Kodi ndi syndromes iti yomwe imawoneka ndi chifuwa chachikulu?

Zifukwa
Zizindikiro za Chronic Pancreatitis
Zizindikiro
Chithandizo cha matenda kapamba
Mavuto ndi udzu

Matenda a kapamba ndi gulu la matenda a kapamba omwe amadziwika ndi kukhalapo kwa chidwi cha necrosis mu kapamba motsutsana ndi gawo la fibrosis ndikuwonongeka kwa ntchito ya gland yamisala yosiyanasiyana. Kupita patsogolo kwa matenda apakhungu am'mimba kumabweretsa kuwoneka ndi kukulira kwa atrophy (kufooka) kwa minyewa ya m'mimba, microsis ndi kusintha kwa ma cell a pancreatic parenchyma okhala ndi minofu yolumikizira.

Zoyambitsa zazikulu za kapamba:

1) kumwa mowa - uchidakwa kapamba (kawirikawiri mwa amuna azaka zopitilira 35) pa mlingo woposa 20-80 mg wa Mowa / tsiku. kwa zaka 8-12. Zakudya zamapuloteni komanso kusuta zimakulitsa kwambiri njira ya kapamba,
2) matenda am'mimba komanso duodenum - biliary pancreatitis (nthawi zambiri mwa akazi),
• Matendawa ndimomwe ndimayambitsa matenda a kapamba 35-55%,
• matenda a sphincter a Oddi (stenosis, kupindika, kutupa, kutupa),
• duodenitis ndi zilonda zam'mimba. Chifukwa chake, zilonda zam'mapazi mu 10,5-16,5% ya milandu ndizomwe zimayambitsa kukula kwa kapamba.

Matenda a kapamba omwe amapezeka ndi matenda a gallstone, choledocholithiasis, amapezeka kwambiri mwa akazi azaka 50-60. Nthawi zambiri, odwalawa ali ndi zizindikiro za metabolic syndrome: kunenepa kwambiri, kuchepa kwa magazi, matenda amitsempha yama mtima, kulolerana kwa carbohydrate, hyperuricemia ndi / kapena hyperuricosuria.

Mfundo ziwirizi ndizodziwikiratu ndipo nthawi zambiri zimayambitsa matenda kapamba. Zoyambitsa wamba:

3) cystic fibrosis (nthawi zambiri mwa ana),
4) cholowa chokhala ndi chibadwa. Chodziwika kwambiri kumpoto kwa Europe, maulendo ake amakhala pafupifupi 5% ya milandu yonse. Mtundu wa chibadwa cha kapamba amatha kukayikiridwa ndi kusapezeka kwa zoyambitsa ndi vuto la kapamba m'mabanja la abale odwala,
5) idiopathic kapamba. Pomwe nthawi yophunzirayo sizinayambike - 10 mpaka 30% ya kapamba onse. Kafukufuku waposachedwa adawonetsa kuti chifukwa cha idiopathic pancreatitis chitha kukhala ma microcrystals a cholesterol, granules of bilirubinate and calcium micospherolites,
6) zifukwa zina:
• autoimmune kapamba,
• matenda matenda ndi vasculitis,
• ma virus (Coxsackie, CMV) ndi matenda obwera ndi mabakiteriya,
• matenda a helminthic (opisthorchiasis),
• matenda a metabolic (hyperlipidemia, matenda a shuga, kulephera kwaimpso, ndi zina).
• matenda a discirculatory (ischemic pancreatitis),
• zonyansa za kapamba,
• kuvulala, poyizoni poyizoni.

Zizindikiro za Chronic Pancreatitis

Matenda a kapamba ndimatenda a pancreas omwe amapita pang'onopang'ono, omwe amaphatikizidwa ndi necrosis (necrosis ya minyewa ya minyewa) yothandizirana ndi fibrosis ndikupangitsa kuti ziwonongeke pang'onopang'ono ziwalo ngakhale zitatha mphamvu ya pathogenic, yomwe idayambitsa matendawa. Mokhazikika, chifuwa chachikulu chimanenedwa pamene njira yotupa mu kapamba imatha miyezi yopitilira 6. Matenda a kapamba nthawi zambiri amapezeka ndimagawo a kutulutsa ndi kutulutsa (kuchotsedwa kwa matendawa).

Ndikofunikira kusiyanitsa pakati pa pancreatitis yovuta komanso yosatha, chifukwa pali kusiyana kwakukulu mu njira zamankhwala za odwala. Izi nthawi zina zimakhala zovuta kuchita, popeza kuchuluka kwa kapamba am'mimba mumayendedwe ake ndi ofanana kwambiri ndi kapamba, komanso kapamba kakang'ono, kumatha kukhalabe kosadziwika (mu 60% ya milandu!), Kuyenda pansi pa chigoba cha matenda ena am'mimba kapena thirakiti , ndipo kenako idzasinthika kukhala yovuta.

Zosankha za chifuwa chachikulu

Matenda Olepheretsa Pancreatitis Amayamba chifukwa chotchinga chachikulu cha kapamba ndi chotupa, ndi kutupa kwa duodenal papilla kapena stenosis, duodenitis chifukwa cha matenda a Crohn, kutsekeka pamimba ndikuchita opaleshoni mu pyloroduodenal zone, kukhalapo kwa ma pseudocysts a kapamba, kupindika kwatsopano. Matenda a Gallstone ndi choledocholithiasis, kukanika kwa sphincter a Oddi biliary ndi mitundu ya pancreatic ndizomwe zimayambitsa kupezeka kwa matenda a pancreatitis aakulu. Kugonjetsedwa kwa kapamba ndi yunifolomu ndipo sikumayendera limodzi ndi kupanga miyala mkati mwa zonyansa za gland. Chizindikiro chotsogola ndi kupweteka kosalekeza.

Ndi calcifying aakulu kapamba mu ma ducts, mpweya wa protein kapena ma calcified, miyala, cysts ndi pseudocysts, stenosis ndi atresia, komanso atrophy ya minyewa ya ziphuphu amapezeka. Njira yotere yamatenda am'mimba amadziwika ndi kubwereranso komwe kumachitika ndi ma episode ochulukirapo, m'mayambiriro ofanana ndi pancreatitis yachilendo. Monga lamulo, chifuwa chachikulu chotere chimayambitsidwa ndi mowa.

Gulu lama calcifying pancreatitis ndi chidakwa cha pancreatitis, kapamba, kamene kamadziwika ndi zotulutsira zachilengedwe, mankhwala ena, mankhwala, komanso kapamba, komwe kunayamba chifukwa cha hyperlipidemia, hypercalcemia yokhala ndi hyperparathyroidism, matenda okhudzana ndi matenda a HCV komanso HBV Kusintha kwatsopano kwa ma pancreatic ducts (owirikiza pancreatic duct).

Chikhodzodzo chokhala ndi chibadwa chamkati chokhala ndi cholowa chosakwanira komanso chokhala m'gulu lomwe limaletsa kapamba ndipo chimakula mwa ana a zaka 10 mpaka 10 kapena azaka 30 mpaka 40. Sizindikirika monga mitundu ya chifuwa cham'mimba, chomwe chimachitika pakadutsa zaka 8 mpaka 10, matenda a shuga opatsirana mu 20% ya odwala komanso okhazikika chifukwa cha 15-20% ya odwala. Kusakhalapo kwa zoyambitsa zina ndi chisonyezo cha milandu ya kapamba m'mabanja kumatsimikizira kukayikira kwa mawonekedwe amtundu wa chifuwa chachikulu.

Matenda a parenchymal pancreatitis yodziwika ndi chitukuko cha maziko a kutupa mu parenchyma ndi predominance ya ma cell a mononuclear cell ndi ma fibrosis omwe amalowetsedwa, omwe amalocha pancreatic parenchyma. Ndi mawonekedwe amtunduwu wa kapamba, palibe kuwonongeka kwa ma ducts ndi ma calancations mu kapamba. Zizindikiro zotsogola ndizizindikiro pang'onopang'ono za exocrine ndi endocrine kusakwanira komanso kusapezeka kwa ululu (mawonekedwe osapweteka).

Kupweteka kwamatenda a kapamba

Nthawi zambiri kukula kwa mawonekedwe opweteka a pancreatitis oyambilira amatsogozedwa ndi gawo lopanda ululu, lomaliza la zochitika zosiyanasiyana, lotsekeka ndi kusapeza mu epigastrium, flatulence, malo osakhazikika omwe ali ndi chizolowezi chofuna kutsegula m'mimba ndi fayilo yopanda kanthu mu chopondapo kapena sitimayo. Mobwerezabwereza kuukira kupweteka kwa mawonekedwe a kupweteka kwa kapamba kapamba kapangidwe ka kapamba ka chifuwa chachikulu cha exocrine kapena endocrine.

Kupweteka kumatha kuchitika nthawi yonse ya kukokomeza komanso gawo lochepetsa matenda a kapamba. Alibe kutulutsa kwachidziwikire, komwe kumachitika m'mimba kapamwamba kapena pakati pamimba kumanzere kapena pakati, kumapereka kumbuyo, nthawi zina kumakhala ndi zoster. Oposa theka la odwala ali ndi ululu kwambiri.

Kutengera ululu matenda kapamba

Zomwe zimayambitsa kupweteka pancreatitis yayitali ndi motere:

1) kutupa kwapakhungu kwamphamvu (kuwonongeka kwa parenchyma ndi kapisozi),
2) ma pseudocysts omwe amatulutsa mitsempha yozungulira,
3) kutsekeka ndi kuchepa kwa pancreatic ndi bile duct,
4) fibrosis m'munda wamanjenje zam'malingaliro, zomwe zimatsogolera kukakamira kwawo,
5) kupanikizika kwa mitsempha yoyandikana ndi zikondamoyo zokulitsidwa,
- stenosis ndi dyskinesia wa sphincter wa Oddi.
- Ululu wophatikizana ndi ma pseudocysts ndi kufinya kwa duct kumawonjezeka kwambiri mukatha kudya. Ululu, monga lamulo, lamba, paroxysmal. Chepetsani kwambiri mankhwala a antisecretory mankhwala ndi makonzedwe a pancreatin (Panzinorm), omwe amachepetsa kubisika kwa kapamba ndi makina a mayankho.
- Zowawa zotupa sizitengera chakudya, chakumaso, ngati lamulo, mu epigastrium, chowalira mpaka kumbuyo. Ululu woterewu umayimitsidwa ndi ma analgesics (NSAIDs, woopsa - narcotic analgesics)
- Kuperewera kwa pancreatic pancreatic kumapangitsa kukula kwambiri kwa mabakiteriya m'matumbo ang'onoang'ono, zomwe zimapangitsanso kupweteka kwakukulu pakuyerekeza kwa odwala omwe ali ndi pancreatitis yosatha. Kupweteka kumeneku kumachitika chifukwa cha kukakamiza kwa duodenum.

