IHemorrhagic pancreatic necrosis (ICD khodi 10 K86.8.1) ukufa okuphelele noma okuyingxenye kwezicubu ze-pancreatic.
Lesi sifo singenye ye-pathologies engaholela ekufeni kwesiguli esikhathini esifushane.
Ubulukhuni bokwelashwa buhambisana nobungako besilinganiso sokukhula kwe-pancreatic necrosis (usuku olu-1) futhi neqiniso lokuthi isitho esithintekile asisalulami futhi asikhiqizi ama-enzymes namahomoni athile ngisho nangemva kokwelashwa.
Kungakho enye yezinkinga zesifo iba uhlobo 2 lwesifo sikashukela.
Indlela yokuthuthukisa
Siyini lesi sifo futhi siyini imbangela yokuthuthuka kwaso? Nge-pancreatic necrosis, kwakheka i-fistula, okuthi kuyo okuqukethwe ama-pancreas kungene ngaphakathi emgodini wesisu cishe kungasekelwa.
Izicubu ezifile kanye ne-hemorrhagic exudate ziba umfutho ekwakhiweni kwe-purother peritonitis, ngamaphesenti angama-50 amacala aholela ekufeni kwesiguli.
I-tissue necrosis ivela ngenxa yokungakwazi kokuqina kwamanyikwe ukubekezelela ijusi lesisu esishubile. Ama-enzymes aqhamuka esithweni esithintekile awakhululwa futhi ama-alkalis aqala ukubhidliza amaprotheni.
Okusho ukuthi, i-pancreas iqala ukuzigaya ngokwayo. Ukubhujiswa akupheleli kulokhu. INecrosis isakazekela emithanjeni yegazi ebhoboza isitho, isilimaze futhi ibangele ukopha.
Izimbangela ze-pathology
I-hemorrhagic pancreatic necrosis ayikhuli kusuka ekuqaleni.
Izinto ezinjengalezi zingavusa ukwephulwa okukhulu:
- ubuthi ngotshwala noma ngokudla;
- ukuhlukunyezwa kwezitsha eziphazamisa ipheshana lesisu (elibukhali, elinosawoti, elinamafutha);
- ukungahambi kahle komzimba;
- izifo ze-autoimmune;
- izilonda ezinobungozi, ezihambisana nokuphulwa kokuqina kwegazi;
- ukuvimbela ipheshana lokuphilisana;
- izifo ezithathelwanayo, ezibandakanya ukutheleleka kwamathumbu asebusweni, i-lupus nama-mumps;
- ukuthatha izidakamizwa kanye nemithi ngaphandle kwemiyalelo kadokotela;
- ukuphazamiseka kwe-endocrine (hypothyroidism, isifo sikashukela mellitus, okuyinkimbinkimbi ngezifo zomgudu wokugaya ukudla).
Phakathi kwabantu abasengozini, umuntu angahlukanisa le mikhakha elandelayo:
- izidakwa nezidakamizwa;
- abantu asebekhulile abanenqwaba yezifo ezihlangene;
- iziguli ezine-pathologies ye-pancreas, isibindi, ipheshana emathunjini;
- abantu abahlukumeza njalo ukudla okunezipayisi, okunosawoti, okubhemayo nokunamafutha;
- abantu abalimele esiswini.
Izimpawu zesifo
Izimpawu ze-hemorrhagic pancreatic necrosis zihlala zilusizi kakhulu. Akunakwenzeka ukuba ungazinaki. Esigabeni sokuqala, isiguli siqala ukukhathazeka nge-nausea, ubuhlungu obukhulu, obuvame ukwenziwa endaweni ethile ku-hypochondrium yangakwesobunxele.
Kwesinye isikhathi izinhlungu zifana ne-bhande, kwesinye isikhathi zifana nezimpawu zokuhlasela kwenhliziyo. Umuntu anganciphisa imizwa ebuhlungu kuphela lapho ehleli khona, njalo amadolo akhe adonsa kakhulu esiswini sakhe.
