Makemake mākou a pau e noho olakino, ʻeā? Eia nō naʻe, i kekahi manawa hiki i nā mea ke hana i loko o ko mākou kino me ka ʻike ʻole. I loko o kou ʻōpū nui—ka ʻāpana o kāu ʻōnaehana hoʻoheheʻe kahi e hele ai nā ʻōpala—hiki i kekahi manawa ke ulu aʻe nā ulu liʻiliʻi ma ka ʻili o loko. ʻO kēia nā mea a nā kauka e kapa ai (Colon Polyps) . Mai hopohopo i ka inoa! ʻO ka hapa nui o kēia mau polyps he mea ʻino ʻole. Eia nō naʻe, hiki i kekahi mau ʻano ke holomua i ka maʻi kanesa inā waiho ʻole ʻia i ka hala ʻana o ka manawa. ʻO ia ke kumu he mea nui iā mākou a pau e ʻike pono e pili ana i (Colon Polyps) .
No laila, he aha nā Colon Polyps?
I ka ʻōlelo maʻalahi, ʻo (Colon Polyps) he mau ulu ʻano ʻē o nā pūnaewele e ulu ana ma ka ʻili o loko (mucous lining) o kou ʻōpū nui. ʻIke ʻia lākou e like me nā puʻupuʻu liʻiliʻi a i ʻole nā puʻupuʻu. Hoʻomaka pinepine lākou ma ke ʻano he hui liʻiliʻi o nā pūnaewele a hiki ke ulu nui aʻe i ka hala ʻana o ka manawa. Hiki i nā polyps like ke ʻike ʻia ma nā wahi ʻē aʻe o ke kino, e like me ka ʻōpū, ka ihu, a i ʻole ka ʻōnaehana hānau wahine.
ʻO ka mea nui e hoʻomanaʻo ai, ʻo ka loaʻa ʻana o ka polyp ʻaʻole ia he manaʻo he maʻi kanesa kou. Eia nō naʻe, ʻo ka hapa nui o nā maʻi kanesa colorectal e puka mai ana mai kēia mau ʻano polyps. ʻO ia ke kumu, i ka wā o ka (Colonoscopy) , e nānā pono nā kauka i kēia mau ulu ʻana a wehe iā lākou inā loaʻa.
Aia kekahi mau ʻano polyp like ʻole? Pehea lākou e ʻokoʻa ai?
ʻAe, ʻokoʻa nā polyp colon, a hoʻokaʻawale nā kauka iā lākou ma muli o ʻelua mau kumu nui.
ʻO kekahi ke ʻano o ka polyp :
- Ua like kekahi me nā halo liʻiliʻi, me kahi ʻōpuʻu liʻiliʻi a me kahi pāpale ma luna. Ua kapa ʻia kēia mau polyps (Pedunculated) .
- ʻO kekahi ʻano he pālahalaha, e moe ana i ka paia o ka ʻōpū me ka ʻole o ke kumu. Ua kapa ʻia kēia mau polyps (Sessile) .
ʻO ka lua o nā kumu, pehea lākou e ʻike ʻia ai ma lalo o kahi microscope (nā hiʻohiʻona microscopic). ʻO ke ʻano o ka ulu ʻana o kēia mau cell e hoʻoholo ai inā loaʻa i kahi polyp ka hiki ke lilo i ka maʻi kanesa. No laila, ʻokoʻa loa ka hiki ke kanesa ma waena o nā ʻano.
ʻO nā ʻano polyp maʻamau:
- Nā polyps adenomatous (a i ʻole adenomas): ʻO kēia nā mea maʻamau. Loaʻa iā lākou nā ʻano liʻiliʻi:
- Nā adenomas tubular
- Nā adenomas villous
- Nā adenoma tubulovillous
- Nā polyps serrated: Loaʻa kēia mau mea i nā ʻano like ʻole:
- Nā polyps hyperplastic
- Nā ʻeha serrated sessile
- Nā adenomas serrated kuʻuna
- ʻO Hamartomas (a i ʻole nā polyps ʻōpio): ʻIke pinepine ʻia kēia mau mea i nā poʻe ʻōpio.
- Nā polyps mumū (a i ʻole pseudopolyps): ʻAʻole kēia he mau polyps maoli; e kūkākūkā mākou i kēia mau mea ma hope.
