Tus kab mob no yog ib qho mob ntawm cov txheej txheem ntawm daim ntawv ntxiv (caecum). Nws muaj ntau heev nyob rau hauv peb lub teb chaws. Thiab nws yog suav hais tias yog cov kab mob ntau tshaj plaws ntawm lub plab kab noj hniav. Feem ntau xav tau kev phais mob sai. Nrog rau daim ntawv ua haujlwm lossis tshuaj noj ntau tshaj ob hnub, cov ntawv ntxiv tuaj yeem tawg. Hauv qhov no, kev tuag tshwm sim. Yog li ntawd, nws yog ib qho tseem ceeb heev uas yuav tau kuaj xyuas nws raws sijhawm thiab ua haujlwm.
Appendicitis: tsos mob, ua rau tus kab mob
Yog vim li cas thiaj nce ntxiv? Cia wb mus saib seb qhov mob appendicitis tshwm li cas. Qhov laj thawj ntawm qhov tshwm sim niaj hnub no tseem tsis tau tsim muaj tseeb. Nws yog ib qho nyuaj hais tias yog vim li cas o pib. Tab sis kev tshawb fawb ntawm tus kab mob qhia tau hais tias ob qho xwm txheej tsim nyog rau nws txoj kev loj hlob. Qhov thib ib yog qhov muaj cov kab mob tsim nyog hauv cov hnyuv, qhov thib ob yog qhov txhaws ntawm lumen ntawm cov txheej txheem nrog quav, noob lossis ntau yam pob txha. Qee lub sij hawm lub cev txawv teb chaws muaj nyob rau hauv daim ntawv ntxiv, xws li cov khoom me me ntawm cov khoom ua si.
Tus kab mob pib mob, tab sis feem ntau nws tsis tuaj yeem txiav txim siab nws qhov chaw meej ntawm koj tus kheej. Zoo li ib tug neeg uas nws nyuam qhuav mob plab, tab sis tom qab tsibteev, qhov mob pib mloog zoo nyob rau hauv iliac txoj cai cheeb tsam ntawm lub cev. Cov ntawv ntxiv feem ntau tuaj yeem nyob ntawm ntau txoj hauv kev, nws nyob ntawm tus qauv ntawm lub cev.
Nyob rau hauv txoj hauj lwm ib txwm ntawm cov txheej txheem, qhov mob yog pom nyob rau hauv txoj cai. Yog hais tias lub appendix yog siab me ntsis, ces nws tshwm nyob rau hauv lub tav, nyob rau sab xis. Yog tias cov txheej txheem nyob hauv qab no, ces qhov mob yuav raug pom nyob rau hauv cheeb tsam pelvic. Tsis tas li ntawd, ntuav thiab qee zaum txawm tias raws plab tuaj yeem pib.
Muaj lwm cov tsos mob uas tshwm sim los ntawm qhov exacerbation tuaj yeem txheeb xyuas tau: tso zis tsaus, qhov ncauj qhuav (feem ntau tus nplaig), ua npaws (feem ntau txog 40 degrees). Thaum cev xeeb tub, thaum tus poj niam nyob rau hauv lub supine txoj hauj lwm, nws muaj mob thaum tig nws lub cev ntawm sab laug mus rau sab xis.
Diagnosis
Qhov ua rau mob plab hnyuv plab tseem tsis tau meej, thiab nws tsis yooj yim los txiav txim rau lawv. Cov tsos mob txawv nyob ntawm qhov chaw ntawm cov txheej txheem o. Kev kuaj mob yog nyob ntawm kev kuaj ntshav (ntau cov qe ntshav dawb tshwm hauv nws) thiab tso zis (cov protein ntau ntxiv). X-rays tsis tshua tau ua, vim lawv tsis txiav txim siab qhov tseeb. Ua tsaug rau daim duab, tsuas yog ib lub pob zeb fecal tau nthuav tawm uas ua rau lub qhov qhib ntawm txoj kev.
Ib qho ultrasound ntxiv los txiav txim siab mob plab hnyuv. Qee zaum - tomography ntawm lub computer. Nrog nws cov kev pab, ib daim duab loj ntawm daim ntawv ntxiv tau txais. Tib lub sijhawm, cov ntaub so ntswg uas tau hloov pauv kuj pom meej.
Kev nyuaj siab
Ib qho teeb meem tshwm sim yog perforation. Nws tuaj yeem ua rau muaj kab mob periappendicular abscess (sau cov kab mob paug) lossis diffuse peritonitis (kab mob plab tag nrho). Ua rau mob plab hnyuv hauv daim ntawv mob hnyav: kuaj tsis raug thiab ncua kev kho mob.
