Ua lohe paha ʻoe i kahi ʻauwai bile e haiki ana a i ʻole e ālai ʻia ana? Ua ʻike paha ʻoe i ka ʻeha ma ka ʻaoʻao ʻākau o luna o kou ʻōpū a i ʻike paha i ka melemele o kou ʻili (i ʻike ʻia ʻo jaundice )? Inā pēlā, pono ʻoe e hoʻolohe i ka ʻike ma lalo nei. I kēia lā, ke kūkākūkā nei mākou i ka Biliary Stricture . Mai hopohopo; ʻo ka hoʻomaopopo ʻana i kēia kūlana ke kaʻina mua e loaʻa ai ka hopena kūpono. Eia ʻo Nirogi Lanka e kōkua iā ʻoe e hoʻokele i kēia.
He aha ka Biliary Stricture? E wehewehe maʻalahi kākou!
I ka ʻōlelo maʻalahi, hana ʻia kahi Biliary Stricture ke hoʻohaiki ʻia a ālai ʻia paha kāu mau ʻauwai bile ma muli o kahi maʻi, ka ʻeha , a i ʻole kahi mea e ālai ʻia ai. E noʻonoʻo iā ia e like me kahi paipu i paʻa ʻia; ke kaupalena ʻia ke kahe ʻana, ʻaʻole hiki i ka wai ke hele pono. Ke hāiki kou mau ʻauwai bile, ua kaupalena ʻia ke kahe ʻana o ka bile mai kou akepaʻa a i kou ʻōpū liʻiliʻi. Hoʻoulu kēia i ka bile e hoʻi i loko o ke akepaʻa a hiki ke paʻakikī i ka ʻai ʻana. Ua kapa ʻia kēia ʻano ma ke ʻano lapaʻau he "bile duct stricture."
No laila, he aha maoli nā ʻāpana bile?
E noʻonoʻo i kāu mau ʻauwai bile ma ke ʻano he ʻōnaehana paipu no kāu ʻōnaehana hoʻoheheʻe . Hoʻopuka kou akepaʻa i ka bile—he wai hoʻoheheʻe e pono ai no ka wāwahi ʻana i ka meaʻai. Lawe nā ʻauwai i kēia bile i kou ʻōpū liʻiliʻi, kahi e kōkua ai nā waikawa i loko o ka bile i ka wāwahi ʻana i nā momona a me nā protein. Hoʻopili pū kāu ʻauwai bile me ka ʻauwai pancreatic, kahi e lawe ai i nā enzymes—kahi ʻano protein e kōkua hou aku i ka hoʻoheheʻe ʻana i kāu mau meaʻai.
Pehea ka maʻamau o ka biliary stricture?
ʻOiai ʻaʻole i loaʻa i nā loea kahi helu pololei o ka nui o ka poʻe i hoʻopilikia ʻia i kēlā me kēia makahiki, me he mea lā e lilo ana ke ʻano i mea maʻamau. ʻO kekahi kumu e kōkua ai, ʻo ia ka hoʻonui pinepine ʻana o ke ʻoki ʻana i ka gallbladder , ʻoiai ka Laparoscopic Cholecystectomy . I loko o ia mau kaʻina hana, hiki ke hōʻino ʻia nā ʻauwai bile a i ʻole ka ulu ʻana o nā ʻiʻo ʻeha, e alakaʻi ana i ka haiki. ʻO ka mea pōmaikaʻi, he mea kakaikahi loa kēia ʻano i nā keiki.
He aha nā kumu nui o ka hoʻohaiki ʻana o ke aʻa bile?
I nā hihia kakaikahi loa, hiki ke hānau ʻia kahi keiki me nā ʻauwai bile i haiki, he maʻi hānau ʻia . Eia nō naʻe, i ka hapa nui o nā hihia—ma kahi o ʻehiku mai ka ʻumi—pili ke kumu i ka maʻi ʻino, e like me ke Kanesa Pancreatic a i ʻole Cholangiocarcinoma (kanesa ʻauwai bile) .
ʻO nā maʻi ʻē aʻe e hiki ke alakaʻi i kēia:
- Ka maʻi ʻaʻai ʻōpū
- Ka maʻi ʻaʻai hepatocellular (Ka maʻi ʻaʻai akepaʻa)
- Ka maʻi ʻaʻai ate
- ʻO ka maʻi ʻōpū
- ʻO ka Metastasis (ka maʻi kanesa i pālahalaha mai nā ʻāpana ʻē aʻe o ke kino)
- Ka maʻi ʻōpū liʻiliʻi
Pehea e pili ana i nā kumu ʻaʻole maʻi kanesa (benign)?
