SYMPTOMATIC ArterIAL HYPERTENSIONS

SYMPTOMATIC ArterIAL HYPERTENSIONS

Syndrome, kapena sekondale, matenda oopsa (matenda oopsa) ndi matenda oopsa, chifukwa chogwirizana ndi matenda ena kapena kuwonongeka kwa ziwalo (kapena machitidwe) okhudzana ndi kayendetsedwe ka magazi.

Pafupipafupi matenda oopsa oopsa ndi 5-15% ya onse odwala matenda oopsa.

Pali magulu anayi akuluakulu a SG.

1. Renal (nephrogenic).

3. Hypertension chifukwa cha kuwonongeka kwa mtima ndi ziwiya zazikulu (hemodynamic).

4. Centrogenic (chifukwa cha kuwonongeka kwa organic)

Kuphatikiza kwa matenda angapo (kawiri kawiri) omwe angayambitse matenda oopsa amatha, mwachitsanzo: matenda ashuga glomerulosulinosis ndi pyelonephritis, atherosranceotic stenosis ya mitsempha ya impso komanso matenda a pyelo- kapena glomerulonephritis, chotupa cha impso mwa wodwala yemwe ali ndi matenda a ateriosulinosis Olemba ena akuphatikizira kuchuluka kwa matenda oopsa monga magulu opanga matenda oopsa. Gululi limaphatikizapo matenda oopsa, omwe adayamba chifukwa cha poyizoni ndi lead, thallium, cadmium, etc., komanso mankhwala osokoneza bongo (glucocorticoids, njira zakulera, indomethacin limodzi ndi ephedrine, etc.).

Pali matenda oopsa oopsa ndi polycythemia, matenda oopsa a m'mapapo ndi zina zomwe siziphatikizidwe ndi gulu.

Zomwe zimayambitsa kuthamanga kwa matenda oopsa ndizo matenda ambiri omwe amaphatikizidwa ndi chitukuko cha matenda oopsa monga chizindikiro. Matenda ofanana opitilira 70 afotokozedwa.

Matenda a impso, mitsempha ya impso ndi kwamikodzo dongosolo:

1) anatengera: kupukusa glomerulonephritis, pyelonephritis, interstitial nephritis, zokhudza zonse vasculitis, amyloidosis, diabetesic glomerulossteosis, atherosclerosis, thrombosis ndi embolism a aimpso minofu, pyelonephritis pamaso pa urolithiasis, chotupa.

2) obadwa nawo: hypoplasia, dystopia, zonyansa pakukweza kwamitsempha yama impso, hydronephrosis, matenda a impso a polycystic, matenda a impso ndi zina zokhudzana ndi kukula kwa impso,

3) matenda okhathamiritsa (vasorenal).

Matenda a endocrine system:

1) pheochromocytoma ndi pheochromoblastoma, aldosteroma (aldosteronism yoyamba, kapena matenda a Conn's), corticosteroma, matenda a Itsenko-Cushing ndi matenda, acromegaly, amafalitsa poyizoni woipa.

Matenda a mtima, msempha ndi ziwiya zazikulu:

1) zolakwika za mtima zomwe zimapezeka (aortic valve insufficiency, etc.) ndi congenital (lotseguka ductus arteriosus, etc.),

2) matenda a mtima, limodzi ndi kulephera kwa mtima komanso chithokomiro chonse,

3) zotupa za kubadwa kwa msempha (coarctation) ndikupeza (arteritis ya msempha ndi nthambi zake, atherosulinosis), zotupa za carotid ndi mitsempha yamitsempha, etc.

Matenda a CNS: chotupa mu ubongo, encephalitis, zoopsa, zotupa ischemic zotupa, etc.

Limagwirira a chitukuko cha matenda oopsa mu matenda aliwonse amakhala ndi magawo osiyanasiyana. Amakhala chifukwa cha chikhalidwe komanso machitidwe a kukula kwamatenda oyamba. Chifukwa chake, mu aimpso a impso komanso zotupa za kukonzanso, chinthu chomwe chimayambitsa matenda a impso, ndi chofunikira kwambiri pakuwonjezera kuthamanga kwa magazi ndi kuwonjezeka kwa zochitika za opanikizira othandizira komanso kuchepa kwa ntchito yothandizira aimpso.

Mu matenda a endocrine, kupangika koyambirira kwama mahomoni enaake kumayambitsa kuchuluka kwa kuthamanga kwa magazi. Mtundu wa mahomoni oopsa kwambiri - aldosterone kapena mineralocorticoid wina, makatekolamaini, STH, ACTH ndi glucocorticoids - zimatengera mtundu wa endocrine pathology.

Ndi zotupa za chapakati mantha dongosolo, zinthu zimapangidwira ischemia malo omwe amayang'anira kuthamanga kwa magazi ndi kusokonezeka kwa chapakati pamafayidwe a magazi, osayambitsa chifukwa chogwira ntchito (monga mu matenda oopsa), koma kusintha kwa organic.

Mu hemodynamic matenda oopsa obwera chifukwa cha kuwonongeka kwa mtima ndi ziwonetsero zazikulu zamagetsi, njira zowonjezera kuthamanga kwa magazi sizikuwoneka kuti zikufanana, ndipo zimatsimikiziridwa ndi chikhalidwe cha zotupa. Zokhudzana:

1) ndikuphwanya ntchito za malo opsinjika (malo a sinocarotid), kuchepa kwa kutanuka kwa khola la msempha (ndi atherosulinosis ya Chipilala),

2) ndi kusefukira kwamitsempha yamagazi komwe kuli pamwamba pa malo ochepa kwambiri aorta (ndi coarctation), ndikuphatikizanso kwina kwa aimpso-ischemic renopressor limagwirira.

3) ndi vasoconstriction poyankha kuchepa kwamatulutsa amtima, kuchuluka kwa magazi, kuchuluka kwa hyperaldosteronism komanso kuwonjezeka kwamitsempha yamagazi (ndi mtima wosagwirizana),

4) ndi kuwonjezeka ndi mathamangitsidwe a systolic ejection ya magazi mu aorta (aortic valve insuffence) ndi kuchuluka kwa magazi kupita kumtima (arteriovenous fistula) kapena kuwonjezeka kwa nthawi ya diastole (kwathunthu atrioventricular block).

Kuwonetsedwa kwamankhwala mu matenda oopsa nthawi zambiri kumakhala ndi zizindikiritso chifukwa cha kuchuluka kwa kuthamanga kwa magazi ndi zizindikiro za nthendayi yoyambira.

Kuwonjezeka kwa kuthamanga kwa magazi kungafotokozedwe ndi kupweteka kwa mutu, chizungulire, kuthina kwa "ntchentche" patsogolo pa maso, phokoso ndikulira m'makutu, zopweteka zosiyanasiyana mdera la mtima ndi zina zotsekemera. Kuzindikira pakuwunika thupi, hypertrophoto yamanzere yamitsempha, kutsindika kwa II kamvekedwe ka msempha kumachitika chifukwa chokhazikika kwa matenda oopsa. Zindikirani kusintha kwa ziwiya za fundus. X-ray ndi electrocardiographally zimazindikira zizindikiro zamanzere yamitsempha yamitsempha yamagazi.

Zizindikiro za matenda oyamba:

1) imatha kutchulidwa, mwanjira zotere, chikhalidwe cha SG chimakhazikitsidwa pamaziko a zidziwitso zowonjezereka zamatenda a matenda ogwirizana,

2) atha kulibe, matendawa amawonetsedwa kokha ndikuwonjezeka kwa kuthamanga kwa magazi, motere, malingaliro okhudza mawonekedwe a matenda oopsa amatha:

a) Kukula kwa matenda oopsa kwa achinyamata ndi akulu kuposa zaka 50- 55,

b) Kukula kwambiri komanso kuthamanga kwa matenda oopsa pamankhwala ambiri,

c) Asymptomatic njira yoopsa matenda oopsa,

g) kukana mankhwala a antihypertensive,

e) mkhalidwe wowopsa wamaphunziro oopsa.

Centrogenic matenda oopsa amayamba chifukwa cha zotupa zamanjenje zamanjenje.

Zodandaula zomwe zimachitika paroxysmal kuchuluka kwa magazi, limodzi ndi mutu wovuta, chizungulire komanso mawonekedwe osiyanasiyana omasulira, nthawi zina epileptiform syndrome. Mbiri yovulala, kupindika, mwina arachnoiditis kapena encephalitis.

Kuphatikizidwa kwa madandaulo omwe ali ndi mbiri yoyenera kumapangitsa kuti lingaliro lamalingaliro okhudzana ndi chiyambi cha kuphatikiza matenda oopsa.

Pakufufuza kwakuthupi, ndikofunikira kupeza chidziwitso chomwe chimatilola kufotokoza za zotupa zathupi lathu lamanjenje. Mu gawo loyambirira la matendawa, zoterezi sizingakhale. Ndi nthawi yayitali ya matendawa, ndizotheka kuzindikira mawonekedwe, mawonekedwe opuwala komanso magawo am'mutu, matenda ochokera ku misempha yama cranial. Ndikosavuta kudziwitsa anthu okalamba, pamene mawonekedwe onse amachitidwe akufotokozedwa ndikupanga matenda a ubongo.

Chidziwitso chofunikira kwambiri chazindikiritso chimapezeka pakagwiritsidwe ntchito ka labotale ndi zida.

Kufunika kwanjira zakufufuzira komwe kumabwera ndi kusintha koyenera mu fundus ("nipples stagants") ndi kuchepera kwa zowonekera.

Ntchito yayikulu ndikuyankha momveka bwino funso ngati wodwalayo ali ndi chotupa muubongo kapena ayi, popeza kungodziwa yekha za panthawi yake kumalola opaleshoni.

