Makemake ʻoe e ʻike hou aʻe e pili ana i ka hoʻāʻo ERCP (Endoscopic Retrograde Cholangiopancreatography)? Mai makaʻu, e kamaʻilio kākou!

Ke haʻi aku kāu kauka iā ʻoe e pono ʻoe e loaʻa i kahi ERCP, nui paha kāu mau nīnau e pili ana i ke ʻano o ia mea, no ke aha e hana ʻia ai, a e ʻeha paha. He mea maʻamau kēlā. He nui ka poʻe e hopohopo iki ke lohe lākou i ka inoa. Akā, ʻaʻohe mea e makaʻu ai ʻo ERCP. He hoʻāʻo holomua loa ia e hiki ke ʻike a mālama i kekahi mau pilikia i kāu ʻōnaehana biliary a me nā ducts pancreatic. No laila, e kamaʻilio kākou e pili ana iā ERCP ma ke ʻano maʻalahi i kēia lā, ʻae?

He aha ka ERCP (Endoscopic Retrograde Cholangiopancreatography)?

E hoʻopūʻiwa iki paha kēia inoa lōʻihi iā ʻoe, akā e wehewehe kākou a e hoʻomaopopo.

I ka ʻōlelo maʻalahi, he hana kūikawā ka ERCP a nā kauka e hoʻohana ai e nānā i loko o kāu mau ʻauwai bile a me nā ʻauwai pancreatic . Lawe kēia mau ʻauwai i ka bile a me ka wai pancreatic, e kōkua iā mākou e hoʻoheheʻe i ka meaʻai a mākou e ʻai ai.

Eia ke ʻano o kēia inoa:

• Endoscopic: Hoʻohana kēia i kahi mea i kapa ʻia he endoscope. He ʻōmole lahilahi a palupalu me kahi kāmela liʻiliʻi a me ke kukui ma kekahi ʻaoʻao. Hoʻokomo ʻia ia ma kou waha a hoʻouna ʻia i lalo i ka ʻaoʻao o luna o kou ʻōpū (ka duodenum). E hāʻawi ʻia ʻoe i kahi mea hoʻomaha e kōkua iā ʻoe e hiamoe, no laila ʻaʻole ʻoe e ʻike i kekahi ʻeha.
• Retrograde: Ma kēia, hoʻokomo ʻia kekahi paipu liʻiliʻi ma o ka endoscope a hoʻokomo ʻia kahi wai kūikawā (contrast dye) i loko o nā ʻauwai bile a me nā ʻauwai pancreatic. ʻO "Retrograde" ʻo ia hoʻi "hoʻi i hope" no ka mea ua hoʻokomo ʻia ka wai i ke kuhikuhi ʻē aʻe e kahe mau ana.
• Cholangiopancreatography: Pili kēia i nā kiʻi i lawe ʻia. ʻO "Cholangio" ke ʻano pili i nā ʻauwai bile. ʻO "Pancreato" ke ʻano pili i ka pancreas. ʻO "Graphy" ke ʻano o ke kiʻi ʻana i nā kiʻi.

No laila, ʻo ka dye contrast e hōʻike maopopo i kāu mau ʻauwai bile a me nā ʻauwai pancreatic ma nā kiʻi X-ray. Hiki i kēia i nā kauka ke ʻike inā he mea e ālai ana i kēia mau ʻauwai - e like me nā gallstones, nā tumors, a i ʻole ka hāiki ʻana o nā ʻauwai ma muli o ka ʻiʻo scar . ʻO ka mea maikaʻi loa, hiki ke mālama ʻia kekahi o kēia mau pilikia ma laila, ma o ka endoscope.

I nā hihia hea e pono ai ka ERCP?

