Cholumikizira chachikulu mu pathogenesis cha pancreatitis pachimake

Malinga ndi V.S. Savlieva et al., 2001

Kukopa kwa secretion + kuphwanya kunja

Kutembenuza kwa trypsinogen kukhala trypsin:

Maziko a pathogenesis a pancreatitis pachimake ndi njira zomwe zimachitika mderalo komanso mwatsatanetsatane chifukwa cha michere ya pancreatic ndi cytokines yamitundu yosiyanasiyana. Lingaliro la enzyme lomwe lili ndi gawo lalikulu la trypsin mu pathogenesis yamatenda limatengedwa kuti ndiwotsogolera. Kuphatikiza kwa zinthu zingapo zomwe zimayambitsa matenda mkati mwa polyetiology ya pancreatitis pachimake ndiye gawo lalikulu la kuyambitsa kwa intacinar kwa michere ya proteinolytic ndi chimbudzi cha patocatalytic cha kapamba. Mu cytoplasm ya cell acinar, fusion ya zymogen granules ndi lysosomal hydrolases imawonedwa ("colocalization theory"), chifukwa chomwe ma proenzymes amathandizira ndikutulutsa kwamasewera kwaposachedwa kwa pancreas. Kukhazikitsa kwa trypsinogen ndikusintha kwake kukhala trypsin ndi chida champhamvu cha ma proenzymes ena onse ndikupanga kwamasewera ovuta kwambiri a pathobiochemical. Chofunika kwambiri mu pathogenesis ya matendawa ndi kukhazikitsidwa kwa nthawi yayitali kwa machitidwe a enzyme, ndipo kagwiritsidwe kake koyambirira kamayanjana ndi kuwonongeka kwa zimagwira cell ndi kusokoneza kwa transmembrane mogwirizana.

Imodzi mwa njira zenizeni za pathogenesis ya pancreatic necrosis pakuwonongeka kwa cell ya acinar ndikusintha kwa kuchuluka kwa calcium ion mu cell ndi kupitirira, komwe kumayambitsa kutsegula kwa trypsin. Ndi kuchuluka kwa calcium ion mu cell, intracellular synthesis wa platelet activation factor (wamkulu woteteza mkhalapakati) amayambitsidwa.

Njira zina zochitira zokha mphamvu zama enzyme mu kapamba: kusakhazikika mu dongosolo la enzyme-inhibitor kapena kuchepa kwa trypsin inhibitors (alpha-1-antitrypsin kapena alpha-2-macroglobulin), kukulira motsutsana ndi masinthidwe amtundu wofanana.

Trypsin ndiye woyamba kuchititsa chisangalalo chachikulu cha zochita za pathobiochemical, koma kuopsa kwa machitidwe amomwe amachitika chifukwa cha kuphatikiza kwakukulu kwa mapangidwe onse a pancreatic enzyme system (trypsin, chymotrypsin, lipase, phospholipase A2, elastase, carboxypeptidase, collagenase, etc.)

Ma enzymes ophatikizidwa ndi pancreatic amakhala ngati zinthu zoyipa kwambiri, amakhala ndi mphamvu yakumaloko, amalowa m'malo otuluka, m'mimba, kudzera m'mitsempha ya chiwindi, komanso kudzera m'mitsempha ya m'mimba. Phospholipase A2 imawononga ma membrane am'mimba, lipase hydrolyzes intracellular triglycerides kwa mafuta acids, omwe, akaphatikizidwa ndi calcium, amapanga zinthu zogwirizana ndi mafuta (lipolytic) necrosis mu kapamba, fayilo ya retroperitoneal space ndi peritoneum. Trypsin ndi chymotrypsin zimayambitsa mapuloteni a minofu, elastase imawononga khoma la chotengera komanso mapulani amtundu wa interstitial, omwe amatsogolera pakukula kwa hemorrhagic (proteinolytic) necrosis. Tinthu tating'onoting'ono ta necrobiosis, necrosis wokhala ndi gawo loyipa la zotumphukira m'matumbo ndi minyewa ya retroperitoneal makamaka ndi aseptic.

