Isifo sikashukela i-insipidus (ikhodi ngokusho kwe-ICD-10 - E23.2) yisifo esibucayi se-neuroendocrine, esibonakaliswa ukungakwazi kwezinso ukumunca amanzi emuva nokugxilisa umchamo. Isisekelo ukuphulwa kokukhiqiza, ukuthutha noma isenzo se-vasopressin (i-antidiuretic hormone). Lesi sifo sikhonjiswa ukoma kwe-pathological kanye nokukhishwa kwenani elikhulu lomchamo. Okuningi ngokuthi siyini i-insipidus yesifo sikashukela, ukuthi yiziphi izinhlobo zokugula nokuthi ungabhekana kanjani nazo okuxoxwa ngazo esihlokweni.
Izici ze-anatomy kanye ne-physiology
Izinso ziyisitho esigoqiwe, esisemva kodonga lwasekhaya lwangemuva kwinqanaba le-vertebrae ephansi ye-thoracic ne-lumbar. Isitho sinesikhumba sokuqina, i-capsule enamafutha kanye ne-renal fascia. Kukhona ukwahlukaniswa okunemibandela kwezinso zibe izingxenye ezimbili:
- i-organ parenchyma - imisebenzi yayo isesimweni sokuhlunga igazi nokwenziwa komchamo;
- i-pelvis - buthelela futhi ususe umchamo emzimbeni.
Izinso ngayinye inenombolo enkulu yezakhiwo ezingama-nephrons, ezinikeza amakhono ayo okusebenza. I-nephron inesakhiwo esilandelayo:
- I-Glomerulus - emelelwa yi-plexus eqinile yama-capillaries okuphuma kuyo igazi. I-glomerulus icwiliswa ku-Shumlyansky-Bowman capsule.
- I-capsule inezindonga ezimbili, futhi kukhona isikhala samahhala phakathi kwabo. I-capulelthi ingena emgodini wezibumbu.
- Ama-tubules atholakala ngendlela yama-loops ekuqineni kwe-renal parenchyma.
INephron iyunithi elincane kakhulu lesakhiwo sezinso.
Imisebenzi
Izinso zisusa uketshezi olwedlulele emzimbeni womuntu, ama-metabolites ezinqubo ze-metabolic ze-allergener, izinto ezinobuthi nezinobuthi, kanye nemithi. Ngaphezu kwalokho, umzimba ubamba iqhaza ekulawuleni ibhalansi lamanzi-usawoti, isimo se-acidity yegazi, nengcindezi.
Kubalulekile! Izinqubo ezifanayo zinikezwa ngenxa yokwakheka komchamo.
Umchamo wakhiwa ngokulandelayo. Igazi le-Arterial lihlungiwe ku-glomeruli ye-nephrons. Lapha, ukuphuma kwegazi kuhamba kancane ngenxa yengcindezi ephezulu emithanjeni yezinso nomehluko ngosayizi wemikhumbi. I-plasma ehlungiwe ingena ku-capsule kanye nobuthi, izinto ezingcolile, ushukela, ama-amino acid. Imikhumbi yezinso ayidlulisi amaprotheni namanye amakhompiyutha amakhulu.
Ngaphezu kwalokho, ku-tubules yomchamo we-nephrons kukhona ukubuyiselwa kwamanzi okubuthakathaka nezinto ezidingekayo emzimbeni. Izinto ezingadingekile ziqongelela futhi zingene ohlelweni lwe-umchamo we-excretion (ukuqoqa izindunduma, i-pelvis, bese kungena ku-ureters kanye nesinye).
Uyini umphumela we-vasopressin?
IVasopressin ibizwa ngokuthi yi-hormone yohlelo lwe-hypothalamic-pituitary, ebandakanyeka ohlelweni lokuchama. Inani elikhiqizwayo lilawulwa yi-microelement sodium. Ukunyuka okuningana komzimba kukhulisa ukwakheka kwehomoni, bese kuthi ukwehliswa kunciphise.
Ngaphansi kwesenzo se-vasopressin, kukhona ukubuyiselwa okubuyisanayo kwamanzi nezakhi zomchamo okuyiwo.
Umsebenzi weHormone:
- inikeza ukwehliswa kwemikhumbi ye-nephrons;
- ugcina emazinga ekucindzetelwa;
- kuthuthukisa ukuqina kwegazi;
- ilawula ukukhiqizwa kwamanye ama-hormone amaningi;
- ilawula ukuhlangana kwe-osmotic of uketshezi lwebhayoloji;
- ivusa amagundane.
