Efficiency Judge Not Only On Subjective Sensations Of

Efficiency judge not only on subjective sensations of the patient, but also according to radiological and - researches During time and in a near time after it development of complications (rupture of a gullet with development , a sharp pishchevodno-gastric bleeding), - urgent measures demanding - acceptance is possible-. To early complications carry also insufficiency with development heavy a reflux-ezofagita In the nearest terms after excellent and good results mark almost at 95 % of patients, however in some years at 30 - 70 % of patients come the relapse demanding a refresher course of treatment. Operative treatment is symptomatic and is directed on elimination of impassability of pishchevodno-gastric transition. Indications to it are 1) impossibility to spend , 2) absence of therapeutic effect after repeated courses , 3) early the diagnosed ruptures of a gullet arising during expansion -, 4) expressed , developed after a restretching and not giving in to conservative therapy and , 5) sharp expansion, a S-shaped curvature - of a gullet in a combination to cicatricial changes in .

Or A Forward Wall Of A Rectum Arises

or a forward wall of a rectum arises at a congestion in a cavity of a small basin inflammatory at a peritonitis or blood at a bleeding ". SHARP STOMACH Sharp stomach (the reasons, the basic clinical signs, - diagnostic methods at different investigation phases of the patient). The term "a sharp stomach" designate clinical , developing at damages and sharp diseases - of bodies of a belly cavity at which it is required or the urgent surgical help can be demanded. The first medical inspection of the patient is often made out of a hospital (in-home or in polyclinic). A problem of primary elementary diagnostics is recognition of a dangerous situation - and necessity of urgent surgical treatment. At a sharp stomach the forecast worsens eventually, therefore the doctor is obliged to hospitalise quickly the patient in profile establishment - where in the near future to the patient necessary diagnostic and medical actions should be carried out. Even at suspicion on a sharp stomach it is necessary to hospitalise the patient urgently-.

Forward The Hernia At Women Begins From Puzyrno-matochnogo

Forward the hernia at women begins from puzyrno-matochnogo deepenings and leaves in the big sexual lip in its central part. Back the hernia begins at men from puzyrno-prjamokishechnogo deepenings , at women from matochno-prjamokishechnogo deepenings, passes from an intersciatic line through cracks in a muscle lifting back pass, and leaves in sedalishchno-prjamokishechnoj hollows. Back a hernia, leaving in hypodermic , settles down either in front, or behind apertures. Promezhnostnye hernias are more often observed at women. The bladder, female genitals happen contents of a hernial bag. At diagnostics about-mezhnostnyh hernias localisation hernial - has essential value-. Forward the hernia at women is necessary for differentiating with a hernia which also leaves in the big sexual lip. Manual research through a vagina helps diagnostics, hernial hernias can be probed between a vagina and a sciatic bone. Sciatic hernias, can leave through the big or small sciatic apertures. Hernial it is located under the big buttock muscle, sometimes leaves from under its bottom edge.

If To 3 - To 5 Years Has

If to 3 - to 5 years has not come self-healings further independent the umbilical ring will not occur. Thus surgical treatment is shown. The indication to operation at earlier age are frequent partial infringements of a hernia, fast increase in the sizes of a hernia. Operation spend on stages: allocation and removal of a hernial bag, an umbilical ring a seam (on a method of Leksera) or the separate seams stitched for edges of defect in a longitudinal direction. At the big umbilical hernias - use a method of Sapezhko or Mayo (are described more low). During operation at children it is necessary to keep a navel as absence of a navel can put a mental trauma to the child. Umbilical hernias at adults make 5 % of all external hernias of a stomach. Development of umbilical hernias is observed at - women is more senior 40 years (80 %) more often-. The reasons of development of umbilical hernias: Congenital defects of umbilical area, repeated the pregnancy, proceeding without observance of a necessary mode, neglect physical exercises and gymnastics.

