First acquaintance with the patient
According to her 53-year-old patient, who accidentally swallowed cherry seeds when eating cherries at home before November, her stomach began to hurt one after another, accompanied by bloating, and this painful feeling was alleviated after eating and going to the toilet, thinking that it was okay and not at ease.
Since the patient swallowed the foreign body by mistake, he sometimes felt that after eating, there was acid reflux, belching, occasional chest tightness, neck discomfort, palpitations and other symptoms, as well as poor sleep, no pus and blood, no nausea and vomiting, no joint pain, eye discomfort and other symptoms. The patient was not at ease so he came to our hospital for gastroscopy, and the examination prompted: 1, esophageal mucosal damage; 2, chronic non-atrophic sinusitis; 3, gastric bottom polyps. Chronic non-atrophic sinusitis is treated symptomatically and the condition improves, during which no medication is taken to control the condition.
Because the patient has a polyp at the bottom of the stomach, it is recommended that the patient control the condition and then our hospital will do a resection of the floor polyp. Before admission, the patient was treated with chinese medicine looking, smelling and cutting: looking forward to the spirit, the expression was free, the face was gorgeous, the shape was moderate; the movement was free, the spirit could be, the development was normal, the nutrition was good; the voice was normal, the speech was clear, the response was free, there was no cough, asthma, no vomiting, too much breath, moaning, abdominal sound; no abnormal odor; red tongue, thin yellow moss, and smooth pulse.
Admission was made to the hospital with a "fundus polyp" according to the patient's gastroscopy.
The course of treatment of the patient
After the patient was admitted to the hospital, I first improved some of her related examinations, including physical examination, routine examination, abdominal CT, electrocardiogram, and painless gastroscopy.
Physical examination: flat abdomen, no abdominal wall varices, soft abdomen, no tenderness, rebound pain, no mass in the abdomen. The liver is untouched under the ribs, the spleen is not touched under the costis, Murphy's sign is negative, there is no tenderness and rebound pain at the Mychs point, there is no percussion pain in the hepatic region, no percussion pain in the bilateral renal area, and the mobility is dull. The bowel sounds are about 4 times per minute. There were no obvious abnormalities in blood routine, fecal occult blood, fecal routine, electrolyte, HIV initial screening + preoperative examination, tumor markers, liver function, kidney function, blood glucose, blood lipids, D-dimer, and coagulation.
CT examination tips: 1. Tiny nodules in the lower lobes of both lungs, please compare with the original tablets and follow up. 2. Small cyst of the right lobe of the liver may be, and the edge of the right lobe of the liver is calcified with nodules. Random blood glucose after admission: 5.7 mmol/L. Bedside 12-lead conventional ECG: 1. Sinus bradycardia with irregularity; 2. Reverse bell transposition. Painless colonoscopy: no significant abnormalities are seen in the intestinal mucosa (poor bowel preparation). Painless gastroscopy: chronic non-atrophic sinusitis, END-of-week polyp EMR resection.
Therefore, the patient underwent ENDoscopic EMR surgery on the second day after admission, and was given omeprazole acid inhibition gastric protection and symptomatic supportive treatment of rehydration, supplemented by moxibustion, septal moxibustion treatment, ultrasound drug penetration and other treatments, and Chinese medicine dialectical treatment was treated with Chinese medicine decoction.
Precautions for patients in treatment
1. When doing gastroscopy, the patient needs to be on an empty stomach for more than 6 hours, and the patient with gastric retention needs to fast and rehydrate for 1 to 3 days or fully aspirate the gastric contents before examination.
2. The elderly, especially those with a history of coronary heart disease, hypertension and stroke, routinely measure blood pressure, take electrocardiogram and other examinations, and then check after the condition is stable.
3. 15 to 30 minutes before surgery, local spraying or oral anesthesia in the throat to alleviate intraoperative pain.
4. During the operation, patients should take abdominal deep breathing through the mouth to alleviate symptoms such as nausea and vomiting.
5, gastroscopy is completed, you can gargle with water, but can not be swallowed, to prevent local anesthesia after accidental inhalation into the trachea, about 1 hour after trying to drink water without cough symptoms, you can eat, diet should be light and non-irritating.
Therapeutic effect of the patient
The patient's mental state can be discharged from the hospital, slight discomfort in the upper abdomen after eating, liquid diet, two stool adjustment, sleep can be. Physical examination: stable vital signs, no dry and wet rales heard in both lungs, no pleural friction sounds. The abdomen is flat, without abdominal wall varices, the abdomen is soft, no tenderness, rebound pain, and no mass in the abdomen. The bowel sounds are about 4 times per minute. The tongue is red, the moss is thin yellow, and the veins are slippery.
Precautions for patients in their daily lives
1. Avoid wind and cold, flirt, and eat carefully.
2. Develop the habit of eating regularly, eat regularly, eat less and eat more, and avoid overeating.
3. Discharge with medicine: aluminum magnesium carbonate chewable tablets, Tianribapa Paite tablets. Herbal decoction, decoction.
4. Re-examine the gastrointestinal endoscopy after 1 year.
5. If you are unwell, go to the gastroenterologist for treatment.
Doctors feel good
At present, chronic superficial gastritis is clinically called "chronic non-atrophic gastritis", which refers to the occurrence of gastric mucosal infiltration mainly by lymphocytes and plasma cells under the action of related pathogenic factors and may be accompanied by erosions and bile reflux, but there is no chronic inflammatory change of gastric mucosa atrophy and metaplasia, the prevalence of the disease increases with age, and Helicobacter pylori (Hp) infection is its most common cause. At present, gastroscopy and histopathology are the main means of diagnosing and differentially diagnosing the disease.
Because the symptoms of chronic superficial gastritis are atypical, many patients rarely take the initiative to go to the hospital for treatment, and most of them are found during physical examination. This is the case with the patient who found himself with chronic superficial gastritis during the gastroscopy and carried out symptomatic treatment in a timely manner. At the same time as the gastroscopy, it was found that the patient had a floor polyp, and EMR surgery for the gastric floor polyp was also done in time to prevent the further development of gastric diseases.
Chinese medicine believes that the cause of gastrointestinal polyps is the spleen and stomach deficiency and cold, spleen loss of good luck, water wet accumulation into phlegm, phlegm and Wei Qi fighting in the gastrointestinal tract, blocking the veins, depression into accumulation, the formation of polyps. You can compare the spleen and stomach to the warehouse and the digestion workshop, if your digestion processing workshop (spleen) has been inefficient, then the warehouse (stomach) will be backlogged with a large amount of food, a long time will be fermented in the stomach, stomach acid will accelerate secretion, further stimulate the gastric mucosa, causing bloating and nausea. Therefore, everyone should do a good job in daily life care, reasonable diet, protection of the spleen and stomach, and prevention of gastrointestinal diseases.
Nie Dan
Chongqing Municipal Hospital of Traditional Chinese Medicine
Department of Gastroenterology Attending Physician
[This article was first published in "Dr. Xiaohe", published by the doctor with the authorization of the doctor, the copyright belongs to the doctor personally, it is forbidden for anyone to reprint plagiarism, and violators will be investigated】