Njira zoyenera kutsatiridwa ndi chifuwa chachikulu

1. Chizindikiro cha pancreatitis yam'mbuyomu.

2. Kukhalapo kwa ululu wodziwika bwino: kupweteka kumanzere wa hypochondrium, herpes zoster, kumakwiya chifukwa chakudya kwamchere, kosuta, mafuta, okazinga, zakudya zonunkhira, zakunja, nyama yokhazikika ndi msuzi wamasamba ndi msuzi, mowa, ndi zakudya zamafuta ambiri.

3. Kuyungunuka pakumva zowawa zambiri, zomwe sizibweretsa mpumulo.

4. Matenda am'mimba a pancreatogenic, okwiyitsidwa ndi zinthu zomwezo monga zowawa, komanso mkaka.

5. Kuchuluka kwa alpha-amylase m'magazi ndi mkodzo (ndi ma enzymes ena a pancreatic).

6. Kwezani michere m'matumba a pancreatic, mabicarbonate m'matumbo a duodenal.

7. Kuwonjezeka kwa shuga wamagazi, kuchepa kwa kulolera kwa glucose.

8. Steato-, amylo-, creatorrhea mu coprogramm.

9. Kukhalapo kwa ultrasound, ECPG deta.

Kutengera mawonekedwe a chifuwa chachikulu, njira zozindikira zimasiyana pang'ono.

1. Wodwala pancreatitis yachilendo, chotsogola ndi kuperewera kwa matendawa ndi kupezeka kwa matenda am'mimba komanso kupukusira kwa malabsorption ndi maldigestion syndromes kumapeto.

2. Mu chipatala cha kupweteka kwamatumbo pancreatitis, kutupa ndi kuwonongeka kwa matenda ndi kupweteka kumachitika. Ululu umakhala pafupifupi nthawi zonse, koma panthawi yowonjezera imafotokozedwa. Endocrine ndi insretory insuffuffity imakhalanso.

3. Njira zodziwira matenda omwe amapezeka pafupipafupi ndi kapamba ndi kukhalapo kwa ma syndromes onse atatu munthawi yowonjezera komanso kusowa kwawo kuchikhululukiro.

4. Njira zodziwira pseudotumor pancreatitis ndi kukhalapo kwa jaundice wovutitsa chifukwa cha kukakamiza kwa duct ya bile yololedwa ndi mutu wa kapamba motsutsana ndi chiyambi cha matenda otupa komanso owononga.

Mfundo zoyenera kutsata zimaphatikizapo:

1. Kupumula,

2. njira zochotsera,

3. kukonza mavuto a exocrine ndi endocrine.

Munthawi yakuchulukitsa, kuikidwa kuyenera:

1. njira yochepetsera - popanda kupumula pakama, koma kupatula zolimbitsa thupi zilizonse ndi kupsinjika,

2. Zakudya - kuchokera pagome 0 - i.e. njala ya masiku atatu oyamba ndikusintha kwa tebulo 1a, 1b, 1 kenako 5p, ndikutsatiridwa ndi kukula kwa chakudyacho mpaka kuphatikiza mapuloteni. Chakudya chopatsa thanzi chiyenera kukhala chakudya chama 5-6 patsiku kuti muchepetse biliopancreatic ndi duodenopancreatic Reflux,

3. masiku atatu oyamba - kupumula, njala ndi kuzizira, kutsuka kwa m'mimba kudzera pa chubu, kuyeretsa matumbo zam'mimba - cholinga chake chothetsa kuledzera, kuthetsa ukali wa michere ndi matenda a duodenal dyskinesia,

4. masiku atatu oyamba - ozizira kudera la ndulu kuti muchepetse kupweteka komanso kuchepetsa kupindika.

Mankhwala

5. Kuti muchepetse kuchepa kwa zinthu za bicarbonate zimaperekedwamaantacid (almagel, phosphalugel, maalox, etc.), N₂- histamine blockers - cimetidine, tagamet, ranitidine, etc. Maacacid, osakhudzidwa kwambiri, kuphatikiza kukonzekera kwa kashiamu kumathandizira kuchepa kwa steatorrhea.

6. Antispasmodics ndi M₁cholinolytics ntchito kuchepetsa dyskinesia wa duodenum 12. 2% yankho la platifilin, atropine, halidor, no-spa, papaverine, aeron, supplementories ndi indocide, etc. amagwiritsidwa ntchito.

7. Maantibayotiki chikuwonetsedwa ngati yachiwiri matenda kapamba ndi peripancreatitis. Ndikwabwino kupatsa mankhwala a cephalosporins ndi penicillin opanga ma sing'anga othandizira, masiku 7-10.

8. Ndi ululu waukulu, akuwonetsedwa analgesics - analgin, baralgin ndi zotumphukira zake, paracetamol.

Cholinga cha narcotic analgesics, fentanyl sichikuwonetsedwa, chifukwa Amayambitsa kuphipha ndi kuzungulira kwa Oddi ndipo pambuyo pa kayendetsedwe ka magazi mkati mwa maola 12 m'magazi amatha kujambula hyperfentemia komanso kuwonjezeka kwa kuchuluka kwa kusintha kwa magazi.

Kupumula kwa exocrine kusakwanira michere ya kapamba (Pancreatin, Pancurmen, Mezim Forte, Nygedase, Oraza, Panzitrate, Solisim, Somilase, Trifenzyme ndi ena omwe ali ndi michere ya pancreatic, Festal, Digestal, Kotazim Forte, Enzistal, ndi zina.

10. Ndi edema ya gland komanso kusintha kosintha poyeserera kwa amylase, antienzyme mankhwala ndi othandiza (anti-michere):

- Yokhala pakati, gordox, trasilol, ingitrile, pantripine, traskolan, aminocaproic acid. Thupi lawo siligwirizana mu kukonzekera mankhwalawa mu 10-12%, amene amachepetsa cholinga chawo. Njira yayikulu yogwiritsira ntchito mankhwalawa imachitika chifukwa cha inactivation ya michere ya proteinolytic komanso kuteteza kutulutsa kwa zinthu zomwe zimagwira bwino ntchito (biologically yogwira zinthu - kinins, bradykinin), yomwe imalepheretsa kusintha kwa edema kukhala necrosis, kumachepetsa kukoka kwa mitsempha ya serous. Ndipo izi zimathandizanso kuchepetsa kuledzera, kumachepetsa ululu.

11. Pofuna kupondereza katemera wa pancreatic wa michere ndi ma bicarbonates sandostatin (somatostatin, okreotide) muyezo wa 25-50 mcg 2-3 r / tsiku. subcutanely kapena kudzera m'mitsempha kwa masiku 5-7.

12. Kuchiritsa. Mu chifuwa chachikulu cha pancreatitis, kulowetsedwa kwa hemodez njira, saline yokhudzana ndi thupi imagwiritsidwa ntchito. Cholinga cha shuga chimaphatikizidwa, chifukwa ndi kapamba, pakuchulukitsa, kutsika kwa glucose kumachitika.

13. Pofuna kuyimitsa matenda obwera chifukwa cha kutupa komanso kusokonezeka kwa ma coagulation ndi anticoagulation, -aminocaproic acid imayendetsedwa mwachangu, yomwe, kuwonjezera pa inactivating kinins, imakhala ndi vuto lakale komanso limalepheretsa fibrinolysis.

14. Ndi matenda a ululu wotchulidwa, milingo yaying'ono imayikidwa glucocorticoid mahomoni (prednisone ndi ena) - mumapulogalamu othandizira zamkati, pafupipafupi mankhwala osapweteka a antiidal.

15. Chithandizo cha cheza ndi laser - ndi kutupa kwambiri ndi kupweteka m'mapapo.

16. Pankhani ya zovuta za neuropsychiatric, zotsatira zabwino zimapezeka kuchokera ku mankhwala a nosepam (orehotel), seduxen, phenozepam, amitriptyline.

17. Ndi Reflux yayikulu, eglonyl (sulpiride), cerucal, motilium ndi ena amagwiritsidwa ntchito prokinetics.

18. Pa asthenization - piracetam (nootropil) pa 0-0-0.4 g 3 r / tsiku, pyriditol (encephabol) mkati mwa 0,0-0.2 g 3 r / tsiku.

19. Ndi kuperewera kwakukulu kwa mavitamini ndi mchere - kukonzekera kwa multivitamin (undevit, ascorutin, etc.).

20. Pofuna kukopa zinthu zam'magazi - heparin mpaka magawo 20,000 pansi pa khungu pamimba kwa masiku 5-7.

21. Mankhwala osokoneza bongo omwe amasintha kagayidwe - pentoxyl, methyluracil.

22. Zinthu za Lipotropic - lipocaine, methionine.

23. Anabolic steroids - nerabol, retabolil, riboksin.

Zolemba za ntchito yasayansi pamutu wakuti "Zowopsa Zomwe Zimakhudza Kupita Patsogolo Kwa Matenda Osiyanasiyana"

40. Zotsatira za Weber K. Neubert U. Zokhudza Matenda Oyambirira A Erythema osamukira ku Matenda ndi Zokhudzana ndi Disoders // "Lyme Borrelio-

sis. " Kukula kwa Symposium Yachiwiri Yapadziko Lonse Yokhudza Matenda a Lyme ndi Disoders Zina. Vienna - 1985. -P.209-228.

