Ama-pancreas akhiqiza ama-enzyme wokugaya, okungenzeka yizinto ezinolaka kakhulu emzimbeni womuntu. Bayakwazi ukudiliza noma yiluphi uhlobo lokudla ezingxenyeni ezilula, ngaleyo ndlela benze lula ukuthathwa kwabo.
Kodwa-ke, ngenxa yezifo ezithile, kukhona ukwephulwa kokuphuma kwe-enzymes yokugaya ukudla okuvela esithobeni, okubangela ukubola kwamanyikwe. Lesi yisimo esiyingozi kakhulu esibeka usongo olukhulu hhayi kuphela empilweni kepha nasempilweni yomuntu.
Ngakho-ke, kubalulekile ukuthi zonke iziguli ezinezifo ze-pancreatic zazi ukuthi ziyini i-pancreatic necrosis, yini ebangela zona, iziphi izimpawu ezibonisa lesi sifo, ukuthi sisithola kanjani isifo futhi siselashwa. Lokhu kuzosiza ekuhambeni kwesikhathi ukubona izimpawu zokuqala zokugula okunamandla futhi kuvikele isiguli ekukhubazekeni nasekufeni.
Isici se-pancreatic
I-pancreas yindlala enkulu kunazo zonke emzimbeni womuntu. Yenza imisebenzi emibili ebalulekile ngasikhathi sinye - ikhiqiza ama-enzymes wokugaya adingekayo ekugayweni kwamaprotheni, amafutha kanye nama-carbohydrate, futhi aqukethe ama-hormone aqhakambisa ukuthathwa kwe-glucose futhi alawule ushukela wegazi.
Kukhiqizwa amajusi e-pancreatic ngaphakathi kwendlala futhi athululelwa kanye nomgodi ophambili e-duodenum, lapho abandakanyeka khona ekugayweni kokudla. Lama enzymes asebenza kakhulu futhi ayakwazi ukudiliza noma yimaphi amafutha namaphrotheni emvelaphi yezitshalo nezilwane, kanye nama-carbohydrate alula futhi ayinkimbinkimbi.
Izici ezinjalo zamanyikwe achazwa inani elikhulu lama-enzyme atholwe ngamangqamuzana alo. Ngakho-ke, odokotela bathi i-pancreas izitho ezibalulekile, ngaphandle kwalokho ukusebenza komzimba okuvamile akunakwenzeka.
Ukuqanjwa kanye nezakhiwo zikajusi we-pancreatic:
- I-Amylase - iyadingeka i-hydrolysis yama-carbohydrate, ikakhulukazi isitashi ne-glucose glycogenado;
- I-Lipase - iphula yonke inhlobo yamafutha, i-polyunsaturated kanye nama-acid anama-acid amaningi, kanye namavithamini anombala ongamafutha A, D, E, K;
- I-pancreatic elastase ukuphela kwe-enzyme engaphula imicu ye-elastin ne-collagen izicubu ezithintekayo;
- I-Nuclease - ifaka phakathi ama-enzyme amaningi (i-exonuclease, i-endonuclease, i-ribonuclease, i-deoxyribonucicela, ukukhawulelwa, njll.) Edingekayo kuma-hydrolysanucleic acid, kufaka phakathi i-DNA ne-RNA;
- I-Carboxypeptidase, i-trypsin ne-chymotrypsin-kusula zonke izinhlobo zamaprotheni ukukhulula ama-amino acid.
Ukuhlukaniswa ngesikhathi kwama-enzymes we-pancreatic kunomthelela ekungeneni kwama-pancreas. Amasistimu wezinzwa we-parasympathetic, uzwela kanye ne-metasympathetic ngendlela yezinzwa ze-vagus, i-nerve enkulu yangakwesokudla, i-celiac nerve plexus kanye ne-ganglia ye-intramural.
Bayingxenye yohlelo lwezinzwa oluzimele, okungukuthi, lukhona ngaphandle kokulawulwa okuvela ezingxenyeni eziphakeme zobuchopho.
Lokhu kusho ukuthi ngenkathi udla ukudla, kuvela imfihlo yokuzilungiselela yama-enzymeni we-pancreatic, ngaphandle kwemizamo yengqondo yomuntu.
