So wunim tebea a asiane wom a ɛwɔ necrotizing pancreatitis mu no?

Have you ever heard of a serious condition where part of the pancreas dies ? Eyi ne nea yɛfrɛ no wɔ aduruyɛ mu sɛ ``Necrotizing Pancreatitis''. Susuw sɛnea ɛyɛ aniberesɛm sɛ yɛbɛhwere akwaa bi a ɛho hia wɔ yɛn nipadua mu no ho hwɛ. Eyi ba bere a tebea bi a wɔfrɛ no ``Acute Pancreatitis '' no mu yɛ den yiye . Ɛnnɛ, yɛbɛka eyi ho asɛm akɔ akyiri, te sɛ nea yɛne yɛn adamfo bi rekasa.

Dɛn ankasa ne ``(Necrotizing Pancreatitis)``?

Sɛ yɛbɛka no tiawa a, ``Necrotizing Pancreatitis`` yɛ wo ``Pancreas`` (Necrosis) no fã bi wu . Eyi ba bere a tebea ``Pancreatitis`` no mu yɛ den yiye. Pancreatitis yɛ bere a dwensɔtwaa no hohoro, ɛyɛ kɔkɔɔ, na ɛyɛ yaw esiane opira anaa biribi te sɛ awuduru nti. Sɛ saa ɔfe yi mu yɛ den yiye a, mogya a ɛkɔ dwensɔtwaa mu ntini no mu no betumi asɛe ``Ischemia``. Afei saa ntini ahorow no nnya mframa pa ne aduannuru a wohia na wofi ase wuwu . Wɔfrɛ eyi ``Necrosis``. Eyi yɛ tebea a asiane wom ankasa.

Sɛ eyi ba a, w’aduruyɛfo kuw no bɛma woakɔ so atra ayaresabea bere tiaa bi na wɔahwɛ wo yiye sɛ ebia ɔhaw foforo biara bɛba . Ade a ɛho hia sen biara a ɛsɛ sɛ yɛhwɛ yiye wɔ ho ne ɔyare mmoawa . Fa no sɛ, sɛ mmoawa fi ase di ntini a awuwu no a, wobetumi adɔɔso ntɛmntɛm na wɔatrɛw wɔ wo nipadua nyinaa mu. Sɛ ɛba saa a, ebetumi de tebea horow a emu yɛ den te sɛ akwaa a entumi nyɛ adwuma yiye , a ebetumi de nkwa ato asiane mu aba. Wɔ tebea horow a ɛtete saa mu no, ebia ɛsɛ sɛ nnuruyɛfo yɛ oprehyɛn yi ntini a awuwu no .

Saa tebea yi abu so dɛn?

Sɛ yɛbɛka no tiawa a, nnipa a wonya dwensɔtwaa a emu yɛ den no mu bɛyɛ 20% benya dwensɔtwaa mu yare a ɛyɛ necrotizing. Wɔ ɔman te sɛ United States mu no, wobu akontaa sɛ nnipa bɛyɛ mpem ahasa na wɔde wɔn kɔ ayaresabea afe biara esiane dwensɔtwaa mu yare nti. Enti, 20% yɛ dodow a ɛho hia, ɛnte saa?

Dɛn ne `(Necrotizing Pancreatitis)` ho sɛnkyerɛnne?

Nsɛnkyerɛnne a edi kan a ɛda adi ne nea ɛfa dwensɔtwaa mu yare a emu yɛ den ho. Wɔne:

• Ɛyaw a emu yɛ den wɔ yafunu no atifi. Saa ɛyaw yi nso betumi atrɛw akɔ akyi.
• Yafunu mu a ɛtrɛw anaasɛ ɛho ayɛ kurukuruwa.
• Akisikuru ne ɔfe.

Bere a dwensɔtwaa mu yare mu yɛ den kɛse no, sɛnkyerɛnne ahorow te sɛ eyinom nso betumi ada adi:

• Atiridii ne awɔw.
• Koma a ɛbɔ kɛse (Tachycardia).
• Sukɔm a emu yɛ den anaasɛ nsu a ɛho ayɛ fĩ.

Dɛn ne nneɛma a ɛde ``Necrotizing Pancreatitis'' ba?

