Biliary Pancreatitis > Zikondwerero

Biliary pancreatitis imawonedwa ngati yachiwiri yotupa ya zotupa m'matumbo a chiwindi ndi dongosolo la biliary (hepatobiliary system). Uwu ndi mtundu wa matenda achisangalalo apakhungu pomwe kukhathamira kulikonse kumatsata kapena kumagwirizana ndi matenda a cholelithiasis (olembetsedwa ndi olemba osiyanasiyana kuchokera pa 25 mpaka 90%).

Pali kuwonjezeka katatu kwa mtunduwu wa kapamba pakati pa ana achikulire komanso kwa ana 4. Kupenyetsetsa kumalumikizana ndi odwala omwe akukana kulandira chithandizo kwa amisala osinthika amiyala m'mitsempha chifukwa cha chiyembekezo chodzapatsa mphamvu.

Nthawi zambiri azimayi ambiri amadwala. Olemba ena amati kusintha kwa ma bancari mu kapamba kumakhala koyambirira kwa zotupa, kusiya pancreatitis yoledzera.

ICD-10 kwenikweni sikufotokozera kuti biliary pancreatitis ndi chiyani. Mwa mtundu wa izi, zitha kutchulidwa kuti ndi zowawa komanso zopweteka. Ndipo malinga ndi code K 86.1 - "pancreatitis" ina popanda kunena komwe zidachokera.

Njira yopititsira patsogolo

Kuphatikizidwa ndi kutupa kwa kapamba m'matenda a chiwindi, chikhodzodzo ndi zidebe ndikotheka m'njira zingapo. Matenda amapita mpaka ku mafunde a m'matumbo kudzera m'mitsempha ya m'mimba, kapamba limayamba ngati koloka, koma limagwira mavu. Kutsekeka kwamakina mwa mawonekedwe a mwala m'mbali yotupa ya bile kumapangitsa kuti kukhale kowonjezereka, kumapangitsa kusungunuka kwa kubisalira pakatikati pa gland ndi edema yake.

Ntchito ya Vater papilla ya duodenum imasokonekera, kudzera pomwe chinsinsi cha kapamba ndi bile zimatuluka limodzi. Zomwe zimapangidwira kuponyera bile mu pancreatic duct ndi kutupa pambuyo pake. Pankhaniyi, hepatitis yogwira ndiyofunikira.

Matenda a chiwindi amachititsa kuchuluka kwa mankhwala a peroxide ndi ma radicals aulere kudutsa mu bile. Ndizowopsa zowonongeka mukalowa mu minofu ya pancreatic.

Mapangidwe a biliary sludge (sediment) - amapezeka ndi cholecystitis ndi cholangitis chifukwa kuphwanya thupi ndi mankhwala a bile. Zina mwazomwe zimapanga nthawi zina mumchere wamchere, ma microstones. Kusunthira, amavulaza mucous membrane, kumakulitsa kutupa ndi kutupa kwa Vater papilla, ndikutchingira kutuluka.

Zotsatira zake, bile simalowa mu duodenum, koma imasamutsidwa ku danc pancreatic, komwe kukakamizidwa kumawonjezereka chifukwa cha kusayenda. Zotsatira zake ndikuyambitsa kwa michere ya pancreatic madzi, kuwonongeka kwa chotchinga chotchinga, kutsegulidwa kwa chipata kwa othandizira.

Kodi ndimatenda ati omwe amathandizira kupezeka kwa biliary pancreatitis?

Zosiyanasiyana zamtundu wa pathogenesis ndizodziwika bwino pamatenda ambiri a hepatobiliary system. Chifukwa chake, kudalira pancreatitis ya biliary amadalira monga kuwonjezera ndi kuvutikira:

matenda a gallstone (2/3 kesi),
kobadwa nako malformations wa bile ndi pancreatic ducts,
ntchito yamagetsi (dyskinesia) ya ndulu ndi njira,
aakulu cholecystitis
chiwindi ndi chiwindi matenda enaake,
matenda am'mimbamo a Vater chifukwa cha kutupa, kusisita, kupindika, mwala, kusintha kwamiyala,
zotupa za chiwindi ndi chikhodzodzo.

Zomwe zimapereka:

kuperewera kwa zakudya m'thupi, kugwiritsa ntchito zinthu zomwe zimapangitsa kuti chimbudzi chikhale bwino,
mankhwala ndi mankhwala okhala ndi choleretic katundu,
kuwonda kwambiri.

Biliary-pancreatitis yodalirika imapezeka mu pachimake kapena nthawi zambiri mu mawonekedwe osakhazikika. Pachimake - amapezeka motsutsana ndi kuukira kwa cholelithiasis, imakulitsa mkhalidwe wa wodwalayo, ndimomwe amafa. Matenda a nthawi yayitali - amatha mpaka miyezi isanu ndi umodzi kapena kupitirira. Kuchulukitsa kumatsatiridwa ndikuchotsedwa. Zotsatira zake zimatengera zotsatira za chithandizo chamankhwala a biliary thirakiti, zakudya.

Chithunzi cha matenda

Chipatala cha biliary-pancreatitis chodalira chimakhala ndi zizindikiro zingapo.

Ululu ndi chizindikiro choyamba chomwe chimapangitsa odwala kuwona dokotala. Itha kukhala yolumikizira kapena yowongolera kumbuyo kapena hypochondrium. Ndi biliary pancreatitis, kupweteka kumachitika mutatha kudya yokazinga, mafuta, popeza mbale zoterezi ndi choleretic. Ululu umachitika maola angapo itatha chakudya chomaliza, komanso umatha kuchitika usiku pakumwa wopanda kanthu. Chifukwa cha chimbudzi chautali chamafuta, ululu umatha kuwonedwa kwa maola angapo.
Matenda a dyspeptic (kusanza, kunyansidwa, kuwonda, kukamwa mkamwa, kumva kupsinjika m'mimba, kuphulika kowawa, kuzengereza kapena kusowa ndowe). Nthawi zambiri, odwala amawona kusanza mobwerezabwereza chakudya komwe kumachitika kutalika kwa ululu. Kuyimitsa sikubweretsa mpumulo, ndipo zilimbikitso zatsopano zimakhala patapita mphindi zochepa.
Zizindikiro za kuledzera: kutentha thupi, kufooka, kusowa chilala.
Jaundice: madera otentha a sclera, pamlomo mucosa, maula a msomali, khungu.

Zofunika! Ngati zizindikirozi zimatenga mawonekedwe obwerekera ndipo zakhala zikusokoneza wodwalayo kwa mwezi umodzi kapena kupitilira, ndiye kuti ichi ndi chizindikiro cha kutupa kosatha. Kuyambira pano, amakambirana za pancreatitis yayitali yodalira biliary.

Kuzindikira ndi njira zofufuzira zasayansi

Kuzindikira kwa pilireatment pancreatitis ya biliary kumachitika pambuyo kotola madandaulo ndi anamnesis, kuyesa kwa wodwalayo. Kupezeka kwa matenda oopsa kwa wodwala (matenda a ndulu, matenda a chiwindi kapena zilonda zam'mimba) kudzakuthandizira kukayikira kuperewera kwa kapamba.

Mukafunsidwa, muyenera kuyang'anira chidwi cha sclera ndi mucous membranes, palpation pamimba. Monga lamulo, ndi biliary pancreatitis, pamimba sichitha kupezeka palpation yakuya mu malo a epigastric ndi subcostal. Kuphatikiza apo, pamakhala zowawa poyerekeza ndulu ya ndulu.

