Hōʻike ʻia ka pancreatitis i ka wā e maʻi ai ka pancreas no nā kumu he nui. I ka piha ʻana o ke kino, paʻakikī ka puka ʻana o nā enzyme, no ka mea ua hoʻomaka nā kino o ke kino e ʻeli kūʻokoʻa.
ʻOiai ke hoʻohana nei i nā lāʻau lapaʻau hou a me ka pono, ʻoi aku ka nui o ka make mai ke pancreatitis. Me nā ʻano maʻamau o ka maʻi, make ka mea maʻi i 7-15% o nā hihia, me nā mea hōʻino - a he 70%.
Ma muli o ka paʻakikī o ka hoʻouluʻana i nā hoʻopiʻi o nā maʻi pancreatic i mea kiʻekiʻe loa, he mea nui e ʻike e pili ana i nā hiʻohiʻona etiological a me nā pathogenesis o ka pancreatitis. Hiki i ka ʻike kikoʻī e pili ana i ka maʻi i ka hōʻike ma lalo nei.
Nā kumu o ka pancreatitis
Ma 80% o nā hihia, loaʻa nā mea o ka hoʻomakaʻana o ka maʻi i ka hōʻino ʻana i ka waiʻona, nā alaʻai o ka pānana a me nā kumu wai. Ma 45% o nā hihia, ua hoʻomaopopo ʻia ka hoʻomohala ʻia ʻana o ka hana o ka maʻi pancreatic e ka choledocholithiasis, cholelithiasis, paʻakikī o nā kahe me nā cysts a me nā kani, a me nā ʻaoʻao o ka ʻōpū.
ʻO kēlā me kēia maʻi hoʻopukapuka kūpono ke kumu o ka hoʻomohala ʻana. Eia naʻe, alakaʻi lākou āpau i ka hiki ʻana o ka maʻi pancreatitis.
ʻO nā mea nui i ka pathogenesis o ka pancreatitis ka: paʻakikī i ka puka ʻana o ka pancreatic enzyme ma o nā papa. No laila, hoʻomaka ka mālama ʻana i nā maʻi lalo o ka mālama ʻana i nā ʻano āpau āpau.
Hoʻopili nui ka etiology o ka pancreatitis maʻa me ka inu ʻākia. I kēia hihia, ke kumu o ka hoʻomohala ʻana o ka maʻi ma ka maʻi o nā palipiki o nā ate a me nā lālani.
Hoʻonui ka hua waina i nā mea huna, e hoʻomoʻi hou i ka hoʻokuʻu. Hoʻonui kēia i ke kaomi ma ke kahawai, kahi e alakaʻi ai i ka hoʻohuihui o ka pancreas, hoʻonāukiuki i ka synthesis o ka enzyme i loko a hoʻoulu i nā kaʻina metabolic i loko o ka ate.
ʻO kekahi kumu maʻamau maʻamau o ka pancreatitis i manaʻo ʻia he mea kūpono meaʻai. I kēia hihia, ulu ka huhū i ka hōʻino ʻana o ke kanaka i ka ʻai, nā mea momona a me nā meaʻai.
ʻO ka liʻiliʻi, ʻo ka pathophysiology o ka pancreatitis hoʻonā i nā kumu'ē aʻe.
- nā maʻi maʻi (mumps, Coxsackie virus, hepatitis);
- predisposition genetic (cystic fibrosis);
- nā pōʻino (mycoplasma, campylobacter);
- ʻeha nā maʻi ʻeha;
- ʻeha hōʻeha;
- mau ala e pili ai i ka hoʻolālā ʻana o ke kino;
- lawe i nā lāʻau lapaʻau (estrogens, corticosteroids, diuretics, azathioprine);
- ka hopena o ka metabolic i hoʻomohala ʻia e ka lehulehu o nā maʻi (vasculitis, maʻi maʻi, AIDS).
Hoʻoulu pū ʻo ka pancreatitis ma muli o ke kaʻina hana i hoʻokau ʻia ma ke ala o nā pancreas a me nā papa lepo. Hiki i ka hōʻeha ʻana i ke kumulāʻau i ka wā o ka dilatation tighture, endoscopy, prosthetics, papillotomy, a me nā ʻano hana ʻē aʻe.
