Pancreatitis imadziwika ngati kapamba amayambitsidwa pazifukwa zingapo. Thupi likatupa, kutuluka kwa michere kumakhala kovuta, chifukwa chomwe minofu ya thupi imayamba kudzimbidwa payokha.
Ngakhale kugwiritsidwa ntchito kwa njira zamakono komanso zogwira ntchito pochizira ,imfa kuchokera ku kapamba ndizambiri. Ndi mitundu wamba ya matendawa, wodwalayo amafa mu 7-15% ya milandu, ndi mitundu yowonongeka - mpaka 70%.
Popeza chiopsezo chokhala ndi zovuta zamatenda a kapamba ndizokwera kwambiri, ndikofunikira kudziwa zokhudzana ndi etiological komanso pathogenesis ya pancreatitis. Zambiri zokhudzana ndi matendawa zimatha kupezeka pazomwe zili pansipa.
Zimayambitsa kapamba
Mu 80% ya milandu, zomwe zimayambitsa matendawa atagona kuledzera, matenda a gallbladder ndi ma ducts. Mu 45% ya milandu, zimadziwika kuti mapangidwe a kutupa kwa kapamba amalimbikitsidwa ndi choledocholithiasis, cholelithiasis, kukakamiza kwa njira ndi ma cysts ndi zotupa, ndi matumbo a matumbo.
Matenda aliwonse omwe ali ndi zifukwa zake ali ndi zomwe zimapangitsa kukula. Komabe, zonsezi zimatsogolera ku kupezeka kwa pancreatitis ya pachimake.
Zomwe zimatsogolera mu pathogenesis ya pancreatitis ndi: kuvuta kutuluka kwa pancreatic enzyme kudzera mu ma ducts. Chifukwa chake, chithandizo cha matenda oyamba amayamba ndi chithandizo cha matenda onse ophatikizika.
The etiology ya pachimake kapamba imakhudzana makamaka ndi uchidakwa. Poterepa, njira yomwe imatengera matendawa imayambira pakukanika kwa chiwindi ndi chithokomiro cha England.
Zoledzeretsa zimawonjezera katulutsidwe, zimapangitsa kuti kutulutsa kumvekeke kwambiri. Izi zimawonjezera kupanikizika mu njira, yomwe imabweretsa kuledzera kwa kapamba, imasokoneza kapangidwe kake kameneka ndipo imakhumudwitsa zochita za chiwindi.
Vuto linanso lodziwika bwino la kapamba limawerengedwa ngati chinthu chopatsa thanzi. Zikatero, kutupa kumayamba munthu akamagwiritsa ntchito nyama, mafuta komanso zakudya yokazinga.
Pafupipafupi, pathophysiology ya kapamba imayambitsa zifukwa zingapo:
- matenda a ma virus (ma mumps, kachilombo ka Coxsackie, hepatitis);
- genetic predisposition (cystic fibrosis);
- mabakiteriya (mycoplasma, campylobacter);
- zilonda zam'mimba;
- kuvulala kwapachibale;
- kobadwa nako matenda a limba chitukuko;
- kumwa mankhwala (estrogens, corticosteroids, diuretics, azathioprine);
- kagayidwe kachakudya koyambitsidwa ndi kupezeka kwa matenda angapo (vasculitis, shuga, AIDS).
Pancreatitis imayambanso chifukwa cha opaleshoni yochitidwa mu matenda a kapamba ndi ma ducts a bile. Kuvulala kwa chiwalo kumatha kuchitika pakulimbitsa thupi, ma endicopy, ma prosthetics, papillotomy, ndi mitundu ina ya ntchito.
Postoperative pancreatitis ndi zovuta zamagulu opaleshoni. Zimachitika ndi kuwonongeka kwa zonyansa ndi kutaya magazi.
Zowopsa zomwe zimayambitsa kutupa kwa pancreatic zimaphatikizapo chiwopsezo cha helminthic (matenda a ascaris), hyperparathyroidism (parathyroid pathology) ndi poizoni wa organophosphate.
Zina mwazinthu zomwe zimapangitsa kuti matendawa aziwoneka zimaphatikizapo scorpion kuluma ndi ischemia dziwe la mesenteric, lomwe limachitika pamene mafupa a mesenteric artery thrombus.
The pathogenesis of pancreatitis pachimake
Gawo lazovuta la kutupa kwa kapamba ndi poizoni wa poizoni. Chofunikira kwambiri pakukula kwa matendawa ndi kudzipatula kwa ma enzymes enieni (ma proenzymes osagwira) kuchokera ku maselo acinar a chiwalo.
