Classic signs of a perforated ulcer (“Mondor’s triad”). Acute pancreatitis. Laboratory diagnostics Mechanism of disease development

1. Presence of a history of ulcers

2. “Dagger Pains”

Stages of perforated ulcer:

1 tbsp. shock (6 hours) characterized by sharp pain in the epigastric region, which arose suddenly like a “dagger strike”.

At the beginning of the disease, vomiting is possible.

The patient is motionless, takes a forced position, pulls his legs to his stomach, leans forward (fetal position)

Holds belly with hands

The facial expression is pained. Facial features are sharpened

Pale skin

Bradycardia alternating with tachycardia

Blood pressure is reduced to collapse (shock)

Tongue dry

board-shaped abdomen (severe tension in the muscles of the anterior abdominal wall)

diffuse pain on palpation of the abdomen

dullness in the sloping areas of the abdomen

sharp pain in the abdomen when coughing

positive symptoms of peritoneal irritation:

Shchetkin-Blumberg symptom - after pressing on the abdominal wall, the fingers are sharply torn off from the anterior abdominal wall, and the pain is stronger than when pressing.

Voskresensky's symptom - when quickly holding a palm over a stretched shirt from the right costal edge downwards, the patient experiences abdominal pain.

Razdolsky's symptom is pain when percussing the anterior abdominal wall.

Sitkovsky's symptom is increased abdominal pain when lying on the left side.

On rectal examination, pain is noted when pressing on the anterior wall of the rectum.

Leukocytosis in the shock stage is not expressed.

Survey radiograph of br. cavities - free gas in the abdominal cavity under the diaphragm.

2 tbsp. – imaginary well-being (6-12 hours) characterized by a decrease in pain and tension in the abdominal muscles, and an improvement in the patient’s well-being.

tachycardia,

temperature increase,

dry tongue,

increasing bloating,

possible gas and stool retention due to intestinal paresis,

percussion can determine the presence of gas in the upper sections

dullness in sloping areas of the abdomen,

intestinal peristalsis is sluggish.

muscle tension,

disappearance of liver dullness

Shchetkin-Blumberg and Voskresensky, Razdolsky, Obraztsov’s symptoms are positive

Leukocytosis progressively increases.

3 tbsp. – peritonitis- develops after 10-12 and corresponds to the pronounced clinical picture of diffuse peritonitis.

Atypical forms of perforation of a stomach ulcer:

1. Perforation between the layers of the omentum - peritoneal symptoms are mild, the disease develops slowly, with the formation of an infiltrate, then an abscess, followed by a breakthrough into the abdominal cavity.

2. Perforation of an ulcer of the posterior wall of the stomach or intestines into the retroperitoneal tissue - pain in the epigastrium, radiating to the back; swelling and crepitus are detected in the lumbar region (entry of air from a hollow organ into the retroperitoneal tissue

Urgent Care :

1. Lay the patient down, allow the patient to take a position that is comfortable for him. The preferred position is on the left side.

3. Cold on the stomach

4. Install a nasogastric tube to drain gastric contents.

5. For hypotension, infusion therapy - Sodium chloride solution 0.9% - 400.0 i.v.

6. Urgent hospitalization on a stretcher in a surgical hospital.

Cord-shaped thrombophlebitis is a rare venous pathology, it was first diagnosed in 1939. The disease is characterized by inflammation of the veins of the sternum and abdominal cavity, manifested by symptoms characteristic of other types of phlebitis. What are the indirect causes of the development of pathology and the main symptoms? Methods of diagnosis and treatment? What complications arise and what is the prognosis for recovery.

What is Mondor's disease

What is cord-like thrombophlebitis? This is a localized pathology of the veins of the anterior and lateral surface of the abdominal wall and chest, and refers to vasculitis.

Expressed in the form of thrombosis with inflammation of the wall of the lateral or superficial vein of the chest. This disease occurs predominantly in women.

During the development of pathology in the axillary region, a compaction forms on the anterior chest wall. Its length varies from 3 to 30 cm. The seal is fused and moves with the skin.

Many doctors classify this disease as damage to the venous vessels of the forearm, shoulder, armpit, penis and testicles.

The problem occurs in people aged 25–40 years, less often - after 60 years.

Mechanism of disease development

Mondor's phlebitis does not particularly affect a person's overall well-being. Signs of intoxication and inflammation are mild or absent altogether.

The primary form of the disease has an unclear genesis; its development can be triggered by malfunctions of the immune system. Secondary – occurs against the background of other pathological processes in the body.