Eyi ba wɔ akwan horow pii so. Nea edi kan no, dwensɔtwaa no mu ɔfe a ɛfata (Acute Pancreatitis) no mu yɛ den. Afei, mogya a ɛkɔ nipadua no mu no sɛe (Ischemia), na awiei koraa no, ntini ahorow no wuwu (Necrosis). Ɛsono nneɛma a ɛde saa nsɛm yi mu biara ba.

Pancreatitis mu yɛ den dɛn?

Nea ɛde dwensɔtwaa mu yare a emu yɛ den ba titiriw ne akisikuru mu yare. Eyi ba bere a akisikuru bi kɔhyɛ akisikuru no mu na esiw dwensɔtwaa no kwan no. Wɔsan frɛ eyi gallstone pancreatitis . Ade titiriw a ɛto so abien a ɛde ba ne nsa a wɔnom boro so .

Ɔfe yɛ ɔkwan a nipadua no fa so yɛ n’ade wɔ opira bi ho ankasa, bɔ mmɔden sɛ ebesiesie nea asɛe no. Nanso ɛtɔ mmere bi a, ɔhyew ho mmuae yi mu yɛ den araa ma efi ase sɛe ade.

Wonnya nhuu nea enti a ɔhyew ho mmuae yi mu yɛ den wɔ nnipa binom mu sen afoforo mu. Nanso, ɛda adi pefee sɛ eyi ma `` sukyerɛmma bɔɔl nkɛntɛnso`` ba dwensɔtwaa no mu.

Nhyɛso kɛse a ɔfe a emu yɛ den de ba no ma dwensɔtwaa mu enzymes a ɛwɔ dwensɔtwaa mu ntini no mu no yɛ adwuma. Mpɛn pii no, saa aduan mu enzyme ahorow yi yɛ adwuma bere a aduan akɔ aduan mu awie no. Nanso sɛ wɔyɛ adwuma ntɛm a, wofi ase yam dwensɔtwaa no ankasa. Fa no sɛ, wode w’ankasa enzymes bɛyam w’ankasa akwaa!

Mogya a ɛso tew no ma ``Ischemia`` ne ntini wuwu ``Necrosis``

Saa ɔsɛe a ɛkɔ so wɔ dwensɔtwaa mu yi ma dwensɔtwaa mu yare no mu yɛ den. Awiei koraa no, dwensɔtwaa no hohoro ma mogya ntini no trɛw, na ɛma mogya a ɛsen kɔ ntini no mu no so tew.

Ade foforo a ebetumi aka eyi ne Systemic Inflammatory Response Syndrome (SIRS). Eyi yɛ tebea a ɛma obi ho hyehye no a ɛba nipadua no nyinaa mu. Eyi betumi ama mogya mmoroso ne mogya a ɛkɔ nipadua no nyinaa so atew.

Mogya a ɛyera (ischemia) ma ntini ahorow wuwu (necrosis). Ebia dwensɔtwaa no mu enzymes a ɛma dwensɔtwaa no yam no nso betumi ama ntini yi awu.

Dɛn ne nsɛnnennen a ebetumi aba wɔ `(Necrotizing Pancreatitis)` mu?

Saa tebea yi betumi de nsɛnnennen ahorow aba wɔ bere tiaa ne bere tenten mu.

Nsɛnnennen a ɛba bere tiaa mu:

