Ndulu (yochokera ku Latin vesica biliaris) imakhala ngati malo osungira ndulu, madzi achikaso otsekemera obisika ndi chiwindi komanso omwe amathandizira pakuwumba.

Nduluyo ili kumanja kwa mimba. Ndi thumba laling'ono lopangidwa ndi peyala lomwe limapezeka kumunsi kwa chiwindi. Mtundu wobiriwira komanso wokhala ndi khoma lochepa, limakhala kutalika kwa 7 mpaka 12 cm. Muli pafupifupi 50 ml ya bile. Kumapeto kwake, chotupacho chimalumikizana ndi njira yodziwika bwino yodzikongoletsera kuti ipange njira yodziwika bwino ya bile. Kudzera munjira iyi ndulu imadutsa mu duodenum, gawo loyamba la m'matumbo ang'onoang'ono omwe amatsata m'mimba.

Milero imakhala ndimadzi, bile salt, bilirubin (pigment chifukwa cha kuwonongeka kwa hemoglobin yomwe imapatsa bile utoto wachikasu), cholesterol ndi phospholipids. Ndi ma salt amchere okha ndi phospholipids omwe amatenga nawo gawo pazakudya. Ngakhale ilibe michere, bile imatha, chifukwa cha mchere wake, kuchepetsa kukula kwa ma globules amafuta, chifukwa chake imathandizira magwiridwe antchito am'mimba.

Khalidwe la ndulu limadalira mkhalidwe wa duodenum. Izi zikapanda kanthu, ndulu imabwereranso mumalowo kuti ikasungidwe mu ndulu. Wotsirizirayo kenako amayika nduluyo poyamwa pang'ono madzi ake, ndikupangitsa kuti mtsogolo ma bile salt akhale othandiza kwambiri. Zakudya zamafuta zikalowa mu duodenum, kutulutsa kwa cholecystokinin, timadzi timene timatulutsa m'matumbo, kumapangitsa kuti ndulu igwirane, yomwe imatulutsa ndulu mumtambo wamba wa bile. Wotsirizirayo amalumikizidwa pakhomo la duodenum ndi chotupa cha pancreatic (monga dzina lake likusonyezera kuti chimachokera ku kapamba), chomwe chimanyamula ma enzyme am'mimba, kuti apange babu la hepato-pancreatic. Kamodzi m'matumbo ang'onoang'ono, minyewa yam'mimba ndi kapamba imayambitsa kuwonongeka kwa chakudya.

Biliary lithiasis : Kapangidwe ka miyala mkati mwa ndulu kapena mkatikati mwa ndulu. Miyala iyi, yofanana ndi timiyala tating'ono, imapangidwa makamaka ndi cholesterol yolumikizidwa. Maonekedwe, kukula ndi kuchuluka kwawo zimasiyanasiyana malinga ndi munthu. Ngakhale amakhala opanda vuto, miyala iyi imatha kulepheretsa zotupa komanso zotupa za bile, motero kutuluka kwa bile kupita ku duodenum. Poterepa, mutuwu uli ndi bicic colic yomwe imatha kukhala mpaka maola 4.

Ma gallstones ang'onoang'ono amakhala ndi zotsatira zakuchepetsa kutuluka kwa bile komwe kumayima mpaka kupangika chomwe chimatchedwa bile sludge, chomwe chimapezekanso mwa anthu ena omwe ali ndi Edzi (3).

Kafukufuku wa 4 (2001) adathandizira kuti majini atengeke ndi lithiasis mu mbewa, zomwe zikusonyeza kuti matendawo angayambike. Kuphatikiza apo, mitundu ina, monga Amwenye aku North America, akuwoneka kuti ali pachiwopsezo chachikulu cha lithiasis.

Pa msinkhu uliwonse, kunenepa kwambiri kumakhalanso kowopsa pachiwopsezo cha miyala yamtengo wapatali. Pakafukufuku wowerengeka (5) wa anthu 2012 azaka za 510 mpaka 000, zidapezeka kuti ana onenepa kwambiri ali ndi mwayi wowirikiza kawiri miyala yamtengo wapatali, pomwe chiopsezo chidali chowirikiza kasanu ndi kawiri pamiyala. anthu omwe ali ndi kunenepa kwambiri.

Mwambiri, azimayi amawonekera kwambiri kuposa amuna pama gallstones awa. Makhalidwe ena atha kuwonjezera chiopsezo chokhala ndi miyala.

