Isi njikọ dị na pathogenesis nke ọrịa pancreatitis nke nnukwu

Dabere na V.S. Savelieva et al., 2001

Mkpali nke nzuzo + na-akpata

Nchighari nke trypsinogen na trypsin:

Ndabere nke pathogenesis nke nnukwu pancreatitis bụ usoro nke mpaghara na mmetụta nke enzymes pancreatic na cytokines nke ọdịdị dị iche iche. A na-ahụta usoro ọmụmụ enzyme na ọrụ bụ isi nke trypsin na pathogenesis nke ọrịa a bụ nke kachasị. Njikọ nke ọtụtụ ihe na - akpata nsogbu n'ime polyetiology nke nnukwu pancreatitis bụ isi ihe na - akpata intacinar nke enzymes proteolytic na mgbaze autocatalytic. N'ime cytoplas nke mkpụrụ ndụ acinar, a na-ahụ ntụpọ nke zymogenic granules na lysosomal hydrolases (“colocalization theory”), n'ihi nke proenzymes na-arụ ọrụ na ntinye nke na - esote ọgwụ nchebe na ntanetị. Ntinye nke trypsinogen na ngbanwe ya n'ime trypsin bụ onye na - eme ka ihe niile proenzymes dị ike na --eme ka ihe na - eme ka ihe na - egbu ihe na - egbu ngwa ngwa. Ihe kachasi mkpa na pathogenesis oria a bu nnabata nke enzyme, usoro mbu bidoro mebiri emebi membranes na emegharia nke mmekorita ncheta.

Otu ezigbo usoro nke pathogenesis nke ọrịa akwara na - emerụ ihe metụtara akụrụngwa acinar bụ ngbanwe nke mkpụbe kalsel dị na sel na karịa, nke na-eduga na mmegharị nke trypsin. Site na ịbawanye ụba nke ion kalsel dị na sel, a na-amalite njikọ intracellular nke ihe na - eme ka platelet (onye bụ onye mgbasa ozi isi na - akpata nsogbu).

Otherzọ ndị ọzọ esi arụ ọrụ nke sistem enzyme na pancreas: ahaghị n ’usoro enzyme-inhibitor system ma ọ bụ ụkọ nke trypsin inhibitors (alfa-1-antitrypsin ma ọ bụ alfa-2-macroglobulin), na-etolite megide nzụlite nke mmụkọ nke usoro ihe kwekọrọ.

Trypsin bụ onye na-ebute ụzọ nke cascade nke mmeghachi ahụ dị egwu, mana ogo nke mmeghachi omume bụ ihe kpatara nsonaazụ nke usoro enzyme niile pancreatic (trypsin, chymotrypsin, lipase, phospholipase A2, elastase, carboxypeptidase, collagenase, wdg).

Enzymes pancreatic na-arụ ọrụ na-arụ ọrụ dị ka ihe ndị bụ isi nke oke iwe, nwee mmetụta mpaghara, banye na oghere retroperitoneal, oghere ime, site na akwara portal n'ime imeju, yana site na akwara lymphatic banye na mgbasa usoro. Phospholipase A2 na-ebibi mkpụkọ nke mkpụrụ ndụ, lipase hydrolyzes intracellular triglycerides na abụba abụba, nke, mgbe ejikọtara ya na kalsel, mejupụtara akụkụ nke abụba (lipolytic) na pancreas, eriri nke oghere retroperitoneal na peritoneum. Trypsin na chymotrypsin na-akpata proteinolysis nke protein anụ ahụ, elastase na-emebi mgbidi arịa na akụkụ akwara njikọ, nke na-eduga na mmepe nke necrosis hemorrhagic (proteolytic). Ọkpụkpụ nke necrobiosis, ụbụrụ necrobiosis, nke nwere mpaghara ịlaghachi azụ nke mbufụt na akwara na akụkụ ahụ bụ ihe na - ebido ebido.

Njikọ dị mkpa na pathogenesis nke nnukwu ọrịa ọrịa pancreatitis bụ trypsin na-agbalite usoro kallikrein-kinin na ịmepụta usoro ihe ike nke abụọ: bradykinin, histamine, serotonin. Nke a bụ mmụba nke vaskụla permeability, microcirculation ntị, nguzo nke edema na pancreas na oghere retroperitoneal, mụba ụba na elu apịtị n’ime.

