Biliary pancreatitis, nyob rau hauv kev sib piv rau tus mob li ib txwm mob ntawm tus txiav, yog ntawm xwm lwm yam. Tom qab tag nrho, nws tshwm sim vim cov kab mob ntawm lub gallbladder, bile ducts thiab daim siab. Qhov no thiaj li hu ua biliary system. Kev ua txhaum ntawm kev tawm ntawm cov kab mob bile, nws txoj kev ua kom tuab los yog pov rau hauv lub qhov quav coj mus rau kev txhim kho ntawm mob huam. Pathology yog dav rau ntawm cov neeg laus, thiab ntau tus poj niam feem ntau tshwm sim. Kwv yees li ntawm ib nrab ntawm cov neeg mob pancreatitis los ntawm qhov laj thawj no. Ua raws li qhov mob hnyav ntawm cov chav kawm, ib qho kev mob tshwm sim ntawm tus kab mob thiab mob ntev biliary-dependant pancreatitis tau txawv. Yog tias tsis kho, pathology tuaj yeem ua rau mob hnyav thiab ua kom tuag taus.
Tshawb pom mechanism
Kev coj ua haujlwm ntawm cov neeg txiav txim siab mus txuas rau txoj kev noj qab haus huv ntawm lwm qhov plab hnyuv ntawm lub plab zom mov. Kev mob ntawm cov bile ducts muaj qhov tshwj xeeb muaj zog rau nws. Lub plab zom zaws yuav khaws thiab khaws cov kua tsib, uas muaj cov tshuaj tshwj xeeb rau kev zom cov rog. Thaum lub sijhawm ua haujlwm ntawm lub zais zis tom qab khoom noj nkag rau hauv lub plab, cov kua tsib tawm hauv cov tog raj mus rau hauv duodenum, qhov uas koom nrog kev zom zaub mov. Thiab yog tias qhov txheej txheem no tau ua txhaum, ntau tus neeg yuav kawm paub txog cov kab mob pancreatitis.
Tom qab tag nrho, qhov teeb meem yog tias ntawm qhov tawm ntawm cov kua tsib lub raj txuas nrog Wirsung duct ntawm cov txiav. Nyob rau hauv ib txwm mob, lawv tsis tau tshaj tawm, txij li cov txiav tawm ntawm pancreatic duct yog kaw los ntawm lub sphincter ntawm Oddi thiab lub siab nyob hauv nws siab dua hauv cov kua tsib. Tab sis qee zaus bile nkag mus rau hauv lub txiav. Qhov no ua rau kev puas tsuaj rau nws cov ntaub so ntswg los ntawm cov kua qaub kua qaub. Qee lub sij hawm feem ntau cov hlab ntaws tawg nyob rau tib lub sijhawm, kua txiv quav yeeb thiab kua txau txau mus rau tag nrho parenchyma ntawm lub caj pas. Tib lub sijhawm, cov enzymes tuaj yeem ua haujlwm los ntawm cov kua tsib kua qaub, thiab "kev zom zaub mov" ntawm lawv tus kheej hauv cov ntaub so ntswg pib. Qhov no ua rau muaj cov txheej txheem ua kom muaj zog.
Feem ntau cov feem ntau, pathology kev nthuav dav hauv pob zeb hauv cov kua tsib lub plab
Vim li cas
Biliary pancreatitis muaj kev txhim kho nrog exacerbation ntawm ntau yam kab mob ntawm lub zais zis los yog bile ducts. Feem ntau feem ntau, mob yog tshwm sim los ntawm kev txhaj tshuaj ntawm cov kua tsib mus rau hauv cov leeg txiav vim yog txhaws ntawm tus pas nrog lub pob zeb. Tab sis nws kuj tseem tuaj yeem ua rau npau taws ntawm cov kab mob los ntawm cov kabmob no rau nws.
