Nuugeynin - waxa uu yahay waxan? Qoondaynta iyo sababaha

xiidmaha yar-yar - mid ka mid ah xiidmaha. Waxaa qabata kala duwan ee hawlaha, kaalin weyn ka dheefshiidka cuntada iyo nuugista nafaqooyin. Iyadoo horumarinta cuduro gaar ah carqaladeeyey waaxda this - cad u nuugeynin syndrome, oo loo soo gaabiyo CMA ah. Waa maxay xilli? syndrome Tani waxaa keena waxa sababaha?

fikradaha kelmadaha

In suugaanta ee caafimaadka, waxaad ka heli kartaa erey la mid ah "nuugeynin". eraygan waxa loo adeegsadaa in lagu tilmaamo nuugeynin xabka xiidmaha ka mid ah qaybaha cuntada. Sidoo kale waxaa jira erey la mid ah "maldigestion". Tani geeddi diinta xadgudub ku ah baruurta, protein iyo dheefshiidka carbohydrate waxyaabaha absorbable.

Khubarada labada isu geeyo muddada kor ku xusan ( "nuugeynin" iyo "maldigestion"), markii mid ka hadlaysaa nuugeynin syndrome. Waxaa loola jeedaa daliilka kiliinikada adag, soo shaac baxa xadgudubyada saabka, derbiga, dheefshiidka xuub iyo gaadiidka ee xiidmaha yar. Maaddaama ay isbedel ka dhacda jidhka bini'aadamka sabab u ah ee u nuugeynin syndrome, xanuunada dheefshiidka muuqan. Dadka ay bilaabaan inay silcin calaamadaha xun.

Sababaha SMA

nuugeynin syndrome arkay in cuduro badan oo la iska dhaxlo oo lagu dhasho kuwaas oo ugu rabshaysan tahay nuugista of walxaha, hoos u dhaqdhaqaaqa enzyme. Tusaale ahaan, cystic fibrosis. In cudurkan, AGR isbeddesho ay sabab u tahay hoos u dhaqdhaqaaqa enzyme iyo cudura qarsoon ganaca ku nafwaayay.

Si keeni cudurada syndrome nuugeynin sababa cudurada iyo dulin, lymphatic aan caadi ahayn iyo nidaamka wareegga dhiigga. CMA waxaa sidoo kale lagu arkay dhacdo dhaawac xiidmaha yar iyo yaraynta aagga nuugista (yeedhay isbedelka ee jirka, noqday sabab ay ku rabshooyin halis ah oo noocyo badan oo is dhaafsi, jirka iyo maskaxda hagaasid).

Sayidka, nuugeynin - go'an calaamadaha xun oo keeni kara sababo badan ee kala duwan. Waxay la isku dari karaa sida soo socota:

1. Kooxda Preenteralnaya. Waxaa ka mid ah cudurada biliary mareenka, beerka, caloosha, cystic fibrosis.
2. Kooxda Postenteralnaya. Waxaa ka mid ah xanuunada lymph iyo wareegga dhiigga ee xiidmaha dheer, oo ku yaalla inta u dhaxaysa caloosha iyo mindhicirka, enteropathy exudative, lymphosarcoma, cudurka Hodgkin ah.
3. Kooxda Enteral mid ah sababaha. Kuwaas waxaa ka mid nuugeynin galactose, cudurka cøliaki, failure disaccharidase, giardiasis, dermatitis herpetiformis.

