Matenda a Peptic Ulcer

Zachidule za Matenda a Ulcer Peptic

Matenda a zilonda zam'mimba ndi matenda omwe amachititsa kuti moyo usakhale wovuta, komanso ukhoza kukhala ndi zotsatira zovuta. Zochitika zatsopano, makamaka chidziwitso chatsopano cha zomwe zimayambitsa ndi chithandizo chake-zasintha chisamaliro cha matenda a zilonda zam'mimba. Ngati inu kapena wokondedwa wanu muli ndi matenda a zilonda zam'mimba, muyenera kuonetsetsa kuti mukudziŵa zatsopano za vutoli.

Kodi Ulusi Wopanda Pansi Ndi Chiyani?

Chilonda cha zilonda zakutchire ndi kutentha kwa mmimba kapena m'mimba (gawo loyambirira la katumbo kakang'ono). Zilondazi zimatchedwa zilonda zam'mimba chifukwa zimagwirizana ndi ntchito ya asidi ndi pepsin (mapulogalamu ofunika kwambiri a digestive digestive digestive digestive enzyme) m'maselo omwe amayendetsa mmimba ndi duodenum.

Chilonda cha m'mimba chomwe chimapezeka m'mimba chimatchedwa chapamimba chilonda. Ngati izo ziri mu duodenum zimatchedwa chilonda cha duodenal.

• Zakudya Zabwino ndi Zoipa za Ulonda Wopanda Peptic

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Zizindikiro zingakhale zosiyana pakati pa mitundu iwiri ya zilonda zam'mimba ndipo dokotala akhoza kuwachitira mosiyana. Madokotala amawona anthu omwe ali ndi zilonda zam'mimba nthawi zambiri. Pa nthawi iliyonse, anthu amodzi peresenti padziko lapansi adzakhala ndi zilonda zam'mimba.

Zizindikiro za chilonda cham'mimba zingakhale zovuta kwambiri. Choipitsitsa, zilonda izi zingayambitse zofunikira, mwinamwake zotsatira zowopsya. Mwamwayi, anthu ambiri amachiritsidwa komanso mavuto aakulu amatha kupezeka ndi mankhwala oyenera komanso njira zothandizira zilonda zam'tsogolo.

Zizindikiro

Chizindikiro chachikulu cha zilonda zam'mimba ndi ululu m'mimba .

Ambiri amatha kufotokozera ululu kapena kupweteka komwe kumapezeka m'mimba mwa m'mimba kapena pansi pa nthiti, kumbali yakanja kapena kumanzere.

Chitsanzo cha ululu m'mimba chimadalira malo a chilonda. Ndi zilonda za m'mimba, kupweteka kumakhala koipidwa ndi chakudya ndipo, nthawi zina, munthu amene ali ndi zilonda zam'mimba akhoza (kudula mosakayikira) kuchepetsa kudya komanso kutaya thupi.

Mosiyana ndi izi, zilonda zam'madzi zimakhala zowawa pakati pa chakudya pamene m'mimba mulibe-ululu umatulutsidwa mwa kudya chinachake. Anthu omwe ali ndi chilonda cha duodenal kaŵirikaŵiri amachepetsa thupi ndipo amatha kulemera.

Ngati zilonda zam'mimba zimakhala zazikulu, zimatha kulowa m'kati mwazi ndi kutulutsa magazi. Madokotala amatcha ichi " chapamwamba chotchedwa GI bleed " chifukwa malo ochotsa magazi ali kumtunda kwa mavitamini. Zizindikiro za kumtunda kwa magazi kumtunda zingakhale zovuta kwambiri komanso zosatheka kunyalanyaza, monga kusanza magazi ofiira.

Koma ngati magazi akuchedwa , zizindikiro zikhoza kukhala zowonongeka komanso zimakhala zofooka pang'ono (kutaya magazi , chizungulire , kupweteka kwa mtima), kupweteka m'mimba (chifukwa cha magazi akuyendayenda, ndi zokwiyitsa, matumbo), ndi melena kapena tarry stool (chifukwa cha kupweteka kwa zakudya zomwe zimayambitsa magazi m'matumbo).

