Kuyesedwa kwa chifuwa chachikulu

Zizindikiro zazikulu za pancreatitis pachimake ndi kupweteka, kusanza ndi chisangalalo (Mondor Triad).
Ululu limawonekera mwadzidzidzi, nthawi zambiri madzulo kapena usiku patangotha ​​cholakwika chazakudya (kugwiritsa ntchito zakudya zosenda kapena mafuta, mowa). Kupezeka kwake komweko ndi dera la epigastric, pamwamba pa navel, lomwe limafanana ndi malo apachifupi. Diso lamapweteka limapezeka pakatikati, koma limasunthira kumanja kapena kumanzere kwa midline ndipo limafalikira pamimba yonse. Nthawi zambiri ululu umawombera mbali yotsika mtengo yopita kumbuyo, nthawi zina mpaka kumbuyo, chifuwa ndi mapewa, mbali yakumanzere ya nthiti. Nthawi zambiri amakhala ngati lamba, zomwe zimapereka chithunzi cha lamba kapena mkono. Ndi ululu wambiri wam'mimbayo, kupweteketsa kwawoko kungafanane ndi cholecystitis yowononga, ndi kuwonongeka kwa thupi lake - matenda am'mimba ndi matumbo aang'ono, komanso kuwonongeka kwa mchira - matenda a ndulu, mtima ndi impso kumanzere. Nthawi zina, matenda owawa amakhala ndi kugwa komanso kuwonongeka.

Pafupifupi ndi kupweteka kumawoneka kambiri, zopweteka komanso zosabweretsa mpumulo kusanza. Zimadzetsa kuyamwa kwa chakudya kapena madzi. Ngakhale kusanza kangapo, kusanza sikunakhalepo ndi chikhalidwe chokhazikika.

Kutentha kwa thupi kumayambiriro kwa matendawa nthawi zambiri kumakhala kotsika. Histic fever ikuwonetsa kusakula kwa mitundu yosabala komanso mitundu yosiyanasiyana ya kapamba. Kutengera kuzunzika kwa zizindikiritso za makonzedwe achilengedwe, titha kungowerenga zikhalidwe ndi kuchuluka kwa njira zowonongera.

Chizindikiro chofunikira komanso choyambirira cha matenda a pancreatic necrosis ndi cyanosis ya nkhope ndi miyendo. Cyanosis mwa mawonekedwe a violet pamaso amadziwika kuti chizindikiro cha Mondor, mawanga a cyanotic pamakoma am'mimba (ma umbilical ecchymosis) - chizindikiro chakumutundi cyanosis wa dera loyambitsanso - Chizindikiro cha grunwald. Pambuyo pake matendawa, cyanosis ya nkhope ikhoza kulowa m'malo mwa hyperemia yowala - "Nkhope ya Kallikrein". Zizindikiro zolembedwera zimatengera kusokonezeka kwapang'onopang'ono kwa hemodynamic ndi microcirculatory, hyperenzymemia ndi cytokinokinesis yosalamulira.

Mukamayang'ana pamimba, zindikirani ukufalikira, makamaka m'malo apamwamba. Ndi pancreatic necrosis yodziwika bwino, pamimba limatupa kwambiri, mokhazikika kwambiri ngakhale ndi khunyu yapamwamba. Ndikukoka kwambiri, ululu wake umakulirakulira, nthawi zina umalephera. Pa palpation ya lumbar dera, makamaka kumanzere nthiti - vertebral mbali, kupweteka lakuthwa kumachitika (Chizindikiro cha Mayo-Robson) Pamalo a hypersensitivity opezeka palpation yapamwamba, minofu yolimba yamkati yam'mimba imawululidwa, yomwe imawonetsa kukhalapo kwa kapangidwe ka pancreatogenic, wolemera mu michere, ndi zochitika za pancreatogenic peritonitis. Nthawi zambiri amawona kupweteka kosagwirizana kwa khoma lakunja kwamkati poyerekeza ndi kapamba (Chizindikiro cha Kerte).

