Chisankho chomwe chiyenera kuyeza bwinobwino
Ngati muli ndi matenda akuluakulu a chiwindi, monga chiwerewere cha chiwindi kapena chiwindi cha hepatitis B kapena C komanso opaleshoni yosafunika yosiyana ndi chiwindi, zinthu zingakhale zovuta. Chigamulo chotsatira ndi opaleshoni mu zochitikazi sikutengedwa mopepuka. Madokotala anu amafunika kulingalira zinthu zingapo pozindikira kuopsa kwa ntchito zanu komanso ngati mutakumana ndi mavuto aakulu kapena imfa chifukwa cha opaleshoni.
Makamaka makamaka, mwa omwe chiwindi chawo chimagwidwa kale ndi matenda ovuta kapena osatha, opaleshoni ikhoza kuyesa mamba kuti chiwindi chikhale chiwindi, kapena kuwonjezeka kwa chiwindi, chiwindi, ndi imfa. Choncho, opaleshoni muyenera kuyang'anitsitsa ngati muli ndi matenda a chiwindi.
Zinthu zomwe zimafukulidwa ndi odwala opaleshoni omwe ali ndi matenda a chiwindi ndi awa:
- chiwindi, chifukwa ndi kuopsa kwa matenda a chiwindi
- mtundu wa opaleshoni
- kuchitidwa opaleshoni mwamsanga
- mtundu wa anesthesia
- Kupweteka kwa magazi kumatulutsa magazi
Tiyeni tiwone zinthu zosiyanasiyana zomwe madokotala, madokotala ochita opaleshoni, a hepatologists (akatswiri a chiwindi) ndi ena osiyanasiyana a gulu la thanzi lalingaliro asanaganize kuti munthu yemwe ali ndi matenda a chiwindi ndi woyenera kuchita opaleshoni.
Kusanthula thupi
Momwe munthu wofunsira opaleshoni akuwonekera, kapena chithandizo chachipatala chisanachitike opaleshoni ndi mbali yofunika kwambiri yowunika chiopsezo cha opaleshoni kwa omwe ali ndi matenda a chiwindi.
Kawirikawiri, dokotala amayang'ana zizindikiro zotsatirazi zomwe zikuwonetsa chiwindi chachikulu cha chiwindi:
- kunyoza
- jaundice
- kusanza
- thukuta usiku
- pruritis (itchiness)
- kulemera
Kwa anthu omwe ali ndi matenda a chiwindi , zizindikiro zambiri zotsatirazi zimachitika kachiwiri kuti zikhale ndi matenda oopsa kwambiri ndipo zimasonyeza kuti zimakhala zosauka kwambiri ndipo zimapereka chifuwa chachikulu cha chiwindi.
- kuwonjezeka m'mimba ya m'mimba (chizindikiro cha ascites )
- phindu lolemera (chizindikiro cha ascites)
- kukumbukira kukumbukira (kusonyeza kukanika kwachisokonezo )
- Kutuluka m'mimba kwaposachedwapa (kutanthauza kuti magazi akutuluka magazi)
- Kusintha kwa kutha kwa kugona
- jaundice (chikasu cha maso, khungu, ndi zina zamagulu)
Anthu ambiri omwe ali ndi vuto la chibwibwi amasintha muzogona. Kusintha kumeneku kwakhala kotchuka chifukwa cha matenda osokoneza bongo komanso odwala matenda a melatonin ; Komabe, sitiyenera kufotokozera momwe matendawa akugwiritsidwira ntchito.
Kuwopsa kwa Matenda a Chiwindi
Anthu omwe ali ndi chiwindi choopsa cha chiwindi kapena matenda opatsirana a chiwindi, komanso chiwindi chachikulu cha chiwindi, sayenera opaleshoni. Izi zimakhala zomveka chifukwa simukufuna kuti wodwalayo akhale ndi chiwindi chopweteka kwambiri pa nthawi ya opaleshoni. Kawirikawiri, kukhalapo kwa chiwindikiro kumakhudza zotsatira za opaleshoni. Odwala opaleshoni opaleshoni amawaphatikizapo anthu omwe ali ndi matenda a chiwindi komanso opanda chiwindi.
