Aia kekahi pilikia nui i loko o kou kino? E aʻo kākou e pili ana i ka Waterhouse-Friderichsen Syndrome!

Ua lohe paha ʻoe e pau ana ka hana ʻana o ʻelua mau kelepa liʻiliʻi i loko o ke kino, a hiki iā ia ke loaʻa ka hopena nui i kou ola? I kēia lā e kamaʻilio mākou e pili ana i kēlā ʻano maʻi weliweli loa, a inā ʻaʻole e mālama koke ʻia, hiki ke make. Ua kapa ʻia kēia ʻo Waterhouse-Friderichsen Syndrome. ʻOiai ke ʻano lōʻihi iki ka inoa, e kamaʻilio wale kākou e pili ana i ke ʻano o ia mea, no ke aha e hana ʻia ai, a pehea e ola ai.

He aha kēia Waterhouse-Friderichsen Syndrome?

I ka ʻōlelo maʻalahi, he maʻi koʻikoʻi loa ka Waterhouse-Friderichsen Syndrome (WFS). ʻO ka mea e hana ʻia, ʻo kāu mau kelepa adrenal , ʻo ia hoʻi nā kelepa liʻiliʻi ʻelua i loaʻa ma luna o kou mau puʻupaʻa, e kahe ke koko (kapa mākou i kēia 'adrenal hemorrhage') a hoʻōki kekahi a i ʻole nā ​​​​​​ʻelua o kēia mau kelepa i ka hana. ʻO ka hapa pinepine, ua hoʻokumu ʻia kēia e kahi maʻi koʻikoʻi. Inā ʻaʻole mālama ʻia, aneane pau loa kēia mau kelepa adrenal i ka hana ʻana i ka hormone cortisol, he mea nui ia no ko mākou kino. ʻO kēia ka mea a mākou e kapa nei he pilikia adrenal . I ka pololei, he pilikia ia!

Aia kekahi inoa ʻē aʻe no kēia, ʻo ia hoʻi ka "hemorrhagic adrenalitis." ʻO ia hoʻi, ua kahe ke koko o nā kelepa adrenal a lilo i pehu.

Pehea ka maʻamau o kēia ʻano?

ʻO kaʻoiaʻiʻo, he mea kākaʻikahi loa ka maʻi Waterhouse-Friderickson. ʻO ka maʻamau, ʻike nā autopsies he 1% wale nō o nā make ke kumu o kēia ʻano. ʻO ke ʻano kēia, ʻaʻole ia he maʻi e hoʻopilikia i nā mea āpau, akā inā loaʻa, he mea weliweli loa ia.

He aha nā hōʻailona o kēia maʻi?

E noʻonoʻo, ua loaʻa koke iā ʻoe kahi maʻi a bacteria paha a loaʻa i kēia kūlana WFS. A laila hiki iā ʻoe ke hoʻomaka koke e hōʻike i nā hōʻailona o kahi maʻi. Ua ʻike anei ʻoe i ke ʻano o ia mea?

• Ke loaʻa nei iaʻu ke kuni kiʻekiʻe.
• Anu a haʻalulu ke kino.
• ʻEha nui koʻu poʻo.
• E luaʻi ana au, e luaʻi ana au.
• ʻEha nā ʻiʻo o koʻu kino, ʻoi aku hoʻi ma nā wahi e like me koʻu kua i lalo, ʻōpū, a me nā wāwae.
• Ua ʻeha koʻu mau hono.
• I kekahi manawa aia paha ka nalowale o ka ʻike (syncope).

Ke hoʻomaka kēia kahe koko e hoʻopilikia ʻaʻole wale i nā kelepa adrenal akā i nā ʻāpana ʻē aʻe o ke kino, hiki ke ʻike ʻia nā hōʻailona ʻē aʻe. ʻO kēia mau mea:

• ʻO ka hoʻopili ʻana o ke koko i hoʻolaha ʻia (DIC): He mea paʻakikī iki kēia, ʻeā? I ka ʻōlelo maʻalahi, he maʻi ia e hele hewa ai ke kaʻina hana o ke koko ma ke kino holoʻokoʻa. Ke hana ʻia kahi ʻūpā koko ma kekahi wahi, ʻaʻole hiki ke hoʻōki i ke kahe ʻana o ke koko ma kahi ʻē aʻe.
• ʻŌhū ʻili:I kekahi manawa hiki ke ʻike ʻia lākou ma ka ʻili me he mau kiko liʻiliʻi a i ʻole nā ​​​​kiko nui.
• ʻO ka haʻalulu Septic: He kūlana kēia e hāʻule ai ke koko i lalo loa ma muli o ka maʻi, e hōʻemi ana i ka loaʻa ʻana o ke koko i nā ʻōkana o ke kino. He mea weliweli loa nō hoʻi kēia.