Hiki i kāu kauka ke kauoha i kahi ERCP inā manaʻo lākou he pilikia me kāu ʻōnaehana biliary. Eia kekahi laʻana:

• Inā loaʻa iā ʻoe ka ʻeha o luna o ka ʻōpū i wehewehe ʻole ʻia, a inā he biliary colic kou.
• Inā aia kahi kūlana kahi i ālai ʻia ai ke kahe ʻana o ka bile a i ʻole he mau hōʻailona o ka liki ʻana o ka bile, no ka laʻana jaundice .

Hiki i kahi hoʻokolohua ERCP ke kōkua i ka ʻike a me ka mālama ʻana i nā pilikia maʻamau e pili ana i kāu mau ʻāpana bile, e like me:

• ʻO ka mumū ʻana o nā ʻāpana bile (cholangitis) a me nā maʻi pili.
• Ka hāiki ʻana o nā ʻauwai bile ma muli o ka ʻiʻo scar (biliary stricture) .
• Ka paʻa ʻana o ka pōhaku i loko o ke kahawai bile maʻamau .
• ʻO ka mumū o ka pancreas i hoʻokumu ʻia e nā pōhaku (gallstone pancreatitis) .
• Nā puʻupuʻu a i ʻole ke kanesa o nā ʻauwai bile.
• Ka liki ʻana o ke aʻa bile a i ʻole nā ​​​​ulia ʻē aʻe.

Pehea e hana ai ka ERCP?

Hoʻohui ka ERCP i ʻelua mau ʻano hana nui: endoscopy a me fluoroscopy . Ua like ka Fluoroscopy me nā kiʻi X-ray e neʻe ana. E noʻonoʻo iā ia e like me kahi wikiō X-ray.

ʻAe kēia fluoroscopy i ke kauka e ʻike pehea e neʻe ai ke kahe kūikawā (contrast dye) ma o kou mau ʻauwai bile a me nā ʻauwai pancreatic. Hiki iā ia ke hōʻike maopopo i nā leaka a i ʻole nā ​​​​​​mea i ālai ʻia.

ʻO ka endoscope ka mea e hiki ai i ke kauka (endoscopist) ke hōʻea i ka wahi. Hoʻokomo ʻia ka dye contrast ma o kēia. Eia kekahi, inā loaʻa kahi pilikia, hiki ke hoʻokomo ʻia nā mea hana liʻiliʻi ma o kēia endoscope e mālama ai.

ʻO wai ka mea e hana ana i ka ERCP?

Hana pinepine ʻia kahi ERCP e kahi gastroenterologist . He poʻe akamai kēia mau kauka i ka mālama ʻana i nā maʻi o kāu ʻōnaehana digestive a me biliary. Ua aʻo ʻia hoʻi lākou e hana i ka endoscopy. Ua aʻo ʻia hoʻi lākou i nā kaʻina hana endoscopic hiki ke hoʻohana ʻia ma kahi o nā ʻoki liʻiliʻi.

Pehea ʻoe e hoʻomākaukau ai no ka ERCP?

E hāʻawi aku kāu kauka iā ʻoe i kekahi mau kuhikuhi kikoʻī e hahai ai ma mua o kāu ERCP. Ma keʻano laulā, ʻo kēia mau mea:

• Pono ʻoe e hoʻōki i ka puhipaka, ka ʻai ʻana, ka nau ʻana i ka gum, a me ka inu ʻana i kekahi mea ʻē aʻe ma mua o ka wai ʻewalu hola ma mua o ka hoʻāʻo ʻana.
• Pono ʻoe e haʻi i kāu kauka e pili ana i nā kūlana olakino ʻē aʻe āu e loaʻa nei a me nā lāʻau lapaʻau āu e lawe nei . Pono paha e hoʻōki ʻia kekahi mau lāʻau lapaʻau, e like me nā mea hoʻokahe koko, no kekahi mau lā ma mua o ka hoʻāʻo ʻana.
• E haʻi i kāu kauka inā ua loaʻa iā ʻoe kahi maʻi allergy ma mua i ka dye contrast a i ʻole anesthesia i hoʻohana ʻia i ka wā o ka hoʻāʻo.
• Pono ʻoe e hoʻonohonoho i kahi kaʻa e hoʻi ai i ka home ma hope o ka hoʻāʻo ʻana, no ka mea, he 24 mau hola ka lōʻihi e pau loa ai nā hopena o ka lāʻau hoʻomake. No laila, ʻaʻole hiki iā ʻoe ke hoʻokele.