Chilonda cha pachilombo chomwe chili pamphambano ya m'mimba ndi duodenum (malo otchedwa pyloric channel) chingayambitse kutupa m'mimba kuti chilepheretse. Ngati ndi choncho, zizindikiro zimaphatikizapo kuphulika, kuthamanga kwambiri, kunyoza, kusanza, ndi kutaya thupi. Anthu omwe ali ndi zilonda zam'mimba amakhalanso ndi mwayi wokhala ndi matenda a reflux a gastroesophageal (GERD) ndi zizindikiro zomwe zimayenderana nawo, makamaka kutentha kwa mtima .

Ngakhale chilonda cham'mimba chimachititsa kuti zizindikiro zambiri zikhale zosiyana, chiwerengero chodabwitsa cha anthu omwe ali ndi zilonda zam'mimba (mwina 50 peresenti) sangathe kuzindikira zizindikiro zinazake. Mwamwayi, ngakhale zilonda zam'mimba zomwe sizimapereka zizindikiro mwachindunji zingathe kuchititsa mavuto aakulu.

Werengani zambiri za zizindikiro za zilonda zam'mimba.

Mavuto

Ngati chinthu chokhacho zilonda zam'mimba zimapangitsa kuti azipweteka m'mimba, sangaoneke ngati vuto lalikulu. Koma, monga taonera kale, akhoza kuchita zambiri kuposa izo!

Matenda akuluakulu a zilonda zam'mimba zimaphatikizapo:

• Kusuta. Ichi ndicho chovuta kwambiri cha matenda a zilonda zam'mimba. Kutuluka kwa magazi kungapite pang'onopang'ono koma m'malo obisika kapena kungakhale yaikulu ndipo nthawi yomweyo imayambitsa moyo. Chodziwika n'chakuti, chilonda chochepa mwazi chimene chingakhale chosadziŵika chingathe kuchitika mwamsanga mwachipatala-ngati chiloŵetsanso m'ziwiya zamagazi.
• Kutsekemera kwa chilakolako cha m'mimba. Matendawa-kutsekedwa pamphambano ya m'mimba ndi duodenum-amatha chifukwa cha zilonda zam'mimba zowononga kapena zilonda zamtunduwu chifukwa cha chilonda cham'mimba. Ngati kulepheretsa kuli koopsa, kapena ngati chitetezo chochepa sichidzathetsedwe pambuyo pa nthawi yodalirika, mankhwala opaleshoni angakhale oyenera.
• Kuthamanga. Ngati zilonda zam'mimba zimachoka kwathunthu kudutsa m'mimba mwa mimba kapena duodenum, zikhoza kuyambitsa kupweteka. A perforation angalole kuti mimba ya m'mimba ichedwe m'mimba, ndipo izi zimapweteka kwambiri m'mimba komanso nthawi zina zimadodometsa . Kuwonongeka kwa zilonda zam'mimba ndizoopsa. Chithandizo chikufuna mankhwala opaleshoni.

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• Fistula. Chilonda cha chilonda chimatha kupangidwanso ndi chiwalo cha m'mimba ndikupanga fistula (kutanthauza kugwirizana) pakati pa mimba kapena duodenum ndi kapangidwe kake. Mafistula angapangidwe ndi mtundu wa colon, biliary, kapasitiki, kapena chotengera chachikulu cha magazi. Malinga ndi chiwalo chimene chimakhudzidwa, zizindikiro zimasiyana ndi kusanza zinthu zakuthupi kuti zikhale zoopsa, zoopsa, kapena zakupha. Mofananamo ndi kupweteka, mankhwala opaleshoni amafunika kuchipatala.

Werengani zambiri pa zovuta za zilonda zam'mimba.

