Ultrasound Ndi Test Test Key
Dzina lakuti "gallbladder disease" limaphatikizapo zinthu zamankhwala zomwe zimakhudza ndulu, ngati ndondomeko zam'mimba, zovuta kapena zosavuta cholecystitis (ndulu yotupa yomwe imabwera chifukwa cha ndulu), ndi khansara ya ndulu.
Ngakhale kuyang'anitsitsa kwa matenda, kuunika kwa thupi, ndi magazi kumagwira ntchito pa matenda a gallbladder matenda, kupeza mimba ya ultrasound (ndipo mwina mayesero ena a m'mimba) ndilofunika kwambiri pa ndondomeko ya matenda.
Mbiri Za Zamankhwala
Ngati dokotala akukayikira matenda a ndulu, adzifunsa za zizindikiro zanu komanso ngati inu kapena achibale anu mudakhala ndi vuto lililonse la ndulu.
Zitsanzo za mafunso omwe angakhalepo ndi awa:
- Kodi muli ndi ululu m'mimba, ndipo ngati ndi choncho? Kupweteka kumtunda kapena kumtunda kwa mbali ya pamimba kumakhudza vuto la ndulu.
- Kodi kupweteka m'mimba kumayenderana ndi kudya? Ndi mitsempha yam'mimba, ululu waukulu, wowawa kwambiri ukhoza kuchitika kamodzi kapena maola ambiri atadya zakudya zamtundu ndikukhala osachepera makumi atatu.
- Kodi munayamba mwakumanapo ndi kupweteka kwa m'mimba? Mipukutu ya ululu wa miyala yamwala imakhala yoipira kwambiri m'kupita kwanthawi ndipo ingayambitse zovuta monga matenda a bile kapena kutupa kwa kapangidwe .
- Kodi mukukumana ndi zizindikiro zina kupatula kupweteka, monga malungo, nseru, kusanza, kapena kulemera? Zizindikiro izi zimathandiza dokotala kudziwa ngati matenda a ndulu ndi mavuto ena alipo.
Kusanthula thupi
Kenaka, dokotala wanu adzafufuza, ndikuyang'ana pa zizindikiro zanu zofunika. Anthu omwe ali ndi cholecystitis amatha kukhala ndi malungo komanso kuthamanga kwa mtima.
Kukhalapo kwa jaundice , kutchulidwa ndi chikasu cha azungu a maso ndi / kapena khungu, kumapweteka chifukwa cha ndondomeko ya gallstone yotchedwa choledocholithiasis yomwe gallstone imachokera mu ndulu ndipo imatseka main bile duct (komwe bile imatuluka m'matumbo).
Panthawi yoyezetsa mimba, dokotala wanu adziwone ngati palibe chomwe chimatchedwa "kulondera" chiripo. Munthu yemwe ali ndi cholecystitis wovuta akhoza "kuyang'anira" kapena kuyika manja awo pamtunda wapamwamba pamimba mwawo pamene ndulu imapezeka panthawi yoyezetsa thupi.
Pomalizira, panthawi ya kuyezetsa thupi, dokotala wanu apanga njira yomwe imatchedwa "chizindikiro cha Murphy." Ndi mayeso omwe munthu akufunsidwa kuti atenge mpweya wozama, kulola ndulu kuti ikhale pansi kotero dokotala akhoza kuigwiritsa ntchito. Ngati munthu akumva kupweteka kwambiri pamayesero awa (otchedwa "chizindikiro cha Murphy"), zimasonyeza kuti akhoza kukhala ndi matenda a ndulu.
Labs
Anthu omwe ali ndi matenda a ndulu nthawi zambiri amakhala ndi chiwerengero choyera cha maselo oyera . Maselo anu oyera amagazi ndi maselo anu okhudzana ndi matenda ndipo pamene chizindikiro chokwera ndi mtundu winawake wa kutupa kapena matenda m'thupi. Kuphatikiza pa kuchuluka kwa maselo oyera a maselo oyera, munthu akhoza kukhala ndi chiyeso cha ntchito ya chiwindi .
Ngakhale pangakhale kuwonjezeka kwa michere ya chiwindi, kukwera kwa chiwerengero cha bilirubin (komanso kachigawo ka chiwindi choyesa magazi) kumapereka vuto lotheka la nthendayi (mwachitsanzo, ngati gallstone imakhudzidwa mu ndondomeko ya bile ndi / kapena pali matenda a bate la bile).
