Ke manaʻo nei anei kou mau māmā ua piha i ka wai? E kamaʻilio kākou e pili ana i ka pleural effusion!

Ua manaʻo paha ʻoe i kahi kaumaha iki i loko o kou umauma, kahi manaʻo ʻē i kou hanu ʻana? A i ʻole ua lohe paha ʻoe i kekahi e ʻōlelo ana, "Ua piha nā māmā i ka wai"? ʻO ia ka mea a mākou e kamaʻilio ai i kēia lā. Ua ʻike ʻia kēia ma ke ʻano lapaʻau ʻo ka pleural effusion.

I ka ʻōlelo maʻalahi, he aha ka pleural effusion?

ʻAe, e nānā kākou i kēia ma nā huaʻōlelo maʻalahi. Aia kou mau māmā i loko o kou lua umauma. A puni kēia mau māmā, a ma loko o kou lua umauma, aia ʻelua mau membrane lahilahi loa. Kāhea mākou i kēia mau membrane ʻo pleura . Me he mea lā ua uhi ʻia lākou ma nā ʻaoʻao ʻelua.

ʻO ka maʻamau, aia kahi liʻiliʻi loa o ka wai ma waena o kēia mau membrane pleural ʻelua. E noʻonoʻo e like me ka ʻaila e hoʻowali ai i nā ʻāpana ʻelua o kahi mīkini. ʻO kēia wai ka mea e hiki ai i kou mau māmā ke neʻe, hoʻonui, a ʻūlū maʻalahi i kou hanu ʻana.

Eia nō naʻe, ma kēia kūlana i kapa ʻia ʻo ka pleural effusion , ʻoi aku ka nui o ka wai ma waena o nā membrane pleural ʻelua ma mua o ka maʻamau . ʻO ke ʻano kēia, ke hana nui nei kou kino i kēia wai, a i ʻole ʻaʻole i hoʻihoʻi pono ʻia ka wai i hana ʻia i loko o ke kino. ʻO ia ka manawa a mākou e ʻōlelo ai "ua piha nā māmā i ka wai."

Aia kekahi mau ʻano o ka pleural effusion?

ʻAe, ua hoʻokaʻawale nā ​​​​kauka i ka pleural effusion i ʻelua mau ʻano nui, ma muli o ke ʻano o ke wai e hōʻiliʻili a puni nā māmā.

1. Wai wai transudative a nele i ka protein: ʻO kēia ʻano wai ka mea maʻamau ke piʻi aʻe ke kaomi o nā wai i loko o ke kino. No ka laʻana, hiki i kekahi me ka cirrhosis (kahi maʻi ate) a i ʻole ka hāʻule ʻana o ka puʻuwai ke loaʻa i kēia ʻano wai. ʻO kēia ka wā e kahe ai ka wai mai loko mai o nā kīʻaha koko.

2. Wai exudative a waiwai i ka protein: ʻO nā kumu nui o kēia ʻano wai, ʻo ia ka maʻi kanesa (no ka laʻana, ka maʻi kanesa o ka māmā, ka maʻi kanesa o ka umauma) a i ʻole kekahi ʻano maʻi . I loko o kēia, nui ka wai e kahe ana ma o nā kīʻaha koko liʻiliʻi loa a i ʻole ʻaʻole i hoʻoneʻe pono ʻia ka wai e ka ʻōnaehana lymphatic.

Hoʻoholo ʻia nā ʻano lapaʻau ma muli o kēia ʻano. No laila he mea nui loa i ke kauka ke ʻike i ke ʻano o kēia wai.

Pehea ka maʻamau o kēia ʻano?

ʻO ka ʻoiaʻiʻo, ʻoi aku ka maʻamau o ka pleural effusion ma mua o kou manaʻo . No ka laʻana, ua hōʻike ʻia ma kahi o 1.5 miliona mau kānaka ma ʻAmelika Hui Pū ʻIa wale nō e loaʻa i kēia maʻi i kēlā me kēia makahiki. ʻIke ʻia kēia maʻi ma ko mākou ʻāina.

He aha nā hōʻailona o ka pleural effusion?

Loaʻa paha iā ʻoe nā hōʻailona ʻē aʻe ma muli o ke kūlana kumu i hoʻokumu ai i ka pleural effusion. Eia nō naʻe, aia kekahi mau hōʻailona e pili pono ana i ka pleural effusion.

