The Pishchevodnoe Aperture Of A Diaphragm Is Formed

The pishchevodnoe aperture of a diaphragm is formed in most cases at the expense of the right internal (medial) leg of a diaphragm, the left leg participates in its formation only in 10 % of cases. Through a diaphragm aperture pass also wandering nerves. Through intermuscular cracks of lumbar department of a diaphragm pass sympathetic trunks, nerves-, unpaired and semiunpaired veins. The aperture for the bottom hollow vein is located in the diaphragm centre. From above the diaphragm is covered intrachest , a pleura and a pericardium, from below-intrabelly and . To diaphragm parts a pancreas, the duodenal gut, the kidneys surrounded with a fatty capsule and adrenal glands. To the right dome of a diaphragm a liver, to left - a spleen, a stomach bottom, the left share of a liver. Between these bodies and a diaphragm there are corresponding sheaves. The right dome of a diaphragm is located - above (the fourth ), than left (the fifth ). The height of standing of a diaphragm depends on the constitution, age, presence of various pathological processes in chest and belly cavities.

N2 - Mobile Lymph Nodes On An Opposite

N2 - Mobile lymph nodes on an opposite side or - bilateral. N2a - The increased lymph nodes do not contain metastasises. N2b - The increased lymph nodes contain metastasises. N3 - The fixed lymph nodes. M - the remote metastasises - there are no displays of the remote metastasises in lymph nodes or - other bodies. M1 - There are remote metastasises. M1a - Metastasises in the remote lymph nodes. M1b - Other remote metastasises. Clinic and diagnostics: in clinical display of a cancer of a gullet it is possible to allocate three groups of symptoms: 1) the places-chye, depending on defeat of walls of a gullet; 2) secondary, resulting distributions of process on the next bodies and fabrics; 3) the general. The beginning of development of a cancer of a gullet passes . The latent period can last 1 - 2 years. (at 70 - 98 % of patients) are the first symptom of disease, but in essence it is the late symptom arising at closing of a gleam - of a gullet by a tumour on 2/3 and more, thus at 60 % of patients there are metastasises in .

If The False Infringement Is Not Distinguished And

If the false infringement is not distinguished and operation concerning a hernia is undertaken, it is important to estimate correctly at this diagnostic stage contents of a hernial bag (a condition of intestinal loops, character ). At the slightest suspicion on an acute disease of bodies of a belly cavity (in a hernial bag a little changed loop of a gut, purulent or ) it is necessary to make median for revealing of a source of a peritonitis. Treatment: the restrained hernia is the indication to - emergency operation. It is necessary to eliminate infringement and to find out viability of the restrained bodies. Operation spend to some stages The first stage - a level-by-level section of fabrics to and an exposure of a hernial bag. The second stage - opening of a hernial bag make - not to damage cautiously - intestines loop, skintight to a wall of a hernial bag. At sliding and femoral hernias there is a danger of damage of a wall of a thick gut or a bladder. Having opened a hernial bag, delete "hernial water".

In A Duodenal Gut Digestion Of All Food

In a duodenal gut digestion of all food - components is carried out-. The duodenal gut has value in regulation functions of a stomach, a pancreas, a liver, in activity coordination the device. Stomach and duodenal gut, participating in a metabolism, provide homeostasis regulation. Being the main link in hormonal - system of a gastroenteric path, the stomach and a duodenal gut influence diverse functions of various systems of a human body. SPECIAL METHODS OF RESEARCH The analysis of gastric juice. To research of secretion of gastric - juice apply stomach sounding by a thin probe. Before the research beginning through a probe take the - contents which have accumulated in a stomach-. Investigate "" secretion during the interdigestive - period and secretion after - stimulator introduction-. Secretion zhel-udochnogo juice is on an empty stomach carried out mainly as a result of influence on the device - of a stomach of wandering nerves, therefore on indicators "" secretions can be judged a condition of a tone of wandering nerves indirectly.

