Ua ʻeha anei kou ʻōpū ma hope o ka lawe ʻana i nā lāʻau antibiotic? E aʻo kākou e pili ana i ka Pseudomembranous Colitis!

Ua loaʻa anei iā ʻoe kahi ʻeha ʻōpū a i ʻole kahi ʻōpū ʻeha ma hope o ka lawe ʻana i kahi papa o nā antibiotics? Nalowale pinepine ia ma hope o hoʻokahi a ʻelua paha lā. Eia nō naʻe, i kekahi manawa hiki i kēia kūlana ke lilo i mea koʻikoʻi iki. I kēia lā e kamaʻilio mākou e pili ana i kekahi ʻano koʻikoʻi e hiki ke pili me ka hoʻohana ʻana i nā antibiotics. Kapa mākou i kēia Pseudomembranous Colitis. ʻOiai ke kani iki nei ka inoa, he mea nui loa ia e ʻike e pili ana i ia mea.

I ka ʻōlelo maʻalahi, he aha ka Pseudomembranous Colitis?

He mumū koʻikoʻi kēia (colitis koʻikoʻi) e kū mai ana i loko o ko kākou ʻōpū nui (colon), ʻo ia hoʻi ka pehu ʻana a me ka ʻeha. E noʻonoʻo e hōʻino ana kekahi mea i ka uhi palupalu (mucosa) i loko o ko kākou ʻōpū nui. Hiki ke hana ʻia kēia pōʻino e kahi bacteria, kahi mea ʻawahia i hana ʻia e kēlā bacteria, a i ʻole kekahi maʻi ʻē aʻe.

Ke hana ʻia kēia pōʻino, e hana ʻia nā palaki mānoanoa a ʻōpala ma luna o nā wahi i ʻeha. E like me ka hana ʻana o ka ʻili ma ko mākou ʻili i ka wā e loaʻa ai iā mākou kahi ʻeha. Akā, ʻaʻole kēia he mau ʻili maoli. Hana ʻia lākou me nā hunaola make a me nā hunaola koko keʻokeʻo. ʻO kēia mau membrane melemele-keʻokeʻo ka mea a nā kauka e kapa ai he "pseudomembranes." ʻO "Pseudo" ke ʻano he "wahaheʻe." ʻO ia hoʻi, he mau membrane wahaheʻe lākou. ʻO kēia kūlana ka mea a mākou e kapa ai he pseudomembranous colitis.

He aha nā hōʻailona o kēia maʻi?

Hiki i ke kanaka me kēia maʻi ke ʻike i nā ʻano hōʻailona like ʻole, akā aia kekahi mau mea nui e hiki ke ʻike ʻia.

No ke aha e loaʻa ai kēia ʻano maʻi? He aha ke kumu nui?

ʻO ke kumu nui a maʻamau o kēia, he maʻi ia me ka bacteria Clostridium difficile , a mākou e kapa nei ʻo C. diff no ka pōkole. ʻO kēia ke kumu o ka ʻoi aku ma mua o 90% o nā hihia.

I kēia manawa ke noʻonoʻo nei paha ʻoe pehea e hiki ai i kēia bacteria C. diff ke hoʻoulu i ia maʻi. Penei ka moʻolelo:

He miliona mau bacteria, maikaʻi a maikaʻi ʻole, e noho ana i loko o ko kākou ʻōpū. He nui ka hana a kēia mau bacteria maikaʻi no ko kākou kino. I kēia manawa, e noʻonoʻo ʻoe ua hāʻawi ke kauka iā ʻoe i nā antibiotics no kekahi maʻi ʻē aʻe (no ka laʻana, kahi maʻi ʻāʻī). Pepehi kēia mau antibiotics i nā bacteria i loko o ko kākou kino. Akā i ka wā e hana ai lākou i kēlā, ʻaʻole lākou e pepehi wale i nā bacteria maikaʻi ʻole i hoʻoulu i ka maʻi, akā, he nui hoʻi nā bacteria maikaʻi i loko o ko kākou ʻōpū.

Hoʻomaka kēia ulu nui ʻana o ka bacteria C. diff e hana i nā mea ʻawahia e hōʻino i ka uhi o ko kākou ʻōpū nui. ʻO kēia mau mea ʻawahia ke kumu o ka make ʻana o nā hunaola ʻōpū a me ka ʻeha ʻana, e hana ana i nā pseudomembranes a mākou i kamaʻilio ai ma mua.

