At A Stomach Specify An Arrangement In Relation

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

Superficial - Quickly (1 - 2 ), Deep

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

Closing Of Hernial Gate Make By Sewing Together

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

The Listed Factors Promote Local Easing Of A

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

Contents Of A Hernial Bag Usually Is The

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

At Define The - Oval Defect Of Filling

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

This Data Is Important For The Characteristic Of

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

Postoperative . Danger Of Infringement Of A Hernia

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

Most Often (at 50 % Of Patients) Insufficiency

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

The Typical Sign Of Infringement Of A Hernia

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

Hernial Gate Dissect - On Obviously Sites. After

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

If There Are No Obvious Signs , The

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

In An Average - Part Of Chest Department

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

If It Is Possible, Expedient To Arrange Seed

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

The Edge Of An Internal Aperture The Channel

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