Exocrine pancreatic insufficiency: ua rau, cov tsos mob, kho thiab tiv thaiv

Kev ntshai thiab kev tswj hwm lub luag haujlwm ntawm cov neeg ua haujlwm secretory ntawm cov txiav

Cov kua txiv tsis muaj zog ntawm lub plab khoob yuav muaj ntau zuj zus thaum (2-3 feeb) thiab tom qab noj mov. Hauv cov xwm txheej ib txwm muaj ntawm kev noj zaub mov, kua txiv quav yeeb pib tshem tawm pib los ntawm qhov pom, tsis hnov ​​ntxhiab tsw ntawm cov khoom noj thiab lwm yam ua rau kev yoo mov nrog cov khoom noj, uas qhia txog qhov ua kom tsis muaj pa zais zis. Nrog kev voos ntawm lub receptors ntawm qog ua kua ntawm lub qhov ncauj kab noj hniav, pharynx, thiab txoj hlab pas nrog cov khoom noj khoom haus, ib qho kev ua haujlwm tsis txawv txav ntawm cov kua txiv quav yeeb tuaj. Kev puas siab puas lub cev los ntawm kev txais kev khaus tawm ntawm txoj kev sib nkag siab mus txog rau ntawm lub plawv ntawm cov hlab leeg, qhov chaw lawv hloov mus rau ntawm cov hlab hlwb ntawm qhov chaw mos ntawm lub cev tsis qab, nrog rau cov kab ntawm lub cev uas mus txog postganglionic neurons. Lawv cov axon ua thooj synaptic nyob rau hauv qab daus daim nyias nyias ntawm pancreatitis. Acetylcholine raug tso tawm thaum lub sij hawm zoo siab ntawm cov xaus no ua rau M-cholinergic receptors ntawm cov kab mob postynaptic. Hauv qhov no, kev sib kho theem nrab (Ca ++ thiab HC-cGMP) tso tawm, uas ua rau muaj kev ua haujlwm zais cia ntawm lub hlwb thiab cov hlwb epithelial ntawm ducts. Thaum ua rau lub plab tsis zoo rau cov leeg ntshav, uas ua rau lub siab ntawm kev txiav txim siab ntawm tus txiav, ua rau nws txoj kev zais cia yog tshuaj tiv thaiv (vim muaj kev ua haujlwm ntawm p-adrenergic receptors los ntawm tus kws kho mob) Cov. Tab sis kev cuam tshuam ntawm kev zais cia yog nrog los ntawm cov ntaub ntawv zais cia hauv cov khoom siv pancreatitis. Kev noj zaub mov rau lub plab thaum noj mov ua rau lub cev ua rau lub cev ua rau lub cev ua rau lub cev ua rau lub cev ua rau lub cev tsis zoo, nrog rau cov kua tsis ua haujlwm nrog rau lub cev ua rau lub plab zom mov, ua rau muaj kev ua kom lub plab ntawm lub qhov ncauj ua rau lub plab, nrog rau duodenopancreatic secretory. ) lub tso pa tawm ntawm gastrointestinal cov tshuaj hormones los ntawm cov kab mob endocrine uas tsim kho lossis inhibit kua txiv qab zib tso pa tawm. Lub luag haujlwm ntawm tus tswj lub luag haujlwm tseem ceeb yog ua los ntawm secretin thiab CCK, uas yog tsim los ntawm S- thiab CCK hlwb ntawm duodenal mucosa. Kev zais cia thiab CCK txhawb nqa ib leeg qhov kev cuam tshuam rau pancreatocytes, tshwj xeeb tshaj yog tiv thaiv keeb kwm yav dhau los ntawm kev tso tawm ntawm acetylcholine nyob rau hauv lub synaptic xaus ntawm cholinergic cov leeg xov uas innervate lub caj pas. Ib qho tseem ceeb humoral causative tus neeg sawv cev ntawm pancreatic secretion yog gastrin, zais los ntawm U hlwb ntawm mucous daim nyias nyias ntawm antrum. Cov nyhuv stimulating ntawm cov tshuaj hormones no tau txais kev txhawb los ntawm bombesin, serotonin thiab insulin. Somatostatin, glucagon, enkephalins, tshuaj P, TIP, PP, ntxiv rau calcitonin thiab ACTH inhibit qhov tso pa tawm ntawm cov kua txiv. Tab sis lawv lub luag haujlwm hauv qhov yooj yim humoral kev cai ntawm cov txiav tsis zoo to taub. Kev haus dej qab zib zais cia yog nqa tawm hauv peb theem. Thawj yog hu ua reflex. Nws yog tshwm sim los ntawm cov nyom uas tsis muaj kev tswj hwm thiab tsis muaj kev xav txog ua ntej thiab nrog ua khoom noj. Hauv thawj theem, txog 10-15% ntawm tag nrho cov kua txiv yog tso tawm rau peb theem, thiab li 25% ntawm cov enzymes. Hauv theem ob ua pais plab, kwv yees li 10% ntawm cov kua txiv ntawm nws cov ntim tag nrho (nrog cov ntsiab lus siab ntawm enzymes) yog tsim tawm. Hauv qib peb plab hnyuv, cov kua txiv tseem ceeb (li 75% ntawm tag nrho cov ntim), tab sis cov nplua nuj tsawg hauv cov enzymes, yog zais. Nws cov muaj pes tsawg leeg tau pom los ntawm cov ntsiab lus siab ntawm bicarbonates tsim nyog rau alkalizing cov ntsiab lus ntawm duodenum.

