Pathology ntawm lub plab zom mov muaj ntau ntawm cov pejxeem. Cov kab mob reflux muaj feem ntau. Lawv cov yam ntxwv yog dab tsi?
YReflux esophagitis
Tus kab mob yog ib qho mob ntev ntawm txoj hlab pas, uas tshwm sim los ntawm kev noj cov kua qaub ntawm lub plab mus tas li. Cov kab mob pathology yog txuam nrog qhov tsis txaus ntawm cov hlab pas esophageal sphincter, uas ib txwm tiv thaiv txoj hlab pas los ntawm kev nkag mus ntawm cov kua txiv hmab txiv ntoo rau hauv nws.
Mob plab reflux gastritis
Daim ntawv no yog tus yam ntxwv los ntawm kev loj hlob ntawm kev mob hnyav hauv cov mucous daim nyias nyias raws li qhov tshwm sim ntawm cov kua tsib nyob rau hauv cov zaub mov bolus. Muaj ntau ntau hom kab mob gastritis:
- Catarrhal gastritis, lub ntsiab tshwm sim ntawm uas yog me ntsis hyperemia thiab o ntawm lub plab phab ntsa. Nws thickens thiab ua npog nrog ib txheej ntawm mucus tuab. Cov mucous membrane muaj petechial hemorrhages thiab me me erosions.
- Fibrinous gastritis, nyob rau hauv cov cheeb tsam ntawm epithelial necrosis yog tsim nyob rau hauv cov phab ntsa, infiltrated nrog fibrinous-purulent exudate. Qhov tshwm sim ntawm qhov tshwm sim no yog ib zaj duab xis nyias fibrin nyob rau saum npoo ntawm qhov chaw cuam tshuam ntawm cov mucous membrane. Ntogastritis yog tus cwj pwm los ntawm friability ntawm zaj duab xis no, thiab nrog tob o, nws fuses nrog lub epithelium.
- Necrotic gastritis, uas, ntxiv rau lub epithelium, lwm txheej ntawm mucous membrane raug cuam tshuam. Necrosis yog to taub raws li kev tuag ntawm cov hlwb nyob rau hauv lub zog ntawm aggressive yam tseem ceeb.
- Purulent gastritis yog hom mob hnyav tshaj plaws. Txhua txheej ntawm lub plab tuaj yeem koom nrog hauv cov txheej txheem, uas ua rau muaj kev hem thawj ntawm perforation. Qhov tshwm sim ntawm qhov sib txawv no yog qhov muaj purulent exudate, nrog rau kev nkag mus ntawm cov mucous membrane nrog leukocytes.
Hom no yog tus yam ntxwv los ntawm kev sib xyaw ua ke ntawm inflammatory thiab dystrophic phenomena. Tsis tu ncua ntawm cov kua tsib thiab pancreatic enzymes rau hauv lub plab ua rau muaj kev loj hlob ntawm kev mob ntev. Tsis tas li ntawd, daim ntawv no tej zaum yuav yog qhov tshwm sim ntawm mob gastritis. Raws li qhov tshwm sim ntawm alkalization nyob rau hauv lub mucous daim nyias nyias, tus nqi ntawm histamine nce, uas ua rau nws edematous thiab hyperemic.
Pathogenesis
Nruab nrab ntawm lub plab, nws lub antrum, thiab lub duodenum muaj sphincter hu ua "pylorus". Kev ua haujlwm ntawm cov leeg no yog txhawm rau txav cov chyme (cov khoom noj bolus) los ntawm lub plab mus rau cov hnyuv ntxiv rau kev zom zaub mov ntxiv thiab tom qab nqus cov as-ham. Kev ua txhaum ntawm sphincter tuaj yeem ua rau muaj kev txhim kho ntawm biliary reflux gastritis, kev kho mob uas yuav tsum muaj kev sib xyaw ntawm cov tshuaj thiab cov khoom noj kom zoo. Tus kab mob no cojuntimely qhib ntawm lub sphincter, raws li ib tug tshwm sim ntawm uas lub pob ntawm cov zaub mov, uas cov kua tsib tsim los ntawm lub siab yog txuas, rov qab mus rau lub plab. Cov muaj pes tsawg leeg ntawm cov kua tsib muaj kev cuam tshuam rau cov mob ntawm nws cov mucous membrane. Nws muaj cov ntsev, acids thiab enzymes, uas yog cais raws li aggression yam.
