Koj txoj hnyuv puas o li no? Cia peb kawm txog Pseudomembranous Colitis!

Koj puas mob plab heev thiab raws plab ntau zaus hauv ib hnub? Tej zaum koj kuj xeev siab nrog rau kub taub hau? Tshwj xeeb, cov tsos mob no puas tau tshwm sim tom qab koj nyuam qhuav noj tshuaj tua kab mob rau qee yam mob? Yog tias yog, qhov no yog ib yam dab tsi uas yuav tseem ceeb rau koj. Hnub no peb yuav tham txog ib qho mob hu ua 'Pseudomembranous Colitis'. Tsis txhob txhawj, yog tias koj paub txog qhov no zoo, koj tuaj yeem tau txais kev kho mob thiab rov zoo sai.

Kab mob Pseudomembranous Colitis yog dab tsi?

Hais yooj yim xwb, 'Pseudomembranous Colitis' yog ib qho mob hnyav uas tshwm sim hauv peb txoj hnyuv loj, lossis txoj hnyuv loj. Hauv qhov no, rau qee qhov laj thawj (nws yuav yog cov kab mob, cov tshuaj lom, lossis lwm yam kab mob), phab ntsa sab hauv ntawm koj txoj hnyuv loj, lossis daim nyias nyias ('mucosa'), raug puas tsuaj. Qhov kev puas tsuaj no ua rau cov plaques daj-dawb, tuab, crusty tsim nyob rau hauv cov chaw raug puas tsuaj. Cov kws kho mob hu cov no 'pseudomembranes'.

Cov 'pseudomembranes' yog dab tsi?

Cov pseudomembranes yog cov uas tsim thaum cov hlwb hauv daim ntaub ntawm txoj hnyuv loj, xws li daim ntaub ntawm txoj hnyuv loj, tuag. Xav txog nws li no: thaum muaj kev raug mob, peb lub cev tiv thaiv kab mob xa cov qe ntshav dawb mus rau qhov chaw. Ib yam li ntawd, ntawm no thiab, cov qe ntshav tuag sib xyaw nrog cov qe ntshav dawb (tshwj xeeb tshaj yog neutrophils) los ua cov pseudomembranes. Cov no yog li 2 centimeters dav, daj-dawb, thiab cov txheej me ntsis tsa rau ntawm qhov chaw.

Cov tsos mob ntawm tus mob no yog dab tsi?

Ib tug neeg uas muaj mob plab hnyuv pseudomembranous colitis yuav muaj cov tsos mob xws li:

• Mob plab heev.
• Raws plab. Qhov no tuaj yeem tshwm sim ntau zaus hauv ib hnub, qee zaum ua kua.
• Ua npaws.
• Xeev siab.
• Qee zaum, koj yuav pom ntshav lossis kua qaub tawm ntawm koj cov quav, tab sis qhov no tsis tshwm sim rau txhua tus.

Dab tsi ua rau mob Pseudomembranous Colitis?

Qhov ua rau qhov no yog kev kis tus kab mob "C. diff" (Clostridioides difficile). Cov tshuaj lom uas cov kab mob no tsim tawm ua rau lub plab hnyuv loj puas tsuaj. Kwv yees li 10% ntawm cov kab mob "C. diff" tuaj yeem hloov mus rau qhov mob hnyav dua hu ua "pseudomembranous colitis." Qhov tseeb, 90% ntawm cov mob no yog tshwm sim los ntawm cov kab mob "C. diff". Txawm li cas los xij, lwm yam mob plab hnyuv kuj tuaj yeem ua rau hom kev puas tsuaj no.

Cov kab mob C. difficile cuam tshuam li cas rau qhov no?

Cov kab mob C. difficile tsim cov tshuaj lom uas rhuav tshem cov hlwb uas nyob hauv peb txoj hnyuv loj. Cov kab mob no tuaj yeem kis tau sai dua thiab hnyav dua li koj xav.

