LOCKS

From Big Medical Encyclopedia

LOCKS (obstipatio, singular) — the slowed-down, complicated or systematically insufficient bowel emptying. 3. can be manifestation various patol, consisting, a consequence of influence of adverse factors of the environment, result of defective food.

Frequency of a chair at healthy people fluctuates in considerable limits and depends on character of food, a way of life, habits. By data A. M. Amineva (1965), at 64,7% of almost healthy people defecation is carried out once a day, at 22,3% — two times, at 6,2% — three times and more, at the others — once in several days. Therefore the concept «lock» is relative; it has diagnostic value if change of frequency of a chair is not connected with change of food or a way of life. For most of people hron, the delay of bowel emptying more than 48 hours can be considered as 3. 3 are observed. often, especially at women, at elderly and old people.

The etiology and a pathogeny

Locks are caused by disturbances of processes of formation and advance a calla on intestines which depend on a condition of motor function, a form, situation and width of a gleam of a large intestine, and also on the volume of intestinal contents, etc.

Leading role in a pathogeny 3. belongs to disturbances of the motility of intestines which is under the influence of nervous and humoral control (see. Intestines, physiology ). These disturbances can be caused by various neurogenic factors (vegetative dysfunctions, reflex influences at diseases of various bodies, back and a brain), inflammatory diseases of intestines, diseases of anorectal area, strengthening or weakening of hormonal influence at endocrinopathies, various toxic influences, reception of some medicamentous means, a circulatory disturbance in vessels of intestines, a hypodynamia, etc. Braking of desires to defecation is most often connected with influence of various psychogenic factors. Narrowings of intestines of various genesis create an obstacle for advance of its contents. Increase in length and gleam of a large intestine of the inborn or acquired character, reduction of number of fecal masses, the increased their dryness, hardness and viscosity (an alimentary origin, in connection with a fluid loss can result in discrepancy between the capacity of a large intestine and volume of fecal masses at disturbance of exchange of electrolytes).

Depending on etiological and pathogenetic factors allocate locks: 1) alimentary; 2) neurogenic: a) Diskineticheskiye, b) reflex, c) owing to suppression of desires on defecation, d) owing to organic diseases of c. N of page; 3) hypodynamic; 4) inflammatory; 5) proktogenny; 6) mechanical; 7) owing to anomalies of development of a large intestine; 8) toxic; 9) medicamentous; 10) endocrine; 11) owing to disturbances of water and electrolytic exchange. On a pathogenetic sign distinguish independent (primary) 3. and symptomatic (secondary). Independent 3. are caused by suppression of a reflex on defecation, disturbance of a vegetative innervation of intestines. Symptomatic 3. are a symptom of organic diseases, anomalies of development, and also defeat not only intestines, but also other bodies or systems. In a pathogeny of these 3. the leading role is played by reflex, uslovnoreflektorny, endocrine and other factors. 3. arise sharply and chronically. Acute 3. it is in most cases observed at impassability of intestines (see) various etiology. Leading role in a pathogeny hron. 3. belongs to inflammatory damages of intestines.

Alimentary locks are among the most widespread. The importance for formation of excrements and allocation them from an organism has structure of food. The ground mass of slags in food of the person is made by the products rich with the rough cellulose, vegetable fibers capable to irritate receptors of intestines and to stimulate its motility. At people, a long time eating on easily acquired processed food, can develop resistant 3. The food consisting preferential of proteins, mealy dishes, digestible sugars well is digested digestive juices, forms a small amount a calla and quickly loses the irritating properties. At healthy people the alimentary factor can seldom be the only cause 3. The combination of uniform food to a slow-moving way of life is more often noted. Quite often alimentary 3. are a consequence of a long sparing diet, arise at persons with defects of the chewing device. According to a number of authors, to development alimentary 3. can give the insufficient use of liquids, drying of fecal masses is a consequence of what.

Neurogenic locks meet often. Main pathogenetic mechanism neurogenic 3. — disturbance of nervous control of intestinal motility. The mental overstrain, a prolonged mental depression etc. can become their reason. In such cases can take place both decrease in a vermicular movement of a large intestine, and its strengthening; the combination of these processes leads to dyskinesia of intestines — Diskineticheskiye 3. The lack of coordination of separate types of movements of a large intestine with development at the same time of a spasm in one and an atony in other its sites is the cornerstone of them. It is reasonable to use the term «Diskinetichesky Locks» only for designation 3., resulting from disorder of motor function of intestines. 3. owing to reduction of motive activity of intestines call hypomotor (hypokinetic), as a result of strengthening of reduction of a wall of a gut — hyper motor (hyperkinetic).

