Mankhwala Angakhale ndi Chakudya, Chakudya Chakudya, Mankhwala, ndi Opaleshoni
Matenda afupipafupi (SBS) ndi chikhalidwe chimene chikhoza kuchitika pamene matumbo aang'ono kwambiri atachotsedwa kapena osamwa zakudya monga momwe ziyenera kukhalira. Mavitamini ndi mchere zomwe thupi limasowa zimatengedwa kuchokera ku chakudya pamene zimadutsa mumatumbo aang'ono. Ngati matumbo aang'ono ndi ofooka kwambiri kuti asatenge chakudya chokwanira, kapena ngati mbali zake sizingathe kutenga zakudya zokha, zingayambitse kusowa kwa zakudya m'thupi.
SBS ikhoza kukhala matenda aakulu omwe amafunikira nthawi zonse oyang'anira, koma nthawi zina ndizochepa zomwe zingayankhe mankhwala.
Malingana ndi Crohn's ndi Colitis Foundation , anthu pakati pa 10,000 ndi 20,000 ku United States amakhala ndi SBS. Chithandizo cha SBS chapita patsogolo m'zaka zaposachedwapa, kusintha miyoyo ya anthu omwe ali ndi vutoli. Nthawi zina, chithandizo chingathandize kuwonjezera ntchito ya matumbo kotero kuti imatenga zakudya zambiri. Zakudya zopatsa thanzi, mankhwala, ndi opaleshoni zingagwiritsidwe ntchito pochitira anthu ndi SBS. Anthu omwe ali ndi matenda a Crohn omwe akhala akuchitidwa opaleshoni angapo ndipo akhoza kusoweka pafupi theka kapena kuposerapo m'mimba mwawo akhoza kupanga SBS.
Kufunika kwa Utumbo Wang'ono Wamatumbo
Ntchito yaikulu ya m'matumbo aang'ono, omwe ali mbali ya zakudya zamagetsi , ndikutenga mavitamini ndi mchere kuchokera ku chakudya. Utumbo wawung'ono uli ngati chubu, ndipo nthawi zambiri amakhala pafupifupi mamita 20.
Ili m'mimba yomwe imayikidwa pakati pa mimba ndi matumbo akulu m'magazi. Chakudya chimachokera m'mimba ndikudutsa m'mimba mwachinyamatako komwe mavitamini amatengedwa, asanalowe mpaka kumtunda kumene madzi amatha.
Utumbo wawung'ono umafotokozedwa kukhala ndi magawo atatu akuluakulu ndipo zakudya zamtundu uliwonse zimatengedwa mu gawo lirilonse.
Pachifukwa ichi, ndizofunika kuti odwala omwe ali ndi SBS adziwe kuti mbali ziti za m'mimba mwachangu zachotsedwa kudzera opaleshoni kapena sizigwira ntchito komanso ziyenera kukhala. Chitsulo chimachokera mu gawo loyamba, duodenum, shuga, amino acid, ndi mafuta acids m'gawo lachiwiri, jejunum, ndi B12, bile acid, ndi ma vitamini ena amalowa mu gawo lachitatu ndi lotsiriza, leamu.
Mavitamini omwe amathandiza kudyetsa chakudya amapangidwa m'mapangidwe ndipo amalowa m'mimba yaing'ono. Chakudya chimathyoledwa ndi mavitamini ndi zakudya zomwe zimatengedwa ndi zipangizo zina zotchedwa villi zomwe ziri pamakoma apakati a matumbo aang'ono.
Zifukwa za Mafupipafupi Ochepa
Kukhala ndi matenda a Crohn ndi magetsi angapo pamatumbo ang'onoang'ono akhoza kuika munthu pangozi kwa SBS. SBS ikhozanso kuchitika pamene matumbo aang'ono sakugwira ntchito bwino osati pokhapokha ngati akusowa kwambiri (monga omwe amabadwa ndi matumbo pang'ono) kapena achotsedwa. Zinthu zina zomwe zimagwirizanitsidwa ndi SBS ndizo:
- Zomwe zimapangidwira: Minofu yopangidwa pambuyo pa opaleshoni ya m'mimba
- Khansa
- Kulepheretsa kusokoneza ubongo: m'mimba mwachinyama umachita ngati kuti pali kutsekedwa
- Matenda a Crohn omwe amagwiritsa ntchito njira zambiri
- Matenda osagwirizana monga congenital short disease, matenda a gastroschisis, matenda a Hirschspring, meconium ileus, microvilius kuphatikiza matenda, midgut volvulus, ndi omphalocele.
