He ʻeke liʻiliʻi anei kou i loko o kou esophagus? (Esophageal Diverticulum)?

Ke manaʻo nei ʻoe i kekahi manawa ua paʻa kekahi mea i loko o kou puʻu ke moni ʻoe i ka meaʻai? A i ʻole he ʻala maikaʻi ʻole kou e puka mai ana mai kou waha? He mau hōʻailona paha kēia o kahi maʻi i kapa ʻia he diverticulum esophageal, a mākou e kamaʻilio ai i kēia lā. Mai hopohopo, ʻaʻole ia he mea maʻamau. Akā he mea maikaʻi ke ʻike iki e pili ana i ia mea. E kamaʻilio maʻalahi kākou e pili ana i ia mea, ma ke ʻano hiki iā ʻoe ke hoʻomaopopo.

He aha kēia ʻeke liʻiliʻi i loko o ka esophagus (Esophageal Diverticulum)?

ʻAe, e nānā mua kākou i ke ʻano o kēia (Esophageal Diverticulum) . ʻIke ʻoe, he ʻōmole ko mākou e lawe ai i ka meaʻai mai ko mākou waha a i ko mākou ʻōpū, kapa mākou ia he esophagus . Ua like ia me ka paipu wai, akā ua hana ʻia ia me nā ʻiʻo. Ma loko o kēia paipu meaʻai, i kekahi manawa e puka mai ana ia mai nā wahi nāwaliwali o ka paia, a hana ia i kahi mea e like me kahi ʻeke liʻiliʻi, a i ʻole kahi ʻeke liʻiliʻi. ʻO ia ke kumu e kapa ai mākou i kēia. E noʻonoʻo iā ia e like me kahi huila ma ke kaʻa e ʻelemakule a puʻupuʻu iki i waho ma kahi hoʻokahi. Pēlā kēia.

ʻElua ʻano o kēia mau ʻeke liʻiliʻi.

• ʻEke 'ʻoiaʻiʻo': ʻO ke ʻano kēia, ua puka mai nā papa āpau o ka paia o ka esophagus , me ka papa ʻiʻo .
• ʻEke 'wahaheʻe': ʻO kēia ka wā e puka wale mai ai kekahi mau papa o ka paia, e like me ka mucosa a me ka papa ma lalo (submucosa). Me he mea lā he mau kaula lole wale nō i huki ʻia i waho.

Hoʻomaopopo nā kauka i kēia mau cysts ma muli o ko lākou wahi i loko o ka esophagus. Hiki ke ʻokoʻa nā kumu o nā cysts ma nā wahi like ʻole.

He aha nā ʻano o ka diverticulum esophageal?

E nānā kākou i nā ʻano nui e ʻike ʻia.

ʻO ka diverticulum o Zenker

ʻO kēia ke ʻano maʻamau . Hoʻokumu ʻia ia ma ka piko o ka esophagus, kahi e hui ai ka puʻu me ka waha. ʻO ka hapa pinepine, he mau ʻeke 'wahaheʻe' kēia. ʻO ke kumu nui, ʻoiai ke paʻakikī ka ale ʻana i ka meaʻai , ke hana pono ʻole nā ​​​​ʻiʻo puʻu, piʻi ke kaomi i loko o ka esophagus a hoʻokuke iā ia i waho ma kahi nāwaliwali. E noʻonoʻo i kahi paipu wai i ālai ʻia i kekahi manawa, a i ka wā e komo koke mai ai ka wai, pehu ka paipu ma mua o kahi i ālai ʻia.

ʻO ke kīʻaha ʻo Killian-Jamieson

ʻAʻole kēia i maʻamau loa. Loaʻa ia ma ka cervical esophagus, ka ʻāpana o ko kākou ʻāʻī e holo like ana me ka iwi kuamoʻo. ʻIke pinepine ʻia ia he ʻeke liʻiliʻi hoʻokahi 'wahaheʻe'. Ua manaʻo ʻia ua hana ʻia e ka nāwaliwali hānau ʻana i loko o nā ʻiʻo ma ia wahi.

