Chophimba chachikulu cha kapamba

Chophimba chachikulu cha kapamba mawu ofanana: chimbudzi, chimbudzi, wirsung duct, Wirsung duct, lat. ductus pancreaticus) ndi duct yomwe madzi a pancreatic amalowa mu duodenum.

Mwa anthu ambiri, umayamba mchira wa kapamba, umayenda mozungulira kutalika kwake ndipo umatha pambuyo pakuphatikizana ndi duct wamba wa bile papill wamkulu wa duodenum (Vater papilla).

Sphincters

Mawonekedwe a duct amatha kumangidwapo, kupindika mawondo ndi S-mawonekedwe, ndipo makamaka kumatsata mawonekedwe a kapamba. Nthawi zambiri, kupindika kwakukulu kwa duct wamkulu kumakhala kudera la mutu wa kapamba, ndipo gawo la chimbudzi lomwe limakhala mthupi la gland limakhala lowongoka.

Mukamadutsa m'mbali mwa tinthu tambirimbiri, timabowola tinthu timene timatulutsa tinthu tating'onoting'ono, pang'onopang'ono kukulira. Zinthu zonse za duct system ndizosiyanasiyana kwambiri. Mitundu iwiri ya kapangidwe kake ikhoza kusiyanitsidwa: yayikulu komanso yomasuka. Ndi mtundu wa thunthu, kuchuluka kwa madontho ang'onoang'ono omwe amatuluka kulowa mumtsinje waukulu ndi kuyambira 18 mpaka 34, ndipo mtunda pakati pawo umasiyana ndi 0.5 mpaka 1.5. Ndi mtundu wotayirira, kuchuluka kwa osaya kumafikira 60, ndipo mipata pakati pawo imachepera 0 8-2 mm.

M'mimba mwake mwa duct: m'dera la mchira wa kapamba - 1.0-1.7 mm, m'dera lamthupi - 2.4-2.6 mm, m'malo a mutu - 2.6-3.3 mm.

Sphincters edit |Gulu

Ma ducts amtunduwu amakhala ndi zazikulu ziwiri (zikuluzikulu zazikulu ndi zowonjezera) ndi zochepa zazing'ono, zomwe zimachokera ku loben kwa ziphuphu. Nembanemba wa ducts imakhala ndi maselo omwe amatulutsa cholecystokinin ya mahomoni, yomwe imakhudzidwa pakusamalira chimbudzi (imawongolera kumverera kwa kusasangalala ndi chidwi).

Dzina lake lachiwiri ndi Wirsung duct. Imayamba mchira wa kapamba, kudutsa thupi lake lonse, ndiye, kulumikizana ndi duct wamba wa bile, imayandikira nipple yayikulu ya dudenal, yomwe kudzera mmalo mwake amapangira duodenum. Duct wamkulu ali ndi kutalika kwa 25 cm.Danga lake m'mphepete mwa mapapo limakwana 1.5 mm, mthupi la gland - pafupifupi 2,5 mm, ndi mutu - mpaka 3.3 mm.

Mapangidwe ndi ntchito

Zingwe zazing'onoting'ono zazing'onoting'ono zimayenda mu msewu waukulu kutalika kwake konse, kuchuluka kwake kumasiyana malinga ndi mawonekedwe ake (kuyambira 20 mpaka 60). Kapangidwe kamene kamapanga pancreatic amadziwika ndi kusinthika kwakukulu. Pafupifupi 60% ya anthu ali ndi potuluka mu ndulu ndi pancreatic duct wamkulu kudzera mu node ya duodenal (Vater).

Sikuti aliyense ali ndi duct yowonjezera pancreatic, ndipo ngati ilipo, mawonekedwe a anatomical nawonso ali ndi zosankha. Zambiri zofufuzira sizipereka kuchuluka konse kwa mitundu yonse yamapangidwe, malinga ndi kuyerekezera koyipa, pafupifupi gawo limodzi mwa magawo atatu a anthu ali ndi lingaliro lomaliza la gawo lowonjezereka kudzera mwa nipple yaying'ono. Ntchito yowunikira ndikusintha katulutsidwe m'matumbo am'mimba imachitika pachitseko cha ma ducts.

Kodi zisa za kapamba zimayenda kuti?

Mtsinje waukulu umaphatikizika ndi wamba bile duct kudzera patali yopanda mbali ya pancreatic ngalande. Pambuyo pakuphatikizika, amapanga ampulla wa nipple wa Vater, mkati mwake momwe mumakhala minofu yosalala yozungulira - sphincter ya Oddi. Chiwalochi chimagwira ntchito ya valovu yomwe imayang'anira kutuluka kwa ndulu ndi kapamba m'mimba, kuti isabwezeretsedwe. Mpaka njira ya chimbudzi isanayambike, sphincter ya Oddi imapanikizika. Chakudya chikalowa mu duodenum, sphincter imatseguka, ndikugulitsa malo a bile ndi ma enzymes.

