Tense ascites (ICD-10 code: R18) yog ib qho mob thib ob uas muaj cov kua dej tshwj xeeb hauv lub plab tshwm sim. Pathology yog qhia los ntawm kev loj hlob ntawm lub plab nyob rau hauv ntim, tsis xis nyob thiab mob, ua tsis taus pa luv, ib tug zoo nkaus li hnyav thiab lwm yam cim.
Hauv tshuaj, hom kab mob no hu ua mob plab plab, uas tuaj yeem nrog ntau tus kab mob los ntawm lwm qhov chaw. Dropsy tsis suav hais tias yog tus kab mob ywj pheej, tab sis ua raws li cov cim qhia ntawm pathology hnyav hauv lub cev.
Infographics ntawm ascites hom qhia tias hauv xya caum feem pua ntawm cov neeg laus nws yog tsim los ntawm cov kab mob siab. Mob qog noj ntshav ua rau tsim cov ascites hauv 10% ntawm cov xwm txheej, lwm 5% yog vim lub plawv pathologies thiab lwm yam kab mob. Nyob rau tib lub sijhawm, ascites hauv menyuam yaus qhia txog kab mob raum.
Nws tau raug pov thawj tias cov dej ntau tshaj plaws hauv lub plab kab noj hniav nrog mob plab ascites (ICD-10 code: R18) hauv tus neeg mob tuaj yeem ncav cuag25 liters.
Yog vim li cas
Ascites yam muaj ntau haiv neeg thiab ib txwm cuam tshuam nrog qee qhov tseem ceeb pathology. Lub plab yog suav tias yog qhov chaw kaw uas tsis muaj cov kua dej tsim nyog yuav tsum tau tsim.
Lub peritoneum muaj ob txheej. Feem ntau, nruab nrab ntawm cov nplooj ntawv no ib txwm muaj dej me me, uas yog tshwm sim los ntawm kev ua haujlwm ntawm cov ntshav thiab cov hlab ntsha lymphatic nyob rau hauv cov kab noj hniav peritoneal. Txawm li cas los xij, cov kua dej no tsis sib sau, txij li yuav luag tam sim tom qab sib cais nws tau nqus los ntawm lymphoid capillaries. Qhov seem me me yog xav tau kom lub voj voog ntawm txoj hnyuv thiab cov kab mob hauv nruab nrog cev tuaj yeem txav tau yooj yim hauv lub cev thiab tsis txhob kov ib leeg.
Thaum qhov teeb meem, excretory thiab resorptive functions raug ua txhaum, cov exudate yuav tsum tsis absorbed ib txwm thiab accumulates nyob rau hauv lub plab mog, vim hais tias ntawm uas khaus ascites yog tsim.
mob siab
Thawj qhov chaw yog muab cov kab mob hu ua cirrhosis, nrog rau cov qog ntawm lub cev thiab Budd-Chiari syndrome. Cirrhosis tuaj yeem tiv thaiv keeb kwm yav dhau los ntawm kab mob siab, steatosis, kev siv tshuaj lom neeg, kev haus dej cawv thiab lwm yam mob, tab sis tas li nrog kev tuag ntawm hepatocytes. Yog li ntawd, lub siab zoo hlwb raug hloov los ntawm caws pliav nqaij, lub cev loj hlob nyob rau hauv ntim, compresses lub portal leeg, thiab yog vim li cas khaus ascites yog tsim. Ntxiv rau, nws pab tso tawmCov dej tsis tsim nyog, txo qis hauv oncotic siab, vim tias lub siab nws tus kheej tsis tuaj yeem tsim cov plasma proteins thiab albumins. Txhim kho cov txheej txheem pathological nyob rau hauv tense ascites nyob rau hauv daim siab cirrhosis, ib tug xov tooj ntawm reflex kev cuam tshuam tshwm sim los ntawm lub cev nyob rau hauv teb rau daim siab tsis ua hauj lwm.
