Hernial defect to the left of the esophagus and may be of various sizes - up to 10 centimeters in diameter. Part of the stomach falls in the hernial sac, lined with fibrous changes of diaphragmatic peritoneum. Stomach, as if wrapped in a defect in relation to fixed in the hole of esophageal-gastric connection. The degree of twisting may be different.
Clinic. Clinical symptoms in brand viagra online paraesophageal hernia is mainly due to an accumulation of food in the stomach, partially located in the thoracic cavity. Patients feel a pressing pain behind the breastbone, especially intense after the meal. First, they avoid eating in large quantities, then in normal doses. Observed weight loss. Symptoms associated with esophagitis, there are only a combination of paraesophageal hernia with a sliding.
When hernia incarceration comes progressive stretching of the stomach that fell down before the break. Rapidly developing mediastinitis with severe pain, signs of sepsis, and accumulation of fluid in the left pleural cavity. Hernia may be the cause of peptic ulcers, as passage of food from the stomach strain disrupted.
These ulcers difficult to treat and is often complicated by bleeding or generic viagra perforation. Diagnosis is mostly X-ray examination, if found gas bubbles in the chest cavity. The study confirms the diagnosis with barium.
To find out the type of hernia, it is very important to determine the localization of the esophageal-gastric anastomosis. With the help of esophagoscopy to diagnose concomitant esophagitis.
Clinic. The most common symptoms are: pain after eating in the epigastric region, belching and vomiting. With prolonged exposure to gastric hernial aperture diaphragm may be dilatation of the distal esophagus and cardia, manifested by hematemesis.
Treatment. Conservative therapy is a special diet. Food should be taken frequently and in small portions. Diet in general is similar to the antiulcer. After the meal is recommended to walk and in any case do not lie. To avoid possible complications - and brand name levitra break the walls of prejudice shown surgical treatment. Optimal access - transabdominal. Careful sipping stomach relegated into the abdominal cavity. Performed herniorrhaphy with additional suturing angle branch block or ezofagofundoplikatsiey. Recurrences are rare. After surgery, reduced clinical symptoms, improve nutrition.
Sliding hernia
The cause of this hernia is a pathology frenoezofagealnoy ligament, which fixes the esophageal-gastric anastomosis in esophageal opening. Part of the cardia of the stomach moves up into the chest cavity. Frenoezofatealnaya ligament becomes thinner and longer. Oesophageal hiatus in the diaphragm expands. Depending on the position of the body and filling the stomach of esophageal-gastric fistula is shifting cialis without prescription from the abdomen into the chest and back. The displacement of the cardia upward angle becomes obtuse branch block, smoothed the folds of the mucosa. Diaphragmatic peritoneum is displaced together with the cardia, a well-defined hernial sac is only for large hernias. Fixation and narrowing of the scars can lead to a shortening of the esophagus and the constant presence of esophageal-gastric anastomosis above the diaphragm. In advanced cases of fibrous stenosis occurs. Sliding hernia is never violated. If the compression comes displaced into the chest cavity of the cardia, the poor circulation does not occur, because the outflow of venous blood is carried out on esophageal veins, the content can bowels through the esophagus. Sliding hernia is often associated with reflux esophagitis.
Displacement cardia up leads to a smoothing angle branch block, disturbed sphincter activity, it becomes possible gastropischevodnogo reflux. However, these changes are not natural, and a significant number of patients reflux oesophagitis does not develop, because the physiological function of the sphincter is preserved. Therefore, a displacement of the cardia is not enough to develop anal sphincter insufficiency, in addition, reflux can occur without a sliding hernia. Unfavorable ratio between the pressure in the stomach and the esophagus promotes penetration of gastric contents into the esophagus. Epithelium of the esophagus is very sensitive to the action of gastric and generic levitra duodenal contents. Alkaline esophagitis due to the influence of duodenal juice flowing even harder than peptic. Erosive esophagitis can become, and even ulcers. Permanent inflammatory edema of the mucous membrane contributes to its mild trauma with bleeding and bleeding, which sometimes manifests itself in the form of anemia. Subsequent scarring leads to the formation of strictures and even complete closure of the lumen. The most frequently reflux esophagitis accompanied by cardiac rupture, less kardiofundalnuyu.
Clinic. Sliding hernia without complications are not accompanied by clinical symptoms. Symptoms arise when the associated gastro-oesophageal reflux and reflux esophagitis. Patients may complain of heartburn, belching, regurgitation. The appearance of these symptoms usually associated with changes in body position, pain worse after eating. The most common symptom of a burning sensation behind the breastbone is observed in 90% of patients. Pain may be localized in the epigastric region, left upper quadrant, and even in the heart. They are not like ulcerative since appear immediately after ingestion, are associated with the amount of the ingested food, especially painful after a heavy meal. Relief occurs after ingestion of lowering the acidity in the stomach. Regurgitation occurs in half of cases, especially after receiving lavish meals, often felt bitterness in the throat. Dysphagia is a late symptoms observed in 10% of cases. It develops as a result of spasms of the inflamed distal esophagus. Dysphagia occasionally occurs periodically disappears. If inflammation progresses, dysphagia occurs more frequently and may become permanent. From the resulting ulceration of the esophagus may have bleeding, which take place covertly.
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