Autoimmune pancreatitis: njira yodziwira matenda, mankhwalawa komanso matendawa

Autoimmune Pancreatitis - mtundu wa kapamba, mu pathogenesis yomwe machitidwe a autoimmune amakhudzidwa. Mu mtundu uwu wa kapamba, hypergammaglobulinemia imawonedwa, milingo yokwezeka ya IgG, IgG4 mu seramu yamagazi, autoantibodies ilipo, yankho losiyana ndi chithandizo cha corticosteroids likujambulidwa.

Mitundu iwiri ya autoimmune pancreatitis imasiyanitsidwa:

1. Mtundu 1 - lymphoplasmacytic sclerosing pancreatitis
2. Mtundu 2 - idiopathic duct-concentric pancreatitis ndi zotupa za epanulocytic epithelial.

Zoyambira zakuzindikira autoimmune pancreatitis zimawonekera mu International Consensus pakuwona za autoimmune pancreatitis, yomwe idalandiridwa ku Japan mu 2010. Choyimira chachikulu cha serological (S1) pakuzindikira matenda a AIP chinasankhidwa kuti chilingalire kuchuluka kwa ma seramu IgG4 azikhalidwe zopitilira 2, komanso kuwonjezeka kwa chizindikirocho, koma osapitilira 2 machitidwe, monga chosasangalatsa.

Njira yodziwitsa matenda

Odwala omwe ali ndi autoimmune pancreatitis mu kuphatikiza kosiyanasiyana komanso pafupipafupi (30-95%), zizindikiro zotsatirazi ndi syndromes zimawonedwa:
• ululu wabwino ululu,
• kupitilizabe maphunziro osaneneka koma osachita kufotokozera,
• Zizindikiro za zovuta za jaundice,

• kuchuluka kuchuluka kwa gammaglobulins, IgG kapena IgG4 mu plasma,
• kukhalapo kwa autoantibodies,
• pukutsani kukula kwa kapamba,
• kusasinthika (kosakhazikika) kwa GLP,

• stenosis ya gawo lograpancreatic la wamba bile duct, nthawi zambiri - kulowetsedwa kwina kwa magawo ena amisempha yodutsa (sclerosing cholangitis), yofanana ndi kusintha mu PSC,
• Kusintha kwa fibrotic mu pancreatic parenchyma yokhala ndi kuperewera kwa mitsempha ya m'mimba ndi ma IgG4-plasmocytes,
• thrombophlebitis obliterans,

• kuphatikiza pafupipafupi ndi njira zina zofunikira: PSC, cirrhosis ya pulayimale, zilonda zam'mimba, matenda a Crohn, matenda a Sjogren's, retoperitoneal fibrosis, kuwonongeka kwa ma interstitium ndi zida zamatumbo a impso,
• mphamvu ya glucocorticoids.

Chifukwa cha kuchuluka kwambiri kwa zolemba za autoimmune CP, zina sizotchulidwa mwachindunji, mu 2002, kwa nthawi yoyamba, Japan Pancreatic Society inapanga njira zodziwitsira za autoimmune CP kuti athandizire kupeza bwino wazomwe akuwunika.

- Zambiri kuchokera ku kafukufuku wothandiza: kupendekera kwa GLP ndi makoma osakhazikika ndikuwonjezera kukulitsa kwa kapamba.
• Zambiri zam'manja: kuchuluka kwa ma seramu a gammaglobulins ndi / kapena IgG kapena kukhalapo kwa autoantibodies m'madzi a m'magazi.
• Zoyeserera zakale: Kusintha kwa mafrotic mu parenchyma ndi ma pancreatic ducts omwe ali ndi kulowa kwa mitsempha ya m'mimba.

Malinga ndi lingaliro la Japan Society of Pancreatologists, kuwunika kwa autoimmune pancreatitis kumatha kukhazikitsidwa pokhapokha njira yoyamba ikaphatikizidwa ndi yachiwiri ndi / kapena yachitatu.

Mu 2006, K. Kim et al. akuti, chifukwa cha kuchuluka kwazovuta za matendawa osagwiritsidwa ntchito masiku ano pogwiritsa ntchito njira ya Japan Society of Pancreatologists, kusinthika komanso kosavuta kwa asing'anga kuti azindikire za autoimmune pancreatitis, pang'ono pang'ono potsatira njira zomwe zaperekedwa kale.

• Craption 1 (yayikulu) - zambiri kuchokera ku maphunziro othandiza:
- phatikizani kuchuluka kwa kapamba malinga ndi CT,
- kusokoneza kapena kusakhazikika kosagwirizana ndi GLP.

- Craption 2 - Zoyeserera zasayansi (chimodzi mwa zosintha ziwirizi):
- kuchuluka kwakukulidwa kwa IgG ndi / kapena IgG4,
- kukhalapo kwa autoantibodies.

- Chenjerani 3 - Zoyang'anira mbiri yakale: - fibrosis,
- kulowa kwa lymphoplasmacytic.

• Chidule 4 - kuyanjana ndi matenda ena a autoimmune. Kuzindikira kwa autoimmune pancreatitis kukhoza kukhazikitsidwa ndi njira zotsatirazi: 1 + 2 + 3 + 4, 1 + 2 + 3, 1 + 2, 1 + 3.

Matendawa atha kudziwa ngati pali kuphatikiza kwa njira 1 1, 4, pokhapokha ngati mayankho olondola a glucocorticoid amathandizira, kuzindikira kwake kumadziwika. Dziwani kuti matendawa ndi otheka pokhapokha ngati umboni 1 ulipo.

Chithandizo ndi matenda am'mimba

Odwala omwe ali ndi zizindikiro za autoimmune CP, chithandizo chofanana ndi cha OP (njala, PPI, antibacterial mankhwala nthawi zambiri sichofunikira. Ngati zizindikiro za zovuta za jaundice zikulephera, kukoka kwa ma transhepatic kapena endoscopic draogrgege kumasonyezedwa, makamaka pakakhala kachilombo ka bacteria.

Ndi histological (cytologically) yotsimikizika ya diagnostic autoimmune CP, pakakhala kuti pakufunika kuyesedwa monotherapy ndi glucocorticoids, tikulimbikitsidwa kukulitsa chithandizo chokwanira ndi kuphatikizidwa kwa regimen (kuwonjezera pa prednisone) ya gastric secretion blockers (makamaka IDN) ndi kukonzekera kwa polyenzyme komwe kumakhala ndi cholinga cholowa (kupweteka pamimba )

Pazifukwa zodziwika bwino, monga momwe zikuwonekera, antispasmodics ndi mankhwala osokoneza bongo omwe amagwiritsa ntchito mankhwala osokoneza bongo amagwiritsidwa ntchito.
Mankhwala a Steroid nthawi zambiri amakhala othandiza pakuwonongeka kwa bile ducts, tiziwindi tinyerere tambiri, komanso kuwonongeka kwa ma pancreatic ducts. Mwa odwala ena, matendawa amakula mosagwiritsa ntchito mankhwala. Nthawi zina, nthawi ya autoimmune CP ikakhala yovuta ndi mtundu 2 wa shuga, chithandizo ndi glucocorticoids chitha kusintha mkhalidwe wa wodwalayo.

