Chovala chowopsa

Jaundice wovulaza ndi matenda opatsirana omwe amapanga kuphwanya kwa matuluka a hepatic bile kudzera mu ndulu ya ducts chifukwa cha kukonzedwa kwamakanidwe.

Kugwirizana kwa matendawa: jaundice wovuta, subhepatic jaundice, acholic jaundice, resorption jaundice, exthepatic cholestasis.

Makina kutsekeka kwa bile ducts amakula ngati vuto lalikulu la matenda a kapamba ndi biliary dongosolo (dongosolo la bile ducts ndi sphincters omwe amayendetsa bile kuyabwa, kupweteka kwam'mimba.

Zotsatira za jaundice wopita patsogolo zimatha kukhala chiwindi, kulephera kwa aimpso, purcin cholangitis, sepsis, cirrhosis ya biliary kapena cholangitis abscess ya chiwindi, makamaka mozunzika kwambiri komanso popanda chithandizo chamankhwala oyenera - imfa.

Mwa zina mwazomwe zimayambitsa zovuta za jaundice, matenda a gallstone (29% ya milandu) ndi zotupa zoyipa (67% ya milandu) zimasiyanitsidwa. Ali ndi zaka 30, matenda a ndulu amakhala ambiri, azaka 30-30, zotupa ndi matenda am'mimba chifukwa zomwe zimayambitsa jaundice ndizofanana. Odwala a zaka zopitilira 40, chotupa neoplasms ambiri.

Pafupifupi, jaundice yolepheretsa imapezeka kwambiri mwa azimayi (82%). Komabe, chotupa chotchinga cha bere yodwala chimakhala chofala kwambiri mwa amuna (54%).

Zoyambitsa zovuta za jaundice

Mpaka pano, zomwe zimayambitsa zovuta za jaundice chifukwa cha kuponderezana kwamtundu wa biliary taphunziridwa bwino.

Kutengera ndi ukadaulo, agawika m'magulu asanu:

Congenital malisation a biliary system: hypoplasia ndi atresia a biliary thirakiti,

Kusintha kwa Benign mu biliary system ndi kapamba chifukwa cha cholelithiasis: calculi (miyala) mu ducts ya bile, diverticulum (protrusion of the wall) ya duodenum ndi stenosis ya duodenal papilla (BDS) yomwe ili mkati mwa gawo lotsika la duodenum, rub aakulu insulin kapamba, sclerosing cholangitis,

Zigawo za main bile ducts chifukwa cha kulowererapo kwa maopareshoni (opangidwa chifukwa changozi kuwonongeka kwa ma ducts kapena suturing yosayenera),

Zotupa zoyambirira ndi sekondale (metastatic) zamatenda a pancreatic-hepatobiliary system: khansa ya chikhodzodzo, khansa yam'mimba yodwala komanso BDS, komanso kukhalapo kwa metastases yam'mimba yosiyanasiyana yokhudza kutulutsa chiwindi (khansa wamba yam'mimba, lymphogranulomatosis),

Zowonongeka kwa chiwindi ndi chithokomiro chokhala ndi majeremusi (alveococcosis, hydatid cyst, etc.).

Zomwe zimayambitsa zovuta za jaundice yovuta ndi chotupa neoplasms (chiwindi, biliary trail, mutu wapa pancreatic) ndi matenda a ndulu. Kubadwa kwatsopano kwa dongosolo la biliary ndi matenda a parasitic ndizochepa. Mukakalamba, kuwerengetsa (chifukwa cha ndulu) ndi zotupa kumayambika makamaka, ali ndi zaka zosakwana 40, chifukwa chake nthawi zambiri chimayambitsa cholelithiasis.

Zilonda zam'mimba za Duodenal ndi pachimake appendicitis (komwe kuli malo amphere m'dera lachiwindi) ndizosowa kwambiri kwa izi.

Cholestasis (kutsika kwa kayendedwe ka bile kulowa mu duodenum) kumachitika nthawi zambiri chifukwa cha kusuntha kwa calculi kupita mu ma ducts kuchokera gallbladder. Mapangidwe a calculi mu ma ducts okha amawonedwa kangapo. Nthawi zambiri amalowa mu gallbladder mu bile bile duct (wamba bile duct) pa nthawi ya chiwindi colour. Kutsekeka kumachitika pamene mwala wawukulu sungathe kudutsamo. Nthawi zina, chifukwa cha kupindika kwakutali kwa phokoso la ku Oddi (minofu yosalala yomwe ili mu BDS), ngakhale miyala ing'onoing'ono imangokhala kumapeto kwa gawo lalikulu la duct bile.

Kupezeka kwa miyala mu ducts kumapezeka pafupifupi 20% ya odwala omwe ali ndi matenda a ndulu. Jaundice yokhala ndi cholestasis chifukwa cha cholelithiasis mu 65% ya milandu ndiyosakhalitsa. Zizindikiro zake zimatsika atatha kuyika miyala m'matumbo. Pafupipafupi chitukuko cha stenosis (kupatulira) wa BDS ndi 25%.

Ma tumor a pancreatic-hepatobiliary zone amachititsa jaundice mu 37% ya milandu. Mu malo oyamba pafupipafupi pali khansa ya mutu wa kapamba ndi BDS, chachiwiri - zotupa za ndulu yayikulu ya ndulu ndi chikhodzodzo. Thupi la chiwindi ndi maudzu ake ndizosowa kwambiri.

Zizindikiro za jaundice yolepheretsa

Zizindikiro zodziwika bwino za matendawa ndi monga:

Zowawa m'gawo la epigastric komanso pansi pa nthiti kumanja, zomwe zimayamba pang'onopang'ono,

Mkodzo wakuda komanso wosungunuka, zotulutsa zomasuka,

Kutupa kwa khungu, mucous nembanemba ndi maso, maonekedwe a pakhungu pang'onopang'ono amatenga pang'onopang'ono,

Kuchepetsa chilakolako cha thupi, kuchepa thupi

Thupi

Nthawi zina, cholesterol yachikasu imayika ma eyelids momwe amawonetsera momveka bwino omwe amapezeka pamwamba pa khungu.

Ndi blockage mwa calculi ya bile ducts, ululu ndi spasmodic, lakuthwa, ukhoza kuperekedwa pachifuwa, kumanja kumanja ndi phewa lakumapewa. Zizindikiro zakunja za jaundice zimawonekera patatha masiku 1-2 atatha kufooka kwa hepatic colic. Kukhazikika kwa chiwindi ndizopweteka. Chikhodzodzo ndulu sichothandiza. Kukhazikika pamalowo pansi pa nthiti kumapangitsa kupuma kosakhudzika. Kusanza ndi kusanza ndizotheka.

