Ultrasound bụ Key Diagnostic Ule
Okwu a bụ "ọrịa gallbladder" gụnyere ọnọdụ ahụike nke na-emetụta gallbladder, dịka ụbụrụ gallstones, nnukwu cholecystitis ma ọ bụ ọrịa na-adịghị ala ala (gallbladder mbufụt sitere na gallstones), na ọrịa cancer gallbladder.
Ọ bụ ezie na nyocha nke mgbaàmà, nyocha anụ ahụ, na ọrụ ọbara nile na-ekere òkè n'ịchọpụta ọrịa ọrịa gallbladder, ịnweta ntinye abdominal (na ikekwe nyocha ndị ọzọ) bụ akụkụ kachasị mkpa nke usoro nchọpụta ahụ.
Akụkọ Ahụike
Ọ bụrụ na dọkịta gị na-enyo enyo ọrịa gallbladder, ọ ga-ajụ maka mgbaàmà gị ma ma gị ma ọ bụ ndị ezinụlọ gị enweela nsogbu nsogbu ọ bụla.
Ihe atụ nke ajụjụ ndị nwere ike ịgụnye:
- Ị na-enwe ihe mgbu abdominal, ma ọ bụrụ otú ahụ ebee? Mgbu na nri aka nri ma ọ bụ n'elu nke dị n'ime afọ na-atụ aro nsogbu nsogbu gallbladder.
- Ihe mgbu abdomina na-eri nri? Site na egbugbere ọnụ, oké ihe mgbu nwere ike ime otu awa ma ọ bụ karịa mgbe o risịrị nri iri abụba na ọ dịkarịa ala minit 30.
- Ị nwetụla mmerụ afọ a? Ọrịa ụfụ gallstone na-akawanye njọ karịa oge, ọ pụkwara ịkpata nsogbu dịka ọrịa nke bile ma ọ bụ nsị nke pancreas .
- Ị na-enwe ihe mgbaàmà ọ bụla ọzọ ma e wezụga ihe mgbu, dị ka eserese, ọgbụgbọ, vomiting, ma ọ bụ ibu arọ? Ihe mgbaàmà ndị a nwere ike inyere dọkịta aka ịchọpụta ma ọrịa gallbladder na nsogbu ndị ọzọ nwere ike ịdị.
Nnyocha ahụ
Ọzọ, dọkịta gị ga-eme nchọpụta nkịtị, na-elekwasị anya na ihe ịrịba ama gị dị mkpa. Ndị nwere nnukwu cholecystitis nwere ike inwe ọkụ na oke obi.
Ọnụnọ nke jaundice , nke a na-egosi site na ịchacha ọcha nke anya na / ma ọ bụ akpụkpọ ahụ, na-echegbu onwe ya maka ngwakọta gallstone nke a na-akpọ choledocholithiasis bụ nke gallstone na-ahapụ gallbladder ma gbochie nnukwu okporo mmiri bile (ebe bile na-asọba n'ime eriri afọ).
N'ime ule abdominal, dọkịta gị ga-achọpụta ma ọhụụ a na-akpọ "na-eche nche" dị. Onye nwere nnukwu cholecystitis nwere ike 'ịche' ma ọ bụ tinye aka ha n'akụkụ aka nri nke elu nke afọ ha bụ ebe gallbladder nọ n'oge ule anụ ahụ.
N'ikpeazụ, n'oge ule anụ ahụ, dọkịta gị ga-arụ ọrụ a na-akpọ "Murphy's sign". N'elu ule a, a gwara mmadụ ka o nwee ume miri emi, na-ekwe ka gallbladder gbadaa ka dọkịta ahụ wee nwee ike ịbanye na ya. Ọ bụrụ na mmadụ enwee ihe mgbu dị ukwuu n'oge ule a (a na-akpọ "Murphy sign"), ọ na - egosi na ọ nwere ike ịnwe ọrịa gallbladder.
Labs
Ndị na-arịa ọrịa gallbladder nwere ọtụtụ ọbara ọbara ọbara dị elu. Mkpịsị ọbara ọcha gị bụ ụlọnga ndị na-ebute ọrịa na mgbe mgbasapụ dị elu na-egosi ụdị mmịnye ma ọ bụ ọrịa na ahụ. Na mgbakwunye na ọnụ ọgụgụ ọbara ọbara dị elu, ọ nwere ike ịbụ na mmadụ nwere ike ịnwa ule .
Ọ bụ ezie na enwere ike inwe mmụba dị nwayọọ n'ime enzymes imeju, nrịgo dị elu nke bilirubin (nakwa akụkụ nke imeju ọbara nyocha ọbara) na-atụ aro mgbagha nke ọrịa gallbladder (dịka ọmụmaatụ, ma ọ bụrụ na a na-emetụta gallstone na ndu bile na / ma ọ bụ enwere ọnya bile).
