ndulu yamunthu

Mphuno ndi chimodzi mwa ziwalo zochepa zomwe sizimaonedwa kuti ndizofunikira. Timakuuzani chifukwa chake munthu amafunikira ndulu, komwe ili komanso chifukwa chake imatha kupweteka

Maonekedwe a thupi la munthu ndi odzaza ndi zinsinsi. Chimodzi mwa izo ndi ndulu.

Mofanana ndi ziwalo zonse zopanda pake, ndulu, momveka bwino, iyenera "kubisika" m'thupi kumbuyo kwa minofu ndi mafupa. Koma kwenikweni, ili pafupi kwambiri pamwamba ndipo motero imavulazidwa mosavuta. Mphuno ilibe ntchito zapadera zomwe ziwalo zina sizingathe kuchita. Inde, ndipo munthu akhoza kukhala popanda izo (zowona, ndi kusintha kwa moyo). Koma panthawi imodzimodziyo, ndulu idakalipo pazifukwa zina mu zinyama zonse. Ndipo ku China, amatchedwa mwaulemu - "mayi wachiwiri wa thupi."

Kodi kapamba ndi chiyani, angapweteke, ndipo amachiritsidwa bwanji? Timayankha mafunso awa ndi ena phungu wa sayansi ya zamankhwala, dokotala wamkulu wa gulu lapamwamba kwambiri ndi katswiri wa gastroenterology ndi cardiology Yulia Esipenko.

Chofunika kudziwa za ndulu ya munthu

Mawonekedwe ndi utoto	Chozungulira (chofanana ndi nyemba) chophwanyika, chofiira chakuda (chofiira).
Kukula kwa akuluakulu	Zosasintha. Pafupifupi, mkati: kutalika - 12-14 cm, m'lifupi - 8-9 cm, makulidwe - 3-4 cm. Imatengedwa kuti ndi gawo lalikulu kwambiri la chitetezo chamthupi.
Kulemera kwa wamkulu	150-200 g (nthawi zina zambiri).
Nchito	1) Nkhumba ndi chiwalo cha chitetezo chamthupi, chimagwira nawo ntchito mu hematopoiesis pamodzi ndi msana ndi ma lymph nodes. 2) Amapanga ma antibodies oteteza, amatsuka magazi a tizilombo toyambitsa matenda ndi maselo akufa, amawononga maselo ofiira akale kapena owonongeka.¹. 3) Amagwira nawo ntchito zochotsa kutupa².

Kodi ndulu yamunthu ili kuti

Mphuno ili kumanzere kumtunda kwa pamimba, pang'ono kumbuyo kwa mimba, pamtunda wa nthiti 9-11. Ndiko kuti, ngati zimapweteka pamwamba pa m'munsi mwa nthiti kumanzere, izi zikhoza kukhala ndulu kuti imveke.

Kuyang'ana malo a ziwalo, ndulu ili pakati pa mimba, kumanzere impso ndi m'matumbo.

Kodi ndulu yamunthu imawoneka bwanji ndipo imagwira ntchito bwanji?

Kunja, ndulu yaumunthu imawoneka ngati nyemba yophwanyika: mawonekedwe ozungulira, ofiirira mumtundu (monga momwe ziyenera kukhalira pachiwalo cha hematopoietic). Mphuno ndi ya ziwalo za parenchymal: ndiko kuti, mulibe mkati (monga, m'mimba), ndipo minofu yogwira ntchito imatchedwa parenchyma. Zikuwoneka ngati siponji, ndipo njira zonse za thupi zimachitika mmenemo.

"Zamkati" za ndulu zimakhala ndi zamkati zoyera ndi zofiira. Yoyamba imapanga ma cell a B, omwe amapanga ma antibodies oteteza, ndi ma T cell, omwe amazindikira ndikuwononga maselo okhala ndi ma antigen akunja. Zamkati zofiira ndizofunikira kuti magazi apangidwenso (amawononga erythrocyte akale komanso osalongosoka, amatenga nawo mbali pakukonza chitsulo), komanso amachotsa mabakiteriya oyipa mothandizidwa ndi macrophages ndi granulocytes.⁴amagwira ntchito ngati nkhokwe ya leukocyte ndi mapulateleti. Monga chosungira, ndulu imakhala ndi kapu ya magazi, yomwe imatulutsidwa m'kati mwa dongosolo lonse la circulatory pakafunika.

