Exocrine pancreatic insuffuffence: zimayambitsa, Zizindikiro, chithandizo ndi kupewa

Mchitidwe wamanjenje ndi wochititsa manyazi wa ntchito zachinsinsi za kapamba

Madzi ofooka pamimba yopanda kanthu amawonjezeka kwambiri panthawi ya (2-3 maminiti) ndikatha kudya. Mwa chizolowezi chamadyedwe akudya, kuchotsedwa kwa mandimu kumayambira kale pakuwona, kununkhira kwa chakudya ndi zinthu zina zakumapeto zomwe zimatsagana ndi chakudya, zomwe zimawonetsa makonzedwe achangu a secretion. Ndi mkwiyo wa zolandilira za mucous nembanemba zamkamwa, pharynx, ndi esophagus ndi zakudya, dipatimenti yosazindikira ya pancreatic madzi ikubwera. Mitsempha yamkati kuchokera ku zolumikizira zolumikizidwa kudzera munjira zothandizana nazo zimafikira pakatikati pobisalira, komwe amasinthana ndi ma neuroguric neuron a neva, mothandizirana ndi mafupa amtundu wa cell omwe amafikira postganglionic neurons. Ma axons awo amapanga matumizidwe opatsirana pancreatitis yapansi. Acetylcholine wotulutsidwa mkati mwa zokondweretsa za malekezero awa amachititsa M-cholinergic receptors a membynane ya postynaptic. Pankhaniyi, oimira achiwiri (Ca ++ ndi HC-cGMP) amasulidwa, zomwe zimayambitsa ntchito zachinsinsi za maselo achikondwerero ndi ma cell a epithelial a ma ducts.Pakakwiyitsa mitsempha ya celiac, yomwe imapangitsa kusungidwa kwachisoni kwa kapamba, kubisala kwake kumalepheretsa (chifukwa cha activation ya p-adrenergicator ya pren adrenergicator. . Koma kuletsa kwa katulutsidwe kumayendera limodzi ndi kudzikundikira kwa chinsinsi cha kapamba. Kukhazikitsidwa kwa chakudya m'mimba pakumeza kumayambitsa kukhumudwa kwa chemo- ndi mechanoreceptors m'mimba, zomwe zimayambitsa kupitiliza kwa secretioned Reflex madzi achinsinsi ndi zikondamoyo, zomwe zimayambitsidwa ndi kukondoweza kwa zolowa zam'mimba zamkati. ) kubisika kwa mahomoni am'mimba kuchokera ku maselo a endocrine omwe amachititsa kuti pakhale secretion ya pancreatic yamadzimadzi. Udindo wa owongolera akuluakulu amamuchitidwa ndi Secretin ndi CCK, omwe amapangidwa ndi S- ndi CCK maselo a duodenal mucosa. Secretin ndi CCK amalimbikitsa chikoka cha wina ndi mnzake pancreatocytes, makamaka motsutsana ndi kumbuyo kwa kumasulidwa kwa acetylcholine kumapeto kwa ma synaptic a cholinergic nerve fibers omwe amapanga gland. Chofunikira cha humus causative wothandizira pancreatic secretion ndi gastrin, yotulutsidwa ndi maselo a mucous wa membrane wa antrum. Mphamvu zolimbikitsira za mahomoni awa zimathandizidwa ndi bombesin, serotonin ndi insulin. Somatostatin, glucagon, enkephalins, P P, TIP, PP, komanso calcitonin ndi ACTH amalepheretsa chinsinsi cha madzi. Koma udindo wawo pakapangidwe kovuta ka ziphuphu samveka bwino. Katemera wa pancreatic amachitika m'magawo atatu. Loyamba limatchedwa Reflex. Zimayambitsidwa chifukwa cha zovuta zomwe zimapangidwa poyambira ndipo zimatsata zakudya. Gawo loyamba, pafupifupi 10-15% ya buku lonse lamadzimadzi limamasulidwa magawo atatu, ndipo pafupifupi 25% ya michere. Mu gawo lachiwiri la chapamimba, pafupifupi 10% ya madzi ake onse (okhala ndi michere yambiri) amapangidwa. Mu gawo lachitatu lamatumbo, kuchuluka kwakukulu kwa madzi (pafupifupi 75% ya buku lonse), koma osakhala ndi michere yambiri, amabisidwa. Kuphatikizika kwake kumadziwika ndi ma bicarbonates ambiri omwe amafunikira kuti azikhala ndi zomwe zili mu duodenum.

