Kodi hemorrhagic pancreatic necrosis imayenda bwanji?

Tikukupatsani kuti muwerenge nkhaniyi pamutuwu: "hemorrhagic pancreatic necrosis" ndi ndemanga kuchokera kwa akatswiri. Ngati mukufuna kufunsa funso kapena kulemba ndemanga, mutha kuchita izi pansipa, nkhaniyo itatha. Katswiri wathu wamtundu wa endoprinologist adzakuyankhirani.

Kodi hemorrhagic pancreatic necrosis ndi zina zapamwamba pothandizira matenda

Matenda omwe amapezeka m'mapapo amadziwika ndi njira yomwe ikupita patsogolo kwambiri, komanso kuthekera kwawo pakubweretsa zovuta zazikulu. Mwa zina zoterezi zimatha kutchedwa hemorrhagic pancreatic necrosis, yomwe ndi matenda osakanikirana komanso oopsa.

Ndi matenda amtundu wanji, ndizinthu ziti zomwe zimayambitsa chitukuko, komanso chifukwa chake ndizovuta kuchiritsa, zidzafotokozedwa m'nkhaniyi.

Hemorrhagic pancreatic necrosis (kapamba) ndi imodzi mwanjira zopweteka kwambiri ndi maphunziro apadera. Ndi chitukuko cha matendawa, kusintha kosasintha komanso kofulumira kwambiri kwa necrosis yamaselo am'maselo kumachitika.

Matendawa atha kukhala awa:

Monga lamulo, mawonekedwe owopsa amawonetsedwa makamaka pancreatitis yovuta, koma amathanso kuwonedwa panthawi yakuchulukirachulukira kwa chifuwa chachikulu.

Hemorrhagic necrosis imachitika:

• Kwamderalo (kufa kwa maselo pang'ono).
• Zokwanira (kufa kwa maselo onse).

Komabe, pazochitika zonsezi, matendawa amakhudza malo obisika a kapamba, otchedwa acinus, omwe ali ndi udindo wopanga ma enzymes, zinthu zapadera zomwe ndi zigawo za madzi a pancreatic.

Komanso, matenda amtunduwu amagawidwa malinga ndi gulu, ndipo ali ndi mitundu ingapo.

Kuchokera kudera lomwe lawonongeka:

• Necrosis yachilengedwe yomwe imakhala yaying'ono, yapakati kapena yayikulu.
• Chokwanira komanso zathunthu, zomwe zimadziwika kuti ndi necrosis, momwe zikondamoyo zina zimakhudzira.

Mwa kukhalapo kapena kusapezeka kwa mabakiteriya:

Kutengera ndi machitidwe anu, matendawa akhoza kukhala:

Mitundu yonse yamatendawa imawoneka panthawi yomwe kuli ma enzyme amphamvu, sichizindikiro chokwanira. Chifukwa chake, ndi kukonzanso kwakukulu kwa ma enzymes, njira ya hydrolysis ya mapuloteni imadziwika.

Kuphatikiza apo, imodzi mwa michereyi (yotchedwa elastase), imatha kuvulaza nembanemba yamitsempha yamagazi, potero imapangitsa kuoneka ngati magazi. Mankhwala, kupatuka uku kumatchedwa "autoaggression of pancreatic enzymes."

Chifukwa chake, hemorrhagic pancreatic necrosis ndi chotsatira cha chikhalidwe chamwano cha michere yotsatirayi: elastase, chymotrypsin, trypsin.

Matendawa amadziwika ndi chitukuko cha magawo.

Gawo loyamba: mu kapamba, pamakhala zochitika zatsopano za zinthu zapakhomo zomwe zimayambitsa zinthu zosafunikira monga autoaggression ndi toxinemia ya michere ya pancreatic, yomwe imawonetsedwa ndi zizindikiro zotere: chopindika chosakhazikika, kusanza ndi kutentha.

Gawo lachiwiri: zomwe zimapangitsa kuti minyewa ya m'mimba izitulutsa purifungo kuyamba, ndikupanga kulephera (dzenje) mu kapamba.

Gawo lachitatu: kutupa kumafalikira kumankhwala athanzi oyandikana, ndikupanga mkhalidwe wopsinjika kwa thupi.

Monga mukuwonera, matendawa ndi oopsa kwambiri pamiyoyo ya anthu ndipo amafunika achire kwambiri ndipo ngati pakufunika kuthandizidwa, amathandizidwa.

Mpaka pano, zamankhwala zimadziwa zingapo zomwe zimapangitsa kuti njira ya pathological iyi ipangidwe. Zodziwika kwambiri pakati pawo ndi:

1. Kutupa kwa kapamba, momwe amakhudzidwa ndi atherosis, komanso kutuluka kosayenera kwa madzimadzi a pancreatic (madzi).
2. Poizoni (kuledzera) kwa thupi ngati muyezo, zomwe zimachitika kawirikawiri ngati wodwala akuledzera.
3. Kulowa mwadongosolo kwa madzi a pancreatic mu ma dancts a pancreatic, omwe amadziwika pamaso pamiyala mu ndulu.
4. Kukhalapo kwa matenda obwera chifukwa cha bile ducts ndi bile ducts, zomwe zimachitika kawirikawiri ndi cholecystitis ndi cholangitis.
5. Amasokoneza intravascular coagulation ndi thrombohemorrhagic syndrome, yomwe nthawi zambiri imayendera limodzi ndi matenda osiyanasiyana a viral kuchokera ku bakiteriya, kapena amapezeka pambuyo pa chemotherapy komanso atatha kuyatsidwa kwambiri pamitsempha yambiri ya radiation.
6. Hemorrhagic vasculitis (autoimmune pathology).
7. Makina zowawa za pancreatic parenchyma, ali ndi chilengedwe mwadzidzidzi kapena atamuchita opareshoni.

Matendawa amakhalanso oopsa chifukwa amathanso kukhudza ziwalo zina zamkati mwa m'mimba, zimakhudza kugwira ntchito kwawo.

Zizindikiro zotsatirazi ndizomwe zimayambitsa matenda:

• Kupweteka kwambiri, kupweteka kwambiri kumanzere kwa hypochondrium, komwe kumamveka m'chifuwa kumanzere, phewa ndi kutsikira kumbuyo.
• Pakamwa pakamwa.
• Kumverera kwa misonkho ya lilime.
• Kusanza mobwerezabwereza.
• Kuchepetsa mseru
• Kuyamba kusanza.
• Kufalikira.
• Kutsegula m'mimba
• Kuchulukitsa kwa mpweya.

Kuphatikiza apo, wodwalayo amadandaula za zizindikiro zina:

• Kutentha kwambiri.
• Kukhalapo kwa mawanga amtundu wabuluu kapena wofiirira kumbali zam'mimba kapena pakati pake, zomwe zimawonetsa kukhalapo kwa magazi mkati.
• Kuthamanga kwa magazi.
• Kukucha kopitilira muyeso.
• Kupuma pang'ono.
• Pikodzo pang'ono pang'onopang'ono pokodza.
• Kusokonezeka kwa malingaliro.

Malinga ndi ziwerengero zamankhwala, pachimake hemorrhagic pancreatic necrosis mu 1/5 ya odwala imayambitsa zovuta, ndipo 1/3 pamakhala kukomoka kapena matenda amisala.

Pankhani yopanga pancreatic-retroperitoneal fistula, mkhalidwe wa wodwalayo ukhoza kukulitsidwa chifukwa cha kumeza kwa zinthu zam'mimba m'matumbo am'mimba, komanso tinthu tating'onoting'ono ta maselo ake okufa, chifukwa chotupa cha m'mimba komanso kukula kwa peritonitis yokhala ndi zizindikiritso zoyipa zimayamba kupanga.

Madokotala mobwerezabwereza amagogomezera kuti kudzichiritsa pawokha pogwiritsa ntchito njira zamtunduwu ndizotsutsana kwathunthu. Zitha kugwiritsidwa ntchito pokhapokha kutha kugwiritsa ntchito njira zamankhwala zapamwamba pakubwezeretsa thupi, komanso pokhapokha kuyang'aniridwa ndi dokotala.

Magawo akuluakulu a chithandizo chamankhwala:

1. Kuthetsa ululu. Kwa izi, analgesics, antispasmodics (Papaverine, No-shpa, Novocaine ndi ena otero) ndi omwe amapatsidwa.
2. Kuyimitsidwa kwa kupsa mtima kwa michere ya pancreatic. Jakisoni wamkati ndi ma dontho amaikidwa pogwiritsa ntchito Trasilol kapena Trotical kulowetsedwa.
3. Kuthetsa ma spasms, omwe amalola kukulitsa kuchuluka kwa zofunikira za gland, ndipo zimachitidwanso kuti muchepetse kuchuluka kwa madzi am'mimbawa omwe amatulutsidwa. Pakadali pano, zakudya zokhwima zomwe zili ndi zigawo za njala yotheratu ziyenera kutsatiridwa. Mwa mankhwala omwe amagwiritsidwa ntchito Ephedrine, Atropine.
4. Kupewa kufalitsa kwa poizoni ndi matenda ku ziwalo zoyandikana. Mwa izi, maantibayotiki amalembedwa mwachitsanzo, Zeporin, Gentamicin kapena Kanamycin. Kuchotsa poizoni m'thupi, shuga ndi insulin ndi njira zina zimagwiritsidwa ntchito.

Ndi gawo lotsogola la matenda omwe amawonongeka ndi ziwalo zambiri, opaleshoni yodzidzimutsa imayikidwa.

Kuphatikiza apo, hemorrhagic pancreatic necrosis, limodzi ndi chizindikiro cha matenda, imafunikira kapamba, kapena njira yoikika kwambiri - kuyimitsidwa kwa kapamba (ntchito iyi imatchedwa pancreatectomy).Komabe, opareshoniyi imachitika nthawi zina, chifukwa imakhala yachilendo komanso kufa.

Njira ina yotsogola ndi kuyamwa kwa masamba akufa (sequestondola).

Nthawi yonseyi, mwayi wovulala mwangozi ziwalo zoyandikana ndi wokwera, zomwe zimapangitsa kuti pakhale zovuta zingapo komanso milandu yakupha.

Chithandizo cha matenda awa ndi njira yayitali kwambiri, yomwe imatenga nthawi kuyambira milungu ingapo mpaka miyezi isanu ndi umodzi, kapenanso kupitirira apo.

Odwala ambiri omwe ali ndi matendawa amaganiza ngati amwalira ndi hemorrhagic pancreatic necrosis. Afunanso kudziwa kuchuluka kwa mwayi wochira, ndipo tsogolo la hemorrhagic pancreatic necrosis lingakhale lotani?

Tsoka ilo, ziwerengero zamankhwala sizinatonthoze kwathunthu: pazaka zonse za matendawa, 50% ndiwophedwa. Choyambitsa imfa ndi poyizoni wathunthu wa thupi, wokwiyitsidwa ndi purulent peritonitis.

Nthawi yomweyo, manambala olondola amadziwikanso, mwachitsanzo, hemorrhagic pancreatic necrosis ngati chifukwa cha imfa:

• 7-15% - kufa kwathunthu.
• 40-70% - ndi mitundu yoopsa kwambiri ya matenda.

Anthu omwe adakonzedweratu, kapena ali ndi vuto lililonse ndi kapamba, ayenera kuyesetsa kutsatira njira zonse zachipatala zochizira ndi kupewa kuchulukitsa kwa matendawa.