Feem ntau, koj tau txais tus kab mob C. diff vim koj muaj lwm yam kab mob.Tom qab siv tshuaj tua kab mob. Xav txog nws, thaum koj noj tshuaj tua kab mob, lwm cov kab mob "zoo" hauv peb txoj hnyuv uas pab peb tuag. Txawm li cas los xij, feem ntau cov tshuaj tua kab mob tsis tuaj yeem tua cov kab mob 'C. diff' no. Yog li, thaum cov kab mob zoo ntawd ploj mus, cov kab mob 'C. diff' muaj lub sijhawm loj hlob thiab kis mus rau lwm qhov tsis muaj kev tswj hwm, ua rau muaj teeb meem no yam tsis muaj kev sib tw.

Cov tshuaj tua kab mob twg zoo tshaj plaws rau qhov mob no?

Qhov tseeb, txhua yam tshuaj tua kab mob uas tua cov kab mob zoo hauv peb txoj hnyuv thiab tsis cuam tshuam rau cov kab mob C. diff tuaj yeem ua rau muaj kab mob C. diff thiab ua rau mob plab hnyuv pseudomembranous. Txawm li cas los xij, qee cov tshuaj tua kab mob xav tias muaj kev pheej hmoo siab dua. Ib txhia ntawm lawv yog:

• Clindamycin
• Cov tshuaj cephalosporin hauv pawg
• Cov tshuaj penicillin pawg
• Cov tshuaj fluoroquinolones
• Aztreonam
• Cov tshuaj Carbapenem

Tseem Ceeb: Qhov no tsis yog hais tias cov tshuaj tua kab mob no phem. Yog tias tus kws kho mob sau ntawv kom siv, yuav tsum siv raws li qhov xav tau. Txawm li cas los xij, kev siv tshuaj tua kab mob yam tsis tsim nyog tuaj yeem ua rau muaj kev pheej hmoo zoo li no.

Puas muaj lwm yam laj thawj?

Kab mob pseudomembranous colitis kuj tseem tuaj yeem tshwm sim thaum o ntawm txoj hnyuv loj los ntawm lwm yam ua rau, tsis yog C. diff. Nov yog ob peb yam piv txwv:

• Kev kis mob Staphylococcus aureus
• Kev kis tus kab mob E. coli '(Kev kis tus kab mob E. coli)'
• Kev kis mob Cytomegalovirus
• Kev kuaj mob plab hnyuv me me
• Kab mob Behçet
• Ischemic colitis (mob o los ntawm kev txo cov ntshav mus rau txoj hnyuv loj)
• Cov tshuaj kho mob qog noj ntshav (Chemotherapy drugs)
• Kev siv tshuaj yeeb (cocaine)
• Vasculitis (mob ntawm cov hlab ntsha)
• Kev lom hlau hnyav

Hauv cov xwm txheej zoo li no, tus kab mob no hnyav dua lossis nyuaj dua li mob plab hnyuv ib txwm muaj. Qee zaum, cov ntshav ntws mus rau sab hauv ntawm lub plab hnyuv txo qis (ischemia), cov nqaij tuag (necrosis), thiab pseudomembranes tshwm sim. Tsis tas li ntawd, cov kab mob uas twb muaj lawm xws li Kab Mob Plab Hnyuv (IBD) kuj tuaj yeem ua rau lub plab hnyuv yooj yim rau tus mob no.

Leej twg muaj feem yuav mob no ntau dua?

Koj yuav muaj feem mob plab hnyuv pseudomembranous colitis ntau dua yog tias koj:

• Yog koj raug kho mob hauv tsev kho mob.
• Yog tias koj nyuam qhuav siv tshuaj tua kab mob.
• Yog tias koj nyuam qhuav phais.
• Yog tias ib tug neeg nyob hauv tsev laus.
• Yog koj muaj hnub nyoog tshaj 65 xyoo.
• Yog tias koj muaj tus kab mob autoimmune.
• Yog tias koj lub cev tiv thaiv kab mob tsis muaj zog.
• Yog tias koj twb muaj tus kab mob C. diff lawm.

Cov teeb meem uas yuav tshwm sim ntawm Pseudomembranous Colitis yog dab tsi?

Yog tias qhov mob no hnyav zuj zus thiab nyuaj rau tswj, tej zaum yuav muaj qee yam teeb meem txaus ntshai tshwm sim. Yog li ntawd, nws tseem ceeb heev uas yuav tsum paub txog qhov no thiab.

