Malabsorption - dab tsi yog qhov no? Classification thiab ua

Hnyuv - ib qho ntawm txoj hnyuv. Nws ua ib tug ntau yam ntawm kev khiav dej num, plays lub luag hauj lwm loj nyob rau hauv lub plab zom mov ntawm cov zaub mov thiab haum cov as-ham. Nrog rau txoj kev loj hlob ntawm tej yam kab mob cuam tshuam no department - tshwm malabsorption syndrome, uas yog abbreviated li cov CMA. Yuav ua li cas yog cov sij hawm no? Qhov no syndrome yog tshwm sim los ntawm dab tsi yog vim li cas?

Txiav suab ntawm cov tswv yim

Nyob rau hauv cov kev kho mob cov ntaub ntawv, koj yuav nrhiav tau ib lub sij hawm xws li "malabsorption". Lo lus no yog siv rau xa mus rau malabsorption plab hnyuv mucosa ntawm khoom noj khoom haus Cheebtsam. Muaj kuj yog ib lub sij hawm xws li "maldigestion". Qhov no txhaum hloov dua siab tshiab kev ntawm roj, protein thiab carbohydrate zom cov zaub mov cov khoom absorbable.

Kws txawj muab ob lub saum toj no lub sij hawm ( "malabsorption" thiab "maldigestion"), thaum ib tug hais lus ntawm malabsorption syndrome. Hais txog lub complex soj ntsuam ces, nej sawv tawm ntawm kev ua txhaum ntawm cov kab noj hniav, cov phab ntsa, membrane kev zom thiab thauj nyob rau hauv cov hnyuv. Vim cov kev hloov uas tshwm sim nyob rau hauv tib neeg lub cev vim yog lub rov tshwm sim ntawm malabsorption syndrome, metabolic mob tshwm sim. Cov neeg pib tsim txom tsis kaj lub siab mob.

Cov ua rau SMA

malabsorption syndrome cai nyob rau hauv ntau raws roj ntsha thiab congenital kab mob nyob rau hauv uas ntxhov haum ntawm tshuaj, txo enzyme ua si. Raws li ib qho piv txwv, cystic fibrosis. Nyob rau hauv no kab mob, lub AGR muaj vim txo enzyme ua si thiab pancreatic mob secrets viscosity.

Yuav kom ua malabsorption syndrome kab mob tshwm sim los ntawm tus kab mob thiab parasites, txawv txav lymphatic thiab lub plawv systems. CMA yog kuj cai nyob rau hauv cov ntaub ntawv ntawm kev puas tsuaj ntawm cov hnyuv thiab txo haum cheeb tsam (hu ua cov kev hloov nyob rau hauv lub cev, ua ib tug ua loj teeb uas muaj ntau hom ntawm exchanges, lub cev thiab kev puas hlwb stunting).

Yog li, malabsorption - ib tug txheej ntawm tsis kaj siab tsos mob uas yuav ua rau ib tug ntau ntawm txawv yog vim li cas. Lawv yuav tsum tau ua ke raws li nram no:

1. Preenteralnaya pab pawg neeg. Cov no muaj xws biliary ib ntsuj av tau cov kab mob, lub siab, mob plab, cystic fibrosis.
2. Postenteralnaya pab pawg neeg. Nws muaj xws li cov qog thiab ntshav mob nyob rau hauv lub ntev hnyuv, uas yog nyob nruab nrab ntawm lub plab thiab cov hnyuv loj, exudative enteropathy, lymphosarcoma, Hodgkin tus kab mob.
3. Enteral pab pawg neeg ntawm yog vim li cas. Cov no muaj xws galactose malabsorption, celiac kab mob, disaccharidase tsis ua hauj lwm, giardiasis, dermatitis herpetiformis.

Cov tsos mob hais rau SMA

Txawm tias muaj tseeb hais tias cov malabsorption syndrome xam qhovkev nyob rau hauv ntau yam kab mob, yuav ua tau distinguished nta cov yam ntxwv ntawm nws. Thaum CMA xeev siab, ntuav. Nyob rau hauv cov neeg mob uas tsis qab los noj mov. cov tsos mob kuj pom li tsam plab, kev hloov nyob rau hauv quav (feem ntau raws plab tshwm sim). Tag nrho cov tej yam tshwm sim no yog hu ua dyspeptic syndrome. Nws yog ua rau kev soj ntsuam kom paub txog SMA.