Kuti mutsimikizire kupezeka kwa matendawa, njira zowonjezera zowerengera ndi zida zothandizira zimayendetsedwa:

Kuyesa kwazachipatala kwaponseponse (popanda kuchulukitsa kwa biliary pancreatitis, kuwonjezeka kwapang'onopang'ono kwa kuchuluka kwa leukocytes kumayang'aniridwa, ndikuwonjezereka - kutchulidwa leukocytosis ndi kusintha kosangalatsa kwa leukocyte formula kumanzere).
Kuyesa kwamwazi wamagazi. Apa mutha kuwona kuchuluka kwa michere ya hepatic: ma amylases (omwe achulukitsa a biliary pancreatitis, owonjezera amatha kukhala maulendo 10 kapena kuposerapo), ma transfer (AcAT, AlAT), alkaline phosphatase, lipase.
Kusanthula ndowe kuti pakhale mafuta mmenemo.
Ultrasound ndiye muyeso wagolide mu diagnostics. Pankhaniyi, mawonekedwe opakika a volumetric amapezeka ndulu
Dynamic cholecystography ndi ERCP (endoscopic retrograde cholangiopancreatography) ithandizanso kudziwa ngati pali kusintha mu piodenal papilla yayikulu komanso pang'onopang'ono calving ducts. Pa ERCP, papillosphincterotomy nthawi zambiri amachitidwa kuti achotseretu ndi kuchepetsa matenda oopsa m'mitsempha ya bile.
EFGDS (esophagogastroduodenoscopy) imachitidwa kwa onse odwala omwe ali ndi vuto la kupweteka kwamanja. Mukamayesedwa, m'mimba timayesedwa kwathunthu. Chidwi chimaperekedwa makamaka kumalo am'mapiri akuluakulu a duodenal, kuyipima ngati kupezeka kwa kusintha kwa ma fibrotic, ma strictures ndi njira zina zamatenda.

Chithandizo cha biliary-amadalira kapamba

Kwa mitundu yofatsa, mankhwala othandizira amasankhidwa. Chofunikira apa ndikutsatira mosamalitsa chakudya ndikumamwa mankhwala antisecretory.

Pamaso pa calculi mu ndulu kapena mitsuko yake, pitani kuchitapo opaleshoni, pomwe amachotsedwa. Opaleshoni imachitidwanso ndi mitundu yapamwamba ya biliary-pancreatitis, pamene necrosis ya tiziwalo timene timayang'ana kale. Opaleshoni iyi ndi yadzidzidzi, yochitidwa pazifukwa zaumoyo.

Ndi kuchulukana kwa biliary pancreatitis, odwala ndiwo mankhwala oyamba 4-5 masiku. Izi zimachepetsa enzymatic katundu paz kapamba, zimapanga kupumula kwothandizira kwa iyo. Kenako wodwalayo amamulembera zakudya zotsalira (tebulo Na. 5) mothandizidwa ndi mafuta, amchere, okazinga, ndi zakudya zamzitini.

Zofunika! Zakumwa za Soda ndi mowa, mbale zomwe zimakulitsa katundu paz kapamba, komanso zakudya zoperewera siziphatikizidwa ndi zakudya.

Ndi biliary pancreatitis, kutsimikizika kumayikidwa pazakudya zama protein, zomwe zimachokera ku mitundu yochepa yamafuta a nyama ndi nsomba, chimanga ndi zinthu zamkaka. Mwa zakumwa zololedwa tei, decoctions, zipatso zouma, zakudya. Mpaka 50 magalamu a shuga ndi kagawo ka mkate wouma (osati watsopano) ukhoza kumudya tsiku lililonse.

Chithandizo cha Conservative

Mothandizana ndi zakudya, mankhwala ogwiritsira ntchito mankhwala amakhazikitsidwa:

Kulimbana ndi zowawa. Pamaso pa ululu, antispasmodics (no-spa, papaverine, platifillin, etc.) Amatha kukhala kuti ululuwo umachitika chifukwa cha ma atony a ndulu. Pankhaniyi, m'malo mwake, zinthu zimagwiritsidwa ntchito zomwe zimachepetsa minofu yosalala (domperidone, cerucal, etc.) Zotsalazo zimakweza matumbo motere, potero kusintha chimbudzi.
Chithandizo cha antisecretory. Ndi kuchulukitsa kwa biliary-pancreatitis yodalira, ndikofunikira kupondereza ntchito ya kondomu yopanga. Kwa izi, Famotidine, Ranitidine, kapena mankhwala a m'badwo waposachedwa - Octreotide ndi mankhwala. Nthawi yomweyo, katulutsidwe ka m'mimba kamatsekedwa ndi Omeprazole, omwe amathandizira kubwezeretsa kapamba.
Mankhwala a Anticoagulant. Imachitika ndi ma heparin ochepa amalemera, omwe amaletsa mapangidwe amitsempha yamagazi m'mitsempha ya gland, kusintha kukoka kwam'magazi, kumapangitsa magazi kulowa m'chiwalo.

Ngati kupindika kwa kupindika kwa papilla yayikulu, ndiye kuti myotropic antispasmodic - Mebeverin ndi mankhwala. Izi zimathandizira kufalitsidwa kwa bile, kumathandizanso matenda oopsa komanso kupindika.

Pamaso pa calculi yaying'ono, kukonzanso kwa deoxycholic kumawonjezeredwa pochizira pancreatitis yotsalira ya biliary, yomwe imathandizira kuti miyala ikhale yayikulu ndi chimbudzi chawo m'matumbo a m'mimba (mwachitsanzo Ursosan).

Pancreatic secretion defence imalipidwa ndi m'malo mwake. Pankhaniyi, kukonzekera kwa enzyme kumayikidwa (mwachitsanzo, Creon), omwe amasintha chimbudzi pamimba, amachepetsa matenda oopsa. Pomwepo imathandizira kutuluka kwa ndulu ndi magwiridwe antchito am'mimba.

Pamaso pa cholecystitis ya bakiteriya etiology kapena purulent foci yotupa mu England, wodwalayo amalamula mwachangu maantibayotiki osiyanasiyana osiyanasiyana.

Mankhwala othandizira

Pamaso pa matenda a gallstone, funso lothandizira opaleshoni limathetsedwa. Zokonda zimaperekedwa ku njira zowukira zochepa. Pankhaniyi, etiological factor imachotsedwa, yomwe imathandizira kuchira kwathunthu, kuchotsedwa kwa zizindikiro zonse za biliary-kudalira kapamba.

Laparoscopy Amagwiritsidwa ntchito nthawi zambiri, chifukwa opareshoni imachitidwa kuchokera kumagulu atatu mini kuchokera pa khoma lamkati lamkati. Ubwino wakugwirira ntchito ndikuti umakupatsani mwayi kuti muchotse chikhodzodzo ndi miyala ya kukula kulikonse ndi mawonekedwe. Mavuto a ntchito zotere, monga lamulo, samabuka.

Papillosphincterotomy. Imachitika mwachindunji panthawi ya ERCP. Pankhaniyi, sphincter ya papilla yayikulu ndi kuperewera kwamatumbo a pancreatic dessis ndi chida chapadera cholamulidwa ndi masomphenya. Kuchita uku kumachitika pokhapokha ngati miyala yaying'ono (mpaka 5mm mulifupi), popeza miyala yokhayo itatha kupusitsika imatha kulowa matumbo awo momasuka ndikutsitsa matupi awo ndi ndowe.

Balloon dilatation. Zimatanthawuza kuyika kolimba mu ducts ya bile ndi cholinga chakukula kwawo. Ndondomeko imachitikanso nthawi yofufuza ERCP kapena yokha.

Akutali mantha wave mankhwala. Mwa njirayi, miyala yomwe imakhala mkati mwa chikhodzodzo kapena chinyewa imaphwanyidwa ndi mafunde owopsa a ultrasound, omwe amatsatira ndi mphamvu inayake komanso pafupipafupi. Mchenga ndi zigawo zotsala za calculi zimalowa palokha m'matumbo, ndipo kutuluka kwa bile kumakhazikitsidwa. Njirayi ikuwonetsedwa kwa miyala yaying'ono yomwe idaphwanyidwa.

Ntchito yotseguka. Pofuna kuchotsa calculi, tsopano sichigwiritsidwa ntchito. Zimachitika pokhapokha ngati zida za laparoscopic zipatala kapena pamaso pa miyala ikuluikulu zomwe ndizovuta kuzichotsa mwachangu. Nthawi zambiri, opaleshoni yotseguka imachitika pancreatic necrosis pazifukwa zaumoyo. Nthawi yomweyo, zigawo za minofu yakufa zimachotsedwa kapena chiwalo chonse chimapangidwanso.