Ndi zotupa za kapamba, BDS, njira yothandizira, kupweteka kumakhala kosavuta, komwe kumachitika m'chigawo cha epigastric, kumabwezeretsa. Pa palpation, chikhodzodzo chachitali chimapezekanso, kukanikiza komwe kulibe zopweteka. Chiwindi chimakulitsidwa, chimakhala ndi zotanuka kapena zowoneka, ndipo zoyipa zimakhala ndi mawonekedwe. Ndulu sizimveka. Zizindikiro zakunja za jaundice zimayambitsidwa ndi kuchepa kwa chikhumbo, kuyabwa khungu.

Kukulitsidwa kwa chiwindi ndi chizindikiro chodziwika bwino cha nthawi yayitali yodwala. Chiwindi chimakulitsidwa chifukwa chakuchuluka kwa bile ndi kutupa kwa biliary thirakiti.

Kuwonjezeka kwa ndulu ndi chizolowezi cha zotupa za BDS, mutu wa kapamba ndi gawo lofala la duct wamba la bile. Kuwonjezeka kwa chiwindi kumachitika mwa 75% ya odwala, kuwonjezeka kwa ndulu mu 65%, koma ndi laparoscopy imapezeka pafupifupi 100% ya odwala.

Khungu loyenda limakonda kuvutikira ngakhale mawonekedwe a jaundice asanafike, makamaka ndi chotupa. Ndi wolimba, wofooketsa, sangathenso kuchotsedwa ndi othandizira. Zikwangwani zimawoneka pakhungu, mawonekedwe ang'onoang'ono a hematomas. Kuchepetsa thupi nthawi zambiri kumawonedwa ndi jaundice chifukwa cha zotupa za khansa.

Kuwonjezeka kwa kutentha kumayenderana ndi matenda am'mimba, makamaka kawirikawiri, ndi kuwonongeka kwa chotupa. Kutalika kotalika kwa kutentha ndi chizindikiro chosiyanitsa chomwe chimasiyanitsa matenda am'mimba mwa hepatitis, momwe, munthawi yamatenda a jaundice, kutentha kumatsika pang'ono.

Dziwani zovuta za jaundice

Kudziwitsa koyambirira sikovuta pakakhala chotupa, chomwe chimagwiritsidwa ntchito mosavuta. Koma ndikuwonetsa koyamba kwa cholestasis, kupezeka kwa matendawa kumayambitsa zovuta zina, chifukwa madandaulo a wodwalayo komanso chizindikiro chazachipatala chitha kukhala zizindikiro za matenda ambiri. Njira zogwiritsira ntchito ma labotale sizigwiritsidwa ntchito kwenikweni pakuzindikira matenda oyamba a jaundice. Kuwonjezeka kwa cholesterol, bilirubin, alkaline phosphatase ntchito ndizodziwika zonse za intrahepatic cholestasis ndi hepatitis ya viral.

Chifukwa chake, gawo lofunikirali ndi la njira zosaka zofufuzira, momwe zotsatirazi zikugwiritsidwa ntchito:

Ma Ultrasound diagnostics. Imawulula kukula kwa ma ducts a bile, kupezeka kwa calculi mwa iwo ndi kuwonongeka kwa chiwindi. Ndi kutanthauzira kwa miyala mu ndulu, kuthekera kwa kupezeka kwawo ndi 90%, pomwe kutukusidwa mu gawo lofala la bile bile - 25-30%. Zolakwika zochepa zimaphatikizapo kuzindikiritsa chotupa cha ndulu monga kudzikundikira kwa calculi.

Mpumulo wa duodenography. Njira ndi x-ray ya duodenum mumikhalidwe yaopanga hypotension. Amagwiritsidwa ntchito pofufuza chizindikiro cha Frostberg (kusintha kwa mkati mwa gawo lakumalo kwa duodenum, chifukwa chomwe chithunzi chake chikufanana ndi chilembo "E") ndi duodenal diverticulum. Chizindikiro cha Frostberg ndi chizindikiro cha kupweteka kwa kapamba kapena khansa ya kapamba yokhala ndi metastases mu duodenum.

Endoscopic retrograde cholangiopancreatography (RCP). Amagwiritsidwa ntchito ngati zotsatira zosakwanira za ultrasound, pamene kutsekedwa kwa BDS kumayikiridwa. Ndi njirayi, wogwirizira wosemphana ndi jekeseni amatulutsira chimbudzi pogwiritsa ntchito cannula (chubu yapadera), kenako ma x-ray amatengedwa. RCHP imakupatsani mwayi kuti muzindikire zotupa zazing'ono, kusanthula kwa cytological ndi mbiri yakale ya epithelium ndi zomwe zili mu duct. Iyi ndi njira yophunzitsira kwambiri, koma popeza ndiyowonongekera, imatha kutsatiridwa ndi zovuta zazikulu.

Percutaneous transhepatic cholangiography. Amawonetsedwa pobowoleza kachulukidwe ka pachipata cha chiwindi. Pankhaniyi, pansi pa opaleshoni yakumaloko yomwe ikuyang'aniridwa ndi ultrasound, singano yopyapyala yokhala ndi sing'anga wina imayikidwa mu imodzi ya zotupa za chiwindi ndi khungu. Kuchuluka kwa zovuta za njirayi ndikokulira kuposa RCHP (kutulutsa magazi mkati, kutulutsa kwa bile, peritonitis).

Radioisotope isanthula chiwindi. Amagwiritsidwa ntchito pofufuza zotupa komanso zotupa za chiwindi (alveococcosis), zikavuta kupeza njira yodutsamo m'njira ina.

Laparoscopy Iyi ndi njira yolowerera kwambiri, ndipo imagwiritsidwa ntchito pamene njira zina sizinaphule kanthu pokhudzana ndi kuzindikira koyenera. Kugwiritsa ntchito laparoscopy ndikofunikira kuzindikira metastases, kudziwa kuchuluka kwa kuwonongeka kwa chiwindi mu alveococcosis, etc.

Mankhwala othandizira

Mulinso zakudya zomwe zimayang'ana masamba, zipatso, mkaka. Chakudya chizikhala chopindika, mbale - chophika ndi chosenda. Ndikulimbikitsidwa kumwa madzi ambiri momwe mungathere (timadziti, madzi).

Mothandizidwa ndi mtsempha wamagazi, mavitamini a B, Essentiale, methionine kapena lipocaine (kuti apangitse magazi kulowa m'chiwindi), Vikasol (kupewa magazi), Trental, glutamic acid amachitika. Ngati ndi kotheka, maantibayotiki, plasmapheresis (kuyeretsa magazi), enterosorption (detoxification process) ndi mankhwala.