Ndikupangira kuti ndi autoimmune CP, azathioprine ikhoza kukhala yogwira mtima. Zotsatira zamankhwala zimapezeka chifukwa chogwiritsa ntchito ursodeoxycholic acid (ursofalk) kukonzekera kwa autoimmune CP, yomwe imachitika ndi matenda osokoneza bongo a shuga ndi cholestasis motsutsana ndi maziko a stenosis a gawo lachiberekero la bile duct: kuchuluka kwa cholestasis amachepetsa, kukula kwa kapamba kumachepa komanso kukula kwa matenda a shuga.

Ursofalk mankhwala a autoimmune CP akhoza kukhala njira ina glucocorticoids. Monga mukudziwa, ursofalk imagwiritsidwa ntchito moyenera pa ciliir cirrhosis yoyambira ndi PSC. Mankhwala amathandizira kukulitsa kutuluka kwa bile, ali ndi hepatoprotective ndi immunomodulating, chifukwa chake, angagwiritsidwe ntchito mu autoimmune CP, makamaka pokhudzana ndi dongosolo la biliary. Algorithm yotsatirayi yotsimikiza yothandizira ndiyotheka (mkuyu. 4-46).

Ndi chithandizo cha nthawi yayitali ndi prednisone, kuyang'anira matendawa ndikofunikira:
• Kuyesa kwa zisonyezo
• kuzindikira matenda a exo- ndi endocrine pancreatic ntchito,
• kuwunikira momwe zikuwonekera pakuwunika magazi ndi kukokomeza magazi,
• Kuwongolera zolemba za autoimmunity,
• kuwongolera ultrasound, ESM yokhala ndi biopsy ya kapamba, CT kapena MRI.

Kukula kwa autoimmune CP kumadalira kukula kwamavuto, zotengera matenda a autoimmune ndi matenda a shuga.

Kodi nthenda ya autoimmune kapamba

Kuwonongeka kwa autoimmune kwa kapamba, kapena monga momwe amachitchulira, autoimmune pancreatitis, yomwe imadziwika ndi kuwonjezeka kwa chitetezo cha mthupi mpaka kumayamba kugwira ntchito motsutsana ndi thupi lake lomwe. Pankhaniyi, kugonjetsedwa kumakhudza zonse kapamba palokha komanso tiziwalo tating'onoting'ono tokhala m'matumbo, zotupa za m'mimba, dongosolo lamapapu, ziwongo, matumbo, matumbo ndi ziwalo zina.

Mtundu wa autoimmune wa kapamba amatanthauza mitundu yosiyanasiyana yamtunduwu womwe umakhala kwa theka la chaka kapena kupitirira. Nthawi zambiri, imakula makamaka mwa abambo, ngakhale azimayi amathanso kukhudzidwa ndi matendawa.

Zomwe zimachitika

Zomwe zimapangitsa kuti pakhale autoimmune pancreatitis sizinakhazikitsidwe, zimangodziwika kuti pakachitika vuto linalake m'thupi, chitetezo chamthupi chimayamba kugwira ntchito mosagwirizana, ndikuwukira ziwalo za thupi lake.

Kukula kwa mawonekedwe a autoimmune matenda a kapamba nthawi zambiri kumalumikizidwa ndi chitukuko cha nyamakazi, matenda a Sjogren, komanso matenda a kutupa kwa matumbo.

Mitundu ya matenda

Gawo lopita patsogolo la matenda a autoimmune pancreatic pa diagnostic histology agawidwa kukhala:

1. Kukula kwa sclerosing lymphoplasmacytic pancreatitis, yomwe imadziwonekera nthawi zambiri mwa okalamba. Amadziwika ndi mapangidwe a khungu la khungu ndi mawonekedwe a mucous a thupi, komanso kuwonongeka kwa kapamba. Amachita bwino ndi mankhwala a steroid.
2. Kukula kwa idiopathic pancreatitis ya mtundu wophatikizika ndi kuwonongeka kwa granulocytic epithelium. Zimachitika nthawi zambiri mwa anthu amsinkhu wocheperako, ngakhale atakhala kuti ndi amuna kapena akazi.

Mitundu iwiri iyi imangosiyana pakuwunika ma microscopic okha.

Mwa kukhalapo kwa concomitant pathological autoimmune matenda omwe amayamba pamene ziwalo zina zimakhudzidwa, matenda a pancreatic pancreatic agawidwa kukhala:

• kukulitsa mawonekedwe apadera a autoimmune pancreatic lesion a gland, momwe zotupa zimakhudzira chiseyeye chokha,
• komanso chitukuko cha autoimmune pancreatitis syndrome, momwe ziwalo zina zimakhudzidwira kuphatikiza kapamba.

Zotsatira zamkati mwa ziwalo za autoimmune:

• mawonekedwe a sclerotic zimakhala zam'mapapo dongosolo la ziwalo ndi chiwindi,
• kuphwanya regular reabsorption mu impso, zomwe zimatsogolera kukukula kwa kusakwanira,
• kutupa kwa chithokomiro, komwe kumatchedwa chithokomiro,
• kutukusira kwa tiziwalo totumata, timatchedwa sialadenitis.

Pamalo a zotupa, matenda omwe akufunsidwa atha kukhala ndi:

• phatikizani mawonekedwe, omwe amadziwika ndi kuwonongeka pafupifupi konsekonse kwa kapamba,
• mawonekedwe ofunika, omwe nthawi zambiri, chidwi chimakhala mdera la mutu wa gland.

Zizindikiro ndi matendawa

Matenda a autoimmune pancreatitis ndi osangalatsa chifukwa samadziwonetsera ndi zizindikiro zotchulidwa komanso kuwonongeka koonekeratu pabwino la wodwalayo, ngakhale munthawi zowonjezera za matenda. Nthawi zina, matendawa amatha kupezeka popanda zizindikiro zilizonse, ndipo matendawa amapangidwa kale pamlingo wa kukulitsa zovuta.