Zimayambitsa

Nthawi zambiri, zilonda zamkati zimayambitsidwa ndi chimodzi mwa zinthu ziwiri:

1. Matenda a bakiteriya otchedwa Helicobacter pylori (H. pylori)
2. Kugwiritsa ntchito mankhwala osagwiritsidwa ntchito mosagwiritsa ntchito mankhwala omwe sali otero (NSAIDS)

Kuzindikira kuti matenda a H. pylori ndi omwe amachititsa zambiri ngati matenda osachiritsika a zilonda zam'mimba ndi chimodzi mwa zinthu zopititsa patsogolo zachipatala zaka makumi angapo zapitazo. Matenda opatsirana ndi H. pylori ndi ofala kwambiri. Owonetsa kuti pafupifupi 50 peresenti ya anthu onse ali ndi H. pylori m'mapepala awo apamwamba m'mimba. Ndipo amakhulupirira kuti izi zakhala zikuchitika m'mbiri yonse ya anthu.

Kafukufuku amasonyeza kuti H. pylori angayambitse anthu zilonda zamtunduwu m'njira zosiyanasiyana, kuphatikizapo:

• Kuchulukitsa kusungunuka kwa m'mimba ya asidi
• Zimapangitsa kutupa
• Kufooketsa njira zothandizira kuteteza m'mimba
• Zimachititsa chapamimba maselo (omwe secrete asidi ndi pepsin) amakula mu chipinda cha duodenum

Matenda a H. H. pylori ndi ofala kwambiri kwa anthu omwe ali ndi zilonda zam'mimba. Pafupifupi 75 peresenti ya zilonda zam'mimba ku US zimayambitsidwa ndi matendawa-ndipo chiwerengero chake n'chokwanira m'dziko losauka. Kuchotsa H. pylori ndi chinthu chofunikira kwambiri cha mankhwala opatsirana ndi zilonda zam'mimba.

Kugwiritsidwa ntchito kosatha kwa NSAID, kuphatikizapo aspirin, kumawonjezera chiopsezo cha zilonda zam'mimba ndi 20. Ogwiritsira ntchito NSAID omwe ali ndi H. pylori (gulu lomwe, kachiwiri, limaphatikizapo oposa theka la anthu onse) ali ndi kuchuluka kwa makumi asanu ndi limodzi pa matenda a zilonda zam'mimba.

NSAID imalingaliridwa kuti ikulitsa chiopsezo cha zilonda zam'mimba mwa kulepheretsa chotupa cha COX-1 m'matumbo apamwamba m'mimba. Kuletsa kwa COX-1 kumachepetsa kupanga mitundu yosiyanasiyana ya prostaglandins yomwe imateteza kuteteza m'mimba ndi m'mimba. (NSAIDs zomwe sizilepheretsa kulandira COX-1 zakhala zikupangidwa, koma awa adzalandira mbiri yoipa chifukwa cha kuwonjezeka kwina kwa mavuto a mtima.)

Werengani zambiri za NSAID ndi mtima .

Anthu opanda H. pylori akhoza kukhala ndi zilonda zam'mimba, makamaka ngati amagwiritsa ntchito NSAIDs. Anthu omwe sagwiritse ntchito NSAID akhoza kukhala ndi zilonda zam'mimba, makamaka ngati ali ndi H. pylori. Koma anthu omwe ali ndi zifukwa zonsezi ali ndi chiopsezo chachikulu cha matenda a zilonda zam'mimba.

Ngakhale H. pylori ndi NSAID ali ndi vuto lalikulu la zilonda zam'mimba, palinso zifukwa zambiri zomwe zingayambitse matendawa. Izi zikuphatikizapo:

• Mankhwala ena (makamaka steroids, clopidogrel , spironolactone , SSRIs, crack cocaine, methamphetamine, ngakhale acetaminophen )
• Chemotherapy ndi mankhwala opangira ma radiation
• Matenda osiyanasiyana kuphatikizapo matenda a Zollinger-Ellison ndi matenda a carcinoid
• Matenda ena, kuphatikizapo herpes simplex ndi cytomegalovirus
• Matenda opweteka monga sarcoidosis ndi matenda a Crohn
• Mowa amagwiritsa ntchito
• Kusuta
• Matenda a mitsempha ya mitsempha yomwe imakhudza mitsempha yomwe imapereka mimba kapena duodenum
• Mkhalidwe wosasamala wa zakudya

Ngakhale kuti mwamvapo bwanji moyo wanu wonse, palibe umboni wakuti kudya zakudya zamtundu uliwonse, monga zokometsera zokometsera, zimayambitsa matenda a zilonda zam'mimba. Mungapeze kuti, mwa inu nokha, kudya zakudya zinazake kungabweretse kukhumudwa, kudzichepetsa, kapena zizindikiro zina za m'mimba-ngati ziri choncho, muyenera kuzipewa. Koma mumapewa kuti azikhala bwino, osati kuteteza matenda a zilonda zam'mimba.