Makamaka, kupewa pancreatic necrosis, njira zonse ziyenera kutengedwa kuti muchepetse kapangidwe ka kapamba:

• Bwerezaninso zakudya zanu.
• Kukana mowa kwathunthu.
• Pamaso pa matenda aliwonse am'matumbo, ayenera kuthandizidwa mwachangu.

Kungosamala zaumoyo wanu kokha ndi komwe kungathandize kupewa mavuto.

Monga mukuwonera, odwala omwe ali ndi matendawa ayenera kutsatira mosamalitsa malangizo onse a gastroenterologist, ndikuwonetsetsa kuti ali ndi vuto lililonse la m'matumbo, popewa kukula kwa zovuta zosiyanasiyana, mutenge njira zonse zoyenera kuti mupewe.

Izi zikutanthauza kuti muyenera kufunafuna thandizo la kuchipatala munthawi yake chifukwa chophwanya pang'ono m'mimba, komanso makamaka kapamba. Kuperewera kwa chithandizo choyenera kumawonjezera mwayi wakufa.

• Kugwiritsa ntchito ndalama ya amonke pochizira kapamba

Mudzadabwa momwe matendawa amachepera msanga. Samalani kapamba! Anthu opitilira 10,000 awona kusintha kwakukulu paumoyo wawo pakumwa m'mawa ...

Kodi necrosis ya pancreatic ndi yoopsa bwanji?

Zikamakula, necrosis imatha kufalikira ndikukhudza ziwalo zapafupi. Nthawi yomweyo, minofu yomwe idagwa, ndiye kuti, imafa, siyikonzanso

Kodi chifukwa chiyani kupweteka kwa mutu kumachitika pancreatitis komanso momwe mungabwezeretsere kuukira kwa migraine?

Ndizosatheka kuzindikira zomwe zimayambitsa kupweteka kwa mutu kwa odwala ndi kapamba, chifukwa chizindikirochi, chimagwirizana ndi kutupa kwa kapamba.

Amayambitsa ndi mawonekedwe a malungo pancreatitis

Dongosolo la ululu lomwe limapezeka m'mimba chapamwamba ndi chisonyezo chachikulu chomwe chimakhalapo nthawi zonse. Zowawa zimatha kukhala zowawa, zodula, kapena zosasinthika, koma zonyozeka.

Momwe mungathetsere kupweteka mwachangu ndi kutupa kwa kapamba?

Kuti ma syndromes azopweteka asathenso kuzolowera moyo wanu, muyenera kuwunika osadyetsa thanzi lokha, komanso moyo wamba.

Hemorrhagic pancreatic necrosis ndi matenda oopsa, momwe mumamwalira mwachangu magulu a maselo mu minyewa ya kapamba. Njirayi siyisintha ndipo mosavutikira imayambitsa kusokonezeka kwa ntchito ya enzyme komanso zamanyazi, zomwe zimakhudza kwambiri mbali yayikulu ya thupi.

Matendawa ndi owopsa, chifukwa nawo amakhala ndi chiopsezo chokwanira choteteza thupi ku matenda osiyanasiyana, kuphatikizapo kufa.

Makina owoneka necrosis ndi kulephera kwa zikondamoyo kuti muthane ndi chiwonongeko chowononga cha enzyme yamphamvu. Madzi a pancreatic ali ndi zamchere zomwe, zikafika m'matumbo, sizimasinthidwa ndi zomwe zili m'mimba. Koma muzochitika izi pamene ma enzyme sangathe kuchotsedwa mu gland, alkali imaphwanya mapuloteni omwe amapanga ma cell. Chiwonongeko chimafikira m'mitsempha yamagazi yomwe imalowa mu gland, ndikupanga kuvulala komwe magazi amatuluka. Njira yowonongera maselo a ziwalo ndi madzi a enzyme imatchedwa auto-aggression.

Malinga ndi gulu la matenda padziko lonse lapansi, matenda a pathology ndi a gulu laling'ono "Acute pancreatitis" ndi code K85.

Madzi ochulukirapo a pancreatic amapangidwa, kudzipangitsa kudzimbidwa kwake mwachangu kumachitika, ndipo kumawonekera kwambiri.

Hemorrhagic pancreatic necrosis imatha kuyambitsa kuwonongeka ndi kufa kwa maselo a ziwalo zina zomwe zili pafupi ndi kapamba.

Zinthu ngati izi zimatha kuyambitsa matendawa:

• yotupa yozungulira mu gland yoyambitsidwa ndi kuphwanya kwa kuchotsa kwa madzi a enzyme,
• mwatsatanetsatane woopsa wa ethyl mowa kwa nthawi yayitali,
• anachedwetsa kapamba wamadzimadzi mumizere,
• matenda opatsirana a m'mimba thirakiti (cholecystitis, cholangitis, etc.),
• kufalikira kwam'mimba (ndi nthenda ya ndulu),
• kuchuluka kwa magazi m'mitsempha yomwe imayenderana ndi neoplasms yoyipa, komanso thrombosis yamitsempha yamagazi mkati mwa thupi pambuyo pozama kwambiri.
• autoimmune matenda (vasculitis),
• zovuta pambuyo ma virus ndi matenda omwe ali ndi vuto lalikulu,
• kuchuluka kwa mitundu yambiri ya mankhwala,
• nkhawa kwambiri,
• kuvulala ndi zovuta pambuyo kuchitira opaleshoni pazinthu za chakudya.

Ma enzymes olimbirana kwambiri omwe amapezeka mu secretion ya pancreatic amapangidwa kuti agwetse mamolekyulu a chakudya omwe amalowa m'matumbo. Elastase, trypsin ndi chemotrypsin zimatsogolera ku kuwonongeka msanga kwa maselo a gland parenchyma, nthawi zina amakhudza madera akuluakulu. Chifukwa cha izi, kapamba limayaka ndikukula, zomwe zimawopseza thanzi la munthu.

Zomwe zimayambitsa kutuluka kwa matenda opatsirana ndikuzindikirika:

• Zakudya zopanda pake zomwe zimapezeka ndimafuta ambiri ndi zakumwa zoledzeretsa,
• pachimake kapena pancreatitis yayikulu
• kudya zamafuta ambiri a trans.

Kukula ndi mawonekedwe owonetsera amadalira makamaka kukula kwa zotupa. Dera lomwe lingakhudzidwe ndi:

• zocheperako (pang'onopang'ono, pakatikati kapena pakuchitika kwakukulu),
• kufalikira (kumakhudza gawo limodzi lokhazikika, zofunikira zonse kapena chabalira mosiyanasiyana mkati mwa minofu).

Komanso, njira ya pancreatic necrosis imasiyana pamaso pa opaleshoni yothandizira:

Kukula kwa matendawa kumachitika m'magawo angapo:

• Pa gawo loyamba, tizilombo tating'onoting'ono timayamba kukula ndikuchulukana mkati mwa gland. Kuwonjezeka kowopsa kwa chiwerengero chawo kumadzetsa poyizoni owonjezereka ndi zinthu zotayidwa, zomwe zimapangitsa kuwonetsa kwa poizoni ndikufooketsa thupi lisanachitike autoxgression. Gawoli limatenga pafupifupi pafupifupi sabata.
• Pa gawo lachiwiri, chifukwa cha kuwonongeka kwa maselo a parenchyma, kutsekemera kwa purosesa kumachitika ndipo mawonekedwe am'deralo amalephera.
• Pomaliza, kutupa kumakhudza malo ambiri ndikufalikira kwa ziwalo zamagulu oyandikana, zomwe zimayambitsa kupweteka kwamphamvu konse kwamatupi athupi.

Chizindikiro chopanda pake chomwe matendawa sapezeka konse ndi ululu. Ululu umapezeka kudera lakumanzere kapena hypochondrium kumanzere.Kukula kwa zomverera zopweteka kumafotokozedwa mwamphamvu ndipo akufotokozedwa ndikuphatikizidwa kwa minyewa yamitsempha yamafuta m'mitsempha yotupa. Ndi kuwonjezeka kwa zizindikiro, ululu umatha kukhala lamba ndikupereka kwa lumbar dera kumbuyo, lamba wamapewa kapena sternum.

Zizindikiro zina:

• kusanza mobwerezabwereza (m'masanzi, kupezeka kwa magazi ndi bile kumadziwika),
• Lilime limakutidwa ndi mitundu yayikulu yachikasu,
• Hypohidrosis wa mucosa wamlomo,
• kutsika kwa kuchuluka kwa mkodzo potengera kuchepa kwa madzi m'thupi,
• chisangalalo ndi m'mimba,
• malungo
• kusintha kwadzidzidzi kwa kuthamanga kwa magazi,
• kupuma movutikira
• kulumikizana m'magulu a shuga kumatha kusokoneza, kuletsa kapena kusangalala kwambiri, chisokonezo.

Mawonekedwe ena amatha kuwonekera pakuwoneka koyang'ana. Zizindikiro izi za hemorrhagic pancreatic necrosis ndi:

• kutulutsa m'mimba
• adawoneka malo owoneka ofiira okhala ndimtambo wabuluu pamimba, m'mbali. Malo omwewo amatha kuzungulira msomali kapena kuwonekera pamabowo, zomwe ndi zotsatira za kukhetsa magazi m'magazi am'mimba,
• kupuma kumakhala kosazama komanso pafupipafupi.
• chifukwa kuchepa kwa lumen ya m'mitsempha yamagazi, nkhope yake imasandulika ofiira, koma ndi kusiyana kwakukulu pamlingo wama glucose, khungu limayamba,
• kuthamanga kwa phokoso la mtima komanso kuthamanga kwa mtima,
• khungu la chikasu kapena imvi pakhungu.

Zizindikiro zimakulirakulira chifukwa cha zovuta. Ndi mawonekedwe a thupi kukhala opsinjika, kulephera kwamankhwala angapo kumachitika. Chifukwa cha kutuluka kwamkati, kuchuluka kwa magazi omwe amayenderera m'thupi lonse kumachepa. Zilonda zimatha kukhudza chiwindi, kupatsanso zovuta m'mapapo, komanso zimayambitsa masakanizo amkati mwa minyewa ya pancreatic ndi regoperitoneal dera.

Pambuyo pa izi, kukula kwa zilonda zam'mimba ndi mawonekedwe a purulent peritonitis atha. Kuthekera kwa chikhalidwe cha kugwa kapena chikomokere ndikwapamwamba.

Zizindikiro zomwe hemorrhagic pancreatic necrosis ali munjira zambiri zofanana ndi kuwonetsa kwa matenda ena am'mimba otupa, motero, kungowunika wodwalayo kuti athe kupeza matenda sikokwanira.

Choyamba, adokotala amatenga deta ya anamnesis, yomwe imaphatikizapo mayankho a mafunso awa:

• Kodi wodwalayo amamwa mowa mopitirira muyeso?
• ngati munthu waledzera panthawi yopanga zizindikiro zamankhwala,
• kaya wodwala ali ndi matenda a chiwindi kapena a biliary.