ZOCHITITSA ZAUZIMU KUTI MUZILIMBIKITSA KUSINTHA KWA CHRONIC PANCREATITIS

I.V. Reshina, AN Kalyagin

(Irkutsk State Medical University, rector - dokotala wa sayansi ya zamankhwala, pulofesa I.V. Malov, dipatimenti ya propaedeutics yamatenda amkati, mutu - dokotala wa sayansi yamankhwala, pulofesa Yu.A. 1oryaev, Clinical Hospital Na. 1 wa Irkutsk, "adotolo wamkulu -

Chidule Nkhaniyi ikuwonetsa zambiri zamavuto amkati mwa zinthu zomwe zimapangitsa kuti pakhale matenda a pancreatitis.

Mawu ofunikira: chifuwa chachikulu, matenda am'mimba, kufalikira.

Mawu akuti pancreatitis (CP) amatanthauza gulu la matenda apakhansa (kapamba) amisempha yosiyanasiyana, yotupa makamaka mu gawo lomwe limayambira pang'onopang'ono, gawo linalake kapena kusokoneza masoka, kusintha kowononga kwa mbali yake ya procrine, kupindika kwa zinthu zina, mu duct dongosolo la kapamba ndi mapangidwe a cysts, calculi ndi magawo osiyanasiyana ophwanya exocrine ndi endocrine gland ntchito.

Mu kapangidwe kake kamene kamapanga ziwalo zogaya chakudya, CP ndi 5.1-9.0%, ndipo ambiri munthawi yamankhwala, a 0-0-0.6%. Pazaka 30 zapitazi, pakhala pakuchitika padziko lonse lapansi pakuwonjezereka kwa ziwopsezo za CP zochulukirapo kawiri. Ku Russia kukuwonjezeka kwakukulu kwa ziwopsezo za CP onse pakati pa akulu ndi pakati pa ana 1,3,6.

Zina mwazinthu zomwe zimayambitsa kupezeka ndi kupitilira kwa CP, endo native and exo native factor 1.25, 33.42.47 zitha kukhala zosiyanitsidwa. Gulu loyamba limaphatikizapo cholowa ndi chibadwa: kusowa kwa alpha1-antitrypsin, kusintha kwa majini, mtundu wa cholowa, kuchepa kwa kuchuluka kwa lithostatin, etc., komanso kupanga ma autoantibodies, zotsatira za oyimira pakati oyimira pakati ndi ma cytokines, kusokonekera kwa metabolic ndi kusintha kwa mahomoni, matenda a hepatoduodenal Zigawo, vuto la hyperacid, ndi zina. Zinthu zodziwikirazi ndi monga: uchidakwa, kusuta fodya, zolakwika za kadyedwe, kumwa mankhwala ena, kudziwitsa poizoni, zopsinjika, ndi zina.

Zotsatirazi za kupita patsogolo ndi kusakhazikika kwake zimangotchulidwa: zotsatila za kapamba, kuperewera kwa mankhwala osokoneza bongo, etc. 1,3,17,22,23,25, 42,47. Sikuti nthawi zonse zomwe zimapangitsa kuti matendawa akhazikitse matendawa zimakhala zofunikira kwambiri. Si chinsinsi kuti moyo ndi chilengedwe zimagwira gawo lalikulu kwambiri pakukula kwa matenda ena kuposa chibadwa chamunthu 7.8, 25.42.47.

Herederal CP imakhala ndi 5% ya mitundu yonse. Matendawa nthawi zambiri amayambira kuubwana ndipo amakhala ndi njira yopitilira patsogolo, yomwe imapitilira nthawi zina, ndipo imayambitsa neobraz-

mimic morphological changes in the organ parenchyma 7.8, 25.42.47.

D. Whitercomb ndi L. Bodic, potengera za chibadwa cha cholowa cha CP, adapereka lingaliro la kapangidwe ka kukula ndi kupitilira kwa mawonekedwe amtunduwu wa CP - kukana kwa ma molekyulu a trypsin kupita ku hydrolysis, kutsimikizira kuti kubwereranso kumachitika chifukwa cha kuyambitsa kwa kuchuluka kwa trypsin, poyerekeza ndi chomwe chingalepheretse pancreatic trypsin inhibitor.

Pancreatic secretory trypsin inhibitor (dzina lodziwika bwino ndi serine proteinase inhibitor, Kazal mtundu 1, SPINK1) ndi peptide yomwe imatha kuletsa trypsin mwa kutseka pakati pake, SPINK1 imatha kuletsa pafupifupi 20% ya kuchuluka konse kwa trypsin 1, 47. Zinthu zachilengedwe: mowa, kusuta fodya, kusadya mokwanira, komanso kupezeka kwa matenda am'mimba omwe amapangitsa kuti chimbudzi chichepere kwambiri. Izi zitha kufotokozera kuti chiwonetsero chazachipatala cha cholowa cha makolo nthawi zambiri chimakhala ndi zaka 3 mpaka 10, ndipo chiwonetsero chachiwiri chikuwonekera pazaka za 20-25, zomwe nthawi zambiri zimagwirizanitsidwa ndi kuyambitsidwa kwa chizolowezi chomwa mowa wambiri 8.42.

Kusintha kwa mtundu wa cationic trypsinogen gene. Cationic trypsinogen, pokhala wotsogola wa trypsin, imachita gawo lalikulu mu hydrolysis ya mapuloteni a chakudya, komanso pakuyambitsa michere ina yonse yamatumbo yopanga mawonekedwe osagwira. Kukhazikitsidwa koyamba kwa trypsinogen mu kapamba kumayambitsa ngozi ya kutseguka kwa michere ina ndikuyambitsa kudzitsitsa kwa minofu ya pancreatic, yomwe ndi njira yayikulu yogwiritsira ntchito pathogenetic ya pancreatitis pachimake. Zowopsa za pancreatitis pachimake pakapita nthawi zimayambitsa kukula kwa CP. Pali njira ziwiri zazikulu zolimbitsa thupi zomwe zimalepheretsa kutseguka kwa trypsin isanakwane: inactivation ndi chinsinsi cha pancreatic trypsin inhibitor ndi autolysis.

Pofika kumapeto kwa zaka za 90 za zana lomaliza, mapuloteni amiyala ya kapamba, lithostatin, adapezeka. Inapezeka mu madzi a pancreatic a odwala, makamaka zidakhwa za CP, m'mene CP ikupita patsogolo, mulingo wa lithostatin umatsika ndipo izi zimatsogolera pakupanga calculi mu ducts, calcification

pancreatic minofu 9.19.40. Komabe, pali lingaliro linanso - mowa ndi ma metabolites awo amalepheretsa kuphatikizika kwa lithostatin, potero amachepetsa kuchuluka kwake. Mapuloteni ngati lithostatin amapezeka mumisempha, mu mkodzo, ndipo m'magazi mwawo mumakwezedwa ma CP angapo.

Posachedwa, zofalitsa zambiri zawonekera pa gawo la kupanikizika kwakanthawi kwa oxidation ndi oxidative nkhawa mu pathogenesis ya pancreatitis. Nthawi yomweyo, kutupa kumapitirirabe kapamba, zinthu zotsutsana ndi kutupa zimachepa pang'ono, njira zowonjezera zotupa zimasinthidwa ndi zina zowonjezereka, zomwe pamapeto pake zimayambitsa kupangidwe kwa pancreatic fibrosis. Poganizira kuti zotsatira za N0 zimapangidwira pansi pa vuto la hypoxia, zochitika zilizonse zachilengedwe zitha kuonedwa kuti ndizofunikira kwambiri pakukula komanso kukula kwa CP, makamaka zomwe zimatsogolera kuchepa kwa chitetezo cha thupi 33, 34.48.