Daim pib 27

Cerebellar muaj nuj nqi.

Cov cerebellum muaj 2 lub hemispheres thiab cov cab nkag ntawm lawv.

Cov teeb meem txho tuaj yeem ua cov tawv ntoo thiab cov nuclei. Dawb yog tsim los ntawm cov txheej txheem ntawm cov neurons.

Lub cerebellum tau txais afferent hlab ntsha impulses los ntawm tactile receptors, vestibular receptors, proprioreceptors ntawm cov leeg thiab cov leeg, nrog rau cov kem ib cheeb tsam ntawm lub cortex. Efferent impulses los ntawm cerebellum mus rau lub pob liab liab ntawm midbrain, Deiters nucleus ntawm medulla oblongata, thalamus, thiab tom qab ntawd mus rau qhov chaw tsav ntawm CBP thiab subcortical nuclei. Ib qho kev ua haujlwm ntawm cerebellum yog txoj cai ntawm kev coj ntawm lub cev thiab txav mus los. Nws ua txoj haujlwm no los ntawm kev saib xyuas cov haujlwm ntawm lwm qhov chaw qoj ib leeg: vestibular nuclei, nucleus liab, cortical pyramidal neurons.

1. Kev tswj hwm ntawm cov leeg nqaij thiab tus cwj pwm nruj.

2. Kev kho ntawm cov kauj ruam qeeb thaum lub sijhawm lawv siv, nrog rau kev ua haujlwm ntawm cov txav no nrog kev rov qab zoo thiab lub cev qhov chaw.

3. Saib xyuas qhov tseeb ua tiav ntawm kev txav ceev tau los ntawm daim tawv ntoo.

Vim yog qhov tseeb tias cerebellum ua cov haujlwm no, thaum nws raug tshem tawm, ua rau txoj haujlwm ntawm lub cev muaj zog, hu ua Luciani triad, kev loj hlob. Nws suav nrog:

1. Pom lub cev thiab dystonia - txo qis thiab kev faib khoom tsis tsim nyog ntawm cov leeg pob txha suab.

2. Astasia - qhov tsis yooj yim ntawm kev txuam nrog tas mus li ntawm tus nas, tswj lub cev ruaj khov thaum sawv, zaum (zaum (co tawm).

