ʻO ka maʻi diabetes (ipipid e like me ICD-10 - E23.2) he ala neuroendocrine pathology, ka mea i loaʻa i ka hiki ʻole o ka pūhuhuhū e pao i ka wai a hoʻi a hoʻoneʻe i ka urine. ʻO ke kumu ke pale hewa o ka hana, ka lawe a me ka hana ʻana o vasopressin (antidiuretic hormone). Hōʻike ʻia ka maʻi e ka make ʻana o nā pathological a me ke hoʻokuʻu ʻana i kahi nui o ka urine. ʻOi aʻe e pili ana i ke ʻano o ka maʻi insipidus maʻi, ke ʻano o nā maʻi a me ke ʻano e launa pū ai e kūkā ʻia ma ka ʻatikala.
ʻO nā hiʻohiʻona o ka anatomy a me ka physiology
ʻO nā pēpē kahi papa paʻa, aia ma hope o ka pā o kahi ʻōpū o ka posterior i ka pae o ka thoracic haʻahaʻa a me ka lumbar vertebrae kiʻekiʻe. Loaʻa ka hanana i ka membrane fibrous, kahi kālepa momona a me kahi fascia renal. Aia kahi mahele o ka maʻi i loko o nā ʻāpana ʻelua:
- organ parenchyma - hana i ka hana ma ke kaʻina hana o ke koko a me ke kūkulu ʻana i ka urine;
- pelvis - hōʻiliʻili a hoʻoneʻe i ka urine mai ke kino.
He nui ka nui o kēlā me kēia pūpū o nā wae umauma o nā nephrons, nāna i hāʻawi i kāna mau hana pono. He kūlike kēia nephron:
- ʻO Glomerulus - i hōʻike ʻia e kahi pili hoʻopiʻi o nā capillaries e holo ai ke koko. Hoʻomapau ka glomerulus i ka kapena Shumlyansky-Bowman.
- He ʻelua pā hale i ka pale a kahi wahi kūlike ma waena o lākou. E hoʻokomo ʻia ka pahu i loko o ke ana o nā ʻalā.
- Loaʻa nā tubules i ke ʻano o nā puka i ka mānoanoa o ka parenchyma ginō.
ʻO Nepron ka liʻiliʻi liʻiliʻi o nā papa hoʻonohonoho o nā keiki.
Nā hana
Hoʻopau ke keiki i nā wai holoʻokoʻa mai ke kino o ke kanaka, nā metabolites o nā kaʻina metabolic o nā allergens, nā mea huʻala a me nā mea huʻala, a me nā lāʻau lapaʻau. Eia kekahi, hui ke kino i ka hoʻoponopono ʻana i ka pae paʻakai-paʻakai, nā kūlana o ka waikawa koko, a me ka paipai.
Nui! Hāʻawi ʻia nā hana like ma muli o ke hoʻokumu ʻana o ka urine.
Hoʻohālikelike ʻia ka paʻakai. Hoʻopili ʻia ke koko arterial i loko o ka glomeruli o nā nephrons. Ma aneʻa e lohi nei ka kahe o ke koko ma muli o ke kaomi nui o ka uha o ka palaki a me ka ʻokoʻa o ka nui o nā moku. Hoʻokomo ʻia ka plasma i kānana i ka pahu me nā mea laʻala, nā mea huna ʻole, ka glucose, nā waikena amino. ʻAʻole lawe nā kīʻaha o ka pūpū i nā protein a me nā mea nui e like me nā mea nui e hoʻonui ai.
Eia kekahi, ma loko o nā uī pūpū o nā nephrons aia kahi keo ʻana o ka wai a me nā mea e pono ai no ke kino. ʻO nā mea pono ʻole e hōʻiliʻili a komo i loko o ka ʻōnaehana kūwaho o ka urine (hōʻili i nā wai, pelvis, a laila i loko o ka ureter a me ka ʻokaʻī).
He aha ka hopena o ka vasopressin?
