Zizindikiro zakulephera kwa kapamba

Matenda a kapamba akuluakulu omwe amakhala ndi kuchepa kwa magazi kwa nthawi yayitali amakula ndi njira yayitali yotupa m'mapapo (zaka 10). Zotsatira za m'malo mwa parenchyma ndi minye yolumikizana, chiwalocho chimataya mwayi wokwanira kuchita chosafunikira komanso chosagwiritsa ntchito.

Matendawa ndi akulu kwambiri chifukwa amatsogolera kapenanso kutaya kwathunthu kwa kapamba.

Zizindikiro zazikulu za matenda am'mimba ndizovuta zam'mimba, kupweteka kwam'mimba, mseru, khungu, tachycardia, kufupika kwa mpweya, kuchepa kwa mphamvu yogwira ntchito komanso kutopa kosalekeza.

Chizindikiro chachikulu cha kutupa kwa pancreatic ndi kuwonongeka kwa ntchito ndikupezeka kwa chopondapo cha tizinthu ta chakudya chosagwirizana ndi kuphatikiza mafuta. Maziko ozindikira ndikuphunzira ndowe. Zomwe zimagwiritsidwa ntchito moyenera ndi zakudya zapadera, kudya kwa michere ya enzymatic ndi proton pump blockers.

Chidule cha Chronic Pancreatitis

Pazaka 30 zapitazi, kuchuluka kwa odwala omwe ali ndi pancreatitis kwachulukanso. Vutoli limafotokozedwa ndi kumwa mowa kwambiri, matenda a gallstone, moyo wopanda ntchito, komanso kudya zamafuta ambiri ndi mafuta osenda. Madokotala amati pancreatitis ndi "yaying'ono": tsopano matenda a zam'mawere amapezeka pafupifupi pazaka 39, pomwe zaka zoyambirira zinali zaka 50.

Chikondwererochi ndi chiwalo chokhacho komanso intrasecretory. Katulutsidwe wakunja ndikupanga madzi a pancreatic, ndipo chinsinsi chamkati ndikupanga mahomoni.

Pancreatitis imachitika ndi kutsegula kwa michere ya m'mimba michereyo. Zotsatira zake, thupi limayamba "kudzimbidwa." Chronic pancreatitis (CP) ndi mtundu wa matenda wodziwika ndi kusintha kwamphesa m'mapapo. Ndi kusinthasintha kwa matenda amisala, fibrosis, kusowa kapena makwinya kwa ziphuphu (mapangidwe a kapamba), kusintha kapangidwe ka zigawo, ndi kapangidwe ka calculi mu parenchyma.

Malinga ndi ICD-10, etiology yodwala yopanda malire imakhala yokhayokha komanso ena. Malinga ndi magawidwe ena, pali biliary-deprous, parenchymal-fibrous and obstriers CP.

Mosiyana ndi pachimake, matendawa amakhala ndi chithunzi chochepa cha matenda kapena amapezeka ndi matenda ena, mwachitsanzo, zilonda zam'mimba ndi zilonda zam'mimba, cholecystitis, bysary dyskinesia, etc.

Madandaulo a wodwala matenda a kapamba amatha kuyanjana ndi:

• kupweteka kwa mu hypochondrium woyenera,
• kuchuluka kwa mpweya,
• kupuma msana ndi kumva kuwawa
• dyspeptic matenda.

Nthawi zambiri, chifukwa chophwanya malamulo a zakudya zochizira khansa ya chifuwa cham'mimba, zimawonekera pachimake, pomwe kudya kwathunthu kumasonyezedwa. Matendawa ndi osachiritsika, motero, amafunika kuwunikira komanso kumwa mankhwala nthawi zonse.

Akatswiri ambiri amasiyanitsa magawo awiri a nthawi ya matenda a kapamba /

Gawo I (zaka 10 zoyambirira) - kusinthana kukhathamiritsa ndi kukhululuka, zovuta zakumimba sizinafotokozedwe, pali zowawa mu dera la epigastric /

Gawo lachiwiri (zaka zopitilira 10) - kupuma kwamankhwala, kuwonjezeka kwa vuto layspeptic.

Ndi gawo lachiwiri lomwe pancreatitis yosatha yomwe imakhala ndi kuperewera kwa pakhungu imayamba, yomwe imadziwika ndi chotupa chachikulu cha kapamba.

Zoyambitsa za exocrine kusakwanira

Njira ya "kudzimbidwa" imayambitsa kusintha kwa dystrophic mu parenchyma ndi kutulutsa kwa pancreatic madzi. Poyerekeza ndi momwe njira izi zimapangidwira, chinsinsi, kapena glandular, minofu ya pancreatic imasinthidwa ndi minofu yaying'ono. Zotsatira zake, ziwalozi sizingagwire ntchito ya exocrine.

Ndizofunikira kudziwa kuti pancreatitis yokhazikika sindiye chifukwa chokhazikitsira kukonzekera kwa exocrine. Vuto linanso la izi limatha kukhala cystic fibrosis - nthenda ya autoimmune yomwe imakhudza ziwalo zomwe zimatulutsa madzi obwera. Izi zikuphatikiza chakudya cham'mimba, kupumira, maphesi, maliseche, thukuta thukuta, milomo yamkamwa ndi m'mphuno.

Matenda a kapamba kwambiri ndi cystic fibrosis ndi njira zazikulu zoyambira kuperewera kwa Procrine. Njira zina zachitukuko chake zimaphatikizira njira ya m'magazi momwe kudya kwa michere yogaya chakudya mu duodenum 12 sikungathandize kukonza chimbudzi cha chakudya.

Izi ndichifukwa chosakwanira, kutsegula ndikuphwanya tsankho. Pancreatitis yokhala ndi kuchepa kwa procrine, komwe kumachitika pazifukwa zachiwiri, kumakhala ndizinthu zina. Kwenikweni, matendawa amapezeka molingana ndi "chiwonetsero" chotsatira:

1. Nembanemba yamatumbo ang'onoang'ono amakhudzidwa ndi zinthu zambiri zoyipa. Zotsatira zake, kupanga cholecystokinin ndi secretin kumachepetsedwa.
2. Izi zimadzetsa kutsika kwa intraduodenal pH pansipa 5.5. Izi zikutanthauza kuti michere ya pancreatic sichiyambitsa.
3. Pali kuphwanya kayendedwe ka chakudya kudzera m'matumbo aang'ono. Zakudya zamafuta osagwiritsidwa ntchito zimayambira kusakaniza ndi tinthu tating'onoting'ono ta chakudya chomwe chimabwera.
4. Zotsatira zake, njira ya kuvunda imayamba - chikhalidwe choyenera cha bacteria wa pathogenic. Matenda osiyanasiyana amalumikizana ndikupanga microflora yoyipa. Kuwonjezeka kwa chiwerengero cha mabakiteriya kumabweretsa kuwonongeka kwa michere ya m'mimba.
5. Pancreatic madzi amasayenda, omwe amatsagana ndi kuchepa kwa bile ndi enterokinase.

Monga lamulo, ndikuchotsa kwathunthu kapamba (gastrectomy), machitidwe onse oyambira komanso apamwamba amatenga nawo mbali.

Gulu ndi zizindikiro za matenda

Kusakwanira kwazinsinsi zakunja kuyenera kufotokozedwa molingana ndi njira zingapo - zomwe zimayambitsa matenda ndi matenda opatsirana.

Zowonetsa zazikulu zakuperewera kwa katulutsidwe wakunja ndi:

1. Kulephera kudya mafuta, okazinga komanso osuta zakudya. Ngati wodwalayo adya chakudya chotere, pakapita kanthawi amamva kuwawa m'mimba mwake. Kenako ululu wa colic umawonjezeredwa. Mukatha kuthira pamimba, chopondapo cha mushy chimawonedwa - chizindikiro chachikulu cha kapamba. Mmenemo mutha kuwona zosayera za ntchofu (mafuta) ndi tinthu tosapatsa chakudya. Pafupipafupi kupita kuchimbudzi ndi katatu kwa katatu patsiku. Zophatikiza zamafuta ndizosavuta kudziwa: tinthu tambiri tambiri timasiya chimbudzi, chifukwa ndizovuta kuchapa ndi madzi.
2. Zizindikiro zakuchepa kwamavitamini sungunuka. Chifukwa cha kuchepa kwawo, ululu m'mafupa umawonedwa, amakhala ochepa mphamvu. Vitamini D hypovitaminosis imayambitsa kukhumudwa, Vitamini K imayambitsa kusokonezeka kwa magazi, vitamini A imayambitsa "khungu usiku" komanso khungu louma, vitamini E imapangitsa kuchepa kwa libido, komanso matenda opatsirana.
3. Zizindikiro zomwe zimakhudzana ndi kuchepa kwa mapuloteni a pancreatic.Ma enzyme amenewa amaphwanya mapuloteni. Kusowa kwawo kumabweretsa kuchepa kwa magazi m'thupi kwa B12, komwe kumadziwika ndi kuchepa kwa ntchito, kufupika, khungu, tachycardia komanso kutopa msanga. Chifukwa cha kusakwanira kwa michere, kuchepa kwamphamvu kwa thupi kumawonedwa.

Njira zamatsenga zimakhudza makamaka akuluakulu. Muubwana, kapamba ndi kuphwanya kwa exocrine ntchito kumachitika kawirikawiri. Kutupa kwa chiwalo kumachitika pazifukwa zina - matenda a m'matumbo ang'ono, matenda a ndulu, kuvulala kwamatumbo osiyanasiyana, kutsekeka kwa duodenal, kusokonekera kwa kapamba ndi kapamba.

Njira zodziwitsira ndi njira zochizira

Popeza adazindikira zizindikiro za kuchepa kwa kapangidwe ka pancreatic, ayenera kufunafuna thandizo kuchipatala.

Kutayika kwa nthawi yamtengo wapatali kumatha kubweretsa kuwonongeka kwathunthu kwa kapamba ndi kuchotsedwa kwake.

Njira yothandiza kwambiri yodziwira matendawa ndi kuwunika kwa stool. Zimathandizira kudziwa mulingo wa pancreatic elastase-1.

Zotsatira za phunziroli zitha kukhala:

• 200-500 μg / g - ntchito yabwinobwino ya procrine,
• 100-200 mcg / g - digiri yofatsa komanso yapamwamba ya exocrine,
• Osakwana 100 mcg / g - matenda oopsa.

Udindo wofunikira kwambiri pothandizira matenda ndi zakudya. Mwa malamulo oyamba azakudya zapadera za exocrine kusakwanira, ndikofunikira kuwunikira:

1. Kudya zakudya sayenera upambana 4 maola.
2. Muyenera kudya m'magawo ang'onoang'ono 5-6 patsiku.
3. Pewani kudya kwambiri madzulo ndi usiku.
4. Musachotse zakudya zokhazika, mafuta komanso zosuta fodya.
5. Ganizirani zokonda za mbewu zomwe zimachokera.
6. Siyani kumwa mowa kwathunthu.

Zomwe zimakhazikitsidwa ndi zakudya ndizopatsa zakudya zopatsa mphamvu - masamba, zipatso, chimanga. Ndi magwero azakudya za fiber, mavitamini, ndizofunikira zazing'ono komanso zazikulu. Sikulimbikitsidwa kudya zakudya monga nyemba, kabichi, biringanya, zopangidwa ndi ufa, chifukwa zimawonjezera mapangidwe a mpweya m'mimba.

Kuphatikiza pa chithandizo chamankhwala, odwala ayenera kumwa mankhwala. Maziko a mankhwalawa ndi mankhwala:

1. Ma enzymes am'mimba omwe amasintha njira yolandirira chakudya (Mezim, Pancreatinum 8000, Creon, Panzinorm). Amatengedwa pachakudya, mlingo wake umatengera kuchuluka kwa zakudya zomwe zimadyedwa ndi kapangidwe kake.
2. Proton pump blockers omwe amathandizira kugaya chakudya (lanzoprazolol, esomeprazole, omeprazole). Zochita za mankhwalawa zimapangidwa kuti apange zomwe zimachitika m'matumbo am'mimba.

