Pancreatic kuwonongeka ndi chiyani

Zomwe zimayambitsa matendawa

Monga matenda onse amamba kapamba, kapamba ka necosis kamayamba chifukwa cha zovuta m'mimba. Kwenikweni, matendawa amayambitsidwa ndi zinthu zingapo:

Zizindikiro ndi kuzindikira kwa pancreatic necrosis

Pancreatic necrosis diagnostic Zizindikiro zazikulu za matendawa ndizopweteka kwambiri kumanzere kwammimba, zikuwonekera kumunsi kumbuyo ndi kumanzere mkono, nseru, kusanza kwadzaoneni, kutentha thupi kuzizira, kutsekeka, kutsokomola. Ululu umapsa kwambiri mwachilengedwe, nthawi zambiri kuyambira kumbuyo ndi kumanja kwa m'mimba. Pa palpation ya khoma lakunja kwa peritoneum ndi epigastric, komanso hypochondrium yoyenera, chizindikiro cha ululu ndi chofatsa. Chizindikiro cha Grey-Turner ndi chodziwika bwino pamatendawa, pomwe mawonekedwe amtambo wapezeka kumbali ya khoma lamkati lakumbuyo. Ngati mawanga amtambo amapezeka kuzungulira msomali, ndiye kuti matendawa amatchedwa Grunwold, ndipo zilonda zikawoneka pamabowo komanso pansi pa nthiti kumbuyo, Davis matenda amapezeka.

Nthawi zambiri, wodwalayo amalowa kuchipatala kale ndi zizindikiro za toxemia, yomwe imayendetsedwa ndi khungu kutalika, kupuma movutikira, kufalikira, ndi tachycardia. Izi zimafunika kupenda mozama kuti mudziwe zoyenera. Ngati kutuluka kwa katulutsidwe kusokonekera, opareshoni imachitidwa. Nthawi zambiri pambuyo pa opaleshoni, wodwalayo amakhala ndi mbiri yochepetsetsa ya kuchuluka kwa ma enzymes. Detoxization imachitidwanso, cholinga chomwe ndikuchotsa ma cytoxin owonjezera.

Ndi chithandizo chosayembekezereka, zovuta zitha kuchitika mwa kuledzera kwa thupi, mapangidwe a cysts, nthawi zina, magazi amkati amatseguka. Ngati zotupa za mano zimachitika, wodwalayo amatuluka thukuta kwambiri, kuzizira komanso kutentha thupi.

Matendawa amatha kutsatiridwa ndi vuto laimpso, nthawi zina kupweteka kwaimpso kumayamba. Pancreatic necrosis imatha kuyambitsa kuphwanya kwamanjenje. Panthawi imeneyi, wodwalayo amakhala wopanda nkhawa, wakula kwambiri, wosachita bwino. Muzochita zachipatala, nthawi zina pamakhala matendawo, wodwala yemwe ali ndi mawonekedwe apamwamba.

Nthawi zina m'madzi omwe amakhala m'mimba, zimayipitsidwa ndi zinthu zina zamagazi zimapezeka. Pankhaniyi, wodwalayo amamuika dialysis pogwiritsa ntchito laparoscopy.

Chithandizo cha Pancreatonecrosis

Ndi matendawa, wodwalayo akulimbikitsidwa kupewa kwathunthu kudya masiku oyamba. Mothandizidwa ndi mankhwalawa, katulutsidwe ka madzi a m'mimba amachepetsedwa, ndipo m'mimba pakokha mumatsukidwa pogwiritsa ntchito kafukufuku. Masiku ano, wodwalayo amakhala ndi nkhawa chifukwa cha ululu waukulu, chifukwa chake simungathe kuchita popanda antispasmodics ndi painkiller. Kupatula matenda, maantibayotiki ndi omwe amapatsidwa mankhwala. Popewa abscesses, wodwalayo amapatsidwa antibacterial ndi immunomodulating mankhwala. Ndi kusagwira ntchito kwa mankhwala, wodwala akuwonetsedwa kuti alowererepo, omwe cholinga chake ndi kupulumutsa minyewa yovuta kupangika komanso kupanga chiwalo kuchokera mthupi lathanzi.

