Hemorrhagic pancreatic necrosis (ICD code 10 K86.8.1) ndiyo imfa yathunthu kapena yochepa yamatenda a pancreatic.
Matendawa ndi amodzi mwa matenda omwe angayambitse kudwala kwa nthawi yochepa.
Kuvuta kwa mankhwalawa kumagwirizanitsidwa onse ndi kuchuluka kwa chitukuko cha kapamba (tsiku 1) komanso chifukwa chakuti gawo lomwe lakhudzidwalo silikuchira ndipo silitulutsa ma enzymes ena ndi mahomoni ena ngakhale atalandira chithandizo.
Ichi ndi chifukwa chake chimodzi mwazovuta za matendawa chimakhala mtundu 2 wa shuga.
Njira yopititsira patsogolo
Kodi nthendayi ndi chiani ndipo ndi ziti zomwe zimapangitsa kuti ikule? Ndi pancreatic necrosis, fistula imapangidwa, yomwe mkati mwake mumakhala zikondamoyo zomwe zimalowa mkatikati mwa m'mimba pafupifupi osazungulira.
Minofu yakufa limodzi ndi hemorrhagic exudate imakhala chothandizira kukulitsa kwa puritis peritonitis, mu 50% ya milandu yomwe imatsogolera kuphedwa kwa wodwala.
Tissue necrosis imawoneka chifukwa cha kulephera kwa kapamba kupiriranso madzi amwano a m'mimba. Ma Enzymes ochokera ku chiwalo chomwe chakhudzidwacho sakutulutsidwa ndipo alkalis amayamba kugwetsa mapuloteni.
Ndiye kuti, kapamba amayamba kudzipenda yekha. Chiwonongeko sichingokhala ndi izi. Necrosis amafalikira kumitsempha yamagazi yolasa chiwalo, chovulaza ndikupangitsa magazi.
Zoyambitsa matenda
Hemorrhagic pancreatic necrosis sikukula kuyambira.
Zinthu ngati izi zimayambitsa kuphwanya kwakukulu:
- poyizoni ndi mowa kapena chakudya;
- kuvutitsidwa ndi mbale zomwe zimasokoneza m'mimba thirakiti (lakuthwa, lamchere, lamafuta);
- thupi lawo siligwirizana;
- matenda a autoimmune;
- zotupa zoyipa, limodzi ndi kuphwanya magazi;
- kufalikira kwa biliary thirakiti;
- matenda opatsirana, omwe akuphatikizira matumbo owopsa, lupus ndi mumps;
- kumwa mankhwala osokoneza bongo komanso mankhwala popanda dokotala;
- endocrine matenda (hypothyroidism, matenda ashuga, kuphatikizika ndi matenda am'mimba).
Mwa anthu omwe ali pachiwopsezo, wina amatha kusiyanitsa magulu otsatirawa:
- zidakwa ndi mankhwala osokoneza bongo;
- anthu okalamba omwe ali ndi gulu la matenda ophatikizika;
- odwala ndi pathologies a kapamba, chiwindi, m'mimba thirakiti;
- anthu omwe amagwiritsa ntchito mankhwala osokoneza bongo nthawi zambiri, amchere, amasuta komanso mafuta;
- anthu ovulala pamimba.
Zizindikiro za matendawa
Zizindikiro za hemorrhagic pancreatic necrosis nthawi zonse zimakhala zowawa. Ndikosatheka kuzizindikira. Pa gawo loyambirira, wodwalayo amayamba kuda nkhawa ndi nseru, kupweteka kwambiri, komwe nthawi zambiri kumakhala kozungulira hypochondrium yamanzere.
Nthawi zina ululu umakhala ngati lamba, nthawi zina umafanana ndi zizindikiro za kugunda kwa mtima. Munthu amatha kumachepetsa zomverera zowawa m'malo okhala, nthawi zonse mawondo ake amakhala akukoka m'mimba mwake.
Komanso, matenda am'mimba amadziwika ndi zizindikiro zotere:
- kusanza komanso kusanza pafupipafupi, komwe sikubweretsa mpumulo;
- kuchuluka kwamphamvu kwa kutentha kwa thupi mpaka pazofunikira kwambiri;
- kusintha pakhungu (redness, pallor, mawonekedwe a hematomas, kuwonjezeka kumverera kwa kupweteka ndi kukhudza kowala);
- motsutsana ndi kumbuyo kwa pancreatic necrosis, ascites, phlegmon yam'mimba imayamba;
- shuga wamagazi amakwera kwambiri, yomwe imakhala yowopsa kwambiri m'matenda a shuga ndipo imatha kuyambitsa kukomoka kwa hyperglycemic;
- kumakhala kumvetsetsa kwa chilankhulo;
- kuchuluka kwa mkodzo wotulutsidwa pokodza kumachepa kwambiri;
- kupuma movutikira kumawonekera, kugunda kumafulumira, kuthamanga kwa magazi kumakhala kusakhazikika;
- kusokonezeka kwa dongosolo lamanjenje (kuletsa kapena kukwiya) kumadziwika;
- wodwala aliyense wachisanu amakhala ndi vuto la kugwa, wodwala aliyense wachitatu amagwa.