The Duodenal Gut Before Receipt In It Of

The duodenal gut before receipt in it of a food chemical moustache - extends thanks to muscles relaxation a little. Thus, evacuation of a contained stomach is caused by sequence of reductions and changes pressure in department, pilori-cheskom the channel and in a duodenal gut. The antralnyj department and the gatekeeper provide regulation of duration of digestion of food in a stomach, are and the switching device. Thanks to the last the - reflux contained in a stomach is prevented-. Wandering nerves stimulate reductions of a stomach and lower a tone and bottom the Sympathetic nervous system has opposite an effect: brakes - and raises a tone . reduces a tone , and - cause reduction - . The basic functions of a stomach and duodenal gut consist that in a stomach the accepted food is exposed to primary digestion. Hydrochloric acid - of gastric juice has bactericidal an effect on stomach contents. Antralnyj department of a stomach, the channel, a duodenal gut. - Represent a uniform complex of motor activity.

The Somatic Pain Arises At Irritation Of Sensitive

The somatic pain arises at irritation of sensitive - fibres of intercostal nerves ( , , a small epiploon) and at a nerve, . Somatic pain cause - 1) inflammatory or tumoral , a tension, , a friction - of the surfaces changed by inflammatory process-, 2) irritation gastric, intestinal, - pancreatic juice, bile, blood, urine, bacterial toxins-, 3) damages of intercostal nerves out of (a hematoma-, , a tumour), 4) an inflammation of nervous backs Localisation of a somatic pain corresponds to an irritation place - the Pain is accurately localised in that part of a body which the same segment of a spinal cord to which belongs given intercostal or a nerve Accurate localisation of a somatic pain is connected by that - intercostal nerves have projection fields in a cerebral cortex. The somatic pain happens cutting and burning, has constant character. pains arises when the irritation grasps the terminations of intercostal nerves in to the tyre or in Knowledge of typical directions - pains which is felt sometimes far from an irritation place-, facilitates recognition of the amazed body.

By Origin Diaphragm Hernias Divide On Traumatic (the

By origin diaphragm hernias divide on traumatic (the section of "diaphragm Damage" see) and not traumatic. Among not traumatic hernias allocate: false congenital hernias (defects) of a diaphragm, true hernias of weak zones - of a diaphragm, true hernias of atypical localisation, a hernia of natural - apertures of a diaphragm ( apertures, rare hernias of natural apertures). False congenital hernias (defects) of a diaphragm are formed as a result existing in the period of messages between a chest and belly cavity. True hernias of weak zones of a diaphragm arise at - increase of intrabelly pressure and belly bodies through grudinno-costal space (a hernia of Larreja - Morgani - a hernia), the pojasnichno-costal - space (a hernia of Bohdaleka), is direct in area - diaphragm parts ( a hernia). Contents of a hernial bag can be an epiploon, cross-section a gut, fatty . True hernias of atypical localisation meet seldom and differ from a relaxation of a diaphragm presence of hernial gate, and consequently, possibility of development of infringement.

At A Dropsy Of Covers Between Leaves Of

At a dropsy of covers between leaves of own cover the liquid accumulates and as a result the sizes increase. Difference of a dropsy of covers from pahovo-moshonochnoj hernias consists that the dropsy has roundish or oval, instead of the pear-shaped form, a consistence, a smooth surface. Palpated formation cannot be delimited from and its appendage. The big dropsy of covers , reaching an external aperture the channel, it is accurate from it can be separated at . At to a hernia palpated in formation has "the leg" leaving in the channel as in a hernial bag there are the contents which have left in it from a belly cavity of Perkutornyj a sound over a dropsy stupid, over a hernia can be . yields positive result at a dropsy of covers . make in a dark room by means of a small lamp densely put to a surface -. If palpated in formation contains a - transparent liquid it at will have reddish colour. Intestinal loops being in a hernial bag, an epiploon do not pass light beams. With a hernia has similarity expansion of veins seed at which in vertical position the patient has stupid holding apart pains and - some increase in the sizes is marked.

Ranevye Surfaces Are Covered By A Dense Scab,

Ranevye surfaces are covered by a dense scab, easily bleed. Hem formation probably within last several months. In the remote terms (to 2 - 3 years) after a burn (a stage of late complications) on the first place in a clinical current act . From starvation the condition of the patient worsens ("Cicatricial narrowings of a gullet") see. Besides , development of a cancer, punching of a wall of a gullet and such complications, as a pneumonia, a lung abscess, , , pishchevodno-bronchial fistulas is possible. The URGENT HELP AT CHEMICAL BURNS of the GULLET And TREATMENT In the SHARP PERIOD the Urgent on-site assistance of incident. For removal of a pain by the patient introduction of drugs (, , etc.) is shown. For reduction and removals of a spasm of a gullet enter atropine, , . - Oral cavity washing, appointment preparations (a Dimedrol, , , etc.) is expedient. The important action directed on deducing and neutralisation of poison, washing of a stomach by means of a rubber probe is. Depending on character of the accepted substance for stomach washing use weak solutions of alkali or acid.

