Pathologies ntawm daim siab, uas yog tshwm sim los ntawm ib nrab lossis ua tiav ntawm cov kua tsib ducts, muaj ntau heev. Lawv cov tsos mob feem ntau yog xim daj ntawm daim tawv nqaij thiab mucous daim nyias nyias. Thiab tus mob no hu ua obstructive jaundice. Nqe lus piav qhia, cov tsos mob, cov cim qhia thiab kev kho mob ntawm nws, peb yuav xav txog hauv kab lus no.
Kev tshwm sim
Yav dhau los, cov kab mob jaundice (ICD-10 code - K83.1) tau pom tias yog kab mob ywj pheej, tab sis ntau cov kev tshawb fawb tau ua pov thawj tias qhov no tsuas yog cov tsos mob xwb. Nws yog tshwm sim los ntawm kev tsis sib haum xeeb hauv cov kab mob hepatobiliary thiab tsim cov kua tsib calculi. Hauv kev sau npe ntawm kev faib tawm thoob ntiaj teb ntawm cov kab mob (ICD-10 code - K83.1), kev cuam tshuam ntawm cov ducts yog hu ua kev cuam tshuam ntawm cov kua tsib ducts. Nws lwm lub npe yog subhepatic lossis obstructive jaundice.
Qhov laj thawj tseem ceeb ntawm kev txhim kho ntawm tus mob no tau lees paub tias yog compression lossis kaw ntawm cov kav dej, uasinterrupts cov kua tsib nyob rau hauv cov hnyuv. Thiab feem ntau lub npe tshwm sim yog tshwm sim los ntawm cov kab mob hauv qab no:
- Qhov tsim ntawm pob zeb nyob rau hauv lub hepatobiliary ib ntsuj av tau tshwm sim los ntawm biliary stagnation, uas yog, cholestasis, los yog nce nyob rau hauv ntsev cov ntsiab lus nyob rau hauv cov kua tsib raws li ib tug tshwm sim ntawm tsis ua hauj lwm nyob rau hauv metabolic dab.
- Kev txhim kho cholangitis, pancreatitis, cholecystitis, thiab lwm yam.
- qog thiab hlwv hauv cov ducts hauv cov ducts, pancreas lossis gallbladder thiab lwm yam oncological neoplasms.
- Tshuaj hnyuv diverticula, biliary atresia thiab lwm yam kev loj hlob tsis zoo. Feem ntau cov kab mob jaundice cuam tshuam nrog cov kab mob no hauv cov menyuam mos liab.
- Kev kis kab mob, suav nrog echinococcus thiab kab mob sib kis.
- Obstructive jaundice (ICD-10 code - K83.1., raws li twb tau hais lawm) nyob rau hauv daim ntawv ntev yuav ua tau ib tug kos npe rau ntawm mob qog noj ntshav nyob rau hauv lub taub hau ntawm lub txiav.
Tab sis Klatskin's qog, lossis cholangiocarcinoma, yog nrog los ntawm tus kab mob no tsuas yog thaum nws nce mus txog qhov loj.
Signs of disease
Cov tsos mob tseem ceeb ntawm cov kab mob jaundice (ICD-10 code twb tau qhia ua ntej lawm) yog yellowing ntawm tag nrho cov ntaub so ntswg hauv lub cev, nrog rau cov dawb ntawm lub qhov muag thiab mucous daim nyias nyias. Qhov tshwm sim no yog vim qhov nce siab ntawm bilirubin. Lwm cov cim qhia yog:
- biliary colic. Characterized los ntawm ntse bouts mob nyob rau hauv lub Upper sab xis plab mog. Qhov mob kis mus rau sab xis ntawm lub xub pwg nyom, lub xub pwg hniav lossis caj dab caj dab thiab feem ntau yog vimkev tawm dag zog, noj zaub mov kib lossis rog, lossis haus dej cawv.
- daim siab loj, lossis hepatomegaly.
- nce lub cev kub.
- Ntaus thiab ntuav ntawm cov kua tsib.
- Lub teeb xim quav thiab tso zis tsaus.
