Subhepatic abscess yog ib qho kev mob purulent tsawg, uas nyob nruab nrab ntawm daim siab thiab lub voj voog ntawm txoj hnyuv thiab yog ib qho teeb meem ntawm kev phais kab mob ntawm lub plab kab noj hniav. Kev kho mob tshwm sim yog mob nyob rau hauv txoj cai hypochondrium, aggravated los ntawm inhalation, kub taub hau, lom, dyspeptic mob. Kev kuaj mob yog nyob ntawm kev kawm ntxaws ntxaws ntawm anamnesis, cov txiaj ntsig ntawm kev sim kuaj thiab lwm yam kev kuaj mob. Kev phais phais muaj kev qhib, tso dej thiab ntxuav cov kab noj hniav uas cuam tshuam, nrog rau kev kho tshuaj tua kab mob tsis tu ncua thiab ntsuas detoxification.
Ntau cov ntsiab lus hais txog lub tsev kho mob, kuaj mob thiab kho mob subhepatic abscess (ICD-10 code - K75.0) - txuas ntxiv.
Ntau yam
Ntshai ntawm qhov chaw subhepatic tuaj yeem yog ob qho tib si pib mob neoplasm thiab qhov tshwm sim ntawm exudate encystationncaj qha hauv qab lub diaphragm.
Yog li ntawd, ob hom kab mob no txawv:
- Primary limit abscess: tsim tawm tsam keeb kwm ntawm kev tsim cov txheej txheem mob nyob ze ntawm lub cev.
- Secondary txwv abscess: cov kab mob pathogenic nyob hauv thaj chaw hauv qab daim siab, vim qhov no yog thaj chaw uas muaj qhov loj tshaj plaws resorption ntawm lub plab, tom qab suppuration yog localized vim qhov tshwm sim ntawm kev sib txuas capsule ntawm purulent xwm.
kab mob yam
Tus kab mob no suav hais tias yog ib qho teeb meem ntawm cholecystitis, pancreatic necrosis, mob purulent o ntawm appendix, perforation, ntau yam tsis xws luag ntawm hollow los yog parenchymal kab mob, circulatory pathologies nyob rau hauv cov hlab ntsha ntawm lub mesentery ntawm txoj hnyuv ib ntsuj av tau nrog strangulated hernias thiab cem quav ntawm txoj hnyuv, kev ua haujlwm. Tsis tas li ntawd, tus kab mob tuaj yeem tsim nrog hematogenous thiab cryptogenic diffuse peritonitis. Cov kab mob kis tau zoo tshaj plaws yog kev sib koom ua ke ntawm cov kab mob hauv plab hnyuv thiab cov kab mob anaerobic.
Cov khoom yas ntawm peritoneum pab tsim cov kab mob: vim muaj qhov tsis xws luag, fibrinous nplaum exudate accumulates ntawm nws lub dav hlau, uas ua rau kev sib txuas ntawm cov nplooj ntawv ntawm cov ntaub so ntswg. Tom qab ntawd qhov tsim ntawm cov ntaub so ntswg adhesions tshwm sim, thiab qhov chaw ntawm purulent o yog cais tawm ntawm lub plab. Nyob rau hauv cov ntaub ntawv ntawm ib tug thib ob subhepatic abscess, lub luag hauj lwm tseem ceeb nyob rau hauv lub pathogenesis yog ua si los ntawm ib tug loj resorptive dynamism ntawm lub peritoneum nyob rau hauv lub subhepatic qhov chaw, uas pab mus rau tsub zuj zuj ntawm exudate nyob rau hauv cheeb tsam no.nrog kev mob peritonitis. Kuj tseem muaj qhov yuav tsum tau ua ua ntej anatomical rau txoj kev loj hlob ntawm tus kab mob - lub xub ntiag ntawm lub siab lub ntsws ntawm lub peritoneum.