Mofananamo, akatswiri tsopano akuchotsa lingaliro lakuti zilonda zimayambitsidwa ndi vuto lalikulu kapena lopweteketsa maganizo, monga momwe zimakhalira ndi bwana wokwiya, pokhapokha kupanikizika kukutsogolerani kuti muzisuta, kumwa, kapena kupatsa Malangizo ambiri.

Werengani zambiri za zomwe zimachititsa zilonda zam'mimba.

Kudziwa

Kuyezetsa magazi kwa chilonda cha zilonda zam'mimba kumakhala ndi zolinga ziwiri zosiyana:

1. Kukhazikitsa kukhalapo kapena kusakhala ndi zilonda zam'mimba
2. Kufufuza chifukwa cha chilonda, ngati alipo

Ngati zizindikiro zanu zili zochepa, dokotala wanu angokupatseni njira yothandizira kuti asiye mimba ya asidi. Ngati zizindikiro zanu zikuchoka ndipo musabwerere pambuyo pa njira yosavutayi, izi zikhoza kukhala zonse. Komabe, ngati zizindikiro zanu zili zovuta kwambiri, kapena ngati mukudwala matenda obwera chifukwa cha mankhwala ochepa, kawirikawiri ndibwino kupanga chitsimikizo chotsimikizirika. Masiku ano, izi zatheka bwino kwambiri komanso zogwirizana kwambiri ndi njira yotsiriza .

Pogwiritsa ntchito mapepala osungirako zinthu, mapaipi omwe amatha kukhala ndi fiberoptic system amatha kupwetekedwa m'mimba komanso m'mimba-ndipo mimba ya m'mimba ndi duodenum imawonetsedwa mwachindunji. Endoscopy ndi yofulumira komanso yolondola. Kuonjezera apo, ngati chilonda chilipo, kuuma kwake kumatha kuyesedwa ndipo kungathe kufufuzidwa chifukwa cha zizindikiro zilizonse za malignancy-pomwe pangakhale chiwombankhanga. Chidziwitso chimathandizanso kudziwa ngati H. pylori alipo.

Maphunziro a GI amphamvu a GI , pogwiritsira ntchito barium yowonongeka kuti apange kusiyana, angagwiritsidwe ntchito kuti azindikire zilonda zam'mimba. Komabe, mayesowa ndi olondola kwambiri kuposa momwe amachitira zinthu, amatenga nthawi yaitali, ndipo sapereka mpata woti athandizidwe kuti aone ngati zingakhale zovuta kapena H. pylori. Kumaphatikizaponso kutuluka kwa dzuwa. Pazifukwa izi, x-ray siigwiritsidwanso ntchito nthawi zambiri kuti adziwe matenda a chilonda.

Ngati chilonda chapachikachi chikupezeka, ndikofunika kufufuza ngati matenda a H. pylori alipo ndipo ngati NSAID zingakhale chinthu. Umenewu ndiwothandiza kwambiri pakuganiza za chithandizo choyenera.

Njira yabwino yodziwira H. pylori ili ndi biopsy yomwe imapezeka pamapeto pake. Mwinanso, urea mpweya mayeso angagwiritsidwe ntchito. H. pylori amavomereza kuti mazira amadzimadzi amachititsa kuti urea apitirire. Kuyezetsa magazi ndi kupima magazi kungagwiritsidwe ntchito kuti azindikire H. pylori.