He aha ka mea e hana ʻia i ka wā o ka hoʻāʻo ERCP?

He hana ma waho ka ERCP. ʻO ia hoʻi, hiki iā ʻoe ke hoʻi i ka home i ka lā hoʻokahi. ʻO ka maʻamau, hoʻokahi a ʻelua paha hola ka lōʻihi o ke kaʻina hana.

E hāʻawi ʻia ʻoe i kahi lāʻau lapaʻau i hāʻawi ʻia i loko o kahi aʻa (ma o kahi "IV") e hoʻohiamoe iā ʻoe (hoʻomaha) . Hiki iā ʻoe ke hiamoe nui, a i ʻole ʻoe e ala iki ana. Eia naʻe, ʻaʻole ʻoe e hoʻomanaʻo i ka hoʻāʻo.

I ka wā o ka hana diagnostic o ka hoʻokolokolo, e hana ke kauka i kēia mau mea:

• Inā makemake ʻoe, hiki ke hoʻopili ʻia kahi anesthetic wai e hōʻemi i ka ʻeha o ka puʻu.
• Hoʻokomo ʻia kahi endoscope ma ka waha a hoʻokomo pono ʻia ma o ka esophagus a me ka ʻōpū i loko o ka ʻaoʻao o luna o ka ʻōpū liʻiliʻi (duodenum). Hōʻike ʻia nā kiʻi i ʻike ʻia mai ke kāmela o ka endoscope ma kahi pale.
• Ma ka nānā ʻana i kēlā mau wikiō, hiki iā ʻoe ke ʻike i ka wehe ʻana o ke kahawai bile a me ke kahawai pancreatic i loko o ka ʻōpū liʻiliʻi.
• Hoʻokomo ʻia kekahi ʻōmole liʻiliʻi ma o ka catheter i loko o ka endoscope a i loko o ka puka.
• Hoʻokomo ʻia ka dye ʻokoʻa i loko o nā kīʻaha koko ma o kēlā ʻōmole liʻiliʻi.
• A laila, me ka hoʻohana ʻana i ka ʻenehana fluoroscopy, lawe ʻia nā wikiō X-ray e ʻike ai pehea e neʻe ai ke wai ma o nā ʻōmole. I ka fluoroscopy, hoʻopuka ʻia nā kukuna X i nā pahū pōkole. Ua manaʻo ʻia kēia he nui palekana o ka radiation.
• Hoʻohana ʻia kēia mau kiʻi e nānā i nā pilikia me nā paipu - ke ālai ʻia, ka pehu ʻana, ka liki ʻana, a pēlā aku.

E noʻonoʻo i kēia, ua like ia me ke kau ʻana i kahi kāmela i loko o kahi paipu, e hoʻouna ana i kahi wai kala ma o ia mea, a e ʻike i kahi i paʻa ai a me kahi e liki mai ana.

I kēia manawa, inā ʻike ke kauka i kekahi mau pilikia i ka wā o kēia hoʻokolokolo ʻana, e hoʻāʻo ʻo ia e mālama iā lākou ma ke komo ʻana i nā mea hana liʻiliʻi ma o ka endoscope. Hiki i ke kauka e hana ana i ka endoscopy ke hana i nā mea e like me:

