Zizindikiro za hepatomegaly ya kufalitsa kusintha kwa chiwindi ndi kapamba

Chiwindi ndi kapamba (kapamba) zimagwira ntchito kwambiri pamizimba yam'mimba, yokhala ndi mndandanda wonse wa ntchito zamthupi.

Chifukwa cha kuchuluka kwa ntchito yake, ziwalo zamagulu zimagwiritsidwa ntchito m'njira zosiyanasiyana: kutupa, necrosis, autolysis, defuction. Mwa zina zosatupa, koma zofala kwambiri, hepatomegaly ndikuyambitsa kusintha kwa chiwindi ndi kapamba zimawonekera.

Kuzindikira kofananako kumamvedwa ndi odwala pambuyo pa kuyezetsa magazi ndi chiwalo cham'mimba, koma sizimangotanthauza kuti matenda oopsa.

Zomwe zimayambitsa gulu lino la zamatsenga ndizambiri. Kuyambira pa kukanika kwa wamba bile duct ndikumaliza ndi kuphwanya shuga.

Anatomy ndi physiology ya chiwindi ndi kapamba

Chiwindi ndi gawo lalikulu, lopanda dzanja, lochita masewera olimbitsa thupi lomwe limagwira ntchito zingapo. Ili pamimba yoyenera. Ili moyandikana ndi khoma lakumunsi kwa diaphragm, 12th matumbo, kapamba, m'mimba ndi impso yakumanja.

Chiwalocho chili ndi ma loboti akumanja ndi kumanzere olumikizidwa ndi ligament. Chiwindi chimakhala ndi ma cell ambiri ochita masewera komanso magazi.

Amadziwika ndi zamankhwala, zofunikira zofunikira ndi chiwalo:

1. Wopusa. Mu hepatocytes (maselo olimba a chiwindi), bile amapangidwa, omwe amathandizira kugaya mafuta.
2. Mapuloteni. Ndi anthu ochepa omwe amadziwa, koma mitundu yonse ya mapuloteni amapangidwa m'chiwindi, popanda thupi la munthu sakanakhala ndi tsiku. Izi zimaphatikizapo albumin, ma globulin ndi mapuloteni omwe akukhudzidwa ndimayendedwe oyambitsa magazi ndi magazi.
3. Ntchito yosefera imagwira ntchito yoyeretsa magazi kuchokera ku zinthu zodetsa zomwe zimapezeka m'maselo a thupi.

Ndikusintha kwa pathological kapangidwe ka chiwindi, kuphwanya kwa ntchito izi kumachitika, komwe kumayambitsa mikhalidwe yayikulu ya thupi.

Mphepoyi ilinso chigawo chachikulu, chosatupa, cha parenchymal chomwe chili m'mimba.

Minofu yake imapangidwa ndimayunitsi omwe amagwira ntchito - pancreatocytes. Ambiri mwa kapamba amatenga malo amtunduwu. Ndiye kuti, mahomoni omwe amayambitsa kuwonongeka kwa mapuloteni ndi zakudya zimapangidwa mkati mwake. Ndi gawo la procrine lomwe "pancreatic juice" limapangidwa.

Gawo lakumapeto kwa kapamba limayimiridwa ndi zisumbu za Langerhans. Amapanga mahomoni angapo omwe amayambitsa kagayidwe kazachilengedwe ka magazi. Choyamba, ndi insulin ndi glucagon, yomwe imayendetsa kagayidwe ka glucose.

Ndi kusintha kwa pathological mu chiwalo, kugaya chakudya ndi endocrine matenda amachitika.

Etiology ya chitukuko cha matenda

Popeza chiwindi ndi kapamba zimagwira ntchito zosiyanasiyana, zinthu zambiri zimakhala ngati zomwe zimayambitsa matenda.

Chiwindi chachikulu ndi kapamba ndizodziwikiratu zomwe zimayambitsa kukhudzidwa kwa zinthu zakunja ndi zina zoyipa pakugwira ntchito kwa ziwalo.

Zomwe zimayambitsa matenda a pathological organ:

• mphamvu ya zakumwa zochokera kunja kapena zopangidwa mkati, zinthu monga: uchidakwa, kusuta fodya, kugwiritsa ntchito mankhwala osokoneza bongo, mankhwala osokoneza bongo omwe ali ndi hepatotoxic athari, chithandizo chosavomerezeka cha matenda ashuga komanso zovuta zina za metabolic;
• Matenda opatsirana omwe gawo la parenchyma limakhudzidwa mwachindunji ndi chizindikiro cha hepatitis ya viral, kuwonjezera, hepatomegaly imatsogolera ku virusi mononucleosis yoyambitsidwa ndi kachilombo ka Epstein-Barr kapena cytomegalovirus, malungo, leptospirosis, pseudotuberculosis ndi ena;
• matenda a metabolic: systemic amyloidosis, matenda a Wilson-Konovalov, matenda a Gaucher, Cartagener syndrome;
• mtima ndi mtima matenda - pachimake koronare, kuwonjezeka mavuto mu m`mapapo mwanga magazi, aneurysms, vasculitis, varicose mitsempha;
• matenda a oncological ndi hematological - khansa ya pachimake komanso yovuta, lymphogranulomatosis, lymphomas, hepatocarcinoma, khansa ya kapamba, khansa ya impso;
• Matenda ena - chiwindi lipomatosis, kunenepa kwambiri kwa chiwindi, amyloid dystrophy, malo enaake a metrase, metastases ya zotupa zina mu chiwindi, kapamba.