Often Mark - Gurgle And Rumbling In A

Often mark - gurgle and rumbling in a thorax on the hernia party, short wind strengthening in horizontal position. After meal there is a vomiting - by the accepted food that brings simplification. At a stomach, - accompanied by a gullet excess, develops paradoxical (the firm food passes better liquid). Direct dependence of expressiveness of clinical symptoms on degree of filling of a gastroenteric path has the big diagnostic value. Infringement hernias characterise sharp pains in a corresponding half of thorax or in areas, in a back, a shovel. The infringement of hollow body - can lead and punching of its wall with development . To suspect a hernia it is possible at presence in the - anamnesis of the trauma, listed above complaints, reduction of mobility - of a thorax and smoothing of intercostal intervals by the defeat party, a stomach at big it is long existing hernias, definition or over a corresponding half of the thorax, changing - intensity depending on degree of filling of a stomach and an intestines-, auscultation an intestines or splash noise in this zone at simultaneous easing or a total absence of respiratory noise, dullness displacement in not amazed - party.

Revealing Of Noise Of Splash Of A Liquid

Revealing of noise of splash of a liquid in a stomach is reached by drawing of short pushes on a belly wall tips of the semibent fingers. Noise of splash of the liquid, defined on an empty stomach, testifies to infringement of evacuation from a stomach (a stenosis of an exit from a stomach, a stomach). Noise of splash of a liquid in intestines can be found out at intestinal impassability. At a stenosis aorta department listen to noise in a point at once below a navel and on 2 sm to the left of an average line. Manual research of a rectum. Define a tone , gut contents (, slime, blood), a condition glands. At manual research of a rectum tumours and gut departments, in a small basin, cancer metastasises on (metastasises of Shnitslera), tumours guts, tumours of a uterus and can be revealed. At sharp diseases of bodies of a belly cavity manual research of a rectum gives the important information. Morbidity at pressing on rectum walls specifies in inflammatory changes prjamokishechno-matochnogo deepenings ( a pocket-) and bodies of a small basin.

To Conduct Research It Is Necessary Very Cautiously

To conduct research it is necessary very cautiously in connection with punching possibility . Treatment at the small sizes , absence of complications, absolute contra-indications to surgical - treatment spend the conservative therapy directed on - preventive maintenance of a delay of food weights in and reduction of possibility of development . The food should be - high-grade, mechanically, chemically and thermally sparing. The patient recommend to eat well crushed food After meal - it is necessary to drink some drinks of water, to accept the position promoting . At the big sizes sometimes there is a necessity for cavity washing -. Indications to surgical treatment a gullet: complications (punching, , a bleeding, a - gullet stenosis-, a cancer, development of fistulas), big , complicated at least a short-term delay in them of food weights, a long - delay of food in irrespective of its sizes. Depending on localisation choose operational - access: at glotochno-pishchevodnyh - cervical, at - right-hand , at - link sided .

In Umbilical Area A Radiant Arrangement Expanded Hypodermic

In umbilical area a radiant arrangement expanded hypodermic veins ("a head of a jellyfish") observe at difficulty - of outflow of blood on to a vein. In departments of a stomach occurrence expanded venous between - femoral and bottom a vein testifies to difficulty of outflow of blood on system of the bottom hollow vein. Observe displacement of a belly wall during the breath certificate. Absence of displacement of any area or all belly wall during breath happens at pressure of muscles as a result a reflex arising owing to irritation . Check active a stomach (a symptom - of Rozanova). To the patient suggest to inflate a stomach, and then to involve it. At sharp inflammatory processes in a belly cavity patients - cannot inflate a stomach because of sharp strengthening of pains. At the - inflammatory processes localised (-, a pleurisy), accompanied sometimes pains in the field of a stomach and pressure of muscles of a belly wall, and stomach retraction probably. The symptom of Rozanova - gets value for difference of sharp inflammatory processes of a belly cavity from processes.

Pharmacological Test - With And Is Negative. In

Pharmacological test - with and is negative. In patients with often find out hernias - diaphragm apertures, the combination of disease with a gullet is possible. Complication are , attacks of a reflex stenocardia. The disease current long, from time to time that - amplifies, disappears almost completely. At a secondary (reflex-) dyskinesia of a gullet its symptoms usually pass at - treatment of the basic disease. Work capacity, as a rule, is not broken. Treatment: should be directed on normalisation of a motility of a gullet. Complex treatment of patients with (primary) includes appointment of a sparing diet-, and sedative preparations, vitamins, - physiotherapeutic procedures. In the absence of a positive effect - from conservative therapy make (as operation of Gellera) to level of an arch of an aorta. Insufficiency . Disease is connected with - infringement of switching function physiological that leads to occurrence zheludochno-pishchevodnogo a reflux and to development of functional and organic changes of a gullet.