Vasopressin ka mea i kapa ʻia ʻo ka nui o ka ʻōnaehana hypothalamic-pituitary, kahi i komo i ke kō o ka urination. ʻO ka nui o nā huahana i hoʻoponopono ʻia e ka sodium microelement. Hoʻonui ka nui helu i loko o ke kino i ke kāpili ʻana o ka hormone, a hoʻemi kaohi ʻana i kahi i lalo.
Ma lalo o ka hana a vasopressin, aia kahi hoihoi ʻana i ka wai a me nā meaʻaiola mai ka urine mua.
Hormone hana:
- hāʻawi i ka hōʻemi o nā moku o nephrons;
- mālama i kahi pae kūpono loa;
- hoʻomaikaʻi i ka kōleʻa koko;
- kaohi ʻana i ka hana o kekahi helu e like me nā hana ʻē aʻe;
- kaohi i ka osmotic konsentrate o nā wai biio;
- hoʻoikaika i nā kiʻi.
Hōʻano hoʻohālikelike o ka vasopressin - kahi antidiuretic hormone, ka hana ʻole o ka alakaʻi i ka hoʻomohala ʻia o nā maʻi.
Hoʻoikaika papa
ʻAʻole pili ka maʻi Endocrine i ka kāne a i ʻole ka makahiki. Hiki iā ia i kekahi mea, akā ulu pinepine hou ma hope o ka hiki ʻana i ka pākeke.
Kaawale kahi hoʻokaʻawale ʻana:
- Intipidus diabetes kūlohelohe - i loaʻa he hopena ma ka hopena o ke ʻano o ka hana o ka hana o nā hana ikaika e pili ana i ka hormonal: ʻano ʻōhua; loaʻa ʻano.
- Insipidus maʻi diabetes neʻe - kūkulu i ke kūlohelohe o ka hoʻoneʻe ʻana o ka naʻau o ka pēpē i ka hana o ka hormone antidiuretic: hoʻoilina; loaʻa ka helehelena.
- ʻO ka polydipsia mua - ka nui o ka waiwai intake e lilo i kumu: ka ʻano psychogenic - ka nui o ke kōpaʻa ma mua o nā pilikia o ka noʻonoʻo ʻAno Dipsogenic - hoʻohaʻahaʻa i ka paepae o nā receptors e ʻike i nā loli i ka osmotic concentrations o ke kahe a puni.
Nā hua hoʻohua o ka maʻi insipidus maʻi
Hoʻopili kēia i ka maʻi maʻi gestagen, ka mea i pili me ka nui o ka hana o ka enzymes placental. Ma hope o ka hānau ʻana o ka pēpē, paʻa ka kūlana o ka makuahine.
Gestagenic diabetes insipidus - kahi maʻi i hiki i ka wā hāpai
Hoʻokumu ka ʻano hana i nā pēpē. ʻO ia ma muli o ka immaturity o ka loulou o ka ulu ʻana o nā pēpē a me ka nui o ka hana o ka phosphodiesterase-5, ka mea e alakaʻi ai i ka emi o ka naʻau o nā receptors i ka hormone a me kona hopena pōkole.
Iatrogenic diabetes insipidus kahi ʻano hana lewa e hoʻopiʻi ʻia e nā diuretics.
Nā kumu hoʻolālā
Nui nā ʻano o nā etiological ma lalo o ka mana o ka maʻi diabetes insipidus e kū nei. Heluhelu hou e pili ana i kēlā me kēia.
Nā kumu genetic
E pili ana i nā maʻi Diabetes 1ʻO ka insipidus maʻi lahilahi olakino e ulu a me ka hopena o ka mutations o ka hua a vasopressin a i ʻole e hui i nā anomalies i ke ʻano o ka midbrain. Hoʻomaopopo ka hōʻailona o kēia ʻano o ka maʻi i ka mau makahiki ʻelima o ke ola o ke pēpē. Me ka nui o ka makahiki, e holomua ana ka pathology, nā hōʻailona o ka hoʻoilo ʻana o vasopressin.