ʻO ka Diverticulum waena o ka esophageal

He mau ʻeke 'ʻoiaʻiʻo' kēia. Hoʻokumu ʻia lākou ma ka ʻāpana o ka esophagus e holo ana ma waena o ko mākou umauma. Ua kapa ʻia lākou ʻo (thoracic diverticula) , ʻo ia hoʻi ke ʻano o lākou e hana ʻia i loko o ka lua o ka umauma. I kekahi manawa ua kapa ʻia lākou ʻo (traction diverticula).ʻO ke kumu o kēia, ʻo ia ka hana ʻana i ka wā e huki ai kekahi ikaika o waho i ka paia o ka esophagus (traction). No ka laʻana, hiki i nā lymph node ma ka umauma ke pehu a pipili i ka esophagus, a laila i ka wā e emi ai ka pehu, hiki i ka paia o ka esophagus ke huki.

ʻO ka Diverticulum Epiphrenic

Hana ʻia kēia ma ka hopena o ka esophagus, ma mua pono o ke komo ʻana o ka meaʻai i loko o ka ʻōpū (distal esophagus). He mau ʻeke 'wahaheʻe' pinepine kēia. Maanei hoʻi, ʻo ke kumu ke kaomi. No ka laʻana, inā ua ālai ʻia ka ʻaoʻao haʻahaʻa o ka esophagus, hiki ke hana ʻia ka ʻeke ma muli o ke kaomi i hana ʻia i ka wā e hoʻāʻo ai ka meaʻai e hele ma loko o ka ʻōpū.

Pehea ka maʻamau o kēia ʻano?

He mea kākaʻikahi loa nā diverticula esophageal. Manaʻo ʻia e hoʻopilikia wale lākou i kahi 1% o ka heluna kanaka. ʻOi aku ka maʻamau o lākou i ka poʻe ma luna o 50 mau makahiki , ʻoi aku hoʻi ma hope o 70 mau makahiki. ʻOi aku ka maʻamau o lākou i nā kāne ma mua o nā wahine.

He aha nā hōʻailona o kahi diverticulum esophageal?

ʻO ka hapa nui o ka manawa, ʻaʻole kēia mau diverticula e hoʻoulu i kekahi mau hōʻailona . ʻAʻole paha ʻoe e ʻike he hoʻokahi kāu. Eia nō naʻe, ʻo kahi ʻano i kapa ʻia ʻo Zenker's diverticulum ka mea e hoʻoulu ai i nā hōʻailona. Inā loaʻa iā ʻoe kēia mau hōʻailona, ​​​​hiki iā ʻoe ke ʻike:

• Ua like ia me ka ʻū me ka ʻaneʻane i ka puʻu.
• Ke manaʻo nei he puʻupuʻu i loko o kou puʻu ke moni ʻoe i ka meaʻai.
• He manaʻo me he mea lā ua paʻa ka meaʻai i loko o ka puʻu.
• Hoʻi hou mai ka meaʻai i loko o ka puʻu (regurgitation) ke kūlou ʻoe i mua a moe paha.
• Hanu ʻino me ke kumu ʻole.
• He leo hūʻū ka hū ʻana i ka wā e hanu ana me ke kumu ʻole.

ʻAʻohe o kekahi poʻe i kēia mau hōʻailona a ʻike wale ʻia ma kahi hanana i ka wā o kahi hoʻokolohua i hana ʻia no kekahi kumu ʻē aʻe.

He aha ke kumu o ka diverticulum esophageal?

ʻElua ʻano kumu nui. ʻO kekahi nā kumu pulsion , a ʻo kekahi nā kumu traction .

Nā ʻeke Pulsion: Hāʻule ka hapa nui o nā ʻeke esophageal i loko o kēia māhele. ʻO ke ʻano o 'Pulsion' ʻo ia hoʻi "pushes." ʻO ke ʻano kēia he kaomi kūloko mau i loko o ka esophagus. Hana pinepine kēia i ka wā e ale ai mākou i ka meaʻai. ʻO kekahi mau kūlana olakino i loko o ka esophagus e paʻakikī ai ke ale i ka meaʻai hiki ke hana i kēia kaomi maʻamau. Eia kekahi laʻana:

• (Achalasia) (nele i ka hoʻomaha ʻana o nā ʻiʻo o ka esophagus lalo)
• Nā ʻūmiʻi esophageal
• Nā ʻūmiʻi esophageal
• ʻO ka esophagitis eosinophilic

