IBD yodziwika kwambiri ndi iyi:
• Ulcerative colitis (YAK) - imakhudza matumbo akulu, kawirikawiri amayamba kuchokera ku rectum;
• Matenda a Crohn - angakhudze mbali iliyonse ya m'mimba: Kuchokera pakamwa pamlomo kupita ku anus. Mu njira yotupa, ululu wonse wa khoma la m'mimba nthawi zambiri umakhudzidwa.
Zimayambitsa ndi kusokoneza
Ngakhale chiwerengero chachikulu cha maphunziro a sayansi, zifukwa za chitukuko cha VZK sizinafotokozedwe bwino. Malinga ndi lingaliro limodzi, tizilombo toyambitsa matenda a IBD ndi mavairasi kapena mabakiteriya omwe amalowa m'matumbo kuchokera ku chilengedwe ndipo amachititsa kuti munthu asatuluke m'mimba mwachisawawa. Ulcerative colitis imalembedwa m'mayiko onse padziko lapansi, kufalikira kwake ndi 50-80 milandu pa anthu 100,000. Matendawa amakhudza anthu a msinkhu uliwonse, koma zaka za zaka 15 mpaka 40 ndizovuta kwambiri. Chiŵerengero cha chiŵerengero cha amuna ndi akazi ndi chimodzimodzi. Pa odwala pafupifupi 15%, achibale apamtima (makolo, m'bale kapena mlongo) amadwala matendawa. Malinga ndi kafukufuku, awiri mwa atatu mwa odwala omwe ali ndi matenda a Crohn amasuta. Kusuta ndi chinthu chokha chokhazikitsidwa chokhazikika cha malo akunja omwe amakhudza chigamulo cha IBD. M'mayiko otukuka, kufalikira kwa matenda a Crohn ndi masentimita 30-4-0 pa anthu 100,000. Matenda a Crohn ndi ulcerative colitis amadziwika ndi njira yowonongeka (zoopsa za matendawa ndi zotsatira za kutuluka kwa matenda). Kuvutika maganizo ndi matenda a tizilombo ndizo zomwe zimayambitsa kubwereza.
Zizindikiro zofanana za ulcerative colitis ndi izi:
• Kufuna nthawi zambiri kubwereza ndi zolemba zambiri;
• kusakaniza magazi kapena ntchentche mu nyansi;
• kupweteka kwa m'mimba kwambiri, kuchepa pambuyo chitetezo;
• Kutentha komanso kutopa;
• Kutentha thupi komanso kusowa kwa njala.
Zizindikiro za matenda a Crohn ndi osiyana kwambiri. Izi ndi chifukwa chakuti gawo lililonse la magawo a m'mimba lingakhudzidwe ndi matendawa. Pamene matenda a Crohn akupezeka:
• thumba lotayirira ndi kusakaniza magazi;
• kupweteka kupweteka m'mimba;
• kutaya thupi;
• Kutha kwa m'mimba, nthawi zina kumabweretsa m'mimba;
• kupanga mapangidwe a fistula (ziwalo zosagwirizana pakati pa ziwalo zomwe m'mimba zimalowa mkati mwazing'ono, monga chikhodzodzo kapena chikhodzodzo).
Kuonjezera apo, matenda a Crohn angakhudze mdulidwe wa pakamwa, m'magulu, m'mapazi apansi. Odwala ena amagwirizanitsa kuwonjezereka kwa matendawa pogwiritsira ntchito zakudya zina, koma palibe zakudya zenizeni zomwe zimaperekedwa kwa odwala omwe ali ndi IBD. Kupezeka kwa matenda alionse a IBD kagulu kawirikawiri kumachokera ku deta ya data ndi kukayezetsa wodwalayo. Pambuyo posonkhanitsa mosamalitsa anamnesis ndi kufufuza kwa thupi lonse, kuphatikizapo kuyesa kwala kwa rectum, kawirikawiri timapepala tambirimbiri timapereka, kuti tifufuze mkatikati mwa kachilomboka ndi m'munsi mwa matumbo akuluakulu. Pochita mayeserowa, chida chapadera (sigmoidoscope) chimayikidwa kudzera mu anus, kuti muyesetse kupenda matumbo mumkati ndi kutenga minofu yowonongeka.
