Madera a pancreatitis ndi mfundo zowawa: chizindikiro cha phrenicus

Zowawa zamatenda a pancreatic zimapezeka mwanjira yomweyo ngati matenda a ndulu (onani gawo lapitalo). Ndi kapamba, kupweteka kwa mfundo zotsatirazi kumatsimikiziridwa.

Malo a choledocho-pancreatic (omwe afotokozedwa gawo lapita) amafanana ndi mutu wa kapamba.

Mfundo ya Kach - 5 cm pamwamba pa msomali pamphepete kunja kwa minofu ya rectus abdominis kumanzere, ikufanana ndi thupi la chithokomiro.

Malire pakati pa gawo lachitatu komanso lakunja kwa chipilala chamtengo kumanzere - likufanana ndi mchira wa gland.

Phrenicus wabwino ndi chizindikiro kumanzere. Zowawa pakpation ya VSh - XI zamitsempha zam'mimba kumbuyo.

Pazochitika zofunika (mwachitsanzo, ngati magazi am'mimba akuwoneka), kuyezetsa kwadigito kumagwiritsidwa ntchito, zomwe zimapangitsanso kuyesa momwe ziwalo ndi minofu yowazungulira (makamaka, gland ya prostate, chiberekero, etc.). Kuyesedwa kwa digito kwa rectum nthawi zambiri kumachitika mwagwedeza m'malo a wodwalayo kapena malo a wodwalayo mbali yakumanzere ndi miyendo yokwezedwa pamimba. Nthawi zina (mwachitsanzo, odwala omwe akudwala kwambiri), amaloledwa kuchita kafukufuku wodwala kumbuyo ndi maondo owongoka ndi miyendo yotsika pang'ono.

Phunziroli limayamba ndikuwunika kwa anus, komwe kumakupatsani mwayi wosintha pakhungu (mwachitsanzo, ndi eczema), kufinya ndi fistulas mu anus, kufalikira kwa ma hemorrhoids kapena rectum. Pambuyo pake, chala chakumanja cha dzanja lamanja chovala chosalala cha mphira, chothira mafuta odzola, chimayambitsidwa mwanzeru. Ngati pa nthawi ya makonzedwe kumachepetsa kwambiri kupweteka ndi kupweteka kwa kunja kwa mapiko, ndiye kuti ndibwino kuchititsa opaleshoni yakumaloko yoyamba. Chala chimayikidwa mu thumbo ndi mayendedwe owunikira mogwirizana ndi kutsogoleredwa ndi bango.

Atadutsa dera la sphincter, chala chimatembenukira chakumadzulo, pambuyo pake chimadzipeza ndikutsalira kwa rectum (nthawi zambiri chala chachikulu chimatha kuyikidwira mpaka pakuya masentimita 12). Kenako, werengani kuwunikira kwa gawo lofunikira kwambiri la rectum, momwe limapangidwira mucous mpanda wake. Mwa amuna, gland ya prostate yomwe ili kutsogolo imayesedwa (kukula kwake, kapangidwe kake, zilonda, ndi zina zotere), mwa akazi, mawonekedwe a rectal-uke Kuphatikiza apo, zindikirani mkhalidwe wa pararectal fiber, mkati wamkati mwa sacrum ndi mchira wamtambo. Mukachotsa chala, chidwi chimakhudzidwa ndi mawonekedwe amipando yomwe yatsala papulogalamu (magazi osasinthika, maukonde onyansa ngati poti, ntchofu, mafinya).

Kufufuza kwamakina a rectal kumathandizira kuzindikira matenda osiyanasiyana a rectum (zotupa, zotupa), minofu ya pararectal (paraproctitis), prostate gland (prostatitis, adenoma, khansa), chiberekero ndi zowonjezera, malo a Douglas (kudziunjikira kwa purulent exudate, chotupa cha metastases).

Tsiku Lowonjezera: 2014-01-03, Views: 1266, Kuphwanya Copyright? ,

Malingaliro anu ndiofunika kwa ife! Kodi zomwe zalembedwazo zinali zothandiza? Inde | Ayi

Kuzindikira ndi mfundo za palpation mu kapamba

Malinga ndi mawonetseredwe azachipatala, sizingatsutsidwe kuti kuwonongeka koopsa m'moyo wa wodwalayo kumagwirizanitsidwa ndendende ndi vuto la kupweteka kwa kapamba. Kuphatikiza pa mawonekedwe a pathological process, mitundu yosiyanasiyana ya kutupa kwa kapamba imasiyanitsidwa, yomwe imalumikizidwa ndi zotsatira zoyipa zamtundu wina.

Kuti mudziwe bwino wodwalayo muyenera kupenda bwino. Wodwalayo amakayezetsa magazi, kuyezetsa mkodzo, kukopera, ultrasound, radiography, CT, MRI amachitidwa.

Kufufuza kwakuthupi koganiza kuti kakulidwe kenakake kovutikira kumakhudza palpation malinga ndi njira yokhazikitsidwa. Njirayi imakhazikika pakumva kuwawa m'malo ena komanso kuzindikira kwa malo omwe amaphunziridwawo. Chithunzi chilichonse chimakhala ndi zake.

Madera a pancreatitis amadziwika ndi olemba, omwe adatchulidwa pambuyo pa akatswiri azachipatala omwe adasanthula izi. Mwachitsanzo, chizindikiro cha Shoffar ndi kapamba, Kacha ndi madotolo ena.

Palpation monga matenda adayamba kugwiritsidwa ntchito kumapeto kwa zaka za zana la 20, pomwe kunalibe zida zapadera zothandizira kuzindikira zomwe zimayambitsa kupweteka kwambiri ndi malaise mwa wodwala. Madokotala adagwiritsa ntchito zala zawo pakuyesa. Muzochita zamakono zamankhwala, njira ya palpation imakwaniritsa ukadaulo - ultrasound, MRI.

Ubwino wake ndikuti mothandizidwa ndi palpation ndizotheka kuyikira mwachangu pancreatitis pachimake, motero, kuti ayambe kulandira chithandizo chokwanira. Mwa munthu wamkulu yemwe alibe kuphwanya kwa kapangidwe kake, ndizosatheka kukweza chiwalo.

Potengera komwe palpation ndi kukhudzika kwa malo a kapamba, amafunikira kuwunika mosamala kusintha kwa chikhalidwe cha kupweteka kwa wodwala.

Zizindikiro zazikulu

Popanga matenda, palpation ndi gawo lazodziwonetsa, kuwonetsa kutanthauzira kwa zopweteka, kusintha kwawo pakukakamiza. Chizindikiro cha Voskresensky cha pancreatitis chimafotokozedwa ngati kusowa kwa chiwopsezo chomenya khoma la msempha - mdera lomwe mumalumikizana ndi kapamba.

Apa pali masentimita asanu pamwamba pa navel pomwe amasuntha masentimita anayi kulowa kumalo owonetsera ndulu ya gallbladder. Kuti mudziwe chizindikiro cha Voskresensky ndikofunikira kujambula zala kuchokera ku dera la epigastric kupita ku chiwonetsero cha chiwindi ndi zovala zowonda. Mu 70% ya kapamba owopsa, zotsatira zabwino zimapezeka. Mankhwala, chizindikiro ichi chimakhala ndi dzina lina, "shati."

Kuwonetsedwa kwachipatala kwa Mayo-Robson kumatsimikiziridwa ndi kupweteka kwambiri m'deralo, komwe kumayang'anira thupi ndi mchira. Kuti mudziwe mfundo, mzere umakokedwa kuchokera kumchombo kupita pakati pa nthiti yakumanzere. Chisoni chidzamvekedwa pamtunda wachitatu wa mzerewu.