Hypokinesia of intestines arises as a result nervous devices of intestines or are poorly irritated, or partially lose ability to perceive irritation. Insufficient stimulation of movements can be a consequence of disturbance went. - kish. reflexes, insufficiency of peripheral reflexes because of small formation of fecal masses. Blockade of a parasympathetic nervous system or increase in a threshold of irritability of receptors of an intestinal wall as a result of use of frequent and strong irritants (strong laxatives, enemas) can be the cause of a hypokinesia.

Hyperkinesia of intestines it is characterized by emergence of spasms, most often in places which also under normal conditions are in a condition of the strengthened reduction (transition of a caecum in ascending colonic, Payr's sphincter, Bali, etc.). Their reasons are extremely various. These 3., in particular, are a consequence of an acrimony of intestines as a result of the stimulating neurogenic influences at irritable persons.

Reflex locks arise at diseases of various departments of system of digestion (a stomach, bilious ways, a pancreas), at pathology of urinogenital system, etc. Reflex influences from the struck bodies can lead to disturbances of motility of a large intestine, cause paresis or spasms of intestinal muscles, disorder of coordination of separate types of movements of intestines. According to some authors, at a peptic ulcer 3. meet in 35 — 45% of cases, and during a recurrence almost twice more often than during remission; at patients with hron, diseases of bilious ways 3. are noted in 72% of cases, at patients hron, by pancreatitis — in 24%. Reflex 3. often arise at diseases of urinogenital system: at adnexites — in 60%, at hron, prostatitises — in 52%, at an urolithiasis — in 45% of cases.

Locks owing to suppression of desires on defecation (usual 3.) arise at women more often than at men; are rather often noted at neuropaths, at mentally sick. The usual rhythm of defecation is created by a certain combination of conditioned and unconditional excitators. Various psychogenic factors, changes of usual living conditions and work can lead to disturbance of the conditioned reflexes providing emergence of desires on defecation. These uslovnoreflektorny mechanisms are especially fragile in the childhood. In cases, when similar 3. appear only owing to suppression of desires on defecation and other factors do not join, motility of a large intestine suffers a little; the kcal accumulates in a rectosigmoid part of intestines while its other departments can be free from a calla (diskheziya).

Locks owing to organic diseases of c. N of page. meet at disturbances of cerebral circulation, tumors and injuries of a head and spinal cord, multiple sclerosis, at meningitis, myelites, back to tabes etc. Quite often they are followed by frustration of the act of an urination — the symptom confirming a disease of c. N of page. At the heart of these 3. disturbances of nervous control of motor function of intestines, disturbance of the act of defecation, a hypodynamia and other factors lie.

Hypodynamic locks more often are passing. They arise at patients, is long observing a bed rest, at the persons suffering various hron, the diseases which are followed by exhaustion, especially at advanced and senile age. In similar cases insufficient physical. activity in a combination to weakness of somatic muscles leads to decrease in motility of intestines, disturbances of the act of defecation.

Inflammatory locks are observed at inflammatory diseases of a large and small bowel, at diverticulites of a large intestine. By data A. V. Frolkis (1975), at patients hron, a coloenteritis 3. are noted in 28,5% of cases, at preferential defeat of a small bowel (enterita) — in 18%, and at colitis — in 44%. Inflammatory 3. arise in connection with the disturbances of intestinal motility caused by influence of local intestinal reflexes with patholologically the changed mucous membrane of a gut. The disturbances of chemical processes in intestines changing properties of contents of intestines can play a Nek-ry role.

Proktogenny locks develop at patients with pathology of anorectal area: at hemorrhoids, cracks of a rectum, proctites, a prolapse of the rectum, perianal abscesses, strictures of a rectum, etc. Reason of similar 3. frustration of the act of defecation owing to its morbidity, easing of sensitivity of nervous receptors of an ampoule of a rectum is; the tone of proctal sphincters is usually raised.