Kev mob plab hnyuv muaj tsawg dua. Nws tuaj yeem tshwm sim yog tias qhov mob nyob ib puag ncig ntawm cov txheej txheem nres cov leeg ntawm txoj hnyuv los ntawm kev ua haujlwm, uas tiv thaiv kev tso quav los ntawm nws. Lub plab o thiab ntuav thiab xeev siab tshwm sim. Ib feem ntawm txoj hnyuv uas nyob saum toj ntawm qhov chaw uas muaj kev cuam tshuam patency yog ntim nrog roj thiab kua.
Tab sis qhov teeb meem tseem ceeb tshaj plaws thiab txaus ntshai yog ntshav lom (tsis yog - sepsis). Qhov no yog ib qho mob hnyav thaum cov kab mob nkag mus rau hauv cov hlab ntsha thiab kis mus thoob plaws lub cev. Ib qho teeb meem tseem tuaj yeem ua rau tuag.
Kev kho mob
kho mob plab hnyuv li cas? Cov laj thawj rau nws qhov tshwm sim tuaj yeem sib txawv heev. Piv txwv li, ib qho exacerbation qee zaum tshwm sim nrog cov teeb meem ntawm cov kab mob ntawm txoj hnyuv lossis plab. Tab sis tsuas yog noj cov noob nrog husks kuj tuaj yeem ua rau mob plab hnyuv. Yog tias nws tau raug tsim muaj tseeb tias nws tau tshwm sim nws tus kheej, ces txhawm rau kom tsis txhob muaj kev phiv tshwm sim, koj yuav tsum tsis txhob noj cov tshuaj laxatives lossis tshuaj tua kab mob, thiab ntau dua li siv cov cua sov. Nws yog qhov zoo tshaj rau muab ib yam dab tsi txias rau ntawm qhov chaw uas mob thiab hu rau lub tsheb thauj neeg mob tam sim ntawd. Yog hais tias tus kab mob appendicitis raug muab tshem tawm, ces lub appendix raug tshem tawm siv ib tug ntawm plaub txoj kev: raug, retrograde,laparoscopic thiab transluminal.
Post-operative period
Nrog rau daim ntawv yooj yim ntawm tus kab mob ntws, tus neeg mob, txawm tias thawj hnub tom qab kev phais, tuaj yeem pib maj mam tig hauv txaj, zaum thib ob, thiab sawv ntawm peb lossis plaub. Koj tuaj yeem noj zaub mov tsuas yog hnub thib 3 xwb, thiab nws yuav tsum yog cov kua lossis cov kua qaub. Twb yog hnub thib rau lawv feem ntau hloov mus rau zaub mov noj.
Children's appendicitis
Nyob hauv thawj xyoo ntawm lub neej, nws tsis tshua muaj heev. Feem ntau tshwm sim tom qab 7 xyoo. Thiab thawj cov tsos mob tuaj yeem yog mob hauv plab. Qhov no tsis hais tshwj xeeb txog tus kab mob no, txij li cov tsos mob no tuaj yeem tshwm sim rau lwm yam laj thawj. Txawm li cas los xij, tseem yuav tau mus ntsib kws kho mob kom paub tseeb. Vim li cas lwm tus tuaj yeem tshwm sim tau? Cov laj thawj rau nws qhov tsos tuaj yeem dag nyob rau hauv lub plab zom mov lossis kab mob hauv lub cev.
Qhov mob no tuaj yeem mob ntev lossis mob. Daim ntawv tom kawg hauv cov menyuam yaus raug kuaj pom feem ntau. Hauv qhov no, tus menyuam qhov mob tshwm sim sai sai, xeev siab thiab ntuav tam sim ntawd pib. Tom qab ob peb teev, qhov mob txav mus rau hauv lub plab thiab pib throb ze ntawm caecum. Thaum hnoos los yog sim pw ntawm sab laug, nws hnyav dua. Nyob rau tib lub sijhawm, qhov ncauj pib qhuav, cem quav lossis raws plab yuav tshwm sim.
Nrog cov menyuam yaus hnub nyoog qis dua 7 xyoos, koj yuav tsum tau ceev faj heev nrog cov tsos mob zoo li no, vim nws feem ntau nyuaj rau kev txiav txim siab mob plab. vimlawv tsuas qhia tsis tau qhov twg thiab qhov mob tiag tiag.
Ua rau mob plab hnyuv rau cov hluas thiab menyuam yaus. Vim li cas thiaj tshwm sim?
Thaum hluas, tus kab mob no tshwm sim heev. Feem ntau exacerbation tshwm sim nyob rau lub caij nplooj ntoos hlav los yog lub caij nplooj zeeg. Ua rau mob plab hnyuv rau cov menyuam yaus thiab cov tub ntxhais hluas: feem ntau, tus kab mob tshwm sim vim qhov txo qis hauv kev tiv thaiv kab mob. Vim li ntawd, lub cev tsis muaj peev xwm tiv tau cov kab mob thiab cov kab mob, ib qho kev kis kab mob uas ua rau mob nkag mus rau hauv daim ntawv ntxiv.
