Ọgwụgwọ spasm nke sphincter nke Oddi

Dysfunction of the sphincter nke Oddi (English sphincter nke Oddi dysfunction) - oria (ọnọdụ ịgwọ ọrịa), nke amamịghe site na ntughari nke ikike nke bile na ihe ọ pancụ pancụ na-egbu egbu na spdicter nke Oddi. Dabere na echiche nke oge a, ọ bụ naanị ọnọdụ nlele nke ọrịa etdilogy nke na - enweghị ọnụọgụ ụrọ ka ana-atụ aka na dysfunctions nke sphincter nke Oddi. Ọ nwere ike inwe ma usoro (Organic) yana ọdịdị arụmọrụ jikọtara ya na arụ ọrụ moto.

Dabere na 1999 Rome Conservation on Digestive Digestive Disorder (“Nkwupụta Rome II”), a na-atụ aro ka eji okwu ahụ bụ "sphincter of Oddi dysfunction" mee ihe kama "okwu postcholecystectomy syndrome", "biliary dyskinesia" na ndị ọzọ.

Sphincter nke Oddi - valve akwara dị na papilla duodenal buru ibu (synonym) Papilla Vater) duodenum, nke na-achịkwa mmiri nke ihe ọ biụleụ na ihe ọ pancụ pancụ na-abanye n'ime duodenum ma na-egbochi ihe dị na eriri afọ ịbanye na dayaịtị na pancreatic (wirsung).

Ọrịa postcholecystectomy

Spasm nke sphincter nke Oddi (Bekee spasm nke Odide) - ọrịa nke sphincter nke Oddi, nke akpọrọ ICD-10 nwere koodu K 83.4 83.4. Nkwekọrịta Rome nke 1999 na-ezo aka na sphincter nke Oddi dysfunction.

Postcholecystectomy syndrome na-emezi |Gini bu sphincter nke Oddi dysfunction?

Ọ bụghị onye ọ bụla maara ọnọdụ sphincter nke Oddi, nke e mepụtara site na njikọ anụ ahụ na eriri anụ ahụ. Ihe owuwu a gbara akụkụ ngwụcha nke gallbladder na pancreas, nke ga - enyere gị aka ịhazi ihe na - egbochi mkpụkọ digesness, na - egbochi ịtụba ọdịnaya n'ime eriri afọ, na - eme ka nrụgide dị n'ime ma ọ na - eme ngwa ngwa.

Sphincter nke Oddi dysfunction pụtara na mmụba nke ụda anụ ahụ, yabụ ducts ahụ gbasaa, enwere ihe nzuzo a na-achịkwaghị achịkwa na duodenum. N'okwu a, ịta ahụhụ nke bile nwere ike ghara iru ụkpụrụ nkịtị, nke na-akpalite ọrịa, mmepe nke ihe mgbaàmà nke mbufụt.

N'ihi nke a, mmebi iwu ndị a mere:

• Gbanwee na ihe mejupụtara microflora eriri afọ,
• Ihe nzuzo intestinal na-efunahụ ọrụ nje,
• Usoro nkewa na imeju oke abụba na-ama jijiji,
• Ọkpụkpụ nkịtị nke ọdụdụ na-agbanwe.

Sphincter nke Oddi erughi ihe na - aputa mgbe ogha adiri ike ya na ogwe aka. N'ọnọdụ ndị dị otú ahụ, a na-ezobe izu nzuzo n'ime anụ ahụ, nke na-eme ka mmepe nke afọ ọria chologenic. Ka oge na-aga, usoro ọmụmụ a na-akpalite mmebi nke mucosa eriri afọ, afọ, nke na-ebute ọdịdị nke dyspepsia.

Ihe na-akpata pathology

Sphincter nke Oddi spasm bụ ọrịa enwetara, isi ihe kpatara ya bụ dyskinesia muscle. Ihe ndị a na-akpalite ajọ ọrịa:

• Gbanwee na ihe mejuputara na udiri akuko nke bile,
• Imebi iwu
• Dysbiosis intestinal,
• Gerywa ahụ
• Mgbanwe nke ulo na sphincter, na-akpalite mmepe nke stenosis,
• Duodenitis.

Ọrịa nke gallbladder na sphincter nke Oddi na-adabara na ndị ọrịa n'ihe ize ndụ:

• Duringmụ nwanyị n'oge menopause, ịtụrụ ime, n'ịgwọ ọgwụ homonụ.
• Ndi asusu
• Mmepe nke ike mmụọ na-eto eto,
• Ndị ọrụ ma ọ bụ ndụ ha na-akpakọrịta na nrụgide ugboro ugboro,
• Ndị ọrịa mgbe cholecystectomy (mwepu gallbladder),
• Ọrịa nwere ọrịa shuga mellitus,
• Ndị nwere ọrịa nke usoro ịba ọcha n'anya,
• Ọrịa ndị a wara ahụ maka akwara.

Ofdị pathology

Dabere na nhazi nke oge a, sphincter nke Oddi dysfunction nwere ike were ụdị ndị a:

• Ilidị biliary I. Ọ bụ omenala ịgụnye nsogbu ndị a na-akpalite ọdịdị nke ọnya dị mma hypochondrium. Oge oge ọgụ ahụ akarịghị nkeji iri abụọ. Na ERPC, a na-ekpebi mbelata nke ọnụego mkpochapu ihe dị iche iche, ihe ndị na-egosi na-abawanye: AST, alkaline phosphatase,
• Ilidị Biliary II. Thisdị ụdị dysfunction nke sphincter nke Oddi dabere n'ụdị biliary, enwere mmetụta na-egbu mgbu na-egosipụta, ihe ngosi 1-2 nke ụdị I pathology,
• Ilidị Biliary III. Naanị ọnya mgbu gosipụtara, mgbaàmà ndị ọzọ adịghị.
• Pandị pancreatic. Sphincter nke Oddi spasm na-akpata mgbu na mpaghara epigastric, nke na-enye azụ. Ahụhụ na-ebelata n'oge na -emegharị ahụ n'ihu. Mmụba nke amylase ma ọ bụ lipase bụ njirimara.

Foto nyocha

Sphincter nke Oddi spasm ka amalitere site na mmepe nke ọrịa mgbu na-ekwu ugboro ugboro, bụ nke dị na hypochondrium ziri ezi, epigastrium. Ihe mgbu na-edetukarị azụ ma ọ bụ aka nri ubu. Ogologo oge mgbu agaghị adịkarị karịa nkeji iri atọ. Ọrịa mgbu nwere ike ịnwe mmetụta dị iche iche, na-ewetara onye ọrịa ahụhụ mgbe mgbe.