• Nyarewa: Eyi ne asiane a ɛyɛ hu sen biara a ɛwɔ Necrotizing Pancreatitis mu. Eyi betumi aba wɔ ayarefo bɛyɛ 20% mu. Ntini a awuwu te sɛ baabi pa a mmoawa a wɔkyinkyin di akɔneaba. Ɛyɛ den sɛ wubedi ɔyare mmoawa bi so bere a woyare dedaw no. Sɛ ɛtrɛw kɔ mogya mu a, ebetumi de ne nkwa ato asiane mu. Ɔyare mmoawa a ɛwɔ mogya mu betumi ama obi anya sepsis , na ebetumi ama akwaa ahorow pii adi huammɔ . Eyi ne ade titiriw a ɛma nnipa a wɔwɔ Necrotizing Pancreatitis wuwu.
• Necrotic Fluid Collections: Wɔ dwensɔtwaa mu yare a emu yɛ den mu no, dwensɔtwaa mu enzymes a wɔayɛ adwuma no betumi atu afi dwensɔtwaa no mu na asɛe ntini a atwa ho ahyia no. Ntini a ɛyɛ tratraa a ɛyɛ capsule bi twa dwensɔtwaa mu nsu no ho hyia. Sɛ ntini a awuwu ne mmoawa wɔ saa aduru yi mu a, ɛnyɛ den sɛ ɔyare mmoawa bi befi ase na atrɛw. Ɛntaa mma sɛ saa aduru yi betumi ayɛ kɛse na apia akwaa a ɛbɛn te sɛ yafunu, mogya ntini, anaa ntini a ɛma mogya tu no.
• Mogya a ɛtɔ: Mogya a ɛtɔ wɔ dwensɔtwaa mu no ntaa mma, nanso sɛ ɛba a, ebetumi de obi nkwa ato asiane mu. Necrotizing pancreatitis ma asiane a ɛwɔ hɔ sɛ mogya bɛtɔ yi yɛ kɛse. Ɔkwan biako a eyi betumi aba ne sɛ ɔfe anaa nsu a ɛwɔ dwensɔtwaa no mu no trɛw kɔ ntini bi a ɛbɛn hɔ mu, na ɛsɛe ntini no fasu na ɛma mogya tu. Ɔkwan foforo ne sɛ dwensɔtwaa mu enzymes bubu ntini bi fasu, na ɛma pseudoaneurysm , a ɛpaapae na ɛma mogya tu ba.
• Yafunu mu Nsõ: Nsu a ɛho ahonhon, mogya a ɛtɔ, ne nsu afoforo a ɛboaboa ano a ɛbata necrotizing pancreatitis ho no betumi ama nhyɛso kɛse aba yafunu no mu. Wohu eyi titiriw wɔ ayarefo a wɔn yare mu yɛ den mu. Eyi betumi ama mogya a ɛkɔ akwaa no mu no so atew, na ebetumi ama mogya atɔ , ischemia, ne hypoxia . Eyi nso betumi ama akwaa ahorow pii adi huammɔ.

Nea ebefi mu aba bere tenten:

• Pancreatic Insufficiency: Sɛ dwensɔtwaa mu ntini pii yera a, ebia dwensɔtwaa no dwumadi ahorow bi ayera. Exocrine Pancreatic Insufficiency yɛ bere a dwensɔtwaa no ntumi nyɛ enzymes a ɛdɔɔso a ɛbɛtumi ayam aduan. Eyi betumi ama obi ntumi nnom aduan yiye na onnya aduan pa . Endocrine Pancreatic Insufficiency yɛ bere a dwensɔtwaa no ntumi nyɛ nkwaadɔm a ɛdɔɔso a ɛhwɛ asikre dodow a ɛwɔ mogya mu so no. Eyi betumi ama asikreyare a ɛboro so ne asikreyare aba .
• Disconnected Pancreatic Duct Syndrome: Ɔhonhon a emu yɛ den, mogya a ɛtɔ, ntini a ewuwu, ne nsɛnnennen afoforo a efi necrotizing pancreatitis mu ba no betumi ama dwensɔtwaa no mu ntini no atew ne ho fã bi afi dwensɔtwaa anaa dwensɔtwaa ketewa no ho. Eyi betumi ama dwensɔtwaa mu enzymes akɔ so atu. Saa nsu a ɛtwetwe yi betumi ama nsu a ɛboaboa ano bere tenten ne/anaasɛ dwensɔtwaa mu yare a enni sabea aba.
• Biliary Nsɛm a Wɔahyehyɛ:Ɔfe a emu yɛ den na ɛtra hɔ kyɛ betumi ama akuru aba ntini a ɛka dwensɔtwaa no ne aduannoa nhyehyɛe no bom (pancreatic duct, bile duct, duodenum - dwensɔtwaa ketewa no mfiase) no mu biara mu. Saa akuru yi ma ntini no yɛ teateaa wɔ ɔkwan a ɛnteɛ so (stricture). Eyi ma bile no brɛ ase, na bile fi ase san kɔ nsu no mu.
• Splanchnic Vein Thrombosis: Wo splanchnic ntini no wɔ wo dwensɔtwaa ase. Pancreatitis a emu yɛ den betumi ama wɔn ho ayɛ wɔn hyew. Eyi betumi ama mogya atɔ (thrombosis) wɔ saa ntini yi mu. Saa ntini yi bi ne splenic vein, mesenteric vein, hepatic vein, ne portal vein. Sɛ mogya a ɛtɔ gu eyinom mu biako mu a, nsɛnnennen ahorow betumi aba, te sɛ portal hypertension , yafunu mu akisikuru, yafunu mu mogya a ɛtɔ, ischemic colitis, ne mesenteric ischemia.

