So wo esophagus no mu apaapae? (Esophageal Rupture) Eyi yɛ aniberesɛm, momma yɛnhwehwɛ nsɛm no mu nsɛm!

So woanya wo koko mu yaw kɛse mpofirim, ɛyɛ den sɛ wobɛmene, na ɛyɛ den sɛ wobɛhome? Mmere a ɛtete saa mu no, yensusuw ho mpo, nanso ebetumi ayɛ asiane kɛse. Tebea biako a anibere wom a yɛrebɛka ho asɛm nnɛ ne esophageal rupture, anaa `(Esophageal Rupture)`. Ɛho hia paa sɛ wuhu eyi, efisɛ ayaresa a wɔde ma ntɛm no betumi agye obi nkwa mpo.

Dɛn ne aduannuru a ɛpaapae? Sɛ yɛbɛka no tiawa a...

Esophagus ne tube a ɛde aduan a yedi na yɛnom fi yɛn anom kɔ yɛn yafunu mu. Fa no sɛ ɛte sɛ nsu paipu. Enti, sɛ tokuru, ntetewmu, anaa nsensanee bi wɔ baabiara wɔ saa aduannuru yi fasu mu a, ɛno ne nea yɛfrɛ no aduannoa mu a ɛpaapae.

Afei ebia woredwene sɛ, "Enti dɛn na ɛyɛ kɛse wɔ eyi ho?" Dabi, eyi yɛ tebea a emu yɛ den yiye . Susuw ho hwɛ, yɛn ahurututu no wɔ koko no mu, ahurututu no ntam. Ɛnyɛ aduan a yedi ne nea yɛnom nko, na mmom mmoawa ne nnuru a ɛfa yɛn aduan mu nhyehyɛe ho nso fa saa ahurututu yi mu. Enti, sɛ tokuru bi wɔ ahurututu no mu a, saa nneɛma yi nyinaa betumi aboaboa ano wɔ koko no mu, ahurututu mu, anaa mogya no mu. Sɛ ɛba saa a , nyarewa a emu yɛ den betumi aba, na ebetumi de nkwa ato asiane mu.

Ɛno nti na ɛho hia sɛ wokɔ ayaresabea ntɛm ara, wɔ nnɔnhwerew 24 ntam, sɛ wususuw sɛ wowɔ saa tebea yi a. Ɛtɔ da bi a, wobetumi de ɔkwan bi te sɛ ``Endoscopy'' anaa oprehyɛn ayɛ.

Saa tebea yi abu so dɛn?

Nokwarem no, ahurututu a apaapae yɛ tebea a ɛntaa nsi koraa . Ɛno kyerɛ sɛ ɛnyɛ biribi a obiara nya. Nanso sɛ obi nya bi a, ɛyɛ aniberesɛm yiye, enti ɛho hia sɛ wohu.

Nsonsonoe bɛn na ɛda ahurututu a apaapae ne tebea afoforo yi ntam?

Ɛtɔ mmere bi a nkurɔfo de eyi frafra tebea afoforo a ɛwɔ sɛnkyerɛnne a ɛte saa ara. Momma yɛnhwɛ nea ɛnonom yɛ.

Esophageal a Ɛpaapae ne Mallory-Weiss Tete

``Mallory-Weiss tear`` yɛ tetew anaasɛ akisikuru a ɛwɔ esophagus no mu kɛkɛ. Ɛnfa aduan mu ɔfasu no mu nyinaa , a ɛkyerɛ sɛ ɛnnyɛ tokuru. Nanso, wɔ esophagus a apaapae mu no, ɔfasu no mu atetew koraa.

Esophageal Rupture ne Esophageal Variceal a Ɛpaapae

Eyi ne bere a mogya ntini a ɛwɔ nsu mu no hohoro, ɛtrɛw, na ɛpae. Eyi betumi ama mogya pii atu , nanso ɛnkyerɛ sɛ nsu a ɛkɔ nsu mu no ankasa mu apaapae. Nsuo a ɛkɔ nsuo mu no fasuo no nsɛee.