• Ke kuʻi ʻana a me ka wehe ʻana i nā pōhaku gall.
• Ke wehe ʻana i nā puʻupuʻu a i ʻole ka lawe ʻana i kahi hāpana ʻiʻo (biopsy). (Ke lawe ʻia kahi biopsy, hoʻouna ʻia i kahi keʻena hoʻokolohua e ʻike ai inā he maʻi kanesa a ʻaʻole paha.)
• E hoʻonui a hoʻolōʻihi paha i nā kīʻaha koko i haiki a ʻūmiʻi paha.
• Ke kau ʻana i kahi mea liʻiliʻi e like me ka paipu (stent) i loko o kahi moku e wehe ai.
• Ke hoʻoponopono nei i kahi liki a i ʻole ka ʻeha i loko o ka paipu.
• He ʻoki liʻiliʻi ka sphincterotomy i hana ʻia i loko o ka ʻiʻo a puni ka puka o ke duct e hoʻonui iā ia. (Kōkua kēia i ka wai bile a me ka pancreatic e kahe maʻalahi.)

He aha kāu e manaʻo ai ma hope o ka ERCP?

Ma hope o ka hoʻāʻo ʻana, e mālama ʻia ʻoe ma ka haukapila a i ʻole ke kikowaena lapaʻau no hoʻokahi a ʻelua paha hola, a pau nā hopena o ka anesthesia. A laila hiki i ka mea nāna i hele mai e kiʻi iā ʻoe ke lawe iā ʻoe i ka home. Hiki paha iā ʻoe ke hiamoe iki, hoʻoluliluli a hakahaka paha i kēlā lā.

Hiki ke loaʻa nā ʻeha liʻiliʻi e like me kēia no hoʻokahi a ʻelua paha lā ma hope o ka hoʻāʻo ʻana:

• ʻEha ka ʻāʻī a me ka paʻakikī i ke ale ʻana: Hiki i ka endoscope ke hōʻeha i kou ʻāʻī. ʻOi aku ka maikaʻi o ka lawe ʻana i nā wai a i ʻole nā ​​​​meaʻai palupalu a hiki i ka wā e ho'ōla ai.
• ʻEha ʻōpū pehu a ʻeha kinoea paha: Ke hoʻokomo ʻia ka endoscope, puhi ʻia kahi ea liʻiliʻi i loko o ke ala GI e ʻae ai i ka ʻike maikaʻi. ʻO kēia ke kumu o kēia ʻeha. E emi iho ia ma hope o kekahi manawa (ke hoʻokuʻu ʻia ka ea).
• Luli: He hopena ʻaoʻao paha kēia o ka anesthesia. Hoʻomaha nō hoʻi ia i ka lā aʻe.

He aha nā pilikia o ka ERCP?

Loaʻa nā pilikia ma kahi o 5% a 10% o nā kaʻina hana ERCP. Pili kēia pilikia i kou mau kūlana olakino mua a me ke ʻano o ka lāʻau lapaʻau āu e loaʻa ai i ka wā o ka ERCP. E kūkākūkā kāu kauka i kēia me ʻoe ma mua. Hiki i nā pilikia ke komo pū me:

• Ka hopena maikaʻi ʻole i ka lāʻau hoʻomaha: Hiki i kēia ke hana i nā pilikia cardiopulmonary i ka poʻe me ka maʻi māmā a i ʻole ka maʻi puʻuwai mua.
• ʻO ka hopena maʻi i ka dye contrast: Inā hana kēia, e hāʻawi koke ke kauka iā ʻoe i ka lāʻau lapaʻau e hoʻōki i ka hopena.
• ʻEha i kāu ʻāpana GI mai ka endoscope: Hiki i kēia ke hoʻoulu i ke kahe koko i loko a i ʻole, i nā hihia koʻikoʻi, he lua.
• Ka liki ʻana o ka bile ma muli o ka hōʻeha ʻana i nā ʻauwai bile i hoʻokumu ʻia e nā mea hana endoscopic.
• ʻO ka maʻi i loko o kāu ʻōnaehana biliary: I mea e pale ai i kēia, hiki i kāu kauka ke hāʻawi iā ʻoe i nā lāʻau antibiotics ma mua.
• Hiki i ke kaʻina hana ke hoʻonāukiuki a me ka mumū o ka pancreas (pancreatitis). ʻO kēia ka pilikia maʻamau ma hope o ka ERCP.