Cov cim qhia ntawm pathology
Qhov kev kho mob ntawm tus kab mob subhepatic abscess nyob ntawm qhov hnyav ntawm tus txheej txheem thiab cov kab mob hauv qab. Ib qho kev qhia ntau zaus yog qhov mob ntawm sab xis hauv qab tav, hla mus rau sab nraub qaum, lub xub pwg hniav lossis lub xub pwg, qhov saturation ntawm qhov ua pa tob tob. Tsis tas li ntawd, hyperthermia yog ib qho mob (tus mob ua npaws muaj qhov tshwm sim tsis sib xws), mob, lub plawv dhia, thiab nce siab. Hauv qhov xwm txheej hnyav, tag nrho cov tshuaj tiv thaiv rau suppuration yog tsim, mus txog rau ntshav lom thiab mob plawv.
Cov tsos mob ntawm tus mob subhepatic abscess tej zaum yuav los yog tsis tuaj. Nyob rau hauv xws li mob, subfebrile lub cev kub, leukocytosis thiab nce nyob rau hauv ESR nyob rau hauv cov ntshav kuaj, raws li zoo raws li pathogenicity thaum hnov nyob rau hauv txoj cai hypochondrium, pab kom xav tias tus kab mob no. Cov tsos mob ntawm tus kab mob subhepatic muaj xws li ntuav, tsam plab, cem quav; Nrog rau qhov txhab loj, cov tsos mob ntawm plab hnyuv muaj feem yuav.
Yog tias muaj kev sib cais thib ob tuaj yeem ua tau, hauv daim duab kho mob nws yog ua ntej los ntawm cov cim tshwj xeeb ntawm kev mob peritonitis. Nyob rau tib lub sijhawm, tawm tsam keeb kwm yav dhau los ntawm kev maj mam txhim kho hauv tus neeg mob tus mob, kev txhim kho ntawm qhov abscess ua rau muaj kev mob plab thiab qaug dab peg.
Kab mob sib kis
Qhov kev cia siab rau kev tsim ntawm subhepatic abscess tuaj yeem ua rau tsis zoo, yog tias tsis yogua txhua yam ntsuas tau los kho nws.
Qhov tshwm sim ntawm tus kab mob siab tsis kho:
- Peritonitis, kab mob ntshav uas tshwm sim los ntawm kev raug mob abscess thiab kis ntawm cov khoom necrotic mus rau hauv lub plab kab noj hniav.
- Subphrenic abscess vim muaj kab mob hauv qab lub dome ntawm lub diaphragm.
- Pericarditis, pericardial tamponade ntawm lub plawv vim cov kua paug nkag mus rau hauv lub hnab pericardial.
- Ascites.
- Hemorrhage vim muaj zog hauv cov leeg.
- Brain abscess.
- Septic blockage ntawm cov hlab ntsha hauv lub ntsws.
- Kev txhim kho ntawm fistulas hauv lub ntsws thiab pleura vim abscess rupture mus rau hauv pleural kab noj hniav.
Diagnosis
Vim tias tus kab mob subhepatic abscess yog qhov nyuaj rau kev sib txawv ntawm cov kab mob zoo sib xws, nws yog ib qho tseem ceeb kom ntsuas tus neeg mob qhov kev tsis txaus siab, nws cov anamnesis. Tus kws kho mob pom qhov xwm txheej ntawm kev tsis txaus siab, muaj qhov chaw kis kab mob, kev ua haujlwm, raug mob, mob hnyav.
Kev tshawb fawb soj ntsuam kuaj lub siab abscess yuav zoo ib yam li lwm yam kab mob.
Instrumental Methods
Txoj kev ntawm kev ntsuas ntsuas, uas pom qhov pom ntawm subhepatic abscess, yog raws li hauv qab no:
- X-ray ntawm lub plab kab noj hniav qhia pom cov tsos mob ntawm ascites, muaj cov kab noj hniav hauv daim siab nrog kua thiab kua paug.
