REGURGITATION

From Big Medical Encyclopedia

REGURGITATION (Latin the re-prefix meaning retroaction + to flood gurgitare) — the return normal the rapid movement of liquids or gases arising in hollow muscular bodies at their reduction. It is usually observed at disturbance of functions of muscular presses or separating baffles (e.g., valves of heart), and also at the opposite direction of a wave of muscular contraction (e.g., at an antiperistalsis of a stomach). Along with the concept «regurgitation» use the concept «reflux», a cut is not a synonym of River. At reflux (see) unlike R. there is passive flowing of liquids in the located spaces, hl nearby. obr. owing to dysfunction of dividing environments. So, the pelting in a gullet of contents of a stomach at its reduction is designated as gastroesophagal regurgitation, and flowing of contents of a stomach in a gullet at change of position of a body with vertical on horizontal — as a gastroesophagal reflux.

Regurgitation in cardiovascular system, consisting in the movement of blood on the direction, the return natural, can arise both in the heart, and in vessels. In R.'s heart of blood can occur in a phase of a systole and a diastole. Disturbance of switching function of mitral, three-leaved valves, valves of an aorta or a pulmonary trunk is the reason.

In a phase of a systole of R. appears at insufficiency of mitral and three-leaved valves when blood from a ventricle moves back to an auricle via insufficiently densely close atrioventricular valves (in the left auricle — at insufficiency of the mitral valve, in right — the three-leaved valve). Deformation of their shutters, a prolapse of one or two shutters in an auricle at a ventricular systole, perforation of a shutter can be the reason of insufficiency of mitral or three-leaved valves (see. acquired ). So-called relative insufficiency of valves most often results from dysfunction of papillary muscles, is much more rare — in connection with re-stretching of a fibrous ring at sharp dilatation of one of ventricles. At the same time there is a systolic noise listened at insufficiency of the mitral valve on a top of heart at insufficiency of the three-leaved valve — on the right at the basis of a xiphoidal shoot of a breast.

The river during a diastole arises at insufficiency of valves of an aorta or a pulmonary trunk. At insufficiency of valves of an aorta blood moves from an aorta to a left ventricle», that at auscultation of heart is shown by the diastolic noise listened in the second mezhreberye on the right at edge of a breast and in Botkin's point — Erba. Organic not - sufficiency of valves of an aorta is observed at nek-ry, preferential rheumatic, heart diseases, relative arises owing to sharp expansion of an aortic bulb, napr, at a syphilitic mesaortitis with education aortic aneurysms (see). At the insufficiency of the valve of a pulmonary trunk having, as a rule, relative character and which is observed at high pulmonary hypertensia, blood moves from a pulmonary artery to a right ventricle. Auskultativno R. is shown by the so-called diastolic noise of Graham Steel better listened in the second mezhreberye at edge of a breast at the left (see. Noise cordial ).

The river in arteries of a big circle of blood circulation is observed at aortic incompetence. It is connected with the fact that in a phase of a diastole a part of blood comes from an aorta back to a left ventricle of heart.; Than distalny the artery and the less than its caliber is located, the degree of regurgitation is less; at the level of arterioles and precapillaries it does not come to light. R.'s duration in the main arteries at aortic incompetence usually does not exceed 0,2 sec. At inspection of the patient regurgitation is shown in the form of so-called double tone of Traube, is more rare in the form of double noise of Dyurozye (see. Vascular noise ). The specified phenomena are observed during the listening of arteries, (hl. obr. femoral) if to squeeze them a head of a stethoscope (phonendoscope). Normal at a prelum of an artery one tone and systolic noise is listened. The river accurately is reflected curves of intra arterial pressure, it can be diagnosed also by data rentgenokimografiya (see) or elektrokimografiya (see). At aneurism of the descending department of an aorta of R. can arise because of sharp increase in distensibility of a wall of aneurism and disturbance of the damping action of an aorta. In similar cases arterial R.; comes to light by means of tool methods — an intra-arterial manometriya (see. Blood pressure ), aortografiya (see). The regurgitation in system of the arteries departing from a pulmonary trunk caused by insufficiency of its valve can be revealed only by means of invasive methods of a research — catheterization of a pulmonary trunk (see. Catheterization of heart ). Rentgeno-and an elektrokimografiya seldom allow to obtain necessary diagnostic information.

The river of blood in veins of a big circle of blood circulation considerably is interfered by venous valves. However at a nesmykaniye of mouths of venas cava owing to restretching of the right auricle there is a throwing of blood in venas cava and the veins of large diameter falling into them. Clinically it is most accurately shown in the form of the pulsation of outside jugular veins remaining if to press a vein a finger approximately on the middle of its visible part, in the department located proksimalny. Registration of the phlebogram synchronously with an ECG shows that R. matches an auricular systole (an interval P — Q on an ECG). At a nesmykaniye of mouths of pulmonary veins there is R. of blood in their cavity in the period of an auricular systole, and with insufficiency of the mitral valve to the expressed atriomegaly — and in a phase of a ventricular systole. Identification of this form P. at an all-medical research is difficult; the expressed regurgitation in pulmonary veins gives an additional tooth on a systolic knee of pressure of jamming in a pulmonary trunk.

The river can be observed also in veins of a uterus, at nek-ry ginekol. diseases; this form P. is revealed with the help metrosalpingografiya (see).

Regurgitation in digestive tract it is shown in the form of vomiting at a tumoral and cicatricial stenosis, diverticulums, an achalasia of a gullet, a prolapse of a mucous membrane of a stomach in a gullet. At the same time undigested food comes to an oral cavity. The feeling of vomiting behind bottom edge of a breast is characteristic of the high gastrostenosis disposed closer to its cardial department. Regurgitation of a small amount of contents of a stomach in a gullet and further in an oral cavity without feeling of nausea and vomiting, shown heartburn, bitterness, an eructation air, arises at disturbances of locking function of cardial department of a stomach because of an esophagitis, gastritis, hernia of an esophageal opening of a diaphragm. The river of contents of a duodenum in a stomach can be caused by dysfunction of the gatekeeper and is distinguished during the sounding of a stomach on emergence of bile in a gastric juice or during gastroscopy and rentgenol. researches of a stomach. Sometimes emergence of bitter smack in a mouth without vomiting and nausea demonstrates throwing of bile in a stomach, i.e. about duodenogastralny R. Zabros of contents of a caecum in ileal via the bauginiyevy gate (the ileocecal valve, T.) can come owing to its functional insufficiency and it is diagnosed at rentgenol. research on regurgitation of a contrast agent. Also holedokhopankreatichesky R. at stones of the general bilious channel in the field of Oddi's sphincter is observed (a sphincter of the general bilious channel, T.), its spasm or tumor of a faterov of a nipple (big nipple of a duodenum, T.) and holedokhoduodenalny R. at insolvency of a sphincter of Oddi. At newborns and children of chest age of R. it is shown by vomiting and can be caused by dysfunction went. - kish. a path because of defects during the feeding of the child or a reforage or is an indicator of a spasm or a pyloric stenosis.


V. A. Bogoslovsky, V. V. Murashko.

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