ʻO ka pancreatitis postoperative kahi hoʻopiʻi pono ʻana o ka hoʻomaʻamaʻi ʻana. Hele pū ia me ka hōʻino i nā kumu o nā kelepona a me ko lākou hypertension.
Nā kumu pālua o ka maʻi pancreatic i loko o ka hoʻouluulu ʻana o helminthic (maʻi ascaris), hyperparathyroidism (parathyroid pathology) a me nā mea make o ka organophosphate.
ʻO nā mea ʻē aʻe ʻē aʻe o ke ʻano o ka maʻi ke ʻano o ka huʻu scorpion a me ka ischemia o ka loko mesenteric, ka mea e loaʻa ana i ka puka mesenteric artery thrombus form.
ʻO ka pathogenesis o ka pancreatitis maʻa
ʻO ke ʻano o ka huakaʻi o ka maʻi pancreatic ka mea huʻipiʻi o ka enzymopathy. ʻO ka mea nui i ka hoʻomohala ʻana i ka maʻi, ʻo ka noho kaʻawale ʻana o nā enzyme kikoʻī (neʻe ʻole i ka proenzymes) mai nā aʻai o acinar o ka huina.
Hoʻomaka ka kaʻina hana ma muli o ka hoʻouluʻana o ka hana exocrine organ function, hoʻonui i ka poi a i ʻole bile reflux i ka wai Wirsung, a me nā keʻa o ka duodenal papilla ampoule.
Ma muli o ka hypertension intraductal, lilo i paia nā paia o nā kēpau o ka terminal, e hoʻōla ana i nā huina. Ke alakaʻi nei ka pathogenesis o ka pancreatitis maʻa e hoʻomaka i kahi kaʻina hana o ka hoʻoneʻe ʻana o ka hana ponoʻī, kahi i hoʻopili ai i nā enzyme lipolytic (lipase, phospholipase A).
He mea nui ia inā ʻaʻole i pili ka lipase i nā maʻi olakino wale nō. Phospholipase Ua hoʻopōʻino i nā membrane cell, kahi i komo koke ai ka lipase. Hoʻolaha ka hoʻokuʻu o ka hope i ka hoʻōla kūmole lipid a hoʻonāukiuki i nā hana luku. ʻO nā enzyme a pau i hoʻouluhua i ka wahi o ka mumū, ʻo ka mea i hoʻopilikia loa i ka pancreas he granulocyte elastase - ʻo ia ka pilina nui ma ka pathogenesis o ka pancreatitis maʻa.
ʻO ka hopena o ka hoʻolahaʻana o ka enzyme ʻo ka foci o ka liprite pancratic lipid. Ma kahi kokoke i kēia mau wahi, ma ke ʻano o ka hana ʻana i nā hana, kahi demarcation shaft form, e hoʻopau ana i nā wahi i hoʻopili ʻia me nā kino ola.
Ke pau ka pae ʻana o ka pathobiochemical i kēia kahua, a laila ulu ka momona pancreatic fatty. Inā, ma muli o ka hōʻiliʻili o nā waikela momona i ka pancreatocytes lipase e pā ana i ka loli, ua loli ka pH (mai ka 3.5 a hiki i ka 4.5), a laila ua hoʻololi ʻia ka trypsinogen i loko o nā mea i loko o nā trypsin. E hoʻolilo i ka proteinases a me ka lysosomal enzymes, e alakaʻi ana i nā loli hoʻololi proteolytic i nā pancreatocytes.
Hoʻopau ʻo Elastase i nā pā vascular a me nā loulou interlobular interlobular o nā ligament. Ke alakaʻi nei kēia i ka hoʻoili koke ʻana o nā enzymes i ka wā holoʻokoʻa a pau o nā pancreas a me nā ʻala kokoke.
ʻO ke kūlana hope loa no ka pathogenesis o ka wīwī o ka maʻi parenchymal o ka hoʻomaka mua ʻana o nā enzyme pancreatic. Ma lalo o ka mana o trypsin, ua hoʻomaka ʻia nā ʻano nui o ke kaʻina, e hoʻopau me kahi maʻi pathobiochemical:
- Hoʻālaʻi ʻia nā zymogens enzyme pancreatic;
- hoʻonui piʻi koko;
- nā hoʻololi i ka fibrinolysis;
- hoʻōla ʻia ka ʻōnaehana kallikrein-wedge.
