Search results for \"complicated stomach\". Diagnosis and symptoms of stomach diseases

The volume of the stomach plays a big role in the normal well-being of a patient of any age. It appears to be an important digestive organ, consisting of muscle and mucous tissue. A bolus of food enters the cavity from the esophagus, is digested and enters the intestines for absorption and release from the body. They are also carried out there primary stages food bolus processing. Volumes differ significantly from cavity sizes in children early age. All differences are due to anatomical features, functional criteria and volume of food intake for full life person.

Image of the stomach

The main role of the stomach

The empty cavity holds up to 0.5 liters and has a length of up to 20 cm. The back and front walls of the stomach are in contact with each other. The maximum filling of the stomach is up to 1.5 liters. Muscle muscles provide contraction and stretching of food at the time of digestion and transition of the food bolus into the intestinal cavity. With systematic overeating, a person’s stomach can stretch to the volume of a 3-liter reservoir.

The size of the formed stomach of an adult depends on many factors:

  • genetically determined factors;
  • anatomical structure internal organs;
  • anomalies in the size and structure of the stomach;
  • food culture;

The stomach is a complex organ. The mucous tissues of the stomach produce gastric juice, under the influence of which food is broken down and crushed into molecular components.

Functions of hydrochloric acid

The size of an adult's stomach allows it to produce more hydrochloric acid in gastric juice. Hydrochloric acid, which is part of the gastric juice, performs important functions:

  • breaks down complex components into simple ones;
  • disinfects food components;
  • converts iron for better absorption into the blood.

Gastric juice produces special enzymes that protect the delicate mucous membrane of the organ from the aggressive effects of food, external or internal negative factors. The mucus produced prevents the processes of self-digestion of organ tissues. Fermentation of gastric juice occurs already at the moment of eating, sometimes even when thinking about food during relative hunger.

Important! When eating at the same time, and also when observing special diet, a mode of operation of the stomach is developed that excludes its stretching, excessive compression and the development of pathological foci in its structures.

Acceptable volumes

Clinicians in the gastroenterological field of medicine conventionally determine the normal capacity of an adult’s stomach to be 2 fists, up to 20 cm in length and about 6-8 in width. These sizes are applicable for an empty (empty) stomach. When full, the volume of the human stomach can reach 4 liters. Filling an organ with food is not the only cause of pathological stretching of the walls. The main causes of sprains include:

  • non-compliance with the drinking regime (drinking large amounts);
  • huge single portions with frequent consumption;
  • snacks, lack of routine;
  • stress, mental disorders;
  • drug treatment;
  • developmental anomalies of the organ and adjacent structures.

The volume of an adult’s stomach also depends on the speed of food digestion. With slow processes there are congestion, which are accompanied by long-term relaxation of the muscles. This contributes to a decrease in muscle tone, which leads to pathological stretching. People with distended stomachs do not feel full for a long time, which again causes overeating.

Important! When determining the norm of a child’s stomach, experts pay attention to the type of diet, age and weight of the baby. Thus, during the newborn period, the child’s stomach can hold up to 100 ml of liquid. As the body grows, the stomach also grows, requiring gradual filling to 150, 200, 300 or more ml.

Consequences of overeating

If the diet is not followed, with systematic overeating, snacking on heavy, hard-to-digest food, the stomach cavity stretches, and the muscle structures cease to provide the necessary contraction. A distended stomach in a person negatively affects human health, leading to the following complications:

  • increase in body weight, up to the development of obesity;
  • difficulty breathing (due to compression of the pulmonary structures);
  • chronic tachycardia (complication of cardiac history);
  • slowing down blood flow to the spleen (provokes the desire to sleep);
  • hepatic colic (due to compression of the liver on the right).

When systematically overeating and squeezing internal organs, it also suffers. Food masses are pressed, petrified, and prevent deposition and passage to the rectum. Hence constipation, weight gain, mild intoxication of the body, feeling unwell. The volume of food at one time should not exceed 0.5 liters. Treatment methods meals provide fractional meals 300 ml single serving.

Modern gastroenterology and surgery can solve a number of problems with a distended stomach. To reduce the volume, surgical resection (gastroplasty) is often used. Indications for surgery may include dysfunction of vital important organs, poor health, life-threatening heart complications, overweight(including final stages obesity), addition of diabetes mellitus.

Existing methods of practical medicine in the field of dietetics and physical therapy make it possible to restore the previous muscle tone of the stomach cavity and accelerate digestive processes, improve the health of the patient of any age. Compliance healthy image life and simple recommendations from doctors, patients achieve good therapeutic results: weight decreases, blood pressure normalizes, cardiac activity increases, overall quality life.


1. Digestion in the stomach

In the stomach, food is subjected to mechanical and chemical processing.

Mechanical processing of feed involves the motility of the gastric muscles, as a result of which the feed is kneaded, mixed and moved into the intestines. Distinguish three types of stomach muscle contractions:

tonic – long-term persistent muscle contractions that provide tone to the stomach when it is overfilled with food;

peristaltic – wave-like muscle contractions spreading from the esophagus to the intestines (stomach “interceptions” occur);

antiperistaltic - peristalsis in the opposite direction, causes a protective reflex act - vomiting.

