{"id":13319,"date":"2008-11-17T20:00:00","date_gmt":"2008-11-17T20:00:00","guid":{"rendered":""},"modified":"2008-11-17T20:00:00","modified_gmt":"2008-11-17T20:00:00","slug":"gastroenterologija-egzokrinines-kasos-funkcijos-nepakankamumas","status":"publish","type":"post","link":"https:\/\/www.pasveik.lt\/lt\/naujausi-medicinos-straipsniai\/gastroenterologija-egzokrinines-kasos-funkcijos-nepakankamumas\/13319\/","title":{"rendered":"Gastroenterologija. Egzokrinin\u0117s kasos funkcijos nepakankamumas"},"content":{"rendered":"<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><span lang=\"EN-US\" style=\"font-size: 10pt; color: black; font-family: Arial; mso-bidi-font-size: 11.0pt; mso-ansi-language: EN-US\">Egzokrinin\u0117s kasos funkcijos nepakankamumas &ndash; kasos ferment\u0173 (lipaz\u0117s, tripsino) sintez\u0117s ir i\u0161siskyrimo suma\u017e\u0117jimas arba sutrik\u0119s \u0161i\u0173 ferment\u0173 aktyvinimas dvylikapir\u0161t\u0117je \u017earnoje. Kai fermentai yra nepakankami aktyv\u016bs ar j\u0173 stinga, gali atsirasti funkcin\u0117 <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/dispepsija\/4503\">dispepsija<\/a> arba funkcinis <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/pilvo-putimas\/56475\">pilvo p\u016btimas<\/a>, <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/viduriavimas-2\/72707\">viduriavimas<\/a>, skausmai pilvo ir skrand\u017eio srityje. Egzokrinin\u0117s kasos funkcijos nepakankamum\u0105 gali lemti l\u0117tinis pankreatitas, kasos v\u0117\u017eys, <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/cistine-fibroze\/72664\">cistin\u0117 fibroz\u0117<\/a>, cukrinis diabetas bei keletas kit\u0173<o:p><\/o:p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><span lang=\"EN-US\" style=\"font-size: 10pt; color: black; font-family: Arial; mso-bidi-font-size: 11.0pt; mso-ansi-language: EN-US\">lig\u0173. Pakei\u010diamasis gydymas kasos fermentais skiriamas esant sutrikusiai kasos egzokrininei funkcijai, kai kasa d\u0117l \u012fvairi\u0173 prie\u017eas\u010di\u0173 i\u0161skiria per ma\u017eai ferment\u0173, blogai vir\u0161kinamos maisto med\u017eiagos (baltymai, riebalai, angliavandeniai), sutrinka j\u0173 pasisavinimas.<o:p><\/o:p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><b><span lang=\"EN-US\" style=\"font-size: 10pt; color: #89866d; font-family: Arial; mso-bidi-font-size: 14.0pt; mso-ansi-language: EN-US\">&nbsp;<o:p><\/o:p><\/span><\/b><\/p>\n<h3 style=\"margin: 0cm 0cm 0pt; text-align: justify\"><span lang=\"EN-US\" style=\"font-size: 10pt; font-family: Arial; mso-bidi-font-size: 14.0pt\"><o:p><\/o:p><\/span><\/h3>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><b><i><span lang=\"EN-US\" style=\"font-size: 10pt; color: black; font-family: Arial; mso-bidi-font-size: 11.0pt; mso-ansi-language: EN-US\">Da\u017eniausios b\u016bkl\u0117s, kai sutrinka kasos funkcija<\/span><\/i><\/b><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><b><i><span lang=\"EN-US\" style=\"font-size: 10pt; color: black; font-family: Arial; mso-bidi-font-size: 11.0pt; mso-ansi-language: EN-US\">&nbsp;<o:p><\/o:p><\/span><\/i><\/b><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><b><i><span lang=\"EN-US\" style=\"font-size: 10pt; color: black; font-family: Arial; mso-bidi-font-size: 11.0pt; mso-ansi-language: EN-US\">Funkciniai vir\u0161kinamojo trakto sutrikimai<o:p><\/o:p><\/span><\/i><\/b><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><span lang=\"EN-US\" style=\"font-size: 10pt; color: