Lub txiav ua lub luag haujlwm tseem ceeb tsis yog hauv cov txheej txheem ntawm kev zom zaub mov, tab sis kuj tseem nyob hauv lub neej ntawm lub cev tag nrho. Cov kab mob no ntawm cov kab mob endocrine thiab digestive system tsim cov enzymes tsim nyog rau kev zom cov zaub mov nkag mus rau hauv lub plab, nrog rau qee cov tshuaj hormones los tswj cov rog thiab carbohydrate metabolism.
piav qhia lub cev
Xav txog cov qauv thiab kev ua haujlwm ntawm pancreas. Nws yog nyob rau hauv lub retroperitoneal qhov chaw nruab nrab ntawm cov seem ntawm lub duodenum thiab lub Upper vertebrae ntawm lub sab nraub qaum, saum lub ob lub raum, thiab outwardly zoo li ib tug elongated "comma". Qhov hnyav ntawm tus neeg laus lub cev yog li ntawm 80-90 g.
Tus qauv ntawm tus txiav yog ib qho ua ke ntawm glandular lobules, los ntawm cov hlab ntsha hla, thiab cov ducts excretory. Lobules tsim kua txiv pancreatic, cov enzymes uas (lactase, amylase, trypsin, invertase, lipase) cuam tshuam rau cov txheej txheem ntawm cov khoom noj. Passes thoob plaws hauv lub caj pasib qho channel los ntawm cov kua txiv hmab txiv ntoo nkag mus rau hauv duodenum, qhov twg nws sib xyaw nrog cov kua tsib thiab ua kom cov txheej txheem ntawm txoj hnyuv plab zom mov. Lub complexes ntawm cov hlwb ntawm lobules nrog lub capillary network tsim yog hu ua islets ntawm Langerhans. Cov qauv no los ntawm alpha, beta thiab delta hlwb ua ke cov tshuaj hormones (insulin thiab glucagon).
qauv
Lub cev muaj cov qauv hauv qab no:
- taub hau (loj 2.5-3.5 cm) haum snugly rau hauv lub flexure ntawm duodenum;
- lub cev daim duab peb sab (2.5 cm) nyob rau sab laug ntawm tus txha nraub qaum ntawm tus po;
- caj;
- pear-puab tus Tsov tus tw (3 cm), dhau los ntawm lub ntsiab duct ntawm lub caj pas hla.
Qhov twg tib neeg pancreas mob, peb yuav qhia hauv qab no.
Lub luag haujlwm ntawm lub cev
Tus txiav txiav, raws li tau hais lawm, tsim kua txiv kab mob pancreatic. Hauv duodenum, cov khoom noj tau tawg mus rau lub xeev tsim nyog rau kev nqus. Qhov no tshwm sim nyob rau hauv qhov kev txiav txim ntawm hydrolytic digestive enzymes ntawm lub txiav, uas yog lub luag hauj lwm rau kev sib cuam tshuam ntawm cov khoom noj khoom haus tshuaj nrog dej.
kua txiv pancreatic muaj hydrolases uas ua haujlwm sib cais. Lawv muab faib ua plaub pawg:
- Lipase yog ib qho enzyme uas zom cov rog mus rau hauv cov ntsiab lus nyuaj: glycerol thiab ntau dua fatty acids. Nws kuj ua kom muaj kev nqus ntawm cov vitamins A, E, D, K.
- Proteases (chymotrypsin, carboxypeptidase, trypsin) uas ua kom cov enzymes zom cov proteins rau hauv cov amino acids.
- Carbohydrases (amylase, m altase, lactase, invertase) xav tau los zom cov carbohydrates rau qabzib.
- Nucleases yog cov enzymes uas zom cov nucleic acids thiab tsim lawv tus kheej cov qauv caj ces.
Lub hauv paus ntsiab lus ntawm kev ua haujlwm ntawm pancreas yog qhov nyuaj heev. Enzymes pib tsim nyob rau hauv qhov yuav tsum tau 2-3 feeb tom qab cov zaub mov nkag mus rau hauv lub plab. Nws tag nrho yog nyob ntawm qhov concentration ntawm cov rog, proteins thiab carbohydrates muaj nyob rau hauv nws. Nyob rau hauv lub xub ntiag ntawm cov kua tsib, zus tau tej cov kua txiv pancreatic nrog enzymes yuav kav mus txog 12 teev.
