So wo dwonku mu ayɛ hyew saa? Momma yensua Pseudomembranous Colitis ho ade!

So wo yafunu mu yɛ wo yaw kɛse na wo ho yɛ wo yaw mpɛn pii da biara? Ebia wo nso wote nka sɛ wo ho yɛ wo yaw a atiridii ka ho? Ne titiriw no, so sɛnkyerɛnne ahorow yi daa adi bere a wonom nnuru a ekum ɔyare mmoawa nnansa yi maa yare bi akyi? Sɛ saa a, eyi yɛ biribi a ebia ɛho hia wo. Ɛnnɛ yɛbɛka tebea bi a wɔfrɛ no ‘Pseudomembranous Colitis’ ho asɛm. Mma ɛnhaw wo, sɛ wɔbɔ wo amanneɛ yiye wɔ eyi ho a, wubetumi anya ayaresa na wo ho atɔ wo ntɛm.

Dɛn ne Pseudomembranous Colitis?

Sɛ yɛbɛka no tiawa a, ‘Pseudomembranous Colitis’ yɛ ɔyare a emu yɛ den a ɛma obi ho hyehye no a ɛba yɛn dwensɔtwaa kɛse, anaa yɛn akyi berɛmo mu. Wɔ eyi mu no, esiane biribi nti (ebetumi ayɛ mmoawa, awuduru, anaa yare foforo), wo dwensɔtwaa kɛse no mu ɔfasu, anaasɛ ntini (`mucosa`), sɛe. Saa ɔsɛe yi ma nsensanee a ɛyɛ kɔkɔɔ-fitaa, ɛyɛ den, na ɛyɛ kurukuruwa ba mmeae a asɛe no. Nnuruyɛfo frɛ eyinom ‘pseudomembranes’.

Dɛn ne ‘pseudomembranes’?

Pseudomembranes ne nea ɛba bere a nkwammoaa a ɛwɔ dwensɔtwaa kɛse no mu te sɛ dwensɔtwaa kɛse no mu nneɛma wuwu no. Susuw ho saa kwan yi so: sɛ opira bi wɔ hɔ a, yɛn nipadua mu tumi a ɛko tia nyarewa no de mogya mu nkwammoaa fitaa kɔ beae no. Saa ara na wɔ ha nso, nkwammoaa a awuwu asinasin ne mogya mu nkwammoaa fitaa (titiriw neutrophils) bom yɛ pseudomembranes. Eyinom trɛw bɛyɛ sɛntimita 2, ɛyɛ kɔkɔɔ-fitaa, na ɛkɔ soro kakra wɔ soro.

Dɛn ne tebea yi ho sɛnkyerɛnne?

Obi a ɔwɔ pseudomembranous colitis betumi anya sɛnkyerɛnne ahorow te sɛ:

• Yafunu mu yaw a emu yɛ den.
• Ayamtuo. Eyi betumi aba mpɛn pii da biara, ɛtɔ mmere bi a sɛ nsu.
• Huraeɛ.
• Abofono.
• Ɛtɔ da bi a, ebia wubehu sɛ mogya anaa akisikuru refi wo nsu mu, nanso eyi nsi obiara.

Dɛn na ɛde Pseudomembranous Colitis ba?

Ade titiriw a ɛde eyi ba ne ɔyare mmoawa `C. diff` (Nneɛma a ɛyɛ den). Awuduru a mmoawa yi de ba no sɛe dwensɔtwaa kɛse no mu nneɛma. Bɛyɛ 10% wɔ `C. diff` nyarewa betumi akɔ tebea a emu yɛ den kɛse a wɔfrɛ no `pseudomembranous colitis.` Nokwarem no, saa nsɛm yi mu 90% fi `C. diff` mmoawa. Nanso, dwensɔtwaa mu tebea afoforo a ɛma obi ho hyehye no nso betumi de ɔsɛe a ɛte sɛɛ aba.

Ɔkwan bɛn so na C. difficile mmoawa no nya eyi so nkɛntɛnso?

Mmoawa a wɔfrɛ no C. difficile no ma awuduru a ɛsɛe nkwammoaa a ɛkata yɛn dwensɔtwaa kɛse no so no. Saa ɔyare mmoawa yi betumi atrɛw ntɛmntɛm na ayɛ den sen sɛnea ebia wubesusuw.