• Kev qhuav dej thiab poob electrolyte: Hauv cov mob plab hnyuv loj heev, raws plab tuaj yeem tshwm sim txog li 10-15 zaug hauv ib hnub. Qhov no tuaj yeem ua rau lub cev qhuav dej thiab poob electrolyte. Qhov no tuaj yeem ua rau muaj cov mob txaus ntshai xws li cov ntshav tsawg, ntshav siab tsawg, thiab lub raum tsis ua haujlwm.
• Cov kua dej xau: Cov kua dej tuaj yeem xau los ntawm phab ntsa ntawm txoj hnyuv loj uas puas lawm mus rau hauv lub plab, ua rau lub plab o. Qhov no hu ua ascites. Cov protein xws li albumin kuj tuaj yeem ploj ntawm txoj hnyuv loj. Thaum albumin qis, cov kua dej xau tawm ntawm cov hlab ntsha, ua rau o ntawm ob txhais ceg (o).
• Toxic megacolon: Ib qho mob o ntawm txoj hnyuv loj uas tsis tuaj yeem tswj tau uas ua rau txoj hnyuv loj o thiab tsis ua haujlwm. Thaum xub thawj, cov leeg nqaij hauv txoj hnyuv loj tsis sib zog, thaiv txoj kev hla ntawm cov quav. Thaum txoj hnyuv loj txuas ntxiv o, nws cov phab ntsa tuaj yeem tawg, ua rau cov khoom hauv plab ntws mus rau hauv lub plab. Qhov no hu ua peritonitis. Qhov no tuaj yeem ua rau tuag taus.
• Kev Txhaws Hauv Plab: Ib lub qhov hauv phab ntsa ntawm txoj hnyuv loj tuaj yeem tshwm sim yam tsis muaj tshuaj lom megacolon. Qhov no tuaj yeem tshwm sim yog tias cov qhov txhab loj hlob hauv txoj hnyuv loj thiab mus dhau phab ntsa, lossis yog tias muaj kev tuag ntawm cov nqaij (necrosis) hauv phab ntsa ntawm txoj hnyuv loj. Thaum cov kab mob hauv txoj hnyuv loj nkag mus rau hauv lub plab (peritonitis), lawv tuaj yeem kis mus rau hauv cov ntshav (septicemia).
• Kab mob Sepsis: Kab mob Sepsis yog ib yam mob uas tshwm sim los ntawm kev sib sau ua ke ntawm cov kab mob hauv cov ntshav (septicemia). Kab mob Sepsis yog ib yam kab mob hnyav, txaus ntshai rau lub neej uas kis mus thoob plaws lub cev. Qhov no tuaj yeem ua rau mob septic shock, ua rau ntau yam kab mob tsis ua haujlwm, thiab txawm tias tuag taus.

Cov teeb meem no tuaj yeem ua rau ntshai heev thaum hnov ​​txog. Tab sis nco ntsoov, lawv tsis tshwm sim rau txhua tus. Kev kuaj mob thaum ntxov thiab kev kho mob kom zoo tuaj yeem tiv thaiv cov mob hnyav no.

Yuav kuaj mob li cas?

Tus kws kho mob yuav xub nug koj txog koj cov tsos mob thiab koj keeb kwm kev noj qab haus huv. Tom qab ntawd, lawv yuav xaj ntau yam kev kuaj mob kom nrhiav tau qhov ua rau koj cov tsos mob. Piv txwv li, lawv yuav xaj kev kuaj ntshav, kev kuaj duab xws li kev luam theej duab, thiab kev kuaj quav. Cov kev kuaj no nrhiav kev kis kab mob, o, thiab lwm yam kev pheej hmoo.

Koj qhov kev kuaj quav yuav kuaj xyuas seb puas muaj kab mob C. diff. Yog tias pom muaj, kev kho mob yuav pib tam sim ntawd. Yog tias koj tsis muaj teeb meem thiab teb tau zoo rau kev kho mob, tej zaum yuav tsis muaj laj thawj tshwj xeeb los saib sab hauv koj txoj hnyuv loj rau cov kab mob pseudomembranes.