Pakumapeto kwa matenda a kapamba, ndimatenda a fibrosis, ululu umachepa ndipo amatha kutha patatha zaka zochepa. Kenako kuwonekera kwa kulephera kwa procrine kumadzaonekeranso.

Kodi kutupa kwa kapamba kumachitika bwanji?

Ngakhale zizindikilo zotsogolera zotupa za kapamba sizipezeka mwa odwala onse. Komabe, ayenera kutchedwa oyamba. Zizindikiro zachikhalidwe za pathological zimatsimikiziridwa ndi a Mondor triad - awa ndi ululu pamimba, kumatulutsa komanso kuwukira.

Matendawa amakula pakapita maola angapo. Wodwala sangathe kunena komwe zakupwetekera. Ululu umafotokozedwa ponseponse; motsutsana ndi maziko awa, kutengera chikhalidwe sikumakhazikitsidwa momveka bwino. Imatha kupatsa mapewa, m'munsi kumbuyo, kolala ndi mbali zina za thupi.

Muzojambula zambiri, kusanza kumayambanso mwadzidzidzi. Ndi 20% yokha ya odwala omwe amayamba kudwala mseru. M'masanzi muli zidutswa za chakudya chosasamba, pambuyo pake pali bile lomwe limatsala.

Zizindikiro zazikulu zakukula kwa kapamba:

• Kuperewera kwa chopondapo ndi chifukwa cha kutsata kwa matumbo. Kapenanso, wodwalayo amakhala pansi mpaka kasanu patsiku. Ma Fecal misa ndi mafuta, amakhala ndi mawonekedwe osilira, omwe amawonetsa chitukuko cha steatorrhea (kupenda kwapofukufuku kumawonetsa kukhalapo kwa mafuta mu ndowe pamwamba pazabwino),
• Chizindikiro cha kusowa kwamadzi ndi kuyanika kwambiri mkamwa. Monga lamulo, chizindikiro cha kuchepa madzi m'thupi chimawonjezeka ngati wodwalayo akuwulula nthawi yomweyo kusanza komanso kutsegula m'mimba pafupipafupi.
• Minofu yakhoma yam'mimba khoma ndimakomoka - peritoneal irrit syndrome. Pa palpation, ululu ululu umayamba kukula,
• Khungu la pakhungu, kupuma movutikira, kugunda kwamtima, kutsekemera kwa sclera ya maso, ndi zina zambiri.

Muzochita zamankhwala, zizindikiro za pancreatitis pachimake zimasiyanitsidwa, zomwe zimathandiza kudziwa matendawa "ndi diso". Komabe, ndizosowa kwambiri mwa odwala - pafupifupi 10% pazithunzi zamankhwala.

Ndipo amachitira umboni za kuwonongeka kwa kapamba.

Zizindikirozi zimaphatikizira kuwoneka kwa mawanga ansalu pankhope, kuphulika m'dera lachiwonekero, kupindika kwa malekezero am'munsi, zotupa zodontha m'dera lumbar.

Pancreatitis Pain

Kodi ma pancreatitis syndromes ndi chiyani? Wodwala akaulula zizindikiro zingapo zowopsa za kuphwanya dongosolo limodzi mthupi, amaphatikizidwa kukhala matenda. Mwanjira ina, iyi ndi mawonekedwe ena azachipatala omwe amatha kuphatikizidwa m'gulu limodzi, popeza ali ndi kufanana.

Matenda aliwonse amakhala ndi ma syndromes ena, cholecystitis, kapamba ndi zina zomwe zimachitika. Ululu ndi kutupa kwa kapamba amapezeka nthawi zonse.

Mwa kuukiridwa kwambiri, kupwetekako kumakhala kwamphamvu kwambiri, kungayambitse kudandaula. Poyerekeza ndi mawonekedwe a mawonekedwe osakhazikika, mwa odwala ena ululu umakhalapo nthawi zonse, koma umadziwika ndi kuchepa kwambiri.

The kwachulukidwe ululu amayamba ndi chotupa mu kapamba. Ngati magwiridwe amutu wa chiwalocho ali ndi vuto, ndiye kuti ululu umawoneka mbali yakumanja ya epigastric dera. Thupi la glandular likapunduka, limapweteka kumanzere. Zowonongeka za mchira zikapezeka, zimapweteketsa pansi pa nthiti yakumanzere.

Ululu umatha kupatsa ziwalo zina zamthupi:

1. Kumbuyo kumapeto kwa nthiti.
2. Pansi pa tsamba lamanzere.
3. Mapewa.
4. Mchigawo cha iliac.
5. M'chifuwa (pamenepa, chizindikiro chimafanana ndi angina pectoris).

Chodabwitsa cha matendawa ndikuti ma pinkiller samathandizira kuwongolera. Mwapadera, ululu umakhala wofewa, pomwe ena amakhalabe wamphamvu.

Chikhalidwe cha chizindikiritso ndi kukula kwa kapamba kapamba ndizosiyanasiyana. Limagwirira zomwe zimachitika zimakhazikika pakuwonjezeka kwakukulu kwa kupanikizika kwa ma ducts ndi glandular tishu, kutupa kwa chimbudzi cha dongosolo la chimbudzi, chifukwa chomwe kutuluka kwa pancreatic secretion kumakulirakulirabe.

Zizindikiro za exocrine kusakwanira

Exocrine pancreatic insuffence ikuwonetsedwa ndikuphwanya njira za kupukusa kwamatumbo ndi mayamwidwe. Zizindikiro

• kutsekula m'mimba (chopondapo 3 mpaka 6 pa tsiku),
• steatorrhea (zimachitika pamene katulutsidwe kapamba kafupika 10%, ndowe ndi mushy, fetid, ndi mafuta Sheen).
• kuchepa thupi,
• nseru
• kusanza kwakanthawi,
• Kuchepa kwa njala.

Matenda a bakiteriya omwe amakula kwambiri m'matumbo ang'onoang'ono amakula msanga, zomwe zimakhala:

• chisangalalo,
Kung'ung'udza m'mimba
• kubetcha.

Pambuyo pake, zizindikiro zomwe zimakhala ndi hypovitaminosis - kuchepa kwa magazi, kufooka, kusintha pakhungu, tsitsi, komanso kagayidwe - kolowa.

Maziko a exocrine pancreatic insufficiency ndi njira zotsatirazi:

- Kuwonongeka kwa maselo acinar, komwe kumapangitsa kuchepa kwa michere ya pancreatic,
- kusungunuka kwa kapamba wam'mimba, kusokoneza kutuluka kwa madzi a pancreatic mu duodenum,
- kuchepa kwa katulutsidwe ka ma bicarbonates ndi epithelium ya ma ducts a gland kumabweretsa acidization ya zomwe zili mu duodenum mpaka pH ya 4 kapena kutsika, zomwe zimapangitsa kuwonongeka kwa ma pancreatic enzymes ndi mpweya wa ma acid acids.

Dyspeptic syndrome

Dyspeptic syndrome imayendera njira zambiri zamatenda m'thupi. Zipatala zawo ndizosiyanasiyana, ndipo sizotheka kudziwa zovuta za chifuwa chokha chifukwa cha dyspepsia.

Mwa odwala ena, dyspeptic syndrome imayambira pang'ono m'mimba, pang'onopang'ono imasandulika kukhala zomverera zowawa. Belching imawonedwa ndi mpweya.

Kukumana ndi nseru ndi kapamba sikuchitika mwa aliyense. Nthawi zambiri, kusanza kumadziwika mwa odwala. Samabweretsa mpumulo. Pambuyo pake, kutentha kwadzuwa, komwe kumalimbikitsidwa ndi kuwotcha kummero. Amayamba chifukwa cha zomwe zimachitika m'mimba zomwe zimalowa m'mimba mwa munthu.

Pancreatitis syndrome mu mawonekedwe a dyspepsia amawonetsedwa ndi zizindikiro zotsatirazi:

• Kuchulukirachulukira, kumva kudzaza m'mimba,
• Malo othamanga kwambiri. Ndi kutupa kwa kapamba, amaphatikizidwa ndi fungo la fetid, losasamba bwino lomwe kukhoma la chimbudzi,
• Kulawa koyipa mkamwa kumasonyeza kusowa kwa michere yokugaya,
• Kuwonongeka kwathunthu kwa thanzi, kufooka ndi ulesi, kugwedezeka kwambiri pamimba.

Ndi kapamba, kukomoka kwa dyspepsia kumatha kuchitika, chifukwa cha kupesa njira mumatumbo.Wodwalayo amadandaula kuti akung'ung'udza m'mimba, kupangika kwa mpweya, kupendekera pafupipafupi. Kutsanulira matumbo kumabweretsa zowawa. Ikasokonekera m'matumbo, dyspepsia yowonongeka imawonekera - kufooka komanso kufupika, chovala chamdima chokhala ndi fungo losasangalatsa komanso losasangalatsa.

Monga lamulo, motsutsana ndi maziko a kapamba, ma syndromes angapo amawonedwa nthawi imodzi, chifukwa kapamba amachita ntchito yoposa imodzi mthupi. Chifukwa chake, kuphwanya magwiridwe ake kumayambitsa kusokonezeka kwa ziwalo zambiri zamkati ndi machitidwe.

Ngati zizindikiro za dyspeptic zikuphatikizidwa ndi kupweteka kwambiri kwa ululu, komwe ndi kakhalidwe kakulidwe ka chifuwa chachikulu, tikulimbikitsidwa kuyimbira gulu la ambulansi nthawi yomweyo.

Hemodynamic syndrome ndi kapamba

Kwa odwala, hemodynamic syndrome ya pancreatitis yachilendo imawonetsedwa nthawi zambiri. Kuwonongeka kwa hememnamic kumakhazikitsidwa ndi kuchepa kwa kugunda kwa mtima, kuchepa kwa kuthamanga kwa magazi kwa diastolic ndi systolic m'mitsempha yama cell, aorta ndi m'mapapo.

