Kutsekula ndi chimodzi mwa zifukwa zambiri zomwe zingayambitse
Angioedema ndi kutupa kwa minofu yomwe imakhala pansi pa khungu kapena mu nsalu. Kutupa kumakhudza kwambiri nkhope, lilime, milomo, mmero, manja, ndi miyendo koma zingakhale zoopsa komanso zingasokoneze moyo ngati zimapezeka pamphuno, mapapo, kapena m'mimba. Angioedema kawirikawiri imayambitsidwa ndi zovuta koma zimayambitsanso chifukwa cha mankhwala osokoneza bongo, matenda, khansara, majini, komanso nkhawa.
Chithandizo chimadalira chifukwa chomwe chimayambitsa, koma chimaphatikizapo antihistamines, steroids, ndi kupeŵa zovuta zomwe zimadziwika.
Zizindikiro
Ngakhale angioedema ikugwirizana kwambiri ndi ming†™ oma ( urticaria ) poti amagawana zofanana, zizindikiro zimasiyana.
Angioedema amapezeka m'magulu ang'onoang'ono a khungu (wotchedwa dermis ndi epidermis). Momwemo, zimayambitsa kutupa kwakukulu, komwe kumachitika nthawi yaitali kuposa ming'oma. Mosiyana ndi izi, urticaria imaphatikizapo epidermis ndi udzu ndipo imadziwika ndi magudumu okwera ndi malire owonetseredwa bwino.
Ndi angioedema, kutupa kungayambike mkati mwa mphindi kapena kumapitirira maola ambiri. Malo opweteka a khungu nthawi zambiri si ovuta (pokhapokha ataphatikizidwa ndi urticaria) koma nthawi zambiri amatha kuyaka, kuyimba, kapena kupweteka. Kutupa kumatha kwa maola kapena masiku angapo. Pamene kutupa kumatsimikiziranso, khungu likhoza kuwonekera mwachibadwa popanda kuthamanga, kupukuta, kupweteka, kapena kuvunda.
Mitundu ina ya angioedema ikhoza kukhala yaikulu kwambiri, makamaka ngati imadutsa pamtunda, nkhope, kapena thunthu. Zina mwazovuta:
- Matenda a angioedema amachititsa kusanza kwaukali, kupweteka kwambiri pakatikati, ndi kuchepa kwa madzi (chifukwa cholephera kusunga madzi).
- Angioedem ya mapapo amatha kuyambitsa kupuma, kupuma pang'ono, ndi kutsekeka kwa pandege.
- Angioedema ya larynx (mawu a bokosi) angayambitse kuphepetsedwa ndi imfa.
Zimayambitsa
Kuchokera pamtundu waukulu, angioedema imayambitsidwa ndi njira yowonongeka ya chitetezo cha mthupi momwe mankhwala otchedwa histamine kapena bradykinins amamasulidwa m'magazi.
Mbiri , yomwe imakhala mbali ya chitetezo cha mthupi, imayambitsa mitsempha ya mthupi kotero kuti maselo a chitetezo amatha kuyandikira malo a chovulala. Bradykinins imachititsanso kuti mitsempha ya magazi ichepetse, koma chitani kuti muyambe kugwira ntchito monga thupi monga kupuma kwa magazi ndi kupuma. Akawamasulidwa mopanda malire, kaya paokha kapena palimodzi, mankhwalawa angayambitse kutukumuka kwathu monga angioedema.
