The Ends A Gut Site Take In. Between

The ends a gut site take in. Between resulting and taking away loops impose the end in the end or a side sideways At this stage of operation - cavity isolation from a cavity of a hernial bag can be carried out-. With that end in view round a mouth of a hernial bag dissect - and it in the parties on 1,5 - 2 see Resulting and taking away loops guts near to hernial gate stitch two numbers of mechanical seams (or tie up two ). Then between seams cross loops guts and delete them together with their part Over the blind ends of the restrained - gut which are in a hernial bag, sew - . Edges sew. Thus the cavity is isolated from a cavity of a hernial bag. A wound of a belly wall take in tightly. The second stage - surgical processing of the purulent centre (a - hernial phlegmon). Radical surgical processing of the purulent centre - consists in impractical, , - fabrics. , sharp skin - its harbingers of the subsequent . An authentic sign of viability of fabrics is the plentiful capillary - bleeding.

Hernial Is In Close Contact To A Sciatic

Hernial is in close contact to a sciatic nerve, therefore pains can on a nerve course. Sciatic hernias are more often observed at women in connection with in the width of a female basin. The small intestine, the big epiploon can be hernia contents. Treatment: the surgical. COMPLICATIONS OF EXTERNAL HERNIAS OF THE STOMACH Complications of external hernias of a stomach: infringement, , not-vpravimost, an inflammation. The infringement of a hernia is the most frequent and dangerous complication - of a hernia demanding immediate surgical treatment. The bodies which have left in a hernial bag are exposed more often at level of a neck of a hernial bag in hernial collars. Infringement of bodies in the most hernial bag probably in one of chambers of a hernial bag, in the presence of cicatricial , - squeezing bodies at unions of bodies with each other and with a hernial - bag (at hernias). The infringement of a hernia arises more often at people of middle age and at old people. Femoral hernias are restrained in 5 times more often, than and umbilical.

The - Hernial Bag Is Formed By Means

The - hernial bag is formed by means of a stretching and progressing - . Clinic and diagnostics: the Basic symptoms - of disease are a pain in the field of a hernia and in a stomach, presence in one of hernial zones. appears at or in vertical position of the patient, - disappears or decreases in horizontal position after manual reposition. The pain in the field of hernial arises at - physical activity, walking, sharp movements, at changes - of barometric pressure. Quite often there is a nausea, an eructation, a stomach swelling, locks. Hernia development occurs, as a rule, slowly. In the beginning in a place of a formed hernia there is a pricking pain at physical activity, walking, run, weight lifting. After a while appears which disappears in horizontal position of the patient and again arises at - physical activity. gradually increases, - gets the roundish or oval form. At the hernias which have sharply arisen - at the moment of sharp increase of intrabelly pressure, patients feel a severe pain in the field of a formed hernia, sudden occurrence a belly wall and a hemorrhage - in surrounding fabrics.

Treatment: In Connection With Infringement Possibility At -

Treatment: in connection with infringement possibility at - operation is shown a hernia. At right-hand localisation of a hernia operation make through access to the fourth , at hernias the best - access - top median , at link sided hernias it is shown access to the seventh - the eighth -. After division of unions, clearings of edges of defect in a diaphragm reduce the moved bodies in a belly cavity and take in defect separate central seams with formation . At the big sizes of defect resort to alloplasti-cheskomu to replacement of a diaphragm by artificial limbs from kapron, nylon, teflon, lavsan, etc. At hernias (a hernia of Larreja, a hernia) reduce the moved bodies, turn out and cut at a neck a hernial bag, impose and consistently fasten P-shaped seams on edges of defect of a diaphragm and a back leaf of a vagina of belly muscles, a breast and edges. At hernias of pojasnichno-costal space defect - of a diaphragm take in separate seams with - formation . At restrained hernias access -.

The Distalnyj Site Of A Gullet Is Sharply

The distalnyj site of a gullet is sharply narrowed, in it find out a dystrophy cages and fibres nervous textures up to their �destruction. In a - muscular layer observe a dystrophy of muscular fibres, growth of a connecting fabric, especially in a wall of the narrowed segment, - , expansion of vessels, occurrence round them - from and plasmatic cages. In all layers walls and in surrounding fabrics find out signs - of inflammatory process. A gullet mucous membrane , , places . - Changes near to the narrowed site of a gullet are More expressed-. Clinic and diagnostics: for the - triad of symptoms is characteristic: , , pains. - the basic and in most cases the first symptom of disease-. At one patients it arises suddenly, as though among full health, at others develops gradually. Strengthening at the majority of patients mark after nervous excitation-, during hasty meal, at reception of the dense, dry and badly chewed food. It is sometimes observed paradoxical -: the dense food passes in a stomach better, than liquid and semi-fluid.

