Mankhwala omwe amagwiritsidwa ntchito kawirikawiri komanso owonjezera omwe angapangitse mankhwalawa angapangitse zilonda zam'mimba.
Chilonda cha zilonda ndizogwiritsidwa ntchito pa zilonda zomwe zimapezeka m'mimba, m'mimba, kapena m'mimba. Pamene zilonda zili mmimba zimatchedwanso zilonda zam'mimba. Zilonda m'mimba yoyamba ya m'mimba mwachangu (duodenum) ikhoza kutchedwa chilonda cha duodenal. Chinthu chofala kwambiri cha chilonda cha chilonda ndi mtundu wa mabakiteriya wotchedwa Helicobacter pylori (H pylori) .
Chinthu chachiwiri, chosafunika, koma chowonjezeka chowonjezeka, chifukwa cha zilonda zam'mimba ndizo mankhwala osagwiritsidwa ntchito ndi anti-inflammatory (NSAIDs) .
Kugwiritsa ntchito NSAID zowonjezereka, monga aspirin kapena ibuprofen chifukwa cha kupweteka kwa mutu kapena kupweteka sikudzachititsa chilonda chachikulu. M'malo mwake, matenda opatsirana ndi zilonda zam'mimba ndi omwe amatha kuchitika ndi mankhwala apamwamba a NSAID omwe amagwiritsidwa ntchito kwa nthawi yayitali, monga kupweteka kwanthawi yaitali komwe kumayambitsa matenda a nyamakazi kapena zinthu zina zotupa. Anthu omwe ali ndi nkhawa iliyonse ponena za kugwiritsa ntchito NSAID komanso momwe chiwerengero cha m'mimba chingakhudzire ayenera kulankhula kwa dokotala.
Chifukwa chiyani NSAIDs Zimayambitsa Ulcers
NSAID monga aspirin, ibuprofen, ndi naproxen , zingayambitse zilonda mwa kulepheretsa mphamvu ya mmimba kutetezera ku zidulo zamkati. Ngakhale ziwalo za m'mimba zimakhala zofunika kwambiri pakamwa, zimatha kuwononga ngati zotetezo za mmimba zimasokonezeka.
Kawirikawiri, m'mimba muli chitetezo zitatu motsutsana ndi mimba ya asidi:
- Mucus yopangidwa ndi maselo ofiira omwe amayendetsa mmimba
- Bicarbonate yomwe imapangidwa ndi maselo ofiira omwe amathandiza kuchepetsa mimba ya asidi
- Kuyenda kwa magazi komwe kumathandiza pakukonza ndi kukonzanso maselo m'mimba ya mucosal wosanjikiza
NSAIDs zimachepetsanso kupanga ntchentche yoteteza komanso kusintha maonekedwe ake.
Kapepala ka lipids kamene kamapangidwa ndi thupi lotchedwa prostaglandins kamakhala ndi zotsatira zowawa zowawa. NSAID zimayesetsa kuchepetsa kupweteka poletsa mavitamini omwe amaphatikizapo kupanga prostaglandins. Prostaglandins amakhalanso otetezeka mu mucosal wosanjikiza m'mimba, ndipo pamene iwo atha, pangakhale kuphwanya mu wosanjikiza. Kuponderezedwa kwa chitetezo cha thupi pamatenda amchere kungachititse kutupa m'mimba. M'kupita kwa nthawi, izi zingayambitse kupopera kwa mchere wa capillary, kuyambitsa magazi ndi kukula kwa zilonda zamatenda, zowonda zilonda za mucosal.
Zizindikiro za Ulcer Wopanda Peptic
Chilonda cha zilonda zingayambitse zizindikiro za m'mimba koma anthu ena alibe zizindikiro. Chizindikiro chofala kwambiri ndi ululu wamimba m'mimba (kumene mimba ilipo) yomwe ikhoza kumverera ngati yovuta kapena yotentha. Ululu umakhala wolimba kwambiri, ndipo ena amakumana ndi zowawa zochepa komanso ena akuvutika kwambiri. Nthawi zambiri ululu umachitika pambuyo pa chakudya koma kwa anthu ena ukhozanso kuchitika usiku. Izo zikhoza kupitirira kwa kulikonse kuchokera maminiti angapo mpaka maora angapo.