3. Asthenia - cov leeg nrawm nrawm nrawm.

4. Ataxia - txoj haujlwm tsis zoo ntawm kev txav thaum taug kev. Qhov tsis khov kho tsis txaus ntseeg lub gait.

5. Adiadhokinesis - qhov ua txhaum ntawm qhov tseeb ntawm kev hloov mus ceev.

Hauv qhov chaw kuaj mob, cov kab mob cerebellar muaj mob me me yog pom los ntawm Charcot triad:

1. Nystagmus ntawm lub qhov muag ntawm so.

2. Tshaj plaws ntawm qhov kawg uas tshwm sim los ntawm lawv qhov kev tsiv.

3. Dysarthria - hais lus tsis meej.

L. A. Orbeli tau tsim los tias cerebellum cuam tshuam ntau yam txoj kev ua kom loj, cov cawv tuaj yeem ua tau zoo siab thiab inhibitory. Piv txwv, nrog kev voos cerebellum, ntshav nce siab lossis poob qis, lub plawv dhia, kev ua pa thiab hloov plab zom mov. Lub cerebellum cuam tshuam metabolism hauvCov. Nws ua los ntawm cov chaw zov me nyuam lub zog, tswj lawv cov haujlwm nrog kev txav. Lub luag haujlwm ntawm cov khoom nruab nrog sab hauv hloov pauv vim qhov hloov pauv hauv cov metabolism hauv lawv. Yog li ntawd, cov cerebellum siv kev hloov kho kom zoo rau lawv.

Tsis pom qhov koj tab tom nrhiav? Siv txoj kev tshawb:

Cov lus zoo tshaj:Zoo li nkawm niam txiv, ib tus kws qhia ntawv tau hais thaum qhuab qhia xaus - nws yog qhov kawg ntawm khub: "Qee yam tsw zoo li thaum kawg ntawm no." 8174 - | 7856 - lossis nyeem tagnrho.

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Dab tsi yog exocrine pancreatic tsis txaus?

Kev zom zaub mov - Nov yog cov txheej txheem nyuaj thiab ntau theem txheej txheem.

Nws pib txawm nyob rau hauv lub qhov ncauj kab noj hniav, thaum koj zom thawj daim thiab moisten nws nrog qaub ncaug. Sai li sai tau cov khoom noj tau nqos, lub plab nkag los ua nrog nws cov hydrochloric acid thiab pepsin.

Tom qab li 30 feeb, cov zaub mov zom zom tau nkag mus rau hauv txoj hnyuv me, uas yog duodenum, hauv nws qhov pib. Ntawm no, tus txiav nrog kev pabcuam ntawm cov enzymes tsoo cov lwg me me loj rau hauv cov khoom yooj yim thiab ntau dua haum rau kev nqus hauv cov ntshav.

Qhov txiav ua ke, nrog rau kev ua kom muaj kua qaub ncaug thiab cov qog ua hws, yog ib qho ntawm cov qog tseem ceeb tshaj plaws ntawm kev zais tawm sab nraud. Qhov no txhais tau tias nws tso cov tshuaj lom neeg lom rau thaj chaw los ntawm cov kav dej tshwj xeeb. Lub txiav ua pa tseem muaj lub cev ua haujlwm endocrine: nws muaj nyob hauv kev tsim cov tshuaj hormones insulin, somatostatin, ghrelin thiab pancreatic polypeptide hauv tib neeg cov ntshav.

Yog tias koj tus txiav ua kom lub cev noj qab haus huv, nws tsis tuaj yeem tsis tsuas yog muab cov zaub mov zom, tab sis kuj txhawb nqa cov metabolism, nrog rau cov piam thaj. Nrog exocrine tsis txaus, digestive enzymes ua tsis txaus, thiab lub cev yog vim li cas thiaj tsis muaj cov vitamins thiab cov as-ham.

Yog tias tsis kho, exocrine tsis ua hauj lwm tuaj yeem ua rau me nyuam kev loj hlob thiab kev loj hlob, ua rau muaj teeb meem ntawm cov pob txha pob txha, tawm hauv lub cev tiv thaiv kev tiv thaiv kab mob thiab ua rau lub neej luv.

