Abdominal distension

　　Abdominal distension is relatively common in daily life and has a significant impact on patients' lives and studies. So, what factors cause abdominal distension? Let me explain it to you below.

　　1. Gastric diseases:It is one of the important causes of abdominal distension, seen in chronic gastritis, chronic atrophic gastritis, peptic ulcer, gastric dilatation, gastric torsion, gastric prolapse, pyloric stenosis, and gastric cancer, and so on.

　　2. Intestinal diseases:It is also an important cause of abdominal distension, commonly seen in acute and chronic intestinal infections (such as bacterial dysentery, amebic colitis, intestinal tuberculosis, Crohn's disease, ulcerative colitis, and so on), malabsorption syndrome, acute and chronic intestinal obstruction, pseudointestinal obstruction, intestinal diverticulosis, constipation caused by various reasons, and so on.

　　3. Functional gastrointestinal disorders:Such as aerophagia, intractable belching, functional dyspepsia (non-ulcerous dyspepsia), irritable bowel syndrome, and so on.

　　4. Liver diseases:It is also an important cause of abdominal distension, commonly seen in acute and chronic hepatitis, especially in severe hepatitis (abdominal distension is one of the main and stubborn symptoms), liver cirrhosis (abdominal distension is often the main symptom in the early stage of liver cirrhosis), liver abscess, liver cancer, and so on.

　　5. Biliary diseases:Including acute and chronic cholecystitis, gallstones, and biliary obstruction caused by various reasons, etc.

　　6. Pancreatic diseases:Including acute and chronic pancreatitis, giant pancreatic cysts, pancreatic cancer, etc.

　　7. Peritoneal diseases:Including acute suppurative peritonitis, tuberculous peritonitis, peritoneal cancer, etc.

　　8. Acute infectious diseases:Including shock pneumonia, typhoid fever, severe pulmonary tuberculosis, and sepsis, etc.

　　9. Cardiovascular diseases:Seen in acute and chronic congestive heart failure (especially right heart failure), mesenteric vascular embolism or thrombosis, etc.

　　10. Other causes:Including chronic renal insufficiency, electrolyte and acid-base metabolism disorders, connective tissue diseases, diabetic gastroparesis, blood system diseases, central nervous system or spinal cord lesions, pleural effusion and ascites caused by various reasons, etc.

　　Patients with long-term abdominal distension that has not been effectively treated may also develop the following diseases:

　　1. Acute gastroenteritis

　　The symptoms of acute gastroenteritis are mainly abdominal pain above the upper abdomen and around the umbilicus, often presenting as persistent acute pain with intermittent exacerbation. Patients often have nausea, vomiting, diarrhea, and may also have fever. On physical examination, tenderness in the upper abdomen or around the umbilicus may be found, with minimal muscle tension and no rebound tenderness, and slightly hyperactive bowel sounds. The diagnosis is not difficult if there is a history of unclean diet before onset.

　　2. Gastric and duodenal ulcers

　　Gastric and duodenal ulcers are more common in middle-aged and young adults, with pain mainly located in the middle and upper abdomen, mostly persistent dull pain, often occurring during fasting, which can be relieved by eating or taking antacids. Physical examination may show tenderness in the middle and upper abdomen, but without muscle tension or rebound tenderness. In cases of frequent attacks, positive stool occult blood test may be present. Barium meal examination or endoscopy can establish the diagnosis.

　　3. Intestinal obstruction

　　Intestinal obstruction can occur in patients of all ages, with ascaris infection and intussusception being more common in children. In adults, it is more common due to hernia or intestinal adhesion, while in the elderly, it can be caused by colon cancer and other conditions. The pain of intestinal obstruction is usually located around the umbilicus, presenting as intermittent colicky pain, accompanied by vomiting and cessation of defecation and flatus. On physical examination, intestinal shape and marked abdominal tenderness can be seen, with hyperactive bowel sounds, and even the sound of 'water passing through' can be heard. If the pain is continuous with intermittent exacerbation, marked abdominal tenderness with muscle tension and rebound tenderness, or if ascites is found and shock develops rapidly, it suggests strangulated intestinal obstruction. X-ray film examination can establish the diagnosis if intestinal air is found and multiple fluid levels are present.

　　Generally, abdominal distension may present with abdominal distension and discomfort, with distension localized to the upper abdomen more commonly seen due to gas accumulation in the stomach or transverse colon. Gas accumulation in the small intestine can cause distension localized to the middle abdomen or even throughout the entire abdomen. Gas accumulation in the colon can cause distension localized to the lower abdomen or the lower left abdomen. In cases of pyloric obstruction, the upper abdomen may show gastric shape and peristaltic waves. In cases of intestinal obstruction, intestinal shape and peristaltic waves can be seen, with hyperactive or decreased bowel sounds. Patients with peritonitis may have tenderness and muscle tension.

　　To prevent abdominal distension, it is important to develop healthy dietary and lifestyle habits. Below, I will briefly introduce what aspects should be paid attention to:

　　1, Eat less high-fiber foods. Such as potatoes, bread, beans, and vegetables like cabbage, cauliflower, and onions, which are prone to produce gas in the gastrointestinal tract and eventually lead to abdominal distension.