Kwa ma pathologies awa, hepatosplenomegaly ndiwodziwika kwambiri, ndiko kuti, kuwonjezera osati pachiwindi, komanso ndulu.

Zizindikiro zamatendawa

Chizindikiro cha hepatomegaly ndikuwonetsa kusintha ndichuma chochuluka.

Ndikosavuta kuchita ma diagnostics osiyanasiyana ngakhale kwa dokotala wodziwa zambiri.

Nthawi zambiri, odwala omwe amabwera kwa dokotala ndi matenda amtunduwu amapereka madandaulo osakhala achindunji.

Madandaulo awa ndi:

1. Kufalikira. Nthawi zambiri, chifukwa cha kukula kwa chiwindi, khoma lam'mimba limatuluka. Izi zimapereka chithunzithunzi chamimba yayikulu, yotupa. Koma adotolo, mothandizidwa ndi palpation ndi percussion, amatha kudziwa kukula kwamtundu wina wa parenchymal wa kukula kwam'mimba.
2. Zovuta kapena kusasangalala kumanja, pansi pa nthiti. Zomverera zoterezi zimayenderana ndi kutalika kwa kapisozi kachiwalo, komwe kali ndi mathero a mitsempha, kuwonjezera, zoterezi zimatha kuchitika chifukwa cha kukakamiza kwa ndulu ya ndulu.
3. Ululu, kachiwiri, ndi chifukwa cha kutalika kwamphamvu kwa kapisozi kachilengedwe kwam'mimba. Ululu ndi chinthu chosasinthika, chomwe chimawonetsa kunyalanyaza kwa njirayi.
4. Kuphwanya mobwerezabwereza ndi mawonekedwe aulesi ndi chiwonetsero cha dyspeptic syndrome, chomwe chimayamba chifukwa cha kuchepa kwa enzyme.
5. Mseru ndi kusanza zimatha kukhala zapakati kapena zotumphukira. Mtundu wapakati ukhoza kukhala chiwonetsero cha zotsatira za michere ya chiwindi ndi pigment ku ubongo. Kusanza kwamtunduwu ndi mseru kumadziwika ndi liwiro lopanda malire. Kusiyanasiyana kwa zotumphukira kumalumikizidwa ndi matenda am'mimba, komwe nthawi zambiri kumakhala kutsutsana pang'ono ndi mseru.
6. Kukhazikika pansi. Kusintha kwamatumbo kwa wodwala ndi hepatomegaly kumatha kukhala kosiyanasiyana. Kuphatikizapo kutsegula m'mimba, kudzimbidwa, kusinthasintha, kusasinthika.
7. Kupuma kwapadera kwa hepatic kumalumikizidwa ndi kuperewera kwa poyizoni.

Kuphatikiza apo, mkhalidwe wamba wa wodwalayo ukusokonezeka. Odwala amakhudzidwa ndi kugona, kumangogwira ntchito kwambiri, kukumbukira komanso kusamala.

Ma syndromes apadera a hepatomegaly

Pali zizindikiro zomwe zimafotokoza kwambiri matenda a chiwindi.

Thupi loyimbira khungu ndi zotupa za mucous. Mwanjira ina, mthunzi wovuta kwambiri. Chizindikiro ichi chimalumikizidwa ndi zambiri za bilirubin pigment m'magazi. Aepuse icteric hue angatanthauze impephalopathy yomwe ikubwera.

Cholestasis syndrome, yomwe imawonetsedwa mwa kuwongolera kwambiri khungu osawoneka ngati zotumphukira zake. Cider wa zakumwa zoledzeretsa pankhaniyi akufotokozedwa ndi malungo, kusintha kwa magawo a labotale, kuphwanya wamba.

Hemorrhagic syndrome imachitika pamene kusintha kwa kapangidwe ka mapuloteni amomwe amapezeka. Metabolic Disorder Syndrome. A cytolysis syndrome, yomwe imavuta kudziwa kuchipatala, koma imapezeka bwino pogwiritsa ntchito njira zofufuzira zasayansi. Mesenchymal kutupa syndrome kumakhalanso kovuta kukhazikitsa popanda kuyesa kwa labotale.

Ma syndromes onsewa ayenera kutsimikiziridwa labotale komanso yothandizira.

Njira zodziwira matendawa

Matendawa amatha kudwala mwa chaka chimodzi, koma ndikukaikira pang'ono, mndandanda wathunthu wamaphunziro uyenera kuchitika.

