Hernia of the esophagus( esophageal opening of the diaphragm) symptoms
Mar 06, 2018
Hernia of the esophagus ( passage leading from the throat to the stomach) or of the hiatal hernia of the diaphragm is a condition in which the gastroesophageal junction( junction) or part of the stomach moves through the esophagus of the diaphragm into the thoracic cavity, leading to a critical conditionpatient, requiring rapid diagnosis and treatment. Esophagus can be ruptured if vomiting, chemicals, trauma or other esophageal disease, such as esophageal cancer, occur. The pain in the chest from a large rupture in the esophagus may resemble the symptoms of a heart attack.
In a healthy person, the esophageal opening of the diaphragm with its edge tightly covers the esophagus, reliably separating the thoracic and abdominal cavities. Relaxation of the muscle of the diaphragm promotes the appearance of a free space between the outer wall of the esophagus and the edge of the esophageal opening of the diaphragm. This process can be based on congenital weakness of the muscle of the diaphragm, inflammatory diseases of it, disorders of the nervous regulation of muscle tone, the consequences of injuries to the chest or abdomen, and other causes. In the resulting space( crevice) in conditions of increased pressure in the abdominal cavity or overflow of the stomach, the wall of the gastroesophageal junction( sliding hernia) can penetrate, and in more severe cases, the wall of the stomach( a clotting hernia).
The most common hernia of the esophageal opening of the diaphragm occurs in the elderly;Aging of the organism is accompanied by a gradual relaxation of the tone of the tissues. Often this condition is noted in individuals with omission of internal organs( splanchnoptosis);people who have been doing heavy physical work for a long time;in patients with severe and significant thinness and muscular dystrophy.
Leaking the contents of the esophagus, such as saliva, food or vomit into surrounding tissues, can lead to the development of a bacterial infection and an abscess. Treatment usually involves an operation to restore the rupture and remove the contents of the esophagus from surrounding tissues;At operation use antibiotics to prevent a bacterial infection or to struggle with it. If the esophagus has been severely damaged, it may be necessary to surgically remove part or all of the esophagus.
In practice, doctors often have to deal with pain, which is usually diagnosed as a hernia of the esophageal opening of the diaphragm. In this case, the upper part of the stomach is displaced into the thoracic cavity through the esophageal opening of the diaphragm. This position for the stomach is unnatural, since the process of digestion of food becomes painful. In addition, the acid in the stomach penetrates the esophagus and, touching its wall, causes severe heartburn.
If the stomach is located normally, the acid has no access to the esophagus: first, the intestinal peristalsis is directed toward the rectum, and secondly, the person has 2 valves that block the access of the digestible food back to the esophagus. The first of these valves is inside, between the stomach and esophagus, and the second - outside, in the diaphragm, in the place where the stomach connects to the esophagus. The described valves synchronously relax at a time when past their food passes into the stomach, and at other times they are tightly closed, which prevents regurgitation of food( its movement in the direction otherwise physiological).
Gastrointestinal tract can be schematically represented as a long hollow tube starting in the mouth and ending with a hole in the rectum. The various organs of this complex system have special functional characteristics, which turns the digestion of food and the utilization of waste into one well-established physiological process. This process is controlled by so-called local hormones that distribute the time of each stage of digestion, the extraction of the necessary enzymes, etc.
At the initial stage of digestion of food, gastric juice containing acid and active enzymes is released, which promotes the breakdown of proteins and other difficult digestible foods. After that, the liquid, but sufficiently active content of the stomach enters the upper intestine. Here is the so-called pyloric valve, which regulates the interaction of both ends of the gastrointestinal tract.
The pancreas that produces insulin also releases several kinds of enzymes into the intestines, but its most important function is the release of a special alkali neutralizing gastric acid. To produce this alkali, the pancreas needs a lot of water, which it extracts from the bloodstream. With a chronic lack of water, this process is ineffective, so the pyloric valve, not receiving clear signals from the nervous system, is only partially revealed, since its main function is to prevent penetration of the active gastric environment into the intestine. The described condition causes characteristic pains, caused by chronic thirst, experienced by the body.
Depending on the amount of water being drunk, an appropriate amount of a specific substance called motiline is produced in our body. The more water we drink, the more motilin enters the gastrointestinal tract. The effect of this substance is to stimulate peristalsis, which causes timely closure or opening of valves throughout the gastrointestinal tract.