Gastric motility promotes mixing of food and its uniform saturation with gastric juice.

Chemical processing of feed is ensured by the action of gastric juice.

Gastric juice- secretion of glands located in the secretory epithelium of the gastric mucosa.

The secretory epithelium of the stomach is represented three types of cells:

the main ones are the production of enzymes;

lining - produce hydrochloric acid;

additional - produce mucus.

Depending on the location of the glands, they are divided into:

cardiac (contain mainly accessory cells);

pyloric (contains main and accessory cells).

Composition and properties of gastric juice.

Gastric juice– colorless transparent liquid of acidic reaction (pH 0.8-1), which includes:

water (98%) and dry matter (2%): organic matter (enzymes, lactic acid, phosphoric acid, ATP) and inorganic substances(hydrochloric acid, chloride salts, potassium, sodium, calcium, sulfates, carbonates, etc.).

Gastric juice enzymes:

proteolytic;

lipolytic;

amylolytic enzymes are not produced in the stomach, but enter it with saliva.

Proteolytic enzymes:

Pepsin– active only in acidic environment. Initially produced in an inactive form (pepsinogen), which under the influence of hydrochloric acid is converted into active form(pepsin). Pepsin breaks down proteins into peptones, sometimes into dipeptides. Pepsin does not act on all types of proteins, but only on digestible proteins of meat and blood (fibrin). Egg white and collagen are digested less well. The proteins of hair and wool are not digested at all.

Chymosin(rennet) – digests milk proteins. Produced in young animals milk period. Under its action, milk caseinogen is converted into casein and a milk lump is formed. Chymosin curdles milk, but this requires calcium ions.

Gelatinase– breaks down proteins connective tissue– collagen, elastin, etc.

Lipolytic enzymes:

Gastric lipase– breaks down neutral fats into glycerol and fatty acids. Acts mainly on emulsified fats (vegetable, dairy).

Functions of hydrochloric acid in gastric juice:

creates the necessary pH for the activation of the pepsinogen enzyme and for its transition to pepsin;

acts bactericidal and disinfects feed. With insufficient hydrochloric acid content in gastric juice and excessive protein consumption, putrefactive processes occur in the stomach.

Participates in the regulation of motor activity of the stomach and intestines. At low acidity gastric juice – atony and hypotension of the gastrointestinal tract.

The importance of mucus produced by accessory cells of the stomach: protects the gastric mucosa from mechanical and chemical (self-digestion) damage.

Mechanism of gastric juice secretion:

Gastric juice is constantly secreted, but its quantity and composition are not constant. In dogs on an empty stomach, gastric juice is alkaline and contains a lot of mucus.

Gastric juice is separated in two phases:

reflex;

neurohumoral.

Reflex phase occurs under the influence of conditioned (the sight, smell of food, conversations and thoughts about it, the noise of the feed dispenser, the clinking of dishes, etc.) and unconditioned (the act of eating, chewing, swallowing, taste, etc.) stimuli. This phase begins 5-6 minutes after the onset of the stimulus and lasts 1-2 hours. The secret produced in the reflex phase was called by I.P. Pavlov an appetizing (ignition) juice. It has the greatest digestive ability and is very rich in enzymes.

Neurohumoral phase– begins from the moment food (feed) enters the stomach. The incoming portion of food is saturated with gastric juice produced in the reflex phase. In this case, intermediate metabolic products (extractives) are formed, which are absorbed by the stomach wall and act as a stimulant for the production of a new portion of gastric juice. Gastric juice will be produced as long as food remains in the stomach. This juice has less digestive power and contains less enzymes and more hydrochloric acid. This phase begins 30 minutes after food enters the stomach and lasts up to 10 hours.

Evacuation of stomach contents into the intestines occurs periodically due to the opening and closing of the pyloric sphincter (pylorus). The pH in the stomach is acidic, and the pH in the intestines is alkaline. When a portion of the stomach contents enters the intestines, the pH in it shifts to the acidic side. At an acidic pH in the intestine, the pylorus is closed. The portion of food that enters the intestines is saturated with intestinal and pancreatic juices, which have an alkaline reaction. At the same time, the pH in the intestines becomes alkaline again. The difference in pH on both sides of the pylorus will be a signal for the opening of the sphincter.

2. Features of digestion in a single-chamber stomach

Gastric digestion in the horse.

The horse has a single-chamber stomach, 6-15 liters in size. In the cardiac part there is a blind sac covered with stratified glandular epithelium. In the blind bag, the pH is slightly alkaline, thanks to the saliva that enters here; therefore, there is a large amount of microflora that breaks down the fiber and starch of the feed. The food in the stomach is arranged in layers and is poorly mixed. Gastric juice gradually permeates the feed mass. In all layers of the gastric contents, the processes of breakdown of proteins, fats and carbohydrates take place. The food takes a very long time to digest. Water is evacuated into the intestines without retention, along the upper part of the stomach. Gastric juice in a horse is secreted continuously and in large quantities; with each feed intake, its secretion increases. Secretory phases are poorly expressed. Gastric motility is periodic and wave-like. As the acidity of the gastric contents decreases, motility increases. During digestion and evacuation of food, the acidity of the stomach contents decreases and motility weakens.