Nui! ʻIke ʻia nā maʻi ʻoihana maʻi e pili ana i ka holomua o nā maʻi maʻi a me nā kāne o nā makahiki he 40.
Hiki i kekahi hapa o ka hormon ke lilo i kahi o ka maʻi ona, ʻoiai, i ka hoʻohui ʻana i ka diabetes insipidus, loaʻa i ka diabetes mellitus, ke kuli, ka neʻe o nā nū optic.
Nā moʻo wāwae moe
Loaʻa i nā keiki ka nui o ka nui o ka nui o ka hormone i ka pō, e hōʻemi ana i ka nui o ka urine. I nā pēpē maʻi me ka walaʻau o ka urine incontinence i ka pō, ua hoʻemi nui ka nui o ka hormone antidiuretic i kēlā me kēia pō, ʻo ia hoʻi, kahi nui o ka urine urine i hoʻopiha ʻia.
Mahele ʻeha
ʻO kekahi helu o nā hōʻeha (no ka laʻana, kahi hōʻeha o ke kumu o ka ʻōpala, kahi hōʻeha o ke kanikani Turkish) hiki i ka hoʻomohala ʻana o ka huehue a puni nā kuleana e pili ana i ka hoʻokumu ʻana i ka hormone. ʻO ka hemahema o ke kāpili ʻana he manawa pōkole a mau paha. I kekahi mau mea maʻi, loaʻa nā hōʻailona o ka maʻi ma mua ma mua o 1-1,5 mau mahina ma hope o ka hōʻeha.
Nā mea lawelawe
ʻO ka hana e wehe ai i ka adenoma pituitary, metastases, craniopharyngiomas he kumu maʻamau o ka maʻi maʻi o ka maʻi insipidus. Pono ka poʻe loea e hoʻokaʻawale i waena o ka hōʻea o ka pathology a me ke kaʻina o ka physiological e wehe i ka wai i komo i ke kino ma o ka infusions i ka wā o ka hoʻomaʻamaʻa ʻana.
ʻO nā Tumors
ʻO kahi kumu maʻamau he dysgerminoma. E hoʻolilo i ka hoʻomaka ʻana o ka maʻi, pono ka nui a i ʻole kūkaʻi paha i kahi ma kahi o ka nui o nā kelepona i kuleana no ka huna ʻana o nā vasopressin. Hiki i ka maʻi maʻi maʻi insipidus ke ulu me ka pohō o ka hypothalamus e nā metastases i mua o ka maʻi o ka pēpē, ka māmā, a me ka umauma paha.
Endocrinologist - kōkua i ka hakakā me ka pathology
Neuroinfection
ʻO nā kumu no ka hoʻomohala ʻana i ke ʻano o ka nāheleʻa o ke ʻano o ka patology he meningococcal, maʻi cryptococcal, toxoplasmosis, cytomegalovirus, ka mea i pili i ka waihona a me ka membrane o ka lolo i ke kaʻina hana.
Nā hōʻailona o ka maʻi
ʻO ka hōʻailona mua ka hōʻailona me ka make wai a me ka urination pinepine (ma ke ao a me ka pō). Hiki i ka nui o nā urine ke piʻi i 13-18 luleka i ka lā. ʻO ka mea maʻi ka ʻōhumu nei:
- ʻili maloʻo a me ka membous mucous;
- waiho kaumaha;
- nele o ka momona;
- constipation pinepine;
- ka hoʻemi ʻana o ke kaomi, tachycardia;
- ka ʻike ʻole o ka momona mau;
- pōkole o ka ulaula a me ka luaʻi;
- hoʻomoe;
- huhū, hoʻāʻelemakule, luhi.
No ka ʻike hou aku i nā hōʻailona o ka maʻi insipidus maʻi, e ʻike i kēia ʻatikala.
