Magulu a kapamba owopsa pachaka malinga ndi Savelyev

KULIMA KWA ACUTE PANCREATITIS

Zotsutsana pakumasulira kwa lingaliro la "pachimake pancreatitis" zikupitirirabe mpaka pano. Ngakhale V.M. Voskresensky (1951), A.I. Abrikosov (1957), ndi ena amakhulupirira kuti pancreatitis yovuta kwambiri ndi yonse yachilengedwe komanso yopanda matenda. Howard ndi James (1962) anati kapamba ka pachimake ndi matenda osachiritsika opatsirana a kapamba. S. V. Lobachev (1953) ndi olemba ena ambiri, M'malo mwake, amakhulupirira kuti matendawa amakumananso. Olemba ena adaganiziratu kuti pancreatitis pachimake sichikugwirizana kwenikweni ndi kuyankha kwakutupa. Pankhaniyi, nthawi zambiri amakambirana za mtundu wina wa matenda osachiritsika komanso osachiritsika omwe mwina, amakula ndi mtundu wapadera wa Rufanov I. G., 1925, Majdrakov G. M 1961, Dragstedt et al. 1954, Brocq, Varangot, 1949, Roberts et al. 1950, Pizziecco, 1960, Goldstein et al., 1963, Hess, 1969, ndi ena. Pankhaniyi, akuyenera kusintha mawu oti "kapamba" ndi amakono kwambiri: "kapamba", "kapamba", "pan-creodystrophy", ndi zina zambiri. Majradkov G.M., 1961, Akzhigitov G.N., 1974.

Pomaliza, palinso lingaliro lakuti pancreatitis yachilendo ndi lingaliro chabe ndipo liphatikiza matenda angapo osiyana mu etiology ndi pathogenesis A. Abrikosov, 1957, I. Davydovsky, 1958, A. A. Shelagurov, 1967, Chaplinsky V.V., Gnatyshak A.I., 1972.

Kutsutsana kwa malingaliro a I.V. Davydovsky (1958), omwe amafotokoza pulayimale, kapamba kapamba ndi pancreatic necrosis yachilengedwe yopanda zotupa, ndizosangalatsa. Komabe, ngati mugwiritsa ntchito tanthauzo lake, malinga ndi omwe ". kutupa ndi zomwe zimachitika mdera lachiwonetsero chazinthu zofananira zimalumikizidwa ndi kuwonongeka kwam'kati kapena kuwonongeka kwa minyewa ", ndi". choyambitsa chachikulu cha kutupa ndi kuwonongeka kwa matupi athupi lathu ”1, nanga bwanji ngati kapamba owopsa, yemwe ali ndi ziwonetsero zam'mbuyomu, zothandiza komanso zamankhwala zomwe zimayambitsa kutupuka, sichikutupa?

Maphunziro athu, kuphatikizapo kuphunzira za etiological factor ndi matenda owonera zamatenda a pancreatitis pachimake, kuchuluka kwa zamankhwala am'magazi, laparoscopic, angiographic, intraoperative ndi pathomorphological kwa odwala opitilira 650 ndi kuyesa kwanyama kumatsimikizira malingaliro pazomwe zimayambira aseptic yotupa komanso kusakhazikika kwa matendawa.

Zotsatira za phunziroli zimatilola kukhala ndi pancreatitis yovuta kwambiri monga chilengedwe cha demarcational, chomwe chimadalira njira za pancreatic necrobiosis komanso enzymatic autoaggression ndi chitukuko cha necrosis, kuwonongeka kwa ndulu komanso kuwonjezereka kwa matenda ena. Chifukwa chake, lingaliro la "pancreatic necrosis", lomwe linayambitsidwa m'chipatalachi ndi A. N. Bakulev ndi V. Vinogradov (1951), limagwirizana kwambiri ndi malingaliro amakono pazokhudza matenda a pathogenetic. Kusazindikirika kwachilendo kwa morphological, kogwira ntchito, komanso kwamankhwala chifukwa cha pancreatitis pachimake ndi zotsatira za enzymatic necrobiosis ndi autolysis ya pancreatocytes, komanso kutenga nawo mbali kwa mapangidwe a pancreatic enzyme pakukonzekera kwachilengedwe komanso zochitika zosiyanasiyana za pathological.

Chiwerengero chochulukirapo chazindikirika komanso mwatsatanetsatane komanso poyesererapo chazomwe chimayambitsa kukula kwa njira yotupa komanso kusokonekera kwa kapamba, komanso malingaliro omwe alipo omwe amafotokoza kufunika kwa izi, tithandizireni kunena kuti pancreatitis yovuta kwambiri ndi matenda a polyetiological.

Tidasanthula kuchuluka kwa zinthu zosiyanasiyana zaumunthu zomwe zimapangitsa kuti pakhale pancreatitis yayikulu, kutengera zomwe zidachitika mwa chimodzi mwazinthu zitatu zomwe zimayambitsa matendawa zomwe tidazindikiritsa mosiyana kwambiri ndipo nthawi yomweyo zimalumikizana kwambiri mthupi: 1) makina, 2) neurohumoral, 3) poyizoni .

Gulu loyambirira la zifukwa limaphatikizapo mitundu yonse ya blockade ya hepato-pancreatic ampoule ndi chachikulu pancreatic duct, kuphatikizapo omwe akupanga duodenal dyskinesia, matenda oopsa kapena duodenal pancreatic Reflux, komanso kuwonongeka kwa ziphuphu. Mukuwona kwathu, kuphatikiza kwa zinthu izi mu kuphatikiza kwinanso kumadziwika. Blockade ya hepatic-pancreatic ampoule yokhala ndi ndulu chifukwa chotsimikizika ndi kukakamira kwa chotupa kapena chotupa chotupa cha duodenal papilla yapezeka mu 16.8% ya odwala, mu 47.8% panali kupanikizika kosalekeza kwa sphincter ya hepatic-pancreatic ampoule pafupipafupi chifukwa cha chiberekero chanthawi yayitali. postcholecystectomy syndrome, mu 44,9% ya odwala panali zovuta za ntchito ya duodenum: dyskinesia chifukwa cha zilonda zam'mimba kapena chakudya chosakwanira

kubangula, duodenostasis ndi duodenal pancreatic Reflux. Matenda obwereza kapamba monga chimodzi mwazomwe zimayambitsa blockade ya pancreatic duct yodziwika ndi ife mu 31% ya odwala. Matenda a pancreatic - otsekeka, otseguka komanso othandizira - adatsogolera matendawa mu 5.1% ya odwala. Chifukwa chake, pakati pazomwe zimayambitsa, zovuta zamagulu a sphincter za hepatic-pancreatic ampoule ndi duodenum predomine.

Mwa zina za neurohumoral causative, zomwe zinali zofala kwambiri zinali zovuta za metabolism yamafuta ambiri (30,7%), matenda a mtima (27,8%), matenda: am'mimba (13.6%), omwe nthawi zambiri amakhala ovuta kwambiri kwachiwiri m'matumbo a kapamba (8.9% ), matenda a chiwindi (7.3%), mimba ndi nthawi yobereka (6%).

Tidagawa chakudya ndi mankhwala omwe anali ndi mankhwalawa (7,3%), kupezeka kwa matenda oyipa kwambiri kapena matenda obwera nawo (11.1%) ndi uchidakwa (13.3%) ku gulu la oopsa omwe amachititsa.

Malinga ndi lingaliro lathu, kugawanika kwa zinthu zomwe zimadziwika kuti zimapanga kudziwikiratu, kupanga, ndikusintha kungakhale ndi tanthauzo lofunikira. Zina mwa zifukwa zomwe zimatanthauziratu, kuwonjezera pa zinthu zomwe zimapangidwa motsatira malamulo, zomwe zimatengera kubadwa kwa mwana, komanso nyengo.

Malinga ndi zomwe tawona, zinthu zina zomwe zimapangitsa kuti pakhale zovuta zina ndi zina zokhudzana ndi matenda amisala yodwala komanso kupweteka kwa thupi. Kutengera pa kusanthula kwazinthu zambiri zomwe zimayambitsa kupangika kwa zinthu, tidazindikira mitundu yotsatirayi ya kapamba pancreatitis: 1) ductogenic (duodenobiliary, i.e., Refluxogenic ndi genuinic), 2) cholecystogenic, 3) kukhudzana, 4) angiogenic, 5) pambuyo-zoopsa, 6) cryptogenic , 7) kusokonekera. Pafupipafupi komanso machitidwe amtundu wa etiology omwe amachitika pancreatitis pachimake amaperekedwa patebulo. 1.

Monga tikuwonera patebulopo, mitundu yodziwika bwino kwambiri ya kapamba kapamba, imakhala yofunikira kwambiri, chifukwa njira zingapo zolepheretsa zachinsinsi zimatha kuthetsedwa kokha. Izi zimapangitsa kufunikira kozindikiritsa komwe kumakhala vuto.

Udindo wapazinthu zonse za pamwambapa zomwe zimapangitsa kuti pakhale kuwonongeka kwa pancreatocytes ndikupanga magwiridwe antchito ndi kuyambitsa kwokha kwa machitidwe a pancreatic enzyme.

Zowonetsa zosiyanasiyana za morphological za pancreatitis pachimake ndi mitundu yake yamankhwala zimawonetsedwa m'magulu 46 omwe timawadziwa, omwe nthawi zambiri amakhala ofotokozera. Kupenda koyerekeza kwa magawikawa kumawonetsera kuti onse amasiyana pokhapokha pomanga komanso kutanthauzira kosiyanasiyana kwa mawu molingana ndi kuchuluka kwa chidziwitso chokhudza pathogenetic yamitundu yosiyanayo ndi mitundu yamatendawa.

Kuchokera pa mfundo yogawana ndi morphological, pancreatitis ya pachimake imadziwika kwambiri ndi Carnot (1908), A. I. Abrikosov (1957), Blumenthal, Profestein (1959). Frtihling et al. (1961), Yu. G. Boyko (1970). Kugawidwa kwa Sarles ndi Camatte (1963) kutengera chikhalidwe, ndipo gulu la Duprez ndi Kiekens (1966), Gekula (1972) ndi ena lakhazikitsidwa pa zamankhwala.

Chikhalidwe chofala kwambiri pa zamankhwala komanso zamakhalidwe abwino zopanga gulu, chifukwa zimakwaniritsa zofunikira pakuchita. Kugawidwa koyamba kwa kapamba ka pachimake mu mabuku apanyumba kunavomerezedwa mu 1897 ndi A.V. Martynov. Popanda kufotokoza tsatanetsatane wa mayendedwe azachipatala omwe atchulidwa mu zomwe tanena, tikuwona kuti ndikofunikira kuzindikira kuti "N. e. purulent pancreatitis "imayamba kuwonetsedwa ngati magawo otsatizana a chinthu chimodzi.

Matenda azachipatala komanso morphological a pancreatitis pachimake.

Ine. Mitundu ya Clinical ndi anatomical

Edematous kapamba (abortive pancreatic necrosis)

Pancreatitis Gulu

Kutulutsa kwina kulikonse kwa kapamba ndi kuyesa kusintha mwazizindikiro, mawonekedwe, mkhalidwe kapena digiri ya kusintha, pa nthawi yotupa mu chimodzi mwamagawo ofunikira a m'mimba.