Pofuna kumveketsa matenda ake oyambirirawo, dokotalayo apereka nthawi yokumana ndi mayeso ofufuza:

• kuyezetsa magazi, komwe kumatsimikizira kuchuluka kwa kukhalapo kwa michere ya pancreatic secretion. Ndi hemorrhagic pancreatic necrosis, ntchito ya enzymatic imatha kupitilira nthawi 6-9,
• urinalysis ndi kutsimikiza kwa uroamylase ndi trypsinogen,
• kutsimikiza kwa acidity zam'mimba,
• Ultrasound yamimba yam'mimba kuti ithandizire kupeza,
• kufunafuna katulutsidwe ka pancreatic kuti mupeze ma bicarbonate komanso ma enzyme akhama,
• Coproscopy, yomwe imathandizira kukhazikitsa kuchuluka kwa mafuta osakwanitsidwa mu ndowe,
• pancreatic radiology,
• kutsimikiza kwa amylase ndi triglycerides mu mpweya wotuluka,
• endoscopic pancreatocholangiography,
• kuchotsera potenga zitsanzo za minofu ya necrotic,
• magonedwe amatsenga ndi CT kuti adziwe mawonekedwe a necrotic formations.

Ndi hemorrhagic pancreatic necrosis, wodwalayo, monga lamulo, amatha kumapeto kwa chipatala atayimba ambulansi, chifukwa chomwe amamuika kuchipatala ndipo kuwunika kwakukulu kumachitika.

Wodwalayo ali ndi vuto lalikulu.

Kuchiza ndi wowerengeka azitsamba amangoikidwa padera chifukwa cha kusakwanira.Chithandizo cha mankhwalawa chimachitika pokhapokha kuwunika kwa ola lathunthu ndi anthu odziwa ntchito zachipatala.

M'masiku atatu oyamba, chithandizo chokhwima chimachitika motsutsana ndi maziko akumva kufa kwathunthu. Pakadali pano, michere imaperekedwa kudzera m'mitsempha. Pofuna kupewa kut katemera wa pancreatic, zomwe zili m'mimba zimachotsedwa ndikutsuka.

Chipinda chomwe wodwalayo amasungidwamo ziyenera kukhala ndi mpweya wabwino. Munthu sayenera kuyenda kuti achepetse kufalikira kwa poizoni m'thupi.

Ntchito zazikuluzikulu za madokotala panthawiyi:

• Lekani kupweteka. Pothandizira pakumva ululu, mankhwala monga Ketanov amagwiritsidwa ntchito, peritoneal-lumbar blockade amachitidwa ndi zosakaniza zochokera ku Novocaine kapena Promedol.
• Chotsani kwakanthawi ntchito za kapamba ndikuchepetsa zochita za mankhwala am'mimba. Pazifukwa izi, mankhwala ozikidwa pa Atropine sulfate, Ftorafur, Trasilol, Gordoks, etc. amagwiritsidwa ntchito.
• Pulumutsani kupindika, pumulani minofu ndikuchotsa kuvutikaku mu ma pancreatic ducts. Kwa izi, mankhwala antispasmodic No-shpa, Dortaverin kapena Platifillin amagwiritsidwa ntchito.
• Chepetsani katundu pachetechete pochepetsa kuchuluka kwa katulutsidwe ka m'mimba ndikubweretsa acidity yake pazachilendo. Izi zimatheka mothandizidwa ndi antisecretolytics Ephedrine, Atropine kapena Quamatel.
• Pewani kuchuluka kwambiri kwa matenda opatsirana ndikuwonjezera kawopsedwe, chotsani mwayi wokuthandizira m'mimba. Udindo wa antimicrobial othandizira amachitika ndi mankhwala a Zeporin, Cephalexin kapena Kanamycin.
• Chotsani poizoni msanga momwe mungathere pogwiritsa ntchito kulowetsedwa kwa shuga ndi insulin, mchere kapena njira ya Ringer.

Mwambiri, chithandizo chamankhwala samathandizira wodwalayo. Kenako funso limabuka la opaleshoni njira yochizira.

Ngati njira yopanda matenda ya hemorrhagic pancreatic necrosis ikakhazikitsidwa, ngalande za laparoscopic zimagwiritsidwa ntchito. Ndi ma voliyumu akuluakulu a exudate, kuyeretsa magazi kwa peritone kumachitika motsatana - intraperitoneal dialysis.

Matenda akasankhidwa, mtundu wina wa opaleshoni amasankhidwa: pancreatic resection yochotsa madera omwe akhudzidwa ndi necrosis.

Pankhani ya malo akulu omwe adafa, opaleshoni yayikulu imachitidwa - pancreatectomy, yomwe imaphatikizapo kuchotsa kwathunthu kwa kapamba. Panthawi imeneyi.

Njira ina yodzithandizira yochiritsira ndikutsatizanatsatizanatsatizanenso ndi magawo akufa.

Opaleshoni sikuti nthawi zonse imathetsa vutoli, nthawi zina kumwalira kumachitika pambuyo pa opaleshoni ndipo kumafunanso kuchitanso mgwirizano.

Nthawi yochira imatha pafupifupi miyezi isanu ndi umodzi, pambuyo pake wodwala amalembetsedwa ndi dispensary. Munthu amayenera kukayesedwa kachiwiri miyezi isanu ndi umodzi.

Munthawi zonsezi, zotsatira za matendawa zitha kukhala zabwino komanso zoyipa. Zimatengera zinthu izi:

• kufalikira kwa matenda
• Gawo lomwe munthu amalandila chithandizo,
• kukula kwa njira zochizira
• zaka odwala
• mulingo wa kuchira kwa wodwalayo.

Chiwopsezo cha kufa kwa hemorrhagic mtundu pancreatic necrosis ndi 40-70%. Chovuta chofala kwambiri ndikubwera kuchipatala. Chotsatira ndi kukula kwa njirayi: kukulira dera la zotupa zokhazokha, ndizochulukirapo zomwe zingathe kufa.

Nthawi zina zotsatira za matendawa ndi kulumala. Izi zimatha kuchitika mwamphamvu ndi matendawa kapena chifukwa cha zovuta pambuyo pakuchita opareshoni.

Mwayi wopulumuka umachulukitsidwa ngati pakufunika thandizo ndi chithandizo choyenera. Pambuyo kuchira, munthu ayenera kutsatira zakudya zapadera za moyo wonse, kupatula mowa ndipo onetsetsani kuti akusiya kusuta ngati anali wosuta fodya asanadwale.

Mu kanemayo, mtsikanayo amakamba za mbiri yake yazaumoyo ndi moyo atamuchita opareshoni.

Amayambitsa ndi zotsatira za hemorrhagic pancreatic necrosis

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 kumagwirizana komanso kuchuluka kwa chitukuko cha pancreatic necrosis (tsiku 1) komanso kuti 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.

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 puritive 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.

Hemorrhagic pancreatic necrosis sikukula kuyambira.

Zinthu ngati izi zimayambitsa kuphwanya kwakukulu:

• zakumwa zoledzeretsa kapena zakudya,
• kuvutitsidwa ndi mbale zomwe zimasokoneza m'matumbo am'mimba (lakuthwa, amchere, mafuta),
• thupi lawo siligwirizana
• matenda a autoimmune
• zotupa zoyipa limodzi ndi vuto la magazi,
• bile duct chotchinga,
• 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,
• okalamba omwe ali ndi gulu la matenda ophatikizika,
• odwala ndi pathologies a kapamba, chiwindi, m'mimba,
• anthu omwe amagwiritsa ntchito mankhwala osokoneza bongo nthawi zambiri, amchere, osuta komanso mafuta,
• anthu ovulala pamimba.

Zizindikiro za hemorrhagic pancreatic necrosis nthawi zonse zimakhala zowawa. Ndizosatheka kuzizindikira. Pa gawo loyambirira, wodwalayo amayamba kuda nkhawa ndi nseru, kupweteka kwambiri, komwe nthawi zambiri kumakhala kutchulidwa kumanzere hypochondrium.

Nthawi zina ululu umakhala ngati lamba, nthawi zina umafanana ndi zizindikiro za kugunda kwa mtima. Munthu amatha kumachepetsa zomverera zowawa kukhala pampando, nthawi zonse ndi mawondo ake kwambiri.

Komanso, matenda am'mimba amadziwika ndi zizindikiro zotere:

• kusanza komanso kusanza pafupipafupi komwe sikubweretsa mpumulo,
• kuchuluka kwamphamvu kwa kutentha kwa thupi mpaka pamitengo yayitali,
• kusintha pakhungu (redness, pallor, mawonekedwe a hematomas, kuwonjezereka kumva kwa kupweteka ndi kukhudza kowala),
• motsutsana ndi pancreatic necrosis, ascites, m'mimba phlegmon akufotokozera,
• shuga wamagazi amakwera kwambiri, yomwe imakhala yowopsa kwambiri m'matenda a shuga ndipo imayambitsa kukomoka kwa hyperglycemic,
• kumakhala chilankhulo chopatsa chidwi,
• kuchuluka kwa mkodzo wotulutsidwa pokodza kumachepa kwambiri,
• kupuma movutikira kumawonekera, kugunda kumafulumira, kuthamanga kwa magazi kusakhazikika,
• zosokoneza mbali yamanjenje (zotchinga kapena zamkati) zimadziwika,
• Wodwala wachisanu aliyense amakhala ndi vuto la kugwa, m'modzi mwa atatu amatsika.

Pali magawo angapo ovomerezeka a chitukuko.

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, ndipo mafomu 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, sikungachedwe kuyimbira ambulansi mulimonsemo.

Wodwala akamapita kuchipatala, amawunika mosamala, mtundu ndi gawo la pancreatic necrosis zimatsimikiziridwa, ndipo chithandizo chamankhwala cham'mimba chikuyambika.

Matendawa, omwe amayamba chifukwa cha chinthu chilichonse chofunikira, amafunika kuchipatala mokakamizidwa komanso chithandizo chamankhwala mwadzidzidzi.

Necrosis yochokera ku matenda amagawa m'magulu angapo. Izi zimakuthandizani kuti mupeze mayendedwe olondola kwambiri ndi kugwiritsa ntchito nthawi yake wodwala, yemwe amapita naye kuchipatala.

Kugonjetsedwa kungakhale:

• laling'ono loyang'ana
• chapakati
• chachikulu chachikulu,
• chapamwamba
• chonse.

Kuzindikira kumakhazikitsidwa pa kukula kwa malo a kapamba omwe amakhudzidwa ndi pancreatic necrosis.

Gawo loyamba kapena lachiwiri, malire ake ndiwachangu. Lachitatu - zikuwoneka bwino ndikuwonetsedwa. Gawo lofunika 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.

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 ali ndi matenda otani m'manenis ake.

Kenako, wodwalayo amapimidwa m'matumbo kapena pamimba, kuyezetsa zingapo, kuphatikizapo:

• kuyezetsa magazi komwe kumawonetsa dokotala pazomwe zimapangidwira ma pancreatic enzymes (kuchuluka kwa izi mwa kuchuluka kwa nthawi za 6-9 kukuwonetsa hemorrhagic pancreatic necrosis),
• kusanthula kwa madzi am'mimba, omwe amakupatsani mwayi kuti muzindikire kuchuluka kwa acidity, mwachangu komanso molondola.
• urinalysis kuti mufufuze za ureaplasma ndi trypsinogen,
• kuwomba kwa bicarbonate ndi ma enzyme,
• kusanthula kwa mpweya wotuluka wa 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.

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.

Wodwala amatumizidwa mankhwala omwe amachepetsa ululu, mwachitsanzo, novocaine blockade.Anesthesia imatsitsimula ma ducts, imalola madzi a kapamba 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 zomwe zimapezeka m'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 njira 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.