Tshwj xeeb mloog yuav tsum tau lub rooj zaum. Soj ntsuam tus yam ntxwv ntawm cov quav, cov kws txawj tau txais ib qho tseem ceeb cov ntaub ntawv uas tso cai rau lawv kom muab tso rau qhov tseeb mob:

• thiab frothy kua quav nrog ib tug acidic tsw - ib cov tsos mob uas tej zaum yuav txais tau nyob rau hauv pathologies xws li glucose-galactose malabsorption, disaccharidase tsis muaj peev xwm;
• greasy quav yog nyob rau hauv mob pancreatitis, cystic fibrosis, dermatitis herpetiformis, exudative enteropathy syndrome Pearson, plab hnyuv dysbacteriosis;
• heev greasy quav cai nyob rau hauv cystic fibrosis, congenital lipase tsis muaj peev xwm;
• dej raws plab - ib cov tsos mob uas yuav tshwm sim thaum ib tug kab mob nkag mus rau hauv lub cev, tsim enterocolitis, malabsorption ntawm piam thaj thiab galactose.

Thaum MCA tej zaum muaj kev mob kev nkeeg. Feem ntau cov feem ntau, lawv ua plab hnyuv kab mob thiab infestations. Mob syndrome yuav tshwm sim tom qab siv khoom noj siv mis. Nws ua ke nrog foamy lub rooj zaum nrog ib tug qaub tsw, flatulence qhia ib tug lactase tsis muaj peev xwm. Mob plab thaum lub sij hawm CMA nrog zaub mov tsis haum, plab hnyuv txawv txav, Whipple tus kab mob, ulcerative mob plab, Crohn tus kab mob. Cov nram qab no cov tsos mob muaj cai txawm thaum malabsorption syndrome:

• daim tawv nqaij sawv pob;
• qaug zog;
• ib tug zoo nkaus li tsis muaj zog;
• tsam plab;
• anorexia.

Malabsorption nyob rau hauv cov me nyuam nrog deficient syndromes. Ntxhov lub cev txoj kev loj hlob. Qhov no yog manifested nyob rau hauv lub yuav txo tau ntawm lub cev hnyav, txoj kev loj hlob ntawm malnutrition, stunted kev loj hlob. Nyob rau vitamin tsis muaj peev xwm qhia rau lub xeev ntawm daim tawv nqaij. Cov tawv nqaij yuav qhuav thiab pib dhas tawm. Nyob rau nws yuav tshwm sim tsaus me ntsis. Cov plaub hau thinning thiab pib poob tawm. Lub rau tes ua npub laus thiab exfoliate. Thaum calcium tsis muaj peev xwm tshwm sim tu-sauv, mob nyob rau hauv cov nqaij thiab cov pob txha. Tsis muaj hlau, tooj liab thiab zinc ua rau cov tsos ntawm daim tawv nqaij sawv pob, hlau-deficiency anemia, ua rau kom nyob rau hauv lub cev kub.

uas twb muaj lawm kev faib

malabsorption syndrome muaj ntau tshaj 70 ntau yam kab mob. Nyob rau hauv no hais txog, cov kws txawj muaj ces yuav tsum ib co teeb meem nyob rau hauv lub cais ntawm cov kev npaj. Cov vam meej tshaj plaws yog lub division ntawm roj ntsha thiab mas yuav kis tau malabsorption syndromes:

1. Tus thawj ntawm no yog kuaj nyob rau hauv 10% ntawm cov neeg. Mob muaj keeb SMA yog dhau los ntawm cov niam txiv rau tus me nyuam. Nws kuj yog vim noob change.
2. Nrhiav malabsorption syndrome - qhov tshwm sim ntawm plab hnyuv thiab extraintestinal mob (e.g. hlav, immunodeficiencies, daim siab thiab txiav).