Kusintha

Kuphatikiza pa mawonekedwe amodzi payekha, kusiyana ndi kusasinthika kumadziwika mu mawonekedwe a duct. Pafupifupi aliyense chakhumi, gawo lomaliza la duct lalikulu limagwira, ndipo chinsinsi chonse cha kapamba chimalowa mu duodenum kudzera mumtsempha wowonjezera. Ngakhale pafupipafupi (pafupifupi 4%), kutuluka kosiyana kwa ndulu ndi ma pancreatic ducts kumawonedwa.

Chosowa chowonekera ndichowonjezera (chopereka) kapamba. Uku ndi kudziunjikira kwakapadera kwa minofu ya pancreatic, yomwe ikhoza kukhala ndi njira yake yotulutsa.

Zomwe zimayambitsa kusiyana

Zovuta zina za ma pancreatic ducts zimakhala ndi majini. Zolakwika zina zimayamba chifukwa cha zizolowezi zoyipa za amayi kapena matenda a intrauterine.

Kugwiritsa ntchito mankhwala kwakanthawi yayitali kungakhudze mwana wosabadwayo komanso kungayambitse kuyambika.

Kuwonjezeka kwa m'mimba mwa duct yayikulu kumatha kuwonetsa kupweteka kwam'mimba, kupezeka kwa miyala, kawirikawiri, chotupa pamutu wa kapamba kapena ampulla wa nipple ya Vater akhoza kukayikiridwa. Komanso, kukulitsa kwa dambo la Wirsung kumatha kuchitika chifukwa cha zomata zam'mbuyo kapena kuvulala.

Kapangidwe kolakwika ka ma ducti sikungakhale ndi chiwonetsero chamankhwala konse, nthawi zina zizindikiro zake zimakhala zobisika. Kuti muzindikire zizindikirazi, ndikofunikira kumvetsetsa bwino ubale womwe ulipo pakati pa duct pathologies (kapamba ndi bile wamba) ndikugwira ntchito kwa kapamba ndi chikhodzodzo.

Kusintha kwa m'mimba mwake kwa ma pancreatic ducts kapena kuphipha kwawo kumawonetsedwa ndi kusokonezeka kwa chakudya chamagaya - awa ndi ululu wam'mimba (colic), kutsekula m'mimba, kudzimbidwa.

Zizindikiro zimatchulidwa kwambiri mwadzidzidzi pancreatitis. Pali zowawa zambiri pakuphatikizika kwa kapamba (kapena lamba), nseru, kusanza, pambuyo pake kumakhala mpumulo. Ululu umaperekanso kumbuyo, munthu amafunafuna kutenga mluza, ndikupangitsa kusintha pang'ono.

Zizindikiro

Njira zomwe zilipo zodziwikiratu zimatha kudziwa zazing'ono zamatsenga. Ma ultrasound omwe amagwiritsidwa ntchito kwambiri. Phunziroli, duct yayikulu imawonedwa bwino, ndikotheka kuyesa kukula kwake, kuzindikira kuchepetsa kapena kufalikira.

Nthawi zina dera la ma ducts silimawonedwa kapena njirayi imakhala yovuta (mwachitsanzo, ndi kulemera kwambiri kwa thupi), muzochitika ngati zoterezi zimagwiritsidwa ntchito pakuwunikira, komwe ndi kuphatikiza kwa ultrasound ndi endoscopy ndikukulolani kuti mubweretse sensor mwachindunji pazinthu zomwe muphunzire.

Njira yophunzitsira kwambiri ndi endoscopic retrograde pancreatocholangiography (ERCP).

Nthawi yochita izi, adotolo, motsogozedwa ndi endoscope, amadzaza njira ndi radiopaque, pambuyo pake amawona makopawo pogwiritsa ntchito makina a X-ray. Choipa cha njirayi ndikuwonongeka kwake.

Kuyesedwa kwa labotali ndikofunikanso: kuyezetsa magazi a biochemical, kutsimikiza kwa kuchuluka kwa michere yam'mimba ya kapamba (kupatuka kuzungulira panjira yochepetsedwa kumawonetsa vuto).

Cholinga cha chithandizo chosasamala ndikuchepetsa kutupa ndi ululu. Wopangayo amapereka chithandizo chomwe chimagwirizana ndi kuthetsedwa kwa kapamba. Mulinso:

kukana chakudya kwa masiku 1-2,
antispasmodics
mankhwala okhala ndi michere yokugaya.

Nthawi zina ndi stenosis ya Wirsung duct, kulowererapo kumafunikira.

Mankhwalawa ovuta a matenda a pancreatic duct, malo ofunika amakhala ndi chakudya chamagulu, omwe amayenera kutsatira kwa nthawi yayitali.

Chakudyacho ncholinga chofuna kuchepetsa kubisala kwa Izi zimatheka ndikusintha kapangidwe kake, kuchuluka kwa nthawi imodzi ndi dongosolo lazakudya. Gawo lamapuloteni liyenera kupezeka muzakudya, ndikofunikira kusiya mchere, zonunkhira, mafuta, yokazinga ndi masamba. Kuwotcha ndikofunikira.

Zakudya zozizira komanso zotentha kwambiri ndizoletsedwa; Zakudya za tsiku ndi tsiku ziyenera kugawidwa m'magulu asanu ndi limodzi a 5-6, ndizoletsedwa kudya kwambiri. Ndibwino kugwiritsa ntchito mkate wa dzulo. M'm zipatala zambiri komanso m'malo ophunzirira, zakudya zoyenera zimatchedwa chakudya nambala 5.