Qee zaum, kev kuaj duab (xws li CT scan) tuaj yeem qhia cov cim ntawm pseudomembranous colitis. Yog tias phab ntsa plab hnyuv tuab (zoo ib yam li "thumbprint sign" lossis "accordion sign"), tus kws kho mob yuav txiav txim siab ua lwm yam kev kuaj.

Tom ntej no, yog xav saib kom tob dua, koj yuav tsum ua ib qho kev kuaj uas saib sab hauv txoj hnyuv loj. Nws hu ua kev kuaj plab hnyuv loj. Hauv qhov no, ib lub raj nrog lub koob yees duab siv los saib sab hauv txoj hnyuv loj. Yog tias koj pom qhov hu ua 'pseudomembrane', ib daim ntaub me me (kev kuaj nqaij) raug coj los ntawm nws thiab xa mus rau chav kuaj mob kom paub meej tias muaj kab mob.

Cov kev kho mob yog dab tsi?

Kev kho mob nyob ntawm seb ua rau muaj tus kab mob no li cas.

• Yog tias nws yog kab mob bacterial xws li C. diff, koj yuav tsum tau muab cov tshuaj tua kab mob tshwj xeeb uas ua haujlwm rau nws.
• Yog tias qhov mob no yog ua rau lossis ua rau hnyav zuj zus los ntawm lwm yam tshuaj uas koj noj, tej zaum yuav tsum tsum lossis hloov cov tshuaj ntawd.
• Muaj tej lub sij hawm, tej zaum yuav muab tshuaj rau kom txo qhov o ntawm txoj hnyuv loj.

Ib txhia neeg tsuas xav tau kev pab txhawb nqa xwb. Piv txwv li, cov kua dej hauv cov hlab ntsha (IV kua) los pab kom cov kua dej nyob hauv, lossis cov khoom noj IV los pab kom cov hnyuv so. Lwm tus neeg yuav tsum tau kho rau cov teeb meem, tej zaum yuav nyob hauv chav kho mob hnyav. Ib txhia neeg uas muaj mob plab hnyuv loj heev lossis muaj teeb meem yuav tsum tau phais plab hnyuv (colectomy) (phais kom tshem tawm qhov puas tsuaj ntawm cov hnyuv loj).

Yog tias muaj kab mob C. diff, cov tshuaj tseem ceeb uas muab rau yog dab tsi?

Yog tias tus kab mob C. diff ua rau mob plab hnyuv loj (pseudomembranous colitis) ua rau mob, muaj ntau yam tshuaj kho tau. Koj tus kws kho mob yuav xaiv qhov zoo tshaj plaws rau koj. Cov tshuaj uas muab rau tus kab mob C. diff yog:

• Metronidazole
• Vancomycin
• Fidaxomicin

Puas tiv thaiv tau kab mob Pseudomembranous Colitis?

Txoj kev tseem ceeb tshaj plaws los tiv thaiv tus kab mob no yog tswj kev kis tus kab mob C. diff hauv cov zej zog uas muaj kev pheej hmoo siab (tshwj xeeb tshaj yog cov tsev kho mob thiab cov tsev laus). Cov neeg nyob hauv cov chaw no yuav muaj feem kis tus kab mob thiab muaj cov tsos mob hnyav xws li mob plab hnyuv loj.

Yog li ntawd, cov neeg ua haujlwm kho mob hauv cov tsev kho mob no ua cov kauj ruam tshwj xeeb los tswj kev kis tus kab mob C. diff:

• Kev Cais Tawm: Cov neeg uas muaj tus kab mob C. diff raug muab tso rau hauv ib chav sib cais, lossis hauv ib chav uas tsuas yog sib koom nrog lwm tus neeg uas muaj tus kab mob xwb. Cov hnab looj tes siv ib zaug xwb raug siv thaum nkag mus rau hauv chav.
• Ntxuav Tes: Ntxuav koj txhais tes ntau zaus nrog xab npum thiab dej sov yog txoj hauv kev zoo tshaj plaws los tiv thaiv koj tus kheej ntawm C. diff. Cov kab mob no tiv taus cov tshuaj ntxuav tes. Nws yog ib qho tseem ceeb heev uas yuav tsum ntxuav koj txhais tes ua ntej kov zaub mov.
• Kev Tua Kab Mob: Cov tshuaj tua kab mob ib txwm tsis tuaj yeem tua tau C. diff. Txawm li cas los xij, cov khoom siv chlorine ua tau. Nws yog ib qho tseem ceeb uas yuav tsum tua kab mob kom huv si rau txhua qhov chaw uas tus neeg mob tau kov.

