The main symptoms of hernia of the esophagus, the causesoccurrence, diagnosis and treatment

Update: November 2018

Content:

  • Hernia Symptoms
  • What distinguishes sliding hernia?
  • What are the signs of a hernia?
  • The main causes of esophageal hernia
  • Diagnostics
  • Treatment of diaphragmatic hernia
  • Rehabilitation after surgery

Hernia of the esophagus today according to many experts
refers to a very common disease
gastrointestinal tract, ranking 3rd after peptic ulcer
stomach and cholecystitis.

Moreover, in 50% of cases, the diaphragmatic hernia proceeds hidden,
either asymptomatic or with minimal symptoms and discomfort.
Conception is discovered by chance during endoscopic passage.
examination or radiographic examination of the stomach and
esophagus.

In 30% of patients with hernia of the esophagus primary complaints, with
which patients go to the doctor are heart pains –
non-coronary cardialgia and cardiac arrhythmias –
paroxysmal tachycardia and extrasystole. This is most often
leads to diagnostic errors and ineffective therapy in
cardiologist because a possible cause of heart disorders
is a hernia.

This disease is usually combined with gastroesophageal
reflux disease, which leads not only to cardiac
disorders, but also to the whole complex of pulmonary and
dyspeptic disorders in humans.

Прofнаки грыжи пищеводаDiaphragmatic hernia is an extension
the esophageal opening of the diaphragm at which stretching occurs
ligaments connecting the stomach and esophagus.

Such a violation leads to the reflux of bile and gastric juice in
esophagus, gradually, inflammation and mucous membrane changes
shell, which eventually provokes the formation of malignant
tumors.

According to research by the world gastroenterological associations
in the absence of adequate timely treatment of the hernia after 7-10
лет у пациента увеличивается риск возникновения рака esophagus. If a
treatment is absent for 7 years, the risk increases by 280%
development of oncology, if the disease is more than 10 years old, then the risk
increases to 400%.

Hernia Symptoms

Pain sensations

  • The pains of the diaphragmatic hernia of the esophagus are very diverse and
    depend on its type, duration of illness, age
    patient:
  • The most common localization of pain – in the pit
    area, it appears when you change the position of the body, after taking
    food.
  • Sometimes pain may radiate to the area between the shoulder blades or in
    back.
  • It is also possible the occurrence of surrounding pain, which may
    to remind the symptoms, peculiar to such a disease as
    pancreatitis.
  • In a fifth of patients, especially elderly,
    pain in the heart, this may be associated with concomitant
    diseases – ischemic heart disease, angina.
  • When a hernia leads to various complications, then the direction
    nature, pain intensity varies. When tanning pain
    become unbearable burning character, and, the intensity of their
    increases with pressure in the epigastric region, and when tilted
    forward the patient becomes easier. If perivisceritis occurs
    pains are dull, dull in nature, they are continuous and focused
    high in the epigastric region. In case of infringement of the hernial sac
    shrill, tingling pains behind the sternum appearing in
    the area between the shoulder blades (see back pain between the shoulder blades)

Belching sour

When belching in the mouth remains the taste of bitterness, bile, or the patient
there are very frequent belching air, most often they occur
после приема food.

  • Regurgitation

This symptom most often happens at night, after eating or lying down
position, it is not accompanied by nausea. If a количество масс при
regurgitation significantly, it can cause aspiration
pneumonia.

  • Dysphagia

This is not a permanent symptom of a hernia of the esophagus, it can
appear then disappear. When consumed hot or too
cold liquid food, very swallowed possible
the occurrence of difficulty in passing food through the esophagus. what
touches solid food, it moves along the esophagus more easily and
faster. If a этот прofнак пищеводной грыжи начинает носить
permanent, it is a reason to diagnose
oncology, strictures, esophagus ulcers, hernia incarceration.

  • Heartburn

Самый характерный, выраженный и частый прofнак грыжи esophagus.
It happens after eating, at night and lying down. Most
patients it is a constant symptom and plays the defining
role in the diagnosis of diaphragmatic hernia.

  • Hiccups

Not the most characteristic symptom, because it happens only in 4%
patients. if it occurs, it is characterized by a long period,
the patient may hiccup from several hours to several days.

  • Pain, burning tongue

A rare symptom, it appears only if the gastric contents
thrown into the oral cavity or larynx, while it may
appear hoarseness.

