the contents of the stomach are released into the abdominal cavity, abdominal breathing becomes even more superficial. Pain can reach extreme intensity. Tension of the abdominal muscles develops, especially noticeable at the beginning in the epigastric region. Vomiting often appears, and the admixture of blood in it serves as a direct confirmation of damage to the stomach. The temperature, which fell at the time of perforation of the stomach, begins to rise further. In overwhelming majority of cases the picture of peritonitis develops (see). When the walls of the stomach break through, air is sometimes found in the abdominal cavity, accumulating in the upper abdomen under the diaphragm. All this can be detected by fluoroscopy or on the basis of the disappearance or reduction of hepatic dullness. In the presence of significant bleeding, a sharp pallor of patients and a progressive drop in pulse are observed; depending on the loss of blood, dizziness appears, breathing quickens, the pupils dilate and a picture of internal bleeding develops (see). The most characteristic symptoms of damage to the stomach are: a) vomiting with an admixture of blood and b) the presence of air in the abdominal cavity. If the doctor has a more or less reasonable suspicion of damage to the stomach, the question of urgent surgery should be raised.
Subcutaneous, damage to the stomach is most often observed, most often with bruises with a blunt instrument, a horse's hoof from cavalrymen, with landslides, hits under cars, wagons, from compression by buffers, and the walls of the stomach are crushed on the vertebral bodies. Isolated subcutaneous lesions of the stomach are relatively rare; much more often they are combined with damage to other organs. The nature of subcutaneous damage to the stomach depends on the strength of the bruise, the impact surface, the state of the organ itself at the time of the bruise (degree of filling), previous pathological changes in the walls of the stomach. Most often, damage to the anterior wall, lesser curvature or pylorus is observed. The form of damage to the stomach can be very diverse: the stomach can be torn, crushed, tears can form on it. Sometimes the rupture of the wall is incomplete, and the serous and muscular membranes burst, and the mucous membrane remains white; or, conversely, only one mucosa may be disturbed. Cases of gastric contusion with hemorrhage in the gastric mucosa or submucosa are described; sometimes these hemorrhages can reach a large size and lead to subsequent necrosis of the mucosa. The appearance of damage with a complete rupture of the stomach wall has the character of a gap or defect (hole) with irregular outlines. With small holes, the mucous membrane can protrude and clog the hole in the form of a plug; rare cases of self-healing of gastric ruptures may be based on a similar blockage of the hole with the subsequent formation of adhesions.
Rupture of the stomach may result in the development of general peritonitis; the latter can be demarcated and at this place subsequently come to light in the form of a subdiaphragmatic abscess or in the form of an abscess in the stuffing bag if the back wall of the stomach has been damaged. The development of peritonitis usually occurs immediately after the injury, but may also occur after a few days. When diagnosing a subcutaneous rupture of the stomach, it is necessary to keep in mind the general condition of the patient, the site of the bruise on the abdominal wall, the state of the pulse, the presence of vomiting, the increasing muscle tension of the anterior abdominal wall.
Treatment - urgent laparotomy with stitching of the rupture site; in doubtful cases, it is best to perform a trial cerebrotomy. With significant gaps in the stomach, the question of resection of the stomach can also be raised.
Perforations from the inside are observed when sharp foreign bodies get stuck in the stomach, during medical manipulations with instruments, etc. Upon recognition of the damage, an urgent operation is indicated.
We investigate the causes of gastric ulcer and symptoms that depend on the location of the lesion. Apart from diet, what medicines can prevent risks such as bleeding or perforation of the stomach wall or duodenum?
We answer these questions by studying pathology in every aspect.
What is a stomach ulcer
Gastric ulcer refers, together with an ulcer duodenum and esophagus, to the broader category peptic ulcer. It is a wound on the tissue that covers the inner wall of the cavity of the gastrointestinal tract.
If the lesion affects the stomach, they speak of a stomach ulcer. If the esophagus, then we are talking about an esophageal ulcer. Finally, if the first part of the small intestine or duodenum is damaged, then one speaks of a duodenal ulcer.
Gastric ulcers affect quite a few people, approximately 10% of the population, and are common in young people but more common in older people. There is, in fact, a peak incidence between the ages of 50 and 60. It occurs more often in men than in women, in a ratio of 3 to 1.
What does an ulcer look like and where is it located?
