Qanjidhada Osler - waxa uu yahay waxan? Sababaha pathogenesis, daaweynta

Endocarditis - barar ku dhaca endocardium ah, xuubka hoose oo qalbiga ku jira. Waxay keeni kartaa cudur ee xubnaha badan iyo nidaamyada dhaawaca jirka aadanaha, sababaha non-faafa hypercoagulable oo kale. Sidaa darteed laftiisa endocarditis waa calaamadaha kaliya ay, joogitaanka kaas oo dhibco Roth, qanjidhada Osler iyo finan kale sifo oo jidhka ah uusan ka muuqan. Bukaanka laga yaabaa in aadan dareemin raaxo, iyo dhif cabasho ku saabsan u gunuusaysaan qalbi, qandho. Oo kaliya haddii caabuq ku endocardial sababay dulinka micro-organisms ee dhiigga, waxa uu noqonayaa mid cudur oo kala duwan loo yaqaan faafa, bakteeriyadda ama bakteeriyo endocarditis. qanjidhada Osler - mid ka mid ah calaamadaha ay dibadda. iyaga ku tilmaamay in 1885, dhakhtar cajiib Canadian William Osler. Infective endocarditis - cudur aad khatar u ah in keenaysaa in lahayo ku karin waxyaalaha qalbiga ku jira, sidaas darteed waxaa muhiim ah in la ogaado waxa uu yahay iyo sida ay u muuqato.

Features of endocarditis infective

Cudurkaan waxaa keena bakteeriyo dhammaan pathogenic iyo fangaska, iyo mararka qaar xitaa fayrusyada iyo protozoa ku jira dhiigga Aadanaha. Gelin endocardium laga yaabaa in cudurrada faafa neefsashada, laabotooyinka, periodontitis, qumanka, qaaxada, sanka kaadimareenka, ka saarida ilig iyo manipulations kale. qanjidhada Osler waa signal dhalaalaya siiyey dhibaatooyin cudurka sababaya - endocarditis infective. Xaaladaha intooda badan, bilowga hawsha dulinka sheyga ee wadnaha waa in ay waxyeello sinaba:

- tuubooyin arooriyaha;

- pacemakers;

- lugood ama khaanadaha wadnaha vascular,

- cilladaha wadnaha kala duwan;

- microtrauma;

- qaliinka.

Mararka bakteeriyadu gasho ka endocardium oo aan dhaawac jirka ka hor. Markaas bax, furma iyo cillado kale ee la sameeyey.

calaamadaha

Infective endocarditis naftooda si cad iyo si bayaan ah ku cabiri karaan, waxaana laga yaabaa in markii hore rabshin daal oo kaliya, murmurs wadnaha, tabar guud, iyo calaamadaha qad tartiib ah u kordhi. Kuwaas waxaa ka mid ah:

- xummad,

- qaryo,

- dhididka miidhan;

- muruqyada xanuun iyo laabatooyinka;

- miisaanka oo yaraada;

- isbeddelo ah midabka maqaarka (noqdo grayish, wax yar ka hurdi);

- finan on the xub-axaleedka.

qanjidhada Osler muuqan ka dib calaamadaha kor ku xusan. Qaar ka mid ah khubarada ka fiirsan iyaga u noqon feature kala oo lagama maarmaan ah endocarditis infective, halka qaar kalena ay yihiin muujinta dhif u ah, kaas oo uu cudurku waa qaab subacute ah.

Osler qanjidhada, pathogenesis

dhismayaasha waxay ku gacmaha, faraha, cagaha ay sabab u tahay caabuq uu keeno caabuq leh xididdada dhiigga yar oo wakiil galaan. Daraasad Histological of kuus kuus iyaga oo ku muujiyaan venules wanaajiyey iyo arterioles. Waxaa mararka qaarkood qaldo finan xasaasiyad ama purpura septic. Sidee qanjira Osler, photo waxay muujinaysaa cad. Waa convex, size digir ah ama a formation yar yar mobile ah cado guduudan ama buluug ah, mararka qaarkood daran, mararka qaarkood ma. Waxay si dhakhso ah loo horumariyo baaba'aan ahaantood, ma aha cudur oo kala duwan, sidaas kaniiniyada daawada ama cadar uma baahna. Laakiin haddii qofka ogaaday at kuus kuus sida, waa in uu isla markiiba la tasho dhakhtarkaaga shaybaarka dheeraad ah iyo waxbarashada clinical.

