Exocrine pancreatic insuffence: lisosa, matšoao, kalafo le thibelo

Mokhoa o hlasimollang le o tlotlollang oa tšebetso ea lekunutu ea manyeme

Jusi e fokolang ka mpeng e se nang letho e eketseha haholo nakong ea (2-3 metsotso) le ka mor'a ho ja. Maemong a tloaelehileng a ho ja lijo, ho tlosa lero la pancreatic ho se ho qala ka pono, monko oa lijo le tse ling tse halefisang tse tsamaeang le lijo, tse bonts'ang mokhoa oa secretion oa boemo bo tlase. Ka ho khopisa li-receptor tsa membrane ea mucous ea mokokotlo oa molomo, pharynx, le esophagus ka lintho tsa lijo, ho hlaha lefapha le sa tsebeng letho la lero la pancreatic. Litlamorao tse tsoang ho li-receptor tse halefileng ka litsela tse amanang le tsona li fihla setsing sa bulbar sa secretion ea pancreatic, moo li fetohang li-neuron tsa "preganglionic" tsa "nerus nerve nuclei", hammoho le likhoele tse sebetsang hantle tse fihlellang li-postganglionic neurons. Li-axon tsa tsona li etsa litlamorao tsa mokokotlo ka mokokotlong o ka tlase oa pancreatitis. Acetylcholine e lokollotsoeng nakong ea ha e khahlisoa ke lintlha tsena e kenya tšebetsong li-M-cholinergic receptors tsa membynane ea postynaptic. Tabeng ena, babuelli ba bobeli (Ca ++ le HC-cGMP) ba lokolloa, e leng sesosa sa ts'ebetso ea lekunutu ea lisele tsa pancreatic le lisele tsa epithelial tsa ducts.Ha ho halefisa methapo ea kutlo, e etsang ts'ebetso e nang le kutloelo-bohloko ea pancreas, secretion ea eona e thibetsoe (ka lebaka la ts'ebetso ea p-adrenergicator ea pre adrenergicator. . Empa thibelo ea secretion e tsamaisana le ho bokellana ha boitsebiso ba sephiri ho pancreatitis. Ho kenella ha lijo ka mpeng nakong ea ho kenella ho baka ho teneha ha chemo- le li-mechanoreceptor tsa mpa, tse lebisang ho tsoelleng ha secretion ea Reflex ea secondtion ea li-pancreas, e bakoang ke ho ts'oaroa ha li-receptors tsa patlo ea molomo le ho kenella ka hare ho duodenum ea se ka mpeng ea gastricorcin. ) secretion ea li-hormone tsa gastrointestinal tse tsoang liseleng tsa endocrine tse ntlafatsang kapa tse thibelang secretion ea lero la pancreatic. Karolo ea batsamaisi ba bohlokoa ba humors e etsoa ke siriin le CCK, tse hlahisoang ke S- le lisele tsa CCK tsa mucosa ea duodenal. Secretin le CCK ba matlafatsa tšusumetso ea e mong le e mong ho li-pancreatocytes, haholo-holo khahlanong le semelo sa ho lokolloa ha acetylcholine lipheletsong tsa synaptic tsa li-fiber tsa methapo ea cholinergic tse ka hare ho mofetše. Moemeli oa bohlokoa oa humusative ea pancreatic secretion ke gastrin, e bolokiloeng ke lisele tsa U tsa mucous membrane ea antrum. Matla a susumetsang a lihormone tsena a tšehetsoa ke bombesin, serotonin le insulin. Somatostatin, tsoekere, enkephalin, ntho P, TIP, PP, hammoho le calcitonin le ACTH li thibela secretion ea lero. Empa karolo ea bona ho molao o rarahaneng oa makhopho ha a utloisisehe hantle. Secretion ea lero la pancreatic e etsoa ka mekhahlelo e meraro. Ea pele e bitsoa Reflex. E bakoa ke tšusumetso ea maemo le lintho tse sa hlokeheng tse tlang pele le tse tsamaeang le phepelo ea lijo. Karolong ea pele, hoo e ka bang li-10% tsa jusi ea kakaretso e lokolloa ka mekhahlelo e meraro, le 25% ea li-enzyme. Karolong ea bobeli ea gastric, ho hlahisoa hoo e ka bang 10% ea lero la eona (le nang le enzymes e phahameng). Karolong ea boraro ea mala, palo e ka sehloohong ea lero (hoo e ka bang 75% ea bophahamo bohle), empa e sa fuoe li-enzyme tse ngata e bolokiloe. Sebopeho sa eona se tšoauoa ka litaba tse phahameng tsa bicarbonate tse hlokahalang bakeng sa ho kopanya litaba tsa duodenum.

