OVERVIEW
由于吞服腐蚀剂导致胃黏膜糜烂、溃疡或坏死的疾病
常见症状有疼痛、灼痂等
吞服强酸、强碱及其他腐蚀剂
选择一般治疗、药物治疗、手术治疗等
Definition
Corrosive gastritis is a special type of gastritis that occurs when strong acids (sulfuric acid, hydrochloric acid), bases (potassium hydroxide, sodium hydroxide), or other corrosive agents are swallowed, resulting in degeneration, erosion, ulceration, or necrosis of the gastric mucosa.
The severity of the lesion is determined by the concentration, nature and dose of the strong acid, strong alkali and other corrosive agents, whether or not the stomach is empty, and whether or not there is vomiting.
In mild cases, there may be severe pain in the oropharynx, retrosternum and epigastrium, and in severe cases, there may be vomiting of blood, respiratory distress and perforation of the digestive tract.
Causes
Causes
Corrosive gastritis is mainly caused by swallowing strong acids (sulfuric acid, hydrochloric acid, nitric acid, acetic acid, lysol), strong bases (e.g., sodium hydroxide, potassium hydroxide) or other corrosives (arsenic and phosphorus, etc.), which cause extensive corrosion of the stomach wall.
Pathogenesis
Corrosive gastritis is caused by swallowing strong acid, strong alkali or other corrosive agents, which cause degeneration of the mucosa of the stomach. For example, strong acid can cause proteins and keratin to dissolve or coagulate, and tissues to appear burned or even necrotic, and strong alkali can rapidly absorb the water in the tissues and alkalize the proteins, etc., which ultimately leads to erosion, ulceration, or even perforation of the patient’s mucosa of the stomach.
Symptoms
Main Symptoms
Pain
It can appear in the oropharynx, the back of the sternum, and the upper abdomen.
Often manifested as severe pain, mostly manifested as persistent.
It may be accompanied by dysphagia, pain, nausea, vomiting and other symptoms, and the vomit is often bloody mucus.
In severe cases, shock is caused by extensive corrosive necrosis of the esophagus and stomach.
Cauterized scab
It can be seen on the lips, mouth and throat mucosa.
After swallowing sulfuric acid, the oral mucosa is black, nitric acid is dark yellow scabs, hydrochloric acid is grayish brown, Lysol makes the oral mucosa grayish white, and then turns brownish yellow, and strong alkali is transparent edema.
Perforation
When the mucous membrane corrosion is severe, perforation can occur, common perforations are esophageal perforation, gastric perforation.
It is usually accompanied by severe pain, and can also lead to complications such as esophageal tracheal fistula, mediastinitis and peritonitis.
Obstruction
Scarring of the esophagus, cardia, and pylorus leads to narrowing of this part, which causes obstruction.
Patients may present with difficulty in swallowing, frequent vomiting, nausea and abdominal distension.
Complications
Mediastinitis
After esophageal perforation and gastric perforation in erosive gastritis, the mediastinum suffers contamination, which leads to infection.
Common symptoms include high fever, chills, cough, dyspnea, etc. In severe cases, shock may occur, which may be life-threatening.
Peritonitis
After esophageal perforation and gastric perforation in corrosive gastritis, the peritoneum becomes infected with bacteria, resulting in an inflammatory response.
Common symptoms include abdominal pain, nausea, vomiting, high fever and chills.
Esophageal tracheal fistula
Corrosive gastritis causes patients to develop esophageal perforation and a pathologically connected channel between the esophagus and trachea.
Common symptoms include shortness of breath, coughing, coughing up sputum, choking, difficulty in swallowing, etc. In severe cases, respiratory distress and suffocation may occur.
Systemic poisoning symptoms
Lysol absorption causes renal tubular damage, leading to renal failure, oliguria, elevated creatinine, lower limb edema and other manifestations.
Acid absorption can lead to severe acidosis.
Consultation
Department of Medicine
Gastroenterology
Patients who experience abdominal pain, nausea and vomiting after swallowing strong acids, alkalis and other corrosive agents are advised to consult the Department of Gastroenterology in a timely manner.
Preparation
Consultation: Registration, Preparation of Information, Frequently Asked Questions
Tips for seeking medical treatment
Seek medical attention as soon as possible. If you know the name of the corrosive you swallowed, tell the doctor at the time of consultation.
Preparation Checklist
症状清单
Pay particular attention to the time of the onset of symptoms, special symptoms, etc.
Is there pain and where is it felt?
What color are the burns on the lips, mouth and throat?
Is there difficulty in swallowing?
How often do these symptoms strike?
What aggravates or relieves these symptoms?
病史清单
Is there a history of swallowing strong acids, bases and other corrosive agents?
检查清单
Test results from the last six months to bring to your doctor’s appointment
Imaging tests: barium meal X-ray imaging.
Gastroscopy.
Diagnosis
Diagnosis based on
Medical history
History of swallowing strong acids, bases and other corrosive agents.
Clinical manifestations
症状
Severe pain, dysphagia, dyspnea, nausea, and vomiting in the mouth, pharynx, and retrosternal area, often with bloody mucus.
Perforation of the esophagus and stomach may also occur, causing pleurisy and diffuse peritonitis. High fever develops in secondary infections.