Ɔkwan bɛn so na wohu sɛ obi anya Necrotizing Pancreatitis?

Nnuruyɛfo hu saa tebea yi `(Necrotizing Pancreatitis)` bere a wɔadi kan ahu `(Acute Pancreatitis) akyi.` Nsɛnkyerɛnne a ɛda adi pefee a ɛkyerɛ sɛ ntini wuwu `(Necrosis)` no mpue kosi nnansa kosi anum wɔ dwensɔtwaa mu yare no mfiase akyi. Sɛ wowɔ dwensɔtwaa mu yare a emu yɛ den ho sɛnkyerɛnne wɔ nna kakraa bi akyi wɔ ɔfe a edi kan no akyi a, wo duruyɛfo de CT scan a wɔde fluorescent dye `(Contrast-enhanced CT scan)` anaa MRI.` (MRI - Magnetic Resonance Imaging)` bedi dwuma de ahwehwɛ saa ntini a owu yi. Wɔbɛhwehwɛ nsɛnnennen afoforo te sɛ nsu a ɛboaboa ano nso.

Dɛn ne ayaresa ahorow a wɔde sa eyi?

W’ayaresa no begyina sɛ ebia wowɔ ɔyare mmoawa anaa ɔhaw afoforo so. Sɛ pancreatic necrosis no nyɛ nea wontumi nwo na sɛnkyerɛnne biara nni ho a, mpɛn pii no nnuruyɛfo de ɔhwɛ a ɛboa bɛsa . Sɛ ɔyare no ho sɛnkyerɛnne anaa ɔhaw afoforo ba a, nnuruyɛfo de wɔn ho bɛhyɛ mu sɛnea ɛho hia. Wɔbɛbɔ mmɔden sɛ wɔde akwan a ɛnyɛ den pii beyi ntini a awuwu no afi hɔ ansa na wɔayɛ oprehyɛn.

Adwuma a Wɔde Di Dwuma a Wɔyɛ Akorae

Ɔhwɛ a ɛboa ma ``Sterile Necrotizing Pancreatitis`` a ɛnyɛ ɔyare mmoawa no bi ne:

• Nnuru a wɔde kum ɛyaw.
• Nsuo a wɔde fa ntini mu `(IV Fluids)`.
• Aduandi a Wɔde Di Dwuma wɔ Awotwaa Mu.

Nsɛm a ɛnyɛ den dodow no ara bɛsiesie denam ɔhwɛ a ɛboa nkutoo so. Saa bere yi mu no, w’aduruyɛfo kuw no bɛhwɛ wo tebea no yiye. Wɔbɛhwɛ wo sɛnkyerɛnne ahorow a ɛho hia , yafunu mu nhyɛso, ne mogya dodow a edi mũ.Wɔbɛhwɛ nneɛma te sɛ Complete Blood Cell Count (CBC) so na wɔahwɛ nsɛnnennen a ebetumi aba anaa. Sɛ biribi te sɛ ɔyare mmoawa anaa akwaa bi a entumi nyɛ adwuma yiye a, wɔde nkwa mmoa anaa nneɛma afoforo bɛma sɛnea ɛho hia.

Nsu a Ɛma Nsu Gu Mu ne Debridement

Sɛ wufi ase hu sɛnkyerɛnne ahorow a ɛkyerɛ sɛ woanya ɔyare mmoawa ara pɛ a, w’aduruyɛfo kuw no befi ase de nnuru a ekum ɔyare mmoawa adi wo na wɔayɛ nhyehyɛe sɛ sɛ ɛbɛyɛ yiye a, wobeyi ntini biara a awu afi hɔ. Wɔde ɔkwan a ɛnyɛ den koraa na ebefi ase, afei sɛ ɛho hia a, wɔama emu ayɛ den nkakrankakra.