Symptoms
Jaundice tuaj yeem tshwm sim raws li qhov tshwm sim ntawm lwm yam kab mob uas tsis sib xws nrog cholestasis. Cov tsos mob yog:
- Dyspeptic syndrome, uas yog tus cwj pwm los ntawm xeev siab thiab hnyav hauv thaj av epigastric.
- Courvoisier cov tsos mob, thaum lub zais zis loj tuaj yeem pom tseeb txawm tias nyob ntawm palpation vim nws cov kua tsib ntws dhau. Tsis muaj mob ntawm palpation.
- poob ceeb thawj.
Chronic form
Nyob rau hauv daim ntawv ntev, obstructive jaundice ua rau muaj kev ntxhov siab nyob rau sab xis, hauv cheeb tsam hypochondrium. Qhov mob yog mob thiab npub, hnyav los ntawm kev vibration, khoov dua thiab thaum nqa hnyav.
Npaj nrog jaundice yog tas li, zuj zus tom qab noj cov zaub mov muaj roj thiab dej cawv. Tsis tas li ntawd, tus mob no yog tus cwj pwm los ntawm kev qaug zog, qaug zog thiab kiv taub hau, uas yog cov cim qhia ntawm asthenic syndrome.
Tom ntej no, peb yuav pom dab tsi cuam tshuam cov neeg kho tshuab conjugative jaundice (ICD-10 code - P59).
Kev nyuaj siab
Txawm hais tias dab tsi ua rau muaj kev ua haujlwm tsis zoo hauv cov txheej txheem ntawm cov kua tsib, qhov notuaj yeem ua rau cirrhosis. Tus kab mob no yog tus cwj pwm los ntawm kev tsim cov nodes hauv daim siab, uas muaj cov ntaub so ntswg sib txuas. Qhov no pathology tshwm sim los ntawm kev tuag ntawm active hepatocytes. Nyob rau yav tom ntej, cirrhosis yuav ua rau lub siab tsis ua haujlwm thiab ua haujlwm tsis zoo.
Lwm qhov teeb meem ntawm qhov tsis pom kev tsis pom kev zoo (ICD kuaj kab mob - R17) yog intoxication nrog cov khoom metabolic uas tsis raug tshem tawm hauv lub cev, raug nqus los ntawm cov hnyuv mus rau hauv cov hlab ntsha. Tus kab mob no hu ua toxemia. Ua ntej tshaj plaws, cov ntaub so ntswg ntawm lub raum thiab daim siab raug cuam tshuam, uas thaum kawg ua rau cov kab mob tsis ua haujlwm.
Thaum co toxins nkag mus rau hauv lub hlwb, hepatic encephalopathy tshwm sim, uas feem ntau cuam tshuam rau tag nrho lub paj hlwb. Qhov no tshwm sim raws li qhov tshwm sim ntawm kev ua txhaum cai hauv cov ntshav-hlwb thaiv.
Cholecystitis, cholangitis thiab lwm yam kab mob tuaj yeem ua rau muaj kab mob jaundice. Tsis muaj kev kho raws sij hawm thiab kev nthuav dav ntawm cov txheej txheem tuaj yeem tsim kev pheej hmoo ntawm kev poob siab septic.
Nco ntsoov tias ntau hom kab mob jaundice muaj cov tsos mob zoo sib xws, thiab qhov no tuaj yeem ua rau mob nyuaj. Yog li, hemolytic jaundice yog tus cwj pwm los ntawm kev tawg ntawm cov qe ntshav liab thiab ntau ntau ntawm hemoglobin, uas hloov mus rau hauv bilirubin. Thiab parenchymal jaundice yog tus cwj pwm los ntawm cov txheej txheem inflammatory hauv cov ntaub so ntswg ntawm daim siab.
Thaum kuaj mob, ntxiv rau cov paib sab nraud, kev saib xyuas tshwj xeeb yog them rau cov txiaj ntsigKev tshawb fawb, tshwj xeeb tshaj yog bilirubin feem (ncaj lossis tsis ncaj) thiab qib enzyme.