Futhi, i-pathology ibonakala ngezimpawu ezinjalo:
- ukucabanga kanye nokuhlanza njalo, okungalethi mpumuzo;
- ukukhuphuka okuqinile kokushisa komzimba kumanani aphezulu;
- ushintsho esikhumbeni (ubomvu, i-pallor, ukubonakala kwe-hematomas, ukwanda kokuzwela kobuhlungu ngokuthinta okukhanyayo);
- ngokumelene nesizinda se-pancreatic necrosis, ama-ascites, i-phlegmon yesisu esiswini;
- ushukela wegazi ukhuphuka ngokunamandla, okuyingozi kakhulu kushukela futhi kungaholela ku-hyperglycemic coma;
- kunomuzwa wokubeka ulimi olusebenzayo;
- inani lomchamo okhishwa ngesikhathi sokuchama lehla kakhulu;
- ukuphefumula komoya kuyabonakala, ukushaya kwenhliziyo kuyashesha, umfutho wegazi ube ungazinzi;
- ukuphazamiseka kohlelo lwezinzwa (ukunqanda noma ukugabha) kuyaphawulwa;
- sonke isiguli sesihlanu sihlangabezana nesimo sokuwa, sonke isiguli sesithathu siwela ekhefini.
Izigaba zokuqhubeka
Kunezigaba eziningana zokuphoqelela ezithuthukisiwe.
Ekuqaleni, ama-microorganisms we-pathogenic aqala ukwanda ku-gland ethintekile. Kukulesi sigaba isiguli lapho ukuhlanza kuqala ukuhlukumeza, isitulo siba singazinzi, izinga lokushisa lomzimba likhuphuka kakhulu.
Esigabeni sesibili, ukubola kwamangqamuzana kuqaleka, amafomu ahlulekayo esitho. Isigaba esiyingozi kakhulu kwesesithathu. Ukuvuvukala kusakazeka ngokushesha ezindaweni zezicubu ezinempilo, ukubhujiswa kwamanyikwe kusheshe.
Njengoba unikezwe ijubane lelo sigaba esisodwa esithatha isikhundla salo esedlule, awukwazi ukubambezela ukubiza i-ambulensi nganoma yisiphi isikhathi.
Ngemuva kokuthi isiguli siyiswe esikhungweni sezokwelapha, sihlolwe ngokuphelele, uhlobo nesigaba se-pancreatic necrosis kunqunywa, futhi ukwelashwa okuphuthumayo kwe-pathology kuqalile.
Lesi sifo, esingaqhamuka ngenxa yanoma iyiphi into ebambekayo, sidinga ukulaliswa esibhedlela ngokweqile kanye nokwelashwa okuphuthumayo.
Ukuhlukaniswa nezinhlobo
I-Necrosis ebangelwa yi-pathology ihlukaniswe izinhlobo eziningi. Lokhu kukuvumela ukuthi unqume irejimeni yokwelashwa efanelekile futhi usebenzise isiguli esinikezwa esibhedlela ngesikhathi.
Ukwehlulwa kungaba:
- ukugxila okuncane;
- ukugxila okuphakathi;
- okugxilwe kakhulu
- ubuncane;
- inani.
Ukuxilongwa kwenziwa ngokusekelwe kosayizi bendawo ye-pancreatic ethinteka yi-pancreatic necrosis.
Esigabeni sokuqala noma sesibili, imingcele iyabiza. Okwesithathu - zibonakala ngokucacile futhi zichaziwe. Isigaba esithandekayo sibandakanya ukufa kwesitho esikhulu, okuphelele - ukufa okuphelele kwezicubu ze-pancreatic.
Emabangeni wokugcina, ukuhlinzwa kubalulekile. Izicubu ezithintekile kufanele zisuswe ngokuphelele.
Futhi, i-pancreatic necrosis ihlukaniswa ngokuba khona noma ukungabikho kwenqubo yokutheleleka - onegciwane noma oyinyumba.
Ukuxilongwa
Ekuhlolweni nasekuhlolweni okulandelayo, i-hemorrhagic pancreatic necrosis ihlukaniswe namanye ama-pathologies. Ukuze wenze lokhu, udokotela uxoxisana nesiguli, athole ukuthi usebenzisa kabi utshwala noma ukudla okunamafutha, yiziphi izifo ezingamahlalakhona ku-anamnesis yakhe.
