Kumvetsetsa Kuzindikira ndi Chithandizo cha Zopangira Biliary
MRCP Versus ERCP yotsutsa Biliary
Kuti mumvetsetse zomwe Magnetic Resonance Cholangio-Pancreatography (MRCP) ndi Endoscopic Retrograde Cholangio-Pancreatography ndizo, muyenera kuyamba kumvetsa zomwe zimalepheretsa biliy ndi zomwe zimayambitsa vutoli.
Ngakhale kuti ziphuphu zimayambitsa vuto la biliary, pali zifukwa zambiri zomwe zingathetsere vuto la biliary komanso njira zambiri zothetsera nkhani zomwe zidzadalira mbadwo wa wodwala, thanzi labwino, anatomy, mbiri ya zakudya zamagulu ndi zina zomwe zingasinthe munthu ndi munthu.
Kuletsedwa kwa Biliary
Tiyeni tiyambe momwe dongosolo limagwirira ntchito. Kuti mupeze chakudya chambiri chotheka, chakudya chiyenera kuthyoledwa ndi kapangidwe kakang'ono ka mavitamini, mchere, mapuloteni, mafuta, ndi mavitamini omwe angatengeke ndi matumbo aang'ono. Njirayi ikuyamba ndi kudula chakudya, kenako kumakhala ndi mimba pogwiritsa ntchito zidulo ndikuyendetsa zakudya kuti zithetse. Pambuyo pake, bile imaphatikizidwa ku chakudya kuti chiwononge gawo la mafuta.
Chophika ndi madzi osakaniza omwe amapangidwa m'chiwindi ndipo angagwiritsidwe ntchito mwamsanga kapena kusungidwa kuti agwiritsidwe ntchito. Ngati bulu lidzagwiritsidwa ntchito patapita nthawi, lidzayenda kuchokera ku chiwindi kupita ku ndulu kudzera mu imodzi mwa ma-tub-tubes-tubes omwe amanyamula bile kutali ndi chiwindi kupita komwe amagwiritsidwa ntchito kuthandizira kuchepa.
Ngati bulu lidzagwiritsidwa ntchito mwamsanga mutachoka chiwindi, lidzatuluka pachiwindi mwachindunji mpaka mbali yoyamba ya intestine yaing'ono (duodenum) kudzera m'kati mwa bulu.
Pafupifupi makumi asanu peresenti ya bile amagwiritsidwa ntchito mwamsanga motere pamene theka lina likuyembekezera mu ndulu, pomwe madzi ambiri amachotsedwa ndipo bile imakhala yochulukirapo.
Pamene bile silingathe kudutsa m'modzi mwa mankhwala a chibindi kuchokera ku chiwindi kapena gallbladder chifukwa cha vuto la mazira, izi zimatchedwa kubisa biliary.
Mtundu wambiri wosokoneza biliary ndi gallstone, umene ndi mpira wa bile umene umawumitsa panthawi yochotsa madzi kuchokera mu bile, yomwe ndi imodzi mwa ntchito za gallbladder. Miyala yaing'onoyi imalowa mu ndulu kapena mu njira yomwe imatenga bile kuchokera ku gallbladder kupita ku duodenum.
Zowononga Zowononga Biliary
- Zingwe zamtengo wapatali (izi ndizomwe zimayambitsa vuto la biliary)
- Kusalongosoka kwapadera kwa imodzi ya bile, yomwe imatchedwa biliary stenosis
- Kutha kutentha kwa makoswe
- Mapangidwe a pulasitiki mu imodzi mwa maulendo
- Kukulitsa kakombo kamene kamaphatikizapo kanjira ka kunja
- Pancreatitis, makamaka mobwerezabwereza kapena kosatha
- Kuvulala / kupwetekedwa mtima komwe kumaphatikizapo chiwindi, ndulu, mphukira kapena bile
- Mimba, khansa kapena benign
- Kutengera kwa gallbladder, bile ducts kapena kapangidwe
- Matenda a chiwindi
Zinthu Zowopsa Zowononga Biliary
Pali zifukwa zambiri zomwe zimapangitsa munthu kukhala ndi vuto la biliary, zina mwazimene zimayambitsa:
- Mbiri yamakono
- Mbiri ya opaleshoni yomwe imakhudza madontho a bile
- Mbiri ya khansa ya biliyara
- Mbiri ya khansa ya chiwindi kapena matenda
- Mbiri ya khansa ya pancreatic kapena matenda
- Mbiri ya mavuto a gallbladder
- Mbiri yatsopano ya opaleshoni yakuchotsa ndulu
- Kuperewera kwapang'onopang'ono
- Kunenepa kwambiri
- Kutaya kolemera mwamsanga
Zizindikiro ndi Zizindikiro za Kuwonongedwa Kwa Biliary
Zisonyezo za kusokonezeka kwa biliyasi zidzakhala zosiyana ndi munthu aliyense, koma zimakhala zofanana ndi izi:
- Mavuto m'mimba, makamaka pamimba pamimba
- Kuyabwa
- Jaundice (khungu la chikasu)
- Mphuno ndi Kutupa
- Kusuntha kwa mtundu wamitundu yofiira kapena woyera
- Mtsinje wakuda
Kuzindikira Kuwonongedwa kwa Biliary
Ngati kulimbikitsidwa kwa biliary kukudandaula, pali kuyesedwa kwa magazi, kufufuza zojambula, ndi njira zomwe zingachitike kuti atsimikizidwe.
