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Gullet diseases: burns, ulcer, spasms. Erosion and atresia of a gullet
August 16, 2012
If to compare prevalence of stomach diseases and a gullet, then diseases of a gullet are diagnosed now much less often. If the person is healthy, the food passes through a gullet, without being late. Therefore, this body is less subject to various irritations.
The gullet of the person is a tube of a cylindrical form which length makes about 30 cm. In two places of a gullet is fiziologicheskit narrowings: the gullet is narrowed in that place where it is crossed with an aorta, and also in the place where it passes into a stomach. The wall of a gullet is made by a mucous membrane, a submucosa, muscular and an extima. Let's consider in more detail some diseases of a gullet.
The gullet achalasia – is disorder of neurogenic character at which functions of a gullet are broken. In particular, the peristaltics, and the lower sphincter of a gullet which serves as the locking mechanism between a stomach and a gullet is broken loses ability to relaxation. The etiology of this illness is unknown, but today specialists talk about existence of a genetic, infectious and psychogenic favor. As a rule, the disease develops at aged people from 20 to 40 years.
At development in the patient of an achalasia of a gullet symptoms of an illness are expressed by frequent vomiting (regurgitation). At the same time the food is thrown back in an oral cavity, to it saliva and slime is added. As a rule, it occurs if the person bends forward. In certain cases regurgitation leads to aspiration (there is a hit in lungs of the person of undigested food). Besides, at the patient pains behind a breast which can remind stenocardia attacks periodically develop. At the night of the person can overcome fits of coughing. Patients with a gullet achalasia, as a rule, promptly lose weight, up to exhaustion.
The main diagnostic method of this disease is the roentgenoscopy allowing to estimate a gullet condition. At early stages of an illness of people feels much better if keeps to a sparing diet. Treatment of a disease is directed to reducing pressure in the field of the lower esophageal sphincter. Special devices which promote its relaxation are initially used. The so-called method of pneumocardiodilatation at which pneumatic sphincteri incontinence is made is widely applied. To reduce pressure in the field of a sphincter, it is possible to apply nitrates or antagonists of calcium.
In certain cases the food hard passes through a gullet owing to development of an esophagospasm. Development of reductions of smooth muscles of a gullet which have spastic character is characteristic of this phenomenon. As a rule, the esophagospasm develops at people at young age. Those who easily are exposed to excitability, differ in instability of a nervous system are more subject to such phenomenon. The esophagospasm often develops owing to a stress, the general nervoz, too fast absorption of food. In the latter case the gullet is irritated mechanically, and the spasm reflex develops.
Inogla can be also shown a spasm in that place where the gullet passes into a stomach. In this case it is about a cardiospasm.
The dysphagy is considered the main symptom of this illness. During development of a spasm perhaps full not passing of food on a gullet. At the same time in certain cases the liquid food passes heavier, than firm. Besides, patients often have pains behind a breast, vomiting of the eaten food, but such manifestations have no constant character. The esophagospasm can proceed as several seconds, and it is a lot of hours in a row. Sometimes also dilatation of a gullet can develop. If at the patient the cardiospasm develops, then owing to dilatation of all gullet vomiting can be shown. Unlike gastric vomiting food is shown at once after acceptance of food, and at emetic masses there is exclusively eaten food, without gastric juice. Often at patients spasms develop as a result of influence of some factors. Sometimes over time they completely disappear.
In the course of therapy of a spasm of a stomach it is necessary to strengthen a nervous system. It is for this purpose important to provide to the patient good rest, active exercise stresses. Also some medicamentous drugs – a valerian, bromides are used. In view of the fact that the spasm of a stomach arises as an effect of excitement of a vagus nerve, patients during development of a spasm should apply adrenaline, atropine, ephedrine to treatment. These means are applied inside or under skin. The combination of atropine and a papaverine is also possible.
The burn of a gullet develops if some chemicals get to it. As a rule, it occurs or is accidental, or in attempt of a suicide. The medical statistics demonstrates that among total number of the people who got burns of a gullet, about 70% are made by children who were not 10 years old yet. So large number of injured children is explained by oversight of adults and a habit of small children "to taste" everything.