• ʻEha umauma: Hiki ke ʻoi aku ka ʻeha, ʻoiai ke hanu hohonu a i ʻole ke ʻū ʻana. Manaʻo paha ia e hou ana kekahi mea iā ʻoe mai loko mai.
• Paʻakikī ka hanu ʻana (Dyspnea): Paʻakikī a ʻūlū paha ka hanu ʻana. Hiki ke ʻoi aku ka ʻino o kēia me ka hoʻoikaika kino.
• ʻO ka Orthopnea: He hōʻailona kikoʻī kēia. ʻO ia hoʻi, he paʻakikī iā ʻoe ke hanu ma nā kūlana ʻē aʻe ma mua o ka noho ʻana a i ʻole ke kū pololei ʻana (no ka laʻana, e moe ana i lalo). Moe kekahi poʻe me ʻelua a ʻekolu mau uluna e kākoʻo iā lākou iho no ka mea ua manaʻo lākou ua pio lākou i ka wā e moe ana i lalo.

Eia nō naʻe, loaʻa paha i kekahi poʻe ka pleural effusion me ka ʻole o nā hōʻailona . ʻIke wale lākou i ia mea ke loaʻa iā lākou kahi X-ray umauma no kekahi kumu ʻē aʻe.

No ke aha lā kēia e hana nei? He aha nā kumu o kēia?

Nui nā kumu o ka pleural effusion. I kekahi manawa hiki ke komo ma mua o hoʻokahi kumu. E like me kā mākou i kūkākūkā ai ma mua, hoʻāʻo nā kauka e hoʻoholo i ke kumu ma ka hoʻoholo ʻana inā he transudative ( wai) a exudative paha (waiwai i ka protein) ka wai e hōʻiliʻili ai. I kekahi manawa, hiki i kahi kūlana i kapa ʻia ʻo pulmonary embolism (PE) ke ʻano ʻelua.

ʻO nā kumu nui o ka hōʻiliʻili ʻana o ka wai transudative:

• Ka Holo ʻole o ka Puʻuwai: ʻO kēia ke kumu maʻamau. Ke hana pono ʻole ka puʻuwai, ua hoʻopilikia ʻia ka hoʻoponopono wai o ke kino.
• ʻO Cirrhosis: He maʻi koʻikoʻi e kū mai ana i loko o ke ake.
• ʻO ka Nephrotic Syndrome: He pilikia kēia no nā puʻupaʻa. Hiki ke hana ʻia kēia ʻano ke hoʻokuʻu nui nā puʻupaʻa i ka protein.

ʻO nā kumu nui no ka hōʻiliʻili ʻana o ka wai exudative:

• Pneumonia: He maʻi o nā māmā.
• Ka maʻi ʻaʻai: ʻOi aku ka maʻi ʻaʻai māmā , ka maʻi ʻaʻai umauma , a i ʻole lymphoma .
• Maʻi puʻupaʻa
• Maʻi mumū: Nā ʻano mumū like ʻole e kū mai ana i loko o ke kino.
• Ma hope o ke ʻoki puʻuwai hāmama

Aia kekahi mau kumu i emi pinepine ʻole:

• ʻO ka maʻi puʻupuʻu
• Maʻi Autoimmune: ʻO ia hoʻi nā maʻi kahi e hoʻouka ai ka ʻōnaehana pale ponoʻī o ke kino i kāna mau hunaola ponoʻī.
• Ke kahe ʻana o ke koko ma muli o nā ʻeha o ka umauma.
• Chylothorax: Hana ʻia kēia i ka wā e hōʻiliʻili ai ka wai i kapa ʻia ʻo 'chyle' mai ka ʻōnaehana lymphatic i loko o ka lua o ka umauma. Hoʻokumu pinepine ʻia e kahi ʻeha.
• Nā maʻi umauma a me ka ʻōpū kakaikahi.
• Ka hōʻike ʻia ʻana i ka asbestos.
• Ka haki ʻana o ka esophagus
• ʻO ka maʻi pancreatitis
• ʻO ka Meig's Syndrome: Hana ʻia e kahi puʻupuʻu maikaʻi e ulu ana i loko o ka ovary.
• ʻO ka maʻi hoʻouluulu ovarian
• Kekahi mau lāʻau lapaʻau
• Nā ʻoki ʻōpū.
• Hoʻōla Pāhawewe

I kekahi mau hihia, loaʻa paha i loko o ke wai nā hunaola ʻino , a i ʻole e hōʻiliʻili paha ia ma ke ʻano he hopena ʻaoʻao o ka chemotherapy .