He aha nā hōʻailona o ke kahe koko ʻana o ke kelepa adrenal?

Hoʻopili ʻia ʻo WFS me ke kahe koko adrenal, hiki ke hele pū me nā hōʻailona ʻē aʻe:

• ʻeha ka ʻōpū.
• ʻEha ma ka ʻāpana ma luna o ka pūhaka, ma lalo o nā iwi ʻaoʻao (loins).
• Malaise, manaʻo o ka ʻoluʻolu ʻole.
• Ka palaualelo.
• Ka luaʻi a me ka luaʻi.
• Ka maʻi pākī.

He aha ke kumu o kēia?

I ka hapanui o nā hihia, ʻo ke kumu nui o ka maʻi Waterhouse-Friderickson he mau maʻi bacteria a me viral (sepsis) . I ka pololei, komo kahi germ i loko o ke kino a laha ma ke kino me ka ʻole o ke kāohi ʻia.

Hiki i kekahi mau ʻano bacteria ke maʻalahi loa i kēia. Eia kekahi mau laʻana:

• ʻO ka Pseudomonas aeruginosa
• ʻO ka bacteria Meningococcus: ʻO kēia ka mea weliweli loa e hiki ai ke hana i ka WFS.
• ʻO ka maʻi Streptococcus pneumoniae
• ʻO ka maʻi Haemophilus influenzae
• ʻO ka maʻi ʻo Escherichia coli (E. coli)
• ʻO ka Staphylococcus aureus

Hiki i nā ʻano bacteria ʻē aʻe ke hana i kēia.

Eia kekahi, hiki i kekahi ʻano virus ke hana i kēia:

• ʻO ka maʻi Cytomegalovirus (CMV)
• ʻO ka maʻi Parvovirus
• ʻO ka maʻi Epstein-Barr
• ʻO ka maʻi Ebola `(ka maʻi maʻi Ebola)`
• ʻO ka maʻi Varicella-zoster (ʻo ia ke kumu o nā maʻi e like me ka chickenpox a me ka herpes)

Ma waho aʻe o kēia mau maʻi, aia kekahi mau mea pilikia no ka hoʻomohala ʻana i ka WFS:

• Ke hoʻohana nei i nā lāʻau anticoagulant. Hoʻonui kēia i ka pilikia o ke kahe ʻana o ke koko.
• Thrombocytopenia: ʻO ke ʻano kēia o ka emi ʻana o ka helu o nā platelets (nā pūnaewele e kōkua i ke kāpili ʻana o ke koko) i loko o ke koko.
• Ua hōʻino ʻia nā kelepa adrenal ma kekahi ʻano.

ʻO wai ka mea i hoʻopilikia nui ʻia e kēia kūlana?

ʻOi aku ka nui o ka ulu ʻana o ka maʻi Waterhouse-Friderickson i nā keiki ʻōpio ma mua o nā pākeke . No laila, inā loaʻa i kahi keiki ʻōpio nā hōʻailona e like me ke kuni a me ka ʻeha o ke kino, pono ʻoe e makaʻala loa.

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

ʻO kēia ka mea nui loa. Inā ʻaʻole e mālama koke ʻia a kūpono hoʻi, he mea make ka maʻi Waterhouse-Friderickson. ʻO ia hoʻi, hiki ke hoʻoweliweli i ke ola. No laila, pono e mālama ʻia kēia ma ke ʻano he pilikia.

Pehea e ʻike ʻia ai kēia maʻi?

No ka ʻike ʻana i kēia maʻi, pono ʻoe i ke kōkua o ke kauka. E nīnau ke kauka iā ʻoe e pili ana i kāu mau hōʻailona, ​​e nīnau e pili ana i kāu mau maʻi ma mua, a laila e nānā i kou kino.

Akā, hiki ke paʻakikī iki ka ʻike ʻana i ka WFS, no ka mea, ua like loa kona mau hōʻailona me nā hōʻailona o ka septic shock . No laila, no ka hōʻoia ʻana inā he WFS ia, e kauoha ke kauka i nā hoʻokolohua like ʻole.

He aha nā hoʻokolohua e hoʻohana ʻia e ʻike ai i ka maʻi?

