If There Are No Obvious Signs , The

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

In An Average - Part Of Chest Department

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

If It Is Possible, Expedient To Arrange Seed

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

The Edge Of An Internal Aperture The Channel

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

During A Finding Write In A Stomach Two

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

At And Vomitings Probably Hit Of Food Weights

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

At Carrying Out Of The Differential Diagnosis Of

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

The First Period - Painful, Or The Shock,

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

Big A Tumour, The Bleeding Is Possible-. A

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

Reflex Pressure Of Muscles Comes Out Irritation -

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

A Disease Current Slow, Without - Essential Progressing.

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

It Is Possible To Carry Ruptures Of Large

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

Research Of The Local Status Includes Survey, ,

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

- Allocate Also (primary) Which Reason Are Infringements

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

At To The Form The Hernia Leaves Through

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