Nyob rau hauv tsab xov xwm, peb yuav txheeb xyuas seb qhov mob appendicitis nyob rau hauv ib tug neeg thiab dab tsi yog nws cov cim. Qhov no pathology yog ib tug inflammatory txheej txheem nyob rau hauv lub appendix, uas txuas mus rau lub caecum. Nov yog ib qho mob uas tshwm sim hauv kev phais.
Qhov tseem ceeb ntawm pathology
Appendicitis yog ib qho ntawm cov kab mob hauv plab uas tshwm sim ntau tshaj plaws, suav txog 89.1 feem pua. Appendicitis tuaj yeem tshwm sim hauv cov txiv neej thiab poj niam txhua lub hnub nyoog. Lub culmination ntawm qhov tshwm sim yog pom nyob rau hauv qeb ntawm cov neeg mob los ntawm kaum mus rau peb caug xyoo. Txoj kev loj hlob ntawm cov txheej txheem inflammatory nyob rau hauv daim ntawv ntxiv tshwm sim nyob rau hauv tsib tus neeg tawm ntawm ib txhiab ib xyoos. Appendicitis yog nyob rau hauv kev txiav txim siab ntawm kev phais plab, lossis kev phais plab.
Daim ntawv ntxiv yog dab tsi?
Nov yog ib qho appendage ntawm caecum, uas muaj ib tug rudimentary cim. Outwardly, nws yog ib tug elongated nqaim raj, lub distal sab uas muaj ib tug dig muag kawg, thiab lub proximal sab yog txuas nrog lub kab noj hniav ntawm lub cecum nrog kev pab los ntawm ib tug funnel-puab.qhov.
Yuav ua li cas txhawm rau mob plab hnyuv hauv tsev, ntau tus neeg txaus siab.
Muaj plaub txheej nyob rau hauv phab ntsa ntawm lub appendix: serous, muscular, submucosal thiab mucous. Qhov ntev ntawm cov txheej txheem yog los ntawm tsib mus rau kaum tsib centimeters, lub thickness yog los ntawm xya mus rau kaum millimeters. Cov ntawv ntxiv muaj nws tus kheej mesentery, uas tuav nws thiab ua kom muaj kev txav mus los ntawm cov txheej txheem no.
Nws lub hom phiaj ua haujlwm tsis tau qhia meej meej, tab sis nws tau raug pov thawj tias daim ntawv txuas ntxiv muaj cov haujlwm hauv qab no: thaiv, endocrine thiab secretory. Tsis tas li ntawd, nws muaj kev koom tes hauv kev saib xyuas cov hnyuv microflora thiab tsim cov tshuaj tiv thaiv kab mob. Txhua tus neeg yuav tsum paub cov tsos mob ntawm tus mob appendicitis.
Kev faib kab mob
Muaj ob hom kab mob appendicitis - mob ntev thiab mob. Txhua ntawm lawv muaj ob peb morphological thiab kho mob variants. Nyob rau hauv mob appendicitis, muaj catarrhal (yooj yim) thiab destructive forms (gangrenous, apostematous, phlegmonous-ulcerative thiab phlegmonous).
Nrog rau catarrhal appendicitis hauv cov neeg laus, muaj cov tsos mob ntawm cov qog thiab cov ntshav ncig hauv cov txheej txheem, cov tsos ntawm foci ntawm purulent-exudative o nyob rau hauv lub mucosal txheej. Lub appendix nce, nws cov serous membrane ua puv-ntshav. Muaj kab mob appendicitis.
Vim txoj kev loj hlob ntawm catarrh, ib qho mob purulent tshwm sim hauv daim ntawv mob. Ib hnub tom qab pib ntawm cov txheej txheem, leukocyte infiltration kis mus rau tag nrho cov thickness ntawm lub appendix phab ntsa, thiab qhov no yog suav hais tias yog phlegmonous appendicitis. Daim ntawv no yog tus cwj pwm los ntawm qhov tuab ntawm cov phab ntsa ntxiv, edema thiab hyperemia ntawm mesentery, tso tawm ib qho purulent zais cia los ntawm lumen ntawm daim ntawv ntxiv.