Pomaliza

Biliary-pancreatitis yodwala ndi matenda oopsa opaleshoni, omwe nthawi zambiri amayamba chifukwa cha cholelithiasis kapena matenda am'mimba a duodenal papilla. Pankhaniyi, aseptic kapena purulent kutupa kwa pancreatic minofu kumachitika, komwe kumatha kuphimba chiwalo chonse kwathunthu kapena gawo limodzi lokha. Zizindikiro zoyambirira zomwe zimakayikira biliary pancreatitis ndizopweteka, nseru komanso kusanza mobwerezabwereza, kukoma kwa mkamwa, ndi jaundice. Kuzindikira kumatha kutsimikiziridwa ndi maphunziro a ultrasound ndi radiology Mosiyana. Njira zochizira komanso zopangira opaleshoni zimagwiritsidwa ntchito pochiza matendawa. Kusankhidwa kwa njira kumatengera mtundu ndi matenda.

Kodi biliary-amadalira pancreatitis?

Biliary-amadalira pancreatitis ndi mawonekedwe a kutupa kwa kapamba komwe gululi limataya kwathunthu ntchito zake (mwachitsanzo, kutulutsa kwa mahomoni ndi ma enzymes). Matendawa amakula mikhalidwe ya kubadwa kwa matenda a gland ndi biliary thirakiti. Mawu akuti "aakulu" akuwonetsa kuti matendawa amakula pang'onopang'ono ndikuyenda ndi munthu zaka zambiri.

Pafupifupi theka la milanduyo, kapamba wamtunduwu ndi zotsatira za matenda am'mimba a ndulu, omwe amapezeka pafupi ndi kapamba ndi ndowe zake, ndipo amatseguka, monga milomo ya ndulu iyi, kulowa mu duodenum.

Pancreatic pancreatitis

Pali zizindikiro zingapo zomwe zimasiyanitsa chikhodzodzo chodalira pancreatitis ndi mitundu ina yamatendawa:

Ululu Chizindikiro ichi chimatsagana ndi zochitika zambiri zamatenda, koma ululu umatha kukhala ndi mithunzi yosiyanasiyana komanso kutengera kwina (malo omwe akuwunikirawo). Ndi matenda awa, ululu umafanana ndi hepatic colic, amachitika paroxysmally, nthawi zambiri usiku. Kumva kuwawa ngati "kumadula" munthu m'magawo awiri pamalo pomwe kapamba amapezeka. Nthawi zambiri ululu umawala (umapereka) phewa, kumbuyo, masamba ndi ngakhale khosi.
Kutupa, kusweka, kugwedezeka pamimba, nseru, kusanza, nthawi zina kugwedera.
Kutsegula m'mimba mpaka katatu pa tsiku. Amadziwika ndi zopondera zambiri zowononga, zopweteka za mtundu wa imvi, zomwe zimakhala ndi zotsalira za chyme zomwe sizikuphatikizidwa kale (chakudya chomwe chinapangidwa kale ndi madzi am'mimba koma sichitha kugayikiridwa kupitilira chifukwa chakusowa kwa michere m'matumbo ang'onoang'ono) ndi mafuta (izi zimagwirizananso ndi kuchepa kwapadera kwa michere yam'mimba ndi emulsifiers). Mafuta onenepa amapezeka mosavuta chifukwa chakuti samasungunula madzi osasamba nawo.
Zizindikiro za jaundice (khungu limatembenuka chikasu, mucous nembanemba, mapuloteni amaso amatembenukira lalanje). Kuyesedwa kwa magazi kumavumbula kuchuluka kwambiri kwa bilirubin mmenemo, yomwe mwa anthu athanzi imapangidwa mu chiwindi ndikuchotsa matumbo.
Kuwonjezeka kwa kuchuluka kwa shuga m'magazi ndi mkodzo, matenda a shuga.
Kuchepetsa thupi popanda chifukwa.

Chikhalidwe cha kupweteka pakukula kwa kapamba

Zotsatirazi zimayambitsa kupweteketsa mtima:

Kuledzera kwa choleretic chakudya. Ikhoza kukhala dzira yolk, caviar, etc.
Kugwiritsa ntchito mankhwala a choleretic.
Kuonda kwambiri.

Kukula kwa kutupa kwa kapamba

Biliary pancreatitis ndi matenda achiwiri, zomwe zimayambitsa izi:

Mphamvu yachilendo ya ziwalo zina zam'mimba zam'mimba (ndulu yakeyo, chikhodzodzo, ndulu). Izi zitha kukhala chifukwa cha kusinthika kwa majini ndi zofooka pakukula kwa mwana wosabadwayo. Chithandizo cha Conservative nthawi zambiri sichingachitike pano: opaleshoni ndiyofunikira.
Miyala mu ndulu.
Kulephera kwa ndulu kuti ichite mgwirizano, momwe bile limasiya kulowa mu duodenum.
Cholecystitis yopanda kuwerengetsa (kutupa kwa ndulu, osatsatiridwa ndimapangidwe amiyala).
Cirrhosis ya chiwindi (chosasinthika m'malo mwa chiwindi minofu ndi adipose minofu).
Kutupa kwa duodenal papilla (papillitis).
Kukakamira kwa sphincter ya Oddi. Uwu ndiye minofu ya mphete, yomwe imayendetsa kapena kusadutsa chakudyacho kuchokera m'mimba kupita ku duodenum.
Kuchepetsa kwa duodenal papilla wa duodenum.
Kufalikira kwa papilla amene watchulidwa kale uja.

Zomwe zimayambitsa kudwala kwamatumbo pancreatitis

Mitundu yamatenda

Biliary pancreatitis amadziwika chifukwa cha ma pancreatic pathologies omwe amachitika ndi nthenda yotuluka ya ndulu. Pamene mavuto akuwonjezeka mu duodenum kapena biliary thirakiti, bile ndi kapamba wam'mimba amalowa kapamba. Pakadali pano, trypsin yokhazikitsidwa imalowa mu duodenum, yomwe imayamba kusungunuka osati ma pancreatic misa, koma ma cell a pancreatic. Chifukwa chake, thupi limadzigaya lokha.

Akatswiri a tsamba la zheleza.com amasiyanitsa gulu la kapamba:

Odalirika.
Pseudotumorous.
Kuletsa.
Parenchymal
Idiopathic.
Zotsatira.
Zowononga.
Necrotic.
Zododometsa.
Zowerengera.
Atrophic.
Mowa
Zoopsa.
Biliary.
Sekondale
Zosangalatsa.
Purulent.

Biliary pancreatitis imagawidwa kukhala:

Lakuthwa. Amayamba chifukwa chomwa mowa kwambiri, zakudya zonunkhira, kaphebe, zonunkhira, zokazinga ndi kusuta.
Matenda Amayamba pambuyo pakalibe chithandizo cha pachimake mawonekedwe. Imayendetsedwa ndi atrophy, kusinthitsa kusintha, magwiridwe antchito, mawonekedwe a ma cysts.

pitani

Zomwe zimayambitsa matendawa

Monga tawonetsera, matenda omwe amakhalapo ndulu, biliary trailer ndi duodenum amatsogolera kuonekera kwa pilireat-pancreatitis ya biliary. Kodi zikuyenda bwanji? Mu chikhodzodzo cha ndulu, bile limapangidwa - chinthu chogwira ntchito kwambiri chomwe chimakhudzidwa ndikugaya. Imayenda mumadutsa kupita mu duodenum, komwe imagwira ntchito zake. Ngati zifukwa zina zasokonezeka, ndiye kuti matendawo amakula.

Potsutsana ndi kutuluka kwa bile, imalowa m'matumbo, pomwe kukakamizidwa kumawonjezereka ndipo kumayambira. Bile amalowa m'maselo a kapamba, ndichifukwa chake amayamba kuwonongeka.

Bile imatha kuwonjezera ntchito zake zowononga ngati, pazifukwa zina, kapangidwe kake ndi zinthu zake zikasintha, kutupa kumayamba chiwindi, chithokomiro, kapena chikhodzodzo, ndipo mabakiteriya ochokera ku ziwalo zopatsirana amalowa mu ndulu.

Zizindikiro za Biliary Pancreatitis

Biliary-pancreatitis yomwe imadalira kwambiri ndipo imawonekera muzochitika zomwezo, zofanana ndi mitundu ina ya kapamba:

Ululu pamimba pa lamba kapena chodziwika m'dera la hypochondrium yamanzere.
Thupi.
Kusanza kosalephera ndi mseru.
Kutsekula m'mimba kapena kudzimbidwa.
Jaundice

Aakulu biliary pancreatitis panthawi yopanda chikhululukiro chikuwonetsedwa mu:

Kuchepetsa thupi.
Kuchepetsa mseru.
Kupumira komanso kupweteka.
Anachepetsa chilako.
Kudzimbidwa kwam'mimba kapena kutsegula m'mimba.
Kutentha kwapang'onopang'ono.

