Zizindikiro za khansa ya pancreatic imakhala ndi jaundice, ululu m'mimba pamtunda umene umayambira kumbuyo, kusamba kosayembekezereka kwa shuga, chifuwa cholimba pamimba pamtunda, komanso zizindikiro zosadziwika monga kunyowa, kupweteka, kutayika chilakolako, ndipo nthawi zina kuvutika maganizo. Mwamwayi, zizindikiro zoyambirira nthawi zambiri zimakhala zosaoneka bwino komanso zosaoneka bwino, zomwe zimakhala zosavuta kuti munthu ayambe kufufuza kafukufuku-nthawi zambiri akusowa mpaka matendawa atapita patsogolo.
Zizindikiro Zowonjezereka
Pali zizindikiro zambiri zogwirizanitsidwa ndi khansa yapakhungu, ngakhale zambiri mwazimene zimachitika chifukwa cha zovuta. Zizindikiro izi zimasiyanasiyana malinga ndi kuti khansara ili pamutu wa kapangidwe kapena thupi ndi mchira.
Jaundice wopanda ululu (kuphatikizapo Mitsempha ndi Zojambula Zamasamba)
Jaundice , kutuluka kwa khungu kwa khungu ndi oyera a maso, ndi chikhalidwe choyambitsa khungu la bilirubin pakhungu ndipo liripo pafupi ndi 30 peresenti ya anthu panthawi yomwe amadziwa. Bilirubin ikhoza kusonkhanitsa pamene chotupa cha pancreatic chimalepheretsa kapena kutseka kwathunthu dzira lakale (njira yomwe imanyamula bile kuchokera ku chiwindi kupita m'mimba yaing'ono) ndipo imakhala yowopsa kwambiri ndi khansa pamutu wa makoswe. Ndi khansa ya pancreatic, jaundice kawirikawiri imakhala yopweteka, mosiyana ndi zifukwa zina zambiri za jaundice (monga hepatitis kapena gallstones ) zomwe nthawi zambiri zimawonetsedwa ndi ululu.
Kukumana kwa bilirubin kungachititsenso kuti ziphuphu zikhale zotumbululuka ndi dothi, monga mdima (cola). Zitsulo zingakhalenso ndi fungo lamphamvu, losamvetseka.
Kaŵirikaŵiri kulakwitsa chifukwa cha khungu, khungu lopweteketsa (nthawi zambiri likulu) limayambanso chifukwa cha kumanga kwa salt salts pakhungu.
Jaundice ikhoza kukhala chizindikiro choyambirira cha khansa ya pancreatic pamutu wa ziphuphu chifukwa cha kuvutitsidwa kwa bile, komabe zingatheke ndi khansa zazikulu mumchira kapena thupi la mphukira, kapena ngati khansa ili kufalikira ku chiwindi (metastases ya chiwindi ).
Mimba Yam'mimba ndi Kubwerera
Kupweteka pakati, pamimba pamtunda kumene kumayambira kumbuyo ndi chizindikiro chofala cha khansa ya pancreatic, yomwe ilipo pafupifupi 70 peresenti ya anthu panthaŵi ya matenda. Ambiri ndi zotupa mumchira wa makanda. Nthawi zambiri ululu umatha kupitirira maola atatu kapena anayi atadya kapena atagona. Mosiyana ndi zimenezi, kupweteka kumachepa nthawi zambiri munthu akakhala pansi ndikuyang'ana kutsogolo.
Kutsekula m'mimba
Matenda otsekula m'mimba amatha chifukwa chosowa zakudya m'matumbo chifukwa chosowa mafinya omwe amathandiza kudyetsa chakudya. Kutsekula m'mimba nthawi zina ndi chizindikiro choyamba cha khansa ya pancreatic. Zitsulo zingakhalenso ndi fungo lonunkhira, zimawoneka zotentha kapena zonyezimira, ndipo zimayandama, nthawizina zimapangitsa kuti zikhale zovuta kuzuntha.
Mphuno ndi Kutupa
Nsawa ndi kusanza si zachilendo kwa anthu omwe ali ndi khansara ya pancreatic, ngakhale kuti nthawi zambiri sadziwa bwinobwino matendawa. Kusanza koopsa kungakhale chizindikiro cha chitetezo m'mimba ya m'mimba (gastric outlet) kapena kumtunda kwa m'mimba mwachinyamatako (duodenum).