black; font-family: Arial; mso-bidi-font-size: 9.0pt; mso-ansi-language: EN-US\"><a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/dispepsija\/4503\">Dispepsija<\/a> &ndash; tai grup\u0117 simptom\u0173, susijusi\u0173 su vir\u0161utine vir\u0161kinamojo trakto dalimi. Klinikin\u0117je praktikoje<o:p><\/o:p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><span lang=\"EN-US\" style=\"font-size: 10pt; color: black; font-family: Arial; mso-bidi-font-size: 9.0pt; mso-ansi-language: EN-US\"><a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/dispepsija\/4503\">dispepsija<\/a> pasitaiko da\u017eniausiai, bet iki \u0161iol vis dar n\u0117ra tikslaus jos apibr\u0117\u017eimo.<o:p><\/o:p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><b><span lang=\"EN-US\" style=\"font-size: 10pt; color: black; font-family: Arial; mso-bidi-font-size: 9.0pt; mso-ansi-language: EN-US\">Dispepsijos po\u017eymiai:<o:p><\/o:p><\/span><\/b><\/p>\n<ul style=\"margin-top: 0cm\" type=\"disc\">\n<li class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; color: black; text-align: justify; mso-layout-grid-align: none; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt\"><span lang=\"EN-US\" style=\"font-size: 10pt; font-family: Arial; mso-bidi-font-size: 9.0pt; mso-ansi-language: EN-US\">r\u0117muo;<o:p><\/o:p><\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; color: black; text-align: justify; mso-layout-grid-align: none; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt\"><span lang=\"EN-US\" style=\"font-size: 10pt; font-family: Arial; mso-bidi-font-size: 9.0pt; mso-ansi-language: EN-US\">gastroezofagin\u0117 regurgitacija;<o:p><\/o:p><\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; color: black; text-align: justify; mso-layout-grid-align: none; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt\"><span lang=\"EN-US\" style=\"font-size: 10pt; font-family: Arial; mso-bidi-font-size: 9.0pt; mso-ansi-language: EN-US\">anoreksija, pykinimas, v\u0117mimas;<o:p><\/o:p><\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; color: black; text-align: justify; mso-layout-grid-align: none; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt\"><span lang=\"EN-US\" style=\"font-size: 10pt; font-family: Arial; mso-bidi-font-size: 9.0pt; mso-ansi-language: EN-US\">disfagija,kr\u016btin\u0117s skausmas ryjant;<o:p><\/o:p><\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; color: black; text-align: justify; mso-layout-grid-align: none; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt\"><span lang=\"EN-US\" style=\"font-size: 10pt; font-family: Arial; mso-bidi-font-size: 9.0pt; mso-ansi-language: EN-US\">atsir\u016bgimas, raug\u0117jimas, <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/pilvo-putimas\/56475\">pilvo p\u016btimas<\/a>;<o:p><\/o:p><\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; color: black; text-align: justify; mso-layout-grid-align: none; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt\"><span lang=\"EN-US\" style=\"font-size: 10pt; font-family: Arial; mso-bidi-font-size: 9.0pt; mso-ansi-language: EN-US\">aerofagija, nevir\u0161kinimas;<o:p><\/o:p><\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; color: black; text-align: justify; mso-layout-grid-align: none; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt\"><span lang=\"EN-US\" style=\"font-size: 10pt; font-family: Arial; mso-bidi-font-size: 9.0pt; mso-ansi-language: EN-US\">ankstyvas sotumo poj\u016btis.