Ndondomeko yofufuza
Mosasamala kanthu za zotsatira za sigmoidoscopy, maphunziro otsatirawa nthawi zambiri amachitidwa:
• kuyesa magazi (kuphatikizapo kukhalapo kwa zizindikiro za kutupa);
• Mafilimu a m'matumbo pogwiritsa ntchito enema ya barium. Madzulo, matumbowa amachotsedwa ndi mankhwala ofewetsa tuvi tolimba. Patsiku la phunziroli, njira yothetsera barium imayambitsidwa kudzera mu rectum, yomwe imakhala yosiyana kwambiri ndi X-ray, yomwe imalola kuzindikira malo omwe amatha kutupa kapena kutsekula m'mimba. Ngati akuganiza kuti ali ndi matenda a Crohn, kachilombo ka m'mimba kameneka kamayesedwa. Pachifukwa ichi, wodwalayo amatenga kuyimitsidwa kwa barium mkati, zomwe zimatheketsa kuona m'mimba mwachinyamatayo;
• Colonoscopy. Mu phunziro ili, chida chokhala ndi mapulogalamu osinthika omwe ali ndi gwero la kuwala chimayambitsidwa kudzera mu anus ndipo amalola kuti muyang'ane mu mukati wa matumbo akuluakulu ndi ubongo. Mothandizidwa, simungathe kufufuza zochitika za m'matumbo zomwe sizingatheke ndi sigmoidoscopy, komanso ngati nkofunikira, chitani chigoba. Ngati mukuganiza kuti kugonjetsedwa kwa intestine kumapangidwe, mtundu wina wa masewero olimbitsa thupi umaperekedwa: gastroduodenoscopy. Pogwiritsa ntchito njirayi, endoscope yapadera, yotchedwa gastroscopy, imayikidwa kupyolera mumimba ndi m'mimba. Gastroscope ndi osakaniza fiber optic tube yomwe imakulolani kuti muyende mbali zonse za mmimba. Chithunzicho chimasamutsidwa pazithunzi. Njira imeneyi imagwiritsidwa ntchito pazidziwitso za IBD komanso njira zochepetsera zochepa zomwe zimachitika. Njira zothandizira IBD zimasiyanasiyana pakamwa pakamwa poti steroid akukonzekera kuchitidwa opaleshoni, yomwe imagwiritsidwa ntchito m'mavuto aakulu. Ngakhale kuti sitingakwanitse kuchiza, odwala ambiri amatha kukhala ndi moyo wathanzi. Pambuyo pa matendawa a IBD, wodwalayo amaonedwa ndi gastroenterologist, kawirikawiri pamalo pomwe amakhala.
Kuchiza ndi steroids
Kuchotsa kutupa ndi kuwonjezereka kwa IBD kumapereka mankhwala a steroid mu mawonekedwe a mapiritsi, enemas kapena suppositories. Odwala nthawi zambiri amaopa kusankhidwa kwa steroids, pokhulupirira kuti izi ndizo mphamvu zomwe zingayambitse zosafunika, makamaka ndi kuvomereza kwa nthawi yaitali. Zotsatira za mankhwalawa zikuphatikizapo kupanga mapangidwe a nkhope ya mwezi, phindu la kulemera, kufooka kwa mitsempha ya chigoba ndi kuwonjezeka kwa magazi. Zotsatira zake za mbadwo watsopano wa steroids zikhoza kukhala zochepa, komabe, ziribe kanthu, ndizosayenera kuleka kuwatenga mwamsanga, pamene thupi limatenga nthawi kuti libwezeretse kayendedwe ka kupanga mahomoni a steroid.
Kuchotsa kutupa
Pambuyo pochotseratu zizindikiro zoyambirira za matendawa, 5-aminosalicylic acid yomwe imakonzedwa (monga monotherapy kapena kuphatikizapo steroid) imapanga maziko a mankhwala a IBD. Amaphatikizapo sulfasalazine, mesalazine ndi olsalazine. Udindo wawo umalepheretsa kubwerera kwa matendawa, motero kumapereka chikhululukiro chokhazikika. Mankhwalawa angagwiritsidwe ntchito ngati mapiritsi, enemas kapena makandulo ndipo alibe mankhwala ngati steroids. Zotsatira zoyipa za gulu lino zikuphatikizapo kunyoza, kupweteka, kupweteka mutu ndi kuchepa kwa magazi m'thupi. Kuti adziwe kusagwirizana kwawo, wodwalayo amawunika magazi nthawi zonse. Mankhwala ena okhala ndi mphamvu yotsutsa-kutupa ndi azathioprine. Amagwiritsidwa ntchito polephera kulekerera kuchepa kwa mlingo wa steroids, komanso odwala omwe amalephera kulamuliridwa ndi IBD. Mukamamwa mankhwalawa, mufunikanso kufufuza nthawi zonse magazi. Ochepa peresenti ya odwala omwe ali ndi IBD amafunika kulandira chithandizo. Ngati chithandizo chokwanira sichikutsatiridwa, chitsimikizo cha kufunika kochita opaleshoni kumawonjezeka.
