Yog tias koj muaj mob hnyav nyob rau hauv txoj cai hypochondrium, xeev siab thiab ntuav uas tsis tuaj yeem pab tau, qhov iab saj yog hnov hauv qhov ncauj, nws muaj peev xwm ua rau koj muaj mob cholecystitis.
Cholecystitis yog ib yam kab mob uas muaj ntau tshaj plaws. Raws li kev faib tawm thoob ntiaj teb ntawm cov kab mob (ICD-10), nws yog nyob rau hauv chav kawm ntawm pathologies ntawm lub plab zom mov. Tus kab mob no tuaj yeem ua rau muaj kev ywj pheej, lossis nws tuaj yeem tshwm sim nws tus kheej yog ib qho teeb meem tom qab lwm yam kab mob, xws li pancreatitis, qee hom kab mob gastritis, kab mob siab, thiab lwm yam. Tus kab mob no maj mam, thaum xub thawj tsis tshua pom, yog li nws yuav tsum tau kho tus mob cholecystitis sai li sai tau, cov tsos mob uas twb tshwm sim lawm.
YDab tsi yog cholecystitis
Cholecystitis raws li ICD-10 yog ib qho mob ntawm lub gallbladder. Lub hauv paus ua rau tus kab mob yog cov kua tsib ducts, los ntawm lub gallbladder yog cleared ntawm cov kua tsib, clogged nrog pob zeb. Qhov tshwm sim no muaj qhov tshwm sim tsis zoo. Cov kua tsib stagnates hauv lub cev, poob nwsCov khoom siv tshuaj tua kab mob, vim li ntawd, cov phab ntsa ntawm lub gallbladder tau kis tus kab mob (xws li cov kab mob hauv plab hnyuv). Txog li 95 feem pua ntawm cholecystitis tshwm sim vim cholelithiasis.
Tsis tshua muaj, tus kab mob no tshwm sim los ntawm lwm yam ua rau: acalculous cholecystitis tuaj yeem tshwm sim los ntawm vasculitis, kev tshaib plab ntev, sepsis, phais plab, kev raug mob, salmonellosis thiab lwm yam tsis cuam tshuam nrog kev tsim cov gallstones.
Tus kab mob no tshwm sim nyob rau hauv mob thiab mob ntev. Daim ntawv mob tau kuaj pom nrog cov txheej txheem inflammatory sai. Qhov nruab nrab, 15 feem pua ntawm cov neeg mob uas muaj kab mob hauv plab yog qhov ua rau mob cholecystitis. Lawv raug cim los ntawm qhov mob hnyav hauv plab. Yog tias koj xav tias koj muaj tus mob cholecystitis, mus nrhiav kev kho mob tam sim ntawd (hu rau lub tsheb thauj neeg mob).
mob cholecystitis yog tshwm sim los ntawm kev rov ua dua ntawm tus mob cholecystitis. Feem ntau nws yog calculous (uas yog, nrog gallstones). Cov phab ntsa ntawm lub gallbladder thicken lub sij hawm, pathological hloov nyob rau hauv cov kua tsib ducts los yog lub zais zis nws tus kheej tshwm sim, lub peev xwm khaws cia thiab tso cov kua tsib txo, thiab pob zeb tsim. Txhawm rau tiv thaiv tus kab mob los ntawm kev loj hlob mus rau hauv daim ntawv ntev, nws yog ib qho tsim nyog yuav tsum tau ua tib zoo saib xyuas cov kab mob pathological ntawm lub cev raws sijhawm thiab kho tus mob cholecystitis.
Cov tsos mob
Cov tsos mob pom tau tshaj plaws ntawm tus kab mob yog qhov mob hnyav hauv txoj cai hypochondrium. Mob nrog cholecystitis muaj zog heev, kav ntev - txog rau teev, feem ntau muab rau hauvrov qab los yog nyob rau hauv lub xub pwg hniav sab xis thiab txawm tuaj mus rau cramps.
Nrog rau kev loj hlob ntawm tus kab mob, tus neeg mob yuav muaj kev mob xeev siab, ntuav, qee zaum nrog cov kua tsib, tab sis nws tsis yooj yim dua tom qab ntuav. Tsis tas li, cov neeg mob tuaj yeem yws ntawm qhov ncauj qhuav, tus nplaig furred. Muaj kev tsis txaus siab ntawm plab hnyuv, belching nrog huab cua. Tag nrho cov cim no yuav tsum tau kho tam sim ntawm tus mob cholecystitis.