An ulcer, damage to the inner wall of the stomach, has fairly clear boundaries, round shape or nearly oval. Accompanied by inflammatory and necrotic processes, as well as the formation of fibrous tissue. The lesion usually heals on its own, but often returns with the change of season.
ulcer may touch only the mucous membrane, but can lead to a decrease in the muscle wall. In some cases, they can even pierce the wall of the stomach, as well as penetrate into neighboring organs: the liver, pancreas, etc.
The area of the stomach that is most vulnerable is the area of the lesser curvature, about 5 cm from the pylorus. Recall that the pylorus is the end part of the stomach, which separates it from the small intestine.
The clinical picture that accompanies a stomach ulcer usually consists of the following:
- Abdominal pain. It is usually localized in the epigastric region, that is, in the upper quadrant and in the central part of the abdomen (in the abdomen just below the sternum and above the navel). Appears in connection with nutrition: in some cases it becomes intense on an empty stomach and regresses on a full stomach, in others, on the contrary. Maybe even at night, but often completely absent, there is only a feeling of discomfort and heaviness.
- bloat accompanied by difficulty in digestion (dyspepsia).
- Nausea and sometimes vomiting. In some cases, digestive disorders lead to vomiting.
- Hematemesis. The presence of blood in the vomit that comes from the stomach. The vomit has the color of coffee because the hemoglobin has time to decompose. The symptom indicates hemorrhagic complications of peptic ulcer.
- Blood in stool. The blood is digested and excreted in the feces. Why does the latter turn black. It is also a sign of a bleeding ulcer.
- Weight loss for no apparent reason.
- Iron-deficiency anemia .
In older people over 70, it is not uncommon for gastric ulcers to resolve with very mild and atypical symptoms, where the only sign/symptom is a state of secondary anemia.
Causes and pathogenesis of stomach ulcers
A stomach ulcer is the result corrosion of the stomach wall, for example, under the action of hydrochloric acid present in gastric juice. Under physiological conditions, the inner wall of the stomach is quite able to withstand the highly acidic environment of gastric juice.
It is formed in such a way that it is covered by a mucous membrane, the cells of which secrete mucus with a high molecular weight. These substances form a kind of gel on it: a “barrier of the gastric mucosa”, which protects it from contact with hydrochloric acid.
It can happen, however, that the physiological balance is disturbed and the walls of the stomach are attacked by the aggressive action of the gastric juice, which often results in ulcers.
Possible factors and, therefore, possible causes of stomach ulcers are:
- Helicobacter pylori infection. These bacteria colonize the lining of the human stomach. It is not known how infection occurs, but it has been experimentally proven that the presence of peptic ulcer is associated with Helicobacter infection in 50%-65% of patients. This percentage rises to 90% in the case of duodenal ulcer. In addition, patients who received treatment for the infection had a much lower recurrence rate than those who did not receive antibiotic therapy. All this suggests that infection plays a large role in the pathogenesis of the disease, even if this role is still not well understood.
- Drug therapy based on NSAIDs. It is very common in older people who use them to control pain syndromes caused by degenerative diseases such as arthrosis, etc. To minimize the problem, it is recommended to take NSAIDs on a full stomach and reduce the dosage to the minimum effective. A pain reliever that does not cause stomach problems is acetaminophen (Tylenol).
- Genetic Causes. Subjects with blood type 1 are more likely to develop the disease.
- Zollinger-Ellison Syndrome. An ulcer develops due to the presence in the duodenum or pancreas of a tumor that secretes gastrin, that is, a hormone that causes the proliferation of gastric parietal cells that produce hydrochloric acid. The growth of these cells leads to an increase in hydrochloric acid secretion and hence acidity, which can damage the gastric mucosal barrier and cause ulcers.
Risk Factors for Ulcer Development
There are also a number of conditions that, although not the true causes of stomach ulcers, increase the risk of developing the disease:
- smoking cigarettes. Smoking reduces the production of bicarbonate and is therefore a factor that increases the likelihood of developing peptic ulcers.
- Drunkenness. Excessive alcohol consumption also reduces the amount of alkalis present in mucus.
- A diet too rich in fatty acids. Excess fat reduces the secretion of bicarbonate.
- Excessive consumption of caffeine (coffee and coca-cola). Caffeine increases the secretion of hydrochloric acid and therefore increases the risk of peptic ulcers.
