Ke manaʻo nei anei kou umauma e like me ka piha ʻana i ka wai? He chylothorax paha ia!

Ke paʻakikī koke nei ʻoe i ka hanu ʻana i kekahi manawa? A i ʻole ke manaʻo nei ʻoe i kahi mea kaumaha a paʻa paha i loko o kou umauma? Aia paha kekahi kumu no kēia āu i noʻonoʻo ʻole ai. I kēia lā e kamaʻilio mākou e pili ana i kahi maʻi lapaʻau kakaʻikahi akā koʻikoʻi loa e pono ai ʻoe e makaʻala. ʻO ia ʻo Chylothorax . He mea ʻē paha ke kani ʻana o ka inoa, akā mai hopohopo, e kamaʻilio maʻalahi kākou e pili ana.

He aha ka chylothorax? E hoʻomaopopo maʻalahi kākou.

I ka ʻōlelo maʻalahi, ʻo ka chylothorax kahi kahe ʻana o kahi wai kūikawā mai kā mākou ʻōnaehana lymphatic , i kapa ʻia ʻo chyle , i loko o kahi hakahaka a puni ko mākou mau māmā. I kēia manawa ke noʻonoʻo nei paha ʻoe, he aha kēia ʻōnaehana lymphatic, he aha kēia chyle?

E noʻonoʻo wale, aia i ko mākou kino kahi pūnaewele o nā kīʻaha koko, a me kahi ʻōnaehana ʻē aʻe o nā kahawai maikaʻi. ʻO ia ka mea a mākou e kapa nei he ʻōnaehana lymphatic. Hoʻopau kēia ʻōnaehana i ka wai keu e hōʻiliʻili ana i loko o nā ʻiʻo o ko mākou kino. Eia kekahi, aia nā koa e like me nā hunaola koko keʻokeʻo i loko o kēia lymph. Huli lākou a luku i nā germs, e like me nā bacteria a me nā virus, e komo i loko o ko mākou kino.

I kēia manawa, he ʻano kūikawā o ka lymph ka chyle . Hana ʻia ia i loko o ko kākou ʻōnaehana hoʻoheheʻe ʻana . Hana ʻia ia me nā hunaola koko keʻokeʻo a me nā momona mai ka meaʻai a kākou e ʻai ai, no laila he waiū kona kala. Hele kēia chyle ma loko o ko kākou kino ma o kahi ʻōmole kūikawā i kapa ʻia ʻo ka thoracic duct . Ua like ia me kahi ʻōmole. Hele kēia ʻōmole mai ko kākou ʻōpū, i luna ma o ko kākou umauma, a hoʻi i loko o ko kākou koko ma ka ʻāʻī.

Akā, inā ua hōʻino ʻia kēia thoracic duct ma kekahi ʻano, hoʻomaka kēia wai chyle e kahe i waho. A i ka wā e kahe ai i waho e like me kēlā a hōʻiliʻili i loko o ka hakahaka a puni ko mākou mau māmā, ʻo ia ka mea a mākou e kapa nei he chylothorax. Ua maopopo iā ʻoe?

He aha nā ʻano nui o kēia maʻi?

Hiki ke hoʻokaʻawale ʻia ʻo Chylothorax i ʻekolu mau ʻano nui:

1. Traumatic chylothorax: Hana ʻia kēia i ka wā e hōʻino ʻia ai nā kīʻaha lymphatic i loko o ko kākou ʻōpū a i ʻole ka umauma, ma muli paha o kahi ulia a i ʻole ke ʻoki kino. E noʻonoʻo e like me ia ma hope o kahi ʻoki umauma nui.

2. Chylothorax ʻaʻole traumatic/spontaneous: Hana ʻia kēia ma muli o ke ālai ʻana o ko mākou mau kīʻaha lymphatic, ka nāwaliwali o ko lākou mau paia, a i ʻole ka hōʻiliʻili nui ʻana o ka wai chyle a me ka haki ʻana o nā kīʻaha. I kekahi manawa, hiki ke loaʻa kēia ʻano i nā poʻe i hānau ʻia me kekahi mau ʻano ʻē ma ka umauma. Ua kapa ʻia kēia he chylothorax congenital . Eia kekahi, hiki ke ulu a hiki i loko o kekahi mau lā o ka hānau ʻana.

