Ua pehu a hoʻonui ʻia nā kīʻaha koko i loko o kou esophagus, ke ʻōmole e lawe ana i ka meaʻai mai kou waha a i kou ʻōpū? ʻAʻole paha ʻoe i lohe i kēia. Akā, hiki i kēia ʻano, i kapa ʻia ʻo Esophageal Varices, ke noho mālie a lilo koke i mea weliweli. No laila, i kēia lā, e aʻo kākou i nā mea āpau e pili ana i ia mea me ka maʻalahi, me he mea lā e kamaʻilio ana kākou me kahi hoaaloha.
I ka ʻōlelo maʻalahi, he aha nā varices esophageal?
E noʻonoʻo, i kekahi manawa he pehu a wili nā aʻa koko o ko kākou mau wāwae? Kāhea mākou iā lākou he 'varicose veins'. Hana like ka mea like i loko o ko kākou ʻōpū. He nāwaliwali loa nā paia o kēia mau aʻa koko. No laila, he nui ka manawa e kahe ai ke koko mai loko mai o lākou, a i ʻole e pohā koke a kahe ke koko. Hiki i kēia kahe koko i loko o ke kino ke lilo koke, koʻikoʻi, a hiki i ka hoʻoweliweli ʻana i ke ola.
ʻO ka maʻamau, hoʻokumu ʻia kēia ʻano ma muli o ka piʻi ʻana o ke kaomi i loko o ke kīʻaha koko nui e hele ana ma o ke akepaʻa a me nā aa koko ʻē aʻe e pili ana iā ia (Portal Hypertension). ʻO kēia kaomi kūpono ʻole ke kumu o ka pehu ʻana o nā aa koko liʻiliʻi i loko o ke akepaʻa a lilo i mea nui. ʻIke pinepine ʻia kēia ʻano i nā poʻe me ka maʻi akepaʻa.
Pehea ke koʻikoʻi o kēia kūlana?
ʻO ka pilikia weliweli loa o ka thrombosis vein portal ka hoʻokahe koko . ʻAʻole nā kānaka a pau e kahe ke koko, akā ma kahi o 50% o ka poʻe e pilikia ana. ʻO ke kiʻekiʻe o ka portal hypertension, ʻo ka nui o ka pilikia o ke kahe ʻana. Hoʻonui kēia kaomi me nā maʻi ate, ʻoiai ka cirrhosis .
Hiki i ka poʻe me ka cirrhosis koʻikoʻi o ke akepaʻa ke loaʻa nā pilikia ʻē aʻe ma waho aʻe o kēia mau aa koko e pehu ana. Eia nō naʻe, ʻo ke kumu nui o ka hoʻokipa ʻia ʻana i ka haukapila a me ka make ʻana, ʻo ia ka haki ʻana o kēia mau aa koko a me ke kahe ʻana o ke koko. Inā ʻoe e kahe i ke koko i hoʻokahi manawa ma kēia ʻano, ʻo ka pilikia o ka make ma kahi o 20%. Eia kekahi, hiki ke kahe pinepine ke koko.
He aha nā hōʻailona o kēia maʻi?
No ka mea, aia kēia mau aa koko i loko o ke kino, ʻaʻole ʻike ʻia lākou e like me ke aa koko ma ka wāwae. ʻAʻole paha ʻoe e ʻike iā lākou ke ale ʻoe i ka meaʻai. ʻO ka ʻoiaʻiʻo, ʻaʻole paha lākou e hōʻike i kekahi mau hōʻailona a hiki i ka hoʻomaka ʻana o ke kahe ʻana o ke koko .
Eia nō naʻe, inā ʻike ke kauka i nā hōʻailona ʻē aʻe e hōʻike ana he maʻi ate kou a i ʻole ka hypertension portal, hiki paha iā lākou ke manaʻo i kēia.
