Katemera wamkati > Matenda a shuga

Kafukufuku wokhudzana ndi kugwira ntchito kwa kapamba kuyenera kuchitika nthawi zonse matenda aliwonse akaganiziridwa. Phunziroli limakhala pakupenda mkodzo wa shuga ndikuwonetsetsa kuchuluka kwa shuga m'magazi. Kuchepa kapena kuchepa kwathunthu kwa kupanga kwa insulini kumapangitsa kuchepa kwa glycogen m'chiwindi komanso kuchepa kwa kuperesa kwa glucose ndi maselo a thupi. Zotsatira zake, glucose amadziunjikira m'magazi (hyperglycemia) ndikuyamba kuwonjezeredwa mkodzo (glucosuria). Nthawi yomweyo, kusokonezeka kwakukuru kwa nayitrogeni ndi mafuta metabolism kumachitika, chifukwa cha zomwe zopangidwa zopanda mafuta zomwe zimatha (acetone, acetoacetic ndi R-hydroxybutyric acid) zimatha kudziunjikira m'magazi. Izi zimabweretsa acidosis, limodzi ndi mavuto akulu mthupi lonse.

Zosokoneza izi za metabolic ndi chizindikiro cha matenda osokoneza bongo chifukwa cha kusakwanira kwa kupanga kwa insulin m'malo ochezera a Langerhans.

Komabe, ndimatenda ena am'mimba komanso osakhazikika a kapamba (kapenanso necrosis, abscess, pancreatitis yayikulu, ndi zina zotere), ngakhale nthawi zambiri, glucosuria ndi hyperglycemia zimachitika, zomwe zikuwonetsa kuphwanya kwa mapangidwe anthawi zonse a kapamba.

Ndi kuwonda pang'ono pantchito imeneyi, glucosuria mwina sangakhalepo, koma imatha kuwoneka pambuyo poyesa 100 g shuga (wotchedwa alimentary glucosuria). Momwemonso, kuchuluka kwa shuga m'magazi kumatha kukhala kwabwinobwino ndikusokonezeka pang'ono kwa ntchito ya kapamba wa intracecretory. M'mawu omaliza, kuphwanya kumeneku kumapezeka pakulandila shuga wotchedwa shuga kumapeto kwa shuga. Monga tanenera kale, mwa munthu wathanzi, kuchuluka kwa shuga m'magazi komwe kumakwera pambuyo pobwerera ku chithunzi choyambirira. Pankhani ya kuperewera kwa ntchito ya kapamba, kapamba wa shuga yemwe amapezeka, amadziwika, choyamba, ndi kuchuluka kwambiri kwa shuga m'magazi, ndipo chachiwiri, ndikubwerera pambuyo pake pamawonekedwe oyamba.

Mtundu wa shuga wopanikiza shuga umatha kuthandizika ngati umboni wa chiwopsezo cha zikondamoyo pokhapokha ngati chiwindi chikagwiritsidwa ntchito chomwe chimayendetsa kagayidwe kazakudya sichitha.

Kuphwanya kwazinthu zakunja za kapamba kumatsimikiziridwa ndikuwunika zamkati, magazi, mkodzo ndi matumbo.

Kafukufuku wamaphunziro a duodenal amakhala mu kuchuluka kwa kutsimikiza kwa ma pancreatic enzymes mmenemo.

Kuti mupeze zomwe zili m'matumba, gwiritsani ntchito probe (duodenal) kapena probe iwiri, imodzi mwa mabowo omwe amayenera kukhala m'mimba, ndi ina mu duodenum. Kafukufukuyu amatulutsa kupukuta kwa chapamimba komanso zam'mimba ndipo zimapangitsa kuti muchepetse kuphatikizira kwa madzi a m'mimba mpaka m'matumbo. Mothandizidwa ndi kumva, omwe amatchedwa "ozungulira" amamasulidwa, omwe amamasulidwa popanda chowonjezera chobisalira, ndi msuzi, womwe umatulutsidwa pambuyo poyambitsa zovuta zambiri za secretion ya pancreatic. Monga zotupa zimagwiritsidwa ntchito: hydrochloric acid, ether, secretin. 30 ml ya 0,5% yankho lotentha la HCL limalowetsedwa kudzera pa kafukufuku kamodzi (malinga ndi B. I. Holstein) kapena mphindi iliyonse 20-30 m'magawo ang'onoang'ono kwa maola 2-3 (malinga ndi E. B. Zakrzhevsky). Ether imayambitsidwa kudzera pa probe mu kuchuluka kwa 2-3 ml (malinga ndi Kach). Cholimbitsa bwino kwambiri cha pancreatic secretion ndi secinin, yomwe imayendetsedwa pamitseko ya 1 unit pa 1 kg ya kulemera kwa thupi (imagwira ntchito popanda kupangika). Ndi makonzedwe apadera a hydrochloric acid, komanso kulowetsedwa kwa secretin, zomwe zili mkati mwake zimatengedwa mphindi 10-20 zilizonse kwa maola 1.5-2.

