Acute Gastric Dilation

　　How is acute gastric dilation caused? Briefly described as follows:

　　1. Abdominal and pelvic surgery and vagotomy

　　Abdominal and pelvic surgery and vagotomy can directly stimulate somatic or visceral nerves, causing autonomic nervous system dysfunction of the stomach, reflex inhibition of the gastric wall, leading to relaxation of gastric smooth muscle, and thereby forming gastric dilation. When there is bruising or severe multiple injuries in the upper abdomen, the occurrence of acute gastric dilation is related to strong stimulation of the abdominal plexus. Intubation during anesthesia, postoperative oxygen administration, and nasogastric feeding can also produce a large amount of gas entering the stomach, forming gastric dilation.

　　2. Disease state

　　The following diseases can all cause this condition: gastric volvulus, incarcerated hiatal hernia, duodenal obstruction, etc.; spinal deformities, annular pancreas, pancreatic cancer, etc., which compress the outlet of the stomach; symptoms caused by the application of plaster suits after body immobilization due to plaster suit syndrome; emotional tension, severe pain, depression, etc., can cause autonomic nervous system dysfunction, leading to decreased gastric tone or delayed emptying; the application of anticholinergic drugs, central nervous system injury, uremia, and other factors can all affect gastric tone and gastric emptying.

　　3. Overeating

　　Overeating can also cause acute gastric dilation.

　　What diseases does acute gastric dilation trigger? Briefly described as follows:

　　Acute gastric dilation can lead to acute gastric perforation and acute peritonitis due to necrosis of the gastric wall. The extreme dilation of the stomach can cause disorders of water, electrolyte, and acid-base balance, leading to hypokalemia, hypochloremia, hyponatremia, and alkalosis. A sharp decrease in effective circulating blood volume and an increase in portal venous pressure can lead to hemodynamic abnormalities, resulting in hypovolemic shock, acute renal failure, heart dysfunction, and ultimately, circulatory and respiratory failure, which is the main cause of death in patients with gastric dilation.

　　Acute gastric dilation often occurs 1-2 hours after overeating or after surgery, or within a few hours to 1-2 weeks after trauma.

　　1. Abdominal pain and distension occur suddenly or gradually.Persistent or intermittent pain in the upper abdomen or around the umbilicus, with sudden exacerbation, and abdominal pain is usually not severe. With the onset of abdominal pain, distension occurs. Initially, there is upper abdominal fullness and distension, visible gastric configuration but without peristalsis waves. Abdominal distension gradually increases, expanding to the entire abdomen, with the entire abdomen distended. Patients feel that abdominal distension is particularly severe. Palpation shows tympany, and a gallop sound can be heard; if the stomach contains liquid or food, palpation shows a non-significant tympany and is dull or flat. Bowel sounds are decreased or absent. There may be tenderness around the upper abdomen or umbilicus without muscle tension or rebound tenderness. If there is a gastric perforation or rupture, the tenderness and rebound tenderness are extremely obvious, with marked rebound tenderness and muscle tension, fever, and signs of infection and poisoning.

　　2. Nausea and vomiting.With the intensification of abdominal pain and distension, nausea and vomiting also increase. The characteristics of vomiting are frequent and weak, even showing involuntary overflow-like vomiting. The vomit consists of ingested food and a brownish-green or brownish-black putrid liquid. Early stages may have bile-like substances, and sometimes blood-containing liquid can be seen. After vomiting, abdominal distension does not alleviate, and systemic symptoms do not improve, but the condition gradually worsens. In the early stages, there may be a small amount of flatus and defecation, and in the later stages, most patients stop defecating.

　　3、水电解质和酸碱平衡紊乱。3. Disruption of water, electrolyte, and acid-base balance.

　　How to prevent acute gastric dilation?

　　How to prevent acute gastric dilation? Briefly described as follows:

　　1. Strengthen the publicity of dietary hygiene, prevent overeating, and avoid immediate strenuous physical labor after excessive intake, especially during the busy agricultural season.

　　2. In situations of stress such as trauma, surgery, and anesthesia, if there is upper abdominal fullness and frequent vomiting, early placement of a gastric tube for effective gastrointestinal decompression and attention should be paid to correct water, electrolyte, and acid-base balance disorders.

　　3. During abdominal surgery, tissues and organs should be protected, and efforts should be made to minimize the manipulation of organs, reduce stimulation, and facilitate the rapid recovery of their function after surgery.

