PERIGASTRITIS (perigastritis; grech, peri around, near + gastritis) — inflammatory process of a serous cover of a stomach. The item usually arises as secondary process, most often at patients with a peptic ulcer of a stomach, especially at the long current recuring it. It can develop at cholecystitis, pancreatitis, a duodenitis, a peptic ulcer of a duodenum, a disease Krone, nonspecific ulcer colitis, hron, appendicitis. Extensive inflammatory and commissural process on a serous cover of a stomach can be a consequence of diffuse purulent peritonitis, the abscesses localized in an upper part of an abdominal cavity, tubercular peritonitis, miliary tuberculosis of a peritoneum. The item is sometimes connected with traumatic injury of a stomach (bruises, the getting wounds), a burn of a mucous membrane of a stomach, perforation of a stomach, a gut. In some cases P. develops after operative measures on a stomach and other abdominal organs.
The item is followed by disturbance microcirculation (see), development limfangiita (see) and lymphadenitis (see), allocation serous or fibrinous exudate (see). In the acute period of imposing of fibrinous exudate can promote an otgranicheniye of inflammatory process. The organization of fibrinous exudate leads to gradual development of fibrous fabric and formation of commissures. In one cases of commissure have an appearance of the thin gentle whitish filamentary or filmy educations which are located on the limited site of a serous cover of a stomach without changing its form and without breaking function; in others — commissures surround a stomach from all directions, causing rough deformation of body and disturbance of its functions. Commissures (see) can tie a stomach with the next bodies and fabrics, napr, with a liver, a gall bladder, a pancreas, a cross colon, a front abdominal wall. The item in the field of a back wall of a stomach is more often connected with pancreatitis and colitis. Traumatic P. is quite often characterized by formation of unions between a stomach and a front abdominal wall.
Clinical picture The item it is usually caused by a basic disease. The symptoms connected directly with P. are not certain. Consider that, e.g., the pain syndrome inherent peptic ulcer (see), at P.'s development becomes more expressed and persistent, and pains usually amplify at the time of change of position of a body, at an exercise stress, etc. Independent the wedge, value P. gets in those cases, to-rye are followed by rough deformation of a stomach with disturbance of its motor and evakuatorny functions (see. Stomach ). Patients note feeling of weight and pressure in over-chrevye later food, feeling of swelling and a raspiraniye in this area, an eructation air, and at disturbance of evakuatorny function of a stomach — an eructation the eaten food, sometimes with a smell of rotten eggs, repeated vomiting the remains of the eaten food with impurity of bile.
The general condition of patients even in the presence of symptoms of disturbance motor evakuatornoy function of a stomach is, as a rule, not broken. At survey of a stomach non-constant swelling in a nadchrevya, a thicket at the left, sometimes also visible peristaltics of a stomach is noted.
At a physical research reveal P.'s signs described by N. D. Strazhesko: at percussion the timianichesky zone of a stomach extends to the right, sometimes to the front axillary line, the lower bound of hepatic dullness at the same time takes the form of a semilunum. Effleurage on a front abdominal wall fingers is followed by painful feelings in a nadchrevya.
The fibrogastroscopy (see. Gastroscopy ) at P. connected with a peptic ulcer can reveal changes of a mucous membrane of a stomach. Deformation and disturbance of evakuatorny function of a stomach at preservation of passability of the gatekeeper testify to a perigastritis. At a laparoscopy (see. Peritoneoskopiya ) find signs of inflammatory process and commissure on a serous cover of a stomach (tsvetn. fig. 1).
Rentgenol, P.'s diagnosis is based on identification of various type of deformations of a stomach, unusual fixing of its departments, changes of situation and contours of a stomach. At extensive unions between a stomach and adjacent bodies its active and passive smeshchayemost is limited, the peristaltics is weakened, its waves are asymmetric, contours of a stomach uneven. The stomach at the same time is usually located highly, its antral part is tightened up, to the right or to small curvature (fig.) and during passing of a peristaltic wave takes the atypical form. In the presence of the expressed deformations and excesses evacuation function of a stomach can sharply be broken. The relief of a mucous membrane in the flexing area of body is more often reconstructed or smoothed. Longitudinal folds are usually not visible, however the symptom of break of folds is not observed. Elasticity and sokratitelny ability of walls of a stomach normal or is broken slightly that is important in differential diagnosis of P. with malignant tumors.
