Hernias Allocate Diaphragm Apertures In Separate - Group

Hernias allocate diaphragm apertures in separate - group as they arise most often, have features - of an anatomic structure, clinical displays and demand certain principles of treatment (the section "Hernias diaphragm apertures" see). Describe separate cases of rare hernias of other natural apertures of a diaphragm (a crack of a sympathetic nerve, an aperture - of the bottom hollow vein). Clinic and diagnostics: occurrence and degree - of expressiveness of symptoms hernias depend on character of the moved belly bodies in a pleural cavity, their volume-, degree of filling of the moved hollow bodies, and their excess in the field of hernial gate, degree of a collapse of a lung and displacement , the sizes and the form of hernial gate. Symptoms: gastroenteric, legochno-warm and the general. The factors leading to increase of intrabelly pressure, strengthen expressiveness of symptoms of disease in connection with - increase in a contained hernial bag. Patients complain of feeling of weight and a pain in areas, a thorax, , a short wind and the palpitation arising after plentiful food intake.

Treatment - Surgical - Good-quality Tumours Of A

Treatment - surgical - good-quality tumours of a belly wall also make level-by-level mending of a wound Malignant tumours of a belly wall mostly happen secondary (metastasises of a cancer of a stomach in navel area, metastasises , etc.) STOMACH HERNIAS Hernia (hernia) name interiors through natural or pathological apertures from a cavity - normally occupied with them, under covers of a body or in other cavity. Distinguish external and internal hernias of a stomach External hernias of a stomach is an internal together with from a belly cavity through artificial apertures of a belly wall hypodermic at preservation of integuments. Internal hernias of a stomach are formed in a cavity at penetration of interiors into pockets . Unlike an external hernia of a stomach at - occurs an internal without through the damaged belly wall under a skin (a hypodermic event-portable radio set) or outside (external ). Loss of interiors - name body outside through a natural aperture (for example, loss of a rectum, a uterus).

The External (superficial) Aperture The Channel Is Formed

The external (superficial) aperture the channel is formed by legs an external slanting muscle of the stomach, one of them is attached to - , another - to to an union Size of an external aperture the channel is various In cross-section it happens 1,2 - 3 sm, in - longitudinal - 2,3-3 the external aperture the channel slightly less, than at men see At women. Internal slanting and cross-section muscles of a stomach in . Areas are difficultly separable from each other. This muscular layer, settling down in a fillet - sheaves, approaches to seed and it is thrown through it, forming the different form and size the Border interval an interval: from below - a sheaf, from above - edge of internal slanting and - cross-section muscles of a stomach, from the medial party - external edge of a direct muscle of a stomach. The pahovyj interval can have , or the triangular form. The triangular form an interval testifies to weakness areas Cross-section in areas in two places it is strengthened by fibres on lateral edge of a direct muscle of a stomach goes ligamentum Henle.

Sliding Hernias Of A Thick Gut Happen At

Sliding hernias of a thick gut happen at slanting hernias, and a bladder at straight lines hernias is more often. Sliding hernias make 1 - 1,5 % of all hernias. Sliding hernias on the occurrence mechanism can be congenital and got. At congenital sliding hernias bodies (for example, the thick gut, a bladder) under the influence of the various reasons, sometimes since the period, gradually can some departments which have been not covered - to go down or as though to slide off on friable to internal hernial collars, to leave a belly cavity and to become a component hernial without a hernial bag. The got sliding hernias arise owing to - mechanical tightening adjacent to it of segments of a gut or a bladder, deprived of a serous cover. The sliding hernia of a thick gut has no symptoms. Usually it is the big hernia with wide hernial collars at persons of elderly or senile age. Diagnostics is helped by radiological research of a thick gut . At sliding hernias of a bladder of patients can - disturb frustration or in two ' | reception.

In A Medial Corner Of A Wound File

In a medial corner of a wound file - edge vaginas of a direct muscle of a stomach to - bones in area . Seed - stack on the formed muscular wall. Thanks to imposing of deep seams there is a restoration weakened - back the channel and narrowing - of its internal - aperture till the normal size. Edges an external slanting muscle of a stomach sew over seed edge in edge. Thus reconstruct a forward wall the channel and external a ring In some cases, especially at high a triangle, after sewing together of internal slanting and cross-section muscles with - a sheaf there is a considerable tension of seams that - promotes their procutting and hernia relapse In such cases - it is expedient to spend a cut of a vagina of a direct muscle of a stomach (operation the Poppy-blowing - Venglovsky). Way Kukudzhanova. It is offered for direct and difficult forms hernias After deep rings - impose seams between a vagina of a direct muscle of a stomach and - Cooper's sheaf-, from to a case - vessels In case of an outlined tension before setting - of seams in medial department of a vagina of a direct muscle do - slanting a cut in length 2 - 2,5 sm Then the connected - sinew of internal slanting and cross-section muscles together with top and bottom edges cross-section - file to to a sheaf the Latest seam impose at medial edge of a deep aperture the channel.

Low Arrangement Of A Diaphragm Mark At An

Low arrangement of a diaphragm mark at an emphysema easy, big hernias of a forward belly wall, , constitutions. Paradoxical movement of a diaphragm (lifting at a breath and lowering at an exhalation) happens at paralyses and its relaxation. For studying of character of movements of a diaphragm and its - functional condition use special radiological methods of research: , a tomography. Position and a diaphragm condition judge at contrast radiological research of a gullet, a stomach, intestines, at imposing artificial , and . Change of position and diaphragm function is accompanied by reduction of respiratory volume of lungs, changes . DIAPHRAGM DAMAGES The closed damages of a diaphragm arise at road - traumas, falling from height, an air contusion, a stomach. Diaphragm rupture in these cases is caused by sudden increase of intrabelly pressure. Damages - settle down in area the centre or in a place of its transition in a muscular part of a diaphragm is more often-. In 90 - 95 % of cases occur rupture of the left dome of a diaphragm.

In A Hernial Bag Of Bodies Occurs Outside.

In a hernial bag of bodies occurs outside. The kalovoe infringement arises at easing intestines, is more often observed at people of advanced age. Following-tvie congestions of a considerable quantity intestinal contained in a gut which is in a hernial bag, occurs a - departing loop of this gut, then pressure of hernial gate upon contents of a hernia amplifies and to joins , thus there is a mixed form of infringement. Pathological anatomy: a development principal cause changes in the restrained body is infringement krovo - and . At infringement of a gut owing to venous occurs in a gut wall, in its gleam and in a cavity of a hernial bag. A liquid in a hernial bag name "hernial water". At fast simultaneous a restraining ring of veins and arteries a gut which are in a hernial bag, "hernial water" is not formed, develops "a dry gangrene" restrained gut. In the beginning of infringement the gut gets colouring, "hernial water" the transparent. Nekrotichesky changes in a gut wall begin with a mucous membrane.

Stomach Survey. In Vertical Position Of The Patient

Stomach survey. In vertical position of the patient a normal - configuration of a stomach characterises moderated areas and some the bottom half of stomach. On a back at not corpulent patient level of a forward wall of a stomach is in a prone position below breast level. Uniform - a stomach observe at adiposity, intestines-, a liquid congestion in a belly cavity . Non-uniform - a belly wall can be at - stomach hernias-, at impassability of intestines, at , abscesses - of a belly wall and localised in a belly cavity, at the tumours which are starting with a belly wall and bodies of a belly - cavity. Change of a configuration of a belly wall observe at excessive strengthening a stomach and an intestines. Gathered in the - stomach happens at the exhausted patients, at sharp pressure of muscles of a belly wall (a symptom of muscular protection - a reflex at irritation ). In the presence of - postoperative hems their localisation, the sizes, defects in a belly wall in the field of hems (- postoperative hernias) should be noted-.

Congenital (insufficiency) - A Consequence - The Nervously-muscular

Congenital (insufficiency) - a consequence - the nervously-muscular device physiological or straightening of a corner of Gisa. The clinical picture is similar to displays of a congenital short gullet. Congenital short gullet. At this developmental anomaly the stomach part appears located above a diaphragm. The - clinical picture is caused by insufficiency , - accompanied zheludochno-pishchevodnym a reflux. After feeding at children arise , vomiting sometimes with an impurity of blood as a result of development . Complications of developmental anomalies of a gullet. The most frequent - complication at congenital , stenoses, pishchevodno-respiratory fistulas is the pneumonia. a gullet can lead to starvation of the child, at stenoses develops - stagnant . bronchial tubes the increasing doubled gullet causes a repeated pneumonia, development , the suppuration and break in respiratory ways or a pleural cavity is possible. from a stomach mucous membrane can be exposed with bleeding and punching development.

The Interval Of Lesgafta - Grjunfelda Is Between

The interval of Lesgafta - Grjunfelda is between an internal slanting muscle of a stomach - in front and from below, longitudinal muscles of a backbone and a square muscle from the - middle, the bottom gear muscle and XII edge from above. The interval looks like a - quadrangle. A bottom of this interval is a cross-section muscle - of a stomach. Through these intervals there can be lumbar hernias. On an aetiology they happen congenital, got (traumatic and spontaneous). Diagnostics of these hernias is not difficult. Treatment: the surgical. Zapiratelnye hernias leave through defects membranes apertures. Meet at women in advanced age is more often. It it is possible to explain in the big size apertures and more expressed - inclination of a basin at women. Hernial settles down on a lobby -. However happen hernias when visible approximately is not present. Such hernias are distinguished only at infringement - during operation. Treatment: the surgical. Promezhnostnye hernias (forward and back).

Lymphatic Vessels Cross, Their Central Ends , And

Lymphatic vessels cross, their central ends , and peripheral with veins on type the end sideways or the end in the end. Thus carry out to 6 - 10 . The operations executed in initial stages chronic , completely normalise from the amazed - finiteness, in later stages allow to achieve considerable reduction of a hypostasis of a skin and hypodermic -. GULLET The gullet represents a muscular tube in length about 25 sm, inside a mucous membrane and surrounded with a connecting fabric. It connects to a drink with a stomach part. The gullet begins at level of VI cervical vertebra and is stretched to level of XI chest vertebra. The input in a gullet is located at level a cartilage and will defend from a first line of the top cutters on 14 - 16 sm ("a gullet mouth"). In this place there is a first physiological narrowing. a gullet divide into three departments: cervical (5-6 sm), chest (16 - 18 sm) and - (1-4 sm). The second physiological narrowing of a gullet is approximately in 25 sm from edge of the top cutters at level tracheas and crossings of a gullet with the left main bronchial tube, the third corresponds - to level apertures of a diaphragm and is located on distance 37-40 see In a cervical part and in the beginning of chest department to an arch of an aorta the gullet is located to the left from an average line.