Mchitidwewo umayamba chifukwa cha kukondoweza kwa mphamvu ya ntchito ya procrine, kuwonjezeka kwa kukakamiza kapena kukonzanso kwa bile ku Wirsung duct, kutsekeka kwa kuchuluka kwa mapangidwe a duodenal
Chifukwa cha kuchuluka kwa magazi mkati mwa makina, makoma amtundu wa terminal amakhala ovomerezeka, omwe amachititsa ma enzymes. Pathogenesis ya pancreatitis pachimake imatsogolera kuyamba kwa kudzimbidwa, komwe ma lipolytic enzyme (lipase, phospholipase A) amakhudzidwa.
Ndizofunikira kudziwa kuti lipase sikumangokhudza maselo athanzi okha. Phospholipase A imawononga cell nembanemba, pomwe lipase imalowa mosavuta. Kutulutsidwa kwotsirizira kumalimbikitsa kusweka kwa lipid ndikuthandizira njira zowonongeka. Mwa michere yonse yomwe imayang'aniridwa m'malo otupa, yomwe imawononga kwambiri kapamba ndi granulocyte elastase - ichi ndiye cholumikizira chachikulu mu pathogenesis ya pancreatitis yovuta.
Zotsatira zowonetsera kwa enzyme ndizoyang'ana za lipid pancreatic necrobiosis. Pafupi ndi malo awa, chifukwa cha kutupa, mawonekedwe am'mimbamo otsitsa, ndikuchepetsa madera omwe ali ndi matendawa athanzi.
Momwe pathobiochemical process imatha pa siteji iyi, ndiye kuti mafuta amodzi a pancreatic necrosis amakula. Ngati, chifukwa cha kuchuluka kwa mafuta acids mu ma pancreatocytes okhudzana ndi lipase, kusintha kwa pH (kuyambira 3.5 mpaka 4.5), ndiye kuti trypsinogen mkati mwa maselo amasinthidwa kukhala trypsin. Zimayambitsa ma protein ndi ma enzymes a lysosomal, zomwe zimapangitsa kuti kusintha kwa proteinolytic kusasinthike pancreatocytes.
Elastase amasungunula makoma olimbirana ndi minyewa yolumikizana ndi minyewa. Izi zimabweretsa kufalitsa kwamwini ma enzyme odziyambitsa pancreas komanso ziwalo zapafupi.
Mkhalidwe wotsiriza wa pathogenesis wa kutupa pachimake kwa gulu la parenchymal ndikoyambitsidwa koyambirira kwa michere ya pancreatic. Mothandizidwa ndi trypsin, njira zingapo zimayambitsidwa, zikutha ndi vuto la pathobiochemical:
- pancreatic enzyme zymogen adamulowetsa;
- kuchuluka kwa magazi kumawonjezeka;
- kusintha kwa fibrinolysis;
- kallikrein-wedge dongosolo amakondoweza.
Kuphatikiza pa kusokonezeka kwakanthawi komwe kumayambitsidwa ndi kusokonezeka kwa pathological pachilichonse cha parenchymal, poizoni wambiri wa thupi amachitika.
Kuledzera kwambiri kumapangitsa kugonjetsedwa kwa ziwalo zina - mtima, impso, chiwindi ndi mapapu.
Machitidwe a chitukuko cha mitundu ina ya kapamba
Gulu la kapamba limaphatikizapo mitundu yosiyanasiyana ya matenda. Awo pathogenesis amatha kusiyanasiyana. Chifukwa chake, mtundu wocheperako wa kutukusira kwa ndulu umachitika pamene miyala ipanga mwala womwe umakhudzidwa ndi chimbudzi (carbonic ndi phosphoric lime).
M'mawonekedwe, izi zimafanana ndi miyala yaying'ono kapena mchenga woyera. Kusintha kwa m'matumbo a kapamba, komwe ma calculi amadziunjikira, amayamba chifukwa cha kutupa ndi kukulitsa kwa duct.
Pathogenesis yamtundu wa chidakwa cha kapamba ndi kuti mowa umakulitsa mamvekedwe a sphincter a Oddi. Izi zimalepheretsa kutuluka kwa procrine secretion ndikupanga matenda oopsa m'mizere yaying'ono. Mowa uli ndi mavuto ena angapo:
- Imalimbikitsa kulowa kwa ma enzymes mu gland, yomwe imalimbikitsa ma enzymes a proteinolytic komanso imapangitsa kuti ma cell a cell apangidwe.
- Zimawonjezera katulutsidwe ka madzi am'mimba ndi hydrochloric acid, omwe umawonjezera katulutsidwe, kamene kamakhumudwitsa hypersecretion m'thupi.
The pathogenesis ya biliary pancreatitis imagwirizanitsidwa ndi ingress ya bile ndi kapamba wa pancreatic. Njira zotere zimayambitsidwa pamene kukakamira kumabuka mu duodenum ndi biliary thirakiti. Kutengera izi, tanthauzo la matendawa linapangidwa ngati njira yotupa yotupa yomwe imayamba chifukwa cha kuwonongeka kwa chiwindi ndi njira ya biliary.
