Ua loaʻa anei iā ʻoe kahi manaʻo piha koke a me kahi manaʻo paʻa i loko o kou ʻōpū? Me he mea lā ua paʻa kekahi mea i loko o kou ʻōpū, akā ʻaʻole. ʻO ia ke ʻano ʻē, he kūlana weliweli paha a mākou e kamaʻilio ai i kēia lā. Ua kapa ʻia ʻo Ogilvie Syndrome. E nānā kākou i ke ʻano o ia mea, no ke aha e hana ʻia ai, pehea e ʻike ai, a pehea e mālama ai.
He aha ka Ogilvie Syndrome?
I ka ʻōlelo maʻalahi, ʻo Ogilvie Syndrome ka wā e pau koke ai kāu colon i ka hana me ke kumu ʻole. Ua kapa pū nā kauka iā ia he acute colonic pseudo-obstruction (ACPO) . ʻO ka "pseudo-obstruction" ʻo ia hoʻi ke hana nei kāu colon me he mea lā ua ālai ʻia e kekahi mea, akā ʻo ka ʻoiaʻiʻo , ʻaʻohe mea i ālai ʻia ma ke kino . Aia ka pilikia ma ka ʻōnaehana e kāohi ana i ka neʻe ʻana o ka colon. ʻO ia hoʻi, ua pau ia i ka hoʻokuke ʻana i ka meaʻai a me ka mea inu i mua ma o ka colon. A laila, hōʻiliʻili nā mea e like me ka meaʻai a me ka ea i loko o ka colon, e hoʻonui ai i nā paia o ka colon, a i ʻole e puʻupuʻu. E noʻonoʻo e like me ka jam traffic, kahi e pau ai ka neʻe ʻana o nā kaʻa a ua ālai ʻia ke alanui.
He aha ka ʻokoʻa o ka Ogilvie Syndrome mai nā pseudo-obstructions ʻōpū ʻē aʻe?
He maʻi koʻikoʻi ka maʻi Ogilvy. ʻO ia hoʻi, hiki koke mai ia a he manawa pōkole. Hoʻopilikia wale ia i ka kolona . ʻO ka "Intestinal pseudo-obstruction" kahi huaʻōlelo laulā. Pili ia i kekahi hana ʻino e hana ʻia me ka ʻole o ke ālai kino i loko o nā ʻōpū. Loaʻa i kekahi poʻe nā pseudo-obstructions ʻōpū mau , i kekahi manawa ma muli o kahi maʻi lōʻihi a i ʻole kahi maʻi hānau.
He aha ka ʻokoʻa ma waena o ka Ogilvie Syndrome a me ka Paralytic Ileus?
ʻO ka paralytic ileus kekahi mea hoʻopilikia ʻōpū koʻikoʻi. Eia nō naʻe, hoʻopilikia pinepine ia i nā ʻōpū liʻiliʻi a me nā ʻōpū nui. He mea maʻamau kēia ma hope o ke ʻoki ʻōpū . Hana ʻia kēia i ka wā e hoʻomaka ai nā ʻōpū e hana lohi iki ma hope o ke ʻoki ʻana. Hoʻopau pinepine ia ma kāna iho i loko o kekahi mau lā.
Eia nō naʻe, hoʻopilikia kūikawā ka maʻi Ogilvy i kou kolona , a pinepine i ka ʻāpana o kou kolona i kapa ʻia ʻo cecum , kahi e hoʻomaka ai. ʻAʻole ia he mea maʻamau e like me ka paralytic ileus, a hiki ke lilo i mea paʻakikī iki.
ʻO wai ka mea e loaʻa pinepine ai ka Ogilvie Syndrome?
