Kugwiritsira ntchito Zolemba za Marsh kuti Zipeze Matenda Odwala

by Nancy Lapid; Yofotokozedwa ndi Emmy Ludwig, MD

Maphunziro a Marsh amatha kuwonongeka kwa m'mimba kuchokera ku matenda a leliac

Ngati mukuyesedwa matenda a celiac , dokotala wanu akhoza kuchita zolemba zamkati kuti aziwona ngati matumbo anu aang'ono awonongeka ndi gluteni , mapuloteni omwe amapezeka tirigu, balere, ndi rye. Dokotala wanu adzagwiritsa ntchito chida chachipatala, chotchedwa endoscope, ndi kamera kakang'ono kuti muyang'ane mwachindunji dongosolo lanu lakum'mimba, ndipo mutenga zitsulo zazing'ono kwambiri kuchokera m'matumbo a m'mimba mwanu.

Pambuyo pokumbukira mapulogalamu anu, munthu wodwala matenda amatha kuyang'ana zitsanzo zanu za minofu kuti awone ngati pali zowonongeka zokhudzana ndi gluten. Wodwala ameneyu amatha kusintha chikhalidwe cha zitsanzo izi pogwiritsa ntchito dongosolo lotchedwa Marsh Score. Maphunziro anu a Marsh amadziwa ngati muli ndi matenda a celiac, komanso momwe mkhalidwe wanu ulili.

Matenda a Celiac siwo okha omwe angayambitse zina mwazimenezi, ndiye chifukwa chake chiwerengero ndi chimodzi mwa mayesero opatsirana opatsirana chifukwa cha matenda a celiac-ngakhale kuti biopsy imatengedwa ngati "muyezo wa golide" wa matendawa. Zotsatira za kuyesedwa kwa magazi a celiac komanso momwe munthu angayankhire pa zakudya zopanda thanzi zingathandizenso kupeza chithandizo choyenera.

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Gawo 0

Sayansi Chithunzi / Zojambula Zithunzi

Ichi ndi chithunzi chomwe chimatengedwa panthawi yopuma. Popeza matumbo a m'mimba amawoneka achilendo, sizingatheke kuti munthuyo ali ndi matenda a celiac.

Pachifukwa ichi, chitsanzo cha biopsy chidzasankhidwa ngati Marsh Stage 0, yomwe imadziwikanso kuti "chisanafikepo". imatchedwa "pre-infiltrative" chifukwa ma lymphocytes sanayambe kusuntha, kapena "kulowa mkati," m'mimba mwake.

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Gawo 1 ndi 2

Zovala za m'mimba - Mbendera ya Marsh 1. © Ludvigsson et al, 2009

Mlingo wa 1 Marsh umatanthawuza kuti maselo omwe ali pamwamba pa matumbo, omwe amadziwika kuti maselo a epithelial, ali ndi ma lymphocytes ambiri, maselo oyera a magazi, pakati pawo kuposa momwe amachitira.

M'matumbo amtundu waing'ono, sipangakhale ma lymphocytes osapitirira 30 pa maselo 100 a epithelial, koma pa nthawi yoyesedwa gawo 1, pali zambiri kuposa izo. Ngati muli ndi gawo 1, lipoti lanu la matenda likhoza kuwerengedwa "kuwonjezeka kwa lymphocytes intraepithelial."

Matenda a Celiac siwo okhawo omwe angayambe kuwonjezeka kwa ma lymphocytes omwe amamenyana ndi matenda. Mutha kukhala ndi ma lymphocytes ambiri ngati muli ndi matenda opatsirana, matenda a Sjogren, ndi zina zomwe simukugwirizana nazo. Matenda omwe ali ndi mabakiteriya otchedwa Helicobacter pylori (omwe amathandizidwa ndi zilonda), ndipo kugwiritsidwa ntchito kwa kupweteka kwamtundu wakupha monga aspirin ndi ibuprofen, kungayambitsenso izi.

Anthu omwe ali ndi matenda oopsa omwe akutsatira chakudya cha gluten , anthu apamtima omwe ali ndi matenda a celiac, komanso anthu omwe ali ndi matenda a dermatitis herpetiformis , omwe amawoneka kuti ndi khungu la matendawa, akhoza kukhala ndi Mars 1 Chogoli.

Ndili ndi gawo 2, mumayang'ana ma lymphocytes ambiri kusiyana ndi zachibadwa komanso zovuta kwambiri kusiyana ndi chibadwa cha m'mimba. Zithunzi zimenezi zimatchedwa "crypts", ndipo zazikulu zoposa zomwe zimawoneka kuti "hyperplastic," kotero ngati lipoti lanu la chidziwitso likutsatiridwa ndi bvuto lanu limati muli ndi "hyperplastic crypts" kapena "crypt hyperplasia" ndi zazikulu kuposa momwe zikanakhalira m'mimba ya m'mimba.