Qhov ua rau ntawm daim ntawv ntawm pathology no yog cov kab mob nram qab no:
- mob pob zeb;
- tuab ntawm cov kua tsib thiab qhov tsim los ntawm cov nag lossis daus ntawm cov xuab zeb zoo hauv nws;
- anomalies hauv cov qauv ntawm cov khoom ua ke;
- suav cholecystitis;
- zais zis dyskinesia;
- cholangitis;
- cov hlwv thiab lwm cov leeg hlwb;
- duct khuam kev;
- spasm ntawm lub sphincter ntawm Oddi;
- cuam tshuam kev ua haujlwm ntawm Vater papilla, los ntawm kev uas cov kua tsib nkag mus rau hauv duodenum;
- helminthic cov kev sib kis;
- cov txheej txheem mob hauv duodenum;
- qog hauv qhov chaw no;
- cirrhosis ntawm daim siab.
Nws tsis yog tsuas yog cuam tshuam ntawm cov kua tsib lub plab uas tuaj yeem ua rau nrum qhov bile rau hauv lub qhov quav thiab exacerbation ntawm cov txheej txheem inflammatory hauv nws. Qhov nce hauv siab tuaj yeem tshwm sim vim kev siv khoom noj khoom haus uas ua kom txhua yam zom zaub mov. Cov no yog cov cawv, kib, ntsim thiab cov zaub mov rog, haus dej haus. Qhov ua rau exacerbation kuj tseem yog kev siv cov tshuaj choleretic.
Cov tsos mob
Vim yog lub ingress ntawm cov kua tsib los yog cov kab mob nkag mus rau hauv tus kab mob hlwb, muaj cov txheej txheem mob tshwm sim hauv nws. Nquag cov kua tsib cov kua qaub thiab pancreatic enzymes ua rau lub qog ua qog ua rau lub ntsej muag puas tsuaj, maj mam rhuav tshem nws lub hlwb. Vim tias qhov no, cov haujlwm ntawm lub cev no tau cuam tshuam.
Cov tsos mob tseem ceeb ntawm biliary pancreatitis yog mob plab, xeev siab, tsis muaj zog, thiab qee zaum ua npaws
Cov cim tseem ceeb ntawm biliary-dependant pancreatitis yog tib yam li nrog nws lwm daim ntawv. Cov no yog ntse, girdling mob hauv plab sab sauv, xeev siab, hnyav hnyav hauv plab plab tom qab noj mov, ntuav, pom pob, thiab kem plab. Tab sis txij li nrog rau kev voos ntawm tus txiav tus kab mob pathology ntawm lub zais zis pib, nrog cov kab mob no cov kev mob tshwj xeeb tau pom. Raws li lawv qhov muaj, tus kws kho mob uas paub dhau los tuaj yeem ua qhov kev kuaj mob ua ntej kuaj.
Muaj peev xwm muaj pob zeb nyob rau hauv lub txiavKev ua txhaum ntawm kev tawm ntawm cov kua tsib ua rau qhov pom ntawm kev sib tw nrog kev iab siab tom qab. Tsis tas li ntawd, qhov mob tuaj yeem tshwm sim hauv ib cheeb tsam tsis yog nyob sab laug, zoo li ib txwm ua mob taub hau, tab sis ntawm sab xis, thiab yuav muab rau sab xub pwg sab xis, caj npab lossis nraub qaum. Qee lub sij hawm muaj tawv nqaij daj ntseg. Qhov tsos mob no qhia tias yog ib qho kev thaiv ntawm lub bile roj khov nrog pob zeb. Hloov ntawm qhov raws plab ib txwm nyob rau hauv pancreatitis, nws daim ntawv biliary ua rau kev cem quav tas mus li, qee zaum xaus rau qhov hnyuv txuas. Qhov kub hauv qhov mob mob sai sai, yog tias nws nce, nws yog me ntsis.
