Zizindikiro ndi kuchiza kwa kapamba akulu

Matenda a pancreatitis ndi matenda omwe amapanga pang'onopang'ono minofu ya kapamba. Nthawi zambiri, kusintha kwa ziwalo kumachitika pakubwezeretsa pafupipafupi.

Kuwonongeka kwa minofu pang'onopang'ono kumayambitsa kulephera kwa thupi kupanga madzi a pancreatic a chimbudzi ndi mahomoni omwe amawongolera kagayidwe.

Chowopsa cha pancreatitis (CP) choopsa ndichakuti atachotsa zomwe zimayambitsa kutupa, njira yopanga minofu ikupitirirabe. Zotsatira zake, pang'onopang'ono maselo ogwira ntchito amakhala osinthika ndi minyewa yolumikizana, ndipo gululi limataya magwiridwe ake.

Zochitika m'moyo wamakono zimayambitsa kuti matendawa akufalikira kwambiri mwa anthu azaka 30 mpaka 35, ngakhale posachedwapa milandu yambiri inali yachikulire kuposa 50.

Etiology, pathogenesis, gulu

Zomwe zimapangitsa kuti masinthidwe amtunduwu asinthe kwambiri. Ndi kutupa kwapang'onopang'ono, makamaka pakukokoloka, nduluzo zimatsekedwa, zimakhala zake zimasanduka mafinya, ndikupanga miyala yaying'ono (calcification) imawonedwa.

Pamtima pathogenesis ya CP imayamba kugwira ntchito kwa ma enzymes mkati mwa thupi. Zimachitika osati mu zonyansa za gland, komanso m'maselo, zomwe zimabweretsa kuwonongeka kwa minofu. Ngati zotupa mu bile ducts, michere imayamba kugwira ntchito popanda kusiya kapamba mothandizidwa ndi bile Reflux.

Ndi mowa pancreatitis, kutsegula kwa michere kumayambitsidwa ndi mowa, chifukwa, calcium bicarbonate imapangidwa, minofu imasandulika, mawonekedwe a cysts. Ndi chibadwidwe cha matendawa, kupatuka kwakapangidwe kamapangidwe am michere kumawonedwa.

Ndi pang'onopang'ono matendawa, kutupira kwa England, kusintha kosinthika kumawonedwa, zigamba za minofu yakufa yomwe imagwira ntchito imawoneka m'thupi lake, kuchuluka kwa minofu yolumikizika. Gawo la endocrine la kapamba limapangidwanso pang'ono ndi pang'ono. Chitsulo chimadzaza ndi miyala yaying'ono, yambiri imasinthidwa ndi minofu yaying'ono, imakhala yofiyira, nikhala yaying'ono.

Zimayambitsa ndi matenda omwe amachititsa kuti pakhale matenda a kapamba:

• kumwa mowa;
• kudya kwambiri, kudya mafuta, kusuta, zakudya zokazinga;
• pachimake mawonekedwe a kapamba;
• matenda a ndulu;
• kutengera kwa chibadwa;
• matenda a endocrine (makamaka matenda a shuga);
• kuvulala ndi poyizoni wokhala ndi zinthu zapoizoni (mankhwala, lead, mercury);
• matenda ena am'mimba thirakiti.

Odwala ambiri omwe ali ndi CP amakonda kudya kwambiri kapena kumwa kwambiri. Matenda a kapamba nthawi zambiri amakhala ndi matenda a duodenum, ndulu, chiwindi, m'mimba.

Kanema kochokera kwa Dr. Malysheva:

Kugawidwa kwa CP kumakhala kovuta, pali zizindikiro zingapo zomwe matendawa amakonzedwa mwadongosolo.

Mtundu woyambirira wa matendawa umawoneka ngati chotupa cha kapamba, chachiwiri - chifukwa cha matenda ena am'mimba. Njira yachiwiri imakwiyitsa matenda a gallstone (cholelithiasis), matenda, poyizoni.

Mwa chikhalidwe cha mawonekedwe, pali:

• kawirikawiri zomwe zimachitika kawirikawiri - kuwonongeka kumachitika kawiri pachaka;
• pafupipafupi kubwereza - koposa katatu;
• ndi zizindikiro zomwe zimakhalapo nthawi zonse - Zizindikiro za matendawa zimawonekera mu mawonekedwe a ululu ndi zodetsa nkhawa nthawi zonse.

Pali tanthauzo la matendawa ndi etiology - chomwe chimayambitsa: zakumwa zoledzeretsa, zamankhwala, zodwala, zodwala komanso zina.

Mwa kuzunzika, matendawa amagawidwa kukhala ofatsa, odziletsa komanso owopsa.