Opaleshoni ya pancreatic pancreatic necrosis Ndi chithandizo cha panthawi yake, matendawa amatha kuimitsidwa koyambirira. Ngakhale, monga lamulo, zotsatira zabwino za matendawa ndizosakwana 50% ya milandu yonse. Iwo omwe ali ndi mwayi wopeza zotsatira za matendawa amafunika kutsatira malamulo ena pakudya kwawo pamoyo wawo wonse. Chilichonse mafuta, okazinga, osuta, amchere, zonunkhira, zotsekemera zimangokhala chabe. Zoletsedwa nawonso mowa, chokoleti, mkaka, zakudya zamzitini, zipatso ndi ndiwo zamasamba, buledi watsopano, koloko, tiyi wamphamvu ndi khofi. Mutha kudya nyama yophika yophika, masamba otentha kapena owiritsa m'madzi, sopo wophika ndi msuzi wopepuka, chimanga pamadzi, zinthu zamkaka, mkate wowuma. Zakudya zonse zizikhala pamoto wotentha, wopanda mafuta, osasinthika.

Ndi matendawa, ndikofunikira kukumbukira kuti mankhwala omwe mumadzipatsa nokha akhoza kudwala wodwala, chifukwa chake, ndi mawonekedwe oyamba a pancreatic necrosis, muyenera kufunsa dokotala nthawi yomweyo.

Acute pancreatic necrosis (pancreatic necrosis)

Ndi njira yayikulu yotupa, kufa kwa wodwalayo kumachitikanso chifukwa cha kuthekera kwachulukidwe kamapangidwe ena a mahomoni ndi michere yokugaya. Pancreatic minofu, yomwe idawonongeka pazifukwa zingapo kapena kupitilira, ilibe mphamvu yoti ingadzisinthire payokha. Mavuto ambiri ndi kusowa kwa puloteni, matenda a shuga 2 ndi 3 digiri, kapamba wambiri.

Kodi ndi mitundu iti ya pancreatic necrosis yomwe ilipo?

Pancreatic necrosis ikhoza kugawidwa ndi mtundu wa njira, malo ake, chikhalidwe cha maphunzirowo ndi nthawi yake. Gawani:

• pachimake okonda kupweteka mtundu wa pancreatic necrosis,
• hemorrhagic pancreatic necrosis ndi mitundu yake yamafuta,
• mitundu yodziwika bwino
• Waulesi kapena wopita patsogolo,
• heestatic, ntchito komanso purulent zowononga mitundu ya pancreatic necrosis.

Pozindikira, ndikofunikira kudziwa molondola momwe ntchitoyi ikuyendera, kuchuluka kwa kuwonongeka kwa minyewa ya gland komanso kutalika kwa kusintha kwakusiyana. Kutengera izi, chisankho chimapangidwa pamtundu wa opaleshoni kapena mwamakhalidwe.

Chidziwitso chabwino kwambiri cha moyo ndi thanzi labwino ndi edematous pancreatic necrosis. Mu mawonekedwe awa, masinthidwe onse a pathological amakhumudwitsidwa ndi edema ya parenchyma komanso kuwonjezeka kwamlingo wopanikizika pancreatocytes. Izi zimaphatikizidwa ndi hyperemia, kusokonezeka kwa microcirculation, edstitial edema.

Poyerekeza ndi mtundu wamtunduwu, mtundu wina wa minofu ya necrosis ungayambike. Izi zimachitika pokhapokha ngati paliwofatsa mankhwala ochizira omwe amayambitsa matendawa. Edema imabweretsa kuti ma enzymes a gulu logaya chakudya amasiya kusiya momasuka patsekeke. Njira yogaya mkati mwa minofu yawo imayamba. Chithandizo cha Conservative ndizothekanso pano.

Magawo otsatirawa akuphatikizidwa ndi kukula kwa zovuta zomwe zimakhudzana makamaka ndikulowerera kwa purulent exudate kulowa m'malo a retroperitoneal. Zomwe zili za purulent zimalowa m'mimba. Pachimake peritonitis akuyamba. Pakadali pano, akuchitira opaleshoni mwadzidzidzi. Popanda opaleshoni, yokhala ndi pancreatic necrosis, wodwalayo amafa patangotha ​​maola ochepa kuchokera ku purulent sepsis.