Zizindikiro zowoneka za matendawa zikufotokozedwa motere:

1. Mawonekedwe osasangalatsa pamimba pamimba ndikupanga mawonekedwe opweteka a herpes zoster ndi mawonekedwe ofooka kapena owonjezera.
2. Kapangidwe ka khungu losazungulira pakhungu ndi mucous nembanemba mkamwa, komanso ngakhale sclera ya maso.
3. Mtundu wa ndowe umakhala wopepuka ndipo mkodzo umakhala wakuda kwambiri.
4. Kukula kwa kuyabwa pakhungu
5. Anachepetsa chilako.
6. Kuphulika ndi mawonekedwe a mseru, zomwe nthawi zambiri zimayambitsa kusanza kwambiri.
7. M'mawa m'mawa, odwala nthawi zambiri amamva pakamwa pouma komanso kumva kuwawa.
8. Kutopa kwambiri komanso kuchepa msanga kwa thupi limodzi ndi kuphwanya kwa maganizo a wodwalayo.
9. Maonekedwe a kupuma movutikira, kupweteka m'misempha yaumisempha poyang'ana kumbuyo kwa kutupa kwawo. Wodwalayo amamva ululu akamalankhula, kumeza chakudya ndi kumwa zamadzi.

Kuzindikira matendawa

Kuzindikira koyenera ndi kolondola kumatha kupangidwa kokha pokhapokha ngati mayeso anu awona bwino, kupatsira mayeso ndikudutsa njira zowonjezera zowunikira.

Kuti mupeze chithunzithunzi chonse cha momwe matendawa akukhalira, njira zotsatirazi zikulimbikitsidwa:

• Kutsimikiza kwa ndende ya IgG4 immunoglobulin mu seramu yamagazi, ndi matenda, amatha kuchuluka maulendo 10,
• mayeso azachipatala ambiri amaikidwa: magazi a biochemistry, kusanthula kwamkodzo ndi ndowe,
• kupenda ndale,
• chizindikiritso cha zotupa,
• kudziwa kuchuluka kwa zowonongeka ndi momwe gawo la parenchymal lakhalira, gawo la compact tomography ndi ultrasound ndiloyikidwa,
• komanso osachita popanda biopsy ndi histology.

Atalandira chithunzi chonse chachipatala, dokotalayo amafufuza moyenera, adziwe momwe matendawa agwiritsidwire ntchito, ndikupanga njira yodalirika komanso yotetezeka.

Ndikofunika kudziwa kuti mwana wocheperako atha kudwala matenda ofanana, ngakhale izi ndizosowa kwambiri. Komabe, pakapangidwa khanda, limawonetsedwa ndi khungu lowala kwambiri, lomwe silingayang'anitsidwe ndi madokotala.

Kuzindikira kwa Ultrasound

Ma diagnostics a Ultrasound amatha kuyeza molondola magawo akunja a gawo lomwe lakhudzidwalo, kuwunika mawonekedwe ndi kuchuluka kwa kupitirira kwa matenda am'mitsempha ya kapamba, chiwindi ndi ndulu.

Kugwiritsa ntchito njira yofufuzira iyi, zomwe zimayambitsa kuphwanya kutuluka kwa bile, komanso kukhalapo kwa zotupa ngati ma neoplasms ndi miyala m'matumbo a gland zimawululidwa.

Kudziwitsa za IgG4 immunoglobulin

Mukamachita kafukufuku wokhudzana ndi kuyesedwa kwa magazi, chisamaliro chapadera chimalipiridwa ku ndende ya IgG4 immunoglobulin. Mwa munthu wathanzi, kuphatikiza kwake sikufikira 5% ya kuchuluka konse kwa seramu. Ndi kuwonjezeka kowopsa mu ndende yake, titha kulankhula bwinobwino za chitukuko cha matenda m'thupi la munthu, limodzi ndi njira yolowera ziwalo zomwe zimatulutsa immunoglobulin iyi.

Mwanjira ina, pali gawo lokhazikika la njira yotupa m'magulu a minofu ndikupanga fibrosis ndi mikwingwirima.

Odwala omwe amapanga autoimmune pancreatitis m'malo opitilira 88%, pamakhala kuchuluka kwa immunoglobulin mu 5 kapenanso 10 nthawi zopitilira muyeso.

Kuchiza matenda

Ndizosatheka kuchira kwathunthu pochiza matenda a autoimmune pancreatitis. Ichi ndichifukwa chake njira zazikulu zamankhwala zimayang'aniridwa kuchotsedwa kwa zizindikiro zowonetsera komanso kulepheretsa kwa pang'onopang'ono panjira.

Choyamba, malingaliro a akatswiri monga Igor Veniaminovich Maev (Honored Gastroenterologist ndi Doctor of Science) ndi Yuri Alexandrovich Kucheryavy (PhD), amatsatira kwambiri zakudya zamagulu kuti adziwitse kupewetsa kupweteka komanso kukulitsa mpumulo wa kupanikizika kwapancreatic.

Komanso, mankhwala a immunosuppress amadziwika, kuphatikiza pa cytostatics ndi glucocorticoids. Kuti muchepetse zowawa zomwe zimadziwoneka munthawi yakuchulukirachulukira kwa matendawa, mankhwala a spasmolytic ndi mankhwala.

Ndi zovuta zotuluka za bile komanso kukula kwa kufalikira kwa pakhungu ndi mucous nembanemba, mankhwalawa amagwiritsidwa ntchito, omwe amaphatikizapo ursodeoxycholic acid.

Ndi chitukuko cha stenosis mu patsekeke pancreatic ducts, mankhwala opaleshoni ndi mankhwala.

Zakudya zamagulu

Ndikulimbikitsidwa kugwiritsa ntchito zinthu monga mkaka, zakudya zam'mera, komanso mitundu yazakudya za nyama yoyera ngati zakudya zofunikira.

Kupatula kuyenera kukhala:

• Zakudya zonse zokhala ndi mafuta ambiri, zonunkhira, nyama ndi mchere.
• ophika buledi ndi zoperekera zida,
• mowa ndi zakumwa zoziziritsa kukhosi,
• Chocolate ndi khofi
• tiyi wamphamvu
• zonunkhira zosiyanasiyana ndi zokometsera,
• kabichi yoyera, radish, radish, adyo ndi anyezi.

Muyeneranso kusiya kusuta.

Mavuto ndi Zotheka

Kusachira bwino kwa matendawa kumadziwika ndi zovuta zotsatirazi:

• kukulitsa kwa hypovitaminosis ndi kuchepa kwa mapuloteni,
• Kuchepetsa thupi kwambiri, zomwe zimapangitsa kuti thupi lizitopa kwambiri,
• chitukuko cha madzi m'thupi
• kuphwanya kagayidwe kamchere wamadzi,
• kupitilira kwa subhepatic jaundice,
• matenda a thupi, mawonekedwe a sepsis, peritonitis, purcin cholangitis, kutupa kulowa,
• zilonda zam'mimba komanso zowonongeka zam'mimba
• kutsekeka kwa duodenum 12,
• chitukuko cha pancreatogenic ascites,
• chiopsezo chachikulu cha khansa.

