What Is the Pylorus?

Pylori: The part of the stomach that communicates with the duodenum. It has thick circular muscles around it and glands inside. It can secrete mucus proteins and protect the gastric mucosa from rough food abrasions and acid erosion.

Chinese name: Pyloric cave
Foreign name: pylorus
Pinyin: Yu mén

Acupoint method: The upper abdomen of the human body, when the upper part of the umbilicus is 6 inches
Alias: Shangmen Point, Shangguan Point, Youguan Point
Indications: Abdominal pain, vomiting, shivering, etc.
Note: Chongmai, Foot Shaoyin Acupoint, etc.

Pylorus overview

The pyloric part: the lower part of the stomach, the right side of the corner notch, and the part near the pylorus is called the pyloric part. The pyloric part includes the pyloric duct and pyloric sinus near the pylorus. This is the site of multiple gastric ulcers, which can also cause obstruction due to shrinkage of tumors and lesions, which is of great clinical significance. The stomach can be divided into 4 parts. The part between the stomach body and the pylorus is called the pylorus.

Pyloric sinus: There is often a line groove called the middle sulcus on the large curved side of the pyloric part. This sulcus has the left and right pyloric parts, the left part is the pyloric sinus, and the right part is the pyloric duct. Refers to an inconspicuous shallow groove called the middle groove on the large curved side of the pyloric part. The pyloric part is the right pyloric duct and the left pyloric sinus. The pyloric sinus is usually at the bottom of the stomach. Gastric ulcers and gastric cancers occur in the small curvature of the stomach near the pylorus. The clinically called "gastric sinus" is the pyloric sinus, or the pylorus including the pyloric sinus.

Pyloric anatomy

The pylorus is the exit of the duodenum from the lower end of the stomach. On its surface there is a narrowed ring, where the pyloric sphincter is located. The part near the pylorus is called the pylorus or pyloric sinus. It is located inside the 1st lumbar vertebra. The lamina propria contains mucus glands and secretes mucus. The ring-layer muscle thickens at the pylorus, forming the pyloric sphincter. This part is the site of multiple ulcers and is prone to obstruction. There is an anterior pyloric vein in front of the pylorus, which is an important sign to identify the pylorus during surgery. There is an annular narrow groove on the outer side of the pylorus, and the inner side protrudes into a circular pyloric valve (formed by the pyloric sphincter). The part near the pylorus is called the pylorus or pylorus. The pylorus is inside the 1st lumbar spine. The pyloric mucosa has a mucus gland that secretes mucus. The ring-layer muscle thickens at the pylorus, forming the pyloric sphincter. This part is the site of multiple ulcers and is prone to obstruction, which is of great clinical significance.

Pyloric and pyloric-related diseases

Pyloric obstruction: refers to the obstruction of gastric contents through the pylorus. Can be divided into two kinds of functional and organic. The former is mostly due to edema of the pyloric mucosa; the latter is mostly due to the formation of peptic ulcer scars. The main clinical manifestations are nausea and vomiting, and the vomit is indigestible or overnight food. X-ray barium meal and gastroscopy can make a diagnosis. Functional obstruction is mainly medical treatment, organic patients often need surgery. A group of symptoms caused by pyloric sphincter spasm. Due to pyloric stenosis, obstruction, or seen in duodenal ulcers, the clinical manifestations are: epigastric discomfort, vomiting, gastric dilatation and peristaltic waveforms can be seen in the middle and upper abdomen, and there are often water vibrations. Treatment should be tailored to the disease.

Pyloric obstruction is a group of symptoms of blocked pyloric passages. Etiology and clinical: Obstruction caused by pyloric spasm and edema during ulcer treatment, which are called spastic pyloric obstruction and edema pyloric obstruction; these obstructions are temporary and can disappear with the improvement of the ulcer. obstruction. Obstruction caused by ulcer scar healing is called scar pyloric obstruction, which is permanent and is an absolute indication for surgical treatment. It is also called organic or surgical pyloric obstruction. A diagnosis can be made based on a long history of ulcer disease and typical gastric retention symptoms (such as vomiting and sleeping, epigastric stomach type, and tremors). Gastrointestinal decompression was performed 5-7 days before the operation, and the stomach was lavaged daily with warm saline. The surgical method is still selected according to the surgical principles of ulcer disease. 90% of the results were satisfactory. Most often occur in duodenal ulcer, followed by pyloric duct or prepyloric ulcer. The clinical manifestations are discomfort in the upper abdomen, which is aggravated after meals, and therefore anorexia; frequent vomiting, and the symptoms of upper abdomen fullness can be temporarily reduced after vomiting. The vomit often contains food residues and has a sour smell; there is a tremor in the fasting stomach. Medical treatment of this disease is not easy and effective, and often requires surgical treatment.