Ihe ihe ike nke atọ metụtara na pathogenesis nke mmeghachi omume mbufụt nke mpaghara na systemic, microcirculatory na sistemụ hemodynamics, akwara na okuku ume, gụnyere mkpụrụ ndụ mononuclear, macrophages na neutrophils nke ndị mgbasa ozi mkpali dị iche iche (cytokines): interleukins 1, 6 na 8, necrosis factor akpụ akpụ, ihe na - eme ka platelet dị na ya, ụdị ọgwụ phospholipase A2 na - emeghị ka ọ bụrụ ọgwụ, prostaglandins, thromboxane, leukotrienes, nitric oxide.

Proinflammatory cytokines gụnyere: tumor necrosis factor, interleukins 1-beta na 6, yana ndị na - egbochi mkpali - interleukins 1 na 10. Na mmalite nke ọrịa ahụ, ntinye nke ndị mgbasa ozi niile na - akpata mkparịta ụka na ngụgụ, umeji, ngụgụ, spleen na sistem sistem na - abawanye, nke na - akọwa usoro mmepe. mpaghara, anụ ahụ na mmeghachi omume mkpali.

Enzymes, cytokines na metabolites nke ọdịdị dị iche iche, nke etolite n'oge nnukwu ọrịa pancreatitis na pancreas, oghere retroperitoneal, eriri afọ na lumen nke eriri afọ, na-abanye n'ọbara ngwa ngwa na site na oghere thoracic lymphatic banye na sistemu sistemu na mmepe nke toxinemia. Akụkụ ndị mbụ a na-achọ ụzọ ha na-esite na oghere nke ime mmụọ ruo na akụkụ ahụ dị na mpaghara imeju bụ imeju na ume, obi, ụbụrụ na akụrụ. Nsonaazụ mmetụta siri ike nke cytotoxic nke mmiri ọgwụ ndị a na mmalite ọrịa bụ mmepe nke ujo pancreatogenic na otutu ahụ na-ekpebi ogo ọnọdụ onye ọrịa na ọrịa pancreatitis.

Na pathogenesis nke nsogbu usoro, tupu mmepe nke nsogbu nsogbu septikasị, toxinemia nke nje na karịa, lipopolysaccharide nke sel nke mkpụrụ ndụ na-adịghị mma (endotoxin), nke emepụtara na lumen nke eriri afọ site na microflora eriri afọ, bụ ihe dị mkpa. Na nnukwu pancreatitis, mmegharị nke microflora endogenous na endotoxin nke nje bacteria na-emetụta mkpụrụ ndụ na-apụta n'okpuru otu ọnọdụ nke arụ ọrụ (obere morphological) ọdịda nke metabolic na mgbochi nke eriri afọ, usoro reticuloendothelial nke imeju na ngụgụ.

Ntughari nke microflora endogenous site na eriri afọ n'ime eriri afọ na oghere retroperitoneal bụ njikọ kachasị na pathogenesis nke pancreatitis na-emebi emebi. Usoro a bụ njikọ ejikọtara na mbido, “mbido” (nke butere ọrịa), na nke sochiri, “mbubreyo” (septic), usoro nke nnukwu ọrịa a na-eme.

Na pathogenesis nke nnukwu ọrịa pancreatitis, a na-amata usoro abụọ bụ isi. Oge mbu bụ n'ihi nhazi nke mmeghachi omume n’oge mbụ site na mmalite nke ọrịa ahụ, mgbe mbufụt, autolysis, necrobiosis na necrosis nke pancreas, anụ ahụ retroperitoneal bụ aseptic. N'okpuru ọnọdụ ndị a, n'izu mbụ nke ọrịa ahụ, dabere na nkwarụ ọrịa pathomorphological, ịmepụta usoro ndị na-eso nke nnukwu pancreatitis ga-ekwe omume:

ya na necrobiosis, mbufụt na delimitation nke usoro ahụ, nnukwu ọrịa metụtara pancreatitis nke ukwuu (ụdị edematous),

ya na necrosis na-egbu egbu ma ọ bụ ọbara ọgbụgba - necrotic pancreatitis sterile.