Zotsatira zakuchuluka mwadzidzidzi chifukwa cha chotupa cha autoimmune chotupa chachikulu chotupa chitha kukhala chochuluka. Koma, ndikofunikira kudziwa kuti, malinga ndi kuwunika kambiri, chithandizo chokwanira komanso chapanthawi yake chithandizira kuti chiwongola dzanja chikhale chathanzi, komanso kukonza bwino wodwalayo.

1. Bezrukov V.G. Autoimmune zimachitika matenda kapamba. Matenda a kapamba: etiology, pathogenesis, zochitika zamankhwala, diagnostics a immunological, chithandizo. Omsk, 1995 mas. 34–35.
2. Yarema, I.V. Autoimmune pancreatitis of the Ministry of Health of the Russian Federation, maphunziro opitilira azachipatala ndi zamankhwala. M. GOU VUNMTS Ministry of Health of the Russian Federation, 2003
3. Bozhenkov, Yu. G. Pancreatology Yothandiza. Maupangiri a madokotala M. Honey. buku N. Novgorod Publishing nyumba ya Novosibirsk State Medical Academy, 2003
4. Bueverov A.O. Zoyimira pakati zotupa ndi zowonongeka kwa kapamba. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 1999, Na. 4, masamba 15-18.
5. Velbri S.K. Matenda a immunological a matenda a kapamba. M: Mankhwala, 1985
6. Midlenko V.I. Matenda a patinical ndi pathogenetic a kusintha kwa chitetezo chamthupi kwa odwala omwe ali ndi pancreatitis pachimake. Chotsitsa cha dissertation. Barnaul, 1984

Zizindikiro zazikulu za matenda

The pachimake gawo la matendawa kulibe. Nthawi zina zizindikiro sizimachitika nkomwe. Zikatero, matendawa amapangidwa molingana ndi zovuta zowonekera. Zizindikiro zazikulu za matendawa:

1. Kupweteka ndi kusapeza bwino pamimba, nthawi zina m'munsi kumbuyo. Izi zimatha kukhala kwa mphindi zingapo, ndipo nthawi zina maola. Ululu muzochitika zotere ndi wofatsa kapena wapakati. Izi zimachitika nthawi zambiri mukamadya zakudya zamafuta, zokometsera kapena zokazinga.
2. Kupaka khungu la wodwalayo (jaundice), kumanzere kwamkamwa, malovu, ndi zina. Nthawi zina bile ikalowa mkatikati mwa duodenum kapena pamene ngalande zapachiberekero ndi chimbudzi cha ndulu chimatuluka.
3. Zidutswa zokhala ndi kapamba wamtunduwu ndizopepuka kuposa masiku onse, ndipo mkodzo umakhala wakuda kwambiri.
4. Odwala ambiri, kuyabwa kumayamba.
5. Kulakalaka kumachepa.
6. Matumbo amatupa, wodwala akudwala, kusanza ndikotheka.
7. M'mawa, wodwalayo amakhala ndi pakamwa komanso zowawa, ndipo kuchokera pakatikati kamlomo limanunkhira kwambiri, mosasangalatsa.
8. Matenda a shuga amatha kupezeka.
9. Kuchepetsa thupi ndi kutopa msanga.
10. Zofooka zambiri, kugona tulo masana, kuchepa kwa ntchito.
11. Kupsinjika, kusasangalala bwino, kunawonjezera kukwiya.
12. Kupuma pang'ono chifukwa cha kuwonongeka kwa mapapo.
13. Mapuloteni mumkodzo akuwonetsa kuti ntchito yovuta ya impso.
14. Pali mitundu ingapo ya chiwindi yomwe imayamba popanda chotupa.
15. Kutupa kwa tiziwalo tating'ono, kupweteka m'derali. Pangakhale zovuta kumeza, kupuma, ndi kuyankhula.

Werengani za kusintha kwakumapeto kwa kapamba pano.

Mitundu yosiyanasiyana ya autoimmune pancreatitis

Pali mitundu iwiri yamatenda malinga ndi kusintha kwa ziwalo zomwe zimawonedwa ndi ma microscope:

• sclerosing lymphoplasmacytic kapamba,
• mtundu wa duct-concentric idiopathic.

Kusiyanitsa pakati pa mitundu iwiriyi kumawululidwa pokhapokha pa maphunziro a mbiri yakale. Ngati wodwalayo ali ndi mitundu ina ya matenda a autoimmune, ndiye kuti kapamba amawagawa:

• matenda achilendo,
• autoimmune syndrome.

Pomwe pali matendawa, mitundu yosiyanasiyana ndi yokhazikika imasiyanitsidwa.

Kuzindikira matendawa m'njira zosiyanasiyana ndi njira

Madokotala amafufuza wodwalayo m'maso ndikulemba nthawi (pafupifupi) mawonekedwe a matendawo. Kuthekera kwa wodwala wokhala ndi matenda osachiritsika, cholowa chake, zizolowezi zake, ndi zina zotero, zimaphunziridwa.

Kenako kuyezetsa kwakuthupi kumachitika: kutsimikiza kulemera kwa thupi, kuwona kuyeseza, kupenyerera pamimba, kugunda kwake. Kukula kwa chiwindi, kapamba, ndulu zimayezedwa.

Kenako maphunziro a labotale amayambira. Kuyesedwa kwa magazi ndi a biochemical kwatengedwa, kuchuluka kwa shuga m'thupi la wodwalayo kumatsimikiziridwa, hemoglobin ya glycated imayang'aniridwa, mbiri ya lipid imapangidwa (kukhalapo kwa mafuta m'magazi).

Wodwalayo amayesedwa pogwiritsa ntchito zilembo za chotupa, kuyezetsa mkodzo kumatengedwa, ndipo kuchuluka kwa immunoglobulin kumatsimikiziridwa. Kusanthula kumapangidwa ndi ndowe za munthu wodwala.

Kuyesa kwa Ultrasound pamimba kungakhale kofunikira kuti muyeze wodwalayo. Wodwala amatha kutumizidwa kuti akafotokozere za matendawa pofotokoza momwe mungagwiritsire ntchito njira inayake yozungulira. Mungafunike zomwe zimatchedwa kuti reapogade cholangiography - kuwunika wodwalayo pogwiritsa ntchito zida za x-ray ndi nkhani yapadera. Izi zimachitika kuti magwiridwe antchito akuchotsa bile mthupi la wodwalayo.

Kuphatikizika kwa kapamba, chiwindi, ndulu, ndi zina zambiri.

Ngati ndi kotheka, ndiye kuti madokotala omwe amapita kukafunsidwa ndi akatswiri othandizira odwala matenda am'mimba ndi endocrinologist.

