The Cavity Is Widely Informed With A Gullet

The cavity is widely informed with a gullet gleam. At its mucous cover is inflamed, can be . at the majority of patients settle down - on a lobby or on the right lateral wall of a gullet, have the roundish or slightly extended form. Their diameter more than at , in the field of a neck often is available small narrowing. Even at the big sizes in the delay and decomposition of food weights is seldom marked. The wall has a structure of a wall of a gullet, the muscular cover can be badly expressed or there is no Mucous membrane at the - majority of patients is not changed Unions with the next - bodies usually it is not marked. Clinic and diagnostics: small glotochno-pishchevodnyj it is shown by feeling , in a throat, dry cough, sensation of a foreign matter in a drink, raised , sometimes spastic . In process of - increase filling by its food can be accompanied by gurgling noise at swallowing, to lead to development to different degree of expressiveness, to occurrence on a neck at head assignment back.

Sometimes - For Moving Seed More Dissect -

Sometimes - for moving seed more dissect - internal slanting and cross-section muscles, in a crack place seed in a direction-. Under seed sew muscles so that they densely adjoined to it, but did not squeeze it. Further strengthen a wall in area the channel. Edge of a vagina of a direct muscle together with the connected sinew of internal slanting and cross-section muscles file to to a sheaf. Further the top rag together with internal slanting and cross-section - muscles file to lobkovo-podvzdoshnomu and to to a sheaf-. These seams should remove to a limit seed in the party (if muscles earlier have not been crossed). The bottom rag the external slanting muscle, spent under seed , fix over the top rag -. Again formed " the channel" with seed - should pass through myshechno-aponevrotichesky a layer in a slanting direction behind beforehand and from within so that its internal and external apertures have not appeared opposite each other. Seed stack on and over it - sew hypodermic and a skin.

Lymphatic Vessels Of Cervical Department Of A Gullet

Lymphatic vessels of cervical department of a gullet take away a lymph to and to deep cervical lymph nodes. From chest department of a gullet lymph outflow occurs in , , lymph nodes. For the bottom third of gullet - lymph nodes are lymph nodes, knots in the field of left gastric and arteries the Part of lymphatic vessels of a gullet opens directly in a chest lymphatic channel. These can explain in certain cases earlier occurrence a metastasis, than metastasises in lymph nodes a gullet. Branches of wandering nerves form forward and back textures on a gullet surface. The fibres forming a nervous texture intermuscular and depart from them in a gullet wall. A cervical part of a gullet returnable nerves, chest branches of wandering nerves and a fibre of a sympathetic nerve, bottom branches a nerve. The parasympathetic department of nervous system - carries out regulation of motor function of a gullet and physiological . The role of sympathetic nervous system in gullet physiology definitively is not found out.

The Reasons Of A Sharp Stomach The Following.

The reasons of a sharp stomach the following. 1. Damages of bodies of a belly cavity. 2. Sharp inflammatory diseases of bodies of a belly - cavity, including a peritonitis. 3. Punching of hollow body. 4. Mechanical intestinal impassability. 5. Sharp infringements the arterial and venous - blood circulation, conducting to a heart attack of intestines and a gangrene, accompanied by dynamic intestinal impassability. 6. Internal bleedings in a gleam of a gastroenteric path and in a cavity . 7. Sharp inflammatory processes in uterus appendages, - extra-uterine pregnancy, , legs or tumours , uterus or tumour knot . The basic clinical signs of a sharp stomach: a belly-ache-, an anaemia, a shock (the scheme 1). The following enters into methods of primary research of the patient. The anamnesis: time and the beginning of occurrence of a pain (sudden, - gradual), pain localisation; and the phenomena-; temperature; the diseases of bodies of a belly cavity transferred in the past and operation on stomach bodies Survey: the compelled position of the patient; the anxiety of the patient, changes a pose; , block; dehydration signs (the pointed features, dryness of mucous membranes of an oral cavity); pallor, a jaundice, allocation (vomiting, a chair, blood).

With The Beginning Of Feeding Milk Is Belched

With the beginning of feeding milk is belched and arrives in a mouth . The stenosis can be as a result of a hypertrophy of a muscular - cover, presence in a wall of a gullet fibrous or - rings, formations by a mucous membrane of thin membranes. Small stenoses long time proceed and are shown only at reception of rough food. At the - expressed stenosis it is marked , during time and after meal. Gradually occurs razviti - gullet expansions, food weights are late in it and - are exposed to rotting, there is a putrefactive smell from a mouth. Congenital bronho - fistulas (the section "Inflammatory diseases of a trachea" see). Gullet doubling - rare anomaly. The gleam - can be isolated or to have the message with the basic channel of a gullet. The gleam isolated is filled by a secret allocated their mucous, sometimes they look like , in other cases are informed with a trachea or a bronchial tube. In process of growth symptoms a gullet and respiratory ways develop, at patients develops , there is a cough, a short wind.

Are Most Often Observed Hernias (75 %), Then

Are most often observed hernias (75 %), then femoral (8 %), umbilical (4 %), postoperative (12 %) hernias-, 1 % is made by all other forms of hernias. At men - happen hernias, at women - femoral and umbilical is more often-. In an origin of hernias many factors, as local, and the general matter. Local factors: features of an anatomic structure of area hernias. To them carry the channel through which at men passes seed , the femoral channel through which take place femoral vessels, area of a navel and a white line of a stomach where there are free intervals from muscles. The general factors promoting formation of a hernia, divide on contributing and making. Contributing factors: a heredity, age (a weak belly wall at children of the first year of a life, an atrophy of fabrics of a belly wall at old people), a floor (features of a structure of a basin and the big sizes of a femoral ring at women, the big weakness areas at men), features of a constitution, fatness degree (a fast weight loss), frequent childbirth, a trauma of a belly wall, postoperative hems, a paralysis of nerves, a belly wall.

At The Healthy Person In The Conditions Of

At the healthy person in the conditions of rest within an hour it is allocated about 50 ml of gastric juice. Production of gastric juice in connection with - digestion process - and as a result reactions of an organism to action of harmful factors (mental and physical) increases-. The secretion of gastric juice connected with food intake, conditionally divide into three phases: brain , gastric and intestinal. Ability of gastric juice to damage and digest living tissues - is connected with presence of hydrochloric acid and . In a stomach of the healthy person, aggressive properties kislotno-pepticheskogo the factor of gastric juice are eliminated thanks to neutralised action food, a saliva, the alkaline slime, thrown in a stomach contents, and as a result influences . Protect fabrics of a stomach and a duodenal gut from gastric juice a protective barrier of a mucous membrane, the local fabric resistance, the integrated system of the mechanisms stimulating and braking secretion of hydrochloric acid, a motility of a stomach and a duodenal gut.

It Allows To Differentiate - Disease From Other

It allows to differentiate - disease from other aetiology. And a pain it is possible to stop a heartburn change of position of a body of the patient, food intake, alkaline waters, soda, weak solutions hydrochloric or - organic acids (at in a gullet of pancreatic or alkaline intestinal juice). The frequent complaint is the empty - eructation. Eventually patients have symptoms dis-fagii which are caused in the beginning by functional infringements-, and then the expressed inflammatory hypostasis of a mucous membrane - and development of cicatricial changes in a gullet. Cicatricial - narrowing of a gullet leads to heartburn reduction, the basic - symptoms of disease become , pains, . If disease arises against a stomach ulcer, a hernia apertures of a diaphragm, a cholecystitis, etc. in a - clinical picture symptoms of the basic disease can prevail-. In the absence of timely treatment and disease progressing there can be complications . The Most frequent complication is the bleeding. The latent bleedings find out almost constantly, expressed (with vomiting or -) - is rare.

On The Left Lateral Area Are Projected: Descending

On the left lateral area are projected: descending a gut, a part of loops of a small intestine, the left kidney with . In area are projected, small intestine loops, a bladder, a uterus. H right podvzdoshno-pahovuju area are projected: a blind gut with - a shoot, final department guts, right , the - right appendages of a uterus, right vessels. On left podvzdoshno-pahovuju area are projected: a gut, left , the left appendages of a uterus, left vessels. Projections of bodies of a belly cavity to stomach walls depend on a constitution and vary with the years the patient. RESEARCH METHODS One of the basic symptoms of diseases of bodies of a belly cavity is the belly-ache. Revealing of a kind and a pain origin gives the important instructions on certain diseases. It is necessary to find out: the pain beginning (sudden, gradual), pain development in time (initial and later localisation, , change of intensity and character of a pain), symptoms accompanying a pain (, the phenomena, rise in temperature of a body, change of a pulse rate and - arterial pressure) By origin distinguish pains , somatic and .

Conditionally Allocate Four Stages Of Clinical Displays -

Conditionally allocate four stages of clinical displays - of disease: I stage - sharp (the period sharp -); II stage - a stage chronic (a stage of "imaginary well-being"); III stage - a formation stage with 2 - 3 to 2 - 3 years (organic narrowing - of a gullet); IV stage - a stage of late complications (a gleam obliteration, punching of a wall of a gullet, cancer development). On weight of defeat in a sharp stage allocate three degrees - of a burn of a gullet: easy (first), average weight (second) and heavy (third). The first degree of a burn results from intake of a small amount of caustic substance in small concentration or hot food. Blankets on or a smaller site of a gullet are thus damaged. The second degree of a burn is characterised by more extensive on all depth of a mucous membrane. The third degree of a burn - grasps a mucous membrane-, and muscular layers, extends on and the next bodies. Defeat of a gullet by acid or alkali can - be accompanied by defeat of a stomach, duodenal and initial department of a lean gut with occurrence of sites and - their punching that conducts to peritonitis development in the sharp period-, and also to cicatricial deformations of a stomach subsequently.

Treatment: To The Majority Of Patients With Not

Treatment: to the majority of patients with not complicated - a gullet ulcer spend conservative treatment a diet (a table 1, 1, ""), a fractional food, , enveloping, astringents, preparations, - vitamins, sedative therapy To the period clinical - symptoms and ulcer scarring spend physiotherapeutic treatment. All patient recommend to avoid the positions promoting occurrence zheludochno-pishchevodnogo of a reflux. At an ulcer bleeding spend therapy, coagulation - of a bleeding vessel through At presence a gullet good effect give , in the Spring and recommend carrying out of preventive courses of treatment Surgical treatment it is shown in the absence of effect from conservative therapy, in the presence of disease complications (the punching, not stopping plentiful bleeding, - extended , absence of effect from ), a combination of an ulcer of a gullet to insufficiency , a hernia diaphragm apertures, the congenital or got - short gullet in the autumn--. Make on Nissenu in a combination with selective or at rough anatomic changes a resection of a gullet with .