Symptoms of cord-like thrombophlebitis:

• in the area of ​​the mammary glands and armpits, a hard, elongated vertical thickening 3–30 cm long is formed, which moves along with the skin; palpation of the formation causes severe pain;
• pain can radiate to the armpits, epigastrium, intensifies when inhaling, raising arms;
• bothered by a constant burning sensation in the affected area;
• the inflamed area swells and turns red;
• age spots appear, rosacea around the affected area, symmetrical rash;
• rarely the body temperature rises to subfebrile levels, with weakness, drowsiness, and headaches;
• axillary lymph nodes become inflamed;
• As the disease develops, the pathological process covers nearby tissues, and radial-shaped wrinkles form on the skin along the veins.

Cord-like thrombophlebitis is diagnosed more often in women than in men.

The disease develops after difficult childbirth, prolonged lactation, chronic mastitis, and constant wearing of tight bras.

Causes

The reasons for the development of thrombophlebitis of the veins of the peritoneum and thoracic region are poorly understood.

Pathology can occur as a complication of respiratory infections, furunculosis, allergies. After surgical interventions and chest injuries, in the presence of malignant neoplasms.

Reasons contributing to the development of the disease:

• appendix removal;
• hidradenitis;
• infectious processes in the sebaceous glands;
• sudden or constant tension in the hands during work.

In women with Mondor syndrome, pathological processes occur on one side. In men, the disease is bilateral.

Risks of developing Mondor syndrome

Complications with cord-shaped thrombophlebitis occur rarely. More often in older people, with advanced forms of pathology, and the presence of chronic diseases.

The most dangerous consequence of phlebitis is pulmonary embolism. The disease develops suddenly and is often fatal.

Diagnostics

Cord-like phlebitis can be determined during the initial examination by palpation of the veins in the affected area.

To confirm the diagnosis and determine the severity of the pathological process, the doctor prescribes additional tests.

Methods for diagnosing cord-shaped thrombophlebitis:

• clinical blood test - eosinophilia, monocytosis, leukocytosis are observed;
• general urine analysis;
• blood chemistry;
• coagulogram;
• ultrasound angioscanning - determine the degree of thickening of the venous walls, the presence of blood clots, and identify problems with blood flow in the affected vein;
• chest x-ray;
• phlebography – x-ray examination of veins using a contrast agent;
• test for tumor markers - pathology often occurs with cancer.

Based on the examination results, the doctor selects medications for home treatment or prescribes a referral to a hospital.

Which doctor should you contact?

If signs of cord thrombophlebitis appear, you should visit your local physician.

After examination and initial diagnosis, the doctor will write a referral to Sometimes a consultation with an oncologist is required.

Treatment of Mondor's phlebitis

When diagnosing Mondor's syndrome, symptomatic drug therapy, physiotherapy, and diet are prescribed.

Treatment of cord thrombophlebitis includes taking the following medications:

• non-steroidal anti-inflammatory drugs – Dicloberl, Ortofen, Butadione;
• antiplatelet agents – Aspirin, eliminate increased blood viscosity;
• vasotonics – Aescusan, Anavenol;
• polyenzyme preparations – Wobenzym;
• antibiotics of the penicillin group - rarely prescribed when nearby tissues are involved in the inflammatory process;
• heparin ointment to strengthen venous walls, reduce the risk of blood clots;
• Vishnevsky ointment – ​​eliminates inflammatory processes;
• for severe pain, novocaine blockades are prescribed;
• physiotherapy - electrophoresis with drugs, UHF, mud therapy, hydrotherapy, hirudotherapy, acupuncture, magnetic therapy;
• if frequent relapses are observed, the affected vein is excised.

Among traditional methods, sea buckthorn oil helps well - the product has an antiseptic and anti-inflammatory effect.

Soak sterile gauze with an oil solution, apply a compress overnight, and secure with a woolen scarf.

The duration of treatment is 30–40 days.

For phlebitis, the basis of the diet is vegetables, fruits, herbs, dairy products, fish and seafood.

It is forbidden to consume fast carbohydrates, fatty, fried, smoked foods. All dishes should be steamed, stewed, boiled or baked.

It is necessary to reduce the amount of salt. Drink at least 2 liters of clean water without gas per day.

Forecasts

Cord-like phlebitis often occurs without pronounced symptoms, cases of self-healing are not uncommon, so the prognosis for complete recovery is favorable.

In the presence of impaired renal function, diseases of the central nervous system, and digestive system organs, in patients over 50 years of age, the pathology occurs in a more severe form. Constant medical supervision is required.

Painful sensations and increased sensitivity of the skin disappear within 7 days. The burning sensation continues for 3–4 weeks. Lumps and pigmentation remain for several months.

Mondor syndrome is a rare and harmless venous pathology, the inflammatory process is localized in the thoracic and abdominal region.