At Complications Illness (an Ulcer, A Bleeding), To

At complications illness (an ulcer, a bleeding), to the expressed hernia a diaphragm aperture, and also unsuccessfulness of long conservative therapy accepts - surgical treatment. Carry out on Nissenu. Operation consists in department of a gullet a wall of a bottom of a stomach. A stomach fix to a diaphragm around apertures several seams. Good results are noted more than at 90 % operated. PEPTICHESKY ULCERS OF THE GULLET Peptichesky ulcers of a gullet make about 1,5 % of diseases - drinks and a gullet. To thicket men, - mainly average and advanced age fall ill-. Aetiology and : in development of an ulcer of a gullet action the factor matters. Disease is often combined with a stomach ulcer of a stomach and a duodenal gut, with a hernia diaphragm apertures, a congenital short gullet, observed after the operations breaking function physiological , after imposing ezofagogastro-anastomoza, i.e. In those cases when there is a zheludochno-gullet th a reflux. Presence at sick infringements of nervous regulation a wall and changes in the central departments of nervous system (in a cerebral cortex, gipotalamiche-skoj areas, a grey hillock) is doubtless.

The Way Spasokukotsky Is Updating Of A Way

The way Spasokukotsky is updating of a way Zhirara - and differs from it only that to to a sheaf - muscles internal slanting simultaneously file and cross-section together with the top rag an external slanting muscle of a stomach At this way the sheaf is less injured . Seam of Kimbarovojugo. Provides connection of the fabrics with the same name. By means of this seam the edge of the top rag an external slanting muscle shrouds edges of internal slanting and - cross-section muscles. The first introduction of a needle is spent on distance by of 1 sm from edge of the top rag an external slanting muscle, then, having spent a needle through edges of muscles, stitch again at the edge the Same thread stitch a sheaf In comparison of the fabrics with the same name is provided. The way Bassini - provides strengthening of a back wall - the channel. After high removal of a hernial bag seed remove aside and under it file internal slanting and cross-section muscles together with cross-section a stomach to to a sheaf.

A Hernial Bag, Edges Sew It In A

a hernial bag, edges sew it in a cross-section direction. Hernial gate expand in a cross-section direction - with two cuts through a white line of a stomach and a forward wall of a vagina of direct muscles to their internal edges. P-shaped seams file the bottom rag under top which in a kind separate seams file to the bottom rag. HERNIAS OF THE WHITE LINE OF THE STOMACH The white line of a stomach is formed skintight to each other by bunches of fibrous fibres wide belly muscles. Between them there are cracks and deepenings which can serve as contributing anatomic factors in - formation of hernias of a white line of a stomach. In the beginning through such crack passes , forming -, and then the hernial bag is formed. Hernias of a white line of a stomach seldom happen big, process can sometimes stop - at a stage . On localisation of a hernia of a white line of a stomach can be/over-umbilical, and . Podpupochnye hernias - meet extremely seldom. Okolopupochnye hernias settle down - more often sideways from a navel.

Observe Cases Of Spontaneous Rupture Of A Gullet.

Observe cases of spontaneous rupture of a gullet. Factors contributing to spontaneous ruptures of a gullet, are alcoholic intoxication, an overeating, vomiting during emetic movements occurs simultaneous disclosing , pressure of muscles of an abdominal tension, reduction of a diaphragm and a muscular cover of a stomach, glotochno-pishchevodnyj remains closed. As a result of pressure substantial increase in a gullet there is longitudinal or cross-section a rupture of its wall, more often directly over a diaphragm ( in 95 %, right in 5 % of cases) gullet Rupture arises at attempt to constrain vomiting or at coordination infringement in work specified above as a result of strong alcoholic intoxication, diseases of the central nervous system. Rupture looks like a linear wound is more often, can extend on a stomach. Develops sharp , at damage pleurae - it . At spontaneous ruptures of a gullet the pain arises suddenly (more often during vomiting) in area a shoot, can in area, a back, the left shoulder.

The Diagnosis Represents Great Difficulties. On Clinical Displays

The diagnosis represents great difficulties. On clinical displays the infringement of a gut differs oi infringements of a gut from it . There are no shock phenomena. Symptoms of intestinal impassability can be absent as contents occurs freely in the diarrhoeia is sometimes observed. There is a constant pain in a place of infringement of an intestinal wall in a hernia where it is possible to probe small painful dense formation. The pain is unsharply expressed as according to the restrained site of a gut is free. It is especially difficult to distinguish infringement when it happens the first clinical display of the arisen hernia. At corpulent women it is especially difficult to probe a small swelling under a sheaf. The general condition of the patient can remain in the beginning accrediting then progressively worsens in connection with development of a peritonitis of a phlegmon of fabrics surrounding a hernial bag At patients with the started form in a femoral hernia inflammation development in fabrics surrounding to a hernial bag can feign infringements sharp or .

Seed Stack On The Generated Back Wall The

Seed stack on the generated back wall the channel. Operation finish creation an external slanting muscle of a stomach and formation - of an external aperture the channel. Way the Poppy-blowing - Venglovsky. Kukudzhanova is close enough by the way. Its essence consists in narrowing of an internal aperture the channel and reconstruction of a back wall the channel. Deep a ring form by a cross-beam - On a vagina of a direct muscle of a stomach do big a cut in length 4 - 5 sm to improve mobility - of sewed fabrics. Cross-section together with the connected - sinew of internal slanting and cross-section muscles frequent seams sew to to a sheaf (from howl sheaves to femoral vessels) Stack seed and in a kind sew an external slanting muscle, forming an external aperture the channel. The way Postempsky consists in a complete liquidation - the channel, an interval and in creation the channel with absolutely new direction. Seed as it is possible further in a direction, at the medial - party narrow internal a ring.

The Bleeding, More Often Sudden, Arises Almost At

The bleeding, more often sudden, arises almost at 50 % of patients-. At allocation of scarlet blood from a mouth it is difficult to spend the - differential diagnosis with a pulmonary bleeding. At blood hit in a stomach emetic weights can get colour of a coffee - thick, in this case difficultly distinguish a bleeding - from the gastric. The profuznoe bleeding can lead to a heavy anaemia and end with death of the patient Against a - chronic ulcer of a gullet the cancer can to develop. The clinical picture of disease allows to suspect - presence gullet ulcers. The basic radiological symptom of an ulcer of a gullet is presence of a niche with inflammatory - shaft around. It is possible to observe also strengthening - gullet walls, local expansion of its gleam over an ulcer, convergence of folds of a mucous membrane to the niche basis to Confirm the diagnosis ulcers of a gullet and to spend the differential diagnosis with and a malignant - tumour helps with . , research and pharmacological test help to spend the differential diagnosis with At an ulcer of the big sizes it is necessary to exclude a - gullet for which the - constancy of its form revealed at radiological - research and sizes is characteristic-, absence - of a site of spastic reduction of a gullet should be remembered possibility of development of nervously-trophic ulcers at tumours, a trauma and inflammatory diseases of the central nervous - system, , and also the ulcers formed at a tuberculosis, a syphilis and fungoid defeats of a gullet.

EXTERNAL HERNIAS OF THE STOMACH External Hernia Of

EXTERNAL HERNIAS OF THE STOMACH External hernia of a stomach - frequent disease, make 3 - 4 % of all population the Hernia limits - work capacity , poses hazard to life the - patient because of possible development of complications (infringement, an inflammation-). Elements of an external hernia of a stomach: hernial gate-, a hernial bag, contents of a hernia, a hernia cover. Hernial gate represent weak places in myshechno-aponevroticheskoj to a stomach wall, through which internal - with leave a belly cavity. - Such weak in places there can be natural channels or the cracks which are passing in thickness of a belly wall the channel, the femoral channel, the umbilical channel, cracks between the fibres - forming a white line of a stomach, a semilunar line, an aperture, sciatic apertures Hernial gate - can be defect in myshechno-aponevroticheskom a layer or the channel which includes a deep aperture, directly channel and an external or superficial aperture. The gryzhevyj bag represents - through hernial gate In a hernial bag distinguish a - mouth, a neck, a body and a bottom.

At The Big Hernias Of A White Line

At the big hernias of a white line of a stomach use a method of Sapezhko. At a divergence of direct muscles of a stomach accompanying a hernia apply a method of Napalkova. After allocation of hernial gate and removal of a hernial bag dissect vaginas of direct muscles of a stomach lengthways on internal edge and sew at first internal, and then external edges vaginas. Thus create doubling of a white line of a stomach. TRAUMATIC AND POSTOPERATIVE HERNIAS Traumatic hernias result from the trauma of a stomach accompanied by hypodermic rupture of subject muscles, - and . Under influence pressure together with an internal - it is stuck out in a place of rupture and the hernia is formed. At the moment of reception of a trauma patients mark a severe pain which gradually passes within several days. If the patient arrives directly after a trauma it is possible - to find out the bruises formed on a place of rupture - of fabrics of a belly wall. Quite often the pain is accompanied by irritation symptoms .

To All Patients With Good-quality Formations Of A

To all patients with good-quality formations of a gullet it is shown for specification of character of formation, its localisation and extent, conditions of a mucous membrane of Ezofagokopija allows to reveal a tumour, to examine its basis, to be convinced of absence - gullet walls. a mucous membrane at - good-quality tumours and a gullet - it is observed seldom. it is possible to make only at presence a mucous membrane and at - new growths. Treatment: at good-quality tumours in connection with - possibility of development of a bleeding, , - surrounding bodies, and at their suppuration and punching - surgical treatment is shown. Tumours of the small sizes on a - thin leg can be removed through by means of special and electrocoagulations At tumours on the wide basis make them with a site - of a wall of a gullet At tumours and a - gullet almost always it is possible to make them without - mucous membrane damage. The remote results of operations the good. GULLET CANCER The cancer makes 60 - 80 % of diseases of a gullet.

In Development Hernias Result Weakness Fabrics-, Age ,

In development hernias result weakness fabrics-, age , adiposity, pregnancy, the factors promoting increase of intrabelly pressure. At - sliding hernias diaphragm apertures often insufficiency , leading zheludochno-pishchevodnomu to a reflux (the section "Insufficiency " see). Clinic and diagnostics: at sliding hernias - apertures of a diaphragm symptoms are caused a reflux-ezofagitom. Patients complain on burning or dull aches behind a - breast, at level a shoot, in areas, in , in heart area, a shovel, the left shoulder quite often sick therapists concerning a stenocardia observe-. The pain amplifies in horizontal position of the patient and at physical activity, at trunk inclinations forward (a symptom, " a boot"), i.e. When occurs zheludochno-pishchevodnyj a reflux is easier. The pain is accompanied by an eructation, , a heartburn. In due course at patients appears which to a thicket has alternating character and becomes a constant at development a gullet. The frequent symptom - a bleeding which usually happens hidden, is seldom shown by vomiting by blood of scarlet colour or colour of a coffee thick, degteobraz th chair.

Some Patients It Is Artificial Cause Vomiting For

Some patients it is artificial cause vomiting for sensation removal behind a breast and the pains appearing during meal. The fetid odour from a mouth is marked in connection with decomposition of the food which has late over a tumour or disintegration of the tumour. The nausea and eructation are observed at patients at by a tumour of walls - of a gullet in the field of physiological . Strengthened , at a gullet cancer, as well as at stenoses of other aetiology, results from reflex excitation - of salivary glands at irritation of receptors of a gullet and wandering nerves. Plentiful bleedings from a gullet in connection with tumour disintegration happen seldom. The general displays of disease (the weakness, a progressing weight loss (at 51 %), an anaemia) are a consequence of starvation and - intoxications. Symptoms of a cancer of the gullet, arising owing to - process distribution - on the next bodies and fabrics, carry to late displays of illness, usually they testify about neoperabel-nosti tumours.