Angioedema nthawi zambiri amasankhidwa kukhala amodzi mwa magulu awiri:
Angeededema Angeedema
Kupeza angioedema (AAE) kungayambitsidwe ndi immunologic (yokhudzana ndi chitetezo cha mthupi) ndi zina zomwe sizimayambitsa matenda. Zikuphatikizapo:
- Zimayambitsa mankhwala , zakudya , tizilombo toyambitsa tizilombo , kapena kukhudzana ndi zinthu monga latex kapena nickel
- Mankhwala osagwirizana ndi mankhwala osokoneza bongo, monga opiates (makamaka codeine ndi morphine) ndi mankhwala osagwiritsidwa ntchito poletsa kutupa, NSAID (makamaka aspirin)
- Kuwotcha thupi monga kutentha, kuzizira, kuchita masewera olimbitsa thupi, kuthamangitsidwa , kutuluka dzuwa, komanso kupsinjika maganizo
- Kutsegula matenda ngati lupus ndi Hashimoto's thyroiditis
- Khansa monga lymphoma ndi myeloma
- Matenda opatsirana monga kachilombo, HIV, cytomegalovirus , ndi Epstein-Barr
Padzakhalanso milandu yomwe palibe chifukwa chodziwika. Izi zimatchulidwa kuti idiopathic angioedema.
Chronic idiopathic angioedema ndi chikhalidwe chomwe chimakhudza amayi kuposa amuna. Ena amakhulupirira kuti zimakhudzana ndi msambo, momwe zimayambira mu estrogen nthawi zambiri zimakhala zikuphatikizapo kuwuka kwa bradykinins.
Angededicated Angioedema
Angereded angioedema (HAE) ndi matenda aakulu a autosomal , kutanthauza kuti mungathe kulandira jini yovuta kuchokera kwa kholo limodzi. Zosintha za jini zimayambitsa kuchulukitsana kwa mabakiteriya ndipo zimakhudza zamoyo zonse, kuphatikizapo khungu, mapapo, mtima, ndi m'mimba.
Ngakhale kuti HAE ingayambitsidwe ndi nkhawa kapena kuvulala, zovuta zambiri sizidziwika chifukwa. Kubwereza kumakhala kofala ndipo kumatha kukhala masiku awiri kapena asanu. ACE inhibitors ndi njira zowonongeka za estrogen , zomwe zonsezi zingakhudze miyeso ya bradykinin, imadziwika kuti iwonjezere kuchuluka kwa chiwopsezo.
HAE ndi yosawerengeka, yomwe imapezeka m'modzi yekha mwa anthu 50,000, ndipo nthawi zambiri amaganiza kuti antihistamines kapena corticosteroids satha kupereka chithandizo cha zizindikiro.
Kudziwa
Angioedema kawirikawiri imapezeka kuti imachokera kumayendedwe ake a kuchipatala komanso kubwereza mbiri yanu yachipatala ndikutsatira zizindikiro.
Ngati mukuganiza kuti mukudwala, dokotala wanu angakuuzeni kuti muyesedwe kuti muzindikire kuti causal trigger (allergen). Izi zingaphatikizepo chiyeso choyambitsa khungu (momwe kachilombo kakang'ono kameneka kakuyidwira pansi pa khungu), patch test (pogwiritsa ntchito chikwama chophatikizapo mankhwala), kapena kuyesedwa kwa magazi kuti muwone ngati antibiotic yodwala ili m'magazi anu .
Mayeso a magazi angagwiritsidwe ntchito kuti azindikire HAE. Ngati zifukwa zina zonse za angioedema sizichotsedwa, dokotala wanu angasankhe kuwona mlingo wa chinthu chotchedwa C1 esterase inhibitor , chomwe chimayang'anira bradykinins , m'magazi anu. Anthu omwe ali ndi HAE sangathe kutulutsa mapuloteniwa, choncho chiwerengero chochepa cha C1 esterase inhibitor chimawoneka ngati chisonyezero cholimba cha angioedema.
Chithandizo
Njira imodzi yabwino yopezera zowonongeka m'tsogolomu ndi kupewa chodziwika chilichonse. Ngati izi sizingatheke, chithandizochi chiyenera kuwonetsetsa kuti chitetezo cha mthupi chitetezedwe pofuna kuchepetsa kuchuluka kwa histamine kapena bradykinins m'magazi anu.