Gastric digestion in a pig.

The stomach is single-chamber, mixed type. In the cardiac part there is a blind sac (diverticulum), the mucous membrane of which produces mucus. This is where bacterial breakdown of feed fiber and weak fermentation processes take place. Gastric juice is secreted continuously. The food mass is mixed weakly when eating feed with a dense consistency. The food in the stomach is also distributed in layers. In the stomach of pigs, carbohydrates are digested (under the influence of salivary enzymes and microflora) and proteins.

Gastric digestion in dogs.

In carnivores, the main digestion occurs in the stomach. The mucous membrane produces many enzymes that allow it to digest even bones (except tubular ones). Gastric juice is acidic, the mucous membrane does not have glandular zones and blind sacs.

3. Gastric digestion in ruminants

In ruminants, the stomach is complex, multi-chambered and in cattle and small cattle consists of four sections: rumen, mesh, book and abomasum; in camels the stomach consists of three sections (there is no book).

Tripe, mesh and book are forestomach. They do not have secretory glands; mechanical, chemical and biological processing of feed and the breakdown of some nutrients. Digestion in them occurs under the influence of symbiont microflora.

Abomasum is true stomach ruminants Its mucosa has secretory glands that produce gastric juice. The digestive processes in it are similar to those in a single-chamber stomach.

Scar digestion

The rumen is the largest chamber of the ruminant stomach. The volume for cattle is 100-300l, for small-scale cattle it is 13-23l. Occupies the entire left half abdominal cavity. The mucous membrane has no glands, is lined with stratified squamous keratinizing epithelium and covered with papillae 0.5-1 cm long.

The food enters here immediately after swallowing and is subjected to mechanical processing due to periodic contractions of its walls, as well as periodic ruminant periods, during which the food is regurgitated into the oral cavity, thoroughly chewed, moistened with saliva and swallowed again.

Up to 70% of the dry matter of the diet is digested in the rumen, without the participation of digestive enzymes. It contains a huge amount of diverse microflora (anaerobic protozoa (ciliates) and bacteria), which ferment the rumen contents and break down the nutrients of the feed with their enzymes. This is facilitated by the constant supply of alkaline saliva into the rumen, which contains urea and ascorbic acid, necessary for the life of microflora, and also neutralizes acids formed during the fermentation process. The pH of the ruminal contents is 6.5-7.4.

As a result of fermentation processes, a large amount of gases (carbon dioxide, methane, nitrogen, VFA, hydrogen, hydrogen sulfide, oxygen, etc.) are formed in the rumen (especially when feeding green legumes), the excess of which is released during belching.

Under the influence of microflora, fiber, which is the main component of ruminant feed, and polysaccharides (starch) are broken down into di- and monosaccharides (glucose). Educated simple carbohydrates do not have time to be absorbed into the blood, but are fermented to volatile fatty acids(VFA) (acetic, lactic, propionic, oil). VFAs are absorbed into the rumen veins and replace the functions of glucose in the body of ruminants (used for energy purposes, in the synthesis of complex carbohydrates and lipids (milk fat)). The blood glucose content of ruminants is significantly lower than that of monogastric animals.

Proteins entering the rumen with feed and saliva are broken down by microflora into peptides, amino acids and then into ammonia, which are partially used by microflora for the synthesis of bacterial proteins that have high nutritional value for ruminants. Due to the microorganisms that entered the abomasum along with the feed, ruminants receive up to 100 g of microbial biologically complete protein per day. Microorganisms of the forestomach can use, in addition to feed proteins, non-protein nitrogenous substances (urea), which is widely used in practice.

Normally, the rumen microflora synthesizes sufficient quantities of B vitamins (riboflavin, thiamine, nicotinic, folic and pantothenic acids, biotin, pyridoxine, cyanocobalamin) and vitamin K (phylloquinone).

Grid functions

The mesh is a small round bag lying on the xiphoid cartilage. The mucous membrane of the mesh also does not have glands and forms peculiar cells. The mesh communicates with the scar and book through openings, and with the esophagus through the esophageal groove. The esophageal gutter is a semi-closed tube running from the esophagus along the bottom of the mesh into the book. It carries liquid food and water from the esophagus through the canal into the abomasum, bypassing the proventriculus.

The mesh functions as a sorting organ. At the entrance to it, there is a fold on the mucous membrane of the rumen, through which only liquefied and crushed food enters the mesh from the rumen. The net traps foreign objects that come with the food.

Book functions

The book lies in the right hypochondrium between the reticulum and the abomasum, and has a round or oval (in sheep) shape. The mucous membrane does not have glands and forms folds - leaves covered with rough papillae. The book is a kind of filter; poorly ground particles of food that come from the net are retained and crushed in its leaves. The book intensively absorbs water, mineral solutions and acids.