Cholumikizira chofunikira mu pathogenesis ya pancreatitis pachimake ndi trypsin activation ya kallikrein-kinin dongosolo ndikupanga yachiwiri yaukali zinthu: bradykinin, histamine, serotonin. Izi zimaphatikizidwa ndi kuwonjezeka kwa mtima kukhathamira, kusokonekera kwamakina, mapangidwe a edema m'mapapo ndi malo a retroperitoneal, kuchulukitsidwa kwa exidation kulowa m'mimba.

Zinthu zankhanza zachitatu zomwe zimakhudzidwa ndi pathogenesis yamomwe zimachitika mkati mwathu komanso mwatsatanetsatane, zotupa zam'mimba komanso kupuma, kuphatikizapo kulephera kwa cell, ma macrophages komanso neutrophils a oyimira pakati otupa (ma cytokines): ma interleukins 1, 6 ndi 8, necrosis factor zotupa, mapuloteni activation, osakhala kapamba wa phospholipase A2, prostaglandins, thromboxane, leukotrienes, nitric oxide.

Ma proinflammatory cytokines amaphatikizapo: chotupa necrosis factor, ma interleukins 1-beta ndi 6, komanso omwe amatsutsana ndi kutupa - ma interleukins 1 ndi 10. Kumayambiriro kwa matendawa, kuchuluka kwa oyimira matenda obwera chifukwa cha kapamba, chiwindi, mapapu, ndulu ndi kayendedwe kazinthu zimawonjezeka, zomwe zimafotokozera njira zoyambira. ammudzi, ziwalo komanso zokhudzana ndi zotupa.

Ma Enzymes, ma cytokines ndi metabolites amitundu yosiyanasiyana, omwe amapangidwa pancreatitis yapachimbudzi, malo opatsirana, m'mimba komanso chimbudzi cha m'mimba, amalowa mwachangu m'magazi a portal komanso kudzera mu thoracic lymphatic duct mu systemic circulation ndi chitukuko cha pancreatogenic toxin. Ziwalo zoyambilira zomwe zikuyenda kuchokera ku malo obwezeretsanso mpaka ziwalo zina zowonjezera pamimba ndizo chiwindi ndi mapapu, mtima, ubongo ndi impso. Zotsatira zamphamvu za cytotoxic pazomwe amapanga zamankhwala am'magazi kumayambiriro kwa matendawa ndikukula kwa matenda a pancreatogenic ndi zovuta zingapo za ziwalo zomwe zimazindikira kukula kwa mkhalidwe wa wodwalayo ndi pancreatitis yayikulu.

Mu pathogenesis yokhudzana ndi kusokonezeka kwazinthu, ngakhale isanayambike zovuta za septic, toxinemia ya bakiteriya ndipo koposa zonse, lipopolysaccharide ya cell khoma la mabakiteriya a gram-negative (endotoxin), yopangidwa mu lumen ya m'mimba mwa m'mimba mwa microflora yamatumbo, ndiyofunikira. Mu pachimake kapamba, kuyenda kwa amkati microflora ndi endotoxin wa gram-sanali m'mimba mabakiteriya zimachitika mu zofanana magwiridwe antchito (zochepa morphological) kulephera kwa kagayidwe kachakudya kagawo kagayidwe kachakudya ka minyewa ndi chotupa, reticuloendothelial dongosolo la chiwindi ndi mapapu.

Kusuntha kwa ma microflora amkati kuchokera m'matumbo am'mimba kupita m'matumbo a kapamba ndi malo a retroperitoneal ndiko kulumikizana kwakukulu mu pathogenesis yowononga pancreatitis. Njirayi ndi yolumikizira pakati pa woyamba, "oyambirira" (pre-matenda), ndi yotsatira, "mochedwa" (septic), magawo a pancreatitis pachimake.