More Than In 50 % Of Cases The

More than in 50 % of cases the foreign matter freely passes on a gullet and through other departments of a gastroenteric path and leaves a natural - way. Sharp foreign matters (needles, nails, the fish and meat bones, etc.) jam in initial department of a gullet, large subjects are late in places of physiological narrowings of a gullet (at level tracheas, over ). The foreign matter delay in a gullet is promoted by its pathological changes (a tumour, good-quality , , etc.), and also a spasm muscles in reply to irritation of a mucous membrane a foreign matter. Clinic and diagnostics: symptoms depend on character - of a foreign matter, level of its delay in a gullet, a damage rate of a wall of a gullet. Patients have sensation of fear, sensation of constraint, pressure or a sore throat, in area poles or behind a breast. These sensations amplify at a saliva, a liquid. A frequent symptom is which is caused not only a foreign matter, but also development of a spasm of muscles of a gullet and an inflammatory hypostasis of its mucous membrane.

The Violent Reposition Of The Restrained Hernia Made

The violent reposition of the restrained hernia made by the patient, is observed seldom. In medical institutions violent reposition of a hernia is forbidden At violent reposition of the restrained hernia there can be damages of a hernial bag and contents of a hernia up to rupture of a gut and it to development of a peritonitis and an intrabelly bleeding-. The peritonitis, an intrabelly bleeding are indications to emergency operation the operation Purpose - audit of bodies of a belly cavity, a bleeding stop, removal of a source of a peritonitis, a belly cavity (sm "Peritonitis"). At violent reposition the hernial bag can be displaced in space together with the contents restrained in area of a neck of a hernial bag. At a separation in the field of a neck of a hernial bag there can be an immersing of the restrained loop of a gut together with a restraining ring in a belly cavity or in space. Important in due time to distinguish imaginary board of a hernia as at the patient the phenomena of intestinal - impassability and a peritonitis can quickly develop-.

Most Often Happen In Chest Department Of A

Most often happen in chest department of a gullet. Pathological anatomy: glotochno-pishchevodnye develop slowly, drinks are formed in a back wall, is direct over an input in a gullet, more often in the field of a triangle of Lane - Gakkermana where the muscular cover drinks is presented by weak muscular bunches - drinks, is more rare - in the field of a triangle of Lajmepa limited from above m.cricopharyngeus, and from sides - - longitudinal muscular fibres than a wall. The major importance in formation has perstnevidno-pharyngeal muscles (infringement of disclosing - top in reply to swallowing). go down downwards between a back wall of a gullet and a backbone, can be displaced under lateral muscles of a neck. Their size is various, they have a wide mouth. The wall does not contain muscular - fibres, usually not with surrounding fabrics, - its internal surface is covered by a mucous membrane drinks, on it there can be superficial erosion or hems. settle down on a forward or left lateral wall of a gullet is more often, their diameter seldom exceeds 1 - 2 the Bottom see is usually directed upwards and with the - next bodies, the wall has a structure of a wall of a gullet.

At Detection A Blind Gut Make Median And

At detection a blind gut make median and carry out a resection of the right half of thick gut with imposing . Operation finish plastic arts of hernial gate. At bladder walls the resection of a bladder with - imposing is necessary-. In hard cases - also impose . The sixth stage - the restrained epiploon separate sites without formation of the big general . With massive an epiploon probably and occurrence - as a result of this bleeding from vessels of an epiploon of century a belly cavity. The seventh stage - at a choice of a method of a plasticity of hernial gate it is necessary to prefer the most simple. For example, at small slanting hernias at young men it is necessary to apply a way Zhirara - Spasokukotsky - Kimbarovsky, at straight lines and difficult hernias - ways Bassini and Postempsky. At the restrained hernia complicated by a phlegmon of a hernial bag, operation should be begun with median (the first stage) for danger reduction a belly cavity contents of a hernial bag. During time make a resection of a gut within viable fabrics.

Occasionally Develops - A Cancer. From Other Malignant

Occasionally develops - a cancer. From other malignant tumours - of a gullet it is necessary to note , consisting of ferruterous both elements, and (a cancer and sarcoma combination). The international classification of a cancer of a gullet provides the - tumour characteristic on system TNM. - a primary tumour TIs - . THAT - is not present display of a primary tumour. 1 - The tumour involves less than 5 sm of length of a gullet, without causing gleam narrowing. There is no circular defeat of walls of a gullet. Vnepishchevodnogo - distribution of a tumour is not present. 2 - A tumour more than 5 sm on length of a gullet. The tumour of any size - causing narrowing of a gullet. A tumour extending on all walls - of a gullet. Vnepishchevodnogo distribution of a tumour is not present. - the tumour extends on the next structures. N - lymph nodes NO - lymph nodes are not palpated. N1 - Mobile lymph nodes on the defeat party. N1a - The increased lymph nodes do not contain metastasises. N1b - The increased lymph nodes contain metastasises.

A Cancer Of This Localisation Treat By Means

A cancer of this localisation treat by means of beam therapy more successfully. At a cancer gullet department make operation - of Dobromyslova-Tereka. From access - delete chest department of a gullet and impose . Subsequently (later 3 - 6 ) create an artificial gullet from thick or a small intestine. At strong young men probably performance of a resection of a gullet with imposing between the rest of a gullet and the stomach moved to the right pleural cavity (Lewis's operation). At a cancer department of a gullet choice operation is the resection of a gullet with one-stage imposing intrachest pishchevodno-gastric under an arch of an aorta or at its level. Good results from the combined beam and surgical treatment are received. Preoperative beam therapy spend on a beta throne or in a dose 30 - 50 Gr (3000 - 5000 it is glad). Influencing the basic centre of defeat and the possible centres , beam therapy allows to translate a tumour from doubtful in , to eliminate accompanying inflammatory changes.

The Ends A Gut Site Take In. Between

The ends a gut site take in. Between resulting and taking away loops impose the end in the end or a side sideways At this stage of operation - cavity isolation from a cavity of a hernial bag can be carried out-. With that end in view round a mouth of a hernial bag dissect - and it in the parties on 1,5 - 2 see Resulting and taking away loops guts near to hernial gate stitch two numbers of mechanical seams (or tie up two ). Then between seams cross loops guts and delete them together with their part Over the blind ends of the restrained - gut which are in a hernial bag, sew - . Edges sew. Thus the cavity is isolated from a cavity of a hernial bag. A wound of a belly wall take in tightly. The second stage - surgical processing of the purulent centre (a - hernial phlegmon). Radical surgical processing of the purulent centre - consists in impractical, , - fabrics. , sharp skin - its harbingers of the subsequent . An authentic sign of viability of fabrics is the plentiful capillary - bleeding.

Hernial Is In Close Contact To A Sciatic

Hernial is in close contact to a sciatic nerve, therefore pains can on a nerve course. Sciatic hernias are more often observed at women in connection with in the width of a female basin. The small intestine, the big epiploon can be hernia contents. Treatment: the surgical. COMPLICATIONS OF EXTERNAL HERNIAS OF THE STOMACH Complications of external hernias of a stomach: infringement, , not-vpravimost, an inflammation. The infringement of a hernia is the most frequent and dangerous complication - of a hernia demanding immediate surgical treatment. The bodies which have left in a hernial bag are exposed more often at level of a neck of a hernial bag in hernial collars. Infringement of bodies in the most hernial bag probably in one of chambers of a hernial bag, in the presence of cicatricial , - squeezing bodies at unions of bodies with each other and with a hernial - bag (at hernias). The infringement of a hernia arises more often at people of middle age and at old people. Femoral hernias are restrained in 5 times more often, than and umbilical.

The - Hernial Bag Is Formed By Means

The - hernial bag is formed by means of a stretching and progressing - . Clinic and diagnostics: the Basic symptoms - of disease are a pain in the field of a hernia and in a stomach, presence in one of hernial zones. appears at or in vertical position of the patient, - disappears or decreases in horizontal position after manual reposition. The pain in the field of hernial arises at - physical activity, walking, sharp movements, at changes - of barometric pressure. Quite often there is a nausea, an eructation, a stomach swelling, locks. Hernia development occurs, as a rule, slowly. In the beginning in a place of a formed hernia there is a pricking pain at physical activity, walking, run, weight lifting. After a while appears which disappears in horizontal position of the patient and again arises at - physical activity. gradually increases, - gets the roundish or oval form. At the hernias which have sharply arisen - at the moment of sharp increase of intrabelly pressure, patients feel a severe pain in the field of a formed hernia, sudden occurrence a belly wall and a hemorrhage - in surrounding fabrics.

Treatment: In Connection With Infringement Possibility At -

Treatment: in connection with infringement possibility at - operation is shown a hernia. At right-hand localisation of a hernia operation make through access to the fourth , at hernias the best - access - top median , at link sided hernias it is shown access to the seventh - the eighth -. After division of unions, clearings of edges of defect in a diaphragm reduce the moved bodies in a belly cavity and take in defect separate central seams with formation . At the big sizes of defect resort to alloplasti-cheskomu to replacement of a diaphragm by artificial limbs from kapron, nylon, teflon, lavsan, etc. At hernias (a hernia of Larreja, a hernia) reduce the moved bodies, turn out and cut at a neck a hernial bag, impose and consistently fasten P-shaped seams on edges of defect of a diaphragm and a back leaf of a vagina of belly muscles, a breast and edges. At hernias of pojasnichno-costal space defect - of a diaphragm take in separate seams with - formation . At restrained hernias access -.

The Distalnyj Site Of A Gullet Is Sharply

The distalnyj site of a gullet is sharply narrowed, in it find out a dystrophy cages and fibres nervous textures up to their �destruction. In a - muscular layer observe a dystrophy of muscular fibres, growth of a connecting fabric, especially in a wall of the narrowed segment, - , expansion of vessels, occurrence round them - from and plasmatic cages. In all layers walls and in surrounding fabrics find out signs - of inflammatory process. A gullet mucous membrane , , places . - Changes near to the narrowed site of a gullet are More expressed-. Clinic and diagnostics: for the - triad of symptoms is characteristic: , , pains. - the basic and in most cases the first symptom of disease-. At one patients it arises suddenly, as though among full health, at others develops gradually. Strengthening at the majority of patients mark after nervous excitation-, during hasty meal, at reception of the dense, dry and badly chewed food. It is sometimes observed paradoxical -: the dense food passes in a stomach better, than liquid and semi-fluid.

Long Inflammatory Process Can Lead To Cicatricial Changes

Long inflammatory process can lead to cicatricial changes in a gullet, its shortening and development or progressing of a hernia to food of a water aperture - of a diaphragm. Gullet punching at usually does not happen. The diagnosis establish at presence at sick characteristic symptoms of disease, the data - of radiological research - and . Radiological - research allows - to find out zheludochno-pishchevodnyj a reflux, especially - at research of patients - and a prone position, . (a smoothness, or deformation of folds of a mucous membrane, local or a thickening the walls, insufficient elasticity of a wall of the amazed - site, narrowing of a gleam of a gullet, etc.) At - mark various degree and prevalence - inflammatory changes of a mucous membrane of a gullet: 0 stage _ a - normal mucous membrane; I stage - not merging defects of a mucous membrane; II stage - merging, but not circular defects, III stage - circular ' that cover; IV stage - complications illnesses (ulcers, , a short gullet, ' ).

