Pamene ife timamva mawu akuti " chiwindi cha chiwindi ," timakonda kugwirizanitsa ndi matenda a chiwindi ndi matenda ena okhudza chiwindi. Koma sizinali nthawi zonse. Monga momwe zilili ndi matenda ena opatsirana, matenda a chiwindi amatha kugwiritsira ntchito njira imodzi (mwachidziwitso, chiwindi) pomwe zimakhudzidwa molakwika ndi ziwalo zina.
Njira imodzi yosagwidwa ndi matenda a chiwindi ndi njira yapakati ya mitsempha, makamaka makamaka ubongo.
Pa matenda oopsa a chiwindi, matenda oopsa a chiwindi amatha kuunjikira m'magazi ndikufalitsa (kapena kufalitsa) thupi lonse. Pamene zinthu izi zimalowa mu ubongo, zingayambitse matenda a ubongo wotchedwa hepatic encephalopathy .
Kuchuluka kwa ubongo kumaphatikizapo kusokonezeka, kusokonezeka, komanso nthawi zina kusintha kwa khalidwe ndi zamagetsi. Ngati sanasamalidwe, matendawa amatha kupita patsogolo ku coma (coma hepaticum) kapena imfa.
Zonse zanenedwa, pakati pa 30 ndi 45 peresenti ya anthu omwe ali ndi chibwibwi adzakhala ndi zizindikiro zina zozizwitsa, ngakhale kuti ndi zochepa zoiwalika kapena zovuta kwambiri za amnesia kapena kupweteka.
Zifukwa za Kuchulukanso Kwambiri
Ngakhale kuti matendawa amachititsa kuti chiwindi chilephereke , nthawi zambiri zimakhala zowonjezera. Zambiri mwazifukwazi sizikugwirizana ndi chiwindi kapena ubongo; iwo amangowoneka kuti amachititsa kuukira kapena kupititsa patsogolo chochitikacho.
Zina mwa zinthu zomwe zingakhale zofanana pakati pa anthu omwe ali ndi chiwindi chachikulu:
- Kumwa kwambiri mowa
- Kulephera kwa impso
- Kutsekedwa, komwe kumawonjezera matumbo kupanga ammonia
- Chibayo
- Mwazi wamagazi, umene umapezeka nthawi zambiri pamatenda a chiwindi
- Mavitamini otchedwa peritonitis , kawirikawiri amachokera ku chiwindi cha chiwindi
- Matenda a m'matope
- Pasiziyamu yapamwamba ndi / kapena ma sodium, omwe nthawi zambiri amayamba chifukwa cha diuretics yogwiritsira ntchito ascites m'matenda amtsogolo
- Benzodiazepines, sedative yomwe nthawi zambiri imalangizidwa kuti imwetse mowa
- Mankhwala osokoneza bongo komanso odana ndi psychotic
- Kugwiritsidwa ntchito kwa zizindikiro (zomwe zimadziwika pa transjugular intrahepatic portosystemic shunt, kapena MACHITIDWE), zimagwiritsidwa ntchito kukonza magazi mu chiwindi
Pozindikira zifukwa zomwe zimayambitsa matenda osokoneza bongo, madokotala amatha kuchiza matendawa mosavuta pochepetsa zinthu zomwe zatha kapena zoopsa.
Mmene Chiwindi Chimalephera Kukhudza Ubongo
Kuchuluka kwa ululu kumachitika makamaka pamene chiwindi sichikwanitsa kuchita ntchito yake yachizoloŵezi yamagetsi.
Kwa anthu omwe ali ndi chiwindi chachiwindi, mavitamini a m'matumbo amanyamula kupita ku chiwindi, komwe amachotsedwa ndi kuchotsedwa ku thupi. Pamene chiwindi chimagwira ntchito, mankhwala omwe ali ndi nitrojeni amayamba kumangoyamba, zomwe zimayambitsa kuchuluka kwa ammonia.
Mitundu ya ammonia imeneyi imafalikira m'magazi onse ndipo imadutsa mu nthendayi yomwe imayang'ana ubongo. Kumeneko, amachititsa kuti kutupa kwa maselo a ubongo kumatchedwa astrocytes, komwe pamapeto pake kumachepetsa kupanga opaleshoni ya ubongo yomwe imathandiza kwambiri kuganiza bwino.
Zizindikiro ndi Zizindikiro za Kuchulukanso Kwambiri
Kawirikawiri kupweteka kwambiri kumakhala kovuta kufotokoza m'mayambiriro a matendawa. Kuiwalika, kukwiya, nkhawa, ndi chisokonezo nthawi zambiri zimakhala zizindikiro zoyamba, zomwe ambiri amangoziphonya mosavuta ngakhale anthu omwe amadziwika ndi matenda a chiwindi.
