Pancreatitis ndi ascites

Pancreatitis ndi nthenda yotupa ya kapamba, momwe ma enzymus omwe amatulutsidwa ndi iwo amathandizira mu gland yokha, m'malo moponyedwa mu duodenum. Matendawa amatha kuonekera pa zaka zilizonse ngati njira yodziyimira payokha, komanso motsutsana ndi matenda ena am'mimba.

Pancreatitis nthawi zambiri imagawidwa malinga ndi mawonekedwe a chotupa, kupezeka kwa matenda, zizindikiro za morphological, komanso nthawi ya matendawa. Ponena za matendawa, chithunzi chake cha chipatala chimasiyanitsa:

• Acute pancreatitis, momwe matenda amapezeka mwachangu, ali ndi dalili.
• Pachimake kupezekanso kapamba, momwe zizindikiro amatchulidwa, koma zimawoneka nthawi ndi nthawi.
• Pancreatitis yosatha, momwe zizindikiro zake sizimatchulidwira, koma ndizosatha, zimakulitsidwa ndi zifukwa zosiyanasiyana. Matenda a kapamba amachitika m'magawo awiri: kuchulukitsa ndi kukhululuka.

Nawonso, pancreatitis pachimake imapezeka m'magawo angapo:

• enzymatic: masiku 3-5,
• yogwira: masiku 6-14,
• gawo lobwereza: kuyambira tsiku la 21,
• zotsatira: miyezi 6 kapena kupitirira.

Matenda a chifuwa chachikulu amagawika m'mitundu iwiri pazomwe zimachitika:

• Pancreatitis yoyamba: imachitika ngati matenda odziyimira pawokha.
• Second pancreatitis: limachitika motsutsana ndi maziko am'matumbo ena, mwachitsanzo, matenda amtundu wam'mimba, zilonda zam'mimba.

Zomwe zimayambitsa matendawa Matenda oyamba kwambiri a kapamba amapoledzera ndi kusuta fodya, kutuluka kwa ndulu chifukwa cha mabala am'mimba otupa, kupezeka kwa cholelithiasis komanso kusadya bwino. Komanso matenda amtundu wa m'mimba amatha kupweteketsa kapena kugwira ntchito pa kapamba komanso kugwiritsa ntchito mankhwala ena osafunsa dokotala.

Zizindikiro Zizindikiro za pancreatitis pachimake zimatengera mtundu wa momwe zimakhalira Mwachitsanzo, pancreatitis yayikulu, munthu amatha kudandaula za kupweteka kwam'mimba chifukwa cha kuphulika, kuwotcha thupi, kusanza mseru, kusanza, kutulutsa tulo tokhala ndi tinthu tating'onoting'ono tambiri, kufooka kwa thupi, kutentha thupi mpaka 38 madigiri. Pancreatitis aakulu, Zizindikiro zake sizimatchulidwa ndipo zimakhala kwamuyaya. Matendawa amatha kuzindikiridwa ndi kupezeka kwa kupweteka kwamankhwala a herpes zoster, kukulitsidwa pambuyo podya zakudya zamafuta, mwa mseru wosanza komanso kusanza, chopondera chopondera thupi ndi kuchepa thupi.

Kuzindikira Kuti mudziwe matendawa, mudzafunika kufunsidwa kwa dokotala wofufuza m'maso kapena dokotala wa opaleshoni. Kenako, madotolowo adzakuwuzani njira zoyenera zodziwikitsira, zomwe zingaphatikizepo:

• kuyesa kwamagazi ndi ambiri,
• Ultrasound yam'mimba,
• CT kapena MRI
• endoscopic retrograde cholangiopancreatography (ERCP): kuyang'anira ndulu ndi ma pancreatic ducts.

Chithandizo Kudzinyenga nokha pancreatitis kunyumba sikungangowononga thanzi, komanso kungayambitse imfa. Ndiye chifukwa chake, ngati muwona mawonekedwe omwe ali ndi mawonekedwe, muyenera kulumikizana ndi gastroenterologist kuti akupatseni mankhwala ofunikira .. Choyamba, kusala kudya kumayendetsedwa kuti muchepetse katundu kuchokera ku gland ndipo ayezi amamuyikira pamimba kuti athetse ululu.

• kupweteka kwa antispasmodic
• pancreatic enzyme-kuchepetsa mankhwala
• antioxidants ndi mavitamini.

Opaleshoni imalembedwa chifukwa cha kufa kwa gland (pancreatic necrosis) kapena kusagwira bwino kwa chithandizo chamankhwala.

Mavuto Acute pancreatitis amatha kukulitsidwa ndi pancreatic necrosis, mapangidwe abodza a kapamba, pancreatic abscess, pancreatogenic ascites, ndi zovuta zam'mapapo.

Ngati simukufuna kukhudzana ndi kapamba, muyenera kusiya mowa ndi kusuta, kudya zakudya zabwino komanso zosakwanira, ndikufunsani dokotala munthawi yake ngati mukukayikira kuti muli ndi matenda amitsempha.

Chifukwa chiyani madzimadzi amadziunjikira m'mimba?

Kwa zaka zambiri, osagwirizana ndi gastritis ndi zilonda zam'mimba?

Mutu wa Bungwe: “Mudzadabwa momwe kuliri kovuta kuchiritsira matenda am'mimba ndi zilonda mwakumwa tsiku lililonse.

Zizindikiro zamtundu wa ascites ndizowonjezera kukakamiza kwa m'mimba, kuwonjezeka pamimba kuchokera kuzinthu zochuluka.

Pochizira gastritis ndi zilonda zam'mimba, owerenga athu amagwiritsa ntchito tiyi wa Monastic bwino. Kuwona kutchuka kwa malonda, tidaganiza zoperekera chidwi chanu.

Ascites (kuchuluka kwa madzimadzi) kumasokoneza kugwira ntchito kwa mapapu ndi ziwalo zam'mimba.

Zomwe zimapangitsa kuti madzi azikhala mosiyanasiyana zimatha kukhala zosiyana: ascites imatha kuwoneka chifukwa cha zovuta zingapo za thupi, matenda a ziwalo. Choyambitsa chachikulu cha ascites chingakhale cirrhosis.

Kuzindikira kwa ascites kumachitika pogwiritsa ntchito ultrasound ndi kuyesedwa kwa dokotala. Pambuyo pakuzindikira, chithandizo chimatenga nthawi yambiri. Muyenera kupulumutsa munthu kuchokera ku ascites komanso ku matenda omwe adayambitsa nthawi yomweyo.

Kutalika kwa maphunzirowo, kuopsa kwa matendawa, kupititsa patsogolo kwake kumadalira thanzi la munthu, chomwe chimayambitsa matendawa. Ascites amatha kuoneka mwadzidzidzi kapena pang'onopang'ono pakupita kwa miyezi ingapo.

Zizindikiro za ascites zimayamba kuwonetsedwa ngati madzi opitilira lita imodzi atumphuka pamimba.

Zizindikiro za kuchuluka kwamadzi amadzimadzi:

• kupuma movutikira
• kuchuluka kwa kulemera ndi kuchuluka kwa m'mimba,
• kutupa kwa miyendo
• kubwatula
• kusapeza bwino pakugwada
• kuphukira pamimba, ululu,
• kutentha kwa mtima
• scrotal edema (mwa amuna).

Nthawi zambiri, poyamba, munthu amatchera khutu kuzizindikiro monga kumerera kwa msana, kukulira kwa m'mimba - pamalo oyimilira, pamimba amachepetsa, amawoneka ngati mpira, ndipo munthu akagona, m'mimba "amadzuka".

Mwa akazi, zodziyera zotuwa zitha kukhala chizindikiro - ichi ndi chimodzi mwazizindikiro za ascites.

Zizindikiro zina zimaphatikizidwa ndi zovuta zowonjezera, zomwe zimayambitsa ascites.

Mwachitsanzo, ngati madzi owonjezera amayamba chifukwa cha kupanikizika mu ziwindi za chiwindi, ndiye kuti mitsempha imatchulidwa pamimba (kutsogolo, mbali).

Ngati mavuto ali m'matumbo pansi pa chiwindi, ndiye kuti zizindikiro za matendawa ndi kusanza, jaundice, nseru.

Tuberculous ascites amadziwika ndi zonsezi pamwambapa, komanso mutu, kuwonjezeka kutopa, kufooka, komanso kugunda kwamtima mwachangu.

Mavuto otumphuka m'mitsempha ya m'mimba amathandizira kukulira kwam'mimba kwambiri. Ngati pali mapuloteni osowa, ndiye kuti zizindikiro za ascites ndikutupa kwa malekezero, kufupika kwa mpweya.

Ngati matendawa amakhudzana ndi mavuto m'mitsempha ya m'mimba, ndiye kuti ma ultrasound a mitsempha, ziwiya za malo amvuto zimayikidwa. Ngati oncology ikukayikiridwa, kuwunika kwa ultrasound kumachitidwanso.

Matenda a pancreatic ascites

Kuchulukitsidwa mu peritoneal patsekeke ndi OP kumawoneka nthawi zambiri, komabe, pancreatic ascites ndichinthu chachilendo kwambiri cha phenological. Nthawi zina, kukula kwa njira yowonjezera m'mimba sikumatha bwino; kuyambiranso kumachitika pambuyo pa OP ndikukhazikika ndi chizolowezi chodzikundikira pang'onopang'ono. Zomwe zimayambitsa, monga tafotokozera pamwambapa, zitha kukhala kupsinjika ndi thrombosis mu portal vein system. Izi zimawonedwa nthawi zambiri ndi OP kapena kuvulala kwamphamvu kwa CP m'magazi a chiwindi - kuphatikizidwa kwa pancreatic kumbuyo kwa kuwonongeka kwa matenda amitsempha yamagazi ndi kufalikira kwa matenda a portal kumachitika mu ascites yeniyeni.

Nthawi zambiri, pancreatic ascites amapezeka pang'onopang'ono kwa odwala omwe amapezeka kuti ali ndi ziwalo zam'mimba zam'mimba. Zotsatirazi zimathandizira kukulitsa kwa pancreatic ascites: chipika cha retroperitoneal lymph node (parapancreatitis) ndi matenda oopsa mu thoracic lymphatic duct, kuperewera kwambiri kwa mphamvu ya protein monga kwashiorkor.

Mitundu iwiri yosiyanasiyana yamatenda a pancreatic ascites imasiyanitsidwa. Mu njira yoyamba, kutsatira kupezeka kwa vuto la kupweteka kwambiri, madzi amadzimadzi amadzaza m'mimba, omwe amayamba chifukwa chokhazikitsidwa ndi mbali ya pancreatic duct ndi mapangidwe a pseudocysts omwe amalumikizana ndi m'mimba. Njira yachiwiri imadziwika ndi kudzikundikira pang'onopang'ono kwamadzi motsutsana ndi njira yam'mbuyomu ya CP, yomwe imawonedwa nthawi zambiri pakuwonongeka kwa malo ochepa a pancreatic cyst.