<o:p><\/o:p><\/span><\/li>\n<\/ul>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><span lang=\"EN-US\" style=\"font-size: 10pt; color: black; font-family: Arial; mso-bidi-font-size: 9.0pt; mso-ansi-language: EN-US\">Pasirei\u0161kiantys, protarpiais ar nuolat, simptomai b\u016bna susij\u0119 (arba ne) su valgiu, kai kuriais maisto produktais.<o:p><\/o:p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><b><i><span lang=\"EN-US\" style=\"font-size: 10pt; color: black; font-family: Arial; mso-bidi-font-size: 11.0pt; mso-ansi-language: EN-US\">&nbsp;<o:p><\/o:p><\/span><\/i><\/b><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><strong><span lang=\"EN-US\" style=\"font-size: 10pt; color: black; font-family: Arial; mso-bidi-font-size: 9.0pt; mso-ansi-language: EN-US\">L\u0117tinis pankreatitas<\/span><\/strong><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\">&nbsp;<\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><span lang=\"EN-US\" style=\"font-size: 10pt; color: black; font-family: Arial; mso-bidi-font-size: 9.0pt; mso-ansi-language: EN-US\">Egzokrinin\u0117s kasos funkcijos nepakankamumas yra v\u0117lyva l\u0117tinio pankreatito (LP) komplikacija, su<o:p><\/o:p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><span lang=\"EN-US\" style=\"font-size: 10pt; color: black; font-family: Arial; mso-bidi-font-size: 9.0pt; mso-ansi-language: EN-US\">alkoholiu susijusio LP atveju ji pasirei\u0161kia po 10&ndash;15 met\u0173. Tyrimais \u012frodyta, kad kasa i\u0161skiria iki 8 gram\u0173<o:p><\/o:p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><span lang=\"EN-US\" style=\"font-size: 10pt; color: black; font-family: Arial; mso-bidi-font-size: 9.0pt; mso-ansi-language: EN-US\">baltymo (daugiausia vir\u0161kinimo ferment\u0173) per par\u0105, o tai gerokai daugiau nei reikia: steator\u0117jos i\u0161vengti pakanka ma\u017eiau nei 1 gramo. Endokrininis nepakankamumas taip pat prasideda gana v\u0117lai, nes sergant LP Langerhanso salel\u0117s ma\u017eai pa\u017eeid\u017eiamos. Jas apsupa fibrozinis kasos audinys, d\u0117l to sutrinka endokrinin\u0117 funkcija. Cukrinis diabetas pasitaiko apie 10 proc. Alkoholinio LP atvej\u0173. Tinkamai parinktas pakei\u010diamasis gydymas kasos fermentais ne tik pa\u0161alina malabsorbcijos simptomus, bet ir naudingas gydant endokrinin\u012f kasos funkcijos nepakankamum\u0105. Angliavandeni\u0173 vir\u0161kinimas sergant LP ilgai nesutrinka d\u0117l seili\u0173 amilaz\u0117s ir membraninio vir\u0161kinimo plonosiose \u017earnose. Gliukoz\u0117s netoleravimas b\u016bdingas 40&ndash;90 proc. vis\u0173 sunkaus LP atvej\u0173. Ry\u0161kus baltym\u0173 vir\u0161kinimo sutrikimas ir azotor\u0117ja &ndash; labai v\u0117lyvos LP komplikacijos. Ilg\u0105 laik\u0105 baltym\u0173 vir\u0161kinim\u0105 palaiko skrand\u017eio ir membraninio vir\u0161kinimo plonosiose \u017earnose fermentai. Kitaip yra su riebalais. Daugiausia jie yra skaidomi skrand\u017eio lipaz\u0117s ir kasos lipaz\u0117s plon\u0173j\u0173 \u017earn\u0173 spindyje, o membraninio vir\u0161kinimo fermentin\u0117s sistemos n\u0117ra. Sutrikus egzokrininei kasos funkcijai suma\u017e\u0117ja ir bikarbonat\u0173 sekrecija, d\u0117l to po valgio r\u016bg\u0161tingumas dvylikapir\u0161t\u0117je \u017earnoje gali suma\u017e\u0117ti. Nustatyta, kad kasos lipaz\u0117 yra jautresn\u0117 r\u016bg\u0161tinei aplinkai ir jos veiklumas grei\u010diau u\u017eslopinamas. Taigi ir taip ma\u017eas kiekis \u0161io fermento d\u0117l sutrikusios egzokrinin\u0117s kasos funkcijos patenka \u012f