Ọrịa pancreatitis

Isi ihe na-egosi na ọ na-arịa ọria mgbu, vomiting na flatulence (Mondor Triad).
Mgbu na-apụta na mberede, ọtụtụ mgbe na mgbede ma ọ bụ n'abalị obere oge njehie na nri (ojiji nke eghe ma ọ bụ abụba oriri, mmanya). Mpaghara a na-ahụkarị bụ mpaghara epigastric, karịa otube, nke kwekọrọ na ọnọdụ anatomical nke pancreas. Ebe etiti ihe mgbu dị n’etiti midline, mana ọ nwere ike ịgbaga n’aka nri ma ọ bụ aka ekpe nke midline na ọ gbasaa n’ime afọ. Oge mgbu na –eme ka akwara dị ọnụ wee laa azụ, oge ụfọdụ na azụ ala, obi na ubu, gaa n'akụkụ ọgịrịga ọgịrịga ya. Ha na-abụkarị ihe eji eme ihe n'úkwù, nke na-enye echiche nke eriri ma ọ bụ mkpọchi ụkwụ. Site na mmerụ akwara nke isi akwara, nsonaazụ mgbu ahụ nwere ike ịdị ka nnukwu cholecystitis na-emebi emebi, na-emebi ahụ ya - ọrịa nke afọ na obere eriri afọ, yana mbibi ọdụ ya - ọrịa nke ọnya, obi na akụrụ aka ekpe. N'ọnọdụ ụfọdụ, ọrịa mgbu na-esochi ida na ujo.

Ihe fọrọ nke nta ka ọ bụrụ na ihe mgbu na-apụta ọtụtụ, na-egbu mgbu ma ghara iweta enyemaka vomiting. Ọ na-akpasu iwe banyere mmiri ma ọ bụ mmiri. N'agbanyeghị otutu vomiting, vomit emetụbeghị (fecaloid) ọdịdị.

Ahụ aru n'oge mmalite nke ọrịa na-abụkarị subfebrile. Ahụ ọkụ na-egbu egbu na-egosi mmepe nke nsị na ọrịa dịgasị iche iche nke ọrịa pancreatitis. Dabere n'ịdị njọ nke ihe mgbaàmà mmeghachi omume sistemu, anyị nwere ike kpebie ụdị nke usoro mbibi ahụ ma ọ bụ ọnọdụ ya.

Ihe ịrịba ama dị mkpa na nchọpụta oge ọria nke ọrịa akwara bụ cyanosis nke ihu na aka. A mara Cyanosis n'ụdị violet tụrụ na ihu dị ka mgbaàmà nke Mondor, ntụpọ cyanotic n'akụkụ mgbidi nke afọ (ecilmosis nke eriri nwa) - dị ka ihe ntụgharị ntụ ntụna cyanosis nke mpaghara eriri nwa - Mgbaàmà Grunwald. Na mpaghara ndị ikpeazụ, ọrịa ahụ, hyperemia na-egbuke egbuke dochie anya cyanosis nke ihu. "Kallikrein ihu". Ihe iriba ama edeputara na nsogbu a na –akpata osooso na ọrịa microcirculatory, hyperenzymemia na cytokinokinesis nke na - adighi anagide.

Mgbe ị na-enyocha afọ, chọpụta ya bloating, tumadi na ngalaba elu. N’igbo n’ọkpụkpụ akwara n’ọkpụkpụ, afọ na-emegharị aza, na -emechi anya nke ọma ọbụna site na palpation nke elu. Site na mgbali miri emi, ihe mgbu ahụ na-akawanye njọ, mgbe ụfọdụ ha agaghị edili. Na palpation nke lumbar mpaghara, ọkachasị akụkụ ọgịrịga-vertebral, ihe mgbu na-eme (Mgbaama Mayo-Robson) Na mpaghara hyperensitivity nke palpation na-ahụ anya, a na-ekpughere olu siri ike nke mgbidi ihu, nke na-egosi ọnụnọ nke ọgwụ pancreatogenic, ọgaranya enzymes, na ihe ịtụnanya nke pancreatogenic peritonitis. Ọtụtụ mgbe, a na-ahụ ihe na-egbu mgbu na-egbu mgbu nke oghere ihu nke ime nwa na amụma nke pancreas (Ọrịa Kerte).