Zovuta
Popanda kuchiritsidwa ndi ulcerative colitis, zizindikiro za chithandizo cha opaleshoni zimachitika pafupifupi odwala 30 peresenti. Chithandizo cha opaleshoni n'chofunika ngati simungathe kuthetsa kuopsa kwakukulu ndi thandizo la mankhwala oyenera, komanso kuchepa kwakukulu kwa moyo wa wodwalayo. Kuonjezera apo, opaleshoni imafunika ngati zizindikiro zoyambirira za katemera wambiri m'matumbo zimapezeka.
Mitundu ya ntchito
Mu matenda a Crohn, mankhwala opaleshoni makamaka amagwiritsa ntchito kuthetseratu mavuto mwa kuchotsa malo okhudzidwa m'matumbo. Kwa odwala ambiri omwe ali ndi ulcerative ulcitis, ntchito yosankha ndi yotchedwa reconstructive proctocollectomy, yomwe imatulutsa mbali ya matumbo akuluakulu ndikupanga "thumba" m'matumbo omwe amatuluka m'mimba mwagwirizano ndi anastomosis kwa anus. Opaleshoni imagwiridwa mu magawo awiri, mosiyana ndi colectomy, momwe matumbo akuluakulu ndi kachilomboka amachotsedwa panthawi imodzi, ndipo excretion ya stool imapangidwa kudzera ileostoma mu sac yapadera. Matenda oyenerera amachititsa kuti odwala ambiri athe kuyendetsa bwino matenda a IBD, koma matendawa sangafe. Odwala amenewa, pazifukwa zina, chiopsezo chotenga zilonda zoopsa za m'matumbo chimakula.
Kuopsa kokhala ndi khansara ya colon kapena rectum kumawonjezeka ndi ubweya wonse (kapena mbali yaikulu) mu kutupa, komanso kuwonjezeka kwa nthawi ya matendawa. Kuopsa kwa njira yowopsya ikhoza kuchepetsedwa mwa kupititsa nthawizonse colonoscopy, yomwe imalola kuti muzindikire kusintha kwakukulu msinkhu. Ndikofunika kuzindikira kuti odwala omwe ali ndi ubweya wofatsa, ndi otsika kwambiri. Kawirikawiri, kusintha kwakukulu kumachitika motsatira maziko a matenda a Crohn, omwe amapitirira popanda kugonjetsedwa kwa matumbo ambiri.
Zolemba
Ma IBD amadziwika kuti ndi achilendo, ndipo mawonetseredwe awo mwa wodwala aliyense ali pawokha. Pa nthawi yogwira ntchitoyi, matendawa amatha kuvulaza kwambiri, koma ndi kusankha bwino mankhwala, powaganizira nthawi zonse za matendawa, odwala ambiri amakhalabe ndi mphamvu zokwanira, ngakhale kuti sangathe kuchiza. Pa nthawi ya chikhululukiro, wodwalayo ali ndi IBD akhoza kukhala ndi moyo wabwino. Pakati pa odwala pali malingaliro akuti kuwonjezeka kwa IBD kumawonekera "pamanjenje", zomwe ziri zolakwika kwambiri. Ndipotu, kubwereza kwa matendawa kungachititse kuti munthu asamanjenjemera kwambiri komanso kuvutika maganizo, makamaka pamene wodwalayo amakakamizika kuti aziyendera chimbudzi. Choncho, panthawi yovuta, chifundo ndi kumvetsetsa kwa mbali ya onse a m'banja la wodwala ndi anzake ndizofunikira kwambiri. Kwa amayi akukonzekera kutenga mimba, mwayi wokhala ndi pakati ndi wapamwamba panthawi yakhululukidwa. Pakati pa mimba, pangakhale kuwonjezereka kwa matendawa, koma kaŵirikaŵiri kumachitika mwachilendo chachikulu ndikuyankha bwino mankhwala ozunguza bongo. Chiŵerengero cha ubwino ndi chiopsezo chotenga steroid pa nthawi ya mimba ndikulingalira kuti ndibwino, popeza kuti kuthekera kwa zotsatirapo zazomwezi m'nthawi imeneyi ndi kochepa mokwanira.