Mitundu ya kapamba ndi ochepa, koma kutupa pakokha ndi kosiyanasiyana. Nthawi zambiri zimakhala zovuta kuyesa kufanana ndi dongosolo limodzi, lomwe lingaphatikizepo kusiyana konse komwe kulipo.

Pancreatitis imatha kufotokozedwa molingana ndi kuopsa kwa vutoli, chizindikiro cha umunthu, kusintha kwa chiwalo, kuchuluka kwa mawonekedwe, ngakhale zovuta zomwe zimatha kuwoneka pakadutsa matendawa.

Pokwaniritsa kumvana, mabungwe azachipatala padziko lonse lapansi amagwiritsa ntchito gulu la Modern Marseille-Roman, lomwe linakhazikitsidwa mwalamulo mu 2989, ndipo mpaka pano silinataye mwayi kapena kudziwika mwapadera.

Momwe vuto limayambira komanso makina ake enieniwo mwangozi

Pancreatitis ndi njira yovuta kapena yopweteka yotupa kwamatumbo, chifukwa cha kuphatikiza kwa zinthu zopanda pake zomwe zimawononga maselo ndi minyewa yofunikira.

Magwiridwe ake ndi gawo lofunikira pakukhazikitsa chimbudzi cha thupi, chifukwa chake kupezeka kwa thupi la munthu ndizinthu zonse zofunika.

Osati kokha ntchito yogaya chakudya zimatengera ntchito za kapamba. Monga chiwalo chilichonse cha endocrine, chimagwira ntchito yopanga mahomoni ena ndi ma enzymes ofunikira pakuwonongeka kwa zinthu zomwe zimapezeka ndi anthu.

Panthawi ya kuphwanya magwiridwe antchito, kapamba samakhudzanso chimbudzi cha chakudya, komanso mkhalidwe wa ziwalo zina za hepatobiliary system, womwe umalumikizana kwambiri komanso umakhudzana, komanso njira za metabolic, kuchuluka kwa chitetezo chokwanira, kuchuluka kwa mahomoni ndi zina zambiri.

Matendawa amakula mosinthika ndipo amayamba kufooka mpaka masinthidwe n atafika pamlingo wina.

Mkhalidwe wa chiwalo panthawiyo umasinthika kale kwambiri kotero kuti njira zochizira ndizochepa pakukonza bwino ndikuwonjezera moyo wa wodwalayo.

Mitundu yodziwika ya njira zoyipa za kapamba ndizofunikira, chifukwa njira ya pancreatitis yovuta pachaka imakhala yopanda mawonekedwe.

Njira ya kapamba wamankhwala amasinthika kwamuyaya ndi ma exacerbation akuti, amakumbukira za chikhalidwe cha kapamba kapamba.

Mavuto a matendawa amateteza thupi osati kokha pafupi ndi ziwalo, amakhudzidwa pafupifupi thupi lonse, ndipo chithandizo cha matendawa sichimapereka zotsatira zenizeni ngati mwapezeka kuti simumayamwa.

Kugawidwa kwa kapamba, pachilichonse chosiyanitsa matendawa, ndikuyesa kulinganiza mwanzeru zomwe zingachitike kuti mudziwe bwino.

Kudziwa chiyambi kumakupatsani mwayi kuti muchepetse zomwe zimapangitsa, chikhalidwe cha maphunzirowa - kuchepetsa kuchuluka kwa kusintha koyipa, kupewa kutuluka kwa zizindikiritso zatsopano, kuchuluka kwa zotupa kapena nthawi yayitali ya matenda kumatanthauza njira zoyenera zamankhwala.

Zambiri zomwe anthu akudziunjikira, ndikazigwiritsa ntchito, sayansi ingathe kuthana ndi matenda wamba.

Kugawika pamilandu iyi ndi mfundo yomwe kapamba amadziwika kuchokera pofunika kuwawona.

Gulu la Mayiko a Marseille

Gulu la anthu padziko lonse lapansi likugwiritsa ntchito bwino MMK, yomwe, mwa mfundo zake, imakhala yoyenera kwambiri ndi ophatikizira a International Classization of Diseases, omwe adalandiridwa mu 2010.

Amadziwikanso kuti gulu lamakono la International Marseille gulu la kapamba ndipo limasiyana pakati pa matendawa ndi magulu akuluakulu asanu okha.

Mfundo za kusiyanasiyana kwa mitundu ndizokhazikitsidwa ndi momwe matendawa aliri, motero, magulu a kapamba amawagawa:

pachimake kapamba
pachimake pancreatitis,
chifuwa chachikulu chokhala ndi matenda oopsa (obwereza),
zotchinga (limodzi ndi kudzipatula ndi mawonekedwe osayenera chifukwa chodwala ma pancreatic ducts),
osavulaza, pomwe matendawa amaphatikizidwa ndi kusintha mwachindunji m'ziwalo.

ICD inaphatikiza kapamba mu gulu la matenda ampamba, koma amangosunga mitundu yambiri ya zilonda zam'mimba, pomwe m'matenda ena a kapamba amatinso mitundu ina ya matenda kapamba, ndikuwunenanso mowa womwe umakhala pagawo lina.

M'mbuyomu izi zisanachitike, mu 1988, akatswiri azachipatala omwe adakumana pamsonkhano wapadziko lonse ku Roma adaganiza zosiya malingaliro akuti kupweteka kwambiri kwa pancreatitis.

Kugawikidwako kwa kapamba, atakonzanso koyenera, adadziwika kuti Marseille-Roman imodzi ndipo sikunakhale chaka cha msonkhano wachipembedzo cha gastroenterologists, koma kufikira chaka chomaliza.

Kufunika kwa Marseille-Roman kumakhala kukanidwa kwa stereotypical, lingaliro lomwe lidalipo kale la kapamba m'mitundu itatu ndikugawidwa kwa mitundu inayi ikuluikulu, yomwe ikadali yamakhalidwe akatswiri.

Mrmk ndi mitundu ya pancreatitis yosatha

Pancreatitis yosatha ndi kutupa kwakanthawi kwa ziwalo zomwe zimachitika motsutsana ndi maziko azinthu zingapo zoyambitsa matenda.

Gulu la Roma-Marseille lapadziko lonse lapansi lomwe limapatsidwaku limasiyanitsa mitundu:

calcifying - mogwirizana ndi kapangidwe ka magawo a chiwalo chamadongosolo amchere a calcium,
zotchinga - chifukwa cha kufalikira kwa mzere waukulu,
yotupa - yotchedwanso fibro-induction (yothandizidwa ndi kulowetsa ziwalo zam'mimba zomwe zili ndi masamba a fibrosis),
kupukusa (kapena fibrosis),
cysts ndi pseudocysts,
kunyowa.

Masiku ano, magawo ogwirira ntchito ndiofala kwambiri, pomwe mitundu iwiri yotsalayo imapatsidwa gawo lina.

Mulinso zovuta za kapamba: ma cysts, ma pseudocysts, ma abscesses, ndi zina zinagawidwa, zotupa, endocrine, matenda opatsirana komanso padera, matenda a portal komanso kuphwanya kwathunthu kwa duct ya bile.

Za magulu azachipatala komanso a morphological a V.T. Ivashkina

Mwatsatanetsatane, mwatsatanetsatane, kutengera pafupifupi zizindikiro zonse zomwe zingatheke, kukulolani kuti mudziwe bwino mtundu womwe ulipo wa matenda.

Mosiyana ndi kuyesa kwina kupatutsa mtundu umodzi wa kapamba kuchokera ku wina, KMK V.T. Ivashkina nthawi yomweyo amatenga malingaliro anayi omwe angadziwike ndikudziwidwa pamaziko a Hardware, maphunziro, mayeso a labotale, kuyankhulana kwamawu ndi anamnesis a:

koyambira (mwina) chiyambi komanso kuthekera kotupa,
mikhalidwe yozikidwa pa kafukufukuyu,
maphunziro azachipatala (mbiri ya zamankhwala ndi mbiri yakale): kawirikawiri kapena mobwerezabwereza, kulimbikira (kumakhala kowonetsedwa molakwika),
kuzindikiridwa (zizindikiro zamankhwala) - obisika, opweteka, ophatikiza, hyposecretory ndi astheno-neurotic (V.T. Ivashkin adazindikira mitundu isanu yamatenda a kapamba chifukwa cha chizindikiro cha kupweteka.

Kusiyanitsa kwa morphological komwe katswiri wasayansi wapakhomo V.T. Ivashkin akutengera pa lingaliro linanso - kafukufuku wazotsatira za tomography (makompyuta ndi magineti a resonance).

Mosiyana ndi gulu lomwe A.I Khazanov adagwirizana zaka zitatu m'mbuyomu, pomwe adasiyanitsa mitundu ya anthu malinga ndi chikhalidwe cha mikhalidwe yachipatala (idaphatikizanso mitundu yotsatirayi ya subacute, pseudo-nthabwala, cystic ndi zomwe zimachitika mobwerezabwereza), Ivashkin adamaliza kusintha pamadongosolo malinga ndi kusintha kwa chikhalidwe.

interstitial-edematous, ndi kuchuluka kwakukulu kwa kuchuluka kwa kapamba ndi kusinthika kwa zinthu zachilengedwe,
Matenda obwereza, okhala ndi chizindikiro chachikulu chosiyanitsa ndi kanyumba kapangidwe kake,
wosakhazikika m'malingaliro, ndi kuwonjezeka kowoneka kwa mzere ndi kuwonongeka kwa minofu,
pseudo-nthabwala, ndi kusintha mu dipatimenti ndi kukulitsa kwa pancreatic duct,
cystic - pakakhala maphunziro, fibrosis ndi kukula kwa duct.

KMK Ivashkina mwina ndi gulu lopambana kwambiri la kapamba, lomwe linapangidwa chifukwa cha zovuta zake, ndipo sizosadabwitsa kuti lalandiridwa ndikugwiritsidwa ntchito kwambiri.

Poyesayesa kufotokozera zomwe zilipo, sikuti zosintha zokha zokha komanso ma duct omwe adawonetsedwa pakuphunziraku adasinthidwa, komanso kuchuluka kwa kukokomeza, madandaulo a wodwalayo pazomwe akuwonetsa, komanso kuthekera kwa zovuta, zochokera ku ziwerengero zamankhwala.

Ubwino wa gulu lokhazikitsidwa wagona chifukwa chakuti limaganizira zomwe zimayambitsa matendawa komanso momwe matendawo angakhalire.

Izi zimapangitsa kuti zikhale zodziwikiratu zomwe zidzachitike ndikuzindikira njira zamankhwala pofuna kupewa zomwe zingachitike.