Ɔkwan bɛn so na saa nusu kwan yi ba?

Mpɛn pii no, aduannoa mu tetew bere a aduannoa no asɛe wɔ ɔkwan bi so no . Saa ɔsɛe yi betumi ayɛ nea efi akyi anaa nea ɛwɔ mu. Ebinom betumi apirapira mpofirim, afi akwanhyia mu, bere a afoforo nso tumi nya nkakrankakra bere a bere kɔ so no.

Ɛntaa mma sɛ aduannuru no betumi apaapae mpofirim esiane nhyɛso a ɛboro so nti. Wɔsan frɛ eyi ``Boerhaave's syndrome.'' Eyi taa ba bere a ɔfe a ɛboro so, ɛkyɛ.

Dɛn na ɛtaa ma obi menewa mu paapae?

Mpɛn pii no, esophageal ruptures fi ɔsɛe a ɛba bere a wɔreyɛ ayaresa (`iatrogenic ruptures`). Eyi betumi asi titiriw wɔ ayaresa ahorow a ɛfa ``endoscope`` a wɔde hyɛ aduan mu no mu. ``Endoscope`` yɛ afiri ketewa bi a wɔde mfoninitwa afiri abata ho. Wɔde fa ano na wɔde hwehwɛ aduannoa mu na wɔsa.

So ntease afoforo wɔ hɔ?

Yiw, nneɛma afoforo pii wɔ hɔ a enti ɛte saa:

• Oprehyɛn a wɔyɛ wɔ aduan mu, titiriw Nissen fundoplication ne myotomy.
• Nhyɛso a ɛboro so: tebea horow a ɛfa nhyɛso a ɛboro so ho, te sɛ ɔfe a ɛkɔ so, nneɛma a emu yɛ duru a wɔma so, akisikuru, anaa awo.
• Ananafo ade anaa nnuru a ano yɛ den a wɔbɛmene: Ɛtɔ mmere bi a mmofra nkumaa tumi mene sika, agode asinasin, anaa sɛ obi nom biribi a ano yɛ den te sɛ acid a, wɔ akwanhyia mu.
• Apirakuru a ɛwɔ aduan no akyi: Nneɛma te sɛ sekan a wɔde apirapira obi, atuo a wɔde apirapira, anaa kar akwanhyia mu akuru.
• Chronic acid reflux (GERD): Yafunu mu acid a ɛsan kɔ esophagus no mu no betumi ama akuru ayɛ, na ɛde nkakrankakra atumi akɔ akyiri na ama esophagus no mu atu.
• Nhyɛso a akisikuru anaa ade foforo bi a akɔhyɛ nsu a ɛkɔ nsu mu no de ba: Eyi betumi ama ntini awuwu (necrosis) wɔ nsu a ɛkɔ nsu mu no mu.

Henanom na wɔwɔ asiane kɛse mu wɔ eyi ho?

Yɛn urethra no yɛ soronko kakra wɔ akwaa afoforo ho. Ɛne sɛ, nea ɛnte sɛ akwaa afoforo no , nsu a ɛkɔ nsu mu no nni biribi a ɛbɔ ho ban (serosal layer) wɔ akyi . Eyi ma ɛyɛ mmerɛw sɛ nsu a ɛkɔ nsu mu no sɛe. Asiane yi yɛ kɛse titiriw sɛ ɔyare mmoawa, ɛho ahonhon, anaa opira bi wɔ nsu a ɛkɔ nsu mu no mu a.