Kutsutsa kwamitsempha yamagazi kumawonjezeka chifukwa cha kumasulidwa kwa zigawo za biologically - serotonin, histamine, endorphin, ndi zina zotere.

Tcheni chonsechi chimadzetsa kusintha kwa magazi. Kupsyinjika kwa ma systolic ndi diastolic kumachepa kwambiri, pomwe kutsekeka kwa makoma amitsempha yamagazi kumawonjezeka.

1. Tachycardia mu mtima kulephera.
2. Kutupa kwamadzi pakhungu.
3. Maonekedwe otupa kumaso, kumalekezero apansi.

Nthawi zina, vuto lalikulu limawululidwa mu amayi ndi abambo - kukhetsa magazi kwambiri. Imfa mu zovuta kuzungulira thupi mokwanira. Ndi mtundu wa hypodynamic, womwe umatsika kwambiri ndi kuthamanga kwa magazi, ndi woposa 50%.

Ndi mtundu wa hyperdynamic, magazi akakwera, matulukidwe amakomera kwambiri - kuthekera kwa kufa sikupitilira 10%.

Ma syndromes ena

Odwala achikulire, pachimake kukanika kwa kapamba, kupuma kumadziwonekera. Zomwe zimayambitsa mwachangu ndikulowa kwa alveoli - ma cell omwe amapanga mapapu amunthu. Zizindikiro zake zimaphatikizapo kupuma movutikira, kupuma movutikira, khungu lamtambo - chifukwa cha kuchepa kwa mpweya.

Ndi zizindikirozi, wodwala amafunika kuthandizidwa. Matenda opatsirana nthawi zambiri samayamba, koma kupezeka kwake kumawonjezera chiopsezo cha zovuta. Malinga ndi ziwerengero, anthu omwe amafa pakati pa odwala akuluakulu chifukwa cha kupuma kwambiri amakhala opitilira 60%, nthawi zina amakhala okwera kwambiri.

Mu kapamba kapamba, chiwindi chimadwala. Odwala amadandaula za kupweteka kwa chiwindi. Kuchuluka kwa chiwindi, kumawawa kwambiri. Choyambitsa ndikuwonongeka kwa poizoni chifukwa cha pachimake kutupa ndi pancreatic edema. Poyerekeza ndi kuwonongeka kwa chiwindi, ma syndromes ena alipo.

Jaundice - madontho a khungu, phukusi lamaso, ma mucous membrime amalilime mosiyanasiyana chikasu. Kuwonetsera kwakanthawi pano kumalumikizidwa ndi vuto la kayendedwe ka bile kapena bilirubin metabolism m'thupi. Ndi zovuta za chiwindi, kuthamanga kwa magazi, kuchepa kwa magazi, kusokonezeka kwa tulo, tachycardia imatha kuonedwa.

Ral syndrome imapezeka mu edematous komanso zowononga mawonekedwe a kapamba. Imadziwoneka ngati kuchepa kwa kuchuluka kwa diuresis tsiku ndi tsiku. M'magazi, kuchuluka kwa urea ndi creatinine kumawonjezeka kwambiri. Mavuto a impso amayamba ndi:

• Kuthetsa magazi chifukwa cha m'mimba ndi kusanza,
• Kuwonongeka kwa impso ndi zinthu zowola za pancreatic minofu,
• Kuwonongeka kwa impso ndi mabakiteriya okhala ndi chifuwa chachikulu cha pancreatitis,
• Kutsika kwakukulu kwa kuthamanga kwa magazi pazofunikira kwambiri.

Kukhalapo kwa kuwonongeka kwaimpso sikuwonjezera vutoli. Ntchito ya ziwalo zimabwezeretsedwa mwachangu ndi chithandizo chokwanira cha kapamba.

Chithandizo cha pancreatitis pachimake chimachitika nthawi zonse m'malo mopumira. Nthawi zina, pathology ndiyosavuta, wodwalayo amabwezeretsedwa mwachangu popanda zotsatirapo zoyipa zaumoyo.

Nthawi zina pancreatitis pachimake imafunikira chithandizo chachikulu komanso chithandizo cha opaleshoni - zojambula zambiri zimakhala zokhudzana ndi mtundu wowononga wa matenda. Edematous pancreatitis ndiosavuta, amakhala ndi zovuta zochepa.

Malingaliro azithandizo ndi zakudya. Poyamba, wodwalayo amaletsedwa kudya chilichonse kuti asapatse katundu wambiri kapamba. Njala imachitika moyang'aniridwa ndi achipatala, nthawi zambiri masiku 2-5.

1. Chepetsani mtolo pamigayo.
2. Sinthani kufalikira kwa magazi mthupi.
3. Malipiro am'madzi.
4. Pewani ululu, dyspeptic syndrome.
5. Mankhwala a antibacterial amalepheretsa zovuta.

Ngati wodwalayo ali ndi mawonekedwe owonongeka, kachilombo koyambira kamapezeka, ndiye kuti chithandizo chimachitika. Pali njira zambiri zamankhwala. Chisankho chimatengera momwe zinthu ziliri.

Ntchito zimatsegulidwa ndikutseka, pogwiritsa ntchito endoscope. Njira zotseguka zimagwiritsidwa ntchito pokhapokha - necrosis, kukonzanso kwa abscess, puritis peritonitis, kutulutsa magazi kwambiri.

Chifukwa chake, pancreatitis yovuta kapena yogwira imayendera limodzi ndi ma syndromes osiyanasiyana. Komabe, kupezeka kwawo kuti azindikire sikokwanira. Kuphatikiza apo, zidziwitso zothandizira ndi zasayansi zimafunikira.

Zizindikiro za kapamba zimafotokozedwa mu kanema munkhaniyi.

Zizindikiro za kapamba

1. Zowawa palpation malinga ndi Grogt ndi Mayo-Robson powerengera kapamba (zowonongeka kumutu pamalo a Desjardins ndi malo a Schoffar, ndi kuwonongeka kwa mchira - pamalo ndi malo a Mayo-Robson, ndi kuwonongeka kwa thupi - mdera la Gubergrits-Skulsky - motsatira mzere kulumikiza mutu ndi mchira).

2. Zowawa pa malo a Desjardins (pancreatic point) - 4-6 cm kuchokera ku navel yomwe ili ndi mzere wolumikizira navel ndi kumanja kwa axillary.

3. Zowawa mu Shoffar zone (kuchuluka kwa mutu wa kapamba (kapamba).

4. Zowawa pamalo a Mayo-Robson point (pancreatic mchala) - malire a gawo lakunja ndi lakunja kwa gawo lachitetezo cholumikizira msomali ndikulowera mtengo wamanzere pomwe mukupitilira kudera lamanzere lakumanzere.

5. Zowawa m'dera la Mayo-Robson (mbali yakumanzere ya nthiti).

6. Chizindikiro cha Grott - hypo- ndi atrophy of subcutaneous fat kumanzere kwa navel mukulumikizira kwa kapamba.

7. Chizindikiro cha phrenicus chakumanzere kwamanzere (chizindikiro cha Mussi-Georgiaievsky).

8. Chizindikiro chofunikira cha Voskresensky ndi kusapezeka kwa kupsinjika kwa mimbulu yam'mimba pakuwonekera kwa kapamba.

9. Chizindikiro cha Tuzhilin ndi kupezeka kwa utoto wofiirira (wakuda bii wa burgundy) womwe umakhala wamtundu kuchokera pa 1-2 mpaka 4 mm, omwe ndi angiomas apadera, chifukwa cha proteinol pakuwonjezereka kwa chifuwa chachikulu cha kapamba (CP).

10. Zowawa m'dera la Kacha - m'chiwonetsero cha njira zosinthika za vertebrae kumanja kwa T_IX-T_Xi, ndi kumanzere - m'dera T_VIII-T_IX.

Njira zakuchitika kwa odwala

Kukula kwa ululu kwa odwala omwe ali ndi CP sikumveka bwino, ndipo makamaka chifukwa cha zotsatira zoyipa, kuphatikizira kutupa, ischemia, kutsekeka kwa ma pancreatic hypertension ndikupitilira katulutsidwe ka mafinya a pancreatic. Lingaliro limatsimikiziridwa ndikuwona kwa odwala omwe ali ndi ma pancreatic fistulas, momwe kuyambitsidwa kwa madzimadzi kudzera mu fistula mu dancts ya pancreatic (isotonic sodium chloride solution kapena kusiyanitsa kwapakati) nthawi yomweyo kumayambitsa kupweteka kwapakati komwe kumatha pambuyo pothawa madzi obaya kuchokera kuzinyalala.

Makina ofanana ndi omwe amapezeka pakumva ululu akufotokozera kuwonjezeka kwawo mutatha kudya (onani pansipa) ndi zina zowonjezera zamadzimadzi zachitetezo cha pancreatic, kuwonjezeka kwa kupanikizika kwa ductal system, pang'ono kapena kotsekeka kwathunthu chifukwa cha kuponderezedwa kwamatumbo ndi zotupa, calculi. Kutengera makinawa, kugwiritsa ntchito ngalande pochotsa ma CP kumakhazikitsidwa. Njira ina yam'mimba yopweteka matenda am'mimba imayamba chifukwa cha zovuta, makamaka pseudocyst, yomwe, pamalo ena ndi kukula kwake, imatha kupanikizika ndi duodenum, GLP, trailer yothandizira komanso ziwalo zina.

Concomitant matenda am'mimba ndi duodenum, omwe amapanga 40% kapena kuposerapo pogwirizana ndi CP, imathandizanso pakuyimira komanso kuzunza kwam'mimba kupweteka matenda. Makina allodynia apakati oyambira (malingaliro owawa ndi kupweteka kwapweteka) ndi imodzi mwazinthu zopangira kupweteka kwamimba m'mimba mwa odwala omwe ali ndi CP. Ndi munthawi yomweyo kugwiritsa ntchito njira ziwiri ndi zoyera, kulimbikira kopitilira mosalekeza kwa ululu kumayamba, komwe kunenedwa ngakhale zitachitika kuti kuchulukitsa kwa CP kwatsika.