Mpɛn pii no, wunya C. diff yare esiane sɛ wowɔ yare foforo nti.Bere a wɔde nnuru a ekum ɔyare mmoawa adi dwuma awie no. Susuw ho hwɛ, sɛ wofa nnuru a ekum ɔyare mmoawa a, mmoawa afoforo "papa" a wɔwɔ yɛn akyi berɛmo mu a wɔboa yɛn ma yewuwu no. Nanso, nnuru a ekum ɔyare mmoawa dodow no ara ntumi nkum saa `C. diff` mmoawa. Enti, sɛ saa mmoawa pa no fi hɔ a, `C. diff` mmoawa nya hokwan nyin na ɛtrɛw a wontumi nsiw ano, na ɛde ɔhaw ahorow yi ba a akansi biara nni mu.

Nnuru a ekum ɔyare mmoawa bɛn na etu mpɔn kɛse wɔ tebea yi mu?

Nokwarem no, nnuru biara a ekum ɔyare mmoawa a ekum mmoawa pa a wɔwɔ yɛn dwensɔtwaa mu na ennya C. diff mmoawa no so nkɛntɛnso no betumi de C. diff yare mmoawa ne pseudomembranous colitis a efi mu ba no aba. Nanso, wosusuw sɛ nnuru bi a ekum ɔyare mmoawa de asiane kɛse ba. Ebi ne:

• Clindamycin a wɔde yɛ nnuru
• Cephalosporin kuw a wɔde yɛ nnuru
• Penicillin kuw a wɔde nnuru di dwuma
• Fluoroquinolones a wɔde yɛ nnuru
• Aztreonam na ɔkyerɛwee
• Nnuru a wɔfrɛ no Carbapenems

Nea ɛho hia: Eyi nkyerɛ sɛ nnuru a ekum ɔyare mmoawa yi nye. Sɛ oduruyɛfo bi kyerɛw wɔn a, ɛsɛ sɛ wɔde di dwuma sɛnea ɛho hia. Nanso, nnuru a ekum ɔyare mmoawa a wɔde di dwuma a ɛho nhia betumi de asiane ahorow te sɛ eyinom aba.

So ntease afoforo wɔ hɔ?

Pseudomembranous colitis nso betumi aba bere a nneɛma afoforo a ɛde ba, a ɛnyɛ C. diff. Nhwɛso kakraa bi ni:

• Staphylococcus aureus yare mmoawa
• E. coli yareɛ `(E. coli yareɛ)`
• Cytomegalovirus a ɛma obi nya ɔyare mmoawa
• Microscopic colitis a ɛyɛ mmerɛw
• Behçet yare no
• Ischemic colitis (ɔfe a ɛba esiane mogya a ɛkɔ akyi berɛmo no mu a ɛso tew nti) .
• Nnuru a wɔde ko tia kokoram `(Nnuru a wɔde sa kokoram)`
• Cocaine a wɔde di dwuma
• Vasculitis (mogya ntini a ɛyɛ hyew) .
• Dade a emu yɛ duru a wɔde awuduru ayɛ

Wɔ tebea horow a ɛtete saa mu no, yare no mu yɛ den anaasɛ ɛyɛ den sen akisikuru a ɛyɛ daa. Ɛtɔ mmere bi a, mogya a ɛkɔ akyi berɛmo no fasu a ɛwɔ mu no so tew (ischemia), ntini wuwu (necrosis), na pseudomembranes ba. Afei nso, nyarewa a na ɛwɔ hɔ dedaw te sɛ Inflammatory Bowel Disease (IBD) nso betumi ama akyi berɛmo no ayɛ mmerɛw kɛse wɔ tebea yi mu.

Hena na ɔwɔ asiane kɛse mu sɛ obenya saa tebea yi?

Ɛda adi sɛ wubenya pseudomembranous colitis sɛ:

• Sɛ wɔde wo kɔ ayaresabea a.
• Sɛ wode nnuru a ekum ɔyare mmoawa adi dwuma nnansa yi a.
• Sɛ wɔayɛ wo oprehyɛn nnansa yi a.
• Sɛ obi tra nkwakoraa ne mmerewa fie a.
• Sɛ woadi boro mfe 65 a.
• Sɛ wowɔ yare bi a nipadua no tumi ko tia nyarewa a.
• Sɛ wo nipadua mu ahoɔden a ɛko tia nyarewa no yɛ mmerɛw a.
• Sɛ woanya C. diff yareɛ dedaw a.

Dɛn ne nsɛnnennen a ebetumi aba wɔ Pseudomembranous Colitis mu?