Ọnọdụ nke onye ọrịa nwere nnukwu ọrịa ọrịa pancreatitis bụ n'ihi pathomorphology nke ọrịa na ọrịa pancreatogenic toxinemia, ujo nke pancreatogenic na otutu akụkụ ọdịda. Site na usoro ọgwụgwọ oge, enwere ike ịkwụsị usoro pathological na ogbo nke ọrịa pancreatitis, ebe n'ọnọdụ dị iche, ọ na - aghọ ọria akwara.

Site na ngbanwe nke ọrịa ahụ na nsonaazụ na akwara nke pancreatic, usoro ahụ na - agafe na mpaghara nke abụọ (septic) nke nnukwu pancreatitis, nke metụtara ọrịa nke mpaghara nke necrosis nke nsonye dị iche iche na izu nke 2-3 nke ọrịa ahụ. N'okpuru ọnọdụ ndị a, nrụgharị na mịpụta nke ndị ogbugbo dịka agba nke mbụ na-ewere ọnọdụ, ihe na - akpalite ya bụ nsị nke ụmụ ahụhụ na - eme ka mpaghara necrosis. Na nje na-efe efe nke ọrịa ahụ, ajọ ihe mmekpa ahụ bụ ihe nrịba ama ọhụụ na -emepụta ụdị ọrịa nje a na-egbu egbu na afọ na-enwe ọfụma na akwara nke ukwuu. Ogologo oge ọrịa na pancreatic necrosis bụ 30-80%, nke kpebisiri ike site na njupụta nke pancreatic necrosis, oge nke mmalite nke ọrịa ahụ, ọdịdị nke ọgwụgwọ mgbanwe na usoro nke ọgwụgwọ ịwa ahụ. Ekwesịrị ịtụle mmepe nke ọrịa necrosis dị ka akụkụ dị mkpa na mmalite nke usoro pathomorphological.

Enwere njikọ dị n'etiti ogo nke ọrịa ọnya akwara na ohere nke ọrịa. A na - achọpụta ụdị ọrịa necrosis na onye ọrịa anọ ọ bụla na izu mbụ nke ọrịa ahụ, ihe fọrọ nke nta ka ọ bụrụ ọkara nke ndị ọrịa na - ata ahụhụ na pancreatic necrosis na izu nke abụọ, na onye ọrịa ọ bụla nwere ọrịa na - emebi emebi n'ime izu nke atọ na nke anọ site na mmalite nke ọrịa.

Ndị na - ahụkarịkarị ihe na - ebute ọrịa ọrịa pancreatogenic: E. coli (26%), Pseudomonas aeruginosa (16%), Staphylococcus (15%), Klebsiella (10%), Streptococcus (4%), Enterobacter (3%) na Anaerobes. Ọrịa Fungal na-etolite mgbe izu abụọ ma ọ bụ karịa sitere na mmalite nke ọrịa akwara nke pancreatic, nke bụ n'ihi oge nke ọgwụgwọ ọgwụ gara aga.

A na - ebute mbufụt nke akụkụ adịghị adị nke ọrịa akwara na - akpata site na mmetọ nke microflora ifetọ nke endogenous (colon) na exogenous (na onye ọrịa ahụ na - arụ ọrụ site na nsị na tampons site na gburugburu ngalaba nlekọta ahụike).

Akuko mbu nke banyere oria akwara

1641 - Dọkịta Dutch van Tulp N. (Tulpius) bụ onye izizi lere ọrịa akwara nke akpa ume.

1578 - Alberti S. - Nkọwa nke mbụ nke nlele ngalaba nke nnukwu ọrịa ọgbụgbọ na-efe efe.

1673 - Greisel bụ onye mbụ kọwara ọnọdụ ikpe gbasara ọrịa akwara na - akpata ọnwụ n'ime awa 18 mgbe mmalite nke ọrịa ahụ ma gosipụtara site na ijiji.

1694 - Diemenbroek I. hụrụ nje nke ọrịa nje na - egbochi necrosis na onye ahịa si Leiden nke butere ọrịa purulent.

1762 - Stoerk kọwara nkọwapụta onyonyo ọria “arịa ọbara ọbara n'ọbara.