Ponena za opaleshoni yokha, kupatsirana kwa chiwindi ndi chiwindi chachikulu cha matenda a chiwindi ndi zifukwa zomveka zopewera opaleshoni. Ngati muli ndi matenda aakulu a chiwindi, muyenera kupewa opaleshoni ngati n'kotheka.
Njira zitatu zosiyana siyana zogwiritsira ntchito zizindikiro zimagwiritsidwa ntchito pofuna kupanga momwe munthu ali ndi matenda a chiwindi ndi wofunsira opaleshoni: chiwerengero cha Child-Pugh, chiwerengero cha Model for End-Stage Chiver disease (MELD) ndi chiyero cha hepatic mpweya woopsa wa veous (HVPG).
Zindikirani, HVPG imagwiritsidwa ntchito pazipatala zamaphunziro akuluakulu ndipo sizipezeka kulikonse. Komabe, ndibwino kwambiri kulongosola zamankhwala kapena zochitika zachipatala.
Magazi Omwe Amatsitsimutsa
Mwina chinthu chovuta kwambiri chomwe chikhoza kuchitika pa opaleshoni kwa iwo omwe ali ndi matenda a chiwindi ndi kuchepetsa kutuluka kwa magazi opatsirana ku chiwindi. Izi zimachepetsanso kuthamanga kwa magazi kumayambitsa matenda a chiwindi ndi a necrosis (imfa ya maselo a chiwindi), zomwe zingayambitse chiwindi kapena kuchepa kwa chiwindi, komanso kumasulidwa kwa ziwalo zomwe zimayambitsa kulephera kwa ziwalo zambiri.
Kawirikawiri, mitsempha imapereka magazi okonzedwa ndi ziwalo.
Komabe, mu chiwindi, kupatsidwa kwa magazi okosijeni kumachokera ku mitsempha yodabwitsa kwambiri ndi mitsempha yam'nyumba. Ndipotu, mitsempha yamakono imapereka magazi ochulukirapo ambiri mwa anthu ambiri.
Pa opaleshoni, kuthamanga kwa magazi ndi madontho otuluka m'mtima. Madonthowa amachepetsa kutaya kwa magazi okosijeni ku chiwindi. Kawirikawiri, mitsempha yamtunduwu imatulutsa kapena imathamanga kuti ikatenge nyepete ndipo imabweretsa kuchepa kwa magazi okosijeni ku chiwindi kupyolera mu mitsempha yam'nyumba. Komabe, kwa anthu omwe ali ndi matenda a chiwindi, kusintha kwachilendo ku chiwindi cha chiwindi, monga fibrosis ndi chisokonezo, kusokonezeka ndi mphamvu ya mitsempha yowonongeka kuti iwonjeze ndi kuonjezera kutuluka kwa magazi okosijeni ku chiwindi. Kuonjezera apo, anesthetics amalepheretsanso kusokoneza mitsempha yapamwamba yomwe imapangitsanso vutoli.
Mwa kuyankhula kwina, anthu odwala matenda a chibwibwi amakumana ndi vuto loperekera madontho m'magazi othamanga kupita ku chiwindi, chomwe chimayambitsidwa ndi opaleshoni ndi anesthesia komanso kusintha kwa chiwindi. Popanda magazi okwanira okwanira ku chiwindi pamene opaleshoni, munthu akhoza kuwonongeka kwambiri ndi chiwindi.
Mtundu Wopaleshoni
Munthu asanakhale ndi matenda a chiwindi, nkofunika kulingalira ngati mtundu wina wa opaleshoniyo umapangitsa munthuyo kukhala pachiopsezo chachikulu.
Pa opaleshoni ya m'mimba (taganizirani laparotomy), kukhudzana kwachangu ndi mitsempha ya mthendayi kungayambitse kupwetekedwa ndi chiwindi. Kuwonjezera apo, kupota mozungulira mitsempha iyi kumachepetsa kuchepa kwa magazi mpaka chiwindi pamene opaleshoni.
Anthu omwe ali ndi matenda akuluakulu a chiwindi, ngati matenda a chiwindi, omwe amafunikira opaleshoni yosayembekezereka chifukwa cha kunyozedwa, monga sepsis kapena kupwetekedwa mtima, ali pa chiopsezo chachikulu chofa imfa itatha.
