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*Only for medical professionals to read and reference.
Physical examination is very important, we must pay attention to it, and don't "lost big because of small things"; treatment is no small matter, and care must be taken everywhere to avoid "falling down.
"
The initial situation of the case: A 62-year-old male patient, with a history of chronic gastritis for more than 20 years, no history of major diseases such as cardiovascular and cerebrovascular diseases, and a history of smoking for more than 40 years.
I have quit smoking for one year and occasionally drink a small amount of alcohol.
I started to feel abdominal pain on a certain day and did not relieve for several days.
There were no other concomitant symptoms and signs.
What disease might the patient have? Let's take a look at the specific situation of this case story.
Case details One day after dinner, Xiao Deng received a call from his mother who was far away from home.
"Dad had a stomach problem recently, and he just went to the hospital to prescribe some medicine.
" Mom said.
"Dad's stomach troubles occur every two years for decades, and it happens again and again.
It seems that this is another attack?" Xiao Deng pondered.
But the mother on the other end of the phone said no, and began to hesitate: "Wait a minute, I will tell you more when your father walks away.
" After a while, his mother said to Xiao Deng, "Your father has a stomachache.
A few days, although it is not very violent, but it is more obvious than before.
I
went to a nearby hospital for a B-ultrasound, and found that the liver had a space of about 8cm.
It was said that it might be a liver cyst, but other conditions were not ruled out.
The doctor recommended further CT Diagnosis.
" Hearing this, Xiao Deng couldn't help but feel a little bit in his heart: If it's a liver cyst, it's generally not a big problem, but what if it's liver cancer? Tips for knowledge: Small and asymptomatic cysts can be reviewed and followed up regularly; if they are large or have some symptoms and effects, they can be treated with surgery.
The incidence of liver cancer ranks fifth among all malignant tumors, and the mortality rate ranks second.
Although abdominal color Doppler ultrasound is a more suitable preliminary screening item, it is often confirmed by CT etc.
due to insufficient accuracy.
On the phone, Xiao Deng urged his mother to take his father to the big hospital for further examination.
A few days later, the patient was further checked after admission.
Alpha-fetoprotein (AFP) is in the normal range, but several other tumor markers such as CA19-9 and CA242 are abnormal.
In particular, CA19-9 is several times higher than normal.
Soon the CT results came out, and it was heading towards the worst-the doctor had almost confirmed that there was a tumor on the liver, and it was still a malignant tumor.
This result, like a bolt from the blue, brought a huge blow to Xiao Deng's entire family.
My father had just retired for a few years, and such an accident happened within a few days.
1 Without hepatitis and seldom drinking, why do I get liver cancer? In China, an important factor leading to liver cancer is hepatitis B, hepatitis C and other viral hepatitis, and Xiao Deng's father has never had viral hepatitis.
Another common cause of liver cancer is alcohol.
Although the patient usually drinks alcohol, neither the dosage nor the frequency is much, it belongs to occasional drinking.
Then why do you still get liver cancer? Primary liver cancer can be divided into hepatocellular carcinoma (HCC) and cholangiocarcinoma (ICC).
The former is what we call "liver cancer" in the ordinary sense, accounting for about 85% of the entire liver cancer, while ICC only accounts for 10% Around, it is a relatively rare malignant tumor.
And Xiao Deng's father suffered from ICC.
Many people don't know much about this type of liver cancer, and there is no national ICC incidence data in my country.
Some materials show that the total number of ICC patients in my country accounts for more than half of the world's total, and about 90% occur in 55-75 years of age.
Although ICC is a relatively rare type of tumor, the incidence of ICC has increased from 0.
32 per 100,000 to 0.
85 per 100,000 in the 30 years from 1985 to 2015, an increase of 165%. The clinical characteristics of ICC are no obvious symptoms in the early stage, rapid progress of the disease, and high degree of malignancy.
Its common symptoms are similar to most liver malignancies, manifested as unexplained fatigue, lack of appetite, night sweats, nausea, abdominal pain, and ascites.
What is even more headache is that its cause is not very clear so far, it is generally believed to be related to intrahepatic bile duct stones, intrahepatic bile duct sclerosis, and parasitic diseases such as schistosomiasis.
