Kodi Nthenda Yotchedwa Nutcracker Esophagus (Hypertensive Peristalsis) ndi yotani?

Mbalame yotchedwa Nutcracker isophagus ndi mawonekedwe ochepa kwambiri. Zili m'gulu lomweli la matenda osokoneza bongo omwe amachititsa kuti jackhammer ayambe kugwilitsika nchito komanso kuti azikhala ochepa kwambiri. Ku US pafupifupi 1 mwa 100,000 anthu amapezeka kuti ali ndi vuto la kuchepa kwa umoyo pachaka, komabe, chikhalidwe chenichenicho chimaganiziridwa kukhala chapamwamba kwambiri chifukwa nthawi zambiri sichidziwika kuti ndi reflux acid.

Maseŵera ang'onoang'ono angakhale ofala kwambiri ku anthu a ku Caucasus ndipo amapezeka kawirikawiri mwa amayi kuposa amuna. Okalamba mumakhala osowa kwambiri.

Zomwe zimapangidwira pamtundu wa nutcracker zimaphatikizapo mavuto akuluakulu ndi malo osokonezeka omwe amachitika motsatizana. Mphuno ya mitsempha yotsekula imatha kuchititsa kuti chakudya chikhale cholimba kapena chokhalapo pamimba. Koma ali ndi nthenda yotchedwa nutcracker esophagus, komabe, chifukwa zimakhala zikuchitika motsatizana komanso mwakonzedwe kawirikawiri zimakhala zovuta kupweteka pachifuwa kusiyana ndi vuto lomeza.

Sikudziwika bwino chomwe chimayambitsa chiwonongeko cha nutcracker. Zolingaliro zina ndizokuti chikhalidwe chikugwirizana kwambiri ndi matenda a reflux a gastroesophageal (GERD) ndipo akhoza kuyambitsa ndi izo. Nthano ina ndi yakuti imayambitsa matenda a mitsempha, ndipo anthu ena amakhulupirira kuti imayambitsidwa ndi yankho lachilendo kwa mankhwala acetylcholine.

Zizindikiro za Nutcracker Esophagus

Nutcracker oophagus angapangitse ena kuphatikizapo zizindikiro zotsatirazi:

• zovuta kumeza (dysphagia) zomwe zimapezeka ndi chakudya cholimba komanso chakuda ndipo nthawi zina zimangokhalapo
• kupweteka pachifuwa
• kubwezeretsedwa kwa chakudya
• reflux

N'zotheka kuti nutcracker ikhale yopanda mphamvu (osati chifukwa cha zizindikilo zomveka).

Kafukufuku wina amasonyeza kuti anthu okhala ndi nutcracker esophagus akhoza kukhala ndi mitsempha yomwe imakhala yothamanga kwambiri.

Zizindikiro za matenda ena a motility (jackhammer epopus ndi kuperewera kwapopang'ono) zimakhala zofanana ndi nutcracker epopus test yofunika kwambiri yomwe iyenera kuchitidwa pofuna kusiyanitsa pakati pa matendawa.

Kusanthula Nutcracker Esophagus

Mayesero otsatirawa angathandize dokotala kuti azindikire nthenda ya nutcracker:

1. Katemera wotchedwa Barium ndi mayeso omwe amachititsa kumeza chinthu chotchedwa barium sulphate. Barium sulphate imapanga ma x-rays kotero n'zotheka kuwona njira ya barium sulphate kudzera m'thupi. Kuphatikiza pa masewera olimbitsa thupi, mayeserowa angathandize kuthana ndi mavuto monga kuvutika kukumeza kapena kuchepetsako. Musakhale ndi mayeso ngati muli osakwanira kwa barium sulphate koma mwachidule, mayeso ali ndi mbiri yabwino ya chitetezo. Komabe, sulfate ya barium imadziwika kuti imamatira kotero kuti mumayenera kumwa madzi ambiri kapena kugwiritsa ntchito pulogalamu yowonongeka pamsewu pambuyo pa mayesero.
2. Kansalu ya CT ingasonyeze kukula kwa khoma (osapitirira 3mm) mwa anthu omwe ali ndi nthenda ya nutcracker. Komabe, izi zikhoza kuchitika m'mavuto ena kuphatikizapo khansa ya m'mimba. Ngati CT yanu ikuwonetseratu kukulirakulira kwa dothi lanulo dokotala wanu adzafunika kuyesa kuti awonetseni kuti mukudwala.

1. Kuthamanga kwambiri kwa ultrasound kungakhale kothandiza kusiyanitsa pakati pa nutcracker epopus, jackhammer epopus, ndi kupopera kwapopang'ono kokwanira.
2. Esophageal Manometry ndiyeso yabwino kwambiri kuti apeze matenda osokoneza bongo komanso chifukwa cha ululu wosapweteka pamtima. Chiyesocho chimaphatikizapo kuyika tiyi yaing'ono m'mphuno mwako, pansi pakhosi ndi m'mimba mwako. Phukusi limakhala lovuta kwambiri ndipo limatha kuyeza mphamvu ndi kupanikizika kwa mitsempha ya m'mimba pamene mukumeza. Mayesowa akhoza kuyambitsa mavuto omwe amachepetsedwa ndi utsi umene umatulutsa mkati mwa mphuno ndipo nthawi zina pamwamba pammero.

