Miyala

Miyala yamiyala ndimadontho ovuta omwe amapanga mkati mwa ndulu. Izi zitha kukhala zazing'ono ngati mchenga kapena wokulirapo ngati mpira.

Zomwe zimayambitsa ma gallstones zimasiyanasiyana. Pali mitundu iwiri yayikulu yamiyala:

• Miyala yopangidwa ndi cholesterol - Uwu ndiye mtundu wofala kwambiri. Mafuta am'magazi a cholesterol sagwirizana ndi kuchuluka kwama cholesterol m'mwazi. Nthawi zambiri, samawoneka pazithunzi za CT.
• Miyala yopangidwa ndi bilirubin - Imatchedwa miyala ya pigment. Zimachitika maselo ofiira akawonongeka ndipo bilirubin wambiri amakhala mu bile.

Miyala yamiyala imapezeka kwambiri mu:

• Kugonana kwazimayi
• Amwenye Achimereka komanso anthu ochokera ku Puerto Rico
• Anthu opitilira zaka 40
• Anthu onenepa kwambiri
• Anthu omwe ali ndi mbiri yakale yamabanja

Zinthu zotsatirazi zimakupangitsanso kuti mukhale ndi miyala yamtengo wapatali:

• Mafupa a mafupa kapena cholimba cholimba
• Matenda a shuga
• Kulephera kwa ndulu kutulutsa ndulu moyenera (izi zimachitika nthawi yapakati)
• Matenda a chiwindi ndi matenda amtundu wa biliary (miyala yamitundu)
• Matenda omwe amachititsa kuti maselo ofiira ambiri awonongeke
• Kutaya thupi mwachangu pakudya zakudya zochepa kwambiri, kapena mutachita opaleshoni yochepetsa thupi
• Kulandila zakudya kudzera mumtsempha kwa nthawi yayitali (kulowetsa m'mitsempha)
• Kumwa mapiritsi olera

Anthu ambiri omwe ali ndi miyala yamtengo wapatali alibe zizindikiro zilizonse. Izi zimapezeka nthawi zambiri pa x-ray, opaleshoni yam'mimba, kapena njira zina zamankhwala.

Komabe, ngati mwala waukulu watseketsa chubu kapena ngalande yomwe imatulutsa ndulu, mutha kukhala ndi ululu wopweteka pakati mpaka pamimba yakumanja. Izi zimadziwika kuti biliary colic. Kupweteka kumatha ngati mwalawo umadutsa gawo loyamba la matumbo ang'onoang'ono.

Zizindikiro zomwe zingachitike ndi monga:

• Kupweteka kumtunda chakumtunda kapena chapakati chapakati pamphindi zosachepera 30. Ululu ukhoza kukhala wokhazikika kapena wopanikizika. Imatha kumva yakuthwa kapena kuzimiririka.
• Malungo.
• Chikasu chachikopa ndi azungu amaso (jaundice).

Zizindikiro zina zitha kuphatikiza:

• Zojambula zofiira
• Nseru ndi kusanza

Mayeso omwe amagwiritsidwa ntchito pozindikira ma gallstones kapena kutupa kwa ndulu ndi awa:

• Ultrasound, pamimba
• CT scan, pamimba
• Endoscopic retrograde cholangiopancreatography (ERCP)
• Gallbladder radionuclide scan
• Endoscopic ultrasound
• Magnetic resonance cholangiopancreatography (MRCP)
• Percutaneous transhepatic cholangiogram (PTCA)

Wothandizira zaumoyo wanu akhoza kuyitanitsa mayeso amwazi awa:

• Bilirubin
• Kuyesa kwa chiwindi
• Kuwerengera kwathunthu kwa magazi
• Enzyme ya Pancreatic

KUGWIDWA

Nthawi zambiri, opaleshoni sikofunikira pokhapokha ngati zizindikiro ziyamba. Komabe, anthu omwe akukonzekera opaleshoni yochepetsa thupi angafunike kuchotsedwa ndulu zam'mimba asanachite izi. Mwambiri, anthu omwe ali ndi zizindikilo amafunika kuchitidwa opaleshoni nthawi yomweyo kapena mwalawo ukangopezeka.

