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DEVELOPMENT AND FUNCTIONING OF THE GULLET
Gullet together with a trachea develop from primary digestive tube, being allocated from its ventral part. Lateral walls of two laryngotracheal grooves grow together among themselves, separating primary gullet from a trachea.
The main function of a gullet consists in transporting firm and liquid food in a stomach and to warn her regurgitations). Even at the most malovesny premature children it is possible to observe the peristaltic movements of a gullet; at the child whose body weight is equal only 1500 swallowing and suction, apparently, are well coordinated. At the children who were born in time the deglutitory movements arise after the short sucking movements, but in several days (in several weeks at premature) the periods of suction become long and on their background there are coordinate rhythmical deglutitory and respiratory movements.
Swallowing — the difficult act which begins with fast raising of back part of language; along with it the entrance to a throat is displaced kpered and closed by an epiglottis, the nasopharynx is closed by a soft palate, the perstneglotochny part of the lower constrictor of a throat relaxes that facilitates passing of food to a gullet. The peristaltic waves arising at the same time advance a food lump on a gullet. Three types of pressor wavy movements of a gullet are described.
Rio. 12-3. and. An esophageal manometriya at the healthy baby. Pressure was registered by means of a 3-channel probe; sensors of pressure were located at distance of 2,5 cm from each other. The distance from the line of gums to the distal sensor, equal 21,5 cm, corresponds to its localization in; lower esophageal sphincter. The deglutitory movement excites primary peristaltic wave. In the beginning it is registered the proximal sensor, then average and distal. Thanks to a relaxation of the lower esophageal sphincter the food gets into a stomach. The Pishchevodpy manometriya at the patient. Simultaneous increase of pressure in proximal and average points of registration is characteristic of a tertiary wave. The lower esophageal sphincter does not relax. Such type of a vermicular movement is characteristic of an achalasia.
Stimulated the deglutitory movement primary peristaltic wave represents a zone of the increased intra esophageal pressure which extends lengthways on a gullet. Secondary waves are usually formed at gullet stretching; they clear it of the remains of food and gastric contents. Mekhapizm of clarification of a gullet reminds expression of toothpaste by twisting of a tube since one end. Tertiary waves — the nepropulsiviy, peperistaltichesky reductions reminding a tube prelum in its middle part; if such waves arise often, then it is regarded as a symptom of pathology. In distal department of a gullet the special segment of circular muscles 1 — 3 cm wide, i.e. the lower esophageal sphincter is localized. Intracavitary pressure in this site is higher, than in proximal departments of a gullet and a stomach. This sphincter interferes with throwing in a stomach contents gullet, and during swallowing it reveals, allowing a food lump to pass in a stomach.
Cough and poperkhivaniye when swallowing belong to the main symptoms of diseases of a gullet, vomiting, a dysphagy, full loss of ability to swallow, pains when swallowing, a hematemesis. Each of these symptoms can be caused by one or several defects of difficult process of swallowing, and for its assessment additional researches can be required. The usual drink of a baric suspension depicts a relief of a mucous membrane, allowing to reveal the tumor acting in a gullet gleam or a gastrointestinal reflux. Studying of dynamics of swallowing and its disturbances requires roentgenoscopic research. Quantitative characteristics of functions of a gullet can be received by means of an esophageal manometriya, previously entering into a stomach, and then slowly taking the probe registering intracavitary pressure. Pressure in the lower esophageal sphincter is often reduced at patients with a gastroesophagal reflux, especially against an esophagitis; at an achalasia pressure is increased, the insufficient relaxation of walls when swallowing (fig. 12-3,6) is noted. The most sensitive method of detection of throwing of an acid gastric juice in a gullet — registration of pH in a cavity of distal department of a gullet by means of the sensor with a diameter of 2 mm. Ezofagoskopiya allows to estimate visually a condition of a mucous membrane, and also to find and remove a foreign body. Flexible endoscopes give the chance to make straight vision and to take bioptata, without resorting in most cases to the general anesthesia.