Astaamaha u gaarka ah SMA

In kasta oo xaqiiqda ah in syndrome nuugeynin ismaqalkii cudurro kala duwan, waxay noqon kartaa Sharaf qoreysa sifo isaga. Marka CMA lallabo, matag. In bukaanka qaba hoos u xumo. calaamadahan ayaa sidoo kale loo arkaa dibiro, isbeddel in saxarada (shuban badanaa ka dhacdaa). All calaamadahaan waxaa lagu magacaabaa dyspeptic syndrome. Waxa uu hogaaminaya daliilka caafimaad ee SMA.

fiiro gaar ah waa in ay kursi. Qiimaynta sifooyinka saxarada, khubaro hesho macluumaad muhiim ah in u ogolaanaya inay ka dhigay cudurka saxda ah:

• iyo saxaro dareere frothy leh ur acidic - calaamad u ah in waxa laga yaabaa in asalka ah ee heley sida nuugeynin glucose-galactose, deficiency disaccharidase;
• saxaro dufan waa in pankreatit chronic, cystic fibrosis, herpetiformis dermatitis, exudative enteropathy syndrome Pearson, dysbacteriosis xiidmaha;
• saxaro aad u dufan lagu arkay cystic fibrosis, deficiency lipase dhasho;
• shuban-biyood - calaamad u ah in uu dhici karaa marka infakshan uu galo jirka, enterocolitis soo koraya, nuugeynin glucose iyo galactose.

Marka MCA mararka qaarkood waxaa jira xanuun. Inta badan, waxay keeni cudurada caloosha iyo injirta waxaa. Xanuun syndrome dhici kara kadib marka la cuno waxyaabaha caanaha. Waxa uu la kursi foamy leh ur dhanaan marka la isku daro, yaaqyaaqsi muujinaysaa deficiency lactase ah. Calool xanuun inta lagu jiro CMA raaci xasaasiyad cunto, cilladaha caloosha, cudurka Whipple ee, ulcerös kolit, cudurka Crohn. Calaamadaha soo socda ayaa lagu arkay xitaa marka nuugeynin syndrome:

• finan maqaarka ah,
• daal,
• dareen ah itaaldarro,
• dibiro,
• anorexia.

Nuugeynin in carruurta la socda syndromes yari. Jeediya horumarka jireed. Tan waxaa lagu muujiyey in hoos u of miisaanka jidhka, horumarinta nafaqo, koritaanka faaqidaad. On vitamin deficiency muujinaysaa gobolka ee maqaarka. maqaarka uu noqdo mid qalalan oo uu bilaabo inuu dhil off. waxaa On muuqan dhibco mugdi. Timaha khafiifiya iyo bilaabaan in ay ka tagaan. Ciddiyaha noqon midab caajis iyo exfoliate. Marka deficiency calcium dhici casiraad, xanuun murqaha iyo lafaha. La'aanta bir ah, copper iyo zinc keenaysaa in muuqaalka kore ee finan maqaarka ah, dhiig-yaraan bir-yaraan, la kordhiyo in heerkulka jidhka.

kala soocidda jira

nuugeynin syndrome waxa ka mid ah in ka badan 70 cudur oo kala duwan. Marka tan la eego, khubarada la kulanto dhibaatooyin qaar ka mid ah in kala soocidda ee diyaarinta. The ugu guulaha badan waa kala qeybinta syndromes nuugeynin dhaxlo oo helay:

1. The ugu horeysay oo ka mid ah la ogaado in 10% ka mid ah xaaladaha. Dhaxlo SMA waxaa waalidka u gudbi kartaa ilmaha. Waxa uu sidoo kale waxaa sabab u ah Isbedelo hiddo.
2. nuugeynin helay syndrome - natiijada xanuunada caloosha iyo extraintestinal (tus burooyinka, immunodeficiencies, beerka iyo xameetida).