Kuyesedwa kwa magazi komwe kungasonyeze kuti vutoli likhoza kukhala ndi vuto la mankhwala, kuphatikizapo kuchuluka kwa alpine phosphatase level, chiwerengero cha bilirubin chokwanira, ndi kuchulukitsa mavitamini a chiwindi.
Vuto lomwe limayambitsa bile kuti libwererenso m'chiwindi lidzasintha kusintha kwakukulu m'mayesero a magazi omwe amayendera chiwindi.
Mayesero owonjezereka omwe angakhoze kuchitidwa kuti apeze chithandizo cholimbana ndi bili ndi awa:
- Ultrasound ya mimba
- CT scan ya mimba
- Percutaneous transhepatic cholangiogram (PTCA)
- Cholangio Chokhazikitsira Maginito (MRCP)
- Kupititsa patsogolo Kukhazikitsanso Cholangio-Kufukula (ERCP)
Mankhwala omwe angakhoze kuchitidwa kuti athetse vuto labasi amadalira pa chifukwa ndi malo a vutoli. Chifukwa chofala kwambiri ndi ndulu, ndipo mankhwalawa ndi Endoscopic Retrograde Cholangio-Pancreatography (ERCP) ndi opaleshoni kuchotsa ndulu (cholecystectomy).
Ngati chifukwa chachisokonezo ndi chinthu china osati ndulu, mankhwalawo amasiyana mosiyana ndi munthu. Mwachitsanzo, munthu amene akudwala matenda a khansa chifukwa cha khansa adzachiritsidwa mosiyana ndi munthu yemwe ali ndi vuto lomwelo chifukwa cha matenda. Wodwala amene ali ndi matendawa amatha kulandira chithandizo chosiyana ndi mayi wa zaka 30 yemwe ali ndi zizindikiro zofanana, monga momwe wodwala wamkulu sangathe kulolerana mofanana ndi wamng'ono.
Kawirikawiri, njira yochepetsetsa yochizira ndi yochizira ndiyo yoyamba kuyesedwa-monga MRCP-pamene njira yowonongeka yowonjezera ngati ERCP kapena opaleshoni yamagulu ikuchitidwa ngati kuli kofunikira. Icho chinati, opaleshoni ya ndulu, yomwe imadziwikanso kuti cholecystectomy, ndi imodzi mwa machitidwe opaleshoni omwe amachitika ku United States.
Kodi Magnetic Resonance Cholangio-Pancreatography (MRCP)
Cholangio Maginito Resonance-Pancreatography, yomwe imadziwikanso kuti MRCP, ndiyeso yowononga ngati MRI . Mayesowa amagwiritsidwa ntchito poyesa chiwindi, mapasitiki, ndulu, ndi madontho a bile kuti aone ngati pali chitetezo. Chiyesochi chingakuthandizeni kupeza chithandizo, ndipo chingathandizenso kudziwa chomwe chimayambitsa vutoli, chomwe chingathe kudziwa momwe chithandizocho chiyenera kukhalira.
Kodi MRCP Idachitika Liti?
Bungwe la MRCP likuchitidwa ngati pali kukayikira kuti njira yothetsa bongo ilipo ndipo imayambitsa vuto. Sikuti kokha kokha mayesowa angadziwe ngati njira yothetsa bongo ilipo, mayesowa amatha kudziwa chomwe chikuyambitsa vutoli. Mwamwayi, pamene MRCP ndi njira yabwino yodziwira vutoli, mayeserowa angathandize kuthana ndi momwe mungagwiritsire ntchito vutoli - MRCP yokha siingathetse vutoli.
Kodi Chimachitika Panthawi ya MRCP?
Pakati pa MRCP wodwalayo akuyenera kuti akhalebe pabedi lomwe limalowa ndi kunja kwa makina a MRI. Chiyeso sichiri chosasokoneza, kutanthauza kuti palibe chomwe chimayikidwa kapena mu thupi. Monga x-ray, makina sakuyenera kukukhudzani kuti mufufuze mkati mwa thupi. Chiyeso ndi phokoso ndipo nthawi zambiri amatenga maola angapo.