The First Symptoms Of Illness Are More Often

The first symptoms of illness are more often shown, at the age of 20 40 years. Women is more often are ill. Aetiology and : factors - congenital anomalies of development of the nervous device of a gullet (a degeneration intermuscular textures); a neurasthenia with occurrence a gullet motility; reflex dysfunctions of a gullet; infectious-toxic defeats of nervous textures and . The resolving factor is the stress or a long emotional pressure. : at research pressure in the field of pishchevodno-gastric transition it is found out (physiological ). At healthy people it in rest is in a condition of tonic reduction, and after swallowing relaxes-. The main infringement defining symptoms of disease, absence of a relaxation or an insufficient relaxation after swallowing is. Various reactions (incomplete disclosing at swallowing, incomplete disclosing and a spasm, full aha-lazija, and a spasm, an initial hypertone, etc.) Have one initial mechanism infringement walls. Cases , proceeding with a hypertone -, cannot be considered as true "" as the basic mechanism breaking passableness , the hypertone , and absence of its relaxation is not at swallowing.

Persistent Pains In The Left Half Of Thorax

Persistent pains in the left half of thorax can be connected with tumour germination in a pleura. At defeat physiological - at patients the nausea - and an eructation is marked-. Tumour germination in a nerve causes a hiccups. In late stages arise and vomiting. The basic method of diagnostics of a cancer of a gullet is radiological research which begin with survey - a chest and belly cavity where against back - in slanting positions against a - gas bubble of a stomach at a number of patients the tumour shade is possible to see. Survey and a chest cavity allow to reveal metastasises in lungs and . After that investigate a - gullet by means of a water suspension of sulphate of barium. In an initial stage - of a cancer define on from walls - of a gullet defect of filling, deformation and roughness of contours of a mucous membrane. In the field of a tumour arrangement is available gullet walls. At - circular growth of a tumour there comes narrowing of a gleam of a gullet which - looks like and the rough channel.

Treatment, Antibiotics, Heat, At Occurrence Of Signs Of

Treatment, antibiotics, heat, at occurrence of signs of a suppuration is shown abscess opening. Extremely seldom meet specific inflammatory about in a belly wall (, a tuberculosis, a syphilis). Tumours of a belly wall happen good-quality and - malignant. In areas often meet so-called - which give rise to hernias - of a white line of a stomach. Fibromas, , rabdomio and a belly wall to distinguish a tumour - which is starting with fabrics of a belly wall, from a tumour located in a belly cavity are described-, it is necessary to spend a stomach during - pressure of muscles of a belly wall For this purpose to the patient - suggest to rise from horizontal position, leaning against the hands bent in elbows. At pressure of muscles of a belly wall the tumour located , is not palpated, and the - tumour of a belly wall is defined more distinctly. formation in the field of a navel the endometriosis This tumour can be original meets only at - women, for it the sharp increase in sizes and in connection with a cycle and pregnancy is characteristic-.

At <4,5 In A Gut Cavity Liberated Brakes

At <4,5 in a gut cavity liberated brakes secretion of hydrochloric acid, stimulates - allocation of bicarbonates and water with a pancreas, a liver, glands of Brunnera. At neutralisation of hydrochloric acid by an alkaline secret in a cavity of a duodenal - gut value raises, liberation stops and secretion of gastric acid renews. Powerful secretions of hydrochloric acid is . It is developed , cages, concerns family . Brake action on secretion of hydrochloric acid renders gastric brake ( - ). - Increase of concentration in blood is observed after reception fat write also carbohydrates. As a result actions stimulating and braking - secretion of hydrochloric acid of mechanisms production of hydrochloric acid is carried out by cages in the limits necessary for digestion and maintenance - of a kislotno-alkaline condition in physiological limits. Motor function Out of a phase of digestion a stomach is in the - slept condition. During the meal certificate thanks to change of a tone of muscles ("- ") the gastric tank can contain about 1500 ml without appreciable increase pressure.

A Cancer Of The Bottom Third Of Gullet

A cancer of the bottom third of gullet in the lymph nodes located round a gullet and , lymph nodes, on a course an artery and its branches in a liver. At tumour localisation in department of a gullet metastasises extend in , - radical and lymph nodes. However at a - cancer department of a gullet the tumour can in the lymph nodes located below a diaphragm in area , on a course an artery and its branches. That is why some surgeons recommend operation at a gullet cancer always - to begin with and audits of bodies of a belly cavity and spaces. At a gullet cancer observe metastasises on and to a pleura. The remote metastasises meet - in a liver more often-, is more rare - in lungs, bones and other bodies. Gematogennoe distribution occurs in a late stage of disease. at the overwhelming majority of patients the - gullet cancer - happens . Meet (at 8 - 10 %) which develop from ektopiro-bathroom islets in a gullet of a mucous membrane of a stomach or from glands which are available in the bottom department of a gullet Less often.

Diaphragm Blood Supply Carry Out Top And Bottom

Diaphragm blood supply carry out top and bottom the arteries departing from an aorta, myshechno-diafragmalnaja and perikardo-diafragmalnaja the arteries departing from internal chest, and also six bottom intercostal arteries. Blue blood outflow occurs on the veins with the same name, on unpaired and - semiunpaired veins, and also on gullet veins. Lymphatic vessels of a diaphragm form some networks: , pleural, intrapleural, , . On the lymphatic - vessels located along a gullet, an aorta, the bottom hollow vein and other vessels and the nerves passing through a diaphragm, inflammatory process can extend from a belly cavity in pleural and on the contrary. - Lymphatic vessels take away a lymph from above through and back knots, from below - through and . diaphragms carry out and intercostal nerves. Allocate static and dynamic functions of a diaphragm. Statistical function of a diaphragm consists in maintenance of a difference of pressure in chest both belly cavities and normal mutual relations between their bodies.

Further Comes - Tumours And Development Inflammations. Supras-Tenotichesky

Further comes - tumours and development inflammations. Supras-Tenotichesky expansion of a gullet at a cancer seldom happens - considerable as the tumour develops in rather short period of time. Distribution of a cancer of a gullet occurs by direct - germination, and . The tumour can extend on a gullet upwards and downwards, to sprout all layers of its wall, to squeeze the next bodies. Rather late complication is tumour germination in the next bodies which can lead to fistula formation between a gullet and a trachea or a bronchial tube, to development of a pneumonia, a gangrene and processes in lungs and a pleura, to a deadly - bleeding at tumour germination in an aorta. cancer cages on lymphatic vessels in a gullet wall can occur on 10 - 15 sm from visible - border of a tumour. Such "cancer " meets at process localisation in the top and average third of gullet is more often. Along with distribution of a tumour to process - superficial and deep lymph nodes are involved-. The tumours - located in cervical and departments of a gullet, mainly in , over - and lymph nodes.

Diagnostics Hernias At Women Is Based On Survey

Diagnostics hernias at women is based on survey and as finger introduction in an external aperture - the channel is impossible. At women a hernia differentiate with a round sheaf of the uterus which is passing in the channel. a round sheaf of a uterus unlike a hernia does not change the sizes at horizontal position of the patient, - a sound over it always stupid, and over a hernia can be . Treatment a round sheaf of a uterus, as well as hernias, surgical. Operation consists at a distance with a subsequent plasticity the channel. Differential diagnostics between hernias and a femoral hernia is resulted at the description of a femoral hernia. Table 4: Differentsialno-diagnostic signs a plait and a straight line hernias of PriznakiKosaja a hernia Forms and an arrangement hernial Back wall the channel Direction a push The relation of a hernial bag to seed to a congenital Thicket happens in children's and middle age of the Oblong form at plumpness on a course the channel Often the - unilateral falls in - to the Thicket It is expressed in an initial stage of formation of a hernia The kashlevoj push in an initial stage of formation of a hernia is felt sideways from outside a deep aperture the channel The thickening seed on the party happens at elderly and old people The roundish form a swelling at a medial part sheaves Seldom falls in to the Thicket bilateral (especially at elderly patients) It is always weakened The kashlevoj push is felt directly against an external aperture the channel The hernial bag is located from seed pahovo-moshonochnaja a hernia, the increase in the sizes , gets similarity to a dropsy of covers .

Pressure Increase In Physiological Thus Is Secondary And

Pressure increase in physiological thus is secondary and is caused by its reaction to - constant pressure of contents filling a gullet, rubtsovo-inflammatory changes in fabrics of terminal department - of a gullet and loss of elasticity by them. At simultaneously change a tone and - a gullet. Instead of extending to a stomach - reductions appear (- not providing a passage) waves, join them segmentary reductions of a wall of a gullet. The food long is late in a - gullet and arrives in a stomach owing to mechanical disclosing under the influence of hydrostatic pressure of a column of a liquid over it. Long stagnation of food weights, a saliva and slime in a - gullet leads to considerable expansion of its gleam, development and that in turn aggravates infringements - a gullet. Pathological anatomy: in the expressed cases of disease mark gullet expansion in diameter to 15 - 18 sm, its lengthening owing to what it can accept the S-shaped form. Its capacity reaches 2 - 3 l instead of 50 - 100 ml at healthy people.

Treatment: Principles Of Surgical Treatment At A Sarcoma

Treatment: principles of surgical treatment at a sarcoma same, as well as at a gullet cancer. Some kinds of sarcomas well - give in to beam therapy. In the started cases of disease - spend symptomatic therapy. DIAPHRAGM Diaphragm - the suhozhilno-muscular formation dividing chest and belly cavities. The muscular part of a diaphragm begins on a circle - of the bottom aperture of a thorax from a breast, an internal surface of cartilages VII - XII edges and lumbar vertebras (, costal and lumbar departments of a diaphragm). Muscular bunches go up and radially and - dome-shaped cambers come to an end - with the centre, forming on the right and at the left. Between and costal department is available space (a triangle - of Morgani, Larreja), filled . Lumbar and costal departments are divided by pojasnichno-costal space (a triangle of Bohdaleka). The lumbar - department of a diaphragm consists from each party of three legs: external (-), intermediate and internal (medial). Suhozhilnye edges of both internal (medial) legs of a diaphragm form at level of I lumbar vertebra more to the left from a median line an arch limiting an aperture for an aorta and a chest lymphatic channel.

At A Stomach Specify An Arrangement In Relation

At a stomach specify an arrangement in relation to a diaphragm, study a condition - of the part of a stomach moved to a - thorax and its mutual relation with a gullet and . it is shown at suspicion on an ulcer a polyp or on a stomach cancer. Treatment: at not complicated sliding hernias - diaphragm apertures spend conservative treatment - which is directed on decrease zheludochno-pishchevodnogo a reflux reduction of the phenomena , the prevention of increase of intrabelly pressure. The patient recommend to sleep with the raised headboard of a bed, to avoid the positions of a body facilitating - occurrence of a reflux, to watch regular function of intestines a Food should be in the small portions 5 - 6 times a day last food intake for 3 - 4 to a dream. Depending on expressiveness appoint mechanically and chemically sparing diet (a table 1, 16, 1 on Pevzneru). The food should contain a - considerable quantity of fibers. Appoint , enveloping-, astringents, preparations, , , , sedative means and vitamins Surgical treatment at a sliding hernia diaphragm apertures is shown at a bleeding, development a gullet, and also at unsuccessfulness of long conservative therapy at patients with the expressed symptoms a reflux-ezofagita (see has undressed "Gullet").

