I-Mechan jaundice yisimo se-pathological esibonakaliswa ukwephulwa kokuphuma kwe-bile ngokusebenzisa imigoqo ye-bile ukungena ku-duodenum 12 ngenxa yokuvinjwa kwemishini. Amagama aqondana nalesi sifo afaka imigomo: Uhlobo oluvimbelayo lwe-jaundice, i-acholic jaundice.
Ukuvinjwa kwama-ducts we-bile kwenzeka njengomphumela ongemuhle weqembu elikhulu le-pancreas kanye nohlelo lwe-biliary lomuntu (igama lelo lisho ohlelweni lwe-bile ducts kanye ne-sphincters egxile ekulawuleni ukuhamba kwe-bile). Izimpawu ezejwayelekile zifaka: kuphuzi kwesikhumba, ulwelwesi lwama-mucous, i-sclera yamehlo, njll.
Uma unganikeli ukwelashwa okwanele okukusiza ukubuyisa ukuphuma kwe-bile ngokuphelele, khona-ke amathuba okuba nezinkinga aphakeme - ukwehluleka kwe-hepatic / renal, i-purulent ch chitisitis, i-sepsis, nesibindi. Ezimweni ezinzima kakhulu, ngokumelene nesizinda sokuntuleka kosizo lwezokwelapha, isiguli siyafa.
Izimbangela ezivamile ze-jaundice ezivimbayo: i-cholelithiasis (ikakhulukazi ngaphansi kweminyaka engama-30), i-neoplasms enobungozi, i-pathologies yesistimu yokugaya ukudla. Ukugula akunakudluliselwa kusuka kumuntu kuya komunye. Cabanga ukuthi yiziphi izimpawu ezihambisana nalesi sifo nokuthi ziselashwa kanjani.
I-Etiology of jaundice evimbayo
Emithini yesimanje, i-pathanatomy yalesi sifo iqondakala kahle. Ngokuya ngesizathu esivusayo, i-pathological syndrome ihlukaniswa ngamaqembu amakhulu amahlanu. Esokuqala sifaka ukungafani kwemvelo yangaphakathi, ngenxa yokuthi uhlelo lwebhiliary alukwazanga ukuthuthuka ngokugcwele.
Iqembu lesibili lisho ukuguqulwa okungahambi kahle ku-pancreas kanye nesistimu yokusebenza komuntu, esekelwe ku-cholelithiasis. Isibonelo, ukwakheka kwe-calculi ku-duct ye-bile, ukuphuma kodonga lwe-duodenum 12, ukunciphisa i-duodenal papilla, i-cysts, ifomu lokufaka i-pancreatitis, i-pancreatic necrosis, njll.
Iqembu lesithathu lingukuqina kwezicubu ezinkulu ze-bile ngenxa yokungenelela kokuhlinzwa. Imbangela ngokushesha ifaka ukulimala kwengozi ngesikhathi sokuhlinzwa noma ngokuhlafunwa okungafanele.
I-neoplasms eyisisekelo noma yesibili (iqembu lesine). Izifo ezisetshenzisiwe:
- I-Oncology ye-gallbladder.
- Umdlavuza we-pancreatic wekhanda.
- Ukuba khona kwama-metastases wesibindi ngenxa yezimila zezindawo ezahlukahlukene.
Isizathu sesihlanu izifo ezibangelwa yisinambuzane. Isibonelo, i-echinococcosis, ngenxa yokuthi i-cysts enefomu lokuqukethwe kokumaphakathi. Ukuntuleka kosizo okufika ngesikhathi kuyithuba lokufa ngaphezulu kwama-90%.
I-etiology ye-jaundice ezinganeni ezisanda kuzalwa isuselwa emazingeni aphezulu e-bilirubin egazini lengane. I-Bilirubin yinto esetshenziselwa i-hemoglobin nezakhi zamaprotheni eziqukethe i-iron. Uma okuqukethwe kwe-bilirubin kukhula, khona-ke isikhumba somuntu siba ophuzi. I-genesis imi ngalendlela elandelayo: ukuzivumelanisa nezimo zezemvelo, ukungavuthi kohlelo lwe-enzyme enganeni.
Imbangela evame kakhulu yi-tumor neoplasms. Isigaxa singafakwa kwasendaweni esibindini, emgudwini we-biliary, esophagus, ekhanda le-pancreatic.
Ama-Helminthiasis kanye nokuvela kabusha kohlelo lwe-biliary akuvamile.