Kuzindikira sikovuta. Ascites amatsimikizika mwakuthupi, omwe amatsimikiziridwa ndi maphunziro owonjezera (njira za ultrasound, x-ray). Ascites nthawi zambiri imayendera limodzi ndi pleural komanso pericardial activation, makamaka odwala omwe ali ndi genesis ya ascites (portal matenda oopsa, kwashiorkor, matenda oopsa a thoracic lymphatic duct).

Matendawa amatsimikiziridwa ndi laparocentesis. Kuchuluka kwamadzimadzi pamimba yam'mimba nthawi zambiri kumakhala kofunika kwambiri ndipo kumatha kufika malita a 10-15. Madzi omwe amapezeka nthawi ya laparocentesis ali ndi mtundu wachikaso wowoneka bwino, mapuloteniwo sapitilira 30 g / l, kuwunika kwa cytological, lymphocyte predominate. Pafupipafupi, ma ascites amakhala achilengedwe. Ntchito ya ma pancreatic michere mu ascitic fluid imakulitsidwa.

Laparocentesis ndi kutuluka kochulukirapo kwa madzi osakanikira kumakhala ndi kanthawi kochepa, kuphatikizika kwam'mimba kumayambanso mwachangu. Laparocentesis sayenera kubwerezeredwa, popeza izi ndi mankhwala othandizira, ngakhale kuti kwakanthawi zimasintha thanzi la wodwalayo. Kubwerezabwereza kwa laparocentesis kumachulukitsa kuchepa kwa magazi ndipo kumatha kubweretsa zizindikiro za kwashiorkor chifukwa chotaya mapuloteni ambiri ndi madzi a ascitic.

Ndi pancreatic ascites, pharmacotherapy yokhala ndi octreotide (sandostatin) mu Mlingo wabwinobwino kwa masabata 2-3 ndikulimbikitsidwa, ndiye kuti opaleshoni imachitidwa.

Popeza pancreatic ascites imachitika makamaka chifukwa cha ma pancreatic cysts, chithandizo cha opaleshoni chitha kuganiziridwa ngati chokhacho chokwanira, ndipo chofunikira kwambiri ndikulowera mkati mwa ma cysts. Monga chithandizo chowonjezereka, mankhwala omwe cholinga chake ndi kuchiza matenda osokoneza bongo a chidakwa, kuthandizira pazakudya ndi kukonza hypoproteinemia, komanso diuretics (spironolactone) ziyenera kugwiritsidwa ntchito.

Pancreatogenic pleurisy

Pleural imprusion mu pancreatitis nthawi zambiri imayenda ndi ma pancreatic ascites ndipo imachitika kawirikawiri pamaso pa pancreatic cyst moyandikana ndi diaphragm, makamaka pamene ikuwonjezera, komanso ndikupanga fancula ya pancreatic yomwe imatseguka mu pleural patsekeke. Kukongoletsa kwa chotupa chokongoletsera m'mitsempha ya m'mimba kumayambitsa kukhazikitsidwa kwa purulent.

Kuzindikira koyenera kumakhala kovuta pokhapokha ngati mukupimidwa sikumawululira nthawi zonse zikhalidwe za pathognomonic pleurisy. Matendawa amadzakhazikika pofufuzira ziwalo za x-ray. Kufunika kofunikira pofufuzira ndikumangodula mosiyanasiyana, komwe kumalola kumveketsa mtundu wa kulowetsedwa ndikuzindikira njira zamankhwala ena. Kuphatikiza apo, ndi kuphatikizika kwakukulu, makamaka purulent, punctuation punction ingagwiritsidwenso ntchito pochiritsa (kuthamangitsa exudate, kuthetseratu kukakamiza kwa atelectasis, kuyambitsa kwa maantibayotiki mu pleural patsekeke, ndi zina).

Kapangidwe ka kapamba ka pancreatogenic kamatsimikiziridwa ndi kutsimikiza kwa ntchito ya pancreatic michere mmenemo. Ngati kulumikizana kwa cystic-pleural kumayikiridwa pambuyo pobaya, kafukufuku wosiyanitsa (pleurography yokhala ndi madzi osungunuka) amachitika kuti awone uthenga wotere kapena mkati mwa kapamba ka fancula.

Ngati zadziwika kuti chomwe chimayambitsa kuphatikizika kwa pleural ndi pancreatic cyst, kuchitapo kanthu kwa opaleshoni pa cyst palokha ndikofunikira (drainage wamkati kapena kunja, cystectomy, mbali yamanzere pancreatic resection, etc.). Monga chithandizo chosasinthika, octreotide (sandostatin) amagwiritsidwa ntchito pa mlingo wa 200 μg subcutaneily katatu pa tsiku kwa milungu ingapo, yomwe imachepetsa kwambiri kupanga zomwe zili mu cyst.

Mitsempha ya Varicose yam'mero ​​ndi m'mimba

Mitsempha yopanda hepatogenic varicose ya esophagus ndi m'mimba imatuluka pamene mitsempha ya portal ndi nthambi zake imapanikizika ndi mutu wokulirapo wa pancreatic kapena pancreatic cyst, kapena chifukwa cha thrombosis yawo. Choyipa chachikulu ndichotsetsa magazi m'mitsempha ya varicose, zizindikiro zazikulu zomwe ndi kusanza kwamagazi kapena kusanza kwa "malo a khofi", melena, pachimake posthemorrhagic anemia, hypovolemia mpaka hemorrhagic.

Conservative mankhwala a kuphatikizika ali okwanira kulowetsedwa-magazi, makonzedwe a etamsylate ndi waukulu Mlingo wa ascorbic acid. Kuti mukwaniritse hemostasis yakwanuko, ndibwino kugwiritsa ntchito kafukufuku wa Blackmore, yemwe amakakamiza mitsempha yotupa ya magazi a esophagus ndi Cardia kwa maola angapo (mpaka tsiku). Ngati mwanjira imeneyi sizingatheke kuyimitsa magazi m'matumbo, pitani kuchiteni opaleshoni.

Kuchita opweteka kwambiri kumagwiritsidwa ntchito - gastrotomy ndikung'ambika mkati mwa mitsempha yotulutsa magazi m'matumbo a gastroesophageal motsutsana ndi kukhazikitsidwa kwa kumanzere kwa m'mimba ndi kufinya kwam'mimba. Ndi mitsempha ya varicose yoyambitsidwa ndi kupindika kwa mitsempha ya portal kapena nthambi zake ndi pancreatic cyst, kukhetsa kapena kuchotsa kwa cyst kumabweretsa osati kusiya magazi, komanso kufalikira kwa mitsempha ya varicose.

Mallory - Weiss Syndrome

Matenda a Mallory-Weiss amapezeka ndi odwala osakwana 3% pomwe njira yotupa kapena yowonongeka mu kapamba ikuwonekera posanza pafupipafupi kapena mosasangalatsa. The morphological maziko a matendawa amakhala ndi zigawo za mucous membrane ndi submucosal wosanjikiza khoma lam'mimba m'dera la matumbo kusintha, makamaka kuchokera kumbali ya kupindika kocheperako. Kupuma, kuti pakhale mawonekedwe osintha ofunikira ofunikira amasintha ndikusinthika kwa gawo la m'mimba limodzi ndi ziwiya za varicose, kulowetsedwa kwazinthu zina ndi micronecrosis mu gawo lamatumbo. Kukula kwa mitundu yochepetsa matenda oopsa a portal sikuwonetsedwa.

Zomwezi zomwe zimathandizira kuukira kwa kapamba, kumwa mowa kwambiri komanso kudya kwambiri, zimayambitsa chitukuko cha matenda a Mallory-Weiss. Mu pathogenesis, kufunikira kwakukulu kumaperekedwa pakutsekeka kwa kutsekeka kwa zamkati ndi pyloric zamkati, zomwe zimapangitsa kuti chiwopsezo chiziwonjezereka mwadzidzidzi pazovuta za intragastric panthawi ya kusanza. Chofunika kwambiri ndikuwonjezereka kwa mucosa wam'mimba ndikuwunikira kwa esophagus, komanso kukhalapo kwa chophukacho chotsekemera cha esophageal kutsegulidwa kwa diaphragm.

Mawonetsedwe azachipatala a Mallory-Weiss syndrome amapangidwa ndi zizindikiro zapadera za kutuluka magazi ndi zizindikiro za kuchepa kwa magazi. Tiyenera kukumbukira kuti mwa achinyamata omwe ali ndi edematous pancreatitis, ngakhale amatuluka magazi, kuthamanga kwa magazi kumatha kukhalapo kwa nthawi yayitali, kosagwirizana ndi kuchuluka kwa magazi.

Diagnosis of Mallory-Weiss syndrome imakhazikitsidwa ndi data ya EGDS yadzidzidzi, yomwe imalola osati kungoyambitsa zomwe zimayambitsa magazi komanso kudziwa kuya kwa kusiyana kwake, koma kuchita hemostasis yakudziko. Mukamachita endoscopy, kuunika kwathunthu kwam'mphepo, m'mimba ndi duodenum ndikofunikira, chifukwa odwala omwe ali ndi OP komanso kuchulukitsa kwa CP, kukokoloka kwachilengedwe ndi zilonda zam'mimba nthawi zambiri kumatha kupezeka.

Chithandizo cha Mallory-Weiss syndrome chimaphatikizanso kukhazikitsidwa kwa mankhwala a antiemetic: metoclopramide (cerucal) intramuscularly kapena domperidone (motilium) pang'onopang'ono patsiku la 40 mg. Mofananamo, chithandizo cha hemostatic ndi kulowetsedwa chimayikidwa. Mankhwala othandizira opaleshoni amakhala poyambitsa matenda a Blackmore (kwa maola 12) monga maziko a chithandizo cha hemostatic. M'masiku amakono, endoscopic diathermic (bipolar) kapena laser coagulation yopanga mucosal imawonedwa ngati njira ina. Kukhazikitsidwa kokhazikika kwa ma PPIs (omeprazole, lansoprazole, rabeprazole), komwe kumalepheretsa mapuloteni a thrombus wopangika mu lumen pamimba chifukwa cha kutchinga kwa ntchito ya pepsin,

Zilonda zam'mimba komanso zam'minyewa

Zowopsa zomwe zimapangitsa kuti pakhale kukokoloka pachimake komanso zilonda zam'mimba mwa odwala ndi kapamba:
• ukalamba,
• Kulephera kwa chiwindi ndi encephalopathy,
• Kulephera kupuma ndi hypoxemia yayikulu,
• Hypovolemia ndi hemodynamic kusakhazikika,
• matenda a hepatorenal,
• pancreatitogenic peritonitis, purulent-septic njira mu kapamba ndi parapancreatic fiber,
• kuchitapo koopsa kwa necrotic pancreatitis kapena matenda ena a kapamba.