1804 - Nkwupụta banyere ọrịa akwara na-apụ n'anya.

1813 - Perival hụrụ ikpe gbasara nnukwu akwara anụ ahụ.

1830 - Rekur gosiputara obodo ahụike ahụ nkwado nke nwere ọtụtụ ọgịrịga.

1831 - Lawrence bipụtara nlebara anya banyere ọrịa n’akwara ọbara.

1842 - Claessen bu ụzọ mara nnukwu ọrịa pancreatitis

1842 - Karl Rokytansky mụrụ banyere ọrịa pathologies nke ọrịa mgbu na-efe efe

1864 - Otu aka bipụtara akwụkwọ ntụzịaka izizi na Paris.

1865 - Karl Rokytansky gụrụ akwụkwọ n'ụzọ zuru ezu banyere akparamaagwa nke ọnya na-efe efe.

1866 - Spiess kọwara okwu banyere ọnwụ site na “oke ọgbụgba ọbara” na akwara.

1867 - Luke na Klebs bụ ndị buru ụzọ rụọ ọrụ mgba okirikiri nke plọg ụgha, mana onye ọrịa ahụ nwụrụ n'oge adịghị anya.

1870 - Klebs - ọkà mmụta banyere ọrịa ọrịa America mepụtara nkewa mbụ nke nnukwu ọrịa ọrịa pancreatitis, nke mechara nwee ihe ịga nke ọma na ọrụ nke ọtụtụ ndị na-eso ya ọ mere naanị mmezi.

1874 - Zenker kọwara “apoplexy” nke pancreas.

1881 - Tirsh na Kulenkampf tụrụ aro ka agbapu mmiri nke necrotic cysts.

1882 - Bozeman onye America na-awa ahụ nke ọma wepụrụ cystreatic cyst nke na-eme ka ọpụpụ nke oke akwa nke nwanyi.

1882 - Balser mere ọmụmụ gbasara akwara ozi gbasara necrosis na nnukwu pancreatitis.

1882 - Gussenbauer choputara ihe na-eme pulostomy ugha ma megharia onyunyo (marsupialization) nke oma site na enweghi ike imechi ya n'ihi na idi nso na nnukwu arịa.

1886 - Miculicz tụpụtara ịba ọcha n'anya nke ọria akwara nke akwara.

1886 - onye America na-awa ahụ Senn tụpụtara ọgwụgwọ nke ịwa ahụ, dịka Ekwenyesiri m ike na ntinye ịwa ahụ ga-emetụta nsonaazụ nke ọrịa ahụ na ọrịa akwara na-akpata akwara.

1889 - Reginald Fitz, onye ọkachamara n'ọrịa na Hospitallọ Ọgwụ Massachusetts dị na United States, tụrụ aro maka nhazi nke mbụ, nke gụnyere ụdị ọrịa mgbu mmadụ ise. Ọ kwadoro nkwado ịwa ahụ mberede, nke ọ nwere nkụda mmụọ n'oge na-adịghị anya, na-ekwupụta na "ịwa ahụ n'oge adịghị arụ ọrụ ma dị ize ndụ."

1890 - Edepụtara akwụkwọ izizi maka ọgwụgwọ ịwa ahụ nke ọrịa pancreatic (Braun).

1894 - E buru ụzọ kwuo banyere nsogbu nke nnukwu ọrịa ọrịa na nzukọ ndị dọkịta na-awa na Germany, ebe Kerte tụpụtara ụzọ maka ịwa ahụ mberede.

1895 - A na-ebipụta akwụkwọ ndekọ mbụ nke nje ihe gbasara akwara na-arịa oria n’akpori ọrịa (Diekhoff).

1896 - Ọrịa Ọrịa Ọrịa Austrian Chiari H. tinye echiche maka mkpa "mgbaze onwe" na mmepe nke pancreatic necrosis na parapancreatic adipose anụ ahụ.

1897 - onye Russia na-awa ahụ Martynov A.V. agbachitere akwụkwọ mbụ Russia na ọrịa na-efe efe. N'ịkọwa ihe isi ike na ịchọpụta ọrịa pancreatitis, ọ dere, sị: "Mgbe ị na-achọpụta nnukwu ọrịa ọ bụla," njehie bụ iwu, ebe nchọpụta ziri ezi bụ ihe dị iche. " A. Martynov kpọrọ ogbo nke ọrịa ọrịa metụtara ọria, “oge ịmara akụkụ ọria nke ọrịa”.

