Mphengoyi imawoneka ngati imodzi mwa ziwalo zovuta za thupi, munthu sagwira ntchito chifukwa chovuta kudziwa, ndipo sangapatsidwe mankhwala.
Kafukufuku wambiri wa akatswiri azachipatala, opangidwa kuti azindikire zoopsa zomwe zimachitika pancreatitis yacute, akuwonetsa zifukwa mazana awiri. Komabe, zomwe zimapangitsa kuti mukhale ndi cholelithiasis komanso kumwa mowa.
Kafukufuku akuwonetsa kuti kuchuluka kwa odwala omwe adalandiridwa kuchipatala ndi matenda amtundu wa kapamba am'mimba amadwala. Malinga ndi chidziwitso china, oposa 35% ya odwala ndi zidakwa omwe ali ndi mbiri ya pancreatic necrosis kapena ziwalo zowonongeka.
Tiyeni tiwone zovuta zomwe zingayambitse kukula kwa kapamba, kapangidwe ka matenda, komanso kudziwa njira zomwe zingathandizire kupewa?
The pathogenesis of pancreatitis pachimake
Zochita zamankhwala zimazindikira zinthu zingapo zomwe ndizomwe zimayambitsa kukula kwa gawo lathanzi la matendawa. Kuti mumvetsetse zamtunduwu, ndikofunikira kulingalira za kapamba kogwira ntchito.
Chiwalo chamkati chimayimira ziwalo za kuphatikiza katulutsidwe. Imagwira ntchito zingapo. Zomwe zimaphatikizidwazo zimaphatikizira exocrine, zomwe zimapangitsa kuti pakhale michere ya m'mimba yomwe imathandizira kugaya chakudya kumachitika. Ntchito yachiwiri ndi endocrine. Zikondazo zimatulutsa insulin ya mahomoni, yomwe imakhudzidwa ndi kayendedwe ka shuga m'thupi.
Ma pancreatic Enzymes (lipase, proteinase ndi amylase), pamodzi ndi zina zonse zotulutsira, Lowani mu system ya tubule, yomwe potuluka imaphatikizidwira pancreatic duct. Ma Enzymes amathandizira kugwetsa zigawo zikuluzikulu za chakudya - mafuta, chakudya ndi mapuloteni.
Pofuna kupewa kudzimbidwa kwa gawo lamkati, mapuloteni amapangidwa osagwira. Mothandizidwa ndi zina zomwe zimagwira ntchito mu duodenum, amasinthidwa kukhala gawo logwira, chifukwa chomwe amathandizira kugwetsa ma protein. Ndi kulephera mu unyolo uwu komwe kumayambira pathogenesis.
Pathanatomy imazindikira njira zingapo zomwe zimayambitsa kupukusira kwa kapamba. Izi zikuphatikiza:
- Reflux.
- Njira ina.
- Zopatsa chidwi.
Kusintha ndikusinthidwa kwachilendo kwa maselo a pancreatic, omwe amaphatikizidwa ndi vuto mu magwiridwe awo. Kusiyana pakati pa makina otukukaku kumachitika chifukwa cha zoyipa zakunja, osati zamkati. Amayamba njira yowonongera maselo. Zinthu zomwe zimayikidwa motere:
- Chemical - poizoni ndi mankhwala, zamchere zinthu, zidulo, mchere.
- Zachilengedwe - tizilombo kapena matenda opatsirana.
- Makina - zoopsa, opaleshoni.
Ndi zosakanikira zazikulu, kuwonjezeka kwa kupanikizika mkati mwa ma pancreatic ducts kumawonedwa mwa odwala. Pali zifukwa zingapo zothandizira matenda:
- Kukula kwa matendawa chifukwa chomwa mowa kwambiri komanso zakudya zamafuta. Zitsukazo sizingachotse mwachinsinsi chinsinsi chonsecho. Nthawi zina, pathogenesis yamatenda amtunduwu imadalira matupi a munthu.
- Gawo la pachimake ndi kufalikira kwa ma pancreatic ducts. Nthawi zambiri, kutsekeka kumayamba chifukwa cha matenda a gallstone kapena kufinya ndi chotupa.
Ndi mawonekedwe a Reflux, wodwalayo amawulula jakisoni wa bile mu pancreatic duct, yomwe imatsogolera kuwonongeka kwa maselo a pancreatic.
Zomwe zimayambitsa ndikutchinjiriza kwamatumbo, kamvekedwe kosakwanira ka sphincter ya Oddi.
Zomwe zimatsogolera pakupanga kutukusira kwa mapapo kwa gland
Kutupa kwa kapamba m'njira yanthawi yina patakhala kuti sikunachitike muchipatala. Iron imagwira ntchito zambiri zamankhwala komanso zamankhwala am'mthupi, zimayendetsedwa ndi matenda osiyanasiyana a ziwalo zamkati, makamaka kugaya chakudya.