Zoyambitsa zovuta za jaundice

Zomwe zimayambitsa zovuta za jaundice yovuta ndi kutsekeka (chotchinga) cham'mimba. Itha kukhala yochepa kapena yathunthu, yomwe imatsimikiza kuuma kwa matenda akuwonekera kwa matendawa.

Jaundice wowopsa akhoza kukhala chifukwa cha matenda otsatirawa:

• cholecystitis
• cholangitis
• ma cysts a biliary thirakiti
• matenda a ndulu
• matalala kapena zipsera za ma ducts a bile,
• chiwindi, matenda a chiwindi,
• kapamba
• zotupa za chiwindi, duodenum, m'mimba, kapamba,
• majeremusi
• Mirizzy syndrome
• malo okhala ndi chipata cha chiwindi,
• opaleshoni njira pa biliary thirakiti.

Makina a pathological a development of jaundice ovuta ndi ovuta. Nthawi zambiri zimadalira kutupa komwe kumakhudza ma ducts a bile. Potengera maziko a kutupa, kutupa ndi kukula kwa mucous nembanemba zamkati zimachitika, zomwe zimatsogolera kuchepa kwa lumen yawo. Nokha, njirayi imaphwanya gawo la bile. Ngati pakadali pano ngakhale kachulukidwe kakang'ono kakalowa mu mzerewo, kutuluka kwa ndulu kudzera pamenepo kungathe kutheratu. Zowonjezera ndi kusuntha mu ndulu za bile, bile limawonjezera kukulira, kuwononga hepatocytes, ndi bilirubin ndi bile acid zomwe zimalowa mu kayendedwe kazinthu. Bilirubin, yemwe amalowetsa magazi kuchokera mumitsempha ya bile, samapangidwa ndi mapuloteni - izi zikufotokozera kawopsedwe wake wama cell ndi minofu ya thupi.

Wodwalayo akulimbikitsidwa kumwa pafupifupi malita awiri amadzimadzi patsiku, izi zimapangitsa kuti bilirubin ichotsedwe mwachangu, potero amachepetsa zotsatira zake zoipa pakhungu lamanjenje, impso, mapapu.

Kutha kwa kuchepa kwa ma asidi am'mimba kulowa m'matumbo kumasokoneza mayamwidwe amafuta ndi mavitamini osungunuka a mafuta (K, D, A, E). Zotsatira zake, njira yophatikizira magazi imasokonekera, hypoprothrombinemia imayamba.

Kutalika kwa nthawi yayitali kwa bile mu dragi ya intrahepatic kumapangitsa kuti chiwopsezo chachikulu cha hepatocytes, pang'onopang'ono chikupangitse kuti chiwindi chilephereke.

Zomwe zimawonjezera chiopsezo chokhala ndi zovuta zowononga mimbulu ndi:

• kuwonda mwadzidzidzi, kapena, kunenepa kwambiri,
• matenda a chiwindi ndi kapamba,
• kuchitapo kanthu kwa maopail
• kuvulala kwam'mimba kwamatumbo anayi pamimba.

Chithandizo cha kupewa jaundice

Njira yayikulu yothanirana ndi jaundice yovuta ndikuchita opaleshoni, cholinga chake ndikobwezeretsa kutulutsa kwa bile mu duodenum. Pofuna kukhazikika pamatenda a wodwalayo, kuchepa kwa thupi, kulowetsedwa ndi antibacterial. Njira zotsatirazi zimagwiritsidwa ntchito kukonza kwakanthawi kwa bile:

• choledochostomy - mapangidwe amadzina pogwiritsa ntchito fistula yakunja kumtsempha wa bile,
• cholecystostomy - kapangidwe ka fistula yakunja kwa ndulu,
• puncutaneous gallbladder punication
• kukoka kwa nasobiliary (kulowetsedwa kwa catheter mu njira ya biliary panthawi yobwezeretsanso cholangiopancreatography).

Ngati, ngakhale atachitidwa chithandizo cha jaundice yodwalitsa, wodwalayo sasintha, kulumikizidwa kwam'kati mwa ndulu ya bile kumasonyezedwa.

Pambuyo kukhazikika kwa mkhalidwe wa wodwalayo, funso lotsatira lotsatira la chithandizo cha jaundice yovuta limathetsedwa. Njira za Endoscopy zimasankhidwa chifukwa ndizovuta. Panthawi ya zotupa ndi ma cicatricial stenosis, ma biliary treo bougienage amachitidwa, kenako ndikuikapo zitsulo mu lumen, i.e., endoscopic bile duct stenting imachitika. Mukamaletsa sphincter ndi mwala, Oddi amayamba kuchepa kwa balloon endoscopic.

Ngati njira za endoscopic zalephera kuchotsa cholepheretsa kutuluka kwa ndulu, pitani kuchipatala. Popewa kutulutsa kwa bile kulowa m'mimba kudzera m'matumba mu nthawi yovutikira, kutulutsira kunja kwa ndulu ya bile chifukwa maluso a Halstead (kukhazikitsa chimbudzi cha polyvinyl chloride mu chitsa cha cystic duct) kapena ngalande yakunja ya ndulu za bile kumachitika.

Ngati wodwala salandira chithandizo chamankhwala, ndiye kuti pambuyo pa kufa kwa hepatocytes, chiwindi chimagwira, ndipo chiwindi chimayamba.

Zakudya za jaundice zopewera

Mankhwala ovuta a jaundice ovuta, chithandizo chamankhwala sichofunikira kwenikweni.Panthawi yogwira ntchito, chakudyacho chikuyenera kupereka kuchepa kwamphamvu pama cell a chiwindi, ndipo atatha kuchitapo kanthu opaleshoni, iyenera kuyambitsa kuchira kwamphamvu kwa thupi.

Wodwalayo akulimbikitsidwa kumwa pafupifupi malita awiri amadzimadzi patsiku, izi zimapangitsa kuti bilirubin ichotsedwe mwachangu, potero amachepetsa zotsatira zake zoipa pakhungu lamanjenje, impso, mapapu.

Mndandanda wa odwala omwe ali mu nthawi ya preoperative ayenera kuphatikizapo zakumwa zoziziritsa kukhosi (shuga yankho, compote, tiyi wopanda mphamvu). Izi zimakuthandizani kuti mukwaniritse zosowa zamphamvu za thupi ndipo nthawi yomweyo sizimayambitsa kuchuluka kwa chiwindi, zimathandizira kukonza njira za metabolic.

Pambuyo pakuchita opaleshoni ndikuthandizira mkhalidwe wa wodwalayo, chakudyacho chimakulitsidwa pang'onopang'ono, pang'onopang'ono zimayambitsa zipatso zamkati, mapira amkaka, soups zamasamba muzakudya. Zakudya ziyenera kumwedwa mwaukhondo, komanso kutentha. Ndi kulolera bwino kwazakudya, nsomba kapena nyama (zotenthedwa kapena zophika) zimaphatikizidwa muzakudya.