The commissures fixing big curvature or a back wall of a stomach come to light at a research on the right side better, and unions in the field of a peloric part and small curvature — on left. At the same time the wall patholologically of the fixed department of a stomach is deformed, forming ledges and teeth of various form. For identification of an union between the arch of a stomach and a diaphragm sometimes resort to a research in conditions pneumoperitoneum (see) and to pariyetografiya (see). At an union with mobile bodies (a large intestine, an epiploon) the smeshchayemost of a stomach can be kept. Existence of unions with a large intestine is confirmed at irrigoskopiya (see).
The item and the cicatricial changes caused by the basic patol process, napr, a chronic ulcer, antral gastritis, can cause deformation of a stomach in the form of hourglasses, shortening of small curvature (a helical and kisetopodobny stomach), wrinkling of small curvature and sagging big, and also a pyloric stenosis.
For differential diagnosis deformations of a stomach of organic and functional character conduct a research against the background of administration of atropine or Methacinum, attaching crucial importance to stability of the revealed changes.
In cases of an aggravation of the basic disease which caused P. treatment in the conditions of a hospital is shown. Improvement of a condition of patients is promoted in most cases by observance of the mode and dietary food (see. clinical nutrition ). In a complex to lay down. actions the favorable effect is rendered by physical therapy. In the period of aggravations appoint UVCh daily or every other day and microwave therapy.
During remission applications of paraffin or ozokerite at t are shown ° 48 — 50 °, mud cure, an electrophoresis with lidazy, Platyphyllinum, novocaine, ronidazy, and also iodine electrophoresis. Along with physical methods of treatment appoint hloridno-sodium, radonic, iodine bromic bathtubs, alternating them to local procedures. Improvement of health of patients is promoted, as a rule, by easy physical exercises.
The resort therapy at P. includes medicinal bathtubs, drinking treatment, the dietary and motive modes. Yessentuki No. 4 mineral waters, Smirnovskaya, Slavyanovskaya, warm or cold Narzan are shown (Pyatigorsk, to Sairma, Dzhermuk, Borjomi). Appoint mud applications to area of the right hypochondrium at t ° 38 — 40 ° lasting 15 — 20 min. It is possible to apply galvano-or a diathermomudtherapy.
In case of unsuccessful conservative therapy at P. which is followed by rough deformation of a stomach carry out operational treatment. The indication to an operative measure is also P. with disturbance motor evakuatornoy functions of a stomach in connection with the deformation stenosing it. The main method of operational treatment is the resection of a stomach (see. Stomach , operations ). The divisions of unions and the soldered bodies applied earlier, excision of commissures are ineffective and are almost not used.
The forecast and Prevention
the Forecast generally favorable, depends on character of a current of a basic disease.
Prevention comes down to the prevention and timely treatment of the diseases leading to development of the Item. The organization of dietary food and a dignity is of great importance. - hens. treatments of patients with damage of digestive organs. A big role in prevention of exacerbations of diseases, to-rye can promote P.'s development, medical examination of patients plays.
Bibliography: Belousov A. S. Differential diagnosis of diseases of digestive organs, M., 1978; Diseases of digestive organs, under the editorship of Ts. G. Masevich and S. M. Ryss, JI., 1975; To ud and she in B. B., etc. Clinicoradiological diagnosis of commissural deformation of a stomach, Kazansk, medical zhurn., t. 59, No. 2, page 25, 1978; Parfyonov A. P. Physical remedies and resort factors, JI., 1968; Popov A. Ya. X-ray semiotics of perigastrites, Nauch. works Leningr, in-that usovershen. doctors, century 89, page 213, 1970; P about-zenshtraukh JI. Page N. U. O ishniger an excess of a stomach («a cascade stomach») at a peptic ulcer, Owls. medical, «Ne 2, page 37, 1965; Simonyan K. S. Adhesive desease, M., 1966; Fanardzhyan V. A. Radiodiagnosis of diseases of a digestive tract, t. 1, Yerevan, 1961; Shekhter I. A. and Shniger N. U. About deformation of a stomach of the ulcer nature, Vestn, rentgenol, and radio-gramophones., «Ns 3, page 39, 1963; Alimentary tract roentgenology, ed. by A. R. Margulis a. H. J. Bur-henne, St Louis, 1973; Gastroenterology, ed. by H. Bockus, v. 1, Philadelphia — L., 1974; Teschendorf W., A n a with k e r H. u. Thurn P. Rontgenologische Dif-ferentialdiagnostik, Bd 2, Stuttgart, 1978.
A.S. Belousov, T. L. Kozhevnikova; A. N. Kishkovsky (rents.).