Otu n'ime ihe ịrịba ama nke ọrịa pancreatitis na-emebi emebi bụ ihe a na-ahụ anya na ọpụpụ nke ọria akwara n'ihi mmụba nke pancreas na edema nke eriri retroperitoneal. Ihe mgbaàmà Voskresensky.

Mgbe emebere usoro a n'ime akpa nri, a na-ahụta mgbatị akwara tumadi na mpaghara epigastric, yana mgbasa nke mbufe ókè ya (ruo na parietal na anụ ahụ, yana na peritoneum), akpọpụtara esemokwu akwara ma dị mma. Ọrịa Shchetkin-Blyumberg. Ekwesịrị icheta na site n'ịkọwa usoro necrotic na ọdụ nke pancreas, ihe mgbaàmà nke mgbakasị ahụ nwere ike ịdị nro, nke a na-ejikọ ya na ntinye azụ na-enweghị atụ nke usoro ahụ na enweghị peritonitis. Mgbe emetụta isi, ọ na-abụkarị mmepe ngwa ngwa nke ọrịa jaundice syndrome na gastroduodenal paresis.

Uda olu nke uda olu na-egosiputa oghere nke oghere n’afọ. Mgbatị nke afọ na-ekpughere nkụda mmụọ na-akụda mmụọ ma ọ bụ na-enweghị ọnya n'ihi mmepe nke ihe mgbochi akụkụ eriri afọ na ọrịa peritonitis pancreatogenic.

Nyocha ụlọ nyocha

Ngosipụta pụtara ìhè nke ọrịa pancreatitis bụ nsogbu arụ ọrụ nke pancreas, ọkachasị, hyperfermentemia onu. Njirimara nke pathogenesis nke ọrịa pancreatitis kemgbe ọtụtụ iri afọ ejirila ọdịnala mee nchọpụta ọdịiche na ọrịa ndị ọzọ chọrọ ngwa ngwa nke akụkụ afọ. Mkpebi ihe amylase na plasma ọbara (obere oge - lipases, trypsin, elastase) - ọkọlọtọ nchọpụta. Ihe kachasị dị na omume ụlọ ọgwụ bụ mkpebi nke amylase na ọrụ lipase n'ime ọbara. Mmụba dị okpukpu anọ na ọrụ nke ngụkọta na pancreatic amylase na 2pill lipase ikwu na oke nke ụkpụrụ ahụ na-egosi ihe ịtụnanya nke pancreatostasis.

Maximumkpụrụ kachasị nke ọrụ amylase serum bụ njirimara maka ụbọchị mbụ nke ọrịa ahụ, nke kwekọrọ na usoro ụlọ ọgwụ nke ọtụtụ ndị ọrịa nwere nnukwu ọrịa ọrịa pancreatitis n'ụlọ ọgwụ. Kpebie ọrụ lipase n'ime ọbara bụ nnwale nyocha dị mkpa na ụbọchị mgbe e mechara site na mmalite nke ọrịa ahụ, ebe ọ bụ na ọrụ ya na ọbara onye ọrịa nwere nnukwu ọrịa ọria na-adịgide ruo ogologo oge karịa ụkpụrụ amylasemia. Ihe omume a na-ekpebi oke uche na nkọwapụta nke nyocha lipase na amylase.

N'ime usoro ọgwụgwọ ụlọ, ana - eji amylase na mmamịrị eme ihe. Nnwale ọzọ bụ nyocha nke ọrụ amylase na peritoneal exudate n'oge laparoscopy (laparocentesis). Mgbe ị na-eji usoro Volgemut (mkpebi nke amylolytic dum nke mmamịrị), dabere na nke amylase dị na mmamịrị bụ nkeji 16-64, enwere ike ịchọpụta ọkwa dị iche iche nke mmụba ya - nkeji 128-1024. ọzọ. Volzọ Volgemut akọwapụtaghị nke ọma maka reat-amylase nke pancreatic, ebe ọ na-egosipụta ngụkọta nke enzymes glycolytic dị na usoro ihe omimi nke ezigara maka ọmụmụ ihe ahụ.

Mkpebi nke trypsin na ọrụ elastase n'ọbara n'ime nyocha nke ọrịa pancreatitis nwere obere ọgwụgwọ karịa nyocha ụlọ nyocha nke amylase (lipase) n'ihi ịdị mgbagwoju anya na ọnụ ahịa nke ụzọ.