r\u016bg\u0161tesn\u0119 aplink\u0105, kur grei\u010diau netenka savo veiklumo. Tai sutrikdo<o:p><\/o:p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><span lang=\"EN-US\" style=\"font-size: 10pt; color: black; font-family: Arial; mso-bidi-font-size: 9.0pt; mso-ansi-language: EN-US\">riebal\u0173 vir\u0161kinim\u0105 ir ry\u0161k\u0117ja steator\u0117ja. Kasos egzokrinin\u0117 funkcija sutrinka sergant cukriniu<o:p><\/o:p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><span lang=\"EN-US\" style=\"font-size: 10pt; color: black; font-family: Arial; mso-bidi-font-size: 9.0pt; mso-ansi-language: EN-US\">diabetu, cistine fibroze, kepen\u0173 ir tul\u017eies p\u016bsl\u0117s ligomis, \u017earn\u0173 ligomis, esant alergijai maistui, po skrand\u017eio ir \u017earnyno operacij\u0173. Ne visada kasos ferment\u0173 skiriama tik ligoms gydyti, jie gelbsti ir pacientus, varginamus funkcinio pob\u016bd\u017eio vir\u0161kinamojo trakto negalavim\u0173.<o:p><\/o:p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><span lang=\"EN-US\" style=\"font-size: 10pt; color: black; font-family: Arial; mso-bidi-font-size: 9.0pt; mso-ansi-language: EN-US\">&nbsp;<o:p><\/o:p><\/span><\/p>\n<h3 style=\"margin: 0cm 0cm 0pt; text-align: justify\"><span lang=\"EN-US\" style=\"font-size: 10pt; font-family: Arial; mso-bidi-font-size: 14.0pt\">Pakei\u010diamasis gydymas kasos fermentais<o:p><\/o:p><\/span><\/h3>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><span lang=\"EN-US\" style=\"font-size: 10pt; color: black; font-family: Arial; mso-bidi-font-size: 9.0pt; mso-ansi-language: EN-US\">&nbsp;<o:p><\/o:p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><span lang=\"EN-US\" style=\"font-size: 10pt; color: black; font-family: Arial; mso-bidi-font-size: 9.0pt; mso-ansi-language: EN-US\">Kasos fermentai &ndash; vieni da\u017eniausiai vartojam\u0173 vaist\u0173 gastroenterologin\u0117je klinikin\u0117je praktikoje. Daugelis pacient\u0173 juos geria net nepasitar\u0119 su gydytoju. Pagrindinis gydymo kasos fermentais tikslas &ndash; kompensuoti egzokrinin\u0119 kasos funkcij\u0105 ir panaikinti ar palengvinti kasos funkcijos nepakankamumo sukeltus simptomus, palaikyti pakankam\u0105 ferment\u0173 aktyvum\u0105 dvylikapir\u0161t\u0117je \u017earnoje tuo metu, kai ten patenka maistas. Kadangi kiekvieno paciento kasos egzokrinin\u0117s funkcijos nepakankamumo laipsnis labai skiriasi, ir gydymas kasos fermentais kiekvienam ligoniui turi b\u016bti skiriamas individualiai. Kada ir kok\u012f preparat\u0105 pasirinkti: tabletes l\u0117tinio pankreatito skausmui mal\u0161inti, pavyzd\u017eiui,<span style=\"mso-spacerun: yes\">&nbsp; <\/span><i>Mezym forte <\/i>20 000;<o:p><\/o:p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><span lang=\"EN-US\" style=\"font-size: 10pt; color: black; font-family: Arial; mso-bidi-font-size: 9.0pt; mso-ansi-language: EN-US\">kapsules vir\u0161kinimo sutrikimams gydyti, pavysd\u017eiui, <i>Pangrol <\/i>10 000\/25 000. <i>Pangrol <\/i>kapsul\u0117s rekomenduojamos ir esant funkcini\u0173 vir\u0161kinamojo trakto sutrikim\u0173, nes jose yra vis\u0173 reikaling\u0173 kasos ferment\u0173, palengvinan\u010di\u0173 maisto vir\u0161kinim\u0105 bei ma\u017einan\u010di\u0173 varginan\u010dius simptomus.