Ma kahi o 30% o nā hihia i hana ʻia e nā kūlana maikaʻi ʻole a i ʻole nā kaʻina hana lapaʻau, e like me:
- Nā ʻeha a i ʻole ka trauma o ka ʻōpū
- ʻO ka pancreatitis Autoimmune a me ka pancreatitis (ka mumū o ka pancreas)
- ʻO ka ʻeha o ke aʻa bile ma muli o nā pōhaku gallstones
- ʻO ka maʻi Mirizzi (kahi e hoʻoulu ai nā gallstones i ke kaomi waho o nā ʻauwai bile)
- ʻO ka cholangitis biliary mua
- ʻO ka cholangitis sclerosing mua
- Lapaʻau radiation
He aha ke ʻano o ka "Anastomotic Biliary Stricture"?
Ma hope o kekahi mau ʻokiʻoki paʻakikī, e like me ke kaʻina hana Whipple (hana pinepine ʻia no ka maʻi kanesa pancreatic) a i ʻole kahi hoʻoili ate, hiki iā ʻoe ke hoʻomohala i kahi Anastomotic biliary stricture.I loko o kēia mau ʻoki kino, pono ke kauka lapaʻau e hoʻopili hou i nā ʻāpana o kou ʻōnaehana hoʻoheheʻe, kahi hana i kapa ʻia ʻo anastomosis . I kekahi manawa, hiki i kahi i hoʻopili hou ʻia ai kēia mau ʻiʻo ke loaʻa i nā ʻiʻo ʻeha a i ʻole ka hōʻino ʻana, e alakaʻi ana i kahi hāiki. Ua kapa ʻia kēia he anastomotic biliary stricture.
He aha nā hōʻailona o ka hāʻule ʻana o ke aʻa bile?
Inā loaʻa iā ʻoe kēia maʻi, hiki iā ʻoe ke ʻike i nā hōʻailona ma lalo nei. E hoʻomanaʻo, ʻo ka loaʻa ʻana o hoʻokahi a ʻelua paha o kēia mau mea ʻaʻole ia he manaʻo koke ua loaʻa iā ʻoe kēia maʻi, akā he mea nui e nīnau aku i ke kauka inā ʻoe e hopohopo nei:
- ʻEha ma ka ʻaoʻao ʻākau o luna o kou ʻōpū .
- Kuni a me ke anu .
- Nā loli i ke kala o kou noho (e ʻike ʻia ana he keʻokeʻo, hina, a lepo paha).
- Ka ʻili ʻili mau (Pruritus).
- Jaundice (melemele o ka ʻili a me nā keʻokeʻo o kou mau maka).
- Ka nalowale o ka makemake .
- Ka luaʻi a me ka luaʻi .
He aha nā pilikia lōʻihi?
Inā noho haiki a paʻa paha kahi ʻauwai bile no kekahi manawa lōʻihi, hiki i ka bile ke piʻi hou i loko o ke ake. Hiki i kēia ke alakaʻi i nā maʻi , nā maʻi akepaʻa mau , a i ʻole Cirrhosis o ke akepaʻa (ka ʻeha nui o ke akepaʻa). Ma muli o kēia mau pilikia, he mea nui e makaʻala pono i kāu mau hōʻailona.
ʻO wai kāu e ʻike ai no ka hōʻoia ʻana a me ka mālama ʻana?
Inā hōʻike ʻoe i kēia mau hōʻailona, pono ʻoe e kūkākūkā me kahi Gastroenterologist . ʻO lākou nā loea i lako pono e ʻike a mālama i nā kūlana e pili ana i kāu ʻōnaehana hoʻoheheʻe.
Pehea e ʻike ai nā kauka i nā koʻikoʻi biliary?
Hiki i kāu kauka ke kuhikuhi i kekahi mau hoʻokolohua e hōʻoia i ke kūlana:
- Nā hoʻāʻo koko:
- Hoʻāʻo Bilirubin: Ke hoʻohaiki ʻia nā ʻauwai bile, hōʻiliʻili ka bilirubin (kahi huahana ʻōpala) i loko o ke kino. Ana kēia hoʻāʻo i kēlā mau pae.
- Nā hoʻāʻo hana ate: Hoʻohana ʻia e nānā i nā enzymes ate kiʻekiʻe, e hōʻike ana i ke kaumaha o ke ake.
- Nā hoʻokolohua kiʻi: ʻAe kēia mau hoʻokolohua i kāu kauka e nānā i ke kūlana o kāu mau ʻāpana bile mai loko mai.
