Digestive tract dyskinesia - functional disease, manifested a violation of tone and peristalsis of the digestive system, with smooth muscle (esophagus, stomach, biliary tract, intestines).
Dyskinesia of esophagus is manifested in the form of its atony and paralysis, spastic dyskinesia (esophagism), lack of pharyngoesophageal sphincter and the cardia.
Atony and paralysis of the esophagus caused by a breach of its innervation and lesions observed at both central (head trauma, brain hemorrhage, brain tumors, poliomyelitis, etc.) and peripheral nervous system (vagus nerve damage, nerve plexus of the esophagus), and and muscular layer of the esophagus (systemic sclerosis, myasthenia gravis, etc.).
The symptoms of atony and paralysis of the esophagus in most cases the signs are masked by the underlying disease. Atony of the esophagus manifested dysphagia arising in the use of a dry and poorly chewed food and eating in the supine position. In atony pharyngoesophageal sphincter and swallowing difficulty arises due to choking getting the contents of the esophagus in the respiratory tract. The diagnosis is established on the basis of characteristic clinical symptoms, X-ray data impact studies ezofagotonokimografii.
Treatment-holinoliticheskie and anticholinesterase agents. In atony of the esophagus secondary treatment of the underlying disease.
Cardiochalasia occurs when the axial hiatal hernia, cardiac sphincter injury due to surgical intervention in systemic sclerosis, as well as due to dyskinesia of the esophagus and stomach (functional failure of the cardia).
Characterized by belching, regurgitation of gastric contents after a heavy meal, the torso and in the supine position. The diagnosis is established on the basis of complaints of frequent, sometimes painful belching and regurgitation (especially in the torso), and these x-rays, which produce, in addition to the vertical position of the patient in a horizontal position, which allows you to identify the leaking contrast barium suspension from the stomach into the esophagus, and often establish the presence of hiatal hernia. Ezofagotonokimografiya to determine the presence and degree of reduction of the cardiac sphincter tone. With ezofagofibroskopii and pH-metry indirectly confirm the presence of cardia failure, identifying reflux of gastric contents into the esophagus (gastroesophageal reflux). As a result of systematic contact with active gastric juices into the esophagus often develop reflux eeofagit, peptic ulcer, and then peptic stricture of the esophagus.
Treatment. Patients should be advised to avoid the provisions under which manifests cardiac sphincter insufficiency, there is tons of gastro-oesophageal reflux. Contraindicated exercise, all kinds of work-related stress abdominals, bend of the trunk. Sleep is highly recommended to elevated headboard. If you experience peptic complications of antacid therapy and astringent.
Dyskinesia of esophagus spastic (esophagism). There are primary esophagism, which is a consequence of violations of the regulation of cortical function of the esophagus, and the secondary (reflective and symptomatic), occurs when esophagitis, peptic ulcer, and gallstone disease, etc., or in cases involving the general convulsive syndrome (epilepsy, etc.). Long expressed esophagism leads to severe hypertrophy of the muscular layer of the esophagus wall.
Dysphagia is characterized by an unstable, sometimes having a paradoxical character: occurs when fluid intake, and absent if swallowed thick and pasty food. Often noted chest pain associated with swallowing, but in some cases reminiscent of the coronary. The diagnosis is confirmed by X-rays, ingestion of the contrast suspension revealed a variety of spastic deformation of the esophagus. The course may be prolonged. Complications are the formation of true diverticula of the esophagus (cm), axial hiatal hernia.
The differential diagnosis is carried out with the initial stages of achalasia cardia. The main importance is the X-ray examination and where the normal patency of the cardia is well revealed gas bubble stomach. Ezofagofibroskopiya eliminates the cancer of the esophagus and its other organic lesions, often occurring with secondary esophagism.
Treatment of secondary esophagism should first be directed to the treatment of the underlying disease. We recommend regular frequent (4-6 times per day) fractional power, mechanically and thermally light diet. In all cases, prescribe antispasmodics, and sedatives holinoliticheskie.
Diskimeziya manifested acute gastric atony, chronic hypotension and gastroptosis, hypertonic dyskinesia, pneumatosis.
Acute gastric atony - paresis of the muscles of his stitches, which arises as a consequence of direct destruction of nerve innervating the stomach formations, and reflexively. The disease is rare, can occur in myocardial infarction, peritonitis, pneumonia, thrombosis of vessels of the stomach, and sometimes - against the backdrop of long-existing stenosis of the pylorus, with some serious infectious diseases (typhoid fever, etc.) in surgical practice - an injury of the stomach, spinal cord injury in the postoperative period, and the output of the patient from anesthesia.