Motility of the proventriculus and the ruminant process

Contractions of the forestomach are sequentially coordinated.

The contractions of the rumen are called rumination. Normally, the scar contracts 2-5 times every 2 minutes. In this case, first the vestibule contracts sequentially, then the dorsal sac, ventral sac, caudodorsal blind protuberance, caudoventral blind protuberance, and again the dorsal and ventral sacs. When the dorsal sac contracts, regurgitation of gases occurs. As a result of rumination, the scar contents are evenly mixed counterclockwise. The cessation of rumination (atony) causes the death of rumen microflora, the development of putrefactive processes and intoxication.

The mesh contracts every 30-60 seconds, contracting and unclenching; during belching, an additional third contraction occurs. In this case, the coarse particles of food are pushed back into the rumen, and the liquid contents into the book.

In the cavity of the book, there is a lower atmospheric pressure compared to the mesh, and the book, as it were, sucks in food when relaxing and squeezes it into the abomasum during contraction through the always open book-rennet opening.

The nerve center that regulates the motility of the proventriculus is located in the medulla oblongata and the cerebral cortex.

Peristalsis is enhanced by steam irritation sympathetic nerves and receptors of the oral cavity during chewing. Peristalsis is inhibited by irritation of the sympathetic nerves and receptors of the duodenum. In the wall of the proventriculus there are intramural nerve plexuses that regulate uncoordinated contractions of the proventriculus.

When ruminants consume food, they swallow it practically without chewing. Subsequently, the feed masses are regurgitated from the rumen into the oral cavity and thoroughly chewed a second time and swallowed again. This process called ruminant The time during which repeatedly regurgitated scar mass is chewed is called ruminant period.

The ruminant process begins in cattle 30-70 minutes, in small cattle 20-45 minutes after ingestion of feed. There are 6-8 ruminant periods per day, lasting 40-50 minutes.

Belching- a complex reflex act that occurs as a result of irritation of the mechanoreceptors of the vestibule of the rumen, esophageal gutter and mesh. The center of belching is located in the medulla oblongata.

Digestion in abomasum

Abomasum – the stomach itself is ruminant. The digestive processes in it are similar to those in a single-chamber stomach.

The mucous abomasum has secretory cells over its entire surface that produce enzymes (pepsin, chymosin and lipase), hydrochloric acid and mucus. There are no blind sacs or diverticula in the abomasum. A feature of rennet digestion is the continuous secretion of gastric juice. The pH of rennet juice in cattle is 1.5-2.5, in sheep – 0.97-2.2.

Features of gastric digestion in young ruminants.

In newborn ruminants, the proventriculus does not function. Intensive development of the forestomach is observed in the first months of life after habituation to roughage. There is very little microflora in the proventriculus of newborns and it does not take part in the processes of hydrolysis and fermentation of feed, e.g. Digestive processes in newborns resemble those in a single-chamber stomach.

In young ruminants, milk passes through the esophageal gutter into the book, bypassing the rumen. In this case, the act of sucking is a stimulus for closing the lips of the esophageal gutter. When large portions of milk are quickly swallowed, the lips of the esophageal gutter do not close completely, the milk enters the non-functioning proventriculus and rots there. The stimulus for the development of forestomach in young animals and their colonization with microflora is contact with adult animals and consumption of roughage.



Digestion- an indispensable process. As a result of the activity of the digestive system, a person receives the necessary chemicals and energy for life.


The grinding of food occurs in the stomach. As a result chemical reactions food decomposes, it becomes possible to extract the simplest components from it and their absorption into the blood. It all starts with a person chewing food, which then goes down into the stomach. The opening through which food passes from the esophagus to the stomach is called the cardia. The muscles in the cardia area work like a gateway, i.e. food only goes in one direction.


During the process of digesting food, the stomach is filled with gastric juice by more than half. Food falls into this liquid and begins to digest there. Bottom part the stomach is not so spacious. The end of the stomach is somewhat narrowed and is located in horizontal position. This part of the stomach is called the pylorus.


As already mentioned, in the pyloric part the stomach narrows and becomes like a tube. Next is a hole leading to duodenum. The pyloric muscles act like a valve. They push semi-digested food into the intestines, preventing food from passing back.


The stomach is surrounded by muscles - longitudinal, circular and oblique. Its inner part is called body of the stomach, while the inside of the stomach is lined with mucous membrane. The stomach needs muscles to move food from the cardia to the exit from the stomach. The muscle movements are wave-like, and along the way they mix food with gastric juice, compress the food and force it to grind into even smaller pieces. A slurry is formed, almost liquid. This product of the stomach is called chyme.



Food is ground in the stomach not only due to muscles, but also due to chemistry - in the stomach food is exposed to strong acid - gastric juice. Stomach acid appears in the stomach itself (it is secreted by cells on the inner surface of the stomach). In addition, the enzyme is produced pepsin and hydrochloric acid. All three substances help digest incoming food and break it down into parts.