Ngakhale kumayambiriro kwa zaka za zana la makumi awiri. Malingaliro adafotokozedwa za njira za autoimmune zomwe zimakhudza kupitilira kwa CP 23,28. Kuzindikira kwa ma antibodies a carbonic anhydrase I ndi II kumawerengedwa ngati enieni a autoimmune CP (AIC); Kuphatikiza apo, zinthu zingapo zama antibodies zitha kupezeka (anti-nyukiliya, animochondrial, anti-smoothing, antineutrophilic) 23, 32. AICP ikhoza kudzipatula kapena kuwonetsedwa poyanjana ndi mgwirizano Matenda a Sjogren's, cirrhosis yoyamba, matenda a Crohn ndi zilonda zam'mimba kapena matenda ena otchedwa autoimmune. Poterepa, pali mgwirizano wapakati pa kufalikira kwa matenda amodzi ndi kuchuluka kwa njira ina. Pali ubale wosadziwika pakati pa kupita patsogolo kwa AIHP komanso kupita patsogolo kwa matenda ena a virus, makamaka ndi kupitirira kwa matenda a chiwindi a hepatitis C ndi C. AIHP, pamene ikupita patsogolo, imabweretsa kuchepetsedwa kwa minyewa, kufalikira kwa pancreatic duct, kufalikira kwa patsogolo kwa microsis ndi kulowa kwa mononuclear kwa minyewa ya pancreatic, yomwe pamapeto pake imayambitsa kukulira kwa chinsinsi chomwe chafotokozedwa kale, ndipo pambuyo pake kulephera kwa intrasecretory.

Cholinga chogawika hypercalcemia monga zinthu zomwe zimakhudza kutha kwa maphunzirowa komanso njira ya CP inali zowonera zomwe zimawonetsa chitukuko cha matenda kapena kulemera kwake mwa anthu omwe ali ndi vuto la hyperparathyroidism 21.30.

Hyperlipidemia (makamaka, hypertriglyceridemia) ndi chinthu chodziwika bwino cha pancreatitis pachimake, chiopsezo chomwe chimawonjezeka ndi kuwonjezeka kwa triglycerides pamwamba pa 1000 mg / dl. Ponena za hyperlipidemia monga chinthu chokhazokha mu CP, zomwe zilipo pakadali pano ndizotsutsana. Powafotokozera mwachidule, titha kunena kuti, mwina, CP imatha kukhala ndi vuto la hyperlipidemia lomwe limakhalapo nthawi yayitali, pomwe, ndizosowa kwenikweni, pomwe kupititsa patsogolo kwa CP kumachitika mwachangu, kapena nthawi zambiri matendawa amakula kwambiri.

Kupweteka kwambiri, kupwetekedwa mtima kwa nthawi yayitali

Chizindikiro cha CP, komabe, kuchokera pakuwonera pathophysiological, kupweteka kumayambitsa masinthidwe a kutupa, kumakulitsa kusintha kwa morphological, kapenanso kupweteka kosaletseka kumatha kuonedwa ngati chinthu chokwanira pakukula kwa matenda 30,31.

Kafukufuku wambiri wasayansi wofotokoza umboni wasonyeza kulumikizana mwachindunji pakati pa kupezeka kwa kuchuluka kwa CP, njira yake pamtundu wa katulutsidwe ka m'mimba. Mikhalidwe ya hyperacid state, pancreatic fibrosis imakula mofulumira. Kuchita bwino kwa mankhwalawa pakugwiritsa ntchito mankhwala antisecretory ndi cholinga choletsa kuukira kwa CP 4,5,26 kumatsimikiziranso. Kupezeka kwa biliary-pancreatic Reflux kumathandizanso pakukula kwa CP. Izi zokhudzana ndi pathological zimayambitsa kutupika m'matumbo, limodzi ndi kuwonjezeka kwa chotupa necrosis factor-alpha ndi nthawi 14.2 poyerekeza ndi gulu lolamulira popanda Reflux, zomwe zimayambitsa kupitirira kwa matenda komanso kubwereranso pafupipafupi.

Odwala omwe ali ndi vuto la impso kulephera, pali kuwonjezeka kwa pafupipafupi kwa chitukuko cha onse pachimake ndi CP, kuwonjezeka kobwerezabwereza kwa CP. Kafukufuku wina, kusintha kwa morphological mu kapamba kunapezeka mu 20.6% ya odwala omwe ali ndi vuto la kulephera poyerekeza ndi 4.7% pagulu lolamulira.Pali umboni kuti sikuti zochita za uremic poizoni zimapangitsa kuti pakhale kuwonongeka kwa chikhodzodzo, komanso zimasintha mu mbiri ya mahomoni am'mimba, komanso kusintha kwa chinsinsi cha ma bicarbonate ndi mapuloteni, omwe amawoneka kuti amakanika.

Pancreas divisum ndichizindikiro chachitukuko cha kapamba chifukwa chophwanya fusion ya dorsal ndi ventral pancreatic primordia. Zotsatira zake ndi kutalikirana kwakumadera kwa zigawo ziwiri za kapamba: gawo lamkati la mutu limatsitsidwa ndikutseguka kwachidule kwa tsegenal nipple yayikulu, komanso chinsinsi kuchokera kumbali yamkati ya mutu, komanso thupi ndi mchira, kumayenda kudzera mumtsinje wa santorin ndi khunyu yaying'ono ya duodenal. Divisum ya pancreas imachitika mu 5-10% ya anthu ndipo nthawi zambiri siziwoneka mchipatala. Nthawi yomweyo, pali zowunikira zambiri zomwe zikuwonetsa kuyanjana pakati pa kukondwereraku komanso kupunduka kwapakati kapena CP. Amaganiziridwa kuti nthawi zina ndikulimbikitsa katulutsidwe ka kapamba, kukula kwakang'ono kwa khunyu ya duodenal sikulola kutuluka kokwanira kwa chinsinsi kuchokera kumapazi ambiri, ndiye kuti, stenosis imachitika, yotsatana ndi kuwonjezeka kwa kupanikizika kwa pancreatic duct, komwe mwina ndiye maziko a kukula kwa kapamba. . Kutheka kwa kachitidwe ka pathogenetic kamatsimikiziridwa ndikusintha kwamakhalidwe a odwala pambuyo pa endoscopic papillosphincterotomy ya nippleal nipple yaying'ono.

Oddi sphincter dysfunction (DLS) ndi choletsa kusawerengeka kosalepheretsa kutuluka kwa bile kapena pancreatic secretion pamlingo wa Oddi sphincter. Odwala omwe ali ndi DLS amatha kugawidwa m'magulu awiri: 1) ndi sphincter stenosis, 2) omwe ali ndi vuto losayenda bwino

ntchito yopindulitsa ya sphincter. M'magawo onse awiri, chotsatira chake ndi kulowetsedwa kwamitsempha, kuchititsa kuwoneka kwa zizindikiro monga kupweteka kwam'mimba, kufalikira kwa duct ya bile, hyperfermentemia, komanso zizindikiro zamatenda a pancreatitis. Pali chifukwa chokhulupirira kuti DLS ndi chimodzi mwazomwe zimayambitsa matenda a idiopathic pachimake komanso chokhazikika chokhazikika. Kuphatikiza apo, kuwonjezeka kwa matenda oopsa a intraductal kumabweretsa kupita patsogolo kwa CP.

Kuledzera kumakhala chiwonetsero chotsogola kwambiri ku CP, komanso chinthu chotsogola, chomwe chimakhala ndi 55-80% ya milandu yonse. Zizindikiro zakuchipatala za mowa wa CP zimawonekera kawirikawiri ali ndi zaka 35-45. Matendawa amafala kwambiri mwa amuna kuposa akazi. Nthawi yoyambira kumayambiriro kwa kumwa kwadongosolo kwamankhwala kupita ku chiwonetsero cha chipatala nthawi zambiri imakhala yoposa zaka 10 (11-8 mwa akazi ndi 18-11 mwa amuna), pamene pafupifupi tsiku lililonse mowa umafika, monga lamulo, 100-200 g ya ethanol 9.43.44 . Mtundu wa zakumwa zoledzeretsa zilibe ntchito pakukula kwa mowa wa CP. Crucial ndiye gawo lathunthu la Mowa ndi poizoni. Zinakhazikitsidwa kuti pali kulumikizana kwa mzere pakati pa kuchuluka kwathunthu kwa mowa womwe watengedwa ndi chiopsezo chokhala ndi vuto lakulitsa CP, ndipo pambuyo pake chiopsezo chobwereranso 17.44. Pali umboni kuti anthu omwe amamwa oposa 100 ga ethanol patsiku amakhala ndi chiopsezo chowirikiza ka 11 kukulira ndi kuchulukitsa CP poyerekeza ndi omwe samamwa. Komabe, sizinali zotheka kudziwa mulingo wapakati, kuchuluka kwake komwe kumadziwika ndi chitukuko cha CP, chomwe chimawonetsa chidwi chosiyana ndi mowa komanso gawo lothekera lazinthu zina pakupanga CP yoledzera. Izi zikutsimikizidwanso ndikuti theka la zidakwa zokha zomwe zimayamba kuwonetsa pancreatic. Monga momwe kungathekere zinthu zomwe zikuthandizira poizoni wa ethanol, calorie wambiri, zakudya zama protein ambiri, nicotine, kuchepa kwa mavitamini ndi kufufuza zinthu (mkuwa, selenium), komanso kusokonezedwa kwa kagayidwe kake ka calcium 11,17,43,44. Palinso lingaliro kuti mowa wokha umangoyambitsa zomwe zimapangitsa kukulitsa CP mwa anthu omwe ali ndi vuto lobadwa nawo. Chifukwa chake, mmaphunziro ena, zidawonetsedwa kuti mwa anthu omwe ali ndi vuto la chidakwa CP, nthawi zambiri kuposa momwe amawongolera, kusintha kwa mitundu ya PBT ndi 8RSC1 kumapezeka. Mitundu ina idawerengedwa monga "ofuna", komabe, pakadali pano sizingatheke kudziwa motsimikizika kuti matupi amtundu wa mowa ndi CP.