Sɛ woanya tebea horow a edidi so yi mu biara pɛn a, asiane a ɛwɔ hɔ sɛ wubenya uvula a apaapae no betumi ayɛ kɛse kakra:

• Yafunu mu yare a enni sabea (`Asid a ɛsan kɔ nipadua no mu a enni sabea / GERD`).
• Eosinophilic esophagitis (tebea a ɛma ɔfe wɔ aduan mu).
• Esophageal diverticulum (ade ketewaa bi a ɛte sɛ kotoku a ɛpuepue wɔ esophagus no fasu mu).
• Sɛ́ wowɔ kokoram wɔ aduan mu anaasɛ wɔayɛ no mframa a wɔde sa yare a wɔde ma wɔ aduan mu no.
• Nsã a wɔnom boro so.
• Esiane sɛ wɔadi kan ayɛ me menewa oprehyɛn nti.

Dɛn ne eyi ho sɛnkyerɛnne? Momma yɛnhwehwɛ mu pɛpɛɛpɛ!

Nsɛnkyerɛnne a ɛtaa ba a ɛkyerɛ sɛ ahurututu mu apaapae ne:

• Koko mu yaw a emu ye den - Wei ne sɛnkyerɛnne titiriw.
• Ɛyɛ den sɛ wobɛmene .
• Ahome a ɛyɛ tiaa .
• Koma a ɛbɔ ntɛmntɛm .
• Abofono .
• Mogya a wɔfe .
• Mogya mmoroso a ɛba fam .
• Huraeɛ .

Mpɛn pii no, nusu no ba wɔ koko no mfinimfini anaa ase. Wɔ eyi mu no, wɔte ɛyaw no nka wɔ koko mu. Nanso, sɛ nusu no ba wɔ menewa no atifi anaa fam koraa a, wobetumi ate ɛyaw no nka wɔ kɔn, yafunu atifi, anaa mmati nifa so.

Sɛ wowɔ saa sɛnkyerɛnne ahorow yi mu biako anaa nea ɛboro saa a, mmu w’ani ngu so. Ɛho hia sɛ wokɔ oduruyɛfo nkyɛn ntɛm ara, titiriw sɛ saa sɛnkyerɛnne ahorow yi ka wo koko mu yaw a emu yɛ den mpofirim ho a.

Nsɛnnennen a asiane wom bɛn na eyi betumi de aba?

Sɛ yafunu no mu nneɛma ne mmoawa no fa tokuru a ɛwɔ aduan no mu no mu fi adi a, tebea horow a asiane wom nyinaa betumi aba. Fa no sɛ, ɛte sɛ nsukorabea a ɛho agu fĩ a tokuru wɔ mu na nsu rehwie agu baabiara.

• Nnuru a ɛma obi ho hyehye (pleurisy) a ɛwɔ koko no mu no betumi aba.
• Nsu boaboa ano wɔ koko no mu (pleural effusion), na ebetumi apae mpo.
• Mframa betumi akɔhyɛ ahurututu no ntam (`mediastinum`) (`mediastinal emphysema`).
• Saa ɔfe yi betumi ama ntini awuwu (necrosis) wɔ koko no mu anaa ahurututu no ntam.
• Mmoawa bi a ɛde ɔyare mmoawa ba mogya no mu (`septicemia`) betumi aba.
• Sɛ saa ``septiceemia'' tebea yi mu yɛ den a, ebetumi de tebea bi a ɛde nkwa to asiane mu a wɔfrɛ no ``sepsis'' aba, a awiei koraa no ebetumi ama ``septic shock'' ne akwaa a entumi nyɛ adwuma yiye aba.

Eyi nyinaa kyerɛ sɛnea ahurututu a apaapae yɛ aniberesɛm.

Wobɛyɛ dɛn ahu no yiye sɛ wo menewam apaapae? Bere bɛn na ɛsɛ sɛ wokɔ oduruyɛfo nkyɛn?

