Deformation of the stomach on the ground ulcer

Inflammatory and cicatricial changes in soil chronic gastric ulcers can lead to various deformities. Scar processes with transverse direction, causing the formation of organic "hourglass". In the case of scar process in the longitudinal direction can occur shortening the lesser curvature with the tightening up of the output section of the stomach and returns the stomach. On the basis of ulcers form peripateticism changes to various extent and prevalence.
Organic "hourglass" are two of the stomach, which takes such a form because of cicatricial stenosis in the area of his body. Between the upper and lower divisions of similar stomach there is a narrow channel that in most cases stretches the continued curvature. Often on the upper pole of this channel you can watch ulcerative niche. Each Department has a clear contours and self peristalsis. Differential diagnosis with more frequent spastic "hourglass" is sometimes very difficult, as is often used in similar circumstances test with a relaxing spasm means (atropine, ganglioblokirtee substances) are rare. Spastic "hourglass" sometimes disappear quickly under the influence of heat, rest and diet.
Another type of deformation developing on the ground cross-Cicatrical changes, is a cascading stomach. When cascading stomach hauling formed not in the direction of the small curvature, and from the back wall of the stomach. This also
two stomach, and characteristic x-ray characteristic is the presence of two contrasting levels. The upper chamber lies back, and the bottom goes to the front. Binder their channel is adjacent to the front wall and the small curvature.
Cascading stomach requires differentiation between organic process, spasm and a pushing stomach filled with gases colon, wieloletni swelling or increase any authority of the abdominal cavity.
Lithography stomach or, as it is called, "Shmidtovsky", represents the combination of the impact scar retraction in longitudinal and transverse direction. A similar process occurs as a result of ulcer cicatrization, located on the lesser curvature towards the back and is accompanied by extensive perigastric. At the same time small curvature is shortened, the porter pulls itself up and spaevaet against the rear wall of the stomach. In such cases, the stomach takes the form set vertically bulb with a broad base. Over time the stomach loses its tone, resulting in significantly lower pole stretched (Fig. 88).

Fig. 88. A stomach ulcer. Extensive perigastric with "withopenid" the shrinking of the stomach (x-ray).

Extensive perigastric can cause other changes in the shape and position of the stomach to the limitation of his smaduamei as palpation and at change of position of a body in question.
Great attention should be paid eccentric position gatekeeper against the duodenal bulb, which is developing on the ground peripatetically phenomena. Such changes always indicate transferred ulcer pyloric or preprocessor Department. When the gatekeeper is curved or cranked bent and depending on the nature of perigastric in this area either gaping (for longitudinal scars), or is narrowed, resulting in delayed evacuation (circular scars). Often in this place is determined and the niche, which can deeply panettiruling separated from the gatekeeper narrow way and pressed close to the base of the duodenal bulb. To cicatricial changes arising on the basis of stomach ulcers and accompanied by deformation, is the narrowing of the pyloric, specifics of which will be discussed in a special section.