Nā ʻeke traction:Hoʻokumu ʻia kēia mau mea ke huki kekahi mea ma waho o ka paia o ka esophagus a huki iā ia. ʻO kēia ke kumu o nā ʻeke 'maoli', ʻo ia ka mānoanoa holoʻokoʻa o ka paia esophagus i huki ʻia i loko. Loaʻa pinepine kēia mau mea ma waenakonu o ka umauma. Hiki i kahi maʻi i loko o ka lua umauma (mediastinitis) ke hoʻoulu i ka pehu, hiki ke hoʻopili i ka esophagus, a laila huki i ka esophagus i ka wā e iho ai ka pehu. ʻO nā hiʻohiʻona o ia mau maʻi:

• ʻO ka maʻi puʻupuʻu
• ʻO ka Histoplasmosis , kahi maʻi fungal

ʻO kēia mau kumu ʻelua he mau ulu hou e ulu ana i ko kākou ola ʻana. I ka manawa kākaʻikahi, hiki ke loaʻa kekahi mau ʻeke anal i ka wā hānau. A i ʻole, ʻo ka nāwaliwali hānau ʻana i loko o nā ʻiʻo o ke kahawai anal e maʻalahi ai ka ulu ʻana o kahi ʻeke ma hope. Akā i ka hapa nui o ka manawa, ʻaʻole e ulu kēia ʻeke ke ʻole kahi maʻi ʻē aʻe e kū mua.

He aha nā pilikia e hiki mai ana o kēia diverticulum esophageal?

I ka nui ʻana o kēia ʻeke i ka hala ʻana o ka manawa, ʻoi aku ka paʻa ʻana o ka meaʻai i loko . Hiki i kēia ke manaʻo e like me kahi puʻu i loko o kou puʻu, a i ʻole hiki ke lilo i maʻi a ʻeha . Hiki i ka meaʻai i paʻa ke hana i ka hanu ʻino a me kahi ʻono ʻino i loko o kou waha. Inā loaʻa ka maʻi, hiki ke kahe ke koko a pehu. I nā hihia koʻikoʻi, hiki ke manaʻo e like me kahi puʻu i hiki ke ʻike ʻia ma waho o kou ʻāʻī.

ʻO kekahi mea ʻē aʻe, hiki i ka meaʻai ke noho paʻa no kekahi manawa a laila hoʻi hou i luna i loko o ka puʻu ke hoʻololi ʻoe i nā kūlana (no ka laʻana, ke kūlou ʻoe). Hiki i kēia ke kumu i ka ʻū ʻana, ka pōkole o ka hanu, a me ka ʻeha o ka puʻu. Inā hana kēia i ka pō i kou hiamoe ʻana, hiki i nā ʻāpana meaʻai ke komo i loko o nā māmā me ka ʻike ʻole ʻoe (silent aspiration) . Inā hana kēia, hiki iā ia ke hana i kahi maʻi i loko o nā māmā (aspiration pneumonia) . ʻO kēia ka mea maʻamau i nā poʻe me ka diverticulum Zenker.

He maʻi kanesa anei kēia? He maʻi kanesa paha?

Ua ʻike ʻia he hapa liʻiliʻi loa (ma kahi o 0.05%) o ka poʻe me ka diverticulum esophageal e hoʻomohala i ka squamous cell carcinoma o ka esophagus. Eia nō naʻe, ʻaʻole maopopo inā he mea kūlike wale nō kēia a i ʻole inā he mea hoʻonāukiuki mau mai ka diverticulum ke kumu o ke kanesa. Eia nō naʻe, he haʻahaʻa loa kēia pilikia .

Pehea e ʻike ai inā he diverticulum esophageal kou?

Hiki i kahi hoʻokolohua lapaʻau e nānā ana i loko o ka esophagus ke ʻike i kēia ʻeke. ʻO ka hapa nui, ʻaʻole lākou he mau hōʻailona, ​​​​no laila ua ʻike ʻia lākou ma ke ʻano ulia i ka wā o ka hoʻokolokolo no kekahi kumu ʻē aʻe. Inā loaʻa iā ʻoe nā hōʻailona e pili ana i kou esophagus, e hana kāu kauka i kahi hoʻokolohua i kapa ʻia ʻo radiology a i ʻole endoscopy. ʻOiai ke kiʻi nei ka radiology i nā kiʻi mai waho, hoʻohana ka endoscopy i kahi kāmela e nānā i loko.

