Izimpawu ze-hepatomegaly ze-diffuse izinguquko esibindini kanye namanyikwe

Isibindi nama-pancreas (ama-pancreas) yizitho ezisebenza kakhulu ze-parenchymal zesikhala sesisu, ezibhekele uhlu lonke lwemisebenzi yomzimba.

Ngenxa yomthwalo wayo osebenzayo ophakeme, idatha yesitho ingaphansi kwenqubo ehlukahlukene ye-pathological: ukuvuvukala, i-necrosis, i-autolysis, i-deformation. Phakathi kwezifo ezingavikeleki, kepha ezijwayelekile, i-hepatomegaly kanye nokushintshanisa izinguquko esibindini kanye namanyikwe.

Ukuxilongwa okufanayo kuzwakala ezigulini ngemuva kokuhlolwa kwe-ultrasound yisitho esiswini, kepha lokhu akuvezi njalo i-pathology enkulu.

Izizathu zaleli qembu le-pathology ziningi. Kusukela ekungasebenzi kahle kwe-bile duct ejwayelekile kanye nokuphela kwephula umthetho we-glucose metabolism.

I-Anatomy kanye ne-physiology yesibindi nama-pancreas

Isibindi siyisitho esikhulu, esingenavuthi, se-parenchymal esenza imisebenzi eminingana. Itholakala esiswini sokudla. Kusondele odongeni olungaphansi lwe-diaphragm, i-12 perth amathumbu, i-pancreas, isisu kanye nezinso kwesokudla.

Isitho siqukethe ama-lobes angakwesokunxele nakwesobunxele axhunywe yi-ligament. Isibindi sinethiwekhi ecebile yemithambo yegazi nokuchichima kwegazi.

Yaziwa ngomuthi, imisebenzi ebalulekile yesitho yile:

1. Isigangi. Ema-hepatocytes (amaseli wesibindi asebenzayo), i-bile iyenziwa, ebandakanyeka ekugayweni kwamafutha.
2. Okwenziwe ngamaphrotheni. Bambalwa abantu abaziyo, kepha uchungechunge lonke lwamaprotheni lwenziwa esibindini, ngaphandle kwalo umzimba womuntu belungeke luphile ngosuku. Lokhu kufaka i-albhamuin, ama-globulin kanye namaprotheni abandakanyeka ohlelweni lokuqothuka kwegazi.
3. Umsebenzi wokuhlunga ubhekene nokuhlanza igazi emikhiqizweni kadoti enobuthi yamaseli womzimba.

Ngokushintshwa kwe-pathological ekwakhekeni kwesibindi, ukwephulwa kwale misebenzi kwenzeka, okuholela ezimweni ezinzima zomzimba.

Ama-pancreas futhi yisitho esikhulu, esingenamikhawulo, se-parenchymal esisemgodini wesisu.

Izicubu zalo zakhiwa amayunithi asebenzayo - ama-pancreatocytes. Iningi lama-pancreas lihlala isiza esibonisa ukumbiwa. Okusho ukuthi, ama-hormone abhekene nokuqhekeka kwamaprotheni nama-carbohydrate akhiwe kuwo. Kuyingxenye ye-exocrine lapho kwakhiwa khona i- "pancreatic juice".

Ingxenye ye-pocreas yamapancreas imelelwa iziqhingi zaseLangerhans. Bahlanganisa amahomoni amaningi abangela ukulingana kwe-metabolic yegazi. Okokuqala, yi-insulin ne-glucagon, elawula i-glucose metabolism.

Ngokushintshwa kwezifo emzimbeni wesitho, izifo zokugaya kanye ne-endocrine zenzeka.

I-Etiology yentuthuko yalesi sifo

Njengoba isibindi namanyikwe kunemisebenzi ehlukahlukene, izinto eziningi zisebenza njengezimbangela zezifo.

Isibindi esikhulisiwe namanyikwe kungukubonakaliswa okujwayelekile kwethonya lezinto zangaphandle nezimbi ezithile zangaphakathi ekusebenzeni kwezitho.