Cholecystitis : Kutupa kwa ndulu, komwe kumatha kutsagana ndi matenda. Nthawi zambiri zimachitika chifukwa chakupezeka kwa miyala mu ndulu kapena njira yodziwika bwino ya bile.

Zovala zadothi : pambuyo cholecystitis, calcium imatha kulumikizidwa pamakoma a ndulu, omwe amauma. Nkhaniyo ndiye imakhala ndi chotchedwa porcelain vesicle.

Cholestatic jaundice : Pamene ngalande za ndulu zatsekedwa, bile imabwerera m'magazi. Popeza bilirubin sakutulutsidwanso mu chopondapo, imakhala yopanda mtundu, pomwe khungu limasandukira chikaso pang'ono. Nthawi yomweyo, kuchuluka kwa bilirubin kwamikodzo kumawonjezeka, komwe kumadzetsa mkodzo wakuda. Izi ndizizindikiro za jaundice ya cholestatic.

Chotupa Choledochal : Kutupa kosazolowereka kwamitsempha ya ndulu. Matenda omwe amapezeka pobadwa, amachulukitsa chiopsezo chokhala ndi khansa ya ndulu.

Mpangidwe wosadziwika wa pancreatic-biliary : kobadwa nako anomaly pa mphambano pakati pa njira ya ndulu ndi kapamba. Poterepa, ma enzyme omwe amapangidwa ndi kapamba sangathe kufikira duodenum. Amatha kuyambitsa ndulu.

Khansara ya gallbladder : Mofanana ndi cholecystitis, mawonekedwe a carcinoma a ndulu amavomerezedwa ndi ndulu. Matenda osowa ku France, amakhudza makamaka azimayi azaka zopitilira 70. Kawirikawiri amapezeka akachedwa kufalikira ku ziwalo zoyandikana nawo, nthawi zina amatsagana ndi kupweteka m'mimba, kusanza komanso kusowa kwa njala. Zikhalidwe zimayenera kuganiziridwanso kuti ziwunikire momwe zimakhalira. Kuwonetsedwa ku Thorotrast (9) (chosiyanitsa chomwe kale chimagwiritsidwa ntchito poyerekeza zamankhwala) kumawonjezeranso chiopsezo chokhala ndi khansa ya ndulu.

Mwalawo usanawerengedwe ndipo usapitirire kukula kwake, chithandizo chowasungunula, monga Actigall, ndichotheka. Kubwezeretsa, komwe sikukhudza kwenikweni tsiku ndi tsiku, kumakhalabe kofala pakagwa ma gallstones.

Zakudya zimatha kukopa mapangidwe amiyala yamiyala. Zakudya zopatsa mphamvu zambiri zimalimbikitsa mawonekedwe awo, pomwe chakudya chokhala ndi masamba ambiri chimachepetsa kuchuluka uku. Pakapezeka miyala yoyamba, kusintha kwa moyo wanu (kuchepetsa kumwa mafuta, shuga, kusungunuka kwabwino, kuchita masewera olimbitsa thupi, ndi zina zambiri) kumatha kuthetsa ululu uliwonse.

Matenda ena am'matumbo, monga matenda a Crohn, amatha kuwirikiza kawiri kapena kuwirikiza katatu kuchuluka kwa ndulu (10).

Ultrasound pamimba: mayeso osavuta komanso achangu kwambiri kuzindikira ma gallstones. Ikhoza kuzindikira kuwerengera kwa 90%. Amalumikizidwa ndi kuyezetsa kwachilengedwe (kuyesa magazi ndi kusanthula kwa bilirubin) kuti muwone zovuta zake.

Echo-endoscopy: kuyeza kwamphindi makumi awiri kumakupatsani mwayi wowonera mkatikati mwa ndulu ndikuwunikiranso kapamba.

Kuchotsa gallbladder (kapena cholecystectomy): Opaleshoni yomwe ingachitike pofuna kuthana ndi miyala yam'mimba ya ndulu kapena njira yolumikizirana ndi bile mukakumana ndi zowawa zazikulu.

Ku Antiquity, Galen adakhazikitsa lingaliro lazoseketsa zinayi (11) malinga ndi momwe nthabwala (magazi, chikasu, ndulu yakuda, phlegm) zimayang'anira thanzi lamunthu komanso lamunthu. Marble wachikaso amalumikizidwa ndi mkwiyo, pomwe bile yakuda imabweretsa chisangalalo ndi chisoni. Wotsirizirayo anali, m'malingaliro, woyambitsa nkhawa komanso zoyipa. Ndi kuchokera ku chiphunzitso chachi Greek ichi kuti "kukhala ndi bile" (12) kumabwera.