Impassability of a thick gut is a pathological state at which owing to the mechanical or functional reasons there is a violation of passing of food and liquid on a large intestine. Symptoms of impassability are sharp pain on the intestines course, vomiting, nausea, lack of defecation and an otkhozhdeniye of gases, uneven increase in a stomach in sizes, violation of the general state. For diagnostics of impassability of a thick gut the general survey, a stomach palpation, a survey X-ray analysis and a computer tomography of abdominal organs is used. The principles of treatment depend on the nature of pathology and often consist in a resection of an affected area of intestines.
Impassability of a thick gut
Impassability of a thick gut is an urgentny surgical state which is characterized by violation of a passage of food and water on the intestinal channel. This pathology makes about 3,8% of all states entering a concept of a sharp stomach. Among all types of impassability of intestines the share of tolstokishechny impassability makes about 35%. Slightly more often the disease is registered at patients of advanced age. Danger of pathological process is that in the absence of adequate treatment the probability of a nekrotizirovaniye of a wall of a gut and the subsequent perforation is high against the background of what there is peritonitis which demands urgent surgery for rescue of life of the patient. The gastroenterology, a proktologiya and surgery is engaged in studying of a problem of tolstokishechny impassability.
Reasons of impassability of a thick gut
Can result various congenital factors, such as lengthening of segments of intestines, anomaly of development in impassability of a thick gut ( guts, a disease of Girshprunga). From the acquired reasons contributing to development of this pathological state allocate an adhesive disease after abdominal organs operations, to a tumor of a large intestine, foreign matters of intestines, stomach hernia, helminthoses, cholelithiasis. Impassability of a thick gut arises against the background of a certain contributing factors under the influence of various mechanisms to which refer sharp increase in intra belly pressure, plentiful meal, the increased physical activity.
Impassability of a thick gut can be mechanical and functional (paralytic). The most often mechanical impassability develops at hernias, tolstokishechny solderings, inflammatory diseases, kalovy stones, tumors, a zavorota and invagination of intestines. 60 years in 93% of cases are aged more senior malignant tumors which grow in a gut gleam are the reason of this pathological state. intestines occupies 4% of all reasons of impassability of a thick gut. All other pathological states result in mechanical impassability in 3% of cases.
The infections affecting nervous system are the main reasons for paralytic impassability. Besides, leads administration of drugs to this state, the smooth muscles of intestines influencing a tone. Paralytic intestinal impassability can develop against the background of Parkinson's disease – this option of impassability of a thick gut is connected with muscular and nervous breakdowns. On their background of reduction of intestines are weakened or absolutely stop. As a result of it advance of food on a gastrointestinal tract is broken.
Symptoms of impassability of a thick gut
The main signs of impassability of a large intestine are periodic spastic belly-aches, vomiting, nausea, an abdominal distension, locks and a delay of gases. These clinical manifestations develop against the background of a normal general state. The first symptom of a disease usually is sharp belly-ache. Initially pain is felt only in some certain place, then extends to all stomach. At the same time the patient feels active reductions in intestines which are followed by a sharp swirling in a stomach. Vomiting, a delay of a chair and gases are considered as Patognomonichny symptoms of pathology. Against the background of intestinal impassability the condition of the patient can sharply worsen. The patient turns pale and becomes covered cold then. At objective survey the asymmetric abdominal distension is noted. At emergence of similar symptoms the emergency hospitalization as for treatment of impassability of a thick gut urgentny expeditious treatment is generally used is necessary.
If in time not to carry out adequate treatment, then at this disease there can be serious complications which threaten the patient's life. In particular, against the background of impassability of a large intestine perhaps nekrotizirovany the struck gut segment. This pathological state arises because of violation of a blood-groove in vessels of an abdominal cavity; death of tissues of intestines results that leads to perforation of a thick gut and development of an inflammation of a peritoneum (peritonitis). If at peritonitis not to carry out timely surgery, the disease comes to an end with the death of the patient.
Diagnostics of impassability of a thick gut
Diagnostics of intestinal impassability is based on clinical and tool methods of researches. At survey and a palpation of a stomach protrusions and inflation of a forward belly wall come to light. From tool methods of the most widespread and the X-ray analysis of an abdominal cavity is available. The computer tomography is more informative. Both of these methods allow to define a type of impassability of a thick gut accurately. In particular, they give the chance to distinguish paralytic impassability from mechanical. Besides, radiological methods of a research allow to specify extent of damage of intestines. By means of these diagnostic techniques the doctor can distinguish full impassability from partial.
Laboratory methods of a research play a supporting role in diagnostics of tolstokishechny impassability. At development of complications, such as a perforation and peritonitis, in blood acceleration of SOE and stab shift is noted , to the left. These changes demonstrate development of the expressed inflammatory and necrotic process.
Treatment of impassability of a thick gut
The principles of therapy depend on the nature of impassability and the reason which caused it. Anyway treatment of this disease is carried out in the conditions of a hospital. At mechanical impassability of a thick gut of partial character when a part of food and liquid can move ahead on intestines, long stay in a hospital will not be required. The low-fibrous diet which the foodstuff which is not slowing down digestion enters is recommended to such patients. However, if partial impassability of a thick gut is not stopped independently against the background of correction of food, then for its permission surgical treatment can be required. It consists in a resection of the struck part of intestines with further reconstruction of a continuity of a gut.
At full mechanical impassability of a thick gut its contents cannot move ahead on a digestive tract. Therefore for treatment surgeries are used. The volume of operation depends on a concrete situation, extent of damage of intestines, localization of pathological process. Most often surgeons carry out a resection of a nekrotizirovanny segment of intestines and carry out plasticity of a thick gut.
Paralytic, or functional impassability of a thick gut in most cases is a state which can be resolved after a while. However, if symptoms of a disease do not pass, for treatment the medicamentous therapy directed to stimulation of reduction of smooth muscles of intestines and improvement of neuromuscular conductivity is used. These medicines provide normal advance of food and liquid on a digestive tract. One of the most effective medicines for therapy of this pathological state is . Treatment of paralytic impassability of a thick gut can be carried out both in out-patient conditions, and in a hospital. At the same time it is focused on therapy of a pathological state which led to impassability emergence. If violation of passability of a large intestine was caused by reception of certain medicines, then they need to be cancelled urgently.
Forecast and prevention of impassability of a thick gut
At in due time provided medical care the forecast of mechanical impassability of a thick gut generally favorable. The exception is made by cases when the pathological state was caused by a colon cancer which already gave the remote metastasises in other bodies. Paralytic tolstokishechny impassability on condition of adequate treatment has, as a rule, the favorable forecast. For its prevention by the patient 60 years are more senior it is necessary to conduct examination of intestines at the proctologist and the surgeon regarding existence of tumors or other pathology which can become a cause of infringement of intestinal passability.