Pankhaniyi, kudzipereka nokha sikungatheke. Kutsatira malangizo onse a dokotala, zotsatira zabwino za kuchiritsa zingatheke. Zotsatira zake, kupweteka kwamatumbo ndi kutsegula m'mimba kudzadutsa, ndipo sipadzakhala kuphatikizika kwamafuta ndi tinthu tosaphatikizika mu chopondacho. Nthawi ndi nthawi, wodwalayo amayesedwanso. Matenda amtundu wa chakudya amasonyezedwa ndi kuchepa kwa mafuta mu ndowe mpaka 7 g.

Akatswiri azikambirana za chifuwa chachikulu cha kanema mu nkhaniyi.

Mtundu wa vuto

Zikondwererozi zimagwira ntchito zazikulu ziwiri:

Choyambirira ndikupangidwa ndi chitsulo cha zinthu zomwe zimakhudzidwa ndikugaya chakudya (madzi a pancreatic ndi mitundu yoposa 20 ya ma enzyme). Gawo la kapamba limakhala ndi ma acini (maselo a gland) omwe amapanga ma enzymes (trypsin, lipase, chymotrypsin, amylase, ndi zina), omwe amaphwanya mapuloteni, mafuta ndi mafuta omwe amalowa mthupi ndi chakudya mu duodenum.

Lipase imapereka kuwonongeka kwa mafuta kukhala mafuta acids m'malo a bile.

Gawo la endocrine la gland ndi zisumbu za Langerhans, zomwe zimakhala pakati pa acini ndipo zimakhala ndi insulinocyte zomwe zimatulutsa insulin, glucagon, somostatin ndi ma polypeptides osiyanasiyana omwe amathandizira kusinthana kwa glucose ndikuwongolera kuchuluka kwa shuga m'magazi. Zisumbuzo ndizopangidwa ndi khungu la A, B, ndi D. Glucagon imapangidwa mu ma cell A (25% ya maselo onse), ma B-cell (60% maselo onse) amatenga nawo mbali popanga insulin, ndipo ma cell a mtundu D (15%) amapanga ma polypeptides ena.

Pancreatic insuffential chifukwa cha kuwonongeka kwa minyewa yachilengedwe komanso ma cell mu chiwalo ndi m'malo mwake pang'onopang'ono ndi minyewa yolumikizana (fibrosis), yomwe pambuyo pake imayambitsa kuchepa kwa ntchito ya gland popanga ma enzymes ofunikira ndi mahomoni. Chifukwa chake, matenda am'mimba amatha kubweretsa kusagwira bwino ntchito kwa machitidwe onse amthupi.

Mitundu ya kuperewera kwa kapamba ndi zizindikiro zawo

Matenda a pancreatic amawagawa m'magulu anayi:

1. Exocrine pancreatic insuffence, chifukwa chakuchepa kwa ntchito ya zinthu zapadera zachinsinsi zomwe zimaphwanya chakudya mu zinthu zomwe zimatengedwa momasuka ndi thupi, kapena kuphwanya kwachinsinsi kwa madzi a pancreatic m'matumbo chifukwa chakuchepa kwa ma ducts chifukwa chotupa kapena fibrosis. Poyang'aniridwa ndi ntchito ya enzyme, chinsinsi chake chimakhala chodinira ndikuwoneka bwino ndikuwononga chakudya. Mukachepetsa mayendedwe, madzi osakwanira amalowa m'matumbo, omwe samatha kugwira ntchito yawo mokwanira. Zizindikiro zake zazikulu: kulekerera zakudya zonunkhira ndi mafuta, kulemera m'mimba, kutsekula m'mimba, kumatulutsa ndi colic, zazing'ono: kufupika kwa mpweya, tachycardia, kupweteka thupi lonse. Mafuta omwe amalowa m'matumbo samakonzedwa ndikuwachotsa mu mawonekedwe osavomerezeka limodzi ndi ndowe (pancreatic steatorrhea). Kusowa kwamafuta acid kumabweretsa mafupa osakhazikika, kuchepa kwa magazi m'magazi, kukokana, kusawona kwamaso usiku, kusabala. Kutsika kwa kupatsa mphamvu kwa mapuloteni kumapangitsa kupuma movutikira, tachycardia, kuchepa magazi, kufooka, komanso kutopa.
2. Exocrine pancreatic insuffential ndi chifukwa chakuchepa kwa kapangidwe ka kapamba (kapamba), womwe umayang'anira magwiridwe antchito a m'mimba. Amawonetsedwa ndi kudzimbidwa, mseru komanso kulemera m'mimba, mpweya wambiri m'matumbo ndi kuphwanya kwake, ndizomwe zimayambitsa kukula kwa matenda osokoneza bongo. Exocrine pancreatic insuffuffing ikhoza kukhala yocheperako komanso mtheradi. Loyamba limasinthika, kukhulupirika kwa chiwalo pamenepa sikuphwanyika, khungu limayamba chifukwa cha kusakhazikika kwa kapamba kapena kubisala, komwe kumakhala kokwanira mwa ana. Kusakwanira kokwanira kumayendetsedwa ndi atrophy ya acini ndi fibrosis yamatenda achinyumba, kuchepa pakupanga ma enzyme. Ndizotsatira zamatenda monga matenda apakhungu kapena pachimake a kapamba, cystic fibrosis, Schwachmann-Diamond syndrome.
3. Kuperewera kwa ma enzymes m'matumbo a m'mimba omwe amaphatikizidwa ndi kugaya chakudya ndi kuperewera kwa enzymatic pancreatic. Zizindikiro zosonyeza ma enymes osakwanira okumba chakudya: chakudya chambiri, mseru ndi kusanza, kutsegula kwa m'mimba mwa mayi, kuchepa magazi, kufooka, zina zambiri. nkutuluka kuchimbudzi, kutuwa imvi.
4. Ndi kuperewera kwa endocrine pancreatic, kupanga mahomoni insulin, glucagon, ndi lipocaine kumachepa. Kuperewera kwamtunduwu ndi kowopsa chifukwa kumayambitsa vuto pantchito ya ziwalo zonse za anthu ndipo kumakhala ndi zotsatira zosasintha. Zizindikiro ndizofanana ndi zomwe zimagwirizanitsidwa ndi kusowa kwa michere ya pancreatic. Insulin ndi yomwe imapangitsa kuti shuga azichotsa magazi kupita m'maselo a thupi ndikutsitsa shuga, kuchuluka kwa shuga. Matenda a shuga m'magazi ndi 3.5-5,5 mmol / l. Kusintha kwazomwe zimayambitsa kukula kwa matenda - hyperglycemia (kuchuluka kwa glucose) ndi hypoglycemia (chimodzimodzi kuchepetsedwa). Kuphwanya kapangidwe ka insulin kumabweretsa kuchuluka kwa shuga m'magazi ndikukula kwa matenda monga matenda a shuga.Zizindikiro zazikulu zosonyeza kuchepa kwa mahomoni a insulin: shuga yayikulu itatha kudya, ludzu, kukodza pafupipafupi, mwa azimayi - kuyabwa kumaliseche. Ndi kuchepa kwa kupanga kwa glucogan, zizindikiro zotsatirazi ndizodziwika: kufooka, chizungulire, kugwedezeka mwamphamvu, kusintha kwa psyche (kuda nkhawa, kukhumudwa, nkhawa zopanda pake), kukhumudwa, kulephera kudziwa. Ngati endocrinologist ikupereka chithandizo cha kuchepa kwa insulin, ndiye kuti psychotherapist amafunikanso thandizo ndi vuto la glucogan.

Zomwe zimapangitsa kuperewera kwa kapamba

Zomwe zimayambitsa zovuta mu kapamba zingakhale motere:

• kusintha kwachilengedwe
• kuchepa kwa vitamini (kusowa kwa mavitamini B, C, E, PP, nicotinic acid), zomwe zimayambitsa matenda a chiwindi komanso kukula kwa matenda a ndulu.
• kutsika kwa mapuloteni komanso kuchepa magazi,
• zosavomerezeka mu chakudya - mafuta ambiri, zakudya zonunkhira m'zakudya, uchidakwa,
• matenda opatsirana am'mimba, kapamba, duodenum 12,
• kuchuluka kwa kapamba kapena kapamba wamatumbo - kutupa kwa kapamba,
• helminthiasis,
• kugwiritsa ntchito mankhwala kwa nthawi yayitali
• kuperewera kwa zakudya m'thupi
• kagayidwe kachakudya
• kusokonezeka kwamatumbo ang'ono ndi duodenum, kusintha kwachuma m'matumbo a microflora,
• kubadwa kwatsopano kwa kapamba.

Panthawi imodzimodziyo, minofu ya kapamba imamwalira ndipo zophuka zawo zamakhalidwe zimasinthidwa ndipo, monga chotulukapo, amalephera kuchita.

Dziwani za kusintha kwamatenda am'mapapo

Choyamba, dokotala yemwe amapita ku kafukufuku amafufuza wodwala, kuti adziwe zomwe zimasiyanitsa ndi kuperewera kwa pancreatic enzyme. Kuzindikira matendawa, kuyezetsa magazi a labotale kumachitika (pazomwe zili hemoglobin ndi zinthu zazamoyo, za kuchuluka kwa shuga), maphunziro a kukhalapo kwa michere mkodzo, kusanthula ndowe ndi kapulogalamu wokhutira zamafuta (nthawi zambiri osapitirira 7%), elastase-1 ndi mkhalidwe wololera komanso kukonza chakudya ndi thupi.

Kuti muzindikire kusintha kwamphamvu mu ziwalo, ma Ultrum yam'mimba, CT ndi MRI ndi mankhwala. Njira yofunika yodziwitsira matenda ndi endoscopic retrograde pancreatocholangiography (kuwunika ma dancts a pancreatic ndi bile ducts awo patency ndi kukhalapo kwa keloid formations. Pofuna kufotokoza bwino za matendawa, njira imagwiritsidwa ntchito pophunzira mwachinsinsi chinsinsi chomwe chimapezeka kuchokera ku kapamba chifukwa cholakalaka mafuta am'mimba, omwe amalola kudziwa zomwe zili komanso kuchuluka kwa madzi a pancreatic.

Kuperewera kwa Endocrine kumafufuzidwa poyesa kulolera kwa glucose - kuyezetsa magazi kumatengedwa pamimba yopanda kanthu ndipo magazi omwe amatengedwa patatha maola awiri atatha kudya kapena 75 g shuga. Kusanthula kumeneku kumawonetsa mphamvu ya thupi yopanga insulin komanso glucose.

Zizindikiro zotsatirazi zimapereka umboni wa kuchepa kwa glucose metabolism: kuchuluka kwa glucose osachepera 6.7 mmol / L, maola 2 mutatenga shuga wa glu gose - 7.8-11.1 mmol / L. Nthawi zambiri, shuga wamagazi sayenera kupitirira 6.4 mmol / L. Ngati kuchuluka kwa shuga m'magazi omwe atengedwa pamimba yopanda kanthu ndi ofanana 7.8 mmol / l kapena kuposa mtengo uwu, ndiye kuti pali matenda a shuga.

Chithandizo cha matenda apamba

Kuti muchepetse ntchitoyo ndi kuthetsa kusokonezeka kwa kapamba, chithandizo chimayikidwa malinga ndi mtundu wa kusakwanira: Ngati zizindikiro za nthendayo zapezeka zomwe zikuwonetsa kuchepa kwa enzyme, mankhwala a multienzyme adayikidwa kuti alowe m'malo mwa zinthu zomwe zasowa.

Exocrine pancreatic insufficiency chifukwa cha kuchepa kwa intrasecretory pancreatitis amathandizidwa ndi mankhwala okhala ndi ma enzymes (Mezim-forte, Pancreatin, Creon, Panzinorm-forte), tikulimbikitsidwa kugwiritsa ntchito mavitamini a mavitamini okhala ndi mavitamini osungunuka a A, D, E, K.Mankhwala othandiza kwambiri ndi Mezim-forte, okhala ndi proteinase, amylase ndi lipase, angagwiritsidwe ntchito ndi odwala omwe ali ndi zaka zochepa.