Cov tsos mob ntawm tus mob cholecystitis tseem muaj xws li:
- ua npaws, kub taub hau;
- jaundice;
- lub rooj zaum grey;
- palpitations thiab lwm yam cim ntawm intoxication.
Dhau li ntawm qhov no, koj yuav tsum xyuam xim rau cov tsos mob hauv qab no:
- Murphy thiab Obraztsova: nrog tob palpation ntawm txoj cai hypochondrium, nws nyuaj rau tus neeg mob ua pa, nws mob ua pa;
- Grekova - Ortner: tus neeg mob ntsib kev mob thaum tapping tus nqi raug nqi nrog nws txhais tes;
- Shchetkina-Blumberg: mob cholecystitis hnyav dua yog tias koj ceev koj txhais tes ntawm phab ntsa plab plab thiab tso nws.
Ua rau mob cholecystitis
Lub ntsiab ua rau cholecystitis yog gallstones:
- pob zeb roj cholesterol (feem ntau);
- bilirubin pob zeb, lossis pob zeb xim (tshwm sim thaum cov qe ntshav liab raug rhuav tshem).
Lwm yam ua rau muaj kab mob:
- stagnation ntawm cov kua tsib hauv lub cev;
- cirrhosis ntawm daim siab thiab biliary tract;
- nrawmpoob phaus (txawm yog vim kev noj zaub mov lossis kev phais mob rog);
- cev xeeb tub (txoj haujlwm ntawm tus menyuam hauv plab cuam tshuam rau lub gallbladder, nrog rau kev hloov pauv hormonal hauv lub cev).
Poj niam los txiv neej thiab hnub nyoog ua lub luag haujlwm tseem ceeb hauv qhov tshwm sim ntawm tus mob cholecystitis. Cov poj niam raug cuam tshuam rau qhov nruab nrab 2-3 zaug ntau dua li cov txiv neej. Nws kuj tau sau tseg tias tus kab mob no tshwm sim ntau dua yog tias tus poj niam yug tau tsawg kawg yog ib tus menyuam, raug tiv thaiv los ntawm cov tshuaj tiv thaiv kab mob uas muaj cov tshuaj estrogen ntau, thiab rog dhau. Txawm li cas los xij, qhov hnyav ntawm lub cev tuaj yeem ua rau muaj kab mob tsis hais poj niam txiv neej: kev ua neej nyob tsis muaj zog thiab noj zaub mov tsis zoo nrog cov khoom noj muaj roj ntau ua rau nws 4 npaug ntau dua los nrhiav kev pab kho mob rau tus mob cholecystitis. Txawm li cas los xij, kev ua haujlwm ntawm lub cev hnyav kuj tseem ua rau muaj kev loj hlob ntawm cholecystitis, vim tias muaj kev ntxhov siab ntau ntxiv cuam tshuam rau lub gallbladder thiab cov kua tsib.
Kev pheej hmoo mob kis mob hnyav tom qab 40-50 xyoo, tab sis qhov tseeb vim li cas qhov no tseem tsis tau qhia meej. Cov txiv neej laus feem ntau yuav muaj mob cholecystitis.
Cholecystitis feem ntau tshwm sim rau cov neeg laus dua li cov menyuam yaus, tab sis feem ntau tus kab mob pib thaum yau thiab mus ntxiv mus rau cov neeg laus.
Kuj, yam uas ua rau mob cholecystitis muaj xws li kab mob xws li ntshav qab zib, Crohn's kab mob, tiv thaiv kab mob.
Pathology tuaj yeem tshwm sim los ntawm kev noj tshuaj txo cov roj cholesterol, ua kom nrawm nrawm, mob plab.
Kev kuaj kab mob
Thaum qhov kev xav tias me ntsis ntawm tus mob cholecystitis, tus neeg mob feem ntau yuav tsum tau mus pw hauv tsev kho mob thiab ua cov kev tshawb fawb hauv 24 teev kom paub meej tias qhov kev kuaj mob, vim tias tus kab mob ua rau muaj kev phom sij rau lub neej.
Nyob rau hauv cov chav kawm ntawm tus mob cholecystitis, nws tsis yog qhov nyuaj rau tus kws kho mob paub meej tias qhov kev kuaj mob.