Ua rau exocrine pancreatic tsis txaus

Cov laj thawj ntawm exocrine tsis ua hauj lwm muaj ntau. Txhua yam uas ua rau puas tsuaj rau lub txiav lossis thaiv qhov tso tawm ntawm nws cov enzymes tuaj yeem ua rau tus mob no. Cov kev mob tshwm sim feem ntau, raws li peb tau hais, yog mob pancreatitis thiab cystic fibrosis.

Cystic fibrosis, lossis cystic fibrosis - Muaj qhov tshwm sim tsis tu ncua nyob rau hauv cov keeb kwm uas qhov tuab thiab khov ua tso tawm rau hauv cov zom zaub mov thiab lub tshuab ua pa, txhaws lub ducts ntawm lub txiav, nrog rau bronchioles thiab bronchi me me.

Nyob rau hauv ntev mob ntawm tus txiav - pancreatitis - ntaub so ntswg ib txwm yog maj mam hloov los ntawm tsis zoo caws pliav nqaij. Nyob rau tib lub sijhawm, kev khiav haujlwm ntawm cov qog ua kom lub qog ua kom tsis zoo, ua kom cov enzymes tsawg zuj zus, thiab koj lub cev tsis tuaj yeem kho txawm tias cov zaub mov li ib txwm muaj.

Kev tshawb fawb pom tseeb hais txog qhov sib txuas ntawm kev haus luam yeeb thiab mob ntsws qhuav.

Lwm yam ua rau exocrine pancreatic insufficiency:

• mob kheesxaws pancreatic
• Kev phais tawm ntawm ib feem ntawm lub qog
• Thaiv ntawm lub pancreatic duct
• Celiac enteropathy
• Crohn's mob
• Mob caj dab
• mob ntshav qab zib
• Zollinger-Ellison syndrome
• Cov mob tom qab phais mob txoj hnyuv
• tso pob tseg rau mob

Cov tsos mob ntawm exocrine pancreatic tsis txaus

Tus mob no tuaj yeem nyuaj rau kev kuaj mob vim tias nws cov tsos mob cuam tshuam nrog lwm yam kab mob, suav nrog kev ua tsis taus pa phoov, mob plab, mob plab, mob gallstone, mob plab hnyuv, thiab lwm yam.

Feem ntau cov feem ntau, exocrine pancreatic insufficiency nws tus kheej li mob raws plab ntev thiab poob phaus. Steatorrhea yog cov xeeb ceem - tso tawm ntawm cov roj ntau ntawm cov tsis muaj rog nrog cov quav, uas muab cov quav uas muaj roj thiab tsw ntxhiab tsw.

Lwm cov tsos mob ntawm exocrine tsis ua haujlwm:

• Tsis muaj zog thiab nkees
• Kev tsim cov roj ntau dhau
• Ua mob rau hauv plab nruab nrab, txuas ntxiv rau tom qab
• Poob hauv cov leeg, qhov ua tsis tau poob zoo
• Cov cim ntawm hypovitaminosis (thim cov rau tes, plaub hau poob)

Kev kuaj mob ntawm exocrine pancreatic tsis txaus

Paub cov tsos mob no tsis txaus. Qhov teeb meem yog mob raws plab tsis tuaj yeem mus txog thaum lub qog tau poob 90% ntawm nws lub peev xwm, uas yog, rau qee lub sijhawm tus kab mob tuaj yeem tshwm sim nrog cov quav ib txwm.

Txhawm rau kom paub tseeb exocrine pancreatic tsis txaus, koj xav tau kev kuaj quav, kuaj ntshav rau cov vitamins thiab fatty acids, nrog rau suav tomography - txheeb xyuas cov hauv paus hauv ntsis.

Kev khomob thiab kev tiv thaiv

Kev kho mob rau exocrine tsis txaus yuav tsum tau pib kho mob sai li sai tau.

Pancreatic enzyme hloov txoj kev kho yog tus txheej txheem kub hauv kev kho tus mob no. Txog kev hloov kho, ib qho loj ntawm cov tshuaj siv yog siv uas muaj cov kabmob npua pancreatic, thiab qee zaum ntxiv cov khoom siv ntxiv.