Biliary-pancreatitis yodziwika bwino imadziwika ndi izi:

Ululu umawonjezeka ndi kugwiritsa ntchito mankhwala a choleretic kapena mankhwala osokoneza bongo.
Matenda a ululu amafanana ndi colic biliary, omwe amakhala kumbali yakumanja ndikupatsidwa dzanja lamanja, tsamba lamapewa kapena kumbuyo.
Zowawa zake zimakhala zachikhalire.
Pafupipafupi ndi matumbo paresis (kudzimbidwa kwambiri ndi nthawi yayitali mpaka kutsekeka kwamatumbo) kuposa kutsekula m'mimba.
Jaundice monga chinthu chotsatira.
Kugunda kwakuthwa ndi kuwawa mkamwa nthawi zina.

pitani

Kuzindikira ndi kuchiza kwa ma biliary-pancreatitis

Popeza pancreatitis ili ndi mitundu yambiri yamawonekedwe ake, madokotala amayenera kuzindikira kaye, kenako ndikuzindikira chomwe chimayambitsa. Njira zosiyanasiyana zodziwirira matenda zimagwiritsidwa ntchito:

Ultrasound kuti mupeze miyala mu ducts ndi kutupa mu kapamba.
Kuyesa kwa magazi pa biochemical kwa shuga, lipase, amylase.
MRI
Cholangiopancreatography Mosiyana.
Kuyesa kwamagazi kambiri kuti mudziwe kuchuluka kwa maselo oyera.
CT scan kuti mudziwe momwe khansa yapansi ndi ziwalo zoyandikana, minofu necrosis.
X-ray kuti mudziwe momwe thupi limakhalira.

Pochizira pancreatitis, njira zambiri ndi zapadera zamankhwala amtundu uliwonse zimagwiritsidwa ntchito. Chifukwa chake, ma pinkiller, zakudya, kupatula chikonga ndi mowa, kugwiritsa ntchito mankhwala othandizira, mavitamini ambiri ndiofala. Ndi biliary-pancreatitis yomwe imadalira, imawerengedwa:

Ululu syndrome: kwa ma hypermotor amati, antispasmodics ndi mankhwala (Debridate, No-shpa), komanso hypokinesia, prokinetics (Motilium, Cerucal, Eglonil).
Mankhwala osakanikirana omwe amafunikira pakukonzanso, ndi hepatostabilizing, antispasmodic katundu, wokhoza kutulutsa mawonekedwe a bile: Hepatofalk, Odeston.

Matenda a pilireatic biliary-pancreatitis amathandizidwira onse ndi mankhwala. Kuchitapo kanthu kwa opaleshoni kumaperekedwa kwa zotupa za Vater papilla, matenda a ndulu, kuchepa kwamitsempha yamagazi. Nthawi zambiri, zochitika zotsika kwambiri za endoscopic zimachitika pobweretsa zida zing'onozing'ono komanso kamera kudzera mwa magawo atatu a 3-4 khoma la pamimba kapena lotseguka lotseguka lotupa kudzera pakuloweka kwakukulu.

Wodwalayo ayenera kutsatira zakudya - zopatsa thanzi, mapikidwe a 5-6 tsiku lonse pang'ono. Mowa, nyama zosuta, zakudya zowuma, zakudya zamafuta ndi mafuta okazinga amachotsedwa muzakudya. Kuchuluka kwa mafuta ndi chakudya cham'mimba kumayenera kuchepetsedwa, ndipo kuchuluka kwa mapuloteni kuyenera kuchulukitsidwa. Mwanjira yamatendawa matendawa, pamafunika kukana kudya masiku atatu ndikungodya madzi osafunikira ochepa okha.

Monga mankhwala amalembera:

Maantibayotiki matenda.
Mavitamini
Ma Enzymes kuti athetse ntchito yapancreatic.
Oyang'anira shuga.
Analgesics ndi antispasmodics kuti athetse ululu.
Mankhwala osokoneza bongo kuti muchepetse kusanza ndi mseru.

pitani

Anthu omwe amakonda mitundu yosiyanasiyana yamatenda a kapamba amalangizidwa kuti azitsatira zakudya ndikusiya zoopsa. Matendawa amayenda bwino ngati munthu agwiritsa ntchito chithandizo kuchipatala akangoyamba kudwala.

Makhalidwe opweteka

Ululu umapezeka mu 90% ya odwala, pokhapokha nthawi zina mtundu wopweteka womwe umakhala wopanda vuto umatha. Amasanjidwa m'dera la epigastric, akuwongola mbali zonse, kumapewa, kutsikira kumbuyo.

Ululu umachitika pambuyo pa maola awiri ndi awiri ndi theka kuchokera pakudya, usiku. Ululu wambiri umatha kuchitika mukangomwa madzi otuwa. Amayambitsa kuphipha kwa kupindika kwa Oddi ndipo kumakwiyitsa. Chifukwa chofala kwambiri ndikuphwanya zakudya: kudya zakudya zamafuta ndi okazinga, mowa, soseji zotentha ndi zokometsera, marinade ndi pickles, nyama zosuta.

Zizindikiro za Kulephera Kwa Enzymatic

Njira yotupa m'maselo a kapamba imasokoneza ntchito zonse za endocrine ndi exocrine. Kugonjetsedwa kwa zisumbu za Langerhans kumayambitsa kuchepa kwa kupanga kwa insulin ndi zovuta zamafuta amthupi kagayidwe kazakudya. Pakuwukira, kuwonjezereka kapena kuchepa kwa shuga m'magazi ndikotheka.

Kusintha kwa exocrine (exocrine) kumayenderana ndi kusowa kwa kuchuluka kwa ma pancreatic enzymes m'mimba yaying'ono. Kubisala kwa gland kumakhala ndi mitundu yopitilira 20 ya ma enzyme omwe amatsimikizira kuwonongeka kwa mafuta ndi mapuloteni ndikutanthauzira kwawo kuzinthu zamagetsi zomwe zimapangidwa. Biliary pancreatitis mu nthawi yayitali imayambitsa kubisala pang'onopang'ono kwa kutulutsa maselo pamisempha.

Kuperewera kwa kapamba kumawonekera ndi dyspepsia yamatumbo:

chopondapo kumasuntha kangapo patsiku ndi chopondapo cha fetid, chokhala ndi filimu yamafuta (steatorrhea),
chisangalalo
kumverera kwa "kubuula" m'mimba,
kuchepa kwamtima
nseru
malamba komanso kutentha kwa mtima.

Zizindikiro zowonjezera

Popita nthawi, odwala amachepetsa thupi. Zizindikiro za kuperewera kwa Vitamini (khungu lowuma, ming'alu pakamwa, tsitsi lakhomedwe, misomali, kutulutsa magazi pakhungu) ndi kuchepa kwa ma elekitiroma. Kukumana ndi slag kulowa m'magazi kumayambitsa mseru komanso thupi.

Kugonjetsedwa kwamalamulo amanjenje kumakhudza ntchito ya ma sphincters. Odwala amakhala ndi Reflux bile m'mimba, zizindikiro za gastritis, komanso kumva kuwawa pambuyo kupasuka.

Kusiyanitsa mitundu

Zizindikiro zamankhwala zodalira pancreatitis ya biliary zimatha kubisika kumbuyo kwachiphunzitso china cha m'mimba. Chifukwa chake, pakuzindikiritsa ndikofunikira kupatula:

zilonda zam'mimba ndi duodenum,
zotupa zam'mimba
antral gastritis,
matenda a chiwindi,
zotupa zapachifuwa,
aakulu osawerengeka cholecystitis.

Kodi biliary pancreatitis ndi chiyani

Mtundu wa biliary wa kapamba ndimatumbo a kapamba, omwe amalumikizidwa ndendende ndi mavuto a dongosolo la hepatobiliary. Imatha kukula nthawi yayitali (kwa miyezi 6 kapena kupitirira), komanso mwachangu. Kunyalanyaza kwa matenda amzeru kumayambitsa kusokonezeka kwathunthu kwa ntchito ya kapamba.

