Mowa wa Cirrhosis ndi Maddrey Score

Mankhwala Oledzeretsa Oledzeretsa

Score Maddrey amadziwika ndi mayina ambiri, kuphatikizapo Maddrey Discrimination Function, MDF, DF kapena DFI. Ndi chida chogwiritsidwa ntchito ndi ogwira ntchito zaumoyo kuti apeze mtundu woyenera wa chisamaliro cha wodwala yemwe ali ndi mtundu wina wa chiwindi chotchedwa chiwindi chakumwa mowa.

Chida chogwirira ntchito nthawi zambiri chimagwiritsidwa ntchito ku chipatala, chifukwa anthuwa nthawi zambiri amadwala akamadwala matenda omwe amafunika kugwiritsa ntchito Maddrey Score.

Mwachidule, chiwerengero cha Maddrey chimathandiza kudziwa momwe chiwindichi chinawonongeke kwambiri, kuti pakhale dongosolo la chisamaliro.

Ndani Akusowa Chalk ya Maddrey?

Anthu omwe ali ndi chiwerewere chakumwa chauchidakwa ndi odwala omwe amawerengera Maddrey Score. Awa ndi odwala omwe amawononga chiwindi chawo chifukwa cha uchidakwa, kapena moledzeretsa, ndipo nthawi zambiri amakhala ndi zizindikiro zovuta kwambiri pamene chiwerengero cha Maddrey chikugwiritsidwa ntchito.

Ena mwa anthuwa adzakhala m'chipatala, ena adzawoneka pamtunda. Muzochitika zonsezi, ayenera kulandira chisamaliro kuchokera kwa wothandizira yemwe ali mwapadera mu gastroenterology kapena hepatology. Gastroenterologists amayang'anira chigawo chonse cha m'mimba, kuphatikizapo chiwindi, pamene hepatologists amaganizira pachiwindi.

Kodi Chidakwa N'chiyani?

Kachilombo koyambitsa matenda a chiwindi ndi mtundu wa matenda a chiwindi chifukwa chomwa mowa mopitirira muyeso. Ikhoza kukhala yofatsa mpaka yovuta ndipo ingayambitse mavuto ambiri kuphatikizapo imfa.

Matenda a cirrhosis amachititsa kutupa kosatha kwa chiwindi, mafuta amatha ndipo amachititsa kuti chiwindi chimapangitsa kuti chiwindi chikhale chovuta kugwira ntchito bwino. Nthawi zina chiwindi chimakula kwambiri.

Zizindikiro Zodziwika ndi Zizindikiro za Cirrhosis

Pali mitundu yambiri ya chiwindikiro, chomwe chingayambe kapena chosayambitsidwa ndi kumwa mowa.

Mosasamala kanthu komwe, odwala omwe ali ndi chibwibwi amakhala ndi zizindikiro zofanana , zomwe zimakhala zochepa poyambirira kwa matendawa ndipo zimawonjezeka kwambiri mu matenda aakulu.

• Mavuto a m'mimba: Chiwindi chili m'mimba mwakachetechete ndipo odwala ena amanena kuti amamva kupweteka kwambiri pachiwindi chimene chimakula ndi matenda owonjezereka.
• Nausea: Odwala ena amakumana ndi kusanza, koma kusuta ndi kofala kwambiri ndipo kungafunike mankhwala kuti amuthandize kudya chakudya nthawi zonse.
• Kuthamanga mosavuta: chiwindi chimathandiza kwambiri pothana ndi magazi pambuyo pa bala kapena kuvulala. Pamene chiwindi chimadwala, kuvulaza kumachitika mosavuta ndipo nthawi zina, kutuluka mwadzidzidzi kumachitika mwadzidzidzi, popanda kuvulazidwa ngati chowombera.
• Kusokonezeka maganizo / fogginess : Pamene chiwindi sichitha kugwira ntchito yake, ammonia ikhoza kumanga m'magazi, kumabweretsa chisokonezo, kutopa, kusokonezeka maganizo, ndi kusakwanitsa kusamalira ntchito zosavuta za tsiku ndi tsiku.
• Kuiŵala: Pamene chiwindi chimadwala mpaka kufika poti sichikanatha kugwira ntchito yake kwathunthu, zizindikiro ziwoneka ndipo zikuipiraipira pamene matendawa amachititsa. Mankhwala angagwiritsidwe ntchito pofuna kusintha zizindikiro.
• Kutopa / kufooka: Kutopa ndi kofala ndipo nthawi zambiri ndizo zomwe zimayambitsa matenda a chibwibwi.