ʻO wai ka mea i ʻoi aku ka nui o ka pilikia o ka hoʻomohala ʻana i kēia?

Aia kekahi mau kumu pilikia e hiki ke kōkua i ka ulu ʻana o ka pleural effusion.

• Loaʻa nā kūlana olakino e hoʻoulu ai: No ka laʻana, inā loaʻa iā ʻoe ka maʻi puʻuwai, ka maʻi ake, ka maʻi puʻupaʻa, a i ʻole ke kanesa, ʻoi aku ka nui o kou pilikia o ka hoʻomohala ʻana i ka pleural effusion.
• Ka hoʻohana ʻana i nā huahana paka: ʻOi aku ka nui o ka poʻe puhi paka i ka loaʻa ʻana o nā pilikia o ka māmā.
• ʻIke ʻia i ka asbestos: He mea hana hale maʻamau kēia. ʻO ka ʻike lōʻihi ʻana iā ia hiki ke hōʻino i ka māmā.

He aha nā pilikia e hiki ai i kēia ke hana?

Inā ʻaʻole mālama pono ʻia ka pleural effusion, hiki ke loaʻa kekahi mau pilikia.

• ʻO kahi maʻi e lilo ana i abscess: Hiki i ka wai i hōʻiliʻili ʻia ke lilo i mea maʻi me nā germs, e lilo ai i abscess.
• Ka ʻōpala a puni nā māmā: Hiki ke hana i nā ʻiʻo ʻōpala ma kahi o ka wai, e hoʻopilikia ai i ka hana o ka māmā.
• Ka hōʻino ʻana i kou mau māmā.

Pehea ʻoe e ʻike pono ai i kēia kūlana?

Ke hele ʻoe e ʻike i ke kauka, e nīnau mua ʻo ia iā ʻoe e pili ana i kou mōʻaukala olakino . He aha nā maʻi ʻē aʻe āu i loaʻa ai a i ka manawa hea i hoʻomaka ai kēia mau hōʻailona? A laila e hana lākou i kahi hoʻokolokolo kino . E hoʻolohe lākou i kou mau māmā i kou hanu ʻana (me ka stethoscope). A laila wale nō e kauoha ai lākou i nā hoʻokolohua e pono ai.

He aha nā hoʻokolohua e hana ʻia nei no kēia?

Hoʻohana nā kauka i kēia mau hoʻokolohua e ʻike a hoʻomaopopo i ke ʻano o ka effusion pleural:

• X-ray umauma: Hiki i kēia ke kōkua i ka hoʻoholo ʻana inā ua hōʻiliʻili ʻia ka wai a me ka nui.
• ʻO ke kiʻi CT umauma (Computed Tomography - CT scan): Hiki ke hana i nā kiʻi ʻoi aku ka maopopo a me nā kikoʻī ma mua o nā kukuna X. Hiki iā ia ke nānā i ke kūlana o nā māmā ma lalo o ke kahe a no nā mea ʻē aʻe e like me nā puʻupuʻu.
• ʻO ke kani ʻana o ka umauma:Kōkua pū kēia i ka loaʻa ʻana o kahi a me ka nui o ka wai, a me kahi kikoʻī kahi e hoʻokomo ai i kahi nila maikaʻi e wehe ai i ka wai.
• Thoracentesis a i ʻole Biopsy: Pili kēia i ke kau ʻana i kahi nila lahilahi loa i loko o kou umauma ma waena o ʻelua o kou mau iwi ʻaoʻao e lawe i kahi laʻana o ke wai i hōʻiliʻili ʻia. I kekahi manawa hiki ke lawe ʻia kahi ʻāpana liʻiliʻi o ka membrane pleural (biopsy).
• Ka Nānā ʻana i ka Wai Pleural: Hoʻouna ʻia ka hāpana wai i ka lab no ka hoʻāʻo ʻana. Hiki i kēia ke hoʻoholo i ka nui o ka protein, nā ʻano o nā cell, inā he mau germs, a i ʻole nā ​​cell cancer. ʻO kēia ka mea e hiki ke haʻi pololei iā ʻoe inā he transudative a exudative paha ka wai.

