Stomach burn

Intentional or accidental ingestion of hot-burning or corrosive mucous membranes and tissues of liquid substances leads to stomach burn. As a rule, he is accompanied by a burn of the esophagus, pharynx and oral cavity, which are first encountered with an aggressive environment.

[1], [2]

Epidemiology

Chemical burns of the stomach often occur, most often these are the effects of satisfying children's curiosity (3/4 of cases of burns occur in children, mostly preschool age) who taste household chemicals, strong alcohol or medicinal tinctures left by careless parents in accessible places.

The remaining quarter falls on adults, mistakenly or deliberately taking in chemical reagents. Erroneously eat corrosive substances, mostly drinking people who are looking for liquor hidden from them. The lethal outcome is approximately 2% of cases.

Attempts to commit suicide with the help of aggressive chemicals are almost always performed by women, their choice usually falls on the vinegar essence. Approximately one third of such attempts are possible, the rest lead to disability.

[3], [4], [5], [6], [7],

Causes of the burn of stomach

This pathology arises from the reaction to a very hot food that has got into the stomach, boiling water or prolonged inhalation of hot vapors - a thermal burn. Such cases are rare and less dangerous, since only the mucous membrane is affected, deeper tissues remain intact.

Physicians often face chemical burns caused by corrosive liquid substances: acid (hydrochloric, sulfuric, acetic), alkali (caustic soda), alcohol-containing concentrated solutions (medicinal plants, iodine, ammonia), gasoline, acetone, potassium permanganate solution, household means chemistry. Chemical burns lead to more severe consequences, up to necrosis and tissue perforation.

The most common cause of stomach burn is the accidental ingestion of burning fluid, and to chance leads careless attitude to the storage of dangerous substances. Risk factors for this injury: storage of household chemicals, medicinal tinctures and other caustic liquids in accessible places for young children, placement of hazardous substances near food in packagings without labels.

[8], [9]

Pathogenesis

Ingestion of hot and corrosive substances causes a burn of the esophagus and stomach and changes in their tissues. In the stomach the most aggressive action is exposed to its narrow parts - cardial (connection with the esophagus) and pyloric (exit into the small intestine).

It is believed that in the case of ingestion of concentrated acid, the esophagus will suffer more, since the gastric mucosa is more resistant to the action of acid, and the consequences of penetration of alkaline substances are more harmful for the stomach. Corrosive material leads to destruction of the epithelial and subsequent layers of esophagus and stomach tissue. The severity of the lesion is due to the characteristics of the burning fluid, its concentration and volume. The walls of the stomach suffer less if it is filled with recently absorbed food.

There is a rejection of disturbed tissues, in its place remains a knobby (cicatricial) surface, the epithelization of which occurs very slowly. Then the lumen of the esophagus narrows down to its full closure in one or several places, the pylorus of the stomach narrows, and sometimes its complete obstruction sets in. With severe degrees of damage, the whole stomach wrinkles. Obstruction of the esophagus and / or stomach leads to the patient's dystrophy and dehydration.

There is hepatic and renal failure, the work of the adrenal glands and other organs is disrupted because of neurotrophic disorders and poisoning of the body with toxins, the absorption of decomposition products of tissue necrosis, secondary infection.

[10], [11], [12], [13], [14]

Symptoms of the burn of stomach

Intentionally or accidentally swallowed aggressive reagent on the way to the stomach causes a burn of the oral cavity and esophagus, its traces are clearly visible on the lips and in the mouth.

The first signs of a stomach burn are a burning pain in the epigastric zone, which can be given to the chest area and neck; muscle spasms in the affected organs and vomiting. Swelling of the larynx causes disorders of swallowing, breathing, pronunciation; intoxication with decomposition products - fever and tachycardia. In the vomit masses mucus, blood and particles of the gastric epithelium are observed. With ulcerative and necrotic burns, a collapse may occur.

Burns of the esophagus and stomach are dangerous not only by the destruction of the tissues of these organs, but also by subsequent intoxication, complicated by a disturbance in the metabolic processes, pulmonary edema, liver and kidney dysfunction.

[15]

Stages

Three clinical stages are classified:

• acute - necrosis of affected tissues of the stomach wall;
• rejection of necrotic sites;
• scarring of the inner wall of the stomach, stenosis of the pyloric area (more often) or the entire stomach.