Zilonda zam'mimba komanso zotupa za esophagogastroduodenal zone zitha kupezeka ndikuwunika kwatsatanetsatane wa endoscopic mu 2/3 ya odwala omwe ali ndi OP. Nthawi zambiri, kukokoloka ndi zilonda zam'mimbazi zimapangidwa kumtunda ndi thupi lam'mimba, kawirikawiri m'matumbo. Zilonda zam'mimba nthawi zambiri zimakhala zingapo.

Mukukula kwa zovuta za hemorrhagic, nthawi yomwe ikukonzekera - kutulutsa magazi kumawonedwa kuyambira masiku atatu mpaka 20 chitukuko cha chiwonongeko cha pancreatic.

Pathogenesis ya zilonda zam'mimba, kusintha kwa zilonda zam'mbuyo zam'mimba komanso kupezeka kwa magazi pachimake chifukwa cha izi zimaphatikizapo izi: kusokonezeka kwa microcirculation m'malo osiyanasiyana am'mimbamo, kukondoweza kwambiri kwa secretion ya chapamimba ndi kuchepa kwa mphamvu ya zotumphukanso za pancreatic.

Kuphatikizika kwa ischemia, bile acid ndi lysolecithin, hypersecretion ya hydrochloric acid ndi kuchuluka kwa pepsin mwachilengedwe kumasuntha bwino zomwe zidalipo za mucosal kuzungulira pazovuta. Mavuto am'deralo a heestasis nthawi zambiri amaphatikizidwa ndi kuchepa kwa zinthu zina chifukwa cha kusokonekera kwa kapangidwe ka chiwindi kwa odwala omwe ali ndi chidakwa cha CP ndi CP yovuta chifukwa cha subhepatic portal matenda oopsa, hepatoprivial syndrome, komanso kulephera kwa chiwindi.

Mwa odwala ambiri omwe ali ndi kapamba, zilonda zam'mimba komanso zotupa zimapweteka kwambiri, samawonetsa kawirikawiri ndi chipatala chotulutsa magazi, kusanza "chifukwa cha khofi" komanso kugwedezeka kwa hemorrhagic, amayamba kuwonetsedwa ndi melena, omwe nthawi zambiri amapezeka pambuyo pa tsiku lokha magazi. Malo otsogolera pakuzindikira ndi a endoscopic mayeso, ngakhale kutuluka magazi kungayikiridwe odwala omwe ali ndi nasogastric kapena kawiri-lumen lerintestinal probes ya chakudya chokwanira.

Mankhwalawa ndi ovuta, akuphatikiza ammudzi (mothandizidwa ndi endoscopy) ndi systemic he hetatic chithandizo, kugwiritsa ntchito ma gastric secretion blockers, cytoprotectors ndi antioxidants, akutsatiridwa ndikuyambitsidwa kwa mankhwala omwe amasintha microcirculation ndikukonza.

Zolakwika zomwe zimachitika kawiri kawiri mzipatala za opaleshoni ndizomwe zimathetsa chithandizo chamankhwala atayimitsa magazi, kugwiritsa ntchito atropine, pirenzepine, ranitidine mu Mlingo wokhazikika kapena ma antacid ngati blockers, zomwe sizili zomveka mu "nthawi" ya IDUs. Mankhwala osankhidwa motere ndi omeprazole ndi lansoprazole paulamuliro wa makolo. Ndi magazi kwambiri, kugwiritsa ntchito octreotide, analogue yopanga somatostatin, imagwira ntchito.

Mankhwala othandizira zilonda zam'mimba amasonyezedwa kukhetsa kwa nthawi yayitali kapena kubwereza magazi, ngakhale mwakakhalidwe, komweko kapena endoscopic heestasis yomwe ilipo.

Pancreatic fistula

Fistula wa kapamba ndi amodzi mwa mavuto omwe amaphunziridwa bwino pancreatology. Izi zimachitika makamaka chifukwa cha kupezeka kwachilendo kwa vuto ili (ngakhale kuchuluka kwa odwala omwe ali ndi pancreatic fistula kwadziwika posachedwapa). Pancreatic fistula nthawi zonse imagwirizanitsidwa ndi duct system ya kapamba, imatha kuwonekera pamutu, thupi kapena mchira wa kapamba.

Pancreatic fistulas agawidwa:
• zomvetsa chisoni, zolemba pambuyo, komanso zam'mbuyo,
• kumaliza (kotheratu) komanso kosakwanira (kofunikira),
• chakunja (chotseguka pakhungu kapena pang'onopang'ono mpaka kulowa pachilonda cha khomo lam'mimba kapena chifupifupi cham'mimba) ndi mkati (kotseguka mpaka mbali ya pancreatic cyst, ziwalo zoyandikana ndi ena kapena ma patsekeke ena - mwachitsanzo, pleural).

Kuti mupeze matenda am'mimba a pancreatic fistula, ndikofunikira kudziwa ma enzymes ophatikizika mu fistulous discharge ndi fistulography.

Mankhwalawa pancreatic fistula, kuphatikiza kopindulitsa kwambiri kwa njira zothetsera komanso opaleshoni. Fistulas yosakwanira komanso yosavuta imayendetsedwa molingana ndi pulogalamu ya CP yodziwikiratu ndi njira yoyeretsa yoyambira komanso yolimba, yochotsa maceration mozungulira. Chithandizo chokhazikika cha pancreatic fistula chakhala chopambana kwambiri posachedwa pokhudzana ndi kukhazikitsidwa kwa octreotide (sandostatin) mu pancreatology. Mukamagwiritsa ntchito mankhwalawa, kuchepa kwa kuchuluka komwe kumachoka pang'onopang'ono nthawi 10 kapena kupitirirapo kumadziwika, komwe kumakupatsani malipiro azisokonezo zamagetsi, kukonza mokwanira mawonekedwe owongolera komanso kuthetsa khungu lonse. Pali umboni kuti octreotide mu tsiku lililonse la 100-300 μg amathandiza kutseka fistula woposa 70% mwa odwala mkati mwa masiku 6.

Kukhalapo kwa pancreatic fistulas kumabweretsa zovuta zambiri: kusokonekera kwa malabsorption chifukwa cha kuchepa kwa michere, kuchepa kwaposachedwa chifukwa cha kuperewera kwa malabsorption komanso kutayika kwakanthawi kwamapuloteni, madzi am'mimba komanso kufufuza zinthu zokhudzana ndi kuperewera, kuperewera kwapafupipafupi (kuwonjezeredwa kwa fistula, abscesses of the ridiling poutrement. zotupa zosiyanasiyana za pakhungu kuzungulira fistulous ndima (ulcerative dermatitis, eczema), magazi akutuluka.

Kuti muwonetsetse momwe mungagwiritsire ntchito mankhwala opangira opaleshoni, makamaka pakapita nthawi yayitali (masabata a 4-6) komanso osagwiritsa ntchito mankhwala othandizira, ndikofunikira kuchita fistulography, momwe zingatheke kudziwa kulumikizidwa kwa njira yolimba ndi GLP, kupezeka kwa mafunde, mawonekedwe a cystic. Kuwonjezeka kwa nthawi yokhazikika yochizira odwala omwe ali ndi pancreatic fistula kumawonjezera zotsatira za kuchitira opaleshoni. Ndi ma fistulas athunthu kapena osakwanira a pancreatic fistulas omwe amalimbana ndi pharmacotherapy, njira ina yothandizira pakuchita opaleshoni ikhoza kukhala chithandizo chamankhwala - "kudzaza" fistula ndi magawo a pancreatic duct system ndi zida za polymeric.

Gelatoprivial syndrome, tepatocellular insufficiency ndi hepatic encephalopathy

Gelatoprivial syndrome ndi complication ya pachimake, kwambiri kapamba matenda. Zimayambitsa hepatoprivial syndrome:
• kuwonongeka mwachindunji kwa chiwindi ndi pancreatic, hemorrhagic kapena zoopsa, kuphatikizidwa ndi kuvulala kwachikondwerero (chotchedwa chiwindi cha mantha),
• pancreatitis yowononga kwambiri, yopezeka ndi endotoxemia wambiri wopanda chithandizo (chotchedwa pancreatic-hepatic insuffence),
• kuledzera tizilombo toyambitsa matenda tizilombo toyambitsa matenda tikayambitsa matenda obwera chifukwa cha matenda obwera chifukwa cha zotupa za OP (zotchedwa kufooka kwa chiwindi, kapena chiwindi cha septic),
• portal mtsempha thrombosis,
• kulowererapo kwa opaleshoni ya kapamba (mwadzidzidzi kapena kukonzekera) ndi kuvutika kwakukulu komanso kuthekera kwachitetezo cha mankhwala ochita kupanga, makamaka motsutsana ndi maziko a kuphwanya kwakukulu kwa chiwindi asanafike opaleshoni,
• cholestasis yayitali komanso yayitali, makamaka motsutsana ndi maziko a kuwonongeka kwa chiwindi ndi poizoni chifukwa cha opaleshoni, OP, zizindikiro za kusiya, mankhwala osokoneza bongo a hepatotoxic, etc.

Kukula kwa hepatoprivial syndrome kumadziwika ndi kusintha kwakuya kosiyanasiyana kwa mapuloteni opanga ntchito ya chiwindi, makamaka, kusintha pazomwe zimapangidwa ndi mapuloteni a Whey (albin, transerrin, serum cholinesterase), mawonekedwe a zilembo za cytolysis ndi cholesstasis.

Chithandizo cha zovuta - etiotropic, pathogenetic komanso chisonyezo. Njira zokhudzana ndi chilengedwe ndizosiyana ndipo cholinga chake ndicho kukonza zomwe zimayambitsa matendawa. Kugwiritsa ntchito hepatoprotectors (heptral, ursofalk, forte ofunika), antioxidants (ascorbic acid, oligogai-Se, unitiol, etc.), glucocorticoids (prednisolone, methylprednisolone), detoxification chithandizo ndi chithandizo chazakudya ndizoyenera. Detoxization imaphatikizapo osati kulowetsedwa mankhwala, komanso njira zowonjezera za hemocorrection (plasmapheresis, hemosorption). Makamaka a enterosorbents (enterosgel, polyphane) amagwiranso ntchito, ndipo lactulose (dufalac) ndi othandiza kwambiri.

