Mdziko lomwe mulibe nthawi yotsalira ya chakudya choyenera komanso chopatsa thanzi, matenda a kapamba - kapamba, matenda a shuga ndi matenda ena okhudzana ndimadyedwe oyipa amapezeka nthawi zambiri.
Kutupa kwamkati kumawonekera chifukwa cha ululu wowopsa, womwe sungathe kuchiritsidwa ndi opweteka, limodzi ndi kusanza mobwerezabwereza, chimbudzi, ndi kudzimbidwa.
Zikondazo zimalumikizana kwambiri ndi ziwalo zina zamkati. Ngati magwiridwe ake aphwanyidwa, izi zimakhudza ntchito yonse yamoyo yonse. Komabe, ndizosatheka kupanga matenda kuchipatala chimodzi; maphunziro a labotale ndi othandizira amafunikira.
Chifukwa chake, kodi mfundo zowawa mu kapamba zimatanthawuza chiyani? Ganizirani za Shoffar, Kach, Mayo-Robson ndi madotolo ena omwe atsimikiza ndi palpation.
Kuzindikira ndi mfundo za palpation mu kapamba
Malinga ndi mawonetseredwe azachipatala, sitinganene kuti kuwonongeka koopsa m'moyo wa wodwalayo kumagwirizanitsidwa ndendende ndi kupweteka kwamatenda a kapamba. Kuphatikiza pa mawonekedwe amachitidwe a pathological, mitundu yosiyanasiyana ya kutupa kwa kapamba imasiyanitsidwa, yomwe imalumikizidwa ndi zotsatira zoyipa zamtundu wina.
Kuti mudziwe bwino wodwalayo, muyenera kupenda mosamala. Wodwalayo amakayezetsa magazi, kuyezetsa mkodzo, kukopera, ma CD, ma radiology, CT, MRI amachitidwa.
Kufufuza kwakuthupi koganiza kuti kakulidwe kenakake kovutitsa kamakhudzidwa kumakhudza palpation malinga ndi njira yokhazikitsidwa. Njirayi imakhazikika pakumva kuwawa m'malo ena ndi kuzindikira kwa malo phunziroli. Chithunzi chilichonse chimakhala ndi zake.
Madera a pancreatitis amadziwika ndi olemba, omwe adatchulidwa pambuyo pa akatswiri azachipatala omwe adasanthula izi. Mwachitsanzo, chizindikiro cha Shoffar ndi kapamba, Kacha ndi madotolo ena.
Palpation ngati matenda adayamba kugwiritsidwa ntchito kumapeto kwa zaka za m'ma 1900, pomwe kunalibe zida zapadera zothandizira kudziwa zomwe zimayambitsa kupweteka kwambiri komanso kupweteka kwa wodwala. Madokotala adagwiritsa ntchito zala zawo pakuyesa. Muzochita zamakono zamankhwala, njira ya palpation imakwaniritsa ukadaulo - ultrasound, MRI.
Ubwino wake ndikuti mothandizidwa ndi palpation mutha kukayikira mwachangu pancreatitis, makamaka, mwachangu momwe mungayambire chithandizo chokwanira. Mwa munthu wamkulu yemwe alibe kuphwanya kwa kapangidwe kake, ndizosatheka kukweza chiwalo.
Potengera komwe palpation ndi kukhudzika kwa kapamba, kumayenera kuwunika mosamala kusintha kwa chikhalidwe cha kupweteka kwa wodwala.
Zizindikiro zazikulu
Popanga njira yodziwira, palpation ndi gawo lazodziwonetsa, kuwonetsa kutanthauzira kwa zopweteka, kusintha kwawo pakukakamiza. Chizindikiro cha Voskresensky cha pancreatitis chimafotokozedwa ngati kusowa kwa chiwopsezo chomenya khoma la msempha - mdera lomwe mumalumikizana ndi kapamba.
Apa pali masentimita asanu pamwamba pa navel pomwe amasuntha masentimita anayi kulowa kumalo owonetsera ndulu ya gallbladder. Kuti mudziwe chizindikiro cha Voskresensky ndikofunikira kujambula zala kuchokera ku dera la epigastric kupita ku chiwonetsero cha chiwindi ndi zovala zowonda. Mu 70% ya kapamba owopsa, zotsatira zabwino zimapezeka. Mankhwala, chizindikiro ichi chili ndi dzina lina la "chovala cha malaya."
Kuwonetsedwa kuchipatala kwa Mayo-Robson kumatsimikiziridwa ndi kupweteka kwambiri m'deralo komwe kuli polojekiti ya thupi ndi mchira. Kuti mudziwe mfundo, mzere umakokedwa kuchokera kumchombo kupita pakati pa nthiti yakumanzere. Chisoni chidzamvekedwa pamtunda wachitatu wa mzerewu.