Inā ʻaʻole i loaʻa i kēia mau hoʻokolohua maʻalahi ke kumu, pono paha ʻoe e hana i kahi kaʻina hana i kapa ʻia he thoracoscopy . Ua kapa ʻia hoʻi kēia he ʻoki thoracic kōkua wikiō (VATS) . Hana ʻia kēia i ka wā e noho ana ʻoe ma lalo o ka anesthesia laulā. Pili kēia i ka hoʻokomo ʻana i kahi kāmela liʻiliʻi a me nā mea hana i loko o kou umauma e ʻike pono ai i ka pleura a me nā wahi e pili ana. Hana pinepine ʻia ka lāʻau lapaʻau i ka manawa like me kēia kaʻina hana.

Pehea e mālama ʻia ai kēia?

ʻElua mau pahuhopu nui i ka mālama ʻana i ka pleural effusion: ʻO kekahi, ʻo ia ka wehe ʻana i ke kahe keu . ʻO kekahi, ʻo ia ka hoʻōki ʻana i ka hōʻiliʻili hou ʻana o ke kahe . Koho nā kauka i ka lāʻau lapaʻau ma muli o ke kumu kumu a me ka nui o ka paʻakikī o kou hanu ʻana ma muli o ke kahe.

Nā lāʻau lapaʻau

• Inā loaʻa iā ʻoe ka paʻa ʻana o ka wai ma muli o kahi kūlana e like me ka congestive heart failure , e kuhikuhi nā kauka i nā diuretics (i ʻike ʻia hoʻi he "wai pila" no ka mea kōkua lākou i ke kino e hoʻopau i ka wai keu ma o ka mimi) a me nā lāʻau lapaʻau ʻē aʻe no ka puʻuwai puʻuwai.
• Inā he maʻi ka hopena, pono ʻoe e lawe i nā antibiotics .
• Inā ke kumu o ke kūlana e ka maʻi kanesa (malignant effusion), hiki iā ʻoe ke loaʻa i ka chemotherapy , radiation therapy , a i ʻole ka hoʻokomo ʻana o kahi lāʻau wai i loko o ka lua o ka umauma.

Nā ʻano lapaʻau (Nā Kaʻina Hana)

• Inā pilikia ʻoe i ka hanu ʻana, hiki i kāu kauka ke hana i kahi thoracentesis therapeutic (ua like kēia me ka lawe ʻana i kahi hāpana wai, akā ua wehe ʻia ka nui o ka wai e like me ka hiki). A i ʻole e hoʻokomo paha lākou i kahi ʻōmole umauma . Pili kēia i ke komo ʻana i kahi ʻōmole liʻiliʻi i loko o kou umauma a ʻae i ka wai e kahe i loko o kahi ʻōmole.
• I kekahi manawa, ʻoiai ke hōʻiliʻili ka wai ma muli o ke kanesa, hiki i ka wai ke hōʻiliʻili hou ma hope o ka wehe ʻia ʻana. I kēlā mau hihia paʻakikī ke kāohi, hiki i ke kauka ke hoʻohana i kahi ʻōmole umauma e hoʻokahe i ka wai.Hoʻokomo ʻia kekahi ʻano lāʻau i kapa ʻia he sclerosing agent i loko o ka lua pleural. Hoʻokumu kēia lāʻau lapaʻau i kahi ʻeha (fibrosis) ma waena o nā membrane pleural ʻelua. Ua kapa ʻia kēia he pleural sclerosis a i ʻole pleurodesis . Ke hana ʻia kēia ʻeha, pili pū nā membrane pleural ʻelua, e pale ana i ka hōʻiliʻili hou ʻana o ka wai. He 50% wale nō ka maikaʻi o kēia ʻano hana i ka pale ʻana i ka hōʻiliʻili hou ʻana o ka wai.

ʻoki kino

Inā ʻaʻole lawa ka drainage a i ʻole ka pleural sclerosis e kāohi i kou kūlana, pono paha ʻoe i ke ʻoki ʻana. E nānā pono kāu kauka ʻoki iā ʻoe a kūkākūkā i nā pono a me nā pōʻino o ke ʻoki ʻana me ʻoe.

ʻElua ʻano nui o ke ʻoki kino:

1. ʻO ke ʻoki kino Thoracoscopic i kōkua ʻia e ke wikiō (VATS): Pili kēia i ka hana ʻana i hoʻokahi a ʻekolu mau ʻoki liʻiliʻi loa (ma kahi o ka hapalua ʻīniha) ma ka umauma a me ke komo ʻana i kahi kāmela a me nā mea hana ʻoki ma o lākou e hana i ke ʻoki. Hoʻohana ʻia kēia ʻano hana no nā effusions pleural i paʻakikī ke kāohi a i ʻole e hana hou ʻia ana ma muli o ke kanesa. I ka wā o ke ʻoki ʻana, ua kau ʻia kahi mea e like me ka talc a i ʻole kahi antibiotic i loko o ka lua pleural e hoʻāʻo e pale i ka hōʻiliʻili hou ʻana o ka wai.