At All Patients With Suspicion On A Gullet

At all patients with suspicion on a gullet cancer it is shown . Depending on the anatomic form of a cancer the tumour kind happens various. Initial forms of a cancer can look - as or a polyp. At - to the form mark local the gullet walls, revealed at pressing by the end . At the further - progressing the hilly weight covered grayish or for a short while is visible to a tumour. The tumour surface - easily bleeds at a touch. There is a concentric or unilateral narrowing of a gleam of a gullet. At the ulcer form define a bleeding tumour with the rough - pitted edges. The infiltrirujushchaja form is shown a rough bleeding mucous membrane, - narrowing of a gleam of a gullet. it is easily realizable at tumours, it is more difficult to receive for research a fabric slice - at ulcer and a cancer. At the negative answer in doubtful cases it is necessary to repeat. At it is necessary to make also cytologic - research of a contained gullet and dabs from tumour area. Cytologic research in a combination with at the - majority of patients allows to confirm or reject the cancer diagnosis.

The Greatest Damages - First Of All Arise

The greatest damages - first of all arise in area furrows on a place guts a restraining ring. Eventually changes progress-. The restrained gut of sine-black colour, its serous cover dim, plural subserous hemorrhages. A gut flabby, not , vessels do not pulse. "Hernial water" muddy, character, has a smell. Nekrotichesky changes are accompanied by a gangrene of a wall of a gut, punching, development so-called a phlegmon and a peritonitis. At infringement of a gut it is considerably broken krovo - and not only in the restrained gut, but also in - resulting department of intestines. Owing to intestinal impassability intraintestinal pressure raises, gut walls - are stretched, squeezed veins, is broken -. The congestion in a wall and in gut cavities, overflow by its intestinal contents even more is aggravated with blood circulation infringements in connection with vnutriste-night arteries. First of all the mucous membrane on a considerable extent is damaged. From visible outside of border of the changed wall of a gut mucous membrane damage extends for 20 - 30 It see it is necessary to consider at definition of level of a resection of a resulting loop.

An Operational Wound Take In. In A Method

An operational wound take in. In a method basis the principle of simultaneous - injection is put - in a zone destroyed and inflamed an antiseptic solution and this solution together with the contents accumulating in a zone of a posttraumatic purulent inflammation. There are various methods at gullet damages. - during time - it is possible at integrity preservation pleurae-. At damages cervical and gullet departments - use with hermetic . At - wounds of chest department of a gullet with damage of mediastinal th pleura it is shown access with simultaneous and a pleural cavity. Extrapleural active it is possible at damages - and gullet departments. To the Tonic-nie active tight at a - gullet allows to replace operation with carrying out in a stomach a thin-walled silicone probe for feeding of the patient. The resection of the damaged gullet is shown only at - tumours or at its sharp cicatricial change during the first hours after punching at people young and middle age. GULLET FOREIGN MATTERS The reasons of hit of foreign matters in a gullet can be: a habit to hold various subjects in a mouth (at small children, at workers of some trades), Negligence in cooking and hasty meal, deliberate various - subjects mentally sick.

Pains Behind A Breast And In A Back

Pains behind a breast and in a back amplify, the short wind and a tachycardia accrues, the body temperature gets character, are replaced by down-pour sweats, formation of a hypodermic emphysema, cough occurrence at reception of liquid food is possible. , arisen in the sharp period, it can be shown by symptoms sharp , a pneumonia, a lung abscess. In hard cases in the presence of extensive surfaces on gullet walls probably development of a sepsis. The latent period is characterised by function infringement bodies that is caused by dystrophic - changes, albuminous starvation. By the end of month (a formation stage ) under the influence of treatment the burnt sites of a gullet heal. At 10 - 15 % of patients at radiological research find out absence longitudinal a mucous membrane, single or plural sites of narrowings of a gullet of various - extent. At 20 % of patients by the end of month of the phenomenon "alternating-" increase. At mark various extent the sites which healing - occurs inertly.

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.