Zowawa

Ndi CP, kupweteka sikumakhala kwachidziwikire, komwe kumachitika m'mimba kapamwamba kapena pakati kumanzere kapena pakati, kukuzizira kumbuyo, nthawi zina kumakhala kakhalidwe. Nthawi zina, ululu umayambitsidwa kumbuyo. Shingles pamimba yam'mimba ndizotsatira za parresis ya transon colon sludge ndi njira yodziyimira payokha yamatumbo akulu. Nthawi zambiri odwala amadera nkhawa za kupweteka kwa epigastrium ndikumanzere kwa hypochondrium.

Nthawi zina odwala amadandaula za kupweteka kwakukulu ", kuwatanthauzira ngati zowawa m'miyendo, m'munsi mwa theka la chifuwa. Ndi kukula kwa exocrine pancreatic insufficiency, sekondale yachiwiri imalumikizidwa ndi CP chifukwa cha kuchuluka kwama bakiteriya m'matumbo (makamaka omwe amadziwika kuti ndi zidakwa komanso ma biliary a matendawa), omwe amapangidwa kukhala gawo lina la enteropancreatic syndrome. Nthawi yomweyo, ululu mu epigastric dera, wosiya hypochondrium pang'ono kuchepa, ululu wa cramping chikhalidwe m'chigawo cha umbilical umayamba kulamulira. Odwala omwe ali ndi zakumwa zoledzeretsa za CP, ululuwu nthawi zambiri umalowetsedwa mu hypochondrium yoyenera chifukwa cha concyitant cholecystitis, hepatitis, cirrhosis, duodenitis.

Chodziwika kwambiri ndi kupweteka kwam'mawa kumapewa, theka kumanzere kumbuyo ngati "lamba wamanzere" kapena mtundu wa "lamba wathunthu". Zowonjezera kumanzere kumanzere, pansi pa tsamba lamanzere, kumbuyo kwa sternum, kudera lamtunda, theka lamanzere la nsagwada yam'munsi ndiyotheka. Pankhaniyi, odwala nthawi zambiri amagonekedwa kuchipatala m'madipatimenti amtima omwe amaganizira kuti ali ndi vuto la pachimake.

Nthawi yamadzulo yopweteka

Muoposa 50% ya odwala, ululu wam'mimba ululu umakhalapo kwa nthawi yayitali. Monga lamulo, kupweteka kumakulirakudya pakudya, nthawi zambiri pakatha mphindi 30 (makamaka ndi stenosis ya ma pancreatic ducts). Izi ndichifukwa choti panthawiyi kutuluka kwa chakudya kuchokera m'mimba kupita ku duodenum kumayamba ndipo kapamba amakumana ndi mavuto obisika.

Pakutentha kotheratu, ululu umayambitsidwa ndi zochulukirapo, zamafuta, zokazinga, zotsekemera komanso zosapatsa mphamvu zokometsera zakudya, zakumwa zoledzeretsa ndi zakumwa zoziziritsa kukhosi, kukula kwa ululu kumalumikizidwa ndi kuwonjezeka kwa zotsatira zake zomwe zimayambitsa. Nthawi zambiri, odwala amazindikira kuchuluka kwa CP ndi kuphatikiza kwa zinthu zomwe zili pamwambapa komanso kusuta. Mwa odwala ena, mawonekedwe a ululu samayenderana ndi chakudya. Ululu umatha kukhala paroxysmal ndi nthawi yayitali yovutikira kuchokera kwa maola angapo mpaka masiku awiri, kuwongolera kosalekeza kapena kupitiliza kwa paroxysmal. Ndi chitukuko cha pancreatic necrosis, ululu umachepa chifukwa cha kufa kwa malekezero a mitsempha yamatsitsi. Nthawi zambiri, odwala amasokonezeka ndi zowawa za usiku zomwe zimakhudzana ndi kubisala kwapadera kwa bicarbonates kupondereza usiku hypersecretion ya hydrochloric acid, ndikupangitsa adokotala kuti aziganiza za kupezeka kwa zilonda zam'mimba.

Zosankha zopweteka zam'mimba:
• zotupa-ngati,
• malingana ndi mtundu wa colic wamanzere amanjenje,
• matenda a hypochondrium woyenera (mu 30 mpaka 40% amapezeka ndi cholestasis),
• kusokoneza,
• kufalikira (popanda kutulutsa zomveka).

Pancreatic Exocrine Failure Syndrome

Matenda a exocrine osakwanira mu CP amayamba chifukwa cha kuchepa kwa kuchuluka kwa ntchito ya exocrine parenchyma chifukwa cha atrophy, fibrosis, kapena kuphwanya kutulutsa kwa pancreatic secretion mu duodenum chifukwa cha kutsekeka kwa patcreic ducts ya penancreas ndi calculus, secretion wakuda komanso wamaso. Mwachidule, matendawa amadzionetsera ngati vuto logaya chakudya chifukwa chakuchepa kwa kapangidwe ka michere ya pancreatic - maldigestia.

Kukula kwa steatorrhea mu CP nthawi zambiri kumagwirizanitsidwa ndi kuphwanya kwa pancreatic lipolysis chifukwa chakuchepa kwa kaphatikizidwe ka pancreatic lipase. Kuphatikiza apo, kuphwanya kubisika kwa ma bicarbonates komwe kumachitika chifukwa cha kutsekeka kwakanthawi kwa thirakiti, komanso m'maiko ena, kumabweretsa "acidization" ya duodenum. M'malo acidic, limodzi ndi pancreatic lipase, mpweya wa bile umapezeka ndipo michere imasokonekera. Njirayi imakulitsa mafuta malabsorption mu exocrine pancreatic insuffence. Mafuta osatulutsa amadzaza hydroxylated mu lumen ya colon ndi mabakiteriya, chifukwa chomwe chinsinsi cha colonocytes chimakhudzidwa.

Chithunzi cha chipatala chimadziwika ndi kuchuluka kwa chopondapo (polypecal) komanso kuchuluka kwa chopondapo (kutsegula m'mimba), ndowe zimakhala ndi mosy kapena madzi osasinthika, omwe amapezeka fungo losasangalatsa, lokhumudwitsa, limadziwika ndi mtundu wa imvi wokhala ndi wonyezimira (wonenepa, "wamafuta"), ndipo wotsukidwa kwambiri osazizira. kuchokera makoma achimbudzi. Nthawi zambiri, odwala amadziona kuti owonda.

Chifukwa cha malabsorption m'matumbo omwe ali ndi inshuwaransi ya pancreatic insufficiency, tropholoengqondo insufficiency syndrome imayamba, yodziwika ndi kuchepa thupi pang'onopang'ono, mu milandu yayikulu - kuchepa magazi, kuchepa kwa thupi, makamaka mavitamini osungunuka a mafuta ndi zovuta zina, kuchepa kwa magazi ndi zovuta zina.

Nthawi zina, odwala omwe ali ndi vuto lalikulu la pancreatic kuchepa, kuchepa thupi kumachitika motsutsana ndi maziko azolimbitsa thupi. Chofunika kwambiri nthawi zambiri chimaphatikizidwa ndi dysmotoria yam'mimba, yomwe imawonetsedwa ndi nseru, kusanza, kukwiya msanga ndi zizindikiro zina. Ndikofunika kudziwa kuti zizindikirozi zimatha kukhala zazifupi kwakanthawi, zofanana ndi nthawi ya vuto la kapamba, komanso kutalika kwakanthawi chifukwa cha zovuta zam'mimba komanso malamulo am'mimba othandizira odwala omwe ali ndi duodenogastric Reflux komanso kukomoka kwakukulu kwa pancreatic.

Gawo lina lothandizira pakukula kwa kuwonda ndi kuwonetsetsa mosamalitsa kwa odwala omwe amachepetsa zakudya mothandizidwa ndi zinthu zomwe zimakhala zamafuta kwambiri - mafuta ndi chakudya, komanso kukhalanso kwa vuto la kuchepa kwa mitsempha - sitophobia. Kuphatikiza apo, zovuta zam'mimba zopatsa mphamvu ndizochepa kwa anthu omwe ali ndi matenda apamwamba a pancreatogenic. Endocrine Disorder Syndrome

Mawonetseredwe azachipatala a matenda a pancreatic incretory function ali m'gulu la zizindikiro zofala, koma mochedwa za CP, zomwe zimapezeka pafupifupi 25% ya odwala. Mitundu iwiri yamawonekedwe: hyperinsulinism ndi pancreatogenic shuga mellitus.

Hyperinsulinism imadziwika ndi kuukira kwa machitidwe a hypoglycemic, omwe amapezeka nthawi zambiri kumayambiriro kwa CP, pomwe pancreatic functionalities imasungidwa. M'mapeto omaliza a CP, hyperinsulinism yapachibale imayamba ndi kutsika kwa kupanga kwa ma contrainsular hormone - glucagon. Pali kumverera kwanjala, kunjenjemera thupi lonse, thukuta lozizira, kufooka, nkhawa, kukwiya, kunjenjemera kwa minofu ndi paresthesias. Matendawa amatha kukhala maola angapo mpaka masiku angapo.

Kuukira koteroko nthawi zambiri kumawonekera m'mimba popanda kanthu kapena pakudya nthawi yayitali, kumatha mofulumira mutatha kudya, koma kumatha kubwereza pambuyo pa maola 2-3.Pafupifupi 1/3 ya odwala, kuukiridwa kumayendera limodzi ndi zizindikiro zotsimikizika zomwe zimakhala ndi khunyu - kusiya kukonzekera, kukodza mosazindikira ndi kulekerera, amnesia otsogola amadziwika. Ndi kuwonjezeka kwa kuukira kwa hypoglycemia ndi kuchepa kwambiri kwa shuga m'magazi ndi kuwoneka kwa zizindikiro zowonongeka m'matumbo a cortex, kudziwika mosiyanasiyana ndi insulinoma kumafunika.

Pancreatogenic shuga mellitus imayamba chifukwa cha kusintha kwa maselo a islet ndi kusintha kwa minyewa yolumikizana; imakonda kupezeka pancreatitis ndi kusintha kwamphamvu kwambiri kwa pancreatic parenchyma. Tiyenera kukumbukira kuti ndi kuchulukitsa kwa CP, kuchuluka kwa shuga m'magazi nthawi zambiri kumakwera. Pankhaniyi, hyperglycemia imalumikizidwa ndi pancreatic edema ndi trypsin yoletsa yopanga insulin. Milandu imeneyi, pomwe chipatala chimakulitsa kuchuluka kwa CP, kuchuluka kwa shuga m'magazi nthawi zambiri kumasintha.