Tikiti 27

Ntchito ya Cerebellar.

Cokratumum imakhala ndi ma hemispheres awiri ndi nyongolotsi pakati pawo.

Nkhani ya imvi imapangidwa ngati khungwa ndi mtima. Choyera chimapangidwa ndi ma process a neurons.

Cerebellum imalandila zikhumbo zothandizana nazo kuchokera ku ma tactile receptors, vestibular receptors, proprioreceptors a minofu ndi tendons, komanso magawo oyendetsa mota a kotekisi. Malingaliro odziwika bwino kuchokera ku cerebellum amapita ku maukono ofiira a ma midbrain, ma Deiters nucleus a medulla oblongata, thalamus, kenako kumadera a motor a CBP ndi subcortical nuclei. Ntchito yodziwika bwino ya cerebellum ndikuyendetsa kayendedwe ka kayendedwe komanso kayendedwe. Amachita izi pogwirizanitsa zochitika zama malo ena ama mota: vestibular nuclei, red nucleus, cortical pyramidal neurons.

1. Kayendedwe ka minofu kamvekedwe ndi kaimidwe.

2. Kuwongolera mayendedwe osayenda pang'onopang'ono nthawi yomwe akukwaniritsa, komanso kulumikizana kwa kusunthaku ndi mawonekedwe ndi mawonekedwe a thupi.

3. Kuyang'anira kuwongolera koyenera kwa mayendedwe othamanga omwe amapangidwa ndi khungwa.

Chifukwa chakuti cerebellum imagwira ntchitozi, ikachotsedwa, zovuta zovuta zamagalimoto, zotchedwa Luciani triad, zimayamba. Mulinso:

1. Agony ndi dystonia - kuchepa komanso kugawa kosayenera kwa kamvekedwe ka minofu.

2. Astasia - kuthekera kwa kupendekeka kosalekeza kwa mbewa, kukhalabe ndi khola pokhazikika m'thupi mukayimirira, mutakhala (ndikugwedezeka).

3. Asthenia - kutopa kwa minofu.

4. Ataxia - kulumikizana kosasunthika poyenda. Chidakwa chosakhazikika.

5. Adiadhokinesis - kuphwanya kutsatira koyenera kwa mayendedwe olowezedwa mwachangu.

Mu chipatalacho, zotupa za cerebellar zolimbitsa zimawonetsedwa ndi Charcot triad:

1. Nystagmus wamaso kupuma.

2. Kutentha kwamphamvu komwe kumachitika chifukwa cha mayendedwe awo.

3. Dysarthria - zovuta pakulankhula.

L. A. Orbeli anakhazikitsa kuti cerebellum imakhudza zosiyanasiyana ntchito zamagulu, izi zitha kukhala zosangalatsa komanso zoletsa. Mwachitsanzo, ndi kukwiya kwa cerebellum, kuthamanga kwa magazi kumawonjezera kapena kuchepa, kugunda kwa mtima, kupuma, ndi kusintha kwa chimbudzi. Kusokonekera kumakhudza kagayidwe. Imagwira ntchito kudzera m'malo a mitsempha yodziyimira payokha, ikugwirizanitsa ntchito yawo ndi kayendedwe. Ntchito za ziwalo zamkati zimasintha chifukwa cha kusintha kwa kagayidwe kazinthu mkati mwake. Chifukwa chake, cerebellum imakhala ndi kusintha kosinthika kwa iwo.

Sanapeze zomwe mukuyang'ana? Gwiritsani ntchito kusaka:

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Kodi exocrine pancreatic insuffence?

Kupukusa chakudya - Izi ndi zovuta komanso zingapo.