Kuchita opaleshoni ya mtima kumapangitsa kuti magazi asapitirire ku chiwindi ndi kuwonjezera vutoli. Kuonjezerapo, makina opatsirana (mankhwala opatsirana kuwonjezera mphamvu ya magazi pa nthawi yoperekera nthawi) komanso matenda opatsirana m'magazi angadwale kuvulala kwa chiwindi.
Monga tanenera kale, kupweteka kwa magazi kungathandizenso kuchepetsa kuthamanga kwa magazi ndi kuthamanga kwa magazi ku chiwindi ndipo zimapangitsanso kuwonongeka kwa chiwindi. Komanso, mwa anthu omwe ali ndi matenda a chiwindi, anesthetics amatha kumangika mozungulira nthawi yaitali ndipo sapeza minofu mosavuta kotero zimakhala ndi nthawi yayitali.
Kutsiliza
Choyamba, ngati mavitamini anu a chiwindi akukwera pamwamba koma matenda anu a chiwindi sanagwiritsidwe ntchito, mukhoza kukhala oyenerera opaleshoni. Chachiwiri, ngati muli ndi matenda a chiwindi omwe muli ndi chiwindi chabwino, mukhoza kukhala opaleshoni yabwino yakuchita opaleshoni. Chachitatu, ngati muli ndi chiwindi chakumwa mowa mwauchidakwa ndipo mumasiya kumwa mowa kwa nthawi ndithu ndipo mulibe matenda, mukhoza kukhala wopaleshoni wabwino.
Chonde pitirizani kukumbukira kuti chifukwa chakuti mukudwala matenda a chibwibwi sakutanthauza kuti simungathe kuchitidwa opaleshoni. Komabe, kukhalapo kwa chibwibwi kumakhudzadi zotsatira ndipo motero sikuyenera kubwezeredwa panthawi ya opaleshoni (ganizirani katundu, ascites, m'mimba, kapena variceal, magazi ndi zina zotero).
Ngati muli ndi chiwindi chachikulu cha chiwindi kapena matenda a chiwindi, opaleshoni ndizolakwika. Ndi bwino kulingalira za chiwindi mwa anthu omwe ali ndi matenda aakulu a chiwindi monga matenda a chiwindi kapena chiwindi ngati chimphona chogona. Zovuta, madokotala opaleshoni amagwira ntchito pafupi ndi chimphona chogona, ndipo zowonongeka kapena zotetezedwa ndi chiwindi zowonjezereka ndi kupweteka kwapiritsi kumapangitsa kuti chimphona chogona chikhale chopanda phokoso.
Zotsatira za opaleshoni kwa omwe ali ndi matenda a chiwindi zingakhale zovuta kwambiri. Anthu ena amavutika ndi chiwindi ndi kufa pambuyo pa opaleshoni imeneyi. Choncho, malingaliro opanga opaleshoni kwa anthu omwe ali ndi matenda a chiwindi amalingalira mosamalitsa ndi gulu lanu la thanzi. Komanso, monga wodwalayo, uyeneranso kupereka chilolezo chodziwitsidwa, kapena uvomereze njirayi.
Muyenera kupemphedwa kupereka chidziwitso chadzidzidzi pokhapokha ngati dokotala wanu ndi gulu la zaumoyo akufotokozeratu za ngozi, mapindu, ndi zotsatira za njirayi. Kumbukirani kuti kuchitidwa opaleshoni ndilo lingaliro lomwe mumapanga.
Zotsatira
Bacon BR. Cirrhosis ndi Zovuta Zake. Mu: Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. eds. Mfundo za Harrison za Internal Medicine, 19e . New York, NY: Hill ya McGraw; 2015.
Okonza. Mankhwala a Mankhwala. Mu: Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. eds. Mfundo za Harrison za Internal Medicine, 19e . New York, NY: Hill ya McGraw; 2015.
Montagnese S, De Pitta C, De Rui M, et al. Kugona-Kukanika Kwambiri kwa Odwala Amene Ali ndi Chiwindikitsiro. Hepatology . 2014; 59 (2): 705-712.
Qamar AA, Grace ND. Chaputala 53. Kupenda Zowonongeka kwa Matenda a Chiwindi. Mu: McKean SC, Ross JJ, Dressler DD, Brotman DJ, Ginsberg JS. eds. Malamulo ndi Zochita za Chipatala . New York, NY: Hill ya McGraw; 2012.