Pali magawo awiri a ndulu: diaphragmatic ndi visceral. Pamapeto pake pali zipata za ndulu - mtundu wa doko. Mtsempha wa splenic umadutsa pachipata, kumene magazi amalowa m'chiwalo, ndipo mitsempha ya splenic imatuluka. Amatenga magazi kuchokera ku ndulu, m'mimba, kapamba, ndi omentum yayikulu, kenako amalumikizana ndi mitsempha ya mesenteric kupanga mtsempha wa portal. Kuchokera apa, magazi okhala ndi zinthu zowola amalowa m'chiwindi kuti achotse poizoni, makamaka, kukonza komaliza.

Chifukwa chiyani ndulu yamunthu imatha kupweteka

Chiwalochi chimakhala ndi minyewa (chifukwa chake munthu amatha kumva kuwawa) zomwe zili mu kapisozi. Choncho, ndulu imatha kupweteka kokha ndi kuwonjezeka kwa voliyumu, komanso, mofulumira kwambiri⁵. Izi zikhoza kuchitika pazifukwa zingapo.

Kupweteka kwa thupi kungawonekere, mwachitsanzo, panthawi kapena pambuyo pake. Chifukwa cha katundu, kuchuluka kwa magazi kumawonjezeka kwambiri, ndulu imatambasulidwa, ndipo zomverera zosasangalatsazi zimawonekera kumanzere kwa hypochondrium, zomwe zimadziwika kwa ambiri (kumbukirani maphunziro osachepera a maphunziro a thupi). Kwa amayi apakati, ndulu, pamodzi ndi ziwalo zina za m'mimba, "zimaponderezedwa" ndi chiberekero m'kupita kwanthawi, zomwe zingayambitsenso ululu.

Nthawi zambiri ndulu imapezeka m'mawu a akatswiri azachipatala: chiwalocho nthawi zambiri chimawonongeka pankhondo komanso kuchita zachiwawa. Ndipo ngakhale ndulu ili kuseri kwa nthiti, ili pafupi ndi pamwamba, kotero ikhoza kuvulazidwa osati ndi chida chokha, koma ndi nkhonya kapena ngakhale kugwa.

Pali zambiri pathological zifukwa ululu m`dera ndulu. Iwo amawonetseredwa osati ndi ululu, komanso ndi zizindikiro zina. Tiye tikambirane za iwo.

Anthu ambiri amavomereza kuti munthu ali ndi ndulu imodzi yokha. Koma pali zochitika zachilendo za kukula kwa minofu: kunja kumawoneka ngati "mini-spleens" yowonjezera. Iwo amatchedwa mu sayansi - zowonjezera spleens.³. Vuto ndiloti ngakhale ali ndi kukula kwake kochepa (nthawi zambiri mpaka 2 cm), amatha kupondereza mitsempha ya magazi, kuwononga thanzi.

Kusamuka kwa ndulu

Nthawi zambiri ndulu imakhala yosasunthika chifukwa cha minyewa yomwe imagwira. Koma nthawi zina, mwachitsanzo, pambuyo pa mimba zambiri kapena kukulitsa chiwalo, zida za ligamentous zimafooketsa, ndipo ndulu imatha kusuntha ngakhale kupotoza. Volvulus wa ndulu ndiye mtundu wowopsa kwambiri wa kusamuka, chifukwa ukhoza kuyambitsa thrombosis kapena necrosis ya ziwalo za chiwalo (necrosis).

Munthu yemwe ali ndi ndulu yothamangitsidwa amamva kupweteka chifukwa cha kugwedezeka kwa mitsempha ndi kusokonezeka kwa kayendedwe ka magazi.