1897 - Hale-White N.N. bipụtara nkwupụta gbasara nyocha ụlọ ọgwụ Guy na London, nke gụnyere nyocha 142 nke ọrịa dị iche iche nke pancreas na ihe fọrọ nke nta ka ọ bụrụ mgbanwe dị iche iche nke mgbanwe ọrịa na parenchyma na ducts nke akụkụ a.

1899 - Razumovsky gosipụtara nke ahụ, n'agbanyeghị eziokwu ahụ na nsonaazụ na-egbu egbu na-anọchite anya njedebe nke ọbara ọgbụgba na-apụtakarị, “n'ọnọdụ a maara, enwere ike ịgbake.”

1900 - Bessel-Hagen tụpụtara ọria mmiri nke cystogastrostomy.

1901 - Opie E. L. na Halsted W. S. rụtụrụ aka na mmekọrịta etiopathogenetic dị n'etiti cholelithiasis na hemorrhagic pancreatitis, na-etolite "usoro ọwa na-ahụkarị."

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Ihe na-akpata pancreatitis

Na 80% nke ikpe, ihe dị iche iche nke mmalite nke ọrịa ahụ bụ ị abuseụbiga mmanya ókè, ọrịa nke gallbladder na ducts. Na 45% nke ikpe, a na-achọpụta na etolite ọnya afọ na-akwalite site na choledocholithiasis, cholelithiasis, mkpakọ nke ọwa nwere cysts na etuto ahụ, ọrịa eriri afọ.

Ọrịa ọ bụla a na-agakọta nwere ihe ndị na-akpata ya. Agbanyeghị, ha niile na - eduga na nhụsianya nke ọria.

Ihe ndị na - ebute isi na pathogenesis nke pancreatitis bụ: ihe isi ike na mwepu nke enzyme nke pancreatic site na mmiri. Ya mere, ọgwụgwọ nke ọrịa na-amalite site na ọgwụgwọ nke ọrịa niile na-efe efe.

Usoro etiology nke nnukwu pancreatitis bụ ihe metụtara ya na ị withụbiga mmanya ókè. N'okwu a, usoro nke mmepe nke ọrịa bụ dysfunction nke ọwa mmiri na ọnya afọ.

Ihe ọ Alụcoụ na-egbu egbu na-eme ka mmadụ nwekwuo mmiri ara, na-eme ka mwepu ahụ na-enwetụ karịa viscous.Nke a na - eme ka nrụgide dị na ọwa dị elu, nke na - eduga n'ị intoụbiga pancreas, na - akpaghasị njikọ enzyme na ya ma na - eme ka usoro metabolic dị na imeju ghara ịdị.

A na-ahụta ihe ọzọ na - akpata pancreatitis dị ka ihe na-edozi ahụ. N'okwu a, ọria na-ebilite mgbe mmadụ mebiri anụ, oke abụba na nri eghe.

O bu ihe na - adighi adi, oria a na - ebute oria a na - ebute oria a na - ebute ihe ndi ozo.

1. nje na-efe efe (mumps, coxsackie virus, ịba ọcha n'anya),
2. mkpụrụ ndụ ihe nketa (cystic fibrosis),
3. nje (mycoplasma, campylobacter),
4. ọnya afọ,
5. mmerụ ahụ
6. ọrịa ịmụ nwa nke mkpụrụ ndụ,
7. ị medicationsụ ọgwụ (estrogens, corticosteroids, diuretics, azathioprine),
8. nsogbu metabolism kpatara ọnụnọ nke ọtụtụ ọrịa (vasculitis, ọrịa shuga, ọrịa AIDS).

Ọrịa akwara na-etolitekwa n'ihi nsonaazụ ịwa ahụ a rụrụ na pathology nke pancreas na bile ducts. Mmerụ ahụ ahụ nwere ike ime n’oge nrụrụ aka zuru oke, endoscopy, prosthetics, papillotomy, na ụdị arụmọrụ ndị ọzọ.

