Pancreatitis yog ib yam kab mob loj ntawm tus txiav txiav. Niaj hnub no, tus naj npawb ntawm cov neeg mob los ntawm tus kab mob no tau nce zuj zus. Vim li cas? Dab tsi yog qhov ua rau mob pancreatitis? Cov tsos mob dab tsi qhia txog nws txoj kev loj hlob? Thiab yuav kho tus kab mob no li cas? Qhov no thiab ntau lwm yam yuav tau tham tam sim no.
Pathogenesis
Feem ntau feem ntau ua rau mob pancreatitis nyob hauv tib neeg kev noj haus thiab kev ua neej. Txhawm rau kom cov protein, rog thiab carbohydrates tau nqus los ntawm lub cev, muaj cov enzymes xws li trypsin, lipase, thiab lwm yam. Tab sis yog tias ib tug neeg quav cawv, haus cawv, lossis siv qee yam tshuaj, nws yog qhov tsim nyog. pancreas cuam tshuam.
Yog li ntawd, kua txiv stagnates. Qhov no ua rau muaj kev cuam tshuam ntawm kev zom zaub mov. Tom qab lwm qhov overeating, raug mob los yog lom, lub caj pas yuav o.
Tam sim no tus mob pancreatitis tau dhau los ua ntau dua. Yog hais tias 5-10 xyoo dhau los no pathologycuam tshuam rau cov neeg muaj hnub nyoog 30 xyoo, tam sim no nws tau kuaj pom txawm tias cov hluas.
Muaj kev pheej hmoo yog cov neeg uas nquag ua phem rau cov khoom noj rog, noj ntau dhau thiab cawv. Cov no yog cov laj thawj uas ua rau muaj kev tsim cov enzymes tshwj xeeb hauv cov txiav. Thiab cov txheej txheem no ua rau kev txhim kho ntawm o.
Predisposing factors
Lawv yuav tsum tau sau npe. Vim nws yog lawv uas txiav txim siab ua rau mob pancreatitis. Txhua yam tshwm sim tuaj yeem raug txheeb xyuas hauv cov npe hauv qab no:
- Kev puas tsuaj rau cov kab mob peritoneal. Feem ntau tshwm sim los ntawm kev raug mob.
- Kev haus cawv, tshwj xeeb tshaj yog tsis zoo. Kev haus luam yeeb yog qhov ua rau mob pancreatitis.
- Kab mob ntawm lub plab thiab lub siab.
- Kev siv tshuaj estrogens, diuretics thiab tshuaj tua kab mob.
- Kev cuam tshuam kev phais.
- Kev raug rau kev lag luam, zaub mov thiab tsev neeg co toxins.
- Ntau tshaj.
- kab mob kis los yog kab mob.
- Teeb meem ntawm cov hlab plawv.
- Vim.
- Txoj kev phem.
- Malignant neoplasms, nqaim ntawm cov channel thiab lwm yam kev loj hlob tsis zoo.
- Kev noj zaub mov tsis zoo (kev noj ntau dhau, yoo mov, hom txawv txav).
- Kev hloov pauv hauv keeb kwm hormonal.
- Hyperparathyroidism thiab lwm yam endocrine pathologies.
- Genetic predisposition.
Nws yog ib qho tseem ceeb kom nco ntsoov tias hauv25-35% ntawm cov neeg mob tsis tuaj yeem txiav txim siab qhov ua rau tus kab mob pancreatitis hauv cov neeg mob.
Qee cov txheeb cais
Txhua yam paub uas ua rau muaj qhov pib ntawm tus kab mob tau teev tseg saum toj no. Thiab ntawm no yog qhov txheeb cais zoo li, suav nrog qhov ua rau mob pancreatitis:
- 40% ntawm cov neeg mob raug kev quav dej caw. Ntxiv nrog rau tus kab mob, lawv feem ntau muaj kev puas tsuaj ntawm lub txiav lossis nws cov necrosis.
- 30% ntawm cov neeg mob muaj keeb kwm ntawm tus kab mob gallstone.
- 20% ntawm cov neeg rog rog.
- 5% ntawm cov neeg mob muaj keeb kwm qaug cawv, mob pancreatic, lossis siv cov tshuaj mus ntev.