Sɛ tebea yi mu yɛ den na ɛyɛ den sɛ wobedi so a, nsɛnnennen bi a asiane wom betumi aba. Enti ɛho hia sɛ wuhu eyi nso.

• Nsu a ɛtɔ ne electrolyte a ɛyera: Wɔ pseudomembranous colitis a emu yɛ den mu no, akisikuru betumi aba mpɛn 10-15 da biara. Eyi betumi ama nsu a ɛho ayɛ fĩ na electrolyte ahwere. Eyi betumi de tebea horow a asiane wom te sɛ mogya dodow a ɛba fam, mogya mmoroso a ɛba fam, ne asaabo a entumi nyɛ adwuma yiye aba.
• Nsu a ɛtwetwe: Nsu betumi afi dwensɔtwaa kɛse no fasu a asɛe no mu akɔ yafunu no mu, na ama yafunu no ahonhon. Wɔfrɛ eyi sɛ ascites. Protein te sɛ albumin nso betumi ayera afi dwensɔtwaa kɛse no mu. Sɛ albumin sua a, nsu fi mogya ntini no mu, na ɛma akwaa no hohoro (edema).
• Megacolon a awuduru wom: Ɔfe a emu yɛ den a wontumi nni so a ebetumi ama akyi berɛmo no ahon dodo na agyae adwumayɛ. Mfiase no, ntini a ɛwɔ akyi berɛmo no mu no gyae twetwe, na esiw nsu a ɛkɔ nsu mu no kwan. Bere a akyi berɛmo no kɔ so hohoro no, n’afasu betumi apaapae, na ama emu nneɛma akɔ yafunu no mu. Wɔfrɛ eyi peritonitis. Eyi betumi de nkwa ato asiane mu.
• Yafunu mu tokuru: Tokuru betumi aba dwensɔtwaa kɛse no fasu mu a awuduru megacolon nni mu. Eyi betumi aba sɛ akuru ba wɔ dwensɔtwaa kɛse no mu na ɛfa ɔfasu no mu, anaasɛ sɛ ntini a ewuwu kɛse (necrosis) wɔ dwensɔtwaa kɛse no fasu mu a. Sɛ mmoawa a wɔwɔ dwensɔtwaa kɛse no mu tu kɔ yafunu no mu (peritonitis) a, wobetumi atrɛw akɔ mogya no mu (septicemia).
• Sepsis: Sepsis yɛ tebea a mmoawa a wɔboaboa wɔn ho ano wɔ mogya mu (septicemia) na ɛde ba. Sepsis yɛ ɔyare mmoawa a emu yɛ den a ɛde nkwa to asiane mu a ɛtrɛw kɔ nipadua no mu nyinaa. Eyi betumi ama obi anya septic shock, akwaa ahorow pii a entumi nyɛ adwuma yiye, na owu mpo.

Saa nsɛnnennen yi betumi ayɛ hu sɛ wobɛte. Nanso kae sɛ, ɛnto obiara. Sɛ wohu yare no ntɛm na wɔsa no yiye a, ebetumi asiw tebea horow a emu yɛ den yi ano.

Ɔkwan bɛn so na wobetumi ahu yare yi?

Oduruyɛfo bedi kan abisa wo wo yare no ho sɛnkyerɛnne ne w’akwahosan ho abakɔsɛm. Afei, ebia wɔbɛhyɛ sɛ wɔnyɛ nhwehwɛmu ahorow na ama wɔahu nea ɛde wo sɛnkyerɛnne ahorow no ba. Sɛ nhwɛso no, wobetumi ahyɛ sɛ wɔnyɛ mogya mu nhwehwɛmu, mfoniniyɛ mu nhwehwɛmu te sɛ scan, ne poop nhwehwɛmu. Saa nhwehwɛmu ahorow yi hwehwɛ ɔyare mmoawa, ɔfe, ne nneɛma afoforo a ɛde asiane ba.

Wo nsuo mu nhwehwɛmu no bɛhwɛ pɔtee sɛ wowɔ C. diff yareɛ anaa. Sɛ wohu a, wobefi ase ayɛ ayaresa ntɛm ara. Sɛ wunni nsɛnnennen biara na woreyɛ w’ade yiye wɔ ayaresa ho a, ebia ntease pɔtee biara nni hɔ a enti ɛsɛ sɛ wohwehwɛ wo dwensɔtwaa kɛse no mu sɛ ebia atoro ntini ahorow.

