Pancreatitis ndi matenda oopsa omwe amadziwika ndi kukula kwa njira yotupa mu kapamba. Pali njira ziwiri zamatenda omwe angayambitse matendawa - pachimake komanso matenda a kapamba.
Ndi mtundu uwu wa matendawa womwe umatenga malo achitatu pakati pamavuto ena owoneka pantchito yam'mimba. Kuwonetsedwa kofananako kwa matendawa kumapereka chithandizo chokwanira kuchipatala. Ngati timalankhula za malo awiri oyamba, ndiye kuti amapita ku pachimake appendicitis ndi cholecystitis.
Malinga ndi ziwerengero, mchaka chimodzi, kuchokera pa anthu 200 mpaka 800 kuchokera pa miliyoni miliyoni padziko lapansi amapezeka ndi kapamba wambiri. Monga lamulo, amuna amadwala matendawa. Zaka zawo zimatha kukhala zaka 35 mpaka 69, pomwe nthawi zambiri chithandizo cha pancreatitis pachimake chimafunikira.
Zomwe zimapangitsa kuti pakhale pancreatitis yachuma komanso chitukuko
Pali zifukwa zingapo zomwe zimapangitsa kuti pakhale pancreatitis yovuta kwambiri:
- kumwa kwambiri mowa;
- kusiya kumwa mopanda malire kwa zakudya zamafuta ndi zonunkhira;
- matenda a ndulu;
- matenda osiyanasiyana ma virus kapena mabakiteriya;
- kuvulala kwam'mimba zingapo;
- opaleshoni kulowererapo limodzi ndi zina pathologies a kapamba;
- kumwa mankhwalawa omwe ali ndi njira yothandizira thupi, komanso makamaka mankhwala: thiazide diuretics, corticosteroids, estrogens, azathioprine;
- kubadwa kwatsopano kwa kapamba, cystic fibrosis;
- yotupa njira m'mimba dongosolo (hepatitis, cholecystitis, gastroduodenitis).
Pali chiphunzitso chodziwika bwino cha kapangidwe kake kapamba, chomwe chimanena kuti chachikulu chomwe chimayambitsa matendawa ndicho kuwonongeka kwa maselo chifukwa chakuyambitsa kwamphamvu kwa ma enzymes, koma izi sizimapatula kufunikira kwa chithandizo chanthawi ya pancreatitis pachimake.
Munthawi yovomerezeka, ma enzyme opakawo ayenera kupangidwa ndi gland osagwira ntchito, ndikuyamba kugwira ntchito atangodutsa m'mimba. Mothandizidwa ndi zinthu zakunja, komanso zam'kati zam'magazi, njira yonse yopangira zinthu imasokonezeka kwambiri.
Enzymes imayamba kugwira ntchito pancreas yokha (potero imayambira njira yodzigaya yokha ya chiwalo), yomwe imayambitsa kufunikira kwa mankhwala. Chifukwa chake, mankhwalawa a pancreatitis pachimake ayenera kuyamba mwachangu. Zotsatira zake zimachitika motere:
- kutupa kwa minofu;
- kutupa;
- kuwonongeka kwa ziwiya ziwalo parenchyma.
Matenda a pathological panthawi ya pancreatitis yovuta kwambiri amatha kufalikira ku minofu yozungulira gland (retroperitoneal minofu, emsa bursa, mesentery yamatumbo, komanso peritoneum ndi omentum).
Ndi mawonekedwe owopsa a kutupa pachimake, kuchuluka kwa zinthu zogwira ntchito m'magazi kumawonjezeka kwambiri, komwe kumakhala kofunikira kuti pakhale zovuta kwambiri m'thupi. Pankhaniyi, mankhwalawa okha omwe ali ndi vuto la analgesic sangagwire ntchito.
Mitundu ya Acute Pancreatitis
Kutengera ndi kuuma, kapamba ammagulu amatha kugawidwa:
- opepuka. Itha kuchitika ndikuwonongeka kochepa mkati mwa ziwalo zamkati ndipo imangowonetsedwa ndi kutupa kwa kapamba. Mlingo wocheperapo wa kapamba amkati amayankha bwino chithandizo, ndipo matendawa ndi abwino;
- zolemetsa. Njira yamatendawa imakhudzanso kukula kwa zovuta zingapo mu minofu kapena ziwalo zoyandikana ndi kapamba. Kuphatikiza apo, zovuta zimatha kukhala zamderalo ndikuwoneka ngati minofu necrosis, cystic neoplasms, abscesses, kapena matenda.
