Alakụba na-arịa ala > Ọria mamiri

Ihe kpatara
Ọrịa ọgbụgba na-adịghị ala ala
Diagnostics
Ọgwụ nke pancreatitis na-adịghị ala ala
Nsogbu na prognosis

Ọrịa na-adịghị ala ala bụ otu ihe dị iche iche nke ọrịa akwara na-egosipụta ọnụnọ nke necrosis na pancreas megide mmebi fibrosis na mmebi nke ọrụ nke gland nke ogo ịdị iche iche. Ọrịa pancreatitis na-adịghị ala ala na-eduga n'ọdịdị na mmepe nke atrophy (mwepu) nke anụ ahụ glandular, fibrosis na nnọchi nke mkpụrụ ndụ akwara nke paịrisy parenchyma na anụ ahụ na-ejikọta.

Isi ihe kpatara ọrịa pancreatitis na-adịghị ala ala:

1) ị consumptionụ mmanya na - egbu egbu - ọ pancụ pancụ na - egbu egbu (karịa na ụmụ nwoke karịrị afọ 35) na dose nke ihe karịrị 20-80 mg nke ethanol / ụbọchị. maka 8-12 afọ. Nri protin na ị smokingụ sịga na-eme ka ọrịa pancreatitis ka njọ.
2) ọrịa nke biliary tract na duodenum - biliary pancreatitis (ọtụtụ mgbe na ụmụ nwanyị),
Ọrịa gallstone bụ ihe na-ebute ọrịa na-adịghị ala ala na 35-56% nke ikpe,
• pathology nke sphincter nke Oddi (stenosis, siri ike, mbufụt, ọzịza),
• duodenitis na ọnya afọ. Ya mere, ọnya duodenal na 10.5-16.5% nke ikpe bụ ihe na-akpata mmepe nke ọrịa na-adịghị ala ala.

Ọrịa na-efe efe na-efe efe nke na-arịa ọrịa gallstone, choledocholithiasis, bụ ihe a na-ahụkarị na ụmụ nwanyị 50-60. Dị ka ọ na-adịkarị, ndị ọrịa dị otú ahụ nwere ihe ịrịba ama nke ọrịa metabolic: oke ibu, hyperlipidemia, ebumnuche nke ọbara mgbali, ọrịa obi na -akpata, ịnagide ikike carbohydrate, hyperuricemia na / ma ọ bụ hyperuricosuria.

Isi ihe abụọ a yikarịrị ka ọ na-akpatakarị ọrịa ọ na-akpata. Ihe kacha akpata:

3) cystic fibrosis (ọtụtụ mgbe na ụmụaka),
4) Ọrịa akwara na-eketa eketa. A na-ahụkarị na Northern Europe, ugboro ole ya bụ ihe dịka 5% nke okwu niile. A pụrụ inyocha ụdị ọrịa a na-eketa site na ọrịa nke pancreatitis site na enweghị ihe ndị a na-ahụ anya na ikpe nke pancreatitis na ezinụlọ nke ndị ikwu onye ọrịa,
5) idiopathic pancreatitis. Mgbe n’oge ọmụmụ ihe anaghị edozi ihe kpatara ya - 10 ruo 30% nke ọrịa nje niile. Nnyocha ndị e mere n'oge gara aga egosila na ihe kpatara ọrịa idiopathic pancreatitis nwere ike ịbụ microcrystals nke cholesterol, granules nke bilirubinate na microspherolites calcium,
6) ihe ndi ozo:
• autoimmune pancreatitis,
• ọrịa system na vasculitis,
• malitere ịrịa (Coxsackie, CMV) na ọrịa nje,
• ọrịa helminthic (opisthorchiasis),
• nsogbu nke metabolic (hyperlipidemia, ọrịa shuga mellitus, ọdịda gbasara akụrụ na-adịghị ala ala, wdg),
• Ọrịa diski diski (ischemic pancreatitis),
• usoro nke pancreas,
• mmerụ ahụ, nsị na-egbu egbu.

Ọrịa ọgbụgba na-adịghị ala ala

Ọrịa mgbu na-efe efe na-arịa nwayọọ nwayọọ na - efe efe nke pancreas, yana necrosis (necrosis nke gland tissue) yana fibrosis ma na - eduga nbibi nke anụ ahụ na - aga n'ihu mgbe ọ kwụsịrị mmetụta pathogenic, nke butere ọrịa ahụ. Nkwekọrịta, a na-ekwu na ọria na-adịghị ala ala mgbe usoro mkpali na pancreas na-ewe ihe karịrị ọnwa isii. Alakụba na-egbu ala na-apụtakarị ọnọdụ nke iwe na mgbakasị ahụ (mgbagha nke ọrịa ahụ).

Ọ dị mkpa ịmata ọdịiche dị n'etiti ọrịa akwara na-adịghị ala ala na nke na-adịghị ala ala, ebe ọ bụ na e nwere ọdịiche dị iche na ụzọ ọgwụgwọ nke ndị ọrịa dị otú ahụ. Nke a bụ oge ụfọdụ siri ezigbo ike ịme, ebe ọ bụ na iwe iwe nke ọrịa pancreatitis na-adịghị ala ala na mgbaàmà ya yiri nnukwu ọrịa ọrịa pancreatitis, na nnukwu pancreatitis, n'aka nke ya, nwere ike ịnọgide na-amabeghị (na 60% nke ikpe!), Na-agba n'okpuru mkpuchi nke ọrịa ndị ọzọ nke eriri afọ ma ọ bụ soro ya , mgbe ahụ ọ ga-agbanwe bụrụ nke na-adịghị ala ala.

Nhọrọ maka ọnya na-adịghị ala ala

Ọrịa Pancreatitis na-egbu egbu na - etolite n'ihi ihe mgbochi nke akụkụ abụọ nke pancreas site na akpụ, ya na mbufụt nke duodenal papilla ma ọ bụ stenosis ya, duodenitis n'ihi ọrịa Crohn, ahụ mkpụchi ọnya na ọrụ ịwa ahụ na mpaghara pyloroduodenal, ọnụnọ nke pseudocysts nke pancreas, nnabata afọ abụọ. Ọrịa gallstone na choledocholithiasis, nsị nke sphincter nke Oddi biliary na ụdị pancreatic bụ isi ihe na-eme ka e guzobe ọgwụ mgbochi na-adịghị ala ala. Nmebi nke pancreas bu ihe edoghi anya ya na uzo esi ejikota ya na ogwe gland. Mgbaàmà na-eduga bụ ihe mgbu na-adịgide adịgide.

Na calcifying nkịtị pancreatitis n'ime ducts, a na - achọta protein protein ma ọ bụ calcifications, nkume, cysts na pseudocysts, stenosis na atresia, yana atrophy nke acinar anụ ahụ. Ejiri ụdị ọrịa a na-egbu mgbu na-arịa ọrịa metụtara ọrịa na-eme ka mmadụ na -akpọ ngwa ngwa n'oge akwara. Dịka iwu, ọrịa mmanya na-egbu egbu na-akpata mmanya na-egbu egbu.

Otu ndi mmadu n’eme ka aru di ya n’ahụ bu ihe otite nke puru ime, oria akwara, nke n’edolite mgbe ekpughere ya na nkpuru ogwu, ufodu kemikal, ogwu, ya na obido n’abia site na hyperlipidemia, hypercalcemia na hyperparathyroidism, oria na-ala ala (nke bu oria HCV na oria HBV), Mgbanwe congenital na nke ogwe akwara.

Nweta ihe akwara nke ekpuchisiri site na udiri akwara ihe ana - ekpuchita ya na aru ndi umuaka anakpo 10-12 rue ma obu ndi gbara iri-ano rue iri-ano. Ọ bụ enweghị ihe ọ bụla site na ụdị ọgwụgwọ ọrịa pancreatitis, yana mwakpo nke mgbu afọ, mgbe afọ 8-10 gasịrị, ọrịa shuga mellitus na 20% nke ndị ọrịa na nnukwu steatorrhea na 15-20% nke ndị ọrịa. Enweghị ihe ndị ọzọ na-egosi na ngosipụta nke ikpe nke pancreatitis n'ime ezinụlọ na-eme ka enyo enyo enyo n'ụdị ụdị ọrịa ọrịa pancreatitis na-adịghị ala ala.

Ọrịa mgbu na-adịghị ala ala mara mmepe nke oria nke mbufụt na parenchyma nwere ọtụtụ mkpụrụ ndụ mononuclear na fibrosis na infiltrates, nke na-anọchi paịlịna paniya. Site n'ụdị ọrịa a na-egbu mgbu na-adịghị ala ala, ọ nweghị ihe ọ bụla mebiri emebi na akwara ndị dị na pancreas. Ihe mgbaàmà ndị a na-ebute nwayọ bụ ihe ịrịba ama na-aga n’ihu nke enweghị ume na endocrine na enweghị ụfụ (ụdị na-enweghị mgbu).

Ọrịa mgbu na-egbu mgbu

Mgbe mgbe mmepe nke ụdị mgbu na-egbu mgbu na-aga n'ihu site na enweghị mgbu, oge ngwụcha nke ụdị dịgasị iche iche, nke ahụ erughị ala na epigastrium, flatulence, stools na-ejighị n'aka nke nwere ịrịa afọ na ọnya na-enweghị eriri na oche ma ọ bụ steatorrhea. Ugboro ugboro ugboro n'ụdị mgbu na-egbu mgbu nke ọrịa pancreatic n'ụdị nke pancreatic insufficiency na oke ọnya nke exocrine ma ọ bụ ọrụ endocrine na mmepe nke ụdị shuga 2.

Mgbu nwere ike ime ma oge iwe ọkụ ma n'oge usoro ịgbado nke ọrịa akwara na-adịghị ala ala. O nweghi uzo doro anya, na - eme n’ime elu ma obu n’ime ime ekpe ma obu n’etiti, na - enye n’azu, na - ewere ya zoster mgbe ufodu. Ihe karịrị ọkara nke ndị ọrịa nwere nnukwu ihe mgbu.