Chimodzi mwazizindikiro za kapamba wowononga chimawerengedwa ngati chodabwitsa cha kusapezekanso kwa kuphipha kwam'mimba chifukwa cha kuwonjezeka kwa kukula kwa kapamba ndi edema ya retoperitoneal fiber - Chizindikiro cha Voskresensky.

Pamene njirayi itapangidwira kumtunduwo mu thumba lodzikongoletsera, kusokonezeka kwa minofu kumawonekera makamaka mu gawo la epigastric, ndikulalikira kwa kutupa kupitilira malire ake (mpaka parietal ndi minofu ya pelvic, komanso peritoneum), kutanthauzira kwa minofu ndikuwoneka bwino Shchetkin-Blyumberg chizindikiro. Kumbukirani kuti ndi kutanthauzira kwa necrotic mu mchira wa kapamba, zizindikiro za kupsinjika kwa peritoneal zimatha kukhala zofatsa, zomwe zimagwirizanitsidwa ndi kutanthauzira kwakanthawi kwakanthawi kwa ndondomekoyi komanso kusowa kwa peritonitis. Mutu ukakhudzidwa, nthawi zambiri imayamba kukula kwa matenda a jaundice komanso gastroduodenal paresis.

Kuchepa kwa kamvekedwe ka mawu m'masamba am'mimba kumawonetsa kukhalapo kwa kuphatikizika pamimba. Kukopa kwam'mimba kumawonetsa kufooka kapena kusapezeka kwa phokoso lamatumbo chifukwa cha kufooka kwamatumbo am'mimba komanso pancreatogenic peritonitis.

Laborator diagnostics

Kuwonetsera kwakukulu kwa pancreatitis pachimake ndi vuto lachiwonetsero cha kapamba, makamaka, chodabwitsa hyperfermentemia. Mbali iyi ya pathogenesis ya pancreatitis ya pachimake kwazaka zambiri yakhala ikugwiritsidwa ntchito mosiyanitsa ndi matenda ena ofulumira am'mimba. Kudziwitsa za ntchito za amylase m'madzi a m'magazi (kawirikawiri - lipases, trypsin, elastase) - muyezo wazidziwitso. Chodziwika kwambiri muzochitika zamankhwala ndicho kutsimikiza kwa ntchito ya amylase ndi lipase m'magazi. Kuwonjezeka kokwana 4 kwa ntchito yonse komanso kapamba wa pancreatic amylase komanso 2-yolumikizana ndi lipase wachibale mpaka kukafika pamwambowu kumaonetsa chodabwitsa cha pancreatostasis.

Mitengo yayitali ya serum amylase imadziwika ndi tsiku loyamba la matendawa, lomwe limafanana ndi mfundo zakugonekedwa kwa odwala ambiri omwe ali ndi pancreatitis yayikulu mu chipatala. Kutsimikiza kwa ntchito ya lipase m'magazi ndi njira yayikulu yodziwitsira matenda pambuyo pake kuyambira kumayambiriro kwa matendawa, popeza zomwe zimachitika m'magazi a wodwala omwe ali ndi pancreatitis yayikulu imakhalapo kwa nthawi yayitali kuposa malingaliro a amylasemia. Chodabwitsachi chimawonetsa kukhudzika kwapamwamba komanso kutsimikizika kwa mayeso a lipase mokhudzana ndi amylase.

Muzochitika zamankhwala othandizira kunyumba, tanthauzo la amylase mu mkodzo limagwiritsidwa ntchito. Chiyeso chowonjezera ndikuwerenga kwa zochitika za amylase mu peritoneal exudate nthawi ya laparoscopy (laparocentesis). Mukamagwiritsa ntchito njira ya Volgemut (kutsimikiza kwa mkodzo wonse), malinga ndi momwe zochitika zamkodzo mumkodzo ndi magawo 16-64, magawo ake ochulukirapo amatha kuwoneka - mayunitsi a 128-1024. ndi zina zambiri. Njira ya Volgemut sichinafotokozeredwe mokwanira pancreatic cy-amylase, chifukwa ikuwonetsa ntchito yonse ya michere ya glycolytic yomwe ili mkati mwachilengedwe yotumizidwa kuti iphunzire.