Mu pathogenesis ya pancreatitis yovuta, magawo awiri akuluakulu amadziwika. Gawo loyamba limachitika chifukwa cha kupangika kwachilengedwe m'masiku oyambira kuyambira matendawa atayamba, pamene kutupa, Autolysis, necrobiosis ndi necrosis ya kapamba, minofu ya retoperitoneal iseptic. Pansi pa izi, sabata loyamba la matendawa, kutengera kuwonongeka kwa matenda a pathomorphological, kupangika kwa mitundu yotsatirayi ya kapamba kovuta kumachitika:

ndi necrobiosis, kutupa ndi kusanthula kwa njirayo, kupweteka kwapakati pancreatitis kumayamba (edematous mawonekedwe),

ndi mafuta kapena hemorrhagic necrosis - wosabala pancreatic necrosis (necrotic pancreatitis).

Kuopsa kwa vuto la wodwalayo ndi kupweteka kwa pachimake ndi chifukwa cha patomorphology ya matenda ndi chifuwa chachikulu cha m'mimba, chifuwa chachikulu cha kapamba komanso kulephera kwa ziwalo zingapo. Mwa njira zochiritsira panthawi yake, njira ya pathological imatha kuyimitsidwa pamlingo wa pancreatitis ya interstitial, pomwe pakuyenderana, imakhala pancreatic necrosis.

Ndi kupitirira kwa matendawa ndi zotsatira za pancreatic necrosis, njira ya pathological kusintha kwa gawo lachiwiri (septic) la pancreatitis yodziwika bwino, yomwe imalumikizidwa ndi matenda am'magazi a necrosis osiyanasiyana kutanthauzira kwa sabata la 2-3 la matenda. Pansi pa izi, kukonzanso ndi kubalanso kwa oyimira pakati ofanana ndi gawo loyamba kumachitika, zomwe zimayambitsa poizoni wa tizilombo tating'onoting'ono tomwe timayambitsa magulu a necrosis. Mchigawo chopatsirana cha matendawa, malo ozungulira a pathological reaction ndi gawo latsopano mu kapangidwe ka mitundu yosiyanasiyana ya kachilombo ka kapamba ndi chifuwa chachikulu cha m'mimba ndi septic kugwedezeka komanso zingapo ziwalo. Pafupipafupi pafupipafupi matenda omwe amapezeka ndi pancreatic necrosis ndi 30-80%, omwe amatsimikiziridwa ndi kuchuluka kwa pancreatic necrosis, nthawi yamayambiriro a matendawa, chikhalidwe chake chokhazikika komanso njira zamankhwala othandizira opaleshoni. Kukula kwa matenda ndi pancreatic necrosis kuyenera kuonedwa kuti ndi gawo lofunikira pakukula kwa njira ya patomorphological.

Pali kulumikizana mwachindunji pakati pa kuchuluka kwa zotupa za necrotic komanso kuthekera kwa matenda. Matenda a necrosis omwe amapezeka ndi wodwala aliyense wachilungu choyamba cha matendawa, pafupifupi theka la odwala omwe ali ndi vuto la kapamba mu sabata yachiwiri, mwa wodwala aliyense wachitatu yemwe ali ndi pancreatitis yowonongeka mkati mwa milungu yachitatu ndi yachinayi kuyambira pomwe matendawa adayamba.

Omwe amachititsa kwambiri matenda a pancreatogenic: E. coli (26%), Pseudomonas aeruginosa (16%), Staphylococcus (15%), Klebsiella (10%), Streptococcus (4%), Enterobacter (3%) ndi Anaerobes. Matenda oyamba ndi mafangasi amayamba pambuyo pa masabata awiri kapena kupitilira apo kuchokera pa chikhansa chotchedwa pancreatic necrosis, chomwe chimachitika chifukwa cha nthawi yayitali ya mankhwala othandizira.

Kuperewera kwa malo oyamba a pancreatic necrosis amayamba chifukwa cha kuipitsidwa kwa microflora ya mwayi wamkati (colonic) ndi exo native (mu opaleshoni yoyendetsedwa ndi drainage ndi ma tampons ochokera kuzungulira malo opangira chisamaliro chachikulu).

Malipoti oyamba a kapamba kapamba

1641 - Dokotala wa ku Netherlands van Tulp N. (Tulpius) anali woyamba kuwona pancreatic abscess at autopsy.

1578 - Alberti S. - Kafotokozedwe koyamba kachigawo chowunika pancreatic yotupa.

