Izimpawu nokwelashwa kwe-pancreatitis engapheli kubantu abadala

I-pancreatitis engapheli yisifo lapho kwenzeka khona ukonakala kancane kancane kwezicubu ze-pancreatic (pancreas). Ezimweni eziningi, izinguquko zezitho zenzeka ngesikhathi sokuvuselela okuvuselelwa njalo.

Ukubhujiswa kwezicubu ezithuthukayo kuholela ekungakwazi komzimba ukukhiqiza ijusi le-pancreatic lokugaya kanye nama-hormone alawula i-metabolism.

Isici esiyingozi se-pancreatitis (CP) esingapheli ukuthi ngemuva kokuqedwa kwezimbangela zokuvuvukala, inqubo yokuwohloka kwezicubu iyaqhubeka. Ngenxa yalokhu, kancane kancane amaseli asebenzayo aya ngokuya athathelwa indawo yizicubu ezithintekayo, bese isitho siphelelwa umsebenzi.

Izici zempilo yesimanje ziholela eqinisweni lokuthi lesi sifo siya ngokuya sitholakala kubantu abaneminyaka engama-30 ukuya kwengama-35, yize muva nje iningi lamacala lalindala kuneminyaka engama-50.

I-Etiology, pathogenesis, ukuhlukaniswa

Imbangela yoshintsho olubhubhisayo kwezicubu zesikhumba liba ukuqhekeka kweziqubu, ikakhulukazi eyinhloko, ngama-enzyme, ukubola kwabo emiseleni, isimila nokuqhekeka kwe-organ parenchyma. Ngokuvuvukala okuqhubekayo, ikakhulukazi ngesikhathi sokuqhuma, izindunduma ziyavinjwa, izicubu zazo ziwohloka zibe yimicu, futhi kwakhiwa amatshe amancane (ukubalwa).

Enhliziyweni ye-pathogenesis ye-CP ukwenziwa kwangaphambi kwesikhathi kwama-enzyme ngaphakathi emzimbeni. Kwenzeka hhayi kuphela ezindundwini zesikhumba, kodwa nakumaseli, okuholela ekuqhekekeni kwezicubu. Uma kwenzeka kokuhlukunyezwa emiseleni ye-bile, ama-enzyme aqala ukusebenza ngaphandle kokushiya ama-pancreas ngaphansi kwethonya le-bile reflux.

Nge-pancreatitis yotshwala, kusebenze ama-enzyme adalwa utshwala, ngenxa yalokho, kwakheka i-bicarbonate ye-calcium, izicubu zihlukaniswa, ifomu le-cysts. Ngokwemvelo yesifo, kuphambuka ukwakheka kwamangqamuzana ama-enzyme kuyabhekwa.

Ngenqubo eqhubekayo yesifo, ukuvuvukala kwendlala, ukuguqulwa kokucushwa kuyabonakala, izingxenye zezicubu ezisebenzayo ziyavela emzimbeni wakhe, ukwanda kokuxhunyaniswa. Ingxenye ye-endocrine yamanyikwe kancane kancane nayo ibandakanyeka enqubweni yokuwohloka. I-Iron igcwele amatshe amancanyana, iningi layo lithathelwa indawo yizicubu zesikhafu, liba denser, liba lincane.

Izimbangela nezifo ezidonsela phambili ukukhula kwe-pancreatitis engapheli:

• ukuphuza utshwala;
• ukudla ngokweqile, ukudla amanoni, ukubhema, ukudla okuthosiwe;
• ifomu elinamandla le-pancreatitis;
• isifo se-gallstone;
• isakhi sofuzo;
• izifo ze-endocrine (ikakhulukazi isifo sikashukela mellitus);
• ukulimala kanye nobuthi ngezinto ezinobuthi (izidakamizwa, ukuhola, i-zebus);
• ezinye izifo zepheshana emathunjini.

Iningi leziguli ezine-CP zithambekele ekudla ngokweqile noma ekuphuzeni ngokweqile. I-pancreatitis engapheli ivame ukuhambisana nezifo ze-duodenum, i-gallder yesibindi, isibindi, isisu.