Mwinamwake chizindikiro choyamba chowonekera chikanakhala chinachake chomwe chimatchulidwa kuti chizolowezi chogona chogona, momwe munthu angagone masana ndi kukhalabe maso usiku. Izi nthawi zambiri zimatsatiridwa ndi zizindikiro zosiyanasiyana zamtsogolo, zomwe zingaphatikizepo:
- Lethargy
- Kusintha kwa umunthu kumasintha
- Kuwonjezera chisokonezo
- Mavuto ndi kulemba ndi kuyenda bwino
- Kusasuntha manja kapena kusasuntha kwa manja
- Kugwedezeka kwa miyendo
- Khalidwe losavomerezeka
- Amnesia
- Kuwonongeka kwa gag reflex
Mavuto oopsa angapangitse kukhala ndi chidziwitso chochulukirapo, nthawi zambiri kupita patsogolo kwa kugwidwa ndi chiwawa komanso kukhumudwa. Imfa imayambitsidwa chifukwa cha kutupa kwakukulu kwa ubongo (wotchedwa cerebral edema).
Zotsatira za Hepatic Encephalopathy
Zigawo za matenda opatsirana mwachangu zimagwiritsidwa ntchito pamtunda wotchedwa West Haven Criteria, zomwe zimaphatikizapo kuopsa kwa zizindikiro zogwirizana ndi msinkhu wa matenda a ubongo:
- Zochepa: kusintha kwa motor mothamanga popanda zizindikiro za kusintha kwa maganizo
- Gawo 1: kuchepa kwadzidzidzi, kudandaula kapena nkhawa, kuchepetsa kuchepa, kusinthana kugona
- Maphunziro a 2: Kutaya mtima kapena kusasamala, Kusokonezeka, Kusintha kwa umunthu, Kusayenerera, Mavuto a magalimoto, Kuthamanga ndi "kukwapula" kwa manja
- Gawo 3: dziko lopanda pake, chisokonezo, kusokonezeka kwakukulu, khalidwe lopanda pake
- Kalasi 4: koma
Mankhwala opatsirana am'chipatala amapangidwanso chifukwa cha chiwopsezo chachikulu cha chiwindi (mtundu wa A), ndondomeko ya MFUNDO (Type B), kapena cirrhosis (Type C). Zina mwazigawozi zimathandizira kusankha njira yoyenera yothetsera vutoli.
Kudziwa
Matendawa amatha kupezeka pokhapokha atapezeka ndi matenda a chiwindi kapena anthu omwe adatsatira njira zoyenera. Kuzindikira kumaphatikizapo kupatulapo zina zonse zomwe zingayambitse matendawa.
Maluso am'chipatala amafunika kuti apange kusiyana kwake ; palibe mayeso omwe angatsimikizire kapena kusasamala mkhalidwewo. Ngati akuganiza kuti akudwala matendawa, madokotala amatha kuyesa mayesero, omwe angaphatikizepo:
- Kufufuza kwa luso, zithunzi ndi magetsi
- CT ikuyesa kuti ikhale yosasamala kapena kutsimikizira ubongo wamadzi
- Electroencephalograms (EEG) ngati kugwedezeka kukudziwika
- Mayeso a magazi kuti muwone ma seamu ammonia
- Zotsatira zamagulu kuchokera ku peritoneal cavity (yomwe imalekanitsa mimba m'mimba mwa khomo) kuti asatuluke kapena kutsimikizira kachilombo kabakiteriya
- Mayesero ena, kuphatikizapo chifuwa X-rays ndi urinalysis, kuti asatuluke zina zomwe zingayambitse
Chithandizo
Kuchulukanso kwachinyengo kumachiritsidwa. Chithandizochi chimayang'ana kuthetsa vuto lililonse limene lingayambitse kapena likuchulukitsa. Nthawi zina (monga anthu omwe adatsatira ndondomeko ya MFUNDO), chikhalidwecho chingathetsere mwadzidzidzi ndipo sichiyenera kuchitapo kanthu. Nthawi zina, kuthetsa mankhwala ena kapena mankhwala odzoza kungathandize kwambiri kusintha kwa ubongo.
Nthawi zina matendawa atapezeka, mankhwala opha tizilombo amayenera kutchulidwa ngati rifaximin . Kuonjezerapo, lactulose imatchulidwa ngati mankhwala oyamba kuti achepetse ammonia m'matumbo.
Chizindikiro cha munthu yemwe ali ndi vuto lodziletsa kwambiri akhoza kukhala mosiyana kwambiri. Kupezeka kwa matendawa, kuphatikizapo mayendedwe a chiwindi, nthawi zambiri kumagwiritsidwa ntchito kudziwa ngati munthu angafunike kuika chiwindi . Kwa anthu omwe ali ndi matenda akuluakulu a chiwindi, monga matenda opatsirana odwala matenda a chiwindi kapena khansa ya chiwindi, kuika chiwindi nthawi zambiri kumasonyezedwa.
> Zotsatira:
> Vilstrup, H ;; Amodio, P .; Bajaj, J .; et al. " Hepatic Encephalopathy mu Matenda a Chiwindi Osatha: Malemba Otsogolera a 2014 kuchokera ku AASLD ndi EASL." Malangizo Othandizira AASLD. 2014: 3-67.
> Conn, H. "Kulingalira koopsa." Schiff, L ndi Schiff, E., eds. Matenda a Chiwindi . 7th ed. Philadelphia, PA: Kuwombera; 1993: 1036-1060.