YEndocrine muaj nuj nqi
Kev ua haujlwm endocrine ntawm lub caj pas yog ua tsaug rau insulocytes - cov hlwb tshwj xeeb ntawm cov islets ntawm Langerhans. Lawv synthesize ntau cov tshuaj hormones: thyroliberin, c-peptide, somatostatin, insulin, gastrin, glucagon.
Exocrine pancreatic insufficiency
Nws yog ib qho tshwm sim feem ntau ntawm cov kab mob hauv nruab nrog cev, tshwj xeeb tshaj yog tias cov kab mob no tshwm sim los ntawm kev mob ntev.
Ib lub cim ntawm exocrine pancreatic insufficiency yog qhov txo qis hauv kev nqus ntawm cov khoom noj khoom haus (malabsorption) tawm tsam keeb kwm ntawm kev loj hlob ntawm maldigestion - kev ua txhaum ntawm kev tawg ntawm cov zaub mov rau hauv cov khoom siv tau rau txoj kev zom zaub mov. Qhov no pathology tseem hu ua enzyme deficiency. Txawm hais tias muaj qhov tshwm sim ntawm cov kab mob pathologies ntawm txhua pab pawg neeg, enzyme deficiency yog suav tias yog ib qho mob hnyav uas tuaj yeem ua rauqaug zog thiab txawm tuag ntawm tus neeg mob yog tias tsis kho.
Ntau yam
Exocrine pancreatic insufficiency tuaj yeem yog qhov tshwm sim (ib yam kab mob caj ces uas cuam tshuam lossis cuam tshuam cov enzymes zais cia) thiab tau txais. Tsis tas li ntawd, pathology tuaj yeem yog thawj thiab theem nrab, kiag li lossis txheeb ze.
Primary exocrine insufficiency yog tshwm sim los ntawm kev puas tsuaj rau lub caj pas thiab txo qis hauv nws txoj haujlwm exocrine. Hauv hom kab mob thib ob, cov enzymes tau tsim muaj ntau txaus, tab sis lawv txoj kev ua kom tsis muaj zog hauv cov hnyuv.
Ua rau kev loj hlob ntawm pathology
Qhov laj thawj tseem ceeb ntawm kev loj hlob ntawm exocrine pancreatic insufficiency ntawm thawj hom muaj xws li txhua hom kab mob pancreatitis, cystic fibrosis, pancreatic cancer, degeneration ntawm pancreas nyob rau hauv kev rog, kev phais mob ntawm lub caj pas, Schwachmann's syndrome, congenital enzyme. deficiency, agenesis lossis hypoplasia ntawm lub cev, nrog rau Johanson syndrome - Blizzard.
Pathogenetic ua rau exocrine gland insufficiency muaj xws li:
- fibrosis thiab atrophy ntawm lub cev (raws li kev haus dej cawv, ua rau muaj kev cuam tshuam, tsis suav lossis calculous pancreatitis, atherosclerosis, malnutrition, hnub nyoog hloov pauv, hemosiderosis, ntshav qab zib mellitus);
- pancreatic cirrhosis (xws li qhov tshwm sim ntawm qee hom kab mob pancreatitis: fibrocalculous, cawv, syphilitic);
- pancreatic necrosis (tuagqog hlwb);
- tsim cov pob zeb hauv cov kab mob pancreatic.
Secondary exocrine insufficiency tshwm sim nrog cov kab mob ntawm cov mucous membrane ntawm txoj hnyuv me, tom qab ua haujlwm ntawm lub plab thiab cov hnyuv, nrog gastrinoma, txo qis qis ntawm enterokinase, pathologies ntawm hepatobiliary system, protein-zog deficiency.
Tsis muaj enzyme tsis txaus ntawm lub caj pas yog vim muaj kev cuam tshuam ntawm kev zais ntawm bicarbonates thiab enzymes tawm tsam keeb kwm yav dhau los ntawm qhov txo qis hauv lub cev. Cov txheeb ze tsis txaus yog vim qhov txo qis ntawm cov kua txiv pancreatic rau hauv txoj hnyuv vim kev cuam tshuam ntawm lumen ntawm cov qog ntawm cov qog los ntawm qog, pob zeb, nti.
Nplaim ntawm lub txiav ua rau tshwm sim los ntawm kev tuag ntawm cov hlwb hauv parenchyma ntawm lub cev. Nyob rau hauv cov cheeb tsam no ntom nti caws pliav yog tsim. Cov txheej txheem zoo sib xws hauv cov tshuaj hu ua fibrosis, thiab nws kuj ua rau kev loj hlob ntawm exocrine insufficiency.