2. Thoracotomy (ʻoki umauma kuʻuna, "hāmama"): Ma kēia kaʻina hana, hana ke kauka ʻoki i kahi ʻoki 6-8 ʻīniha ma ka umauma. ʻO kēia ke kaʻina hana maʻamau i hoʻohana ʻia inā loaʻa iā ʻoe kahi maʻi. Hoʻopau ka thoracotomy i nā ʻiʻo fibrous āpau a kōkua i ka hoʻomaʻemaʻe pono ʻana i ka maʻi i loko o ka lua pleural. Pono paha ʻoe e hoʻokomo i kahi paipu umauma e hoʻokahe i ke kahe no ʻelua lā a ʻelua pule ma hope o ke ʻoki ʻana.

Aia kekahi mau hopena ʻaoʻao mai ka lāʻau lapaʻau?

ʻAe, e like me nā lāʻau lapaʻau āpau, hiki i nā lāʻau lapaʻau no ka effusion pleural ke hana i kekahi mau hopena ʻaoʻao.

• ʻEdema Pulmonary: Hiki ke hana i kēia, ʻoiai inā e wehe ʻia ka nui o ka wai i ka manawa hoʻokahi.
• Nā ʻūpā koko
• Nā ʻano puʻuwai maʻamau ʻole
• Pneumothorax: He hiolo kēia o nā māmā ma muli o ka hoʻopiha ʻana o ka ea i nā māmā. I kekahi manawa hiki ke hana ʻia kēia ke kuʻi ʻia ka nila i hoʻohana ʻia e wehe i ka wai.

ʻEhia ka lōʻihi e hoʻōla ai?

ʻOkoʻa kēia ma muli o ka lāʻau i hana ʻia.

• Inā ua hana ʻia kāu thoracentesis , pono ʻoe e akahele iki no kahi o ʻelua lā.
• Inā ua hana ʻia ʻoe i ke ʻoki VATS , pono ʻoe e noho i ka haukapila no kekahi mau lā ma hope.
• Inā ua hana ʻia ʻoe i kahi thoracotomy (ʻoki hāmama), pono ʻoe e noho ma ka haukapila no hoʻokahi pule.

He aha kā mākou e hana ai e hōʻemi i kēia pilikia?

He mea paʻakikī ke pale aku i nā mea he nui e hoʻoulu ai i ka pleural effusion. Eia nō naʻe, hiki iā ʻoe ke hōʻemi iki i kou pilikia ma o:

• E noho mamao aku mai nā huahana paka.
• E pale i ka pili ʻana i ka asbestos.
• Inā ua ʻōlelo ʻia ʻoe e kāu kauka, e lawe i ka ʻai paʻakai haʻahaʻa.
• E lawe i kāu mau diuretics i kuhikuhi ʻia (nā pila wai) i ka manawa kūpono.
• Inā ʻōlelo kāu kauka iā ʻoe, e kaupalena i kāu lawe ʻana i ka wai.

He aha kā mākou e manaʻo ai me kēia kūlana?

Ma hope o kou loaʻa ʻana o ka lāʻau lapaʻau, pono ʻoe e hana hou i nā X-ray . Makemake ke kauka e ʻike inā ua holomua ka lāʻau lapaʻau. Pono nō hoʻi ʻoe e hoʻomau i ka loaʻa ʻana o ka lāʻau lapaʻau no ke kūlana i hoʻoulu ai i ka pleural effusion.

ʻO ke koʻikoʻi o kou kūlana e pili ana i kēia mau kumu:

• He aha ke kumu nui o ka pleural effusion?
• Ke hoʻopilikia nei anei ia i kou hanu ʻana?
• E pili ana ia inā pane maikaʻi ia i ka lāʻau lapaʻau.

He aha ka manaʻo no kēia kūlana?

ʻOkoʻa loa ka nānā ʻana, a i ʻole ka wānana , ma muli o ke kumu o kou pleural effusion a me nā kūlana olakino ʻē aʻe āu. No kekahi poʻe, ua holomua ka mālama ʻana i ka pleural effusion. Eia nō naʻe, hiki ke hoʻi hou mai ka pleural effusion .