Momwe mungayeretsere ma pancreatic ducts

Kutsuka kwa duct ndi njira yodabwitsika yomwe ilibe kuvomerezedwa ndi mankhwala ovomerezeka. Pamaso pa miyala, kukondoweza kwa kubisalira kungayambitse kutsekeka kwa mzere. Koma pakakhala kusunthika, ngalande zapang'onopang'ono zimatha kubisika pang'ono ndi madzi a pancreatic, omwe amachititsa kuti miyala ipangidwe.

Maphikidwe ena wowerengeka omwe cholinga chake ndi kuteteza chinsinsi kuti chikhale ndi zifukwa zoyenera zakuthupi, koma kugwiritsa ntchito kwawo kumafuna kupatula miyala mwadongosolo la pancreatic ndi bile ducts. Musanayambe njirayi, muyenera kuchepetsa zakudya kwa sabata: osapatula mowa, mchere, mchere, mafuta, zonunkhira, kumwa madzi ambiri momwe mungathere. Zitsanzo:

6-8 Bay masamba kutsanulira 1 chikho madzi otentha, kusiya mu thermos usiku. Amwani kulowetsedwa kwa 50 g musanadye sabata limodzi,
madzulo, kutsanulira 1 chikho cha buckwheat groats mu 0,5 malita a mafuta ochepa a kefir, idyani theka la misa chifukwa cham'mawa, theka lachiwiri - maola 2 asanagone.

Mwa zina azitsamba azitsamba zomwe zimathandizira kuyeretsa ma canchi a pancreatic ndi mizu ya parsley ndi chicory, tsamba lotchedwa sea buckthorn.

Mavuto

Matenda a ma pancreatic ducts amapezeka mu mawonekedwe a chifuwa chamkati ndi nthawi yowonjezereka komanso kukhululuka. Popanda chithandizo kapena mitundu ikuluikulu, zovuta zimatheka:

chotupa
fistula
kusintha kwamakhalidwe
kapangidwe ka miyala
kuchuluka kwa mavuto m'mizere,
kulowetsa matenda
chotupa (pancreatic carcinoma).

Pankhani ya opaleshoni, pamakhala ngozi ya zovuta za postoperative.

Kupewa ndi Matenda a Canal

Kupewera koyambirira kumapangidwira kuti muchepetse mavuto obwera chifukwa cha zizolowezi zoipa, kugwira ntchito mopitilira muyeso, kusowa tulo komanso kuvulala m'mimba. Kusungabe moyo wokangalika, kupangitsa malo abwino okhala, kudya zakudya zabwino - izi zimathandizira kupewa matenda a kapamba ndi ndowe.

Kupewa kwachiwiri kumafunika ngati matendawo apezeka kale. Pofuna kupewa kufalikira, ndikofunikira kuti zikondamoyo zizigwira ntchito mopanda kuchuluka, mabowo amachotsa chinsinsicho kudzera mwa ma sphincters, omwe amatsegula komanso kutseka nthawi. Kutsatira malangizo omwe dokotala amakupatsani komanso zakudya zake kudzakuthandizani kusintha njira zonse komanso kupewa kubwereranso m'mbuyo.

Zambiri pamakina oyenda

Lingaliro la njira zosinthika za kapamba limayambira mu acini. Mayendedwe ang'onoang'ono amaphatikizidwa ndi njira zazikulu zotuluka ku lobules ndikuphatikizidwa mu njira yayikulu yotulutsa. Kubedwa kwakukulu kumayenderera molunjika kupanikizira kwathunthu, kumatenga zotsatira mu gawo la mchira ndikutha mu mutu. Chifukwa chake, kuphatikiza kwa njira yowonjezera kumachitika - Santorini. Kenako njira yayikulu yotulutsa imaphatikizidwa ndi bile duct.

Chophimba chachikulu cha kapamba ndi santorinia chimaphatikizidwa pamodzi ndi anastomoses. M'dongosolo la ngalande yayikulu, kapangidwe kake kamakhala kotayirira kapena kwakukulu.

Kapangidwe kake kakakulu ka kapamba - kamakhala ndi mipata yaying'ono ya 30-34, yoyenda mu wirsungs, yomwe ili mkati mwa 5 mm.
Makina otayidwa - ali ndi mayendedwe a 55-60, nthawi yomwe pakati pawo ndi 1-2 mm.

Zotsekemera za kapamba ndi chikhodzodzo zimachotsa ma enzyme amadzimadzi mu gawo la duodenum.

Pali mitundu inayi ya malo omwe anatomical m'madipatimenti omaliza a bile ndi m'mimba njira.