Ọrịa mgbu na-enwekarị mgbaàmà ndị dị ka:

• Ogbugbu na vomiting
• Ire uto n'ọnụ
• Belching na ikuku
• Ikekwe ntakịrị mmụba na ahụ ọkụ,
• Ọdịdị nke mmetụta arọ.

Akara oria edepụtara na-enwekarị nsogbu mgbe ị dishesụchara nri abụba na oseose.

Ihe omuma nke ulo ogwu nke Oddi gunyere:

• Enzymes imeju na-abawanye,
• Na-agbapụ mkpochapụ nke ọdịiche n'oge ERCP,
• Mgbasawanye nke obere bile.

Dysfunction na - etolite n'ime afọ 3-5 mgbe cholecystectomy gasịrị. N'okwu a, ndị ọrịa na-achọpụta mmụba nke ihe mgbu, nke a na-esonyere na iwepu mmiri esite.

Dị Mkpa! Ihe mgbu ahụ na-etolite n'abalị, enweghị ike ịkwụsị ya site na ị painụ ọgwụ mgbu, na-agbanwe ọnọdụ ahụ.

Usoro nyocha

Iji chọpụta ọnụnọ nke nsị sphincter, ndị dọkịta depụtara nyocha ọbara ọbara nyocha, nke a na-eme n'oge mmepe nke ọrịa mgbu ma ọ bụ n'ime awa 6 mgbe ọ nwụsịrị. Nke a na - enyere gị aka ịchọpụta ọkwa amylase na lipase dị elu, aspartate aminotransferase, alkaline phosphatase na gamma-glutamyl transpeptidase.

Mgbapụta nke ọrịa nwere ike igosipụta mmepe nke ọrịa ndị ọzọ nke ngwara nri nke ihe mgbochi na-akpata ihe na-akụ azụ. Yabụ, a na-eji ụzọ nchọpụta ụdị ngwaọrụ a dị iche iche iji gosipụta nchoputa ahụ:

• Ultrasound A na-enyocha nyocha megide ndabere nke iwere ndị na-akpasu iwe, nke na-enye gị ohere ịtụle mgbanwe mgbanwe. Site na mmụba nke ihe ndị na-adịkarị mma site na 2 mm, enwere ike ịtụle mkpọchi ezughị ezu nke dule bile,
• Cholescintigraphy. Usoro a na-enye ohere ikpebi mmebi nke motility sphincter site na ọsọ nke mmegharị nke isotope ewepụtara site na imeju na eriri afọ dị elu.
• Endoscopic retrograde cholangiopancreatography (ERCP). Usoro a gụnyere iwebata duodenoscopes na mpụta n'akụkụ iji chọpụta dayameta nke ducts ahụ, iji chọpụta etu ọsọ ha si adị,
• Manometry. Usoro a dabere na ntinye nke catheter lumen atọ site na otu duodenoscope n'ime dupe iji tụọ mgbanye nke sphincter.

Njirimara ọgwụgwọ

Ọgwụgwọ sphincter nke Oddi dysfunction gụnyere nnwere onwe nke ihe mgbu na mgbaàmà ndị ọzọ, ịdịkarịsịrị mma nke anụ ahụ na mwepụ nke ihe nzuzo diges. Site na mmepe nke mbufụt na dysbiosis, a ga-achọ ikpochapụ ọrịa nje na ịhazi biocenosis nke eriri afọ. Ebumnuche a, ọgwụ ọgwụ, ọgwụgwọ nri, endoscopy na ọgwụgwọ ịwa ahụ ka eji n'ọtụtụ ebe.

Ọgwụ ọgwụ

A na-eji otu ọgwụ dị iche iche eme ihe iji kpochapụ dysfunction:

• Nitrates (Nitrosorbide, Nitroglycerin). Ọgwụ nwere ike belata ogo ihe mgbu,
• Anticholinergics (Biperiden, Akineton) na-enyere aka iwepụ spasm muscle,
• Ndị na-egbochi Calcium ọwa na-eme ka izu Oddi dị jụụ. Ọtụtụ mgbe na-akpata mmeghachi omume ọjọọ, n'ihi ya, ọ na-adịkarịghị eji,
• Antispasmodics (Papaverine, Pinaveria bromide, Drotaverinum) na-ewepụ spasm na ihe mgbu,
• Myotropic antispasmodics. Mebeverin na-ebelata ụda sphincter na agagharị nke eriri anụ ahụ dị nro. Gimekromon na-ekpochapụ spasm, na-enwe mmetụta choleretic,
• Iji kpochapụ ọrịa nje, a na-eji dysbiosis, ọgwụ mgbochi nje nke nsia (Rifaximin, Enterofuril, fluoroquinolones), prebiotics na probiotics (Lactulose, Bifiform, Hilak forte),
• Ihe nke putara na ursodeoxycholic acid (Ursosan, Ursofalk) nwere ike wepu enweghi oke nkpa biliary.

Nri ọgwụ

Ọgwụgwọ dị irè nke ọrịa nke digestive tract agaghị ekwe omume na-esoghị nri pụrụ iche. N'ihe banyere imebi sphincter nke Oddi, ndị ọkachamara n'ihe banyere nri na-atụ aro ịhapụ ịhapụ oke abụba, ihe oriri na-ekpo ekpo, nri ngwa ngwa. Ekwesịrị iji mkpụrụ osisi na - eri nri mee ka nri dị mma, nke na - enyere aka ịme ka akụrụngwa nri.

Ga-ajụ ịnabata inine na mkpụrụ osisi dị ọhụrụ - ngwaahịa ndị ahụ ga-enwerịrị ọgwụgwọ ọkụ. Efere kwesịrị sie, stewed, butere, steamed. Ekwesịrị ekewa nri ubochi kwesiri ka odi 6-7, nke ekwesiri ka ewere ya kwa awa 3-3.5.

Dị Mkpa! Nri abalị tupu nri ụra na-ezere ịagụ mmiri.