Characterized by a feeling of heaviness, fullness in the epigastrium, retching (vomiting more greenish liquid), hiccups, arching dull pain in the stomach. Symptoms rapidly growing, there are complications (circulatory disorders of the stomach wall, gastric rupture). On examination, is determined by a large, rapidly growing bulging in the epigastric region, with percussion over it defined a broad zone of tympanic sound, the setting of the median line to the right. Gastric tube to freely enter into the stomach, with a very large number of evacuated liquid contents and temporary relief comes.
Treatment. Spend gastric intubation with one-stage extraction of total accumulated in the stomach contents, and then - the constant drainage (with a probe or catheter held in the esophagus and stomach through the lower nasal passage) to restore the tone of the stomach. At the same time carry out an intensive treatment for the underlying disease, against which there was a sharp expansion of the stomach. To combat dehydration intravenously injected a large amount of isotonic sodium chloride solution and 5% glucose solution. To improve the tone and gastric motility of stimulation administered carbachol (1 ml 0.01% solution of p / k), atseklidin (1-2 mL 0.2% solution of p / k, can be reused 2-3 times at intervals of 20-30 min) , antiholin-esterase preparations (Neostigmine, etc.), and strychnine (1 ml of 1% solution 2-3 times a day). Prohibited medication and food inside. Narcotic analgesics and anticholinergics are contraindicated.
Chronic hypotension gastroptosis stomach and are usually combined. There are three degrees gastroptosis a. With a small degree of curvature is defined by 2-3 cm above l. biiliaca, with II degree-level and III degree-below it. There are also gastroptosis total and partial, ie antropiloroptoz. Gastroptosis is more common in women, usually aged 15-45 years of age and older.
The etiology and pathogenesis. Congenital gastroptosis primarily due to the constitutional asthenia: overly long mesentery of the colon? which, falling, tightens gastrocolic ligament, and pulls a large curvature of the stomach, causing gastroptosis. Omission of the stomach antropiloricheskogo leads to kink the initial part of the duodenum, which further violates the evacuation of the stomach and can cause pain. Acquired gastroptosis observed with a sharp weakening of the muscles of the abdominal wall due to significant weight loss after delivery, removal of ascitic fluid or large tumors of the abdominal cavity. He explained stretching ligaments, fixing the position of the stomach. In most cases antropiloroptoz combined with lengthening of the stomach and hypotension; total gastroptosis observed only with simultaneous deletion of the diaphragm (due to emphysema, massive pleural effusion, etc.)? move down the bottom of the stomach.
Symptoms within. In most cases, a gastroptosis or II symptoms. Less commonly, there are complaints of a feeling of heaviness, distention, fullness in the epigastric region, especially after a heavy meal, dull aching pain in the epigastric facilitated the patient in the supine position due to tension and fix the stomach ligaments. Sometimes there kardialgiya. In some patients there is a short-term stomach pain while running or jumping, which is itself, nausea, loss of appetite. Often there is constipation. The combination of ptosis gastroptosis other organs (liver, kidney, etc.) can produce additional symptoms. Patients with konstitutsionapnym gastroptosis often impose a large number of neurotic complaints. On examination, the patient gastroptosis noteworthy pendulous abdomen, while pulling it up with the pain often decreases or disappears. Omission of the pylorus and greater curvature of the stomach can be determined by palpation. The diagnosis is confirmed by X-ray examination. In the gastric juice is frequent achlorhydria.
Treatment. When gastroptosis I-II degree, asymptomatic, recommend physical education, exercise, aimed at strengthening the abdominals. When gastroptosis III degree prescribe specific courses of physiotherapy, massage the abdomen, hydrotherapy. In all cases, is shown fractional frequent meals and easily digestible high-calorie foods, especially with a sharp weight loss. In order to increase appetite - bitterness, low doses [4-6 units) of insulin for 20 minutes before a meal n / a, and other means of stimulating the appetite, with ahilii appoint gastric juice and its substitutes. Also recommend anabolic hormones (methandrostenolone 0,005 g 1-2 times daily before meals), the drugs strychnine and arsenic (duplex - 1 ml of 1 - 2 times a day p / k). Should be the elimination of constipation with laxatives and dietary measures. In severe cases, gastroptosis associated with severe sagging abdominal wall is recommended for 1-1.5 hours after eating to lie down and prescribe medical bandage, it is applied with the patient lying down.
Prevention of hypotension and gastroptosis stomach is in the right physical training of children and adolescents. Of great importance is the strengthening of the abdominal wall in women during pregnancy and the first months after birth, the use of therapeutic exercises.
