Andreeva I. Mechanisms of development of esophageal-gastric bleedings

The investigation object: esophageal-gastric bleeding; the investigation goal: complex experimental and clinic studying of mechanisms of development of esophageal-gastric bleeding, especially mechanisms of adaptation of the liver and mucous layer of the cardial cardial part of the stomach to diffuse liver diseases and portal hypertension; methods of research: experimental modeling of portal hypertension; morphofunctional study of the liver and mucous layer of the stomach; value of the liver hemodynamics and functional reserve (ultrasound dopplerometry, rheohepatography); clinic, laboratory and endoscopic methods; the theoretical and practical importance of the received results: the experimental models of hepatic pathology in connection with portal hypertension in basis of intra-, extra- and united blocks of the portal vein system were elaborated in the research. The method of quantative value of the liver functional reserve by ultrasound dopplerometry for prognosis of the results of the process and choose of treatment tactics was proposed. The method of ultrasound of the rats for experimental researches was elaborated. The criteria for diagnostics of the manifested and nonmanifested forms of portal hypertension were proposed; the quantative analysis of morphofunctional parameters of the liver pathology in connection with portal hypertension is the basis for the prognosis of changes in gastric mucosa in different stages of the process development; the scientific novelty of the investigation results: the complex experimental-clinic studying of the role of hepatic pathology with portal hypertension in development of esophageal-gastric bleeding and Mallory-Weiss syndrome was spent. It was established in the experiment, that the liver pathology in connection with the portal hypertension was a cause of destructive processes in mucous layer of cardial part of the stomach. They developed consecutive from an appearance of venous teleectasies, primary alteration of mucous layer and cardial glandulae, induration of mucous layer, formation of micro- and macrotears, erosions and ruptures of the gastric wall. A character of changes of morphofunctional parameters connected with development of the process had a direct correlation with form and difficulty of hepatic pathology and expression of portal hypertension; it was revealed that mechanism of development of the acute esophageal-gastric bleedings had a connection with increasing of the pressure in the portal vein. In some cases the destructive changes of the mucous layer of the stomach may be classified as portal gastropathy that perhaps connect with development of collateral anastomices (porto-portal and porto-caval ones). The morphological changes were confirmed by additional studies, which included the dynamics of hydratation and sorbtion. The level of the common water and exposition dynamics of sorbtion of the neutral red in the hepatic tissue were increased. The activity of the catalase in blood was also increased; the analysis of quantative parameters of the liver hemodynamics in healthy persons and in patients with diffuse liver disease and portal hypertension was spent.The types of portal hemodynamics (hypo-, normo- and hyperdynamic ones) and criteria of prognosis of acute esophageal-gastric bleeding were divided; the degree of implementation: the results of the research are implemented in practice of surgical department of Lugansk City Clinic Multiprofile Hospital №1, Chair of anaestesiology, reanimatogy and surgery of postgraduate education faculty of Lugansk State medical University, diagnostic center ''Medakom", in the educational process at Chairs of pathophysiology of National Medical Bogomolets University, Kharkov, Donetsk, Lugansk, Dnepropetrovsk and Krym State Medical Universities, Human and Animal Anatomy and Physiology Chair of Lugansk Taras Shevchenko National Pedagogic University; branch of usage: medicine, pathophysiology, surgery