What Causes Canker Sores?

Stress ulcers generally refer to acute gastritis that occurs during shock, trauma, surgery, and severe systemic infections. It is often accompanied by bleeding symptoms and is an acute gastric mucosal lesion. The incidence of stress ulcers has increased in recent years, mainly due to the intensification of intensive care, effective support of living organs, and the update of anti-infective drugs, increasing the chance of stress ulcers.

Basic Information

English name

stress ulcer

Visiting department

Internal medicine

Common locations

Digestive tract

Common causes

Severe trauma, large area burns, intracranial diseases, brain trauma, abdominal surgery, etc .; prolonged hypotension; anticancer drugs and steroid hormone treatment, etc.

Common symptoms

Hematemesis, tar-like stool, shock, anemia, abdominal tenderness, muscle tension, etc.

Causes of stress ulcers

Severe trauma

Traumas that put the body in a stressful state include: severe trauma, large-scale burns, intracranial disease, brain trauma, and abdominal surgery.

2. Prolonged hypotension

Such as shock, chronic renal failure, multiple organ failure and so on.

3. Drug use

Such as anti-cancer drugs and steroid hormones, long-term use of aspirin, indomethacin and so on.

4. Other factors

(1) Increased excitability of the central nervous system The stomach is the most sensitive organ under stress. Emotions can inhibit gastric acid secretion and gastric motility, and tension and anxiety can cause gastric mucosal erosion.

(2) Damage of gastric mucosal barrier Corresponding to ulcers, damage of gastric mucosal barrier is a very important cause of disease. Any factor that affects blood flow in gastric wall will affect the function of gastric mucosal epithelial cells and weaken the gastric mucosal barrier. . Stress conditions such as major surgery, severe trauma, and systemic infections, especially low blood flow perfusion caused by shock, can reduce blood flow in the gastric wall and cause stress ulcers.

(3) The role of gastric acid and H ⁺ Stomach acid and H ⁺ have been considered to be important factors in the pathogenesis of ulcer disease. The increase in gastric acid can obviously increase the load on the gastric mucosal defense system, but gastric acid is generally not high or even reduced during stress ulcers. Nevertheless, the role of H ⁺ in the pathogenesis of stress ulcers cannot be denied. Due to the damage of the gastric mucosal barrier, although the H ⁺ concentration is not high, it can still diffuse retrogradely, and acidification occurs in the stomach wall. Can cause acute gastric mucosal damage.

(4) The effects of metabolites, such as the reduction of PG production, and the loss of control of other inflammatory mediators.

(5) Helicobacter pylori infection According to reports, the detection rate of Hp in patients with duodenal ulcers is 85% and that in patients with gastric ulcers is 53%. . It is believed that Hp can cause acute gastritis, but rarely causes acute ulcers and does not cause obvious bleeding.

(6) The effects of bile salts on the effects of bile salts on gastric mucosa should not be ignored. Bile salts are considered to be the third most harmful substance in the gastric mucosa except aspirin and alcohol.

Clinical manifestations of stress ulcers

When the disease is not serious clinically, there is no upper abdominal pain and other stomach symptoms, which are often overlooked. The obvious symptoms are vomiting and tar-like stools; major bleeding can cause shock; repeated bleeding can cause anemia. Peritoneal manifestations such as abdominal tenderness and muscle tension occur when gastroduodenal perforation occurs.

In addition, attention must be paid to the presence of combined lung and kidney lesions (ie, MODS).

Stress ulcer test

Laboratory inspection

Hemoglobin is reduced during routine blood tests, and hematocrit is decreased. Stool occult blood test was positive.

2. Other auxiliary inspections

(1) Gastroscopy is of special importance. Most scattered pale spots can be seen on the proximal mucosa of the stomach in the early stage. Multiple superficial red erosion points can be seen after 24 to 36 hours. Later, ulcers can appear, even black Some manifested as active bleeding.

(2) Selective arteriography The location and extent of bleeding can be determined, and drugs can be injected through the catheter to stop bleeding.

Stress Ulcer Diagnosis

This disease should be considered in severe trauma, burns, sudden upper gastrointestinal bleeding, or acute colic and peritoneal inflammation after major surgery or serious illness.

Differential diagnosis of stress ulcers

Stress ulcers should be distinguished from diseases such as acute erosive gastritis, peptic ulcer, cirrhosis, and rupture of esophageal varices. Differentiation is usually made by medical history and gastroscopy.

Stress ulcer complications

Acute ulcers can cause heavy bleeding when they invade exposed blood vessels. Patients can develop vomiting or even hypovolemic shock.

Stress ulcer treatment

The first is to treat the primary disease, and the second is to maintain the pH in the stomach above 4.0. Including the following measures:

Systemic treatment

Remove stress factors, correct insufficient oxygen supply, maintain water, electrolyte, acid-base balance, and provide early nutrition support. Nutritional support is mainly provided by enteral nutrition as early as possible, and within 24 to 48 hours, the formula diet is applied, and the increase is from 25ml / hour to 100ml / hour. It also includes prophylactic use of antacids and antibiotics, as well as measures to control infections.

2. Intravenous hemostatic drugs

Such as standing hemostasis, PAMBA, vitamin K ₁ , posterior pituitary and so on. In addition, esomeprazole and famotidine can be administered intravenously to inhibit gastric acid secretion.

3. Partial processing

Place the gastric tube for drainage and irrigation or inject enzyme-producing agents such as esomeprazole and thrombin into the gastric tube. Flush the stomach with iced saline or soda water until the gastric juice is clear. Including gastrointestinal decompression, injecting aluminum sulfate into the gastric tube to protect the gastroduodenal mucosa, and injecting H ₂ receptor antagonists and proton pump inhibitors.

4. Endoscopic treatment

Gastroscopy can be used to stop bleeding. Electrocoagulation, laser coagulation can be used to stop bleeding, and gastroscopy can be used locally.

5. Interventional Therapy

Available selective arterial angiography, embolization, injection of vasoconstrictor drugs, such as vasopressin.

6. Surgical treatment

Vaginotomy and gastrectomy (usually 70% to 75% of the stomach) can be performed, and the bleeding ulcer is removed together. Hemorrhagic ulcers remaining on the bottom of the stomach were sutured and ligated. In elderly patients with higher risk, vagotomy plus pyloroplasty can be performed and bleeding ulcers can be sutured.