Imayamba ngakhale mkamwa yamkamwa, mukafuna kutulutsa kachidutswa koyamba ndikumanyowetsa malovu. Chakudya chikamezedwa, m'mimba mumayamba kugwira ntchito ndi hydrochloric acid ndi pepsin.

Pakatha mphindi pafupifupi 30, chakudya chokhala ndi theka m'mimba chimalowa m'matumbo aang'ono, omwe ndi duodenum, pachigawo chake choyambirira. Apa, zikondamoyo mothandizidwa ndi ma enzyme zimaphwanya mamolekyulu akulu kukhala osavuta komanso oyenera kuyamwa magazi.

Zikondamoyo, limodzi ndi zotulutsa ndi tiziwalo thukuta, ndimodzi mwazinthu zofunika kwambiri zotulutsira kunja. Izi zikutanthauza kuti imatulutsa zinthu zofunikira pansi pamiyendo yapadera. Zikondamoyo zimakhalanso ndi ntchito ya endocrine: imakhala ndikupanga mahomoni insulin, somatostatin, ghrelin ndi pancreatic polypeptide m'magazi a anthu.

Ngati kapamba wanu ali wathanzi, ndiye kuti sangangopereka chakudya chokwanira, komanso kuthandizira kagayidwe kake, kuphatikizapo shuga. Ndi kupanda kwa exocrine, michere yam'mimba imakhala yosakwanira, ndipo thupi chifukwa chake limasowa mavitamini ndi michere.

Ngati sanalandiridwe, kulephera kwa procine kungachedwetse kukula ndi kukula kwa ana, zimabweretsa zovuta ndi minofu yamafupa, kusiya thupi likudzitchinjiriza ku matenda ndikufupikitsa moyo.

Amayambitsa exocrine pancreatic insuffence

Zomwe zimapangitsa kulephera kwa procrine ndizambiri. Chilichonse chomwe chimawononga kapamba kapena kuletsa kumasulidwa kwa ma enzymes ake, chimatha kubweretsa izi. Zomwe zimayambitsa kwambiri, monga tafotokozera, ndi kapamba wambiri komanso cystic fibrosis.

Cystic fibrosis, kapena cystic fibrosis - Matenda osachiritsika omwe amatulutsa chinsinsi ndipo chimatulutsa chinsinsi cha m'mimba ndi kupuma, chotsekeranso kapamba, komanso bronchioles ndi bronchi yaying'ono.

Mu kutupa kosatha kwa kapamba - kapamba - minofu yabwinobwino imasinthidwa ndi minyewa yopanda ntchito. Nthawi yomweyo, ntchito ya gland imayamba kuwonongeka, kupanga ma enzyme kumachepa, ndipo thupi lanu limaleka kulimbana ndi zakudya wamba.

Kafukufuku wasayansi amatsimikizira mgwirizano pakati pa kusuta ndi chifuwa chachikulu cha pancreatitis.

Zomwe zimayambitsa kuperewera kwa exocrine pancreatic:

• khansa ya kapamba
• Kuchotsa opaleshoni kwa gawo lina la ndulu
• Kutulutsa kwa pancreatic duct
• Celiac enteropathy
• Matenda a Crohn
• Autoimmune pancreatitis
• shuga
• Zollinger-Ellison syndrome
• Zinthu pambuyo pa opaleshoni ya m'mimba
• kutaya matenda

Zizindikiro za exocrine pancreatic insuffuffence

Vutoli limakhala lovuta kudziwa, chifukwa zizindikiro zake zimayenderana ndi matenda ena, kuphatikizapo matumbo osagwira, zilonda zam'mimba, matenda a ndulu, matenda a matumbo otupa, ndi zina zambiri.

Nthawi zambiri, exocrine pancreatic insufficiency imadziwonetsa ngati matenda am'mimba komanso kuwonda. Steatorrhea ndi chikhalidwe - kumasulidwa kwa mafuta osaphatikizidwa ndi ndowe, zomwe zimapatsa ndowezo mawonekedwe amafuta komanso fungo lakuthwa losasangalatsa.