Thrombosis ya mitsempha ya splenic

Potengera maziko a kapamba kapena matenda opatsirana, pambuyo povulala, zovuta monga thrombosis ya splenic vein zitha kukhala. Koma nthawi zina magazi amaundana mu lumen ya mtsempha amadzipangira okha, popanda mavuto am'mbuyomu.

Ndi kutsekeka kwathunthu kwa chotengera chamagazi, kutuluka kwa magazi kuchokera ku ndulu kumayima, chiwalo chimakula kukula.

The peculiarity matenda ndi kuti poyamba zimapitirira mosazindikira ndi munthu. Pambuyo pake, pali ululu ndi kumverera kwa kulemera kumanzere, nthawi zina kutentha kwakukulu kumatuluka. Umu ndi momwe kutupa kumawonekera. Nthawi zina pali hemorrhagic syndrome: nosebleeds, kusanza ndi magazi.

Pazizindikiro zoyambirira, muyenera kufunsa dokotala: mungafunike kuyimitsa magazi kuti mupewe zovuta.

Infarction ya ndulu

Matendawa amagwirizana ndi kuphwanya kwa magazi: pamene kwa nthawi yaitali magazi samayenda bwino m'dera limodzi kapena lina, pang'onopang'ono amafa. Izi zimachitika chifukwa nthambi za mtsempha wa splenic sizigwirizana ndipo sizingathandize kukhazikitsa magazi pakachitika "kulephera".

Infarction ya ndulu ikhoza kuwonetsa:

kupweteka kumanzere kwa hypochondrium, kumatuluka kumanzere kwa phewa (kuwonjezeka ndi kupuma);
kuzizira, subfebrile fever⁶.

Malinga ndi zizindikiro, splenic infarction imatha kusokonezeka ndi kapamba kapena pyelonephritis. Koma nthawi zina, matenda a mtima sangawonekere.

Neoplasms

Chotupa ndi kabowo kakang'ono mu ndulu yomwe imatha kubadwa kapena kupezeka (mwachitsanzo, pambuyo povulala kapena matenda a parasitic). Pakhoza kukhala ma neoplasms angapo mu chiwalo chimodzi. Zizindikiro sizingawonekere kwa nthawi yayitali mpaka chotupa (kapena cysts) chiwonjezeke kukula. Kupweteka kwake kumakhala kochepa. Mwa zina zizindikiro: kulemera kumanzere hypochondrium, kufooka, pokodza matenda, chopondapo kusintha.

Ngati palibe zovuta, ndipo chotupacho sichimakula mofulumira, ndiye kuti kawirikawiri palibe mankhwala omwe amafunikira - koma ayenera kuyang'anitsitsa nthawi zonse. Pazovuta, zosankha zosiyanasiyana zimatheka, mpaka kuchotsedwa.

Ma neoplasms ena amasiyanitsidwanso: owopsa (mwachitsanzo, hemangiomas, lipomas) ndi zowopsa.

Kutopa, kukhumudwa kopanda chifukwa, kupweteka ndi kulemera kumbali yakumanzere, kusowa kwa njala ndi kutaya thupi mwadzidzidzi - zizindikirozi ziyenera kuperekedwa ndipo mwamsanga funsani dokotala.

Momwemo

Mphuno yodzaza ndi mafinya imapanga mkati mwa ndulu. Nthawi zambiri, abscess akufotokozera monga Vuto la matenda ena. Choyambitsa chikhoza kukhala matenda, kuvulala (pamene hematoma ikuyamba kuphulika), kapena kuphulika kwa ndulu. Kuwonjezera pa ululu, zizindikiro zingaphatikizepo kutentha thupi, kuzizira, ndi thukuta.

Kodi ndulu yamunthu imachitidwa bwanji?

Kusintha kulikonse kwa thanzi, muyenera kufunsa dokotala. Kuti muyambe, onani dokotala. Dokotala adzayang'ana, kupereka mayeso ndi maphunziro ena, ngati kuli kofunikira, atumize kwa katswiri wopapatiza. Kuzindikira kungafune kuyesa kwa labotale, ultrasound, fluoroscopy, computed tomography.