Mafuta m'zakudya ndizochepa. Ndi kulolerana kwabwino, wodwalayo amatha kupatsidwa mafuta ochepa kwambiri ndi mafuta a masamba. Mafuta achinyama amatsutsana.

Wodwala atakhazikika pang'onopang'ono, mikate yoyera kapena mkaka wopanda mkaka ndi mafuta a mkaka ochepa amaloledwa kuphatikizidwa muzakudya.

Kupewa

Kupewera kwa jaundice yovuta kumakhala ndi izi:

• kudziwika kwakanthawi ndi chithandizo cha matenda a ndulu, matenda osachiritsika a dongosolo la hepatobiliary,
• zakudya zoyenera (kuletsa kukazinga, mafuta ndi mafuta ambiri m'zakudya, kutsatira zakudya)
• kukana kumwa mowa kwambiri,
• moyo wokangalika
• makonda a thupi.

Zizindikiro zina zotupa za jaundice ndizosowa kwamkodzo, kusungunuka kwa ndowe, kuyabwa kwa khungu.

Zovuta zotheka

Ndi kuyamba kwakanthawi kachipatala, matendawa ndi abwino. Amayamba kuwonongeka chifukwa cha kuponderezedwa kwa chotupa cha bile. Wodwala akapanda kulandira chithandizo chamankhwala chanthawi yake, pamakhala zovuta zina:

• matenda a chiwindi
• bilirubin encephalopathy,
• sepsis
• pachimake (ndi kufalikira kwathunthu kwa dambo la bile) kapena kuperewera (kosaletseka) chiwindi kulephera.

Ichi ndi chiyani

Zizindikiro zimawoneka mwa anthu omwe ali ndi vuto lotuluka kwa bile.

Jaundice wowopsa ndi matenda a chiwindi. Ndi iyo, kutuluka kwa ndulu kumasokonezeka, khungu ndi mucous nembanemba zimasanduka chikaso. Izi ndichifukwa choti ma pigment a bile amalowa m'magazi. Matendawa amakhala ndi chotupa nthawi zambiri.

Zilonda zopweteka nthawi zambiri zimapezeka mwa odwala nthawi zambiri kuposa chosaopsa. Nthawi zina, jaundiceyu ndi wopanda chotupa mwachilengedwe.

Chithunzi cha matenda nthawi zambiri chimayamba pang'onopang'ono. Matendawa amayambika kawirikawiri, nthawi zambiri amakhala osokoneza bongo chifukwa cha kutupa kwa biliary thirakiti.

Zomwe zimachitika

Zomwe zimayambitsa kwambiri ndi zotupa zoyipa ndi matenda a gallstone. Tumor neoplasms nthawi zambiri amapezeka odwala omwe ali ndi zaka zopitilira 40. Nthawi zambiri zovutitsa zamankhwala zimachitika mwa akazi.

Nthawi yomweyo, chotupa chotupa cha njira yothandizira imadziwika kwambiri kwa abambo.

Zomwe zimachitika zimatha kugawidwa m'magulu:

• Kusintha kofananira kwa dongosolo la biliary ndi kapamba zomwe zachitika chifukwa cha matenda a ndulu, mwachitsanzo, pamaso pamiyala m'miyala ya bile,
• kubadwa kwatsopano kwa biliary dongosolo,
• zotupa za pancreatic-hepatobiliary system, mwachitsanzo, khansa ya gallbladder,
• kuwonongeka kwa chiwindi ndi njira yothandizira yokhala ndi majeremusi,
• mawonekedwe a bile duct pambuyo pa opaleshoni,
• zilonda zam'mimba ndi zam'mimba,
• kuchepa kwa kayendedwe ka bile mu duodenum - cholestasis.

Zizindikiro

• matumba otupa, mkodzo wakuda,
• nseru, kusanza kosowa,
• kupweteka m'dera la epigastric komanso pansi pa nthiti kumanja,
• Khungu
• kusintha kwa khungu pakhungu, mucous nembanemba wamaso,
• kukulitsa chiwindi
• Kuchepetsa thupi komanso kusowa chakudya,
• malungo.

Patatha masiku awiri pambuyo pa colic ya hepatic, zizindikiro zakunja za jaundice zimayamba. Kusanza ndi kusanza kumatha kuonekanso. Ululu wofowoka umalowetsedwa kudera la epigastric ndipo umatulukira kumbuyo ngati zotupa za kapamba ndi mapindikidwe a bile. Chizindikiro chodziwika bwino cha jaundice wotalikilapo ndi chiwindi chokulitsidwa chifukwa cha kutupa kwa biliary thirakiti ndi kusefukira kwake kwa chotupa cha bile.

Chithunzicho chikuwonetsa dongosolo lapaubwino. Panthawi yolephera pantchito yake, makina oyatsira amatha kuwoneka.

Kuyabwa kwambiri pakhungu nthawi zambiri kumayamba kuvutitsa wodwalayo asanaonekere kunja kwa matenda a jaundice, omwe amatchulidwa makamaka ndi chotupa cha matenda. Sizothandiza kuti achotsere othandizira achire. Zotsatira zake, zisa ndi mikwingwirima zimawonekera pakhungu. Ndi jaundice yoyambitsidwa ndi zotupa za khansa, kuchepa kwambiri kwa thupi kumawonedwa. Matenda am'mimba amtundu kapena kuwola kumayambitsa malungo.

Njira Zodziwitsira

Pamaso pa chotupa chomwe chikuyenda chomwe sichingatheke mosavuta, ndikosavuta kudziwa. Kuzindikira kumayambitsa zovuta zina ndi mawonekedwe a cholestasis oyamba. Zodandaula za odwala komanso zizindikiro zapachipatala zambiri zimatha kuwonetsa matenda ena ambiri. Pakadali pano, njira zopangira ma labotale sizipereka zotsatira zomwe mukufuna.

Njira zikuluzikulu ndizofufuza zothandiza:

• duodenography kapena x-ray ya duodenum,
• ma diagnostics a ultrasound amatha kuwona kuwonongeka kwa chiwindi, kukula kwa ma ducts a bile ndi kupezeka kwa calculi mwa iwo,
• percutaneous transhepatic cholangiography amachitika ndi blockade wa biliary thirakiti. Koma njirayi imakhala ndi zovuta zambiri, mwachitsanzo, kutayikira kwa ndulu, peritonitis kapena magazi amkati,
• endoscopic retrograde cholangiopancreatography imagwiritsidwa ntchito pakuwunikira kwa BDS. Njira yodziwikirayi imakuthandizani kuti mupeze zotupa zazing'ono ndikuwunika zomwe zili mumtsempha wa bile ndi epithelium, koma zingayambitse zovuta zazikulu,
• Njira yolowerera kwambiri ndi laparoscopy. Amagwiritsidwa ntchito posakhala zotsatira kuchokera ku njira zina zofufuzira. Ndikofunikira kudziwa kuchuluka kwa kuwonongeka kwa chiwindi mu alveococcosis ndikuwona metastases,
• radioisotope kusanthula kwa chiwindi ikuchitika ndi parasitic zotupa a chiwindi ndi matenda a zotupa.

