So woanya yafunu mu yaw anaa yafunu mu mmoawa bi pɛn bere a woanom nnuru a ekum ɔyare mmoawa bi awie no? Ɛtaa kɔ da koro anaa nnanu akyi. Nanso, ɛtɔ mmere bi a, tebea yi betumi ayɛ nea emu yɛ den kakra. Ɛnnɛ yɛrebɛka tebea biako a emu yɛ den a ɛte saa a ebetumi ne nnuru a ekum ɔyare mmoawa a wɔde di dwuma no abata ho asɛm. Yɛfrɛ eyi Pseudomembranous Colitis. Ɛwom sɛ ebia edin no bɛyɛ te sɛ nea ɛyɛ nwonwa kakra de, nanso ɛho hia yiye sɛ wubehu ho asɛm.
Sɛ yɛbɛka no tiawa a, dɛn ne Pseudomembranous Colitis?
Eyi yɛ ɔfe a emu yɛ den (colitis a emu yɛ den) a ɛba yɛn dwensɔtwaa kɛse (colon) mu, a ɛkyerɛ sɛ ɛho ahonhon na yepira. Fa no sɛ biribi sɛe yɛn dwensɔtwaa kɛse no mu ntini a ɛyɛ mmerɛw (mucosa) no. Saa ɔsɛe yi betumi afi ɔyare mmoawa bi, awuduru bi a saa mmoawa no de ba, anaa yare foforo bi mu.
Sɛ saa ɔsɛe yi ba a, nsensanee a ɛyɛ den na ɛyɛ kurukuruwa ba mmeae a apira no so. Sɛnea akisikuru ba yɛn honam ani bere a yɛwɔ kuru no ara pɛ. Nanso eyinom nyɛ abon ankasa. Nkwammoaa a awu ne mogya mu nkwammoaa fitaa na ɛwom. Saa ntini kɔkɔɔ-fitaa yi ne nea nnuruyɛfo frɛ no "pseudomembranes." "Pseudo" kyerɛ "atoro." Ɛno kyerɛ sɛ wɔyɛ atoro ntini. Saa tebea yi ne nea yɛfrɛ no pseudomembranous colitis.
Dɛn ne tebea yi ho sɛnkyerɛnne?
Obi a ɔwɔ saa tebea yi betumi anya yare no ho sɛnkyerɛnne ahorow, nanso nneɛma atitiriw kakraa bi wɔ hɔ a wobetumi ahu.
| Nsɛnkyerɛnne a ɛkyerɛ | Nkyerɛmu |
|---|---|
| Atiridiinini a emu yɛ den | Eyi ne sɛnkyerɛnne titiriw no. Ebia wobɛkɔ wo dwensɔtwaa mu bɛyɛ mpɛn 10-15 da biara. Ɛtɔ da bi a, ebia wubehu sɛ mogya anaa akisikuru repue afi nsu mu. |
| Yafunu mu Ɛyaw | Ebia yafunu mu yaw a emu yɛ den na ɛyɛ mmerɛw. Yafunu no nso betumi ayɛ yaw sɛ wode wo nsa bɛka. |
| Huraeɛ | Atiridii betumi aba nipadua no mu. Eyi kyerɛ sɛ ɔyare mmoawa bi retrɛw wɔ nipadua no mu. |
| Abofono | Ebia wobɛte nka sɛ wobɛfe. Ebia nnipa binom bɛfe mpo. |
Dɛn nti na yare a ɛte sɛɛ ba? Dɛn ne ade titiriw a ɛde ba?
Ade titiriw a ɛtaa de eyi ba ne ɔyare mmoawa a wɔfrɛ no Clostridium difficile , a yɛfrɛ no C. diff tiawa no. Eyi na ɛde nsɛm bɛboro 90% ba.