Biliary pancreatitis tseem yog cim los ntawm kev tiv thaiv sab hauv thiab sab nraud tsis txaus. Qhov no ua rau muaj ntau yam malfunctions hauv cov txheej txheem zom zaub mov. Txo tus nqi ntawm cov enzymes cuam tshuam rau kev zom zaub mov ntawm cov protein, tawg rog ntawm cov rog thiab qhov nqus ntawm carbohydrates. Ntxiv nrog rau xeev siab, kub siab, pom pob txha thiab qhov quav tsis zoo, qhov no ua rau muaj qhov tsis txaus siab, poob phaus thiab tsis muaj qhov tseem ceeb ntawm cov kab kawm. Yog tias cov kab mob uas lub luag haujlwm rau kev tsim cov tshuaj hormones yog puas lawm, hypo- lossis hyperglycemia tau pom. Qhov no tuaj yeem ua rau ntshav qab zib.
Kev kuaj mob
Txawm hais tias muaj tseeb tias nrog biliary pancreatitis cov tsos mob tshwj xeeb tau pom, nws tseem tsim nyog los ua qhov kev soj ntsuam kom ntxaws. Txhua yam kab ke ntawm lub qog, nws txoj kev mob thiab mob rau hauv lub txiav ua qab nws tus kheej feem ntau txiav txim siab los ntawm ultrasound. Yog tias muaj kev ua xyem xyav ntawm cov pob zeb, lawv cov duab thiab qhov loj dua tau pom zoo dua los ntawm CT lossis MRI, qee zaum cholangiopancreatography kuj tau ua.
Ib qho ntxiv, kev kuaj ntshav thiab zis yog qhov yuav tsum tau ua. Lub xub ntiag ntawm biliary pancreatitis yuav qhia tau los ntawm kev nce qib ntawm leukocytes, transaminase, bilirubin thiab alkaline phosphatase enzymes. Tus mob urinalysis yuav ua kom pom tias nce txog qib kawg hauv cov piam thaj. Xws li kev tshuaj xyuas txhua tus pab ua kom muaj qhov sib txawv ntawm cov kab mob pathology los ntawm kev mob rwj ntawm lub plab lossis duodenum, ntau yam mob ntsws, kab mob siab, cholecystitis thiab lwm yam kab mob.
Kev Kho Mob
Kev mob hnyav rau tus mob biliary pancreatitis, uas yog biliary colic, ntuav thiab mob daj ntseg, yuav tsum tau pw hauv tsev kho mob. Thaum cov ducts raug kaw nrog gallstone, kev phais mob feem ntau tsim nyog, txwv tsis pub muaj kev puas tsuaj loj rau ntawm lub cev pancreatic yog ua tau, uas tuaj yeem ua rau mob peritonitis, sepsis, thiab tuag.
Tus mob hlwv nplooj siab, tshwj xeeb yog mob me, tuaj yeem kho nyob hauv kev saib xyuas mob hauv tsev. Kev kho rau tus kab mob no yuav tsum muaj txhij txhua. Nws tas nrog kev siv cov tshuaj tshwj xeeb thiab cov zaub mov noj zaub mov. Kev pab cuam rau kev phais qee zaum yuav tsum tau pab kom rov muaj dua qub los ntawm kev rov qab los dua.
Nrog biliary pancreatitis, kev phais mob feem ntau yuav tsum tau ua.
Kev siv tshuaj kho mob rau tus kab mob nqaj qab zib yuav tsum yog kws kho mob sau tseg. Feem ntau, ntau pawg tshuaj tau siv rau qhov no. Cov kev kho mob nyuaj no pab ua kom rov ua tiav pancreatic thiab txhim kho tus neeg mob tus mob.
Ua ntej tshaj plaws, nws yog ib qhov tsim nyog los daws qhov mob. Antispasmodics zoo tshaj plaws rau qhov no: Tsis muaj-Shpa, Papaverin, Drotaverin. Hauv cov mob hnyav ntawm cov kab mob pathology, lawv raug tswj hwm ntawm cov leeg lossis intramuscularly. Cov mob me yuav raug muab tshem tawm nrog kev ua kom loog: Baralgin lossis Analgin.
