He aha kēia (Boerhaave's Syndrome)?
I ka ʻōlelo maʻalahi, ʻo kēia `(Boerhaave's Syndrome)` he ʻano ia e pohā koke ai ka paia o kā mākou paipu meaʻai, ʻo ia hoʻi, ka `(esophagus),`. Hana ʻia kēia i ka wā e nui loa ai ke kaomi, ʻo ia hoʻi, ka paʻi ʻana, i loko o ka paipu meaʻai. I ka pololei, ʻoi aku ka nui o kēia e hana ʻia ke luaʻi ʻoe me ka ikaika a i ʻole e hoʻoikaika iā ʻoe iho ma kekahi ʻano ʻē aʻe. Kāhea pū nā kauka i kēia `(effort rupture)` a i ʻole `(spontaneous rupture)`, no ka mea, ʻaʻole kēia he mea e hana pololei ana i ka paipu meaʻai. He mea kākaʻikahi loa kēia ʻano, ʻo ia hoʻi, pili ia i kahi 0.0003% o ka heluna kanaka. Eia nō naʻe, 15% o nā ulia paipu meaʻai āpau i hana ʻia e kēia `(Boerhaave's Syndrome)`.He aha ka ʻokoʻa ma waena o (Boerhaave's Syndrome) a me (Mallory Weiss Syndrome)?
I kēia manawa, ke noʻonoʻo nei paha ʻoe, 'ʻO kēia anei kaʻu i lohe ai i ka wā e lohe ai au i kahi waimaka ma ka esophagus?' Aia kekahi ʻokoʻa iki ma waena o nā mea ʻelua. ʻO ka waimaka Mallory Weiss kahi waimaka e hana ʻia ke luaʻi ʻoe me ka ikaika a i ʻole ke hoʻoluhi ʻoe. He waimaka ia ma ka ʻili o ka esophagus. He mea maʻamau nā mea ʻelua i ka poʻe e inu nui ana i ka waiʻona . Hiki i ke kanaka me ka waimaka Mallory Weiss ke luaʻi i ke koko. Eia naʻe, ʻaʻole e haki loa ka esophagus. Eia naʻe, ʻoi aku ka koʻikoʻi o ka Boerhaave's Syndrome. He waimaka kēia e pālahalaha ana ma o ka mānoanoa holoʻokoʻa o ka paia esophagus. Kapa pū nā kauka iā ia he waimaka transmural. Ke haki loa ia, pono e hoʻoponopono ʻia me ke ʻoki kino ulia pōpilikia . Hiki ke lilo i kūlana ola a make paha.He aha ka mea e hana ʻia ke pahū kahi ʻōmole meaʻai?
E noʻonoʻo i ka mea e hana ʻia ke pahū ko kākou esophagus. He pilikia maoli kēia, a inā ʻaʻole mālama koke ʻia , hiki ke hoʻoweliweli i ke ola . Ua ʻike anei ʻoe i ke kumu? ʻO ko kākou esophagus kekahi ʻāpana o kā kākou ʻōnaehana hoʻoheheʻe (gastrointestinal tract). No laila, i ka wā e pahū ai ka esophagus, hiki i nā ʻāpana meaʻai, nā bacteria, a me nā kemika hoʻoheheʻe ke komo i loko o ko kākou umauma a i ʻole ka ʻōpū. Inā hana ʻia kēlā, hiki ke loaʻa nā maʻi bacteria koʻikoʻi .Inā komo kēia maʻi i loko o ke koko o ko kākou kino holoʻokoʻa, hiki ke loaʻa nā kūlana i kapa ʻia ʻo "septicemia" a me "sepsis". He hopena hoʻoweliweli ola kēia "sepsis". Hiki iā ia ke alakaʻi i ka "haʻalulu", ka hāʻule ʻana o nā ʻōkana he nui, a me ka make hope loa.
ʻO wai ka mea e hoʻopilikia nui ʻia e kēia?