3. Chylothorax idiopathic:I kēia hihia, ʻaʻole hiki i nā kauka ke ʻike i ke kumu kūpono o kēia maʻi.

Pehea ʻoe e ʻike ai inā loaʻa iā ʻoe kēia? He aha nā hōʻailona?

ʻO ka hōʻailona nui o kēia maʻi, ʻo ia ka pōkole o ka hanu . Manaʻo paha ʻoe e like me ʻoe e hanu ana a ʻaʻole hiki ke hanu. Ma waho aʻe o kēlā, aia paha kekahi mau hōʻailona ʻē aʻe:

• Ke kaumaha, ka paʻa, a i ʻole ke kaumaha i loko o ka umauma .
• Ke manaʻo mau nei i ka luhi loa .
• Ka pohō kaumaha i manaʻo ʻole ʻia .

Inā loaʻa iā ʻoe nā hōʻailona e like me kēia, ʻoi aku ka maikaʻi o ka ʻimi ʻana i ke kōkua mai ke kauka.

No ke aha e kū mai ai ka chylothorax? He aha nā kumu nui?

ʻO ka ʻoiaʻiʻo, ʻo ke ʻoki kino ke kumu maʻamau o kēia. ʻO ia hoʻi, ka chylothorax postoperative. Eia naʻe, ʻo nā mea āpau e hiki ke hōʻino i ka thoracic duct, ka mea e lawe ana i ka wai chyle, hiki ke hana ia. ʻO ia ka manawa e kahe ai ka wai chyle mai ka ʻōnaehana lymphatic i loko o ka umauma. ʻO kekahi mau kumu ʻē aʻe:

• Nā ʻeha o ka umauma a i ʻole ke kua: Hiki i kēia ke lilo i mau ʻeha trauma blunt, a i ʻole nā ​​​​ʻeha e pili ana i kahi ʻeha ʻili (e like me ka ʻeha hou ʻana o ka pahi).
• Nā kūlana hānau: Loaʻa paha i kekahi poʻe kēia kūlana i ka wā hānau, ma muli paha o kekahi mau loli kino a i ʻole nā ​​​​kūlana olakino. ʻO ia hoʻi, i ka wā hānau (congenital) a i ʻole i loko o kekahi mau lā o ka hānau ʻana.
• Nā ʻano maʻi kanesa like ʻole: Hiki i nā ʻano maʻi kanesa he nui ke hana i ka pale ʻana a i ʻole ka hōʻino ʻana i nā ʻano i loko o ka umauma, kahi e hiki ai ke hoʻokahe i ka chyle. ʻO nā laʻana e komo pū me ka lymphoma , ka leukemia lymphocytic mau loa , ka maʻi kanesa māmā , ka maʻi kanesa esophageal , a me ka sarcoma Kaposi .
• Nā maʻi: I kekahi manawa hiki i nā maʻi ke hōʻino i nā ducts e lawe ana i ka chyle, e hoʻoheheʻe ai i ke wai. ʻO ke kumu nui o kēia, ʻo ia ka maʻi puʻupuʻu .
• Pāpaʻa: ʻO kēlā me kēia kūlana e hiki ke ālai i ke aʻa thoracic hiki ke hana i kēia. ʻO nā laʻana e like me ka sarcoidosis , nā ʻūpā koko, a me ka goiter .

ʻO wai ka mea i ʻoi aku ka nui o ka pilikia o ka hoʻomohala ʻana i kēia?

Aia paha ʻoe i ka nui o ka pilikia o ka hoʻomohala ʻana i ka chylothorax inā ʻoe:

• Inā ua hana ʻia ʻoe i ke ʻoki kino ma kou umauma, ʻāʻī, a i ʻole ka ʻōpū , ʻoiai hoʻi ke ʻoki kino o ka māmā a i ʻole ka cardiovascular.
• Inā he ʻeha ma ka umauma a i ʻole ke kua .
• Inā loaʻa iā ʻoe ke kanesa a i ʻole kahi maʻi e hoʻoulu ai i ka ʻūhū o ka umauma a i ʻole ka hōʻiliʻili ʻana o ka wai i loko o ka ʻōnaehana lymphatic.