Ntughari ihe mgbu na pancreatitis na-adịghị ala ala

Ihe na-akpata mgbu na pancreatitis na-adịghị ala ala bụ ndị a:

1) ọnya na-egbu mgbu nke ukwuu (mbibi parenchyma na capsule),
2) pseudocysts nwere mbufụt perifocal,
3) ihe mgbochi na nsogbu nke akụkụ akwara ozi,
4) fibrosis n'ọhịa nke akwara akwara, na-eduga ha mkpakọ,
5) nsogbu ndị dị n'akụkụ akwara ozi plexuses nke ịmụba amụba,
- stenosis na dyskinesia nke sphincter nke Oddi.
- Mgbu nke sitere na pseudocysts na mgbochi ụdọ na-abawanye nke ukwuu n’oge ma ọ bụ ozugbo nri. Mgbu, dịka iwu, akwa, paroxysmal. Mbelata ọgwụ mgbochi ọgwụ mgbu na nkwonkwo pancreatin (Panzinorm), nke na -ebelata nzuzo nke pancreas site na usoro nzaghachi.
- Mgbu mgbu na-adabere na ntinye nri, nke dị n'ime ya, dịka iwu, na epigastrium, na-eme ka azụ gbadaa. A na-akwụsị ihe mgbu dị otú ahụ site na analgesics (NSAIDs, n'ọnọdụ ndị siri ike - analgesics narcotic)
- Enweghi nkpuchita nke oria “Exocrine” na-ebute oke nje na obere eriri afọ, nke bụkwa ihe na - akpata ihe mgbu na oke ọnụọgụ nke ndị ọrịa nwere ọrịa na - adịghị ala ala. Ihe mgbu ndị a na-akpata site na nrụgide dị ukwuu na duodenum.

N'ọgwụgwụ nke ọrịa pancreatitis na-adịghị ala ala, na mmepe nke fibrosis, ihe mgbu belatara ma nwee ike ịhapụ mgbe afọ ole na ole gasịrị. Mgbe ahu ekpughere ngosiputa nke nmeghari-amara.

Kedu ka mbufụt nke pancreas?

Ọbụnadị ihe ịrịba ama na-ebute mbufụt nke pancreas adịghị na ndị ọrịa niile. Agbanyeghị, ekwesịrị ịkpọ ha ụzọ. Ihe omimi ọdịnala nke usoro a na - eji ọgwụ Mondor triad kpebiri - ndị a bụ ihe mgbu na afọ, bloating na ọgụ nke ọgbụgbọ.

Ọrịa na-ebilite n'ime awa ole na ole. Onye ọrịa enweghị ike ikwu kpọmkwem ebe ọ na-ewute. A na-akọwa ihe mgbu n'akụkụ niile; na nzụlite a, anaghị akọwapụta ebe niile. O nwere ike inye ogwe ubu, ala azụ, olu olu na akụkụ ndị ọzọ nke ahụ mmadụ.

N’ọtụtụ eserese, ọgbụgbọ na-amalite na mberede. Naanị 20% ndị ọrịa na-enwe ọgbụgba tupu oge eruo. Na vomita, enwere iberibe nri anaghị enye ya akara, mgbe nke a gasịrị

Isi ihe mgbaàmà nke njọ nke pancreatitis:

Enweghị stool bụ nsonaazụ nke mgbochi afọ. Ma ọ bụ onye ọrịa nwere akpọnwụ akwa ruo ugboro ise n'ụbọchị. Nnukwu akwara na -ebu abụba, na-enwe njirimara, nke na-egosi mmepe nke steatorrhea (nyocha nke ọnụnụ na-egosi ọnụnọ abụba na feces karịrị nke nkịtị),
Ihe ịrịba ama nke akpịrị ịkpọ nkụ bụ nkụ kpọrọ nkụ gabiga ókè. Dịka iwu, akara nke akpịrị ịkpọ nkụ na-abawanye ma ọ bụrụ na onye ọrịa ahụ na-ekpughe ọgbụgbọ na shuga ugboro ugboro.
Ọkpụkpụ akwara nke dị n'ime oghere dị mkpụmkpụ - akpụ akpụ - na -akpata iwe mgbu. Na palpation, ihe mgbu ahụ na-akawanye njọ,
Pallor nke akpụkpọ ahụ, iku ume siri ike, ọnya obi dị ngwa, edo edo nke anya anya, wdg.

N'ime omume ahụike, a na-ahụ ihe mgbaàmà nke nnukwu ọrịa pancreatitis, nke na-enyere aka ikpebi ọrịa ahụ "site na anya". Agbanyeghị, ha dị ụkọ na ndị ọrịa - n'ihe dị ka 10% nke foto ụlọ nyocha.

Ha na-agba akaebe na mbibi nke pancreas.

Ihe ịrịba ama ndị a gụnyere ọdịdị ntụpọ na-acha odo odo na ihu, ọnya na mpaghara, mmerụ nke akụkụ ala, oghere ọbara na mpaghara lumbar.

Ahụ mgbu Pancreatitis

Gịnị bụ syndromes pancreatitis? Mgbe onye ọrịa kpughere ọtụtụ ihe ngosipụta dị egwu maka imebi otu usoro ahụ, a na-ejikọkarị ha na ọrịa. N’ikwu ya n’ụzọ ọzọ, nke a bụ ụfọdụ ihe ngosipụta nke ụlọ ọrụ nwere ike ijikọ ọnụ n’otu otu, ebe ha nwere ụfọdụ myirịta.

Ọrịa ọ bụla nwere ụfọdụ syndromes, cholecystitis, pancreatitis na ọrịa ndị ọzọ, enweghị ndị ọzọ. Mgbu na mgbu nke pancreas na-adị oge niile.

Na ọgụ dị egwu, mgbu ahụ siri ike, nwere ike ibute oke ụjọ. Na-emegide ọdịdị nke ụdị adịghị ala ala, n'ụfọdụ ndị ọrịa ihe mgbu na-adị mgbe niile, mana enwere ya na ike dị ala.

A na - akọwa ihe mgbu site na ọnya na pancreas. Ọ bụrụ na arụmọrụ nke isi anụ ahụ anaghị arụ ọrụ, mgbe ahụ, a na-ahụ ihe mgbu n'akụkụ aka nri nke mpaghara epigastric. Mgbe aru gland dị ọkụ, ọ na-afụ ụfụ n'aka ekpe. Mgbe achọpụtara mpaghara ọdụ ọdụ, ọ na-afụ ụfụ n'okpuru ọgịrị ekpe.

Akụkụ ahụ ndị ọzọ na-enwe ihe mgbu:

Na azụ n'akụkụ ọgịrịga ruo na ogwe nke ogwe aka.
N’okpuru agụba aka ekpe.
Ke afara ubu.
Na mpaghara iliac dị ala.
N'ime mpaghara obi (na nke a, mgbaàmà yiri angina pectoris).

Ọdịmma nke ọrịa a bụ na ndị na-egbu mgbu anaghị enyere aka ịhazi ya. N'ọnọdụ ndị ọzọ, ihe mgbu ahụ na-aghọ nkụda mmụọ, ebe ndị ọzọ ọ ka na-agbasi ike.

Naturedị nke mgbaàmà ya na mmepe nke nnukwu ọrịa pancreatitis dị iche iche. Usoro nke ihe omume sitere na mmụba dị ukwuu na akwara ndị na-emetụta ahụ, ihe na-agbawa agbaze na ngwa ahụ, n'ihi nsị nke ihe na-agbasawanye njọ.

Ọria nke ezughi oke nke exocrine

A na - egosipụta ụkọ mmiri nke na - eme ka mmadụ topụta onwe ya site na imebi nghazi afọ na ịmịkọrọ afọ. Ọrịa

• afọ ọsịsa (stool ugboro atọ ruo ugboro isii n'ụbọchị),
• steatorrhea (na - apụta mgbe ejiri pasent 10 belata ihe nzuzo ọria, feces bụ mushy, fetid, with with sheen oil).
• belata,
• ọgbụgbọ
• voming nke oge,
• enweghị agụụ.

Ọrịa bakteria na-abawanye na obere eriri afọ na-amalite ngwa ngwa, ihe mgbaàmà ya:

• flatu,
Na-asụ ngọngọ n’afọ
• ili.

E mesịa, akara ngosipụta nke hypovitaminosis - anaemia, adịghị ike, mgbanwe na akpụkpọ, ntutu, na metabolism - sonyere.

Ntọala nke enweghi ike imu ihe anakpo exocrine.

- mbibi nke mkpụrụ ndụ acinar, na - ebute nsonaazụ nke enzymes pancreatic.
- mgbochi nke a na - egbu mmiri, a na - egbochi imebi nke ihe ọ juiceụ pancụ nke pancreatic n'ime duodenum,
- Mbelata na secretion nke bicarbonates site na epithelium nke ducts nke gland na-eduga na acidification nke ọdịnaya nke duodenum gaa pH nke 4 ma ọ bụ nke ala, na-ebute ngbanwe nke enzymes pancreatic na ọdịda nke bile acid.

Ọrịa dyspeptik

Ọrịa dyspeptik na-eso ọtụtụ usoro nyocha na ahụ. Cliniclọ ọgwụ ha dị ezigbo iche iche, ọ gaghị ekwe omume ịchọpụta nnukwu ọrịa nke ọrịa ọrịa pancreatitis naanị site na dyspepsia.

N’ebe ụfọdụ ndị ọrịa nọ, ọrịa dyspeptik bidoro obere erughị ala n’ọkpụkpụ, ọ na - eji nwayọ gbanwee ka ọ bụrụ ihe na-egbu mgbu. A na-ahụ ikpuchi ụkwụ.

Mwakpo ọgbụgbọ na pancreatitis anaghị eme onye ọ bụla. Ọtụtụ mgbe, a na-achọpụta vomiting ozugbo na ndị ọrịa. Ọ dịghị eweta ahụ efe. Mgbe nke a gasịrị, obi na-egbu mgbu, nke a na-emeju site na ibanye na esophagus. Ọ bụ ihe dị egwu nke afọ na-abanye anụ ahụ mmadụ.

A na-egosipụta ọrịa ọria pancreatitis n'ụdị dyspepsia site na mgbaàmà ndị a:

Tuba ụba flatulence, mmetụta nke afọ n'ime afọ,
Ahịhịa tọgbọ ọtọ. Site na mbufụt nke pancreas, a na-esite ya n’ite na-eme nwa, ichachaa nke ụlọ mposi,
Ihe uto ojoo na onu na egosi udiri nri enzymes,
Ọdịda ahụike n'ozuzu ya, adịghị ike na nsogbu, oke mkpọmkpọ ebe.

Site na pancreatitis, dicepepsia fermentative nwere ike ime, n'ihi usoro ịgba ụka na eriri afọ.Onye ọrịa ahụ na-eme mkpesa nke mkpọpu afọ n'ime afọ, ịba ụba gas na -eme ka oche, na-anọkarị ọdụ ala. N’ime mmegharị afọ, ihe mgbu dị. Mgbe ọ na-agbagharị na eriri afọ, a na-egosipụta putrefactive dyspepsia - adịghị ike na oke ịrịa, ọnya gbara ọchịchịrị nke nwere isi na-adịghị mma.

Dịka iwu, na-emegide nzụlite nke ọrịa akwara, a na-ahụ ọtụtụ syndromes n'otu oge, ebe ọ bụ na pancreas na-arụ ọrụ karịrị otu. Yabụ, imebi arụmọrụ ya na - ebute ọgba aghara n'akụkụ ọtụtụ akụkụ anụ ahụ yana sistem.