Kutaya Kwambiri Kwambiri
Kudzidzimutsa kwadzidzidzi ndi kosayembekezeka nthawi zambiri kumasonyeza kuti chinachake ndi cholakwika. Kuwonongeka kosayembekezereka , kuphatikizapo kuchepa kwa njala, kungakhale chimodzi mwa zizindikiro zoyamba za khansa ya pancreatic.
Anthu ena amaonanso kuti amamva mofulumira ngakhale pamene amadya chakudya chochepa.
Kusanthula Mwachidziŵitso cha Shuga
Kuyamba kosayembekezereka kwa mtundu wa shuga wa mtundu wa 2 (monga matenda a munthu amene alibe ziopsezo , monga kupitirira kunenepa) mwa munthu wa zaka zoposa 45 akhoza kukhala chizindikiro cha khansa ya pancreatic. Zimapezeka pamene makoswe sangathe kutulutsa insulini yokwanira chifukwa cha kukhalapo kwa chotupa.
Magazi Amagazi
Magazi amatha kupitirira, ndipo nthawi zina magazi amatha kukhala chizindikiro choyamba cha matendawa. Ndi khansara ya pancreatic, mitsempha ya magazi ikhoza kuchitika m'malo osiyanasiyana mu thupi nthawi (kusamuka thrombophlebitis).
Zomwe zimachitika m'magazi popanda chifukwa choyenera zimayesedwa.
Misa ya m'mimba
Anthu ena amatha kuona zovuta kwambiri pamimba pamtunda-zomwe ziridi ndulu. Kuphatikizidwa kwa ndulu yomwe imatha kuzimva ndi kupweteka kwa jaundice (ngati nkhanza kapena matenda a ndulu palibe) zimadziwika ngati chizindikiro cha Courvoisier. Ichi ndi chisonyezero champhamvu kwambiri kuti kansa ya pancreatic ikhoza kupezeka.
Kusokonezeka maganizo
Sizingakhale zodabwitsa kuti mukuvutika maganizo mukatha kuphunzira kuti muli ndi khansa ya pancreatic, koma tikuphunziranso kuti kuvutika maganizo nthawi zina ndi chizindikiro choyamba cha khansa yapakhungu. Popeza kuti kuvutika maganizo kumayamba nthawi zambiri asanatuluke, amaganiza kuti kusintha kwa chilengedwe komwe kumayenderana ndi khansara ndilo chifukwa chachikulu, m'malo momangodziwa za matendawa. Malinga ndi kafukufuku wa 2017, kuyamba kwa kuvutika maganizo pamaso pa matenda a khansa ya pancreatic ndi yowonjezereka kuposa ena ena khansa.
Zizindikiro Zosazolowereka
Zizindikiro zomwe si zachilendo, koma nthawi zina zowonjezera za khansa ya pancreatic, kawirikawiri zimapezeka ngati khansa yapita patsogolo. Izi ziphatikizapo:
Nkhungu Yowonjezera Lymph pamwamba pa Collarbone
Mphuno yowonjezereka (yotupa) yomwe imatha kumveka pamwamba pa collarbone kumbali ya kumanzere (nthendayi yapamwamba) ikhoza kuchitika. Izi zimatchulidwa mwapadera monga mankhwala a Virchow.
Misa mu Bokosi la Belly
Chotupa chomwe chimapezeka mumimba (umbilicus) si chachilendo ndipo chimatchedwanso Mlongo Mary Joseph.
Paraneoplastic Syndromes
Matenda a Paraneoplastic syndromes ndi masango a zizindikiro zomwe zimagwirizana ndi mahomoni kapena zinthu zina zomwe zimayikidwa ndi maselo a kansa. Imodzi mwa syndromes iyi yomwe ingawonekere ndi khansa ya pancreatic imaphatikizapo kuphatikiza khungu lakuda khungu (chifukwa cha kutupa kwa minofu pansi pa khungu), ziwalo zotupa (arthritis), ndi kuchuluka kwa mtundu wa maselo oyera a magazi omwe amadziwika ngati eosinophils .
Mimba Zambiri za Pancreatic
Mankhwala ambiri amtundu wa pancreatic amapezeka mu maselo a exocrine, omwe amachititsa mapuloteni osokoneza bongo omwe amathandiza mu chimbudzi. Zomwe zimachitika mu maselo otchedwa endocrine (maselo omwe amachititsa mahomoni) nthawi zambiri, koma nthawi zonse, amatulutsa mahomoni omwe amachititsa zizindikiro. Ambiri mwa zotupa za "neuroendocrine" zingayambitse kulemera. Zina mwa izi zingaphatikizepo:
Insulinomas
Insulinomas imatulutsa insulini yomwe imayambitsa shuga wotsika kwambiri ( hypoglycemia ). Zizindikiro ndizo za shuga wotsika kwambiri, monga kumutu, kutukuta, nkhawa, ndi kufulumira kwa mtima.