No ka hōʻoia inā he maʻi, hiki i ke kauka ke hana i nā hoʻokolohua penei:

Nā hoʻokolohua kiʻi

• Hiki ke hana ʻia kahi scan ultrasound a i ʻole kahi scan CT (computed tomography) e nānā i ke koko i loko o nā kelepa adrenal. Lawe kēia mau scan i nā kiʻi o loko o ke kino, i hiki iā lākou ke ʻike maopopo i nā wahi e kahe ana ke koko.

Nā hoʻāʻo koko

• Hiki i kahi hoʻāʻo koko ke haʻi maopopo inā loaʻa iā ʻoe kahi maʻi bacteria. ʻO kēia ka lawe ʻana i kahi nila liʻiliʻi mai kahi aʻa koko ma kou lima, ka lawe ʻana i kahi koko liʻiliʻi, a me ka nānā ʻana iā ia ma lalo o kahi microscope. E nānā kēia i nā hōʻailona o ka maʻi.

Nā hoʻokolohua bacteria Meningococcus

Inā manaʻo ke kauka he bacteria meningococcus ke kumu, a laila hiki iā lākou ke hana i nā hoʻokolohua e like me kēia:

• ʻO ke kī ʻana o ka iwi kuamoʻo / lumbar puncture: Pili kēia i ke kau ʻana i kahi nila lahilahi i loko o kou kua haʻahaʻa, ma waena o ʻelua mau iwi kuamoʻo, a me ka lawe ʻana i kahi wai liʻiliʻi o ka iwi kuamoʻo. He mea weliweli paha kēia, akā hana akahele nā ​​kauka.
• Biopsy ʻili: Inā he ʻeha kou ma kou ʻili, e lawe ʻia kahi ʻāpana ʻili liʻiliʻi mai ka ʻeha a nānā ʻia.
• Hoʻāʻo Gram stain: Lawe ʻia kahi laʻana mai kahi wahi i manaʻo ʻia (e like me kahi ʻeha) e nānā i ka bacteria.
• Urinalysis: E noi ʻia ʻoe e mimi i loko o kahi pahu kūikawā. A laila e hoʻāʻo ʻia ka hāpana mimi no nā hōʻailona o ka maʻi.

Nā hoʻokolohua pilikia adrenal koʻikoʻi

Kōkua kēia mau hoʻokolohua e hoʻoholo inā ʻoe e ʻike nei i kahi pilikia adrenal , kahi kūlana i hana pono ʻole ai nā kelepa adrenal:

• Hoʻāʻo hoʻoulu ʻana o ka hormone Adrenocorticotropic (ACTH): Ma kēia hoʻāʻo, hāʻawi kāu kauka iā ʻoe i kahi inikini liʻiliʻi o kahi hormone i kapa ʻia ʻo ACTH. A laila, 30 a 60 mau minuke ma hope, lawe lākou i kahi hāpana koko e ʻike ai pehea e pane ai kāu mau kelepa adrenal i ka ACTH. He hoʻāʻo kēia e ana i ka maikaʻi o ka hana ʻana o kāu mau kelepa adrenal.
• Nā hoʻāʻo kō koko:Lawe ʻia kahi koko liʻiliʻi a ana ʻia ka nui o ke kō (glucose) i loko. Hiki ke haʻahaʻa nā pae kō i ka wā o ka pilikia adrenal.
• Hoʻāʻo Cortisol: Lawe ʻia kahi laʻana o kou koko, mimi, lawai, a i ʻole ka hui pū ʻana o ʻelua a ʻekolu paha o kēia mau mea e nānā i ka nui o ka cortisol e hana nei kāu mau kelepa adrenal.
• hoʻāʻo koko pH: Lawe ʻia kahi hāpana o ke koko a ana ʻia kona pae acid-base (pH). Hiki ke hana ʻia kēia me kahi hoʻāʻo kinoea koko arterial (ABG) a i ʻole kahi panel electrolyte. ʻO ka maʻamau, pono ka pH o ko kākou koko ma waena o 7.35 a me 7.45.
• Hoʻāʻo koko Potassium: He hoʻāʻo koko e ana i ka nui o ka potassium i loko o kou koko. He meaʻai ka Potassium e kōkua i ko mākou mau aʻalolo a me nā ʻiʻo e hana pono. Hiki ke loli kēia mau pae i ka wā o ka pilikia adrenal.
• Hoʻāʻo koko sodium: Ke ana nei kahi hoʻāʻo koko i ka nui o ka sodium i loko o kou koko. He mea nui nō hoʻi ka sodium no ka hana pono ʻana o kou mau aʻalolo a me nā ʻiʻo. Hiki ke ʻokoʻa kēia mau pae.