Kuyesa kwazinthu zina

Mpaka pano, mitundu yambiri yosiyanitsa pancreatitis yakhala ikufunsidwa, momwe kuyesera kwapangidwira kusiyanitsa mitundu yamatendawa malinga ndi amodzi, osati mawonekedwe mokwanira, kapena kutsimikiza, koma gawo lodziwika:

mawonekedwe osakhazikika komanso owuma (malinga ndi chipatala ndi chithandizo), nthawi zina
zoyambitsa kapena pathogenic ejenti (etiology) - yothandiza bediary, uchidakwa, wowononga, mankhwala, parenchymal, nthabwala choseketsa, etc.),
malo a zotupa (thupi, mutu kapena mchira),
kusiyanasiyana kwa mawonekedwe pachimake,
chachikulu kapena sekondale (zimachitika mwachindunji mu chiwalo kapena chimakhala chotsatira cha ziwonetsero zina za ziwalo zogaya chakudya - chikhodzodzo, chiwindi, m'mimba, matumbo),
malinga ndi mawonekedwe a chipatalachi: ndi zizindikiro zambiri, dyspeptic. madzi obisika (adalowa mgulu la Ivashkin, ngati chimodzi mwazizindikiro),
malinga ndi kuchuluka kwa chitukuko (choyambirira, chapakati, chovuta),
mtengo wophedwa
zotheka.

Ngati tizingoyang'ana mopepuka kuti mawonekedwe a pancreatitis oyipa komanso osachiritsika alipo, sizivuta kutembenukiridwa.

Pali katswiri komanso katswiri, KMK Ivashkina, amene amatenga zigawo 4 zikuluzikulu za matenda a kapamba.

Fomu yovuta kwambiri, yomwe idachita bwino pakusiyanitsa kwa chithunzi cha wodwalayo, idaphunziridwa mofananamo.

Itha kugwa pansi pazomwe zimachitika kapena zimasiyana, kutengera thupi ndi mawonekedwe a matendawa.

Mawonekedwe omwe alipo a OP: ndi mawonekedwe ndi mawonekedwe ake

Pancreatitis yovuta kwambiri m'masukulu ambiri azachipatala imadziwika kuti ndi matenda osiyana ndi matenda osatha, kotero pali zisonyezo ndi mawonekedwe ambiri omwe amayesayesa kuigawana.

Zina mwazomwe zimachitika chifukwa cha mawonekedwe enieni, koma pali zizindikiro zosiyanitsa ndi matenda ena aliwonse:

mwamakani, pakakhala mitundu yodonthekera, yovomerezeka komanso yovuta,
malinga ndi mitundu ya zipatala (zamkati komanso zodziwika bwino, kumapeto kwake amasiyanitsa zam'deralo ndi zofala),
ndi chikhalidwe ndi kuchuluka kwa kusintha kwakatundu komwe kumabwera chifukwa cha matendawa (edematous, wosabala komanso kachilombo ka pancreatic necrosis, chifuwa cha pancreatogenic ndi pseudocystosis),
mwamphamvu ndi zizindikiro zooneka (zamkati, zochepa, zosokoneza komanso zodzaza pancreatic necrosis),
pamakhalidwe olimbitsa thupi (makina, neurohumoral, toxico-allergic and alimentary.

Kusiyanitsa kotsatiraku kuli ndi zofunikira, chifukwa zifukwa zambiri zomwe zimayambitsa pancreatitis yovuta kwambiri zimaphatikizidwa m'magulu onse malinga ndi mawonekedwe.

Koma OP ndimatenda a polyetiological ndipo imatulukira motsutsana ndi maziko a malo omwe alipo kale, omwe amafunikanso kukumbukiridwa.

Cop pa Savelyev

Wasayansi wanyumba V.S. Savliev, mogwirizana ndi asing'anga ena, kutengera njira yachikale ya Atlanta, adapanganso gulu lina la pancreatitis yovuta kwambiri, yomwe tsopano ili ponseponse muzochita zamankhwala.

Mulinso zikwangwani zingapo zingapo, zomwe zimavuta kudziwa mtundu womwe ulipo wodwalayo:

kutupa mawonekedwe (mkati) kapena kapamba necrosis (wosabala),
mawonekedwe a zotupa (mafuta, hemorrhagic, osakanikirana),
kuchuluka kwa magawidwe (ochepa kapena akulu, ozungulira, onse),
nthawi (vuto la hemorrhagic, kusakwanira, purulent),
zovuta zazikulu (kuyambira kulowetsedwa mpaka magazi oyambira)
chithunzi cha chipatala
etiology (chakudya, gastrogenic, ischemic, biliary, poizoni, matupi awo onse, idiopathic, zoopsa, zopatsirana, zobadwa nazo).

Ngakhale opambana kwambiri pazomwe akufuna kuchita mwadongosolo, nthawi zonse pamakhala chiopsezo chogwiritsidwa ntchito mosiyanasiyana pakuchita opareshoni kapena pochiritsa.

Nthawi zambiri mawonekedwe a pancreatitis pachimake amatsimikiza pambuyo pa opaleshoni, ngati nkotheka kupanga kafukufuku wodalirika wazosintha zamakhalidwe.

Mulimonsemo, kuzindikira komaliza kumapangidwa pambuyo pa maphunziro onse omwe angathe kuchitika mothandizidwa ndi kusanthula ndi kufufuza kwa maware, ndipo koyambirira kumakhala kusiyanasiyana kwa mitundu iliyonse (yovuta komanso yovuta) mwa mitundu, malinga ndi zizindikiritso ndi nthawi yayitali yowonetsera.

Chifukwa chake, adotolo amatsogozedwa ndi mbiriyakale komanso kufunsa kwamawu, ndikuzindikira komaliza kumapangidwa pambuyo pake.

Gulu la pachimake

Mu 1963, akatswiri pa zamaphunziro a kapamba adakumana pamsonkhano wapadziko lonse ku Marseille, yemwe adatengera gulu limodzi pancreatic phenomena. Zinangokhala ndi zisonyezo. Pali kuchepa kwa kulondola kwadongosolo la magulu. Kugwiritsa ntchito mosavuta pakachipatala, izi zidadziwika mwachangu.

Mwa lingaliro la msonkhano, magawo otsatirawa a pancreatitis pachimake adadziwika:

Lakuthwa.
Zotsatira.
Matenda
Matenda obwereza.

Chidziwitso chosakwanira pa matenda a ziwalo zimabweretsa kubwereza kwa msonkhano wa akatswiri. Pambuyo pazaka 20, mu 1984, koyamba ku Cambridge, kenako ku Marseille, gulu lidasinthidwa ndikusinthidwa kuti lipeze zowonjezera pophunzira za matendawa.

Kugawidwa kwa Cambridge kumakhazikitsidwa pa mawonekedwe a anthropological a kapamba pa nthawi yayikulu yopanga ndondomekoyi, komanso pamankhwala azachipatala komanso kuwunika kwa matenda ena onse. Pancreatitis pachimake imagawidwa pang'onopang'ono komanso njira zazikulu, zomwe zinaphatikizapo phlegmon, cyst yabodza, ndi abscess. Komanso kupatula njira yodwalayo yamatenda.

Msonkhano wa Marseille wa 1984 umakhala ndi pancreatitis yovuta komanso yosatha, ndikugawa iwo mwa chikhalidwe komanso zamankhwala.

Kugawika kwa kusintha kwa pancreatic malinga ndi kuphimba kwa tinthu timene timakhudzidwa ndi glandular ndipo mtundu wa zotupa umayamba kusiyanitsidwa ndi gulu la akatswiri omwe adasonkhana ku Atlanta.

malo kapamba

Matendawa amagawanidwanso ndi mtundu wakuuma: wofatsa, wofatsa komanso wowopsa. Fomu yofatsa imadziwika ndi ululu wa epigastric, dyspepsia popanda chitukuko chachikulu. Zowonjezera, kuwonjezera pazowoneka bwino komanso kufooka kwathunthu, kumayendera limodzi ndi kugwiritsidwa ntchito molakwika kwa ziwalo zapafupi ndi machitidwe.

Matenda amitundu ya pachimake kapamba

Kachitidwe ka gulu la matanthauzidwe amakono a kapamba apanja adadziwika kale ku Atlanta. Kenako idatsimikizika ku Greece mu 1998.

Ndi mwambo kusiyanitsa kapamba, limodzi ndi kuphwanya ntchito kwa ziwalo zonse. Mitundu ya kapamba owopsa:

Amitundu yosiyanasiyana.
Necrotic.
Olowerera necrotic.
Purroc necrotic.

Interstitial pachimake kapamba amamufotokozera ngati njira yofatsa yazizindikiro komanso kuchira. Chithunzi cha chipatala chimawonetsedwa ndi kupweteka pang'ono, kusanza ndi kutsekula m'mimba.

Kuphatikizika kwamadzi (kusakanikirana kwamadzi am'madzi) kumachitika kumayambiriro kwa matendawa ndipo kumakhala kuzama kwa kapamba kapena pafupi nayo. Mavuto a ziwalo zina samachitika kawirikawiri.

Mwachitsanzo, pali kupindika, kapena kutupa kwa mucosa wam'mimba.

Magawo atatu akuwonongeka ali ndi necrotic pancreatitis: hemorrhagic, mafuta komanso osakanikirana. Zizindikiro zake ndizowala, zazitali - kwa 2, nthawi zina 4, masabata, ndikutsatira kukonzanso mu mwezi ndi theka.

Amadziwika ndi kufalitsa kwa atomiki ya acinar parenchyma. Hemorrhagic pancreatic necrosis imakula mofulumira, ndikutsatira minofu necrosis.

Kutupa ndi kuphatikizika kumawonetsedwa ngati mawonekedwe amadzimadzi amadzimadzi a pancreatic necrosis mu retoperitoneal fiber, yomwe ilibe malire.

Mukazindikira, mbali zamagazi mumatumbo a serous zimawonedwa. The foci ya mafuta pancreatic necrosis amatchedwa stearin plaques ndipo amapezeka makamaka pa peritoneum, subcutaneous and pre-proneitoneal mineral minnes, yomwe ilibe malire. Pokhala kukula kwakukulu kwa matendawo, gawo lidzatsimikiziridwa ndi kulowererapo kwa opaleshoni.

opaleshoni ya pancreatic necrosis

Mawu akuti pancreatic necrosis adangotchulidwa mu 1992.

Pancreatic necrosis imayendera limodzi ndi matenda a ziwalo zina ndi machitidwe: myocardial dystrophy, pulmonary edema, pachimake gastroduodenal erosive phenomena.

Ndi kulowetsedwa kwa necrotic, kutsimikizira kwa pancreatic edema (kulowetsedwa) kumadziwika ngakhale ndi palpation. Maphunzirowa ndiwotalikirapo, ophatikizidwa ndi kufooka, kusowa kudya, ngakhale njira zochizira.

Purroc-necrotic ndondomeko chifukwa cha kukhalapo kwa matenda a purulent-putrefactive. Maselo otupa amitundu yosiyanasiyana amaloza chithokomiro, dera lotanganidwa, lomwe limakhudza ziwalo zoyandikana.

Kenako, necrotic pancreatitis imagawidwa m'mitundu iwiri:

Mavuto am'deralo. Pachimake kapamba amawonekera ndi edematous mawonekedwe a parenchyma ndi ziwalo oyandikana, ndi necrosis, abscess, kapena kukula kwa pseudocysts.
Zovuta zovuta za chilengedwe cha pancreatogenic ndi zovuta zama metabolic mwa hyper- kapena hypocalcemia, DIC, kugwedezeka.