Izimbangela ezivame kakhulu zokulimala kwesitho se-pathological:

• ithonya lobuthi eliphuma ngaphandle noma elenziwe ngaphakathi, izici ezinjengalezi: ukudakwa, ukubhema, ukujova ukusetshenziswa kwezidakamizwa, ukusetshenziswa ngokweqile kwezidakamizwa onomphumela we-hepatotoxic, ukwelashwa okungahambi kahle kwesifo sikashukela kanye nokunye ukuphazamiseka kwe-metabolic;
• ama-nosologies wokutheleleka lapho i-organ parenchyma ibandakanyeka ngqo isibonakaliso esivamile se-virus hepatitis, ngaphezu kwalokho, i-hepatomegaly iholela egazini mononucleosis ebangelwa i-Epstein-Barr virus noma i-cytomegalovirus, umalaleveva, i-leptospirosis, i-pseudotuberculosis nabanye;
• ukuphazamiseka kwe-metabolic: i-amyloidosis e-systemic, isifo seWilson-Konovalov, isifo seGaucher, iCartagener syndrome;
• izifo zenhliziyo nezemithambo yegazi - i-acute coronary syndrome, umfutho okwandayo ekujikelezweni kwe-pulmonary, aneurysms, vasculitis, veic varicose;
• Izifo ze-oncological kanye ne-hematological - i-leukemia ebabayo futhi engamahlalakhona, i-lymphogranulomatosis, ama-lymphomas, i-hepatocarcinoma, umdlavuza we-pancreatic, umdlavuza wezinso;
• amanye ama-pathologies - i-lipomatosis yesibindi, ukukhuluphala kwesibindi, i-amyloid dystrophy, isimo sakwambuso, ama-metastases amanye amaqhubu kusibindi, i-pancreatitis.

Kula ma-pathologies, i-hepatosplenomegaly ibonakala kakhulu, okungukuthi, ukwanda hhayi esibindini kuphela, kodwa nakulolaka.

Izimpawu zomuntu zesifo

Isimpawu se-hepatomegaly futhi siguqula izinguquko sinothile ngobuningi baso.

Kunzima ukwenza ukuxilongwa okuhlukile ngisho nakudokotela onolwazi olukhulu.

Imvamisa, iziguli eza kudokotela nge-pathology enjalo ziveza izikhalazo ezingacaciswanga ngokuphelele.

Lezi zikhalazo yilezi:

1. Ukuqhakaza. Imvamisa, ngenxa yobukhulu obukhulu besibindi, udonga lwesisu luyaphuma. Lokhu kunikeza umbono wesisu esikhulu, esinegazi. Kepha udokotela, ngosizo lwe-palpation ne-percussion, angakwazi ukubona ukuthi yikuphi ukukhula okuthembekile kwesitho esithile se-parenchymal ubukhulu obunjalo besisu.
2. Ukungakhululeki noma ukungakhululeki ngakwesokudla, ngaphansi kobambo. Ukuzwa okunjalo kuhlotshaniswa nokwelulwa kwekhompiyutha yesitho, okucebe emaphethelweni ezinzwa, ngaphezu kwalokho, imizwa enjalo ingabangelwa ngenxa yokucindezela kwe-gallbladder duct.
3. Ubuhlungu, futhi, buwumphumela wolulwa okunamandla kwesembozo se-fibrous organ. Ubuhlungu yinto engathandeki ngokuqhubekayo, ekhombisa ukunganakwa kwenqubo.
4. Ukuqhuma njalo kanye ne-flatulence kuwukubonakaliswa kwe-dyspeptic syndrome, ekhula ngenxa yokushoda kwe-enzyme.
5. Isicanucanu nokuhlanza kungaba yimvelaphi ephakathi nendawo noma yangaphandle. Uhlobo oluphakathi lungaba yimbonakaliso yemiphumela yama-enzyme wesibindi nokuphuphuma kwengqondo ebuchosheni. Lolu hlobo lokuhlanza kanye nenausea lubonakala ngejubane elikhulu, nejubane elingenakuphikwa. Ukuhlukahluka okuphathelene ne-peripheral kuhlotshaniswa nokuphazamiseka kokugaya kwendawo, imvamisa ukuhlasela okubandayo kokuhlanza kanye nauseuse.
6. Isihlalo sokwehlisa. Ukuhamba kwamathumbu ngokomzimba esigulini esine-hepatomegaly kungahluka kakhulu. Kubandakanya uhudo, ukuqunjelwa, ukudideka, ukuguquguquka.
7. Ukuphefumula okuqondile kwe-hepatic kuhlotshaniswa nokusetshenziswa kabi kwamakhambi.

