Njira yodziwika bwino ya bile imalumikiza ndulu ndi duodenum. Njira yodziwika bwino imeneyi ya bile ndi njira yomwe ntchito yake ndikutulutsa bile mu duodenum, chiwalo chomwe chimapanga m'mimba. Chifukwa chake, bile ndi gawo lofunikira pakugayidwa kwa chakudya. Njira yodziwika bwino ya ndulu, yomwe imabweretsa ndulu iyi ku gawo loyambirira la matumbo aang'ono, imapangidwa ndi kuphatikizika kwa njira yodziwika bwino ya hepatic ndi cystic duct. Matenda ambiri a bile amayamba chifukwa cha ndulu, timiyala ting'onoting'ono timeneti nthawi zina timapanga makamaka chifukwa cha kutsekeka kwa ndulu ndi miyala ya ndulu, yomwe imasanduka miyala.

Njira yodziwika bwino ya ndulu imapangidwa ndi kuphatikizika kwa njira yachiwindi ndi cystic duct. Chifukwa chake, bile canaliculi, tinjira tating'onoting'ono timene timasonkhanitsa ndulu yopangidwa ndi maselo a chiwindi (ma cell omwe amatchedwanso hepatocytes), amaphatikizana kupanga ma ducts a bile. Apanso, timitsempha ta ndulu timeneti timalumikizana n’kupanga njira ya kumanja ya hepatic komanso ya kumanzere ya hepatic, yomwe imalumikizana kuti ipange njira yolumikizira chiwindi. Ndilo njira yachiwindi yomwe imalumikizana ndi cystic duct, mtundu wa thumba lochokera ku bilary vesicle, ipanga njira wamba ya bile. Kuchokera ku njira ya ndulu, bile imatha kulowa mu duodenum, gawo loyambirira la matumbo aang'ono omwe amatsatira m'mimba. Tizilombo totuluka kudzera m'chimbudzi chodziwika bwino choterechi chimatenga nawo gawo m'chigayo cha thupi.

Mwachilengedwe, njira yolumikizira ndulu imapangitsa kuti zitheke kutulutsa bile kudzera mu babu ya hepato-pancreatic kulowa mu duodenum. Kulowa m'chiwalo ichi cham'mimba, nduluyo itenga nawo gawo pogaya chakudya. Ndipotu njira imene imanyamula ndulu yotuluka m’chiŵindi imatchedwa njira yaikulu ya ndulu yotuluka m’chiŵindi ndipo imatchedwa common duct duct ikalumikizidwa ndi ndulu, kutanthauza kuti ya ndulu.

Udindo wa bile mu chimbudzi

Bile amapangidwa m'chiwindi asananyamulidwe kudzera m'mitsempha ya ndulu, kenako amatuluka kudzera munjira wamba. Chiwindi chimatulutsa pafupifupi 500-600 ml ya bile tsiku lililonse. Chiphuphu ichi chimapangidwa makamaka ndi madzi ndi ma electrolyte, komanso ma organic compounds, makamaka mchere wa bile. Mchere wa bile, womwe umatulutsidwa mu gawo loyambirira la matumbo ang'onoang'ono, duodenum, ndiye amakhala ndi ntchito zofunikira zopangira mavitamini osungunuka a liposoluble, komanso mafuta omwe adalowetsedwa: izi zimapangitsa kuti chimbudzi chawo komanso kuyamwa kwawo. . Kuphatikiza apo, ndulu imakhalanso ndi bile pigment, zinthuzi zomwe zimabwera chifukwa cha kuwonongeka kwa maselo ofiira a magazi ndipo gawo lina lomwe limachotsedwa m'thupi kudzera pa chopondapo.

Kuchulukitsa kwa ndulu

Kudya kumatulutsa mahomoni kuchokera m'matumbo. Kuonjezera apo, mitsempha ina imakondoweza (yotchedwa cholinergic mitsempha), yomwe imayambitsa ndulu. Izi zidzatulutsa 50 mpaka 75% ya zomwe zili mu duodenum, kudzera munjira wamba ya ndulu. Potsirizira pake, mchere wa m’chiwindi umayenda kuchokera kuchiŵindi kupita m’matumbo kenako n’kubwerera kuchiŵindi kakhumi mpaka kakhumi ndi kaŵiri patsiku.

Matenda ambiri a bile ducts amayamba chifukwa cha ndulu, timiyala tating'onoting'ono timene timapanga m'mitsempha ya bile. Pamapeto pake, matenda atatu akuluakulu a ducts ya bile amadziwika: kusungidwa kwa biliary, zotupa ndi miyala.