Mtundu wa 1 umadziwika mu 55% - gulu lalikulu kwambiri komanso lodziwika bwino la bile limaphatikizidwa, ndikupanga phokoso limodzi, limatuluka kudzera mu vechlear vesers chifukwa cha sphincter ya Oddi.
33% ndi amtundu wa 2 - kuphatikiza kwa njira ziwiri zimawonetsedwa pafupi ndi Oddi, koma ma ampoule sanapangidwe.
Mitundu itatu imatenga 4% - ya bile duct ndi pancreatic imadzilowetsa m'matumbo kudzera mu Vater papillae.
M'mitundu inayi, 8% - kulumikizidwa kwa njira ziwiri zomwe zikulumikizana kuchokera pakati pa nipple zimawonedwa.

Kodi makina a Wirsung ndi chiyani?

Odwala ambiri amachita chidwi ndi komwe pancreatic duct imalowa. Ndi funso latsoka lalikulu la chiwalo lomwe limalowa m'matumbo.

Wirsung duct, yotchedwa duct yayikulu, imapereka chinsinsi kwa duodenum ndipo imawerengedwa kuti ndiyo ikulu kwambiri papancreas. Ma duct, omwe njira zambiri zazing'ono zimayendayenda, amapanga nthambi. Pa gawo lomaliza, sphincter imayikidwa, yomwe imayang'anira kubwera kwa madzi obwera. Kukula kwa ma bend kwa anthu onse ndi kosiyana.

Chotupa chachikulu cha kapamba chimayimiriridwa ndi magulu otsatirawa:

nthambi yayitali ndi 20-25 cm,
m'dera la mchira, msewu ndi mainchesi 1 mm,
pafupi ndi matumbo, kale m'malire amutu, mtengo wake umasiyanasiyana 3-3.5 mm.

Nthawi zambiri kapangidwe kamakumba kamakayidwe kamayimiriridwa ndi mawonekedwe a chipilalacho, chosawoneka kawirikawiri ndi bondo ndi mtundu wofanana ndi S.
Chingwe chachikulu chimatha ndi minofu yosalala yomwe imatseguka m'matumbo. Ntchito ya sphincter ya Oddi ndikuwongolera ndikukhazikitsa chimbudzi chomwe chikuyenda m'matumbo.

Pali zosankha ngati kapangidwe ka ziwalo zamkati, mothandizidwa ndi zifukwa zina, duct yayikulu imagawidwa m'magawo awiri, omwe amagwira ntchito mosiyana chifukwa chida chomwe nthambi ziwiri zimapangidwa. Kapangidwe kameneka ndi kobadwa nako, kosowa kwambiri, kumayambitsa kuchepetsedwa kapena kutsekeka kwamakondo konse.

Kuzindikira matendawa kumachitika pogwiritsa ntchito mayeso a CT kapena endoscopic retrograde pancreatocholangiographic.

Chitani matenda

Kukula kwa chododometsa mu kapamba, kutseguka kwa nthambi zothandizira, kutambasula ndi kupangika kwa gawo logaya chakudya m'mimba, ndi zina zotsutsana ndi njira zoperekazo zimayambitsa kupotoza kapamba ndi chimbudzi.

Monga mukudziwa, ngalande zapancreatic ndi machubu amphamvu. Kuchoka, pomwepo msuzi umalowa mu duodenum, umaganiziridwa kuti ndiye woyamba. Nthambi zambiri zing'onozing'ono zomwe zimayenda mumakina amapanga dongosolo lonse. Kusintha kwa ma ducts kumatha kuchitika pazifukwa zosiyanasiyana (kupatulira, kukulitsa, kuvala), ndichifukwa chake ma pathologies akuluakulu a pancreatic amapanga.

Chifukwa chake, kukula kwa cystic fibrosis mu pancreatic parenchyma kumapangidwa chifukwa cha kusunthika ndi kusintha kwa madzimadzi. Ma densi akachepetsedwa, madera omwe amatsogolera steanosis amafalikira, izi zimapangitsa kuti zisasokonekera.

Kudukiza kwa khwawa lalikulu la kapamba ndiye chinthu chachikulu pakupanga kapamba. Ngati kudula nthambi zing'onozing'ono kumawonedwa, kumakula kupitilira malo a steanosis, ndiye kuti kukakamizidwa kumawonjezeka.

Komanso woimira woopsa komanso wowonongeka ndi helicobacter microbe, vuto la nthendayi. Kupezeka kwa chilonda cha peptic kumachitika pamene zotsatira zowonongeka pamatumbo a mucosa zimayambitsa zowopsa zimayamba kugwedezeka chifukwa cha chitetezo cha mthupi. Chomwe chimakulitsa chilonda cha m'mimba ndi:

Helicobacter pylori matenda,
kugwiritsa ntchito mankhwala osokoneza bongo,
sarcoma
zotupa
matenda ashuga
syphilis ndi ena.

Zilonda zikapangika m'mimba, kupweteka kumachitika mutatha kudya, mu duodenum Zizindikiro zopweteka zimatchedwa kuti zanjala zikakula pamimba yopanda kanthu, ndipo mutatha kudya sizidutsa. Ndi kutupa kwa ndulu, kutentha kwamtima, colitis, flatulence, belching akuwonekera.

Ngati zizindikiro zina zikuwoneka kuti zikulephera kugwira ntchito mu kapamba, muyenera kufunsa dokotala.