Yuav kom txo cov txheej txheem mob, nws yog qhov tsim nyog los txo cov kev ua haujlwm ntawm cov enzymes digestive. Rau qhov no, siv tshuaj tiv thaiv kab mob los kho siv. Nws tuaj yeem yog omeprazole, somatostatin lossis gastrocepin.
Thaum muaj kev kis kab mob, kev siv tshuaj tua kab mob yog tsim nyog. Feem ntau, qhov no yog Ceftriaxone, Amoscicillin lossis Abactal.
Nyob rau hauv kev ua txhaum ntawm exocrine kev ua haujlwm ntawm lub txiav, txiav txim siab enzymes feem ntau yog: Creon, Pancreatin, Panzinorm. Qee zaum yuav tsum tau siv cov tshuaj tiv thaiv hypoglycemic.
Rau qhov kho cov tsos mob, siv tshuaj sib txawv. Nyob rau hauv muaj nyob rau hauv lub xeev siab thiab ntuav - Motilium, Domperidone los yog Tserukal. Txhawm rau li qub thiab muaj zog ntawm cov kua tsib - Hepatofalk lossis Odeston. Ursofalk tuaj yeem yaj lub pob zeb me me.
Yog tsis muaj kev noj haus tshwj xeeb, tsis muaj kev kho kom zoo.
Cov khoom noj tshwj xeeb yog qhov tseem ceeb heev rau kev kho sai. Tom qab tag nrho, feem ntau muaj kev tawm tsam tshaj tawm los ntawm kev siv cov khoom noj uas muaj cov khoom choleretic los yog txhawb cov kev ua ntawm cov kua txiv pancreatic. Xws li cov khoom lag luam yuav tsum tau muab pov tseg tam sim ntawd. Cov no yog cov dej cawv thiab haus dej haus, cov zaub mov muaj roj, ntsim thiab zaub mov kib. Cov khoom lag luam Cholagogue yog qab zib, butter, nkaub qe, zaub ntsuab, zaub qhwv, txiv lws suav, kua txiv kab ntxwv, tseem nplej, kua muaj zog. Lawv kuj yuav tsum tau ua kom muaj kev cais nyob ntawm cov zaub mov noj.
Tus neeg mob cov khoom noj khoom haus yuav tsum muaj cov khoom noj siav, khoom noj hauv av uas yooj yim zom. Cov no yog cov cereals, nqaij ntses tsis muaj rog lossis ntses, tsev cheese muaj roj tsawg, mov qhuav, kua zaub hno, rosehip broth, dej ntxhia. Noj zoo dua nyob rau hauv feem me me, 5-6 zaug ib hnub.
Teeb meem
Yog hais tias biliary pancreatitis tsis pib kho raws sijhawm, muaj tshwm sim loj heev. Ua ntej tshaj, cov kua tsib kua qaub thiab kua txiv kab ntxwv uas tau poob ntawm lub qog ua haujlwm tuaj yeem ua rau daim tawv nqaij txha caj qaum txhaws, uas feem ntau ua rau mucosal atrophy lossis pancreatic necrosis. Tsis tas li ntawd, kev puas tsuaj rau cov qog yuav ua rau los ntshav hauv txoj hnyuv plab hnyuv, lub plab zom mov, thiab ntshav qab zib mellitus. Feem ntau kuj ua mob rau daim siab ua rau lub cev ntaj ntsug tuaj yeem tshwm
Nws yog qhov nyuaj thiab ntev los kho biliary pancreatitis, tab sis nws txoj kev txhim kho tuaj yeem zam dhau. Txhawm rau ua qhov no, nws yog qhov tseem ceeb heev uas yuav tau soj ntsuam kev noj zaub mov kom zoo nkauj, tseg cov cwj pwm tsis zoo thiab cov zaub mov nrawm thiab saib xyuas kev noj qab haus huv ntawm txhua yam plab hnyuv plab hnyuv. Kev tshuaj xyuas tas li los ntawm kws kho mob thiab kev ua neej kom zoo yuav pab tswj kev noj qab haus huv ntawm pancreatic.