dhibco Roth ee

Waxa intaa dheer in qanjira Osler, in endocarditis infective dhici kara dhiigbaxa finan qof dhinacyadiisa iyo lugaha, dhiig-bax ka yar saxanka dhidibkii, dhibco ku Zhaneve timi iyo sidoo kale qanjidhada Osler, on the Timir iyo calaacalaha. Laakiin, in la barbardhigo qanjira ah, dhibco kuwanu waa gabi ahaanba aan xanuun lahayn, ma u eg digir ah iyo waa natiijada rush ka mid ah dhiigga qubaan.

In endocarditis infective, marka lagu daro maqaarka, indhaha iyo saamayn ku yeelan karaan. Mid ka mid ah calaamadaha ugu badan ee dareen-celin ah si ay caabuq yihiin dhibco Roth. Waxa uu tilmaamay in ay dhakhtar Swiss Roth. dhibco Roth wakiil microbleeds in ileyska. In foomka, iyagu waa gadood ama wareega leh dhibic cad dhexda ku leh. In dadka buka, qaababka, kuwaas oo keeni kara hoos u aragti, taas oo, ka dib markii daawaynta cudurka sababaya waa lay soo celiyey.

dhibco Roth waa calaamad ma aha oo kaliya ee endocarditis infective, laakiin sidoo kale dhiig, cudurka unugyo. Sidaa darteed, u soo ogaado waa lagama maarmaan si ay u qabtaan waxbarashada oo dheeraad ah.

Calaamadaha kale waxaa ka mid ah endocarditis infective

Waxaa ku saabsan dersin calaamado muujinaya of caabuq endocardium sababtoo ah hordhaca ah ee cudurka yihiin.

qanjidhada Osler, dhibco Lukin (ama midig ee calaamadda Lukin Liebman), calaamadaha Rock, Dmitrienko, Janeway iyo dhakhtarro kale ee caawimo ogaado, gaar ahaan xaaladaha marka calaamadaha kale ee caadiga ah ee cudurka waa isku darsamay ama maqan.

Calaamadaha Lukin-Liebmann waa muuqaalka kore ee dhibic petechiae xarunta a anfac on laalaabka kaaha iyo conjunctiva.

calaamad Rock muuqato in ballaarinta ardayga ee isha bidix.

Calaamadaha Janeway - waa waxbarasho erythematous, iyo sidoo kale baro Roth, ku simaha on calaacalaha iyo cagaha, laakiin ay dhacdo in this ay yar oo size yihiin.

Calaamadaha Dmitrienko ka kooban yahay in sareyso meletariga ee garoonka midab aan, taas oo ah sababta waxa ay sidoo kale waxaa loo yaqaan "midab maro jilicsan." Waxaan arkay habkaani ku jira marxaladaha ugu horreeya ee cudurka.

daaweynta

Si aad u adkayn Jidka calaamad gaar ah waxaa laga yaabaa in dhakhtar. Sida caadiga ah, waxay u baahan tahay baaritaan dhiig shaybaarka, ECG, echocardiography. Waxaa waajib ah in la fuliyo dhiig bakposev si ay u aqoonsadaan wakiilka faafa. Haddii baaritaano ay muujiyeen joogitaanka endocarditis infective in bukaan, antibiotic loo qoray kooxda ku haboon. Xaaladaha daran, qaliin lagu sameeyaa (caag ah, khaanadaha wadnaha bedalay).

Iyada oo ogaanshaha sax ah waqtiga iyo waqtigii bilowday daaweynta 50-90% bukaannada ku nool yihiin in ka badan 5 sano. Si looga hortago dhacdo ee endocarditis infective horumariyo farsamo gaar ah loogu talogalay dadka halis. Waxay leedahay dhowr ah qaabab ka-hortagga, oo ku salaysan soo dhaweynta ah ee daawooyinka ee farsamo xaaladaha soo xulay.