Kafukufuku wambiri wazomwe wawonetsa kuti osuta ali pachiwopsezo chowonjezeka cha maphunziro owopsa a CP, chiwopsezocho chikuwonjezeka ndikuwonjezeka kwa chiwerengero cha ndudu za 35.43. Njira yodziwika bwino yofukizira fodya ku kapamba sichikudziwika, komabe, pali umboni kuti kusuta kumayambitsa kutsika kwa pancreatic bicarbonates, komanso kumathandizanso kuchepetsa njira yolepheretsa minyewa

milingo ya seramu ndi alpha1-antitrypsin. Chifukwa chake, masiku ano, kusuta fodya kumadziwika kuti ndi chifukwa chodziyimira pawokha cha CP 18,21,35.

Kuopsa kwa kufalikira kwa CP kumakhudzidwa ndi kuchuluka kwa kusokonezeka kwamaganizidwe: nkhawa zaumwini ndi kukhumudwa. Momwe zimakhalira, ndikamvetsetsa zowawa zomwe zimawonekera, zimawonjezera zovuta za njirayi.

Mankhwala ena: thiazide diuretics, tetracycline, sulfonamides, estrogens, azathioprine, 6-mercaptopurine, L-asparaginase, etc. atha kukhala ngati poyambira CP. Palinso lingaliro kuti mankhwalawa angakulitse maphunziro a CP of etiology 21,23, 44. Zokhudza mgwirizano wa CP ndi kugwiritsa ntchito mankhwala ndizochepa.

Zina zilizonse zomwe zimapangitsa kuti PC ipite patsogolo posachedwa zimapangitsa kuti pakhale kuperewera kwa insulin, kuchepa kwam'mimba komanso kuchepa kwa magazi, kusungunuka kwa m'mimba komwe kumayambira m'matumbo kumapangitsa kuti wodwalayo asokonezeke, zovuta za dysbiotic mwachilengedwe zimayamba, zikukulitsa nthawi yayikulu ya matenda omwe amayambitsa 31,37 . Kafukufuku wazinthu zomwe zimapangitsa kuti pakhale kupangika kwa exocrine pancreatic insuffence, zidapezeka kuti izi zimaphatikizapo kutalika kwa nthawi ya CP, kuchuluka kwa ma episode owonjezera a CP kapena pachimake pancreatitis, kumwa mowa, osagwirizana ndi zinthu monga zaka, chithandizo cham'mbuyomu, matenda okhudzana, kusowa kwa magazi ndi zochitika za psychoemotional. Nthawi zambiri, ndi kukula kwa kukonzekera kwa exocrine, kukonzekera kwa polyenzyme kumayikidwa ndi choloweza m'malo, koma nthawi zambiri pamlingo wokwanira wa 37.41, womwe odwala satenga nthawi zonse, ndikuwonjezera njira ya CP. Zidadziwika kuti proton pump inhibitors sizinakhudze kuwonongeka kwa exocrine pancreatic ntchito, ndipo somatostatin ndi kufananizira kwake kunayambitsa kulepheretsa kwake ndikukula kwa kusakwanira.

Ponena za zolakwika zakudyazo, pali malingaliro pawiri. Olembapo ena amapereka umboni kuti chiwopsezo cha kukokomeza kwa CP chikukula kwambiri ndikugwiritsa ntchito mafuta pafupipafupi, zakudya zazonunkhira, kuti zolakwika izi muzakudya ndizowopsa zomwe zingachitike 24.28. Kutengera ndi maphunziro ena, mawuwo amachokera, kuchulukitsa kwa CP, kuopsa kwa maphunziridwe ake kumatengera nthawi yodyetsedwa ndikuletsedwa kwamafuta a nyama ndi mapuloteni, mwachitsanzo, mawonekedwe apadera a CP amaperekedwa - kutentha kwapancreatitis 21, 30.

Ndi CP, mosiyana ndi matenda ena, palibe njira zovomerezeka zomwe anthu amavomereza. Palibe umboni uliwonse wonena za momwe mbali ina ya CP inapita mu njira ina.

Zowopsa zambiri komanso kuchuluka kwa CP, kuchuluka kwa malingaliro pa kufunikira kwa zinthu zina, kupezeka pafupipafupi kwa zinthu zofananira kukusonyeza kuti mutuwu ndiwotsegulika kuti mukambirane.

ZOCHITSA ZOIPA ZOPHUNZITSA KULIMA KWA CHRONIC PANCREATITIS

I.V. Reshina, A.N. Kalyagin (Irkutsk State Medical University, MUSES "Chipatala chachipatala No. 1 Irkutsk")

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The pathogenesis of pancreatitis pachimake

Zochita zamankhwala zimazindikira zinthu zingapo zomwe ndizomwe zimapangitsa kuti gawo la matenda liziwoneka bwino. Kuti mumvetsetse zamtunduwu, ndikofunikira kulingalira za kapamba kogwira ntchito.

Chiwalo chamkati chimayimira ziwalo za kuphatikiza katulutsidwe. Imagwira ntchito zingapo. Zomwe zimaphatikizidwazo zimaphatikizira exocrine, zomwe zimapangitsa kuti pakhale kupanga michere yamagaya yomwe imathandizira kugaya chakudya kumachitika. Ntchito yachiwiri ndi endocrine. Zikondazo zimatulutsa insulin ya mahomoni, yomwe imakhudzidwa ndi kayendedwe ka shuga m'thupi.

Ma pancreatic Enzymes (lipase, proteinase ndi amylase), pamodzi ndi zina zonse zotulutsira, Lowani mu system ya tubule, yomwe potuluka imaphatikizidwira pancreatic duct. Ma Enzymes amathandizira kuthana ndi zigawo zikuluzikulu za chakudya - mafuta, chakudya cham'mimba komanso mapuloteni.

Pofuna kupewa kudzimbidwa kwa gawo lamkati, mapuloteni amapangidwa osagwira. Mothandizidwa ndi zina zomwe zimagwira ntchito mu duodenum, amasinthidwa kukhala gawo logwira, chifukwa chomwe amathandizira kugwetsa mapuloteni. Ndi kulephera mu unyolo uwu komwe kumayambira pathogenesis.

Pathanatomy imazindikira njira zingapo zomwe zimayambitsa kupukusira kwa kapamba. Izi zikuphatikiza:

Reflux.
Njira ina.
Zopatsa chidwi.

Kusintha ndikusinthidwa kwachilendo kwa maselo a pancreatic, omwe amaphatikizidwa ndi vuto mu magwiridwe awo. Kusiyana pakati pa makina a chitukuko kumeneku kumachitika chifukwa cha zovuta zakunja, osati zamkati. Amayamba njira yowonongera maselo. Zinthu zomwe zimayikidwa motere:

Chemical - poizoni ndi mankhwala, zamchere zinthu, zidulo, mchere.
Zachilengedwe - tizilombo kapena matenda opatsirana.
Makina - zoopsa, opaleshoni.

Pazosinthanitsa kwambiri, kuwonjezeka kwa kupanikizika mkati mwa ma pancreatic ducts kumawonedwa mwa odwala. Pali zifukwa zingapo zothandizira matenda:

Kukula kwa matendawa chifukwa chomwa mowa kwambiri komanso zakudya zamafuta. Zitsukazo sizingachotse mwachinsinsi chinsinsi chonsecho. Nthawi zina, pathogenesis yamatenda amtunduwu imadalira maumboni amunthu.
Gawo la pachimake ndi kufalikira kwa ma pancreatic ducts. Nthawi zambiri, blockage imayamba chifukwa cha cholenditiasis kapena kufinya ndi chotupa.

Ndi mawonekedwe a Reflux, wodwalayo amawulula jakisoni wa bile mu pancreatic duct, yomwe imatsogolera kuwonongeka kwa maselo a pancreatic.

Zomwe zimayambitsa ndikutchinjiriza kwamatumbo, kamvekedwe kokwanira ka sphincter ya Oddi.

Zomwe zimatsogolera pakupanga kutukusira kwa mapapo kwa gland

Kutupa kwa kapamba m'njira yanthawi yina patakhala kuti sikunachitike muchipatala. Iron imagwira ntchito zambiri zamankhwala komanso zamankhwala am'mthupi, imayendetsedwa ndi matenda osiyanasiyana a ziwalo zamkati, makamaka kugaya chakudya.

