At Occurrence Of Early Bleedings Spend Haemostatic Therapy.

At occurrence of early bleedings spend haemostatic therapy. At a poisoning with an acetic essence and development vnutrisosu-distogo application is necessary for therapy (5 % a solution of bicarbonate of sodium) and forced . At development of sharp nephritic insufficiency hemodialysis carrying out is shown. At defeat of a throat and development the patient impose . At gullet punching urgent surgical intervention is necessary. During all sharp period of disease careful care of an oral cavity is necessary. For the control over changes in a gullet periodically spend . Cicatricial narrowings of a gullet. have considerable extent and are is more often located in places of physiological narrowings of a gullet: glotochno-pishchevodnogo, , . Depending on depth of damage - of a wall of a gullet are formed various extent. Filmy represent thin membranes in the thickness in some millimetres, in the thickness 2 - 3 sm, tubular in the extent 5 - 10 sm and more, subtotal and total. can be single and plural, full and incomplete.

Hernial - Has The Small Sizes That Corresponds

Hernial - has the small sizes that corresponds to the small sizes a hernial bag. Hernial dense, painful. (stagnation weights) and infringement. - hernia complication when contents of a hernial bag is the thick gut. Develops as a result ' - frustration of motor function of the intestines connected with sharp fall of a tone of an intestinal wall. The inactive - way of life, plentiful meal promote hernias-. it is observed more often at corpulent patients of senile age, at men at hernias, at women at umbilical hernias. Symptoms: basic locks, belly-aches, a nausea, seldom vomiting. Hernial in process of filling of a thick gut in weights, it slowly increases almost Table 6: Differentsialno-diagnostic signs and forms of infringement of a hernia. Koprostazelastichesky infringement of a hernia B slowly, gradually Hernial , the consistences, slightly strained The kashlevoj push is defined Closing of intestines the incomplete Vomiting rare The general condition of average suddenly, quickly Hernial very painful, very strained The kashlevoj push is not defined Full impassability of intestines Vomiting frequent The general condition heavy, a collapse Without serious consequences, it is poorly strained, consistences, the symptom a push is defined.

The Question "where Localises A Pain?" The Doctor

The question "where localises a pain?" The doctor defines, what pain at the patient: At indistinct localisation - a pain , exact localisation - is possible only at a somatic pain. When there is a pain? This question specifies, whether the pain is periodic, - incidental, constant. The pain arises a question "why?" - Reveal the factors provoking a pain. Such factors can be, for example, an emotional pressure (at a stomach ulcer of a duodenal gut), certain food (at a chronic cholecystitis), horizontal or bent - body position -(at a hernia diaphragm apertures). Fizikalnoe research begin with the general survey, thus on a suffering look of the patient it is possible - to assume that the patient feels a pain. The pale face with the pointed - lines, hollow cheeks and eyes causes suspicion on disease with involving in inflammatory process (Hippocratic face). At survey of eyes it is possible to reveal a jaundice, an anaemia. Dryness of integuments happens is expressed at the - diseases accompanied by infringements vodno-elektrolitnogo of balance.

In Mild Cases It Is Shown And A

In mild cases it is shown and a mucous membrane hypostasis, in heavier - presence of rough and - non-uniform folds, erosion, ulcers which are usually located a - little above the narrowed site. The bleeding, gullet punching, further can develop. Chronic can be at the bottom of occurrence of a cancer of a gullet and . Frequent complications are repeated aspira-tsionnye , abscesses of lungs, a pneumosclerosis. - Especially often these complications meet at children. The - complications caused by the expanded gullet of a returnable nerve, the right main bronchial tube, the top hollow vein, a wandering nerve and are described-. In Petrovsky - allocates four - stages of disease: I stage - a functional changeable spasm , - gullet expansions - is not observed; II stage - a stable spasm with unsharp expansion of a gullet, III stage - cicatricial changes muscular ate with the expressed expansion of a gullet, IV stage sharply expressed - stenosis with a gullet, often S-shaped form, and . The basic methods of diagnostics are oe research, , , pharmacological tests.

Operation Consists In Laparoto-mii, Resections Of The Changed

Operation consists in laparoto-mii, resections of the changed site of a gut to level of the kept sufficient blood circulation in resulting and taking away intestinal - loops The patient at whom at receipt in a reception it is not revealed signs of a peritonitis, an intraintestinal bleeding-, should be hospitalised in a surgical hospital for dynamic supervision. To release the patient home it is dangerous. Dynamic supervision of the patient should be directed on early revealing of signs of a peritonitis and an intraintestinal - bleeding. Methods of dynamic research of the patient with spontaneously set restrained hernia the following: Complaints: a belly-ache, dryness of mucous membranes of an oral cavity. Survey: integuments (pallor); an oral cavity (dryness of mucous membranes). Haemodynamics indicators: pulse, the HELL, a shock index = / the HELL. Temperature and . Stomach research (pressure of muscles and local morbidity), local morbidity, easing of intestinal noise Research through a rectum morbidity at pressure upon gut walls, a blood impurity in contents.