Inā hāpai ʻoe i ka manawa o ka hoʻāʻo ʻana, he liʻiliʻi ka pilikia o ka hōʻeha ʻana i ka ʻōpū mai ka radiation i hoʻopuka ʻia i ka wā o ka fluoroscopy, akā he liʻiliʻi ka pilikia. E nīnau mua kāu kauka iā ʻoe inā he hiki ke hāpai ʻoe. Inā pēlā, e hoʻāʻo kāu kauka e hoʻonohonoho hou i ka hoʻāʻo a hōʻemi paha i kou ʻike ʻana i ka radiation inā pono.

ʻEhia ka lōʻihi e ʻike ai i nā hopena o ka hoʻokolohua?

Inā ʻaʻole ʻoe e hiamoe ana mai ka anesthesia,Pono ke kauka (endoscopist) nāna i hana i ka ERCP e kamaʻilio koke me ʻoe e pili ana i ka hoʻāʻo. E haʻi aku ʻo ia iā ʻoe i ka mea i loaʻa a me ka mea hiki ke hana ʻia e pili ana i ia mea. Inā ua lawe ʻia kahi hāpana ʻiʻo (biopsy), hiki ke hala i kekahi mau pule e hoʻi mai ai nā hopena.

Inā ʻaʻole loaʻa i kāu ERCP kekahi mea, pono paha ʻoe e loaʻa i kahi ʻano hoʻāʻo ʻē aʻe. Inā ʻaʻole hoʻoponopono ka hoʻāʻo i kāu pilikia, a inā hōʻoia nā hopena biopsy i kahi pilikia hou, pono paha ʻoe e loaʻa i kahi ʻano lāʻau ʻē aʻe. E kamaʻilio kāu kauka me ʻoe e pili ana i ka mea e hana ai ma hope.

Āhea ʻoe e pono ai e kāhea aku i ke kauka?

Inā loaʻa iā ʻoe kekahi o kēia mau hōʻailona koʻikoʻi a ʻano ʻē paha ma hope o ka ERCP, e kāhea koke i kāu kauka:

• ʻEha nui o ka ʻōpū a i ʻole ka pehu ʻana.
• ʻEha ka umauma a i ʻole ka paʻakikī o ka hanu ʻana.
• Ke kuni, ka luaʻi, a i ʻole nā ​​hōʻailona ʻē aʻe o ka maʻi.
• Ke kahe koko ʻana o ke koko i ka rectal a i ʻole nā ​​​​​​ʻōpala ʻeleʻele a ʻala.

He aha ka ʻokoʻa ma waena o ka ERCP a me ka endoscopy maʻamau?

He ʻano holomua ʻo ERCP o ka endoscopy. ʻO ka esophagogastroduodenoscopy maʻamau (EGD) e nānā wale i kou ala GI o luna. ʻO ia hoʻi, nānā wale ia i ka esophagus, ka ʻōpū, a me ka hapa mua o ka ʻōpū liʻiliʻi.

Akā i loko o kahi ERCP, hoʻohana ʻia kahi hoʻonui ʻē aʻe me ka endoscope maʻamau - ʻo ia hoʻi, kahi paipu ʻelua (catheter) e hele ana i loko o ka paipu mua - ʻo ia ka mea e hiki ai i kāu mau ducts biliary.