Waxa kale oo jira kala soocidda, kaas oo ku salaysan yahay darnaanta nuugeynin syndrome:

• Darajada I (foomka khafiif ah) - carruurta yar hoos u miisaanka jidhka, calaamadaha kici failure fiitamiinada arkay horumarka jireed disharmonious;
• degree II (qaab celcelis) - bukaanka uu leeyahay khasaare mass jirka (fogaanta dhexdeena ka caadi ah waa ka weyn yahay 10%) waxaa lagu arkay daahina horumarka jireed, arkeen aayaad dhawaaqaa deficiency elektrolytka iyo yaridu fiitamiinada;
• Grade III (daran) - carruurtu waa jidh ahaan dib dhacsan, jidhka u dhaca mass ka badan 20%, in bukaanka qaarkood ay jirto dib u dhac ah ee horumarinta psychomotor.

noocyada kala duwan ee u nuugeynin

In 1977 lagu qabtay VIII World Congress of Gastroenterology. Waxaa ku takhasusay ayaa loo aqoonsaday dhawr nooc oo u nuugeynin, ku xiran tahay sababaha ay:

• intracavitary;
• posttsellyulyarnaya;
• enterotsellyulyarnaya.

La'aanta bile ku qarisay oo ay xammeetidu iyo walxaha taas oo saameyn ku dheefshiidka baxsan oo sababa u dhexaysay, - nooca intracavitary nuugeynin. Toddlers inay soo sara kacaan ay sabab u tahay cystic fibrosis, hypoplasia lagu dhasho ee beeryarada. In carruurta muuqaalka ka weyn u nuugeynin intracavitary syndrome cadhaysiinina cudurada sida cirrhosis, pankreatit chronic.

Nooca labaad ee SMA - nuugeynin posttsellyulyarnaya. syndrome Tani, taas oo ah waxa lagu gartaa khasaaro of protein plasma derbiga xiidmaha. Waxa uu arkay la cillado ka mid ah nidaamka wareegga dhiigga iyo durey. Mid ka mid ah cudurada - an lymphangiectasia xiidmaha idiopathic. Iyadu waa asalka ah ee khasaaraha culus ee calcium, subaga iyo borotiinka ee mareenka caloosha iyo mindhicirka.

nooca Enterotsellyulyarny isku daraa marka ay ku dheefshiidka xuub jabay ama nuugista sabab u ah cillad ka mid ah hababka enzyme ah unugyada xiidmaha. Noocan oo kale ah ku dhici kara carruurta yaryar sababta oo ah cudurada la iska dhaxlo la xiriira xadgudubku ka dhacay:

• nuugid;
• dheefshiidka xuub;
• dheefshiidka iyo nuugista.

carruurta ee nooca enterotsellyulyarny da'da ka weyn ee u nuugeynin syndrome wuxuu dhacaa sabab u tahay dhaawac u mindhicirrada iyo unugyada dhimashada ay sabab u tahay saameynta ay cudurada ama dulin, qaaxada, burooyinka xiidmaha yar, cudurka Crohn.

Tusaalooyinka nuugeynin intracavitary

Iyada oo noocan ah AGR inta badan soo dhibtay dheefshiidka baruurta. Ay hydrolysis waxaa lagu fuliyaa by lipase ganaca, kaas oo la shaqeysiin by bile. Iyadoo yaraanta qalabkan u muuqda calaamad sida steatorrhea. Tani xulashada saxarada baruur xad-dhaaf ah. Tan waxaa inta badan si cad u muujiyey in steatorrhea pankreatit chronic. In ka yar dareemi calaamad this ee beerka iyo marinka biliary.

Waxaa ka mid ah sababaha nuugeynin intracavitary, waa in ay tixgeliyaan hypoplasia dhasho ganaca (hypoplasia). Astaamaha ka muuqan in ay maalmood ee ugu horreeya ama todobaad ee nolosha. Waxaa jira kursiga degdeg luster a dareere hodan malodorous iyo dufan. Fat xitaa si joogto ah waxay gudbin karaan baxay futada.

