Malabsorption - Iyini? Ukwahlukanisa nezimbangela

emathunjini amancane - omunye emathunjini. It wenza ezihlukahlukene nemisebenzi, inendima enkulu e ukugaya ukudla kanye ukumuncwa kwezakhi. With ukuthuthukiswa izifo ezithize kwaphazamisa lo mnyango - sobala malabsorption syndrome, okuyinto esifushanisiwe njengoba CMA. Kuyini lokhu eside? Lesi sifo sibangelwa yini izizathu?

imiqondo kulungiswa

Esikhathini izincwadi zezokwelapha ezisekelwe ekwazisweni, ungathola elithi ezifana "malabsorption". Leli gama lisetshenziswa ukuze libhekisele malabsorption mucosa emathunjini izingxenye ukudla. Kukhona elithi ezifana "maldigestion". Lokhu izinqubo ukwephulwa ukuguqulwa fat, amaprotheni kanye carbohydrate ukugaya imikhiqizo absorbable.

Ochwepheshe ukuhlanganisa kokubili eside ngenhla ( "malabsorption" futhi "maldigestion"), lapho omunye ukhuluma malabsorption syndrome. Kushiwo eziyinkimbinkimbi ukubonakaliswa yomtholampilo, okungenxa ukwephulwa ingaphakathi, udonga, ulwelwesi ukugaya kanye ezokuthutha emathunjini amancane. Ngenxa izinguquko ezenzeka emzimbeni womuntu ngenxa ukuvela malabsorption syndrome, iziyaluyalu umzimba ukuvela. Abantu baqale ukuhlupha izimpawu ezingezinhle.

Izimbangela SMA

malabsorption syndrome ebonwe izifo eziningi zenani elikhulu eziyifa kanye azalwa naso lapho enyakaziswa ukumuncwa izinto, wanciphisa ukuhileleka enzyme. Njengoba isibonelo,-cystic fibrosis. Kulesi sifo, AGR eba ngenxa wehlise enzyme umsebenzi futhi pancreatic iziyaluyalu izimfihlo viscosity.

Ukuze abangele malabsorption izifo syndrome kubangelwa izifo kanye nezinambuzane, isimiso se-lymph okungafanele izinhlelo kwegazi. CMA is yaphawula uma umonakalo emathunjini amancane kanye nokunciphisa ukumuncwa endaweni (okuthiwa izinguquko emzimbeni, ibe imbangela yokuphazamiseka ezibucayi izinhlobo eziningi Ukuhwebelana, ngokomzimba futhi ubambezela engqondo).

Ngakho, malabsorption - iqoqo izimpawu ezingemnandi ukuthi kungabangela eningi izizathu ezahlukene. Bona zingahlanganiswa kanje:

1. Preenteralnaya iqembu. Lezi zihlanganisa izifo biliary pheshana, isibindi, esiswini,-cystic fibrosis.
2. Postenteralnaya iqembu. Kuhlanganisa lymph kwegazi iziyaluyalu emathunjini eside, esemgwaqweni phakathi isisu ikholoni, enteropathy exudative, lymphosarcoma, isifo Hodgkin sika.
3. iqembu enteral yezizathu. Lezi zihlanganisa galactose malabsorption, yesifo celiac, ukwehluleka disaccharidase, giardiasis, dermatitis herpetiformis.

Izimpawu ethize ukuze SMA

Naphezu kweqiniso lokuthi lesi sifo malabsorption esivela izifo ezihlukahlukene, kungaba avelele izici sobuntu bakhe. Lapho CMA isicanucanu, ukuhlanza. In iziguli kwehle iphango. lezi zimpawu nazo ngimbone njengoba umoya esiswini, ukuqunjelwa, ushintsho sezinyawo (uhudo ngokuvamile kwenzeka). Zonke lezi zimpawu abizwa ngokuthi dyspeptic syndrome. Yena uhola ukubonakaliswa basemtholampilo SMA.

ngokukhethekile kufanele kube esihlalweni. Ukuhlola izici endleni, ochwepheshe ukwamukela imininingwane ebalulekile evumela ukuthi ukubeka okuyikona:

• futhi frothy sezinyawo ketshezi nge nephunga esidi - uphawu ukuthi kungaba esivela pathologies ezifana zikashukela-galactose malabsorption, ukuntula disaccharidase;
• sezinyawo okunamafutha ungaphakathi pancreatitis okungamahlalakhona, cystic fibrosis, dermatitis herpetiformis, exudative enteropathy syndrome Pearson dysbacteriosis emathunjini;
• izigqiki okunamafutha kakhulu nasemkhakheni-cystic fibrosis, uyisithulu lipase ukuntula;
• uhudo lwamanzi - uphawu okwenzeka lapho isifo engena emzimbeni, enterocolitis asathuthuka, malabsorption of glucose ne-galactose.