- Kuwonongeka kwa matumbo aang'ono opangidwa ndi mazira (radiation enteritis)
- Kuonongeka ndi matenda kapena kuvulala kwa mitsempha ya magazi (kuvulala koopsa)
- Ischemia: kusowa kwa magazi kapena chotengera cha magazi choletsedwa
- Kutengera: pamene gawo la m'mimba limapinda ngati telescope
- Necrotizing enterocolitis: vuto limene lingakhalepo m'mwana asanakwane
- Volvulus: kupotoza gawo lina la m'mimba
- Kuchita opaleshoni yoperewera kwa thupi
- Zovuta
Zizindikiro za Mafupipafupi Ochepa
Ngati chinachake chikuyenda molakwika, mwina chifukwa chakuti matumbo aang'ono sali okwanira kapena chifukwa chaleka kugwira ntchito moyenera, chakudya sichinagwedezeke ndi kugwiritsidwa ntchito moyenera monga momwe chiyenera kukhalira, ndipo pakhoza kukhala zizindikiro ndi zizindikiro za SBS onse kapepala kakang'ono ka m'mimba komanso thupi lonse. Kutsekula m'mimba nthawi zambiri ndi chimodzi mwa zizindikiro zowonjezereka ndipo, zomveka, zingayambitse kulemera kwa thupi ndi kuchepa kwa madzi.
Zina mwa zizindikiro ndi zizindikiro za matenda afupipafupi angaphatikizepo:
- Kuponda
- Kutseka
- Kutsekula m'mimba
- Edema (kutupa) m'milingo
- Kutopa
- Kuthamangitsani
- Kusadya zakudya m'thupi
- Kufooka
- Kutaya thupi
Kusadya zakudya m'thupi ndi chizindikiro cha SBS chomwe chidzakhala chifukwa cha kusalandira zakudya zokwanira kuchokera ku chimbudzi cha chakudya. Kusadya zakudya m'thupi kumakhudza thupi lonse ndipo sikudzangowonjezera kukhala ndi zizindikiro monga kutopa ndi kutaya, koma kungayambitse mavuto ena monga tsitsi ndi khungu louma komanso mavuto aakulu monga kutupa (edema) ndi kutaya minofu ya minofu.
Kulephera kwa Vitamini
Kulephera kwa vitamini kungatheke ndi SBS malingana ndi chigawo china cha katumbo kamene kamakhudzidwa ndi matendawa. Mavitamini ena amatha kukhala ndi zizindikiro zosiyanasiyana. Ngati palibe vitamini chifukwa chakuti sagwiritsidwa ntchito, gulu lachipatala likhoza kuthana ndi vutoli ndi zowonjezera mavitamini kuti likhale ndi mavitamini omwewo m'thupi.
Zina mwazofala kwambiri za vitamini ndi izi:
- Iron : Iron imalowa mu duodenum, choncho ngati chigawo chimenecho cha katumbu kakang'ono kamakhudzidwa, zotsatira zake zingakhale kusowa kwachitsulo. Kusakhala ndi chitsulo chokwanira kungayambitse kuchepa kwa magazi m'thupi, komwe kungayambitse kutopa.
- Vitamini A: Vitamini A imathandiza kuti maso ndi khungu likhale ndi thanzi labwino, zomwe zikutanthauza kuti kusowa kwa zakudya zamtunduwu kungabweretse mavuto a maso (monga ubweya wa usiku) ndi zinthu monga khungu. Mavuto aakulu kwambiri amatha chifukwa chosowa kwambiri, kuphatikizapo kutaya kwa cornea, matenda opuma, komanso kuphulika kwa khungu. Vitamini A idzatengedwera mu jejunum, choncho ngati gawolo la m'matumbo silikuyenda bwino, kusowa kwa vitamini A kungatheke.
- Vitamini B: Mavitamini B amapezeka mu jejunamu ndi vitamini B12 amapezeka mu gawo lotsiriza la leamu, lotchedwa terminal leum. Kuperewera kwa vitamini B kungapangitse zizindikiro monga edema, kupweteka kwa mtima, ndi kuwonongeka kwa mitsempha (nthenda ya ubongo).
- Vitamini D : Vitamini D ndi vitamini D othandizira calcium kotero kuti kutaya vitamini D kwa nthawi yayitali kungayambitse matenda monga mafupa a mitsempha. Mavitamini otsika a vitamini D angayambitsenso minofu ndi ming'oma kapena mapepala ndi masingano (paresthesias). Jejunamu ndi pamene vitamini D imatengedwa ndi thupi m'matumbo aang'ono.