Tekete ea 27

Ts'ebetso ea cerebellar.

Cerebellum e na le li hemispheres tse peli le seboko pakeng tsa tsona.

Taba ea Grey e etsa bark le nuclei. Bosoeu bo bopeha ka tšebetso ea li-neuron.

Cerebellum e amohela litšusumetso tse amanang le methapo ea kutlo tse tsoang ho li-tactile receptors, li-vestibular receptors, proprioreceptors ea mesifa le tendon, hammoho le likarolo tsa motor tsa cortex. Litlamorao tse sebetsang tsa "cerebellum" li ea ho "khubu" e khubelu ea methapo, methapo ea Deiters ea medulla oblongata, thalamus, ebe e ea libakeng tsa makoloi tsa CBP le subcortical nuclei. Ts'ebetso e tloaelehileng ea cerebellum ke taolo ea ho ema le ho sisinyeha. O etsa mosebetsi ona ka ho hokahanya tšebetso ea litsi tse ling tsa makoloi: vestibular nuclei, khubu ea khubelu, cortical pyramidal neurons.

1. Taolo ea molumo oa mesifa le boemo ba 'mele.

2. Khalemelo ea metsamao e liehang ho sebetsa nakong ea ts'ebetso ea ona, hammoho le khokahano ea metsamao ena ka maikutlo le boemo ba 'mele.

3. Ho beha leihlo ts'ebetso e nepahetseng ea metsamao e potlakileng e entsoeng ke makhapetla.

Ka lebaka la hore mokopu o etsa mesebetsi ena, ha o tlosoa, ho ba le bothata bo boholo ba mathata a makoloi, bo bitsoang Luciani triad. E kenyeletsa:

1. Agony le dystonia - ho fokotseha le ho ajoa ho sa lokelang ha molumo oa mesifa ea marapo.

2. Astasia - ho sa khonehe ha karohano e tsoelang pele ea panya, ho boloka boemo bo tsitsitseng ba 'mele ha u eme, u lutse (wigrag).

3. Asthenia - mokhathala o potlakileng oa mesifa.

4. Ataxia - ts'ebelisano e mpe ea metsamao ha u tsamaea. Mofuta o sa tsitsang oa tahi.

5. Adiadhokinesis - tlolo ea tatellano e nepahetseng ea metsamao e lebisitsoeng ka potlako.

Tleliniking, liso tse tloaelehileng tsa "cerebellar" li bonts'oa ke Charcot triad:

1. Nystagmus ea leihlo phomolong.

2. Mofuthu oa lipheo tse hlahisitsoeng ke ho sisinyeha ha tsona.

3. Dysarthria - mathata a puo.

L. A. Orbeli o thehile hore cerepatum e ama tse fapaneng mesebetsi ea limela, litšusumetso tsena e ka ba tse thabisang le tse thibelang. Mohlala, ka ho ts'oenya ho ts'oaroa ha pelo, khatello ea mali ea eketseha kapa ea fokotseha, sekhahla sa pelo, phefumoloho le phetoho ea tšilo ea lijo. Cerebellum e ama metabolism. E sebetsa har'a litsi tsa methapo ea kutlo, e hokahanya tšebetso ea bona le motsamao. Mesebetsi ea litho tsa ka hare e fetoha ka lebaka la phetoho ea li-metabolic process ho tsona. Ka hona, "cerebellum" e ka ba le tšusumetso e matla ea boitšoaro ho bona.

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What is exocrine pancreatic insuffence?

Tšilo ea lijo - Ona ke mohato o rarahaneng ebile o le mekhahlelo e mengata.

E qala leha e le ka har'a molomong oa molomo, ha o hlafuna karolo ea pele ebe o e roka ka mathe. Hang ha lijo li entsoe, mpa e qala ho sebetsa ka hydrochloric acid le pepsin.