Pancreatitis ndi yoyamba komanso yachiwiri. Mtundu woyamba umakhala wosowa kwambiri, chifukwa m'mazithunzi ambiri azachipatala, kutupa kwa kapamba kumayambitsidwa ndi matenda ena, chifukwa chake amalankhula za yachiwiri matenda.
Miyezo yakuopsa kwa kapamba amatsimikizika pazinthu zambiri. Gulu la wodwalayo limawaganiziridwa (chiwopsezocho ndi chachikulu ngati wodwalayo ali ndi zaka zopitilira 55), matenda oyanjana, kuchuluka kwa leukocytes ndi glucose m'magazi, gawo la matendawa (ngati kuchulukitsa kwa mawonekedwe osakhazikika kumawonedwa).
Zomwe zimayambitsa pancreatitis pachimake zimatha kugawidwa m'magulu angapo. Nthawi zambiri, zotsatirazi pathologies amakhala chifukwa cha kutupa:
- Kuwonongeka gallbladder magwiridwe. Pathologies amasiyanitsidwa: kuwerengera, pachimake kapena kuperewera kwa cholecystitis, cholelithiasis.
- Type 2 matenda a shuga.
- Mtsempha wamagazi thrombosis, chifukwa chomwe kapamba amakhala ndi vuto la kuperewera kwa mpweya ndi michere.
- Bile duct chilema cha kubadwa mwatsopano.
- Matenda a papilla wamkulu wa duodenum 12 (chotupa neoplasms, njira zotupa).
- Aakulu mawonekedwe a chiwindi kulephera (matenda am chiwindi, mtundu uliwonse wa chiwindi).
- Matenda am'mimba am'mimba thirakiti yodwala (colitis, matenda a Crohn).
- Zokhudza zonse matupi awo sagwirizana; bysary dyskinesia mwa mayi wapakati; zokhudza zonse lupus erythematosus; zokhudza zonse scleroderma.
Mndandandawo ungathe kuphatikizidwa ndi kachilombo koyambitsa bakiteriya (syphilis, typhoid fever), sepsis, kufooka kwa mafuta m'thupi, komanso ma systemic pathologies a minofu yolumikizira.
Mu malo achiwiri malinga ndi kufunikira kwa zinthu ndi zizolowezi zoyipa za wodwalayo. Izi zimaphatikizapo kumwa mowa kwambiri, kusuta, kusadya bwino - kuchepa kwa mapuloteni, kudya zakudya zamafuta, ndi zina zambiri.
Mu malo achitatu ndimavuto omwe amayamba chifukwa chogwiritsa ntchito mankhwala kwanthawi yayitali. Chifukwa china ndikuchita opaleshoni mwadzidzidzi.
Kugwiritsa ntchito mankhwala monga glucocorticosteroids, diuretics, sulfonamides, estrogens, Furosemide, Metronidazole, Tetracycline kumatha kupangitsa chitukuko cha pancreatitis pachimake.
Chithandizo cha pachimake gawo la matenda
Malinga ndi ICD code 10, kapamba amatha kukhala osiyanasiyana. Zinthu zomwe zimakhudza kapamba zimayambitsa matenda kapena mtundu wina wa matenda. Kuti mupeze chithandizo, muyenera kudziwa komwe mumachokera.
Mkhalidwe wapansipansi wa kapamba amatsimikiziridwa ndi izi: kufalikira kwamayendedwe, palpation, ululu wamadzimadzi umadziwonetsa mu kuchuluka kwa kapamba. Mimba ndi yofewa, yowawa ndikulowerera mkati mwa ziwalo zimatsimikiziridwa ndi palpation. Kusokonezeka kwa m'mimba kumawonekera pamaso pa exudate pamimba.
Pakuwopsa, odwala amadandaula za zizindikiro: kupweteka kwambiri, kuwonongeka koopsa mu thanzi, nseru ndi kusanza, kudzimbidwa - m'mimba. Ngati simupatsa munthu wamkulu thandizo la panthawi yake, ndiye kuti zovuta zingapo zimawonjezeka (mwachitsanzo, pancreatic necrosis). Pazizindikiro zoyambirira za kutupa, ambulansi iyenera kuyitanidwa.
Pazindikiritso, kuyesa kwa labotale kumagwiritsidwa ntchito - kuwunika kwamkodzo ndi mkodzo, kuyezetsa magazi kwa biochemical kwa ndende ya amylase, trypsin, glucose. Monga njira zothandizira, CT, MRI, radiography, ultrasound imagwiritsidwa ntchito.
Chithandizo cha matenda pachimake matenda amachitika mu chipatala. Kulemba mankhwala kumaphatikizapo:
- Kulowetsedwa mankhwala ndi mtsempha wa magazi makonzedwe omwe amathandiza kuyeretsa magazi a poyizoni zinthu ndi pancreatic enzyme.
- Mankhwala opweteka.
- Mapiritsi omwe amathandizira kuthana ndi ma pancreatic enzymes (Gordox).
- Mankhwala osokoneza bongo omwe cholinga chake ndi kuchepetsa pancreatic secretion (Atropine).
- Mankhwala a antiemetic.
- Maantibiotic, antispasmodics.