Mechanical locks arise at patients with tumors of intestines, at inflammatory and cicatricial narrowings of a large intestine, a diverticulitis, owing to ulcer colitis, a disease Krone, ileocecal tuberculosis, syphilis, a lymphogranulomatosis, etc., during the closing of a gleam of intestines with foreign bodys, fecal stones, at a mechanical prelum of a rectum tumors, inflammatory processes in a pelvic cavity. At patients with a scleroderma 3. can be caused by narrowing or dilatation of a gut in connection with an atrophy of its muscular coat.

Locks owing to anomalies of development of a large intestine arise at persons with a disease of Girshsprunga, idiopathic megacolon, at mobile blind and sigmoid guts, at persons with a constitutional splanchnoptosia. Defect vegetative intramural gangliyev at a disease of Girshsprunga makes impossible normal motility of a gut. In the extended and expanded gut of kcal loses a lot of liquid that also weakens its propulsive activity of intestines.

Toxic locks meet at hron, professional lead poisoning, mercury, thallium, at poisonings with nicotine, at abuse of foodstuff high content of tanning agents. At the same time it is possible as immediate effect of poisons on the neuromuscular device of a gut, and their mediated influence through external departments of c. N of page.

Medicamentous locks actually treat toxic; their allocation in separate group is necessary in connection with great practical value. Morphine and its derivatives, in particular codeine, ganglioblokator and cholinolytics, sedatives and tranquilizers, weakening intestinal motility, can bring to 3. Some antacids, holestiramin promote 3., since cause drying a calla. Medicamentous 3. can be caused by administration of drugs of iron, calcium, and also abuse of the laxatives which are directly breaking motility of a large intestine or causing disorder of intestinal absorption.

Endocrine locks are observed at a myxedema, a hyperparathyreosis, an acromegalia, an adiposagenital syndrome, in certain cases a diabetes mellitus, at a climax, a pheochromocytoma, a glucagonoma. Hormonal dysfunction at endocrine diseases leads to disturbances of intestinal motility and as to the investigation, to 3.

Locks owing to disturbances of water and electrolytic exchange can result from loss by an organism of liquid after ponos, at the increased perspiration at in the fever patients, at an artificial diuresis, ascites of various etiology, deficit of potassium, heart failure, diseases of kidneys. To 3. the hypercalcemia, a cholestasia brings. 3. at a mucoviscidosis the calla owing to disorder of exchange of electrolytes is caused by sharp increase in viscosity. At these conditions of disturbance of water and electrolytic exchange lead to reduction of number of fecal masses, increase in their dryness, hardness and viscosity. Arising thereof discrepancy between the capacity of a large intestine and volume of its contents causes the complicated emptying.

Clinical picture

Clinical picture 3. it is very various and substantially depends on an etiology and a pathogeny of a disease. In one cases 3. — the only complaint, in others — patients show a large number of complaints of various character.

Frequency of defecations at 3. can be various: from once in 2 — 3 days, to once a week and less often. Some patients have a daily chair, but with the complicated act of defecation, sometimes several defecations in day insignificant quantity a calla without content after a chair. At 3. with kcal it is usually condensed, dry, fragmented in the form of dry dark balls or lumps, reminds sheep kcal; at spasms of distal departments of a large intestine — in the form of tapes. In less expressed cases only the header of the fecal cylinder is condensed, and a final part represents kashitseobrazny weight. Quite often in kcal it is shrouded in the whitish or vitreous slime which is formed in a rectum owing to irritation of her mucous membrane dense fecal masses. The so-called locking diarrhea when at a long delay of bowel emptying at patients with persistent 3 is in some cases observed. there is a fluidifying of fecal masses slime and allocation liquid a calla. Patients with 3. can complain of pain and feeling of a raspiraniye in a stomach; simplification comes after a chair or a passage of flatus. The kolikoobrazny abdominal pains which more often are noted at diskinetichesky, reflex, mechanical 3 can sometimes be observed. At some patients of pain are localized in the left upper quadrant of a stomach, can irradiate in the left shoulder, the left half of a thorax and be followed by an asthma, heartbeat (a syndrome of a splenic corner), less often patients complain of pains in the right upper quadrant of a stomach (a syndrome of a hepatic corner). In cases when the delay of intestinal contents occurs hl. obr. in a caecum, pain are localized in the right ileal area and can simulate appendicitis; quite often abdominal pains have no continuous localization. Rather often sick pain in an anus, and also other anorectal frustration — an itch, false desires disturbs. Also various dispeptic phenomena are observed: a loss of appetite, an eructation air, nasty taste in a mouth, abdominal distention, rumbling etc. Especially burdensome symptom at patients with 3. can become meteorism (see), caused by a slow passage a calla on intestines and increase of amount of the gas which is emitted as a result of activity of intestinal microflora. Quite often 3. are followed by the decrease in working capacity, headaches, muscle pains, the general nervousness suppressed by mood, frustration of a dream, chilling, numbness of extremities, an asthma, etc.