Nthawi zambiri muzochita zamankhwala mumakhala mitundu yosiyanasiyana ya pancreatic necrosis.

Zimayambitsa pancreatic necrosis

Zomwe zikuluzikulu zimayambira pancreatic necrosis zimayenderana ndi zovuta m'mimba. Ndi mwayi waukulu, pancreatic necrosis imatha kuyambitsa zifukwa zotsatirazi:

1. kumwa zakumwa zoledzeretsa zamitundu yambiri,
2. kudya kwambiri mpaka kumatha kumva kupweteka kwambiri m'mimba,
3. kuphwanya ufulu wa kutuluka kwa enzymatic exudate kuchokera pancreatic patsekeke ndi cholangitis, kuwerengetsa cholecystitis, biliary dyskinesia.

Kuphatikiza apo, pancreatic necrosis imatha kuchitika chifukwa chogwiritsa ntchito molakwika mankhwala ena, omwenso amapezeka mkati mwa intravascular coagulation, matenda opatsirana pachimake, zochitika zovuta komanso zovuta zamaganizidwe.

Mulimonsemo, necrosis imayamba mogwirizana ndi microparticle ya chiwalo ichi. Selo limodzi limatchedwa acinus. Ndi kugonjetsedwa kwake, ntchito yokhazikika ya kapamba imasokonekera ndipo izi zimatsogolera pakupanga njira ina ya pathological.

Njira yofunika kwambiri yopangira matendawa. H yakhazikika pazinthu ziwiri izi:

• kuchuluka kwambiri
• kusowa kwa kutuluka kwa ma enzyme opangidwa mopitilira muyeso.

Zotsatira zake, michere yamphamvu yogaya chakudya monga phospholipase ndi trypsin, elastazin ndi chymotrypsin wothandizila amalowa m'matumba a kapamba. Onse omwe ali mkati mwachitukuko chawo ndi osagwira ntchito. Awo kutsegula ikuchitika mothandizidwa ndi trypsinogen ndi kallikrein mu bile ducts. Ma peptides am'mimba amapangika pamenepo, omwe amatha kuwononga minyewa iliyonse kukhala mamolekyulu, kuphatikizapo kapamba payekha.

Ngati kutuluka kwa ma enzymes kumayipa, amayamba pomwe amapezeka pancreatocytes ndikuyamba kwa kuwonongeka kwamkati (necrosis) kumayamba. Zotsatira zake, maselo a serotonin ndi mamina amatulutsidwa m'maselo ambiri, omwe amakulitsa edema ndi kuphipha kwamitsempha yamagazi. Kutulutsa kwa unyolo kumayambitsidwa, komwe kumatha kuyimitsidwa ndi kulowetsedwa kwa mankhwala apadera.

Zizindikiro za pancreatic necrosis ndi chithunzi cha matenda

Nthawi zambiri, pancreatic necrosis imakula mofulumira. Wodwalayo amayamba kusokonezeka mwadzidzidzi ndikumverera kolemetsa m'mimba ndi mseru, zomwe zimasandukanso kusanza mobwerezabwereza. Pali kupweteka kwambiri mu hypochondrium yamanzere. Nthawi zambiri ululu umakhala ngati lamba - pomwe theka lathunthu lakumzimba limapweteka pansi. Ndi chikhazikitso chaposachedwa cha pancreatic necrosis, Zizindikiro zake zimafanana ndi chizindikiro cha kugunda kwa mtima. Chizindikiro chodziwika bwino - kupweteka kumatha kuwonekera kumapewa ndi pansi pa phewa.

Kuti akwaniritse kufooka kwa vuto la ululu, wodwalayo amatha bwino pokhapokha atakhala miyendo ndi miyendo yokhotakhota pamiyendo yolokedwa mwamphamvu pamimba. Zonsezi zitha kutsatiridwa ndi:

• kuchuluka kwa kutentha kwa thupi mpaka manambala ocheperako,
• kusanza mobwerezabwereza, pambuyo pake wodwalayo sadzapuma,
• Kuchepetsa khungu kapena kutsika kwa msempha pakhungu latsoka.
• kuchuluka kwa pancreatic amylase pamayendedwe amwazi amkati ndi mkodzo,
• maonekedwe a khungu madera owonjezerapo kuchepa kwa chidwi (kupsinjika).

