Matenda a mtima ndi kapamba

Zikondwererozi zimapezeka m'mimba mwa m'mimba (pafupifupi gawo loyamba ndi lachiwiri lumbar vertebrae). Chiwalocho chimakhala kumbuyo kwa m'mimba ndikuchigwirizanitsa bwino ndi duodenum.

Ngati mumagwira zowerengera pambali ya khoma lam'mimba, malo ake ali pafupifupi 5-10 cm pamwamba pa msomali.

Mutu wa gland umazunguliridwa ndi duodenum, yomwe imazungulira mozungulira ngati mawonekedwe a chivalo cha akavalo. Kudzera m'mitsempha ya kapamba - duodenal, magazi amapezeka ku kapamba amaperekedwa.

Kodi zikondamoyo zimapweteka bwanji?

Matenda a kapamba monga pancreatitis, adenocarcinoma, miyala mu ducts, necrosis ndi shuga nthawi zambiri amapezeka.

Zizindikiro zotsatirazi zikuwonetsa pancreatitis - kutupa kwa kapamba, komanso kuwonongeka kwake:

• kupweteka m'dera pansi pa nthiti mbali yakumanzere,
• kufooka
• kutuluka thukuta kwambiri
• zokonda mtima
• malungo
• kusanza, kusanza,
• kuteteza khungu ndi mapuloteni amaso,
• kutsegula m'mimba
• mwina mawonekedwe akunjenjemera.

Ndi zowawa zowonjezereka, mawonekedwe osanza amakhala olimba. Kutsukidwa kungachitike musanayambike ululu. Nthawi zambiri, kusanza kumawoneka m'mawa kapena ngati chakudya pakudya, i.e. chifukwa cha kukokana m'mimba. Pambuyo pakusanza, komwe kumakhala ndi zowawa kapena zowawa, kupumula kumabwera kwakanthawi. Kusintha kumatha kukhala mwadongosolo komanso kuwoneka nthawi ndi nthawi.

Chithandizo cha pancreatic kunyumba

Zizindikiro za pancreatitis pachimake zimaphatikizapo kusanza ndi kupweteka pamimba, komwe kumatenga masiku angapo. Zizindikiro zomwezo zimatha kuzindikira cholecystitis, appendicitis, kutsekeka m'matumbo, kapena zilonda zam'mimba. Kuti mudziwe matenda oyenera, muyenera kupita kwa dotolo mwachangu. Pancreatitis pachimake amathandizidwa mu chipatala.

Zithandizo za anthu

Njira zotsatirazi wowerengeka azithandizira kuchiza kupweteka kwapancreatic.

Yogurt compress

Kusakaniza kwa mandimu ndi adyo

Kupititsa patsogolo izi, kumwa osakaniza ndikulimbikitsidwa ndi kulowetsedwa kothandiza. Amakonzedwa motere: tengani ma buluu ofanana, lingonberry, masamba a sitiroberi, stigmas, nyemba nyemba. Supuni imodzi yotsatira ya zotsalazo imathiridwa mu thermos ndi kapu imodzi yamadzi otentha ndikuyika usiku. Kapu ya kulowetsedwa imagawidwa m'magawo atatu ndikuledzera ndi msuzi wa adyo. Chithandizo chikuchitika kwa miyezi itatu.

Msuzi wa mkaka wa Parsley

Malo azachipatala

Magulu amankhwala amagwiritsidwa ntchito pochiza matenda a pancreatic.

Kuchepetsa kupanga ma enzyme, odwala amalembedwa "Contrical", "Aprotinin". Ngati matenda owopsa achoka kapena chifuwa chachikulu cha m'mimba, mankhwala othandizira amafunikira kuthandiza kugaya ntchito m'mimba. Potere, sankhani: "Mezim", "Panzinorm", "Pancreatin", "Festal", "Creon". Kugwiritsa ntchito kwawo kumatsutsana ndi chifuwa cha nkhumba, popeza izi ndiye maziko. Muubwana, kuchitika kotereku kumatha kudzetsa matumbo, ndiye kuti mankhwala azitsamba amathandizidwa: Somilase, Unienzyme, Somilase, akuphatikiza mafangasi a papain kapena mpunga.

M'matenda a kapamba, munthu sangathe kudzipangira yekha mankhwala omwe angayambitse matenda monga matenda ashuga, necrosis, ndi poyizoni wamagazi.

Kuchepetsa ululu komanso kupewa kukwiya, zida zamankhwala mwanjira ya gels kapena kuyimitsidwa zimagwiritsidwa ntchito. Ntchito yawo ndikusokoneza hydrochloric acid (Fosfalugel, Almagel) kapena kuchepetsa kapangidwe kake (Omez, Proseptin, Contralock, Omeprazole, Ocid, Gastrozole).

Makulidwe achikondwerero

Gawo lalikulu la kapamba wa munthu wamkulu ndi mutu: limafika m'lifupi mwake masentimita 5, kutalika kwa 1.5-3 cm. Thupi ndilo gawo lalitali kwambiri la thupi, ndipo m'lifupi mwake ndi masentimita 1.7-2,5. - mpaka 3.5 masentimita ndi m'lifupi mwake pafupifupi 1.5 cm.

Kuti muzindikire ma pathologies mu mankhwala, ultrasound imagwiritsidwa ntchito, chifukwa chomwe mawonekedwe ndi kukula kwa ziwalo zimatsimikiziridwa, kuwonetsa momwe aliri. Njira zina zofufuzira ndizovuta chifukwa kapamba ndizakuya mokwanira.

Kapangidwe ka chiwalo chathanzi sikamawonongeka. Kusintha kocheperako kukula kwa mutu, mchira kapena thupi kungatengedwe ngati chizolowezi pakuwonetsedwa bwino kwa kuyezetsa magazi kwa biochemistry.

Ntchito ya procrine

Imodzi mwa ntchito zofunika kwambiri za kapamba m'thupi ndi kupanga msuzi wa kapamba, womwe umakhala ndi mchere, madzi, ma enzymes (proenzymes).

Ma pancreatic enzymes amaphatikizapo:

• Trypsin ndi chymotrypsin (thandizirani kugaya mapuloteni)
• Amylase - agwetsa chakudya,
• Lipase - akumaliza njira yogawa mafuta omwe anali mchikakamizo cha ndulu kuchokera ku ndulu.

Madzi a pancreatic amakhala ndikufufuza zinthu - mchere wamchere, womwe umapereka zotsatira zamchere. Izi zimalepheretsa asidi wazakudya kubwera m'mimba ndipo amathandizira kuyamwa michere.

Chinsinsi cha madzi a pancreatic chikugwirizana mwachindunji ndi chakudya. Izi zikutanthauza kuti mukamadya zakudya zosiyanasiyana, michere ya mandimu yopanga mosiyanasiyana ndi voliyumu imapangidwa.

Zomwe zimayambitsa ndi chizindikiro cha matenda

Mowa matenda a ma virus (mumps, hepatitis B),

Matenda a kapamba amatha kuchitika kaamba ka zifukwa zingapo, zochulukirapo pankhaniyi "Nkhani ya pancreatitis yayitali."

Biliary hypertension imachitika chifukwa chotseketsa kumasulidwa kwa bile chifukwa chotsatira cha jaundice yolepheretsa. Chifukwa chachikulu cha izi ndi zotupa ndi calculi.

Malinga ndi kuchuluka kwa njirayi, ikhoza kukhala:

• zamkati (ndi kukakamira kowonjezereka kokha m'mitsempha ya splenic),
• okwanira (kuphwanya dongosolo lonse lamatumbo a chiwindi).

Malinga ndi kutengera kwanthawi yotseka:

• posthepatic
• prehepatic,
• wosakhazikika,
• kusakaniza.

• choyambirira, ndi zovuta zazing'ono zothandizira,
• zolipirira
• zopangidwa ndi mawonekedwe owonekera,
• zovuta (kukula kwa magazi ndi chiwindi kulephera).

Zomwe zimapangitsa kuti mtundu uwu wa matenda oopsa ukhale:

1. Kulowa kwa Helminthic (echinococcosis).
2. Cicatricial kupendekera mu biliary thirakiti.
3. Kutupa kwa kapamba.
4. Anomalies monga kapangidwe ka tinthu tating'onoting'ono tomwe timakhala mkati.
5. Benign neoplasms m'dera la mutu wa kapamba.
6. Kupezeka kwa miyala.
7. Chotupa chotupa.
8. Ma metastases m'chiwindi.
9. Kodi zikuwoneka bwanji?