After A Section Of A Restraining Ring Investigate

After a section of a restraining ring investigate - contents of a hernial bag. At viability preservation the dropped out - body set in a belly cavity, at irreversible - changes - . Defect in a diaphragm take in. HERNIAS OF THE APERTURE OF THE DIAPHRAGM Hernias can be congenital and got. Allocate sliding (axial) and hernias - diaphragm apertures. Sliding hernias. The kardialnyj department of a stomach located -, moves above a diaphragm on an axis of a gullet and takes part in formation of a wall of a hernial bag. Sliding hernias on classification. V.Petrovskogo and . N.Kanshina subdivide on , , and huge (subtotal and total - gastric) at which occurs a stomach in a chest - cavity. The sliding hernia can be fixed and - unstable. Besides, allocate the got short gullet ( I degree is located over a diaphragm at level of 4 sm, above 4 sm - II degree) and a congenital short gullet (a chest stomach). On to the factor sliding hernias can be , and mixed. The major importance - in development of the got sliding hernias diaphragm apertures has the mechanism arising at reduction of longitudinal muscles of a gullet as a result of reflexes from a stomach and other bodies at a stomach ulcer, a cholecystitis and other diseases.

At Research Mark Tone Decrease , Infringement -

At research mark tone decrease , infringement - a type gullet , zheludochno-pishchevodnyj a - reflux which also can be confirmed by the data rN-metrii (decrease to 4,0 and more low) (a sm technique in section "Special methods of research"). Treatment: paramount action is treatment of the basic disease creating conditions for zheludochno-pishchevodnogo of a reflux (a hernia diaphragm apertures, pi-loroduodenalnyj a stenosis, ). Conservative treatment is directed on reflux decrease, reduction of displays -, the prevention of increase of intrabelly pressure. The patient - recommend to avoid the positions of a body facilitating occurrence - of a reflux, to sleep with highly raised headboard of a bed. Depending on degree appoint mechanically and chemically sparing diet (table No 1, 16, 1 on Pevzneru). A food should be frequent (4 - 6 times a day), last food intake for 3 - 4 to a dream. Appoint , enveloping-, astringents, , , preparations, sedative, means, vitamins. At bleedings and spend therapy, at stenoses - .

However At The Majority Of Patients Of A

However at the majority of patients of a pain arise at overflow of a gullet and disappear after or passages - of food to a stomach. Some patients have attacks spontaneous support a breast as painful crises Similar pains observe in a disease initial stage, sometimes in addition before development and which not always - act in film atropine or nitroglycerine is more often - that allows to assume - their communication with progressing dystrophic process in a nervous texture of a gullet. Pains on an empty stomach or after vomiting are is more often caused and act in film food intake. An eructation air, the nausea, the raised salivation, burning on the gullet course, an unpleasant smell from a mouth also - are caused . At patients both with sharp, and with the gradual beginning of disease - in due course symptoms progress: amplifies , arises is more often. Many patients hesitate of the lack, become closed, painfully sensitive. The - most frequent complication of disease is stagnant which arises at a long delay of food weights in a gullet.

Distinctive Signs From Infringements Are Resulted In 6.

Distinctive signs from infringements are resulted in 6. Treatment: clearing of a thick gut of contents. At hernias it is necessary to try to keep a hernia in the set condition then it is easier to achieve restoration intestines. Apply small enemas with a - hypertensive solution of chloride of sodium, with glycerine or repeated siphon enemas with deeply entered probe to guts. Application of a depletive as overflow of a resulting loop by contents can cause transition in the form of infringement of a hernia is counter-indicative. can owing to in hernial collars of a taking away loop to pass in the form of infringement of a hernia. Signs intestinal impassability accrue. The belly-ache amplifies, gets character, vomiting becomes frequent. Further owing to overflow in weights of the gut which are in a hernial bag, occurs hernial collars of all loop of a gut and it . There is a mixed form of infringement of a gut. From this point on there are signs - impassability of intestines. The infringement of the big epiploon causes a constant pain in the field of hernial .

Owing To Mucous Membrane Damage The Intestinal Wall

Owing to mucous membrane damage the intestinal wall becomes nontight for microbes that conducts to peritonitis development. There can be a punching of a resulting loop in area furrows. In a taking away loop of the restrained gut of infringement krovo arise throughout 10 - 15 see Kinds of infringements of hernias and their recognition Clinical displays of infringement of a hernia depend on the form of the infringement, the restrained body, time last from the moment of infringement by the Basic symptoms of infringement of a hernia are a pain in the field of a hernia and a hernia which were earlier freely set. Intensity of a pain the various. The sharp pain can cause a faint, a state of shock Local signs of infringement of a hernia, hernial is sharply painful at , dense, strained. a push it is not possible to reveal a symptom. At it is defined if the hernial bag contains an epiploon a bladder, "hernial water". The perkutornyj sound happens if in a hernial bag there is a gut containing gas.

Early Reception Of Mixture And Food As Though

Early reception of mixture and food as though carries out "soft" a gullet. Formation of hems is interfered also by appointment (, , etc.) Which detain development and reduce inflammatory changes in a gullet. Now carrying out early (with 9 - 11th day) a gullet during 1 - 1 1/2 in a combination to hypodermic introduction or during 2 is recognised expedient. Too early, before this term begun gives opposite effect, causing an aggravation of inflammatory process in a gullet and scarring strengthening. Before the beginning it is necessary to make - which will allow to establish burn degree, absence fabrics. a gullet it is unsafe and can become complicated its punching with development purulent and a pleurisy, therefore he should be spent carefully. Hyperbaric oxygenation is applied to preventive maintenance of cicatricial stenoses of a gullet which reduces depth of a zone , delimits , promotes clarification to a surface and causes it by the end of 1st month. suppresses formation of a connecting fabric that leads to development more friable, thin and a gullet hem.

RARE SPECIES OF HERNIAS OF THE STOMACH Hernias

RARE SPECIES OF HERNIAS OF THE STOMACH Hernias a shoot are formed in the presence of defects in it. Through crevices and apertures in a shoot can be stuck out as , and the Diagnosis it is possible to put true hernias on the basis of the found out consolidation in area a shoot, defect presence in a shoot and the data a shoot. Treatment: the surgical Delete a hernial bag and a shoot of the Hernia semilunar lines are localised on a line connecting a navel with top forward of the bone at a place of transition of muscular fibres of internal slanting and cross-section muscles of a stomach in a stretching. Treatment: the surgical. At small hernias hernial gate close - by suture; at the big hernias after sewing together of muscles it is necessary to create . Lumbar hernias. Weak zones of lumbar area are the triangle - of Peti and an interval of Lesgafta - Grjunfelda. The triangle of Peti is formed by lateral - edge of a wide muscle of a back, back edge of an external slanting muscle of a stomach the triangle basis the comb bones is.

In Cases Heavy A Reflux-ezofagita Make Or Transpleural

In cases heavy a reflux-ezofagita make or transpleural with a stomach in a chest cavity. Congenital insufficiency treat conservatively. Usually eventually there comes function normalisation . GULLET DAMAGES Gullet damages divide on internal (closed) from outside a mucous membrane and the external - necks (opened) at - getting wounds and a thorax. Internal damages of a gullet are possible during - carrying out of diagnostic and medical actions: at -, a gullet, . There are gullet wounds from within at hit in it of foreign matters (see "Gullet foreign matters"). gullet walls arise at a long finding in it of probes, from pressure or tubes. Punching of a wall of a gullet can occur at its various diseases: tumours, an ulcer, chemical burns. At an irradiation of malignant tumours of damage of a gullet arise owing to tumour disintegration. Stupid traumas of a neck, thorax and stomach can lead to infringement of a food and walls of a gullet as a result of its squeezing between a breast and bodies of vertebras Thus often mark damage of the next bodies the Straight line to a gullet trauma can occur during operations on bodies and lungs.

Bottom Possesses "unilateral - Passableness". Pressure Suffices For

Bottom possesses "unilateral - passableness". Pressure suffices For advancement of a contained gullet through penalties-diju in 4 mm hg, in a return direction movement is possible only at increase of pressure to 80 mm hg In norm pressure in the field of physiological above, than in a gullet and a bottom of a stomach, and is equal on the average 22 - 28 mm hg It are caused by the tonic reduction of circular muscular - fibres interfering zheludochno-pishchevodnomu a reflux. The - greatest value has a part physiological - which interferes with a reflux at a considerable difference of pressure in a chest and belly cavity. The normal anatomic arrangement of a gullet in relation to a diaphragm is very important for correct functioning of the closing mechanism physiological . Hit gastric - contained in a gullet is interfered also presence of "the mucous socket" in the field of pishchevodno-gastric , by an acute angle of Gisa, presence of the valve of Gubarev - folds of a mucous membrane at a junction of a gullet with a stomach, a switching reflex on at irritation of a mucous membrane department of a stomach food, etc.

At Disintegration And Knots The Macroscopical Picture Differs

At disintegration and knots the macroscopical picture differs from a picture of an ulcer cancer a little. The ulcer type of a cancer of a gullet meets approximately at 30 % of patients. In an initial stage of disease represents a small knot in thickness of a mucous membrane which quickly is exposed . The tumour grows mainly along a gullet, amazing all layers of its wall and extending on surrounding bodies and fabrics. Edges of the formed ulcer dense, the bottom is pruinose is dirty-grayish colour. Tumour early in and the remote lymph nodes. In a wall of a gullet throughout 5 - 6 sm from tumour edge often develop cancer . The infiltrativnaja form of a cancer of a gullet makes about 10 %. The tumour develops in deep layers of a mucous membrane, quickly amazes a layer and extends mainly on a gullet circle. Expanding, the tumour grasps all layers of a wall of a gullet, its gleam. On length the tumour seldom occupies more than 3 - 4 sm, is characterised by plentiful development -, slowly .

At A Congenital Short Gullet And Insufficiency There

At a congenital short gullet and insufficiency there is a reflux-ezofagit, the ulcer, and then a gullet develops , - frequent complication is the pneumonia. The diagnosis congenital anomaly of development of a gullet - establish by means of radiological research at which into a gullet gleam on thin enter 1 - 2 ml . Research allows to find out the blind end - of a gullet, level of its arrangement, extent and narrowing size, gullet expansion, presence - of the message of a gleam of a gullet with bronchial tubes or a trachea. At gullet doubling mark an additional shade with the accurate contours, adjoining a shade and pushing aside a gullet. At a short gullet it has no bends, and the stomach part is located - above a diaphragm. Insufficiency is shown zheludochno-pishchevodnym by a reflux of contrast substance during research. The big role in diagnostics of developmental anomalies - of a gullet play ezofago - and . Treatment: features of surgical treatment a - gullet are defined by its kind.

Apply : Allocate From Surrounding Fabrics To A

Apply : allocate from surrounding fabrics to a neck, make , it and take in an aperture in a gullet wall. At considerable muscular defect or an atrophy - of muscular fibres of a gullet make plastic restoration of its wall by a rag of a diaphragm, a pleura. apply only at the small sizes . after operation makes 1 - 1,5 %. GOOD-QUALITY TUMOURS AND THE GULLET Good-quality tumours of a gullet and are observed seldom. Pathological anatomy: tumours in relation to a gullet wall can be and . On a histologic - structure of a tumour divide on ( - polyps, papillomas) and (, , fibromas, , , , , , etc.). Vnutriprosvetnye tumours settle down more often in or gullet department, - in - its bottom two thirds. From good-quality tumours - of a gullet the most frequent kind is , - developing of smooth muscular fibres. The place second for frequency among good-quality - gullet formations occupy (, , ). represent the thin-walled - formations containing a light viscous liquid. The wall consists of a fibrous fabric with an impurity of smooth muscular fibres and a cartilage.