Refers to the obstruction of gastric contents through the pylorus, which is one of the common complications of peptic ulcer. Divided into two kinds of functional and organic. The former is caused by local mucosal edema due to ulcers or ulcers near the pylorus. The latter is associated with ulcerous scar stenosis. Mainly manifested as upper abdominal discomfort, belching, regurgitation, vomiting, vomiting is indigestible or overnight food, and has metabolic alkalosis, hand and foot convulsions and so on. The upper abdomen is swollen, and the stomach type is visible. There are reverse peristalsis and vibration sound. Barium meal X-rays and gastroscopy can make a diagnosis. Generally, medical treatment can be performed first, including gastrointestinal decompression and correction of water and electrolyte imbalance. Organic (scarring) patients need surgery.

The diameter of the pylorus is about 1.5 cm, which is the narrowest part of the digestive tract. When local lesions occur, it is easy to cause obstruction (pyloricobstruction).

Pyloric etiology

1. Gastric duodenal ulcer:

Pyloric obstruction is one of the common complications of gastrointestinal ulcers, with an incidence of 5% to 10%; pyloric ulcers (pyloric ulcer, pyloric ulcer, duodenal ulcer) are the main causes of pyloric obstruction, especially ten Duodenal ulcers are more common, accounting for about 80%. There are three types of obstruction caused by ulcers: spasticity, inflammatory edema, and scarring. The ulcer active phase is stimulated by inflammation to stimulate pyloric sphincter spasm or local tissue inflammation and edema, which can cause pyloric obstruction. Such obstructions are temporary, and they can alleviate by themselves or disappear with the improvement of the ulcer, so it is also called functional pyloric obstruction. Scar pyloric obstruction is caused by the recurrence of ulcers and the shrinkage of scars formed by local tissue fibrosis. Such lesions are permanent and cannot be resolved without surgery, so they are also called organic obstructions. In most cases, pyloric obstruction is the result of the combined effects of the above factors. Long-term ulcers cause scarring of the pyloric duct due to scarring. On the basis of this, spasm and edema factors aggravate the obstruction and go from partial to complete.

2. Tumor:

Various benign and malignant tumors near the pylorus can cause obstruction, which can be caused by infiltration and growth of malignant tumor cells; larger gastric polyps or pedicled polyps in the pylorus and external tumors can also cause obstruction.

3. Congenital hypertrophic pyloric stenosis:

Common neonatal diseases, the cause is unknown.

4. Other:

Such as foreign body in the stomach, gastric mucosa prolapse, acute gastric torsion, etc., but clinically rare.

Essentials of pyloric diagnosis

1. Clinical manifestations:

(1) Symptoms: The main clinical symptoms of pyloric obstruction are abdominal pain and vomiting. Abdominal pain was initially swollen and heavy in the upper abdomen, and then turned into paroxysmal colic, followed by belching, nausea and vomiting. Some patients have no obvious symptoms of abdominal pain, but simply bloating. Because of stomach tension in the early stage of obstruction, vomiting is more frequent, and vomit is more recently eaten. As the obstruction worsens, gastric tension decreases and the number of vomiting decreases, but The amount of vomiting increased significantly, up to 1 to 2L each time. Vomiting mostly occurred in the afternoon and evening. Most of the vomiting was meal-separated food or hangovers. The taste was sour and odorless, and did not contain bile. Some patients are reluctant to eat because of fear of vomiting, and even actively induce vomiting to relieve discomfort. When there is severe disturbance of water, electrolyte and acid-base balance, thirst, oliguria, irritability, shortness of breath, twitching of hands and feet, and even convulsions and coma may occur.

(2) Signs: The patient's upper abdomen is swollen, and the stomach type can be seen, sometimes the gastric peristaltic wave from left to right, and occasionally the reverse peristaltic wave of the stomach can be seen; Elderly obstruction can lead to weight loss, dry skin, and loss of elasticity; vitamin deficiency can also occur. In hypocalcemia, the neuromuscular irritability is increased, which is positive for Chvostek sign (facial spasm can be caused when the facial nerves in the parotid gland are tapped lightly) and Trousseau sign (spastic contraction of the muscle when the nerve that innervates a muscle is compressed) .