Ngokulandelayo, isiguli sibhekana ne-scan scan ye-cavity yesisu noma i-ultrasound, kunqunywa izivivinyo eziningi, kufaka phakathi:
- ukuhlolwa kwegazi okukhombisa idatha kadokotela kokuqukethwe kwama-enzymes e-pancreatic (ukwanda kwalezi zinkomba ngezikhathi ezi-6-9 kukhombisa hemorrhagic pancreatic necrosis);
- ukuhlaziywa kwejusi yesisu, evumela ukuthi wena unqume ngokushesha futhi ngokunembile izinga le-acidity;
- i-urinalysis yocwaningo nge-ureaplasma ne-trypsinogen;
- umsindo wokunqunywa kwama-bicarbonates nama-enzyme;
- ukuhlaziywa komoya we-amylase ne-triglycerides;
- I-Coproscopy edingekayo ukutadisha amafutha asele kumalondolo.
Ukubhobozwa kwendawo ye-necrosis kuthathwa ngokungaziphathi kahle, i-endoscopic pancreatocholangiography futhi, uma kunesidingo, kwenziwa i-laparoscopy yesisu, okwenza sikwazi ukubona isithombe sonke somonakalo wamanyikwe nezinye izitho ezibalulekile.
Kuphela ngemuva kwezindlela eziyinkimbinkimbi zokuxilonga lapho beqala ukwelapha isiguli.
Ukwelashwa kwezifo
Ezimpawu zokuqala ze-pancreatic necrosis, isiguli siyalaliswa esibhedlela. Ngemuva kokuxilongwa, isiguli sithunyelwa endaweni yokunakekela kakhulu, noma ngokushesha egumbini lokuhlinzwa. Kubalulekile ukuthatha isinyathelo ngokushesha okukhulu ukuze usindise ama-pancreas nempilo yesiguli.
Ukwelashwa ngukuthi:
- ukudambisa izinhlungu nokuqhekeka kwezihlakala ze-bile;
- ukumisa umsebenzi we-enzymatic;
- ukukhiqizwa okwehlile kwejusi yesisu;
- ukuvimbela ukunamathisela kokutheleleka kwesibili.
Isiguli sifakwe izidakamizwa ezidambisa izinhlungu, isibonelo, i-novocaine blockade. I-anesthesia ivuselela izindunduma, ivumela ujusi we-pancreatic ukuphuma.
Bangakwazi ukubhekana nokukhula okukhiqizwayo kwama-enzyme ngamalungiselelo e-antienzyme, futhi ukwelashwa nge-antibacterial kuvimbela ukutheleleka kwezinye izitho nezicubu. Lokhu kukuvumela ukuthi uyeke inqubo yokwephulwa kwemisebenzi ye-enzymatic neyehlisayo yamanyikwe.
Ukwelashwa kokugcina umzimba kwenziwa ngaphandle kwesizinda sokuzila ukudla okugunyaziwe. Izakhamzimba ezidingekayo zihanjiswa kuphela ngaphakathi ukuze zingafakwanga imfihlo yokuqashelwa kwe-pancreatic.
Phambilini konke okuqukethwe esiswini kususwa ngokugeza. Kubalulekile ukuhlinzeka isiguli ukuthula kanye nezimo ezihamba kahle kakhulu. Igumbi kufanele linikezwe umoya okushisa komoya. Lokhu kuzosiza ukuvimbela ukwanda okwengeziwe kobuthi obukhishwa yisiguli.
Uma kungabikho ntuthuko efika, kunesidingo sokungenelela kokuhlinzwa okuphuthumayo. Uhlobo lokuhlinzwa luncike enkambweni ye-hemorrhagic pancreatic necrosis. I-Laparoscopy noma i-drainage drainage iyasebenza uma kwenzeka ukutheleleka kungabikho.