Nthawi zambiri, matenda a shuga amabwera motsutsana ndi maziko a kapamba ndipo amatha kukhala pachithunzi cha matenda. Matenda a shuga odwala matenda a CP amasiyana ndi mitundu ina ya kuperewera kwa insulin, makamaka, chizolowezi cha hypoglycemic, chifukwa chake amafunika kuwunika pafupipafupi kuchuluka kwa shuga m'magazi. Zizindikiro zoyambira matenda ashuga zimaphatikizapo matenda omwe amapezeka pafupipafupi komanso matenda a pakhungu.

Biliary Hypertension Syndrome

Amawonetsedwa ndi jaundice wopewera komanso cholangitis. Pafupifupi 30% ya odwala omwe ali ndi CP pachimake pachimake amakhala ndi hyperbilirubinemia wosakhalitsa. Kukhalapo kwa stenosis kwa intrapancreatic gawo la wamba duct limayamba ndi pafupipafupi la 10-6% ya milandu. Zomwe zimayambitsa matendawa ndikuwonjezereka kwa mutu wa pancreatic ndikukakamiza kwa gawo lofala la bile duct, matenda a BDS (calculi, stenosis). Poyamba, jaundice imayamba pang'onopang'ono, pang'onopang'ono, mwina ikhoza kusowa, matenda oopsa amatha kuonekera pokhapokha ngati ululu wowoneka bwino mu hypochondrium, kuwonjezeka kwapang'onopang'ono kwa bilirubin ndi phosphatase ya alkaline mu seramu yamagazi, kuchepa kwina kwa ma ducts a bile.

Pancreatitis yosagwirizana ndi cholelithiasis, matenda ogwirizana a x-ray, kuphatikizapo ziwonetsero za x-ray zochepetsera gawo limodzi lodziwika bwino la bile duct ndi proximal biliary hypertension, ndizofala kwambiri kuposa jaundice woopsa. Kupsinjika kwakanthawi kofala kwa duct ya phula pang'onopang'ono kumabweretsa kutsetsereka kwathunthu kapena kosakwanira, ndipo mwakathithi ku jaundice yowala ndi acholia, pruritus, hyperbilirubinemia ndi zina zodziwika bwino.

Mu CP yokhala ndi chotupa chachikulu cha mutu wa kapamba, maonekedwe a jaundice nthawi zambiri amawonetsa kuchuluka kwa matendawa kapena kupezeka kwa zovuta (pseudocyst), kawirikawiri kuoneka kwa jaundice kumachitika, m'malo mwake, ndi kuphedwa kwa njira yotupa komanso kukulira kwa gawo lalikulu lachitetezo cha gawo la drracancic.

Chidziwitso Chowunikira Cholinga

Anamnesis. Mukamamveketsa anamnesis, chidwi chiyenera kuperekedwa kwa anamnesis wobadwa mwanjira imodzi, uchidakwa, kugwiritsa ntchito zakumwa zoledzeretsa, kusuta, OP yapitayi.

Kuyendera kozungulira. Matenda a wodwalayo atha kukhala osiyana - kuchokera okhutira mpaka owawa kwambiri, zomwe zimatengera kuuma kwa ululu, zizindikiro za kuledzera, kuchuluka kwa tropholoqondo kusakwanira, kusokonezeka kwapakati komanso kufalikira kwa hemodynamics. Mlingo wa kuperewera kwa zakudya m'thupi umasiyana kwambiri. Lilime limakulilidwa, nthawi zina limaphwa.

Zizindikiro zophatikizana ndi kupewa ma enzymes m'magazi ndizosowa. Zizindikiro zofala kwambiri zamagulu osowa zakudya m'thupi. Kuchokera kumbali ya mtima dongosolo la mtima ndi kuledzera, myocardial dystrophy phenomena imatha kutsimikizika: kukulira kwa malire a kusachedwa kwa mtima, matoni omveka, tachycardia, kung'ung'udza kwa systolic panthawi yayikulu, extrasystole. Kufanana ndi kuuma kwa OP, kuthamanga kwa magazi kumachepa. Nthawi zingapo, zizindikiritso zakumanzere zimawululidwa kumanzere, nthawi zambiri mbali zonse ziwiri. Ndi palpation yapamwamba pamimba, kupweteka kwa epigastrium, hypochondrium ya kumanzere ikhoza kutsimikizika. Pakuwonetseratu kwa kapamba, nthawi zambiri pamakhala kusagwirizana chifukwa choti gland imapezeka.

Ululu wammbuyo

The kufalikira ululu zimatengera kugonjetsedwa kwa kapamba:

• ululu kumanzere kwa hypochondrium kumanzere kwa navel kumachitika mchira wa kapamba ukakhudzidwa,
• kupweteka m'dera la epigastric, kumanzere kwa midline, - ndi kuwonongeka kwa thupi,
• kupweteka kumanja kwa midline mu zone ya Shoffar - ndi matenda a mutu wa kapamba.

Zowonongeka kwathunthu kwa chiwalo, zopweteka zimatulutsa, ngati "lamba" kapena "lamba" pakati pamimba yapamwamba. Ululu umawuka kapena kumakulitsa mphindi 40-60 mutatha kudya (makamaka kuchuluka, zokometsera, zokazinga, mafuta). Zowawa zimakulitsa malo a supine ndikuchepera pakukhala pansi ndikugwedeza pang'ono pang'ono. Imatha kuwala kumadera a mtima, kumanzere kwa scapula, kumanzere phewa, kuyerekezera angina pectoris, ndipo nthawi zina kumka kumanzere kwa iliac dera.

Ululu umatha kwakanthawi, ungachitike kwa maola angapo mpaka masiku angapo, nthawi zambiri umatha kudya, makamaka zonunkhira ndi mafuta, mowa, kapena kusinthika, kumakulirakudya. Kupweteka kosalekeza, kopweteka kumakakamiza kugwiritsa ntchito mankhwala opweteka kwambiri mpaka mankhwala osokoneza bongo, omwe ndi osayenera, chifukwa mtsogolomu izi zingayambitse kusuta kwa mankhwala osokoneza bongo.

Nthawi zina, pamaso pa zizindikiro zina za kapamba, ululu umatha kupezeka kwathunthu - wotchedwa mawonekedwe osapweteka.

Zomwe zimayambitsa kupweteka kosatha pancreatitis ndizowonjezereka pazitsulo za kapamba chifukwa chophwanya kutuluka kwa chikondwerero, komanso kusintha kwa kutupa ndi matenthedwe m'misewu ya m'matumbo ndi minyewa yoyandikana nayo, zomwe zimayambitsa kukwiya kwa mitsempha yodutsa.

Kupweteka kosalekeza kumachitika chifukwa chotsalira chotsalira cha kapamba ndi kakulidwe kazovuta, monga pseudocyst, solidation kapena mwala wa pancreatic duct, stenotic papillitis, kapena solaritis yomwe imakonda kupezeka ndi matendawa.

Pakakulirakulira matendawa, kapamba wokulirapo amatha kuyambitsa kupanikizika kwa celiac, ndikupweteketsa kwambiri. Pankhaniyi, odwala amakhala ndi mawonekedwe - amakhala, atatsamira patsogolo. Nthawi zambiri, chifukwa cha kupweteka kwambiri, odwala amadzilimbitsa okha pakudya, chomwe chimakhala chimodzi mwazifukwa zochepetsera thupi.

Tiyenera kudziwa kuti, kuphatikiza pa zowawa (zomwe zimatha kuwoneka koyambirira kwa matendawa), zizindikiro zina zonse za chifuwa chachikulu chimawonetsedwa m'magawo apambuyo a matendawa.

Nthawi zambiri odwala odwala ndi kapamba, chizindikiritso cha dyspeptic chimadziwika: kuchepa kapena kusowa kwa chidwi cha chakudya, kugwedezeka kwa mpweya, malovu, nseru, kusanza, kusweka, kusokonezeka kwa chimbudzi (kutsegula m'mimba kapena kusinthana m'mimba ndi kudzimbidwa). Kupumira sikubweretsa mpumulo.

Odwala ambiri amadandaula chifukwa cha kufooka, kutopa, kudwala, komanso kusokoneza tulo.

Kusintha kwaudindo m'mutu wa kapamba ndi kapamba (edema kapena kukula kwa fibrosis) kungayambitse kuponderezedwa kwa duct ya bile komanso kukulitsa kwa jaundice.

Zizindikiro za chifuwa chachikulu chodwala chimatanthauzanso gawo la nthendayi: gawo lachiwiri makamaka gawo lachitatu limachitika ndikuphwanya kwa kapangidwe kake ndi kapangidwe ka kapamba, kaphatikizidwe kamankhwala ndikusintha koopsa komwe kumapezeka ndi ma labotor ndi njira zothandizira. Odwala ambiri amakhala ndi ululu wopitilira ndi paroxysmal, zovuta zam'mimba zimayamba kutchulidwa, chimbudzi cha zakudya komanso kuperewera kwamatumbo, kuphatikizapo mavitamini, amasokonezeka. Chipatalachi chimayang'aniridwa ndi matenda otsekula m'mimba (otchedwa pancreatogenic kutsegula m'mimba) okhala ndi mafuta ambiri (ndizovuta kutsuka kuchimbudzi). Olamulidwa ndi odwala omwe amachepetsa thupi. Nthawi zina, ndi pancreatitis yayitali, kuchepa kwamphamvu kwa kupweteka kapena kutha kwawo kwathunthu kumadziwika.

Zizindikiro za Biliary Hypertension

Biliary hypertension syndrome imawonetsedwa mu jaundice yovuta ndi cholangitis ndipo imakhala yofala. Mpaka 30% ya odwala omwe achulukitsa matenda a kapamba amakhala osakhalitsa kapena hyperbilirubinemia. Zomwe zimayambitsa matendawa ndikuwonjezereka kwa mutu wa kapamba ndi kukakamiza kwa gawo lodziwika bwino la bile duct, choledocholithiasis ndi matenda am'mimba a duodenal papilla (calculi, stenosis).

