Zizindikiro ndi mankhwala a pancreatic insulinomas
| Insulinoma | |
|---|---|
 Chithunzi cha histopathological cha pancreatic insulinoma. | |
| ICD-10 | C 25.4 25.4, D 13.7 13.7 |
| ICD-9 | 157.4 157.4 , 211.7 211.7 |
| ICD-O | M8151 / 1 |
| Diseasesdb | 6830 |
| Medlineplus | 000387 |
| eMedicine | med / 2677 |
| Mesh | D007340 |
Insulinoma (kuchokera lat. insulin - timadzi ta peptide timene timapangidwa ndi ma cell a beta a Langerhans ndi lat. oma - chotupa, mapangidwe) kumabweretsa kukula kwa vuto la hypoglycemic ndipo nthawi zambiri limawonetsedwa ndi matenda osala kudya a hypoglycemic. Zomwe sizachilendo kwambiri ndi insulin-secreting APUDomas (apudomas) - zotupa za maselo a paraendocrine (osati ma cell a beta a isanger of Langerhans), kutanthauzira komwe kumakhala kovuta kwambiri kukhazikitsa. Pali malipoti a insulinomas omwe amapezeka m'maselo a enterochromaffin a m'matumbo. Malignant insulinomas nkhani ya 10-15%, gawo limodzi mwa magawo atatu. Mu 4-14% ya odwala, insulinomas ndi yambiri, pafupifupi 2% ya neoplasms amapezeka kunja kwa kapamba. Chotupa chobisira insulin chikufotokozedwa m'magulu onse azaka - kuyambira makanda mpaka okalamba, komabe, chimadziwonetsedwa mu msika wogwira ntchito kwambiri - kuyambira zaka 30 mpaka 55. Pakati pa odwala onse, ana amapanga pafupifupi 5%.
Etiology
Mu 1929, Graham anali woyamba kuchotsa bwino chotupa cha insulin. Kuyambira pamenepo, pakhala pali lipoti padziko lonse lapansi za odwala pafupifupi 2,000 omwe amagwira ntchito ndi beta-cell neoplasms.
Ma tumors okhala ndi mainchesi opitilira 2 ... 3 masentimita nthawi zambiri amakhala ovulaza. Mu 10 ... 15% ya milandu, insulinomas ndi yambiri, mu 1% ndi ectopically (zipata za ndulu, chiwindi, khoma la duodenal). Kuchuluka kwa milandu yatsopano ndi munthu m'modzi pa 1 miliyoni pachaka. Mu 85 ... 90% ya milandu, insulinomas ndi yoyipa. Pancreatic insulinoma nthawi zambiri amakhala yokhazikika, yolimba, yokhayokha. Mu ana, insulinoma nthawi zina imayendetsedwa ndi beta-cell hyperplasia kapena nezidioblastosis. Nthawi zambiri (kuposa 50% ya odwala), insulinoma ndi gawo la MEN syndrome (Multiple Endocrine Neoplasia) mtundu wa I (Vermeer syndrome).
Sinthani ya Etiology |Amayambitsa ndi pathogenesis
Zomwe zimayambitsa insulinomas sizikudziwika. Chiyanjano chokhacho cha neoplasm ndi adenomatosis, chomwe chimakhala ngati matenda osowa kwa chibadwa komanso chothandizira kupangika kwa zotupa zamahomoni, chakhazikitsidwa.
Komabe, pali malingaliro angapo onena za gwero la insulinoma, lomwe silinalandire chitsimikiziro cha sayansi.
Izi ndi monga:
- chibadwa chomwe chimapangitsa kuchuluka kwa maselo am'magazi,
- zosokoneza mu njira zomwe zilipo mthupi.
Neoplasm ilibe mawonekedwe amodzi, ngakhale zigawo za chotupa chomwecho zimatha kusiyana. Utoto wazomwe zili m'maselo awo umasiyanasiyana ndipo umatha kukhala ndi mthunzi wowala kapena mawonekedwe amdima. Izi zikufotokozera mphamvu ya insulini kupanga ndikupanga timadzi tambiri tambiri.
Ma neoplasms osagwira, monga momwe amasonyezera, amakhala akulu kwambiri, ndipo pakapita nthawi amatha kukula kukhala zotupa zoyipa. Mtunduwu nthawi zambiri umalumikizidwa ndi mawonetseredwe ang'onoang'ono am matendawa, komanso kuchedwa kwake.