Kugawika kwa mawonekedwe osakhazikika

Pa mawonekedwe osakhazikika, magulu angapo amadziwika omwe ndi osiyana ndi mitundu yonse yazizindikiro.

Malinga ndi morphology, mitundu yotsatirayi imasiyanitsidwa:

chamtundu wina
wopatsa chidwi
parenchymal
chotupa
pseudotumorous.

Kutengera kuchulukitsa kwa mawonekedwe owonetsa, osachitanso kawirikawiri komanso pafupipafupi, komanso kapamba wokhazikika, yemwe amadziwika ndi zizindikiro zosalekeza, amadziwika.

Matenda a kapamba, kumachitika ndi zovuta zina:

Zopatsirana. Mbovu imayamba, nthawi zambiri limodzi ndi kutupa kwa ndulu zomwe ma bakiteriya adalowa.
Matenda oopsa a portal. Kupindika kwapang'onopang'ono kwa mitsempha yamtunduwu kumachitika chifukwa cha kutupira kwa minyewa yake.
Kutupa Kukula kwa cyst kapena abscess nthawi zambiri kumakhala kovuta ndi magazi, komanso kumayendetsedwa ndi kulephera kwaimpso.
Endocrine, momwe matenda ashuga kapena hypoglycemia ikupita.
Kulephera mu kutuluka kwa bile.

Kukula ndi chikhalidwe cha zotupa zapakhosi, kapamba amphaka amagawika m'mitundu isanu:

Zosangalatsa. Zizindikiro zowoneka bwino zitha kulandira chithandizo ndikukula kwamtsogolo kwa njira zosinthira. Opaleshoni yamatenda a pakhungu sachitidwa.
Sterile pancreatic necrosis, yomwe imaphatikizapo hemorrhagic, mafuta komanso osakanikirana.
Wosokonekera pancreatic necrosis.
Pancreatogenic abscess.
Pseudocyst yemwe amapezeka kuti akuyamba matendawo. Cysts zabodza kapena ma abscesses mkati mwa mwezi umodzi. Pseudocysts omwe ali ndi matenda osiyanasiyana opatsirana pathogenic amatchedwa dzina la phlegmon - mawonekedwe opatsirana a volumetric okhala ndi purulent zomwe zimakhala.

Kodi kapamba ndi chiyani?

Mitundu yonse yamatenda a kapamba imatha kugawidwa pang'onopang'ono komanso pachimake. Kusintha kulikonse kwa matendawa kumawonetsedwa ndi zingapo za mawonekedwe amphaso ndi kusiyanasiyana. Kugawika komwe kulipo kumagawika minofu yowonongeka kutengera kutengera kwa kupezeka kwa njira ya masinthidwe, kusintha koopsa, kuchuluka kwa kuwonjezeka kwamavuto ndi magawo ena.

Mitundu yonse yamatenda a kapamba imatha kugawidwa pang'onopang'ono komanso pachimake.

Matenda

Matenda apathengo amadziwika ndi njira yobwererera. Mtundu wa matendawa walembedwa mu ICD-10 pansi pa code K86. Matenda a ubongo ndi oopsa, chifukwa mukadzabwezeretsanso chilichonse, mbali ina ya maselo a chiwalo imamwalira ndipo m'malo mwake mumakhala minyewa yotupa.

Matenda amtunduwu amayenda limodzi ndi kuphwanya koonekeratu kwa zida zama insular. Pang'onopang'ono, kuphwanya kumeneku kumabweretsa kuperewera kwa michere. Izi zimatha kusokoneza chimbudzi.

Woopsa milandu, mafinya amapanga ziwalo za pancreatic, zomwe pambuyo pake zimatha kukhala zilonda kapena cyst yabodza.

Mgwirizano

Kuchulukirachulukira kumachitika nthawi zambiri chifukwa cha munthu amene akudwala matenda a kapamba, mafuta okazinga zakudya kapena mowa. Ndi kuchulukitsa, wodwalayo sangathe kuchita popanda thandizo la dokotala. Kutupa kwa minofu chifukwa cha kuchuluka kwa kutupa kumayambitsa kutsekeka kwa ducts ya bile.

Chifukwa chophwanya kutuluka kwa ndulu, ma enzyme amayamba kugwira ntchito mu gland, zomwe zimapangitsa kuti chimbudzi chake chikhale chimbudzi.

Pakuchulukirachulukira kwa kapamba, mwayi wokhala ndi mavuto akulu, kuphatikizapo sepsis ndi magazi, ndiwokwera, kotero wodwala amayenera kupita kuchipatala.

Mowa

Fomu yovuta ya mankhwala osokoneza bongo omwe amamwa mowa amalembedwa mu ICD-10 pansi pa code K85.2. Zili chifukwa cha kumwa kwa nthawi yayitali. Pankhaniyi, zizindikiro zake ndizofatsa.

Odwala amakhala ndi zodandaula za kupweteka mu hypochondrium, zovuta zam'mimba komanso kuwonda. Matenda osokoneza bongo omwe amapezeka pakadali pano amatsogolera kukula kwa matenda osokoneza bongo chifukwa cha kuwonongeka kwa zilumba za Langerhans.

Ngati wodwala sasintha momwe amakhalira, nthawi yochulukitsa imawonedwa. Izi zimafunikira chithandizo kuchipatala kuti akhazikike.

Biliary pancreatitis ndi matenda otupa a England omwe amachitika chifukwa cha kuwonongeka kwa ma ducts a bile ndi minofu ya chiwindi.

Matenda amtunduwu amapezeka kwambiri mwa akulu ndipo pafupifupi samapezeka mwa ana, chifukwa mawonekedwe ake nthawi zambiri amagwirizana ndi kugwiritsa ntchito zakudya zachangu komanso zakudya zina zopanda pake.

Mtundu wa bancary pancreatitis uli ndi code malinga ndi ICD-10 K85.1. Kuphwanya kumeneku kumatha kuchiritsidwa kwathunthu pofunafuna thandizo la kuchipatala panthawi yake. Popanda kulimbana ndi mankhwalawa, pamakhala chiwopsezo chachikulu chotenga vuto lalikulu kwambiri mpaka matumbo athu.

Pancreatitis pachimake mu ICD imawoneka pansi pa code K85. Njira yamatendawa imaphatikizapo:

kunyowa
necrosis ndi wopanda matenda,
mtundu wa hemorrhagic
purulent zotupa a England.

The pachimake maphunziro a matenda nthawi zonse limodzi ndi kuwonongeka msanga mu ambiri mkhalidwe wodwalayo.

The pachimake maphunziro a matenda nthawi zonse limodzi ndi kuwonongeka mwachangu mu mkhalidwe wodwalayo, mawonekedwe a zovuta zam'mimba komanso kupweteka kwambiri m'chigoba. Nthawi zambiri, njira yotupa imayamba popanda kachilomboka, ndipo nthawi zina, kugonjetsedwa kwa England kumachitika chifukwa cha mabakiteriya omwe amalowa m'thupi.

Mankhwala

Mankhwala pancreatitis ndi mtundu wachilendo wa pachimake. Monga mitundu ina yambiri ya kapamba, mankhwalawa amakula chifukwa chakuwonongeka kwa poizoni. Mankhwala omwe angayambitse kutupa kwa tiziwalo timene timaphatikizira:

okodzetsa
sapha mavairasi
maantibayotiki
mankhwala ena ochizira mavuto a mtima.

Pakukula kwa kapamba ka mankhwala, mankhwala omwe amakhala nthawi yayitali sofunikira.

Yogwira

Reactive pancreatitis ndi matenda omwe amadziwika ndi chotupa cha tiziwalo timene timatupa. Njira yamtunduwu imayendera limodzi ndi kuwonongeka pang'onopang'ono komanso kulowa mkati mwa ziwalo.

The yogwira mawonekedwe a matenda kumachitika ngati yankho la thupi matenda osiyanasiyana kutupa m'mimba. Matenda amtunduwu omwe ali ndi chithandizo chokwanira amatha kuchiritsidwa kwathunthu.

Mu njira yoyipa, kuphwanya kumeneku kungayambitse kukula kwa kapamba, limodzi ndi chiwonongeko chachikulu cha ziwalo zathupi.

Dyspeptic

Dyspeptic pancreatitis ndi mtundu wodwala. Kusintha kumene kwa matendawa kumadziwika ndi kuwonongedwa kwakukulu kwa mawonekedwe a dyspeptic syndrome.

Odwala ali ndi dandaulo lotulutsa.

Chifukwa cha kuwonongeka kwa michere ndi magene komanso kuwonongeka kwa ma ducts a bile, kuperewera kwa dongosolo la chakudya kumawonedwa. Odwala amadandaula za:

kupindika pafupipafupi
ukufalikira
kudya zakudya zamafuta,
nseru

Woopsa milandu, mtundu uwu wa kapamba zingayambitse thukuta ndi mtima palpitations. Kuphatikiza apo, kukulitsa kwa zinthu zadzidzidzi ndikotheka. Nthawi zambiri, dyspeptic pancreatitis imayamba chifukwa chogwiritsa ntchito molakwika zakudya komanso mowa.

Pseudotumor

Pseudotumor pancreatitis amapezeka wovuta mawonekedwe. Pankhaniyi, matendawa amadziwika ndi kuwoneka ngati jaundice wokhazikika. Kuphwanya kofananako kumachitika pamene mutu wa gland wakhudzidwa.

Kuwonongeka kwa minofu m'derali kumabweretsa kuwoneka kwa malo a sclerosis.

Chifukwa cha njirayi, mutu wa chiwalo pang'onopang'ono umayamba ndikuyamba kuponderezana duct ya bile.

Mtundu wa pseudotumor wa kapamba umatsatiridwa ndi kupweteka kosalekeza.

Popeza bile siimatha kuyenda m'njira, jaundice imachitika.

Njira ya pseudotumor ya kapamba imayendera limodzi ndi kupweteka kosalekeza komanso kuwonjezeka kwa mavuto am'mimba. Matendawa amayambitsa kuwonda kwambiri.

Nthawi zambiri, kuchitapo kanthu opaleshoni kumafunika kuti wodwalayo akhazikike.

Malinga ndi Ivashkin

V.T. Ivashkin imatanthauzira kapamba malinga ndi mawonekedwe a morphological, kukhalapo kwa zovuta, etiology, mawonetsedwe azachipatala ndi chikhalidwe cha matenda.

Kutengera ndi kusintha kwa momwe matupi a V.T. Ivashkin amasiyanitsa mitundu yotsatirayi:

adampost
wopatsa chidwi
parenchymal
chotupa
zopangika.

Kutengera mawonekedwe a manenedwe azachipatala a V.T. Gulu la Ivashkin m'gulu lake limazindikiritsa mitundu iyi:

zopweteka
kapangidwe
kuphatikiza
chisawawa,
hypochondriac.

Kutengera mphamvu ya kupweteka kwa kapamba, asayansiwa amasiyanitsa:

mawonekedwe osasunthika
njira yobwereza pafupipafupi,
Inde, ndi kutulutsa kochulukirapo kwa njira yotupa.