Quite often Locks accompany changes of skin, it is pale, sometimes with a yellowish shade, flabby, loses elasticity. It is occasionally possible to observe small tortoiseshell (see), a dermatosis in a look eczemas (see), furunculosis (see), etc. Language dry, is laid over. The stomach is more often blown up, can be pulled in. The palpation of a stomach often finds the certain sites of a large intestine filled with dense fecal masses most often in the field of descending and a bend of sigmoid; the caecum increases in volume and gets a sacculate form. At hyperkinetic 3. quite often it is possible to probe spastic the reduced segment of a gut in the form of a tyazh, a little painful. Total absence of peristaltic reductions of a sigmoid gut during a long palpation is observed at hypokinetic 3. At the research per rectum the rectum is stretched and executed by a dense stake or spastic is reduced, empty and painful at introduction of a finger in case of diskinetichesky and reflex 3.; the same changes are noted at rektoromanoskopiya (see).

Long existence 3. causes various complications among which are most often observed secondary colitis (see) and proctosigmoiditis as result of a reactive inflammation; anorectal diseases — hemorrhoids (see), cracks (see. Anus ), a paraproctitis with fistulas of a crotch (see. Paraproctitis ) etc.; dyskinesia of bilious ways; fecal stones (see) which can cause intestinal impassability, etc. Colitis, anorectal complications strengthen 3. At patients with 3. sometimes there are changes of mentality of hypochiondrial character. Some authors allocate so-called false 3., when even at a normal chair individuals show the increased care of the act of defecation, strenuously fix the attention on quality and quantity of excrements, on a condition of proctal area. Similar psychogenic reactions quite often develop against the background of already existing 3.

The diagnosis

the Diagnosis is established usually on the basis of the anamnesis and complaints of the patient. Clarification of an etiology and type 3 is important., especially timely recognition of the tumoral processes causing mechanical 3.; at the same time along with a wedge, data (advanced age, the recent beginning 3. with a normal chair, impurity of blood in Calais, etc.) great diagnostic value gets from persons rentgenol, a research, kolonoskopiya (see), rektoromanoskopiya (see). At a rektoromanoskopiya in case of hyper motility a mucous membrane of direct and sigmoid guts wet, is visible a peristaltics, spasms, coloring of a mucous membrane changes quickly, at hypomotility — a mucous membrane dry, dim, distal department of a large intestine in the fallen-down state, advance of a tube is complicated. The known difficulties arise at differentiation inflammatory 3. at colitis and 3. preferential functional nature. To recognition of the nature and differentiation 3. promotes koprol. a research (see. Kal ), biopsy of a mucous membrane of a direct or sigmoid gut. Definition like motor disturbances of a large intestine is of great importance. Some data can be obtained at a palpation: at preferential hyper motor disturbances of distal departments of a large intestine the sigmoid gut spastic is reduced, at hypomotor disturbances it can be stretched, does not peristaltirut. Important information is given by record of motility of intestines by a ballonotenzografichesky method.

Rentgenol. the research aims to reveal disturbances of motor function and a tone of a large intestine, primary or secondary 3. It will be out later certain time terms after intake of a baric suspension — in 4 — 6 — 9 — 12 — 24 — 48 hours and later. The main attention is paid to the nature of filling and emptying of a gut, passage on it of barium, a look gaustr, by existence of spastic reductions, and also accumulations of gas and liquid. To irrigoskopiya (see) resort in cases when it is necessary to exclude anomaly of development of a gut or its organic lesion, at which 3. (secondary) can be a symptom of a disease.