Zizindikiro zakuwonjezereka kwa nkhaniyi sikuwoneka kwa nthawi yayitali. Mwina pokhapokha pakukula kwa kufooka wamba, kuwonda pang'ono m'gawo la epigastric ndi hypochondrium yoyenera.

Kudzimbidwa nthawi zina kumadziwika. Wodwala sawona kuti izi ndi zowopsa, ndipo saonana ndi dokotala. Ndiye pali kuwonjezeka kwa ndulu ndi zochitika za hypersplenism.

Mu magawo amtsogolo, kudzikundikira pang'onopang'ono kwa madzimadzi mu peritoneal patsekeke kumachitika. Chodabwitsachi, chomwe chili ndi dzina loti ascites, sichimachotsedwa pakumwa mankhwala okodzetsa. Ululu umalimba.

Panthawi yofunsidwa, katswiriyo akuwona kuwonjezeka pamimba, kutupira m'mbali zam'munsi, kukulitsa kwamitsempha kutsogolo kwam'mimba, kuchepera kwa sclera ndi khungu.

Ndi chotupa chamavuto, mkodzo umakhala wakuda, ndipo pondayo inayamba kusungunuka. Zikwangwani zimawoneka pakhungu, pomwe wodwalayo akukumana ndi kuyabwa kwambiri pakhungu.

Pang'onopang'ono, asthenisation imachitika (makamaka ndi matenda a oncological), kuchepa kapena kusowa kwathunthu kwa chidwi.

Pa palpation, pali kuchuluka kwa chiwindi, kupweteka m'dera la onse hypochondria ndi m'mimba. Kuphatikiza kwa kutupa kumawonjezera kutentha, komwe kumakhala kosalekeza, ndipo sikumachoka ndi mawonekedwe a jaundice (mosiyana ndi hepatitis yovomerezeka).

Pa nthawi ya zovuta, wodwalayo amatuluka magazi. Amawoneka ngati kuwonongeka kwamitsempha yotupa mu mtsempha, thumbo ndi m'mimba. Chizindikiro cha chizindikiritso chotere ndicho kuchitika kwadzidzidzi ndikuwonjezera magazi.

Kutsimikizira kwa matendawa kumachitika pogwiritsa ntchito ma ultrasound, duodenography, radioisotope kuwunika kwa chiwindi. Mwazovuta kwambiri, matenda a laparoscopic amagwiritsidwa ntchito.

Thandizo ndi chithandizo

Odwala omwe ali ndi zizindikiro zotere ayenera kukhala kuchipatala nthawi zonse. Ndi chitukuko cha zovuta za anthu, amagonekedwa m'chipinda chothandizira kwambiri.

Zakudya ziyenera kukhala ndi mafuta ochulukirapo komanso mapuloteni. Ngati zizindikiro za encephalopathy zimachitika, ndiye kuti mapuloteni samalimbikitsidwa kuti azigwiritsidwa ntchito mu chakudya. Mu nthawi yovuta kwambiri, chakudya chimayenera kudyedwa m'malo ochepa komanso pafupipafupi.

Chithandizo cha matenda oopsa a biliary chitha kukhala chosasinthika ngati zovuta zokhazo zadziwika. Kuthandiza kumagwiritsidwa ntchito:

• beta-receptor blockers (atenolol),
• nitrate (nitrosorbitol),
• ACE inhibitors (monopril),
• glycoaminoglycans (sulodexide).

1. Matenda a kuthamanga kwamadzimadzi ndi zamagetsi zamagetsi. Izi zimatheka mothandizidwa ndi kukonzekera kwamkati ndi akutsikira.
2. Kukakamizidwa diuresis kuyeretsa thupi ndi kuchepetsa kuledzera.
3. Matenda a rheological a magazi.
4. Ndi concentitant cholangitis, njira ya antibacterial mankhwala imagwiritsidwa ntchito. Mankhwala osankha pankhaniyi ndi cephalosporins.
5. Kugwiritsa ntchito mankhwala kukonza magazi ndi kuthana ndi maselo a chiwindi.
6. Kukhumudwa kwa biliary thirakiti (transhepatic kapena percutaneous).

Njira zopangira opaleshoni zimagwiritsidwa ntchito ngati zikuwonjezereka komanso kutha kwa chithandizo cha mankhwala.

Gawo loyamba ndi kuchitapo kanthu kuti muthane ndi vuto lanu. Chotupa kapena chikhodzodzo chimachotsedwa. Ngati vuto la vuto loti lisagwire ntchito, mankhwala othandizira amagwiritsidwa ntchito - chemotherapy ndi radiation. Nthawi zina, amazika chiwindi.

Chitsulo chimakhala kumbuyo kwa m'mimba, chimagona mosiyanasiyana ndipo kukula kwake kumafika masentimita khumi ndi asanu.

Pancreas wathanzi ndi wapinki.

Ndipo ngati chiwalo chikugwidwa ndi matenda aliwonse, chimakhala imvi, chosalala, chofewa komanso chotupa.

Zojambula pamwambapa zimayimiriridwa ndi zigawo zingapo za thupi:

1. Thupi, lomwe lili m'matumbo a duodenum,
2. Lobe lakumanzere kapena m'mimba, lomwe limayandikira kupindika pang'ono kwam'mimba ndikufika ku ndulu ndi impso kumanzere,
3. Lobe wakumanja, kapena duodenal lobe, yomwe imakafika ku impso yoyenera.

Kuphwanya heterogeneity ya kapamba si matenda odziyimira pawokha. Mankhwala, amawonedwa ngati chizindikiro cha anomaly. Kuzindikira kumachitika chifukwa cha kuyesedwa kwa chiwalocho pogwiritsa ntchito ultrasound.

Zovuta zapakhungu zosakanikirana zimatha kukhala chisonyezo cha kukhalapo kwa matenda osiyanasiyana a kapamba, kuphatikizapo kapamba.

Zikondamoyo ndi gawo lalikulu komanso lofunikira. Imagwira ntchito zingapo zofunika mthupi, kuphatikizapo kapangidwe ka kapamba, kamene kamayambira kugaya chakudya. Ngati pali kusokonezeka kwa zochitika za chiwalo chonse, vuto la kugaya chakudya limatha kuonedwa.

Kuunika kwa kapamba kumayikidwa ngati pali zovuta ndi izo zomwe zikuwonetsa kale ndipo pali zizindikiro zowopsa. Ngati mankhwalawa apezeka ndi vuto, muyenera kuchititsa maphunziro ena omwe azindikire bwino zomwe zachitika.

Chimodzi mwazifukwa zofunika kwambiri chimatchedwa kuperewera kwa zakudya m'thupi komanso kudya zakudya zochepa, komabe, zinthu izi nthawi zambiri zimayambitsa kuwoneka ngati kuphwanya yunifolomu ya chiwalo. Zomwe zimayambitsa kusokoneza heterogeneity ya kapamba zimatha kukhala izi:

1. Subacute kapamba. Matendawa amatanthauza kudwala kwamatenda kapamba kapena kufalikira kwa matenda. Izi zimachitika kwa nthawi yayitali. Nthawi yomweyo, mapangidwe a chithokomiro amasintha pang'ono, ndipo zizindikiro (zomwe zimakonda kulemera pamimba, nseru, kupweteka pang'ono) ndizofooka. Ngati simutsatira zakudya, nthawi yaying'ono imasandulika kukhala pachimake, komwe ndi matenda owopsa komanso osasangalatsa.
2. Matenda a kapamba Gawoli limatha kupitilira mosiyanasiyana. Ndi mawonekedwe ofatsa ochulukirapo ndi osowa, pafupifupi nthawi 1-2 pachaka. Fomu yolimba imadziwika ndi kukhathamira kwapafupipafupi ndi kupweteka kwambiri, kuchepa thupi msanga. Pakukhululukidwa, kusintha kwa ma ultrasound sikuwoneka, komabe, pakuwonjezereka kwa chifuwa chachikulu, kapangidwe ka ziwalo kumawonedwa ngati zopatsa mphamvu,
3. Pancreatic cyst. Ngati heterogeneity ya chiwalo imayambika ndi ma cysts, omwe ali m'mitsempha ya ndulu yomwe imadzazidwa ndi madzimadzi, ndi ultrasound amatchulidwa ngati mapangidwe ndi kuchepa kwa kuchepa kwa thupi,
4. Tumor Zilonda zoopsa komanso zodziwikiratu zimatha kuwonekeranso ndi ultrasound ngati magawo omwe amapangira mawonekedwe. Matenda a oncological amasintha kapangidwe ka chiwalo kale magawo oyambira.