Gawo lina V.T. Ivashkin amatchula mitundu ya matenda apakhungu, omwe ndi zovuta za matenda otsatirawa:

zotupa zomwe zimayambitsa kuphwanya kwa mapangidwe a bile,
matenda opatsirana
zovuta za endocrine,
yotupa njira
kuchuluka kwa mitsempha ya portal mtsempha chifukwa cha kuwonongeka kwa mtima mu chiwindi ndi ziwalo zina.

Gawo lina V.T. Ivashkin imazindikira mitundu yamatenda a kapamba, omwe ndi zovuta za endocrine.

Kutengera ndi ukadaulo womwe umayambitsa kutupa kwa gland, V.T. Ivashkin amasiyanitsa mitundu yotsatira ya kapamba:

chidziwitso
odalira
dysmetabolic
chidakhwa
zopatsirana
mankhwala.

Gulu la kapamba malinga ndi V.T. Poganizira za etiology, Ivashkin tsopano imawonedwa kuti yatha, chifukwa zina zomwe zimayambitsa matendawa zidadziwika pambuyo pake.

Mitundu ya kapamba malinga ndi Savelyev

V.S. Savelyev adapanga gulu la anthu omwe amagwiritsidwa ntchito kwambiri pancreatitis pachimake.

Monga maziko, adatenga magawo ofunikira monga mawonekedwe, chikhalidwe cha kuwonongeka kwa minofu, kukula kwa njira, maphunziridwe, nthawi ya matendawa komanso zovuta zake.

Kutengera kutuluka kwa V.S. Savelyev anazindikira mitundu yotsatirayi ya kutukusira kwakapha kwa England:

kutupa,
wosabala pancreatic necrosis.

Kutengera mtundu wa minyewa yotupa ya chotupa V.S. Savelyev anazindikira njira zotsatirazi pamatendawa:

Kutengera mtundu wa minyewa yotupa ya chotupa V.S. Savelyev amatulutsa mafuta ndipo
hemorrhagic kapamba.

Mitundu yotsatirayi ya kapamba wak pachimake imasiyanitsidwa potengera kuwonongeka kwa minofu ya tinyezi:

chonse
chapamwamba
chachikulu chachikulu
laling'ono loyang'ana.

Ndi chikhalidwe cha maphunzirowa, kutupira kwakanthawi kachilengedwe kumatha kukhala:

Kuphatikiza apo, wasayansi amasiyanitsa nthawi zitatu zamatendawa. Nthawi yoyamba imatenga masiku 1 mpaka 3 ndipo imayendera limodzi ndi mawonekedwe a zosokoneza za hemodynamic, kuphatikizapo kugwedezeka ndi kuwonongeka.

Nthawi yachiwiri imatenga masiku 5 mpaka 7, yodziwika ndi kuperewera kwa minofu yam'mimba. Nthawi yachitatu imaphatikizidwa ndi mawonekedwe a purulent zovuta.

V.S. Savelyev adapanga gulu la zovuta za pachimake pamatendawa. Gawoli lili ndi:

parapancreatic kulowa
katemera wa kapamba,
kachilombo ka kapamba kachilombo,
peritonitis
pseudocysts
septic phlegmon wa retroperitoneal fiber,
Kutulutsa magazi
chotupa choteteza.

V.S. Savelyev adapanga gulu la zovuta za pachimake pamatendawa. Gululi limaphatikizapo zovuta zoyipa.

Kutengera ndi gulu la V.S. Savelyev, madokotala amatha kupereka zidziwitso zolondola zokhudzana ndi njira yotupa komanso zomwe zingachitike kwa wodwalayo.

Kodi tanthauzo la kapangidwe ka kapamba ndi chiyani?

Pofuna kukhazikitsa matenda olondola, gulu ndi mitundu yapangidwe mu zamankhwala. Chodziwika kwambiri ku Russia ndikugawidwa kwa pancreatitis pachimake malinga ndi Savelyev mogwirizana ndi madokotala (V. A. Gagushin ndi V. I. Filin). Adziwonetsa yekha kuti ndiwothandiza kwambiri. Malinga ndi kagawidwe kameneka, matenda am'mimba amadziwika ndi zizindikiro zitatu: mwa kuopsa kwa matenda, zifukwa zake, komanso chifukwa cha matendawa.

Osatchuka konse ndi gulu la mayiko ena, lomwe lidatengedwa ku Atlanta mu 1992 kenako lotchedwa Atlanta Classization of Acute Pancreatitis. Kuzindikira matenda mwa izi pang'onopang'ono kumawonetseranso tanthauzo lake. Zimagwirizananso ndi gulu malinga ndi Savelyev komanso gulu lamakono la kapamba.

Gulu Losavuta

Kapangidwe kosavuta ka chifuwa chachikulu cha pancreatitis kumaonetsa kusiyanasiyana kwa njira ya pathological:

Pachimake kapamba.
Pachimake kapamba ndi kukula kwa exacerbations.
Matenda a kapamba
Kuchulukana kwa kapamba, kumapitirira mawonekedwe osakhazikika.

Gulu la matenda

Mtundu wa gulu la pancreatitis pachimake umaphatikizapo: Zizindikiro za matenda, kuwonongeka kwa ziwalo, kutsimikiza kwa mayeso a labotale ndi kugwiritsa ntchito bwino kwa mankhwala omwe amagwiritsidwa ntchito. Nthawi yomweyo, mitundu ingapo yayikulu ya matendawa imasiyanitsidwa.

Edematous mawonekedwe a kapamba. Mtundu wofatsa kwambiri wa kapamba, komwe kusintha kwakulu konse kumachitika. Ndi chithandizo choyenera komanso chapanthawi yake, vutoli limathandiza. Mukazindikira wodwala, fupa lokwera m'magazi limapezeka, zomwe zikuwonetsa kukula kwa kutupa. Njira yamtunduwu wa pancreatitis yodziwika bwino imadziwika ndi: kuwonjezeka kwa kutentha kwa thupi, kufinya khungu, kupweteka kwa hypochondrium kumanzere, nseru.
Pancreatic necrosis yochepa. Njira yotupa ndi mawonekedwe amtunduwu wa kapamba imapezeka m'chigawo chimodzi chokhacho - imatha kukhala thupi, mchira kapena mutu. Zizindikiro zake ndi: nseru, kutulutsa, kusanza, kutsekereza m'matumbo. Mukazindikira, kuchuluka kwa shuga m'magazi, mawonekedwe a ma pancreatic enzymes, kuchepa kwa magazi m'magazi omwe amachititsa kuti pakhale mpweya wabwino wapezeka. Ndi chithandizo choyenera, matendawa ndi abwino, koma mawonekedwe amtunduwu amatha kuthandizidwa movutikira kuposa kale.
Diffuse pancreatic necrosis. Fomuyi imayamba ngati chiwopsezo chachikulu cha ma cell a kapamba. Kuphatikiza pa zomwe tafotokozazi, pamakhala kutentha thupi, zizindikiro za poizoni, oliguria, nthawi zina kutulutsa magazi m'mimba. Mu kusanthula - hyperglycemia ndi hypocalcemia. Chithandizo cha mankhwalawa chimafuna kulowererapo mwachangu ndi mitundu ingapo ya mankhwala. Nthawi zambiri, njira imodzi yochizira yothandizira kupatsirana pancreatic necrosis ndi opaleshoni.
Onse pancreatic necrosis. Njira yamtunduwu wa kapamba imakhudza kapamba wonse. Wodwala amakula m'mapapo, aimpso komanso kulephera kwa mtima, ngati njira zonse zochotseredwa sizinatenge nthawi, wodwala amakhala pachiwopsezo cha kufa.

Kuyambitsa Kutulutsa kwa Pancreatitis

Kugawidwa kwa Atlantian kwa pancreatitis pachimake kumatanthauza kukhalapo kwa zifukwa zoyambitsa matenda:

Makope. Amayamba mukamadya zakudya zokazinga, zamafuta ndi zonunkhira zomwe zimakhala ndi zokometsera zambiri, komanso mukamamwa mowa.
Biliary. Kukula kumachitika motsutsana ndi maziko a matenda osiyanasiyana a chiwindi, biliary thirakiti ndi ndulu.
Gastrogenic. Zomwe zimayambitsa chitukuko cha matenda ndi matenda am'mimba, makamaka, gastritis ndi zilonda zam'mimba.
Ischemic. Zomwe zimathandizira kukula kwa ischemic pancreatitis ndizosokoneza mu kapamba.
Mankhwala osokoneza bongo a chifuwa cha poizoni umayamba chifukwa chogwiritsa ntchito kwambiri mankhwala osokoneza bongo kapena chifukwa chakusagwirizana ndi mankhwala ena.
Zopatsirana. Amayamba pomwe mabakiteriya osiyanasiyana komanso mavairasi awonekera m'thupi.
Zowopsa. Matenda amtundu wamtunduwu amapezeka nthawi zambiri pambuyo povulala kwa khoma lakunja kwam'mimba.
Congenital. Pancreatitis yotere nthawi zambiri imaphatikiza matenda ena obadwa nawo kapena majini achilengedwe.

Mwa kuopsa

Kugawika kwa pancreatitis yovuta kwambiri yomwe imagwiritsidwa ntchito ku Atlanta kumatanthawuza gawo lochepa, lozama, lovuta komanso lofunikira la chitukuko cha matenda. Pankhaniyi, kufatsa ndi kachulukidwe kachulukidwe kakakang'ono kanyumba kogwiritsa ntchito mosamalitsa, pomwe matenda akuvuta kwambiri nthawi zambiri amafunika kugwiritsa ntchito opaleshoni.

Atlanta Pancreatitis Classization adaganiziridwa mu 1992. Pambuyo pake, mu 2012, zidasinthidwa. Ndi chitukuko chachikulu cha matenda, njira zadzidzidzi zimafunikira kupereka chithandizo choyamba kwa wodwala kuti asafe.

Kukula ndi mawonekedwe a chotupa

Malinga ndi gulu, pancreatitis pachimake malinga ndi njira izi zitha kugawidwa m'magulu asanu:

Zosangalatsa. Matendawa amatuluka popanda kusintha kwa kapamba. Ndi mawonekedwe odabwitsa a kapamba, chithandizo cha opaleshoni sichifunikira, popeza matendawa amadziwika ndi njira yosinthira, chifukwa ndizokwanira kuchita mankhwala osokoneza bongo ndikutsatira kudya kwakanthawi.
Pancreatic necrosis ndi wosabala. Zosiyanasiyana zimadziwika ndi kuwonongeka kwa magawo ena a kapamba ndi ma enzymes ake, koma palibe zovuta zopatsirana.
Matenda opatsirana pancreatic necrosis. Pakadali pano, matendawa amatenga nthendayi, akukhudza kapamba komanso ziwalo zoyandikana nawo.
Pancreatogenic abscess. Zotsatira zakulidwe ka matenda a kapamba, patsekeke pakuwoneka kuti ladzala ndi mafinya.
Pseudocyst. A patsekeke lodzaza ndi madzi limapezeka m'mapamba, amatha kukhala exudate, madzi a kapamba kapena magazi.