ʻO nā lāʻau antibiotics ka mea maʻamau e hoʻoulu ai i ka maʻi C. diff

ʻOiai hiki i kekahi antibiotic ke hoʻoulu i kēia pilikia, ʻoi aku ka nui o kekahi mau ʻano e hoʻoulu i kēia pilikia. ʻO kekahi o kēia mau mea:

• ʻO Clindamycin
• Nā ʻano o Cephalosporins
• Nā ʻano Penicillin
• Nā ʻano o Fluoroquinolones

Aia kekahi mau kumu ʻē aʻe ma waho aʻe o C. diff?

ʻAe. ʻOiai ʻo ka maʻi C. diff ke kumu nui, hiki ke loaʻa kēia ʻano ma muli o nā kumu ʻē aʻe, kākaʻikahi loa.

• Nā maʻi bacteria ʻē aʻe (e.g. *Staphylococcus aureus*, *E. coli*)
• ʻO ka maʻi Cytomegalovirus
• Hoʻemi ʻia ke kahe koko i ka kolona (Ischemic colitis)
• ʻO kekahi mau lāʻau chemotherapy no ka maʻi kanesa
• ʻO kekahi mau maʻi autoimmune

ʻO wai ka mea i pilikia nui i ka loaʻa ʻana o kēia maʻi?

ʻOiai hiki i kekahi ke loaʻa i kēia maʻi, ʻoi aku ka nui o ka pilikia o kekahi poʻe.

• Ka poʻe e mālama ʻia ana ma nā haukapila: ʻO nā haukapila nā wahi e hiki ai i nā germs e like me C. diff ke laha maʻalahi.
• ʻO ka poʻe i lawe hou i nā lāʻau antibiotic: E like me kā mākou i kamaʻilio ai ma mua, ʻo ia ke kumu nui o ka pilikia.
• Nā kānaka ma luna o 65 mau makahiki: No ka mea, e emi ana ka palekana o ke kino me ka ʻelemakule.
• Nā kānaka ma nā hale mālama:
• Nā kānaka me nā ʻōnaehana pale maʻi nāwaliwali: (e.g. poʻe i loaʻa i ka maʻi HIV, nā maʻi kanesa)
• Nā kānaka me nā maʻi autoimmune: (e.g. Inflammatory Bowel Disease - IBD)
• ʻO ka poʻe i loaʻa mua i ka maʻi C. diff:

He aha nā pilikia e hiki ke kū mai inā lilo kēia i mea koʻikoʻi?

He mea hopohopo iki paha kēia iā ʻoe. Akā e hoʻomanaʻo, ʻike pinepine ʻia kēia mau pilikia ke lilo ka maʻi i mea koʻikoʻi a ʻaʻole hāʻawi ʻia ka lāʻau kūpono. No laila ke paipai nei mākou e ʻike mua i ke kauka.

• Ka maloʻo ʻana o ka wai a me ke kaulike ʻole o ka electrolyte: Ke loaʻa iā ʻoe he 10-15 mau neʻe ʻana o ka ʻōpū i ka lā, e nalowale ana ka nui o ka wai a me nā electrolytes. Inā lilo kēia i mea koʻikoʻi, hiki iā ia ke alakaʻi i nā kūlana weliweli e like me ke koko haʻahaʻa a me ka hāʻule ʻana o nā puʻupaʻa.
• Megacolon ʻawahia: He kūlana weliweli loa kēia. ʻO ka mea e hana ʻia ana, ʻo ia ka lilo ʻana o ka mumū o ka kolona i mea koʻikoʻi loa a lilo ka kolona i mea hana ʻole, paʻa ka kinoea a me ka ʻōpala, a lilo ka kolona i mea nui loa a hiki ke pohā.
• Ka puka ʻana o ka ʻōpū: Hiki i nā ʻeha koʻikoʻi ke hana i kahi lua i loko o ka paia o ka ʻōpū. Inā hana ʻia kēia, hiki i nā bacteria mai ka ʻōpū ke komo i loko o ka lua ʻōpū a hoʻoulu i nā maʻi e hoʻoweliweli i ke ola (peritonitis, sepsis).
• Sepsis: He kūlana hoʻoweliweli i ke ola kahi e laha ai ka maʻi ma ke kino a hoʻomaka nā ʻōkana o ke kino e hāʻule.

Pehea e ʻike pololei ai ke kauka i kēia maʻi?