Etiology
Yog vim li cas rau kev txhim kho ntawm biliary reflux gastritis yog txuam nrog kev ua txhaum ntawm kev ua haujlwm ntawm pyloric sphincter. Qhov no tuaj yeem ua rau muaj kev cuam tshuam kev phais uas cuam tshuam rau kev txav ntawm lub plab zom mov. Tsis tas li ntawd, ntawm cov yam ntxwv etiological, kab mob xws li kab mob siab, cholecystitis thiab mob duodenitis tuaj yeem paub qhov txawv. Tsis muaj zog ntawm cov leeg sphincter thiab nce siab nyob rau hauv cov hnyuv feem ntau yog ua rau gastritis, thiab ib tug xov tooj ntawm pathologies ntawm lub plab zom mov tuaj yeem ua rau qhov no. Lub luag hauj lwm ntawm predisposing yam tseem ceeb. Piv txwv li, qhov kev ntxhov siab tas mus li txo cov khoom tiv thaiv ntawm cov mucous membrane, thiab nws tsis tshua muaj resistant rau qhov kev ua ntawm irritating yam. Tib yam siv rau cov tshuaj uas tsis yog-steroidal anti-inflammatory, uas ua rau muaj kev pheej hmoo ntawm gastritis ob peb zaug. Cov tshuaj no cuam tshuam rau kev sib txuas ntawm prostaglandins, thiab lawv ua haujlwm tseem ceeb - txhawb kev tsim cov hnoos qeev los ntawm goblet hlwb, uas ua rau kom muaj kev tiv thaiv ntawm cov mucous membrane. Cov tshuaj tiv thaiv kab mob thaiv cov enzyme cyclooxygenase, ua rau txo qis ntawm cov tshuaj prostaglandins, thiab yog li cov hnoos qeev.
Rau qhov tsim ntawm reflux esophagitisua rau ascites, raws li qhov tshwm sim ntawm qhov siab nyob rau hauv lub plab kab noj hniav nce, nqaim ntawm pyloroduodenal qhib. Lwm yam tseem ceeb yuav yog kev noj zaub mov tsis zoo, khaub ncaws nruj, tshuaj noj, kev ntxhov siab thiab haus luam yeeb. Qhov tshwm sim no tuaj yeem tshwm sim thaum cev xeeb tub, tom qab ntawd nws tsis cuam tshuam nrog pathology.
Biliary reflux gastritis thiab reflux esophagitis: cov tsos mob
Cov tsos mob tseem ceeb ntawm reflux esophagitis yog kub siab thiab qaub belching, uas feem ntau tshwm sim tom qab noj mov, nrog rau thaum khoov rau pem hauv ntej. Ntxiv rau qhov no yog qhov tsis xis nyob hauv thaj tsam epigastric.
Cov kab mob plab reflux gastritis muaj qhov chaw kho mob hnyav dua. Cov tsos mob ntawm tus kab mob no muaj xws li mob thiab lwm yam kab mob. Feem ntau cov neeg mob muaj kev txhawj xeeb txog qhov kev xav ntawm qhov puv thiab plab, nrog rau qhov hnyav hauv thaj tsam epigastric. Mob feem ntau tshwm sim ntawm lub plab khoob, thiab lawv qhov kev siv zog tuaj yeem sib txawv - los ntawm qhov hnyav mus rau qhov mob. ntuav yog tshwm sim.
Diagnosis
Kev kuaj mob ntawm biliary reflux gastritis yog ua tom qab kev tshawb fawb tshwj xeeb thiab anamnesis. Kev tsis txaus siab ib leeg tsis txaus rau qhov no, lawv tsuas yog pab qhia txog kev txhim kho tus kabmob. Ua ntej tshaj plaws, tus neeg mob raug xa mus rau kev xa cov quav, uas cov kws tshaj lij qhia pom cov ntshav zais. Nws kuj tseem yuav tsum tau ua EGD, uas yuav pab kom pom kev ntsuas qhov mob ntawm cov mucous daim nyias nyias, txhawm rau txheeb xyuas cov kab mob hloov pauv foci. Nce siab nyob rau hauvduodenum tuaj yeem kuaj pom los ntawm manometry.
Reflux esophagitis yog kuaj pom los ntawm X-ray siv tus neeg sawv cev sib txawv. Txoj kev no tso cai rau koj taug qab lub sijhawm ntawm reflux ntawm cov ntsiab lus ntawm lub plab mus rau hauv txoj hlab pas. Nws kuj tseem pom zoo kom ua qhov kev tshuaj ntsuam xyuas endoscopic, uas yuav tso cai rau ntsuas qhov mob ntawm cov mucosa thiab nqa cov khoom siv lom neeg rau kev tshawb fawb ntxiv.