Stomach acid is so strong that it can burn through a carpet or digest a piece of iron (such as a razor blade). Without this property, gastric juice would not cope with ordinary tasks, because... Digesting proteins is very difficult. It is also important that he the stomach is made of protein. Why then does the process of digestion not concern the stomach itself? The secret lies in the properties of the stomach walls. They are uneven and consist of jagged zigzag folds. And in the depths of these folds there are special cells that can protect the stomach from its own juice. These cells are capable of producing mucus, which coats the stomach, forming the so-called mucous membrane. It turns out that two completely opposite groups of cells work in the stomach - some secrete strong acid, others secrete the opposite substance “mucus” (mucus that protects against acids).


The mucous membrane protects not only from acid, but also from microbes. Viruses cannot enter the body through food thanks to amazing properties mucus. Another function of this mucus is to facilitate the movement of food to the bottom of the stomach. Thanks to the cardia, stomach acid does not penetrate higher (into the esophagus). If there were no such protection, the esophagus would quickly become destroyed (burnt by acid), because the esophagus does not have protection in the form of mucus.


Gastritis and ulcers appear only when the thickness of the mucus layer becomes too thin. As a result, wounds appear on the walls - the stomach begins to digest itself. Only simultaneous operation mucus and acid in the stomach makes the digestion process possible. And this one complex mechanism works for a person from the moment of his birth until his last days.

Stomach I Stomach

extended department digestive tract, in which chemical and mechanical processing of food is carried out.

Structure animal stomach. There are glandular, or digestive, glands, the walls of which contain the digestive glands, and muscular, or chewing glands, the walls of which are usually lined with cuticle. The muscular gland is formed as part of the glandular gland (in vertebrates and some invertebrates) or arises independently (in most invertebrates). Some coelenterates already have gas as a differentiated part of the intestinal system among invertebrates, a number of flatworms and annelids. Zh. is well developed in rotifers, brachiopods, and bryozoans. In mollusks the stomach is usually curved in a horseshoe shape; In many gastropods, bivalves, and cephalopods, a blind outgrowth, sometimes spirally twisted, extends from the posterior end of the stomach. In cephalopods, the liver ducts open into this outgrowth. In some gastropods, the stomach is divided into a chewing proventriculus and the stomach itself. digestive system In arthropod animals, the chewing stomach plays a major role in the mechanical processing of food. Among crustaceans, only the lower crayfish have a glandular stomach, while the higher ones have a chewing stomach, equipped with chitinous “teeth.” In arachnids, the midgut usually splits into 2 sections, one of which is located in the cephalothorax, the other in the abdomen. The first section with blind sac-like appendages is sometimes called the gland. In insects, the chewing gland is well developed. rice. 1 ); The glandular stomach, as an independent part of the midgut, does not develop in all forms. Among echinoderms, gland is well developed in crinoids, stars, and brittle stars. Among the lower chordates, some hemichordates and tunicates have well-separated organs.

In vertebrates, the gastrointestinal tract is an expanded part of the foregut located behind the esophagus. In cyclostomes and some fishes the stomach is not differentiated. Usually the stomach of fish is curved in a horseshoe shape. Its descending limb, starting from the esophagus, is called the cardiac part, and the ascending limb, which passes into the duodenum, is called the pyloric part. The bag-like part of the stomach lying between the two knees forms its bottom. The concave part of the vein is called the lesser curvature, and the convex part is called the greater curvature. In the abdominal area, bony fish usually develop pyloric appendages. The jacket is lined with a single layer columnar epithelium, from which tubular glands are formed. In many fish, amphibians, reptiles, and birds, there are glands of the bottom of the stomach and pyloric glands. Most mammals also have cardiac glands (absent in carnivores and primates). The glands of the stomach secrete mucus and gastric juice. The smooth muscles of the walls of the stomach at the place where the stomach passes into the intestine usually forms a powerful pyloric sphincter. The body of birds consists of glandular and muscular sections ( rice. 2 ). In many birds, the cuticle of the muscular stomach forms outgrowths, which, due to the absence of teeth in birds, together with swallowed small stones or grains of sand (the so-called gastroliths), contribute to the mechanical processing of food. In birds that eat meat, the muscular belly is thin-walled; in granivores, insectivores and omnivores - thick-walled; in fish-eating birds, which swallow fish whole, it is very small, and the glandular stomach forms a voluminous sac. In mammals, Zh. ( rice. 3 ) reaches the most complex differentiation and is divided into esophageal, cardiac, fundic and pyloric sections. Typically, in herbivorous mammals (rodents, ruminants, etc.), the esophageal part, lined with stratified epithelium and devoid of glands. It often breaks up into separate 2 or 3 sections, which serve both as a container for voluminous food and as a “fermentation tank” in which fermentation occurs under the influence of bacteria and symbiotic ciliates living in the body. vegetable fiber. The belly of some ruminants is the most complex (see Ruminants), divided into 4 sections: rumen, mesh, book and abomasum ( rice. 4 ). The first 3 sections, developing from the esophageal part of the stomach, are devoid of glands; only the abomasum contains them. From the esophagus to top edge There is a groove running up to the book, the edges of which are usually adjacent to each other and form a tube. Camels have numerous depressions in the rumen wall, the so-called. water cells that store water.