Zizindikiro

Chimodzi mwazeso zazikulu zomwe muyenera kutenga mukayikira kuti ndi kapamba ndi kuyesa kwamwazi wamagazi.

The matenda ndi morphological gulu la pachimake kapamba ndi zovuta. Kuti tithane ndi matendawa kwa gulu limodzi kapena gulu lina, munthu amafunika kuphunzira zingapo: kuyezetsa zam'mimba, ziwonetsero, kupatsa chiyembekezo, komanso kusanja mawu.

Zotheka kupezeka kwa kapamba

Ndi matenda omwe amapezeka mwanjira yovuta kwambiri, chiopsezo cha zovuta zotsatirazi ndizotheka.

Fistulas yomwe imatha kuwoneka mkati komanso kunja kwa kapamba.
Mapangidwe oyipa kapena kachilombo ka pseudocyst.
Bakiteriya amatupa am'mimbamo, omwe amachititsa kuti akhale ndi enzymatic peritonitis.
Kufinya ndi kutupira kwa Vater papilla, womwe umapangitsa mtundu wa kutuluka kwa ndulu. Chifukwa cha kukakamira koteroko, kukula kwa jaundice yama makina kapena yotseketsa ndikotheka.
Kuwonongeka kwa ziwiya zam'mimba, zomwe zimayambitsa kukula kwa magazi. Makamaka, tikulankhula za kutulutsa magazi m'matumbo, nthawi zambiri magazi amatuluka m'matumbo mwaiwo.
Pancreatogenic pamimba.

Chiwopsezo cha kufalikira ndikuwonjezereka kwa chifuwa chachikulu cha kapamba chimatha kuchepetsedwa, ndipo gulu siligwirizana nazo. Kuti mukwaniritse izi, muyenera kuchepetsa kapena kusiya kumwa zamankhwala, kusiya kudya zosayenera komanso zosagwiritsidwa ntchito bwino, gwiritsani ntchito mankhwala onse okhawo adanenedwa ndi dokotala, athandizire matenda onse a ziwalo zamkati munthawi yake ndikukhala ndi moyo wokangalika - pitani patsogolo ndikuwonongerani nthawi zambiri momwe mungathere mu mpweya watsopano.

Acute pancreatitis ndi matenda oopsa, mitundu ina yomwe imakhala yofulumira, yomwe imatha kubweretsa zovuta zomwe sizingachitike ngati wodwala sanapatsidwe thandizo mwadzidzidzi.

Kenako, necrotic pancreatitis imagawidwa m'mitundu iwiri:

Pafupi Njira yachilengedwe yopitilira ma kondomu siyipitilira zakumbuyo.

Zofala. Zovuta zamachitidwe zitha kuchitika:

kugwedeza
kulephera kwa ziwalo zingapo
magazi (pancreatogenic kapena chapamimba)
kusokonezeka kwa metabolic ndi electrolyte
DIC

Necrotic pancreatitis imagawanidwanso m'mitundu, kutengera kuwonongeka kwa kapamba. Itha kukhala yoyang'ana komanso yodziwika.

Focal pancreatic necrosis imatha kukhala ndi foci yaying'ono, yapakatikati kapena yayikulu.

Pancreatic necrosis yodziwika bwino imatha kukhala yaying'ono kapena yokwanira. Mitundu yamatendawa ya matenda nthawi zambiri imatha muimfa.

Kugawidwa kwa matenda kapamba

Malinga ndi chikhalidwe cha morphological, mitundu isanu yamatenda akuluakulu a kapamba amadziwika:

chamtundu wina
wopatsa chidwi
parenchymal
chotupa
pseudotumorous

Monga mukudziwira, nthawi yayitali pancreatitis, magawo ochulukirachulukira amasiyanitsidwa, pomwe zizindikiritso za kapamba zimakulirakulira, komanso magawo akhululukidwe, pomwe palibe kuwonetsa matendawa. Kutengera kwa kufalikira, kuchuluka kwa kapamba kumaphatikizira magawo atatu,

sikubwerezabwereza
mobwerezabwereza
kulimbikira (Zizindikiro zikupitirirabe)

Pancreatitis yosatha imawonetsedwa ndi zizindikiro zosiyanasiyana. Mitundu isanu ya matenda imasiyanitsidwa kutengera mtundu waukulu wa matenda:

Ululu
Hyposecretory (yodziwika ndi kuperewera kwakukulu kwa pancreatic excretory function)
Hypochondria (zizindikiro za matenda amitsempha yama neuropsychiatric)
Zotsatira (pafupifupi popanda zizindikiro)
Wophatikizika (palibe wodwala wamkulu)

Kutengera zomwe zimayambitsa matenda a kapamba, amatha:

kudalira-biliary-(kudalirana kwa njira yothandizira biliary ndiko kudayambitsa)
chidakhwa
dysmetabolic (chifukwa cha kapamba ndi hemochromatosis, matenda osokoneza bongo, hyperparathyroidism ndi matenda ena omwe amayenda ndi matenda a metabolic)
zopatsirana
mankhwala
idiopathic (chifukwa cha kapamba sichidziwika)

Kugawika kwa matenda kapamba kumaphatikizanso zovuta zake. Agawika m'magulu asanu:

Matenda (abscess, cholangitis)
Kutupa (aimpso kulephera, chotupa, magazi am'mimba)
Matenda oopsa a portal (portal vein compression)
Endocrine (shuga, hypoglycemia)
Kulakwila kwa kutuluka kwa ndulu.

Pali magulu ambiri azigawo zomwe zimapweteka kwambiri komanso kupweteka kwa kapamba. Ndi okhawo omwe nthawi zambiri amagwiritsidwa ntchito ndi madokotala popanga amapatsidwa.

Zokhudza gulu la matendawa

Zochita zamankhwala zimadziwa magawo makumi anayi a zotupa zam'mimba, zomwe zimapangitsa kuti pakhale zovuta pakulankhulana kwapadziko lonse pamutu wokhudza diagnostics ndi chithandizo. Chifukwa cha izi, ICD - International Classifier of Diseases idapangidwa. ICD imawunikiridwa pafupipafupi ndi WHO. Kugawa kwaposachedwa kukukhala pamtundu wa ICD-10 code. Nambala ya “khumi” ikutanthauza kuti ICD ikutanthauza kubwereza khumi.

Malinga ndi chidziwitsochi, matendawa ndi amtundu wapadera wamtundu (K85) ndi maphunziro osatha (K86). Monga tanena kale, anthu ambiri amagwiritsa ntchito kalasi ya 1983, yomwe idapangidwa ku Marseille. Zinasintha pang'ono mu 1984, komanso mu 1992 ku Atlanta.

Malinga ndi kugawanika kwa matendawa, pali mitundu inayi. Izi zikuphatikizapo mawonekedwe pachimake, pachimake mawonekedwe, mawonekedwe mawonekedwe ndi kuchuluka kwa matenda a pathological process.

Kugawika kochulukirapo kumaganizira za pathogenesis yotupa, kuwonongeka kwa kapamba, zomwe zimapangitsa kuti chipatalacho chiwonjezeke, kuthekera kwa kusinthanso kwa minofu yowonongeka.

Mwambiri, kupatukana kumawoneka motere:

Pachimake kapamba.
Pachimake kubwezeretsanso mawonekedwe pambuyo pake kubwezeretsa magwiridwe antchito mkati.
Njira yotupa yopatsirana kumbuyo komwe kusungidwa kwa kapamba.
Matenda apakhungu a pancreatitis, omwe adayamba chifukwa chotseka kwa lumen kwa ma ducts.
Mtundu wa munthu wobwererera womwe uli ndi mawonetseredwe am'kati mwa kuvulala kovuta. Palibe mwayi wodzikonzanso tokha pancreatic minofu.
Kutupa kosagwirizana ndi maziko a kudzikundikira kwamchere mu chiwalo. Ma pancreatic ducts amatsekedwa ndi ma calcified, zomwe zimatsogolera pakukula kwawo.

Kutupa kovuta komanso koopsa kumagawidwa malinga ndi njira zosiyanasiyana. Nthawi zina mavuto obwera chifukwa cha matendawa amawonjezeredwa ku gulu.

Mitundu ndi mitundu ya pancreatitis yovuta

Kugawika kwa pachimake kapamba kumaphatikizapo kulekanitsa kwa masanjidwe othandizira poyerekeza ndi zovuta za maphunzirowa, mawonekedwe, zochitika zina. Nthawi zambiri, zizindikilo zonse zimayang'aniridwa pakuzindikiritsa.

Kutengera ndi kuuma, chiphunzitsochi ndichopatsa, modekha komanso moopsa. Ndi mawonekedwe ofatsa, palibe kutanthauzira kosintha kwa minyewa ya chiwalo, chiwalo chimakhalabe ndi magwiridwe ake.

Ndi kuwonongeka kwapakati, kumakhala kusintha kwa ntchito kapamba, nthawi zambiri zovuta za machitidwe zimadziwika. Mlingo woopsa umadziwika ndi zovuta zapakhomo komanso zadongosolo, wodwalayo amatha kufa.

Kugawidwa kwa kapamba mu mawonekedwe kumaganizira kuchuluka kwa zowonongeka, mawonetseredwe azachipatala, mayeso a labotale, kuyembekezeredwa kwazotsatira zamankhwala. Mitundu iyi imasiyanitsidwa:

Mtundu wa edematous amadziwika kuti ndiwo mtundu wosavuta kwambiri. Monga lamulo, palibe kusintha kwakukulu mu minofu. Zotsatira zomwe akuyembekezeredwa kuchokera ku mankhwalawa nthawi zonse zimakhala zabwino. Mayeso a labotale akuwonetsa kuwonjezeka kwa fibrin, yomwe imawonetsa kutukusira kwa thupi. Zizindikiro zake ndizopweteka m'dera la nthiti yakumanzere, nseru, kuperewera kwa khungu, kutentha thupi.
Organic pancreatic necrosis ikuwonetsa kuti chidwi cha kutupa chimapangidwira m'chigawo chimodzi chamkati. Imatha kukhala mutu, thupi kapena mchira. Malo osungirako malo amakhala kwambiri. Ndi mawonekedwe awa, wodwalayo amadandaula za kupweteka kwambiri, kutulutsa, kusanza ndi mseru. Mu zithunzi zina, matumbo otsekemera, jaundice. Mayeso a Laborator amawonetsa kuchuluka kwa shuga m'thupi, kupezeka kwa michere ya m'mimba m'magazi.
Zovuta (zosakanikirana) za pancreatic necrosis zimachitika chifukwa cha kuwonongeka kwakukulu kwa minofu ya pancreatic. Kuphatikiza pazizindikiro zomwe tafotokozazi, wodwalayo aledzera, kutentha thupi, kuchepa kwa mphamvu yake ya mkodzo patsiku. Kukula kwa magazi am'mimba sikuphatikizidwa. Pazofufuza - shuga wambiri, kuchepa kwa calcium m'magazi. Pano, chithandizo cha pancreatitis kuchipatala chogwiritsidwa ntchito ndi kuchuluka kwa mankhwalawa chimafunikira.
Pancreatic necrosis ya mawonekedwe athunthu imakhudza gawo lonse lamkati. Chifukwa cha kuledzera kwakukulu, vuto lakanjenjemera, m'mapapo, aimpso kapena mtima kulephera. Popanda thandizo lokwanira, chiopsezo cha imfa ndi chachikulu.

