Pancreatitis ndi gulu la matenda ndi mawonetseredwe azachipatala, omwe machitidwe amtundu wa kapamba amawonekera. "Omwe akuvutika" ndimatendawa amaphatikizapo anthu omwe amagwiritsa ntchito kwambiri zakudya zamafuta, zakumwa zoledzeretsa.
Zakhala zikuwonetsedwa kuti mawonekedwe a matendawa amakula chifukwa cha zinthu zoyipa. Pathophysiology imayimiridwa ndi kuvulala kwa makina kapena mankhwala a pancreatic omwe amachitika chifukwa chogwiritsa ntchito yowonongeka - makristalo amchere, bile, solution ya hypertonic, etc. zinthu zomwe zimalowa mu minyewa yamkati.
Ziwerengero zimazindikira kuti njira yotupa imapezeka kwambiri mwa akazi kuposa amuna. Matendawa amakhudza odwala omwe ali ndi mbiri yamatenda am'mimba, onenepa kwambiri.
Ganizirani za kagawidwe ndi mitundu ya kapamba, komanso kudziwa kusiyana pakati pancreatitis yovuta kwambiri ndi kutupa.
Pancreatitis Gulu
Limagwirira kukula kwa kapamba kumachokera pakuwonjezera katundu mu ma ducts, ndipo ma enzyme omwe amalowa mkati mwa ziwalo zamkati amathandizira kuti awonongeke. Ngati pancreatitis yayikulu ikuwoneka (munkhaniyi tikulankhula za necrosis ya minofu), ndiye kuti matendawa amatengedwa ndi necrosis ya gawo lalikulu la kapamba.
Kunyalanyaza zizindikiritso ndi kusowa kwa chithandizo chokwanira kumayambitsa matenda a necrosis am'tsogolo, chifukwa, njira ya pathological imafalikira kwa ziwalo zina zotulutsidwa mu peritoneum.
Ngati michere yokugaya imalowa m'mimba, peritonitis imayamba. Panthawi imeneyi, kusowa kwa mankhwalawa kumabweretsa chiyembekezo chabwino - chowopsa.
Muzochita zamankhwala, mitundu ndi mitundu ya pancreatitis imasiyanitsidwa. Kutengera mtundu wa momwe matenda amapangidwira, matendawa ndi acute, achiyambiranso, osachulukitsa, okhalitsa komanso ochulukitsa a mtundu wodwala.
Mitundu ya kapamba owopsa:
- Fomu yokhazikika imadziwika ndi kutupa kwa kapamba;
- Ma hemorrhagic amawonekera motsutsana ndi kukoka kwa zotupa m'mimba;
- Pachimake pancreatic necrosis limodzi ndi kuphatikiza zamkati, zofunika minofu kuwonongeka.
M'mazithunzi ena, pancreatitis yovuta kwambiri imayambira limodzi ndi njira ya kutupa pachimake mu ndulu - munthawi iyi, cholecystopancreatitis yapezeka. Fomu ya purulent imadziwika ndi mapangidwe a mafinya mu kapamba.
Mtundu uliwonse wamatenda a pancreatitis amatha kukhala ndi mphamvu yosintha, kotero amatha kusuntha kuchokera kwina kupita kwina. Mwachitsanzo, mawonekedwe a hemorrhagic amatha kusinthidwa kukhala minofu necrosis ndi mapangidwe apamwamba a purulent.
Pachimake pancreatitis kumabweretsa mavuto osiyanasiyana - abscesses, hemorrhages angapo, fibrosis, minyewa atrophy, etc. pamaso pamavuto, matendawa amatha kukhala osavomerezeka, ngakhale atalandira mankhwala okwanira.
Matenda apathengo amatchedwa kutupa, kumapitirira pang'ono pang'onopang'ono. Zotsatira zake, fibrosis ya minofu yofewa kapena kuwerengera kwa pancreatic minofu imawonedwa. Kutengera zakumbuyo kwa mawonekedwe awa, kuchotsedwa kumalowetsedwa ndikuchulukirachulukira. Odwala nthawi zambiri amadwala matenda ashuga.
Mawonekedwe osagawika amagawidwa m'magulu awa:
- Maonekedwe a asymptomatic (latent) amakhala ndi nthawi yayitali wodwala kwa nthawi yayitali.
- Mtundu wam ululu umakhala ndi kupweteka kosalekeza m'mimba, komwe kumawonjezeka kwambiri panthawi yomwe matendawa amakula.
- Mawonedwe apompopompo. Kupweteka kwamatenda kumachitika kokha motsutsana ndi maziko a kufalikira kwa matendawa.
Mtundu wamafuta ngati cystic pancreatitis umachitika limodzi ndi mapangidwe a cysts. Ndizowona (zosadziwika kawirikawiri) komanso zabodza (zomwe zimapezeka pazithunzi zambiri zamankhwala).
Akapezeka ndi pancreatitis yogwira, pachimake njira yotupa imakhudzidwa, ndikuphatikizana ndi kufalikira kwamatenda a duodenum, chiwindi, ndi ziwalo zam'mimba.