Pehea e ʻike ai nā kauka i kēia? (Diagnosis)

‍ , ‍ (Chylothorax) (imaging tests) .

ʻO kekahi o nā hoʻokolohua i hana ʻia no kēia:

• Kiʻi: No ka hoʻoholo ʻana inā ua hana ʻia kāu mau hōʻailona e ka wai nui i loko o kou umauma, pono kāu kauka e kiʻi i nā kiʻi o loko o kou umauma. Hiki i kēia ke komo pū me nā X-ray , nā ultrasounds , a i ʻole nā ​​​​scan CT .
• Thoracentesis: Pili kēia i kāu kauka e lawe ana i kahi wai liʻiliʻi mai kou umauma a hoʻouna aku i kahi lab e aʻo hou e pili ana i ke ʻano o ka wai a me ke kumu e liki ai.
• Lymphangiography a i ʻole lymphoscintigraphy: He mau hoʻokolohua kiʻi kūikawā kēia e nānā i kāu ʻōnaehana lymphatic.

He aha nā lāʻau lapaʻau no kēia? Hiki ke ho'ōla ʻia?

ʻO ka lāʻau no ka chylothorax e pili ana i ke kumu. ʻO ka mea mua, hiki i kāu kauka ke kuhikuhi i kahi papaʻai kūikawā a hoʻokahe paha i ka wai mai kou umauma. Inā ʻaʻole holo pono kēia mau mea, pono paha ʻoe i ke ʻoki ʻana e hoʻōki i ka leaka (kahi lymphangiogram a me ka embolization) a i ʻole kekahi hana ʻē aʻe e hoʻōki ai i ka wai mai ka hōʻiliʻili hou ʻana. ʻO ka mālama ʻana i ke kumu kumu ke ala maikaʻi loa e pale aku ai i ka hana hou ʻana.

ʻO kekahi o nā lāʻau lapaʻau kūikawā no kēia:

• (Bowel rest): (chyle) . ‍ , ‍ (IV) . .
• Nā hoʻololi ʻana i ka ʻai: No ka hōʻemi ʻana i ka nui o ka momona e pono ai kou kino e ʻeli, hiki i kahi meaʻai meaʻai ke kau iā ʻoe i kahi ʻai haʻahaʻa loa ka momona a i ʻole ka momona i hoʻololi ʻia . He manawa pōkole wale nō kēia. ʻO ka hoʻopaʻa ʻana i nā momona olakino ma kēia ʻano no ka lōʻihi loa hiki ke alakaʻi i ka ʻai ʻole.
• Ka hoʻokahe ʻana i ka wai: Hiki i ke kauka ke wehe i ka wai mai kou umauma me ka hoʻohana ʻana i ka thoracentesis . Hiki ke hana ʻia kēia i ka manawa hoʻokahi, a i ʻole e kau ʻia kahi ʻōmole umauma no kahi manawa pōkole. ʻOiai ʻaʻole kēia wale nō e ho'ōla i ka pōʻino, hiki iā ia ke kōkua i ka hōʻemi ʻana i nā hōʻailona i ka wā e ho'ōla ai kou kino.
• Nā lāʻau lapaʻau Somatostatin a i ʻole octreotide: He mau lāʻau lapaʻau kēia i hāʻawi ʻia ma o kahi IV. Hana lākou ma ka hoʻololi ʻana i ke ʻano o ka omo ʻana o kou kino i ka momona a me nā meaʻai. I kekahi manawa hoʻohana nā kauka iā lākou me nā lāʻau lapaʻau ʻē aʻe, e like me nā hoʻololi ʻana i ka meaʻai, e kōkua i kou kino e ho'ōla wikiwiki.
• ʻO ka hoʻopaʻa ʻana a i ʻole ka embolization ʻana o ke ala thoracic: Inā ua hōʻino ʻia kou ala thoracic a ʻaʻole paha e hana pono, hiki i ke kauka ke nakinaki iā ia ma ke ʻoki ʻana (ligation) a i ʻole e ālai iā ia me ka manaʻo (embolization). Hiki i kēia ke hoʻoponopono i ka pōʻino a hoʻohuli hou paha i ke kahe i ʻole e liki.
• (Pleurodesis): (Pleurodesis) ‍ , . .