- excessive stress. Although the link is not clear, several studies have shown that people who experience frequent stress are more likely to develop ulcers.
Diagnosis of peptic ulcer
Diagnosis is based on observation of the clinical picture: analysis of symptoms and signs, patient history and physical examination. To confirm the hypothesis and to exclude possible malignant lesions (malignant ulcer), gastroscopy is performed. An endoscope is inserted into the stomach, and then samples of damaged tissue are taken to be biopsied to rule out cancer.
Damage can also be studied using x-rays.
How to cure a stomach ulcer
The therapeutic protocol for ulcer treatment includes:
Antibiotics
Needed to eradicate Helicobacter if present. Use amoxicillin or tetracycline. Therapy continues until normal results are obtained in the breath test.
Drugs, acid blockers
One of the most famous is cimetidine (the notorious tagamet).
proton pump inhibitors
Reduce the acidity of gastric juice over a long period. Omeprazole and lansoprazole belong to this category.
Protecting the walls of the stomach
such as sucralfate and bismuth subsalicylate.
In the past, often resorted to surgical therapy. Today it is used only in cases of persistent ulcers unresponsive to medical treatment.
The right diet: what to eat and what foods to avoid
Therapy, of course, goes hand in hand with adopting a proper lifestyle, reducing the risk factors described above, and following a dietary regimen.
The ulcer diet involves the consumption of large amounts of milk and a very limited diet. However, gastroenterologists today allow a much looser diet, with the exception of certain types of food and some food preparation systems that stimulate the secretion of gastric juice.
Foods to Avoid: they stimulate the secretion of hydrochloric acid and digestive enzymes:
- soups in broth;
- meat;
- sausages;
- fried and spicy sauces;
- hard cheese;
- nuts;
- coffee;
- alcohol;
- ice drinks.
- well-cooked pasta;
- lean meat;
- fish;
- scrambled eggs;
- lean ham;
- fresh cheeses;
- fresh fruits;
- bread and cookies.
In addition, the patient must eat little and often, because the concentration of acid depends on the amount of food consumed.
Complications and risk of stomach ulcers
Essentially, the possible complications of stomach ulcers are:
- Bleeding. An ulcer can cause bleeding - weak which, over time, leads to anemia, or plentiful requiring emergency medical attention, hospitalization, blood transfusion and surgery.
- Perforation. An ulcer can perforate the wall of the stomach, which leads to the release of contents into the abdominal cavity and the development of peritonitis. A perforated ulcer requires immediate surgical intervention.
- Penetrating ulcer. An ulcer can deepen and damage the walls of the stomach or duodenum, as well as neighboring organs: the liver and pancreas.
- Occlusions. Inflammation and swelling can restrict the passage of food from the stomach to the duodenum.
- such damage to the body, in which the integrity of all its layers is violated and the cavity of the stomach communicates with the abdominal cavity. With incomplete ruptures (tears), there are damages to only individual membranes of the organ. In many cases, complete ruptures are combined with isolated ruptures of individual layers of the walls of the stomach.
There are spontaneous and traumatic ruptures. Spontaneous ruptures most often occur along the lesser curvature, on the anterior and posterior walls, with traumatic ruptures, often on the anterior and posterior walls. Least of all, there are detachments of the cardia and ruptures of the posterior wall of the stomach and the lower horizontal part of the duodenum. The basis of spontaneous ruptures is the weakness of the muscular wall of the stomach. Spontaneous ruptures are usually observed in patients with chronic expansion of the stomach as a result of pyloric stenosis (congenital, ulcerative or tumor origin), with relative or absolute atony of the muscle layer as a result of repeated overstretching of food or liquid against the background of chronic gastritis, in patients with diabetes, with mental disorders, neurasthenia , gastroptosis.
Traumatic ruptures are most often based on the hydrodynamic effect. The size of the gap in this case depends on the force of impact and the degree of filling of the stomach. With an empty stomach, ruptures are possible only with a very severe injury. Damage to the stomach is also possible when a person falls from a height. At the moment of landing, as a result of a counter-blow, the stomach is either torn or detached from the ligaments. Most often there is a detachment of the cardia, pylorus and duodenum from the stomach.
Clinic. With gastric ruptures, the clinical picture is not always characteristic, and therefore the recognition of both spontaneous and traumatic ruptures presents significant difficulties. In these cases, a diagnosis of perforated ulcer, intestinal obstruction, peritonitis, food poisoning is often made.