ʻOiai hiki ke hana kēia i kekahi, ʻoi aku ka maʻamau o ia mea i ka poʻe ʻelemakule a me ka poʻe me nā pilikia olakino ʻē aʻe.. E noʻonoʻo i kahi kanaka i hana ʻia i ke ʻoki kino nui, kahi ulia, kahi maʻi puʻuwai, a i ʻole kahi maʻi koʻikoʻi. Hiki i kēia mau mea ke hana i ka maʻi Ogilvy. Eia kekahi, ʻo nā electrolyte imbalances , nā maʻi neurological , a me ka lawe ʻana i nā lāʻau lapaʻau he nui i ka manawa like he mau mea pilikia. Hoʻopilikia kēia mau mea a pau i kā mākou ʻōnaehana nerve . ʻO kēlā ʻōnaehana nerve ka mea e haʻi aku i nā ʻiʻo i loko o ko mākou ʻōpū nui e hoʻokuke i ka meaʻai i mua.
Pehea ka maʻamau o kēia?
Ua hōʻike ʻia ka maʻi Ogilvy e loaʻa ana ma kahi o hoʻokahi i loko o 1,000 mau komo haukapila. ʻO ka awelika o ka makahiki o ka poʻe i hoʻopilikia ʻia ma kahi o 60 mau makahiki.
He aha nā hōʻailona o ka Ogilvie Syndrome?
Ke hoʻomaka ka hōʻiliʻili ʻana o ka meaʻai a me ka ea i loko o kou ʻōpū nui, hiki iā ʻoe ke ʻike i nā mea e like me:
- ʻŌpū pehu: ʻO ke ʻano o ka ʻōpū e pehu ana a hoʻonui ʻia.
- ʻEha ʻōpū: Hiki ke loaʻa ka ʻeha nui o ka ʻōpū.
- Ka nalowale ʻana o ka makemake e ʻai: Ka nalowale ʻana o kekahi makemake e ʻai.
- Ka luaʻi a me ka luaʻi ʻana: Manaʻo maʻi a me ka luaʻi ʻana.
- ʻO ka pehu a me ke kinoea: He manaʻo o ka piha i loko o ka ʻōpū.
- Ka paʻa ʻana a me/a i ʻole ka maʻi palahēhē: Hiki i kekahi poʻe ke loaʻa i ka paʻa ʻana, aʻo kekahi poʻe e loaʻa paha i ka maʻi palahēhē.
E noʻonoʻo iā ʻAnakala Nimal, he 65 ona makahiki, he maʻi diabetes kona, a he maʻi puʻuwai hoʻi. Ua hana ʻia ʻo ia i kahi ʻoki pani ʻūhā. Ma hope o ʻelua a ʻekolu paha lā, ua piha koke kona ʻōpū a ua paʻakikī iā ia ke hanu. I kona hoʻopā ʻana i kona ʻōpū, ua paʻakikī e like me ka pōhaku. Ua ʻōlelo ʻo ia ʻaʻohe ona makemake e ʻai, a ua luaʻi hoʻi. I ka wā i nānā ai nā kauka iā ia, ua ʻike lākou he maʻi ʻo Ogilvy ia.
He aha ke kumu o ka Ogilvie Syndrome?
ʻAʻole maopopo loa ke kumu kikoʻī. Akā, manaʻoʻiʻo nā kānaka ʻepekema ua hana ʻia ia e kahi hana hewa i loko o kā mākou ʻōnaehana nerve autonomic . ʻO kēia ʻōnaehana nerve autonomic ka ʻāpana o ko mākou kino e kāohi ana i nā neʻe ʻana o nā ʻiʻo a mākou i ʻike ʻole ai. Hoʻokele pū ia i ka neʻe ʻana o ka nalu (peristalsis) e hoʻokuke ana i ka meaʻai i mua i loko o ko mākou ʻōpū. ʻOiai he maʻi koʻikoʻi kēia, hoʻoulu ʻia e kekahi kaumaha maʻamau ʻole ma ka ʻōnaehana nerve autonomic. Eia nō naʻe, hiki i nā mea olakino ʻē aʻe ke kōkua pū i ia mea.
