Osler nodes - yintoni na le nto? Izinto ezibangela Pathogenesis, unyango

Endocarditis - kukukrala endocardium, ingaphakathi zombilini. Oku kunokubangela izifo kwizigqeba emininzi kunye neenkqubo ze-yokwenzakala emzimbeni womntu, oonobangela hypercoagulable kunye nabanye abasebenzi abanga-esosulelayo. Ngoko ngokwayo endocarditis yi iimpawu zabo nje, ubukho apho Roth amabala, Osler iindawo kunye nezinye irhashalala uphawu emzimbeni alibonakali. Izigulane angamphathi ubuhlungu, yaye kunqabile ukukhalaza malunga ukumbombozela ngentliziyo, nomkhuhlane. Kwaye kuphela ukuba ukudumba endocardial yabangela olwaye lwamfimfitha micro-eziphilayo egazini, kuba sisifo esahlukileyo ekuthiwa esosulelayo, bacteriological okanye bacteria endocarditis. Osler iindawo - enye imiqondiso yayo lwangaphandle. Wachaza ngo 1885, ugqirha ephawulekayo waseKhanada William Osler. Infective endocarditis - isifo esiyingozi kakhulu ekhokelela deformation vuhlayiseki wentliziyo, ngoko kubalulekile ukuba wazi ukuba yintoni na yaye kubonakala ngayo ngokwayo.

Iimpawu endocarditis infective

Esi sifo sibangelwa iintsholongwane nomngundo Phantse zonke izifo, kwaye maxa wambi nkqu iintsholongwane lenyama ke egazini lomntu. Ukungena ukuze endocardium kuzo izifo ezosulelayo zemiphunga, rheumatism, periodontitis, tonsils, isifo sephepha, urethral catheterization, ukususwa izinyo kunye nezinye zazo. Osler nodes kukho uphawu okuqaqambileyo wamnika ingxaki izifo engundoqo - endocarditis infective. Kwiimeko ezininzi, ukuqala umsebenzi ekumfimfitheni ezincinane entliziyweni kufuneka zimoshwa nangayo nayiphi na indlela:

- catheters lwemithambo;

- pacemakers;

- zitho mbobo intliziyo nemithambo;

- ngenhliziyo ukukhubazeka ezahlukeneyo;

- microtrauma;

- uqhaqho.

Ngamanye amaxesha iintsholongwane ukungena endocardium nangaphandle umonakalo inyama ngaphambi. Emva koko kwakhiwa mathumba, fistulas kunye nezinye izifo.

iimpawu

Infective endocarditis bayiveze ngokucacileyo ngokucacileyo, yaye ekuqaleni aphazamise ukudinwa kuphela, luyambombozela intliziyo, ubuthathaka jikelele, kwaye iimpawu enamandla ngaphezu ukwandisa ngcembe. Ezi ziquka:

- umkhuhlane;

- Ukugodola;

- umbilo lweenkcukacha;

- izihlunu ibuhlungu kunye namalungu;

- komzimba;

- utshintsho kwesikhumba (kuba nombala, tyheli kancinci);

- kwamaqhakuvana kwi inwebu yangaphakathi.

Osler iindawo kuvela emva mpawu zingentla. Ezinye iingcali awajonge ngendlela isici esasenza ebalulekileyo endocarditis infective, ngoxa abanye kubonakaliswa inqabile kakhulu kuyo, apho esi sifo ingohlobo subacute ngayo.

Osler iindawo, Pathogenesis

Ezi zithinteli kuvela phezu izandla, zomnwe, iinyawo ngenxa komtshiso okubangelwa usuleleko kunye imithambo yegazi yaye zimele infiltrate. ukufunda Histological amaqhina kuzo kombisa venules andiswe kwaye arterioles. ngamanye amaxesha badidekile kunye amaqhakuvana komzimba okanye purpura yokubolisa. Njani maqhuqhuva Osler, photo ubonisa kakhulu ngokucacileyo. Kuyinto khaxa, ubukhulu-ertyisi okanye ukubunjwa kancinane yefoni nombala obomvu okanye ezimfusa, maxa wambi buhlungu, maxa. Baza kucinga ngokukhawuleza nyamalala ngokwazo, akunguye isifo eyahlukileyo, ngoko iipilisi unyango okanye namafutha aqholiweyo musa ukuba. Kodwa ke ukuba umntu wabona ngesantya ezinjalo, ngoko nangoko kufuneka udibane nogqirha wakho elebhu ezongezelelweyo kunye nezifundo clinical.