Hypreamylasemia na mgbanwe nke ọrịa ahụ, ọ bụ akara dị mkpa maka arụ ọrụ chekwara pancreatic na ọnọdụ nke pancreatostasis, nke bụ ụdị maka ọrịa pancreatitis interstitial ma ọ bụ nke na-elekwasị anya (mmalite nke isi). Dysfermentemia (imebi ruru nke amylase na lipase ọbara) na-egosi ọrịa akwara nke necrobiosis nke anụrị, ebe ọkwa amylase dị n'ọbara, hypoamylasemia (na fermentemia) bụ njirimara nke akwara nke pancreatic, nke na-egosi ọdịdị mbibi nke pancreas na mwepu nke ọrụ ihe egwu.

Enweghị mmekọrịta dị n'etiti ọkwa amylasemia (amylazuria), njupụta na ụdị pancreatic necrosis (interstitial, faty, hemorrhagic). Nsonaazụ nke ọmụmụ nke enzyme ụdịdị dị iche iche nke ọbara kwesịrị ka echebara ya echiche naanị na njikọta data sitere na ụlọ ọgwụ ndị ọzọ, ụlọ nyocha na ụzọ ọrụ maka inyocha onye ọrịa nwere nnukwu ọria.

Mgbanwe na nyocha ọbara nke clinical maka ọrịa pancreatitis dị njọ enweghị nkọwa siri ike. N'akụkụ a, a maara ọtụtụ ihe isi ike dị na nyocha ụlọ nyocha ọdịiche nke aseptic na ụdị ọrịa akwara nke pancreatic necrosis, nke dị ezigbo mkpa site n'echiche nke ọgwụgwọ n'oge. Mmụba nke ndị na-egosi ihe ndị a na ịdị omimi nke ọrịa site na ihe karịrị 30% nke ọkwa mbụ, yana data nyocha na ụlọ nyocha ndị ọzọ, na-atụkwasị obi na mmepe nke ọrịa pancreatogenic, mana n'otu oge ahụ, dịka iwu, a na-agbaghara ha ruo ụbọchị 2-3. Ihe kachasị ekwenye na ọ dị mma maka ọrịa nje akwara na-akpata ọnụnọ bụ ọnụọgụ ọbara nke leukocytes karịa 15x10 9 / l yana ndekpo egbu egbu leukocyte karịa 6 nkeji.

Ihe ịrịba ama di iche bute ọrịa thrombocytopenia, anaemia na acidosis, ekwesiri iburu n'uche ha na nchịkọta nke data na akụrụngwa.

Mgbanwe nke ndu sitere na ọbara na-egosi mmepe nke ọrịa hyper- na dysmetabolism syndrome, nke a na-akpọkarị n'ụdị mbibi nke pancreatitis. N'ime ọnọdụ ndị a, mgbanwe ndị kachasị mkpa n'ọdịdị biochemical ọbara bụ dysproteinemia, hypoprotein na hypoalbuminemia, hyperazotemia na hyperglycemia. Ọrịa hyperglycemia na-adịgide adịgide na - egosi necrosis nke pcastic buru ibu, uru ya kariri 125 mg / dl (7 mmol / l) - ihe na - adịghị mma prognostic. A na-edekọ hypertriglyceridemia, hypocholesterolemia, ụkọ lipoprotein nke ukwuu, yana mmụba nke mkpo abụba n'ime ụdị nke ọbara.

C-reactive protein tinyere haptoglobin na α₁-antitrypsin - protin nke ukwu nke mbufụt. Na nnukwu pancreatitis, ọdịnaya nke C-reactive protein nke ihe karịrị 120 mg / l n'ọbara onye ọrịa na-egosi mmerụ nke necrotic na pancreas. Ntinye nke protein C-reactive na-egosipụta ogo njọ nke usoro mkpali na necrotic, nke na-enye gị ohere iji nnwale a iji chọpụta, n'otu aka, edematous pancreatitis ma ọ bụ pancreatic necrosis, na nke ọzọ, sterili ma ọ bụ ọrịa nke usoro necrotic.