Zizindikiro za matenda a kapamba ndimakhala chizolowezi cham'mimba, kusanza, kuwonda komanso kupweteka pamimba, kuphimba mtima, kudzimbidwa kapena kutsegula m'mimba, kusowa kudya.

Malinga ndi malingaliro omwe analandiridwa masiku ano, mitundu yonse yamatenda a kapamba imayamba chifukwa cha momwe thupi limayendera komanso zimachitika mthupi chifukwa chogwiritsa ntchito ma protein omwe amachititsa kuti ma protein azitha kugwira ntchito.

Mwa zina zomwe zimapangitsa kuti pancreatitis, makina, neurohumoral ndi poyizoni zizindikirike.

Zinthu zoyeserera zimaphatikizira kuphwanya kutuluka kwa kapamba wa pancreatic chifukwa chotsekerera pamwambapo pomwe ma duct wamba a pancreatic atseguka. Zomwe zimapangitsa blockade imatha kukhala:

Mwa zina za neurohumoral, zofunika kwambiri ndizoperewera zamafuta ndimatenda amisempha, komanso pakati pazakumwa zoledzeretsa, kumwa kwambiri mowa. Mankhwala osokoneza bongo ndi mankhwala omwe amapezeka m'malo ogona amakhala m'malo ochepa kwambiri mwazifukwa izi. Zinthu izi nthawi zambiri zimadziwika mukamwa mowa, zakudya zamafuta ndi zonunkhira.

Pancreatic infaration

Pancreatic necrosis ndi njira yomwe ikuwonetsedwa mu kufa kwa minofu motsogozedwa ndi zinthu zingapo zovuta, zomwe zimakhazikika pakukhumudwa kwachakudya komanso koopsa. Kukula kwa necrosis kumachitika ngati kuwunika ndi chithandizo cha kapamba kuchedwa.

Nthawi zina, makamaka ndi chotupa chachikulu chotupa cham'mimba mwa okalamba ndi senile, nthawi zina pamakhala kupindika kwa thrombosis ndi pancreatic.

Zomwe zimayambitsa zimatha kukhala magazi ochepa ndi embolism kuchokera kumanzere atrium omwe ali ndi vuto la mtima, wokhala ndi endocarditis yotupa, embolism yochokera ku zolembedwa za atheromatous. Amakhulupirira kuti muzochitika izi, emboli amalowa ziwalo zina zosiyanasiyana: impso, ndulu, chiwindi, ndi zina zotere. Amakhulupirira kuti chithandizo cha anticoagulants ndi aortography, chifukwa izi zimathandizira kuti magawano azigwirizana ndi zolembedwa za atherossteotic. .

Apoplexy ndi pancreatic infarction, osachepera kumayambiriro kwa chitukuko, amasiyana ndi pachimake hemorrhagic pancreatitis mu morphological mu njira zawo zochepa, okhazikika okhazikika hemorrhagic.

Mankhwalawa ikuchitika mu dipatimenti ya opaleshoni kuchipatala molingana ndi mfundo zamankhwala othandizira pachimake hemorrhagic pancreatitis.

Matenda a kapamba afotokozedwa mu kanema munkhaniyi.

Mkazi

Sonyezani shuga lanu kapena sankhani jenda kuti mulimbikitsidwe

Zikondwererozi ndi gawo la chinsinsi chakunja ndi chamkati. Imatsekera madzi a pancreatic mu duodenum. Zikopa ndi ma ducts a bile zimapanga limodzi ndi duodenum, yomwe imawonetsedwa mu mgwirizano wawo wogwira ntchito komanso kudalirana. Nthawi zambiri pamakhala matenda amodzimodzi a ziwalozi.

Zikondamoyozi zimapezeka mobwerezabwereza pamlingo wa 1-11 lumbar vertebrae, wokhala m'malo opingasa pakati pa duodenum ndi zipata za ndulu. Thupi la kapamba wokhala ndi mbali yakutsogolo moyandikana ndi kumbuyo kwa m'mimba. Ziwalo izi zimalekanitsidwa wina ndi mzake ndi chopapatiza - thumba lozungirapo.

Zombo zapamwamba za mesenteric zimadutsa kumbuyo kwa kapamba pamlingo wakusintha kwa mutu wake kulowa m'thupi. Pancreatic duct (Wirsung duct) imapangidwa kuchokera pakuphatikizidwa kwa ducts yaying'ono. Mutu, pancreatic duct imalumikizana ndi zida zapakhosi ndipo zimatsikira mu duct wamba wa bile.

Pancreatic parenchyma imakhala ndi ma boles ambiri, olekanitsidwa wina ndi mzake ndi zigawo za minofu yolumikizana. Ululu uliwonse umakhala ndi maselo a epithelial omwe amapanga acini. Kwa tsiku limodzi, chitsulo chimakhala ndi madzi osokoneza bongo a 1000-1500 ml ya kapamba. Pakati pa maselo a parenchymal a kapamba, pali maselo ena apadera omwe amapanga masentimita a 0-1-1, otchedwa pancreatic islets.

Ntchito ya pocreatic pancreatic imalimbikitsidwa ndi mitsempha ya vagus, mahomoni am'mimba ndi duodenum (secretin, pancreosimine). Amylase omwe amaphwanya chakudya ndi lipase yomwe imaphwanya mafuta imasungidwa ndi kapamba mu mawonekedwe. Mapuloteni - trypsinogen ndi chymotrypsinogen - amawachotsa mawonekedwe osagwira.

Amayikidwa mu duodenum, pomwe trypsinogen mothandizidwa ndi enterokinase amasinthidwa kukhala trypsin, omwe amachititsa kuti chymotrypsinogen akhale chymotrypsin. Kukhazikitsa kwa michere ya proteinolytic mu duodenum kumateteza kapamba kuti adzigaye. Kuphatikiza apo, ma acinus cell secrete proteinase inhibitors. Ma cell a pancreatic duct amakhalanso ndi njira zoteteza.

Choyambitsa chachikulu cha insulin secretion ndi chakudya chomwe chili ndi mapuloteni komanso chakudya yambiri. Mphamvu zowongolera za kapamba ndizabwino kwambiri kwakuti ndikuchotsa pafupifupi 80% ya parenchyma yake, chiwonetsero chazachipatala cha kusakwanira kwa ntchito zake (shuga mellitus, ndi zina).

Zizindikiro za kapamba.

Mtundu wamatendawa umayendera limodzi ndi mawonekedwe owonetsa. Njira yotupa imayambitsa zovuta za kapamba. Nthawi zambiri, ma enzymes omwe ali mmenemo amasungidwa osagwira, ndipo amayamba kuchita ngati atangolowa m'matumbo. Komabe, ndi kukula kwa mkhalidwe monga pachimake kapamba, ma enzyme amasungidwa mu kapamba, kugaya thukuta lake. Matendawa ndi owopsa chifukwa angayambitse zovuta monga:

• Matenda a pleuropulmonary,
• kugwedeza
• aimpso ndi kulephera kwa mtima,
• kulephera kwa mtima
• peritonitis
• pericarditis
• Mitsempha yamagazi mumitsempha,
• jaundice
• matenda amisala omwe amayamba chifukwa cha kuledzera kwa thupi.

Zina mwazinthu izi zimatha kuyambitsa mavuto akulu, pambuyo pake wodwalayo akafa. Ngati kutupa kumatha msanga kwa milungu iwiri, mavuto enanso amakumana, omwe pancreatitis yayikulu imakhala yoopsa.

Nthawi zambiri pamakhala kupezeka kwa zotupa m'mimba, fistulas, phlegmon. Poyamba, njira yotupa mu kapamba wa kapamba ndimatumbo achilengedwe, koma m'tsogolomo matenda amatha kujowina. Izi matenda angayambitse kukula kwa magazi poyizoni. Lesic lesion nthawi zambiri imayambitsa kufa pachimake cha pancreatitis pachimake. Njira yotupa imatha kuyambitsa kusinthika kwa gland.