Maonekedwe a insulinoma amathandizira kupanga insulin yambiri. Kuchuluka kwa mahomoni m'thupi kumayambitsa hypoglycemia, pomwe phindu la shuga limatsika kwambiri. Nthawi zambiri kupezeka kwa neoplasm kumadziwika chifukwa cha mavuto ndi endocrine gland. Gulu lomwe liziika pachiwopsezo chotenga matendawa limaphatikizapo anthu azaka 25 mpaka 55. Matenda a ubongo samawoneka kwambiri mwa makanda kapena achinyamata.
Maziko a pathogenesis a hypoglycemic state omwe ali ndi insulinoma ndi hyperproduction ya insulin, yomwe sikudalira phindu la glycemia.
Kusala kudya kwanthawi yayitali kumatha kupangitsa munthu wathanzi kutsitsa glucose mpaka kutsika kwazomwe zimachitika, komanso kuchepa kowopsa kwa kuchuluka kwa mahomoni.
Kwa anthu omwe ali ndi chotupa, glycogenolysis imapanikizika chifukwa cha kuchuluka kwa insulini, chifukwa chake, pakalibe kudya kwa glucose chakudya, kuchitika kwa hypoglycemia.
Ngati vutoli limachitika pafupipafupi, ndiye kuti kusintha kwa dystrophic kumachitika m'mitsempha yamagazi ndi mitsempha yamagazi, zomwe zingayambitse kukulira kwa edema yam'magazi ndikupanga mapangidwe amwazi.
Zizindikiro
Zizindikiro za pancreatic neoplasm zimatha kusiyanasiyana chifukwa cha izi:
- kuchuluka kwa insulin yomwe imapangidwa
- zotupa
- kukula kwa insulinoma
- mawonekedwe odwala.
Zizindikiro zazikulu za insulinoma ndizo:
- matenda a hypoglycemic omwe amachitika patatha maola atatu chakudya chitatha,
- kuchuluka kwa shuga muamu seramu ndi 50 mg,
- kuyimitsidwa kwa zizindikiro za hypoglycemia chifukwa cha shuga.
Kuchitika pafupipafupi kwa hypoglycemia kumasokoneza magwiridwe antchito amanjenje (chapakati komanso cham'mbali). Pakati pazovuta zoterezi, pamakhala mawonetseredwe amanjenje, chidwi, myalgia, kuchepa kwa kukumbukira, komanso luso la malingaliro.
Zambiri mwa zopatukazi zimapitilira pambuyo pochotsa chotupacho, zomwe zimatsogolera pakutha kwa maluso aukadaulo komanso kupeza bwino pakati pathu. Zovuta za hypoglycemia zomwe zimapezeka mwa amuna nthawi zonse zimatha kubweretsa kusowa chiyembekezo.
Zizindikiro za insulinoma amagawika m'magulu a hypoglycemia, komanso mawonetsedwe kunja kwa kuwukira.
Zizindikiro zakuwukira
Mawonetseredwe a Hypoglycemic omwe amapezeka mu mawonekedwe owopsa amayamba chifukwa cha kuyambika kwa zinthu zotsutsana ndi kusokonezeka kwa kayendedwe kazinthu zazikulu zamkati. Vutoli limakonda kuchitika m'mimba yopanda kanthu kapena pakudya kwakanthawi.
- kusintha kwadzidzidzi kwa mutu
, - kulumikizana mosasamala poyenda,
- kutsika kwamawonedwe owoneka,
- kupezeka kwa kuyerekezera zinthu zakumaso,
- nkhawa
- kuphatikiza mantha a mantha ndi chisangalalo,
- kusuntha kwa zifukwa
- kunjenjemera miyendo
- kukomoka mtima,
- thukuta.
,Nthawi zotere, glucose amakhala wocheperako 2,5 mmol / L, ndipo kuchuluka kwa adrenaline kumawonjezeka.
Zizindikiro zakunja
Kukhalapo kwa insulinomas popanda kuchulukitsa ndikovuta kuzindikira. Mawonekedwe akuchepa kwambiri ndipo mulibe.
Zizindikiro zakunja
- kudya kwambiri kapena kukana chakudya kwathunthu,
- ziwalo
- kumva kwachisoni, komanso kusasangalala panthawi yosuntha ma eye,
- kusokonezeka kwa kukumbukira
- kuwonongeka kwa nkhope
- kutayika kwa malingaliro ndi zizolowezi zina,
- kuchepa kwa ntchito zamaganizidwe.