Aia kekahi mau maʻi koʻikoʻi e hiki ai ke hoʻoulu i ka maʻi Ogilvy:
- Maʻi hohola
- ʻO ka hāʻule ʻana o ka puʻuwai congestive (nāwaliwali o nā ʻiʻo puʻuwai ma muli o ka maʻi puʻuwai)
- ʻEha ʻeha
- nā maʻi koʻikoʻi (e like me ka pneumonia a i ʻole sepsis)
- ʻO ke ʻoki ʻōpū hāmama
- ʻO ke ʻoki puʻuwai hāmama
- ʻO ke ʻoki kino Orthopedic (e.g. pani ʻūhā)
- Ka hānau ʻana ma ke ʻano he Caesarean / C-section
Nā kumu olakino i loaʻa mua e hiki ke kōkua i ka maʻi Ogilvy:
- Ka hāʻule ʻana o ka puʻupaʻa
- Ka hāʻule ʻana o ka hanu
- Maʻi neurological
- Maʻi cardiovascular
- Ka maʻi ʻaʻai
- Nā maʻi metabolic
- Nā kaulike ʻole o ka electrolyte
- Makahiki kiʻekiʻe
- Loaʻa nā nāwaliwali kino
- Ke lawe nei i nā lāʻau lapaʻau he nui i ka manawa like
ʻO kekahi mau lāʻau lapaʻau e pili ana me ka maʻi Ogilvy:
- Nā lāʻau lapaʻau antipsychotic
- Nā Amphetamine
- Nā Corticosteroids
- ʻO nā opioids (nā lāʻau hoʻopau ʻeha)
- Nā lāʻau pale kino
- ʻO ka anesthesia spinal
He aha nā pilikia e hiki ke loaʻa mai ka Ogilvie Syndrome?
ʻO ka hapa nui o ka manawa, hoʻopau wale ʻia ka maʻi Ogilvy a i ʻole me ke kōkua. Eia nō naʻe, i kekahi manawa pono ke komo ʻana . Inā ʻaʻole i ʻike ʻia no ka manawa lōʻihi, hiki iā ia ke alakaʻi i nā pilikia koʻikoʻi inā e ʻoi aku ka ʻino o ke kūlana. Hōʻike nā haʻawina e ʻoi aku ka nui o nā pilikia inā ua hoʻonui ʻia ka kolona (ʻoi aku ma mua o 12 kenimika). ʻO ke anawaena maʻamau o ka kolona ma kahi o 8 kenimika.
ʻO ka nui o ka hoʻonui ʻana o ka ʻōpū, ʻo ka nui aʻe o ka pilikia. Nā Pōʻino Hiki:
- Ischemia: ʻO ke kaomi nui ʻana ma nā paia o ka colon hiki ke hoʻopau i ke kahe koko . Hiki i kēia ke alakaʻi i ka mumū nui, i kapa ʻia ʻo ischemic colitis . Inā ʻaʻole mālama ʻia, hiki ke make nā ʻiʻo (necrosis) . E noʻonoʻo e like me ke kaomi ʻana i kahi paipu wai me ka ikaika a hiki i ka pau ʻana o ke kahe ʻana o ka wai.
- Perforation: Hiki i nā wahi o ka ʻiʻo necrotic ke haehae a haki paha . Inā loaʻa kahi perforation gastrointestinal, hiki i nā mea ʻawahia a me nā bacteria ke pālahalaha i loko o ka lua ʻōpū, e hana ana i kahi maʻi koʻikoʻi i kapa ʻia ʻo peritonitis .
- Sepsis: Hiki i ka Peritonitis ke pālahalaha maʻalahi i ke kahe koko (septicemia) . He pilikia kēia! ʻO Sepsis ka wā e laha ai ka maʻi ma ke kino aHiki ke loaʻa kahi kūlana i kapa ʻia ʻo septic shock. Hiki i kēia ke alakaʻi i ka hāʻule ʻana o nā ʻōkana he nui.
