Pancreatitis pachimake ndi njira yotupa yotupa yomwe imachitika m'mapapo mothandizidwa ndi zinthu zingapo zopangitsa kuti munthu azidwala. Zimakhazikitsidwa ndi zoyipa zam'mimba zama enzymes, zomwe zimabweretsa kudzimbidwa kwa chiwalo.
Kudzimbidwa kwa tinthu tawo tomwe timayendera limodzi ndi kuchuluka kwa kapamba, kumakhala kutupa kwamphamvu ndi kufa kwa maselo, madera a necrotic (chiwonongeko) amapangidwa, omwe amapezeka motsutsana ndi maziko a kupweteka kwambiri kwa ululu.
Malinga ndi ziwerengero, matendawa amapezeka kwa odwala azaka zapakati pa 30 mpaka 60. Posachedwa, kuchuluka kwa odwala kudakulanso kangapo, komwe kumalumikizidwa ndi kumwa mowa mwauchidakwa, zizolowezi zoyipa zakudya.
Mu 20% ya milandu, pachimake gawo la matenda chifukwa cha pathologies a biliary thirakiti. Zina mwazomwe zimapangitsa ndizovulaza zam'mimba, zovuta zamankhwala ena, komanso mavuto omwe ali ndi kachilombo komanso matenda.
Amayambitsa ndi limagwirira a pachimake kapamba
Nthawi zambiri, mu kapamba, ma enzyme okugaya amapangidwa omwe amakhala osagwira. Pambuyo pake, amalowa m'matumbo, pomwe amasinthidwa kukhala mawonekedwe othandizira, amatenga nawo gawo pogawa mapuloteni, mafuta ndi chakudya.
Ndiye kodi pancreatitis yayikulu ndi chiyani? Njira yogwiritsira ntchito chitukukoyi imachitika chifukwa cha kuyambitsa koyamba kwa michere ya m'mimba, ndiye kuti, amayamba kugwira ntchito m'thupi lokha, zomwe zimabweretsa chimbudzi cha ziwalo zawo.
Lipase, yomwe imayambitsa kuphwanya kwamphamvu kwamafuta, imakhudza maselo a ziwalo zamkati, chifukwa chomwe mafuta adatembenuza izi. Active trypsin (amapukusa mapuloteni zinthu) amakhumudwitsa kutulutsa kosiyanasiyana kwamankhwala komwe kumayambitsa kutupa, kutupa ndi kupweteketsa mtima. Kulephera kupereka chithandizo chamankhwala kumachitika kwambiri.
Izi zimachitika mthupi la munthu zimapangitsa kuti gland iwonjezeke, mawonekedwe a necrotic foci mu minofu yake (maselo amafa). Kumayambiriro kwa njira ya pathological, kufa kumadziwika ndi matenda (mulibe matenda), koma ndikupita patsogolo kwa matendawa kumalumikizana, komwe kumayambitsa purcin necrosis, mapangidwe a foci omwe ali ndi nkhani za purulent. Zikatero, pakufunika opaleshoni yomweyo.
Zifukwa zomwe zimayambitsa zovuta za michere:
- Zakumwa zoledzeretsa;
- Pathology ya biliary thirakiti (muma penti ambiri ndi cholelithiasis);
- Kuvulala kwam'mimba;
- Zizolowezi zoyipa kudya (yokazinga zakudya pamimba yopanda kanthu);
- Njira za endoscopic pomwe kapamba amavulala;
- Kumwa mankhwala osokoneza bongo okwanira, komwe kumayambitsa poizoni. Metronidazole, tetracycline, ndi mankhwala ena amakhudza gland;
- Matenda a endocrine chikhalidwe. Mwachitsanzo, hyperparathyroidism.
Matenda opatsirana komanso mavairasi ofanana ndi herpes simplex virus, mycoplasma, etc. amakhudzidwa ndi minyewa ya pancreatic, yotsatiridwa ndi njira yoyeretsa komanso kuyambika kwa pancreatitis pachimake.