Afei ebia woresusuw sɛnea saa C. diff mmoawa yi betumi de yare a ɛte saa aba no ho. Asɛm no kɔ so sɛ:
Mmoawa ɔpepem pii, papa ne bɔne nyinaa, te yɛn dwensɔtwaa mu. Saa mmoawa pa yi yɛ pii ma yɛn nipadua. Afei fa no sɛ oduruyɛfo bi ma wo nnuru a ekum ɔyare mmoawa ma yare foforo (sɛ nhwɛso no, menewam yare). Saa nnuru a ekum ɔyare mmoawa yi kunkum mmoawa a wɔwɔ yɛn nipadua mu no. Nanso sɛ wɔyɛ saa a, ɛnyɛ mmoawa bɔne a wɔde yare no bae no nko na wokum wɔn, na mmom mmoawa pa dodow bi a wɔwɔ yɛn dwensɔtwaa mu nso.
Nanso nea ɛyɛ nwonwa ne sɛ C. diff tumi ko tia nnuru pii a ekum ɔyare mmoawa. Enti sɛ mmoawa afoforo wuwu a, C. diff nya hokwan dɔɔso ntɛmntɛm sɛnea ɔpɛ, a akansi biara nni ho.
Saa C. diff mmoawa a enyin boro so yi fi ase yɛ awuduru a ɛsɛe yɛn dwensɔtwaa kɛse no mu nneɛma. Saa awuduru yi ma dwensɔtwaa mu nkwammoaa wuwu na epirapira, na ɛyɛ pseudomembranes a yɛadi kan aka ho asɛm no.
Nnuru a ekum ɔyare mmoawa a ɛtaa de C. diff yare mmoawa ba
Bere a nnuru biara a ekum ɔyare mmoawa betumi de asiane yi aba no, ɛda adi sɛ nnuru ahorow bi de asiane yi ba. Eyinom bi ne:
- Clindamycin a wɔde yɛ nnuru
- Cephalosporins Ahorow Ahorow
- Penicillin Ahorow a Wɔde Di Dwuma
- Fluoroquinolones ahorow ahorow
So nneɛma afoforo wɔ hɔ a ɛde ba a ɛnyɛ C. diff?
Aane. Ɛwom sɛ C. diff yare mmoawa titiriw na ɛde ba de, nanso saa tebea yi nso betumi aba esiane nneɛma afoforo nti, ɛntaa nsi koraa.
- Mmoawa afoforo a wɔde nyarewa ba (e.g. *Staphylococcus aureus*, *E. coli*) .
- Cytomegalovirus a ɛma obi nya ɔyare mmoawa
- Mogya a ɛkɔ akyi berɛmo mu no so tew (Ischemic colitis) .
- Nnuru bi a wɔde sa kokoram
- Nyarewa bi a nipadua no tumi ko tia nyarewa
Hena na ɔwɔ asiane kɛse sɛ obenya saa yare yi?
Ɛwom sɛ obiara betumi anya saa tebea yi de, nanso nnipa binom wɔ asiane kɛse mu.
- Nnipa a wɔrenya ayaresa wɔ ayaresabea: Ayaresabea yɛ mmeae a mmoawa te sɛ C. diff tumi trɛw ntɛmntɛm.
- Nnipa a wɔanom nnuru a ekum ɔyare mmoawa nnansa yi: Sɛnea yɛadi kan aka ho asɛm no, eyi ne ade titiriw a ɛde asiane ba.
- Nnipa a wɔadi boro mfe 65: Efisɛ nipadua no tumi a ɛko tia nyarewa no so tew bere a obi nyin no.
- Nnipa a wɔwɔ nkwakoraa ne mmerewa afie:
- Nnipa a wɔn nipadua mu ahoɔden a ɛko tia nyarewa no yɛ mmerɛw: (e.g. nnipa a wɔanya HIV, wɔn a wɔwɔ kokoram) .
- Nnipa a wɔwɔ nyarewa a nipadua no tumi ko tia nyarewa: (e.g. Inflammatory Bowel Disease - IBD) .
- Nnipa a wɔadi kan anya C. diff yare no:
Sɛ eyi yɛ aniberesɛm a, nsɛnnennen bɛn na ebetumi aba?
Ebia eyi bɛyɛ te sɛ nea ɛyɛ hu kakra ama wo. Nanso kae sɛ, mpɛn pii no, bere a yare no mu yɛ den na wɔmfa ayaresa a ɛfata mma nkutoo na ɔhaw ahorow yi ba. Ɛno nti na yɛhyɛ nyansa sɛ kɔ oduruyɛfo nkyɛn ntɛm no.