Kamora metsotso e ka bang 30, lijo tse halikiloeng li kena ka mpeng e nyane, e leng duodenum, karolong ea eona ea pele. Mona, manyeme ka thuso ea enzymes a roba limolek'hule tse kholo hore li be bonolo le ho loketseng haholoanyane ho kenngoa maling.

Makhopho a makhopho, hammoho le litšoelesa tse tsoang mokhoeng le mofufutso, ke e 'ngoe ea litšoelesa tsa bohlokoahali tsa secretion ea kantle. Sena se bolela hore e tšolla lintho tse sebetsang ho tsa tlhaho ka holim'a li-ducts tse khethehileng. Manyeme e boetse e na le ts'ebetso ea endocrine: e na le tlhahiso ea li-insulin tsa li-hormone, somatostatin, ghrelin le pancreatic polypeptide maling a motho.

Haeba makhopho a hao a phetse hantle, a ka se fane feela ka tšilo ea lijo, empa hape a ts'ehetsa metabolism, ho kenyeletsa le tsoekere. Ka lebaka la ho haella ha li-exocrine, li-enzyme tsa tšilo li haella, 'me' mele o haelloa ke livithamini le limatlafatsi.

Haeba a sa phekoloe, ho hloleha ho tsoa ho 'mele ho ka liehisa kholo le kholo ea bana, ho lebisa mathateng ka lithane tsa masapo, ho siea mmele o sa itšireletse khahlanong le ts'oaetso le ho khutsufatsa bophelo.

Lisosa tsa ho hloka inshorense ea pancreatic

Lisosa tsa ho hloleha ha exocrine li ngata. Ntho efe kapa efe e senyang manyeme kapa e thibelang ho lokolloa ha li-enzyme tsa eona e ka baka boemo bona. Lisosa tse atileng haholo, joalo ka ha re se re boletse, ke pancreatitis e sa foleng le cystic fibrosis.

Cystic fibrosis, kapa cystic fibrosis - Ke lefu le sa phekoleheng la liphatsa tsa lefutso leo ho lona ho lokolloang lekunutu ka hare ho ts'ilo ea lijo le ho phefumoloha, le koaloang marang-rang a manyeme, hammoho le bronchioles le bronchi e nyane.

Ka ho ruruha ho sa feleng ha manyeme - pancreatitis - butle-butle tiske e tloaelehileng e nkeloa sebaka ke lisele tsa letlalo tse se nang thuso. Ka nako e ts'oanang, mesebetsi ea gland e senyeha, tlhahiso ea li-enzymes ea fokotseha, 'mele oa hau o khaotsa ho sebetsana le lijo tse tloaelehileng.

Lithuto tsa mahlale li tiisa khokahano lipakeng tsa ho tsuba le pancreatitis e sa foleng.

Lisosa tse ling tsa ho haella ha pancreatic pancreatic:

• mofetše wa pancreatic
• Ho tlosa tšebetso ea karolo e itseng ea tšoelesa
• Blockage ea pancreatic duct
• Celiac Enteropathy
• Lefu la Crohn
• Autoimmune pancreatitis
• lefu la tsoekere
• Leqhubu la Zollinger-Ellison
• Maemo ka mor'a ho buuoa ka mpeng
• lefu la ho lahla

Matšoao a ho ba le inshorense ea pocreatic ea ho haella

Boemo bona bo ka ba thata ho bo tseba hobane matšoao a bona a kopana le maloetse a mang, ho kenyelletsa lefu la mothapo o bohloko, seso sa peptic, lefu la gallstone, lefu la mokokotlo la mmele, jj.

Hangata, ho haella ha pancreatic pancreatic ho iponahatsa e le lets'ollo le sa foleng le boima ba 'mele. Steatorrhea e na le tšobotsi - ho lokolloa ha mafura a mangata a sa foleng ka furu, e fanang ka furu ponahalo ea mafura le monko o bohale o sa thabiseng.

