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Current stomach (ZZh) - rarely encountered disease. It proceeds hard enough. It occurs around its transverse and longitudinal axis by 180-360 °. Zeh rarely exceeds 180 °. Current of its parts can achieve even 360 °. There are two main types of ZZH: 1) transverse or mesenterico-axial, most frequent and 2) longitudinal or organoaxial (O.P. Krugsov, 1998).
Stomach Current:
a, b - mesenterico-axial; in - organoaxial type
Etiology. The predisposing factors of the ZEG are congenital anomalies, changes in the longitudinal axis of the stomach, relaxation or lack of a ligament apparatus, excessive mobility of the DPK and spleen, the insertion of the stomach, the hernia under and sharp weight loss.
Directly promotable factors of the ASP include vegetative and neuropsychic violations. The latter, causing regular and strong reductions in the gastric wall, can cause even its break. This also contributes to the reception of a large amount of dense food, an increase in intra-abdominal pressure and closed damage to the abdomen. The urges may arise on the basis of its scar deformations ("hourglass"), tumors of the stomach, defects in the diaphragm. The emergence of the ZP is facilitated by the persistent antiperistaltics, violations of the normal act of evacuation of gastric content when overflowing the stomach, bloating of the stomach and intestines.
The longitudinal turn occurs in the direction of the longitudinal axis of the stomach. Starting from the cardiac department, it continues towards its weekend. The longitudinal zh is in two versions. In one case, a small curvature, including a large gland and transverse OK, turns to great curvature, and in another case, the vicious starts from the rear section of great curvature and spreads towards the distal part. This process usually includes also transverse ok and large gland.
The transverse or mesenterial-axial overwhelming occurs more often than longitudinal. This occurs as a result of the steep of the stomach around its horizontal land. It passes through a small curvature and continues towards the inner edge of great curvature. The horizontal ZZH also occurs in two directions - both in the direction of the clockwise direction and against it.
Clinical picture and diagnostics. ZZH starts suddenly, sharp sharp pain in the epigastric area. Pain irradiates in the back and left hypochritic region and are accompanied by nausea, vomiting, and then unsuccessful urges towards vomiting and bloating. Massows, as a rule, do not contain bile impurities. Vomiting arises after each attempt to swallow the sip of water or food.
The overall condition of the patient is progressively deteriorating up to the collapse and development of shock phenomena. Acute pains irradiate in the back and area of \u200b\u200bthe left shoulder belt. At the same time, a feeling of gravity and bloating in the epigastric and hypochritic regions appears. Immediately after that, vomiting appears, which at first happens with food, and then acquires a mucosa.
The epigastric area seems to be filthy, while the lower engine of the abdomen is drawn and placed. In the first hours after the UZ, it is possible to obey the peristaltics in the epigastric region, and peristaltic waves, in contrast to the stenosis of the gatekeeper, are traced not only in iso-, but also in the antiperistaltic direction. With the complete closure of the input and output sections of the stomach vomiting, it is stopped, but the painful nausea and belching appear. The general condition of the patients is progressively worsening.
The phenomena characteristic of the clinical picture of high NK develop, the dehydration of the body is rapidly developing, which is manifested by non-rigid thirst, dry mouth and so on. In addition, there are also pain in the field of chest, shortness of breath, breathing and cardiac activity are disturbed. The pulse becomes frequent, weak filling and voltage, drops blood pressure, collapse develops.
From local symptoms, the bloating is more pronounced, the tension of the muscles of the abdominal wall. With palpation, the belly is painful. Percussion gives a high tympanite, there is a symptom of stomaching in the area of \u200b\u200bthe stomach. Enter the probe in the stomach fails. Characterized by Triad Borhard: the impossibility of introducing the probe to the cavity of the stomach, the increasing bloating of the abdomen and pain in the ass and the virgin hypochondrum.
The correct diagnosis of the RI is promoted. It detends the high position of the diaphragm, the expressed expansion of the stomach and the presence of a horizontal level of fluid in the stomach and a large gas bubble above it. With a complete break, the ri cannot be due to the impossibility of introducing the barium suspension into the stomach. In case of incomplete, it can be revealed by one or another strain of the stomach and the retention of the evacuation of gastric content.
The study of peripheral blood gives high leukocytosis with a shift to the left of the leukoformula. It is characterized by a decrease in the volume of circulating blood (OCC) (hypovolemia), shift of the brain towards alkalosis. Dehydration, hypochloremia, hypoproteinemia, which leads to a sharp deterioration in the state of patients, is rapidly developing.
In the urges, the samples of its wall can also develop, often leading to its perforation and the development of spilled peritonitis. With the unrecognizing this complication and inorganization of timely operational intervention, the disease is usually completed by an unfavorable outcome.
In chronic supplement, its input and outlet openings are not fully closed. At the same time, parodious pains in the epigastric region are arising, which extend towards the left hypochred region. Pains are enhanced, especially after meals. There is also a bloating, a sense of tension and gravity in the epigastric area. A number of patients have a violation of the act of swallowing (dysfagia).