Most often people get gullet burns after reception of caustic natron, strong solutions of acids, in more exceptional cases there are burns owing to influence of phenol, lysol, spirit solution of iodine. If caustic substance gets inside, then not only the gullet, but also a stomach, a mucous membrane of a mouth and a throat suffers. Depending on concentration and amount of substance which got inside, extent of defeat is defined. It is accepted to allocate three degrees of a burn of a gullet. At the first degree there is only a defeat of blankets mucous a gullet. At the second degree also the layer of muscles is surprised. Defeat all of gullet wall layers is characteristic of a third-degree burn. At the third degree of a burn not only local signs, but also the general symptoms are shown: state of shock and intoxications. If the patient had a burn of a gullet of the second or third degree, it creates cicatricial changes in a gullet.
The main symptom of a similar state is the feeling of strong burning in a throat, a mouth, behind a breast. Often the person who drank caustic liquid at once has a vomiting, lips can swell.
If the severe defeat takes place, then the victim can faint, stay in a state of shock at once. Sometimes for one or two days there comes the lethal outcome. If the death did not occur, then the patient can have a pronounced short wind as an effect of hypostases of a throat, vomiting with slime and blood, increase of body temperature. The person cannot swallow. If the wall of a gullet is struck deeply, then there can be esophageal bleeding, be broken function of kidneys.
To establish the final diagnosis, it is necessary to conduct X-ray inspection. However in the first days after defeat it will not be carried out as it is important that the general condition of the patient was stabilized. During scarring of fabrics it is also possible to make an ezofagoskopiya, however it is very important to conduct research carefully.
The patient with a gullet burn is quickly hospitalized then means for anesthesia are parenterally entered. To remove stomach contents, to the patient enter the gastric tube oiled. Depending on substance which became the burn reason means for a gastric lavage is selected. If the doubtful case takes place, the gastric lavage is made by milk. However it is necessary to consider that efficiency of a gastric lavage sharply decreases after the expiration of six hours after poisoning. For the purpose of ensuring disintoxication therapy to the patient Haemodesum, saline solutions is parenterally entered reopoliglyukin. To avoid complications of a state further, antibiotics of a broad spectrum of activity parenterally are applied. Also for reduction of cicatricial educations drugs of adrenal hormones are appointed. In an individual order the doctor makes the decision on purpose of drugs which improve work of cardiovascular system, function of kidneys.
Foreign body in a gullet
In certain cases existence of a foreign body in a gullet can be diagnosed for the person. It occurs if in a gullet there are big pieces of not chewed food, or the objects swallowed accidentally which are not intended in food. In medical practice the diagnosis "the foreign body in a gullet" is established rather often. The similar phenomenon arises at different situations: at too fast absorption of food, at laughter or talk in the course of food. Also bones of chicken, fish, meat often get into a gullet. Such phenomenon also is characteristic of people who often hold in a mouth inedible objects – paper clips, matches, etc. Generally foreign bodys which have a pointed end are implemented into a wall of a gullet. At the same time the inflammation of an esophageal wall can be shown. At its perforation the mediastinitis can develop.
The person at whom in a gullet the large foreign body was late feels pain behind a breast which has the pressing character. It has a feeling of existence in a gullet of a foreign body, at the same time the victim cannot often swallow even liquid.
If in time not to provide to the person medical care, in several days at him the general state considerably worsens. Some foreign bodys can be found at X-ray inspection, but to reveal the smallest objects it turns out not always.
It is possible to find and take a foreign body by carrying out an ezofagoskopiya. But at the same time doctors consider also that moment that some people often have feeling of existence of a foreign body in a gullet at an injury of its wall.
If the patient complains of the symptoms testimonial of the swallowed foreign body, he needs to conduct as much as possible quickly X-ray inspection and an ezofagoskopiya (if there is such need). If it is not possible to remove on an outpatient basis foreign body, the person should be sent to a surgical hospital.
Specialists recommend not to apply the national methods directed to pushing through of foreign bodys. Such efforts can come to the end with its stronger fixing in a gullet.
At the person the ulcer of a gullet develops owing to the insufficient cardia provoking flowing of a gastric juice in a gullet. It has proteolytic effect. Very often stomach ulcer arises in combination with a peptic ulcer of a stomach and duodenum or with hernia of an esophageal opening of a diaphragm. As a rule, in a gullet there are single ulcers, but also multiple ulcerations sometimes develop.
Display of an ulcer of a gullet provokes several factors. Such pathology develops as an effect of operative measures in the field of esophageal and gastric transition, hernia of an esophageal opening of a diaphragm, at disturbance of a vermicular movement of a stomach, etc.
The main symptoms of an ulcer of a gullet is constant heartburn, emergence of an eructation, pain behind a breast which become more intensive in the course of acceptance of food and after that. A characteristic symptom is periodic vomiting by acid contents of a stomach.