Matšoao a mang a ho hloleha ha exocrine:

• Bofokoli le mokhathala
• Ho theha khase e ngata
• Ho utloa bohloko bohareng ba mpa, ho fihla mokokotlong
• Ho lahleheloa ke boima ba mesifa, ho fokotsa boima ba 'mele bo ke keng ba qojoa
• Matšoao a hypovitaminosis (lipekere tsa brittle, tahlehelo ea moriri)

Tlhahlobo ea ho hloka tsebo ea pocreatic pancreatic

Ho tseba matšoao ana ha hoa lekana. Bothata ke hore lets'ollo ha le hole ho fihlela tšoelesa e lahlehetsoe ke 90% ea ts'ebetso ea eona, ke hore, ka nako e itseng lefu lena le ka hlaha ka setulo se tloaelehileng.

Ho netefatsa ho haella ha "procrine pancreatic", o hloka ho hlahlojoa ha motsoako, tlhahlobo ea mali bakeng sa livithamini le mafura acid, hammoho le tomography e thathamisitsoeng - ho tseba lisosa tsa motso.

Phekolo le thibelo

Phekolo ea ho haella ha procrine e lokela ho qala kapele kamoo ho ka khonehang.

Pancreatic enzyme e tlatselletsang kalafo ke boemo ba khauta ho phekola boemo bona. Bakeng sa phekolo e nkang sebaka, ho sebelisoa motsoako o moholo oa lithethefatsi o nang le li-enzyme tsa pancreatic ea pig, ka linako tse ling likarolo tse eketsehileng tse sebetsang.

Lithethefatsi tsena li na le lipolytic (li senya mafura), amylolytic (li senya starch) le tšebetso ea protheine (e hlakola liprotheine), e lekantsoeng ka likarolo tse tloaelehileng - 8000, 10000, 20,000. Tsena li kenyeletsa pancreatin, mezim, panzinorm, festal, creon, pangrol le lithethefatsi tse ling .

Ho ka thoe ho na le kalafo ea mofuta oa "pancreatic enzyme" e sebetsang, eo mosebetsi oa makhopho o sa khone ho sebetsana le eona. Ha e khutlise litšoelesa, empa e khona ho ts'ehetsa mmele oa mokuli ka lilemo tse ngata, e o lumella ho monya limatlafatsi.

Karolo ea bohlokoahali ea ho phekola ho haella ha "procrine pancreatic" e bapaloa ke phepo e nepahetseng le bophelo bo botle..

Bakuli ba eletsoa ka tse latelang:

• Ho qoba khatello ea maikutlo
Ho tlohela ho tsuba le joala
• Lijoa khafetsa ka likarolo tse nyane
• Lijo tse leka-lekaneng ka mafura a fokolang
• Ho nka li-supplements tsa vithamine (haholo-holo livithamini A, D, E le K)

Mesebetsi ea Pancreatic Enzyme

O mong oa mesebetsi ea mantlha ke tlhahiso ea li-enzymes tsa pancreatic.

Li-enzyme tse joalo li fana ka tšilo ea mefuta eohle ea lijo.

Li-enzyme tse hlahisoang ke manyeme ke tsa lihlopha tse 'maloa.

Sehlopha sa li-enzyme tse ngata ka ho fetisisa ke liprotheine. Ho ata ha sehlopha sena sa li-enzymes tsa pancreatic ho bakoa ke ho ba teng hoa mefuta e fapaneng ea liprotheine.

Li-enzymes tsa protheine tse silang metsoako ea protheine li kenyelletsa metsoako e latelang e sebetsang:

Ntle le sena, tšepe e hlahisa:

1. Lipase - motsoako o tlokolang mafura.
2. Amylase ke karolo e sebetsang e arolang li-polysaccharides.
3. Li-nyutlelie ke motsoako oa li-enzyme tse netefatsang ho fokotseha ha li-nucleic acid.

Haeba ho na le ho ferekana ho hlahiseng likarolo tsa lero la pancreatic, ho se sebetse hantle ha litho tse ling tsa tšilo ea lijo, ho lebisang ho keneng ka botlalo ha lijo le mathata a metabolic.

Ho sitoa ha tlhahiso ea li-enzymes ho lebisa nts'etsopele ea ho haella ha mosebetsi oa pancreatic oa exocrine.

Tlolo ea ts'ebetso ea pancreatic ea exocrine

Sesosa sa mathata a ts'ebetso ea "procrine pancreatic" ke nts'etsopele ea maloetse a setho. Hangata, boemo bona bo hlaha ka lebaka la ho ruruha ha mesifa ho pancreatitis e mpe kapa e sa foleng, ha ts'ebetso ea ho ruruha e lebisa timetsong ea karolo ea pancreatic parenchyma.