Chizindikiro ichi ndichilengedwe 50% cha zithunzi zamankhwala. Itha kutsimikizidwa ndi kupanikizika kwapang'onopang'ono - kupweteka kowonjezereka kumawonetsa kukulira kwa kuukiridwa kwamphamvu.

• Shoffar Zone. Kulimba kumafotokozedwa pakati pa mzere wakutsogolo wapakatikati ndi mzere womwe umalumikiza msomali kumanja wamanzere ndikumatsika kwa mzere wapakati wa Desjardins,
• Chizindikiro cha Kerth ndi kupweteka palpation pamalo omwe amapezeka masentimita 5 pamwamba pa msomali mosavutikira. Kupezeka mu 65% ya zojambulazo. Komanso chizindikirochi chimawoneka kuti ndi chabwino ngati mavuto azachuma am'mimba m'chigawo cha epigastric apezeka,
• Zomwe Kach akunena pancreatitis ndizopweteka kumbuyo kwa kukhudza kukhudzika kwa mchira wa chida chogaya. Malo amalo: dera la kusintha kwa njira ya 8 ya thoracic vertebra. Nthawi zina matenda a kapamba, amatha kuwonetsa khungu pakadali pano,
• Chizindikiro cha Razdolsky chimapezeka pafupifupi pazochitika zonse za pachimake kapamba. Imayendera limodzi ndi ululu wowopsa womwe umachitika pakhungu pakhungu m'dera la makondedwe. Zimatengera kutupa komwe kumachitika m'mimba.

Komabe, palpation sikokwanira kupanga matenda - kuzindikira kwathunthu kumachitika nthawi zonse, chifukwa kuukira kovuta kumatha kuyambitsa matenda ena - cholecystitis, cholelithiasis.

Kupezeka kwa zizindikiro zomwe zafotokozedwayi ndiye chifukwa chakuchipatala komwe wodwalayo amathandizira kuti amupimitsenso kuchipatala.

Zizindikiro pa palpation

Kuphatikiza pa omwe alembedwa pamwambapa, mutha kutchula zizindikilo zina zomwe zimatchulidwa pambuyo pa madokotala ndipo zimatsimikiziridwa ndi palpation. Zomwe zakhala zikufotokozedwa kale zikuwoneka kuti ndizofala kwambiri, motere, nthawi zambiri zimawathandiza.

Chizindikiro cha Mondor, malinga ndi madokotala, chimawonetsedwa pafupifupi pazonse zokhudzana ndi pancreatitis yovuta kapena yogwira. Zimayendera limodzi ndi mawonekedwe amtundu wakuda wa tint wabuluu pakhungu la munthu. Amawoneka pathupi komanso pankhope. Cholinga chake ndikulowerera kwa zinthu zapoizoni zomwe zikondamoyo zimalowa mkati mwake.

Chizindikiro cha Grott chimadziwika ndi matenda opweteka kwambiri, omwe amapezeka nthawi zina. Pali zingapo, zilizonse zili ndi dzina lake, zimathandizira kutsimikizira kutupa kwa mchira, thupi kapena mutu wa chindayo.

Pa palpation amatsogozedwa ndi izi:

1. Desjardins. Ululu umawoneka pamlingo womwe ndi mainchesi 4 pamwamba pa msomali wolumikizira kulumikizana. Wabwino mu 71%, makamaka motsutsana ndi maziko a matenda owononga.
2. Munjira yotupa kwambiri, zotsatira zabwino zimapezeka nthawi zambiri ndi kukakamiza pamalire, omwe amapezeka mu fossa ya minofu ya sternocleidomastoid. Dzinalo la chizindikirocho ndi chizindikiro cha Mussie-Georgiaievsky. Ndi chifukwa chakukwiya kwambiri kwa khoma lam'mimba, kutsekemera kwa mathero am'mitsempha.

Ndikofunika kudziwa kuti chizindikiro cha Mussie-Georgiaievsky ndichabwino osati chokhacho cha kapamba, komanso kutupa kwa ndulu. Chifukwa chake, kupezeka kwake sikukuzindikira kotsirizira, kuzindikira kwakofunikira kumafunikira.

Chizindikiro cha Tuzhilin chimayendera limodzi ndi mawonekedwe ofiira pakhungu, makulidwe ake mpaka mamilimita anayi. Zimatsimikiziridwa ndikuyambiranso kwa ulesi.

Chithandizo cha kugwidwa kwamphamvu kumachitika mu chipatala. Pambuyo pakuchotsa, muyenera kutsatira kadyedwe, imwani mankhwala omwe dokotala amakupatsani. Kuphatikiza apo, njira zosakhala zachikhalidwe zimagwiritsidwa ntchito - ma massage complexes, acupuncture, decoctions azitsamba, etc.

Zambiri pazizindikiro za kapamba zimaperekedwa mu kanema munkhaniyi.

Kodi kapamba ndi chiyani?

Chaka chilichonse, kuchuluka kwa anthu omwe ali ndi vuto la kutupa kwa mitsempha kumawonjezeka pakudya pafupipafupi, kugwiritsa ntchito mankhwala osokoneza bongo mopitirira muyeso ndi mafuta ambiri, komanso mbale zomwe zimaphikidwa ndi kuyamwa ndi kumwa zakumwa zoledzeretsa.

Pancreatitis ndi njira yotupa komanso yoipa mu kapamba. Njira ngati izi zikuwonekera, ndiye ma enzyme opangidwa ndi kapamba sakalowa mu duodenum. Chifukwa chake, amayamba kuchita mwachangu kale kapamba, pang'onopang'ono akuwononga.

Ndondomeko iyi imatchedwa Autolysis, yomwe, mu Latin, imatchedwa "kudzimbidwa." Tsopano mukudziwa, nthawi zambiri, pancreatitis yayikulu, chomwe ili. Kungokhala kuwukira kwa mankhwala, ndikusintha kwa chindende "pachokha" kukhala chovunda chovunda.

Njira yamachitidwe

Matenda
virus hepatitis 1:

aakulu
tizilombo toyambitsa matenda a chiwindi B,

aakulu
virus hepatitis D (delta),

aakulu
viral hepatitis yosadziwika (ndi
kachilombo osadziwika).

Autoimmune
hepatitis 2:

mtundu
1 (anti SMA, anti ANA positive),

mtundu
3 (anti SLA yabwino).

Cryptogenic
hepatitis (etiology yosadziwika).

Matendawa
kusakwanira L₁antitrypsin.

Poyamba
sclerosing cholangitis.

Poyamba
biliary cirrhosis.

Matenda
chidakwa cha hepatitis (kuyambira mutu
"Matendawa
chiwindi ”).

1
Kuphatikiza koyambira
cholangitis, matenda oyamba a biliary cirrhosis
chiwindi, matenda a Wilson-Konovalov
HG rubric ndi chifukwa chakuti awa
matenda ndi osachiritsika
morphological mayeso a biopsy zitsanzo
mwa odwala nthawi zambiri kuwulula
Zizindikiro zodziwika ndi autoimmune
kapena matenda a chiwindi a hepatitis.

Gawo
kachiromboka (komwe kasonyezedwa liti
aakulu matenda a chiwindi)

Kuyankha
(kuyambiranso ndi matenda a HCV)

FRGP ndi SFD -
zovuta zamankhwala
anakonza chifukwa cha motor-sensory
ndulu ya chikhodzodzo
maukonde ndi zomata zawo

Malinga ndi Mroma
2006 mgwirizano, m'malo mwa mawuwo
"Biliary treysctionction",
mawu oti "othandiza" amagwiritsidwa ntchito
vuto la gallbladder ndi sphincter
"Oddie."

