Kab mob appendicitis yog kab mob gastroenterological feem ntau. Kev mob feem ntau tshwm sim tam sim ntawd. Kev tshwm sim ntawm appendicitis muaj ntau haiv neeg thiab nyob ntawm daim ntawv ntawm pathology, lub hnub nyoog ntawm tus neeg mob thiab localization ntawm appendix. Tsis tas li ntawd, cov tsos mob nyob ntawm seb muaj cov kab mob ntev ntawm txoj hnyuv, thiab hauv cov poj niam - cev xeeb tub.
Appendicitis: piav qhia ntawm tus kab mob
Appendicitis yog ib qho pathology ntawm lub plab kab noj hniav, tus yam ntxwv los ntawm o ntawm lub appendix ntawm caecum (appendix). Hauv gastroenterology, tus kab mob yog suav hais tias yog feem ntau. Ntawm tag nrho cov tsev kho mob hauv kev phais, 89.1% yog rau mob plab hnyuv. Tus kab mob no tshwm sim nyob rau hauv cov txiv neej thiab poj niam nrog sib npaug zaus. Qhov nruab nrab, 5 ntawm 1,000 tus neeg muaj hnub nyoog 10 txog 30 xyoo raug kuaj mob appendicitis txhua xyoo.
Nrog qhov tshwm sim ntawm qhov tshwm sim ntawm pathology, nws tsis yog qhov xav tsis thoob tias qee qhov tsis xis nyob hauv plab yog yuam kev rau cov tsos mobo ntawm thawj ntu ntawm txoj hnyuv. Txhawm rau kom tsis txhob ntshai ua ntej, koj yuav tsum xub xyuas seb sab twg ntawm tus mob appendicitis nyob. Yuav kom ua tau li no, nws yog ib qho tsim nyog yuav tau ua kom lub cim xeeb ntawm tib neeg lub cev.
Cov ntawv ntxiv yog ib qho rudimentary, tsis tag nrho cov txheej txheem ntawm caecum. Nws qhov tseeb localization nyob ntawm qhov chaw ntawm caecum. Yeej, lub rudiment nyob rau hauv lub iliac fossa, thiab tej zaum yuav pw saum cov hnyuv los yog hauv qab no nyob rau hauv lub me me pelvis, tab sis tsuas yog nyob rau sab xis mus rau hauv qab.
Kev faib tawm
Thaum qhov tsis xis nyob tshwm sim hauv plab, ntau tus sim nco ntsoov tias sab twg ntawm qhov mob plab, nws cov tsos mob thiab cov tsos mob. Tab sis yog tias qhov chaw nyob tsis tu ncua, tom qab ntawd cov tsos mob tshwm sim muaj qhov sib txawv uas nyob ntawm daim ntawv ntawm pathology.
Muaj ob hom ntawv tseem ceeb: mob thiab mob. Ob leeg muaj ntau txoj kev xaiv. Thaum mob hnyav ntawm lub cev rudimentary, cov ntaub ntawv hauv qab no yog qhov txawv:
- Catarrhal (yooj yim). Nws yog yam ntxwv los ntawm impaired ntshav thiab lymph ncig nyob rau hauv tus txheej txheem, tsim ntawm purulent exudate nyob rau hauv lub mucous txheej. Kev tshwm sim ntawm appendicitis ntawm daim ntawv no yog qhov txawv ntawm polymorphism. Pathology tau masquerade raws li ntau yam kab mob phais.
- Purulent thiab phlegmonous (cov ntaub ntawv puas tsuaj). Kev loj hlob ntawm catarrhal appendicitis ua rau purulent. Ib hnub tom qab, leukocyte infiltration npog tag nrho cov thickness ntawm cov txheej txheem phab ntsa, uas yog xam raws li ib tug phlegmonous daim ntawv.
- Tswv Ntuj. Nws tshwm sim nyob rau hauv ib hnub, tus cwj pwm los ntawm microabscesses. Ua rau mob hnyav, kub taub hau txog 40 degrees.
- Nkauj hmoob. Nws tshwm sim los ntawm infiltration ntawm phab ntsa ntawm cov hlab ntsha ntawm cov txheej txheem, uas ua rau lawv puas thiab tsim ntawm cov ntshav txhaws. Raws li kev txheeb cais, kab mob qog noj ntshav tau kuaj pom hauv 8.1-8.5% ntawm cov neeg muaj hnub nyoog qis dua 20 xyoo, thiab tom qab 60 - 30-33%.