Fig. 1. The roentgenogram of a large intestine at primary lock (colitis) in 48 hours after reception of barium inside: staz contrast weight preferential in the left half of a gut, the tone is unevenly raised, haustration is strengthened, a spastic banner in the field of a sigmoid gut (it is specified by an arrow).
Fig. 2. The roentgenogram of a large intestine at a hyperkinetic lock (colitis) in 72 hours after reception of barium inside: the tone of the descending and sigmoid guts is sharply raised, certain sites of a gut spastic are reduced (the sites spastic the reduced gut which are not filled with contrast weight are designated by a white dashed line).
Fig. 3. The roentgenogram of a large intestine at a hyperkinetic lock (colitis), a research by means of an opaque enema: certain sites of a gut spastic are reduced; have an appearance of a cord.

At primary 3. usually find decrease in motor function, increase or decrease in a tone of a gut. These changes can extend to all gut or to its separate segments (fig. 1). The relief of a mucous membrane has normal or a little «angry» character (an irrigational relief): folds are raised, located more longwise or cross, but deprived of signs of an inflammation. The Smeshchayemost of a gut is not broken. At hyperkinetic 3. delay of a passage of barium is combined with a regional spasm and the deep, quite often segmenting haustration in the form of numerous banners (fig. 2). The Spazmirovanny department of a gut sometimes has an appearance of a thin cord (fig. 3). More rare, at atonic 3., find the lowered tone of all large intestine or its separate segments which is followed by expansion of a gleam, superficial smoothed haustration.

Emptying of a gut from a contrast agent at 3. can occur within 72 — 96 and more hours (norm of 24 — 36 hours). At 3. with a limited colostasis (segmented 3.) the long delay of contrast weight takes place only in certain sites of a gut — in blind and ascending colonic (3. the ascending type, right-hand), cross colonic (transversal type 3.) or in the bottom sigmoid and a rectum (proktogenny 3., diskheziya). At the same time the passage of barium on other departments of a gut remains normal or, more rare, accelerated. The long delay of barium in a sigmoid gut is often observed at its lengthening. Staz in the blind and ascending colon can be followed stazy barium in an ileal gut and a worm-shaped shoot. Perhaps also a combination of different types of limited colostases, napr, right-hand with transversal, transversal — with left-side.

Classification 3. and their differential and diagnostic characteristic are presented in the table.

Treatment

Therapeutic tactics at 3. substantially depends on their type and first of all provides treatment of a disease, 3 can be a symptom to-rogo.

At alimentary 3. good results are achieved by a corrective diet. Recommend food with high content of cellulose and enough liquid (1,5 — 2 l a day), the products promoting bowel emptying (acid milk, fruit juice, bread from coarse flour, etc.). The use of the prunes and a fig, infusion soaked in water from them is useful, for dried fruits puree.

At diskinetichesky 3. with hyper motility first of all it is necessary to appoint a besshlakovy diet with impurity of fats, gradually adding to food cellulose gentle, and afterwards more rough consistence. It is necessary to avoid the products promoting the strengthened gas generation (bean, milk, etc.). At hypokinetic 3. appoint seed fats, in particular luccu oil; food needs to be eaten in sufficient volume.

Despite a big role of a diet in treatment 3., it can not yield any result if at the patient the habit to release intestines in certain time of day is not developed. It is especially important to consider it at treatment 3., the desires which arose owing to suppression on defecation. For recovery of this reflex it is recommended to drink in the mornings on an empty stomach a glass of a cold water or the fruit juice activating a peristaltics. In half an hour after meal of the patient shall by means of certain techniques (the corresponding pose, massage of a stomach, rhythmical retraction of an anus, pressing on area between a tailbone and an anus) to try to cause defecation. In repeated attempt introduction to an anus of a glyceric candle is reasonable. It is very important that the doctor with the psychotherapeutic purpose emphasized absolute efficiency of this method in all cases of this sort 3. Necessary at treatment 3. the actions regulating a work-rest schedule of patients, promoting adjustment of a normal chair are.

Medicamentous therapy at 3. it has to be carried out carefully, short-term courses, under close medical check. As the indication to use of purgatives serve acute 3. Within a short period of time it is reasonable to use spasmolytic drugs. At disturbance of structure and properties of intestinal microflora drugs from live cultures of lactobacilli in a dry form from 50 to 150 mg a day (or in the form of curdled milk from 250 ml to 1 l a day) during 4 weeks are shown. Purpose of bacterial drugs — a kolibakterin, a bifikol is in certain cases reasonable. Mosses, algas possess aperient and carminative action, to lay down. herbs (senna, bark of a buckthorn, fruits of a buckthorn, seeds of fennel, flowers of a camomile, leaves of mint, a root of a valerian, flowers of an immortelle) which appoint in the form of various collecting. Oils (vaseline, olive), drugs Cafiolum, agarol, etc. are sometimes effective.