Lwm yam ua rau mob plab hnyuv rau menyuam yaus: nws tuaj yeem tshwm sim los ntawm kev hloov pauv kev noj haus thiab ua txhaum txoj haujlwm ntawm lub plab. Feem ntau kev siv cov noob, txiv ntseej, thiab berries plays lub luag haujlwm tseem ceeb. Cov menyuam yaus feem ntau nqos cov husks, plhaub, cov pob txha me, yog li cov niam txiv yuav tsum ua tib zoo saib xyuas lawv. Txawm cov worms zoo tib yam kuj ua rau muaj kab mob.
Vim tias tus menyuam lub cev tseem tsis tau tsim tiav, nws tuaj yeem nyuaj rau kev kuaj mob kom raug. Nyob rau hauv ib tug me nyuam, kev loj hlob ntawm tus kab mob yog sai npaum li cas nyob rau hauv ib tug neeg laus. Cov menyuam yaus ua rau qaug zog, muaj qhov txo qis hauv qab los noj mov, ua daus no, xeev siab, cem quav thiab mob plab hauv plab. Qhov kub tuaj yeem nce mus txog 40 degrees.
Tus neeg laus
Ntau qhov tshwm sim tshwm sim thaum muaj hnub nyoog 20 thiab 30. Feem ntau appendicitis tshwm sim nyob rau hauv cov poj niam cev xeeb tub nrog ib tug predisposition rau cov kab mob ntawm txoj hnyuv thiab kev txom nyem los ntawm cem quav. Txawm hais tias pathology tsis nyob ntawm poj niam txiv neej. Leej twg yuav kis tau tus mob appendicitis? Cov laj thawj rau nws yog hais txog tib yam hauv ib qho twghnub nyoog. Txawm li cas los xij, nyob rau hauv cov menyuam yaus, cov txheej txheem yog underdeveloped thiab yog yooj yim dhuav, thaum nyob rau hauv cov neeg laus nws yog vice versa. Yog li ntawd, tom kawg raug mob ntau dua los ntawm tus kab mob no.
Ua rau mob plab hnyuv rau cov neeg laus: nws tuaj yeem ua rau txhua yam kab mob hauv plab, mob plab, mob plab zom mov lossis kab mob helminthic. Tsis tas li ntawd, cov kws kho mob ntseeg tias qhov ua rau tuaj yeem yog kev tsim txom ntawm cov khoom noj protein.
ntse zoo
Dab tsi ua rau mob plab hnyuv loj? Yog vim li cas rau qhov tshwm sim ntawm daim ntawv no: thawj - blockage ntawm cov txheej txheem, qhov thib ob - ingress ntawm staphylococci, E. coli, streptococci thiab enterococci rau hauv nws. Lawv muaj kev sib cuam tshuam, txij li ob qho tib si cov xwm txheej zoo tshaj plaws yog tsim rau kev loj hlob sai ntawm cov kab mob. Hauv thawj kis, txhua yam ua rau stagnation ntawm cov ntsiab lus thiab o ntawm cov phab ntsa ntawm lub appendix, thiab nyob rau hauv lub thib ob, qhov tshwm sim ntawm inflection ntawm txoj hnyuv thiab impossibility ntawm khoob yog provoked.
Nyob rau sab hnub poob, cov kws kho mob tau txheeb xyuas qhov ua rau exacerbation - thaum fusobacteria nkag mus rau cov txheej txheem, uas ua rau necrotization hauv nws cov ntaub so ntswg. Tus kab mob no loj hlob sai thiab ua rau purulent thiab inflammatory txheej txheem. Nyob rau sab hnub poob, kev saib xyuas kev kho mob muaj ntau, tab sis nyob rau hauv Russia nws yog siv tsis tshua muaj.
Lwm yam ua rau mob plab hnyuv loj: yersiniosis, typhoid fever, tuberculosis, amoebiasis, thiab lwm yam. Tsis tas li ntawd, cov txheej txheem tau yooj yim los ntawm kev tsim cov protein ntau hauv lub cev, uas ua rau lawv tawg sai sai hauv cov hnyuv thiab lub cev. pib ntawm cov txheej txheem ntawm putrefaction. Kuj txawv raws li ib qho kev sib cais yog ib qho nyiam rau cem quav, hauvRaws li qhov tshwm sim ntawm qhov tsis muaj lub sijhawm tshem tawm ntawm cov hnyuv, thiab cov xwm txheej tau tsim rau kev loj hlob sai ntawm cov kab mob.
mob plab hnyuv laus
Hauv cov neeg laus, nws tau sau tseg tsis tshua muaj, tsis pub ntau tshaj ib feem pua ntawm tag nrho cov kab mob appendicitis. Ib tug neeg muaj kev mob ib ntus, hnyav los ntawm kev taug kev thiab hnoos. Nrog kev rov ua haujlwm dua, cov tsos mob zoo ib yam li nrog mob plab hnyuv. Hauv qhov no, lub cev kub yog qhov qub lossis subfebrile. Feem ntau cov kab mob appendicitis yog cais raws li pyelonephritis, peptic ulcer, kab mob ntev ntawm lub plab kab noj hniav.
