Ukushaqeka kwe-pancreatogenic yisimo esibi kakhulu, esiyinkimbinkimbi ye-pancreatitis eyingozi. I-pathology enjalo iyingozi ngoba nangesikhathi somuthi wanamuhla, izinga lokufa kweziguli ezinesifo licishe libe amaphesenti angama-50.
Ukuthuthukiswa kwesimo esibucayi kuhambisana nokuwohloka kokusebenza kwezitho ezibaluleke kakhulu zangaphakathi, ukwehla komfutho wegazi, kanye nokwephulwa kokugcotshwa kwezitho nezicubu.
Njengomthetho, ukubonakaliswa kokwephulwa komthetho kungumphumela wokuthi i-acanc pancreatic necrosis ikhula. Ngenxa yokushaqeka, ifomu elinamandla, elibhubhisayo le-pancreatitis liyinkimbinkimbi, i-necrosis ithinta izindawo ezibalulekile zepancreas. Uma i-pancreatic necrosis ibanzi, i-endotoxin shock ingakheka.
Izici zokuthuthumela kwe-pancreatogenic
I-pancreatogenic noma i-pancreatic shock inqubo yenqubo ekhula ngomonakalo omkhulu wamanyikwe. Ucwaningo lwalesi simo lubandakanyeke kwi-pathophysiology. Kulokhu, umfutho wegazi wesiguli uyancipha, umthamo wegazi elijikeleziwe uyancipha, ama-hemodynamics ayaphazamiseka ngenxa yesenzo esisebenzayo sama-enzyme e-pancreatic.
Isixhumanisi esiyisihluthulelo se-pathogenesis asiyonto edlula umphumela wama-endotoxins ezicutshini zesitho sangaphakathi. Ngaphezu kokwehla okukhulu komfutho wegazi, isiguli sinezimpawu ngendlela yokulimala kwesikhumba, ukukhuphuka kokujuluka, ukubonakala kobuhlungu obukhulu esiswini.
Ukubonakala kwegazi nakho kuyancipha, ishayela linomlingiswa onjengentambo, isimo sihambisana nokuhlanza, i-oliguria, i-anuria, ukuvimbela kwamathumbu ngokuphelele. Umuntu angaphazanyiswa yi-psyche, ebonakala ngokuphazamiseka kwengqondo, ukubukeka kwe-delirium kanye ne-hallucinations.
Njengoba izimpawu ezifanayo nazo zibonisa esinye isimo sokushaqeka, kubalulekile ukuthi ungazindli futhi ngokushesha uthintane nodokotela ukuze kutholakale ukuthi uphethwe yini.
Kungani i-pathology ikhula?
Ukushaqeka kwe-pancreatogenic kungakhula ngokuphuza ngokweqile kanye nokudla ngokweqile njalo. Kulesi simo, indlela ebandayo ye-pancreatitis isebenza njengomanduleli wesimo esibi. Ukuchazwa okuningiliziwe kwesimo kuyatholakala ku-ICD-10 International Classization of Diseases.
Isifo se-pancreatic ukuvuvukala okunobuthi kwama-pancreas, okwenzeka ngenxa yokuchayeka esithweni sangaphakathi sama-enzyme akhe. Ngenxa yokudla okuningi kokudla, i-gland hyperstimulation iyenzeka, eba yisizathu sokukhishwa okusebenzayo kwezakhi ze-pancreatic.
Ikakhulu, ama-enzyme enziwa ngaphambi kokusebenza ngenxa yokuthi i-bile ingena emigundwini ye-gland, noma kumuntu onempilo kufanele ibe se-duodenum futhi ihlanganyele ujusi we-pancreatic.
- I-Bile iphonswa ngenxa yokuthi ama-ducts ama-excretory avinjelwe ngokwengxenye noma umehluko wokucindezela kwenzeka.
- Ngenxa yokusebenza ngokweqile, ama-enzyme agaya amaseli e-pancreatic, okuholela ekubhujisweni kolwelwesi.
- Ngemuva kokuba ulwelwesi lwama-lysosome selonakalisiwe, ama-enzyme e-lysosomal ahlanganiswa kakhulu, okudala ukwanda kwenqubo yokuzigaya.
Ama-enzymes abaluleke kakhulu ama-lipases, anecala lokwephulwa kwama-lipids kulwelwesi lweseli, ama-trypsins, enza ama-enzyme ngaphakathi kwamangqamuzana, ama-elastases, aphula amaprotheni abe ama-amino acid. Lapho umuntu ephuza utshwala, i-spasm ye-sphincter ye-ducts ye-excretory iyenzeka, okwenza ukuphuma kwe-enzyme nejusi le-pancreatic kube nzima kakhulu.
Ngenxa yokuzenzakalisa kwamaseli, i-necrosis yezicubu iqala bese inqubo yokuvuvukala iba. Izimpawu ezifanayo ziholela ebuhlungwini, kanye nokukhululwa kwe-histamine, kinins, amaprotheni e-granulocyte. Ngaphezu kwalokho, uketshezi oluvela ku-lumen luqala ukuphuma lube izicubu eziseduze, isiguli sine-edema yamanyikwe.
Uhlobo olunzima kakhulu lokulimala kwezicubu ze-pancreatic yi-hemorrhagic pancreatitis, lapho, ngaphansi kwethonya lama-enzyme alo uqobo, i-organ parenchyma nemithambo yegazi iwa ngokushesha. Lokhu kuholela ku-necrosis, hemorrhage kanye ne-peritonitis.
