An ulcer perforation is tissue destruction that affects all wall sections of an organ, resulting in a hole in the organ wall. This tissue destruction is caused by ulcers. The stomach or small intestine are most commonly affected by ulcers and thus also by ulcer perforations.
What is an ulcer perforation?
An ulcer is an ulcer. In most cases, it is an ulcer of the stomach or small intestine. A gastric ulcer is also called a gastric ulcer, the intestinal ulcer is also called a duodenal ulcer. The type of perforation can also be distinguished in the case of an ulcer perforation. With a free perforation, there is a continuous connection between the interior of the organ and the abdominal cavity. With covered perforation, the hole in the wall is covered by neighboring organs and thus remains closed. For what does the abbreviation mcph stand for, please visit usvsukenglish.com.
Causes
By definition, an ulcer perforation is always based on an ulcer. The causes of ulcers in the stomach and intestines are varied. Many ulcers are caused by gastritis, i.e. inflammation of the stomach lining. Nonsteroidal anti- inflammatory drugs (NSAIDs) such as ibuprofen, diclofenac or acetylsalicylic acid reduce the formation of gastric mucus. The aggressive gastric acid attacks the mucous membrane of the stomach and ulcers form.
This cause is particularly insidious because the painkillers also numb the pain of the ulcer. Even pronounced ulcers are often not noticed by those affected. Toxic substances such as nicotine or alcohol also irritate the mucous membranes of the gastrointestinal tract. In addition, gastric ulcers can be the result of diseases such as hyperparathyroidism or Zollinger-Ellison syndrome. Stress can also promote a stomach ulcer. The fact that the disease runs in families also points to a hereditary predisposition. The causes of small intestine ulcer are similar to those of gastric ulcer.
Symptoms, Ailments & Signs
Ulcer bleeding occurs in only about five to ten percent of all ulcer perforations. This manifests itself in the form of vomiting or spitting up blood. In either case, perforation of the ulcer results in an acute abdomen. The key symptoms include severe and sudden abdominal pain. The general condition is bad. The pain associated with a perforated gastric ulcer is in the epigastrium.
A perforated ulcer of the small intestine usually causes pain in the right upper quadrant of the abdomen. Often the pain is accompanied by vomiting. The abdominal wall shows a reflex defensive tension. The belly is rock hard when touched. In addition, the entire abdomen is distended. There may also be a fever.
Diagnosis & course of disease
The symptoms provide the first indications of an ulcer perforation. Patients may report pain in the stomach or intestines in their medical history. Painkillers in the medication history also indicate an ulcer and possible perforation.
After the anamnesis, a palpation and an auscultation of the abdomen are carried out. The abdomen is hard and sensitive to pressure. If the severe inflammation has already resulted in a paralytic ileus, no bowel sounds can be heard through the stethoscope. Free fluid in the abdominal cavity can be detected by means of an ultrasound examination. In addition, an X-ray of the entire abdomen is usually taken while lying down and standing up. The chest is also x-rayed.
This often shows an air sickle under the diaphragm. If the findings are still unclear despite these examinations, an esophago-gastro-duodenoscopy can be performed. The esophagus, stomach and duodenum are examined with an endoscope. The endoscope consists of a flexible tube with a video camera at the tip. This allows the condition of the organs and in particular the condition of the organ walls to be assessed well.
If the ulcer perforation is not treated, it can lead to inflammation of the peritoneum (peritonitis) and blood poisoning (sepsis). With peritonitis, a lot of fluid is lost through the peritoneum due to the inflammatory processes. Proteins also enter the abdominal cavity. Edema develops and, under certain circumstances, hypovolemic shock. Very high fever, rapid breathing, impaired consciousness and shock indicate sepsis. Both conditions are life-threatening.
Complications
Ulcer perforation causes an acute abdomen, which can lead to various complications during the course of the disease. Typically, there are inflammations and abscesses in the abdominal cavity, which, if the course is unfavorable, lead to sepsis. Accompanying this, the general condition of the patient deteriorates and there is persistent pain in the affected region.
If the ulcer perforation occurs in the area of the small intestine, symptoms such as vomiting, intestinal obstruction and occasionally high fever also occur. In about five to ten percent of cases, ulcer perforation causes ulcer bleeding. This is associated with vomiting blood and can later lead to anemia and the resulting complications. Surgical intervention can be associated with injuries to the tissue structures, infections, bleeding and secondary bleeding.