Ividiyo evela kuDkt Malysheva:

Ukwahlukaniswa kwe-CP kuyinkimbinkimbi, kunezimpawu eziningana lapho lesi sifo sihlelwa khona.

Uhlobo oluphambili lwalesi sifo lubangelwa ukuvuvukala kwepancreas uqobo, olwesibili - ngenxa yezinye izifo zohlelo lokugaya ukudla. Ifomu lesibili licasule isifo se-gallstone (cholelithiasis), ukutheleleka, ubuthi.

Ngokwesimo sokuboniswa, kukhona:

• akuvamile ukuphindeka - ukonakala kwenzeka izikhathi ezi-1-2 ngonyaka;
• kuvame ukubuyela emuva - izikhathi ezingaphezu kwezingu-3;
• ngezimpawu ezihlala zikhona - izimpawu zesifo zivele ngendlela yobuhlungu nezimpawu dyspeptic ngaso sonke isikhathi.

Kunencazelo yalesi sifo nge-etiology - imbangela yokwenzeka: utshwala, ubuthi, ukwelapha, i-idiopathic, ukutheleleka nabanye.

Ngokuqina, lesi sifo sehlukaniswe saba mnene, silinganisele futhi sibucayi.

Ngokuya ngezimpawu ze-morphological, i-CP ihlukaniswe:

• i-cystic ngokwakhiwa kwama-cysts kanye ne-pseudocyst;
• i-pseudotumorous - ngobuhlungu nokwanda kwezinye izingxenye zamanyikwe;
• i-parenchymal;
• i-fibrosulinotic;
• hlangana nezizwe.

Ngendlela yokubonakaliswa - isithombe somtholampilo - izifo ziyahlukaniswa: izinhlungu, i-hypochondria, i-latent, i-hyposecretory ne-CP ehlangene.

Njengoba kuvela izindlela ezintsha zokuxilongwa, ukuhlukaniswa kwalesi sifo kuyashintsha nokungezelela. I-pancreatitis engapheli inekhodi ye-ICD 10 - K86 ngezigatshana.

Izimpawu ze-pancreatitis engapheli kubantu abadala

Isimo senkambo ye-CP singase sehluke, kuya ngezici eziningi. Kwezinye izimo, izimpawu zivele kuphela ngomonakalo obalulekile wesitho.

Ngokuvamile, isithombe esilandelayo siyabonakala:

1. Ubuhlungu Ezimweni eziningi, ukwenziwa kwasendaweni kwemizwa ebuhlungu isiswini sangaphezulu sangakwesobunxele ngaphansi kwezimbambo. Kodwa-ke, kwesinye isikhathi izinhlungu ziyibhande, zifinyelela emuva emuva noma esifundeni senhliziyo. Ubuhlungu bungaba yi-paroxysmal, noma baphazamise njalo. Kulokhu, izinhlungu ziyaqaqamba. Ngemuva kokudla, Ubuhlungu abuqinisi, noma kunjalo, ukuhlaselwa kungenzeka ngemuva kokudla ukudla okusindayo noma utshwala. Ubuhlungu kwesinye isikhathi abuqedwa yi-antispasmodics kanye ne-narcotic analgesics.
2. I-Dyspepsia Isikhuxungu, isicanucanu, ukushisa kwenhliziyo kuyabonakala. Ukuqothula kusinda, akulethi ukukhululeka. Ukuphazamiseka kweStool - ukuqunjelwa kubuye kuhambisane nesifo sohudo. Ehlanzeni nasezindondweni, kunezingcezu zokudla ezingaphanjwanga. Kukhona ukungahambisani nemikhiqizo.
3. I-Intoxication. Ukwanda kokujuluka, ukukhathala nokucasulwa kungenye indlela yokungakhathaleli, ukulahleka kwesifiso sokudla. Isisindo somzimba sehla.
4. Ukukhuphuka okuncane kokushisa kuya ku-subfebrile.

Uma ingxenye ye-endocrine ye-gland iphazamisekile, kuvela izimpawu zesifo sikashukela - ukoma, inani elandayo lezinkanuko nomchamo okhutshiwe.

