Biliary system - gallbladder nrog ducts. Lub siab, gallbladder, thiab cov ducts tau sau ua ke hu ua hepatobiliary system. Lub gallbladder (GB) yog ib qho uas tsis muaj kev sib koom ua ke uas muaj cov cim tshwj xeeb. Nws lub hom phiaj tseem ceeb yog tsub zuj zuj, khaws cia, thickening ntawm cov kua tsib thiab nws cov tswj kev tso tawm thaum lub sijhawm. Lub npuas nws tus kheej tsis tsim dab tsi. Cov kua tsib tshwm sim hauv daim siab. Cov kua tsib los ntawm lub zais zis tso rau hauv duodenum thaum noj mov.
Cov qauv ntawm cov ducts
Txhua tus ntawm lawv tau muab faib ua intrahepatic thiab extrahepatic. Muaj kaum ob ntawm lawv tus kheej. Intrahepatic nyob rau hauv daim siab, lawv maj mam sau lub siab los ntawm hepatocytes.
Cov kab mob gallbladder ntws mus rau hauv lub ntsiab lus. Extrahepatic ducts muaj xws li ducts ntawm sab laug thiab sab xis lobes ntawm daim siab. Los ntawm nws, lawv tsim cov kab mob siab, cov kab mob sib xws thiab cov ducts ntawm lub gallbladder. Gallbladderducts, pib ntawm lub caj dab ntawm lub zais zis, txuas nrog rau cov kab mob siab. Yog li, tus general yog tau. Cov ducts ntawm lub gallbladder tsim tag nrho cov system. Lawv lub hom phiaj yog hloov cov ntsiab lus. Lawv txoj haujlwm tau qhib thaum noj mov - lawv nqa cov kua tsib mus rau duodenum (duodenum). Tshwj xeeb tshaj yog nws xav tau cov zaub mov muaj roj ntau.
Kev ua haujlwm ntawm cov kav dej sib txawv ntawm lawv lub hom phiaj. Lub gallbladder ducts tsuas yog nqa cov kua tsib mus rau lub gallbladder. Nws qhov kev nce qib yog ua tau vim yog lub siab ntawm kev tso tawm ntawm daim siab. Qhov no tshwm sim nrog kev pab ntawm li qub ntawm lub zais zis thiab kev cog lus ntawm cov leeg ntawm lub gallbladder nyob rau hauv lub suab ntawm cov phab ntsa ntawm lub gallbladder ducts lawv tus kheej.
Bile ib hnub tuaj yeem tsim tau txog 2 litres, tab sis feem ntau mus txog 1 liters. Cov kev cai ntawm lub biliary system yog ua los ntawm lub autonomic paj hlwb.
Bile muaj nuj nqi
Bile ua haujlwm hauv qab no:
- Sib faib lipids rau hauv cov roj me me (fat emulsification).
- Ua kom cov lipase enzyme xav tau los zom cov rog.
- Destroy toxins.
- koom nrog hauv qhov sib npaug ntawm electrolyte.
- Ua kom lub peristalsis ntawm txoj hnyuv me.
- Tsis pub hydrochloric acid nkag mus rau hauv cov hnyuv me, ua rau nws tsis zoo
- Kev koom nrog hauv kev nqus cov as-ham los ntawm cov zaub mov.
- Tiv thaiv cov txheej txheem fermentation hauv cov hnyuv.
Pathology ntawm cov kua tsib thiab lawv cov tsos mob
Cholelithiasis (GSD) txhim kho ob qho tib si hauv lub zais zis nws tus kheej thiab hauv nws cov ducts. Ntau tshaj nyob rau hauv cov neeg rog. Calculi yog tsim vim cholestasis nrog impaired metabolismtshuaj. Nrog rau qhov me me, cov pob zeb tsis ua rau tsis xis nyob, tab sis thaum lawv hloov mus, lawv tuaj yeem txhaws cov hlab ntsha thiab ua rau lub siab colic. Nyob rau hauv cov ntaub ntawv no, cov phab ntsa ntawm lub ducts yeej ib txwm puas thiab o tshwm sim. Nrog colic, qhov mob tshwm sim nyob rau hauv cheeb tsam ntawm txoj cai hypochondrium, radiates rau sab xis lub xub pwg nyom, xub pwg hniav los yog mus rau sab xis ib nrab ntawm lub cev. Feem ntau, qhov kub thiab txias tuaj yeem nce, xeev siab, thiab ntuav tsis tuaj yeem txo tus neeg mob tus mob.