Ọ bụrụ na dọkịta gị na-enyo enyo cancer gallbladder na- adabere na ule nyocha (dịka ọmụmaatụ, ultrasound, CT scan, ma ọ bụ MRI), ọ nwere ike ịnye usoro nyocha ọbara ọbara, dika CEA ma ọ bụ CA 19-9. Otú ọ dị, a pụkwara ibuli ndị a akara n'ihu ọrịa cancer ndị ọzọ, n'ihi ya, ha abụghị ihe na-egosi kpọmkwem ọrịa kansa gallbladder. Ugboro ugboro karịa, a na-eji akara ndị a na-agwọ ọrịa na-agbaso omume mmadụ na ịgwọ ọrịa cancer (ọ bụrụ na ebuli ya elu).
Imaging
Ọ bụ ezie na akụkọ nlekọta ahụike, nnyocha anụ ahụ, na ụlọ ọrụ nwere ike ịkwado nchoputa ọrịa ọrịa gallbladder, ọ dị mkpa ịnweta foto iji chọpụta nchoputa. N'ikwu ya n'ụzọ ọzọ, a ghaghị iji anya nke uche hụ ihe gallbladder, nke a na-emekarị ya na ultrasound.
Ultrasound
Ngwiagwu ihe omumu bu ugwo ihe omimi nke na-eme ihe n 'uzo ozo iji mee ihe oyiyi nke gallbladder. Na mgbakwunye na nkume agba, gallbladder mgbidi mgbidi ma ọ bụ ọzịza na gallbladder polyps ma ọ bụ igwe nwere ike ịhụ.
N'oge ihe na-eme ka ultrasound, onye nyocha ahụ pụkwara igosi "Murphy's sign". Mgbe a na-emegharị ihe a, a na-emegharị transducer ultrasound na gallbladder mgbe onye ahụ na-enwe ume miri emi. Ọ bụrụ na ọ dị mma, onye ahụ ga-enwe ihe mgbu mgbe nsogbu gallbladder na-agbada.
HIDA Iṅomi
Ọ bụrụ na nchoputa nke ọrịa gallbladder adịghị ama mgbe ọ bụla ultrasound gachara, a ga - emejuputa HIDA. Nlere a na-enye ohere iji anya nke mmeghari bile site na usoro bile duct. N'oge a na-ekpo ọkụ na HIDA, a na-agbazi onye na-emegharị redio site na mmadụ. A na-ejide mkpụrụ ndụ ajuju ma wepụ ya na bile.
Ọ bụrụ na enweghi ike iji anya nke uche hụ ule ahụ, ule ahụ "dị mma" n'ihi na ọ pụtara na e nwere ụdị ihe mgbochi (mgbe ọ bụla site na ụbụrụ, ma eleghị anya site na ụfụ) na eriri cystic, nke bụ tube nke na-ebufe bile si gallbladder Oke na-agakarị na bile.
CT Iṅomi
Ngwunye CT nke afọ gị nwere ike igosi ihe ịrịba ama nke ọrịa gallbladder, dị ka gallbladder ọkpụkpụ ma ọ bụ abụba. Ọ nwere ike ịba uru karịsịa maka ịchọta nsogbu dị egwu nke nnukwu cholecystitis, dị ka gallbladder perforation (mgbe oghere na-amalite na gallbladder) ma ọ bụ cholecystitis mgbapụta (nke nwere mgbapụta gallbladder sitere na nje bacteria).
Magnetic Resonance Cholangiopancreatography (MRCP)
Nnyocha ule a na-adighi emetụta ihe na-eme ka onye dọkịta nwee ike ịtụle bile ducts ma n'ime imeju na imeju. Enwere ike iji ya nyocha na nkume dị na mmiri bile (a na-akpọ choledocholithiasis).
Endoscopic Retrograde Cholangiopancreatography (ERCP)
ERCP bụ ma nyocha ma nwee ike ịnwa ọgwụgwọ. N'oge ERCP , onye gastroenterologist (onye dọkịta nwere ọkachamara na ọrịa usoro ọgwụ) ga-etinye igwefoto dị nro, nke nwere ike ịchọta njedebe n'ime ọnụ mmadụ, ala esophagus, gafere afo, na n'ime eriri afọ.
Mmadụ na-anọ jụụ n'oge usoro a ka ọ ghara inwe nchekasị. Mgbe ahụ, site na njedebe, a na-etinye obere obere tube n'ime ọwa bile. Ejiri ihe dị iche iche na-egbuke egbuke n'ime obere tube a iji mee ka usoro okporo ígwè bile, nke nwere ike ịhụ site na ụzarị ray.