Biliary pancreatitis imatha kuchitika chifukwa cha kusintha kwa morphological komwe kumachitika mu sphincter ya Oddi kapena duodenal papilla. Ntchito ya Trypsin imathandizira kuwunika kwa m'mimba ndi m'mimba mwake.
Ndi biliary mawonekedwe a matendawa, madera onse okhudzidwa ndi nduluyo amadzala ndi minyewa ya fibrous. Pakakhala chithandizo chapanthawi yake, chiwalocho chimasiya kugwira ntchito.
Mtundu wa pathogenesis umayamba pamene majini amasinthidwa, omwe amatengera. Kulephera kumachitika ndikusintha leino ya amino acid ndi valine.
Komanso, cholowa champhamvu chokhala ndi chibadwa chimayendetsedwa ndi kukanika kwa maselo. Zotsatira zake, kapamba amayamba kugaya thukuta lake.
Njira yonga ya kutupa kwapancreatic imawoneka makamaka mwa odwala omwe ali ndi vuto lotchedwa rhinitis, urticaria, kapena mphumu wa bronchial. Limagwirira kukula kwa matenda amtunduwu zachokera kupezeka kwa sayanjana, ikuchitika magawo atatu:
- kudziwa thupi;
- mapangidwe a antibodies kwa pathogen;
- kuwonongeka kwa zimakhala za parenchymal gland.
Kukula kwa njira za autoimmune kumathandizira pazinthu zambiri komanso kusintha. Chifukwa chake, chifuwa chachikulu cha kapamba chimakhala ndi zovuta pa pathogenesis.
Zizindikiro ndi mankhwala a kapamba
Pancreatitis ndizosavuta kudziwa nthawi yomwe imapezeka mu gawo lazowawa. Potere, chithunzithunzi cha matenda chimatchulidwa kwambiri.
Zizindikiro zotsogola za kutupa kwa pancreatic ndizopweteka kwambiri nthawi zonse mu epigastrium, nthawi zambiri zimatulutsa kwa hypochondrium yamanzere, chifukwa chomwe wodwalayo amatha ngakhale kuzindikira. Zovuta zimawonjezereka pamene wodwala wagona kapena adya chakudya.
Kuphatikiza pa kupweteka, kapamba amatsatiridwa ndi kusanza, kutentha thupi, nseru ndi chikasu pakhungu. Odwala ena amakhala ndi zotupa m'mchombo. Komabe odwala amadandaula za kutentha kwadzuwa ndi kusungunuka.
Kuperewera kwa mankhwalawa chifukwa cha kutupa kwamphamvu kwa pancreatic kumapangitsa kuti pakhale zovuta zingapo zowopsa - matenda ashuga, m'mimba, cystic fibrosis, ndi mtima. Chifukwa chake, chithandizo chikuyenera kuchitika kuchipatala moyang'aniridwa ndi madokotala.
Zolinga zazikulu za chithandizo:
- Kuchotsa kwa zopweteka;
- Kuchotsa kwa michere ya pancreatic pamtsinje wamagazi;
- Cholinga cha chakudya chapadera.
Munthu wamakono nthawi zambiri amanyalanyaza malamulo azakudya zabwino komanso zabwino, zomwe zimayambitsa mavuto m'mimba. Chifukwa chake, gawo lofunikira la mankhwalawa a kapamba ndikuwonetsetsa kuti chodwala chikhale chododometsa pochiritsa komanso kudya. Patsiku loyamba lachipatala, wodwalayo sangadye chilichonse, ndiye kuti amamuika mu dontho la shuga ndipo pokhapokha amasinthira zakudya zopepuka.
Popeza kutupa pachimake kumayendera limodzi ndi kupweteka, mankhwala amphamvu a analgesic nthawi zambiri amakhazikitsidwa. Komanso, njira zapadera (Contrical, Trasilol) zimaperekedwa kwa wodwalayo kuti athetse kuledzera kwa thupi ndi michere ya pancreatic. Ngati ndi kotheka, mankhwala opha maantibayotiki ndi calcium amapatsidwa.
Ngati palibe kusintha pambuyo pa sabata la mankhwala, laparotomy imachitika. Nthawi ya opaleshoni, dokotalayo amachotsa gawo lakufa la chiwalo cha parenchymal. Muzochitika zadzidzidzi, ndikupanga kwa pseudocysts (kudzikundikira kwa minofu yakufa, michere) mu kapamba, kukhetsa kwachitika.
Zambiri pa pancreatitis pachimake zimaperekedwa mu kanema munkhaniyi.