Pambuyo pozindikira matendawa, dokotala adzapereka chithandizo. Thandizo la Conservative, choyamba, limapereka mtendere ndi kuzizira m'chigawo chakumanzere kwa hypochondrium. Zina zonse zimadalira matenda.

Kukonzekera

Kugwiritsa ntchito mankhwala kumatanthauza chithandizo chanthawi zonse. Mankhwala amaperekedwa ndi dokotala kokha malinga ndi zomwe zikuwonetsa.

Mwachitsanzo, ndi abscess wapezeka, yotakata sipekitiramu antibacterial mankhwala amaperekedwa kuwonjezera pa opaleshoni njira mankhwala.

Splenopexy

Pamene ndulu imachotsedwa popanda zovuta (monga zipsera kapena necrosis), opaleshoni imachitidwa kuti amangirire chiwalo ku diaphragm. M’malo mwake, nduluyo imapangidwa ndi sutured kuti isayende mozungulira m’mimba kuti ipewe ngozi yokhotakhota.

Kuchotsa

Opaleshoni imachitidwa ngati opaleshoni ikufunika kumtunda kapena kumunsi kwa ndulu, ndipo nthawi yomweyo n'zotheka kupulumutsa chiwalocho. Mbali ya ndulu imatha kuchotsedwa, mwachitsanzo, ndi chotupa chosaopsa.

Splenectomy

Ili ndi dzina la opareshoni yochotsa ndulu. Zizindikiro za izi zingakhale matenda osiyanasiyana ndi anomalies (mwachitsanzo, kusamuka kwa chiwalo chomwe chinayambitsa volvulus ndi necrosis).

Ndizotheka kukhala popanda ndulu: ntchito zazikulu za chiwalo "zimasokoneza" chiwindi ndi ma lymph nodes pakati pawo. Koma panthawi imodzimodziyo, chiopsezo chotenga matenda oopsa, monga meningococcus ndi pneumococcus, chimawonjezeka. Choncho, anthu amene ndulu zawo kuchotsedwa pazifukwa zina tikulimbikitsidwa kuti katemera angapo matenda, kuphatikizapo fuluwenza.⁴.

Njira Zina Zochizira Mphuno

Kutengera ndi zomwe zikuwonetsa, chithandizo chosiyanasiyana chingafunike.

Ma abscesses ndi ma cysts ena angafunike kuthirira madzi. Kupyolera mu bowo laling'ono, dokotala amalowetsa chubu cha ngalande mu chiwalo, momwe zomwe zili mkati mwake zimachotsedwa ndikuchiritsidwa ndi antiseptic solution.

Ngati khansa yapezeka, dokotala angakupatseni mankhwala a chemotherapy ndi/kapena ma radiation. Koma kokha mu magawo oyambirira. Gawo 3 ndi 4 la oncology limakhudza kokha kuchotsedwa kwa ndulu.

Momwe mungasungire ndulu yanu yathanzi kunyumba

Kupewa matenda a ndulu kumaphatikizapo mfundo zofunika kukhala ndi thanzi. Ichi ndi chakudya chamagulu ndi masamba ambiri, zitsamba ndi zipatso, moyo wokangalika, kusowa kwa zizolowezi zoipa. Koma pali malamulo ena enieni amene muyenera kutsatira ngati simukufuna kupita kwa dokotala.