<o:p><\/o:p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><b><i><span lang=\"EN-US\" style=\"font-size: 10pt; color: black; font-family: Arial; mso-bidi-font-size: 8.0pt; mso-ansi-language: EN-US\">&nbsp;<o:p><\/o:p><\/span><\/i><\/b><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><b><i><span lang=\"EN-US\" style=\"font-size: 10pt; color: black; font-family: Arial; mso-bidi-font-size: 8.0pt; mso-ansi-language: EN-US\">Pangrol <\/span><\/i><\/b><b><span lang=\"EN-US\" style=\"font-size: 10pt; color: black; font-family: Arial; mso-bidi-font-size: 8.0pt; mso-ansi-language: EN-US\">kapsuli\u0173 sud\u0117tis<\/span><\/b><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><b><span lang=\"EN-US\" style=\"font-size: 10pt; color: black; font-family: Arial; mso-bidi-font-size: 8.0pt; mso-ansi-language: EN-US\"><o:p><\/o:p><\/span><\/b><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><i><span lang=\"EN-US\" style=\"font-size: 10pt; color: black; font-family: Arial; mso-bidi-font-size: 8.0pt; mso-ansi-language: EN-US\">Lipaz\u0117s Amilaz\u0117s Proteaz\u0117s<o:p><\/o:p><\/span><\/i><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><i><span lang=\"EN-US\" style=\"font-size: 10pt; color: black; font-family: Arial; mso-bidi-font-size: 8.0pt; mso-ansi-language: EN-US\">Pangrol 10 000 10 000 9 000 500<o:p><\/o:p><\/span><\/i><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><i><span lang=\"EN-US\" style=\"font-size: 10pt; color: black; font-family: Arial; mso-bidi-font-size: 8.0pt; mso-ansi-language: EN-US\">Pangrol 25 000 25 000 22 500 1 250<o:p><\/o:p><\/span><\/i><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><i><span lang=\"EN-US\" style=\"font-size: 10pt; color: black; font-family: Arial; mso-bidi-font-size: 7.0pt; mso-ansi-language: EN-US\">Ph. Eur. (Europos farmakop\u0117jos) vienet\u0173<o:p><\/o:p><\/span><\/i><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><b><i><span lang=\"EN-US\" style=\"font-size: 10pt; color: black; font-family: Arial; mso-bidi-font-size: 11.0pt; mso-ansi-language: EN-US\">&nbsp;<o:p><\/o:p><\/span><\/i><\/b><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><b><i><span lang=\"EN-US\" style=\"font-size: 10pt; color: black; font-family: Arial; mso-bidi-font-size: 11.0pt; mso-ansi-language: EN-US\">Kasos ferment\u0173 preparat\u0173 vartojimo ypatumai<o:p><\/o:p><\/span><\/i><\/b><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><span lang=\"EN-US\" style=\"font-size: 10pt; color: black; font-family: Arial; mso-bidi-font-size: 9.0pt; mso-ansi-language: EN-US\">&nbsp;<o:p><\/o:p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><span lang=\"EN-US\" style=\"font-size: 10pt; color: black; font-family: Arial; mso-bidi-font-size: 9.0pt; mso-ansi-language: EN-US\">Gydymo s\u0117km\u0117 priklauso nuo tinkamai parinkto preparato. Konkreti kiekvieno fermentinio kasos preparato doz\u0117 nustatoma pagal lipaz\u0117s kiek\u012f jame. Gydymo kasos fermentais taktika:<o:p><\/o:p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><span lang=\"EN-US\" style=\"font-size: 10pt; color: black; font-family: Arial; mso-bidi-font-size: 9.0pt; mso-ansi-language: EN-US\">pradedama nuo 25 000 Ph. Eur. vienet\u0173 lipaz\u0117s; vartojama valgant; doz\u0119 galima didinti 2 ar 3 kartus; jei nepadeda, tikslinti diagnoz\u0119; did\u017eiausia lipaz\u0117s doz\u0117 250 t\u016bkst. Ph. Eur. vienet\u0173; paros riebal\u0173 kiekis maiste &ndash; 40&ndash;60 g; skirti H2 receptori\u0173 blokatori\u0173 arba proton\u0173 siurblio inhibitori\u0173. Gydymas veiksmingas, jei vartojant ferment\u0173 preparat\u0173 i\u0161nyksta pilvo skausmai, viduri\u0173 p\u016btimas ir kiti simptomai.