Ɛtɔ mmere bi a, mfoninitwa nhwehwɛmu (te sɛ CT scan) betumi ada pseudomembranous colitis ho sɛnkyerɛnne adi. Sɛ akyi berɛmo no fasu yɛ den (te sɛ "nsateaa nkyerɛwee sɛnkyerɛnne" anaa "accordion sɛnkyerɛnne") a, oduruyɛfo no betumi asi gyinae sɛ ɔbɛyɛ nhwehwɛmu foforo.

Afei, sɛ wobɛhwɛ mu akɔ akyiri a, ɛsɛ sɛ woyɛ sɔhwɛ bi a ɛhwɛ dwensɔtwaa kɛse no mu. Wɔfrɛ no colonoscopy. Wɔ eyi mu no, wɔde afiri bi a mfoninitwa afiri wom di dwuma de hwɛ dwensɔtwaa kɛse no mu. Sɛ wuhu nea wɔfrɛ no ‘pseudomembrane’ a, woyi ntini ketewaa bi (biopsy) fi mu na wɔde kɔ aduruyɛdan mu de si yare no so dua.

Dɛn ne ayaresa ahorow no?

Ayaresa no gyina nea ɛde yare yi ba so.

• Sɛ ɛyɛ ɔyare mmoawa te sɛ C. diff a, ɛho behia sɛ wode nnuru pɔtee a ekum ɔyare mmoawa a ɛyɛ adwuma ma no ma.
• Sɛ aduru foforo a worenom na ɛde tebea yi ba anaasɛ ɛma ɛyɛ kɛse a, ebia ɛho behia sɛ wugyae saa aduru no anaa wosesa.
• Wɔ tebea horow bi mu no, wobetumi akyerɛw nnuru a wɔde bɛtew ɔfe a ɛwɔ dwensɔtwaa kɛse no mu no so.

Nnipa binom hia ɔhwɛ a ɛboa nkutoo. Sɛ nhwɛso no, nsu a wɔde fa ntini mu (IV nsu) a ɛboa ma nsu no kɔ so tra hɔ, anaasɛ IV aduan a ɛbɛboa ma akyi berɛmo no agye n’ahome. Ebia ɛho behia sɛ wɔsa afoforo yare wɔ nsɛnnennen ho, ebia wɔ baabi a wɔhwɛ wɔn a wɔyare denneennen. Ebia ɛho behia sɛ wɔyɛ nnipa binom a wɔwɔ akisikuru anaa nsɛnnennen a emu yɛ den yiye no colectomy (oprehyɛn a wɔyɛ de yi akyi berɛmo no fã a asɛe no).

Dɛn ne nnuru titiriw a wɔde ma sɛ efi `C. diff`?

Sɛ nea ɛde pseudomembranous colitis ba ne C. diff yare mmoawa a, nnuru pii wɔ hɔ a wɔde sa. Wo duruyɛfo bɛpaw nea eye ma wo. Nnuru a wɔde ma C. diff yare no ne:

• Metronidazole a wɔde ma
• Vancomycin a wɔde yɛ aduru
• Fidaxomicin a wɔde yɛ nnuru

So wobetumi asiw Pseudomembranous Colitis ano?

Ɔkwan a ɛho hia sen biara a wɔfa so siw yare yi ano ne sɛ wobesiw C. diff mmoawa a wɔtrɛw mu wɔ mmeae a asiane kɛse wom (titiriw ayaresabea ne nkwakoraa ne mmerewa afie). Nnipa a wɔwɔ mmeae yi taa nya ɔyare no na wonya sɛnkyerɛnne a emu yɛ den te sɛ pseudomembranous colitis.

Enti, akwahosan ho adwumayɛfo a wɔwɔ asoɛe ahorow yi mu no tu anammɔn titiriw bi de siw C. diff yare mmoawa ano:

• Tew a wɔtew wɔn ho: Wɔde nnipa a wɔanya C. diff no gu dan a ɛyɛ soronko mu, anaasɛ wɔde gu dan a wɔne nnipa afoforo a wɔanya bi no nkutoo te mu. Wɔde nsateaa a wɔtow gu di dwuma bere a wɔrehyɛn dan no mu no.
• Nsa a wobɛhohoro: Sɛ wode samina ne nsuo a ɛyɛ hyew hohoro wo nsa mpɛn pii a, ɛno ne ɔkwan pa a wobɛfa so abɔ wo ho ban afiri C. diff ho. Saa mmoawa yi tumi ko tia nnuru a wɔde tew nsa ho. Ɛho hia titiriw sɛ wobɛhohoro wo nsa ansa na woadi aduan ho dwuma.
• Nnuru a wɔde kum mmoawa: Nnuru a wɔde kum mmoawa daa ntumi nkum C. diff. Nanso, nneɛma a wɔde chlorine ayɛ no betumi. Ɛho hia sɛ wɔde nnuru a ekum ɔyare mmoawa gu nneɛma a ɛwɔ soro a onipa a ɔyare no aka no nyinaa so yiye.