Kutsimikiza kwa trypsin ndi elastase ntchito m'magazi pofufuza pachimake pancreatitis alibe kugwiritsa ntchito kwachipatala poyerekeza ndi ma labase amylase (lipase) chifukwa chovuta ndikuwononga kwa njira.

Hyppyylasemia mu mphamvu ya matendawa, ndi chofunikira chodziwika pancreatic function mikhalidwe ya pancreatostasis, yomwe imakonda kupezeka pakati pancreatitis kapena focal (capended) pancreatic necrosis m'masiku oyambirira a matenda. Dysfermentemia (kuphwanya chiŵerengero cha amylase ndi lipase yamagazi) kumawonetsa pancreatic necrobiosis, pomwe mulingo wamba wa amylase m'magazi, hypoamylasemia (ndipo ngakhale Fermentemia) ndiwodziwika kwambiri pancreatic necrosis, zomwe zikuwonetsa kuchuluka kwa chiwonongeko cha kapamba ndi kutayika kwa ntchito yake yopanda kanthu.

Palibe ubale wachindunji pakati pa mulingo wa amylasemia (amylazuria), kuchuluka ndi mawonekedwe a pancreatic necrosis (yapakati, yamafuta, hemorrhagic). Zotsatira za kafukufuku wa kuchuluka kwa magazi a enzyme ziyenera kuganiziridwa nthawi zonse molumikizana ndi deta kuchokera ku zina zamankhwala, ma labotale ndi njira zothandizira kupenda wodwala yemwe ali ndi pancreatitis yayikulu.

Zosintha pakuyezetsa magazi kwa pacute pancreatitis sikuti kwenikweni. Pankhaniyi, zovuta zazikulu zowerengera matenda a aseptic komanso matenda a pancreatic necrosis amadziwika kwambiri, zomwe ndizofunikira kwambiri kuyambira pakuwona chithandizo chanthawi yake. Kuwonjezeka kwa zizindikirozi pamphamvu ya matendawa poyerekeza ndi 30% ya gawo loyambirira, palimodzi ndi zina zamankhwala ndi ma labotale, zimatsimikizira kukula kwa matenda a kapamba, koma panthawi imodzimodzi, monga lamulo, amakhalabe osowa kwa masiku atatu. Chowoneka chotsimikizika kwambiri pothandizira matenda omwe amapezeka pancreatic necrosis ndi kuchuluka kwa magazi a leukocytes pamtunda wa 15x10 9 / l ndi chindapusa cha leukocyte cha mitundu yoposa 6.

Zizindikiro zosadziwika matenda kuganizira thrombocytopenia, kuchepa magazi ndi acidosis, ziyenera kukumbukiridwa pakuphatikizidwa kwa zidziwitso zamankhwala ndi zothandiza.

Kusintha kwamomwe mumagazi kumawonetsa kukula kwa hyper- ndi dysmetabolism syndrome, yomwe imatchulidwa kwambiri mu mitundu yowononga ya kapamba. Muzochitika izi, kusintha kwakukulu mu magazi a biochemical spectrum ndi dysproteinemia, hypoprotein ndi hypoalbuminemia, hyperazotemia ndi hyperglycemia. Kulimbikira kwa hyperglycemia ikuwonetsa pancreatic necrosis yayikulu, ndipo mtengo wake umaposa 125 mg / dl (7 mmol / l) - chinthu chosavomerezeka. Hypertriglyceridemia, hypocholesterolemia, kusowa kwambiri kwa lipoprotein, komanso kuwonjezeka kwa mafuta acids kulembedwa m'magazi a lipid.

C-yogwira mapuloteni komanso haptoglobin ndi α₁--antitrypsin - mapuloteni a pachimake gawo la kutupa. Mu chifuwa chachikulu cha pancreatitis, zomwe zimakhala ndi mapuloteni othandizira a C mg osaposa 120 mg / l m'magazi a wodwalayo zikuwonetsa kuwonongeka kwa kapamba. Kuchulukitsidwa kwa mapuloteni a C-reactive kumawonetsa kuwuma kwa njira zotupa ndi ma necrotic, zomwe zimakuthandizani kuti mugwiritse ntchito mayesowa kudziwa, mbali inayo, edematous pancreatitis kapena pancreatic necrosis, ndipo kumbali inayo, kusabala kapena kufalikira kwa mawonekedwe a necrotic.

