胃胀嗳气放屁是怎么形成的以及吃什么药治疗
三甲 北京大学第三医院 消化内科
清晨左上腹隐痛有灼热感放屁食欲差
病情描述:病史:本人现年27岁,从小体质不好,早餐从来都没胃口,后来演变成老是不吃早饭,不过午饭和晚餐都正常,但喜欢暴饮暴食,比较挑食,喜爱辛辣和冷饮.终于到了高中时因高考压力大,心情紧张情绪喜怒不定,老是吃不下饭,又很傻很天真地强迫自己吃很多东西,结果每次吃完又会呕吐出来,最终导致在04年高中毕业前无法进食,去医院通过胃镜检查发现得了浅表性胃溃疡和十二指肠球部溃疡,后经吃药数月,复查胃镜显示,已无器质性病变,仅剩浅表性胃炎,07年和14年也复查过胃镜和肠镜,均显示仅有浅表性胃炎,肠道无任何病变,04年至今10年来,本人的肠胃跟正常健康人相比就不会太好,主要症状是:1.有时会腹胀,没胃口食欲不振,尤其喝酒应酬或者太过劳累以后,但喝点中药调理就能慢慢恢复,一年最多两三次吧;2.老是嗳气,极偶尔会反酸;3.次数总体上正常,不腹痛,也不腹泻(吃了不干净的食物除外),但长年稀溏,不成形,有拉不尽的感觉,肠鸣也是家常便饭,肚子咕咕声,像一个气囊里装了水一样;2014年的症状:2014年全年,本人的肠胃犯病的频率比往年提高了不少,全年犯病去医院看病的次数多达8次,每2个月基本上就犯一次病,所幸开了药吃了以后症状能缓解,只是奇怪的是今年无论生活环境和生活习惯也没发生什么改变,不过本人今年做了心理测试,貌似得了中度焦虑,不知道会不会对肠胃有负面影响,目前的症状:2014年12月,天天早上六点多还在床上的时候特别容易左上腹隐痛:以我自己的角度看,在肚脐左上一点的位置,一定要准确定位,大概在太乙穴和滑肉门穴的位置吧,隐隐作痛,内部有灼热感,伴随胀气,放屁能缓解点,食欲也非常不振,早上一般会,但也只是稀溏,次数也正常,做过常规检查OB,全部子项目都是阴性,一切正常,最不解的是,开的那些药再怎么吃,症状都没有多少缓解,无论中西药都是,最近一个月吃过的西药有:匹维溴铵片酪酸梭菌肠球菌三联活菌片复方阿嗪米特肠溶片盐酸屈他维林片复方消化酶胶囊双歧杆菌四联活菌片磷酸铝凝胶泮托拉唑钠肠溶胶囊;中药就是些调理脾胃的,
肝气郁结会导致肝区疼痛么
三甲 首都医科大学宣武医院 中医科
我奶奶她75岁了!她说她胸口里面痛!...
病情分析: 您好,这种情况首先考虑的是心脏疾患。冠心病表现为胸骨后的压榨感,闷胀感,伴随明显的焦虑,持续3到5分钟,常发散到左侧臂部,肩部,下颌,咽喉部,背部,也可放射到右臂。
有时可累及这些部位而不影响胸骨后区。用力,情绪激动,受寒,饱餐等增加心肌耗氧情况下发作的称为劳力性心绞痛,休息和含化硝酸甘油缓解。
有时候心绞痛不典型,可表现为气紧,晕厥,虚弱,嗳气,尤其在老年人。根据发作的频率和严重程度分为稳定型和不稳定型心绞痛。
稳定型心绞痛指的是发作一月以上的劳力性心绞痛,其发作部位,频率,严重程度,持续时间,诱使发作的劳力大小,能缓解疼痛的硝酸甘油用量基本稳定意见建议:建议立即检查心电图及心脏彩超。![](data:image/png;base64,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