mob plawv
Tense ascites tuaj yeem tshwm sim vim lub plawv tsis ua haujlwm, lossis vim muaj kab mob pericarditis. Muaj peev xwm ua tau ntawm yuav luag txhua yam kab mob plawv. Cov txheej txheem ntawm ascites tsim nyob rau hauv cov ntaub ntawv no yuav yog vim lub fact tias lub hypertrophied cardiac nqaij tsis muaj peev xwm mus nqus cov ntshav uas yuav tsum tau, uas pib mus rau hauv cov hlab ntsha, nrog rau lub inferior vena cava system. Vim muaj kev kub siab, cov kua dej yuav pib tawm ntawm lub txaj vascular, tsim cov ascites. Cov txheej txheem ntawm kev tsim ntawm ascites nyob rau hauv pericarditis yog kwv yees li qub, txawm li cas los xij, nyob rau hauv cov ntaub ntawv no, txheej txheej ntawm lub plawv yuav o, uas ua rau lub impossibility ntawm nws ib txwm sau nrog cov ntshav. Tom qab ntawd, qhov no cuam tshuam rau kev ua haujlwm ntawm venous system.
Kidney disease
Vim los ntshav ntawm lub raum tsis ua haujlwm ntev, uas tshwm sim los ntawm ntau yam kab mob (pyelonephritis, glomerulonephritis, urolithiasis, thiab lwm yam). Cov kab mob raum ua rau qhov tseeb tias ntshav siab nce, sodium, ua ke nrog cov kua dej, khaws cia hauv lub cev, vim li ntawdascites yog tsim. Kev txo qis hauv plasma oncotic siab, uas ua rau ascites, kuj tuaj yeem tshwm sim tawm tsam keeb kwm ntawm nephrotic syndrome.
Lwm yam
Ascites tuaj yeem ua tiav nrog qhov tsis xws luag hauv cov hlab ntsha lymphatic. Qhov no yog vim kev raug mob, vim muaj cov qog hauv lub cev uas muab cov metastases, vim yog kis kab mob filariae (cov kab mob uas tso lawv cov qe hauv cov hlab ntsha loj).
Ntau qhov txhab ntawm peritoneum feem ntau ua rau ascites. Ntawm lawv - diffuse, tuberculous thiab fungal peritonitis, peritoneal carcinosis, hlav ntawm txoj hnyuv loj, plab, mis, zes qe menyuam, endometrium. Qhov no kuj suav nrog pseudomyxoma thiab peritoneal mesothelioma.
Polyserositis yog suav hais tias yog ib tus kab mob uas ua rau muaj mob tshwm sim nrog rau lwm yam cim, suav nrog pleurisy thiab pericarditis.
Cov kab mob uas muaj kab mob tau npaj ua rau cov dej nkag mus rau hauv peritoneum. Cov no yog rheumatism, rheumatoid mob caj dab, lupus erythematosus thiab ntau dua.
Ascites hauv cov menyuam yug tshiab kuj tshwm sim thiab feem ntau suav hais tias yog qhov tshwm sim ntawm tus kabmob hemolytic ntawm tus menyuam hauv plab. Nws, nyob rau hauv lem, yog tsim thaum lub sij hawm ib tug intrauterine immunological teeb meem, yog hais tias cov ntshav ntawm lub fetus thiab leej niam tsis sib xws nyob rau hauv lub txiav txim ntawm antigens.
Kab mob ntawm lub plab zom mov tuaj yeem ua rau muaj dej ntau dhau hauv lub plab kab noj hniav. Nws tuaj yeem ua rau mob pancreatitis, mob raws plab ntev, Crohn tus kab mob. Nws tseem tuaj yeem suav nrog ntawm no tag nrho cov txheej txheem uas tshwm sim hauv peritoneum thiab cuam tshuam rau cov zis lymphatic.
xwm txheejlocalis ntawm tense ascites (cov tsos mob)
Qhov pib ntawm ascites yog qhov loj hlob sai ntawm lub plab, thiab tshwj xeeb tshaj yog, nws qhov o. Qhov tseem ceeb tshaj plaws yog tias cov dej ntau ntau ntxiv ntxiv, uas yuav luag tsis tuaj. Ib tug neeg pom ascites hauv nws tus kheej, raws li txoj cai, thaum nws tsis tuaj yeem haum rau hauv cov khaub ncaws zoo tib yam, uas tsis ntev dhau los ua rau nws haum rau qhov ntim.
