Clinical nta
Muaj mob ua paug, o, thiab qee zaum leeg khaus ntawm lub plab mog. Cov neeg mob feem ntau txhawj txog xeev siab thiab ntuav; qee qhov - tsuas yog lub zog ntuav rau ntuav. Tej zaum yuav muaj qhov me me xiav ntawm thaj tsam ntawm lub pij ntaws (Cullen tus tsos mob) lossis cyanosis (xiav) ntawm daim tawv nqaij nyob rau ntawm sab nraud ntawm qhov plab (ib qho kev qhia ntawm Grey-Turner). Qhov no tuaj yeem qhia tias ib qho hemorrhage nrog rau hauv plab kab noj hniav. Qhov tsos mob ntawm Cullen ua tim khawv rau qhov muaj ntshav hauv cov ntshav, uas cov ntaub so ntswg nyob ib ncig ntawm lub pwg tau ntub nrog ntshav. Subcutaneous hemorrhage yog ib qho txiaj ntsig ntawm kev ua txhaum ntawm ntshav khov kho ua haujlwm li ntawm kev nqus ntawm pancreatic enzymes. Cov pancreas nyob sab nraud ntawm lub plab rov qab rau sab nraub qaum ntawm lub plab. Nws lub taub hau nyob rau khoov ntawm duodenum.
Cov txiav ua rau:
- insulin thiab glucagon - cov tshuaj hormones uas tso tawm ncaj qha rau hauv cov hlab ntsha thiab tswj ntshav qab zib;
- kua txiv pancreatic - muaj plaub lub enzymes uas zom cov nqaijrog (trypsin, chymotrypsin), nrog rau cov rog (lipase) thiab hmoov txhuv nplej siab (amylase). Cov pancreatic duct empties rau hauv cov kab mob feem ntau ciav tam sim ntawd ua ntej nws tawm hauv duodenum.
Pancreatic kua txiv, nrog rau bile, yog tov nrog cov zaub mov digested nyob rau hauv lub plab, qhib kom ua thiab ua tiav cov txheej txheem ntawm kev muab cev.
Feem ntau yog ua rau mob pancreatitis yog:
- kab mob hauv cov kua mis (45%); piv txwv li, ib txoj hlua ntawm gallstones hauv duav dej ua ntej nkag nws duodenum;
- ntev cawv (35%).
Lwm yam yog:
- blunt los yog mob plab mog, piv txwv, vim yog phais;
- perforated ulcer ntawm duodenum;
- metabolic ntshawv siab, xws li hypercalcemia (vim yog lub chaw pathology ntawm cov kabmob parathyroid thiab qhov intake ntawm calcium uas muaj cov tshuaj); hypertriglyceridemia (kom muaj zog ntawm triglycerides hauv cov ntshav); raum tsis ua hauj lwm;
- cov tshuaj tiv thaiv rau cov khoom muaj yees, piv txwv li, muaj qee cov tshuaj tiv thaiv kabmob hauv qhov ncauj;
- Cov kab mob kis, xws li kab mob parotitis, kab mob siab, HIV;
- organic kab mob, xws li kabmob pancreatic;
- idiopathic mob (ntawm keeb kwm tsis paub). Lub tswv yim ntawm cov teeb meem no tsis tau raug nthuav dav, tiam sis, raws li ib qho ntawm theories, nws muaj nyob rau hauv "tus kheej-digestion" ntawm lub caj pas, thaum ua kom cov enzymes tshwm sim hauv nws cov ntaub so ntswg. Los ntawm kev rhuav tshem lub caj pas, lawv, nyeg, qhib lwm lub enzymes, xws li elastase (dissolving elastic fibers ntawm cov hlab ntsha) thiab phospholipase.
Chav kawm ntawm tus kab mob
Cov kab mob pancreatic enzymes ua kom puas hlwb thiab puas cov nqaij, ua rau ntshav, edema thiab necrosis ntawm tus txiav. Nrog nws kim heev, cov kabmob uas nyob ib sab muaj peev xwm kuj raug puas tsuaj, uas ua rau muaj kev poob siab thiab lwm yam teeb meem. Nrog rau mob hnyav pancreatitis tsawg dua, qhov mob tsuas yog siv rau lub caj pas xwb. Cov tsos mob zoo li no tuaj yeem tau cai rau lwm cov kab mob plab (qhov tob hauv lossis plab hnyuv ntawm txoj hnyuv, mob ntsws ntawm lub gallbladder), thiab lub hauv siab (lub plawv nres (mob plawv) mob ntsws.