Poyerekeza ndi pancreatic necrosis, m'mimba phlegmon, ascites, imatha kukhala. Woopsa milandu, madzimadzi kulowetsedwa kumachitika mu pericardial zimagwira, zomwe zimapangitsa kwambiri ntchito ya mtima dongosolo. Ndi chitukuko cha zizindikiro za pancreatic necrosis, hemorrhagic umatheka mu pleural patsekiti amapangidwa.

Ndi kuwonongeka kwa tiziwalo tating'onoting'ono tating'ono tating'ono, magazi a m'magazi amawonjezeka kwambiri, omwe angayambitse kukula kwa hyperglycemic coma. Chizindikiro chodziwika bwino cha pancreatic necrosis ndikuwoneka kwa mawanga amtambo wakuda pazithunzi zamkati mwa khoma lamkati lamkati. Chizindikiro ichi chimatchedwa Gray-Turner. Ndi matenda a Grunwold's, ma cyanotic ndi crimson mawanga amatha kupezeka mozungulira umbilical patsekeke, ndipo ngati mabala akupangika pamtunda komanso pansi pa nthiti kumbuyo, ndiye kuti Davis syndrome imakhazikitsidwa.

Kuzindikira kumakhazikitsidwa pamaso pa kusanza mobwerezabwereza kwa bile kuyambira kumbuyo kwa ululu waukulu wa herpes zoster. Izi zitha kutsatana ndi kukhathamiritsa komanso kusilira. Nthawi yomweyo, palpation khoma lachiberekero lam'mimba m'chigawo cha epigastric ndi hypochondrium yoyenera sichimapereka mtundu wopweteka wamtunduwu, womwe wodwalayo amadandaula nawo. Ululu umakonda kupweteka kwambiri, wosapiririka. Odwala amatha kumva kutentha kuchokera kumbuyo ndi pang'ono kumanja kwa m'mimba.

Khalidwe la pancreatic

Kachilombo kakang'ono kwambiri ndiye kakang'ono kwambiri m'thupi la munthu. Imagwira ntchito ziwiri nthawi imodzi - imapanga michere yamagayidwe oyenera kugaya mapuloteni, mafuta ndi chakudya, komanso mahandiredi achinsinsi omwe amalimbikitsa kuthamanga kwa shuga ndikuwongolera shuga.

Madzi a pancreatic amapangidwa mkati mwa gland ndipo amatsanuliridwa mumkamwa waukulu mu duodenum, pomwe amatenga nawo gawo logaya chakudya. Ma enzyme amenewa amagwira ntchito kwambiri ndipo amatha kuthana ndi mafuta ndi mapuloteni amtundu uliwonse wa mbewu ndi nyama, komanso chakudya chovuta komanso chovuta kupanga.

Mphamvu zoterezi zimafotokozedwa ndi kuchuluka kwa ma enzymus omwe amasungidwa ndi maselo ake. Chifukwa chake, madokotala amati kapambayu amakhala ndi ziwalo zofunika, popanda zomwe zimachitika kuti thupi liyenera kugwira ntchito.

Kapangidwe kake ka madzi a kapamba:

1. Amylase - ndiyofunikira pa hydrolysis yama chakudya, makamaka wowuma ndi shuga glycogenado,
2. Lipase - imaphwanya mitundu yonse yamafuta, ma polyunsaturated ndi mafuta acid, komanso mavitamini osungunuka a mafuta A, D, E, K,
3. Pancreatic elastase ndiyo enzyme yokhayo yomwe ingathe kuwononga ulusi wa elastin ndi collagen mu minofu yolumikizana,
4. Nuclease - imaphatikizapo ma enzyme angapo (exonuclease, endonuclease, ribonuclease, deoxyribonuclease, restase, etc.) ofunikira ma hydrolysanucleic acids, kuphatikiza DNA ndi RNA,
5. Carboxypeptidase, trypsin ndi chymotrypsin - fafaniza mitundu yonse ya mapuloteni kuti amasule ma amino acid.

Kudzilekanitsa kwakanthawi kwa michere ya pancreatic kumathandizira kuti pakhale paliponse. Magulu a parasympathetic, chisoni komanso metasympathetic mu mawonekedwe a mitsempha ya vagus, mitsempha yayikulu yakumanja, celiac nerve plexus ndi gulu la intramural ganglia.

