Amayambitsa, Zizindikiro ndi Chithandizo cha Pancreatic Steatosis

Pancreatic steatosis ndi mkhalidwe wam'magazi, chifukwa cha momwe masisitiridwe achilendo a kapamba (kapamba) amasinthidwa ndi lipocytes (maselo amafuta). Pathology si matenda odziyimira pawokha, ndi chiwonetsero cha njira zosokonezeka m'matumbo a gland. Amachitika mogwirizana ndi kusintha kwa kagayidwe ka lipids ndi shuga m'thupi.

Pathology imayamba pang'onopang'ono, ndipo palibe mawonetsedwe azachipatala m'magawo oyambira. Izi zimasokoneza kuzindikira matendawa koyambirira ndipo m'lingaliro ili ndiwopseza: ngati kusintha sikupezeka, njirayi ipita patsogolo, chiwalo chidzafa. Ngati minofu yambiri imayimiriridwa ndi maselo amafuta, mawonekedwe ake adzakhalabe, koma ntchitoyo silingabwezeretse.

Kodi Steatosis ya chiwindi ndi kapamba ndi chiani?

Steatosis (lipomatosis) ndi chida cha maselo a chiwalo chatsopano ndikusinthidwa ndi minofu ya adipose. Mchitidwewu ndi osasinthika, umatha zaka, chiwalocho chimayamba kutaya ntchito pang'onopang'ono chifukwa cha kufa kwa maselo omwe amagwira ntchito nthawi zonse. Ngati kusinthasintha kwa mtundu wa steatosis kwapezeka ndi ultrasound, atakambilana ndi dokotala wam'magazi, ndikofunikira kuti mupitirize chithandizo chamankhwala popewa kuwonongeka kwa minofu ina. Chithandizo chosafunsidwa chikhoza kuwopseza kukula kwa madongosolo osungidwa am'mimba komanso kuwonongeka kwathunthu kwa ziwalo zosinthidwa.

Pokhudzana ndi kufalikira kwa vutoli, mawu osiyanasiyana amagwiritsidwa ntchito posonyeza kusintha kwamatenda: lipomatosis, kuchepa kwamafuta kwa kapamba.

Ndi kunenepa kwambiri kwa kapamba, steatosis ya chiwindi imapezeka kawirikawiri, kapena njira izi zimayamba motsatizana. Vutoli limafunikira chithandizo, chifukwa lingayambitse mavuto akulu. Mwa amuna, zakumwa zoledzeretsa zimakonda kupezeka, mwa akazi - matenda osokoneza bongo a mafuta a chiwindi (NAFLD). Popeza ziwalo zonse zam'mimba zimalumikizidwa ndi ntchito wamba, izi zokhudzana ndi kuphipha komanso chiwindi zimachokera nthawi imodzi. Kugawidwa kwa Matenda a ICD ku mayiko ena: - 10

• mafuta a hepatosis - K.70 - K.77,
• steatosis (lipomatosis) - K. 86.

Zimayambitsa steatosis

Zomwe zimayambitsa kuwonekera kwa steatosis sizinazindikiridwe ndi mankhwala, koma kulumikizidwa kwatsimikiziridwa pakati pakupanga kwamafuta omwe alipo mu dermis (lipomas) ndi ziwalo zapafupi. Nthawi zambiri zimawonekera m'dera la ndulu. Pali ubale pakati pa kukula kwa lipomas ndi steatosis mu kapamba ndi chiwindi.

Steatosis imatha kuwonedwa ngati njira yoteteza thupi kuti isokoneze zakunja ndi zamkati zamkati pamene chitetezo cha thupi chatha, ndipo imaleka kulimbana ndi pathological mu kapamba, poyankha nawo ndi steatosis.

Chimodzi mwazinthu zazikulu pakuwoneka kuti kulowa kwa mafuta pancreatic ndikulowerera:

• mavuto azakudya
• zizolowezi zoyipa (kusuta, kumwa).