Saa akwan yi bi ne:

• Nsu a wɔde fa honam ani: Nsu a wɔde fa honam ani kyerɛ sɛ ɛfa honam ani. Oduruyɛfo a ɔde ne ho hyɛ mu de mfoninitwa akwan (mpɛn pii no ultrasound anaa CT scan) di dwuma de hwehwɛ baabi a ntini a awuwu no wɔ na ɔde afiri bi fa wo honam ani. Wogyaw afiri no wɔ nea ɛwɔ hɔ na wɔde nkyene hohoro ho mpɛn pii da biara ma nsu no fi mu. Eyi nkutoo ne ɔkwan a ayarefo bɛyɛ nkyem abiɛsa mu biako betumi afa so. Wɔ afoforo fam no, ɛboa ma wodi ɔyare mmoawa no so kosi sɛ wobetumi ayɛ akwan foforo a wɔfa so yi nipadua no fi nipadua no mu dwoodwoo.
• Endoscopic Debridement: Adeyɛ bi a wɔfrɛ no endoscopy ma yafunu mu yafunu ho oduruyɛfo tumi kɔ ntini a awu a ɛwɔ wo nipadua mu no ho a ontwitwa wo honam ani. Ɔde endoscope a wɔde ultrasound probe ahyɛ mu no afa wo yafunu mu kwan a ɛwɔ soro no mu akɔhwehwɛ baabi a dwensɔtwaa no wɔ. Afei, wɔde nnwinnade fa endoscope no mu ma ɛyɛ kwan bi wɔ ntini a awuwu no ne wo yafunu mu ntini no ntam. Wɔnam saa kwan no so yi ntini a awuwu no.
• Video-assisted Retroperitoneal Debridement (VARD): Eyi nso yɛ oprehyɛn a ɛnyɛ den pii. Eyi hwehwɛ sɛ wode nnwinnade a wɔde yɛ oprehyɛn bɛhyɛ mu denam ntwitwiridii koro no ara a wowɔ dedaw wɔ wo honam ani a wɔfrɛ no Percutaneous Drainage Portal no so na woakɔ baabi a ntini a awu no wɔ no. Oduruyɛfo a ɔyɛ oprehyɛn de forceps, nsu a wɔde gugu nnɔbae so ne suction di dwuma de yi ntini a awu no fa nea wɔatwa no mu. Sɛ ɛho hia a, wobetumi atrɛw baabi a wɔatwa no mu na wɔde afiri a wɔde mfoninitwa afiri ahyɛ mu a wɔfrɛ no laparoscope ahyɛ mu. Afei wɔde laparoscopic kwan a wɔfrɛ no laparoscopic surgery na yi ntini a aka no.
• Open Surgery - Necrosectomy: Necrosectomy yɛ ntini a awuwu a woyi fi hɔ. Oprehyɛn a wɔabue mu no hwehwɛ sɛ wobue yafunu no mu na wohu ntini a awu no (Laparotomy). Eyi da so ara yɛ ɔkwan a ɛyɛ ntɛm sen biara a wɔfa so hwehwɛ nsɛnnennen a egye ntɛmpɛ na wɔsa. Ɛwom sɛ oprehyɛn de asiane ahorow bi ba de, nanso ɛyɛ ɔkwan a etwa to a wɔfa so yɛ adwuma wɔ tebea horow a egye ntɛmpɛ mu ne bere a akwan a wɔmfa nhyɛ mu pii no adi nkogu no.

Dɛn ne owu dodow ne ahoɔden a wɔsan nya wɔ `(Necrotizing Pancreatitis)` ho?

Hokwan a ɛwɔ hɔ sɛ wo ho bɛtɔ wo no gyina wo dwensɔtwaa no fã dodow a awu, sɛ ebia wubenya ɔyare mmoawa anaasɛ akwaa bi a entumi nyɛ adwuma yiye, ne sɛnea woyɛ w’ade yiye wɔ ayaresa ho no so. Sɛ wo dwensɔtwaa no nnu 30% na ɛka wo a, owu dodow no nnu 15% . Sɛ ntini a owu nkutoo na ɛwɔ hɔ a ɔyare mmoawa biara nni mu a, ɛnyɛ papa. Nanso sɛ wo dwensɔtwaa bɛboro 50% ka wo, na wunya ɔyare mmoawa anaasɛ akwaa bi a entumi nyɛ adwuma yiye a, owu dodow kɔ soro kodu bɛboro 30% .