Yog tias ascites tshwm sim, tom qab ntawd hauv lub cev, tau kawg, muaj tsawg kawg yog ob qhov kev ua haujlwm tseem ceeb uas yuav tsum tau kho. Feem ntau ntawm tag nrho cov, nws yog txoj haujlwm pathological ntawm txoj hnyuv, plab zom mov lossis lub siab tsis zoo.
Tus nqi nce hauv cov paib cuam tshuam ncaj qha rau qhov ua tau los ua qhov ascites. Cov txheej txheem tuaj yeem ua tiav sai, lossis nws tuaj yeem siv li ob peb lub hlis.
Local status of tense ascites:
- Lub xeev hnyav hauv plab kab noj hniav.
- Tseem muaj qhov tsis xis nyob thiab mob hauv plab thiab plab.
- Bloating, cov cim qhia ntawm flatulence.
- Kev kub nyhiab hauv txoj hlab pas.
- nyuaj mus rau chav dej thiab noj.
- -bouts ofa.
- Npaj plab loj. Yog tias tus neeg mob nyob rau hauv kab rov tav, ces lub plab o nyob ib ncig ntawm cov npoo thiab zoo li lub plab ntawm tus qav. Yog hais tias ib tug neeg nyob rau hauv lub upright txoj hauj lwm, lub plab hangs.
- Cov tsos mob ntawm plab swaying lossis hloov pauv. Tsis tas li ntawd tshwm sim thaum ntim cov kua.
- Cov dej ntau ntxiv hauv plab kab noj hniav, ua tsis taus pa ntau dua,o ntawm qis extremities zuj zus, txav mus qeeb. Tshwj xeeb tshaj yog nyuaj rau tus neeg mob ntsoos mus rau pem hauv ntej.
- Vim yog nce siab hauv plab, femoral lossis umbilical hernia yuav ua rau bulge. Tawm tsam tib lub keeb kwm yav dhau, hemorrhoids thiab varicocele tuaj yeem tsim. Prolapse ntawm lub qhov quav yuav tsis txiav tawm.
Cov tsos mob nyob ntawm qhov xwm txheej
Qhia txog cov xwm txheej ntawm thaj chaw ntawm qhov mob hnyav ascites thiab xws li:
Tuberculosis peritonitis. Nyob rau hauv cov ntaub ntawv no, dropsy yog suav hais tias yog ib tug tshwm sim ntawm ib tug tuberculous lesion ntawm lub reproductive system los yog txoj hnyuv. Tus neeg mob pib poob ceeb thawj sai, nws lub cev kub nce, cov tsos mob ntawm intoxication ntawm lub cev nce. Lymph nodes loj hlob, uas dhau los ntawm mesentery ntawm txoj hnyuv. Ntxiv rau cov lymphocytes thiab erythrocytes, mycobacterium tuberculosis yuav raug cais nyob rau hauv cov sediment ntawm cov exudate coj los ntawm puncture.
Peritoneal carcinosis. Yog hais tias tus kab mob tshwm sim vim muaj cov qog nyob rau hauv lub peritoneum, ces cov tsos mob ntawm tus kab mob yuav ua ntej ntawm tag nrho cov nyob rau hauv uas nws cuam tshuam lub cev. Txawm li cas los xij, tsis tu ncua nrog ascites ntawm oncological etiology, qhov nce ntawm cov qog ntshav qog tshwm sim, uas tuaj yeem hnov los ntawm phab ntsa. Cov effusion sediment yuav muaj cov hlwb atypical.
Lub plawv tsis ua hauj lwm. Tus neeg mob muaj cov xim xiav-violet ntawm dermatological integument. Cov ceg qis, tshwj xeeb tshaj yog cov ko taw thiab cov ceg qis, yuav ua rau khaus heev. Nyob rau tib lub sijhawm, lub siab nce hauv ntim, qhov mob tshwm sim, nyob hauv txoj cai hypochondrium.