Chizindikiro ichi ndichilengedwe 50% cha zithunzi zamankhwala. Itha kutsimikizidwa ndi kupanikizika kwapang'onopang'ono - kuwonjezeka kwa ululu kumawonetsa kukulira kwa kuukiridwa kwakuthwa.
Zizindikiro zina:
- Shoffar Zone. Kulimba kumafotokozedwa pakati pa mzere wakutsogolo wapakatikati ndi mzere womwe umalumikiza msomali kumanja kumanja ndi kuponderezana kumatsitsidwa kumzere wapakati wa Desjardins;
- Chizindikiro cha Kerth ndi kupweteka palpation pamalo omwe ali patali masentimita 5 pamwamba pa msana kulowera kwenikweni. Kupezeka mu 65% ya zojambulazo. Komanso chizindikirochi chimawoneka ngati chabwino ngati mavuto azachuma am'mimba m'chigawo cha epigastric apezeka;
- Zomwe Kach akunena pancreatitis ndizopweteka kumbuyo kwa kukhudza kukhudzika kwa mchira wa chida chogaya. Malo amalo: dera la kusintha kwa njira ya 8 ya thoracic vertebra. Nthawi zina wodwala kapamba, amatha kuwonetsa khungu pakadali pano;
- Chizindikiro cha Razdolsky chimapezeka pafupifupi pazifukwa zonse za pancreatitis pachimake. Imayendera limodzi ndi ululu wowopsa womwe umachitika pakhungu pakhungu m'dera la pancreas. Zimatengera kutupa komwe kumachitika m'mimba.
Komabe, palpation sikokwanira kupanga matenda - kuzindikira kwathunthu kumachitika nthawi zonse, chifukwa kuukira kovuta kumatha kuyambitsa matenda ena - cholecystitis, cholelithiasis.
Kupezeka kwa zizindikiro zomwe zafotokozedwayi ndiye chifukwa chakuchipatala komwe wodwalayo amathandizira kuti amupimitsenso kuchipatala.
Zizindikiro pa palpation
Kuphatikiza pa omwe alembedwa pamwambapa, mutha kutchula zizindikilo zina zomwe zimatchulidwa pambuyo pa madokotala ndipo zimatsimikiziridwa ndi palpation. Zomwe zakhala zikufotokozedwa kale zikuwoneka kuti ndizofala kwambiri, motere, nthawi zambiri zimawathandiza.
Chizindikiro cha Mondor, malinga ndi madokotala, chimawonetsedwa pafupifupi pazonse zokhudzana ndi pancreatitis yovuta kapena yogwira. Zimayendera limodzi ndi mawonekedwe amtundu wakuda wa tint wabuluu pakhungu la munthu. Amawoneka pathupi komanso pankhope. Cholinga chake ndikulowerera kwa zinthu zapoizoni zomwe zikondamoyo zimalowa mkati mwake.
Chizindikiro cha Grott chimadziwika ndi matenda opweteka kwambiri, omwe amapezeka nthawi zina. Pali zingapo, chilichonse chimakhala ndi dzina lake, chimathandizira kutsimikizira kutupika m'mchira, m'thupi kapena kumutu kwa chindayo.
Pa palpation amatsogozedwa ndi izi:
- Desjardins. Ululu umadziwonekera pa malo omwe ali masentimita 4 pamwamba pa msana wolumikizana ndi chingwe. Wabwino mu 71%, makamaka motsutsana ndi maziko a matenda owononga.
- Munjira yotupa kwambiri, zotsatira zabwino zimapezeka nthawi zambiri ndi kukakamiza pamalire, omwe amapezeka mu fossa ya minofu ya sternocleidomastoid. Dzinalo la chizindikirocho ndi chizindikiro cha Mussie-Georgiaievsky. Zimayambitsidwa ndi kupweteka kwambiri kwa khoma lam'mimba, kukwiya kwa mitsempha yotsiriza.
Ndikofunika kudziwa kuti chizindikiritso cha Mussie-Georgiaievsky ndichabwino osati pokhapokha chifukwa cha kapamba, komanso kutupa kwa ndulu. Chifukwa chake, kupezeka kwake sikukuzindikira kotsirizira, kuzindikira kwakofunikira kumafunikira.
Chizindikiro cha Tuzhilin chimaphatikizika ndi mawonekedwe a mawanga ofiira pakhungu, kukula kwake mpaka mamilimita anayi. Zimatsimikiziridwa ndikuyambiranso kwa ulesi.
Chithandizo cha kuvulala kwambiri chikuchitika mu chipatala. Pambuyo pakuchotsa, muyenera kutsatira kadyedwe, kumwa mankhwala okhazikitsidwa ndi dokotala. Kuphatikiza apo, njira zosakhala zachikhalidwe zimagwiritsidwa ntchito - ma massage complexes, acupuncture, decoctions azitsamba, etc.
Zambiri pazizindikiro za kapamba zimaperekedwa mu kanema munkhaniyi.