ʻAʻole ʻokoʻa nā hōʻailona o ka patology i nā keiki. Loaʻa i ke keiki ka paona liʻiliʻi, hōʻole i ka umauma, koho i ka wai maʻemaʻe. Ua minamina ke keiki, me nā waimaka, lehulehu paha ka waimaka a liʻiliʻi paha.
Nā ʻōpiopio - kahi hui he mau kānaka i hōʻailona ʻia e ka hoʻomohala ʻana o kahi ʻano maʻi maʻi waena
Hōʻike ʻia nā ʻōmaʻomaʻo o ka pale wai: ua emi ke ʻano o ke kino, hoʻonaninani nā hiʻohiʻona, nānā ka maka, ʻike hou ʻia ka ihu, ʻike ʻia nā paila mua. Hoʻomau pinepine ka luaʻi. Hiki i ka hoʻohemo koʻikoʻi ke alakaʻi i nā pōpoki a nalowale i ka ʻike. I kēia hihia, pono kahi kōkua kōkua koke, ʻoiai he mea hiki ke hopena ʻeha.
ʻO nā heluhelu hou e pili ana i nā hōʻike ʻana o ka diabetes insipidus i nā keiki hiki ke loaʻa ma kēiaʻatikala.
Naʻi hoʻolika
Inā hōʻike nā ʻike a pau o ka anamnesis a me nā hōʻike kulana i ka make ʻana o ka pathological a me ka urination nui loa, pono e noiʻi i nā huaʻōlelo aʻe:
- ka pae o nā peʻei o ke ala i ke koko (calcium, sodium, potassium);
- nā hōʻailona o ke kō koko a me ka waiʻai (ʻo kekahi o nā ʻokoʻa ma waena o ka maʻi a me ka maʻi diabetes);
- urea hōʻailona ma biochemistry;
- kūʻai kūikawā o ka urine;
- osmotic kahe koko a me ka wai.
Kūʻai hoʻoliʻi
ʻAʻole hiki i kēia ala ke hoʻokō i ka hiki ʻana o ka maʻi, akā e hoʻohālikelike ʻia i waena o ka indipidus diabetes kūloko a me nephrogenic. I ke kakahiaka ma luna o kahi ʻōpū ʻole, e ana i ke kaumaha o ke kino o ka mea maʻi, a ma hope o ia e ʻole e inu i nā ʻano wai. ʻO ka lōʻihi o ka manawa he 6-8-24 mau hola. I kēlā me kēia hola, ke kaupaona, ka nui a me ka maʻamau o ka urine, ua hōʻike ʻia nā hōʻailona o ka sodium a me ka osmotic concentration.
Hōʻike Desmopressin
Hana ʻia e pili ana i kahi papaʻaina o kahi hōʻike dehydration a ʻokoʻa paha iā ia. Ua kuhikuhi ʻia ka mea maʻi Desmopressin i loko o ka papa a i ʻole palapala inikua. Hoʻāʻo ʻia ka poʻe maʻi e like me Zimnitsky, ua hoʻoholo ʻia ka hoʻoneʻe ʻana o ka osmotic, nā kuhikuhi o ka sodium i ka urine aʻo ka lawe ʻana i ka lāʻau lapaʻau ma mua o ka kuhikuhi ʻia.
Nā maʻi diagnostics mea pono
Ua hoʻohana ʻia nā ʻano hana i kēia:
- MRI o ka lolo - e hiki ai iā ʻoe ke hoʻoholo i ka hele ʻana o nā pathology, akā no ka hoʻonohonoho pū ʻana i ke kumu o ka maʻi.
- ʻO ka pōkole o nā pūlima.
- X-hihi o ka māmā.
- CT nānā o ka ʻōpū ʻeha.
- Maikaʻi
Nā hiʻohiʻona hana
ʻO ka pahuhopu o ka lāʻau ʻo ia e hoʻopau i ka make nui o ka pathological a me ke urination nui, a mālama i kahi kiʻekiʻe o ke ola no ka mea maʻi. ʻO ka mea mua, ke kāpae nei i ke kumu i hopena i ka hoʻomohala ʻana o ka maʻi. A laila, kuhikuhi ʻia nā lāʻau lapaʻau ma muli o ke ʻano o ka maʻi insipidus maʻi.