Muaj kuj yog ib tug faib uas yog raws li nyob rau hauv lub heev ntawm malabsorption syndrome:

• Qib I (me me daim ntawv no) - cov me nyuam me ntsis txo lub cev hnyav, cov tsos mob tshwm sim multivitamin tsis ua hauj lwm cai disharmonious lub cev txoj kev loj hlob;
• II degree (nruab nrab zoo) - tus neeg mob muaj ib lub cev loj tshaj (txawv los ntawm cov cai yog ntau tshaj 10%) yog cai lag nyob rau hauv lub cev txoj kev loj hlob, pom cov lus hais tej yam tshwm sim ntsha tsis muaj peev xwm thiab insufficiency multivitamin;
• Qib III (mob loj heev) - cov me nyuam yog lub cev underdeveloped, lub cev loj tshaj tshaj 20%, nyob rau hauv ib co neeg mob muaj yog ib tug nyob rau hauv ncua sij hawm psychomotor txoj kev loj hlob.

hom malabsorption

Nyob rau hauv 1977 nyob rau VIII ntiaj teb Congress ntawm Gastroenterology. Nws tshwj xeeb tau pom ob peb hom malabsorption, nyob ntawm seb nws ua:

• intracavitary;
• posttsellyulyarnaya;
• enterotsellyulyarnaya.

Tsis muaj cov kua tsib secreted los ntawm lub pancreas thiab cov tshuaj uas muaj feem xyuam rau cov recessed zom cov zaub mov thiab ua rau qhov ua txhaum cai, - malabsorption intracavitary hom. Cov me nyuam lawv tshwm sim vim cystic fibrosis, congenital hypoplasia ntawm lub pancreas. Nyob rau hauv cov me nyuam laus tsos intracavitary malabsorption syndrome ntxias cov kab mob xws li mob npuas paug, mob pancreatitis.

Qhov thib ob hom SMA - posttsellyulyarnaya malabsorption. Qhov no syndrome, uas yog yus muaj los ntawm kev poob ntawm ntshav protein los ntawm cov plab hnyuv phab ntsa. Nws ua Kev Cai nrog anomalies ntawm lub plawv thiab lymphatic systems. Ib tug ntawm cov kab mob - ib tug idiopathic plab hnyuv lymphangiectasia. Nws yog xam qhovkev nyob rau hauv lub hnyav tsis calcium, lipids thiab cov proteins nyob rau hauv txoj hnyuv ib ntsuj av.

Enterotsellyulyarny hom combines cov mob uas lub siab tawg tag membrane zom cov zaub mov los yog haum vim ib tug kho raws ntawm enzyme systems ntawm plab hnyuv epithelial hlwb. Tej zaum yuav tshwm sim nyob rau hauv cov me nyuam yaus vim hais tias ntawm roj ntsha kab mob txuam nrog rau kev ua txhaum:

• suction;
• membrane zom cov zaub mov;
• plab zom mov thiab haum.

Cov me nyuam nyob rau hauv cov laus hnub nyoog enterotsellyulyarny hom malabsorption syndrome tshwm sim vim kev puas tsuaj rau cov hnyuv thiab ntawm tes tuag vim qhov tus kab mob los yog parasites, tuberculosis, hlav hauv cov hnyuv, Crohn tus kab mob.

Piv txwv intracavitary malabsorption

Nrog rau qhov no hom ntawm AGR lom zem ntau ntxhov roj digestion. Lawv hydrolysis yog nqa tawm los ntawm pancreatic lipase, uas yog tshuab txais los ntawm bile. Nrog lub shortage ntawm cov ntaub ntawv zoo nkaus li cov tsos mob xws li steatorrhea. Qhov no xaiv nrog quav tshaj rog. Qhov no yog feem ntau kom meej meej manifested nyob rau hauv mob pancreatitis steatorrhea. Tsawg hnov no cov tsos mob nyob rau hauv daim siab thiab biliary ib ntsuj av.

Ntawm cov ua intracavitary malabsorption, yuav tsum xav txog congenital hypoplasia ntawm lub pancreas (hypoplasia). Cov tsos mob yuav tshwm sim nyob rau hauv thawj hnub los yog lub lim piam ntawm lub neej. Muaj yog ib tug kua nplua nuj sai lub rooj zaum malodorous thiab greasy ci. Rog muaj peev xwm txawm lossi paim quav tawm ntawm lub qhov quav.

Piv txwv posttsellyulyarnoy malabsorption

Posttsellyulyarnaya plab hnyuv malabsorption tshwm sim thaum exudative enteropathy. Qhov no yog ib syndrome nyob rau hauv uas ntshav protein yog poob los ntawm lub mucosa. Qhov ua rau ntawm exudative enteropathy tej zaum yuav nyob rau hauv lub xub ntiag ntawm congenital malformation ntawm lymphatic plob tsis so tswj cov hlab ntsha. Feem ntau cov feem ntau ua rau syndrome Whipple tus kab mob, Crohn tus kab mob, me me quav hlav, khoom noj khoom haus kev tsis haum tshuaj.