Ọria pania na-esochi ya bụ nsogbu nke ịwa ahụ. Ọ na - ebute mbibi nke gland na ọbara mgbali elu ha.

Ọrịa na - ebute oke ụjọ na - akpata mmerụ ahụ na - akpata mwakpo helminthic (ọrịa ascaris), hyperparathyroidism (ọrịa parathyroid) na nsonaazụ nke organophosphate.

Ihe ndị ọzọ na - apụtaghị maka ọdịdị nke ọrịa ahụ gụnyere ụta na akpukpo mmiri na ischemia nke ọdọ mmiri mesenteric artery thrombi.

Pathomorphogenesis

Pathomorphogenesis nke nnukwu ọrịa pancreatitis na-abụkarị nke usoro na / ma ọ bụ mgbanwe mmekọrịta na usoro nke mbufụt, necrobiosis, necrosis na ọrịa na mpaghara anatomical dị iche iche. A na - ahụkarị ihe dị iche iche mebiri akụkụ akụkụ nke pancreas na / ma ọ bụ azụ na - adịkarị iche: site na edema ma ọ bụ microscopically achoputara echiche nke steatonecrosis na pancreas (ya na ọrịa dị nwayọ) gaa na mpaghara anya abụba na / ma ọ bụ ọrịa akwara n’akwara na - emetụta ọnya azụ (retroperitoneal tissue) , oghere, ogwe ala) na akụkụ afọ.

Nkọwa ziri ezi nke mgbanwe nke ọrịa necrosis. Dabere ogo usoro necrotic dị na pancreas na oghere retroperitoneal, nkịtị na amachaghị n'ụdị nke necrosis.

Na Ọkpụkpụ akwara na-agbasa enwere necrosis nke ihe karịrị otu ngalaba nke pancreas na ntinye aka na usoro pathological nke eriri parapancreatic na mpaghara ndị ọzọ nke oghere retroperitoneal (parietal, paranephral, ​​obere pelvis).
Na necrosis nke anakpo na pancreas, obere (ihe ruru 1 cm) na / ma ọ bụ buru ibu (> 1 cm) a na-ahụta akwara nke necrosis na mbibi n'ime otu akụkụ nke pancreas na mpaghara kwekọrọ na eriri parapancreatic. N'ụzọ dị iche n'ụdị usoro akwara nke pancreatic necrosis, mbibi necrotic na mbufụt perifocal na-abụkarị nke a kpaara ókè nke mpaghara parapancreatic.

Dabere na ụdị dị iche iche nke enzymes acinar nke acinar, pancreatic necrosis na-etolite proteolysis (hemorrhagic necrosis) yana lipolysis (necrosis fat) nke pancreas na abụba retroperitoneal. Oge mmepe nke ụdị sistemụ necrotic (necrosis na-agakọ) bụ njiri mara.

Ọbara akwara nke neprosis na-enwe otutu ngosipụta dị egwu. Na akwara na anụ ahụ gbara ya gburugburu, a na-ahụ ebe buru ibu, ọbara ọgbụgba, mpaghara na-agba oji na / ma ọ bụ isi awọ. Eriri nwa n’ime ya nwere nnukwu ọbara ọgbụgba na arụ ọrụ enzymes na bekee.

N'ihi na abụba A na - amata ihe akwara puru iche na - eme ka mmerụ ahụ ya dị, na - adịwanye ala, ma ọ bụ na - eme ka ọ bụrụ akwara na - ewe iwe na akwara, na mkpo ya, ma na - agbasa ya. N'ime oghere dị n'ime afọ, enwere ike ịchọpụta ihe ngwa ngwa exudate.

Maka nrịanrịa necrotic pancreatitis, mgbanwe nke mpaghara nke necrobiosis na necrosis nke pancreas na retroperitoneal fiber, na-agbatị oge na iche iche n'ụdị nke pathomorphology, bụ ihe kacha pụta ìhè na oge niile.