Usoro ọgwụgwọ ọdịnala

Ka iwelie ịdị mma nke ọgwụ ọgwụ, enwere ike ịgwọ gị site na ọgwụgwọ ndị mmadụ. Agbanyeghị, iji usoro ọgwụgwọ ọdịnala ga-ekwe omume naanị mgbe ịgachara ọkachamara na ọkachamara. Iji rụzie ọrụ nke sphincter, a na-eji ihe ndị dị otú ahụ ọgwụ na-eji eme ihe:

• Ọka ọka. A na-eji osisi ahụ agwọ ọtụtụ ọrịa nke usoro hepatobiliary. Ihe akụrụngwa akpọpụtala choleretic, ọgwụ mgbochi mkpali. Iji dozie infusion, o zuru iji wunye 20 g nke ọka stigmas na 200 ml nke esi mmiri, na-esi ọnwụ nke mejupụtara 1 awa. A na-a drugụ ọgwụ ahụ 40 ml ruo ugboro ise kwa ụbọchị,
• Ọgwụ Hypericum. A na-eji ihe dị nro na-eme ka imeju na eriri afọ dị mma, ọgwụgwọ dyskinesia. Iji kwadebe ihe ndozi, o zuru ezu ị ghee 1 tablespoon nke akụrụngwa, wụsa ihe mejupụtara ya na 250 ml nke mmiri esi. A na-eweta ngwá ọrụ ahụ ka obụpde na mmiri ịsa ahụ, siri ọnwụ ruo 1 awa. A na-ewere ofe 50 ml ruo ugboro 3 kwa ụbọchị,
• Ifuru osisi Helichrysum. A na-eji ihe ọkụkụ a eme ihe n'ọtụtụ ebe iji gwọọ mgbaka bile, ịba ọcha n'anya, ọrịa nrịanrịa. Iji kwadebe ọgwụ, naanị wụsa 2 tablespoons nke okooko osisi a họọrọ n'ime mmiri ịkpụ 250 ml. Ihe mejupụtara ya bụ nkeji iri, sie ya, kpụchaa. Maka ọgwụgwọ pathologies nke sistem hepatobiliary, a na-atụ aro ka ị were 50 ml nke decoction minit 30 tupu nri ugboro atọ n'ụbọchị.
• Passa repeshka. Ihe akụrụngwa nwere ike belata akwara ịba ọcha n'anya, ọrịa nrịanrịa, cholecystitis, biliary dyskinesia. Iji dozie infusion, o zuru iji wunye 200 ml nke esi mmiri 1 tablespoon nke ngwaọrụ ndị e gwepịara egwepịa. A na-ekwenye ihe osise ahụ ruo awa 2, mgbe ọ takingụchara 100 ml ugboro atọ n'ụbọchị.

Ọgwụ endoscopic na ọgwụgwọ ịwa ahụ

Ọ bụrụ na ọgwụgwọ achọghị iwepụtara nsonaazụ bara uru, jiri ụzọ ndị a:

• Papillosphincterotomy Endoscopic. Usoro gụnyere ịgbasa nnukwu paodenal papilla,
• Balloon agbatị nke sphincter na ntinye nke obere oge,
• Sphincteroplasty transduodenal,
• Ntinye ọgwụ botulinum na papilla duodenal. Mmetụta ọgwụgwọ nke ọgwụ ahụ na-adịgide ruo ọnwa 3-4, mgbe nke ahụ gasịrị wepụrụ ihe ahụ kpamkpam.

Ibu amụma na mgbochi

Ejiri ngagharị nke moto nke spdictdi nke Oddi site na ịkọ ezi. Site na nlekọta nchekwa ogologo oge zuru oke, ọ ga-ekwe omume wepu kpamkpam mgbaàmà na-adịghị mma nke ọrịa ahụ.

Enweghị prophylaxis akọwapụtara nke pathology akọwapụtara. Agbanyeghị, iji gbochie nsogbu mmerụ ahụ na - emebi emebi, ndị na - ahụ maka ndị na - ahụ maka akwara na - atụ aro iri nri dị mma, na - enwe ahụ ahụ dị mma, ma na - emega ahụ mgbe niile.

Sphincter nke Oddi bụ akụkụ dị mkpa nke sistemụ hepatobiliary. Ọ bụrụ na ọrụ ya na-enye nsogbu, nsogbu dị njọ nke akụkụ ahụ diges. Ya mere, ọ dị mkpa ịgbaso ụzọ ndụ dị mma, yana akara mbụ nke ọrịa, chọọ enyemaka site na ọkachamara.

Gini bu spructer nke Oddi?

Na 1681, onye mbụ kọwara sphincter nke Oddi. Onye dibia bekee aha ya bụ Francis Glisson mere nke a, mana onye ọkpụkpọ oku a ka amaara aha onye sayensi Italy bụ Oddi Ruggiero. Ọ bụ ya bipụtara akwụkwọ sayensị na usoro ihe banyere morphological na 1888, ma buru ụzọ rụọ ọrụ nyocha nke biliary.

Ọzọkwa, onye ọkà mmụta gbasara anụ ahụ nke totali bụ nkọwa mbụ nke mgbasawanye nke nnukwu mmiri mgbe ụdị Galịladder (cholecystectomy) yiri.

Sphincter nke Oddi di na nnukwu paodenal papilla. N’ile anya, ọ bụ akwara dị nwayọ, arụ ọrụ nke ya bụ ime ka ọ banye n’odide afọ iri na abụọ nke ihe ọ ofụ pancụ na-egbu egbu. Ọ na - egbochi ihe ndị dị na duodenum ịbanye na mmiri ahụ.

Thedị udiri akwara nke Oddi spasm, ọkachasị, ụlọọgwụ nke ọrịa a, yiri ọrịa ndị ọzọ nke usoro nri, yabụ na-enyocha ọkwa nke nsogbu a ọtụtụ oge. N'ime usoro ahụike, pathology bụ nsogbu dị iche nke ọnya biliary.

A na-ahụkarị ihe osise a na - adakarị ụmụ nwanyị dị n'agbata afọ 35 ruo 60, bụ nsonaazụ nke cholecystectomy, nke a rụrụ iji gwọọ ụdị ọgbụgba cholecystitis.

A na - achọpụta nsogbu ọrịa akwara nke ọrịa Oddi na udiri akwara na ọrịa pancreatitis.

A na - achọpụta nchikota nke sphincter dysfunction na pancreatitis na - adịghị ala ala ugboro anọ karịa nke CP na - enweghị nkwarụ ọrụ.

Nkewa nke Sphincter Oddi Dysfunction

N'ime ọrụ ahụike, a na-amata ọtụtụ ụdị arụmọrụ arụmọrụ. Nke mbu bu echiche biliary 1. Fọm a gụnyere nkwarụ ọrụ nke na-esite na mgbu ma ọ bụ nnukwu mgbu na hypochondrium ziri ezi ma ọ bụ mpaghara epigastric.