Clogged ducts
Tus mob no yog qhov tshwm sim ntawm cholelithiasis, o, qog nqaij hlav, nruj, caws pliav ntawm cov kav dej. Qhov no clogs txoj kev nyob rau hauv tej duct.
Cov tsos mob ntawm lub gallstones feem ntau tshwm sim maj mam, feem ntau tom qab muaj keeb kwm ntawm kab mob biliary. Kev mob tshwm sim tsis tshua muaj. Mob nyob rau hauv lub hypochondrium ntawm sab xis yog cramping, tus neeg poob phaus, kub yuav nce, feem ntau muaj yellowness ntawm daim tawv nqaij, khaus thoob plaws lub cev.
Cov tsos mob ntawm pob zeb nyob rau hauv lub gallbladder ducts kuj tshwm sim vim tsis muaj fatty acids nyob rau hauv txoj hnyuv, yog li cov quav yuav tsis muaj xim. Nyob rau hauv lem, bilirubin raug tso tawm los ntawm ob lub raum, thiab cov zis yuav tsaus. Yog tias qhov blockage yog ib feem, muaj kev hloov pauv ntawm cov quav tsaus thiab lub teeb.
Cov tsos mob ntawm pob zeb hauv lub gallbladder duct tuaj yeem ua rau hnyav dua los ntawm kev puas tsuaj rau hepatocytes, tom qab ntawd lub siab cuam tshuam, thiab daim siab tsis ua haujlwm. Lub cev yog dej nyab nrog cov co toxins, muaj kev ua txhaum ntawm kev ua haujlwm ntawm lwm yam kabmob - lub ntsws, lub plawv, lub raum. Pom taunce qaug zog, qaug zog thiab mob taub hau. Thaum tsis muaj kev ntsuas ceev, qhov kev cia siab tsis zoo. Rau kev kuaj mob, nws yog ib qho tseem ceeb uas yuav tau ua cov ntshav biochemistry, ultrasound, MRI thiab CT.
Kev tshem tawm pob zeb hauv lub gallbladder ducts feem ntau yog ua los ntawm cov kws phais. Kev ua haujlwm tuaj yeem yog endo-, laparoscopic.
Dyskinesia
Pathology yog tus cwj pwm los ntawm kev ua haujlwm tsis zoo ntawm cov kab mob biliary thiab zais zis. Nws tuaj yeem yog tus kab mob ywj pheej lossis cov tsos mob.
Cov tsos mob tshwm sim rau cov hauv qab no: tom qab noj mov, tom qab 2 teev, muaj hnyav thiab mob tsis yog nyob rau hauv txoj cai hypochondrium, tab sis kuj nyob rau hauv lub epigastrium, uas ua rau kev kuaj mob nyuaj. xeev siab thiab ntuav ntau zaus.
Kev kho lub gallbladder ducts hauv neurotic dyskinesia, yuav tsum tau teem caij sedatives. Feem ntau cov tshuaj yog valerian paus. Hauv lwm qhov xwm txheej, cov tshuaj choleretic.
YCholangitis
Cholangitis yog ib qho mob ntawm lub gallbladder ducts. Feem ntau nrog mob cholecystitis. Mob, tawm hws ntau, ua npaws, ntuav paroxysmal tshwm nyob rau hauv txoj cai hypochondrium. Jaundice tuaj yeem tshwm sim.
mob cholecystitis
Nws keeb kwm feem ntau kis tau. Nws muab tsis tau tsuas yog mob thiab kub, tab sis kuj nce nyob rau hauv lub gallbladder loj. Pathology aggravates tom qab noj cov zaub mov muaj roj los yog haus cawv.