At A Thrombosis Of Venous Knot The Big

At a thrombosis of venous knot the big hypodermic vein tie up and cross at a place of its confluence of a deep vein of a hip to warn and thrombosis distribution on a deep vein of a hip. A trombirovannuju vein . Sudden infringement of earlier not coming to light hernias. On a belly - wall in typical for formation of hernias sites can remain after a birth (predsushche-stvujushchie hernial bags). More often such preprepared hernial bag in areas is brjushinno-pahovyj a shoot the Reason of sudden occurrence of a hernia and its infringement sharp increase of intrabelly pressure (- considerable physical pressure, strong cough, ) is-. In the anamnesis patients do not have instructions on signs before - existing hernias: , painful sensations in the places typical for localisation of hernias. The basic sign of suddenly arisen restrained hernias - acute pain occurrence in typical places hernias. At sudden occurrence of an acute pain in areas, in the field of the femoral channel, in a navel it is necessary - to define at inspection - of the patient at the most painful sites corresponding to hernial collars.

Small Hernias With The Narrow And Rubtsovo-changed Neck

Small hernias with the narrow and rubtsovo-changed neck of a hernial bag are restrained more often, than the big hernias. The infringement is not destiny only a hernia long existing. The hernia at occurrence can prove infringement at once. Frequency of separate kinds of hernias at adult patients with the restrained hernias: hernias - 43,5 %, postoperative hernias - 19,2 %, umbilical hernias - 16,9 %, femoral hernias - 16 %, hernias of a white line of a stomach - 4,4 %. Any body can be restrained, the small intestine and the big epiploon are more often restrained. On the occurrence mechanism distinguish , and mixed, or combined, infringement. The Elastichesky infringement occurs at the moment of sudden - increase of intrabelly pressure at physical activity, cough, , etc. Thus there comes a restretching of hernial gate therefore in a hernial bag leaves more than usually an internal. Returning of hernial gate in a former condition leads to infringement of contents of a hernia. At infringement the left.

Among Other Symptoms Gullet Narrowings Are Often Observed

Among other symptoms gullet narrowings are often observed pains of a breast at the food intake, raised , an eructation, a heartburn. As a result of food infringement the exhaustion of patients progresses. To one of the most frequent complications of cicatricial narrowing of a gullet is a gullet food at which ( urgent medical aid is necessary for extraction of a food lump). - Owing to food and it chronic inflammatory diseases of bronchial tubes and lungs often develop - in respiratory ways. - As a result of longitudinal cicatricial shortening of a gullet probably formation or hernia increase diaphragm apertures. Development of a cancer tumour in area is possible. At patients with stenoses more often, than at healthy people, punching of a gullet is observed during tool researches. The diagnosis of a stenosis of a gullet is confirmed with the data of the anamnesis and radiological research with liquid and dense contrast - substance. Gullet narrowings have the form, the relief of a mucous membrane in the field of narrowing is absent, is not defined.

Borders Of A Femoral Ring: From Above -

Borders of a femoral ring: from above - a sheaf; from below - a comb bones; outside - a femoral vein; to the middle - a sheaf. In normal conditions of the femoral channel does not exist. It is formed at formation of a femoral hernia. The oval pole on wide hips is an external aperture of the femoral channel. The most frequent form of a hernia is the hernia leaving a belly cavity through a femoral ring. The hernial bag advances ahead of itself and a lymph node of Pirogova - Rozenmjullera. Leaving from under sheaves, the hernia settles down in an oval pole from a femoral vein. The hernial bag is covered here fatty , superficial and a skin. Less often the femoral hernia leaves between a femoral artery and a vein. Hernias of a vascular lacuna can be identified only during operation. Sometimes the - hernia leaves through defect sheaves. Occasionally observe hernias of a muscular lacuna, usually in a zone of passage of a femoral nerve. This hernia owing to its characteristic arrangement a vascular bunch can be distinguished before operation.

At Germination By A Tumour Of Returnable Nerves

At germination by a tumour of returnable nerves at patients hoarseness of a voice, defeat of knots - of a sympathetic nerve develops-, the syndrome of Gornera is shown. a wandering - nerve can cause a bradycardia, fits of coughing, vomiting-. Germination by a tumour a nerve is accompanied - by a diaphragm paralysis on the corresponding party, and a humeral - texture - a pain, , and then a paralysis of the top finiteness. Transition of a tumour to a throat is accompanied by change - of sounding of a voice, occurrence of a short wind and breath. At (germination) of a trachea and bronchial tubes there is a cough, a short wind (at 7,2 %). Formation pishchevodno-trahealnogo or a pishchevodno-bronchial fistula is shown by cough at - liquid reception-. This complication usually comes to an end with development of a pneumonia, an abscess or a lung gangrene. Owing to transition of an infection from a gullet can develop , , -. At destruction by a tumour of a wall of a large vessel there are massive bleedings.

For A Cancer Progressing Increase Of Impassability Of

For a cancer progressing increase of impassability of a gullet which at one patients develops quickly, at others - slowly (during 1 1/2 - 2 years) is characteristic. Infringement of passableness of a gullet is connected not only with narrowing of its gleam by a tumour, but can be caused development pe-rifokalnogo inflammations, occurrence of a spasm of a gullet at defeat by a tumour nervous textures. More often the spastic phenomena mark at tumours. In a - disease initial stage arises at proglaty-vanii the dense or not enough chewed food. Patients feel as though its "sticking" to a wall of a gullet or a time - delay at certain level. The water drink usually eliminates - these phenomena. Even well chewed food further ceases to pass, and patients are compelled to accept semi-fluid - and liquid food, becomes a constant and arises even at the liquid use. Sometimes after the proof period there is an improvement of passableness of food on a gullet, connected with tumour disintegration. To occurrence can precede appearing at firm food of sensation of a foreign matter in a - gullet, feeling "" behind a breast, morbidity at defeat level.

Edges Of Hernial Gate Firm Owing To Development

Edges of hernial gate firm owing to development of a dense cicatricial fabric. External covers of a postoperative hernia are presented by a cicatricial fabric, is intimate with a hernial bag, or a skin with hypodermic and a postoperative hem in the middle. - Muscles adjoining - to hernial collars can also - be changed-. The hernial bag quite often happens multichamber, and a hernia . Recognition of postoperative hernias does not represent - difficulties. Detection in a postoperative hem hernial , appearing at , cough, is sufficient for diagnosis statement. For definition of the body which is in a hernial bag, make radiological research of a gastroenteric path. Treatment: the surgical. At the big hernias operation presents difficulties because of unions of contents of a hernia with a - hernial bag and presence of major defects of a belly wall. At small hernias probably closing of defect at the expense of soft fabrics. During operations concerning the big postoperative - hernias apply methods , and methods of the combined plasticity of defects of a belly wall.

It Is Necessary To Exclude Also A Gullet

It is necessary to exclude also a gullet pushing off from the outside tumours - back , an intrachest craw, the aortas, the increased lymph nodes, filled . The important radiological sign a gullet - is its displacement Even substantial growth of the next bodies - long time does not cause as smeshchae-most a gullet in friable connecting it is great enough. and infringement of passableness of a gullet can be caused (cicatricial change - ), arising after inflammatory - diseases of lungs and lymph nodes . In the anamnesis these patients have instructions on sharp and chronic diseases - of lungs, causeless rises in temperature of a body. at them develops quickly. At radiological research - contours of the narrowed site of a gullet equal, are more rare - wavy-, the mucous membrane relief is kept, the gullet wall at swallowing and breath is not displaced, round a gullet the shade condensed is visible. At a gullet tuberculosis a clinical and radiological picture of disease can have a strong likeness with displays of a cancer of a gullet.

Clinic And Diagnostics: The Most Frequent Complaint Is

Clinic and diagnostics: the most frequent complaint is the heartburn or sensation of burning in areas, behind a breast or on a course of all gullet; after a heartburn there is a - pain. Symptoms arise or amplify at a trunk inclination forward (a symptom " a boot"), are caused by influence on the inflamed mucous membrane of a gullet - of gastric or intestinal juice with bile. Attacks of pains can be connected with strong spastic reductions of a gullet that confirms radiological and ezofagoto-nokimograficheskoe research. Pains can in a back-, between shovels, in a neck, jaws, upwards on a gullet, in the left half of thorax. It is almost always marked . At at night can occur - food weights and gastric juice in respiratory ways that causes strong cough. Disease is connected with insufficiency of the switching mechanism physiological and consequently the conditions promoting return receipt of contents from a stomach in a gullet (a prone position, a trunk inclination forward), cause occurrence of the basic symptoms.

Survey Of The Patient In Vertical Position Gives

Survey of the patient in vertical position gives representation - about asymmetry areas. At presence a belly wall it is possible to define the sizes and the hernia form At define a surface, a consistence hernial -, intestines rumbling, at - a sound (, ). Manual research external from the channel make in horizontal position of the patient after reposition of a contained hernial bag. The doctor a forefinger, a skin , gets to a superficial aperture the channel, . inside and a little above from In norm the superficial aperture the channel at men passes a finger-tip. At easing of a back wall the channel it is possible to get freely a finger-tip for a horizontal branch bones that it is not possible to make at well expressed back wall formed cross-section of a stomach. Being in the channel the finger of the doctor at a tussiculation of the patient feels - transfer pushes of an internal - a symptom a push. Both investigate the channel. It is necessary to investigate bodies ( seed , and its appendage).

Characteristic Changes For A Tuberculosis In Lungs Can

Characteristic changes for a tuberculosis in lungs can be absent. The definitive diagnosis is possible only after - with . Treatment: the choice of a method of treatment of a cancer of a gullet depends on level of localisation of a tumour, a stage of process, presence of accompanying - diseases Good results of surgical treatment it is possible to expect in I stage of disease, is more rare in II and III stages. However a gullet cancer seldom diagnose early, the majority of patients address for the help after half a year after occurrence of the first symptoms of disease Inoperable patients happen for two reasons: 1) - germination by a tumour of the next bodies - aortas, tracheas, a lung, in lymph nodes of the second, third order and other bodies (a liver, lungs); possibility of removal of a tumour at the majority of patients becomes definitively clear - only during operation; 2) presence of accompanying diseases of heart, lungs, kidneys, a liver and other bodies in a stage . At a cancer cervical and departments of a gullet the tumour quickly sprouts surrounding bodies and early gives metastasises.