Biliary pancreatitis ndi matenda omwe amapezeka kawirikawiri omwe amakhudza oposa theka la odwala onse omwe amapezeka ndi matenda a chamba. Pathology imatha kubadwa nthawi iliyonse, kwa akulu ndi ana, koma nthawi zambiri matendawa amakula kwambiri. Mwa amuna, matendawa ndi ocheperako kuposa azimayi.

Biliary pancreatitis ndi nthenda yachiwiri, yokhala ndi mawonekedwe a kutupa. A pathology amapangika motsutsana ndi maziko a matenda omwe akupezeka kale. Matenda oyamba amakhudza chiwindi, chikhodzodzo, kapena ndulu. Njira yayitali ya matenda oyambira ndi njira yofunika kwambiri yowonjezera mwayi wokhala ndi matenda apansi a biliary pancreatitis. Matendawa amakula nthawi zambiri motsutsana ndi maziko a cholelithiasis popanda calculi kapena ndi kupezeka kwa calculi wamkulu wamkati mwa ndulu za ndulu.

The biliary mawonekedwe a kapamba zimawoneka chifukwa cha kuwonongeka kwa gawo la parenchymal. Chotupa chija chimakulitsidwa ndi kupezeka kwa ma radicals aulere omwe amalowera mwachindunji kuchokera ku duct ya bile kupita kumtunda wa kapamba. Njira yotalikilapo ya cholecystitis pakalibe miyala imayambitsa kusintha kwachinsinsi, chomwe, chifukwa cha kusakhazikika kwa nthawi yayitali, chimathandizira kupanga mapokoso. Zimatulutsa ndulu ndipo, m'mene zimanyamulidwa, zimatha kuvulaza zingwezo, zomwe zimatsogolera kuchepa kwawo chifukwa cha kupindika. Mwanjira iyi, bile Reflux yosakwanira imapezeka mu duodenum, yomwe imapangitsa kuti katulutsidwewo alowe m'matumba a pancreatic ndikuyambitsa kutupa.

Zomwe zikuwoneka, chithunzi

Kuwona kwa biliary pancreatitis kumachitika pogwiritsa ntchito endoscopic retrograde cholangiopancreatography (ERCP). Mu chithunzi mutha kuwona kukhalapo kwa stenosis mu ngalande zazikulu ndi kupunduka kwapangidwe pazinyumba zazing'ono.

Kudziwika kwa kufalikira kumawonekera; ngati kulipo, kuwerengera kwakubisika ndi mapulagi apuloteni ndizodziwika bwino. Kuwona kumakupatsani mwayi wowunika kusintha kwa kapamba, chikhodzodzo ndulu ndi chiwindi.

Nthawi zina, pachithunzichi mutha kuwona cysts yokhala ndi madzimadzi okhutira komanso malo okhala a purulent m'matumbo a kapamba (ma abscesses).

Kodi ndimatenda ati omwe amathandizira kupezeka kwa biliary pancreatitis?

Kuposa 60% ya matendawa amachitika chifukwa cha kutsekeka kwa kutuluka kwa kapamba ndi ndulu (ndulu ya ndulu).

Matenda omwe amachititsa kuti pakhale mtundu wa kapamba wa kapamba ndi monga:

Kuphwanya kapangidwe ka njira za choleretic,
Matenda a kapamba,
Gallbladder motility disorder,
Kutupa mu bile ducts, kuchititsa kuphwanya kwa patency yawo (cholangitis),
Cirrhosis
Cysts of chill
Dyskinesia gvp kapena zhp,
Mphamvu ya ya ndulu ndi inclusions wa kukula kwa microscopic kukula,
Helminthic infestation,
Kutupa ndi mawonekedwe a pathological m'dera la duodenal papilla.

yachiwiri chikhalidwe cha biliary pancreatitis ngati matenda chifukwa chakuti matendawa sikuti amatulutsa kapamba, koma amawoneka chifukwa cha zolakwika zomwe zimachitika mu ziwalo zapafupi.

Matenda a Biliary Pancreatitis

Pali pachimake biliary pancreatitis ndi aakulu biliary-amadalira kapamba.

Biliary-amadalira pancreatitis yayitali imapitilira miyezi isanu ndi umodzi. Ndi matenda a kapamba omwe amapanga motsutsana ndi maziko a matenda a pathologies ndi obadwa nako matenda a biliary thirakiti. Matendawa amawonetsedwa ndi kutha kapena kutaya kwathunthu kwa ntchito ya enzymatic ndi mahomoni othandiza kuzimiririka kwa kapamba

Njira yovuta yokhala ndi pancreatitis ya biliary ndiyofala. Matenda amitsempha yapamtunda amachititsa pafupifupi theka la matenda onse kapamba.

Kwa matenda a pancreatitis a biliary-amadalira pancreatitis, kuoneka ngati kusasangalala pamimba kwa munthu wopweteka ndi chizolowezi, komwe kwa nthawi yayitali kumadetsa nkhawa wodwalayo, kupezeka kwa vuto la dyspeptic, mapando otayirira, jaundice, kuchepa thupi. Maonekedwe okhalitsa a biliary pancreatitis amapezekanso ndi kudzimbidwa kosatha kapena kutsegula m'mimba.

Acute Biliary Pancreatitis

Acute biliary pancreatitis imayamba chifukwa cha kutupa pamimba ndipo, popanda chisamaliro chamankhwala choyenera, nthawi zambiri imabweretsa imfa. Pofuna kupewa komanso kukonza njirayi, njira zochizira zomwe zimagwiritsidwa ntchito nthawi zambiri zimagwiritsidwa ntchito. Ngati sangapereke zotsatira, kuchitapo kanthu kwa opaleshoni kwasonyezedwa. Nthawi yovuta kwambiri imadziwika ndi hyperthermia yambiri nthawi zambiri mkati mwa mfundo zochepa.

The pachimake maphunziro a matenda amadziwika ndi zotsatirazi zizindikiro:

Ululu womwe wapezeka kumanzere kwa hypochondrium. Ululu umakhala ngati lamba.
Kuwonetsedwa pafupipafupi ndi mseru kwambiri,
Kuteteza khungu,
Kuchulukitsa kwa kupanga kwa mpweya, kukulitsa kudzimbidwa kapena kutsekula m'mimba.

Choopsa cha matendawa ndikuti kusintha kwa kapamba nthawi zambiri kumasintha. Kukhazikika kwa matendawa kumadziwika ndi njira yotupa yomwe imayambitsa vuto mu gland. Popita nthawi, thupi la kapamba limapunduka, lomwe limatha ndikamakula kwa maselo owonongeka mumagulu azitsulo, boma limayamba kukhala lopanda gawo.

Chithunzi cha chipatala cha matenda am'mimba chimafanana ndi mitundu ina yamatenda a kapamba. Komabe, palinso mawonekedwe a matendawa:

Maonekedwe a ululu m'mimba chifukwa chogwiritsa ntchito mankhwala omwe ali ndi choleretic, komanso zakudya zomwe zili ndi katundu wofanana,
Kutalika kwa kupwetekedwa mtima. Ululu umatenga nthawi yayitali kuyerekeza ndi matenda ena,
Mapangidwe a paresis m'matumbo. Nthawi zambiri, mtundu uwu wa kapamba amayamba ndi kudzimbidwa, pomwe mitundu inanso ya matendawa imayambitsa kutsegula m'mimba.
Kuwonetsedwa kwa zowawa mu hypochondrium kuli kumanja, osati kumanzere. Zowawa zimafanana ndi colic biliary,
Maonekedwe a jaundice, omwe ndi mawonekedwe am'mimba a kapamba, amadziwika ndi khungu lopindika komanso mawonekedwe owoneka bwino a mucous,
Kugona pafupipafupi ndimalo owawa, kuwawa pamkamwa.

Ngati biliary pancreatitis imayendera limodzi ndi kufinya kwamkati mwa zikondamoyo kapena khungu lotsekemera, khungu limapeza kutulutsa kwachikasu, kuthekera kwaphwanya kagayidwe kazakudya.