Vutoli limakhala kuti nthawi zina mumakhala kuti mwadzindikira kapena muli ndi vuto. Kukodwa pafupipafupi kumatha kudzetsa munthu vuto.
Anthu omwe amakakamizidwa kusiya zizindikiro za hypoglycemia, nthawi zambiri, amakhala onenepa kapena amakhala ndi thupi lochulukirapo poyerekeza ndi miyambo. Nthawi zina, zizindikiro za insulinomas zimatha kutha kuchepa kwa thupi chifukwa chodana ndi chakudya chilichonse.
Zizindikiro
Mawonetsero oyamba omwe ali ndi insulinomas ayenera kukhala chifukwa chochitira mayeso amunthu.
Mitundu yamaphunziro azidziwitso:
- labotale (imakhala ndi mayeso a labotale operekedwa ndi dokotala),
- zothandiza
- zothandiza.
Kafukufuku wothandiza akuphatikizapo:
- Kusala kudya kwa tsiku ndi tsiku - kumakupatsani mwayi kuti muwone kuchuluka kwa glucose ndi mahomoni omwe amapangidwa. Chifukwa cha njirayi, ndizotheka kuyambitsa kuyambika kwa vuto la hypoglycemia, momwe zingatheke kudziwa zizindikiro zingapo zofunikira.
- Kuyesedwa kopanikizira kwa insulin - kutengera kuzindikira kwa misinkhu ya shuga ndi mfundo za C-peptide.
- Kuyesa kwa insulini-kakhazikitsidwe kochokera pakubweretsa shuga kuti muwone kuyankha kwa thupi.
Gawo lomaliza limaphatikizapo maphunziro othandiza:
- scintigraphy
- MRI (magnetic resonanceapy),
- Ultrasound (ultrasound),
- catheterization ya portal system kuti muzindikire neoplasms,
- angiography (sakani chotupa m'mitsempha yamaukosi),
- kuwunika kwa radioimmunological - kuwulula kuchuluka kwa insulin.
Kufunika kwa maphunziro aliwonse awa kumatsimikiziridwa ndi adokotala.
Kanema wochokera kwa Dr. Malysheva wodzipereka ku insulinoma, chomwe chimapangitsa kuti adziwe komanso azindikire:
Njira zochizira
Kulandira chithandizo sikuchotsa komwe kumayambitsa matendawa ndipo sikungapangitse wodwalayo kuchira kwathunthu.
Milandu yodzisamalira:
- kukana wodwala kuchitidwa opaleshoni,
- chiopsezo chowonjezereka cha imfa
- kupezeka kwa metastasis,
- osayesa mayeso kuchotsa kachidindo.
Njira zochizira:
- kumwa mankhwala ochulukitsa glycemia,
- kagayidwe ka shuga (m'mitsempha),
- chemotherapy.
Chofunikira china cha matenda a insulinoma ndi chizindikiro chomwe chimaphatikizapo shuga wambiri.
Opaleshoni
Njira yogwiritsira ntchito ndiyoyamba kupeza chotupa, ndikuchichotsa. Kuchita opareshoni kumatanthauza njira yokhayo yothetsera chotupacho.
Insulinoma yomwe imapezeka m'mapapo nthawi zambiri imapezeka pamwamba pa chiwalo.
Ili ndi mbali zomveka bwino, kotero ndizosavuta kuchotsa. Ma neoplasms ang'onoang'ono nthawi zambiri amakhala ndi mawonekedwe a atypical ndipo sangawonekere panthawi yopanga opaleshoni.
Zikatero, kuchotsedwako kumakhazikitsidwa tsiku lina, chotupa chikakula. Kudikira kwa ntchito yotsatira kumayendera limodzi ndi chithandizo chokhazikika kuti tiletse hypoglycemia ndikuwonongeka kowopsa mumitsempha yamanjenje.
Kubwezeretsa pambuyo pakuchita opaleshoni kumachitika mwaoposa theka la odwala. Chiwopsezo cha kuphedwa chilipo pafupifupi 10% ya milandu. Nthawi zina, mungabwezere m'mbuyo. Ndikofunika kumvetsetsa kuti kuzindikira koyambirira kumawonjezera mwayi wa kuchiritsa bwino kwa insulinomas.