Xiao Deng's father lived in the middle and lower reaches of the Yangtze River when he was a child.
There were indeed some parasites infestation at that time.
However, whether he was infected with parasites is not clear.
After all, the age is long, and the sanitary conditions at that time were relatively backward, and there was no way to study it.
2The tumor was successfully removed, and the tumor body reached 8cm! At this time, the more difficult and critical thing is not to explore the cause, but how to better treat and save the patient's life.
This is the top priority.
ICC is a malignant tumor with a high degree of malignancy.
Because its pathogenesis and metastasis mechanism are not clear, the effective treatment options available are very limited.
Radical surgery is currently the only way to cure ICC, but because of the early symptoms are hidden, most of them are already in the advanced stage when they are discovered, the rate of radical surgery is low, and there is a lack of effective chemotherapy regimens.
This is the case in this case, and the tumor has reached 8 cm when it was discovered.
The patient's usual physical condition is fair, but he is thin and his nutritional status is not very ideal.
Although there are no basic diseases such as high blood pressure and high blood sugar, the overall physical fitness is not very good.
Considering the factors of age, the decision to perform surgery is to give it a go.
The operation soon started as scheduled.
Xiao Deng’s family waited anxiously at the door of the operation for one hour, two hours, three hours.
.
.
Finally, Xiao Deng’s father was pushed out of the operating room.
The entire operation lasted eight.
Many hours.
The tumor removed was eight or nine centimeters long.
Xiao Deng's family was very surprised, and felt extremely regretful.
Two years ago, Xiao Deng suggested that his father go for some medical examinations because he had never had a medical examination for so long.
However, Xiao Deng's father never agreed.
This procrastination led to a major illness, and I mistakenly thought that the old stomach disease of the past few decades had relapsed, but it actually came from the liver, which is a nearby organ.
The next day, Xiao Deng's father finally woke up slowly and was pushed back to the general ward by the staff.
At this time, the family was hanging with a heart, and he was finally relieved.
3 fell short! Severe complications "death" recovery after the operation is very important.
It is the biggest goal and hope of Xiao Deng's family to survive this period of time and leave the hospital smoothly.
After the operation, the patient needed liquid food, but after a few days passed, Xiao Deng's father felt that his stomach was always swollen and he had no appetite.
Eating something makes me feel uncomfortable, and it's easy to vomit.
At this time, the doctor felt that it was not normal.
What happened? After a series of examinations, it was discovered that Xiao Deng's father had a serious postoperative complication-gastroparesis.
Gastroparesis is a complication seen after abdominal surgery.
After this happens, it will affect normal eating, because the food does not enter the small intestine smoothly for digestion and absorption, which will have a great impact on the patient's nutritional status and seriously affect the recovery of the entire disease.
The doctor hurriedly took some relevant measures for treatment, but half a month later, Xiao Deng's father's gastroplegia problem has not been well improved and resolved, which pushed the family into an abyss again.
After trying a series of related drug treatments such as acupuncture, erythromycin, antacids, and gastric motility drugs, this problem has not been effectively improved.
The patient's nutritional support can only be carried out through parenteral nutrition every day, and gastric decompression and drainage can be carried out at the same time.
There is a lot of drainage every day, reaching nearly 1000 mL.
Xiao Deng's father became weaker and weaker, and finally suffered a severe lung infection and respiratory failure.
He died after 3 days.
.
.
4 What is gastroparesis? How to prevent it? The official name of gastroparesis should be called gastric emptying disorder.
It is a delay in gastric emptying due to various reasons.
It is also one of the complications of abdominal surgery.
The overall incidence is not very high.
Gastroparesis is often secondary to surgical operations such as subtotal gastrectomy and pancreaticoduodenectomy.
The reason is probably that the sympathetic nervous system is activated to increase the inhibitory activity of gastrointestinal sympathetic nerves, which is the main cause of gastroparesis.
.
It can also be secondary to certain diseases, such as endocrine and metabolic diseases, which means diabetes.
In addition, other digestive diseases, vagus nerve damage, infections, drugs, emotions, etc.
may affect the occurrence and development of gastroplegia.