Ntxiv rau kev kuaj lub cev ntawm lub plab, kev kuaj mob xws li ultrasound thiab suav tomography ntawm lub plab yuav tsum tau ua. Thaum kuaj mob, tus kws kho mob yuav tsum xyuas kom meej tias peb tab tom tham txog mob cholecystitis, thiab tsis yog hais txog tus mob pancreatitis, cov tsos mob uas zoo sib xws, lossis mob plab hnyuv lossis lwm yam kab mob. Nyob rau hauv ultrasound, tus kws kho mob yuav saib seb qhov luaj li cas ntawm lub gallbladder yog loj, yog hais tias nws cov phab ntsa yog thickened, yog hais tias muaj lwm yam kev hloov, kua paug, pob zeb, thiab lwm yam. Kev ua tau zoo ntawm txoj kev tshawb no nce mus txog 90 feem pua.
Nyob rau qee kis, radiography, endoscopic, laparoscopic thiab lwm yam kev tshawb fawb yuav tsum tau. Kev kuaj zis thiab ntshav yog qhov yuav tsum tau ua - dav dav, rau bilirubin, amylase thiab lipase, pancreatic enzymes, nrog rau cov tsom rau kev ntsuas lub siab ua haujlwm.
Kev kho mob rau tus mob cholecystitis
Yog tias tsis muaj kev hem thawj ntawm diffuse peritonitis nyob rau hauv mob cholecystitis, kev kuaj xyuas thiab kev kho kom zoo yog qhia. Tus neeg mob feem ntau yog cov tshuaj tua kab mob thiab tshuaj tua kab mob. Nrog cholecystitis, antispasmodics tau qhia los txo qhov mob (piv txwv li, "Papaverine", "No-shpa" thiab lwm yam). Combined tshuaj rau cholecystitis(piv txwv li antispasmodics thiab tshuaj tua kab mob) yog qhov zoo tshaj plaws.
Tshuaj tua kab mob rau cholecystitis yog siv los tua cov kab mob gallbladder thiab tiv thaiv nws los ntawm kev tsim.
Tus neeg mob thaum lub sijhawm kho yuav tsum tswj hwm kev noj zaub mov nruj, ua tiav kev tshaib plab yog ua tau rau thawj hnub. Txias yog siv rau sab xis hypochondrium.
Chenodeoxycholic los yog ursodeoxycholic acid npaj yog siv los yaj pob zeb. Txhawm rau tswj hwm lub luag haujlwm ntawm lub cev, choleretic thiab hepatoprotectors raug sau tseg. Cov kev kho mob zoo li no tuaj yeem kav ntev tshaj li ob xyoos, tab sis qhov muaj peev xwm ntawm kev rov qab los tseem nyob.
kev kho mob phais
Thaum kuaj pom pom tias muaj kab mob peritonitis, tus neeg mob tau txais kev phais xwm txheej ceev - cholecystectomy (tshem tawm ntawm lub gallbladder). Nrog peritonitis, kev tuag yog siab heev txawm tias muaj kev ua haujlwm kub ntxhov, yog li ncua kev mus pw hauv tsev kho mob nrog cov tsos mob ntawm tus mob cholecystitis yog qhov txaus ntshai heev.
Yog tias qhov kev ntsuam xyuas pom pom cov kab mob cholecystitis (uas yog, nrog pob zeb), tsis pub dhau peb hnub txij li qhov pib muaj tus kab mob, thaum tsis muaj contraindications, kev ua haujlwm ntxov yog pom zoo kom tiv thaiv cov teeb meem tom qab mob cholecystitis. Nws lub ntsiab lus yog kev tshem tawm ntawm lub gallbladder puas los ntawm tus kab mob.
Tam sim no, muaj ob hom kev ua haujlwm: laparotomy thiab laparoscopic cholecystectomy. Nyob rau hauv thawj rooj plaub, qhov no yog ib tug ntau qhib kev ua hauj lwm nrog ib tug incision nyob rau hauv lub plab kab noj hniav, uas yog tam sim no ua tsawg thiab tsawg zaus. Laparoscopy yog ua tsis tau phaisincisions siv cov cuab yeej tshwj xeeb. Thaum lub sij hawm phais laparoscopic, me me incisions yog ua los ntawm lub koob yees duab video thiab cov twj paj nruag tso. Hom cholecystectomy no tsis tshua muaj kev raug mob, muaj lub sijhawm luv luv, tsis muaj stitches sab laug tom qab nws, thiab tsis muaj qhov adhesions. Nws kuj tseem siv tau los ua txoj kev kuaj mob.