- Me ntsis tsawg dua 5% ntawm cov tib neeg muaj cov kab mob tshwm sim los yog qee yam ntawm qhov tsis xws luag hauv kev loj hlob ntawm lub cev.
theem kev txhim kho
Lawv kuj yuav tsum tau txiav txim siab, vim peb tab tom tham txog qhov ua rau mob pancreatitis hauv cov poj niam thiab txiv neej. Nws yog kev cai kom paub qhov txawv plaub theem:
- Nyob ntawm tus txiav.
- Hemorrhagic Phase.
- Pakreonecrosis.
- YCholecystitis-pancreatitis.
Tab sis qhov no tsis yog qhov kev faib tawm nkaus xwb. Kuj tseem muaj txoj cai Filin. Raws li nws, muaj plaub theem, txhua qhov uas kav ib lub sijhawm. Cov no suav nrog:
- Enzymatic theem (3-5 hnub).
- Reactive (6-14 hnub).
- Sequestration stage (los ntawm 15 hnub).
- Qhov tshwm sim ntawm tus kab mob (tshaj rau lub hlis).
Tseem muaj kev faib tawm ntawm AD Tolstoy. Hauv nws lub hauv pausmuab pancreatic necrosis thiab nws ntim. Kuj tseem muaj plaub theem:
- Interstitial lossis edematous pancreatitis. Nws yog tus yam ntxwv los ntawm me ntsis ntws.
- Me me focal fat necrosis. Khiav nruab nrab.
- Nyob rau hauv necrosis nrog loj foci thiab hemorrhagic syndrome. Ntxim qab heev.
- Subtotal thiab tag nrho pancreatic necrosis. Ntau tus neeg tuag raug kaw nyob rau theem no.
Kawm kab mob
Nws yog ib qho tseem ceeb uas yuav tsum tau ua tib zoo saib me ntsis rau lub ncauj lus no, vim peb tab tom tham txog qhov ua rau mob pancreatitis hauv cov neeg laus. Lub hauv paus ntawm tus kab mob, raws li nws twb tau nkag siab, yog kev zom ntawm cov txiav txiav nws tus kheej, uas cuam tshuam nrog kev ua haujlwm ntau dhau ntawm cov enzymes phospholipase thiab lipase.
Kev loj hlob ntawm tus kab mob pib nrog edema. Lub pancreas loj tuaj. Tsis muaj pancreatic necrosis nyob rau hauv cov ntaub so ntswg, tab sis cellular twb tshwm sim. Raws li txoj cai, muaj mob girdle nyob rau sab xis thiab sab laug hypochondrium, nrog rau hauv thaj tsam epigastric.
Thaum ib tus neeg raug mob pancreatitis mob hnyav, cov laj thawj uas tau piav qhia saum toj no, qhov tsis xis nyob yuav dhau los ua qhov tsis txaus ntseeg txawm tias tsis nco qab tuaj yeem ua tau. Txhawm rau txo qhov mob, qee tus neeg mob tsis tuaj yeem rub ob txhais ceg mus rau hauv plab.
Tseem muaj ntuav ntuav, uas tsis tuaj yeem pab tau. Thiab lub khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob. Mucous daim nyias nyias, daim tawv nqaij integuments kuj tig daj ntseg. Qee lub sij hawm muaj blueness. Maj mam txhim khotachycardia.
Ntau zaus, cov neeg mob tau kuaj pom tias muaj leukocytosis. Cov ntshav ua tuab, muaj cov amylase ntau ntxiv.
Cov tsos mob tshwj xeeb
Nyob rau theem pib ntawm tus mob pancreatitis, tshwm sim los ntawm ib qho ntawm cov uas tau hais dhau los, muaj qhov ua paug hnyav. Yog tias koj hnov, ces tus neeg mob yuav hnov mob hauv plab. Thiab cov nqaij hauv plab yuav nruj rau lub sijhawm ntawd.
Kuv kuj pom qhov txo qis hauv peristalsis. Kwv yees li ntawm 50% ntawm cov neeg mob tsim Mayo-Robson cov tsos mob, tus cwj pwm los ntawm qhov mob uas nyob hauv thaj tsam ntawm sab laug costophrenic kaum sab xis.
Nyob rau theem 4, cov txheej txheem inflammatory kis mus rau lwm cov ntaub so ntswg thiab kabmob. Muaj cov teeb meem xws li:
- Kab mob ntawm cov hlab plawv.