Pambuyo pakupeza zidziwitso zonse, kuzindikira koyenera kumapangidwa ndipo njira zothetsera matendawa zimafotokozedwa.

Chithandizo cha Autoimmune Pancreatitis

Nthawi zina, matendawa amapita pawokha osagwiritsa ntchito mankhwala aliwonse. Koma milandu ngati imeneyi siisowa. Kwa odwala ambiri oyambira matenda, mankhwalawa amaperekedwa ndi chakudya No. 5. Zimaphatikizapo wodwala kudya chakudya 6 pa tsiku. Zakudya zothira, zonunkhira, mafuta, osuta, okhala ndi zakudya zamafuta ambiri siziyenera kuperekedwa kuchakudya. Kugwiritsa ntchito sodium chloride (sodium chloride) kumachepera 3 g mu maola 24. Kudya kuyenera kukhala mitundu yonse ya mavitamini, mchere wamchere ndi phosphates. Kuti muchite izi, mutha kugwiritsa ntchito nyama yophika, mafuta amkaka omwe ali ndi mafuta ochepa, nsomba, msuzi wamasamba ndi soups zochokera, etc. Njira izi zimathandizira kapamba wamatenda.

Ngati wodwala ali ndi matenda a shuga, ndiye kuti ndikofunikira kuti muchepetse kugwiritsa ntchito shuga, ndikuisintha ndi zotsekemera - zotsekemera. Munthu yemwe ali nawo muzochitika zotere ayenera kukhala ndi maswiti kapena shuga kuti abwezeretse, ngati kuli kotheka, cholowera shuga m'magazi a magazi.

Chithandizo cha Conservative chimaphatikizapo kugwiritsa ntchito glucocorticoids, immunosuppressants, antispasmodics. Kupititsa patsogolo ngalande zam'mimba, kungakhale kofunikira kuyambitsa michere ya pancreatic kwa wodwala, ndikukhazikitsa magwiridwe antchito a bile ducts, ursodeoxycholic acid imagwiritsidwa ntchito.

Ndikulimbikitsidwa kuti odwala omwe ali ndi autoimmune pancreatitis apereke proton pump inhibitors ndi insulin, onse omwe amakhala nthawi yayitali komanso samachita zinthu mwachidule.

Kuchitapo kanthu kwa opaleshoni kumagwiritsidwa ntchito kuti muchepetse kufupika kwa njira yomwe bile imachotseredwa.

Kuti muchite izi, kununkha kwa ma ducts kumachitika: mawonekedwe apadera amaikidwa mkati mwawo, omwe amakulitsa m'mimba mwake. Odwala ambiri amalola kuvala bwino.

Autoimmune Pancreatitis Mavuto

Ndi mwayi wachipatala wosayembekezereka, zingachitike ngati izi:

• kuyamwa kwa michere yambiri m'matumbo anu kumasokonekera,
• pali zomwe zimatchedwa kuperewera kwa protein,
• thupi lilibe mavitamini
• thupi la wodwalayo limatsika, zomwe zimatsogolera kukukula kwa kufooka,
• wodwala amakhala ndi ludzu losalekeza,
• kuchepa thupi kwa wodwala kumayamba,
• kutupa ndi kukokana kumawonekera
• jaundice imachulukirachulukira,
• pamakhala chiopsezo chotenga kachilombo ka m'matumba mwa kapamba,
• Nthawi zambiri amatupa kutupa mu bile ducts - purulent cholangitis,
• poyizoni wamagazi (sepsis) kapena peritonitis (njira yotupa pa peritoneum) ndiyotheka,
• kukokoloka kumawoneka m'magawo osiyanasiyana a m'matumbo,
• Zilonda ndi zolakwika zina zimapezeka m'matumbo am'mimba,
• kupanikizika kwamitsempha yama portal kumawonjezeka
• Pali cholepheretsa mu duodenum, yomwe imakhala ndi mawonekedwe osatha,
• magazi salowa mkatikati mwa m'mimba, pomwe madzi ake amayamba kudziunjikira,
• khansa ya kapamba ndiyotheka.

Zotsatira za matendawa

Ngati wodwalayo adayendera adotolo mwachangu, ndiye kuti nthawi zambiri amakhala ndi vuto lolondola komanso chithandizo choyenera, matendawa ali koyambirira, ndizotheka kubwezeretsanso kapangidwe kake ndi kapamba.

Ngati wodwala wayamba kulandira chithandizo pambuyo pake matendawa ndipo chithandizo chamanthawi yayitali chikufunika chifukwa cha kusintha kosasintha m'ziwalo zosiyanasiyana, ndiye kuti kubwezeretsa kwathunthu kwamachitidwe ndi ntchito ya chiwalo sikuchitika. Koma ngakhale zitakhala choncho, madokotala amatha kuletsa matendawa.

Kukula kwa matendawo kuyambika kwa matendawa kumatengera kwathunthu zovuta zomwe zimachitika ndi autoimmune pancreatitis ndi zovuta zomwe zimadwala zomwe wodwala anali nazo (mwachitsanzo, matenda a shuga).

Njira zodzitetezera za chifuwa chamtunduwu mulibe, chifukwa chomwe chimapangitsa matendawo sichidziwika.

Zizindikiro za Autoimmune Pancreatitis

Zomwe zimachitika mu autoimmune pancreatitis ndizovuta zakuthwa kwa zisonyezo zonse komanso kusowa kwa vuto lodana ndi matenda (episode ofooka kwambiri mu mkhalidwe wa wodwalayo). Nthawi zina, sipangakhale zizindikiro, ndipo matendawa amangokhazikitsidwa pokhapokha ngati pali zovuta.

• Matumbo a m'mimba ululu (chizindikiritso chopitilira): kupweteka kapena kusamva bwino pamimba, nthawi zambiri kumadera lumbar, kumachitika pafupifupi theka la odwala, ndipo amatha kukhala kwa mphindi kapena maola angapo. Kukula kwa ululu kumakhala pang'ono kapena pang'ono. Monga lamulo, ululu umapwetekedwa chifukwa cha zakudya zonunkhira, zamafuta ndi zokazinga.
• Jaundice - chikasu cha pakhungu, mucous nembanemba (mwachitsanzo, chamkamwa patsekeke) komanso zinthu zamadzimadzi (mwachitsanzo, malovu, madzi osungira, etc.). Amayamba chifukwa chophwanya kayendedwe ka bile mu duodenum (gawo loyambirira la m'matumbo ang'onoang'ono) ndikukhazikika kwa ma pancreatic ducts ndi bile ducts:
  • ndowe ndi zopepuka kuposa masiku onse
  • mkodzo wakuda kuposa masiku onse
  • madontho achikasu, malovu, madzi amadzimadzi, madzi am'madzi, ndi zina zotere,
  • Khungu.