2. Auxiliary inspection:

(1) Laboratory examination: Routine blood examination can find mild anemia, hemoglobin or hematocrit can be increased in severe dehydration; fecal occult blood during active ulcer can be positive; urine specific gravity increased, urine sodium and potassium decreased; blood Urea nitrogen and creatinine are increased; pH is often increased in severe pyloric obstruction and blood sodium, potassium, and blood chloride are decreased.

(2) X-ray barium meal examination: see enlargement of gastric shadow, decrease of tension, barium agent sinks into gas, liquid and barium after entering into the stomach; barium agent retention more than 25% 6 hours after barium meal indicates gastric retention, 24 hours Those who still have barium residues suggest the presence of scarring pyloric obstruction: if it is pyloric spasm, the gastric enlargement is not obvious, the gastric motility is enhanced, and the pyloric opening is loosened for a long period of time, and the gastric contents are temporarily emptied.

(3) Gastroscopy: Gastroscopy can provide a diagnosis of the cause of pyloric obstruction. Through gastroscopy, the pyloric stenosis, edema, tumor, mucosal prolapse, ulcer, and ulcer scar can be seen directly. Suspicious lesions can also be biopsied to determine the nature.

(4) Saline load test: After the gastric juice is sucked up with a Levin tube, 750 mL of physiological saline is injected in 3 to 5 minutes, and it is aspirated after 30 minutes. Normally, it should be less than 300 mL. If it is greater than 300 mL, it indicates that there is pyloric obstruction.

(5) Radionuclide scintigraphy: Radionuclide-labeled meals are used to determine the time required for food to pass from the stomach to the pylorus, which is helpful for diagnosis.

Pyloric condition judgment

Patients with pyloric obstruction generally have no difficulty in diagnosis, but during the treatment process, the serum potassium level of the patient needs to be closely monitored to prevent arrhythmia and hypokalemia caused by hypokalemia.

Pyloric treatment

Take different treatment measures for different causes:

Congenital hypertrophic pyloric stenosis

Gastric pyloric myotomy can be performed with active support.

2. Pedicled stomach polyps

Can be removed under the gastroscope. Partial gastric resection can be performed for larger broad-based gastric polyps; radical surgery can be performed for malignant tumors. If the tumor cannot be removed, gastric jejunostomy is performed.

3. Stomach and duodenal ulcer inflammation and edema

Should take conservative treatment measures. These include gastrointestinal decompression, correction of dehydration and electrolyte disturbances, metabolic alkalosis, and nutritional support. In addition, intensive drug treatment of ulcers is also necessary, such as intravenous administration of H2 receptor blockers. The amount of fluid replacement includes lost, daily loss and normal daily requirements, and electrolytes should be supplemented according to the results of biochemical examination, especially the supplement of potassium. Mild alkalosis generally does not require special treatment, just correct hypokalemia and supplement enough Normal saline can be corrected; if the alkalosis is severe, in addition to sufficient saline, dilute hydrochloric acid and arginine hydrochloride can be given treatment. Patients with a long course of disease accompanied by significant malnutrition, who are estimated to have a long gastric tube indwelling period, should be given parenteral nutrition support treatment. Gastrointestinal decompression can first use a thicker gastric tube to suck up food residues, and then use an ordinary gastric tube to continuously suck for 3 to 5 days, and then wash the stomach with physiological saline or hypertonic saline daily. When the cumulative amount of suction during the day is less than 250mL This indicates that the gastric emptying function has been basically restored, the gastric tube can be removed, a small amount of fluid can be taken, and the amount of food can be gradually increased. At this time, you can take H2 receptor blocker (0.2g cimetidine, 1 time before meals and before bedtime, 4 to 6 weeks as a course of treatment) or proton pump inhibitor (omeprazole 20mg, orally) , 2 times a day) to promote ulcer healing, reduce pyloric inflammation and edema, and relieve obstruction.

4. Ulcer scars

Mainly surgical treatment. Before surgery, you must make adequate preparations, including fasting, gastric lavage, correction of water, electrolytes and acid-base imbalances, and improve the nutritional status of patients; for young adults, hyperacidity, large gastric resection or highly selective vagus nerve cutting plus Pyloroplasty is suitable; elderly, low gastric acid, poor general condition, can not tolerate major surgery or combined with other serious medical diseases; feasible gastrojejunostomy plus vagus nerve amputation; if conditions permit, you can also consider Microscopy balloon dilation, after the whole body condition improves, then do further processing.