Tus kab mob appendicitis yog tsawg heev. Muaj 3 daim ntawv:
- residual - kev tawm tsam ntawm mob plab hnyuv, xaus hauv kev rov qab los yam tsis muaj kev phais;
- recurrent - rov tawm tsam ntawm daim ntawv mob hnyav nrog cov tsos mob tsawg;
- primary-chronic - sluggish development of appendicitis without acute attacks.
Kev tshwm sim
Kev swb ntawm cov kab mob ntxiv yog tshwm sim los ntawm cov kab mob flora uas cog rau hauv txoj hnyuv. Hauv cov neeg mob loj tshaj plaws, cov "culprits" ntawm kev txhim kho cov txheej txheem pathological yog staphylococci, E. coli, diplococci, anaerobes thiab lwm yam.
txheej txheem yog nplua nuj hauv cov ntaub so ntswg lymphoid, uas ua rau nws koom nrog cov txheej txheem nrog lub cev tiv thaiv kab mob. Mob tshwm sim ntawm appendicitis yog txuam nrog kev ua kom lub lymphatic apparatus, uas ua rau o ntawm lub rudiment thiab squeezing ntawm cov kab mob nyob ze.
Muaj cov kab mob pathogenic microflora hauv cov hnyuv yog qhov yuav tsum tau ua. Nrog kev pab los ntawm nws, cov txheej txheem ntawm kev zom zaub mov yog nqa tawm. Tab sis nyob rau hauv qee yam mob, cov kab mob ua rau muaj kev kub ntxhov thiab ua rau mob:
- Mechanical blockade ntawm lub lumen ntawm daim ntawv ntxiv. Raws li qhov tshwm sim ntawm kev khoov ntawm cov txheej txheem ntawm lub xub ntiag ntawm fecal pob zeb hauv nws lumen,proliferation ntawm lymphoid cov ntaub so ntswg, stagnation ntawm cov hnyuv cov ntsiab lus tshwm sim thiab o tshwm sim.
- Impaired ncig. Nrog rau cov ntshav tsis zoo nyob rau hauv cov phab ntsa ntawm cov hnyuv, muaj qhov tsis muaj cov as-ham, kev tiv thaiv hauv zos txo qis, uas ua rau muaj kev ua kom cov kab mob pyogenic.
- Qhov xwm txheej ntawm kev noj haus ua lub luag haujlwm. Nrog rau kev noj cov zaub mov muaj roj ntau, kev noj cov kua dej tsis txaus thiab nyiam cem quav, ntau dhau ntawm ammonia, carbon dioxide thiab lwm yam khoom siv protein ntau hauv cov hnyuv. Cov xwm txheej zoo li no yog qhov zoo rau kev txhim kho cov kab mob pathogenic.
Kev tshwm sim ntawm kab mob appendicitis hauv cov neeg laus
Cov tsos mob ua npaws txawv raws hnub nyoog. Cov neeg muaj hnub nyoog nruab nrab muaj lub zog tiv thaiv kab mob, lub cev sim tiv thaiv cov kab mob ntawm nws tus kheej. Hauv cov menyuam yaus, kev tiv thaiv kev ua haujlwm tsis zoo, dhau li ntawd, cov neeg mob me yog qhov nkag siab ntau dua.
Tsis zoo li menyuam yaus, cov neeg laus paub tias sab mob plab yog dab tsi. Tab sis qhov no tsis txaus kom paub txog qhov kev tawm tsam ntawm daim ntawv mob ntawm qhov mob ntawm daim ntawv ntxiv. Cov tsos mob ntawm tus mob appendicitis yog mob hnyav nyob rau hauv cheeb tsam iliac ntawm sab xis. Raws li txoj cai, nws tshwm tam sim ntawd. Thaum xub thawj, qhov mob muaj tus cwj pwm txawv lossis muaj ntau dua nyob rau hauv cov tav los ze rau thaj tsam ntawm lub plab.