Kutengera ndi pathogenesis, matendawa amakhala oyamba - amapezeka chifukwa cha kuwonongeka kwa minofu ya chiwalo chokha komanso chachiwiri - matenda amapezeka ndi ziwalo zamkati. Gulu la magulu ena ndilofanana, kaya ndi mwana kapena wamkulu.

Pancreatitis pachimake, kutengera chifukwa, ndi:

Maonedwe azakudya. Matendawa amakula chifukwa cha kadyedwe koyenera, pamene wodwala agwiritsa ntchito zonunkhira, mafuta, zonunkhira komanso mchere. Nthawi zina, gululi limaphatikizapo kapamba wa uchidakwa. Koma muzojambula zambiri mtunduwu umagawidwa ngati gulu logawanika.
Biliary pancreatitis imapezeka chifukwa cha kuphwanya chiwindi, chithokomiro cha biliary ndi chikhodzodzo cha ndulu.
Fomu ya ischemic imachitika chifukwa cha kusokonezeka kwa kaperekedwe ka magazi kwa kapamba, chinthu choyambirira chitha kukhala matenda osiyanasiyana, zovuta zakunja kapena zamkati.
Njira yotupa ya gastrogenic imadziwika chifukwa cha mavuto am'mimba, monga matenda am'mimba a m'mimba.
Mitundu ya poizoni ndi yonsinye imayamba chifukwa chogwiritsa ntchito mankhwala osokoneza bongo kapena othandizira poizoni. Cholinga china ndikuyambitsa mavuto kwa ma allergen motsutsana ndi kuyankhidwa kwa "matenda" a chitetezo cha m'thupi.

Kugawika kwa etiological factor kumatha kuphatikizidwa ndi matenda apakhungu a m'mimba (ma bacteria ndi ma virus ndizomwe zimayambitsa), mawonekedwe owopsa (kuvulala kwam'mimba), mawonekedwe obadwa nawo - ophatikizidwa ndi ma pathologies ena a chibadwa chamkati kapena chibadwa.

Mitundu yayikulu ya matenda a kapamba

Kalasi ili mokulira limakhudza kuwonongeka kwa kapamba, kuchuluka kwa magwiridwe ake. Muzochita zamankhwala, mitundu inayi imasiyanitsidwa. Yoyamba ndi njira yotupa yotupa yomwe imadziwika ndi mapangidwe a mawebusayiti.

Mtundu wachiwiri ndi fomu yolepheretsa, yomwe idayamba chifukwa chotseka ma pancreatic ducts, zomwe zidapangitsa kuti zikhale zovuta kuchotsa madzi mu duodenum. Monga lamulo, etiology pamilanduyi imachitika chifukwa cha mawonekedwe a ndulu kapena chotupa cha kapamba.

Mtundu wachitatu ndi fibrosis wamkati, popeza minofu yofewa idasinthidwa ndi minyewa yolumikizana. Chizindikiro chachikulu kapamba a foda - mtundu wachinayi. Zimaphatikizanso kusintha kwa kapangidwe ka pancreatic ndi kuvuta kwa kutuluka kwa pancreatic madzi.

Pancreatic abscess ndi mapangidwe a cysts nthawi zina amatchedwa njira yotupa yotupa, nthawi zina amawonedwa ngati zovuta za kapamba. Nawo, ma cysts amawaika m'magulu osiyanasiyana (ma pseudocysts, posungira kapena parasitic cysts, etc.).

Zambiri pancreatitis zimaperekedwa mu kanema munkhaniyi.

Sonyezani shuga lanu kapena sankhani jenda pamayendedwe Kusaka OsapezekaKusaka Kuyang'ana kosapezeka

MRMK ndi mitundu ya pancreatitis yosatha

Pancreatitis yosatha ndi kutupa kwakanthawi kwa ziwalo zomwe zimachitika motsutsana ndi maziko azinthu zingapo zoyambitsa matenda.

Gulu la Roma-Marseille lapadziko lonse lapansi lomwe limapatsidwaku limasiyanitsa mitundu:

calcifying - mogwirizana ndi kapangidwe ka magawo a chiwalo chamadongosolo amchere a calcium,
zotchinga - chifukwa cha kufalikira kwa mzere waukulu,
yotupa - yotchedwanso fibro-induction (yothandizidwa ndi kulowetsa ziwalo zam'mimba zomwe zili ndi masamba a fibrosis),
kupukusa (kapena fibrosis),
cysts ndi pseudocysts,
kunyowa.

Masiku ano, magawo ogwirira ntchito ndiofala kwambiri, pomwe mitundu iwiri yotsalayo imapatsidwa gawo lina.

CPC pa Savelyev

Mulinso zikwangwani zingapo zingapo, zomwe zimavuta kudziwa mtundu womwe ulipo wodwalayo:

kutupa mawonekedwe (mkati) kapena kapamba necrosis (wosabala),
mawonekedwe a zotupa (mafuta, hemorrhagic, osakanikirana),
kuchuluka kwa magawidwe (ochepa kapena akulu, ozungulira, onse),
nthawi (vuto la hemorrhagic, kusakwanira, purulent),
zovuta zazikulu (kuyambira kulowetsedwa mpaka magazi oyambira)
chithunzi cha chipatala
etiology (chakudya, gastrogenic, ischemic, biliary, poizoni, matupi awo onse, idiopathic, zoopsa, zopatsirana, zobadwa nazo).

Ngakhale opambana kwambiri pazomwe akufuna kuchita mwadongosolo, nthawi zonse pamakhala chiopsezo chogwiritsidwa ntchito mosiyanasiyana pakuchita opareshoni kapena pochiritsa.

Nthawi zambiri mawonekedwe a pancreatitis pachimake amatsimikiza pambuyo pa opaleshoni, ngati nkotheka kupanga kafukufuku wodalirika wazosintha zamakhalidwe.

Chifukwa chake, adotolo amatsogozedwa ndi mbiriyakale komanso kufunsa kwamawu, ndikuzindikira komaliza kumapangidwa pambuyo pake.

Kanema wothandiza

Pancreatitis ndi njira yotupa mu kapamba, chifukwa chomwe ma enzymes opangidwa samaponyedwa mu duodenum. Amakhalabe m'matumbo ndipo amawonongera.

Gulu lamakono la kapamba

Magulu amakono a kapamba omwe adapangidwa pamaziko a gulu la International Marseille, adazindikira magulu otsatirawa a matenda:

mawonekedwe pachimake
mawonekedwe olepheretsa (pali miyala, zowonjezera, ma occlusions),
mawonekedwe obwereranso pachimake (pachipatala komanso mwachilengedwe),
matenda osalepheretsa matenda (ndi kuwonongeka kwa ntchito ndi thunthu la chiwalo),
kukhalanso mawonekedwe a matenda osachiritsika (kutupa kosatha ndi mawonekedwe a matenda owopsa a matenda osakwanira kukonza minyewa).

Pancreatitis yosagwira ntchito yolepheretsa imakhala ndi mitundu yambiri yamatenda opatsirana amchere ndi kudzikundikira kwa mchere m'magawo omwe kale anali opanga pancreatic necrosis.

Gulu la mayiko apansi a kapamba

Mu 2007, asayansi aku Germany adapanga gulu lamakono la matenda. Mlingo wa mawonetseredwe amasiyanitsa pakati pa matenda, pachimake komanso pachimake pamatendawa, komanso kuchulukitsa kwa nyengo yodwala.

Monga lamulo, matenda osachiritsika amatuluka pambuyo pakuwonjezereka. Pakati pochulukirachulukira komanso chifuwa chachikulu cha khansa, pamakhala magawano.

Marseille-Roman gulu la kapamba

Gulu la Marseille-Roman limagawa matenda a kapamba m'mitundu iyi:

kuwerengera maakaunti a 45-90% ya milandu.Matendawa amatsimikiziridwa ndi chotupa chosasinthika ndipo amadziwika ndi mphamvu ya stenosis ndi duct atrophy. Choyambitsa matendawa ndikuchepa kwa secretion ya lipostatin, yomwe imaletsa mawonekedwe amchere amchere,
yotupa mawonekedwe. Kukhazikika kwa parenchyma ndi madera a fibrosis kumawonedwa,
mawonekedwe osokoneza. Matendawa amadziwonetsera mu kusokoneza kwa pancreatic duct yayikulu. Pali yunifolomu yawonongeka yomwe ili mbali ya dera. Zizindikiro zazikulu ndi microsis ndi michere ya epocrine ya chiwalo, epithelium yopanda pake, kusowa kwa kuwerengera ndi mchere mu kapamba.
fibrosis. Perilobular fibrosis ikhoza kuphatikizidwa ndi mawonekedwe a perilobular, palibe atrophy ya exocrine parenchyma. Diffuse fibrosis ndi kutayika kwa gawo lalikulu la parenchyma yogwira intra- ndi exocrine.

Mitundu yodziyimira ya matendawa, gulu la kapamba limasiyanitsa ma pseudocysts ndi cysts, ma pancreatic abscesses.

Kugawidwa kwa kapamba kumaphatikizapo kulekanitsa mitundu yamatenda kutengera zomwe zimayambitsa kukula kwawo ndi chithunzi cha chipatala. Potere, mankhwalawa amitundu iliyonse amasankhidwa payekha.

Zambiri

Pancreatitis ndi matenda ofala kwambiri pakati pa pathologies a ziwalo zamkati. Zimagwirizanitsidwa ndi njira yotupa mu kapamba. Monga lamulo, kudwala kumeneku kumachitika chifukwa cha kuperewera kwa zakudya m'thupi komanso kumwa mowa kwambiri. Ngati m'mbuyomu matendawa amakhudzanso anthu okalamba, ndiye pakalipano chifukwa cha kusakhala ndi thanzi labwino, kusadya bwino, zovuta zamatumbo zimakhudzanso ana ndi achinyamata.

Kupatula kwamatendawa:

pachimake kapamba
aakulu mawonekedwe a matenda.

Awa si magawo a kakulidwe ka matenda kapamba, koma mitundu yosiyanasiyana yotupa, iliyonse yomwe imakhala ndi njira yochizira.

Pachimake kapamba

Amadziwika ndi kukula kwa njira zakuthwa mwadzidzidzi mu chiwalo, zomwe zimayendetsedwa ndi necrosis ya minofu ya England. Zokhudza gulu la matenda akulu, zitha kupha.

Pancreatitis pachimake imatha kuchitika mofatsa kapena mwamphamvu, kutengera kuuma. Poyambirira, pali kuwonongeka kochepa kwa ziwalo ndi machitidwe, edema imawonedwa mu gland. Ndi chithandizo choyenera, wodwala wofatsa matenda atha kuchira msanga ndikubwerera m'moyo wawo wakale.

Pancreatitis yayikulu imadziwika ndi kusokonezeka kwakukulu mu ziwalo ndi zimakhala. Ma Abscesses, cysts, necrosis ya minofu ndizotheka.

