Symptom of coughing. The procedure for determining the inflammatory process in the organs of the abdominal cavity
The abdominal hernia manifests itself by protrusion of the wholean internal organ or a separate part thereof through the gates to the subcutaneous area of the anterior wall of the trunk or into the pocket formed. In half the cases, the organs come out of the abdomen simultaneously with the parietal peritoneal sheet covering the subcutaneous space from the inside. A characteristic manifestation of a hernia is a symptom of a cough thrust.
To identify the relationship of emerging urges withdisease, put their hand to the protrusion and trace its behavior when coughing. Usually, a push is felt that indicates the communication of an abnormal formation with the peritoneum, the absence of such a testifies to the infringement of the hernia. The protrusion of the organs occurs through the hernial gates. The parietal peritoneum with part of the intestines, nerve endings, tendons, trapped during the exit, is a hernial sac.
Functions of peritoneum
The fixing framework for vital organs helps in the process of homeostasis, fluid exchange, maintains intra-abdominal pressure:
- performs a resorptive function, namely absorbs protein decay products, tissue necrosis, exudates, bacteria;
- the serous cover on separate sites of a thin and duodenal gut is capable to allocate fibrin and a liquid;
- a large epiploon, serving as a kind of barrier for infection of the inflammatory focus, provides mechanical protection for cellular and humoral immunity.
Herniated belly and its complications
If during the surgical procedurean inconsistent suture is made, the patient does not fully comply with the prescription of the doctor, then a recurrent hernia appears, the collar for which is the thin place of the scar. The non-operated hernia has the following complications:
- if the organs contained in the hernial sac are impaired, then their necrosis gradually takes place, which is dangerous for the onset of inflammation and is fatal;
- if part of the intestine is involved in the protrusion, the passage of food masses and contents is difficult;
- to the appearance of peritonitis leads and marginal jamming of the lateral wall of the gut, which leads to the necrosis of the captured area;
- develops purulent process (phlegmon);
- the hernia of the white line increases to huge sizes, this leads to the case when, after its removal, the organs contained in the bag do not fit into the abdominal cavity.
Stages of peritonitis due to the duration of the disease
In acute inflammatory process in the regionbelly urgently call an ambulance, procrastination is dangerous for human life. Peritonitis differs completely or affects a certain area. Inflammation is caused by various aerobic and anaerobic species of bacteria trapped inside the abdominal cavity. The method of determination according to the theory of LS Simonyan, depending on the pathological changes and the duration of the disease, distinguishes the stages of peritonitis:
- The reactive period lasts for the first 24 hours and shows maximum symptomatology;
- the transition to the toxic stage is carried out over a period of 24 to 72 hours, differs by the appearance of messengers intoxication and poisoning of the organism;
- deep, in most cases, the irreversible form develops after three days, the course of the disease with sharp manifestations of the local inflammatory process.
Classification of the disease by the nature of the infection
Primary peritonitis is rare, on hisshare accounts for about 1% of inflammatory events. Infection occurs after the entry of microbes behind the peritoneum by the internal route, hematogenous, lymphogenous way or from the female reproductive organs through the fallopian tubes.
Hernia of the diaphragm causes secondary peritonitis after surgery or due to complications of injured abdominal tissues. The following causes of infection are distinguished:
- infection from the inflammatory process;
- perforated way;
- getting microbes due to trauma;
- postoperative complication.
Variations of peritonitis depending on other factors
Division into acute and chronic stagecomes from the symptoms and clinical picture of the disease. The method of determination, depending on the exudate, allows to reveal fibrinous, serous, purulent, fibrinous-purulent, hemorrhagic nature of inflammation.
The etiological division of forms of peritonitis is caused bya lot of varieties of microflora and bacteria that cause inflammation. The main pathogenic microbes to date are staphylococci, streptococci, anaerobes, proteas, enterococci, E. coli. To the army of bacteria carry pneumococci, gonococci, hemolytic streptococcus and other species.