Imodeli ye-molecule ye-vasopressin - i-hormone ebulala amagciwane, ukwehluleka kwayo okuholela ekwakhiweni kwesifo
Ukuhlukaniswa kwe-Pathology
Isifo i-Endocrine asinamatheli ebulilini noma eminyakeni yobudala. Ingenzeka kunoma yimuphi umuntu, kepha imvamisa iba khona ngemuva kokufika ebudaleni.
Ukwehlukanisa okulandelayo kukhona:
- I-insipidus yesifo sikashukela esisezingeni eliphakathi nendawo - kwenzeka njengomphumela we-pathology wokukhiqizwa kwezinto ezisebenza ngama-hormone: uhlobo lwendlalifa; uhlobo olutholakele.
- I-Nephrogenic sikashukela insipidus - ikhula ngemuva kwesizinda sokuncipha kwezinzwa sezinso esenzweni se-hormone ye-antidiuretic: ifa; umlingiswa
- I-polydipsia eyisisekelo - ukuphuza ngokweqile kwe-fluid kuba imbangela: uhlobo lwe-psychogenic - ukuphuza okumanzi okukhulu lapho kukhona ukuphazamiseka kwengqondo; Uhlobo lwe-dipsogenic - kwehlisela umkhawulo wama-receptors abona ushintsho ekuhlushweni kwe-osmotic koketshezi oluzungezile.
Izinhlobo ezingefani zesifo sikashukela
Lokhu kufaka phakathi isifo sikashukela se-gestagen, esihambisana nomsebenzi owandayo wama-enzyme omhlaba. Ngemuva kokuzalwa kwengane, isimo sikamama siyazinza.
I-Gestagenic sikashukela insipidus - indlela eyenzeka ngesikhathi sokukhulelwa
Uhlobo lomsebenzi luthuthukisa ezinganeni. Kungenxa yokungazinzi kohlelo lokuhlushwa kwezinso nomsebenzi owandayo we-phosphodiesterase-5, okuholela ekuncipheni kokuzwela kwe-receptors kwi-hormone nomphumela wayo wesikhathi esifushane.
Iatrogenic sikashukela insipidus yifomu lesikhashana elibangelwa yi-diuretics.
Izizathu zokuthuthuka
Kunezinto ezimbalwa zezinto zemvelo ezingaphansi kwethonya okwenzeka ngalo isifo sikashukela. Funda kabanzi ngakunye.
Izizathu zofuzo
Konke Mayelana Nesifo Sikashukela 1 sohloboI-insipidus yesifo sofuba esimaphakathi iba ngokuvela kokuguquka kofuzo lwe-vasopressin noma ukungafani kokumiswa kwesakhiwo sebanga eliphakathi nendawo. Izimpawu zalolu hlobo lwalesi sifo ziyabonakala eminyakeni emihlanu yokuqala yokuphila kwengane. Ngominyaka, i-pathology iyaqhubeka, izinkomba zokuncipha kwe-vasopressin ziyancipha.
Kubalulekile! Amacala emitholampilo okuthuthuka okuningana ngesimo sabesifazane abagulayo nabesilisa abaneminyaka engaphezu kwengama-40 ayaziwa.
Ukushoda kwama-hormone kungaba yingxenye yesifo esiyindlalifa, okuthi ngaphezu kwesifo sikashukela kufaka i-mellitus yesifo sikashukela, isithulu, ukuvunyelwa kwezinzwa.
Ukuhlalisa umbhede oyinhloko
Izingane zinezinga eliphakeme lezinto ezisebenza ngama-hormone ebusuku, ezinciphisa inani lomchamo. Ezinganeni ezigulayo ezinezinkinga zokuqeda umchamo ebusuku, inani lama-antidiuretic linciphisa kakhulu ebusuku, ngokulandelana, inani elikhulu lomchamo oxutshwe likhishwa.
Ukulimala ekhanda
Ukulimala okuningana (ngokwesibonelo, ukwaphuka kwesisekelo sgebhezi, ukwaphuka kwesihlalo saseTurkey) kungadala ukukhula kokuvuvukala okuzungeze amaseli abhekene nokukhiqizwa kwe-hormone. Ukuntuleka kokuqamba kungaba okwesikhashana noma okuphikelelayo. Kwezinye iziguli, izimpawu zesifo zivela ngaphambi kwezinyanga eziyi-1-1,5 emva kokulimala.