Superficial - Quickly (1 - 2 ), Deep

Superficial - quickly (1 - 2 ), deep heal with formation of granulations and a connecting fabric. Healing occurs slowly, a connecting fabric and - hem formation probably during 2 - 6 months Are the period chronic - . Cicatricial narrowings of a gullet - are formed more often in several places, in process is quite often involved surrounding . Unions and - gullet deformation develop-. Rubtsovo-ulcer process in a gullet after chemical burns can last for years. As a result of it at separate patients cicatricial narrowings of a gullet arise even after the lapse of 10 - 20 years from the moment of a burn. Thus, at a burn it is possible to distinguish four stages of pathoanatomical changes conditionally: I stage - and a mucous membrane hypostasis, II stage - and , III stage - formation of granulations, IV stage - scarring. At chemical burns of a gullet the substance accepted inside renders, besides local, and action on an - organism from which first of all suffer heart, a liver, kidneys. Heavy nephritic insufficiency can develop.

Closing Of Hernial Gate Make By Sewing Together

Closing of hernial gate make by sewing together by an internal plait, cross-section muscles, an upper edge cross-section with and sheaves. It is necessary to pay attention to width of an internal aperture - of the channel and if necessary it should be taken in till the normal size additional seams on cross-section . A round sheaf of a uterus (seed ) stack on muscles. A plasticity - of a forward wall the channel make by an external slanting muscle of a stomach. UMBILICAL HERNIAS Umbilical hernia name bodies of a belly - cavity through defect of a belly wall in the field of a navel. At - normal development the umbilical ring completely grows. To a skin it is direct umbilical and . - Disease of an umbilical hernia reaches the highest point twice - the first time in the early childhood, and the second time is elderly about 40 years. At women the umbilical hernia meets twice more often, than at men that is connected with a stretching of an umbilical ring during pregnancy-. Umbilical hernias at children arise in the first 6 after a - birth when the umbilical ring was not generated yet.

The Listed Factors Promote Local Easing Of A

The listed factors promote local easing of a belly wall. Making factors - the factors causing increase of intrabelly pressure: heavy physical work, difficult - childbirth, difficulty (an adenoma glands, , urethras), locks, long cough (a tuberculosis-, a chronic bronchitis). The effort promoting increase of intrabelly pressure, can be unique and sudden -(a hard work, weight lifting) or often repeating and minimum (cough). The mechanism of formation of hernias is distinguished depending on a - hernia origin (congenital or got). The reason of formation of a congenital hernia is a belly wall in the pre-natal period ( umbilical hernias-, a hernia umbilical ), brjushinno-pahovogo a shoot. Hernial gate and hernial bag are formed - in the beginning, and then as a result of physical effort an internal gets into a hernial bag. At the got hernias an internal leaves at level of hernial gate and gets further more often on a course of a vascular bunch or body (the femoral channel, the channel). Under the influence of the raised intrabelly pressure an - internal moves apart ahead of themselves layers of a belly wall.

Contents Of A Hernial Bag Usually Is The

Contents of a hernial bag usually is the small intestine loop, an epiploon. Less often in a hernial bag there is a thick gut (on the right - blind, at the left - ). Femoral hernias seldom happen big, are inclined to infringement. Clinic and diagnostics: the femoral hernia in the course of formation passes three stages: initial, channel and - full. In an initial stage hernial does not fall outside the limits an - internal femoral ring. Clinically this stage difficultly comes to light. At this stage it is possible infringement of a gut. In an incomplete (channel) stage hernial it is located near to a vascular bunch, does not fall outside the limits superficial , does not get in hypodermic a triangle. The femoral hernia - passes all femoral channel in a full stage-, leaves through its external aperture in hypodermic hips. The diagnosis of an initial and channel femoral hernia presents difficulties. To suspect such hernias it is possible only on the basis of complaints to a pain in a groin, in the bottom department of a stomach, in the top department of the hip, amplifying at walking, physical activity, at - weather changing.

At Define The - Oval Defect Of Filling

At define the - oval defect of filling - extended on of a gullet, from - barium depot - . At the big - tumours characteristic radiological signs of a cancer are roughness and gullet contours, breakage of folds of a mucous membrane in the field of pathological process. The important role in revealing beginning cancer plays research by means of the - electron-optical converter. Above a tumour the gullet is a little expanded. in this department active or even it is a little strengthened. In case of a long stenosis the gullet loses a tone and almost completely is absent, over narrowing mark a delay of a baric suspension. To definition of distribution of a tumour on the next bodies apply - radiological research in conditions , do tomograms in direct and lateral projections. Radiological research not always reveals early stages of a cancer of a gullet. In some patients a tumour find out only at repeated researches. That is why absence of the radiological data at presence or pains at food passage does not allow - to exclude a gullet cancer.

This Data Is Important For The Characteristic Of

This data is important for the characteristic of a hernia and should be reflected in the diagnosis. To special methods of research carry definition of hernial gate and a symptom a push. After reposition of contents of a hernia by a finger entered into hernial gate, specify the size, the form of an external aperture of hernial gate. At a tussiculation of the patient the finger of the investigating feels pushes stuck out and adjacent bodies (a symptom a push). A kashlevoj push - a characteristic symptom - of an external hernia of a stomach. For revealing of hernias it is necessary - to survey all hernial zones. At the big hernias for definition of a contained hernial bag conduct radiological research of a gastroenteric path, a bladder. Sliding hernias are hernias in which one of walls of a hernial bag is the body partially covered (for example, a bladder, ascending and descending guts). Seldom hernial bag is absent, and all is formed only by those segments of the slid off body which are not covered almost .

Postoperative . Danger Of Infringement Of A Hernia

Postoperative . Danger of infringement of a hernia to a life of the patient increases in process of lengthening of time last from the moment of infringement before operation. after the operations made after the beginning of infringement - in first 6 , makes 1,1 %, in terms from 6 to 24 - 2,1 %, later 24 - 8,2 %. After operations during which time made a - gut resection, makes 16 %. At a phlegmon of a hernial bag when a gut resection made by a paw-rotomii, reaches 24 %. Complications after independently set, - violently set and operated restrained hernias. The patient with the restrained hernia spontaneously set, should be urgently hospitalised in surgical branch. Danger of spontaneous reposition before the restrained gut consists that as a result of the infringements which have arisen in it of blood circulation it can become a source and an intra-intestinal bleeding If at inspection of the patient - at the moment of receipt in a surgical hospital diagnose a - peritonitis or an intraintestinal bleeding, the patient it is necessary to operate urgently.

Most Often (at 50 % Of Patients) Insufficiency

Most often (at 50 % of patients) insufficiency , leading a reflux-ezofagitu and to a gullet ulcer, observe at hernias diaphragm apertures (the section "Hernias diaphragm apertures" see). Reflux-ezofagit : disease - is caused by repeated influences on a mucous membrane - of a gullet of gastric juice, and also bile, intestinal or - pancreatic juice. A disease current or chronic. Aetiology and : the reason the reflux-ezofagita is zheludochno-pishchevodnyj a reflux which at a part of patients - is connected with infringement of switching function physiological -, at others arises after various surgical - interventions (a resection , , a stomach resection, , etc.), . Peptichesky it is most often observed at - hernias diaphragm apertures, it is frequent at a stomach ulcer of a stomach and a duodenal gut, , a stenosis, a cholecystitis. Pathological anatomy: in mild cases mark moderated and a mucous membrane hypostasis, in heavy - - inflammatory changes not only a mucous membrane, but also subject layers, presence of erosion and , hems, in some cases there is a shortening of a gullet of Change are localised mainly in gullet department, they can be , grasping a considerable part of a mucous membrane of a gullet above , and limited.

The Typical Sign Of Infringement Of A Hernia

The typical sign of infringement of a hernia from , is not present intense hernial However the data (violent reposition of a hernia), a belly-ache, sharp morbidity at soft fabrics in the field of hernial gate, hypodermic hemorrhages allow to assume imaginary reposition of a hernia and urgently to operate the patient. The late complications which observed after spontaneous reposition of restrained hernias and have developed after operations concerning restrained hernias, are characterised by signs of chronic - intestinal impassability (a belly-ache, , humming , splash noise) They formation of solderings of intestinal loops among themselves, with other bodies, with - result - and cicatricial , narrowing a gleam of a gut formation cicatricial intestines occurs on a place from a mucous membrane to the subsequent development of a connecting fabric and its scarring. it is caused by presence in a hernial bag sra-shcheny an internal among themselves, and also with a hernial bag. Development is caused the bodies which are in a hernial bag.

Hernial Gate Dissect - On Obviously Sites. After

Hernial gate dissect - on obviously sites. After cautious - clearing and moving of intestinal loops from a hernial bag it take in. STOMACH AND DUODENAL GUT The stomach is located in the left half of top floor of a belly cavity and its only target department comes to the right for a median plane of a body. On a forward - belly wall the stomach is projected on area left and area, and at stomach filling its big curvature on the top department of umbilical area. In a stomach distinguish a part, a bottom and a body, department, the channel. Border between a stomach and a duodenal gut is . The duodenal gut bends around a head of a pancreas and at a sheaf of Trejttsa forms an excess. The length of this initial department of a small intestine 25 - 30 see In a duodenal gut distinguish three parts top, descending and bottom In a descending part of a duodenal gut on to a wall is located big - a place of a confluence of a gut of the general bilious channel and the main pancreatic channel. Arterial blood supply receives a stomach from branches a trunk.

If There Are No Obvious Signs , The

If there are no obvious signs , the restrained gut is irrigated with a warm isotonic solution of chloride of sodium. It is important to remember that guts begins with a mucous membrane, and change in a gut wall, visible from outside it a cover, appear later. The basic criteria of viability of a small intestine: restoration of normal pink colour of a gut, absence a furrow and subserous hematomas, preservation of a pulsation of small vessels and gut reductions. Indisputable signs of frailty of a gut: dark colouring of a gut, a dim serous cover, a flabby wall of a gut, absence of a pulsation of vessels , absence guts. The fifth stage - an impractical gut should be deleted. From visible from outside a border cover it is necessary not less than 30 - 40 sm of a resulting piece of a gut and 15 - 20 sm of a taking away piece. The gut resection should be made at detection in a gut wall furrows, subserous hematomas, the big hypostasis, and hematomas guts. At infringement of sliding hernias there is a necessity for an estimation of viability of that part of body which is not covered .