Kuphatikiza pa X-ray ya chigaza (zomwe zili ndizofunikira kwambiri pazotupa zazikulu za ubongo), wodwalayo amapitilizidwa ndi electroencephalography, rheoencephalography, kusanthula kwa ultrasound ndi computer tomography ya chigaza.

Hemodynamic matenda oopsa obwera chifukwa cha kuwonongeka kwa mtima ndi ziwiya zazikulu ndipo agawidwa kukhala:

1) kuphatikiza kwa systolic mu atherosulinosis, bradycardia, aortic insufficiency,

2) matenda oopsa pa nthawi ya coarctation,

3) hyperkinetic circulatory syndrome yokhala ndi fistulas arteriovenous,

4) ischemic congestive matenda oopsa mu mtima kulephera ndi mitral valavu zolakwika.

Matenda onse a hemodynamic amagwirizanitsidwa mwachindunji ndi matenda a mtima ndi ziwiya zazikulu, kusintha zochitika zamagazi, komanso zimathandizira kukwera kwa magazi. Khalidwe lodzipatula kapena kuchuluka kwakukulu pamagazi a systolic.

Kuchokera kwa odwala zambiri zitha kupezeka:

a) nthawi yachilendo yowonjezereka kwa kuthamanga kwa magazi, chikhalidwe chake komanso zotengera zomwe zimachitika,

b) mawonetseredwe osiyanasiyana a atherosulinosis okalamba ndi kuuma kwawo (pang'onopang'ono kudandaula, kuchepa kwamphamvu kwa kukumbukira, ndi zina zambiri).

c) Matenda a mtima ndi ziwiya zazikulu, zomwe zimapangitsa kuti magazi azithamanga,

g) pazowonekera za kulephera kwachulukidwe kwamtima,

e) chikhalidwe ndi luso la mankhwala.

Kupezeka kwa matenda oopsa poyerekeza maziko a matenda omwe alipo komanso momwe akuwonekera chifukwa cha kuwonongeka kwa njira ya matenda omwe amayambitsidwa nthawi zambiri kumawonetsa chidziwitso cha matenda oopsa (matenda oopsa).

Phunziro lofunikira limawerengera:

1) kuchuluka kwa kuchuluka kwa kuthamanga kwa magazi, chikhalidwe chake,

2) matenda ndi mikhalidwe yomwe imapangitsa kuwonjezeka kwa kuthamanga kwa magazi,

3) Zizindikiro zoyambitsa matenda oopsa.

Mwa odwala ambiri okalamba, kuthamanga kwa magazi sikokhazikika, zopanda pake zimadzuka ndipo madontho amwadzidzidzi amatha. AH imadziwika ndi kuwonjezeka kwa kupanikizika kwa systolic kochita bwino komanso nthawi zina kumachepetsa kukakamiza kwa diastolic - otchedwa atherosulinotic matenda oopsa kapena okhudzana ndi zaka (sclerotic) mwa okalamba (popanda kuwonetsa kachipatala komwe kumawonetsa atherosulinosis). Kuzindikiritsa zizindikiro za zotumphukira kwamatumbo a mtima (kuchepetsa kwamkati mwa mitsempha yam'munsi, kuziziritsa, ndi zina zotere) kumapangitsa kupezeka kwa matenda oopsa a atherosselotic. Ndi chisangalalo cha mtima, mutha kupeza kung'ung'udza kwambiri kwa msempha, mawonekedwe a II kamvekedwe kachiwiri mkati mwa mbali yakumanja, zomwe zimawonetsa atherosulinosis ya aorta (atherosulinotic matenda nthawi zina amapezeka). Kujowina kale systolic koopsa komanso kuwonjezereka kwakanthawi kwa kuthamanga kwa diastolic kumatha kuwonetsa kukula kwa atherosulinosis ya mitsempha ya impso (systolic kung'ung'udza pa msempha wam'mimba pa navel sikumamveka nthawi zonse).

Kuwonjezeka kwakukulu kwa kuthamanga kwa magazi m'manja ndi kuchepa kwa magazi m'miyendo kumatha kupezeka. Kuphatikizika kwa AH koteroko ndi kuwonjezeka kwamitsempha yamagetsi (mkati mwa kuyeserera ndi palpation), kufooketsa kupindika kwamitsempha yam'munsi, ndikuchepetsa mafunde m'mitsempha yachikazi kumapangitsa munthu kuti azikayikira ngati coortctation imachitika. Kung'ung'udza kwakukulu kumawululidwa pansi pamtima, kumvekera kumbuyo kwa kumbuyo komanso kumbuyo (m'dera la interscapular), phokosoli limatulutsa m'mizere yayikulu (carotid, subclavian). Chithunzithunzi chodziwikiratu chimatithandizira kuzindikira molimba mtima kuwongolera kwa msempha.

Pakusanthula kwakuthupi, zizindikiritso za aortic valve kusakwanira, kusatseka kwa ductus arteriosus, kuwonetsa kwa mtima wovuta kugundika kumatha kupezeka. Zonsezi zimatha kubweretsa matenda oopsa.

Kuwonjezeka kwa cholesterol (nthawi zambiri alpha-cholesterol), triglycerides, beta-lipoproteins yomwe imapezeka pakuphunzira kwa lipid sipekitiramu yamagazi imawonedwa ndi atherosulinosis. Pamene ophthalmoscopy atha kupezeka kusintha mu ziwiya za ocular fundus, kukulitsa ndi atherosulinosis ya ziwiya. Kuchepetsa mphamvu ya ziwiya zamagawo am'munsi, nthawi zina mitsempha ya carotid ndikusintha mawonekedwe a ma curves pa rheogram kumatsimikizira kuwonongeka kwa mitsempha ya atherosrance.

Makhalidwe a electrocardiographic, radiological ndi echocardiographic zizindikiro za matenda amtima apezeka.

Odwala omwe ali ndi coarctation ya msempha, angiography nthawi zambiri imapangidwa kuti imveketse bwino malo ndi malo omwe akukhudzidwa (asanafike opaleshoni). Ngati pali ma contraindication othandizira opaleshoni, kuyezetsa thupi ndikokwanira kupanga matenda.

Matenda oopsa a renzi ndi omwe amachititsa kwambiri matenda oopsa (70-80%). Amagawika matenda oopsa mu matenda a impso parenchyma, kukonzanso kwamitsempha yamagazi (vasorenal) komanso matenda oopsa ogwirizana ndi mkodzo womwe umatuluka mu mkodzo. Matenda ambiri a impso ndi matenda a renoparenchymal ndi vasorenal pathologies.

Chithunzi cha matenda ambiri ophatikizidwa ndi matenda amtundu wa impso, amatha kuwonetsedwa ndi ma syndromes otsatirawa:

1) matenda oopsa ndi matenda amkodzo potengera,

2) matenda oopsa komanso kutentha thupi,

3) matenda oopsa komanso kung'ung'udza chifukwa cha mitsempha yaimpso.

4) matenda oopsa komanso chotupa cham'mimba,

5) matenda oopsa (monosymptomatic).

Ntchito yofufuza momwe muli matenda anu akuphatikizira:

1) Chidziwitso cha matenda am'mbuyomu kapena impso,

2) chizindikiritso chotsimikizika cha madandaulo omwe amapezeka mu aimpso, momwe matenda oopsa amatha kuchitira monga chizindikiro.

Zowonetsa wodwala matenda a impso (glomerulo- ndi pyelonephritis, urolithiasis, ndi zina), kulumikizana kwake ndi chitukuko cha matenda oopsa, atilole ife kuti tipeze lingaliro lazoyambitsa matenda.

Popanda mawonekedwe a anamnesis wodziwika bwino, kukhalapo kwa zodandaula za kusintha kwa maonekedwe ndi kuchuluka kwa mkodzo, vuto la kusowa kwa magazi, ndi mawonekedwe a edema kumathandizira kuyanjana kwa kuthamanga kwa magazi ndi aimpso a mafupa popanda mawu osatsimikizika amtundu wa kuwonongeka kwa impso. Chidziwitsochi chikuyenera kupezedwa pazochitika zotsatila zakuwunika kwa wodwalayo.

Ngati wodwalayo akudandaula chifukwa cha malungo, kupweteka m'malo ndi m'mimba, kuwonjezeka kwa magazi, ndiye kuti nodular periarteritis imatha kukayikiridwa - matenda omwe impso ndi amodzi mwa ziwalo zomwe zimagwira nawo ntchitoyo.

Kuphatikizidwa kwa kuthamanga kwa magazi ndi kutentha ndi chida cha matenda amkodzo (zodandaula za matenda osokonekera), komanso zimachitika ndi zotupa za impso.

Nthawi zina, mutha kupeza chidziwitso chongowonjezera kuchuluka kwa magazi. Kuthekera kwa kukhalapo kwa matenda a impso a monosymptomatic ayenera kuganiziridwanso, chifukwa chake, kufunikira kwa magawo omwe amatsatila pakuwunika kwa wodwala kumawonjezera kuzindikira zomwe zimayambitsa kuthamanga kwa magazi.

Kukhalapo kwa edema yotchulidwa yokhala ndi mbiri yoyenera kumapangitsa kudziwika koyambirira kwa glomerulonephritis kudalirika kwambiri. Pali malingaliro okhudza amyloidosis.

Pakumuunika wodwalayo, kung'ung'udza kwam'mimba pamwamba pamimba pamimba kumatha kupezeka, ndiye kuti matenda obwezereza amatha kuganiziridwanso. Kuzindikiritsa kosinthidwa kumapangidwa malinga ndi angiography.