Cov tshuaj no muaj cov lipolytic (zom cov rog), amylolytic (zom hmoov txhuv nplej siab) thiab proteolytic (zom cov protein) cov haujlwm, uas ntsuas hauv cov qauv txheem - 8000, 10000, 20,000. Cov no suav nrog pancreatin, mezim, panzinorm, festal, creon, pangrol thiab lwm yam tshuaj Cov.

Pancreatic enzyme hloov txoj kev kho, zoo li nws tau ua haujlwm uas tsis tuaj yeem kho tus txiav Nws tsis kho lub qog, tab sis tuaj yeem txhawb nqa tus neeg mob lub cev tau ntau xyoo, cia koj nqus cov khoom noj muaj txiaj ntsig.

Ib qho tseem ceeb heev hauv kev kho mob ntawm exocrine pancreatic insufficiency yog ua si los ntawm kev noj zaub mov kom raug thiab lub neej noj qab nyob zoo..

Cov neeg mob yuav tsum qhia raws li nram no:

• Kev ntxhov siab ua kom tsis txhob muaj mob
• Txiav kev haus luam yeeb thiab cawv
• Nquag noj pluas mov me me
• Noj kom tsawg nrog cov rog tsawg
• Noj cov tshuaj vitamin (tshwj xeeb tshaj yog cov vitamins A, D, E thiab K)

Pancreatic Enzyme Kev Tso Cai

Ib qho ntawm cov haujlwm tseem ceeb yog kev ua tiav ntawm pancreatic enzymes.

Xws li cov enzymes muab kev zom ntawm txhua hom zaub mov.

Cov enzymes uas ua los ntawm kev txiav yog los ntawm ntau pab pawg.

Cov enzymes ntau heev tshaj plaws yog cov khoom tiv thaiv. Qhov ntau ntawm cov pab pawg no ntawm pancreatic enzymes yog vim muaj ntau yam sib txawv ntawm cov protein.

Cov enzymes proteolytic uas zom cov khoom sib txuas protein suav nrog cov khoom xyaw nquag hauv qab no:

Ntxiv rau qhov no, hlau tsim tawm:

1. Lipase - lub chaw tub rog uas zom cov rog rog.
2. Amylase yog ib qho khoom xyaw uas cais cov polysaccharides.
3. Nucleases yog cov txheej txheem ntawm cov enzymes uas ua kom cov cleavage ntawm nucleic acids.

Yog tias muaj qhov tsis sib haum xeeb hauv kev tsim cov kua txiv ua kua txiv hmab txiv ntoo, ntau qhov ua haujlwm tsis zoo ntawm lub plab zom mov tau pom, uas ua rau kev zom cov zaub mov tsis zoo thiab ua rau lub cev tsis ua haujlwm.

Ua tsis tiav cov tshuaj enzymes ua rau kev txhim kho ntawm tsis muaj txiaj ntsig ntawm exocrine pancreatic muaj nuj nqi.

Ua txhaum ntawm exocrine pancreatic muaj nuj nqi

Qhov ua rau ntawm exocrine pancreatic muaj nuj nqi cuam tshuam yog kev txhim kho ntawm cov kab mob hauv nruab nrog. Feem ntau, cov xwm txheej no tshwm sim los ntawm cov nqaij mob ua rau mob nqaij ntshiv lossis mob txha caj qaum, thaum cov txheej txheem ua rau lub cev ua rau kev puas tsuaj ntawm ib feem ntawm tus txiav npluav txha caj qaum.

Kev ua haujlwm Exocrine yog qhov tsis muaj zog nyob rau hauv feem ntau cov neeg mob uas muaj mob txha caj qaum.

Kev ntseeg tau tias muaj pov thawj txuas tau nrog kev txhim kho tsis ua hauj lwm, kev haus luam yeeb thiab mob ntsws qhuav.