Ukuhlinzwa
Ukuhlinzwa ukususa i-pituitary adenoma, metastases, craniopharyngiomas kuyimbangela ejwayelekile yesifo sikashukela. Uchwepheshe kufanele ahlukanise phakathi kokuvela kwe-pathology nenqubo yomzimba yokususa uketshezi olungene emzimbeni ngokusebenzisa i-infusions ngesikhathi sokuhlinzwa.
Ama-tumors
Imbangela ejwayelekile i-dysgerminoma. Ukubangela ukuqala kwesifo, isimila kumele sibe sikhulu noma sibekwe ngqo endaweni lapho inani elikhulu kakhulu lamaseli abhekene nokugcinwa kwe-vasopressin lenziwa khona. Isifo sikashukela i-insipidus singakhula ngomonakalo we-hypothalamus ngama-metastases lapho kunomdlavuza wezinso, amaphaphu, noma isifuba.
I-Endocrinologist - umsizi ekulweni ne-pathology
Ukungalingani
Izizathu zokuqamba kohlobo lwe-pathology engenashukela ukuvela kwe-meningococcal, ukutheleleka kwe-cryptococcal, i-toxoplasmosis, i-cytomegalovirus, okubandakanya isisekelo nolwelwesi lobuchopho kule nqubo.
Izimpawu zesifo
Isibonakaliso sokuqala sici ukoma kwe-pathological kanye nokuchama okuvamisile (kokubili ngesikhathi sasemini nasebusuku). Inani lomchamo lingafinyelela amalitha ayi-13-18 ngosuku. Isiguli sinezikhalazo ezilandelayo:
- isikhumba esomile nolwelwesi lwe-mucous;
- ukunciphisa umzimba;
- ukuntuleka kokudla;
- ukuqunjelwa njalo;
- ukuncishiswa kwengcindezi, i-tachycardia;
- umuzwa wokukhathala okungapheli;
- ukuphefumula kwenhliziyo kanye nokuhlanza;
- ukuphazamiseka kokulala;
- ukungahambi kahle, uvalo, izinyembezi.
Ukuthola eminye imininingwane ngezimpawu zesifo sikashukela, bheka le ndatshana.
Izimpawu ze-pathology ezinganeni empeleni azihlukile. Ingane ithola isisindo esincane, iyenqaba ukuncelisa ibele, ikhetha amanzi angenalutho. Ingane ikhathazekile, ngezinyembezi, izinyembezi zingase zingabikho noma zimbalwa kakhulu.
Izingane - iqembu labantu elibonakaliswa ukukhula kwenhlobo yesifo
Izimpawu zokuphelelwa ngamandla ziyavela: izinga lokushisa lomzimba liyancipha, izici zobuso ziyaqaqamba, ukucwila kwamehlo, ikhala liba sobala ngokwengeziwe, amashubhu angaphambili abonakala ngokucacile. Ukuqhafaza kuvame ukwenzeka. Ukomisa okubucayi kungaholela ekunciphiseni nasekulahlekelweni yimizwa. Kulokhu, usizo olufanele ngokushesha oluqeqeshiwe luyadingeka, ngoba noma umphumela obulalayo kungenzeka.
Funda kabanzi mayelana nokuvezwa kwesifo sikashukela ezinganeni kutholakala kule ndatshana.
Ukuxilonga
Uma yonke idatha ye-anamnesis kanye nokubonakaliswa kwemitholampilo kukhombisa ukoma okuvela emzimbeni kanye nokuchama ngokweqile, kubalulekile ukutadisha izinkomba ezilandelayo:
- Izinga lokulandela izinto esegazini (i-calcium, i-sodium, i-potassium);
- izinkomba zikashukela wegazi nomchamo (omunye umehluko phakathi kwesifo sikashukela nesifo sikashukela);
- izinkomba ze-urea ku-biochemistry;
- amandla athile omchamo;
- ukuhlushwa kwe-osmotic kwegazi nomchamo.
Ukuhlolwa kwamanzi emzimbeni
Le ndlela ayivumeli nje kuphela ukusungula ukuba khona kwalesi sifo, kodwa futhi nokuhlukanisa phakathi kwe-insipidus ephakathi ne-nephrogenic. Ekuseni ngesisu esingenalutho, ukukala isisindo somzimba wesiguli, ngemuva kwalokho akufanele aphuze noma yiluphi uketshezi. Isikhathi sesikhathi singamahora angama-6-8 kuya kwayi-24. Njalo ngehora, isisindo, inani kanye namandla adonsayo omchamo, izinkomba zokuhlushwa kwe-sodium ne-osmotic kuyaqoshwa.