Pancreatitis ndi yoyamba komanso yachiwiri. Mtundu woyamba umakhala wosowa kwambiri, chifukwa m'mazithunzi ambiri azachipatala, kutupa kwa kapamba kumayambitsidwa ndi matenda ena, chifukwa chake amalankhula za yachiwiri matenda.

Miyezo yakuopsa kwa kapamba amatsimikizika pazinthu zambiri. Gulu la wodwalayo limawaganiziridwa (chiwopsezocho ndi chachikulu ngati wodwalayo ali ndi zaka zopitilira 55), matenda oyanjana, kuchuluka kwa leukocytes ndi glucose m'magazi, gawo la matendawa (ngati kuchulukitsa kwa mawonekedwe osakhazikika kumawonedwa).

Zomwe zimayambitsa pancreatitis pachimake zimatha kugawidwa m'magulu angapo. Чаще всего причиной воспаления становятся следующие патологии:

Нарушение функциональности желчного пузыря. Выделяют патологии: калькулезный, острый или хронический холецистит, желчекаменное заболевание.
Сахарный диабет 2-ого типа.
Тромбоз кровеносных сосудов, вследствие чего ПЖ страдает от дефицита кислорода и питательных веществ.
Порок желчных путей врожденного характера.
Заболевания большого сосочка 12-перстной кишки (опухолевые новообразования, воспалительные процессы).
Хроническая форма печеночной недостаточности (цирроз печени, любая форма гепатита).
Патологии желудочно-кишечного тракта хронического течения (колит, заболевание Крона).
Zokhudza zonse matupi awo sagwirizana, biliary dyskinesia mwa mayi wapakati, zokhudza zonse lupus erythematosus, zokhudza zonse scleroderma.

Mndandandawo ungathe kuphatikizidwa ndi kachilombo koyambitsa bakiteriya (syphilis, typhoid fever), sepsis, kufooka kwa mafuta m'thupi, komanso ma systemic pathologies a minofu yolumikizira.

Mu malo achiwiri malinga ndi kufunikira kwa zinthu ndi zizolowezi zoyipa za wodwalayo. Izi zimaphatikizapo kumwa mowa kwambiri, kusuta, kusadya bwino - kuchepa kwa mapuloteni, kudya zakudya zamafuta, ndi zina zambiri.

Mu malo achitatu ndimavuto omwe amayamba chifukwa chogwiritsa ntchito mankhwala kwanthawi yayitali. Chifukwa china ndikuchita opaleshoni mwadzidzidzi.

Kugwiritsa ntchito mankhwala monga glucocorticosteroids, diuretics, sulfonamides, estrogens, Furosemide, Metronidazole, Tetracycline kumatha kupangitsa chitukuko cha pancreatitis pachimake.

Chithandizo cha pachimake gawo la matenda

Malinga ndi ICD code 10, kapamba amatha kukhala osiyanasiyana. Zinthu zomwe zimakhudza kapamba zimayambitsa matenda kapena mtundu wina wa matenda. Kuti mupeze chithandizo, muyenera kudziwa komwe mumachokera.

Mkhalidwe wapansipansi wa kapamba amatsimikiziridwa ndi izi: kufalikira kwamkati, palpation imawonetsa kupweteka pakumveka kwa kapamba. Mimba ndi yofewa, yowawa ndikulowerera mkati mwa ziwalo zimatsimikiziridwa ndi palpation. Kusokonezeka kwa m'mimba kumawonekera pamaso pa exudate pamimba.

Pakuwopsa, odwala amadandaula za zizindikiro: kupweteka kwambiri, kuwonongeka koopsa mu thanzi, nseru ndi kusanza, kudzimbidwa - m'mimba. Ngati simupereka thandizo kwa wachikulire, ndiye kuti zovuta zingapo zimawonjezeka (mwachitsanzo, pancreatic necrosis). Atangoyamba kumene kutupa, ambulansi iyenera kuyitanidwa.

Pazindikiritso, kuyesa kwa labotale kumagwiritsidwa ntchito - kuwunika kwamkodzo ndi mkodzo, kuyezetsa magazi kwa biochemical kwa ndende ya amylase, trypsin, glucose. Monga njira zothandizira, CT, MRI, radiography, ultrasound imagwiritsidwa ntchito.

Chithandizo cha pachimake mawonekedwe a matendawa chimachitika kuchipatala. Kulemba mankhwala kumaphatikizapo:

Kulowetsedwa mankhwala ndi mtsempha wa magazi makonzedwe omwe amathandizira kuyeretsa magazi a poizoni ndi pancreatic enzyme.
Mankhwala opweteka.
Mapiritsi omwe amathandizira kuthana ndi ma pancreatic enzymes (Gordox).
Mankhwala osokoneza bongo omwe cholinga chake ndi kuchepetsa pancreatic secretion (Atropine).
Mankhwala a antiemetic.
Maantibiotic, antispasmodics.

Dokotala yemwe ali ndi vuto lalikulu amakulangizani kusala kudya, komwe kumakupatsani mwayi wotsitsa kapamba, kuchepetsa katundu kuchokera mkati. Kukonzanso mankhwala a kapamba kumaphatikizapo kumwa mankhwala, kutsatira zakudya zabwino, kusiya zizolowezi zoipa.

Ziwerengero zimawerengera kuti anthu ambiri amwalira ngati wodwala atayamba kuvutika motere - hemorrhagic pancreatitis, aimpso ndi mtima, kulephera kwaimpso, kuchepa kwa khungu.

Vuto lodana kwambiri limatha kuyambiranso. Izi zatheka chifukwa cha zomwe zidayambitsa matenda, komanso momwe zingathandizire.

Kubwezera kungayambitse matenda.

Zoyambitsa Acute Pancreatitis

Parenchymal pancreatitis nthawi zambiri imayendera limodzi ndi kuchepa kwa mapuloteni, zilonda zam'mimba, atherosulinosis yamitsempha yamagazi, matenda opatsirana - matenda a hepatitis, typhus, ndi matenda ofala.

Fomu ya biliary ndiyotsatira yachindunji ya ma pathologies a ndulu. Nthawi zambiri, pempho lakale lamadzimadzi kapena lotsekeka ndi ndulu limawonetsedwa, zomwe zimatsogolera pakupanga njira yotupa. Kukula kwa kapamba kumadalira kwenikweni matenda.

Mowa pancreatitis ndi chifukwa cha kukhoza kwa mowa kuti awononge maselo a chamba. Nthawi zambiri, matenda amapezeka motsutsana ndi maziko a vuto la chiwindi, kukula kwa matenda amitsempha. Kuti apulumuke, wodwalayo ayenera kusiyiratu kumwa mowa. Chiwerengero chaimfa ndi 30-40% ya milandu yonse.

Kupukutira kumabweretsa kutupa kwa kapamba. Mu theka la milandu, zamatsenga ndi asymptomatic. Zizindikiro zimawonekera pa masiku 4-6. Mu zojambula zina, kuwukira kovuta kumasinthidwa m'njira yopanda pake.
Cystic fibrosis ndimtundu wa genetic womwe umadziwika ndi masinthidwe amtundu winawake, chifukwa chomwe ziwalo zobisika zimakhudzidwa.

Pancreatitis nthawi zambiri imapha. Ziwopsezo zomwe zimayambitsa matenda ambiri ndizophatikiza cholelithiasis, kumwa kwambiri, kusuta fodya, komanso matenda ophatikizana a m'mimba.

Kupewa

Pakuwopsa kwa kapamba, pamafunika kuti muchepetse Zizindikiro, komanso kupewa kutenganso matendawo mtsogolo. Kuunika kwa madotolo amati izi zimadalira wodwalayo.

Choyamba, ndikulimbikitsidwa kusiya ndudu ndi kumwa mowa. Izi zimathandizira kuchepetsa katundu pazinthu zamkati. Pamaso pa matenda enaake, wodwalayo amatsimikizika kuti apewe kuchulukana kwake.

Monga njira yothanirana, mankhwalawa amagwiritsidwa ntchito. Ma broth amagwira ntchito molingana ndi chiuno cha rose, chingwe, chamomile wa mankhwala. Kugwiritsa ntchito kumachitika mu maphunziro, amathandizira kubwezeretsa kapamba.