A. N. Druzhinin.

Structure human stomach. The gland is located in the abdominal cavity ( rice. 5 , 6 ); its long axis is directed from top to bottom, from left to right and from back to front, for the most part (5/6) located in the upper left square of the Belly a. The shape of the liquid resembles a flattened retort. In the gland there are anterior and posterior walls. The place where the esophagus passes into the stomach near the diaphragm is called the entrance to the stomach (cardia). Upper part the body of the stomach (bottom) is expanded and facing the diaphragm. The place of exit from the stomach is the pylorus, extends beyond the midline of the abdomen to the right; it is fixed to back wall abdomen at the level of the I-II lumbar vertebrae. The concave edge of the stomach (lesser curvature) faces to the right and up, the convex edge (greater curvature) faces left and down. To the left of J. lies the spleen, below and behind it is the pancreas. The stomach is covered on all sides by the peritoneum, which passes to its lesser curvature from the liver and diaphragm, forming the hepatogastric and diaphragmatic-gastric ligaments, which, together with the hepatoduodenal ligament, make up the lesser omentum (see Omentum). Along the greater curvature, the anterior and posterior layers of the peritoneum come together and stretch towards the transverse intestine (gastrocolic ligament), giving rise to greater omentum. From the bottom of the stomach, the fold of the peritoneum goes to the spleen (gastrosplenic ligament). The capacity of the stomach varies individually, and also depending on age: in a newborn it is 20-30 cm 3, for an adult - up to 2.5 thousand. cm 3.

The wall of the stomach consists of three shells. Under serosa(peritoneum) lies the muscular layer, consisting of 3 layers: external longitudinal, middle circular and internal oblique. Constructed from smooth muscle tissue, the muscles of the stomach contract involuntarily, and the contours and lumen of the stomach change. Inner surface The gland is lined with a mucous membrane, separated from the muscularis mucosa by a submucosal layer of loose connective tissue. The mucous membrane has its own muscle bundles, when contracted, due to the presence of loose submucosal tissue, it gathers into folds characteristic of internal relief G. The epithelium of the mucous membrane is single-layered cylindrical. Numerous glands are located deep in the mucous membrane. The glands in the area of ​​the entrance to the stomach (cardiac) produce mucus; the glands in the area of ​​the pylorus (pyloric) also secrete enzymes that break down proteins. The secretion of the glands in the area of ​​the bottom of the stomach (fundus) contains pepsin and hydrochloric acid. The openings of the excretory ducts of the gastric glands open into the pits of the gastric fields - roundish elevations with a diameter of 1-6 mm. At the border of the stomach and duodenum there is a pyloric sphincter, built from several circular layers of muscle. It regulates periodic emptying of the stomach.

The blood supply to the gastrointestinal tract is carried out from the celiac trunk system (unpaired branch abdominal aorta). The left gastric artery, arising from the celiac trunk, along the lesser curvature connects (anastomoses) with the right gastric artery (a branch of the common hepatic artery). The branches of the gastroepiploic arteries are distributed along the greater curvature. The gastric veins flow into the portal vein system, with the exception of the left gastric vein, which passes into the venous plexuses of the esophagus. Branches of the vagus nerves and branches of the sympathetic celiac plexus, which form 3 nerve plexuses in the wall of the stomach, take part in the innervation of the gland. For gastric diseases, see Gastritis, Cancer, Peptic ulcer disease.

V. V. Kupriyanov.

Activity of the stomach. The main functions of gas are deposition, mechanical and chemical processing, and evacuation of food into the intestines. Mechanical processing and evacuation of food are carried out as a result of the motor activity of the stomach, chemical processing - mainly with enzymes and hydrochloric acid gastric juice. The stomach also has protective, endocrine, absorptive, and excretory functions. The digestive processes in the digestive tracts of invertebrates are characterized by considerable diversity. Some of them (for example, crayfish) chewing liquid serves both for grinding food and for filtering it. In the glandular stomach, food is processed by enzymes secreted by the mucous membrane of the stomach and entering through ducts from the digestive glands located outside the stomach. A characteristic feature of digestion in the stomach of vertebrates (with the exception of some groups of fish) is the presence of proteases and acidic environment. Processing of food is most complex in the multi-chambered diet of ruminants. In omnivorous and carnivorous mammals, the structure and functions of the stomach are largely similar. The activity of the stomach has been most fully studied in dogs and humans. A mixture of solids and liquid substances, pre-treated in the oral cavity. Thanks to hydrochloric acid, denaturation and swelling of the cellular structures of food occur in the stomach and an optimal environment is created for the action of hydrolytic enzymes of gastric juice. Food entering through the esophagus wedges into what is already in the stomach, occupying a middle position. Thanks to this, protein digestion occurs in surface layer a bolus of food, inside which the breakdown of carbohydrates by salivary enzymes, which began in the oral cavity, continues. Actually gastric digestion mainly comes down to the initial hydrolysis of proteins by gastric juice proteases. To a small extent, fats are digested in the stomach, mainly due to enzymes released into the stomach from the duodenum. The secretion of enzymes and hydrochloric acid by the cells of the stomach corresponds to the quality and quantity of incoming food and is regulated by nervous and humoral factors. In the first (complex reflex) phase, gastric secretion is stimulated by the usual external environment associated with food intake, its appearance and smell, the effect on the receptors of the mouth and pharynx, the acts of chewing and swallowing. In the second (neuro-humoral) phase, secretion is caused by the direct effect of food on the gastric mucosa. In the third (intestinal) phase, secretion is determined by reflex influences arising from irritation of the receptors of the duodenum and humoral influences caused by food breakdown products absorbed in the intestine. The mucous membrane of the pylorus contains gastrin, a histohormone that stimulates the secretion of hydrochloric acid by the parietal cells of the stomach. Its formation is inhibited by enterogastron, a hormone produced in the upper intestines. The secretory activity of the gland is also influenced by hormones of the pituitary gland, adrenal glands, thyroid, parathyroid, and sex glands. An important role in the activity of the stomach is played by the mucus secreted in it, which protects the mucous membrane of the stomach from self-digestion by adsorbing bicarbonates and phosphates.