In An Average - Part Of Chest Department

In an average - part of chest department it deviates to the right an average line and lies to the right of an aorta, and in the bottom third of chest department again deviates to the left an average line and over a diaphragm is located in front from an aorta. Such anatomic arrangement of a gullet dictates corresponding operational access to its various departments - to cervical link sided, to - right-hand , to - link sided transpleural. The place of transition of a gullet in a stomach is called . The left wall of a gullet and a stomach bottom form a corner of Gisa. Gullet wall form four layers - mucous, , muscular and external a cover. The mucous membrane is formed multilayered flat which passes in cylindrical gastric at level of the gear line located some above anatomic . The podslizistyj layer is presented and by fibres. Muscular, the cover consists of internal circular and external longitudinal fibres between which large vessels and nerves in top 2/3 of gullet of a muscle are located, in the bottom third muscular cover consists of smooth muscles.

If It Is Possible, Expedient To Arrange Seed

If it is possible, expedient to arrange seed between rags an external slanting muscle of a stomach FEMORAL HERNIAS Femoral hernias settle down on a hip in area skarpov-skogo a triangle On frequency of formation they make 5 - 8 % of all hernias of a stomach Femoral hernias meet less often and happen mainly at women Among patients to femoral - hernias of the woman at the age of 30 - 60 years make 80 % the - Greatest frequency of femoral hernias at women explain wider basin that causes the big expressiveness - of muscular and vascular lacunas and smaller durability sheaves. Between a sheaf and basin bones it is located which is divided podvzdoshno-grebeshkovoj by a sheaf on two lacunas muscular and vascular In a muscular lacuna there is a lumbar muscle and a femoral nerve. In a vascular lacuna are located a femoral artery with a femoral vein. Between a femoral vein and the interval filled with a fibrous connecting fabric and a lymph node of Pirogiva - Rozenmjullera is available a sheaf. This interval name a femoral ring through which there is a femoral hernia.

The Edge Of An Internal Aperture The Channel

The edge of an internal aperture the channel is outlined accurately thanks to arcuate fibres ligamentum Hesselbachu. On a place of an internal aperture the channel cross-section it is funneled bent and passes on seed , forming the general a cover seed and . Round the sheaf at level of an external aperture the channel is divided into the fibres which part terminates on bones, another in hypodermic areas. Congenital hernias. If the shoot - remains completely , its cavity is freely informed with a cavity . Further the hernia at which the shoot is a hernial bag is formed congenital . Congenital hernias make a - great bulk of hernias at children (90 %). However and at adults happen congenital hernias (nearby 10 - 12 %). Got hernias. Distinguish slanting external a hernia and direct (internal) a hernia. Slanting the hernia passes through external a pole; a straight line - through medial a pole. In an initial stage of development slanting hernias approximately hernial it is imperceptible. At or a tussiculation of the patient the - swelling quickly disappearing after only the patient is defined the oval form stops , at the channel form the bottom of a hernial bag reaches an external aperture - the channel.

During A Finding Write In A Stomach Two

During a finding write in a stomach two types of movements are observed: tonic and . Muscles of a body of a stomach put constant weak pressure upon its contents-. Separate waves mix food with juice glands and move it in department At this time and densely closes an exit from a stomach. The reflux gastric contained - in a gullet prevents the difficult physiological switching - mechanism promoting closing of pishchevodno-gastric transition. The food lump moves in department which deep interception waves separates from a cavity of a body of a stomach. Further the wave in the form of rings extends in a direction. There is a - crushing of a food lump, its mixing to an alkaline secret glands When the wave reaches the gatekeeper, it relaxes, the part contained department arrives in a duodenal gut Then the gatekeeper becomes isolated, there is a total reduction of walls department. The high pressure in department forces contained to move in the opposite direction to a cavity of a body of a stomach where it again is exposed to influence - of hydrochloric acid and .

At And Vomitings Probably Hit Of Food Weights

At and vomitings probably hit of food weights in a tree and development of heavy inflammatory pulmonary complications. The clinical - clinical course depends on level of defeat of a gullet. The cancer and cervical departments of a gullet proceeds especially painfully. In the beginning patients complain of sensation of a foreign matter, a scratching, burning in a gullet during meal. Later there are symptoms of pharyngeal insufficiency - frequent -, , attacks . At a cancer gullet department quite often on the first place acts , then there are symptoms of germination - of a tumour in the next bodies and fabrics (roots of lungs, the chest lymphatic channel wandering and sympathetic nerves, a - backbone, etc.). These patients have heavy complications: , traheo - and fistulas, bleedings, a pleurisy, etc. of which they also die. The cancer of the bottom third of gullet is shown often by pains in areas, in the left half of thorax and feigning a stenocardia. The origin of similar pains is connected with germination by a tumour a nerve.

At Carrying Out Of The Differential Diagnosis Of

At carrying out of the differential diagnosis of a cancer of a gullet it is necessary to exclude other diseases accompanied : , cicatricial narrowings after chemical - burns, good-quality stenoses at patients with and gullet ulcers, good-quality tumours, a tuberculosis. The differential diagnosis with see in section "Ahalazija ". For after a burn, a gullet trauma the anamnesis is characteristic-. At radiological research gullet contours - wavy, narrowing extends on the big extent. To patients - it is shown for an exception . Patients with and gullet ulcers in the anamnesis have instructions on presence of a stomach ulcer, a hernia apertures of a diaphragm and other diseases - accompanied by symptoms a reflux-ezofagita. The great value For differential diagnostics has with -. At good-quality gullet tumours accrues very slowly throughout many years. The general condition of patients is not broken. Radiological and - researches specify in absence of changes - of a mucous membrane of a gullet.

The First Period - Painful, Or The Shock,

The first period - painful, or the shock, second period - imaginary well-being, the third period - the poured peritonitis. For the first period the sharpest pain which causes the shock phenomena is characteristic. Pulse weak frequent, arterial pressure is lowered, breath becomes frequent and superficial. This period happens is expressed at to the infringement form. In imaginary well-being there is a reduction of a pain which was before very intensive. It can mislead the doctor and the patient accepting reduction or disappearance of a pain for improvement of a current of disease-. It is possible to explain pain reduction the restrained - loop of a gut. However local displays of infringement of a hernia remain. If patient do not operate, its condition quickly worsens, there comes the third period of the poured peritonitis. The body temperature - raises, pulse becomes frequent. The stomach swelling increases, - there is a vomiting. Puffiness in the field of hernial increases, appears skin, the - phlegmon develops-.

Big A Tumour, The Bleeding Is Possible-. A

Big a tumour, the bleeding is possible-. a gullet can . Owing to having handed over-livanija to a tumour of bodies - (tracheas, bronchial tubes, the hearts-, wandering nerves) - can arise cough, a short wind, , palpitation, pains in the field of heart, and - other frustration. Probably malignant regeneration of good-quality tumours and a gullet. The diagnosis of a good-quality tumour of a gullet put on the basis of the analysis of a clinical - picture of disease, the - data of radiological - research and . For good-quality tumours of a gullet following - radiological - signs are characteristic--: accurate equal contours of defect of the filling which is settling down on one of walls of a gullet, a relief of a mucous membrane and elasticity - of walls of a gullet in the field of defect, an accurate corner between a wall of a gullet and tumour edge ("a peak" symptom). At - cinema research good-quality formation - of a gullet at swallowing is displaced up together with a gullet wall. For an exception a gullet from the outside a new growth which is starting with , or it is abnormal the located large - arterial vessel use and .

Reflex Pressure Of Muscles Comes Out Irritation -

Reflex pressure of muscles comes out irritation - of the termination of intercostal nerves in and intestines. The patient avoids movement as - position change - strengthens a pain. At the morbidity zone, pressure of muscles of a belly wall, is defined by corresponding intercostal nerves. Concussion of a belly wall causes morbidity. Transition pains in somatic is the disturbing sign specifying in transition of inflammatory process from one of an internal on . Transition example pains in somatic - is the acute appendicitis current. In the disease beginning when the inflammation is limited to a shoot, the patient - feels the poured dull ache round a navel, at this time there is no pressure of muscles of a belly wall. At inflammation transition on a shoot and the pain is localised in right areas, becomes sharp, there is a pressure of muscles and morbidity at in right areas. At inquiry of the patient about a belly-ache it is recommended to put questions and to receive on them answers in such sequence: what? Where? When? Why? Question "that disturbs?" Find out character of a pain on which - it is possible to judge the amazed layers of a wall of body.

A Disease Current Slow, Without - Essential Progressing.

A disease current slow, without - essential progressing. Tsenkerovsky can become complicated development which in turn can become the reason - of a phlegmon of a neck, , developments a fistula, a sepsis. and contents lead to a chronic bronchitis, to a repeated pneumonia, abscesses of lungs Are possible a bleeding from a mucous membrane -, development in it of polyps, its walls. At a long delay of food weights in and there can be complications: , an abscess with break in a bronchial tube, a gullet, a pericardium and other bodies , the massive bleeding Chronic contributes to cancer occurrence. Glotochno-pishchevodnye sometimes it is possible to find out at survey and necks. The basic method of diagnostics - a gullet is the contrast radiological - research establishing presence , width of a neck, duration of a delay in it of barium, degree of infringement of passableness - of a gullet, development signs in a polyp and a cancer, formation pishchevodno-bronchial and fistulas. Endoskopichesky research gives the chance to establish presence , to find out its mucous membrane-, bleeding presence, to diagnose a polyp or a cancer in -.

It Is Possible To Carry Ruptures Of Large

It is possible to carry ruptures of large vessels, a separation of lateral branches, rupture to consequences of a stupid trauma of a stomach aorta aneurysms. These damages are accompanied by a massive intrabelly - bleeding and in some cases can end with death of the patient from a shock. At a trauma of the bottom department of a stomach - bladder rupture -(is possible - at the filled bladder). At rupture of a bladder the urine expiration in free the cavity quickly causes development of the poured peritonitis. bladder rupture is often combined with heavy crises of bones of a basin with displacement . Almost always such traumas are accompanied and frustration up to a sharp delay of urine. At damage of an extrabelly part of a bladder on the first place frustration and infectious complications (uric become numb) act. An additional method of diagnostics is . Inspection of the patient with a stupid trauma of a stomach begin with survey at which already external signs of a trauma (hypodermic and intraskin hemorrhages) can serve as the first instructions - for diagnosis statement So, hypodermic hemorrhages in left , a sharp pain in this area with in left allow to assume spleen damage, a pain in right with in right - forces to suspect liver damage.

Research Of The Local Status Includes Survey, ,

Research of the local status includes survey, , and special receptions. The patient examine in a - standing position and in horizontal position; thus it is necessary to bare a stomach and the top third of both hips. Survey in a standing position gives the chance to define sometimes imperceptible asymmetry - in areas and under sheaves. At - and cough define insignificant , earlier imperceptible, and at the big hernias establish their greatest size. At hernial it is listened a sound at presence in a hernial bag of the gut - containing gas, and when contents of a hernial bag is the big epiploon or the body which is not containing gas. At define a consistence of contents of a hernia (sensation consistences are given by an intestinal loop, the lobular structure of a soft consistence has the big epiploon). In horizontal position of the patient define a hernial bag. At the moment of reposition of the big - hernia it is possible to hear characteristic rumbling in intestines. The hernia can be , partially and .