N'ime usoro oria na-efe efe nke ọrịa, mmepe nke nsogbu akwara post-necrotic ga-ekwe omume. Gburugburu akụkụ nke steriiki necrosis dị n’ime akwara na / ma ọ bụ n’akụkụ ọ bụla nke anụ ahụ na - emegharị ahụ, ihe ana --eme ka akụkụ ahụ dị ya n’afọ (afọ, duodenum, omentum, splin, imeju), mesịa nke nnukwu na obere eriri afọ. Na mpaghara pancreas pụtara parapancreatic infiltratena mpaghara parietal na paranephral na akwara nke pelvis, infiltration anụ ahụ na - amalite gburugburu ntụpọ nke necrosis na necrobiosis, nke kwekọrọ na foto a necrotic (aseptic) phlegmon Oghere cellular kwekọrọ.

Akụkụ abụba nke necrosis n'okpuru ọnọdụ aseptic anaghị agbaze ma ọ bụghị ihe na-egbu egbu, mana mgbe emesịrị (mgbe izu 3-4 gasịrị) ọ na - adị mfe ịgbachi nkịtị, nke na-eduga na ịkpụzi pseudocysts. Site na izu nke abụọ nke ọrịa ahụ, mgbanwe ọzọ nke necrosis na-agakọ yana ịmepụta obere ọgịrịga nke nwere oke detritus-like.

N’iche na abụba mejupụtara necrosis, ihe metụtara ọbara nke na - esite n’ọkpụkpụ azụ azụ bụ ihe ịtụnanya na - agbaze ngwa ngwa na mmepe nke ihe ana - akpọ degenerative phlegmon, nke na - eso ya (usoro buru ibu) na usoro nke pseudocysts.

Ofzọ mmepe nke ụdị ụdị ọrịa pancreatitis ndị ọzọ

Nhazi nke pancreatitis gụnyere ụdị ọrịa dị iche iche. Ha pathogenesis nwere ike ịdị iche iche. Yabụ, ụdị mbufụt nke gland na-adịkarị mgbe mkpụrụ nke akwara guzobere n'ụdị akwara mmiri (carbonic na phosphoric lime).

N'ihe anya, nke ikpeazụ yiri obere okwute ma ọ bụ aja aja na-acha ọcha. Na mgbanwe ọrịa na - amalite na akwara, ebe akwara na-agbakọ, na-esite site na mbufụtụ na mmụba nke maịlị ahụ.

Usoro pathogenesis nke ụdị ọreatụ pancụ na-egbu egbu nke pancreatitis bụ na mmanya na-abawanye ụda nke sphincter nke Oddi. Nke a na - egbochi mmụcha nke exocrine ma mepụta ọbara mgbali elu n'ime obere akwara. Mmanya nwere ọtụtụ mmetụta ọjọọ ndị ọzọ:

1. Na-akwalite ntinye nke enzymes n'ime gland, nke na-akpali enzymes proteolytic ma na-akpali akpaaka sel nke mkpụrụ ndụ.
2. Na-eme ka nzuzo mmiri ọ gastụ gastụ na-egbu egbu na hydrochloric acid, nke na-abawanye secretion, nke na-akpasu hyperecretion exocrine.

A na - ejikọta pathogenesis nke biliary pancreatitis na mmegharị nke bile na ihe ọ pancụleụ pancreatic. Usoro ndị dị otú a na-amalite mgbe nrụgide bilitere na duodenum na ọnya biliary. Site na nke a, akọwapụtara ọrịa ahụ dịka usoro mkpali na-adịghị ala ala nke mebiri imeju na ọnya biliary.

Enwere ike ime ya na biliary pancreatitis site na mgbanwe mgbanwe morphological na-eme na sphincter nke Oddi ma ọ bụ paodenal papilla. Ọrụ trypsin na - akwalite nyocha nke parenchyma na mgbaze onwe ya.

N'ihi ụdị ọrịa a na-emetụta ọrịa, akụkụ nile nke ọrịa gland jupụtara na anụ ahụ na-eme ihe. Ọ bụrụ na ọgwụgwọ enweghị oge, akụkụ ahụ akwụsịla ịrụ ọrụ.

Ọrịa dị iche iche sitere na mkpụrụ ndụ ihe na-ebilite mgbe mkpụrụ ndụ ihe nketa na-agbanwe agbanwe, nke a na-eketa. Ọdịda ahụ na-apụta mgbe ejiri valine dochie amino acid leucine.

Ọzọkwa, ọrịa akwara na-esite n'ụmụ sel ndị ọrịa trypsin na-eso. N'ihi ya, ngba a na - amalite itughari akwara nke ya.