Portal leeg. Tus neeg mob yuav yws yws ntawm qhov mob hnyav, lub siab nce hauv ntim, tab sis tsis ntau. Muaj kev pheej hmoo los ntshav hnyav. Ntxiv nrog rau qhov nce hauv daim siab, muaj kev txaus siab rau qhov ntim ntawm tus po.
Kev kuaj mob ascites
Kev kuaj mob ntawm qhov mob hnyav (hauv ICD-10: R18) pib nrog kev cais tawm ntawm lwm yam ua rau muaj qhov nce hauv lub plab. Piv txwv li, cysts, cev xeeb tub, qog, rog. Raws li ib feem ntawm kev txheeb xyuas, cov kev ua hauv qab no yog siv:
- Palpation, kev tshuaj xyuas qhov muag, percussion.
- kuaj ultrasound.
- Ultrasound ntawm cov hlab ntsha.
- Scintigraphy.
- Laparoscopic plab zom mov.
- Ascitic fluid analysis.
Thaum lub suab nrov, lub suab nrov yog yam ntxwv, thaum lub sijhawm palpation ntawm sab nraud, cov tsos mob ntawm qhov hloov pauv tau lees paub. Radiography ua rau nws muaj peev xwm kuaj tau cov ascites yog tias ntau tshaj 0.5 litres ntawm cov kua dej dawb khaws cia hauv lub plab kab noj hniav. Raws li rau ultrasound, thaum lub sij hawm kev ntsuam xyuas no, them nyiaj mloog mus rau cov ntaub so ntswg ntawm lub siab thiab tus po, lawv kawm txog lawv tus mob, xyuas lub peritoneum rau cov qog thiab mechanical lesions.
Kev Tshawb Fawb
Ib theem tseem ceeb ntawm kev tswj xyuas tom qab kev tsis txaus siab nrog cov ascites khaus yog cov qauv ntawm kev sim:
- Coagulogram.
- siab biochemistry.
- Tshuaj xyuas cov tshuaj tiv thaiv kab mob.
- Ua tiav urinalysis.
Yog tus neeg mob ascites thawj zaug, tus kws kho mobteem ib lub laparocentesis los kawm cov kua nws tus kheej. Nyob rau hauv lub chaw soj nstuam, muaj pes tsawg leeg, ntom, protein cov ntsiab lus raug kuaj, kab lis kev cai bacteriological yog ua tiav.
kev kho mob
Tshuaj kho mob ascites yog ua ob qho tib si nrog diuretics thiab potassium npaj, albumin tov, asparkam. Qhov no yog ua los ntawm ib qho laj thawj, tab sis rau plasma siab, yog li nce ntshav ntim. Yog tias tus neeg mob muaj cov ascites hnyav, nrog rau kev siv tshuaj, nws raug xa mus rau tus txheej txheem laparocentesis siv ultrasound navigation. Piercing nrog ib tug trocar tshem tawm cov kua los ntawm lub plab kab noj hniav. Qee lub sij hawm cov kws kho mob muab tso rau hauv qhov dej kom tshem tawm cov exudate los yog transudate mus sij hawm ntev.
Txhawm rau tshem tawm cov kua dej ascitic koj xav tau:
- txo qis sodium kom tsawg;
- tshem tawm sodium hauv cov zis sai li sai tau.
Txhawm rau txo cov sodium hauv lub cev, nws yuav tsum txwv tsis pub noj zaub mov. Txhawm rau ua qhov no, koj yuav tsum noj 3 grams ntsev ib hnub. Tom qab tag nrho, nws tau raug pov thawj tias qhov tsis muaj ntsev muaj qhov cuam tshuam tsis zoo rau cov protein metabolism hauv lub cev. Tam sim no ntau tus tau pib noj tshuaj xws li Captopril, Fosinopril, Enalapril rau kev kho mob ascites. Lawv paub tias yuav ua rau kom lub cev tawm ntawm sodium los ntawm lub cev thiab nce cov zis ib hnub. Thiab tseem pab txhawb kom khaws cov poov tshuaj hauv lub cev. Tsis txhob hnov qab tias diuretics tsis tsuas yog txo cov ascites, tab sis kuj tshem tawm cov kua dej los ntawm ntau cov ntaub so ntswg.