Kugwiritsa mayeso a procalcitonin mu mitundu yosiyanasiyana ya kapamba wamankhwala osokoneza bongo adawonetsa kuti odwala omwe ali ndi kachilombo ka pancreatic necrosis, kuchuluka kwa procalcitonin ndikokwera kwambiri kuposa njira yowonongeka.

Kuthamanga kwa pancreatic necrosis yodziwika bwino kumawerengedwa kuti kumakhala kuchuluka kwa mapuloteni a C omwe amaposa 150 mg / l, ndi procalcitonin - oposa 0.8 ng / ml. Matenda ofala a pancreatogenic amadziwika ndi kuchuluka kwa mapuloteni a C omwe amagwira ntchito m'magazi a wodwala wopitilira 200 mg / l ndi procalcitonin woposa 2 ng / ml.

Mwa zina zolembera zamankhwala amodzi zomwe zimawonetsa kuopsa kwa kapamba kapamba, maphunziro othandizira a phospholipase A akulonjeza₂, trypsinogen, urotrypsinogen-2, trypsin-activated peptide, mapuloteni ogwirizana ndi pancreatitis, ma interleukins 1, 6 ndi 8, chotupa necrosis factor ndi neutrophil elastase. Zinapezeka kuti kuchuluka kwa trypsin-activated peptide mu mkodzo kumalumikizana ndi kuchuluka kwa C-yogwira mapuloteni komanso ma interleukin 6. Kuzungulira kwa metabolite iyi mu peritoneal fluid kumafanana mwachindunji mpaka muyeso wa pancreatic necrosis.

Ngakhale kuti zomwe zili ndi zinthu zambiri zam'magazi zimachulukana kwambiri m'magazi a odwala omwe ali ndi pancreatic necrosis posachedwa (maora 24-48) kuyambira kumayambiriro kwa matendawa, kugwiritsa ntchito izi polemba mankhwalawa pochita opaleshoni mwadzidzidzi kumachepetsedwa ndi mtengo wokwera wa njira ndi kusapezeka kwa gawo lodziwika lotsimikizika. Mtundu wonyengerera pazinthu zomwe zilipo komanso zamakono.

Kupangika ambiri mawonekedwe owononga mitundu ya pachimake kapamba. Hematocrit yoposa 47% panthawi yovomerezeka ya odwala kuchipatala komanso kusowa kwake kuchepa mkati mwa maola 24 othandizira kwambiri kumawonetsa chitukuko cha pancreatic necrosis.

Kuphunzira kwamawonekedwe a chiwindi michere odwala omwe ali ndi pancreatitis pachimake, ovuta chifukwa cha chitukuko cha hepatocellular insufficiency, mawonekedwe a pancreatic necrosis, ndizotheka kuzindikira ntchito yayikulu ya alanine ndi aspartic aminotransferases. Kuwonjezeka kwakukulu kwa ntchito ya lactate dehydrogenase kumawonetsa kuwonongeka kwakukulu kwapancreatic. Kuchokera pamalingaliro azidziwitso zakusiyanitsa, ndikofunikira kukumbukira kuti kusintha komweku ndi chikhalidwe cha infarate yokhala ndi myocardial infarction, infarction yayikulu yamatumbo, ndi hepatitis yamitundu yosiyanasiyana.

Ndi biliary pancreatitis chifukwa cha choledocholithiasis, komanso chikhodzodzo chachikulu cha mutu wa kapamba, cholestasis imakhala ndi khalidwe, lomwe limafotokozedwa ndi hyperbilirubinemia ndi predominance ya mwachindunji (yomangidwa) kachigawo ka bilirubin, ntchito yayikulu ya aspartate aminotransferase ndi alkaline phosphatase.

O wanena kusintha kwamasamba amagetsi-electrolyte umboni wa hemoconcentration, kuchepa kwa potaziyamu, sodium, calcium. At mitundu yodziwika ya pancreatic necrosis kuchepa kwa ndende ya calcium m'magazi am'magazi chifukwa chakuwoneka kwa steatonecrosis mu mawonekedwe amchere wa bile.