Long Inflammatory Process Can Lead To Cicatricial Changes

Long inflammatory process can lead to cicatricial changes in a gullet, its shortening and development or progressing of a hernia to food of a water aperture - of a diaphragm. Gullet punching at usually does not happen. The diagnosis establish at presence at sick characteristic symptoms of disease, the data - of radiological research - and . Radiological - research allows - to find out zheludochno-pishchevodnyj a reflux, especially - at research of patients - and a prone position, . (a smoothness, or deformation of folds of a mucous membrane, local or a thickening the walls, insufficient elasticity of a wall of the amazed - site, narrowing of a gleam of a gullet, etc.) At - mark various degree and prevalence - inflammatory changes of a mucous membrane of a gullet: 0 stage _ a - normal mucous membrane; I stage - not merging defects of a mucous membrane; II stage - merging, but not circular defects, III stage - circular ' that cover; IV stage - complications illnesses (ulcers, , a short gullet, ' ).

After A Section Of A Restraining Ring Investigate

After a section of a restraining ring investigate - contents of a hernial bag. At viability preservation the dropped out - body set in a belly cavity, at irreversible - changes - . Defect in a diaphragm take in. HERNIAS OF THE APERTURE OF THE DIAPHRAGM Hernias can be congenital and got. Allocate sliding (axial) and hernias - diaphragm apertures. Sliding hernias. The kardialnyj department of a stomach located -, moves above a diaphragm on an axis of a gullet and takes part in formation of a wall of a hernial bag. Sliding hernias on classification. V.Petrovskogo and . N.Kanshina subdivide on , , and huge (subtotal and total - gastric) at which occurs a stomach in a chest - cavity. The sliding hernia can be fixed and - unstable. Besides, allocate the got short gullet ( I degree is located over a diaphragm at level of 4 sm, above 4 sm - II degree) and a congenital short gullet (a chest stomach). On to the factor sliding hernias can be , and mixed. The major importance - in development of the got sliding hernias diaphragm apertures has the mechanism arising at reduction of longitudinal muscles of a gullet as a result of reflexes from a stomach and other bodies at a stomach ulcer, a cholecystitis and other diseases.

At Research Mark Tone Decrease , Infringement -

At research mark tone decrease , infringement - a type gullet , zheludochno-pishchevodnyj a - reflux which also can be confirmed by the data rN-metrii (decrease to 4,0 and more low) (a sm technique in section "Special methods of research"). Treatment: paramount action is treatment of the basic disease creating conditions for zheludochno-pishchevodnogo of a reflux (a hernia diaphragm apertures, pi-loroduodenalnyj a stenosis, ). Conservative treatment is directed on reflux decrease, reduction of displays -, the prevention of increase of intrabelly pressure. The patient - recommend to avoid the positions of a body facilitating occurrence - of a reflux, to sleep with highly raised headboard of a bed. Depending on degree appoint mechanically and chemically sparing diet (table No 1, 16, 1 on Pevzneru). A food should be frequent (4 - 6 times a day), last food intake for 3 - 4 to a dream. Appoint , enveloping-, astringents, , , preparations, sedative, means, vitamins. At bleedings and spend therapy, at stenoses - .

However At The Majority Of Patients Of A

However at the majority of patients of a pain arise at overflow of a gullet and disappear after or passages - of food to a stomach. Some patients have attacks spontaneous support a breast as painful crises Similar pains observe in a disease initial stage, sometimes in addition before development and which not always - act in film atropine or nitroglycerine is more often - that allows to assume - their communication with progressing dystrophic process in a nervous texture of a gullet. Pains on an empty stomach or after vomiting are is more often caused and act in film food intake. An eructation air, the nausea, the raised salivation, burning on the gullet course, an unpleasant smell from a mouth also - are caused . At patients both with sharp, and with the gradual beginning of disease - in due course symptoms progress: amplifies , arises is more often. Many patients hesitate of the lack, become closed, painfully sensitive. The - most frequent complication of disease is stagnant which arises at a long delay of food weights in a gullet.

Distinctive Signs From Infringements Are Resulted In 6.

Distinctive signs from infringements are resulted in 6. Treatment: clearing of a thick gut of contents. At hernias it is necessary to try to keep a hernia in the set condition then it is easier to achieve restoration intestines. Apply small enemas with a - hypertensive solution of chloride of sodium, with glycerine or repeated siphon enemas with deeply entered probe to guts. Application of a depletive as overflow of a resulting loop by contents can cause transition in the form of infringement of a hernia is counter-indicative. can owing to in hernial collars of a taking away loop to pass in the form of infringement of a hernia. Signs intestinal impassability accrue. The belly-ache amplifies, gets character, vomiting becomes frequent. Further owing to overflow in weights of the gut which are in a hernial bag, occurs hernial collars of all loop of a gut and it . There is a mixed form of infringement of a gut. From this point on there are signs - impassability of intestines. The infringement of the big epiploon causes a constant pain in the field of hernial .