Chronic urges proceed more favorably. In some cases, they can be acute and acquired a very difficult course.
In chronic urges, the high position of the diaphragm dome is also noted, and the gas bubble detected in the stomach is relatively large. In the transverse break of the stomach, it seems to be shortened, it acquires a cross-shaped form.
The differential diagnosis of the ZP is carried out between high NK, reducible with a diaphragmal hernia, acute expansion of the stomach, OP and other diseases of the abdominal cavity.
In some severe cases, it is necessary to resort to emergency diagnostic laparotomy, which will give the opportunity to finally clarify the nature of the disease. Preoperative diagnostics is extremely rare. Patients are operated most often with a diagnosis of high NK, probulous ulcer (FI) stomach, etc.
Treatment ZZh surgical. Part of the surgeons adheres to the opinion that at the early stage of acute urges it is necessary to produce relatively light operational interference. During the operation, it is possible to eliminate (straighten) only after eliminating adhesions, battles and emptying its contents using a trocar. To reduce the pressure created in the cavity of the stomach and warnings of the re-soldered, gastrostomy or GEA is produced, as well as gastrophexia (sewing the front wall of the stomach to the front wall of the abdomen).
When necroticing the wall of the stomach, perforation and its break, the opening is embedded, and in the presence of indications also its partial or total resection, if the patient's condition allows. When the diaphragmal hernia is detected, there is a plastic surgery and a stomach fixation to the front abdominal wall (gastropkaxy).
The postoperative period is usually heavier. Therapeutic measures are directed here against shock, peritonitis, falling the tone of the stomach, etc. Measures are being taken, also aimed at the correction of WEB and KOS. For this purpose, a permanent stomach transformation is used, plasma transfusion, albumin, protein, the introduction of a 5-10% glucose solution, isotonic sodium chloride solution. Antibiotic therapy, hearty preparations, vitamins, etc. are also prescribed.
In chronic urge, if the evacuation of the contents of the stomach is not disturbed, conservative treatment is mainly carried out. With severe urge, the outcome of the disease is often unfavorable. However, despite the measures taken, mortality remains high and reaches 41% (P.N. Nakalkov et al., 1976).
Grigoryan R.A.
Turning the stomach - the disease is quite rare, besides, and little known doctors. The main clinical manifestations of the stomach are reminded in principle the symptoms of high obstruction of the gastrointestinal tract. In the absence of diagnosis and treatment, the disease is dangerous for human life and ends with a fatal outcome.
The conditions for anomalous stomach reversal along the transverse or longitudinal axis are created as a result of the attachment of the gatekeeper and cardia, elongation of the ligament apparatus, the overflow of the stomach, enhanced peristaltic and vomiting.
The patient needs urgent hospitalization into a stationary surgical department for immediate operational intervention, namely, fragrant frauds and using the gastric cavity emptying probe.
The disease is found according to statistics, at any age, but most of all are subject to 40-50-50-year-old. Somewhere 20% of pathological diseases happen in breast-age children.
There are information that directly indicate the possibility of the appearance of the stomach harness in people with gastroptosis, ulcerative ulcer of the stomach, perigastite, scar deformation, an atonium of the stomach, a tumor of the stomach, which is observed in the abdominal cavity, aerophage.
Diseases of the diaphragm - especially predisposing factors for the progression of the stomach coast. Especially - Parasezophageal hernia. Much less often, the disease occurs in the hernia of the sliding esophageal hole of the diaphragm, the hernias of Larrey-Morganya, Bochdalek, during the relaxation of the diaphragm and the traumatic diaphragmal hernia.
There are evidence certificates of the stomach and in the case of surgical interventions: selective Wagotomy, Gastrostomy, Lewis operations, Nissen's Fundoplikation.
A starting factor in the occurrence of the disease may be an increase in intra-abdominal pressure due to abundant food, abdominal injuries, vomiting, physical exertion.
Turning the stomach in its etiology is divided into two types - congenital or acquired and idiopathic.
Usually, idiopathic type is observed in 2/3 of all patients and develops due to the weak state of the ligament apparatus of the stomach, which helps bring the attractions and cards with a stomach filled with a stomach.
The second type is observed in 1/3 of patients and directly depends on the acquired or congenital deviations that lead to excessive mobility of the stomach.
The stomach break is acute and chronic. The first is common, as a rule, less frequently chronic and occurs equally often regarding both axes of the stomach. As for chronic type, the disease is the result of the rotation of the stomach regarding the transverse axis.
Symptoms
Symptoms usually depend on the age of the patient, the pace of development of the disease, the degree of irrest of the stomach.
In the clinical course of the disease, two main phases are distinguished:
- The 1st - the breakdown did not reach 180 ° and the complete closure of the lumen of the pyloric and cardiac sections of the stomach is not available;
- The 2nd - the vico reaches 180 ° and the complete closure of certain stomach departments occurs.