kev kho mob phais
Laparocentesis yog kev kho mob phais rau ascites. Txhawm rau kom tshem tawm cov kua dej ntau dhau, ib qho puncture yog tsim thiab ib qho cuab yeej tshwj xeeb, trocar, muab tso rau. Nyob rau ntawm lub plab khoob thiab nrog lub zais zis, tus neeg mob zaum los yog pw ntawm nws sab, tshuaj loog hauv zos tau sau tseg. Tawm ntawm qhov nruab nrab 1-2 cm ntawm lub plab thiab pubis - qhov chaw puncture. Nco ntsoov ua raws li cov cai ntawm cov tshuaj tua kab mob. Ib qho puncture yog ua rau ntawm daim tawv nqaij nrog ib tug taw tes scalpel, ces ib tug trocar yog muab tso rau. Txhawm rau kom tsis txhob poob siab tam sim ntawd, cov kua dej tau maj mam tshem tawm, ntawm ntu 1-2 feeb.
Txhawm rau tshem tawm cov kua dej, qhwv lub cev nrog ib daim phuam thiab sib npaug ntawm tus neeg mob lub plab nrog nws. Cov kua dej yog muab tshem tawm ib zaug los yog muab tso rau hauv ib lub catheter mus tas li. Qhov no yog txiav txim los ntawm tus kws kho mob. Nws tsis pom zoo kom rho tawm ntau tshaj 5-6 litres dej ib zaug, vim tias muaj teeb meem tshwm sim, xws li mob plawv. Tom qab tshem tawm cov trocar, sutures yog siv. Thaum lub catheter raug ntsia, muaj peev xwm tsim tau ib qho ascitic fistula. Lub fistula yog tsim ntawm qhov chaw puncture los yog nruab nrab ntawm cov seams. Yog tias cov kua dej ascitic tuaj yeem kav ntev tshaj li ib hnub, nws yuav tsum tau kaw lub qhov nrog kev cuam tshuam sutures
kev kho neeg zoo
Ascites yog, raws li koj paub, tee ntawm lub plab kab noj hniav, uas feem ntau cuam tshuam rau cov neeg muaj kab mob plawv, raum tsis ua haujlwm thiab ua rau muaj kev loj hlob ntawm oncology. Kev kho mob thiab kev tiv thaiv ntawm ascites nyob hauv ib qho chaw tseem ceeb hauv kev kho mob, yog li ntawd, hauv cov chaw kho mob hnyav tshaj plaws, cov kws kho mob kuj pom zoo kom siv lwm cov tshuaj ntxiv kom muaj kev cuam tshuam rau qhov teeb meem.
txhais li cas ntawm kev sib ntaus sib tua ascites yog qhov kev coj ua ntawm kev noj qab haus huv hauv lub neej qhia:
Siv nplooj thiab buds los ua tshuaj potions:
- "Qhuav" birch da dej. Birch nplooj tau sau thiab muab tso rau hauv ib da dej, ib lub thoob loj, ib lub phiab. Npog nrog yas qhwv thiab cia nws brew nyob rau hauv ib qho chaw ci rau ob peb teev. Sai li cov nplooj lwj, lawv qhib thiab qhuav me ntsis. Tus neeg mob tau muab tso rau hauv ib da dej kom tiav thiab tso cai rau pw rau 30-40 feeb. Qhov xwm txheej ib txwm muaj tom qab da dej birch qhuav yog tus cwj pwm los ntawm me ntsis tingling ntawm daim tawv nqaij.
- Da dej nrog decoction ntawm birch. 50 grams ntawm qhuav los yog tshiab birch nplooj yog nchuav rau hauv da dej thiab sau nrog 10 thoob dej sov boiled. Tom qab ntawd, tus neeg mob nrog ascites yog muab tso rau hauv ib lub decoction rau 30-40 feeb. Yog hais tias, thaum tawm hauv da dej, ib qho loog loog me ntsis ntawm cov ceg tawv tau hnov thiab cov kab txaij liab liab thiab cov pob pom ntawm lub cev, cov nyhuv ntawm decoction yog suav tias yog qhov zoo.