Hiki i kekahi ke loaʻa i kēia `(Boerhaave's Syndrome). Eia naʻe,ʻO ka mea maʻamau ia i nā kāne a me nā poʻe ma luna o 50 mau makahiki. Ma kahi o 80% o ka poʻe i hoʻopilikia ʻia he mau kāne waena. He mea maʻamau nō hoʻi ia i ka poʻe e inu nui ana i ka waiʻona .He aha nā hōʻailona o ka Boerhaave's Syndrome?
ʻAe, e nānā kākou i nā hōʻailona o ka `(Boerhaave's Syndrome)`. He mea nui loa ka ʻike ʻana i kēia mau mea.- ʻEha koke a koʻikoʻi ka umauma. ʻO kēia ka hōʻailona nui.
- Ka luaʻi a me ka luaʻi . I kekahi manawa aia ke koko i loko o ka luaʻi.
- He mea maikaʻi ke ʻeha i ka moni ʻana a i ʻole ke kuʻi ʻana.
- Piʻi ka pōkole a me ka wikiwiki o ka hanu ʻana .
- Hoʻopiha ʻia nā ʻiʻo i loko o ka lua o ka umauma me ka ea a i ʻole ke wai, e hoʻoulu ai i ka pehu.
- Ua paʻa koʻu ʻōpū, me he pōhaku lā.
- Nā hōʻailona o ka maʻi e like me ke kuni a me ka hou ʻana .
Inā ʻike koke ʻia kekahi a ʻoi aku paha o kēia mau hōʻailona, ʻoiai ma hope o ka luaʻi nui ʻana, he mea nui loa ia e ʻimi koke i ke kōkua lapaʻau .
Pehea ke ʻano o ka ʻeha?
Pehea ke koʻikoʻi o ka ʻeha o ka `(Boerhaave's Syndrome)`? Wahi a kekahi poʻe he ʻeha hiki ʻole ke hoʻomanawanui . Loaʻa ka ʻeha ma kahi i haki ai. ʻO ka hapa nui o ka manawa, hiki mai kēia haki ma ka hapakolu o lalo o ko kākou esophagus. ʻO ia hoʻi, ma waena o ka lua o ka umauma o lalo a me ka lua o ka ʻōpū o luna. Eia naʻe, hiki ke ʻoi aku ma mua o kēlā. Hiki i kēia ʻeha ke pālahalaha i ke kua a i ʻole nā poʻohiwi .He aha nā pilikia e hiki mai ana?
Aia kekahi mau hopena ʻaoʻao e hiki ke loaʻa inā ʻaʻole mālama pono ʻia kēia maʻi:- ʻO ka mumū a me ka pehu ʻana i loko o kou umauma.
- Ka hōʻiliʻili ʻana o ka pus i loko o ka lua o ka umauma (empyema)
- Ka ea i paʻa i loko o ka lua o ka umauma a i ʻole i loko o nā ʻiʻo ma lalo o ka ʻili.
- Ka hoʻokahe ʻana o ka wai i loko o ka umauma ( ka ʻili ʻana o ka wai i loko o ka umauma)
- ʻO ka maʻi hoʻopilikia hanu koʻikoʻi ( ARDS )
- ʻO ka Septicemia, ka sepsis, a me ka haʻalulu. Hiki i kēia mau mea ke hoʻoweliweli i ke ola.
He aha nā kumu o ka maʻi ʻo Boerhaave?