Glucagonomas
Glucagonomas imatulutsa glucagon, mahomoni omwe amachititsa shuga wambiri m'magazi. Izi nthawi zina zimayambitsa matenda a shuga, ndi zizindikiro za njala yowonjezereka, kukodza nthawi zambiri, ndi kulemera kosavuta. Zingathe kuyambitsa kutsekula m'mimba komanso kufooka kwa zakudya zomwe zimapweteka pakamwa ndi m'lilankhulo.
Gastrinomas
Gastrinomas imatulutsa gastrin, mahomoni omwe amachititsa kuti zilonda za m'mimba zimatuluke ( zilonda zam'mimba ), asidi reflux, ndi ululu m'mimba.
Somatostatinomas
Somatostatinomas ndi zotupa zomwe zimatulutsa seatostatin, mahomoni omwe amachititsa kuti mahomoni ena achotsedwe. Zizindikiro zingaphatikizepo kutsegula m'mimba, kupweteka kwa m'mimba, ziphuphu zonunkhira, zizindikiro za shuga, ndi jaundice.
VIPomas
Nthawi zambiri VIPomas imatulutsa pepadi ya vasoactive (VIP), yomwe imawathandiza kutsekula m'mimba (nthawi zambiri madzi ndi zovuta), kunyoza, kusanza, kupweteka m'mimba ndi kupweteka, komanso kupukuta nkhope ndi khosi.
Mavuto
Khansara yotchedwa Pancreatic ingayambitse mavuto chifukwa cha zifukwa zingapo, kuphatikizapo kuponderezedwa kumbali yoyandikana nayo, kusowa kwa zinthu zomwe zimapangidwa ndi maselo ofanana ndi khansa, kapangidwe ka khansa yokha, kapena kufalitsa (metastases) kuchokera ku chotupacho.
Mavuto angakhale monga:
Kusakwanira kwa Pancreatic
Khansa yapancretic nthawi zambiri imachitika m'ma maselo (exocrine maselo) omwe amachititsa mavitamini a pancreatic. Mankhwalawa amapanga makapu asanu ndi atatu a mavitaminiwa tsiku ndi tsiku, omwe amachititsa kuti asidi apitirire m'mimba komanso kuthandizira kuthetsa mafuta, mapuloteni, ndi zakudya. Pamene chotupa chimatenga maselowa, kusowa kwa michere kungachititse malabsorption, kupweteka m'mimba, ndi kuperewera kwa zakudya, ngakhale chakudya choyenera. Kulephera kwapancretic kumachitika 80 peresenti mpaka 90 peresenti ya anthu omwe ali ndi kansa ya pancreatic ndipo amachiritsidwa ndi mpweya wosakanikirana wa puloteni .
Kukhazikitsa Mitsempha Yotsitsa
Kuwonongedwa kwa kachitidwe kawiri kawiri ndi kachitidwe kawiri kawiri ka kansa ya pancreatic ndipo ikhoza kupezeka panthawi yomwe akudziŵa. Ngakhale pamene opaleshoni sizingatheke, ntchentche ikhoza kuikidwa kudzera pa endoscopy , ndondomeko yomwe imaphatikizapo kuika chubu m'kamwa ndikukakankhira pansi mpaka mu njira yakufala ya bile.
Kumangidwanso Kwambiri Kumimba
Kulepheretsa (chifukwa cha chifuwa chochulukirapo chikhoza kuchitika kumalo kumene chiwalo cha m'mimba chikudutsa m'mimba mwachinyamatako (chiberekero cha m'mimba) kapena mbali yoyamba ya m'mimba yaing'ono (duodenum). zikhoza kuikidwa kuti zikhale zotseguka, kapena mmalo mwake, opaleshoni ikhoza kuchitidwa kudutsa chisokonezo.
Matenda a shuga
Monga tanenera kale, chiyambi chadzidzidzi cha matenda a shuga chikhoza kufalitsa khansa ya pancreatic. Ngakhale osakhalapo pa nthawi ya matendawa, pafupifupi 85 peresenti ya anthu omwe ali ndi matendawa adzakhala ndi insulini kukana kapena shuga pa nthawi ina.