| ʻAno o ka hōʻailona | Wehewehena |
|---|---|
| Nā hōʻailona e hōʻike ana i ka maʻi akepaʻa | |
| ʻĀʻī | Melemele kou ʻili a me kou mau maka. |
| Nā ʻūlū | ʻO ka pehu ʻana o ka ʻōpū ma muli o ka hōʻiliʻili ʻana o ka wai i loko o ka ʻōpū (ʻōpū). |
| ʻEdema | Ka pehu ʻana o nā wāwae a me nā wāwae. |
| ʻEha ʻōpū o luna | ʻEha i hoʻokumu ʻia e ka pehu ʻana o ke akepaʻa a i ʻole ka spleen. |
| He manaʻo o ka manaʻolana ʻole | ʻO ka encephalopathy hepatic kahi kūlana i hana pono ʻole ai ke akepaʻa, e hoʻopilikia ana i ka lolo. |
| Nā hōʻailona o ke kahe koko mai kahi vein | |
| Ke luaʻi ʻana i ke koko | Inā lohi ke kahe ʻana o ke koko, e like paha ka luaʻi me ka ʻōpala kope. Inā pohā koke kahi aʻa koko, e luaʻi ʻia ke koko ʻulaʻula hou. |
| Koko i loko o ka ʻōpala | Inā hele ke koko ma o ke ala ʻai, hiki iā ia ke hoʻolilo i ka ʻōpala i ʻeleʻele ʻeleʻele, e like me ke kēpau (melena). I nā hihia o ke kahe wikiwiki ʻana o ke koko, hiki ke kahe ʻia ke koko ʻulaʻula hou. |
| Keʻokeʻo | He helehelena keʻokeʻo me he mea lā ua kahe ke koko mai ka maka mai. |
| Luhi a me ka poniuniu | Manaʻo luhi, nāwaliwali, a me ka poniuniu ma muli o ke koko haʻahaʻa. |
He mea nui loa: Inā loaʻa iā ʻoe nā hōʻailona o ka haʻalulu hypovolemic ma muli o ke kahe koko nui, e hele koke i ka lumi pilikia o ka haukapila (ETU). ʻO kēia mau hōʻailona: ka puʻuwai wikiwiki, ka hanu wikiwiki, ka hou anu, a me ka nalowale o ka ʻike.
No ke aha e pehu ai kēia mau aa koko? He aha ke kumu?
E like me kā mākou i kūkākūkā ai ma mua, ʻo ke kumu nui he kūlana i kapa ʻia ʻo "Portal Hypertension." E hoʻomaopopo iki kākou i kēia.
E noʻonoʻo i ko kākou akepaʻa e like me kahi kānana nui. ʻO ke koko e puka mai ana mai ka meaʻai i loko o ka ʻōpū e hele ana ma o ke akepaʻa, kahi e hoʻomaʻemaʻe ʻia ai a laila hele i ka puʻuwai. ʻO ke aʻa nui e lawe mai i kēia koko i ke akepaʻa ua kapa ʻia ʻo "Portal Vein".
I kēia manawa, inā ua ʻeha a paʻakikī ke akepaʻa ma muli o kahi maʻi e like me ka cirrhosis , ʻaʻole hiki i kēlā koko ke hele maʻalahi ma o ke akepaʻa. Me he mea lā he kaʻa nui ma ke alanui. ʻO kēia ke kumu e piʻi nui ai ke koko i loko o ka aʻa portal.
Hoʻāʻo ke kino e uku no kēia kaomi i hoʻonui ʻia ma o ka hoʻohuli ʻana i ke koko ma o nā kīʻaha koko liʻiliʻi (nā aa koko liʻiliʻi). He mau kīʻaha koko liʻiliʻi wale nō nā aa koko i loko o ka ureter. Akā, ʻaʻole hiki i kēia mau aa koko liʻiliʻi ke lawelawe i ka nui o ke koko a me ke kaomi. ʻO ka hopena, pehu lākou, lilo i mea nui, a hiki ke pohā i kēlā me kēia manawa.
ʻO nā kumu nui o ka cirrhosis akepaʻa:
- Ka inu nui ʻana i ka waiʻona.
- ʻAke momona (Nonalcoholic Steatohepatitis).
- Nā maʻi hepatitis viral lōʻihi.
- Hoʻouka ka ʻōnaehana pale ponoʻī o ke kino i ke akepaʻa (Autoimmune Hepatitis).
- ʻO nā kumu ʻē aʻe e like me nā ʻōpū koko, nā maʻi parasitic (Schistosomiasis) a me nā mea ʻē aʻe.
Pehea ʻoe e ʻike ai inā loaʻa iā ʻoe kēia maʻi?
ʻO ka hapa nui o ka manawa, ʻike wale ʻoe i kēia ma hope o ka nānā ʻana o ke kauka iā ʻoe. Inā loaʻa iā ʻoe ka cirrhosis o ke akepaʻa, e ʻōlelo pinepine kāu kauka i ka nānā ʻana no kēia ʻano pehu ʻana o nā aʻa.
ʻO ka hoʻāʻo nui ka Upper Endoscopy a i ʻole ka hoʻāʻo EGD .
ʻO kēia ke komo ʻana i kahi ʻōmole lahilahi a palupalu me kahi kāmela i hoʻopili ʻia ma kou waha a nānā i kou esophagus, ʻōpū, a me ka hoʻomaka ʻana o kou ʻōpū liʻiliʻi. ʻAe kēia i kāu kauka e ʻike maopopo inā ua pehu kou mau aa koko, pehea ko lākou nui, a inā paha e pilikia ana lākou i ke kahe ʻana o ke koko.
He aha nā lāʻau lapaʻau no kēia?
ʻO ka mea pōmaikaʻi, aia nā ʻano lapaʻau like ʻole e loaʻa ai ke kāohi ʻana i ke kahe koko a pale i ke kahe hou ʻana o ke koko. ʻO nā pahuhopu nui o ka lapaʻau ʻana:
- E kāohi i ke kahe koko ʻana inā he hoʻokahi.