Ke hele ʻoe e ʻike i ke kauka, e nīnau ʻo ia iā ʻoe e pili ana i kāu mau hōʻailona, ​​​​nā lāʻau lapaʻau āu i lawe ai (ʻoi aku hoʻi nā lāʻau antibiotic), a laila e hana paha i kekahi mau hoʻokolohua e hōʻoia i ka maʻi.

1. Hoʻāʻo ʻana i ka noho: ʻO kēia ka hoʻāʻo koʻikoʻi loa. Lawe ʻia kahi hāpana o kou noho a hoʻāʻo ʻia no ke alo o nā bacteria C. diff a i ʻole nā ​​​​mea ʻawahia i hana ʻia e ka bacteria.

2.Nā hoʻāʻo koko: Kōkua kēia i ka nānā ʻana i ka maʻi a me nā helu koko keʻokeʻo kiʻekiʻe.

3. Colonoscopy: Pili kēia i ke komo ʻana i kahi ʻōmole lahilahi me kahi kāmela ma o ka anus e nānā i loko o ka ʻōpū nui. Hiki iā mākou ke ʻike me nā maka ʻelua inā he mau pseudomembranes a mākou i kamaʻilio ai. Inā pono, hiki ke lawe ʻia kahi ʻāpana liʻiliʻi o ka ʻiʻo (biopsy) no ka hoʻokolokolo ʻana.

He aha nā lāʻau lapaʻau no kēia?

ʻO ke ʻano o ka lāʻau lapaʻau e pili ana i ke kumu a me ke koʻikoʻi o ka maʻi.

• Ke mālama ʻana i ke kumu: Inā he maʻi C. diff ke kumu, e kuhikuhi kāu kauka i kahi antibiotic kikoʻī e hiki ke pepehi i ka bacteria. ʻO Metronidazole, Vancomycin, a me Fidaxomicin kekahi o kēia mau lāʻau lapaʻau.
• Mālama Kākoʻo: Hiki i kēia ke komo pū me ka hāʻawi ʻana i nā wai IV e pale aku i ka maloʻo ʻana o ka wai a me ka hāʻawi ʻana i ka meaʻai intravenous e hoʻomaha ai i nā ʻōpū.
• ʻO ke ʻoki kino: I nā hihia koʻikoʻi loa, e like me nā pilikia e like me ka megacolon ʻawahia, pono paha ka wehe ʻana i ka ʻāpana i hōʻino ʻia o ka colon (colectomy). Eia naʻe, he mea kākaʻikahi loa kēia.

He aha kā mākou e hana ai e ola ai i kēia kūlana?

He mea nui loa ka pale ʻana i kēia, ʻoiai hoʻi ma nā wahi e like me nā haukapila a me nā hale mālama maʻi.

• E holoi pinepine i kou mau lima: Kūʻē ʻo C. diff i nā mea hoʻomaʻemaʻe lima i loaʻa i ka waiʻona, no laila ʻo ka holoi pono ʻana i kou mau lima me ke kopa a me ka wai ka pale maikaʻi loa.
• Kaʻawale: Ma nā haukapila, mālama ʻia nā maʻi me ka maʻi C. diff ma kahi lumi ʻokoʻa.
• Ka hoʻomaʻemaʻe ʻana i nā ʻili: Hiki iā C. diff ke ola ma luna o nā ʻili no ka manawa lōʻihi. He mea nui e hoʻomaʻemaʻe mau i nā ʻili me kahi mea hoʻomaʻemaʻe i loaʻa i ka chlorine.

Āhea mākou e ʻike ai i ke kauka i ka wā hikiwawe loa?

Inā loaʻa iā ʻoe kekahi o kēia mau hōʻailona, ​​e ʻike koke i ke kauka a i ʻole e hele i ka Emergency Department (ETU) o ka haukapila.

ʻOiai he mea maʻamau ka ʻeha o ka ʻōpū ma hope o ka lawe ʻana i nā lāʻau antibiotic, ʻaʻole ia he mea maʻalahi mau. I kekahi manawa hiki ke lilo i hoʻomaka o kahi maʻi koʻikoʻi e like me ka Pseudomembranous Colitis. ʻO ia ke kumu he mea nui loa ka hoʻolohe ʻana i kou kino. Inā he kānalua kāu e pili ana i kāu mau hōʻailona, ​​​​mai kānalua e kamaʻilio me kāu kauka. Me ka mālama kūpono, hiki iā ʻoe ke hoʻōla piha mai kēia maʻi.