In etiological groups,non-bacterial aseptic case of the disease, when the hernia of the diaphragm is complicated because of penetration into the cavity of the peritoneum of urine, blood, bile or gastric juice. This is a dangerous picture, and peritonitis in a few hours turns into an infectious one, as the walls become permeable to bacteria very soon after the onset of inflammation.
Disorders of metabolic processes
Violation of the water-electrolyte ratio inbody and protein balance is considered as an exacerbating sign of external abdominal hernia. Protein output is accelerated due to hypermetabolism, loss of important building material is carried out with urine, vomit masses, exudate. Significant hypoproteinemia and a decrease in the amount of protein are manifested with extensive severe peritonitis.
Together with body fluids, potassium is released,it leaves the intercellular space, because of this, patients develop hypokalemia. After the development of the inflammatory process, the picture can drastically change, as the secretion of liquid by the kidneys decreases, the death of a sufficient number of cells is noted. As a result of the changes, hyperkalemia develops.
Two of the third patients develop bloodalkalosis, sometimes in the tissues there is a shift towards acidosis, which occurs as a result of circulatory disorders, disorganization of metabolic processes and hypoxia, these processes interrupt the removal of the hernia.
In the terminal phase of the developingoliguria, the hematopoietic system begins to work on the production of acidic metabolic products, such as magnesium, nitrogen, potassium, and phosphorus. There is a shift in blood values towards respiratory and metabolic acidosis. Analyzes for acute peritonitis change rapidly, so it is recommended that the blood, urine and other body fluids be monitored continuously.
Symptoms of peritonitis
There are a number of standard signs on which it is known how to determine the hernia and inflammation of the peritoneum:
- severe intolerable pain in the peritoneum;
- The stomach swells, becomes firm;
- sensation of weakness throughout the body;
- vomiting and nausea;
- disruption of the gastrointestinal tract, constipation, flatulence.
Cough Relief Syndrome
Is manifested in acute and chronic diseasesabdominal cavity. Diagnosis during coughing was suggested by GG Karavanov and described in detail by IM Siomashe. Many clinics of surgery have adopted this symptom for the preliminary determination of the sign of an inflamed abdomen.
Method of use
Fingers slightly bend in the direction of the palm andKnuckles slightly pressed on the area under investigation. Some time after this action they do nothing to stop the pain from pressing. After this, the patient is tested for a symptom of coughing. He is offered to reproduce a cough, if after the procedure there is pain in the area of pressure, this indicates an inflammatory process inside the peritoneum.
Principle of operation
Sharp reduction in cough crampsthe peritoneum and the diaphragm imparts a push to the surface of the liver and lower organs. The action is also affected by the filled intestine, which transmits the movement downward. The sensation of pain appears when, during movement, this or that sick organ encounters a hand-pressed area. If the inflammatory process affects the peritoneum, the pain sensation is manifested by the concussion of the inner layer, while the intra-abdominal pressure rises.
The author of research A.S. Cheremskaya describes the effect of cough syndrome with regard to appendicitis. When the patient coughs in case of inflammation of the appendage, pain in the ileum is constantly felt. The effect of this effect is slightly different from coughing with peritonitis and hernia.
Syndrome of diffuse acute peritonitis andchronic stage of the disease cause different sensations when you cough. The aged appendix responds with intermittent breathing, as if the patient is trying to stop the pain. The acute stage is characterized by intolerable pain. The symptom of a cough shock differently reveals the stages of peritonitis.
In addition to peritonitis, hernia and appendicitis, thisSymptom manifests itself in acute and chronic diseases of other abdominal organs. Pain from tension when coughing occurs in case of inflammation of the gallbladder, stomach ulcers, intestinal obstruction, etc. Thus, the symptom of a cough shock differs from other studies in that it reveals a large number of diseases at the initial stage.