The leading clinical symptom of gastric ruptures is pain resembling that of a perforated ulcer. The sharpest pain is localized in the epigastric region, quickly spreads throughout the abdomen, and when the posterior wall of the stomach is ruptured, it radiates to the back. As a rule, pain occurs shortly after a heavy meal (in almost half of the cases after dinner.) With a heavy meal, accompanied by fermentation, a gap may occur after a few hours.
The rapid development of peritonitis makes diagnosis difficult. From the first hours of the disease, the abdomen is sharply swollen, with percussion there is no hepatic dullness. With traumatic ruptures of the stomach, in contrast to spontaneous stomachs in the first hours of the disease, a board-like density, hepatic dullness either does not disappear, or is smoothed out. Anamnesis is important for the timely diagnosis of the disease: eating a large amount of food, the presence of chronic diseases of the stomach.
An extremely important symptom is the presence of gas in the abdominal cavity.
Treatment. Surgical.
Forecast. Depends on the timing of the surgery.
Only early surgical treatment saves the patient's life. Mortality in gastric ruptures is high.
What is a bruise of the abdomen and what is this type of bodily injury fraught with? Everyone is concerned about the question of whether to seek emergency medical care or is there appropriate therapy? Such simple answers would help many patients avoid dangerous complications. Therefore, an important rule should be remembered: a bruised abdomen is a serious injury, after which it is necessary to see a doctor.
Varieties and diagnosis
Abdominal injuries are of two types: open and closed. An open wound is different in that when it is applied, the integrity of the skin is violated. The most common cause of open injury is gunshot and stab wounds.
The causes of closed blunt trauma of the abdominal cavity are very diverse:
- the fall;
- muscle strain;
- blows.
Open and closed injuries of the abdomen often suggest the presence of such injuries, in which a bruise of the abdominal wall will cause injury to the internal organs (intestines, spleen, liver, kidneys).
So, the main symptom of an open abdominal injury is a violation of the integrity of the skin of the abdominal region. The symptoms of a closed injury are numerous:
- Sharp and severe pain in the abdomen.
- Decreased blood pressure and increased heart rate.
- Frequent urination.
- The growth of the shock index.
- Vomiting and diarrhea.
- Hematoma, abrasions or bruises.
Always point to the damaged organ. For example, swelling, bruising, abrasions, painful bowel movements may indicate a bruise in the abdominal wall. If there is a rupture of the abdominal muscles, intestinal obstruction will appear, and for intestinal rupture, the most characteristic are: vomiting, a state of shock and intra-abdominal bleeding.
Liver damage manifests itself as dizziness, loss of consciousness, a drop in blood pressure, and with damage to the spleen, the patient is diagnosed with bleeding and pain that extends up to the left shoulder. If the kidneys are damaged, urine becomes pinkish (gross hematuria), body temperature rises, and back pain is noted. Injury to the bladder is frequent false urge to urinate and gross hematuria.
First aid
Not only an open bruise of the abdomen, but also a closed blunt injury is a sufficient reason for contacting a medical institution. The patient and his relatives cannot correctly diagnose a possible lesion and prescribe the necessary treatment. Everything related to abdominal bruises belongs to the field of emergency surgery, and abdominal injuries are often the reason for surgical intervention. With a minor injury, before the arrival of doctors, first aid can be provided. Unskilled first aid is allowed only in case of closed blunt injury.
The affected person should take a set of measures to alleviate the symptoms. Gently, without sudden movements, lay the victim on a flat horizontal surface. While laying down, support it: if the abdominal cavity is bruised, the victim may lose consciousness, experience dizziness. It is important to avoid additional injuries and falls in addition to those that were received with the main damage.
Then it is necessary to apply cold to the damaged cavity, as this will help relieve tension and acute pain. To do this, fill a heating pad with cold water and apply to the abdomen. Instead of a heating pad, you can use an ice pack, pieces of cold tissue matter. Applying cold occurs within 10-20 minutes. After this time, a five-minute break should be taken, after which the procedure with a break should be repeated again. The duration of first aid should not exceed 2-2.5 hours.
If the adoption of these measures does not give the patient relief, only doctors can repair the resulting damage. Paleness of the victim, loss of consciousness, bleeding, increased pain are symptoms that are usually dealt with by emergency ambulance specialists. After a blow or bruise, it is strictly contraindicated to drink water, food or painkillers.