Sɛ wowɔ adwenem naayɛ bi sɛ wowɔ saa tebea yi a, kɔ ayaresabea dan a wɔhwɛ wɔn a wɔwɔ ayaresa a egye ntɛmpɛ mu (ER) ntɛm ara. Ɛyaw a emu yɛ den, ɛyɛ den sɛ ɔbɛmene, ne ahome a ɛyɛ den nyinaa yɛ sɛnkyerɛnne a ɛkyerɛ sɛ biribi a egye ntɛmpɛ asi. Hwɛ hu sɛ wobɛka sɛnea wo yare no ho sɛnkyerɛnne no fii ase ne nea esii saa bere no ankasa akyerɛ wo duruyɛfo.

Sɛ saa sɛnkyerɛnne ahorow yi fii ase wɔ akwanhyia bi akyi, mene biribi a ɛmfata, anaasɛ ɔfe pii a, ebetumi ayɛ aduan a wɔtetew mu. Oduruyɛfo no bɛhwehwɛ eyi ho adanse.

Ɔkwan bɛn so na nnuruyɛfo hu eyi?

Oduruyɛfo no bɛhyɛ sɛ wɔnyɛ nhwehwɛmu mpɛn pii mfa nhwɛ sɛ nusu bi tetew wɔ aduan no mu anaa.

• Nea edi kan no, wɔtaa yɛ koko X-ray de hwɛ sɛ nsu a ɛretu anaa mframa a ɛretu wɔ koko no mu anaa.
• Nea ɛbɛyɛ na wɔasi eyi so dua no, ebia wɔbɛka akyerɛ wo sɛ wobɛyɛ X-ray nhwehwɛmu foforo a ɛyɛ mmerɛw a wɔfrɛ no esophagogram . Wɔ sɔhwɛ yi mu no, wonom nsu a ɛwɔ kɔla (contrast dye) na wɔyɛ X-ray. Eyi ma wutumi hu wo esophagus no mu yiye. Sɛ nsu a ɛwɔ kɔla yi retu afi tokuru no mu a, wobehu no pefee wɔ X-ray no so. Eyi nso betumi akyerɛ baabi a tokuru no wɔ ne sɛnea ɛretu ntɛmntɛm.
• Ɛtɔ da aEbia wɔbɛkamfo CT scan nso akyerɛ. Eyi ho hia titiriw sɛ wosusuw sɛ ntetewmu wɔ ɛwo kotoku a ɛwɔ soro anaa ase no mu a. CT scan betumi aboa ma wɔahu mmeae a nsu ayɛ kɛse wɔ kɔn anaa yafunu mu na wɔahu sɛ ebia ɛsɛ sɛ woyi fi hɔ anaa.

Dɛn ne ayaresa a wɔde sa eyi?

Ayaresa ahorow pii wɔ hɔ a wɔahyɛ da ayɛ ama eyi:

• Nsu a wɔde fa ntini mu (IV nsu): Wɔde besi nsu a ɛyera esiane mogya a ɛtɔ, ɔfe, anaa nea wontumi nnom nti no ananmu.
• IV nnuru a ekum ɔyare mmoawa ne/anaasɛ nnuru a ekum fungal: Sɛnea ɛbɛyɛ a wobesiw ɔyare biara ano anaasɛ wɔbɛsa ɔyare mmoawa bi a ɛwɔ hɔ dedaw.
• IV aduannuru anaa tube feeding: Worentumi mfa w’ano nmene aduan bere a wɔreyɛ ayaresa no ne kosi sɛ wo ho bɛtɔ wo.
• Nsu a wɔde fa honam ani: Ebia eyi ho behia na ama woayi nsu a ɔyare mmoawa wom a aboaboa ano wɔ wo nipadua mu ntokuru mu no afi hɔ na wɔakum mmoawa. Wo duruyɛfo bɛbɔ mmɔden sɛ obeyi saa nsu yi denam ade anaa afiri a ɔde bɛhyɛ wo moma so ntɛm ara sɛnea obetumi so.
• Endoscopic ayaresa: Wobetumi de endoscope ayɛ nusu nketenkete nketenkete bi a wɔnyɛ oprehyɛn. Endoscope yɛ afiri tenten bi a wɔde mfoninitwa afiri abata ho. Wɔde fa menewa no mu kɔ aduan no mu na wobetumi de nhama, nhama, vacuum sponge, anaa stent asiesie nusu no.
• Oprehyɛn: Ɛsɛ sɛ wɔyɛ nnipa binom oprehyɛn na ama wɔatumi asiesie nusu no tẽẽ. Bere a wɔreyɛ oprehyɛn no, oduruyɛfo a ɔyɛ oprehyɛn no yi nsu a ɛboro so ne ntini a awuwu no fi hɔ. Ɛdenam wo tebea so no, ebia wo oprehyɛn ho oprehyɛn no de ɔkwan bi a ɛnyɛ den pii te sɛ Video-Assisted Thoracoscopic Surgery (VATS) bedi dwuma. Nanso, wɔ tebea horow bi a egye ntɛmpɛ mu no, ebia ɛho behia sɛ wɔyɛ oprehyɛn a wɔabue ano. Eyi ma wotumi kɔ baabi a asɛe no ntɛmntɛm na eye.