Zizindikiro za endocrine matenda aakulu kapamba

Amadziwika pafupifupi gawo limodzi mwa magawo atatu a odwala. Chomwe chimayambitsa kukula kwa zovuta izi ndikugonjetsedwa kwa maselo onse am'mapulogalamu apake a kapamba, chifukwa chomwe chimapangitsa kuti pakhale kusowa kwa insulini kokha, komanso glucagon. Izi zikufotokozera nthawi ya matenda a shuga a pancreatogenic shuga: chizolowezi cha hypoglycemia, kufunika kwa Mlingo wochepa wa insulin, chitukuko chachilendo cha ketoacidosis, mtima ndi mavuto ena.

Kuzindikira matenda kapamba

Kuzindikira kwa chifuwa chachikulu cha khansa kumakhala kovuta kwambiri ndipo kumakhazikitsidwa pazizindikiro zazikulu zitatu: mbiri yamakhalidwe (kupweteketsa mtima, uchidakwa), kupezeka kwa exocrine ndi / kapena endocrine kusakwanira, komanso kuzindikira kwa kusintha kwa kapangidwe kake kapamba. Nthawi zambiri, kupezeka kwa matenda a kapamba kumachitika pambuyo poti nthawi yayitali wodwala yemwe ali ndi matenda akuwonetsa kupezeka kwa matenda kapamba.

Laborator diagnostics

Mwazi wama biochemistry. Mlingo wa amylase, serum lipase nthawi zambiri imakhala yachilendo kapena yochepetsedwa pakuwukira kwa kapamba, komwe amafotokozedwa ndi kuchepa kwa chiwerengero cha maselo acinar omwe amapanga ma enzymes awa. Ndi kuphatikiza kwa pancreatitis yoledzera ya mowa ndi matenda am chiwindi, kuyesedwa kwamphamvu kwa chiwindi kumatha kupezeka. Mu 5-10% ya milandu yokhudzana ndi pancreatitis yayitali, pali zizindikiro za kuponderezedwa kwa gawo la ndulu ya bile, chifukwa cha edema kapena fibrosis ya mutu wapa pancreatic, womwe umatsatiridwa ndi jaundice, kuwonjezeka kwa milirubin mwachindunji ndi serum alkaline phosphatase.

Kuwonongeka kwa glucose kulolerana kumayamba mu 2/3 mwa odwala, matenda a shuga - 30% ya odwala omwe ali ndi pancreatitis yayitali.

Kukwanira kwa procrine kumawonekera ndipo kumadziwika mosavuta ndi chitukuko cha vuto la mayamwidwe, komwe mafuta ofunikira amatha kutsimikiziridwa ndi kuyera (Sudain stain) kapena njira yowonjezera. Kusakwanira kwachinsinsi m'magawo oyambirira kumadziwika pogwiritsa ntchito mayeso a pancreatic.

An enzyme yolumikizidwa immunosorbent akutsimikiza mtima wa elastase-1 mu seramu yamagazi ndi ndowe za odwala amathandizidwa muzipatala kuti azindikire matenda a kapamba, omwe amalola kuwunika kwa exocrine pancreatic ntchito.

Chida chazindikirika ndi chifuwa chachikulu

Zambiri zothandizira kutsimikizira za kupezeka kwa matenda a kapamba angatengedwe kukhala kopindulitsa. Zogwiritsidwa ntchito ndi:

- ultrasound pamimba,
- endoscopic ultrasound, yozungulira yozungulira ndi maginidwe oyendera matsenga a kapamba.

ERCP imalola kuti idziwe duct stenosis, kutulutsa kwa zotchinga, kusintha kwamapangidwe ang'onoang'ono, ma calorization a intraductal ndi mapulagi apuloteni, komabe, pali chiopsezo chachikulu cha pancreatitis yayikulu

Kusiyanitsa kwapadera kwa kapamba

Zizindikiro za kapamba zimatanthauzira Zizindikiro za "chifuwa cham'mimba." Izi zikutanthauza kuti ndikofunikira kusiyanitsa kapamba ndimatumbo am'mimba ophatikizika, omwe ndi: kuchokera ku zilonda zapamwamba, cholecystitis, matumbo kutsekeka, matumbo a m'mimba.

Zilonda zopumira. Kukongoletsa kwa m'mimba kapena zilonda zam'mimba zimasiyana ndi chifuwa chachikulu cha pancreatitis mu "ululu wammbuyo". Kupweteka kumeneku kumalumikizidwa ndi kulowa kwa chapamimba kapena matumbo mkati mwa peritoneum, yomwe imayambitsa kukhudzika kwa khoma lamkati la m'mimba, kapena chotupa chakuda. Pancreatitis, ichi sichikhalidwe. Kuyamba ndi kupola kwa zilonda ndizosowa kwambiri. Wodwala sagwedezeka. Wodwala pancreatitis amakhala ndi nkhawa, akuthamangira pabedi. X-ray yojambulidwa imawonetsa gasi pamimba yam'mimba yokhala ndi chilonda chokonzanso. Kuzindikira komaliza kumapangidwa pamaziko a ultrasound kapena laparoscopy.

Pachimake cholecystitis. Zitha kukhala zovuta kusiyanitsa pakati pa izi ziwiri. Koma m'malo mwa cholecystitis amalankhula kupweteka kwakumanja kumanja ndi radiation kudera lamapewa. Mukamachita ultrasound, kutanthauzira kwa kutupa kumatha kutsimikizika, koma ndikofunikira kukumbukira kuti kapamba angayende ndi cholecystitis.

Pachimake matumbo kutsekedwa. Ululu wokhala ndi matumbo umachepa, ndipo ndi kapamba, kupweteka kumakhala kupweteka nthawi zonse. Pa radiograph ya pancreatitis, matumbo akulu adzakhuta, koma wopanda mbale za Kloiber.

Mesothrombosis. Mesothrombosis nthawi zambiri imakhudza anthu okalamba omwe ali ndi matenda amtima. Zizindikiro zimawonjezeka mwachangu, koma sizogwirizana ndi kudya. Laparoscopy kapena angiography amathandizira kuthetsa kukayikira.

Myocardial infaration. Titafika kuchipatala, electrocardiography imachitidwa pafupipafupi; sizovuta kusiyanitsa kapamba ndi kulowerera kwa myocardial.

Chithandizo cha matenda kapamba

Chithandizo cha pancreatitis chovuta kwambiri chitha kuchitika kunja kwa kuyang'aniridwa ndi gastroenterologist kapena psychapist.

Cholinga cha mankhwalawa matenda a kapamba angatengedwe ngati yankho la mavuto angapo:

- kupatula zina zoyambitsa mkwiyo (mowa, mankhwala osokoneza bongo, zododometsa),
- kupweteka
- kukonza exo- ndi endocrine kusowa,
- mankhwala a matenda a concomitant.

Zolinga zikuluzikulu zamankhwala othandizira ndikuyimitsa kapena kuchepetsa kufalikira kwa kapamba komanso kuthana ndi zovuta zake. Kutengera ndi kuopsa kwa kupweteka kwam'mimba m'mimba, chithandizo chamankhwala cha pancreatitis chogwiritsidwa ntchito, chimaphatikizapo zinthu izi:

- Zakudya, zakudya zopatsa thanzi, mafuta osakwana 60 g / tsiku.
- Pancreatic enzymes (pancreatin, creon, mezym, panzinorm, festal, penzital, enzistal) + H2-blockers (Famotidine, ranitidine, cimetidine, nizatidine).
- Non-narcotic analgesics (acetylsalicylic acid, diclofenac, ibuprofen, piroxicam).
- Octreotide (sandostatin).
- ngalande za Endoscopic (Olimpus, LOMO, Pentax, Fujinon).
- Narcotic analgesics (butorphanol, antaxone, fortal, tramadol, sedalgin-neo).
- Kuletsa kwa ma solar a solar.
- Opaleshoni yolowerera.

Ndi ululu wofooka wopweteka, kupambana kumatheka chifukwa chamadongosolo okhwima, chakudya chokwanira (maola atatu aliwonse) chakudya komanso kuletsa mafuta mpaka 60 g patsiku, zomwe zimathandiza kuchepetsa katemera wa pancreatic wokhala ndi zakudya zochepa zopatsa mphamvu.

Mankhwala zochizira matenda apakhungu

Popeza kuti chachikulu chomwe chimapangitsa kupweteka ndizovomerezeka zamkati, ndikofunikira kugwiritsa ntchito mankhwala omwe amachotsa katulutsidwe ka pancreatic.Nthawi zambiri, kutulutsidwa kwa cholecystokinin, chofunikira kwambiri cha pancreatic ntchito, imayendetsedwa ndi cholecystokinin-kumasula peptide m'matumbo ang'onoang'ono, omwe amakhala ndi chidwi ndi trypsin ndipo amagwira ntchito ku lumen. Kukhazikitsidwa kwa ma pancreatic enzymes (mesim forte, pancreatin, panzinorm, ndi lycraase pancitrate) kumapereka mpumulo wofunikira mu ululu m'madwala ena chifukwa cha kuphatikizika kwa kayendedwe ka mayankho: kuwonjezeka kwa kuchuluka kwa mapuloteni mu lumen wa duodenum kumachepetsa kumasulidwa ndi kaphatikizidwe ka mahomoni am'mimba (cholecystokinin), komwe kumabweretsa. kukondoweza kwa exocrine pancreatic ntchito, kuchepa kwa chidwi ndi kupsinjika kwa minofu ndikuthandizira mpumulo.

Tiyenera kukumbukira kuti ndizotheka kuphatikiza michere yakunja yogaya michere ndi gastric acid ndi pancreatic proteinase. Popewa izi, kuphatikiza kwa ma enzymes (pancreatin, creon, mezim, panzinorm, festal, penzital, enzistal) ndi H2-histamine blockers (Famotidine, ranitidine, cimetidine, nizatidine) amagwiritsidwa ntchito kwambiri. Mlingo wa enzyme kukonzekera kupweteka kwamankhwala uyenera kukhala wokwanira, mu kafukufuku wopezeka kawiri-kawiri wakhungu pancreolipase mu mapiritsi a 6 mapiritsi 4 pa tsiku la mwezi umodzi wachepetsa kwambiri ululu mu 75% ya odwala omwe ali ndi pancreatitis yolimba komanso yolimba. Ma enzymes omwe amaphatikizidwa ndi ma pancreatic microspheres (Creon) omwe ali pakadali pano ali kusankha koyamba kuchitira kupweteka kwam'mimba mu exocrine pancreatic insufficiency. Mitundu ya Microgranular dosage (Creon 10,000 kapena 25,000) imadziwika ndi kufulumira (pambuyo pa mphindi 45) ya michere yoposa 90% pa pH ya duodenal ndi matumbo ang'onoang'ono a 5.5 ndi apamwamba.