Ngozi za MRCP
Kuopsa kwa MRCP kuli kochepa. Odwala omwe ali ndi vuto la claustrophobia kapena olemera kwambiri angafunike makina otseguka otseguka a MRI kuti aphunzire m'malo mogwiritsa ntchito makina a zipangizo zamakono, koma palibe vuto lalikulu lowerenga. Ngati mankhwala osokoneza bongo amagwiritsidwa ntchito, pali chiopsezo chochepa chothetsera mavuto, ndipo kusiyana kuli koyenera kugwiritsidwa ntchito mosamala kwa odwala omwe ali ndi mavuto a impso.
Odwala okhala ndi zitsulo angakhale ndi MRCP ngati alowetsa MRI kukhala otetezeka, pamene njirayi imagwiritsa ntchito maginito amphamvu kuti apange zithunzi za mkati mwa thupi. Palibe mawonekedwe a mpweya pa MRI.
ERCP Imafotokozedwa
Kupititsa patsogolo Pang'onopang'ono Cholangio-Kutchuka, kotchuka kwambiri monga ERCP, ndi njira yowonongeka pamene endoscope yowonongeka imalowetsamo pakamwa ndipo imakankhira mokoma kudzera m'mimba, kenako kumalo oyamba a matumbo omwe amatchedwa duodenum.
Endoscope ili ndi kuwala ndi kamera pamapeto, zomwe zimathandiza dokotala kuti ayang'ane mkati mwa kapangidwe ka zakudya. Izi ndizotheka chifukwa njira yowonjezera ya bulu imatha kulowa mu duodenum, ndipo ngati galasi kapena chinthu china choletsedwa chiripo mu ndondomeko ya bile, gastroenterologist katswiri amatha kuchotsa mwalawo pogwiritsira ntchito waya, basiti kapena bulloon attachment pa endoscope.
Ndi liti ERCP Yachitidwa?
ERCP ikuchitidwa chifukwa chimodzi mwa zifukwa ziwiri. Chifukwa choyamba ndichopangitsa kuti azindikire ngati palibenso njira yowonongera biliyano poyang'ana njirayi. Chifukwa chachiwiri chimene ERCP ikuchitirako ndi pamene maphunziro ena, monga kuyesa magazi kapena MRCP, amasonyeza kuti kulepheretsa biliyali sikuti kulipo, koma vuto lingathe kukhazikitsidwa mwa kuika ndondomeko kapena kuchotsa gallstone kuchoka ku bile.
Mosiyana ndi MRCP, yomwe imapereka zithunzi za zomwe zikuchitika m'thupi, ERCP ikhoza kuthetsa vutoli.
Ngozi za ERCP
Ngakhale kuti ERCP imaonedwa kuti ndi yovuta kwambiri, ngati njira iliyonse yowonongeka ili ndi mavuto omwe angakambirane. Kuphatikiza pa zoopsa zogonana ndi anesthesia , ERCP ingayambitse matenda opatsirana, matenda, ndi magazi.
Vuto lalikulu kwambiri limakhala lopweteka-m'matumbo kapena m'madera ena omwe ERCP ikuyendera. Kuopsa kwa pulojekiti kumakhala m'manja mwa katswiri wa gastroenterologist, komabe n'zotheka.
Anesthesia ndi ERCP
Ndondomeko ya ERCP imayendetsedwa ndi wodwalayo akulandira anesthesia wambiri kuti asadziwe momwe ntchitoyi ikuchitikira. Wodwalayo adzasungunuka ndi kuikidwa pa mpweya wabwino ndipo wagona kuti azichita zonsezi.
Pamene ndondomekoyo yatsirizidwa, mankhwala amaperekedwa kuti athetse sedation ndipo wodwalayo adzakwera pang'onopang'ono. Pomwe wodwalayo atha kupuma, chubuchi chimachotsedwa ndipo wodwalayo amatengedwa kupita ku Post Anesthesia Care Unit ( PACU ) kapena chipinda chawo kuchipatala kuti akapeze.
Ndondomekoyi ikhoza kuchitidwa ngati odwala matenda opatsirana kapena odwala matenda opatsirana. Ngati wodwalayo sakudwala kwambiri, akhoza kubwerera kwawo tsiku lomwelo, pamene odwala odwala angafunike kuchipatala kuchipatala.
> Chitsime:
> Kutseka Duct Kumanga. Inapezeka mu February, 2017. http://www.nytimes.com/health/guides/disease/bile-duct-obstruction/overview.html