Chronic occlusion of mezenterialny vessels (belly toad) – the chronic ischemia of intestines developing at violation of its blood supply owing to an obturation or a spasm of bryzheechny vessels. The belly toad is shown by attacks of abdominal pains after food, persistent ponosa, weight loss. Diagnostics of a belly toad includes a survey X-ray analysis of an abdominal cavity, an angiography of mezenterialny vessels, radio isotope research GIT, according to indications – a gastroduodenoskopiya, a kolonoskopiya, etc. Conservative treatment of chronic occlusion is directed to improvement of microcirculation and removal of an angiospasm; at subcompensation and a decompensation reconstructive interventions on mezenterialny vessels are carried out.
Chronic occlusion of mezenterialny vessels (belly toad, belly quinsy, abdominal ischemia, subdiafragmalny stenocardia) develops at the long disorder of blood circulation in unpaired visceral branches of a belly aorta (bryzheechny top or lower, chrevny arteries) leading to intestines ischemia. In gastroenterology and abdominal surgery when carrying out a purposeful angiography chronic occlusion of mezenterialny vessels in a varying degree comes to light at 50-75% of elderly patients. At full sudden thrombosis or an embolism there is sharp occlusion of mezenterialny vessels and a limited heart attack of intestines.
Reasons of a belly toad
As immediate cause of a belly toad serves the spasm or partial obstruction of mezenterialny vessels. The factors promoting emergence of a belly toad share on intravazalny and ekstravazalny. Chronic intravazalny occlusion develops in the top bryzheechny artery more often. In most cases the clinic of a belly toad arises against the background of atherosclerosis of belly department of an aorta and its visceral branches, is more rare – at the changes of a vascular wall caused by a nonspecific aortoarteriit or a nodular periarteriit, a hypoplasia, aneurism, arteriovenozny fistulas, a fibromuskulyarny giperplaziya of walls of visceral arteries.
Development of a belly toad can be caused by the ekstravazalny reasons: sdavleniye of mezenterialny vessels from the outside fibrous tyazha, medial "leg" or crescent linking of a diaphragm, pancreas tumor, cicatricial fabrics. To Ekstravazalny it is squeezed, as a rule, the chrevny trunk is exposed.
Stages and forms of a belly toad
Depending on localization of occlusion of mezenterialny vessels distinguish the chrevny, verkhnebryzheechny, nizhnebryzheechny and mixed forms of chronic abdominal ischemia which differ with clinical manifestations.
The Chrevny form of abdominal ischemia is characterized by prevalence of a pain syndrome. At chronic occlusion of a verkhnebryzheechny artery there is a tonkokishechny enteropatiya with the prevailing phenomena of absorbing and sekretorny dysfunction of intestines; in clinical manifestations of a belly toad dispepsichesky violations (an eructation, heartburn, vomiting, instability of a chair, an abdominal distension) prevail. At damage of a nizhnebryzheechny artery the tolstokishechny kolonopatiya at which motor function of a thick gut is mainly broken that involves locks, ischemic colitis develops. The mixed form of chronic occlusion of mezenterialny vessels combines damage of several arteries and is shown by the corresponding symptomatology.
On degree of expressiveness of a belly toad distinguish stages of relative compensation, subcompensation and a decompensation. In a stage of relative compensation dysfunction of a GIT is expressed slightly; chronic occlusion of mezenterialny vessels, as a rule, comes to light incidentally at inspection concerning other vascular pathology (vazorenalny hypertensia, Lerish's syndrome). In a stage of subcompensation the expressed disorders of function of digestion, a pain syndrome take place. The stage of a decompensation proceeds with the developed clinic of a belly toad: abdominal pains, intestines dysfunction, the progressing weight loss, an asteno-ipokhondrichesky depressive syndrome.
Symptoms of a belly toad
The belly toad proceeds with constant pains in various departments of a stomach. Emergence of a pain syndrome is connected with meal: pain develops accurately in 20-40 min. after food. The painful spasm is stopped after reception of spazmolitik, the artificial caused vomiting, applying of a warm hot-water bottle to a stomach, adoptions of the compelled knee and elbow provision.
GIT dysfunction at a belly toad is characterized by nausea, vomiting, an abdominal distension, an unstable chair (at occlusion of a verkhnebryzheechny artery), a lock (at damage of a nizhnebryzheechny artery). The progressing loss of body weight is observed at patients with a long dekompensirovanny current of a belly toad. Weight loss is caused by violation of processes of absorption in intestines, constant ponosa, abstention from food in view of the expressed abdominal pains. The Asteno-ipokhondrichesky depressive syndrome is a consequence of long and unsuccessful treatment of a belly toad.
Diagnostics of a belly toad
Diagnostics of a belly toad carries the integrated approach considering clinical manifestations, results of functional and radiological inspection. At an auskultation of a stomach systolic noise in points of projections chrevny and bryzheechny arteries are listened. Visceral noise differs from kardialny noise in loss of the intensity as approaching heart; from aortal – what is not listened from a back. As an objective method of functional diagnostics serves the fonoenterografiya – registration of noise of intestines.
At suspicion on a belly toad the angiography of mezenterialny vessels (mezenterikografiya) or a chrevny trunk is surely carried out (tseliakografiya) which allows to reveal occlusion, a stenosis, poststenotichesky expansion of arteries, localization and extent of violation of passability of vessels. At a survey X-ray analysis of an abdominal cavity in some cases it is possible to find a belly aorta.
Fibrogastroduodenoskopiya and kolonoskopiya at a belly toad, as a rule, reveal hypostasis and an atrophy of a mucous membrane of a stomach, a duodenal and thick gut, sometimes erosion and ulcers. At a research of a koprogramma undigested muscle fibers and slime in a large number are found that demonstrates violations of digestion and absorption in intestines.
In addition at a belly toad the termografiya, a GIT stsintigrafiya, a reogepatografiya, ultrasonography of an abdominal cavity, UZDG of a belly aorta, an electromagnetic floumetriya can be carried out. In the course of inspection other pathological processes in an abdominal cavity are excluded: gastritis, pancreatitis, stomach ulcer of a stomach and stomach ulcer of a 12-perstny gut, cholecystitis.
Treatment of a belly toad
Treatment of the main disease is carried out to stages of relative compensation of a belly toad, the spazmolitik, anticoagulants, medicines improving blood circulation are appointed. At an intestinal dysbiosis the attention is paid to normalization of intestinal microflora. In certain cases effective is an acupuncture. Fractional food in the small portions, an exception of rough and gas-forming food is recommended to patients.
Expeditious treatment of a belly toad is shown at subcompensation and a decompensation of chronic ischemia. Operations at a belly toad can have conditional and reconstructive and reconstructive character. Crossing of a medial leg or a section of a crescent linking of a diaphragm, release of arteries from fibrous tyazhy, removal a solar plexus, etc. can be referred to the first group of interventions. Reconstructive operations on visceral branches of an aorta are among a decompression of a chrevny trunk; endarterektomiya, prosthetics, dilatation and stenting of a chrevny trunk or bryzheechny arteries.
Forecast and prevention of a belly toad
The postoperative lethality at a belly toad reaches 1-5%. In 75-90% of cases gradual regress of symptoms, normalization of digestion and health is noted. In the absence of treatment in the conditions of a decompensation of a belly toad there can be ischemic enteritis, enterokolit, an intestines necrosis, peritonitis.
Prevention of chronic occlusion of mezenterialny vessels demands timely treatment of the vascular and ekstravazalny diseases leading to development of a belly toad.