BELLY TOAD (angina abdominalis; synonym: belly quinsy, subphrenic stenocardia, dyspragia intestinorum intermittens angiosclerotica) — the attacks of abdominal pains caused by dyskinesia of intestines owing to insufficiency of its blood supply at organic obturation or at a spasm of mezenterialny arteries. Forms can clinically be observed acute and hron. It is most sharply expressed B. at thrombosis and a thrombembolia of mezenterialny vessels. The first description of clinic hron, insufficiency of blood supply of intestines belongs to Shnittsler (J. Schnitzler, 1901).
Main reason for emergence B. — atherosclerosis of belly department of an aorta with transition to mouths, a trunk and branchings of belly arteries; much more rare (at persons of young age) B. it is connected with arteritis, is even more rare — with embryonal hypoplasias, a prelum of arteries hems, aneurisms, tumors.
The main role in pathogeny B. belongs to ischemia of smooth muscle digestive organs (most often walls of intestines) owing to a spasm of mezenterialny arteries or their organic lesion. After food when the strengthened blood supply of intestines is required, the affected arteries do not provide adequate inflow of blood, there is ischemia of an intestinal wall with disturbance of secretory and motor function of a gut. Re-stretching of the site of a gut which lost a tone owing to ischemia is a proximate cause of pain; quite often in ischemic intestinal loops at the same time there are sites of a distenziya and hypertensive spasm. It is possible that an irritant of pain receptors regarding cases is the acidosis arising in a wall of a gut.
Pathoanatomical the changes in mezenterialny arteries characteristic of a basic disease (atherosclerosis, arteritis etc.) are observed. At atherosclerosis more often upper mesenteric, celiac and splenic arteries are also more affected. However quite often found stenoses and occlusions of these arteries are not always followed by attacks B., what is connected with wide network of an anastomosis in mezenterialny vascular system. Owing to uneven development of the last great opportunities for development of ischemia arise in an upper part of an abdominal cavity in comparison with lower.
At hron, mezenterialny vascular insufficiency, except B., the dispeptic phenomena, dysfunction of intestines, the progressing disturbance of food, emergence of vascular noise in epigastric area are noted.
B. arises at height of digestion (in 30 min. after food later), has sharp character, pain is localized by hl. obr. in epigastric area without any irradiation, keeps of 1 — 2 min. till 1 — 3 o'clock. In the beginning painful attacks appear only after plentiful food; with progressing of a disease patients limit its quantity more and more. The attack of pains is followed by abdominal distention, a lock. Often there is an eructation. Further there can be fetid ponosa, exhaustion, an obezvozhennost develops, turgor of fabrics decreases, skin color becomes earthy. At the expressed meteorism the diaphragm costs highly, a peristaltics sluggish, patients feel heartbeat, an asthma, sometimes pains in heart (see. Gastrocardial syndrome ), pulse is speeded up, arterial pressure is quite often increased. In epigastric area systolic vascular noise is sometimes listened.
Less expressed B. form is more often observed. as manifestation of initial degrees of mezenterialny insufficiency at which complaints are less certain (a meteorism, locks, pressure sense in an anticardium and in right hypochondrium). At a laboratory research in Calais blood can be found. At X-ray inspection sometimes on roentgenograms the centers of calcification in the places corresponding to an otkhozhdeniye and a bed of mezenterialny arteries are visible. The aortoarteriografiya is of great importance, edges reveals disturbances of arterial passability.
Differential diagnosis it is carried out with cholecystitis, pancreatitis, pochechnokamenny and cholelithic diseases, a peptic ulcer, stenocardia with atypical localization of pain.
Forecast depends on expressiveness of defeat of vessels.
Is carried out therapy of a basic disease, most often atherosclerosis (see). Food with frequent receptions of small portions of easily assimilable food; use of laxative mineral waters and nezhnodeystvuyushchy purgatives (senna, rhubarb). At painful attacks: warmly on a stomach (if the picture of an acute abdomen is excluded), nitroglycerine under language. From vasodilators are preferable Nospanum (on 0,04 g 3 — 4 times a day), Dibazolum in the same doses. The papaverine is not shown since can strengthen a meteorism. If pains are not stopped, morphine or Promedolum in combination with prozeriny, Pipolphenum is parenterally entered. At obliterating damages of mezenterialny arteries reconstructive operations are applied.
Bibliography: Ananikyan P. P. and Berezov Yu. E. Aortoarteriografiya in diagnosis of atherosclerosis of a ventral aorta and its vetey, Yerevan, 1966; Moiseyev S. G. and Tinditnik V. S. An abdominal syndrome at damage of an aorta and its branches, Cardiology, t. 11, No. 12, page 12, 1971, bibliogr.; Pokrov-skiya. Century, etc. Clinic and diagnosis of angina abdominalis, Klin, medical, t. 48, No. 1, page 49, 1970, bibliogr.; By of i e s-s m a η η A. Diagnostik der Angina abdominalis, Dtsch, med. Wschr., S. 2383, 1970; it, Therapie der Angina abdominalis, ibid., S. 2385.
A. I. Gritsyuk.