Exudative enteropathy tej zaum tshwm sim tsis muaj overt soj ntsuam ces. Tej zaum muaj kev cov tsos mob xws li mob raws plab thiab steatorrhea. Cov neeg mob yuav tshwm sim peripheral edema, laus ntawm lub ntsej muag, rov qab, perineum, nqua.

Piv txwv enterotsellyulyarnoy malabsorption

Enterotsellyulyarny hom AGR malabsorption tej zaum yuav vim ib tug pathology xws li glucose-galactose malabsorption. Qhov no yog ib qho pub kab mob qhov twg tawg active thauj cov zib thiab galactose nyob rau hauv cov hnyuv mucosa. Mob nyob rau hauv thawj hnub ntawm lub neej yog manifested los ntawm raws plab. Quav faib los ntawm 10 mus rau 20 lub sij hawm ib hnub. Lawv cov quav muaj dej, li zis. Tus me nyuam seb puas tsimnyog tau rau hauv lub cev kub, ntuav. Yog hais tias koj rho cov mis nyuj mov yog cov tsos mob. Tsis kam ntawm cov khoom qab zib thiab mis nyuj haus tseem rau ib tug lub neej.

Lwm cov piv txwv enterotsellyulyarnogo CMA - fructose malabsorption. Qhov no yog ib caj tsawg malabsorption. Cov tsos mob tshwm sim tom qab noj txiv hmab txiv ntoo thiab kua txiv hmab, muaj nyob rau hauv nws cov qauv ib tug loj npaum li cas ntawm fructose. Qhov no yog apples thiab txiv kab ntxwv, thiab txiv ntoo qab zib thiab lws suav. Hais tias fructose yog tsis absorbed los ntawm lub cev, yuav ua tau rau flatulence, dej raws plab, colicky mob nyob rau hauv lub plab mog. Nyob rau hauv tej rooj plaub, muaj yog ntuav. Cov heev ntawm cov tsos mob nyob rau tus nqi ntawm cov fructose nkag mus hauv lub cev.

Feem ntau yog vim li cas enterotsellyulyarnoy malabsorption nrog impaired membrane plab zom mov - nws disaccharidase tsis muaj peev xwm. Yog hais tias nws tsis yog kiag li phua disaccharides. Lawv tsis absorbed thaum nkag mus kawm rau distal hnyuv thiab yauv kab mob fermentation nrog evolution ntawm hydrogen. Muaj bouts ntawm plab hnyuv Colic, tsam plab, raws plab, tsis qab los noj mov, ntuav, ntuav.

Enterotsellyulyarnaya plab hnyuv malabsorption malabsorption thiab kev zom yuav tshwm sim nyob rau hauv celiac kab mob. Nws yog ib tug mob raws roj ntsha kab mob nyob rau hauv uas puas villi hauv cov hnyuv los ntawm tej yam khoom noj. Celiac kab mob no yog manifested nyob rau hauv cov me nyuam ib tug ob peb lub hlis tom qab cov kev taw qhia ntawm catering glyutensoderzhaschih khoom. Thaum tus kab mob:

• defecation zaus yog 2 mus rau 5 lub sij hawm ib hnub twg;
• quav zooj, tej zaum frothy, nws yog xam qhovkev nyob rau hauv ib tug fetid tsis hnov tsw, ci;
• tsub kom lub plab;
• muaj tsis txaus koj qhov hnyav nce (tom qab ib co sij hawm mus rau loj tshaj koom txoj kev loj hlob muaj peev xwm).

Ua diagnostics nrog malabsorption syndrome

Mob malabsorption yog tsis nqa tawm. Kws txawj nyob rau hauv paub SMA cov tsos mob tshuaj rau lawv cov neeg mob cov kev hloov ntawm tshwj xeeb kev ntsuam xyuas thiab ntsuam kom paub meej tias yog ib txoj kev los sis lwm xav tias pathology provoked los ntawm impaired haum los yog zom cov zaub mov.