Hernia and its variants
The protrusions in humans can be acquiredand congenital. The second option is for newborn babies. This disorder occurs due to an incorrectly formed peritoneum in prenatal development. Acquired protrusions of internal organs appear during the life of the patient and are divided into three types:
- with a weakened musculature of the abdominal wall;
- due to significant sports or work load;
- posttraumatic, arising from breach of the integrity of the peritoneum, if the previous operation takes place; The laser has an advantage over conventional surgical instruments in this case.
Internal hernias are located in the area of the chest cavity or in the abdomen. External protrusion of organs is located in the following places:
- in the groin;
- on the hip from the inside or outside;
- on the lumbar sacrum;
- in the location of the perineum and pelvis;
- on the front side of the trunk (hernia of the white line);
- in any area of the body on the scar from the operation.
A person's hernia is classified into a recurrent,complicated or not complicated (with the possibility to correct). The first type of protrusion, constantly arising again after surgery.
Symptoms of a hernial protrusion
The initial stage arises as a swellinga round shape that has a soft consistency, and the patient can independently level it with a slight pressure. After repositioning on the surface of the peritoneum in this place, the entrance gates are probed, protruding in the form of a slit or a circular defect of the abdominal wall.
Seal sizes vary from a couplemillimeters to several tens of centimeters. If a part of the intestinal wall or her body is trapped in the hernial sac, then during the palpation a characteristic gurgling sound of the passage of the contents is heard. Symptoms of sluggishly manifested hernia include constipation, nausea, heartburn, swelling, heaviness, violation of urination.
Removal of a hernia is recommended in case of infringement of a protrusion which is characterized by the following symptoms:
- there is most often a sudden sharp pain after lifting the severity, physical activity, emptying the intestine, rarely infringement happens for no reason;
- at some point the patient can not, as before, smooth out the compaction, it becomes firm and painful;
- along with previous symptoms, there are vomiting, a disorder of the stool.
Causes of hernia
All causes are divided into conditionally disposed to occurrence and joggling. The first group consists of the following reasons:
- congenital defects and abnormal development of the abdominal wall;
- for some reason, the expansion of the natural weak points of the abdomen (femoral and inguinal rings, navel);
- decrease in resistance of fabrics to stretching because of age changes or exhaustion of an organism;
- the presence of post-traumatic weak areas in the abdomen or if there was an operation, the laser produces the safest incisions in this regard.
The next group relates to joggling or triggering factors and is the cause of increased pressure inside the abdominal cavity:
- hard work or power sports;
- frequent constipation;
- chronic cough;
- internal swelling of the abdominal organs due to abnormal body function;
How to identify a hernia
The surgeon states the presence of a hernial protrusionafter examining the patient and ascertaining the presence in the patient's life of the foregoing determining and jerking factors. Lifestyle, surgery and body trauma are taken into account. In order to find out which cavity organs are contained in the hernial bag, the doctor performs an examination with the help of instruments and tools.
Ultrasound of the abdominal organs and the protrusionallows you to consider the internal content and diagnose differentiation with other diseases. X-ray method is used for contrasting images of the bag and hernia gate.
Treatment procedures and surgery
The main method of treatment is surgicaldirection. Wearing a supporting band is prescribed to those patients who have serious contraindications against surgery, such as age-related changes or poor blood clotting. Removal of the protrusion is carried out according to plan, if the patient is preparing for an operation, or in acute cases, surgery is carried out urgently. An example of such an unscheduled case is the incarceration of a hernia with unbearable pain or physical obstruction of the intestine.
The operation involves opening the hernia sac.and viewing the contents. If the internal organs are not damaged, they are set, and the bag and gate are sutured to impassable dimensions. Gate plastic is made using tissues from the patient’s body or using synthetic materials of a new generation. Observance of postoperative doctor's prescriptions is obligatory in order to reduce the risk of recurrence of hernial protrusion.
In conclusion, it should be said that during the firstsymptoms of protrusion in the chest or abdominal wall should immediately consult a doctor. Surgical intervention to remove a hernia is not a difficult operation, it is much more difficult to avoid complications of neglected protrusion and pain associated with it.