• Jaundice (khungu la chikasu): Pamene chiwindi sichikanatha kusefera magazi bwino khungu ndi ziwalo zina za thupi zimatha kuyang'ana chikasu. Izi kawirikawiri zimazindikiridwa mwa azungu a maso, kumene kusintha kosasinthasintha ndi koonekera kwambiri.
• Mitsempha yowonjezereka m'mimba: Chifukwa cha kuwonjezeka kwa magazi ndi kukhudzana m'mitsempha ya magazi pafupi ndi chiwindi, mitsempha ya m'mimba imakhala yayikulu komanso yowoneka pansi pa khungu.
• Mitsempha yowonjezereka m'magazi (esophageal varices): Kuphatikiza pa mitsempha m'mimba yomwe ili ndi mimba ndipo ikukulitsidwa mu kukula, zomwezo zikhoza kuchitika kwa ziwiyazo. Pamene mitsemphayi ikukulitsidwa kwambiri, pali chiopsezo chotaya magazi, choncho nthawi zambiri mankhwala amafunikira kuti achepetse vutoli.

• Osafuna kudya, kulemera kwa thupi: Odwala ambiri akhoza kulemera chifukwa cha kusungidwa kwa madzi, koma ena amapeza kuti akutopa chifukwa chosowa chakudya ndi kutopa. Nausea ikhozanso kutayitsa kulemera.
• Kukulitsa kwa abambo kwa abambo ndi amai: Ngakhale kuti chifukwa chenicheni cha izi sichimveka bwinobwino, chiwindi chimayambitsa kusamvana kwa mahomoni komwe kumadzetsa kusintha kwa kukula kwa mawere.
• Gesi (flatulence)
• Kupuma: Magazi ofiira amatha kapena sakuwoneka. Ena, magazi amatha kukhala ngati "malo a khofi" omwe amawonekera pamene akusanza. Ena angaone kuti malo awo sakhala ofiirira koma amakhala mdima kapena wakuda, ndipo amawoneka otayirira kapena phula. Zonsezi ndi zizindikiro za magazi m'magazi ndipo ayenera kuuzidwa kwa wothandizira zaumoyo.
• Kusungirako madzi ( ascites ): Odwala ena amakhalabe ndi madzi ambiri, makamaka m'mimba, chikhalidwe chomwe chingapangitse kufunika kochotsa madzi.
• Kuwomba: Izi zikhoza kukhala chizindikiro kuti chiwindi sichikuyeretsa mwazi womwe ungawonongeke.
• Kutupa miyendo, maikola, ndi mapazi: Chizindikiro china cha kusungunuka kwamadzimadzi, kutupa m'munsi mwake kungakhale chizindikiro cha nkhani ndi chiwindi mwa anthu ena.
• Kupuma pang'ono: Kupuma pang'ono kungakhale kovuta ngati kusungunuka m'mimba kumapangitsa kuti kukhale kovuta kupuma kapena kuonjezera kupweteka m'mimba.

Momwe Malipoti a Maddrey Amawerengedwera

Maphunziro a Maddrey amagwiritsa ntchito mayeso awiri a magazi kuti adziwe kuchuluka kwake kwa chiwindi, bilirubin ndi prothrombin nthawi.

Bilirubin ndi malalanje a malalanje omwe chiwindi chimapanga pamene chimathyola hemoglobini (gawo la magazi) ndipo chimachotsedwa mu bile. Kawirikawiri, izi zimachotsedwa m'thupi koma ngati chiwindi chowonongeka bilirubin chingamangidwe m'magazi omwe amachititsa jaundice.

Nthawi ya prothrombin ndiyeso ya momwe magazi amawonekera mwamsanga mumasekondi. Chimodzi mwa ntchito za chiwindi ndicho kuthandiza magazi, nthawi yochuluka kwambiri imayembekezeredwa pamene chiwindi chawonongeka.