Ọ bụrụ na ihe mgbaàmà ọrịa dyspeptik na-esoro ọrịa mgbu mgbu, nke bụ njiri mara mmepe nke nnukwu pancreatitis, a na-atụ aro ịkpọ otu ambulance ozugbo.

Ọrịa akụrụngwa na-egbu egbu na pancreatitis

N'ime ndị ọrịa, a na-egosikarị ọrịa hemodynamic nke nnukwu pancreatitis. Ahụ erughị ala na-esite n'ọdịda obi, mbelata ọbara mgbali na systolic ọbara na ventricles, aorta and pulmonary artery.

Ihe nkwụghachi nke akwara ọbara na-abawanye n'ihi ntọhapụ nke ihe ndị na - arụ ọrụ n'ihe metụtara biologically - serotonin, histamine, endorphin, wdg N'ọnọdụ a, a na - achọpụta mbelata nke olu na - ekesa mmiri n'ime ahụ.

Ugbo a dum na-akpali mgbanwe mgbanwe ọbara mgbali. Systolic na diastolic pressure na-ebelata nke ukwuu, ebe ikike nke mgbidi arịa ọbara na-abawanye.

Tachycardia na nkụchi obi.
Hemorrhages na anụ ahụ.
Ngosiputa ihe iru n’iru, n’iru ikpe azu.

N'ọnọdụ ụfọdụ, a na-ekpughe nnukwu nsogbu n’ime ụmụ nwanyị na ụmụ nwoke - oke ọgbụgba. Ọnwụ n’arụ n’ọbara n’arụ dị nke ukwuu. Site n'ụdị hypodynamic, nke na-aga n’ibelata ọnụego ọbara dị elu, ọ karịrị 50%.

Site n'ụdị hyperdynamic, mgbe ọbara mgbali biliri, prognosis ka mma - enwere ike ịnwụ bụ ihe karịrị 10%.

Syndromes ndị ọzọ

N'ime ndị ọrịa okenye, n'oge nnukwu ọrịa nke pancreas, ọrịa iku ume na-egosipụta onwe ya. Ihe na - ebute ya bu ihe egwu bu banye alveoli - sacs nke mejuputara mmadu. Ihe mgbaàmà na-agụnye ume mkpụmkpụ nke iku ume, nsogbu iku ume, anụ ahụ na-acha anụnụ anụnụ - n'ihi ụkọ oxygen.

Site na mgbaàmà ndị a, onye ọrịa chọrọ nlekọta ahụike. Ọrịa Respiratory anaghị etolite mgbe niile, mana ihe mere ya na-ebute oke ọghọm nke mmetụta ọjọọ. Dabere na ọnụ ọgụgụ, ọnwụ n'etiti ndị ọrịa okenye n'ihi oke iku ume na-akarị ihe karịrị 60%, mgbe ụfọdụ dị elu.

Na nnukwu pancreatitis, imeju na-ata ahụhụ. Ndị ọrịa na-eme mkpesa maka ihe mgbu na imeju. Nnukwu ibu dị na imeju, ihe mgbu ka ukwuu. Ihe na-akpata ya bụ nsị na-egbu egbu n'ihi oke usoro mkpali na ọrịa anụ ahụ. Na-emegide ihe mmebi imeju, syndromes ndị ọzọ dị.

Jaundice - imechi nke anụ ahụ, akwa protein nke anya, akpụkpọ ahụ mucous dị n'ire na ndo dị iche iche. A na-ejikọta ngosipụta a nke ọrịa na-akpata nsogbu nke mbugharị bile ma ọ bụ metabolir bilirubin na ahụ. Site na nsogbu imeju, ọbara mgbali na-abawanye, nsogbu uche, nsogbu ụra, tachycardia nwere ike ịhụ.

A na-achọpụta ọrịa nro na edematous na ụdị pensụl na-emebi ihe. Ọ na-egosipụta onwe ya dị ka mbelata ọnụego kwa ụbọchị nke diuresis. N'ime ọbara, ọnụego urea na creatinine na-abawanye n'ike n'ike. Ihe kpatara nsogbu akụrụ bụ:

Akpịrị ịkpọ nkụ na-akpata ọnya afọ na afọ ọsịsa,
Imebi akụrụ site na ngwaahịa ire ure nke anụ ahụ.
Nmebi akụrụ na-emerụ ahụ nke nsị na nje na-efe efe na nnukwu oria pancreatitis.
Ndalata nke ọbara mgbali elu na ụkpụrụ dị oke mkpa.

Ọnụnọ nke akụrụngwa ezughị ezu anaghị eme ka prognosis ka njọ. A na-eweghachi ọrụ nke akụkụ ahụ ngwa ngwa site na ọgwụgwọ zuru oke nke pancreatitis.

A na-eme ọgwụgwọ nke nnukwu pancreatitis mgbe niile na ọnọdụ anyị, ọ nweghị ihe ọ bụla. N'ọnọdụ ụfọdụ, pathology dịtụ mfe, a na-eweghachi onye ọrịa ngwa ngwa enweghị nsonaazụ ahụike na-adịghị mma.

Mgbe ụfọdụ, ọrịa palọ na-achọ nnukwu ọgwụgwọ na ntinye ọgwụ - ọtụtụ ihe osise ndị ahụ bụ ụdị ọrịa ahụ na-emebi emebi. Edematous pancreatitis dịtụ mfe, nwere nsogbu ole na ole.

Usoro ọgwụgwọ bụ nri. Na mbido, a machibidoro onye ọrịa iwu iri ihe ọ bụla iji ghara imepụta ibu karịrị akwara. Agụụ na-eme n'okpuru nlekọta ahụike, ọ na - abụkarị ụbọchị 2-5.

Belata ibu dị na sistemụ nri.
Normalize mgbasa ọbara n'ime ahụ.
Onye kwụrụ ụgwọ maka akpịrị ịkpọ nkụ.
Wepu mgbu, ọnyụnyụ dyspeptik.
Ọgwụ antibacterial na-egbochi nsogbu enwere ike.

Ọ bụrụ na onye ọrịa ahụ nwere ụdị mbibi, achọpụtara ọrịa nke abụọ, yabụ, a na-arụ ọrụ ọgwụgwọ. Enwere ọtụtụ usoro eji arụ ọrụ ahụike. Nhọrọ ahụ dabere na ọnọdụ akọwapụtara.

A na-emeghe ma mechie, iji endoscope. A na-eji usoro emeghe eme ihe naanị n'ọnọdụ ndị dị oke njọ - necrosis, perforation nke etuto ahụ, purulent peritonitis, ọbara ọgbụgba dị ukwuu.

N'ihi ya, ọrịa akwara ma ọ bụ na-emeghachi omume na-esochi syndromes dị iche iche. Agbanyeghị, ọnụnọ ha maka nchọpụta ezughị. Ozokwa, achoro ihe nlere ma obu ulo nyocha.

A kọwara ihe mgbaàmà nke pancreatitis na vidiyo ahụ n'isiokwu a.

Ebumnuche nke ebumnuche nke pancreatitis

1. Soreness na palpation dị ka Grogt na Mayo-Robson dị na ntule nke pancreas (na mmebi nke isi na isi nke Desjardins na Schoffar mpaghara, na mmebi nke ọdụ - na isi na mpaghara nke Mayo-Robson, mebiri anụ ahụ - na mpaghara Gubergrits-Skulsky na - ejikọ isi na ọdụ).

2. Soreness na Desjardins isi (ntụgharị akwara) - 4-6 cm site na otube n'okirikiri ahịrị na-ejikọ otube na mpaghara aka nri ziri ezi.

3. Ahụhụ na mpaghara Shoffar (ntule nke isi pancreatic).

4. Ahụhụ na mpaghara Mayo-Robson (isi ọdụ ya) - ókèala nke etiti na nke atọ nke mpaghara ahịrị na-ejikọ otube na mpaghara aka ekpe na-akwụ ụgwọ mgbe ọ na-aga n'ihu na mpaghara mpaghara akara aka ekpe.

5. Ahụhụ na mpaghara Mayo-Robson (akụkụ aka ekpe - ọgịrịga).

6. Ihe nrịba ama nke Grott - hypo- na atrophy nke abụba subcutaneous n'aka ekpe nke otube na ntule nke pancreas.

7. Positive phrenicus n'akụkụ aka ekpe dị mma (mgbaàmà nke Mussi-Georgievsky).

8. Ọmarịcha mgbaàmà nke Voskresensky bụ enweghị ọtịta nke nwa afọ na amụma nke pancreas.

9. Ihe atụ nke Tuzhilin bụ ọnụnọ nke odo na-acha odo odo (ọchịchịrị burgundy) nke ọbara ọcha na-agba site na 1-2 ruo 4 mm, nke bụ angiomas nke dị iche iche, n'ihi proteolysis n'oge iwe nke ọrịa pancreatitis na-adịghị ala ala (CP).

10. Ahụhụ na mpaghara Kacha - na ntule nke usoro njeghasị nke vertebrae n'aka nri T_IX-T_Xi, na aka ekpe - na mpaghara T_VIII-T_IX.

Usoro nke omume nke ọrịa

Aghọtaghị mmalite nke ihe mgbu na ndị ọrịa nwere CP, yana o yikarịrị ka ọ bụ n'ihi nsonaazụ multifactorial, gụnyere mbufụt, ischemia, ihe mgbochi nke ọrịa akwara na mmepe nke ọbara mgbakasị ahụ na-aga n'ihu na njiri nke enzymes pancreatic. Ekwenyere echiche a site na nlebara anya nke ndị ọrịa nwere fistulas nke mpụga, na ntinye nke mmiri site na fistula banye na pancreatic ducts (isotonic sodium chloride solution ma ọ bụ ọdịiche) ozugbo na-ebute ihe mgbu na-apụ n'anya mgbe mwepụ nke mmiri a gbanyere na mmiri ahụ.

Similarzọ yiri ya maka ihe mgbu na-akọwa mmụba ha mgbe ha risịrị nri (lee anya n'okpuru) na ihe mkpali ndị ọzọ nke sistem, na-abawanye nrụgide na sistemụ ductal, akụkụ ma ọ bụ na-egbochi kpamkpam n'ihi cicatricial na mkpali, calculi. Dabere na usoro a, ojiji a na-eji nsị mmiri na-agwọ CP. Usoro ọzọ nke ọrịa mgbu afọ bụ site na mmepe nke nsogbu, ọkachasị pseudocyst, nke, n'otu ọnọdụ na nha, nwere ike mpikota duodenum, GLP, traktị biliary, na akụkụ ndị ọzọ.

Usoro ọgwụgwọ nke afọ na duodenum, nke na-ekpebi 40% ma ọ bụ karịa na mkpakọrịta na CP, na-ekerekwa oke ọrụ na nnọchite na ogo nke ọrịa mgbu afọ. Mechanical allodynia nke isi mmalite (nghọta banyere ihe mgbu na-enweghị mgbakasị ahụ) bụ otu n'ime usoro nke etolite ọrịa afọ mgbu na ndị ọrịa CP. Site na ntinye aka nke abụọ na ọcha, usoro mgbu na-adịgide adịgide na-apụta, gosipụtara ọbụlagodi oke ihe mgbu nke iwelata CP.