Ntshav daj daj
ICD-10 code - P59 - yog hais txog qhov tsis paub meej ntawm cov menyuam mos liab daj daj uas cuam tshuam rau cov menyuam mos. Nws yog physiological thiab pathological. Thawj ntawm lawv manifests nws tus kheej nyob rau hauv thawj lub lim tiam ntawm tus me nyuam lub neej thiab tom qab ib co sij hawm dhau los ntawm nws tus kheej. Tab sis qee zaum nws tuaj yeem yog cov tsos mob ntawm tus mob hauv qab.
Nyob rau hauv cov menyuam mos, ua txhaum ntawm cov txheej txheem ntawm cov metabolism hauv cov enzyme bilirubin yog ua tau. Qhov no ua rau cov kab mob pigmentation ntawm cov mucous thiab daim tawv nqaij.
Yog jaundice yog ib daim ntawv physiological, ces qhov no tsis cuam tshuam rau kev noj qab haus huv, qab los noj mov, pw tsaug zog thiab wakefulness ntawm tus me nyuam. Nyob rau hauv cov ntaub ntawv ntawm ib tug pathological daim ntawv ntawm tus kab mob, daim duab kho mob yog supplemented los ntawm cov tsos mob hauv qab no:
- Tus me nyuam loj hlob tuaj ntawm daim tawv nqaij thiab sclera.
- Nws tsaug zog thiab tsaug zog.
- Tsis kam pub.
- Kub nce.
- Qhia ntau zaus, thaum muab nws lub taub hau rov qab, arching nws lub cev.
- Tseem ntuav ntuav.
- Txhawj xeeb.
Kev kho mob jaundice li cas, peb yuav xav txog hauv qab no.
Diagnosis
Ib qho yuav tsum tsis txhob kwv yees cov cuab yeej thiab cov kev tshawb fawb hauv chaw soj nstuam hauv kev kuaj mob jaundice, ICD-10 code uas tau qhia hauv kab lus. Tom qab tag nrho, tsuas yog lawv tuaj yeem pab nrhiav qhov tseeb ua rau kev loj hlob ntawm tus mob no. Qhov kev cia siab rau kev rov zoo yog nyob ntawm lub sijhawm ntawm qhov chaw ntawm tus neeg mob nyob rau hauvphais department. Txhawm rau txheeb xyuas qhov ua rau muaj qhov tshwm sim ntawm qhov tsis zoo, cov kev kuaj mob hauv qab no tau siv:
- suav ntshav kom tiav. Yog tias kuaj pom cov ntshav liab, uas yog tus cwj pwm los ntawm kev txo qis ntawm hemoglobin thiab cov qe ntshav liab, qhov no qhia tau tias muaj kab mob ntev. Kev nce hauv ESR thiab leukocytosis qhia tias muaj cov txheej txheem inflammatory.
- Kev kuaj ntshav rau biochemistry. Nyob rau hauv cov ntaub ntawv no, kev mloog yog them mus rau ib tug txawv txav nyob rau hauv cov theem ntawm ALT, AST, gamma-glutamyl transferase, alkaline phosphatase, cholesterol, thiab lwm yam. Hom kev tshawb fawb no kuj qhia txog qhov zoo ntawm qhov ncaj feem ntawm bilirubin nyob rau hauv kev sib raug zoo ntawm indirect. ib.
- Computed tomography thiab kuaj ultrasound ntawm lub plab kab noj hniav tuaj yeem pab txiav txim siab qhov loj thiab qauv ntawm lub gallbladder thiab daim siab, kuaj pom muaj pob zeb, thiab ntsuas cov ntshav ntws thiab cholestasis.
- YEsophagogastroduodenoscopy. Nws yog ib qho kev kuaj mob ntawm cov kab mob hauv plab hnyuv los ntawm endoscope. Lub tom kawg yog lub raj kho qhov muag hloov tau thiab pab txhawm rau txheeb xyuas cov kab mob uas twb muaj lawm.
- Sib nqus resonance cholangiopancreatography. Nws yog ua los ntawm kev qhia cov kua dej sib txawv, uas tso cai rau kev pom ntawm cov ducts.