Kuzindikira kwa kupulumuka mu mkhalidwe wa pathological kumeneku kumatengera momwe thupilo lakhudzidwira. Kuyembekeza moyo kumakhudzidwa ndi kupambana kwa chithandizo ndikutsatira malingaliro a dokotala.

Mtundu wamatendawa umakhudza zakukula kwa kupulumuka. Matenda a kapamba amachititsa kuti masinthidwe achilengedwe azikhala kwambiri. Nembanemba wa mtundu wina wamatenda omwe ali ndi matendawa ali ndi zizindikiro za chifuwa.

Madera a necrosis amadziwika ndi mtundu wachikaso. Ndi mawonekedwe a parenchyma, zophuka zazingwe zazingwe zimasiyanitsidwa, zimadziwika ndi mawonekedwe opindika. M'malo ena a chiwalo, ma ducts amachepetsedwa mosiyanasiyana, m'malo ena amakhala ndi madzi ambiri. Izi zimathandizira kuoneka ngati kusayenda bwino kwa kapamba m'mikhalidwe yodwala kapamba, ndipo kumadetsa kulosera. Zovuta zomwe zimawoneka motsutsana ndi maziko amtunduwu wamatenda ndizowopsa, kuphatikizapo:

• matenda ashuga
• kunyowa
• ma pancreatic ascites,
• matenda oopsa a portal
• kuchepa magazi
• phlegmon m'malo obwezeretsa, etc.

Mphete ya epithelial m'mabuku oterewa palibe. Mtsogolomo, izi zitha kukhudzidwa ndi pathogenic microflora. Imakhala ndi mtundu wamtundu wobiriwira. Thupi limakhala ndi fungo losasangalatsa kwambiri. Pamakongoletsedwe, timabowo tating'onoting'ono timatha kupezeka. Anthu ena amafa ndendende chifukwa cha kuwonongedwa kwa mitundu iyi.

The pancreatitis yachilendo yomwe nthawi zambiri imakhala ndi kukokoloka, imachepetsa chiyembekezo chodwala.

Tiziwalo zonse zamtunduwu zimakhudzidwa ndi pathological process: mtima kama, epletlium, acini, minofu ya duct, minyewa yamitsempha, minyewa yam'mimba. Matenda aakulu kapamba, ma calancous ma amana Kuchuluka kwa ntchito parenchyma kumachepetsedwa. Muzovuta kwambiri, minofu iyi imatha kusakhalapo.

Pamene matenda akupita patsogolo, minyewa ya glandular atrophy ndi kuwonongeka kwa ziwalo zimawonedwa. Potengera kusintha kumeneku, kapamba amachititsa kuti chimbudzi chikhale chopanga komanso chofunikira kwambiri, zomwe zimabweretsa zotsatira zakupha. Kuneneratu kolondola kwa moyo wa wodwala wokhala ndi pancreatitis sikutheka, chifukwa ngati chithandizocho chiri chokwanira ndipo wodwalayo amatsatira zomwe dokotala akuwonetsa, kusiya zizolowezi zoyipa, matendawa akhoza kukhala abwino.

Kudzimbidwa, kutulutsa, kukhumudwa, kudya pambuyo pake, kusasangalala m'mimba - awa ndi mabelu oyamba omwe muyenera kuyang'anira m'mimba ndi kapamba.

Mu pancreatitis pachimake, pali kuphwanya kwa kutuluka kwa pancreatic madzi, komwe kumapangitsa kudzimbidwa kwa ndulu ndi ma enzymes ake. Matendawa amadziwika ndi matenda owawa. Ululu mu pancreatitis pachimake umapezeka pamimba kumanzere, patapita kanthawi amapeza chikhalidwe cholimbitsa, chotsatira ndi mseru, kusanza.

Chifukwa cha kuledzera, kuchepa thupi (kusanza pafupipafupi), mkhalidwe wa odwala umatha kukhala wolimba: kuthamanga kwa magazi kumatsika, chikumbumtima chimalephera. Kugwa ndi kugwedezeka kumayamba. Matendawa amatengedwa kuti ndi achangu pakuchita opaleshoni, ndipo amafunika kuwunika mwachangu ndi dokotala wa opaleshoni ndi kuchipatala.

Nthawi yomweyo, wodwalayo amatha "kupirira" kumenyedwa kofatsa, komwe, sikuyenera kuchitika, chifukwa popanda chithandizo amatha kudwala kapamba, ndipo izi sizingatheke.

Panthawi ya chifuwa chachikulu, nthawi ziwiri zimasiyanitsidwa: zoyambirira ndi nthawi yowonongeka kwambiri kwa kapamba. Mu nthawi yoyambira (pafupifupi zaka 10), chizindikiro chachikulu ndi kupweteka. Kupweteka kumachitika makamaka kumtunda ndi pakati pamimba, theka lamanzere la chifuwa, m'dera la mtima (monga matenda am'mtima) m'mbali yakumanzere ya lumbar (ofanana ndi aimpso colic), kumatha kufalikira mozungulira thupi, kuzunguliridwa, kuchepa pakukhala, ndi torso kutsogolo, nthawi zambiri kumachitika mphindi 15-20 mutatha kudya. Kuukira kwa odwala omwe ali ndi pancreatitis yayikulu amadziwika kuti ndi pancreatitis yovuta kwambiri.

Mafuta ochulukirapo, amafuta ambiri, okazinga, osuta, zakumwa zoledzeretsa komanso zakumwa zoziziritsa kukhosi, chokoleti, khofi, cocoa zimayambitsa kupweteka. Ululu ndi kapamba kumayendera limodzi ndi zizindikiro za dyspeptic - nseru yayitali, kusanza, komwe sikumadzetsa mpumulo, kumatulutsa, thukuta lotayirira. Zizindikiro za Dyspeptic sizimawonedwa nthawi zonse ndipo zimakhala ndi mawonekedwe ofanana, zimayimitsidwa mosavuta pakumwa. Exocrine pancreatic ntchito, monga lamulo, imakhalabe yolimba.

Ndi kukhalapo kwa nthawi yayitali pancreatitis, kusintha kwa kapangidwe ka minyewa kapamba kumachitika, kuthekera kwake kwa kupanga ma enzyme ndi mahomoni kumatsika, ndi mafomu obisika. Ululu umayamba kuchepekedwa, ndipo nthawi zambiri umatha kusakhalapo. Dyspeptic syndrome imakhazikika mu chithunzi cha chipatala, exocrine pancreatic insufficiency inayamba, yowonetsedwa ndi malabsorption ndi maldigestion syndromes.

Maldigestion ndikuphwanya kwa chimbudzi cha chakudya kuzinthu zofunika kuzamwa. Malabsorption ndikuphwanya njira ya mayamwidwe amatumbo. Chizindikiro chotsogola ndi chopondapo cha mushy katatu patsiku kapena kuposerapo, "pancreatic stool" (yambiri, fetid, mafuta).

Kutulutsa magazi kumachitika pafupipafupi chifukwa cha kuchuluka kwa mpweya m'matumbo. Kuchepetsa thupi kumachitika. Zizindikiro za hypovitaminosis zimawonekera: kutayika kwamadzulo m'mawa, vuto la pigmentation (kuchepa kwa vitamini A), kutulutsa magaziamu (kuchepa kwa vitamini K ndi C), conjunctivitis, stomatitis, kuyabwa pakhungu (vitamini B12), kuchepa kwa magazi (vitamini B12 ndi folic acid).

Kuchepetsa kashiamu kumabweretsa kupweteka, kupweteka kwa mafupa (mafupa). Pancreatic endocrine kusakwanira kumayamba. Pali zigawo za hypoglycemia (kutsitsa shuga) ndi kufooka kwamakhalidwe, kuchepa kwa mitsempha ya tulo, thukuta lozizira, kunjenjemera m'thupi. Pancreatogenic shuga mellitus imakulanso. Khungu lowuma, ludzu limadziwika.

Chimodzi mwazomwe zimaphatikizidwa pafupipafupi machitidwe a gastroenterologist ndi kuphatikiza kwa matenda apathengo a gancroitisophageal Reflux (GERD), ndipo izi zimaperekanso chizindikiro chake, ndipo nthawi zambiri kuphatikiza uku kumachitika motsutsana ndi maziko a kunenepa kwambiri.