ʻAʻole maikaʻi loa ka nānā ʻana no ka pleural effusion i hoʻokumu ʻia e ka maʻi kanesa. A inā ʻaʻole ʻoe e mālama pono i ka pleural effusion, ʻaʻole maikaʻi hoʻi.

Pehea ʻoe e mālama ai iā ʻoe iho?

Pono kekahi mau kūlana e hoʻoulu ai i ka pleural effusion i ka mālama lōʻihi . E kamaʻilio me kāu kauka e pili ana i ka lāʻau lapaʻau lōʻihi maikaʻi loa no kou kūlana. A laila, e hahai pololei i kāu hoʻolālā lapaʻau . E lawe i kāu mau lāʻau lapaʻau i ka manawa kūpono a mālama i nā hoʻololi nohona a kāu kauka e ʻōlelo ai.

Āhea ka manawa kūpono e ʻike ai i ke kauka?

E hele i nā hālāwai hoʻomaʻamaʻa a pau a kāu kauka i kauoha ai e mālama i kou maʻi maʻi. Inā pilikia ʻoe i ka hanu ʻana , e ʻimi koke i ke kōkua lapaʻau . Mai hoʻokaʻulua.

He aha nā nīnau koʻikoʻi e nīnau aku ai i kāu kauka?

Hiki iā ʻoe ke nīnau i ke kauka i nā nīnau e like me kēia:

• No ke aha i loaʻa ai iaʻu kēia pleural effusion?
• ʻEhia mau manawa e pono ai iaʻu e hele mai e ʻike iā ʻoe (nā hālāwai hoʻopaʻa)?
• He aha nā manawa kūpono e loaʻa hou ai iaʻu ka pleural effusion?
• He aha nā hopena lōʻihi o koʻu pleural effusion?

No laila, he pleural effusion kou, ʻaʻohe paha ou hōʻailona. ʻO ke kī, ʻo ia ka ʻimi ʻana i ke kumu.. Ke ʻike ke kauka i ke kumu, e hana ʻo ia i nā hana e mālama ai. ʻO ka pane pololei ʻana i nā nīnau a ke kauka hiki ke kōkua i ka kāpae ʻana i kekahi o nā kumu. He mea maʻamau ka makaʻu i ka wā e pilikia ai ʻoe i ka hanu ʻana, no laila mai makaʻu e nīnau i nā nīnau e pili ana i nā mea āu e makemake ai e hoʻomaopopo.

No laila, he aha nā mea e pono ai kākou e hoʻomanaʻo mai kēia mau mea a pau?

ʻO ka pleural effusion ka hōʻiliʻili ʻana o ka wai ma waena o ka pleura, nā membrane e hoʻopuni ana i nā māmā. Ua kapa pū kekahi poʻe i kēia he "wai i loko o nā māmā."

• Nui nā kumu no kēia. ʻO nā mea e like me ka maʻi puʻuwai, ka maʻi niumonia, a me ke kanesa nā mea nui.
• Hiki i nā hōʻailona ke komo pū me ka ʻeha o ka umauma a me ka paʻakikī o ka hanu ʻana . ʻAʻole paha i loaʻa i kekahi poʻe kekahi mau hōʻailona.
• Hiki i ke kauka ke ʻike i kēia ma o nā X-ray, CT scans, a i ʻole kahi hoʻāʻo hāpana wai (thoracentesis) .
• Kuhi ʻia ka lāʻau lapaʻau i ke kumu kumu a me ka wehe ʻana i ke wai . Pono paha ka lāʻau lapaʻau, nā ʻano hana wehe wai, a i kekahi manawa hiki ke ʻoki kino.
• ʻO ka mea nui loa, ʻo ia ke ʻike koke i ke kauka inā pilikia ʻoe i ka hanu ʻana a i ʻole e manaʻo ana i kahi puʻupuʻu i loko o kou umauma. ʻO ka ʻike mua ʻana e maʻalahi ai ka mālama ʻana a hōʻemi i ka pilikia o nā pilikia.

Inā he mau nīnau hou aku kāu e pili ana i kēia, mai kānalua e kamaʻilio me kāu kauka. E noho olakino!

ʻO ka wai i loko o ka umauma, ka wai i loko o ka umauma, ka paʻakikī o ka hanu ʻana, ka ʻeha o ka umauma, ka maʻi o ka māmā, ka lāʻau lapaʻau