Ngwa nnwale procalcitonin n'ụdị dị iche iche nke nnukwu ọrịa pancreatitis gosipụtara na ndị ọrịa nwere ọrịa akwara ọria ọria, ịta procalcitonin dị elu karịa na usoro mbibi na-enweghị atụ.

Ozo nke necrosis na-ahụkarị bụ ihe na-eme ka protein nke C-reactive nke ihe karịrị 150 mg / l, na procalcitonin - karịa 0.8 ng / ml. A na-ahụkarị ọrịa na-efe efe ọsịsa nke C-reactive protein n'ọbara onye ọrịa karịa 200 mg / l na procalcitonin karịa 2 ng / ml.

N'etiti ihe nrịbama nke ihe omimi banyere ihe ojoo banyere oria nke anakpo pancreatitis, omumu ihe banyere achoro achoro nke phospholipase A₂, trypsinogen, urotrypsinogen-2, peptide trypsin na-arụ ọrụ, protein na-akpata pancreatitis, interleukins 1, 6 na 8, tumor necrosis factor na neutrophil elastase. Achọpụtara ya na mkpokọta nke pepside trypsin na-arụ ọrụ n'ime mmamịrị na njikọta protein C-reactive na interleukin 6. Theta ahụ metabolite na mmiri peritoneal bụ nke kwekọrọ na ogo ọria akwara.

Agbanyeghi eziokwu na ọdịnaya nke ọtụtụ ihe ndị na - eme biochemical na - abawanye n'ọbara nke ndị ọrịa nwere ọrịa pancreatic necrosis ozugbo enwere ike (awa 24 - 48) site na mmalite ọrịa ahụ, ojiji nke ihe nrịbama a na ụlọ ọgwụ gbasara ịwa ahụ mberede na - ejedebe ụgwọ dị elu nke ụzọ na enweghị nnweta ntụkwasị obi a maara nke ọma. Kinddị nkwekọrịta na ihe dị ugbu a na ọnọdụ ọrụ ya yiri ka ọ bụ mkpebi nke ịta protein nke C-reactive na ụlọ nyocha ihe ọmụmụ ọ bụla.

Igwe anwansi njirimara kachasị nke ụdị mbibi nnukwu ọrịa pancreatitis. Hematocrit kariri 47% n'oge nnabata onye ọrịa n'ụlọ ọgwụ na enweghị mbelata ya n'ime awa iri abụọ na anọ nke ọgwụgwọ kpụ ọkụ n'ọnụ na-egosi mmepe nke necrosis pancreatic.

Ihe omumu banyere enzymes imeju n'ime ndị ọrịa nwere nnukwu ọrịa pancreatitis, ihe mgbagwoju anya site na mmepe nke ụkọ hepatocellular, njirimara maka necrosis pancreatic, ọ ga-ekwe omume ịchọpụta nnukwu ọrụ nke alanine na aspartic aminotransferases. Mmụba dị ukwuu na ọrụ dehydrogenase lactate na-egosipụta mbibi nnukwu nsogbu nke pancreatic. Site na echiche nke nchọpụta ọdịiche, ọ dị mkpa icheta na mgbanwe ndị yiri ya bụ njirimara nke nnukwu ọrịa myocardial infarction, nnukwu ịrịa afọ, na ịba ọcha n'anya nke etiologies dị iche iche.

Site na biliary pancreatitis n'ihi choledocholithiasis, yana ya na ọnya isi nke pancreatic isi, cholestasis bụ njirimara, nke hyperbilirubinemia gosipụtara nwere akara nke bilirubin, ọrụ dị elu nke aspartate aminotransferase na alkaline phosphatase.

Ewoo ekwuru mgbanwe na mmiri-electrolyte ihe akaebe nke oke obara, erughi nke potassium, sodium, calcium. Na commondị nkịtị nke pancreatic necrosis mbelata nke mkpo calcium na plasma ọbara bu n’iburu n’uche ya n’ime steatonecrosis n’aru osili nnu.