Site na ERCP, a ga-ahụ anya ma wepụ ya na otu oge. A pụkwara ịhụ mgbagwoju anya nke bile ducts na ERCP, a pụkwara itinye stent iji mee ka ọwa ahụ meghee. N'ikpeazụ, n'oge ERCP, dọkịta nwere ike ịme ihe ntanetị (nke a na-akpọ biopsy) nke polyps ma ọ bụ ndị ọ bụla enyo.
Nchọpụta dị iche iche
Ọ bụ ezie na ọ bụ ezi uche na-eche na ọrịa gallbladder ọ bụrụ na mmadụ nwere mgbu n'akụkụ aka nri nke oke ha, a ghaghị ịtụle etiologies ndị ọzọ (ọtụtụ nsogbu imeju). Nke a bụ n'ihi na imeju gị dịkwa n'akụkụ aka nri nke afọ gị ma jikọọ ya na gallbladder site na usoro nke biliary ducts.
Ihe atụ nke nsogbu imeju nke nwere ike ime ka mgbu na akụkụ aka nri nke elu nke afọ gụnyere:
- Ịba ọcha n'anya (dịka ọmụmaatụ, ọrịa ịba ọcha n'anya) : E wezụga ihe mgbu, ihe mgbaàmà ndị ọzọ nke ịba ọcha n'anya nwere ike ịgụnye jaundice, ụrọ na-acha uhie uhie , na urine mmiri.
- Ọrịa ọrịa Fitz-Hugh-Curtis (ọrịa ịba ọcha): Ọrịa a na-ezo aka nsị nke imeju imeju nke na-eme n'ime ndị inyom nwere ọrịa pelvic.
- Ihe na-akpata izu ike: Ndị na-arịa ọrịa shuga, ndị na-emeju umeji imeju, ma ọ bụ ndị nwere ọrịa ime mmụọ, gallbladder, ma ọ bụ ọrịa pancreatic kachasị n'ihe ize ndụ nke ịmepụta ihe.
- Ọkpụkpụ Portal vein thrombosis: Ọrịa a na-ezo aka na ọbara na-erikọta na veeti veal, nke bụ ọbara arịa na-eburu ọbara na imeju na eriri afọ.
- Ọrịa Budd-Chiari: Nke a bụ ọrịa siri ike nke na-eme mgbe enwere ihe mgbochi nke imeju imeju.
E wezụga mgbu na akụkụ aka nri nke elu nke afọ, onye na-arịa ọrịa gallbladder nwere ike ịnwe ahụ mgbu na mpaghara etiti etiti nke afo (nke a na-akpọ mgbu epigastric).
Ihe ndị ọzọ nwere ike ịkpatara mgbu na-agụnye:
- Ọrịa reflux gastroesophageal (GERD): Na mgbakwunye na ihe mgbu epigastric, onye nwere GERD nwere ike ịdekọ obi mgbawa na nsogbu ọ na-emetụta.
- Ọrịa na-egbu egbu nke Peptic: Ọnọdụ a na-akọwa ọnyá dị iche iche nke na-etolite n'ime afọ ma ọ bụ akụkụ mbụ nke eriri afọ. Ọrịa abdominal na-ere ọkụ bụ ihe mgbaàmà kachasị.
- Gastritis: Ọnọdụ a na-ezo aka mbufụt nke imechi afọ ma ọ nwere ike kpatara ya site n'ọtụtụ ihe dị iche iche dị ka mmanya, ọgwụ ndị na-adịghị egbochi ọrịa, ma ọ bụ nje.
- Pancreatitis: Ndị na pancreatitis na-enwetakarị mgbu nke na-egbuke egbuke ma ọ bụ aka ekpe nke na-egbuke egbuke na azụ ma jikọtara ya na ọgbụ na vomiting.
- Mwakpo obi (mgbatị mgbochi nke myocardial): Ihe mgbu nke ọnyá nwere ike ịbụ ihe mgbaàmà mbụ nke nkụchi obi . Mmadụ nwekwara ike ịnwe mkpụmkpụ ume na ume gbasara ọrịa obi.
> Isi mmalite:
> Abraham S, Rivero HG, Erlikh IV, Griffith LF, Kondamudi VK. Njikwa na-enweghị atụ nke gallstones. > Ọkachamara Fm . 2014 Mee 15; 89 (10): 795-802.
> American Cancer Society. (2016). Kedu ka esi achọ Gallbladder Ọrịa cancer?
> Sanders G, Eze nke AN. Nyochaa Clinical: Gallstones. > BMJ . 2007 Aug 11; 335 (7614): 295-99.
> Zakko SF, Afdhal NH. (2016). Nnukwu cholecystitis: Pathogenesis, ihe gbasara ahụike, na nyocha. Chopra S, (ed). UptoDate, Waltham, MA: UpToDate Inc.