Treatment and possible complications
Treatment for injuries is prescribed by the attending physician, sometimes it is done by the surgeon. To correctly diagnose, it is best to undergo an ultrasound and x-ray examination, computed tomography or laparoscopy. Perhaps, after the injuries received, the patient will need operable intervention. For less serious injuries, the patient will be prescribed bed rest, cold therapy, physical therapy to treat hematomas, bruises and abrasions.
It is worth remembering that many injuries of the abdominal cavity are often accompanied by complications. The most common of these is a hernia, which is formed due to muscle rupture. Internal bleeding is the most dangerous consequence of a bruise. It is always a direct threat to the life of the patient.
Another common post-traumatic complication is called peritonitis. This is a specific inflammation associated with damage to the abdominal cavity. Peritonitis can be fraught with infection of the patient's blood and death.
For any injury to the abdominal region, it is best to consult a doctor. Even if qualified first aid was provided, after such injuries, an ultrasound examination should be performed. The patient cannot know for sure what pathological processes occur in his stomach after injuries and bruises. Only timely diagnosis can save the life and health of the patient from possible complications.
Injuries to the stomach are closed and open. Of the open injuries, stab wounds are more common.
According to I.A. Krivorotov (1949), during the Great Patriotic War, stomach injuries occurred in 4% of closed injuries of the abdominal organs. In 40% of the damage occurred from a direct blow to the stomach and 60% from a fall from a height.
In addition, damage to the stomach can be from exposure to an air wave, hitting the stomach against a board or sitting on a road or rail transport.
Clinical picture with wounds of the gastrointestinal tract, it mainly boils down to a number of symptoms:
1. Direct signs of damage to the stomach or intestines (presence of contents).
2. Symptoms of intra-abdominal bleeding.
3. Symptoms of peritonitis.
4. Symptoms of shock.
These symptoms may occur individually or in combination in different individuals.
The most persistent local symptoms of damage to the gastrointestinal tract are:
1. Locally localized independent pain in the abdomen.
2. Soreness of the abdomen during examination (palpation, percussion, detection of symptoms of peritoneal irritation).
3. Protective contraction of the muscles of the anterior abdominal wall (rigidity, resistance, restriction of respiratory excursions of the abdominal muscles).
The wound of the stomach, as a rule, is localized on the anterior wall, in the cardial, antrum, greater or lesser curvature, however, penetrating wounds are not uncommon (1/3 of the victims), therefore, revision of the posterior wall of the stomach is required during the operation.
With a closed abdominal injury, a complete rupture of the stomach wall and an incomplete one are possible, when only the serous or muscle layers or both layers are damaged, while the gastric mucosa is preserved. Ruptures and hematomas of the ligamentous apparatus of the stomach can be detected. With a slight injury - a bruise of the stomach wall - only hemorrhages under the serous membrane and its ruptures are observed.
In such a situation, the patient is worried about pain, when examined in the epigastrium, pain is determined, but there are no symptoms of peritoneal irritation.
When the stomach is damaged, peritonitis develops much more often than intra-abdominal bleeding.
If we take into account the mechanism of injury and objective data, then the diagnosis of gastric damage does not present any special diagnostic difficulties.
For the purpose of diagnosis, fibrogastroscopy is performed. In case of its impossibility, fluoroscopy of the stomach is performed using water-soluble contrast agents.
Treatment. Before the operation, it is advisable to insert the probe into the stomach and empty it. The operation is performed under anesthesia from the median access. After revision of the stomach, if a complete rupture of the stomach wall is detected, the operation is reduced to economical excision of the edges of the wound of the stomach and suturing it with a two-row silk suture, followed by covering the sutured gastric defect with a pedunculated omentum (Fig. 15.10).
With extensive ruptures, the walls of the stomach and its separations in the pyloric or cardiac section, suturing should also be limited.
Serious attention should be paid to hematomas of the stomach wall. They can lead to circulatory disorders in the walls of the stomach and its necrosis. Hematomas of the stomach wall must be removed, bleeding stopped, and the stomach wall sutured. The operation ends with suturing the abdominal wall tightly. Drainage of the abdominal cavity - according to indications.
Rice. 15.10. Sewing of the wound of the stomach.
a - economical excision of the gastric wound; b – General view of the stomach wound sutured in the transverse direction.