Lapho MCA ngezinye izikhathi kunezindlela izinhlungu. Ngokuvamile, babangela izifo emathunjini bese kucabanga. Ubuhlungu syndrome singenzeka sebephuze izingilazi imikhiqizo yobisi. Yena kuhlangene foamy esihlalweni ephethe iphunga omuncu, ukubuyisa libonisa ukuntula lactase. Ubuhlungu besisu ngesikhathi CMA ezihambisana engezwani nokudla okuthile, kwezinso emathunjini, isifo Whipple sika, izilonda emathunjini, isifo Crohn. Izimpawu ezilandelayo kuyagcinwa ngisho nalapho malabsorption syndrome:

• ukuqubuka kwesikhumba;
• ukukhathala;
• umuzwa ngenxa yobuthakathaka;
• ukuvuvukala;
• ye-anorexia.

Malabsorption ezinganeni ephelezelwa syndromes untula. Siyabhubha ukuthuthukiswa ngokomzimba. Lokhu kubonakala wokwehla isisindo somzimba, ukuthuthukiswa yokungondleki, ukungakhuli kahle. On amavithamini sibonisa isimo kwesikhumba. Isikhumba iba ezomile futhi iqala ikhasi off. On ibonakale amnyama. Izinwele thinning bese uqala ukuba baphume. Izinzipho abe ithoni buthuntu futhi exfoliate. Lapho i-calcium ukuntula zenzeka amajaqamba, ubuhlungu bemisipha kanye amathambo. Ukuntuleka kokukhulumisana iron, ithusi ne-zinc kuholela ukubukeka ukuqubuka kwesikhumba, i-iron-ukuntula kwegazi, ukwandisa izinga lokushisa komzimba.

ngezigaba ekhona

malabsorption syndrome kuhlanganisa izifo ezahlukene ezingaphezu kwama-70. Kule ndaba, ochwepheshe zihlangabezane nobunzima e Ukwahlukaniswa ukulungiswa. I aphumelela kakhulu division of zenani elikhulu eziyifa kanye atholwe malabsorption syndromes:

1. Eyokuqala yalezi itholwa e-10% amacala. SMA Ukubambezeleka lidluliselwa abazali ingane. Wabuye kungenxa zofuzo.
2. malabsorption Kutholiwe syndrome - umphumela iziyaluyalu emathunjini bese extraintestinal (isb izimila, immunodeficiencies, pancreas).

Kukhona ngezigaba ogxile kobukhulu malabsorption syndrome:

• Ibanga mina (sibi) - izingane esisindo yehliswe kancane, kuphakama izimpawu ukwehluleka multivitamin waphawula ukuthuthukiswa ngokomzimba disharmonious;
• II degree (umumo isilinganiso) - isiguli kusilela umzimba mass (ukuphambuka kusuka kuyinsakavukela mkhulu kuka-10%) is baphawula lag ekuthuthukisweni ngokomzimba, labona izibonakaliso liphinyiselwe electrolyte ukuntula futhi esingamahlalakhona multivitamin;
• Ibanga III (esibi kakhulu) - izingane kukhona ampofu emzimbeni, umzimba kusilela mass idlula 20% kwezinye iziguli kukhona ukubambezeleka ukuthuthukiswa lengqondo.

izinhlobo malabsorption

Ngo-1977 labetibambile VIII World Congress of Gastroenterology. It Ochwepheshe baye bathola izinhlobo eziningana malabsorption, kuye ngokuthi izimbangela zalo:

• intracavitary;
• posttsellyulyarnaya;
• enterotsellyulyarnaya.

Ukuntuleka kokukhulumisana Bile ethakwa ngu kwamanyikwe futhi izinto esithinta ukugayeka lalihlehliswa futhi kubangela ukubakhulumela, - malabsorption uhlobo intracavitary. Izingane kuphakama ngenxa cystic fibrosis, hypoplasia azalwa naso kwamanyikwe. Ezinganeni ezindala ukubukeka malabsorption intracavitary syndrome avuse izifo ezifana isifo sokusha, pancreatitis ezingamahlalakhona.

Eyesibili uhlobo SMA - malabsorption posttsellyulyarnaya. Lesi sifo, okuyinto libhekene ukulahlekelwa plasma amaprotheni ogangeni emathunjini. Waphawula nge anomalies izinhlelo kwegazi futhi lymph. Esinye sezifo - i lymphangiectasia idiopathic emathunjini. Nanguya esivela ukulahlekelwa esindayo calcium, lipids kanye namaprotheni pheshana emathunjini.

uhlobo Enterotsellyulyarny ihlanganisa ikakhulukazi ezimweni lapho ephukile ulwelwesi ukugaya noma ukumuncwa ngenxa Isici enzyme izinhlelo lamaseli emathunjini EPITHELIAL. Okunjalo kungenzeka izingane ngoba izifo lezinceku elihlobene ne ukuhlukumeza:

• ukuncela;
• ulwelwesi ukugaya;
• ukugaya kanye ukumuncwa.