Jaundice wowopsa amathandizidwa m'magawo awiri. Pachigawo choyamba, njira zosiyanasiyana zowononga zachilengedwe zimagwiritsidwa ntchito kuti athetse kusayenda kwa bile, ndiye kuti cholestasis. Conservative tiba tikulimbikitsidwanso.

Chithandizo chowonongera chimaphatikizapo vitamini ndi mankhwala othandizira kusintha chiwindi: Cirepar, Essentiale, Cocarboxylase. Kuphatikiza apo, adotolo atha kutumiza Prednisolone, chothandizira cha kagayidwe ka Pentoxyl ndi ma amino acid mu mawonekedwe a methionine. Wodwalayo adapangidwira glucose wamitsempha, Glutamic acid, Vikasol, mavitamini B, Trental. Maantibiotic, detoxification ndi kuyeretsa magazi - plasmapheresis imagwiritsidwa ntchito ngati pakufunika.

Mankhwala othandizira

Njira zopangira opaleshoni mwachindunji zimayikidwa pokhapokha pakuchitika zoyenera za njira zowukira zochepa. Mulinso:

• lithoextraction
• kukhetsa ngalande
• percutaneous cholangiostomy ndi ngalande zakunja kapena zamkati,
• ngalaroscopic ngalande,
• opaleshoni yowonjezera pamitsempha ya biliary ndi kupatsidwa kwa bilio-matumbo anastomoses,
• laparotomy ndi kuchotsa ndulu.

Mu gawo lachiwiri Kwambiri kulowetsedwa mankhwala ndi okakamiza diuresis adzagwiritsiridwa ntchito mankhwala. Komanso, wodwalayo amaperekedwa kudzera mu mtsempha wa magazi kukapanda kuleka, magazi m'malo, shuga njira ndi insulin, njira zamchere.

Katswiri yekha ndi amene angadziwe komanso kupereka mankhwala. Onetsetsani kuti mwayesa mayeso onse ofunikira kuti dokotala amvetsetse bwino zaumoyo wanu.

Kuchiza ndi wowerengeka azitsamba

Ngati jaundice wa pakhungu kapena sclera, muyenera kulumikizana ndi katswiri woyenera. Kugwiritsa ntchito mankhwala achikhalidwe kuphatikiza ndi mankhwala amchikhalidwe kumapangitsa kuti pakhale kuchira msanga. Zomera zochiritsa zimathandizira kulimbitsa chitetezo cha mthupi komanso kubwezeretsa mphamvu.

Koma chithandizo cha zitsamba chizingoyenera kulandira chithandizo chamankhwala, ndipo chithandizo chamankhwala chovomerezeka chovomerezeka chovomerezeka ndi adokotala.

Chithandizo cha mankhwala achiwewe:

• msuzi wosafa
• decoction wa peppermint, maluwa osafa, ulonda wa masamba atatu, zipatso za korona,
• makungu oyamwa,
• tincture wa tsamba loyera pa vinyo yoyera,
• horseradish muzu kulowetsedwa, koma sayenera kumwa mankhwala a odwala gastritis, enterocolitis ndi nephritis,
• msuzi wa sauerkraut,
• kulowetsedwa kwa masamba otentha,
• kulowetsedwa kwa zopindika hop,
• kulowetsedwa kwa chisokonezo chimanga.

Masamba, zipatso, mkaka zizipezeka muzakudya. Chakudya chizikhala chopindika. Ndikofunika kuwira kapena kupukuta mbale. Ndikofunikira kumwa madzi ambiri momwe mungathere.

Zomwe ndimatenda ndi matenda omwe amayambitsa jaundice

Kuti mumvetsetse machitidwe a chitukuko cha jaundice, ndikofunikira kukhazikitsa kudalira kwa mitundu yayikulu yamikhalidwe iyi.

Suprahepatic jaundice ndi zomwe zimachitika chifukwa cha kuwola komanso kuwonongeka kwa maselo ofiira am'magazi. Zimawonjezera kuwonjezeka kwa zomwe zili bilirubin m'magazi, ndi "kugwiritsidwa ntchito" komwe chiwindi sichitha kuwongolera kwathunthu.

Tcherani khutu: bilirubin ili ndi mitundu iwiri yayikulu. Choyamba ndi kumasuka (zosakhudzika, zopanda pake, zosakhudzana) ndi poizoni yemwe amalumikizidwa ndi mapuloteni amwazi ndipo amayenda momasuka m'magazi. Chachiwiri - osati mfulu (mwachindunji, sungunuka, wophatikizidwa), wopangidwa mwa kumanga m'maselo a chiwindi amtundu woyamba ndi glucuronic acid. Mankhwala osavulaza alibe kachakudya ndipo amatulutsira m'matumbo ngati gawo la bile.

Ndi mtundu wapamwamba wa jaundice, kukula kwa bilirubin kwathunthu ndikuwonjezereka kwa bilirubin yaulere, popeza ma cell a chiwindi sangathe kuthana ndi zomangika zake. Poizoniyu amabweretsa poizoni m'thupi.

Mtundu waukulu wamatenda oyambitsa suprahepatic jaundice ndi hemolytic anemia (ndi kuwonongeka kwa maselo amwazi): achibale hemolytic jaundice, thalassemia, odwala matenda am'mimba, etc.

Malungo amatsogolera ku hemolysis, njira zina za autoimmune.

Hepatic jaundice amayamba chifukwa cha kuwonongeka (kusintha) kwama cell a chiwindi (hepatocytes), intrahepatic bile capillaries. Njira yowonongera hepatocytes imayendera limodzi ndi kuchuluka kwa bilirubin yonse m'magazi, motsutsana ndi kumbuyo kwa kuwonjezereka kwa bilirubin yaulere.

Kukula kwa hepatic jaundice kumachitika chifukwa:

• kachilombo matenda a chiwindi (mitundu pachimake ndi matenda),
• chiwindi matenda osiyanasiyana,
• kusintha kwa chiwindi pakulimbana ndi poyizoni wa zakumwa zoledzeretsa, zotupa zina zamankhwala
• matenda mononucleosis,
• Matenda a Gilbert
• leptospirosis,
• khansa (hepatocellular) ya chiwindi,
• matenda a autoimmune omwe amawononga chiwindi.

