METEORISM (grech, meteorismos raising, swelling; synonym: abdominal distention, pucheniye, tympanitis) — excess accumulation of gases in digestive tract due to the increased their formation or insufficient removal from intestines.
The amount of gases at healthy faces depends on character of food, age, a way of life and other factors. In fiziol, conditions gases accumulate preferential in a stomach, in the right and left bends of a colon, less them in blind and sigmoid colonic guts, it is a little in a small bowel. Gases of a digestive tract are formed at the expense of the swallowed air (see. Aerophagia ), their allocations in the course of digestion in a stomach and intestines, at neutralization of gastric and pancreatic juice bicarbonates; a nek-swarm the quantity them can come to intestines from blood. In formation of gases the large role is played by intestinal microflora. Gases are removed from an organism through a rectum, a part by their way of diffusion gets from intestines to blood and is allocated through lungs.
The composition of intestinal gases considerably varies. According to Levitt (M. of D. Levitt, 1971), in a large intestine of healthy people nitrogen makes 24 — 80%, oxygen of 0,1 — 2,3%, hydrogen of 0,6 — 47%, methane of 0 — 26%, carbon dioxide gas of 4,3 — 29% of total quantity of gases; there is also a hydrogen sulfide. In a stomach concentration of carbon dioxide gas is lower, and is higher than oxygen, than in intestines, the content of carbonic acid, methane and hydrogen increases in a rectum, especially at patients with M.
the Aetiology and a pathogeny
the Aetiology and a pathogeny are various that causes variety of forms M. Its division into the following forms can be for practical purposes recommended:
1) an alimentary Meteorism — because of plentiful consumption rich with cellulose and starch of the products giving a large amount of gases at digestion (bean, cabbage, potatoes, black bread, etc.);
2) A meteorism because of disturbance of processes of digestion (at enzymatic insufficiency, malabsorptions, disorders of enterogepatichesky circulation bilious to - t, intestinal dysbacteriosis etc.);
3) the mechanical Meteorism — because of mechanical disturbance of evakuatorny function went. - kish. a path (at a stenosis, commissures, a tumor);
4) the dynamic Meteorism — because of disturbance of motor activity went. - kish. a path (at an aerophagia, peritonitis, acute infections and intoxications, after vagisection, childbirth; here belong reflex M., napr, at infringement of a mesentery, children's and senile M., etc.);
5) the circulator Meteorism — because of the general and local circulatory disturbances (e.g., at stagnation in veins of intestines), as a result to-rykh decreases absorption of gases from intestines in blood and receipt them from blood in intestines increases;
6) a psychogenic Meteorism, napr, at hysteria.
A clinical picture
the complaints to feeling of a raspiraniye and weight in a stomach sometimes aching or nagging pains in various sites of a stomach without accurate localization Are characteristic. At sharp M. there can be attacks of colicy pains (gas colic) abating later passages of flatus. In one cases — a frequent and noisy otkhozhdeniye, in others — a delay of gases. Various dispeptic frustration are observed: an eructation, nausea, locks or ponosa, off-flavor in a mouth, a loss of appetite. The off-flavor from a mouth, in some cases, especially at young people leading to a peculiar psychoneurosis is possible. The m can be followed by quite burdensome feelings from other bodies and systems (a digestivny adynamy): burning sensation in heart, heartbeat, interruptions of heart, headaches, muscle pains, a sleep disorder, frustration of mood, the general weakness, weakness, numbness of extremities etc. Sometimes patients are disturbed by an asthma, in some cases quite strong («dispeptic asthma»). At survey swelling of all stomach (the general M.) or its departments can be noted, is more often side (a local Meteorism). The general M. meets at accumulation of gases in a small bowel, napr, at enteric impassability, side — at accumulation of gases in a large intestine, napr, at colic Ilheus. At percussion of a stomach strengthening of a tympanic sound is noted. At auscultation depending on a form M. intestinal noise can be strengthened (before an obstacle) or weakened, sometimes disappear absolutely. At a palpation the probed blown-up caecum can indicate localization of an obstacle in a large intestine; the fallen-down caecum can testify to enteric Ilheus. In preferential gastric M.'s cases swelling is localized by hl. obr. in epigastriß area, the tympanic sound in Traube's space amplifies (see. Traube space ).
Diagnosis comes down to identification of the basic, sometimes a dangerous disease, a cut became the reason of M. At rentgenol, a research the loops of intestines, preferential large intestine inflated by gas are found (aerocoly).
Treatment is based taking into account a basic disease. Are completely excluded from a diet cabbage, bean, fresh bread; the products rich with starch (potatoes, farinaceous dishes), easily acquired carbohydrates are limited. The colloid substances adsorbing intestinal gases on the surface are appointed: trisilicate of magnesium, active coal (it is effective only in high doses), white clay, colloid gels. Recommend drugs of bismuth, carminative herbs (camomile infusions, fennel, mint, a yarrow, etc.). At M. because of insufficiency of intestinal digestion are shown salt to - that with pepsin, a natural gastric juice, fermental drugs (Pancreatinum, abomin, panzinorm, Polyzimum, etc.). Treatment is carried out dysbacteriosis (see), at pains appoint spasmolytic drugs (see. Antispasmodics ), at M. because of an aerophagia the slow food, restriction of reception of liquid, tranquilizers and cholinolytics for decrease in a sialosis are shown. Treatment is necessary locks (see) and ponos (see). At M. connected with mechanical disturbances of evacuation, peritonitis, abdominal organs operations, childbirth, besides, hold special medical events (see. Impassability of intestines , Peritonitis , Postoperative period , Puerperal period ).
1) balanced balanced diet;
2) sufficient physical activity, observance of the general gigabyte. governed;
3) timely treatment of the diseases contributing to M.;
4) fight against abuse of laxatives and enemas;
5) puerperal and postoperative to lay down. - professional, actions (physical culture, massage, use of a bandage, regulation of a chair etc.).
Bibliography: Beyul E. A. and Ekisenina N. I. Chronic enterita and colitis, M., 1975, bibliogr.; Diseases of digestive organs, under the editorship of Ts. G. Masevich and S. M. Ryss, L., 1975; Clinical gastroenterology, under the editorship of G. I. Burchinsky, Kiev, 1978, bibliogr.; Frolkis A. B. Chronic coloenterites, L., 1975, bibliogr.; Gall L. S. The role of intestinal flora in gas formation, Ann. N. Y. Acad. Sci., v. 150, p. 27, 1968; Gastroenterolo gy, ed. by H. L. Bockus, v. 2, Philadelphia, 1976; Glaessner K. Meteorismus und seine Behandlung, Wien. klin. Wschr., S. 1268, 1927; Lasser R. B., Levitt M. D. a. B o n d J. H. Studies of intestinal gas after ingestion of a standard meal, Gastroenterology, v. 70, p. 906, 1976; Levitt M. D. Volume and composition of human intestinal gas, New. Engl. J. Med., v. 284, p. 1394, 1971; S 1 e i s e n g e r M. H. a. Fordtran J. S. Gastrointestinal disease, p. 245, Philadelphia, 1973.
A. B. Frolkis.