Izingane amadala yobudala enterotsellyulyarny uhlobo malabsorption syndrome kwenzeka ngenxa ukulimala amathumbu yokufa kwamangqamuzana engokwemvelo ngenxa ithonya izifo noma izilokazane eziphila ngezinye, isifo sofuba, izimila emathunjini amancane, isifo Crohn.

Izibonelo malabsorption intracavitary

Nge lolu hlobo AGR kakhulu siyabhubha ukugaya amafutha. hydrolysis wabo wenziwa lipase pancreatic, okuyinto ivuswe ngu Bile. Nge nokushoda lezi zinto ubonakala uphawu ezifana steatorrhea. Lokhu Ukukhetha ne indle fat ngokweqile. Lokhu ibonakala kahle kakhulu e ezingamahlalakhona pancreatitis steatorrhea. Obunganakekile lokhu uphawu e isibindi ipheshana biliary.

Phakathi kwezimbangela ka malabsorption intracavitary, kufanele ucabangele hypoplasia azalwa naso kwamanyikwe (hypoplasia). Izimpawu avele ngezinsuku zokuqala noma amasonto zokuphila. Kukhona ocebile esihlalweni okusheshayo ayebuthaka ketshezi malodorous futhi okunamafutha. Fat kungaba ngisho njalo angena aphume ingquza.

Izibonelo malabsorption posttsellyulyarnoy

Posttsellyulyarnaya malabsorption emathunjini kwenzeka enteropathy lapho exudative. Lena syndrome lapho plasma amaprotheni kulahleka ngokusebenzisa le mucosa. Imbangela enteropathy exudative kungenzeka khona malformation azalwa naso imithambo wamathumbu lymph. Ngokuvamile kubangele isifo syndrome Whipple sika, isifo Crohn, izimila ezincane wamathumbu, yokungezwani komzimba ukudla.

ngezinye izikhathi enteropathy Exudative kwenzeka ngaphandle nezisobala ukubonakaliswa emtholampilo. Ingase ibe nezimpawu ezithile njengesifo sohudo steatorrhea. Iziguli avele edema neuropathy, owenziwe waba owasendaweni ebusweni, emuva, perineum, nemilenze.

Izibonelo enterotsellyulyarnoy malabsorption

Enterotsellyulyarny uhlobo AGR malabsorption kungase kube ngenxa zokugula ezifana malabsorption zikashukela-galactose. Lena isifo ngofuzo lapho ngobugebengu ezokuthutha asebenzayo of glucose ne-galactose ku encane emathunjini mucosa. Ukugula ezinsukwini zokuqala zokuphila livezwa sohudo. Fecal abelwe kusukela ezikhathini 10 kuya ku-20 ngosuku. Ziyakwazi lwamanzi, efana umchamo. Ingane evusa lokushisa komzimba, ukuhlanza kwenzeka. Uma ukhansela supply nobisi izimpawu. ukubekezelelana Kubi emaswidi ubisi uhlala for a lifetime.

Esinye isibonelo enterotsellyulyarnogo CMA - fructose malabsorption. Lena malabsorption esingavamile esidluliselwa ngofuzo. Izimpawu okuyokwenzeka ngemva ukusetshenziswa izithelo ayo, eliqukethe e oyiyo semali fructose. Lena apula namawolintshi, futhi cherry kanye cherry. Lokho fructose akuyona amuncwa wumzimba, okubangela ukubuyisa, ukukhishwa isisu lwamanzi, ubuhlungu colicky esiswini. Kwezinye izimo, kukhona ukuhlanza. Kobukhulu izimpawu incike inani fructose langena umzimba.

Okuvame kakhulu isizathu enterotsellyulyarnoy malabsorption nge kahle ulwelwesi ukugaya - ke disaccharidase ukuntula. Uma uhlukanise ngokuphelele disaccharides. Abenzi lutho ugxile uma ufaka emathunjini distal futhi ibhekane ukuvutshelwa webhaktheriya nokuziphendukela kwemvelo hydrogen. Kukhona neziqubu colic emathunjini, ukuqunjelwa, uhudo, kwehle esesuthi, ukuhlanza, ukuhlanza.

Enterotsellyulyarnaya emathunjini malabsorption malabsorption futhi ukugaya kungavuka yesifo celiac. Kuyinto isifo esidluliselwa ngofuzo lapho lilimele villi emathunjini amancane nge ukudla okuthile. yesifo celiac kubonakala izingane ngemva kwezinyanga ezimbalwa ukwethulwa imikhiqizo iIgama glyutensoderzhaschih. Lapho lesi sifo:

• sokuzikhulula imvamisa kuba izikhathi 2 kuya 5 ngosuku;
• sezinyawo kuyinto mushy, ngezinye izikhathi frothy, kuba esivela iphunga fetid, avalele izinkanyezi;
• kwandisa esiswini;
• kukhona enganele kwesisindo (ngemuva kwesikhathi esithile ukuze lokhu kusilela mass ijoyina ukuntula ukukhula).

Buciko ukuhlola nge malabsorption syndrome

Sifo malabsorption akuyona kwenziwe. Ochwepheshe ekukhombeni SMA izimpawu ebekiwe iziguli zabo ushintsho ukuhlolwa okukhethekile kanye ihlaziya ukuqinisekisa ngandlela-thile zokugula esolwa cuphuluza ukumuncwa kahle noma ukugaywa.

Lapho efeza umsebenzi ukuhlola, odokotela siholwa algorithm ngezansi akhiwa Umhlaba Gastroenterology Inhlangano:

• kuqala kwenziwe umlando olunzulu, iqoqa ulwazi mayelana imithi uzibophezele muva ukuhamba, ukusetshenziswa ukudla neziphuzo akufakiwe ekudleni evamile;
• wafunda umlando umndeni;
• ngu behlolwa izimpawu malabsorption;
• wafunda kuso, ikhumbula izici zawo;
• ukuhlolwa laboratory abazenzi ukuze uthole olunye ulwazi.

Imiphumela yaloku kuhlola okungenhla obengeziwe malabsorption syndrome kuhlanganisa uphenyo abacula ababanjwe ngamaphoyisa celiac isifo, khona Giardia, ama-bacterium namagciwane emzimbeni. Ulwazi olubalulekile zokuxilonga ivumela ukuthola ultrasound izibilini komgodi ongaphakathi kwamathumbu. Ngokusebenzisa ultrasound kungenzeka ukulinganisa isimo ISIZINDA isibindi, amanyikwe, nenyongo sesinye, izindlala zamanzi.

Ukuze ususe noma uqinisekise kolwelwesi sokuhlasela kwamasosha omzimba, yesifo celiac, isifo Crohn akudingeki esophagogastroduodenoscopy nge biopsy isisu futhi duodenum. Ukuqinisekisa ukuntuleka exocrine umsebenzi pancreatic labetibambile sezinyawo izifundo, ikhompyutha magnetic resonance tomography, cholangiopancreatography retrograde ngeso lengqondo mapayipi. Ukuze ufunde mayelana nokuba khona noma ukungabi khona izilonda ileum, izazi esimisiwe ileokolonoskopiyu nge biopsy kwendawo cwaningo kanye ikholoni.

Ukwelashwa nokuvikelwa malabsorption syndrome

Ngemva ekuxilongeni izimbangela malabsorption odokotela etiotropic linqume ukwelashwa okuhloswe ngalo ukubhekana nesifo siyachazwa. Ngokwesibonelo:

• Uma yesifo celiac lutholwa, onguchwepheshe uncoma isiguli umngane wokuphila Ukudla gluten-free;
• uma sitholakale malabsorption carbohydrate noma ukudla ukungabekezelelani ke eyabelwe ohambelana An nokuqedwa noma imingcele eqinile ekudleni;
• izinqubo ezithathelwanayo imithi elwa namagciwane kuboniswa;
• e umzimba kanye endocrine izifo kudinga ezanele yokwelapha pathogenetic.

Lapho uzwakalise syndrome sohudo elibangela malabsorption, ukwelashwa kungase kube etiologic, futhi lingaze pathogenetic. Patogenetichekaya yokwelapha etiological futhi kungase kube edonsa izindlela ezilandelayo:

• imithi sohudo esibangelwa amagciwane;
• "Metronidazole" nge amebiasis;
• izidakamizwa anthelmintic helminthiasis;
• glucocorticoids, cytostatics, "infliximab" e ukuvuvukala wamathumbu isifo;
• "Tetracycline", "Ceftriaxone", "co-trimoxazole" isifo Whipple sika;
• "Octreotide" nge endocrine izimila pheshana emathunjini.

ukwelashwa okunezimpawu kuhlanganisa nokwamukela probiotics, opiates, "Loperamide" ejenti umswakama (bismuth amalungiselelo "Diosmektita").

Ukuzithiba ayinakwenzeka uma umcimbi izimpawu SMA. Akukona ukunikeza imiphumela emihle. Ngaphezu kwalokho, malabsorption - siwukubonakaliswa izifo sína futhi eziyingozi. Uma uhlangabezana izimpawu SMA kutuswa kudokotela. Kuphela onguchwepheshe kungenziwa ngokuthi imbangela yalesi sifo kweqiniso futhi imise yokwelapha ngempumelelo futhi bawabulale lesi sifo sitholakale.