- Allocate Also (primary) Which Reason Are Infringements

- Allocate also (primary) which reason are infringements of function of nervous system and - a gullet. Pathological anatomy: macroscopical - changes in a gullet are absent or there are signs , sometimes mark a thickening of a muscular cover walls-. At microscopic research reveal considerable dystrophic changes of branches of a wandering nerve, a gullet. Character of defeat of nervous trunks and - gullet textures - at and various that confirms independence of these diseases. Clinic and diagnostics: in a clinical picture - of disease pains which appear behind a breast during food passage on a gullet prevail, have various - intensity, jaws, a neck, hands can in a back, etc. Sometimes pains arise out of food intake then them happens difficultly from the pains caused by a stenocardia. For are characteristic inconstancy and it is frequent its paradoxical character that allows the - given disease from a cancer, a gullet and at which there passes dense food is worse, and its water brings simplification.

At To The Form The Hernia Leaves Through

At to the form the hernia leaves through an - external aperture the channel and settles down on various seed . At pahovo-moshonochnoj to the form the hernia goes down in , stretching it. Only in initial stages of disease slanting the hernia has a slanting direction. In process of hernia increase the internal aperture the channel extends in a medial direction-, removing vessels . The further the medial hernial gate extend, the the back wall - becomes weaker - than the channel. At it is long existing pahovo-moshonochnyh hernias - the channel gets a direct direction, and its superficial aperture is almost flush with an internal aperture (a slanting hernia with the straightened course). At the big hernias considerably increases in sizes, the sexual member disappears under a skin, - hernia contents independently are not set in a belly cavity. At reposition rumbling in intestines is listened. Direct the hernia leaves a belly cavity through a medial pole, sticking out cross-section (a back wall the channel).

The Femoral Hernia Is Located - More Low

The femoral hernia is located - more low sheaves, - above. In relation to the hernia is located above and , and femoral - more low and (Cooper's symptom). At corpulent patients to specify arrangement hernial in relation to sheaf (under it or over it), is necessary to spend mentally a line connecting a lobby top with . For femoral a hernia can be accepted , settling down in the top department a triangle. has a lobular structure, it is not connected with an external - aperture of the femoral channel. , leaving through the femoral channel and having with it communication, it is more difficult to distinguish from a femoral hernia at which too can be . At a hernia and at the same operations - closing of an internal aperture of the femoral channel are required. Feign a femoral hernia the increased lymph nodes in area a triangle (chronic , tumour metastasises in lymph nodes) can. The - Lymph node it is possible, having grasped fingers, to delay and establish absence of its communication with the femoral channel.

As A Result Inflammations Arise Dense Unions Of

As a result inflammations arise dense unions of bodies with each other - and with a wall of a hernial bag. can be partial when the part of contents of a hernia can be set in a belly cavity, and other part to remain . At full hernia contents are not set in a belly cavity. Development is promoted by long - carrying of a bandage. there are umbilical, femoral and postoperative hernias is more often. Often enough hernias happen multichamber (umbilical, postoperative). Owing to - development of plural solderings and chambers in a hernial bag the hernia becomes complicated infringement of bodies in - one of chambers of a hernial bag or development of adhesive intestinal - impassability in a hernial bag is more often--. The hernia inflammation arises owing to a hernial - bag. It can occur from within at an acute inflammation a shoot or Mekkelja which are in a hernial bag, as a result of punching or tubercular ulcers of intestines in a cavity of a hernial bag, at a tuberculosis . At the inflammation of a hernia caused from outside of bodies of a belly cavity, the general condition of patients worsens, a body temperature high, a fever, vomiting, a delay of gases and a chair.

The Definitive Diagnosis Establish At Radiological Research. The

The definitive diagnosis establish at radiological research. The radiological picture depends on character and volume of the belly bodies which have moved to a thorax, from degree of filling of a gastroenteric path. At stomach loss the big horizontal level in the left half of the thorax is visible, rising at reception of a liquid and write. At loss of loops of a small intestine against a pulmonary field - define separate sites of an enlightenment and blackout. Moving - of a spleen or a liver gives blackout in corresponding - a pulmonary field. At some patients the dome - of a diaphragm and the belly bodies located above it are well visible-. At contrast research of a gastroenteric path define character of the dropped out bodies (hollow or -), specify localisation and the sizes of hernial gate on the basis of a picture the dropped out bodies at aperture level - in a diaphragm (a symptom of hernial gate). At some patients for diagnosis specification impose diagnostic . At a false hernia air can pass in a pleural cavity ( define a picture ).

Unlike A Hernia At An Abscess It Is

Unlike a hernia at an abscess it is possible to receive a - fluctuation symptom-, to reveal at backbone research painful points at pressing on awned shoots of vertebras, and at loading on a backbone axis - morbidity in the field of lumbar - department of a backbone. - It is necessary to make for acknowledgement of the diagnosis of a tuberculosis - of a backbone a backbone. Treatment: the surgical. Way Bassini - a cut do in parallel to a sheaf and below it over hernial . After high allocation - of a hernial bag it open, stitch as it is possible above and cut. Close hernial gate by sewing together - and sheaves. Impose 2 - 4 seams. The second row of seams between crescent edge wide hips and edge take in the femoral channel. Operation of a femoral hernia by way (on a method of Rudzhi) - do a cut as at to a hernia. Open - an external slanting muscle of a stomach. Bare an - interval. Dissect cross-section in a longitudinal direction. Removing , allocate a neck of a hernial bag. A hernial bag deduce from the femoral channel, open-, stitch and delete.

). Expansions Of A Gullet Do Not Observe. At

). Expansions of a gullet do not observe. At some patients a gullet are shown by these volumes similar to symptoms (, -, pains). However radiological research allows to make the correct diagnosis. Treatment: conservative therapy at apply only in initial stages of disease, and also use as addition to and by preparation of patients for surgical treatment. The food should be and thermally sparing, rich fibers, vitamins. A food fractional, last food intake for 3 - 4 to a dream. Reduction in I - II stages of disease can achieve by - application of preparations of nitrogroup - nitroglycerine, At the phenomena stagnant apply - gullet washing - by a weak solution of antiseptic tanks Therapeutic effect mark after physiotherapeutic procedures with , deep on area , long-wave , etc. The basic method of treatment - which consists in a violent stretching and a partial anguish of muscles a site of a gullet and . it is possible to spend in any stage - of disease by Contra-indication to its use are, a - portal hypertensia with expansion of veins of the gullet, expressed , the diseases of the blood accompanied - raised the Greatest distribution to the USSR now has received pneumatic - which consists from a rubber tube-probe on which end the cylinder Diameter of a cylinder from 25 to 45 mm Pressure in system is strengthened forms create a pear and supervise a manometre In an initiation of treatment apply dilators - of the smaller size and create in them pressure 180 - 200 mm , apply subsequently cylinders diameter and gradually increase in them pressure to 300 - 320 mm Duration - of procedure of a stretching 30 - 60 with, Interval between sessions 2 - 4 days Usually during a stretching patients a moderate pain behind a breast and in areas After procedure by the patient appoint a confinement to bed and hunger on 2-3 before pain disappearance.

At A Bleeding, For Definition - Of Deficiency

At a bleeding, for definition - of deficiency of volume , circulating in a vascular channel, it is possible to be guided by a shock index: Shock index = the Pulse rate / the HELL In norm this indicator makes 0,5. Losses of volume - of a circulating liquid to 30 % raise a shock index to 1, thus indicators of a pulse rate and arterial pressure nearby 100. At the expressed picture of a shock c 120 in a minute and arterial pressure about 80 mm hg, the indicator of a shock index raises to 1,5 and testifies to the beginning of danger to a life of the patient. The shock index equal 2 (pulse 140 in a minute, arterial pressure of 70 mm the item), corresponds to reduction of volume of a circulating liquid by 70 %. At women at gathering of the gynecologic anamnesis it is necessary to pay attention to the transferred gynecologic diseases, - a cycle, time of the last . The reason of occurrence of a belly-ache of century for the middle a cycle can be - . At a delay there is a basis - to suspect extra-uterine pregnancy.

Ultrasonic Research Of A Bilious Bubble, Pancreas, Liver,

Ultrasonic research of a bilious bubble, pancreas, liver, spleen for revealing of an inflammation or damage - of bodies. Laparoscopy for revealing of an inflammation or body damage. Diagnostic peritoneal th make at suspicion on punching of hollow body-, a bleeding, not revealed by other - methods. Into a belly cavity enter through a small cut of a belly wall on an average line of a stomach and make washing - of a belly cavity by an isotonic solution of chloride of sodium. In a washing liquid the blood impurity testifies to inside-brjushinnom bleeding, and gastroenteric contents - about punching of hollow body. The differential diagnosis: the - diseases simulating a sharp stomach, a myocardium heart attack, , spontaneous , nephritic , Shenlejna - Genoha should be excluded-. Preoperative preparation. Antishock actions (correction of infringements vodno-elektrolitnogo balance and a kislotno-alkaline condition, at a bleeding completion ). Introduction of antibiotics at the confirmed diagnosis of an inflammation, punching of body, intestinal impassability.

Spend Under Local Or General Anaesthesia. Conservative Treatment

spend under local or general anaesthesia. Conservative treatment of hernias spend at umbilical hernias At children. It consists in application of bandages with which interfere an internal. At adults apply a - various kind bandages. Bandage carrying appoint patient who cannot be operated because of presence at them serious contra-indications to operation ( - chronic diseases of heart, lungs, kidneys, a cirrhosis, -, , malignant new growths). The purpose of carrying - of a bandage - to interfere an internal in a hernial - bag. The bandage promotes closing of hernial gate. Bandage carrying probably only at hernias. - Long carrying of a bandage promotes an atrophy of fabrics of a belly wall, formation of unions between an internal and a hernial bag, i.e. Conducts to development hernias. Preventive maintenance: observance of hygiene of chest - children which consists in care of a navel, correct feeding, regulation of function of intestines matters-. Regular employment by physical culture and sports as means of strengthening of muscles and an - organism in general.

On And Functions Distinguish Three Ferruterous - Zones.

On and functions distinguish three ferruterous - zones. L Kardialnye of gland - allocate slime thanks to which sliding of a food - lump is provided-. 2. , or the main things, glands are constructed of four kinds of cages. The main cages allocate - . Parietalnye cages develop hydrochloric acid and the internal factor of Kestlja. Additional cages allocate the soluble slime possessing buffer properties. Not differentiated cages are initial for all other cages of a mucous membrane. 3. Antradnye glands allocate soluble slime with , close to an - extracellular liquid, and a hormone from G-cages. Accurately outlined border between and glands is not present. A zone where both kinds of glands are located, name transitive. The area of a transitive zone of a mucous membrane is especially sensitive to action of damaging factors, here mainly arise . With the years there is a - distribution glands in a direction, i.e. To , at the expense of an atrophy glands. In a mucous membrane of a duodenal gut between cages are located cages: G-cages develop , S-cages-sekretin, I-kdetki - - .