Kufika kovuta kwa pachimake kapamba kumatha kutsagana ndi:
- kudzikundikira kwamkati mwa thupi kapena malo ena mozungulira;
- kapamba necrosis ndi mwayi minofu matenda. Malo ocheperako kapena otayidwa pokhapokhapokha parenchyma ndi zotumphukira m'thupi zimatha kuchitika. Kuphatikiza apo, matenda ndi kukulira kwa puranc pancreatitis amatha kujowina, komwe kangapo kumawonjezera mwayi wakufa;
- pachimake mapangidwe abodza cystic. Madzi a pancreatic amadziunjikira mozungulira makoma kapena mafinya. Matendawa amatha kuchitika chifukwa chakuwopsa kwa kapamba;
- chikopa. Pus imadziunjikira mu kapamba palokha kapena m'ziwalo zoyandikana.
Zizindikiro za pancreatitis pachimake
Pali zizindikiro zokhudzana ndi pachimake kapamba. Choyamba, ndi ululu. Zitha kupweteka mu epigastrium kapena pansi pa nthiti yakumanzere. Chikhalidwe cha zopweteka ndi ma shingles, ndipo chimatha kusuntha pansi pa scapula lamanzere. Zimatha kupweteka pafupipafupi, ndipo makamaka ikagona kumbuyo kwanu. Zosangalatsa zosasangalatsa zimakulitsa pakudya kapena mafuta, okazinga kapena zonunkhira.
Pancreatitis yovuta imatha kuonekera mu gagging ndi mseru. Kusintha kumatha kukhala kosalekeza komanso kumachitika ndulu.
M'dongosolo lino, kuwonjezeka kwa kutentha kwa thupi, kufalikira kwamkati mwa sclera, komanso kukula kwa chizindikiro cha kukomoka, mawonekedwe a khungu.
Momwe mungadziwire matendawa?
Kuzindikira kwa pancreatitis pachimake kumatha kuchitika pamaziko a zovuta zomwe zimakhudza wodwala, kufufuza kwake, komanso kuzindikira zazikulu za matendawa. Ngati wodwala amayeza kugunda ndi kuthamanga kwa magazi, zidzadziwika kuti pali tachycardia ndi hypotension. Kuti muwonetsetse kuti mwazindikira, ndikufunikanso kuyesa mayeso angapo:
- kuyesa kwa magazi ndi mkodzo;
- kupezeka kwa ultrasound kwam'mimba;
- multispiral compute tomography (MSCT);
- magonero amatsenga a michere (MRI).
Pakayezetsa magazi ambiri, zizindikiritso za njira yotupa zimatha kudziwika, zomwe zimawonetsedwa ndi kuthamanga kwa ESR, komanso kuchuluka kwa leukocytes. Kulemba kwamwazi m'magazi kuwonetsa kuwonjezeka kwa ntchito ya amylase ndi lipase (main pancreatic enymes), hyperglycemia ndi hypocalcemia. Kuphatikiza apo, kuwunika kwa kuchuluka kwa michere mu mkodzo kudzachitika. Kuchuluka kwa zochita za ma enzymes a chiwindi, komanso bilirubinemia, zitha kuzindikirika.
Kafukufuku wopenda yemwe ali ndi matenda atha kupangitsa kuti pakhale kusintha kwa ma pathological mu parenchyma, kusintha kwa kukula kwa kutulutsa, zotupa, matayala, kukhalapo kapena kusowa kwa miyala m'miyala.
Ndikofunika kuchita mosiyanitsa matenda a pancreatitis pachimake ndi matenda ena:
- pachimake cholecystitis;
- pachimake appendicitis;
- kukonzanso kwa ziwalo zopanda pake;
- matumbo kutsekeka mu pachimake mawonekedwe;
- pachimake ischemic pamimba syndrome;
- pachimimba kapena kutuluka magazi m'mimba.
Kodi amathandizira bwanji?
Potsimikizira za matendawa, dokotalayo amalimbikitsa kuti agonekere kuchipatala chachipatala kapena ku opaleshoni. Odwala onse omwe ali ndi pancreatitis yovuta kwambiri amawonetsedwa kuti apumule pakama, ndipo machitidwe onse azikhala ndi cholinga choletsa kupweteka, kupulumutsanso katundu ku matenda, komanso kudzilimbikitsanso thupi.
Munthawi imeneyi, othandizira opweteka kwambiri, ndipo mankhwalawa adzakhala mankhwala okhazikika.