• Mawonetseredwe a Dyspeptic (matenda am'mimba):
  • kuchepa kwamtima
  • kusanza ndi kusanza
  • ukufalikira
  • kuwawa ndi mkamwa youma,
  • mpweya wabwino.

• Kuphwanya kwa procrine ntchito ya kapamba (kugawa kwa michere yomwe imakhudzidwa ndi chimbudzi cha chakudya) nthawi zambiri ilibe mawonekedwe, imapezeka ndi kafukufuku wapadera wa labotale.
• Shuga mellitus (kuphwanya kagayidwe kazakudwala - shuga) kamakula mwachangu chifukwa chakuwonongeka kwa ntchito ya endocrine ya kapamba (kupanga mahomoni omwe amawongolera kagayidwe kazakudya). Chizindikiro cha matenda ashuga mu autoimmune pancreatitis ndi njira yake yabwino ndikuthekanso kusintha (kuchira) motsutsana ndi maziko a chithandizo choyenera.
• Kuchepetsa thupi.
• Asthenic syndrome:
  • kuchepa kwa magwiridwe
  • kutopa,
  • kufooka
  • kugona pakati masana
  • kuchepa kwamtima
  • kukhumudwa.

• Kugonjetsedwa kwa ziwalo zina.
  • Mapapu. Imadziwoneka ngati kupuma movutikira (kupumira mwachangu), kumverera kosowa kwa mpweya chifukwa cha kupangika kwa magawo a kapangidwe kazinthu zam'mapapu.
  • Impso. Amawonetsedwa ndi kulephera kwa impso (kuphwanya ntchito zonse za impso) ndi mawonekedwe a mapuloteni mumkodzo (izi siziyenera kukhala zabwinobwino).
  • Chiwindi (pseudotumor chiwindi) - kukula kwa kuphatikizika kwa minyewa ya chiwindi yopanda ma cell a chotupa. Imadziwika ndi palpation (palpation) kapena pogwiritsa ntchito njira zofufuzira. Itha kuphatikizidwa ndi zovuta zazitali mu hypochondrium yoyenera, yosagwirizanitsidwa ndi kudya.
  • Salivary gland (sclerosing sialadenitis) - kutukusira kwa tiziwalo timene timataya ndimalo ndikusintha minyewa yabwinobwino yotupa. Mawonekedwe:
    • kamwa yowuma
    • kupweteka m'misempha
    • kuvuta kumeza, kupuma, ndi kuyankhula chifukwa chamilomo yowuma.

Malinga ndi chithunzi cha mbiriyakale(Zosintha kapangidwe ka kapamba wovumbulutsidwa pansi pa microscope) mitundu iwiri ya autoimmune pancreatitis ndiosiyanitsidwa:

• Mtundu 1—lymphoplasmacytic sclerosing pancreatitis,
• Mtundu 2 - idiopathic duct-concentric pancreatitis ndi zotupa za epanulocytic epithelial.

Kusiyana pakati pa zosankha izi ndi mbiri chabe (ndiye kuti, kuwululidwa mwa kuwunika kwa mbiriyakale - kuphunzira ziwalo pansi pa maikulosikopu).

Kutengera ndi kukhalapo kwa matenda ena a autoimmune (kukulitsa pamene ziwalo zingapo zowonongeka chifukwa cha mphamvu ya chitetezo chokwanira - dongosolo lodzitchinjiriza m'thupi) pali mitundu iwiri ya autoimmune pancreatitis:

• okha autoimmune kapamba - amakula mwa wodwala yemwe alibe matenda ena a autoimmune,
• autoimmune pancreatitis syndrome - amakula mwa wodwala yemwe ali ndi matenda ena a autoimmune.

Kutengera kutengera kwawoko (malo) a chotupa kusiyanitsa:

• kusokoneza mawonekedwe (kuwonongeka kwa kapamba wonse)
• mawonekedwe oyang'ana (kuwonongeka kwa zigawo zina za kapamba, nthawi zambiri mutu wake, ukagwiritsidwa ntchito, umafanana ndi khansa (chotupa chowopsa) cha kapamba).

Dokotala wazachipatala amathandizira pochiza matendawa

Chithandizo cha Autoimmune Pancreatitis

Nthawi zina, kudzichiritsa kumachitika (ndiye kuti, popanda kugwiritsa ntchito mankhwala).

Zoyambira zochizira autoimmune pancreatitis.

• Zakudya zamankhwala.
  • Zakudya Zakudya Zisanu 5 - kudya 5-6 kawiri pa tsiku, kupatula zokometsera, mafuta, yokazinga, kusuta, kotsekemera (kulemera kwa fiber - zovuta kugaya gawo la mbewu) zakudya kuchokera kuzakudya, kutsitsa sodium chloride mpaka magalamu atatu patsiku. Zakudya ziyenera kukhala ndi mavitamini okwanira, calcium ndi phosphorous (mwachitsanzo, nsomba, nyama yophika, soups pa broths zamasamba, mkaka wa mafuta okwanira, ndi zina zambiri). Cholinga cha chakudya ichi ndikuchepetsa katundu pa kapamba.
  • Ndi chitukuko cha matenda osokoneza bongo a shuga (kuphwanya kagayidwe kazakudya kanyumba - shuga) monga chiwonetsero cha autoimmune pancreatitis, kumwa shuga kuyenera kukhala kochepa, mutha kusintha m'malo mwa zotsekemera.
  • Ndi chitukuko cha matenda ashuga, pamakhala chiopsezo cha hypoglycemia (kutsika lakuthwa m'magazi a glucose (mafuta osavuta), limodzi ndi kusokonezeka kwa chikumbumtima). Chifukwa chake, wodwalayo ayenera kukhala ndi zakudya zotsekemera (shuga kapena maswiti) naye kuti abwezeretse misempha yamagazi.

