Besisu ithumba: Izimbangela Nemiphumela

Izacile serosa - peritoneum - okuyinto e ngandlela-thile isendaweni izingxenye ephakeme kwezitho, anezakhi ethize zokuzivikela. Ngokwesibonelo, uma ukuvuvukala, kungaba delimit indawo ethintekayo, ukwakha ithumba besisu. Ngo isitsotsi yezokwelapha libizwa ngokuthi "nokunamathisela ngomthofu", okungukuthi, ukwakheka ukuvuvukala phakathi kwezitho eduze ukuze bathole isikhala avaliwe.

definition

Ithumba besisu - a ukuvuvukala ubovu of uhlaka noma ingxenye yalo, ne eminye ukuncibilika kwezicubu capsule kumiswa ingaphakathi nxazonke. It zingase zimiswe ngokuphelele kunoma iyiphi "phansi" we ingaphakathi lesisu kanye ephelezelwa izimpawu zokudakwa, imfiva kanye sepsis.

Ngaphezu kwalokho, isiguli kuyovama ubuhlungu, waphawula ukuzivikela imisipha besisu, kungenzeka isicanucanu nokuhlanza. Ngezinye izikhathi, ezimweni ezimbi kakhulu, ukuvuvukala kubangele isimiso emathunjini.

lwezifo

Ithumba besisu, hhayi Akumangazi, ekhiqizwa elandela izinqubo kuhlinzwa futhi esichazwa njengesono esiphambene inkinga yalolu hlobo ukwelashwa. Uma sicabangela ukukhula kwenani imisebenzi eyenziwa minyaka yonke, inani yezinkinga ezifana kwandisa kancane kancane. A indima enkulu lena Ukwehla amasosha omzimba futhi kusakazeke nokusetshenziswa kwamaphilisi nezilwanyana ezincane ukwakha ukuzinza kanye uyawuthiya nokuvimbela yezinkinga nasezinkingeni ezilandela ngemva kokuhlinzwa.

Ngokusho iziphetho okungeziwe, amaphesenti esinye seziguli kuhlinzwa ekuthuthukiseni ithumba nasezinkingeni ezilandela ngemva kokuhlinzwa. Lesi sibalo ephakeme uma kokungenela sasiphuthuma nesikhathi sokulungiselela preoperative wayengekho.

engcupheni

The main eyingozi, ngenxa okuyinto kungase ithumba we komgodi ongaphakathi kwamathumbu - Yebo, ukuhlinzwa cavernous. It is ngokuvamile kwenzeka emva kokwelashwa izifo pancreatic, nenyongo sesinye, wamathumbu iluphu uthunge.

Ukubukeka ukuvuvukala ngenxa ukuchayeka okuqukethwe emathunjini ku peritoneum, nokungcola kwayo ngo egumbini lokuhlinza. Kungase kubangelwe blunt ukuhlukumezeka besisu. Esikhundleni kokucindezelwa ekhiqizwa ukuvuvukala aseptic, owawungumnyaka Kamuva lahlangana flora yesibili.

Abangaphezu kwesigamu ithumba kungaba parietal (parietal) isiqeshana peritoneum, noma phakathi parietal yayo futhi amashidi visceral.

izizathu

abscesses besisu (ICD10 - K65) kungaba umphumela uhlukunyezwe esiswini, isibonelo, compressions eside noma ukushaqeka, izifo ezithathelwanayo tube emathunjini (iersiteoz, salmonellosis, i-typhoid fever), ukuthuthukiswa izinqubo ukuvuvukala kwezitho zomzimba noma mucosa, kanye ngemva perforation izilonda isisu noma amathumbu.

Kunezizathu ezinkulu ezintathu:

1. Ukuba khona peritonitis yesibili ngenxa ukudabuka we appendix ngongakwazi ukukhokha izikweletu anastomoses emathunjini, kulandela ukugasela besisu, necrosis ikhanda pancreatic, ukuhlukumezeka besisu.
2. Ubovu ukuvuvukala ezithweni kwezitho zangasese, ezifana salpingitis, imingcele piosalpinks, tubo-wesibeletho ithumba nabanye.
3. ukuvuvukala olunamandla kwamanyikwe kanye nenyongo sesinye, izilonda emathunjini.