Mpaghara mgbu

Site na CP, ihe mgbu ahụ enweghị nkọwa doro anya, na-eme na elu ma ọ bụ afọ ime na aka ekpe ma ọ bụ n'etiti, na-achagharị na azụ, mgbe ụfọdụ, na-ewere ụdị ejiji n'úkwù. N'ụfọdụ, mgbu na-ebu ụzọ chọta azụ. Ọkpụkpụ n’ime olu afọ bụ nsonaazụ nke paresis nke akụkụ eriri afọ na nnwere onwe nke nnukwu eriri afọ. Ọtụtụ mgbe ndị ọrịa na-enwe nchegbu banyere ihe mgbu na epigastrium na hypochondrium ekpe.

Mgbe ụfọdụ ndị ọrịa na-eme mkpesa maka ihe mgbu “dị elu”, na-akọwa ha dịka ihe mgbu na ọgịrịga, akụkụ ala nke ọkara aka ekpe. Site na mmụba nke ọrịa exocrine pancreatic insufficiency, nke abụọ (enteritis) na-esonyere CP n'ihi mmụba nke nje na-emetụta oke na eriri afọ (ọkachasị na mmanya na biliary dịgasị iche iche nke ọrịa ahụ), zoro ezo n'ime ọrịa enteropancreatic iche. N'otu oge, ihe mgbu na mpaghara epigastric, hapụrụ hypochondrium dịtụ mbelata, ihe mgbu nke ọdịdị na-asọ oyi na mpaghara. N'ime ndị ọrịa nwere CP mmanya, a na-ahụkarị ihe mgbu ahụ na hypochondrium ziri ezi n'ihi cholecystitis conpatitant, ịba ọcha n'anya, cirrhosis, duodenitis.

Ihe kachasị dị mma bụ irradiation nke mgbu na ọkara nke ara na azụ, na ọkara aka ekpe nke azụ dị ka “eriri aka ekpe” ma ọ bụ ụdị “eriri ukwu”. Ọkpụkpụ aka n’aka ekpe, n’okpuru agụba aka ekpe, n’azụ azụwa, banye mpaghara aka ekpe, aka ekpe nke mgbada ala kwere omume. N'okwu a, a na-enwetakarị ndị ọrịa n'ụlọ ngalaba nke ọrịa obi nwere ọrịa akwara ọria.

Oge mgbu

N'ime ihe karịrị 50% ndị ọrịa, ọrịa afọ mgbu na-adịgide ruo ogologo oge. Dịka iwu, ihe mgbu na-agbasi ike mgbe a na-eri nri, ọ na - abụkarị mgbe ọ dị nkeji iri atọ (ọkachasị ya na stenosis nke akwara panreatic). Nke a bụ n'ihi n'eziokwu na n'oge nke a, mkpụpụ nri sitere na afọ gaa duodenum bidoro na ahụrụ akwara na-enwe.

Na okpomọkụ zuru oke, ihe mgbu na-akpasu iwe site na hiri nne, mmanụ, nke a riedụrụ n’ọkụ, na-aokedụ sịga ma na-erughị nri na-atọ ụtọ, mmanya na ihe ọ carbonụ carbonụ carbon, ike nke ihe mgbu na-esonye na mmụba nke nsonaazụ ya na-akpali ya. Ọtụtụ mgbe, ndị ọrịa na-achọpụta ihe na-akpata iwe CP na njikọta nke ihe ndị a dị n'elu na ị smokingụ sịga. N'ime ụfọdụ ndị ọrịa, ọdịdị nke ihe mgbu adịghị nri. Mgbu nwere ike ịbụ paroxysmal ya na oge ọgụ site na ọtụtụ awa ruo ụbọchị 2-3, monotonous mgbe niile ma ọ bụ iji nkwalite paroxysmal. Site na mmepe nke necrosis pancreatic, ihe mgbu ahụ na-ebelata n'ihi ọnwụ nke nsọtụ akwara. N’oge na-adịghị anya, ndị ọrịa na-agbasasị obi site na mgbu abalị na - emetụta mmiri nzuzo nke bicarbonates iji belata hyperecretion acid nke hydrochloric acid, na - eme ka dọkịta chee banyere ọnụnọ ọnya duodenal.

Nhọrọ maka mgbu afọ mgbu:
• ọrịa ime,
• dị ka ụdị aha mkpụrụedemede ekpe dị n'akụkụ aka ekpe,
• ọrịa nke hypochondrium ziri ezi (na 30-40% sitere na cholestasis),
• dismotor,
• zuru ebe nile (na-enweghị nkọwa doro anya).

Ọdịda Ahụike Pancreatic Exocrine

Ọrịa nke exocrine insufficiency na CP bụ nke a na-akpata site na mbelata nke oke ọrụ exocrine parenchyma n'ihi atrophy, fibrosis, ma ọ bụ mmebi nke mmịpụta nke ihe mmịpụta nke mkpụrụedemede na duodenum n'ihi ngọngọ nke mmiri na - egbochi imeju nke akwara site na akwara nkọlọ, oke na viscous secretion. Site na ogwu, oria na egosiputa onwe ya dika oria nri digestive n’ihi mbelata nke oru nke enzymes pancreatic - maldigestia.

Mmepe nke steatorrhea na CP na-ejikarị mmebi nke akwara mkpụrụ nke pancreatic lipolysis n'ihi mbelata nke njikọta akwara palọ. Na mgbakwunye, mmebi nke nzuzo nke bicarbonates nke na-apụta n'ihi nkwụsị nke akụkụ nke akwara, yana na steeti hyperacid, na-eduga na "acidification" nke duodenum. N'ebe gburugburu acidic, yana inactivation nke lipase pancreatic, ọdịda nke bile acid na-apụta ma mebie nhazi micelle. Usoro a na-eme ka ike na-anyụbiga abụba ike dị na ezughi oke ume nke exocrine. A na-egbochi abụba na-enweghị isi na lumen nke eriri afọ site na nje, n'ihi nke a na-akpali ọrụ nzuzo nke colonocytes.

Egosiputara onyonyo a site na mmụba nke ukwu nke stool (polypecal) na ugboro nke stool (afọ ọsịsa), feces nwere mushy ma ọ bụ mmiri na-agbanwe agbanwe, na-enwekarị isi na-adịghị mma, na-akpasu iwe, na-egosi ntụpọ na-acha ọcha na elu na-egbu maramara (na-egbu egbu, "mmanụ"), yana ajọ steatorrhea ọ na-adịghị ọcha na-asachapụ site na mgbidi nke mposi. Ọtụtụ mgbe, ndị ọrịa na-achọpụta lethrea.

N'ihi ịba mmiri n'ime eriri afọ nke na-ezuru ụkọ mmiri exocrine, ọrịa ụkwara ume ọkụ na-amalite, na-enwe oke ibu na-aga n’ihu, n’ajọ ikpe - mmiri ọgbụgba, ụkọ, nke bụ vitamin na-agbanye ike na ihe ndị metụtara ya, anaemia na nsogbu ndị ọzọ.

N'ọnọdụ ụfọdụ, na ndị ọrịa nwere oke ume nke nkụpu ume nke oke ụjọ, oke ibu na-ebilite nzụlite ahụkarị na agụụ. Nke dị oke mkpa ka a na-ejikọkarị ya na dysmotoria gastric nke na-egosipụta, nke ọgbụgbọ, ọgbụgbọ, satiety n'oge na mgbaàmà ndị ọzọ. Ọ dị mkpa iburu n’uche na mgbaama ndị a nwere ike ịbụ nke obere oge, nke dọnyere oge nke mwakpo nke pancreatitis, na ogologo oge n’ihi nsogbu nri nri na-agbari n’ime ya na ime ka ọgbụgba akwara dị n’ime ndị ọrịa na-anọgidesi ike na -akwu ọnya afọ ma nwee oke ume nke umeji.

Ihe ntinye di iche na mmepe nke oke ibu bu nlezianya nlebara anya nke ndi ọrịa nke nri riri oke na mmachi nke ngwa agha kachasi ike - okpukpo na carbohydrates, ya na oburu oria neko nke neko nke ozo. Na mgbakwunye, carbohydrates dị mfe digestible nwere oke maka ndị nwere ọrịa shuga dị elu. Ọrịa Endocrine ọrịa

Ngosiputa nke ogwu banyere oria akwara nke oru puru iche di n’etiti ndi mmadu, ma ihe ngosi nke oge adighi nke CP, bu nke achoputara na 25% nke ndi oria. Varizọ abụọ dị iche iche nke ngosipụta: hyperinsulinism na ọrịa shuga nke mellitus.

Ejiri Hyperinsulinism site na mwakpo nke ọnọdụ hypoglycemic, na-abụkarị nke na-amalite na mmalite nke CP, mgbe echekwara ọrụ pancreatic. N'oge ngwụsị nke CP, a na - amalite hyperinsulinism dị ala site na mbelata nke mmepụta nke homonụ na - egbochi glucagon. Enwere mmetụta agụụ, ịma jijiji n'ahụ niile, ọsụsọ oyi, adịghị ike, nchekasị, mkpasu iwe, ịma jijiji na paresthesias. Ọnọdụ a nwere ike ịdị ọtụtụ awa ruo ọtụtụ ụbọchị.

Mwakpo ndị dị otú a na-apụta n'ụtụtụ na afọ na-enweghị isi ma ọ bụ n'oge agụụ nọrọ ogologo oge, na-apụ n'anya ngwa ngwa mgbe ị risịrị nri, mana ọ nwere ike ịmaliteghachi mgbe awa 2-3 gachara. na mmeri, amnesia post-Attack ka amaputara. Site na mmụba nke ọgụ hypoglycemia na mbelata ọbara shuga na ọdịdị nke ihe ndị mebiri emebi nke ụbụrụ, a na-achọ nchọpụta ọdịiche na insulinoma.

Ọrịa pancreatogenic na-arịa mellitus na-etolite n'ihi atrophy nke mkpụrụ ndụ islet na nnọchi ya na anụ ahụ na-ejikọta ya; a na-ahụkarị ya na pancreatitis na mgbanwe ndị kacha sie ike na paịlị pancreatic. Ekwesiri icheta na site na iwe nke CP, ogo nke glucose ọbara na-agbadakarị. N'okwu a, hyperglycemia jikọtara ya na ọrịa palọlọ na mpụga mpụga ọgwụ insulin. N'okwu ndị a, ka ụlọọgwụ na-eme ka iwe CP aka njọ, ọkwa glucose ọbara na-abụkarị nke ọma.