Hepatocellular insuffidence ndi gawo lovuta kwambiri la hepatoprivial syndrome lomwe limatha kuyenda limodzi ndi mitundu yayikulu ya OP, cholestasis yotalikirapo yotsutsana ndi maziko a chipika cha gawo la wamba la duct, biliary-amadalira CP yokhala ndi gawo lalitali la bile duct calculus. Kukula kwa hepatopellular kusowa kwa odwala omwe ali ndi kapamba nthawi zambiri kamakhala kokwanira, monga momwe amathandizira ndi viral kapena hepatitis ya mankhwala, nthawi zambiri zimachitika molingana ndi mtundu wopendekera, womwe umachitika chifukwa cha kupatsirana kwina kwa hepatostabilizing mwa zina mwa zinthu zofunika kuzisamalira.

Chowonetseratu chachikulu cha matenda a hepatocellular insufficiency ndi hepatic encephalopathy. Mawu akuti hepatic encephalopathy amadziwika kuti amatanthauza zovuta zonse za matenda ammatumbo omwe amayamba chifukwa cha kuwonongeka kwa chiwindi kapena kupweteka kwa chiwindi. Mavuto osinthika a mitsempha komanso malingaliro amasinthasintha mwamphamvu ndipo amatha kuwonedwa mosiyanasiyana, zomwe zimapangitsa kusiyanitsa magawo (zovuta) a hepatic encephalopathy.

Kuchiza kwa hepatic encephalopathy kumakhalabe ntchito yovuta, chifukwa kuchotsedwa kwa mankhwalawa chifukwa cha matendawa sikutheka nthawi zonse, ndipo njira zogwiritsidwa ntchito masiku ano ndizomwe zimagwiritsidwa ntchito m'njira zambiri ndipo sizofanana. Ambiri mwa gastroenterologists amalimbikitsa kugwiritsa ntchito mapuloteni otsika, kugwiritsa ntchito mankhwala othandizira mankhwala osokoneza bongo komanso njira zosiyanasiyana zoyeretsa matumbo, kugwiritsa ntchito maantibayotiki pofuna kukonza matumbo, kusintha kwapakati pa kuzungulira kwa urea, ma amino acid, otsutsa a benzodiazepine receptors ndi mankhwala ena.

Pofuna kuchepetsa mapangidwe a ammonia m'matumbo, lactulose (duphalac) imagwiritsidwa ntchito - kupanga disaccharide yomwe imagwera mkati mwa kolon mu ma lactic ndi acetic acids, imatsitsa pH m'matumbo a lumen, imalepheretsa kuyamwa kwa ammonia. Mlingo wa mankhwalawa amasankhidwa payekhapayekha (kuyambira 30 mpaka 120 ml / tsiku). Ngati simungathe kugwiritsa ntchito mankhwalawa, mumayamwa enema (300 ml ya madzi pa 700 ml ya madzi kawiri pa tsiku).

Kufunika kwakukulu kwa hyperammonemia mu pathogenesis ya hepatic encephalopathy ndiye maziko a mankhwala omwe amathandizira kutsutsana kwa ammonia m'chiwindi. Chodziwika kwambiri ndi L-ornithine-L-aspartate.

The kuwonekera kwa hepatocellular kusakwanira ndi hemorrhagic syndrome n`zotheka - pali mphuno ndi chiberekero magazi, zotupa pa jekeseni ndi cannulation malo mitsempha, hemorrhage zotupa pa miyendo, m'malo povutikira, kupezeka kwa m'mimba kumayambira.

Ma labotale a hepatocellular osakwanira ngati koyamba cholestasis amadziwika ndi hyperbilirubinemia, ndipo pali "kusintha kwa mtsogoleri" - gawo la bilirubin lomwe silinapangidwe limakulirakulira. Ndi kuwonongeka kwa chiwindi, postoperative hepatorenal syndrome yokhala ndi zotsatira za encephalopathy, hyperbilirubinemia imatha kukhala yochepa. Hypercholesterolemia imazimiririka, kuchuluka kwa cholesterol yathunthu m'magazi seramu kumayandikira gawo lotsika la malire (3.5 mmol / L), zomwe zimapangidwira cholesterol gawo ndizochepa. Kuchuluka kwathunthu kwa albumin kumatsika kwambiri (mpaka 20 g / l), ngakhale kuli kwovuta kupsinjika, kusintha kosadziwika bwino mu urea ndi chithandizo chokwanira cha pulasitiki chogwiritsa ntchito zakudya zopanda pake.

Hypoalbuminemia yomaliza nthawi zambiri imaphatikizidwa ndi hyperazotemia. Gawo lalikulu la nitrogenous slag ndi ma nitrogen polypeptides omwe samayamwa ndi chiwindi. Ntchito za serum pseudocholinesterase ndi kuchuluka kwa ceruloplasmin, transerrin imachepa kwambiri, zomwe zimawonetsa kusokonezeka kwakukulu kwa mapuloteni opanga ntchito ya chiwindi. Fomu yotsalira ya kuchepa kwa hepatocellular imadziwika ndi kukula kwa edema syndrome, kuphatikiza ascites, gawo lofunikira pakukonzekera komwe kumasewera osati kokha ndi hypoproteinemia yomwe ikukula komanso kuwonjezeka kwa portal venous pressure, komanso kuchepa kwa mphamvu ya chiwindi ndi aldosterone.

Kusintha kwakukulu mu coagulogram ndi mawonekedwe a kuchepa kwa hepatocellular: kuchepa kwapang'onopang'ono mu index ya prothrombin (mpaka 60% ndi kutsika), proconvertin (pansipa 40%), kuchepa kwapang'onopang'ono kwa ndende ya fibrinogen, ngakhale kupezeka kwa odwala ena omwe amagwira ntchito yotupa yoyipa-yotupa, yomwe nthawi zambiri imathandizira kupsa mtima. Nthawi yomweyo, ntchito ya fibrinolysis ndi proteinolysis imakulanso.

The cytolytic labotale syndrome mwa odwala amakhala ndi zizindikiro za kuwonjezeka kosayenera kwa aspartylaminotransferase ndi kunamizira kwamatenda a de Ritis coeffnty. Ntchito zapamwamba za γ-glutamyl transpeptidase zimatsalira, koma pazovuta kwambiri zimachepa. Kuwona kuchepa kwakukulu kwa zochitika za chitetezo cha antioxidant zachilengedwe, ngakhale kuchulukitsa pang'ono kwa lipid peroxidation (komwe kumatsimikiziridwa ndi kuchuluka kwa malondialdehyde ndi diene conjugates) kumakhala ndi zotsutsana ndi thupi la wodwalayo ndi hepatoprivial syndrome.

Kuchita bwino kwa hepatocellular kusakwanira kumatheka pokhapokha pamlingo wa precoma. Kubwezeretsanso magazi, komwe kumakupatsani mphamvu zamagetsi (kuchuluka kwa plasma yokhala ndi Mlingo waukulu wa vicasol) sikupereka mphamvu yokhazikika. Pogwiritsa ntchito mphamvu zamagawo (glucose), munthu ayenera kukumbukira za kuchepa kwa kulolera kwa insulin kwina ndi mwayi wokhala ndi hypoglyxmic state.

Kubwezeretsanso kuchepa kwa albumin pogwiritsa ntchito saluretics (ndi impso zowonongeka pang'ono) kungachepetse zovuta za edematous-ascitic syndrome. Pofuna kuponderesa kukula kwa mabakiteriya, kumeza maantibayotiki osagwiritsanso ntchito ngati kanamycin (mpaka 4 g / tsiku), tobramycin, polymyxin, ndi zina zotere.

Amagwiritsa ntchito antioxidants mwachindunji (Vitamini E mpaka 600-800 mg / tsiku intramuscularly, dibunol mkati), komanso mankhwala omwe amakhazikika machitidwe oteteza antioxidant (5 ml unitiol katatu patsiku). Kugwiritsa ntchito hepatoprotectors (heptral, forte zofunika, ndi zina) kungakhale kopanda phindu mukamakhalabe ndizomwe zimayambitsa kuperewera kwa hepatocellular.

Kuchepa kwa kuopsa kwa hyperbilirubinemia ndi kuwonjezeka kwa kuchuluka kwa magazi ndi kuchepa kwa magazi mu ntchito ya fibrinolytic, kukhazikika kwazinthu zokhala ndi serum albin, ceruloplasmin (komanso pambuyo pake mankhwala a serum cholinesterase), kuchepa kwa mafotokozedwe a lipid peroxidation product m'magazi ndikuwonetsetsa kuti wodwalayo akuchira.

Kodi zimachitika bwanji?

Zomwe zimapangitsa kuti madzi azisokonekera:

• oncology (mawonekedwe oyipa),
• matenda a chiwindi (opezeka 75% ya anthu)
• kulephera kwa mtima
• matenda osiyanasiyana a impso
• chifuwa chachikulu
• kuchuluka kwa chiwindi
• Matenda azachipatala (mwa akazi),
• kapamba.

Imodzi mwazovuta kwambiri ndi kukhalapo kwa oncology. Wodwala yemwe ali ndi vuto lokhumudwitsa komanso wodwalayo amatha kupatsidwa opaleshoni.

Makanda atsopano amathanso kuvutika ndi ascites. Nthawi zambiri amayamba chifukwa cha zovuta m'matumbo am'mimba mwa mwana, zosiyanasiyana edgenital edema.

Zowonadi, pankhani iyi, zoyambitsa zazikulu za matenda ndi matenda osiyanasiyana kapena zizolowezi zoyipa za amayi omwe anali atanyamula mwana.

Madzi ochulukirapo angayambitse kusowa kwa mapuloteni muzakudya za mwana. Nthawi zina zakutsogolo kwa ascites kwa akhanda kumakhumudwitsa

Kuti mumvetsetse bwino chifukwa chake madzi ochulukirapo adayamba kudziunjikira mthupi, muyenera kupita kukaonana ndi katswiri ndikuzindikira zinthu zamagetsi.

Njira yodzikundikira kwamadzi ndi ma diagnostics

Kukula kwa matenda mwa munthu aliyense kumachitika mosiyanasiyana. Tiyeni tiwone thupi la munthu kuti timvetsetse bwino momwe izi zimachitikira.

Mkati mwake muli nembanemba wa serous (membrane) wokutira ziwalo. Imaphimba ena kwathunthu, ena samakhudza. Kuphatikiza pa ziwalo zokuta, nembanemba imatulutsa madzimadzi.

Masana, chimakhala chobisalira komanso cholowa, kuti ziwalozi zizigwira ntchito bwino osagwirizana. Ngati munthu akuvutika ndi madzimadzi owonjezera, ndiye kuti ntchito yake yopanga imaphwanyidwa.