Mukafuna kuyesedwa pakakhala matenda kapamba

Zizindikiro zoyambirira za kuphwanya kwa kapamba zizayamba kuonekera, muyenera kupita kukakumana ndi katswiri wazodziwa. Gastroenterologist kapena othandizira adzalemba mayeso akuluakulu, pambuyo pake, malinga ndi zotsatira zomwe apeza, atumizanso maphunziro ena.
Kusanthula kumaperekedwa ndi izi:

• kupweteka kwa kumanzere kwa hypochondrium, kuwonetsedwa nthawi ndi nthawi, komwe kumakulirakudya ndikumachepa nthawi yofulumira kapena yokhala pansi.
• kuchuluka kwa masisitere,
• kusanza
• kubwatuka pafupipafupi ndi mpweya kapena chakudya,
• kuchepa kwamtima
• kuchuluka kwa gasi,
• kutsegula m'mimba (ndowe zachikasu kapena udzu, wokhala ndi fungo losasangalatsa, nthawi zina zimakhala ndi tinthu tating'onoting'ono)
• kuwonda
• thupi limatopa msanga.

Zomwe zili pamwambapa zimawonetsa kusayenda bwino kwa kapamba, zomwe zimakhudza thanzi, zimalepheretsa kugwira ntchito, khungu limakhala louma, tsitsi limatuluka, magazi amayamba.
Chachikulu ndikuzindikira matenda a nthawi ndikuyamba kulandira chithandizo. Kuchepa mphamvu, kusokonezeka kwa ma electrolyte komanso kutayika kwa zinthu zofunika kuziwopseza kungakhale koopsa pa moyo wamunthu.

Zofunika! Muyeneranso kudziwa kuti musanayeze mayeso a chifuwa chachikulu, sikuletsedwa kudya, ndipo masiku angapo zisanachitike muyenera kukana zakudya zamafuta ndi zamkaka. Ngati kuyezetsa kumayenera kuchitika kuti mupeze kuchuluka kwa shuga, ndiye kuti mutha kudya chakudya mwachizolowezi, osadziletsa.

Ndi mayeso ati omwe amayenera kuchitika ndi izi

Mosalephera, wodwalayo adalangizidwa kuti achite maphunziro angapo. Kuti mupeze chithunzi chonse cha momwe wodwalayo alili, dokotala amayenera kuwunika:

• kuyezetsa magazi konse
• shuga wamagazi
• cholesterol mulingo
• milingo ya amylase m'magazi, mkodzo, malovu,
• kuwunikira
• ntchito ya enzyme (lipase, trypsin),
• mulingo wa bilirubin ndi ntchito ya transaminase,
• nkhani zamkati
• madzimadzi am'mimbamo omwe amapezeka pa laparoscopy (mayesedwe am'mimba),
• REA,
• kuyesa kwa zotupa.

Kuyesedwa kwa magazi

Ndi mayeso ati omwe amayenera kutenga kwa chifuwa chachikulu, katswiri wa gastroenterologist angayankhe.

Ndi kuyesedwa kwa magazi kwambiri kuti mupeze matenda apathengo, maselo oyera am'magazi, maselo ofiira am'magazi (ESR), komanso kuchuluka kwa ma enzymes atsimikiza. Lamulo lalikulu ndikuwunika m'mawa pamimba yopanda kanthu. M'mayendedwe a pathological, zizindikirozo zitha kukhala zabwinobwino ndipo zimawonetsa kuyang'ana kwa kutupa mthupi. Chosangalatsa ndichakuti pancreatitis yosatha, kuchuluka kwa ma enzymes sikusiyana mwanjira iliyonse kuchokera kuzowonetsa munthu wathanzi.

Mapazi amwazi

Biochemistry imakupatsani mwayi kudziwa mulingo wa:

• glucose, yemwe ndi wokwera (chizolowezi sichiyenera kupitirira 5.5 mmol / l),
• cholesterol yotsika (tloaelehileng 3-6 mmol / l),
• michere ya pancreatic (alpha 2-globulin idzatsitsidwa).