E1 - yothandiza
vuto la ndulu

E2 - yothandiza
SFD biliary vuto,

E3 - zothandiza
matenda a kapamba

Ndi zamankhwala
Malingaliro amawoneka omasuka
gulu lotsatirali lothandiza
kuyang'aniridwa kwa biliary thirakiti:

- zothandiza
vuto la ndulu

- Yogwira
zovuta za sphincter za Oddi.

Pogwira ntchito
mkhalidwe:

- Hyperfunction

Ngati FGF ndi SFD
yodziwika ndi kutulutsa mawu
chikhodzodzo ndi zotupa ndiye
wotchedwa hyperkinetic
hypertonic (Hyperfunction). Mu
vuto lafiyira ndulu
ndipo ma sphincters am'mimba amadziwika
hypokinetic hypotonic
kukanika (hypofunction). Pakhoza kukhala
Mitundu yosakanizika ya FGF ndi SFD.

Ine.
Bacteria matenda. Chimodzi mwazofunikira kwambiri
etiological zifukwa aakulu
cholecystitis.

Matenda
kapamba ndimatenda a polyetiological.
Zoyambira zazikulu
awa ndi awa.

Nkhanza
mowa. Mowa
imakhala ndi poizoni
ma pancreatic acinar cell, amachititsa kuphipha
sphincter wa Oddi, kuchuluka kwawonjezera mkati
milomo ya gland, imathandizira koyamba
onjezerani ntchito ya exocrine, kenako
depletion of pancreatic reservation,) amachititsa kukula
pancreatic madzi chifukwa chamvula
mapuloteni m'mizere, komwe kumabweretsa
intraductal matenda oopsa, kuchuluka
kukwiya kwa bile, kumayambitsa kuponyera
imalowa mu ma pancreatic ducts ndi kutupa kwawo.

Matenda
bile ducts
makamaka cholelithiasis (63%
milandu). Pamaso pa matenda
kusinthika kwa thirakiti la biliary kumachitika
matenda amtundu wa biliary mu kapamba
m'mphepete mwa zamitsempha, kuvuta
kutuluka kwa pancreatic secretion ndi
Kukula kwa intraductal matenda oopsa
(ndi cholelithiasis), kuponyera
bile mu ndulu za kapamba.

Zosankha ziwiri ndizotheka
chitukuko cha matenda kapamba.

1. Zama
njira.

2. Zosachita
njira.

Atatu
njira. Mgwirizano
tryptic variant of chronic
kapamba ndi
zovuta mukutuluka kwa pancreatic
madzi ndi kuchuluka kukakamiza mu ma ducts
zotupa tchire la besali
nembanemba ya acini ndi kutsegula kwa proenzymes
m'miyala ya kapamba yotsatiridwa ndi kudzimbidwa
minofu ya gland. Zotsatira zake zimachepa
Unyinji wa acini ndipo utachepa pancreatic ntchito.

Mu 50-95% ya milandu
aakulu kapamba
kuwongolera ndi kuletsa.
Zambiri za mapuloteni othamanga komanso
kuwerengetsa mu ma pancreatic ducts a gland ndi
Zotsatira zakuchepa kwa mapuloteni
lithostatin amafunikira kuti azisamalira
calcium m'malo osungunuka.
Mawonekedwe a protein pripitates mu
ma pancreatic ducts amachititsa mowa,
Kusintha kwa kagayidwe kachakudya ndi kagayidwe.

Zosachita
njira. Mgwirizano
chosakhala monga
kuti motsogozedwa ndi ambiri
zinthu zaubongo zomwe zikukula
kuwonongeka kwa acini ndi kulowa kwawo
minofu yolumikizika.

Thandizani pa izi
Hypoacid zikhalidwe za m'mimba, uchidakwa
ndi matenda oyenda m'mimba
ndi duodenum 12. Kusowa kwa Secretin
kumabweretsa kutsika kwamadzi ndipo
zamchere mbali ya pancreatic madzi
ndi kuwonjezera mamasukidwe ake, kupota kwa sphincter
Oddi ndi kuchuluka kukakamiza kwa duct
Kapamba

Nthawi yomweyo, kutuluka kumakhala kovuta
pancreatic madzi ndikukula
kapamba edema wopita
kuwonongeka kwa acini ndi khungu lawo.
Kukwiya kwa acini kumayambitsa
kukhudzana mwachindunji ndi mowa
kagayidwe kachakudya matenda, hyperlipidemia,
kuperewera kwa zakudya m'thupi (mapuloteni
ndi Vitamini), kukhudzana ndi ma virus,
mankhwala.

Pang'onopang'ono
kuwonda kwa ntchito parenchyma
Pancreas imayambitsa kutsika kwake
michere, kenako insulin ndi chitukuko
kugaya chakudya ndi shuga
matenda ashuga.

Zoyambitsa Pancreatitis

Kukula kwa pancreatic matenda atha kudutsidwa ndi ma pathologies omwe amapezeka mu patsekeke la biliary thirakiti, pomwe amachititsa kuyambitsa kuphwanya kwazinthu zakale zotuluka za bile, monga cholecystitis, kapena cholelithiasis.

Zakudya zopanda pake, komanso cholowa cham'tsogolo, uchidakwa komanso kupanikizika kosalekeza, zilinso zokhazokha zomwe zimapangitsa kuti ziwonongeko za pancreatic ziwonongeke.

Kukula kwa matenda monga kungayambitse matenda a pancreatic:

• matenda a chimfine
• kutupa kwa zowonjezera
• gawo la patsogolo la gastritis,
• nsungu
• Mwachitsanzo, kuvulala kwam'mimba, mwachitsanzo, pakugwa kapena kugwera pamimba ndi mpira,
• kusalolera kwa mitundu ina ya zakudya, etc.

Chinsinsi cha matendawa ndikuti chifukwa cha njira zotsatizana, ma pancreatic ducts amatsekedwa pomwe ma enzyme omwe amaswa michere amatulutsidwa mu duodenum.

Sitingathe kufikira komwe akupita popanda cholepheretsa, michere yogaya yogaya yogaya pancreatic minofu. Ndondomeko iyi imatchedwa Autolysis, yomwe, mu Latin, imatchedwa "kudzimbidwa."

Tsopano mukudziwa, nthawi zambiri, pancreatitis yayikulu, chomwe ili. Kungokhala kuwukira kwa mankhwala, ndikusintha kwa chindende "pachokha" kukhala chovunda chovunda.

Microcirculatory
mtundu wamagazi wamtundu wa
thrombocytopenia ndi thrombocytopathy.
Supombocytopenic purpura
limodzi ndi mawonekedwe a khungu
zotupa ndi zotupa kuchokera
mucous nembanemba.

Khungu kutupa
akhoza kukhala ecchymoses kapena
petechial totupa. Khungu
kutikumbutsa "nyalugwe
khungu. "

Mu kafukufuku wa zasayansi
mapulateleti amachepetsa m'magazi.

Mukamawunika wodwalayo
ndi magazi a mtundu wa hematoma
chachikulu, kuya
wamantha komanso wopweteka kwambiri
zotupa mu mafupa akulu, minofu,
subcutaneous ndi retroperitoneal fiber, mu
nembanemba zamanjenje.

Zovulala
wambiri komanso wautali
magazi ndi hematuria amene
Khalidwe la matenda monga
akusowa hemophilia 8
chinthu (antihemophilic globulin),
matenda obadwa nawo
pumira.

At
odwala kukhala hemarthrosis,
ndiye kuphatikiza pamodzi
chachikulu - bondo, nsapato, mkono,
contractures ndi ankyloses.