Uhlolo lwe-Desmopressin
Kwenziwe ngokumelene nesizinda sokuhlolwa komzimba noma ngokuhlukile kukho. Isiguli sinqunywe i-Desmopressin kufomu lethebhulethi noma lomjovo. Iziguli zihlolwa ngokuya nge-Zimnitsky, ukunqunywa kwe-osmotic kunqunywa, izinkomba ze-sodium emchameni ngenkathi uthatha umuthi nangaphambi kokuba unqunywe.
Ukuhlonza izinsimbi
Izindlela ezilandelayo zisetshenzisiwe:
- I-MRI yobuchopho - ikuvumela ukuthi unqume hhayi kuphela ukuba khona kwe-pathology, kodwa futhi nokusungula imbangela yalesi sifo.
- I-Ultrasound yezinso.
- I-X-ray yamaphaphu.
- I-scan scan ye-patity esiswini.
- I-Mammography
Izici zokwelapha
Inhloso yokwelapha ukuqeda ukoma kwe-pathological kanye nokuchama ngokweqile, kanye nokugcina izinga lempilo eliphezulu lesiguli. Okokuqala, basusa imbangela eyadala ukukhula kwesifo. Ngokulandelayo, umuthi unikezwa ngokuya ngohlobo lwesifo sikashukela.
Indlela yokuphuza esunguliwe ingesinye sezigaba zokwelashwa kwalesi sifo
Ukwelashwa okuphakathi
Amasu wokuphatha isiguli ancike ekutheni ulahlekelwe uketshezi olungakanani. Uma inani lomchamo lingaphansi kwamalitha ama-4 ngosuku, imithi ayisetshenziswa. Uchwepheshe unquma ukwelashwa kokudla kanye nohlobo olwanele lokuphuza.
Uma inani lomchamo lingaphezu kwamalitha ama-4, kungaba ukuthi kusetshenziswa ukwelashwa okufaka endaweni noma lezo zinto zokwelapha ezikhuthaza ukwakheka kwe-hormone. Isikhathi eside, kwakunikezwa umuthi owawufakwa ezindlini zamakhala (Desmopressin). Manje, ngokwelashwa okufaka esikhundleni, kusetshenziswa i-analog yeMinirin.
Izidakamizwa ezikhuthaza ukukhiqizwa kwe-hormone ye-antidiuretic: Chlorpropamide, Carbamazepine, Miskleron.
Funda kabanzi mayelana nemihlahlandlela yokwelashwa kwesifo sikashukela kule ndatshana.
Ukwelashwa kwezinso
Okokuqala, inqubo yokwenza kabusha uketshezi ilawulwa. Ngokulandelayo, ukwelashwa kwezidakamizwa kunqunyelwe:
- I-Thiazide diuretics akuyona into emangazayo, kepha ngesifo sikashukela baba nomthelela ekubuyiselweni kwamanzi kabusha lapho kwakhiwa umchamo wesibili. Abamele iqembu - iHydrochlorothiazide, Indapamide.
- Ama-NSAIDs - ngenxa yezinqubo ezithile ezithile, ama-ejenti aleli qembu akhulisa i-osmolarity yomchamo futhi anciphise inani lawo (Indomethacin, Ibuprofen).
Ukwelashwa ngezidakamizwa kuyingxenye yokwelashwa okuphelele okuphelele
Ukwelashwa ngemithi yesintu kuvunyelwe, noma kunjalo, kuphela ngemuva kokubonisana nodokotela owelapha i-endocrinologist.
Ukwelashwa kokudla
Ukudla sikashukela i-insipidus kususelwa kule migomo elandelayo:
- ukunciphisa umunyu usawoti kuya ku-4 g ngosuku;
- ukupheka ngaphandle kosawoti, engeza usawoti endishini eseqediwe;
- ukusetshenziswa kwezithelo ezomisiwe;
- ukwenqaba amaswidi;
- ukungafakwa kotshwala;
- ukuphuza imifino emisha ephuma kuzithelo, amajusi neziphuzo zezithelo, imikhiqizo yezinhlanzi, amaqanda;
- imikhawulo yamaprotheni, kanye namafutha kanye nama-carbohydrate kumele abekhona ngamanani anele;
- ukondleka okuphathelene nezingxenye ezincane.
Kubalulekile ukukhumbula ukuthi lesi sifo ngokwaso sinomphumela omuhle. Ngokuvakashela uchwepheshe ngesikhathi esifanele, ngokulandela izincomo futhi ususe imbangela, ungafinyelela ukululama okusheshayo.