Puas kho tau tus kab mob no kom zoo tag nrho? Tus nqi tuag yog pes tsawg?

Yog, mob plab hnyuv pseudomembranous colitis kho tau zoo tag nrho nrog kev kho mob. Feem ntau, cov tsos mob yuav ploj mus sai sai. Txawm li cas los xij, qee tus neeg yuav xav tau kev kho mob ntau dua thiab siv sijhawm ntev dua li lwm tus. Yog tias koj muaj tus kab mob C. diff uas nyob ntev thiab nyuaj rau tswj, koj yuav tsum tau phais me me los kho nws. Qee zaum, kev phais yuav tsim nyog.

Hais txog kev tuag, tsuas yog 2% ntawm cov neeg mob uas muaj mob plab hnyuv pseudomembranous colitis tuag xwb. Txawm li cas los xij, rau cov neeg uas tau txais kev saib xyuas mus sij hawm ntev thiab cov neeg uas lub cev tiv thaiv kab mob tsis muaj zog, tus nqi no tuaj yeem siab txog 15%. Yog tias qhov teeb meem uas tau hais ua ntej hu ua toxic megacolon tshwm sim, tus nqi tuag tuaj yeem nce mus txog 35%. Yog vim li ntawd kev kho mob sai yog qhov tseem ceeb.

Thaum twg koj yuav tsum mus ntsib kws kho mob?

Yog koj muaj ib qho ntawm cov tsos mob no, nrhiav kev pab kho mob tam sim ntawd:

• Mob plab heev los yog o.
• Yog koj raws plab ntau tshaj tsib zaug hauv ib hnub.
• Yog tias muaj ntshav nyob rau hauv cov quav.
• Yog tias koj tsis tau tso zis tau peb hnub.
• Yog tias koj tsis tau tso zis ib hnub, lossis yog tias koj cov zis tsaus.
• Yog tias koj muaj kub taub hau ntau tshaj 39 degrees Celsius (102 degrees Fahrenheit) rau peb hnub.

Thaum kawg, tej yam uas yuav tsum nco ntsoov

Cov kab mob bacterial uas ua rau mob plab hnyuv yog ib qho uas muaj ntau, thiab feem ntau lawv tsis loj heev. Tsis yog txhua tus neeg uas tau txais C. diff yuav mob plab hnyuv pseudomembranous. Txawm li cas los xij, yog tias koj ua li ntawd, nws tuaj yeem ua rau ntshai me ntsis. Kev paub tias koj txoj hnyuv loj raug puas tsuaj los ntawm sab hauv tuaj yeem ua rau ntshai, nrog rau cov tsos mob xws li mob thiab los ntshav.

Yog koj muaj cov tsos mob zoo li no, tej zaum koj yuav xav tau kev kho mob tshwj xeeb. Tab sis nco ntsoov tias, yog tias koj kho kom zoo, koj txoj hnyuv loj tuaj yeem kho tau.Cov ntaub so ntswg hauv plab hnyuv, zoo li daim ntaub ntawm peb txoj hnyuv loj, kho tau zoo thaum lawv tsis puas. Yog tias koj xav tias koj cov tsos mob ntawm koj txoj hnyuv loj tsis zoo dua, nrog kws kho mob tham. Nws tuaj yeem pab koj nrhiav qhov ua rau koj mob, ua qhov tsim nyog los tiv thaiv nws, thiab muab koj txoj hnyuv loj so kom txaus. Qhov tseem ceeb tshaj plaws yog tsis txhob ntshai thiab nrhiav kev kho mob sai sai.

` Kab mob plab hnyuv loj (Pseudomembranous Colitis), C. diff, raws plab, mob plab, mob plab hnyuv loj, tshuaj tua kab mob