Kulamulira ndi chiwerengero chimene labu amagwiritsira ntchito kuti azindikire zomwe "zachibadwa" zotsatira ziri pa malo omwewo, ndipo si chifukwa cha labu kuchokera ku magazi a wodwalayo.

Lingaliro limene limagwiritsidwa ntchito powerengera Maddrey Score ndi:

• Bilirubin (mg / dL) + 4.6 nthawi (prothrombin nthawi mumasekondi osachepera)

Ndondomeko ya Maddrey ikugwiritsidwa ntchito bwanji?

Pamene wodwalayo ali ndi matenda oledzeretsa akudwala, Maddrey Score akugwiritsidwa ntchito kudziwa ngati angapindule ndi kugwiritsa ntchito steroid monga gawo la mankhwala awo. Zingathenso kulinganiratu mwayi wopulumuka, makamaka m'miyezi itatu yomwe mphambu ikuwerengedwa.

Ngati chiwerengero cha Maddrey chili ndi zaka zopitirira 32, wodwalayo amawoneka kuti ali ndi vuto lachidakwa chochepa komanso sangapindule ndi kugwiritsa ntchito steroids. Pafupifupi 90 peresenti ya odwala omwe ali ndi chiwerengerochi adzapulumuka miyezi yotsatira yomwe mipikisanoyo itatha.

Mwamwayi, mapiritsi apamwamba kuposa 32 amasonyeza matenda oledzeretsa a chiwindi, kutanthauza kuti chiwindi chawonongeka kwambiri ndi mowa. Pazochitikazi, pafupifupi 60 mpaka 65 peresenti ya odwala ali moyo patatha miyezi itatu ataponya. Odwalawa ndi omwe amafunikira kwambiri kugwiritsa ntchito steroids monga gawo la mankhwala awo. Kwa odwala awa, kuopsa kwa nkhanza kulipiritsidwa ndi mphotho zowonjezereka.

Ndikofunika kukumbukira kuti Maddrey Score ndi chida, osati mtheradi. Izi zikutanthauza kuti chiwerengerocho ndi chinthu chimodzi chomwe dokotala kapena katswiri wa zaumoyo akuyang'ana pamene akudziŵa njira yabwino kwambiri. Pa chifukwa chimenechi, mukhoza kuona wodwalayo ali ndi masewera a 30 omwe amalandira steroid ndipo mukhoza kuona wodwala wina ndi mphambu pamwamba pa 32 yemwe samatero. Steroids imakhala ndi zotsatira zoyipa, monga kusokoneza shuga m'magazi, zomwe zingafunike kupeŵedwa kwa odwala ena.

Mmene Mungakulitsire Mbali ya Maddrey

Maphunziro a Maddrey sanagwiritsidwe ntchito pamwala, kapena kuti ndi mawu omalizira momwe matenda a mliri angayankhire mankhwala. Maphunzirowa ndi chida chofotokozeratu zotsatira, komabe wodwalayo angathe kusintha matenda awo nthawi zina.

Kwa odwala omwe ali ndi matenda ochepa, kusintha kwa moyo kumatha kupanga kusintha kwakukulu komwe chiwindi chimagwira ntchito ndipo chikhoza kuthetsa vutoli. Odwala ena omwe ali ndi matenda ochepa omwe amaletsa kumwa mowa amatha kukhala ndi matenda ambiri. Kwa odwala omwe ali ndi matenda oopsa, n'zotheka kuwona kuti matenda a chiwindi amathandiza ena. Kwa ena, moyo umasintha sizimasintha koma umateteza kuti matendawa asapitirire kuwonjezereka-zingakhale zovuta kufotokozera momwe zinthu zidzakhalira bwino.