Malinga ndi mawonekedwe a morphological, CP imagawidwa:

• cystic ndi mapangidwe a cysts ndi pseudocyst;
• pseudotumorous - ndi ululu komanso kuwonjezeka kwina kwa kapamba;
• parenchymal;
• fibrosulinotic;
• zamitundu mitundu.

Mwa njira yowonetsera - chithunzi cha chipatala - matenda amadziwika: zowawa, hypochondria, latent, hyposecretory ndi CP yophatikizika.

Momwe mitundu yatsopano yazidziwitso imawonekera, magawidwe a matendawa amasintha ndikuwonjezera. Pancreatitis yosatha ili ndi code ku ICD 10 - K86 yokhala ndi zigawo.

Zizindikiro za pancreatitis yokhazikika mwa akulu

Chithunzi cha maphunziro a CP chikhoza kukhala chosiyana, zimatengera zinthu zambiri. Nthawi zina, zizindikiro zimangowoneka ndi kuwonongeka kofunikira kwa chiwalo.

Mwambiri, chithunzichi chikuwoneka:

1. Ululu Nthawi zambiri, kutulutsa kwazinthu zopweteka ndikumanzere kwam'mimba pansi pa nthiti. Komabe, nthawi zina ululu umamangirira, mpaka kumtunda wakumbuyo kapena dera lamtima. Ululu umatha kukhala paroxysmal, kapena kusokoneza pafupipafupi. Poterepa, kupwetekako kumawuma. Mukatha kudya, ululu wakewo sukula, komabe, kuukira kumatha kuchitika mutatha kudya zakudya zoledzeretsa kapena mowa. Ululu nthawi zina suyimitsidwa ndi antispasmodics komanso ngakhale narcotic analgesics.
2. Dyspepsia Kukwiya, mseru, kutentha kwa mtima kumawonedwa. Kupumula kumakhala kovuta, sikubweretsa mpumulo. Matenda a Stool - kudzimbidwa kumasinthana ndi matenda am'mimba. M'masanzi ndi ndowe, mumapezeka zidutswa za chakudya chosasamba. Pali zinthu zina zomwe sizigwirizana.
3. Intoxication. Kuchulukitsa thukuta, kutopa ndi kukwiya zimasinthana ndi kusowa chidwi, kulephera kudya. Kulemera kwa thupi kukugwa.
4. Kukwera pang'ono kutentha kwa subfebrile.

Ngati gawo la endocrine la gland limasokonekera, zizindikiritso za matenda ashuga zimawoneka - ludzu, kuchuluka kowonjezereka kwa mkodzo.

Ndi chitukuko cha matendawa, kuchuluka kwa khunyu kumakulirakulira. Amakhala ndi khungu ndi khungu. Khungu lowuma, misomali ya brittle, tsitsi. Dera la epigastric ndilopweteketsa.

Zizindikiro za chifuwa chachikulu sichitha kuonekera kwa nthawi yayitali. Zakudya zochepa zam'mimba zimayikidwa poizoni. Njira ya asymptomatic ndiyo mtundu wowopsa kwambiri wamatenda omwe ndiosavuta kuyamba.

Njira Zodziwitsira

Kuwunika kowonekera, kusonkhanitsa madandaulo ndi palpation kumapereka chithunzi chowoneka bwino cha kutupa kwapancreatic. Matendawa amathandizidwa ndi a gastroenterologist.

Maphunziro otsatirawa amaperekedwa:

• pulogalamuyo imawonetsa mafuta mu ndowe, zomwe zikuwonetsa kuchepa kwa michere;
• kuwunikira zomwe zili ndi ma enzymes (lipase, amylase, trypsin ndi ena) m'magazi;
• CT, MRI;
• kuyezetsa magazi konsekonse, biochemical, kwa shuga;
• Ultrasound ikuwonetsa calcification, kusintha kwa ma ducts, kumathandizira kupatula zotupa, momwemo amazindikira milandu ya CP mu 80-90% ya milandu;
• radiology;
• endoscopic ultrasonography - imakuthandizani kuti muwone kapangidwe ka minofu ya kapamba ndi chikhalidwe cha ma ducts; kudziwa madera a kuwonongeka kwa necrotic ndi kuchuluka kwa madzimadzi mu parenchyma.

Njira ya endoscopic (ERPC) ndi njira yovuta kwambiri yomwe imayikidwa molingana ndi zisonyezo zozindikira kutulutsa kwa zodzaza, kudzaza kwawo ndi ma calcifying ndi mapulagi.

Kodi kuchitira?