Nthawi yomweyo, wodwalayo amadandaula ndi kutentha kwa pamtima, kupindika, kuchepa kwa chakudya, kuchepa thupi, kudzimbidwa, mawonekedwe am'mimba, kusintha kwa ndowe (imvi yoyera), ndowe zimamasulidwa ndi fungo la fetid.

Zolinga za maonekedwe

Zifukwa zazikulu zomwe zimapangitsa kukhazikika kwa biliary pancreatitis ndimatenda a gallstone, komanso kukula kwa bile ndi mapangidwe a mawonekedwe a microscopic calcication (biliary sludge). Zofooka zobadwa nazo za bile duct, njira yotalikitsa ya cholecystitis, komanso kusokonekera kwa hepatic exocrine kungakhale chifukwa cha matenda.

Matenda a kapamba amtunduwu amatha chifukwa cha dyskinesia ya bile duct (choledoch), yomwe imayambitsa kuchotsedwa kwa ndulu pamkono wa ndulu ndi chithokomiro cha hepatic, kupitilira kwa cholangitis, cholestasis ya cholestasis, kuwonongeka kwa maselo a chiwindi (cirrhosis), kuwonongeka kwa mapangidwe amthupi la chibelekero cha ma Vater. 12 - duodenum.

Kukula kwa ma pathologies awa ndi biliary pancreatitis mu parenchymal gland kumathandizidwa ndi:

Njira zotupa
Kutsegula kwa zochita zakusokonekera,
Kupezeka kwachulukidwe kuchuluka.

Momwe tiyenera kuchitira

Amathandizira matendawa kwathunthu. Njira yochizira yothandizira bancary pancreatitis cholinga chake ndikuchotsa ululu, kupukutitsa thupi, kukhazikitsa chinsinsi cha kapamba, kupewa matenda opatsirana, kuchotsa calculi (ngati ilipo). Endoscopy ya Vater papilla imachitika zonse pofuna kuzindikira ndi kuchiritsa. Mankhwalawa ovutikawa akuphatikizanso zakudya zamankhwala komanso mankhwala.

Choyamba, amachotsa zomwe zimapangitsa kuti pathological bile Reflux. Ngati matendawa ali pachimake, nthawi zambiri opaleshoni imachitidwa kuti achotse miyala pachimake. Miyala ikakhala yocheperako, chithandizo chamankhwala chimaperekedwa, chogawanika ndikuchotsa miyala ku ndulu.

Poletsa kupweteka, antispasmodics ndi analgesics amagwiritsidwa ntchito. Mankhwala atha kupatsidwa mankhwala opaka pakamwa, komanso kuphatikizidwa kudzera m'mitsempha. Mu gawo lowopsa la matenda, mankhwala a choleretic amagwiritsidwa ntchito.

Kukonzekera kwa Enzymatic amalembedwa kuti kuwonjezera ntchito za kapamba. Zomwe zimagwiritsidwa ntchito kwambiri ndi creon, mezim, pancreatin. Mankhwala a gululi amapanga kuchepa kwa ma enzyme omwe amayamba chifukwa cha kusakwanira kwa chinsinsi cha kapamba, motero amakhala ndi vuto logaya chakudya. Zinthu zikayamba kuyenda bwino, pang'onopang'ono amasiya.

BP ikamayendera limodzi ndi kupanga ma hydrochloric acid ndi maselo am'mimba, mankhwala ena amaphatikizidwanso mothandizidwa: proton pump blockers. Omeprozole, nolpase, emaner amalembedwa, mothandizidwa ndi njira yopanga hydrochloric acid imasinthidwa.

Mu mtundu wa BP wamankhwala osokoneza bongo, mankhwala amawunikira omwe amathandizira kutulutsa kwa bile. Nthawi zambiri, mankhwala azitsamba amagwiritsidwa ntchito pazolinga izi. Hofitol, yomwe imapangidwa pamaziko a artichoke Tingafinye, imawoneka kuti yothandiza. Mankhwala amalola kuthetsa kuchulukana mu bile ducts, kupewa mapangidwe a ndende ya ndulu.

Chithandizo chovuta cha BP chimaphatikizanso sulfonamides, biguanides, insulini kuti muchepetse shuga m'magazi, maantibayotiki kuti ateteze zotsatira zoyipa, mankhwala omwe ali ndi ursodeoxycholic acid, omwe cholinga chake ndikukhazikitsa gallbladder ndi zinthu zina zomwe zingayambitse vuto la mankhwala opweteka komanso kuchepetsa kukhumudwa.

Mankhwala othandizira a BP amachitika ngati matendawa amayamba ndi cholelithiasis. Zisonyezero za opaleshoni ndi mitundu yapamwamba ya cholelithiasis, pomwe kukula kwake kwamiyayo ndi yayikulu, miyala sangathe kuphwanyidwa ndi euvl ndikutsekereza ndulu za bile. Ndi njirayi, cholecystectomy (kuchotsedwa kwa ndulu pamodzi ndi calculi) kumachitika.

Opaleshoni imachitidwanso ndi chitukuko cha adenoma yomwe ili m'chigawo cha mphuno ya Vater, yokhala ndi ma cicatricial kupendekera kapena kupezeka kwa mawonekedwe.

Opaleshoni imachitika m'njira ziwiri:

Laparotomy Ngati kunja kukapangika mkati mwa khoma lam'mimba, ndikutsatira ndikuchotsa ndulu pamodzi ndi calculi. Pambuyo pamtunduwu wa kulowererapo, chisamaliro chapadera chiyenera kulipidwa panthawi yobwezeretsa.
Laparoscopy Njirayi imawonedwa ngati yowononga ndipo imagwiritsidwa ntchito kudzera m'miyala yaying'ono yomwe imapangidwa pakhoma lamimba. Opaleshoniyo imachitika pogwiritsa ntchito zida zamavidiyo. Dotolo amayang'anitsitsa zowona zonse kudzera pa polojekiti.

Kuchita opaleshoniyo kungachedwetsedwe ngati wodwalayo atsika magazi kwambiri, mikhalidwe yododometsa, malo osakhazikika a neuropsychic, kusungika kwamikodzo mwamphamvu, kuwonjezeka kwakukulu pamlingo wa michere kapena shuga. Kuthandizira kwa opaleshoni mu zochitika zotere kumachitika pambuyo pokhazikika kwa wodwalayo.

Zakudya za bancary pancreatitis: chomwe chitha komanso chosatheka

Chithandizo cha biliary pancreatitis chimatanthawuza kutsatira mosamalitsa zakudya zoperekedwa ndi katswiri. Chakudya chopatsa thanzi chizikhala chopatsa chidwi komanso chokwanira. Zakudyazo zimasinthidwa malinga ndi chakudya patebulo lambala 5. Mu kuwonda kwambiri kapena kubwezeretsanso kwa BP kwa masiku atatu, kumayikidwa njala, zomwe zimapangitsa kuti gawo lathanzi lipumitse othandizira komanso kupewa mavuto.

Zakudya zonse zotengedwa ndi wodwalayo ziyenera kukhala zogwirizana ndi mbatata yosenda, mousse, pudding. Zakudya zonse ziyenera kukhala zonenepa, ndikugwiritsira ntchito chakudya chophika, chophika chakudya pamlingo wa chikhululukiro chokhazikika chololedwa. Kutentha kwa mbale sikuyenera kupitirira 50 madigiri. Muyenera kukonza chakudya osachepera 5 patsiku m'magawo ang'onoang'ono.

Amafunikira kupatula kwathunthu yokazinga, mafuta, zakudya zonunkhira ndi mowa, zipatso ndi mabulosi odzola, msuzi wowawasa wowawasa, kabichi yoyera, nyemba, mtedza, tiyi wamphamvu, khofi, zakumwa zoziziritsa kukhosi kuchokera ku zakudyazo.

Saloledwa kugwiritsa ntchito mankhwala a choleretic, monga kirimu wowawasa, batala, ndikofunikira kuwonjezera kuchuluka kwa mapuloteni. Kwa tsiku limodzi ndi BP, tikulimbikitsidwa kudya mapuloteni pafupifupi 120 g ndikuchepetsa kuchuluka kwa chakudya chamagulu muzakudya.