After gastroparesis, the most significant symptom is that food cannot be smoothly transported from the stomach down to the small intestine, followed by abdominal distension and vomiting.
The amount of vomiting is often very large, which can generally be easily determined by clinical manifestations and X-ray examinations.
Whether there is gastroparesis.
It can cause great damages and even life-threatening if it occurs in patients with major diseases and weak physiques.
In terms of treatment, fasting water, gastrointestinal decompression, maintenance of water and electrolyte balance and other nutritional support and drug treatment are the main treatments, such as the use of gastrokinetic drugs cisapride, mosapride, itopride, etc.
, and surgical treatment The method needs to be used with caution.
From this case, we can get some relevant enlightenment.
For a disease that can only be treated by surgery, especially when it is a serious disease, we still need to make an accurate and detailed assessment as much as possible to judge the trade-off between surgical risks and benefits.
If we only consider whether the operation itself is successful, is it possible to ignore some complications and possible accidents? The final result may also be unsatisfactory, and this is not what our medical staff and family members hope See the results.
References: [1] Sun Bei, Xu Jun, Zhou Zunqiang, et al.
Clinical analysis of 36 cases of functional gastric emptying disorder after abdominal surgery[J].
Chinese Journal of Practical Surgery, 2003,(8).
465-46.
[2 ]Wang Yonggang, Zhang Rugang, Zhang Dawei.
27 cases of gastric emptying disorder after esophageal cancer resection[J].
Chinese Journal of Thoracic and Cardiovascular Surgery, 1998, 14(4):224-226.
[3]He Jianmiao, Pu Yongdong, Cao Zhiyu, et al.
Diagnosis and treatment of gastric emptying disorder after subtotal gastrectomy[J].
Chinese Journal of Practical Surgery, 2003, 23(8):471-471.
[4] Quan Zhufu.
Postoperative gastric emptying disorder [J].
Parenteral and Enteral Nutrition, 2006, 13(1): 58-61.
[5] He Honglun, Deng Shaoqing.
Clinical analysis of abdominal surgery and simple dynamic gastric emptying disorder[J].
Chinese Journal of Practical Surgery, 1996, 16(05):277-278.
Physical examination is very important, we must pay attention to it, and don't "lost big because of small things"; treatment is no small matter, and care must be taken everywhere to avoid "falling down.
"
The initial situation of the case: A 62-year-old male patient, with a history of chronic gastritis for more than 20 years, no history of major diseases such as cardiovascular and cerebrovascular diseases, and a history of smoking for more than 40 years.
I have quit smoking for one year and occasionally drink a small amount of alcohol.
I started to feel abdominal pain on a certain day and did not relieve for several days.
There were no other concomitant symptoms and signs.
What disease might the patient have? Let's take a look at the specific situation of this case story.
Case details One day after dinner, Xiao Deng received a call from his mother who was far away from home.
"Dad had a stomach problem recently, and he just went to the hospital to prescribe some medicine.
" Mom said.
"Dad's stomach troubles occur every two years for decades, and it happens again and again.
It seems that this is another attack?" Xiao Deng pondered.
But the mother on the other end of the phone said no, and began to hesitate: "Wait a minute, I will tell you more when your father walks away.
" After a while, his mother said to Xiao Deng, "Your father has a stomachache.
A few days, although it is not very violent, but it is more obvious than before.
I
went to a nearby hospital for a B-ultrasound, and found that the liver had a space of about 8cm.
It was said that it might be a liver cyst, but other conditions were not ruled out.
The doctor recommended further CT Diagnosis.
" Hearing this, Xiao Deng couldn't help but feel a little bit in his heart: If it's a liver cyst, it's generally not a big problem, but what if it's liver cancer? Tips for knowledge: Small and asymptomatic cysts can be reviewed and followed up regularly; if they are large or have some symptoms and effects, they can be treated with surgery.
The incidence of liver cancer ranks fifth among all malignant tumors, and the mortality rate ranks second.
Although abdominal color Doppler ultrasound is a more suitable preliminary screening item, it is often confirmed by CT etc.
due to insufficient accuracy.
On the phone, Xiao Deng urged his mother to take his father to the big hospital for further examination.
A few days later, the patient was further checked after admission.