The Pain Results From Short-term - Partial Infringement

The pain results from short-term - partial infringement of contents of a hernia in narrow, an - internal aperture of the femoral channel. . quite often is the first clinical expression of such hernias. Characteristic clinical signs of a full femoral hernia - are hernial in area bedrenno-pahovogo a bend in the form of hemispherical formation of the small size, located under a sheaf from femoral vessels. Seldom hernial rises up and - settles down over a sheaf. Appears hernial - at vertical position of a body, , at reposition disappears, sometimes with rumbling. a sound over - a hernia sign in which there is a gut containing gas. A hernia sign is also the symptom - a push which happens positive even at the initial form of a hernia. At sliding hernias of a bladder can be the phenomena. The differential diagnosis: spend more often between - femoral and a hernia. At to a hernia well probed to a sheaf, especially men at whom the external aperture the channel is easily palpated, - do not have difficulties at carrying out of the differential diagnosis between femoral and a hernia.

Symptoms: Gradually Increasing In Sizes - In The

Symptoms: gradually increasing in sizes - in the field of a navel, a belly-ache arising at - physical activity and cough. At research find out roundish - in the field of a navel in diameter from 1 - 3 sm to 30 sm and more. At the big hernias the sizes of hernial gate can be considerable the smaller sizes, than itself the belly - wall, caused by a hernia. It creates anatomic preconditions for development of such complications, as chronic impassability of intestines, , infringement. In a horizontal position of the patient decreases in sizes or disappears. Through a skin covering , it is possible to notice intestines waves. At hernias define edges and size of hernial gate. At a tussiculation it is accurately defined a push. Umbilical - hernias often happen , at the big hernias the hernial bag can be multichamber. Diagnostics of umbilical - hernias is simple, however it is necessary to mean that small consolidation in the field of a navel can appear ^ a stomach in a navel. All patients with umbilical hernias should - conduct radiological research of a stomach and a duodenal - gut or for the purpose of revealing - of the diseases accompanying a hernia and causing a pain in the top half of a stomach.

At This Time Intestinal Loops Being In A

At this time intestinal loops being in a hernial bag, can be still viable. Before operation it is impossible to establish the diagnosis During operation the surgeon, having found out in a hernial bag two intestinal loops, should to deduce after a section of a restraining ring from a belly cavity a binding intestinal loop and to define character of the arisen changes in all restrained intestinal loop. If during operation it is not distinguished infringement as the surgeon has not examined a binding intestinal loop being in a belly cavity at the patient the peritonitis will develop. The binding loop of a gut will be a peritonitis source . The pristenochnoe infringement occurs in a narrow restraining ring when the part of an intestinal wall opposite to an attachment line is restrained only. It is observed infringement of a small intestine more often in femoral and hernias is more rare in the umbilical. Frustration and in the restrained site of a gut leads to development of destructive changes to and gut punching.

Through A Mouth It Is Blindly Shown At

through a mouth it is blindly shown at small on extent verhne - and gullet departments. Treatment spend by means of a special set . If passes easily, spend the following on a thickness of number. The technique has been improved at application - of metal conductors and hollow -. They give the chance the radiological control for course definition and advancements on a gullet that raises efficiency of procedure and reduces danger of punching of a gullet. under the control it is shown at located , the channel of narrowing expressed expansion when there are difficulties at conductor carrying out. "Buzhirovanie endlessly" apply at presence at patients with tubular, or plural -. To the silk thread entered through a mouth and deduced through , attach rubber tubes of various diameter. Stretching, them spend through the narrowed site and leave at some o'clock. through it is more safely and easier transferred by patients At some patients mechanical expansion cicatricial a gullet can lead to formation .

The Long Anamnesis Of Disease Is More Characteristic

The long anamnesis of disease is more characteristic for , than for a cancer. At a cancer the first symptom usually is , the pain joins later at germination by a tumour of a wall of a gullet and nervous trunks. At the first symptom - quite often is the pain, arises later. at a cancer unlike always has steadily progressing character. For a cancer it is not peculiar plentiful and night . At appetite at the majority - of patients happens is kept, seldom comes considerable on-hudanie. At radiological research of a gullet at a cancer mark narrowings, roughness of its contours, destruction of a relief of a mucous membrane, its walls, there is no considerable expansion and a S-shaped curvature of a gullet, there are no expressed infringements , the gas bubble of a stomach is kept. Crucial importance for diagnosis statement has with aim for - histologic and cytologic research of the received - material. At good-quality tumours of a gullet radiological research reveals roundish defect of filling with equal contours.

A Protective Barrier Of A Mucous Membrane: 1)

a protective barrier of a mucous membrane: 1) " a barrier", covering ; 2) the first line of protection - membranes of cages, 3) the second line of protection - a membrane mucous. The mechanisms stimulating secretion of hydrochloric acid: , , products of digested food, . - parasympathetic nervous system it is liberated in a stomach wall in the answer as on stimulation of wandering nerves (in a brain - phase of gastric secretion), and on local stimulation nervous textures at a food finding in a stomach (in a gastric phase of secretion) Acetyl-holin is an average on force a stimulator of production of hydrochloric acid and the strong - activator of liberation from G-cages. - the hormone, is allocated from G-cages department of a stomach and the top department of a small intestine, stimulates secretion of hydrochloric acid with cages and their sensitivity to parasympathetic and other stimulation. Clearing from G-cages parasympathetic stimulation, albuminous food, cause, amino acids, calcium, a mechanical stretching of a stomach, alkaline value in department.

To Birthday Of The Child Are In ,

To birthday of the child are in , the shoot grows. At brjushinno-pahovogo a shoot the hernia is formed congenital . In case of incomplete brjushinno-pahovogo a shoot on its separate sites arise a kisty-dropsy seed . The brjushinno-pahovyj shoot covering , forms own a cover . - Cross-section a stomach forms the general a cover for and seed . Internal slanting and cross-section muscles participate in about a muscle lifting Anatomy areas. At survey of a forward belly wall from within from outside the belly cavity can see five folds - and the deepenings (pole) which are places of hernias - External a pole is an internal aperture the channel, it is projected approximately over the middle sheaves on 1-1,5 sm above it. In norm the channel represents the space filled at men seed and at women - round a sheaf of Pahovyj the channel passes obliquely at an angle to to a sheaf and has length at men nearby 4-4,5 see Walls the channel a lobby - an external slanting muscle of a stomach, bottom a sheaf, back - cross-section a stomach, top - free edge of internal slanting and cross-section muscles of a stomach.

For The Prevention In A Belly Cavity Of

For the prevention in a belly cavity of the restrained bodies the assistant to the surgeon keeps them by means of a gauze napkin. The section of a restraining ring before opening of a hernial bag as the uninspected restrained bodies will move to a belly cavity together with infected with "hernial water" is inadmissible. The third stage - a section of a restraining ring make under the sight control not to damage the bodies soldered to it from within. At femoral hernias a cut spend medially from a neck of a hernial bag in order to avoid damage of the femoral vein located at of the party of a bag. At umbilical hernias restraining ring dissect in a cross-section direction in both parties. The fourth stage - definition of viability of the restrained bodies is the most responsible stage of operation After a section of a restraining ring and introduction in solution guts from a belly cavity deduce those parts of the restrained bodies which were above a restraining ring It is impossible to tighten strongly a gut as there can be a - rupture its (separation) in area furrows.

Hernias Dvenadtsatiperstno-toshchekishechnoj Poles. In - The Period Of

Hernias dvenadtsatiperstno-toshchekishechnoj poles. In - the period of development as a result of turn of an umbilical loop round an axis top arteries is formed dvenadtsatiperstno-toshekishechnaja a pole (recessus duodenojejunalis - a pole of Trejttsa). This pole can become hernial collars with formation - of the internal restrained hernia. Hernias poles (recessus retroduodenalis) name hernias. Small intestine loops get between plates guts to the right or to the left. To thicket hernial collars of internal hernias are pockets in the field of a blind gut (recessus ileocecalis superior et interior, recessus retrocecalis) or guts (recessus intersigmoideus). Damages - during operations on bodies of a belly cavity can be the reasons of formation of hernial gate-: not taken in cracks in , in the big epiploon. Disease symptoms at internal hernias arise at impassability of intestines in which occasion of patients operate. During operation carefully investigate walls of hernial gate, to the touch define absence of a pulsation of a large vessel (top - or bottom arteries).

At Occurrence Of Early Bleedings Spend Haemostatic Therapy.

At occurrence of early bleedings spend haemostatic therapy. At a poisoning with an acetic essence and development vnutrisosu-distogo application is necessary for therapy (5 % a solution of bicarbonate of sodium) and forced . At development of sharp nephritic insufficiency hemodialysis carrying out is shown. At defeat of a throat and development the patient impose . At gullet punching urgent surgical intervention is necessary. During all sharp period of disease careful care of an oral cavity is necessary. For the control over changes in a gullet periodically spend . Cicatricial narrowings of a gullet. have considerable extent and are is more often located in places of physiological narrowings of a gullet: glotochno-pishchevodnogo, , . Depending on depth of damage - of a wall of a gullet are formed various extent. Filmy represent thin membranes in the thickness in some millimetres, in the thickness 2 - 3 sm, tubular in the extent 5 - 10 sm and more, subtotal and total. can be single and plural, full and incomplete.

Hernial - Has The Small Sizes That Corresponds

Hernial - has the small sizes that corresponds to the small sizes a hernial bag. Hernial dense, painful. (stagnation weights) and infringement. - hernia complication when contents of a hernial bag is the thick gut. Develops as a result ' - frustration of motor function of the intestines connected with sharp fall of a tone of an intestinal wall. The inactive - way of life, plentiful meal promote hernias-. it is observed more often at corpulent patients of senile age, at men at hernias, at women at umbilical hernias. Symptoms: basic locks, belly-aches, a nausea, seldom vomiting. Hernial in process of filling of a thick gut in weights, it slowly increases almost Table 6: Differentsialno-diagnostic signs and forms of infringement of a hernia. Koprostazelastichesky infringement of a hernia B slowly, gradually Hernial , the consistences, slightly strained The kashlevoj push is defined Closing of intestines the incomplete Vomiting rare The general condition of average suddenly, quickly Hernial very painful, very strained The kashlevoj push is not defined Full impassability of intestines Vomiting frequent The general condition heavy, a collapse Without serious consequences, it is poorly strained, consistences, the symptom a push is defined.

The Question "where Localises A Pain?" The Doctor

The question "where localises a pain?" The doctor defines, what pain at the patient: At indistinct localisation - a pain , exact localisation - is possible only at a somatic pain. When there is a pain? This question specifies, whether the pain is periodic, - incidental, constant. The pain arises a question "why?" - Reveal the factors provoking a pain. Such factors can be, for example, an emotional pressure (at a stomach ulcer of a duodenal gut), certain food (at a chronic cholecystitis), horizontal or bent - body position -(at a hernia diaphragm apertures). Fizikalnoe research begin with the general survey, thus on a suffering look of the patient it is possible - to assume that the patient feels a pain. The pale face with the pointed - lines, hollow cheeks and eyes causes suspicion on disease with involving in inflammatory process (Hippocratic face). At survey of eyes it is possible to reveal a jaundice, an anaemia. Dryness of integuments happens is expressed at the - diseases accompanied by infringements vodno-elektrolitnogo of balance.