Subhepatic jaundice amakumana ndi kuphwanya kutuluka kwa ndulu kuchokera ku intra- ndi exthepatic bile ducts. Kuphwanya kumeneku kumakwiyitsa makina osokoneza bongo panjira ya secretion ya bile (blockage ,riers).

Kutuluka kwakhanda kwa bile kungaletsedwenso ndi:

• gallstones (calculi)
• mawonekedwe a cystic
• kapamba (kutupa kwa kapamba),
• zotupa za kapamba, chiwindi, ndulu, 12 - duodenum,
• kuchuluka kwa majeremusi,
• lymphogranulomatosis,
• mavuto pambuyo opaleshoni pa chiwindi, bile ducts, kapamba,
• machitidwe a atrophic munjira yamabatire,
• kuphipha ndi kupindika (stenosis) kwa sphincter ya Oddi (minyewa yozungulira yomwe imayang'anira kutulutsa kwa bile kuchokera wamba bile duct - choledoch kulowa m'matumbo).

Jaundice wowopsa amapereka kusintha kwa mapangidwe ake amwazi a magazi. Mlingo wa Bilirubin umakwera makamaka chifukwa chachigawo cholunjika. Fomu yosadziwika imatha kukhala yopanda malire, kapena kuwonjezeka pang'ono. Bilirubin amapezekanso mkodzo.

Kuzindikira matenda omwe amatsogolera jaundice

Odwala, akamafuna kudziwa chifukwa cha jaundice, amayezetsa, komwe kumayambira ndikufunsidwa ndi dokotala.

Zowonjezera:

• kuyesa kwa magazi kwamankhwala am'magazi (makamaka, maphunziro a milingo ya bilirubin). Nthawi zambiri, bilirubin yathunthu ya malire apamwamba sapitilira 20 μmol / L, yosalunjika - 17 μmol / L, ndipo mwachindunji - osati apamwamba kuposa 2.5 μmol / L,
• fibrogastroduodenoscopy (FGDS),
• Ultrasound wa chiwindi, ndowe, chikhodzodzo, kapamba,
• Kuunika kwa chiwindi ndi ma ducts a bile,
• MRI
• mayeso a immunological kuti athe kudziwa kukhalapo komanso kuchuluka kwa ma immunoglobulins okhala ndi matenda a chiwindi.

Zolemba za matendawa

Mkhalidwe womwe umawerengedwa, wotchedwanso resorption (acholytic, obstriers, subhepatic) jaundice, kapena extrahepatic cholestasis, umayamba chifukwa cha kuwoneka ngati kutsekeka kwamakina komwe kumalepheretsa kuyenda kwaulere kwa bile ku lumen kwa duodenum. Nthawi yomweyo, zomwe zili bilirubin, penti yofiirira yofiirira yomwe imapangika pakuphwanya maselo ofiira am'magazi ndikutulutsa m'matumbo ndi secretion ya biliary, imakwera m'madzi a m'magazi. Hyperbilirubinemia imayamba, ikupereka mawonetsero akunja kwa icteric.

Zizindikiro za jaundice mwa akulu zimawonetsa kuopsa kwa matendawa. Ndipo kwa ana ambiri obadwa kumene, izi ndizomwe zimachitika mwazomwe zimachitika mu 60% ya milandu. Ndiotetezeka ku thupi ndipo sikutanthauza kulowererapo kuchipatala. Jekeseni wowononga makanda amakhala osowa ndipo amayamba chifukwa cha kubereka kwakubadwa. Pano, chithandizo choyang'aniridwa ndikofunikira, kuchitapo kanthu kwa opaleshoni kungafunike.

Mankhwala othandizira

Zimatengera matenda oyamba omwe adabweretsa chodwala. Kutengera izi zitha kuchitika:

Kutulutsa kwakunja kwa bile ducts - kubwezeretsa kutulutsa kwa ndulu panthawi ya kufalikira kwa dongosolo la biliary. Iyi ndi njira yolowerera yomwe ingagwiritsidwe ntchito monga momwe wakonzera.

Endoscopic cholecystectomy - kuchotsedwa kwa ndulu pogwiritsa ntchito mabowo a endoscopic khoma lam'mimba.

Endoscopic papillosphincterotomy - kuchotsedwa kwa miyala kuchokera ndulu.

Choledocholithotomy - imachitika limodzi ndikuchotsa ndulu ndipo imakhala ndikuchotsa miyala ku duct wamba ya bile, yomwe khomo lake lakutsogolo limatsegulidwa.

Gawo hepatectomy - kuchotsedwa kwa malo a chiwindi minofu omwe amakhudzidwa ndi njira yothandizira.

Maphunziro: Dipuloma mu "General Medicine" yapadera idapezeka ku Russian State Medical University. N.I. Pirogova (2005). Maphunziro omaliza maphunziro mu "Gastroenterology" yapadera - maphunziro apamwamba komanso sayansi.

Choonadi chonse pamafuta pamimba - mfundo 8!

Zakudya zisanu, kudya kwake komwe kumatsimikiziridwa ndi sayansi yamakono

Jaundice ndi mndandanda wazizindikiro zomwe zimawoneka ngati madontho a pakhungu, sclera ndi mucous membrane chikasu, chomwe chimalumikizidwa ndi kuchuluka kwambiri kwa bilirubin m'thupi. Nthawi zambiri, chinthuchi chimamasulidwa pakuphulika kwa maselo ofiira am'magazi omwe amapezeka mu ndulu.

Jaundice amawonekera chikasu cha pakhungu, mucous nembanemba chifukwa cha kufalikira kwa ndulu zamkati ndi chiwindi. Jaundice imachitika pamene kutuluka kwa bile mu duodenum kumachedwa, ndipo kumalowa m'magazi. Kupatula njira zachikhalidwe.

Mavuto owononga a viral chiwindi - matenda a Botkin. Pakadali pano, matendawa amadziwika kuti ndi hepatitis A. Zizindikiro zazikuluzikulu za matendawa: kufooka, kutentha thupi, kuzizira, kutulutsa thukuta, khungu ndi mawonekedwe a mucous, mkodzo wa mtundu wa mowa wakuda, ndowe zopanda khungu.

Chimodzi mwazinthu zofunikira kwambiri za chiwindi ndikumanga kwa bilirubin ya magazi ndi kusaloledwa kwake. Mwakutero, zimakhala za thupi, makamaka ubongo, zimatetezedwa ku zovuta zake. Kuchita kwa chiwindi kumeneku kungayesedwe chifukwa cha kuyezetsa magazi a biochemical kuti adziwe kuchuluka kwa bilirubin, ndipo ngati kuli kotheka, gawo lililonse la magawo ake.