Mawonetseredwe azachipatala
Zizindikiro za pancreatitis pachimake zimayamba msanga. Kuukira kumadziwika ndi ululu wa herpes zoster. Zimapweteka mu hypochondrium kumanja kapena kumanzere, malo otchingidwa. Ululu uli ndi katundu wopereka mbali yakumanzere kumbuyo, pansi pa masamba.
Ululu umawonedwa nthawi zonse. Ngakhale motsutsana ndi momwe mankhwalawo amathandizira, amapitilira kwakanthawi, ndipo mphamvu zake sizisintha. Zomwe zimayambitsa chizindikiro ichi ndi kufa kwa minofu yofewa komanso mizu ya mitsempha ya kapamba.
Ndi ululu wam'mimba wotupa m'matumbo, odwala ena amachepetsa, pomwe ena amadana ndi chakudya. Izi ndi zotsatira za kuchepa pakumachotsa michere yam'mimba m'matumbo.
Zizindikiro zina:
- Kusanza, pambuyo kusanza mobwerezabwereza, komwe kumayambitsa kudya. Tizilombo toyambitsa matenda tizilombo toyambitsa matenda timakhala chifukwa cha kusowa kwa zinthu zomwe zimafunikira pakudya kwakuthupi. Kupumira sikubweretsa mpumulo. Choyamba, m'masanzi mumakhala zidutswa za chakudya, mutatha kusanza tu bile.
- Ngati wodwalayo akula kwambiri purulent foci mu kapamba, ndiye kuti zizindikiro za kuledzera zimonekera. Kutentha kwa thupi kumakwera mpaka madigiri 38, kumayendetsedwa ndi kutentha, kuzizira. Kukoka kumachitika pafupipafupi - kumenyedwa kopitilira 90 pamphindi, khungu limakutidwa ndi thukuta lomata, kukuyamba kuzizira. Amapumira pafupipafupi komanso mwamphamvu.
- Ndi ululu waukulu, chizindikiro cha kugwedezeka chimawonedwa - uku ndi kuchepa kwa magazi.
- Mimba yam'mimba imatupa, chifukwa njira yotsegulira imasokonekera.
- Khungu limakhala lotumbululuka, nthawi zina limakhala lamtambo.
Pa palpation, khoma lam'mimba ndilovuta. Kugunda pachimake kumadziwika ndi zizindikiro za cyanosis, zomwe zimachitika chifukwa chakuchepa kwa kuchuluka kwa madzi ozungulira mthupi, kusanza kwambiri komanso kutsegula m'mimba pafupipafupi.
Wodwala akapanda kuthandizidwa, akhoza kufa.
Zizindikiro
Kuukira kovuta sikuyenera kuthandizidwa payokha kunyumba. Othandizira opaleshoni sangathe kuchepetsa ululu, osakhudza zomwe zimayambitsa matenda. Wodwalayo amafunika kuwunika mozama komanso kumuthandiza pambuyo pake pancreatitis pachimake kuchipatala.
Kuzindikira kumakhala kosiyanasiyana mu chilengedwe, popeza njira yotupa yotupa imafanana ndi ma pathologies ena am'mimba komanso m'mimba. Atavomereza kupita kuchipatala, kuyezetsa thupi kumachitika, ndikutsimikizira khoma lam'mimba. Pali kusowa kwathunthu kwamatumbo motility.
Kuyesedwa kwa magazi ambiri kumatengedwa, komwe kumathandiza kuzindikira zizindikiritso zosatsatirika za njira yotupa. Kuwonjezeka kwa kuchuluka kwa leukocytes kumawonedwa, kuchuluka kwa erythrocyte sedimentation mu plasma ya magazi kumakulanso.