Ndi gawo limodzi la ziwonetsero zamagetsi, zomwe zimagwira ntchito popanda kuwunikira kuchokera kumadera apamwamba aubongo.

Izi zikutanthauza kuti mukamadya chakudya, mumakhala zotulutsa zokha za ma pancreatic enzi, popanda kuyesayesa kwa munthu.

Zizindikiro

Kuzindikira kwa pancreatic necrosis kuyenera kuchitika mwachangu, popeza ndi matendawa mphindi iliyonse ndi okwera mtengo. Kuphatikiza pa gastroenterologist, dokotalayo ndi othandizanso amatenga nawo mbali pakuwunika kwa wodwalayo, yemwe amawunika kukula kwa mkhalidwe wa wodwalayo ndikuchita zonse zofunika kuti apulumutse moyo wake.

Chofunika kwambiri paz njira zonse zodziwira matendawa ndikuwonetsetsa kuchuluka kwa michere ya kapamba m'magazi ndi mkodzo, makamaka, kuyesa kwa amylase. Ngati kuchuluka kwambiri kwa puloteni kumeneku kwapezeka m'magazi a munthu, izi zikuwonetsa mwachindunji chitukuko cha pancreatic necrosis.

Njira ina yofunika yodziwira ndi kuyesa magazi kwa maselo oyera a magazi ndi kuchuluka kwa maselo a erythrocyte. Ngati zizindikirozi zakwezedwa kwambiri, ndiye kuti izi zikuwonetsa njira yotupa yayikulu mthupi la wodwalayo.

Kuphatikiza apo, ngati pancreatic necrosis ikukayikira, wodwalayo amatumizidwa kuti akafufuze (ultrasound), yomwe imakupatsani mwayi kuti muwone ngati pali kufooka kwa mankhwalawa, ndikuwona mawonekedwe operewera komanso mawonekedwe osagwirizana a minofu necrosis.

Pogwiritsa ntchito computer tomography (CT) ndi imagonance imaging (MRI), mutha kupeza chithunzi chowoneka bwino cha matenda amtunduwu kuposa ndi ultrasound. Chifukwa chake, njira zamtunduwu ndizomwe zimagwiritsidwa ntchito kudziwa malo enieni a minofu necrosis, kuphatikiza zazing'ono, komanso kuzindikira kufalikira kwa matendawa kufupi ndi ziwalo ndi ziwalo zapafupi.

Angiography ndi njira yofufuzira yomwe imakuthandizani kuti mupeze kuphwanya magazi m'magawo am'mapapo omwe amakhudzidwa ndi necrosis, komanso kudziwa kusamutsidwa kwamitsempha yamagazi yofunika kwambiri, makamaka mitsempha ya hepatic ndi gastro-duodenal.

Choyambirira kuchita ndi pancreatic necrosis ndikupereka kapamba kupuma kwathunthu. Chifukwa cha izi, wodwalayo saloledwa kuchita masewera olimbitsa thupi, kudya chakudya chilichonse komanso chakumwa chilichonse. Kupatsa thanzi kwa wodwala kumachitika kokha.

Ndi matendawa, wodwalayo nthawi zambiri amatsuka m'mimba ndi madzi ozizira kuti athetseretu zinyalala zonse za chakudya. Izi zimakuthandizani kuti muimitse chimbudzi ndikuchepetsa kupanga kwa ma pancreatic enzymes.

Chimodzi mwazinthu zofunika kwambiri zochizira kupindika khunyu ndikuchotsa kupweteka kwambiri. Pachifukwa ichi, mitundu yosiyanasiyana ya mankhwala opweteka imagwiritsidwa ntchito, monga analgin, baralgin ndi amidopyrine, omwe amaperekedwa kwa wodwala ndi jekeseni wamkati.

Komanso, chifukwa cha mankhwala oletsa kupweteka, amasiya ma glucose-novocaine osakaniza muyezo wa malita 1-2 amagwiritsidwa ntchito. patsiku. Ndi ululu wolekerera, wodwalayo amapatsidwa novocaine blockade, yomwe imachotsa ululu wopweteka kwambiri komanso imakupatsani mwayi wambiri wa analgesic.