The acute steepness of the stomach occurs suddenly and is mainly characterized by the occurrence in the left hypochondrium intensive pain and the epigastric region, sometimes irradiating into the chest (lower departments) and the back.
There is a multiple vomiting for the cards' cards. The patient facilitates does not bring. It is observed due to the scoring in the epigastric area of \u200b\u200bthe asymmetry of the abdomen, during the palpation moderately painful.
In the first hours, after the occurrence of the stomach, the stool and the separation of gases can be, and peristaltic reinforced noises can also be listened. In the case when the gatekeeper and cardia are completely closed - the patient's condition deteriorates. The bloating occurs, pain is enhanced.
Over the bloated section of the abdomen during physical research, the noise of intestinal and high tympanite are revealed, after just a few sips of water, swallowing, is almost impossible to swallowing, thirst is growing.
When the stomach breaking about the longitudinal axis is observed: involuntary repeated vomiting, acute and strong pain in the epigastric region, the impossibility or the difficulty of conducting the probe in the stomach.
With acute breakdown of the stomach (for diseases and congenital anomalies of the diaphragm), the flow of which is localized in the pleural cavity, there are sharp pain in the epigastric region and the chest, which are given in the shoulder, the blade, there is a shortness of breath.
Diagnostics
The clinical picture of this abnormal disease resembles the infringement of the diaphragmal hernia. Such a phenomenon like the blink of the belly quadrant is a distinctive sign of the stomach charger. Visually observed enhanced peristalistic of the stomach.
Relaxation of the left half of the diaphragm is one of the most common causes of the stomach harness. It is also possible to turn the stomach if it turns out to be in the diaphragmal hernia. Due to obstruction, all attempts to administer the gastric probe are intact. Specify the diagnosis with a radiographic study in a hospital, which is undertaken immediately.
The acute course of the stomach is common, as a rule, is manifested by pronounced intoxication, in parenchymal organs with dystrophic changes, metabolic severe disorders and hemodynamic disorders. The diagnosis is based mainly on clinical inspection and x-ray data.
Diagnose the stomach breaking about the longitudinal axis is quite difficult, especially if there is no diaphragm defect.
It manages to reveal on radiographs a high standing diaphragm and the existence of a large gas bubble with a liquid level - horizontal.
In the stomach during a breaking about the transverse axis of the body during a radiological study (the patient is in the standing position) two levels of fluid are revealed: the first - in the day of the stomach, the second is in the body of the stomach.
X-ray-contrast research is important and in identifying diaphragm diseases leading to the formation of chronic stomach charger.
Despite the fact that alkaline phosphatase and amylase indicators can be elevated, laboratory data is nonspecific.
Prevention
The disease is so rare that there are no special preventive measures today.
Treatment
Treatment of stomach charging is extremely operational. Conservative events can sometimes be successful, but the reasons leading to the breakfast of the guts are not eliminated. In the case of stomach, immediately decompression of the stomach must be carried out. If it is impossible to install the probe, then attempts should be left, as this may well contribute to the perforation of the stomach wall, especially in children.
Incompretation operational treatment leads to the progression of severe complications and the increase in mortality.
Perforation of the wall with the development of peritonitis, as well as necrosis - the most frequent complications of acute stomach harness. The necrosis of the stomach wall due to strong blood supply to the stomach happens only in 5-28% of all observations. Complications that are most common: acute pancreatitis, spleen break, gap of general bile duct, jaundice, gastric bleeding due to the formation of sharp ulcers.
Mortality during acute breakdown of the stomach ranges from 30 to 50%, in case of complication, its walls are complicated - reaches 60%.
Middle laparotomy is considered the most frequent operational intervention. Current stomach, which was complicated by the walls of the wall directly in the hernia holes of the esophageal diaphragm, is an indication for thoracotomy.
The stomach separation is the main stage of the operation, but it is performed solely after the decompression of the organ. This produces gastrostomy and puncture of the stomach.
The necrosis of the stomach wall is also indicated to resection of the stomach, and sometimes gastrectomy.
Often after frauding the stomach, the disease occurs a relapse of the disease and here surgeons differ in opinion. Some believe that the operation should be completed by gastropseysia, the other - gastrostomy. Some surgeons use, as a rule, both of these interventions.
Today there are data on the use of a laparoscopic method with chronic stomach burst.
The stomach dog is a single-chamber twisted bag, located so that its wide part is aimed forward. In the direction back, he narrows. The esophageal inlet in the stomach is quite wide, funcontummy, so the dog is so easily shrinking food, exit from the stomach is significantly already. Both input and output from the stomach are equipped with a locking muscles (pilurus). The shape of the stomach varies very varies and depends on the degree of its filling, on the degree of filling and stretching of the intestine, etc. The stomach capacity also varies - from 0.6 to 8 liters, making up the dog weighing 10 kg on average about 1 liter. The cavity of the stomach is lined with a mucous membrane, in which there are countless glands that produce gastric juice. This juice dissolves some components of food and prepares them to further splitting and sucking in the intestine. In a healthy stomach, food dogs are processed very quickly and quickly removed from it - when the stomach is examined with a normally working panel, there are a contrasting agent after 10 minutes and after about 2 hours the stomach should be emptied.