Hoʻokaʻawale ʻana e ka pilikia o ka maʻi kanesa: Neoplastic a me Non-neoplastic
ʻO kēia ka hoʻokaʻawale koʻikoʻi loa. ʻO nā polyp (Neoplastic) nā mea hiki ke lilo i ka maʻi kanesa, ʻoiai ʻo nā polyp (Non-neoplastic) nā mea hiki ʻole (a i ʻole he haʻahaʻa loa ka pilikia o ka hana ʻana pēlā).
- nā polyps (Neoplastic) (aia ka pilikia o ka maʻi kanesa ):
- ʻO nā polyps Adenomatous āpau (Adenomas)
- Nā ʻeha serrated sessile
- Nā adenomas serrated kuʻuna
- Nā polyps (ʻAʻole neoplastic) (haʻahaʻa/ʻaʻohe pilikia o ka maʻi kanesa):
- Nā polyps hyperplastic
- Nā polyp ʻōpio (Hamartomas)
- Nā pseudopolyps mumū
Pehea ka maʻamau o nā polyp colon?
He ʻano maʻamau kēia ma mua o kou manaʻo, ʻoiai i kou wā ʻelemakule. Ma ke ʻano laulā, ma kahi o 20% o nā pākeke—ʻo ia hoʻi hoʻokahi i loko o ʻelima mau kānaka—hiki ke loaʻa kēia mau polyps. Ma waena o ka poʻe ma luna o 50, hiki ke piʻi ka nui i 40%. ʻO ka mea kupanaha, hiki iā lākou ke loaʻa ma kahi o 6% o nā keiki. Me ka nānā ʻole i ka lāhui, ka hoʻomana, a i ʻole ke kāne, loaʻa i kēlā me kēia kanaka kekahi pilikia no nā polyps colon a me ke kanesa colorectal. ʻOi aku ka kiʻekiʻe o nā helu hanana ma nā ʻāina Komohana.
Ehia mau polyp e lilo i ka maʻi kanesa?
E ʻoluʻolu e hoʻomaopopo pono i kēia: He nui nā ʻano polyp i hiki ke lilo i maʻi kanesa. ʻO ia ke kumu e wehe ai nā kauka iā lākou i ka wā o ka (Colonoscopy) . Eia naʻe, he hapa liʻiliʻi wale nō e lilo i maʻi kanesa, a he nui ka manawa e lilo ai ka polyp i maʻi ʻino. ʻO ia ke kumu he mea nui nā nānā mau (Colonoscopy) i nā manawa i ʻōlelo ʻia e hopu a wehe iā lākou ma mua o ko lākou lilo ʻana i mea weliweli.
Ma ke ʻano kikoʻī, ma kahi o 75% o nā maʻi kanesa colorectal e hoʻomaka ana ma ke ʻano he polyps adenomatous, a ma kahi o 80% o nā polyps āpau i loaʻa he ʻano adenoma. Eia nō naʻe, ma kahi o 5% wale nō o kēia mau adenomas e lilo maoli i (malignant) . Ua manaʻo ʻia he 8% ka pilikia o kahi polyp maʻamau e lilo i maʻi kanesa i loko o 10 mau makahiki a ma kahi o 24% i loko o 20 mau makahiki.
He aha nā hōʻailona o nā polyps colon?
ʻO kēia ka ʻāpana paʻakikī. ʻO ka hapa nui o ka manawa, ʻaʻole hōʻike iki nā polyps i kekahi mau hōʻailona. ʻOiai ke kanesa colorectal mua loa, hiki ke lilo i mea ʻole nā hōʻailona, ʻo ia ke kumu he mea nui loa nā hoʻokolohua nānā. I ka manawa e ʻike ʻia ai nā hōʻailona, ua holomua paha ka polyp i ke kanesa.
Eia nō naʻe, i nā hihia kakaikahi, hiki iā ʻoe ke ʻike:
- Ke kahe koko ʻana o ka rectal a i ʻole nā hōʻailona pili: E ʻike paha ʻoe i ke koko i loko o kou noho a i ʻole ma ka pepa toilet. I kekahi manawa he microscopic loa ke kahe ʻana o ke koko a ʻike ʻole ʻia, akā i ka hala ʻana o ka manawa, hiki iā ia ke alakaʻi i ka (anemia deficiency iron) , e hoʻoulu ai i ka luhi nui (luhi) a me ka nāwaliwali.