In Mild Cases It Is Shown And A

In mild cases it is shown and a mucous membrane hypostasis, in heavier - presence of rough and - non-uniform folds, erosion, ulcers which are usually located a - little above the narrowed site. The bleeding, gullet punching, further can develop. Chronic can be at the bottom of occurrence of a cancer of a gullet and . Frequent complications are repeated aspira-tsionnye , abscesses of lungs, a pneumosclerosis. - Especially often these complications meet at children. The - complications caused by the expanded gullet of a returnable nerve, the right main bronchial tube, the top hollow vein, a wandering nerve and are described-. In Petrovsky - allocates four - stages of disease: I stage - a functional changeable spasm , - gullet expansions - is not observed; II stage - a stable spasm with unsharp expansion of a gullet, III stage - cicatricial changes muscular ate with the expressed expansion of a gullet, IV stage sharply expressed - stenosis with a gullet, often S-shaped form, and . The basic methods of diagnostics are oe research, , , pharmacological tests.

Operation Consists In Laparoto-mii, Resections Of The Changed

Operation consists in laparoto-mii, resections of the changed site of a gut to level of the kept sufficient blood circulation in resulting and taking away intestinal - loops The patient at whom at receipt in a reception it is not revealed signs of a peritonitis, an intraintestinal bleeding-, should be hospitalised in a surgical hospital for dynamic supervision. To release the patient home it is dangerous. Dynamic supervision of the patient should be directed on early revealing of signs of a peritonitis and an intraintestinal - bleeding. Methods of dynamic research of the patient with spontaneously set restrained hernia the following: Complaints: a belly-ache, dryness of mucous membranes of an oral cavity. Survey: integuments (pallor); an oral cavity (dryness of mucous membranes). Haemodynamics indicators: pulse, the HELL, a shock index = / the HELL. Temperature and . Stomach research (pressure of muscles and local morbidity), local morbidity, easing of intestinal noise Research through a rectum morbidity at pressure upon gut walls, a blood impurity in contents.

Temperature: And . Haemodynamics Indicators: Pulse, Arterial Pressure,

Temperature: and . Haemodynamics indicators: pulse, arterial pressure, hearts. Stomach research: survey, , , auskulta-tsija, stomach volume, research through a rectum (morbidity-, walls). For definition of indications to urgent hospitalisation it is enough - to establish, whether there is a peritonitis, an inflammation or body corking, a bleeding. Not to enter drugs, antibiotics! The diagnosis at a direction in a hospital a sharp stomach or at the revealed reason of a sharp stomach specify the disease form. On a direction on hospitalisation apply an extract from the case record (the data of the anamnesis and about the spent treatment). At a shock it is necessary during transportation in specially equipped car carrying out of antishock treatment. Into methods of research of the patient in a hospital enters - research: the anamnesis, the data on systems. At research of cardiovascular system along with - and hearts, definition of a pulse rate, arterial pressure at suspicion on a myocardium heart attack - do an electrocardiogram.

Radical Operative Treatment Consists In Defect At Prescription

Radical operative treatment consists in defect at prescription of damage of a gullet till 1 days. defect in a gullet wall make two numbers of seams in a longitudinal direction. Tightness of seams and their isolation from infected and a pleural cavity diaphragms, walls of a bottom of a stomach provide round them depending on level of an arrangement of defect of muscles of a neck, a site pleurae, a pericardium. and a pleural cavity for , introductions of antibiotics-, antiseptic tanks, enzymes. The reason of failures of radical operations - is frequent development of insufficiency of seams. Palliative operations (, , , , spaces of a neck, a pleural cavity) are shown at through wounds - of a gullet when time for radical operation is missed, and at heavy accompanying diseases. Recently at gullet punching - was extended a method active and tight -. Thus carry out taking into account a place of damage of a gullet, more often from a cut on a neck, also bring to a punching place a drainage tube which deduce away from an operational wound.

Treatment: Only The Surgical. After Removal Of A

Treatment: only the surgical. After removal of a hernial bag and make a belly wall on a method of Sapezhko or on a method of Mayo. Method of Sapezhko: two longitudinal sections bordering a - hernia, a skin together with a navel. Hernial - gate dissect upwards and downwards on a white line of a stomach to places where it is narrowed and is not changed. Open a hernial bag, set the internal separated from a hernial bag in a belly cavity. from a back - surface of a vagina of one of direct muscles of a stomach. a hernial bag, edges sew it. Separate seams grasping - on the one hand edge a white line of a stomach and on the other hand a part of a vagina of a direct muscle where , create from myshechno-aponevroticheskih rags "thus a rag located - superficially, file to bottom in a kind . Method of Mayo: two cross-section - cuts bordering a hernia - a skin together with a navel. From hernial gate from hypodermic fatty - on a circle distance 5 - 6 see After opening of a hernial bag divide unions, the soldered big epiploon, set an internal in a belly - cavity.

At First The Patient Empties A Bladder, And

At first the patient empties a bladder, and then after pressing on hernial there is a new desire on , and the patient starts to be wetted again. At suspicion on a sliding hernia of a bladder it is necessary to execute a bladder and . Last - to reveal the form and the sizes of a hernia of a bladder, presence of stones in a bladder. Treatment: only the surgical. If not to know anatomic features of a sliding hernia, it is possible to open during operation instead of a hernial bag a wall of a gut or a - bladder wall-. Surgical treatment - the basic method of treatment of external - hernias of a stomach. Operation - it unique possibility to prevent such heavy complications of a hernia, as its infringement-, an inflammation, etc. Operation of not complicated hernias spend on stages: dissect - fabrics over a hernial bag, dissect hernial gate, allocate a hernial bag, open it, set contents of a hernial bag in a belly cavity, stitch and tie up a - hernial bag in the field of a neck, cut a hernial bag and strengthen a belly wall in the field of hernial gate by a plasticity local fabrics or materials.

Research Make So That The Healthy Place Has

Research make so that the healthy place has been investigated in last turn. Rough superficial make to reveal pressure of muscles of a belly wall and morbidity localisation. Research carry out, making easy pressing by a hand on a belly wall. Pressure of muscles judge on expressiveness of resistance which is felt by a palpating hand at a - touch to a stomach. It is necessary to compare a tone of the muscles of the right and left parties of a belly wall with the same name at identical level, conducting research at first less painful areas. On degree of expressiveness of pressure of muscles distinguish: the small resistance, the expressed pressure, pressure-. Pressure of muscles happens is expressed on the limited - small site or has poured character. Pressure of muscles - display a reflex as a result of the - irritation which are starting with , bodies - of a belly cavity. It is the major symptom of an inflammation -. However he can be observed and at disease of the bodies located ( a pleurisy, , a myocardium heart attack, nephritic ), at presence in space of hematomas, abscesses, at bruises of the bottom edges to which muscles of a belly wall are attached.

Expansion Of An Umbilical Ring And Hernia Formation

Expansion of an umbilical ring and hernia formation are promoted by the various diseases connected with increase of intrabelly pressure (a whooping cough, a pneumonia, , a dysentery). Hernias at children happen the small sizes is more often. Symptoms: a belly-ache causing anxiety - of the child, in the field of a navel, disappearing at pressing-, expansion of an umbilical ring. Umbilical hernias at children usually are not restrained, however this complication is possible. Parents of the child should be informed on signs of infringement of a hernia and to explain necessity - of immediate hospitalisation of the child at development of this complication-. Treatment: at small children in process of development of a belly wall probably self-healing at the age from 6 till 3 years, sometimes by 6 years. If the hernia does not give to the child of troubles, apply conservative treatment. Appoint massage, the medical gymnastics promoting development and strengthening belly . On navel area impose a bandage interfering of interiors in a bag.

Presence Zheludochno-pishchevodnogo A Reflux Can Be Confirmed By

Presence zheludochno-pishchevodnogo a reflux can be confirmed by the data rN-metrii (decrease to 4,0 and more low) (see has undressed "Gullet", "- Special methods of research"). Paraezofagealnye hernias subdivide on , , intestinal, intestinally-gastric, . remains, on a place, and through the diaphragm aperture near to a gullet occurs displacement in a stomach or an intestines. Unlike sliding hernias at hernias probably development of infringement. Observe hernias is more often. At hernias the clinical picture depends on a kind and contents of a hernia, degree of displacement of surrounding - bodies. Switching function is not broken (there are symptoms - zheludochno-pishchevodnogo no reflux) gastroenteric or is warm-pulmonary complaints Can prevail. Most often there is a moving to a chest cavity of the stomach, shown by pains in areas and behind a breast, arising after food intake, , an eructation. At infringement - sharp pains, vomiting with a blood impurity are observed. At hernias during time a - thorax reveal in back against a heart shade a roundish enlightenment, sometimes with liquid level.

Pain (at 33 %) - A Frequent Symptom

Pain (at 33 %) - a frequent symptom of a cancer of a gullet. Pains behind a - breast of stupid pulling character arise during food intake-, can in a back, a neck, the left half of thorax. The mechanism of occurrence of pains the various. Pains behind a breast-, arising during food intake, are caused injured - by food of the inflamed wall of a gullet about a tumour and . Stupid pains during food intake - arise at a gullet a tumour. In this case occurrence of pains is connected with the strengthened reduction of a wall - of the gullet, directed on food advancement through the narrowed site. The constant pains not dependent on food intake or amplifying - after meal, are caused by tumour germination in - fabrics surrounding a - gullet and bodies, wandering and sympathetic - nerves, development and . Metastasises in a backbone can be the reason of pains. food and vomiting (at 23 %) appear at considerable a gleam of a gullet and a food congestion over a narrowing place. Emetic weights consist of not digested - food, a saliva and slime, sometimes with a blood impurity.

- A Powerful Stimulator Of Secretion Of Hydrochloric

- a powerful stimulator of secretion of hydrochloric acid. in a stomach synthesise and store mucous membrane cages (corpulent, entero-hromaffinnye, ). Secretion, , grows out of activation 2- on a membrane cages. So-called antagonists 2- (, , , and ) block action and other stimulators of gastric secretion. The mechanisms suppressing secretion of hydrochloric acid: acid "brake", small intestine factors (, , . The antralnyj department depending on contents carries out production of hydrochloric acid cages. Allocated from G-cages stimulates secretion of hydrochloric acid, and its surplus, causing contained department, liberation brakes. At low value <2,0 liberation and secretion of hydrochloric acid stops. On a measure and neutralisations of hydrochloric acid by an alkaline secret glands at 4,0 liberation and secretion of hydrochloric acid renews. There is an assumption of participation of wandering nerves in a braking mechanism of secretion of hydrochloric acid at contained department. Receipt of sour contents from a stomach in a duodenal gut is a stimulator for functions of S-cages.

- Deterioration Of The General Condition Of The

- Deterioration of the general condition of the patient, pain strengthening testify to development of inflammatory process in -, character of a body temperature, short wind and - tachycardia strengthening-, increase in leukocytes, increase . In the absence of treatment patients with purulent die within the next few days. Profuznye bleedings arise at extensive ruptures of a mucous membrane of a gullet by Frequent complication at damage - pleurae is pleurae. At distribution of inflammatory process on a backbone, - covers back and a brain there is a pain at movement of hands, at pressing on awned shoots of vertebras, a headache In the remote terms can develop and the cicatricial deformations of a gullet shown . Radiological research is the basic method of diagnostics of damages of a gullet It begin with survey and at which it is possible to find out an emphysema , expansion of its shade, , an emphysema necks In the absence of air in investigate a gullet with contrast substance in position - of the patient lying on a back, on right and left to a side, on a stomach.