Ngati mukukayikira kuti chiwopsezo cha kapamba chimakhala thandizo loyamba - kupuma, mutakhala pansi ndi mawondo anu atapanikizika pachifuwa chanu, kufa ndi njala kwambiri ndi kotala imodzi ya madzi mphindi 30 zilizonse - ola limodzi, ikani kuwira kwa kapamba kuyambira kumbuyo. Kupuma mwapamwamba kumathandizira kuukira.

Ma painkiller ndi anti-yotupa mankhwala sayenera kumwedwa, izi zimapangitsa kuti azindikire. Kukonzekera kwa enzyme kumapangidwanso. Kuchepetsa vuto la wodwalayo kungathandize 0,8 mg koma shpy kapena drotaverine hydrochloride mu Mlingo wofanana, ngati kuli kotheka, ndibwino kuti mupeze jakisoni wambiri wa papaverine 2 ml, mutha kusintha mankhwalawo ndi yankho la shpy. Ndipo nitroglycerin pansi pa lilime, chabwino, si mwansanje, koma kumayambitsa khungu.

Zosintha mu kapamba zimawerengedwa ngati njira ya necrosis yoyamba ndi necrobiosis yama cell a acinus mothandizidwa ndi awo ma lipolytic ndi ma protein enzymes. Kuzungulira pakati pa necrosis, kutupa kwa demarcation kumayamba ndi mziwopsezo wamankhwala othamanga, kupweteka kwa edzi, kuchuluka kwake, komwe kumawerengedwa ngati mawonekedwe a pancreatitis. Mwa odwala ambiri, kukula kwa njira ya pathological kumaima pakadali pano
Pazoyambira zosiyanasiyana, minofu ya pancreatic epithelial imasinthidwa ndi minyewa yolumikizana, ndikutsatiridwa ndikukula kwa fibrosis ndi sclerosis, zomwe zimatha kutsitsa kapena kuwonjezeka kukula kwa kapamba. Malo apadera amakhala ndi pancreatitis (calcifying) pancreatitis, pomwe mchere wamkati umayikidwa mu minofu ya pancreatic kapena mu lumen ya ma supretory ducts (wirsungolithiasis). Mukamatseka ma ducts ake ocheperako chifukwa chotupa kapena chifukwa cha sclerotic, cysts mawonekedwe ena mwa odwala.
Mitundu yosiyanasiyana yamatenda a pancreatitis pachimake imagawidwa malinga ndi chikhalidwe ndi zamankhwala.
Mitundu inayi yamankhwala ndi morphological ya pancreatitis yosatha imasiyanitsidwa.
• wosakhazikika,
• pseudotumor,
• pseudocystic,
• kuwerengetsa (kuphatikizapo virsungolithiasis).
Kuzindikira kwa pancreatitis pachimake kumakhazikitsidwa pa kafukufuku (kuwoneka kwa ululu wam'mimba pambuyo chakudya chachikulu, mowa, kuchuluka kwa matenda am'mbuyo), zambiri kuchokera ku zolinga ndi maphunziro a labotale. Thandizo lofunikira pakuwonetsa matendawa limaperekedwa ndi ultrasound, yomwe imakupatsani mwayi wokhazikitsa zomwe zimachitika (cholecyst - ndi choledocholithiasis), kuopsa kwa kusintha kwa morphological mu kapamba ndi nthawi ya matendawa, limodzi ndi zovuta za matendawa. Kulondola kwa kupezeka kwa cholecystitis ndi kutuluka kwa ndulu nthawi ya kupimidwa kwa ultrasound kumafika pa 92-98%. Zizindikiro za edema ya pancreatic ndikuwonjezeka kwa voliyumu yake ndikuchepera pamlingo wowonetsa chizindikiro.
Kuzindikira kwa pancreatitis yosatha kumakhazikitsidwa pazodandaula za wodwala, mbiri ya zamankhwala, zakuthupi, ma labotale ndi njira zofufuzira. Ndi kuchulukitsa kwa matendawa ndikuphwanya kutuluka kwa pancreatic madzi (nthawi zambiri ndi virsungolithiasis), kuchuluka kwa amylase, lipase ndi trypsin m'magazi ndi amylase mumkodzo amadziwika. Ndi matenda osachiritsika a kapamba kapena mawonekedwe obwerezabwereza a matendawa m'magazi a chikhululukiro, kuchuluka kwa ma pancreatic enzymes m'magazi ndi mkodzo nthawi zambiri sikusintha, chifukwa chake, muzochitika izi, zitsanzozi ndizosafunikira kwenikweni.
Pulogalamu yamankhwala ochizira pancreatitis yovuta iyenera kumangidwa chifukwa chakuyambitsa matendawa, kuuma kwake komanso matenda ake. Wodwalayo amafunikira kuyang'aniridwa ndi dokotala wa opaleshoni, othandizira komanso othandizira odwala kwambiri (omwe amathandizanso), omwe pamodzi amathetsa zovuta za chithandizo chake. Pulogalamu ya mankhwalawa imaphatikizapo chithandizo chamankhwala, kuletsa kwa encyme katulutsidwe, kupewa kwa minyewa ya minyewa komanso kukula kwa zovuta, kuchotsa kwa zomwe zimachitika, chithandizo cha zovuta ndipo, pamapeto pake, kuchitapo kanthu.
Chithandizo chachikulu cha pancreatitis chosavuta chodwala. Zakudya zimayikidwa kupatulapo mafuta, yokazinga, mchere, zakudya zonunkhira (tsabola, adyo, viniga, ndi zina).

Acute Pancreatitis Video

Pakati pazakhumudwitsa za foci ya necrosis, mapampu amadzi a calcium, mawonekedwe a mafuta acids amawonekera. Kuzungulira kapamba, chotupa chokhala ngati chakhazikika chimayamba, pomwe m'mimba ndi m'mimba mwake mumaphatikizidwa. Madzi amadzimadzi am'mimba amadzimadzi am'mimba. Ndi hemorrhagic pancreatic necrosis, kapamba amakulitsidwa pang'ono, mwamphamvu. Mtundu wake, chifukwa cha kuchuluka kwa zotupa m'mimba ya m'matumbo ndi m'tizungulira, zimatembenuka zofiirira.

Gawolo likuwonetsa kusintha kwa mawonekedwe a mtundu wofiirira wakuda ndi madera a parenchyma osasinthika. Tizilombo ta pancreatic timadzaza magazi, timayang'ana zotupa m'mizere yaying'ono. Kuchuluka kwakuti hemorrhagic exudate imapezeka m'mimba. Visceral ndi parietal peritoneum imakutidwa ndi zokutira polumikizana ndi chitukuko cha aseptic peritonitis. M'tsogolomu, matendawa akamapitilira, kapamba amayamba necrosis m'madera akulu.

Ndi hemorrhagic kusowetsa pancreatic necrosis, wathunthu kapena pafupifupi wathunthu neancosis amapezeka nthawi zambiri. Zikachitika kuti wodwalayo apulumuke, madera omwe anamwalawo amakanidwa, ndipo pambuyo pa matenda, kupatsirana kwawo ndi mapangidwe a parapancreatic ndi retoperitoneal abscesses. M'mapeto omaliza, mawonekedwe a pancreatic cysts.

Chifukwa chake, mtundu wonyansa wa focal pancreatic necrosis ungatchedwe edematous, kapena interstitial, kapamba. Ndi pancreatitis yomwe ikukula pang'onopang'ono, pakudziwononga kwa kapamba, ma enzymes a lipolytic makamaka amakhala ndi pancreatic necrosis. Mothandizidwa ndi ma enzymes ochulukirapo a proteinolytic, hemorrhagic pancreatic necrosis imayamba kupanga mapangidwe a edema mu retoperitoneal minofu ndi mawonekedwe a hemorrhagic activation pamimba yam'mimba (pancreatogenic aseptic peritonitis).

Nthawi zina, mitundu yosakanikirana ya kapamba imawonekera: hemorrhagic pancreatitis ndi foci ya mafuta necrosis ndi mafuta a pancreatic necrosis okhala ndi zotupa m'mimba. Kutengera kufalikira kwa njirayi, wamba (chokhazikika), chapamwamba komanso chithuza chonsecho amadziwika. Malinga ndi maphunziro azachipatala, njirayi ndi yodabwitsanso komanso yopita patsogolo.