Wound healing disorders can also occur after an operation, which can have serious consequences due to the localization of the perforation. If a catheter is placed, there is a risk that an infection will occur. Major injuries can also occur, which can be accompanied by sensory disturbances and nerve damage. Accompanying prescribed medicines are always associated with certain risks and side effects.
When should you go to the doctor?
In the case of an ulcer perforation, the person concerned is dependent on treatment by a doctor. This disease cannot heal on its own, so treatment by a doctor must always be carried out. As soon as the first symptoms or symptoms appear, a doctor should be consulted to treat the disease. As a rule, the doctor should be contacted if the person concerned suffers from a bloody vomit or if he spits up blood.
There is also very severe pain in the abdomen, so that the quality of life is also significantly reduced by this disease. In many cases, this can also lead to diarrhea or fever, so that the usual symptoms of flu also appear. The ulcer perforation should be treated directly in a hospital. You should either call an ambulance or go straight to the hospital.
Treatment & Therapy
First, the wall defect is surgically closed. The damaged tissue parts are removed and the open areas are sewn over with healthy tissue. In addition, a so-called peritoneal lavage is performed. The abdomen is rinsed to remove the necroses and any pathogens that may have entered.
In peritoneal lavage, the abdominal cavity is punctured with a large cannula in the area below the navel. Body-warm Ringer’s solution or saline solution is then fed into the abdominal cavity via a catheter . The rinsing liquid finally runs back into the infusion bottle according to the siphon principle.
Prevention
Without an ulcer there is no ulcer perforation. For prevention, it is therefore advisable to initially omit all stomach-irritating foods and drinks. Very spicy or very hot food as well as high-proof alcohol and coffee are not particularly well tolerated. To prevent a stress-related ulcer, relaxation exercises or stress management can be helpful.
Anyone who takes medication that is harmful to the stomach (e.g. non-steroidal anti-inflammatory drugs) over a longer period of time should discontinue it after consultation with the treating person or replace it with alternatives that are gentler on the stomach. If the gastric mucosa is attacked by the bacterium Helicobacter pylori, antibiotics may be necessary.
If there is a genetic risk, it may be advisable to take acid blockers or proton pump inhibitors as a preventive measure. If, despite all these preventive measures, an ulcer develops, it should be treated early or surgically removed. This is the only way to prevent perforation.
Aftercare
Ulcer rupture is a serious condition that requires consistent follow-up care. This depends closely on the localization and is discussed with the general practitioner or specialist. In the case of a stomach ulcer, for example, the internist or gastroenterologist is the right contact person for check-ups or the aftercare measures carried out by the patient.
In the case of gastric ulcers, which will be discussed here as an example, gastroscopies are necessary at regular intervals determined by the doctor. Here, an ulcer can be quickly discovered as a recurrence and treated adequately. Bacteria such as Helicobayter pylori, which can cause gastritis and, as a result, an ulcer, are also tracked down as part of this follow-up care.
Nutrition is also of great importance after ulcer therapy. The diet must not burden the sensitive area even in the aftercare phase. Fatty and spicy dishes are to be avoided, as are acidic drinks such as freshly squeezed orange juice.
Ideally, coffee lovers limit their consumption in favor of herbal tea; still water is more recommended than carbonated products. Alcohol and especially nicotine should be avoided, at least for the time of aftercare. Stress is a common factor in the development of an ulcer. Therefore, the reduction of stress factors as well as relaxation methods and yoga are helpful in aftercare.
You can do that yourself
A perforated ulcer is a medical emergency. The most important measure is to contact the emergency services. Until the emergency doctor arrives, the patient must lie down quietly and cool the affected area. After the wall defect has been surgically closed, rest and protection apply.
The affected area must be checked regularly, which is why a hospital stay is required at first. The patient should consult with the doctor during this time to determine possible causes of the ulcer perforation. There is usually an underlying ulcer that needs to be removed. If necessary, general measures are useful. Changing diet and lifestyle reduces the risk of ulcers and improves overall well-being. Sport and physically demanding work should be avoided in the first two to four weeks after the procedure.
The diet must be changed immediately after the operation. Patients need to consume plenty of fresh fruits and vegetables, whole grains, fish, dairy, and legumes. The supply of high-quality proteins and vitamins optimally supports the body’s regeneration process. The doctor who treated the actual ulcer can name further measures.