Kuzindikira kwa mapangidwe a chotupa mwa odwala omwe ali ndi matenda oopsa pamatumbo am'mimba akuwonetsa matenda a impso, hydronephrosis, kapena hypernephroma.

Kutengera kuwunika kwa ma syndromes odziwika, malingaliro otsatirawa atha kupangidwa pokhudzana ndi matenda omwe amaphatikizidwa ndi matenda a impso.

Kuphatikiza kwa matenda oopsa ndi matenda a kwamikodzo amtunduwu kumaonekera:

a) glomerulonephritis wodwala komanso pachimake,

b) aakulu pyelonephritis.

Kuphatikiza kwa matenda oopsa ndi kutentha thupi kumakhala kofala kwambiri ndi:

a) Matenda a pyelonephritis,

b) polycystic matenda a impso ovuta a pyelonephritis,

c) zotupa za impso,

d) nodular periarteritis.

Kuphatikiza kwa matenda oopsa ndi chotupa cham'mimba pamimba imawonedwa ndi:

a) zotupa za impso,

Kuphatikiza kwa matenda oopsa ndi phokoso pamitsempha yamafungo imadziwika ndi aimpso a stenosis a chiyambi osiyanasiyana.

Matenda oopsa a Monosymptomatic ndi a:

a) michere yotupa ya mitsempha ya mafupa a m'magazi a impso (ochepa stenotic atherosulinosis ya mitsempha ya impso ndi mitundu ina ya arteritis),

b) zonyansa pokonza zotupa za impso ndi thirakiti.

Kutsimikizira kuti:

a) kuvomerezedwa kwa odwala onse,

b) maphunziro apadera molingana ndi mawonekedwe.

Kafukufuku wazizindikiro akuphatikizapo:

1) kuchuluka kwa mabakiteriya, kutayika kwa mapuloteni tsiku lililonse mumkodzo,

2) Kuwerenga mwachidule ntchito za impso,

3) kafukufuku wapadera wamagulu a impso zonse (kusinthanso kukonzanso ndi kusanthula, kulowetsedwa ndi kubwezeretsanso pyelography, chromocystoscopy),

4) kusanthula kwa impso,

5) makina owerengeka a impso,

6) kusiyanitsa angiography (aortography ndi maphunziro a impso magazi ndi cavagraphy ndi venological a impso).

7) kuyezetsa magazi pazomwe zili ndi renin ndi angiotensin.

Zowonetsera za izi kapena kuti kafukufuku wowonjezerapo zimatengera choyambirira chofufuzira chidziwitso ndi zotsatira za njira zoyesera (zovomerezeka).

Kale malingana ndi zotsatira za njira zoyenera zakufufuzira (chikhalidwe cha kwamikodzo, njira yofufuzira bakiteriya), wina nthawi zina amatha kutsimikizira kuganiza kwa glomerulo- kapena pyelonephritis. Komabe, pofuna yankho lomaliza la nkhaniyi, kufufuza kowonjezera kumafunikira.

Izi zimaphatikizapo kusanthula kwa mkodzo malinga ndi Nechiporenko, chikhalidwe cha mkodzo malinga ndi Gould (ndi mayeso oyesa ndi kuchuluka kwa bacteriuria), mayeso a prednisolone (oyambitsa leukocyturia pambuyo pa intravenous makonzedwe a prednisolone), isotopic renography ndikuwunika, chromocystoscopy ndi kubwezeretsanso pyelography. Kuphatikiza apo, kulowetsedwa urography kuyenera kuchitidwa mosasamala.

Mwazokayikira, kuperewera kwa impso kumachitidwa pofuna kudziwa zenizeni za matenda a latent pyelonephritis kapena glomerulonephritis.

Nthawi zambiri, matenda a impso mu impso kwa zaka zambiri amatuluka mobisika ndipo amathandizana ndi kusintha kochepa komanso kwakanthawi kwamkodzo. Mapuloteni ang'onoang'ono amapeza phindu lodziwitsa pokhapokha poyerekeza kuchuluka kwa mapuloteni omwe amawonongeka mkodzo: proteinuria yoposa 1 g / tsiku imatha kuonedwa ngati chisonyezo chosamveka cha mgwirizano wamankhwala oopsa ndi kuwonongeka kwa aimpso. Kuwonetsa kumbuyo kwaumboni sikumatula (kapena kutsimikizira) kukhalapo kwa miyala, zododometsa za kutukuka ndi malo a impso (nthawi zina zotupa za impso), zomwe zingayambitse macro- ndi micro Calculatoruria.

Pankhani ya hematuria, kupatula chotupa cha impso, kuwonjezera pa kuyamwa, kupsinjika kwa impso, kusakanikirana kwamkati ndipo, pomaliza, kusiyana kwa angiography (aorto ndi patragi) kumachitika.

Kuzindikiritsa kwa nestritis ya interstitial, yomwe imasonyezedwanso ndi micromaturia, imatha kuchitika kokha poganizira zotsatira za impso.

Kufufuza kwa impso ndi mbiri yakale ya kubadwa kwa zotsalazo kungatsimikizire kuti matenda ake amyloid.

Pankhani ya lingaliro la vasorenal matenda oopsa, chikhalidwe chake chitha kukhazikitsidwa molingana ndi angiography.

Maphunziro awa - a biopsy a impso ndi angiography - amachitidwa molingana ndi mawonekedwe okhwima.

Angiography imagwira ntchito kwa odwala achichepere komanso azaka zapakati omwe amakhala ndi matenda osakhazikika a diastolic komanso osagwiritsa ntchito mankhwalawa (kuchepa kwapang'onopang'ono kwa magazi kumawonedwa pokhapokha ngati pakugwiritsira ntchito Mlingo waukulu wa mankhwala omwe amapanga magawo osiyanasiyana a magazi.

Zambiri za angiography zimamasuliridwa motere:

1) unilateral stenosis ya mtsempha wamagazi, mkamwa komanso pakati pa impso, ndi masizidwe a atherosulinosis yam'mimba aorta (chosagwirizana ndi vuto lakelo), mwa anthu azaka zapakatikati amakhala ndi vuto la atherosulinosis la mtsempha wamagazi.

2) kusinthika kwa stenosis ndi kuchepa kwa magazi a minyewa okhudzana ndi angiogram ndikudziwonetsa kwa stenosis pakati pa gawo lachitatu (osati pakamwa) ndi msempha wosasintha wa azimayi ochepera zaka 40 kumawonetsa michere yotupa ya fupa lamitsempha.

3) kuwonongeka kwapakati pamitsempha yamafungo kuyambira pakamwa kupita pakati lachitatu, mawonekedwe a msempha osagwirizana, zizindikiro za stenosis zamtundu wina wa thoracic ndi m'mimba msempha ndizochitika za arteritis yamitsempha yamafungo komanso msempha.

Chithunzi cha chipatala cha matenda ena amtundu wa endocrine omwe amachitika ndi kuthamanga kwa magazi amatha kuperekedwa mwa ma syndromes otsatirawa:

1) matenda oopsa komanso achifundo pamavuto,

2) matenda oopsa ndi minofu kufooka ndi urinosis,

3) matenda oopsa komanso kunenepa kwambiri,

4) AH ndi chotupa chaposachedwa cham'mimba (osowa).

Madandaulo a wodwalayo pakubwera kwamatenda oopsa, limodzi ndi kugunda kwamkati, kunjenjemera kwa minofu, kutulutsa thukuta komanso kutuluka kwa khungu, kupweteka mutu, kupweteka kuseri kwa sternum, kupangitsa kuti azitha kulankhula za pheochromacetoma. Ngati madandaulo ali pamwambawa apezeka chifukwa cha kutentha, kuchepa thupi (kuwonetsa kuledzera), limodzi ndi ululu wam'mimba (metastases to the reg retroperitoneal lymph node), lingaliro la pheochromoblastoma lingakhale.

Kunja kwa zovuta, kuthamanga kwa magazi kumatha kukhala kwabwinobwino kapena kukwezedwa. Chizolowezi chokomoka (makamaka pogona pakama) pamphepete mwa kuthamanga kwambiri kwa magazi imadziwikanso ndi pheochromocytoma, yomwe imayamba popanda mavuto.

Madandaulo a wodwalayo pakuwonjezereka kwa magazi komanso kuchepa kwa kufooka kwa minofu, kuchepa mphamvu kwamthupi, ludzu komanso kukodza mopitirira muyeso, makamaka usiku, zimapanga chithunzi chapamwamba cha matenda oopsa a hyperaldosteronism (matenda a Conn) ndikudziwitsa zomwe zingayambitse matenda oopsa kale poyambira gawo loyamba lofufuzira. Kuphatikiza kwa zizindikiro zomwe zili pamwambapa ndi kutentha thupi komanso kupweteka kwam'mimba kumapangitsa kuganiza kwa adrenal adenocarcinoma.

Ngati wodwalayo akudandaula za kuwonjezeka kwa kulemera kwa thupi komwe kumagwirizana ndi kukula kwa matenda oopsa (onenepa kwambiri, monga lamulo, kuchuluka kwa kulemera kumachitika kale zisanachitike chitukuko cha matenda oopsa), kusokonezeka kwa maliseche (dysmenorrhea mwa azimayi, kuchepa kwa libido mwa amuna), ndiye kuti tingoyerekeza matenda a Itsenko-Cushing kapena matenda. Lingaliro limathandizidwa ngati wodwalayo akhudzidwa ndi ludzu, polyuria, kuyabwa (chiwonetsero cha matenda a carbohydrate metabolism).