Lwm qhov ua rau kev txhim kho kabmob yog:

• Oncological neoplasm nyob rau hauv cov ntaub so ntswg ntawm lub qog.
• Kev phais tawm ntawm ib feem ntawm cov qog ua qog.
• Qhov tshwm sim ntawm kev khaus ntawm pancreatic ducts.
• Kev tsim kho ntawm celiac enteropathy.
• Kev txhim kho ntawm Crohn's mob.
• Kev nce qib ntawm autoimmune pancreatitis.
• Mob ntshav qab zib mellitus.
• Kev loj hlob hauv lub cev ntawm Zollinger-Ellison.
• Tej yam mob tom qab txiav tawm ntawm txoj hnyuv.
• Kev tsim cov mob pob tseg.

Lwm qhov laj thawj ntawm kev nce qib ntawm pancreatic tsis txaus ntseeg yog qhov kev vam meej hauv tus neeg mob lub cev ntawm cystic fibrosis lossis cystic fibrosis, qhov kev txiav txim siab rau cov caj ceg hauv cov txheej txheem uas tsim kom muaj cov tuab thiab khov ua kom tsis txhob txhawm rau txhawm rau ua kom lub plab thiab hlab ntsws txhaws.

Cov tsos mob tseem ceeb ntawm kev ua haujlwm tsis zoo hauv lub cev yog kem plab thiab qhov pom ntawm dyspeptic cuam tshuam.

Tus mob no yog pom los ntawm cov tsos ntawm cov cim tseem ceeb hauv qab no:

1. polyfecals,
2. heev thiab xoob tso quav
3. cov tsos ntawm cov rog hauv cov quav,
4. qhov tshwm sim ntawm kev ib ce heev,
5. poob phaus.

Nyob rau hauv cov ntaub ntawv ntawm kev loj hlob ntawm endocrine tsis txaus, tus neeg mob muaj mob ntshav qab zib mellitus. Hom ntshav qab zib hom no yooj yim dua li ntshav qab zib hom 1. Qhov no yog vim qhov tseeb hais tias tsis yog txhua lub hlwb ntawm islets ntawm Langerhans.

Feem ntau, cov neeg mob zoo li no tom qab ib pliag xav tau kev qhia ntxiv ntawm cov tshuaj insulin.

Qee qhov xwm txheej, nws hloov tawm mus rau qhov qub theem ntawm cov piam thaj hauv cov ntshav uas siv cov tshuaj noj tshwj xeeb thiab cov tshuaj hypoglycemic.

Cov tsos mob thiab kuaj mob ntawm exocrine tsis ua hauj lwm

Kev ua tsis tau yog qhov nyuaj rau kev kuaj mob.Qhov no yog vim qhov tseeb hais tias tag nrho cov tsos mob ntawm tus kab mob pathological no zoo ib yam li cov tsos mob ntawm lwm cov kab mob, ntawm cov uas muaj qhov mob zoo li mob plab hnyuv voos, peptic rwj, cholelithiasis, mob hauv cov hnyuv thiab lwm yam.

Qhov feem ntau pom ntawm exocrine caj pas tsis ua hauj lwm yog qhov tshwm sim ntawm mob zawv plab ntev thiab poob phaus.

Lwm cov tsos mob ntawm tus kab mob pathology tuaj yeem yog kev loj hlob ntawm hypovitaminosis manifested hauv brittle ntsia hlau thiab plaub hau ploj.

Qhov teeb meem ntawm kev kuaj pom tus kab mob pathological yog qhov tseeb tias nws tsis tshwm sim kom txog thaum lub nruab nrog cev ploj txog li 90% ntawm nws lub peev xwm. Thoob plaws lub sijhawm no, tus neeg mob tsis qhia pom cov tsos mob thiab cov quav yog qhov qub.

Txhawm rau lees paub los yog rov ua kom tus mob, ua cov kev sim hauv chav kuaj, suav nrog:

• Tsom tshuaj ntsuam.
• Kev kuaj ntshav rau ntshav qab zib nrog lub nra.
• Kuaj ntshav rau cov vitamins thiab fatty acids.
• Ntshav qab zib rau qab zib.

Tsis tas li ntawd, suav tomography yog ua tiav, uas tso cai rau koj los txheeb xyuas cov hauv paus hauv kev tshwm sim ntawm cov kab mob pathological hauv kev ua haujlwm ntawm cov khoom nruab nrog.