Pazinthu zochepa kwambiri za pH, mankhwala othandizira omwe ali ndi H2 antagonists kapena proton pump inhibitors (lansoprazole, omeprazole, pantoprazole, rabeprozole) amagwiritsidwa ntchito m'mimba. Kuphatikiza apo, adawonetsedwa kuti chithandizo cha enzyme cholowa m'malo mwake chimathandizira kuchoka kwa chakudya m'matumbo am'mimba, zimakhudza ntchito yamagalimoto m'mimba ndipo potero zimathandizira kuchepetsa malabsorption.

Ma pancreatic michere amalembedwa nthawi zonse za kapamba kuti akonze ntchito ya pancreatic ya pancreatic. Kumwa mankhwalawa kumachepetsa kusokonezeka kwamatumbo komanso kutsekula m'mimba chifukwa cha kuyamwa kwamafuta, komwe kumachepetsa ululu. Kukonzekera kwa enzyme kumachepetsa ululu wambiri pancreatitis, makamaka azimayi omwe ali ndi pancreatitis yotsutsana ndi maziko a pancreatic duct. Amuna omwe ali ndi chizolowezi chomwa zoledzeretsa, mankhwalawa sagwira ntchito kwenikweni.

Pothandizira mpumulo wa steatorrhea mu pancreatitis yayitali, kukonzekera komwe kumakhala ndi lipase yayikulu kumawonetsedwa, utoto; kupumula kwa ululu, kukonzekera ndi mawonekedwe ambiri a mapuloteni popanda kuphika amasonyezedwa.

Pokhapokha pakuchitika kwa enzyme m'malo othandizira limodzi ndi H2-histamine blockers, kuyikidwa kwa analgesics ndikofunikira, paracetamol (daleron, prodol, efferalgan), mankhwala osokoneza bongo a anti-kutupa: diclofenac (apo-diclo, voltaren, diclofenac, ortofen), ndipo ibupen -ibuprofen, ibuprofen, ibuphene, solpaflex), piroxicam (pirooticam, piroxifer, felden, erazon), celecoxib (celebrex), lornoxicam (xefocam), meloxicam (meloxicam, movalis), nimesulide (mesulide, nayz) proxene (apo-naproxen, nalgesin, naproxen).

Poletsa kupweteka kwambiri pancreatitis, octreotide (sandostatin) ndi mankhwala. Woletsa wamphamvu wa mahomoni am'matumbo a neuroendocrine, ma sandostatin amalepheretsa kukula komanso kusunthika kwa chitetezo cha pocreatic potsatira mwachindunji pa minyewa ya exocrine ndikuchepetsa kutulutsa kwa secretin ndi cholecystokinin. Mankhwala amathandizanso pochiza pseudocysts, pancreatic ascites ndi pleurisy. Ntchito 50-100 mcg subcutaneous kawiri pa tsiku kwa sabata 1 pochiza matenda opweteka a kapamba.

Pomwe mukusunga ululu, ndikofunikira kuyendetsa ERCP pakufotokozera mwatsatanetsatane za kuwonongeka kwa ma ducts, kuchotsa kwa kusagwira ntchito kwa sphincter ya Oddi. Pankhaniyi, kuthekera kwa kugwiritsa ntchito njira zachilendo zowerengera zimakambidwa: kukhetsa kwa endoscopic ndi shunting, kutsekeka kwa dzuwa ndi ma cellids, pancreaticoejunostomy ndi resection ya pancreatic.

Zovuta zazikulu zimagwirizanitsidwa ndi chithandizo cha sphincter cha kukomoka kwa Oddi, chimodzi mwazomwe zimayambitsa kukula kwa kapamba, chovuta kudziwa. Ndi kusokoneza kwa sphincter ya Oddi, pali chidwi chowonjezeka cha khoma la pancreatic ndi bile limasintha kuti lisinthe voliyumu ndi kukakamiza.

Ndikofunikira kupatula mankhwala omwe ali ndi choleretic zotsatira (ma bile acid, kuphatikiza omwe ali mu kukonzekera kwa enzyme - chikondwerero, enzystal, etc., decoctions a zitsamba za choleretic, mankhwala opangira choleretic).

Kuchepetsa kuphipha kwa minofu yosalala ya Oddi ndi cystic duct, ma nitrate amagwiritsidwa ntchito: nitroglycerin - pakuthandizira mpumulo wa ululu, nitrosorbitol - pakuyenda kwamankhwala (motsogozedwa ndi kulolerana kwa mankhwala).

Myotropic antispasmodics (bendazole, benzocyclan, drotaverin, mebeverin, papaverine) amachepetsa kamvekedwe ka mawu ndi mota minofu yosalala. Omwe akuimira gululi ndi papaverine, drotaverin (no-shpa, no-shpa forte, vero-drotaverin, spazmol, spakovin), benzocylan (halidor). Mankhwala othandiza kwambiri a myotropic antispasmodic ndi duspatalin (mebeverin) - mankhwala ochepetsa minofu, otentha, omwe amakhala ndi mphamvu yokhudza minofu yosalala. Mwakusankha pochita pang'onopang'ono ku Oddi, imakhala yothandiza kwambiri kuposa 20apa papaverine molingana ndi kuthekera kwake kutsitsimutsa mphamvu ya Oddi. Ndikofunikira kuti duspatalin isakhudze dongosolo la cholinergic chifukwa chake sichimayambitsa mavuto monga mkamwa youma, kusawona bwino, tachycardia, kusungika kwamikodzo, kudzimbidwa komanso kufooka. Imapukusika mwachangu pakudutsa m'chiwindi, metabolites yonse imatulutsidwa mwachangu mkodzo. Kutulutsa kwathunthu kwa mankhwalawa kumachitika mkati mwa maola 24 mutatha kumwa kamodzi, chifukwa, sizikundikira thupi, ngakhale odwala okalamba safuna kusintha kwa mlingo. Duspatalin amatchulidwa 1 kapisozi (200 mg) kawiri pa tsiku, ndikofunikira kumwa mphindi 20 asanadye.

Wina wa myotropic antispasmodic wokhala ndi katundu wosankha ndi gimekromon (odeston) - chinthu chotengera cha coumarin chomwe sichikhala ndi anticoagulant ndipo chimatchedwa antispasmodic ndi choleretic. Gimekromon ndi analogue yopanga ma ambulosone opezeka mu zipatso za anise ndi fennel, omwe adagwiritsidwa ntchito ngati antispasmodics. Mankhwala amapereka imodzi kapena ina malinga ndi zomwe akuchita pazochitika zosiyanasiyana zamtundu wamabala. Odeston amachititsa kuchepa kwa ndulu, amachepetsa kukakamiza kwina, motero, amakhala wotsutsana ndi cholecystokinin. Pa mulingo wa sphincter wa Oddi, imagwira limodzi mogwirizana ndi cholecystokinin, imachepetsa kuthamanga kwa basal ndikuwonjezera nthawi yotseguka kwa sphincter ya Oddi, potero kumakulitsa gawo la bile kudzera mumitsempha ya bile. Popeza antispasmodic wosankha kwambiri, Odeston amakhalanso ndi choleretic katundu. Mphamvu yake ya choleretic imachitika chifukwa cha kuthamanga ndi kuchuluka kwa ndulu mumatumbo ang'ono. Kuwonjezeka kwa kayendedwe ka bile ku lumen kwa duodenum kumathandizira kukonza chimbudzi, kutseguka kwa matumbo a m'mimba ndi kufalikira kwa chopondapo.
Odeston zotchulidwa 400 mg (mapiritsi 2) katatu patsiku mphindi 30 asanadye, zomwe zimapereka kuchuluka kwa mankhwala mu seramu owonjezera 1.0 μg / ml. Kutalika kwa chithandizo ndi munthu payekha - kuyambira 1 mpaka 3 milungu. Odeston ali ndi poizoni wotsika, kulekerera kwake nthawi zambiri kumakhala kwabwino.

Pokhapokha mphamvu yawofatsa mankhwala a kukomoka kwa sphincter wa Oddi ndi kupezeka kwa idatha pa stenosis, patency ya sphincter ya Oddi imabwezeretsedwa kugwira ntchito (sphincterotomy).

Njira yothandizira matenda a kapamba

M'malo mankhwala othandizira exocrine pancreatic kusowa chifukwa cha chifuwa chachikulu chimachitika mu kukhalapo kwa steatorrhea oposa 15 g mafuta patsiku, kuchepa thupi pang'onopang'ono ndi matenda okomoka. Mulingo umodzi wa michere uyenera kukhala ndi magawo 20,000-40,000 a milomo, motero, umafotokozedwa m'mapiritsi 2-5 am'magulu akulu a chakudya ndi 1-2 makapisozi ena owonjezera zakudya zochepa. Ndi chifuwa chachikulu chokhala ndi kapamba wam'mimba, steatorrhea nthawi zambiri samachotsedwa kwathunthu. Kulemera, kuchepa kwanyumba, komanso kutsika kwazinthu zimawonetsa kukwana kwa mtundu wosankhidwa wa michere.

Kuperewera kwa mankhwala olowa mmalo kumafuna kuphatikizidwa kwa zifukwa zina za vuto la mayamwidwe - Matenda a Crohn, matenda a celiac, thyrotooticosis. Pofuna kukonza vuto la kuperewera kwa zakudya m'thupi, ma CD amtundu wa triglycerides (trisorbon) ndi mavitamini osungunuka a mafuta A, D, E, K.

Mavuto aakulu a kapamba

Mavuto a pancreatitis aakulu amaphatikizapo malabsorption syndrome, matenda a shuga, pseudocysts, portal kapena splenic vein thrombosis, pyloric stenosis, kutsekeka kwa wamba duct, ndi chotupa. Pancreatic adenocarcinoma amapezeka mu 4% ya milandu mwa anthu omwe ali ndi mbiri yoposa 20 mbiri ya chifuwa chachikulu.

