Pancreatitis, kapena kutupa kwa kapamba, amadziwika kuti ndi matenda oopsa chifukwa cha zovuta zomwe zimapangidwa zomwe zikuwopseza moyo wa wodwalayo. Imfa ya minyewa yamtundu chifukwa cha zovuta za ma enzymes awo imayambitsa kuwonongeka kwa kapamba, kumasulidwa kwa poizoni m'magazi ambiri, ndikupanga ma systemic pathologies. Izi zimatchedwa pancreatic necrosis ndipo ndizovuta zomwe zimayambitsa kufa pafupifupi theka (malinga ndi malipoti ena - 80%).
Kuwonongeka kwa mitsempha yamagazi ya kapamba, komwe kumachitika motsutsana ndi maziko a kutupa, nthawi zambiri kumayambitsa mapangidwe a zotupa m'mimba. Ma hematomas amenewa amakulitsa njira ya pathological, kufinya ma ducts ndikupangitsa kuti zikhale zovuta kukhetsa chiwalo. Hemorrhagic pancreatic necrosis imapangidwa, pomwe matenda amitsempha amapita koyamba pakuwonongeka kwa gland.
Zolinga ndi makina otukuka
Nthawi zambiri, matenda am'mbuyomu (komanso oyambira) amakhala pachimake cha hemorrhagic pancreatitis, ndiko kuti, gawo loyamba la chiwonongeko cha minofu ya pancreatic ndi ma enzymes komanso njira yotupa. Amadziwika ndi kuwonongedwa kwa makoma amitsempha, kutulutsa magazi m'malo omwe amapangika, mapangidwe a zotupa. Mapangidwe awa amayamba kufinya magwiridwe antchito a chiwalo, chomwe chimasokoneza ntchito ya gland ndi kukonzanso kwake.
Nthawi zina, kuwonongeka kwamitsempha yamagazi kapena kuwonda kwa makoma awo sikuchitika, koma mawonekedwe a magazi, omwe amaphatikizidwa ndi kayendetsedwe kazinthu. Amatseka zombozo, chifukwa cha zomwe zimapangitsa kuti ziwalo zina za nduluzo zikhale zopanda oxygen ndikuyamba kufa. Hemorrhagic pancreatitis, yomwe imasandulika kukhala necrosis, imatchedwa ischemic, ndiko kuti, koyambirira kakhazikitsidwa ndi kufa kwa maselo, koma njira yotupa imayamba pambuyo pake.
Kulunjika kwa zotupa kukhala madera a necrosis
Mosasamala zomwe zidapangitsa kuwonongeka kwa madera a kapamba kapena chiwalo chonse, zotsatira za ma enzymes, hemorrhages kapena minofu ischemia, zimayamba kugwa mwachangu kwambiri. M'malo mwake, amayamba kuwola, komwe magazi, timadzi tating'onoting'ono, timene timaphatikizana ndi poizoni. Zinthu zonsezi zimayamba kulowa m'magazi, "ziphe" m'thupi. Ndi hemorrhagic pancreatitis, yomwe imasanduka necrosis, impso, mtima, chiwindi, ndi ubongo zimavutika.
Pali zifukwa zingapo zomwe zimatha kuyambitsa pancreatitis yovuta, yovuta ndi necrosis. Itha kuyimiridwa motere:
- kumwa kwambiri mowa;
- kudya kwambiri mafuta, zonunkhira, zakudya zosuta;
- matenda a chiwindi ndi ndulu chikhodzodzo (cholecystitis, cholelithiasis, biliary dyskinesia);
- kusokonezeka kwa magazi;
- autoimmune pathologies (systemic vasculitis);
- kuwonongeka kwa kapamba panthawi ya kuvulala kapena kulowererapo.
Monga momwe kachipatala amasonyezera, pachimake hemorrhagic pancreatic necrosis nthawi zambiri imakhala ya zaka zapakati, ndipo zolakwa za mowa ndi zopatsa thanzi zimakhala zoyambitsa. Nthawi yomweyo, odwala nthawi zambiri sakhala "okonda chakumwa," koma kumwa kamodzi kwa ethanol kopitilira muyeso kumabweretsa zotsatira zowopsa mu gland. Mwa zakumwa zoledzeretsa, kumwa kwambiri mthupi nthawi zambiri kumayambitsa matenda a kapamba, nthawi zambiri chifuwa cham'mimba chimayamba, ndikutsatiridwa ndi chifuwa chachikulu.