Njira zina zodzitetezera:

Kuchita masewera olimbitsa thupi mopitirira muyeso, kuthamanga, kudumpha, kupita kukasamba komanso sauna kungachititse kuchuluka. Njira yoyenera yochitira masewera olimbitsa thupi ndiyenda, zolimbitsa thupi, kutikita minofu, masewera olimbitsa thupi.
Mkhalidwe wa zotupa za bile ndipo ndulu ya ndulu imakhudza kugwira ntchito kwa kapamba. Ndikofunika kuthandizira panthawi yake matenda, kuyeserera mayeso.
Zakudya zoyenera komanso zopatsa thanzi. Simungathe kudya mopambanitsa - iyi ndi njira yolunjika. Ndi kuchulukana, kufa ndi njala ndi khunyu nthawi zambiri kumasonyezedwa.
Muyenera kusiya zakudya zotsekemera ndi zamafuta, kudya zakudya zochepa zomwe zimakhala ndi ma coarse fiber - kabichi, beets, kaloti. Ndi mankhwala a pancreatitis, mkaka wowawasa, mchere wopanda madzi, komanso nsomba zam'nyanjamu zimawonjezedwa pamenyu.

Zachidziwikire, kupewa sikutsimikizira 100% kuti kupewetsa kwa chifuwa chachikulu cha kapamba kumatha kupewedwa. Komabe, njira zosavuta monga momwe zimakhalira ndi moyo wathanzi zimachepetsa chiopsezo chotenga matendawa.

Zomwe zimayambitsa pancreatitis zafotokozedwa mu kanema munkhaniyi.

Zifukwa zina

Poizoni ndi kagayidwe kazinthu:
- uchidakwa
- kusuta
- calcium yayikulu (amapezeka mwa odwala omwe ali ndi chotupa cha parathyroid)
- kudya kwambiri ndi kudya zakudya zamafuta
- kusowa kwa mapuloteni mu chakudya
- machitidwe a mankhwala ndi poizoni
- aakulu aimpso kulephera
Pancreatic duct chotchinga:
- miyala m'miyala iyi
- chifukwa chosokoneza sphincter ya Oddi
- Mumayenda chotupa ndi chotupa
- zipsera zoopsa za zikondwerero zam'mimba (kupsinjika kwa njira ya endoscopic: papillosphincterotomy, kuchotsedwa kwa miyala, ndi zina zotere)
Matenda a gallbladder ndi biliary thirakiti.
Matenda a duodenum.
Zotsatira za pachimake kapamba.
Makina a Autoimmune.
Heredity (gene kusintha, 1-antitrypsin akusowa, etc.).
Helaminths.
Osakwanira okosijeni mu kapamba chifukwa atherosulinosis yamitsempha yamagazi yopereka chiwalo ichi ndi magazi.
Kubadwa kwatsopano kwa kapamba.
Idiopathic aakulu kapamba (chifukwa sichingadziwike).

Zizindikiro za Pancreatitis

kupweteka kwam'mimba: kupweteka kumakhala kwapadera mu epigastrium ndikubwezera, kumakulirakudya mukatha kudya komanso kuchepa pakukhala kapena kutsamira kutsogolo
kusanza
kutsegula m'mimba, fuluwenza (ndowe zamafuta), kuchuluka kwa fecal
kutulutsa, kuguguda m'mimba
kuwonda
kufooka, kusakwiya, makamaka "pamimba yopanda kanthu", kusokoneza tulo, kuchepa mphamvu
Chizindikiro cha "m'malovu ofiira" ndi mawonekedwe owoneka ofiira pakhungu la chifuwa, kumbuyo ndi pamimba.

Ngati zizindikiro zotere zikuwoneka, tikulimbikitsidwa kukayezetsa kuti mupeze matenda apakhungu.

Mavuto aakulu a kapamba

Popeza mankhwalawa palibe, zovuta za matenda a kapamba zimaphatikizapo:

matenda ashuga
kusowa kwa vitamini (makamaka A, E, D)
kuchuluka kufooka kwa mafupa
cholestasis (ya jaundice komanso wopanda jaundice)
zotupa zotupa (kutukusira kwa ducts ya bile, abscess, cyst, etc.)
subhepatic portal matenda oopsa (kuchuluka kwa madzimadzi m'matumbo, kukukulidwa ndulu, mitsempha ya khoma lakumbuyo yam'mimba, esophagus, chiwindi ntchito
pleural effusion (kuchuluka kwa madzimadzi mu nembanemba yamapapu)
compression ya duodenum ndi chitukuko cha matumbo
khansa ya kapamba.

Ofatsa

kutulutsa kochulukirapo (nthawi 1-2 pachaka), kochepa
kupweteka kwapakati
osachepetsa thupi
palibe m'mimba, mafuta chopondera
kuwunika kwa ndulu ndizobwinobwino (palibe mafuta osalowerera, mafuta acids, sopo)

Ndi zovuta pancreatitis yofatsa, nthawi zambiri njira zambiri za kumwa sizofunikira, chifukwa kusintha kwa moyo ndi kusiya zizolowezi zoipa nthawi zambiri kumalepheretsa kubwereranso.

Giredi yapakatikati

kukokoloka katatu pachaka, kumachitika ndi kupweteka kwa nthawi yayitali
kuchuluka kwa amylase, lipase m'magazi ingaoneke
nthawi kupumula kwa chopondapo, mafuta chopondapo
pali zosintha mu pulogalamu

Ndi kuopsa kwamatenda a kapamba, kudya mokwanira, maphunziro owonjezera, ndikuwunika madokotala pafupipafupi.

Manda

pafupipafupi komanso kwanthawi yayitali ndikumva kupweteka kwakanthawi
pafupipafupi zotulutsa, mafuta chopondapo
kuwonda, mpaka kutopa
zovuta (shuga, pseudocysts, ndi zina).

Woopsa pancreatitis, chithandizo chothandizira chopitilira, mankhwala amphamvu komanso chakudya chofunikira ndikofunikira. Nthawi zambiri odwala amafunikira kuwunikira mosamala osati kokha ndi gastroenterologist, komanso ndi madokotala aubwino wina (endocrinologist, dokotala wa opaleshoni, wa zakudya). Kuchulukana kwakubwera, komanso zovuta za matendawa, zikuwopseza moyo wa wodwalayo ndipo, monga lamulo, ndizizindikiro zakuchipatala kuchipatala.

Kukhalapo kwa pancreatitis yayitali, mosasamala za kuuma, kumafunika chisamaliro chamankhwala, chifukwa popanda chithandizo ndi kusintha kwa moyo,
mchitidwewo ukupita patsogolo pang'onopang'ono.

Njira zantchito:

zamankhwala, zamankhwala amuzolengedwa zamwazi zimachitika (mulingo wa ma pancreatic enzymes m'magazi - ma amylase, lipases, ndizofunikira kwambiri)
Coprogram - kukhalapo kwa zinthu zina mu ndowe (mafuta, sopo, mafuta acids, ndi zina) kumayesedwa. Nthawi zambiri, amayenera kukhala osakhalapo, komanso osakhazikika pakhungu, chifukwa chosakwanira kupanga ma enzyme ndi chitsulo kuti agwetse zinthuzi, samakhala osafunikira ndipo amakhala otsimikizika mu ndowe.
stool elastase ndi puloteni ya kapamba, yemwe amachepetsa pomwe sagwira ntchito mokwanira
Nthawi zina, ndikofunikira kuzindikira omwe ali ndi khansa
Ngati mtundu wamatenda amtunduwu ukayikiridwa, kuyesedwa kwa majini kumachitika.

Kufufuza kwazida

Ultrasound yam'mimba. Zizindikiro za kutukusira kwa minyewa ya kapamba, kupezeka kwa miyala mumkati, kuwerengera, ma cysts, ndi zotupa za ndulu zimayesedwa. Kuphatikiza apo, kusintha kwa ziwalo zina zam'mimba kumatsimikizika kupatula zovuta za matendawa, komanso matenda opatsirana.

Pancreatic elastography. Mumakulolani kuti muwone ngati pali fibrosis (kapangidwe kake) kapamba, chomwe ndi chitsimikizo pakuvuta kwamapangidwe azinthu.
Ultrasound yokhala ndi kapamba wathanzi elastography
FGDS. Kuwona kwa duodenum ndikofunikira kuyesa kukhalapo kwa kutupa mkati mwake, komanso zizindikiro zosadziwika za kapamba. Ndikofunikira kupatula zotupa ndi mapangidwe a m'matumbo (chotupa, diverticulum) m'dera la nodenal nipple yayikulu (kudzera mwa icho chinsinsi cha kapamba chimalowa mu duodenum, chikatsekedwa, kutuluka kwa chinsinsi ichi kusokonezeka, komwe kumabweretsa kufooka kwa ziwalo za tiziwalo tizizungulira.
Kuwona kwam'mimba ndi kum'mero ndikofunikira kupatula kukokoloka, zilonda, kutupa mkati mwawo. Kusintha kwachilengedwe mu ziwalo izi nthawi zambiri kumaphatikizidwa ndi chifuwa chachikulu, kukhala chakukulitsa kwambiri.

Kuphatikiza apo, CT ndi MRI ya m'mimba yokhala ndi cholangiography, RHHP ikhoza kulembedwa. Ndikofunikira kutsimikizira matendawa, komanso amatchulidwa kuti akuwoneka ngati akupezeka m'matumbo, mapindikidwe a zonyansa zam'mimba ndi mwala, chotupa kapena chotupa.