Alpha-fetoprotein (AFP) is in the normal range, but several other tumor markers such as CA19-9 and CA242 are abnormal.
In particular, CA19-9 is several times higher than normal.
Soon the CT results came out, and it was heading towards the worst-the doctor had almost confirmed that there was a tumor on the liver, and it was still a malignant tumor.
This result, like a bolt from the blue, brought a huge blow to Xiao Deng's entire family.
My father had just retired for a few years, and such an accident happened within a few days.
1 Without hepatitis and seldom drinking, why do I get liver cancer? In China, an important factor leading to liver cancer is hepatitis B, hepatitis C and other viral hepatitis, and Xiao Deng's father has never had viral hepatitis.
Another common cause of liver cancer is alcohol.
Although the patient usually drinks alcohol, neither the dosage nor the frequency is much, it belongs to occasional drinking.
Then why do you still get liver cancer? Primary liver cancer can be divided into hepatocellular carcinoma (HCC) and cholangiocarcinoma (ICC).
The former is what we call "liver cancer" in the ordinary sense, accounting for about 85% of the entire liver cancer, while ICC only accounts for 10% Around, it is a relatively rare malignant tumor.
And Xiao Deng's father suffered from ICC.
Many people don't know much about this type of liver cancer, and there is no national ICC incidence data in my country.
Some materials show that the total number of ICC patients in my country accounts for more than half of the world's total, and about 90% occur in 55-75 years of age.
Although ICC is a relatively rare type of tumor, the incidence of ICC has increased from 0.
32 per 100,000 to 0.
85 per 100,000 in the 30 years from 1985 to 2015, an increase of 165%. The clinical characteristics of ICC are no obvious symptoms in the early stage, rapid progress of the disease, and high degree of malignancy.
Its common symptoms are similar to most liver malignancies, manifested as unexplained fatigue, lack of appetite, night sweats, nausea, abdominal pain, and ascites.
What is even more headache is that its cause is not very clear so far, it is generally believed to be related to intrahepatic bile duct stones, intrahepatic bile duct sclerosis, and parasitic diseases such as schistosomiasis.
Xiao Deng's father lived in the middle and lower reaches of the Yangtze River when he was a child.
There were indeed some parasites infestation at that time.
However, whether he was infected with parasites is not clear.
After all, the age is long, and the sanitary conditions at that time were relatively backward, and there was no way to study it.
2The tumor was successfully removed, and the tumor body reached 8cm! At this time, the more difficult and critical thing is not to explore the cause, but how to better treat and save the patient's life.
This is the top priority.
ICC is a malignant tumor with a high degree of malignancy.
Because its pathogenesis and metastasis mechanism are not clear, the effective treatment options available are very limited.
Radical surgery is currently the only way to cure ICC, but because of the early symptoms are hidden, most of them are already in the advanced stage when they are discovered, the rate of radical surgery is low, and there is a lack of effective chemotherapy regimens.
This is the case in this case, and the tumor has reached 8 cm when it was discovered.
The patient's usual physical condition is fair, but he is thin and his nutritional status is not very ideal.
Although there are no basic diseases such as high blood pressure and high blood sugar, the overall physical fitness is not very good.
Considering the factors of age, the decision to perform surgery is to give it a go.
The operation soon started as scheduled.
Xiao Deng’s family waited anxiously at the door of the operation for one hour, two hours, three hours.
.
.
Finally, Xiao Deng’s father was pushed out of the operating room.
The entire operation lasted eight.
Many hours.
The tumor removed was eight or nine centimeters long.
Xiao Deng's family was very surprised, and felt extremely regretful.
Two years ago, Xiao Deng suggested that his father go for some medical examinations because he had never had a medical examination for so long.
However, Xiao Deng's father never agreed.
This procrastination led to a major illness, and I mistakenly thought that the old stomach disease of the past few decades had relapsed, but it actually came from the liver, which is a nearby organ.
The next day, Xiao Deng's father finally woke up slowly and was pushed back to the general ward by the staff.
At this time, the family was hanging with a heart, and he was finally relieved.
3 fell short! Severe complications "death" recovery after the operation is very important.
It is the biggest goal and hope of Xiao Deng's family to survive this period of time and leave the hospital smoothly.