Chifukwa chakuti NSAID (ndi nthawi zina mankhwala ena) nthawi zambiri zimathandiza kwambiri kuti chitukuko chikhale chonchi, ndikofunika kupereka dokotala chidziwitso chonse cha mankhwala omwe mwakhala mukugwiritsa ntchito, mankhwala kapena mankhwala.

Ngati muli ndi zilonda zam'mimba ndipo mulibe kachilombo ka H. pylori kapena kugwiritsa ntchito NSAID, dokotala wanu angafunikire kufufuza zachipatala, ndikuyang'ana zina zomwe zingayambitse. Ambiri mwa anthu omwe ali ndi zilonda za zilonda zam'mimba, izi siziri zofunikira.

Werengani zambiri zokhudzana ndi zilonda zam'mimba.

Chithandizo

Nthaŵi zambiri, zilonda zam'mimba zimatha kuchiritsidwa bwino ndi mankhwala. Kawirikawiri, mankhwala azachipatala ali ndi zinthu zitatu:

1. Kuchotsa H. pylori
2. Kupereka mankhwala a proton pump inhibitor (PPI)
3. Chotsani zinthu zomwe zimapangitsa zilonda zam'mimba

Ngati kuyezetsa kuli kowonjezera kwa H. pylori, chinsinsi chothandizira kuchiza matenda a chilonda ndicho kuchotsa matendawa ndi mankhwala enaake. Kawirikawiri, ma antibayotiki awiri amagwiritsidwa ntchito masiku asanu ndi awiri kapena 14-nthawi zambiri clarithromycin, metronidazole, ndi / kapena amoxicillin.

Ndikofunika kubwereza mayeso a H. pylori pambuyo pa mankhwala ophera tizilombo kuti adziwe kuti matendawa achoka. Ngati sichiri, njira yothandizira ena, pogwiritsira ntchito mankhwala osiyana kapena mlingo wosiyana, idzafunika. Kulephera kuchiza chilonda, ndi zilonda zam'tsogolo, ndizovuta kwambiri kwa anthu omwe H. matenda a H. pylori sakuwongolera mokwanira.

Kuchiza machiritso kungathenso kumalimbikitsidwa poletsa kutsekemera kwa m'mimba mwa asidi. Ngati chilonda cham'mimba chilipo, izi zimatheka bwino pogwiritsa ntchito PPI, monga esomeprazole (Nexium) , pantoprazole (Prevacid), omeprazole (Prilosec) , kapena rabeprazole (AcipHex). Kuchepetsa asidi mmimba sikumangothandiza chilonda kuti chichiritse komanso kumapangitsa antibiotics kukhala ovuta kutsutsana ndi H. pylori. Thandizo la PPI nthawi zambiri limapitilira kwa masabata asanu ndi atatu kapena khumi ndi awiri kwa anthu omwe ali ndi matenda a zilonda zam'mimba.

Kuwonjezera pa kupewa NSAID zonse, aliyense amene ali ndi zilonda zam'mimba ayenera kusiya kusuta ndi kumwa mowa mopitirira muyeso umodzi pa tsiku (ngati choncho).

Pambuyo pa ma antibiotic atengedwa, H. H. pylori anathetsa masabata asanu ndi atatu kapena khumi ndi awiri a PPI mankhwala, ndikuchotseratu anthu okhumudwitsa ngati a NSAID, mwayi wochiritsidwa ndi chilonda chapamwamba kwambiri, makamaka pamwamba pa 90-95 peresenti. Komanso, chiopsezo cha zilonda zam'thupi ndizochepa.

Komabe, ngati H. pylori sakuchotsedwa-kapena ngati mukupitiriza (kapena mukuyamba) kugwiritsa ntchito NSAIDS, kusuta, kapena kumwa mowa wochuluka-pali mwayi waukulu kuti chilonda chilephera kuchepetsa kapena kubwerera.

Akatswiri ambiri amalimbikitsa kubwereza mapepala apamtima atatha mankhwala a chapamimba chilonda kuti atsimikizire kuti machiritso amatha. Zilonda za m'mimba nthawi zina zimapanga malo a khansa yapakhungu - komanso zingakhale zofunikira kuwonetsa dera lanu atatha mankhwala kuti zitsimikize kuti malo ochiritsidwa ndi achilendo. Kawirikawiri sikofunikira kubwereza mapepala osungirako mankhwala atatha mankhwala a chilonda cha duodenal.