  • The combination of a hernia of the esophagus with impaired respiratory
    the system

Most often, esophageal hernia is accompanied by bronchial asthma,
obstructive bronchitis, aspiration pneumonia. Most dangerous of
These pathologies are aspiration of the gastric masses into the respiratory tract.
At the same time, the patient suffocates, persistent cough and pain
sternum.

whatбы дифференцировать боли в пищеводе при грыже, прofнаки
which are similar and characteristic of other diseases, should be considered
следующие факторы, характерofующие наличие диафрагмальной грыжи у
patient:

  • After eating, in most cases the pain intensifies, also
    интенсивность болевых ощущений возрастает при кашле, фofической
    нагрузке, любом напряжении, даже просто в горofонтальном
    position
  • After vomiting, belching or regurgitation, inhaling deep pain
    weaken or stop. It also helps to reduce pain.
    intake of soda, water, recumbency.
  • The nature of pain is rather moderate, aching, dull, only in rare
    Cases can be extremely strong pain.

What distinguishes sliding hernia?

Один of видов диафрагмальных грыж – это скользящее грыжевое
bulging In this case, through the weak point of the diaphragm into the pectoral
cavity penetrates part of the esophagus or stomach. Periodically, they
return to their normal location (in the abdominal cavity) that
leads to the disappearance of symptoms. Фofические нагрузки, напряжение
abdominal muscles and a number of other factors leads to repeated
формированию грыжи esophagus.

The characteristic symptom of sliding hernias is pain of burning character,
which is located behind the sternum or in the upper abdomen. She is
increases in the “prone” position and with strong bends, often
сопровождается отрыжкой, ofжогой или тошнотой.

What are the signs of a hernia?

Одно of самых опасных осложнений диафрагмальных грыж – ее
infringement. It may occur as after a long period
disease, so be the first manifestation of the disease. whatбы своевременно
to identify the infringement, the patient should be assessed for the following
symptoms:

  1. Sudden pain of a sharp or shooting character at the bottom
    half breast / upper third of the abdomen. Often, she radiates to
    scapula or supraclavicular fossa. Increased pain provokes increased
    перистальтика кишечника (of-за приема пищи, жидкости, некоторых
    drugs, etc.). The intensity of the pain is extremely high, in rare
    cases, it can lead to shock;
  2. Vomiting that does not stop for a long time
    (from several hours to days). As a rule, increases at height
    pain;
  3. Severe bloating with increased pain.

Наличие одного of этих прofнаков требует неотложного оказания
medical care to the patient.

The main causes of esophageal hernia

Прofнаки диафрагмальной грыжи чаще всего появляются у людей
пожилого возраста, когда по естественным причинам ofнашивается
органofм, а ткани, мышцы, внутренние органы теряют эластичность.
With the progression of a hernia in some patients by the age of 60 can
form the so-called “hernial ring” when the esophageal
the hole may increase by a few centimeters.

Causes of esophageal hernia formation:

  • Age-related weakening of the muscles, ligaments of the esophagus
  • Resorption of adipose tissue under the diaphragm
  • Changing the position of internal organs, for example, when
    of pregnancy
  • Atrophy of the left side of the liver
  • Esophageal dyskinesia
  • Метеорofм, напряжение брюшных мышц
  • Increased intra-abdominal pressure
  • Congenital anomalies of development – shortened esophagus
  • Surgery on the esophagus
  • Thermal burns from hot foods help reduce
    esophagus and provoke the formation of hernia.

There is both an asymptomatic course of the disease, and
on the contrary, in patients with a variety of diseases
желудочно-кишечного тракта обнаруживается еще и грыжа esophagus.
Thus, according to some data, 40-60% of patients with a stomach ulcer or
Duodenum, 50% of patients with chronic gastroduodenitis,
20-40% of people with cholecystitis (see Cholecystitis symptoms and treatment) and
pancreatitis (see pancreatitis symptoms, treatment)
диагностируется диафрагмальная грыжа.

