One of the common problems faced by practical medicine is bloating (excessive stretching). This symptom may indicate the onset of a systemic disease or be the only manifestation of the pathology of internal organs located in the abdominal cavity.
The feeling of an increase in the abdomen in size is subjective, patients in such cases complain of a feeling of overcrowding, swelling from the inside; this condition, as a rule, over time passes, and the cause may be a violation of the normal functioning of the organs of the gastrointestinal tract - in the event that subjective sensations are not confirmed by real facts revealed during medical examination.
If the bulge of the abdomen is caused by excessive weight or a defect in the spine that has forward bending (lumbar lordosis), an experienced doctor can distinguish these conditions from a real swelling, carefully studying the history and conducting a detailed external examination.
Causes of bloating in healthy people In people who do not suffer from any disease, bloating usually occurs due to the accumulation of air or gases.
The ingestion of large portions of air during the meal, as well as the excessive use of various soda, can lead to swelling, which quickly passes. "Superfluous" air partially regurgitates, partially enters the intestine and either exits through the anus or is absorbed by the intestinal walls.
The formation of gases can occur when digesting food that enters the stomach and intestinal tract; also provokes gas formation intake of soda neutralizing the gastric secret (the usual "folk" remedy for heartburn).
The cause of bloating after eating can be excessive eating of sweet and sweet foods: they are rich in digestible carbohydrates, causing a fermentation reaction - and, accordingly, increased gas production.
Another reason for the swelling is the ingestion of starch and fiber in large amounts (these substances are found in rye black bread, legumes, potatoes and cabbage and some other products).
What diseases are bloated?.
Also can cause bloating of the gasses, formed as a result of the patient's presence of some kind of fermentopathy. For example, most adults have a deficiency in the body of the enzyme responsible for the cleavage of complex milk sugar (lactose) into monosaccharides (glucose and fructose). This enzyme is lactase, it is produced in the small intestine; when lactase is deficient, milk with unsplit milk sugar passes into the large intestine, and is digested already there with the help of local microflora. This process is accompanied by an active gas generation, causing a feeling of bursting and bloating after eating.
Dysbacteriosis, often diagnosed in patients of different ages, can cause bloating. The disease is characterized by a qualitative change in the intestinal microflora, manifested in a violation of the balance between the number of opportunistic and normal ("useful") bacteria. Both those and others are constantly living in our body; but while the person is healthy, necessary for normal digestion, useful microorganisms easily suppress pathogenic. With dysbacteriosis, the amount of pathogenic microflora in the intestine increases, normal food processing is disrupted, and as a result of the dominance of putrefactive processes, gas formation.
If there is a constant swelling of the abdomen of a local type, and according to its location it corresponds to a certain area of ??the intestine, it is worthwhile to suspect a mechanical obstruction in the path of the moving gases; it can be a tumor or other intestinal obstruction. An inflated abdomen can be a consequence of impaired motor function of the intestines (a frequent occurrence in invasions that cause intestinal musculature intoxication), problems with blood circulation (for example, it occurs with varicose veins when the blood stagnates in the venous intestinal network). Able to cause bloating mental pathologies, in particular, hysterical disorders.
In medical practice, other diseases are known, accompanied by bloating, after eating or constantly.
Anamnesis of the disease Often the first symptoms of a constant swelling of the abdomen are detected by the patient himself, who is constantly having to loosen the belt, wear clothes larger than usual sizes, worried about the appearance of a hernia of the abdominal wall or a hernial tumor in the groin, local swelling. In other cases, even a large stretch may remain unnoticed for months: if a person suffers from excessive weight, or with asymptomatic abdominal dropsy (ascites). The gradually stretching abdominal wall can be evidenced by a feeling of "tension" in the lateral areas of the abdomen (flanks), in the groin, as well as vague pain in the lower back.
Localized pain syndrome often occurs when a pathological process captures any of the internal organs; it can be a stagnant liver, a spleen enlarged in size, a large intestine struck by a tumor. Pain of local character is not characteristic for abdominal edema, developing against cirrhosis; more likely to suggest pancreatic inflammation (pancreatitis) or peritoneum (peritonitis), or the presence of primary liver cancer (hepatoma).
If the causes of bloating lie in progressive ascites, accompanied by distention of the abdominal wall, or developing tumors in the abdominal cavity, intra-abdominal pressure. As a result, there is a violation of digestive processes, the reverse movement of the stomach and esophagus (reflux) leads to heartburn, raising the diaphragm provokes dyspnoea in a supine position (orthopnea), frequent shallow breathing (tachypnea). An additional cause of respiratory disorders may also be an exudate leaking into the pleural cavity (usually on the right side); it is not excluded that the effusion is caused by the penetration of the free fluid on the lymphatic channels of the diaphragm formed during ascites.
If the patient has a bloating disorder of a diffuse type, the doctor should inquire about the following data:.
propensity of the patient to abuse alcoholic beverages;.
presence of an anamnesis of jaundice, hematuria;.
manifestations of violations of the intestinal activity;.
heart diseases of a rheumatic nature.
The information obtained can help an experienced physician to identify previously unrecognized cirrhosis, diagnose colon cancer with metastases to the peritoneal region, kidney pathologies (nephrosis), or CHF (congestive heart failure).
Examination by physical methods The most valuable information, often allowing to establish the causes of the disease and determine the optimal treatment of bloating, can be given by the physical methods of examining the patient. For example, the reddening of the palms (erythema) or arachnoid vascular hyperplasia revealed during visual examination makes you suspect a hidden type of liver cirrhosis, and the "Virchow's glands" discovered by the palpation method (enlarged lymph nodes in the subclavian area) suggest a cancer tumor in the stomach or intestine. Do not underestimate the importance of external examination of the abdomen; Thus, the contours of the bloat allow us to speak of its local or general character. If the abdominal wall is stretched to hardness, the lateral parts of the abdomen protrude, the navel is twisted - this pattern is characteristic of the abdominal dropsy. High pressure in the portal vein system (portal hypertension) is often indicated by the swelling of the superficial veins of the outflow of blood from the navel. To blockage of one of the main veins of the body - the inferior vena cava, the lateral branches of the venous vessels (collaterals) serving for blood flow from the lower abdomen to the navel region can be indicated, and the venous current directed to the navel from above serves as a basis to suspect an obstruction of the superior vena cava.
When the stomach has the shape of a dome on which folds from the intestinal loops are viewed, there is a high probability of blockage or stretching of the intestine as causes of bloating. The latent occlusion of the sphincter (pylorus) of the stomach is indicated by seals in the epigastrium and visually observed wave-like contractions (peristalsis) oriented from the left to the right. The metastatic tumor affected by the tumor is determined by palpation of the upper right part of the peritoneum, as a tightening of a nodular character that changes the position to the rhythm of breathing.
Treatment of bloating is prescribed depending on the causes that caused the pathology.
Auscultation.
Whistling high-pitched noises - a characteristic sign of intestinal obstruction in the early stages - or splashing sound, released by the fluid and gases accumulated in the cavity of the distended intestine, can be distinguished by auscultation (listening to internal organs). On the right side of the abdomen, above the enlarged liver, scrupulously conducted listening allows you to fix noises indicating the presence of a tumor (most often hepatoma); in the umbilical zone, one can hear the noise of venous blood flow, which speaks of possible portal hypertension and active blood movement along the hepatic collateral.
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