Chithandizo chimaphatikizanso zakudya zomwe zimayang'anira kuthamanga kwa shuga m'magazi ndi kumwa mankhwala omwe amafunsidwa mwachindunji kwa wodwala aliyense. Chakudya chizikhala chosakanizika komanso pafupipafupi (nthawi 5-6 patsiku), chimadya masamba ambiri ndi chimanga chomwe chili ndi zakudya zamagulu (tirigu ndi oat), komanso zakudya zama protein.

Ndi kuchepa kwa ntchito ya enzyme, mankhwala omwe amakhazikika m'malo am'mimba m'mimba yamagetsi (Omeprazole, Pantoprazole, Lanzoprazole, ndi ena otero) amatchulidwa kuti athe kuwonjezera luso logaya chakudya. Chithandizo choyenera chofuna kuchiza zomwe zimayambitsa matendawa: matenda am'mimba, kapamba ndi zilonda 12 zam'mimba.

Chithandizo cha kuperewera kwa endocrine zimatengera matenda omwe amayamba chifukwa chosowa mtundu wina wa mahomoni. Matenda ofala kwambiri ndi matenda a shuga, omwe amayamba chifukwa cha insulin, omwe amachititsa kuti magazi azikhala ndi shuga. Chithandizo cha matenda a shuga chimakhazikika pa mfundo zitatu izi: kubwezeretsanso insulin, kubwezeretsa matenda a metabolic ndi mahomoni, komanso kupewa zovuta zomwe zingachitike.

Chofunikira kwambiri ndizakudya, kuwonjezeka kwa zochita zolimbitsa thupi za wodwala, kugwiritsa ntchito mankhwala omwe amachepetsa shuga, komanso mankhwala a insulin (odwala omwe amadalira insulin). Chakudyacho chimayenera kukhala ndi 60% ya chakudya chochepa pang'onopang'ono (mkate wopanda bulawu, chinangwa cha tirigu wokhala ndi pectin), 24% wamafuta opepuka, ndi 16% ya zakudya zama protein. Chakudyacho chimapereka kukanidwa kwathunthu kwazinthu zokhala ndi sucrose ndi fructose, zophatikizika mosavuta zamafuta (maswiti, ufa ndi zinthu zophika, zipatso zotsekemera, zakumwa zoziziritsa kukhosi), kuletsa zakudya zamchere komanso zonunkhira, mitundu ina ya nyemba.

Chifukwa chochulukitsa zolimbitsa thupi, shuga amawotchedwa popanda kutenga insulin. Kwa okalamba ndi odwala omwe ali ndi matenda ena, kuyenda kwa tsiku lililonse kwa maola 1-2 kapena masitepe ofulumira osachepera mphindi 40 ndikulimbikitsidwa.

Kuika ndi kumwa kwa mankhwalawa omwe amachepetsa shuga ya magazi amapangidwa ndi endocrinologist kutengera kusanthula kwake. Monga lamulo, Glucophage, Siofor, Metamorphine, Glutazone, Actos, Pioglar, ndi zina zotchulidwa.

Othandizira a insulini amapatsidwa magawo apamwamba a matenda ashuga, pamene kapamba limaleka kutulutsa insulini. Pali mitundu iwiri ya zinthu zotuluka ndi kukonzekera kwa insulin:

1. Ndalama zopangidwa kuchokera kuzinthu za insulin yaumunthu (tekinoloje ya DNA kapena maumboni apangidwe),
2. Ndalama zopangidwa kuchokera ku zigawo za insulin zakomwe nyama zimachokera (makamaka kuchokera ku nkhumba).

Zothandiza kwambiri ndizokonzekera insulin zochokera ku mahomoni amunthu.

Kuneneratu za kuperewera kwa kapamba kumapangitsa kuti anthu azilakalaka. Zonse zimatengera kuchuluka kwa kuwonongeka kwa parenchyma. Popeza kuti pathology imayamba motsutsana ndi maziko akumwalira kwa gawo lofunika kwambiri la chiwalo, mankhwala amafunikira pano moyo wonse. Ndikotheka kuti muchepetse kukula kwa vutoli pozindikira matenda ake komanso kuchiza matenda a kapamba, kukana kumwa mowa, ndi kusuta.

Makina owononga

Pamene kutupa kwa kapamba kufalikira ndikuzama mu chifinya chachikulu, tiziwalo tosiyanasiyana tomwe timene timapezeka timatulutsa timafa ndi ulusi wolumikizika kapena mawonekedwe amtundu wa malo m'malo mwake. Chifukwa chake, ndi kuchepa kwa chiwerengero cha maselo acinar (mobisa), ntchito yake imachepa, ndiye kuti, kupanga ndi kulowa m'matumbo ndikofunikira pakugaya ma enzyme.

Ntchito zazikuluzikulu za ma cell a acinar a gland zimayankhidwa pakupereka chakudya, kukonza ndikupereka madzi a pancreatic odzaza ndi michere ndi alkali kupita ku duodenum ya duodenum 12. Munthawi yake yabwinobwino, katulutsidwe wa kapamba kamakhala ndi ma enzyme ofunikira omwe amawononga mosavuta mafuta, mapuloteni ndi chakudya.

Mwachitsanzo, ma enzyme monga lipase ndiyofunikira pakugawikana mu mafuta acids ndikuyamwa mafuta. Palibe chiwalo chimodzi chogaya chakudya chomwe chimapanga chinthu chomwe chitha kuganiza pang'ono za ntchito za lipase. Chifukwa chake, pakufa kwa gawo lama cell achinsinsi chifukwa cha kapamba, poyamba, pali kusowa kwa ma enzymes opaka mafuta ndi mavitamini osungunuka a mafuta, omwe nthawi yomweyo amakumana ndi vuto pakudya ngakhale mafuta ochepa. Zakudya za anthu otere nthawi zambiri zimakhala ndi zakudya zabwino, zomwe zimakhudza kawirikawiri.

Popita patsogolo pancreatitis yodwala komanso kuchepa kwa magazi, komanso kusintha kwachulukidwe kakang'ono ka minyewa yotupa, zizindikiro za vuto la endocrine zimawonekera, wodwalayo amadwala matenda a shuga.

Zimayambitsa ndi gulu la matenda

Kugawika kwa procrine pancreatic insufficiency kutengera zomwe zimayambitsa kuphwanya ntchito zachinsinsi, matenda opatsirana komanso kukula kwa zotupa. Kusiyanitsa:

1. Kulephera kwa kubadwa chifukwa cha kusowa kwa majini komwe kumalepheretsa kapena kufikisa kwathunthu kupanga michere.
2. Wodzipeza, akukula moyo wonse, makamaka motsutsana ndi chiyambi cha matenda kapamba.

Kupangika kwa procrine pancreatic kuchepa, ngati matenda odziimira pawokha kapena chifukwa cha kuwonongeka kwa chiwalo china, kutilola kusankha gulu kuti:

1. Choyamba, komwe matenda amisempha amachitika chifukwa cha matenda amtundu wa kapamba komanso kuletsa kwa kaphatikizidwe ka enzyme.
2. Chachiwiri, momwe kupanga ma enzyme kwadzaza, koma kutsegula kwawo mu 12 duodenum ndi matumbo aang'ono sikumachitika kapena inactivation yawo imachitika.

Zomwe zimayambitsa mawonekedwe apamwamba a enzymatic pancreatic insufficiency ndi mitundu yonse ndi mitundu ya pancreatitis yayitali, komanso:

• cystic fibrosis - kubadwa kwatsopano kwa zinthu zachinsinsi zomwe zimayendetsedwa ndi zovuta zamagulu,
• zotupa zapakhosi, zoyipa ndi zoyipa,
• kuchepa kwamafuta kwama cell a kapamba okhala ndi kunenepa kwambiri,
• Zotsatira za opareshoni
• kobadwa nako enzymatic,
• Matenda a Schwahman
• Matenda a Johanson-Blizzard,
• kapamba kapena ajeniis,

Nthawi zambiri zimayambitsa kuchepa kwa ntchito ya procrine, fibrosis kapena atrophy, yomwe imapangidwa motsutsana ndi maziko a:

• chidakwa kapamba, pancreatitis wowerengeka kapena kapamba woletsa,
• atherosulinosis,
• kuphwanya zakudya nthawi zonse, osatsatira kadyedwe kalikonse ndi vuto la zakudya zokometsera komanso zamafuta,
• hemosiderosis - pigstrary dystrophy yokhala ndi zochuluka mu minyewa ya hemosiderin - utoto wokhala ndi chitsulo,
• shuga monga zovuta za chifuwa chachikulu,
• kapamba wamanyazi,
• pancreatic necrosis - pang'ono kapena kufa kwathunthu kwa maselo a kapamba,
• mapangidwe a miyala mu zikondamoyo.

Zomwe zimayambitsa mawonekedwe achiwiri a exocrine pancreatic insufficiency ndi ma pathologies a m'matumbo aang'ono, mwachitsanzo:

• gastrinoma - chotupa chogwira ntchito,
• kuwonongeka kwa mucosal,
• osakwanira enokemasease enokemase,
• mavuto a dongosolo la hepatobiliary,
• kuchepa kwa mphamvu zama protein
• Zotsatira za opaleshoni pamimba kapena matumbo.

Mtheradi komanso kuperewera kwa enzymatic kosakwanira kwa kapamba kumasiyanikanso.

Kukwanira kwathunthu kwenikweni kumayambira, ndipo kumayambira kumbuyo kwa kutsika kwamphamvu ya parenchyma, chifukwa komwe sikokwanira kuteteza kwa ma enzyme ndi ma bicarbonates. Muzochita zamankhwala, mawonekedwe awa samapezeka kawirikawiri.

Zomwe zimapangitsa kuti Mfumukazi izikhala yoperewera komanso imapezeka mu zonse. Nthawi zambiri, kuwunika kwa mtheradi exocrine pancreatic insuffence kumawonedwa mu ana omwe ali ndi vuto lobadwa nawo monga:

• khunyu hypoplasia,
• kapamba ka chibadwa,
• Kukula kwa zonyansa za tchire.

Nthawi zambiri, mtundu uwu wa matendawa umayamba chifukwa cha matenda omwe amapezeka. Choopsa chachikulu mwa iwo ndi pancreatitis yayikulu kapena pancreatitis pachimake yotsitsimutsidwa ndi mankhwala azinyumba.

Kusakwanira kwachibale kumakula makamaka ngati njira yachiwiri yamatendawa, ndipo kumalumikizidwa ndi kulowa kwapovuta kwa pancreatic mu lumen yaing'ono yamatumbo kapena mayendedwe ake othamanga. Nthawi zambiri, ndi mawonekedwe awa, tiziwalo ta kapamba timagwira munjira yofananira, koma ma enzymes mwina alibe nthawi yoti amalize ntchito yawo kapena sangachite izi chifukwa cha kufinya kwathunthu kapena pang'ono pang'onopang'ono (kufinya) kwa kuwala kwa ma pancreatic ducts. Zopinga zazikulu ndi zipsera, zotupa kapena miyala mwanjira zomwe zimayimitsa madzi a pancreatic.