Kuyesedwa kwa biochemical magazi pakuwonekeratu:
- Zolemba za amylase zochulukirapo;
- Kuzungulira kwa lipase kumachulukitsa;
- Kukula kwa shuga mthupi;
- Zinthu zonse zomanga thupi zimakhala zochepa;
- Urea m'magazi imakula.
Chifukwa cha kusanza kosalephera, zizindikiritso za kusowa kwamadzi nthawi zambiri zimawonedwa. Chipatalachi chimatsimikiza ndikuchepa kwa calcium, potaziyamu ndi sodium m'magazi. Pakuwukiridwa kovuta, zinthu za amylase mumkodzo zimakulanso.
Kufufuza kwa Ultrasound kwa ziwalo zopangidwira mkati kukuwonetsa kukula kwake, kuchuluka kwa zinthu zachilengedwe, malire osagwirizana, kupezeka kwa madzimadzi aulere m'malo omwe ali kumbuyo kwa peritoneum akupezeka.
Ngati njira zomwe zafotokozedwerazi sizilola kukhazikika molondola kuti kuwonongeka kwa mkhalidwe wa wodwalayo kumachitika chifukwa chakuwopsa kwa kapamba kakakulu, njira ya laparoscopic imagwiritsidwa ntchito. Amatha kuzindikira zizindikiro zotsatila za matendawa:
- Hemorrhagic madzimadzi.
- Amabereka pa peritoneum ndi kapamba.
- Kutulutsa magazi pang'onopang'ono pamtunda wa peritoneum.
Zizindikiro zosadziwika zomwe zikuwonetsa kuti chiwopsezo cha matenda ophatikizika chimaphatikizanso kuphatikizika kwa ndulu, kupindika kwam'mimba, kutupa kwa mafupa a chiwindi.
Mankhwala
Kupanda thandizo pakulimbana kwadzaoneni kumapha. Wodwala ambulansi amatengedwera kumalo osamalirira odwala kwambiri, amawunika, mankhwala ochita opaleshoni amachitidwa. Pambuyo pakuzindikira, chithandizo choyenera chimaperekedwa poganizira mawonetseredwe amtundu wazovuta ndi zovuta zina.
Pa chithandizo, katswiri wa zamankhwala amavomereza kuti anthu azikhala ndi njala. Izi zimakuthandizani kuti muchepetse katundu kuchokera kanyumba zoyipa. Pambuyo pa chithandizo, zakudya zamafuta zimayikidwa. Chakudyacho chimaphatikizapo zakudya zosasamalidwa zokha komanso chakudya chamafuta.
Olemba pakamwa pothandizira ululu sangapereke zotsatira zomwe mukufuna. Pofuna kuthana ndi vuto la wodwalayo, mitundu ingapo yamasamba imagwiritsidwa ntchito, mwachitsanzo, mankhwala opha ululu ndi kukhazikitsa kwa mankhwala oletsa kupweteka kudzera mu catheter.
Popetsa kugwiritsira ntchito mankhwala osokoneza bongo monga Baralgin, Tramadol. Ngati ululu wamankhwala ulibe pakati, ndiye kuti No-shpu amathandizira kudzera m'mitsempha. Kusintha kwa magazi mthupi, mankhwala amatumizidwa:
- Hemodez;
- Reopoliglyukin.
Pofuna kupewa zoyipa, kuchulukitsa kwa cholecystitis, yomwe nthawi zambiri imakhala imodzi mwazifukwa zomwe zimayambitsa kuvulala kovuta, muyenera kuchotsa ma enzymes m'thupi. Chifukwa cha izi, kukakamiza diuresis kumachitika, pambuyo pake Lasix diuretic imalembedwa.
Kubwezeretsa madzi ndi electrolyte bwino m'thupi, zothetsera zimayambitsidwa kudzera m'mitsempha, zomwe zimaphatikizapo mchere pakapangidwe kake. Zizindikiro zakugwedezeka (kuthamanga kwa magazi) zimachotsedwa ndi Albumin.