Izimbangela zePancreatonecrosis
Izizathu zokubola kwama-pancreas zingahluka kakhulu, kepha esikhathini esiningi lesi sifo sibangelwa ukungondleki kanye nokuphuza ngokweqile ngokweqile. Ngaphezu kwalokho, i-pancreatic necrosis ingagula hhayi kuphela abantu abahlala baphuza utshwala, kodwa nalabo abaphuza utshwala kuyaqabukela, kodwa ngamanani amakhulu.
Ukudla okungenamsoco notshwala kunciphisa ukuvikelwa kwama-pancreas, kwandise imfihlo yamanyanisi we-pancreatic, kukhuphule ngokweqile imisele futhi kuphazamise ukuphuma kwama-enzyme ku-duodenum. Ngenxa yalokhu, kusebenze ukusebenza kwama-enzymes wokugaya ukudla ngaphakathi kwesitho, okuholela kumonakalo omkhulu kakhulu we-enzymatic kwezicubu ze-gland nokuzigaya.
Kulesi simo, isiguli sakha i-pancreatic necrosis ngokushesha okukhulu, bese izicubu zomzimba ziyafa. Esikhathini esizayo, iziguli eziningi zithola ukulimala kwemithambo, lapho ujusi we-pancreatic ungena ohlelweni lokujikeleza umzimba futhi usakazeka emzimbeni wonke, ube nomthelela onamandla onobuthi kuwo.
Imvamisa nge-pancreatic necrosis, kanye nama-enzymes wokugaya ukudla, amagciwane e-pyogenic anjenge-streptococci ne-staphylococci angena egazini. Ngenxa yalokhu, isiguli sakha i-sepsis - ubunzima obunamandla bokuwohloka kwe-pancreatic, okudinga ukwelashwa okuphuthumayo.
Izimbangela ze-pancreatic necrosis:
- Ukuphuza utshwala ngamanani amakhulu;
- Ukudla ngokweqile njalo kanye nokudla kokudla okunamafutha nokuningi okuthosiwe, ukudla okunama-khalori aphezulu, ukudla okunezipayisi nokunambithekayo
- Amagagasi
- Isilonda esisesiswini kanye ne-duodenal;
- Ukuhlanganiswa kwezifo ezibangelwa amagciwane;
- Ukuhlinzwa kwesisu
- Ukuthatha imithi ethile: i-Azathioprine, iMetronidazole, iTetracycline, i-Isoniazid, i-Aspirin namanye ama-salicylates;
- Ukuthatha izidakamizwa, ikakhulukazi i-amphetamine nama-iopiate;
- Ubuthi bokudla obukhulu;
- Ukulimala kwesisu.
Izimpawu
Imvamisa, i-pancreatic necrosis iyinkimbinkimbi ye-pancreatitis eqeda noma engalapheki. Ngakho-ke, iziguli ezake zahlushwa ukuvuvukala kwamanyikwe zisengozini ethile yokuthola lesi sifo esiyingozi.
Ukwehla kwamanyikwe kunezigaba ezintathu eziphambili zokuthuthuka. Esigabeni sokuqala, isiguli sizwa i-malaise, esivame ukuyihlanganisa nokudla ngokweqile noma ukuphuza utshwala. Ngemuva kwalokho, ukuphazamiseka kwesitulo, isicanucanu, ukuhlanza nomkhuhlane kuyangezelelwa kukho.
Esigabeni sesibili salesi sifo, lapho izicubu ze-gland zithinteka ngama-enzyme abo e-pancreatic, ukuvuvukala okunzima kuqubuka emzimbeni ngokwakhiwa kwenqwaba yephaphu. Ngalesi sikhathi, kwakheka zonke izindawo zezicubu ezifile kumanyikwe abangela ukudakwa komzimba.
Isigaba sesithathu sesi sifo sizibonakalisa ngesimo se-pancreatic necrosis ephelele, esemboza wonke amaseli esitho. Kulesi sigaba salesi sifo, inqubo yokuvuvukala ivame ukuya kwizicubu eziseduze nezitho zomzimba, futhi kuthinte ubonda, i-duodenum kanye nesisu esincane.
Ukugxila okukhulu kangako kokuvuvukala kungavimbela ukwehluleka kwezitho eziningi, okuyisimo esibulalayo futhi ezimweni eziningi kuholela ekufeni kwesiguli. Ngakho-ke, kubalulekile ukuqonda ukuthi i-pancreatic necrosis yisifo esisongela impilo yesiguli futhi sidinga ukuvuselelwa ngokushesha.