Pehea e mālama ʻia ai kēia?

Inā loaʻa iā ʻoe ka WFS, loaʻa paha iā ʻoe ka sepsis . No laila, ʻo ka mea mua a nā kauka e hana ai, ʻo ia ke hoʻomaka koke iā ʻoe i nā antibiotics ʻoiai lākou e hana i nā hoʻokolohua e ʻike ai i ke kumu maoli o ka WFS. E nānā pū lākou i kāu electrolyte (paʻakai) a me nā pae wai.

Ke hoʻomalu ʻia nā hōʻailona o ka sepsis, e hoʻomaka nā kauka e hāʻawi iā ʻoe i nā lāʻau i kapa ʻia ʻo glucocorticoids a me mineralocorticoids . He mau hormones steroid kēia. Hana nā Glucocorticoids e hōʻemi i ka mumū i loko o ke kino. Hana nā Mineralocorticoids e hoʻoponopono i ka paʻakai a me ka wai o kou kino. I nā huaʻōlelo maʻalahi, ua like lākou me ka hāʻawi ʻana iā ʻoe i nā hormones e pono ai kāu mau kelepa adrenal e hana, akā ʻaʻole.

Pono paha ʻoe i kahi hoʻoili koko a i ʻole kahi hana i kapa ʻia ʻo angioembolization . Pili kēia i ka hoʻohana ʻana i kahi angiogram a me kahi clot koko (embolization) e ʻike a ālai i nā aʻa e hoʻolako ana i ke koko i nā kelepa adrenal. Hana ʻia kēia e hoʻōki i ke kahe ʻana o ke koko.

ʻO ka mea nui loa, ma hope o ka WFS, pono ka poʻe he nui e lawe i nā lāʻau lapaʻau hormone hou no ke koena o ko lākou ola , no ka mea, i ka wā e hōʻino ʻia ai nā kelepa adrenal, ʻaʻole hiki iā lākou ke hana pono i nā hormones.

Pehea ka wikiwiki o koʻu ʻoluʻolu ma hope o ka lāʻau lapaʻau?

Hoʻomaka ka hapa nui o ka poʻe e ʻoluʻolu i loko o hoʻokahi a ʻelua paha pule o ka hoʻomaka ʻana o ka lāʻau lapaʻau. Eia nō naʻe, ma hope o kou hoʻōla piha ʻana, hiki nō iā ʻoe ke loaʻa kekahi mau pilikia kino a noʻonoʻo paha no nā mahina, a i ʻole nā ​​makahiki. Eia kekahi laʻana:

• ʻAʻohe ʻono o ka meaʻai.
• Luhi loa.
• Ka paʻakikī o ka hiamoe ʻana (insomnia).
• Ke ʻano maʻalahi o ka maʻi ʻana.
• Hopohopo.
• Kaumaha.

No laila, he mea nui e hoʻomanaʻo he lōʻihi paha ka manawa e hoʻōla piha ai.

He aha kāu e manaʻo ai inā loaʻa iā ʻoe kēia maʻi?

E like me kā mākou i ʻōlelo ai ma mua, inā ʻaʻole mālama ʻia, he maʻi make ʻo WFS. ʻAʻohe kānalua no ia mea.

Eia nō naʻe, me ka mālama mua a kūpono a me ka hoʻōla hou ʻana, hoʻōla ka hapa nui o ka poʻe me WFS. Eia nō naʻe, pono paha ʻoe i ka mālama olakino koʻikoʻi, a hiki i nā hopena o WFS ke mau no nā mahina, a hiki i nā makahiki. No laila, ʻaʻole ia he mea e lawe māmā ʻia.

Hiki ke pale ʻia kēia kūlana?

Aia kekahi mau mea hiki iā ʻoe ke hana e hōʻemi i kou pilikia o ka hoʻomohala ʻana i ka maʻi Waterhouse-Friderickson:

• ʻO ka holoi mau ʻana i kou mau lima a me ka holoi pono ʻana e hiki ke kōkua i ka pale ʻana i nā maʻi. He mea maʻalahi loa kēia, akā hiki iā ia ke hoʻopakele iā ʻoe mai nā maʻi he nui.
• He mea nui loa ka loaʻa ʻana o ka lāʻau pale bacteria meningococcal no nā keiki.
• Inā manaʻo ʻoe he maʻi kou, e ʻimi koke i ka lāʻau lapaʻau. Mai hoʻowahāwahā i kahi kuni iki a i ʻole ke kuni.