Tom qab ob peb teev, kev txom nyem lub cev hnyav zuj zus tuaj thiab pom meej dua hauv thaj av iliac ntawm sab xis. Nrog rau qhov chaw atypical ntawm tus txheej txheem, qhov mob tau hnov hauv lub nraub qaum, hauv cheeb tsam pelvic. Mobpronounced, tas li, txawm ntau aggravated los ntawm hnoos, luag. Nws txo qis thaum pw ntawm sab xis.
Cov txheej txheem inflammatory tau tshwm sim thiab cuam tshuam rau lub plab zom mov. Yog li ntawd, qhov mob feem ntau tshwm sim los ntawm cov tsos mob ntawm dyspepsia (kev zom zaub mov): xeev siab, nce roj tsim, quav quav (zaub mov lossis cem quav), ntuav. Intoxication yog tshwj xeeb tshaj yog hais nyob rau hauv purulent, phlegmonous daim ntawv.
Muaj qhov kub nce mus txog 38 ° C rau ob peb teev, nce lub plawv dhia mus txog 90-100 neeg ntaus ib feeb yam tsis muaj kev tawm dag zog. Nyob rau hauv tsawg zaus, o ntawm iliac thiab pelvic leeg nrog thrombus tsim. Qhov no tuaj yeem ua rau pulmonary embolism.
Symptoms of appendicitis in me
Qhov ua rau mob ntawm cov txheej txheem rudimentary hauv cov menyuam yaus yog tib yam li cov neeg laus. Tab sis daim duab kho mob txawv me ntsis.
Cov menyuam yaus feem ntau tsis muaj lub tswv yim ntawm qhov mob ntawm qhov mob plab, nws cov tsos mob yog qhov tsis paub ntau dua rau lawv. Hauv cov menyuam yaus hnub nyoog qis dua 2 xyoos, qhov mob ntawm lub appendage ntawm caecum yog tsis tshua pom vim yog cov yam ntxwv ntawm lub cev ntawm lub cev. Qhov laj thawj tseem ceeb ntawm cov kab mob appendicitis ntawm lub hnub nyoog no yog qhov kev loj hlob tsis txaus ntawm cov qog nqaij hlav hauv cov txheej txheem. Thaum muaj hnub nyoog 6-8 xyoo, cov follicles hauv cov qog ntshav tau tsim tag nrho, qhov zaus ntawm kev loj hlob ntawm cov txheej txheem inflammatory hauv cov txheej txheem ntawm caecum nce.
Tus yam ntxwv tseem ceeb tshwm sim ntawm cov kab mob appendicitis hauv cov menyuam yaus, nrog rau cov neeg laus, yog mob. Nws yog nyob rau hauv thaj tsam ntawm lub hnub ci plexus ze rau ntawm lub plab, tom qab ib pliagconcentrating nyob rau hauv txoj cai iliac cheeb tsam. Yog hais tias lub rudiment nyob nruab nrab ntawm lub caecum thiab lub plab phab ntsa, qhov mob yog muab nyob rau hauv qis rov qab. Yog hais tias muaj qhov chaw siab nruab nrab - nyob rau hauv txoj cai hypochondrium. Cov menyuam yaus yooj yim qhia tau hais tias sab twg ntawm cov kab mob appendicitis. Ntxiv nrog rau qhov mob, qhov mob ntawm lub appendage ntawm caecum hauv cov neeg mob hluas yog tshwm sim hauv cov hauv qab no:
- Cov me nyuam mob plab mob plab ntxhov siab, quaj, nias ob txhais ceg rau hauv plab, tsis pub lawv tus kheej mus kuaj.
- Vim mob tas li, tus menyuam tsis kam noj.
- Muaj ntuav ntuav.
- Cov me nyuam yau yog cem quav, me nyuam yaus muaj cov quav tsis tu ncua nrog cov hnoos qeev.
- Cov me nyuam kawm ntawv muaj cov tsos mob ntawm "txiab" - qhov sib txawv ntawm lub cev kub thiab mem tes.
- Nyob rau hauv daim ntawv catarrhal ntawm o, tus nplaig ntawm cov me nyuam yog moist nrog ib txheej ntawm lub hauv paus.
- Thaum phlegmonous - tus nplaig ntub thiab dawb.