He mea weliweli loa kēia mau pilikia, ʻo ia ke kumu he mea nui e ʻimi i ke aʻo lapaʻau i ka wā e ʻike ai ʻoe i nā hōʻailona o ka maʻi Ogilvy.
Pehea e ʻike ʻia ai ka maʻi ʻo Ogilvie?
Hoʻokumu ʻia ka hōʻailona ma muli o kēia mau kumu:
- Hōʻoia nā hoʻokolohua radiology ua hoʻonui ʻia ka kolona nui a ʻaʻohe mea keʻakeʻa kino o ka ʻōpū.
- Nā hoʻokolohua kūikawā e kāpae i nā maʻi ʻē aʻe e hiki ke hoʻoulu i kou kūlana.
He aha ke ʻano o nā hoʻokolohua radiological e hiki ai ke hōʻoia i kēia?
No ka loaʻa ʻana o kahi nānā kikoʻī i loko o kou kolona, hoʻohana nā kauka i kahi kaʻina hana i kapa ʻia he mea hoʻohālikelike kūloko me ka radiology. Ua uhi ʻia kēia mea hoʻohālikelike ma loko o kou kolona a ʻike maopopo ʻia ma nā kiʻi X-ray. Hiki ke hāʻawi ʻia kēia mea hoʻohālikelike iā ʻoe e inu, ma ke ʻano he enema, a i ʻole he wai i hāʻawi ʻia i loko o kahi aʻa (IV). ʻO ka CT scan hoʻohālikelike a me ka fluoroscopy hoʻohālikelike ʻelua mau ʻano i hoʻohana ʻia no kēia.
Aia kahi hoʻāʻo i kapa ʻia he enema gastrografin , hiki ke hoʻohana ʻia i kekahi manawa ma ke ʻano he lāʻau lapaʻau. Pili kēia i ke kau ʻana i kahi hopena hoʻohālikelike wai-hoʻoheheʻe ʻia i kapa ʻia ʻo gastrografin i loko o kou kolona ma o kou rectum, a me ka lawe ʻana i nā kukuna X-fluoroscopic. (Ua like ka Fluoroscopy me kahi wikiō X-ray e hiki ke ʻike i ke ʻano o ka neʻe ʻana o ka hopena.) Ma ke ʻano he hopena ʻaoʻao, hiki i ka gastrografin ke hana ma ke ʻano he laxative i loko o ka kolona, e kōkua ana i kou ʻōpū e neʻe hou.
Pehea e mālama ʻia ai ka Ogilvie Syndrome?
Aia ka lāʻau lapaʻau i ke ʻano o ka hoʻonui ʻia ʻana o kou kolona a inā paha ʻoe e pilikia ana i nā pilikia. I nā manawa hiki, hoʻāʻo nā kauka e mālama iā ia me ke kākoʻo a me ka nānā pono ʻana . ʻO ia hoʻi ke kōkua ʻana i ke kino e ho'ōla iā ia iho me ka ʻole o ka nui o ke komo ʻana. Akā inā pono, hoʻohana lākou i nā lāʻau lapaʻau a i ʻole nā kaʻina hana e hoʻomaha i ke kolona a hōʻemi i ka pilikia o nā pilikia. Inā loaʻa nā pilikia, pono lākou i ka lāʻau lapaʻau ulia pōpilikia.
Hiki i ka lāʻau lapaʻau Conservative ke komo pū me:
- Ke mālama ʻana i nā maʻi kumu e kōkua ai i kēia kūlana.
- ʻO ka hoʻōki ʻana i ka lāʻau lapaʻau e hiki ke kōkua i kēia maʻi.
- Hoʻomaha ʻōpū: Hoʻemi i ke kaomi ma ka ʻai ʻole ʻana ma ka waha.
- Nā wai intravenous (nā wai IV):Ka mālama ʻana i ka hydration a me ka hoʻoponopono ʻana i nā kaulike ʻole electrolyte ma ka hāʻawi ʻana i nā mea e like me ka saline i loko o kahi vein.