Izimpawu eziphambili zokubola kwe-pancreatic:
- Ubuhlungu obukhulu ku-hypochondrium yesobunxele. Cishe i-50% yeziguli iluchaza njengobuhlungu obukhulu obungabekezeleleki obungenakudambisa nganoma yimuphi umuthi wobuhlungu. Imvamisa unikela emuva, ihlombe, uhlangothi lwesobunxele ngisho nendawo yenhliziyo. Ngalesi sizathu, i-pancreatic necrosis kwesinye isikhathi ididaniswa ne-myocardial infarction;
- Ukuhlanza okukhulu ngaphandle kokukhululeka. Uma isiguli sesivele sakha i-lesion yemithambo yegazi ekuhlanzeni, igazi lingaba khona;
- Izimpawu ze-hepatitis ukuhlanza kwe-bile, kuphuzi kwesikhumba kanye namhlophe wamehlo. Nge-pancreatic necrosis, ukulimala kwesibindi okunzima kwenzeka, okungaholela ekuhlulekeni kwesibindi;
- Umkhuhlane, ukubanda, umkhuhlane;
- Ukuqunjelwa, okuvela ngenxa yokuphazamiseka ngokuphelele kohlelo lokugaya ukudla;
- Ukuqhakaza okukhulu nokungezwani kwemisipha ye-peritoneum;
- Umlomo omkhulu owomile, ukwehla okuphawulekile kwenani lomchamo, ukuthuthukiswa kokuhluleka kwezinso kungenzeka;
- Ukwehla okukhulu komfutho wegazi;
- Ukwehluleka kokuphefumula, ukuhlaselwa kwe-suffocation kuvame, okuwumphumela wokudakwa kanzima komzimba;
- Ukwakheka kokulimala onsundu e-hypochondrium yangakwesobunxele, ukubonakala kokulimala ohlangothini lwesobunxele eduze nenkaba;
- Ukudideka, okuchazwa ukwanda koshukela wegazi ukuya emazingeni abucayi.
Kubalulekile ukukhumbula ukuthi i-pancreatic necrosis ayikwazi ukuba kumuntu omdala kuphela, kodwa futhi nengane. Ebuntwaneni, lesi sifo singakhula ngokushesha okukhulu futhi siholele ekuweni, okuwukuthi, ukwehla okukhulu komfutho wegazi.
Lokhu kuyinkinga ebeka impilo yakho konke engozini, umphumela wayo uvame ukungabikhona kwemithambo nokufa kwesiguli.
Ukuxilonga
Ukuxilongwa kwe-pancreatic necrosis kufanele kwenziwe ngokushesha, ngoba ngalesi sifo imizuzu yonke iyabiza. Ngaphezu kwe-gastroenterologist, udokotela ohlinzayo kanye ne-resuscitator naye ubamba iqhaza ekuhlolweni kwesiguli, esivivinya ubukhulu besimo sesiguli futhi sithathe zonke izinyathelo ezidingekayo ukusindisa impilo yakhe.
Okubaluleke kakhulu kuzo zonke izindlela zokuxilongwa kwalesi sifo ukuthola izinga lama-enzymes e-pancreatic egazini nomchamo, ikakhulukazi, ukuhlolwa kwe-amylase. Uma ukutholakala okukhulu kwale enzyme kutholakala egazini lomuntu, khona-ke lokhu kukhombisa ngokuqondile ukuthuthukiswa kwe-pancreatic necrosis.
Enye indlela ebalulekile yokuxilonga ukuhlolwa kwegazi lokubala amaseli amhlophe egreyidi kanye ne-erythrocyte sedimentation rate. Uma lezi zinkomba ziphakeme kakhulu, khona-ke lokhu kubonisa inkambiso yenqubo yokulimala kanzima emzimbeni wesiguli.
Ngaphezu kwalokho, uma kusolwa i-pancreatic necrosis, isiguli sithunyelwa ngokushesha ukuze kuthathwe i-ultrasound scan (i-ultrasound), ekuvumela ukuthi uhlole ngokokubona izinga lokuvuvukala kwepancreatic, ubone ukungqubuzana okungatheni nokwakheka okungalingani kwesici sesici se-tishu ye-necrosis.