Zizindikiro za pachimake kapamba zimadalira mtundu wa pancreatitis, nthawi ya kukula ndi kuopsa kwa matendawa. Mu nthawi yoyambirira ya matendawa (masiku atatu), onse omwe ali ndi edematous (abortive) mawonekedwe a kapamba komanso chifuwa chachikulu cha irencosis, i.e. pancreatitis yomwe ikupita patsogolo, odwala amadandaula za kupweteka kwapadera kwa dera la epigastric (pamimba chapamwamba), kupweteka kwa m'chiuno, nseru, kusanza mobwerezabwereza. Ululu umakonda kutulutsidwa pakati theka la epigastrium, kumbuyo, ndi hypochondrium yoyenera.

Palibe kulumikizana kowoneka bwino pakati pa zowawa ndi kutanthauzira kwazomwe zimachitika mu kapamba. Mitundu ya ululu imakhala yofala kwambiri. Kukula kwa kupweteka nthawi zambiri kumadalira kukula kwa kusintha kwa kapamba. Nthawi zambiri ululu wowopsa komanso wamphamvu umawonedwa. Nthawi zina amakhala ndi boma. Zimachitika nthawi zambiri zimafulumizitsidwa. Kuthamanga kwa magazi ndikwabwinobwino kapena kukwezedwa pang'ono kwakanthawi.

Mukamayang'ana pamimba, ululu umadziwika m'dera la epigastric ndi hypochondrium wamanzere. Palibe mkangano m'mimba za m'mimba. Nthawi zina pokhapokha amadziwa zowawa zawo mdera la kapamba pamimba yakhoma yam'mimba (chizindikiro cha Kerth). Palpation mu mbali yakumanzere-kumbuyo kwa phokoso (kuchuluka kwa mchira wa pancreatic) nthawi zambiri imakhala yopweteka (chizindikiro cha Mayo-Robson).

Munthawi zoyambirira, phokoso lodziwika bwino lapezeka. Ndi mafuta pancreatic necrosis, kulowetsedwa pambuyo-necrotic kumapangidwa koyambirira, komwe kumatha kutsimikiziridwa mu dera la epigastric nthawi ya palpation. Pankhaniyi, odwala sangayesere momveka bwino chizindikiro cha msempha (Voskresensky chizindikiro). Paresis komanso kusamukira kwa koloni yopingasa kumathandizanso izi.

Mukamayang'ana pamimba, kumatulutsa kwina kumadziwika. Kuyika kumayang'ana kwambiri tympanitis. Komabe, mawonekedwe akuwonekera m'mimba, kumveka kwamkati kumachitika m'matumbo am'mimba, omwe amapezeka mosavuta m'malo a wodwalayo pambali. Khungu la pamimba lomwe limakhala ndi pancreatitis yayikulu nthawi zina limakhala losalala.

Malo awa amatha kuwonedwa ndi magazi m'mimba pamimba pa ectopic mimba, ndi gangrene yamatumbo ang'ono. Pancreatitis yayikulu, kugunda ndi kumvetsera kumatha kuwonetsa kuyambiranso, komwe kumawoneka koyambirira. Nthawi yomweyo, odwala ambiri amakhala ndi serous-hemorrhagic peritonitis ndi zododometsa, amakhala ndi hemorrhagic pancreatitis.

Ndi kutayika kwa madzimadzi ndi kusanza, kukanidwa kwake mu minyewa yodutsa ya peritoneum, minofu ya retroperitoneal, muzu wa mesentery wamatumbo ndi minofu ina, ukuwonjezeka mpaka 1.0-1.5. Mowonekeratu, kudabwitsa kumawonekera pallor of the khungu ndi mucous membranes, kuchuluka thukuta, cyanosis wa malekezero, pafupipafupi filform zamkati, mitsempha yomwe yatsika, kuchepa kwa kuchuluka kwa magazi, magazi amkati, komanso kutulutsa mtima ndi mtima.

Ntchito zokhudzana ndi chiwindi zimawonetsedwa ndi mtundu wa icteric pakhungu, kukulitsa kwa chiwindi, kuyezetsa magazi kumawonetsa kuwonjezeka kwa bilirubin, kuchepa kwa mapuloteni, komanso kuwonjezeka kwa chiwerengero cha leukocytes ndi ESR, acidosis, hyperkalemia, kuchepa kwa Ca, zomwe zikuwonetsa kupitilira kwa mafuta necrosis.

Palibe kulemberana mosamalitsa pakati pa kuchuluka kwa seramu amylase ndi lipase komanso kuopsa kwa kapamba. Tiyenera kukumbukira kuti kuwonjezeka kwa ntchito ya amylase ndi lipase kumatha kuwonanso kuchepa kwa impso chifukwa kuchepa kwa ma imphuzitsi amkodzo mu mkodzo, panthawi ya zilonda zodzikongoletsera, kutsekeka kwam'mimba (kuchepa kwam'mimba kuchokera m'matumbo ang'onoang'ono), komanso pachimake cholecystitis (a concomitant pancreatic reaction).

Kafukufuku wambiri ndi kutsimikiza kwa serum trypsin, alpha-chymotrypsin, elastase, makamaka phospholipase Az, yomwe imapangitsa gawo lalikulu la hemorrhagic pancreatic necrosis. Komabe, kusokonezeka kwa kutsimikiza kwawo kumalepheretsa kugwiritsa ntchito njirazi m'njira zambiri.

Kuunika kwa X-ray sikothandiza. Nthawi zina zimakuthandizani kuzindikira calculi calculi mu ducts ya bile, mu pancreatic duct, kusintha komwe kumakhala m'mimba ndi duodenum panthawi yama volumetric process mu kapamba. Kuunika kwa X-ray ndikofunikira kuti mupeze ziwopsezo zophatikizika, kuphatikizika kwa pleural patsekeke, ma atelectasis ya m'mapapo, yomwe nthawi zambiri imayendera limodzi ndi pancreatitis yovuta. Kafukufuku wam'mimba ndi matumbo omwe ali ndi wothandizira mosiyana ndi nthawi ya pancreatitis amakhala wotsutsana.

Yogwiritsidwa ntchito pa tomography imagwiritsa ntchito ultrasound. Zimakuthandizani kuti muzindikire bwino za necrosis, kusintha kwa parapancreatic fiber, "njira za necrosis" kunja kwa kapamba, komanso zovuta mu mawonekedwe a ma abscesses ndi cysts. Ultrasound ndiyosavuta kugwiritsa ntchito kuyang'anira njira ya matendawa.

Esophagogastroduodenoscopy sikuti ndizofunikira kwambiri pakuwonetsa pancreatitis. Zisonyezero zake zimachitika ndi magazi am'mimba motsutsana ndi kapamba. Retrograde choledochopancreatography mu pachimake kapamba amatsutsana, kupatula milandu yotsinulira pazowonjezera, pomwe papillotomy ndikuchotsa kwake kukufunika.

Laparoscopy imagwiritsidwa ntchito pofufuza mosadziwika, ngati kuli kotheka, kuyika kwa laparoscopic drainage zochizira pancreatitis pachimake. Kuti muthane ndi kulowetsedwa kwamatumbo ndikuwongolera matenda otsegula, mutha kugwiritsa ntchito kuyambitsa catheter pamimba yam'mimba kudzera pakupaka khoma lam'mimba. Electrocardiography ndiyofunikira pazochitika zonse, kuti azindikire mosiyana ndi infarction yovuta yamtima, komanso kuwunika mkhalidwe wamtima wamtima mkati mwa matenda.

Kusiyanitsa kwakusiyana kuyenera kuchitika makamaka ndi thrombosis ya mesenteric chotengera (matumbo am'mimba), popeza kupweteka modzidzimutsa, dziko lodzidzimutsa lomwe limakhala ndi chifuwa chofewa komanso kutentha kwa thupi kumatha kufanana ndi pancreatitis yovuta kwambiri. Paralytic matumbo oletsa ndi peritonitis amapezeka m'matenda onse awiri.

Malinga ndi kuchuluka kwa zamankhwala, kulowetsedwa kwa myocardial kumakhala kovuta kusiyanitsa ndi chifuwa chachikulu cha pancreatitis, popeza ECG imasintha infarction yachilendo ya myocardial imachitika mu gawo la pancreatitis yovuta kwambiri. Monga momwe zimakhalira ndi mesenteric infarction yamatumbo, komanso infarction ya myocardial, ultrasound imathandizira kusiyanitsa matendawa. Ndi matenda osadziwika, ndikofunikira kuchita ma arteryografia a ziwiya zam'mimba.