He aha ke ʻano o nā hoʻokolohua e hana ʻia?

Eia kekahi mau hoʻokolohua hiki ke hana ʻia:

• Hoʻāʻo ale ʻana i ka esophagram / barium:

He ʻano X-ray kēia. Lawe ʻia kahi wikiō (fluoroscopy) o kou esophagus i kou ale ʻana. Ma kēia, hāʻawi ʻia ʻoe i kahi wai ʻōniʻoniʻo i kapa ʻia ʻo barium e inu. Uhi ia i loko o kou esophagus. A laila, lawe ʻia kahi X-ray i kou ale ʻana. ʻAe kēia iā ʻoe e ʻike maopopo i ke ʻano o kou esophagus, ke ala e hele ai ka meaʻai, a me nā ʻeke e loaʻa ana paha.

• Hoʻāʻo Endoscopy / EGD o luna:

Ma kēia, ua hoʻokomo ʻia kahi ʻōmole lōʻihi me kahi kāmela liʻiliʻi i kapa ʻia ʻo endoscope ma o ka waha a hoʻouna ʻia ma o ka esophagus a i ka ʻōpū. E hoʻomaha ʻia ʻoe i kēia manawa, no laila ʻaʻole ʻoe e ʻike i kekahi ʻeha. Hiki ke nānā ʻia nā kiʻi mai ke kāmela ma kahi pale kamepiula. Inā he ʻeke, hiki ke ʻike pololei ʻia.

• Hoʻāʻo Manometry Esophageal:

ʻOiai ʻo nā pilikia ale kekahi kumu nui o nā ʻeke pharyngeal, hiki i kāu hui lapaʻau ke kuhikuhi i kēia hoʻokolohua. Ana kēia i ka paʻakikī o ka ʻūlū ʻana o nā ʻiʻo o kou puʻu i kou ale ʻana. Lawe ʻia kēia mau ana me ka hoʻohana ʻana i nā mea ʻike ma kahi ʻōmole i kau ʻia ma kou ihu a i loko o kou puʻu.

He aha nā lāʻau lapaʻau no ka diverticulum esophageal?

ʻAʻole pono ka hapa nui o nā ʻeke scrotal i ka mālama ʻana . Inā ʻaʻole lākou e hoʻoulu i kekahi mau hōʻailona a i ʻole nā ​​​​pilikia, hiki ke waiho wale ʻia. Eia nō naʻe, inā ʻo ka ʻeke ke kumu o nā hōʻailona a i ʻole nā ​​​​pilikia, pono paha e pani ʻia a wehe ʻia paha. He ʻano like ʻole nā ​​​​​​ala a nā kauka e hana ai i kēia. Pono paha ʻoe e mālama i ke kūlana kumu i hoʻokumu ai i kāu ʻeke scrotal.

Pehea e mālama ʻia ai kahi diverticulum esophageal?

Hiki i ke kauka ke hana i kēia ma o ke ʻoki kino a i ʻole ma o ka endoscopy. ʻOi aku ka maikaʻi o nā ʻano hana like ʻole no nā ʻano ʻeke like ʻole. Na kāu kauka e hoʻoholo i ke ʻano hana maikaʻi loa iā ʻoe ma muli o kou olakino holoʻokoʻa. No ka laʻana, inā makemake ʻoe i kahi hana minimally invasive, he koho maikaʻi paha ka endoscopy. E kamaʻilio kāu kauka me ʻoe e pili ana i nā pilikia a me nā pono o kēlā me kēia ʻano hana.

Hoʻoponopono ʻoki kino

Hiki i ke kauka lapaʻau ke ʻoki loa i ka ʻeke (diverticulectomy) a i ʻole e huki i luna a humuhumu hou i ka paia o kou esophagus (diverticulopexy) . Hiki i ke ʻoki ke komo i kahi kaʻina hana i kapa ʻia he myotomy . ʻO ka myotomy kahi kaʻina hana e ʻoki ai i kahi ʻiʻo i loko o kou esophagus e hōʻemi i ka paʻa. Pono paha kēia e kōkua i ka paʻakikī o ka ale ʻana i hoʻokumu i kāu ʻeke.