Zizindikiro zina za kulephera kwa exocrine:

• Kufooka ndi kutopa
• Kupanga kwamphamvu kwa mpweya
• Ululu pakati pamimba, kufikira kumbuyo
• Kutayika kwa minofu, kuchepa thupi
• Zizindikiro za hypovitaminosis (brittle misomali, kuchepa kwa tsitsi)

Kuzindikira kwa exocrine pancreatic insuffuffence

Kudziwa zizindikiro izi sikokwanira. Vuto ndilakuti kutsekula m'mimba sikumakula mpaka chithaphwi chake chatayika 90% ya magwiridwe ake, ndiye kuti, kwakanthawi matenda angayambe ndi chopondapo chabwinobwino.

Kuti mutsimikizire kuperewera kwa procrine pancreatic, mufunika kuwunika ndowe, kuyezetsa magazi kwa mavitamini ndi mafuta acids, komanso compact tomography - kuzindikira zomwe zimayambitsa.

Chithandizo ndi kupewa

Chithandizo cha kukomoka kwa procrine ziyenera kuyamba posachedwa.

Pancreatic enzyme m'malo mankhwala ndi muyezo wagolide pochiza izi. Mankhwala obwezeretsa m'malo mwake, amagwiritsa ntchito mankhwala osokoneza bongo omwe amakhala ndi ma enzymes a nkhumba, ndipo nthawi zina amagwira ntchito zina.

Mankhwalawa ali ndi lipolytic (kuphwanya mafuta), amylolytic (kuphwanya wowuma) ndi proteinolytic (kuphwanya mapuloteni) ntchito, yomwe imayezedwa m'mayunifolomu - 8000, 10000, 20000. Izi zimaphatikizapo pancreatin, mezim, panzinorm, festal, creon, pangrol ndi mankhwala ena .

Pancreatic enzyme m'malo, momwemo, imagwira ntchito momwe kapamba sangathe. Sabwezeretsa chithokomiro, koma amatha kuchirikiza thupi la wodwalayo kwazaka zambiri, amakupatsani mwayi wopeza michere.

Udindo wofunikira kwambiri pantchito ya procrine pancreatic insuffence imaseweredwa ndi zakudya zoyenera komanso moyo wathanzi..

Odwala amalangizidwa izi:

• Kupewa kupsinjika
Kusiya kusuta fodya komanso mowa
• Zakudya zambiri pafupipafupi
• Zakudya zoyenera ndi mafuta ochepa
• Kumwa zowonjezera mavitamini (makamaka mavitamini A, D, E ndi K)

Ntchito za Pancreatic Enzyme

Chimodzi mwazochita zazikulu ndikupanga ma enzymes a pancreatic.

Ma enzyme otero amapereka chimbudzi cha mitundu yonse ya chakudya.

Ma enzyme opangidwa ndi kapamba amakhala m'magulu angapo.

Gulu lalikulu kwambiri la ma enzymes ndi ma protein. Kuchulukitsa kwa gululi la michere ya pancreatic kumachitika chifukwa cha kupezeka kwa mitundu yambiri yama protein.

Ma enzymes a proteinolytic omwe amapukusa mapuloteni ena amaphatikizira izi:

Kuphatikiza pa izi, chitsulo chimapanga:

1. Lipase - phula lomwe limaphwanya mafuta.
2. Amylase ndi gawo lomwe limagawika polysaccharides.
3. Mitsempha yamagetsi ndi zovuta za ma enzymes omwe amatsimikizira kufalikira kwa ma nucleic acid.

Ngati pali zosokoneza pakupanga zigawo za madzi a pancreatic, zovuta zina zam'mimba zimayang'aniridwa, zomwe zimayambitsa kugaya chakudya chosakwanira komanso zovuta zama metabolic.

Kulephera pakupanga ma enzymes kumapangitsa kuti pakhale kuperewera kwa exocrine pancreatic ntchito.

Kuwonongeka kwa exocrine pancreatic ntchito

Zomwe zimayambitsa matenda a exocrine pancreatic function is the development of organ organ organ. Nthawi zambiri, izi zimachitika chifukwa cha kufooka kwa minofu mu kapamba kapena pancreatic yayikulu, pomwe njira yotupa imayambitsa kuwonongeka kwa gawo la pancreatic parenchyma.