Dangerous Complication Is Perforation - Of A Gullet

Dangerous complication is perforation - of a gullet and development . Indications to operation at cicatricial a gullet: 1) a full obliteration of a gleam of a gullet; 2) numerous unsuccessful attempts of carrying out through ; 3) fast cicatricial after repeated ; 4) presence fistulas with a trachea or a bronchial tube; 5) expressed extended ; 6) repeated gullet punching at . At a heavy exhaustion for a food by the patient impose as the first stage of treatment. At a choice of a method of operation consider age and the general condition of the patient, localisation and extent of narrowing of a gullet. At the majority of patients make plastic operations. A mnogoetapnuju plasticity carry out at the weakened patients. At segmentary make any partial plastics of a gullet. At defeat of the bottom part of a gullet or apply: imposing roundabout to food-vodno-gastric , a resection of the amazed site and replacement by its tube formed of the big curvature of a stomach, a transplant from a thin or thick gut.

Stomach Vessels With Each Other And With Branches

Stomach vessels with each other and with branches top arteries, form the branched out network vessels. - Rich blood supply of a stomach complicates a spontaneous stop of a bleeding - from ulcers, even defeats only a mucous membrane (erosion) can cause plentiful bleedings. Veins correspond to an arrangement of arteries and Venous textures in a layer around system veins with system of the top hollow vein are veins At portal these can become a source of bleedings. Studying of areas of lymphatic outflow has practical value at performance of radical operations concerning a stomach cancer. pau a stomach it is carried out by nervous textures (, intermuscular, ), wandering nerves and sympathetic nerves. Wandering nerves forward and back trunks reach along a gullet a stomach. Above the forward (left) trunk gives a hepatic branch, and from a back (right) trunk departs a branch to to knot. The left - wandering nerve before passage through a diaphragm aperture can be divided into two or three trunks.

At A Number Of Patients With Depends On

At a number of patients with depends on food temperature: badly passes or there does not pass warm food, and cold passes, or on the contrary. Patients gradually adapt to facilitate passage of food to a stomach by means of a number of receptions (walking, gymnastic exercises, air and a saliva-, reception of a considerable quantity of warm water, etc.). Expressed at observe seldom. at small expansion of a gullet comes after several drinks of food, at considerably expanded - gullet happens more rare, but plentiful and it is caused by the strong spastic reductions of a gullet arising at it nepe. in a prone position and at a strong - inclination of a trunk it is caused by mechanical pressure of a contained - gullet on glotochno-pishchevodnyj and its stretching. Night it is connected with some decrease in a tone glo-was exactly-pishchevodnogo . Pains behind a breast at have various character. They can be connected with a spasm muscles and are eliminated by nitroglycerine reception, and atropine.

Often Simultaneously There Are Damages Of A Thorax,

Often simultaneously there are damages of a thorax, bones of a basin, bodies of a belly - cavity. At ruptures and wounds of a diaphragm owing to - negative intrachest pressure there comes moving to a - pleural cavity of a stomach, a thin or thick gut, an epiploon, a spleen, a liver part. Moving of bodies can arise as directly after a trauma, and after any - time interval. Open damages of a diaphragm happen at koloto-rezanyh and fire wounds. They - are in most cases combined with damage of bodies of a chest and belly cavity. The clinic and diagnostics, in the sharp period prevail - symptoms of an accompanying trauma ( a shock, cardiovascular and respiratory insufficiency, a bleeding, a peritonitis, , crises of bones). Have diagnostic - value symptoms a lung and displacement of bodies . There can be an infringement - of the bodies which have dropped out in a pleural - cavity. To suspect diaphragm wound it is possible at presence over a - thorax at , intestinal noise at , at development of symptoms of intestinal impassability, - occurrence haemo- or at stomach wounds.

- Surgical Intervention Make Through 2 - 3

- Surgical intervention make through 2 - 3 after the - termination of beam therapy. At tumours, in the presence of contra-indications to radical operation make palliative interventions for the purpose of restoration of passableness of a gullet, improvement of a food of the patient. To palliative operations carry: palliative resections-, tumours an artificial limb (endoproteziro-vanie), imposing . Beam treatment apply both at radical, and at palliative therapy of a cancer of a gullet. Optimum results are received at use of sources high - (gamma therapies, brake radiation and fast ), providing leading to a tumour of a gullet of a high dose - of radiation. At a cancer of the top third of gullet after - imposing the patient spend radical beam therapy in a total dose 60 - 70 Gr (6000 - 7000 it is glad) at a - daily dose 1,5 - 2 Gr (150 - 200 is glad). At a cancer of an average third of gullet the patient impose , and then spend palliative beam therapy in a dose 20 - 40 Gr (2000 - 4000 it is glad), - which overall objective - removal , pains and delay of progressing of tumoral process.

Outside The Gullet Is Surrounded Friable Connect-telnoj In

Outside the gullet is surrounded friable connect-telnoj in which pass lymphatic, blood vessels and nerves the cover has only gullet department. Gullet blood supply in cervical department is carried out from the bottom thyroid arteries, in chest department - for the account actually the arteries departing from an aorta, branches of bronchial and intercostal arteries. Blood supply gullet department occurs from an ascending branch of the left gastric artery and a branch bottom arteries. In chest department gullet blood supply has segmentary character, therefore its allocation on a considerable extent from surrounding fabrics during surgical interventions can lead walls. Outflow of a blue blood from gullet department goes from and venous textures in and further in a vein. From the top departments of a gullet the blue blood flows through the bottom thyroid, unpaired and semiunpaired veins in system of the top hollow vein. Thus, in the field of a gullet are available between system and top hollow veins.

At A Method Apply To Closing Of Defect

At a method apply to closing of defect of a belly wall wide hips, plates and laces from skin. At a method use grids from synthetic fabrics (lavsan, teflon, , etc.). Implanted between layers of the rubtsovo-changed fabrics the implant can be used as a skeleton which then is filled with a cicatricial fabric in the course of healing-. This method apply at repeated relapses of postoperative - hernias when there is an extensive trellised defect in a hem, and fabrics of a belly wall are not differentiated almost-. To close defect local fabrics it is not obviously possible-. Preventive maintenance: a choice of correct operational - access without considerable damages of muscular layers, and nerves; refusal of application resolving a - material; restriction of indications to and a belly cavity; level-by-level mending of a wound of a belly - wall; preventive application of antibiotics during the operation accompanied by opening of hollow bodies and possible -, an exception of excessive physical activity after operation.

The Big Epiploon Is Restrained Usually In Umbilical

The big epiploon is restrained usually in umbilical and big hernias. The infringement of a bladder arises at sliding and femoral hernias, is accompanied frequent painful , sometimes by a delay , reduction - in connection with reflex decrease in function of kidneys. False infringement of a hernia. At sharp diseases of bodies of a belly cavity (the acute appendicitis, a sharp cholecystitis, perforation of an ulcer of a duodenal gut or a stomach, intestinal impassability) , getting to a hernial bag of not restrained hernia, causes in it inflammation development. Hernial increases in sizes, becomes painful and strained. These signs correspond to signs of infringement of a hernia. The diagnosis: to make the correct diagnosis of sharp diseases of bodies of a belly cavity and to exclude infringement of a hernia - carefully collected anamnesis of these diseases and the carried objective investigation of the patient helps. First of all it is necessary to find out time of occurrence of a belly-ache and in the field of a hernia, the pain beginning (sudden, gradual).

- Radiological Research Is The Basic Method Of

- Radiological research is the basic method of diagnostics - of damages of a diaphragm. It begin with survey - and bodies of a chest and belly cavity, - then in need of remote terms spend research of a stomach, a thin and thick gut. At - damages of the right dome of a diaphragm liver position judge according to radiological, ultrasonic researches and scanning. Treatment: at ruptures and diaphragm wounds the urgent operation consisting in of defect by separate - seams from of a material after bringing down - of belly bodies is shown--. Depending on a prevalence of symptoms of accompanying damages of bodies of a belly or chest cavity operation begin with laparo - or . HERNIAS Diafragmalnaja hernia - moving of belly bodies to a chest cavity through defects or weak zones of a diaphragm. The true hernia is characterised by presence of hernial gate, a - hernial bag and hernial contents. In the absence of a hernial - bag a hernia name false. At a true hernia the hernial bag is formed , from above covered - by a pleura.

Elastichesky Infringement. The Complication Beginning Is Connected With

Elastichesky infringement. The complication beginning is connected with increase of intrabelly pressure (a physical activity, cough, and ) Suddenly arises a strong constant pain in the field of hernial , earlier hernias, hernial it is necessary to mean increase, sharp pressure and morbidity that the infringement can be the first display of the arisen hernia. The infringement of a gut is one of forms intestinal impassability. In these cases signs of intestinal impassability against a constant acute pain in a stomach, caused vessels and nerves the restrained gut join, there is a pain connected with strengthening , a delay of a chair and gases, vomiting is possible. At a stomach continuous intestinal noise are listened. At survey a stomach the stretched loops of intestines with - horizontal levels of a liquid and gas over them ("bowls of Klojbera") come to light-. The peritonitis Later develops. At infringement of a gut in a clinical current of complication it is possible to allocate three periods.

In I Sharp Stage Of Disease (5 -

In I sharp stage of disease (5 - 10 ) patients - test heavy sufferings. After reception of caustic alkali or acid there are severe pains in an oral cavity, a drink, behind a breast, in areas, plentiful salivation-, repeated vomiting, owing to a spasm of a gullet in the field of a burn and a mucous membrane hypostasis. Swallowing - is impossible. Patients are raised, frightened. Integuments pale, damp. Breath is speeded up, there is a tachycardia. Mark - various degree of the phenomenon of a shock: excitation or block, slackness, bad reaction to surrounding conditions, drowsiness, , a tachycardia, decrease in the arterial pressure, - deaf tones of heart, reduction of quantity of urine up to -. In some hours after a burn along with shock symptoms there are symptoms burn : rise in temperature - of a body to 39 �, block is replaced by excitation, sometimes there is a delirium, muscular twitchings. Breath frequent, superficial, a pulse rate to 120 - 130 in minute, arterial pressure is lowered owing to .

As A Mouth Is Called The Part Of

As a mouth is called the part of a hernial - bag which borders on a belly cavity. As a neck - of a hernial bag is called the narrow department of a hernial bag which are - in thickness of a belly wall - in hernial collars. A body of a hernial bag - its greatest part. Distalnyj department of a hernial bag name a bottom. The hernial bag can be , two - three- and sometimes . At increase in a hernia as a result of a trauma and an inflammation in a hernial bag solderings - and are formed - that can promote infringement of contents - of a hernia in one of cavities (chambers) of a hernial bag. The full partition of a hernial bag with isolation of one segment can lead to formation a hernial bag. Contents of a hernial bag - the internal which has left in a hernial bag. Any body of a belly cavity (except a - pancreas) can be contents of a hernial bag to the Thicket the hernial bag contains the most mobile bodies of a belly cavity: the big epiploon, a small intestine. Classification of external hernias.