Kusintha kotereku kumachitika, ndikupanga malo abwino a poizoni. Pankhaniyi, Zizindikiro zomwe zimadziwika zimawonekeranso.

Ngati munthu akudwala matenda a chiwindi, ndiye kuti madzimadzi amadziunjikira mwanjira ina.

Pali njira zinayi za mapangidwe a ascites:

1. Ndi cirrhosis ya chiwindi, kupsinjika kwamphamvu kumachitika, chifukwa pali kuchuluka kwa madzi am'mimba,
2. Thupi limayesetsa kuchepetsa kuchuluka kwa mitsempha ndi ngalande zamitsempha. Mankhwala oopsa a Lymphatic amapangidwa (thupi silingathe kulimbana ndi katundu), madzi amatuluka kuchokera m'matumbo kupita m'mimba. Kwa kanthawi, amayamwa mumadzi, kenako amasiya kulimbana nawo,
3. Ndi cirrhosis ya chiwindi, kuchuluka kwa maselo a chiwindi kumachepa, mapuloteni ochepa amapangidwa, madzimadzi amasiya zotengera, peritoneum yaulere imatha,
4. Pa nthawi yomweyo ndi kuchuluka kwa madzi m'mimba, ndipo kutuluka kwa magazi kumatuluka. Kenako kutsika kwa kuchuluka kwa mkodzo kumatulutsidwa, kuthamanga kwa magazi kumakwera.

Pambuyo pa mfundo yachinayi, kudzikundikira kwamadzi kumathamanga ndipo kumachulukana. Mavuto ena chifukwa cha oncology (ngati alipo) ndizotheka.

Ngati munthu ali ndi vuto la mtima, ndiye kuti chiwindi chake chimadumpha, chifukwa chamadzimadzi chimatuluka m'matumbo ake.

Kutupa kwa peritoneum kumapangitsa kuti pakhale madzi ambiri, omwe sangathe kupirira, chifukwa chomwe amalowerera peritoneum.

Madokotala nthawi zambiri amagwiritsa ntchito ultrasound, yomwe imathandizira kuzindikira ascites. Pamodzi ndi izi, chiwindi chimayesedwa ngati matenda enaake.

Ultrasound imachitidwanso kuti imvetsetse momwe mtima ulili, mitsempha ya wodwala, malo omwe madzi akhathamira.

Mutha kuyeserera popanda ultrasound - kupanga palpation pamimba pa wodwalayo. Ngati kugwedeza kwamadzi kumamveka, ndiye kuti ascites amapezeka.

Tekinoloji zamakono ndi ultrasound zimakupatsani mwayi kuti muganize zamadzimadzi okhala ndi voliyumu yoposa theka la lita.

Ikani hepatoscintigraphy (analog ya ultrasound) kuti mupeze momwe chiwindi chilili, kuchuluka kwa matenda a cirrhosis.

Mlingo wa cirrhosis, kukula kwake kumakhazikitsidwa ndi coagulometer - chipangizo chomwe chimathandiza kudziwa kugunda kwa magazi.

Madokotala nthawi zina amatenga magazi a venous fetoprotein, omwe amatha kudziwa khansa ya chiwindi yomwe imayambitsa madzi ochuluka.

X-ray ya ziwalo zimathandizanso kuzindikira. Mwachitsanzo, X-ray yamapapu ithandizira kuzindikira kuchuluka kwa chifuwa chachikulu, kupezeka kwa madzimadzi, zomwe zimapangitsa kuchuluka kwa madzi.

Pali angiography - kafukufuku wamagazi (analogue of ultrasound), omwe amathandiza kudziwa zomwe zimayambitsa ascites (ascites of vascular source).

Kuwunika kwa biopsy kwa peritoneum ndi chiwindi ndikotheka. Nthawi zina madokotala amatenga mayeso amadzimadzi, atatha kafukufuku. Wodwala angafotokoze kuwunika kwa urea, sodium, creatinine, potaziyamu.

Njira zochizira matenda

Tsopano pali njira zingapo zochitira ascites. Matendawa nthawi zambiri amagwirizana ndi kuphwanya kwam'mimba, chiwindi.

Pochizira gastritis ndi zilonda zam'mimba, owerenga athu amagwiritsa ntchito tiyi wa Monastic bwino. Kuwona kutchuka kwa malonda, tidaganiza zoperekera chidwi chanu.

Poganizira izi, madokotala nthawi zambiri amakupatsani zakudya zopanda zakudya zambiri, zakudya zoyipa, mowa, ndi mchere.

Sopo wochepa-mafuta, msuzi wazakudya wophika pa nkhuku, nyama yamphongo imalimbikitsidwa. Porridge iyenera kusinthidwa ndi mtedza.

Odwala omwe ali ndi ascites ayenera kutsatira zakudya mosamalitsa, apo ayi pamakhala chiopsezo cha zovuta kapena kubwereranso matenda.

Simungadye radish, adyo, anyezi, radara, sorelo, kabichi, turnips, mitundu yosiyanasiyana ya zipatso zamitundumitundu. Mkaka wa skim ndi mkaka wa skim wokha ndi womwe muyenera kudya.

Simungathe kudya yokazinga, amchere, komanso onunkhira. Zakudya zosiyanasiyana zakusuta, soseji, mphodza ndizosavomerezeka. Confectionery kuchokera pa mtanda, kuphika kulikonse ndikothekanso.

Komabe, zakudya za matendawa sizitanthauza kuchepa kwakukulu kwa zakudya zamunthu. Wodwala ayenera kumwa zakumwa zoziziritsa kukhosi.

85% ya mbale iyenera kuwotcha. Mkate ukhoza kuwuma. Nyama zophika nyama zikulimbikitsidwa. Mutha kuphika phala popanda mapira.

Mazira amatha kudyera ngati omelet, kamodzi kapena kawiri pa sabata. Pakudya mchere, mutha kudya zakudya zamafuta, marshmallows.

Cholinga chachikulu cha chithandizo choterocho ndikupangitsa odwala kuti achepetse thupi. Pakatha sabata, munthu ayenera kutaya ma kilogalamu awiri.

Ngati izi sizingachitike, ndiye kuti amatumizidwa kuchipatala, okodzetsa amamulembera. Wodwala nthawi zambiri amayesa ma electrolyte m'mwazi.

Pambuyo panjira yodwala, chithandizo cha matenda omwe ali ndi ascites chimatha kusintha.

Opaleshoniyo amalembedwa makamaka muzovuta, ngati chithandizo cha zakudya ndi mankhwala sichithandiza. Monga lamulo, ndi lingaliro loterolo, zotsimikizika za ascites ndizokhumudwitsa.

Zotheka kuti wodwala wotereyu atha kukhala ndi gawo limodzi la oncology. Zizindikiro za ascites ndi njira zakufufuzira zamakina zithandizira kudziwa izi mwatsatanetsatane.

Tsopano pali ntchito zotsatirazi zochizira ascites:

1. Kukhazikitsa kwa shunt machitidwe
2. paracentesis, kupyoza kwa khoma lam'mimba (transudate imachotsedwa pambuyo popuma),
3. Thirani chiwindi.

Chochita chodziwika kwambiri chothana ndi ascites ndi kubowoleza khoma pamimba, momwe timadzi tomwe timatulutsa mwaulere timangotuluka.

Mitundu ina yolowerera imafunikira mikhalidwe yapadera - anesthesia, kuyang'anira bwino. Mwachitsanzo, kufalikira kwa chiwindi kumachitika ndi ma degree a oncology osiyanasiyana.

Ngati wodwalayo adayikiridwa paracentesis, mankhwala am'chipatala amachitika - dera la navel. Pambuyo pa izi, kuyika kwa sentimita imodzi kutalika kumachitika, kupompa kwamadzi owonjezera kumayamba.

Kuchita uku kumaphatikizapo kukhala pomwe wodwala amakhala.

Tiyenera kudziwa kuti opareshoniyo ali ndi zotsutsana zina. Pali chiopsezo cha hepatic chikomokere, magazi amkati.

Odwala omwe ali ndi matenda opatsirana, mtundu uwu wa opaleshoni umayesedwa. Paracentesis nthawi zina amayambitsa zovuta - emphysema, kukha magazi m'mimba, ndi kufooka kwa ziwalo.

Nthawi zina opareshoni imachitika pogwiritsa ntchito ultrasound. Pambuyo pakuchita opaleshoni, madzi osungunuka amatha kutuluka m'thupi la wodwalayo kwa nthawi yayitali, zomwe zimathandiza kuthana ndi matendawa.

Omwe akufuna kuthana ndi ascites amatha kugwiritsa ntchito njira zina zamankhwala zomwe zimachepetsa zizindikiro za matendawa.

Mankhwala ena amagwiritsidwa ntchito kwa iwo omwe ali ndi "kufatsa" pang'ono kwa kuchuluka kwa madzimadzi, chiyembekezo chodalirika, komanso osakayikira madigiri osiyanasiyana a oncology.

Dzungu limathandizira kuti chiwindi chizigwira bwino ntchito. Zochizira za ascites (kudzikundikira kwa madzimadzi), mutha kupanga dzungu la dzungu, dzungu lophika.

Parsley tincture nthawi zambiri amagwiritsidwa ntchito ngati diuretic. Supuni ziwiri za parsley zimanyowa mu kapu yamadzi otentha.

Kukula kumafunika kutsekedwa, kumafunika kukakamizidwa maola awiri. Muyenera kumwa mamililita zana a kulowetsedwa kasanu patsiku.

Parsley akhoza kuwanyowa mkaka. Muyenera kutenga muzu umodzi wa parsley, zilowerere mu lita imodzi ya mkaka wotentha, ikani kusamba kwamadzi. Kuumirira theka la ola. Zakumwa ziyenera kukhala zochuluka pamwambapa.

Madokotala nthawi zambiri amapereka okodzetsa. Mankhwala ofananawo amatha kukonzedwa kunyumba. Mwachitsanzo, mutha kupanga zida za nyemba za nyemba.

Matumba amafunika kudulidwa - muyenera supuni ziwiri za ufa wotere. Kenako, muyenera kuwira ufa m'madzi (malita awiri) kwa mphindi khumi ndi zisanu.

Kuti muthane ndi ascites, muyenera kumwa katatu mamililita zana patsiku.

1 Zifukwa zoyambitsa matenda

Ndi ascites, kudzikundikira kwa madzimadzi kumachitika m'mimba, komwe sikutuluka. Nthawi zambiri, madokotala amagwirizanitsa izi ndi kuphwanya kwamchere wamchere ndi edema. Ndikosavuta kuganiza kuti munthu wakwera. Munthu amakhalabe ndi moyo mwachizolowezi mpaka zizindikiro zazikulu zoyambirira zitafika, mpaka matenda atayamba kusokoneza wodwalayo.