Ngaphezu okungenhla, ngezinye izikhathi imbangela ithumba kungenzeka ukuvuvukala izicubu perinephric, osteomyelitis, lumbar nomgogodla, spondylitis tuberculous. Ngokuvamile ku ukuvuvukala seeded staphylococci, streptococci, clostridia futhi isherihy, ie izitshalo, okuyinto evamile kungenzeka emathunjini.

pathogenesis

Ithumba besisu nasezinkingeni ezilandela ngemva kokuhlinzwa livela ngenxa yokusabela ngokweqile kwesimiso somzimba sokuzivikela ezifweni ukuba angenelele imvelo yangaphakathi noma kabusha nezilwanyana ezincane. I-ejenti kungenzeka ukungena ngaphakathi komgodi peritoneal futhi yegazi noma lymph kanye seep ogangeni emathunjini. Ngaphezu kwalokho, kukhona njalo kuyinto ingozi yokutheleleka nge udokotela ohlinzayo ukubeka izandla zakhe, amathuluzi noma izinto ngesikhathi ukusebenza. Esinye isici aphume ashone emizimbeni yokuxhumana imvelo yangaphandle, ezifana amashubhu fallopian noma amathumbu.

Asikwazi ukubeka eceleni ukubukeka lingene ukuvuvukala emva okungena ekujuleni besisu izilonda, izilonda futhi perforations kwehlukana sutures ngemva kokuhlinzwa.

Peritoneum iphendula ukubonakala isici emnandi (ukuvuvukala) stereotypically, okungukuthi, uphehla fibrin ku ubuso bayo okuzokwenza nesibopho ndawonye izingxenye mucosa futhi ngaleyo ndlela ibeka le kusuka inyama ephilile. Uma lokhu Ukuvikelwa libhujiswa ngenxa ubomvu, le detritus ukuvuvukala agelezela ekhukhwini esiswini semfenisha isikhala. With ukuthuthukiswa onjalo sepsis simo Ukukhuluma.

izimpawu

Kwenzekani umuntu lapho edala ithumba besisu? Izimpawu zifana yimuphi isifo ukuvuvukala:

1. High, a kuqala ngokuzumayo imfiva ephelezelwa Ukugodola nomjuluko kakhulu.
2. Ukudweba ubuhlungu esiswini, okuyinto eseshukumisa touch noma ingcindezi.
3. ukuchama kaningi, njengoba peritoneum sisalokhu futhi ecasula baroreceptors esinyeni udonga.
4. Sezinyawo ukushayisana ifomu ukuqunjelwa.
5. Ukucanuzela kwenhliziyo nokuhlanza ngesikhathi ibambene umkhuhlane.

Ngaphezu kwalokho, nangesineke kungase kube palpitations. Kwenzeka ngenxa yezizathu ezimbili: nemfiva ukudakwa. Futhi njengoba uphawu pathognomonic kuyinto imisipha ukungezwani cindezela. Lena reflex zokuzivikela, ezivikela okwengeziwe ona endaweni elikhanyayo.

Uma ithumba itholakala ngqo ngezansi diaphragm, ngaphezu izimpawu ezivamile are labo ukhombe kulesi sici. Umehluko sokuqala ukuthi ubuhlungu itholakala ku hypochondrium, wanda phakathi ugqozi obusuka ku esifundeni scapular. Eyesibili umehluko - ushintsho Gait. Man uqala yezimo abhekene banakekele abagulayo incika wakhe, ukunciphisa imisipha ukungezwani.

yezinkinga

abscesses besisu (ICD-10 - K65) angahlala akubonakali uma asathuthuka e-zasemuva zezinye izinhlelo isimo sesisibi, noma isiguli akafuni usizo. Kodwa kufanele sikhumbule ukuthi ngenxa yokuziphatha budedengu angagcina izimo ezisongela ukuphila, ezifana sepsis futhi ekubhebhetselisa peritonitis.