Ngati dokotala akukayikira khansa ya ndulu yochokera ku zojambula zojambula (mwachitsanzo, ultrasound, CT scan, kapena MRI), akhoza kulamula kuyesa magazi, monga CEA kapena CA 19-9. Komabe, zizindikirozi zingakhale zowonjezereka pamaso pa khansa zina, kotero sizomwe zimasonyeza kuti khansa ya ndulu. Kawiri kawiri, izi zimagwiritsidwa ntchito kutsata yankho la munthu ku chithandizo cha khansa (ngati kukwezedwa poyamba).
Kujambula
Ngakhale mbiri yachipatala, kuunika kwa thupi, ndi ma laboratory angathandize kuti matenda a gallbladder asamalidwe, kuganizira zofunikira kumatsimikizira kuti munthu akudwala matendawa. Mwa kuyankhula kwina, ndulu imayenera kuwonetsedwa, ndipo izi nthawi zambiri zimachitika ndi ultrasound.
Ultrasound
An ultrasound ndiyeso lofulumira komanso lopweteka lomwe limagwiritsa ntchito mafunde kuti apange fano la ndulu. Kuwonjezera pa gallstones, ndulu khoma thickening kapena kutupa ndi ndulu polyps kapena masisimo angaoneke.
Panthawi ya ultrasound, wothandizira amatha kupanga chizindikiro cha "Murphy Murphy". Panthawi imeneyi, transducer ya ultrasound imakanikizika pa ndulu pamene wodwala amatenga mpweya waukulu. Ngati ali ndi vutoli, munthuyo amva ululu pamene ndulu ikugwedezeka.
HIDA Sintha
Ngati matenda a gallbladder akudziwika sakhala otsimikizika pambuyo poyesa ultrasound, akhoza kuthandizidwa ndi HIDA. Mayesowa amavomereza kuyang'ana kwa bile kusinthana kudzera mu ndondomeko ya bile. Panthawi ya HIDA, chojambulidwa cha radioactive chimayikidwa kudzera mu mitsempha ya munthu. Thupi limeneli limatengedwa ndi maselo a chiwindi ndi kuchotsedwa mu bile.
Ngati nthendayi sungakhoze kuwonetsedwa, ndizo "zabwino" chifukwa zikutanthauza kuti pali vuto linalake (nthawi zambiri kuchokera ku gallstone, koma mwina kuchokera ku chotupa) mumtsinje wa cystic, umene umatulutsa bile kuchokera mu ndulu mpaka njira yodziwika ya bile.
CT Scan
Kachilombo ka CT kamimba kanu kanakhoza kuwulula zizindikiro za nthendayi, monga ndulu yotupa khoma kapena mafuta okhwima. Zingakhale zothandiza makamaka pozindikira kuti zosavuta, zomwe zimawopsyeza moyo wa cholecystitis, monga ndulu poforation (pamene dzenje likuyamba mu ndulu) kapena emphysematous cholecystitis (momwe muli matenda a ndulu kuchokera ku mabakiteriya opanga mpweya).
Magnetic Resonance Cholangiopancreatography (MRCP)
Chiyeso chosagwiritsa ntchito chithunzichi chimalola dokotala kuti aone kuti bile imatulutsa mkati ndi kunja kwa chiwindi. Zingagwiritsidwe ntchito pozindikira kuti mwala umapezeka m'kati mwa mankhwala omwe amachititsa kuti tizilombo toyambitsa matenda (choledocholithiasis).
Endoscopic Kubwezeretsanso Cholangiopancreatography (ERCP)
An ERCP ndizoyezetsa matenda komanso kuyezetsa magazi. Panthawi ya ERCP , gastroenterologist (dokotala yemwe amagwiritsa ntchito matenda opatsirana m'mimba) adzaika kamera yopyapyala kamene imatchedwa endoscope m'kamwa mwa munthu, pansi pamimba, kudutsa mimba, ndi m'mimba yaing'ono.
Munthu amatengeka panthawiyi kuti asawonongeke. Kenaka, kupyolera mu endoscope, chubu yaing'ono imapititsidwa mu njira yodziwika ya bile. Dzira imasiyanitsa mu chubu chaching'ono ichi kuti muyambe kuyendetsa ndondomeko ya bile, yomwe imawoneka kudzera mu x-ray.