Kuchepetsa ululu womwe umachitika chifukwa cha kuphipha kwa chiwalo chomwe chakhudzidwa, antispasmodics, mwachitsanzo, papaverine, nopa, platifillin, amaperekedwa kwa munthu. Kuphatikiza apo, wodwalayo adalandira mankhwala othandizira okodzetsa, monga lasix ndi furosemide, omwe amathandizira kupumula kwathunthu kwa kapamba kapamba.

Chofunika kwambiri kuthandizira matenda oyambawa ndikugwiritsa ntchito maantibayotiki, omwe amalimbana bwino ndi kutupa ndikuwononga mabakiteriya a pyogenic omwe amalimbikitsa kuwonongeka kwa ziwalo. Komanso, wodwala yemwe ali ndi pancreatic necrosis amalimbikitsidwa kumwa ma antihistamines omwe amathandizanso minofu edema.

Chithandizo cha pancreatic necrosis nthawi zonse chimaphatikizapo opaleshoni, yomwe imachitika patsiku lachisanu, atagonekedwa m'chipatala. Munthawi imeneyi, madotolo amatha kuyimitsa njira yotupa, kupewa kufalikira kwa matendawa kumaselo athanzi ndikuchepetsa chiopsezo cha zovuta pambuyo pake.

Pa opaleshoni ya kapamba, wodwalayo amachotsedwa atafa, ziwalo zouma, kupatsidwa magazi, ndikubwezeretsanso kutuluka kwa michere ya kapamba. Woopsa matendawo, wodwalayo angafunikire kuchitapo kanthu maopaleshoni angapo.

Komanso, munthawi ya mankhwalawa pancreatic necrosis, njira zingapo zamankhwala zimachitika zomwe zimayenera kulimbikitsa m'mimba komanso kuteteza wodwalayo pakulephera kwa ziwalo zambiri. Njira zambiri zochizira kuchipatala zitha kutenga miyezi ingapo.

Katswiri mu kanema mu nkhaniyi adzalankhula za pancreatic necrosis.

Kapangidwe ka histanc kapamba

Zikondazo zimatulutsa madzi okwanira 1.5 malita a pancreatic patsiku. Kuphatikiza pa iye, zazikulu, zovuta, komanso zopatula ziwalo zina zamthupi zomwe zimatulutsa kuchuluka kwazobisika zimaphatikizapo mammary, lacrimal, salivary yayikulu.

Kutulutsa kwa gland kumachitika chifukwa cha ntchito yomwe imagwira: endocrine ndi m'mimba. Izi ndizotheka chifukwa cha m'mbiri ya kapangidwe ka kanyumba. Lili ndi:

• kuchokera ku lobules (acini), olekanitsidwa ndi septa minyewa yolumikizana, momwe zotengera, ulusi wamanjenje, zonyansa zazing'ono zazing'ono zimadutsa,
• zilumba za Langerhans zomwe zili pakati pa zipini. Zimapangidwa ponseponse mu minofu ya tinyezi tosiyanasiyana, koma zochuluka zimagwera mchira wa chiwalo.

Ziphuphu zokhala ndi ma ducts ena okhudzana ndi momwe timakhalira ndi maziko a kapamba. Lili ndi:

• ma pancreatocytes ochokera ku 8−12 maselo a mawonekedwe ofanana, okhala ndi mipando yake mpaka pakati,
• duct maselo a epithelial: akaphatikizana, amayamba kupangika.

• nsabwe za acini,
• zapakati
• chodabwitsa,
• kulumikizana
• wamba wirsung duct kapamba.

Kapangidwe ka mpanda wa ma ducts zimatengera kukula kwa duct yokha. Ku Wirsung, kudutsa kutalika konse kwa kutulutsa, pali maselo otchinga khoma omwe amatsekemera madzi a kapamba ndipo amatenga nawo mbali m'dera la endocrine.

Zisumbu za Langerhans zikuyimira kocheperako, koma kosafunikira kwenikweni.