Ts'ebetso ea Exocrine ha e ame hantle ho bakuli ba bangata ba nang le pancreatitis e sa foleng.

Khokahano e netefalitsoeng ea saense lipakeng tsa kholo ea ho hloleha, ho tsuba le pancreatitis e sa foleng.

Lisosa tse ling tsa nts'etsopele ea lefu lena e ka ba:

• Neclasm ea oncological liseleng tsa tšoelesa.
• Ho tlosoa ha karolo ea lithane tsa senya.
• Ketsahalo ea tšitiso ea li-dancts tsa pancreatic.
• Ntshetsopele ea celiac enteropathy.
• Nts'etsopele ea lefu la Crohn.
• Tsoelo-pele ea autoimmune pancreatitis.
• Lefu la tsoekere.
• Nts'etsopele 'meleng oa Zollinger-Ellison.
• Maemo a ts'ebetso ka mor'a ts'ebetso ea opereishene ea tšilo ea lijo.
• Nts'etsopele ea "dumping syndrome".

Lebaka le leng hape la ho haella ha pancreatic ke ho haella hoa 'mele oa mokuli oa cystic fibrosis kapa cystic fibrosis, ketso e ikemiselitseng ea liphatsa tsa lefutso e koaloang makhopho a manyeme le a bronchioles a shejoang ts'ebetsong ea tšilo ea lijo le ea ho hema.

Letšoao le ka sehloohong la ho se sebetse hantle 'meleng ke ho kenella le ponahalo ea mathata a dyspeptic.

Boemo bona bo khetholloa ke ponahalo ea matšoao a latelang a sehlooho:

1. polyfecals,
2. litulo tsa khafetsa le tse hlephileng
3. ponahalo ea mafura mefuteng,
4. ho hlaha hoa lipalesa khafetsa,
5. ho theola boima ba 'mele.

Tabeng ea kholo ea khaello ea endocrine, mokuli o hlaolela lefu la tsoekere. Mofuta ona oa lefu la tsoekere o bonolo ho feta lefu la tsoekere la mofuta oa 1. Sena se bakoa ke taba ea hore ha se lisele tsohle tsa lihlekehleke tsa Langerhans.

Hangata, bakuli ba joalo kamora nakoana ba hloka ho hlahisoa ha tekanyetso e eketsehileng ea insulin.

Maemong a mang, e fetoha tloaelo ea tsoekere maling e sebelisa lijo tse khethehileng le meriana ea hypoglycemic.

Matšoao le tšoaetso ea ho hloleha ha exocrine

Ho sitoa ho tseba hore na ho na le bothata bofe.Sena se bakoa ke taba ea hore matšoao ohle a boemo bona ba methapo ea methapo a tšoana le matšoao a mafu a mang, ao ho ona ho nang le maloetse a kang lefutso la mokokotlo, lesapo la mokokotlo, cholelithiasis, lits'oaetso tsa ts'oaetso ka mpeng le tse ling tse ngata.

Ponahatso e atileng haholo ea ho hloleha ha lets'oa la procrine ke ho ba teng ha lets'ollo le sa foleng le ho theoha hoa mmele.

Letšoao le leng la pathology e ka ba nts'etsopele ea hypovitaminosis e bonahatsang lipekere tsa brittle le tahlehelo ea moriri.

Bothata ba ho khetholla boemo ba methapo ea methapo ke hore ha e hlahe ho fihlela setho se lahleheloa ke bokhoni ba eona ba tšebetso bo 90%. Ka nako ena eohle, mokuli ha a bonts'e matšoao le setoro ke se tloaelehileng.

Ho netefatsa kapa ho hanyetsa boits'oaro, ho etsoa liteko tse ngata tsa laboratori, ho kenyelletsa:

• Tlhahlobo ea fecal.
• Teko ea mali bakeng sa tsoekere e nang le mojaro.
• Teko ea mali bakeng sa livithamini le acid e mafura.
• Teko ea mali bakeng sa tsoekere.

Ntle le moo, tomography e kopantsoeng e etsoa, ​​e u lumellang ho khetholla lisosa tsa ponahalo ea pherekano ea methapo tsamaisong ea setho.