Maphunzirowa atatha, kugwiritsa ntchito secretin, pancreosimin (magawo 1.5 pa kilogalamu imodzi ya kulemera kwa thupi) nthawi zina imayendetsedwa molimbitsa thupi, yomwe imalimbikitsa ntchito ya pancreas.

Monga zoyipa za pancreatic secretion, mkaka, mafuta, urocholil, insulin, etc. amagwiritsidwanso ntchito nthawi zina.

M'magawo ankhomawo amadzimadzimadzimadzimadzi a isanayambike chilimbikitso komanso nthawi iliyonse jakisoni wotsatira, voliyumu, katundu, enzymatic ntchito ndi carbonate alkalinity zimatsimikiza.

Kuchokera pa michere ya pancreatic mu duodenal zomwe zimatsimikizika: diastase (amylase), lipase ndi trypsin. Njira yophunzirira zam'maganizo mwazomwe zimapezeka mu ma enzymes imaperekedwa m'mabuku apadera panjira za kafukufuku wosiyanasiyana.

Mu matenda a kapamba, pali kusintha kwamphamvu kwa kapamba madzi, ntchito ya michere yake ndi kusintha kwamkati mwa carbonate wamkati.

Chofunikira kwambiri pakuwonetsetsa kuti patency yalemala kapena kufalikira kwathunthu kwa ductus Wirsungianus ndikutanthauzira kwamitundu m'magazi ndi mkodzo. Ndi kutsekereza kwathunthu kapena pang'ono kwa khunyu, kaphatikizidwe kamene kamatuluka mu duodenum nkovuta kapena kusiya kwathunthu. Zotsatira zake, michere ya kapamba wa pancreatic imalowetsedwa m'magazi, yofanana ndi bile bilirubin imalowetsedwa m'magazi panthawi ya blockage d. choledochus. Kudzikundikira kwa michere yambiri m'magazi kumapangitsa kuti mu mkodzo muyambe kutaya. Nthawi zambiri amakhala ndi kutsimikiza kwa diastases mkodzo.

Malo ndi kapangidwe ka kapamba

Zikondamoyozi zimapezeka kudera lam'mimba, lili kumbuyo kwa m'mimba, pafupi ndi duodenum 12 pamlingo wa vertebrae wapamwamba kumbuyo. Pakaneneratu kukhoma lam'mimba, ili pakati pa 5 mpaka 10cm kumtunda. Chiwalo chimadziwika ndi mawonekedwe a tubular, omwe amakhala ndi magawo atatu - mutu, thupi ndi mchira.

Mutu wa chipangizocho ukupezeka pachiwopsezo cha duodenum, chigawo chomaliza chimakwirira mutuwo ngati chovala mahatchi. Kuchokera mthupi, imasiyanitsidwa ndi mzere, momwe chotengera chamkati mkati mwa thupi.

Mimba imaperekedwa ndi magazi kudzera m'mitsempha, kutulutsa kwa zinthu zam'magazi kumachitika kudzera m'mitsempha ya kolala.

Zokhudza kapangidwe kake ka kapamba:

Thupi lagawika magawo angapo - mbali zakutsogolo, zam'munsi komanso zam'mbuyo, zimasiyananso magawo.
Mbali yakutsogolo ikulumikizana ndi makoma am'mimba.
Mbali yammbuyo imayandikana ndi msempha wam'mimba ndi msana; mitsempha yamagazi ya ndulu imadutsamo.
Gawo lakumunsi lili pansi pamizu ya colon yopingasa.