- Ultrasound: Hoʻohana kēia kaʻina hana i nā nalu kani e hana i nā kiʻi e ʻike ai i nā poloka a i ʻole ka haiki ʻana i loko o nā ʻauwai bile. Ma muli o kāu mau pono, hiki iā ʻoe ke hana i kahi ultrasound Endoscopic (kahi ultrasound i hana ʻia ma o kahi ʻōmole kūikawā me kahi kāmela), kahi ultrasound ʻōpū, a i ʻole kahi ultrasound akepaʻa.
- ʻO ka Endoscopic retrograde cholangiopancreatography (ERCP): Hoʻohui kēia i kahi endoscopy luna me nā kukuna X. Ma hope o ka hoʻomāʻū ʻana i kou puʻu, ua hoʻouna ʻia kahi ʻōmole palupalu me kahi kāmela (endoscope) e nānā i kāu mau ʻōpū ʻai a me nā ʻāpana bile. I loko o kēia kaʻina hana, hiki i kāu kauka ke hōʻiliʻili i kahi biopsy (kahi laʻana ʻiʻo) no ka nānā ʻana e nānā i nā hunaola kanesa.
- ʻO ka cholangiopancreatography resonance magnetic (MRCP): He scan MRI kūikawā, hāʻawi kēia i nā kiʻi kikoʻī loa o kāu mau ʻāpana bile, ate, pancreas, a me ka gallbladder.
- ʻO ka cholangiography transhepatic Percutaneous (PTC): He kaʻina hana X-ray kikoʻī kahi e hoʻokomo ai kāu kauka i ka dye contrast ma o ke akepaʻa i loko o nā ʻauwai bile. A laila hoʻohana ʻia nā kukuna X e hahai i ke kahe o ka dye i loko o kou ʻōpū liʻiliʻi, e hōʻike maopopo ana i nā wahi i ālai ʻia.
Pehea e mālama ʻia ai ka ʻūlū ʻana o ke aʻa bile?
I nā hihia he nui, hiki i kāu kauka ke hoʻoponopono i ke kumu o ka poloka i ka wā o kahi kaʻina hana ERCP a i ʻole PTC.
Ma muli o ke kumu kumu, hiki i kāu kauka ke hana i kēia mau mea:
- Ka wehe ʻana i nā gallstones inā ʻo lākou ke kumu o ka palaka ʻana.
- Ke hoʻohana nei i kahi mea like me ka balloon e hoʻonui i ke kahawai bile i hoʻopili ʻia a hoʻokomo i kahi stent(he paipu metala liʻiliʻi a palaki paha) e wehe mau ai ke auwai.
- Ke wehe ʻana i nā ʻōpū a i ʻole nā mea ulu.
He aha nā koho ʻoki kino?
He kakaikahi wale nō nā mea maʻi e pono ai ke ʻoki ʻana no nā ʻoʻoleʻa o ke kahawai bile, ʻoiai ke kumu o ka haiki ʻana e ka maʻi ʻino a i ʻole ke kanesa.
ʻO nā koho ʻoki kino e komo pū ana:
- ʻO ke ʻoki ʻana me ke ala ʻole: Ke hoʻohuli nei i ke kahe i hiki ai i ka bile ke neʻe pololei i loko o kou ʻōpū liʻiliʻi, e pale ana i ke kahawai i ālai ʻia.
- Resection a me Anastomosis: Wehe ʻoki ʻana i ka ʻāpana maʻi o ke aʻa bile a hoʻopili hou i nā wēlau olakino.
Hiki ke hoʻi hou mai kēia maʻi ma hope o ka mālama ʻana?
ʻAe, hiki i ke ala bile ke hoʻololi hou ma hope o ka mālama ʻana. Inā hana ʻia kēia, hiki i kāu kauka ke hana i ke ʻoki ʻana i ke ala bile e wehe i ka wahi i hoʻopilikia ʻia a hoʻopili hou i ke ala olakino i kou ʻōpū liʻiliʻi.
Aia kekahi mau pilikia ma hope o ka mālama ʻana?
ʻOkoʻa nā pilikia ma muli o ke kaʻina hana i hana ʻia. Hiki i kekahi poʻe ke loaʻa i ka pancreatitis acute (ka mumū o ka pancreas) ma hope o ka ERCP. He mea nui e hahai pono i nā kuhikuhi ma hope o ke kaʻina hana a kāu kauka.
Hiki iaʻu ke pale i ka hoʻohaiki ʻana o ke ala bile?
Hiki iā ʻoe ke hōʻemi i ka pilikia o nā kūlana e alakaʻi ai i nā koʻikoʻi biliary ma o ka hoʻohana ʻana i nā ʻano olakino, e like me:
- ʻAi ʻana i ka ʻai momona a kaulike hoʻi i nā huaʻai a me nā mea kanu hou.