Patients Have A Painful Thirst As A Result

Patients have a painful thirst as a result , . At a blood test mark , shift - formulas to the left, increase , increase , hypo- and . In hard cases it is observed -, and , metabolic -. At an accompanying burn of a throat and vocal chords can be the voices, complicated-breath, . In - hard cases toxic defeat bodies (sharp hepatic and nephritic insufficiency) develops. The poisoning with an acetic essence can cause development intravascular . Patients have a jaundice, urine gets colour of meat slops, it is marked , , the anaemia accrues. As a result at patients the pneumonia can develop . At direct damage of vessels in the field of a burn there are early - bleedings. Sometimes on 5 - 7th day develops a psychosis (a mental trauma, stress, a pain, burn ). II stage - a stage of "imaginary well-being" - proceeds with 7 about 30 days. By the end of 1st week tearing away gullet fabrics begins. than liquid food becomes slightly more free, bleedings are possible. At deep there is a punching of a gullet with development - of symptoms , , pleurae, a pishchevodno-bronchial fistula.

These Substances Accept For The Purpose Of -

These substances accept for the purpose of - suicide or by mistake. Heavy damage of departments - of a digestive path happens also at reception of a solution of permanganate , , acetone. The mechanism of their action on a fabric other, than acids and alkalis. So, permanganate and operate on a fabric as oxidizers. At chemical burns of a gullet there can be simultaneously - burns of a mouth, a throat, a hypostasis of lungs, sharp respiratory - insufficiency. It happens at reception of acetic acid and liquid ammonia owing to them and at influence of steams of the concentrated acids and alkalis. Pathological anatomy: the most expressed changes arise in places of physiological narrowings - in - area , glotochno-pishchevodnogo , at level tracheas, over physiological . As a result of a chemical burn the oral cavity mucous membrane, drinks, a gullet, a stomach is damaged first of all. After and a mucous membrane hypostasis quickly comes - fabrics. By the end of 1st week tearing away sites from subject fabrics and formation superficial or deep begins.

The Main Task Of A "flowing" Method -

The main task of a "flowing" method - maintenance - of sufficient outflow separated of a wound Use - of powerful modern antiseptic tanks (, ) allows - to achieve utter annihilation microflora - effectively enough washing of wounds by solutions , - boric acid, a sodium hydrocarbonate. Advantages of the given - method : technical simplicity and availability. The method of active surgical treatment of sharp purulent - diseases includes probably early closing surfaces - by means of the primary, primary delayed, early secondary seams. The basic condition for suture on a purulent wound - is carrying out of high-grade surgical processing of a purulent wound or clarification by its chemotherapeutic means. The usual - central seam stitched through all layers of a wound, provides good adaptation of edges and wound walls. Carrying out (the general and local) should be a necessary component of complex treatment of patients. The antibiotic choice should be carried out taking into account sensitivity - to it of the activator.

Results Of Research Document By Means Of Roentgenograms,

Results of research document by means of roentgenograms, videorecording, . To specification of prevalence of tumours of a gullet and - their differential - diagnostics from formations apply (radiological research of bodies , contrasted by means of entered in - gas). To an estimation of a condition of walls of a gullet apply (radiological research at simultaneous - a gullet air in conditions ). If necessary resort to a tomography, allows to examine a gullet mucous membrane on all extent, precisely to make by means of special nippers from suspicious sites, to make dabs for cytologic research. Remote slices of a fabric subject to histologic research. rigid - apply with the medical purpose to extraction of foreign matters and for forced a - gullet. The important additional method of diagnostics of functional and some organic diseases of a gullet ( , , hernias apertures of a diaphragm-, etc.) is (graphic record of reductions and a tone of walls of a gullet and it ). At differential diagnostics of organic and - functional narrowings of a gullet apply tests with nitroglycerine, , .

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-.