Zambiri duct

Ma Enzymes ndi madzi a pancreatic amachokera ku kapamba mpaka duodenum kudzera m'miyendo ya kapamba. Pali mitundu iwiri ya ma ducts - chachikulu komanso chachiwiri.

Duct wamkulu wakuluzanso amatchedwa Wirsung. Mwachilengedwe, mkati mwa duct iyi, tubules tating'onoting'ono tambiri timabweramo, chilichonse chimakhala ndi chinsinsi.

Madera awo ndi kuchuluka kwake zimasiyana kwambiri munthu ndi munthu. Wirsung duct imatha kukhala ndi mawonekedwe osiyana: arched, mawonekedwe a bondo, mawonekedwe a Chingerezi S, koma nthawi zambiri imabwereza mawonekedwe a England. Pomwe imayandikira duodenum, m'mimba mwake mwa duct imayamba kuchepa.

Pali mitundu iwiri ya kapangidwe ka dancal system ya kapamba - thunthu ndi kumasuka. Mtundu waukulu umadziwika ndi osachulukitsa zazing'onozing'ono zomwe zimalowa zikuluzikulu. Kuchuluka kwake ndi 18-34, pomwe mtunda pakati pa malo omwe amakumbukirana sizidutsa sentimita imodzi ndi theka. Ndi makina otayirira, mpaka ma ducc ang'ono 60 amatuluka, mipata yomwe simaposa mamilimita awiri.

Tizilombo ta kapamba timeneti timatha kutseguka mosiyanasiyana mu duodenum. Pafupifupi 60% ya anthu amakhala ndi maphatikizidwe azinthu zazikulu komanso zowonjezera pafupifupi mamilimita atatu asanalowe m'matumbo. Kuwongolera kwa nthambi yotsiriza ya Wirsung duct nthawi zina kumachitika, ndipo madzi onse a pancreatic amalowa m'malo osankhidwa kudzera duct yowonjezera.

Dongosolo ili limapezeka pokhapokha 10% ya milandu. Mu 20%, duct wamkulu samalumikizana ndi bile wamba ndikutseguka mu duodenum 2-4 masentimita pamwamba pa malo omwe akufuna.

Ndipo nthawi zina, ndizotheka kuphatikiza zigawo zazikulu ndi zowonjezera pamtunda wawutali kwambiri kuchokera ku confluence. Nthawi zambiri, m'mimba mwake simupita 2 mm.

Ma ducke onse amatseguka, monga tafotokozera pamwambapa, kulowa mu duodenum. Malowa amatchedwa papilla wamkulu wa kapamba, kapena kuti Vater papilla. Malamulo a pancreatic madzi ndi kudya kwa enzyme imayendetsedwa ndi minofu yowzungulira mu papilla. Dzinalo lina ndi sphincter wa Oddi. Kuchepetsa kwake kumalepheretsa kudutsa kwamkati mwa tubule kulowa mu lumen yamatumbo.

Papilla waung'ono wa duodenum amathanso kukhalapo, pakamwa pake, nthawi zina, owonjezera, kapena Santorinius, amatsegula. Iye wazunguliridwa ndi sphincter Helly.

Zotupa zoyipa

Pali zosankha zingapo za malo ndi kulumikizana kwa ma ducts, koma palinso kuphwanya kapangidwe kake ndi kutulutsa kwa ma pancreatic ducts.

Zophwanya lamulo zoterezi zimatchedwa anomalies. Anomalies ndi wobadwa nawo ndipo amatengedwa. Zomwe zikuluzikulu zakukula kwawo zimawerengedwa ngati mtundu wakudziwikiratu, zotsatira za mabakiteriya komanso matenda am'mimba, komanso kuwonongeka koopsa kwa kapamba.

Kubadwa kwatsopano kumaphatikizira stenosis ya ma ducts. Zimayamba chifukwa chokhazikitsa nthambi ya Wirsung patulutsidwe ziwiri zazikulu.

Chifukwa cha stenosis, kuyika kwa katemera wa pancreatic mu duodenum kumatha kusokonezeka, ndipo izi zimatha kubweretsa chimbudzi chokwanira komanso kuperewera kwa chakudya, kuchepa kwa michere mthupi, komanso kupweteka.

Kuphatikiza pa kubadwa kwa stenosis, cystic fibrosis imadzipatula. Ndi izi zosasinthika, zochulukirapo komanso zovomerezeka mu pancreatic madzi zimayamba. Izi zimatha kubweretsa kuphwanya kwamkati kapangidwe ka kapamba ndi matenda osiyanasiyana.

Zolakwika zomwe zimaphatikizidwa zimaphatikizapo kukulitsa ndi kulepheretsa ma ducts. Nthawi zambiri, m'mimba mwake mwa machubu simapitilira 2 mm. Kukula kumabweretsa zifukwa zosiyanasiyana, monga:

ma neignlas opweteka m'mutu wa kapamba,
kupezeka kwa calculi (miyala) m'miyala,
kuchuluka kwa lumen,
aakulu yotupa mu gland (kapena kapamba),
mavuto omwe adachitika atagwiritsa ntchito Whipple,
Kuchotsa pang'ono pang'ono kwa kapamba.