Kev kho mob
Cov kab mob reflux gastritis thiab reflux esophagitis yuav tsum tau kho tam sim. Qhov no yuav pab txhim kho tus neeg mob tus mob thiab zam kom tsis txhob muaj teeb meem tshwm sim. Yog tias kuaj pom tus kab mob esophagitis, tus cwj pwm tsis zoo yuav tsum raug tso tseg, nrog rau kev siv lub cev hnyav ntawm thaj tsam plab.
Kev kho tshuaj yog ua raws li kev teem sijhawm ntawm cov tshuaj tiv thaiv kab mob, uas yuav txo qis kev ua phem ntawm cov kua txiv hmab txiv ntoo rau ntawm cov mucosa ntawm txoj hlab pas. Ntawm lawv, Almagel, Maalox, siv los ntawm chav kawm, tuaj yeem paub qhov txawv. Lawv muab cov phab ntsa ntawm lub plab thiab txo cov acidity.
Ntxiv rau, nws raug nquahu kom siv cov tshuaj uas txo qis cov kua dej hauv plab ("Omeprazole"). Prokinetics tuaj yeem txhim kho lub suab ntawm lub sphincter, uas yog kev tiv thaiv kev tawm tsam ntawm cov ntsiab lus acidic. Ntawm cov tshuaj no, Motilium thiab Motilak tuaj yeem paub qhov txawv. Yog tias kev kho mob tsis zoo, kev phais yuav tsum tau ua, uas yog siv cov khoom siv endoscopic.
HowPuas yog kev kho mob rau cov kab mob xws li biliary reflux gastritis tau ua tiav? Cov tsos mob thiab kev kho mob ntawm no pathology yog inextricably txuas. Cov neeg mob xav tau ib txoj hauv kev ntawm cov tshuaj pharmacological thiab cov tshuaj tsis yog tshuaj uas yuav txhim kho lawv tus mob thiab txo cov kev mob tshwm sim. Ua ntej tshaj plaws, koj yuav tsum normalize koj txoj kev ua neej - muab cov cwj pwm phem, noj zaub mov kom zoo. Ntawm cov tshuaj, histamine receptor blockers feem ntau yog muab tshuaj, uas yuav txo qis kev zais cia. Koj tsis tuaj yeem ua yam tsis muaj gastroprotectors - lawv yuav ua kom cov kab mob ntawm cov mucous zoo. Tsis tas li ntawd, kev khi ntawm cov kua tsib acids yog tsim nyog, uas yog nqa tawm nrog kev pab ntawm ursodeoxycholic acid. Cov tshuaj xws li Domperidone thiab Metoclopramide yuav pab tiv thaiv kom tsis txhob muaj chyme rau hauv plab.
Kev Tiv Thaiv
Kev noj zaub mov kom raug thiab kuaj xyuas raws sijhawm ntawm cov txheej txheem pathological yuav pab tiv thaiv kev tsim ntawm biliary reflux gastritis thiab esophagitis. Nws raug nquahu kom ua cov tshuaj endoscopic tsis tu ncua rau lub hom phiaj ntawm kev tiv thaiv, uas yuav pab txheeb xyuas tus kab mob thaum ntxov. Qhov no yuav ua rau kom muaj txiaj ntsig ntawm kev saib xyuas kev noj qab haus huv, zam kev phais mob thiab tshwm sim ntawm cov teeb meem loj.
Ntxiv rau, cov khoom tiv thaiv ntawm cov mucous membrane yuav tsum tau nce ntxiv. Ua li no, nws raug nquahu kom tso tus cwj pwm phem (lossis txo qis kom tsawg), sim noj zaub mov noj qab haus huv thiab zam qhov xwm txheej ntxhov siab.
Tseem yog qhov tseem ceeb tshaj plaws yog kev siv cov tshuaj uas tsis yog-steroidal anti-inflammatory, uas txo cov hnoos qeev hauvplab, raws li qhov tshwm sim, lub mucous daim nyias nyias yuav yooj yim. Lub luag haujlwm tseem ceeb yog ua los ntawm kev tiv thaiv thiab kho raws sijhawm ntawm cov kab mob sib kis.
Qhov teeb meem ntawm biliary reflux gastritis thiab esophagitis yog qhov cuam tshuam, vim tias cov kab mob no tuaj yeem ua rau tus neeg mob tsis zoo xwb, tab sis kuj ua rau muaj teeb meem. Kev kuaj mob raws sij hawm yuav tso cai rau kev kho mob raws sij hawm.