- Vitamini E: Kulephera kwa Vitamini E sikuli wamba kunja kwa dziko lotukuka, koma kwa anthu omwe ali ndi SBS komwe jekisamu imakhudzidwa, kusowa kwa vitamini kungatheke. Kuperewera kwa vitamini E kungapangitse kuti ziphuphu ndi singano zisamveke mavuto ndi masomphenya, komanso mavuto monga mkokomo.
- Vitamini K: Vitamini K imathandiza magazi, choncho kusowa kwa vitamini kumatha kuvutika ndi kuvulaza mosavuta komanso kutuluka magazi ambiri. Pamodzi ndi mavitamini ena, vitamini K imatengedwa mu jejunum, kotero kuchepa kumatha ngati kachilombo kameneka kamakhudzidwa ndi SBS.
- Zinc: Kutaya kwa Zinc sikuli wamba kwa anthu abwinobwino koma kusowa kwa mchere kungatheke pamene SBS ikukhudzidwa ndi kuyamwa kwake. Kulephera kwa Zinc ndi kovuta kufotokozera koma kungayambitse kusowa kwa njala ndi kuchepetsa mphamvu ya chitetezo cha thupi (zomwe zingatanthauze kukhala ndi chimfine kapena chimfine).
Kuzindikira Matenda Ochepa Ochepa
Nthawi zina, SBS ikhoza kukhala pangozi yomwe ili patebulo chifukwa cha opaleshoni ya m'mimba (monga anthu omwe ali ndi matenda a Crohn omwe amawachitira opaleshoni angapo), choncho matendawa sangatanthauze kuyesedwa kwakukulu. Muzochitika zina, zingakhale zofunikira kwa dokotala komanso / kapena akatswiri kuyang'ana zotsatira za mayesero osiyanasiyana kuti azindikire kuti SBS ndi vuto.
Mayesero a magazi amagwiritsidwa ntchito kuti onse azindikire ndikuyang'anira SBS. Kuchuluka kwa maselo a m'magazi (CBC) kungasonyeze ngati pali matenda a chiwindi, mavitamini a chiwindi angasonyeze ngati kuwonongeka kwa chiwindi kungakhaleko, ndipo magulu aumulungu angasonyeze ngati pali vuto ndi ntchito ya impso. Mayeso a magazi angagwiritsidwenso ntchito kuti adziwe ngati pali zochepa za vitamini.
Zina mwa mayesero omwe angagwiritsidwe ntchito kuti azindikire SBS ndi awa:
- Kujambula kwa computerized axial tomography (CAT) : Kuyesedwa komwe kumachitidwa ndi dye yosiyana yomwe imaperekedwa kudzera mwa IV yomwe ingasonyeze vuto ndi chiwindi ndi matumbo.
- Kujambula kwa computerized tomography (CT) : Kusinkhasinkha kwa mimba komwe kumapereka mtanda wambiri wa thupi.
- Kujambula kwa maginito (MRI) : Maginito amagwiritsidwa ntchito kupanga chithunzi cha mimba makamaka matumbo aang'ono.
- Ultrasound: An ultrasound ya mimba ingagwiritsidwe ntchito kuyang'ana nkhani ndi bile ducts kapena gallbladder.
- Mndandanda Wopambana wa GI : Mtundu wa x-ray umene watengedwa mimba mutatha kumwa yanum yothetsera yomwe imathandiza kuona zomwe zikuchitika m'mwamba.
- X-rays : Mimba yammimba ya mimba ingagwiritsidwe ntchito poyang'ana mazembera kapena mavuto ena m'mimba.
Kuchiza
Mankhwala a SBS angaphatikizepo kudya, mankhwala, kusintha kwa zakudya, vitamini supplement, ndi opaleshoni. Mtundu wa chithandizo womwe umagwiritsidwa ntchito udzakhala wosiyana chifukwa wodwala aliyense yemwe ali ndi SBS adzakhala ndi zosowa zosiyanasiyana malinga ndi mankhwalawa. Pakhoza kukhala zifukwa zina zomwe zimagwira ntchito posankha chithandizo, monga zofuna za wodwala, zofunikira zina zomwe wodwala angakhale nazo, komanso ngati wodwalayo ali wamkulu kapena mwana.