Ngokuthuthuka kwalesi sifo, inani lokuxhuga liyanda. Joyina ukukhalipha kwesikhumba kanye nesifo somoya. Isikhumba esomile, izipikili ezibunjiwe, izinwele. Isifunda se-epigastric sibuhlungu, siqhakaza kakhulu.

Izimpawu ze-pancreatitis engapheli zingase zingabonakali isikhathi eside. Izinkinga ezincane zokugaya ukudla zibangelwa ubuthi. Inkambo ye-asymptomatic iyindlela eyingozi kakhulu yesifo okulula ukuqala ngaso.

Izindlela Zokuxilonga

Ukuhlolwa okubonakalayo, ukuqoqwa kwezikhalazo ne-palpation kunikeza isithombe esicacile sokulimala kwe-pancreatic. Lesi sifo selashwa nge-gastroenterologist.

Izifundo ezilandelayo zibelwe:

• i-coprogram ikhombisa amafutha ezindlekeni, okukhombisa ukuntuleka kwama-enzyme;
• ukuhlaziywa kokuqukethwe kwama-enzymes (lipase, amylase, trypsin nabanye) egazini;
• CT, MRI;
• ukuhlolwa kwegazi okujwayelekile, i-biochemical, ushukela;
• I-Ultrasound ikhombisa ukulinganisa, izinguquko emaduneni, isiza ukukhipha amathumba, ngayo iveza i-CP ngamacala angama-80-90%;
• i-radiography;
• i-endoscopic ultrasonography - ikuvumela ukuba ubone ukwakheka kwezicubu ze-pancreatic kanye nesimo semiphu; bona izindawo zomonakalo we-necrotic kanye nokuqunjelwa uketshezi ku-parenchyma.

Indlela ye-endoscopic (i-ERPC) inqubo eyinkimbinkimbi enqunywe ngokuya izinkomba zokunquma ubunikazi bama-ducts, ukugcwaliswa kwabo ngamabala kanye nama-plugs.

Ukwelashwa kanjani?

Ukwelashwa kwe-CP kubandakanya ukwelashwa ngezidakamizwa, izindlela zokuhlinza, izinqubo zomzimba, kanye nokudla. Zonke lezi zindlela ziyahambisana. Esigabeni esibuhlungu, kusetshenziswa izindlela ezifanayo njengakwindlela yesifo.

Ukwelashwa okwandisa

Okunzima kakhulu kuvame ukukhululeka kobuhlungu, ngoba lokhu kuyadingeka ukusebenzisa izidakamizwa ze-narcotic kwezinye izimo.

Izimali ezabiwe ngesikhathi sokwanda:

• ama-analgesics - i-Analgin, i-Papaverine, i-narcotic (iTrimeperidine, i-Promedol, iTramadol);
• izidakamizwa ezingezona ze-steroidal ezilwa nokuvuvukala - i-Diclofenac, iParacetamol;
• ama-antispasmodics - iDrotaverin, uPlatifillin, iBarralgin;
• ukumnika izixazululo zokuvimbela ukopha futhi ubuyisele ukulahleka; ukwakhiwa kwamaprotheni kanye ne-colloidal ukuqinisekisa ukuqeda ngokushesha ubuthi;
• izidakamizwa ze-antisecretory zisiza ukunciphisa ukukhiqizwa kwama-enzyme - iSandostatin, i-Omeprazole, iGordox, i-M-anticholinergics - Atropine;
• ukudambisa ukuphazamiseka kwe-dyspeptic - Cerucal, Domperidone;
• ama-antibiotics - i-metronidazole, azithromycin;
• i-enzyme inhibitor - Ehlanganayo.

I-Cholagogue, amavithamini nawo anganqunyelwa. Uma isimo singeke sizinze, izinkombandlela zomtholampilo zinquma ukusetshenziswa kwe-glucocorticoids (i-prednisone).

Ukwelashwa Kwesifo

Uma kungekho okuqhakaza, ukwelashwa okuyinhloko ukudla. Ukuhambisana nokudla kungavikela ukuwohloka futhi kwehlise ukulungiswa kwezicubu. Ukwelashwa komzimba nokwelashwa kwe-spa usebenzisa amanzi amaminerali kuyakhonjiswa.