Different corrosive agents may produce burned scabs of different colors on the mucous membranes of the mouth, lips, and throat.
体征
Cauterized scabs appear on the mucous membranes of the lips, mouth and throat.
Edema appears in the oral and pharyngeal mucosa.
Imaging
X线钡餐造影检查
The condition of the stomach can be clarified, whether there is scarring of the cardia and pylorus, and stenosis.
Precautions: Barium X-ray contrast is prohibited in the early stage, and can be performed during the patient’s recovery to check the patient’s gastric recovery.
Gastroscopy
Gastroscopy is used to find out if the patient has scarring and narrowing of the esophagus, cardia and pylorus.
Precautions: Gastroscopy is prohibited in the early stage to avoid causing perforation, and can be performed during the patient’s recovery to check the recovery of the patient’s esophagus and stomach.
Differential Diagnosis
Acute suppurative gastritis
Similarities: both have symptoms of epigastric pain, nausea, vomiting, and fever.
Differences: Acute suppurative peritonitis is mostly due to bacterial infection and usually has only epigastric pain. Corrosive gastritis has a history of swallowing strong acids and bases, which can lead to severe pain in the patient’s mouth, throat, posterior sternum, and epigastric region, and is accompanied by burning scabs on the lips, mouth, and throat mucosa.
Acute gastric perforation
Similarities: Both have symptoms of epigastric pain, nausea and vomiting.
Differences: Acute gastric perforation is caused by the damage of the whole layer of the stomach wall, and the common causes are gastric ulcer, followed by gastric cancer, trauma and so on. Corrosive gastritis is caused by swallowing corrosive agents, such as strong acid, strong alkali, etc. Common symptoms include severe pain in the mouth, throat, back of the sternum, epigastrium, and burning scabs on the lips, mouth and throat mucosa.
Treatment
Treatment purpose: to relieve the patient’s symptoms and reduce the occurrence of complications.
Treatment principle: corrosive gastritis should generally be neutralized in time, and then supplemented with antibacterial drugs and antacid drugs.
Reduce the damage secondary to corrosive agents
In order to reduce the absorption of poisons, according to the type of corrosive agents to choose the appropriate neutralizing substances to reduce the degree of mucosal burns.
For those who swallow strong acids, drink water first and take 30-100 ml of aluminum hydroxide gel orally, or give 100-200 ml of milk, egg white or vegetable oil orally as soon as possible.
Those who swallow strong alkali can be given 300～500ml of vinegar plus 300～500ml of warm water orally, and then a small amount of egg white, milk or vegetable oil.
For taking phenolics, vegetable oil, such as peanut oil, sesame oil, etc., can be used first, followed by milk and egg white.
Gastric lavage and emetic treatment are prohibited to prevent causing intestinal perforation.
Symptomatic treatment
Patients who are unable to eat are preferred to be treated with parenteral nutrition, such as amino acids, fats, electrolytes and vitamins.
For severe pain, give painkillers such as morphine intramuscular injection.
Oxygen inhalation is given to those with respiratory difficulties. Those who already have laryngeal edema and severe respiratory obstruction should be tracheotomized early and broad-spectrum antibiotics should be applied to prevent secondary infection.
In the early stage, in order to avoid the occurrence of laryngeal edema, can be appropriate within 24 hours of the onset of the disease, the use of glucocorticoids such as hydrocortisone, dexamethasone, prednisone, etc., in order to reduce the local edema of the throat, and can reduce the formation of collagen and fibrous scar tissue. However, they should not be taken for a long period of time.
Complications
Complicated esophageal stenosis and pyloric obstruction can be treated with endoscopic balloon dilatation.
Localized esophageal and pyloric stenosis can be treated with stent implantation.
Those who are not suitable for balloon dilatation or stenting should undergo surgical treatment.
Prognosis
Cure
Most cases of erosive gastritis have a good prognosis after prompt medical treatment. However, if not treated promptly and effectively, the condition can be life-threatening.
Corrosive gastritis may lead to restrictive stenosis, such as esophageal stenosis and pyloric stenosis, which may affect swallowing and breathing.
Daily
Daily Management
Dietary management
Supplement more protein-rich food, such as lean meat, fish, eggs, etc., to enhance nutrition.
Eat a regular diet and more vitamin-rich foods, such as broccoli, dragon fruit and radish.
Avoid overeating and do not eat spicy and stimulating foods, such as chili peppers, fried chicken and kebabs.
Life management
Pay attention to bed rest during treatment.
Ensure sufficient sleep time in daily life and stay up less late.
Pay attention to rest and avoid overwork.
It is recommended to take a walk in daily life to strengthen the body resistance.
Psychological management
Patients with corrosive gastritis will have bad moods such as irritability, worry and depression due to corrosive agent, patients should be encouraged to keep an optimistic state of mind, which will help the recovery of the disease.
Follow-up
Regular follow-ups will help the doctor assess the patient’s condition and prevent complications.
The main review items include gastroscopy and barium meal X-ray.
Prevention
Pay attention to dietary hygiene and avoid taking corrosives by mistake.
Keep corrosives in a high place to avoid accidental ingestion by children.
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