So ebetumi aba sɛ wobeguan tebea yi? Dɛn na ebetumi ama obi ho atɔ no?

Yiw, wobetumi asa ahurututu a apaapae. Nanso, wo nkɔmhyɛ no gyina sɛnea wohwehwɛ ayaresa ntɛmntɛm no so. Dodow a egye bere tenten ansa na ɔyare no atrɛw afa koko no mu akɔ mogya no mu no, dodow no ara na asiane a ɛwɔ hɔ no yɛ kɛse.

Wɔn a wonya ayaresa wɔ nnɔnhwerew 24 a edi kan bere a wɔapae no mu no wɔ hokwan kɛse sɛ wɔn ho bɛtɔ wɔn koraa. Nkwa dodow a wonya wɔ kuw yi mu no bɛyɛ 85%. Nanso, sɛ nnɔnhwerew 48 twam a wɔannya ayaresa a, saa dodow no so tew kodu 50%.

So eyi nkyerɛ sɛnea ayaresa a wɔde ma ntɛm ho hia?

Nkrasɛm a Etwa To a Wɔde Kɔ Fie

Ahurututu a apaapae yɛ tebea a ɛyɛ hu nanso ɛntaa nsi. Nanso, sɛ ɛba a, ebetumi ayɛ den sɛ wubehu ntɛm ara. Ɛno nti na ɛho hia sɛ wommu w’ani ngu koko mu yaw so da no.

Yɛn aduan a yɛde di dwuma no yɛ teateaa na ɛnyɛ den sɛ ɛbɛsɛe. Ebetumi asɛe no wɔ akwan a wɔnhwɛ kwan so. Sɛ ɛba saa a, ebia worente baabi a ɛyaw no fi anaa nea ɛkyerɛ ase. Nanso, nsusuw kɛkɛ sɛ, "Eyi bɛkɔ kɛkɛ."

Sɛ wo koko yɛ wo yaw mpofirim, a emu yɛ den, anaasɛ ɛyaw wɔ wo menewa anaa wo yafunu atifi a, kɔ baabi a wɔhwɛ wɔn a wɔwɔ ayaresa a egye ntɛmpɛ mu ntɛm ara. Sɛ obi tow ade ketewaa bi mpo a, ebetumi ama wanya ɔyare mmoawa ne nsɛnnennen a asiane wom a yɛadi kan aka ho asɛm no nyinaa. Wo nkwa som bo, enti hwɛ yare no ho sɛnkyerɛnne no yiye na hwehwɛ aduruyɛ ntɛm ara sɛnea wubetumi.

Esophageal Paepae, Koko mu Ɛyaw, Ɛyɛ den sɛ ɔbɛmene, Ɛyɛ den sɛ ɔbɛhome, Boerhaave Syndrome, Ayaresa a Egye Ntɛmntɛm