- Nā loli i wehewehe ʻole ʻia i nā ʻano ʻōpū: I kekahi manawa, hiki i kekahi poʻe ke loaʻa i ka maʻi diarrhea mau a i ʻole (constipation) , a ʻike paha i ka piʻi ʻana o ka hoʻokuʻu ʻana o ka mucus. ʻOiai he nui nā kumu ʻē aʻe no kēia mau hōʻailona, inā ʻike ʻoe i kahi loli i wehewehe ʻole ʻia, ʻoi aku ka maikaʻi o ke kūkākūkā me kāu kauka.
ʻO ka hopena: Mai kali no nā hōʻailona. Ke hala ʻoe i ka makahiki 45-50 (a i ʻole ma mua inā he mōʻaukala ʻohana kou), he mea naʻauao ke kamaʻilio me kāu kauka a hoʻonohonoho i kahi (Colonoscopy) .
No ke aha mākou e hoʻomohala ai i nā polyps colon?
ʻO ka hapa pinepine, loaʻa pinepine kēia mau polyps, ʻo ia hoʻi ke ulu nei lākou me ka ʻole o kahi kumu maopopo a hiki ke ʻike ʻia. Eia nō naʻe, no kekahi poʻe, hiki i nā maʻi hoʻoilina ke alakaʻi i ko lākou ulu ʻana. I ia mau hihia, aia paha ka nui o ka hiki ke ulu i nā polyps he nui, kahi e hiki ai ke hoʻonui i ka pilikia o ka maʻi ʻaʻai colorectal.
He aha ke kumu nui o nā polyps?
ʻO ke kumu nui, ʻo ia nā hoʻololi genetic . I ka ʻōlelo maʻalahi, ke māhele ʻia kā mākou mau cell e hana i nā mea hou, hiki ke loaʻa nā hewa liʻiliʻi i kā lākou code genetic. No ka mea, ke hoʻoulu hou nei nā cell e uhi ana i ka colon, ʻoi aku ka maʻalahi o lākou i kēia mau hewa. Ke hana ʻia kēia mau loli genetic, hoʻololi lākou i ke ʻano o ka ulu ʻana a me ke ʻano o nā cell.
Hoʻoili ʻia kekahi mau hoʻololi genetic ma o nā ʻohana (nā maʻi hereditary), aʻo nā mea ʻē aʻe e kū pinepine ʻia, ʻoiai hiki i kēia mau mea ke pili i ka hui pū ʻana o nā mea pilikia genetic a me ke kaiapuni.
He aha nā kumu ʻē aʻe e kōkua ai i ka ulu ʻana o ka polyp?
1. Nā Kumu Hoʻoilina:
Inā loaʻa i kahi lālā pili o ka ʻohana (nā mākua, nā kaikaina, a i ʻole nā keiki) nā polyps, ʻoi aku ka kiʻekiʻe o kou pilikia ma ka helu helu. Eia kekahi, hiki i nā kūlana hoʻoilina kikoʻī ke hoʻoikaika iā ʻoe i nā polyps, e like me:
- ʻO ka Polyposis Adenomatous Familial (FAP)
- ʻO ka maʻi Peutz-Jeghers
- ʻO ka polyposis e pili ana iā MUTYH
- ʻO ka maʻi Gardner
- ʻO ka maʻi puʻupuʻu hamartoma PTEN
- ʻO ka maʻi Turcot
- ʻO ka maʻi polyposis serrated
- ʻO ka maʻi polyposis ʻōpio
2. Nā Kumu Kaiapuni a me ke ʻAno o ka Nohona:
ʻO kou wahi a me nā hana maʻamau o kēlā me kēia lā e hoʻopilikia nui i kou olakino a hiki ke kōkua i ka ulu ʻana o nā polyps:
- Ka ʻelemakule: Ke piʻi nei kou pilikia i kou wā ʻelemakule.
- Puhi paka.
- Ka inu nui ʻana i ka waiʻona.
- ʻAi momona kiʻekiʻe, haʻahaʻa fiber: ʻAi kiʻekiʻe i ka ʻiʻo ʻulaʻula a i ʻole ka ʻiʻo i hana ʻia a haʻahaʻa i nā huaʻai a me nā mea kanu.
- Ka hana ʻole kino.
- Ka momona.
- Ka maʻi diabetes.
