Ua ʻike mākou a pau e pili ana i ke koko kiʻekiʻe, a i ʻole "kaomi." Akā, ua lohe anei ʻoe i kahi kūlana kahi e piʻi ai ke kaomi i loko o kahi kīʻaha koko kūikawā i loko o ko kākou ake? I ka lāʻau lapaʻau, kapa mākou i kēia ʻo 'Portal Hypertension.' ʻOiai he paʻakikī iki ka inoa, he kūlana kēia e hiki ke hoʻopilikia nui i ke olakino o ko kākou ake. No laila, mai hopohopo, i kēia lā e kamaʻilio maʻalahi mākou e pili ana i kēia, ma ke ʻano hiki iā ʻoe ke hoʻomaopopo.
He aha maoli ka Portal Hypertension?
I mea e hoʻomaopopo ai i kēia, e nānā mua kākou i kahi mea kupaianaha e hana ʻia ana i loko o ko kākou kino. ʻO ke koko momona a pau mai kou ʻōpū, nā ʻōpū, a me ka spleen e hōʻiliʻili a hele i ke akepaʻa ma o hoʻokahi aa nui. Ua kapa ʻia kēia aa nui ʻo "portal vein." I mea e pololei ai, ʻo ia ke kumu nui o ke koko i ke akepaʻa.
I kēia manawa, e noʻonoʻo ʻoe aia kahi "paʻa kaʻa" nui ma kekahi wahi o kēia aʻa nui, ʻo ia hoʻi, i loko o ke ake. Inā ua hōʻino ʻia kekahi mea i loko o ke ake a ua ālai ʻia nā kīʻaha koko liʻiliʻi i loko, ʻaʻole hiki ke kahe pono ke koko e komo mai ana. He aha ka mea e hana ʻia a laila? Hoʻonui nui ʻia ke koko i loko o kēlā aʻa portal nui a me nā aʻa ʻē aʻe i pili iā ia. ʻO ia ka mea a mākou e kapa nei he Portal Hypertension .
Ke piʻi aʻe kēia kaomi, hoʻāʻo ke koko e kahe ma o nā aʻa koko ʻē aʻe, liʻiliʻi a nāwaliwali. A laila pehu kēlā mau aʻa koko (ʻoi aku hoʻi nā mea i loko o ka esophagus a me ka ʻōpū), lilo i mea like me ka balloon, a hiki ke pohā a kahe ke koko. Kāhea mākou i kēia mau aʻa koko pehu he mau aʻa koko varicose . ʻO kēia ka pilikia weliweli loa o kēia maʻi.
He aha nā kumu o kēia kūlana?
ʻO ke kumu nui a maʻamau o ka Portal Hypertension ʻo ia ka cirrhosis o ke akepaʻa . I ka ʻōlelo maʻalahi, ʻo ka cirrhosis kahi kūlana kahi e hōʻino mau ʻia ai ke akepaʻa no kekahi kumu a lilo ke akepaʻa i paʻakikī ma muli o nā ʻōpala e hana ʻia i ka wā e ho'ōla ai nā ʻeha. E like me ka ʻōpala e hana ʻia ma ko mākou ʻili i ka wā e ho'ōla ai kahi ʻeha. Ke ālai nei kēia ʻiʻo ʻōpala i ke kahe koko i loko o ke akepaʻa.
Aia kekahi mau kumu nui e hiki ai ke hōʻino ʻia ke akepaʻa:
- Ka inu nui ʻana i ka waiʻona.
- Nā maʻi viral e like me ka Hepatitis B a me C.
- Maʻi ʻAke Momona.
Ma waho aʻe o kēia, hiki ke hana ʻia kēia ʻano e nā ʻōpū koko i loko o ke aʻa portal, kekahi mau maʻi parasitic (e like me Schistosomiasis), a me nā kumu kakaikahi ʻē aʻe. I kekahi manawa, ʻaʻohe kumu kikoʻī e loaʻa.