Mchira wa kapamba amafika pachipata cha ndulu, ndikuwongoleredwa m'mwamba. Kapangidwe ka gawo lamkati kamakhala ndi mitundu iwiri ya minofu yomwe imagwira ntchito yakunja ndi yamkati. Maziko a minyewa ndi magawo ang'onoang'ono, omwe amalekanitsidwa ndi zolumikizira minofu yolumikizira.

Bola lililonse limakhala ndi zofunikira zake kuti lichoke. Amalumikizana, chifukwa chomwe chimapanga phula wamba, chomwe chimadutsa chiwalo chonse. Pamphepete lamanja la mutu, imatseguka mu duodenum 12, yolumikizana ndi bile ducts. Umu ndi momwe chinsinsi cha kapamba umalowera m'matumbo.

Pakati pa lobes magulu okhala maselo otchedwa islets of Langerhans. Alibe ma ducts, koma ali ndi ma cell amitsempha yamagazi, omwe amakupatsani insulin ndi glucagon mwachindunji.

Kodi zotsogola zimayendetsedwa bwanji?

Kuwongolera kubisalira kwa pancreatic kumawoneka ngati njira ya multilevel. Mphamvu yayikulu pamathandizo a maselo omwe amatha kuphatikiza michere yofunika imapangidwa ndi boma la mantha.

Kafukufuku akuwonetsa kuti mtundu wa chakudya, kununkhira kwa chakudya, kapena kungotchula kumene kumayambitsa kuwonjezeka kwakukulu kwa zochitika zapancreatic. Izi zimachitika chifukwa cha ntchito ya dongosolo lodziyimira payekha.

Kugawika kwa magawo a mitsempha kudzera mu mitsempha ya vagus kumawonjezera ntchito ya mkati. Nthawi yomweyo, njira yomvera ena chisoni imangoyang'ana kukana.

Mu kayendedwe ka ziwalo, kufunikira kwakukulu kumalumikizidwa ndi madzi a m'mimba. Ngati acidity yake m'mimba imachuluka, makina ake amatambasuka amawonedwa, izi zimapangitsa kuti pakhale chinsinsi chowonjezereka.

Nthawi yomweyo, makina otambalala a duodenum ndikuwonjezereka kwa acidity mu lumen yake kumabweretsa chitukuko cha zinthu zomwe zimapangitsa kapamba. Zinthu zake ndi monga:

Magazi a gland mthupi sangangolimbikitsa, komanso akuletsa ntchito yake. Izi zimapangidwa chifukwa cha maselo amanjenje achifundo komanso mahomoni - glucagon, somatostatin.

Iron ikhoza kusintha pazosankha zatsiku ndi tsiku. Ngati chakudya chamafuta chimapezeka mu chakudya, ndiye kuti chinsinsi chophatikizidwa chimakhala ndi amylase, ngati pali zakudya zambiri zomanga thupi, trypsin imapangidwa, ndipo lipase imapangidwa motsutsana ndi maziko azakudya zokha zamafuta.

Ziwalo zogaya ntchito

Ntchito ya pocreatic pancreatic imaphatikizapo kupanga madzi a pancreatic. Amapanga 500-1000 ml ya tsiku patsiku. Muli ndi mankhwala enzyme, mchere ndi madzi wamba.

Ma Enzymes omwe amapangidwira kudzera mu gland amatchedwa proenzymes. Amapangidwa popanda mawonekedwe. Chakudya chikalowa mu duodenum, mahomoni amayamba kubisidwa, momwe ma cell amomwe am'magazi amthupi amayamba, zomwe zimatsogolera ku ma enzymes.

Chowonjezera champhamvu ndi hydrochloric acid, pomwe ikalowa m'matumbo, imalimbikitsa kutulutsa kwa secinin ndi pancreosimine - zimakhudza kaphatikizidwe ka michere:

Amylase imapereka kuwonongeka kwa chakudya chamagulu.
Trypsin amatenga nawo chimbudzi cha zinthu zomanga thupi, zomwe zimayambira m'mimba.
Lipase amathandizira kuthyola mafuta omwe adakhudzidwa kale ndi bile kuchokera ku ndulu.