Diagnostics

The first step in the detection of diaphragmatic hernia is to look for
typical patient symptoms and possible causes. Thereafter,
It is necessary to proceed to direct examination, in which
можно обнаружить следующие прofнаки болезни:

  • Inspection – with a hernia of the esophagus, the chest is practically not
    двигается в процессе дыхания, of-за нарушения функции диафрагмы.
    If a человек долгое время страдает от этой патологии, живот
    becomes “sunken”. This symptom may not be seen in humans.
    increased body weight;
  • Feeling of the abdomen (palpation) – it becomes tight in
    верхних отделах брюшной стенки, of-за сильного напряжения мышц.
    Pain on palpation is also possible;
  • Auscultation (listening with a phonendoscope) – characteristic
    прofнаком диафрагмальной грыжи это появление шума кишечника в
    chest cavity. A normal breathing sound is usually
    missing or significantly reduced.

ATышеперечисленных прofнаков достаточно, чтобы предположить
diagnosis. However, to reliably confirm the presence of a hernia of the esophagus can
only with the help of instrumental methods of diagnosis.

Chest X-ray / X-ray

This is not an informative enough method, but it is necessary for
order to to distinguish the pathology of the diaphragm from diseases of the chest
cavities (pneumothorax, pleurisy, pneumonia, etc.). You can also
обнаружить некоторые косвенные прofнаки грыжи пищевода:

  • The dome of the diaphragm is above normal;
  • The presence of intestinal loops / gastric gas bladder in the cavity
    chest;
  • Mediastinum shadow offset (white area between lungs
    X-ray) away from the median line.

Обнаружить эти ofменения на рентгенограмме/флюорографии
hard enough without adequate experience. Therefore it is important that
снимок ofучал квалифицированный доктор.

X-ray of the esophagus and stomach with contrast

In the absence of CT, X-ray diagnostic diagnostics is the best.
way to confirm diaphragmatic hernia. For this purpose, the patient
give to drink a solution of a contrast agent (about 200 ml of barium
sulfate), then perform an x-ray. Достоверный прofнак
diaphragmatic hernia – the presence in the chest of the stomach or thin
guts.

How to prepare for the study?

For optimum radiography quality, begin
Preparation 3 days before the procedure:

  • For this period, the patient is shown a diet with a minimum
    the amount of fiber. Should be excluded: rye bread, barley and
    кукурузную крупы, молочные продукты, фрукты, овощи и их проofводные
    (juices, preserves, etc.);
  • 12 hours before the contrast radiography is necessary
    eat a “hungry” diet;
  • In the evening and in the morning before the procedure, the patient is put on one
    очистительной клofме.

It should be noted that taking laxatives is not recommended.
as they increase the amount of free gas in the intestines and
reduce the quality of diagnosis.

Ultrasound of the pleural cavity

An additional method that is used when questionable
x-ray results. Using ultrasound distinguish the loop
small intestine or stomach from other pathological processes in
rib cage. The procedure does not require any preparation and
takes 7-10 minutes.

CT scan of the chest and abdomen

With this expensive x-ray examination,
diaphragmatic hernia is determined in 100% of cases. Presence of false
результатов исключено, благодаря отличной вofуалofации. TO
Unfortunately, hospitals only have CT scanners.
major cities and regional centers. Research is usually
chargeable (average price – about 2000 rubles.) This explains
its rare use.

Laparoscopy / Thoracoscopy

This is not just a way to diagnose diaphragmatic hernia, but
full surgical intervention. Its principle is simple – in
certain anatomical region (abdomen or chest
respectively) two cuts 1-2 cm long are made. Through them
An endoscopic instrument is inserted into the cavity.
narrow metal tubes with a working tip
(branches). На одном of них обязательно имеется видеокамера с
light source. Thus, the surgeon can directly
inspect the diaphragm and choose further tactics.

It should be noted that these procedures are most often used.
with severe injuries to the abdomen or chest. TOак метод диагностики,
laparoscopy and thoracoscopy are rarely used.

Treatment of diaphragmatic hernia

First of all it is necessary to emphasize that the treatment of hernia
esophagus without surgery is impossible. Единственный способ ofбавиться от
this disease – surgery. Should execute it
as early as possible, since a long wait can lead to
the following complications: the infringement of a hernia, obstruction
digestive tract, respiratory failure, etc.

This operation has no absolute contraindications for
carrying out, therefore can be carried out to all patients. Depending
from the severity of their condition, it is carried out either urgently (for 2
hours), or according to plan. Emergency intervention is shown as follows.
sick:

  • With the pinching of the hernia of the esophagus;
  • With severe respiratory failure;
  • When abnormalities in the work of the heart caused by hernia;
  • With severe symptoms (invincible vomiting, intense acute
    pain, etc.).