- E paipai i ka neʻe ʻana o ka ʻōpū ma ka hele wāwae a i ʻole ka hoʻololi ʻana i nā kūlana.
- ʻŌmole Nasogastric: No ka wehe ʻana i ka ea keu a me ka wai mai ka ʻōpū.
- ʻŌmole Rectal: He catheter i hoʻokomo ʻia ma o ka rectum e wehe i ka ea a me ka wai ma o ke kaumaha.
- Ke nānā ʻana i ke kūlana ma o nā kiʻi maʻamau a me nā hoʻāʻo koko.
ʻIke pinepine ʻia kēia no ʻelua a ʻekolu mau lā (ma kahi o 72 mau hola). Eia nō naʻe, inā ua hoʻonui mua ʻia ke kolona ma mua o 12 kenimika, a inā ʻaʻohe hoʻomaikaʻi ma hope o kēia mau lāʻau lapaʻau mālama, hiki i ke kauka ke hoʻoholo e komo e hōʻemi i ke kaomi ma luna o ke kolona.
ʻO nā hana komo:
- ʻO ka Colonoscopy decompression: He kaʻina hana diagnostic a me ka mālama ʻana ʻo Colonoscopy . Pili ia i ke kau ʻana i kahi kāmela liʻiliʻi ma ka hopena o kahi paipu lōʻihi i kapa ʻia he colonoscope i loko o ka ʻōpū nui ma o ka anus. ʻO ka pahuhopu o ka colonoscopy decompression, ʻo ia ke omo i ka ea keu i loko o ka ʻōpū nui ma o ka paipu a laila hāʻawi i kahi enema ma o ka paipu. Hiki i kēia kaʻina hana ke hōʻoluʻolu i kahi ālai wahaheʻe inā ʻaʻole i kūleʻa ka lāʻau lapaʻau a ʻaʻole palekana iā ʻoe. Eia nō naʻe, hoʻohana nā kauka me ke akahele no ka mea he paʻakikī ke hana a he liʻiliʻi ka pilikia o nā pilikia. I kekahi mau hihia, hiki i ka colonoscope ke hana i kahi lua i loko o ka colon (perforation bowel).
- ʻInu Neostigmine: Hāʻawi ʻia kēia lāʻau lapaʻau ma o ka IV. He mea hoʻoulu ʻiʻo ia. Hoʻohana pinepine ʻia e kōkua i nā ʻiʻo e hoʻomaha ma hope o ka anesthesia. Ua hōʻike ʻia he pono ia i ka "hoʻāla ʻana" i nā ʻiʻo i loko o ka colon a me ka hoʻomaka hou ʻana i ka peristalsis i nā poʻe me ka maʻi Ogilvy. Eia naʻe, no ka mea he lāʻau lapaʻau ikaika loa ia, hāʻawi wale ʻia ma lalo o ka nānā pono ʻana i loko o ka ʻāpana mālama koʻikoʻi (ICU) . E nānā nā kauka i kou puʻuwai e hōʻoia ʻaʻole e lohi nui ka helu o kou puʻuwai i kou wā e loaʻa ana iā neostigmine.
- Colectomy / Colostomy: Inā hoʻomau ka hoʻonui ʻana o kou kolona me ka nānā ʻole i kēia mau hana komo, a inā paha he mau pilikia e like me ka perforation a i ʻole necrosis, pono paha ʻoe i ke ʻoki ʻana e wehe i ka ʻāpana i hoʻopilikia ʻia o kou kolona . He koho hope loa kēia. Me kahi colectomy, loaʻa paha iā ʻoe kahi colostomy manawa pōkole a mau loa paha.He mea pono paha ke hana i hoʻokahi. ʻO ia hoʻi, e hana i kahi puka kaʻawale no ka hele ʻana o ka ʻōpala. I kekahi manawa, hiki ke hoʻohuli ʻia ka colostomy ma hope o ka pau ʻana o ke ʻoki ʻana.
Hiki i ka Ogilvie Syndrome ke lilo i mea make?