No ke aha i loaʻa ai ka maʻi Boerhaave? ʻElua kumu nui no kēia. ʻO kekahi, ʻo ke kaomi i loko o ka esophagus e piʻi ana ma muli o ke kaumaha a i ʻole ke kaumaha ʻana . ʻO kekahi, ʻo ia ka wā e hoʻomaha ʻole ai ka ʻiʻo cricopharyngeus (ka sphincter esophageal kiʻekiʻe) ma luna o ko kākou puʻu i ka pane ʻana i kēia kaomi, e ulu ana kahi kaomi maikaʻi ʻole ma waho o ka esophagus.ʻO ke kumu nui o kēia `(Boerhaave's Syndrome)` ʻo ia ka luaʻi nui a mau paha . Eia kekahi, hiki i ka hānau keiki ʻana, nā ʻūlū, ka hāpai kaumaha, a me ka moni ʻana i nā mea ʻawaʻawa a ʻino paha ke kumu. ʻO ka maʻamau, i ia mau hihia, pono nā hōʻailona aʻalolo e hoʻomaha i ka `(ʻiʻo cricopharyngeus)` a hoʻokuʻu i ke kaomi i loko. Eia nō naʻe, i ka `(Boerhaave's Syndrome)`, no kekahi kumu ʻaʻole hana pono kēia hoʻonohonoho neuromuscular `(neuromuscular coordination)`.Ke hoʻopilikia nei ka hoʻohana ʻana i ka waiʻona?
Hiki i ka inu ʻona ke kumu i ka haki ʻana o ka esophagus? ʻO ka inu nui ʻana i ka waiʻona he kumu pilikia . ʻO ke ʻano maʻamau o ka Boerhaave's Syndrome ka luaʻi ʻana ma hope o ka ʻai nui a ma hope paha o ka inu ʻana i ka waiʻona. ʻO ka maʻi hoʻohana ʻona, ka ʻai nui ʻana, a me ka bulimia nā kumu pilikia. ʻO nā kumu pilikia ʻē aʻe e pili ana i nā kūlana olakino ma lalo o ka esophagus, e like me ka esophagitis a me ka eosinophilic esophagitis, ka esophagus Barrett, a me ka maʻi peptic ulcer. Eia nō naʻe, ʻo ka hapa nui o ka poʻe me Boerhaave's Syndrome he esophagus maʻamau ko lākou.Pehea e ʻike ʻia ai ka maʻi ʻo Boerhaave?
Hiki ke paʻakikī ke ʻike i ka maʻi Boerhaave, akā he mea nui e loaʻa koke . ʻOi aku ka maʻalahi o ka ʻike ʻana i ka wā e loaʻa ai iā ʻoe ʻekolu mau hōʻailona, i ʻike ʻia ʻo ka Mackler triad. ʻO kēia mau mea: 1. Ka luaʻi nui a hoʻi hou paha. 2. Ka hoʻomaka koke ʻana o ka ʻeha umauma. 3. Subcutaneous emphysema. ʻO kēia hōʻailona hope loa e hōʻike nui ana i ka haki ʻana o ka esophagus. Eia naʻe, ʻaʻole e loaʻa i nā kānaka a pau kēia mau hōʻailona maʻamau. Inā loaʻa ka haki ma kahi ʻē, hiki iā ʻoe ke ʻeha ma kahi ʻē, e like me ka ʻāʻī a i ʻole nā iwi collarbone. Hiki ke hana ʻia e kekahi mea ʻē aʻe ma mua o ka luaʻi ʻana, a i ʻole e hele pū ʻia me nā hopena ʻaoʻao ʻē. Hiki i kahi X-ray umauma maʻalahi ke hāʻawi i kahi kuhi, akā pono kahi hoʻāʻo kiʻi ʻoi aku ka naʻauao e ʻike i ke kūlana.Nā hoʻokolohua Radiological i hoʻohana ʻia no ka hōʻoia ʻana
He aha nā hoʻokolohua radiological i hoʻohana ʻia e ʻike ai i ka "Boerhaave's Syndrome"?`(ʻEsefakalama)` (ʻEsefakalama)
Ke kānalua ke kauka i ka Boerhaave's Syndrome, ʻo ka mea mua a lākou e hana ai, ʻo ia ke lawe ʻana i kahi X-ray. Hoʻohana lākou i kahi dye contrast. Ua kapa ʻia kēia he esophagram. He hoʻāʻo wikiwiki kēia, ʻaʻole invasive a pololei loa. No kēia hoʻāʻo, inu ʻoe i kahi hopena i loaʻa kahi dye contrast hiki ke hoʻoheheʻe ʻia i ka wai. Hoʻomaopopo kēia i loko o kāu paipu meaʻai ma ka X-ray. Inā he haehae, hiki iā lākou ke ʻike i kahi e liki ai ka dye contrast.(Ke nānā ʻana o CT)
Inā ʻaʻole hiki iā ʻoe ke loaʻa kahi esophagogram, a inā makemake kāu kauka i ka ʻike hou aku e pili ana i nā ʻōpū a puni, hiki ke hana ʻia kahi CT scan. ʻOiai ʻaʻole hiki ke hōʻike i kahi kikoʻī o ka waimaka, hiki iā ia ke ʻike i nā liʻiliʻi o ka dye contrast a i ʻole ka ea i hoʻokahe ʻia i loko o nā ʻiʻo a puni mai ka esophagus. Hiki ke hoʻohana ʻia e ʻike i ka hōʻiliʻili ʻana o ka wai i loko o ka umauma a i ʻole ka ʻōpū e pono ai ke hoʻokahe ʻia.Pehea e mālama ʻia ai ka maʻi ʻo Boerhaave?