Oncological ascites imatha kuchitika motsutsana ndi maziko a matenda ambiri oyipa, pomwe chiwalo chimodzi kapena china sichingathe kuthana ndi zovuta zomwe zimayikiridwa. Kudzikundikira kwamadzi mu peritoneum kumawonekera ndi khansa ya chiwindi, mtima, ndi impso. Izi ziwalo zimagwira nawo gawo logawa madzi kuchokera mthupi lonse. Ngati mavutowo achokera mu mtima, ndiye kuti amayamba chifukwa cha vuto la valavu, myocarditis.

Kulephera kwamkati komwe kumachitika chifukwa cha hypoplasia, chifuwa chachikulu, khansa, kuledzera kwamthupi kumapangitsanso kuchuluka kwa madzi m'mimba. Hepatitis ndi cirrhosis zimayambitsa chitukuko cha matenda.

Choyambitsa matendawa chimatha kukhala oncology. Maselo a khansa akachulukana, amakhudza kugwira ntchito kwa ziwalo zambiri ndi machitidwe ambiri, makamaka ngati zotupa zachiwiri zimatuluka mu ziwalozi chifukwa cha maselo a khansa omwe adalowa chiwalo ndi magazi. Chiwalochi chimasiya kugwira ntchito mwa njira yake, ndipo chifukwa cha ichi - kuchuluka kwa madzi ambiri.

2 Khalidwe

Ascites ali ndi mawonekedwe apadera okhawo. Mwachitsanzo, ngati munthu ali pamsana pake, ndiye kuti m'mimba amayamba kuyenda m'mphepete. Izi ndichifukwa choti madziwo amagawidwanso. Chizindikiro china ndi batani la m'mimba. Ngati mukumenya dzanja lanu pamimba, phokoso chifukwa chamadzimadzi akuchulukirachulukira limakhala gontha. Matendawa amatha kutsagana ndi kuthamanga kwa magazi komanso mavuto kupuma. M'malo osasamalidwa, kuchulukana kwa rectum kumatha kuchitika.

Chithandizo cha ascites zimatengera chifukwa cha mapangidwe ake. Kuti muchotse madzi osakanikirana, wodwalayo amatuluka ndi laparocentesis, cholinga chake ndikutulutsa madziwo pakubaya pamimba.

Ndi magawo apamwamba a khansa, ascites imawonetseredwa ndikuwonekera kwa makoma am'mimba. Mitsempha yomwe ikudutsa m'derali imakhala yotupa. Madzimadzi amatha kudziunjikiranso m'chigawo cha pleural. Ndi khansa, mwayi wokhala ndi ascites, malinga ndi madokotala, ndi 10%.

Koma si khansa iliyonse yomwe imatha kutsagana ndi ascites. Kukula kwa zamatenda kumachitika makamaka ngati wodwalayo:

• khansa ya colorectal
• khansa yam'mimba kapena m'matumbo
• zotupa zoyipa za tinthu tating'onoting'ono tambiri tomwe timayambitsa mazira.

Chiyembekezo chamoyo

Ndi zowonongeka kwa kapamba, mwayi wopanga ascites ndi wocheperako. Ali kwambiri khansa yamchiberekero, mpaka 50%. Imfa ndi matenda amtunduwu sachokera ku khansa, yomwe imachokera ku ascites. Kodi chimachitika ndi chiyani madzi akayamba kuchuluka m'mimba?

Kupanikizika kwapakati pamimba kumakwera, chifukwa chomwe diaphragm imasunthira. Imalowa m'chifuwa. Ndizachilengedwe kuti kupuma komanso ntchito ya mtima kusokonezeka.

Munkhalidwe wathanzi, madzimadzi amapezeka nthawi zonse pamimba. Ma voliyumu ake ndi ochepa, kupezeka ndikofunikira. Zimalepheretsa kulumikizana kwa ziwalo zamkati ndikuzilepheretsa kuti zisamatayane.

Kuchuluka kwamadzi m'mimba yam'mimba imayendetsedwa nthawi zonse. Zowonjezera zimamwa. Ndi oncology, njirayi imasiya kugwira ntchito konse. Mwina kukula kwa zochitika mbali ziwiri. Poyamba, madzi ambiri amapangidwa, chachiwiri sichingamwe madzi kwathunthu. Zotsatira zake, ascites imachitika. Malo onse omasuka amakhala ndi madzi. Vutoli limawonedwa kukhala lalikulu pamene kuchuluka kwa madzi owazidwa ndi malita 25.

Ma cell a khansa amatha kulowa peritoneum, kusokoneza mayamwidwe ake, kuchuluka kwa madzimadzi kumawonjezeka.

Ascites sapezeka mu mphindi imodzi. Kuphatikizika kumachitika pang'onopang'ono - kuyambira milungu ingapo mpaka miyezi ingapo, motero gawo loyambalo silikudziwika. Kupanikizika pachifuwa kumawonjezeka. Zimakhala zovuta kuti wodwalayo azichita zosavuta.

Njira yamatendawa imayendetsedwa ndi cholinga chachikulu - khansa. Momwe mkhalidwewo uliri kwambiri, ndiye kuti kusamba kwa sitejiyo ndi kotsimikizika. Poyamba, ascites sichikhudza mkhalidwe wa wodwalayo, ndiye, momwe madzi amadzisonkhanira, zizindikiro zimawoneka zofanana kwambiri ndi appendicitis.

Ngati mungalowerere nthawi ndi kuyamba kulandira chithandizo, zotsatirapo zake zingakhale zabwino. Kuti muchite izi, chotsani madzi owonjezera ndikutsatira zakudya. Nthawi zambiri, moyo wa wodwala umadalira kwathunthu momwe matenda amayambira, zaka komanso momwe thupi lakhalira.

Pali zinthu zambiri zomwe zimapangitsa moyo kukhala ndi kuchuluka kwa madzi: ngakhale mankhwalawa adachitika, anali othandiza, momwe chotupa chowopsa chidayamba. Ngati wodwalayo ali woopsa kwambiri, ndipo khansayo ili pamlingo wapamwamba ndi metastases, ndipo ascites ikupitirirabe kukula, zizindikiro za matendawa zimawonjezeka, ndipo chithandizo sichimapereka zotsatira zabwino. Potere, odwala amatha kukhala ndi milungu ingapo mpaka miyezi ingapo.

Ngati matendawa ndi ofatsa kapena ochepa, ndipo mankhwalawo ndi othandizira, ndiye kuti odwala oterewa amatha kukhala ndi moyo wautali. Pankhaniyi, tikuyembekeza kuti chithandizo chamankhwala chotsogola chidzatsogolera ku kukwaniritsidwa kwathunthu kapena pang'ono kwa khansa ndi ascites. Koma ndikofunikira kutsatira malingaliro onse a katswiri, khalani mosamala ndikuwuzani kusintha kochepa m'thupi kwa asing'anga.

Zolemba za zakudya za odwala omwe ali ndi kapamba komanso gastritis

• Chakudya cham'mawa - phala lamadzi-amadzimadzi m'madzi kapena mkaka (mpunga, oatmeal, buckwheat, semolina), yophika nyama yamafuta ochepa, tiyi wopanda mphamvu, makeke osapsa.
• Chakudya chamasana kapena chamasana - omelet kuchokera ku mazira awiri popanda yolks, madzi a zipatso.
• Chakudya chamasana - msuzi wamasamba, ng'ombe stroganoff kuchokera ku nyama yophika isanachitike, mikate yoyera yoyera, masamba ophika osenda ndi zipatso, mbatata yophika, zipatso zabwino.
• Zokhwasula - kanyumba tchizi, msuzi wa duwa lakuthengo.
• Chakudya chamadzulo - nsomba yophika kapena yophika, masamba osenda, tiyi ndi mkaka.
• Asanagone, mkaka kapena kefir amafunikira.

Kugwiritsa ntchito mkaka kapena mkaka wothira mkaka m'maphikidwe kuyenera kuyanjanitsidwa ndi mtundu wa gastritis yokhazikitsidwa - ndi acidity yotsika, mkaka wonse umasinthidwa ndi madzi kapena kefir. Kuchuluka kwa shuga, kupatsidwa zachilengedwe mu zipatso ndi ndiwo zamasamba, sikuyenera kupitilira 40 g patsiku ndi 15 g nthawi imodzi.

Malangizo azakudya

Ngati mutsatira malamulo ochepa osavuta pakudya, m'mimba wathanzi amatha kugaya, osadzivulaza, zambiri zomwe odwala amadwala. Poletsa kukula kwa matenda opatsirana am'mimba, chikhalidwe chamadyedwe sichofunikira chimodzimodzi ndi mtundu wa chakudya chomwe mumadya, komanso kwa omwe adwala kale ndi gastritis ndi pancreatitis, kuyang'anira kwake ndikofunikira. Mfundo zazikuluzikulu:

1. Pewani kudya kwambiri. Zakudya zochulukirapo zimakwiyitsa khoma la m'mimba, ndikupanga zotupa ndi zilonda zam'mimba, kuwonjezera, kutentha kwa mtima, kusasunthika komanso kuwola kwa chakudya kumatha kuchitika, zomwe zimayambitsa kusokonezeka kwa kapamba.

2. Chakudya chizikhala cha pafupipafupi komanso chokhazikika. Munthawi yakuchulukirachulukira, ndikofunikira kudya kangapo patsiku, pakatha sabata - 5, matenda osachiritsika - osachepera kanayi. Ndime ya chakudya cholimba kuyambira m'mimba mpaka m'matumbo ndi maola 3-6, mndandanda wazakudya tsiku lililonse umapangidwa kotero kuti maola 3-4 mutatha kudya pamakhala chakudya chambiri.

3. Chakudya cham'mawa chimayenera kukhala choyambirira, ndi chakudya chochepa - osapitirira maola atatu asanagone. Munthu akagona ndipo ali m'malo opingasa, chimbudzi m'mimba chimasiya, ndipo kuvunda kumayamba.

4. Ngati kapamba ndikofunikira kwambiri kutafuna chakudya. Izi zimalepheretsa kukwiya kwa makina, kufulumira kugaya, kuchepetsa katundu pa kapamba. Kuyika hamburger yayikulu tsiku lililonse pakupuma kwamphindi zisanu ndiyo njira yabwino yolowera kuchipatala zaka 25-30 zapitazo.