Ọtụtụ mgbe, ọrịa shuga mellitus na-apụta na ndabere nke ọrịa pancreatitis na-efe efe ma nwee ike ịbụ ihe osise na-adakarị na ọrịa. Ọrịa shuga dị n'ime ndị ọrịa nwere CP dị iche n'ụdị insulin ndị ọzọ, ọkachasị, ebumnuche nke ọnọdụ hypoglycemic, yabụ ha chọrọ nlebara anya ugboro ugboro maka ọkwa glucose ọbara. Ihe mgbaàmà mbụ nke ọrịa shuga gụnyere ọrịa na-efekarị na ọrịa anụ.

Ọrịa ọbara mgbali elu Biliary

Egosiputa ya site na jaundice na cholangitis. Ihe ruru 30% nke ndị ọrịa nwere CP na oke nwere ọrịa hyperbilirubinemia dị mkpụmkpụ ma ọ bụ nke na-adịgide. Ọnụnọ nke stenosis nke akụkụ nke intrapancreatic nke ihe na-emetụta otu ihe na - emetụta ọnụọgụ nke 10,46% nke ikpe. Ihe na - akpata ọrịa a bụ mmụba nke isi akwara site na mkpakọ nke akụkụ ọnụ nke ihe na - apụtakarị mmadụ, ọrịa nke BDS (calculi, stenosis). N'okwu nke mbụ, jaundice na-etolite nwayọ nwayọ, nwayọ, na mbụ ọ nwere ike ịnọ ebe ahụ, ọbara ọgbụgba biliary nwere ike igosipụta onwe ya naanị site na mgbu mgbu na hypochondrium dị mma, mmụba dị elu na bilirubin na alkaline phosphatase na ọbara ọbara, ụfọdụ mmebi nke bile dupe na mbelata ọrụ nsị nke ọnya.

Na pancreatitis na-esoghị cholelithiasis, ọgbụgba biliary latent, nke gụnyere akara x-ray nke warara nke akụkụ intrapancreatic nke ihe na -adakarị azụ na mgbali biliary proximal, bụ ihe a na-ahụkarị karịa jaundice siri ike. Naanị mgbako agbatị ogologo oge nke dule nkịtị na-eji nwayọọ nwayọọ na-eduga na ngụkọta ma ọ bụ okpuru ulo nke duct ahụ, yana ụlọ ọgwụ na -akwu jaundice na acholia, pruritus, hyperbilirubinemia na mgbaàmà ndị ọzọ.

Na CP nwere ọnya mmerụ ahụ nke isi akwara ahụ, ọdịdị nke jaundice na-egosikarị ọrịa ahụ ma ọ bụ ngbanye nsogbu (pseudocyst), ọ na-esikarị ọdịdị nke jaundice, na ntụle, site na nbibi nke usoro mkpali na mmepe nke nnukwu ịba ụba na mpaghara akụkụ abụọ nke intrapancreatic.

Data Nnyocha ebumnuche

Anamnesis. Mgbe ị na-akọwapụta ihe anamnesis, ekwesịrị ị attentiona ntị na nrụrụ e kesara eketa n'ihi ị ,ụbiga mmanya ókè, iji ihe ọ alcoholụ alcoholụ na-aba n'anya, ị smokingụ sịga, OP nke gara aga, onye ọrịa maara nke ọma na ọnya ọrịa biliary.

Nnyocha General. Ọnọdụ ọnọdụ onye ọrịa ahụ nwere ike ịdị iche - site na afọ ojuju ruo oke njọ, nke dabere na ogo ọrịa mgbu, ihe mgbaàmà nke ịxụbiga mmanya ókè, ogo nke oke ume ọkụ ọgbụgba, ọgba aghara nke etiti na nsogbu akwara. Ogo nke erighị ihe na-edozi ahụ na-agbanwe nke ukwuu. Ire rere ure, mgbe ụfọdụ, asị.

Ọrịa ndị metụtara nzere enzyme n'ime ọbara dị ụkọ. Ihe nrịba ama nke nsogbu nri-protein na-adịghị mma. Site n'akụkụ nke usoro akwara obi megide ihe mmerụ ahụ, enwere ike ikpebi mpụtaịkasị dystrophy: mmụba nke ókèala adịghị ala obi, ụda akpịrị, tachycardia, mkpesa systolic na kolx, extrasystole. Yiri na ogo nke OP, ọnya ọbara na-ebelata. N'ọtụtụ ọnọdụ, a na-ekpughere ihe ịrịba ama nke ikike iwepụ ibu dị iche iche n'aka ekpe, ọ na-adịkarị n'akụkụ abụọ. Site na palpation nke oke nke afọ, mgbu na epigastrium, hypochondrium ekpe nwere ike kpebie. N'ime amụma nke pancreas, a naghị enwekarị nguzogide n'ihi eziokwu ahụ bụ na gland dị adịghachi azụ.

Ọrịa mgbu

Ofkọwapụta ihe mgbu dabere na mmeri nke pancreas:

mgbu na hypochondrium nke aka ekpe nke otubebere na-eme mgbe emetụta ọdụ nke pancreas,
mgbu na mpaghara epigastric, n'aka ekpe nke midline, - na mmebi ahụ,
mgbu rue aka nri nke midline na mpaghara Shoffar - ya na oria nke isi akwara.

Na mmerụ ahụ zuru oke, akụkụ ahụ na - agbasasị, n'ụdị "eriri" ma ọ bụ "ọkara eriri" n'ime akpa afọ. Mgbu na-ebili ma ọ bụ gbasie ike oge 40-60 mgbe erichara nri (karịchaa, oseose, eghe, mmanụ). Ọfụma na-akawanye ike n'ike n'ike, ọ na-esikwa ike n'otu oche dị nfe. O nwere ike itughari na mpaghara obi, gaa na scapula ekpe, ubu aka ekpe, simulating angina pectoris, na mgbe ụfọdụ gaa mpaghara mpaghara ekpe.

Ihe mgbu ahụ nwere ike ịbụ nke oge, na-adigide site na ọtụtụ awa ruo ọtụtụ ụbọchị, na-adịkarị mgbe e risịrị nri, ọkachasị abụba na abụba, mmanya, ma ọ bụ na-agbanwe mgbe niile, mgbe ị risịrị nri. Painụ ọruụ mgbe niile na-eme ka ị ofụ ọgwụ ike sie ike ruo ọgwụ ọjọọ, nke a na-adịghị mma, n'ihi na n'ọdịnihu nwere ike ibute iri ọgwụ ọjọọ.

Mgbe ụfọdụ, n’ihu ihe ịrịba ama ndị ọzọ nke pancreatitis, mgbu nwere ike ịnọ kpamkpam - ụdị a na-akpọ ụdị enweghi mgbu.

Isi ihe na-akpata mgbu na pancreatitis na-adịghị ala ala bụ mmụba dị ukwuu na ngụgụ nke pancreas n'ihi mmebi nke mmiri nke mmiri, yana mgbanwe mkpali na sclerotic na parenchyma nke gland na anụ ahụ na-esote ya, na-eduga na mgbakasị akwara endings.

Ihe mgbu na-adịgide adịgide bụ ihe kpatara nsị anụ na akwara na mmepe nke nsogbu, dịka pseudocyst, siri ike ma ọ bụ okwute nke okpomoku akwara, stenotic papillitis, ma ọ bụ ụkwara anyanwụ nke na - ebutekarị ọrịa a.

N'oge nsogbu ahụ, ọrịa palza na-ebuwanye ibu nwere ike itinye mgbali na celiac plexus, na-akpata nnukwu ihe mgbu. N'okwu a, ndị ọrịa na-arụ ọrụ e ji mara ha - ha na-anọdụ ala, na-atụgharị ihu. Ọtụtụ mgbe, n'ihi nnukwu ihe mgbu, ndị ọrịa na-amachi onwe ha na iri nri, nke na-aghọ otu n'ime ihe kpatara eji egbulata ibu.

Ekwesịrị iburu n'uche na, na mgbakwunye mgbu (nke enwere ike ịhụ ya na mmalite nke ọrịa ahụ), ihe mgbaàmà ndị ọzọ nke ọrịa na-adịghị ala ala na-apụtakarị na ọkwa nke ọrịa ahụ.

Ọtụtụ mgbe na ndị ọrịa nwere ọrịa ogbu na nkwonkwo, a na-ahụta ihe dị iche iche nke ọrịa dyspeptik: mbelata ma ọ bụ enweghị agụụ, njigide ikuku, nnu, ọgbụgbọ, ọgbụgbọ, flatulence, ọgba aghara oche (ọnya afọ ma ọ bụ ọria ụkwara na afọ ntachi). Vomiting adịghị eweta ahụ efe.

Ọtụtụ ndị ọrịa na-eme mkpesa banyere adịghị ike n'ozuzu, ike ọgwụgwụ, adynamia, na nsogbu ụra.

Ngosipụta akara na isi nke pancreas nwere ọrịa pancreatitis (edema ma ọ bụ mmepe nke fibrosis) nwere ike ibute mkpakọ nke agịga nkịtị na mmepe nke jaundice.

Ihe mgbaàmà nke ọrịa pancreatitis na-adịghị ala ala dabere na ọkwa nke ọrịa ahụ: ogbo II na karịsịa ogbo nke III na-eme na mmebi nke ọrụ excretory na endocrine nke pancreas, akara ngosipụta ahụike karịa na mgbanwe siri ike achọpụtara site na laabu na ụzọ ọrụ. Imirikiti ndị ọrịa nwere ihe mgbu na paroxysmal, ọrịa dyspeptik na-aka ekwupụta, mgbaze nke ngwaahịa nri na ntinye afọ, gụnyere vitamin, na-enye nsogbu. Ọrịa afọ ọria (nke a na-akpọ pancreatogenic afọ ọsịsa) nwere nnukwu abụba (enwere ike ịsacha n'ụlọ mposi). Ndị ọrịa na-enwe oke ahụ ha. N'ụfọdụ, enwere ogologo oge nke ọrịa pancreatitis, a na-achọpụta mbelata nke ihe mgbu ma ọ bụ mwepu kpamkpam.

Mgbaàmà nke ọbara mgbali Biliary

A na-egosipụta nrịanrịa ọbara mgbali na ọrịa jaundice na cholangitis ma bụrụ ihe a na-ahụkarị. Ihe ruru 30% nke ndị ọrịa nọ n'ọgba aghara nke ọrịa pancreatitis na-adịghị ala ala nwere hyperbilirubinemia dị mkpụmkpụ ma ọ bụ nke na-adịgide. Ihe ndị na-akpata ọrịa ahụ bụ mmụba nke isi pancreas na mkpakọ nke ọnụ nke ihe a na-akpọ bile dupe, choledocholithiasis na ọrịa nke nnukwu paodenal papilla (calculi, stenosis).