Ukubonakaliswa kwemitholampilo kwe-jaundice evimbayo
I-jaundice eyonakalisayo ngokuya nge-International Classization of Diseases (ICD 10) inqunywa yikhodi K83.1. Ukubonakaliswa okuyinhloko komtholampilo kufaka ushintsho kumbala wesikhumba, ulwelwesi lwama-mucous kanye nesifo samehlo.
Iziguli zivame ukukhononda ngobuhlungu obuthuntu esifundeni se-epigastric. Isifo sezinhlungu sivame ukuqina. Isihlalo siyamanzi, njalo. Umchamo uba mnyama ngombala, iphunga elithile.
Ukulunywa kwesikhumba nakho kuba khona, kwesinye isikhathi isiguli siyagula, kwesinye isikhathi siyahlanza. Isiguli siphulukana nesifiso sokudla, ngokulandelana, ukwehla kwesisindo somzimba. Ukushisa komzimba kuyenyuka. I-Ultrasound ikhombisa ukwanda kosayizi wesibindi.
Lapho amatshe evalela imicu ye-bile, izinhlungu zihlala zibukhali, zi-spasmodic. Inganikezwa i-sternum, noma i-axilla yangakwesokudla, i-scapula. Izimpawu zangaphandle zihlala zitholwa amahora angama-24-48 ngemuva kokuba usizi seluphelile. Lapho umuntu ebonakala esibindini lapho ebonwa isibindi, ulimele. Isigaxa senyongo asinyakazeki.
Lapho inqubo yokuthuthukiswa kwe-jaundice ingenxa yokuqubuka kwamanyikwe, ukwephulwa kohlelo lwe-biliary, i-bile ducts, khona-ke izimpawu zinjengokulandelayo:
- Imizwa ebuhlungu ibonakala esifundeni se-epigastric, ibenyezela emuva;
- Nge-palpation, ungembula i-gallbladder enwetshiwe, ingcindezi kuyo ayiholeli emizweni ebuhlungu;
- Isibindi sikhulisiwe, sinesakhiwo esiminyene;
- Uma ukwakheka kwesimo esidabukisayo, khona-ke lesi sakhiwo siqukethe izincazelo ezincane kunazo zonke.
- I-Spleen ayivelwanga ngemibuzo.
Isibindi esikhulisiwe yisibonakaliso esivame kakhulu sokugula isikhathi eside. Ishintsha ngosayizi ngenxa yokuqina kwenqubo ye-bile nokuvuvukala emiseleni ye-bile.
I-Pruritus yesikhumba ihlukumeza iziguli ngisho nangaphambi kokuvela komtholampilo wokuxineka kwesikhumba, okubonakala ngokucacile ku-tumor pathogenesis ye-pathology. Unamandla futhi unobuhlungu ngokwanele, unika umuntu ukukhathazeka okuningi. Imithi ayisizi ukuyeka. Ukuqhekeka kwenzeka esikhunjeni, kwakheka ukwakheka kwamaqhubu amancane. Ukwehla kwesisindo kuvame ukukhula ezinqubweni zomdlavuza.
Uma izinga lokushisa lomzimba wesiguli landa kanye nezinye izinkomba, khona-ke kusolwa ukutheleleka kwamapheshana asebusweni. Umkhuhlane isikhathi eside uphawu oluhlukanisayo oluhlukanisa i-jaundice ne-hepatitis. IHepatitis iyathathelana, ingatheleleka ngokuthintana nomuntu ogulayo emavikini ama-3-4 wesikhathi sokufakwa kwesifo.
I-gallbladder inyuka ngesimila sepilla enkulu ye-duodenal, ikhanda le-pancreatic kanye nengxenye yesifo se-duct evamile ye-bile.
Isibindi sikhushulwe ku-75% wezithombe, kanye nesinye inyongo kuma-65% amacala, atholakala ezihlolweni ze-laparoscopic ku-100% yeziguli.
Ukuxilongwa kwe-jaundice
Ukuze wenze ukuxilongwa okulungile futhi unikeze ukwelashwa okuvumayo okwanele, kwenziwa ukuxilongwa okugcwele. Kubandakanya ukuhlolwa okubonakalayo kweziguli, i-palpation yesisu, izindlela zelebhu kanye nezinsimbi zokuxilonga.
Uma isiguli sinesimila esithuthukile, khona-ke ukuxilongwa kwesibalo kulula impela, ngoba kulula kakhulu ukucasulwa. Esikhathini sokuqala kwentuthuko ye-jaundice, ukuxilongwa kungadala ubunzima obuthile, ngoba izimpawu zingaba wuphawu lwama-pathologies amaningi.