- ntsws atelectasis, ua pa tsis ua haujlwm, pleurisy.
- Toxic kab mob siab.
- Lub siab thiab lub raum tsis ua haujlwm.
- Abscesses hauv cheeb tsam retroperitoneal, peritonitis.
- plab fistulas, los ntshav.
Enzyme tso tawm nrog omental necrosis. Vim tias cov kua txiv pancreatic nkag mus rau hauv cov hlab ntsha, cov ntshav siab poob qis heev. Txawm yog vau los yeej ua tau.
Chronic form
Ib yam twb tau hais txog qhov ua rau tus kabmob "pancreatitis", nrog rau cov tsos mob ntawm tus kabmob. Nws yuav tsum tau muab sau tseg tias nws daim ntawv ntev muaj nta. Thiab lawvtsim nyog saib xyuas tshwj xeeb. Nov yog peb yam cim tseem ceeb ntawm tus kab mob pancreatitis:
- Hloov cov theem ntawm kev zam txim thiab exacerbation.
- Thyroid disorders.
- kev kawm qib siab.
Raws li txoj cai, daim ntawv mob ntev tshwm sim vim yav dhau los hloov pauv pancreatic necrosis. Tus kab mob tuaj yeem yog cov qauv hauv qab no:
- Cystic. Nrog rau kev tsim ntawm pseudocysts.
- Fibrosclerotic lossis indurated. Nws yog tus cwj pwm los ntawm kev txo qis hauv kev ua haujlwm ntawm lub qog.
- Fistula. Nrog rau daim ntawv no, fistulas tsim nyob rau hauv tus Tsov tus tw, lub cev los yog lub taub hau ntawm caj pas.
- Xauv. Nws yog tus cwj pwm los ntawm kev tso cov calcium ntsev hauv cov ntaub so ntswg.
Daim ntawv mob ntev ntawm tus kab mob yog qhia los ntawm qhov mob hnyav zuj zus hauv thaj av epigastric, jaundice, kub taub hau, tsam plab, thiab raws plab, uas tau hloov los ntawm cem quav.
Thaum tus neeg mob zoo lawm, kev zam txim yuav tshwm sim. Tab sis qhov no yog theem tsis ruaj khov heev. Ib qho exacerbation tshwm sim los ntawm ib qho, txawm tias me ntsis kev noj haus. Txawm li cas los xij, yog tias koj ua raws li kev noj haus thiab ua raws li tus kws kho mob cov lus pom zoo, kev zam txim yuav kav ntev mus rau lub hlis, txawm tias xyoo.
Diagnosis
Hais txog cov tsos mob thiab ua rau mob pancreatitis hauv cov neeg laus, koj yuav tsum tham txog yuav ua li cas kuaj mob.
Ua ntej tshaj plaws, tus kws kho mob gastroenterologist sau ib qho anamnesis thiab suav nrog tus neeg mob qhov kev tsis txaus siab. Ntawm kev kuaj mob, tus kws kho mob them sai sai rau daim tawv nqaij, qhov tsos ntawm cov mucous daim nyias nyias, thiab tseem yuav tsum palpates lub plab mog. Feem ntau pomcov kev sib txawv hauv qab no:
- No pulsation ntawm lub plab aorta.
- Phenicus symptom positive.
- Cov rog subcutaneous yog thinned.
Ib qho kev tshuaj ntsuam kuj tau ua los txiav txim seb muaj cov enzymes hauv lub txiav, kev ua haujlwm, kev tshuaj ntsuam biochemical ntawm cov zis thiab ntshav. Ntawm cov txheej txheem ntsuas, ultrasound ntawm lub plab kab noj hniav yog sau. CT yuav raug txiav txim yog tias muaj teeb meem tshwm sim.
Kev kho mob
Tau kawm txog cov tsos mob thiab ua rau mob pancreatitis, koj tuaj yeem ua tib zoo mloog cov ncauj lus ntawm kev kho mob. Kev noj tshuaj yog kws kho mob tau sau tseg rau ntawm tus kheej, qhov no yuav tsum nco ntsoov. Txhawm rau txo qhov mob, piv txwv li, ib qho ntawm cov hauv qab no yuav raug sau tseg:
- H2 blockers. Pab nrog qhov mob tsis tu ncua. Nws tuaj yeem yog Famotidine lossis Ranitidine.