A na-ahụkarị ọgụ na-egbu mgbu n'ime oge 20-30. Endoscopic retrograde cholangiopancreatography na-egosi iwepu nwayọ nke ihe ndị dị iche (igbu oge karịrị nkeji iri anọ na ise). Mgbe ị na-eme ọmụmụ ihe okpukpu abụọ nke enzymes imeju, a na-achọpụta oke nke itinye uche alkaline phosphatase nkịtị site na ihe abụọ. Ọzọkwa, a na-achọpụta mmụba nke ebe ihe ọgịga dị site na ihe karịrị 1.2 santimita.

Echiche biliary 2. Site n'ụdị a, ọnụnọ nke sensations na-egbu mgbu nke kwekọrọ n'ihe mgbu nke ụdị nke mbụ. Manometry na-akwado arụmọrụ sphincter arụ ọrụ na 50% nke ihe osise. Ọrịa ndị a chọpụtarala bụ arụmọrụ ma ọ bụ nhazi na okike.

Echiche nke biliary 3. Enwere ọrịa mgbu, mana enweghi ebumnuche ebumnuche a na-ahụ ndị ọrịa nke ụdị mbụ. Manometry na-egosi dysfunction sphincter na 10-30% nke foto.Mmebi nke ụdị arụkarị ọrụ (na 80% nke ikpe).

N'iji ihe nkwụghachi azụ mgbu, ọrịa ahụ na-esochi azụ, nke na-enye azụ. Ọ bụrụ na onye ọrịa ahụ na-agbatị ahụ, mgbe ahụ, ihe mgbu belata. Nyocha ụlọ nyocha na-egosi mmụba dị ukwuu nke lipase na amylase.

Manometry na-akwado nkwonkwo Oddi sphincter na 40-85% nke ikpe.

Etiology na ihe ndị na-akpata ya

Cdị dyskinesia nke pancreatic nke sphincter nke Oddi na-etolite n'ime ndị ọrịa n'ihi ọrịa stenosis (ịnọgidesi ike) nke sphincter ma ọ bụ pathogenesis n'ihi mmachi nkwarụ. Ọrịa warara na-etolite n'ihi usoro mkpali, fibrosis, na ụfọdụ onyonyo onyonyo, ihe kpatara ya nwere ike na-abawanye na akpụkpọ ahụ mucous.

Mgbanwe nke ihe mkpali na agwa dị egwu bụ nsonaazụ mmetụta nke obere klọọkụ na-agafe na ebe ihe na-agakọ. Ozizi ahụ pụtara dị ka mgbanwe mgbanwe mkpali si akpasu iwe nke ọrịa pancreatitis na-adịghị ala ala.

Nkewa nke nsogbu na ọrụ arụ dị ezigbo iche, ebe ọ bụ na ọnọdụ abụọ adịghị njọ nwere ike inwe otu isi. A na-achọpụta imirikiti dysfunction na ndị ọrịa nwere akụkọ banyere ọrịa mgbu nke ọnya. A na-achọpụta ndị ọrịa site na sphincter nke Oddi erughi, n'ihi nke a nke ihe omimi na-abanye na lumen nke duodenum.

Ọ bụrụ na mmadụ nwere ezi ahụike, mgbe ahụ ọ na ebudata ya na homonụ neuropeptide, ọnya ahụ kwesịrị ibute nsị, bele na-abanye na duodenum, yana sphincter Oddi na-ezu ike. Mgbe ị na-ewepụ gallbladder, ị nwere ike inyocha ụda sphincter gabigara ókè yana mmụba nke ọnya ọnya mmiri.

N'ọnọdụ ụfọdụ, mgbe a wachara ya ahụ, ụda ahụ na-ebelata, yabụ, ọgịga na - ezughị ezu na - abanye na eriri afọ. N'ihi ya, a na-ahụta ibute ọrịa nke mmiri ahụ, na-eduga na ọnya oke.

Ọrịa Biliary-pancreatic syndrome na-eduga n'ọgba aghara nke usoro ahụ, n'oge nke bile na-abanyekarị na eriri afọ, n'ihi nke a, mmadụ na-amalite igosipụta akara dị iche iche nke nsogbu nri.

Ọ bụrụ na bile abanye n'ime eriri afọ ya, ụlọ ọgwụ dị otú a na-egosipụta nke a:

• Ọgba aghara nke enterohepatic mgbasa nke bile asịd,
• Malfunctions na usoro nke ịgbari nri, belata oriri.
• A na-ebelata ihe ndị a na-ahụ maka ihe ndị dị na nje a na - egbochi duodenal.

Ihe na - akpata nkụda mmụọ maka mmepe nke dyskinesia bụ enweghị usoro homonụ nke metụtara afọime, menopause, na iji ọgwụ homonụ. Nakwa nchekasị na-adịghị ala ala, ọrịa shuga mellitus, pathology nke pancreas, ọnya duodenal iri na abụọ, ọrụ imeju na-emebi emebi, ihe ịwa ahụ na akụkụ biliary na afọ.

Ihe mgbaàmà nke dyskinesia nke sphincter nke Oddi

Dị ka anyị kwurula, ọrịa gosipụtara site na mgbu, ọkachasị, ihe ọdịdọ na-adịgide oge nkeji 20-30. Ihe mgbu ahụ na-adịte aka ma ọ bụ sie ike. Ogologo oge nke ọrịa a bụ ihe karịrị ọnwa atọ.

Ndị ọrịa na-eme mkpesa maka mmetụta nke ịda oke na afọ nke elu, mgbu mgbu n'okpuru ọgịrịga aka nri. A na-egosipụta ihe mgbaàmà dyspeptik n'ihi nsị nke usoro nri. Ndị a gụnyere ọgbụgbọ, ọgbụgbọ, ọgbụgba n'ime afọ, ịba ụba gas, belching, wdg.

O siri ike, mgbu na-apụta site na colic. Agbanyeghị, ọ bụrụ na ejikọtara pathology na ụdị mgbu na-adịghị ala ala nke pancreas, ihe ahụ na-egbu mgbu na-egosipụta onwe ha n'ụzọ dịgasị iche iche.

Na mmalite nke usoro ọgbụgba, ihe mgbu na - adịkarị ụk, mana ọ nwere ike ịdịru elekere ole na ole. Enweghị ihe mgbu n'etiti ọgụ, ọnọdụ onye ọrịa na-akawanye mma. Mgbe ụfọdụ ana - achọpụta ugboro ugboro ihe ọdịdọ na - enwe mmetụta na - egbu mgbu na - anọkwa n’etiti oge n’etiti ha.