Kuphatikiza apo, mu milandu 5%, njira yowonjezera yowonekera ikupezeka, yomwe imayambira kumutu kwa gland ndikutseguka m'chigawo cha Helly sphincter.

Ndi blockage, kuyambiranso kwa chifuwa chachikulu cha pancreatitis.

Pancreatitis - zimayambitsa ndi zizindikiro

Popeza pancreatitis ndi chimodzi mwazomwe zimayambitsa, komanso pafupipafupi chifukwa chotsutsana ndi duct, muyenera kuyankhula mwatsatanetsatane.

Pancreatitis ndimatenda otupa omwe amakhudza kapamba.

Matendawa amagawidwa pachimake komanso chovuta. Acne pancreatitis imachitika mwadzidzidzi, ndi yovuta kwambiri ndipo nthawi zambiri imafunikira opaleshoni. Matenda opita patsogolo amakula kwambiri, akuwonetsedwa ndi zovuta zamagayilo.

Zomwe zimayambitsa pancreatitis ndi izi:

Kumwa pafupipafupi komanso kumwa kwambiri.
Zowonongeka zowopsa m'mapamba.
Kusuta kwakutali.
Kugwiritsa ntchito mankhwala kwa nthawi yayitali komwe kumawononga thupi.
Kukhalapo mukudya kwamafuta, yokazinga, ndi fodya.
Kudziletsa.
Matenda a Gallstone.
Mavuto akulu azakhungu.
Njala yayitali.
Matenda a chiwindi.
Matenda a ma virus ndi bakiteriya.
Cystic fibrosis.
Kupukutira (kutukusira kwa tiziwalo tating'ono)
Thupi lawo siligwirizana ndi chakudya.

Njira yayitali ya kapamba imakhala yabwino kwambiri ndipo ali ndi zizindikiro zochepa kuposa pachimake. Nthawi zina, amatha kukhala asymptomatic, koma nthawi zambiri pamakhala zizindikiro pa nkhope. Pazovuta zochitika, mawonetsedwe wamba ndi:

munthu amadziwika ndi kunyansidwa pakuwona mafuta,
Pakulimbitsa thupi, kupweteka kosasangalatsa kumachitika pansi pa nthiti yakumanzere,
Pali zovuta zamagulu am'mimba zomwe zimayambitsa matenda am'mimba ndi stetorrhea chifukwa chosowa ma enzymes,
odwala amasiya kudya,
odwala amachepetsa thupi msanga ndipo samatha kulemera,
kunyengerera kwambiri
kubwatula
kutentha kwa mtima popanda chifukwa.

Mu gawo la kuchulukitsa kwa chotupa, chisamaliro chiyenera kulipidwa mwachangu kuti muwonekere zizindikiro izi:

Ululu wa pachimake, wosokonekera, umakonda kupezeka mu epigastrium, koma kumaganizira kakhalidwe. Ululu umatha kuwala kumanzere. Ululu umatha kukhala paroxysmal. Amatchulidwa makamaka ataphwanya zakudya zomwe adatipatsa kale.
Chilichonse. Nthawi zina kusanza kumachitika pachimake kapamba.
Kusanza kooneka ngati kasupe, pafupifupi sikubweretsa mpumulo.
Mimba imakhala "yolakwika" chifukwa cha kusokonezeka kwa minofu kukhoma kwam'mimba,
Kuchulukitsa thukuta.
Pallor, kufooka koopsa.
Kukweza kutentha ku manambala a matondo (38-39 madigiri).
Mukamayendetsa matumbo, wodwalayo amawonera chopondapo chamadzimadzi chopezeka ndi mafuta, omwe amawonetsa kusowa kwa lipase.
Kusweka mtima kumakhala pafupipafupi komanso mwamphamvu.

Pancreatitis imatha kukulira, makamaka chifukwa chophwanya zakudya.

Zimakumba kapamba

Ma ducts a bile ndi dongosolo lonse lomwe limachotsa bile lonse mu duodenum ku ndulu ndi chiwindi. Chifukwa chake, kuchokera ku chiwindi, mitsempha imatsegukira mu duodenum.

Kugaya kummba kumayamba. Kukhazikika kwa ma ducts a bile kumachitika mothandizidwa ndi nthambi za mitsempha ya mitsempha, yomwe imayikidwa mwachindunji.

Kuyenda kwa ndulu mowonjezerapo pamayendedwe okondweretsa kumachitika pogwiritsa ntchito kupanikizika komwe chiwindi chimapereka. Kamvekedwe ka makoma a ndulu ndi zitseko zimathandizidwanso pakukweza kwa bile. Zitsitsi zosiya chiwindi ndi zina mwazinthu zothandiza zam'mimba.

Chikondamoyo ndi chiwalo chokhudzana ndi chimbudzi cha anthu. Ma pancreatic ducts mwa anthu ambiri ali ndi mawonekedwe omwewo. Koma anthu ambiri sadziwa komwe amachokera ndi komwe amapita. Dongosolo lonselo lili ndi ma ducts awiri am'magazi, omwe, amadzalowa mu duodenum.

Kuphatikiza pa ma ducts awiri akulu, palinso machitidwe ang'onoang'ono otulutsa.