Zakudya
Mavuto akuluakulu a SBS, kusintha kwa zakudya komanso kuwonjezera mavitamini ndi mavitamini ena amathandiza kuti zowonjezera zowonjezera zimakhudzidwe ndi thupi. Odwala amauzidwa kuti adye zakudya zosiyanasiyana monga kuloledwa, koma zakudya zimatha kugwiritsidwa ntchito ndi katswiri wamaphunziro kuti azisamalira kwambiri zakudya zomwe zimafunikira kwambiri. Kudya zakudya zingapo zing'onozing'ono patsiku m'malo mochepetsera chakudya chochepa kungakhale kosavuta kwa wodwala ndi SBS. Njira yothetsera madzi m'thupi (ORS) ingathenso kugwiritsidwa ntchito kuti mukhale ndi thupi labwino la madzi ndi electrolyte.
Kusintha kwa m'mimba
Matumbo aang'ono amatha kusinthasintha pakapita nthawi ndipo akhoza kuyamba kuyamwa zakudya zambiri, kuphatikizapo zigawo zomwe sizikuyenda bwino kapena zikusowa. Mankhwala ena amathandizira njirayi, ndipo pamene nthawi yowonjezera m'mimba imatha kumvetsetsa, ikhoza kutenga pakati pa miyezi 6 mpaka 2 mpaka 3.
Nthendayi Yonse ya Parenteral (TPN)
Nthawi zambiri SBS, odwala amaikidwa pa mawonekedwe a TPN, omwe ndi zakudya zoperekedwa kudzera mwa IV. Chifukwa chakuti zakudya zimenezi sizidutsa m'mimba, zimalola kuti zakudya monga shuga, mapuloteni, mafuta, mavitamini, ndi mchere zimalowe m'magazi ndikugwiritsidwa ntchito ndi thupi. Kugwiritsira ntchito TPN kungakhale kosakhalitsa kapena kungakhale kosatha, malingana ndi momwe SBS ikukhudzira thupi.
Nthawi zina, chakudya chimaperekedwa kudzera mu chubu lapadera chomwe chimalowetsedwa mmimba kapena m'mimba, yomwe imatchedwa tizilombo toyambitsa matenda. Anthu omwe akulandira chakudya chamagazi akhoza kapena sangathe kudya chakudya pakamwa. TPN ingaperekedwe kwa odwala akakhala kuchipatala ndipo angaperekedwe kunyumba pamene wodwala ali wokhazikika kuti athe kumasulidwa.
Mankhwala
Mitundu yosiyanasiyana ya mankhwala imagwiritsidwa ntchito pochiza SBS kuti zithandize matumbo kulandira zakudya zambiri, kuchepetsa kutsegula m'mimba, ndi kuchepetsa kupanga m'mimba ya asidi. Mankhwala otsekula m'mimba omwe angagwiritsidwe ntchito amagwiritsa ntchito diphenoxylate / atropine, loperamide, somatostatin, ndipo, kawirikawiri, codeine ndi tincture ya opiamu. Zikuganiza kuti mimba ya mimba imatha kuchepetsa kuthamanga kwa m'mimba, komanso kusokoneza, komanso kuchepetsa mavitamini a acid acid (histamine-2 receptor blockers ndi proton pump inhibitors ) zomwe zimachepetsa kapena kuletsa kupanga mimba ya asidi zingagwiritsidwe ntchito, kuphatikizapo famotidine, lansoprazole, omeprazole, ndi ranitidine.
Kuchuluka kwa mahomoni, somatropin, komanso kuphatikizapo zakudya zovuta kwambiri, kungapangitse kuti thupi likhale ndi zakudya zamatumbo ndipo zingagwiritsidwe ntchito kwa odwala omwe amalandira TPN. Mafuta amadzimadzi okhala omanga monga cholestyramine angagwiritsidwe ntchito kuchepetsa mchere wa bile, zomwe zingathandize kuchepetsa kutsekula m'mimba. Mavitamini a pancretic angaperekedwe kuwonjezera kuwonongeka kwa mafuta, mapuloteni, ndi chakudya cha chakudya pamene chimadutsa mumatumbo aang'ono. Gulu la pepalade la glucagon 2, teduglutide, lingaperekedwe kwa akuluakulu omwe amalandira TPN chifukwa chasonyezedwa kuti yowonjezera ma mucasa m'matumbo ang'onoang'ono, ndipo potero amathandiza zakudya zambiri kuti zidziwe.