- ʻO ka maʻi ʻōpū mumū (IBD): Nā kūlana e like me ka maʻi a Crohn a i ʻole ka colitis ulcerative.
He Hihia Kūikawā: Nā Pseudopolyps Puhi
E like me ka mea i ʻōlelo ʻia ma mua, ʻaʻole kēia he mau polyp "ʻoiaʻiʻo" i hoʻokumu ʻia e nā hoʻololi genetic. He mau puʻu maoli lākou o nā ʻiʻo ʻeha i hana ʻia ma muli o ke kaʻina hana ho'ōla o nā ʻeha i loko o ka colon. ʻO ka mumū mau, e pili pinepine ana me IBD, ke kumu nui o kēia mau ʻeha. ʻO ka mea nui, ʻaʻole e lilo kēia i ka maʻi kanesa.
Pehea e ʻike ai nā kauka i nā polyps?
ʻO ke kūlana gula no ka ʻike ʻana i nā polyps colon he colonoscopy. I loko o kēia kaʻina hana, hoʻokomo ʻia kahi ʻōmole palupalu a hoʻomālamalama ʻia (colonoscope) me kahi kāmela liʻiliʻi i loko o ka rectum e nānā i ka colon holoʻokoʻa. ʻOiai hiki i nā hoʻokolohua kiʻi ʻē aʻe ke ʻike i nā polyps, ʻo ka pōmaikaʻi nui o ka colonoscopy ʻo ia ka hiki i kāu kauka ke ʻimi a wehe i nā polyps, a i ʻole e lawe i nā laʻana ʻiʻo (biopsy) no ka hoʻāʻo ʻana i ka wā hoʻokahi.
Hoʻouna ʻia kēia mau laʻana biopsy i kahi keʻena hoʻokolohua kahi e nānā ai kahi pathologist iā lākou ma lalo o kahi microscope e hoʻoholo ai i ke ʻano o ka polyp a inā he mau cell cancerous paha.
ʻO ka hoʻomākaukau ʻana no ka colonoscopy e pono ai ka hoʻomaʻemaʻe ʻana i ka ʻōpū ma mua, a no ka mea e hoʻomaha ʻia ʻoe, hiki i kekahi mau maʻi ke ʻike i ke kaʻina hana he mea paʻakikī. No laila, hoʻomaka paha nā kauka i kekahi manawa me nā hoʻokolohua nānā maʻalahi. Eia nō naʻe, inā hōʻike kekahi hoʻokolohua ʻē aʻe i ke alo o nā polyps, pono kahi colonoscopy hahai e wehe iā lākou.
ʻO nā hoʻokolohua ʻē aʻe i hoʻohana ʻia e noiʻi i nā polyps i manaʻo ʻia:
- Nā hoʻāʻo koko: Hiki i ka Helu Koko Piha (CBC) ke ʻike i ka anemia i hoʻokumu ʻia e ke kahe koko lōʻihi, ʻoiai ʻo kahi panel metabolic maʻamau e ʻike i nā hemahema electrolyte. Inā he moʻolelo ʻohana kou o ka polyposis hoʻoilina, hiki i ka hoʻāʻo genetic ke hoʻoholo inā loaʻa iā ʻoe nā hoʻololi gene kikoʻī.
- Nā hoʻāʻo ʻana i ka noho: Nānā kahi Fecal Occult Blood Test (FOBT) no nā nui microscopic o ke koko. Hiki i nā hoʻāʻo ʻē aʻe ke kālailai i ka DNA i loko o nā hāpana noho e ʻimi i nā māka kanesa.
- Nā hoʻāʻo kiʻi: ʻO nā koho ʻē aʻe i ka colonoscopy maʻamau e komo pū me ka colonoscopy virtual (kahi ʻano CT scan) a me ka capsule endoscopy (kahi āu e ale ai i kahi capsule liʻiliʻi i lako me ke kāmela). Hiki i kahi barium enema X-ray ke hōʻike i nā polyps.
Ehia mau polyp i manaʻo ʻia he "maʻamau" i ka wā o ka colonoscopy?
ʻO ke kūpono, ʻaʻohe ou polyps. Eia nō naʻe, ʻo ka loaʻa ʻana o hoʻokahi a ʻelua paha, a i ʻole kekahi manawa ʻoi aku ka nui, hiki ke lilo i mea maʻamau. E loiloi kāu kauka i ka helu, ka nui, ka wahi, a me ke ʻano o nā polyps i loaʻa. Ma muli o ka ulu lohi ʻana o nā polyps, ʻo kekahi mau polyps liʻiliʻi ke ʻano o kou pilikia no ka maʻi ʻaʻai colon e mau ana ka haʻahaʻa.