The disease is highly treatable, relapses and complications are rare, and with proper therapy you can get rid of the disease in 1–2 months.

Useful video: Mondor's disease or cord thrombophlebitis

Pancreatitis occurs in three forms - acute, reactive and chronic. The most severe and serious form of the disease is acute, in which the disease develops rapidly and is complex. The causes of such pancreatitis are self-digestion of the pancreas, caused by the closure of the lumen of the gland or its spasm (sharp narrowing).

Most often, symptoms appear unexpectedly and are acute. The first thing patients complain about is severe pain in the pit of the stomach, in the right and left hypochondrium. The main symptoms of this period are vomiting of undigested gastric contents and flatulence. The combination of these three components in medicine is called Mondor's triad (a characteristic feature of pancreatitis). The pain is girdling in nature, pressure is felt at a level slightly above the navel (at the level of the pancreas). Most often, pain appears either in the evening or when the diet is not followed. The intensity of the pain does not subside; with prolonged severe pain, patients may lose consciousness. The pain reaches its greatest intensity in the midline of the abdomen, and then spreads throughout the entire abdomen. Radiation of pain is typical in the lower back, chest, hypochondrium. If the head of the pancreas is affected, the symptoms resemble acute cholecystitis; if the body of the pancreas is affected, gastric diseases are observed; if the tail is affected, cardiac and renal pathologies are observed. Therefore, differential diagnosis is important in acute pancreatitis. In some situations, pancreatitis can give symptoms of shock - cold sweat, drop in blood pressure, tachycardia and a weak thread-like pulse. At the beginning of the process, the temperature may rise to high levels, after which a low-grade fever persists. Patients with pancreatitis are restless, often overly nervous, and ask for painkillers. In acute pancreatitis, cyanotic spots (in some cases, hyperemia) appear on the patient’s face and abdomen.

Treatment of acute pancreatitis can be either conservative or surgical.

Both treatment tactics are characterized by several stages: 1. elimination of pain, 2. blood purification, 3. strict gentle diet, 4. treatment of symptoms of pancreatitis.

To relieve pain, both non-narcotic drugs and narcotic drugs (in especially severe cases) are used.

To cleanse the blood, infusion therapy is used - solutions are introduced that dilute the blood and thus lower the level of pancreatic enzymes in the blood. Pancreatic enzymes can be neutralized in patients using the drugs Trasylol, Gordox or Contrical.

To ensure rest for the pancreas, you need to fast for the first time and drink only water. The body's nutritional needs are met by administering special solutions intravenously. Throughout the fast, the body will be supported in this way. Typically, fasting is prescribed for three to six days, and then the patient is allowed to consume liquid food in small quantities.

To alleviate symptomatic signs, medications are given that suppress the gag reflex (especially if vomiting does not stop), increase the level of calcium in the blood, etc.

In some cases, the affected organ may become infected. To prevent this from happening, it is necessary to prescribe a course of antibiotics for the purpose of prevention.

Typically, conservative therapy is followed for about a week (unless urgent surgery is necessary). If the situation improves, treatment is continued further, and if the above methods do not help, then surgery is performed - laparotomy to remove the necrotic parts of the pancreas. The operation is performed under general anesthesia.

Surgical treatment of pancreatitis is used for necrotic pancreatitis or for serious complications (peritonitis, abscess, septic phlegmon). The nature of the operation can be organ-preserving (removing a necrotic part of an organ) or resection (complete removal of the pancreas). Confinement in a medical facility takes up to three weeks.

After removal of the pancreas or partial removal of one area, the patient must remember that he should then take enzymatic preparations, which to some extent will replace the functions of the pancreas. It is also worth remembering that without a pancreas, diabetes mellitus can develop - this situation is subject to medical control. Further nutrition is gentle, without foods that cause stress on the gastrointestinal tract.

Voskresensky's symptom in pancreatitis and some other clinical manifestations are the most important signs of this particular disease. Pancreatitis is an inflammatory-dystrophic disease of pancreatic tissue.

The pathology is characterized by a chronic and rapidly progressive course. The absence of the required drug treatment leads to pancreatic dysfunction, that is, the organ stops working.

There are many causes of pathology. These include alcohol abuse for 3-10 years, some diseases of the biliary system (usually in women), poor diet with a low content of proteins and fats, and hereditary predisposition.

Typically, patients complain of pain in various locations. During an exacerbation, the pain syndrome is acute, haunts the patient, is localized in the upper abdomen, and radiates to the back. In the chronic course, the pain is less pronounced.