1. Esophagogastroduodenoscopy (EGD) ndi ndondomeko yomwe sitingathe kudziwa kuti nutcracker isophagus koma ingakhale yothandiza pakugwirizanitsa zovuta zina monga chilakolako chogonana kapena GERD.

Kuchiza kwa Nutcracker Esophagus

Inu ndi dokotala wanu mungasankhe kugwiritsa ntchito zina mwa mankhwalawa kuti muthandize kuthana ndi zizindikiro za nthenda ya nutcracker.

Mankhwala ambili amagwiritsidwa ntchito pochiza matendawa ndipo amagwiritsa ntchito calcium channel blockers, nitrates, ndi phosphodiesterase inhibitors. Majekeseni a botulinum poizoni pamwamba pa sophageal sphincter akhoza kuthetsa kanthawi kokha zizindikiro poletsa kutulutsa acetylcholine. Proton pump inhibitors angathandize kuthetsa zizindikiro zokhudzana ndi asidi reflux. Imodzi mwa mankhwala ogwiritsidwa ntchito kwambiri othetsera vuto la kuchepa kwa motility kuphatikizapo nutcracker isophagus ndi tricyclic anti-depressants.

Pulogalamuyi imakhala ndi njira yomwe imakhala yaikulu kwambiri ndipo imatha kuthetsa zizindikiro za nthenda ya nutcracker. Ndondomekoyi imakhala ikuchitika panthawi yopuma komanso pansi. Mudzalandira malangizo apadera okhudza kusadya ndi kumwa kwa nthawi inayake musanayambe njira yanu. Mavuto a balloon ophatikizapo zotsatirapo kapena zotsatira zowonongeka kwa mankhwala a antiesthesia omwe amagwiritsidwa ntchito kapena kawirikawiri phokoso la mankhwala.

Pazochitika zovuta kwambiri zomwe sizinayende bwino kwa mankhwala ena, opaleshoni yotchedwa myotomy ikhoza kukhala yoyenera. Ndondomeko imeneyi imatchedwanso Heller myotomy kapena yochepa kwambiri yomwe imakhala yogwiritsidwa ntchito pochiza achalasia koma ikhoza kugwiritsidwa ntchito pochiza nthenda ya nutcracker. Amagwiritsidwa ntchito ngati njira yomaliza chifukwa nthawi zina zakhala zikupangitsa kuti minofu yothyola minofu ikhale yoipa kwambiri.

Ndondomekoyi imatha kupangidwa mwatsatanetsatane kapena njira yotseguka koma njira ya laparoscopic imagwirizanitsidwa ndi nthawi yochepetsetsa yochepa komanso yocheperako. Kutengeka pang'ono kumapangidwira pamwamba pa mimba ya mimba ndipo kenako minofu yakunja ya mimba imadulidwa kuti iteteze kuti asagwirizane. Kuwonjezera pamenepo, kufooketsa minofu pamagulu a gastroesophageal kumayambitsa sphincter pakati pa mimba ndi mimba kukhalabe otseguka.

Zowopsa zowopsa kwa myotomy zimaphatikizapo kuwonongeka kwa ziwalo zozungulira monga nthenda, chiwindi, kapena m'mimba komanso matenda opatsirana. Monga momwe zilili ndi opaleshoni iliyonse, palinso chiopsezo chotengera kapena zotsatira zake za anesthesia. Monga tafotokozera kale ngati ntchito yogwiritsira ntchito chipangizo cha nutcracker pali chiopsezo kuti zizindikiro zidzakula kwambiri. Ngakhale zizindikiro zikatha pakatha zaka zingapo zotsatira zake zingatheke.

Kuphatikiza pa zofukufuku zomwe tazitchulazi zikusonyeza kuti nthenda ya nutcracker ikuwoneka ikukhala bwino mwayekha mkati mwazaka zingapo.

> Zotsatira:

> Barium Swallow. emedicinehealth. Idasinthidwa pa June 25, 2015. https://www.emedicinehealth.com/barium_swallow/article_em.htm#what_is_a_barium_swallow

> Manopotopu oyenerera. Medline Plus. https://medlineplus.gov/ency/article/003884.htm

> Esophageal Spasm. Kusaka. https://emedicine.medscape.com/article/174975-overview

> Heller Myotomy kwa Achalasia. Sukulu ya Yunivesite ya Washington ku St. Louis Cardiothoracic Surgery. http://cardiothoracicsurgery.wustl.edu/en/Thoracic/Benign-Esophageal-Disease/Heller-Myotomy-for-Achalasia