Zizindikiro za pancreatitis pachimake
Chikhansa ndi gawo laling'ono lomwe limagwira ntchito zofunika kwambiri mthupi la munthu. Zimaphatikizanso kupanga michere yokugaya, yomwe imawongolera njira yabwino komanso yokwanira kugaya chakudya. Komanso kupanga insulini, kusowa kwa komwe kumabweretsa kukula kwa matenda ashuga.
Kusiyana pakati pa mtundu wa matenda komanso owopsa a nthendayi ndikuti pamapeto pake, mawonetseredwe azachipatala amatchulidwa kwambiri motsutsana ndi kumbuyo kwa matenda. Wodwalayo amadandaula za kupweteka kwakanthawi komanso kosalekeza kwa ululu, othandizira pakhungu samathandiza kuthetsa ululu.
Limagwirira ntchito ya chitukuko cha matenda pachimake amayamba chifukwa cha kuchepa kwa michere mu kapamba ndi ziwalo za mkati, zomwe zimabweretsa chiwonongeko chake. Akalowa m'zigawo zoyendera magazi, zizindikiro za poizoni m'thupi zimawonekera.
Kuphatikiza pa zowawa, wodwalayo ali ndi zizindikiro zotere:
- Kutentha kwambiri kwa thupi, kuthamanga kapena kuthamanga kwa magazi. Ndi kukula msanga kwa kutupa, mkhalidwe wodwalayo umachepa msanga, kutentha kumatha kukwera mpaka madigiri 40, lability ya magawo ochepa amadziwika;
- Maso a wodwalayo amawoloweka, khungu limasandulika. Popanda thandizo, khungu limakhala laimvi komanso lansontho. Khungu limazizira kukhudza, kuphimba thukuta;
- Kuukira mseru, hiccups, kusanza. Nthawi zambiri zizindikirozi zimatsagana ndi pakamwa lowuma, malamba. Kusunthika sikubweretsa mpumulo, m'matsamba mumakhala ma bile / zidutswa za chakudya chosasankhidwa;
- Kupanda chilimbikitso. Kudya kumayambitsa kusanza kosalephera. Kumayambiriro kwa matendawo pachimake pa matenda, sipangakhale nkhani ya chakudya, popeza kufa ndi njala ndiye njira yayikulu yolimbikitsira thanzi la wodwalayo
- Kusokoneza kwam'mimba, komwe kumawonetsedwa ndi chimbudzi nthawi zambiri kapena kudzimbidwa kwa nthawi yayitali. Poyerekeza ndi pancreatitis, ndowe mu utoto wambiri ndimadzimadzi, ndi kuphatikizika kwa thovu, pali tinthu tating'onoting'ono ta chakudya;
- Kupuma movutikira kumayamba chifukwa cha kuchepa kwa ma elekitirodi pakusanza. Kuphatikiza apo, thukuta likuwoneka, pali chikhazikitso chachikaso pachilime chaanthu.
Zizindikiro zina zodwala kwambiri zimaphatikizapo kuphuka, mpweya wowonjezereka, khungu, komanso kufinya kwa khungu. Ndi zizindikirazi, kuchuluka kwake kumapita kwa mphindi, chisamaliro chamankhwala chofunikira chimafunika.
Chithandizo cha pachimake kapamba
Pancreatitis yovuta kwambiri komanso yodwala imakhala ndi kusiyana komwe kumangowonetsa kuchepa kwa zizindikiro, komanso pamankhwala. Kusiyana kwake ndikuti kuukira kokhazikika kuyenera kuyimitsidwa pokhapokha ngati izi zingachitike.
Thandizo loyamba kwa wodwala limakhala kunyumba asanafike akatswiri azachipatala. Pofuna kuchepetsa ululu, chimfine chimayikidwa pamimba. Kugwiritsa ntchito mankhwala antispasmodic, mwachitsanzo, Papaverine, ndikuloledwa. Onetsetsani kuti mwakana chakudya chilichonse.
Maziko a chithandizo chathanzi ndi njala, mtendere ndi kuzizira. Sitikulimbikitsidwa kuchita zodzichitira nokha, chifukwa pali kuthekera kwakukulu kokhala ndi zovuta zingapo za matendawa.
Thandizo ladzidzidzi pakubwera gulu lachipatala limakhala ndi izi:
- Kuyambitsidwa kwa dontho lokhathamira ndi mchere.
- Mankhwala antiemetic, mwachitsanzo, Cerucal mu mlingo wa 10 mg.
- Kuthira mankhwala ochititsa dzanzi - Ketanov.
- Jakisoni wa mankhwala a antisecretory mu mlingo wa 250 mg.
Wodwala ayenera kuchipatala. Monga lamulo, pakumenya kwadzaoneni, matenda osiyanasiyana samachitika, chifukwa ndizosavuta kusiyanitsa ndi matenda ena. Ngati pali kukayikira kwa mtundu wowononga wa kapamba, ndiye kuti kuchitapo kanthu kwa opaleshoni ndikofunikira. Chithandizo chowonjezereka chimachitika mu dipatimenti yochita opaleshoni.