Eia nō naʻe, hiki ke manaʻo ʻia ʻoe he kiʻekiʻe aʻe ka pilikia inā:
- He ʻoi aku ma mua o ʻekolu mau polyp āu.
- ʻOi aku ka nui o ka polyp ma mua o 10 millimeters (1 kenimika).
- Aia nā polyp ma nā wahi kikoʻī o ka kolona (e like me ka sigmoid a i ʻole ka kolona transverse).
- Loaʻa lākou i ke ʻano adenoma villous a tubulovillous paha.
- He mau ʻeha serrated sessile a i ʻole adenomas serrated lākou.
- Loaʻa iā ʻoe kahi maʻi polyposis hoʻoilina ma lalo.
Pehea e mālama ʻia ai nā polyps colon?
ʻO ke ʻano maʻamau o ka mālama ʻana, ʻo ia ka wehe ʻana i nā polyps. Inā loaʻa iā ʻoe nā polyps non-neoplastic (non-cancerous), hiki i kāu kauka ke koho ʻaʻole e wehe iā lākou; akā naʻe, no ka mea, ʻaʻole hiki ke hoʻokaʻawale ma waena o nā polyps neoplastic a me nā polyps non-neoplastic me ka ʻole o ka nānā ʻana i ka microscope, ʻo ka wehe ʻana ka ala palekana loa. ʻO ka hopena o ka biopsy maʻamau he hoʻokahi a ʻelua paha pule.
ʻO ka wehe ʻana i nā polyp neoplastic hiki ke hōʻemi i kou pilikia o ka loaʻa ʻana o ke kanesa colorectal ma kahi o 80%! Eia nō naʻe, i ka wā i loaʻa ai iā ʻoe nā polyp, aia kahi pilikia o lākou e hoʻi hou mai. E loiloi kāu kauka i kou pilikia no nā polyp e hiki mai ana ma muli o nā ʻano o ka poʻe i wehe mua ʻia a e hoʻoholo i ka papa hana no kāu colonoscopy aʻe ma muli o kēlā loiloi.
Ka wehe ʻana i ka Colon Polyp
I ka wā o kāu colonoscopy , hiki i kāu kauka—ʻo ia hoʻi he gastroenterologist a he kauka lapaʻau colorectal paha—ke wehe pinepine i nā polyps he nui i ka wā o ke kaʻina hana ponoʻī. Ua kapa ʻia kēia kaʻina hana maʻalahi he polypectomy . Eia nō naʻe, inā he nui a paʻakikī paha kāu mau polyps, pono paha i kāu kauka ke hoʻohana i nā ʻano hana kūikawā e like me EMR (Endoscopic Mucosal Resection) a i ʻole ESD (Endoscopic Submucosal Dissection) e hōʻoia i ka wehe palekana ʻia ʻana.
Nānā ʻana i ka Colonoscopy
Inā ʻaʻole hōʻike kāu colonoscopy i nā polyps neoplastic , ʻaʻole paha ʻoe e pono hou i kahi nānā ʻana no kahi o 10 mau makahiki. Eia nō naʻe, inā ua wehe ʻia nā polyps neoplastic, e hoʻoponopono ʻia kāu papa hana hahai. Ma muli o kāu mau kumu pilikia pilikino, hiki i kāu kauka ke ʻōlelo aku i kahi hoʻokolokolo hou i hoʻokahi, ʻekolu, ʻelima, a ʻehiku paha makahiki.
Hiki ke pale i nā polyps colon?
ʻOiai ʻaʻole hiki iā ʻoe ke pale i nā hoʻololi genetic e alakaʻi ai i kekahi mau polyps, hiki iā ʻoe ke hōʻemi nui i kou pilikia ma o ka hoʻonohonoho ʻana i kou olakino holoʻokoʻa:
- E ʻai i ka nui o nā palaoa piha, nā huaʻai, a me nā mea kanu.
- E kaupalena i nā momona holoholona (ʻoi aku hoʻi nā ʻiʻo ʻulaʻula a me nā ʻiʻo i hana ʻia).
- E mālama i kahi hana hoʻoikaika kino maʻamau.