Kuchita masewera olimbitsa thupi moyenera. Ndizothandiza kusuntha, chifukwa mwanjira iyi mutha kupewa kuyimilira m'thupi. Koma ndikofunika kutsatira malamulo otetezera - kumbukirani kuti ndulu imakhala yosatetezeka, n'zosavuta kuiwononga.
Zovala malinga ndi nyengo ndi kukula kwake. Mpweya ukhoza kukhudzidwa kwambiri ndi hypothermia, koma izi zikhoza kupewedwa mwa kuvala zovala zoyenera nyengo yozizira ndi mphepo. Panthawi imodzimodziyo, zovala ziyenera kukhala zazikulu, osati zolimba kwambiri: malamba ndi malamba amatha kusokoneza kayendedwe ka magazi.
Tiye tikambirane za detox. Mphuno imamva bwino ngati mumamwa madzi oyera okwanira tsiku lililonse (omwe ndi madzi, osati tiyi, khofi kapena madzi). Ndikofunikiranso kulabadira kapangidwe ka zakudya zomwe mumadya (zosiyana za E-Necks ziyenera kukhala zochepa). Ndipo musagwiritse ntchito mankhwala osokoneza bongo: "chemistry" iliyonse imakhudza kwambiri mkhalidwe wa ndulu ndi ziwiya zake.

Mafunso ndi mayankho otchuka

Momwe mungadziwire mavuto oyamba ndi ndulu, ndi mafunso ena otchuka adayankhidwa candidate of medical sciences, general practitioner of the higher category with specialization in gastroenterology and cardiology Yuliya Esipenko.

Ndi dokotala uti amene amachiza ndulu ya munthu?

- Popeza kuti ndulu ndi chiwalo cha hematopoietic, nthawi zonse imakhudzidwa ndi matenda a magazi, ndipo mavuto onse ndi thanzi lake amagwirizana ndi kusintha kwa kukula ndi ntchito ya chiwalo chokha. Palibe matenda enieni, monga cholecystitis kapena zilonda zam'mimba, mu ndulu. Choncho, katswiri wamkulu yemwe amagwira ntchito ndi vutoli ndi hematologist. Kuvulala kwa ndulu, cysts kapena abscesses ndi udindo wa maopaleshoni.

Kodi zizindikiro zoyamba za vuto la ndulu ndi ziti?

- Pamimba pamimba kumanzere, kuwonjezera pa ndulu, pali kapamba, impso. Choncho, poyamba zimakhala zovuta kumvetsa chomwe ndulu "ikudwala" muzochitika zinazake. Popeza chiwalocho chili pansi pa mtengo wamtengo wapatali, mwachibadwa sichikhoza kugwedezeka. Koma ngati ndulu yayamba kutuluka pansi pa nthiti, izi zimasonyeza kuti chiwalocho chikuchitapo kanthu m’thupi. Kwenikweni, awa ndi matenda a magazi.

Palinso matenda omwe amakhudza ndulu - ndi cirrhosis ya chiwindi. Pali matenda a hepatolienal, omwe amapezeka poyesa magazi, omwe amasonyezanso kuwonjezeka kwa ndulu. Panthawi imodzimodziyo, munthuyo mwiniyo sangamve ululu ndi zowawa zina zachilendo. Ndi dokotala yekha amene angazindikire matenda malinga ndi zotsatira za mayesero ndi kufufuza kwathunthu.

Nthawi zambiri, pankhani ya mavuto a ndulu, tikukamba za mtundu wina wa kuvulala pambuyo pa chinthu chosamveka m'mimba kapena kugwa. Zomwe zimachitika: kapisoziyo imasweka, kutuluka magazi kwakukulu kumachitika. Symptomatically, izi zimaonekera motere: munthu amasanduka wotumbululuka, thukuta, kugunda kwa mtima wake ifulumizitsa, ndipo zonsezi motsutsana maziko a ululu waukulu pamimba. Izi zimafuna chithandizo chamankhwala mwachangu. Choncho, ngati kuvulala kulikonse, choyamba timaganizira za ndulu.

Kuyeza magazi ambiri kungathandize kuzindikira mavuto ena, makamaka ngati pali kuchepa kwa hemoglobini, kuwonjezeka kapena kuchepa kwa mlingo wa leukocytes, mapulateleti.

Ndi zakudya ziti zomwe zili zabwino kwa ndulu?