Purulent appendix
Qhov no yog qhov mob ntawm daim ntawv ntxiv, uas sib txuas ntau hom kab mob hnyav. Vim li cas purulent appendicitis tshwm sim? Yog vim li cas tej zaum yuav muaj raws li nram no: ib tug abundance ntawm lymph, cov ntshav tsis zoo, muaj ib tug tortuous nqaim lumen, variability nyob rau hauv qhov chaw. Hauv qhov no, microbes nkag mus rau hauv cov txheej txheem los ntawm hematogenous, lymphogenous los yog (feem ntau) enterogenous txoj kev. Nrog hom mob no, cov nroj tsuag yog polymicrobial.
theem kab mob
cais ntau lub sijhawm:
- Catarrhal appendicitis (thawj 12 teev). Cov tsos mob tshwm sim yog qhov tsis xis nyob thiab mob hauv plab, feem ntau thaum yav tsaus ntuj thiab hmo ntuj. Zoo sib xws nrog cov tsos mob ntawm gastritis. Thaum lub sij hawm no, tsis muaj zog, malaise, tab sis lub plab mog tseem mos, txawm tias mob thaum nias rau ntawm sab xis.
- Phlegmonous appendicitis (thaum kawg ntawm thawj hnub). Qhov mob yog qhia meej meej nyob rau sab xis, hauv cheeb tsam iliac. Nws pulsating thiabmob siab heev. Muaj xeev siab, tachycardia, ua npaws. Lub plab hauv cheeb tsam ntawm cov txheej txheem o yog nruj.
- Gangrenous appendicitis (hnub thib ob thiab thib peb). Muaj kev tuag ntawm qhov kawg ntawm cov txheej txheem, kev qaug cawv hauv lub cev nce ntxiv, tachycardia tau hais. Qhov kub thiab txias poob qis, lub plab o, tsis muaj peristalsis.
- Perforated appendicitis (thaum kawg ntawm peb hnub). Mob hnyav thiab mob hnyav nyob rau hauv txoj cai qis plab, nws qhov mob hnyav zuj zus tuaj. Yog tsis muaj lub sij hawm ntawm nyem, lub plab yog o thiab nruj, ntuav tas li pib. Cov txheej ntawm tus nplaig tig xim av tsis yog dawb. Qhov kub nce mus rau qhov tseem ceeb. Cov txiaj ntsig - purulent appendicitis lossis hauv zos abscess.
Kev nyuaj siab
Vim li cas qee zaum nyuaj rau kuaj mob appendicitis? Cov laj thawj rau nws qhov tshwm sim, cov kws kho mob tseem pom tias nws nyuaj rau npe raws nraim. Txoj hauj lwm ntawm qhov tua yog txawv. Feem ntau nws yog nyob rau hauv lub plab mog - nyob rau hauv txoj cai cheeb tsam, tab sis tej zaum yuav muaj ib tug mesentery. Qhov no yog ib daim ntawv zoo li zaj duab xis uas txuas cov txheej txheem rau cov qauv uas nyob rau hauv lub plab kab noj hniav. Nrog ib tug ntev mesentery, cov txheej txheem tej zaum hloov noticeably. Tsis tas li ntawd, qee zaum nws tuaj yeem ntev dua li niaj zaus.
Nyob rau hauv qee kis, cov kab mob ntxiv mus rau hauv lub plab mog, thiab hauv cov poj niam nws nyob nruab nrab ntawm nws cov pob qij txha. Nws tseem tuaj yeem nyob hauv qab txoj hnyuv. Nyob rau hauv tas li ntawd, cov tsos mob zoo ib yam li o ntawm ntau yam kabmob (piv txwv li, pelvic kabmob).
Nws yog ib qho nyuaj rau kev txiav txim siab kab mob appendicitis nyob rau hauv cov xwm txheej uas ib tug neeg muaj lwm yam inflammatorycov txheej txheem uas tuaj yeem muab cov tsos mob zoo sib xws. Yog li ntawd, thawj zaug tus neeg mob raug soj ntsuam rau qee lub sijhawm txhawm rau kuaj xyuas kom raug, vim tias cov tsos mob ntawm mob plab hnyuv yuav tshwm sim ntau dua tom qab ib ntus.