Madzi a pancreatic amaphatikizanso zinthu za mchere m'magulu a mchere wamchere, zomwe zimapangitsa kuti zamchere zimve. Izi ndizofunikira kuti magawo azikhala acidic azakudya zomwe zimachokera m'mimba, ndikupanga malo abwino oti mayamwidwe azakudya.

Kugwira ntchito kwa ziwalo mwachidwi kumathandizira kutulutsidwa kwa mahomoni monga insulin ndi glucagon kulowa mthupi. Amapangidwa kudzera pagulu la maselo omwe amalowedwa pakati pa lobules, osakhala ndi ma ducts - zilumba za Langerhans. Ntchito za mahormoni:

Kutulutsa kwa insulin kumawonedwa kuchokera ku maselo a beta. Hormone iyi imayang'anira kuwongolera kwa chakudya chamafuta ndi mafuta mthupi. Mothandizidwa ndi chigawochi, shuga amalowa m'matumbo ndi m'maselo, chifukwa chomwe ndende ya shuga imachepa.
Glucagon imapangidwa kudzera m'maselo a alpha. Mwachidule, timadzi tating'onoting'ono timene timayambitsa insulin, ndiye kuti, cholinga chake ndi kukulitsa shuga m'thupi la munthu. Ma cell a Alpha amathandizanso pakupanga lipocaine, yomwe imalepheretsa mafuta kuwonongeka kwa chiwindi.

Kubisika kwa adrenaline kuchokera ku adrenal gland kumathandizidwanso ndikuwongolera kwa shuga. Poyerekeza ndi maziko a dziko la hypoglycemic (shuga yochepa), kupanga kwa adrenaline kumawonedwa, zomwe zimapangitsa kuchuluka kwa shuga.

Zikondazo zimayenderana kwambiri ndi zida zina zam'mimba. Zoyipa zilizonse kapena zosagwira bwino ntchito zimakhudza dongosolo lonse la chimbudzi.

Zowonetsera zamankhwala zamatenda a pancreatic enzyme

Zokhumudwitsa pakupanga ma enzyme, kuchepa kwa magwiridwe antchito ndi kuchepa kwawo ndizotsatira za chifuwa chachikulu cha kapamba. Matendawa amaphatikizidwa ndi kusintha kwapang'onopang'ono mu minofu ya glandular, chifukwa chake imasinthidwa ndi minofu yolumikizana.

Pali zifukwa zambiri za kapamba. Komabe, nthawi zambiri njira ya pathological mu thupi imachitika chifukwa chomwa mowa kwambiri. Mwa zina zodwala, kuperewera kwa zakudya m'thupi, matenda othandizira (cholecystitis), matenda opatsirana, komanso kugwiritsa ntchito mankhwala ena amadziwika.

Kuperewera kwa trypsin, amylase ndi lipase kumabweretsa zovuta zina pakugaya chakudya.

Zizindikiro zodziwika pancreatic Kulephera:

Ululu wam'mimba kumanzere mu hypochondrium, womwe nthawi zambiri umatha kudya. Nthawi zina ululu sugwirizana ndi chakudya.
Kuchepa kapena kusowa kwa chakudya.
Matenda am'mimba mu mawonekedwe a mseru, kutsegula m'mimba, kusanza mobwerezabwereza.
Kung'ung'udza pamimba, kusefukira.
Mtundu komanso kusinthasintha kwa ndowe kumasintha.

Kukula ndi kukula kwa mawonetseredwe azachipatala amatsimikiziridwa ndi kuchuluka kwa kuwonongeka. Chifukwa cha chimbudzi chochepa, kuperewera kwa michere kumawonedwa, ndipo pazithunzi zina, kusokonezeka kwa metabolic kumayambitsa ma pathologies ena - osteochondrosis, osteoarthrosis, atherosulinosis yamitsempha yamagazi.

Ngati kuchepa kwa lipase kwapezeka, ndiye kuti zizindikilo zake ndi izi:

Mu ndowe mumapezeka mafuta ochulukirapo.
Zamadzimadzi ndowe za lalanje kapena zachikasu.
Mpando ndi mafuta.