Degrees of severity are considered in connection with the damage to the stomach tissues:

• First degree burn (catarrhal) - only the surface of the mucous membrane is affected, it is edematic and hypersensitive;
• Second degree burn (erosive) - the mucous membrane of the stomach is completely damaged, it necrotic and torn away;
• Third degree burn (ulcerative) - not only mucosal tissues are damaged, but deeper layers of the stomach wall, a greater probability of perforation and further inflammation of the abdominal cavity;
• fourth degree burn (necrotic) - the integrity of the stomach is broken and the tissues and organs close to one another are damaged.

The severity of pathological changes is determined by the characteristics of the aggressive substance, its amount and duration of exposure, the presence of contents in the stomach. An important role belongs to the timely provision of first aid.

[16]

Forms

A thermal burn of the stomach causes liquid substances that are heated to boiling point (boiling water, hot oil) to enter it. It is rare enough. The first aid is to cool the burnt mucous membranes - it is necessary that the victim drank at least a liter of cooled liquid (can be with ice).

Thermal burns of the first degree do not necessarily have to be treated in a hospital, there may be sufficient competent care of loved ones, salt, sharp and smoked dishes are excluded from the patient's diet. Nevertheless, damage to the second and, of course, third-fourth degree require compulsory medical supervision.

A chemical burn of the stomach is caused by erosive epithelium and deeper tissues of the body walls with liquids, for example, acid or alkali.

Concentrated acid, getting on the mucous membrane, forms coagulative (dry) necrosis, which protects the tissue from further penetration. If you know exactly about the ingestion of the acid, the patient is given an alkaline solution prepared as follows: dissolve a teaspoon of drinking soda in a liter of filtered (boiled) non-cold water. Then induce vomiting.

The ingestion of alkaline substances causes collisional (moist) necrosis due to the dissolution of protein and saponification of fat, so they freely penetrate deep into the interior and cause more serious damage. But a small amount of alkali, trapped in the stomach, is neutralized by the acid there.

If you know exactly about ingestion of alkali, the patient is given an acid solution. A liter of cool boiled water is added a little acid (acetic, tartaric or lemon). Then induce vomiting.

A stomach burn with alcohol, like acid, causes coagulative necrosis, which prevents the spread of damage. The stomach burn with alcohol is manifested by a typical pain syndrome, lack of taste sensations, weakness and dizziness. First aid is gastric lavage. With such a burn, a full recovery is usually predicted.

A solution of potassium permanganate is used inside with poisoning exclusively filtered and pale pink. Otherwise, if the particles do not penetrate, or if it is too concentrated, you can cause a stomach burn with potassium permanganate, which leads to dyspepsia; there is a risk of mechanical asphyxia due to laryngeal edema and shock.

Symptoms are manifested as follows: dark brown color of the oral and pharyngeal mucosa and its swelling, in the mouth - severe burning, pain in the chest and epigastric zone. Brown dots (burns) can appear on the skin of the face, neck, and chest.

Shortness of breath up to suffocation, cyanotic skin and mucous membranes, bloody diarrhea, trembling paralysis.

In severe cases, convulsions, burn shock, acute hepatic and renal dysfunction (toxic hepatitis, jaundice, anuria, uremia), collapse. Pregnancy can result in miscarriage.

First of all, the stomach is washed with a mouth and throat rinsing solution: two liters of water - 100 g of hydrogen peroxide and 200 g of 3% vinegar. Washing is done until the washing water is completely discolored. The mouth, gums and tongue are wiped with a tissue moistened with the same solution. Be sure to call an ambulance.

The stomach burn with vinegar 6-9% occurs when it is accidentally swallowed. The degree of gravity is proportional to the volume of swallowed vinegar. Ingestion of one or two pharynx usually leads to a minor burn of the esophagus, passing alone and without consequences. If you swallow more than 50 g, then in addition to significant burns, it is likely poisoning - absorbed in the stomach and intestines, vinegar gets into the blood and destroys the membranes of red blood cells. When released from them, hemoglobin disrupts the microcirculation of blood in the kidneys, disrupting their function. Renal failure leads to intoxication and liver dysfunction. The result of using 200 g of vinegar and more can be the death of the victim.