- kuaj mob ultrasound ntawm hepatobiliaryqhov system txiav txim qhov loj thiab qhov chaw ntawm cov kab noj hniav abscess.
- MRI, MSCT ntawm lub plab kab noj hniav ntsuas qhov chaw, tus lej thiab ntau npaum li cas ntawm abscesses los kho cov tswv yim kho mob.
- Radioisotope scanning ntawm daim siab qhia pom qhov tsis txaus ntawm cov ntshav xa mus rau lub siab, qhov chaw ntawm qhov abscess.
- Diagnostic laparoscopy - lub koob yees duab me me thiab cov khoom siv tau muab tso rau hauv lub plab kab noj hniav los ntawm kev txiav me me kom tso dej tawm ntawm qhov abscess.
Nws yog ib qho tseem ceeb kom paub qhov txawv ntawm tus mob peb tab tom txiav txim siab thiab mob purulent cholecystitis, pleurisy, subdiaphragmatic abscess. Distinguishing a subhepatic abscess ntawm ultrasound yog ib qho yooj yim txaus yog tias tus kws kho mob tsim nyog.
Kev kho mob
Kev kho mob ntawm cov kab mob subhepatic yog ua los ntawm kws phais mob, kws kho mob plab, thiab yog tias tsim nyog, tus kws kho mob tshwj xeeb. Ib lub tswv yim zoo suav nrog kev kho tshuaj tua kab mob ua ke nrog kev cuam tshuam tsawg kawg nkaus.
Kev tso dej tawm ntawm qhov abscess tau qhia, rau lub hom phiaj ntawm kev siv thev naus laus zis tsawg feem ntau siv hauv peb lub sijhawm. Raws li kev tswj hwm ntawm kev kawm ultrasound, ib qho percutaneous puncture ntawm abscess yog ua, cov kua paug yog aspirated. Lub kaw lus tshwj xeeb yog muab tso rau hauv qhov chaw so ntawm qhov abscess, uas tau tso cai rov qab ntxuav cov kab noj hniav thiab qhia cov tshuaj tua kab mob. Cov txheej txheem tsis tshua muaj kev puas tsuaj thiab yooj yim dua rau cov neeg mob dua li qhib kev phais.
Yog tias cov thev naus laus zis no tsis muaj tseeb los siv, qhov tob tob ntawm cov abscess qhib thiab ntws nrog kev phais.txoj kev. Ob leeg transperitoneal thiab extraperitoneal nkag raws li Melnikov siv. Txoj kev tom kawg yog qhov zoo dua, vim nws ua rau nws tuaj yeem tshem tawm cov kab mob loj heev enterobacterial ntawm lub plab kab noj hniav.
Reviews
Cov neeg mob tau qhia kom kho cov kab mob uas ua rau muaj kev tsim cov kab mob hauv lub sijhawm. Tsis txhob hnov qab txog thawj cov tsos mob ntawm tus kab mob thiab mus ntsib kws kho mob tam sim ntawd.
Huab cua
Nrog kev tshawb pom raws sijhawm thiab kev kho mob tsim nyog, qhov kev cia siab yog qhov zoo. Lub subhepatic abscess tuaj yeem ua rau hnyav zuj zus los ntawm kev nkag mus rau hauv lub plab kab noj hniav nrog kev tsim ntawm diffuse peritonitis thiab qhov chaw tshiab ntawm purulent o, sepsis thiab ntau lub cev tsis ua haujlwm. Nyob rau hauv cov ntaub ntawv no, qhov prognosis yog heev tsis zoo. Kev tiv thaiv ntawm cov kab mob no muaj nyob rau hauv kev kho mob tsim nyog ntawm cov kab mob uas tuaj yeem ua rau muaj qhov tshwm sim ntawm abscess, nrog rau kev mob siab rau kev saib xyuas tom qab ntawm cov neeg mob uas tau raug mob peritonitis thiab lwm yam kab mob purulent ntawm lub plab zom mov.