- Ke mālama nei i kāu mau pae cholesterol e mālama i ke olakino o ka gallbladder a pale i nā gallstones.
- Ka mālama ʻana i ke kaumaha olakino.
- Ke ʻimi nei i ke kākoʻo no nā pilikia e pili ana i ka waiʻona e pale aku i ka pancreatitis a me ka hōʻino ʻana o ke ake.
ʻO ka mea nui loa, ʻo ia ka mālama ʻana i kahi nohona olakino. ʻO ka ʻai kaulike a me ka hoʻoikaika kino mau kāu mau pale maikaʻi loa e kūʻē i nā kūlana olakino he nui.
He aha ka manaʻo no kekahi me kēia maʻi?
Aia kou manaʻo hoʻōla i ke kumu o ka haiki ʻana. ʻO ka laulā o nā lāʻau lapaʻau e wehe i nā ʻauwai bile he holomua, ʻoiai ʻo nā kūlana ma lalo e like me ke kanesa e koi aku i ka mālama paʻakikī a hoʻomau.
He aha ka manawa hoʻōla ma hope o ka lāʻau lapaʻau?
Aia kou manawa hoʻōla i ke kaʻina hana kikoʻī. ʻO nā lāʻau lapaʻau minimally invasive , e like me ERCP, hāʻawi pinepine i ka hoʻōla wikiwiki a me ka ʻeha liʻiliʻi i hoʻohālikelike ʻia me nā ʻoki kino hāmama.
E hahai pono i nā ʻōlelo a kāu kauka e hōʻoia i ka palekana o ka hoʻōla ʻana. Hiki ke aʻo ʻia ʻoe e ʻai i nā meaʻai maopopo a palupalu paha a hoʻoponopono paha i kāu papaʻai e hoʻokomo i nā meaʻai maʻalahi ke ʻai ʻia no kekahi manawa.
Āhea wau e ʻimi ai i ke kōkua lapaʻau?
E ʻimi koke i ke kōkua lapaʻau inā ʻike ʻoe:
- Ke kuni mau.
- ʻEha hou o ka ʻōpū luna.
- Nā hōʻailona o ka maʻi ma hope o ke kaʻina hana (e like me ke kahe ʻana o ka pus, ka ʻulaʻula).
- Ka pohō kaumaha i wehewehe ʻole ʻia, ka nausea, a i ʻole ka luaʻi ʻana.
- Melemele o nā maka a i ʻole ka ʻili (Jaundice).
He aha nā nīnau e pono iaʻu e nīnau aku i kaʻu kauka?
E ʻoluʻolu e nīnau i kāu kauka i kēia mau mea:
- He aha ke kumu o ka emi ʻana o koʻu ʻauwai bile?
- ʻO wai ka lāʻau lapaʻau kūpono loa iaʻu?
- He aha nā hana e hiki iaʻu ke hana e hōʻemi i ka pilikia o kēia hana hou ʻana?
Pono e noʻonoʻo pono ʻia nā hōʻailona e like me ka ʻeha o ka ʻōpū, ke kuni, ke anu, a i ʻole ka jaundice—ʻoiai ke ʻike koke ʻia. E ʻoluʻolu e kelepona koke aku i kāu kauka inā loaʻa kēia mau hōʻailona i hiki iā lākou ke ʻike i ke kumu a paipai i ka mālama kūpono ma Nirogi Lanka a i ʻole kou haukapila kūloko.
Leka Lawe-Home: Nā mea nui e hoʻomanaʻo ai
Lana ko mākou manaʻo e hāʻawi kēia ʻike holoʻokoʻa iā ʻoe i kahi ʻike maopopo e pili ana i ka Biliary Stricture .
- ʻO ia hoʻi ka hoʻohaiki ʻana o kahi ʻauwai bile, kahi e ālai ai i ke kahe maʻamau o ka bile.
- Nui nā kumu, me ke ʻano o ke ʻoki ʻana, nā pōhaku gallstone, a i ʻole nā puʻupuʻu.
- E makaʻala no nā hōʻailona e like me ka ʻeha o ka ʻōpū, ka jaundice, ka ʻili maneʻo, a i ʻole nā loli i ke kala o ka ʻōpala.
- Inā loaʻa iā ʻoe kēia mau hōʻailona, e nīnau koke aku i kahi gastroenterologist .
- Aia nā lāʻau lapaʻau kūpono, no laila mai hopohopo. ʻO ka ʻike mua ʻana a me ka mālama ʻana e alakaʻi i nā hopena maikaʻi loa.
- He mea nui ka nohona olakino i ka pale ʻana.
Inā he mau nīnau hou aku kāu, mai kānalua e kūkākūkā me kāu kauka. E noho olakino!