Mowa sugwiranso ntchito kwa aliyense: zimatsimikiziridwa kuti kukulitsa kwa steatohepatosis kapena pancreatic steatonecrosis sikudalira mlingo wa mowa. Amapezeka mwa anthu omwe nthawi zambiri amatenga zakumwa zazikulu za zakumwa zoledzeretsa, koma ena amafunikira zochepa chabe kuti ayambitse matenda a pancreatic minofu degeneration.

Chakudya chopanda pake ndi chiopsezo champhamvu: sikuti kumangokhala kudya zakudya zamafuta ambiri komanso kunenepa kwambiri kwamtsogolo kumapangitsa kukula kwa kapamba ndi chiwindi lipomatosis. Kupangitsa kumatha kukazinga, kusuta, mchere wambiri, zokometsera zokometsera.

Matenda ena amatha kudwala steatosis:

Kutupa m'thupi lililonse, komanso makamaka kapamba, kumapangitsa kusintha kwa maselo ndi kufa kwawo. M'malo mwawo, minofu ya adipose imakula.

Mavuto owononga amakhala ndi magulu ena a mankhwala. Nthawi zina piritsi limodzi limatha kusintha zosasintha. Nthawi zambiri, steatosis imayamba chifukwa cha antibacterial mankhwala, glucocorticosteroids (GCS), cytostatics, painkillers, ngakhale, kuphatikiza pa iwo, pali magulu ambiri a mankhwala omwe amachititsa kuyambitsa kwa pancreatic necrosis.

Pancreatic minofu imatha kutha chifukwa cha kuchitapo kanthu pochita opaleshoni: ngakhale ngati opaleshoniyo singachitike chifukwa cha kapamba, koma ziwalo zapafupi, izi zimapangitsa kusintha kwa minyewa.

Pali mwayi wolandira pancreatic lipomatosis. Koma kuchuluka kwa odwala omwe ali ndi majini othandizira kufalitsa kwa steatosis ndi ochepa kwambiri. Ndi kuthekera kwakukulu, titha kunena kuti kukulitsa kwa matenda amisala kumadalira munthu: momwe amakhalira, machitidwe, zakudya, ntchito.

Zizindikiro zamatsenga

Choopsa chachikulu cha steatosis ndikusowa kwa zizindikiro zoyambirira za mawonekedwe ake m'magawo oyamba a matenda. Kwa nthawi yayitali (miyezi ingapo kapena zaka), palibe zodandaula kapena zizindikiro zamatenda zomwe zingachitike. Kusapeza bwino pang'ono kumawoneka pomwe pancreatic parenchyma ili kale ndi 25-30% yopangidwa ndi maselo amafuta. Ndipo ngakhale panthawiyi, maselo amoyo wathanzi amalipira gawo lomwe likusowa, ndipo chida cha pancreatic sichimalephera. Uwu ndiye digiri yoyamba ya matenda.

Pamene dystrophy ya maselo a ziwalo ikupita patsogolo, matendawo angakulire. Mlingo wachiwiri wowonongeka kwa parenchyma umafanana ndi mulingo wa kulowetsedwa kwa minofu ya adipose mu kapamba kuyambira 30 mpaka 60%. Momwe maselo osinthika afika 60%, ntchito zake zimasokonezeka pang'ono.

Koma chithunzi chonse cha chipatala chokhala ndi madandaulo apadera ndi mawonekedwe akuwonekera mu gawo lachitatu la matenda, pomwe pafupifupi ziwalo zonse za chiwindi ndi pancreatic parenchyma zimasinthidwa mosavomerezeka ndi lipocytes (zoposa 60%).

Mawonetsedwe oyamba amawu ndi:

• kutsegula m'mimba
• kupweteka kwam'mimba - kutengera kwina kosiyanasiyana ndi mphamvu,
• chisangalalo, mpweya woyenda,
• nseru
• thupi lawo silimadya
• osati chofoka, kutopa,
• chitetezo chochepetsedwa, chomwe chimawonetsedwa ndi chimfine pafupipafupi,
• kusowa kwa chakudya.