- Scintigraphy. Thaum txoj kev tshawb no, cov tshuaj radiopharmaceuticals raug faib rau cov ntaub so ntswg, uas yog tswj raws li lub sij hawm tsis.
- Laparoscopy thiab biopsy. Sampling cov ntaub ntawv los ntawm cov qog rau kev tshawb fawb ntxiv thiabcytology.
Mechanical jaundice: prognosis and treatment
yog dab tsi, tham ua ntej. Tam sim no nws tsim nyog kawm txog cov txheej txheem ntawm kev kho tus kab mob. Lub xub ntiag ntawm obstructive jaundice yuav tsum tau kev kho mob tam sim ntawd, tsis hais seb nws tshwm sim nyob rau hauv ib tug me nyuam los yog nyob rau hauv ib tug neeg laus. Thawj lub hom phiaj ntawm kev kho yog kom tshem tawm biliary stagnation. Qhov no ua tiav los ntawm kev siv tshuaj kho mob nrog cov tshuaj hauv qab no:
- hepatoprotectors, uas suav nrog B vitamins, ursodeoxycholic acid, Gepabene, Essentiale, Silymarin, thiab lwm yam.;
- Pentoxyl, uas pab txhawb cov txheej txheem metabolic;
- amino acids xws li methionine thiab glutamic acid;
- tshuaj hormones, suav nrog Prednisolone;
- tshuaj "Neorondex", "Rheosorbilact" thiab "Rheopolyglukin", stimulating ntshav ncig hauv daim siab.
Yog tias muaj tus kab mob kis thib ob ntxiv, kev kho tshuaj tua kab mob yog ua nrog tshuaj xws li Imipenem, Ampicillin, thiab lwm yam.
Kev ua haujlwm
Cov neeg mob kuaj pom tias muaj cholestasis feem ntau xav tau kev phais. Tab sis icteric syndrome yog ib qho contraindication rau xws li kev ntsuas, raws li nws yog suav hais tias yog ib qho kev pheej hmoo loj rau lub neej thiab kev noj qab haus huv ntawm tus neeg mob. Yog li ntawd, nyob rau hauv thawj theem ntawm tus kab mob, lub siab nyob rau hauv cov kua tsib ducts yog txo los ntawm txoj kev endoscopic. Lithotripsy kuj tso cai.
Cov kauj ruam tom ntej yog rau nruab ib lub stent lossis anastomoses. Cov kev ntsuas no yog tsom rau kev nthuav tawm cov kua tsib thiab tshem tawm cov khoom tsim tawm.
Kev tshem tawm tag nrho ntawm lub zais zis yog muab rau cov neeg mob uas muaj mob ntev lossis mob cholecystitis. Qhov kev cuam tshuam kev phais mob no tsis dhau yam tsis muaj kab mob rau lub xeev ntawm lub cev. Cov teeb meem tom qab phais tuaj yeem ntuav, xeev siab, mob ntawm sab xis. Hauv qhov no, nws raug nquahu kom ua raws li kev pw tsaug zog thiab kev ua haujlwm, ua raws li kev noj zaub mov kom raug thiab noj tshuaj antispasmodic thiab hepatoprotectors. Qee zaum kev kho enzyme, xws li Pancreatin, tuaj yeem raug tshuaj.
Kev noj haus
Txhua tus neeg uas tau muaj tus kab mob jaundice raug pom zoo kom ua raws li qee yam kev noj haus, tso tseg cov zaub mov kib, rog thiab ntsim, thiab siv dej cawv. Nws yog tsim nyog los noj fractionally, nyob rau hauv me me feem. Kev hnyav hnyav yuav tsum tsis suav nrog. Kev kho mob jaundice yog ib txoj kev nyuaj thiab ntev uas lub ntsiab yog ua siab ntev thiab ua raws li tag nrho cov lus qhia ntawm tus kws tshaj lij.
Peb cia siab tias cov ntaub ntawv uas tau nthuav tawm hauv tsab xov xwm hais txog kev mob jaundice, kev kho mob, kev kuaj mob thiab ua rau tus kab mob no yuav pab tau rau koj.