Umsebenzi we-cavity wenziwa lapho inani elikhulu le-exudate libuthwa. I-Peritoneal dialysis isetshenziswa kabanzi, okuhlanza igazi lobuthi nama-enzyme futhi ngaleyo ndlela kuvimbele isiguli ekufeni ngenxa yokudakwa yimikhiqizo yokubola.
Impilo ngemuva
Isikhathi sokusebenza mude futhi sinzima. Isimo esibaluleke kakhulu sokululama ukuhambisana nokubusa konke ngokuzivocavoca okuncane ngokomzimba kuyo yonke inkathi yokutakula (okungenani izinyanga ezi-4).
Kuyadingeka ukuthatha izidakamizwa eziqukethe i-insulin, izidakamizwa ezikhuthaza ukugaya ukudla (ama-enzyme).
Isiguli esibe ne-acute pancreatic necrosis sinqunywa izinqubo zomzimba kanye nokuzivocavoca komzimba okudingekayo ekuvuseleleni ngokushesha.
Imikhawulo yokudla ihlala impilo yonke. Ukudla kusho ukunciphisa umthwalo kumanyikwe. Kubalulekile ukudla njalo futhi kaningi (izikhathi ezingama-5-6 ngosuku). Ukudla kufanele kube lokushisa okungathathi hlangothi kanye nokungaguquguquki okuthambile.
Phakathi kwemikhiqizo enconyelwe ukusetshenziswa nsuku zonke yile elandelayo:
- imifino ebilisiwe noma enosiwe;
- okusanhlamvu emanzini;
- isinkwa (somisiwe);
- amabhlogo akhanyayo;
- imikhiqizo yobisi enokuqukethwe okunamafutha amancane;
- inyama yenkukhu.
Kunemikhiqizo eminingana abantu abaye baba nalesi sifo esibi kufanele bakhohlwe unomphela.
Ukwembiwa kweTaboo:
- ukudla okukheniwe (inhlanzi, inyama, imifino);
- iziphuzo ezidakayo, noma ngesilinganiso esincane;
- usawoti;
- ukubhema inyama;
- inyama enamafutha;
- noma yimaphi ama-pastries amasha;
- ukudla okusheshayo
- ubisi lonke;
- izinongo;
- ukhukhamba;
- imifino, izithelo namajikijolo (okusha).
Kubalulekile ukunamathela ekudleni okunjalo ukuze uvikele ukuthuthukiswa kwezinkinga ezihambisana nokungakwazi kwama-pancreas ukukhiqiza ama-hormone nama-enzyme adingekayo.
Njengoba i-mellitus yesifo sikashukela ihlala iba yinkinga ye-pancreatic necrosis, kubalulekile ukubheka amazinga kashukela wegazi, ihlolwe njalo futhi ilandele zonke izincomo zezokwelapha ze-endocrinologist.
Ividiyo evela esigulini esinesifo:
Ukuvimbela i-hemorrhagic pancreatic necrosis
Umuntu osengozini yokuthuthukisa le-pathology kufanele athathe izindlela zokuvimbela. Ukuze wenze lokhu, yeka ngokuphelele ukusetshenziswa kotshwala, unamathele ezimisweni zokudla okufanele.
Kuyadingeka ngokuphelele ukuxilonga nokwelapha izifo ngesikhathi esingaholela ekukhuleni kwe-hemorrhagic pancreatic necrosis - dyskinesia ye-biliary, duodenal ulcer kanye nesilonda sesisu, cholecystitis.
Kuhle ukukhumbula ukuthi ngisho nokuhlukumeza okwesikhathi esisodwa kokudla okunamafutha noma utshwala kungaholela ekunciphiseni i-pancreatic necrosis futhi, ngenxa yalokho, ukuhlinzwa okuyinkimbinkimbi nokufa.
Abantu abanomlando wanoma yiluphi uhlobo lwesifo sikashukela kufanele banake kakhulu etafuleni lamaholide. Izinyathelo ezilula zokuvikela azikuqinisekisi ukuthi i-pancreatic necrosis ayikhuli, kepha banciphisa amathuba okuthola kuwe i-pathology ngokwakho.