Zizindikiro
Zizindikiro za pachimake pancreatic necrosis imakula msanga, patangopita maola ochepa mpaka tsiku limodzi. Kumayambiriro kwa njira ya pathological, pamene chikumbumtima chikudziwikiratu, wodwalayo angagwirizanitse momveka bwino kuyambika kwa matendawa ndi kumwa, mwachitsanzo, ndi mowa wambiri (odwala oterewa amamwa). Kenako, matenda obwera chifukwa cha kuledzera ndi kuwonongeka kwa ubongo akapangika, kumangosunthika ndikuchoka kwa chikumbumtima.
Chifukwa chake, chisamaliro chamankhwala chiyenera kuperekedwa kwa wodwala mwadzidzidzi. Odwala oterowo amagonekedwa m'chipatala mosamala kwambiri, chifukwa mphindi iliyonse imatha kusankha zoyenera kuchita.
Mwambiri, zizindikiro zamatenda za hemorrhagic pancreatic necrosis ndizofanana kwambiri ndi kapamba am'mimba, koma mawonekedwe awo ndi kukula amapezeka mwachangu kwambiri. Kuphatikiza apo, m'masiku oyambira kuchokera ku chiyambi cha necrosis, kuwonongeka kwa impso kumayamba kuwoneka, matenda amitsempha ndi amisala amapangidwa.
Zizindikiro zodziwika bwino za pancreatic necrosis ndi izi:
Kodi munthu sangakhale opanda kondomu- Lakuthwa, kukula ululu pamimba pamimba ndikusiya hypochondrium, kufalikira kumanzere. Mu maola oyamba a necrosis, kukula kwa kupweteka kumafanana ndi kuopsa kwa matenda ndi kuchuluka kwa chiwonongeko cha kapamba. Komano, kufa kwa mitsempha kumatha mthupi, kulandira ululu kumatha. Kukhalapo kwa kuledzera kwambiri ndi chizolowezi chochepetsa ululu kumawoneka ngati chizindikiro chosavomerezeka.
- Kusanza mobwerezabwereza, komwe kumawonekera patangotha kupweteka kumayambitsa kuperewera kwamphamvu kwa munthuyo (m'masanzi - ntchofu, ndulu ndi magazi).
- Khungu lowuma komanso zimagwira pakhungu lanu chifukwa chakutha kwamadzi, komwe kumakhala kowuma.
- Lilime louma lomwe limakutira ndi zokutira zoyera.
- Intoxication syndrome (kutentha thupi, kuzizira, kufooka kwambiri, kusowa kwa chakudya).
- Matenda a mtima, omwe amawonetsedwa ndikusintha kwa kuthamanga kwa magazi. Nthawi zambiri, imagwera, ndikupangitsa kuti igwe (kukomoka).
- Kukula kwa flatulence chifukwa cha pang'onopang'ono matumbo motility ndi kusowa kwa chopondapo.
- Kuchepa kwa mkodzo kapena kusowa kwamikodzo.
- Kapangidwe ka encephalopathy, kapena kuwonongeka kwa ubongo (kusokonezeka kwa chikumbumtima, kusokonezeka, kukhumudwa, kenako zizindikirozi zimasanduka chikomokere).
Kuphatikiza apo, zotupa zowonjezereka zomwe zimapangika ndi hemorrhagic pancreatic necrosis zitha kuzindikirika pakhungu la pamimba kutsogolo ndi mbali. Amawoneka ngati ma cyanotic (cyanotic) kumbuyo kwa khungu loyera komanso lozizira.
Zilonda zomwe zimakhala pakhungu zimapangitsa kuti azindikire moyenera.
Imfa yofulumira ya minyewa ya chiwalo ndi kapisozi, yomwe imachitika nthawi ya chiwonongeko, makamaka chiwonongeko chokwanira, pambuyo maola ochepa imatsogolera pakupangidwe kwa zotsatira zowopsa. Zinthu za kapamba, zidutswa za necrotic minofu, hemorrhagic exudate, poizoni umapitilira thupi, kutanthauza kulowa m'mimba. Peritonitis imayamba, mapangidwe a purulent abscesses mu peritoneum ndi ziwalo zina zamkati, sepsis imayamba (matenda ambiri a magazi). Njira zonsezi zimapangitsa wodwalayo kukhala ndi mwayi wopulumuka.