Mma akontaabu ahorow yi nnyɛ wo hu. Eyinom yɛ nsɛm a ɛfa nneɛma nyinaa ho ara kwa. Aduruyɛ kuw a wɔresa wo yare no nkutoo na wobetumi aka wo tebea no ne hokwan a wowɔ sɛ wo ho bɛtɔ wo no ho asɛm akyerɛ wo yiye.

Dɛn na ɛba wɔ ayaresa akyi?

Wɔ wo bere a wobɛkɔ akɔhwɛ wo wɔ ayaresa akyi no, wo duruyɛfo no bebisa wo sɛnkyerɛnne biara a ɛkɔ so anaa foforo ho asɛm. Necrotizing Pancreatitis betumi anya nsɛnnennen a ɛtra hɔ kyɛ wɔ ayaresa akyi mpo. Sɛ wowɔ sɛnkyerɛnne ahorow a, wobetumi aka akyerɛ wo sɛ yɛ mogya mu nhwehwɛmu, yɛ nhwehwɛmu wɔ lab, anaa mfoninitwa nhwehwɛmu mfa nhwɛ sɛ ebia ɛwɔ hɔ anaa. Ebia nsɛnnennen no behia ayaresa foforo, a ebetumi ayɛ bere tiaa anaa bere tenten.

Necrotizing pancreatitis yɛ ɔhaw a emu yɛ den yiye a efi dwensɔtwaa mu yare a emu yɛ den mu ba. Bere a nnipa dodow no ara nya ahoɔden fi dwensɔtwaa mu yare a emu yɛ den mu denam ɔhwɛ a ɛboa nkutoo so no, wɔn a wonya dwensɔtwaa mu yare a emu yɛ den ne necrosis no hia ɔhwɛ a emu yɛ den bere tenten. Wubehia nnuruyɛfo kuw a wɔyɛ adwuma ahorow pii a wɔbɛhwɛ wo tebea no ne nsɛnnennen biara a ebetumi aba no so. Ebia wubehia nneɛma a wɔde wɔn ho bɛhyɛ mu anaasɛ wɔyɛ wo oprehyɛn, na ebia wobɛhwɛ wo akyi.

Nneɛma a ɛho hia paa a ɛsɛ sɛ yɛkae fi saa asɛm yi mu (Take-Home Message) .

• Necrotizing Pancreatitis yɛ tebea a emu yɛ den a ɛma dwensɔtwaa no fã bi wuwu.
• Mpɛn pii no, dwensɔtwaa mu yare a emu yɛ den na ɛde eyi ba. Nea ɛde ba titiriw ne akisikuru ne nsa a wɔnom boro so .
• Sɛ wowɔ sɛnkyerɛnne ahorow te sɛ yafunu mu yaw a emu yɛ den, atiridiinini, akisikuru, ne ɔfe a, hwehwɛ aduruyɛfo afotu ntɛm ara.
• Ɔyare mmoawa ne ɔhaw titiriw a ɛyɛ hu sen biara a ɛde tebea yi ba.
• Ɛsono ayaresa a wobetumi apaw a egyina ɔyarefo no tebea so. Ayaresa ahorow wɔ hɔ , efi ɔhwɛ a wɔde boa so kosi oprehyɛn so .
• Ɛwom sɛ eyi yɛ tebea a emu yɛ den de, nanso nnipa pii ho tɔ wɔn denam ayaresa ne ɔhwɛ a ɛfata so , enti mma anidaso nnyae.

Sɛ wo anaa obi a wunim no wɔ saa sɛnkyerɛnne yi bi a, yɛsrɛ wo kɔ oduruyɛfo nkyɛn ntɛm ara. Sɛ wɔsa yare ntɛm a, ebetumi agye nnipa nkwa!

` Necrotizing Pancreatitis, Pancreatitis, Pancreatic owuo, Yafunu mu yaw, Pancreatic yareɛ, Pancreatitis Sinhala, Pancreatic nyarewa