Chilonda chimene sichichiritsa pambuyo pa milungu 12 ya mankhwala a PPI chimatchedwa chilonda cha "refractory". Ngati muli ndi chilonda chowombera pamwamba pa maphunziro ena a PPI masabata 12:

• Mwinanso mumakhala ndi mapulogalamu ena osakanikirana ndi ma biopsies ambiri, mukuyang'ana matenda a H. pylori otsala, ndikuonetsetsa kuti palibe chizindikiro cha malungo.
• Mwinanso mungafunike kuchipatala kwambiri kuti muwone zovuta zomwe zimayambitsa matenda a chilonda.
• Muyenera kuyembekezera dokotala wanu kuti afunse mafunso anu okhudzana ndi kugwiritsa ntchito NSAID, kusuta, kumwa, ndi kugwiritsa ntchito mankhwala ena alionse.

Zonsezi ndi zofunika. Kupeza njira yothandizira zilonda zamatenda ndizofunikira, popeza anthu omwe ali ndi zilonda zamakono amatha kukhala ndi vuto limodzi la matenda a zilonda zam'mimba.

Ine sindinalipo kale, chithandizo cha opaleshoni cha matenda a chilonda cha chilonda chinali chofala kwambiri. Komabe, popeza H. pylori anadziwika kukhala chinthu chofunikira komanso chobwerezabwereza-ndipo chifukwa chakuti mankhwala opangidwa ndi PPI amphamvu anapangidwa-opaleshoni sizimafunika kwenikweni.

Kuchita opaleshoni tsopano kuli kofunika makamaka kwa zilonda zomwe zimatsimikiziranso kuti akudwala, akuganiza kuti akudwala matendawa, kapena kuti amachiza matenda a zilonda zam'mimba, monga kutaya magazi, kukhumudwitsa, kupopera, kapena fistula.

Werengani zambiri zokhudza kuchiza zilonda zam'mimba.

Mawu Ochokera

Ngakhale chilonda cham'mimba ndi vuto lalikulu lachipatala lomwe lingakhale ndi zotsatira zoopsa, kupita patsogolo kwa chithandizo chamankhwala kwa zaka makumi angapo zapitazi kwasintha kwambiri chithandizo cha matendawa ndi zizindikiro za anthu omwe ali nazo.

Ngati mwapezeka ndi matenda a zilonda zam'mimba, ngati mutagwira ntchito ndi dokotala kuti mumvetsetse chifukwa chake, muzitsatira mokhulupirika malamulo awiri kapena atatu a mankhwala omwe mwinamwake adzatchulidwa, ndipo pewani kumwa mankhwala ndi zizoloŵezi-ndinu Choyenera kupewa, pali mwayi waukulu kuti chilonda chanu chichiritsidwa mwathunthu ndipo sichidzabweranso.

> Zotsatira:

> JY, Sung J, Hill C, et al. Kusanthula Mwatsatanetsatane wa Epidemiology Yowopsya Peptic Ulcer Matenda: Chikoka, Kubwereza, Zinthu Zowopsa ndi Kufa. Kupanga chakudya 2011; 84: 102.

> Leodolter A, Kulig M, Brasch H, et al. Kusanthula Meta Kufanizira Kuthetsa, Kuchiritsa ndi Kubwerera Kuchiza Odwala ndi Helicobacter pylori-yogwirizana ndi Gastric kapena Duodenal chilonda. Kudyetsa Pharmacol Ther 2001; 15: 1949.

> Li LF, Chan RL, Lu L, et al. Kusuta fodya ndi m'mimba: Matenda a Causal ndi Njira Zomwe Zimagwirira Ntchito (Kufotokozera). Int J Mol Med 2014; 34: 372.

> Malfertheiner P, Megraud F, O'Morain CA, et al. Kusamalira Helicobacter Pylori Infection - Maastricht IV / Florence Consensus Report. Gut 2012; 61: 646.