An empty stomach is located in the left hypochondrium. Its front surface adjacent to the liver and aperture, rear - to the bowel hinges. Like all predators, the stomach dog is able to stretch very strongly and, if filled, can reach the lower wall of the abdomen. The expansion of the stomach occurs due to an increase in its left half, which at the same time acquires a spheroid form. In the correct position of the stomach is held with gastric ligaments, which in many breeds of dogs are quite weak. In addition, dogs have no gastrointestinal bunch.
Mechanism of the occurrence of the stomach
Option Acute Extension-Current ...
Under the acute expansion it is understood as an unexpectedly emerged massive bloating (trickening) of the stomach - no matter whether it happened due to the large volume of food and fluid or due to the strong accumulation of gases. In many cases, the extension takes place in itself after vomiting or the contents take place in the duodenum. But sometimes, as a result of a bad reduction in the stomach, due to the walls stretched with puppies or because of the spasm of the pylorus (exit from the stomach in the intestine), the cause of which may be pain shock, fright or nervous stress, too cold or hot food, not digested Food is delayed in the stomach. The microorganisms that have fallen together with food (cocci, lactic acid bacteria, etc.) as a result of the interaction of hydrochloric acid of gastric juice with a bicarbonic soda from saliva and a small-scale juice cause a large volume of gases. The accumulation of fermentation gases contributes to the appearance of tympania (methiorism). Because of the large bend, the pillar is shifted to the left (\u003d twisted). At this point, the stomach turns clockwise around the esophagus (\u003d vibration of the intestines), the spleen shifts in the ventral direction to the right. Access to the stomach is completely closed and finally does not allow to move away the gases.
When the stomach is filled or crowded with food, the walls are stretched, and the ligaments that must support it, weak, then with a sharp movement or sudden braking on the run, or even when turning onto the back relaxed in a dream the dog's dog can shift and wrap. If there is a twisting, the contents of the stomach will not be able to go into the intestines and the release gases swell the stomach to incredible dimensions.
In both cases, the stomach stretching in itself is usually not fatal, but when the gasein vein is compressed under the pressure of gases, the aperture is oppressed, the vessels can be shifted and the blood supply to the heart and other internal organs will be stopped. A minute heart rate decreases, the blood pressure drops, the flow of oxygen is reduced throughout the body and in the absence of timely assistance, this may lead to a deadly outcome. Sometimes everything is happening so quickly and with such an obvious violation of cardiac activity, that it is more like a heart attack.
Symptoms (clinical signs)
Appear after abundant food. The dog is anxious, healing is increasing, a vomiting appears for vomiting. There is an increasing increase in the abdomen behind the ribs, "empty sound", like a drum, intensifying shortness of breath, and superficial respiration is heard. Tachycardia (reinforced heartbeat) is growing, the heart rate is more than 80-100 shots per minute. Anxiety is replaced by stiffness, careful movements, lethargy. In the initial stage, dark red gums, with time, as cardiopulmonary failure, the gums are whites or shine. Weakness increases, the dog flows into the collapse ...
Diagnostics
First aid.Timely and competent assistance can save the life of your dog. Intensive therapy is to reduce the pressure in the stomach to reduce its stretching, in the elimination of cardiovascular - pulmonary failure of the dog and the removal of pain.
-For and the most urgent event is the puncture of the stomach. A special hollow needle is inserted through the dog's skin, pierce the wall of the stomach and produces gases through it.Careful pressure removal in the stomach can prevent the breakdown, and the dog will only have an extension.
.-Dog is experiencing such a strong pain from bloating, which will not notice the pain from the needle injection by conducting manipulation, remember that this procedure can save your dog's life.
-New transport animal to veterinarian / possible causes and risk factors
Why so it turns out?
The etiology of the stomach coast of the stomach is not fully clarified. Doctors did not come to a consensus about the causes of this formidable disease. Many specialists allocate one of the components of the syndrome, the so-called acute expansion of the stomach, in a separate disease. Others, and not without reason, consider the expansion of the stomach of only the initial stage of his coast. We will try to deal with the reasons.
1. Although the specific gene, the "boring responsibility" for this disease is not defined, a strong hereditary connection is established, since the probability of stomach charger increases significantly if parents or relatives of this dog have been subject to this fear.
2., mass and physique of the dog. The massiveness of the dog and its physique make up two important factors that increase the risk of stomach charger. The massiveness and "looseness" predetermine the weakness and stretching of ligaments that are not able to keep the overcrowded stomach in the correct position.3, temperament and psyche, or all diseases from nerves.
