Acute suppurative gastritis

　　Acute suppurative gastritis is caused by the invasion of purulent bacteria into the gastric wall. About 70% of the pathogenic bacteria are hemolytic streptococcus, followed by Staphylococcus aureus, pneumococcus, and Escherichia coli. The route by which bacteria enter the gastric wall may be:
　　1. Due to gastric ulcer, chronic gastritis, gastric diverticula, gastric cancer, gastric foreign bodies, and others, the gastric mucosa is damaged, and the ingested pathogenic bacteria directly invade the gastric wall through the damaged mucosa.
　　2. When suffering from diseases such as sepsis, bacterial endocarditis, scarlet fever, osteomyelitis, and others, pathogenic bacteria enter the gastric wall through the blood flow.
　　3. When suffering from cholecystitis and peritonitis, pathogenic bacteria enter the gastric wall through the lymphatic system.
　　

　　Acute peritonitis and septic shock are common complications of acute suppurative gastritis. If it is acute peritonitis, the main clinical manifestations include abdominal pain, abdominal tenderness, abdominal muscle tension, and rebound pain, often accompanied by nausea, vomiting, abdominal distension, fever, hypotension, tachycardia, dyspnea, and leukocytosis, among other toxic phenomena. Diagnosis of acute peritonitis is generally not difficult based on typical symptoms and signs, white blood cell count and classification, abdominal X-ray examination, ultrasound examination, and CT examination.

　　Acute suppurative gastritis often manifests as acute abdominal pain, with sudden onset of upper abdominal pain, accompanied by fever, chills, nausea, vomiting, and other symptoms. Abdominal pain may gradually worsen, with relief when sitting and exacerbation when lying down, which are characteristic symptoms of the disease. As the condition progresses, the body temperature may further rise, vomiting may change from purulent fluid to purulent and bloody fluid, and abdominal distension, signs of peritonitis, and melena may occur, but diarrhea is usually absent.

　　Acute suppurative gastritis is caused by the invasion of purulent bacteria into the gastric wall. To prevent acute suppurative gastritis, it is necessary to actively and effectively treat diseases such as gastric ulcer, chronic gastritis, gastric diverticula, cholecystitis, peritonitis, and sepsis.

　　The laboratory examination of acute suppurative gastritis shows an elevated peripheral blood white blood cell count, usually above 1×10^10/L, mainly neutrophils, and with nuclear left shift phenomenon. Bacterial culture of gastric juice, ascites, and blood may reveal pathogenic bacteria. Other auxiliary examinations include:
　　1. X-ray abdominal film. X-ray shows gastric dilation with bubbles present in the gastric wall.
　　. B-type ultrasound examination. Ultrasound shows that the gastric wall is significantly thickened.

　　In addition to conventional treatment, dietary adjustment is also needed for acute purulent gastritis. The following aspects should generally be paid attention to in diet:
　　1. After the patient stops vomiting and the frequency of diarrhea decreases, choose to drink a small amount of millet porridge or konjac starch, and then gradually eat some congee, soft thin noodles, etc. Continue to drink plenty of water, do not eat meat, eggs, and other foods rich in protein and fat and those that are easy to cause flatulence and foods rich in dietary fiber, such as milk should not be consumed temporarily.
　　2. After the condition improves, for example, when the pain stops, the frequency of defecation decreases, and the body temperature approaches normal, one can start eating egg soup, steamed egg custard, yogurt, congee, soup, toast, steamed or braised fresh fish, minced lean meat, tender vegetable leaves, etc. The amount of food per meal should be small.
　　3. During the recovery period, it is advisable to eat easily digestible, low in stimulation, and light in flatulence foods, and try to make them soft and light.

　　The treatment of acute purulent gastritis includes non-surgical and surgical treatment. The specific treatment is as follows:

　　1. Non-surgical Treatment
　　The application of high-dose broad-spectrum antibiotics and active surgery can improve the survival rate. When there is disturbance in water, electrolyte, and acid-base balance or shock, active correction should be made, and at the same time, general supportive therapies such as blood transfusion and fluid replacement should be strengthened. Most cases can be cured with conservative treatment.

　　2. Surgical Treatment
　　If peritoneal inflammation does not improve or even worsens during conservative treatment, it is considered a surgical indication. The surgical methods include peritoneal abscess drainage and partial gastrectomy, and the latter is preferred if the patient's condition permits. Appropriate antibiotics should be routinely injected into the abdominal cavity. If the excision of the focus and the cleaning of the abdominal cavity are thorough, drainage tubes may not need to be placed. The survival rate of purulent gastritis after comprehensive treatment is nearly 70%.

　　3. Postoperative Management
　　The course of patients who require surgical treatment is often in the middle and advanced stages, with severe illness. After surgery, attention should be paid to the following situations: continuous gastrointestinal decompression, maintaining unobstructed drainage; monitoring vital signs, closely observing water, electrolyte, and acid-base balance; paying attention to changes in renal function; continuing to use high-dose broad-spectrum antibiotics; strengthening nutritional support, and if conditions permit, intravenous nutrition should be provided.