Research Of The Local Status Includes Survey, ,

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

- Allocate Also (primary) Which Reason Are Infringements

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

At To The Form The Hernia Leaves Through

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

The Femoral Hernia Is Located - More Low

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

As A Result Inflammations Arise Dense Unions Of

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

The Definitive Diagnosis Establish At Radiological Research. The

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

Unlike A Hernia At An Abscess It Is

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

). Expansions Of A Gullet Do Not Observe. At

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

At A Bleeding, For Definition - Of Deficiency

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

Ultrasonic Research Of A Bilious Bubble, Pancreas, Liver,

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

Spend Under Local Or General Anaesthesia. Conservative Treatment

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

On And Functions Distinguish Three Ferruterous - Zones.

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

Dangerous Complication Is Perforation - Of A Gullet

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

Stomach Vessels With Each Other And With Branches

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

At A Number Of Patients With Depends On

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