Zamkatimu
Kodi opisthorchiasis ndi chiyani?
Opisthorchiasis amayamba chifukwa cha helminths (chiwindi trematodes) chomwe chimakhudza chiwindi ndi kapamba. Malinga ndi ziwerengero, chiwerengero cha anthu omwe ali ndi kachilombo padziko lonse lapansi ndi pafupifupi anthu 21 miliyoni, ndipo magawo awiri mwa atatu mwa odwala onse omwe ali ndi opisthorchiasis amakhala ku Russia. Vuto lofulumira kwambiri la helminth carriage lili m'chigawo cha Dnieper ndi ku Siberia (kumadzulo ndi Kum'mawa kwa Siberia).
Zifukwa za opisthorchiasis
Chifukwa cha maonekedwe a opisthorchiasis mwa anthu ndi mphaka, kapena Siberia, fluke (Opisthorchis felineus). The causative wothandizira matenda parasitizes mu chiwindi, ndulu ndi ducts, komanso kapamba anthu, amphaka ndi agalu. Gwero la matenda ndi munthu wodwala kapena chiweto. Mazira a tizilombo toyambitsa matenda, pamodzi ndi ndowe za chonyamulira cha matendawo, amalowa m’madzi, mmene amamezedwa ndi nkhono. M’thupi la nkhono, mphutsi zimatuluka m’mazira ndipo zimaberekana. Ndiye mphutsi mu mawonekedwe a cercariae kulowa m'madzi, ndi kutuluka kwa madzi kulowa mu thupi la cyprinids. Matenda a anthu ndi nyama omwe ali ndi opisthorchiasis amapezeka pamene akudya nsomba, nyama yomwe siinayambe kutentha mokwanira, imakhala ndi mchere wambiri kapena wosauma. Nsomba zoterezi zimatha kukhala ndi mphutsi zomwe zimawononga thanzi la anthu ndi nyama zina. Poyang'ana kwambiri, matenda amapezeka nthawi zambiri mukamagwiritsa ntchito zida zodulira zosasamba zomwe zimakhala ndi tinthu tating'ono tating'onoting'ono ta nsomba, pophika kapena kudula zinthu zomwe sizimaperekedwanso chithandizo cha kutentha (mkate, zipatso, ndi zina).
M'mimba mwa munthu kapena nyama, kapisozi wa metacercariae amawonongedwa, mphutsi imaphwanya kansalu kakang'ono ka hyaline payokha, kale mu duodenum, kenako mphutsi za tizilombo toyambitsa matenda zimalowa mu ndulu ndi ma ducts ake ndi kapamba. Pochita njira zodziwira, opisthorchia amapezeka m'mitsempha ya chiwindi ndi ndulu mu 100% ya odwala, tizilombo toyambitsa matenda timadziwikiratu mu ndulu mu 60% ya omwe adalowa, mu kapamba - mwa 36% ya odwala. Metacercariae yomwe yalowa mu hepatobiliary system ndi kapamba imakhwima pakugonana pakatha masabata 3-4 ndikuyamba kuyikira mazira. Chifukwa chake, kufalikira kwa tizilombo toyambitsa matenda kumatenga miyezi inayi mpaka inayi ndi theka ndipo kumaphatikizapo magawo onse a chitukuko cha tizilombo toyambitsa matenda - kuchokera ku dzira kupita kwa munthu wokhwima, kenako helminths okhwima amayamba kuikira mazira. M'thupi la anthu ndi nyama, zomwe zimatengedwa kuti ndizo zomaliza za tizilombo toyambitsa matenda, kuwonjezeka kwa chiwonongeko kumatha kuchitika pokhapokha mutatenganso kachilomboka. Kutalika kwa moyo wa tizilombo toyambitsa matenda ndi zaka 20-25.
Zizindikiro za opisthorchiasis
Zizindikiro za opisthorchiasis zimadalira momwe thupi limakhalira, mphamvu ya matenda ndi nthawi yomwe yadutsa kuchokera pamene wodwalayo adatenga kachilomboka. Matendawa ndi aakulu kapena aakulu. Pachimake siteji, matenda kumatenga 4-8 milungu, nthawi zina ma pathological kumapitirira kwa nthawi yaitali. Matenda a opisthorchiasis amatha zaka: zaka 15-25 kapena kuposerapo.
Mu pachimake siteji, odwala kuzindikira zizindikiro zotsatirazi: malungo, zotupa pakhungu monga urticaria, kupweteka kwa minofu ndi mfundo. Patapita nthawi, odwala amayamba kudandaula za ululu mu hypochondrium yoyenera, kufufuza kumawonetsa kuwonjezeka kwa chiwindi ndi ndulu. Ndiye ululu m`dera epigastric, nseru, kusanza, kutentha pa chifuwa agwirizane mawonetseredwe a matenda, chopondapo odwala amakhala pafupipafupi ndi madzi, flatulence zikuoneka, ndi njala amachepetsa. Pamene fibrogastroscopic kufufuza matenda erosive gastroduodenitis, chizindikiro chilonda cha chapamimba mucosa ndi duodenum. Nthawi zina, opisthorchiasis amapezeka ndi zizindikiro zomwe zimakhala ndi matenda am'mapapo a matupi awo sagwirizana, monga asthmatic bronchitis.
Mu matenda aakulu, zizindikiro za opisthorchiasis zimakhala zofanana kwambiri ndi mawonetseredwe a cholecystitis aakulu, gastroduodenitis, kapamba, chiwindi: wodwalayo amadandaula ndi kupweteka kosalekeza mu hypochondrium yoyenera, yomwe ili ndi paroxysmal m'chilengedwe ndipo imafanana ndi biliary colic. mphamvu zawo, pamene ululu akhoza kusuntha kumanja mbali pachifuwa. Komanso, matenda yodziwika ndi: dyspeptic syndrome, kupweteka pa palpation mu ndulu, dyskinesia wa ndulu. Pakapita nthawi, m'mimba ndi matumbo zimakhudzidwa ndi njira ya pathological, yomwe imatsagana ndi zizindikiro za gastroduodenitis, kapamba komanso kusokonezeka kwamatumbo.