• Siyani kumwa mowa. Ngati munthuyo akupitiriza kumwa mowa, njira yomwe yatsimikiziranso njira yothetsera matenda owonjezereka ndipo mwinamwake kusintha kwa chiwindi ntchito ndiko kusiya kumwa mowa kwathunthu. Izi sizikutanthauza kumwa mowa, ngakhale kumwa vinyo kapena mowa nthawi zina. Kusiyiratu kumwa mowa kungakhale kovuta kwambiri, komabe kudzakhala kofunikira kwambiri kuti wodwala apulumuke, ngati kumwa mowa pambuyo poti adwale matenda oledzeretsa amangowonjezera liwiro limene wodwalayo akupita kumapeto kwa chiwindikiro ndipo potsirizira pake imfa.
• Mafuta ochepa / zakudya za sodium. Zakudya zingathandize kuchepetsa matenda a cirrhosis. Chakudya chochepa kwambiri cha mafuta ndi sodium chingathandize kuchepetsa kuwonjezereka kwa matenda ndipo zingachepetse kusungira kwa madzi omwe amachititsa chiwindi. Kwa anthu omwe amafuna kuchotsedwa kwa madzi kuchokera m'mimba, ndondomeko yotchedwa paracentesis, chakudya chingakhudze momwe kawirikawiri ndondomeko imafunira mwa kuchepetsa kusungidwa kwa madzi.
• Supplementation. Anthu ena omwe ali ndi matenda oledzeretsa oledzeretsa amakhala osoŵa zakudya kwambiri ndipo adzawona kusintha kwa chikhalidwe chawo ndi kuwonjezeka kwa mavitamini ndi minerals kuwonjezera pa zakudya monga mwadongosolo ndi wothandizira zaumoyo. Gwero la kusowa kwa zakudya m'thupi ndilo kusowa kwa zakudya monga chakudya, monga momwe anthu ena omwe ali ndi chiwerewere choledzeretsa amadya pang'ono ndikudya makilogalamu awo mowa mwauchidakwa. Kwa ena, zakudya zoperewera zabwino kapena zinthu zina zingayambitse kusowa kwa zakudya m'thupi.
• Makilogalamu okwanira. Kwa odwala omwe ali ndi matenda aakulu ndi njala yosauka, pangakhale koyenera kuwonjezera zakudya ndi zakumwa monga Kuonetsetsa kapena Kuwonjezera. Ngati wodwala sangathe kudya zakudya zokwanira zofunikira za thupi, kawirikawiri makilogalamu 2,000 kapena ochulukirapo, angafune kugwiritsira ntchito chubu kuti awonjezere kuchuluka kwa mavitamini omwe akuwatenga. kwa odwala ena aliwonse ali ndi chakudya cholandiridwa ngati akuvutika kuti azipeza zakudya zokwanira.
• Kuwedza kwa chiwindi. Chithandizo chimodzi chowona cha cirrhosis, mosasamala chomwe chimayambitsa, ndi kuika chiwindi. Kuwombera kumakhala kovuta kwambiri kwa anthu omwe ali ndi chiwindi chakumwa chifukwa chakuti ayenera kupewa kumwa mowa kwa nthawi ndithu - kawirikawiri miyezi 6 kapena kupitilira - kuti ayenere kusamba. Izi zikhoza kukhala zovuta kwambiri, ndipo anthu ambiri sangakwanitse kufera chifukwa sakulephera kumwa mowa.

Wodwalayo ayeneranso kumwa mowa atalandira kachilombo katsopano, monga chiwalo chatsopano chikhoza kuonongeka ndi mowa ngakhale mofulumira kuposa chiwindi choyambirira chifukwa cha mankhwala oyenera kupewa kupewa.

Mawu Ochokera

Maddrey Score ndi chinthu chimodzi chimene anthu ogwiritsa ntchito amachigwiritsa ntchito powasamalira odwala omwe amapezeka kuti ali ndi chiwindi cha uchidakwa. Maphunzirowa amathandiza kudziwa kuopsa kwake kwa chiwongolero ndipo amapereka chitsimikizo chakuti ngati steroid ayenera kugwiritsidwa ntchito kwa munthuyo. Ngakhale izi ndi mbali yofunikira ya chisamaliro choperekedwa, zifukwa zina ndi zofunika kwambiri kapena zofunika kwambiri, monga ngati wodwalayo akupitiriza kumwa mowa, amalola kuti atsatire malangizo ndi zinthu zina zomwe sangasinthe, monga zaka.

> Zotsatira:

> Chizungulire. Kusaka. https://emedicine.medscape.com/article/185856-overview

> Kodi matendawa ndi otani? NIDDK. https://www.niddk.nih.gov/health-information/liver-disease/cirrhosis