The acute expansion of the stomach and also the corner more often happened in dogs, which the owners themselves call "fearless", "impressionable" or "nervous". Friendly, gullible and happy dogs very rarely met among patients with such a diagnosis.
4, impairment of mineral metabolism (this is the opinion of both domestic and foreign researchers). The development of the disease contributes to the violation of both phosphorous calcium and potassium-sodium metabolism in the body.
5, the error of the cultivation of the puppy, there is a clear connection between the puppies feeding with large volumes of cheap feed and the frequency of cases of expansion and stomach of the stomach in these dogs in adulthood. Because of the desire of the breeder, to save or because of his ignorance, puppies, just taken from the mother, sharply switch to a malfunctive and difficult to digest food. Real breeders translate puppies, due to lack of time, on 3 meals a day, instead of 4-5 times. The everyday overflow of the stomach puppy leads to the stretching of its walls. The volume of the stomach increases and gradually its walls become flabby (atony), poorly reduced. As a rule, dogs that have grown out of such puppies eat much more than it can accommodate a normal stomach, and make up the main risk group against stomach charger. In addition to the purely mechanical stretching of the stomach walls, the foundation of all sorts of mineral metabolism disorders is laid. Incorrect feeding from childhood lays down "mines of slow motion" into the life of an adult dog.
6, power disorders. Feeding and walk, and especially the working use of animals, should be "separated" in time at least one and a half or two hours. Too often, the patient with a stomach breakthrough falls into the clinic after the exercise, which was preceded by a plenty of feed.
Pozyabin S.V.
candidate of veterinary sciences assistant of the Department of Veterinary Surgery, MGAVMIB them. K.I.Skryabina,
Torch of the stomach in the dog-polyethological disease is an acute surgical disease, which develops due to mechanical obstruction or reflex spasm of cardia and stomach pylorus, with subsequent accumulation of gases in it, shifting it along the longitudinal or transverse axis, splenomegaly, blood circulation impairment in a large circulation circle and the development of shock The states of the body leading to death.
With unconstitution of emergency surgical care, death can occur within 4-6 hours from the moment of the disease. Despite the wide fame of this disease among practitioners, the number of complications and mortality in the postoperative period remain high: mortality in the postoperative period reaches 25%. Despite the favorable outcome of the disease in the postoperative period, the likelihood of a disease recurrence is great: up to 30% of the total number of animals in the first 2-8 months after a favorable outcome of treatment.
One of the first references to this disease in domestic literature is a private surgery textbook, 1952, however, the causes of the disease are not described there, although the course of operational intervention is described quite in detail, which the author and postoperative diet offers. In the future, in the textbook on operational surgery Petrakova K.A. et al. (1991) is mentioned only by GOSTROACTASIA in dogs or acute expansion of the stomach without twisting it in its longitudinal or transverse axis. According to foreign literature, the frequency of the appearance of dogs with a diagnosis of the "stomach breakdown" was gradually increased from 0.036% in 1964 from the total number of surgical patients in veterinary clinics to a peak of 0.57% in 1994, that is, the frequency of diseases increased by about 15 times. According to our data, in Moscow, the percentage of patients with such a diagnosis does not exceed 0.4% of the total number of surgical patients, but this, at first glance, a small number requires particularly close attention from the practitioners of veterinary specialists. Surgical intervention with this pathology requires a doctor not only the knowledge of the anatomy of dogs and skills of extensive surgery, but also a complete idea of \u200b\u200bthe etiology and pathogenesis of this disease, without which it is impossible not only to successfully carry out surgical intervention, but also to ensure adequate preoperative preparation of the patient and appoint postoperative treatment .
Etiology of the disease.
Turning the stomach in dogs - the disease with multifactor etiology. It is impossible to allocate one single reason, caused the beginning of this disease, however, systematizing the data of many authors, you can identify that risk factors for this disease are:
Dimensions of the dog- The most frequently cited risk factor of the disease in a stomach in dogs. The most predisposed dogs of large breeds with a body weight of more than 25 kilograms. When considering the breeds of animals, by these disease, it is possible to distribute rocks, taking into account the reduction of the risk of stomach charging as follows: Eastern European and German, Big Dog, Risencnauzer and Basset Hound, Doberman, Black Terrier, Erdelterier, Labrador, Bardos Dog, Rottweiler , Bullmastiff, Russian boosa, other breeds. However, it should be borne in mind that this pathology may arise from all the breeds of dogs without exception.
Constitution of a dog. Under the Constitution should be understood to understand the general physique of the body, due to an anatomy-physiological structure, hereditary factors and manifested in the nature of its response to the influence of environmental factors. As the risk factor of the risk of the stomach of the carnivorous, the average value of the depth ratio to the width of the chest for different breeds can also be estimated. Under the depth of the chest, they understand the distance vertically from the highest point of the withers behind the blades to the lower surface of the chest. Breast width - the greatest distance between the arcs of the ribs. If this indicator is greater than or equal to 1.4, such a dog is most susceptible to break the stomach.