1) tizilombo toyambitsa matenda
(mumps, hepatitis B, kachilombo
Koksaki B)

2) kusintha kwa mtima
Kapamba - atherosulinosis, thrombosis, vasculitis,

3) hyperlipoproteinemia
(chotupa cha magazi ndi magazi tinthu tambiri,
mafuta kapamba, etc.),

4) hyperparathyroidism
- kuchuluka kwa parathyroid mahomoni ndi hypercalcemia
tsitsani chinsinsi cha ma enzyme ndipo
imayendetsa trypsin ndi lipase mkati
ma ducts

5) kusamutsidwa
pachimake kapamba

6) majini
cholowa chamtsogolo
matenda (cystic fibrosis, hemochromatosis),

7) mankhwala
kukhudzika (cytostatics, tetracyclines,
sulfonamides).

Pancreatitis mwa akulu ndi vuto lodziwika bwino lomwe aliyense angathe kukumana nalo. Kusokonezeka komwe kumachitika chifukwa cha kutuluka kwa bile, komanso zakudya zopatsa thanzi (mwachitsanzo, kudya zamafuta ndi nyama yambiri chakudya, kupsinjika, cholowa cholowa, mowa, ndi zina zambiri) kumatha kuyambitsa chitukuko.

Zotsatira zake, iwo omwe amamwa mowa mopitirira muyeso ali pachiwopsezo chachikulu chotenga kapamba. Malinga ndi ziwerengero, nthawi zambiri zimakhazikika mwa amayi apakati komanso mwa amayi achichepere nthawi yobereka. Njira yolepheretsa kukula kwa kapamba ndi njira yoyenera yakhazikitsira zakudya.

Zotsatirazi zingayambitse kapamba:

• opaleshoni pamimba yothandiza kwambiri pamimba.
• m'mimba, kuvulala,
• parasitic infestation, matenda, makamaka tizilombo hepatitis,
• mumps (mumps),
• chibadwa.

Chiwerengero cha kapamba pazifukwa

• 40% ya odwala onse omwe ali ndi kutupa kwa pancreatic ndi zidakwa. Amakonda kuwonetsa mwina necrosis ya chiwalo, kapena mavuto ake owononga.
• 30% ya odwala ndi odwala omwe ali ndi mbiri ya cholelithiasis.
• 20% ya odwala ndi odwala onenepa kwambiri.
• 5% ya odwala ndi odwala omwe avulala kapena adwala thupi, akumamwa mankhwala.
• Osakwana 5% ya odwala ndi odwala omwe ali ndi cholowa chamtundu wa mapangidwe a kutupa, kapena akuvutika ndi zolakwika zakubadwa pakukonzekera ziwalo.

Ma gallstones ndi uchidakwa ndizomwe zimayambitsa pafupifupi 90% ya zipatala chifukwa cha pancreatitis yovuta. Malinga ndi malipoti ena, opitilira 40% mwa odwala onse amakhala zidakwa za kapamba kapena chamba chowononga.

5. Etiology ndi pathogenesis ya cholecystitis yosatha.

(Zowerengedwa
lolemba Shelley W. Dooley J., 1999)

1)
Virtual hepatitis B, V D, C.

3)
Matenda a metabolism:

glycogenosis
Mtundu wa IV

4)
Yaitali-intra- komanso yowonjezera
cholestasis.

5)
Kuphwanya kwa zamkati zotulutsa pachiwindi:

6)
Matenda Oyipa (autoimmune
hepatitis).

7)
Kusokoneza, poizoni
mankhwala.

Ana Indian matenda enaake.

9)
Cryptogenic cirrhosis (cirrhosis yonyansa
etiology).

Gulu
CP pa morphology

Mfundo zazing'ono
(micronodular) CPU - yocheperako
kusinthika magawo mpaka 0,3 cm (ofanana
makulidwe) ndi kutalika, kwazungulira septa.

Coarse
(macronodular) CPU
- masentimita oposa 0.3 masentimita, mkati mwamtunda waukulu
wamba wamba akhoza kupezeka,
septa osiyanasiyana osiyanasiyana.

Zosakanizidwa
(Micro-macronodular) CPU.

- hypofunction.

Zowonjezera

Masiku ano, mitundu 6 yayikulu yamatenda a pancreatic apezeka:

• Pachimake kapamba. Mofulumira kukulira kutupa. Ngati sanapatsidwe, chiwopsezo cha kusintha kosasintha m'thupi lathu ndi chachikulu.
• Kuyambiranso. Kuukira kwa pachimake kapamba kumabwerezedwa kwa miyezi 6.
• Kubwezerera kosatha kwa kapamba. Ili ndi zizindikiro zowopsa, koma mankhwala atatha, ziwalo za ziwalo sizinabwezeretse kwathunthu.
• Zopindulitsa. Ma calctures (madipoziti) amapezeka m'malo okumbika a chiwalo, ndipo milomo yake imakulitsidwa kapena kufupikitsidwa.
• Matenda osapweteka. Gawo lazopanda pancreas limataya ntchito chifukwa cha kuwonongeka kwa minofu, gawo la endocrine silikhudzidwa. Ducts zowoneka bwino zimafalikira, timadzi tambiri tambiri timadzipangira tiziwalo timene timatulutsa ma cell.
• Kuletsa. Mitundu yosiyanasiyana komanso yodziimira payokha ya mitundu yosalepheretsa. Imayendera limodzi ndi mawonekedwe amchere wamchere osakhala mu ma ducts a chiwalo, koma mu parenchyma.

Pancreatitis yovuta kwambiri komanso yokhazikika imasiyana ndi mawonekedwe a matenda akuti m'nthawi ziwiri zoyambirira, minofu ya kapamba imatha kubwezeretsedwanso, ndipo kumapeto kwake, mankhwala atatha, zovuta zowoneka zimagwira.

192. Zowawa ndi malo omwe ali ndi matenda a kapamba

Madera owopsa ndi mfundo. Ngati mujambula mizere iwiri yolumikizana kudzera mu navel - linea Mediana anterior ndi linea umbilicalis ndikugawa ngodya yakumanja yapamwamba ndi bisector, ndiye kuti ngodya yamkati yopangidwayi imatchedwa Shoffar zone kapena patatu (AEChauffard, dokotala waku France) kapena dera la kwacha lingasokonekera. kapamba. Dera loyimira kumanzere limatchedwa M. Hubergritsa-Skulsky zone, yomwe imapweteka panthawi ya machitidwe m'thupi la kapamba.

Desjardins point (A.Dejardins, dokotala wa opaleshoni waku France) ali pamtunda wa 6 cm kuchokera mchombo motsatira mzere wolumikiza navel kumanja kumanja. Zowawa mu magawo a mutu wa kapamba.

Point A. Hubergrits - malo oyanjana kumanzere 6 cm kuchokera ku navel motsatira chingwe cholumikizira kumanzere kwa axillary patsekeke.

Zowawa mu zotupa za caudal kapamba.

Ndi chikhalidwe cha chotupa cha England

Chikhalidwe chodabwitsa ndi gawo loyamba la njira yotupa. Zimatha pawokha kapena zimalowa mu pancreatic necrosis. Ma gallstones amatha kupangitsa kutupa, kutsekeka kutsekeka kwa ndulu.

Kuwonongeka kwa chotupa ndi pamene kufa kwathunthu kapena pang'ono kwamasisitidwe amisempha kumawonedwa. Dzina lina ndi pancreatic necrosis. Mitundu yake:

• yaying'ono yokhazikika - imakhudza zimakhala za gawo limodzi la chiwalo (mchira, thupi kapena mutu),
• sing'anga- ndi yayikulu-yozungulira - imasiyana ndi yaying'ono-yokhazikika pazofanana ndi kukula kwa zotupa zapakhosi,
• subtotal - minofu yambiri ya chiwalo imafa,
• okwanira - necrosis yathunthu ya zimakhala zonse za m'madipatimenti a kapamba.