Mwa zakudya zomwe zili ndi chakudya chamagulu owaluka, zophera thukuta, semolina, oatmeal, barele, mpunga, pasitala ndizololeka. Amaloledwanso kudya mbatata, kaloti, beets, dzungu, squash, squash. Zakudya zamasamba ziyenera kukhala zotentha kapena pamadzi, mutha kudya masamba pang'onopang'ono. Masamba ophika amagwiritsidwa ntchito bwino mu mawonekedwe osenda ndi kuwonjezera msuzi wa phala.

Zipatso, kugwiritsa ntchito mitundu ya maapulo omwe si acidic kumalimbikitsidwa: Zipatso zokhwima zimatha kuphika, kupukuta, kupangidwa kuchokera kwa iwo, zouma zipatso zophatikizanso ndizothandiza. Ndikofunikira kwambiri kupewa kudya kwambiri. Kutumikirako sikuyenera kupitirira 250g. Kuchuluka kwa mchere ndi shuga ziyenera kukhala zochepa.

Zakudya zamagulu onse, menyu

Zakudya za zakudya za PD zimakupatsani mwayi wosankha zovuta zomwe zingachitike komanso kupewa kubwereranso m'mbuyo.

Malinga ndi kakhazikitsidwe ka chakudya, mbale zoyambirira ziyenera kukhala msuzi wopangidwa kuchokera ku chimanga (mutha kugwiritsa ntchito mkaka munthawi yachikhululukiro chokhazikika), masamba, mbale zam nyama ndi nyama yopendekera, komanso nsomba. Amaloledwanso kugwiritsa ntchito sopo wokoma wokhala ndi zipatso ngati maphunziro oyamba.

Njira yachiwiri - yophika ng'ombe, nkhuku, nsomba, omelet, otentha kwa azungu azira.

Menyuyi muyenera kuphatikiza mbale za chimanga (chimanga), pasitala, mkate wa dzulo, mafuta a masamba ndi othandiza. Amaloledwa kugwiritsa ntchito zinthu zopanda mkaka zopaka mkaka, batala (tsiku lililonse osaposa 0.25 g).

Monga mchere, mutha kugwiritsa ntchito uchi, zipatso zokoma za zipatso ndi zipatso, zipatso zouma zokhala ndi mawonekedwe osalala, owonjezeredwa ku mousses ndi mbewu monga chimanga.

Kugwiritsa ntchito misuzi yatsopano yosenda bwino ya zipatso zotsekemera popanda shuga, misuzi ya masamba, zakudya, zonunkhira ndizovomerezeka.

Mndandanda wazitsanzo za tsiku la wodwala wokhala ndi pancreatitis ya biliary imaphatikizapo:

Chakudya cham'mawa. Oatmeal mkaka wothira madzi, chidutswa cha ng'ombe yophika, tiyi wobiriwira,
Chakudya cham'mawa chachiwiri. Omeled yolimba, apulo wophika, zakudya,
Chakudya chamadzulo Msuzi wamasamba, masamba a nyama kuchokera ku nsomba, pasitala, zakudya zonunkhira, msuzi wa rosehip,
Chakudya chamadzulo Ma cookies a Curd ndi biscuit,
Chakudya chamadzulo Phala la mpunga ndi tiyi wobiriwira.

Mavuto

Mavuto amabwera makamaka ndikunyalanyaza matendawa. Mavuto otsatirawa ndi BP akupezeka:

Fysid cysts
Tsindikani chikumba mu tiziwambo tinthu ta kapamba tokhala ndi zotulutsa za purulent,
Jaundice wowopsa chifukwa cha kuchuluka kwa bilirubin m'magazi,
Parenchymal kapamba,
Matenda a shuga. Matendawa amatengedwa kuti ndi zotsatira komanso chizindikiro cha bp,
Matenda a kapamba ndi kuwonjezeka kwa kuchuluka kwa zotumphukira mu kapamba. Matenda a ubongo amatha kugwira gawo la chiwalo kapena chiwalo chonse.

Kupewa

Kupewa kwamatenda a kapamba kumatha ngati matenda am'mimba, chiwindi, matenda ammimba komanso chikhodzodzo amathandizidwa munthawi yake.

Chofunika ndikukana mowa, kusuta fodya, kugwiritsa ntchito zakudya zoyipa komanso zolemetsa. Zochita zolimbitsa thupi, masewera olimbitsa thupi komanso masewera.

Kuyesedwa pafupipafupi ndi dokotala, makamaka ngati pali zovuta ndi matenda am'mimba, amakupatsani mwayi wofufuza matendawa kumayambiriro ndikukonzekera njira zamankhwala zomwe zimathandizira kubwezeretsa magwiridwe antchito munthawi yochepa.

Malangizo ndi kuneneratu

Mukakonza zovuta zamankhwala a BP, ndikofunikira kubwezeretsa magwiridwe antchito a ndulu ndi kapamba, komanso kuthetseratu kwa matenda am'mimba.

Ngati vutoli likukulirakulira chifukwa cha kuperewera kwa chiwindi, tikulimbikitsidwa kumwa mankhwala omwe kuchitapo chake kukukonzanso maselo a chiwindi. Muzochitika zapamwamba, chithandizo chitha kukhala chopanda phindu, kawirikawiri, koma kupatsirana kwa chiwindi kumachitika.

Matenda a biliary pancreatitis nthawi zambiri amathandizidwa pansi pano. Ngati vuto la bile duct likukula, kulowererapo kwa opaleshoni kumagwiritsidwa ntchito.

Odwala omwe ali ndi BP amalangizidwa kuti azigwiritsa ntchito mchere wam'madzi kutentha kwa chipinda popanda mpweya, chithandizo cha sanatorium ndichothandiza ndikuphatikizidwa kwa mankhwalawa kuti abwezeretse magwiridwe antchito a kapamba.

Psychotherapy tikulimbikitsidwa, monga odwala pancreatitis amakumana ndi phobias osiyanasiyana. Zikatero, antidepressants ndi anti-nkhawa mankhwala amalembedwa (munthawi yayitali). Ngati matenda a shuga amayamba chifukwa cha matendawo, mankhwalawa amagwiritsa ntchito shuga.

Ngati mutsatira zakudya, imwani mankhwala omwe adokotala adakuwuzani ndikuyamba kulandira chithandizo munthawi yake, ndiye kuti matendawo ndi abwino. Zambiri zimatengera matenda omwe amakhala nawo, mwachitsanzo, ndi matenda enaake, matendawa amatha kukhala osavomerezeka.

Mitengo yamankhwala

Chithandizo cha biliary pancreatitis ndi chochitika chovuta. Pofuna kudziwa kuti muli ndi matenda, kufunsira mafunso ambiri ndi maphunziro zimaperekedwa ndi akatswiri osiyanasiyana.

Kafukufuku wowonjezera akuphatikiza MRI ndi CT ya chiwindi ndi chithokomiro chothandizira - mtengo wapakati wa njirazi ndi pafupifupi ruble 8000. Kukambirana ndi endocrinologist ndi gastroenterologist kuli pafupifupi ma ruble 3000 (mosiyana), kuyesa kwa labotale palimodzi kumawononga pafupifupi 2500 rubles. Mwambiri, chithandizo mosaganizira mtengo wa mankhwalawa, popeza amasankhidwa payekhapayekha kwa wodwala aliyense, atenga pafupifupi ma ruble 15,000.

Mtundu wa biliary wa pancreatitis ndi matenda oopsa, komabe, kusintha kwa zakudya ndi chithandizo choyenera kungathandize kuchiritsa kwathunthu ndikubwerera ku moyo wokangalika.

Okondedwa owerenga, malingaliro anu ndiofunika kwambiri kwa ife - chifukwa chake, tidzakhala okondwa kuwunika pancreatitis ya biliary m'mawu, ingakhale othandiza kwa ogwiritsa ntchito ena a tsambali.

Alice

Biliary pancreatitis mwa ine idabuka chifukwa chakuwopseza kwa helminthic. Zizindikiro za kuledzera, nkhawa, m'mimba kupweteka, mseru komanso kusanza pang'onopang'ono, mtundu wa ndowe unasintha. Pambuyo pa mayeso a labotale ndi ultrasound, chithandizo choyenera chidalembedwa. Maphunzirowa anali othandiza, mpaka anayamba kunenepa.