- Lapho ukuvuvukala kusakazekela ohlelweni lokujikeleza, inqubo ye-pathological iba yanda. Umzimba ulahlekelwa uketshezi, ukuqina kwegazi, imithambo yegazi ivalekile, kanye nezimo ze-thrombosis.
- Izinkinga ezinkulu zibandakanya ne-DIC, lapho igazi lihlangana khona kuyi-microvasculature. Lokhu kuholela ekunciphiseni kwegazi elijikelezayo eliphelele, ukwehla kwengcindezi yegazi, ukwehla kwamandla okuphuma kwenhliziyo, kanye nokuvela kokushayeka kwenhliziyo.
- Ngenxa yokugcizelela kobuhlungu ngokweqile, uhlelo lwe-sympatho-adrenaline luyasebenza. Ngenxa yesenzo se-adrenaline, kukhona ukuncipha kwemithambo yethambo lesisu, lokhu kuholela ekujuleni kwegazi okuningi esifundeni senhliziyo nobuchopho.
- Eminye imithambo yegazi nayo inciphile, ngenxa yokuntuleka kokugeleza kwegazi izicubu ze-hypoxia. Ngokuntuleka komoya-mpilo ngenxa yokuphazamiseka kokujikeleza kwegazi, kwakheka i- "lung lung". Uma kulesi simo isiguli singasizwa ngesikhathi, kufa kwenzeka.
- Lapho izinso zingatholi lonke igazi elanele, azikwazi ukwakha umchamo noma uketshezi luphume ngobuningi. Lesi simo sibonisa nge-shock fig syndrome.
Isikhumba sesiguli siyaphenduka siphunga, ngokulahleka okuncane koketshezi, ukujuluka kuyaqina. Njengoba kungekho ama-enzyme e-duodenum, inqubo yokugaya iyama.
Icala lomtholampilo liphelezelwa ukuqina komgudu wamathumbu esiswini, obangela ukuhlanza nokuvinjwa kwamathumbu.
Ukwelashwa kwe-pathology
Isigaba esithuthukile salesi sifo selashwa ngokuphindaphinda uketshezi olulahlekile kanye nokulinganisa i-acid-base esele ngosizo lwezisombululo zemithi. Izinyathelo nazo zithathwa ukubuyisela ukwakheka kwamakhemikhali, ukubukeka kanye ne-acidity yegazi.
Ukunciphisa umsebenzi wohlelo lozwela nokubuyisela ithoni ejwayelekile yemithambo yegazi, kubekwa ama-painkiller. Ezinsukwini zokuqala, udokotela unquma ukuzila ukudla okwelashwa. Ukuze ususe izinto ezinobuthi emzimbeni, kusungulwa imisele.
Uma kunesidingo sokuthulula isisu, kwenziwa umsindo.
Ngokuya ngokuthi i-pancreas ithinteka kanjani, ingxenye yesitho sangaphakathi iyasuswa.
- Njengoba ukushaqeka kwe-pancreatogenic kuyisimo esibi kakhulu, kubangela zonke izinhlobo zezinto ezilimazayo. Ngeke zimiswe ngaphandle kokungenelela okuphuthumayo kwezokwelapha, ngakho-ke, i-pathology esheshayo ikhonjwe bese kunikezwa usizo oluqeqeshiwe, inciphisa ingozi yokufa.
- Ukwelashwa kwama-pancreas kuqala ngokushesha ngemuva kokutholwa kwezimpawu ze-pathology. Isiguli silaliswa esibhedlela ngokuphuthumayo emtholampilo.
- Udokotela unquma ukwelashwa okuyinkimbinkimbi kokuqhaqhazeka kanye ne-syndromic disorder ene-antispasmodics, blockers, iSandostatin noma i-Octreotide, ukuphathwa ngomlomo kwama-enzyme e-pancreatic. Esimweni esiphuthumayo, izidakamizwa zithathelwa indawo i-5-fluorouracil.
- Njenge-prophylaxis yokutheleleka kwe-necrosis, isiguli sithatha imithi elwa namagciwane. Ngaphezu kwalokho, kuthathwa izinyathelo zokulwa nokwakhiwa kwezinkinga ze-thromboembolic nokuguguleka kwe-gastroduodenal. Uma kunesidingo, kwethulwa izondlamzimba zokudla ukuze kugcinwe umzimba.
Ukusebenza kwezokwelapha kuncike ekutheni ukunakekelwa kwezokwelapha okufika ngesikhathi kunikezwa kanjani. Ukwelashwa okujulile nokuqondisiwe kwenziwa ngokushesha nje lapho isiguli esesibhedlela sokuhlinzwa.
Uma amasu angahlaseli awasebenzi, nge-pancreatitis enzima, kunqunywa i-laparoscopy yokuxilonga. I-Peritoneal exudate yomsebenzi we-amylase nayo kufanele ihlolwe. Ngemuva kokuba kwenziwe umsebenzi wokulungiselela, ukuthuthwa kwendle nokukhanywa kwethambo lesisu, i-cholecystostomy, i-marsupialization, uma kukhonjisiwe, kuyenziwa.
Mayelana ne-pancreatitis kanye nezinkinga zayo ezichazwe kuvidiyo kule ndatshana.