Hypertonic dyskinesia is characterized by increased gastric tone and its violation of peristalsis spastic type. Observed against the background of common diseases that manifest spastic muscle condition (tetanus, lead intoxication, etc.), and as a result of reflex changes in motility of the stomach (peptic ulcer of the stomach, pylorus, cholelithiasis, etc.). Sometimes it is the result of hysterical neurosis, or a temporary increase in the tone of the stomach under the influence of emotions and mental stress. Limited (local, local), hypertension and spasm of the muscle membrane of the stomach wall are usually reflex (local spasm of the greater curvature of peptic ulcer of the small curvature of the stomach, pylorus pilorospazme ulcer or duodenal bulb). Gastric tetany may be a consequence and a manifestation of parathyroid deficiency and hypocalcemia. Smoking increases the reduction of stomach cramping. Significant hypersecretion and giperatsidnom condition of the stomach pyloric spasm, promote strengthening.
Symptoms within. Hypertonic dyskinesia asymptomatic or manifested by pain in the area epigastrapnoy often yazvennopodobnoy. If there is a tendency to pilorospazme vomiting. When X-ray size of the stomach (in cases of total hypertension) are small, it has the shape of horns. Contrast the mass of long delays in the upper stomach, takes the form of a wedge with apex broadened, directed distally. In contrast pilorospazme promotion through the mass of the gatekeeper is difficult and takes place in small portions, rare, in a phase of decompression and the pyloric stenosis compensate pilorospazme stomach expanded, its motility impaired. Long existing pilorospazme may lead to the formation of organic pyloric stenosis.
Treatment. In neurogenic and psychogenic dyskinesia hypertensive gastric fractional sparing diet is recommended for the type of antiulcer, work and rest, sedative medications, tranquilizers, holinoliticheskie (atropine, platifillin, metatsin, etc.) and spasmolytic (papaverine, no-spa, etc.) means , heat to the area of epigastrium.
Pneumatosis of the stomach - the high content of air in the stomach. It may be due to organic disease (with hiatal hernia, phrenic nerve injury, the left dome of the diaphragm, etc.), but more often, in violation of the higher nervous activity, hysterical psychosis (neurogenic aerophagia, belching nervous).
Symptoms within. Feeling of heaviness, pressure, fullness in the epigastrium and frequent severe regurgitation, sometimes so loud that prevents the appearance of patients with gastric pneumatosis in public places. Because of the high standing of the left dome of the diaphragm can be observed kardialgiya (relieved after belching, probing the stomach, increasing after a heavy meal). For percussion, and X-ray examination revealed large gas bubble stomach.
Differential diagnosis with axial hiatal hernia and kardioezofagealnym cancer is performed using X-ray and gastroskopicheskogo study.
Treatment of pneumatosis of the stomach is carried out by means of a functional origin of strengthening therapy, sedatives and tranquilizers, physical therapy. In some cases, help hypnosis, acupuncture. Patients are encouraged to frequently split meals, carbonated beverages are prohibited.
Biliary dyskinesia - functional disorders of tone and motility of the gallbladder and biliary tract. There are hypertonic-hyperkinetic, characterized by a hypertonic condition of the gall bladder (usually in combination with hypertonicity sphincter of Oddi and Lyutkensa), and hypotonic-hypokinetic, which is characterized by hypotonic state of the gallbladder and sphincter of Oddi. More common in women. Hypertonic-hyperkinetic dyskinesia thicket detected at a younger age, and hypotonic-hypokinetic - at astenikov and in persons over 40 years.
The etiology and pathogenesis. Biliary dyskinesia due primarily to a violation of neurohumoral regulation, occur in neurosis, diencephalic syndrome, a solarium, endocrine and hormonal disorders (for hypo-and hyperthyroidism, menopause, lack of ovarian, adrenal and other endocrine glands). Hypertonic-hyperkinetic form there is a reflex (ulcers, colitis, appendicitis, adnexitis, etc.), breach of developing gastrointestinal hormones (cholecystokinin-pancreozymin) duodenal mucosa in atrophic duodenitis and other diseases. Asthenic conditions caused by severe left over infectious diseases, viral hepatitis, vitamin deficiency, malnutrition, and various endogenous and exogenous intoxication can also lead to the development of biliary dyskinesia. In severe asthenic constitution, sedentary lifestyle, poor nutrition with very long intervals between meals rather frequently detected form of hypotonic-hypokinetic dyskinesia. Frequent but irregular meals, excessive passion for spicy dishes, systematic use of spices in food, irritating the mucous membrane of the digestive tract, predispose to the emergence of hypertonic-hyperkinetic biliary dyskinesia. Organic lesions biliary system (cholecystitis, cholangitis, cholelithiasis, etc.), parasitic, worm infestation of digestive tract are often present with pronounced symptoms of dyskinesia of the gallbladder and biliary tract.