Osangokhala ntchito za exocrine zokhala ndi vuto logaya chakudya zimakhudzidwa, komanso impretory: kapangidwe ka insulin Langerhans islet ndi maselo a beta, mahomoni omwe amachititsa kagayidwe kazachilengedwe, amachepetsa kwambiri. Nthawi yomweyo, mapangidwe a zinthu zina za mahomoni amasokonezedwa, kuphatikiza somatostatin, glucagon (kapamba amawatulutsa mu 11).

Kodi chiwopsezo cha steatosis chimabweretsa chiani kwa anthu?

Kukula kwa steatosis kumatsimikiziridwa ndi mawonekedwe a anatomical komanso kufunika kwa kapamba. Ili ndiye chiwalo chachikulu chogaya chakudya, chimapanga ma enzyme omwe amathandizira kugaya mafuta, mapuloteni, michere monga mbali ya chakudya cham'mimba. Izi zimachitika m'malo apadera a pancreatic glandular minofu - acini. Iliyonse mwa iyo ili ndi:

• kuchokera kumaselo opanga madzi a pancreatic,
• kuchokera ku zombo
• Kuchokera pa duct yomwe chinsinsi chimatulutsidwira m'mizere yayikulu, kenako ndikulowetsedwa.

Mpweya wa Wirsung umayenda kudutsa chithaphwi chonse ndikualumikizana ndi ndulu ya ndulu, ndikupanga chopunthira chomwe chimatseguka ndikuwala kwamatumbo aang'ono chifukwa cha sphincter ya Oddi.

Chifukwa chake, kapamba amaphatikizidwa ndi chikhodzodzo, chiwindi, matumbo ochepa, osalunjika - ndi m'mimba. Kuphwanya kulikonse mu gland kumabweretsa kusintha kwa kagayidwe kachakudya ziwalo zoyandikana ndi zomwe zimayambitsa:

• mafuta a hepatosis m'matumbo a chiwindi,
• kuwonongeka kwa ndulu, komwe kutupa kumayamba (cholecystitis), komanso chifukwa cha kusayenda kwa miyala ya bile imapangidwa (cholelithiasis),
• makulidwe a makoma ndi kuchepera kwa lumen ya duct yodziwika kumabweretsa chiwopsezo chochuluka mwa katulutsidwe ka pancreatic, kubwerera kwa ma enzymes ndi pachimake pancreatic necrosis,
• kumwalira kwa zilumba za Langerhans chifukwa cha kukulira necrosis kumayambitsa kuchepa kwakukulu kwa insulin, kuchuluka kwa glycemia komanso kukula kwa mtundu wa matenda a shuga 1.

Pancreatic pancreatitis mu shuga mellitus amafotokoza kusinthana kwa atrophy ndi hyalinosis ya ma islets omwe amakhala ndi chiphuphu chokwanira.

Pa magawo 2 ndi 3 a steatosis, kukula kwakukulu kwa maselo amafuta kumachitika ndikusokoneza ntchito ya kapamba. Koma ngakhale ndi zotupa zoyenera za madera ena a gland, chidzalo cha chithunzithunzi cha kapamba chimatha kuwonekera chifukwa cha chitukuko cha Autolysis (kudzimbidwa) ndi necrosis yotsatira komanso mapangidwe a madera ophatikiza - fibrosis, kuphatikizapo lipomatosis. Matenda ochita kupindika ngati kusintha kwa atrophic ndi fibrolipomatosis pang'onopang'ono sikungasinthike, nthawi zambiri kumachitika chifukwa cha chifuwa chachikulu. Ndi matenda amachitika:

• Kuchulukana kwa kulowetsedwa kuchokera ku minofu yolumikizika, komwe kumatha kufinya mizere, mtsempha wamagazi, minofu yotsalira,
• kufooketsa ziwalo chifukwa chotupa chotupa.