Njira zoyeserera zathupi lanu zimavumbula:

a) kusintha kwa mtima dongosolo, kukhala mchikakamizo cha kuchuluka kwa magazi,

b) kuchuluka kwa mafuta m'thupi ndi miyendo yopyapyala, zipere za pinki, ziphuphu, matenda oopsa, matendawa ndi matenda a Itsenko-Cushing's,

c) kufooka kwa minofu, kufooka kwam'mimba, mawonekedwe a matenda a Conn, zizindikiro zabwino za Hvostek ndi Trousseau, zotumphukira edema (nthawi zina zimawonedwa ndi aldosteroma),

d) mapangidwe ozungulira m'mimba (adrenal gland).

Ndikofunikira kuchita kuyesa kopitilira muyeso: kupangika kwa malo a impso mosiyanasiyana kwa mphindi ziwiri ziwiri kungayambitse vuto la catecholamine ndi pheochromocytoma. Zotsatira zoyipa za mayeserowa sizimapatula pheochromocytoma, chifukwa chitha kukhala ndi malo owonjezera.

Kusaka kwachipatalaku ndikofunikira chifukwa kumakupatsani mwayi:

a) dzipatseni matenda omaliza,

b) dziwa malo otupa,

c) kufotokozerani za chilengedwe chake,

d) kudziwa njira zamankhwala.

Pakatikati pa maphunziro ovomerezeka, kusintha kwamakhalidwe kumapezeka: leukocytosis ndi erythrocytosis m'mitsempha yamagazi, hyperglycemia ndi hypokalemia, kulimbikira kwamkodzo kwamkodzo (chifukwa cha potaziyamu yambiri), khalidwe la hyperaldosteronism yapamwamba. Ndi chitukuko cha "hypokalemic nephropathy," polyuria, isostenuria, ndipo nocturia amawululidwa pakuphunzira mkodzo malinga ndi Zimnitsky.

Mwa njira zowonjezera zowerengera kuti mudziwe kapena kupatula zofunika kwambiri za aldosteronism:

1) Kufufuza kwapafupipafupi wa potaziyamu ndi sodium mumkodzo ndimawerengera a Na / K (omwe ali ndi matenda a Conn, ndi oposa 2),

2) kutsimikiza kwa zomwe zili potaziyamu ndi sodium m'madzi am'magazi isanachitike komanso mutatha kutenga 100 mg ya hypothiazide (kuzindikira kwa hypokalemia mu aldosteronism yoyamba, ngati zoyambirira zimakhala zofanana),

3) kutsimikiza kwamchere zamagazi (otchedwa alkalosis mu aldosteronism),

4) kutsimikiza kwa mankhwala a aldosterone mumkodzo wa tsiku ndi tsiku (kuchuluka ndi aldosteronism),

5) kutsimikiza kwa mulingo wa renin m'magazi am'magazi (kuchepa kwa ntchito ya renin mu matenda a Conn).

Chofunika kwambiri pakuzindikiritsa zotupa zonse za adrenal ndizambiri kuchokera ku maphunziro awa:

1) retro-pneumoperitoneum ndi adrenal tomography,

2) Kuunika kwa ma radionuclide a tiziwalo tamadontho tambiri,

3) makina ophatikizira,

4) kusankha phlebography ya adrenal glands.

Makamaka zovuta kudziwa pheochromocytoma extrenalization kwachulukidwe. Pamaso pa chithunzithunzi cha matenda ndi kusapezeka kwa chotupa cha adrenal (malinga ndi retro-pneumoperitoneum ndi tomography), ndikofunikira kuchita mwamphamvu ndi m'mimba mwa aortography kutsatiridwa ndikuwunika bwino kwa aortograph.

Mwa njira zowonjezera zodziwira pheochromocytoma musanagwiritse ntchito njira zofunikira, mayeso otsatirawa a Laborator amachitidwa:

1) kutsimikiza kwamkodzo wa tsiku ndi tsiku wa masekisiti ndi vanillylindic acid motsutsana ndi vuto (lakukula kwambiri) komanso kunja kwake,

2) kafukufuku wapadera wofufumitsa kwa adrenaline ndi norepinephrine (zotupa zomwe zimapezeka m'matumbo a adrenal komanso khoma la chikhodzodzo secrete adrenaline ndi norepinephrine, zotupa za malo ena - norepinephrine),

3) histamine (provocative) ndi mayeso a regitin (oyimitsa) (pamaso pa pheochromocytoma positive).

Mwa njira zowonjezera zakufufuzira za matenda omwe akuyembekezeredwa ndi matenda a Itsenko-Cushing, amapanga:

1) Kutsimikiza mu mkodzo watsiku ndi tsiku wa zomwe zili ndi 17-ketrateoids ndi 17-hydroxycorticosteroids,

2) kuwerenga kwa circadian mpweya wachinsinsi wa 17- ndi 11-hydroxycorticosteroids m'magazi (mu matenda a Itsenko-Cushing, zomwe zimapangitsa kuti mahomoni m'magazi awonjezeke masana),

3) Kafukufuku wofotokoza za chishalo cha ku Turkey komanso mapangidwe ake apadera (kupezeka kwa pituitary adenoma),

4) njira zonse zomwe zafotokozedwapo kale pazomwe zimagwiritsidwa ntchito pophunzira ma grenicosteromas.

Kuzindikira kwa matenda amtundu wa endocrine kumatha ndikusaka kofufuza.

Kuzindikiritsa kwa matenda oopsa kwachidziwitso kumakhazikika pakuwonetsetsa bwino matenda omwe akuphatikizidwa ndi kuwonjezeka kwa kuthamanga kwa magazi komanso kupatula mitundu ina ya matenda oopsa.

Zizindikiro zoopsa zitha kukhala chizindikiro kutsogolera kwa matenda omwe amayamba, kenako zimawonekera pakuwonekera: mwachitsanzo, kukonzanso kwamitsempha yamagazi. Ngati matenda oopsa ndi chimodzi mwazomwe zikuwonetsa matendawa ndipo sikuwoneka kuti ndi chizindikiro chachikulu, ndiye kuti matendawa sangatchulidwe, mwachitsanzo, ndi matenda obwera chifukwa cha matenda, kapena matenda a Itsenko-Cushing.

I. Zochizira.

Hypertension ikapezeka chifukwa cha impso mtima wamitsempha, coarctation wa msempha, kapena mahomoni-yogwira adrenomas adenomas, funso la kuchitapo opaleshoni limadzutsidwa (kuthetsa zomwe zimayambitsa matenda oopsa). Choyamba, izi zimakhudza pheochromocytoma, adenomas opanga ma aldosterone ndi adrenal adenocarcinomas, corticosteromas, ndipo, mwachidziwikire, khansa ya impso.

Ndi pituitary adenoma, njira zowonetsera yogwira ntchito pogwiritsa ntchito x-ray ndi radiotherapy, chithandizo cha laser chimagwiritsidwa ntchito, nthawi zina amagwira ntchito.

Mankhwala ochizira matenda oyamba (periarteritis nodosa, erythremia, congestive mtima kulephera, matenda amkodzo thirakiti, ndi zina zotere) zimapereka chiwopsezo cha matenda oopsa.

Ngati matenda oopsa ndi chimodzi mwazizindikiro ...

Popeza zifukwa zomwe zikuwonjezera kukondera kwina ndizambiri, kuphweka zidaphatikizidwa m'magulu. Kugawikaku kumawonetsa kusinthika kwa vuto lomwe limatsogolera ku matenda oopsa.

Mgwirizano wa matenda amkati.
Endocrine.
Matenda oopsa mu matenda a mtima.
Fomu ya Neurogenic.
Mankhwala oopsa.

Kupenda madandaulo ndi zizindikiro, mawonekedwe a matendawa, kumathandizira kukayikira chikhalidwe chachiwiri cha matenda oopsa. Chifukwa chake Hypertatic matenda oopsa, mosiyana ndi pulayimale, amayenda ndi:

Chiwopsezo chachikulu, pamene ziwonetsero zimakwera mwadzidzidzi komanso mwachangu,
Zochepa zotsitsa za antihypertensive therapy,
Kuchitika mwadzidzidzi kwa kuwonjezeka kwapang'onopang'ono kwa asymptomatic popanda nthawi yapitayo,
Kugonjetsedwa kwa achinyamata.

Zizindikiro zina zosakhudzidwa zomwe zimachitika kale pa nthawi yoyesedwa komanso kukambirana ndi wodwalayo zingaonetse kuti zikuyambitsa matendawo. Chifukwa chake, ndi mawonekedwe aimpso, kupanikizika kwa diastolic ("m'munsi") kumakwera bwino, zovuta za endocrine-metabolic zimapangitsa kuchuluka kwakukulu mu kupanikizika kwa systolic ndi diastolic, ndipo ndi matenda a mtima ndi mitsempha ya m'magazi, kuchuluka "kwamphamvu" kumawonjezeka.

Pansipa timaganizira magulu akuluakulu a matenda oopsa ogwirizana ndi zomwe zimayambitsa matenda.

Choyimira china mu genesis yachiwiri matenda oopsa

Impso ndi amodzi mwa ziwalo zazikulu zomwe zimapereka kuthamanga kwa magazi. Kugonjetsedwa kwawo kumayambitsa kuchuluka kwa kuthamanga kwa magazi, pambuyo pake amathandizika ngati gawo lolimbana ndi matenda oopsa. Zizindikiro zazikulu za impso zimayenderana ndi kuwonongeka kwa ziwiya zamagulu (kukonzanso mawonekedwe) kapena parenchyma (renoparenchymal).