Symptoms
Cia peb saib seb qhov twg pancreas mob rau tib neeg. Qhov tseem ceeb tshaj plaws nyob rau hauv daim duab kho mob ntawm no pathology yog lub syndrome ntawm maldigestion, uas yog yus muaj los ntawm inhibition ntawm digestive txheej txheem nyob rau hauv txoj hnyuv. Undigested rog nyob rau hauv txoj hnyuv nkoos zus tau tej cov colonocytes - raws plab thiab polyfecal teeb meem, feces tau ib tug fetid tsw, grey xim, nws nto yog ci thiab oily. Tej zaum kuj yuav muaj cov khoom noj uas tsis tau digested hauv cov quav.
Protein maldigestion pab txhawb kom pom cov protein-zog noj tsis txaus, uasmanifested los ntawm lub cev qhuav dej, nce yuag poob, deficiency ntawm kab thiab vitamins, anemia. Kev poob phaus yog cuam tshuam los ntawm kev noj zaub mov tsawg hauv carbohydrates thiab cov rog, nrog rau kev ntshai ntawm kev noj mov, uas ua rau ntau tus neeg mob uas muaj tus mob pancreatitis.
Cov tsos mob ntawm exocrine pancreatic insufficiency yog qhov tsis txaus siab. Dysmotility ntawm lub plab (dyspeptic teeb meem, kev xav ntawm fullness) tuaj yeem tshwm sim los ntawm ob qho tib si exacerbation ntawm pancreatitis thiab cuam tshuam ntawm exocrine caj pas tsis txaus vim yog kev hloov pauv hauv plab hnyuv, qhov tshwm sim ntawm duodeno-gastric reflux.
YPancreatitis ua rau muaj kab mob
Tus kab mob pancreatitis ntev yog qhov tseem ceeb ua rau tsis muaj enzyme. Qhov no yog qhov mob ntawm lub txiav ntawm cov kab mob inflammatory-destructive genesis, ua rau ua txhaum ntawm nws cov dej num. Dab tsi yog qhov tshwm sim ntawm pancreatitis, ob peb tus neeg paub. Nrog rau qhov exacerbation ntawm tus kab mob, qhov mob tshwm sim nyob rau hauv lub plab mog thiab sab laug hypochondrium, cov tsos mob dyspeptic, icterus ntawm sclera thiab daim tawv nqaij raug soj ntsuam.
Qhov laj thawj tseem ceeb ntawm tus mob pancreatitis hauv cov neeg laus (ICD-10 code K86) yog cholelithiasis thiab haus dej cawv, uas yog tshuaj lom heev rau parenchyma ntawm lub cev. Hauv cholelithiasis, cov txheej txheem inflammatory yog tshwm sim los ntawm kev kis kab mob los ntawm cov kab mob mus rau hauv lub qog los ntawm cov hlab ntsha lymphatic, kev loj hlob ntawm biliary hypertension, los yog reflux ntawm cov kua tsib rau hauv lub caj pas.
Kev kho mob ntawm tus kab mob no suav nrogteeb tsa kev ntsuas. Kev kho mob yog ua raws li cov hauv qab no:
- khoom noj khoom haus;
- pancreatic insufficiency yuav tsum kho;
- mob mob yuav tsum tau muab tshem tawm;
- kev nyuaj siab yuav tsum tiv thaiv.
Hauv kev kho mob pancreatitis, nws yuav tsum tsis suav nrog kev haus cawv, noj tshuaj uas tuaj yeem ua rau muaj kev puas tsuaj rau txiav txiav (cov tshuaj tua kab mob, tshuaj tua kab mob, sulfonamides, diuretics: hypothiazide thiab furosemide, indirect anticoagulants, indomethacin, brufen, paracetamol, glucocorticoids, estrogens thiab ntau lwm yam).
Qhov tshwm sim ntawm tus kab mob pancreatitis tuaj yeem sib txawv: lub caj pas exocrine tsis txaus, obstructive jaundice, portal hypertension, kab mob (parapancreatitis, abscess, retroperitoneal cellulitis, o ntawm biliary ib ntsuj av), los ntshav sab hauv. Nrog rau kev loj hlob ntawm tus kab mob no, ntshav qab zib mellitus, poob phaus, thiab mob qog noj ntshav tuaj yeem tshwm sim.