Zizindikiro za Jaundice

Chimodzi mwa matendawa ndi kusintha kwa khungu pakhungu, chifukwa cha zomwe matendawa amayamba kudziwonetsa. Oyera amaso ndi ma mucous nkhope nawonso amatembenukira chikasu. Ndi cholestasis wautali, khungu limakhala lachikasu. Utoto wamtunduwu umaperekedwa ndi pigment bilirubin, yomwe yambiri ya jaundice imadziunjikira mkati mwa ndulu, kuchokera komwe imalowanso m'magazi, ndikuphatikizira ku albumin.

Pali zizindikiro zina za matendawa:

• kupweteka kwa epigastrium ndi / kapena hypochondrium yamanja, yomwe imatha kuwonjezeka pakapita nthawi,
• mkodzo wakuda
• choipitsa chimbudzi, chosiyanitsa ndowe,
• kusanza, kusanza ndikotheka,
• kutaya mtima, komwe kumayambitsa matenda a anorexia,
• malungo, kuzizira,
• kufooka, kutopa,
• kuyabwa kosasunthika, zomwe zimapangitsa kuti pakhale kukwapula komanso kulalira pang'ono,
• kukulitsa chiwindi mu kukula kwake.

Ma Xanthelasms nthawi zina amapezeka pazowoneka - ma chikasu achikasu, omwe ndi ma cholesterol amana. Kupanga kwawo kumalumikizidwa ndi kuphwanya kwa cholesterol excretion, chochuluka chomwe chimasamutsidwa ndi bile.

Mtundu wa ululuwo ukhoza kukhala wosiyana. Chifukwa chake, ndikusunthika kwa bile chifukwa cha mawonekedwe a ndulu, kupweteka kowoneka bwino kumatha kuwunikira mbali yamanja kulowa sternum, axillary ndi scapular dera. Ululu umachitika pakadutsa chiwindi. Ndi zotupa zotupa za ma pancreato-hepatobiliary, ululu umachepa. Amakhala okhazikika pansi pa dzenje, koma nthawi zambiri amapereka kumbuyo. Kukhazikika kwa malo a chiwindi sikupweteka.

Kukhazikika komwe kumawoneka sikungathetsedwe ndi machitidwe ochita kupanga kapena mwa njira zapadera. Khungu limayamba kuyatsidwa ngakhale isanayambe kuoneka yellowness. Kuyabwa ndi chizindikiro cha kuwonda kwambiri ndi zotupa. Ngati kulakalaka kwazimiririka nthawi yayitali lisanachitike kuwonetsa zizindikiro zina, uwu ndi umboni kuti chotupacho chikhoza kukhala chopweteka.

Mu jaundice, kuchuluka kwa chiwindi kumalumikizidwa ndi kufalikira kwa chikhodzodzo ndi bile ndipo zotsatira zake cholecystitis / cholangitis. Ndi mawonekedwe a neoplasms, ndulu imamva bwino komanso imapweteka ikapanikizidwa.

Kukhalapo kwa malungo nthawi zambiri kumawonetsa chitukuko cha matenda. Kutentha nthawi yayitali ndi chizindikiro cha jaundice wolepheretsa. Amadziwikanso pa matenda osiyanasiyana kupatula hepatitis, momwe kutentha kumatsikira patatha masiku angapo.

Mayendedwe a matenda a jaundice mwa akulu

Kusankha kwa chithandizo chamankhwala kumadalira matenda oyambitsidwa ndi nthendayi, komanso kuopsa kwa mkhalidwe wa wodwalayo. Pankhaniyi, kufunikira kwa chithandizo chamankhwala (mu madipatimenti achire kapena opaleshoni) kapena kuthekera kwa chithandizo chanthawi yotsimikiza kwatsimikizika.

Odwala amapatsidwa:

• Chithandizo chowongolera - Amawerengera mitundu yamatenda am'matumbo, limodzi ndi kuledzera kwambiri. Kutalika kwa nthawi ndi kuchuluka kwa kulowetsedwa kumasankhidwa payekhapayekha, kutengera momwe wodwalayo alili ndi kuwunika kwawotchiyo (makamaka matenda opatsirana a chiwindi, pachimake komanso poyizoni waukali, kuwonongeka kwa chiwindi cha mankhwala, zovuta za chipatala.
• Mankhwala othandizira - akuwonetsa milandu ya matenda opatsirana ndi bakiteriya obwera chifukwa cha jaundice. Onetsetsani kuti mwapanga kutsimikiza mtima kwa kuzindikira kwa tinthu tating'onoting'ono tokhala tinthu tanthete. Kuthana ndi regimens ya chithandizo, Mlingo wambiri komanso concomitant antifungal therapy ndikofunikira kwambiri.
• Mu matenda omwe amatsogolera jaundice kumbuyo kwa kuwonongeka kwa hepatocyte, zotsatira zabwino zimaperekedwa hepatoprotectors kuteteza ndi kubwezeretsa minofu ya chiwindi.
• Anemia nthawi zambiri amafunikira hematotherapy (magazi achilengedwe ndi kukonzekera kwake, komanso kuthira kwa madzi am'magazi komanso m'malo mwake magazi).
• The oncologist amasankha njira zamankhwala othandizira njira ya neoplasm (chithandizo cha opaleshoni, chemotherapy, radiotherapy).
• Mankhwala othandizira - akuwonetsa pamaso pa miyala ikuluikulu mu chikhodzodzo, ndulu. Opaleshoni yapulasitiki imachitidwa chifukwa chotsutsana ndi njira yothandizira batiary patatha zovuta pambuyo poyambira opaleshoni yapitayo. Nthawi zina kumuika chiwindi ntchito.
• Immunotherapy.
• Woopsa milandu - mankhwala mankhwala a mahomoni.

Mavuto a matenda omwe amapatsa odwala jaundice

Kuwonetsedwa kwa jaundice kwenikweni kumatha kuchitika chifukwa cha zovuta zamatenda. Zotsatira zomwe zitha kuchitika motsutsana ndi maziko a jaundice omwe alipo zitha kukhala zosiyana.

Nthawi zambiri, ma pathologies omwe amapezeka ndi jaundice nthawi zambiri amatsogolera ku:

• kuchepa magazi
• kuvutika kwa njira yayikulu,
• Kukhazikitsa njira zoyipa ndi zoyipa,
• pachimake ndi matenda osatha a chiwindi,
• kugwedezeka, kumbuyo kwa ululu,
• hepatic encephalopathy,
• kumwalira movutikira kwambiri.

Zakudya za jaundice ndi kupewa maonekedwe ake

M'm zipatala, odwala omwe ali ndi matenda omwe amawonetsa ma icteric amalandila zakudya zopatsa thanzi No. 5 malinga ndi Pevzner.