1673 - Greisel anali woyamba kufotokozera zamankhwala matenda a kapamba chifukwa cha imfa 18 patatha masiku 18 chiyambireni matendawa ndikutsimikiziridwa ndi autopsy.

1694 - Diemenbroek I. adawona pathoanatomical semiotic ya pancreatic necrosis m'malonda a Leiden omwe adwala puranc pancreatitis.

1762 - Stoerk walongosola za matenda azachipatala a "kukhumudwa m'matumbo."

1804 - Portal adalongosola kuunika kwa pancreatic necrosis ndi abscess.

1813 - Perival adawona nkhani ya chikopa chachikulu cha kapamba.

1830 - Rekur adawonetsa gulu lachipatala kukonzekera kwapancreatic ndi ma abscesses angapo.

1831 - Lawrence adafalitsa kuwunika kwa hemorrhagic pancreatitis.

1842 - Claessen kachipatala koyamba adazindikira kupweteka kwa kapamba

1842 - Karl Rokytansky adaphunzira chithunzi cha matenda otupa a kapamba

1864 - Ancelet adasindikiza kalozera woyamba wa matenda a kapamba ku Paris.

1865 - Karl Rokytansky adaphunzira mwatsatanetsatane za pathological anatomy of hemorrhagic pancreatitis.

1866 - Spiess adafotokoza mlandu wamwalira kuchokera ku "zotupa zowunda" mu zikondamoyo.

1867 - Luke ndi Klebs anali oyamba kuchita chojambula choyambirira cha pancreatic cyst, koma wodwalayo atamwalira posachedwa.

1870 - Klebs - katswiri wazamankhwala waku America adapanga gulu loyambilira la kapamba, ndipo lidachita bwino kwambiri kuti pantchito za otsatira ake ambiri adakonzanso zina.

1874 - Zenker adalongosola "apoplexy" wa kapamba.

1881 - Tirsh ndi Kulenkampf adakonza zotulutsa zakunja kwa ma post-necrotic cysts.

1882 - Dokotala wa opaleshoni waku America a Bozeman adachotsa bwino chotupa cham'mimba chomwe chimayendetsa cyst yayikulu ya ovari.

1882 - Balser anachita kafukufuku wakapangidwe kazachilengedwe wa mafuta necrosis mu pachimake kapamba.

1882 - Gussenbauer adazindikira kuti pancreatic cyst yabodza ndipo adachita nthawi yomweyo cystostomy (marsupialization) chifukwa chosatheka chifukwa cha kuwonekera kwake chifukwa choyandikira kwa sitima zazikulu.

1886 - Miculicz akufuna marsupialization wa pancreatic necrosis ndi pancreatic abscess.

1886 - Dokotala wa opaleshoni waku America Senn adati akufuna kuchitidwa opaleshoni, monga Ndinali wotsimikiza kuti kuthandizira opaleshoni kungakhudze zotsatira za matendawa ndi kapamba kapena chimbudzi.

1889 - Reginald Fitz, dokotala wa zamankhwala pachipatala cha Massachusetts ku United States, adafotokozera za mayikidwe oyamba omwe anaphatikiza mitundu isanu ya pancreatitis yayikulu. Analimbikitsa opaleshoni yodzidzimutsa, yomwe posachedwa adakhumudwa nayo, nati "opaleshoni yoyambirira siyothandiza ndipo ndiyowopsa."

1890 - Upangiri woyamba wamankhwala othandizira odwala matenda a kapamba (Braun) adasindikizidwa.

1894 - Vuto la pancreatitis yacute idakambidwa koyamba pamsonkhano wa madokotala othandizira opaleshoni ku Germany, pomwe Kerte adapereka malingaliro othandizira opaleshoni yodzidzimutsa.

1895 - The monograph woyamba pa pathological anatomy of pancreatic matenda (Diekhoff) adasindikizidwa.

1896 - Chiari H. ikani chidziwitso chakufunika kwa "kudzimbidwa" pakukonza khungu ndi mafuta a parancancic.