Cholangiocarcinoma
tuaj yeem tsim nyob rau hauv ib qho kab mob intrahepatic. Qhov kev pheej hmoo ntawm nws qhov tshwm sim nce nrog cov kab mob ntev xws li ducts, pob zeb, cholangitis. Tsis ntev los no, tus naj npawb ntawm cov kev kuaj mob no tau nce zuj zus. Koom nrog qhov tsis zooecology.
Tag nrho cov tsos mob ntawm biliary tract pathologies muaj: mob ntawm sab xis, kub, khaus tawv nqaij, beer-xim tso zis thiab quav dawb, daim tawv nqaij icterus, ntuav thiab xeev siab. Thaum lub sijhawm ua haujlwm, cov ducts cuam tshuam raug tshem tawm, nrog rau kev loj hlob hauv daim siab - thiab ib feem ntawm lub cev cuam tshuam. Kev hloov pauv daim siab ua rau muaj txiaj ntsig zoo.
Benign neoplasms tsis muab cov tsos mob rau lub sijhawm ntev, tab sis kev loj hlob sai zoo li mob cholecystitis - mob tshwm sim, khaus khaus ntau ntxiv, jaundice, kev tsis zoo ntawm kev noj qab haus huv.
Congenital malformations ntawm biliary tract
Tsis muaj leej twg tiv thaiv los ntawm qhov tsis xws luag. Nws yog qhov zoo dua yog tias lawv raug kuaj pom hauv tsev kho mob lossis thawj lub lis piam ntawm lub neej. Tom qab ntawd muaj kev pab ntxiv.
Ntawm cov tsis sib xws yog:
- pab atresia;
- hypoplasia ntawm cov kua tsib;
- duct cyst.
Atresia yog qhov thaiv ntawm lub lumen ntawm cov kav dej. Nws lub ntsiab tshwm sim yog qhov loj hlob jaundice nyob rau hauv tus me nyuam. Nrog atresia, quav thiab zis yog unnaturally daj. Tus me nyuam tsis xis nyob, ntuav thiab cog lus. Nws tshwm sim rau 2-3 hnub ntawm lub neej. Vim qhov txhaws ntawm cov ducts, cov kua tsib tsis tau tawm, thiab lub siab loj tuaj. Kev kuaj mob yog tsim los ntawm lub hauv paus ntawm lub xov tooj cua tom qab 4, 6 thiab 24 teev. Xws li tus me nyuam, nrog kev kho tsis raug, tsuas yog tuaj yeem nyob txog 8-12 lub hlis, ces nws tuag ntawm daim siab tsis ua haujlwm. Kev kho mob ntawm pathology tsuas yog phais xwb.
Hypoplasia ntawm intrahepatic bile ducts
Nrog nws, cov ducts tsis muaj peev xwm ua kom cov kua tsib. Cov tsos mob zoo ib yam liatresia, tab sis tsis kaj. Qee lub sij hawm lawv tsis tuaj. Thaum 4 lub hlis muaj qhov khaus tsis tu ncua. Hypoplasia feem ntau yog nrog los ntawm pathologies ntawm lub plawv. Kev kho mob ntev thiab nyuaj, thiab daim siab mob siab tuaj yeem txhim kho.
Cyst of common bile duct
Muaj hnub nyoog 3-5 xyoos. Cov menyuam yaus yws txog qhov mob hnyav, tshwj xeeb tshaj yog thaum palpation. Hauv cov menyuam yaus, ntuav thiab xeev siab ntxiv, qhov kub thiab txias nce. Daim tawv nqaij, zis thiab quav yog uncharacteristically daj. Kev kho mob tsuas yog radical xwb.