Chingwe chachikulu chimatsegukira mchira wa kapamba ndikupitilira duodenum. Kutalika konse kwa njira ino, zina, zazing'ono m'mlifupi ndi kutalika kwa mitsinje yotseguka.

Chiwerengero cha mitsinje ya munthu aliyense payekhapayekha idzakhala payokha. Pamutu penipeni, chowonjezera chimalowanso mumkamwa waukulu.

M'dera la mutu wa Wirsung, ngalande imalumikizana ndi Santorinium ndi duct wamba wa bile. Kenako, kudzera mu lumen, amatseguka m'matumbo ndi chikopa chachikulu cha Vater (duodenal).

Kuphatikizika kwa njira zowonekera za chiwindi ndi kapamba zimadutsa mu wamba bile. Amapangika pambuyo pakuphatikizika kwa ngalande ya ndulu ndi kufalikira kwa chiwindi.

Mwa 40% ya anthu, duct yowonjezera imatseguka m'matumbo padera ndi nippleal yaying'ono ya duodenal.

Mu mawonekedwe a kulumikizana kwa ma pancreas apakhungu ndi chiwindi, mapangidwe anayi amadziwika. Mlandu woyamba umakhala wa 55%, pomwe ampamu wamba imapangidwa pamalo omwe amakhudzidwa ndi ma ducts.

Ndi kapangidwe kameneka, sphincter imawongolera kutuluka konse. Kachiwiri, njira zowonekera zimaphatikizika popanda kupanga ma ampoules, ndikutseguka m'matumbo.

Dongosolo ili limapezeka mwa 34% ya anthu. Mtundu wachitatu wa zotuluka (4%) zimawerengedwa kuti ndizosowa, pomwe michere yayikulu ya chiwindi ndi kapamba imayenda mosiyana.

Mlandu wachinayi ndi wa 8.4%, pomwe ma ducts onse awiri amodzi amalumikizidwa patali kwambiri kuchokera ku mphuno ya duodenal.

Kapangidwe ka mayendedwe a chiwalocho

Njira yotchinga katulutsidwe imakhala ndi ma ducts awiri akulu. Yaikulu ndi Virsunga Canal, ina yowonjezera ndi Ngalorini Canal.

Choyimbira chachikulu chimachokera mchira wa tinthu timene timayenderera gawo lonse. Kanemayo ali ndi mawonekedwe a arc kapena chilembo S, nthawi zambiri amabwereza mawonekedwe a England.

Kuchokera pamutu mpaka mchira, kupendekera kwa pancreatic duct kumawonekera bwino. Kutalika kwake konse, amaphatikiza ndi ma ducts ang'ono.

Kapangidwe kake ndi kuchuluka kwake ndizofanana kwa munthu aliyense payekha. Ena ali ndi kapangidwe kake, ndiye kuti kuchuluka kwa ma tubules kumafika 30, ena - kumasuka, komwe mutha kuwerengera mpaka mitsuko yaying'ono 60.

Poyamba, mtunda pakati pa ducts wosaya umasiyana kuchokera ku 0.6 mpaka 1.6 cm, ndipo wachiwiri ndi wocheperako - kuchokera 0,08 mpaka 0.2 cm.

Njira yayikulu ya kapamba imadutsa gawo lonse mpaka kumutu, pomwe imalowa mu duodenum kudzera ku lumen. Valavu imapangidwa m'malo osakanikirana, omwe amatchedwa sphincter of Oddi.

Imawongolera kuchotsedwa kwa ma enzymes ku gland. 0.3 masentimita isanachitike, njira ya Santorini imalowa.

Pazokha, ili ndi kutuluka kwayekha kuchokera ku gland, yomwe sikuti imadziwika ngati matenda. Kapangidwe kameneka sikakhudza thanzi la munthu.

Kuchita anatomy

Ma pancreatic ducts ndi ndulu zimachotsa ma enzyme omwe amapezeka kuti amatulutsa chimbudzi cha duodenum. Pali mitundu inayi ya anatomical yachilengedwe yamigawo yomaliza ya zikondamoyo ndi bile ducts:

Mtundu 1 - wolembedwa mu 55% ya milandu: ma Wirsungs ndi wamba duct (wamba bile duct) amaphatikizidwa kukhala gawo limodzi lomwe limatuluka mu nipple ya Vater chifukwa cha sphincter ya Oddi.

Mtundu 2 - (33%): njira zonse zowonetsera zolumikizana zimalumikizana moyandikana ndi Oddi sphincter popanda kupangika kwapamwamba wamba.

Mtundu 3 - (4%): duct iliyonse imalowetsa m'matumbo lumen payokha, mosadukiza inayo, kudzera mu nsonga zazikulu ndi zazing'ono za Vater.

Mtundu 4 - (8%): njira zonse ziwiri zimaphatikizidwa pamtunda wautali kuchokera ku nipple yayikulu ya Vater.