Feeding and content.Pre-predisposing to this disease is the feeding of bulky feeds, such as Hercules, pearl, millet porridge, poor-quality products, in some cases there is a crossing of dogs with industrial dry foods .. Thunderful feeds are distinguished by high ferotic activity, contribute to the weakening of the contractile ability of the stomach, which leads to abstraction and In the future hyperplasia of the walls of the stomach. Also one of the reasons may become greed with traditional food, aerophage. Disposable abundant feeding before walking provokes twisting the stomach, crowded with feed masses.
Anatomical reasons They consider the insufficiency of the ligament apparatus of the stomach of the dog. It is known that due to its significant ability to displacement, the stomach is not tightly fixed in the abdominal cavity, but it has certain points of attachment, due to which it remains relatively low. These points serve as gastrointestinal and ductal, gastrointestinal, and gastrointestinal ligaments, the ultimate part of the esophagus and the initial duodenum. In dogs, the gastrointestinal bunch is very loose, and there is no gastrointestant. As a result, the cardiac, the pyloric parts and the small gland form a practically still axis around which the stomach rotates when filling.
To physiological reasons The violation of the stomach motility is associated with both chronic gastritis and hyperplasia of the stomach walls. Also, the disease can provoke chronic liver diseases, gallbladder, pancreas (hepatopathy of different etiologies, cholecystitis), helminthous lesions of the gastrointestinal tract, dysbacteriosis. Also predisposing factors there may be a violation of the work of Vagus, which is responsible for both the production of gastric juice and the stomach motor. It is possible to provocate the stomach of the stomach with the emergence of a stress situation.
Pathogenesis of the disease.
The pathogenesis of the stomach of the stretching stomach consists of several stages that show their impact on different organs and systems of the dog. Conditionally can be divided into these stages on:
- primary filling of the gastric gases due to the early ferrous processes and spasms of the pyloric and cardiac parts of the stomach (gastrectation)
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- twisting the stomach and spleen around the esophagus and the globe (actual stomach version);
- impaired hemodynamics in aorta, portal vein of the liver and caudal vein, increase pressure in the abdominal and chest cavity;
- Disorders of water and electrolyte metabolism, hypoxia, hypovolemia, toxicosis growth and fatal outcome.
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The main in the development of the pathogenesis becomes acute expansion of the stomach of the dog, accumulation in non-gases, violation of the blood supply to the wall of the stomach and innervation - gastrectation. The next step occurs to twist it around the esophagus together with the spleen and the gastrointestinal bunch. When you switch the stomach vessels that feed it also turn out to be twisted, as a result, the nutrition of the stomach walls is disturbed (venous outflow and arterial influx) is disturbed). In the walls of the stomach, blood flows, causing chemistry of fabrics, hemorrhagic inflammation after a certain period of time and, as a result, necrosis. The first are great curvature and bottom of the stomach. After about 4 hours from the beginning of the disease, the necrosis of these parts of the stomach can be detected, which will require a partial gastroectomy.
The next stage is the development of splenomegaly. An increase in the spleen can be up to 200-400%. In an enlarged spleen, the processes of venous stagnation of blood, blood hemolysis and accumulation in the blood of unsophisticated products are beginning, which in the postoperative period leads to acute inflammation of the organ. The following exposure to the body of the inflated stomach is the pressure on the organs of the abdominal and the chest cavity, as a result of which the outflow of the caudal hollow and the hepatic veins is reduced, which leads to a decrease in blood flow to the heart and a decrease in blood volume in a small circle of blood circulation. The pressure on the diaphragm has a decrease in the volume of metabolic air and as a result, a decrease in the enrichment of blood oxygen coming from the pulmonary artery. Reducing the flow into light blood and depletion of blood oxygen leads to oxygen starvation of the body, violation of metabolic processes due to accumulation in the blood and tissues of unsophisticated exchange products. The next step is the drop in body temperature due to violations in the thermoregulation system due to the violation of the water-elitrolite balance and disruption of the central nervous system, the drop in temperature leads to a deeper change in the body. The acute toxicosis of the organism begins, violation of all systems and organs.
The next step is the development of reactive pancreatitis. The pancreas is excreted by endotoxins and a myocardial suppression factor, a polypeptide, which is allocated in the process of enzymatic activation occurring under the ischemia of the pancreas. The dysfunction of myocardial leads to a violation of the heart. All these irreversible changes ultimately lead to a fatal outcome.
From the foregoing, it can be concluded that the main pathogenetic effect of the expanded stomach is primarily aimed at violating blood circulation, water-electrolyte balance, hypovolemia and hypoxia causing toxicosis, which ultimately leads the shock with the subsequent heart stop and death.