After the operation, the patient needed liquid food, but after a few days passed, Xiao Deng's father felt that his stomach was always swollen and he had no appetite.
Eating something makes me feel uncomfortable, and it's easy to vomit.
At this time, the doctor felt that it was not normal.
What happened? After a series of examinations, it was discovered that Xiao Deng's father had a serious postoperative complication-gastroparesis.
Gastroparesis is a complication seen after abdominal surgery.
After this happens, it will affect normal eating, because the food does not enter the small intestine smoothly for digestion and absorption, which will have a great impact on the patient's nutritional status and seriously affect the recovery of the entire disease.
The doctor hurriedly took some relevant measures for treatment, but half a month later, Xiao Deng's father's gastroplegia problem has not been well improved and resolved, which pushed the family into an abyss again.
After trying a series of related drug treatments such as acupuncture, erythromycin, antacids, and gastric motility drugs, this problem has not been effectively improved.
The patient's nutritional support can only be carried out through parenteral nutrition every day, and gastric decompression and drainage can be carried out at the same time.
There is a lot of drainage every day, reaching nearly 1000 mL.
Xiao Deng's father became weaker and weaker, and finally suffered a severe lung infection and respiratory failure.
He died after 3 days.
.
.
4 What is gastroparesis? How to prevent it? The official name of gastroparesis should be called gastric emptying disorder.
It is a delay in gastric emptying due to various reasons.
It is also one of the complications of abdominal surgery.
The overall incidence is not very high.
Gastroparesis is often secondary to surgical operations such as subtotal gastrectomy and pancreaticoduodenectomy.
The reason is probably that the sympathetic nervous system is activated to increase the inhibitory activity of gastrointestinal sympathetic nerves, which is the main cause of gastroparesis.
.
It can also be secondary to certain diseases, such as endocrine and metabolic diseases, which means diabetes.
In addition, other digestive diseases, vagus nerve damage, infections, drugs, emotions, etc.
may affect the occurrence and development of gastroplegia.
After gastroparesis, the most significant symptom is that food cannot be smoothly transported from the stomach down to the small intestine, followed by abdominal distension and vomiting.
The amount of vomiting is often very large, which can generally be easily determined by clinical manifestations and X-ray examinations.
Whether there is gastroparesis.
It can cause great damages and even life-threatening if it occurs in patients with major diseases and weak physiques.
In terms of treatment, fasting water, gastrointestinal decompression, maintenance of water and electrolyte balance and other nutritional support and drug treatment are the main treatments, such as the use of gastrokinetic drugs cisapride, mosapride, itopride, etc.
, and surgical treatment The method needs to be used with caution.
From this case, we can get some relevant enlightenment.
For a disease that can only be treated by surgery, especially when it is a serious disease, we still need to make an accurate and detailed assessment as much as possible to judge the trade-off between surgical risks and benefits.
If we only consider whether the operation itself is successful, is it possible to ignore some complications and possible accidents? The final result may also be unsatisfactory, and this is not what our medical staff and family members hope See the results.
References: [1] Sun Bei, Xu Jun, Zhou Zunqiang, et al.
Clinical analysis of 36 cases of functional gastric emptying disorder after abdominal surgery[J].
Chinese Journal of Practical Surgery, 2003,(8).
465-46.
[2 ]Wang Yonggang, Zhang Rugang, Zhang Dawei.
27 cases of gastric emptying disorder after esophageal cancer resection[J].
Chinese Journal of Thoracic and Cardiovascular Surgery, 1998, 14(4):224-226.
[3]He Jianmiao, Pu Yongdong, Cao Zhiyu, et al.
Diagnosis and treatment of gastric emptying disorder after subtotal gastrectomy[J].
Chinese Journal of Practical Surgery, 2003, 23(8):471-471.
[4] Quan Zhufu.
Postoperative gastric emptying disorder [J].
Parenteral and Enteral Nutrition, 2006, 13(1): 58-61.
[5] He Honglun, Deng Shaoqing.
Clinical analysis of abdominal surgery and simple dynamic gastric emptying disorder[J].
Chinese Journal of Practical Surgery, 1996, 16(05):277-278.