1897 - Dokotala wa opaleshoni waku Russia Martynov A.V. adateteza kufalitsa koyamba ku Russia pa matenda a kapamba. Pofotokoza zovuta zomwe zimapezeka pancreatitis yovuta kwambiri, adalemba kuti: "Pozindikira pancreatitis pachimake," cholakwika ndi ulamuliro, pomwe kupezeka koyenera ndikoyenera. " A. Martynov adatinso gawo lakuwerenga matenda a pancreatic amakono kwa iye "nthawi yodziwika bwino ndi matenda azachipatala".

1897 - Hale-White N.N. inafalitsa lipoti la Guy's Hospital prisecture ku London, komwe kunaphatikizapo kuwunika 142 kwamatenda osiyanasiyana a kapamba ndipo pafupifupi mitundu yonse ya kusintha kwa ma pathological mu ma parenchyma ndi ma ducts a gawo ili.

1899 - Razumovsky adawonetsa kuti, ngakhale kuti zotsatira zakupha zikuyimira kumapeto kwa zotupa za m'mimba, "munthawi yodziwika, kuchira ndikotheka."

1900 - Bessel-Hagen akufuna kukhetsa ma pancreatic cysts ndi cystogastrostomy.

1901 - Opie E. L. ndi Halsted W. S. adatinso ubale wa etiopathogenetic pakati pa cholelithiasis ndi hemorrhagic pancreatitis, ndikupanga "zofala zomwe zimanenedwa."

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Zimayambitsa kapamba

Mu 80% ya milandu, zomwe zimayambitsa matendawa atagona kuledzera, matenda a gallbladder ndi ma ducts. Mu 45% ya milandu, zimadziwika kuti mapangidwe a kutupa kwa kapamba amalimbikitsidwa ndi choledocholithiasis, cholelithiasis, kukakamiza kwa njira ndi ma cysts ndi zotupa, ndi matumbo a matumbo.

Matenda aliwonse omwe amakhala ndi omwe ali ndi zifukwa zake zoyambira. Komabe, zonsezi zimatsogolera ku pancreatitis yachuma.

Zomwe zimatsogolera mu pathogenesis ya pancreatitis ndi: kuvuta kutuluka kwa pancreatic enzyme kudzera mu ma ducts. Chifukwa chake, chithandizo cha matenda oyamba amayamba ndi chithandizo cha matenda onse ophatikizika.

The etiology ya pachimake kapamba imakhudzana makamaka ndi uchidakwa. Poterepa, kukula kwa matendawa ndi kusokonezeka kwa njira ya chiwindi ndi chithokomiro.

Zoledzeretsa zimawonjezera katulutsidwe, zimapangitsa kuti kutulutsa kumvekeke kwambiri.Izi zimawonjezera kupanikizika mu njira, yomwe imabweretsa kuledzera kwa kapamba, imasokoneza kaphatikizidwe kameneka mkati mwake ndipo imakhumudwitsa zochita za chiwindi.

Vuto linanso lodziwika bwino la kapamba limawerengedwa ngati chinthu chopatsa thanzi. Zikatero, kutupa kumayamba munthu akamagwiritsa ntchito nyama, mafuta komanso zakudya yokazinga.

Pafupipafupi, pathophysiology ya kapamba imayambitsa zifukwa zingapo:

1. matenda a ma virus (ma mumps, ma virus a coxsackie, hepatitis),
2. ma genetic (cystic fibrosis),
3. mabakiteriya (mycoplasma, campylobacter),
4. zilonda zam'mimba,
5. kuvulala kwachikondwerero
6. kobadwa nako matenda a ziwalo,
7. kumwa mankhwala (estrogens, corticosteroids, diuretics, azathioprine),
8. kagayidwe kachakudya koyambitsidwa ndi kupezeka kwa matenda angapo (vasculitis, shuga, AIDS).

Pancreatitis imayambanso chifukwa cha kulowererapo kwa opaleshoni komwe kumachitika mu matenda a kapamba ndi ma ducts a bile. Kuvulala kwa chiwalo kumatha kuchitika pakulimbitsa thupi, ma endicopy, ma prosthetics, papillotomy, ndi mitundu ina ya ntchito.

Postoperative pancreatitis ndi njira yothandizira opaleshoni. Zimachitika ndi kuwonongeka kwa zonyansa m'mimba ndi kutaya kwa magazi.