Malinga ndi gawo la matendawa

Pachimake kapamba ali ndi magawo lotsatira:

• Enzymatic - woyamba 3-5 masiku. Pakadali pano, kufa kwa minofu kumachitika, endotoxemia (kumasulidwa kwa poizoni m'thupi) kumawonedwa.
• Kutakataka - kumayamba sabata yachiwiri yamatendawa. Kutupa kovunda kumakhala ndi khalidwe (ndiye kuti, popanda mphamvu ya ma virus) motsutsana ndi maziko a foci a necrosis. Kwambiri, izi zimasonyezedwa ndi parapancreatic kulowetsedwa (kudzikundikira kwa maselo achilendo akunja ndi magazi a m'mimba ndi magazi) komanso kutentha thupi kwa kutentha (kuchuluka kwa kutentha kwa 1-2 ° C chifukwa cha kuphatikizika kwa zopindika za minofu m'magazi).
• Sequestration - imachitika pakadwala milungu itatu ndipo imatha kukhala mpaka miyezi isanu ndi umodzi. Kuchulukana (madera a minofu yakufa pakati pa amoyo) kumayamba kuonekera patadutsa masiku 10 mpaka 14 kumayambiriro kwa matendawa. Pathology imakhala ndi mitundu iwiri: wosabala pancreatic necrosis ndi mapangidwe a cysts ndipo ali ndi purapy complication.

Gawo lazotsatira limanenedweratu miyezi isanu ndi umodzi kuchokera pachiwonetsero cha matendawa. Zotsatira zomwe zingachitike: kuchira kwathunthu kapena kosakwanira, kusintha kwamphamvu kwa ziwalo, kufa.

Gawo la maphunziro a kapamba:

• Asymptomatic. Pathology imadziwika mwangozi, molingana ndi zotsatira za mayeso a labotale magazi kapena mkodzo, komanso ndi ultrasound yam'mimba.
• Ndi mawonetseredwe azachipatala. Matenda a pancreatitis agawika m'magawo anayi, aliyense wa iwo ali ndi magawo ake, omwe amadziwika ndi kupweteka kwambiri, kupezeka kwa zovuta komanso kutalika kwa matenda.

1.
kwambiri (lakuthwa mwachangu) ngati PE
amakula mkati mwa masiku 7 kuyambira pachiyambi
jaundice

2.
pachimake ngati PE imakula mkati
Masiku 8-28 kuyambira pachilimwe,

3.
subacute ngati PE ikukula nthawi
kuyambira masabata 5 mpaka 12 mpaka 26 milungu itachitika
jaundice.

2)
Latent PE. Zizindikiro zamankhwala
kulibe koma kugwiritsa ntchito psychometric
kuyesedwa kumatha kuwona kuchepa kwa malingaliro
maluso ndi luso lamagalimoto ochenjera.

3)
Nthawi zonse (zomwe zimachitika) PE. Kuchuluka kwa
kuopsa kwa matenda opatsirana
zimasiyanasiyana kuyambira kufatsa (gawo I) mpaka kukomoka
(Gawo IV).

Mu
pachimake PE chomaliza
zoona (zakale,
hepatocellular) chikomokere.

Kupita patsogolo
aakulu PE odwala odwala matenda enaake
chiwindi chimayambitsa zakunja
(port-systemic, shunt) chikomokere.

kugonjera
(akupita patsogolo) GN,

(Ryabov
S.I., Serov V.V., 2000, Shulutko B.I., 2001,
Shumilkin V.R., 2004)

1.
Kupitilira GN:

a)
immunopositive (Ig A nephropathy -
Matenda a Berger, Ig G ndi Ig M nephropathy,
kuphatikiza ma depositi angapo),

mesangiocapillary
(membrane-proliferative I ndi III
mtundu)

nembanemba kuchuluka
Mtundu wa GN II (matenda owonda kwambiri),

2.
GN Yocheperako (GN yocheperako
kusintha, lipoid nephrosis).

3.
Membranous GN - I, II, III, magawo a IV.

4.
Focal segmental glomerulosulinosis.

5.
Sclerosing (fibroplastic) GN.

Pancreas point

»Z kapamba» Zovuta za kapamba

Palpation ya kapamba ndimachitidwe ovuta, chifukwa limba ili mkati mwa peritoneum. Ngati chiwalo chili bwino, ndi 1% yokha mwa amuna ndi 4% ya azimayi omwe amatha kumva. Koma ma psychology nthawi zambiri samadziulula mwanjira iliyonse, kupatuka komwe kumakhala muumoyo wathanzi kumakhala kosadziwika kwa nthawi yayitali.

Ntchito Kuyendera

Zikondazo nthawi zambiri zimangopezeka ndi kuphatikizika ndi kukulitsa. Pa palpation, malo, mawonekedwe ndi kukula kwa limba zimakhazikitsidwa. Ngati kupatuka kapena kuwonjezeka kwapezeka, ndiye kuti pali kusiyana pakati pa kusiyanasiyana komwe kumayambitsa ziwalo, kutupa ndi neoplasm.

Palpation nthawi zambiri imaphatikizidwa ndikuwunika kuti adziwe zowawa. Dera lomwe ladziwikalo liyenera kuzindikirika ndi kukula kwake, kuchuluka kwa kachulukidwe ndi kupweteka.

Kuyendera kumayamba ndikusonkhanitsa madandaulo. Ululu umatha kukhala wosiyana nthawi komanso chikhalidwe. Attacker omwe amachitika patatha maola atatu itatha chakudya amakhala ndi pancreatitis yowerengeka.

Makamaka ululu waukulu umawonedwa pachimake pancreatitis. Ngati amalimbikira kwa nthawi yayitali, ndiye kuti izi ndizotheka ndi zotupa.

Kufufuza kwapadera kumapangitsa kuti wodwala athe kutopa kwambiri, kupezeka kwa jaundice.

Ndi kapamba, pakhungu lotuwa ndi malo a cyanosis amawonedwa, omwe amakula motsutsana ndi maziko a kuledzera. Mitundu yayitali, kuchepa thupi, khungu lowuma komanso kuchepa kwa turgor kumawonedwa.

Njirayi imakupatsani mwayi kuti muwone kukhalapo kwa blimp tympanic kapena blunt. Izi nthawi zambiri zimawonedwa ndi cysts kapena zotupa.

Imachitika m'mizere ya topographic kuyambira msomali wokwera. Mwa anthu athanzi, kapamba samapezeka ndi chizungu.

Matenda a kapamba, njirayi imalola kuzindikira:

• tympanite
• kupweteka
• ascites
• Malo opanda phokoso pakatikati pa chitetezo.

Chifukwa chake, zotupa zazikulu kwambiri kapena ma cysts ndi omwe amatha kusuntha m'mimba ndi matumbo. Pankhaniyi, kumveka kofiyira kumamvekedwa pakatikati pamimba.

Kukhazikika kwa kapamba

Palpation ikuchitika mu supine udindo pambuyo oyeretsa matumbo ndi enema. Nthawi zina zotumphukira chapamimba zimayikidwa. Ngati chilichonse chili bwino ndi chiwalo, ndiye kuti khungu la epigastrium ndilopweteka, palibe kusamvana. Makulidwe a subcutaneous wosanjikiza wamafuta kumanzere ndi kumanja kuyenera kukhala womwewo.

Ndi palpation yapamwamba, chidwi chimakopeka ndi chidwi cha khungu.

Zowawa zimatha kukhala ndi pancreatitis pachimake kapena panthawi yowonjezera mawonekedwe osakhazikika. Kusokonezeka kumawonetsera kukula ndi kufalikira kwa kutupa. Koma kumayambiriro kwa matendawa, chizindikiro ichi chikhoza kukhala palibe.