<o:p><\/o:p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><b><i><span lang=\"EN-US\" style=\"font-size: 10pt; color: black; font-family: Arial; mso-bidi-font-size: 11.0pt; mso-ansi-language: EN-US\">&nbsp;<o:p><\/o:p><\/span><\/i><\/b><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><b><i><span lang=\"EN-US\" style=\"font-size: 10pt; color: black; font-family: Arial; mso-bidi-font-size: 11.0pt; mso-ansi-language: EN-US\">LP gydymo ypatumai<\/span><\/i><\/b><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><b><i><span lang=\"EN-US\" style=\"font-size: 10pt; color: black; font-family: Arial; mso-bidi-font-size: 11.0pt; mso-ansi-language: EN-US\"><o:p><\/o:p><\/span><\/i><\/b><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><span lang=\"EN-US\" style=\"font-size: 10pt; color: black; font-family: Arial; mso-bidi-font-size: 9.0pt; mso-ansi-language: EN-US\">Sergant LP, kasos ferment\u0173 pakaital\u0173 b\u016btina prad\u0117ti vartoti, kai riebal\u0173 su i\u0161matomis i\u0161siskiria daugiau kaip 15 gram\u0173 per par\u0105. Norint efektyviai suma\u017einti steator\u0117j\u0105, ferment\u0173 pakaitalus rekomenduojama prad\u0117ti vartoti anks\u010diau &ndash; kai riebal\u0173 su i\u0161matomis i\u0161siskiria daugiau kaip 7,5 gramai per par\u0105. Steator\u0117ja pasirei\u0161kia anks\u010diausiai ir paprastai j\u0105 sunkiau koreguoti nei azotor\u0117j\u0105, taigi svarbiausia u\u017etikrinti pakankam\u0105 lipaz\u0117s kiek\u012f ir jos efektyvum\u0105. Pagrindin\u0117 prie\u017eastis, kod\u0117l sunku garantuoti pakei\u010diamojo gydymo lipaze veiksmingum\u0105, &ndash; jos neatsparumas r\u016bg\u0161\u010diai terpei. Baltymus skaidantys fermentai (tripsinas ir chimotripsinas) \u0161iuo at\u017evilgiu yra prana\u0161esni, tod\u0117l jais papildyti organizm\u0105 papras\u010diau ir azotor\u0117ja lengviau pa\u0161alinama. Savo ruo\u017etu angliavandeni\u0173 vir\u0161kinimo sutrikimai kelia<o:p><\/o:p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><span lang=\"EN-US\" style=\"font-size: 10pt; color: black; font-family: Arial; mso-bidi-font-size: 9.0pt; mso-ansi-language: EN-US\">ma\u017eiausiai r\u016bpes\u010di\u0173, nes j\u0173 malabsorbcija pasirei\u0161kia, kai kasos egzokrinin\u0117 funkcija yra labai sutrikusi.<o:p><\/o:p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><span lang=\"EN-US\" style=\"font-size: 10pt; color: black; font-family: Arial; mso-bidi-font-size: 9.0pt; mso-ansi-language: EN-US\">Nustatyta, kad norint pa\u0161alinti steator\u0117j\u0105 ar azotor\u0117j\u0105, reikia papildyti bent 10 proc. viso lipaz\u0117s ar tripsino kiekio, kurie sveiko \u017emogaus organizme i\u0161siskiria per 4 valandas po valgio. Tai sudaro 33 000 vienet\u0173 lipaz\u0117s ir 10 t\u016bkst vienet\u0173 tripsino. B\u016btinasis lipaz\u0117s paros kiekis yra 100 t\u016bkst. Ph. Eur. (Europos farmakop\u0117jos vienet\u0173), tai atitinka 20&ndash;40 t\u016bkst. Ph. Eur. Kiekvieno valgio metu. Svarbu, kad kasos egzokrinin\u0117s funkcijos<o:p><\/o:p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><span lang=\"EN-US\" style=\"font-size: 10pt; color: black; font-family: Arial; mso-bidi-font-size: 9.0pt; mso-ansi-language: EN-US\">pakei\u010diamasis gydymas b\u016bt\u0173 parenkamas individualiai kiekvienam pacientui. Egzokrininio kasos funkcijos nepakankamumo gydymas veiksmingas, jei vartojant ferment\u0173 preparat\u0173 did\u0117ja k\u016bno mas\u0117, praeina <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/viduriavimas-2\/72707\">viduriavimas<\/a>, pilvo skausmai, viduri\u0173 