Allergicdị nfụkasị nke ihe puru iche na-aputa ihe n’etiti ndi n’enwe oria oge rhinitis, urticaria, ma obu ukwara umechi. Usoro mmepe nke ụdị ọrịa a sitere na omume nke mmeghachi omume nfụkasị na-apụta na usoro atọ:

• uche anụ ahụ,
• guzobe ọgwụ mgbochi ọrịa na pathogen,
• mmebi nke anụ ahụ nke parenchymal gland.

Mmepe nke usoro autoimmune na-enye aka n'ọtụtụ ihe na mgbanwe. Ya mere, pancreatitis nfụkasị nwere usoro mgbagwoju anya nke pathogenesis.

Ọrịa na ọgwụgwọ nke pancreatitis

Ọrịa pancreatitis kachasị mfe iji chọpụta mgbe ọ mere na mpaghara oke. N'okwu a, a na-ekwukarị banyere nyocha ụlọ ọrịa ahụ.

Ihe mgbaàmà nke mgbu na-efe efe bụ ihe mgbu na-adịgide adịgide na epigastrium, na -emekarị hypochondrium nke aka ekpe, n'ihi nke onye ọrịa ahụ nwere ike nwetakwa mmụọ. Ahụ erughị ala na-abawanye mgbe onye ọrịa dina ma ọ bụ rie nri.

Na mgbakwunye na mgbu, pancreatitis na-esonye na ọgbụgbọ, okpomọkụ febrile, ọgbụgbọ na yellowing nke anụ ahụ. Patientsfọdụ ndị ọrịa nwere ọbara ọgbụgba na ọkpọkọ. Ma ndị ọrịa na-eme mkpesa banyere nkụchi obi na flatulence.

Enweghị ọgwụgwọ maka ọrịa mgbu nke nnukwu ọrịa ga-ebute mmepe nke ọtụtụ nsogbu dị egwu - ọrịa shuga, afọ ime, cystic fibrosis, na vaskụla thrombosis. Ya mere, ekwesịrị ịmalite ọgwụgwọ n'ụlọ ọgwụ n'okpuru nlekọta ndị dọkịta.

Ebumnuche bụ isi nke ọgwụgwọ:

1. iwepụ ihe mgbaàmà na-egbu mgbu,
2. mwepu nke enzymes pancreatic na ọbara iyi,
3. nzube nke nri pụrụ iche.

Onye ọgbara ọhụrụ na-echefukarị iwu nke nri dị mma ma zie ezi, nke na-eduga ná nsogbu nri. Ya mere, akụrụngwa dị mkpa na ọgwụgwọ nke ọrịa ọrịa pancreatitis bụ iji hụ na ịdị jụụ nye anụ ahụ nwere ọrịa site na ibu ọnụ na nri. N’ụbọchị mbụ nke ụlọ ọgwụ, onye ọrịa enweghị ike iri ihe ọ bụla, mgbe ahụ ha tinyere ya na akwa mmiri nwere glucose na naanị mgbe ahụ ọ gbanwere nri dị mfe.

Ebe ọ bụ na mgbu na-esochi mgbu, a na-edenye ọgwụ ọgwụ siri ike. Ọzọkwa, a na-enye ndị ọrụ ọgwụgwọ pụrụ iche (Ọdịnaya, Trasilol) ka onye ọrịa ahụ wepụ ya n'ime ahụ na enzymes pancreatic. Ọ bụrụ na ọ dị mkpa, a na-enye ọgwụ mgbochi na nhazi nke kalịnda.

Ọ bụrụ na enweghị ọganihu ọ bụla mgbe otu izu ọgwụ gachara, a na-eme laparotomy. N'oge ịwa ahụ, dọkịta na-awa ahụ na-ewepụ akụkụ ndị nwụrụ anwụ nke akụkụ parenchymal. N'ọnọdụ mberede, na-etolite nke pseudocysts (mkpo nke anụ ahụ nwụrụ anwụ, enzymes) na pancreas, a na-eme mmepu mmiri.

Enyere ozi banyere nnukwu ọrịa pancreatitis na vidiyo ahụ n'isiokwu a.