Oleg

Anali ndi cholecystitis. Nthawi zina kuchuluka kwa matendawa kumatha miyezi ingapo. Kale ndimakonda kuziziritsa, koma atamuunika, adotolo adati ndidadwala matenda apachifuwa. Vutoli ndi lalikulu, limakhudza kapamba ndi chiwindi. Ndinayenera kulandira chithandizo chazitali kwambiri. Zotsatira zake zimakhala zabwino, komabe, kuyang'aniridwa kosamalira kuchipatala ndikofunikira.

Malangizo apadera komanso kupewa zovuta

Monga matenda ambiri osachiritsika, wodwalayo amaletsedwa kumwa mowa, makamaka wamphamvu (vodika, cognac, zakumwa, ndi zina zambiri). Sizoletsedwa kudya zakudya zokazinga, mafuta a nyama, margarine, etc. Zakudya zapadera zimatha kulembedwa (tebulo No. 5), yomwe imaphatikizapo mapuloteni osakanikirana, michere yambiri ndi mavitamini.

Chifukwa cha kufalikira kwa matendawa komanso atamuchita opaleshoni, dokotalayo atha kukuwuzani kuti mufunika kufa ndi njala kwa masiku angapo.

Zakololedwa zapa pancreatitis

Mulimonsemo, ndikofunikira kutsatira malingaliro a katswiri, osati kupereka mankhwala nokha.

Zambiri

Biliary pancreatitis ndimatenda a pancreatic omwe amaphatikizana kwambiri ndi kutupa ndi matenda ena a hepatobiliary system. Padziko lonse lapansi, kuchuluka kwa kapamba pazaka makumi zapitazi kwachulukanso, pomwe ku Russia chizindikiro ichi chikuwonekera katatu, ndipo mwa ana - anayi. Chimodzi mwazinthu zodziwika bwino za kupezeka kwa kapamba ndi cholelithiasis (nthenda ya ndulu) - kapamba wambiri wapezeka mu 25-90% ya milandu.

Kuchulukitsa kwa matendawa nthawi zambiri kumalumikizidwa ndi kusuntha kwamiyala panjira yothandiza. Panthawi imeneyi, wodwala akulimbikitsidwa kulandira opaleshoni. Ngati wodwala akukana kuchitidwa, akuyenera kuchenjezedwa kuti ndi colic mobwerezabwereza kuchuluka kwake kungakhale kokwanira. Munthawi yake matenda a bile duct kumabweretsa kuchepa pafupipafupi biliary pancreatitis.

Zoposa zaka makumi atatu zapitazo, akatswiri otsogola ku gastroenterology adawonetsa kuti matenda am'mimba amachititsa kupweteka kwa chifuwa chachikulu cha 60% cha odwala. Biliary pancreatitis imatha kupezeka m'matenda otsatirawa: cholelithiasis, zonyansa pakapangidwe ka ndulu ndi kapamba, dyskinesia wa gallbladder, biliary dyskinesia, cholecystitis, cirrhosis, matenda am'mimba. Kuchulukirachulukira kwa matenda kapamba kumatha kupweteketsa mtima pogwiritsa ntchito mankhwala kapena mankhwala okhala ndi choleretic, kuwonda kwambiri.

Pali njira zingapo zoyambira biliary pancreatitis. Choyamba chimadziwika kudzera kufalikira kwa kachilombo ka GVP kupita ku kapamba komwe kunjira. Lachiwirili limapezeka pamene pali miyala mu dambo wamba la bulu, zomwe zimabweretsa kukula kwa matenda oopsa m'mizere ya kapamba, kenako ndi edema ya kapamba.

Njira yachitatu ndiyo kuponyera kwa ndulu mu ma pancreatic ducts ndi matenda a Vater papilla (malo akutsegulira kutsekeka kwachilendo kwa chiwindi ndi kapamba mu duodenum). Zotsatira zake, kuwonongeka kwa ma duckewo ndi minofu ya pancreatic kumachitika, ndipo kumayamba kutupa. Otsirizawo adzakulitsidwa ndi matenda otupa a chiwindi, chifukwa ndi iwo mu ndulu yomwe imaponyedwa mu kapamba pali mitundu yayikulu ya ma radicals aulere ndi mankhwala a peroxide, omwe amawononga kwambiri kapamba.

Kafukufuku wazaka zamakono gastroenterology watsegula njira ina yotupa mu bancary pancreatitis - mapangidwe a biliary sludge. Ndi cholecystitis ndi vuto lotsatira la ndulu, mphamvu ya bile ya kusokonekera imasokonezeka, zina mwazomwe zimapanga zimapangidwa ndi ma microstones - uku ndi kuperewera kwa biliary. Mukasuntha limodzi ndi GWP, matope awa amavulaza mucous nembanemba, ndikupangitsa kufinya kwa ma ducts ndi Vater papilla. Stenosis yotsirizira imayambitsa kuphwanya chobisalira cha bile mu duodenum 12 ndikuponyera kwa ducts ya pancreatic, komanso kusunthika kwa chobisalira m'mizere ya kapamba.

Chifukwa cha kusayenda bwino, michere ya pancreatic yomwe ili mchinsinsi imachitika osati matumbo, koma m'mitsempha. Chotchinga chotchinga chikuwonongeka, ndipo matendawa amalowa mosavuta mu minyewa ya ndulu. Miyala yayikulu ya ndulu imatha kubowola wamba wa duct kapena sphincter ya Oddi, zomwe zimapangitsanso bile relux mu ducts ya pancreatic.

Chithandizo cha Biliary Pancreatitis

Mankhwalawa samaphatikizapo gastroenterologist yekha, komanso endoscopist, dokotala wa opaleshoni. Chofunikira kwambiri pakuletsa kupitirira kwa matendawa ndikuletsa kuchulukana ndikuchiritsa matenda oyambitsidwa. Ngati ndi kotheka, miyala imachotsedwa kapena momwe vuto la chikondwerero cha Vater limapangidwira (makamaka ndi njira ya endoscopic).

Ndi kuchulukitsa kwa matendawa, chithandizo chikuyenera kuphatikizira kuchotsa ululu (analgesics ndi antispasmodics), kukonza kwa ntchito zamkati ndi zamkati za kapamba, kupatsirana, kupewa matenda opatsirana. Nthawi zambiri, m'masiku atatu oyambilira, kuchulukitsa kwa mankhwala kumalimbikitsidwa, muyenera kumwa madzi osowa a carbonated alkaline. Pambuyo pa kuyambiranso kwa zakudya, muyenera kuchepetsa kuchuluka kwa mafuta m'zakudya, mosamala kudya chakudya chamagulu. Chakudya chimayenera kumadyedwa pafupipafupi, mothandizidwa ndi kusungidwa kwa makina ndi matenthedwe.

Kuti muchepetse zowonongeka zomwe zimayambitsa ma enzymes a pancreatic, somatostatin, proton pump inhibitors, ndi proteinase inhibitors ndi omwe amapatsidwa. Ma microspherical enzymes amathandizira kubwezeretsa pancreatic enzymatic dysfunction, ndipo othandizira a hypoglycemic adalembedwa kuti achulukitse shuga. Chithandizo cha opaleshoni chimachitika pokhapokha pakuyang'ana calculi ndi matenda a sphincter a Oddi.

Zotsogola ndi kupewa

Kukula kwa biliary pancreatitis ndi munthawi ya chithandizo cha kuwerengera cholecystitis ndi cholangitis ndi yabwino. Kukana kuchitidwa opaleshoni yake kwakanthawi kungayambitse kuwonongeka kwa njirayo, ndikuwonjezereka kungafunike kuchitidwa opaleshoni. Pankhani ya kusatsatira malangizo a kadyedwe, kukana chithandizo, kumwa mowa, zotsatira zake sizabwino.

Kupewa kwa matenda amtunduwu kapamba ndiko kudziwitsa ndi kuchiza matenda a hepatobiliary system, ngati pangafunike, opaleshoni yochotsa calculi. Pamaso pa zizindikiro za biliary pancreatitis popewa kutulutsa, muyenera kutsatira zakudya, kupewa kugwiritsa ntchito mankhwala ndi mankhwala a choleretic. Ndikofunikira kuti nthawi zonse muzimayesedwa ndi gastroenterologist (chaka chilichonse).