Diagnosis
Lub luag haujlwm tseem ceeb hauv kev tshawb nrhiav cov enzyme deficiency hauv pancreatitis hauv cov neeg laus (ICD-10 code K86) yog ua los ntawm kev kuaj tshwj xeeb (tsis muaj teeb meem thiab tsis txaus ntseeg), uas feem ntau ua ke nrog X-ray, ultrasound thiab endoscopic txoj kev. Kev soj ntsuam kuaj pom tau tias kim dua thiab yuav ua rau tsis xis nyob rau cov neeg mob, tab sis nws cov txiaj ntsig yog qhov tseeb dua. Probeless cov txheej txheem yog pheej yig dua, lawv tau yooj yim zam, tab sis lawv ua kom txiav txim siab qhov noCov txheej txheem pathological hauv lub cev tsuas yog nrog qhov tsis ua tiav lossis txo qis hauv pancreatic enzymes.
Qhov kev ntsuas ncaj qha-cholecystokinin sojntsuam yog suav tias yog tus qauv kub rau kev kuaj mob exocrine pancreatic insufficiency. Cov txheej txheem no yog ua raws li kev txhawb nqa ntawm cov qog ua kua los ntawm kev qhia txog cholecystokinin thiab secretin, nrog rau kev kuaj ntxiv ntawm duodenal cov ntsiab lus nrog lub sijhawm luv ntawm 10 feeb. Cov qauv raug tshuaj xyuas rau tus nqi thiab kev ua haujlwm ntawm pancreatic secretion, qib zinc, bicarbonates, lactoferrin.
Indirect Lund Probing zoo ib yam li txoj kev dhau los, txawm li cas los xij, qog nqaij hlav qog nqaij hlav los ntawm kev qhia zaub mov rau hauv kev sojntsuam.
Lub hauv paus ntawm cov txheej txheem tsis tu ncua yog kev taw qhia rau hauv lub cev ntawm qee yam tshuaj uas tuaj yeem cuam tshuam nrog pancreatic enzymes hauv cov ntshav thiab zis. Txoj kev tshawb fawb ntawm cov khoom lag luam metabolic ntawm xws li kev sib cuam tshuam muab lub sijhawm los soj ntsuam cov haujlwm ntawm lub caj pas exocrine. Kev kuaj tubeless suav nrog: pancreato-lauryl, bentyramide, trioleic, iodolipol thiab lwm yam.
Nws tuaj yeem txiav txim siab theem ntawm kev ua haujlwm ntawm pancreatic hauv qee txoj hauv kev tsis ncaj ncees: los ntawm qib ntawm kev nqus ntawm plasma amino acids los ntawm txiav txiav, los ntawm kev tshuaj xyuas zoo ntawm coprogram, txiav txim siab qhov ntim ntawm cov rog, trypsin thiab quav. chymotrypsin, elastase-1 hauv cov quav.
Cov txheej txheem rau kev kuaj mob yog: x-ray ntawm peritoneum, CT, MRI, ultrasound ntawm lub txiav, ERCP.
Kev kho mob ntawm pathology
Kev kho mob ntawm exocrine pancreatic insufficiency feem ntau yog nyuaj. Nws suav nrog kev kho cov khoom noj khoom haus, hloov pauv thiab kho etiotropic, nrog rau kev kho mob. Etiotropic therapy yog tsom rau kev tiv thaiv kev loj hlob ntawm qog cell tuag. Kev hloov pauv txoj kev ua neej muaj nyob rau hauv kev tsis suav nrog haus cawv thiab haus luam yeeb. Nws kuj tseem npaj kom nce cov protein ntau hauv cov zaub mov, txo cov rog, thiab noj cov vitamins.
Txoj kev tseem ceeb ntawm kev kho mob rau hr. pancreatitis yog hloov enzyme (rau lub neej). Cov lus qhia rau kev hloov enzyme yog steatorrhea nrog poob ntau tshaj 15 g ntawm roj ib hnub twg, ib tug zuj zus protein-zog deficiency.
Microgranular enzyme npaj nyob rau hauv cov kua qaub-resistant plhaub thiab nyob rau hauv gelatin tsiav tshuaj, uas yaj nyob rau hauv lub plab, muab tej yam kev mob rau uniform mix ntawm cov tshuaj granules nrog zaub mov. Cov koob tshuaj ntawm cov tshuaj no raug xaiv ib tus zuj zus thiab nyob ntawm qhov hnyav ntawm tus kab mob, kev ua haujlwm ntawm pancreatic secretion.