Cov tsos mob ntawm mob plab hnyuv, tau kawg, tau hais. Tab sis qee zaum daim duab yog qhov muag plooj. Yog hais tias thaum lub sij hawm o ntawm ib tug diffuse xwm ib tug loj tus naj npawb ntawm microabscesses yog tsim, ces apostematous appendicitis yog tsim; Yog hais tias muaj ulcerations nyob rau hauv lub mucosa, ces phlegmonous-ulcerative appendicitis tsim. Kev loj hlob ntawm cov txheej txheem kev puas tsuaj yav tom ntej dhau los ua qhov ua rau gangrenous appendicitis. Thaum cov ntaub so ntswg uas nyob ib puag ncig lub appendix koom nrog cov txheej txheem purulent, nws yog nrog los ntawm cov tsos mob ntawm periappendicitis, thaum mesentericitis tshwm sim nyob rau hauv mesentery. Cov teeb meem ntawm mob hnyav (feem ntau yog phlegmonous-ulcerative) hom kab mob appendicitis yog perforation ntawm tus txheej txheem, uas ua rau muaj kev txwv los yog diffuse peritonitis, los yog appendicular abscess.
Ntawm cov hom mob appendicitis yog thawj cov kab mob ntev, seem thiab rov tshwm sim. Cov chav kawm ntawm tus kab mob yog tus yam ntxwv ntawm sclerotic thiab atrophic txheej txheem nyob rau hauv cov txheej txheem, kev puas tsuaj thiab inflammatory kev hloov nrog ntxiv kev loj hlob nyob rau hauv lub appendix phab ntsa thiab lub lumen ntawm cov ntaub so ntswg granulation, cov tsos ntawm adhesions ntawm cov ntaub so ntswg thiab serous membrane. Thaum cov kua dej serous accumulates nyob rau hauv lub lumen, ib cyst tshwm.
Cov tsos mob ntawm mob plab hnyuv yuav tau tham ntxiv hauv qab no, tab sis tam sim no cia peb tham txog qhov ua rau ntawm tus kab mob no.
Ua rau mob plab hnyuv
Appendicitis tsim, raws li txoj cai, vim muaj cov kab mob polymicrobial, uas sawv cev los ntawm staphylococci, anaerobes, streptococci, E. coli thiab enterococci. Cov kab mob nkag mus rau phab ntsa ntxiv rau hauv txoj kev enterogenic, uas yog, los ntawm lumen.
Cov kab mob appendicitis tshwm sim thaum cov kab mob plab hnyuv stagnate nyob rau hauv daim ntawv ntxiv vim nws kink, muaj cov pob zeb thiab cov khoom txawv teb chaws hauv lumen, hyperplasia ntawm cov qog nqaij hlav. Mechanical blockage ntawm lub lumen ua rau muaj kev nce siab hauv nws, circulatory defects nyob rau hauv lub appendix phab ntsa, uas yog nrog los ntawm ib tug txo nyob rau hauv lub zos tiv thaiv, nce nyob rau hauv cov kev ua ntawm cov kab mob pyogenic thiab lawv ntxiv nkag mus rau hauv lub mucosa.
Khoom noj
Cov khoom noj khoom haus thiab qhov chaw tshwj xeeb ntawm cov txheej txheem yog qhov tseem ceeb. Qhov no predisposes tsim ntawm appendicitis. Nws yog lub npe hu hais tias vim yog noj ntau heev ntawm cov nqaij thiab ib tug neeg nyiam cem quav, ib tug loj npaum li cas ntawm cov protein decay khoom nyob rau hauv cov hnyuv cov ntsiab lus, thiab qhov no tsim ib tug zoo heev ib puag ncig rau lub hav zoov ntawm pathogenic flora. Ntxiv nrog rau qhov ua rau lub cev, cov kab mob appendicitis tshwm sim vim muaj kab mob parasitic thiab kis kab mob - typhoid fever, yersiniosis, plab hnyuv tuberculosis, amoebiasis, thiab lwm yam.
Cov poj niam cev xeeb tub
Cov poj niam cev xeeb tub muaj feem yuav mob plab hnyuv. Qhov no yog vim qhov kev hloov ntawm lub appendix thiab caecum vim qhov loj ntawm lub tsev menyuam. Tsis tas li ntawd predisposing yam hauv cov poj niam cev xeeb tub yog cem quav, kev hloov hauv cov ntshavpelvic organ, transformation of the immune system.
Signs of appendicitis
Yog tias mob plab hnyuv loj muaj ib daim ntawv raug, ces muaj qhov mob ntawm sab xis hauv cheeb tsam iliac, hais lus dav dav thiab hauv zos. Hauv qhov no, kev tawm tsam ntawm qhov mob feem ntau tshwm sim sai. Thaum xub thawj, nws kis tau los yog nyob hauv cheeb tsam feem ntau nyob rau hauv cheeb tsam ze ntawm lub plab thiab hauv epigastrium. Tom qab ob peb teev, muaj qhov mob ntawm qhov mob plab hnyuv hauv thaj tsam iliac ntawm sab xis.