Kev kuaj ntshav
Ntshav suav rau cov kab mob pancreatitis tsis muaj nyob, tiam sis kev kuaj ntshav pab txhawb ntxiv rau daim duab khomob. Feem ntau, qhov nce qib ntawm pancreatic enzymes (amylase thiab lipase) nyob rau hauv cov ntshav. Cov ntsuas no yog qhov tseem ceeb ntawm kev kuaj mob thaum ntxov ntawm tus kab mob, vim li ntawm ib lub lim tiam lawv rov qab los ntawm qhov qub. Qib siab ntawm cov dawb fatty acids uas ua los ntawm qhov kev txiav txim ntawm lipase ua enzymatic saponification thiab txo tus concentrated calcium hauv cov ntshav. Cov leukocytes nyob rau hauv cov ntshav hauv cov neeg mob uas muaj pancreatitis feem ntau yog siab (leukocytosis), thiab vim yog dej ntub, hematocrit (qhov sib piv ntawm qhov ntim ntawm erythrocytes rau plasma ntim) nce.
Cov qauv ntawm kev pom
Qhov kawg ntawm tus kab mob pancreatitis yog nyob ntawm seb cov txiaj ntsim tau los ntawm kev pab los ntawm kev siv cov khoom siv: ultrasound thiab computed tomography. Computed tomography yog tas ua rau mob hnyav pancreatitis thiab hauv cov teeb meem. Nrog kev pab los ntawm cov hau kev no nws yog ib qho ua tau kom paub qhov ua rau pancreatitis. Tshawb xyuas qhov ua rau ntawm tus kab mob pub rau kev kho mob ntsuas rau nws tshem, uas yav tom ntej yuav pab kom tsis txhob rov qab ntau dua ntawm pancreatitis.
• Cov kab sib sib zog ua rau cov ntsej muag daj ntawm lub pseudocolor scan ua nrog rau lub tshuab hluav taws xob tsom ntaw (lymphocytes) (ib yam leukocytes). Tus leukocytes hauv cov ntshav hauv mob pancreatitis yog feem ntau nce. Qhov kev ntsuam xyuas raug soj ntsuam ntawm ib kauj lus kaum-tsib raws li cov txheej xwm tsis pom zoo, uas muaj xws li:
- hnub nyoog tshaj 55 xyoo ntawm lub sijhawm sau npe;
- kuaj sim (plaub ntawm kev tso cai thiab rau tom qab 48 teev). Yog tias muaj peb lossis ntau qhov ntxiv ntawm lub sijhawm nkag mus, qhov tshwm sim ntawm qhov ua tau tshwm sim yog 1: 5; Yog tias muaj ntau xya lossis ntau dua, nws nce.
Thawj thawj ob peb hnub, txoj kev tuag tshwm sim vim muaj ntau yam khoom tsis ua haujlwm. Feem ntau cov neeg mob (80%) cov neeg mob tuag tom qab ib lub lim tiam, feem ntau yog vim muaj kev tsim cov kab mob (abscessing) los yog tsim muaj cov cyst cuav. Txoj kev loj hlob ntawm tus kab mob nyob rau hauv keeb kwm ntawm necrosis ntawm pancreas yuav tsum tau xav tias yog tsis muaj kev cuam tshuam ntawm kev kho mob los yog sai deterioration. Lub siab ntawm tus txheem ntawm lub plab hauv plab hauv kev tswj ntawm computed tomography yuav pab tau rau kev kuaj mob. Yog hais tias cov tshuaj tua kab mob hauv lub cev tsis tshwm sim rau lub sij hawm, qhov kev tuag ntawm tus tuag yog 100%. Ib hom kabmob me ntsis ntawm pancreatitis tuaj yeem kis tau nthawv. Tus neeg mob tau txhaj cov tshuaj tua kab mob hauv lub cev, kev noj cov zaub mov thiab cov dej haus tsis zoo kiag li. Txhawm rau tshem tawm qhov xeev siab thiab ntuav nrog lub raj nas nas, lub plab yog tsis muaj zog. Qhov no yuav pab tiv thaiv kev poob siab, limiting kua poob. Kev sojntsuam tseem siv los tswj kev siv tshuaj loog, qee zaus siv tus neeg mob cov tshuaj. Qhov no yuav ua rau tus neeg mob lub sijhawm los tswj kev noj cov tshuaj, ntawm qhov kev siv ntawm qhov mob. Yuav kom tsis txhob muaj overdose, nws muaj cuab yeej tshwj xeeb tsim los siv cov xaum ntawm cov tshuaj rau qee lub sijhawm.
Tag nrhav kev xeem
Hauv cov mob necrotic pancreatitis, pw hauv tsev kho mob tshwj xeeb yog tsim nyog rau ib lub chaw kho mob tshwj xeeb uas ua rau tus neeg mob soj ntsuam kom zoo thiab cov tsos mob hnyav uas qhia tias muaj kev phom sij heev. Kev kho yog tsom rau kev tiv thaiv teeb meem ntawm tus kab mob.