Clinical signs and diagnosis of the disease
With a breakdown of the stomach of carnivorous in the first 1-2 hours after the start of the disease, the following clinical signs are present, usually detectable when collecting anamnesis: a sharp deterioration in the status of a dog, most often after feeding and active walk. An animal becomes restless, can not find a painless position, constantly moving, or takes a forced lying position. In the animal, we can observe unsuccessful attempts to vomiting, an increase in the abdominal cavity in the amount. Although the activity of the stomach is present, but when the stomach breaks, the esophagus occurs, which prevents the passage of the vomit.
In the future, 2 hours after the start of the disease under clinical inspection, we register the following signs:
An increase in the abdominal wall volume, especially in the left hypochondrium due to the accumulation of gases in the stomach. At percussion, a tympanic sound is heard in almost all the front two-thirds of the abdominal cavity, and in the region of the sword-shaped cartilage or a little left, you can find a dull sound, caused by an increased spleen, displaced with an extended stomach;
In the auscultation of the abdominal cavity, the reinforced gas formation is heard, the peristalsis is not listened, with auscultation, heart tachycardia, sometimes with the phenomena of arrhythmia and extrasystole;
- Temperature of the body lowered, mucous membranes anemic, dry, tachipne, weakness first rear, and then the front limbs, modest filling.
Differential diagnosis The stomach of the stomach in dogs should be carried out taking into account the similarity of the clinical picture of this disease with a sharp expansion of the stomach - gastrectasia. The acute expansion of the stomach of dogs is considered as bloating of the stomach without its displacement with an anatomically correct position in the abdominal cavity (twisted) caused by the spasm of the stomach content or mechanical obstruction of food into the duodenum. This must be taken into account, since these two at first glance the same pathologies require various treatment schemes. If, with acute expansion of the stomach (gastrojectation), it is possible to carry out the procedure for producing a gastric probe, then with a true breakdown of the stomach, urgent laparotomy is needed to give the stomach anatomically correct position, sensing and lowering gases.
As a rule, dogs with signs of acute expansion and stomach of dogs have the same symptoms listed above. For the differential diagnosis of these two pathologies, it is resorted to the formulation of the gastric probe. For large breeds of dogs (mass from 20 kg and above), which most often sick in the breakdown of the stomach of the carnivore are suitable as soft probes from rubber, and more rigid from rubberized plastics. The diameter of the probe may vary from 2.0 to 3.5 cm, depending on the size of the dog, the length should be one and a half of the distance from the cutters to the last edge with the head stretched forward. For the production of the probe, the rotor sewer is used, after which the probe is lubricated with vaseline or oily ointment under the sky curtain in a throat and esophagus. It must be remembered that the esophagus is centrally trachea, so the probe when the animal standing on the back should move over the sky curtain forward and up. After promoting the probe by 20-30 centimeters per sky curtain, it is necessary to test the test with a filled vessel with water to enter the trachea (when the end of the probe is exhaled, bubbles go out from the end in the water). If the probe went into the esophagus, but it cannot go into the stomach, it means that this is a stomach of dogs (when the stomach is twisted, the esophagus is twisted, the probe cannot pass). If the probe passed in the stomach, and gastric gases are out of the probe, it is an acute expansion of the stomach, and then stomaching the stomach from the dietary masses and the introduction of anti-focal agents (hypertensive solution of soda, alcohol, activated carbon, etc.).
If the diagnosis is doubtful, when there is no possibility to put the gastric probe, or the probe cannot pass into the esophagus, it is necessary to conduct x-ray research on the stomach of carnivorous in Dorso-Ventral and laatero-medial projection. We recommend carrying out x-ray studies in the Dorso-Ventral projection in the stomach position, and in the laatero-medial projection in the position on the left side, as they are the least stressful for the animal when the stomach break. During the analysis of X-ray pictures confirming and doubting a diagnosis to the incentive of the stomach of dogs, we allocated the main criteria, comparing which you can make the right conclusion about the presence or absence of the stomach of the dog.
- shifting the pylorus of the Kepende or the location of it in the left hypochondrium: the displacement of the cardia and the pylorus from the anatomical location places will indicate the reversal of the stomach on the radiograph. It is easy to detect in a lato-medial projection;
- deformation of the gas-filled stomach, manifested by the X-ray symptom of hourglass in the dorsovetral projection (the presence of a hallery on the large curvature of the stomach);
- Displacement of the intestine and spleen in the right hypochondrium or illegah will indicate the stomach rear, this is found in the laater-medial projection.
On the rendered rantgeniogram No. 1, a gas-filled stomach is visible in the dorsovetral projection, which occupies most of the abdominal cavity, intestinal displacement and spleen in the right illeg. In this case, the conclusion is made about the breakdown of the stomach at Srbaka. On the radiograph number 2, the snapshot of the same dog in the side projection, the unequivocal conclusion about the breakdown of the stomach cannot be done.
Radiograph №1 - Turnover of the stomach in the dog.
It is necessary to take into account the fact that he always performs the performance of radiography only in one projection allows you to carry out accurate diagnosis on this pathology. Only an analysis of X-ray studies in Doros-vectral and laatero-medial projection at the same time allows reliably to diagnose the disease and proceed to the operational treatment of this pathology.
