Chikhansa ndi chimodzi mwa ziwalo zofunika kwambiri zam'mimba m'matumbo a munthu. Kulemera kwake sikufika magalamu 200. Kutikako kumapangidwanso, kumbuyo, pamimba, monga zikuwonekera ndi dzina lenilenilo, pafupifupi pamlingo wamiyala iwiri yoyambirira. Kuchuluka kwa ziwalo kumawonedwa wazaka 30 mpaka 40, kenako zimayamba kuchepa pang'onopang'ono.
Zomwe zimachitika pankhaniyi ndizosavuta. Zikondamoyo zaumunthu zimakhala ndi magawo atatu - mutu, thupi ndi mchira. Mutu umakhuthala pang'ono, ndiye kuti pali gawo laling'ono la kutalika kwa yunifolomu ndi makulidwe - ili ndi thupi. Zimatha ndikuchepera pang'ono kwa ndulu, yomwe ndi mchira. Mchira umakhudza impso yakumanzere ndi ziwiya zake (mitsempha, mtsempha), thupi - msempha ndi mtsempha, womwe umasonkhanitsa magazi kuchokera kumutu, ndi mutu - wokhala ndi chotupa cham'mimba komanso ziwiya zosiyanasiyana zam'mimba.
Ntchito za kapamba ndizosiyanasiyana. Ndi chiwalo chobisika. Kodi izi zikutanthauza chiyani? Ntchito ya endocrine ndikupanga mahomoni, omwe amaphatikizapo:
- Insulin ndi mahomoni omwe amayang'anira kuchuluka kwa shuga m'magazi. Imatsitsa shuga. Ndi kusakwanira kwake kapena kusakhalapo kwathunthu, matenda oopsa omwe amatchedwa shuga mellitus amakula, kenako odwala amakakamizidwa kuti akhalebe jakisoni wa kukonzekera insulin.
- Glucagon - mahomoni awa amakhudzidwanso ndi kayendedwe ka kagayidwe kazakudya, koma zotsatira zake ndizosemphana ndi insulin. Amawonjezera shuga wamagazi. Matenda omwe amabwera chifukwa chobisala, samakhala ochepa.
- Somatostatin ndi mahomoni omwe amalepheretsa kupanga ndi zochita za mahomoni okula (kukula kwa mahomoni).
- Pancreatic polypeptide ndi chinthu chomwe chimakhudzidwa mwachindunji pakupanga chimbudzi, ndikuthandizira kuyamwa kwathunthu kwa chakudya.
Zinthu zonse zokhala ndi mahomoni zimapangidwa ndi maselo apadera a kapamba, omwe amatchedwa ma islets a Langerhans, ndipo amapezeka mchira kwambiri.
Ntchito ya exocrine imatsimikiziridwa ndi kupanga kwa michere yamagayidwe am'mimba ndi madzi a pancreatic. Ma Enzymes monga trypsin (amakhudzidwa ndi kuphulika kwa ma polypeptides), amylase (amathandizira kugaya chakudya m'magazi) ndipo lipase (imaphwanya mafuta kuti triglycerides) italikirane.
Zambiri pamayendedwe azambiri
Ma Enzymes ndi madzi a pancreatic amachokera ku kapamba mpaka duodenum kudzera m'miyendo ya kapamba. Pali mitundu iwiri ya ma ducts - yoyamba komanso yachiwiri.
Duct wamkulu wakuluzanso amatchedwa Wirsung. Mwachilengedwe, mkati mwa duct iyi, timabulu tambiri tambiri timabisalamo, chilichonse chimakhala ndi chinsinsi.
Malo awo ndi kuchuluka kwake zimatha kusiyanasiyana kuchokera pamunthu. Wirsung duct imatha kukhala ndi mawonekedwe osiyana: arched, mawonekedwe a bondo, mawonekedwe a Chingerezi S, koma nthawi zambiri imabwereza mawonekedwe a England. Pomwe imayandikira duodenum, m'mimba mwake mwa duct imayamba kuchepa.
Pali mitundu iwiri ya kapangidwe ka dancal system ya kapamba - yayikulu ndi yotayirira. Mtundu waukulu umadziwika ndi osachulukitsa zazing'onozing'ono zomwe zimalowa zikuluzikulu. Kuchuluka kwake ndi 18-34, pomwe mtunda pakati pa malo omwe amakumbukirana sizidutsa sentimita imodzi ndi theka. Ndi makina otayirira, mpaka ma ducts ang'ono 60 amatuluka, mipata yomwe simaposa mamilimita awiri.
Tizilombo ta kapamba timeneti timatha kutseguka mosiyanasiyana mu duodenum. Pafupifupi 60% ya anthu amakhala ndi mapangidwe akuluakulu ndi zowonjezera pafupi mamilimita atatu asanalowe m'matumbo. Kuwongolera kwa nthambi yotsiriza ya Wirsung duct nthawi zina kumachitika, ndipo madzi onse a pancreatic amalowa m'malo osankhidwa kudzera duct yowonjezera.