Njira zodziwira matenda amisempha

Kutsimikizika kwa kutayika kwa ntchito kumatsimikiziridwa ndi maphunziro azidziwitso, omwe amakhala ndi njira zothandizira ntchito. Njira zonse zodziwira matenda zimagwiritsidwa ntchito kuti mudziwe kuwonongeka kwa minofu ya chiwalo, kuthetsa vuto la njira zina zamankhwala.

Mankhwala amakono sanapangiretu njira zobwezeretsera maselo otayika ndi ntchito. Maselo akufa sabwezeretseka. Koma ndikotheka kupereka chithandizo choyenera chothandizira kusintha ndikusintha vutolo.

Laborator diagnostics

Kuyesedwa kwa Laborator ndikofunikira kwambiri pakuwazindikira. Kuti mudziwe zovuta zomwe zimachitika chifukwa cha kapamba ndi kuwunika kwa chiwindi:

• magazi ndi mkodzo,
• shuga wamagazi
• bilirubin - yonse, mwachindunji, mwachindunji, transaminase, mapuloteni onse ndi zigawo zake.

Kuphatikiza apo, muyenera kuphunzirira ndowe - pangani pulogalamu yomwe izindikire kapamba.

Chida chozindikira

Kuti mumve bwino za kapamba, kaphatikizeni:

• Ultrasound ya kapamba ndi ziwalo zina zam'mimba,
• CT - yowerengera makanema,
• MRI - kulingalira kwa maginito.

Ultrasound ndi njira yosavuta komanso yotsika mtengo kwambiri. Imasiyanitsidwa ndi chitetezo, imawulula kusintha kulikonse kwa ziwalo zam'mimba.

Ndi steatosis, kukula kwa kapamba kumakhalabe chimodzimodzi, kumveka kwa malire sikusintha, kufalikira kwa zinthu zina kumawonjezeka, komwe kumatsimikizira matenda omwe amapezeka mu organ parenchyma.

Fibrolipomatosis amadziwika ndi kuchuluka kachulukidwe kapangidwe ka chiwalo chifukwa kapangidwe kazinthu zolumikizana.

Mu magawo oyambirira a chitukuko, pamene palibe zodandaula, ndipo zizindikiro zamankhwala zilibe, monga lamulo, palibe amene amachita ultrasound. Kusintha kwamafuta m'matumbo oyambira m'magawo oyamba amapezeka ngati mukupeza chifukwa china. Zotsatirazi zimatsimikiziridwa ndi biopsy, pambuyo pake mankhwala adalembedwa - izi zimapangitsa kuti pasakhale kupita patsogolo.

Njira yovuta yotupa mu minofu imatsogolera ku necrosis, yomwe imayendetsedwa ndi edema, kukula kwakukulu ndikuchepa kachulukidwe pa ultrasound.

MRI imayikidwa pazochitika zosadziwika, pomwe mawonekedwe a ultrasound sanathandizire kuti adziwe kuti ali ndi vuto komanso panali kukaikira. Njira yake molondola komanso mwatsatanetsatane imafotokozera kapangidwe kake komanso kapangidwe kake panthawi iliyonse yosintha. Ndi steatosis, MRI imazindikira chiwalo:

• ndi mauni omveka
• ndi kufupika kachulukidwe
• ndi miyeso yochepetsedwa,
• ndi minyewa yosinthika (kupukusa, kupukusa mutu, kusintha kosiyanasiyana kumatsimikizika).

Kuboola mafupa kumachitika pochita chiwindi.

Njira zochizira matenda

Mukazindikira lipomatosis, ndikofunikira kupatula zakumwa zoledzeretsa, kusuta fodya ndi kuchepetsa zinthu zoyipa. Izi ndizofunikira zomwe zimapangitsa kuti kuyimitsa kupitilira kwa steatosis. Mukunenepa kwambiri, kuyesayesa kulikonse kuyenera kuchitika kuti muchepetse kunenepa: kuchepa kwa 10% m'thupi kumapangitsa bwino vutoli. Zakudya zopatsa thanzi umalimbana ndikuchepetsa mafuta ndikuchepetsa ma carbohydrate ngati utapezeka ndi matenda a metabolic. Ndi chitukuko cha matenda ashuga, tebulo nambala 9 limayikidwa, lomwe liyenera kutsatira kwambiri.