Njira zazikulu zochizira ndi monga:
- Kuchotsa kupweteka kwambiri ndi antispasmodics, komanso novocaine blockade;
- kutsatira kupumula kwa chakudya, kugwiritsa ntchito mapiritsi ozizira otenthetsera kuti muchotse ntchito zowonetsa ntchito za kapamba. Zakudya za makolo zimaperekedwa, ndipo zomwe zili m'mimba zidzachotsedwa;
- poika deactivators a michere michere;
- kukonza kwa homeostasis, mankhwala osokoneza bongo komanso kulowetsedwa kwa mapuloteni ndi saline adzafunika pano;
- Chithandizo chokhudza kuchotsa kuledzera;
- Mankhwala opha maantiotic ngati njira yofunika kwambiri yopewa matenda opatsirana, mankhwala opha maantibayotiki apita pano.
Nthawi zina, chithandizo cha opaleshoni chingasonyezedwe. Opaleshoniyo ikhoza kukhala yofunikira kuulula miyala m'makonzedwe, kudzikundikira kwamadzi mu kapamba kapena pafupi nayo, ndikupanga kapangidwe ka penancic, chotupa cha chotupa kapena chotupa.
Kuchita kwa opaleshoni yomwe ikuyenera kuchitika pachimake cha kapamba kumaphatikizapo:
- kukhetsa kwa endoscopic;
- marsupialization a chotupa;
- cystogastrostomy.
Mukazindikira malo omwe minofu yakufa, kutengera kuchuluka kwa kuwonongeka, necrectomy kapena resection ya kapamba zitha kuchitidwa. Ngati miyala ikapezeka mu kapamba, kuchitira opaleshoni ya chiwalo kukachitika.
Opaleshoni imayambiranso kupezeka komwe kukayikira kumakhala kotsimikizika, ndipo palinso kuthekera kwakukulu koperewera zovuta zina zochita opareshoni.
Pambuyo pa njirayi, njira zopewera mphamvu zimaperekedwa kuti zikhale zovuta kwambiri za purulent-septic, komanso chithandizo chamankhwala chobwezeretsa thupi.
Mitundu yofatsa ya pachimake ya kapamba siyikupereka zovuta zapadera pakukonzekera, ndipo zotsatira zake zimangotha sabata limodzi pambuyo poyambira chithandizo.
Kodi zingakhale zovuta ziti?
Chiwopsezo chonse cha kupweteka kwambiri kwa kapamba chimakhala pachiwopsezo chotenga zovuta zazikulu. Ngati matenda atapezeka, pancreatic necrosis kapena abscess ikhoza kuyamba kukulira. Matendawo amatsogolera pakufa kwa wodwala, ngati simupereka chithandizo chanthawi yake.
Ndi njira yowonjezereka ya pancreatitis yowopsa, pakhoza kukhala kuyambika kwa boma lodzidzimutsa komanso kulephera kwamankhwala angapo. Kuphatikiza apo, mapangidwe a pseudocystic amatha kupanga m'matumba a pancreatic, omwe amatha kuwononga kapangidwe ka ziwalozo ndi ma ducts a bile. Ngati ma cysts abodzawa amawonongeka, ndiye kuti ascites imachitika.
Njira zopewera
Kupewa koyambirira kwa chitukuko cha pancreatitis pachimake ndi zakudya zapamwamba komanso zomveka, zomwe zimapatsa kukana kwathunthu zakumwa zoledzeretsa, kusuta, mafuta, zakudya zamchere komanso zamkaka.
Kutupa kovuta kumatha kukhala chifukwa chosamwa mowa wambiri, komanso chifukwa chogwiritsa ntchito kamodzi zakumwa zokhala ndi zakumwa zoledzeretsa pamodzi ndi mbale zamafuta.
Kukula kwa matendawo kumadalira mtundu wake ndi chithandizo chomwe chikugwiritsidwa ntchito, komanso kukhalapo kwa zovuta. Ngati pancreatitis yachilendo imapezeka mu mawonekedwe ofatsa, ndiye kuti zimakhala zosavuta kuchira. Ndi necrotic ndi hemorrhagic pancreatitis, mwayi wa imfa ndi wokwera kwambiri.
Ndi chithandizo chosakwanira komanso osagwirizana ndi zomwe dokotala amakupatsani zokhudzana ndi njira komanso zakudya, kubwereranso kapena kusintha kwa matendawa ku fomu yopweteka kumatha kuyamba.