Kukonzanso kwamphamvu kwamphamvu

Kusintha kwamtunduwu kumachitika chifukwa chakuchepa kwa kuchuluka kwa magazi omwe amapita m'mitsempha kupita ku impso, poyankha izi, njira zomwe zimabwezeretsa kuthamanga kwa magazi zimayendetsedwa, kukonzanso kwa renin kumamasulidwa, komwe kumapangitsa mkwiyo wamawu, kupindika kwawo, ndipo chifukwa chake, kuwonjezeka kwa zisonyezo.

Mwa zina mwazomwe zimayambitsa kukonzanso kwamitsempha yamagazi, ma atherosulinosis, omwe amapezeka mu 3/4 ya odwala, komanso kusokonezeka kwatsopano kwa aimpso, omwe amachititsa gawo 25% ya matenda amtunduwu. Nthawi zina, vasculitis (zotupa m'matumbo) zimawonetsedwa ngati zifukwa - mwachitsanzo, Goodpasture syndrome, aneurysms ya mtima, kukakamiza kwa impso kuchokera kunja ndi zotupa, zotupa za metastatic, etc.

Zomwe zimachitika pakuwonetsedwa kwa matenda obwezeretsanso matenda oopsa:

Matendawa amayambika, amuna makamaka azaka 50 kapena akazi osakwana zaka makumi atatu,
Mitengo yayikulu ya BP yolephera kuchiza,
Zovuta zopanda pake sizodziwika bwino,
Kwambiri kupanikizika kwa diastolic kumakwera,
Pali zizindikiro za matenda a impso.

Hypoparenchymal matenda oopsa

Renoparenchymal yachiwiri yokhudzana ndi matenda oopsa imagwirizanitsidwa ndi kuwonongeka kwa parenchyma ndipo imadziwika kuti ndi njira yofala kwambiri yamaphunziro, yomwe imayambitsa mpaka 70% ya matenda onse otsika. Zomwe zimayambitsa zimaphatikizidwa ndi glomerulonephritis, pyelonephritis, matenda a impso ndi kwamikodzo, matenda a shuga, komanso neoplasms ya renal parenchyma.

Kusintha kwachiwiri kwa renoparenchymal pachipatalachi kumadziwika ndi kuphatikiza kwa kupanikizika ndi chizindikiro cha "aimpso" - kutupa, kufinya kwa nkhope, kupweteka m'dera lumbar, kusowa kwa maselo, kusintha kwa chikhalidwe ndi kuchuluka kwa mkodzo. Mavuto amtunduwu wamatenda samadziwika, makamaka kukakamizidwa kwa diastolic kumawonjezeka.

Endocrine mitundu yachiwiri matenda oopsa

Zizindikiro za endocrine ochepa matenda oopsa zimachitika chifukwa cha kusakhazikika kwa mphamvu zamafuta amthupi, kuwonongeka kwa ma gland ya endocrine komanso kuyanjana pakati pawo. Kukula kwambiri kwa matenda oopsa m'matendawa komanso matenda a Itsenko-Cushing's, chotochromocytoma chotupa, matenda a pituitary ndi aceromegaly, adrenogenital syndrome ndi zina.

Ndi zovuta za endocrine, kupangika kwa mahomoni omwe amatha kupititsa patsogolo kuphipha kwamitsempha, kuonjezera kupanga kwa mahomoni a adrenal, omwe amayambitsa kuchepa kwamadzi ndi mchere m'thupi. Zomwe zimachitika mu mphamvu ya mahomoni ndizosiyanasiyana ndipo sizimamveka bwino.

Kuphatikiza pa matenda oopsa, Zizindikiro zakusintha kwa mahomoni nthawi zambiri zimatchulidwa kuchipatala. - kunenepa kwambiri, kukula kwambiri kwa tsitsi, kupangika kwa striae, polyuria, ludzu, kusabereka, etc., kutengera matenda a causative.

Neurogenic Symbertatic matenda oopsa

Matenda oopsa a Neurogenic amagwirizanitsidwa ndi matenda am'mimba. Zina mwazomwe zimayambitsa nthawi zambiri zimakhala zotupa za ubongo ndi ma membala ake, kuvulala, njira zama voliyumu zomwe zimapangitsa kuti magazi azikhala mwamphamvu, komanso diencephalic syndrome.

Pamodzi ndi kuwonjezeka kwa kupanikizika, pali zizindikiro zowonongeka kwa kapangidwe ka ubongo, matenda oopsa, komanso deta yovulala kumutu.

Matenda oopsa komanso mtima

Kuwonjezeka kwa kuthamanga kwa maziko a mtima kapena mtima hemodynamic yachiwiri matenda oopsa. Kuwonongeka kwa atherosclerotic, kuwola, kuvunda kwina kwamphamvu, kulephera kwa mtima, kusokonezeka kwakukulu kwa mtima kumabweretsa.

Aortic atherosulinosis imawonedwa ngati njira yokhazikika ya okalamba, zomwe zimapangitsa kuwonjezeka kwa kupanikizika kwakukulu kwa systolic, pomwe diastolic ikhoza kukhalabe pamlingo womwewo. Zotsatira zoyipa za matenda oopsa pa matenda am'tsogolo zimafunikira kuvomerezedwa, poganizira zaumoyo.

Mitundu ina yamatenda oopsa

Kuphatikiza pa matenda a ziwalo ndi minyewa ya endocrine, kuwonjezeka kwa zovuta kumatha kuyambitsidwa ndimankhwala (mahomoni, antidepressants, anti-yotupa mankhwala, ndi zina), zovuta zakumwa zoledzeretsa, kugwiritsa ntchito zinthu zina (tchizi, chokoleti, nsomba zosankhidwa). Udindo woyipa wopsinjika kwambiri, komanso mkhalidwe pambuyo pakuchita opaleshoni, umadziwika.

Mawonekedwe ndi njira zodziwitsira matenda oopsa

Zizindikiro zachiwiri zamatenda oopsa zimagwirizana kwambiri ndi matendawa, zomwe zidapangitsa kuwonjezeka kwa zisonyezo. Chizindikiro chachikulu chomwe chimagwirizanitsa unyinji wonse wa matenda awa chimawerengedwa ngati kuwonjezeka kwa kuthamanga kwa magazi, osayankha bwino chithandizo. Odwala amadandaula za kupweteka kwa mutu pafupipafupi, phokoso m'mutu, kupweteka m'zigawo zam'mimba, kumverera kwa phokoso ndi kupweteka pachifuwa, kuthina kwa "ntchentche" patsogolo pa maso. Mwanjira ina, kuwonetsa kwachiwiri kwa matenda oopsa ndi ofanana kwambiri ndi mawonekedwe ofunikira a matenda.

Zizindikiro za matenda a ziwalo zina zimawonjezeredwa pazowonjezereka. Chifukwa chake ndi aimpso matenda oopsa edema, kusintha kwa kuchuluka kwa mkodzo ndi chikhalidwe chake, kusokoneza, kutentha thupi, kupweteka pang'ono kwakumbuyo ndikotheka.

Kuzindikira mawonekedwe a impso monga momwe ambiri amaphatikizira:

Urinalysis (kuchuluka, mgonero tsiku ndi tsiku, mawonekedwe a phokoso, kupezeka kwa tizilomboti),
Kukonzanso kwa Radioisotope,
X-ray kusiyanasiyana pyelography, cystography,
Impso angiography
Kuyesa kwa Ultrasound,
CT, MRI yokhala ndi kuchuluka kwamagulu,
A biopsy.

Endocrine matenda oopsaKuphatikiza pa kuwonjezeka kwenikweni kwa kupanikizika, kumayendetsedwa ndi zovuta za chisoni, kufooka mu mbewa, kulemera kwakukulu, ndi kusintha kwa diuresis. Ndi pheochromocytoma, odwala amadandaula thukuta, kunjenjemera ndi palpitations, nkhawa wamba, mutu. Ngati chotupa chikupanda vuto, ndiye kuti chipatalacho chikukomoka.

Kuwonongeka kwa thumbo la adrenal mu Cohn's syndrome kumayambitsa matenda oopsa komanso kufooka kwambiri, mkodzo wambiri, makamaka usiku, ludzu. Kulowa ndi matenda otentha kumatha kuwonetsa chotupa choyipa cha adrenal gland.

Kulemera mothandizana ndi kuyambika kwa matenda oopsa, kuchepa kwa kugonana, ludzu, khungu loyang'ana, mawonekedwe otambasuka (striae), matenda a metabolism a carbohydrate kumawonetsa matenda a Itsenko-Cushing's.

Kufufuza kwamankhwala oopsa a endocrine yachiwiri kumaphatikizapo:

Kuwerengera kwamwazi (leukocytosis, erythrocytosis),
Kuwerenga kwa kagayidwe kazakudya (hyperglycemia),
Kudziwitsa zamagetsi am'magazi (potaziyamu, sodium),
Kuyesedwa kwa magazi ndi mkodzo kwa mahomoni ndi ma metabolites awo molingana ndi zomwe akuti zimayambitsa matenda oopsa,
CT, MRI ya adrenal gland, pituitary gland.

Hemodynamic yachiwiri matenda oopsa ogwirizana ndi matenda a mtima ndi mtsempha wamagazi. Amadziwika ndi kuwonjezeka kwa kupanikizika kwakukulu kwa systolic. Njira yosakhazikika pamatendawa imawonedwa nthawi zambiri kuwonjezereka kwa magazi kumatsatiridwa ndi hypotension. Odwala amadandaula za kupweteka mutu, kufooka, kusasangalala mumtima.