Komabe, mu zotupa ndi ma neoplastic, matenda a impso, amadzuka (kawirikawiri 7-13%), trypsin imawonjezeka (zabwinobwino 10-60 μg / L) ndipo lipase limawonjezeka (zabwinobwino 22193 U / L).

Yang'anani! Woopsa kwambiri pancreatitis wamkulu ndi mulingo wa shuga, womwe wodwala amayenera kuwunika. Chizindikiro choposa 7 mmol / l chikusonyeza kukhalapo kwa matenda ashuga.

Kusanthula kwamaganizidwe

Pakufufuza ndowe zaku biochemistry, CHIKWANGWANI chimapezeka chomwe chinalibe nthawi yogaya, minyewa ya minofu, mtunduwo umakhala wonyezimira pang'ono, kusinthasintha ndikopaka mafuta. Pamaso pancreatitis, kuchepa kwa procrine insuffence kumawonedwa, komwe kumawonetsa kuchepa kwa ntchito ya enzyme.

Urinalysis

Pancreatic amylase mumkodzo amadzuka kambiri. Ndikofunikira kusakaniza mkodzo wam'mawa mozungulira 100-150 ml. Chikhalidwe cha pancreatic amylase ndi magawo 0-50 / lita.
Mukadutsa kuyesa kwamikodzo chifukwa cha chifuwa chachikulu, amino acid imatsimikizika, popeza ndi matendawa amadziwika kwambiri, omwe amawonetsa kuyamwa kwa amino acid m'matumbo ang'onoang'ono. Kuyesa kwa Lasus kumathandiza kudziwa kupezeka kwawo. Pakufufuza, mkodzo wam'mawa umagwiritsidwa ntchito, kutolera gawo lakumapeto mumtsuko wosabala.

Zofunika! Mu chifuwa chachikulu cha pancreatitis, kuchuluka kwa CEA (khansa-embryonic antigen) kumawonjezeka ndi 70%.

Mu chifuwa chachikulu, chizindikiritso cha CA 125 chimadziwika. Mu kapamba, kuchuluka kwa chikhomo cha CA 72-4 kumachulukitsidwa.

Kuwona kuchuluka kwa zotupa

Kutengera ndi izi, kuwunika komaliza komwe kumakhalapo chifukwa cha matenda kapamba sikuchitika. Ndikofunikira kuti mupimidwe mozama kuti mudziwe momwe aliri:

• Ultrasound yam'mimba kuti ithandizire kuzindikira kusintha kwa ziwalo za kapamba,
• X-ray - kutsimikizira pancreatic calcization,
• kuyesedwa ndi tomograph kuti mupeze madera a necrosis kapena chotupa,
• magonero amatsenga osonyeza kupanikizika,
• kutenga kafukufuku wazowerengeka,
• fibrogastroscopy ikuthandizira kupenyetsetsa kwambiri kapamba.

Odwala ambiri nthawi zambiri amafunsa chifukwa, podziwika ndi chifuwa chachikulu cha kapamba, mayesero ambiri amakhala mkati mwa nthawi zonse.. Chowonadi ndi chakuti kuzindikira kwa matendawa kumakhala kovuta chifukwa cha kupangika kwa kapamba komanso ubale wake ndi ziwalo zina zam'mimba.
Komabe, mndandanda wazowonjezereka wa machitidwe omwe akupitilizidwa uthandizira katswiriyo kuti adziwe matenda oyenera komanso asankhe chithandizo choyenera. Kuti zotsatira zake zikhale zodalirika, ndikofunikira kutsatira malamulo onse osonkhanitsa mayeso.

Wodwalayo amamuika kuti azingoganizira zamatsenga

Kodi njira zopewera matenda am'mimba thirakiti ndi ziti?

Popewa matendawa, muyenera kutsatira zakudya zoyenera. Zakudyazi ziyenera kuphatikizapo mavitamini ndi michere yonse yofunikira. Kudya zipatso ndi ndiwo zamasamba ndikofunikira. Zakudya zamafuta ndi zowotcha zimagwera pansi pa zoletsedwa; mchere wambiri komanso wokoma uyenera kutayidwa. Pewani ma carcinogens, mankhwala osungira komanso zina zowonjezera zamankhwala.