He aha nā hōʻailona o ka Portal Hypertension?
I ka hapanui o nā hihia, ʻaʻohe hōʻailona kikoʻī i nā pae mua o kēia maʻi. ʻIke wale ʻia nā hōʻailona ke ulu aʻe nā pilikia a mākou i kūkākūkā ai. Inā ua haʻi aku ke kauka iā ʻoe he maʻi akepaʻa kou, he mea nui loa ia e makaʻala i kēia mau hōʻailona.
| Hōʻailona/pilikia | He aha ke ʻano o kēia? |
|---|---|
| Ke kahe koko ʻana o ka ʻōpū | Ka luaʻi ʻana i ke koko, ka hele ʻana o ka ʻōpala ʻeleʻele, ka ʻōpala kala, a i ʻole ke kahe ʻana o ke koko me ka ʻōpala. ʻO kēia ma muli o ka haki ʻana o nā aʻa koko pehu (varices). He pilikia kēia. |
| Nā ʻūlū | Pehu ka ʻōpū ma muli o ka hōʻiliʻili ʻana o ka wai i loko o ka ʻōpū. Ua kapa pū kekahi poʻe i kēia he "mahodaraya". |
| Ka huikau noʻonoʻo (Encephalopathy) | ʻO ka hana maikaʻi ʻole o ke akepaʻa ke kumu o ka hele ʻana o nā mea ʻawahia i loko o ke koko i ka lolo, e hoʻoulu ai i ka huikau, ka poina ʻana, ka hiamoe ʻana, a me nā loli o ke ʻano. |
| Nā hunaola koko i hoʻemi ʻia | ʻO ka emi ʻana o nā platelets, ka mea e kōkua ai i ke kāpili ʻana o ke koko, hiki ke alakaʻi i ka maʻalahi o ka palapū a i ʻole ka emi ʻana o nā keʻokeʻo koko, ka mea e hakakā ai i nā maʻi. |
E hoʻomanaʻo, inā ʻoe e luaʻi ana i ke koko a i ʻole e kahe ana i nā ʻōpala ʻeleʻele, he pilikia ia. Pono ʻoe e hele koke i ka ʻOihana Pilikia (ETU) o ka haukapila kokoke loa.
He aha nā lāʻau lapaʻau?
ʻO ka mea pōʻino, ʻaʻole hiki ke ho'ōla piha ʻia ke kumu nui o ka Portal Hypertension. No laila, ʻo ka pahuhopu nui o ka mālama ʻana, ʻo ia ke pale a me ka mālama ʻana i nā pilikia, ʻoiai ke kahe koko mai nā varices.
1. Hoʻōla Endoscopic
ʻO kēia ka mea mua i hoʻohana ʻia no ka mālama ʻana i nā veins varicose.
- Ke kāʻei ʻana: Hoʻokomo ʻia kahi endoscope, kahi paipu me kahi kāmela, ma o ka waha a kau ʻia kahi kaula liʻiliʻi a puni ke kīʻaha koko, e pani ana i ke aʻa.
- ʻO ke kālai ʻana o ka ʻili:Hoʻopili kēia i ka hoʻokomo ʻana i kahi hopena hoʻokahe koko i loko o ke aʻa.
2. Nā lāʻau lapaʻau
- Nā mea pale Beta: Hoʻemi nā lāʻau lapaʻau e like me Propranolol i ke kaomi i loko o ka ʻōnaehana vein portal a hoʻemi i ka pilikia o ke kahe ʻana o ke koko.
- Diuretics: Inā piha ka ʻōpū i ka wai (ascites), hāʻawi ʻia kēia mau lāʻau lapaʻau e wehe i ka wai keu mai ke kino.
- Lactulose: Kōkua kēia lāʻau lapaʻau i ka mālama ʻana i ka encephalopathy.
3. Nā loli o ke ʻano o ka nohona
He ʻāpana koʻikoʻi loa kēia.
- E ho'ōki loa i ka inu ʻana i ka waiʻona.