Tom qab ua haujlwm, tus neeg mob rov zoo sai sai, tom qab ob lub hlis nws tuaj yeem rov qab mus rau nws lub neej li qub, txawm li cas los xij, tseem yuav tsum tau ua raws li kev noj zaub mov nruj rau rau lub hlis thiab tswj nws cov zaub mov.
Ntxhais yam tshiab ntawm kev ua haujlwm tsis muaj kev cuam tshuam - tej thaj chaw deb shock yoj lithotripsy. Lithotripsy ntawm lub gallbladder yog siv yog hais tias muaj contraindications rau intracavitary phais. Nws yog ua los ntawm kev siv lub tshuab uas xa cov yoj yoj mus rau lub pob zeb thiab tsoo nws kom txog thaum nws hloov mus ua hmoov av.
Kev kuaj mob rau tus mob cholecystitis feem ntau yog qhov zoo. Tom qab kev phais rau calculous cholecystitis, yuav luag txhua tus neeg mob tsis muaj cov tsos mob ntawm tus kab mob lawm.
Kab mob sib kis
mob cholecystitis ntau dua li lwm yam kab mob ua rau muaj kab mob peritonitis. Peritonitis tshwm sim nyob rau hauv ib qho kev mob loj heev nyob rau hnub 3-4 ntawm tus kab mob, nro hauv cov leeg ntawm phab ntsa plab, mob hauv peritoneum.
Tsis tas li, mob cholecystitis tuaj yeem ua rau lub zais zis perforation. Hauv qhov no, qhov mob yuav txo qis rau ib ntus, tab sis tom qab ntawd tag nrho cov tsos mob, suav nrogmob, muaj zog.
Cov teeb meem ntawm tus kab mob muaj xws li cholangitis, pancreatitis, gangrene ntawm lub gallbladder, suppuration nyob rau hauv lub zais zis. Ib qho teeb meem tshwj xeeb yog kev puas tsuaj rau cov ducts thaum lub sijhawm ua haujlwm kom tshem tawm lub gallbladder.
Rov ua dua ntawm tus mob cholecystitis tuaj yeem ua rau muaj tus kab mob mus ntev.
ntsuas kev tiv thaiv
Nrog ib qho kev xav rau kev tsim cov gallstones, nws yog ib qho nyuaj rau kev tiv thaiv kom txhob muaj tus mob cholecystitis. Txawm li cas los xij, qhov tshwm sim ntawm kev tsim cholelithiasis tuaj yeem txo qis los ntawm kev tiv thaiv, vim tias qhov kev pheej hmoo ntawm kev tawm tsam ntawm tus mob cholecystitis thiab kev loj hlob ntawm cholecystitis ntev yuav txo qis.
Stagnation ntawm cov kua tsib yog tiv thaiv los ntawm kev ua neej nyob. Mobility tiv thaiv kev tsim ntawm pob zeb, thiab tseem tuav lub cev hnyav.
Yog koj rog dhau, tsis txhob poob siab.
Nws kuj tseem yuav tsum tswj kom muaj dej sib npaug (koj yuav tsum haus tsawg kawg 2 litres dej ib hnub).
Ua tib zoo saib xyuas koj txoj kev noj qab haus huv, tso tseg cawv thiab haus luam yeeb, vim lawv txo kev tiv thaiv thiab ua rau tsis zoo rau kev zom zaub mov.
Tus mob cholecystitis feem ntau yog ib qho kab mob sib kis hauv plab hnyuv, yog li txhua yam kab mob ntawm txoj hnyuv yuav tsum tau kho raws sijhawm.
Txoj cai yooj yim yog kev noj zaub mov kom raug. Nws yog ib qho tsim nyog yuav tsum noj tsis tu ncua, tib lub sijhawm, tsawg kawg peb mus rau tsib zaug hauv ib hnub, hauv qhov me me. Qhov no pab tiv thaiv cov kua tsib nyob rau hauv lub gallbladder.
Khoom noj khoom haus rau mob cholecystitis
Kev noj haus ua lub luag haujlwm tseem ceeb hauv kev kho tus kab mob. Yog li ntawd, tus neeg mob yuav tsum ua ntej ntawm tag nrho cov nco ntsoov dab tsi lawv noj nrog cholecystitis, thiab nruj me ntsis raws li tag nrho cov kev txwv nyob rau hauv thiaj li yuav tiv thaiv ib tug rov tshwm sim ntawm ib tug nres.