• Chithandizo cha Conservative (chosapanga opaleshoni).
  • Glucocorticoids (ma analogues opanga mahomoni a adrenal cortex) - kugwiritsa ntchito mankhwalawa ndiko maziko a chithandizo. Odwala ambiri amafunika glucocorticoids pakatha milungu ingapo. Odwala ena angafunike kugwiritsidwa ntchito kwa nthawi yayitali ya mankhwalawa.
  • Immunosuppressants - gulu la mankhwala omwe amachepetsa kwambiri chitetezo cha mthupi (chitetezo chamthupi), chomwe chimawononga ziwalo zake zomwe. Ma immunosuppressants amagwiritsidwa ntchito ngati glucocorticoids sagwira ntchito kapena sangathe kugwiritsidwa ntchito (mwachitsanzo, ndikupanga zovuta.
  • Mankhwala osokoneza bongo (antispasmodics) (mankhwalawa omwe amachepetsa minofu ya mkati ndi m'mitsempha yamagazi) amagwiritsidwa ntchito pochiza ululu womwe umachitika pamene milomo ya kapamba ikachepetsedwa.
  • Ma pancreatic michere amagwiritsidwa ntchito kukonza chimbudzi cha chakudya.
  • Kukonzekera kwa Ursodeoxycholic acid kumathandizira kukonza kutuluka kwa ndulu ndikubwezeretsa maselo a chiwindi.
  • Proton pump inhibitors (mankhwala omwe amachepetsa kupanga hydrochloric acid ndi m'mimba) amagwiritsidwa ntchito kubwezeretsa pansi pamimba pakuwonongeka.
  • Insulin yosavuta (yofupikitsa) ya insulin yopanda njira zina zowonjezera zomwe zimawonjezera nthawi yayitali ya zochitika zake) imagwiritsidwa ntchito kupangitsa matenda a shuga kukhazikitsa shuga.
  • Ma insulin omwe amakhala ndi nthawi yayitali (ma insulin hormone yokhala ndi zowonjezera zina zomwe zimachepetsa kuyamwa kwake) zitha kugwiritsidwa ntchito kuteteza matenda a shuga m'magawo a shuga.

• Mankhwala othandizira. Opaleshoni decompression (kubwezeretsa kwa lumen wamba) kwa ma dancts a pancreatic ndi ducts ya bile imagwiritsidwa ntchito pakuchepa kwakukulu kwa milulu, yomwe singathe kuthandizidwa ndi glucocorticoids. Kuluma kwa ma ducts ndikofunikira (kuyambitsa kufupikitsa kwa kukoka kwa stent - chimango chomwe chimakulitsa lumen), chifukwa opaleshoni iyi nthawi zambiri imalekerera odwala.

Mavuto ndi zotsatirapo zake

Mavuto a autoimmune pancreatitis.

• Kuyamwa kwa michere m'matumbo.
  • Kuperewera kwa mapuloteni (chikhalidwe chomwe chimayamba chifukwa chakuchepetsedwa kapena kuchepa kwa mapuloteni).
  • Hypovitaminosis (kusowa kwa mavitamini m'thupi), makamaka mafuta sungunuka (A, D, E, K).
  • Kuchepetsa thupi mpaka ku cachexia (mkhalidwe wotopa kwambiri komanso kufooka kwa thupi).

• Kuphwanya mphamvu yamagetsi pamagetsi.
  • W ludzu.
  • Kutupa.
  • Kuthetsa madzi m'thupi (khungu lowuma komanso mucous nembanemba).
  • Ma cramp (paroxysmallayo odzipereka a minyewa).

• Subhepatic jaundice - chikasu cha pakhungu, ma mucous owoneka ndi michere (mwachitsanzo, malovu, madzi osalala, etc.) chifukwa chophwanya kutuluka kwa ndulu.
• Mavuto opatsirana:
  • zotupa kulowa (kuchuluka kwa kuchuluka ndi kachulukidwe ka gawo lina la chiwalocho chifukwa cha kuchuluka kwa maselo achilendo mwa iwo - mwachitsanzo, ma tizilombo, ma cell a magazi, ndi zina).
  • purulent cholangitis (kutukusira kwa ma ducts a bile),
  • sepsis (poyizoni wa magazi - matenda oyambitsidwa ndi kupezeka kwa magazi a tizilombo toyambitsa matenda ndi poizoni wawo (zinthu zonyansa),
  • peritonitis - kutukusira kwa peritoneum (membrane akalowa mkati mwa m'mimba ndikutseka ziwalo zomwe zilimo).

• Kukokoloka (zolakwika zapamwamba) ndi zilonda zam'mimba (zolakwika zazikulu) zamitundu yosiyanasiyana yokhudza kugaya chakudya (esophagus, m'mimba, matumbo).
• Subhepatic portal hypertension (kuchuluka kwa nkhawa mu portal vein system (chotengera chomwe chimabweretsa magazi ku chiwindi kuchokera kumimba) chifukwa chotchinga kutulutsa kwa magazi kuchokera ku chiwindi).
• Matenda otsekemera a duodenum chifukwa cha kutupa ndi kukakamira kwa kapamba wokulitsidwa.
• Abdominal ischemic syndrome (magazi omwe amayenda m'matumbo) chifukwa cha kupindika kwamankhwala.
• Pancreatogenic ascites (kudzikundikira kwa madzimadzi aulere m'mimba).
• Khansa (chotupa chowopsa - chotupa chomwe chimakula ndikuwonongeka kwa zimakhala zowazungulira) za kapamba.

Zotsatira za autoimmune pancreatitis.

• Ndi chithandizo cha panthawi yake, chokwanira, chokhala ndi nthawi yayifupi ya matendawa, kubwezeretsa kwathunthu kapangidwe kake ndi zochitika za kapamba ndizotheka.
• Ndi nthawi yayitali ya matendawa, kusintha kwamankhwala kosokoneza bongo kumapangitsa kuti zisinthe mosasintha mu kapangidwe kake ndi zochitika zake, koma ngakhale mwa odwalawa, chithandizo chokwanira chokwanira chimayimitsa kupitilira (kupititsa patsogolo) kwa njirayi.

Ziwonetserondi autoimmune pancreatitis zimatengera kukula kwamavuto obwera ndi matenda a autoimmune (kuwonongeka kwa ziwalo zanu ndi chitetezo cha mthupi - chitetezo cha mthupi) komanso matenda a shuga mellitus (carbohydrate-sukari metabolism).

Zambiri

Ngakhale autoimmune pancreatitis imawonedwa ngati matenda osowa, gawo lawo mu kapangidwe ka kutupa kwa kapamba limafikira 4-6%. Kuchuluka kwa matendawa sikapitilira 0,0008%. Matendawa adafotokozedwa koyamba ndi dotolo waku France a G. Sarles mu 1961. Matendawa adazindikiridwa ngati gawo lopatula la nosological mu 2001 pambuyo pa chitukuko cha gulu la etiological la TIGAR-O pancreatitis. Kuwonongeka kwa autoimmune ku chamba cha pancreatic mwa amuna kumadziwika kawiri kawiri ndi kawiri kuposa akazi. Mpaka 85% ya odwala amadwala atatha zaka 50. Matendawa nthawi zambiri amaphatikizidwa ndi nyamakazi, retroperitoneal fibrosis, sclerosing cholangitis ndi njira zina za autoimmune.

