2011年4月8日星期五

What should be done ulcer checked?

What should be done ulcer checked? 1. Gastric acid analysis and determination of gastric acid analysis and determination of the gastric ulcer diagnosis and treatment of choice have helped. The basis of gastric acid secretion (basal acid output, BAO)> 5mmol / h may be duodenal ulcer, BAO> 7.5mmol / h should be surgery. BAO> 20mmol / h the maximum amount of acid secretion (MAO) is greater than 60mmol / h, or the BAO / MAO> 0.6 may as gastrinoma, gastrin determination should be further examined.

There are hospitals acid type selected by vagotomy in the treatment of duodenal ulcer, the specific method is: when BAO <15mmol / h, maximum pentagastrin stimulate gastric acid secretion (PMAO) less than 40mmol / h and low insulin the maximum blood glucose stimulated gastric secretion (IMAO) greater than or equal to PMAO, while the line is not accompanied by pyloric obstruction vagotomy highly selective treatment of duodenal ulcer; when the BAO> 15mmol / h, PMAO> 40mmol / h, PMAO> IMAO, is also associated with pyloric obstruction underwent selective vagotomy plus gastric resection. Postoperative follow-up showed that gastric acid secretion in type selection based on fan cut surgical method can significantly reduce the ulcer recurrence rate and improve the therapeutic effect.

2. Serum gastrin and serum gastrin determination of serum calcium can help rule out or diagnose gastrinoma, serum gastrin> 20pg/ml consider gastrinoma is possible; when gastrin> 100pg / ml can be sure that the gastrinoma. Hyperparathyroidism complicated by peptic ulcer disease, determination of serum calcium and therefore some degree of help.

3. Fecal occult blood test combined ulcer bleeding can be positive, but the fecal occult blood test positive should be considered for continued gastric malignant lesions.

4. Associated with ulcer bleeding in check, including hemoglobin, hematocrit, reticulocyte count, bleeding and clotting time.

5. Schilling test (Schilling test) in patients with atrophic gastritis in a wide range for determination of vitamin B12 in Schilling test (Schilling test).

6. Helicobacter pylori check for this check, while not based on the diagnosis of ulcer disease, but because of its close relationship with the recurrence of ulcer disease, it is important in treatment. Where this positive bacteria, the drug should be used effectively to eradicate it.

1. Endoscopy with biopsy is better than the accuracy and sensitivity, confirmed rate. Accurate understanding of electronic fiber endoscopy ulcer size, location, with or without bleeding, penetration, active or quiescent, according to the pathological form of ulcer is benign or malignant can be broadly understood, together with biopsy can also be benign or know malignant. At the same time can also be combined endoscopic detection of Helicobacter pylori, to understand whether Helicobacter pylori infection. Endoscopy can be certain treatments, such as endoscopic local hemostasis.

2. Barium meal examination is simple, less painful. Form according to the general understanding of gastric motility and whether gastric stomach leather bags, while changes under the Kanying can be identified and the mucosa of benign or malignant. Benign gastric ulcer Kanying were located outside the radial concentration of the surrounding mucosa. Barium can also understand the duodenum and pyloric deformation, narrow, obstruction. However, barium has some false negatives (Figure 2,3).







3.CT inspection is not the first choice for this disease and the routine examination, but in the ulcerative disease diagnosis and differential diagnosis is still a certain significance. CT manifestations of gastric ulcer ulcers, stomach swelling, and scar the comprehensive changes.

The formation of gastric ulcer gastric wall edema by different defects in the CT performance are quite different. When not associated with stomach edema and scarring, in the cross-sectional diagram gastric ulcer showed only dish depression, gastric wall thickening around the obvious, if not carefully observed likely to miss lesions. When significant changes in the stomach when the edema and scarring, CT lesions more easily found. Edema and thickening in the backdrop of the stomach, stomach ulcer within the concave surface of the deep defects, according to the choice of the stomach cavity of different contrast agents, can be seen in the stomach the low-density or high-density contrast agent shadow, its external Week no thickening of the stomach wall; submucosal edema, the performance of low-density suspension of the edge of the ulcer with. Enhanced scan shows normal gastric mucosa and the surrounding mucosa of the strength of the break in the ulcer edge showed stratification around the stomach, and gastric cancer in the identification of this feature may have important value.

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