At treatment proktogenny 3. use means for rectal use — candles, microclysters. At 3. mineral waters (Dzhermuk, Yessentuki, Batalinskaya, etc.) inside in the cold or warmed-up look, rectal ways of their introduction are shown.

Great value at treatment of all types 3. has the strengthening therapy is general, psychotherapy (see). The patient with 3. various physiotherapeutic procedures are shown: faradisation and massage of area of a stomach, treatment by a galvanic current, UF-radiation. At hyper motility apply an electrophoresis spasmolytic drugs (a papaverine, Platyphyllinum, Dibazolum), drugs of magnesium, at hypomotility — drugs of calcium. At diskinetichesky 3. with hyper motility appoint a diathermy, paraffin applications to a stomach. At patients with dominance of hypomotor frustration cool hydrotherapeutic procedures are shown, at dominance of hyper-motility — warm hydrotherapeutic procedures. Mud treatment (applications of dirt on the stomach, mud tampons entered into a rectum) is recommended at inflammatory 3. The patient with proktogenny 3. appoint massage of a rectum, faradisation of area of proctal sphincters.

Physiotherapy exercises in complex treatment 3. exerts fortifying and recreational impact on all organism, and also special action on functions of intestines, improving its blood circulation and motility.

In advance and removal of fecal masses the significant role is played by the change of intra belly pressure arising during the respiratory act at reduction and relaxation of muscles of a prelum abdominale, during execution of physical. exercises. Fullestly listed mechanisms operate during the change of provisions of a body.

The main forms to lay down. physical cultures is to lay down. gymnastics, morning gigabyte. gymnastics, pedestrian walks, the dosed driving the bicycle, swimming, ski walks and so forth. Selection of exercises for implementation of the general impact on an organism, and also special exercises for a prelum abdominale shall be carried out taking into account features of a current patol, process and the general condition of the patient.

Fig. 4. A complex of gymnastic exercises at locks: 1 — from the initial position (nominative) being on all fours squat on heels; 2 — from nominative being on all fours alternate assignment of legs back; 3 — from nominative lying on spin turn of the lower half of a trunk and the legs bent in knees, to the right and to the left; 4 — from nominative lying on spin alternate bending of legs in knee joints; 5 — from nominative lying on spin, having clasped a knee, alternate pressing of legs to a stomach; 6 — from nominative lying on spin alternate lifting of direct legs; 7 — from nominative lying on spin alternate assignment of legs aside; 8 — from nominative lying on spin the movement of legs reminding driving the bicycle; 9 — from nominative lying on spin, hands on a belt, transition to a sitting position; 10 — from nominative lying on spin with the stuffed ball clamped between feet lifting of legs with their subsequent bending in knee joints; 11 — from nominative lying on spin with a stuffed ball in hands transition to a sitting position; 12 — from nominative sitting alternate turn of a trunk with simultaneous assignment of the corresponding hand aside; 13 — from nominative sitting, hands on a belt, alternate rotation of the case to the right and to the left; 14 — from nominative standing, legs at shoulder length, turn of the case to the right and to the left with cultivation of hands in the parties; 15 — from nominative standing, legs at shoulder length, an inclination of the case with a dostavaniye fingers of hands of a sock of an opposite leg; 16 — from nominative standing, legs at shoulder length, hands on a belt, alternate rotation by the case to the right and to the left; 17 — from nominative standing, legs at shoulder length, rolling of a ball around a body. Note. Each of the exercises specified in the text is carried out 6 — 8 times, the number of their repetitions can be respectively reduced or increased depending on physical fitness and the state of health.