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 zimalimbikitsidwa kugwiritsa ntchito tsiku lililonse ndi izi:

• masamba ophika kapena otentha,
• phala pamadzi
• buledi (wouma)
• msuzi wowala
• zopangidwa mkaka zopanda mafuta ambiri,
• nyama yankhuku.

Pali zinthu zingapo zomwe anthu omwe adadwala matendawa ayenera kuyiwalika kwamuyaya.

Taboo wapangika pa:

• Zakudya zamzitini (nsomba, nyama, masamba),
• Zakumwa zoledzeretsa, ngakhale zochulukirapo,
• koloko
• ankasuta nyama
• nyama zamafuta
• makeke atsopano
• chakudya chofulumira
• mkaka wonse
• zokometsera
• maapulo
• 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:

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 kusamala kwambiri patebulo la tchuthi. Njira zodzitetezera zosavuta sizitsimikizira kuti pancreatic necrosis sikukula, koma amachepetsa mwayi wokhala ndi matenda ochepa.

1. 
   Aleksandrov, D. N. Mfundo Zazikulu Zazachuma. Umunthu ndi chidziwitso cha wabizinesi: monograph. / D.N. Alexandrov, M.A. Alieskerov, T.V. Akhlebinin. - M: Flint, Nauka, 2016 .-- 520 p.
2. 
   "Ndani komanso chani mdziko la matenda ashuga." Handbook yokonzedwa ndi A.M. Krichevsky. Moscow, Art Business Center, 2001
3. 
   Matenda a shuga. Mavuto owopsa komanso osatha, Medical News Agency - M., 2011. - 480 c.

Ndiloleni ndidziwitse. Dzina langa ndi Elena. Ndakhala ndikugwira ntchito ya endocrinologist kwa zaka zoposa 10. Ndikukhulupirira kuti pakadali pano ndili katswiri pantchito yanga ndipo ndikufuna kuthandiza alendo onse omwe amapezeka pamalowo kuti athetse zovuta osati ntchito. Zinthu zonse za tsambalo amazisonkhanitsa ndikuzikonza mosamala kuti athe kufotokoza zambiri zofunikira. Musanagwiritse ntchito zomwe zikufotokozedwa pa webusaitiyi, kufunsana ndi akatswiri ndizofunikira nthawi zonse.

Mowa

Matendawa amapezeka mwa anthu omwe amamwa mowa kwazaka zambiri. Mankhwala okhala ndi poizoni omwe amamasulidwa panthawi ya kuwonongeka kwa mowa wa ethyl amalowa m'maselo a kapamba, amathandizira kuti awonongeke. Kuchulukirachulukira kumachitika motsutsana ndi maziko a kuledzera kapena kugwiritsa ntchito zakudya zosapatsa thanzi.

Nthawi zambiri, zakumwa zoledzeretsa zimapezeka mwa anthu omwe akhala akumwa mowa kwa zaka zambiri.

Tizilombo tambiri ta kapamba timakhudzidwa ndi matenda. Matendawa amatenga koopsa. Matenda a wodwalayo amachepa msanga ngakhale kuyamba kwake kulandira chithandizo. Pakakhala chithandizo chokwanira, zizindikiritso za ziwalo zingapo zimawonjezeredwa ku minofu necrosis - mkhalidwe wakugwa, kutsika kwakukulu kwa kuthamanga kwa magazi, chikumbumtima chovulala.

Chachikulu

Mtundu uwu wa pancreatic necrosis umadziwika ndi kufa kwa 50-75% ya maselo a pancreatic. Imayendera limodzi ndi zovuta zamagazi, zomwe zimapangitsa kuwoneka kwa magazi m'ziwiya zazikulu za chiwalo. Kutsukidwa kwa minofu michere kumathandizira dongosolo la kuwonongeka kwawo. Kuchiza kumachitidwa kudzera pakuchitapo kanthu kwa opaleshoni ndikutsatira kukonzekera kwa enzyme.

Subtotal pancreatic necrosis amathandizidwa ndi opaleshoni.

Chifukwa

Hemorrhagic pancreatic necrosis imayamba mothandizidwa ndi izi:

• kutupa kwa kapamba, limodzi ndi kuphwanya kwa kutuluka kwa msuzi wa kapamba wokhala ndi ma enzymes a protein,
• Poizoni yemwe ali ndi matenda owola a ethyl (anthu omwe amamwa mowa wamphamvu ndi omwe amatenga matendawa),
• cholelithiasis, yomwe imathandizira kuponyera mkati mwazinthu zikuluzikulu za ndulu,
• pachimake matenda a ndulu ndi chindoko,
• thrombohemorrhagic syndrome, limodzi ndi kuchuluka kwa magazi m'makutu am'mitsempha,
• mabakiteriya owonongeka m'matumbo ndi zimakhala
• ntchito kwa nthawi yayitali mankhwala achemotherapeutic,
• kukhudzana ndi radiation,
• autoimmune nkhonya, limodzi ndi hemorrhagic mtima kuwonongeka,
• matenda a mtima, omwe amaphwanya thanzi la ziwalo zonse ndi matishu,
• kuvulala ndi kuyipitsidwa kwa peritoneum,
• zovuta za chithandizo cha opaleshoni.

Mosasamala kanthu za zomwe zimayambitsa pancreatic necrosis, magwiritsidwe amakula a matendawa amaphatikizapo magawo otsatirawa:

1. Kukwiya kwa chipinda cha acinus-chinsinsi chomwe chimayambitsa kuphipha kwachimbudzi.
2. Kuwonjezeka kwa kuchuluka kwa ma enzymes mu minofu ya kapamba mpaka pazovomerezeka zomwe zili zovomerezeka.Zimathandizira kuyambitsa njira yakuwonongeka kwa maselo - hydrolysis ya protein.
3. Kuphwanya kukhulupirika kwa makoma a mitsempha ndi mitsempha. Kulowa kwa elastase mu minofu kumayendetsedwa ndi kukha magazi. Zofanana mu mankhwala amatchedwa pancreatic autoaggression.
4. Kuwonongeka kwa mapuloteni omwe amapezeka motsogozedwa ndi pancreatopeptidase ndi trypsin.
5. Kuphwanya machitidwe ochititsa manyazi kuwongolera kupanga kwa ma pancreatic enzymes.

Kwa hemorrhagic pancreatic necrosis, mawonetsedwe otsatirawa ndi otchuka:

• kudula ululu wopezeka m'mimba ndi mbali yakumanzere, mpaka kufikira phewa ndi phewa,
• pakamwa mokhazikika
• Pamaso pa chovala chamkaka chamkaka,
• Zizindikiro za matumbo a m'mimba (nseru), zomwe zimapangitsa kuti kusanza kusam'pumulitse wodwalayo),
• ulemu, kuphulika ndi kutulutsa,
• kudzimbidwa, m'malo mwake ndi matenda otsegula m'mimba.
• khungu ndi nkhope ya pakhungu la nkhope, khosi ndi chifuwa,
• peritoneal syndrome, limodzi ndi mapangidwe amtambo wa pakhungu pamimba.
• kudumphira m'magazi,
• kuchuluka kwa mtima,
• Kutulutsa kwamkodzo,
• Zizindikiro za chapakati mantha dongosolo (kuchuluka galimoto kusangalala, zoletsa zimachitikira).

Zizindikiro

Kuti mudziwe bwino matenda, njira zakufufuzira za labotale ndi zamtunduwu zimagwiritsidwa ntchito pothandiza kudziwa mtundu wa matendawa ndikuwasiyanitsa ndi ma pathologies ena am'mimba omwe amapereka zizindikiro zam'mimba kwambiri. Wodwalayo ali ndi vuto lalikulu, lingaliro lamachitidwe opanga matenda opimidwa kuti awonenso matenda am'mimba.

Ndondomeko amathandiza kudziwa mtundu komanso kuchuluka kwa masinthidwe amisempha minyewa ya kapamba. Kuvomerezedwa ndi kuyesa kwa ultrasound kwa ziwalo ndi ziwalo zapafupi.

Kuunika kwa Ultrasound kumathandiza kudziwa mtundu ndi kuchuluka kwa kusintha kwa ma pathological mu zimakhala za kapamba.

Kuti atsimikizire matendawa, madokotala amagwiritsa ntchito mitundu yotsatirayi yoyesa ma labotale:

1. Kuyesedwa kwa magazi konse. Ndi chiwonongeko cha minofu ya gland, kuchepa kwa kuchuluka kwa hemoglobin ndi maselo ofiira amwazi, kuchuluka kwa ESR, kuchuluka kowonjezereka kwa leukocytes kumadziwika.
2. Kusanthula kwamaganizidwe. Kuperewera kwa michere yam'mimba kumasokoneza mayamwidwe abwinobwino a michere, yomwe imakhudza kapangidwe ka ndowe. Tizilombo ta pancreatic necrosis tili ndi mafuta okhathamira ndi tinthu tosiyanasiyana ta chakudya.
3. Kuyesa kwamwazi wamagazi. Imathandizira kuzindikira bilirubin - gawo la bile, lomwe limakulanso ndi kufalikira kwa ma ducts a bile. Zomwe zili amylase ndi trypsin, ma enzyme omwe akhudzidwa ndi kuphulika kwa michere, akuwonjezeka.
4. Kuyesa kwa mkodzo kwa trypsinogen.

Kuwopseza kwambiri kwa hemorrhagic pancreatic necrosis ndikuwonetsa kuti aziika wodwalayo kuchipinda chothandizira kwambiri. Therapy imayendetsedwa motere:

• Kuchotsa kupweteka kwambiri
• kuchepa kwa kapamba,
• cramping
• kubwezeretsa patency ya zonyansa,
• kutsika kwa acidity ya m'mimba,
• kupewa kupewetsa madzi m'thupi ndi kupha thupi
• kupewa imfa ngati matenda a m'mimba.

Ndondomeko ya mankhwalawa imaphatikizapo kuchitapo kanthu kwa opaleshoni, chithandizo cha mankhwala, kupuma pabedi ndi kudya.

Chithandizo cha pancreatic necrosis ndicholinga chothandizira kupweteka kwambiri.

Mankhwala othandizira

Kulimbitsa wodwala ndi pancreatic necrosis, mankhwala otsatirawa amagwiritsidwa ntchito:

1. Ma painkiller ndi antispasmodics. Kukhazikitsidwa kwa yankho la novocaine wokhala ndi glucose kumathandizira kuti muchepetse mavuto. Woopsa, narcotic analgesics amagwiritsidwa ntchito.Mtsogolomo, a Ketanov, Papaverine, Plifillin amagwiritsidwa ntchito.
2. Othandizira a antibacterial (Kanamycin, Cefazolin). Mlingo waukulu wa mankhwala umawononga tizilombo toyambitsa matenda omwe timayambitsa peritonitis ndi abscess.
3. Isotonic yankho. Imathandizira njira yochotsa poizoni, imalepheretsa madzi m'thupi komanso kuledzera.
4. Inhibitors a proteinolytic enzymes (Kontrikal). Zimapangitsa kuti michere ya ma pancreatic, yomwe imayimitsa njira yowonongera maselo a ziwalo.
5. Maantacid (Ephedrine). Amagwiritsidwa ntchito kuteteza zilonda zam'mimba pamimba posala.