ʻO ka Diverticulotomy Endoscopic

ʻO kahi koho ʻē aʻe i ke ʻoki ʻana, ʻo ia ke hoʻokomo ʻana i kahi endoscope ma o ka waha i loko o ka esophagus a hana i ke ʻoki ʻana ma o ia mea. Ua kapa ʻia kēia ʻo ke kaʻina hana Dohlman.ʻO kēia ke ʻoki ʻana i ka septum ma waena o ka ʻeke a me ka paia ʻē aʻe o ka esophagus. Hiki ke hana ʻia kēia me ka hoʻohana ʻana i ka laser, electrocautery, a i ʻole kahi stapler. Hiki i kēia mau mea ke ʻoki a sila i ka ʻeha.

ʻEhia ka lōʻihi e hoʻōla ai ma hope o kēia ʻoki kino?

Pono ʻoe e noho ma ka haukapila no hoʻokahi lā. A laila pono ʻoe e hoʻomaha ma ka home no kekahi mau pule. Hiki ke ʻeha a pehu kou puʻu no kekahi mau pule. Hiki i kēia ke paʻakikī i ka ale ʻana i ka meaʻai. Hiki ke aʻo ʻia ka hōʻoluʻolu ʻeha, akā ʻaʻole pono. E aʻo aku kāu kauka iā ʻoe pehea a me ka manawa e hoʻomaka ai me nā meaʻai wai, e neʻe mālie ana i nā meaʻai palupalu, a laila i nā meaʻai maʻamau.

He aha kāu manaʻo hope loa no kēia kūlana?

Loaʻa i ka hapa nui o nā kānaka kahi diverticulum esophageal a ʻaʻole ia e hoʻoulu i kekahi pilikia . Akā inā hana ia, aia kekahi mau ala e hoʻoponopono ai. ʻOi aku ka nui o ka holomua o kēia mau ʻoki kino ma mua o 90% . Eia nō naʻe, aia kahi pilikia o 10% o nā pilikia e like me ke kahe ʻana o ke koko, ka maʻi, a i ʻole ka hōʻino ʻana i ka esophagus. E kūkākūkā kāu hui lapaʻau i nā pilikia a me nā pono o nā koho lapaʻau like ʻole me ʻoe pākahi.

Inā loaʻa iā ʻoe kahi maʻi e paʻakikī ai iā ʻoe ke ale, hiki iā ʻoe ke loaʻa kahi ʻeke e like me kēia ma ka paia o kou esophagus. Hiki i kēia ʻeke ke hana ma kahi nāwaliwali o kou esophagus ma muli o ke kaomi maʻamau ʻole e hana ʻia i ka wā e ale ai ʻoe. ʻAʻole paha ia e hoʻopilikia iā ʻoe. Akā inā loaʻa iā ʻoe kekahi mau hōʻailona hou e pili ana i kou esophagus, e ʻike i ke kauka. Ma kēlā ʻano, hiki iā lākou ke hoʻoholo pololei inā he ʻeke a i ʻole kekahi mea ʻē aʻe a hāʻawi iā ʻoe i ka lāʻau lapaʻau e pono ai.

Nā mea nui e hoʻomanaʻo (Leka Lawe-Home)

• ʻO kahi diverticulum esophageal he ʻeke liʻiliʻi e hana ana ma ka paia o ka esophagus.
• He mea kākaʻikahi loa kēia a ʻaʻole pinepine e hōʻike i nā hōʻailona.
• Inā kū mai nā hōʻailona, ​​​​​​hiki ke komo pū me ka paʻakikī i ka moni ʻana, ka paʻa ʻana o ka meaʻai i ka puʻu, a me ka hanu ʻino.
• ʻO ka hapa nui o ka manawa, ʻaʻole pono kēia mau lāʻau lapaʻau .
• Eia nō naʻe, inā koʻikoʻi nā hōʻailona a loaʻa paha nā pilikia, hiki ke mālama pono ʻia ke ʻoki ʻana a i ʻole nā ​​​​kaʻina hana endoscopic.
• He mea nui e ʻimi i ke kōkua lapaʻau inā pilikia ʻoe i ka ale ʻana a i ʻole nā ​​hōʻailona hou. Mai hopohopo, aia nā kauka ma laila e kōkua iā ʻoe.

Manaʻolana wau he mea pono kēia ʻike iā ʻoe. E ola kino!

ʻEsophagus , esophageal, diverticulum, paʻakikī i ke ale ʻana, ʻeha puʻu, reflux, endoscopy