Ihe mgbaàmà nke nsogbu endocrine na pancreatitis na-adịghị ala ala

Amata ihe dịka otu ụzọ n'ụzọ atọ nke ndị ọrịa. Ihe ndabere maka mmepe nke nsogbu ndị a bụ mmeri nke mkpụrụ ndụ niile nke islet ngwa nke pancreas, n'ihi nke enwere ụkọ nke ọ bụghị naanị insulin, kamakwa glucagon. Nke a na - akọwa usoro nke ọrịa mamịrị nke ọrịa pancreatogenic: mwepu hypoglycemia, mkpa insulin insulin, obere mmepe nke ketoacidosis, vaskụla na nsogbu ndị ọzọ.

Nchọpụta nke ọrịa pancreatitis na-adịghị ala ala

Agnochọpụta ọrịa pancreatitis na-adịghị ala ala bụ ihe gbagwojuru anya ma dabere na ihe ịrịba ama 3: akụkọ ihe mere eme (mwakpo mgbu, ị abuseụbiga mmanya ókè), ọnụnọ nke exocrine na / ma ọ bụ enweghi oke endocrine, na njirimara nke mgbanwe nhazi na pancreas. Ọtụtụ mgbe, a na-achọpụta nchọpụta nke ọrịa pancreatitis na-adịghị ala mgbe ọ nyochasịrị ogologo oge nke onye ọrịa nwere akara akara na-egosi na ọnụnọ nke pancreatitis na-adịghị ala ala.

Nyocha ụlọ nyocha

Ọbara maka mmiri ọgwụ. Ọkwa amylase, serum lipase na-abụkarị nke nkịtị ma ọ bụ belata n’oge ọgụ nke pancreatitis, nke akọwara site na mbelata ọnụ ọgụgụ mkpụrụ ndụ acinar na-emepụta enzymes ndị a. Site na njikọta nke pancreatitis na-egbu egbu na ọrịa imeju na-egbu egbu, enwere ike ịchọpụta ule imeju na-arụ ọrụ. Na 5-10% nke ikpe nke pancreatitis na-adịghị ala ala, enwere akara nke mkpakọ nke intrapancreatic akụkụ nke bile dupe, n'ihi edema ma ọ bụ fibrosis nke isi pancreatic, nke a na-esonyere jaundice, mmụba nke ọkwa bilirubin na serum alkaline phosphatase.

Mmebi nke nnabata glucose na-etolite na 2/3 nke ndị ọrịa, ọrịa shuga mellitus - na 30% nke ndị ọrịa nwere ọrịa na-adịghị ala ala.

Enweghi ike nke Exocrine bu nke aputara ma ahuta ya ngwa ngwa site na mmetuta ahu na-adighi nma, bu nke ike ukwu (Sudan taboro aru) ma obu usoro onodu ya. A na-achọta ezughi ezu na ọkwa mbụ site na iji ule arụ ọrụ.

A na-ewebata enzyme njikọta ọgwụ enzyme maka mkpebi nke elastase-1 n'ọbara ọbara na feces nke ndị ọrịa ka emee ha n'ọrụ omume maka nchọpụta nke ọrịa pancreatitis na-adịghị ala ala, nke na-enye ohere ịtụle ọrụ exocrine pancreatic.

Nchọpụta ọrịa nke ọrịa pancreatitis na-adịghị ala ala

Enwere ike ịtụle data sitere na nkwenye nke ọnụnọ nke ọrịa pancreatitis na-adịghị ala ala. Ejiri ndị a:

- ultrasound nke eriri afọ,
- endoscopic ultrasound, agbakọrọ agbakọ gbadoro ụkwụ na onyonyo ndọta nke pancreas.

ERCP na-enye ohere ịchọpụta stitosis duct, nsonaazụ ihe mgbochi, mgbanwe nke ihe owuwu na obere ducts, ntinye anụ na protein protein, agbanyeghị, enwere nnukwu ihe ize ndụ nke nnukwu ọrịa pancreatitis.

Ọrịa dị iche iche banyere ọrịa akwara nke pancreatitis

Ọrịa nke pancreatitis na-ezo aka na akara nke "oke ime." Nke a pụtara na ọ dị mkpa ịmata ọdịiche nke ọrịa pancreatitis site na ọrịa ịwa ahụ na-arịa oke nke akwara afọ, ya bụ: site na ọnya afọ zuru oke, nnukwu cholecystitis, ihe mgbochi afọ, eriri afọ nke akwara.

Ọrịa afọ na-apụ n'anya. Imeju afọ ma ọ bụ ọnya afọ dị iche na nnukwu ọrịa palọ na "mgbu dagger". Ihe mgbu a na njikọta nsị nke eriri afọ ma ọ bụ eriri afọ n'ime peritoneum, nke na-eme ka mgbatị ahụ dị n’azu ime, ma ọ bụ afọ a na-akpọ plasta. Maka ọrịa ogbu egbu, nke a abụghị njirimara. Vomiting na ọnya afọ na-adịkarị ụkọ. Onye ọrịa ahụ enweghị ogbi. Onye ọrịa pancreatitis na-echegbu onwe ya, na-awagharị n'ihe ndina. Ihe onyonyo panoramic na-egosi mmanụ n’ọkpụkpụ n’ime afọ nwere ọnya afọ juru. Emechara nchọpụta ikpeazụ na ndabere nke ultrasound ma ọ bụ laparoscopy.

Nnukwu cholecystitis. Ọ nwere ike isi ezigbo ike ịmata ọdịiche dị n'etiti ọrịa abụọ a. Ma na ihu ọma nke cholecystitis ga-ekwu ihe kasịnụ mmegharị ahụ mgbu n'akụkụ aka nri na radieshon na mpaghara nke ubu aka nri. Mgbe ị na-eme ultrasound, enwere ike ikpebi nsonaazụ nke mbufụt, mana ọ bara uru icheta na pancreatitis nwere ike iso cholecystitis.

Nnukwu mgbochi afọ. Mgbu na mgbochi afọ eriri afọ na - akpọ nkụ, yana ọrịa pensụl, ihe mgbu ahụ na - adịgide, na - egbu mgbu. Na radiographitis maka ọrịa pancreatitis, a ga-ebute nnukwu eriri afọ, mana enweghị ụta Kloiber.

Mesothrombosis. Mesothrombosis na - ebutekarị ndị okenye nwere ọrịa obi. Ọrịa na-abawanye ngwa ngwa, mana ọ nweghị ụzọ ọ bụla metụtara nri. Laparoscopy ma ọ bụ angiography ga-enyere aka dozie obi abụọ.

Myocardial infarction. Mgbe ọ rutere n'ụlọ ọgwụ, a na-arụ ọrụ elektrokki mgbe niile; ọ naghị esiri ike ịmata ọdịiche dị n'etiti ọrịa pọdkasị.

Ọgwụ nke pancreatitis na-adịghị ala ala

Enwere ike ịgwọ ọrịa ọrịa mgbu na-adịghị ala ala site na nlekọta nke onye ọrịa na-ahụ maka eriri afọ ma ọ bụ usoro ọgwụgwọ.

Ebumnuche nke ọgwụgwọ nke ọrịa pancreatitis na-adịghị ala ala nwere ike ịtụle ihe ngwọta nke ọtụtụ nsogbu:

- mwepu nke ihe ndị na-akpali iche (mmanya, ọgwụ ike, mgbochi),
- enyemaka mgbu
- mgbazi nke exo- na endocrine ezughi oke,
- ọgwụgwọ nke nsogbu concomitant.

Ebumnuche ebumnuche nke ọgwụgwọ nchekwa bụ ịkwụsị ma ọ bụ mee ka ọ na-aga n'ihu nke ọrịa na-adịghị ala ala na ịlụso nsogbu ya ọgụ. Dabere na ịdị njọ nke afọ mgbu, a na-eji usoro ọgwụgwọ nke pancreatitis na-adịghị ala ala eme ihe, nke nwere ike ịgụnye ihe ndị a:

- Nri, nke nri di nkpa, okpukpu pere mpe karia 60 g.
- Enzymes pancreatic (pancreatin, creon, mezym, panzinorm, festal, penzital, enzistal) + H2-blockers (famotidine, ranitidine, cimetidine, nizatidine).
- analgesics non-narcotic (acetylsalicylic acid, diclofenac, ibuprofen, piroxicam).
- Octreotide (sandostatin).
- Opupu mmiri Endoscopic (Olimpus, LOMO, Pentax, Fujinon).
- analgesics narcotic (butorphanol, antaxone, fortal, tramadol, sedalgin-neo).
- Igwe mgbochi nke anyanwụ plexus.
- ogwugwo ogwugwo.

Site na ọrịa mgbu na-adịghị ike, enwere ike nweta ihe ịga nke ọma n'ihi nri siri ike, nkebi (kwa awa 3) nri nri na igbochi abụba ruo 60 g kwa ụbọchị, nke na-enyere aka belata ihe nzuzo na nri kalori.

Ọgwụ maka ọgwụgwọ nke ọrịa pancreatitis na-adịghị ala ala

N'iburu n'uche na isi ihe na-akpata ihe mgbu bụ ọbara mgbali intrasiaal, ọ bụ ihe amamihe dị na ya ị drugsụ ọgwụ na-egbochi ihe nzuzo puru iche.Nọmalị, mwepụta nke cholecystokinin, ihe na - akpali akpali nke ọrụ pesọciko, bụ nke a na - achịkwa peptide cholecystokinin na obere eriri afọ, nke na - ahụ maka trypsin ma na - arụ ọrụ na akwara nke eriri afọ. Nhọpụta nke enzymes pancreatic (mesim forte, pancreatin, panzinorm, na lycraase pancitrate) na-enye nnwere onwe mgbu na ụfọdụ ndị ọrịa n'ihi ntinye nke usoro nzaghachi: mmụba nke ọkwa nke nchebe na lumen nke duodenum na-ebelata ntọhapụ na mkpokọta homonụ eriri afọ (cholecystokinin), nke na-eduga na mkpali nke arụ ọrụ exocrine pancreatic, mbelata nke intralenceal na nrụgide anụ ahụ yana enyemaka mgbu.

Ekwesịrị icheta na ọ ga-ekwe omume iji acid gastric na protein a na-egbochi ọgwụ nri. Iji gbochie mmetụta a, a na-eji ngwakọta enzymes (pancreatin, creon, mezym, panzinorm, festal, penzital, enzistal) na ndị na-egbochi H2-histamine blockers (famotidine, ranitidine, cimetidine, nizatidine). Ọtụtụ usoro nhazi enzyme maka iwepụ ihe mgbu kwesịrị ịbụ nke zuru oke, n'ọmụmụ ihe abụọ na-achịkwa okpukpu abụọ nke pancreolipase na dose 6 mbadamba 4 kwa ụbọchị maka ọnwa 1 belata belata ihe mgbu na 75% nke ndị ọrịa nwere nnukwu ọria. Enzymes enzymes nke na-egbochi acid-mini-microspheres (Creon) bụ nke mbụ ugbu a na ọgwụgwọ ọgwụgwọ mgbu mgbu na oke nke oke ume. A na - amata ụdị usoro onyonyo microgranular (Creon 10,000 ma ọ bụ 25,000) ngwa ngwa (mgbe 45 min) hapụsịrị ihe karịrị 90% nke enzymes na pH nke duodenal na obere eriri afọ nke 5.5 na elu.