Kupanga kuwonongeka mu wachibale exocrine kusakwanira kwa gland ili ndi mawonekedwe. Nthawi zambiri, matenda a zam'mimba amakula malinga ndi zochitika monga:

1. Mu mucosa wamatumbo ang'onoang'ono, owonongeka pazifukwa zosiyanasiyana, katulutsidwe ndi cholecystokinin kamachepetsedwa kwambiri.
2. Chifukwa cha kutsika kwa mtengo wa intraduodenal pH pansipa 5.5, komwe ndikofunikira pakuyambitsa kwa michere ya pancreatic. Zotsatira zake, ma enzyme ochokera ku kapamba sangathe kuyambitsa.
3. Kuyenda kwa chakudya kudzera m'matumbo aang'ono kumasokonezeka, komwe kumayambitsa kusakanikirana kwa michere yopanda chakudya ndi mtanda wazakudya.
4. Kusasunthika kumayambitsa mikhalidwe yabwino kwambiri yolowera ndi kubereka kwa microflora ya pathogenic, komanso kupatsirana kwa matenda. Kukula kosalamulirika kwa mabacteria ang'onoang'ono am'mimba kumawononga ma enzyme omwe alipo.
5. Cholepheretsa kupita patsogolo kwamadzi a pancreatic amadziwika ndi kuchepa kwa bile ndi enterokinase.

Kuphatikiza apo, exocrine insuffuffing imatha kukhala chifukwa chosala kudya kapena kudya ndi mapuloteni ochepa. Kuperewera kwa mapuloteni nthawi zambiri kumayambitsa kuphwanya kwa enzymatic ntchito ya kapamba, komanso chifukwa cha chifuwa chachikulu.

Zizindikiro ndi mawonetseredwe azachipatala

Chizindikiro choyambirira komanso chachikulu cha exocrine pancreatic insuffence ndi kusachita koyipa kwa thupi pazakudya zamafuta, makamaka pamene yokazinga, ndi kuwonjezera kwa zonunkhira zambiri.

Wodwalayo amadandaula kuti akumva kupsinjika, nseru, kupweteka kwamtima, amasintha pang'onopang'ono atatha kudya mafuta. Zonsezi ndi chizindikiro cha kuchepa kwapang'onopang'ono kwa kutaya mphamvu m'mimba yaying'ono.

Ndi kukulira maldigestion, mafuta osasinthika amathamangira m'matumbo akulu, pomwe colonocyte secretion imalimbikitsa. Chifukwa cha izi, pali kuphwanya kwa caloforming ndi matumbo owonjezereka. Zizindikiro za steatorrhea, ndowe za khungu losasangalatsa la imvi ndi fungo la fetid, komanso mawonekedwe amafuta onyezimira, kapena mafuta onunkhira amadziwika. Mutha kuonanso kusakanikirana kwamitundu ina. Pafupipafupi imachulukanso, ziwonetsero zimatha kufika 6 pa tsiku.

Kwa odwala, zizindikiro monga kufalikira ndi kupweteka kwa m'mimba zimawonedwa.Mphamvu yochepetsedwa ya kusweka kwa mapuloteni pang'onopang'ono imatsogolera pakuchepa kwa mphamvu zama protein, zomwe zimafotokozedwa pakupita patsogolo kuwonda, kuchepa thupi komanso kuchepa magazi. Kusowa kwathunthu kwama mavitamini, ma macro ndi zinthu zambiri, komanso kuchepa kwa madzi m'thupi kumakhala kowopsa makamaka kwa ana. Izi zitha kukhala zowopsa pamoyo.

Kukakamizidwa kutsatira zakudya zokhwima, komanso mantha a chakudya omwe amayamba chifukwa cha mantha amtsogolo, kumathandizanso kuchepetsa kuchepa kwa thupi.

Kusowa kwamavitamini osungunuka kwamafuta kumawonetsedwa ndi chizindikiro cha ululu m'mafupa ndi mafupa, kukokana kwakanthawi, kuchuluka kwakukwiya - kusowa kwa vitamini "D".

Kuperewera kwa Vitamini K kumayambitsa magazi ochulukirapo, ndipo vitamini A hypovitaminosis imayambitsa kusawona bwino kwa khungu lowuma komanso misomali ya tsitsi ndi tsitsi.

Wodwala ali ndi kukhalapo kwa zizindikiro monga:

• khungu losakhala lachilengedwe
• kupuma movutikira ndi tachycardia pambuyo kuchita masewera olimbitsa thupi pang'ono,
• kutopa ndi kufooka kosalekeza.

Zonsezi ndi chizindikiro cha "B12" - kuchepa kwa magazi m'thupi.

Zinthu za exocrine kusowa kwa ana

Matenda a kapamba mwa ana ndiofala, koma amakhala amtundu, ngakhale milandu yaposachedwa yawonjezeka kwambiri. Pancreatitis ya ana, yonse komanso yovuta kwambiri, imapezeka kawiri masiku ano. Akatswiri amati izi zikuwonongeka kwazinthu zachilengedwe, kugwiritsa ntchito zinthu zamafuta m'zakudya za mwana, kuyamwa poyamwa, kusintha mkaka wa m'mawere ndikusakanikirana bwino, kuyambitsa zakudya zosakwanira, komanso zakudya zosayenera m'badwo.

Mawonekedwe amankhwala ndi zizindikiro za kapamba, kuchepa kwa mphamvu ya pancreatic, komanso zina za pancreatic ana, monga pancreatitis yayitali, ali ndi kusiyana kwawo ndi mawonekedwe kutengera mtundu wa matenda.

Cystic fibrosis

Ma genetic pathologies ndi zovuta zomwe zimakula mwa ana zimatenga malo oyamba mndandanda wazomwe zimayambitsa kapamba. Cystic fibrosis, kuphwanya kwachilengedwe kwa kuphwanya kwachinsinsi ntchito komanso kuwonongeka kwa minofu, ndizomwe zimayambitsa kusokonekera kwa exocrine gland.

Pathology imayamba chifukwa cha kusintha kwa masinthidwe amtundu wa jini, omwe amawongolera mawonekedwe ndi magwiridwe antchito a protein. Jini imapezeka m'matumbo a bronchi, matumbo ochepa, mapapo, ndi ziwalo za genitourinary system, koma zambiri zimakhala m'maselo a epithelial a ma pancreas a epancreas. Vutoli limawonedwa makamaka mu kupumira kwamankhwala ndi kapamba. Mwana amadwala matenda a kapamba komanso chifuwa chachikulu.

Pafupipafupi, matenda am'mimba amawonetsedwa ndi zizindikiro za steatorrhea. Ana otere nthawi zambiri amadwala matenda a bronchitis ndi chibayo, ndipo kuchira kumachepa kwambiri komanso nkovuta. Ali ndi mbiri ya atrophic gastritis ndi enterocolitis, komanso chifuwa chachikulu cha pancreatitis.

Kuthandiza kusowa kwa procrine mwa ana otere kumayambira pomwe apezeka ndi matenda ndipo amakhala moyo wonse. Chithandizo cha mankhwalawa chimaphatikizapo kudya kwa moyo wonse, zakudya zimasainidwa ndi adokotala malinga ndi zotsatira zaposachedwa zoyesedwa, kuchuluka kwakukulu kwa kukonzekera kwa pancreatic, ma steroid ndi mavitamini. Matendawa siabwino mokwanira, chifukwa minyewa ya pafupifupi ziwalo zonse imakhudzidwa. Ndipo maselo a kapamba samabwezeretseka.

Matenda a Schwahman

Congenital pathology yachilengedwe, yomwe imadziwika kuti Schwahman's syndrome, imafotokozedwa pakuperewera kwa pulase ya lipase yomwe imayambitsa kuphwanya, kugaya ndi kugawa zigawo zamafuta. Mtundu wa kuperewera kwa exocrine mwa ana kumawonekera chifukwa cha kuphwanya mu nthawi ya intrauterine.Panthawi yopanga kapamba, vuto lotere limachitika, lomwe limatsogolera pakukula kwake kapena hypoplasia. Pakuwunika magazi, mwana ali ndi neuropenia, thrombocytopenia komanso kuchepa magazi m'thupi. Ana ali kumbuyo kwambiri kuchokera kwa anzawo, nthawi zambiri pamakhala chotupa cha mutu wa fupa la m'chiuno kapena bondo, chifuwa chopapatiza, hypoplasia ya phalanges.

Chithunzi cha chipatala chimaphatikizapo:

• chithuzi
• Zizindikiro za kapamba,
• matenda ashuga
• sinusitis
• otitis media.

Mwana amatenga matenda a pakhungu, ndipo amakhala akuvutika ndi matenda opuma. Zimafunikira chakudya chokhwima.

Monga cystic fibrosis, chithandizo chimaphatikizira mankhwala othandizira ndi ma pancreatic, nthawi zina kuphatikiza maantibayotiki. Amadyetsa kwambiri malinga ndi boma lomwe lakhazikitsidwa. Chakudyacho chimalemekezedwa mu chilichonse ndipo chimasainidwa payekhapayekha.

Pancreatitis

Pancreatitis yovuta kapena yachilendo imachitika kawirikawiri kwa ana. Kwenikweni, kutupa kwa kapamba mwa mwana kumachitika motsutsana ndi malembedwe ena a pathologies omwe amakhala ndi vuto pa chithokomiro.

Mwachitsanzo, osati pancreatitis yokhazikika yomwe ingayambitse kuchepa kapena kuphwanya kwa ntchito zachinsinsi, komanso:

• matenda ang'onoang'ono matumbo
• kutsekeka kwachitetezo,
• ZhKB - cholelithiasis. M'zaka zaposachedwa, kuchuluka kwa cholelithiasis mwa ana osakwana zaka 10 kwachuluka kwambiri.
• kuvulala kwam'mimba ndi ziwalo zam'mimba,
• kuphwanya chitukuko cha kapamba ndi ndowe zake.

Zakudya zopatsa mphamvu zachinsinsi zokwanira, monga pancreatitis yayitali, ziyenera kukhala zokwanira, koma osati zokwiyitsa. Chakudya chopatsa thanzi chokwanira m'mapuloteni ena am'mimba ochepa komanso ochepa mafuta komanso chakudya chamagulu ambiri. Komanso muzakudya muyenera kukhala ndi mavitamini ambiri ofunikira kuti chimbudzi chikhale.

Kuphatikiza apo, gawo lofunikira lazakudya limakhala lokwanira lamadzi ndi sodium chloride.

Pomaliza

Njira zamakono zamankhwala zimapatsa anthu ovutika ndi exocrine kusakwanira mwayi wokhala moyo wokangalika. Kuthana ndi chithandizo chamankhwala chodwala matenda a pancreatitis kumathandiza. Ntchito yazinsinsi imabwezeretseka pang'onopang'ono.

Kutsatira zakudya, kuwongolera kwambiri zakudya, komanso mankhwala omwe amapezeka chifukwa cha kusowa kwa ma pancreatin ndi michere ya pancrealipase, kumawonetsa zotsatira zabwino.

Matenda a kapamba, monga mdani wamkulu wa kapamba, ndiosavuta kupewa kuposa kutsatira zakudya kwa moyo wonse, ndi mndandanda wazinthu zochepa.

Kutenga mbali kwa kapamba m'mimba

Chimbudzi chimatanthauzanso kukonzedwa kwa michere ya zinthu zovuta (mapuloteni, mafuta, chakudya) muzinthu zosavuta zomwe zimayamwa pambuyo pake.

Njira zazikulu za hydrolytic zimapezeka m'matumbo ang'onoang'ono, pomwe zakudya zimaphwanyidwa kukhala ma monomers, kumamwa, ndikulowetsa magazi ndi zamitsempha. Njira yothandizira kukonza michere m'matumbo ang'onoang'ono imachitika m'magawo atatu olumikizana, omwe adalumikizidwa ndi A. M. Ugolev (1967) mu lingaliro la "chimbudzi-chonyamula katundu": chimbudzi, chimbudzi, chimbudzi.

1. Gawo loyambilira la chakudya chamagetsi - chimbudzi cha patsekeke - limaphatikizanso kapangidwe ka chyme ndi ma hydrolysis azinthu zamagulu azakudya kupita ku dziko la oligo- ndi monomeric. Udindo wofunikira mu chimbudzi cham'mimbamo umaperekedwa kwa ma pancreatic enzymes.
2. Pancreatic Enzymes adsorbed pa michere ikupitabe gawo lotsatira, lomwe limapitilira mu parietal wosanjikiza. Kukonzanso komaliza kwa michere kumachitika pakumapeto kwakunja kwa ma enterocytes ogwiritsira ntchito matumbo hydrolases - uku ndikunyumba.
3. Kenako pakubwera gawo lotsiriza - mayamwidwe, i.e., kusamutsa kwa magawo ogawikawo a michere kuchokera ku lumen ya matumbo kulowa mkati mwa thupi.