To Liquid Revealing In A Belly Cavity Apply

To liquid revealing in a belly cavity apply a method . The doctor puts a palm On one party of a stomach, on an - opposite side the bent fingers of other hand makes an abrupt push which in the presence of a liquid is defined by a "listening" palm. In order to avoid the erroneous conclusion it is necessary to exclude push transfer on a belly wall. For this purpose the doctor asks the patient or staff nurse to put an edge a brush on an average line of a stomach. At such reception distinct transfer of a push proves liquid presence in a belly cavity. In localisation of pathological process the - zone morbidities (a sign of local irritation -) allows to be guided--. the semibent fingers or a brush edge on the right costal arch can cause morbidity - in right (a symptom of Ortnera-Grekova) at an - inflammation of a bilious bubble, bilious channels, a liver. a stomach make in various positions - of the patient. At research of the patient in horizontal position it is necessary to ask the patient for a relaxation of muscles of a belly wall to bend feet in knee joints and slightly to dissolve them in the parties.

The Pain Arises Or Amplifies During Meal Owing

The pain arises or amplifies during meal owing to a trauma of a wall of a gullet a passing food lump, and also in a prone position when arises - zheludochno-pishchevodnyj a reflux is easier-. at to a gullet ulcer it is caused - by an inflammatory hypostasis of a wall of a gullet in the field of an ulcer, formation of a stenosis of a gullet, joining . Patients often disturb a heartburn, with held (at a gullet) or stomach contents at insufficiency ). A disease current slow, monotonous. Aggravations arise during the spring and autumn periods is more often. Complications gullet ulcers: a stenosis, punching, a bleeding, . The expressed stenosis of a gullet develops at 25 % of patients, is shown and peryp. In process of increase of a stenosis of a gullet progresses , a food of patients is broken. Rubtsovo-inflammatory changes of a wall of a gullet can lead to its shortening ("the got short gullet") and to hernia formation - diaphragm apertures. At 15 % of patients punching of an ulcer of a gullet in - is observed-, is much more rare - in the left pleural cavity, an aorta, heart, is the extremely rare - in a belly cavity Punching is shown - by a sudden pain behind a breast or a shoot, amplifying at swallowing, bloody vomiting, a hypodermic - emphysema, a tachycardia At radiological research define - contrast substance in or in a - pleural cavity.

After A Trauma Traumatic Hernias - Arise At

After a trauma traumatic hernias - arise at once or within the next few days. Hernial - appears at vertical position of the patient, , i.e. At the slightest increase of intrabelly pressure. Traumatic - hernias can be single and plural. Treatment: if after a trauma there is a suspicion on damage - of an internal of a belly cavity, the patient it is necessary to operate urgently. After audit of bodies of a belly cavity the damaged - fabrics sew . During operation on an occasion of the generated hernia delete a - hernial bag and close hernial gate in the way - creating optimum conditions for strengthening of a belly - wall. Postoperative hernias are formed in the field of a postoperative - hem. The reasons of formation of postoperative hernias: Operation end and a belly cavity a suppuration postoperative , fall of regeneration of fabrics, the big physical activity in the postoperative period damage of nervous trunks during operation. In the field of a postoperative hem hernial gate settle down, they are formed by edges of muscles and , dispersed - in the area of an operational hem.

At Defeat Drinks, Cervical Or Cervicothoracic Department Of

At defeat drinks, cervical or cervicothoracic department of a gullet carry out a partial plasticity. Use transplants from a thin or thick gut. One end - of a transplant with a gullet above, and another below narrowing. At extensive the total plasticity of a gullet with or intrachest (, intrapleural, ) an arrangement of a transplant from a thin or thick gut is shown. It is not necessary to start creation of an artificial gullet before 2 years from the moment of a burn. Only after that term degree of scarring of a gullet can come to light and becomes clear that the generated cicatricial fabric will not allow to achieve expansion of a gleam of a gullet by conservative methods INFRINGEMENTS OF THE MOTILITY OF THE GULLET the nervously-muscular disease - of a gullet shown by infringement of passage of food weights in a stomach owing to proof infringement of reflex - opening at swallowing, changes and - tone easings - walls. Frequency of disease in relation to other diseases - of a gullet from 3 to 20 %.

Diagnostics: Difficulties Does Not Cause. Treatment: The Surgical.

Diagnostics: difficulties does not cause. Treatment: the surgical. Make a fistula and defect in a gut wall. At normal development the - uric channel is completely obliterated, the eminence over it - carries the name of a median umbilical fold (plica umbilicalis mediana) At an uric channel mark urine in the field of a navel. Especially it happens considerably at shout or crying of the child. Treatment an uric channel - a fistula to a bladder defect in which sew up. Diagnostic difficulties arise at partial - zheltochno-intestinal and uric channels then separating - slime and pus fistulas accept for not healing defect on a place of tearing away of an umbilical cord. It is necessary to distinguish the got umbilical - fistulas when at bandaging of an umbilical cord in case of presence of a hernia umbilical in the wall of the dropped out gut can be grasped from congenital fistulas-. Sharp inflammatory processes of a belly wall. - It is possible to carry a suppuration to primary - inflammatory processes in - hypodermic fatty and a phlegmon in the field of a vagina - of a direct muscle of a stomach Secondary inflammatory processes can be a consequence of transition of inflammatory process on a belly wall at a tuberculosis or an osteomyelitis of bones of a basin, at - thorax abscesses, paranephrites, etc.

Pathological Anatomy: Gullet Sarcomas Are Very Various On

Pathological anatomy: gullet sarcomas are very various on a histologic structure. They develop from a muscular fabric (, ), from a connecting fabric (, , , the osteosarcoma, ), from vessels , meets tumoral a gullet (, ). From malignant tumours most often in a gullet - develops , - localised basically in average and bottom its thirds, having the form-. Sarcomas can settle down - and grow for limits of a wall of a gullet, - and adjacent bodies. sarcomas - of a gullet are more rare, than cancer - tumours. Clinic and diagnostics-: - the basic symptom of disease. Pains behind a breast, in about- appear in far for- going stages. Others about the- disease phenomena - the weakness, progressing loss of weight of a body, anemiza - . At disintegration of the tumour sprouting in respiratory ways, there comes formation pishchevodno-trahealnogo or a pishchevodno-bronchial fistula. The diagnosis of a sarcoma of a gullet put on the basis of the analysis - of a clinical picture, the data of radiological research and - with .

Survey Intestines, Free Gas In A Belly Cavity.

Survey intestines, free gas in a belly cavity. Survey emetic weights (a bile impurity), a chair (at blood in weights). Measurement . Laboratory researches the blood analysis (, , ). Early signs of a peritonitis occurrence of the constant belly-ache amplifying at cough, sensation of dryness in an oral cavity, pulse increase, local morbidity at and a stomach, occurrence of easy local pressure of muscles of a belly wall, . Early signs of an intraintestinal bleeding weakness, dizziness, pallor of integuments, pulse increase, decrease in arterial pressure, haemoglobin decrease, , a blood impurity in weights. Occurrence of signs of a peritonitis, bleeding in intestines is the indication to emergency operation Operation consists in , resections of the changed site of a gut to level of the kept sufficient blood supply in resulting and taking away intestinal loops. To the patient at whom at dynamic supervision signs of a peritonitis are not revealed, an intraintestinal bleeding, it is shown in a planned order with a plasticity of a belly wall in the field of hernial gate.

It Depends On A - Diaphragm Tone. Dynamic

It depends on a - diaphragm tone. Dynamic function of a diaphragm is caused by influence of a moving diaphragm at breath on lungs, heart and bodies of a belly cavity. Diaphragm movements carry out ventilation of lungs, facilitate - blue blood receipt - in the right auricle, promote to a blue blood from a liver, a - spleen and bodies of a belly cavity, to movement of gases in a gastroenteric path, to the certificate , . RESEARCH METHODS At it is possible to define level of an arrangement - of a diaphragm, to suspect moving of bodies of a belly cavity to the chest-. Radiological research is the basic method of diagnostics of damages and diaphragm diseases. The top - of the right dome of a diaphragm in front settles down at level of V edge, left - on one edge more low. At quiet breath diaphragm excursion is equal 1 - 2 sm, at forced reaches 6 see - High arrangement x diaphragm domes mark at - pregnancy, , a peritonitis, paralytic intestinal - impassability. High standing of one of diaphragm domes happens at , paralyses, a diaphragm relaxation, tumours, and liver abscesses, abscesses.

As Symptoms Of An Intra-belly Bleeding The Stomach,

As symptoms of an intra-belly bleeding the stomach, in the beginning local morbidity serve strained, increased in at , and then a stupid constant pain and development a shock. At damage of hollow body of the phenomenon of a peritonitis - traumas develop - not right after. For its development some time is required, therefore the patient should be under supervision of the doctor At suspicion on a peritonitis or a bleeding after a stomach trauma it is necessary to spend research at which it is possible to define a forward wall of a rectum and sharp morbidity at . From additional methods of research it is expedient - to use a laparoscopy and ultrasonic scanning of bodies of a belly cavity. At damage of an aorta or arteries - diagnostic value easing or absence of a pulsation on femoral arteries, has a shock. Additional method of diagnostics is research. DISEASES OF THE BELLY WALL Congenital umbilical fistulas develop as a result a zheltochno-intestinal channel (ductus omphalomesentericus) or an uric channel (urachus) At a zheltochno-intestinal channel in the field of a navel the fistula with intestinal is formed or mucous separated Sometimes through a fistula the - gut mucous membrane drops out-.

At - Suspicion On Defect Presence In Its

At - suspicion on defect presence in its wall owing to rupture or punching it is necessary to apply water-soluble contrast substances as a barium suspension, leaving through defect in a gullet wall in , it and does - the subsequent researches. Besides, it as a foreign matter promotes development of an infection of Jodsoderzhashchie water-soluble connections (, , etc.) . Easily - get through small defects in a gullet wall, not inflammatory reaction surrounding , are quickly soaked up Often researches happens enough for localisation and the sizes of a punched aperture In doubtful cases use under anaesthetic by means of rigid . Treatment, conservative (a food exception through a mouth, a prescription of antibiotics, a food of patients, etc.), spend - 1) to an establishment of the definitive diagnosis and at a delay of delivery of the patient to a surgical hospital, 2) at damages of cervical department of a gullet; 3) as addition to surgical treatment. Surgical treatment (radical and palliative) is shown at extensive damages of a gullet, presence of messages of its gleam with , a tree, a pleural cavity.

As A Result Of - Scarring And An

As a result of - scarring and an inflammation the gleam of a gullet in the field of narrowing has the wrong form. Over often is available expansion, arises - strengthened -. At - reveal presence , pockets, - hems. Both methods of research - allow to specify degree, localisation, extent of narrowing, its course, presence expansions-, a pishchevodno-bronchial - fistula. Treatment: the basic - method of treatment a gullet after a - chemical burn - is - which leads to proof - recover 90 - 95 % of patients Unlike early (with 9 - 11th day after a burn) later - spend for the purpose of expansion of already developed - narrowing of a gullet-. Begin - from 7th week. it is shown all patients with a gullet when it is possible to spend a metal conductor through narrowing. Contra-indications to buzhiro-vaniju: , a pishchevodno-bronchial fistula. For - achievement proof effect treatment is necessary for spending within many weeks and even months Apply: 1) "blind" through a mouth, 2) gullet expansion hollow plastic on a metal conductor; 3) under the control , 4) by a principle " endlessly"; 5) .