The etiology ya autoimmune pancreatitis sichinakhazikitsidwe. Mwachizolowezi, matendawa amadziwika kuti ndi amodzi pokhapokha atazindikira mtundu wa G4 immunoglobulins komanso kusapezeka kwa zina zomwe zingayambitse kuwonongeka kwa kapamba. Akatswiri azachipatala a gastroenterology amavomereza gawo lotsogola la choloho, pakapita maphunziro azachipatala mayanjano amachitidwe a autoimmune ndi serotypes HLA DRβ1-0405, DQβ1-0401, DQβ1-57 idakhazikitsidwa. Kuchokera m'magazi a odwala omwe ali okha Whey mapuloteni olemera 13.1 kDa, omwe amadziwika kuti ndi antigen.

Ma autoantigen omwe amatha kukhala ndi carbonic anhydrase yomwe ilipo mu tinthu timene timayamwa, matumbo a bronchial ndi distal renal tubules, lactoferrin, yomwe yapezeka ndi pancreatic acini, bronchial and gastric glands, zigawo za cell nuclei ndi minofu yosalala ya minofu, pancreatic trypsinogen inhibitor. Kukhudzidwa kwa mtanda ndi othandizira opatsirana sikumatsutsidwa - kuyerekezera kwamaselo pakati pa ma antibodies kupita ku mapuloteni a helicobacteriosis pathogen ndi mapuloteni omanga a plasminogen.

Njira yomwe imayambitsa masinthidwe a pancreatic gland ndi ziwalo zina zowopsa ndizokhudzana ndi seramu Ig G4 ndi maantiantigenic ma cell acinar, maselo abwinobwino a epithelial cell a pancreatic, bile, salivary ducts, etc. Antigenic kuwonongeka kumayendera limodzi ndi kusokonekera kwa apoptosis ya ma cell a chitetezo cha mthupi. Cholumikizira chofunikira kwambiri mu pathogenesis ya autoimmune pancreatitis ndikudzikundikira kosalekeza kochitidwa kwa T ndi B lymphocyte, neutrophils ndi eosinophils mu minye yolumikizika, yomwe imayambitsa njira za fibrosulinotic.

Kuunika kwa cytological mu pancreatic stroma kumavumbula zizindikiro za fibrosis ndi sclerosis pakalibe ma pseudocysts ndi calculi. Chifukwa cha kulowetsedwa kwa lymphoplasmacytic, neutrophilic, ndi eosinophilic, makoma a duct amakhala omangika, oponderezedwa, ndikugawika mkati mwanjira yayitali ya autoimmune. Kufalikira kwa kufalikira kofikira ku maubongo a kapamba kumapangitsa kuti chiwalo chamatumba chisathe ndipo nthawi zambiri zimaphatikizidwa ndi phlebitis. Monga mitundu ina ya matenda kapamba, kupweteka kwa parenchyma ndi stroma ndikotheka.

Gulu

Mukapangira mitundu ya autoimmune pancreatitis, kufalikira kwa njira ya fibro-sclerotic, kukhalapo kwa zotupa zokhudzana ndi ziwalo zina, komanso mawonekedwe a morphological a kutupa kumaganiziridwa. Mukukhazikika kwa matendawa, magawo amodzi a pancreatic parenchyma, makamaka mutu wa chiwalo, amawonongeka. Nthawi zambiri, osachepera 1/3 a gland amakhudzidwa (gawo la kapamba). Pa mtundu wina wa matenda, kuphatikizidwa kwa ziwalo zonse.

Pakakhala matenda ena a autoimmune, kapamba amatchedwa yekha. Pankhani yachulukitsa zotupa za ziwalo zingapo, amalankhula za syndromic autoimmune pancreatic kutupa. Popeza chithunzi cha m'mbiri, mitundu iwiri yayikulu yamatenda imasiyanitsidwa, iliyonse yomwe imasiyana mu mawonekedwe ake azachipatala:

• Lymphoplasmacytic-sclerosing mawonekedwe a kapamba. Kulowetsedwa ndi maselo opanga ma immunoglobulin, okhala ndi zilema zam'mimba ndipo zimasokoneza phlebitis. Kuphatikizidwa ndi matenda a autoGmune ogwirizana a IgG4. Maphunziro obwereranso ndi kupitirira kwa kusintha kwa sclerotic ndi khalidwe.
• Ductal-concentric idiopathic pancreatitis. Morphologically imawoneka ngati kulowerera kwa neutrophilic ndi masango a maselo ofanana ndi ma cellabscesses. Phlebitis ndi fibrosis sakutchulidwa kwenikweni. Magawo a Serum IgG4 nthawi zambiri amakhala abwinobwino. Mu 30% ya milandu, imagwirizanitsidwa ndi zilonda zam'mimba. Zimachitika popanda kuyambiranso. Imachitika ka 3.5-4 kangapo.

Zizindikiro za autoimmune pancreatitis

Chithunzi cha chipatala cha matendawa ndi chosiyana ndi kutupa kwa kapamba. Mu mtundu wa autoimmune wowonongeka wa ziwalo, ululu sucheperachepera, wowuma, osagwirizana ndi zolakwika pakudya. Ululu wammbuyo umayamba theka la odwala okha. Chizindikiro china chofunikira cha autoimmune pancreatitis ndi jaundice yolepheretsa, yomwe imapezeka pafupifupi 60-80% ya odwala ndipo imawonetsedwa ndi kusintha kwa khungu ndi sclera, kuyabwa kwa khungu, komanso kusungunuka kwa ndowe.

Autoimmune pancreatic pathology nthawi zambiri imayendera limodzi ndi vuto la dyspeptic: nseru, kusintha kwa chikhalidwe cha chopondapo (profuse fetid stool of greenish color), ukufalikira. Ndi kukula kwa matendawo, kuperewera kwa zakudya m'thupi ndi kuperewera kwa michere kumachitika, zomwe zimawonetsedwa ndi kuchepa kwa thupi la wodwala, maperesi a nkhope komanso maperesi ochepa. Pakumapeto kwa kapamba, kumadza ludzu kosatha, polyuria (zizindikiro za kuchepa kwa glucose metabolism).

Zotsogola ndi kupewa

Zotsatira za matendawa zimatengera kuchuluka kwa kuwonongeka kwa minofu, kukula kwa zovuta. Ngakhale mankhwala a steroid amalola kukhululukidwa koposa kwa 90% ya odwala, matenda a autoimmune pancreatitis ndi ocheperako, mwa odwala ena pamakhala kuchepa kosasintha kwa ntchito za endocrine ndi exocrine. Chifukwa chophunzitsidwa mosakwanira kachitidwe ka etiopathogenetic, njira zopewera zenizeni sizinapangidwe. Pofuna kupewa zovuta, ndikofunikira kuzindikira komanso kuchiza matenda a autoimmune omwe amathandiza kugaya chakudya munthawi yake.