Zikondazo zimatulutsa chinsinsi chomwe chimakhala ndi ma enzymes omwe amachepetsa mitundu yonse ya michere: mapuloteni, chakudya, mafuta. Mndandanda wa michere yayikulu ya kapamba komanso kutenga nawo gawo pang'onopang'ono mu tebulo. 1.

Ma Enzymes hydrolyzing chakudya ndi mafuta (alpha-amylase, lipase) amasungidwa mu malo omwe amagwira ntchito, ma protein enzymes (trypsin, chymotrypsin, elastase, carboxypeptidase) mu mawonekedwe a proenzymes omwe adayikidwa mu lumen yamatumbo ang'ono. Enzyme yamatumbo, enterokinase, yomwe imatembenuza trypsinogen kukhala yogwira trypsin, imakhala malo ofunikira kutsegula kwawo. Trypsin nayenso imayambitsa michere ina ya proteinolytic.

Mukukonzekera kugaya kwa patsekeke, ma carbohydrate (wowuma, glycogen) amawonongeka ndi pancreatic amylase kuti atulutse magazi pang'ono. Mothandizidwa ndi ma enzymes a proteinolytic, ma peptides ochepa a kulemera ndi glucose ochepa amapangidwa. Mafuta pamaso pa bile ndi hydrolyzed ndi pancreatic lipase kuti di- ndi monoglycerides wamafuta acid ndi glycerol.

Kuchita kwa michere ya pancreatic kumachepa pamene akusuntha kuchokera ku duodenum (duodenum) kupita ku terminal ileum. Mlingo wa kuchepa kwa ntchito ya ma enzymes amtundu ndiosiyana. Chifukwa chake, lipase imataya ntchito yake mosavuta ndipo mu ileamu nthawi zambiri imangotsimikizidwa pokhapokha. Mapuloteni, makamaka amylase, amakhala okhazikika ndipo amasungabe 30% ndi 45%, motero, zochitika zawo m'magawo am'mimba ochepa. Maziko a kuchepa kwa ntchito ya lipase ndi ma proteinol ake mothandizidwa ndi ma protein, ndipo koposa zonse, chymotrypsin. Kutsika kosagwirizana kwa ntchito ya ma enzymes kuchokera ku proximal mpaka intestine yaying'ono kumawonedwa onse amoyo wathanzi, makamaka kwa anthu omwe ali ndi chitetezo chokwanira cha pancreatic. Izi zikufotokozera kuti kuphwanya kwa chimbudzi cha mafuta kumayamba kale kwambiri kuposa wowuma kapena mapuloteni.

Pancreatic secretion regulation

Chinsinsi cha zikondwererozi chimakhala ndi zinthu ziwiri - ductal (isorganic) ndi acinar (organic).

Ductal epithelium imabisa chinsinsi chomwe chili ndi ma electrolyte, makamaka ma bicarbonates, pakupanga yankho lamadzi. Ntchito ya gawo ili la kapamba wamadzimadzi ndikutsutsana kwa acidic chapamimba kulowa kulowa m'matumbo a duodenum ndikusintha kwa chimbudzi m'mimba. Choyambitsa chachikulu chobisalira cha chigawo chapansi ndi secin, chomwe chimapangidwa ndi ma S-cell a duodenal mucosa poyankha zomwe zili asidi zomwe zimachokera m'mimba.

Pancreatic acinus glandulocytes synthesize ndi secrete hydrolytic michere mothandizidwa ndi pancreosimine (cholecystokinin), yomwe imapangidwa ndi ma J-cell a duodenal mucosa. Chomwe chimatithandizira kutulutsa pancreosimine makamaka ndi chakudya.

Clinic komanso matenda a zovuta zam'mimba chimbudzi ndi exocrine pancreatic ntchito

Chizindikiro chimodzi choyambirira cha vuto la kugaya chakudya ndimatenda. Zidutswa zimakhala mafuta, zonyezimira, zachilendo. Odwala omwe ali ndi vuto lalikulu la exocrine pancreatic ntchito amadandaula kuti amatulutsa, kupanga kwambiri kwa mpweya, kumverera kwa magazi ndi kugundidwa pamimba. Milandu yayikulu kwambiri, polyphecalia, steatorrhea, kutsegula m'mimba ndi kuwonda.

Njira yoyenera kwambiri yophunzirira kupuma kwa pancreatic pancreatic ndi kutsimikiza kwa pancreatic elastase-1 mu ndowe. Mwayi waukulu wodziwitsa fecal elastase-1 ndi enzyme immunoassay ndikuti elastase-1 ili yokhazikika kwa kapamba, elastase-1 satsala pang'ono kuwonongedwa akamadutsa m'matumbo, kusinthasintha kwa zochitika za stool elastase sikokwanira, komwe kumatsimikizira kukonzanso kwakukulu kwa zotsatira, njirayi imatsimikiza munthu elastase, chifukwa chake, mayeso sakutengera chithandiziro chakukula kwakanthawi.

Ntchito yachilendo ya exocrine pancreatic imatsimikiziridwa ndi elastase-1 mtengo wa 200 mpaka 500 μg mu 1 g ya ndowa ndi pamwamba, wofatsa komanso wofatsa - 100-200 μg / g, woopsa - osakwana 100 μg / g.

Malangizo a kusokonezeka kwam'mimba chimbudzi ndi ma pancreatic michere

Kukonzekera kwa kondomu kumapeto kwake kumagwiritsidwa ntchito kulipirira chimbudzi.

Tsopano kwakhazikitsidwa kuti mankhwala opangira mankhwala omwe amathandizirana m'malo mwa chithandizo chamankhwala ayenera kukhala ndi awa:

• ntchito zaposeti zapamwamba,
• kukana kwa chapamimba madzi
• kutuluka mofulumira m'mimba ndikusakaniza ndi chyme,
• kusungunuka kwakanthawi kwa membrane wa microcapsule m'matumbo aang'ono,
• kumasulidwa mwachangu kwa michere yogwira ntchito m'mimba yaying'ono,
• kutenga nawo mbali pamimba.

Ma Microgranular mitundu ya enzyme yokonzekera imakwaniritsa izi. Pancreatin microtablets ndi awiri a 1 mpaka 2 mm, wokutidwa ndi asidi wosagwira, wokutira, amaikidwa mu kapisozi ka gelatin. Kusungunuka m'mimba m'mphindi zochepa, kapisozi kamatulutsa micronanules omwe amakhala osagonjetseka ndi madzi am'mimba kwa maola 2. Ma Microganeles amakhala osakanikirana ndi chymechamu cham'mimba ndikutulutsidwira m'matumbo aang'ono, komwe amasungunuka mwachangu m'malo otetezeka. Chifukwa chake, kuyambika kwakanthawi kwa mankhwala m'matumbo ang'ono kumatsimikiziridwa.

Lipase limataya msanga ntchito yake, yomwe imawonetsedwa ndi steatorrhea. Chifukwa chake, pakukonza kwa exocrine pancreatic insuffuffence, choyambirira, amatsogozedwa ndi zomwe zili lipase pamankhwala.

Kukula kwa ma microbead ndikofunikira kwambiri kudziwa kuthamanga kwawo komanso nthawi yake yotuluka kuchokera m'mimba. Dongosolo la ma micogranules liyenera kukhala 1.4 ± 3.0 mm kuti liwonetsetse kuyenda kwawo munthawi yomweyo ndi chakudya kudzera pyloric sphincter. Mapiritsi a Mini (2 mamilimita awiri, opanda mawonekedwe) samapereka gawo labwino.

Zomwe zimakonzekera zazikulu za Microganular polyenzyme zimaperekedwa pagome. 2 ndi 3.

Kwa odwala ambiri omwe ali ndi kuchepa mphamvu kwa exocrine pancreatic ntchito, kutenga makapisozi a 1-2 (10,000-20,000 IU of lipase) ndi chakudya ndikokwanira kuti athetse steatorrhea. Mwa mitundu yayikulu ya kusakwanira ndi steatorrhea yoopsa, kuchuluka kwa makapisozi omwe amatengedwa kumawonjezeredwa mpaka 4-5.

Mukamayambitsa kukonzekera kwa enzyme, ndikofunika kuyang'ana kwambiri mulingo wa elastase-1 mu ndowa (tebulo. 4).

Tawunika momwe Micrasima ikukonzekera.

Odwala a 50 omwe ali ndi CP yokhala ndi exocrine pancreatic insuffuffence adayesedwa. Gulu la odwala 30 limalandira Mikrasim 10,000 unit 2 makapisozi 3 katatu pa tsiku kwa masiku 14 ndipo gulu lolamulira (odwala 20) amalandira mapiritsi 4 a Pancreatin katatu patsiku kwa masiku 14.

Kuchita bwino kwathunthu kunayesedwa ngati: kutchulidwa, kwabwino, kokhutiritsa, kopanda zotsatira. Mphamvu zopweteka, kusuntha kwa matumbo, komanso kusasunthika kwa chopondacho kunawaganiziridwa.

Kafukufukuyu adawonetsa kuti Mikrasim yotchulidwa kwambiri kuposa pancreatin ya piritsi, imakhudza kusintha kwa chimbudzi, kuchepetsa kupweteka kwam'mimba komanso kuphatikizira kwanyumba.

Kuchita kwa kukonzekera kwa enzyme kumawonjezereka ndikuwonjezeranso ma antisecretory agents (H 2 -blockers, proton pump inhibitors) ku mankhwalawa pancreatin, popeza momwe mulingo woyenera wa michere yamapanchipini imapezeka pamene pH mu lumen ya m'matumbo ang'ono ikupitilira 5.0.

Zomwe zimapangitsa kuti ntchito yathu isagwire bwino ntchito zingakhale zotsatirazi:

• matenda olakwika okhazikika (steatorrhea of ​​non-pancreatic source, giardiasis, celiac matenda, kwambiri tizilombo toyambitsa matenda a m'mimba yaying'ono),
• kuphwanya regimen yoikidwa (kuchepetsa pafupipafupi kumwa mankhwalawa, mothandizana ndi chakudya),
• kudya kosakwanira kwa enzyme, kuchepa kwa ntchito ya mankhwalawa chifukwa chosungika kwakanthawi kapena kosayenera,
• inactivation ya enzyme mu acidic zam'mimba.

Pomaliza

Kwazaka makumi angapo zapitazi, pakhala kuwonjezeka kowonekera kwambiri kwamatenda a kapamba ndipo, chifukwa chake, odwala omwe ali ndi exocrine pancreatic insuffence omwe amafunikira chithandizo chamankhwala. Kugwiritsa ntchito kwa mayesowo kwatsopano - kutsimikiza kwa elastase-1 mu ndowe kunapangitsa kuti athe kuzindikira bwino za exocrine pancreatic insuffence ndikuwunika zotsatira za mankhwala. Chiwerengero chambiri cha kukonzekera kwa enzymatic kosiyanasiyana kwamphamvu ya enzymatic ntchito kunonekera. Mitundu yamakono yamapiritsi, momwe ma enzymes a pancreatic adatsekera mu micronanules (Pancytrate, Creon, Mikrazim), amalola ngakhale zovuta kwambiri zam'mimba kuti zikonzedwe.