Palpation malinga ndi Grotto imakhazikitsidwa ndi njira zopweteka. Kuti achite izi, wodwalayo wagona kumanja kwake, koma miyendo yake ndiyotupa. Dzanja lamanja lavulala. Palpation imadutsa mbali yamanzere yam'mimba kuchokera ku minofu ya rectus. Pa kudzoza, zala zikugwera kukhoma lakumbuyo.

Mfundo zazikuluzikulu zikufufuzidwa:

• Desjardins amaloza. Ndili pamsewu wapa mizere yolumikizana yomwe imalumikiza kulumikizana kumanja ndi navel. Ndi zowawa, titha kulankhula zowonongeka kumutu wa kapamba.
• Mayo-Robson mfundo. Ili pamunsi kuchokera pa navel kupita kumanzere wakumanzere. Kupweteka kwambiri pamtunda kukuwonetsa kutupa kwa mchira.
• Shoffar point. Amayankhulanso zamavuto amutu.Mupezeke kudzanja lamanja pakati pa m'mimba m'mphepete mwa gawo la umbilical.

Njira ya Grotto imagwiritsidwa ntchito nthawi zambiri. Njira yapamwamba imakuthandizani kuzindikira vutoli pokhapokha ngati pali zotupa, komanso khoma lam'mimba kwambiri. Pamenepa, gland imakhomedwa ngati chingwe chowoneka bwino chakumaso.

Ngati nkotheka kupeza chida chabwinobwino, ndiye kuti mukugubuduza chala chake kudzera pakubowoleza kosapweteka kotalika masentimita 1.5-2. Kapangidwe kayenera kukhala kosasunthika, kosagwedezeka, sikusintha mawonekedwe poyankha pazomwe mwatenga. Mwanjira iyi, imasiyana ndi ziwalo zapafupi.

Kuyendera kumayamba ndi minofu yathanzi. Mchira wa gland umakutidwa ndi dzanja lamanja. Amayikidwa pamphepete kwakunja kwa m'mimba (minofu ya rectus kumanzere). Chitani izi kuti zala zanu zili pamlingo wa chipilala chakumanzere.

Kuti zitheke, madokotala amagwiritsa ntchito njira ziwiri zamkati. Potere, dzanja lamanzere limayamba kumbali yakumanja pansi pamsana wa wodwalayo. Pakufufuza, adotolo amatulutsa khomo lakumbuyo kwa wodwalayo komwe mkono wamkati ukugwera.

Ngati pali kukulitsa kwa kapamba, kukakamira kwa m'mimba kumachitika. Pankhaniyi, ndi kutulutsa mpweya kwathunthu, kung'ung'udza kwa systolic kumveka.

Phonendoscope imagwiritsidwa ntchito pochita izi. Ndi mpweya uliwonse, umalowetsa m'mimba. Kuchita izi kumabweretsa kukokomeza kwa msempha ndikuwoneka ngati phokoso la stenotic.

palpation wa kapamba malinga ndi Obraztsov:

Palpation (palpation) ya kapamba monga njira yodziwira matenda

Kukhazikika kwa kapamba

Pancreatic palpation ndi njira yodziwira matenda omwe amakupatsani mwayi kuti mudziwe momwe muliri. Ndizachilendo kwambiri kumva kapamba mwa wodwala yemwe samadandaula ndi ntchito yake. Amuna 1% ndi 4% yokha mwa azimayi ndi omwe amatha kupezeka ndi chiwalo.

Mothandizidwa ndi palpation, matenda osiyanasiyana a kapamba amatha kupezeka. Kubera kumachitika ndi katswiri, chifukwa kuti muwone zopatuka, ndikofunikira kuti mukhale ndi chidziwitso chapadera. Kuphatikiza apo, chiwalo chomwe chikuwunikiracho chimakhala chakuya kwambiri pamimba ndipo ndizovuta kuchiphunzira.

Njira

Mu chifuwa chachikulu, kapamba amatha kupezeka mwa 50% ya odwala. Pa gawo loyambirira la matendawa, ziwalo zimachulukana kukula, komabe, mtsogolomo zimapeza zolemba, zomwe zimasokoneza mayeso.

Dera lomverera limawonedwa ngati gawo lolowera komanso gawo lalikulu la m'mimba. Adotolo amawapeza pasadakhale kuti asasokoneze iwo ndi chitsulo mtsogolo. Palpation imachitika m'mphepete mwa ziwalo zotchulidwa, mbali yolunjika ("imakokedwa" chala chachikulu chala chimodzi pamwamba pamimba yopindika.

Pamaso pa njirayi, wodwalayo amachenjezedwa kuti amachitidwa pamimba yopanda kanthu. Ndi kupumira kwakuya kwa nkhaniyi, katswiriyo amaika zala zopindika pakati pamimba ya pilo.

Ngati chilichonse chikugwirizana ndi ndulu, siimamva konse, kapena imayesedwa ngati gawo losasunthika mkati mwa silinda yokhala ndi mainchesi (pamenepa, ululu wammbuyo suwoneka).

Magawo Ofufuza

Ngati munthu ali wathanzi, ndiye kuti zikondamoyo, monga lamulo, sizowonekera. Milandu yapadera imawonedwa mwa anthu omwe ali ndi khoma lofooka pamimba, kuperewera kwa zakudya, okhala ndi ziwalo zopanda kanthu za m'mimba.

Madera achikopa:

1. Mutu. Kukhudza, ndimapangidwe ofewa, otanuka, osasanjika pafupifupi masentimita atatu ndipo ali ndi malo osalala popanda ma tubercles ndi mabump.
2. Thupi. Ndiwotalika masentimita 3-6 kuposa chingwe cholumikizira ndipo amakhala pamalo opingasa. Mukamafufuza, gawo ili limafotokozeredwa ngati silinda yofewa yomwe imasunthidwa, kuchokera pa 1 mpaka 3 cm, osasunthika, okhala ndi mawonekedwe osatulutsa. Ululu panthawi yamkamwa suwoneka.

Thupi la chithokomiro ndikosavuta kupeza ngati mungatengere kutalika kwa m'mimba (gland yomwe imagwira ntchito nthawi zambiri imakhala yotalika masentimita atatu kuposa gawo la kupindika kwakukulu pakati). Komabe, njirayi iyenera kugwiritsidwa ntchito mosamala, popeza kupindika kwakukulu kumasintha malo m'malo.

Mchira wa "England" umabisa "mu hypochondrium yamanzere, kotero ndizosatheka kuzitsimikizira. Kukhazikika kwa thupi ndi mutu wa kapamba kumachitika ndi thupi kutsamira kumanzere (munthu amene amapita kwa dotolo amatenga malo okhazikika). Izi zimakuthandizani kuti muchepetse minofu ya atolankhani ndikupeza ziwalo zomwe zikufufuzidwa.

Kapangidwe ka kapamba

Kukhazikika kwa kapamba malinga ndi Grotto ndi motere: wodwala amatenga malo oyimirira (agona kumanja kwake).

Kudzimbidwa kumachitika pambuyo poyambiranso matumbo a wodwalayo pokhazikitsa enema yotsuka.

Zala za dotolo, zikusunthira msana, zimadutsana pamtanda wa chiwalocho pakufufuzidwa ndi msana, chifukwa chomwe minofu ya rectus imasunthira kumsewu wapakati ndipo sizisokoneza mayeso.

Kuzindikira njira zotupa

Chikondamoyo ndi chiwalo chomwe chimbulu chake chimalolera kuzindikira momwe ziliri. Zizindikiro zopweteka zomwe zimapezeka nthawi yodabwitsayi nthawi zambiri zimasonyezera kutupa. Ngati kupweteka kukukhazikika mu gawo la Shoffar, izi zikuwonetsa kutukusira kwa mutu wa chiwalo, ngati atapangidwira m'chigawochi ndi kumanzere - mavuto ndi thupi la chithokomiro.

