At This Time Intestinal Loops Being In A

At this time intestinal loops being in a hernial bag, can be still viable. Before operation it is impossible to establish the diagnosis During operation the surgeon, having found out in a hernial bag two intestinal loops, should to deduce after a section of a restraining ring from a belly cavity a binding intestinal loop and to define character of the arisen changes in all restrained intestinal loop. If during operation it is not distinguished infringement as the surgeon has not examined a binding intestinal loop being in a belly cavity at the patient the peritonitis will develop. The binding loop of a gut will be a peritonitis source . The pristenochnoe infringement occurs in a narrow restraining ring when the part of an intestinal wall opposite to an attachment line is restrained only. It is observed infringement of a small intestine more often in femoral and hernias is more rare in the umbilical. Frustration and in the restrained site of a gut leads to development of destructive changes to and gut punching.

Through A Mouth It Is Blindly Shown At

through a mouth it is blindly shown at small on extent verhne - and gullet departments. Treatment spend by means of a special set . If passes easily, spend the following on a thickness of number. The technique has been improved at application - of metal conductors and hollow -. They give the chance the radiological control for course definition and advancements on a gullet that raises efficiency of procedure and reduces danger of punching of a gullet. under the control it is shown at located , the channel of narrowing expressed expansion when there are difficulties at conductor carrying out. "Buzhirovanie endlessly" apply at presence at patients with tubular, or plural -. To the silk thread entered through a mouth and deduced through , attach rubber tubes of various diameter. Stretching, them spend through the narrowed site and leave at some o'clock. through it is more safely and easier transferred by patients At some patients mechanical expansion cicatricial a gullet can lead to formation .

The Long Anamnesis Of Disease Is More Characteristic

The long anamnesis of disease is more characteristic for , than for a cancer. At a cancer the first symptom usually is , the pain joins later at germination by a tumour of a wall of a gullet and nervous trunks. At the first symptom - quite often is the pain, arises later. at a cancer unlike always has steadily progressing character. For a cancer it is not peculiar plentiful and night . At appetite at the majority - of patients happens is kept, seldom comes considerable on-hudanie. At radiological research of a gullet at a cancer mark narrowings, roughness of its contours, destruction of a relief of a mucous membrane, its walls, there is no considerable expansion and a S-shaped curvature of a gullet, there are no expressed infringements , the gas bubble of a stomach is kept. Crucial importance for diagnosis statement has with aim for - histologic and cytologic research of the received - material. At good-quality tumours of a gullet radiological research reveals roundish defect of filling with equal contours.

A Protective Barrier Of A Mucous Membrane: 1)

a protective barrier of a mucous membrane: 1) " a barrier", covering ; 2) the first line of protection - membranes of cages, 3) the second line of protection - a membrane mucous. The mechanisms stimulating secretion of hydrochloric acid: , , products of digested food, . - parasympathetic nervous system it is liberated in a stomach wall in the answer as on stimulation of wandering nerves (in a brain - phase of gastric secretion), and on local stimulation nervous textures at a food finding in a stomach (in a gastric phase of secretion) Acetyl-holin is an average on force a stimulator of production of hydrochloric acid and the strong - activator of liberation from G-cages. - the hormone, is allocated from G-cages department of a stomach and the top department of a small intestine, stimulates secretion of hydrochloric acid with cages and their sensitivity to parasympathetic and other stimulation. Clearing from G-cages parasympathetic stimulation, albuminous food, cause, amino acids, calcium, a mechanical stretching of a stomach, alkaline value in department.

To Birthday Of The Child Are In ,

To birthday of the child are in , the shoot grows. At brjushinno-pahovogo a shoot the hernia is formed congenital . In case of incomplete brjushinno-pahovogo a shoot on its separate sites arise a kisty-dropsy seed . The brjushinno-pahovyj shoot covering , forms own a cover . - Cross-section a stomach forms the general a cover for and seed . Internal slanting and cross-section muscles participate in about a muscle lifting Anatomy areas. At survey of a forward belly wall from within from outside the belly cavity can see five folds - and the deepenings (pole) which are places of hernias - External a pole is an internal aperture the channel, it is projected approximately over the middle sheaves on 1-1,5 sm above it. In norm the channel represents the space filled at men seed and at women - round a sheaf of Pahovyj the channel passes obliquely at an angle to to a sheaf and has length at men nearby 4-4,5 see Walls the channel a lobby - an external slanting muscle of a stomach, bottom a sheaf, back - cross-section a stomach, top - free edge of internal slanting and cross-section muscles of a stomach.

For The Prevention In A Belly Cavity Of

For the prevention in a belly cavity of the restrained bodies the assistant to the surgeon keeps them by means of a gauze napkin. The section of a restraining ring before opening of a hernial bag as the uninspected restrained bodies will move to a belly cavity together with infected with "hernial water" is inadmissible. The third stage - a section of a restraining ring make under the sight control not to damage the bodies soldered to it from within. At femoral hernias a cut spend medially from a neck of a hernial bag in order to avoid damage of the femoral vein located at of the party of a bag. At umbilical hernias restraining ring dissect in a cross-section direction in both parties. The fourth stage - definition of viability of the restrained bodies is the most responsible stage of operation After a section of a restraining ring and introduction in solution guts from a belly cavity deduce those parts of the restrained bodies which were above a restraining ring It is impossible to tighten strongly a gut as there can be a - rupture its (separation) in area furrows.

Hernias Dvenadtsatiperstno-toshchekishechnoj Poles. In - The Period Of

Hernias dvenadtsatiperstno-toshchekishechnoj poles. In - the period of development as a result of turn of an umbilical loop round an axis top arteries is formed dvenadtsatiperstno-toshekishechnaja a pole (recessus duodenojejunalis - a pole of Trejttsa). This pole can become hernial collars with formation - of the internal restrained hernia. Hernias poles (recessus retroduodenalis) name hernias. Small intestine loops get between plates guts to the right or to the left. To thicket hernial collars of internal hernias are pockets in the field of a blind gut (recessus ileocecalis superior et interior, recessus retrocecalis) or guts (recessus intersigmoideus). Damages - during operations on bodies of a belly cavity can be the reasons of formation of hernial gate-: not taken in cracks in , in the big epiploon. Disease symptoms at internal hernias arise at impassability of intestines in which occasion of patients operate. During operation carefully investigate walls of hernial gate, to the touch define absence of a pulsation of a large vessel (top - or bottom arteries).

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.