1. Brooklis E.R. Ivashkin V.T. Matenda a kapamba: etiology ya pathophysiology ndi mankhwala othandizira // Ros. zhur. gastroen., hepatol., coloproct. 2006. Ayi 6. S. 79-86.
2. Vinogradova L.V., Trubitsyna I.E., Gubina A.V., Chikunova B.Z. Yogwira pancreatic insuffuffing ndi kukonzanso kwake kutengera gawo la pancreatitis yayitali // khansa ya m'mawere. 2010. Ayi 13. S. 837-840.
3. Gastroenterology ndi hepatology: kuzindikira ndi chithandizo. Ndondomeko ya madokotala / ed. A.V. Kalinina, A.F. Loginov, A.I. Khazanov. M: Kuganizira zamkati. 2011.864 s.
4. Hubergrits N. B., Khristich T. N. Matenda a kapamba. Donetsk, 2002.413 s.
5. Kalinin A.V. Matenda a kapamba: kuzindikira, kuchiza, kupewa // Kawonedwe. gastroen. hepatol. 2007. Ayi 1. S. 37-40.
6. Mayev I.V., Kazyulin A.N., Kucheryavy Yu.N. Matenda a kapamba M: Mankhwala, 2005.504 s.
7. Simonekov V.I., Poroshina E.G. Kugwiritsa ntchito mosiyanasiyana muzochitika zamankhwala zamapiritsi ndi michere yokonzekera michere..Mankhwala ogwirizana. 2011.S. 83-88.

A.V. Kalinin,Doctor wa Medical Science, Pulofesa

GU MONIKI iwo. M.F. Vladimirsky Ministry of Health and Social Development of Russia, Moscow

- chinsinsi chochepa kapena ntchito yochepa ya michere ya pancreatic, zomwe zimayambitsa kusokonekera kwa kuwonongeka ndikupezeka kwa michere m'matumbo. Imadziwonetsa ngati kunenepa kwambiri, kuwonda, kuchepa kwa magazi, kusinza, polypecal, kutsekula m'mimba ndi polyhypovitaminosis. Kuzindikira kumakhazikitsidwa ndi njira zasayansi zophunzirira katulutsidwe wakunja wa kapamba, kuchititsa pulogalamu, kutsimikiza kuchuluka kwa ma enzymes mu ndowe. Chithandizo chimaphatikizapo chithandizo cha matenda oyambitsidwa, kuchuluka kwa michere, kusintha kwa michere ya pancreatic, ndi chithandizo chamankhwala.

Zizindikiro

Kufunika kofunikira kuti muzindikire kuperewera kwa pancreatic enzyme ndizoyesa kwapadera (kafukufuku ndi zosafunikira), zomwe nthawi zambiri zimaphatikizidwa ndi njira za ultrasound, radiology ndi endoscopic. Njira za Probe ndizokwera mtengo kwambiri ndipo zimapangitsa kuti odwala asamasangalale, koma zotulukapo zawo ndizolondola. Mayeso osafunikira ndi otsika mtengo, ofatsa omwe amalekeredwa ndi odwala, koma amapangitsa kuti azitha kudziwa kuperewera kwa pancreatic kokha ndi kuchepa kwakukulu kapena kusowa kwathunthu kwa ma enzymes.

Mayeso achindunji a probe secretin-cholecystokinin ndi muyezo wagolide wofufuza kuperewera kwa mapiritsi a pancreatic. Njira imakhazikitsidwa ndi kukondoweza kwa katulutsidwe ka pancreatic ndi makina a secretin ndi cholecystokinin, otsatiridwa ndi zitsanzo zingapo zam'mapepala a duodenal ndi gawo la mphindi 10. Mu zitsanzo zomwe zapezeka, ntchito ndi kuchuluka kwa katemera wa pancreatic, mulingo wa ma bicarbonate, zinc, ndi lactoferrin amaphunziridwa. Nthawi zambiri, kuchuluka kwa katulutsidwe pambuyo pa mayeso ndi 100%, kuchuluka kwa ma bicarbonates ndi 15%. Kuwonjezeka kwa kuchuluka kwa katulutsidwe ochepera 40%, kusowa kwa chiwonjezero cha mabicarbonates, kumayankhula za kuchepa kwa mapangidwe a kapamba. Zotsatira zabodza zimatheka ndi matenda a shuga, matenda a celiac, hepatitis, ndikadzakhala gawo limodzi la m'mimba.

Kuyesedwa kosadziwika kwa Lund kuli kofanana ndi njira yapita, koma kubisala kwapancreatic kumatheka chifukwa chobweretsa chakudya chama test. Kuwerenga uku ndikosavuta kuchita (sikutanthauza jakisoni wa mankhwala okwera mtengo), koma zotulukapo zake zimadalira kapangidwe ka chakudya choyesa.Zotsatira zabwino zabodza zimatheka ngati wodwala ali ndi matenda a shuga, matenda a celiac, gastrostomy.

Njira zosafunikira zimachokera pakubweretsa zinthu zina mthupi zomwe zimatha kulumikizana ndi ma enzymes mu mkodzo ndi seramu yamagazi. Kafukufuku wazinthu za metabolic za kuyanjana uku kumapangitsa kuti ntchito yama pancreatic igwiritse ntchito. Mayeso omwe sangatheke amaphatikizapo bentiramide, pancreato-lauryl, iodolipol, triolein ndi njira zina.

Kuphatikiza apo, munthu amatha kudziwa kuchuluka kwa katulutsidwe ka kapamba pogwiritsa ntchito njira zosamveka: ndi kuchuluka kwa mayamwidwe a plasma amino acid ndi kapamba, mwakuwunikira bwino kwa pulogalamuyo (zomwe zimakhala zamafuta ndi sopo) kudzachulukitsidwa motsutsana ndi maziko a mafuta achilengedwe), kuchuluka kwa ndowa, ndinthu zina zamkati mwa fisi. elastase-1.

Njira zozindikira ngati chida (radiography of the m'mimba patsekeke, MRI, CT, ultrasound ya kapamba ndi hepatobiliary system, ERCP) amagwiritsidwa ntchito pozindikira matenda oyamba komanso ogwirizana nawo.

Chithandizo cha kuperewera kwa enzyme

Chithandizo cha exocrine pancreatic insufficiency iyenera kukhala yokwanira, kuphatikizapo kukonza zakudya zaumoyo, etiotropic ndi mankhwala othandizira, othandizira chithandizo. Etiotropic therapy imapangidwa makamaka poletsa kupitirira kwa imfa ya pancreatic parenchyma. Kuwongolera machitidwe a kudya kumakhala ndikuchotsa kugwiritsa ntchito mowa ndi kusuta fodya, kuwonjezera kuchuluka kwa mapuloteni m'zakudya mpaka 150g / tsiku, kuchepetsa kuchuluka kwa mafuta osachepera kawiri pazachilengedwe, komanso kumwa mavitamini pazithandizo zochizira. Ndi kukomoka kwambiri, zakudya zochepera kapena zathunthu za makolo zingafunike.

Chithandizo chachikulu cha kuperewera kwa pancreatic enzyme ndikutengera moyo wonse kudya michere ndi chakudya. Zisonyezo za enzyme m'malo mankhwala pancreatic akusowa: steatorrhea ndi kutaya kwamafuta oposa 15 g kugogoda, pang'onopang'ono mapuloteni mphamvu mphamvu.

Kukonzekera kwa michere ya microganular mu chipolopolo chosagwira asidi, chokhala ndi kapisozi ya gelatin, imakhala ndi ntchito yabwino kwambiri masiku ano - kaphatikizidwe kamasungunuka m'mimba, ndikupangitsa kuti pakhale kusakanikirana kwa magawo a mankhwala ndi chakudya. Mu duodenum, mutafika pH ya 5.5, zomwe zili m'mipukutuyi zimamasulidwa, ndikupereka kuchuluka kokwanira kwa michere ya pancreatic mu madzi a duodenal. Mlingo wa mankhwala amasankhidwa payekha, kutengera kuopsa kwa matendawa, kuchuluka kwa chinsinsi cha pancreatic. Miyezo yothandiza pakubwezeretsa mankhwala ndikwanira kwamalingaliro a kukonzekera kwa enzyme ndikulemera kwambiri, kuchepa kwaulesi, komanso chopondapo chambiri.

Zotsogola ndi kupewa

Kukula kwa matenda a kapamba chifukwa cha kuchepa kwa matenda oyambitsidwa ndi kuwonongeka kwa pancreatic parenchyma. Popeza kuti kuperewera kwa pancreatic encyme kumayamba ndi kufa kwa gawo lalikulu la chiwalo, matendawa nthawi zambiri amakayikira. Ndikotheka kuti muchepetse kukula kwa vutoli pozindikira matenda ake komanso kuchiza matenda a kapamba, kukana kumwa mowa, ndi kusuta.

Zizindikiro za kuperewera kwa kapamba (zomwe zimatchulidwanso kuti kapamba) zimaphatikizira kumverera kolemetsa m'mimba (nthawi zambiri kumatha maola angapo mutatha kudya zakudya zamafuta), komanso kugunda kwamtima pafupipafupi, mafupa opweteka ndi zizindikiro zina zambiri, zomwe tidzakambirana pambuyo pake m'nkhaniyo.

Zikondazo zimagwira gawo lofunikira mthupi la munthu, ndipo zizindikiro zofananazo zikuwonetsa kuti zimasiya kugwira ntchito mwanjira zonse.

Izi zitha kuchititsa kuti machitidwe onse amthupi amalephera.

Kulephera kwa pancreatic

Monga matenda ena aliwonse, kusowa kwa kapamba kumakhala ndi zomwe zimayambitsa.

Chiwalo ichi cha chimbudzi ndi chimbudzi chachikulu kwambiri cha thupi, chomwe kwa nthawi yayitali chimatha kugwira ntchito "kuvala", ndipo nthawi yomweyo osapereka zizindikiro za kupsinjika.

Zikondamoyo zili ndi ntchito za endocrine komanso exocrine.

Ndi thandizo lawo, thupi limatha kuyendetsa kagayidwe kachakudya mthupi ndikutulutsa ma enzymes omwe amathandizira kuphwanya zigawo zovuta za chakudya m'matumbo.

Ngati kapamba pazifukwa zina atasiya kusekemera madzi a kapamba omwe ali ndi michere ya m'mimba, ndiye kuti kapangidwe ka kapamba kake kamachitika.

Mndandanda wa zifukwa zazikulu zomwe zosokoneza mu chimbudzi chitha kupezekera ndi izi:

• kusintha kwamomwe maselo a ziwalo,
• kuchepa kwa mavitamini a gulu B, mavitamini C ndi E, nicotinic acid,
• kuchuluka kwa mapuloteni ndi hemoglobin m'magazi,
• Kudya zakudya zamafuta, zonunkhira kwambiri komanso zamchere.

Ma cell a kapamba amatha kusinthika chifukwa chomwa zakumwa zoledzeretsa. Zotsatira zake, minofu ya ziwalo imaloŵedwa m'malo ndi minyewa yolumikizana, yomwe imasokoneza thupi lonse.

Mwachitsanzo, chitsulo chimatha kusiya kutulutsa insulini, yomwe thupi limafunika kuyamwa glucose. Monga momwe mumadziwira, chifukwa cha kuphwanya kotero, munthu amakhala wodwala matenda ashuga.

Kuphatikiza apo, minofu ya gland imatha kukhudzidwa ndi matenda, chiwopsezo cha helminthic ndi matenda a collagen.

Koma zofala kwambiri za pathologies zomwe zimakhudzanso kapangidwe kazinthu zopanga zam'mimba ndizopweteka komanso kupweteka kwa kapamba.

Mavitamini a gulu B amatenga nawo gawo pa kapangidwe ka michere, popanda chiwindi kusiya kugwira bwino ntchito.

Ngati chinsinsi cha ma enzymes ndi bile mu duodenum 12 chikuphwanya, ndiye kuti chimbudzi sichingayende bwino.

Ndi kuperewera kwa kapamba, mavitamini a gululi amaphatikizidwa ndi mankhwala. Kuperewera kwa Nicotinic acid (B 3 kapena PP) kumapangitsa kuchepa kwa trypsin, amylase ndi lipase.

Kuperewera kwa mavitamini C ndi E kumapangitsa kuti ma gallstones apange.

Mwa zina zazikulu zomwe zimapangitsa kuti munthu akhale ndi kuphwanya kwa ntchito kapamba, pali cholowa cham'tsogolo.