- YM-cholinolytics. Cov tshuaj zoo tshaj plaws yog Chlorosil, Atropine, Metapin thiab Gastocepin.
- Anspasmodics. Cov tshuaj hauv pawg no suav nrog Sparex, Drotaverin, Spazmalgon, Maksigan, Fenikaberan, No-Shpa thiab Duspatalin.
Tsis tas li ntawd, cov tshuaj tiv thaiv enzymatic tau sau tseg, lub hom phiaj yog los nres cov txheej txheem uas rhuav tshem cov txiav. Cov tshuaj hauv pawg no suav nrog "Kontrykal", "Gordoks", "Trazilol", "Pantripin", "Amidopyrin", "Omez", "Rabelok", "Nexium", "Omeprazole"
txhawm rau txo qhov hnyav ntawm tus txiav, txiav cov enzymes rau pancreatic. Feem ntau nws yog "Festal", "Ermital", "Biozim", "Penzital", "Vigeratin", "Pancreatin",Gastenorm, Mezim, Creon. Kev noj cov tshuaj no kuj pab tshem tawm tsam plab, xeev siab thiab quav quav.
kev kho mob phais
Nws tau qhia yog tias tus neeg mob pancreatitis nyob rau theem siab lossis mob hnyav. Kev ua haujlwm feem ntau yog ua los ntawm laparoscopy.
Tom qab kev cuam tshuam, tus neeg yuav tau txais kev kho tshuaj tua kab mob. Nws kuj tau sau lwm yam tshuaj, lub hom phiaj yog kom tsis txhob muaj cov txheej txheem inflammatory.
Yog tus kws kho mob pom zoo, cov tshuaj enzymatic thiab kev kho lub cev qhuav dej tau raug sau tseg.
kev kho mob Sanatorium
Nws tau pom zoo. Tsawg kawg yog 1-2 zaug hauv ib xyoos, ib tus neeg yuav tsum tau mus xyuas sanatoriums thiab chaw so uas lawv kho cov kab mob plab.
Hom kev kho mob nrov tshaj plaws yog kev siv cov dej ntxhia uas tsis yog carbonated. Raws li txoj cai, cov neeg uas muaj mob pancreatitis mus ntsib Truskavets, Morshin, Zheleznovodsk, Pyatigorsk thiab Kislovodsk sanatoriums.
Kev noj haus
Nws tseem yuav tsum tau tham txog kev noj zaub mov kom raug, vim peb tab tom tham txog cov tsos mob, ua rau thiab cov hau kev kho mob pancreatitis.
Kev noj haus yog qhov tseem ceeb tshaj plaws, cov ntsiab lus ntawm kev kho mob. Nws yog tsom rau kev tso tseg cov kua txiv pancreatic. Nov yog cov hauv paus ntawm kev noj zaub mov zoo:
- tais yuav tsum tau boil, so thiab tws.
- Koj yuav tsum tau nce koj cov protein thiab carbohydrates kom tsawg. Cov rog tau pib maj mam, thiab tsis pub ntau tshaj 70 g / hnub.
- Fiber thiab extractives yuav tsum raug tshem tawm ntawm kev noj haus. Yog li ntawd, cov nqaij yog boiled nyob rau hauv pieces ntawm 100 grams, nco ntsoov ntws thawj dej.
- Ntsev yuav tsum tsawg kawg (txog 6 g / hnub).
- Yuav tsum noj 5-6 zaug hauv ib hnub, feem, feem me me.
- Cov tais diav uas muaj kua txiv hmab txiv ntoo (nceb, ntses, pob txha, nqaij broths) yuav tsum tsis suav nrog. Fried, ntsim, s alty, greasy - too.
- Yuav tsum tso cawv, dej qab zib, kas fes, cocoa. Thaum lub sij hawm tso cai, dej ntxhia ntxhia tau tso cai.
Koj tuaj yeem noj dab tsi? Mucous soups, boiled cereals (oatmeal, mov, semolina), pureed cereals, dawb crackers, compotes, zaub kua txiv, lean boiled nqaij thiab ntses, ib co khoom noj siv mis, boiled zaub. Kev noj zaub mov nruj, tab sis lub cev yuav tau txais tag nrho cov tshuaj thiab cov vitamins nws xav tau. Tus kws qhia noj zaub mov yuav muab cov lus qhia ntxaws ntxaws thiab qhia txog kev noj zaub mov zoo.