Kev raug mob ntawm lub cev
Ntau heev. Lawv tsuas tuaj yeem tshwm sim nrog kev tsom mus rau lub siab. Kev loj hlob sai ntawm peritonitis yuav ua rau muaj teeb meem. Kev kuaj mob yog qhov nyuaj los ntawm qhov tseeb tias, nrog rau qhov mob dav dav, tsis muaj lwm yam tshwm sim. Tus mob no yuav tsum tau phais sai.
ntsuas ntsuas
Kev kuaj mob tsuas yog niaj hnub:
- Choledo- lossis cholangioscopy thaum phais.
- Ultrasound ntawm daim siab thiab gallbladder. Cov txheej txheem tso cai rau koj los txheeb xyuas cov pob zeb hauv cov ducts, lawv qhov loj me tuaj yeem txiav txim siab, qhia qhov xwm txheej ntawm cov phab ntsa ntawm cov ducts, lawv qhov loj me.
- Duodenal suab - tuaj yeem kuaj thiab kho hauv qhov sib npaug. Stimulants raug txhaj rau hauv lub gallbladder, uas ua rau nws cog lus thiab so lub sphincter.
- Cov kua tsib yog kawm thiab nws cov bacanalysis yog ua.
- Cholangiography - tus neeg sawv cev sib txawv yog txhaj rau hauv cov hlab ntsha thiab kawm txog lub xeev ntawm cov ducts. Cov txheej txheem yog siv tshwj xeeb rau cov teeb meem nyuaj.
- X-ray tsis tshua siv. Ntawm cov duab hluav taws xob, cov pob zeb calcium pom meej meej, thiab cov roj cholesterol tsis yogpom.
- Thaum nyuaj, kws kho mob tau sau CT thiab MRI.
Kev kho mob ntawm cov kab mob biliary tract
Kev kho mob yog txiav txim siab los ntawm theem ntawm tus kab mob. Hauv kev zam txim, kev noj zaub mov thiab tshuaj txaus txaus.
Rau tus mob cholelithiasis, cov tshuaj tau sau tseg kom yaj pob zeb. Cov no suav nrog cov tebchaw ntawm cheno- thiab ursodeoxycholic acid, nrog rau cov tshuaj ntsuab. Txawm hais tias qhov kev kho mob ntev, cov nyhuv yog qhia nyob rau hauv qhov txo ntawm pob zeb. Txhawm rau txhim kho cov kua tsib, tshuaj choleretic, antispasmodics, hepatoprotectors thiab tshuaj tonic tuaj yeem raug sau.
Qhov tseem ceeb! Cholagogues raug sau tseg tsuas yog thaum lub sij hawm tshem tawm. Hepatoprotectors raug sau los ntawm kws kho mob rau txhua yam mob ntawm cov kab mob hepatobiliary.
Gepabene, Hofitol, Hepa-Merz, Karsil, thiab lwm yam tshwj xeeb tshaj yog cov kws kho mob tau siv dav - tshuaj ntsuab ntawm mis nyuj thistle, immortelle, St. John's wort, thiab lwm yam.
Cov tshuaj rau qhov mob tsis pom zoo kom noj, lawv tsis muaj txiaj ntsig, thiab tuaj yeem ua rau lub plab zom mov sai sai.
Thaum kho mob, noj zaub mov tas li. Nyob twj ywm tseem ceeb hauv kev noj zaub mov kom zoo, antispasmodics, choleretic. Kev cob qhia hnyav tsis suav nrog. Cov txheej txheem mob tau kho nrog cov tshuaj tiv thaiv kab mob thiab txhawb kev tiv thaiv kab mob.
kev kho mob phais
Txoj kev xaiv kev kho mob rau kev txhaws ntawm cov ducts yog txiav txim los ntawm tus kws phais mob thiab tus kws kho mob gastroenterologist. Tus mob hnyav yuav tsum tau nyob hauv chav saib xyuas mob hnyavKev kho mob nrog ib chav kawm ntawm infusions, detoxification thiab antibacterial kho.