If the amount of water necessary for the digestive process arrives in the body, the pancreas releases enough alkaline solution to prepare the upper intestine to accept the acid content of the stomach. Under normal conditions, the pyloric valve opens in time to allow the intestines to take food digested in the stomach, and the motilin produced in the right amount clearly coordinates these actions.
Digestive problems occur if the body chronically lacks water to digest food. In this case, the system does not allow the acid content of the stomach to enter the intestine, and the mechanism for neutralizing the acid functions inefficiently. And the first thing that happens as a result is a change in the intensity of contraction of the valves located next to the stomach. In particular, the pyloric valve begins to strongly contract, and the external and internal valves located between the stomach and intestine, on the contrary, relax. In this case, part of the acid from the stomach enters the esophagus and causes painful sensations, which we call heartburn.
In some cases, the flaccidity of the diaphragm valve is so significant that the upper part of the stomach can pass through it into the chest, which is called the hernia of the esophageal opening of the diaphragm. In addition, food can not remain in the stomach all the time, and if it is impossible to get into the intestine, it has only one way out - through the mouth. As a result of changes in the direction of peristalsis, the most unpleasant phenomenon is vomiting.
Symptoms of the disease with a small size of the hernial opening for a long time may be absent( the stage of asymptomatic flow of the hernia of the esophageal opening of the diaphragm).As the hernial opening increases and penetrates through it into the thoracic cavity, all the larger walls of the gastroesophageal esophagus or gastric wall progressively develop signs of the disease. The most characteristic complaints are the pain behind the sternum or in the upper abdomen( under the pit of the stomach).The cause of the development of pain are mechanical factors: esophagus sprain, tension of the tissues as a result of the organ wall retraction into the hernial opening, pressure of the hernial sac on the surrounding tissues.
Pains can spread( give, irradiate) up, down or in the back. Very often painful sensations resemble( simulate) retrosternal pains with angina pectoris. As a rule, the emergence of pain in patients with a hernia of the esophagus of the diaphragm is associated with food and comes after a plentiful meal, especially if the patient then rests lying down.
The most severe, painful pains occur if the hiatus of the esophagus is accompanied by inflammatory processes of the esophagus mucosa( esophagitis).This occurs as a result of frequent or permanent casting of acidic gastric contents into the lower part of the esophagus and chemical irritation of its mucous membrane with hydrochloric acid. Esophagitis contributes to the occurrence in patients of heartburn, belching, regurgitation of food, burning or difficulty in passing food when swallowed.
Prolonged and intolerable pains in the hernia of the esophageal opening of the diaphragm can indicate the most frequent complication of the disease - infringement, compression of the hernia in the hernia gates. Violation of blood circulation in strangled tissues as a result of compression can lead to severe consequences of necrosis of the wall of the stomach or esophagus.
A gastroenterologist( or therapist) and a surgeon should be examined. Reliable methods of diagnosis of a hernia of the esophageal aperture of the diaphragm are X-rays of the stomach and fibrogastroscopy.
• Chest X-ray. It may be necessary for you to take a contrast agent before the X-ray, so that the site of the esophagus rupture can be clearly identified.
Treatment, as a rule, is conservative, only in severe cases of the course of the disease surgical intervention is indicated. Carrying out the doctor's recommendations, it should be remembered that by observing the diet, physical activity, rejection of bad habits, it is possible to significantly prevent the progression of the disease, significantly alleviate the course of the pathological process. In this regard, frequent fractional meals are recommended in small portions of food. In cases of a combination of a hernia of the esophagus of the diaphragm and esophagitis, diet No. 1 should be followed. In the remaining patients, it is necessary to exclude acute, acidic, salty foods, effervescent drinks, products that cause bloating( legumes, rye bread, cabbage, etc.) from the diet.
By limiting the calorie content of food should try to reduce body weight, which will help significantly reduce the symptoms associated with the hernia of the food hole of the diaphragm and esophagitis. Alcohol intake and smoking are contraindicated. It is necessary to refrain from drinking black coffee and strong tea. After eating, you can not go to bed or do hard work, physical stress, connected with the torso of the body forward. In addition, it is desirable that during sleep the patient's head lies 10-15 cm above the trunk, which will prevent the acidic gastric contents from flowing into and out of the esophagus, to prevent the appearance of symptoms of hernia of the esophageal opening of the diaphragm. Patients who underwent surgical treatment of the disease in question, after the operation, must comply with all the above recommendations.