In other cases, the operation is carried out according to plan
not limited but recommended for a few weeks) in
специалofированном отделении «торакальной хирургии».

Preparing for a planned operation

Before surgical treatment, the anesthetist / surgeon details
interrogates the patient about the state of his health, the presence of allergies,
previous blood transfusions, etc. To patient
A number of studies are assigned to evaluate the functions.
основных органов: общие аналofы крови и мочи, биохимический аналof
венозной крови, кислотно-щелочное состояние, ЭTOГ.

If a есть необходимость, состояние больного несколько улучшают
(стабилofируют давление, деятельность сердца, функцию дыхания и
etc.). Immediately before surgery, they cleanse the intestines.
(если нет ущемления грыжи пищевода), катетерofируют мочевой пузырь
and inject the necessary medication.

TOак лечить грыжу пищевода?

The main purpose of the operation is to set the hernial protrusion back into
abdominal cavity and suture the damaged area of ​​the diaphragm. whatбы это
сделать, хирург может выполнить один of двух доступов: cut
anterior abdominal wall at the midline or make thoracotomy
(open the lower parts of the chest). When injured
diaphragmatic hernia, the doctor needs both of these access.

If a операция выполняется планово в отделении торакальной
surgery, the doctor may use a more modern method
treatment of hernia – video endoscopic surgery. TOак и при
diagnostic laparoscopy, make two 1-2 cm incisions, through
which introduce special tools into the chest cavity. Один of
They are necessarily equipped with a video camera with a flashlight, through which
the surgeon controls his actions. The second can perform the function
forceps, electric / plasma knife, fluid suction and
etc.

After the organs are repositioned into the abdominal cavity, the diaphragm is sutured and
укрепляют тканями органofма (чаще всего – сухожилием или
aponeurosis) to prevent the recurrence of a hernia
esophagus.

Rehabilitation after surgery

Surgical treatment of hernia of the esophagus is quite traumatic.
Therefore, in the postoperative phase, the patient may experience pain,
be confronted with a digestion disorder or infectious
complications. whatбы этого ofбежать, врачи-клиницисты рекомендуют
hold the following events:

Adequate pain relief

TOак правило, для этого достаточно НПATС, которые вводят путем
intramuscular injection (in the buttock). More often –
TOеторолак/TOеторол. When expressed pain may be the introduction of local
anesthetics (Lidocaine or Novocain) into the surgical incision or
method of epidural anesthesia.

TOак делают эпидуральную анестезию (обезболивание)? Dumb doctor
needle enters the drug (Lidocaine, Novocain) in the spinal canal, in
the space between the spinal cord and the inner surface
vertebrae. If necessary, epidural analgesia can
Maintain continuously if in the specified space install
tube through which the anesthetic is constantly supplied.

Diet

Dietary treatment: hernia of the esophagus often disrupts normal
promotion of food through the intestines. Therefore, in the postoperative phase
it is important to gradually restore its function. For patients
recommended diet, excluding flour, salty, spicy and fatty
the dishes. In the diet should include porridge (rice, buckwheat,
corn), which contain a moderate amount of fiber;
boiled meat (chicken or beef); soups cooked on
chicken broth;

Prevention of thromboembolic complications

After most surgery, there is a risk of developing these complications. AT
In this case, on the wall of a vessel in a patient increases
тромб, который может оторваться и закрыть просвет жofненно важных
артерий (легочной, коронарной, позвоночной и etc.) или попасть в
heart cavity. whatбы этого не проofошло, больным рекомендуют
wear compression stockings and perform injection preparations
heparin (if there is no pronounced bleeding).

ATыполнение вышеперечисленных рекомендаций позволяет снofить риск
complications of the postoperative phase and speed recovery
the patient. AT среднем, для этого достаточно 7-10 дней.

Грыжа пищевода может стать опасным для жofни состоянием, при
choice of waiting tactics or treatment of folk remedies. therefore
after the diagnosis is necessary to determine the date of the operation
and the technique of its implementation. If a хирургическое вмешательство было
carried out in a timely manner – the prognosis for the patient, in most
cases favorable. Proper rehabilitation and prevention
postoperative complications allow the patient to return the same
качество жofни в течение короткого срока.

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