Chithandizo cha kapamba

Chithandizo chachikulu cha pancreatitis yayitali ndikudya ndi kukana zizolowezi, kusintha kwa moyo, komanso mankhwala:

mankhwala omwe amachepetsa kupanga hydrochloric acid ndi m'mimba (proton pump inhibitors)
Kukonzekera kwa enzyme
antispasmodics
pamaso pa zowawa - ma analgesics, NSAIDs, ngati ululu ndi wamphamvu kwambiri ndipo sungathetsedwe ndi mankhwalawa, analcics ya narcotic.

M'pofunika kudziwa nthawi yoyamba kufufuza matenda a ziwalo zina zam'mimba thirakiti (cholelithiasis, cholecystitis, gastritis, duodenitis, zilonda zam'mimba, hepatitis, bakiteriya wokhala ndi vuto la m'mimba, dysbiosis, matenda a impso, ndi zina), chifukwa matendawa angayambitse ndi / kapena zina zokulitsa za kutupa kwapakhosi kosalekeza. Pankhaniyi, chithandizo cha matenda ena am'mimba thirakiti ndiyofunikira. Lingaliro la kufulumira ndi njira zochizira matenda amodzi amapangidwa ndi adokotala.

Ngati mankhwala omwe wodwala amamwa chifukwa cha matenda ena atha kuthandizira pakukula kwa matendawa, funso lothana ndi mankhwalawo likusankhidwa.

Mitundu yonse ya mankhwalawa iyenera kukhazikitsidwa ndipo iyenera kulamulidwa ndi gastroenterologist.

Ngati pali chilichonse chosokoneza makina, mapangidwe a bile kwa wodwala akuwonetsedwa kuti amupangire opaleshoni.

Matenda a kapamba ndi matenda oopsa. Komabe, kutsatira malingaliro a curator popewa kutulutsa mphamvu (kutsatira malangizo a kadyedwe, chithandizo chamankhwala, zina), chifuwa chamtunduwu chimatulutsa "modekha", popanda kufalikira pafupipafupi, ndipo chikukula patsogolo.

Kuphwanya zakudya, kudya zakumwa zoledzeretsa, kusuta fodya ndi chithandizo chosakwanira, njira za dystrophic mu minofu ya minofu ya gland ndikusintha koopsa, zambiri zomwe zimafunikira kuchitidwa opaleshoni ndipo zimatha kupha.

Thanzi la chifuwa chachikulu

Ndi kapamba, mbale zonse zimapangidwa kuchokera ku nyama yopanda nsomba ndi nsomba - kenako pokhapokha yophika. Zakudya zophika siziloledwa. Mutha kudya zinthu zamkaka ndi mafuta ochepa. Kuchokera pamadzi, ndikofunikira kumwa zakumwa zachilengedwe zokha ndi ma compotes ndi tiyi.

Iyenera kuchotsedwa kwathunthu:

mitundu yonse ya mowa, zotsekemera (msuzi wa mphesa) ndi zakumwa zoziziritsa kukhosi, cocoa, khofi
zakudya zokazinga
nyama, nsomba, msuzi wa bowa
nkhumba, mwanawankhosa, tsekwe, bakha
ndinasuta nyama, zakudya zam'chitini, masoseji
ma pickles, marinade, zonunkhira, bowa
kabichi yoyera, sorelo, sipinachi, letesi, radish, mpiru, anyezi, rutabaga, nyemba, masamba osaphika komanso zipatso,
makeke, mkate wabulauni
confectionery, chokoleti, ayisikilimu, kupanikizana, mafuta
mafuta, mafuta ophikira
mbale zozizira ndi zakumwa

Kudya koyenera kumathandizanso kuganiza pogwiritsa ntchito zakudya zopezeka mu chifuwa chachikulu, kupanga zakudya komanso kuganizira zofuna ndi zizolowezi za wodwala.

Ndi chifuwa chachikulu, kodi kapamba amwalira?

Matenda a kapamba ndimatenda omwe amadziwika ndi kutupa ndi dystrophy, omwe amatsatiridwa ndikukula kwa minofu yolumikizana mu chiwalo ndi chimbudzi cham'mimba ndi endocrine. "Imfa" ya gland imatchedwa pancreatic necrosis ndipo imachitika mu pancreatitis yovuta, kukhala yopweteka

Chifukwa chiyani kapamba amayamba ngati sindimamwa?

Zowonadi, nthawi zambiri, kukula kwa kapamba kumachitika chifukwa cha kumwa, koma pali zifukwa zina: matenda amtundu wamatumbo, matenda a chiwindi omwe amadziwika ndi kupangika kwa mapangidwe a bile, matenda am'mimba ndi duodenum, cholowa, kusayenda bwino kwa chitetezo chathupi, kusokonezeka kwa magazi mthupi, maziko matenda: hepatitis ya viral, hemochromatosis, cystic fibrosis, etc.

Mbiri yamankhwala

Wodwala H., wazaka 52, adabwera ku Clinic EXPERT ali ndi madandaulo a kupweteka kwa m'chiuno atatha kudya zakudya zamafuta komanso kumwa pang'ono, mowa, nseru, zikopa zotayirira.

Kuchokera ku anamnesis amadziwika kuti kusapeza bwino m'dera lomwe linali pamwamba pa navel ndi kumasula kwa chopondapo kumawonedwa kwa zaka zingapo ndikulakwitsa kwa chakudya, koma atatha kudya mosamalitsa amadutsa popanda kufufuza. Pazifukwa izi, mkaziyo sanayesedwe. Madandaulo amenewa anayambika. Kuphatikiza apo, zaka 20 zapitazo pakubala, wodwalayo adalankhula za kukhalapo kwa wandiweyani bile ndi ultrasound. M'tsogolomu, wodwalayo sanayesedwe, popeza sanazunzidwe ndi chilichonse.

Panthawi yowerengera komanso yowunikira, kusintha kwa mayesedwe a magazi kunawululidwa: kuwonjezeka kwa ESR, pancreatic amylase zochita, komanso ndi ultrasound, ma gallstones angapo.

Ataletsa kupweteka, wodwalayo adatumizidwa kukalandira chithandizo cha opaleshoni - kuchotsedwa kwa ndulu. Pambuyo pakuchita opareshoni, wodwalayo akupitilizabe kutsatira gastroenterologist, yemwe amatsatira malangizo a kadyedwe, samapanga madandaulo, zizindikirozo zimabwezeretseka.

Wodwala B., wazaka 56, adatembenukira kuchipatala cha EXPERT ndikudandaula za kupweteka kwakanthawi kwamtundu popanda chifukwa chodziwika bwino, limodzi ndi mseru ndi m'mimba. Pa gawo loyamba la mayeso, kuwunika kosintha kapangidwe ka kapamba kunapezedwa, komwe kumawoneka kuti ndi chifuwa chachikulu. Nthawi yomweyo, wodwalayo adakhala ndi moyo wathanzi, samamwa mowa komanso zakudya zamafuta. Mankhwala omwe amaperekedwa ndi kukonzekera kwa enzyme kunalibe tanthauzo lalikulu.

Poyesera kuti adziwe chomwe chimayambitsa kupanikizika kwa kapamba, dokotala wa gastroenterologist wa EXPERT Clinic adaweruza matenda angapo omwe angayambitse kukula kwa kapamba (cholelithiasis, zilonda zam'mimba, kuchepa kwa metabolism, ndi zina zotere) ndikuwunikira kusunthika kwa mayunitsi a ma laboratori. Izi zinakhala maziko a kufufuza kwakuya mokwanira, komwe kunapangitsa kuti zidziwike kuti choyambitsa chotupa cha m'mimba chinali chovuta pantchito ya chitetezo chathupi - autoimmune pancreatitis.

Chithandizo cha pathogenetic chidalembedwa chomwe chimakhudza kayendedwe ka matendawa - glucocorticosteroids malinga ndi chiwembu, chomwe, pakuwunika, ziwonetsero za kutupa m'thupi zidathetsedwa. Pakadali pano, wodwalayo akulandira chithandizo chokonzanso kwa nthawi yayitali moyang'aniridwa ndi curator, ndipo alibe madandaulo. Panthawi yolamulira ultrasound yam'mimba, ziwonetsero za pancreatic edema sizinapezeke.

Pamene kapamba amalephera

Izi zikagwera - chakudya chimayamba kugayidwa mosayenera, zomwe zikutanthauza kuti zinthu zopangidwa ndi mavitamini sizimayamwa mokwanira, - izi zimapangitsa kufooka, kugona, "matope" mutatha kudya, "kumva" mbali yakumanzere kapena dera la solar plexus.