The ingestion of acetic essence (70%) or laboratory acetic acid (98%) causes deep, large lesions of the upper digestive organs. The victim can immediately die from a traumatic shock. With survival - damage to tissues and internal organs it is provided. With successful long-term surgical and conservative treatment, usually complete recovery does not occur.

First aid for ingesting concentrated acetic acid - rinsing the mouth and throat with water, better - with a weak solution of soda. It is necessary to give the affected person a chilled liquid (not less than a liter of water or milk, it is possible with ice) and seek medical help. Before the ambulance arrives to ensure the traumatized person peace, do not wash the stomach with a solution of soda and induce vomiting - this can lead to the perforation of the esophagus.

If accidentally swallowed quite a bit, it is permissible to try to do household activities - rinsing, washing the stomach, drinking plenty of water (or milk). However, in the presence of pain, weakness, nervous arousal or, conversely, retardation, it is necessary to urgently seek medical help.

The disorder of physiological processes can lead to the release of bile into the stomach and trigger a stomach burn with bile. A single case of the appearance of bile in the stomach should alert, however, adjusting the lifestyle, the diet will help prevent relapses. Bile in the stomach can be eliminated with drugs of the antacid group.

In the case of a constant sensation of the presence of bile in the stomach, you need to see a doctor. The main signs of her presence in the stomach are pain, a feeling of heaviness and raspiraniya in the abdominal area without specific localization, belching, heartburn, yellowish plaque in the tongue.

Complications and consequences

The consequences and complications of a stomach burn can be very serious. With extensive injuries that did not immediately lead to the death of the victim, irreversible changes occur in the internal organs, significantly worsening the prognosis and course of the disease. They can necrotize all layers of the tissues of the stomach wall, which causes its perforation, most often in the prepiloric zone, and peritonitis. Intoxication by tissue decay products leads to acute hepatic and / or renal failure, infection of closely located organs.

Rejection of the scab after acid burn can cause gastric bleeding, scarring of the walls leads to narrowing of the pylorus lumen and can lead to obstruction in this department. Such complication of chemical burn of the stomach, requiring surgical intervention, develops in approximately 70% of cases of necrotic burns.

Chemical burns of the stomach are often complicated by pulmonary edema, the life of the patient is constantly threatened.

[17], [18], [19], [20]

Diagnostics of the burn of stomach

Based on a survey of the patient or his relatives, an anamnesis is made, the main indicators of the physiological state are examined, focusing on the work of the respiratory system, fever, symptoms of irritation of the peritoneum, indicating the perforation of the stomach.

Analyzes are made on indications, at receipt in a hospital - the general analysis of a blood.

With the help of instrumental diagnostics, the degree of tissue damage is assessed. X-ray examination of the stomach consists of X-ray and serial radiography, contrasting is usually not first applied (except cases where perforation of the stomach wall is suspected). Burn complications are diagnosed 5-6 weeks after the burn - with the help of radiography it is possible to determine deformities and cicatricial narrowing.

Endoscopy with a thin flexible endoscope (diameter less than 10mm) is shown immediately after the injury. If there is a suspicion of perforation of the stomach (clinic or radiography), endoscopy is not performed.

[21], [22], [23], [24]

Differential diagnosis

Differential diagnosis in the first day after the burn is carried out in the case when the burn reagent is not determined, for its determination (according to the medical history, X-ray study, esophagogastroscopy).

When complicating a stomach burn with pyloric stenosis or a more extensive pathology, deviations from the norm of the blood test results are observed. A clinical blood test shows the presence of anemia, inflammation, dehydration; biochemical - reducing the content of proteins, sodium, chlorine, potassium, calcium, and sometimes - iron.

The electrocardiogram shows diffuse changes in the myocardium. The diagnosis is diagnosed with the help of X-ray study, esophagogastroduodenoscopy, ultrasound diagnosis, electrogastroenterography. When confirming the diagnosis, only surgical treatment is possible. Differential diagnosis of complications is performed with cicatrical and ulcerative strictures in the prepiloric zone. Later, in the presence of scars, differentiate the effects of burns with neoplasms.

Treatment of the burn of stomach

Catarrhal damage does not require medical treatment, but it is advisable to see the doctor to clarify the diagnosis and prevent complications. With a more severe burn, specialized medical care is needed. From the speed of its receipt depends on the further prognosis for recovery, and sometimes the life of the victim.