Njira Zodziwitsira
Kuthamanga kwa njira zodziwira matenda komanso kuzindikira koyenera kumatsimikizira mwachindunji kupambana kwa chithandizo cha mankhwala ndi zam'tsogolo. M'dipatimenti yovomerezeka ya chipatala cha odwala, omwe nthawi zambiri amakhala ovuta kwambiri, madotolo angapo akuwunika (akatswiri a zamankhwala, gastroenterologist, dokotala wa opaleshoni, resuscitator). Zambiri za anamnesis zimatchulidwa mwa anthu omwe amatsagana ndi wodwalayo, madandaulo, ngati nkotheka, mwa wodwalayo. Mkhalidwe wa pakhungu, kupezeka kwa mfundo zowawa, kuchuluka kwa mkodzo, kumveka bwino.
Ziyeso zofunika zimatengedwa mwachangu:
- magazi kuti azindikire zomwe zimakhala ndi ma enzymes (amylase, lipase, trypsin, elastase);
- mkodzo wa amylase;
- kugwiritsa ntchito kuwomba, madzi am'mimba komanso chimbudzi cha pancreatic amatengedwa, momwe ma enzymes ndi kuchuluka kwa acidity amatsimikiza;
- pulogalamu yokhuza zamafuta.
Kuphatikiza pa ma diagnostics a labotale, njira zothandizira zimagwiritsidwanso ntchito. Awa ndi ma ultrasound, radiografia, CT, MRI. Ngati ndi kotheka, laparoscopy kapena endoscopy imagwiritsidwa ntchito, yomwe imakulolani kuti mwachindunji, ndikuwonana ndi maso, muziyang'ana mkhalidwe wamapapo ndi pamimba ponse.
Mayeso onse a pancreatic necrosis amachitika mwachangu.
Njira zonse zodziwitsa, munthawi yomweyo ndikumveketsa matenda a kapamba kapena pancreatic necrosis, amatha kupatula ma pathologies ena omwe amapezeka ndi zizindikiro zofanana. Ichi ndi pachimake matumbo kutsekeka, pachimake appendicitis, pachimake cholecystitis, mafuta a m'mimba chilonda, kutumphukira kwa m'mimba msempha, thrombosis ya ziwiya zam'mimba.
Njira zochizira
Mankhwalawa a necrosis ndi ovuta ndipo amaphatikiza njira zowongolera komanso zosinthika. M'masiku ochepa oyambira kuchokera pancreatic necrosis, chithandizo cha opaleshoni sichikulimbikitsidwa, popeza kuthekera kwachiwiri komwe kumayang'aniridwa ndi maziko a "kusungunuka" kwapang'onopang'ono kwa minofu ya pancreatic kumatha kuvulaza kwambiri mkhalidwe wa wodwalayo. Munthawi imeneyi, amakonda kupatsidwa chithandizo chokhazikika.
Cholinga chake ndi:
- kutsika kwa ululu waukulu;
- kumasulidwa kwa kapamba kuchokera kubisalira;
- kutsika kwa kupanikizika kwa intraorgan;
- Kuchotsa poizoni m'thupi.
Kuti muchepetse ndikuchotsa ma enzyme ku kapamba, Trasilol, Contrical, Ribonuclease amagwiritsidwa ntchito. Ndikofunikanso kuchepetsa acidity ya madzi am'mimba ndi Atropine, Ephedrine. Kugwiritsa ntchito okodzetsa kumabweretsa kuchepa kwa edema mu chiwalo komanso kuchepa kwa kukakamiza kwa kapisozi pa parenchyma. "Kudziyeretsa" magazi kuchokera ku poizoni, ndiye kuti, kukonzanso thupi, kumachitika ndikumayambitsa zolowa m'malo mwa magazi ndi kukakamiza kwina komwe kwa ma diresis pogwiritsa ntchito okodzetsa.
Hemorrhagic pancreatic necrosis nthawi zambiri imafunika opaleshoni
Pakatha masiku angapo, ngati kugwiritsa ntchito njirazi ndizochepa, kuchitidwa opareshoni. Pakupanga opaleshoni, ma hemorrhagic ndi ma necrotic misa amachotsedwa, patency ya ma gland imabwezeretsedwa, kutuluka kwa magazi kumakonzedwa. Onse hemorrhagic pancreatic necrosis amafuna resection wa chiwalo kapena kwathunthu kuchotsedwa.
Matenda a mitundu yonse ya hemorrhagic pancreatic necrosis ndi odabwitsa. Chiwopsezo chaimfa chimakhala chambiri, makamaka chifukwa cha zotupa zapamtima, koma nthawi zonse pamakhala chiyembekezo.