Tusaalooyinka nuugeynin posttsellyulyarnoy

Posttsellyulyarnaya nuugeynin xiidmaha dhacdaa enteropathy markii exudative. Tani waa syndrome oo borotiin plasma waxaa laga badiyay iyada oo loo marayo xabka. Sababta oo ah enteropathy exudative waxaa laga yaabaa in ay goobjoog ka ahaayeen khalad lagu dhasho, oo weelasha mindhicirka durey. Inta badan waxay sababi cudurka syndrome Whipple ee, cudurka Crohn, burooyin yar yar oo saxarada, xasaasiyadda cuntada.

enteropathy Exudative mararka qaarkood dhacdaa iyada oo aan daliilka kiliinikada dhagar. la kulmi karaan calaamadaha sida shubanka iyo steatorrhea. Bukaan-socodka muuqdaan barar durugsan, kooban wajiga, dib, perineum, addimada.

Tusaalooyinka enterotsellyulyarnoy nuugeynin

nooca Enterotsellyulyarny AGR nuugeynin sabab u noqon kara cudurada sida nuugeynin glucose-galactose. Tani waa cudur dhaxlay halkaas oo jebiyey gaadiidka firfircoon ee glucose iyo galactose xuubka xiidmaha yar-yar. Cudur maalmood ee ugu horreeya ee nolosha lagu muujiyey by shuban. Fecal min 10 ilaa 20 jeer maalintii loo qoondeeyay. Waxay yihiin biyood, eg kaadida. ilmaha u kiciyo heerkulka jidhka, matagu dhaco. Hadii aad joojisid caanaha waa calaamadaha. dulqaad Poor ee macmacaanka iyo caano weli ee Meyeydaan.

Tusaale kale enterotsellyulyarnogo CMA - nuugeynin fructose. Tani waa a nuugeynin isirkiisa. Astaamaha dhacaan ka dib isticmaalka miraha iyo cabitaanka, oo ay ku jiraan in ay qaab-dhismeedka xaddi weyn oo fructose. Tani waa tufaax iyo liin, iyo jeeriga iyo cherry. fructose oo aan jidhku u nuugo, keenaya yaaqyaaqsi, shuban-biyood, xanuun colicky caloosha. Xaaladaha qaarkood, waxaa matag. Darnaanta calaamadaha ku xiran tahay xaddiga fructose jidhka soo galay.

The sabab u nuugeynin enterotsellyulyarnoy ugu badan ee la dheefshiidka xuub oo yaraada - waxaa disaccharidase deficiency. Haddii la gabi ahaanba aan kala tagno disaccharides. Iyagu ma nuugo marka galaya xiidmaha distal iyo mari halsano bakteeriyada la horumar ah hydrogen. Waxaa jira joog- calool xiidmaha, dibiro, shuban, hoos u xumo, matag, matag.

Enterotsellyulyarnaya nuugeynin nuugeynin xiidmaha iyo dheefshiidka ku dhici kara cudurka cøliaki. Waa cudur joogto ah la iska dhaxlo, taas oo ay waxyeello villi xiidmaha yar by cuntooyinka qaarkood. cudurka cøliaki lagu muujiyey in carruurta dhowr bilood ka dib hordhaca ah ee alaabta glyutensoderzhaschih cuntada. Marka cudurka:

• inta jeer ku saxaroodaan waa 2 ilaa 5 jeer maalintii,
• saxarada waa fudud, mararka qaarkood frothy, waa asalka ah ee ur carow ah, noo iftiimi,
• kordhiyaa caloosha;
• waxaa jira miisaan ku filnayn faa'iido (time qaar ka mid ah in hoos u dhaca dhaqaalaha mass ka dib ku biiray deficiency koritaanka).

Bandhigyada Baadhista xanuunada la nuugeynin syndrome

nuugeynin Cilad looma fuliyo. Khubarada in la aqoonsado calaamadaha SMA qoray in bukaanka ay isbedel ee baadhitaan gaar ah iyo lafaguridda si loo xaqiijiyo qaab ama mid cudurada kale looga shakisan yahay xanaajiyeen by nuugista oo yaraada ama dheefshiidka.