Pachimake cholecystitis ndi zovuta zake zimatha kusiyanitsidwa mosavuta ndi chithunzi cha matenda azachipatala ndi zizindikiro za ultrasound. Pancreatitis pachimake iyenera kusiyanitsidwa ndi chilonda chophatikizidwa, kupindika kwamatumbo ochepa, chotupa cha aortic, aimpic colic.

Matenda a kapamba.

Pa ululu wam'mimba, onetsetsani kuti mumayimbira dokotala. Acute pancreatitis amatha kusokonezeka ndi matenda ena oopsa, ndipo ngakhale ovulala kwambiri amatha kupha.

1. Transabdominal ultrasound (ultrasound). Imatsimikizira kuwonjezeka kwa kukula kwa kapamba, kuwerengera minofu, mawonekedwe owoneka bwino komanso osagwirizana, kusinthika kwa kapangidwe kake, kusintha kosinthika, kupezeka kwa ma cysts, ndi kukula kwa ma ducts. Kuzindikira kwa ultrasound pakuwonetsa pancreatitis ndi 80-85%.

2. Computed tomography (CT) ndi maginito a resonance imaging (MRI) - amawulula kuchuluka kwa kapamba, kudziwa kuchuluka, ma pseudocysts, kudziwa kukula kwa ma ducts, kuwulula zotupa za ziwalo zoyandikana, ma neoplasms oyipa.

3. ERCP - endoscopic retrograde cholangiopancreatography. Pakadali pano amatenga imodzi mwamagulu omwe akutsogolera pancreatitis. Kuzindikira kwa njirayi ndi 93-100%.

1. Kudziwika kwa fecal pancreatic elastase - 1. Njirayi imangotengera elastase yaumunthu, chifukwa chake, zotsatira zoyeserera sizikhudzidwa ndi chithandizo chothandizira cha enzyme. Ndiye "muyezo wagolide" wokhudzana ndi matenda a chifuwa chachikulu. 2. Kuyesedwa kwa magazi pafupipafupi - pali zizindikiro za kutupa, kuchepa magazi.

Pozindikira pancreatitis, gawo lotsogolera ndi la akatswiri - dokotala wothandizira kapena gastroenterologist. Ndi okhawo omwe amatha kusankha njira zodziwitsira, momwe amathandizira wodwala aliyense kuti athe msanga, molondola komanso mtengo wokwanira kuti adziwitse kuzindikira koyenera.

1. Gastroenterologist, kusankha njira zamankhwala 2. Opaleshoni, yokhala ndi ululu wammbuyo wammbuyo wamakono, kukulira kwa zovuta. 3. Endocrinologist, ndikupanga matenda a shuga. 4. Cardiologist kupatula matenda a mtima dongosolo.

Acute pancreatitis amadziwika ndi kukula kwa edema ya kapamba (edematous pancreatitis) kapena makamaka aseptic pancreatic necrosis (chiwonongeko chowononga), ndikutsatiridwa ndi chotupa. Pancreatitis yowononga kwambiri imakhala ndi gawo, ndipo gawo lililonse limafanana ndi mtundu wina wamankhwala. Maluso azidziwitso ndi chithandizo cha wodwala zimatengera izi.

Gawo I ndi enzymatic, masiku asanu oyamba a matendawa, panthawiyi pali kupangika kwa pancreatic necrosis ya kutalika kosiyanasiyana, kukula kwa endotoxemia (nthawi yayitali ya hyperfermentemia ndi masiku 5), ndipo odwala ena amakhala ndi ziwalo zingapo komanso kulephera kwa endotoxin. Nthawi yayitali kwambiri yopanga pancreatic necrosis ndi masiku atatu, nthawi imeneyi siyikupitabe patsogolo.

Kwambiri pachimake kapamba. Pafupipafupi mwadzidzidzi ndi 5% ,imfa - 50-60%. The morphological gawo lokonda kwambiri kapamba pancreatic ndi pancreatic necrosis (chachikulu chachikulu ndi kwathunthu subtotal), womwe umafanana kwambiri endotoxicosis. Nthawi zambiri zomwe zimachitika ndi 95%, zakufa ndi 2-3%.

Pancreatic necrosis mu mawonekedwe amtundu wa kapamba kapenanso sikhala (edema ya kapamba), kapena yocheperako ndipo sinafalikire kwambiri (focal pancreatic necrosis - mpaka 1,3 cm). Kufatsa kapamba kofatsa kumayendera limodzi ndi endotoxemia, kuopsa kwake komwe sikufika pamlingo woopsa.

Gawo II - yotakasika (sabata lachiwiri la matenda), yodziwika ndi momwe thupi limayambira ku necrosis (pancreas komanso minofu ya parapancreatic). Mtundu wazachipatala wa gawoli ndiwofalikira.

Gawo lachitatu - kusungunuka komanso kudziwikiratu (kumayambira sabata 3 ya matendawa, kumatha miyezi ingapo). Zotsatira zam'mapapo zikuluzikulu zakumapapo ndi minyewa ya m'mimba zimayamba kupanga kuyambira tsiku la 14 kuyambira chikhazikitso cha matendawa. Pali mitundu iwiri ya gawo ili: 1. aseptic kusungunuka ndi sequestration - wosabala pancreatic necrosis,

yodziwika ndi mapangidwe a post-necrotic cysts ndi fistulas, 2. septic kusungunuka komanso kufananizira - kachilombo ka kapamba ndi necrosis ya parapancreatic minofu ndikupitiliza kwina kwa zovuta za purulent. The matenda mawonekedwe a gawo ili la matendawa ndi purulent-necrotic parapancreatitis ndi zovuta zake (purulent-necrotic sagging, abscesses ya retroperitoneal space ndi m'mimba, purulent omentobursitis, purulent peritonitis, arrosion ndi m'mimba kutaya magazi, fistulas, etc. .

Odwala omwe ali ndi matenda a pancreatitis pachimake ayenera, ngati zingatheke, atumizidwa ku zipatala zamitundu yambiri.

Monga lamulo, zimachitika mu rechipatimenti cholandila kapena mwadzidzidzi.

1) Maziko okhazikitsira matenda a pancreatitis pachimake (atapatula njira ina ya opaleshoni ina) ndi kuphatikiza pazizindikiro ziwiri izi: a) chithunzi cha chipatala (kupweteka kwambiri kwa ululu wa herpes zoster, kusanza kopanda, kuphuka,

kumwa mowa, zakudya zonunkhira kapena kukhala ndi mbiri ya cholelithiasis, ndi zina), b) ultrasound (kuchuluka kukula, kuchepa kwa zachilengedwe, kutsutsana kosadziwika kwa kapamba, kupezeka kwa madzi aulere m'mimba), c) magawo a labotale (hyperamylasemia, hyperamilazuria), d) ntchito yayikulu ya amylase enzymatic exudate (2-3 kuchulukirapo kuposa ntchito ya amylase) yoyambitsidwa ndi laparocentesis,

2) Mothandizirana ndi matenda am'mimba kapamba, tifunika kudziwa kuopsa kwa matendawa (kwambiri kapena ofatsa). Chofunika kwambiri ndikudziwidwa koyambirira kwa kapamba, zotsatira za mankhwalawa zomwe zimatsimikiziridwa ndi nthawi yake isanayambike. Zizindikiro za pancreatitis yayikulu ya pachimake ndi izi: a) zamankhwala: - peritoneal syndrome,

- wosakhazikika hemodynamics - tachy- (

Kapangidwe kabwino ka kapamba: ndi chiyani

Zikondamoyo mwa munthu wathanzi poyesedwa ndi ultrasound zimawonetsa mawonekedwe. Nkhope zonse zimawonekera ndipo zimakhala ndi mawonekedwe ofanana ndikuwala chimodzimodzi - echogenicity. Kusintha kulikonse mu gawo lomwe lawerengedwa lomwe limasiyana ndi chizolowezi amadziwika kuti mawonekedwe osasintha. Mawuwo akayamba kusokonekera pofotokoza zotsatira zake, izi zikutanthauza kuti magawidwe ofanana achokera mchigawo chonse.