Tus neeg mob tus mob yuav tsum tau ruaj khov rau kev ua haujlwm. Txhawm rau ua qhov no, siv txoj hauv kev uas tsis muaj kev cuam tshuam los pab txhawb cov kua tsib. Cov no yog rho tawm cov pob zeb hauv cov kav dej, cov kua dej nasobiliary, percutaneous puncture ntawm lub gallbladder, thiab lwm yam.
Pob zeb hauv lub gallbladder thiab hauv cov kav dej - kev ua haujlwm tuaj yeem, raws li tau hais tseg, ua laparoscopic thiab endoscopic. Nws nyob ntawm qhov hnyav ntawm tus txheej txheem.
Tom qab kev ruaj ntseg ntawm tus mob, kev ua haujlwm zoo dua endoscopic. Yog tias qhov no ua tsis tau, kev ua haujlwm txuas ntxiv yog ua laparoscopically. Thaum lub plab phab ntsa raug txiav, ib qho anastomosis yog siv los ntawm cov kua tsib mus rau duodenum (duodenum 12). Cov kua tsib tau qhib. Nyob rau tib lub sijhawm, lub sijhawm tsis zoo yog tias cov kua tsib tuaj yeem nkag los ntawm cov seams mus rau hauv lub plab kab noj hniav. Txhawm rau tiv thaiv cov xwm txheej zoo li no, lub raj T-shaped yog ntxig raws li Ker thiab cov dej ntws tawm sab nraud, piv txwv li. tshem tawm cov kua stagnant mus rau sab nraud receiver. Ib yam li ntawd, cov tshuaj tuaj yeem muab tshuaj los ntawm qhov ncauj.
Cov kua dej sab nraud ntawm cov ducts thiab tshem tawm ntawm lub gallbladder raws li Halsted yog ua raws li nram no: ua ntej lub gallbladder raug tshem tawm, thiab ces cov ducts yog drained.
Yog tias qhov thaiv tsis tau kho, sepsis txhim kho, lub hlwb puas nrog bilirubin hauv cov ntshav, cirrhosis ntawm daim siab thiab daim siab tsis ua haujlwm (nws yuav mob tag nrho, nrog rau ib feem).
pob zeb loj ua ntej sim ua kom crushing. Cov txheej txheem no hu ualithotripsy thiab nqa tawm los ntawm txoj kev poob siab yoj, thiab tom qab ntawd mus rau qhov haujlwm tseem ceeb.
Crushed pob zeb los ntawm intrahepatic ducts raug tshem tawm siv catheters uas muab tso rau hauv lub siab. Kev ua haujlwm yuav tsum muaj tus kws phais neeg paub zoo.
txhawm rau rhuav tshem tus kab mob, siv tshuaj tua kab mob, nrog rau cov tshuaj probiotics. Infusion therapy thiab enzyme therapy kuj tseem xav tau. Kev ua haujlwm radical tshaj plaws yuav tsis ua kom rov qab ua tiav yog tias kev noj zaub mov tsis ua raws.
Huab cua thiab tiv thaiv
Yog tias qhov kev thov rov hais dua raws sijhawm, nrog rau kev kho mob, qhov kev cia siab rau kev txhaws ntawm cov ducts yuav zoo. Nws ua tsis zoo nrog kev kho mob lig thiab muaj cov txheej txheem oncological.
Kev tiv thaiv ntawm kev cuam tshuam ntawm cov kua tsib yuav tsum tau ua tas li. Yog tias koj tsis hloov ib yam dab tsi, coj tib lub neej tsis zoo, noj nrog ntau yam ntawm kib thiab rog - lub pob zeb yuav tsis ua rau koj nco txog lawv tus kheej.
Nws yog ib qho tsim nyog los kho cov kab mob hepatobiliary, nws tseem yuav tsum tau mus ntsib kws kho mob thiab kuaj txhua xyoo. Fried, fatty, extractive zaub mov tsis suav nrog. Kev tawm dag zog lub cev yuav tsum muaj nyob hauv lub neej.
