And whether you know...
Commissures of intestines
Commissures of intestines – rather widespread diagnosis today. Commissures are tyazh from connecting fabric owing to which internals are spliced and displaced.
Reasons of commissures of intestines
Similar unions appear owing to ability of connecting fabric grow because of influence of disturbing factors. For example, growth of fabric of this type the mechanical injuries, diseases caused by acute and persistent infections, availability of the accumulated earlier streamed blood, foreign bodys can provoke, influence of chemicals, etc. If to speak about the bodies located in an abdominal cavity, in particular, about intestines, then injuries of mechanical character, and also contact of a peritoneum with air in the course of surgical intervention become the reasons of commissures most often. Therefore, commissures of intestines mainly arise as an effect of surgeries. According to statistical data, the adhesive desease develops at 2-15% of patients who underwent operations. Commissures can be shown and at once after carrying out any operation on a peritoneum, and several years later after the person underwent such operation. However commissures arise only at those people who have predisposition to this disease in view of contents in an organism of excess of specific enzymes. Under their influence at injuries there are very large hems. But if there is no such feature in a human body, then commissures at it do not develop.
Commissures of intestines are a serious disease, owing to their education at the person acute intestinal impassability – a state which sometimes even threatens life can develop. Besides, emergence of commissures is fraught with emergence of pain of different weight, and also can negatively influence functioning of other internals.
Types of commissures of intestines
Process of formation of commissures of intestines happens as follows. On walls of an abdominal cavity of the person the peritoneum which is a connecting cover with two parties — visceral and parietal is covered. All bodies in an abdominal cavity among themselves and adjoin to a parietal peritoneum, there are no spaces in an abdominal cavity.
Interorgan unions can be subdivided on viscerovisceral (in this case there is an union directly between bodies) and visceroparietal (the gut grows together with a parietal peritoneum).
Symptoms and displays of a disease depend on what character of unions in what place they arose and as far as influence work of bodies which grew together among themselves.
Commissures of intestines can be shown differently. First, symptoms of an adhesive desease can not be shown in general. In this case commissures of intestines find accidentally: on the course of ultrasonography inspection or during any operation on a peritoneum.
Secondly, at commissures of intestines the painful form of an illness can be shown. In this case the patient is disturbed by abdominal pains, especially often they arise in the field of hems after operation. Pains often happen pulling, in the course of an exercise stress they amplify. Sometimes pain passes independently, in other cases it is necessary to appoint drugs with the anesthetizing influence.
Thirdly, manifestation of a painful form of commissures of intestines with dysfunction of internals is possible. Owing to commissural process there are failures in functioning of bodies of a digestive tract. As a result, the patient suffers from locks, ponos, feeling of a raspiraniye after acceptance of food, abdominal distention.
One more option of development of a disease – the heaviest. This emergence of acute commissural intestinal impassability. In this case because of commissures there is an obstacle for passing of contents through an intestinal tube. It is about very dangerous state which it is necessary to treat urgently. The lethal outcome is otherwise inevitable. Sharp developing of pains in a stomach is characteristic of commissural impassability. After that at the person vomiting attacks begin, gases do not depart, there is no chair. At the same time the constant aggravation of symptoms is observed. As a result of the patient it is forced to ask for the help the doctor.
Intestinal impassability at commissures of intestines
Disturbance of a passage of contents of intestines on an intestinal tube is characteristic of this state. in development of an illness microcirculation in an intestinal wall is broken, the abdominal cavity inflames. Intestinal impassability can be dynamic and mechanical.
The arisen spasm of an intestinal wall is the reason of dynamic impassability. The similar phenomenon – consequences of a variety of reasons: poisonings with toxic agents, heavy infections, etc.
At the same time most often commissures of intestines are the reason of mechanical impassability. The last is characteristic of a small intestine, at the same time colic impassability approximately in half of cases is provoked by malignant tumors. Intestinal impassability is shown owing to squeezing by commissure of a gleam of an intestinal tube. Besides, around commissural tyazhy torsions and excesses of loops can appear. Commissural intestinal impassability often arises as a result of the wrong food allowance. So, the continuous use of rough cellulose, food owing to which there is a strong gas generation, and also a regular overeating can provoke the beginning of development of impassability. Sharp attacks of commissural impassability are shown as a result of inflammatory diseases of intestines or a heavy exercise stress.
Symptoms of commissural impassability of intestines
As the first symptom of impassability of intestines owing to commissures the person has a pain in a stomach. Character of pain can vary from gradually accruing to arisen sharply. Periodically pain can calm down and later renew again. Besides, at impassability swelling which either is shown unevenly surely takes place, or covers all stomach. In most cases patients complain of a delay of gases and a chair though at partial obstruction gases can periodically depart, and also the liquid single chair can take place.
On process of a disease vomiting of which the congestive discharge is mainly characteristic is shown. The illness progresses, and symptoms from respiratory and cardiovascular systems join the symptoms described above. So, at the patient tachycardia can be shown, decrease arterial pressure. Also of a similar state it is characteristic alternations of depression and excitement. In the presence of such symptoms it is necessary to call the ambulance immediately.
Diagnosis of commissural impassability of intestines
First of all, the doctor has to perform careful inspection of the patient, and also carry out a survey. At diagnosis of commissures of intestines and commissural impassability very important role is played by information on character of pain at an attack. Detection of postoperative hems in the course of physical inspection gives the grounds to suspect development of commissural intestinal impassability. In the course of diagnosis also manual research of a rectum is conducted. The patient surely takes a blood test for the laboratory analysis.
The X-ray analysis of abdominal organs allows to define existence of commissural process. This method is most often used at diagnosis of intestinal impassability. For more detailed research often appoint carrying out ultrasonography and a computer tomography. These diagnostic methods differ in high precision.
Treatment of commissural impassability of intestines
First of all, measures are taken for simplification of a condition of the patient. The special nazogastralny probe which is intended for aspiration of contents of a stomach is for this purpose used. Intravenously sick solutions for the purpose of recovery of an electrolytic and water balance are entered. After carrying out infusion intestines are stimulated by carrying out hypertensive enemas and injections of antikholinesterazny drugs. Further tactics of treatment is selected by the doctor in an individual order.
It should be noted that approximately in eighty percent of cases of the commissures of intestines complicated by intestinal impassability it is possible to do without surgical intervention, with use exclusively conservative treatment. However if the doctor suspects existence at sick disturbance of blood supply of intestines, then operation needs to be performed immediately.
Surgical intervention at commissural impassability is directed to removal of an obstacle and recovery of a passage on intestines. Adgeziolizis is the main stage of operation at which the adhesiotomy is made. There are several types of operations which appoint depending on nature of commissures of intestines. At open operations of manipulation are carried out through a big section, at the video assisted surgical interventions the puncture and a small section is carried out, at laparoscopic operations intervention is carried out only through a puncture.
Prevention of commissures of intestines
For prevention of emergence of commissures of intestines it is very important not to allow inflammatory processes in bodies of a peritoneum, to be protected from poisonings with food. People who were already ill earlier intestinal impassability should select very carefully a food allowance, not to use the products containing rough cellulose. Also the diet is not less important: it is necessary to eat food strictly in certain time, it is not necessary to overeat, however it is not necessary to starve also. It is the best of all to eat often and small portions.
It is impossible to subject itself to heavy exercise stresses. If the lock disturbs, it is possible to accept laxative drug, but at the same time it is necessary to watch that similar practice did not become a habit.