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

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

The Way Spasokukotsky Is Updating Of A Way

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

A Hernial Bag, Edges Sew It In A

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

Observe Cases Of Spontaneous Rupture Of A Gullet.

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

The Diagnosis Represents Great Difficulties. On Clinical Displays

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

Seed Stack On The Generated Back Wall The

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

The Bleeding, More Often Sudden, Arises Almost At

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

EXTERNAL HERNIAS OF THE STOMACH External Hernia Of

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

At The Big Hernias Of A White Line

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

To All Patients With Good-quality Formations Of A

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

In Development Hernias Result Weakness Fabrics-, Age ,

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

Some Patients It Is Artificial Cause Vomiting For

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

The First Symptoms Of Illness Are More Often

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

Persistent Pains In The Left Half Of Thorax

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

Treatment, Antibiotics, Heat, At Occurrence Of Signs Of

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