To lay down. the physical culture is shown at neurogenic 3. with existence both hypo - and hyperkinetic disturbances. Contraindications are organic changes of intestines: the expressed commissural process, existence of a tumor, bleeding. At dominance of the hyperkinetic phenomena much attention shall be paid to the choice of the initial positions promoting relaxation of a front abdominal wall — being on all fours, lying on spin with the bent legs (fig. 4, 1—4), and also exercises for muscles of a prelum abdominale and especially those from them in which the moment of effort — simultaneous lifting and lowering of direct legs in a prone position, «bicycle» and so forth is expressed. At dominance of the hypokinetic phenomena in intestines and a top general condition of the patient place emphasis on exercises for muscles of a stomach in various initial positions with power elements and considerable loading (fig. 4, 5—17).

The good effect gives a combination to lay down. physical cultures with hydrotherapeutic procedures and differentiated massage (see). The course of treatment lasts of 2 — 3 weeks to several months. In the course of the occupations to lay down. physical culture increase in loading shall happen gradually, to constant control behind a condition of the patient and his reaction to physical. exercises.

At some diseases which are followed 3., operational treatment is applied. Tumors can be such diseases went. - kish. a path, a mesentery, inflammatory infiltrates and cicatricial strictures, fecal stones, the inborn and acquired anomalies of a large intestine — different types of expansion and its lengthening, etc. Operational treatment is shown also at some forms 3., accompanying ischemic colitis.

In the presence of a tumor, inflammatory infiltrate in a large intestine or its mesentery, commissural process of the same localization make resections of the struck departments of a large intestine or a mesentery; at a prelum of a gut a cicatricial tyazh the last is cut and places of its attachment to a gut peritonize.

At the inborn and acquired forms megacolon (see) resections of aganglionarny departments thick or a rectum are applied. At ischemic colitis apply the operations recovering a blood stream in arteries of a large intestine. In case of strictures of intestines of an ischemic origin make wide resections of the narrowed sites of a gut within fabrics with good blood supply.

Prevention

the Actions directed to the prevention 3., include first of all development since the early childhood of a habit to daily bowel emptying in certain time. Among the population it is necessary to carry out a dignity. - a gleam, work about hygiene of food, value of vegetables and fruit in a diet, sufficient physical. mobility to recommend the actions strengthening the general physical. condition of an organism, nervous system. The maintenance of toilets in good a dignity is of great importance. conditions, restriction of uncontrolled use of pharmaceuticals.

Locks at children

the Most frequent reason 3. babies have a disturbance of feeding and digestion of nutrients. At a quantitative underfeeding or very good absorption of breast milk the volume of excrement is too small to excite a desire to defecation. The constant delay of a chair for 2 — 3 days in such cases is not carried to true 3. also consider as a pseudo-lock. To emergence 3. at chest and early age conducts feeding of hl. obr. milk food without sufficient addition of the vegetable dishes and carbohydrates containing cellulose. Excess of fat at the same time aggravates 3., promoting the strengthened formation of alkaline-earth soaps and by that to a bigger hardening a calla. Lack of release of meconium and delay of a chair at newborns are observed also at mekonialny Ilheus, at an inborn atresia or narrowing of any piece of intestines, megacolon. 3 occur at children of these age groups, besides. owing to the general hypomyotonia which is combined with the hypotonia of intestines caused by rickets, expressed by the hypotrophy, a hypothyroidism, a Down syndrome postponed intestinal infectious diseases.

To emergence 3. at children of advanced age the same reasons which bring to 3 promote. at adults. Development usual spastic 3. at children of preschool and school age can be a consequence of lack of a habit to regular bowel emptying in certain time, systematic suppression of the desire to defecation arising during the occupations, fascinating games, etc.

Klin, symptoms 3. at children and a technique of inspection are similar described at adults. Health at 3. the long time can remain satisfactory with children. After a multi-day delay of a chair intoxication with repeated vomiting, dehydration, fervescence, pristupoobrazny abdominal pains, signs of cardiovascular disturbances is possible.

Treatment 3. at children appoint taking into account its reason. During the breastfeeding adjust regime of the nursing mother, correlate food of children, entering dokorm or the feeding up corresponding to age of the child: in the first half of the year — juice (carrot, grape) in number of 30 — 50 ml, after half a year — the wiped vegetables and fruit. The child needs to be accustomed from early age to systematic daily bowel emptying.