Mgbu ahụ na-amalite mgbe awa ole na ole gachara. Agbanyeghị, ọ gaghị ekwe omume ijikọ ya na ụdị nri, ebe ọ bụ na onye ọ bụla na-eme mkpesa banyere ngosipụta dị iche iche nke ọrịa.

Na nwata, dyskinesia nke sphincter nke Oddi gosipụtara site na ọnọdụ febrile (anaghị adịte aka) yana ụdị nsogbu dịgasị iche iche nwere onwe.

Nwatakịrị enweghị ike ịchọpụta ịmata ihe mgbu dị, yabụ, na-egosipụtakarị mpaghara eriri nwa.

Ọrịa na usoro ọgwụgwọ

Iji chọpụta usoro ọrịa, chọpụta mkpokọta enzymes diges na ahụ, ọdịnaya nke enzymes imeju. Site na mwakpo, ndị ngosi ahụ na-abawanye ọtụtụ oge karịa ka ọ dị. Ha nwere ike ibuwanye n'ihi ọrịa ndị ọzọ nke eriri afọ, ya mere, a na-egosi nchọpụta ọdịiche.

Iji gosipụta nchoputa, a na - eme ultrasound site na ntinye nke ihe dị iche, nke na - enyere aka ikpebi oke nke bile na isi ihe nke pancreas.

Ọ bụrụ na usoro ndị na-abụghị nke ịta ahụhụ emeghị nchọpụta nchoputa, jiri ụzọ nchọpụta ọrịa merụọ ahụ. Emere ERCP. Allowszọ a na-enye ohere igosipụta dayameta nke eriri abụọ ahụ, iji mee ihe dị iche maka mmebi nke ọrụ sphincter nke Oddi na ọrịa ndị yiri ya. Ọ ga - ekwe omume ịchọpụta oge nhichapụ nke dule dule.

Manometry bu ihe omuma nke n’ebu ihe n’ile n’ihu. Dị ka ọ na-adịkarị, nrụgide dị na ya ekwesịghị ịgafe 10 milimita nke mercury. Agbanyeghị, ọ bụrụ na enwere malfunction, ọmụmụ a gosipụtara nsonaazụ nke 115 ± 20.

N'ihe dị ka 10% nke eserese, mmejuputa manometry na-eduga na mmepe nke ọrịa ọrịa pancreatitis, mgbe ahụ ọmụmụ a bụ ihe dị oke mma mgbe ụzọ nchọpụta ndị ọzọ mere ka ọdịda.

Ọgwụgwọ gụnyere ihe ndị a:

1. Usoro ọgwụgwọ uche na-elekwasị anya na mbenata mgbaàmà na-adịghị mma na ngosipụta dyspeptik.
2. Nri
3. Treatmentkpachapu anya ọgwụgwọ dị mkpa mgbe a hụrụ nsogbu nje nke eriri afọ.
4. Mkpochapu enweghi nke oru biliary.

Iji belata ihe mgbu, a na-enye ọgwụ ọgwụ na belladonna, ihe ndị dị ka buscopan na metacin. Maka mgbu na-adịghị mma, a na-atụ aro No-shpa. Iji kpochapụ ihe ịtụnanya dyspeptik, a na-eji ọgwụ eme ihe - Creon, Pancreatin.

Usoro ọgwụgwọ nri na - esite n'ụkpụrụ nri nri - ruo ugboro asaa kwa ụbọchị na obere akụkụ. Ọ dị mkpa iri nri zuru ezu, nke na - enye aka na mweghachi nke eriri afọ.

Contkpochapu ọgwụ ọgwụgwọ gụnyere ịba ọgwụ mgbochi ọrịa, ọgwụ mgbochi afọ na ọgwụ nje. A na-eji ọgwụ Urosan agwọ ọgwụ ezughị ezu.

A kọwara nsogbu nke pancreatitis na vidiyo n'isiokwu a.

Dị biliary

Otu a buru otutu ndi DSO, ihe iriba ama ndia bu ndi a:

• ihe mgbu na - ahụkarị nke biliary colic - ihe na - egbusi ike, ịgbatị n'azụ, ubu aka nri, mgbe ụfọdụ olu,
• data nyocha ngwa - mgbasawanye nke bile dupe karịa 12 mm,
• mmụba dị iche n'oge iwepụ ihe karịrị nkeji iri anọ na ise,
• data ụlọ nyocha - mmụba nke ọkwa transaminases na alkaline phosphatase ọbụlagodi ugboro 2 na nyocha ugboro ugboro.

Dabere na nyocha nke manometric, a na-ekewa ụdị biliary ahụ na ụdị 3, ebe n'ụdị nke mbụ enwere stenosis (warara) nke sphincter, n'ụkpụrụ nke abụọ na-ahụ na 63% nke ndị ọrịa, na nke atọ - na 28%. Nsogbu ndị ọzọ bụ arụmọrụ (atụgharịgharị, dyskinetic).

Pandị pancreatic

Ofdị DSO a na ngosipụta nke ụlọ ọgwụ yiri ọrịa pancreatitis na-adịghị ala ala, naanị nyocha zuru oke na-enye gị ohere igosipụta nchọpụta ziri ezi. Ihe mgbaàmà mbu bu:

• mgbu mgbu na-egbu azụ,
• mmụba na plasma nke amylase na enzyme lipase.

Mgbu ndị yiri ọrịa ọria pịpatịa na -akpata ya. A na-agbanwe data ụlọ nyocha naanị ma ọ bụrụ na ahọpụtara ihe maka ọmụmụ ihe n'oge ọgụ mgbu. N'oge dị jụụ, ọ fọrọ nke nta ka ọ bụrụ na enweghị ntụgharị ọ bụla.

Ngosipụta doro anya nke ụdị ọrịa dịgasị iche iche

N'otu oge ahụ, enwere akara ndị na-eme ka o kwe omume ịmata ọdịiche dị n'etiti ụdị DSOs dị iche iche.

Ihe Ndị Na-akpata Esemokwu

A na-ahụta ihe kpatara ya bụ ọrịa metabolic na imeju, mana ndị a dịkwa mkpa:

• mgbanwe na mejupụtara nke bile,
• mebiri nke nzipu nke bile, ihe na-agbagide ya,
• dyskinesia nke obere dupe ma ọ bụ njikọ nke bile na extracreatic extracts,
• oge ịwa ahụ nke Oddi merụrụ ahụ, ọbụlagodi ntakịrị,
• oke ibu nke pathological eriri afọ microflora.

