Bloody Vomiting Is Marked, And The Hypodermic Emphysema,

Bloody vomiting is marked, and the hypodermic emphysema, develops a shock, the body temperature raises. At damage pleurae arise symptoms ). External (openly) traumas of a gullet in a peace time meet seldom. Usually they are combined with plural the next bodies (a thyroid gland, a trachea, heart, easy, large vessels, etc.). The clinic and diagnostics, at wound of a cervical part of a gullet patients complain of a pain at swallowing, the hypodermic emphysema on a neck Through 12 20 develops and . At damage of chest department of a gullet patients mark a sharp pain behind a breast, amplifying at a breath, cough, the swallowing, the raised salivation, sensation of a foreign matter and a gullet. The compelled position of patients is characteristic - the trunk is inclined forward There is a vomiting with a blood impurity, ooa a neck emphysema, symptoms , , a pleurisy. Wounds of belly department of a gullet can lead to peritonitis development. is frequent complication of damages of a gullet.

Diagnostic Value Has Occurrence At Cough Of A

Diagnostic value has occurrence at cough of a pain and its localisation. a stomach make for delimitation of a liver, a spleen, the sizes of pathological formations in a stomach (-, a tumour, an abscess). Sonorous a sound give: Gas congestions in intestines , gas congestions in a belly cavity , at punching of hollow body (disappearance of hepatic dullness). For revealing of a congestion of a free liquid in a belly cavity (, , ) spend comparative both half of stomach in a direction from an average line to its lateral departments, then on right and left to a side. Change a sound (instead of dullness) happens in the presence of freely moving liquid in a belly cavity. In vertical position sick a stomach spend in a direction from top to down on an average line and to lines. Zone a sound over a bosom with horizontal - concave top border - a sign of a free liquid in a belly cavity. A zone with horizontal top border and over it - a sign of a congestion of a liquid and gas. If the top border of a zone a sound over a bosom forms convex up a line is the sign - specifying in overflow by contents of a bladder, on - uterus increase, presence .

The External Bottom Border Of A Stomach Passes

The external bottom border of a stomach passes on the lines spent from of bones in the parties to , further to lobbies top bones, on their crests and the basis . The stomach cavity a belly cavity - is limited in front, from sides and behind - by belly walls, above - a diaphragm, below passes in a cavity of a small basin. From within a belly cavity . Belly cavity subdivide on a cavity limited -, and space. In a belly cavity allocate two floors: top and bottom. Border between them is cross-section guts. Stomach walls divide into two departments: and back, or lumbar area Borders between them are the right and left back axillary lines. At diagnostics of diseases of bodies of a belly cavity the doctor for revealing of localisation of pathological process should imagine mentally - spatial parities of bodies with each other and their projections to a belly wall. In clinical practice use division stomach walls on the areas formed as a result of carrying out of conditional two horizontal and two vertical lines.

Primary Localisation Of A Belly-ache, And Then Later

Primary localisation of a belly-ache, and then later - pain joining - in area hernias it is characteristic more for sharp diseases of bodies of a belly cavity, than for the - restrained hernia. Sudden occurrence of an acute pain in areas with development of a peritonitis at sick of a stomach ulcer is characteristic for ulcer perforation. Primary localisation of a pain in right with under the right shovel, in right , the greatest morbidity and pressure of muscles in right -, positive symptoms of Grekova - Ortnera, Murphys are characteristic for a sharp cholecystitis. Pain occurrence initially in areas or round a navel with the subsequent moving of a pain in right the area, the greatest morbidity and pressure of muscles of this area are characteristic for an acute appendicitis Consecutive occurrence in the beginning signs of intestinal impassability, then a peritonitis and after changes in hernia area allow to treat a pain in the field of a hernia, increase in the sizes and pressure of a hernia as displays of false infringement.

Development Of A Cancer Of A Gullet In

Development of a cancer of a gullet in patients (at 4 - 7 %) is noted, especially at considerable expansion of a gullet and long stagnation in it , and also at patients with - a gullet, hernias apertures of a diaphragm and with a congenital short gullet owing to presence at them - chronic are Always suspicious on possibility - is long not healing gullet ulcers (especially Barret's ulcer; sm "Peptichesky ulcers - of a gullet") One of the factors conducting to occurrence of a cancer of a gullet are cicatricial after chemical burns. a gullet consider as a precancer. Occurrence in these patients is long not healing , , fistulas, a fast weight loss are the indication to removal the changed gullet gullet Deenergizing at a total plasticity a thick gut at burn eliminates possibility in connection with liquidation In the presence of gullet polyps always there is a real danger of their regeneration, therefore a gullet polyp it is necessary to remove. As precancer disease consider a syndrome (a syndrome of Plammera - Vinsona) which is shown by an anaemia, , an atrophy of mucous membranes, and later an oral cavity mucous membrane, drinks and a - gullet Consider that it can arise at the exact maintenance in food of iron and vitamins, especially vitamins - B2 and With.

At Radiological - Research Of A Thorax -

At radiological - research of a thorax - of patients with reveal additional the right contour , presence of level of a liquid in a projection back , a gas bubble of a stomach. The basic radiological sign - narrowing of terminal department of a gullet with accurate, equal and elastic contours ("a flame of the turned - candle", "a mouse tail") Folds of a mucous membrane - in the field of narrowing are kept the First drinks of barium can to arrive freely in a stomach, then contrast weight is long is late in a gullet. Over a baric suspension define a layer of a liquid and the food rests. Gullet expansion over a place of its narrowing is expressed in various degree At a number of patients mark lengthening and a gullet curvature. a gullet at all patients it is sharply broken: reductions are weakened, have spastic character and insufficient amplitude. At development changes of a relief of a mucous membrane of a gullet are visible: granularity, a thickening and tortuosity of folds. allows to confirm the diagnosis , - to reveal its complications and to spend the differential diagnosis with - other diseases accompanied .

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.