Marka fulinta Baadhista xanuunada, dhakhaatiirta waxaa haga geynta hoos ku horumariyo by Hay'adda World Gastroenterology ah:

• marka hore ku qaadeen taariikh qoto dheer, ururiya macluumaad ku saabsan dawada dhawaan ka go'an safraan, isticmaalka cuntada iyo cabitaanka oo aan lagu darin cunto caadiga ah;
• taariikh qoys bartay;
• by baaritaan jireed calaamadaha u nuugeynin;
• bartay saxarada, iyada oo la tixgelinayo dabeecadaha ay galeen;
• sheybaar ayaa la fuliyaa wixii macluumaad dheeraad ah.

cudurka dheeraad ah oo u nuugeynin syndrome waxa ka mid ah baaritaanada natiijadoodu cudurka cøliaki looga shakisan yahay, joogitaanka Giardia, bakteeriyada iyo dulin ee jirka. macluumaad muhiim ah ogaanshaha ogolaanaya in la helo ultrasound oo ka mid ah xubnaha gudaha ee saabka caloosha. Iyada oo ultrasound suurto gal ah in la qiyaaso xaaladda ka mid ah qanjidhada beerka, xameetida, xameetida, lymph.

Si aad u saaro ama loo xaqiijiyo gastritis ah, shalalka, cudurka cøliaki, cudurka Crohn esophagogastroduodenoscopy baahan biopsy oo ka mid ah caloosha iyo mindhicirka yar. Si loo xaqiijiyo la'aanta ah ee shaqo ganaca waxbarashada exocrine qabtay saxarada, computer iyo raajito loogu resonance magnetic, joogayso retrograde loo arki laga shido. Si aad u ogaatid oo ku saabsan joogitaanka ama maqnaanshaha of lesions of axalaha ah, khubarada loo magacaabay ileokolonoskopiyu la biopsy ka mid ah meelaha waxbarashada iyo xiidanka.

Daaweynta nuugeynin syndrome

Ka dib markii baaritaanka u nuugeynin sababaha dhakhaatiirta etiotropic qoro daaweynta loogu talagalay wax ka qabashada cudurka loo aqoonsado. Tusaale ahaan:

• Haddii cudurka cøliaki la ogaado, ku takhasusay waxay ku talineysaa bukaanka cunto gluten-free nolosha oo dhan,
• haddii la ogaado nuugeynin carbohydrates ama diid cuntada, ka dibna waxaa loo xilsaaray in ay u dhigma baabi'inta ama cunto xanibaada;
• geeddi socodka faafa antibiotics muujiyay,
• cudurada dheefshiidka iyo hormoonada jidhka u baahan therapy pathogenetic ku filan.

Marka muujiyay syndrome shubanka oo sababa u nuugeynin, daaweynta waxaa laga yaabaa in etiologic, iyo astaamaha pathogenetic. Patogenetichekaya therapy etiological oo waxaa laga yaabaa in qaadashada ah oo ka mid ah hab soo socda:

• antibiotics shubanka bakteeriyada,
• "Metronidazole" la amebiasis;
• daroogada anthelmintic helminthiasis;
• glucocorticoids, nudaha, "infliximab" in cudur mindhicireed barar,
• "Tetracycline", "ceftriaxone", "Co-trimoxazole" cudurka Whipple ee;
• "Octreotide" kasoobaxyo hormoonada jidhka ee mareenka caloosha iyo mindhicirka.

Calaamadaha waxaa ka mid ah helo fogaado, opiates, "Loperamide" wakiilka dhuuqda (bismuth diyaarinta "Diosmektita").

Si is-wax aan macquul aheyn in ay dhacdo of calaamadaha SMA. Waxa aanu ku siin natiijo fiican. Intaa waxaa dheer, u nuugeynin - waa muujin ka mid ah cudurro halis ah oo khatar ah. Haddii aad isku aragto calaamadaha SMA waxaa lagu talinayaa in la tasho dhakhtar. takhasus u leh oo keliya ayaa la odhan karaa waa sababta dhabta ah ee syndrome iyo in uu magacaabo therapy waxtar u leh baabi'inta cudurka laga helay.