In case of a stomach burn with boiling water, first aid is needed - more cold liquid (water or milk) and rest.

If you get into the chemical aggressor, the injured person needs specialized medical assistance. The brigade of the "ambulance" arriving on call, as a rule, uses a probe for washing the stomach, which is unpleasant, but quite effective.

Treatment of a stomach burn is based on the following principles:

• the appointment of analgesics for the removal of pain;
• the appointment of antispasmodics and sedatives;
• maintenance of normal functions of the heart, respiratory organs and secretions;
• measures to remove the patient from a shock state;
• elimination and / or prevention of intoxication.

Schemes of therapeutic treatment the doctor appoints individually, according to the clinical manifestations of the development of pathological processes.

A fundamental modern way to combat the consequences of a chemical burn of II-IV degree is endoscopic laser photostimulation, in combination with the appointment of drugs that relieve pain, intoxication, inflammation, which increase tissue resistance to oxygen deficiency and prevent the development of infection. Endoscopic laser photostimulation is the irradiation of the burned mucous esophagus and stomach with a low-energy laser (laser radiation with a wavelength of 0.63 μm at a power density of 10-100 mW). Such treatment allows to reduce the incidence of cicatricial stenosis.

Even more promising method of treatment is endoscopic laser photostimulation with a preliminary introduction of mexidol, which enhances its effect due to the fact that laser irradiation improves blood microcirculation at the site of exposure.

Mexidol has an active effect that prevents tissue hypoxia. It increases resistance to conditions associated with inadequate oxygenation, including shock, and reduces toxic effects. Use it for intramuscular or intravenous injection. The duration of therapy and the choice of dosage is proportional to the severity of the patient's condition. The daily dosage is not more than 0.8 g. As a rule, patients tolerate mexidol well. Occasionally, nausea and dryness in the mouth are likely.

Contraindicated in hepatic and renal insufficiency, allergy to vitamin B6 in the anamnesis.

To prevent vaginal infection, antibiotics are prescribed, for example, Cefazolin, which has a broad spectrum of antimicrobial effects. The effect is based on a violation of the process of building a bacterial cell membrane. The drug is used for intramuscular and intravenous injections. Like all antibiotics has side effects and is contraindicated in cases of allergy to cefalosporin group drugs.

Anesthesia is carried out by both non-narcotic and narcotic analgesics, such as Omnupon is a complex drug consisting of three narcotic analgesics (morphine, codeine, tebain) and papaverine, which prevents spastic contractions of the smooth muscles of the intestine. Inhibits any pain sensations without turning off consciousness, while retaining the remaining sensations.

Patients are prescribed subcutaneous injections in a dosage of 10 mg of the drug from three to four times a day.

May cause nausea, vomiting, respiratory depression. Continued use causes drug addiction.
Contraindicated in respiratory dysfunction, dystrophy, patients of advanced age.

For the prevention of thrombohemorrhagic syndrome in the area of burn, Heparin is prescribed , an anticoagulant that directly acts on blood coagulation factors, blocking the biosynthesis of thrombin; reducing thrombogenesis. Activates the ability of blood to dissolve clots, improves blood circulation in the coronary arteries. The method of administration and dosage of heparin is calculated individually. Using this drug, you need to take into account the possibility of bleeding.

For early prevention of stenosis of the stomach, hormone therapy is suggested, but this is more than controversial. Not all authors agree with the need for the appointment of glucocorticoids, the risk of their use, associated with side effects (suppression of immunity, therefore, inhibition of the healing process, masking signs of perforation and infection) exceeds the benefits, so it is better not to use them.

According to the indications prescribe drugs to maintain the normal functioning of the heart muscle and kidneys, respiratory organs, fat and hormone mixtures to accelerate the repair of the gastric epithelium, weakly alkaline mineral water.

Drug therapy is supplemented by the introduction of vitamins of group B (B6 and B12) intramuscularly or subcutaneously and ascorbic acid orally.

Physiotherapy treatment for stomach burns is intended to compensate for insufficient oxygenation of burned areas (hyperbaric oxygenation).

Laser therapy and high-intensity pulse magnetotherapy, which stimulates repair of damaged tissues, can be useful.