Ultrasound imakupatsani mwayi kuti muwone momwe amatchulidwira kuti heterogenible echostosition ya kapamba ndi. Itha kutsitsidwa, kuchulukitsidwa kapena kusapezeka kwathunthu. Pa nthawi yoyeserera, dokotala amayenera kudziwa kuchuluka kwa kupweteka kwa wodwalayo. Ngati pali ululu, kutupa kumachitika m'matumbo. Chizindikiro ichi chimatha kuwonetsa mitundu yosiyanasiyana ya pathologies.

Kupezeka kwa kusokoneza heterogeneity ya kapangidwe ka kapangidwe kake ndikungolankhula chabe kosemphana ndi zomwe zimachitika m'thupi, osati kuzindikira matenda enaake. Kusintha kotereku kumatha kuwonekera nthawi zambiri, mawonekedwe ake omwe amakhudzidwa ndi zochitika zambiri.

Ndikofunikira. Kuti adziwike bwino, dokotalayo amapereka mankhwala ena owonjezera.

Zomwe zimayambitsa kusintha kwa kapamba

Kusintha kwamphamvu kwa kapangidwe kake kapamba kumachitika mothandizidwa ndi zinthu zosiyanasiyana. Kupatuka kulikonse kuchokera pachiwonetsero ndi chizindikiro chowopsa. Kuti mudziwe zoyenera ndikuti mupeze chithandizo choyenera, ndikofunikira kumvetsetsa zomwe zimayambitsa kusokonekera kwa chiwalo. Izi ndi monga mndandanda:

1. Makamaka.
2. Ukalamba.
3. Pancreatitis koyamba kapena mawonekedwe osakhazikika.
4. Matenda a metabolism ndi pancreatic dystrophy.
5. Kuphwanya magazi kwamwayi.
6. Zakudya zoyipa.
7. Kuwonongeka kwa njira yothandizira.
8. Zizolowezi zoipa: mowa, fodya.
9. Kupsinjika
10. Matenda a mahomoni.
11. Matenda a shuga

Zina mwazifukwa sizingatheke podzikonza nokha, ndipo pezani thandizo kwa dokotala. Koma pazinthu zina zomwe zikondazo zimatha kukhala zosakanikirana, wodwalayo amatha kuzisintha ndikuziwachotsa.

Choyambitsa chachikulu kwambiri m'thupi ndi kuperewera kwa m'thupi. Chakudya chopanda malire chimatha kuvulaza kapamba. Iwo omwe ali ndi mavuto kale ndi thupi ili, ndibwino kukana mchere, zonunkhira, zotsekemera, zakudya zowonjezera, ndikuwonjezera zakudya zamafuta ochepa komanso zopatsa thanzi muzakudya zanu.

Kuledzera kwa mowa ndi fodya kumayambitsanso mavuto a kapamba. Kwa anthu ena, ndudu imodzi kapena kapu imodzi ya vinyo ndikokwanira kuyambitsa masinthidwe m'thupi omwe angayambitse kutupa.

Ndikofunikira. Izi ndichifukwa chakuwonjezeka kwa dongosolo la endocrine laumunthu pazovuta zoyipa pang'ono.

Zovuta za kupsinjika pa thanzi la pancreatic zimatha kuwongoleredwanso ndikuwongolera. Nthawi zambiri, kapamba amayamba kusokonezeka komanso kusinthika kwakukuru m'malingaliro amisala ndi nkhawa zakuntchito kapena kunyumba, zomwe zimayambitsa kusayenda bwino kwa vuto la mahormoni komanso zovuta ndi dongosolo la endocrine.

Matenda omwe angathe kukhala ndi kapangidwe ka kapangidwe ka kapangidwe kake ndi zizindikiro zake

Kukula kwa hengenegene kwa kapamba kumayendetsedwa ndi zizindikiro zotsatirazi: kusokonezeka kwa chopondapo, nseru, kuchepa kapena kusowa kwa chakudya, ndi zina zambiri.

Kulephera kwa homogeneity kapangidwe ka kapamba kungakhale zizindikiro za matenda otsatirawa:

1. Pancreatitis mu gawo la pachimake, pomwe imfa ya minofu yoyaka imachitika. Izi zimadzetsa kuledzera kwa thupi ndi kusokonezeka kwa njira ya katulutsidwe ka madzi a m'mimba. Pa ultrasound, kutupa kumadziwika ndi kapangidwe kake kapangidwe kake ndi kukula kwa chiwalo ndi mtundu wotchulidwa. Zizindikiro zoonekeratu za matendawa ndizopweteka kwambiri, kusanza komanso kuthamanga kwa magazi.
2. Matenda a kapamba Pa ultrasound, chithunzicho chidzawonetsedwa ngati mawonekedwe osakhazikika omwe ali ndi kukula kwakukulu kwa ziwalo komanso kuchepa kowala. Matendawa amatenga nthawi yayitali m'magawo angapo. Kumayambiriro kwa matendawa, chifukwa cha kuwonongeka, kutulutsa thukuta kumatupa, ndipo patapita kanthawi nthawiyo imachepa. Pambuyo pakuchepetsa, kupanikizika kwa kapamba kumatayika ndipo njira yopanga enzyme imasokonekera. Ndi kuchulukitsa, kupweteka kwa wodwala kumakhazikitsidwa kumanzere kumimba.
3. Lipomatosis Mawuwa amatanthauza chidziwitso chosagwirizana ndi zaka. Pakukalamba, kukula kwa kapamba kumachepa, ndipo kuchepa kwake kumalipidwa ndi mafuta. Nthawi zambiri, vutoli limatha kupezeka ndi ultrasound, chifukwa ndi asymptomatic. Lymphomatosis imatha kuchitika chifukwa cha matenda ashuga kapena imafalikira pa jini.

Atatha kuyesa mayeso ndikupanga matenda, dokotala amapita kukalandira chithandizo. Imachitika ngati ili kunyumba kapena kunyumba. Zonse zimatengera momwe wodwalayo alili ndi matendawo. Chithandizo cha mankhwala osokoneza bongo chimaphatikizapo njira ya michere. Kutalika kwa mankhwala amakhazikitsidwa kutengera kutengera kwa matendawa.

Ndikofunikira. Ngati wodwala akumva kupweteka komanso kusanza, ma painkillers ndi antiemetics amasankhidwa.

Chithandizocho chimaphatikizaponso kutsatira kwambiri zakudya komanso kupatula zakudya zoyipa m'zakudya. Ndi matenda, ntchito:

• mowa ndi fodya,
• yokazinga, yosuta, mchere wamchere,
• zakudya zama protein ambiri
• khofi ndi tiyi wamphamvu,
• maswiti: chokoleti, makeke.

Yoyenera, panthawi yake chithandizo ndikutsatira zakudya zomwe zingalimbikitsidwe zimathandizira kuyambiranso kwa kuchotsedwa. Kupanda kutero, kutupa kwa kapamba pakapita nthawi kumabweretsa zovuta: abscess, oncology, magazi, stenosis, pleurisy, chibayo.

Zomwe zimachitika parenchyma ya limba

Mphepoyi ndi chiwalo chofunikira chomwe chimagwira ntchito zakunja (zomanga ma enzymes) ndi endo native (kupanga insulin ndi glucagon).

Chiwalocho chili ndi mawonekedwe osokoneza ndipo chimakhala ndi ma nyemba za alveolar. Gawo lotsogolera limayimiridwa ndi gulu lalikulu la ma ducts lomwe limayendetsa ma enzymes (amylase, proteinase, lipase) kulowa mu duodenum. Gawo la endocrine la chiwalocho ndi zisumbu za Langerhans, zomwe zimatulutsa insulin, glucagon, somatostatin, ghrelin ndi pancreatic polypeptide.

Kapangidwe ka macroscopic ka chiwalo kamakhala ndi mutu, thupi ndi mchira. Ndi mchira womwe umakhala ndi ma buluku ambiri opangidwa ndi ma pancreatic omwe amapanga mahomoni.

Kusakhazikika kwamapangidwe mu kukula kwa chithokomiro, kuwonjezeka kwa chiwalo chonse kapena m'madipatimenti ake pawokha kungawonetse kukhalapo kwa zovuta m'matenda komanso kukula kwa matendawa. Kukula kwa ziwalo zonse ndikwanira. Pankhani yakuwonjezeka kwa kukula kwa magawo amodzi a kapamba, amachedwa wamba.