Opaleshoni
Ngakhale kuti zingawoneke ngati zachilendo, opaleshoni nthawi zina amagwiritsidwa ntchito pochiza SBS. Mitundu yochepa ya opaleshoni ikhoza kugwiritsidwa ntchito kuonjezera kutalika kwa thumba laling'onoting'ono, lomwe limaphatikizapo ndondomeko ya Bianchi ndi njira yowonongeka yopangidwira (STEP). Mu opaleshoni yonseyi, zotsatira zake ndi gawo lalikulu la matumbo omwe ali ochepa kwambiri, koma chakudya chidzathera nthawi yochulukirapo, ndipo zakudya zambiri zimatha kuzipeza.
Njira ina yopaleshoni yomwe si yachilendo ndipo kawirikawiri ndi kwa omwe ali ndi mavuto ochokera ku SBS-monga chiwindi chosalimba ndi matenda-ndikumatenda m'mimba. Mwa njirayi, amphasana aang'ono opatsirana amaperekedwa kwa wodwalayo ndi SBS. Kuchita opaleshoniyi ndi mwatsoka kumayanjananso ndi mavuto ambiri kuphatikizapo kuthekera kwa kukanidwa. Anthu omwe alandira kabotolo kakang'ono adzafunikanso kutenga mankhwala osokoneza bongo kuti athe kuchepetsa zotsatira za kukanidwa.
Kugwedeza Kwabakiteriya Kakang'ono Kwambiri
Matumbo aang'ono samakhala ndi mabakiteriya ambiri, koma anthu ena omwe ali ndi SBS akhoza kukula kwambiri mabakiteriyawa, omwe amatchedwa kukula kwa mabakiteriya aang'ono m'mimba . Matendawa amachititsa kuti zizindikiro zowonongeka, kutsekula m'mimba, kunyowa, ndi kusanza. Matendawa amatha kupangitsa SBS kusokoneza komanso kuchepetsa kusintha kwa m'mimba. Chithandizochi chingaphatikizepo mankhwala opha tizilombo kuti athetse kukula kwa mabakiteriya m'matumbo aang'ono komanso kuthana ndi zinthu zina zomwe zingayambitse vutoli. Maantibiotiki angaperekedwe kuti akalimbikitse regrowth ya mabakiteriya othandiza pambuyo pochiza mankhwala ndi maantibayotiki.
Mawu Ochokera
SBS ndi chikhalidwe chimene sichikhudza mbali zonse za thupi, koma ziwalo zonse za moyo wa wodwala. Mankhwalawa angathe kuchepetsa zotsatira za SBS pa thupi ndi kupereka moyo wapamwamba kwa odwala. Ngakhalenso TPN ikhoza kuchitidwa kunja kwa chipatala, ngakhale ngakhale mutatuluka m'nyumba patsiku kapena poyenda.
Ngakhale zili choncho, vutoli likubwera ndi mavuto akuluakulu ndikuyika gulu lothandizira pa malo omwe lidzakhala lovuta kuti liziyendetsa bwino. Osati akatswiri okha monga gastroenterologist, dokotala wamkulu wa opaleshoni, ndi katswiri wamaphunziro, komabe gulu la abwenzi, achibale, odwala ena, ndi dokotala wa zamaganizo. Munthu yemwe ali ndi SBS akhoza kukhala ndi mavuto ambiri omwe ali ndi vutoli, zomwe ayenera kuyembekezera. Kuyesetsa kupeza thandizo ndi kuthandizidwa ndikukhala pafupi kwambiri ndi chithandizo chothandizira chithandizo chidzakupatsani mwayi wapadera wogwiritsira ntchito mankhwala abwino komanso kukhala ndi moyo wabwino kwambiri ndi SBS.
> Zotsatira:
> Crohn's ndi Colitis Foundation. "Short Bowel Syndrome ndi Matenda a Crohn." CrohnsColitisFoundation.org Jul 2013.
> Johnson LE. "Kutaya kwa Vitamini, Kudalira, ndi Kuopsa: Vitamini A." Merck Manual Sept 2016.
> Johnson LE. "Kutha kwa Vitamin, Dependency, and Toxicity: Vitamini E." Merck Manual Sept 2016.
> Johnson LE. "Kutha kwa Vitamin, Dependency, and Toxicity: Vitamini K." Merck Manual Sept 2016.
> Chitukuko cha National Diabetes ndi Digestive and Kidney Diseases (NIDDK). "Mafupipafupi a Bowel Syndrome." National Institute of Diabetes ndi Digestive and Impney Diseases Health Information Center.