Yog hais tias cov ntaub ntawv ntxiv nyob rau qhov tsis zoo, ces cov tsos mob tsis zoo yuav hnov hauv thaj tsam lumbar, nyob rau hauv txoj cai hypochondrium, saum lub pubis thiab ze ntawm lub plab mog. Mob mob nyob rau hauv daim ntawv mob ntawm mob appendicitis yog qhia txhua lub sij hawm, nce thaum lub sij hawm luag los yog hnoos, txo nyob rau hauv sab xis nyob rau hauv lub supine txoj hauj lwm.
Cov tsos mob thaum ntxov
Cov tsos mob ntxov ntxov ntawm cov kab mob appendicitis yog cov tsos mob ntawm plab zom mov: ntuav, xeev siab, raws plab, roj thiab tso quav. tachycardia thiab subfebrile mob tau sau tseg. Intoxication yog tshwj xeeb tshaj yog pronounced nyob rau hauv destructive appendicitis. Cov chav kawm ntawm tus kab mob tuaj yeem cuam tshuam los ntawm abscesses ntawm peritoneal kab noj hniav - Douglas, plab hnyuv, subphrenic thiab appendicular qhov chaw. Qee zaum, thrombophlebitis ntawm pelvic lossis iliac veins raug tsim, uas tuaj yeem dhau los ua PE.
Nyob rau menyuam yaus thiab cov neeg laus
Tshwj xeeb ntawm cov tsos mob ntawm mob plab hnyuv kab mob yog nyob rau hauv lub chaw kho mob ntawm pathology nyob rau hauv cov neeg laus, cov poj niam cev xeeb tub, cov me nyuam,Cov neeg mob uas muaj qhov chaw tsis zoo ntawm daim ntawv ntxiv.
Rau cov menyuam yaus thaum muaj hnub nyoog ntxov uas muaj mob plab hnyuv, cov tsos mob hauv qab no tau pom, cov yam ntxwv ntawm ntau yam kabmob thaum yau: raws plab, febrile kub, ntuav ntuav. Tus me nyuam qhov kev ua si txo qis, nws dhau los ua lethargic thiab capricious. Raws li qhov mob syndrome nce, tej zaum yuav muaj kev ntxhov siab.
Kev mob plab hnyuv rau cov neeg laus yog qhov txawv me ntsis. Cov neeg laus uas muaj kab mob appendicitis feem ntau muaj daim duab tsis pom kev kho mob. Tus kab mob feem ntau dhau mus ua haujlwm, nrog rau kev puas tsuaj ntawm cov kab mob. Lub cev kub tsis tas yuav nce siab, qhov mob hauv hypogastrium yog qhov tsis tseem ceeb, lub plawv dhia tsis zoo, cov tsos mob ntawm plab plab yog qaug zog, me ntsis leukocytosis. Cov neeg laus, tshwj xeeb tshaj yog tias muaj palpable infiltrate hauv ileum, yuav tsum tau kuaj xyuas qhov sib txawv ntawm cov kab mob nrog cov qog hauv caecum. Rau lub hom phiaj no, nws yog ib qho tsim nyog yuav tau ua ib qho irrigoscopy los yog colonoscopy.
Yog tias mob appendicitis tau kuaj pom hauv cov poj niam cev xeeb tub, ces qhov mob tuaj yeem ua rau thaj tsam ntau dua li qhov chaw ntawm thaj chaw iliac vim qhov kev txav ntawm caecum mus rau ntawm lub tsev menyuam loj. Lwm cov tsos mob ntawm tus mob appendicitis yuav mob me dua. Mob plab hnyuv mob rau hauv cov neeg mob cev xeeb tub yuav tsum paub qhov txawv ntawm qhov kev pheej hmoo ntawm kev nchuav menyuam, nrog rau kev yug ntxov ntxov.
Nyob rau hauv daim ntawv mob ntev, muaj qhov mob npub nrog mob plab hnyuv hauv thaj tsam iliac ntawm sab xis. Tej zaum lawv yuav nce zuj zus tuajnta thaum lub sij hawm siv lub cev.