Strengthening Of A Back Wall The Channel By

Strengthening of a back wall the channel by till the normal size internal rings should be an obligatory stage of operation at all - forms hernias. The fourth stage - a plasticity the channel. At a choice of a method of a plasticity the channel it is necessary to consider that a formation principal cause hernias is weakness of a back wall - the channel. Strengthening of a forward wall the channel with obligatory deep rings till the normal sizes can be applied at young men at small slanting hernias. At direct hernias and difficult forms hernias (slanting with the straightened channel, sliding hernias, recurrent) - strengthening of a back wall the channel should - be made. There are some ways of a plasticity the channel. The way Zhirara provides strengthening of a forward wall - the channel. Over seed to to a sheaf sew - at first edge of internal slanting and cross-section muscles of a stomach, and then separate seams - the top rag an external slanting muscle. The bottom rag fix seams on the top rag , forming thus from rags an external slanting muscle of a stomach.

Having Passed Through An External Aperture The Channel,

Having passed through an external aperture the channel, settles down at a root over a sheaf in the form of roundish formation. Cross-section interferes with lowering direct hernias in . Often direct - the hernia happens bilateral. Allocate special group hernias. At these hernias the hernial bag is located between various layers of a belly wall. Allocate hernias when the hernial bag is located between and cross-section , intermuscular hernias when the - hernial bag is located between various layers of muscles and ; superficial hernias when the hernial bag - is located for superficial a ring between an external slanting muscle of a stomach and superficial . Clinic and diagnostics: to distinguish generated a hernia Easy typical the anamnesis is: sudden occurrence of a hernia at the moment of physical pressure or gradual development hernial , occurrence a belly wall at , in vertical position of a body of the patient and hernia reposition in horizontal position of the patient. Patients disturb a pain in the field of a hernia, in a stomach, feeling of inconvenience at walking, the phenomena, and at sliding hernias of a bladder arise the phenomena.

The Hernia Increases In Sizes As A Result

The hernia increases in sizes as a result of a hypostasis and - fabrics, appears skin. Treatment: emergency operation. At an acute appendicitis in a hernia make , in other cases delete a source - a hernial bag. Chronic inflammation of a hernia at a tuberculosis distinguish during operation. Treatment consists in , specific antitubercular - therapy. Source hernias can be inflammatory processes on hernia integuments (a furuncle, skin damage (, grazes, ). In these cases can be made only after liquidation of inflammatory processes on a skin. Preventive maintenance of complications: surgical treatment of all patients with hernias in a planned order before development of their - complications. Revealing is possible at carrying out of mass prophylactic medical examination of the population. Hernia presence is the indication to operation. INTERNAL HERNIAS OF THE STOMACH Internal hernias of a stomach name hit of bodies of a belly cavity in pockets and cracks . To internal hernias carry also hernias.

Survey Of Integuments Of The Bottom Half Of

Survey of integuments of the bottom half of belly wall, foot, buttocks and i.e. Areas for which lymph nodes are will allow to reveal entrance gate of an infection (furuncles, wounds, cracks between foot fingers) If the diagnosis is not clear the last a method is operation During a cut of fabrics under a sheaf find out either the restrained hernia, or the increased inflamed lymph nodes. Thus during operation there is a possibility dangerous complication infringement and to eliminate it. Feign infringement of a femoral hernia the thrombosis of knot of the big hypodermic vein at a place of its confluence of a deep vein of a hip can At a thrombosis of venous knot at the patient there is a pain and painful consolidation under a sheaf Along with it often is defined is available expansion of veins of a shin emergency operation as in case of infringement of a hernia and a thrombosis of venous knot Is shown. At the restrained hernia eliminate infringement of body and make a plasticity in the field of hernial gate.

Specifies The Presumable Diagnosis. Patients With , Ulcers

specifies the presumable diagnosis. Patients with , ulcers and hundred a gullet show complaints to a painful heartburn, an eructation air, food which arise at them or amplify in a prone position or at a strong inclination - of a trunk forward. At development of a stenosis the heartburn decreases, but amplifies . At radiological research define terminal department of a gullet. At research in horizontal position often reveal a hernia diaphragm apertures. The great value directed by the diagnosis has . For a gullet after a burn, the transferred sharp - infection, a trauma the corresponding anamnesis and a - radiological picture are characteristic-. At can arise in the beginning and in the end of meal, there is no selectivity to firmer and dry food, has alternating character, is accompanied by a pain arising at the moment of swallowing and passage of food but a gullet. , as a rule, not plentiful. At radiological research mark infringement of impellent function and about a gullet out of its terminal department, the - disclosing mechanism - is not broken, spastic reductions quite often fancifully - deform a gullet gleam (, a gullet, etc.

To Surgical Treatment Are Exposed 15 - 20

To surgical treatment are exposed 15 - 20 % of patients . Now from all offered operations to the tonic only what are based on idea extramucous . on Gelleru carry out from access, making a longitudinal section we covers of terminal department of a gullet on forward and back walls throughout 8 - Operatsiju Gellera 10 sm combine with or on Nissenu for the development prevention Results of operations at depend on degree gullet changes (change of a motility and a tone, expressiveness of the inflammatory phenomena), and also from carefulness of performance of plastic operation - the disease of a gullet caused - by spastic reductions of its wall at normal function to the Thicket arises at men and basically at persons of an average and advanced age. Makes 6 % from all - functional diseases of a gullet. Aetiology at a number of patients it is caused vistsero-vistseralnymi by reflexes and it is combined with other diseases -(a stomach ulcer, gullet and stomach new growths, a cholecystitis, , a hernia Diaphragm apertures, an atherosclerosis, a stenocardia and ) Thereof it has received the name reflex (secondary) .

During Strong Spastic Reductions Of A Gullet Can

During strong spastic reductions of a gullet can be a small amount of just accepted food in a mouth. It never happens plentiful, eaten - for some hours to or the day before. Radiological research reveals changes of a gullet in the form of "beads", "psevdodi-vertikulov", "corkscrew". Diameter - of a gullet above and below the narrowed sites is not changed, - gullet walls - are elastic, mucous membrane folds longitudinal, - non-uniform and irregular. At repeated - radiological researches the same type of infringement usually remains. at this disease also matters only for an exception of organic diseases of a gullet, it is frequent it happens it is complicated because of strong the pains arising during research. The gullet mucous membrane is not changed or there are inflammation signs. Ezofagotonokimografichesky research allows to reveal spastic reductions of a gullet in a wave mode of the various form and amplitude, simultaneously register and - reductions. The reflex relaxation (disclosing ) is constantly defined.

An Internal Surface Of A Wall Vibrating ,

An internal surface of a wall vibrating , - - cylindrical or . settle down in a layer of a gullet and are formed - as a result of corking of channels of glands. They never reach the big sizes. Clinic and diagnostics: good-quality tumours and a gullet grow slowly, long time do not cause clinical symptoms and are found out casually at - radiological research of a gastroenteric path. - Their clinical - displays depend on level of localisation, size and presence of complications (, an inflammation, pressure upon the next-. Bodies). The Most frequent symptom - periodic, slowly accruing throughout many years . Is more often it - is observed at the big tumours on a long leg. At tumours, the gullet, can - have constant character, sometimes patients mark pains, sensation of pressure or - overflow behind a breast, - the phenomena. At tumours - of cervical department of the gullet, having a long leg, - can arise tumours and development . At a polyp or damage of a mucous membrane - of the gullet which has been stretched over.

Ezofagotonokimografichesky Research At Patients With Functional - Infringements

Ezofagotonokimografichesky research at patients with functional - infringements of a motility of a gullet at carrying out of these tests registers normalisation gullet functions. To intensity definition zheludochno-pishchevodnogo a reflux apply rN-metriju by means of a special probe or a radio capsule which establish on 5 sm above . Into a stomach enter 300 ml 0,1 . Hydrochloric acid. At a pishchevodno-gastric reflux there is a sharp decrease and strengthening of a painful syndrome. CONGENITAL ANOMALIES OF DEVELOPMENT OF THE GULLET To congenital developmental anomalies of a gullet carry: a gullet total absence ( or full ), full - impassability of a site of a gullet , stenoses, fistulas, gullet doubling, a congenital short gullet, congenital (insufficiency) . Frequency - 1:1000 newborns. - a total absence of a gleam of a gullet on its any site or on all extent. In 40 % of cases it is combined with other developmental anomalies. During the first hours and days after a birth at newborns mark constant allocation of a saliva and slime from a mouth and a nose, there can be a strong cough, a short wind and as a result a contained gullet in respiratory ways.

Similarity To A Femoral Hernia Has - Expansion

Similarity to a femoral hernia has - expansion of the big hypodermic vein at a place of its confluence of a femoral vein. At such patients at vertical position of a body owing to - fillings of venous knot appears under - a sheaf which disappears in horizontal position. Difference of a femoral hernia from knot of the big hypodermic vein are the signs resulted in tab. 5. Table 5: Diagnostic signs of a femoral hernia and knot of the big hypodermic vein Priznakianevrizmatichssky knot big hypodermic a hernia Skin condition over Varikoznoe expansion of veins Symptom a push , dark blue colour Is available for the majority of patients on a shin Sensation a blood current Vascular noise and symptom colours No It is defined It is defined nothing Swelling occurrence under a sheaf in vertical position of the patient can be caused distribution an abscess on a course of a lumbar muscle on a hip at a tuberculosis of lumbar department of a backbone. The natechnyj abscess at pressing decreases in sizes, as well as a hernia.

The Cut Should Be Made With The Account

The cut should be made with the account anatomo-topogra-ficheskoj characteristics of localisation of a hernial phlegmon. Over a hernia dissect fabrics. A hernial bag open-, delete purulent . Hernial gate cautiously make cuts so to take the restrained gut and its blind ends of resulting and taking away pieces. After removal of the restrained gut separate a mouth and a neck of a hernial bag from hernial gate. A plasticity of hernial gate do not make. On edges of hernial gate impose some seams for the purpose of the prevention in the postoperative period . Further delete a hernial bag together with the changed fabrics (at umbilical, hernias it probably to make the uniform block). Surgical processing of the purulent centre finish - wounds. The punched drainage stack on a wound bottom, the drainage ends deduce from a wound through healthy fabrics. Resulting - end of a drainage connect to system from blood transfusion with the antibacterial preparations, taking away end connect to a tube lowered in bank with an antiseptic tank Through a drainage - carry out long constant "flowing" washing of a wound by antibacterial preparations.