Pofuna kupewa zovuta za septic ndi peritonitis, amagwiritsa ntchito antibacterial othandizira omwe amawonekera kwambiri - Metronidazole.
Kuchepetsa kaphatikizidwe ka michere yamagaya, kugwiritsa ntchito ma statins (somatostatin), Protease inhibitors amakono (Gordox). Mankhwala a antisecretory akulimbikitsidwa (mutha kumwa Omez chifukwa cha kapamba) - amathandizira kuti asatulutse zomwe zili m'mimba, chifukwa hydrochloric acid ndiwothandiza kwambiri popanga ma enzymes am'mimba.
Ngati pancreatitis idasinthidwa kukhala gawo la purulent complication, ndiye kuti kuchitapo kanthu kwa opaleshoni ndikofunikira. Amachitidwa pansi pa mankhwala oletsa kupweteka kwambiri komanso mapapo. Pa nthawi ya opareshoni, minofu "yakufa" imayikidwa.
Mavuto aukali
Kuukira kovuta kumabweretsa kukula kwamavuto ambiri. Kutengera nthawi yomwe amapezeka, amalembedwa m'mavuto oyambilira komanso mochedwa. Zoyambazo zimatha kukulira nthawi imodzi ndi zizindikiro zoyambirira za matenda. Zimakhazikitsidwa ndikutulutsidwa kwa michere yamagayilo m'thupi. Mavuto obwera pambuyo pake amapezeka pakadutsa masabata 1-2, chifukwa chachiwiri.
Hypovolemic mantha amatengera kuchepa kwamphamvu kwamadzi oyenda mthupi la munthu, komanso kuwonongeka kwa michere. Ziwalo zonse sizilandira kuchuluka kwa mpweya kwa ntchito wamba, matupi amtundu wa insufficiency amakula.
Pa gawo la kupuma kwamphamvu, kuwonjezereka kwa mawonekedwe a exudative kumayamba, kulephera kupuma, kugwa kwamapapu. Mavuto ena oyambirira amaphatikizapo:
- Kuwonongeka kwa chiwindi. Zojambula zopepuka zowonetsedwa ndi jaundice yovuta. Woopsa, hepatitis yovuta kwambiri imachitika. Chomwe chimapangitsa ndikuwopseza komanso kuwopsa kwa michere. Pangozi ndi odwala omwe ali ndi mbiri yamatenda aliwonse omwe ali ndi chiwindi - amatha kuphedwa.
- Kulephera kwamkati (kumayambitsa kufanana ndi kulephera kwa chiwindi).
- Kuphwanya magwiridwe antchito a mtima.
- Kutulutsa magazi mkati.
- Peritonitis ndi njira yotupa m'mimba. Zimachitika popanda matenda kapena purulent.
- Matenda a m'maganizo amayamba chifukwa cha kuwonongeka kwa ubongo chifukwa cha kuledzera kwambiri.
Zochitika mochedwa zimaphatikizapo poyizoni wamagazi, zotupa za purulent m'mimba, kutulutsa kwamkati pamimba, mapangidwe a fistula, kapamba ka neancosis, mapangidwe a pseudocysts, tumor neoplasms, etc.
Kuneneratu kwa kapamba kumadalira mawonekedwe, zokwanira ndi nthawi yayitali ya chithandizo, kupezeka / kusakhalapo kwa zovuta zoyambirira. Ndi mawonekedwe ofatsa, matendawa ndi abwino. Ngati pali zotupa za necrotic kapena hemorrhagic, ndiye kuti chiopsezo cha kufa chimawonjezeka kangapo. Kusakwanira kwa chithandizo chamankhwala komanso kusatsatira malangizo a dokotala komanso zakudya kumabweretsa chitukuko cha ulesi cha kapamba - chifuwa chachikulu.
Zambiri pa pancreatitis pachimake zimaperekedwa mu kanema munkhaniyi.