Lub tsev kho mob appendicitis yog tus cwj pwm los ntawm cov tsos mob ntawm plab zom mov (mob raws plab lossis cem quav), kev xav hnyav thiab tsis xis nyob hauv thaj tsam epigastric. Lub cev kub nyob rau hauv ib txwm txwv, kev kuaj ntshav thiab zis tsis muaj kev hloov pauv. Thaum sib sib zog nqus palpation, qhov mob yog hnov nyob rau hauv lub plab mog sab xis.
mob plab hnyuv li cas?
Kev kuaj kab mob
Tus mob appendicitis yuav tsum txawv ntawm yuav luag tag nrho cov kab mob ntawm cov kab mob ntawm cov kab mob peritoneal. Qhov no yog yooj yim los ntawm qhov chaw tshwj xeeb ntawm cov txheej txheem, nrog rau qhov tsis muaj cov tsos mob tshwm sim. Yuav ua li cas los txiav txim qhov mob appendicitis tom tsev? Kev kuaj mob appendicitis yog kuaj los ntawm kev kuaj mob thiab kev nug, cov ntaub ntawv ultrasound, nrog rau kev kuaj ntshav kuaj. Thaum lub sij hawm siab ntawm lub plab ntawm sab xis, qhov mob hnyav zuj zus, tab sis lawv muaj zog tshwj xeeb tshaj yog thaum lub siab ntawm cov ntiv tes ntawm phab ntsa ntawm lub peritoneum raug tshem tawm sai sai.
Thaum tus neeg mob raug hais kom sawv ntawm tus ntiv taw, nws ua tsis tau vim qhov mob hnyav ntxiv. Tus naj npawb ntawm leukocytes tuaj yeem nce lossis txo qis, tab sis ib txwm muaj kev hloov pauv ntawm neutrophic tam sim ntawd. Kev kuaj mob appendicitis yuav tsum tau raws sijhawm.
Txoj kev kho mob
Feem ntau lees txais rau tus mob appendicitis yog lub tswv yim ntawm kev phais tshem tawm cov kab mob appendix sai li sai tau.
Yog tias muaj tus kab mob no tshwm sim, ua ntej kev kho mob hauvHauv ib lub tsev kho mob, kev noj zaub mov thiab dej tsis suav nrog, daim ntawv thov txias rau thaj tsam iliac ntawm sab xis thiab lub txaj so yog qhia. Nws yog txwv tsis pub haus cov tshuaj laxatives, siv cov ntaub qhwv cua sov, thiab siv tshuaj tua kab mob kom txog thaum qhov kev kuaj mob tau tsim tiav. Yuav ua li cas kev phais kom tshem tawm cov kab mob appendicitis?
Nyob rau hauv daim ntawv mob, ib qho appendectomy yog ua, uas yog, tshem tawm cov txheej txheem los ntawm laparoscopy los yog los ntawm ib tug qhib incision nyob rau hauv lub iliac cheeb tsam ntawm sab xis. Yog hais tias tus mob appendicitis nyuaj los ntawm peritonitis, ib tug nruab nrab laparotomy yog ua. Tus neeg mob tau noj tshuaj tua kab mob hauv lub sijhawm tom qab phais.
Nyob rau hauv daim ntawv mob ntev, kev ua haujlwm tshem tawm cov kab mob appendicitis yog qhia - appendectomy, yog tias muaj qhov mob tsis tu ncua uas ua rau tus neeg mob tsis ua haujlwm. Yog tias cov tsos mob me me, ces kev kho mob yog siv, uas suav nrog kev siv cov tshuaj antispasmodics, physiotherapy thiab tshem tawm cem quav.
Huab cua
Tsab twg ntawm tus neeg mob appendicitis tseem ceeb heev uas yuav tsum paub kom muaj sij hawm txiav txim.
Yog tias kev ua haujlwm tau ua tiav raws sijhawm thiab raug, ces qhov kev cia siab tau zoo. Nws feem ntau yuav siv li peb mus rau plaub lub lis piam rov qab mus ua haujlwm.
Cov teeb meem tuaj yeem yog qhov tshwm sim ntawm cov kab mob inflammatory infiltrate tom qab kev phais, ib qho abscess ntawm lub plab hnyuv thiab Douglas qhov chaw, kev loj hlob ntawm kev cuam tshuam ntawm plab hnyuv adhesions. Cov xwm txheej no yuav tsum tau rov mus pw hauv tsev kho mob xwm txheej ceev.
Cov teeb meem xws li kev tuag, tuaj yeem ua tauqhov tshwm sim ntawm kev mus pw hauv tsev kho mob lig, nrog rau kev ua haujlwm tsis raws sijhawm.
Peb tau saib cov cim qhia thiab kev kho mob appendicitis.