Zizindikiro zina sizodziwikiratu koma zimatha kuphatikizapo gasi, kunyoza, kusanza, kusowa kwa kudya, kulemera, komanso kumangokhalira kudya pang'ono.
Nthawi zambiri, anthu omwe ali ndi zilonda zam'mimba amatha kuona magazi m'magulu awo kapena amakhala ndi mdima wakuda chifukwa ali ndi magazi. Magazi omwe amachokera ku zilonda zamtundu umodzi kapena zingapo amatha kuwonanso mu masanzi.
Kusanthula Ulonda wa Peptic
Pamene zizindikiro za chilonda cham'mimba zilipo, dokotala akhoza kulamula mayesero angapo kuti adziwe chomwe chimayambitsa ndi kutsimikizira kuti akudwala matendawa. Kwa anthu omwe akulandira NSAID kuti amve kupweteka kosalekeza, dokotala akhoza kale kukhala ndi kukayikira kwakukulu kuti ichi ndi chifukwa chake, kapena chikuthandizira, matenda a zilonda zam'mimba. Chifukwa chakuti amachititsa kuti zilonda zam'mimba zikhale zovuta, matendawa ndi H. pylori nthawi zambiri amawagwiritsa ntchito pogwiritsa ntchito mpweya kapena kuyesedwa.
Gulu lakumwamba la GI kapena chapamwamba chotchedwa endoscopy lingagwiritsidwe ntchito kuyang'ana mkati mwa kapamwamba kakang'ono kakang'ono kakang'ono ndi kumayang'ana zilonda. Mu GI chapamwamba, odwala amamwa mankhwala omwe amatchedwa Barium ndipo ma x-ray amatengedwa. The barium amathandiza ziwalo zamkati ziwonetsere pa x-ray. Pa chipangizo cham'mwamba chimatha kugwiritsa ntchito chubu yokhala ndi kamera kuyang'ana mkati mwa mimba, mimba, ndi duodenum. Odwala amatha kupitilira panthawiyi ndi minofu ( biopsy ) amatha kuchotsedwa kuchokera mu chigawo cha digestive kuti apitirize kuyesedwa.
Zowopsa
NSAID zonse zimatha kuyambitsa matenda, kupweteka kwa m'mimba, ndi zilonda zam'mimba. Komabe, anthu ena ali ndi kachilombo koyambitsa matenda a chilonda kuposa ena. Mwachitsanzo, pamene kafukufuku akusonyeza kuti pafupifupi 25 pa 100 peresenti ya anthu omwe ali ndi dozi zapamwamba za NSAID adzakhala ndi zilonda, koma peresenti yokha ya iwo idzapitirira kukhala ndi mavuto aakulu.
Matenda aakulu ochokera ku zilonda zam'mimba zomwe zimayambitsa NSAID zimakhala zovuta kuchitika mwa anthu omwe:
- Akuluakulu kuposa 65
- Komanso tengani corticosteroids
- Anagwiritsira ntchito NSAID kwachepera mwezi
- Khalani ndi mbiri ya zilonda
- Tengani NSAID za mlingo wapamwamba
- Khalani ndi matenda a H. pylori
- Gwiritsani ntchito aspirin tsiku ndi tsiku (kuphatikizapo aspirin yaing'ono ya cholinga cha cardioprotective)
- Tengani magazi ochepa
Kuchiza Ululu Wa Peptic
Tsopano akudziwika kuti chakudya cha zokometsera ndi zosautsa sizimayambitsa zilonda zam'mimba. Komabe, pali kusintha kosintha kwa moyo komwe kungakhale kolimbikitsidwa pofuna kuthandizira zilonda zam'mimba . Dokotala angalimbikitse kuti wodwala yemwe ali ndi zilonda zam'mimba amayamba kusuta fodya, asamwe mowa, asamamwe tizilombo ta khofi, asiye NSAID, ndipo tipewe mitundu ina ya zakudya zomwe zimakhala zovuta kwambiri.
Nthaŵi zina mankhwala amatha kuuzidwa kwa odwala omwe amatenga NSAID kuti ateteze zilonda zam'mimba kuti zisachitike poyamba. Zilonda zamtundu wa NSAID nthawi zambiri zimachiza chithandizo kamodzi ndi NSAID. Pofulumizitsa njira ya machiritso, dokotala angapangire kutenga mankhwala owonjezera pa mankhwala. Nthendayi, yomwe ingapezeke popanda mankhwala, ikhoza kulamulidwa chifukwa imathandiza kuchepetsa mimba ya asidi. Nthawi zina bismuth subsalicylate (monga Pepto-Bismol kapena Kaopectate ) ingagwiritsidwe ntchito.