Mbiri yaifupi ya chisumbucho: imakhala ndi mitundu isanu ikuluikulu ya maselo omwe amatulutsa mahomoni.Mtundu uliwonse wa khungu ndi voliyumu yosiyana ndi dera la islet ndipo limapanga mahomoni enaake:

• alpha (25%) - glucagon,
• beta (60%) - insulin,
• delta (10%) - somatostatin,
• PP (5%) - vasoactive matumbo polypeptide (VIP) ndi pancreatic polypeptide (PP),
• maselo a epsilon (ochepera 1%) - ghrelin.

Maselo a Beta ali pakatikati, ena onse amawazungulira mozungulira paripere.

Kuphatikiza pa mitundu ikuluikuluyi, maselo ac200let omwe ali ndi mitundu yosakanikirana ya endo- ndi exocrine amapezeka paliponse.

Magazi ochepa

Zikondamoyo sizikhala ndi zake zonyamula ziwalo. Njira yoperekera magazi imachokera ku aorta (gawo lake lam'mimba). Thunthu la celiac limabowolerana, ndikugawana ziwiya zomwe zimapereka magazi kwa kapamba. Amapanga maukonde onse a mitsempha yaying'ono yamagetsi ndi ma arterioles. Onse omwe akukhudzidwa ndi magazi:

• ziwiya zapamwamba zakunja ndi zam'mbuyo za kapamba,
• m'munsi pancreatoduodenal mtsempha wamagazi ndi nthambi zakunja ndi zapambuyo,
• mitsempha yam'munsi yapancreatic,
• dorsal pancreatic
• kugwedezeka kwamchira.

Iliyonse ya ziwiya zotere imayiyika m'mitsempha yaing'ono yaying'ono mpaka ma arterioles ang'ono kwambiri ndi ma capillaries omwe akukhudzidwa ndi magazi ku gawo lililonse la kapamba.

Mitsempha ya Lymphatic imachitika kudzera m'mitsempha ya m'mimba yomwe imayenda m'mitsempha yamagazi.

Kuphulika kwaphokoso

Kuchokera ku boles ndi ma islets, magazi a venous ophatikizidwa ndi kaboni diokosijeni amalowa kudzera pa intaneti yokhala ndi nthambi zambiri zamitsempha yama minyewa ndi mitsempha yolowera mu dongosolo la infa ya vena cava ndi mitsempha ya portal. Poyamba, magazi amadutsa:

• kudzera mesenteric (kumtunda ndi wotsika),
• Mitsempha ya splenic
• chapamimba
• portal

Magazi a venous atadutsa m'chiwindi kudzera mu vena cava wotsekemera amalowa mumtima, ndikumaliza magazi ambiri.

Matenda a pancreatic

Ndikosavuta kudziwa komwe kumayambitsa matenda am'magazi komanso kupezeka kwa kapamba. Psychology yotereyi siyodziyimira payekha, koma imayamba chifukwa cha matenda oopsa a mtima. Zikatero, zisonyezo za matenda oyambira zimadziwika.

Kuzindikira kumachitika chifukwa cha matenda omwe alipo omwe amayamba ndi kuchepa kwa magazi. Amayambitsa kusintha kwa parenchyma ndi kufa pang'onopang'ono kwa maselo othandizira pancreatic ndikusintha m'malo mwa minyewa yolumikizana - ma fibrosis amatulutsa, ziwalo zonse zimagwira. Kasitomala ndi chiwalo chomwe chimakhudzidwa ndi zinthu zazing'ono zakunja ndi zamkati. Kusintha kulikonse komwe magazi amapereka kapena zakudya zimayambitsa matenda akulu.

Zomwe zimayambitsa ndi zizindikiro za zovuta

Zosintha mu tiziwalo ta kapamba zimakhudzana ndimatenda am'mimba omwe amachitika:

• ndi atherosulinosis,
• ndi kulephera kwa mtima
• ndi ochepa matenda oopsa chifukwa cha atherosulinosis.

Choyambitsa chimatha kukhala pang'onopang'ono komanso kwa nthawi yayitali kukhala ndi matenda osokoneza bongo, kapena pancreatitis yovuta kwambiri yomwe imayamba mwadzidzidzi popanda chifukwa chodziwika bwino. Chochititsa chidwi ndi kuphwanya myocardial.

Pancreatic vascular thrombosis ndiyowopsa. Thrombosis imawonjezera matenda oopsa, thrombophlebitis, infarction ya myocardial. Kusokonezeka kwa magazi kumachitika ndi atherosclerosis, pamene makoma amitsempha yama calibers osiyanasiyana amasinthidwa.