Mgbe ịchọrọ ile ule maka ọnụnọ nke ọrịa pancreatitis na-adịghị ala ala

Ozugbo akara nke mbụ nke imebi arụmọrụ nke pancreas bidoro ịpụta, ị ga-agakwuru onye ọkachamara nwere ahụ ọfụma ozugbo. Onye na-ahụ maka eriri afọ ma ọ bụ onye na-ahụ maka ọgwụgwọ ga-edepụta nyocha dị mkpa, mgbe nke a gasịrị, dabere na nsonaazụ ndị ọ nwetara, ọ ga-eziga maka ọmụmụ ihe ndị ọzọ.
Enyere ihe nchoputa ndia:

ihe mgbu na hypochondrium nke aka ekpe, gosiputara oge, nke na-abawanye mgbe i risịrị nri ma belata oge ebu ọnụ ma ọ bụ nọrọ ọdụ nke ahụ,
ubara nnu,
vomiting
ikuku na nri ugboro ugboro.
nri riri
ịba ụba gas,
afọ ọsịsa (ọnya nke na-acha odo odo ma ọ bụ ahịhịa ahịhịa, na-enweghị isi na-adịghị mma, mgbe ụfọdụ nwere ụfọdụ nri nri na-adịghị mma),
ifelata
Ahụ́ na-agbasi ike ngwa ngwa.

Mgbu nke hypochondrium nke aka ekpe bu akara nke oria

Ọnọdụ dị n’elu anụ ahụ na-egosi arụ ọrụ nke pancreas, nke na-emetụta ọdịmma, na-egbochi ikike ịrụ ọrụ, akpịrị na-akpọ nkụ, ntutu na-ada, anaemia amalite.
Isi ihe bụ ịchọpụta ọrịa ahụ oge a wee malite ọgwụgwọ. Mbelata nke ukwuu, nguzozi nke ihe elektrik na mfu nke ihe ndị dị mkpa nwere ike ibute ndụ mmadụ.

Dị Mkpa! Must ga-amakwarịrị tupu ịmalite ule maka ọrịa ogbu na nkwonkwo, amachibidoro iri nri, yana ụbọchị ole na ole tupu ịhapụ iri abụba na eghe. Ọ bụrụ na a ga-enyocha ule iji chọpụta ọkwa nke glucose, mgbe ahụ ị nwere ike iri nri dị ka ọ dị na mbụ, na-ejedebeghị onwe gị.

Kedu ule kwesiri iwere na usoro ogwu a

N’enyeghị nsogbu, a na-enye onye ọrịa iwu ka ọ gaa usoro ọmụmụ. Iji nweta nkọwa zuru oke banyere ọnọdụ ahụike nke onye ọrịa, dọkịta ahụ ga-enyocha:

nnwale ọbara dum
ọbara ọgbụgba
ọkwa cholesterol
amylase etoju n'ime ọbara, mmamịrị, asu,
nyocha fecal
enzyme ọrụ (lipase, trypsin),
ọkwa bilirubin na ọrụ transaminase,
duodenal ọdịnaya
mmiri si na oghere dị n’ime afọ nke a na-enweta n’oge a na-achọ laparoscopy (ule ịgba).
REA,
nnwale maka nrịbama tumor.

Nnyocha ọbara nyocha

Kedu ule a ga-eme maka ọrịa pancreatitis na-adịghị ala ala, onye ọkachamara na-ahụ maka gastroenterologist nwere ike ịza.

Site na nnwale ọbara n'ozuzu iji chọpụta ọrịa pancreatitis na-adịghị ala ala, leukocytes, erythrocytes (ESR), na olu nke enzymes kpebisiri ike. Isi nke iwu bụ ị nyocha nyocha nke ụtụtụ n'ụtụtụ afọ. Na usoro nyocha, ihe ndị na-egosi ihe ga-akarị nke ọma ma gosipụta mmerụ ahụ na-emetụta ahụ. N'ụzọ na-akpali mmasị, na ọrịa pancreatitis na-adịghị ala ala, ọkwa nke enzymes adịghị iche n'ụzọ ọ bụla site na ngosipụta nke mmadụ nwere ahụ ike.

Omuma ọbara

Ihe omumu ihe ndia na enyere gi aka ikpebi ogo:

glucose, nke dị elu (usoro ekwesịghị gafere 5.5 mmol / l),
cholesterol dị ala (nkịtị 3-6 mmol / l),
enzymes pancreatic (a ga-ebelata alfa 2-globulin).

Agbanyeghị, na mbufụt na neoplastic Filiks, akụrụ ọrịa, ọ na-ebili (ejikari 7-13%), trypsin na-abawanye (nkịtị 1060 μg / L) na lipase na-abawanye (nkịtị 22-193 U / L).