Gawo lachiwiri ndilosawoneka losavuta-limapezeka kwambiri mwa anthu omwe ali ndi dermatitis herpetiformis.

_{Photomicrograph iyi ikuchokera ku Chithunzi 1b cha Ludvigsson et al.} _{BMC Gastroenterology 2009 9:19.} _{lembani: 10.1186 / 1471-230X-9-19.} _{Mapulogalamu a photomicrographs anapezedwa ndi Prof. Åke Öst, yemwe anali mkulu wa sukulu ya Swedish National Steering Group ya Matenda aang'ono Amatumbo.}

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Gawo 3

Izi zikuwonetsa matumbo m'mimba ku Marsh Mphindi 3. © Ludvigsson et al, 2009

Madokotala ambiri sangathe kupeza matenda a kilisiyo mpaka matumbo anu a m'mimba atha msinkhu 3. Pachigawo chino, kusintha kwa siteji 2 kulipo - ma lymphocytes ambiri kuposa achizolowezi ndi aakulu-kuposa -momwe mumawonongera - kuphatikizapo kuchepa ndi kutsika m'mimba. , chimene chimatchedwa villous atrophy.

Gawo 3 liri ndi magawo atatu:

Matenda oopsa a atrophy (Gawo 3a): Matumbo anu a m'mimba amapezekabe, koma ali ochepa
Zowonongeka zowonongeka (Stage 3b): Matumbo anu a m'mimba ali ndi shrunken kwambiri
Zowonongeka zowonongeka (Gawo 3c): Matumbo anu m'mimba amakhala ophweka popanda matumbo a villi omwe achoka

Anthu ambiri amene amapezeka ndi matenda a celiac ali ndi gawo la 3 Marsh.

_{Photomicrograph iyi ikuchokera ku Chithunzi 1c cha Ludvigsson et al.} _{BMC Gastroenterology 2009 9:19.} _{lembani: 10.1186 / 1471-230X-9-19.} _{Mapulogalamu a photomicrographs anapezedwa ndi Prof. Åke Öst, yemwe anali tcheyamani wa Swedish National Steering Group for Pathology Small Intestinal.}

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Gawo 4

Gawo lachinayi ndilo sitepe yabwino kwambiri ndipo mwatsoka sizimawoneka nthawi zonse. Mu gawo lachinayi, villi yanu imakhala yosamveka bwino (atrophied) kuwonetsa pakati pawo (crypts) ndi shrunken komanso.

Gawo lachinayi ndilofala pakati pa anthu achikulire omwe ali ndi matendawa. Ngati nambala yanu ya Marsh ndi siteji yachinayi, mukhoza kukhala ndi chiopsezo chachikulu cha matenda a leliac, kuphatikizapo lymphoma.

Kuyamikira:

_{Photomicrograph iyi ikuchokera ku Chithunzi cha 1d cha Ludvigsson et al.} _{BMC Gastroenterology 2009 9:19.} _{lembani: 10.1186 / 1471-230X-9-19.} _{Mapulogalamu a photomicrographs anapezedwa ndi Prof. Åke Öst, yemwe anali tcheyamani wa Swedish National Steering Group for Pathology Small Intestinal.}

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Mawu ochokera

Gastroenterologists amagwiritsa ntchito ma Marsh kuti awonetse kuwonongeka kwa matumbo anu a m'mimba kuchokera ku matenda a celiac. Mapiritsi anu a Marsh amadziwa ngati muli ndi matenda a celiac, ndi kuchuluka kwa zomwe zasokoneza matumbo anu a m'mimba.

Mtsogoleli uwu wa masewera a Marsh akhoza kukuthandizani kutanthauzira lipoti kuchokera ku chiberekero cha m'mimba. Komabe, ngati muli ndi vuto loti mumvetsetse, musachite mantha kulankhula ndi adokotala za zomwe zikutanthauza. Ndipo kumbukirani: mutangoyamba kudya zakudya zopanda thanzi, ngakhale kuwonongeka kwa m'mimba kumayamba kuchira.

> Zotsatira:

> Ludvigsson JF et al. Kuvomerezeka kuphunziridwa kwa atrophy wonyansa ndi kutupa kwa m'mimba m'matumbo a Swedish. BMC Gastroenterology . 2009; 9:19.

> Snyder CL, Young DO, Green PHR, Taylor AK. GeneReviews: Matenda a Celiac. 2009.

> Hill ID ndi al. Malangizo othandizira kupeza ndi kuchiza matenda a leliac kwa ana: Malingaliro a North American Society a Pediatric Gastroenterology, Hepatology ndi Nutrition. Journal of Pediatric Gastroenterology ndi Zakudya Zabwino. 2005; 40: 1-19.

> Zolemba Zopangira Opaleshoni za Stanford Mayi: Matenda a Celiac.

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