Chithandizo cha CP chimaphatikizapo chithandizo cha mankhwala, njira zopangira opaleshoni, njira zolimbitsa thupi, komanso zakudya. Njira zonsezi zimathandizana. Mu gawo la pachimake, njira zomwezo zimagwiritsidwa ntchito monga momwe zimakhalira ndi mtundu wa matenda.

Chithandizo chowonjezera

Chovuta kwambiri nthawi zambiri chimakhala kupumula kwa ululu, chifukwa ndikofunikira kugwiritsa ntchito mankhwalawa nthawi zina.

Ndalama zomwe mwapatsidwa mukachulukitsa:

• analgesics - Analgin, Papaverine, narcotic (Trimeperidine, Promedol, Tramadol);
• mankhwala osapweteka a antiidal - Diclofenac, Paracetamol;
• antispasmodics - Drotaverin, Platifillin, Baralgin;
• kulowetsedwa njira zothetsera kuchepa madzi m'thupi ndi kubwezeretsa zotayika; mapangidwe a protein ndi colloidal amathandizidwa kuti athe kuwononga poizoni;
• mankhwala a antisecretory amathandizira kuchepetsa kupanga ma enzyme - Sandostatin, Omeprazole, Gordox, M-anticholinergics - Atropine;
• kuti muchepetse vuto la dyspeptic - Cerucal, Domperidone;
• mankhwala - metronidazole, azithromycin;
• enzyme inhibitor - Yothandizira.

Cholagogue, mavitamini amathanso kutumikiridwa. Ngati vutoli silitha kukhazikika, malangizo a chipatala amathandizira kugwiritsa ntchito glucocorticoids (prednisone).

Chithandizo Chachikhululukiro

Palibe exacerbations, chithandizo chachikulu ndikudya. Kuthana ndi zakudya kumatha kulepheretsa kuchepa kwa thupi ndikuchepetsa kuchepa kwa minofu. Physiotherapy ndi spa chithandizo pogwiritsa ntchito madzi am mineral akuwonetsedwa.

Pankhani ya kuperewera kwa enzyme, miyezo ya chithandizo imalimbikitsa kutenga Pancreatin, Festal kapena michere ina yopanga. Maofesi a multivitamin amadziwika. Ndi kuwonda kwakukulu, amino acid, emulsions yamafuta imayambitsidwa.

Zoyeserera zamankhwala zimachitika kawiri pachaka poika mankhwala okonza. Kuyang'anira shuga nthawi zonse ndikofunikira kuti muzindikire kukula kwa matenda ashuga panthawi.

Njira zopangira opaleshoni

Ntchito zimagwiritsidwa ntchito nthawi zina ndimatenda a necrosis a minofu komanso matenda amtundu wa purulent.

Mitundu yotsatirayi yophatikiza ikugwiritsidwa ntchito:

• Kuchotsa miyala kumiyeso;
• mu purulent njira - kuyamwa kwa malo owonongeka;
• ntchito pa ndulu - kuchotsa miyala ndi chikhodzodzo;
• resection wa kapamba.

Komanso, ndi CP, opaleshoni ya pulasitiki ya ndulu zakumaso, mitsempha yamagazi, komanso kupatula kwam'mimba kumachitika.

Njira zokuukira

Panthawi ya vuto la CP, kulandira zipatala ndikofunikira, chifukwa chake muyenera kuyitanitsa ambulansi.

Asanafike:

• kukagonetsa wodwala;
• lembani kuzizira kwa dera la epigastric kwa mphindi 15 mpaka 20, mutatha kubwereza maola angapo;
• kupatula kudya, zakumwa, kupatula madzi;
• ngati madokotala akuchedwa, perekani piritsi la No-shpa, Drotaverin, Baralgin kapena Ibuprofen.

Simungathe kumwa mankhwalawa okhala ndi zakumwa zoledzeretsa, zomwe nthawi zambiri zimalimbikitsa njira zamankhwala azikhalidwe. Osathira kutentha kapena kuyika wodwalayo posamba.

Ululu umachepetsedwa ngati mutatsamira kapena squat. Maluso olondola amathandizira kuyembekezera chithandizo chamankhwala. Ngati vuto silikuvuta, ndipo wodwalayo amadziwa momwe angakhalire panthawi yowonjezera, mutha kuyimbira dokotala kunyumba.

Ngati ndizosatheka kukaonana ndi dokotala, muyenera kukumbukira kuti njala iyenera kupirira masiku atatu. M'tsogolomu, mbewu zomatira (mwachitsanzo, zochokera ku oatmeal) ziyenera kukonzedwa.