- Nsu a ɛho nhia ne electrolyte a ɛnkari pɛ: Sɛ wokɔ wo dwensɔtwaa mu mpɛn 10-15 da biara a, wohwere nsu ne electrolytes pii. Sɛ eyi mu yɛ den a, ebetumi de tebea horow a asiane wom te sɛ mogya mmoroso a ɛba fam ne asaabo a entumi nyɛ adwuma yiye aba.
- Toxic Megacolon: Eyi yɛ tebea a ɛyɛ hu yiye. Nea ɛba ne sɛ akyi berɛmo no mu ɔfe no mu yɛ den araa ma akyi berɛmo no ntumi nyɛ adwuma yiye, mframa ne nsu a ɛwɔ akyi no siw, na akyi berɛmo no yɛ kɛse araa ma etumi pae.
- Yafunu mu tokuru: Sɛ obi pira kɛse a, ebetumi ama tokuru akɔ dwensɔtwaa no fasu mu. Sɛ eyi ba a, mmoawa a wofi dwensɔtwaa no mu betumi akɔ yafunu no mu na wɔde nyarewa a ɛde nkwa to asiane mu (peritonitis, sepsis) aba.
- Sepsis: Tebea a ɛde nkwa to asiane mu a ɔyare mmoawa bi trɛw kɔ nipadua no mu nyinaa na nipadua no akwaa ahorow fi ase di huammɔ.
Nsuro saa nneɛma yi. Saa nneɛma yi ntaa nsi. Ade a ɛho hia sen biara ne sɛ wobɛhwehwɛ aduruyɛ mu afotu bere a sɛnkyerɛnne ahorow no da adi ara pɛ.
Ɔkwan bɛn so na oduruyɛfo tumi hu yare yi pɛpɛɛpɛ?
Sɛ wokɔ oduruyɛfo nkyɛn a, obebisa wo wo yare no ho sɛnkyerɛnne, nnuru biara a woanom nnansa yi (titiriw nnuru a ekum ɔyare mmoawa), na afei ebia wayɛ nhwehwɛmu ahorow bi de akyerɛ sɛ woahu sɛ wowɔ yare no.
1. Nsu mu sɔhwɛ: Eyi ne sɔhwɛ a ɛho hia sen biara. Wɔfa wo nsuo mu nsuo bi na wɔsɔ hwɛ sɛ C. diff mmoawa anaa awuduru a mmoawa no de ba wɔ mu anaa.
2. 2. .Mogya mu nhwehwɛmu: Eyinom boa ma wohu sɛ ɔyare mmoawa ne mogya mu nkwammoaa fitaa dodow a ɛkɔ soro anaa.
3. Colonoscopy: Eyi hwehwɛ sɛ wɔde afiri a ɛyɛ tratraa bi a mfoninitwa afiri wom fa akyi berɛmo no mu de hwehwɛ dwensɔtwaa kɛse no mu. Eyi ma yetumi de aniwa abien no nyinaa hu sɛ ebia pseudomembranes bi wɔ hɔ a yɛkaa ho asɛm anaa. Sɛ ɛho hia a, wobetumi afa ntini ketewaa bi (biopsy) akɔyɛ mu nhwehwɛmu.
Dɛn ne ayaresa ahorow a wɔde sa eyi?
Ayaresa no gyina nea ɛde yare no ba ne sɛnea emu yɛ den so.
- Nea ɛde ba no a wɔbɛsa: Sɛ C. diff yare no na ɛde ba a, wo duruyɛfo bɛkyerɛw nnuru pɔtee bi a ekum ɔyare mmoawa a ebetumi akum mmoawa no. Metronidazole, Vancomycin, ne Fidaxomicin yɛ nnuru yi bi.
- Ɔhwɛ a Ɛboa: Ebia nea ɛka eyi ho ne nsu a wɔde fa IV mu a wɔde siw nsu a ɛho ntew ano na wɔde aduannuru a wɔde fa ntini mu ma na ama dwensɔtwaa no ahome.