Magawo opita patsogolo
Pali magawo angapo omwe ayenera kuvomerezeka.
Poyamba, tizilombo tating'onoting'ono toyambitsa matenda timayamba kuchuluka ochulukitsa. Ndi nthawi iyi yomwe wodwalayo amasanza kuyamba kuzunza, chopondacho chimakhala chosakhazikika, kutentha kwa thupi kumakwera kwambiri.
Pa gawo lachiwiri, kuwola kwa maselo kumayamba, ma cell amalephera. Gawo lowopsa kwambiri ndi lachitatu. Kutupa kumafalikira mwachangu kumadera a minofu yathanzi, chiwonongeko cha kapamba chimathandizira.
Popeza liwiro lomwe gawo limodzi limasinthira lina lakale, simungachedwe kuyimbira ambulansi mulimonsemo.
Wodwala akamapita kuchipatala, amamuwunika bwino, mtundu ndi gawo la pancreatic necrosis amatsimikiza, ndipo chithandizo chamankhwala cham'mimba chikuyambika.
Matendawa, omwe amayamba chifukwa cha chinthu chilichonse chofunikira, amafunika kuchipatala mokakamizidwa komanso chithandizo chamankhwala mwadzidzidzi.
Gulu ndi mitundu
Necrosis yochokera ku matenda amagawika m'mitundu ingapo. Izi zimakuthandizani kuti mupeze mayendedwe abwino kwambiri ndikugwirira ntchito kwa wodwala yemwe amapititsidwa kuchipatala panthawi yake.
Kugonjetsedwa kungakhale:
- laling'ono laling'ono;
- chapakati;
- chachikulu chachikulu;
- chapansipansi;
- chonse.
Kuzindikira kumapangidwira potengera kukula kwa malo a pancreatic omwe amakhudzidwa ndi pancreatic necrosis.
Gawo loyamba kapena lachiwiri, malire ake ndiwachangu. Lachitatu - zikuwoneka bwino ndikuwonetsedwa. Gawo lofunikira kwambiri limaphatikizapo kufa kwa chiwalo, chokwanira - kufa kwathunthu kwa minofu yokhudza pancreatic.
Pomaliza, opaleshoni ndiyofunikira. Tishu yomwe yakhudzidwa iyenera kuchotsedwa kwathunthu.
Komanso, pancreatic necrosis imasiyanitsidwa ndi kukhalapo kapena kusakhalapo kwa matenda opatsirana - kachilombo kapena kosabala.
Kuzindikira
Pakufufuza ndi kuyesedwa pambuyo pake, hemorrhagic pancreatic necrosis imasiyanitsidwa ndi ma pathologies ena. Kuti muchite izi, dokotala amafufuza wodwalayo, kuti adziwe ngati amamwa mowa kapena zakudya zamafuta, kodi ndi matenda ati omwe ali mu anamnesis ake.
Kenako, wodwalayo amapimidwa m'matumbo kapena pamimba, kuyezetsa zingapo, kuphatikizapo:
- kuyezetsa magazi komwe kumawonetsa dokotala pazomwe zimapangidwira ma pancreatic enzymes (kuwonjezeka kwa izi ndi nthawi 8-9 kumawonetsa hemorrhagic pancreatic necrosis;
- kusanthula kwa madzi am'mimba, omwe amakupatsani mwayi mwachangu komanso molondola kuchuluka kwa acidity;
- urinalysis kuti mufufuze za ureaplasma ndi trypsinogen;
- kuwomba kwa kutsimikiza kwa ma bicarbonate ndi ma enzyme;
- kusanthula kwa mpweya kwa amylase ndi triglycerides;
- Coproscopy zofunika kuphunzira zotsalira mafuta mu ndowe.
Kujambula kwa dera la necrosis kumatengedwa modabwitsa, endoscopic pancreatocholangiography ndipo ngati kuli kotheka, laparoscopy yam'mimba imachitidwa, zomwe zimapangitsa kuwona chithunzi chonse cha kuwonongeka kwa kapamba ndi ziwalo zina zofunika.
Pambuyo pokhazikitsa njira zovuta zodziwirira matenda zimayamba kuthandiza wodwalayo.
Kuchiza matenda
Pazizindikiro zoyambirira za pancreatic necrosis, wodwalayo amapita kuchipatala. Pambuyo pakuzindikira, wodwalayo amatumizidwa kumalo othandizira odwala kwambiri, kapena nthawi yomweyo kuchipinda chothandizira. Ndikofunikira kuchitapo kanthu mwachangu kuti mupulumutse kapamba ndi moyo wa wodwala.
Chithandizo chake ndi:
- Kuchepetsa ululu ndi kuphipha m'mitsempha;
- kuyimitsa ntchito ya enzymatic;
- kutsika kwa madzi a m'mimba;
- kupewa kuphatikiza kwachiwiri.
Wodwalayo amaphatikizidwa ndi mankhwala omwe amachepetsa ululu, mwachitsanzo, novocaine blockade. Anesthesia imatsitsimula ma ducts, imalola madzi a pancreatic kutuluka.