p\u016btimas. Norint pasiekti optimal\u0173 lipaz\u0117s aktyvum\u0105, svarbu<o:p><\/o:p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><span lang=\"EN-US\" style=\"font-size: 10pt; color: black; font-family: Arial; mso-bidi-font-size: 9.0pt; mso-ansi-language: EN-US\">dozavimo re\u017eimas. Seniau manyta, kad kasos fermentus vartoti reguliariai kas valand\u0105 yra geriau nei kiekvieno valgio metu, ta\u010diau naujausi\u0173 tyrim\u0173 duomenys neprie\u0161tarauja abiem ferment\u0173 vartojimo b\u016bdams. Pasirinkti reik\u0117t\u0173 pagal tai, kaip patogiau pacientui. Kai kasos nepakankamumas sunkus geriau ferment\u0173 preparatus vartoti valgio metu. Dvylikapir\u0161t\u0117je \u017earnoje, i\u0161situ\u0161tinant skrand\u017eiui, labai suma\u017e\u0117ja r\u016bg\u0161tingumas ir lipaz\u0117 sunaikinama. Tod\u0117l reikiam\u0105 lipaz\u0117s doz\u0119 reikia suvartoti dalimis prie\u0161 pat valgym\u0105, jo metu, ir i\u0161kart po valgio. \u0160iuo atveju labai svarbus apsauginis maisto vaidmuo. LP atveju pakei\u010diamasis gydymas kasos fermentais turi ir kit\u0173 privalum\u0173. Manoma, kad skausmas kyla<o:p><\/o:p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><span lang=\"EN-US\" style=\"font-size: 10pt; color: black; font-family: Arial; mso-bidi-font-size: 9.0pt; mso-ansi-language: EN-US\">d\u0117l padid\u0117jusio spaudimo ir ferment\u0173 aktyvumo kasos<o:p><\/o:p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><span lang=\"EN-US\" style=\"font-size: 10pt; color: black; font-family: Arial; mso-bidi-font-size: 9.0pt; mso-ansi-language: EN-US\"><span style=\"mso-spacerun: yes\">&nbsp;<\/span>atakuose. Tokiu atveju kasos sekrecijos slopinimas neigiamu gr\u012f\u017etamuoju b\u016bdu b\u016bt\u0173 pageidaujamas.<o:p><\/o:p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><b><span lang=\"EN-US\" style=\"font-size: 10pt; color: #89866d; font-family: Arial; mso-bidi-font-size: 14.0pt; mso-ansi-language: EN-US\">&nbsp;<o:p><\/o:p><\/span><\/b><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><strong><span lang=\"EN-US\" style=\"font-size: 10pt; font-family: Arial; mso-bidi-font-size: 8.0pt; mso-ansi-language: EN-US\">Literat\u016bra&nbsp;<\/span><\/strong><span lang=\"EN-US\" style=\"font-size: 10pt; font-family: Arial; mso-bidi-font-size: 8.0pt; mso-ansi-language: EN-US\"><o:p><\/o:p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><span lang=\"EN-US\" style=\"font-size: 10pt; font-family: Arial; mso-bidi-font-size: 8.0pt; mso-ansi-language: EN-US\">&nbsp;<o:p><\/o:p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><span lang=\"EN-US\" style=\"font-size: 10pt; font-family: Arial; mso-bidi-font-size: 8.0pt; mso-ansi-language: EN-US\">1. Matthew J. DiMagnoa and Eugene P. DiMagnob Chronic pancreatitis Curr Opin Gastroenterol 22:487&ndash;497. _<o:p><\/o:p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><span lang=\"EN-US\" style=\"font-size: 10pt; font-family: Arial; mso-bidi-font-size: 8.0pt; mso-ansi-language: EN-US\">2006 Lippincott Williams &amp; Wilkins.<o:p><\/o:p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><span lang=\"EN-US\" style=\"font-size: 10pt; font-family: Arial; mso-bidi-font-size: 8.0pt; mso-ansi-language: EN-US\">2. Draganov P, Toskes PP. Chronic pancreatitis: controversies in etiology, diagnosis and treatment. Rev Esp Enferm<o:p><\/o:p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><span lang=\"EN-US\" style=\"font-size: 10pt; font-family: Arial; mso-bidi-font-size: 8.0pt; mso-ansi-language: EN-US\">Dig 2004; 96: 649-659.