Diaphragm Blood Supply Carry Out Top And Bottom

Diaphragm blood supply carry out top and bottom the arteries departing from an aorta, myshechno-diafragmalnaja and perikardo-diafragmalnaja the arteries departing from internal chest, and also six bottom intercostal arteries. Blue blood outflow occurs on the veins with the same name, on unpaired and - semiunpaired veins, and also on gullet veins. Lymphatic vessels of a diaphragm form some networks: , pleural, intrapleural, , . On the lymphatic - vessels located along a gullet, an aorta, the bottom hollow vein and other vessels and the nerves passing through a diaphragm, inflammatory process can extend from a belly cavity in pleural and on the contrary. - Lymphatic vessels take away a lymph from above through and back knots, from below - through and . diaphragms carry out and intercostal nerves. Allocate static and dynamic functions of a diaphragm. Statistical function of a diaphragm consists in maintenance of a difference of pressure in chest both belly cavities and normal mutual relations between their bodies.

Further Comes - Tumours And Development Inflammations. Supras-Tenotichesky

Further comes - tumours and development inflammations. Supras-Tenotichesky expansion of a gullet at a cancer seldom happens - considerable as the tumour develops in rather short period of time. Distribution of a cancer of a gullet occurs by direct - germination, and . The tumour can extend on a gullet upwards and downwards, to sprout all layers of its wall, to squeeze the next bodies. Rather late complication is tumour germination in the next bodies which can lead to fistula formation between a gullet and a trachea or a bronchial tube, to development of a pneumonia, a gangrene and processes in lungs and a pleura, to a deadly - bleeding at tumour germination in an aorta. cancer cages on lymphatic vessels in a gullet wall can occur on 10 - 15 sm from visible - border of a tumour. Such "cancer " meets at process localisation in the top and average third of gullet is more often. Along with distribution of a tumour to process - superficial and deep lymph nodes are involved-. The tumours - located in cervical and departments of a gullet, mainly in , over - and lymph nodes.

Diagnostics Hernias At Women Is Based On Survey

Diagnostics hernias at women is based on survey and as finger introduction in an external aperture - the channel is impossible. At women a hernia differentiate with a round sheaf of the uterus which is passing in the channel. a round sheaf of a uterus unlike a hernia does not change the sizes at horizontal position of the patient, - a sound over it always stupid, and over a hernia can be . Treatment a round sheaf of a uterus, as well as hernias, surgical. Operation consists at a distance with a subsequent plasticity the channel. Differential diagnostics between hernias and a femoral hernia is resulted at the description of a femoral hernia. Table 4: Differentsialno-diagnostic signs a plait and a straight line hernias of PriznakiKosaja a hernia Forms and an arrangement hernial Back wall the channel Direction a push The relation of a hernial bag to seed to a congenital Thicket happens in children's and middle age of the Oblong form at plumpness on a course the channel Often the - unilateral falls in - to the Thicket It is expressed in an initial stage of formation of a hernia The kashlevoj push in an initial stage of formation of a hernia is felt sideways from outside a deep aperture the channel The thickening seed on the party happens at elderly and old people The roundish form a swelling at a medial part sheaves Seldom falls in to the Thicket bilateral (especially at elderly patients) It is always weakened The kashlevoj push is felt directly against an external aperture the channel The hernial bag is located from seed pahovo-moshonochnaja a hernia, the increase in the sizes , gets similarity to a dropsy of covers .

Pressure Increase In Physiological Thus Is Secondary And

Pressure increase in physiological thus is secondary and is caused by its reaction to - constant pressure of contents filling a gullet, rubtsovo-inflammatory changes in fabrics of terminal department - of a gullet and loss of elasticity by them. At simultaneously change a tone and - a gullet. Instead of extending to a stomach - reductions appear (- not providing a passage) waves, join them segmentary reductions of a wall of a gullet. The food long is late in a - gullet and arrives in a stomach owing to mechanical disclosing under the influence of hydrostatic pressure of a column of a liquid over it. Long stagnation of food weights, a saliva and slime in a - gullet leads to considerable expansion of its gleam, development and that in turn aggravates infringements - a gullet. Pathological anatomy: in the expressed cases of disease mark gullet expansion in diameter to 15 - 18 sm, its lengthening owing to what it can accept the S-shaped form. Its capacity reaches 2 - 3 l instead of 50 - 100 ml at healthy people.

Treatment: Principles Of Surgical Treatment At A Sarcoma

Treatment: principles of surgical treatment at a sarcoma same, as well as at a gullet cancer. Some kinds of sarcomas well - give in to beam therapy. In the started cases of disease - spend symptomatic therapy. DIAPHRAGM Diaphragm - the suhozhilno-muscular formation dividing chest and belly cavities. The muscular part of a diaphragm begins on a circle - of the bottom aperture of a thorax from a breast, an internal surface of cartilages VII - XII edges and lumbar vertebras (, costal and lumbar departments of a diaphragm). Muscular bunches go up and radially and - dome-shaped cambers come to an end - with the centre, forming on the right and at the left. Between and costal department is available space (a triangle - of Morgani, Larreja), filled . Lumbar and costal departments are divided by pojasnichno-costal space (a triangle of Bohdaleka). The lumbar - department of a diaphragm consists from each party of three legs: external (-), intermediate and internal (medial). Suhozhilnye edges of both internal (medial) legs of a diaphragm form at level of I lumbar vertebra more to the left from a median line an arch limiting an aperture for an aorta and a chest lymphatic channel.

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.