Temperature: And . Haemodynamics Indicators: Pulse, Arterial Pressure,

Temperature: and . Haemodynamics indicators: pulse, arterial pressure, hearts. Stomach research: survey, , , auskulta-tsija, stomach volume, research through a rectum (morbidity-, walls). For definition of indications to urgent hospitalisation it is enough - to establish, whether there is a peritonitis, an inflammation or body corking, a bleeding. Not to enter drugs, antibiotics! The diagnosis at a direction in a hospital a sharp stomach or at the revealed reason of a sharp stomach specify the disease form. On a direction on hospitalisation apply an extract from the case record (the data of the anamnesis and about the spent treatment). At a shock it is necessary during transportation in specially equipped car carrying out of antishock treatment. Into methods of research of the patient in a hospital enters - research: the anamnesis, the data on systems. At research of cardiovascular system along with - and hearts, definition of a pulse rate, arterial pressure at suspicion on a myocardium heart attack - do an electrocardiogram.

Radical Operative Treatment Consists In Defect At Prescription

Radical operative treatment consists in defect at prescription of damage of a gullet till 1 days. defect in a gullet wall make two numbers of seams in a longitudinal direction. Tightness of seams and their isolation from infected and a pleural cavity diaphragms, walls of a bottom of a stomach provide round them depending on level of an arrangement of defect of muscles of a neck, a site pleurae, a pericardium. and a pleural cavity for , introductions of antibiotics-, antiseptic tanks, enzymes. The reason of failures of radical operations - is frequent development of insufficiency of seams. Palliative operations (, , , , spaces of a neck, a pleural cavity) are shown at through wounds - of a gullet when time for radical operation is missed, and at heavy accompanying diseases. Recently at gullet punching - was extended a method active and tight -. Thus carry out taking into account a place of damage of a gullet, more often from a cut on a neck, also bring to a punching place a drainage tube which deduce away from an operational wound.

Treatment: Only The Surgical. After Removal Of A

Treatment: only the surgical. After removal of a hernial bag and make a belly wall on a method of Sapezhko or on a method of Mayo. Method of Sapezhko: two longitudinal sections bordering a - hernia, a skin together with a navel. Hernial - gate dissect upwards and downwards on a white line of a stomach to places where it is narrowed and is not changed. Open a hernial bag, set the internal separated from a hernial bag in a belly cavity. from a back - surface of a vagina of one of direct muscles of a stomach. a hernial bag, edges sew it. Separate seams grasping - on the one hand edge a white line of a stomach and on the other hand a part of a vagina of a direct muscle where , create from myshechno-aponevroticheskih rags "thus a rag located - superficially, file to bottom in a kind . Method of Mayo: two cross-section - cuts bordering a hernia - a skin together with a navel. From hernial gate from hypodermic fatty - on a circle distance 5 - 6 see After opening of a hernial bag divide unions, the soldered big epiploon, set an internal in a belly - cavity.

At First The Patient Empties A Bladder, And

At first the patient empties a bladder, and then after pressing on hernial there is a new desire on , and the patient starts to be wetted again. At suspicion on a sliding hernia of a bladder it is necessary to execute a bladder and . Last - to reveal the form and the sizes of a hernia of a bladder, presence of stones in a bladder. Treatment: only the surgical. If not to know anatomic features of a sliding hernia, it is possible to open during operation instead of a hernial bag a wall of a gut or a - bladder wall-. Surgical treatment - the basic method of treatment of external - hernias of a stomach. Operation - it unique possibility to prevent such heavy complications of a hernia, as its infringement-, an inflammation, etc. Operation of not complicated hernias spend on stages: dissect - fabrics over a hernial bag, dissect hernial gate, allocate a hernial bag, open it, set contents of a hernial bag in a belly cavity, stitch and tie up a - hernial bag in the field of a neck, cut a hernial bag and strengthen a belly wall in the field of hernial gate by a plasticity local fabrics or materials.

Research Make So That The Healthy Place Has

Research make so that the healthy place has been investigated in last turn. Rough superficial make to reveal pressure of muscles of a belly wall and morbidity localisation. Research carry out, making easy pressing by a hand on a belly wall. Pressure of muscles judge on expressiveness of resistance which is felt by a palpating hand at a - touch to a stomach. It is necessary to compare a tone of the muscles of the right and left parties of a belly wall with the same name at identical level, conducting research at first less painful areas. On degree of expressiveness of pressure of muscles distinguish: the small resistance, the expressed pressure, pressure-. Pressure of muscles happens is expressed on the limited - small site or has poured character. Pressure of muscles - display a reflex as a result of the - irritation which are starting with , bodies - of a belly cavity. It is the major symptom of an inflammation -. However he can be observed and at disease of the bodies located ( a pleurisy, , a myocardium heart attack, nephritic ), at presence in space of hematomas, abscesses, at bruises of the bottom edges to which muscles of a belly wall are attached.