Amatha kuthana ndi kuchuluka kwa michere pogwiritsa ntchito mankhwala a antienzyme, ndipo antibacterial chithandizo chimaletsa matenda a ziwalo zina. Izi zimakuthandizani kuti muchepetse kuphwanya kwa enzymatic ndi zamanyazi ntchito za kapamba.
Conservative mankhwala ikuchitika motsutsana maziko a kuvomerezedwa kudya. Zofunikira zakumwa zimaperekedwa kokha kudzera m'mitsempha kupatula kutulutsidwa kwa katulutsidwe ka kapamba.
M'mbuyomu, zonse zam'mimba zimachotsedwa ndikusamba. Ndikofunikira kupatsa wodwala mtendere ndi malo abwino kwambiri. Chipindacho chizikhala ndi mpweya wabwino. Izi zikuthandizira kupewa kufalikira kwa poizoni woperekedwa ndi wodwalayo.
Ngati palibe kusintha komwe kumabwera, pakufunika chithandizo chamankhwala othandizira mwadzidzidzi. Mtundu wa ntchito umatengera nthawi ya hemorrhagic pancreatic necrosis. Laparoscopy kapena ngalande zowonongeka ndizofunikira pamilandu pomwe matenda kulibe.
Opaleshoni yamkati imachitika pamene kuchuluka kwakukulu kwadzikundana. Peritoneal dialysis imagwiritsidwa ntchito kwambiri, yomwe imayeretsa magazi a poizoni ndi ma enzyme ndipo potero imalepheretsa wodwalayo kuti asafe chifukwa cha kuledzera ndi zinthu zowola.
Moyo pambuyo
Nthawi yogwira ntchito ndi yayitali komanso yovuta. Chofunikira kwambiri pakuchira ndikutsata boma lonse ndikupatsa mphamvu yayitali nthawi yonse yobwezeretsa (osachepera miyezi 4).
Ndikofunikira kumwa mankhwala okhala ndi insulin, mankhwala omwe amalimbikitsa chimbudzi cha chakudya (ma enzymes).
Wodwala yemwe adakhala ndi pancreatic necrosis yodziwika bwino amapatsidwa njira zolimbitsa thupi ndi masewera olimbitsa thupi ofunikira kuti akonzenso mwachangu.
Kuletsa zakudya kumakhala moyo wonse. Zakudya zimatanthawuza kuchepetsa katundu pa kapamba. Ndikofunikira kudya pafupipafupi komanso nthawi zambiri (nthawi 5-6 patsiku). Chakudya chizikhala chosalowerera ndale komanso chofewa.
Zina mwazinthu zomwe zalimbikitsidwa kugwiritsa ntchito tsiku ndi tsiku ndi izi:
- masamba ophika kapena otentha;
- chimanga pamadzi;
- buledi (wouma);
- broth kuwala;
- zopangidwa mkaka zopanda mafuta ambiri;
- nyama yankhuku.
Pali zinthu zingapo zomwe anthu omwe adadwala matendawa ayenera kuyiwalika kwamuyaya.
Kugundika kwa Taboo:
- zakudya zamzitini (nsomba, nyama, masamba);
- zakumwa zoledzeretsa, ngakhale pang'ono;
- koloko;
- kusuta nyama;
- nyama zamafuta;
- makeke atsopano;
- chakudya chofulumira
- mkaka wonse;
- zokometsera;
- ma pickles;
- masamba, zipatso ndi zipatso (zatsopano).
Ndikofunika kutsatira chakudya choterocho kuti muchepetse zovuta zomwe zimakhudzana ndi kulephera kwa kapamba kupanga mahomoni ndi ma enzymes ofunikira.
Popeza shuga mellitus imakonda kukhala pancreatic necrosis, ndikofunikira kuwunika kuchuluka kwa shuga m'magazi, kupimidwa pafupipafupi ndikutsatira malangizo onse azachipatala a endocrinologist.
Kanema kuchokera kwa wodwala yemwe anali ndi matendawa:
Kupewa hemorrhagic pancreatic necrosis
Munthu amene ali pachiwopsezo chotenga matendawa ayenera kutenga njira zopewera. Kuti muchite izi, siyani kugwiritsa ntchito zakumwa zoledzeretsa, kutsatira mfundo za zakudya zoyenera.
Ndikofunikira kuzindikira ndi kuchiza matenda m'nthawi yomwe ingayambitse kukula kwa hemorrhagic pancreatic necrosis - dyskinesia wa biliary, duodenal chilonda ndi zilonda zam'mimba, cholecystitis.
Ndikofunika kukumbukira kuti ngakhale kuvutikira kamodzi kwa zakudya zamafuta kapena mowa kumatha kubweretsa pancreatic necrosis ndipo, chotsatira chake, kuchitidwa opareshoni yayikulu komanso ngakhale kufa.
Anthu omwe ali ndi mbiri yamtundu uliwonse wamatenda a shuga ayenera kukhala osamala kwambiri patebulo la tchuthi. Njira zodzitetezera zosavuta sizitsimikizira kuti pancreatic necrosis sikukula, koma amachepetsa mwayi wokhala ndi matenda ochepa.