Ndi kulephera kwa mtima komwe kulipo, kuphwanya kwa venous kutuluka kwa magazi kumachitika, komwe kumayambitsa pancreatic edema, kukula kwake kwakukulu, komanso kusagwira ntchito. Kutupa kumachitika mu parenchyma, yomwe imatsimikiziridwa ndi kuwonjezeka kopanda magazi ndi mkodzo diastases.

Choopsa kwambiri chomwe chimayambitsa kuphwanyidwa kwa magazi ndi mowa. Zimayambitsa kuchepera kwa ziwiya zazing'onoting'ono, chifukwa zomwe maselo amthupi amasiya kulandira michere ndi mpweya wabwino. Izi zimawatsogolera kuti afe ndipo amatha kuyambitsa necrosis kwathunthu.

Chithandizo cha matenda a mtima

Palibe chithandizo chamankhwala chovutitsidwa chamkati ndi kusintha kwa kapamba. Matenda oyambira amathandizidwa. Ndi njira yofikira patali, pamene kusintha kwamatenda kapena ma necrotic amayamba mu kapamba wa pancreas parenchyma, wotsimikiziridwa ndi maphunziro ogwira ntchito ndi a labotale, mankhwala ovuta a kapamba amalembedwa. Mulinso:

• chakudya chokakamizidwa - tebulo nambala 5,
• enzyme m'malo mankhwala
• ngati kuli kotheka - antispasmodics, painkillers ndi mankhwala omwe amaletsa kupanga hydrochloric acid.

Ngati chithandizo sichikuchitika, komanso ngati pali vuto lalikulu la matenda otaya magazi, matenda a shuga amayamba pakapita nthawi. Izi zimachitika chifukwa cha kufa kwa timabwaloli ta Langerhans komanso kuchepa kwa kapangidwe ka mahomoni akuluakulu - insulin.

Zotsatira za kuwonongeka kwa kosungidwa kwa kapamba

Pancreas parenchyma imakhala ndi netiweki yama nerept receptors. Zikondamoyo, monga ziwalo zonse, zimayendetsedwa ndi dongosolo lamanjenje lamanjenje - nthambi za vagus nerve (n. Vagus dexter). Amayang'anira ntchito ya exocrine - kupanga ndi kubisalira kwa michere. Zovuta zam'mimba zomwe zimachokera kumapeto kwake a mitsempha zimathandizira kupanga ma enzyme.

Amalumikizidwa ndi dipatimenti yachifundo kudzera pazingwe zazing'ono zomwe zimachokera ku ma plexuse:

• zamankhwala
• otupa
• celiac
• chapamwamba mesenteric.

Gawo lazachifundo lamanjenje limabweretsa zotsatirapo zotsatirazi: kuyamwa kwa thunthu la celiac kumapangitsa kutsekeka kwa katulutsidwe ka madzi a pancreatic. Koma kukhudzana kwanthawi yayitali ndi maselo a tsinde kumayendera limodzi ndi kuchuluka kwa michere.

Mitsempha yamagazi yomwe imapereka magazi ku zikondamoyo imalumikizidwa ndi ulusi womvera chisoni: imayendetsa kamvekedwe ka makoma a venous.

Ma labules, opangidwa ndi minyewa ya glandular yomwe imatulutsa katulutsidwe ka pancreatic ndi ma enzyme, amalekanitsidwa ndi magawo, omwe amayikidwa matupi odzitukumula a Fater-Pacini.

Zilumba za Langerhans, zomwe maselo ake amapanga mahomoni ofunikira 11, amakhala ndi mbali imodzi ndi acini ndi magulu a zigawenga za dongosolo la ziwopsezo zam'magazi.

Kuwonongeka kwa mitsempha pamlingo uliwonse kumabweretsa kukula kwa zovuta za hemodynamic ndi neurovegetative mu kapamba. Izi zimapangitsa kusintha kwakukulu osati mu zofunikira zokha, komanso mu ziwalo zolumikizana komanso zimagwira ntchito zina. Kuchiza pazinthu zotere kumakhala kovuta komanso kumakhala kwa nthawi yayitali.