Isibonelo, ngokwanda kokuhlushwa kwe-cholesterol "eyingozi", i-bilirubin, umsebenzi we-alkaline phosphatase, i-jaundice ne-virpatitis hepatitis.
Ukusungula ukutholwa okuyikho, kwenziwa ukuhlolwa kwegazi okujwayelekile. Ikuvumela ukuthi ubone ukuncipha kwamangqamuzana abomvu egazi, i-hemoglobin. Kune-leukocytosis, i-ESR ephezulu - imaka yenqubo yokuvuvukala; futhi wenze ukuhlaziya kwamakhemikhali wezinto eziphilayo.
Izindlela zokuhlonza insimbi:
- Ukuhlolwa kwe-Ultrasound Besebenzisa indlela engaqondile, umuntu angabona ukwanda kwe-bile duct, ukuba khona kwamatshe kuyo, kanye nokulimala kwesibindi okugxile. Ngaphezu kwalokho, kungabekwa i-ultrasound yamanyikwe kanye nezinye izitho zangaphakathi.
- I-Duodenography. Le yi-X-ray ye-duodenum 12 ephikisana nesizinda sokudalwa kwe-hypotension yokufakelwa, isiza ukubonakalisa ukungasebenzi kahle kwamathumbu - uphawu lweFrostberg.
- I-RCHP isetshenziswa kulezo zithombe zomtholampilo lapho ezinye izindlela zokuhlola izinsiza zinikeza imininingwane encane, kuyilapho kusolwa i-blockade ye-duodenal papilla enkulu. Kufakwe ishubhu ekhethekile emthonjeni, lapho kungena khona ingxenye ehlukile, ngemuva kwalokho kuthathwe uchungechunge lwezithombe. Ngenxa yale ndlela, ungathola isimila, utadishe okuqukethwe eziteshini. Le ndlela iyafundisa, kepha njengoba iqondile, imvamisa ihambisana nobunzima obuhlukahlukene.
- I-radioisotope scan yesibindi isiza ekuboneni ama-neoplasms nokuphazamiseka okubangelwa yi-helminth.
Kwesinye isikhathi kusetshenziswa i-laparoscopy - inqubo engahlaseli esiza ukubona ama-metastases, ukuthola ubungako bokungasebenzi kwesibindi ngesikhathi se-helminthiases - alveococcosis kanye ne-echinococcosis.
I-Pathology Therapy kanye ne-Prognosis
Ukwelapha ezimweni eziningi kuhilela ukuhlinzwa. Imithi iqukethe ukudla okunengqondo. Isiguli sinconywa ukuthi sigxile kwimenyu yemifino, ukudla izithelo nemikhiqizo yobisi.
Ukudla kuze kube kasikhombisa ngosuku izingxenye ezincane. Indlela yokulungiselela iyabilisa. Qiniseka ukuthi uthobela umbuso wokuphuza - amalitha ambalwa kaketshezi ngosuku.
I-glucose ne-Vitamin B zenziwa ngemithambo.Izindlela futhi ziyahanjiswa ezivikela isibindi futhi zandise ukuhamba kwegazi esakhiweni. Ukwelapha isiguli, kudalwa imishanguzo ye-antibacterial uma kunesidingo. Ngaphambi kokuhlinzwa, kwenziwa izivivinyo zokuqina kwegazi.
Ukwelashwa kokuhlinzwa kwe-jaundice eyinqaba:
- Uma uhlelo lwebhiliary luvinjelwe, khona-ke imisele yedamu kufanele ikhishwe ukuze kubuyiswe ukugeleza okugcwele kwe-bile.
- I-Mechanation excision of the gallbladder.
- Ukususwa kwe-calculi etholakala gallbladder.
- Ukubukeka okuyingxenye kwesakhiwo sesibindi, okuthinteka inqubo engajwayelekile.
Injongo eyinhloko yokusebenza ukubuyisela ukuphuma kwejwayelekile kwe-bile. Uma icala liyinkimbinkimbi, khona-ke izindlela eziningi zokuhlinza zingahlanganiswa ngasikhathi sinye.
Isikhathi se-jaundice esivimbayo siyahlukahluka ebangeni elibanzi: kusuka ezinsukwini ezimbalwa ngama-blockage wesikhathi esifushane ngamatshe kuya ezinyangeni ezimbalwa ezinamaqhubu. Ngakho-ke, ukwanda kokuphila nokusinda kwesiguli kuncike enkambisweni yesifo esiyimbangela.
Mayelana ne-jaundice kuchazwe kule vidiyo kule ndatshana.