Gastroenterologists ka na-atụle hepatocellular dyscholia dị ka isi ihe kpatara e guzobere DLS. Nke a bụ ọnọdụ emepụtara cholecystokinin ezughi oke. Ihe a bụ ihe na-ahụ maka ihe ebumnuche ya na eriri afọ ya. N'okpuru mmetụta nke cholecystokinin, ụda sphincter na-abawanye ruo mgbe eriri jupụtara na bile. Ozugbo ejuputara, sphincter na-ezu ike ka ebe ihe na-acha uhie uhie wee nwee ike ịgafe n'efu. Mgbe cholecystectomy gasịrị, ụda olu na-agbanwe agbanwe, ma ọ nwere ihe na-agbanwe ma ọ bụ na-aga n'ihu. Nke a na-agbanwe mmepụta nke ihe dịka homonụ nke na-edozi metabolism na pancreas, pancreatitis nke abụọ na-apụta.

Nnyocha ụlọ nyocha

• bilirubin ịta
• alkaline foseti
• aminotransferase
• lipases na amylases.

A na-ele mgbanwe mgbanwe anya ka ọ bụrụ ihe dị mkpa ma ọ bụrụ na -elebe nnwale ọbara ọbara na-erughị elekere isii mgbe ọgụ ahụ gasịrị.

Nnyocha nyocha

• Ultrasound nke eriri afọ - ekpebisiri ike ịgbatị ebe a na-agakarị nso na ebe ihe ime. Iji kọwaa, nye ụtụtụ nri mara abụba, ma lelee mgbanwe n'ọha nke ihe na -emekarị ihe na -eme ka ọ bụrụ nkeji iri na ise kwa elekere. Mgbasawanye ihe karịrị 2 mm bụ akara doro anya nke DLS. Iji chọpụta ọrụ nke eriri afọ, a na-eme nnwale na nzuzo. Dika odi, mgbe ochichi nke ogwu a gachara, okpomoku gha abawanye, ma n’ime ihe dika ọkara elekere laghachite n’onodu mbu ya. Ọ bụrụ na mbelata ahụ weere ihe karịrị nkeji iri atọ, mgbe ahụ, nke a bụkwa ihe ịrịba ama nke DSO,
• CT nke mpaghara hepatoduodenal - a na-ahụ nha na nhazi ya,
• ERCP - retrograde cholangiopancreatography. Iszọ a na-akpali akpali, ya bụ, na-abanye kpọmkwem na spain na obere ogwe. N'iji nyocha, ewee gosipụta ọdịiche, wee mee x-ray. Ọ bụrụ na dupe dupe nkịtị na-agbasa karịa ihe karịrị 12 mm, ma ọdịiche nke mkpụmkpụ gafere nkeji iri anọ na ise, mgbe ahụ nchọpụta ahụ na -agaghị agbagha
• Manometry bu ihe nha n’olu n’olu. N'oge ọmụmụ ihe ahụ, enwere ike iji izu ike maka akwara dị nro. Iszọ ahụ dị mgbagwoju anya na teknụzụ, nwere ọtụtụ contraindications, enwere nsogbu, yabụ ojiji ya enweghị oke.

Usoro ọgwụgwọ nwere ọtụtụ ụzọ dị mkpa a na-esi eji otu oge.

Ọ bụrụ na ịgbaso ụkpụrụ dị mfe, ahụike dị mma agaghị ekwe omume. Ọ dị mkpa:

• Nri 4 kwa ụbọchị, nri abalị tupu ị lakpu ụra - na --emepụta onodu maka ikpu kaadi ahụ,
• mgbochi nke abụba anụmanụ (kacha - ntakịrị abụba na ofe),
• mwepu zuru oke nke eghe,
• ọtụtụ mkpụrụ osisi na akwụkwọ nri agbanye, ego ga-ezuru oche kwa ụbọchị,
• ihe eji eme bran.

Ọgwụ

Mgbe cholecystectomy gasịrị izu 24, a na-enye ọgwụ ọgwụ - ọgwụ mgbochi, nke kachasị mma bụ Duspatalin, nke a na-ewere n'ụtụtụ na mgbede.

Iji belata usoro ịgba ụka n’ime eriri afọ 1 ma ọ bụ ugboro abụọ n’afọ, a na-agwọ ọgwụ nje na ọgwụ mgbochi mkpali, n’oge nke ọ bụla. A na-ahọrọ ọgwụ ndị si n'aka ndị dibịa bekee, Ciprofloxacin, Biseptol, Enterol, Tetracycline na ihe ndị ọzọ.

Mgbe ị antibioticsụsịrị ọgwụ nje, a na-enye ọgwụ mgbochi ọgwụ mgbochi yana Bifiform, Hilak Forte na ndị ọzọ.

Maka afọ ntachi, a na-eji ọgwụ lax, ọkachasị Dufalac, nke na-akwado uto nke microflora nkịtị.

Oge izizi mgbe a gbasịrị ya, mgbe ụfọdụ ọgwụ ndị na-egbochi acid (Maalox, Smecta), enzymes diges (Creon, Mezim) chọrọ.

Ọ bụrụ na nyocha ụlọ nyocha na-egosi enweghị nsogbu na imeju, a na-eji hepatoprotector - LIV 52, Heptral, nkwadebe acid acid.

Usoro ọgwụ a kapịrị ọnụ na-adabere na foto a na-adakarị.

Ozi izugbe

Sphincter nke Oddi spasm bụ ọnọdụ a na-ahụkarị na gastroenterology, bụ nke a na-ahụkarị na ụmụ nwanyị. Onwe ogugu omuma banyere nosology adighi, ma a maara na n'etiti ndi oria aria cholecystectomy nke oma, ihe mgbu na –eme n’azu na nsogbu dyspeptik nke dyspection dysfunction metụtara na sphincter dysfunction dysfunction na-adigide na 15% nke nsogbu. Ọrụ sphincter nke Oddi na-ahụ maka ọrụ nhazi nke ngwa biliary niile. Mgbe eriri afọa butere, uru ahụ dị na ume ga-ezu ike, ma ọ bụ nke ọzọ. Nke a na - ebute ntinye enzymes n'oge kwesịrị ekwesị na lumen nke duodenum. Inggbanwe arụmọrụ mmekọrịta nke ngwa ihe na-eduga ná mmebi nke ọgbụgba, ihe mgbu na dyspepsia.