Dietary treatment 3. at children of advanced age similarly described at adults; outdoor games on air, walks are recommended. To children with hyperkinetic 3. recommend the crushed processed food, appoint vitamin drugs, first of all thiamin. At hypokinetic 3. are shown massage of a stomach, to lay down. the gymnastics promoting strengthening of muscles of a prelum abdominale, improvement of motility of intestines. In an initiation of treatment it is possible to appoint inside a liquid paraffin on tea or a dessertspoon of 1 — 2 time a day, a cut softens fecal masses.

At emergence of symptoms of acute intoxication it is necessary to wash out intestines, according to indications to appoint cardiacs. Inborn malformations of a digestive tract, defiant 3., demand operational treatment.

Locks at advanced and senile age

Locks at advanced and senile age meet often. They are caused by the same etiol, factors, as at more young faces. Mucosal atrophy and a muscular layer of intestines, the increased population of intestines microflora and change of its structure, weakness of muscles of a prelum abdominale and pelvic bottom — the factors contributing to development 3. in these age groups. The known role is played also by disturbances of mezenterialny blood circulation, decrease of the activity of a number of the enzymes participating in membrane digestion. At advanced and senile age all types 3 can be observed., however 3 meet more often. alimentary, owing to organic diseases of c. N of page, hypodynamic, proktogenny.

In addition to the symptoms characteristic for 3. at any age, at advanced and senile age the complications which are usually not observed at young people can meet: an incontience a calla, mechanical impassability of intestines, an ischuria owing to pressure upon a bladder of the overflowed ampoule of a rectum, rectal bleedings from ulcers of a mucous membrane of a rectum.

Diagnosis 3. at advanced and senile age it is carried out according to the practical standard. Feature of treatment 3. in this age group — purpose of reduced doses of medicamentous means.

Table. Classification of locks and their short differential and diagnostic characteristic

Bibliography: Aminev A. M, Guide to a proctology, t. 1 — 3, Kuibyshev 1965 — 1973; Ghukasyan A. G. Locks and their treatment, M., 1959, bibliogr.; Isakov Yu. F., Lyonyushkin A. I. and Doletsky of S. Ya. Hirurgiya of malformations of a large intestine at children, M 1972, bibliogr.; N. L jackpot. Locks at children, Kiev, 1976, bibliogr.; Lyonyushkin A. I. Proctology of children's age, M., 1976, bibliogr.; Leporsky A. A. Medical physical culture at diseases of system of digestion, M., 1963, bibliogr.; Mayanskayak. A. Functional interrelations of digestive organs, L., 1970; M about sh to about in V. N. Medical physical culture in clinic of internal diseases, M.! | 1977; V. P Is model. Stomach diseases, guts and peritoneum, page 106, Kiev, 1924; Fundamentals of gerontology, under the editorship of D.F. Chebotaryov, etc., page 222, M., 1969; Persits B. P. Studying of a tone of a proctal sphincter at locks, in book: Aktualn, vopr, gastroenterol., under the editorship of. В\X. Vasilenko and A.S. Loginov, century 5, page 534, M., 1972; P and-bukhina N. A. X-ray inspection of digestive tract using pharmacological drugs, M., 1971, bibliogr.; Rosenbaum Ue. M. About use of adrenergic means at motor disturbances of a large intestine, Klin, medical, t. 54, No. 1, page 56, 1976; The Guide to gastrointestinal diseases at children, under the editorship of N. I. Nisevich, page 94, M., 1969; P and x A. N. The atlas of operations on direct and thick guts, M., 1968; F and N and r-d I am V. A N. Radiodiagnosis of diseases of a digestive tract, t. 2, Yerevan, 1964; Fedorov V. D., Gelfenbeyn L. S. and May t at in M. B. Megakolon at adults, Surgery, No. I, page 136, 1973; Physiology of digestion, under the editorship of A. V. Solovyov, page 531, L., 1974; F r about l to and with And. B. Chronic coloenterites, L., 1975, bibliogr.; D e v r about e d e G. S o f-f i e M. Colonic absorption in idiopathic constipation, Gastroenterology, v. 64, p. 552, 1973; StelznerF. Die anorecta-len Fisteln, B., 1976; Waller S. L. Differential measurement of small and large bowel transit times in constipation and diarrhea, Gut, v. 16, p. 372, 1975.

A. V. Frolkis; E. M. Vitebsky (ped.), A. N. Kishkovsky (rents.), V. D. Fedorov (hir.), G. S. Fedorova (to lay down. physical.), author of the table A. V. Frolkis.

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