Zizindikiro za kapamba zimatha kupezeka palpation. Matendawa akuwonetsedwa ndi kusintha kwa kachulukidwe ka chiwalo: kamakhala koyenda kapena kosasintha kofanana ndi mtanda.

Matenda a ululu amayambukira kumbuyo ndipo amakula kwambiri pamene thupi lakhazikika kutsogolo (ndipo ngati munthu wagona kumanzere kwake, kusokonekera kumatsika).

Malo opweteka ndi malo omwe ali ndi chifuwa chachikulu

Dokotala yemwe amachititsa kuti zikondwerero zoyipazo ziziwoneka, monga lamulo, akuti kuchotsedwa kwa zotupa zam'mimba ndi machitidwe a "Voskresensky". Izi zikuchitika chifukwa cha kukula kwa ziwalo ndi edema ya fiberoperoperone. Kusokonezeka komwe kumabuka m'mimba mwa chifuwa cha chinthu chodwala pakhoma lakunja kumatchedwa chizindikiro cha Mape.

Kuzindikira za cysts ndi zotupa

Zikondamoyo zimakhazikika bwino ndi kuwonda kwa khoma lam'mimba, zomwe zimawonedwa mwa anthu omwe ali ndi vuto la kufooka kwa thupi, komanso mwa anthu ambiri achiwerewere omwe abereka ana.

M'magulu ena a anthu omwe amalandila zakudya zabwino, kuthekera kwa kulimba kwa chiwalo nthawi zambiri kumawonetsa kukula (izi ndizomwe zimachitika ndi kutupa), kukhalapo kwa pancreatitis kapena neoplasm.

Palpation pazikhalidwe zomwe zawonetsedwa pamwambapa, monga lamulo, limatsatiridwa ndi kuphipha, komwe limayang'ana ku msana kapena kumbuyo. Ngati pali chotupa cha kapamba, ndiye kuti tuberosity ndi kupangika kwa thewacho kapena mchira wa thupilo kumamveka.

Pamaso pa neoplasm, ziwalo zomwe zakhudzidwa zimachulukana, pakulimba kwake, ululu umamveka. Chotupa cha mchira kapena mutu ndichosavuta kuzindikira kuposa matenda amtundu wa England.

Ngati kupukusira kwa msempha kumafotokozedwa kuti ndi kwamphamvu kwambiri, izi zikusonyeza kuti pali chotupa mu gland.

Pamene palpation ikuwonetsa kupweteka kwambiri, kapena munthu akudwala matenda a Injili, ndikofunikira kuti muwunikenso ngati pali zopatuka pakugwira ntchito kwa ndulu.

Kuwonjezeka kwa kukula kwa chomaliziraku kukuwonetsa kutulutsa kolakwika kwa bile kuchokera ku chiwalo choyesedwa, chomwe chimapezeka nthawi zambiri pamene duct ya bile imapanikizidwa ndi neoplasm ya mutu wa gland komanso pazifukwa zina.

Kudziwitsa za dera lomwe lakhudzidwa

Mukadutsa malo owongolera omwe amayang'ana kukhoma lamkati lam'mimba limakupatsani mwayi kuti mupeze malo omwe ziphuphu zimakhudzidwira.

Chifukwa chake, ndikupatuka m'mutu wa chiwalo, kupweteka kwamankhwala kumakhazikika pa malo a Desjardins. Kuti mupeze, muyenera kuwona "kujambula" mzere kuchokera ku navel kupita ku axillary fossa ya dzanja lamanja (patali pafupifupi masentimita sikisi kuchokera ku navel malinga ndi mzere womwe uwonetsedwa, padzakhala malo a Desjardin).

Ngati palpation ya Mayo-Robson point of the gland ikuphatikizana ndi zowawa, izi zikuwonetsa kuwonongeka kwa mchira wa chiwalocho. Kuti mupeze malo omwe akuwonetsedwa, muyenera kulumikiza mkati mwa chipilala chamtengo kumanzere ndi navel. Mukagawa mzere m'magawo atatu, zitheka kupeza malo omwe mukufuna (adzagwera pamalire a gawo lapakati komanso lakunja).

Madokotala amaletsa kapamba kuti azindikire zosiyanasiyana za ziwalo kapena ziwalo zake, komabe, palpation si njira yokhayo yodziwira matenda. Kuti mumvetse bwino za matendawo, mayeso ena owonjezereka omwe adokotala amafunikira.

Madera a pancreatitis ndi mfundo zowawa: chizindikiro cha phrenicus

Mdziko lomwe mulibe nthawi yotsalira yopezera zakudya zoyenera komanso zopatsa thanzi, matenda a kapamba - kapamba, matenda a shuga ndi matenda ena okhudzana ndimadyedwe oyipa amapezeka nthawi zambiri.

Kutupa kwamkati kumawonekera chifukwa cha ululu wopanda pake, womwe sungathe kuchiritsidwa ndi opweteka, limodzi ndi kusanza mobwerezabwereza, chimbudzi, ndi kudzimbidwa.

Zikondazo zimalumikizana kwambiri ndi ziwalo zina zamkati. Ngati magwiridwe ake aphwanyidwa, izi zimakhudza ntchito yonse yamoyo yonse. Komabe, ndizosatheka kupanga matenda kuchipatala chimodzi; maphunziro a labotale ndi othandizira amafunikira.

Chifukwa chake, kodi zowawa mu kapamba zimatanthawuza chiyani? Ganizirani za Shoffar, Kach, Mayo-Robson ndi madotolo ena omwe atsimikiza ndi palpation.

Zikondamoyo ndi mawanga pa thupi

Zochizira kapamba, owerenga athu amagwiritsa ntchito bwino njira ya Irina Kravtsova.

Kuwoneka kwa madontho ofiira pamthupi la wodwala yemwe ali ndi chifuwa cham'mimba, gastroenterologists amaphatikizana ndi kufalikira kwamatenda. Monga lamulo, zotupa zotere zimawonekera, choyambirira, kumbuyo, m'mimba ndi chifuwa (nthawi zina, pakhosi ndi malekezero).

Madontho ofiira ndi kapamba amatchedwa chizindikiro cha Tuzhilin. Njira yoyamba yodziwira zomwe zimayambitsa kuwoneka kwa mfundo ndi kukakamiza.

Ngati, mukangodinira pang'ono pa imodzi mwazinthuzo, sizimatha, zomwe zikutanthauza kuti wodwalayo ali ndi kukokomeza njira zotupa m'mapapo.

Matendawa akamakula, ndiye kuti matendawo amawonekera mthupi la wodwalayo. Chizindikiro ichi sichikugwira ntchito kwa zizindikiro zopanda pancreatitis, popeza totupa imatha kuyang'aniridwa ndi matenda ena (mwachitsanzo, matenda amitsempha yama mtima.

Pofuna kudziwa momwe redness ilili, wodwalayo ayenera kulumikizana ndi dipatimenti ya gastroenterological, komwe katswiri wodziwa bwino, pogwiritsa ntchito njira zapadera zofufuzira komanso kuwunika, awone ngati mawonekedwe owoneka ngati madontho ofiira amagwirizanitsidwa ndi kuchulukitsa kwa matenda apakhungu.

Matenda a kapamba

Chimodzi mwazizindikiro za pancreatitis yomwe ikukula pang'onopang'ono ndi mawanga ofiira ozungulira, zazikulu zomwe zimawonedwa m'thupi la wodwalayo. Zotupa zoterezi sizimatuluka palpation ndi gastroenterologist wawo, chomwe ndi chimodzi mwazizindikiro zakuyamba kwa matenda ochulukitsa kwa chifuwa.