Opaleshoni

Ndi kusakhazikika kwa chithandizo chamankhwala, chisankho chimapangidwa pakufunika kwa opareshoni. Kutengera momwe wodwalayo alili, zalembedwa:

1. Laparoscopic ngalande za omwe akhudzidwa. Cholinga chakuchotsa minyewa yosweka. Imachitika ndi zovuta zovuta za matendawa.
2. Peritoneal dialysis. Mimbulu yam'mimba imatsukidwa ndi madzimadzi otupa ndikuchiritsidwa ndi antiseptics.
3. Pancreatectomy Kuchotsa kwathunthu kwa kapamba kumawonetsedwa kuti chiwonongeko chokwanira cha zimakhala zake.

M'masiku oyamba kusokonezeka, musadye chakudya. Kubweretsa zinthu muzakudya kumachitika pang'onopang'ono. Muyenera kutsatira chakudya chanu moyo wanu wonse, izi zikuthandizani kuti musachulukenso. Chakudya chimaphikidwa, kuwira kapena kuwotcha popanda kugwiritsa ntchito mafuta. Idyani m'magawo ang'onoang'ono, nthawi 5-6 patsiku. Zonunkhira, zakumwa zoledzeretsa komanso zopatsa mphamvu, zakudya zamafuta ndi yokazinga, zipatso zowawasa siziperekedwa kuchakudya.

M'masiku oyamba mutadwala, muyenera kupewa kudya chakudya.

Mavuto

Pafupifupi 20% ya odwala omwe ali ndi vuto lalikulu la pancreatic necrosis amagwera mu chikomokere chomwe chimatha ndiimfa. Muli mavuto anayi aliwonse am'mutu. Pafupipafupi, fistula yobwezeretsanso imapangidwa, kudzera yomwe minyewa yakusokonekera imalowa mkatikati mwa m'mimba. Izi zimathandizira kukulitsa kwa peritonitis ndi purulent abscess.

Kulemala

Gulu la olumala limapatsidwa kuti liziganizira za momwe matendawo aliri, kupanikizika ndi zovuta za wodwalayo kukhala ndi moyo wabwinobwino. M'maphunziro osavuta a chipatalacho, magulu atatu olemala amapatsidwa. Pazakudya zam'mimba kwambiri komanso mapangidwe a fistulas, wodwalayo amalandira magulu awiri. Gulu 1 limayikidwa pambuyo pochotsa kapamba kapena pafupipafupi magazi.

Amayambitsa hemorrhagic pancreatic necrosis

Zomwe zimayambitsa hemorrhagic pancreatic necrosis zimagwirizana ndi zinthu monga:

• kutupa kwa kapamba, limodzi ndi kukanika kwake pang'ono ndi kuphwanya kwa zipatso zotuluka kwa pancreatic madzi,
• kuledzera kwa Mowa mu uchidakwa.
• Reflux wokhazikika wa madzi a pancreatic mu ma dancts a pancreatic (nthawi zambiri amapezeka ndi miyala mu ndulu),
• zotupa zopweteka za bile ducts ndi biliary thirakiti (cholangitis, cholecystitis),
• thrombohemorrhagic kapena DIC-syndrome (yomwazika intravascular coagulation), kukulira pachimake matenda obwera chifukwa cha bakiteriya, pambuyo pa chemotherapy ya khansa, komanso podziwikiridwa muyezo waukulu wa radiation ya ionizing,
• matenda a autoimmune (hemorrhagic vasculitis),
• kuvulala kowopsa kwa ziwalo parenchyma, kuphatikiza pa kuchitapo kanthu pochita opaleshoni.

Koma ziribe kanthu chomwe chimayambitsa kupezeka kwa matenda am'mimba kapena a hemorrhagic pancreatic necrosis (ndiko kuti, kufa kwa gawo kapena maselo onse), matendawa amakhudza kwambiri ziphuphu - gawo lachinsinsi la kapamba, omwe maselo ake amapanga ma enzymes omwe amapanga madzi a pancreatic.Mitundu yonse yamatenda a pancreatic necrosis imachitika pamene zochitika za ma enzymes izi zimafika pamlingo wambiri, ndipo zimayamba kukhudza minofu ya thupilo - kuthana ndi mapuloteni ake. Kuphatikiza apo, enzyme elastase imatha kuwononga ngakhale makoma amitsempha yamagazi, yomwe imatsogolera kukha magazi. Mu chipatala gastroenterology, chodabwitsa ichi chimatchedwa autoaggression of pancreatic Enzymes.

Hemorrhagic pancreatic necrosis imayamba chifukwa chaukali wa trypsin, chymotrypsin ndi elastase (pancreatopeptidase E) - mapuloteni othandizira otulutsa protein omwe amafunikira kugaya zakudya zamapuloteni.

Pofufuza zomwe zimayambitsa matenda a hemorrhagic pancreatic necrosis, ma gastroenterologists adazindikira kuti kulephera kwazinthu zovuta kuchititsa kukhazikitsa ma enzymes am'mimba kumathandizira kwambiri pathogenesis yamatendawa. Ndipo zimaphatikizapo mahomoni ambiri. Chifukwa chake, ma glucagon a mahomoni ndi somatostatin (opangidwa ndi maselo a ma Langerhans ma ipancreas), calcitonin (wophatikizidwa ndi chithokomiro cha chithokomiro), komanso mapuloteni apadera a serum a antitrypsin amalepheretsa kubisala kwa michere ya proteinolytic. Zomwe zimapangitsanso kupanga enzyme ndi ntchito zawo ndi izi: secretin yaphatikizidwa ndi mucosa wamatumbo ang'ono, cholecystokinin (pancreosimine) yopangidwa ndi duodenum, komanso insulin, gastrin ndipo, mwachidziwikire, serotonin, gawo la mkango lomwe limapangidwa mu intestine yaying'ono ndi kapamba.

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Zizindikiro za hemorrhagic pancreatic necrosis

Zizindikiro zodziwika bwino wa hemorrhagic pancreatic necrosis amaoneka ngati:

• kupweteka kwapakati, komwe nthawi zina kumatha kupweteka, kufalikira kumanzere kwa hypochondrium ndikufikira kudera lumbar, kumanzere kwa chifuwa ndi phewa.
• Lilime ndi pakamwa pouma,
• kusanza ndi kusanza kosapweteka,
• kutuluka kwam'mimba, kutsekemera ndi kutsekula m'mimba,
• malungo ndi malungo,
• khungu la nkhope,
• mawanga amtambo wabuluu pakhoma lakumaso kapena mbali za peritoneum,
• kuchuluka kwa spasmodic ndi kuchepa kwa kuthamanga kwa magazi,
• kupuma movutikira,
• chepetsa kutulutsa mkodzo,
• kusokonezeka kwa malingaliro (mkhalidwe wakusangalatsidwa kapena kufooka).

Pachimake hemorrhagic pancreatic necrosis pafupifupi wachisanu amachititsa odwala kugwa, ndipo lachitatu - chikomokere kapena pachimake matenda amisala. Kapangidwe ka fancula ya kapamba (pancreatic-retroperitoneal fistula) kumabweretsa kuti zomwe zili kapamba, zigawo za minofu yake yakufa ndi hemorrhagic exudate zimalowa m'mimba. Izi ndizomwe zimayambitsa kupezeka kwa minofu ya peritoneal ndi puritis peritonitis.

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Magawo a kukula kwa matenda

Matendawa amadziwika ndi chitukuko cha magawo.

Gawo loyamba: mu kapamba, pamakhala zochitika zatsopano za zinthu zapakhomo zomwe zimayambitsa zinthu zosafunikira monga autoaggression ndi toxinemia ya michere ya pancreatic, yomwe imawonetsedwa ndi zizindikiro zotere: chopindika chosakhazikika, kusanza ndi kutentha.

Gawo lachiwiri: zomwe zimapangitsa kuti minyewa ya m'mimba izitulutsa purifungo kuyamba, ndikupanga kulephera (dzenje) mu kapamba.

Gawo lachitatu: kutupa kumafalikira kumankhwala athanzi oyandikana, ndikupanga mkhalidwe wopsinjika kwa thupi.

Monga mukuwonera, matendawa ndi oopsa kwambiri pamiyoyo ya anthu ndipo amafunika achire kwambiri ndipo ngati pakufunika kuthandizidwa, amathandizidwa.

Zoyambitsa kukula kwa matenda m'thupi la munthu

Mpaka pano, zamankhwala zimadziwa zingapo zomwe zimapangitsa kuti njira ya pathological iyi ipangidwe. Zodziwika kwambiri pakati pawo ndi:

1. Kutupa kwa kapamba, momwe amakhudzidwa ndi atherosis, komanso kutuluka kosayenera kwa madzimadzi a pancreatic (madzi).
2. Poizoni (kuledzera) kwa thupi ngati muyezo, zomwe zimachitika kawirikawiri ngati wodwala akuledzera.
3. Kulowa mwadongosolo kwa madzi a pancreatic mu ma dancts a pancreatic, omwe amadziwika pamaso pamiyala mu ndulu.
4. Kukhalapo kwa matenda obwera chifukwa cha bile ducts ndi bile ducts, zomwe zimachitika kawirikawiri ndi cholecystitis ndi cholangitis.
5. Amasokoneza intravascular coagulation ndi thrombohemorrhagic syndrome, yomwe nthawi zambiri imayendera limodzi ndi matenda osiyanasiyana a viral kuchokera ku bakiteriya, kapena amapezeka pambuyo pa chemotherapy komanso atatha kuyatsidwa kwambiri pamitsempha yambiri ya radiation.
6. Hemorrhagic vasculitis (autoimmune pathology).
7. Makina zowawa za pancreatic parenchyma, ali ndi chilengedwe mwadzidzidzi kapena atamuchita opareshoni.

Matendawa amakhalanso oopsa chifukwa amathanso kukhudza ziwalo zina zamkati mwa m'mimba, zimakhudza kugwira ntchito kwawo.

Zizindikiro zokhudzana ndi matendawa

Zizindikiro zotsatirazi ndizomwe zimayambitsa matenda:

• Kupweteka kwambiri, kupweteka kwambiri kumanzere kwa hypochondrium, komwe kumamveka m'chifuwa kumanzere, phewa ndi kutsikira kumbuyo.
• Pakamwa pakamwa.
• Kumverera kwa misonkho ya lilime.
• Kusanza mobwerezabwereza.
• Kuchepetsa mseru
• Kuyamba kusanza.
• Kufalikira.
• Kutsegula m'mimba
• Kuchulukitsa kwa mpweya.

Kuphatikiza apo, wodwalayo amadandaula za zizindikiro zina:

• Kutentha kwambiri.
• Kukhalapo kwa mawanga amtundu wabuluu kapena wofiirira kumbali zam'mimba kapena pakati pake, zomwe zimawonetsa kukhalapo kwa magazi mkati.
• Kuthamanga kwa magazi.
• Kukucha kopitilira muyeso.
• Kupuma pang'ono.
• Pikodzo pang'ono pang'onopang'ono pokodza.
• Kusokonezeka kwa malingaliro.

Malinga ndi ziwerengero zamankhwala, pachimake hemorrhagic pancreatic necrosis mu 1/5 ya odwala imayambitsa zovuta, ndipo 1/3 pamakhala kukomoka kapena matenda amisala.