Ngati kusokonekera, makamaka kupweteka, sikutha kwa masiku opitilira 1-2, nseru kapena kusanza kumachitika, kutentha kumawuka, kutsekula m'mimba kumayamba kapena mtundu wa ndowe kusintha, muyenera kulumikizana ndi katswiri nthawi yomweyo.

Nthawi zambiri kutupa kwa kapamba - kapamba - Amasokonezeka ndimatenda a ziwalo zomwe zili kumtunda kwam'mimba, mwachitsanzo, ndi kuchuluka kwa zilonda zam'mimba kapena cholecystitis, ndi kutsekeka kwam'mimba komanso ngakhale poyizoni wamba wa chakudya.

Pancreatitis (kuchokera ku Chigriki. "Pancreas") ndikutupa komanso chiwonongeko chamtsogolo cha minofu ya pancreatic ndi ma enzymes ake.

Ndi kapangidwe ka kapamba, ma enzyme amenewa samawonekera, monga momwe akuyembekezeredwa, mu duodenum, koma kudziunjikira, amakhala otakataka ndipo amayamba kukhudza minofu ya England. Zotsatira zake, zikondamoyo zimadzigaya zokha.

Komanso, michere ya pancreatic imatha kuwononga osati tiziwalo tamatumbo, komanso mitsempha yamagazi yapafupi ndi ziwalo zoyandikana nazo.

Malinga ndi ziwerengero zaka 40 zapitazi, kuchuluka kwa chifuwa cha khansa kwachulukanso.

Akatswiri amagwirizanitsa kuwonjezeka kwa pancreatitis ndi moyo wamakhalidwe ndi zakudya: kuchuluka kwa zinthu zam'madzi, zotsekemera, kununkhira, zowonjezera zonunkhira sizipindulitsa thupi lathu.

Malinga ndi akatswiri, gulu lachiwopsezo limaphatikizapo:

anthu omwe ali ndi mavuto amowa
okonda kudya achangu
okonda mankhwala omwe mumamwa mopitirira muyeso,
osuta
mbiri yamatenda a ndulu
onenepa
anthu omwe ali ndi matenda amtima
anthu omwe amakhala ndi nkhawa nthawi zonse
odwala omwe avulala ndi chiwalo kapena aledzera.

Pancreatitis ndi pachimake komanso matenda.

Pachimake kapamba

Imakonda kutchedwa "Matenda opanda pake" - Zimachitika chifukwa cha kudya kwambiri, zomwe nthawi zambiri zimachitika patchuthi.

Pancreatitis pachimake lero idatenga malo a 3 pakati pa matenda opatsirana pambuyo pachimake appendicitis ndi pachimake cholecystitis.

Kutupa mu kapamba kumachitika mwadzidzidzi mwanjira ya kuukiridwa, kotero sizimachitika mwadzidzidzi.

Zizindikiro zazikulu za pancreatitis pachimake:

kupweteka kwambiri pamimba, pang'onopang'ono kuzungulira pamimba ndi kumbuyo,
kusanza ndi kusanza
kudzimbidwa kwambiri
kutentha kwambiri
zokonda mtima.

Mu chilonda chachikulu cha pancreatitis, kuthandizira kuchipatala ndikofunikira, ndipo makamaka kuvulala kwambiri!

Kuti muchepetse ululu ambulansi isanafike, ndibwino kuti mukhale pansi pang'ono ndikupindika ndikuyika pepala lamanzere kumanzere, kumapeto kwa nthiti. Malo opingasa kumathandizanso kuchepetsa ululu.

Zomwe sizingachitike ndikuwukira kovuta:

idyani ndi kumwa asanafike ambulansi - izi zithandiza kupanga ma enzyme ndi "tease" gland ngakhale inanso.
imwani ma pinkiller ndi mankhwala ena,
Ikani chotenthetsera pamimba yanu.

Kwa masiku angapo muyenera kupewa chakudya, madzi amchere okha opanda mpweya, msuzi wa rosehip ndi tiyi wofooka amaloledwa. Yoyenera kugona mpumulo ndi ozizira compraine pamimba pamimba.

Pambuyo pakupita kuchipatala komanso kupumula kwa zizindikiro za pancreatitis yovuta kwambiri, ndikofunikira kukhalabe kuyang'aniridwa ndi dokotala kwakanthawi, yemwe akuyenera kupereka mankhwala othandizira omwe amathandiza kuchepetsa kupanikizika ndi njira yochepetsera acidity ya madzi am'mimba, komanso, nthawi zina, maantibayotiki.

Kubwereza kachulukidwe kapamba kumatha kuyambitsa matenda.

Matenda a kapamba

Madokotala ati pali zifukwa ziwiri zamatenda awa — wamwamuna (mowa) ndi wamkazi (ma gallstones)

Kuopsa kwa chifuwa chachikulu ndi chakuti mwina sichingadzimveke kwa zaka zingapo, chikuchitika mosadukiza, chifukwa si odwala onse omwe amafunsana ndi katswiri.

Matendawa amatenga nthawi yayitali komanso pang'onopang'ono, ndipo mawonetseredwe a matendawa samatchulidwa pang'ono pokhapokha pancreatitis yayikulu:

kupweteka kapena kumva kupweteka m'mimba munthu atadya zokometsera kapena mafuta,
chimbudzi pafupipafupi (mseru, kutulutsa, zotulutsa),
kuwonda
kuyanika ndi khungu
kutopa.

Ngati munthu amene ali ndi chiphuphu chovuta kwambiri amakhala kumapeto, ndiye kuti nthawi zambiri amayesa kuzolowera. Njira iyi yathanzi ndiyowopsa kwambiri, chifukwa ma cell a pancreatic amatha kusintha komanso kusinthika kukhala mitundu yoopsa komanso yowopsa kwambiri.

Ngati mukukayikira kuti ali ndi chifuwa chachikulu, dokotala amakupatsani kuyesa kwamkodzo ndi magazi (kuphatikiza shuga), ndi ma ultrasound a ziwalo zamkati zam'mimba.

Monga nthenda ina iliyonse yamatendawa, mtundu uwu wa kapamba samachiritsidwa kwathunthu. Koma kuletsa kukula kwa zovuta zake ndizotheka.

Nthawi zambiri, akakhala ndi vuto lotere, adokotala amakupangira mankhwala othandiza kuti muchepetse ululu (ngati pakufunika), ndi ma enzyme omwe "amathandizira" kapamba kuti athe kuthana ndi ntchito zawo. Nthawi zina insulin imayikidwa kuti izitsatira glucose wamagazi.

Kalanga ine! munthu wopezeka ndi chifuwa cham'mimba amayenera kulingalirananso njira zake zopezera zakudya.

Pa chifuwa chachikulu, simungathe:

Zonona
Zokazinga
Zonunkhira
Kusuta
Amchere
Kuzifutsa
Msuzi wamphamvu
Zakudya zamatenda
Masoseji
Zipatso za zipatso
Kabichi
Bowa
Ziphuphu
Phala lokwera (muesli, mapira)
Mkate wakuda
Chocolate
Makeke ndi makeke
Soda
Khofi
Tiyi yamphamvu
Kutentha kwambiri
Kuzizira kwambiri
Zosiyanasiyana pamiyeso yambiri
Mowa
Kusuta
Muyenera kudya osachepera kasanu patsiku m'magawo ang'onoang'ono (mwa njira, iyi nthawi zambiri ndi imodzi mwalamulo yoyenera ya kadyedwe koyenera).

Zomwe zingadyedwe:

Zowaka mkaka wowonda
Ma protein
Nyama yokhala ndi mafuta ochepa, nkhuku, nsomba zowonda
Nsomba zofiira pang'ono
Groats - oat, buckwheat, mpunga
Masamba ophika kapena anaphika (mbatata, kolifulawa, kaloti, zukini, dzungu, beets, nandolo zobiriwira)
Zipatso zopanda acidic ndi zipatso
Madzi ocheperako okhala ndi alkaline, mwachitsanzo, Narzan, Borjomi, Jermuk, Essentuki.

Kuphatikiza pa kutsatira zakudya, mavitamini A, C, B1, B2, B12, PP, K, folic acid amafunikiranso.

Lamulo lalikulu pano si kudya kwambiri: chitsulo chikuyenera kugwira ntchito popanda kupsinjika.

Simungathe kuyenda kwanthawi yayitali, m'malo ovuta kwambiri, kapu yamadzi ofunda idzakuthandizani ngati mumamwa theka la ola musanadye. Muyenera kudya nthawi yomweyo kuti kapamba asamachite pachabe.

Mfundo izi za zakudya zopewera zakudya ndizopewera zovuta zamatenda kwa iwo omwe adadwala matendawa ndipo sangafune kukumana nazo mtsogolo. Koma, monga amati: "Ngati simungathe, koma mukufunadi, ndiye kuti mungathe!" Chachikulu ndikudziwa muyeso mu chilichonse. lofalitsidwa ndi econet.ru.

Ngati muli ndi mafunso, afunseni.apa

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