Sliding hernia

The cause of this hernia is a pathology frenoezofagealnoy ligament, which fixes the esophageal-gastric anastomosis in esophageal opening. Part of the cardia of the stomach moves up into the chest cavity. Frenoezofatealnaya ligament becomes thinner and longer. Oesophageal hiatus in the diaphragm expands. Depending on the position of the body and filling the stomach of esophageal-gastric fistula is shifting from the abdomen into the chest and back. The displacement of the cardia upward angle becomes obtuse branch block, smoothed the folds of the mucosa. Diaphragmatic peritoneum is displaced together with the cardia, a well-defined hernial sac is only for large hernias. Fixation and narrowing of the scars can lead to a shortening of the esophagus and the constant presence of esophageal-gastric anastomosis above the diaphragm. In advanced cases of fibrous stenosis occurs. Sliding hernia is never violated. If the compression comes displaced into the chest cavity of the cardia, the poor circulation does not occur, because the outflow of venous blood is carried out on esophageal veins, the content can bowels through the esophagus. Sliding hernia is often associated with reflux esophagitis.

Displacement cardia up leads to a smoothing brand viagra online angle branch block, disturbed sphincter activity, it becomes possible gastropischevodnogo reflux. However, these changes are not natural, and a significant number of patients reflux oesophagitis does not develop, because the physiological function of the sphincter is preserved. Therefore, a displacement of the cardia is not enough to develop anal sphincter insufficiency, in addition, reflux can occur without a sliding hernia. Unfavorable ratio between the pressure in the stomach and the esophagus promotes penetration of gastric contents into the esophagus. Epithelium of the esophagus is very sensitive to the action of gastric and duodenal contents. Alkaline esophagitis due to the influence of duodenal juice flowing even harder than peptic. Erosive esophagitis can become, and even ulcers. Permanent inflammatory edema of the mucous membrane contributes to its mild trauma with bleeding and bleeding, which sometimes manifests itself in the form of anemia. Subsequent scarring leads to the formation of strictures and even complete closure of the lumen. The most frequently reflux esophagitis accompanied by cardiac rupture, less kardiofundalnuyu.

Clinic. Sliding hernia without complications are not accompanied by clinical symptoms. Symptoms arise when the associated gastro-oesophageal reflux and reflux esophagitis. Patients may complain of heartburn, belching, regurgitation. The appearance of these symptoms usually associated with changes in body position, pain cialis without prescription worse after eating. The most common symptom of a burning sensation behind the breastbone is observed in 90% of patients. Pain may be localized in the epigastric region, left upper quadrant, and even in the heart. They are not like ulcerative since appear immediately after ingestion, are associated with the amount of the ingested food, especially painful after a heavy meal. Relief occurs after ingestion of lowering the acidity in the stomach. Regurgitation occurs in half of cases, especially after receiving lavish meals, often felt bitterness in the throat. Dysphagia is a late symptoms observed in 10% of cases. It develops as a result of spasms of the inflamed distal esophagus. Dysphagia occasionally occurs periodically disappears. If inflammation progresses, dysphagia occurs more frequently and may become permanent. From the resulting ulceration of the esophagus may have bleeding, which take place covertly.

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