Thaum nqa tawm diagnostics, cov kws kho mob yog ua los ntawm cov hauv qab no algorithm tsim los ntawm lub ntiaj teb Gastroenterology Organization:

• thawj nqa tawm ib txhij txhua keeb kwm, sau cov lus qhia txog cov tshuaj cog lus nyuam qhuav mus, cov kev siv ntawm cov zaub mov thiab dej qab zib tsis muaj nyob rau hauv li ib txwm noj cov zaub mov;
• kawm tsev neeg keeb kwm;
• ntawm lub cev kev xeem rau cov cim qhia ntawm malabsorption;
• kawm quav, noj mus rau hauv tus account lawv cov yam ntxwv;
• laboratory kev ntsuam xyuas yog nqa tawm rau cov lus qhia ntxiv.

Ntxiv mob ntawm malabsorption syndrome muaj xws li ua tau zoo tshawb rau xav tias celiac kab mob, lub xub ntiag ntawm Giardia, cov kab mob thiab cab nyob rau hauv lub cev. Tseem ceeb diagnostic ntaub ntawv tso cai rau muab tau ultrasound ntawm lub hauv nruab nrog cev ntawm lub plab kab noj hniav. Los ntawm ultrasound tau los laij rau tus mob ntawm lub siab, pancreas, tsib lub zais zis, cov qog ntshav hauv.

Yuav kom tshem tawm los yog paub meej tias cov autoimmune gastritis, celiac kab mob, Crohn tus kab mob yuav tsum esophagogastroduodenoscopy nrog me ntawm lub plab thiab duodenum. Yuav kom paub meej tias cov tsis muaj kev exocrine pancreatic muaj nuj nqi nyob quav tshawb fawb, computer thiab sib nqus resonance tomography, retrograde cholangiopancreatography yuav pom tau ducts. Yog xav paub txog ntawm lub xub ntiag los yog tsis tuaj kawm ntawv ntawm qhov chaw mob ntawm tus ileum, cov kws txawj tsa ileokolonoskopiyu nrog ib tug me ntawm lub cheeb tsam tshawb fawb thiab cov nyuv.

Kev kho mob ntawm malabsorption syndrome

Tom qab diagnosing cov ua malabsorption etiotropic kws kho mob muab tshuaj rau kev kho mob aimed ntawm qhov uas tau txheeb xyuas kab mob. Piv txwv li:

• Yog hais tias celiac kab mob no yog kuaj, tus kws khomob tshwjxeeb kom tus neeg mob lub neej gluten-dawb noj cov zaub mov;
• yog tias kuaj tau malabsorption ntawm carbohydrates los yog khoom noj khoom haus intolerance, ces nws yog muab tso rau lub sib nug xov Ib tshem tawm los yog txwv noj cov zaub mov;
• kab dab qhia tshuaj tua kab mob;
• nyob rau hauv metabolic thiab endocrine kab mob yuav tsum tau txaus pathogenetic txoj kev kho.

Thaum qhia raws plab syndrome uas ua rau malabsorption, kev kho mob tej zaum yuav etiologic, thiab pathogenetic symptomatic. Patogenetichekaya etiological txoj kev kho thiab tej zaum yuav ua tau ib tug kom tsawg ntawm cov nram qab no txhais tau tias:

• tshuaj tua kab mob rau cov kab mob zawv plab;
• "Metronidazole" nrog amebiasis;
• anthelmintic tshuaj helminthiasis;
• glucocorticoids, cytostatics, "infliximab" nyob rau hauv inflammatory plob tsis so tswj kab mob;
• "Tetracycline", "Ceftriaxone", "Co-trimoxazole" Whipple tus kab mob;
• "Octreotide" nrog endocrine qog ntawm tus mob huam.

Symptomatic kev kho mob muaj xws li tau txais probiotics, opiates, "Loperamide" ntxeem tau dej neeg sawv cev (Bismuth npaj "Diosmektita").

Rau nws tus kheej-tsis yooj yim sua nyob rau hauv cov kev tshwm sim ntawm cov tsos mob ntawm SMA. Nws tsis muab zoo tshwm sim. Nyob rau hauv tas li ntawd, malabsorption - yog ib tug manifestation ntawm cov loj thiab txaus ntshai kab mob. Yog hais tias koj muaj kev tshwm sim ntawm SMA nws yog pom zoo kom mus tham ib tug kws kho mob. Tsuas yog ib tug kws muaj peev xwm yuav hu ua qhov tseeb ua kom muaj tus syndrome thiab taw ib tug zoo txoj kev kho rau tshem tawm ntawm tus kab mob no thiaj paub hais tias.