Chifukwa chachikulu ndi kumwa mitundu yosiyanasiyana ya zakumwa zoledzeretsa. Njira yodziwika kwambiri ndi kuwala kwa mwezi. Komabe, sikuti okonda zakumwa zoledzeretsa okha ndi omwe amadwala, komanso anthu omwe sagwiritsa ntchito mankhwalawa. Izi zimachitika ndikamadya zakudya zabwino zopezeka bwino.

Pachimake kapamba limodzi ndi zizindikiro zotsatirazi:

Ululu wammbuyo Zowawa zimatha kutulutsidwa mu hypochondrium ya kumanzere, epigastrium. Ili ndi chida chomangira, chotchulidwa, chimakulitsidwa bwino mu supine udindo. Zakudya zokazinga, zokometsera, mowa umakulanso ululu.
Kusanza ndi kusanza kosalephera.
Wofatsa wa jaundice wa nembanemba wamaso amawonedwa.
Kuphulika, kutentha kwa mtima.
Amawoneka buluu pakhungu.

Pancreatitis pachimake imafunikira chisamaliro chamankhwala ndipo, nthawi zina, amathandizira opaleshoni.

Fomu yamatenda

Samalirani thanzi lanu - sungani cholumikizacho

Ili ndi gulu la matenda omwe amachitika nthawi yayitali. Amadziwika ndi kusintha kwa nthawi yowonjezereka komanso bata, pomwe zizindikirozo zitha kutchulidwa kapena kusapezeka kwathunthu.

Matenda a kapamba amakhala ndi gulu la:

kutengera zomwe zimayambitsa chitukuko: mavuto ndi magwiridwe antchito a gallbladder, kumwa kwambiri, matenda a duodenum, hepatitis, matenda a metabolic, kumwa mankhwala ena.
kutengera matendawo mawonetseredwe a matendawa: kupweteka, njira za m'mimba m'matumbo, mawonekedwe a hypochondriac, chithandizo chammbuyo komanso mtundu wosakanikirana.

Ululu womwe umabuka m'mimba mwakuya kwam'mimba ndikusunthira kumtunda ndi mawonekedwe owonetsa matendawa. Zakudya zokometsera, zamafuta, zakumwa zoledzeretsa ndi mpweya zimatha kukulitsa ululu.

Mu matenda osakhazikika, mseru, kusuwa kosasangalatsa, kumatulutsa, kuchitika mwachisawawa kumatha kuchitika. Nthawi zina kumverera kwa magazi, kumveka m'mimba ndipo zovuta ndi chopondacho ndizotheka. Chifukwa chosadya bwino, wodwalayo amayamba kuchepa thupi msanga.

Mavuto ambiri omwe amapezeka ndimatumba oyambitsidwa ndi kapamba, purulent yotupa ya ma ducts. Pali kuthekera kwa mapangidwe a kukokoloka ndi zilonda m'mimba.

Pancreatitis ndi njira yowonongeka komanso yotupa ya parenchyma ndi zimakhala zapamimba. Ichi ndi chimodzi mwa matenda oopsa kwambiri am'mimba. Acute pancreatitis ndi amodzi mwa matenda opatsirana mwachangu (ofunika), limodzi ndi pachimake appendicitis ndi cholecystitis. Kuphatikiza apo, matendawa amasunga mbiri ya zovuta zazikulu zomwe zingachitike. Zonsezi pamwambapa zimachitika chifukwa cha mawonekedwe a kapamba, zomwe zimapangitsa kuti pakhale zovuta pakupima matenda ndi kuzindikira kwa matendawa. Zikondazo zimapanga michere yokumba yomwe imaponyedwa m'matumbo kudzera mumkamwa. Pancreatitis ndi kutukusira kwa kapamba m'mimba mwake momwemo. Likukhalira kuti munthu amatenga chakudya, umalowa m'mimba, kuchokera m'mimba kupita m'matumbo, bongo limayambitsa kakhansa kuti apange michere yokugaya, imawatulutsa, koma sangathe kusiya chindewu chifukwa chakudontha kwa duct, ndikuyamba kugaya kapamba kuchokera mkati mwake , munthuyo amamva kuwawa ndipo amathamangira kwa adotolo.

Etiological (causal) zinthu za matendawa

Pancreatitis ndimatenda a polyetiological. Zomwe zimayambitsa kupezeka kwake kumatha kukhala njira za m'magazi zomwe zimakhudzana ndi kapamba (m'mimba, dongosolo la biliary, duodenum, zombo zazikulu - thunthu la celiac ndi nthambi zake), uchidakwa, kuperewera kwa zakudya m'thupi, komanso zotsatira za mankhwala .

Zoyambitsa zazikulu za pancreatitis pachimake ndi:

cholelithiasis
uchidakwa.

Kuphatikiza apo, zifukwa zake zingakhale izi:

zotsatira za mankhwala (tetracyclines, cyclosporins, corticosteroids, ACE zoletsa ndi ena),
kuvulala kwam'mimba
kuphwanya lipid kagayidwe,
hypercalcemia,
cholowa
kulekanitsa kapamba
matenda a ma virus (matenda a cytomegalovirus, ma virus a hepatitis),
Edzi
mimba

Mawonetseredwe azachipatala

Njira zazikulu zamankhwala zotulutsa kapamba ndi izi:

kupweteka
dyspeptic
mtima matenda syndrome
toxemia syndrome
matenda olephera.

Kuphatikiza apo, ma syndromes atatu omaliza amawonekera ndi chitukuko cha pancreatitis chowononga.

Ululu umachitika patangotha maola ochepa mutatha kudya zakudya zamafuta kapena mowa kwambiri, chilengedwe chachikulu cha kupweteka ndi dera la epigastric ndi hypochondrium yamanzere, ululu umatha kuperekedwa kumbuyo kumunsi komanso kudera lamanzere lamanzere.

Kupweteka kwapweteka kumakhala ndi mavuto a dyspeptic, nseru ndi kusanza. Kusinthasintha kumachitika pafupipafupi, popanda mpumulo.

Zizindikiro zamavuto amitsempha amachepetsa kusokonezeka kwa hemodynamic, hypotension (kutsitsa kuthamanga kwa magazi) ndi tachycardia. Matenda am'magazi ocheperako amatha kuwonekeranso, akuwoneka ngati mawonekedwe ofiirira pankhope ndi khungu la thupi.

Toxemia syndrome nthawi zambiri imayamba patadutsa masiku atatu chichitike matendawa ndipo amadziwika ndi zizindikiro za kuledzera kwa thupi: pallor, kufooka, ulesi, kutentha thupi. Kutsatira toxemia, kufooka kwa ziwalo kumayambika, kuwonongeka koyipa kwa impso ndi chiwindi kumayamba, mu milandu yayikulu, kulephera kwa mapapo, dongosolo lamkati lamkati, endocrine ndi mtima zimayamba.

Matenda a kapamba

Kuzindikira pancreatitis, njira zogwiritsira ntchito ndi labotale zimagwiritsidwa ntchito. Njira zogwiritsira ntchito zida zopangira zida monga: ultrasound, CT (computed tomography), maginito ophatikizika am'mawa (MRI). Laboratory mayeso ndi othandiza kwambiri pa matenda, kutsimikiza amylase, lipase, trypsinogen-activated peptide m'mwazi, komanso kutsimikiza kwa diastase ndi trypsinogen-2 mumkodzo. Makhalidwe a michere pamwambapa amakhalabe achuma kwa nthawi yayitali.

Mavuto

Pali zovuta zam'mbuyo komanso mochedwa za kapamba. Mavuto oyambilira akuphatikiza:

jaundice, genetic wamakina,
matenda oopsa a portal
magazi amatumbo
pseudocysts ndi posungira.

Mavuto apambuyo pake akuphatikizapo:

nyama yonyowa (mafuta mu ndowe),
duodenal stenosis,
encephalopathy
kuchepa magazi
matenda am'deralo
osteomalacia.

Zakudya zopatsa mphamvu za kapamba

Zakudya zopatsa mphamvu mu pancreatitis pachimake komanso kuchulukitsa kwa matenda, cholinga chake chochepetsera kudya mkamwa, ngakhale kudya kwamchere wamankhwala kumatha. Odwala ali paubwino wazakudya kwa masiku 2-5. Kenako pang'onopang'ono yambani kuyambitsa malonda, poona mfundo zosunga makina ndi mankhwala. Chakudyacho chimakulirakulira nthawi yayitali komanso kuchuluka kwa zakudya zomwe zimayambitsidwa komanso zomwe zimapangidwira calorie zimayamba kukula. Zakudya zamlomo zam'mimba zimayambira ndi Mlingo wochepa wamadzimadzi chakudya (michere soups, purees ya masamba, porousges mucous). Chakudya chamasewera chimakhazikitsidwa, chakudya chimakonzedwa kuti chikhale chinyezi kapena chifukwa chophika. Sizoletsedwa kudya zakudya zomwe zimayambitsa kuphwanya, komanso zonunkhira, mafuta, yokazinga, zonunkhira, zakudya zamzitini, komanso zakumwa zoledzeretsa za khofi ndi kaboni.

Chithandizo cha kapamba

Chithandizo cha pancreatitis chimaphatikizapo kukhazikitsidwa kwa njira zopumira komanso za opareshoni. Mu pachimake yogwira pancreatitis, limodzi ndi zizindikiritso za peritoneal mkwiyo ndi zizindikiro za "pamimba pamimba", opaleshoni yodzidzimutsa imayikidwa. Ndi chipatala cholinganizidwa, njira yokhazikika yochizira imachitika, pofuna kukonza kuperewera kwa enzymatic, kuthetsa kupweteka, komanso ndi mawonekedwe amtundu wa kapamba ndi chifuwa chachikulu cha kapamba, mankhwala oletsa antibayotiki amachitidwa.

Pa chithandizo cha Conservative, magulu otsatirawa a mankhwala ndi omwe amaperekedwa:

maantibayotiki (yotakata-yayikulu)
proton pump blockers
histamine H2 blockers,
maantacid
analcics-noncotic analgesics,
antispasmodics
antipsychotic.

Matenda ogwirizana

Nthawi zambiri, pancreatitis imayenderana ndi kupukusira kwa ziwalo zina zapafupi, monga gastritis (makamaka Helicobacter yomwe imakhudzana), duodenitis, zilonda zam'mimba komanso zilonda za duodenal, cholecystitis, kuwonjezera, matenda a shuga a pancreatic amatha kukhala ndi kapamba.

Zotsatira za kapamba

Pancreatitis imadziwika ndi njira yovutitsa, ndiye kuti, kudziyimira pawokha komanso kupangika kwathunthu kwa njira zotupa, zomwe zimatha kubweretsa kusintha ndikuchira kwathunthu. Izi ndi mtundu wa edematous mawonekedwe a matenda. Pafupifupi 20% ya milandu, kuphatikiza kwa njirayi kumachitika, pomwe zosintha zowonongeka m'mapamba zimayamba kukhala zovulaza. Kukula kwa ziwalo zingapo kulephera kumatha kubweretsa imfa.