5. Muyenera kupewa kupsinjika mukamadya, muzilumikizana ndi zakudya. Kuwona kudya kwa matenda a gastritis yochepa ndi acidity yochepa komanso kapamba, ndizofunikira kwambiri kuti tisokonezedwe pazinthu zonse ndikuyang'ana kukoma ndi kununkhira kwa mbale - izi zingathandize kulimbikitsa kugaya chakudya.

6. Ndikofunikira kusiya zizolowezi zoyipa - mowa wokhala ndi kapamba amatha kupha, ndipo kusuta kumayambitsa kupweteka kwamatumbo ndikuwononga ziwalo.

Mukamakonzekera kudya zakudya za kapamba ndi gastritis, dziwani kuti muyenera kutsatira izi kwa moyo wanu wonse. Chakudya chosankhidwa bwino, chosiyanasiyananso komanso chopatsa thanzi chingachepetse nthendayi ndikuwonetsetsa kuti munthu akukhala moyo wopindulitsa, koma chochita china chilichonse chopitilira pamenepo ndi chiopsezo cha kufalikira mwadzidzidzi ngakhale kufa, makamaka kukalamba.

Zambiri

Ascites kapena m'mimba kuchepa kwamatumbo kumatha kuyenda limodzi ndi matenda osiyanasiyana a gastroenterology, gynecology, oncology, urology, mtima, endocrinology, rheumatology, ndi lymphology. Kuchuluka kwa peritoneal fluid mu ascites kumayendetsedwa ndi kuwonjezereka kwa kukhudzidwa kwamkati mwa m'mimba, kukankhira kukongoletsa kwa chifuwa cha chifuwa. Nthawi yomweyo, kupuma kwamapapu kumachepa kwambiri, zochitika zamkati, kayendedwe ka magazi ndi kagwiridwe ka ntchito m'mimba zimasokonezeka. Ma ascites akuluakulu amatha kumayendetsedwa ndi kuchepa kwakukulu kwa mapuloteni komanso zovuta zamagetsi. Chifukwa chake, ndi ascites, kupuma komanso kulephera kwa mtima, kusokonezeka kwakukulu kwa metabolic kumatha kukhazikika, komwe kumapangitsa kufooka kwa matenda oyambitsidwa.

Zoyambitsa ascites

Ascites mu akhanda nthawi zambiri amapezeka hemolytic matenda a mwana wosabadwayo - ndi kuperewera kwa thupi, exudative enteropathy, kobadwa nako nephrotic syndrome. Kukhazikika kwa ascites kumatha kuyenda limodzi ndi zotupa zosiyanasiyana za peritonum: chifuwa chachikulu cha peritonitis, chifuwa chachikulu, mafangasi, parasitic etiology, peritoneal mesothelioma, pseudomyxoma, peritoneal carcinosis chifukwa cha khansa yam'mimba, matumbo akuluakulu, mazira, endometrium.

Ascites amatha kukhala chiwonetsero cha polyserositis (munthawi yomweyo pericarditis, pleurisy ndi dontho la m'mimba), zomwe zimachitika ndi rheumatism, systemic lupus erythematosus, nyamakazi yamitsempha, uremia, komanso Meigs syndrome (imaphatikizapo ovarian fibroma, ascites ndi hydrothorax.

Zomwe zimayambitsa pafupipafupi ndi ascites ndi matenda omwe amapezeka ndi matenda oopsa a portal - kuchuluka kwa kukakamiza kwa njira ya chiwindi (portal vein ndi ma tributaries ake). Matenda oopsa a portal komanso ascites amatha kukhala chifukwa cha cirrhosis, sarcoidosis, hepatosis, chiwindi hepatitis, hepatic vein thrombosis yomwe imayambitsa khansa ya chiwindi, hypernephroma, matenda amwazi, matenda a thrombophlebitis, etc., stenosis (thrombosis) ya portal kapena vena cava, venous stasis ndi kulephera kwamitseko yamkati.

Kuperewera kwa mapuloteni, matenda a impso (nephrotic syndrome, glomerulonephritis), kulephera kwa mtima, myxedema, matenda am'mimba thirakiti (kapamba, matenda a Crohn, matenda am'mimba), lymphostasis yolumikizidwa ndi kupindika kwa thoracic lymphatic duct, lymphangiectasia ndi kutsekeka kwa gawo la lympphic. .

Nthawi zambiri, chivundikiro cha serous pamimba pamimba - peritoneum imatulutsa madzi ochepa omwe amafunikira kuyenda kwamatumbo ndikutseka kwa gluing ziwalo. Izi exudate zimatengedwa mobwerezabwereza ndi peritoneum yomweyo. Ndi matenda angapo, zobisika, zotulutsa ndi zotchinga za peritoneum zimaphwanyidwa, zomwe zimatsogolera ku mawonekedwe a ascites.

Chifukwa chake, pathogenesis ya ascites imatha kukhazikitsidwa pazovuta zovuta zotupa, hemodynamic, hydrostatic, hydrolyte yamadzi, kusokonezeka kwa metabolic, chifukwa chomwe madzi amkati amatuluka thukuta ndi kudzikundikira m'mimba.

Zizindikiro za ascites

Kutengera zifukwa zake, ma psychology amatha kukula mwadzidzidzi kapena pang'onopang'ono, kukulira kwa miyezi ingapo. Nthawi zambiri, wodwalayo amalipira chidwi pakusintha kukula kwa zovala ndi kusakhazikika kwa kukhazikika kwa lamba, kuwonda. Mawonetseredwe azachipatala a ascites amadziwika ndi kukhudzika kwam'mimba, kupsinjika, kupweteka pamimba, kutulutsa, kugunda kwamkati ndi kupindika, nseru.

Momwe kuchuluka kwamadzimadzi kumachulukira, m'mimba mumachulukitsa voliyumu, navel imatuluka. Nthawi yomweyo, pamayimidwe, pamimba pamawoneka zonyansa, ndipo pamalo a supine imayatsidwa, ndikuwoneka m'madipatimenti oyamba ("chule pamimba"). Pokhala ndi kuchuluka kwakukulu kwa kulowerera kwam'maso, kupuma movutikira kumawoneka, kutupa m'miyendo, kusuntha, makamaka kutembenuka ndi mafunde a thupi, ndizovuta. Kuwonjezeka kwakukulu kwa kupanikizika kwapakati pamimba mu ascites kumatha kuyambitsa kukula kwa ma umbilical kapena femoral hernias, varicocele, hemorrhoids, ndi prolfall ya rectum.

Ascites mu chifuwa chachikulu cha peritonitis amayamba chifukwa cha matenda amtundu wa peritoneum chifukwa cha chifuwa chachikulu kapena chifuwa cham'mimba. Kwa ascites of tuberculous etiology, kuchepa thupi, kutentha thupi, komanso kuledzera ambiri amakhalanso ndi chikhalidwe. M'matumbo am'mimba, kuwonjezera pa madzi a ascitic, ma lymph omwe amawonjezeka pafupi ndi mesentery yamatumbo amatsimikiza. Exudate yomwe imapezeka ndi tuberculous ascites imakhala ndi kachulukidwe> 1016, mapuloteni omwe ali ndi 40-60 g / l, zotsatira zabwino za Rivalt, komanso mpweya wabwino wokhala ndi lymphocyte, erythrocyte, maselo endothelial amakhala ndi chifuwa chachikulu cha mycobacterium.

Ascites ophatikizana ndi peritoneal carcinosis amatuluka ndi ma lymph ambiri omwe amakulitsidwa kwambiri omwe amakhazikika mkati mwa khoma lakunja lam'mimba. Madandaulo otsogola ndi mtundu uwu wa ascites amatsimikiziridwa ndi malo a chotupa chachikulu. Peritoneal activation imakhala pafupifupi hemorrhagic mwachilengedwe, nthawi zina maselo a atypical amapezeka mu phompho.

Ndi Meigs syndrome, ovarian fibroma (nthawi zina zotupa za m'mimba zowola), ascites ndi hydrothorax amapezeka mwa odwala. Amadziwika ndi ululu wam'mimba, kupuma movutikira. Kulephera kwamtima kwamitsempha yama mtima kumachitika ndi ascites kumawonetsedwa ndi acrocyanosis, kutupa kwa miyendo ndi miyendo, hepatomegaly, kupweteka kwa hypochondrium yoyenera, hydrothorax. Pakulephera kwaimpso, ascites imaphatikizidwa ndi kutupa kwa pakhungu ndi minyewa yodutsa - masasa.

Ascites, yomwe ikukula motsutsana ndi maziko a portal vein thrombosis, imapitirira, ikuphatikizidwa ndi kupweteka kwambiri, splenomegaly, ndi hepatomegaly yaying'ono. Chifukwa cha kufalikira kozungulira, kutulutsa magazi kwakukulu kuchokera ku mitsempha kapena mitsempha ya varicose ya esophagus nthawi zambiri imachitika. Anemia, leukopenia, thrombocytopenia amapezeka m'magazi a zotumphukira.

Ascites ophatikizana ndi intrahepatic portal matenda oopsa amatuluka ndi minyewa ya dystrophy, hepatomegaly. Nthawi yomweyo, kukula kwa ma venous network mwa "mutu wa jellyfish" kumaonekera bwino pakhungu pamimba. Mu posthepatic portal matenda oopsa, ascites yosalekeza imaphatikizidwa ndi jaundice, yomwe ikuwonetsedwa ndi hepatomegaly, nseru ndi kusanza.

Ascites akusowa kwamapuloteni nthawi zambiri amakhala ochepa, zotumphukira edema ndi pleural effusion zimadziwika. Polyserositis mu matenda amisempha amawonetsedwa ndi zizindikiro zapadera za khungu, ascites, kukhalapo kwa madzimadzi mu pericardial patsekeke ndi pleura, glomerulopathy, arthralgia. Ndikamadzaza m'mitsempha ya m'mimba (chylous ascites), pamimba imachulukana kukula. Ascitic fluid imakhala ndi utoto wopindika, kupindika kwa pasiti, ndipo mu kafukufuku wa zasayansi, mafuta ndi lipoids amapezeka mmenemo. Kuchuluka kwa madzimadzi mu peritoneal patsekeke ndi ascites kumatha kufika 5-10, ndipo nthawi zina malita 20.

Zizindikiro

Nthawi yoyeserera, gastroenterologist imasiyanitsa zina zomwe zingayambitse kuchuluka kwa m'mimba - kunenepa kwambiri, chotupa cha m'mimba, pakati, zotupa zam'mimba, etc. Kufufuza ascites ndi zomwe zimayambitsa, kupsinjika ndi kupindika kwam'mimba, ultrasound yam'mimba, ma ultrasound a venous ndi lymphatic. m'matumbo, chiwindi scintigraphy, diagnostic laparoscopy, ascites madzimadzi kuwunika.