Ntị! Dị oke egwu na ọrịa pancreatitis na-adịghị ala ala bụ ọkwa shuga, nke onye ọrịa ahụ ga-enyocha. Ihe na-egosi ihe karịrị 7 mmol / l na-egosi ọnụnọ nke ọrịa shuga.

Nnyocha nyocha

N'ime omumu nke ahihia biochemistry, achoputara akwara na enweghi oge igbutu, akwara ime ya, na agba ya ga acha aja aja. Na ọnụnọ nke pancreatitis, a na-ahụta mbelata nke oke nke exocrine, nke na-egosi mbelata ọrụ enzyme.

Nnyocha nyocha

Ambila pancreatic na mmamịrị na-ebili ọtụtụ mgbe. Ọ dị mkpa ịnakọta mmamịrị n'ụtụtụ na 100-150 ml. Usoro amylase nke pancreatic bụ 0-50 nkeji / lita.
Mgbe ị na-agafe ule mmamịrị maka ọrịa pancreatitis na-adịghị ala ala, a na-ekpebi amino acid index, ebe ọ bụrụ na ọrịa, a na-ahụkarị nzere ha karịrị akarị, nke na-egosi nnabata amino acid na obere eriri afọ. Nnwale Lasus na-enyere aka ikpebi ọnụnọ ha. Maka nyocha, a na-eji mmamịrị ụtụtụ mee ihe, na-anakọta akụkụ nke etiti na nnukwu ite.

Dị Mkpa! Na pancreatitis na-adịghị ala ala, ọkwa nke CEA (cancer cancer ẹmbrayo antigen) na-abawanye site na 70%.

Na pancreatitis na-adịghị ala ala, a na-ahụ ọkwa dị elu nke akara akara CA 125. Na pancreatitis, a na-abawanye ntinye akara nke akara 72 72.

Eterchọpụta ọkwa nrịbama

Dabere na nsonaazụ ndị a, emeghị nchọpụta ikpeazụ banyere ọnụnọ nke ọrịa pancreatitis na-adịghị ala ala. Ọ dị mkpa iji nyochaa nyocha zuru oke iji chọpụta nchoputa ahụ:

Ultrasound nke akụkụ ahụ nke afọ iji chọpụta mgbanwe mgbanwe akwara nke pancreas,
X-ray - iji kwado njikọta akwara.
nyochaa iji tomograph iji chọpụta mpaghara nke neorosis ma ọ bụ akpụ,
magnetik resonance Onyonyo maka eserese panoramic nke pancreas,
na-ewere biopsy maka nyocha,
fibrogastroscopy ga - enyere aka nyochaa nyocha nke ọma.

Ọtụtụ ndị ọrịa na-echekarị ihe kpatara, na nchọpụta nke ọrịa pancreatitis na-adịghị ala ala, ọtụtụ nyocha dị na njedebe nkịtị.. Nke bụ eziokwu bụ na nchọpụta nchọpụta nke ọrịa a na - agbagha agbagọ site na anatomical predisposition nke pancreas yana mmekọrịta ya na akụkụ ndị ọzọ nke eriri afọ.
Agbanyeghị, usoro usoro ga-aga n’ihu ga-enyere ndị aka na-abịa ahụ aka ịchọpụta nchoputa kachasị wee họrọ ọgwụgwọ kwesịrị ekwesị. Ka nsonaazụ wee bụrụ nke a pụrụ ịtụkwasị obi, ọ dị mkpa iji nlezianya debe iwu niile maka ịnakọta ule.

Edere onye ọrịa ahụ ka onyonyo ndọta maka panoramic onyonyo nke pancreas

Kedụ ihe mgbochi maka ọrịa nke eriri afọ?

Iji gbochie ọrịa a, ị ga-agbaso ezigbo ihe oriri. Ihe oriri kwesịrị ịgụnye vitamin na mineral niile dị mkpa. Iri nkpuru osisi na akwukwo nri bu ihe aghaghi ime. Ihe oriri dị ụtọ na nke e ghere eghe na-ada n'okpuru mmachi; a ga-atụfu nnu na oke ụtọ. Wepu carcinogens, ihe eji edozi ihe na ihe ndi ozo.