- Poganizira kusefa kwakukulu, hematopoietic, chitetezo chamthupi cha ndulu, ndikofunikira kuti zakudya ziziyenda bwino. Ndikoyenera kupewa zakudya zokometsera komanso zamchere kwambiri, mafuta ambiri osavuta komanso ma carbohydrate. Zakudya ziyenera kuphatikizapo nsomba, beets (mosamala ngati muli ndi matenda a shuga), zakudya zomwe zimakhala ndi chitsulo: mapeyala, apulo, makangaza. Pakakhala vuto la ndulu, uchi (popanda chifuwa), mitundu yosiyanasiyana ya chimanga (zamadzimadzi), mtedza pang'ono ukhoza kukhala wothandiza. Zakudya ziyenera kukhala zosiyanasiyana komanso zokwanira.

Kodi moyo wa munthu umasintha bwanji atachotsedwa ndulu?

- Zochititsa chidwi, ubwino wa munthu susintha. Komabe, chiopsezo chotenga matenda opatsirana, mavairasi amawonjezeka, pamene chiwalo chomwe chimagwira ntchito ya chitetezo cha mthupi chimachotsedwa. Nthawi zambiri pali thrombosis, atelectasis (kugwa kwa mapapu minofu), hernial protrusions pa malo postoperative sutures.

Kumayambiriro kwa nthawi ya postoperative, pakhoza kukhala zovuta zina, zomwe zimawonetsedwa ndi malungo, kuwonjezeka kwa ululu, ndi kutuluka magazi.

Pambuyo pa kuchotsedwa kwa ndulu, ndikofunikira kwambiri kuyang'anira thanzi lanu. General kulimbitsa njira tikulimbikitsidwa, kuphatikizapo kuumitsa thupi, katemera motsutsana fuluwenza. Muyenera kutengera nthawi pambuyo pa opaleshoniyo (osachepera zaka 2-3) kuti muwone ndi hematologist kuti musinthe chithandizo. Ndizotheka kupereka mankhwala kuti muteteze thrombosis, chifukwa ichi ndizovuta kwambiri zomwe zimachitika pambuyo pochotsa ndulu.

Komabe, munthu yemwe ali ndi ndulu yochotsedwa akhoza kukhala ndi moyo wabwino, kulankhulana ndi anthu komanso ngakhale kusewera masewera.

Magwero a:

Kapangidwe ndi ntchito ya ndulu. Reina E. Mebius, Georg Kraal // Chilengedwe chimawunikanso chitetezo chamthupi. Ulalo: https://www.nature.com/articles/nri1669
Kuzindikiritsa Ma Splenic Reservoir Monocytes ndi Kutumizidwa Kwawo ku Malo Otupa. Filip K. Swirski, Matthias Nahrendorf, Martin Etzrodt, ena // Science. 2009. 325(5940). 612–616. Ulalo: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2803111/
Chalk ndulu kutengera chotupa kumanja mbali retroperitoneal. TA Britvin, NA Korsakova, DV Undercut // Bulletin of Surgery. 2017. URL: https://cyberleninka.ru/article/n/dobavochnaya-selezyonka-imitiruyuschaya-pravostoronnyuyu-zabryushinnuyu-opuhol/viewer
Chidule cha Mphuno. Harry S. Jacob // Buku la MSD. Ulalo: https://www.msdmanuals.com/en-gb/professional/hematology-and-oncology/spleen-disorders/overview-of-the-spleen
Kupweteka kwa m'mimba: matenda osiyanasiyana, njira zochiritsira zomwe zingatheke. IYE. Minushkin // RMJ. 2002. No. 15. URL: https://www.rmj.ru/articles/gastroenterologiya/Abdominalynaya_boly_differencialynaya_diagnostika_vozmoghnye_lechebnye_podhody/
Opaleshoni ya matenda a ndulu. Thandizo la maphunziro. AV Bolshov, V. Ya. Khryshchanovich // BSMU Minsk. 2015. URL: http://rep.bsmu.by/bitstream/handle/BSMU/7986/366534-%D0%B1%D1%80..pdf?sequence=1&isAllowed=y