Expansion Of An Umbilical Ring And Hernia Formation

Expansion of an umbilical ring and hernia formation are promoted by the various diseases connected with increase of intrabelly pressure (a whooping cough, a pneumonia, , a dysentery). Hernias at children happen the small sizes is more often. Symptoms: a belly-ache causing anxiety - of the child, in the field of a navel, disappearing at pressing-, expansion of an umbilical ring. Umbilical hernias at children usually are not restrained, however this complication is possible. Parents of the child should be informed on signs of infringement of a hernia and to explain necessity - of immediate hospitalisation of the child at development of this complication-. Treatment: at small children in process of development of a belly wall probably self-healing at the age from 6 till 3 years, sometimes by 6 years. If the hernia does not give to the child of troubles, apply conservative treatment. Appoint massage, the medical gymnastics promoting development and strengthening belly . On navel area impose a bandage interfering of interiors in a bag.

Presence Zheludochno-pishchevodnogo A Reflux Can Be Confirmed By

Presence zheludochno-pishchevodnogo a reflux can be confirmed by the data rN-metrii (decrease to 4,0 and more low) (see has undressed "Gullet", "- Special methods of research"). Paraezofagealnye hernias subdivide on , , intestinal, intestinally-gastric, . remains, on a place, and through the diaphragm aperture near to a gullet occurs displacement in a stomach or an intestines. Unlike sliding hernias at hernias probably development of infringement. Observe hernias is more often. At hernias the clinical picture depends on a kind and contents of a hernia, degree of displacement of surrounding - bodies. Switching function is not broken (there are symptoms - zheludochno-pishchevodnogo no reflux) gastroenteric or is warm-pulmonary complaints Can prevail. Most often there is a moving to a chest cavity of the stomach, shown by pains in areas and behind a breast, arising after food intake, , an eructation. At infringement - sharp pains, vomiting with a blood impurity are observed. At hernias during time a - thorax reveal in back against a heart shade a roundish enlightenment, sometimes with liquid level.

Pain (at 33 %) - A Frequent Symptom

Pain (at 33 %) - a frequent symptom of a cancer of a gullet. Pains behind a - breast of stupid pulling character arise during food intake-, can in a back, a neck, the left half of thorax. The mechanism of occurrence of pains the various. Pains behind a breast-, arising during food intake, are caused injured - by food of the inflamed wall of a gullet about a tumour and . Stupid pains during food intake - arise at a gullet a tumour. In this case occurrence of pains is connected with the strengthened reduction of a wall - of the gullet, directed on food advancement through the narrowed site. The constant pains not dependent on food intake or amplifying - after meal, are caused by tumour germination in - fabrics surrounding a - gullet and bodies, wandering and sympathetic - nerves, development and . Metastasises in a backbone can be the reason of pains. food and vomiting (at 23 %) appear at considerable a gleam of a gullet and a food congestion over a narrowing place. Emetic weights consist of not digested - food, a saliva and slime, sometimes with a blood impurity.

- A Powerful Stimulator Of Secretion Of Hydrochloric

- a powerful stimulator of secretion of hydrochloric acid. in a stomach synthesise and store mucous membrane cages (corpulent, entero-hromaffinnye, ). Secretion, , grows out of activation 2- on a membrane cages. So-called antagonists 2- (, , , and ) block action and other stimulators of gastric secretion. The mechanisms suppressing secretion of hydrochloric acid: acid "brake", small intestine factors (, , . The antralnyj department depending on contents carries out production of hydrochloric acid cages. Allocated from G-cages stimulates secretion of hydrochloric acid, and its surplus, causing contained department, liberation brakes. At low value <2,0 liberation and secretion of hydrochloric acid stops. On a measure and neutralisations of hydrochloric acid by an alkaline secret glands at 4,0 liberation and secretion of hydrochloric acid renews. There is an assumption of participation of wandering nerves in a braking mechanism of secretion of hydrochloric acid at contained department. Receipt of sour contents from a stomach in a duodenal gut is a stimulator for functions of S-cages.

- Deterioration Of The General Condition Of The

- Deterioration of the general condition of the patient, pain strengthening testify to development of inflammatory process in -, character of a body temperature, short wind and - tachycardia strengthening-, increase in leukocytes, increase . In the absence of treatment patients with purulent die within the next few days. Profuznye bleedings arise at extensive ruptures of a mucous membrane of a gullet by Frequent complication at damage - pleurae is pleurae. At distribution of inflammatory process on a backbone, - covers back and a brain there is a pain at movement of hands, at pressing on awned shoots of vertebras, a headache In the remote terms can develop and the cicatricial deformations of a gullet shown . Radiological research is the basic method of diagnostics of damages of a gullet It begin with survey and at which it is possible to find out an emphysema , expansion of its shade, , an emphysema necks In the absence of air in investigate a gullet with contrast substance in position - of the patient lying on a back, on right and left to a side, on a stomach.