- Nyob hauv daim ntawv gangrenous, tus menyuam tus nplaig yog qhuav thiab dawb nrog cov quav hniav.
Cov tsos mob ntawm appendicitis thaum cev xeeb tub
Kev mob ntawm lub cev vestigial yog feem ntau mob plab phais pathology hauv cov poj niam cev xeeb tub. Tus kab mob no tshwm sim tsis tau tsuas yog thaum cev xeeb tub, tab sis kuj thaum yug me nyuam los yog tam sim ntawd tom qab lawv.
Qhov tshwm sim ntawm cov kab mob appendicitis nyob rau hauv cov ntxhais nyob rau hauv txoj hauj lwm txawv nyob ntawm seb lub trimester. Cov tsos mob hauv thawj peb lub hlis twg yog tib yam li sab nraud lub sijhawm xeeb tub. Muaj qhov mob nrawm nrawm hauv thaj tsam iliac ntawm sab xis. kev txom nyem lub cev muaj peev xwmua ntu zus los yog mus tas li. Muaj xeev siab, raws plab los yog cem quav, tsam plab, mob plab spasm. Ib tug poj niam uas twb paub txog nws cev xeeb tub tuaj yeem ua rau cov tsos mob tsis meej pem nrog kev tshwm sim ntawm toxicosis. Qhov kev xav tsis zoo no ua rau kev mus ntsib kws kho mob lig, thiab, vim li ntawd, xaus rau kev rho menyuam tawm tsis tu ncua.
Nyob rau hauv II thiab III trimesters, cov poj niam uas muaj kab mob appendicitis muaj mob heev qhov muag plooj ntawm phab ntsa plab mog. Muaj qhov kub thiab txias, ntuav ntuav.
Kab mob tsis tshua tshwm sim thaum yug menyuam. Tab sis yog tias nws tshwm sim, nws nyuaj heev kom paub txog nws. Contractions poob tawm cov tsos mob (mob). Palpation ntawm sab xis ib nrab ntawm lub plab pab kom paub txog cov kab mob: tus poj niam muaj kev mob hnyav thaum nias, tawg mus rau nws txhais ceg.
Yuav ua li cas thiaj paub mob plab hnyuv hauv tsev
Kab mob ntawm lub appendage ntawm caecum yog ib yam kab mob sai heev. Kev ncua mus nrhiav kev pab kho mob tuaj yeem ua rau muaj teeb meem. Hauv cov poj niam cev xeeb tub, kev paub ntxov ntxov yuav txo qis kev pheej hmoo ntawm nchuav menyuam, nyob rau hauv so - tsim ntawm diffuse peritonitis. Muaj ntau ntau txoj hauv kev los txiav txim rau tus kab mob appendicitis koj tus kheej:
- Tactile. Ib tug neeg uas muaj cov tsos mob ntawm tus mob appendicitis yog pw ntawm nws nraub qaum. Lub plab yuav tsum tau so, koj tuaj yeem ua 2-3 qeeb exhalations. Ib lub xib teg sov yog maj mam muab tso rau ntawm qhov chaw cuam tshuam. Ces txhais tes yog sharply rub rov qab. Yog tias qhov mob tau nce ntxiv, feem ntau yuav yog tus neeg muaj mob ntawm daim ntawv ntxiv.
- Txoj kev npau taws. Tus neeg mob yuav tsum tau ua kom luag lossis hais kom nrov nrov, hnoos. Koj tuaj yeem siv qee qhov siab rau qhov chaw uas koj hnov qhov mob tshaj plaws. Yog tias, nrog rau cov kev ua no, qhov mob tau tshwm sim ntau dua thiab mob hnyav, feem ntau yuav tus neeg muaj mob plab hnyuv.
- Tus neeg mob yuav tsum tau pw ntawm nws sab xis thiab khoov nws lub hauv caug. Hauv txoj haujlwm no, nws yuav tsum nyob hauv tsib feeb. Tom qab ntawd tus neeg mob yuav tsum dov ntawm nws sab laug thiab nthuav nws ob txhais ceg. Nws yog ib qho tsim nyog yuav tsum nug tus neeg li cas thaum lub sijhawm no. Yog tias nws hais tias qhov mob tau ploj mus thaum nws pw ntawm nws sab xis, thiab thaum nws tig rov qab, nws hnyav dua, qhov no yog qhov kev lees paub ntawm appendicitis.