In the case when a uniform increase in the stomach is revealed, without the displacement of the spleen and intestines from the anatomical location places, make a conclusion about the presence of an acute expansion of stomaching - gastasation (X-ray diffraction pattern No. 3).
It is possible to use an ultrasound research to confirm the diagnosis of the stomach revolution in dogs. In this case, it is necessary to accurately determine the location of the spleen and the degree of its increase. With a significant increase in the spleen in size (splenomegaly) or when it is located in the right hypochondrium or the area of \u200b\u200bthe sword-shaped cartilage, make a conclusion about the breakdown of the stomach.
enthGonogram No. 3 Gastrectasia in the dog, Dorso-Ventral projection, uniform increase in the stomach, spleen in the left hypochondrium, the intestines is pushed into the pelvis area.
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Conclusion
The etiological features of the stomach of the stomach in dogs are the predisposition of large breeds of dogs with a body weight of more than 25 kilograms and over the age of 4 years with a voluminous type of feeding. In a pathogenetic aspect when the stomach breaks, due to the squeezing of the ductal vein of the liver and the caudal hollow vein, the phenomena of hypovolemia, hypoxia and acute toxicosis begin to increase the pressure in the sore cavity in the patient of the animal, which leads to a deep violation of all systems and organs. Differential diagnosis should be based on the similarity of the stomach stomach with gastrectazia in dogs with special research methods. Turning the stomach in dogs is an acute surgical pathology, requiring a clear idea of \u200b\u200bits etiology and pathogenesis and performing operational interference in the first hours since the beginning of the disease.
1. Filippov Yu.I., Pozyabin S.V. Splenectomy at the breakdown of the stomach in dogs // Veterinary. - 2002.-№12.-S.53-54.
2. Filippov Yu.I., Pozyabin S.V. New in the etiology of the stomach stomach in dogs // Veterinary medicine
3. Pozyabin S.V. Differential diagnosis of stomach stomach in dogs // Veterinary. - 2003.- №1.-S.59-61.
4. Pozyabin S.V. Diagnostics, treatment and prevention of stomach stomach in dogs // DISS. ... candidate of veterinary sciences, MGAVMIB, 2003.
4. Bojrab M. Currient Techniques in Small Animal Surgery.- N.Y.: Baltimore, - 1998.
5. DUPRE G. Gastrectation / Stomach Turnor in Dogs // Focus Vol4 No. 3, 1994.
6. Glickman L. Epidemiology Expansion of the stomach with simultaneous breaks of it in dogs // Focus.- Vol. five.-
The twist of the stomach is rare, since the powerful ligament fixing the cardiac and the pyloric part prevents its development.
Relaxing bundles and rapprochement of the legs of the gastric loop contributes to the twist. Such relaxation can be congenital and acquired.
When relaxing a ligament and overflow of the stomach, the contents of the broth with a cardiac part is obtained. Then there is similarity with the conditions of the coast of the ileocecular angle or the sigmoid intestine, when their extreme points come closer. Strengthening the peristaltics in front of the "legs" or a sudden increase in intra-abdominal pressure (lifting weight, drop, injury) usually and leads to the development of the stomach twist.
Current can be around the transverse and longitudinal axis of it, along the course and against the course of the clockwise. It is most often happening against the time of the clockwise, around the transverse axis of the organ.
Current can be complete when the cardiac and pyloric part of it is closed, and partial when the specified parts remain open. The partial converor in most patients is observed in the diaphragmal hernias when the stomach moves to the chest cavity, and with the shape of the stomach that begins the name of the hourglass.
When charging around the transverse axis, the transverse-colonist remains a book from the stomach, and during charging around the longitudinal axis passing through the cardia in the gatekeeper, it shifts upwards from it.
Symptoms of the twist of the stomach
In the clinical course of the stomach, two main phases should be distinguished: the first one when the overwhelming has not reached another 180 ° and there is no complete closure of the cardiac and pylorarial part of the stomach; And the second when the outlet reaches 180 ° and comes the complete closure of these gastric parts.
The disease in most patients starts suddenly (severe abdominal pain, sometimes collapse, vomiting, bloating). When the breakdown reaches 180 °, vomiting stops and agitating the painful IKOT. The patient usually takes a seven position, the pain is enhanced, anxiety appears, difficulty breathing, the pulse is small and frequent, severe thirst and immediate vomiting after a few sips of drunk water. An attempt to enter the probe is mostly unable, and the probing is permissible only in the initial stage of the process.
When viewed at the top of the abdomen, a spherical protrusion is determined. Visible peristalistic is usually absent. During palpation, a weak pain in the field of protrusion is noticed as a tense ball. With a x-ray study, high standing diaphragms and the presence of a large gas bubble with a horizontal level of fluid.
For the correct recognition of this disease, it is necessary to remember the possibility of stomach charging, which greatly facilitates the diagnosis.