Pankhani yopanga pancreatic-retroperitoneal fistula, mkhalidwe wa wodwalayo ukhoza kukulitsidwa chifukwa cha kumeza kwa zinthu zam'mimba m'matumbo am'mimba, komanso tinthu tating'onoting'ono ta maselo ake okufa, chifukwa chotupa cha m'mimba komanso kukula kwa peritonitis yokhala ndi zizindikiritso zoyipa zimayamba kupanga.

Zomwe zimachitika pochiritsa

Madokotala mobwerezabwereza amagogomezera kuti kudzichiritsa pawokha pogwiritsa ntchito njira zamtunduwu ndizotsutsana kwathunthu. Zitha kugwiritsidwa ntchito pokhapokha kutha kugwiritsa ntchito njira zamankhwala zapamwamba pakubwezeretsa thupi, komanso pokhapokha kuyang'aniridwa ndi dokotala.

Magawo akuluakulu a chithandizo chamankhwala:

1. Kuthetsa ululu. Kwa izi, analgesics, antispasmodics (Papaverine, No-shpa, Novocaine ndi ena otero) ndi omwe amapatsidwa.
2. Kuyimitsidwa kwa kupsa mtima kwa michere ya pancreatic. Jakisoni wamkati ndi ma dontho amaikidwa pogwiritsa ntchito Trasilol kapena Trotical kulowetsedwa.
3. Kuthetsa ma spasms, omwe amalola kukulitsa kuchuluka kwa zofunikira za gland, ndipo zimachitidwanso kuti muchepetse kuchuluka kwa madzi am'mimbawa omwe amatulutsidwa. Pakadali pano, zakudya zokhwima zomwe zili ndi zigawo za njala yotheratu ziyenera kutsatiridwa. Mwa mankhwala omwe amagwiritsidwa ntchito Ephedrine, Atropine.
4. Kupewa kufalitsa kwa poizoni ndi matenda ku ziwalo zoyandikana. Mwa izi, maantibayotiki amalembedwa mwachitsanzo, Zeporin, Gentamicin kapena Kanamycin. Kuchotsa poizoni m'thupi, shuga ndi insulin ndi njira zina zimagwiritsidwa ntchito.

Ndi gawo lotsogola la matenda omwe amawonongeka ndi ziwalo zambiri, opaleshoni yodzidzimutsa imayikidwa.

Kuphatikiza apo, hemorrhagic pancreatic necrosis, limodzi ndi chizindikiro cha matenda, imafunikira kapamba, kapena njira yoikika kwambiri - kuyimitsidwa kwa kapamba (ntchito iyi imatchedwa pancreatectomy).Komabe, opareshoniyi imachitika nthawi zina, chifukwa imakhala yachilendo komanso kufa.

Njira ina yotsogola ndi kuyamwa kwa masamba akufa (sequestondola).

Nthawi yonseyi, mwayi wovulala mwangozi ziwalo zoyandikana ndi wokwera, zomwe zimapangitsa kuti pakhale zovuta zingapo komanso milandu yakupha.

Chithandizo cha matenda awa ndi njira yayitali kwambiri, yomwe imatenga nthawi kuyambira milungu ingapo mpaka miyezi isanu ndi umodzi, kapenanso kupitirira apo.

Kupitilira kwina ndi kufa.

Odwala ambiri omwe ali ndi matendawa amaganiza ngati amwalira ndi hemorrhagic pancreatic necrosis. Afunanso kudziwa kuchuluka kwa mwayi wochira, ndipo tsogolo la hemorrhagic pancreatic necrosis lingakhale lotani?

Tsoka ilo, ziwerengero zamankhwala sizinatonthoze kwathunthu: pazaka zonse za matendawa, 50% ndiwophedwa. Choyambitsa imfa ndi poyizoni wathunthu wa thupi, wokwiyitsidwa ndi purulent peritonitis.

Nthawi yomweyo, manambala olondola amadziwikanso, mwachitsanzo, hemorrhagic pancreatic necrosis ngati chifukwa cha imfa:

• 7-15% - kufa kwathunthu.
• 40-70% - ndi mitundu yoopsa kwambiri ya matenda.

Anthu omwe adakonzedweratu, kapena ali ndi vuto lililonse ndi kapamba, ayenera kuyesetsa kutsatira njira zonse zachipatala zochizira ndi kupewa kuchulukitsa kwa matendawa.

Makamaka, kupewa pancreatic necrosis, njira zonse ziyenera kutengedwa kuti muchepetse kapangidwe ka kapamba:

• Bwerezaninso zakudya zanu.
• Kukana mowa kwathunthu.
• Pamaso pa matenda aliwonse am'matumbo, ayenera kuthandizidwa mwachangu.

Kungosamala zaumoyo wanu kokha ndi komwe kungathandize kupewa mavuto.

Pomaliza

Monga mukuwonera, odwala omwe ali ndi matendawa ayenera kutsatira mosamalitsa malangizo onse a gastroenterologist, ndikuwonetsetsa kuti ali ndi vuto lililonse la m'matumbo, popewa kukula kwa zovuta zosiyanasiyana, mutenge njira zonse zoyenera kuti mupewe.

Izi zikutanthauza kuti muyenera kufunafuna thandizo la kuchipatala munthawi yake chifukwa chophwanya pang'ono m'mimba, komanso makamaka kapamba. Kuperewera kwa chithandizo choyenera kumawonjezera mwayi wakufa.

• Kugwiritsa ntchito ndalama ya amonke pochizira kapamba

Mudzadabwa momwe matendawa amachepera msanga. Samalani kapamba! Anthu opitilira 10,000 awona kusintha kwakukulu paumoyo wawo pakumwa m'mawa ...

Kodi necrosis ya pancreatic ndi yoopsa bwanji?

Zikamakula, necrosis imatha kufalikira ndikukhudza ziwalo zapafupi. Nthawi yomweyo, minofu yomwe idagwa, ndiye kuti, imafa, siyikonzanso

Kodi chifukwa chiyani kupweteka kwa mutu kumachitika pancreatitis komanso momwe mungabwezeretsere kuukira kwa migraine?

Ndizosatheka kuzindikira zomwe zimayambitsa kupweteka kwa mutu kwa odwala ndi kapamba, chifukwa chizindikirochi, chimagwirizana ndi kutupa kwa kapamba.

Amayambitsa ndi mawonekedwe a malungo pancreatitis

Dongosolo la ululu lomwe limapezeka m'mimba chapamwamba ndi chisonyezo chachikulu chomwe chimakhalapo nthawi zonse. Zowawa zimatha kukhala zowawa, zodula, kapena zosasinthika, koma zonyozeka.

Momwe mungathetsere kupweteka mwachangu ndi kutupa kwa kapamba?

Kuti ma syndromes azopweteka asathenso kuzolowera moyo wanu, muyenera kuwunika osadyetsa thanzi lokha, komanso moyo wamba.

Zomwe zimayambitsa matendawa

Hemorrhagic pancreatitis imachitika mchikakamizo cha zinthu zomwe zimayambitsa kutseguka kwa ma enzyme mthupi. Mwa zina zazikulu zomwe zimayambitsa matendawa, gastroenterologists amatcha njira yotupa, limodzi ndi kusintha kwa kutuluka kwa chinsinsi.DIC, kuledzera ndi zovuta za autoimmune zingayambitsenso matenda.

Ndi hemorrhagic pancreatitis, kuwonongeka kwakanthawi kapena kotheratu kwa England kumawonedwa. Izi zimachitika motsutsana ndi maziko okufika pamavuto ambiri a michere - trypsin ndi elastase. Zotsatira zake, gland parenchyma imayamba kudzipanga, ndipo makhoma amitsempha yamagazi amawonongeka. Tiziwalo timene timapangidwa pang'onopang'ono ndimagazi, timagulu tankhanza timathamangira m'mimba, ndikupangitsa peritonitis.

Zizindikiro zoyambirira za matendawa

The Symbomatology ya matendawa imawonjezeka maola angapo. Chizindikiro chake chachikulu ndi kutchulidwa kwa ululu. Hemorrhagic pancreatitis nthawi zonse imayendera limodzi ndi kusapeza kwam'mimba. Zowawa zimatha kukhala zosiyanasiyana mu herpes zoster kapena kuwala kwa msana. Amakhalapo nthawi zonse, koma amachepetsa m'malo okhala ndi miyendo yokhotakhota. Kukula kwa ululu kumadalira kuchuluka kwa kuwonongeka kwa chiwalo.

Ndi ziti zina zomwe zimayenda ndi hemorrhagic pancreatitis? Zizindikiro za matendawa, monga lamulo, zimawonekera mwadzidzidzi. Choyamba, munthu amamva kupweteka kwambiri m'chigawo cha epigastric. Pamene kuchuluka kwa zinthu zotchedwa vasoactive m'magazi kukukulira, khungu la khungu limayamba. Komanso, pamatenda, zochitika monga lilime louma, tachycardia, ndi kuchepa kwa magazi ndizodziwika. Poyerekeza ndi momwe thupi limakhalira kutentha, kugunda kwa mtima kumakwera mpaka kugunda kwa mphindi imodzi.

Panthawi yamatendawa, gastroenterologists amasiyanitsa nthawi zitatu, iliyonse yomwe imasiyana mu chithunzi cha chipatala. Gawo loyamba limadziwika ndi kugwedezeka kwakukulu kwa pancreatogenic. Mu maola 2-3, toxemia imayamba. Pa gawo lachiwiri, chithunzi cha chipatala chimathandizidwa ndi zizindikiro za kusayenda bwino kwa ziwalo zofunika. Mavuto amisala, nkhawa kwambiri komanso chikhalidwe chosayenera chimawonekera. Gawo lachitatu limadziwika ndi kupezeka kwa zovuta za purulent.

Mfundo zoyambirira zamankhwala

Ngati hemorrhagic pancreatitis ikukayikiridwa, zifukwa zomwe zikufotokozedwa m'nkhaniyi, wodwalayo akuwonetsedwa kuchipatala mwadzidzidzi. Kuchiza nthawi zambiri kumathandizira kuthetsa ululu ndi kuwonongeka kwina kwa gland, kupewa zovuta zamkati. Mwa mankhwala zotchulidwa antispasmodics ("Papaverine"), analgesics, antihistamines. Novocain blockade imakhazikikanso. Mavuto opatsirana nthawi zambiri amakhala ndi hemorrhagic pancreatitis, motero antibacterial mankhwala amadziwika kuchokera tsiku loyamba.

Nkhani yothandiza? Gawani ulalo

Mosasamala kanthu za momwe wodwalayo alili, chakudya chanjala chikulimbikitsidwa. Ndi kusakhazikika kwa njira zosasamala zamankhwala, kuperekera chithandizo kumayikidwa. Kuchita kumaphatikizapo kutsegula kapisozi ka England, kumukhetsa ndi kuchotsa malo a necrotic. Ndi njira yayitali yodutsira, chiwonetsero chokwanira cha chiwalo kapena gawo lake chimachitika.

Zotsogola ndi kupewa

Ma hemorrhagic mawonekedwe a kapamba amadziwika kuti ndiosavomerezeka kwambiri pamalingaliro. Malinga ndi ziwerengero, zotsatira zakupha zimachitika mu 50% ya milandu, ngakhale popereka chithandizo chamankhwala. Choyambitsa chachikulu cha imfa ndi pancreatogenic toxemia.