Pankhaniyi, ngakhale moyo wokhala ndi pafupifupi zakudya ndi zakudya sizingatsimikizire kuti matendawa samawonekera.

Kuperewera kwa pancreatic kumatha kukhala kwamitundu inayi: exocrine, exocrine, enzymatic ndi endocrine.

Mtundu uliwonse wa matenda am'mimba uli ndi zomwe zimayambitsa kupezeka, zizindikiro za zochitika ndi mawonekedwe a chithandizo, zomwe tikambirana pansipa.

Exocrine ndi exocrine kusakwanira

Mawu akuti exocrine pancreatic insufficiency amagwiritsidwa ntchito pochita zachipatala pochepetsedwa ndikupanga pancreatic secretion, zomwe zimapangitsa kuti magawo azakudya zovuta azikhala zinthu zofunikira, zomwe zimatengedwa mosavuta ndi thupi.

Kuchepa kwa kapangidwe ka enzyme yogaya chakudya kameneka kukufotokozedwa ndi kuchepa kwa kuchuluka kwa maselo mu kapamba omwe amachititsa kuti apange.

Zizindikiro za exocrine kusakwanira zimatha kudziwika ndi zizindikiro zenizeni, chifukwa ndi thandizo lawo kuti ndizotheka kuzindikira mtundu wamtunduwu wa matenda.

Pankhaniyi, munthu samangolekerera zakudya zazonunkhiritsa komanso zamafuta, monga momwe amachidya, chopondacho chimasweka ndipo kwanthawi yayitali kulemera m'mimba kumamveka.

Mwa anthu ena okhala ndi exocrine pancreatic insufficiency, colic ndi bloating zimachitika.

Nthawi zambiri, Zizindikirozi zimaphatikizidwa ndi kuwoneka kwa ululu m'mafupa ndi kupweteka, kuwoneka kufupika ndi kugunda kwamtima mwachangu.

Zizindikiro zonsezi zimawonekera chifukwa cha kuperewera kwamafuta omwe sangatengeke ndi thupi, koma ndizofunikira kwambiri pakugwira kwake ntchito kwadongosolo.

Zina mwazomwe zimayambitsa kukanika kwa procrine ndi kuchepa kwa kugwira ntchito kwa exocrine cell misa ndi secretion mu duodenum.

Chithandizo cha kuperewera kwa kapamba kameneka kumaphatikizapo kutsatira zakudya zamagulu komanso kugwiritsa ntchito mankhwala omwe amalimbikitsa ntchito ya pancreatic (Mezim, Pancreatin).

Kuperewera kwa pocreatic pancreatic kumachitika ndi kuperewera kwa madzi a pancreatic, omwe amachititsa kuti magwiridwe antchito azikhala bwino komanso osasunthika.

Zizindikiro za exocrine kusakwanira amachepetsa kugaya bwino m'mimba, mawonekedwe a nseru komanso kumva kupsinjika m'mimba. Zinthu zonsezi zimaphatikizidwa ndi chopondapo chopondapo ndi bata.

Zomwe zimapangitsa munthu kuyamba kukhala ndi exancine pancreatic insuffuffence amachepetsedwa ndikuyenda bwino kwa m'mimba, chikhodzodzo ndulu ndi duodenum.

Kenako, kulephera kwa kugwira ntchito kwa ziwalo zam'mimbazi kumatha kuchitika pang'onopang'ono chifukwa cha njala, kumwa zakumwa zoledzeretsa pafupipafupi komanso zakudya zosayenera.

Dziwani kuperewera kwa procrine pogwiritsa ntchito zotsatira za kuyesa kwa magazi.

Ndizofunikira kudziwa kuti anthu omwe ali ndi mtundu uwu wa pathology ali pachiwopsezo chachikulu chotenga matenda a shuga, chifukwa chake amalimbikitsidwa kupereka magazi kuti apange shuga.

Chithandizo cha kukomoka kwa exocrine chithupsa kumatha kuchotsa chomwe chimayambitsa matendawa, kutsatira zakudya, kumwa mavitamini ndi mankhwala omwe amathandizira kutulutsa madzi a pancreatic.

Enzyme ndi endocrine kusowa

Enzymatic pancreatic insufficiency imapezeka ndi kuperewera kwa madzi am'mimba amtundu wina wa chakudya cham'mimba, omwe amathandiza kugaya chakudya.

Pazifukwa zazikuluzikulu za kuchepa kwa enzyme, ndikofunikira kufotokoza:

• kusintha kwachilengedwe m'maselo a kapamba, omwe angachitike chifukwa chokhala nthawi yayitali ndi maantibayotiki ndi mankhwala ena.
• kuwonongeka kwa ngalande ya pancreatic (kukulitsa kwa dambo la Wirsung),
• zida zam'mimba,
• matenda ndi matenda.

Zizindikiro kuti munthu ali ndi enzymatic pathology ya kapamba zimawonekera ndi zofanana ndi zomwe zimachitika pakakhala kusagwira bwino ntchito m'matumbo.

Choyamba, uku ndikuphwanya kwa chopondapo, chomwe nthawi zambiri chimawonetsedwa ndi matenda am'mimba, amadziwika ndi fungo la fetid.

Poyerekeza ndi kutsekula m'mimba kwa nthawi yayitali, anthu ena amakhala ndi vuto lofooka komanso ofooka nthawi zambiri. Kuperewera kwa chakudya ndi mawonekedwe a nseru zimayendera limodzi ndi kupangika kwa mpweya komanso kumverera kowawa m'mimba.

Kukwanira kwa Enzymatic kumapezeka pogwiritsa ntchito zotsatira za kuyezetsa magazi ndi zamankhwala am'mimba, urinalysis ndi ndowe, pogwiritsa ntchito tomography ndi ultrasound.

Chithandizo cha matenda amtunduwu zimaphatikizapo kutsatira zakudya zomwe dokotala wamupatsa ndi kumwa mankhwala omwe angakupatseni chithandizo chofunikira pa kapamba.

Endocrine (intrasecretory) kuperewera kwa pancreatic amadziwika ndi kuchepa pakupanga mahomoni, kuphatikizapo insulin, glucagon ndi lipocaine.

Njira zamtunduwu ndizowopsa kwambiri chifukwa zimatha kuyambitsa machitidwe osasintha m'thupi la munthu.

Cholinga chachikulu cha kuchepa kwa kupanga kwa mahomoni awa chimatsikira pansi kuti chiwononge madera omwe kapamba omwe ali ndi udindo wopanga.

Zizindikiro za zovuta za intrasecretory zimadziwonetsa ngati zopatuka za kuchuluka kwa mahomoni muzotsatira zoyesa magazi.

Vutoli limaphatikizidwa ndimatumbo amadzi pafupipafupi komanso maulemu, momwe fungo la fetid limakhazikika.

Poyerekeza ndi kuwonjezeka kwa matumbo a matumbo, kuchepa kwa madzi m'thupi kumachitika, komwe kumayambitsa kufooka kwathunthu.

Dokotala wodziwika ndi endocrine pancreatic matenda ofanana ndi kulephera kwa enzymatic.

Kuchiza kumaphatikiza chakudya chomwe chikuyeneranso kuchepetsa kuchuluka kwa shuga m'magazi ndi kumwa mankhwala omwe amafunsidwa makamaka kwa wodwala aliyense.

Zikondazo zimagwira ntchito zofunika mthupi zomwe zimatsimikizira kuti thupi limagwira bwino ntchito. Monga mawonekedwe aliwonse amkati, kapamba amatha kudwala matenda aliwonse, chifukwa chake magwiridwe ake amachepa. Chimodzi mwazinthu izi zamatenda ndi kuperewera kwachitsulo.

Chifukwa chachitukuko

Kasitomala amatenga ntchito yopanga ma enzymes enaake, pakadakhala kuti njira yachilengedwe yogaya chakudya ndiosatheka.

Zolephera zikapezeka pakupanga zinthu izi ndipo chitsulo chimayamba kugwira ntchito moperewera, ndiye kuti izi zimatchedwa pancreatic insufficiency.

Pali zifukwa zingapo za kuperewera kwa kapamba. Izi zikuphatikiza:

• Kuperewera kwa Vitamini
• Zowonongeka kwa kapamba
• Kuperewera kwa hemoglobin
• Kuperewera kwa mapuloteni m'magazi,
• Zakudya zopanda thanzi, kugwiritsa ntchito molakwika zakudya zamchere, zakudya zamafuta, zonunkhira zachilendo, zonunkhira, etc.
• Khalidweli
• Matenda ofanana ndi lipomatosis, cystic fibrosis, Schwachmann syndrome,
• Imfa ya maselo a chithokomiro kumbuyo kwa kapamba kapenanso kuchotsedwa kwina kwa chiwalo.

Nthawi zina pali zinthu zingapo zomwe zimayambitsa kukula kwa matenda. Ndipo zitha kuti wodwalayo akuwoneka wathanzi, amakhalanso ndi moyo wathanzi, amadya moyenera, koma kuperewera kwa kapamba kumapezeka. Zikatero, zifukwa zimayambira kubadwa kwa makolo.

Zosiyanasiyana za matendawa: zimayambitsa, Zizindikiro, matenda ndi njira zochizira

Akatswiri amasiyanitsa mitundu inayi ya magwiridwe antchito osakwanira a pancreatic, omwe ali ndi mawonekedwe amtundu wake, mpaka etiology kapena njira yothandizira.

Kuperewera kwa kapamba kungakhale:

• Wopusa
• Wopusa
• Zosangalatsa
• Endocrine.

Popeza aliyense mwa mitunduyo ali ndi kusiyana kwakukulu, ndiye kuti ayenera kuganiziridwa mosiyana.

Exocrine pancreatic kuchepa

Kuperewera kwa procrine pancreatic kumatchedwa pathology momwe kumakhala kuperewera kwa timadziti kwa njira yodalirika yazakudya. Zizindikiro za kuperewera kwa kapamba ndi izi:

1. Zotsatira zoyipa
2. Kufalikira
3. Kumverera kolemetsa mu epigastrium,
4. Mavuto a Stool
5. Chimbudzi cholakwika.

Mavuto osiyanasiyana am'mimba komanso ma pancreatic pathologies chifukwa cha kusintha kwa tiziwalo timene timayambitsa matenda. Kuphatikiza apo, exocrine insuffuffing ikhoza kukhazikitsidwa motsutsana ndi maziko a ndulu kapena matenda am'matumbo, kufa ndi njala kwambiri kapena kuvutitsidwa ndi zakudya zama mono.

Kuperewera kwa exocrine kumatha kupezeka pokhapokha pofotokoza matenda athunthu. Ndi kusakwanira kwa kapamba wotere, chiopsezo chokhala ndi matenda a shuga chikuwonjezereka, motero odwala awa amafunika kuyang'ana shuga wawo wamagazi nthawi zonse.

Kupambana kwamankhwala kumadalira mwachindunji kukhazikitsidwa kwa etiology ya pathological process. Pokhala ndi zomwe mumadya kapena mowa, mudzafunika kusintha moyo wanu pakusiya zakudya zamphamvu komanso zakumwa.

Pazakudya zokhala ndi vuto lofanana ndi kapangidwe kazitsulo ka pancreatic, mavitamini monga ascorbic acid, tocopherol ndi retinol ayenera kukhalapo.Kuphatikiza apo, kukonzekera kwa enzymatic kumayikidwa kwa odwala omwe amathandiza gland kuti ichite bwino ntchito zachinsinsi.

Endocrine

Mtundu wina wa kusowa kwa pancreatic amawonedwa kuti ndi endocrine kapena intrasecretory.

Ntchito zazikuluzikulu za ntchito ya endocrine ndikupanga zinthu za m'magazi monga glucagon, lipocaine kapena insulin. Ngati cholephera chachitika muntchito iyi, ndiye kuti zotsatirapo zakepi lathu sizikhala zosakanika.

Kukhalanso kwofananira kumakonda kukhala komwe kumachitika chifukwa cha zotupa za ma glandular (ma islets a Langerhans) omwe amachititsa kuti pakhale chinthu china cha mahomoni. Ndi zotupa zoterezi, kuopseza kwa matenda a shuga kumatha kukhala wodwalayo.