Ngaphezu kwalokho, isimo esivamile sesiguli siyaphazamiseka. Iziguli zibanjwa ubuthongo, umuzwa wokusebenza ngokweqile, inkumbulo ephazamisekile nokunakwa.

Ama-syndromes acacisiwe we-hepatomegaly

Kunezimpawu ezicacelwe kakhulu izifo zesibindi.

I-icteric hue yesikhumba nolwelwesi lwe-mucous olubonakalayo. Ngamanye amagama, umthunzi we-icteric. Lesi sibonakaliso sihambisana nokuqukethwe okuphezulu kwe-bilirubin pigment egazini. I-diffuse icteric hue ingakhombisa ukuthi i-encephalopathy engenayo.

I-Cholestasis syndrome, ebonakaliswa ngokomtholampilo ngokulunywa kanzima kwesikhumba ngaphandle kokubukeka kwezinto ezithile zokuqhuma. I-Cider yokudakwa ejwayelekile kuleli cala ivezwa ngumkhuhlane, ushintsho ezinhlakeni ze-elebhu, ukuphulwa kwesimo esijwayelekile.

IHemorrhagic syndrome yenzeka lapho kwenzeka ushintsho ekwakhiweni kwamaprotheni kohlelo lwe-coagulation. Ukuphazamiseka kwemetabolic. I-cytolysis syndrome, okunzima ukuyiqonda ngokomtholampilo, kepha itholakala kahle isebenzisa izindlela zokucwaninga zaselebhu. Isifo sokuvuvukala iMesenchymal naso kunzima ukusungula ngaphandle kokuhlolwa kwelebhu.

Onke lama-syndromes kumele aqinisekiswe elebhu futhi abe nethonya.

Izindlela zokuthola lesi sifo

Lesi sifo singakhula esigulini unyaka owodwa, kepha ngokusola okuncane, kufanele kwenziwe uhlu oluphelele lwezifundo.

Ukuze kutholakale isifo esifanele, kusetshenziswa izindlela ezahlukahlukene zokuhlolelwa izinsimbi kanye nokwenziwa elabhorethri.

Kungemva kokuthola yonke imiphumela yocwaningo, ungaxilonga kahle.

Ukuhlolwa okulandelayo kokulekelwa kanye nelabhorethri kuyimpoqo:

• I-Ultrasound yindlela yokucwaninga ebaluleke kakhulu, ngosizo lwayo ungakwazi ukuhlola ukwakheka, usayizi wesitho, ukukhomba ama-neoplasms, futhi nokuhlola ukuphuma kwegazi;
• imaging ye-computed kanye ne-magnetic resonance isiza ekutholakaleni okunembile nokuqinisekiswa kokuxilongwa, ikuvumela ukuthi ukhombe ama-metastases amancane kunqubo ye-oncological;
• i-x-ray yesisu lesisu nesifuba, lolu hlobo lokuxilonga luyindlela ejwayelekile ngenxa yokuqukethwe kolwazi lwayo nokufinyeleleka kwayo;
• ukuhlolwa kwegazi okujwayelekile kuzokuvumela ukuthi unake ushintsho ekwakhekeni kwegazi lamaselula, ikakhulukazi, isilinganiso seplanethi kufanele silinganiswe;
• Ukuhlaziywa kwegazi le-biochemical yiyona "golide" ejwayelekile yokuxilongwa kwesibindi nama-pancreas pathologies, ngayo ungalinganisa izinga le-bilirubin, i-alkaline phosphatase, iprotheni ephelele, ama-enzymes wesibindi (ALT, AST), urea, ushukela, ngamunye walezi zinkomba uvumela udokotela ukuhlukanisa i-nosological eyodwa iyunithi kusuka komunye;
• ukuhlolwa kwe-serological kwamagciwane e-hepatitis namanye amagciwane e-hepatotropic;
• ukuhlolwa kwe-fibrosis nomsebenzi we-necrotic;
• coagulogram.

