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Classification of diseases of a gullet at children

1 Functional disturbances (dyskinesia)

  1. Hypotonic form.
  2. Hypertensive form.
  3. Incompetence of cardia.
  4. Gastroesophagal reflux.
  5. Anomalies of development
    1. Atresia.
    2. Inborn stenosis.
    3. Inborn esophageal and tracheal fistula.
    4. Inborn short gullet.
    5. Inborn incompetence of cardia (cardia halaziya).
    6. Hernia of an esophageal opening of a diaphragm.
    7. Gullet diverticulums.
  6. Acquired diseases
    1. Halaziya — the acquired incompetence of cardia.
    2. Achalasia.
    3. Esophagites.
      1. On a current: acute, subacute, chronic, reflux esophagitis.
      2. On change of a mucous membrane: catarral, erosive, hemorrhagic, necrotic.
      3. The illness period for a chronic esophagitis: aggravation, subsiding of an aggravation, remission.
    4. Foreign bodys.
    5. Burns (chemical damages).
    6. Cysts and tumors.
    7. Round ulcer.
    8. Varicosity.

 

Note: according to N. G. Zernov and soavt. (1988), classification should be added with damages of a gullet at somatopathies.

Signs

Dyskinesia forms

 

hypertensive

hypotonic

Etiology of primary dyskinesia

Disturbance of a neurovegetative innervation (neurosis, vegetative dystonia, hypothalamus pathology). Heredity. Nature of food. Acceleration. Inborn inferiority of an innervation lower 2/3 gullets

Hernia of an esophageal opening of a diaphragm. Incompetence of cardia. Esophagitis

Age immaturity of the neuro muscular device of the cardia (to 6 weeks of life perhaps asymptomatic current). Disturbance of an innervation of distal department of a gullet, lack of an acute angle of Gis, insufficiency of the valve of Gubarev

Etiology of secondary dyskinesia

Esophagitis. Gastritis. Peptic ulcer of a stomach and duodenum. Cholelithiasis. Hernia of an esophageal opening of a diaphragm at 46% of patients

Esophagitis more than at 50% of patients. Acute infectious diseases. Botulism. Organic damages of TsNS. Atropinopodobny medicines. Hernia of an esophageal opening of a diaphragm. Incompetence of cardia

The increased intra belly and intragastric pressure (meteorism, lock, obesity, the gatekeeper's spasm, hernia of an esophageal opening of a diaphragm, short gullet, the increased gastrin level, introduction of an Euphyllinum). Reflux esophagitis. Gastroduodenit

Pathogeny

Disturbance of consecutive alternation after deglutitory peristaltic reductions of a gullet the Muscular spasm of various force and duration instead of relaxation when passing food

Reduction of amplitude and duration of peristaltic reductions, decrease in propulsive ability. Passive advance of food under the influence of the weight

Disturbance of the physiological mechanism of short circuit of the cardia. Involuntary (without vomiting) flowing of gastric (gastrointestinal) contents in a gullet. Physical and chemical injury of a mucous membrane and bacterial contamination of a gullet

Dysphagy

Food delay in a gullet ("a retrosternal lump") at 95% of patients. Lack of constancy and progressing of a dysphagy

Impossibility to swallow of dense food in the absence of an obstacle in a gullet at 1/3 patients

Food delay after a proglatyvaniye at 10% of patients. Hypersalivation — at 30%

Nausea

No

No

At 45% of patients

Vomiting, vomiting

At height of pains, then weakness appears

Can be

Vomiting and vomiting to gastric contents at 87%

Regurgitation

Expressed and frequent leads to loss of body weight. Rare, but plentiful — at an expanded gullet. Night leads to aspiration and chronic diseases of lungs

Heartburn, eructation

 

Pain behind a breast and in epigastriums

Especially at hasty food, is more rare on an empty stomach or after vomiting. Aching, pressing, weak. Amplifies in a prone position and an inclination of a trunk at 25% of patients forward

Less strong (an asymptomatic current at 21% of adult patients)

At 80,6% of patients. Sometimes irradiates in a left shoulder-blade and area of heart. Strengthening in a dream and horizontal position

Weight loss

At frequent and plentiful regurgitation

?

At 73% of patients

X-ray inspection

Lack of a gas bubble in a stomach. Narrowing of proximal department of a gullet, circular with accurate contours, and expansion of a site is higher than the place of narrowing. Pendulum movement of contents of a gullet

Slow running off of a contrast agent in a stomach. The sluggish movements of a gullet, on walls there is a barium trace

Maloinformativno. Throwing of barium from a stomach in a gullet is possible. Hernia of an esophageal opening of a diaphragm

Signs

Dyskinesia forms

Incompetence of cardia. Gastrointestinal reflex

hypertensive

hypotonic

Pharmacological tests with the subsequent X-ray inspection

Effect of use of atropine, nitroglycerine (at an achalasia the effect is absent)

 

 

Ezofagotono-kimografiya

Multipeak waves (spasm) at 77% of patients. Diagnostic value of a wave of 50 mm w.g. and more. Function of the cardia is not broken

Decrease in intra esophageal pressure

Pressure decrease in the field of the lower esophageal sphincter is lower than 6 mm of mercury.

rn-metriya

Decrease in indicators of pH in a gullet at regurgitation

 

Periodic decrease in indicators of pH in the lower third of a gullet (reliability of 97%)

Endoscopy

Normality of a mucous membrane. Lack of organic lesions. The esophageal stenosis in spazmirovanny sites is possible

 

The mucous membrane can be not changed. Visually the reflux is defined

 

Note: synonyms of a hypertensive form of dyskinesia of a gullet — an esophagism, a diffusion esophagospasm, a cardiospasm, hiatospazm.
The etiology of dyskinesia of a gullet is more often secondary.

 
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