Mechanical processing of food is carried out thanks to the motor activity of the stomach. A stomach filled with food is characterized by peristaltic, tonic, and possibly systolic contractions. As a result of the peristaltic activity of the stomach, against the background of its tonic contractions and tonic waves, only the surface layers of the food bolus located in the area of ​​the bottom of the stomach are processed. The bulk of the contents of the stomach are not mixed; the crushed and liquefied surface layers of food are shifted by a peristaltic wave into the pyloric part of the stomach. , where its contents are mixed and squeezed into the duodenum. The nature of the motor skills of the stomach depends on the consistency and chemical composition food. The motor activity of the stomach is regulated by nervous and humoral factors. Vagus nerves They primarily stimulate, and the celiac ones inhibit, the motor activity of the stomach. Gastrin, choline, histamine, and K ions have an stimulating effect on the motor activity of the stomach; enterogastron, adrenaline, and Ca ions have an inhibitory effect. Evacuation of food from the stomach occurs as a result of the coordinated activity of the pyloric sphincter and peristaltic waves of the stomach; This is a complex dynamic process that depends on physical and chemical properties food, the speed of its processing by gastric juice, functional state food and drinking centers, the general emotional state of the body, its need for certain substances, as well as reflex influences, arising from the influence of osmotically active substances on the receptors of the upper intestines. An average portion of food with 3-4 meals a day is evacuated from the human stomach in 3.5-4.5 hours; fatty foods can linger in the stomach for up to 10 hours. Empty liquid is characterized by periodic (at intervals of 1-1.5 hours) motor activity(within 10-30 min). Usually, contractions of the empty stomach are accompanied by feelings of hunger (See Fasting).

The protective function of fat is manifested in bactericidal and bacteriostatic action, associated mainly with the treatment of microorganisms ingested with food with hydrochloric acid and a substance like lysozyme a secreted in fat. Absorption in the stomach is very low. A certain role is played by the excretory activity of the stomach - the release of interstitial metabolic products into its cavity. G. associated with production blood cells, because its glands secrete what is necessary for this process “ internal factor"(Castle factor). The activity of the stomach is closely related to the maintenance of homeostasis in the body, water-salt metabolism, kidney function, endocrine glands, blood circulation. Signals entering the central nervous system when gastric receptors are irritated, they take part in the formation of behavioral reactions, influencing general food arousal, specialized appetite and thirst (See Thirst).

Lit.: Babkin B.P., External secretion digestive glands, M. - L., 1927; Dogel V. A, Comparative anatomy of invertebrates, part 1, Leningrad, 1938; Shmalgauzen I.I., Fundamentals of comparative anatomy of vertebrate animals, 4th ed., M., 1947; Razenkov I.P., New data on the physiology and pathology of digestion. [Lectures], M., 1948; Pavlov I.P., Lectures on the work of the main digestive glands, Complete. collection op., 2nd ed., vol. 2, book. 2, M. - L., 1951; Ugolev A. M., Digestion and its adaptive evolution, M., 1961; Davenport N. W., Physiology of the digestive tract, Chi, 1966; Handbook of physiology, section 6, Alimentary channel, v. 2-6, Wash., 1967-68.

V. G. Kassil.

Inflammation of the appendix is ​​characterized by fairly general symptoms. These include abdominal pain, fever and nausea. It is quite difficult to determine appendicitis from them. This is why doctors use a diagnostic method such as palpation. This procedure allows you to accurately determine inflammation of the appendix at the earliest stages, which allows you to avoid complications.

Purpose of the procedure

Palpation is used at the slightest suspicion of appendicitis. When performing it, the doctor notes painful sensations in the patient, checks the overhang of the anterior wall of the rectum. Palpation of the abdomen should be done with caution, without making sudden movements or pressure. It is important to take into account that only a qualified doctor can palpate and only if a disease is suspected.

Rules for palpation for appendicitis

The procedure must be carried out on an empty stomach.

