30.10. What is heartburn? What is its mechanism?

Heartburn (pyrosis) is feeling of burn in the gullet.

Its development is caused by irritation of gullet receptors in case of filling with gastric contents intto gullet (reflux). It can be caused by :

1. a lot of gastric contents;

2. functional deficiency of cardial sphincter.

30.11. What is belch? What are its mechanisms?

Belch is sudden involuntary secretion of gas into oral cavity from the stomach or gutlet, sometimes with little portions of gastric contents.

Increasing of maintance of gases can be caused by these two reasons: a) entering of food or drink with high quantity of gases (aerated water, swallowing of gases); b) formation of gases in stomach, can be caused by delay of food there (in case of ulcer disease, gastric cancer).

Increasing of intragastric pressure is a result of increasing of quantity of gases in stomach. It reflectively causes: a) contraction of muscles of gastric walls; b) pylorospasm.

30.12. What is nausea and vomiting? What are its mechanisms?

Nausea is original burdensome feeling in chest, oral cavity. Often precodes vomiting and is characterized with weakness, sweating, increasing of salivation, colding of extremities, paleness of skin, decreasing of pressure or symptoms of activation of parasympatic nervous system. Existent of vomiting center causes nausea, but it is not sufficient for vomiting

Mechanism of vomiting includes number of following stages:

1. Deep instipation with sinking of diaphragm happens and in that time epyglottis sinking and larynx rises (entrance into larynx is shut off) palatinum rises (entrance into nasopharynx is shut off)

2. Pylorus constricts stomach body and esophageal-stomach sphincter weakens, cardium rises esophagus widens and shortens.

3. Intensive contraction of diaphragm and muscles of abdominal press happens, it causes increasing of abdominal pressure. It causes eruption of stomach contents through esophagus and oral cavity out- vomiting arises.

They distinguish such pathogenetic variants of vomiting

a) central - it is caused by increasing of excitability of vomiting center. It can be in case of diseases of central nervous system (meningitis, encephalitis, brain tumors), in case of entering of impulses from cortex (conditional reflex vomiting) or receptors of labyrinth (vestibular vomiting);

b) haematogen-toxical is caused by influence of toxical substances that content in blood into hemoreceptors of structures of vomiting center. It can be exogenous substances (carbon oxide, alcohol, drugs, toxins of bacteria) or toxical substances of own organism, which are deposited in case of uraemia, hepatical deficiency, decompensated diabetes melitus etc.

3. visceral (reflective) is a result of reflexes evoked from different receptor fields of inner organs. Such reflexogen organism are situated in stomach, mucous layer of pharynx, coronary vessels, peritoneum, billiary ways.

30.13. What is constipation? When does it happen?

Constipation (obstipation) is delayed, difficult or systematically difficult emptying of intestines.

They distinguish 2 mechanisms of constipation: spastical and atonical. First is caused by spastical contraction of non-striated muscles of intestines (spasm), second is - atony.

Spastical constipations are:

1. inflammative;

2. proctogen- develops in case of pathological process in anorectal region;

3. mechanical- arises in case of digestive impassability;

4. toxical- are result of intoxications of lead, mercury, talium.

Atonical constipations are:

1. nervous- are result of disorders of nervous regulation of digestive motorical function;

2. alimenary- develop in case of entering of good digestion food, which contains few cellular tissue.

3. hypodynamical- arise at laying patients, at seniors, at people with low physical activities.

4. constipations in case of anomalies of large intestines ( for example Girshprung’s disease)

5. constipations, caused by disorders of water–salt balance (for example in case of dehydratation)