Esimweni sokuntuleka kwe-enzyme, izindinganiso zokwelashwa ziphakamisa ukusetshenziswa kwe-Pancreatin, i-Festal noma enye i-enzymes yokwenziwa. Ama-Multivitamin complexes anqunyelwe. Ngokuncipha okukhulu kwesisindo, ama-amino acid, ama-emulsions wamafutha ayethulwa.

Ukuhlolwa kwemitholampilo kwenziwa kabili ngonyaka ngokuqokwa kokwelashwa kwesondlo. Ukuqapha njalo ushukela kuyadingeka ukuze kutholakale ukuthuthukiswa kwesifo sikashukela ngesikhathi.

Izindlela Zokuhlinzwa

Ukusebenza kusetshenziselwa ezimweni ezingandile ngokuthuthukisa i-necrosis yezicubu kanye nezifo ze-purother.

Izinhlobo ezilandelayo zokungenelela ziyasetshenziswa:

• ukususwa kwamatshe emiseleni;
• ezinqubweni ze-purulent - ukumbumbuluzwa kwezindawo ezilimele;
• imisebenzi kwi-gallbladder - ukususwa kwamatshe kanye nesinye;
• resection of pancreas.

Futhi, nge-CP, ukuhlinzwa kwepulasitiki kwe-bile ducts, imithambo yegazi, kanye nokwenziwa kabusha kwesisu okuyingxenye.

Amaqhinga wokuhlasela

Ngesikhathi sokuhlasela kwe-CP, ukulaliswa esibhedlela kuyadingeka, ngakho-ke kudingeka ushayele i-ambulensi.

Ngaphambi kokufika kwakhe:

• ukubeka isiguli embhedeni;
• faka ukubanda esifundeni se-epigastric imizuzu eli-15 ukuya kwengama-20, ngemuva kwamahora ambalwa ungakuphindaphinda;
• ngaphandle kokufakwa kokudla, iziphuzo, ngaphandle kwamanzi;
• uma kufika odokotela ukubambezeleka, nikeza isibhebhe seNo-shpa, iDrotaverin, iBarralgin noma i-Ibuprofen.

Awukwazi ukuthatha ama-tinctures aqukethe utshwala, avame ukutusa izindlela zomuthi wendabuko. Musa ukufaka ukushisa noma ukubeka isiguli kubhavu oshisayo.

Ubuhlungu buyancipha uma uncika phambili noma squat. Amaqhinga afanele azosiza ukulinda usizo lodokotela. Uma ukuhlaselwa kungabi nzima, futhi isiguli sazi ukuthi kufanele siziphathe kanjani ngesikhathi sokuxhamazela, ungabiza udokotela ekhaya.

Uma kungenakwenzeka ukubonana nodokotela, kuzodingeka ukhumbule ukuthi indlala izodinga ukubekezelelwa izinsuku ezintathu. Esikhathini esizayo, okusanhlamvu okunamathelayo (ngokwesibonelo, okuvela ku-oatmeal) kufanele kulungiselelwe.

Ividiyo evela kusazi:

Ukudla njengengxenye ebalulekile yokwelapha

Ukudla kwenkambo engapheli yesifo kukhonjiswa njalo. Amaseli we-pancreatic awabuyiswanga, ukuwohloka kwezicubu kuzothuthuka ngokuphulwa ngakunye kwezimiso zokudla okunconyiwe. Ukubambelela ngokuqinile ekudleni, ukwenqaba utshwala nokudla ngokweqile kungagcina ukubhujiswa okusheshayo kwe-parenchyma necrosis.