Before starting the procedure, the patient must take a supine position. Your arms can be extended along your body or folded across your chest. The doctor’s palms should be warm, since otherwise, when touched, the person’s abdominal muscles will involuntarily tense; such a reaction will significantly interfere with the diagnosis. It is advisable to begin palpation from areas that are located at some distance from the location of the appendix. Compliance with this rule is especially important in the case of children. So, if you press on a place with maximum pain, then subconsciously a fear of the doctor’s further actions will appear. As a result, this will lead to muscle tension.

Gradually moving forward, you need to determine the place where the pain is felt the most. This should only be done with with the help of the lung, superficial palpation. It must be carried out with both hands, moving symmetrically on both sides of the abdomen. This will help distinguish involuntary contractions from intentional ones. So, if the muscles tensed on only one side, this happened involuntarily. Otherwise, the compression is intentional. Once the location has been determined, deeper palpation should begin. It is carried out using both hands: the doctor places the right one on the patient’s lower back, and palpates with the left one. If the patient has a defensive reaction in the form of compression of the abdominal muscles, he should bend his knees. This position will help the patient relax and allow the doctor to palpate effectively. In addition, deep palpation helps determine the presence of compactions in the abdominal cavity.

When performing palpation, you need to constantly ask the patient about his sensations and the degree of pain. This is the only way to determine exactly where it hurts the most. Make a diagnosis acute inflammation appendix" is possible only if the pain has a clear localization, and if, when pressing in the right iliac region, tension in the muscles of the anterior abdominal wall is felt.

Norm and pathology

The appendix normally does not provoke pain upon palpation.

If there is no inflammation of the appendix, then it can be felt only in 10% of patients. If you press harder, then normally it feels like a cylinder with a maximum diameter of 1.5 cm. The vermiform appendix normally does not change density when pressed and does not rumble. Also, in the absence of disease, it is difficult to fix it in a specific position. If the appendix hurts, has a dense consistency and does not move in the abdominal cavity, this indicates the presence of a disease. However, this parameter is practically not used when diagnosing inflammation of the appendix. This is due to the difficulty of palpating the appendix due to tension in the abdominal muscles.

Symptoms that appear

Appendicitis, like other diseases, is characterized by several types of symptoms that manifest themselves if you press on the abdomen. If the main signs are present, the doctor can confidently make a diagnosis without additional examinations and tests. Other symptoms are secondary. Their presence is checked only when the main signs are absent or are weakly expressed. Let's consider how these groups of signs manifest themselves in appendicitis.

Main signs

The main signs that can be identified during palpation include:

  • Availability exact location maximum pain.
  • Contraction of the abdominal muscles in the right iliac region, which occurs involuntarily.

Sharp pain when pressing on McBurney's point indicates the presence of inflammation.

Most intense pain felt at the base of the appendix. There appendix connects to the intestine, and this place is stable, that is, it does not change its position. This point is named after McBurney. If it is she who hurts, then the doctor has the right to diagnose “acute inflammation of the appendix.” Even if there are no signs of illness such as nausea, fever and loss of appetite, palpation data is sufficient for diagnosis. Difficulty can only arise in the early stages of the disease, when the appendix is ​​not enlarged and difficult to palpate. Then it is necessary to investigate secondary symptoms.

Minor signs

The Shchetkin-Blumberg sign can be classified as secondary. To identify it during palpation, the doctor applies shallow pressure on the abdomen, after which he sharply removes his fingers. If the patient feels pain during release, then the sign is positive. The next indicator of the disease is Sitkovsky's symptom. To detect it, the patient lies down on the left side of the body or turns over onto it. If pain is present during these actions, the symptom is confirmed.

If light tapping on the right side of the abdomen provokes pain, this may be a sign of appendicitis.

The next one is Obraztsov’s sign. To do this, the patient takes a lying position, legs extended. The doctor carries out the necessary palpations. Next, the patient lifts up right leg without bending it. The doctor repeats palpation in this position. If the pain intensifies, this indicates inflammatory process in the appendix. Another indicator of the disease is pain when lightly tapping the right side of the abdomen.

Rovsing's sign is also secondary. To detect it, the patient lies down, and the doctor presses with one hand on the area of ​​the abdomen under the colon, and with the other makes short pushes above it. In this case, the gases that were in the intestine pass into the blind part of the intestine, thereby affecting and irritating the inflamed appendix. The last factor indicating the disease will be pain on palpation of the cecum. In the position on the left side, the discomfort and pain will be stronger.

What else should you consider?

When carrying out the palpation procedure, the main thing is to relax the patient’s abdominal muscles. So, if the doctor feels a lot of tension, he cannot correctly diagnose and determine the points with the greatest pain. Therefore, palpation should sometimes be performed while the patient bends his knees. If, in this position, the abdomen remains tense, you should immediately additional examinations, as this may be a consequence of peritonitis.

In general, the palpation method is very effective and provides a lot of information in the case of diagnosing appendicitis. It allows you to identify the disease in the early stages and begin immediate treatment. This approach guarantees full recovery and lack of complications. However, even knowing all the signs of the disease, you should not carry out the procedure and make a diagnosis yourself.