Kodi matendawa amatha kupewedwa? Kupewa kwa hemorrhagic pancreatitis kumakhala mukuwona mfundo za zakudya zoyenera, kukana zizolowezi (kusuta, kumwa mowa mwauchidakwa). Madokotala amalimbikitsanso mayeso anthawi yake ofunika kuti adziwe matenda amkati mwanu.

Chifukwa chodziwitsidwa pazinthu zingapo zowonongeka, kuphwanya zakudya kapena kumwa mowa mwauchidakwa, kapamba ya pachimake imayamba. Vutoli limafunikira chithandizo chamankhwala mwachangu, chifukwa chopanda pake limapindika pancreatic pancreatic necrosis.Chithandizo cha pancreatic necrosis chimachitika kuchipatala ndipo cholinga chake ndikuletsa kudziwotcha kapamba ndi kubwezeretsa thupi lonse.

Limagwirira a chitukuko cha kapamba necrosis

Chifukwa chachikulu chomwe chimapangidwira ma pancreatic necrosis ndikukhazikika kwa proenzymes, komwe kumayambitsa zochitika zosinthika kuti zithandizire kuwonongeka kwa minofu. Zinthu zotsatirazi zingayambitse izi:

• Choyambitsa. Kukondoweza kwambiri kwa gawo la exocrine la gland limachitika, lomwe limayang'anira mitundu yonse ya kagayidwe. Chifukwa cha kuledzera, kudya zamafuta kwambiri kapena zakudya zopanda thanzi, michere yambiri imatulutsidwa m'maselo a ziphuphu, omwe amayamba kuwononga tiziwitsi tokha.

• Cholepheretsa. Pali blockage ya pancreatic duct, monga lamulo, motsutsana ndi maziko a matenda a ndulu. Zotsatira zake, kupanikizika kwa ma ducts kumakwera, mphamvu ya mtima ikukwera ndipo vuto lakomwe limayambitsa ma enzyme limayambitsa, gland "yodzilowetsa"

• Reflux chinthu. The bile amaponyedwa kuchokera duodenum mu kapamba, chifukwa chomwe ma proenzymes adamulowetsa pasadakhale, tinthu timene timayambitsa enzyme imayamba, yomwe pamapeto pake imayambitsa kutukusira kwa gland ndi necrosis ya zimakhala zake.

Biochemical magawo a pancreatic necrosis

Choyamba, ma enzyme monga lipase ndi phospholipase A amathandizira, amaswa ma cell a gland. Pali zofunika zina zamafuta a pancreatic necrosis, omwe amachokera kumadera athanzi a kapamba ndi shaft yotupa. Pamakhala kuchuluka kwamafuta acid, pH yamaselo imasunthidwa mbali ya acidic. Njirayi imayambitsa magwiridwe antchito a intracellular trypsin, imayamba kuphwanya mapuloteni apancreatic. Elastase imayendetsedwa, yomwe imaluka makoma amitsempha yamagazi, ndipo njirayo imadutsa pancreas yokha ndikusintha.

Kodi zikondwerero za kapamba zimawonekera bwanji?

Zizindikiro zazikulu za pancreatic pancreatic necrosis zimadalira kuchuluka kwa kuwonongeka kwa ziwalo komanso nthawi yomwe zadutsa chichitikireni matendawa.

Monga lamulo, kupweteka kwambiri pamimba yapamwamba, yomwe imatha kufalikira kumbuyo ndi miyendo, ndizosokoneza. Kuphatikiza apo, kumatulutsa ndi kusanza kosalekeza kumachitika, zomwe zimapangitsa kuchepa mphamvu kwa thupi. Tizilombo tingaoneke, tofanana ndi mikwingwirima yofiyira chikasu, kumanzere ndikuzungulira msomali. Kuledzera kwa thupi kumakulirakulira, popeza zochita za enzymatic mkati mwa gland zimakhudza ntchito ya ziwalo zonse ndi machitidwe. Popanda chithandizo chokwanira, aimpso, kwa chiwindi, mapapo kapena kuchepa kwa poyizoni.

Zambiri zowonetseratu zasayansi zikuwonetsa kuwonjezeka kwa amylase, diastase, leukocytosis, magazi ndi zina zambiri zomwe zikuwonetsa kuwuma kwa njirayi.

Zotsatira zakupha ndi pancreatic pancreatic necrosis zimawonedwa pamitundu kuyambira 15 mpaka 70% ya milandu, kutengera mtundu wa matendawa ndi nthawi yomwe wodwalayo adagwiritsa ntchito popanda chithandizo. Komabe, ngakhale ndi chithandizo chokwanira, chizindikiro ichi chimakhala chokwera.

Magawo a chitukuko cha matendawa

Pancreatic necrosis kumayambiriro kwa kukula kwake ndi aseptic m'chilengedwe, ndiye kuti, njira yotupa imayambika chifukwa cha zochita za poizoni ndipo ilibe tizilombo toyambitsa matenda.

Mtsogolomo, njirayi imalowa gawo la matenda, zovuta za kapamba zimachitika, monga zotupa za kapamba kapena phlegmon ya danga la retroperitoneal.

Kuphatikiza apo, nthawi ya pancreatic necrosis nthawi iliyonse imatha kupanikizika ndi peritonitis, mapangidwe a pancreatic cyst, kugwedezeka komanso kulephera kwapawiri.

Kuzindikira kwa pancreatic pancreatic necrosis mkati mwa maola 48 oyambilira kuyambira nthawi yolowa kuchipatala kumawunikidwa molingana ndi kukula kwa Ranson, komwe kumaphatikizapo zizindikiro 11 zosokoneza thupi. Mayankho abwino okhudzana ndi izi pamlingo wakewo, amapitilira kudaliraku.

Kodi pancreatic necrosis amathandizira bwanji?

Chithandizo cha pancreatic pancreatic necrosis chimachitika pokhapokha pachipatala ndipo chimasankhidwa payekha kutengera gawo la njirayo ndi kukhalapo kwa zovuta. Malangizo aposachedwa amabwera pansi kuti athetse ntchito ndikuchotsetsanso kwamadzi ndi zotayika zamagetsi.

Mankhwala omwe amathandizira kuti muchepetse minofu ya minyewa yosalala, imachepetsa katulutsidwe ka m'mimba, imalepheretsa kupanga ma michere. Kuphatikiza apo, mahomoni ndi maantibayotiki amatchulidwa malinga ndi gawo la matendawa.

Chithandizo cha opaleshoni chimaphatikizapo laparoscopy kapena laparotomy, kutengera kuchuluka kwa kuchuluka kwa njirayo ndi kukhalapo kwa zovuta.

Kupatsa thanzi kwa pancreatic pancreatic necrosis nthawi zambiri kumakhala kwaubwino. Odwala amapatsidwa chubu cha nasogastric kuti aletse kupanga ma enzymes m'mimba ndi kapamba.

Panthawi yochira, chakudya chosasimbika chikuwonetsedwa, tebulo No. 5 malinga ndi Pevzner. Kuwonetsa chimanga, msuzi wosenda, zakudya zopatsa thanzi. Mowa osapatula, zakumwa zoziziritsa kukhosi, ndi msuzi. Mupeza zoyambirira za chakudya chobwezeretsanso ziwalo m'nkhaniyi: Malangizo pazakudya zanu zamagulu a kapamba.

Malangizo: mowa umagwirizana kwathunthu ndi matenda amtundu uliwonse wa kapamba, chifukwa umawonjezera kukakamiza kwa ma ducts ndikuwonjezera mamvekedwe a sphincters. Izi zimapangitsa kuti zikhale zofunikira kuti ma enzymes akhazikike komanso kukhazikitsidwa kwa zochitika zomwe zidzaonongeke kuti ziwononge minyewa ya kapamba. Kuletsa zakumwa zoledzeretsa, mudzakhala ndi thanzi lanu kwazaka zambiri.

Hemorrhagic pancreatic necrosis ndi njira yachilengedwe yomwe imachitika mu minyewa ya kapamba.

Matendawa amadziwika ndi chiwonongeko chathonje komanso chosasintha.

Ngati mukufuna kudziwa zomwe zimayambitsa matendawa, komanso ngati lingathe kuchiritsidwa, werengani nkhaniyi.

Zomwe zimayambitsa matendawa

Kanyumba ndi chiwalo chamkamwa chamunthu, chokhala ndi ntchito zachinsinsi.

Ma Enzymes opangidwa ndi zikondamoyo za munthu wathanzi yemwe sanakhalepo ndi vuto ndi chiwalochi amasiya malire ake limodzi ndi madzi a pancreatic omwe amalowa mu duodenum.

Cholinga chachikulu cha madzi a pancreatic, odzazidwa ndi ma enzyme monga elastase, trypsin ndi chymotrypsin, ndiko kuphwanya koyenera kwa zakudya zama protein.

Zomwe zimayambitsa hemorrhagic pancreatic necrosis sizimamveka bwino, komabe, madokotala amakhulupirira kuti matenda amtunduwu amatha kupezeka chifukwa cha zotsatira zoyipa za zinthu zotsatirazi:

• kutupa kwapacreas kwaposachedwa, komwe kumapangitsa kuti gawo lonselo lisamalize.
• zotulutsa zotsekemera zamadzimadzi a pancreatic,
• kuledzera komwe kumakhala ndi vuto lambiri mu thupi ndipo kumachitika chifukwa cha mowa kapena poyizoni wa mankhwala.
• matenda osiyanasiyana opatsirana (mwachitsanzo, cholangitis kapena cholecystitis), otchulidwa m'makoma a bile,
• kukhathamira kwa magazi kwambiri, kuwonetseredwa pambuyo pochotsa matenda opatsirana, ma chemotherapeutic zotsatira, etc.,
• matenda ena a autoimmune (mwachitsanzo, hemorrhagic mtundu vasculitis),
• zoyeserera zamakina zomwe zimatsogolera kuwonongeka kwa umphumphu wa pancreatic parenchyma.

Hemorrhagic pancreatic necrosis imayenda mofulumira. Pamaso pa matendawa, sikuti ma parenchyma okha ndi ma mucous membrane wa gallbladder amavutika, komanso gawo lapadera la gawo ili lomwe limayang'anira kupanga michere.

Dera la kapamba limatchedwa "acinus". Kuwonongeka kwa malo kumeneku kumalimbikitsa kupanga ma enzyme ochulukirapo omwe samachoka m'thupi limodzi ndi gawo lalikulu la madzimadzi a pancreatic, koma kukhalabe mkati mwake ndipo amakhala ndi mphamvu yowononga minyewa yowonongeka kale, kutsata mapuloteni awo ndikuwononga makoma amitsempha yamagazi, ndikupangitsa ma micros ambiri.

Vutoli, lomwe limadziwika ndi hemorrhagic mtundu pancreatic necrosis, limayikidwa ndi madokotala ngati autoaggression ya michere ya pancreatic.

Kodi kuchitira hemorrhagic mtundu kapamba necrosis?

Ngati mukumva zizindikiro zomwe zalembedwa munkhaniyi, musazengereze ndipo pitani kuchipatala msanga.

Ndikwabwino kuyimbira gulu la ambulansi zoterezi, m'malo mongopita kuchipatala nokha.

Gulu la madokotala lomwe likufika pamalo oyitaniralo lidzakuyeserani koyambirira kwa zomwe muli nazo ndipo ngati kuli koyenera, lingakupatseni mankhwala aliwonse omwe amaloledwa motere.

Chithandizo cha matenda monga pachimake hemorrhagic mtundu pancreatic necrosis ikuchitika kokha m'malo.