If Between The Allocated Ends Of A Gullet

If between the allocated ends of a gullet does not exceed 1,5 sm, impose direct the end in the end. At considerable the gullet ends a part it deduce on a neck in a kind , impose for a food of the child, subsequently - make . The choice of a kind of operation at a congenital stenosis of a gullet depends - on extent of narrowing. At narrowing to 1,5 sm make a longitudinal section of a wall of a gullet with cross-section sewing together of edges of a wound over . If the site of narrowing does not exceed of 2,5 sm on extent, performance of a resection of a gullet with the end in the end is possible. At considerable extent of narrowing it is shown . At localisation of narrowing in the field of physiological make mio-tomiju (operation of Gellera) with or plastic arts a diaphragm rag. Treatment traheo - and fistulas consists in crossing a course and the formed defects in both bodies At gullet doubling is shown or a resection a site. At a congenital short gullet and absence of complications spend conservative treatment.

The Top Horizontal Line Connect The Lowest Points

The top horizontal line connect the lowest points of edges; the bottom horizontal line spend through the highest points of crests . Thus three - areas are allocated-: top - (regio epigastrium), average - (regio meso-gastnum) and bottom - (regio hypogastrium). The lines spent along external edges of direct muscles of a stomach, divide - each of these areas into three areas. Projections of bodies on a stomach wall. In actually area the stomach, a small epiploon, a part of a duodenal - gut and a pancreas, the left share of a liver and a part of the right share of a liver, a bilious - bubble, an aorta, an artery with arteries departing from it, a vein, the bottom hollow vein are projected---. On - area are projected: the right share of a liver, a bilious bubble, a part of a duodenal gut, a - hepatic bend guts, the top department of the right kidney. On left area are projected: a stomach part, a spleen, a pancreas tail, a bend guts, the top department of the left kidney-. On umbilical area - are projected: small intestine loops, a pain of that an epiploon, cross-section a gut, an aorta, top an artery with its branches, the bottom - hollow vein On the top department of this area are projected: gland and the big curvature of a stomach (especially at it ) On the right lateral area are projected: ascending - a gut, a part of loops of a small intestine, the right kidney with .

Symptoms: A Pain In The Areas, Amplifying After

Symptoms: a pain in the areas, amplifying after food intake, at increase of intrabelly pressure. Occurrence of pains in patients with hernias of a white line of a stomach - explain or time infringement of a hernia, or a tension - of a stomach an epiploon fixed to a hernial bag, or pressure - upon nerves (a hernial bag). At research of the patient find out dense painful - formation in the field of a white line of a stomach. At hernias sometimes it is possible to probe hernial gate. Some patients of a hernia proceed . Various diseases of an internal, such, as a stomach ulcer of a stomach or a duodenal gut, a chronic cholecystitis, chronic , etc. In this connection the patient replying researches for revealing of diseases, sopro-zhdajushchihsja pains in areas should be conducted can accompany a hernia of a white line of a stomach. Treatment: the surgical. Operation consists in allocation - of a hernial bag, its removal and aperture closing in - by imposing a seam or separate central seams.

Physiological Value Of A Gullet Consists In Carrying

Physiological value of a gullet consists in carrying out of food of a cavity drinks in a stomach, carried out a reflex. Thus the important role in normal activity of a gullet belongs to a reflex of timely disclosing , coming in norm through 1 - 2 1/2 with the ambassador of a drink. The relaxation - physiological provides free receipt of food in a stomach under action waves. After passage of a food lump to a stomach there comes restoration of a tone bottom and closing . SPECIAL METHODS OF RESEARCH To diagnostics gullet disease apply - radiological research, , study impellent function. Contrast radiological research of a gullet with a - water suspension of sulphate of barium (at suspicion on punching with water-soluble contrast) spend at various turns of the patient round a vertical axis, in vertical, horizontal position or in position with the raised basin. Pay attention - to character of contours, elasticity, , -, ability of walls of a gullet, study a mucous membrane relief, examine areas of physiological narrowings.

In Group A Precancer Carry Gullet Papillomas. Patients

In group a precancer carry gullet papillomas. Patients with the given disease are subject to supervision with carrying out - repeated for microscopic diagnostics. Pathological anatomy: the gullet cancer develops - more often in places of physiological narrowings: the gullet mouth, at level tracheas, over physiological On frequency of defeat by a cancer on the first place is department (at 60 %) - at level of an arch of an aorta and the left main bronchial tube, on the second place-nizhnegrudnoj and gullet department (at 30 %), on the third - cervical and (At 10 %) On a macroscopical picture distinguish three basic forms of a cancer of a gullet, a central cancer (, ), ulcer, There are mixed forms of growth. Central forms make about 60 % of cancers of a gullet. These - tumours have growth, are presented by the growths - similar to a cauliflower, have more dark colouring, than a normal mucous membrane. The tumour is easily injured, - is subject to disintegration and constantly bleeds. Tumoral extends on and muscular covers.

It Is Necessary To Struggle With Adiposity And

It is necessary to struggle with adiposity and especially with a strong exhaustion after it as these pathological - conditions quite often favour to formation of hernias. At the - enterprises it is necessary to select correctly workers on a physical activity according to their forces and a state of health. The great value has early revealing of the people, suffering stomach hernias, and their direction on operation before development of complications. For this purpose it is necessary to spend population routine inspections, in particular schoolboys and persons of a pension age. HERNIAS Pahovye hernias make 80 - 90 % of other kinds of hernias. Among patients with hernias of the man make 90 - 97 %, and women - 3 - 10 %. More frequent occurrence hernias at men is connected with features of development and an anatomic structure areas at men. Pahovye hernias happen congenital and got. Embriologichesky data - lowering process begins With III month of pre-natal development of a germ - of a male In area rings is formed - brjushinno-pahovyj the shoot the next months pre-natal development occurs Further in the channel In the end of VI VII months start to fall in .

Research Through A Vagina It Is Necessary To

Research through a vagina it is necessary to spend It at all sharp diseases of bodies of a belly cavity - it is necessary for diagnostics of the gynecologic diseases - which are at the bottom of a sharp stomach, and also for revealing - of distribution of inflammatory process on a small basin. At research through a vagina it is possible to reveal the vagina arches, morbidity and increase in appendages of a uterus and painful formation in to a pipe at trumpet pregnancy. the vagina arches happens at a congestion in a cavity of a small basin of blood or . Laboratory analyses: haemogram, urine, a liver and a pancreas. Radiological research: a thorax-, survey a stomach (from a diaphragm to ) for revealing of mobility of a diaphragm, a congestion of free gas under a diaphragm or in intestines, liquid levels in intestines (at impassability); blackouts ; survey - and urography for revealing of stones in kidneys and -; research with a summer residence through a mouth - of water-soluble contrast at suspicion on punching of a stomach or a duodenal gut; at suspicion on impassability.

THE GULLET A Gullet - Limited Walls. Distinguish

THE GULLET a gullet - limited walls. Distinguish and . are formed owing to - walls under the influence of high the - pressure arising during its reduction. Development - fractional is connected with inflammatory process in - surrounding fabrics and formation of hems, which extend a wall of a gullet towards the amazed body ( , chronic , a pleurisy) the - mechanism is observed by Traktsionnyj - at the very beginning of development , then join factors owing to what becomes pulsionno-traktsionnym. subdivide depending on an arrangement on glotochno-pishchevodnye , (, ), Distinguish true - which wall contains all layers of a wall of a gullet, and in which wall there is no muscular layer. The overwhelming - majority got, congenital - meet extremely seldom. At infringements of a motility - of a gullet observe , arising - only at the moment of reduction , at a relaxation of a gullet they disappear. are observed seldom aged till 30 years and it is frequent after 50 years; among patients men prevail.

The Course Often Happens Twisting, Excentricly Located. At

The course often happens twisting, excentricly located. At sharp narrowings arises gullet expansion. Clinic and diagnostics: the basic symptom after-burn - which appears with 3 - 4th weeks from the disease beginning. In the beginning it is unsharply expressed-, arises incidentally, it is accompanied by unpleasant sensations behind a breast. Eventually gullet narrowing progresses, as the surface of the narrowed site - is exposed food that is accompanied by vospalitelno-cicatricial process. Expressiveness increases, full impassability of a gullet can develop. The food delay causes a pain and . At high stenoses of a gullet the food during swallowing can get to respiratory ways, causing , attacks - of painful cough and an asthma. At it is long existing narrowings department of the gullet, accompanied it expansion-, gullet contents are exposed chemical and, - to bacterial decomposition that causes the inflammatory process leading still of a gullet, to development . in these cases arises through a considerable time interval after meal.

The Diagnosis: In Typical Cases Comes Easy. The

The diagnosis: in typical cases comes easy. The basic signs: sharply arisen pain and earlier hernias. Usually the infringement occurs in an external - aperture the channel. At research of the patient find out in areas painful, strained, hernial . If the intestinal loop is restrained, symptoms intestinal impassability join. The infringement in an internal aperture the channel is possible ( the infringement) That is why in the absence of hernial is necessary to conduct manual research the channel instead of to be limited to research only external rings Entered in the channel a finger it is possible to probe small painful consolidation at level of an internal aperture channel Retrogradnoe infringement. the small intestine probably infringement of a thick gut of the big epiploon, etc. Retrogradnoe infringement is restrained arises more often when in a hernial bag intestinal loops (two or more) are located some, and intermediate their binding loops are in a belly cavity to Infringement binding intestinal loops of Nekroz are exposed in a greater degree begins earlier in these intestinal loops located above a restraining ring.

Treatment Gives Fast Clinical Effect At The Expense

Treatment gives fast clinical effect at the expense of removal an inflammation and reduction of the sizes of a tumour. At a gullet beam therapy is inefficient. Beam therapy is counter-indicative at a serious illness of cardiovascular and respiratory systems, - bodies, the central nervous system, tumour disintegration, a bleeding-. At impossibility of performance of surgical or beam treatment at a gullet cancer the - chemotherapy (a combination a number - 5-ftoruratsil or with and ) can be applied as - palliative means. Chemotherapy of a cancer of a gullet till now in connection with low sensitivity of a tumour to known antineoplastic preparations. At all patients with the inoperable form of a cancer of a gullet - it is shown carrying out of the symptomatic therapy directed on removal of pains, liquidation of infringements of a food. The five years' - survival rate after radical operations makes less than 10 %. GULLET SARCOMA The sarcoma - malignant a tumour, - makes 1 - 1,5 % of all malignant tumours of a gullet, meet at men (at 75 %) is more often.

Has A Soft Consistence-, Decreases At Pressing, After

has a soft consistence-, decreases at pressing, after water reception at - over it it is possible to define splash noise. It is possible spontaneous - not digested food from a gleam at certain position of the patient, difficulty of breath because of trachea squeezing, occurrence voices at a returnable nerve At food intake at patients can develop "a blockade phenomenon", shown by a face reddening, sensation - of shortage of air, dizziness, the - putrefactive smell from a mouth appears the unconscious condition disappearing after vomiting At a long delay of food in -. At the majority of patients a - food that leads to their exhaustion is broken. characterises an asymptomatic current more often, the phenomena , pains behind a breast - or in a back are possible-, at chronic - break in a trachea, , development , a lung abscess. also at the majority of patients proceed , but can be shown by pains behind the bottom - part of a breast, , a nausea, vomiting, a reflex short wind-, palpitation, a bronchospasm, symptoms a - gullet and .