Hoʻopili i nā hōʻeha kūloko o nā maʻi ma muli o nā pilikia pathological i ka organ parenchymal, ua hele mai ka nui o nā make o ke kino.
Hoʻopilikia ka mea hoʻonāukiuki i ka nalowale o nā kino o ke kino - ka puʻuwai, nā ʻōpū, nā ʻōpū a me nā māmā.
ʻO ka hana o ka hoʻomohala o nā ʻano ʻē aʻe o ka pancreatitis
ʻO ka māhele ʻana o ka pancreatitis e loaʻa i nā ʻano maʻi like ʻole. Hiki paha i kā lākou pathogenesis. No laila, loaʻa kahi ʻano helu maʻamau o ka mumū o nā kelepona i ka wā e puka ai nā pōhaku i ka dcrcrory i pāpā ʻia i nā hopena (carbonic a me phosphoric lime).
I ka hiʻohiʻona, ka like o ka hopena me nā pōhaku liʻiliʻi a i ʻole ke one hina-keʻokeʻo. A hele nā loli pathological i loko o ka pancreas, kahi i hōʻiliʻili ai ka calculi, nā mea hōʻeha a me ka hoʻonui ʻana o ke au o ka excretory.
ʻO ke pathogenesis o ke ʻano wai ʻawaʻawa o ka pancreatitis ka hoʻonui ʻana i ka leo o ka sphincter o Oddi. Mālama kēia i ka laha ʻana o nā mea huna exocrine a hana i ka hypertension i nā pā liʻiliʻi. He nui nā hopena maikaʻiʻole o ka alkohol:
- Hoʻokumu ia i ke komo o nā enzymes i loko o ka palupalu, e hoʻonāukiuki i nā enzyme proteolytic a hoʻonāukiuki i ka autolysis o nā nui o nā selela.
- Hoʻonui ia i ka mea huna o ka wai pākī a me ka hoʻohuihui hydrochloric, e hoʻonui ai i ka nūnū, e hoʻonāukiuki i ka exocrine hypersecretion i loko o ke kino.
ʻO ka pathogenesis o ka pancreatitis biliary e pili ana me ka ingress o ka hua bile a me ka pancreatic wai. Kuhi ʻia kēlā mau ʻōhua i ka wā e piʻi ai ke kaʻe ma ke duodenum a me ka biliary tract. Aia ma muli o kēia, ua hoʻokumu ʻia kahi ho'ākāka o ka maʻi ma ke ʻano he ʻano maʻi aʻokiʻoki i hōʻino ʻia e ka ʻeha ʻana i ka ate a me ka ate biliary.
Hiki i ka pancreatitis Biliary ma muli o nā loli morphological e ulu ana ma ka sphincter o Oddi a i ʻole prododio papilla. Hoʻokomo ka hana Trypsin i ka lysis o ka parenchyma a me kahi hana ponoʻī ʻana iā ia iho.
Me nā ʻano biliary o ka maʻi, pili ʻia nā wahi āpau i hoʻopiha ʻia me nā iwi fibrous. Ke hana ʻole nei i ka mālama ʻana i ka manawa kūpono, ua pau ka hana o ka hui.
Hoʻohui kekahi ʻano ʻano pathogenesis i ka wā e hui pū ʻia ai nā ʻano mea hoʻoilina, i hoʻoilina ʻia. Ka hopena ʻole i ka wā e ke hoʻololi nei i ka leucine acid amino me ka valine.
Eia pū kekahi, ʻo ka pancreatitis hoʻoilina e hele pū ʻia me ka hana trypsin i loko o nā hale. ʻO ka hopena, ua hoʻomaka ka pancreas i nā ʻili ponoʻī o kāna iho.