Zoyambitsa ndi zizindikiro

Malingaliro a duct amakhazikitsidwa: ayenera kukhala ndi makhoma osalala, ndipo lumen ikhale yoyera, yopanda miyala. Ndi matenda a duct, momwe makoma ake amkati amakhala osagawanika - mtsogolo, izi zimawonjezera momwe ziliri. Kuti muzindikire kusintha koteroko pa ultrasound, muyenera kuyang'ana osati mutu wapamba, koma gawo lonse la biliary.

Zomwe zimapangitsa kukula kwa ma ducts ndi monga:

kupweteka koyipa kwa mutu wa kapamba kapena ampulla wa Vater papilla wa duodenum - izi zimatsatana ndi jaundice wovuta,
miyala yomwe imalepheretsa patency ya pancreatic duct yodziwika bwino, yomwe nthawi zambiri imakhala ikuphatikizidwa ndi ma gallstones ndi dilation (kukulitsa) kwa wamba duct,
Matenda otupa m'mapapo,
masitepe apangidwe pambuyo pa ntchito (pang'ono pancreatectomy, Whipple resection).

Ndikapangira chotupa kapena mapangidwe a calculi, Zizindikiro zimakhalapo mpaka mapangidwe akufika mpaka 4 cm. Izi zimawonjezera chiwopsezo cha matendawa komanso kuvuta kwazidziwitso: pokhapokha mavoliyumu osangalatsa akafika, chotupa kapena mwala chimayamba kusokoneza kugwira ntchito kwa chiwalo. Monga lamulo, khansa ya kapamba imapezeka mu magawo 3 kapena 4, pamene neoplasm ikukula kale m'magulu ofunikira komanso ziwiya, zomwe zimapangitsa kuti zitheke. Mwayi wopulumuka muzochitika zotere ndi wotsika kwambiri.

Popeza bile duct yodziwika bwino imakhudzidwa ndi njirayi, yolumikizana nthawi zambiri pamutu wamutu wapachikondwerero ndi Wingsung duct, jaundice ndi chimodzi mwazizindikiro zoyambira. Malinga ndi makina a chitukuko, ndi olepheretsa, makina. Cholecystitis imayamba. Mtsogolomu, miyala imapangidwa yomwe imatha kubowoleza ndulu ndi mitsuko yake. Njira ya pathological imakulirakulira, kuwira kwokhala ndi miyala kumayatsidwa ndikusintha kukhala matenda a ndulu (cholelithiasis).

Kuphatikiza pa jaundice, zizindikiro zina zimawonekera:

kupweteka kwamphamvu mosiyanasiyana mu hypochondrium wamanzere ndimatsitsi kumbuyo kumbuyo,
kutaya mtima komanso kuchepa thupi msanga,
mseru, kusanza, kusamva bwino m'mimba mukamadya - chifukwa m'mimba, chiwindi, matumbo akulu ndi m'mimba (colon) ndi ziwalo zina zam'mimba zimayendetsa kapamba ndipo zimagwira nawo ntchito yokhudzana ndi matenda.
ludzu, kufooka wamba, kuchepa kwamphamvu kwa kulumala.

Malinga ndi ziwerengero zamankhwala, miyala mu ducts sizimakhala nthawi zambiri, koma imaphatikizidwa pamndandanda wa matenda a pancreatic. Amatha kuchitika okha kapena chifukwa cha kapamba. Mwalawo utapangidwa mu kanjira ka Wirsung, zotchinga zimachitika pamalo omwe zimachitidwira, ndipo kukakamira kwazinthu kukukwera. Ma Enzymes sanatengedwe kupita ku duodenum, mokakamizidwa amalowa mwachangu mu minofu ya minyewa, ndipo njira yodziwira yokha - kudzimbidwa kumayamba. Kupanikizika kwa ndulu kumawonongeka - pancreatic necrosis imayamba, misa yakufa kwa maselo a pancreatic amachitika. Izi zikufanana ndi chifuwa chachikulu cha chifuwa chachikulu. Mankhwala othandiza posamala. Mankhwalawa amachitidwa opaleshoni.

Zomwe zimayambitsa kusiyana

Zomwe zimayambitsa kukula kwachilendo kwa ma ducts nthawi zambiri sizikudziwika. Nthawi zambiri amatchedwa:

masinthidwe amtundu
zinthu zoyipa zomwe mayi wapakati amakhala nazo: kusuta, kuledzera, kugwiritsa ntchito mankhwala osokoneza bongo, komanso mphamvu yama radiation, kutentha kwambiri,
matenda omwe mayi ali nawo pa nthawi yapakati: rubella, herpes, listeriosis (amakhudza minofu ya m'thupi ndi chiwindi) ndi ena,
zochitika zopsinja nthawi zonse
kugwiritsa ntchito mankhwala oletsedwa kwa amayi apakati.

Chifukwa chodziwikiratu komanso kuperewera kwa chithandizo chokwanira, kusintha kwa ma pancreatic ducts pang'onopang'ono kungayambitse kusokonezeka kwa kugaya chakudya komanso zotsatira zosasintha mu minyewa ya chiwalo. Kuti mupewe izi, muyenera kusamala ndi thanzi lanu, kusiya zizolowezi zoyipa, idyani moyenera, pewani kupsinjika ndipo ngati mukumva kuti mulibwino, pitani kwa akatswiri osadziletsa.