It is possible to establish the diagnosis in case of development of stomach ulcer by means of an ezofagoskopiya. Sometimes also researches the calla for the purpose of detection of the concealed hemorrhage is carried out.
Effectively to treat stomach ulcer, the stage of preparation for therapy is initially carried out. It is for this purpose important to clear internals of parasites if those were found.
Further the stage of intensive improvement follows. During this period active and healthy approach to way of life, acceptance of natural means is important for strengthening of an organism, the correct, sparing diet. Alcohol and smoked dishes are strictly forbidden. If conservative methods of treatment do not bring due result, surgical intervention is shown.
The erosion of a gullet is shown, first of all, by heartburn attacks. In the course of acceptance of food of people can note emergence of unpleasant feeling behind a breast. Especially often such feelings is present if it absorbs dry and rigid food. Also in the mornings the patient can periodically feel sick. This the state arises as an effect of hit of a gastric juice in a gullet. As a result the mucous membrane of a gullet is irritated, the inflammation, and later – an erosion develops.
The erosion of a gullet is found only in the course of carrying out gastroscopic inspection. Erosion of a gullet constitute health hazard of the person as development of bleeding can become their effect. If erosion arise very often, mucous is deformed, and existence of hems can break passability of a gullet as a result.
Treatment of an erosion of a gullet provides obligatory use of drugs which block hydrochloric acid. It is necessary to adhere to a rigid diet, having refused those products which stimulate production of hydrochloric acid. It is a citrus, alcohol, coffee, aerated water, spicy and fat food. It is important not to wash down food with water.
Effectively to neutralize influence of hydrochloric acid, it is necessary to adhere constantly to fractional food and not to overeat. The food has to be digested easily therefore it is necessary to prefer porridges, the wiped soups, the steamed ground meat. If the illness becomes aggravated, it is necessary to clean completely from the menu all fruit and vegetables which provoke gas generation. An effective remedy for decrease in level of gas generation is broth of fennel or fennel. It is impossible to remove heartburn, swallowing soda. At attacks of heartburn it is the best of all to drink a glass of water with honey or a little milk. If treatment of an erosion of a gullet does not bring desirable results, then to the patient the biopsy is carried out.
The erosion of a gullet is an illness which can provoke very serious complications. Therefore at the first symptoms which cause suspicion on development of an erosion it is important to visit the specialist.
The atresia of a gullet is very heavy defect of which the blind termination of an upper piece of a gullet is characteristic. At the same time the lower piece of a gullet is generally reported with a trachea. Very often at an atresia of a gullet also other malformations of different systems of an organism take place.
Essential disturbances in pre-natal fetation are considered as the reason of display of such pathology. If on 4-5 week of development of an embryo it is influenced by certain harmful factors, then thereof the gullet can incorrectly be created later.
The gullet atresia at the sick child at once after his birth is shown by cough, cyanosis. At the kid in a drink slime accumulates, from a mouth and a nose foamy allocations appear. During feeding all these signs are aggravated. The child worries, he has a short wind, rattles in lungs. Later respiratory insufficiency and pneumonia which reason is a hit in respiratory tracts of milk and contents of a stomach develops.
To establish such diagnosis, to the child sounding of a gullet is carried out. The diagnosis is established, as a rule, in a maternity home. If necessary X-ray inspection is conducted.
The atresia of a gullet can be cured only by a surgical method. Prepare for operation of the child in a maternity home. The way of performance of operation is chosen depending on character of pathology. It is important to consider that operation needs to be performed as soon as possible.
Candidiasis is an illness of infectious character which affects mucous membranes. However candidiasis of a gullet is considered a visceral disease. Most often candidiasis of a gullet develops as a gullet burn effect, and also at certain chronic diseases of this body. At candidiasis of a gullet of people feels pain when swallowing owing to what it is rather difficult for it to do it. In the course of swallowing behind a breast the discomfort is felt. Most often candidiasis of a gullet is diagnosed for people with disturbances in functioning of immune system, in certain cases this illness can turn out to be consequence of reception of a large number of antibiotics. Besides, too big physical and emotional pressure without due rest, stressful situations, irregular and improper feeding is the reasons of emergence of candidiasis. However most often candidiasis of a gullet is shown at patients with HIV-positive reaction.
For therapy of this type of candidiasis a number of anti-fungal drugs which are accepted both intravenously, and orally is used. Effectively to treat this disease, it is important to entrust the specialist a question of selection of means for therapy.