- qhwv nrog birch broth. Ib qho decoction rau lub cev qhwv yog npaj tib yam li kev da dej. Tus neeg mob yog qhwv rau hauv ib daim ntawv soaked nyob rau hauv ib tug tshuaj nyob rau hauv cov tshuaj los ntawm armpits mus rau lub hauv caug. Tom qab ntawd lawv pw saum txaj thiab npog nrog ob peb txheej ntawm ntaub pua plag. Cia kom pw hauv lub xeev no li 45-50 feeb. Tom qab ntawd lawv ntxuav nrog dej sov.
YDiuretic tshuaj ntsuab infusions:
- Diuretic sau, uas yog nplua nuj nyob rau hauv cov vitamins. Koj yuav xav tau qhuav sawv hips, raspberry nplooj, lingonberries thiab dub currants nyob rau hauv zoo sib xws proportions. Ncuav ib feem peb ntawm ib khob ntawm cov tshuaj no nrog ib khob dej kub heev. Boil ib nrab ib teev tom qabdab tsi txias thiab noj ob zaug ib hnub.
- Khau dej los ntawm taum pods. Nqa cov husk ntawm 20 taum pods thiab steam rau 10-15 feeb nyob rau hauv boiling dej. Qhib lub thawv, sib tov lub substrate thiab cia nws brew rau lwm 30 feeb. Muab faib ua plaub zaug thiab haus ib nrab teev ua ntej noj mov.
Dab tsi yog ascites noj?
Cov zaub mov no muaj nws txoj cai uas yuav tsum tau ua kom pom tseeb, thiab yog tias qhov no tsis ua tiav, tus kab mob yuav sai sai mus rau theem tom ntej. Ib txoj cai tseem ceeb yog noj cov zaub mov me me txhua peb teev, thiab cov tais diav yuav tsum sov. Tsis muaj teeb meem koj yuav tsum tau noj ntau dhau los yog nce lub sijhawm ncua ntawm cov pluas noj, vim qhov no yuav ua rau muaj qhov mob hnyav hauv plab kab noj hniav.
Tag nrho cov khoom xyaw rau cov tais diav nrog ascites yuav tsum tau txais kev kho cua sov tsawg, thiab nws raug nquahu kom ua txhua yam zaub mov, ci yam tsis siv roj lossis stew. Kev noj zaub mov ntawm cov neeg uas raug kev txom nyem los ntawm kev nqhis dej yuav tsum muaj cov khoom noj qab haus huv thiab ntau yam, thiab tseem yuav tsum tau muab tso rau ntawm cov nroj tsuag ntsim uas muaj cov nyhuv diuretic me ntsis. Yog tias tee tshwm sim ntawm keeb kwm ntawm cirrhosis ntawm daim siab, ces nws yog ib qho tsim nyog yuav tsum muaj cov khoom noj uas muaj cov proteins uas yooj yim digestible hauv cov ntawv qhia zaub mov.
tso cai rau cov khoom noj rau tus kab mob
Hauv kev noj zaub mov ntawm cov neeg uas raug kev txom nyem los ntawm ascites, cov ntses hiav txwv ntawm cov rog tsawg yuav tsum suav nrog, uas yuav tsum tau ua kom tsis muaj ntsev hauv qhov cub lossis steamed. Cov ntawv qhia zaub mov yuav tsum suav nrog lub ntswskua tais uas yuav tsum tau npaj nrog cov khoom xyaw xws li fennel, parsley los yog qhiav. Raws li rau cov nqaij, kev nyiam yuav tsum tau muab rau qaib ntxhw, luav lossis nqaij qaib tsis muaj nqaij, thiab nws yog ib qho tsim nyog yuav tsum tau ua cov tais diav los ntawm cov nqaij no. Nws yog ntshaw kom npaj cov dej qab zib los ntawm cov khoom uas muaj ib tug me me diuretic nyhuv, piv txwv li, los ntawm currant nplooj los yog figs.