abscesses Subdiaphragmatic kungenziwa bhotela kanye beso ukuba singangeni ngenkani ingaphakathi pleural, ukwakha ukuvuvukala khona. Esimeni esinjalo kungase kuholele ngisho nasezinkingeni wamaphaphu ukulimala. Ngakho-ke, uma emva kokuhlinzwa noma ukulimala, unemfiva noma ibuphi ubuhlungu, ungalindeli ukuthi zonke kuzodlula ngokwalo. Kulolu shicilelo of eliphakeme extra awukwazi ubuhlungu.

ukuhlola

Postoperative ithumba besisu esibhedlela ukubona sasivumela kalula. Izindlela eziningi ulwazi kukhona x-ray, imisindo ephansi, CT nama-MRI kwesifuba eziyishumi nemitshingo esiswini. Ngaphezu kwalokho, kungenzeka abesifazane ukwenza wokubhoboza egumbini sowesifazane sangasese ukuhlola ukuthi kukhona streaks ubovu ezindaweni ezitshekile.

Futhi, ungakhohlwa mayelana uphethwe laboratory. Ngokuvamile, ukuhlaziya igazi sizoba waba ukwanda okukhulu kwezincwadi erythrocyte sedimentation isilinganiso (ESR), WBC uzoba shift okukhulu kwesobunxele, kungenzeka ngisho kumafomu abasha kanye nenani eliphelele amaseli kuzokhulisa ngenxa neutrophil.

Ezijwayelekile sitholakele ithumba kuyinto ultrasound besisu. Zikhona izimpawu ezicacile ezibonisa khona INGENA ISINYENYELA ukuvuvukala:

• kumiswa has zomhlangano ecacile futhi capsule obukhulu;
• ngaphakathi iwuketshezi;
• okuqukethwe isakhiwo inhomogeneous futhi ihlukaniswe yaba izingqimba;
• Kuyinto ngaphezu igesi ketshezi.

Ukwelashwa abscesses besisu

Indlela eyinhloko ekwelapheni abscesses, Yiqiniso, ukuhlinzwa. Kuyadingeka sokukhipha ingaphakathi ithumba ne ukugeza isinqandakuvunda futhi isixazululo antibiotic. ukwelashwa okulondoloza akukuniki yimuphi isiqinisekiso sokuthi yisishiso luyaphela, futhi uketshezi ngaphakathi ithumba wena ziyakhishwa.

Yiqiniso, ngemva focus isuswe, isiguli kuyadingeka ukuba linqume ukwelashwa elwa namagciwane ukuze ezibanzi spectrum antibiotic. Ngokuvamile, udokotela ekunika esifanayo imithi ezimbili izindlela ezahlukene isinyathelo futhi ababhubhise ngempumelelo abameleli ezihlukahlukene izitshalo amagciwane abe nenkani.

kuwufanele Njalo ukuxwayisa ogulayo nangemiphumela engaba khona ukwelashwa, ezifana ukuhlanza, ukungabi esesuthi, ukuvuvukala ungqimba papillary ulimi, ubuhlungu bekhanda ukuchama kaningi. Futhi kudokotela kufanele bakhumbule kubo bese wengeza ukuba isithombe emitholampilo ye isifo.

Ukubikezela kanye nokuvinjelwa

abscesses besisu (ikhodi ye-ICD-10 - K65) - ngempela isimo esibucayi, ukuze iziguli nodokotela kufanele khona zokuvimbela lesi simo. Kuyadingeka ukuba ngokwanele futhi ngokugcwele ukwelapha izifo ukuvuvukala yanoma yiziphi ingaphakathi lesisu, qiniseka ukuqhuba ukulungiselela ngaphambi nangemuva-operative isiguli, kanye amathuluzi kanye-inzalo futhi izandla likadokotela ohlinzayo.

Ukuze appendicitis esolwa noma uma ukwanda okungazelelwe lokushisa akudingekile ukuba ulinde isibonakaliso esivela ngenhla, futhi kufanele ngokushesha xhumana nodokotela iseluleko. Kungasindisa impilo yakho.

Nokufa kusukela ithumba besisu ifinyelela amaphesenti amane. Konke kuncike futhi kangakanani inqubo, lapho itholakala kanjani okubangelwa yilesi sifo. Kodwa nge ukwelashwa esifike ngesikhathi esibhedlela amathuba umphumela okungekuhle sinciphile.