amabala Roth kaThixo

Ukongeza maqhuqhuva Osler, xa endocarditis infective Inokwenzeka ukopha nokuphololoza uphawu emacaleni kunye neentungo, ukopha phantsi isikhonkwane nembasa, amatshatshazi Zhaneve evela kwakunye Osler iindawo, ezintendeni kunye amathe. Kodwa, xa nshita maqhuqhuva, ezi amabala yalula ngokupheleleyo, alibonakali kanje-ertyisi kwaye iziphumo hawu igazi emithanjeni.

Xa endocarditis infective, ukongeza eluswini, amehlo kwaye kunokuchaphazeleka. Enye imiqondiso zixhaphakileyo sokungamelani komtshiso Bangamabala Roth. Wachaza ugqirha wabo Swiss Roth. Roth iindawo amele microbleeds kwiretina. Xa ifomu ukuba mbhoxo okanye ngeenxa ngezhaphaza emhlophe embindini. Xa izigulane, ngokuseka kunokubangela yehle umbono, leyo, emva konyango esi sifo engundoqo ubuye.

Roth amabala iliphawu nje kuphela endocarditis infective, kodwa anaemia, isifo kwizicwili. Ngoko ke, ukuba benze uphethwe kuyimfuneko ukuba baqhube izifundo ezongezelelweyo.

Ezinye iimpawu endocarditis infective

Kukho malunga iimpawu elinesibini lidiza na ukudumba endocardium ngenxa yokwaziswa usulelo.

Osler iindawo, Lukin amabala (okanye ekunene-uphawu Lukin Liebman), iimpawu Rock, Dmitrienko, Janeway kunye nezinye amagqirha uncedo ukuxilonga, ingakumbi kwiimeko xa neminye imiqondiso imifuziselo sifo imfiliba okanye angekhoyo.

Uphawu Lukin-Liebmann na imbonakalo petechiae indawo nge iziko ezimhlophe phezu ezibayeni zempahla iinkophe kunye conjunctiva.

Rock uphawu esizibonakalisa ekwandeni njengokhozo lweliso ekhohlo.

Uphawu Janeway - it imfundo erythematous, kwakunye amabala Roth, esebenza ezintendeni kunye kweentende zeenyawo, kodwa kulo mzekelo ukuba yayimfutshane ngesithomo.

Uphawu Dmitrienko sikuko ukuthamba ithoni pitch mna, nto ke leyo ebangele ikwabizwa ngokuba "ithoni velvet." Saqhuba lo msebenzi kwi zigaba zokuqala zesi sifo.

unyango

Ukumisela unobangela naluphi uphawu oluthile inokuba ngugqirha. Ngokuqhelekileyo, oku kufuna iimvavanyo zegazi elebhu, ECG, echocardiography. Kunyanzelekile ukuba enze igazi bakposev ukuchonga arhente ezosulelayo. Ukuba iimvavanyo zibonise ubukho endocarditis infective kuyo isigulane, i-zintsholongwane imiselwe iqela elifanelekileyo. Kwiingozi ezimasikizi, utyando olwenziwa (iplastiki, ezase yentliziyo nokufakelwa).

Xa uphethwe ngexesha ngokuchanekileyo nangexesha ungaluqalanga unyango 50-90% ezigulane ubomi iminyaka engaphezu kwama-5. Ukuze kuthintelwe kukuvela endocarditis infective liphuhlise indlela ekhethekileyo abantu engozini. It has iindlela eziliqela yothintelo, ngokusekelwe ulwamkelo amayeza e ezikhethiweyo kwiimeko buciko.