- E hōʻalo i ka puhi paka a hoʻēmi i ka inu nui ʻana i ka waiʻona.
He mea koʻikoʻi nō hoʻi kēia mau hana i ka pale ʻana i ka maʻi ʻaʻai colon.
Pehea ke koʻikoʻi o nā polyps colon?
Lawe koʻikoʻi ʻia nā polyp colon no ka mea hiki i kekahi ke lilo i kanesa. Eia nō naʻe, e hoʻomanaʻo ʻaʻole ka hapa nui o nā polyp he kanesa ke ʻike ʻia. Hiki i kekahi ke lilo i kanesa i ka hala ʻana o ka manawa inā ʻaʻole mālama ʻia, ʻo ia ke kumu e wehe ai nā kauka iā lākou i ka wā e ʻike ʻia ai.
He aha kaʻu e nīnau aku ai i kaʻu kauka e pili ana i kaʻu mau polyps colon?
E noʻonoʻo e nīnau i kāu kauka i nā nīnau aʻe:
- He aha ke ʻano o nā polyp colon i loaʻa iaʻu?
- He neoplastic anei koʻu mau polyps (hiki ke precancerous) a i ʻole non-neoplastic ?
- Haʻahaʻa, awelika, a kiʻekiʻe paha koʻu pilikia o ka loaʻa ʻana o ka maʻi ʻaʻai kolona?
- Pono anei au e hana i ka hoʻāʻo genetic no nā syndromes polyposis hoʻoilina ?
- Pehea ka likelika o ka hoʻi hou ʻana o kēia mau polyp ma hope o ka wehe ʻana?
- Āhea wau e hoʻonohonoho ai i kaʻu colonoscopy aʻe?
Nui ka poʻe e hopohopo nei e pili ana i kā lākou colonoscopy i hoʻonohonoho ʻia a hoʻowalewale ʻia paha e hoʻopaneʻe iā ia. E noʻonoʻo paha ʻoe, "He waiwai anei kēia hoʻoikaika āpau e hōʻoia wale ʻaʻole aʻu polyps?" ʻO ka pane ʻae. Inā loaʻa iā ʻoe nā polyps, ʻo ka colonoscopy ke ala maikaʻi loa e ʻike a mālama iā lākou i ka wā mua, pinepine ma mua o kou ʻike ʻana i kekahi mau hōʻailona.
He mea maʻamau ka hopohopo inā haʻi ʻia iā ʻoe he mau polyp colon kou, akā e ʻoluʻolu e hoʻomaopopo he mea maʻamau kēia, a no ka hapa nui o ka poʻe, ʻaʻole loa kēia e lilo i maʻi kanesa. Ke ʻike ʻia a wehe ʻia kahi polyp, ʻaʻole ia he mea hoʻoweliweli hou. ʻO ka hana nui loa, ʻo ia ka hopu ʻana i kēia mau ulu ʻana i ka wā mua.
Leka Lawe-Home
I kēia manawa, ua maopopo iā ʻoe nā mea hou aʻe e pili ana i nā polyps colon . ʻAʻohe pono e hopohopo.
ʻO ka mea nui e lawe ʻia, ʻo ia ke kūkākūkā me kāu kauka—ʻoi aku hoʻi ma hope o ka makahiki 45-50—a hana i nā hoʻokolohua e like me ka colonoscopy ke ʻōlelo ʻia. Hiki i kēia i nā kauka ke ʻike a wehe i nā polyp me ka maʻalahi a me ka palekana, ma mua o ko lākou ulu ʻana i ka maʻi kanesa.
ʻO ka mālama ʻana i kahi nohona olakino kou pale maikaʻi loa. ʻO ka ʻai kaulike, ka hoʻoikaika kino mau, a me ka pale ʻana i ka paka a me ka waiʻona nui he mea maikaʻi ia no ke olakino o kou kolona a me kou pono holoʻokoʻa.
Inā he mau nīnau hou aku kāu, mai kānalua e hoʻokaʻaʻike aku i kāu kauka lapaʻau mua a i ʻole he gastroenterologist ma Nirogi Lanka a i ʻole kou kikowaena lapaʻau kūloko. Inā loaʻa iā ʻoe kahi pilikia, e ʻoluʻolu e kelepona koke i ka 911 a i ʻole kāu mau lawelawe pilikia kūloko. E noho olakino!