- Mai lawe i nā lāʻau ʻeha, nā lāʻau lapaʻau ʻē aʻe, a i ʻole nā kī lāʻau lapaʻau me ka ʻole o ka nīnau mua ʻana i kāu kauka. Hiki i kekahi mau lāʻau lapaʻau ke hōʻino i ke akepaʻa.
- E hōʻemi i kāu ʻai ʻana i ka paʻakai (sodium). E ʻai e like me nā kuhikuhi a kāu kauka.
- Inā he huikau kou noʻonoʻo, e noi ʻia paha ʻoe e kaupalena i nā meaʻai waiwai i ka protein.
Nā lāʻau lapaʻau kūikawā ʻē aʻe
Inā ʻaʻole hiki i nā lāʻau lapaʻau i luna ke kāohi i ke kahe ʻana o ke koko a i ʻole ka pehu ʻana o ka ʻōpū, hiki i nā kauka ke hoʻohana i nā lāʻau lapaʻau paʻakikī. Hana kēia mau mea ma ka hoʻemi ʻana i ke kaomi i loko o ka ʻōnaehana vein portal.
- TIPS (Transjugular Intrahepatic Portosystemic Shunt): ʻAʻole kēia he ʻoki kino. Ma kēia, hoʻokomo ʻia kahi paipu liʻiliʻi (stent) ma o ke akepaʻa ma lalo o ke alakaʻi ʻana o X-ray, e hana ana i kahi ala hou ma waena o ka vein portal a me kekahi vein ʻē aʻe e haʻalele ana i ke akepaʻa. Hoʻololi kēia i ke kahe o ke koko a hoʻemi i ke kaomi i loko o nā veins. He ʻoi aku ma mua o 90% ka holomua o kēia lāʻau lapaʻau.
- DSRS (Distal Splenorenal Shunt): He ʻoki kino kēia. Ma kēia, ua pili ka aa splenic i ka aa o ka puʻupaʻa hema. Hoʻemi pū kēia i ke kaomi a kāohi i ke kahe koko. Eia naʻe, ʻaʻole hoʻohana pinepine ʻia kēia i kēia manawa.
- Hoʻoili ʻAke: ʻO kēia wale nō paha ka hopena no nā poʻe maʻi me ka maʻi akepaʻa hope loa.
Ma hope o ia mau lāʻau lapaʻau, he mea nui loa ia no kou olakino e hahai pono i nā kuhikuhi a ke kauka a me nā manawa hoʻopaʻa . Hiki i nā scan a me nā hoʻāʻo koko i hana ʻia i kēlā manawa ke kōkua i ka hoʻoholo ʻana i ka holomua o ka lāʻau lapaʻau.
Leka Lawe-Home
- ʻO ke koko kiʻekiʻe ʻo Portal Hypertension ka piʻi ʻana o ke koko i loko o nā kīʻaha koko o ke akepaʻa. ʻO ke kumu nui o kēia he maʻi i kapa ʻia ʻo cirrhosis.
- Inā loaʻa iā ʻoe nā hōʻailona e like me ka luaʻi ʻana i ke koko, ka hele ʻana o nā ʻōpala ʻeleʻele, a i ʻole ka ʻōpū pehu, mai hoʻowahāwahā iā lākou. E ʻike koke i kāu kauka.
- ʻO ka pahuhopu nui o ka mālama ʻana, ʻo ia ke kaohi i nā pilikia weliweli e like me ke kahe ʻana o ke koko.
- He mea nui loa ka hōʻole loa ʻana i ka waiʻona, e lawe i ka lāʻau lapaʻau e like me ke kuhikuhi a kāu kauka, a e hahai i ka ʻai haʻahaʻa paʻakai.
- Mai makaʻu i kēia maʻi a e ʻeha wale. E kamaʻilio ākea me kāu kauka a loaʻa iā ʻoe ka lāʻau lapaʻau a me ka ʻōlelo aʻoaʻo kūpono.
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