Mawonekedwe ofiira ndi kapamba ndi vuto losakhazikika, chifukwa chake, mawonekedwe awo enieni amatha kufotokozedwa pokhapokha ataganizira za ziwalo zamkati m'dipatimenti ya gastroenterological.

Zotupa zotere sizimayambitsa zovuta kwa wodwala, komabe, zimayambitsa kusokonezeka kwamaganizidwe, komwe ndi kosayenera kwambiri matenda a m'mimba.

Pazifukwa izi, dokotala wopezekapo amayenera kupereka chidwi chapadera kwa odwala omwe ali ndi mavuto omwewo.

Mizere imawonekera kumapeto kwenikweni kwa kapamba, komabe, milandu siyimachotsedwa pamene zotupa zimatha kudziwonetsa kumayambiriro kwa chitukuko cha matenda. Zambiri mwatsatanetsatane pamavuto oterewa zitha kuperekedwa ndi katswiri.

Zizindikiro za Cancer wa Cancreatic

Khansa yapakansa ndi yofala, chiwopsezo cha khansa chikuchulukirachuma m'maiko otukuka chifukwa cha zakudya zochulukirapo komanso zopanda thanzi. Zizindikiro za khansa ya pancreatic zimawonekera kumapeto kwenikweni kumapeto kwa matendawa, motero zimakhala zovuta kudziwa kuti ndi yani. Zizindikiro za khansa ya kapamba ndizofanana kwambiri ndi kapamba.

Zizindikiro za Cancer Pancreatic

1. Jaundice. Sclera ndi khungu zimakhala zachikasu. Kupweteka kwam'mimba m'mimba, komwe kumathanso kupita kumbuyo. 3. Kuchepetsa thupi, kulephera kudya, kufooka ndi kutopa.

4. Malo okumbika ochulukirapo oyandama pansi chifukwa cha mafuta osasamba

Zoyambitsa Khansa Yapancreatic

1. Zakudya zopanda pake, zophatikizidwa ndi mbale za nyama ndi mafuta 2. Kusuta. 30% ya milandu yonse ya zotupa zam'mimba zimaphatikizidwa ndi kusuta 3. Kusintha kwokhudzana ndi zaka zam'mapapo 4. Matenda a shuga - zotupa zimapezeka kwambiri kwa odwala omwe ali ndi matenda a shuga.

5. Matenda a kapamba

Zinthuzi zimasindikizidwa pazongophunzitsira chabe ndipo pazifukwa zina sizingaganizidwe m'malo mwa upangiri wa zamankhwala ndi katswiri kuchipatala.

Oyang'anira tsambali sakhala ndi vuto pazotsatira zogwiritsidwa ntchito zomwe zidatumizidwa.

Pamafunso okhudzana ndi matenda komanso chithandizo cha mankhwala, komanso kusankha mankhwala ndi kudziwa nthawi yomwe akudya, tikukulimbikitsani kuti mukaonana ndi dokotala.

Kumbukirani: kudzipereka nokha ndi owopsa!

Maphikidwe a anthu ku Narrecepti.ru

Zizindikiro zakukula kwa kapamba

Ndi kuchulukana kwa matenda kapamba, zizindikiro zomwezo zimawonedwa monga mtundu wa matenda.

Zizindikiro zazikuluzikulu za kuchuluka kwa kapamba:

• Ululu mu epigastric dera, wasiya hypochondrium. Nthawi zambiri, ululu umakhala wopanda mphamvu. Zowawa zopweteka zamatenda a pancreatitis ndizosowa kwenikweni. Amayamba mwadzidzidzi, nthawi zambiri kuwawa kumakupweteketsani mafuta, zonunkhira, zakudya wowawasa, zakumwa zoledzeretsa, zipatso ndi masamba. Ngati wodwala wayamba kupindika pancreatic necrosis, ululu wake umakhala wolimba komanso wopitilira. Kupanikizika kwambiri kwa kapamba, nthawi zambiri ululu umamvekedwa bwino.
• Vuto lakuchuluka kwam'mimba, kutsegula m'mimba, zovuta zina za dyspeptic. Kutsegula m'mimba kumakhala kofala kwambiri kwa odwala omwe amamwa mowa pancreatitis. Zolimbitsa thupi zimapangitsa kuchepetsa kwambiri thupi.
• Kuchepetsa khungu turgor. Khungu limakhala lothana, osacheperako, mavuto ake amachepa.
• Lilime limakutidwa ndi zokutira yoyera. Lilime limakhalanso louma;
• Kusanza, kusanza. Kusanza kumakhala kwamphamvu, kusanza pakokha sikubweretsa mpumulo kwa wodwala. Chichewa chimatha kupezeka m'masanzi.
• Kutentha kwamthupi kumakhalabe kwachilendo. Ndi purulent mawonekedwe a matenda kuchuluka. Nthawi zina, zitha kugwera pansi.
• "Ruby wagwa." Malo ang'onoang'ono ofiira amawonekera pakhungu pamimba ndi chifuwa. Nthawi yowonjezereka ikatha, kuchuluka kwa mfundo kumatsika kwambiri, kapena kuzimiririka.
• Chizindikiro cha Mayo-Robson. Mu kapamba, ululu umamveka pakhungu.
• Chizindikiro cha Kuuka kwa Akufa. Ndi edema ya pancreatic, kupweteka kwapakati kumatsimikiziridwa ndi palpation. Chotupa chikasowa, chisindikizo chimatsimikiza.
• Zizindikiro Chukhrienko. Amatanthauziridwa motere: pansi pa msomali, ikani dzanja (pamimba) ndikusunthira kwakuthwa kuchokera pansi mpaka pansi. Zotsatira zabwino, zowawa zimachitika.
• Zizindikiro za Grey-Turner. Malo amtundu wa cyanotic amawoneka pakhungu kumanzere, nthawi zina amakhala ndi chikasu chachikasu.
• Zizindikiro za Grunwald. Ecchymoses (zotupa pakhungu) pamphumi ndi kuzungulira msomali.
• Chizindikiro cha Grott. Kumanzere kwa navel, minofu ya subcutaneous atrophies.
• Zizindikiro Kacha. Kuchepetsa kwakukulu kwa minofu yam'mimba, yowoneka bwino pa palpation.
• Malo owala pakhungu. Woopsa mitundu ya kapamba ndi kuledzera kwakukulu, mawanga amatchulidwa kwambiri. Kuchepa kwa nkhope ndikothekanso, ndi kulocha pang'onopang'ono.
• Kukodzedwa mu m'mimba kapena m'mimba.
• Jaundice Imadziwonetsa yokha yoposa gawo limodzi mwa magawo atatu a matenda a kapamba. Nthawi zambiri, chomwe chimayambitsa jaundice ndi pancreatic edema, yomwe imafinya bile. Tizilomboto timakhala topepuka, mkodzo umakhala wakuda, khungu limayamba kutuluka chikasu.

Seputembara 2, - 20:50 Alexander Bondarev

Palibe ndemanga pano!

Mayo-Robson Point: Madera Achiphuphu

Matenda a kapamba amatha kuzindikiridwa ndi mfundo zowawa. Kuunikiridwa kumachitika ndi dokotala wodziwa bwino yemwe amatha kuzindikira njira zam'magazi m'thupi. Lero tikambirana za Mayo-Robson kuti ndi chiyani komanso kuti ndi matenda ati omwe angapezeke pambuyo pake.

Kapangidwe ka kapamba

Chiwalo chachikuluchi chili kumbuyo kwa pamimba pamimba. Ili ndi nthambi zitatu: