I-Ultrasound Ingabe Isivivinyo Sokuhlola Okuyisisekelo
Igama elithi "isifo se-gallbladder" lihlanganisa izimo zezokwelapha ezithinta i-gallbladder, njenge-gallstones, i-cholecystitis enamandla noma engapheliyo (i-gallbladder ukuvuvukala okubangelwa ama-gallstones), nomdlavuza we-gallbladder.
Nakuba ukubuyekezwa kwesibonakaliso, ukuhlolwa ngokomzimba, kanye nokusebenza kwegazi konke kudlala indima ekutholeni isifo se-gallbladder, ukuthola i-ultrasound yesisu (futhi mhlawumbe nezinye izivivinyo ze-imaging) yisici esibaluleke kakhulu senqubo yokuxilonga.
Umlando Wezokwelapha
Uma udokotela wakho esolisa isifo se-gallbladder, uzobuza mayelana nezimpawu zakho nokuthi ngabe wena noma yiliphi ilungu lomndeni like laba nezinkinga ze-gallbladder.
Izibonelo zemibuzo engaba khona zihlanganisa:
- Ingabe ubhekene nobuhlungu besisu, futhi uma kunjalo? Ubuhlungu ohlangothini olungenhla noma obuphakathi kwesisu bukhombisa inkinga ye-gallbladder.
- Ingabe ubuhlungu besisu buhambisana nokudla? Ngama-gallstones, ubuhlungu obukhulu, obuhlungu bungase buvele isikhathi esisodwa noma ngaphezulu emva kokudla ukudla okunamafutha futhi kugcina okungenani imizuzu engamashumi amathathu.
- Wake wahlangabezana nalokhu ubuhlungu besisu ngaphambi? Iziqephu zosizi lwama-gallstone ziba zimbi nakakhulu ngokuhamba kwesikhathi futhi zingaholela ezinkingeni ezifana nokutheleleka kwe-bile ducts noma ukuvuvukala kwama-pancreas .
- Ingabe uhlangabezana nanoma yiziphi ezinye izimpawu ngaphandle kobuhlungu, njengemfiva, isicanucanu, ukuhlanza noma ukulahlekelwa isisindo? Lezi zimpawu ezihambisanayo zingasiza udokotela ukuba athole ukuthi isifo se-gallbladder nezinye izinkinga ezikhona kungenzeka.
Ukuhlolwa Kwemvelo
Okulandelayo, udokotela wakho uzokwenza ukuhlolwa kwangokwenyama, egxila kuqala ezibonisweni zakho ezibalulekile. Abantu abane-acute cholecystitis bangase babe nomkhuhlane kanye nenani eliphezulu lenhliziyo.
Ukuba khona kwe- jaundice , okuboniswa ukuphuziza kwabanamhlophe kwamehlo kanye / noma isikhumba, kuyabangela inkinga ye-gallstone ebizwa ngokuthi i-choledocholithiasis lapho i-gallstone iphuma khona i-gallbladder futhi ivimbela i-bile-duct enkulu (lapho ibhala lingena emathunjini).
Ngesikhathi sokuhlolwa kwesisu, udokotela wakho uzoqaphela ukuthi noma cha okutholakele okubizwa ngokuthi "ukuqapha" kukhona. Umuntu one-cholecystitis enzima angase "aqaphe" noma afake izandla zakhe ngakwesokudla phezulu kwesisu sakhe lapho i-gallbladder ikhona ngesikhathi sokuhlolwa ngokomzimba.
Okokugcina, ngesikhathi uhlolwa, udokotela wakho uzokwenza umsebenzi obizwa ngokuthi "uphawu lukaMurphy." Ngalesi sivivinyo umuntu uceliwe ukuba athathe umoya ojulile, avumele i-gallbladder ukuba ihambe phansi ukuze udokotela angacindezela. Uma umuntu ezwa ubuhlungu obukhulu phakathi nalesi sivivinyo (esibizwa ngokuthi "isibonakaliso esihle" se-Murphy), siphakamisa ukuthi kungenzeka abe nesifo sofuba.
Amalebhu
Abantu abanesifo se-gallbladder bavame ukuba nesibalo segazi elimhlophe eliphakeme. Amangqamuzana akho amhlophe egazi ngamaseli akho okulwa nokutheleleka futhi uma isignali ephakeme uhlobo oluthile lokuvuvukala noma ukutheleleka emzimbeni. Ngaphandle kokubalwa kwe-white cell cell, umuntu kungenzeka ukuthi uphakamise ukuhlolwa komsebenzi wesibindi .
Nakuba kungase kube nokwanda okuncane emanzini enzyme, ukuphakama kwezinga le-bilirubin (futhi okuyingxenye yesimo sokuhlolwa kwegazi kwesibindi) kusikisela ukuthi kungenzeka yini ukuhlukunyezwa kwesifo se-gallbladder (isibonelo, uma i-gallstone ithinteka ku-bile duct kanye / noma kukhona ukutheleleka kwe-bile duct).
Uma udokotela wakho esho umdlavuza we-gallbladder esekelwe ekuhlolweni kwe-imaging (isibonelo, i-ultrasound, i-CT scan, noma i-MRI), angase ahlele ukuhlolwa kwegazi kwe-tumor marker, njenge-CEA noma i-CA 19-9. Lezi zimpawu zingahle ziphakanyiswe phambi kwamanye amagciwane, ngakho akuyona inkomba ngqo yomdlavuza we-gallbladder. Ngokuvamile kunalokho, lezi zimpawu zomzimba zisetshenziselwa ukulandela impendulo yomuntu ekwelashweni komdlavuza (uma kuphakanyisiwe ekuqaleni).
Ukucabanga
Ngenkathi umlando wezokwelapha, ukuhlolwa ngokomzimba, kanye namalebhu angase asekele ukuxilongwa kwesifo se-gallbladder, ukucabangela kuyadingeka ukuqinisekisa ukutholakala. Ngamanye amazwi, i-gallbladder idinga ukuboniswa, futhi lokhu kuvame ukwenziwa nge-ultrasound.
I-Ultrasound
I-ultrasound ukuhlolwa okusheshayo nokungenabuhlungu kokucabangela okusebenzisa amagagasi omsindo ukukhiqiza isithombe se-gallbladder. Ngaphezu kwezingqungquthela, ukuqina kwendonga ye-gallbladder noma ukuvuvukala ne-polybladder polyps noma izixuku zingabonakala.
Phakathi ne-ultrasound, lochwepheshe ungenza futhi "isibonakaliso se-Murphy's sonographic." Phakathi nalokhu kuhamba, i-transducer ye-ultrasound igxiliwe kwi-gallbladder ngenkathi isiguli sithatha umoya ojulile. Uma kulungile, lo muntu uzozwa ubuhlungu lapho i-gallbladder icindezelwa phansi.
I-HIDA Skena
Uma ukuxilongwa kwesifo se-gallbladder akuqinisekisiwe ngemuva kwe-ultrasound, isithwebuli se-HIDA singenziwa. Lokhu kuvumela kuvumela ukubonakala kokuhamba kwe-bile ngokusebenzisa uhlelo lwe-bile duct. Ngesikhathi sokukhipha i-HIDA, umculi we-radioactive ujojowe ngomfutho womuntu. Lesi sitho sithathwa ngamangqamuzana wesibindi futhi sisusiwe sibe ne-bile.
Uma i-gallbladder ingakwazi ukuboniswa ukuthi i-test is "positive" ngoba kusho ukuthi kunezinhlobo ezithile zokuvimbela (ngokuvamile ezivela e-gallstone, kodwa mhlawumbe zisuka ku-tumor) emgodini we-cystic, oyishubhu ehambisa i-bile kusuka e-gallbladder kuya i-buct evamile.
I-CT Scan
Iskena se-CT yesisu sakho singase sibonise izimpawu zesifo se-gallbladder, njenge-gallbladder wall ukuvuvukala noma ukugcoba okunamafutha. Kungasiza kakhulu ekutholeni izinkinga ezingavamile, ezisongela impilo ye-cholecystitis ejulile, njenge-gallbladder perforation (lapho umgodi uqala ngaphakathi kwe-gallbladder) noma i-chophycystitis emphysematous (lapho kukhona ukutheleleka kwendonga ye-gallbladder kusuka kubhaktheriya obumba igesi).
I-Magnetic Resonance Cholangiopancreatography (MRCP)
Lokhu kuhlola okungacabangi kwesithombe kuvumela udokotela ukuba ahlolisise ama-bile amancane ngaphakathi nangaphandle kwesibindi. Kungasetshenziselwa ukuxilongwa ngetshe endaweni ejwayelekile ye-bile (isimo esibizwa ngokuthi i-choledocholithiasis).
I-Endoscopic Retrograde ye-Cholangiopancreatography (ERCP)
I-ERCP yikho kokubili ukuhlolwa kokuhlolwa kanye nokwelapha okungase kube nokwelapha. Ngesikhathi i- ERCP , i-gastroenterologist (udokotela obhekene nezifo zesimiso sokugaya) uzobeka ikhamera encane, eguquguqukayo ebizwa ngokuthi i-endoscope emlonyeni womuntu, phansi kwesisu, esidlule esiswini, nasesithombeni esincane.
Umuntu uyadonsa ngale nqubo ngakho-ke akukho okungahambi kahle. Khona-ke, ngokusebenzisa i-endoscope, ithubhu encane idluliselwa emgodini we-bile ovamile. Idayi yokuphambene ifakwe kulesi tube tube encane ukuze kukhanyiswe uhlelo lwe-bile duct, olungabonakala ngama-x-ray.
Kusukela ku-ERCP, i-gallstone evimbela ama-bile amadokodo angabonwa futhi asuswe ngesikhathi esifanayo. Ukwehliswa kwamadaysi we-bile kungabonakala nge-ERCP, futhi i-stent ingafakwa ukuze kugcinwe umgwaqo. Okokugcina, ngesikhathi se-ERCP, udokotela angathatha isampula yesikhumba (ebizwa ngokuthi i-biopsy) yanoma iyiphi i-polyps noma amasosha asolisayo.
Ukuhlonza okuhlukile
Nakuba kunengqondo ukusola isifo sofuba uma umuntu ezwa ubuhlungu esifundeni esiphezulu sesisu sakhe, amanye ama-etiologies (ikakhulu izinkinga zesibindi) kumele acatshangelwe. Lokhu kungenxa yokuthi isibindi sakho siphinde sisehlangothini olungakwesokudla kwesisu sakho futhi sixhunywe ne-gallbladder ngochungechunge lwamadayari e-biliary.
Izibonelo zezinkinga zesibindi ezingabangela ubuhlungu ngakwesokudla phezulu kwesisu kufaka:
- I-hepatitis (isibonelo, isifo sofuba esibandayo) : Ngaphandle kobuhlungu, ezinye izimpawu zesifo sofuba singabandakanya i-jaundice, izitshalo zobumba , nomchamo omnyama.
- I-Fitz-Hugh-Curtis Syndrome (i-perihepatitis): Lesi sifo sibhekisela ekuvukeni kwesibindi sesibindi esenzeka kubafazi abanesifo sofuba sokuvuvukala.
- I-abscess yesibindi: Abantu abanesifo sikashukela, abaye bafaka ukufakelwa kwesibindi, noma abanesifo esibindiwe, isibindi, noma i-pancreatic basengozini enkulu yokuthuthukisa i-abscess.
- I-thrombosis ye-portal ye-portal : Lesi sifo sibhekisela emgodleni wegazi emgodleni we-portal, okuyisitsha segazi esithwala igazi esibindi emathunjini.
- I-Budd-Chiari syndrome: Lesi sifo esingavamile kakhulu esenzeka lapho kunesithiyo semithanjeni esula isibindi.
Ngaphandle kobuhlungu engxenyeni engenhla yesisu, umuntu onesifo se-gallbladder angase azwe ubuhlungu esifundeni esiphakathi esiswini sesisu (esibizwa ngokuthi ubuhlungu be-epigastric).
Ezinye izimbangela ezingabangela ubuhlungu be-epigastric zihlanganisa:
- Isifo se-reflux se-gastroesophageal (GERD): Ngaphezu kokubuhlungu kwe-epigastric, umuntu one- GERD angase aqaphele ukuqubuka kwenkinga kanye nezinkinga zokugwinya.
- Isifo sesilonda se-Peptic: Lesi simo sichaza izilonda ezithuthuka emgqeni wesisu noma ingxenye yokuqala yamathumbu amancane. Ukuvutha ubuhlungu besisu yisimpawu esivame kakhulu.
- I-Gastritis: Lezi zimo zisho ukuvuvukala kwesisu esiswini futhi kungabangelwa izici eziningana ezifana no-alcohol, nonsteroidal anti-inflammatories, noma igciwane.
- I-Pancreatitis: Abantu abane-pancreatitis bavame ukuzwa ubuhlungu obunzima, obukhulu be-epigastric noma obungakwesobunxele obuya emuva futhi buhlotshaniswa ne-nausea nokuhlanza.
- I-Heart Attack (i-infarction ye-myocardial): Ubuhlungu be-epigastric bungaba uphawu lokuqala lokushaya kwenhliziyo . Umuntu angase abe nokuphefumula okuncane kanye nezinkinga zempilo yengqondo.
> Imithombo:
> Abraham S, Rivero HG, Erlikh IV, Griffith LF, Kondamudi VK. Ukuphathwa nokuhlinzeka ngokungenasidingo kwezingulube. > Am Fam Physician . 2014 Meyi 15; 89 (10): 795-802.
> I-American Cancer Society. (2016). I-Gallbladder Cancer Ithola Kanjani?
> Sanders G, i-Kingsnorth AN. Ukubuyekezwa Kwemithi: Ama-Gallstones. > BMJ . 2007 Aug 11; 335 (7614): 295-99.
> Zakko SF, u-Afdhal NH. (2016). I-cholecystitis enamandla: I-Pathogenesis, izici zokwelapha, nokuxilongwa. I-Chopra S, (ed). UptoDate, Waltham, MA: UpToDate Inc.