Ihe kpatara Sphincter Oddi Spasm

Sphincter nke Oddi spasm bụ ọnọdụ achọpụtara ọrịa, ihe kacha akpata ya bụ akwara dyskinesia. Dabere na ngosipụta nke ụlọ ọgwụ, spasm nke sphincter nke Oddi yiri ya stenosis nke kpatara ọgba aghara, na-agakọkarị mgbanwe ndị a. A na-eme hypertonicity nke sphincter site na spasm nke akwara nke akwara nke akụkụ ya (sphincters gbara akụkụ akụkụ distal nke bile duct, na a na-eme ka a na-eme ya na amịkọ nke ọwa mmiri na mpaghara nke mkpokọ nke dupe ndị a). N'ihi ya, nrụgide dị na sistemụ nke biliary tract na pancreas na-abawanye.

Otu ihe doro anya na - ebute spasm nke Oddi ogologo oge ebidobeghị, mbufụt nke nnukwu paodenal papilla na duodenitis bụ ihe. Na-ebu amụma banyere mmepe nke usoro a, nwoke na nwanyị, afọ 30-50 afọ, ahụike asthenic, enweghị mmetụta nke mmụọ, enweghi oke ahụ.

Ọrịa nke spasm nke sphincter nke Oddi

Ngosiputa ogwu nke spasm nke sphincter nke Oddi bu ihe nwute, anabataghi ya na hypochondrium ma obu epigastrium nke oma, na –eme ka azu ma obu mpaghara scapula. Ogologo oge ọgụ mgbu na-abụkarị nkeji iri atọ ma ọ bụ karịa, ike nwere ike dị oke mkpa, na-akpatara onye ọrịa nhụjuanya. Mgbu ahụ anaghị akwụsị ị antụ ọgwụ antacids, na-agbanwe ọnọdụ nke ahụ. A na-ejikọ ọnya mgbu na mgbaàmà dyspeptik: ọgbụgbọ, ọgbụgbọ.

Ugboro ugboro, mana ọ bụghị nlọghachi kwa ụbọchị, anabataghị nri ndị nwere abụba bụ ihe e ji mara ha. Maka oghere spinal nke Oddi, mmepe nke ihe mgbu na abalị bụ ihe a na-ahụkarị, nke bụ ihe nkatọ maka mwepu ọrịa a n'ọtụtụ ọrịa ndị ọzọ nwere ọnya ọnya biliary, yana enweghị ọnya ọgbụgba n'oge ọgụ mgbu. Mmekọrịta ihe mgbu na iri nri maka onye ọrịa ọ bụla bụ nke onwe ya. Ọtụtụ mgbe, ihe ọdịdọ na-ewere ọnọdụ awa abụọ ruo atọ mgbe e risịrị nri. A, onye ọrịa mara nri na-akpasu iwe ahụ (oseose, mmanu mmanu).

Ọtụtụ ndị ọrịa nwere ihe na-enyo enyo nke sphincter nke Oddi nwere akụkọ banyere cholecystectomy.Mgbe a wachara ya ahụ, ọ na - abụkarị ogo ihe mgbu na hypochondrium ziri ezi na - agbada, mana mgbe obere oge gasịrị, mwakpo ahụ amaliteghachi. N'okwu a, ọdịdị nke ọrịa mgbu ihe fọrọ nke nta ka ọ bụrụ otu tupu arụ ọrụ ahụ. Ọtụtụ mgbe, nlọghachị na-eme afọ atọ ruo afọ ise mgbe etinye aka ahụ. N'ọnọdụ ụfọdụ, ozugbo a wachara ya ahụ, mgbu ahụ na-abawanye nke ukwuu, nke a na-emetụta mwepụ nke esite maka bile.

Nchoputa nke spasm nke sphincter nke Oddi

Ofgba aka na onye na-ahụ maka eriri afọ na-atụ aro na onye ọrịa ahụ nwere ọnụnọ nke Oddi spasm na ọnụnọ nke mgbu mgbu mgbu na-adịghị ahụkebe nke choledocholithiasis, njiri ike nke eriri afọ, yana ọrịa ndị na-abụghị hepatobiliary nwere ọrịa ndị yiri ya.

Mgbanwe njirimara nke nsonaazụ nke nnwale ụlọ nyocha bụ mmụba nke ọrụ bilirubin, transaminases, amylases n'oge oge mwakpo ahụ. Na nyocha ọbara dum, enweghị akara nke mbufụt. Nnyocha nyocha adịghị agbanwegharị. Ihe dị iche na nsonaazụ nyocha nke ụlọ nyocha n'oge ihe omume nke spasm na mpụga ya bụ njirimara.

Ultrasound nwere ultrasound nke imeju na ọnya biliary. Researchzọ nyocha a na-enye ohere ọdịiche nke spasm nke sphincter nke Oddi na hyperkinetic gallbladder dyskinesia na ọrịa ndị ọzọ. Ọmụmụ ihe ahụ na-ekpebi dayameta nke ihe na -eme ka ihe dị n'ihu tupu yana mgbe ule nnwale na-aga. A na-emekwa manometry Sphincter, ebe nyocha nyocha bụ mmụba nke mgbali elu karịa 40 mm Hg. Art. Ọzọkwa, ka a na-eme manometry, oge dị iche iche na-ebute ihe mgbapụta nke sphincter, a ga-aza nzaghachi mmekpa ahụ maka mkpali cholecystokinin, na-ezighi ezi mgbazigharị ezighi ezi.

Ihe ozo ozo maka ihe nlere nke sphincter bu hepatobiliscintigraphy di ike na mmebi cholecystokinin. Nsonaazụ nke usoro nchọcha a na 100% na-arụpụta na nsonaazụ ndị a nwetara na nyocha nke manometry, ebe enweghị mmetụta ndị metụtara njiri mara ọrịa nchọpụta. Iji wepu ihe eji achọ ihe, a na - eme plọg nke na - adịkarị na sote dupe mgbe cholecystectomy nke calculi, yana iji nweta bile, a na - eme endoscopic retrograde cholangiopancreaticography.

A na-ejikwa nchọpụta dịgasị iche na cholecystitis na-enweghị atụ, stenosis nke bile ma ọ bụ ntụgharị akwara, na usoro akpụ. Mgbe a na-achọpụta ọrịa a, ekwesịrị iburu n'uche na spasm nke sphincter nke Oddi na-ejikọkarị ya na ọrịa ndị ọzọ na-esite na eriri afọ gastrointestinal, ọgbụ afọ na -akpọ, na ọrịa afọ mgbu.