Ngaphezu kwalokho, impahla ithathwa njenge-biopsy yesibindi - okuyindlela yokufundisa kunazo zonke, kepha ehlaselayo. Ngaphansi kokulawulwa kwe-ultrasound, ingxenye yezicubu zomzimba ithathwa ezigulini bese ithunyelwa elabhoratri ye-pathological ukuze ihlolwe.

Izifo Zepancreas Nezindlela Zokwelapha

Njengoba isibindi nama-pancreas kuhlanganiswa emsebenzini wawo, i-pathology yesitho esisodwa ingaholela ezifweni zesitho sesibili.

Imvamisa, i-pancreatitis ebukhali iholela ku-hepatomegaly.

Lokhu kungenxa yomsebenzi we-autolytic ophezulu noma ukuthuthukiswa kwezindlela ezinzima zesifo sikashukela sezinhlobo zombili.

I-pathologists ejwayelekile eholela ekuphazamiseni ushintsho esibindini namanyikwe:

1. Inqubo yokutheleleka.
2. Izifo ezisezandleni, kubandakanya ne-cystic fibrosis.
3. Izifo ezingamahlalakhona

Ngaphezu kwalokho, ukuwohloka kwezicubu ezinamafutha kungakhula. Ukuphathwa kweziguli ezine-hepatomegaly kanye nokushintshashintsha kwezinguquko kuyinqubo enobunzima futhi kudinga ukuxilongwa ngokufanele komtholampilo. I-algorithm yokwelashwa incike ku-etiology yenqubo. Ukwelashwa kufanele kube okuqakathekileko nangokuzimela.

Okokuqala, kwenziwa isidlo se-hepatomegaly yesibindi namanyikwe. Inikezela ngesimo esikhethekile sokudla kweziguli ngaphandle kokucasulwa okwandayo nokonakala kwemikhiqizo. Itafula lokudla libekwa udokotela ohambela isiguli. Udokotela ubheka izimfanelo zesiguli, futhi unqume ukuthi imiphi imikhiqizo ewusizo esibindini kanye namanyikwe esimweni esithile.

Ngokuya ngomqondo wenqubo, kunikezwa imicimbi ekhethekile:

• nge-virus ye-viral, ukwelashwa okwanele kwama-antiviral kunqunywe nezidakamizwa zesimanje;
• esimweni se-lithiasis (amatshe) we-gallbladder, kungaba ukwelashwa okukhanyayo noma ukususwa kubuye kubhekelwe kukho;
• uma i-genesis yalesi sifo ihlotshaniswa ne-pathology yesifo senhliziyo, okokuqala imisebenzi yaso ilungiswa, khona-ke impikiswano yokwelashwa okuqhubekayo ixazululwe.

Okusho ukuthi, bahlala benaka uhlobo lwesifo. Kubaluleke kakhulu ukuxilonga ngesikhathi bese uqala ukwelashwa okufika ngesikhathi, lokhu kuzonyusa kakhulu amathuba okusinda futhi kwandise ithuba lempilo esezingeni.

Yiziphi izinguquko eziphazamisayo kumanyikwe ekhonjiswe kuvidiyo kule ngxenye.