Yuav ua li cas yog tias cov tsos mob taw qhia tus mob appendicitis?
Kab mob ntawm lub appendage ntawm caecum yog ib qho kev sib haum xeeb. Nws tuaj yeem tshwm sim hauv cov txiv neej thiab poj niam ntawm txhua lub hnub nyoog. Cov tsos mob tseem ceeb ntawm tus kab mob yog mob. Nrog kev hnov mob hauv cheeb tsam umbilical ntawm sab xis, koj yuav tsum tsis txhob nkim sijhawm thiab nrhiav seb qhov twg thiab qhov mob appendicitis. Tsis tas li ntawd, tsis txhob noj tshuaj kho mob. Koj yuav tsum hu rau pab neeg kho mob ambulatory. Tsuas yog tus kws kho mob tuaj yeem kuaj xyuas kom raug thiab muab kev kho mob txaus.
Cov kab mob dab tsi ua rau mob plab hnyuv muaj cov tsos mob zoo sib xws
Appendicitis yog cov txheej txheem inflammatory uas tsim nyob rau hauv ib qho chaw kaw nyob ze rau ntau lub cev. Pathological manifestations feem ntau tsis meej pem nrog cov tsos mob ntawm o ntawm lwm yam kabmob.
Differential diagnosisyog los sib piv cov tsos mob ntawm tus mob appendicitis nrog cov tsos mob zoo sib xws ntawm lwm yam kab mob:
- plab rwj. Cov cim tseem ceeb: mob hnyav nyob rau hauv ntau qhov chaw ntawm lub plab, ntuav uas ua rau kom zoo, tsam plab, hnyav hauv plab.
- Tus mob cholecystitis yog nrog los ntawm qhov mob hnyav hauv txoj cai hypochondrium, xeev siab, ua npaws.
- Ileus lossis plab hnyuv. Tus kab mob no tshwm sim los ntawm kev mob plab ntev ntev, tsis quav ntsej.
- mob pancreatitis - mob epigastric. Muaj tseeb tiag, tsis zoo li kab mob appendicitis, nyob rau hauv lub supine txoj hauj lwm, qhov mob nce.
- Enterocolitis yog nrog los ntawm kev hnov mob hauv plab, ua rau mob hnyav los ntawm cov leeg nqaij hauv plab (luag, ua si lub cev) thiab defecation disorder.
- Nyob rau hauv cov poj niam cev xeeb tub, cov kab mob appendicitis yuav tsum sib txawv ntawm pathologies ntawm txoj hnyuv, o ntawm zes qe menyuam.
- YEctopic cev xeeb tub. Cov kab mob pathology yog tus cwj pwm los ntawm kev txiav qhov mob ntawm qhov chaw ntawm cov hlab ntsha, qhov kub thiab txias.
Kev Tiv Thaiv Kab Mob Kab Mob
Thaum thawj qhov tshwm sim ntawm tus mob appendicitis, koj yuav tsum nrhiav kev pab kho mob sai li sai tau. Kev ua kom raws sij hawm feem ntau tuaj yeem pab zam kev phais.
Txawm hais tias tsis muaj leej twg tiv thaiv kab mob los ntawm kev mob, nws muaj peev xwm txo tau txoj kev pheej hmoo ntawm mob plab hnyuv. Txhawm rau ua qhov no, koj yuav tsum ua raws qee cov lus pom zoo:
- saib koj cov zaub mov. Noj tsawg zaub mov tsis zoo thiab muaj fiber ntau, zaub, txiv hmab txiv ntoo;
- haus kua txiv ntau dua, dej, tshuaj yej (zoo duantsuab);
- saib lub rooj zaum: kev ua haujlwm, sib xws;
- thaum muaj tus kab mob sib kis, nrog kws kho mob tham, thiab tsis txhob kho tus kheej. Ua raws li kev kho mob nruj raws li tus kws kho mob cov lus pom zoo;
- zam kev rog;
- thaum lub sijhawm ua haujlwm tsis tu ncua, ua ib ce ua kom cov ntshav ncig hauv plab.
Tau kawg, koj yuav tsum mus ntsib kws kho mob kom tsis txhob pib mob.