Cachexia
Khansa yotchedwa Cancer cachexia , yomwe imadziwikanso ndi khansa yokhudza matenda a anorexia-cachexia syndrome (CACS), ndi matenda omwe amachititsa kulemera kwa thupi, kuwonongeka kwa minofu, ndi kusowa kwa njala, ngakhale kuti zimayambira ngakhale asanatengeke. Amaganiza kuti alipo 80 peresenti ya anthu omwe ali ndi khansara ya pancreatic panthawi yomwe amadziwa.
Cachexia ikhoza kukhala chifukwa chenicheni cha imfa mwa 20 peresenti ya anthu omwe ali ndi khansa. Kuwonjezera pa cachexia "yachizolowezi", komabe, kusowa kwa michere yapascreatic kungayambitse kusowa kwa zakudya ndi kuperewera kolemetsa, kuti izi zikhale zovuta kwambiri kuti athetse munthu aliyense yemwe ali ndi kansa ya pancreatic.
Magazi Amagazi
Monga tawonera, mazira a magazi ( kwambiri m'mitsempha ya thrombosis ) yomwe nthawi zina amachoka ndikupita kumapapo ( pulmonary emboli ) sikumangokhala ndi vuto la khansa yapakhungu-akhoza kukhala chizindikiro choyamba cha izo. Amakhalanso ovuta kwambiri panthawi iliyonse ndi matendawa. Anthu omwe ali ndi khansa ya pancreatic amakhalanso ndi magazi ambiri odwala magazi kuposa anthu omwe ali ndi khansa, kotero kuti chithandizo chiyenera kusamalidwa mosamala.
Ululu
Ululu wokhudzana ndi khansa ya pancreatic ikhoza kukhala yovuta kwambiri, koma pali njira zosiyanasiyana zochepetsera ululu wa khansa . Kawirikawiri, njira zosiyanasiyana zimagwirizanitsidwa, monga mankhwala opweteka, mankhwala opatsirana ndi mimba mpaka pamimba, ndi "choliacac block," njira yomwe imachepetsa mitsempha pamimba yomwe imapereka chizindikiro cha ululu ku ubongo. Ndili ndi vuto la opioid, akulimbikitsidwa kuti anthu omwe ali ndi kansa ya pancreatic ayese kulankhulana ndi wopweteka kapena katswiri wothandizira kuti athe kulandira mankhwala otetezeka, okwanira, komanso oyenera panthawi yake.
Nthawi Yomwe Muwone Dokotala
Mukawona zizindikiro zilizonse pamwambapa, onani dokotala nthawi yomweyo. Zizindikiro zambiri za khansa yapakhungu yapadziko lapansi zili ndi zifukwa zina, koma zingapo ndizofunika kwambiri kuti muzindikire. Zizindikiro ndizo thupi lathu lakutiuza kuti chinachake sichili bwino. Ndikofunika kukhala ndi kufotokoza, ndipo ngati simutero, funsani. Ngati simukupeza mayankho, ganizirani kupeza yankho lachiwiri.
Anthu ena adazengereza kukaonana ndi dokotala ndi zizindikiro zowononga khansa chifukwa cha mbiri ya matendawa. Ndizowona kuti, akapezeka, ambiri mwa khansawa atsala pang'ono kuchotsedwa ndi opaleshoni, komabe akadakalipo mankhwala omwe angakhalepo. Kuonjezera apo, kuyezetsa ma khansawa mwamsanga kumalola anthu ndi madokotala kuti athetse mavuto ena a matendawa, ndipo pochita zimenezi, kumapangitsa kukhala ndi moyo ngakhale khansayo ilipo.
> Zotsatira:
> Zochitika Zamakono Komanso Zowoneka M'matenda a Pancreatic , Springer Verlag, 2017.
> Khadka, R., Tian, W., Xin, H., ndi R. Koirala. Zowopsa, Kusanthula Kwambiri Kwambiri ndi Kupulumuka Kwadongosolo Kuchuluka kwa Msonkhano pakati pa Khansa ya Pancreatic ndi Matenda a Shuga Mellitus: Kusintha ndi Kupititsa patsogolo, Kupenda. International Journal of Surgery . 2018 Mar 10. (Epub patsogolo pa kusindikiza).
> Laquente, B., Calsina-Berna, A., Caromona-Bayonas, A. et al. Thandizo Lothandizira Pancreatic Ductal Adenocarcinoma. Chipatala ndi Chitembenuzidwe cha Oncology . 2017. 19 (11): 1293-1302.
> Sebti, J., Desseigne, F., ndi P. Saltel. Kuchepetsa Kuvutika Maganizo mu Kansa ya Pancreatic: Kufufuza Kwambiri pa Odwala khumi. Chisamaliro Chothandizira ndi Chothandizira . 2015. 13 (3): 801-7.