Chakudyacho chimaphatikizapo:

• kuchuluka kwa zakumwa - zakumwa zakumwa zakumwa ndi zipatso kuchokera ku ndale ndi zipatso zotsekemera, mchere wamadzi wopanda mpweya, zakumwa zotsekemera,
• mbewu zouma ndi zowoneka bwino, zakudya, mbatata zosenda,
• buledi wowuma, nyama yotsamira mu mawonekedwe owiritsa, kapena otentha (masamba omenyera, mabatani), mafuta ochepa ophika ndi nsomba yophika,
• tchizi ndi tchizi chochepa mafuta, kasseroles, pudding,
• mararmade ndi marshmallows,
• okha mafuta
• Zipatso zatsopano, zotsekemera.

Mukamadwala, muyenera kukana:

• mitundu yonse yosungira
• zakudya zamafuta (nyama ndi mkaka, nsomba),
• yokazinga, yomwe ndi jaundice imatsutsana kwambiri,
• chokoleti, koko, khofi, makeke, zokometsera, zonunkhira,
• mowa wamtundu uliwonse

Kuneneratu komanso kupewa jaundice mwa akulu

Zotsatira za matendawa, limodzi ndi jaundice, zimatengera chomwe chikuchititsa, mawonekedwe ndi kuuma kwa njirayo. Ndi chithandizo chopangidwa mwadongosolo, nthawi zambiri zimakhala zotheka kuti mupeze ochiritsira kapena kusintha kwakukulu pamkhalidwe wake.

Pazolinga zopewera, pofuna kupewa chitukuko cha jaundice, ndikofunikira kufunsa katswiri munthawi yake. Mu matenda osachiritsika - tsatirani malangizo ndi malangizo azakudya.

Lotin Alexander, wowonera zachipatala

12,241 mawonedwe onse, 3 malingaliro lero

Chotupa chowopsa - ndi chiyani

Chifukwa cha kutsekeka kwa duct ya bile, vuto limatha kuchitika lomwe limayendera limodzi ndi kuwonjezeka kwa bilirubin (hyperbilirubinemia). Jaundice wowopsa ndi matenda a m'mimba pakhungu, mucous nembanemba ndipo khungu limakhala lachikasu chifukwa cha bilirubin. Technical jaundice mwa akulu siopatsirana; ili ndi ICD code ya 10 K83.1. Pali mitundu yosiyanasiyana yamatenda: kupsyinjika, kupindika, subhepatic, jaundice. Chithandizo chiyenera kuyambitsidwa mwachangu, apo ayi kuchitika kosakhumudwitsa ndikotheka.

Jaundice wowopsa - zimayambitsa

Chifukwa chododometsa mundime ya biliary, zovuta za jaundice syndrome zimayamba kukula mwa akulu. Kutsekeka, miyala ya dambo ya bile imasokoneza kutuluka kwa ndulu. Zomwe zimayambitsa matendawa zimamveka bwino. Tilowetsedwe, ndulu za bile zimasokoneza khungu, mucous nembanemba. Zomwe zimayambitsa zovuta:

1. Tizilombo timene timatulutsa timadzi tambiri, chiwindi (echinococcal cyst, alveococcosis).
2. Zigawo zazikulu za duct ya bile pambuyo pa opaleshoni (suturing yosayenera, kuwonongeka mwangozi kwa ma ducts).
3. Congenital pathologies a chitukuko cha biliary dongosolo (atresia ya bile ducts, hypoplasia).
4. Zilonda zopweteka: zotupa za metastatic mu pancreato-hepatobiliary system (khansa ya mutu wapa pancreatic, chotupa chachikulu cha duodenal papilla, komanso chotupa cha bile duct, khansa ya chikhodzodzo) ndi metastases ya chiwindi yamalo osiyanasiyana (lymphogranulomatosis, khansa yam'mimba).
5. Benign mawonekedwe, matenda oyamba ndi cholelithiasis: kuchepa (cicatricial okhwima kwa bile ducts), kapamba cyst, protrusion wa duodenal khoma, stenosis wa BDS, sclerosing cholangitis, chokhazikika chovala chamkati, pancreatitis pachimake ndi edema ya pancreatic gland.

Jaundice wowopsa - Zizindikiro

Chithunzi cha chipatala chimatsimikiziridwa nthawi zonse ndizomwe zimayambitsa. Kusintha kwamakhalidwe, zotupa zimadziwika ndi kuwonjezeka kwapang'onopang'ono kwa zizindikiro. Pankhani ya miyala ya valavu yolepheretsa lumen ya duct, mawonekedwe amasinthasintha: amatha kuzimiririka, kuwonekeranso. Chizindikiro chachikulu ndi chikaso cha sclera ndi mucous nembanemba maso, khungu. Popita nthawi, chidwi chimasinthika kukhala pansi. Zizindikiro zina zovuta za jaundice yovuta mwa akulu ndi akhanda:

• kuwonda, kuchepa thupi, kuchepa kwa chakudya,
• Zowawa, zopendekera pang'onopang'ono kumanja pansi pa nthiti, m'chigawo cha epigastric,
• kukulitsa chiwindi
• chopondapo, chosakhazikika, mkodzo wakuda,
• Khungu
• kutentha kwa thupi kumakwezedwa,
• nseru
• Nthawi zina, kusanza, cholesterol yachikasu imayikapo m'mapazi.

Jaundice wowopsa - mankhwalawa

Wowerengeka mankhwala a jaundice yovuta - zakudya, mankhwala. Mankhwala othandizira opaleshoni zimatengera matenda omwe adayambitsa matendawa. Ikani stenting ndi drainage pogwiritsa ntchito endoscopic kapena transdermal. Zotsalazo ndi monga: percutaneous transhepatic cholangiostomy (ChCHS) kapena transcutentous transhepatic cholecystostomy moyang'aniridwa ndi ultrasound, CT. Mwa mitundu ya ngalande za endoscopic, papillosphincterotomy (EPST), ngalande za duodeno-biliary ndizodziwika.

Mitsinje ya Gallbladder yokhala ndi chotupa chowononga

Transhepatic percutaneous drainage (BHP) imathandizira kutuluka kwa bile. Kutulutsa kwakunja kumatsogolera kudutsa kwa ndulu kudzera mu catheter kulowa m'mimba kuti masoka asatayike. Kuyika kwa ndulu ndi kovundikira kovundikira (kunja-mkati) kumafuna kukhazikitsidwa kwa catheter kuchokera kunja. Edema ikamachepetsedwa, imachitika mu duodenum, ndipo bile limatumizidwa m'mimba. Percutaneous endoprosthetics: madokotala amaika pepala la pulasitiki lomwe limalowa m'malo mwa khoma.