Alternative medicine for burns of the esophagus and stomach recommends oral intake of vegetable oil. Moreover, official medicine also includes it in the complex treatment of such injuries. Every morning before eating, you need to swallow a tablespoon of sunflower, olive or sea-buckthorn oil.

A good effect is provided by alternative treatment with Gogol-Mogol, having enveloping and soothing qualities. You need to use gogol-mogol thrice a day. Prepare it simply - whip two raw yolks with sugar. As an option - you can dilute it with a glass of slightly warm milk. In general, it is good to drink fresh milk - a day to 3-5 times.

Propolis has good regenerating and immunity-enhancing properties:

• take 100ml vegetable oil (sunflower, olive) and 20g propolis, boil in a water bath, stirring regularly with a wooden spoon, after an hour - strain, cool and put in the fridge, three times a day to take a tablespoon;
• Propolis Milk - half a liter of milk boil in an enamel saucepan, add 40g propolis, stir and soak for a quarter of an hour at a temperature of about 80 ° C on a small fire or in the oven, strain, cool; remove the hardened wax from the surface, take one dessert spoon on an empty stomach, and have breakfast in 20 minutes.

At home, you can use herbal medicine. To restore the epithelial surface of the stomach, drink infusion of flowers of medicinal chamomile: brew five teaspoons in a thermos for half a liter of water, and drink instead of tea twice or thrice a day.

You can prepare a slimy beverage from flax or quince seeds, fill 10g seeds with a glass of boiling water and shake the mixture for 15 minutes. Let cool, strain and drink before eating.

Extract of the root of the althea promotes cellular renewal and improves blood circulation: two teaspoons of crushed althea root pour 250ml of cold boiled water, insist 30 minutes, stirring occasionally. Strain, drain and warm slightly. Take after meals during the day in small sips.

Treatment of a stomach burn with homeopathic preparations should be carried out strictly individually according to the prescription of a homeopath physician and under his supervision. Homeopathy offers drugs that prevent excessive scarring and stenosis of the stomach, for example, Calcarea fluorica (Calcarea fluoride). This drug can promote resorption of the existing narrowing of the pyloric part of the stomach. In the cicatricial stenosis of the pylorus, Alumina (Alumina), Antimonium crudum (Antimonium crudum) is used, but all indications are "if surgical intervention is not recommended". The drug Cantharis (Kantaris) can be used for diseases of the gastrointestinal tract, accompanied by burning pain. It is used for severe burns with blisters of any localization. Mancinella (Mancinella) accelerates the restoration of the wound surface of any origin.

Properly appointed homeopathic medicines can bring absolute benefits, but to replace the surgical operation by their reception is unlikely to be successful, but it's quite possible to recover after the operation.

Operative treatment

The result is the pyloric stenosis of the stomach or its complete dysfunction, and as a result - dehydration and dystrophy of the patient, resulting in a large area and deep layers of tissue burn burns.

Basically, the stomach burn is combined with a burn of the esophagus. Often the consequence of the esophagus booster procedure is the detection of pathological changes in the stomach.

If bougie is impossible, a laparotomy is performed, during which the character of the gastric pathologies and the course of further treatment are determined.

In cases of local damage to the stomach (pyloric stenosis), drainage is restored by the imposition of gastrostomy. As a rule, resection is performed - surgical removal of a part of the stomach in which the permeability is broken.

With a total burn of the stomach or in an acute period, perform an ejnostomy (imposition of a fistula on the jejunum) to provide nutrition to the patient. Subsequently, the operation to reconstruct the stomach.

Modern surgical techniques can restore the function of the upper digestive tract after a burn.

Prevention

From the foregoing it follows that one should not neglect safety measures by contacting with unknown or aggressive liquids. It is also necessary to observe precautions when storing household chemical products, lacquer-colored, alcohol-containing and other similar substances:

• store them in their original packaging with labels;
• separate from food;
• in places inaccessible to small children.

In conversations with children, explain the danger of chemicals, the possibility and consequences of poisoning and burns.

[25], [26]

Forecast

Burns of the first and second degree usually result in a cure, the duration of the treatment is from ten days to a month. Third and fourth degree - complete recovery is impossible, the victim is deprived, at best, part of the stomach. With such lesions, a fatal outcome is possible.