- Ke pale nei i ke kahe koko i ka wā e hiki mai ana.
- Inā hiki, e hoʻēmi i ke kūlana o `(Portal Hypertension)`.
1. Kāohi i ke kahe ʻana o ke koko (pilikia)
He pilikia olakino kēia. Ma ka haukapila, e hāʻawi ʻia ʻoe i nā wai IV, kahi hoʻoili koko inā pono, a me kahi endoscopy ma hope o ka paʻa ʻana o kou kūlana. Ma laila:
- Hoʻopaʻa ʻana i ke kāʻei Varicose: Hoʻokomo ʻia kahi mea liʻiliʻi ma o ka endoscope a kau ʻia kahi kāʻei laholio liʻiliʻi a puni ka aʻa varicose. Hoʻōki kēia i ke kahe ʻana o ke koko i ka aʻa a kāohi i ke kahe ʻana o ke koko.
- Nā lāʻau lapaʻau: Hāʻawi ʻia nā lāʻau lapaʻau e hoʻohaʻahaʻa i ke koko a hoʻopaʻa i nā kīʻaha koko (Octreotide, Vasopressin) ma o kahi aa koko.
2. Ke kāohi nei i ke kahe hou ʻana o ke koko
Inā he kahe koko a ʻaʻole paha, inā he pilikia o ke kahe koko ʻana, e hoʻomaka ke kauka i ka lāʻau pale.
- Nā mea pale Beta: ʻO kēia ʻano lāʻau lapaʻau, i hāʻawi ʻia no ke koko kiʻekiʻe, hiki ke hōʻemi i ka pilikia o ke kahe ʻana o ke koko ma kahi o 50%.
- Band Ligation: Hoʻohana ʻia kēia ʻano hana ma ke ʻano he mea pale no kekahi poʻe.
3. Ke mālama ʻana i ke kumu kumu
Inā ʻaʻole e hōʻemi nā lāʻau lapaʻau i luna i ka pilikia o ke kahe ʻana o ke koko, hiki i kāu kauka ke kuhikuhi i nā ʻano hana ʻē aʻe e hōʻemi pololei i ke kūlana o ka "Portal Hypertension."
- ʻO ka Transjugular Intrahepatic Portal-Systemic Shunt (TIPS): ʻAʻole kēia he hana ʻoki kino. Ma kēia kaʻina hana, ua hoʻokomo ʻia kahi ʻōmole liʻiliʻi (stent) i loko o kahi aʻa koko i loko o ke akepaʻa e lawe ana i ke koko mai ka aʻa koko portal, e hana ana i kahi pilina hou, a i ʻole "shortcut." Hoʻemi nui kēia i ke kaomi.
- ʻO ke ʻoki kino: ʻO nā kaʻina hana ʻoki kino e like me ka "Distal Splenorenal Shunt (DSRS)" e hōʻemi pū i ke kaomi ma o ka hoʻohuli ʻana i ke kahe koko.
Mai poina: ʻO ka mea nui loa, ʻo ia ka mālama ʻana i ke kumu nui o ka hōʻino ʻana o ke akepaʻa. ʻO ka haʻalele ʻana i ka waiʻona, ka hōʻemi ʻana i ke kaumaha, a me ka mālama ʻana i nā maʻi e like me ka hepatitis C hiki ke kōkua i ka hōʻemi ʻana i ka hōʻino ʻana o ke akepaʻa a pale i ka maʻi mai ka ʻino ʻana.
Leka Lawe-Home
- He maʻi koʻikoʻi nā varices esophageal ʻaʻole pinepine i hōʻike i nā hōʻailona a hiki i ke kahe ʻana o ke koko.
- ʻO ke kumu nui o kēia, ʻo ia ka hypertension portal i hoʻokumu ʻia e nā maʻi ate, ʻoi aku ka cirrhosis.
- Inā loaʻa iā ʻoe ka maʻi akepaʻa, he mea nui loa e kamaʻilio me kāu kauka a loaʻa i nā hoʻokolohua maʻamau.
- Inā ʻike ʻoe i nā hōʻailona e like me ka luaʻi ʻana i ke koko a i ʻole ka hele ʻana o nā ʻōpala ʻeleʻele, he pilikia ia. E hele koke i ka ʻOihana Pilikia o ka haukapila (ETU).
- ʻO nā hoʻololi ʻana i ke ʻano o ka nohona, e like me ka haʻalele ʻana i ka waiʻona a me ka mālama ʻana i kahi nohona olakino, e kōkua nui i ka mālama ʻana i ke olakino o ke akepaʻa a me ka pale ʻana i kēia maʻi mai ka lilo ʻana i mea ʻino.
💬 Comments (0)
ʻAʻohe manaʻo i kau ʻia. Hoʻohui i kāu manaʻo ma ʻaneʻi no ka manawa mua.
Hoʻohui i kāu manaʻo