Ntchito ya procrine imakhala yovuta kwambiri kwa odwala ambiri omwe ali ndi kapamba.

Kukhazikika kwatsimikizika mwasayansi pakati pa kukula kwa kulephera, kusuta ndi chifuwa chachikulu.

Zina zomwe zimayambitsa matendawa zitha kukhala:

• Oncological neoplasm mu zimakhala za gland.
• Kuchotsa opaleshoni ya gawo la tiziwalo timene timatulutsa.
• Kupezeka kwa kutsekeka kwa zikondamoyo.
• Kukula kwa celiac enteropathy.
• Kukula kwa matenda a Crohn.
• Kupita patsogolo kwa autoimmune pancreatitis.
• Matenda a shuga.
• Kukula mthupi la Zollinger-Ellison.
• Zochita pambuyo pa opaleshoni m'mimba.
• Kukula kwa kutaya matenda.

Chifukwa china chopitilira kuchepa kwa kapamba ndi kuchepa kwa thupi la wodwalayo la cystic fibrosis kapena cystic fibrosis, njira yotsimikizika mwanjira yomwe kupangika kwa chimbudzi kwamkati ndi kwa bronchioles kumawonedwa m'malo opukusa ndi kupuma.

Chizindikiro chachikulu cha kusayenda bwino kwa chiwalo ndi kugaya m'mimba ndikusokonekera kwa dyspeptic.

Izi zimadziwika ndi maonekedwe a zizindikiro zazikulu zotsatirazi:

1. ma polyfecals,
2. zopumira pafupipafupi komanso zotayirira
3. Maonekedwe a mafuta mu ndowe,
4. kupezeka kwa duwa pafupipafupi,
5. kuwonda.

Pankhani ya kukula kwa endocrine kuchepa, wodwalayo amakula shuga. Mtunduwu wa shuga ndi wosavuta kuposa mtundu 1 shuga. Izi ndichifukwa choti si maselo onse a zisumbu za Langerhans.

Nthawi zambiri, odwala oterowo pakapita kanthawi kochepa amafunika kukhazikitsa milingo yowonjezera ya insulin.

Nthawi zina, zimachitika kuti magazi amasintha shuga m'magazi pogwiritsa ntchito zakudya zapadera ndi mankhwala a hypoglycemic.

Zizindikiro ndi kuzindikira kwa exocrine kulephera

Kulephera ndikovuta kuzindikira.Izi ndichifukwa choti zonse zomwe zimadziwika ndi matenda am'chiberekerozi ndi zofanana ndi zizindikiro za matenda ena, mwa zomwe mumakhala zovuta monga matumbo am'mimba, zilonda zam'mimba, cholelithiasis, njira yotupa m'matumbo ndi ena ambiri.

Kuwonetsera kofala kwambiri kwa kulephera kwa procrine gland ndi kupezeka kwa matenda otsekula m'mimba komanso kuwonda.

Chizindikiro china cha matenda a m'mimba chimatha kukhala kukula kwa hypovitaminosis yowonetsedwa misomali yovutidwa ndi tsitsi.

Vuto lodziwitsa matenda amtundu wa m'magazi limakhala loti silimawonekera mpaka limba limatayika mpaka 90% ya zomwe limagwira. Munthawi yonseyi, wodwalayo samawonetsa zizindikilo ndipo kupusa kumakhala kwacibadwa.

Kutsimikizira kapena kutsutsa kuti matendawa alipo, mayeso angapo a labotale amachitika, kuphatikiza:

• Kusanthula kwamaganizidwe.
• Kuyesedwa kwa magazi ndi shuga ndi katundu.
• Kuyesedwa kwa magazi ndi mavitamini ndi mafuta acids.
• Kuyesedwa kwa magazi kwa shuga.

Kuphatikiza apo, tomography yowerengera imachitidwa, yomwe imakulolani kuti muzindikire zomwe zimayambitsa kuwoneka kwa vuto la pathological mu kugwira ntchito kwa chiwalo.