ʻO kēia hoʻolōʻihi endoscope mini e hiki ai i ke kauka ke mālama pololei i kāu mau ducts. ʻO ke kaʻina hana endoscopic wale nō e hiki ke mālama pololei i nā ducts ma kēia ʻano ʻo ia ka `ERCP`. ʻOiai ʻo nā kaʻina hana endoscopic ʻē aʻe e like me ka `MRCP` (magnetic resonance cholangiopancreatography) a me ka `EUS` (endoscopic ultrasound) hiki ke ʻike i kāu mau ducts bile a me nā ducts pancreatic, ʻaʻole lākou e hāʻawi i kēia pae o ka maʻalahi no ka mālama ʻana iā lākou.

He hana ʻoki kino nui anei ka ERCP?

ʻAʻole ʻo ERCP he ʻoki kino e like me kā mākou e manaʻo mau ai. ʻAʻole ia he mea e ʻoki ana i ka ʻili a komo i loko o nā ʻōpū i loko o ke kino. He kaʻina hana endoscopic ʻo ERCP. ʻO ia hoʻi, komo ia i loko o ke kino ma o kahi puka kūlohelohe - i kēia hihia, ka puʻu.

Eia nō naʻe, i ka wā e hana ai i kahi ERCP, hiki i ke kauka ke hana i kekahi mau kaʻina hana ʻoki ma o ka endoscope. I kekahi manawa, kapa nā kauka i kēia mau kaʻina hana i hana ʻia ma o ka endoscope he ʻoki endoscopic . He mau kaʻina hana ʻoki kēia no ka mea e pili ana lākou i ka hana ʻana i nā ʻoki a me nā humuhumu i loko o ke kino. Eia nō naʻe, he mau kaʻina hana liʻiliʻi kēia, a ʻoi aku ka liʻiliʻi o ka pilikia a he pōkole ka manawa hoʻōla ma mua o ke ʻoki kuʻuna.

Hana ʻia ka ERCP no ka maʻi pancreatitis.

ʻAe, inā manaʻo kāu kauka he mea e ālai ana i kāu mau ʻauwai bile a i ʻole nā ​​ʻauwai pancreatic, hiki iā ia ke kauoha i kahi ERCP. ʻO nā pōhaku gallstones i paʻa i loko o nā ʻauwai kekahi kumu nui o ka pancreatitis acute. Inā hana ʻia kēlā, pono paha ʻoe e loaʻa i kahi ERCP e wehe i ka mea ālai.

Inā loaʻa iā ʻoe ka pancreatitis mau loa, hiki i ka mumū ke hana i kou mau ducts pancreatic e lilo i ʻeha a me ka wili (strictures). I ia mau hihia, hiki i ka ERCP ke kōkua i ka hoʻonui ʻana i nā ducts a i ʻole e hoʻokomo i kahi stent e mālama iā lākou i ka wehe. Kōkua kēia i nā wai pancreatic e hoʻomau i ke kahe ʻana ma o nā ducts.

E hoʻomanaʻo i ka mea nui loa (Leka Lawe-Home)

ʻO ka ERCP (Endoscopic Retrograde Cholangiopancreatography) kahi hoʻāʻo diagnostics hiki ke hoʻohana ʻia e mālama i ka maʻi ma kahi inā pono. ʻOiai he ʻoi aku ka invasive ma mua o ka hoʻāʻo kiʻi maʻamau, ʻoi aku ka liʻiliʻi o ka invasive ma mua o ke ʻoki kino nui. Hiki ke hoʻohana ʻia e nānā a mālama i ka maʻi i ka manawa like.

Hiki i ka hapa nui o ka poʻe ke hana i kēia hoʻāʻo me ka ʻole o ka pilikia nui, a he nui nā pono. No laila, inā manaʻo ke kauka i kahi ERCP nou, mai makaʻu e kamaʻilio me ia e pili ana i ia mea, a e nīnau i kāu mau nīnau a pau. E kōkua ia iā ʻoe e hana i nā hoʻoholo maikaʻi loa e pili ana i kou olakino!

` ERCP, endoscopy, nā ʻauwai bile, pancreas, nā pōhaku, jaundice, ʻōnaehana hoʻoheheʻe