So wobetumi asa yare yi koraa? Nnipa dodow a wowuwu ne dɛn?

Yiw, wobetumi de ayaresa asa pseudomembranous colitis koraa. Mpɛn pii no, yare no ho sɛnkyerɛnne no befi hɔ ntɛm. Nanso, ebia nnipa binom behia ayaresa pii ne bere tenten asen afoforo. Sɛ wowɔ C. diff yare a ɛkɔ so tra hɔ na ɛyɛ den sɛ wubedi so a, ebia ebehia sɛ woyɛ wo oprehyɛn ketewaa bi de sa. Wɔ tebea horow bi mu no, ebia ɛho behia sɛ wɔyɛ oprehyɛn.

Wɔ owu ho no, ayarefo a wɔwɔ pseudomembranous colitis no mu 2% pɛ na wowuwu. Nanso, wɔ nnipa a wɔhwɛ wɔn bere tenten na wɔn nipadua mu ahoɔden a ɛko tia nyarewa no ayɛ mmerɛw mu no, saa dodow yi betumi akɔ soro akodu 15%. Sɛ ɔhaw a yɛadi kan aka ho asɛm a wɔfrɛ no toxic megacolon no ba a, nnipa dodow a wowuwu no betumi akɔ soro akodu 35%. Ɛno nti na ayaresa a wɔde ma ntɛm ho hia no.

Bere bɛn na ɛsɛ sɛ wokɔ oduruyɛfo nkyɛn?

Sɛ wowɔ saa sɛnkyerɛnne ahorow yi bi a, hwehwɛ aduruyɛfo afotu ntɛm ara:

• Yafunu mu yaw a emu yɛ den anaasɛ ne ho popo.
• Sɛ wowɔ atiridiinini bɛboro mpɛn anum da biara a.
• Sɛ mogya wɔ nsu mu a.
• Sɛ woankɔ wo dwensɔtwaa mu nnansa a.
• Sɛ woantow wo ho da koro, anaasɛ wo nsu no kɔla yɛ tuntum a.
• Sɛ wowɔ atiridiinini a ɛboro digrii Celsius 39 (digrii Fahrenheit 102) nnansa a.

Nea etwa to no, nneɛma a ɛsɛ sɛ yɛkae

Mmoawa a ɛde akisikuru ba no abu so, na mpɛn pii no ɛnyɛ nea emu yɛ den. Ɛnyɛ obiara a obenya C. diff na obenya pseudomembranous colitis. Nanso, sɛ woyɛ saa a, ebetumi ayɛ hu kakra. Sɛ wunim sɛ wo dwensɔtwaa resɛe fi wo mu a, ebetumi ayɛ hu, na ɛwɔ sɛnkyerɛnne te sɛ ɛyaw ne mogya a ɛretu.

Sɛ wunya yare no ho sɛnkyerɛnne te sɛ eyinom a, ebia wubehia ayaresa titiriw. Nanso kae sɛ, sɛ wɔsa wo yare yiye a, wo dwensɔtwaa betumi asa.Ntini a ɛwɔ yɛn akyi berɛmo mu te sɛ yɛn akyi berɛmo no mu ntini no sa yiye bere a ɛnsɛee no. Sɛ wote nka sɛ wo colitis ho sɛnkyerɛnne no nkɔ yiye a, wo ne oduruyɛfo nkasa. Obetumi aboa wo ma woahu nea ɛde wo tebea no ba, ayɛ nea ɛho hia na ama woagyae, na wama wo dwonku no ahomegye a ehia. Nea ɛho hia sen biara ne sɛ woremmɔ hu na worehwehwɛ aduruyɛ mu afotu ntɛm.

` Pseudomembranous Colitis, C. diff, akisikuru, yafunu mu yaw, yafunu mu yare, nnuru a ekum ɔyare mmoawa