Percussion yam'mimba ndi ascites imadziwika ndi kuzimiririka kwa phokoso, kusintha kosunthika kumalire a kuzimiririka ndikusintha kwa maonekedwe a thupi. Kuyika dzanja lanu pambali pamimba kumakupatsani mwayi kuti mumve kugwedezeka (chizindikiro cha kusinthasintha) mukumenya zala zanu kukhoma lina lakumimba. Kupenda kwa radiology yam'mimba kumakupatsani mwayi wodziwa ma ascites omwe ali ndi voliyumu yaulere yoposa malita 0,5.

Kuchokera pa mayeso a labotale a ascites, coagulogram, zitsanzo zam'magazi a chiwindi, kuchuluka kwa IgA, IgM, IgG, urinalysis kumayesedwa. Odwala omwe ali ndi matenda oopsa a portal, endoscopy imasonyezedwa kuti apeza mitsempha ya varicose ya esophagus kapena m'mimba. Ndi chifuwa fluoroscopy, madzimadzi amatha kuwoneka m'mitsempha ya pleural, kuyimirira kwapamwamba pansi kwa chindapusa, kuletsa kwa kupuma koyenda kwamapapu.

Pa ultrasound yamimba yam'mimba ndi ascites, kukula kwake, momwe zimakhala za chiwindi ndi ndulu zimaphunziridwa, njira zotupa ndi zotupa za peritoneum zimasankhidwa. Dopplerography imakuthandizani kuti muone kayendedwe ka magazi m'matumbo a portal system. Hepatoscintigraphy amathandizira kudziwa mayendedwe a chiwindi, kukula kwake ndi kapangidwe kake, ndikuwunika kukula kwa kusintha kwa cirrhotic. Pofuna kuwunika momwe bedi limakhalira lodzaza, kusankha kwa angiography kumachitika - portography (splenoportography).

Odwala onse omwe ali ndi ascites adadziwika koyamba kuti apite ku diagnostic laparocentesis kuti atenge ndi kuphunzira mtundu wa ascitic fluid: kudziwa kuchuluka, kuphatikizika kwa ma cell, kuchuluka kwa mapuloteni, komanso chikhalidwe cha bacteriological. Muzochitika zovuta kusiyanasiyana kwa ascites, diagnostic laparoscopy kapena laparotomy wokhala ndi chandamale cha peritoneal biopsy akuwonetsedwa.

Ascites chithandizo

Chithandizo cha patathogenetic chimafuna kuthetsa chomwe chimapangitsa kuti madzi azikundana, i.e. Kuti muchepetse mawonetseredwe a ascites, chakudya chopanda mchere, kuletsa kwamadzimadzi, okodzetsa (spironolactone, furosemide pansi pa chivundikiro cha potaziyamu) zimayikidwa, zovuta zamagetsi zamagetsi zam'magetsi zimachepetsedwa ndikuthandizira kwa angiotensin II receptor antagonists ndi ACE inhibitors. Nthawi yomweyo, kugwiritsa ntchito hepatoprotectors, kuphatikiza kwamkati pokonzekera mapuloteni (plasma, solutionin ya albumin) akuwonetsedwa.

Pamene ascites ikulimbana ndi mankhwala omwe amapezeka nthawi zonse, amapita pamatumbo paracentesis (laparocentesis) - kuchotsetsa madzimadzi m'mimba. Pa punct imodzi imodzi, tikulimbikitsidwa kuti tisamuke osapitilira malita 4-6 amadzi akumwa chifukwa cha ngozi yakugwa. Kuchita mobwerezabwereza pafupipafupi kumapangitsa kuti pakhale zotupa za m'mimba, mapangidwe a adhesions ndikuwonjezera mwayi wamavuto amtsogolo a laparocentesis. Chifukwa chake, ndi ascites zazikulu zotulutsira madzi kwakutali, patheter yokhazikika yokhazikika imayikidwa.

Zochita zomwe zimapereka njira za njira zotulutsira madzi amkatikati mwa peritoneal fluid zimaphatikizaponso gawo limodzi la makoma am'mimba. Zochita mwachindunji za ascites zimaphatikizapo ntchito zomwe zimachepetsa kuthamanga mu portal system. Izi zimaphatikizapo kulowetsedwa ndikugwiritsira ntchito mitundu ingapo ya portocaval anastomoses (opaleshoni ya portocaval bypass, transjugular intrahepatic portosystemic bypass surge, kuchepa kwa magazi a splenic), anastomosis ya lymphovenous. Nthawi zina, ndi chosinthika ascites, splenectomy amachitika. Ndi ascites yogonjetsedwa, kupatsirana kwa chiwindi kungasonyezedwe.

Zotsogola ndi kupewa

Kukhalapo kwa ascites kumapangitsa zovuta za matenda oyamba ndikuwonjezera kudwala kwake. Mavuto a ascites amatha kukhala ma bacteria a peritonitis, hepatic encephalopathy, hepatorenal syndrome, magazi. Zotsatira zoyipa za odwala omwe ali ndi ascites zimaphatikizapo zaka zopitilira 60, hypotension (pansi pa 80 mm Hg), kulephera kwaimpso, hepatocellular carcinoma, matenda a shuga, kulephera kwa chiwindi, kulephera kwa chiwindi, etc. Malinga ndi akatswiri pazachipatala cha gastroenterology, wazaka ziwiri kupulumuka kwa ascites kuli pafupifupi 50%.

Kodi ascites matenda a kapamba

Mwambiri, ndi ascites, exudate imadutsa pamizere yolowera kumtunda wammbuyo ndikudziunjikira mmalo ochepa. Pankhaniyi, nthawi zambiri imakhazikika mokwanira pambuyo pakupukusira kwa kapamba, ndipo ndiopsa kwambiri.

Ndi nthawi yayitali ya matendawa, madzimadzi amadziunjikira ndipo amakhalapo m'mitsempha nthawi yayitali. Izi zimatha kuyambitsa necrosis ya minofu ndikuwatsogolera kuphwanya kukhulupirika kwa ma ducts.

Madzimadzi amatengedwa nthawi zonse, koma njirayi nthawi zambiri imatha ndikupanga phlegmon kapena pseudocysts.

Ngati mwa anthu omwe ali ndi vuto la pancreatogenic ascites, kuchuluka kwa amylase kumawonedwa m'magazi, kuwotcha kwachilendo kumakhala kosoopsa ndipo kumatha kupezeka ndi ma opaleshoni othandizira.

Ponena za ulesi pancreatitis, ndi iyo, kuchuluka kwa amylase kumachepetsedwa, madzi amadzaza ndikuchotsedwa ndikubwereza kubwereza kwam'mimba.

Zomwe zimachitika pambuyo pake nthawi zambiri zimakhala zabwino, ndipo m'tsogolo ascites sizimawoneka.

Zifukwa zazikulu zomwe pancreatic ascites zimachitika

Zomwe zimayambitsa kwambiri pancreatic ascites ndi:

1. Pamaso pa pancreatic cyst,
2. Kuletsa ma lymph osakhala mu patroperitoneal patsekiti,
3. Matenda oopsa a thoracic lymphatic ducts,
4. Kuperewera kwa mapuloteni.

Ziyenera kunenedwa kuti pathogenis yathunthu ya ascites sinamveke bwino. Koma zamankhwala zomwe matenda amatenga, zitha kugawidwa m'magulu awiri. M'matumba oyamba, Rhinestone amamva kupweteka kwambiri, madzimadzi amalowa m'matumbo mwachangu ndikudziunjikiramo. Pancreatic necrosis imayamba, ikukhudza gawo limodzi mwa milomo ya kapamba, pseudo-cyst imapangidwa, yomwe imafikira m'malo a retroperitoneal.

Ndi mtundu wachiwiri, chipatala sichinatchulidwe motero. Madziwo amatenga pang'onopang'ono ndikupanga motsutsana ndi maziko azinthu zowonongeka zomwe zimachitika m'dera laling'ono la cyst. Matendawa amapezeka pakuwunika kwa x-ray komanso pambuyo pa laparocentesis.

Kuchuluka kwa exudate komwe kumalowa m'mimba ndi ascites kumatha kufika malita khumi. Laparocentesis pamenepa amathandizira kuchotsa madzimadzi, koma alibe mphamvu yokhazikika. Pakapita kanthawi, amadziunjikiranso, ndipo laparocentesis iliyonse yotsatila imapangitsa kuti mapuloteni ambiri atayike. Chifukwa chake, madokotala amatengera kukonzekera kwa opaleshoni komwe kumachitika patatha milungu iwiri ya mankhwala a pharmacological. Kuthandiza ascites kumaphatikizapo mchere wochepa, wokhala ndi zakudya zama protein.

Madokotala amapereka mankhwala okodzetsa, mankhwala, mankhwala omwe amachepetsa kuthamanga mu mitsempha ya portal (ngati yatukulidwa).

Mavuto a ascites ndi kupewa kwake

Mavuto a ascites ndi osiyanasiyana. Zitha kuyambitsa kukula kwa peritonitis, kupuma, kulephera kwamkati ndi ziwonetsero zina zomwe zimayambika chifukwa cha kuchuluka kwa madzimadzi mu peritoneum ndikukakamiza kwa diaphragm, chiwindi, m'mimba. Ndi laparocentesis pafupipafupi, zomata zambiri zimawoneka zomwe zimasokoneza kugwira ntchito kwathunthu kwa magazi.

Zonsezi ndizomwe zimayambitsa chithandizo chosadziwika kapena cholakwika. Ascites amafunika chithandizo chamankhwala mwachangu, apo ayi chitsogola ndikuwonetsa zotsatirapo zoyipa. Chifukwa chake, pokayikira koyamba matenda, muyenera kufunsa chithandizo kuchokera kwa akatswiri.

Kupatula nthendayi, ndikofunikira kupimidwa pafupipafupi komanso kuperekera chithandizo cha pancreatic. Ndikofunikira kupatula zakudya zamkaka, zamchere, zamafuta kuchokera kuzakudya, kuchepetsa kumwa khofi, zakumwa zoziziritsa kukhosi zomwe zimapatsa mpweya, tiyi wamphamvu. Muyenera kusiyiratu zizolowezi zoyipa, kuthera nthawi yochulukirapo monga momwe mungathere mu mpweya wabwino ndikuyesetsa kuti musakhale amantha pazifukwa zilizonse. Ndi pancreatitis ndi ascites, zolimbitsa thupi zolakwika zimatsutsana, chifukwa chake omwe akuchita masewera ayenera kukhutira ndi masewera olimbitsa thupi.

Kodi ascites akufotokozedwa mu kanema munkhaniyi.