Duodenostaza, dyskinesia of the duodenum

Under duodenal stasis refers to the motor and evacuation activities duodenal ulcers of different etiology, leading to a delay (stasis) its contents. When dyskinesia violated coordination and sequence of movements duodenal ulcers, but the delay (stasis) its content is not mandatory.
The etiology and pathogenesis. Acute violation of the cross duodenal ulcer associated with a hit it big gallstones, pressing the duodenum of the superior mesenteric artery aneurysm of the abdominal aorta.
Mechanical causes in the development of chronic duodenostasis, which is observed much more often acute, are less important. They may be congenital (malformations) or acquired. Among mechanical reasons in the development of chronic duodenostasis attached particular importance to the compression of the duodenum of the superior mesenteric artery, which can manifest itself at any time (Mansberger et al., 1968) in violation of the functions of the authority.
The most common etiologic factor in chronic duodenostaza is functional disorders of motor activity of the duodenum. The latter, as is well known, is connected with activity of the autonomic nervous system and intramural nervous apparatus of the intestine. Chronic violation of patency of the duodenum occur as an independent disease rarely. Often this condition is accompanied by other diseases of the digestive system (stomach ulcer, diseases of the biliary tract, pancreatitis or surgery on the stomach). The mechanism of development of duodenostasis in such cases associated with degenerative changes in intramural nervous apparatus of the duodenum. It is possible that the latter is due to a long reflex effects negative side pathologically changed the digestive system. According to A. P. Mirzayev (1970), chronic duodenostasis, is not due to mechanical reasons, meets six times more often than in the presence of mechanical obstacles in the duodenum.
Therefore, duodenostasis - polietiologic disease. Mechanical obstruction of the duodenum, which is of significant importance for the development of acute impaired patency of the colon plays in the etiology of chronic duodenostasis smaller role. The latter may be the main (sometimes)and related (more) disease. Most likely, the formation of chronic duodenostasis is connected with disorder of autonomic innervation or degenerative changes intramural nervous apparatus of the duodenum. Essential thus may have negative reflex influence with pathologically changed the digestive system: stomach, biliary tract and pancreas.
Clinical symptomatology. The diagnosis. The development of acute obstruction of the duodenum goes very quickly (watch!) and is accompanied by rapid clinical picture (sharp pain in the upper abdomen and the navel, frequent vomiting, bloating, kollaptoidnye status).
The clinical picture of chronic duodenostasis diverse. Features of symptoms depend on the duration of the disease, the presence of pathological processes in related bodies, histopathological changes in the mucosa of the duodenum (chronic duodenitis). Finally, during chronic impaired patency of the duodenum, like other chronic diseases, is characterized by the phase of exacerbation and remission, which differ from each other by the expression and manifestation of individual symptoms.
For exacerbations of chronic duodenostasis characterized by the following triad: pain, nausea and vomiting. Pain in most cases not connected with the ingestion. They do not have (in contrast to the pain in the ulcers) clear localization, most intensive in the right hypochondrium, and in podlojecna area. Often the pain of the nature of the attacks, with increasing intensity. You have to think that the origin of the pain is caused by two reasons: the extension of the duodenum content and strong its peristalsis. Particular value is the reflex spasm privratnika (A. D. Yefremov and K. D. Eristavi, 1969). Similar paroxysmal pain can occur in the absence of duodenostasis when dyskinesia of intestines. Nausea when duodenostaza often permanent, long and so it is especially painful. Vomiting happens several times a day, often directly after a meal or independently of it. In vomitus, as a rule, there is an admixture of bile. In this regard, immediately after vomiting or during her patients feel bitter taste in the mouth. After vomiting is the short-term relief.
In addition to these main symptoms in chronic duodenostasis may experience poor appetite, constipation, weight loss, sometimes at the height of intense pain occurs kollaptoidnye condition. A number of patients are General symptoms of intoxication: headache, fever, weakness, insomnia, irritability, pain in the calf muscles (loss of chlorides with frequent vomiting).
Objective examination is marked a moderate or considerable loss of weight. The abdomen may be swollen in the top half. Palpation of his painful mainly in the upper right quadrant, sometimes in this area can determine "the sound of lapping" (barotrauma by palpation).
Essential x-ray examination. The main radiological signs of duodenostasis are: delay barium suspension in the duodenum more than 40 seconds, the expansion of the ulcer in place of delay contrast, the combination of spasm in one segment and expansion in the other and throwing content in the proximal departments (N. A. Gryaznov and M. M. Salman, 1969). The last two x-ray characteristic characteristic also for psoriasis duodenal ulcer in the absence of delay its contents.
Clinical and radiological signs of duodenostasis are often combined with other manifestations of diseases of the digestive system that chronic violation of patency of the duodenum may be genetically related (ulcer, chronic duodenitis, cholecystitis, pancreatitis). In such cases, the diagnosis of duodenostasis sometimes very difficult, as well as the juxtaposition of the symptoms of duodenostasis on the clinical picture of another disease complicates the diagnosis and the last. X-ray signs of duodenostasis then acquire even greater importance.