Hōʻike pinepine ʻia kahi maʻi alaka o ka pancreatic i loko o nā mea maʻi e hōʻeha nei i ka rhinitis wā, i ka urticaria, a i ʻole nā palaka bronchial. Hoʻokumu ʻia ka ʻano hana o kēia ʻano maʻi i ka hapanui o ke ʻano maʻi, e neʻe ana i ʻekolu mau manawa:
- ke kūwili ʻana o ke kino;
- ka hana ʻana o nā antibodies i ke alahele;
- hana ʻino i ka ʻāpana o ka kelepona parenchymal.
Ke kōkua ka hoʻomohala ʻana o nā kaʻina autoimmune i nā mea nui a me nā loli. No laila, he maʻi paʻakikī o ka pancreatitis me kahi mākaukau o ka pathogenesis.
Nā hōʻailona a me ka mālamaʻana i ka pancreatitis
ʻO ka pancreatitis ka mea maʻalahi e hoʻoholo i ka wā e hele ai i ka hopena ʻoi aʻe. I kēia hihia, uaʻike pinepine ʻia ke kiʻi o ka maʻi hau.
ʻO nā hōʻailona alakaʻi o ka maʻi pancreatic ka ʻeha mau loa o ka hōʻeha ʻana i ka epigastrium, pinepine e huli i ka hypochondrium hema, ma muli o ka mea e lilo ai ka mea maʻi. Hoʻonui ka ʻeha i ka wā e moe ai ka mea maʻi a ʻai paha i ka meaʻai.
Hoʻohui i nā ʻeha, hoʻopili ʻia ka pancreatitis e ka luaʻi, ke kōhū febrile, nausea a me ka hoʻōla o ka ʻili. ʻO kekahi mau poʻe maʻi he hemorrhages i loko o ka pōpela. Noho pū kekahi nā mea maʻi me ka puʻuwai a me ka palaualelo.
ʻO ka nele o ka mālama ʻana i ka maʻi pancreatic maʻa e alakaʻi i ka ulu ʻana o kekahi o nā hoʻopiʻi maikaʻi ʻana - ka maʻi diabetes, syphilis o ka ʻōpū, ka cystic fibrosis, a me ka vascular thrombosis. No laila, pono e mālama ʻia ka hana ma loko o kahi haukapila ma lalo o ka mākaʻi o nā kauka.
ʻO nā pahuhopu nui o ka lapaʻau:
- ka hoopau ana i na ano eha;
- ka wehe ʻana o nā enzyme pancreatic mai ke kahe koko;
- kumu o kahi meaʻai kūikawā.
Kūleʻa pinepine kekahi kanaka maʻamau i kēia mau lula o ka meaʻai maikaʻi a me ka kaupaona, e alakaʻi ana i nā pilikia o ka digestive. No laila, he mea koʻikoʻi o ka mālamaʻana o ka pancreatitis i ka hōʻoia ʻana i ka mālie i ke kino maʻi ma o ka wikiwiki therapeutic a me ka ʻai. I ka lā mua o ka haukapila, ʻaʻole hiki i ka mea maʻi ke ʻai i kekahi mea, a laila ua kau lākou iā ia i kahi puna a me ka glucose a e hoʻololi wale ia i ka mea māmā māmā.
ʻO ka ʻoi pū ʻana me ka ʻeha, ua ʻōlelo pinepine ʻia ka lāʻau analgesic ikaika. Pēlā nō, hoʻokaʻawale ʻia nā ʻōmaʻomaʻo kūikawā (Contrical, Trasilol) i ka mea maʻi e hoʻopau i ka hikiwī o ke kino me nā enzyme pancreatic. Inā pono, ua kuhikuhi ʻia ka antibiotika a me ka hoʻomākaukau ʻana no ka calcium.
Inā ʻaʻohe holomua ma hope o ka hebedoma o ka mālama ʻana i nā lāʻau lapaʻau, hana ʻia kahi laparotomy. I ka wā hana, hoʻokaʻawale nā mea maʻi i nā ʻāpana make o ka organ parenchymal. I nā pilikia kūkaʻi, me ka hoʻokumu ʻana o pseudocysts (hōʻiliʻili i ka nui o nā ʻōpū make, nā enzim) i ka pancreas, hana ʻia ka hoʻoheheʻe.
Hāʻawi ʻia ka ʻikepili e pili ana i ka pancreatitis ma ke wikiō ma kēia ʻatikala.