Ọgwụgwọ spasm nke sphincter nke Oddi

A na-eme ọgwụgwọ nke usoro a na outpatient, mana mgbe ụfọdụ enwere ike ikwupụta ihe mgbu, enwere ike ịga ụlọ ọgwụ na ngalaba eriri afọ iji wepụta ihe ọghọm na oghere ime ma na-eduzi nchọpụta. Isi ihe na ọgwụgwọ maka spasm nke sphincter nke Oddi bụ izu ike nke akwara ya, ahụ efe nke ihe mgbu, nhazi nke ihe ọ ofụ ofụ na-egbu egbu na mmiri ọ pancụ pancụ. Usoro ọgwụgwọ nri bụ mwepu nke abụba na nri ụtọ, ngwa nri, galiki na eyịm. Ọ dị mkpa ka ịhazigharị ogo anụ ahụ, yana kwụsị ị smokingụ sịga.

Iji kpochapụ spasm nke sphincter nke Oddi, nitrates, anticholinergics (metocinium iodide), ndị na-egbochi calcium Channel (nifedipine). N'ihi eziokwu ahụ bụ na ọgwụ ndị a nwere mmetụta ndị ọ na-akpata, yana mmetụta akwara ọ bụla, ọ ga-adị mma ka ị jiri ha mee ihe na obere usoro. A na-ejikwa ọgwụ antispasmodics (papaverine, pinaveria bromide, drotaverine), mebeverin nwere nhọrọ zuru oke maka sphincter nke Oddi. Iji wepu spasm, mepụta nsonaazụ choleretic, belata ezughi oke biliary, a na-enye gimecromon.

Na-enweghị nsonaazụ kwesịrị ekwesị site na nlekọta nchekwa, nlọghachi ugboro ugboro mgbu na pancreatitis, a na-eme ọgwụgwọ ịwa ahụ: endoscopic sphincterotomy, ọgbụgba balloon na-adịru nwa oge, stenting nwa oge. Dịka usoro ọzọ, a na-eji njikwa nke nsị botulinum n'ime sphincter.

Amụma na mgbochi nke spasm nke sphincter nke Oddi

Prognosis maka spasm nke sphincter nke Oddi dị mma. N'ọnọdụ ka ukwuu, ọgwụgwọ nchekwa ogologo oge zuru oke na-enye ohere maka nkwado ahụike na-adịgide adịgide; ọ bụrụ na ọnweghị ya, sphincterotomy nwere mmetụta na-eju afọ. Onweghi ihe mgbochi doro anya nke spasm nke sphincter nke Oddi. Ọ bụ ihe amamihe dị na nri nri, na-ebulikwa ezigbo ahụ ike, ọgwụgwọ oge ọrịa ndị ọzọ nke eriri afọ.

Ofdị ọrịa ahụ

Ihe etioloji di iche na ndi a:

• izizi (na-etolite na-enweghị oria na mbụ),
• nke abụọ (nke sitere na ọrịa na-akpata ọrịa).

Ọnọdụ ọrụ:

• dyskinesia nwere hyperfunction,
• dyskinesia nwere hypofunction.

Iji wepụta ụdị sphincter nke Oddi nwụsịrị dabere na ebumnuche ebumnuche n'oge nnọkọ Rome (1999), a tụrụ aro nyocha.

• ọgụ mgbu gboo
• ọ dịkarịa ala, mmụba okpukpu abụọ na ọkwa nke enzymes imeju (AST, alkaline phosphatase) na opekata mpe abụọ,
• na-agbada mkpochapụ nke ihe dị ka nkeji iri anọ na ise n’oge endoscopic retrograde cholangiopancreatography,
• Mgbasawanye nke dule bile na 12 mm ma ọ bụ karịa.

Ddị dysfunction kpebisiri ike dabere na njirisi:

1. Biliary I - mara nke ọnụnọ akara niile a dị n'elu.
2. Biliary II - mwepu oge ochie nke ihe mgbu na njikota akara 1 ma obu 2.
3. Biliary III bụ ọrịa mgbu dịpụrụ adịpụ na enweghị ọrịa ndị ọzọ.
4. Ihe ojoo (pancreatic) - ihe mgbu nke akwara nke usoro mkpali na pancreas (yana mgbakwunye na ọkwa nke enzymes pancreatic).

Ihe onyonyo onyonyo nke sphincter nke Oddi dysfunction di iche:

• ihe mgbu na mpaghara epigastric, na nri hypochondrium nke mgbawa, ọdịdị adịghị mma, mgbe ụfọdụ - ọgbụgba, nke dị mkpụmkpụ, kpalitere site na njehie na nri, oke ume mmụọ, mgbalị anụ ahụ. Mgbu nwere ike inye ike dị mma, ubu, azụ, na ụdị pịrị apị, ha bụ nnukwu ọrịa herpes zoster,
• obi ilu n’onu
• ọgbụgbọ, vomiting nke bile,
• bloating, ihe mgbu na mpaghara eriri nwa,
• ihe afọ ntachi,
• ike ọgwụgwụ,
• mgbakasị ahụ
• nsogbu ịrahụ ụra.

Ọrịa mgbu ahụ bụ paroxysmal na okike, n'ọtụtụ oge enwere mkpesa na oge interictal.

Site na dysfunction nke sphincter nke Oddi, mmiri nke bile na pancreatic secretion na-enwe nkụja, itinye ha na usoro nke nri nri na-apụta na-ezighi ezi, nke na-eduga n'ọrịa dị iche iche nke usoro nri.

Nsogbu na nsonaazụ nwere ike ime

Otutu ihe dysfunction of the sphincter nke Oddi nwere ike ibu:

• cholangitis
• ọrịa gallstone
• ọria aru
• gastroduodenitis.

Amụma ahụ dị mma. Site na iji ọgwụ oge a malitere, a ga-ekpughe mgbaàmà nke ọrịa ahụ na obere oge. Irè ịgwọ ọrịa ọgwụ karịrị 90%.

Mmụta: elu, 2004 (GOU VPO “Kursk State Medical University”), ọpụrụiche “General Medicine”, ntozu “Dọkịta”. 2008-2012 - Nwa akwukwo PhD, Ngalaba nke Pharlọ ọgwụ Clinical, SBEI HPE “KSMU”, nwa akwukwo nke sayensị ọgwụ (2013, ọpụrụiche “Pharmacology, Clinical Pharmacology”). 2014-2015 - ọkachamara eweghachi azụ, ọpụrụiche “Njikwa na agụmakwụkwọ”, FSBEI HPE “KSU”.

A chịkọtara ma nye ya maka ebumnuche ọhụụ. Lee dọkịta gị na ihe ịrịba ama mbụ ọrịa. Medication medicationụ onwe gị ọgwụ dị ize ndụ nye ahụ ike!