Do not forget rule governing ulcer complications

September 19, 2009 · Posted in Treatment of gastric ulcer 

First, massive hemorrhage

 1, the general treatment of absolute bed rest, if necessary, to give a small amount of sedatives, such as stability and so on. Enhanced care, close observation of patients with symptoms, the number of hematemesis and melena, blood pressure and pulse, urine output and so on. Periodically review hemoglobin, hematocrit, urea nitrogen. In addition to a large number of vomiting blood, in general, not fasting, can give the whole flow of food, to neutralize gastric acid, reducing gastric hunger contractions in order to facilitate bleeding.

 2, hemostatic measures in general hemostatic agent such as bleeding or aromatic acid sensitivity can be applied to stop bleeding, but the effect was not sure. Bai Yao (0.5 3 times a day) orally, norepinephrine 8mg adding cold saline 100 ~ 200ml orally or by stomach tube infusion, with some success. H2 receptor antagonists Cimetidine piperazine (day 0. 8 ~ 1. 2g) intramuscular injection or intravenous drip, or furan nitramine has better curative effect. Endoscopic hemostatic agents, such as direct spraying of a ~ 5% of Monteggia (Monsell) solution, as well as high-frequency endoscopic electrocoagulation and laser to stop bleeding and so has a good effect.

 3, supplementary blood volume immediately with blood, intravenous infusion, first fill with normal saline, 5% glucose saline, dextran, or other plasma substitutes, such as the large amount of bleeding, blood transfusion should be as soon as possible.

 4, surgical procedures, such as medical treatment fails, emergency surgery patients.

 2, pyloric obstruction

 Treatment includes:

 1, correct dehydration, electrolyte imbalance and metabolic alkalosis, according to a daily intravenous transmission of compound sodium chloride and 10% glucose (1:2) solution 2000 ~ 3000ml, a low sodium, low potassium, low blood chloride should pay attention to add. Apparent metabolic alkalosis may slow to 2% ammonium chloride solution, 200 ~ 400ml adding 500 ~ 1000ml5% glucose saline infusion (poor liver and kidney functions were hanged). Note added to the heat and the amount of hydrolyzed protein, amino acids and other compound.

 2, gastric tube decompression: Insert gastric tube exhausted, stomach retention materials, every night before bed, gastric lavage with saline once, and to determine the amount of stomach slide to stay in order to understand the situation gastric emptying. 3 to 5 days after aspiration of gastric lavage, if the condition has improved markedly, then the prompt pyloric obstruction of functionality. Since then can liquid food, Shaoliangduocan, gradually increase the flow of food intake, and drugs to the acid treatment, but disable the anti-cholinergic drugs.

 3, surgical treatment of 1 ~ 2 weeks after the treatment of those who have not been improved, suggesting that obstruction of organic, should surgery.

 3, perforated

 Acute perforation is the most serious complication of peptic ulcer, ulcer depth of subserosal layer, can penetrate the sudden acute perforation, to antrum lesser curvature and anterior wall of duodenal ulcers more common. Some patients have a hearty, rough food, increased abdominal pressure and other incentives. After the acute ulcer perforation, stomach, duodenal contents into the abdominal cavity logistics, resulting in acute diffuse peritonitis. Clinical manifestations of sudden severe abdominal pain, abdominal began gradually extended to Cullen, and sometimes gastrointestinal contents along the mesenteric root of flow to the right lower abdomen, right lower abdominal pain caused by perforation of acute appendicitis resembles. Peritoneal irritation after a few hours, most patients pneumoperitoneum Zheng, accompanied by shock symptoms in some patients. Acute abdomen and other required identification, diagnosis often require urgent surgery.

 Sub-acute perforation often is not broken, ranging from acute and chronic perforation of the process between the persons, not as good as the clinical symptoms of severe acute perforation, it is generally caused by the limitations of peritonitis, after non-surgical treatment combined Chinese and Western medicine can be cured.

 Chronic perforation refers to the posterior wall of duodenal bulb and part of the posterior wall or lesser curvature gastric ulcers, and serosal layer dip, often with the surrounding organs or tissue adhesion occurs through natural, multi-penetrated adjacent organs such as the pancreas , etc., its development was chronic process, called chronic penetrating ulcer with acute perforation is different from non-acute abdomen in general the performance of rhythm in patients with ulcer pain disappeared, but more intense and stubborn, often caused by back Bleeding, medical treatment they could not succeed need to consider surgery.

 IV cancer

 Endoscopic biopsy diagnosed as gastric cancer, need to limit surgery.

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