ʻO kahi regimen inu hoʻokūpaʻa kekahi o nā hana o ka mālamaʻana i ka maʻi
ʻO ka mālama waena
Hoʻokumu ka hana hoʻokele waiwai o ka mea maʻi i ka nui o ka nalowale i ka nui. Inā emi iki ka nui o ka urine ma mua o 4 lita i hoʻokahi lā, ʻaʻole hoʻohana ʻia nā lāʻau lapaʻau. Kapa aku ka loea i ka lapaʻau ʻana i ka mea ʻai a me kahi regimen ʻawaʻawa kūpono.
Inā ʻoi aku ka nui o ka urine ma mua o 4 lita, e hoʻolaʻa paha i nā lāʻau lapaʻau a i ʻole nā lāʻau lapaʻau e hoʻoikaika ai i ke ʻano o ka hormone. No ka manawa lōʻihi, ua kau ʻia kahi lāʻau lapaʻau i hōʻai ʻia i ka pōkole nasal (Desmopressin). I kēia manawa, no ka hoʻololi ʻana o ka lāʻau maʻi, ua hoʻohana ʻia kekahi mea hoʻomohala o Minirin.
Ke hōʻemi nei i nā huaʻai e hoʻōla i ka hana antidiuretic hormone: Chlorpropamide, Carbamazepine, Miskleron.
E aʻo hou e pili ana i nā alakaʻi aʻoaʻo maʻi diabetes i kēia ʻatikala.
ʻO ka hoʻomaʻamaʻa o ke keiki
ʻO ka mea mua, hoʻomohala ʻia ke kaʻina o ka hana hou ʻana i ka wai. A laila, ua kuhikuhi ʻia nā lāʻau lapaʻau:
- Kahi mea ʻole ʻo Thinzide diuretics, akā me ka maʻi maʻi o ka maʻi insipidus ua kōkua lākou i ka hoʻihoʻi ʻana o ka wai i ka wā o ka hoʻoneʻe i ka lua. Nā ʻelele o ka hui - Hydrochlorothiazide, Indapamide.
- Nā NSAID - no ka nui o nā kaʻina kūikawā, hoʻonui ka nui o nā hui i ka osmolarity o ka urine a hōʻemi i kāna kumukūʻai (Indomethacin, Ibuprofen).
ʻO ka lāʻau lapaʻau ka ʻāpana o ka mālama nui
Hāʻawi ʻia ke kaʻi ʻia me nā mea lapaʻau me nā kānaka, akā, ma hope o ke kūkākūkā ʻana me ka endocrinologist no ka mālama ʻana.
Hoʻopau i kahiʻai maʻi
Hoʻokumu ʻia ka Diet no ka maʻi maʻamau o ka maʻi diabetes.
- e kaupalena ana i ka paakai a me ka 4 g i ka la;
- ka papa ʻai ʻole me ka paʻakai, hoʻohui i ka paʻakai i ka pā i pau;
- ka hoʻohana ʻana o nā hua maloʻo;
- hoole ana o nā ʻulana;
- kūlike i nā inu ʻaka;
- ka hana ʻana i nā lau momona hou mai nā huaʻai, nā hua ʻaiwa a me nā mea ʻai hua ʻai, nā hua iʻa, nā hua;
- ka paa ʻana o ka protein, a me nā kinamona a me nā momona e pono i ka nui o ka nui;
- ʻaiʻaiʻai i loko o nā wahi liʻiliʻi.
He mea nui hoʻi e hoʻomanaʻo o ka maʻi pono i ka hopena maikaʻi. Me ka kipa manawa e kipa aku ai i kahi loea, ma hope o nā ʻōlelo a me ke kāpae ʻana i ke kumu, hiki iā ʻoe ke hoʻokō me ka wikiwiki.