Endocrine pancreatic kusakwanira kumawonetsedwa ndi mawonekedwe monga:

• Fungo loipa la mpweya wotulutsa,
• Kuchepetsa mseru
• Kufalikira ndi kutsegula m'mimba ndi fungo la fetid la ndowe,
• Kuchulukitsa kwamatumbo
• Kuyeserera kwa magazi kwawoko kukuwonetsa kukhalapo kwa zonyansa.

Kuphatikiza apo, pali zizindikiro za chikhalidwe chofanana, monga kuchepa kwa wodwala komwe kumachitika motsutsana ndi maziko am'madzi chifukwa cha m'mimba.

Matendawa ndi ofanana ndi mitundu ina ya kapangidwe ka kapamba.

Pambuyo pozindikira kuti ali ndi matenda, wodwalayo amapatsidwa mankhwala okhwima kwambiri omwe amachepetsa shuga m'magazi. Ngati zakudya zopanda pake zilibe ntchito, jakisoni wa insulin amapatsidwa.

Ndikothekanso kukhala ndi moyo wamtunduwu, koma kudya kwambiri kumayenera kukhala kwazonse popanda kusiyanitsa kapena kukhululuka.

Malinga ndi ziwerengero, anthu opitilira 30% ali ndi mtundu winawake wa kusowa kwa kapamba. Wina akudziwa za matenda awo ndipo adachitapo kale kanthu kuti athetse, pomwe wina ndi wopanda nzeru, zomwe zimangokulitsa vutoli.

Chachikulu ndichakuti, pamaso pa kusowa kwa kapamba aliyense, tsatirani mosamalitsa zakudya zanu ndikumamwa mankhwalawa malinga ndi chiwembu chokhazikitsidwa.

Zachidziwikire, matenda oterewa kwa munthu aliyense amaphatikizidwa ndi zomverera zosasangalatsa, koma ngati wodwalayo asiya zizolowezi zosayenera komanso chakudya chopanda thanzi, ndiye kuti moyo wabwino umayenda bwino ndipo matendawa amaleka.

Ngati wodwala motsutsana ndi maziko a kudalira mowa atapeza kuperewera kwa kapamba, ndiye kuti atakana kumwa mowa wonse, azikhala ndi moyo zaka zina 10.

Komabe, ngati wodwalayo apitilizabe kumwa mowa ndi kudya zakudya zoletsedwa, ndiye kuti patatha zaka zochepa amakhala kuti waphedwa. Chifukwa chake, HLS ndi kadyedwe kokhala ndi vuto lofananirali sikuti ndi lingaliro chabe la dokotala, koma chinsinsi chakuteteza moyo.

Kanema wonena za kuchepa kwa chitetezo cha pancreatic:

- Ichi ndi chiwalo chofunikira kwambiri mwa anthu. Imagwira ntchito zambiri zomwe zimatsimikizira kuyendetsa bwino kwa thupi. Monga chiwalo china chilichonse, kapamba amatha kugwiritsa ntchito bwino. Chimodzi mwazofala kwambiri ndi kuchepa kwa kapamba.

Pali mitundu ingapo ya kuperewera kwa kapamba

Monga matenda ena onse, izi zimakhalanso ndi zifukwa zomwe kuperewera kumayamba. Mu kapamba, ma enzyme apadera amapangidwa, popanda zomwe zimachitika kuti chimbudzi chitha.

atha kukhala nazo zaka pafupifupi 10 Ngati vuto lakelo lipanga mapangidwe a michere ndi zinthu zina, ndiye kuti kusagwira ntchito koteroko kumatchedwa kuchepa kwa kapamba. Mwa zina zomwe zingayambitse kulephera izi zimadziwika:

• Kuwonongeka kwa minofu ya pancreatic
• Kuperewera kwa mavitamini m'thupi
• Mankhwala ochepetsa magazi
• Hemoglobin wotsika
• Zakudya zopanda pake, makamaka kugwiritsa ntchito zakudya zamafuta ndi mchere, kugwiritsa ntchito zonunkhira zachilendo, etc.

Zachidziwikire, izi sizonse zifukwa zomwe zimapangitsa kuti pakhale kuperewera kwa kapamba. Pali zinthu zambiri. Nthawi zina kubadwa (kutsogola) kungatenge gawo lalikulu. Zikuwoneka kuti munthu amakhala ndi moyo wabwinobwino, amadya moyenera, etc., komabe amadwala matendawa.

Mitundu ya kuperewera kwa kapamba

Masiku ano, pali mitundu inayi ya magwiridwe antchito a kapamba. Chilichonse mwazinthu izi chimakhala ndi zake, kuyambira pazomwe zimayang'ana, zimatha ndi zizindikiro komanso chithandizo. Chifukwa chake, gawani:

1. Kuperewera kwachuma
2. Kulephera
3. Kuperewera kwa enzyme
4. Endocrine kusakwanira

Monga tafotokozera pamwambapa, chilichonse mwaiwo chili ndi mawonekedwe ake. Chifukwa chake, kuti mumvetsetse bwino zomwe kusiyana kwake kuli komanso ngati pali kufanana pakawonetsedwe kazizindikiro, muyenera kudziwana bwino. Kuperewera kwa kapamba si zinthu zosangalatsa. Koma kuti muwone mtundu wa kusowa kwa malo omwe muyenera kukhalapo, muyenera kufunsa dokotala yemwe, malinga ndi zomwe akuwonetsa, adzakuwunikirani moyenera ndikukupatsani chithandizo choyenera.

Kuperewera kwachuma

Tsoka ilo, lero anthu ochulukirapo akuvutika chifukwa cha kuperewera kwa kapangidwe ka pancreatic. Ndipo ngati m'mbuyomu gulu lidayamba zaka pafupifupi 50, lero balero yatsika kwambiri, ndipo anthu azaka zochepa akuvutika nazo. Kuperewera kwa chinsinsi chakunja ndikusowa kwa ma enzymes (chinsinsi), chifukwa chomwe pamakhala kuphwanya kwazinthu zonse zofunika m'thupi. Izi zimachitika chifukwa popita nthawi, mothandizidwa ndi zinthu zina mu kapamba, kuchuluka kwa ma cell omwe amapanga chinsinsi chofunikira kwambiri kumachepa.

Monga matenda ena aliwonse, kusakwanira kwa procrine kumakhala ndizowonetsera zingapo, momwe zimakhalira kutsimikiza kuti uwu ndi mtundu uwu. Zina mwazizindikiro zazikulu ndi:

• Kusagwirizana ndi mafuta komanso zakudya zazonunkhiritsa. Ndizovuta kwambiri kuti anthu omwe ali ndi vuto lotere azitha kudya zakudya zamafuta, chifukwa zimakhala zovuta kugaya kapena kusazindikira thupi konse.
• Kulemera m'mimba. Amapangidwa makamaka munthu atadya zakudya zamafuta, zomwe, monga tafotokozera pamwambapa, samatengekedwa ndi thupi.
• Pondapo mafuta. Komanso, ndi mushy
• Colic
• Kupweteka m'mafupa

Mwa zina, zizindikiro za kuwonetsa kuchepa kwa mphamvu ya exocrine zingathenso kuphatikizira palpitations, kukokana, kupuma movutikira, zovuta zina pakulowerera magazi, khungu lowuma, ndi zina zambiri. Zizindikirozi zimawonekera chifukwa chosowa mafuta m'thupi, ndizofunikanso kwambiri. Chifukwa chakuchepa kwawo m'mimba, mavuto oyanjana nawo amadzuka omwe amabweretsa chisangalalo chochulukirapo kuposa zizindikiro zowonekera za kuwonekera kwa matendawa.

Pali zifukwa zingapo zomwe zimapangitsa munthu kuyamba izi kulephera. Izi zikuphatikiza:

• Kuchepetsa unyinji wa exocrine parenchyma
• Kutuluka kwa katulutsidwe mu duodenum
• Osakwanira nawo michere pokonza zinthu

M'malo mwake, chithandizo chachikulu ndicho kusunga zakudya zoyenera, zomwe mfundo zake ndi izi:

1. Ndikofunikira kuwonjezera kuchuluka kwa chakudya, ndikuchepetsa kuchuluka kwake
2. Chepetsani kugwiritsa ntchito zakudya zamafuta, zomwe zingaphatikizenso nyama zonse zamafuta
3. Muchepetse zakudya zamadzulo ndi usiku
4. Ziyenera kusiyidwa kwathunthu

Zinthu zomwe zimaloledwa kuti zidyedwe zimakambidwa ndi dokotala yemwe amapita, yemwe amayenera kuwongolera kwathunthu chakudya cha wodwalayo.Ngati tikunena za choletsa pakudya kwamafuta ndi nyama, ndiye kuti ndikofunikira kusintha m'malo mwamasamba, ndiye kuti, idyani masamba ndi zipatso zambiri. Kutsogolo kwa anthu omwe akudwala matendawa, pakubwera michere, yomwe imayenera kumamwa moyenera kuti athandize thupi. Koma ndikofunikira kukumbukira chinthu chachikulu chomwe muyenera kuyang'ana kwa zakudya zamagulu m'zakudya zopatsa thanzi, osati m'maswiti, momwe mumapezeka michere yambiri.

Koma pali phanga limodzi m'zonsezi, m'zakudya izi zonse. Odwala ambiri omwe amasinthana kwathunthu ndi zakudya zamasamba amayamba kukumana ndi mavuto omwe amabwera chifukwa cha kuchuluka kwa mpweya. Izi zikachitika, ndiye kuti odwala amalimbikitsidwa kudya chinangwa.

Kuphatikiza pa zakudya, odwala amapatsidwa mankhwala omwe angathandize kapamba mwachindunji. Mankhwalawa akuphatikizapo Creon, Pancreatin, Mezim, etc. Nthawi zambiri, mankhwalawa amaperekedwa ndi chakudya chilichonse kuti athetse vuto logaya chakudya.

Chizindikiro chachikulu cha kulondola kwa chithandizo chamankhwala ndicho kutha kwa matenda otsekula m'mimba, komanso Zizindikiro zowoneka bwino zomwe zimapezeka mu ndulu za wodwalayo. Exocrine pancreatic insuffence ndi vuto lalikulu, koma mutha kukhala nalo. Muyenera kungoyang'anira kudya kwanu ndikutsatira malangizo onse a dokotala.

Pancreatic enzyme akusowa

Ululu ngati chimodzi mwazizindikiro za kuperewera kwa kapamba

Zikondazo zimagwira ntchito zingapo, ndipo zina zake zimatha kupangitsa kuti pasakhale kuperewera. Chimodzi mwazinthu zodziwika bwino za kapamba wa pancreatic ndi enzymatic. zili ndi madzi am'mimba ndikuthandizira kugaya chakudya. Zingachitike kuti enzyme imodzi ilibe kuchuluka kokwanira, ndiye kuti chimbudzi chimasokoneza.

Mwa zina mwa zomwe zimayambitsa matenda a enzyme zimatha kudziwika:

1. Kuwonongeka kwa maselo a pancreatic motsogozedwa ndi mankhwala ena
2. Matenda
3. Zowonongeka kwa pancreatic duct
4. Masoka mu kapangidwe ka limba (kobadwa nako)
5. Dysbacteriosis

Mwa zina mwazomwe zili ndi vuto la enzyme, izi titha kuzisiyanitsa:

• Opindika chopondera, makamaka chopondapo
• Zofooka zambiri
• Chilala
• Kuchulukitsa kwa mafuta
• Kuchepetsa thupi komanso ntchito zolimbitsa thupi za munthu
• Kuchepetsa mseru
• Wamphamvu

Chizindikiro chimodzi chofunikira kwambiri cha kuchepa kwa enzyme ndikusintha kwa chopondapo. Mafuta okhala pansi onunkhira osasangalatsa komanso okhumudwitsa amadziwika ndi matendawa.