Chizindikiro cha laparoscopic ndondomeko ndi kukayikira kwamadzimadzi pamimba kapena zizindikiro za peritonitis. Izi zitha kuchitidwa pofuna kufotokoza bwino mavuto omwe amabwera chifukwa chodwala.
Chithandizo cha kapamba kuchipatala chimaphatikizapo:
- Kugwiritsa ntchito mankhwala okodzetsa kuteteza kutulutsa kwamkati ndi kuchotsa michere yokumba m'magazi. Furosemide kapena Diacarb ndi mankhwala (piritsi);
- Omez akulimbikitsidwa mu mlingo wa 80 mg patsiku;
- Ngati kusanza kulipo, makonzedwe a metoclopramide kudzera mu mtsempha akulimbikitsidwa;
- Mu nthawi yayikulu ya kutupa, m'mimba ma enzyme zotsekemera zimaperekedwa. Omwe akuyimira gululi ndi a Gordoks, Kontrikal.
Kwa pafupifupi masiku 3-6, wodwalayo amamulembera njala ndi kumwa madzi ofunda. Woopsa matenda, kusala kumatenga masiku 7-14.
Potsirizira pake, zakudya za makolo zimafunikira - kukhazikitsa mapuloteni ma hydrolysates ndi emulsions yamafuta.
Zina za chifuwa chachikulu
Mu matenda osachiritsika, kusintha kwakapangika mwa tiziwalo ta kapamba kumapezeka. Akatswiri azachipatala ambiri amakhulupirira kuti kusiyana kwakukulu pakati pa CP kuchokera pakuwukiridwa kovuta ndikuyenda patsogolo kwa masinthidwe a pathological mu chiwalo ngakhale atachotsa zomwe zimachokera.
Poyerekeza ndi momwe njira yotupa imagwirira ntchito, ulesi ndi kulephera kwa chiwalo nthawi zambiri zimapezeka.
Pakukhazikika kwa matenda osakhazikika, nthawi zingapo zimasiyanitsidwa. Woyambayo amatha kukhala zaka, nthawi zina amadzionetsa ngati zizindikilo, ndipo nthawi yomwe kuphwanyidwa kumayendetsedwa ndi chipatala cholimba, kuchepetsa kwambiri moyo wa wodwalayo.
Zizindikiro za kutupira kosalekeza zimakhala kwambiri komanso zofatsa. Nthawi zambiri, pakuchulukitsa, mawonetseredwe azachipatala amawonedwa, omwe amawonetsedwa pakuwonekera kwa matenda.
Wodwalayo amalangizidwa kuti azitsatira pafupipafupi zakudya zina, kumwa mankhwalawa a chinsinsi cha kuperewera kwa kapamba, antispasmodic mankhwala. Chithandizo cha spa cholimbikitsidwa kawiri pachaka.
Njira yovuta kwambiri yothandizira ndi zakudya. Si wodwala aliyense amene angakane maphikidwe ndi mbale zomwe amakonda. Mfundo zofunika kuzitsatsa:
- Zakudya zopatsa thanzi m'magawo ang'onoang'ono mpaka 6-7 pa tsiku. Mutha kudya mpaka 230 g ya chakudya nthawi.
- Kukana mafuta, zonunkhira, mchere komanso zakudya zonunkhira.
- Kukana / kuletsa zakumwa zoledzeretsa.
Zolakwika mu zakudya zimawonetsedwa ndi zowawa. Ndikofunikira kudya pang'ono pazoletsedwa, ndipo patapita maola ochepa, kupweteka m'mimba kumawonekera. Pofuna kuchepetsa kupweteka, gwiritsani ntchito mankhwala:
- Drotaverinum ndi antispasmodic yomwe imathandizira kuchepetsa kutupa m'matumba, motero, ululu wammbuyo umachepa;
- Sparex ndi antispasmodic, yodziwika ndi myotropic action. Amathandizanso kupindika m'matumbo am'mimba;
- Ndi mawonekedwe a edematous, Omez amatha kupatsidwa piritsi limodzi kwa masiku atatu. Kulandila kumachitika mu maphunziro owerengeka komanso monga adokotala amafotokozera.
Ndi nthawi yayitali ya matendawa, minofu yolumikizana yachilengedwe imasinthidwa ndi mafuta komanso zigawo zothandizirana, zomwe zimapweteketsa kutayika kwa gawo lamkati, chifukwa, matenda a shuga amakula, ndipo kupukusa kwathunthu kumasokonekera.
Kuti muchepetse kupweteka komanso kuchepetsa katundu pazinthu zowonongeka, ma enzymes am'mimba amafunikira. Lemberani mankhwala:
- Pancreatin
- Chikondwerero.
- Panzinorm.
- Mezim et al.
Njira zopewera matenda owopsa komanso matenda ophatikiza ndi zakudya zoyenera komanso zokhazikika. Ndikulimbikitsidwa kuchepetsa kumwa zakumwa zoledzeretsa, makamaka kuphatikiza ndi zakudya zamafuta.
About pancreatitis yayikulu komanso pachimake ikufotokozedwa mu kanema munkhaniyi.