Zina mwazochita:
- Mankhwala a antihistamines amadziwika kuti azitha kugwiritsira ntchito angioedema. Zyrtec (cetirizine) ndizovuta kwambiri kuti ziwonongeke mwamphamvu koma zingathenso kuthandizidwa ngati mlingo wotsika, wa usiku kuti upumule.
- Ngati kuyezetsa kuyesera kukutsimikizirani kuti mukungokhalira kugwidwa ndi matenda enaake, zizindikiro zowonjezereka zingaperekedwe kuti pang'onopang'ono muchepetse kukhudzidwa kwanu.
- Mavuto achilendo angayankhe bwino ku machitidwe okhwima a corticosteroids operekedwa ndi jekeseni. Prednisone ndi imodzi mwa njira zomwe anthu amatha kuzigwiritsa ntchito koma amagwiritsidwa ntchito pokhapokha potsitsimutsidwa kwafupipafupi chifukwa cha chiopsezo cha zotsatirapo .
- HAE ikhoza kuchiritsidwa ndi mankhwala Kalbitor (osasinthika) kapena Firazyr (icatibant). Kalibor imaletsa mavitamini omwe amachititsa kupanga bradykinins, pamene Firazyr imateteza bradykinins kuti ikhale yosakanikirana ndi mapepala opangidwira. Nthesa, kutopa, kupweteka mutu, ndi kutsekula m'mimba ndizovuta.
- Anthu omwe ali ndi HAE angapezenso mpumulo mwa kutenga androgens (mahomoni amphongo) monga methyltestosterone ndi danazol. Izi zimagwira ntchito pochotsa magulu a bradykinins omwe amazungulira m'magazi. Kugwiritsira ntchito nthawi yaitali kungayambitse masculinizing kuzimayi (kuphatikizapo tsitsi la mwamuna ndi tsitsi la nkhope) ndi kukulitsa mawere (gynecomastia) mwa amuna.
- Angioedema yaikulu ya larynx iyenera kuchiritsidwa ndi jekeseni mwadzidzidzi wa epinephrine (adrenaline). Anthu omwe amadziwika ndi zovuta zambiri nthawi zambiri amafunika kunyamula injini ya epinephrine yomwe imatumizidwa, yotchedwa EpiPen , pangozi.
Mawu Ochokera
Angioedema ikhoza kukhala yovuta, makamaka ngati kutupa kuli kwakukulu kapena kobwerezabwereza. Ngakhale palibe zizindikiro zina zooneka, muyenera kuwona dokotala ngati kutupa kukupitirira kwa masiku angapo.
Ngati angioedema ikukhulupiriridwa kuti ndi zokhudzana ndi zokhudzana ndi zokhudzana ndi zokhudzana ndi zokhudzana ndi zowononga koma simudziwa chifukwa chake, sungani kalatayi kuti mulembere zakudya zilizonse zomwe mudya kapena zozizwitsa zomwe mumakhala nazo. Kuchita zimenezi kungathandize kuchepetsa kufufuza ndikuthandizani kupewa zovuta.
Komabe, ngati mukuyamba kupweteka kwa mmero ndi kupuma kupweteka kwa mtundu uliwonse, pitani 911 kapena wina akakufulumizitseni chipinda chapafupi chapafupi.
> Chitsime:
> Bernstein, J ;; Cremonesi, P .; Hoffmann, T, et al. Angioedema mu Dipatimenti yowopsa: chithandizo chothandizira kusamvana ndi kusamalidwa. Int J Emerg Med. 2017; 10 (1): 15. DOI: 10.1186 / s12245-017-0141-z.
> Bernstein, J ;; Lang, D ;; Khan, D. et al. Kusanthula ndi kuyang'anira urticaria yovuta komanso yosasintha: 2014. J Zachilombo Zamtundu wa Immunol. 2014; 133 (5): 1270-7.