• Njira yotchedwa laparoscopic cholecystectomy imagwiritsidwa ntchito kwambiri. Njirayi imagwiritsa ntchito maopareshoni ang'onoang'ono, omwe amalola kuti achire mwachangu. Wodwala amatha kupita kunyumba kuchokera kuchipatala pasanathe tsiku limodzi atachitidwa opaleshoni.
• M'mbuyomu, cholecystectomy yotseguka (kuchotsa ndulu) nthawi zambiri imachitika. Komabe, njirayi siodziwika masiku ano.

Endoscopic retrograde cholangiopancreatography (ERCP) ndi njira yotchedwa sphincterotomy itha kuchitidwa kuti mupeze kapena kuchiza ma gallstones mumtambo wamba wa bile.

MANKHWALA

Mankhwala atha kuperekedwa ngati mapiritsi osungunula miyala yamchere ya cholesterol. Komabe, mankhwalawa atha kutenga zaka 2 kapena kupitilira apo kuti agwire ntchito, ndipo miyala imatha kubwerera pambuyo poti mankhwala atha.

Nthawi zambiri, mankhwala amapita mu ndulu kudzera mu catheter. Mankhwalawa amasungunula mwachangu miyala ya cholesterol. Mankhwalawa ndi ovuta kuwachita, chifukwa chake samachitika kawirikawiri. Mankhwala omwe amagwiritsidwa ntchito atha kukhala owopsa, ndipo miyala yamtengo wapatali imatha kubwerera.

LITHOTI

Shock wave lithotripsy (ESWL) ya ndulu yagwiritsidwanso ntchito kwa anthu omwe sangachite opareshoni. Mankhwalawa sagwiritsidwa ntchito mobwerezabwereza monga kale chifukwa ndulu zimabwereranso.

Mungafunikire kukhala ndi chakudya chamadzimadzi kapena mutenge njira zina kuti mupumitse ndulu yanu mukalandira chithandizo. Wopezayo amakupatsani malangizo mukamachoka kuchipatala.

Mpata wazizindikiro kapena zovuta zamankhwala opangira ma gallstones ndizochepa. Pafupifupi anthu onse omwe achita opaleshoni ya ndulu sazindikiranso.

Kutsekedwa ndi ndulu kumatha kuyambitsa kutupa kapena matenda mu:

• Gallbladder (cholecystitis)
• Chubu chomwe chimanyamula bile kuchokera pachiwindi kupita ku ndulu ndi matumbo (cholangitis)
• Pancreas (kapamba)

Itanani omwe akukuthandizani ngati muli ndi:

• Zowawa kumtunda kwanu
• Chikasu cha khungu kapena azungu amaso

Kwa anthu ambiri, miyala yamtengo wapatali imatha kupewedwa. Kwa anthu omwe ali onenepa kwambiri, kupewa kuwonda mwachangu kungathandize kupewa miyala yamtengo wapatali.

Cholelithiasis; Kuukira kwa ndulu; Biliary colic; Kuukira mwala wamwala; Calculator ya Biliary: ma gallstones chenodeoxycholic acid (CDCA); Ursodeoxycholic acid (UDCA, ursodiol); Endoscopic retrograde cholangiopancreatography (ERCP) - miyala yamiyala

• Kuchotsa gallbladder - laparoscopic - kutulutsa
• Kuchotsa ndulu - kutsegula - kutulutsa
• Miyala - kutulutsa

• Dongosolo m'mimba
• Impso chotupa ndi ma gallstones - CT scan
• Miyala, cholangiogram
• Cholecystolithiasis
• Cholelithiasis
• Chikhodzodzo
• Kuchotsa ndulu - Mndandanda

Fogel EL, Sherman S. Matenda a ndulu ndi ma ducts. Mu: Goldman L, Schafer AI, olemba. Mankhwala a Goldman-Cecil. Wolemba 25. Philadelphia, PA: Elsevier Saunders; 2016: chap 155.

Jackson PG, Evans SRT. Dongosolo Biliary. Mu: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Buku Lopanga Opaleshoni. Wolemba 20th. Philadelphia, PA: Elsevier; 2017: mutu 54.

Wang D QH, Afdhal NH. Matenda amtundu. Mu: Feldman M, Friedman LS, Brandt LJ, olemba. Sleisenger ndi Fordtran's Mimba ndi Matenda a Chiwindi: Pathophysiology / Diagnosis / Management. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016: chap 65.