At a disease which is called Barrett's gullet the patient instead of normal cells of a flat epithelium which cover a gullet bottom, has a transformed (metaplazirovanny) cylindrical epithelium. Barrett's gullet is a complication of a chronic gastroesophageal reflux disease. This illness is considered precancerous.
For diagnosis of a disease the general analysis of urine, blood, a calla, and also a biochemical blood analysis is without fail carried out. But the most informative method of research is the biopsy of a site mucous a gullet which is carried out in the course of a fibrogastroendoskopiya. It is important to consider that at Barrett's gullet characteristic symptoms are not shown. Therefore people who a long time are ill a reflux esophagitis need to exclude such pathology. Diagnosis of a gullet of Barrett assumes careful search of the centers of a dysplasia.
This disease on condition of existence of signs of regeneration of cells of a mucous membrane of a gullet is considered one of the main factors promoting development of an adenocarcinoma in the future.
Treatment of an illness is directed to eliminating a gastroesophagal reflux. However at such treatment the changed epithelium of a mucous membrane remains the same. If low extent of regeneration is diagnosed for the patient, to it appoint high doses of drugs which do not allow influence on mucous hydrochloric acid. It is necessary to accept such means about ten weeks. If owing to diagnosis high degree of a dysplasia was confirmed, then carrying out a surgery is recommended to the patient. The patients who successfully cured this pathology need to pass preventive endoscopic researches regularly.
Symptoms and cancer therapy of a gullet are information which patients for whom Barrett's gullet or other pathologies of this body is diagnosed shall study. A cancer of a gullet are rather often found malignancy form. More often the illness is shown at men at advanced age. As a rule, the malignant tumor affects average and lower departments of a gullet.
Some factors which promote development of this disease are allocated. In particular, the wrong approach to food can provoke a gullet cancer, namely – frequent alcohol intake, too hot food. The illness develops at the people suffering from a vitamin deficiency more often (in particular And yes C). Also the probability of cancer of gullet increases in case of a burn alkalis.
At development of cancer of gullet of the patient notes the general deterioration in health: weakness, fatigue, impossibility to work a long time, noticeable loss of appetite. As a result, at the person weight sharply decreases, skin often turns pale. Vomiting is often shown. Because of unpleasant manifestations of people it is forced to pass to the liquid, wiped food. But in certain cases owing to a strong dysphagy of people cannot swallow even saliva. Also manifestation of burning and pain, change of a timbre of a voice is characteristic.
As complications of an illness development of bleeding of a gullet, perforation of a tumor is possible. At such manifestations it is extremely important to ask for the help of physicians immediately.
Diagnosis of cancer of gullet is made by means of tool methods: a X-ray, and also carrying out a biopsy by means of EGDS. Other additional researches are sometimes appointed.
At a cancer therapy of a gullet surgical intervention, radiation therapy, and also the combined treatment at which the beam and surgical method is combined is applied. In the course of operation the gullet is removed, and the plastics of a gastric or intestinal tube is carried out. To improve result of an operative measure, the chemotherapy is applied.
If process is too started, to the patient impose a gastrostomy: the special tube for food is entered into a stomach.
At hernia of a gullet there is an increase in an esophageal opening of a diaphragm. As a result, protrusion of upper part of a stomach takes place. The reasons of this pathology are definitely not established till today. However specialists note a certain role of genetic predisposition. Sometimes developing of hernia of a gullet is provoked by too strong exercise stresses, obesity. As a rule, about what symptoms and treatment of hernia of a gullet, people learns on own experience after sixty years.
Symptoms of this illness in most cases are not shown at all. However regurgitation, heartburn can be symptoms of hernia of a gullet. Sometimes owing to long hit in a gullet of a gastric juice there is a formation of ulcers of a gullet.
Diagnosis of an illness is carried out by X-ray inspection. It is in certain cases reasonable to carry out gastroscopy in addition.
As complications of this illness at the patient chronic heartburn, and also an esophagitis – inflammatory process of lower parts of a gullet can be shown. Also the gullet can be narrowed in a lower part owing to scarring.
It is necessary to treat gullet hernia by a surgical method only when the patient strongly suffers from heartburn or it has notable difficulties when swallowing.
In more mild cases it is recommended not to use dishes and products which promote activation of products of a gastric juice. It is desirable to leave off smoking, not to allow loadings owing to which pressure increases in an abdominal cavity. It is important to avoid emergence of excess weight. If there is such need, for removal of attacks of pain it is possible to accept drug spasmolysant.