ʻAe, e nānā kākou pehea e mālama ai i ka `(Boerhaave's Syndrome)`. Eia nā ʻanuʻu e hahai ai:- Ke hāʻawi ʻana i nā wai intravenous (IV fluids): Ua maloʻo ka nui o ka poʻe, no laila pono e hāʻawi koke ʻia nā wai IV.
- Nā lāʻau antibiotic : Hāʻawi ʻia nā lāʻau antibiotic ākea-ākea e kāohi i nā maʻi.
- Kūkākūkā ʻoki kino: No ka hapa nui o nā kānaka, ʻo ke ʻoki kino ka lāʻau maʻamau. Hiki ke mālama ʻia kekahi poʻe me nā abscess liʻiliʻi, kūloko me ka ʻole o ke ʻoki kino, me ka nānā ʻana a me nā lāʻau antibiotic IV a i ʻole ka endoscopy. Eia nō naʻe, i kēia mau hihia, e loaʻa mau i nā kauka kahi hoʻolālā palekana no ke ʻoki kino.
- Hoʻoponopono ʻoki kino: ʻOi aku ka maikaʻi o ka hoʻoponopono ʻana i ka haki i loko o 24 mau hola o ka haki ʻana. Ma muli o kou kūlana, hiki i kāu kauka ke hoʻohana i kahi ʻoki kino minimally invasive. No ka laʻana, ʻo ke ʻoki kino thoracoscopic i kōkua ʻia e ke wikiō (VATS). I kekahi mau pilikia, pono paha kahi thoracotomy hāmama e loaʻa ai ke komo wikiwiki a piha i ka lua umauma.
- Ka hoʻokahe wai/debridement: Ma waho aʻe o ka hoʻoponopono ʻana i ka haehae, pono e hoʻokahe ʻia a hoʻomaʻemaʻe ʻia kekahi wai i loaʻa i ka maʻi i hōʻiliʻili ʻia i loko o ke ana. Pono hoʻi e wehe ʻia kekahi ʻiʻo i loaʻa i ka maʻi a make paha (necrotic). I kekahi mau hihia koʻikoʻi, pono paha e wehe ʻia kekahi ʻāpana o kou esophagus.
- Ka mālama ʻana i ka holomua: Inā ʻaʻole hiki ke ʻoki ʻia i loko o 24 mau hola o ka haki ʻana, ʻaʻole paha e holomua ka hoʻoponopono pololei. Ua hoʻomaka paha nā lihi o ka ʻeha e paʻakikī a pala paha. Inā hana ʻia kēia, pono paha i kāu kauka ke wehe i kahi ʻāpana a i ʻole kou esophagus āpau (esophagectomy). Inā makemake ʻoe i kahi esophagus pani, hiki ke hana ʻia kēia ma hope o ʻeono pule.