Kwa matenda a hemodynamic mitundu yamatenda oopsa, kuchuluka konse kwa maphunziro a angiographic, ma ultrasound a mtima ndi mitsempha yamagazi, ECG imagwiritsidwa ntchito, lipid sipekitiramu ndizovomerezeka ngati anthu akuganiza kuti atherosulinosis. Zambiri pazakudwala zimaperekedwa ndi kumvetsera kwa mtima ndi mitsempha yamagazi, yomwe imalola kudziwa phokoso lomwe limakhalapo pamitsempha yamavuto, mtima wamagetsi.

Ngati neurogenic Symbertatic matenda oopsa amakayikiridwa khalani ndi kufufuza bwino kwamitsempha, kumveketsa zambiri zokhudzana ndi kuvulala, neuroinfections, kugwira ntchito kwa ubongo. Zizindikiro za matenda oopsa mu odwala oterewa zimayendetsedwa ndi chizindikiro cha kukomoka, kusokonekera kwa magazi (kupweteka mutu, kusanza), kupweteka.

Kuunikako kumaphatikizapo CT, MRI yaubongo, kuwunika kwamitsempha yamagetsi, electroencephalography, mwina ultrasound ndi angiography ya kama wamitseko yaubongo.

Zomwe zimachitika

Zizindikiro zowopsa - kuthamanga kwa magazi chifukwa cha kuwonongeka kwa ziwalo kapena machitidwe amthupi omwe akukhudzidwa ndi kayendetsedwe ka magazi.

Mwanjira imeneyi, kufalikira kwamitsempha kumachitika ndi ma atherosselotic plaque kapena kuchepa kwamitsempha yamagazi chifukwa kuchuluka kwa ma enzymes omwe amawongolera m'mimba mwake. Matenda amtunduwu amatanthauza matenda oopsa apakati.

Ngati matenda oopsa atapezeka mwanjira imeneyi, ziwalo zofunika za munthu zimakhudzidwa: ubongo, impso, mtima, mitsempha yamagazi, chiwindi.

Kukwezedwa kwa intravascular pressure ndi chifukwa cha zomwe zimachitika mu ziwalozi, nthawi zina, matenda oopsa amatha kukhala gwero la matenda mu ziwalo zolimbana.

Kutengera ndi ziwerengero, matenda oopsa achiwonetsero awa amawonekera mu 5-15% ya milandu yolembedwa ndi madokotala. Kuphatikiza apo, madandaulo a anthu omwe ali ndi matenda oyamba komanso olemekezeka anali pafupifupi ofanana.

Kutengera ndi etiology yamatendawa, pali mitundu pafupifupi 70 ya matenda omwe amachititsa kuti magazi awonjezeke. Ichi sichinthu chongokhala ngati chizindikiro, kotero muyenera kufunsa dokotala, osamadzisamalira. Ganizirani zinthu zomwe zimapangitsa kuti anthu azikhala ndi matenda oopsa:

Nthawi zambiri, yachiwiri ya intravascular matenda oopsa imachitika mu mawonekedwe a impso, chifukwa cha matenda a kwamikodzo ziwalo, impso, komanso ziwongo. Izi zitha kubereka komanso kutenganso zina.

Zinthu zatsopano zimaphatikizidwa: Kukula kwamphamvu kwa ziwalo, matenda a impso a polycystic, hypoplasia, impso yam'manja, hydronephrosis, dystopia.

Zopezeka zimaphatikizira: systemic vasculitis, kupatula glomerulonephritis, urolithiasis, matenda a oncological a aimpso, kwamikodzo ndi mtima, atherosclerosis, pyelonephritis, thrombosis, aimpso a impso, embolism a impso.

The endocrine mawonekedwe yachiwiri matenda oopsa kumachitika motsutsana maziko a kagayidwe kachakudya matenda a endocrine glands. Thyrotooticosis, Itsenko-Cushing's syndrome, Pheochromocytoma ndi matenda a Conn ndi zitsanzo zochititsa chidwi kwambiri pankhaniyi.

Thyrotooticosis ndimatenda omwe amakwiya ndikuphwanya magwiridwe antchito a chithokomiro. Nthawi yomweyo, thyroxine (mahomoni) amalowa mthupi mopitirira muyeso. Matendawa amadziwika ndi kuwonjezeka kopitilira muyeso kwamitsempha yamitsempha, momwe ma diastoli amakhalabe opitilira malire, ndipo ma systolic amakula kwambiri.

Pheochromocytoma amatanthauzanso mtundu wa endocrine woipa wamagazi ndipo amachitika chifukwa chotupa cha gren adrenal. Kuwonjezeka kwa kupanikizika kwa mitsempha ndi chizindikiro chachikulu cha matendawa. Kuphatikiza apo, matendawa amatha kusintha pamunthu aliyense payekhapayekha: wodwala m'modzi, muzikhala malire, ndipo mzake - mumayambitsa matenda oopsa.

Matenda a Aldosteroma kapena a Conn amawonekera chifukwa cha kutulutsidwa kwa mahomoni m'magazi - aldosterone, yomwe imapangitsa kuti sodium ichoke m'thupi. Enzyme imeneyi mopitirira muyeso imatha kusokoneza munthu.

Syenko-Cushing's syndrome nthawi zambiri imayambitsa matenda oopsa mu mawonekedwe a endocrine (pafupifupi 80% ya milandu). Zizindikiro zazikulu za matendawa ndi kusokonekera kwa nkhope ndi miyendo. Nthawi yomweyo, miyendo ndi manja a wodwalayo amakhalabe osasinthika, ndipo nkhopeyo imakhala ndi mawonekedwe owumbika mwezi.

Climax imathanso kuyambitsa matenda oopsa chifukwa cha kuchepa kwa zochitika zogonana.

The neurogenic mawonekedwe ochepa ochepa oopsa amadziwika ndi kuperewera kwa magwiridwe antchito amanjenje. Choyambitsa neurogenic yachiwiri arterial matenda oopsa ndi kuvulala kwa ubongo, ischemic zinthu, kupezeka kwa neoplasms, encephalitis mu ubongo. Pankhaniyi, pali zizindikiro zambiri, kotero mtundu uwu wamagazi umasokonezeka mosavuta ndi matenda a mtima (popanda kufufuza kwapadera).

Chithandizo cha matenda amtunduwu ndicholinga chobwezeretsa ntchito za ubongo ndi kugwira ntchito kwa ziwalo.

Zizindikiro za hemodynamic mawonekedwe zimachitika chifukwa cha kuwonongeka kwamitsempha yama mtima ndi chiwalo chokha: aortic kuchepa kwa kubadwa kwachilengedwe, atherosclerosis, bradycardia, matenda obadwa nawo a mitral valve, matenda amitsempha yamagazi. Nthawi zambiri, madokotala amakhazikitsa mu mtundu uwu wa matendawa kukhala kusiyanasiyana pakuwonetsa kuthamanga kwa magazi: ndi ma systolic omwe amakula.

Zizindikiro zowopsa zam'magazi zimatha kuchitika chifukwa cha kuphatikiza kwa matenda angapo a mtima kapena mtima.

Madokotala nthawi zambiri amalemba zolemba zamankhwala osokoneza bongo zomwe zimachitika chifukwa chogwiritsa ntchito anthu mankhwala omwe amalimbikitsa intravascular tonometer values, monga njira zakulera, mankhwala okhala ndi glucocorticoids, indomethacin wophatikizidwa ndi ephedrine, levothyroxine.

Ndizofunikanso kudziwa kuti matenda oopsa opatsirana amawagawa mosakhalitsa, achikondi, okhazikika komanso olakwika. Matenda osiyanasiyana oopsa oterowo amatengera zomwe zimachitika, kuwonongeka kwa ziwonetsero komanso kusasamala kwa matendawa, motero tikulimbikitsidwa kuti muzitha kuyang'ana kwambiri zomwe zikuwonetsedwa mu matenda oopsa amitsempha yamagazi, ndikuwonana ndi dokotala pakuchepa pang'ono kwa kupanikizika (m'malo abata).

Zambiri

Mosiyana ndi matenda olemerera ofunikira (osavuta), owonjezera matenda oopsa ndi zizindikiro za matenda omwe adawadzetsa. Hypertension syndrome imayendera limodzi ndi matenda opitilira 50. Mwa kuchuluka kwamankhwala oopsa kwambiri, kuchuluka kwa matenda oopsa kwambiri ndi 10%. Nthawi ya matenda oopsa oopsa amachitika ndi zizindikiro zomwe zimapangitsa kuti azitha kuwasiyanitsa ndi matenda oopsa (matenda oopsa):

Odwala ochepera zaka 20 kapena zopitilira 60,
Kukula mwadzidzidzi kwa matenda oopsa oopsa komanso kuthamanga kwa magazi,
Njira yoyipa, yomwe ikupita patsogolo,
Kukula kwa mabvuto azomvera chisoni,
Mbiri yamatenda amisala,
Kuyankha kofooka pa chithandizo chokwanira,
Kuchuluka kwa diastolic kuthamanga mu aimpso ochepa matenda oopsa.

Gulu

Malinga ndi ulalo woyamba wa etiological, matenda oopsa amitsempha yamagazi amagawidwa m'magulu:

Neurogenic (chifukwa cha matenda ndi zotupa za chapakati mantha dongosolo):

Hemodynamic (chifukwa cha kuwonongeka kwa ziwiya zazikulu ndi mtima):

Mlingo Wamitundu mukamamwa michere ndi glucocorticoids, progesterone ndi mankhwala okhala ndi estrogen, levothyroxine, mchere wazitsulo zolemera, indomethacin, licorice ufa, etc.

Kutengera kukula kwake komanso kupitiriza kwa kuthamanga kwa magazi, kuuma kwa mapindikidwe amitsempha yamanzere, mawonekedwe amomwe amasinthika, mitundu inayi ya matenda oopsa amkati amasiyana: osakhalitsa, olemetsa, okhazikika komanso olakwika.