- Oprehyɛn: Wɔ tebea horow a emu yɛ den yiye te sɛ nsɛnnennen te sɛ megacolon a awuduru wom mu no, ebia ɛho behia sɛ wɔyɛ oprehyɛn yi akyi berɛmo no fã a asɛe no (colectomy). Nanso, eyi ho yɛ na koraa.
Saa yare yi yɛ nea wotumi sa koraa. Sɛ wɔsa wɔn yare yiye a, nnipa dodow no ara ho tɔ wɔn ntɛm.
Dɛn na ɛsɛ sɛ yɛyɛ na yɛatumi anya yɛn ti adidi mu wɔ tebea yi mu?
Eyi a wobesiw ano ho hia yiye, titiriw wɔ mmeae te sɛ ayaresabea ne nkwakoraa ne mmerewa afie.
- Hohoro wo nsa mpɛn pii: C. diff ntumi ntumi nnya nsa a wɔde tew nsa a nsa wom, enti sɛ wode samina ne nsu hohoro wo nsa yiye a, ɛno ne ahobammɔ a eye sen biara.
- Tew a wɔtew wɔn ho: Wɔ ayaresabea ahorow no, wɔsa ayarefo a wɔwɔ C. diff yare no yare wɔ dan a ɛyɛ soronko mu.
- Nneɛma a wɔde tew nneɛma ho: C. diff tumi tra nneɛma so bere tenten. Ɛho hia sɛ wode aduru a wɔde kum mmoawa a chlorine wom tew nneɛma a ɛwɔ so no ho daa.
Bere bɛn na ɛsɛ sɛ yɛkɔ oduruyɛfo nkyɛn ntɛm ara sɛnea yebetumi?
Sɛ wowɔ sɛnkyerɛnne a edidi so yi mu biara a, kɔ oduruyɛfo nkyɛn ntɛm ara anaa kɔ ayaresabea Dwumadibea a Ɛhwɛ Ntɛmntɛm (ETU) nkyɛn.
| Kɔkɔbɔ nsɛnkyerɛnne a ɛsɛ sɛ wohwɛ yiye | |
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Ɛwom sɛ ɛtaa ba sɛ yafunu mu yɛ wo yaw bere a woanom nnuru a ekum ɔyare mmoawa akyi de, nanso ɛnyɛ bere nyinaa na ɛyɛ mmerɛw saa. Ɛtɔ da bi a ebetumi ayɛ tebea a emu yɛ den te sɛ Pseudomembranous Colitis mfiase. Ɛno nti na ɛho hia paa sɛ wutie wo nipadua no. Sɛ w’adwene mu yɛ wo naa wɔ wo sɛnkyerɛnne ahorow no ho a, ntwentwɛn wo nan ase sɛ wo ne wo duruyɛfo bɛkasa. Sɛ wosa wo yare yiye a, wubetumi anya ahoɔden afi tebea yi mu koraa.
Nkrasɛm a Wɔde Kɔ Fie
- Mmu atiridii ne yafunu mu yaw adewa da bere a woanom nnuru a ekum ɔyare mmoawa awie no.
- Mmoawa bi a wɔfrɛ no C. diff na ɛde Pseudomembranous Colitis ba. Ɛnam mmoawa pa a wɔsɛe no wɔ dwensɔtwaa mu esiane nnuru a ekum ɔyare mmoawa nti na ɛba.
- Sɛ wowɔ sɛnkyerɛnne ahorow te sɛ atiridiinini a emu yɛ den, atiridiinini, anaa yafunu mu yaw a emu yɛ den a, kɔ wo duruyɛfo nkyɛn ntɛm ara a ɛnntwentwɛn wo nan ase.
- Ayaresa a etu mpɔn yiye wɔ hɔ a wɔde sa yare yi. Enti ɛho nhia sɛ wobɔ hu. Nea ɛho hia sen biara ne sɛ wubehu yare no ntɛm na woafi ase sa yare.
- Sɛ wode samina hohoro wo nsa yiye a, ɛyɛ ɔkwan a eye sen biara a wobɛfa so abɔ wo ho ban afi nyarewa te sɛ C. diff ho.
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