N ’ọnụ ala pH dị ala, a na-eji ọgwụgwọ ịgwọ ọrịa na H2 antagonists ma ọ bụ proton pump inhibitors (lansoprazole, omeprazole, pantoprazole, rabeprozole) na eriri afọ. Na mgbakwunye, e gosipụtara na ọgwụgwọ nnọchi enzyme na-eme ka nri dị n'akụkụ eriri afọ, na-emetụta ọrụ ọrụ nke eriri afọ ma si otú a na-enyere aka belata malabsorption.

Edebere enzymes nke a na-akpọ pancreatic n'ọnọdụ ọ bụla nke pancreatitis na-adịghị ala ala iji dozie ọrụ ọgwụ ụjọ nke exocrine. Drugsakingụ ọgwụ ndị a na-ebelata mgbakasị afọ na afọ ọsịsa n'ihi mmịba nke abụba, na-ebelata ihe mgbu. Nkwadebe enzyme belata ike mgbu na-adịghị ala ala pancreatitis na-adịghị ala ala, ọkachasị ụmụ nwanyị nwere ọrịa pancreatitis na-egbochi, na-emegide usoro mkpịsị ugodi abụọ. N'ime ụmụ nwoke na-a pancụ ọgwụ areatụ na-egbu egbu, ọgwụ ndị a adịchaghị arụ ọrụ.

Maka nnwere onwe nke steatorrhea na pancreatitis na-adịghị ala ala, a na-egosipụta nkwadebe nwere nnukwu lipase, mkpuchi maka nhụjuanya nke ihe mgbu, a na-egosipụta nkwadebe nwere nnukwu ọdịnaya nke nchebe na-enweghị mkpuchi.

Na enweghị mmetụta nke ọgwụ enzyme nnọchi na njikọta ya na H2-histamine mgbochi, nhọpụta nke analgesics dị mkpa, paracetamol (daleron, prodol, efferalgan), ọgwụ mgbochi na - abụghị steroidal: diclofenac (apo-diclo, voltaren, diclofenac, ortofen), na ibupen nwekwara ike -ibuprofen, ibuprofen, ibuphene, solpaflex), piroxicam (piroxicam, piroxifer, felden, erazon), celecoxib (celebrex), lornoxicam (xefocam), meloxicam (meloxicam, movalis), nimesulide (mesulide, nayz) proxene (apo-naproxen, nalgesin, naproxen).

Ka ịkwụsị mgbu na pancreatitis na-adịghị ala ala, a na-enye octreotide (sandostatin). Onye nwere ikike mgbochi homonụ nke neuroendocrine eriri afọ, sandostatin na-egbochi ihe ndị ọzọ na-akpali akpali ma na-eme ka ihe nzuzo na-akpali akpali site na ime ihe na anụ ahụ exocrine ma na-ebelata ntọhapụ nke nzuzo na cholecystokinin. Ọgwụ ahụ dịkwa irè na ọgwụgwọ nke pseudocysts, pancreatic ascites and pleurisy. Ejiri subcutaneously 50-100 mcg ugboro 2 kwa ụbọchị maka izu 1 maka ọgwụgwọ nke ụdị mgbu na-egbu mgbu na-egbu mgbu.

Mgbe ị na-echekwa mgbu ahụ, ọ dị mkpa iji duzie ERCP maka ịkọwapụta ihe gbasara ihe mebiri emebi na mkpokoro ahụ, mkpochapu nsị nke sphincter nke Oddi. N'okwu a, enwere ike ịtụle iji ụzọ ọgwụgwọ ndị na-adịghị emerụ ahụ: ngwụsị endoscopic na shunting, na-egbochi steroid nke anyanwụ na steroids, pancreaticoejunostomy na resection.

Nnukwu ihe isi ike jikọtara ya na ọgwụgwọ nke sphincter nke Oddi dysfunction, otu n'ime ihe na-akpata mmepe nke ọrịa pancreatitis na-adịghị ala ala, siri ike nchọpụta. Site na dysfunction nke sphincter nke Oddi, enwere mmetụta na-abawanye nke mgbidi nke pancreatic na bile dupon na-agbanwe na olu na nrụgide.

Ọ dị mkpa ịhapụ ọgwụ na choleretic mmetụta (bile acid, gụnyere ndị nọ na nhazi nke enzyme nkwadebe - festal, enzystal, wdg, decoctions nke choleretic herbs, ọgwụ choleretic sịntetik).

Iji belata spasm nke anụ ahụ dị nro nke spdicter nke Oddi na cystic duct, a na-eji nitrates: nitroglycerin - maka enyemaka ahụ mgbu ngwa ngwa, nitrosorbitol - maka usoro ọgwụgwọ (n'okpuru njikwa ndidi ọgwụ).

Myotropic antispasmodics (bendazole, benzocyclan, drotaverin, mebeverin, papaverine) belata ụda na ọrụ mmegharị nke akwara dị mma. Ndị isi nnọchi anya otu a bụ papaverine, drotaverin (enweghị-shpa, no-shpa forte, vero-drotaverin, spazmol, spakovin), benzocylan (halidor). Myotropic antispasmodic kachasị dị irè bụ duspatalin (mebeverin) - ọgwụ akwara nke akwara-tropic, ọgwụ antispastic nwere mmetụta kpọmkwem na akwara ire ụtọ. N'ịhọrọ ihe dị mma na Oddi, ọ bụ ugboro 20-40 karịa ike karịa papaverine n'ihe gbasara ike ya iji dozie sphincter nke Oddi. Ọ dị mkpa na duspatalin anaghị emetụta usoro cholinergic ma yabụ anaghị akpata mmetụta ndị dị ka ọnụ akọrọ, ọhụhụ ụzọ, tachycardia, njigide urinary, afọ ntachi na adịghị ike. A na-agbakọ ngwa ngwa mgbe ọ na-agafe akwara, metabolites niile na-apụ ngwa ngwa na mmamịrị. Mkpocha ọgwụ zuru oke na-apụta n'ime awa 24 mgbe ị afterụsịrị otu ọgwụ, n'ihi nke a, ọ naghị agbakọ na ahụ, ọbụna ndị ọrịa agadi adịghị mkpa mmezi dose. Edere Duspatalin kapusul 1 (200 mg) ugboro 2 n'ụbọchị, ọ ka mma ị were ya nkeji iri abụọ tupu nri.

Ọgwụ antyopasmodic ọzọ myotropic nwere nhọrọ a na-ahọrọ bụ gimekromon (odeston) - ọgwụ phenolic sitere na coumarin na-enweghị ihe anticoagulant na-enwe ọgwụ antispasmodic na choleretic. Gimekromon bụ analogue nke umbelliferone dị na mkpụrụ nke anise na fennel, nke e ji mee ihe dịka ọgwụ antispasmodics. Ọgwụ ahụ na-enye otu ma ọ bụ mmetụta ọzọ dabere na njirimara nke ihe ya na ọkwa dị iche iche nke ọnya biliary. Odeston na-ebute nsogbu nke ọnya afọ, na-ebelata nrụgide intralence, ma, yabụ, bụ antagonist nke cholecystokinin. Na ọkwa nke sphincter nke Oddi, ọ na cholecystokinin na-eme mmekọrịta, na-ebelata mgbali basal ma na-abawanye oge nke oghere sphincter nke Oddi, si otú a na-abawanye akụkụ nke bile site na dule dule. N'ịbụ onye na-eme nhọrọ antispasmodic nke ukwuu, Odeston nwekwara akụrụngwa choleretic. Mmetụta choleretic ya bụ n'ihi mmụba na mmụba nke bile n'ime obere eriri afọ. Mmụba nke mmiri nke bile n'ime lumen nke duodenum na-enyere aka melite mgbaze, ịgbalite motility eriri afọ yana norm nke stool.
Odeston ka etinyere ọgwụ mg (400 mg) (mbadamba nkume abụọ) ugboro atọ n'ụbọchị nkeji iri atọ tupu nri, nke na - enye ọgwụ ọnụ ka ọ bụrụ oge ihe karịrị 1.0 μg / ml. Oge ọgwụgwọ ọ dị bụ otu onye - site na 1 ruo izu atọ. Odeston nwere nsí na-egbu egbu, ntachi obi ya na-adịkarị mma.

Ọ bụrụ na ọghọm nsonaazụ nke nlekọta nchedo nke dysfunction nke spdicter nke Oddi na nnweta data na stenosis ya, ikike nke sphincter nke Oddi eweghachiri arụ ọrụ (sphincterotomy).

Usoro ogwu eji eme ihe maka ogwe ala ala

Ọgwụ ntụgharị maka ezughị ezu nke nkụpu nke ọrịa ụjọ na-ebute na nsogbu nke ọrịa pancreatitis na-adịghị ala ala na arụ ọrụ na ọnụnọ steatorhur karịa 15 g nke abụba kwa ụbọchị, oke ibu na-aga n'ihu na nsogbu nke dyspeptik. Otu ọgwụ enzymes kwesịrị ịnwe opekata mpe 20,000 - 40,000 nke lipase, yabụ, etinyere ya na 2-4 nke achọrọ nri na 1-2 capsules na nri ọzọ nke obere nri. Site na ụkọ akụrụngwa akwara na-adịghị ala ala, a naghị ekpochapụ steatorrhea kpamkpam. Ikike dị arọ, stool normalization, na flatulence mbelata na-egosi ịba uru nke uru ahọpụtara nke enzymes diges.

Enweghi ike nke usoro ọgwụgwọ na-achọ ka mwepu nke ihe ndị ọzọ na - akpata ọrịa mmịkọ. - Ọrịa Crohn, ọrịa celiac, thyrotoxicosis. Iji dozie ụkọ nri, a na-enye usoro ọgwụ mgbochi triglycerides (trisorbon) yana vitamin A, D, E, K.

Ọrịa dị iche iche nke ọrịa pancreatitis na-adịghị ala ala

Nsogbu nke ọrịa ogbu na nkwonkwo gụnyere ọrịa malabsorption, ọrịa shuga mellitus, pseudocysts, portal ma ọ bụ splenic vein thrombosis, pyloric stenosis, ihe mgbochi nke agịga ọnyị na-ahụkarị, yana akpụ. Ọrịa pancreatic adenocarcinoma na-etolite na 4% nke ndị mmadụ n'otu n'otu nwere ihe karịrị afọ 20 nke ọrịa pancreatitis na-adịghị ala ala.