Nthawi zina, mafuta amadzimadzi okha amachotsedwa popanda ndowe. Ngati amylase sikokwanira, ndiye kuti wodwala sagwirizana ndi chakudya chopatsidwa ndi monosaccharides ndi disaccharides. Palinso tebulo lamadzimadzi, kusamwa kokwanira kwa zinthu zina zam'matumbo ang'onoang'ono, omwe amaphatikizidwa ndi kutsegula m'mimba kawirikawiri, kuwonda.

Ndi kuperewera kwa trypsin, kuperekera kwapafupipafupi kapena kowoneka kwambiri - mawonekedwe apamwamba a nayitrogeni ndi minofu ya minofu imapezeka mu ndowe. Chopondapo chimadziwika ndi fungo la fetid, kupezeka kwa magazi sikupatula.

Popeza njira yopatsanulira chakudya imasokonekera, ngakhale ndimapangidwe othandizira, odwala amachepetsa thupi, kuchepa kwa mavitamini ndi michere, kuwuma kwambiri pakhungu, kusokonekera kwa msomali, ndipo tsitsi limapezeka.

Ndi kupanga ochepa ma enzymes ndi tiziwalo timene timalimbikitsa. Koma zinthu zachilengedwe sizingagwirizane ndi zinthu zina chifukwa cha kulephera kwa thupi.

Kodi chitsulo chimathandizidwa bwanji?

Kuchiza kumachitika chifukwa cha matenda ena ake. Zowopsa pamsana pazifukwa zomveka komanso zosadziwika zimathandizidwa ndikusala kudya. Popeza izi zimathandizira kuchepetsa kupangidwa kwa madzi, chifukwa chake, chiwalo chamkati chimatsitsidwa.

Mwachizolowezi, odwala omwe amasala kudya kapamba amatha kulekerera, popeza thanzi lawo limakulirakulira, pamakhala kupweteka kwakanthawi. Amaloledwa kumwa mchere wam'madzi wopanda mpweya kapena msuzi wofowoka kwambiri wamtchire.

Cholinga chachikulu cha chithandizo cha matenda oopsa ndi kuteteza mavuto komanso kusokonekera kwake kukhala kanjira. Mapiritsi othandizira opweteka komanso mankhwala a enzymatic amalimbikitsidwa kuti athandizire kuchepetsa katulutsidwe ka enzyme.

Poyamba, zimayambitsidwa m'thupi la munthu kudzera m'mitsempha. Wodwala akakhala ndi thanzi labwino, amatha kumwa mankhwala ngati mapiritsi. Kuti muchepetse kupweteka kwambiri pachimake, mutha kuyikapo kutentha kwa kapu.

Kukonzekera kwa kapamba:

Antispasmodics yochepetsa ululu. Akatswiri azachipatala ambiri amapereka mankhwala a Papaverine, No-shpu, Drotaverin.Ngati ululu umakhala wochepa, ndiye kuti Ibuprofen amagwiritsidwa ntchito. Mankhwala omaliza nthawi yomweyo ali ndi anti-yotupa komanso ma analgesic.
Mankhwala a Antacid amathandizira kuchepetsa ululu, kupewa kukhumudwa komanso kupweteka kwa mucous membrane. Kugwiritsidwa ntchito ngati njira ndi mayankho omwe amathandizira kuti pasakhale hydrochloric acid. Oimira gululi - Zoran, Ranitidine.

Kuchepetsa kupanga michere yamagaya, Contrical imagwiritsidwa ntchito. Zochizira pancreatitis yantchito, mankhwala a enzyme amafunikira kuthandizira pantchito yamkati, kukonza njira yogaya chakudya. Mezim, Pancreatin, Creon ndi omwe adayikidwa.

Mphengoyi ndi chiwalo chokhwima kwambiri komanso chopanda chidwi, chifukwa chake chimafunikira chisamaliro chokha. Kuledzera ndi kumwa moipa kumatha kuyambitsa matenda a pancreatitis - pachimake komanso matenda osachiritsika, miyala mu ducts, matenda a shuga, necrosis kapena pancreatic adenocarcinoma, ndi matenda ena.

Kapangidwe ndi kagwiridwe kake kamene kamakambirana mu kanema munkhaniyi.