Mankhwala ovomerezeka omwe angakonzedwenso akuphatikizapo H2-blocker (histamine receptor blocker), yomwe imalepheretsa kupanga m'mimba mwa asidi kupyolera histamine, komanso / kapena proton pump inhibitor (PPI) , zomwe zimachepetsa kuchuluka kwa asidi mmimba. Mankhwala oteteza mucosal (MPAs) ndi gulu lina la mankhwala omwe angagwiritsidwe ntchito, ndipo mankhwalawa amateteza thupi kukhala lopindulitsa mucosal wosanjikiza m'mimba ..
Vuto lalikulu kwa anthu omwe ali ndi matenda a zilonda zam'mimba chifukwa cha mankhwala omwe ali ndi NSAID ndi momwe angagwiritsire ntchito ululu pamene mankhwalawa atha. Pankhani ya ululu wosatha, izi zingafunike thandizo la gulu la akatswiri, kuphatikizapo dokotala woyang'anira ululu. Gulu la mankhwala lotchedwa COX-inhibitors (cyclooxygenase inhibitors) lingagwiritsidwe ntchito kuthetsa ululu kwa anthu ena. COX-inhibitors yasonyezedwa kuti amagwira ntchito yopuma kupweteka ndipo imakhudzidwa ndi zochepa zoyipa za kugaya kusiyana ndi zina za NSAID. Mankhwala awa asonyezedwa kuti ali ndi zotsatira za mtima, komabe, kawirikawiri, nthawi zambiri amalimbikitsa kuti agwiritsidwe ntchito pa mlingo wotsika kwambiri.
Zilonda zambiri zimachiritsa kamodzi kokha ma NSAID atayimitsidwa koma nthawi zina opaleshoni angafunike. Izi nthawi zambiri zimakhala zovuta chifukwa cha ululu, monga kutaya magazi kwambiri, kupopera (m'mimba m'mimba kapena m'mimba), kapena kutsekeka .
Mawu Ochokera
Anthu ambiri omwe amatenga NSAID sangapeze matenda a zilonda zam'mimba. Komabe, anthu omwe ali ndi ululu wosachiritsika komanso amene akulandira mankhwala opatsirana kwambiri ayenera kudziwa kuti akhoza kukhala zilonda zam'mimba. Nthawi zina, zingakhale zoyenera kufunsa dokotala ngati pali njira zothandizira zilonda komanso ngati zitsulozi ziyenera kukhazikitsidwa pokhapokha atalandira mchere wokwanira wa NSAID. Chifukwa zilonda zosayambitsidwa zingayambitse mavuto, ndikofunika kupeza chithandizo ndi kulandira chithandizo pomwepo ngati chilonda chikuwoneka. Kawirikawiri zilonda zamachilombo zimachiza ndi kuleka NSAID ndi zizindikiro zimatha kuyendetsedwa ndi kusintha kwa moyo, koma mankhwala owonjezera komanso mankhwalawa angagwiritsidwe ntchito mofulumira. Ngati kupweteka kosalekeza kumapitirirabe kukhala vuto ndipo pali chiopsezo chokhala ndi zilonda zokhudzana ndi NSAID, kuthana ndi magwero a ululu ndi kugwira ntchito ndi katswiri wa kasamalidwe ka ululu kuti apeze njira zina zopumula zopweteka zingakhale zabwino kwambiri.
> Chitsime:
> Lanza, F, Chan F, Quigley E, et al. "Malangizo othandizira kupewa matenda a zilonda zamtundu wa NSAID." Amer J Gastroenterol. 2009; 104: 728-38. DOI: 10.1038 / ajg.2009.115.
> Larkai EN, Smith JL, Lidsky MD ndi al. Mankhwalawa amachititsa kuti munthu asamadziwe mankhwala osokoneza bongo. Am J Gastroenterol .1987; 82: 1153-1158.
> Chitukuko cha National Diabetes ndi Digestive and Kidney Diseases (NIDDK). "Zizindikiro ndi Zifukwa za Ululu wa Peptic (Ulcer Ulcer)" National Institutes of Health Nov 2014.