Pehea ke koʻikoʻi o kēia maʻi? He mea hoʻoweliweli anei ia i ke ola?

Hiki i ka Chylothorax ke hoʻoweliweli i ke ola inā ʻaʻole mālama pono ʻia . Hiki nō hoʻi ke hana ʻia e nā kūlana olakino koʻikoʻi. No laila, pono paha ka mālama mau ʻana no ke kūlana kumu.

Pono anei ʻoe e makaʻala i ka meaʻai a me ka mea inu?

ʻAe, inā he chylothorax kou, hiki i kāu kauka ke kuhikuhi i kahi papaʻai kūikawā. ʻO ia hoʻi ka ʻai ʻana i nā meaʻai haʻahaʻa loa i ka momona a i ʻole he mau ʻano momona kikoʻī .

E noi ʻia paha ʻoe e hoʻōki loa i ka ʻai ʻana. Inā hana ʻia kēlā, e loaʻa iā ʻoe ka meaʻai āu e pono ai ma o ka IV. E hāʻawi kēia i kou kino i ka manawa e ho'ōla ai. Eia nō naʻe, pono ʻoe e ʻai hou ma ke ʻano maʻamau i loko o hoʻokahi a ʻelua paha pule.

He aha nā manawa kūpono loa e ʻike ai i ke kauka?

Inā loaʻa iā ʻoe ka hanu pōkole i wehewehe ʻole ʻia, e ʻike i ke kauka. ʻOi loa inā:

• Inā ua hana ʻia ʻoe i ke ʻoki kino i hala koke nei.
• Inā ua loaʻa iā ʻoe kahi ʻeha o ka umauma a i ʻole ke kua i hala koke nei.
• Inā loaʻa iā ʻoe kekahi kūlana olakino e hoʻopilikia ai i ka umauma a i ʻole ka ʻāʻī.
• Inā he maʻi kou e hoʻopilikia ai i kāu ʻōnaehana lymphatic.

I ka manawa hea e hele ai i ka Emergency Treatment Unit (ETU) :

Inā pilikia ʻoe i ka hanu ʻana, ʻoiai inā loaʻa iā ʻoe ka ʻeha o ka umauma, e hele koke i ka lumi pilikia kokoke loa . He hōʻailona paha kēia o kahi maʻi e hoʻoweliweli ana i ke ola.

ʻO kekahi mau nīnau koʻikoʻi e nīnau aku i ke kauka

He mea kōkua paha ke nīnau aku i kāu kauka i kēia mau nīnau:

• He aha ke kumu o kēia kūlana iaʻu?
• He aha nā koho lapaʻau e loaʻa iaʻu?
• He aha nā meaʻai a me nā mea inu e pono iaʻu ke ʻai/ʻaʻole e ʻai?
• Aia kekahi ala e pale aku ai i kēia mai ka hana hou ʻana?
• Pehea ka lōʻihi o koʻu ola ʻana?

He aha ka ʻokoʻa ma waena o Chylothorax a me Pleural Effusion?

ʻO ka pleural effusion kekahi hōʻiliʻili ʻana o ka wai i loko o ka hakahaka pleural (ka hakahaka ma waena o nā māmā a me ka paia umauma). ʻO Chylothorax kahi ʻano kūikawā o ka pleural effusion. ʻO ia ke kahe ʻana o ka chyle i loko o ka hakahaka pleural.

Leka Hoʻihoʻi Hope Loa

He maʻi laha ʻole ʻo Chylothorax akā he mea hoʻoweliweli paha i ke ola inā ʻaʻole mālama ʻia. ʻO ke ʻoki kino ke kumu maʻamau. Eia nō naʻe, hiki ke hana ʻia e kekahi mea e ālai ana a hōʻino paha i ke ala thoracic. Hiki i ka hapa nui o ka poʻe ke mālama pono i kēia maʻi me nā hoʻololi ʻai manawa pōkole, ka meaʻai IV, a me nā lāʻau lapaʻau. Pono paha kekahi poʻe i ke ʻoki kino. E kamaʻilio kāu kauka me ʻoe e pili ana i nā koho lapaʻau kūpono loa iā ʻoe. No laila, mai hopohopo, a e hahai i nā ʻōlelo a kāu kauka. Ke makemake nei iā ʻoe e ho'ōla koke!