Zowopsa zomwe zimayambitsa kutupa kwa pancreatic zimaphatikizapo kulowetsa kwa helminthic (matenda a ascaris), hyperparathyroidism (parathyroid pathology) ndi poizoni wa organophosphate.

Zina mwazinthu zomwe zimapangitsa kuti matendawa aziwoneka ndi monga kuluma ndi ischemia ya dziwe la mesenteric, lomwe limachitika panthawi yopanga mesenteric artery thrombi.

Pathomorphogenesis

The pathomorphogenesis ya pancreatitis pachimake nthawi zonse imakhala yotsatizana komanso / kapena kusintha kosiyanasiyana m'njira zotupa, necrobiosis, necrosis komanso matenda m'malo osiyanasiyana a anatomical. Zosakaniza zophatikizana zamankhwala am'magawo a kapamba ndi / kapena minyewa yotulutsa mphamvu nthawi zambiri zimayang'aniridwa: kuchokera mkati mwa edema kapena microscopically yodziwika yokhazikika ya steatonecrosis mu kapamba (ndi mawonekedwe ofatsa a matendawa) kupita ku malo ojambulidwa kwamafuta ndi / kapena hemorrhagic pancreatic necrosis yokhudzana ndi kuperekera mafupa , perinephral, ​​pelvic) malo ndi ziwalo zam'mimba.

Kutanthauzira kolondola kwa kusintha kwa pancreatic necrosis ndikofunikira. Kutengera ndikukula kwa machitidwe a necrotic mu kapamba ndi malo ochepetsa, wamba ndi zochepa mitundu ya pancreatic necrosis.

At kufala kwa kapamba pali necrosis yoposa imodzi dipatimenti ya zikondwerero zomwe zimakhudzidwa ndi gawo la pathological process of parapancreatic fiber ndi madera ena a malo a retroperitoneal (parietal, paranephral, ​​pelvis) yaying'ono.
At limited pancreatic necrosis mu kapamba, yaying'ono (mpaka 1 cm) ndi / kapena yayikulu (> 1 cm) ya necrosis imapezeka ndi chiwonongeko mkati mwa gawo limodzi la kapamba ndi gawo lolingana la parapancreatic fiber. Mosiyana ndi mawonekedwe wamba a pancreatic necrosis, kuwonongeka kwa necrotic ndi kutupa kwa mawonekedwe a chifrific nthawi zambiri kumakhala malire a parapancreatic zone.

Kutengera kuchuluka kwakukulu kwa michere ya acinar secretion, pancreatic necrosis imayamba proteinolysis (hemorrhagic necrosis) ndi lipolysis (mafuta necrosis) a kapamba ndi mafuta obwezeretsera. Kukula kwakamodzi kwa mitundu iyi ya necrotic ndondomeko (yosakanikirana ndi kapamba) imadziwika.

Hemorrhagic gawo la pancreatic necrosis limakhala ndi mawonetsero ochititsa chidwi kwambiri. Mu kapamba ndi matupi oyandikana nawo, malo owonjezereka a hemorrhage, hemorrhagic impregnation, zone of nyeusi ndi / kapena imvi necrosis amapezeka. Mimbulu yam'mimba imakhala ndi kuchuluka kwa hemorrhagic mayankho ndi ntchito yayikulu ya michere ndi poizoni.

Chifukwa mafuta The pancreatic necrosis element amadziwika ndi kuwonjezeka kwa kukula kwa kapamba motsutsana ndi kumbuyo kwake kwa edema, kuwonongeka kwa lobular kapangidwe ka chiwalo, malo angapo a steatonecrosis ndi hemorrhage mu kapamba ndi retoperitoneal minofu, mesentery, mu wamkulu komanso wocheperako womangiririka, komanso subcutaneous minofu. M'matumbo am'mimba, ma serous owonekera poyera amatha kupezeka.

Kwa necrotic pancreatitis, kusintha kwa magawo a necrobiosis ndi necrosis ya kapamba ndi retroperitoneal fiber, yowonjezeredwa munthawi komanso mitundu yosiyanasiyana ya pathomorphology, imakhala yodziwika bwino komanso yokhazikika.