Izimiso zokudla okufanele ku-CP kufanele zifake:

• ukudla njalo izikhathi ezingama-5-6 ezingxenyeni ezincane;
• ukudla kuphela okufudumele, ukwenqaba okushisayo nokubandayo;
• ukuhlafunisisa ukudla, ukwenqena ukudla okulula ukudla lapho usubalekile;
• ukusetshenziswa kwamasobho kumhluzi wemifino, inyama ebilisiwe, izinkukhu nezinhlanzi zezinhlobo ezinamafutha aphansi kudliwa ngokwehlukana;
• ukuvinjelwa kokudla okubhemile, okuthosiwe;
• ukwenqaba ukubhaka okusha, i-muffin, ushokoledi;
• akukho ngaphezu kwama-350 gr. ama-carbohydrate, cishe yi-130 gr. amaprotheni ngosuku nge predominance yezilwane.

Inombolo yokudla enconyiwe yeqembu 5. Ziba nzima kakhulu ngesikhathi sokuxhamazela, zikhululeka kakhulu ngesikhathi sokuxolelwa. Kufanele ufunde uhlu lwemifino enconyiwe, izithelo, okusanhlamvu bese ulandela izeluleko. Ukudla kuyindlela yokwelashwa kwe-CP.

Umuthi wabantu

Amanyikwe siyisitho somunyu kakhulu. Ngaphambi kokusebenzisa amakhambi abantu, kubalulekile ukubheka ukuthi izithako zawo zizowulimaza yini umzimba. Ukubonisana nodokotela kuyadingeka.

Ezinye izindlela zokupheka zemithi yendabuko:

1. Gaya i-oats ibe yimpuphu. Thela isipuni somkhiqizo ngengilazi yamanzi, ufudumele amahora angama-0.5 ngaphandle kokubilisa. Thatha inkomishi engu-1/3 ngaphambi kokudla isonto lonke.
2. Amadevu wegolide Sika amaqabunga amabili wesitshalo bese uthele ½ ilitha lamanzi. Fudumeza imizuzu engama-20, ugcizelele amahora angama-7-8. Thatha 2 wezipuni ngaphambi kokudla.

Ukusetshenziswa kwezidambisi zotshwala akunconywa. Qaphela ukwelapha imifino nezithelo ezingavuthiwe.

Izinkinga kanye ne-diagnostic

Odokotela abanolwazi kumbuzo wokuthi kungenzeka yini ukwelapha i-pancreatitis engapheli ngemithi, ukuhlinzwa noma amakhambi abantu, baphendule ngokungahambi kahle. Ukubuyiselwa kwezicubu ze-pancreatic akunakwenzeka. Amathuluzi anamuhla angawunqande umphumela obhubhisayo wama-enzyme ezithweni zezitho bese wehlisa ukonakala.

Ukuze uthole lokhu, kuyadingeka ukulandela ngokuqinile imithetho ebekiwe yokudla okunempilo, ukuvakashela udokotela osesiswini gastroenterologist ngesikhathi esifanele ukulungisa ukwelashwa.

Izinkinga ze-CP:

• i-jaundice enezinkinga ngokuphuma kwe-bile;
• ukopha ezingxenyeni zamapheshana emathunjini;
• ukutheleleka, kufaka phakathi i-purulent, epheshaneni le-biliary;
• kamuva ezimweni ezinzima zesifo - isibindi, ukwehluleka kwamaphaphu;
• izifo ze-endocrine - isifo sikashukela mellitus;
• amathumba amabi.

I-prognosis iyathandeka ngokuziphatha okufika ngesikhathi kokwelashwa okubuyela emuva kanye nokulawulwa kwemisebenzi yesitho. Izindlela zanamuhla zinganciphisa ukubuyiswa kwe-pancreatic futhi zifinyelele ukuthethelelwa okuzinzile.

Ividiyo yokunakekelwa kwe-pancreatic:

Ukuvimbela lesi sifo kulandela imigomo yokudla okunempilo nokwenqaba ukuphuza utshwala. Ukudla ngokweqile, ukudla okungenamsoco, utshwala kuyizimbangi ezinkulu ze-pancreatitis eyingozi kanye nokushintsha kwesifo kube yifomu elingamahlalakhona. Nge-CP, udinga ukulandela ukudla njalo. Lokhu kuphela okungavimba ukonakala kwesisu.

Izibalo zezokwelapha kanye neziguli uqobo ziyaphawula ukuthi ukulandela ukudla kuyasiza ekudambiseni lesi simo futhi ukhohlwe nangesifo.