Dongosolo ili limapezeka pokhapokha 10% ya milandu. Mu 20%, duct wamkulu samalumikizana ndi bile wamba ndikuyamba kulowa mu duodenum 2-4 masentimita pamwamba pa malo omwe akufuna.
Ndipo nthawi zina, ndizotheka kuphatikiza ma ducts akuluakulu ndi owonjezera pamtunda wawutali kuchokera ku confluence. Nthawi zambiri, m'mimba mwake simupita 2 mm.
Zitsuko zonse zimatseguka, monga tafotokozera pamwambapa, kulowa mu duodenum. Malowa amatchedwa papilla wamkulu wa kapamba, kapena kuti Vater papilla. Malamulo a pancreatic madzi ndi kudya kwa enzyme imayendetsedwa ndi minyewa yozungulira yozungulira papilla. Dzinalo lina ndi sphincter wa Oddi. Kuchepetsa kwake kumalepheretsa kudutsa kwamkati mwa tubule kulowa mu lumen yamatumbo.
Papilla waung'ono wa duodenum amathanso kukhalapo, pakamwa pake, nthawi zina, owonjezera, kapena Santorinius, amatsegula. Iye wazunguliridwa ndi sphincter Helly.
Zotupa zoyipa
Pali zosankha zingapo za malo ndi kulumikizana kwa ma ducts, koma palinso kuphwanya kapangidwe kake ndi kutulutsa kwa ma pancreatic ducts.
Zophwanya lamulo zoterezi zimatchedwa anomalies. Anomalies ndi wobadwa nawo ndipo amatengedwa. Zomwe zikuluzikulu zakukula kwawo zimawerengedwa ngati mtundu wakudziwikiratu, zotsatira za mabakiteriya komanso matenda am'mimba, komanso kuwonongeka koopsa kwa kapamba.
Kubadwa kobadwa nako kumaphatikizapo stenosis ya ma ducts. Zimayamba chifukwa chokhazikitsa nthambi ya Wirsung patulutsidwe ziwiri zazikulu.
Chifukwa cha stenosis, kuyika kwa katemera wa pancreatic mu duodenum kumatha kusokonezeka, ndipo izi zimatha kubweretsa chimbudzi chokwanira komanso kuperewera kwa chakudya, kuchepa kwa michere mthupi, komanso kupweteka.
Kuphatikiza pa kubadwa kwa stenosis, cystic fibrosis imadzipatula. Ndi izi zosasinthika, zochulukirapo komanso zovomerezeka mu pancreatic madzi zimayamba. Izi zimatha kubweretsa kuphwanya kwamkati kapangidwe ka kapamba ndi matenda osiyanasiyana.
Zolakwika zomwe zimaphatikizidwa zimaphatikizapo kukulitsa ndi kulepheretsa ma ducts. Nthawi zambiri, m'mimba mwake mwa machubu simapitilira 2 mm. Kukula kumabweretsa zifukwa zosiyanasiyana, monga:
- benign ndi ma neoplasms oyipa m'dera la mutu wa kapamba;
- kukhalapo kwa calculi (miyala) m'miyala;
- kuchuluka kwa lumen;
- aakulu yotupa njira mu gland (kapena kapamba);
- mavuto obwera atagwira ntchito ya Whipple;
- Kuchotsa pang'ono pang'ono kwa kapamba.
Kuphatikiza apo, mu 5% ya milandu, njira yowonjezerapo ikupezeka, yomwe imayamba kumutu kwa gland ndikutseguka m'chigawo cha Helly sphincter.
Ndi blockage, kuyambiranso kwa chifuwa chachikulu cha pancreatitis.
Pancreatitis - zimayambitsa ndi zizindikiro
Popeza pancreatitis ndi chimodzi mwazomwe zimayambitsa, komanso pafupipafupi chifukwa chotsutsana ndi duct, muyenera kuyankhula mwatsatanetsatane.
Pancreatitis ndimatenda otupa omwe amakhudza kapamba.
Matendawa amagawidwa pachimake komanso chovuta. Acne pancreatitis imachitika mwadzidzidzi, ndi yovuta kwambiri ndipo nthawi zambiri imafunikira opaleshoni. Matenda osachiritsika, kumbali ina, amachotsedwa kwambiri m'matenda, ndipo amawonetsedwa ndi zovuta zamagayidwe am'mimba nthawi zonse.
Zomwe zimayambitsa pancreatitis ndi izi:
- Kumwa pafupipafupi komanso kumwa kwambiri.
- Zowonongeka zowopsa m'mapamba.
- Kusuta kwakutali.
- Kugwiritsa ntchito mankhwala kwa nthawi yayitali komwe kumawononga thupi.
- Kukhalapo mukudya kwamafuta, yokazinga, ndi fodya.
- Kudziletsa.
- Matenda a Gallstone.
- Mavuto akulu azakhungu.
- Kusala kudya kwanthawi yayitali.
- Matenda a chiwindi.
- Matumbo a ma virus ndi bakiteriya.
- Cystic fibrosis.