Kanema kuchokera kwa katswiri:

Zakudya monga gawo lofunika la zamankhwala

Zakudya zodwala zomwe matendawa amadwala zimawonetsedwa nthawi zonse. Maselo a pancreatic sanabwezeretsedwe, kuwonongeka kwa minofu kumapita patsogolo ndikuphwanya kulikonse kwa mfundo zoyenera za zakudya. Kutsatira kwambiri zakudya, kukana kumwa mowa kwambiri komanso kudya mopitirira muyeso kumapangitsa kuti chiwonongeko cha parenchyma ndi necrosis chithe.

Mfundo zachakudya zoyenera mu CP ziyenera kuphatikizapo:

• kudya pafupipafupi 5-6 m'magawo ang'onoang'ono;
• kudya zakudya zofunda, kukana kutentha ndi kuzizira;
• kutafuna mokwanira chakudya, kukana zokhwasula-khwasula kuthawa;
• kugwiritsa ntchito msuzi pamsuzi wamasamba, nyama yophika, nkhuku ndi nsomba zamitundu yamafuta ochepa zimadyedwa mosiyanasiyana;
• choletsa kusuta, nyama yokazinga;
• kukana kuphika kwatsopano, muffin, chokoleti;
• osapitirira 350 gr. chakudya, pafupifupi 130 gr. mapuloteni patsiku ndi kuchuluka kwa nyama.

Chakudya chamagulu 5. Amakhala ovuta kwambiri panthawi yanthawi yochulukirapo, yaulere kwambiri panthawi yachikhululukiro. Muyenera kuphunzira mndandanda wamasamba olimbikitsidwa, zipatso, chimanga ndikutsatira malangizowo. Zakudya ndi mankhwala a CP.

Chithandizo cha anthu

Nkhopeyi ndi chiwalo chambiri. Musanagwiritse ntchito wowerengeka azitsamba, ndikofunikira kuti muwone ngati zosakaniza zawo zingavulaze thupi. Kufunsira kwa dokotala ndikofunikira.

Ena maphikidwe a mankhwala azikhalidwe:

1. Pogaya oats kukhala ufa. Thirani supuni ya malonda ndi chikho cha madzi, kutentha kwa maola 0,5 popanda kuwira. Tengani chikho 1/3 musanadye sabata limodzi.
2. Ma ndevu agolide Dulani masamba awiri azomera ndikutsanulira madzi ½. Tenthetsani kwa mphindi 20, tsimikizani maola 7-8. Tengani supuni ziwiri musanadye.

Kugwiritsa ntchito mankhwala osokoneza bongo osavomerezeka sikulimbikitsidwa. Chenjerani ndi kuchiza masamba ndi zipatso.

Mavuto ndi udzu

Madokotala odziwa bwino funso loti ngati kuli kotheka kuchiritsa kapamba ndi mankhwala, opaleshoni kapena wowerengeka, muyankhe molakwika. Kubwezeretsa minofu ya pancreatic sikutheka. Zida zamakono zimatha kuchepetsa kuwonongeka kwa michere pazinthu zanyumba ndikuchepetsa kuchepa.

Kuti muchite izi, ndikofunikira kutsatira mosamalitsa malamulo omwe amaperekedwa a zakudya, kukaonana ndi gastroenterologist munthawi yake kuti asinthe chithandizo.

Mavuto a CP:

• jaundice omwe ali ndi mavuto ndi kutuluka kwa ndulu;
• magazi m'matumbo am'mimba;
• matenda, kuphatikizapo purulent, mu biliary thirakiti;
• pambuyo pake matenda - chiwindi, mapapo;
• matenda a endocrine - matenda a shuga;
• zotupa zoyipa.

Matendawa amakomera nthawi yoyeserera mankhwala komanso kuwongolera ziwalo. Njira zamakono zimatha kuchepetsa kukakamira kwa pancreatic ndikwaniritsa chikhululukiro chokhazikika.

Kanema Wachisamaliro:

Kupewa matendawa ndikutsatira mfundo za kadyedwe koyenera ndikukana kumwa mowa. Zakudya zamafuta kwambiri, zakudya zopanda pake, mowa ndizomwe zimayambitsa matenda a pancreatitis pachimake komanso kusintha kwa matendawa kukhala mawonekedwe osakhazikika. Ndi CP, muyenera kutsatira zakudya pafupipafupi. Izi zokha ndi zomwe zingaletse kuwonongeka kwa dziko la chithokomiro.

Manambala azachipatala komanso odwala nawonso amadziwa kuti kutsatira zakudya kumathandiza kuchepetsa vutoli komanso kuiwalako za matendawa.