axalaziyakardii

PPTX 45 pages 25.0 MB Free download

45 pages

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Updated Dec 2025

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ppt/slides/_rels/slide15.xml.rels ppt/slides/_rels/slide13.xml.rels ppt/slides/_rels/slide16.xml.rels ppt/slides/_rels/slide14.xml.rels ppt/slides/_rels/slide18.xml.rels ppt/slides/_rels/slide12.xml.rels ppt/slides/_rels/slide19.xml.rels ppt/slides/_rels/slide20.xml.rels ppt/slides/_rels/slide21.xml.rels ppt/slides/_rels/slide17.xml.rels ppt/slides/_rels/slide10.xml.rels ppt/slides/_rels/slide22.xml.rels ppt/slides/_rels/slide1.xml.rels ppt/slides/_rels/slide2.xml.rels ppt/slides/_rels/slide3.xml.rels ppt/slides/_rels/slide4.xml.rels ppt/slides/_rels/slide5.xml.rels ppt/slides/_rels/slide6.xml.rels ppt/slides/_rels/slide7.xml.rels ppt/slides/_rels/slide8.xml.rels ppt/slides/_rels/slide9.xml.rels ppt/slides/_rels/slide11.xml.rels ppt/slides/_rels/slide24.xml.rels ppt/_rels/presentation.xml.rels ppt/slides/_rels/slide37.xml.rels ppt/slides/_rels/slide38.xml.rels ppt/slides/_rels/slide39.xml.rels ppt/slides/_rels/slide40.xml.rels ppt/slides/_rels/slide41.xml.rels ppt/slides/_rels/slide42.xml.rels ppt/slides/_rels/slide43.xml.rels ppt/slides/_rels/slide44.xml.rels ppt/slides/_rels/slide45.xml.rels ppt/slides/_rels/slide36.xml.rels ppt/slides/_rels/slide34.xml.rels ppt/slides/_rels/slide25.xml.rels ppt/slides/_rels/slide26.xml.rels ppt/slides/_rels/slide27.xml.rels ppt/slides/_rels/slide28.xml.rels ppt/slides/_rels/slide29.xml.rels ppt/slides/_rels/slide30.xml.rels ppt/slides/_rels/slide31.xml.rels ppt/slides/_rels/slide33.xml.rels ppt/slides/_rels/slide23.xml.rels ppt/presentation.xml ppt/slides/slide36.xml ppt/slides/slide21.xml ppt/slides/slide22.xml ppt/slides/slide23.xml ppt/slides/slide24.xml ppt/slides/slide25.xml ppt/slides/slide26.xml ppt/slides/slide20.xml ppt/slides/slide19.xml ppt/slides/slide18.xml ppt/slides/slide12.xml ppt/slides/slide13.xml ppt/slides/slide15.xml ppt/slides/slide16.xml ppt/slides/slide17.xml ppt/slides/slide27.xml ppt/slides/slide28.xml ppt/slides/slide29.xml ppt/slides/slide42.xml ppt/slides/slide41.xml ppt/slides/slide40.xml ppt/slides/

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slide39.xml ppt/slides/slide38.xml ppt/slides/slide37.xml ppt/slides/slide43.xml ppt/slides/slide44.xml ppt/slides/slide45.xml ppt/slides/slide30.xml ppt/slides/slide31.xml ppt/slides/slide32.xml ppt/slides/slide33.xml ppt/slides/slide34.xml ppt/slides/slide11.xml ppt/slides/slide9.xml ppt/slides/slide1.xml ppt/slides/slide2.xml ppt/slides/slide3.xml ppt/slides/slide4.xml ppt/slides/slide10.xml ppt/slides/slide6.xml ppt/slides/slide8.xml ppt/slides/slide5.xml ppt/slides/slide7.xml ppt/slidemasters/slidemaster1.xml ppt/slidelayouts/slidelayout6.xml ppt/slidemasters/_rels/slidemaster1.xml.rels ppt/slidelayouts/slidelayout8.xml ppt/slidelayouts/slidelayout7.xml ppt/slidelayouts/slidelayout4.xml ppt/slidelayouts/slidelayout3.xml ppt/slidelayouts/slidelayout2.xml ppt/slidelayouts/slidelayout1.xml ppt/slidelayouts/_rels/slidelayout11.xml.rels ppt/slidelayouts/slidelayout5.xml ppt/slidelayouts/slidelayout9.xml ppt/slidelayouts/slidelayout11.xml ppt/slidelayouts/_rels/slidelayout4.xml.rels ppt/slidelayouts/_rels/slidelayout3.xml.rels ppt/slidelayouts/_rels/slidelayout2.xml.rels ppt/slidelayouts/_rels/slidelayout1.xml.rels ppt/slidelayouts/slidelayout10.xml ppt/slidelayouts/_rels/slidelayout5.xml.rels ppt/slidelayouts/_rels/slidelayout7.xml.rels ppt/slidelayouts/_rels/slidelayout6.xml.rels ppt/slidelayouts/_rels/slidelayout10.xml.rels ppt/slidelayouts/_rels/slidelayout8.xml.rels ppt/slidelayouts/_rels/slidelayout9.xml.rels ppt/theme/_rels/theme1.xml.rels ppt/theme/theme1.xml ppt/media/image1.jpeg ppt/media/image5.jpeg ppt/media/image16.jpeg ppt/media/image17.jpeg ppt/media/image18.jpeg ppt/media/image19.jpeg ppt/media/image20.jpeg ppt/media/image21.jpeg ppt/media/image22.jpeg ppt/media/image23.jpeg ppt/media/image15.jpeg ppt/media/image14.jpeg ppt/media/image13.jpeg ppt/media/image6.jpeg ppt/media/image8.jpeg ppt/media/image9.jpeg ppt/media/image10.jpeg ppt/media/image11.jpeg ppt/media/image3.jpeg ppt/media/image25.jpeg ppt/media/image36.jpeg ppt/media/image37.jpeg ppt/media