Kuchokera ku ERCP, gallstone yomwe imaletsa ma ducts akhoza kuwonetsedwa ndi kuchotsedwa nthawi yomweyo. Kuphwanyidwa kwa madontho a bile kumawonekeranso ndi ERCP, ndipo mpweya ukhoza kuikidwa kuti chitetezo chikhale chotseguka. Pomaliza, panthawi ya ERCP, dokotala akhoza kutenga zitsanzo zamatundumitundu (zotchedwa biopsy) za polyps zilizonse zokayikitsa.
Kusiyanitsa kusiyana
Ngakhale kuti ndibwino kuganiza kuti nthendayi imakhala ngati munthu ali ndi ululu m'mimba mwawo, zizindikiro zina (makamaka matenda a chiwindi) ziyenera kuganiziridwa. Izi zili choncho chifukwa chiwindi chanu chimapezeka kumbali yakumanja ya mimba yanu ndipo chikugwirizanitsidwa ndi ndondomeko ya biliary ducts.
Zitsanzo za mavuto a chiwindi omwe angawononge ululu kumbali yakumtunda ya m'mimba ndi monga:
- Kuchepa kwa chiwindi (mwachitsanzo, kutsekula kwa chiwindi) : Kuwonjezera pa ululu, zizindikiro zina za chiwindi chotchedwa hepatitis zingaphatikizepo jaundice, zida zadothi , ndi mitsempha yamdima.
- Fitz-Hugh-Curtis Syndrome (perihepatitis): Matendawa amatanthauza kutupa kwa chiwindi cha chiwindi chomwe chimapezeka mwa amayi omwe amavutika ndi matenda opatsirana.
- Kupuma kwa chiwindi: Anthu omwe ali ndi matenda a shuga, amene ali ndi chiwindi cha chiwindi, kapena omwe ali ndi chiwindi, gallbladder, kapena pancreatic matenda ali pachiopsezo chachikulu chokhala ndi kachilombo.
- Matenda a mitsempha yotchedwa thrombosis: Matendawa amatanthauza kuika magazi m'mitsempha, yomwe ndi magazi omwe amatengera magazi ku chiwindi.
- Matenda a Budd-Chiari: Ichi ndi matenda omwe sapezeka makamaka pamene pali zipsinjo zomwe zimachotsa chiwindi.
Zina osati kupweteka m'mimba pamtunda, munthu yemwe ali ndi matenda a gallbladder akhoza kumva ululu kumtunda pakati pa mimba (yotchedwa epigastric ululu).
Zina zomwe zingayambitse kupweteka kwa epigastric ndizo:
- Matenda a reflux a Gastroesophageal (GERD): Kuphatikiza pa ululu wa epigastric, munthu yemwe ali ndi GERD akhoza kuzindikira kutsekemera ndi mavuto akumeza.
- Peptic matenda a zilonda: Matendawa amasonyeza zilonda zomwe zimakhala pamimba m'mimba kapena gawo loyamba la matumbo aang'ono. Kutentha ululu m'mimba ndi chizindikiro chofala kwambiri.
- Gastritis: Izi zikutanthauza kutupa kwa mmimba ndipo zingayambidwe ndi zinthu zosiyanasiyana monga mowa, nonsteroidal anti-inflammatories, kapena kachilombo.
- Pancreatitis: Anthu omwe ali ndi chifuwa chachikulu nthawi zambiri amakhala ndi ululu woopsa, wamtundu kapena wamanzere womwe umatuluka kumbuyo ndipo umagwirizanitsa ndi kunyoza ndi kusanza.
- Kuthamanga kwa mtima (myocardial infarction): Kupweteka kwa epigastric kungakhale chizindikiro choyamba cha matenda a mtima . Munthu angakhalenso ndi mpweya wochepa komanso zoopsa za mtima.
> Zotsatira:
> Abraham S, Rivero HG, Erlikh IV, Griffith LF, Kondamudi VK. Opaleshoni ndi zosamalidwa zosamalidwa ndi nyongolotsi. > Am Phys Physician . 2014 May 15; 89 (10): 795-802.
> American Cancer Society. (2016). Kodi Khansara ya Gallbladder Imadziwika Bwanji?
> Sanders G, Kingsnorth AN. Kupititsa kuchipatala: Gallstones. > BMJ . 2007 Aug 11; 335 (7614): 295-99.
> Zakko SF, Afdhal NH. (2016). Zovuta cholecystitis: Pathogenesis, zochitika zachipatala, ndi matenda. Chopra S, (ed). UptoDate, Waltham, MA: UpToDate Inc.