• Pakakhala kusungidwa kwa biliary, ndulu sichilowa mu duodenum. Imayimirira munjira ya ndulu kapena m'chikhodzodzo. Kutsekeka kumeneku kumayambitsa kupsyinjika kwakukulu munjira za bile. Izi zimayambitsa kupweteka kwa chiwindi colic;
• Chodabwitsa ichi cha kusungidwa kwa biliary kumatha kuyambitsidwa ndi chotupa munjira za ndulu kapena mu ndulu ya kapamba. Zotupazi zimatha kukhala zowopsa kapena zowopsa. Kuphatikiza apo, amatha kukhudza ma ducts a bile kuchokera mkati ndi kunja kwa chiwindi;
• Mitsempha yomwe imamera mu ndulu imayamba chifukwa cha kutsekeka kwa ndulu ndi matope a ndulu, omwe amamera ndikukhala miyala. Chifukwa chake, lithiasis wa duct yayikulu ya bile imadziwika ndi kupezeka kwa miyala mumayendedwe a bile. Mitsempha iyi imatha, makamaka, chifukwa chakuwoneka kwa mchere wosasungunuka wa kolesterolini m'mitsempha ya bile. Nthawi zina ndulu iyi imasunthira kulowa munjira yayikulu ya ndulu, njira ya ndulu. Kenako zimayambitsa kuukira kowawa, komwe kumatha kutsatiridwa ndi kutentha thupi komanso jaundice chifukwa cha kutsekeka kwa njira ya ndulu.

Chithandizo cha lithiasis cha ndulu wamba nthawi zambiri chimakhala chamitundumitundu.

• Kumbali imodzi, cholecystectomy (kuchotsa ndulu) kumapangitsa kuti zitheke kuletsa mapangidwe a ndulu;
• Kumbali inayi, mwala womwe umapezeka munjira ya ndulu ukhoza kuchotsedwa panthawi ya cholecystectomy, kapena ngakhale m'masiku otsatira atathandizira dokotala wa gastroenterologist pa opaleshoni yotchedwa endoscopic sphincterotomy.

Kuchotsedwa kwa ndulu sikuyambitsa kusintha kwakukulu kwa thupi. Kuonjezera apo, sikudzakhala kofunikira kutsatira zakudya zapadera pambuyo pake.

Choledochal lithiasis nthawi zina amakhala asymtomatic: amatha kupezeka pakuwunika. Zikayambitsa kutsekeka kwa biliary, zomwe zimatchedwanso cholestasis, zimayambitsa jaundice (jaundice) komanso kupweteka kwa chiwindi chamtundu wa colic. Nthawi zina matendawa amatha kuganiziridwa poyang'aniridwa ndi dokotala.

Mayeso ozama adzafunika:

• Pazinthu zamoyo, pangakhale zizindikiro za cholestasis, monga kuwonjezeka kwa bilirubin, gamma GT (GGT kapena Gammaglutamyl-transferase), ndi PAL (alkaline phosphatase) komanso transaminases;
• The m'mimba ultrasound angasonyeze dilation ya ndulu ducts;
• Endoscopic ultrasound, yomwe mwina imagwirizanitsidwa kapena ayi ndi bili-MRI idzachitidwa kawirikawiri, ndi cholinga chowonera lifiyasi ndikutsimikizira kuti matendawa ndi otani.

Etymologically, mawu akuti cholédoque amachokera ku Greek "kholé" kutanthauza "bile", komanso "ndulu" ndi "kukwiya". M'mbiri yakale, ziyenera kudziwidwa kuti mu Antiquity, ndipo mpaka zomwe zapezedwa mu physiology yaumunthu zomwe zidapanga zamankhwala kukhala zasayansi, zinali zachizolowezi kusiyanitsa zomwe zimatchedwa "nthabwala" zinayi za Hippocrates. Yoyamba inali magazi: yochokera mu mtima, imatanthawuza khalidwe la magazi, lomwe limasonyeza khalidwe lamphamvu ndi lomveka, komanso lokondana kwambiri. Yachiwiri inali pituitis yomwe, yolumikizidwa ku ubongo, inali yolumikizana ndi mitsempha yamagazi, yotchedwanso phlegmatic. Wachitatu mwa nthabwala zomwe Hippocrates adapereka zinali ndulu yachikasu, yochokera m'chiwindi, yomwe idalumikizidwa ndi kupsa mtima. Potsirizira pake, ndulu yakuda kapena atrabile, yochokera ku ndulu, inali ndi udindo wa khalidwe la melancholy.