- Nā ʻano hānai ʻē aʻe: A hiki i ka wā e ho'ōla ai kāu paipu meaʻai, ʻaʻole hiki iā ʻoe ke ale i ka meaʻai ma o ia mea, no laila pono ʻoe e loaʻa i ka meaʻai ma kekahi ʻano ʻē aʻe. Hiki paha kēia ma o kahi paipu a ma o kahi aʻa koko paha.
He aha ka manaʻolana o ka ho'ōla hou ʻana?
He aha ka wānana no kekahi me ka "Boerhaave's Syndrome"? ʻO ka ʻike mua ʻana a me ka mālama ʻana nā mea nui loa hiki iā ʻoe ke hana e pale aku i nā pilikia, me ka make, mai ka maʻi.. Hiki i ka poʻe i loaʻa ka lāʻau lapaʻau i loko o 24 mau hola ke manaʻo i kahi hoʻōla maikaʻi, me ka 75% o ka manawa e ola ai. Ma hope o 24 mau hola, ʻoi aku ka nui o ka make ma mua o 50%, a ma hope o 48 mau hola he 90%. Ma keʻano holoʻokoʻa, ʻo ka nui o ka make ma kahi o 35%. Hiki i ka poʻe i loaʻa ka lāʻau lapaʻau kūpono a holomua ke hoʻōla piha, akā hiki ke hala i kekahi mau mahina. ʻO ka `(Boerhaave's Syndrome)` he ʻano kakaikahi akā he ʻano ʻē loa ia e waiho ana i ka nui o ka noʻonoʻo ʻana . Hiki ke hiki koke mai, me ka ʻole o nā hōʻailona hōʻike - akā ʻo ka inu nui mau he hōʻailona hōʻike maopopo ia hiki iā mākou ke pale aku. ʻAʻole mākou i ʻike i nā mea āpau e pili ana i ka `(Boerhaave's Syndrome)`. ʻAʻole mākou i ʻike i ke kumu e pale ʻole ai ka esophagus iā ia iho mai ka hōʻino ʻia i kēia mau hihia. Akā ua ʻike mākou hiki ke make inā ʻaʻole ʻike ʻia a mālama ʻia i ka wā mua.ʻO nā mea nui loa e pono ai ʻoe e hoʻomanaʻo
ʻAe, i kēia manawa ua ʻoi aku kou maopopo i ka mea a mākou i kamaʻilio ai, ʻo ia hoʻi ka "Boerhaave's Syndrome." Eia kekahi o nā mea nui e hoʻomanaʻo ai:- ʻO ka Boerhaave's Syndrome kahi pilikia olakino i hoʻokumu ʻia e ka haki ʻana o ka esophagus.
- Hana pinepine ʻia kēia ma hope o ka luaʻi ʻana me ka ikaika .
- ʻO nā hōʻailona nui ka ʻeha koke a koʻikoʻi o ka umauma, ka luaʻi ʻana, a me ka paʻakikī i ke ale ʻana .
- ʻOi aku ka nui o ka pilikia o ka poʻe inu nui .
- Inā ʻike ʻoe i nā hōʻailona , e ʻimi koke i ke kōkua lapaʻau . ʻO ka wikiwiki o kou hoʻomaka ʻana i ka lāʻau lapaʻau, ʻoi aku ka maikaʻi o kou manawa e hoʻōla ai.
- Pono pinepine ke ʻoki ʻana ma ke ʻano he lāʻau lapaʻau.
He mea nui e makaʻala i kēia maʻi. Inā ʻike ʻoe a i ʻole kekahi āu i ʻike ai i kekahi o kēia mau hōʻailona, mai hoʻowahāwahā iā lākou. E ʻike koke i ke kauka.
ʻO ka maʻi Borrego, ka haki ʻana o ka esophagus, ʻeha umauma, luaʻi, ka waiʻona, ka haki ʻana o ka esophagus, Meckler triad, sepsis, ʻoki ʻana o ka esophagus
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