- Kupukutira (kutukusira kwa tiziwalo tating'onoting'ono)
- Thupi lawo siligwirizana ndi chakudya.
Njira yodwala ya kapamba imakhala yabwino kwambiri ndipo samalankhula zambiri kuposa pachimake. Nthawi zina, amatha kukhala asymptomatic, koma nthawi zambiri pamakhala chizindikiro pamaso. Pazovuta zochitika, mawonetsedwe wamba ndi:
- munthu amadziwika ndi kunyansidwa pakuwona mafuta;
- Pakulimbitsa thupi, kupweteka kosasangalatsa kumachitika pansi pa nthiti yakumanzere;
- pamakhala zovuta zina zamagayidwe am'mimba mwa mawonekedwe am'mimba ndi stetorrhea chifukwa chosowa ma enzymes;
- odwala amasiya kudya;
- odwala amachepetsa thupi msanga ndipo samatha kulemera;
- kwambiriuleule;
- malamba;
- kutentha kwa mtima popanda chifukwa.
Mu gawo la kuchulukitsa kwa chotupa, chisamaliro chiyenera kulipidwa mwachangu kuti muwonekere zizindikiro izi:
- Ululu wa pachimake, wosokonekera, umakonda kupezeka mu epigastrium, koma kumaganizira kakhalidwe. Ululu umatha kuwala kumanzere. Ululu umatha kukhala paroxysmal. Amatchulidwa makamaka ataphwanya zakudya zomwe adatipatsa kale.
- Chilichonse. Nthawi zina kusanza kumachitika pachimake kapamba.
- Kusanza ngati kasupe, pafupifupi popanda mpumulo.
- Mimba imakhala "yolakwika" chifukwa cha kusokonezeka kwa minofu kukhoma kwam'mimba;
- Kuchulukitsa thukuta.
- Pallor, kufooka koopsa.
- Kukweza kutentha ku manambala a matondo (38-39 madigiri).
- Mukamayendetsa matumbo, wodwalayo amawona chopondapo chamadzimadzi chopezeka ndi mafuta othandizira, omwe amawonetsa kusowa kwa lipase.
- Kusweka mtima kumakhala pafupipafupi komanso mwamphamvu.
Pancreatitis imatha kukulira, makamaka chifukwa chophwanya zakudya.
Kuzindikira ndi kuchiza matendawa
Kuzindikira kwa kapamba kumachitika pogwiritsa ntchito maphunziro a labotale ndi othandizira. Mwa ma labotore, kuyezetsa magazi kwa biochemical kumasiyanitsidwa, komwe kumathandiza kuwona kuwonjezeka kwa milingo ya pancreatic enzymes (lipase, trypsin, amylase), alanine aminotransferase ndi aspartate aminotransferase (zitsanzo za chiwindi). Kuyesedwa kwamkodzo kwamkaka kumachitidwanso, komwe dokotala amatha kuwona amylase, yomwe siyenera kukhala yachilendo. Kuphatikiza pa kusanthula, odwala amatumizidwa kwa ultrasound, firmogastroscopy, chifuwa x-ray, pancreatic angiography, diagnostic laparoscopic, CT ndi MRI.
Chithandizo cha kapamba zimadalira mtundu wa kutupa. Acute pancreatitis amathandizidwa ndi mankhwala omwe amalepheretsa chinsinsi cha michere ya pancreatic, dzina lina ndi proteinase inhibitors.
Mankhwala omwe amagwiritsidwa ntchito kwambiri ndi Contrycal, omwe amaperekedwa kwa odwala ndi kukapumira. Kuphatikiza apo, monga momwe matenda amatetemera, kusamalitsa kwa chakudya ndikofunikira, ndikutanthauza kuti kupatula chakudya:
- mowa
- zakumwa zoziziritsa kukhosi;
- masoseji;
- zakudya zamzitini;
- kusuta nyama;
- zakudya zokazinga;
- zakudya zamafuta ndi mchere;
- zonunkhira zambiri ndi zokometsera;
- maswiti.
Kuphatikiza apo, kudya firiji yofunda kumalimbikitsidwa.
Kuti mupewe kuchitika kapena kuchuluka kwa kapamba, muyenera kudya chakudya chamagulu, molondola komanso pafupipafupi. Muyenera kudziwa muyeso wokhudza kumwa mowa, kutsatira kadyedwe, kusewera masewera, kupewa kuvulala pamimba, kuthana bwino ndi nthawi yake matenda onse omwe, mwanjira inayake, amayambitsa kuyambika kwa kutupa. Ngati munthu wadwala kale ndi mawonekedwe osachiritsika, ndiye kuti ayenera kutsatira malangizo a adokotala, amwe mankhwala onse mosamalitsa malinga ndi malangizo omwe waperekedwa.
Kuphatikiza apo, munthu sayenera kulola kupsinjika kwa mitsempha komwe kumatha kukhudza mkhalidwe wa thupi.
Kapangidwe ndi kagwiridwe kake kofotokozedwera kanema mu nkhaniyi.