　　2, Do not eat indigestible foods. Starchy foods like fried beans and hard cakes are not easy to digest and stay in the gastrointestinal tract for a longer time, which may produce more gas and cause abdominal distension.

　　3, Change the habit of wolfing down food. Eating too fast or eating while walking is easy to swallow a lot of air; using straws to drink beverages will also let a large amount of air seep into the stomach, causing abdominal distension.

　　4, Overcome negative emotions. Anxiety, worry, sadness, depression, and other negative emotions may weaken digestive function or stimulate the stomach to produce too much gastric acid, resulting in increased gas and worsened abdominal distension.

　　5, Moderate physical exercise. Staying active with moderate exercise for about an hour each day not only helps overcome negative emotions but also helps maintain normal function of the digestive system.

　　6, Pay attention to certain diseases. For some diseases, abdominal distension may be a herald or one of the symptoms, including allergic colitis, ulcerative colitis, bladder tumor, etc.

　　Abdominal distension is often a disease of the digestive system. When patients have abdominal distension, they can undergo the following examinations:

　　1, Stool examination:If the stool is mucous, purulent, and bloody, and red blood cells and white blood cells are visible under the microscope, it is mostly inflammatory lesions of the intestinal tract; if there is a lot of undigested food in the stool, and muscle fibers and fat globules are seen under the microscope, it often suggests malabsorption.

　　2, Gastric juice analysis:In chronic atrophic gastritis and gastric cancer, the secretion of gastric acid is often reduced.

　　3, Liver function and serum enzyme tests:It is helpful in the diagnosis of liver and bile duct lesions.

　　4, Gastroscopy:It has diagnostic value for gastric and duodenal diseases such as chronic gastritis, peptic ulcer, and gastric cancer.

　　5, Colonoscopy:It has diagnostic or auxiliary diagnostic value for intestinal tuberculosis, Crohn's disease, ulcerative colitis, amebic colitis, bacterial dysentery, colon cancer, and colon diverticulosis, etc.

　　6, X-ray examination:Abdominal radiography or plain film examination is helpful in diagnosing diseases such as hepatic flexure syndrome, splenic flexure syndrome, ulcer perforation, and intestinal obstruction; barium meal examination can not only diagnose chronic gastritis, peptic ulcer, and gastric cancer but is also conducive to the diagnosis of gastric prolapse; barium enema examination can assist in diagnosing colonic lesions.

　　7, Ultrasound, CT, or MRI examination:It has important diagnostic significance for liver, bile duct, and pancreatic diseases, and has auxiliary diagnostic value for tuberculous peritonitis or ascites caused by various reasons.

　　Patients with bloating should eat less high-fiber foods, such as potatoes, noodles, legumes, as well as vegetables like cabbage, cauliflower, and onions, which are easy to produce gas in the gastrointestinal tract, leading to bloating; do not eat indigestible foods, such as fried beans or hard pancakes, which are difficult to digest and can stay in the gastrointestinal tract for a long time, possibly producing more gas and causing bloating; do not drink milk, as drinking milk can cause a bloated feeling in the abdomen. It is appropriate to eat some light and easily digestible foods.

　　Bloating is often caused by gastrointestinal, liver, biliary tract, or pancreatic diseases. In addition, cardiovascular and other systemic diseases or certain systemic diseases can also cause bloating, so it is necessary to actively find the causes of bloating. Before the diagnosis is completely clear, in order to relieve the patient's bloating, the following symptomatic treatment measures can be adopted.

　　1. Adjust the diet, eat as few gas-producing foods as possible, such as high-sugar foods, legumes, or milk, etc.

　　2. Gastrointestinal motility agents such as domperidone, mosapride, or tegaserod can be used, as the latter two are systemic gastrointestinal motility drugs, so they are more effective. In addition, the gastrointestinal motility regulator mesalamine trimebutine (trade name: Nuowei, Shuliqineng) can also be used.

　　3. Dose-dependent use of osmotic laxatives can facilitate the excretion of gas accumulated in the intestines with feces.

　　4. Anal canal evacuation can be used to accelerate the excretion of gas.

　　5. If severe intestinal paralysis causes severe bloating (such as bloating caused by acute severe pancreatitis), 1000-2000g of sodium nitrite (traditional Chinese medicine) can be placed in a bag and applied to the patient's abdomen. Sodium nitrite has the effect of stimulating intestinal peristalsis to increase, thereby facilitating the excretion of intestinal gas and reducing bloating.

　　6. If the initial judgment is that bloating is caused by liver or pancreatic lesions, hepatoprotective, choleretic drugs, or pancreatic lipase or pancreatic enzyme preparations (trade names: Kangbixun, Pancreatin Capsules, and Demetong Capsules, etc.) can be used for treatment, which is conducive to the digestion and absorption of food, reducing the production of gas.

　　7. If it is considered that bloating is caused by excessive proliferation of bacteria in the small intestine, oral antibiotics such as tinidazole can be used for treatment. If confirmed that the patient has stomach bloating discomfort and Helicobacter pylori infection, proton pump inhibitors, clarithromycin, and amoxicillin (ampicillin) can be used for treatment to kill Helicobacter pylori.