Mu gawo loyambirira la matenda, kukula kwa zovuta za pambuyo-necrotic ndikotheka. Kuzungulira mabowo a osabala necrosis opezeka pancreas ndi / kapena gawo lililonse la minyewa yotulutsa, imalowetsedwa, mawonekedwe ake omwe amaphatikizapo ziwalo zapafupi (m'mimba, duodenum, omentum, ndulu, chiwindi), mesentery yamatumbo akulu ndi ang'ono. M'dera la kapamba amawonekera parapancreatic kulowandipo m'malo a parietal ndi paranephral ndi minofu ya mafupa am'mimba, zotupa zodutsa zimayamba kuzungulira gawo la necrosis ndi necrobiosis, lomwe likufanana ndi chithunzichi. necrotic (aseptic) phlegmon zogwirizana ma cell

Gawo lamafuta la necrosis pansi pa aseptic simasungunuka ndipo silipangitsa kuti munthu adwale kwambiri, koma pambuyo pake (pambuyo pa milungu 3-4 ya matenda) limapangidwanso mosavuta, zomwe zimapangitsa kuti pseudocysts ipangidwe. Kuyambira sabata yachiwiri yamatendawa, kusintha kwina kwa mafuta ndi necrosis kumayendera limodzi ndi kupangika kwa ma michere ang'onoang'ono okhala ndi misa.

Mosiyana ndi gawo la mafuta a necrosis, hemorrhagic element, yomwe imadutsa ndi hemorrhagic impregnation ya retroperitoneal fiber, imadziwika ndi zochitika zosungunuka mwachangu ndi chitukuko cha zotchedwa phlegmon zomwe zimatsatiridwa ndikutsatiridwa kwatsatanetsatane (kwakukulu) komanso kupangika kwa pseudocysts.

Machitidwe a chitukuko cha mitundu ina ya kapamba

Gulu la kapamba limaphatikizapo mitundu yosiyanasiyana ya matenda. Awo pathogenesis amatha kusiyanasiyana. Chifukwa chake, mtundu wocheperako wa kutukusira kwa ndulu umachitika pamene mawonekedwe a calculi omwe ali mu chithokomiro chomwe akhudzidwa (carbonic ndi phosphoric lime).

M'mawonekedwe, izi zimafanana ndi miyala yaying'ono kapena mchenga woyera. Kusintha kwa m'matumbo a kapamba, komwe ma calculi amadziunjikira, amayamba chifukwa cha kutupa ndi kukulitsa kwa duct.

Pathogenesis ya mtundu wa chidakwa cha kapamba ndi kuti mowa umakulitsa mamvekedwe a sphincter a Oddi. Izi zimalepheretsa kutuluka kwa procrine secretion ndikupanga matenda oopsa m'mizere yaying'ono. Mowa uli ndi mavuto ena angapo:

1. Imalimbikitsa kulowa kwa ma enzymes mu gland, yomwe imalimbikitsa ma enzymes a proteinolytic komanso amachititsa kuti ma cell a cell apangidwe.
2. Kuonjezera katulutsidwe wa chapamimba madzi ndi hydrochloric acid, amene kumawonjezera katulutsidwe, kamene kamayambitsa exocrine hypersecretion m'thupi.

Pathogenesis ya biliary pancreatitis imalumikizidwa ndi ingress ya bile ndi kapamba wa pancreatic. Njira zotere zimayambitsidwa pamene kukakamira kumabuka mu duodenum ndi biliary thirakiti. Kutengera izi, tanthauzo la matendawa linapangidwa ngati njira yotupa yotupa yomwe imayamba chifukwa cha kuwonongeka kwa chiwindi ndi njira ya biliary.

Biliary pancreatitis imatha kuchitika chifukwa cha kusintha kwa morphological komwe kumachitika mu sphincter ya Oddi kapena duodenal papilla. Ntchito ya Trypsin imalimbikitsa kuyamwa kwa m'mimba ndi m'mimba mwake.

Ndi biliary mawonekedwe a matendawa, madera onse okhudzidwa ndi nduluyo amadzala ndi minyewa ya fibrous. Pakakhala chithandizo chapanthawi yake, chiwalocho chimasiya kugwira ntchito.