Usebenzisa i-compact tomography (CT) ne-magnetic resonance imaging (MRI), ungathola isithombe esicace kahle sendlala enesifo kunokusebenzisa i-ultrasound. Ngakho-ke, lezi zindlela zokuxilonga zivame ukusetshenziselwa ukuthola indawo ngqo ye-izicubu ze-necrosis, kufaka phakathi okuncane okugxile, kanye nokubona ukusakazeka kwalesi sifo emalungeni nasezitho zomzimba eziseduze.
I-Angiography iyindlela yokucwaninga evumela ukuthi wena ubone ukuphulwa kokuhlinzekwa kwegazi ezindaweni zamaphaphu athinteka yi-necrosis, futhi unqume ukuthunyelwa kwemithambo yegazi ebaluleke kakhulu, ikakhulukazi imithambo ye-hepatic ne-gastro-duodenal.
Ukwelashwa
Into yokuqala okufanele yenziwe yi-pancreatic necrosis ukuhlinzeka ngamanyikwe aphumule ngokuphelele. Kulokhu, isiguli sinqatshelwe ngokuphelele ukwenza noma yimuphi umsebenzi womzimba, ukudla noma yikuphi ukudla neziphuzo. Ukudla okunempilo kwesiguli kwenziwa kuphela ngaphakathi.
Ngalesi sifo, isiguli kwesinye isikhathi senziwa ngokugeza isisu ngamanzi apholile ukusula ngokuphelele udoti wokudla. Lokhu kukuvumela ukuthi umise uhlelo lokugaya ukudla futhi unciphise ukukhiqizwa kwama-enzymes we-pancreatic.
Enye yezimo ezibaluleke kakhulu zokwelashwa kokubola kwe-pancreatic ukususwa kobuhlungu obukhulu. Ngale njongo, kusetshenziswa izinhlobo ezahlukahlukene zemithi yobuhlungu, njenge-analgin, baralgin ne-amidopyrine, enikezwa isiguli ngomjovo we-intravenous.
Futhi, ngenhloso yokusizwa kobuhlungu, kusetshenziswa ama-dropper avela engxenyeni ye-glucose-novocaine eningi lamalitha ama-1-2. ngosuku. Ngobuhlungu obungabekezeleleki, isiguli sinikezwa i-novocaine blockade, esusa ama-syndromes obuhlungu kakhulu futhi ikuvumela ukuba uthole umphumela we-analgesic.
Ukudambisa izinhlungu ezibangelwa i-spasm yesitho esithintekile, ama-antispasmodics, ngokwesibonelo, i-papaverine, i-nopa, i-platifillin, idluliselwa kumuntu. Ngaphezu kwalokho, isiguli siyadingeka ukuthi sithathe ama-diuretics, anjenge-lasix ne-furosemide, anikela ekuphumuleni okuphelele kwekhompiyutha epancreatic.
Okubaluleke kakhulu ekwelashweni kwalesi sifo esingathi sína ukusetshenziswa kwamagciwane, alwa ngempumelelo nenqubo yokuvuvukala futhi aqede namagciwane e-pyogenic, akhulisa ukulimala kwesitho. Futhi, isiguli esine-pancreatic necrosis sinconywa ukuphuza ama-antihistamines asusa ngokushesha ukuvuvukala kwezicubu.
Ukwelashwa kwe-pancreatic necrosis njalo kufaka phakathi ukuhlinzwa, okwenziwa kuphela ngosuku lwesihlanu, ngemuva kokulaliswa esibhedlela yisiguli. Ngalesi sikhathi, odokotela bayakwazi ukumisa inqubo yokuvuvukala, bavikele ukusakazeka kwalesi sifo kumaseli anempilo futhi banciphise nengozi yezinkinga ezi-postoperative.
Ngesikhathi sokuhlinzwa kuma-pancreas, isiguli sisuswa sifile, izingxenye zomzimba zomile, sinqatshelwe ukunikezwa kwegazi, futhi sibuyise ukuphuma okujwayelekile kwama-enzyme e-pancreatic. Ezimweni ezinzima, isiguli singadinga ukungenelela okuningana kokuhlinzwa.
Futhi, ngesikhathi sokwelashwa kwe-pancreatic necrosis, kwenziwa inqubo ehlukahlukene yezokwelapha okufanele ivuse umsebenzi wezitho zesisu nokuvikela isiguli ekuhlulekeni kwezitho eziningi. Inkambo ejwayelekile yokwelashwa esibhedlela ingathatha izinyanga ezimbalwa.
Isazi sevidiyo esikulesi sihloko sizokhuluma nge-pancreatic necrosis.