Kuukira kumayambitsanso matenda a chapakati mantha dongosolo, amene anafotokoza pafupipafupi madandaulo odwala za utachepa ntchito, irritability, tulo chisokonezo, mutu ndi chizungulire. Palinso kunjenjemera kwa zikope, lilime, zala m'manja. Matenda a asthenic nthawi zambiri amatsagana ndi kufooka kwakukulu, kutopa kwakuthupi komanso m'maganizo. Nthawi zina, kusokonezeka kwa dongosolo lamanjenje kumatha kubwera, odwala otere nthawi zambiri amapezeka ndi neurocirculatory dystonia kapena autonomic neurosis.
Matenda a opisthorchiasis, limodzi ndi matupi awo sagwirizana syndrome, amawonetseredwa ndi kuyabwa kwa khungu, urticaria, Quincke's edema, arthralgia, chifuwa cha chakudya. The enieni a matenda opisthorchiasis lagona chakuti pambuyo kuchotsa wathunthu tizilombo toyambitsa matenda, wodwalayo ali sizingasinthe kusintha kwa ziwalo. Odwala matenda a chiwindi, cholangitis, cholecystitis, gastritis, matenda a chitetezo cha m`thupi. Kwa odwala otere, njira zaubwino ndizofunika kwambiri akamaliza chithandizo chonse, chomwe cholinga chake ndi kuwongolera magwiridwe antchito a ndulu, kukonza chiwindi, ndikuwongolera kagayidwe kachakudya.
Chifukwa cha kuwonongeka kwa tizilombo toyambitsa matenda, kutulutsidwa kwa mankhwala awo a metabolic, komanso chifukwa cha necrosis ya minofu ya thupi lomwe, kuledzera kumachitika, komwe kumatsatiridwa ndi matupi awo sagwirizana. Kuphatikiza apo, ma helminths (achichepere mpaka ocheperako, anthu okhwima kwambiri) amavulaza epithelium ya bile ndi pancreatic ducts, ndikuyambitsa kusinthika kwa minofu ya hyperplastic. Zina mwazotsatira za matendawa, nthawi zambiri pamakhala kuphwanya kwamakina kwa kutuluka kwa bile ndi madzi a pancreatic chifukwa cha kuchuluka kwa tizilombo toyambitsa matenda, mazira a tizilombo toyambitsa matenda, ntchofu ndi maselo a epithelial m'mitsempha.
Zovuta kwambiri za opisthorchiasis ndi biliary peritonitis, abscess, cirrhosis kapena khansa yayikulu ya chiwindi, matenda ena a kapamba, monga kapamba yowononga, khansa ya kapamba, yomwe imapezeka kawirikawiri.
chithandizo
Pa gawo loyamba (lokonzekera) la chithandizo cha opisthorchiasis, njira zomwe zimatengedwa kuti zithetseretu ziwengo, kuchepetsa kutupa kwa biliary thirakiti ndi m'mimba, kuonetsetsa kutuluka kwa bile ndi madzi a pancreatic, kusintha magwiridwe antchito a hepatocytes, kuchepetsa kuledzera, kuyeretsa. matumbo.
Kuchita bwino kwa gawo lachiwiri la chithandizo cha matenda kumatengera momwe gawo lokonzekera lidachitikira. Pa chithandizo, odwala ayenera kutsatira zakudya zapadera: zakudya zochepa zamafuta zokha ziyenera kuphatikizidwa muzakudya zawo. A mankhwala zotchulidwa antihistamines, sorbents. Nthawi zina, odwala ayenera kutenga prokinetics, antispasmodics, probiotics ndi michere.
Mu gawo la chikhululukiro mu matenda aakulu, njira yokonzekera mankhwala ndi pafupifupi masabata awiri, ngati wodwalayo ali ndi zizindikiro za cholangitis, kapamba kapena chiwindi, ndiye kuti mankhwala amatha masabata 2-3.
Pa gawo lachiwiri la chithandizo, chithandizo cha anthelmintic chachikulu chimapangidwa, chomwe chimathandiza kuchotsa ma trematode ambiri ndi ma cystodes. Chifukwa cha zovuta zoyipa, njira ya chithandizo ndi mankhwalawa ikulimbikitsidwa kuti ichitike m'chipatala, moyang'aniridwa ndi dokotala.
Pa gawo lachitatu (kukonzanso), ntchito zamagalimoto ndi zobisika za ziwalo zamkati zomwe zimakhudzidwa ndi kuwukira kwa helminthic zimabwezeretsedwa. Tubage ikuchitika ndi xylitol, sorbitol, magnesium sulfate, mchere madzi, mankhwala ofewetsa tuvi tolimba angathe kuperekedwa kwa zina kuyeretsa matumbo. Mankhwala ovuta amathandizidwa ndi hepatoprotectors, choleretic mankhwala azitsamba.
Njira zodzitetezera zimachepetsedwa kudya nsomba zomwe zinali kutentha m'munsimu -40 ° C kwa maola 7 kapena kutentha m'munsimu -28 ° C kwa maola 32, mchere mu brine ndi osalimba a 1,2 g / L pa 2 ° C kwa 10-40 masiku (nthawi kukhudzana zimadalira unyinji wa nsomba), izo yophika kwa mphindi zosachepera 20 kuchokera mphindi yophika kapena yokazinga kwa mphindi 20 mu losindikizidwa chidebe.