Mtundu wa pathogenesis umayamba pamene majini amasinthidwa, omwe amatengera. Kulephera kumachitika ndikusintha amino acid leucine ndi valine.

Komanso, chibadwa chokhala ndi chibadwa chokhala ndi chiberekero chimatha limodzi ndi trypsin kukanika kwa maselo. Zotsatira zake, kapamba amayamba kugaya thukuta lake.

Njira yonga ya kutupa kwapancreatic imawoneka makamaka mwa odwala omwe ali ndi vuto lotchedwa rhinitis, urticaria, kapena mphumu wa bronchial. Limagwirira chitukuko cha matenda amtunduwu zachokera kupezeka kwa thupi lawo siligwirizana mu magawo atatu:

• chidwi cha thupi,
• Kupanga kwa ma antibodies kwa tizilomboti,
• kuwonongeka kwa zimakhala za parenchymal gland.

Kukula kwa njira za autoimmune kumathandizira pazinthu zambiri komanso kusintha. Chifukwa chake, chifuwa chachikulu cha kapamba chimakhala ndi zovuta pa pathogenesis.

Zizindikiro ndi mankhwala a kapamba

Pancreatitis ndizosavuta kudziwa nthawi yomwe imapezeka mu gawo la pachimake. Potere, chithunzithunzi cha matenda chimatchulidwa kwambiri.

Zizindikiro zotsogola za kutupa kwa pancreatic ndizopweteka zopitilira mu epigastrium, nthawi zambiri zimafalikira ku hypochondrium yamanzere, chifukwa chomwe wodwalayo amatha ngakhale kuzindikira. Zovuta zimawonjezereka pamene wodwala wagona kapena adya chakudya.

Kuphatikiza pa kupweteka, kapamba amatsatiridwa ndi kusanza, kutentha kwa thupi, nseru ndi khungu la khungu. Odwala ena amakhala ndi zotupa m'mchombo. Komabe odwala amadandaula za kutentha kwadzuwa ndi kusungunuka.

Kuperewera kwa mankhwalawa chifukwa cha kutupa kwamphamvu kwa pancreatic kumapangitsa kuti pakhale zovuta zingapo zowopsa - matenda ashuga, syphilis, cystic fibrosis, ndi mtima. Chifukwa chake, chithandizo chikuyenera kuchitika kuchipatala moyang'aniridwa ndi madokotala.

Zolinga zazikulu za chithandizo:

1. kuchotsa kwa zopweteka,
2. Kuchotsa kwa michere ya pancreatic pamtsinje wamagazi,
3. Cholinga cha chakudya chapadera.

Munthu wamakono nthawi zambiri amanyalanyaza malamulo azakudya zabwino komanso zabwino, zomwe zimayambitsa mavuto azakudya. Chifukwa chake, gawo lofunikira la mankhwalawa a kapamba ndikuwonetsetsa kuti chodwala chikhale chododometsa pochiritsa komanso kudya. Patsiku loyamba lachipatala, wodwalayo sangadye chilichonse, ndiye kuti amamuika mu dontho la shuga ndipo pokhapokha amasinthira zakudya zopepuka.

Popeza kutupa pachimake kumayendera limodzi ndi kupweteka, mankhwala amphamvu a analgesic nthawi zambiri amakhazikitsidwa. Komanso, njira zapadera (Contrical, Trasilol) zimaperekedwa kwa wodwalayo kuti athetse kuledzera kwa thupi ndi michere ya pancreatic. Ngati ndi kotheka, mankhwala opha maantibayotiki ndi calcium amapatsidwa.

Ngati palibe kusintha pambuyo pa sabata la mankhwala, laparotomy imachitika. Nthawi ya opaleshoni, dokotala wochita opaleshoniyo amachotsa mbali zakufa za chiwalo cham'mimba. Pazinthu zadzidzidzi, ndikupanga ma pseudocysts (kudzikundikira kwa minofu yakufa, michere) mu kapamba, kukhetsa kwachitika.

Zambiri pa pancreatitis pachimake zimaperekedwa mu kanema munkhaniyi.