Matenda oletsa kuchepa kwa magazi omwe amakhala osakhalitsa amadziwika ndi kuwonjezeka kosasunthika kwa kuthamanga kwa magazi, palibe kusintha m'matumba amthumba, kumanzere kwamitsempha yamanzere sikunatsimikizidwe. Ndi olembetsa matenda oopsa, kuwonjezeka kwamphamvu komanso kosasunthika kwa magazi kumawonedwa, komwe sikumachepetsa palokha. Hypertrophy yofatsa yamanzere yam'mimba komanso kuchepera kwa ziwiya za retina imadziwika.

Khola lamitsempha yamagazi yokhazikika imadziwika ndi kulimbikira komanso kuthamanga kwa magazi, matenda oopsa a myocardial, komanso kutanthauza kusintha kwamasamba mu fundus (angioretinopathy I - II degree). Malignant arterial hypertension amadziwika ndi kuthamanga kwambiri komanso kosakhazikika kwa magazi (makamaka diastolic> 120-130 mm Hg), kuyamba kwadzidzidzi, chitukuko mwachangu, ndi chiopsezo cha zovuta zam'mimba kuchokera mu mtima, ubongo, fundus, zomwe zimatsimikizira kudwala koyenera.

Nephrogenic parenchymal ochepa matenda oopsa

Nthawi zambiri, zizindikiro zamitsempha yamagazi zimachokera ku nephrogenic (aimpso) ndipo imayang'aniridwa mu matenda oopsa komanso osakhazikika a glomerulonephritis, pyelonephritis, polycystosis ndi aimpso hypoplasia, gouty ndi matenda ashuga, kuvulala ndi chifuwa chachikulu cha impso, amyloidosis, SLE, zotupa.

Magawo oyamba a matendawa nthawi zambiri amapezeka popanda matenda oopsa. Hypertension imayamba ndi kuwonongeka kwambiri kwa minofu kapena zida za impso. Zina za aimpso ochepa matenda oopsa ndizochitika zazing'ono za odwala, kusowa kwa matenda amitsempha yamagazi ndi matumbo, kukulira kwa kulephera kwa impso, vuto lowopsa la maphunzirowa (mu pyelonephritis - mu 12,2%, glomerulonephritis - mu 11.5% ya milandu).

Pozindikira matenda a parenchymal aimpso matenda oopsa, ma ultrasound a impso, urinalysis (proteinuria, hematuria, cylindruria, pyuria, hypostenuria - mphamvu yotsika ya mkodzo wapezeka), kutsimikiza kwa creatinine ndi urea m'magazi (azotemia wapezeka). Kuti muphunzire ntchito ya impso, ya isotope renography, urology, komanso, angiography, ma ultrasonography a mitsempha ya impso, MRI ndi CT ya impso, biopsy ya impso imachitika.

Nephrogenic Renovascular (Vasorenal) Arterial Hypertension

Matenda a renovascular or vasorenal arterial amakhala chifukwa cha kusokonezeka kwa magazi amodzi kapena awiri a magazi amitsempha yamagazi. Mu 2/3 ya odwala, chomwe chimapangitsa kukonzanso kwamitsempha yamagazi ndi ma atherosulinotic zotupa za aimpso. Hypertension imayamba ndi kuchepa kwa lumen ya mtsempha wama impso ndi 70% kapena kuposerapo. Kuthamanga kwa magazi kwa systolic nthawi zonse kumakhala pamwamba pa 160 mm Hg, diastolic - kuposa 100 mm Hg

Renovascular arterial hypertension amadziwika ndi kuyamba kapena kuwonongeka kwadzidzidzi kwa maphunzirowo, kusagwirizana ndi mankhwala osokoneza bongo, kuchuluka kwakukulu kwa koipa (25% ya odwala).

Zizindikiro za vasorenal arterial matenda oopsa ndi: systolic kung'ung'udza chifukwa cha kuchuluka kwa aimpso, kutsimikizika ndi ultrasonography ndi urology - kuchepa kwa impso imodzi, ndikuchepetsa kuchepa kwa kusiyana. Ultrasound - chizindikiro cha asymmetry cha mawonekedwe ndi kukula kwa impso kupitirira masentimita 1.5. Angiography imawulula kupendekera kwakukulu kwa minyewa ya impso. Kusintha kwa kupindika kwa mitsempha yaimpso kumapangitsa kuphwanya kwamitsempha yayikulu yaimpso.

Pakakhala mankhwalawa vasorenal ochepa matenda oopsa, kupulumuka kwa odwala wazaka 5 kuli pafupifupi 30%. Zomwe zimayambitsa kufa ndi ngozi za ubongo, kuchepa kwa magazi, komanso kulephera kwa impso. Mankhwalawa vasorenal ochepa matenda oopsa, onse ntchito mankhwala ndi opaleshoni ntchito: angioplasty, stenting, miyambo ntchito.

Ndi stenosis yayikulu, kugwiritsa ntchito mankhwalawa kwa nthawi yayitali palibe chifukwa. Chithandizo cha mankhwala osokoneza bongo chimapereka yochepa komanso yocheperako. Chithandizo chachikulu ndikuchita opaleshoni kapena mtima. Ngati vasorenal arterial matenda oopsa, stravascular stent imayikidwa kuti ikulitse mawonekedwe a minyewa ya impso ndikutchingira kupendekera, kulowetsedwa kwa mbali yokhotakhota ya chotengera, kuyambiranso kulumikizana pamtsempha wama impso: resection ndi anastomosis, ma prosthetics, ndi njira yodutsa aastomoses.

Pheochromocytoma

Pheochromocytoma, chotupa chopanga timadzi tomwe timapanga ma cell a chromaffin a adrenal medulla, chimakhala ndi 0,2% mpaka 0,4% mwa mitundu yonse yazodziwika bwino ya matenda oopsa. Pheochromocytomas secate catecholamines: norepinephrine, adrenaline, dopamine. Maphunzirowa amakhala limodzi ndi matenda oopsa, ndipo nthawi zina amakumana ndi mavuto oopsa kwambiri. Kuphatikiza pa matenda oopsa ndi pheochromocytomas, kupweteka mutu kwambiri, kutuluka thukuta ndi palpitations kumawonedwa.

Pheochromocytoma imapezeka ngati catecholamine mu mkodzo wapezeka ndikuwunika mayeso a pharmacological (mayeso ndi histamine, tyramine, glucagon, clonidine, etc.). Ultrasound, MRI kapena CT ya adrenal gland imalola kutulutsa kwatsatanetsatane kwa chotupa. Pochita ma radioisotope kuwunika kwa tiziwalo timene timatulutsidwa m'mimba, titha kudziwa ntchito ya mahomoni ya pheochromocytoma, kuzindikira zotupa za kutuluka kwa adrenal adrenal, metastases.

Pheochromocytomas amathandizidwa kokha, asanachitidwe opaleshoni, kukonza kwa matenda oopsa ndi cy- kapena ial-adrenergic blockers amachitidwa.

Kuphatikiza kwakukulu kwa aldosteronism

Matenda oopsa a arterial mu matenda a Conn kapena hyperaldosteronism yoyamba imayambitsidwa ndi aldosterone yopanga adrenal cortical adenoma. Aldosterone imalimbikitsa kugawa kwa K ndi Naions mu maselo, kusungunuka kwa madzi m'thupi ndi chitukuko cha hypokalemia ndi ochepa hypertension.

Hypertension siingakhale yothandiza pakuwongolera kuchipatala, pali matenda a myasthenia gravis, kupweteka, paresthesia, ludzu, komanso matenda osokoneza bongo. Zovuta zamankhwala oopsa zimatha kupezeka chifukwa cha kupweteka kwamtima kwamitsempha yamitsempha yamtima (mtima wamathiti, pulmonary edema), stroke, hypokalemic ziwalo zamtima.

Kuzindikira kwa aldosteronism yoyamba kumakhazikitsidwa ndi kutsimikiza kwa plasma milingo ya aldosterone, elekitirogiridi (potaziyamu, chlorine, sodium). A kuchuluka kwa aldosterone m'magazi ndi zotupa zake zazikulu mumkodzo, metabolic alkalosis (magazi pH - 7.46-7.60), hypokalemia (

Chithandizo cha matenda oopsa

Chithandizo cha matenda oopsa chiwonetsero chachiwiri chimaphatikizapo njira yodutsira aliyense wodwala, chifukwa chikhalidwe cha mankhwala ndi njira zake zimadalira matenda oyambira.

Ndi coarctation kwa msempha, zolakwika, zotupa zaminyewa ya impso, funso limabweretsa kufunika kwa opaleshoni kukonza kusintha. Ma tumor a gland, pituitary, ndi impso amathanso kuchotsedwa.

Mu njira yotupa ndi yotupa mu impso, polycystic matenda, antibacterial, anti-kutupa mankhwala, kubwezeretsa madzi amchere kagayidwe ndikofunikira, ovuta kwambiri hemodialysis kapena peritoneal dialysis.

Intracranial matenda oopsa amafuna kukhazikika kwa okodzetsa ena, nthawi zina anticonvulsant chithandizo ndi chofunikira, ndipo njira za volumetric (kutupa, hemorrhage) zimachotsedwa modabwitsa.

Mankhwala a antihypertensive amatanthauza kukhazikitsidwa kwa magulu omwewo a mankhwalawa omwe amagwira ntchito makamaka pakufunika kwa matenda oopsa. Kuwonetsa:

ACE zoletsa (enalapril, perindopril),
Beta-blockers (atenolol, metoprolol),
Calcium calcium antagonists (diltiazem, verapamil, amlodipine),
Diuretics (furosemide, diacarb, veroshpiron),
Ma perodheral vasodilators (pentoxifylline, sermion).