<o:p><\/o:p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><span lang=\"EN-US\" style=\"font-size: 10pt; font-family: Arial; mso-bidi-font-size: 8.0pt; mso-ansi-language: EN-US\">3. V Gupta and P P Toskes Diagnosis and management of chronic pancreatitis Postgrad. Med. J. 2005;81;491-497.<o:p><\/o:p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><span lang=\"EN-US\" style=\"font-size: 10pt; font-family: Arial; mso-bidi-font-size: 8.0pt; mso-ansi-language: EN-US\">4. Re&acute;my F. Meier MD Christoph Beglinger MD Nutrition in pancreatic diseases Best Practice &amp; Research Clinical Gastroenterology Vol. 20, No. 3, 507-529, 2006.<o:p><\/o:p><\/span><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><span lang=\"EN-US\" style=\"font-size: 10pt; color: black; font-family: Arial; mso-bidi-font-size: 11.0pt; mso-ansi-language: EN-US\">Egzokrinin\u0117s kasos funkcijos nepakankamumas &ndash; kasos ferment\u0173 (lipaz\u0117s, tripsino) sintez\u0117s ir i\u0161siskyrimo suma\u017e\u0117jimas arba sutrik\u0119s \u0161i\u0173 ferment\u0173 aktyvinimas dvylikapir\u0161t\u0117je \u017earnoje. Kai fermentai yra nepakankami aktyv\u016bs ar j\u0173 stinga, gali atsirasti funkcin\u0117 dispepsija arba funkcinis pilvo p\u016btimas, viduriavimas, skausmai pilvo ir skrand\u017eio srityje. Egzokrinin\u0117s kasos funkcijos nepakankamum\u0105 gali lemti l\u0117tinis pankreatitas, kasos v\u0117\u017eys, cistin\u0117 fibroz\u0117, cukrinis diabetas bei keletas kit\u0173<o:p><\/o:p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin: 0cm 0cm 0pt; text-align: justify; mso-layout-grid-align: none\"><span lang=\"EN-US\" style=\"font-size: 10pt; color: black; font-family: Arial; mso-bidi-font-size: 11.0pt; mso-ansi-language: EN-US\">lig\u0173. Pakei\u010diamasis gydymas kasos fermentais skiriamas esant sutrikusiai kasos egzokrininei funkcijai, kai kasa d\u0117l \u012fvairi\u0173 prie\u017eas\u010di\u0173 i\u0161skiria per ma\u017eai ferment\u0173, blogai vir\u0161kinamos maisto med\u017eiagos (baltymai, riebalai, angliavandeniai), sutrinka j\u0173 pasisavinimas.<o:p><\/o:p><\/span><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[],"tags":[400,50,1255,65,58,1258,372,1259,69,1254,328,1256,57,727,95,1246,1257,55],"site":[],"post_item_type":[27345],"class_list":["post-13319","post","type-post","status-publish","format-standard","hentry","tag-diabetas","tag-dispepsija","tag-egzokrinines-funkcijos","tag-fermentai","tag-fermentais","tag-gydymas-kasos-fermentais","tag-kasa","tag-kasos-egzokrinines-funkcijos","tag-kasos-fermentu","tag-lipazes","tag-nepakankamumas","tag-pilvo-skausmai","tag-putimas","tag-veiksmingas","tag-vezys","tag-viduriavimas","tag-viduriu-putimas","tag-virskinimo"],"acf":{"post_sites":false},"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts\/13319","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/comments?post=13319"}],"version-history":[{"count":0,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts\/13319\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/media?parent=13319"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/categories?post=13319"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/tags?post=13319"},{"taxonomy":"site","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/site?post=13319"},{"taxonomy":"post_item_type","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/post_item_type?post=13319"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}