Pazidziwitso zoyenera, njira zingapo zoyeserera ndi zasayansi zimagwiritsidwa ntchito.

Mukangolandira zotsatira zonse za kafukufukuyu, mutha kudziwa bwinobwino.

Mayeso othandizira ndi a labotale ndizovomerezeka:

• Ultrasound ndi njira yofufuzira yofufuzira, ndi thandizo lake mutha kuyang'ana kapangidwe, kukula kwa chiwalo, kuzindikira ma neoplasms, ndikuwunikanso kayendedwe ka magazi;
• kuyerekezera kophatikizidwa ndi maginito kumathandizira kuzindikira koyenera komanso kutsimikizika kwa matendawa, kumakupatsani mwayi wodziwa metastases pang'ono panjira ya oncological;
• x-ray yam'mimba komanso chifuwa chamkati, mtundu wodziwikiratu ndiwo mulingo chifukwa chazidziwitso zake ndikupezeka;
• kuyezetsa magazi konse kumakupatsani chidwi chokhudzana ndi kusintha kwamomwe magazi amapangidwira, makamaka, kuchuluka kwa ma protein kuyenera kuwerengedwa;
• kusanthula kwa magazi a biochemical ndiko muyezo wa "golide" wofufuzira matenda a chiwindi ndi kapamba, mukamagwiritsa ntchito mutha kuyesa kuchuluka kwa bilirubin, alkaline phosphatase, mapuloteni athunthu, michere ya chiwindi (ALT, AST), urea, glucose unit kuchokera kwina;
• kuyesa kwa serological kwa ma virus a hepatitis ndi ma virus ena a hepatotropic;
• kuyesa kwa fibrosis ndi necrotic ntchito;
• coagulogram.

Kuphatikiza apo, zinthu zimatengedwera ngati chiwopsezo cha chiwindi - chothandiza kwambiri, koma njira zowonekera zodziwira matenda. Mothandizidwa ndi ultrasound, gawo lina la ziwalo limatengedwa kuchokera kwa wodwala ndikutumizidwa ku labotale yachipatala kuti akamuyeze.

Matenda a kapamba ndi Njira Zochizira

Popeza chiwindi ndi kapamba zimaphatikizidwa muntchito yawo, kupangika kwa gawo limodzi kungayambitse matenda a chiwalo chachiwiri.

Nthawi zambiri, kupweteka kwamphamvu kwa pancreatitis kumabweretsa hepatomegaly.

Izi ndichifukwa cha ntchito yapamwamba kwambiri ya mtima kapena kukula kwa mitundu yayikulu ya matenda a shuga a mitundu yonse iwiri.

Madokotala azachipatala omwe amapangitsa kuti asinthe pama chiwindi ndi kapamba:

1. Njira zopatsirana.
2. Matenda a m'matumbo, kuphatikizapo cystic fibrosis.
3. Matenda osachiritsika

Kuphatikiza apo, kuchepa kwa minofu yamafuta kumatha. Kuwongolera kwa odwala omwe ali ndi hepatomegaly ndikusintha kosintha ndi njira yovuta ndipo imafunikira chidziwitso chokwanira cha matenda. Malangizo a algorithm zimatengera ukadaulo wa njirayi. Chithandizo chiyenera kuthandizidwa mwanjira inayake komanso mwamakhalidwe.

Choyamba, chakudya chimakhazikitsidwa hepatomegaly cha chiwindi ndi kapamba. Imaperekanso mtundu wapadera wa zakudya za odwala omwe amakhala ndi chidwi kupatula zomwe zimapangitsa kuti zinthu ziwonongeke. Gome lazakudya limayikidwa ndi dokotala wopezekapo. Dotoloyo amaganizira mawonekedwe a wodwalayo, ndikuwona kuti ndi zinthu ziti zomwe zimapindulitsa chiwindi ndi kapamba makamaka.

Kutengera ukadaulo wa ndondomekoyi, zochitika zapadera zimalembedwa:

• ndi tizilombo matenda, okwanira antiviral mankhwala zotchulidwa mankhwala amakono;
• pankhani ya lithiasis (miyala) ya ndulu, kuchiritsa mosasamala kapena kuchotsedwa kumayambiranso;
• ngati genesis ya matendawa imalumikizana ndi matenda amtima wam'magazi, ntchito zake zimakonzedwa, ndiye kuti nkhani yothandizanso yathandizanso.

Ndiye kuti, nthawi zonse amapereka chidwi ku genesis ya matendawa. Ndikofunika kwambiri kuzindikira mu nthawi ndikuyamba chithandizo chamanthawi, izi zimawonjezera mwayi wopulumuka ndikuwonjezera mwayi wokhala ndi moyo wabwino.

Kodi kusintha kosiyanasiyana kwa kapamba amene akuwonetsedwa mu kanema pankhaniyi ndi chiyani.