Ngati kusintha kwa parenchyma kwabwera kotero kuti kugaya chakudya kusokonekera, chithandizo chokwanira chikuyenera kuperekedwa, kuphatikizapo chakudya ndi mankhwala. Kusintha kwamakhalidwe ndikofunikira: wodwala ayenera kusiya zizolowezi zoyipa, kupewa nkhawa, kuwonjezera ntchito zamagalimoto.

Zakudya zamagulu omwe zimagwirizana ndi tebulo Na. 5: chakudyacho chimaphika chothira, mu uvuni kapena chophika, chimayenera kuphwanyidwa, nthawi zambiri chimadyedwa m'magawo ang'onoang'ono. Sichiyenera kukhala choyipitsa: kutentha kwa chakudyacho kumafikiridwa bwino, mafuta, zonunkhira, osuta, zakudya zophika siziyikidwa kunja. Menyu yonseyo imapangidwa pogwiritsa ntchito matebulo apadera omwe amafotokoza zinthu zoletsedwa komanso zololedwa, komanso kuwerengera mphamvu yawo.

Mankhwalawa ali ndi zolinga zotsatirazi:

• chepetsani njira yotsitsimutsa maselo a minyewa
• Sungani zotsalira zosasinthika,
• Kuphwanya kolondola kwa kagayidwe kazakudya ndi kuperewera kwa enzyme.

Mankhwala osokoneza bongo amaphatikizapo kugwiritsa ntchito mankhwala ena. Zogwiritsidwa ntchito ndi:

• antispasmodics
• enzymatic
• hepatoprotectors
• zikutanthauza kuti muthane ndi katulutsidwe ka hydrochloric acid wa chapamimba mucosa (proton pump inhibitors),
• othandizira antifoam omwe amachepetsa kupanga magesi m'matumbo,
• mankhwala omwe amasintha shuga.

Mlingo wa mankhwala okhazikika ndi nthawi yayitali ya mankhwala amatsimikiziridwa ndi dokotala kutengera kusintha kwa gland ndi zizindikiro zomwe zilipo.

Njira ina yochizira matenda a steatosis siyothandiza: njira za m'matumbo zomwe sizikusintha, motero, nkosatheka kuchiritsa matendawa pogwiritsa ntchito njira zamankhwala azikhalidwe. Kuphatikiza apo, thupi limagwiritsa ntchito mankhwala azitsamba. Chifukwa chake, chithandizo chokha chokha sichilimbikitsidwa.

Kupewa kwa matenda a "kapangidwe kamankhwala osokoneza bongo"

Matenda osagwirizana ndi zakumwa zoledzeretsa amadziwika ndi kudzikundikira kwa milomo yopanga ya lipid mu minyewa ya kapamba ndi chiwindi. Kusintha uku kumawoneka motsutsana ndi maziko a kunenepa kwambiri komanso kusokonezeka kwa metabolic.

Pofuna kupewa matenda osakhala oledzera wamafuta (NLBF), ndikofunikira kutsatira malamulo ofunika:

• simungathe kudya kwambiri, kudya pang'ono komanso nthawi zambiri, kupatula zakudya zoyipa,
• kupatula mowa ndi kusuta,
• kutsatira malangizo a motor, kuchita zochizira zolimbitsa thupi.

Ndi steatosis yomwe yapangidwa, thandizo la akatswiri munthawi yake likufunika. Kwa matenda aliwonse, ndikulimbikitsidwa kukaonana ndi dokotala, osati kuti musadziyese nokha. Pokhapokha ngati izi zingatheketse chikhululukiro chokhazikika komanso chidziwitso chabwino.