Ọnụ ọgụgụ ndị nwụrụ maka ọrịa na-adịghị ala ala na-eru 50% na afọ 20-25 nke ọrịa ahụ. 15-20% nke ndị ọrịa na-anwụ site na nsogbu ndị metụtara nrịanrịa nke pancreatitis, ọnwụ ndị ọzọ kpatara site na trauma, erighị ihe na-edozi ahụ, ọrịa, ị smokingụ sịga, nke a na-ahụkarị na ndị ọrịa nwere ọrịa na-adịghị ala ala.

Exocrine ọdịda

Ejiri ụkọ mmiri nke na - eme ka ihe mgbu pụta bụ mmịrị imeju afọ na ịmịkọrọ, mmepe nke itolite nje na oke nke eriri afọ. N’ihi ya, ndị ọrịa na-arịa afọ ọsịsa, steatorrhea, flatulence, agụụ, agụụ na-egbu. E mesịa, akara ngosipụta nke hypovitaminosis na-apụta.

Ihe ndị a na - akpata nkụda mmụọ

ezughi oke nke enzymes n'ihi erughi enterokinase na bile,
imebi ngwakọta nke enzymes na chyme nri, n'ihi nsogbu ọgba nke duodenum na obere eriri afọ,
mbibi na inacymes enzymes n'ihi oke uto nke microflora na eriri afọ nke elu.
ụkọ protin nri na mmepe nke hypoalbuminemia na, n'ihi nke a, imebi njikọ nke enzymes pancreatic.

Ihe ịrịba ama mbụ nke ezughi ezu nke exocrine bụ steatorrhea, nke na - eme mgbe ibelata pancreatic secretion site na 10% ka ọ dị na nke nkịtị. Dị ka iwu si dị, dị ka a na-achị, anaghị eso ụzọ ngosipụta. Na steatorea siri ike, ugboro ugboro nke afọ ọsịsa dịgasị site ugboro atọ ruo ugboro isii n’ụbọchị, feces na-aba ụba, nwa ebu n’afọ, na-amị amị. Steatorrhea na-ebelata ma ọ ga-apụ n'anya ma ọ bụrụ na onye ọrịa ahụ belata oriri oriri ma ọ bụ were enzymes pancreatic.

N'akụkụ dị mkpa nke ndị ọrịa, a na-achọpụta oke ibu n'ihi ụkọ exocrine pancreatic na mwepu nke mgbaze na ịmịju na eriri afọ, yana n'ihi ntakịrị nri n'ihi ihe mgbu. Ibelata ibu na-akwalitekarị site na agụụ, iji nlezianya na-elebara anya site na ndị ọrịa nke nri siri ike, oge ụfọdụ n'ihi ụjọ nke ịkpasu mwakpo mgbu, yana ịmachi oke oriri na-adịkarị mfe site na ndị ọrịa nwere ọrịa mellitus, na-agbagha usoro nke pancreatitis na-adịghị ala ala.

A na-ahụ ụkọ vitamin nke abụba (A, D, E na K) adịghị ahụkebe na ndị ọrịa nwere steatorrhea siri ike na ogologo oge.

, , , , , , , , , ,

Enweghị ike ọgwụgwụ nke endocrine

Ihe dị ka 1/3 ndị ọrịa nwere nsogbu metabolism n'ụdị hypoglycemic syndrome, naanị ọkara n'ime ha na-ahụ ihe ịrịba ama nke ọrịa shuga. Ihe ndabere maka mmepe nke nsogbu ndị a bụ mmebi nke sel nke islet ngwa, na-ebute erughi nke ọ bụghị naanị insulin, kamakwa glucagon. Nke a na - akọwa usoro nke ọrịa mamịrị nke ọrịa pancreatogenic: mwepu hypoglycemia, mkpa nke insulin inspelaiti, mmepe dị nkọ nke ketoacidosis, vaskụla na nsogbu ndị ọzọ.

, , , , , , , , ,

Ọ na nsogbu nke ọrịa pancreatitis na-adịghị ala ala

Ọrịa pancreatitis na-adịghị ala ala na-enweghị ọgwụgwọ kwesịrị ekwesị na-agakarị, na-enwekwu ọhụụ, ọ na-adịkarị ma ọ bụ na - eme oge nke iwe na mgbakwunye, na - eji nwayọọ nwayọọ na - akwụsị na paịlị pancreatic, nguzobe nke mpaghara ma ọ bụ na - agbasawanye ebe niile nke sclerosis (fibrosis), ihe omume ahụ. pseudocyst, deformations nke akụkụ ductal sistemu, mgbakwunye nke mgbasa na stenosis, Ọzọkwa, ducts na-enwekarị nzuzo nwere oke (coagulation nke ndi na-edozi), microlites, na-agbasasị mgbakwunye mgbatị nke gland (ọnya na-egbu mgbu na-egbu mgbu). Ka ọrịa ahụ na-aga n'ihu, a na-ahụta otu usoro: site na iwe ọhụụ ọhụụ, mpaghara ọbara ọgbụgba na parenchyma necrosis na-abụkarị nke a na-ahụkarị na pancreas (o doro anya, n'ihi ọganihu nke sclerotic Filiks), ọrụ nke akụkụ a kachasị mkpa nke sistem na-agbasawanye.

Nsogbu nke pancreatitis na-adịghị ala ala bụ ihe omume nke ọnụnọ, ihe na-arịa ma ọ bụ calcation nke pancreas, ọrịa shuga siri ike mellitus, splenic vein thrombosis, mmepe nke cicatricial stenosis nke isi mmiri, yana BSD na mmepe nke mgbochi ọgụ, cholangitis, wdg nke abụọ mmepe nke pancreatitis nwere ike iduga mmepe nke abụọ. pancreas.

Ọrịa na - adịghị ike nke nnukwu ọrịa pancreatitis nwere ike ịbụ ascites "pancreatogenic" na etuto interloop. Ascites na pancreatitis bụ nsogbu siri ike nke ọrịa ahụ, ọ na - ebilite na ndị ọrịa nwere nnukwu umeji exocrine pancreatic, yana ọrịa hypoalbuminemia (n'ihi nsị nke nsị na eriri afọ na enweghi oke amino acid, karịsịa n'oge iwe nke pancreatitis na-adịghị ala ala). Otu n'ime ihe na-akpata ascites na pancreatitis nwekwara ike ịbụ thrombosis vaskụla nke sistem veinal.

Nzube ebumnuche

Ọ ga-ekwe omume palpị pancreas naanị na usoro cystic na tumor.

N'elu akpịrị afọ, a na-ekpebi ebe ndị a na-egbu mgbu na isi ihe:

hoffar mpaghara- n'etiti eriri kwụ ọtọ na-agafe otube na bisector nke akụkụ ahụ guzobere site na ahịrị na kwụ ọtọ na-agafe otubo. Ọrịa na mpaghara a bụ ihe kacha njirimara maka nsụ ọkụ na isi nke pancreas,
Hubergritsa-Skulsky mpaghara- yiri mpaghara Shoffar, mana dị n'aka ekpe.Ihe omuma di na mpaghara a bu njirimara maka ntughari oria na mpaghara ahu.
Desjardins rụtụ aka- dị 6 cm n’elu otube ahụ ahịrị na-ejikọ otube aka nri aka abụọ. Ihe mmuta n'akụkụ a bụ njirimara maka nsụrị nke isi na pancreas,
ntụpọ gubergrits- yiri Desjardins isi, mana dị na ekpe. Ahụhụ a na-hụrụ na mbufụt nke ọdụ nke pancreas,
Isi ihe Mayo-Robson- dị na mpaghara nke mpụga na nke atọ nke ahịrị na - ejikọ otubo na etiti nke ọnụ ọnụ akwụkwụ aka ekpe. Ihe mmuta n'akụkụ a bụ njirimara maka mbufụt nke azụ anụre,
mpaghara nke ọgịrịga-vertebral n'akuku aka ekpe- ahu ya na aru ya.

Ọtụtụ ndị ọrịa, ihe dị mma akaraMainsail- atrophy nke pancreas abụba anụ ahụ na mpaghara amụma nke pancreas na mgbidi akụkụ ihu. Enwere ike ịchọpụta mgbaàmà nke "ụmụ irighiri ọbara uhie" - ọnụnọ nke ntụpọ ọbara ọbara na anụ nke afọ, obi, azụ, yana agba aja aja na-acha na ọnya.

Ọrịa dyspeptik(pancreatic dyspepsia) - Ọ bụ ezigbo njiri mara maka ọrịa akwara na-adịghị ala ala, a na-egosipụtakarị ya site na iwe ọkụ ma ọ bụ n'ụzọ siri ike nke ọrịa ahụ. A na-egosipụta ọrịa dyspeptik site na ịba ụba nke salivation, ịba ụba nke ikuku ma ọ bụ nri riri, ọgbụgbọ, ọgbụgbọ, agụụ na-egbu, iju nri nwere abụba, ịmịcha ọnụ.

Ibelata ibu- na - etolite n'ihi ihe mgbochi nri (mgbe ibu ọnụ, ihe mgbu belatara), yana n'ihe metụtara mmebi ọrụ exocrine nke pancreas na ịmịkọrọ na eriri afọ. Ibelata ibu n’enye aka na ibelata agụụ. A na-egosipụta mbelata nke ahụ nke ọma n'ụdị ọrịa pancreatitis na-adịghị ala ala ma na-esonye ya site na adịghị ike, oke isi.

Ọrịa pancreatogenic na syndromes nke nri ezughi oke na nnabata - njirimara nke ụdị dị njọ na nke dị ogologo oge nke pancreatitis na-adịghị ala ala na nnukwu nkwarụ nke ọrụ exocrine pancreatic. Ọrịa afọ ọsịsa na - ebute nsogbu na zoro ezo nke enzymes pancreatic na mgbaze nke eriri afọ. Ngwakọta nke chyme na-ezighi ezi na-akpasu eriri afọ ma na-akpata afọ ọsịsa. Dysregioninal dysregion dịkwa mkpa. N'otu oge ahụ, akụrụngwa buru ibu, nri ala na-ete mmanụ (steatorrhea) na iberibe nri adịghị mma.

A na-ekpebi akara dị mma nke phrenicus (mgbu mgbe ị na-pịa n'etiti ụkwụ nke akwara sternocleidomastoid na ntinye aka na clavicle). Ndị ọrịa adịghị ike n’arụ n’arụ. Na anụ nke obi, afọ, na azụ, ị nwere ike ịchọta obere agba uhie na-acha uhie uhie nke ọdịdị gbara agba, ogo nke 1 mm dị nha, nke na-anaghị akwụsị mgbe akara (akara nke Tuzhilin), bụ akara nke ọrụ nke enzymes pancreatic na-arụ ọrụ. Akọrọ na ịkpụkpọ anụ ahụ, glossitis, stomatitis n'ihi hypovitaminosis bụkwa ihe a na-ahụkarị.