Ndizofunikira kudziwa kuti palibe njira imodzi yothandizira chithandizo chamankhwala othandizira odwala onse, popeza mankhwala ochokera mndandanda womwe udapangidwira njira yayikulu ya matenda atha kupatsirana odwala omwe ali ndi matenda a impso, ubongo kapena mitsempha yamagazi. Mwachitsanzo, zoletsa za ACE sizingafotokozeke ngati matenda a impso.

Munthawi zonsezi, chithandizo choyenera chimasankhidwa potsatira mawonetseredwe, choyambirira cha matenda a causative, omwe amatsimikizira mawonekedwe ndi contraindication pa mankhwala aliwonse. Chisankhocho chimapangidwa ndi kuyanjana kophatikizana kwa akatswiri a mtima, ma endocrinologists, ma psychologists, opaleshoni.

Second arterial hypertension ndivuto lofunika kwambiri kwa madotolo a akatswiri ambiri, chifukwa osati chidziwitso chake chokha, komanso kutsimikiza kwa zomwe zimayambitsa ndizovuta komanso nthawi zambiri zomwe zimafuna njira zingapo. Pankhaniyi, ndikofunikira kuti wodwalayo alandire nthawi yoonana ndi katswiri posachedwa ndikuwonetsa mwatsatanetsatane zonse zomwe akuwonetsa, momwe akupangidwira matenda am'magazi, mbiri yakale yachipatala, milandu ya mabanja pamatenda ena. Kuzindikira koyenera kwa matenda oopsa ndi njira yofunika kwambiri kuchiritsira komanso kupewa zovuta zake zowopsa.

Zizindikiro za Second Hypertension

Kuphatikiza pa kuwonjezereka kwa intravascular mu sekondale, wodwala amakhalanso ndi zizindikiro zina. Akatswiri adalemba mawonekedwe a matenda oonetsa kuchepa kwa magazi, okhala ndi zinthu zitatu: kuchuluka kwa kuthamanga kwa magazi (kofotokozedwa ndi kukana kapena zizindikiro zosasinthika), kukulira zomwe zikuchitika komanso kupezeka kwa zizindikiro zomwe zimachitika mu njira ya pathological yomwe imachitika mu hemodynamic, neurogenic, endocrine ndi mafupa a impso.

Nthawi zina, njira zamatenda am'mimba zimayambira m'njira yokhazikika, koma zimayambitsa chisonyezo chokha chowalozera - matenda oopsa. Chifukwa chake, munthu sayenera kumvera malingaliro a abale, abwenzi ndikupanga chithandizo popanda chidziwitso chamankhwala chokwanira, kapena kulandira chithandizo cha matenda oopsa chokhacho ndi anthu wowerengeka.

Matenda oopsa oopsa amatha kuwonetsedwa ndi zizindikiro zomwe zitha kupezeka mozungulira malire ena, kapena kuwoneka mwadzidzidzi ndikusowa. Hypertonic itha kuwona zovuta izi:

Ululu m'deralo, khosi, akachisi, kutsogolo lobe.
Zovuta ndi mkodzo excretion.
Mutu ukugwedezeka.
Nusea, yomwe imaphatikizidwa ndi kusanza.
Zingwe.
Kuika chidwi kapena kukumbukira.
Kutopa ndi kufooka, ulesi.
Maonekedwe a "ntchentche" patsogolo pa maso.
Kuchulukitsa kwa maulendo a usiku kupita kuchimbudzi.
Kusabala kapena kusamba kwa msambo.
Kuchulukitsa kwamadzi kwamkodzo m'thupi.
Kutopa.
Tinnitus.
Zovuta kapena kupweteka m'dera la mtima.
Kugwedeza thupi kapena manja.
Kukula kwa tsitsi.
Mafupa a Brittle.
Thupi.
Kuwonjezeka kwa kutentha kwa thupi kosayambitsidwa ndi matenda opatsirana.
Kupatuka kuchokera ku psyche (dongosolo lamkati lamanjenje), mu mawonekedwe a anthu opanda chidwi kapena okondweretsa m'maganizo. Amayamba chifukwa cha kusamutsidwa kwa vuto la matenda oopsa kwa odwala.

Poona kuti dongosolo lamanjenje lamphamvu limakumana ndi zovuta za matendawa, zimatha kusokoneza kwambiri munthu yemwe ali ndi mantha, mantha, nkhawa, kuopa kufa.

Zizindikiro za chilengedwe chowonjezerapo zimaphatikizapo kugunda kwamtima mwachangu, thukuta limachulukirachulukira komanso kutsika kwa khungu popanda zinthu zomwe zingakhudze mawonetsedwe awa.

Ndikofunikanso kudziwa kuti zizindikiro zomwe zili pamwambazi ndi zofanana ndi zizindikiro za intracranial matenda oopsa. Izi zimatsimikiziranso kufunika koyezetsa magazi.

Mawonekedwe

Kutengera kuwonetseredwa kwa matenda oopsa, anthu ambiri amasokoneza matenda oopsa apakati ndi matenda oopsa oopsa. Chithandizo cholakwika nthawi yomweyo chimabweretsa zotsatira zosayembekezereka: vuto la matenda oopsa, matenda a mtima, sitiroko, kulowetsedwa kwapanjira, komwe kumapangitsa kwambiri matendawa kumabweretsa kufa msanga.

Hypertension matenda oopsa amasiyana ndi yoyamba m'mayikidwe otere:

Kugwiritsa ntchito antihypertensive mankhwala, kuthamanga kwa magazi sikufalikira, kapena kwa nthawi yayitali kumakhala kwazonse.
Nthawi zambiri ndimakhala ndimantha.
Kupanikizika kwamphamvu kumachitika mwadzidzidzi, khalani pamiyeso yomweyo kapena bwererani kwina kwakanthawi.
Matendawa amakula msanga.
Amawonedwa mwa munthu wosakwana zaka 20, kapena amene akhala zaka zopitilira 60.

Ngati muli ndi zomwe tafotokozazi pamwambapa komanso zizindikiro za matenda ena oopsa, ndiye kuti muyenera kupita kwa dokotala nthawi yomweyo. Ndikofunika kukumbukira: momwe matendawa adapangidwira, ndizosavuta kuchotsa zomwe zimayambitsa kupanikizika kwa mitsempha komanso kupewa zovuta.

Chithandizo cha yachiwiri njira ya ochepa matenda oopsa umalimbana kuchepetsa intravascular magawo. Mwachilengedwe, izi zidzatheka atachotsa chomwe chimayambitsa maonekedwe awo -

Mwa izi, mitundu iwiri ya mankhwala imagwiritsidwa ntchito:

Kuthandizira opaleshoni. Izi zimakuthandizani kuti muchotse ma neoplasms a endocrine, ubongo ndi impso, zolakwika za mtima zomwe zimayambitsa matenda oopsa. Ngati ndi kotheka, pa opaleshoni yokumbira amailowetsa munthu, kapena ziwalo zomwe zakhudzidwazo zimachotsedwa.
Mankhwala osokoneza bongo amafunikira pamene, atachitidwa opaleshoni, matenda oopsa a magazi anapitiliza chifukwa cha kusokonezeka kwamahomoni. Pankhaniyi, wodwalayo ayenera kumwa mankhwalawo mpaka kumwalira (mosalekeza).

Mankhwala, mankhwalawa amagwiritsidwa ntchito - antagonists omwe amaletsa kupanga mahomoni owopsa ndikuletsa kukula kwa matenda oopsa: okodzetsa, soseti, zoletsa za ACE, opanga ma beta-blockers ndi calcium calcium blockers, mankhwala apakati, alpha-blockers ndi mankhwala omwe amaletsa ma receptors a mtima.
Chifukwa chake, matenda oopsa owopsa amakhala ndi mkhalidwe wovuta wa munthu, womwe umaphatikizapo matenda am'magazi a ziwalo zojambulidwa, chifukwa chake kudziziritsa nokha sikokwanira. Ndikulimbikitsidwa kuyezetsa kwapachaka ndi dokotala wamtima, ngakhale atakhala kuti matenda oopsa kwambiri alibe, chifukwa munthu sangasamalire kwambiri kufatsa kwapafupipafupi (lembani matenda olembetsa magazi chifukwa cha kutopa) kapena musawone mawonekedwe a matenda oopsa mu mawonekedwe aposachedwa, kulola kuti matendawa achuluke.

Zotsatira zotsatirazi zinagwiritsidwa ntchito kukonzekera.

Pathogenesis

GB imayamba chifukwa cha kuchuluka kwa zochitika m'maganizo mothandizidwa ndi psychoemotional zinthu zomwe zimayambitsa kusokonezeka kwa kotekisi ndi kayendetsedwe ka kayendetsedwe ka magazi ka vasomotor ndi njira yamahoroni yotulutsa magazi. Akatswiri a WHO adazindikira zinthu zingapo zomwe zingayambitse matenda oopsa: zaka, jenda, moyo wongokhala, kudya sodium mankhwala enaake, kuledzera, kudya mankhwala osokoneza bongo, kusuta fodya, matenda ashuga, kunenepa kwambiri, kuchuluka kwamankhwala osokoneza bongo ndi matenda a triglycerides, cholowa ndi zina zambiri.

Akatswiri a WHO ndi IAG adagawa odwala m'magulu owopsa pokhazikitsidwa ndi kuthamanga kwa magazi komanso kupezeka kwa: a) zinthu zowopsa, b) kuwonongeka kwa ziwalo chifukwa cha matenda oopsa, komanso c) zochitika zachipatala.