Pehea ʻoe e mālama ai iā ʻoe iho i kou wā e ola ana?

I kou ho'ōla ʻana, pono ʻoe a me kāu kauka e hana pū e hoʻomohala i kahi hoʻolālā hoʻōla kūpono, palekana, a maikaʻi loa nou. Hiki i kēlā hoʻolālā ke komo pū me nā mea e like me:

• E hoʻomaha nui. Pono ke kino a me ka noʻonoʻo i ka hoʻomaha.
• He manaʻo maikaʻi ka hahai ʻana i kahi papaʻai kaulike e kōkua iā ʻoe e hoʻihoʻi i kou ikaika. He mea maikaʻi inā hiki iā ʻoe ke loaʻa ka ʻōlelo aʻoaʻo mai kahi meaʻai meaʻai no kēia.
• E hoʻonohonoho i nā pahuhopu liʻiliʻi. Eia kekahi laʻana, e noho i luna ma kahi moe, e kū i luna, e ʻaʻahu ana iā ʻoe iho, e ʻauʻau ana, e hele wāwae ana i kahi mamao pōkole, e piʻi ana i luna o nā alapiʻi.
• He mea nui ke kamaʻilio ʻana e pili ana i kou mau manaʻo me kou ʻohana, nā hoaaloha, a i ʻole ke kauka lapaʻau i kēia mau manawa paʻakikī.
• E hoʻoikaika kino i ka wā e loaʻa ai iā ʻoe ka ikaika a me ka ikehu. E hoʻomaka mālie a hoʻoikaika kino e like me nā kuhikuhi a kāu kauka.

Āhea wau e ʻike ai i ke kauka? / Āhea wau e hele ai i kahi lumi pilikia?

Inā ʻaʻole ʻoe e maikaʻi ana ma hope o ka lāʻau lapaʻau, a inā paha e pilikia ana ʻoe i ka hoʻokō ʻana i kāu mau pahuhopu hoʻōla hou, e kamaʻilio me kāu kauka.

He maʻi koʻikoʻi ʻo WFS hiki ke make inā ʻaʻole mālama ʻia. Inā loaʻa iā ʻoe kekahi mau hōʻailona o WFS, no ka laʻana, kahi maʻi e ʻoi aku ka ʻino ʻaʻole e nalowale, a laila pono ʻoe e hele koke i kahi lumi pilikia (ETU) .ʻAʻole maikaʻi ke hoʻopaneʻe i kēia.

He aha nā nīnau āu e nīnau ai i kāu kauka?

Ke ʻike ʻoe he WFS kou, nui paha kāu mau nīnau. Mai makaʻu, e nīnau i kāu kauka i nā nīnau e like me kēia e hoʻomālamalama i kou mau kānalua:

• Pehea ʻoe e ʻike ai inā loaʻa iaʻu ka Waterhouse-Friderickson syndrome?
• Inā ʻaʻohe oʻu Waterhouse-Friderickson syndrome, he aha ke ʻano ʻē aʻe e loaʻa iaʻu?
• He aha ke kumu o koʻu Waterhouse-Friderickson syndrome?
• Pono anei au e hana i ke ʻoki kino e hoʻoponopono ai i koʻu mau kelepa adrenal?
• Manaʻo ʻoe e hoʻōla loa wau?
• Pono anei au e lawe i nā hormones keu?
• Pehea ka lōʻihi e pono ai iaʻu ke lawe i nā hormones hou aʻe?

No laila, he aha nā mea nui e pono ai kākou e hoʻomanaʻo mai kēia?

He maʻi koʻikoʻi loa ka maʻi Waterhouse-Friderichsen (WFS) e pono ai ke kōkua koke ʻia e ke kauka. Inā loaʻa iā ʻoe kekahi o kēia mau hōʻailona, ​​a inā paha he maʻi kou e hoʻomaikaʻi ʻole ana, he mea nui e hele i kahi lumi pilikia i ka hikiwawe loa.

E hahai pono i nā ʻōlelo aʻoaʻo lapaʻau a pau i hāʻawi ʻia e kāu kauka. A laila hiki iā ʻoe ke kāohi i kēia kūlana WFS a hoʻōla koke. E hoʻomanaʻo, hiki i ka lāʻau lapaʻau mua ke hoʻopakele i ke ola! Eia kekahi, he mea nui loa ia e mālama pono iā ʻoe iho i kou wā e hoʻōla ai.

ʻO ka maʻi Waterhouse-Friderichsen, nā kelepa adrenal, cortisol, sepsis, nā maʻi, ka mālama ulia pōpilikia, nā hormones