Owing To Mucous Membrane Damage The Intestinal Wall

Owing to mucous membrane damage the intestinal wall becomes nontight for microbes that conducts to peritonitis development. There can be a punching of a resulting loop in area furrows. In a taking away loop of the restrained gut of infringement krovo arise throughout 10 - 15 see Kinds of infringements of hernias and their recognition Clinical displays of infringement of a hernia depend on the form of the infringement, the restrained body, time last from the moment of infringement by the Basic symptoms of infringement of a hernia are a pain in the field of a hernia and a hernia which were earlier freely set. Intensity of a pain the various. The sharp pain can cause a faint, a state of shock Local signs of infringement of a hernia, hernial is sharply painful at , dense, strained. a push it is not possible to reveal a symptom. At it is defined if the hernial bag contains an epiploon a bladder, "hernial water". The perkutornyj sound happens if in a hernial bag there is a gut containing gas.

Early Reception Of Mixture And Food As Though

Early reception of mixture and food as though carries out "soft" a gullet. Formation of hems is interfered also by appointment (, , etc.) Which detain development and reduce inflammatory changes in a gullet. Now carrying out early (with 9 - 11th day) a gullet during 1 - 1 1/2 in a combination to hypodermic introduction or during 2 is recognised expedient. Too early, before this term begun gives opposite effect, causing an aggravation of inflammatory process in a gullet and scarring strengthening. Before the beginning it is necessary to make - which will allow to establish burn degree, absence fabrics. a gullet it is unsafe and can become complicated its punching with development purulent and a pleurisy, therefore he should be spent carefully. Hyperbaric oxygenation is applied to preventive maintenance of cicatricial stenoses of a gullet which reduces depth of a zone , delimits , promotes clarification to a surface and causes it by the end of 1st month. suppresses formation of a connecting fabric that leads to development more friable, thin and a gullet hem.

RARE SPECIES OF HERNIAS OF THE STOMACH Hernias

RARE SPECIES OF HERNIAS OF THE STOMACH Hernias a shoot are formed in the presence of defects in it. Through crevices and apertures in a shoot can be stuck out as , and the Diagnosis it is possible to put true hernias on the basis of the found out consolidation in area a shoot, defect presence in a shoot and the data a shoot. Treatment: the surgical Delete a hernial bag and a shoot of the Hernia semilunar lines are localised on a line connecting a navel with top forward of the bone at a place of transition of muscular fibres of internal slanting and cross-section muscles of a stomach in a stretching. Treatment: the surgical. At small hernias hernial gate close - by suture; at the big hernias after sewing together of muscles it is necessary to create . Lumbar hernias. Weak zones of lumbar area are the triangle - of Peti and an interval of Lesgafta - Grjunfelda. The triangle of Peti is formed by lateral - edge of a wide muscle of a back, back edge of an external slanting muscle of a stomach the triangle basis the comb bones is.

In Cases Heavy A Reflux-ezofagita Make Or Transpleural

In cases heavy a reflux-ezofagita make or transpleural with a stomach in a chest cavity. Congenital insufficiency treat conservatively. Usually eventually there comes function normalisation . GULLET DAMAGES Gullet damages divide on internal (closed) from outside a mucous membrane and the external - necks (opened) at - getting wounds and a thorax. Internal damages of a gullet are possible during - carrying out of diagnostic and medical actions: at -, a gullet, . There are gullet wounds from within at hit in it of foreign matters (see "Gullet foreign matters"). gullet walls arise at a long finding in it of probes, from pressure or tubes. Punching of a wall of a gullet can occur at its various diseases: tumours, an ulcer, chemical burns. At an irradiation of malignant tumours of damage of a gullet arise owing to tumour disintegration. Stupid traumas of a neck, thorax and stomach can lead to infringement of a food and walls of a gullet as a result of its squeezing between a breast and bodies of vertebras Thus often mark damage of the next bodies the Straight line to a gullet trauma can occur during operations on bodies and lungs.

Bottom Possesses "unilateral - Passableness". Pressure Suffices For

Bottom possesses "unilateral - passableness". Pressure suffices For advancement of a contained gullet through penalties-diju in 4 mm hg, in a return direction movement is possible only at increase of pressure to 80 mm hg In norm pressure in the field of physiological above, than in a gullet and a bottom of a stomach, and is equal on the average 22 - 28 mm hg It are caused by the tonic reduction of circular muscular - fibres interfering zheludochno-pishchevodnomu a reflux. The - greatest value has a part physiological - which interferes with a reflux at a considerable difference of pressure in a chest and belly cavity. The normal anatomic arrangement of a gullet in relation to a diaphragm is very important for correct functioning of the closing mechanism physiological . Hit gastric - contained in a gullet is interfered also presence of "the mucous socket" in the field of pishchevodno-gastric , by an acute angle of Gisa, presence of the valve of Gubarev - folds of a mucous membrane at a junction of a gullet with a stomach, a switching reflex on at irritation of a mucous membrane department of a stomach food, etc.