Chiwopsezo cha kupha odwala kapamba chimafikira 50% ndi nyengo ya zaka 20-25. 15-20% ya odwala amafa chifukwa chazovuta za kapamba, kufa kwina kumayambitsidwa ndi kuvulala, kuperewera kwa chakudya, matenda, kusuta, komwe nthawi zambiri kumawonekera mwa odwala omwe ali ndi pancreatitis.

Kulephera

Kuperewera kwa pocreatic pancreatic kumadziwika ndi kuphwanya m'mimba ndi mayamwidwe, kukulira kwa kukula kwama bakiteriya m'matumbo ang'onoang'ono. Zotsatira zake, odwala amakhala ndi matenda otsegula m'mimba, anyezi, amakhala osachedwa kudya, kuwonda. Pambuyo pake, zizindikiro zokhala ndi hypovitaminosis zimachitika.

Exocrine pancreatic insuffence ichulukitsidwa ndi zifukwa zotsatirazi:

• osakwanira kutsegula kwa michere chifukwa cha kuchepa kwa enterokinase ndi bile,
• kuphwanya kusakanikirana kwa michere ndi chakudya cha chyme chifukwa cha zovuta zamatumbo a duodenum ndi matumbo aang'ono,
• chiwonongeko ndi ma inactivation a michere chifukwa cha kukula kwambiri kwa microflora m'matumbo apamwamba,
• zakudya kuperewera kwa mapuloteni ndi hypoalbuminemia ndipo, monga chifukwa, kuphwanya kapangidwe ka michere ya pancreatic.

Chizindikiro choyambirira cha exocrine pancreatic insuffence ndi steatorrhea, chomwe chimachitika pamene chinsinsi cha pancreatic chimachepetsedwa ndi 10% poyerekeza ndi zabwinobwino. Wofatsa steatorrhea, monga lamulo, samatsagana ndi mawonetseredwe azachipatala. Ndi steatorrhea wambiri, pafupipafupi kutsegula m'mimba kumasiyana katatu mpaka katatu patsiku, ndowe ndizambiri, fetid, gruff, ndi Sheen wamafuta. Steatorrhea amachepetsa ndipo amatha kutha ngati wodwalayo achepetsa kudya zamafuta kapena amatenga michere ya pancreatic.

Mu gawo lofunikira la odwala, kuchepa thupi kumawonedwa chifukwa cha kuchepa kwa mphamvu ya pancreatic komanso kusokoneza chimbudzi ndi mayamwidwe m'matumbo, komanso chifukwa chochepa cha chakudya chifukwa cha ululu. Kuchepetsa thupi nthawi zambiri kumalimbikitsidwa ndi kuchepa kwa chidwi cha chakudya, kuonetsetsa mosamalitsa kwa odwala omwe amadya zakudya zowonjezera, nthawi zina kufa ndi njala chifukwa choopa kupweteka, komanso kuchepetsa kudya kwam'mimba kwa odwala omwe ali ndi matenda osokoneza bongo.

Kusowa kwa mavitamini osungunuka a mafuta (A, D, E ndi K) amawonedwa kawirikawiri komanso makamaka mwa odwala omwe ali ndi steatorrhea yayitali komanso yayitali.

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Endocrine kusakwanira

Pafupifupi 1/3 ya odwala ali ndi vuto la metabolism wa caroglycemic, ndipo ndi theka lokha lomwe limazindikira zodwala. Zomwe zimayambitsa kukula kwa zovuta izi ndizowonongeka kwa ma cell a islet zida, zimapangitsa kuchepa kwa insulin yokha, komanso glucagon. Izi zikufotokozera nthawi ya matenda a shuga a pancreatogenic: chidwi cha hypoglycemia, kufunika kwa Mlingo wochepa wa insulin, kukula koopsa kwa ketoacidosis, mtima ndi mavuto ena.

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Njira ndi zovuta matenda kapamba

Njira yodwala kapamba popanda kulandira chithandizo nthawi zambiri imakhala yolimba, ndipo imatchulidwa kambiri kapena kangapo, nthawi zambiri zotuluka ndi zotuluka, pang'onopang'ono zimatha ndikuyang'anitsitsa (kapena) kuyambitsa kuchepa kwa ma pancreatic parenchyma, kupangika kwa malo ochulukirapo kapena osayenera a sclerosis (fibrosis), kupezeka. pseudocyst, kufooka kwa ziwalo zapakhungu, kusinthika kwachulukidwe ndi stenosis, mopitilira apo, ma ducts nthawi zambiri amakhala ndi chinsinsi chofinira (pambuyo (kukulira kwa mapuloteni), microlites, yomwe nthawi zambiri imayambitsa kuyamwa kwa gland (matenda oletsa kupindika pancreatitis) amapangidwa. Matendawa akamapitilira, njira ina imadziwika: Ndi kukokoloka kwatsopano kulikonse, malo a hemorrhage ndi parenchyma necrosis nthawi zambiri amakhala ocheperako komanso osadziwika chifukwa cha kapamba (mwachidziwikire, chifukwa cha kupita patsogolo kwa machitidwe a sclerotic), ntchito ya chiwalo chofunikira kwambiri chamkati mwam'mimba ndilowonjezereka.

Mavuto okhalitsa kapamba ndimapapo am'mimba, kapamba kapena kuwerengera kwa kapamba, matenda oopsa a shuga, kupindika kwamitsempha, kupindika kwa matenda am'mimba, komanso BSD ndi chitukuko cha jaundice, cholangitis, ndi zina. kapamba.

Mavuto ocheperako a kapamba amatha kukhala “kapamba” ndi kusowa kwa matumbo. Ascites ndi kapamba ndi vuto lalikulu kwambiri la matendawa, amapezeka mwa odwala omwe ali ndi vuto lalikulu losakanikira la kapamba, ndi hypoalbuminemia (chifukwa cha kupukusidwa kwa m'mimba m'matumbo komanso kuyamwa kosakwanira kwa amino acid, makamaka pakukokomeza kwa chifuwa chachikulu cha pancreatitis. Chimodzi mwazomwe zimayambitsa ascites mu kapamba zingakhalenso ma strombosis a mtima.

Kuphunzira cholinga

Ndizotheka kuchiritsa kapamba kokha ndi njira ya cystic ndi chotupa.

Pazimba zam'mimba, magawo opweteka ndi mfundo zotsatirazi zimatsimikiziridwa:

• malo achisangalalo- pakati pa mzere wokhazikika wopyola msomali ndi chotsekera cha ngodya chopangidwa ndi mizere yokhazikika ndi yopingasa kudutsa navel. Zowawa pamalopo ndizodziwika kwambiri chifukwa cha kutukusira kwa mutu wa kapamba,
• Malo a Hubergritsa-Skulsky- ofanana ndi Shoffar zone, koma ili kumanzere.Zowawa m'derali ndichizolowezi chodziwika bwino pakatupa m'thupi la kapamba,
• Desjardins amaloza- ili pamasentimita 6 pamwamba pa navel motsatira chingwe cholumikiza navel ndi kumanja kumanja. Zowawa pakali pano ndizodziwika kwa kutukusira kwa kutupa m'mutu wa kapamba,
• mfundo gubergrits- zofanana ndi mfundo ya Desjardins, koma ili kumanzere. Zowawa pakadali pano zimawonedwa ndi mchira wa kapamba,
• Mayo-Robson mfundo- ili m'malire a chakunja ndi chapakati pa mzere wolumikiza navel ndi pakati pa chipilala chamtengo kumanzere. Zowawa pakali pano ndizodziwika chifukwa cha kutupa kwa mchira wa kapamba,
• dera lamakona mbali yakumanzere- ndi kutupa kwa thupi ndi mchira wa kapamba.

Odwala ambiri chikwangwaniMainsail- atrophy yamatumbo amafuta a kapamba m'dera la kuchuluka kwa kapamba pazenera lam'mimba lakunja. Chizindikiro cha "m'malovu ofiira" titha kudziwika - kupezeka kwa mawanga pakhungu pamimba, pachifuwa, kumbuyo, komanso kutsekeka kwamkhungu pakhungu.

Dyspeptic syndrome(pancreatic dyspepsia) - Matenda a kapamba amadziwika kwambiri chifukwa cha matendawa. Dyspeptic syndrome imawonetsedwa ndi kuwonjezeka kwa malovu, kutsika kwa mpweya kapena kudya chakudya, nseru, kusanza, kusowa chilakolako, kupewera zakudya zamafuta, kumatulutsa.

Kuchepetsa thupi- Amayamba chifukwa choletsa zakudya (kupweteka kumachepetsa pakusala kudya), komanso polumikizana ndi kuphwanya kwa ntchito ya kapamba ndi mayamwidwe m'matumbo. Kuchepetsa thupi kumathandizanso kuchepa kwa chilimbikitso. Kuchepetsa thupi kumanenedwa makamaka mu mitundu yayikulu ya kapamba ndipo kumachitika limodzi ndi kufooka, chizungulire.

Pancreatogenic kutsegula m'mimba ndi ma syndromes osakwanira chimbudzi ndi mayamwidwe - Khalidwe lovuta kwambiri ndi lalitali la matenda a kapamba chifukwa cha kuwonongeka kwakukulu kwa exocrine pancreatic function. Kutsegula m'mimba kumachitika chifukwa cha zovuta m'matumbo a chimbudzi cha chimbudzi ndi chimbudzi. Kapangidwe kabwino ka chyme kamakhumudwitsa matumbo ndikuyambitsa m'mimba. Gysrointestinal hormone dysregion ndiyofunikanso. Nthawi yomweyo, fetid yambiri, mushy chopondapo ndi mafuta Sheen (steatorrhea) ndi zidutswa za chakudya chosakhudzidwa zimadziwika.

Chizindikiro chodabwitsa cha phrenicus chimatsimikizika (kupweteka mukamapanikizika pakati pa miyendo ya minofu ya sternocleidomastoid pamunsi podziphatika ndi clavicle). Odwala ndi osakwanira m'thupi. Pakhungu la pachifuwa, pamimba, ndi kumbuyo, mutha kupeza mawanga ofiira owala bwino okhala ndi mawonekedwe ozungulira, 1-3 mm kukula kwake, omwe samasowa mukapanikizika (chizindikiro cha Tuzhilin), ndi chizindikiro cha kuchitapo kanthu kwa ma enzymes ophatikizidwa ndi pancreatic. Kuuma ndi kupindika kwa khungu, glossitis, stomatitis chifukwa cha hypovitaminosis ndiwofanizanso.