　　What examinations should be done for acute gastric dilation? Briefly described as follows:

　　One, Blood Routine

　　The total white blood cell count is usually not high, but after gastric perforation, the white blood cell count can increase significantly and show left shift of the nucleus. Due to the loss of a large amount of body fluid, blood becomes concentrated, so hemoglobin and red blood cell count increase.

　　Two, Serum Electrolytes

　　Blood potassium, sodium, and chloride levels are low.

　　Three, Blood Gas Analysis

　　Severe alkalosis may be found, and the carbon dioxide combining power may increase.

　　Four, Blood Biochemistry

　　Non-protein nitrogen increases.

　　Five, Urinalysis

　　Urine specific gravity increases, and protein and casts may appear.

　　Six, X-ray Examination

　　1. Standing abdominal radiograph shows a uniform shadow in the upper abdomen, and can also show a large gastric bubble fluid level, a stomach shadow filling the abdominal cavity, and elevation of the left diaphragm;

　　2. Barium meal examination shows barium entering the dilated gastric cavity, visible contours of the enlarged stomach and duodenum, and can also detect duodenal obstruction where barium cannot enter.

　　Seven, Abdominal Ultrasound

　　Abdominal ultrasound examination shows gastric dilation, thinning of the gastric wall, and if there is a large amount of fluid retention in the stomach, the amount of fluid and its surface projection can be measured.

　　What should be paid attention to in the diet care of patients with acute gastric dilation? Briefly described as follows:

　　1. Diet should be regular, with fixed times and amounts, to avoid overeating and reduce the burden on the gastrointestinal tract. If there is insufficient caloric intake, it can be supplemented with snacks that combine dry and liquid foods.

　　2. Avoid various刺激性 foods such as strong alcohol, strong coffee, raw garlic, horseradish, etc., and avoid eating hard, sour, spicy, salty, hot, cold, and excessively rough foods. A mild diet can be chosen to remove factors that produce adverse effects on the gastrointestinal mucosa and create conditions for mucosal repair. Foods should be fine, crushed, soft, and tender. Cooking methods often used include steaming, boiling, stewing, braising, and braising.

　　What are the treatment methods for acute gastric dilatation? Briefly described as follows:

　　First, Medical Treatment

　　1. Abstain from food and water. Abstain from food and water should be given to avoid exacerbating gastric dilatation.

　　2. Gastric lavage. Saline can be used for gastric lavage until normal gastric fluid is aspirated.

　　3. Continuous gastrointestinal decompression. Continue gastrointestinal decompression until vomiting and abdominal distension symptoms disappear and bowel sounds recover.

　　4. Correct water and electrolyte imbalances and acid-base imbalance.

　　5. Active anti-shock treatment.

　　6. After symptom relief, try to consume liquid food.

　　Second, Surgical Treatment

　　1. Indications for Surgical Treatment.

　　(1) The effect of medical treatment is not significant within 8-12 hours.

　　(2) Presence of duodenal mechanical obstruction.

　　(3) Complications with gastric perforation and massive gastric hemorrhage.

　　(4) Long-term inability to recover stomach function, with retention of food after taking a small amount of food.

　　2. Surgical Methods. Generally, the stomach wall incision is performed first to clear the stomach contents, and the necrotic part of the stomach wall is sutured inwards. If it is not possible to perform an inverted suture, a partial gastrectomy can be considered. Long-term recovery of stomach function can be maintained by jejunostomy to maintain nutrition.

　　(1) Simple Gastric Wall Incision and Decompression: Suitable for those with thick stomach contents or large residues. After decompression, the stomach cavity can be flushed with warm saline, and it is best to place a gastric fistula tube. Continuous decompression and flushing of the stomach cavity should be maintained postoperatively.

　　(2) Partial Resection of Gastric Wall: Excise the necrotic part of the gastric wall and simultaneously clear the contents of the stomach cavity.

　　(3) High-Positioned Jejunostomy: Suitable for those who have not recovered long-term stomach function after clearing stomach contents, in order to maintain nutrition through a jejunostomy tube.

　　(4) Gastric Suturing and Repair: Suitable for those with gastric perforation or rupture.

　　(5) Partial Gastrectomy: Suitable for those with ulcer disease, tumor, and a large area of necrotic stomach wall. If abdominal contamination is found to be significant during surgery, abdominal lavage and drainage should be performed.