ʻAe, hiki i nā pilikia ke make . Me nā pilikia e like me ka perforation a i ʻole ka ischemia, hiki i ka nui o ka make ke piʻi a hiki i ka 40%. Eia nō naʻe, hiki mai kēia mau pilikia ma lalo o 15% o ka poʻe. Me ka ʻole o nā pilikia, ʻoi aku ka kokoke o ka nui o ka make no ka maʻi Ogilvy i 15%. ʻAʻole paha kēia helu e hōʻike ana i ka maʻi Ogilvy wale nō. No ka mea, he nui ka poʻe i loaʻa i ka maʻi Ogilvy he mau kūlana olakino ʻē aʻe e hoʻopilikia ai i ko lākou make ʻana.
ʻO kahi pseudo-obstruction colonic acute kahi hanana i manaʻo ʻole ʻia e hiki ke lawe mai i nā pilikia hou i ka poʻe e hakakā nei me nā kūlana olakino ʻē aʻe. ʻAʻohe mea e manaʻo nei i ka maʻi Ogilvy, akā pono e makaʻala nā mea āpau i nā hōʻailona . ʻO ka ʻike mua ʻana ke kī i ka pale ʻana i nā pilikia koʻikoʻi o ka maʻi Ogilvy. Inā ʻaʻohe pilikia, hiki ke hoʻōla ʻia me ka mālama conservative.
Nā mea nui a mākou e hoʻomanaʻo ai (Leka Lawe-Home)
No laila, ʻo ka Ogilvie Syndrome kahi maʻi i hiki ke ʻoi aku ka koʻikoʻi ma mua o kou manaʻo. Akā, ʻaʻohe mea e hopohopo ai, a ʻo ka makaʻala hiki ke pale i nā pilikia he nui.
- ʻIke: Inā ʻike ʻoe i nā hōʻailona e like me ka pehu koke ʻana, ka ʻeha nui o ka ʻōpū, ka nalowale o ka makemake, ka nausea, a i ʻole ka luaʻi ʻana, e ʻike pono i ke kauka, ʻoiai inā he ʻelemakule ʻoe, he mau maʻi ʻē aʻe kou, a i ʻole ua hana ʻia ke ʻoki kino i hala koke nei.
- Nā Kumu: Hiki ke hana pinepine ʻia kēia e kekahi maʻi ʻē aʻe, ʻoki kino, a i ʻole lāʻau lapaʻau. No laila he mea nui e haʻi i kāu kauka i kāu mōʻaukala olakino piha.
- Nā pilikia: Inā ʻaʻole e mālama koke ʻia, hiki i ka emi ʻana o ke kahe koko i ka kolona ke alakaʻi i ka make ʻana o nā ʻiʻo, ka puka ʻana o ka kolona, a me nā maʻi koʻikoʻi. Hiki i kēia mau mea ke hoʻoweliweli i ke ola.
- Lapaʻau: Hoʻoponopono ʻia ka hapa nui o nā hihia me ka mālama kākoʻo, akā i kekahi manawa pono paha kahi colonoscopy, lāʻau lapaʻau, a i ʻole ke ʻoki ʻana e hōʻoluʻolu i ke kaomi.
- Hoʻōla ke ʻike mua ʻana i nā ola: Mai hoʻowahāwahā i kēia mau hōʻailona no kekahi kumu. ʻO ka mea nui loa, ʻo ia ka ʻike mua ʻana iā lākou a hoʻomaka i ka lāʻau lapaʻau.
Inā loaʻa iā ʻoe a i ʻole kekahi āu i ʻike ai kekahi o kēia mau hōʻailona, mai kānalua e ʻimi i ke aʻo lapaʻau. E noho olakino!
ʻO ka maʻi ʻo Ogilvie, ka pseudo-obstruction colonic acute, colon, ka hana ʻole o ka ʻōpū, ka pehu ʻana, ka ʻeha o ka ʻōpū, ka pseudo-obstruction
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