Ngati pancreatic necrosis ili yathunthu, ndiye kuti wodwalayo sanayikidwe mu chipinda wamba, koma mosamala kwambiri, kuti athe kuyang'anitsitsa momwe aliri ndikuchitapo kanthu panthawi yothandizira.

Munthu yemwe akudwala matenda a pancreatic necrosis afika kuchipatala, amamufufuza mozama.

Ngati matendawa atsimikizira, ndiye kuti madokotala amayenera kuyamba kulandira chithandizo cha wodwalayo.

Poyamba, munthu yemwe akudwala hemorrhagic necrosis amalandila mankhwala apadera amkamwa omwe amatha kuyimitsa kupweteka kwapweteka, komanso mankhwala omwe amalepheretsa kupanga ma enzymes ochulukirapo.

Potsatira magawo a inpatient mankhwalawa a hemorrhagic pancreatic necrosis, madokotala amathandizira wodwalayo kuyeretsa zakumwa zomwe zimapangidwa mu minofu yake, kusintha acidity ya madzi a m'mimba, komanso amayesetsa kuyimitsa pancreatic necrosis.

Pambuyo kukhazikika kwa mkhalidwe wa wodwalayo, opaleshoni imachitidwa.

Monga lamulo, imakhala mu laparoscopic kapena dracutaneous drainage lomwe lakhudzidwa ndi kapamba, kapena paliponse lokhala ndi ziwalo.

Pambuyo powerenga nkhaniyi, mutha kudziwa zomwe zimayambitsa komanso zomwe zimayambitsa maonekedwe monga hemorrhagic pancreatic necrosis, yomwe imadziwika ndi koopsa.

Kuperewera kwa chithandizo chokwanira komanso chapanthawi yake cha hemorrhagic pancreatic necrosis kungayambitse imfa.

Izi zitha kupewedwa pokhapokha ngati mungalumikizane ndi madokotala omwe akuthandiza pa vutoli.

Chimodzi mwa matenda oopsa kwambiri a m'mimba ochita kupukusa munthu ndi pancreatic pancreatic necrosis, zotsatira zakupha kumene, malinga ndi ziwerengero, zimapezeka mu 40-60% ya milandu.

Zimayambitsa pancreatic necrosis

Pachimake kapamba, complication ya pancreatic necrosis, ali lachitatu malo pafupipafupi, kungolola patsogolo pachimake appendicitis ndi cholecystitis. Monga lamulo, limayamba chifukwa cha kuwonongeka kwa ma cell achinsinsi a kapamba, kupanga kwambiri madzi a kapamba komanso kuphwanya kutuluka kwake. Njira izi zitha kupangitsa kuti:

• kuvulala kwam'mimba
• opaleshoni yam'mimba
• kuledzera kwa thupi (kuphatikizapo mowa),
• thupi lawo siligwirizana
• matenda a ndulu
• matenda opatsirana kapena parasitic,
• kudya kwambiri nyama yokazinga, zinthu zina zowonjezera, mafuta a nyama.

Zomwe zimayambitsa pancreatic pancreatic necrosis ndizambiri, koma nthawi zambiri zimayamba kumwa mowa wambiri kuphatikizapo zakudya zama protein.Zimachitika kuti matendawa amatuluka nthawi yomweyo ndipo kuukira kumatha kuchitika motsutsana ndi maziko amoyo wathunthu. Milandu yanenedwa pomwe pancreatic pancreatic necrosis, zotsatira zakupha zomwe zidachitika patangodutsa maola ochepa chiyambireni zizindikiro zamatendawa, pakapita masiku angapo pambuyo pa phwando lochuluka.

Zomwe zimachitika ndi pancreatic necrosis

Chikondamoyo chathanzi chimatulutsa ma enzyme omwe amafunikira kuti chakudya chisalowe m'mimba. Ndili othokoza kuti chakudya chimagawika muzinthu zomwe zingalowe m'magazi kudzera mucous membrane wam'mimba, omwe amawapereka kwa zimakhala ndi ziwalo. Izi zimapangitsa kapamba kukhala chimodzi mwazinthu zofunika mthupi. Kumwa mowa ndi zakudya zamafuta ambiri kumalimbikitsa kwambiri kapamba kuti apange madzi, ndipo popeza ma ducts sangathe kuwachotsa kwathunthu, amayamba kudziunjikira mkati mwa gland. Izi zimabweretsa kukulira kwa edema, kuphatikizidwa kwina kwa ma ducts komanso kutsika kwawo kwotsatira. Ma enzymes olimbirana a kapamba, omwe ntchito yake inali kuwonongedwa kwa mapuloteni, amatuluka thukuta m'makumba ndikuyamba kuyisungunula, mothandizidwa ndi ma enzyme, "ake" a gland "amadzimbidwa". Ma enzymes othandizira ndi zinthu zowola zomwe zimapangidwa munjira imeneyi amalowa m'magazi ndikuthandizira kuti ziwalo zina ndi minyewa itha, ndikupangitsa kuledzera kwambiri. Chifukwa chake, matenda a pancreatic pancreatic necrosis, zomwe mtsogolo mwake zimakhala zovuta kudziwa, ndi matenda oopsa.

Gulu la pancreatic necrosis

Kutengera ndi kuchuluka kwa zotupa za England, tating'onoting'ono tating'ono, tating'onoting'ono, tating'onoting'ono tomwe timayang'ana pakati pathupi lathunthu. Zachidziwikire, kusiyanasiyana pakati pa mitundu iwiri yoyamba kumakhala kotsutsana. Madokotala amagwiritsa ntchito malingaliro awa kuti adziwe kuchuluka kwa kuwonongeka kwa ziwalo. Ndi subtotal pancreatic necrosis, kusintha kwa necrotic kumakhudza kwambiri England. Ngati chiwalocho chikukhudzidwa kwathunthu, ndiye kuti pancreatic pancreatic necrosis yonse yapezeka. Potere, zotsatira zakupha zimawonedwa nthawi zonse.

Palinso mtundu wina wosankha. Amagawa necrosis ya pancreatic m'mitundu iwiri:

• Zochepa. Izi zimaphatikizira njira yomwe cholinga cha zigawo zazikulu zimapangidwa.
• Zofala. Poterepa, zambiri mwa tiziwalo kapena chiwalo chonse chimakhudzidwa.

Mitundu ya pancreatic necrosis

Kutengera kwa kukhalapo kwa matenda omwe akukhudzidwa ndi madera omwe akhudzidwa, wosabala kapena kachilombo ka pancreatic necrosis imasiyanitsidwa. Kuphatikiza apo, matenda akakhala kuti ali ndi kachilombo, matendawa amakhala osavomerezeka, popeza pali kuthekera kwakukulu kodzetsa nkhawa, ndipo zimakhala zovuta kwambiri kuti wodwala atuluke.

Sterile pancreatic necrosis imagawidwa m'mitundu iyi:

• mafuta - amadziwika ndi kukula kwapang'onopang'ono kwa masiku 4-5 komanso njira yofatsa,
• hemorrhagic - yodziwika ndi njira yofulumira komanso magazi pafupipafupi,
• osakanikirana - amapezeka nthawi zambiri, chifukwa ndi pancreatic necrosis, minofu ya adipose ndi pancreatic parenchyma zimakhudzanso chimodzimodzi.

Ngati pancreatic pancreatic necrosis ikapezeka, opaleshoni ndiyosapeweka. Koma nthawi zambiri sizimapereka zotsatira zomwe zikufunidwa, ndipo mwina kukonzanso kwa necrotic foci.

Zizindikiro ndi kuzindikira kwa pancreatic necrosis

Clanical pachimake kapamba amasonyezedwa ndi kupweteka kwambiri mu hypochondrium wamanzere kapena kupweteka komwe kumakhala ndi shingles. Pali kusanza kwam'matumbo, komwe sikubweretsa mpumulo, kutsegula m'mimba. Poyerekeza ndi maziko awa, kusowa kwamadzi kumachitika mwachangu, kuledzera kumakulirakulira. Popanga matenda, kuphatikiza kwa anamnesis ndikofunikira kwambiri.Ngati ili ndi chidziwitso chokhudza kuledzera, zakudya zamafuta kapena chidziwitso cha matenda amchiwindi ndi chikhodzodzo, izi ndizotheka kupanga matenda a pancreatic pancreatic necrosis. Zomwe zimachitika mu vutoli zimadalira kwambiri matenda omwe wodwala amafunafuna chithandizo, komanso kuchuluka kwa zotupa.

Ponena za diagnostics a ma labotale, apa amalipira kusanthula kwamkodzo ndi magazi, momwe mumakhala kuchuluka kwakukulu kwa amylase. Ultrasound yam'mimba, CT kapena MRI imachitidwanso, komwe mumatha kuwona mawonekedwe a necrotic m'misempha ya kapamba.

Nthawi zambiri, pancreatic necrosis imafunika opaleshoni yothandizira. Nthawi yomweyo, ngakhale kuti chiwerengero cha anthu omwalira chimakwera kwambiri, kugwira ntchito kwakanthawi kumapereka mwayi wowomboledwa. Chithandizo cha Conservative chikuphatikiza zotsatirazi:

• patangopita masiku ochepa chichitikire kuukira - njala kwathunthu, ndipo malingana ndi kuopsa kwa matendawa, kuyambitsidwa kwa michere kudzera mu kulowetsedwa kwa mkati kumatha kukhala kwa milungu ingapo,
• kuyeretsa magazi (hemosorption) - kumachitika ndi chidakwa chachikulu,
• somatostatin ndi timadzi timene timatha kuchepetsa mavuto obwera chifukwa cha impso, nthawi zambiri timayendera limodzi ndi pancreatic necrosis,
• ndi matenda opatsirana - maantibayotiki.

Pancreatitis pachimake - Zakudya

Popeza ndizofunikira zakudya zomwe nthawi zambiri zimayamba kukhala chifukwa cha pancreatitis pachimake, ndikofunikira kwambiri pakuthandizira. Monga tafotokozera pamwambapa, m'masiku oyamba atapezeka kuti khansa yapakhungu idayambika, zakudya ndizofunikira kwambiri - kufa kwathunthu kumawonedwa. Woopsa milandu, makonzedwe a makolo pazakudya amatha milungu ingapo.

M'tsogolomu, zakudya mu pancreatic pancreatic necrosis zimatanthawuza boma losasamala, lomwe limatsimikiziridwa ndi kupatula kwakukulu kwa mafuta ndi chakudya kuchokera kuzakudya, komanso zinthu zomwe zimayambitsa kupangika kwa mpweya. Chakudyacho chimawotchera ndi kuwaza. Imatengedwa m'magawo ang'onoang'ono kasanu ndi kamodzi patsiku. Kugwiritsa ntchito mankhwala ochokera kunja ndi mchere kumatha. Chakudya choterocho, kutengera kuuma kwa matendawa, chiyenera kukhala miyezi ingapo mpaka chaka.

Zachidziwikire, ndimatenda oopsa monga pancreatic pancreatic necrosis, zotsatira zakupha ndizotheka, ndipo, ndizachidziwikire, ndibwino kuti musabweretse thupi lanu, kuti muchepetse ziwopsezo momwe mungathere. Koma ngati matendawa adakulirakulirabe, kutsatira mosamala zakudya kumathandizanso kupewa kubwereranso m'tsogolo.