Gastric duodenal ulcer scar pyloric stenosis

　　Scarring pyloric stenosis of gastric and duodenal ulcer is caused by the cicatricial contraction after the healing of gastric and duodenal ulcers near the pylorus, or it can also be caused by the scar formation during the repair process of the ulcers. Both factors can coexist, but one factor is usually predominant. The prominent clinical symptom is severe vomiting, which is leftover food from the previous meal without bile, and can lead to serious malnutrition and water and electrolyte imbalance in patients. The incidence of pyloric stenosis is about 10%. It is more common in patients with duodenal ulcer, and in the early stage, it is often dominated by pyloric spasm and inflammation.

　　Scarring pyloric stenosis of gastric and duodenal ulcer can lead to serious malnutrition and water and electrolyte imbalance. The correct term is water and electrolyte imbalance. Water and electrolytes are widely distributed inside and outside of cells, participating in many important functions and metabolic activities in the body and playing a very important role in maintaining normal life activities. The dynamic balance of water and electrolytes in the body is achieved through the regulation of the nervous and humoral systems. Common clinical water and electrolyte metabolic disorders include hyperosmotic dehydration, hyposmotic dehydration, isosmotic dehydration, edema, water intoxication, hypokalemia, and hyperkalemia.

　　Patients with scarring pyloric stenosis of gastric and duodenal ulcer may show gastric shape and peristaltic waves in the upper abdomen, with a resonant splash sound. Chronic patients may have malnutrition, emaciation, anemia, dry and loose skin, etc. They often have a long history of gastric and duodenal ulcer. There may be a feeling of fullness and weight in the upper abdomen, vomiting a large amount of leftover food from the previous meal without bile.

　　The prevention of scarring pyloric stenosis of gastric and duodenal ulcer mainly includes moderate exercise, avoiding smoking and alcohol, and regular physical examinations. Appropriate exercise is a good way to increase gastrointestinal motility, which can effectively promote gastric emptying, benefit the repair of ulcers, and appropriate rest of the gastrointestinal tract, thus promoting the recovery of the disease. Regularly participate in physical examination activities. In terms of diet, avoid smoking and alcohol, as smoking can promote the recurrence of ulcers. Although there is no evidence to show that smoking causes ulcers, ulcers in non-smokers tend to heal more easily.

　　The main examinations needed for the scarring pyloric stenosis of gastric and duodenal ulcer include gastric residue aspiration, saline loading test, X-ray examination, and fiberoptic gastroscopy.

　　1. Gastric residue aspiration is a simple and reliable method for determining the presence of gastric retention. If more than 300ml of gastric juice can be aspirated 4 hours after a meal, or more than 200ml of gastric juice can be aspirated in the morning after a night of fasting, it indicates the existence of gastric retention. If there is food residue in the gastric juice, it supports the diagnosis of pyloric stenosis.

　　2. After the stomach fluid is aspirated in the salt water load test, 750ml of isotonic saline is injected, and all the stomach contents are aspirated 30 minutes later. If it reaches more than 400ml, it can be considered that there is a pyloric obstruction.

　　3. Abdominal X-ray film shows an enlarged gastric bubble. If an upper gastrointestinal barium meal examination is performed, it can make an accurate diagnosis and understand the nature of the obstruction. However, for patients with severe obstruction, due to a large amount of food retention in the stomach, it affects the filling of barium, so it is often not possible to determine the nature of the obstruction. For such patients, it is advisable to perform gastrointestinal decompression first, and then perform a barium meal examination after the stomach contents are aspirated, which is often helpful for diagnosis.

　　4. Fiberoptic gastroscopy can not only determine the presence or absence of obstruction but also determine the nature of the obstruction, and can perform brushing cell examination or biopsy to make an accurate diagnosis. If there is gastric retention that affects the examination, it can be performed after aspiration under direct vision.

　　In addition to general treatment methods, dietary therapy for improving dietary habits can also effectively alleviate symptoms of gastric duodenal ulcer scar pyloric obstruction. Diet should include more potatoes and pumpkins. Potatoes are rich in vitamin C, potassium, and balanced minerals, and also contain starch, which is not easily destroyed by heat and is convenient to absorb, thereby strengthening the stomach wall. Pumpkins are good for digestion and health of the intestines. Pumpkins are rich in vitamin C and carotene (vitamin A), and their fruits, flowers, seeds, and leaves all have medicinal effects, with a high starch content, and still contain a lot of vitamin C after cooking. To fully exert the medicinal effect, steaming is ideal. For those with stomach cramps, a pumpkin soup can be cooked to aid digestion.

　　The treatment principle for scarring pyloric obstruction of gastric duodenal ulcer is to fast, use gastrointestinal decompression, intravenous fluid therapy, and blood transfusion. Correct imbalances in water and electrolytes and acid-base balance, and wash the stomach with isotonic saline three days before surgery to reduce stomach edema. The surgical procedures include subtotal gastrectomy, which is suitable for young people with high gastric acid and obvious ulcer pain. For those with low gastric acid and weak physique who cannot tolerate subtotal gastrectomy, a simple gastrojejunal anastomosis can be performed. The principle of medication is to administer antibiotics and other auxiliary drugs before and after surgery, pay attention to the balance of water and electrolytes, strengthen supportive therapy, and apply special drugs if necessary for patients with long course of disease and poor physical condition.