Kev noj zaub mov txawv ntawm txhua theem ntawm tus kab mob:
- Txij thaum mus pw hauv tsev kho mob, tus neeg mob tau yoo mov kom txog thaum qhov mob ploj mus (tab sis tsis pub dhau 4 hnub). Nyob rau theem no, tsuas yog cov kua dej tso cai (cov dej ntxhia uas tsis muaj roj, tsis muaj zog tshuaj yej, dej qab zib, decoctions ntawm chamomile, mint, rosehips kuj tau txais). Koj yuav tsum haus ntau zaus, hauv me me sips.
- Tom qab qhov mob tau txo qis, cov khoom noj ua kua ntshiab tuaj yeem nkag mus rau hauv kev noj haus - tsis muaj zog broth, mov, semolina, oatmeal soups, mis nyuj soups, jelly, low-calorie kefir. Koj yuav tsum noj me me. Nyob rau theem no, koj yuav tsum haus dej ntau tshaj 2 litres ib hnub.
- Zoo rau kev rov qab los, ntshiv ntses thiab nqaij ntxiv rau kev noj haus. Tsuas yog cov zaub mov ntshiab, boiled los yog steamed, tseem tso cai, tab sis feem ntau tuaj yeem nce ntxiv. Nyob rau theem no, kev noj zaub mov pub zaub thiab txiv hmab txiv ntoo, qhob cij qhuav, biscuits, marshmallows, kas fes nrog mis nyuj.
Nyob rau hauv mob cholecystitis, tsis muaj teeb meem koj yuav tsum noj kib, haus luam yeeb, ntsim, pickled, ntsim. Cov khoom noj uas txwv tsis pub rau cholecystitis yog chocolate, qab zib qab zib, qab zib pastries, nceb. Cov zaub mov hnyav no muaj qhov tsis zoo rau lub plab zom mov thiab tuaj yeem ua rau muaj kev tawm tsam tshiab.
Tom qab rov zoo lawm, kev txwv kev noj zaub mov tseem tshuav, tus neeg mob tau txais kev noj zaub mov No. 5a (kev noj cov rog thiabzaub mov nplua nuj nyob rau hauv coarse zaub fiber, oxalic acid, cholesterol, nitrogenous extractives).
Kev kho mob nrog pej xeem tshuaj
Cov tshuaj pej xeem raug pom zoo kom siv los ua ntxiv. Nws yog qhov txaus ntshai los hloov cov kev kho ib txwm siv nrog lawv, tshwj xeeb tshaj yog nyob rau hauv daim ntawv mob. Yog tias koj xav tias muaj kab mob, koj yuav tsum xub mus ntsib kws kho mob. Ua ntej, kev kho mob ntawm tus mob cholecystitis, cov tsos mob ntawm kev txhim kho thiab yuav tsum tau saib xyuas kev kho mob tam sim ntawd, yuav tsum tau ua, thiab tsuas yog tom qab ntawd ib tus tuaj yeem siv tshuaj ntsuab thiab kev npaj.
Kev kho mob cholecystitis ntev nrog cov tshuaj pej xeem kuj tseem siv los ntxiv rau txoj hauv kev tseem ceeb ntawm kev kho. Cov nroj tsuag nrog choleretic, anti-inflammatory, antimicrobial zog, raws li zoo raws li zib mu thiab txiv ntseej roj yog tsuas yog siv. Nws raug nquahu kom hloov cov tshuaj yej thaum sawv ntxov nrog lub decoction ntawm pob kws stigmas lossis qus sawv. Ib qho ntawm cov kev kho mob zoo rau ob qho tib si cholecystitis thiab lwm yam kab mob ntawm lub plab zom mov yog decoction ntawm unpeeled oat nplej.
Txhua yam kev kho pej xeem yuav tsum tau pom zoo los ntawm koj tus kws kho mob.
Nrog kev noj zaub mov kom zoo, kev ua neej zoo, kev pheej hmoo ntawm gallstones thiab cholecystitis tsawg heev. Txawm li cas los xij, yog tias cov tsos mob ntawm tus mob cholecystitis tshwm sim, nws yog ib qho tsim nyog yuav tsum tsis txhob noj nws tus kheej, tab sis tam sim ntawd sab laj nrog kws kho mob txhawm rau txhawm rau kuaj xyuas kom raug thiab kho tus kab mob sai li sai tau, tsis muaj teeb meem thiab txhim kho mus raudaim ntawv mob.