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/image38.png ppt/media/image39.jpeg ppt/media/image40.jpeg ppt/media/image41.jpeg ppt/media/image2.jpeg ppt/media/image4.jpeg ppt/media/image33.jpeg ppt/media/image26.jpeg ppt/media/image27.jpeg ppt/media/image34.jpeg ppt/media/image28.jpeg ppt/media/image30.jpeg ppt/media/image32.jpeg ppt/media/image31.jpeg ppt/tablestyles.xml ppt/viewprops.xml ppt/presprops.xml docprops/core.xml docprops/app.xml ppt/media/media1.wmv ppt/media/image12.png ppt/media/image24.png ppt/media/image29.png ppt/media/image35.png ppt/media/image7.png ppt/slides/_rels/slide32.xml.rels ppt/slides/_rels/slide35.xml.rels ppt/slides/slide14.xml ppt/slides/slide35.xml [content_types].xml _rels/.rels docprops/custom.xml u nekotorix bolnix divertikuli pishevoda proyavlyayutsya simptomami, sxodnimi s simptomami axalazii (disfagiya, regurgitatsiya , boli). odnako rentgenologicheskoe issledovanie pozvolyaet postavit pravilniy diagnoz. pervie glotki bariya mogut svobodno postupat v jeludok, zatem kontrastnaya massa dlitelno zaderjivaetsya v pishevode. nad barievoy vzvesyu opredelyayut sloy jidkosti i ostatki pishi. rasshirenie pishevoda nad mestom sujeniya ego virajeno v razlichnoy stepeni. u ryada bolnix otmechayut udlinenie i iskrivlenie pishevoda. peristaltika pishevoda u vsex bolnix rezko narushena: sokrasheniya oslableni, imeyut spasticheskiy xarakter i nedostatochnuyu amplitudu. pri razvitii ezofagita vidni izmeneniya relefa slizistoy obolochki pishevoda: zernistost , utolshenie i izvilistost skladok. ezofagoskopiya endoskopicheskaya kartina zavisit ot dlitelnosti zabolevaniya. v nachale bolezni pishevod rasshiren neznachitelno, po mere progressirovaniya zabolevaniya ego prosvet vse bolee rasshiryaetsya i u …

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to podtverjdaet preimushestvenno funktsionalniy xarakter izmeneniy v pishevode. slizistaya obolochka v meste sujeniya chashe vsego ne izmenena. ezofagotonokimograficheskoe issledovanie — glavniy metod ranney diagnostiki axalazii pishevoda, tak kak narusheniya sokratitelnoy sposobnosti pishevoda i fiziologicheskoy kardii voznikayut znachitelno ranshe klinicheskix simptomov zabolevaniya . issledovanie provodyat s pomoshyu spetsialnogo mnogokanalnogo zonda s rezinovimi ballonchikami ili «otkritimi» kateterami, registriruyushimi sokrasheniya pishevoda i izmeneniya vnutripishevodnogo davleniya. osnovnoy rentgenologicheskiy priznak axalazii — sujenie terminalnogo otdela pishevoda s chetkimi, rovnimi i elastichnimi konturami («plamya perevernutoy svechi», «mishiniy xvost »). skladki slizistoy obolochki v oblasti sujeniya soxraneni. diagnostika osnovnimi metodami diagnostiki axalazii kardii yavlyayutsya rentgenologicheskoe issledovanie, ezofagoskopiya, ezofagotonokimografiya , farmakologicheskie probi . pri beskontrastnom rentgenologicheskom issledovanii grudnoy kletki u bolnix s axalaziey viyavlyayut dopolnitelnoe vibuxanie pravogo kontura sredosteniya, nalichie urovnya jidkosti v proektsii zadnego sredosteniya, otsutstvie gazovogo puzirya jeludka. klinicheskaya kartina dlya axalazii kardii xarakterna triada simptomov: disfagiya, regurgitatsiya , boli . disfagiya — osnovnoy i v …

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tepenno prisposablivayutsya oblegchat proxojdenie pishi v jeludok s pomoshyu ryada priemov (xodba, gimnasticheskie uprajneniya, zaglativanie vozduxa i slyuni, priem bolshogo kolichestva teploy vodi i dr .). virajennuyu kaxeksiyu pri axalazii kardii nablyudayut redko. boli za grudinoy pri axalazii kardii imeyut raznoobrazniy xarakter. oni mogut bit svyazani so spazmom pishevodnoy muskulaturi i ustranyayutsya priemom nitroglitserina, amilnitrita i atropina. odnako u bolshinstva bolnix boli voznikayut pri perepolnenii pishevoda i ischezayut posle srigivaniya ili proxojdeniya pishi v jeludok. u nekotorix bolnix voznikayut pristupi spontannix boley za grudinoy po tipu bolevix krizov. podobnie boli chashe nablyudayut v nachalnom periode zabolevaniya, inogda eshe do razvitiya disfagii i regurgitatsii , kotorie ne vsegda snimayutsya atropinom ili nitroglitserinom, chto pozvolyaet predpolojit ix svyaz s progressiruyushim distroficheskim protsessom v intramuralnom nervnom spletenii pishevoda. boli natoshak ili posle rvoti chashe obuslovleni ezofagitom i snimayutsya priemom pishi. otrijka vozduxom, toshnota, povishennoe slyunootdelenie, jjenie po xodu pishevoda, nepriyatniy zapax izo rta …

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