Dokotala yemwe ali ndi vuto lalikulu amakupatseni kusala kudya, komwe kumakupatsani mwayi wotsitsa kapamba, kuchepetsa katundu kuchokera mkati. Kukonzanso mankhwala a kapamba kumaphatikizapo kumwa mankhwala, kutsatira zakudya zabwino, kusiya zizolowezi zoipa.
Ziwerengero zimawerengera kuti anthu ambiri amwalira ngati wodwalayo akumana ndi zovuta zotere - hemorrhagic pancreatitis, aimpso ndi mtima, kulephera kwaimpso, kupindika kwa necrosis.
Vuto lodana kwambiri limatha kuyambiranso. Izi zatheka chifukwa cha zomwe zidayambitsa matenda, komanso momwe zingathandizire.
Kubwezera kungayambitse matenda.
Zimayambitsa pancreatitis pachimake
Parenchymal pancreatitis nthawi zambiri imayendera limodzi ndi kuchepa kwa mapuloteni, zilonda zam'mimba, atherosulinosis yamitsempha yamagazi, matenda opatsirana - matenda a hepatitis, typhus, ndi matenda ofala.
Ma biliary mawonekedwe ndizotsatira zachindunji za ndulu ya ndulu. Nthawi zambiri, pempho losinthidwa la bile kapena chotchinga ndi ndulu limawonetsedwa, zomwe zimatsogolera pakupanga njira yotupa. Kukula kwa kapamba kumadalira kwenikweni matenda.
Mowa pancreatitis ndi chifukwa cha kukhoza kwa mowa kuti awononge maselo a chamba. Nthawi zambiri, matenda amapezeka motsutsana ndi maziko a vuto la chiwindi, kukula kwa matenda amitsempha. Kuti apulumuke, wodwalayo ayenera kusiyiratu kumwa mowa. Chiwerengero chaimfa ndi 30-40% ya milandu yonse.
Zina:
- Kupukutira kumabweretsa kutupa kwa kapamba. Mu theka la milandu, zamatsenga ndi asymptomatic. Zizindikiro zimawonekera pa masiku 4-6. Mu zojambula zina, kuwukira kovuta kumasinthidwa m'njira yopanda pake.
- Cystic fibrosis ndimtundu wa genetic womwe umadziwika ndi masinthidwe amtundu winawake, chifukwa chomwe ziwalo zobisika zimakhudzidwa.
Pancreatitis nthawi zambiri imapha. Ziwopsezo zomwe zimayambitsa matenda ambiri ndizophatikiza cholelithiasis, kumwa kwambiri, kusuta fodya, komanso matenda ophatikizana a m'mimba.
Kupewa
Pakuwopsa kwa kapamba, sikofunikira kuti muchepetse zizindikiro, komanso kuti tipewe kuyambanso kudwala. Kuunika kwa madotolo amati izi zimadalira wodwalayo.
Choyamba, ndikulimbikitsidwa kusiya ndudu ndi kumwa mowa. Izi zimathandizira kuchepetsa katundu pazinthu zamkati. Pamaso pa matenda enaake, wodwalayo amatsimikizika kuti apewe kuchulukana kwake.
Monga njira yothanirana, mankhwalawa amagwiritsidwa ntchito. Ma broth amagwira ntchito molingana ndi chiuno cha rose, chingwe, chamomile wa mankhwala. Kugwiritsa ntchito kumachitika mu maphunziro, amathandizira kubwezeretsa kapamba.
Njira zina zodzitetezera:
- Kuchita masewera olimbitsa thupi mopitirira muyeso, kuthamanga, kudumpha, kupita kukasamba komanso sauna kungachititse kuchuluka. Njira yoyenera yochitira masewera olimbitsa thupi ndiyenda, zolimbitsa thupi, kutikita minofu, masewera olimbitsa thupi.
- Mkhalidwe wa zotupa za bile ndipo ndulu ya ndulu imakhudza kugwira ntchito kwa kapamba. Ndikofunika kuthandizira panthawi yake matenda, kukumana ndi mayeso.
- Zakudya zoyenera komanso zopatsa thanzi. Simungathe kudya mopambanitsa - iyi ndi njira yolunjika. Ndi kuchulukana, kufa ndi njala ndi khunyu nthawi zambiri kumasonyezedwa.
- Muyenera kukana zakudya zotsekemera ndi zamafuta, kudya zakudya zochepa zomwe zimakhala ndi ma coarse fiber - kabichi, beets, kaloti. Ndi pancreatitis, mkaka wowawasa wowawasa, mchere wokhala ndi madzi, ndi nsomba zam'madzi amawonjezeranso menyu.
Zachidziwikire, kupewa sikutsimikizira 100% kuti kupewetsa kwa chifuwa chachikulu cha kapamba kumatha kupewedwa. Komabe, njira zosavuta monga momwe zimakhalira ndi moyo wathanzi zimachepetsa chiopsezo chotenga matendawa.
Zomwe zimayambitsa pancreatitis zikufotokozedwa mu kanema munkhaniyi.