Symptoms of Voskresensky

During palpation, the medical specialist does not feel the pulsation of the abdominal aorta in the area where this blood vessel intersects with the pancreas. Normally, there should be a pulsation five centimeters above the navel and four centimeters to the left of its axis.

This clinical picture is based on the fact that the internal organ is swollen and has significantly increased in size, thereby blocking a large vessel.

You can feel the pulsation yourself. To do this, the patient lies on his back and stirs his fingers as indicated above. If everything is in order, then he feels a pulsation; in the acute form of pancreatitis it is absent.

You cannot rely entirely on this clinical sign. In some cases, this symptom indicates other pathological conditions:

• Tumors of the pancreas.
• Increased size of lymph nodes.
• Severe gas formation.

The symptom according to the authors, in particular according to Voskresensky, may not give an idea of ​​the clinical picture in obese patients. The correct diagnosis is made after instrumental and laboratory tests; a physical examination is not enough.

If acute appendicitis is suspected, this symptom is most indicative. However, verification occurs using a different method. In medical practice, the symptom has another name - shirt symptom. During palpation, the patient’s shirt, which is located on the back, is lowered and pulled over the body, and through a sliding movement, the ribs of the palm are drawn along the abdomen from top to bottom. This action is repeated on both sides. In acute appendicitis, the patient experiences pain in the right iliac region.

This manifestation is explained by irritation of the peritoneum, which occurs as a result of inflammatory processes in the appendix.

Symptoms by author

Sugar level

Pancreatitis according to the ICD-10 code can be infectious and acute, with purulent complications, subacute, hemorrhagic. K86.0 means a chronic disease of alcoholic etiology, K86.1 means other types of chronic disease.

There are only three classic symptoms associated with an acute illness: painful

sensations, increased gas formation, vomiting. This is Mondor's triad for pancreatitis.

The Mayo Robson symptom for pancreatitis is determined by painful sensations at the site of the projection of the pancreas. This is the left side of the costovertebral ganglion. This sign is observed in 45% of clinical pictures. The sign is determined by lightly pressing this point. If there is an increase in pain, this indicates inflammation of the internal organ.

1. Kerte's sign. The main symptom is pain upon palpation in the area located above the navel five centimeters from the center line. Usually diagnosed in 65% of all morbidity cases. In addition, this author’s sign is positive when muscle tissue tension is detected in the epigastric area.
2. Kach's symptom is defined as intense pain when trying to palpate an area in the projection of the tail of the pancreas. The location of the point is the area of ​​the transverse process of the 8th thoracic vertebra. In most cases, the symptom is positive against the background of the chronic form of the disease. In some pictures it is observed in the form of high susceptibility of the skin in this area.
3. Razdolsky's sign is detected in the acute form of the disease. It is characterized by sharp pain that develops during percussion of the skin in the area of ​​​​the projection of the internal organ. Based on inflammatory processes in the peritoneum.

Chukhrienko's symptom is detected in 38% of pictures. Consists in the presence of pain during jerky movements of the abdominal wall with the hand in the direction from bottom to top.

Additional symptoms

In addition to what is written above, we can identify other specific characteristics that bear the names of doctors. Mondor's sign is detected during the acute course of the disease. It is caused by changes in the patient’s skin. Blue spots appear on the patient's body. The etiology is based on the penetration of toxins that are produced by the gland.

Grotta's sign. This symptom is characterized by pain at certain points, each of which has its own name, and appears to confirm the presence of an inflammatory process in a certain part of the internal organ.

Desjardins' sign is caused by pain in the area, which is located four centimeters above the navel along a line connecting to the armpit on the right side. In the acute form of the disease, it is diagnosed in 70% of cases.

The characteristic signs of acute pancreatitis develop suddenly. Typically, the inflammatory process is provoked by the consumption of fatty and heavy foods, alcoholic beverages, and smoking. Under the influence of these factors, the patient experiences the following clinical manifestations:

• Intense excruciating pain in the epigastric region.
• Increase in body temperature.
• Yellowness of the skin (not in all cases).
• Attack of nausea, vomiting.
• The abdomen increases in volume.
• The functioning of the digestive tract is disrupted.

There are often signs of shock. These include lethargy, low blood pressure, tachycardia, bradycardia, difficulty breathing, shortness of breath, pale skin, etc. These symptoms do not always indicate inflammation of the pancreas, as they may indicate other diseases. However, their appearance is a reason to call a medical team. Often, along with pancreatitis, cholecystitis is diagnosed.

For treatment, medications are used and a special diet is prescribed. In some cases, surgical treatment is required. Surgery is resorted to in the presence of complications of the disease, to eliminate painful sensations.

An expert will tell you what Voskresensky’s symptom is in the video in this article.