Kino kye ki (Boerhaave’s Syndrome)?
Mu ngeri ennyangu, eno `(Boerhaave's Syndrome)` mbeera nga bbugwe wa payipu yaffe ey'emmere, kwe kugamba, `(esophagus),` akutuka mangu. Kino kibaawo nga waliwo puleesa etayinza kulowoozebwako, kwe kugamba, okusika, mu payipu y’emmere. Okubeera omutuufu, kino kisinga kubaawo ng’osesema n’amaanyi oba ng’ofuba mu ngeri endala yonna. Abasawo era kino bakiyita `(okufuba okukutuka)` oba `(okukutuka okw’okwekolako)`, kubanga kino si kintu ekituuka butereevu ku payipu y’emmere. Embeera eno mu butuufu tetera kubaawo nnyo, kwe kugamba, ekosa abantu nga 0.0003%. Wabula ebitundu 15% ku bubenje bwonna obugwa mu payipu z’emmere buva ku `(Boerhaave's Syndrome)` eno.Njawulo ki eriwo wakati w’obulwadde bwa (Boerhaave’s Syndrome) ne (Mallory Weiss Syndrome)?
Kati oyinza okuba ng’olowooza nti, ‘Kino kye mpulidde nga mpulira amaziga mu nnywanto?’. Mu butuufu waliwo enjawulo entono wakati w’ebintu bino ebibiri. Amaziga ga Mallory Weiss ge maziga agabaawo ng’osesema n’amaanyi oba ng’onyiganyiga. Kiba kikutuka mu kisenge ky’omumwa gwa nnabaana. Zombi zitera okubeera mu bantu abanywa omwenge omungi . Omuntu alina amaziga ga Mallory Weiss ayinza okusesema omusaayi. Kyokka omusulo tegukutuka ddala. Kyokka, obulwadde bwa Boerhaave’s Syndrome busingako okuba obw’amaanyi . Kino kikutuka ekiyita mu buwanvu bwonna obw’ekisenge ky’omumwa gwa nnabaana. Abasawo era bakiyita ‘transmural tear’. Bwe kikutuka ddala, kiteekwa okuddaabirizibwa nga kilongoosebwa mu bwangu . Kiyinza okuba embeera ey’obulamu oba okufa.Kiki ekibaawo nga ttanka y’emmere ekubwa?
Teebereza ekibaawo ng’omusuwa gwaffe gukutuse. Kino mbeera ya mangu ddala, era singa tezijjanjabwa mangu , kiyinza okutta omuntu . Omanyi lwaki? Ennywanto yaffe kitundu ku nkola yaffe ey’okugaaya emmere (enkola y’omu lubuto). Kale, omusulo bwe gukutuka, obutundutundu bw’emmere, obuwuka, n’eddagala erigaaya emmere bisobola okukulukuta mu kifuba kyaffe oba mu lubuto. Ekyo bwe kibaawo, yinfekisoni za bakitiriya ez’amaanyi ziyinza okubaawo.Singa yinfekisoni eno eyingira mu musaayi gw'omubiri gwaffe gwonna, embeera eziyitibwa ``septiceemia'' ne ``sepsis'' zisobola okubaawo. ``Sepsis'' eno ye nkola etta obulamu. Kiyinza okuvaako ``okukankana'', okulemererwa kw'ebitundu by'omubiri ebingi, n'okukkakkana ng'omuntu afudde.
Kino kisinga kukwata ku ani?
Omuntu yenna asobola okulwala kino `(Boerhaave's Syndrome). Naye,Businga kubeera mu basajja ne mu bantu abasukka mu myaka 50. Ebitundu nga 80% ku bakwatibwa basajja ba myaka gya wakati. Era kitera okubeera mu bantu abanywa omwenge ekisusse .Bubonero ki obulaga obulwadde bwa Boerhaave’s Syndrome?
Okay, kati ka tulabe obubonero bwa `(Boerhaave's Syndrome)` bwe buli. Kikulu nnyo okumanya bino.- Obulumi obw’amangu, obw’amaanyi mu kifuba. Kano ke kabonero akakulu.
- Okuziyira n'okusiiyibwa . Oluusi mu kusesema muyinza okubaamu omusaayi.
- Si kibi okuwulira obulumi ng’omira oba okusesema.
- Okussa kufuuka kumpi era kwa mangu.
- Ebitundu ebiri mu kifuba bijjula empewo oba amazzi ekivaako okuzimba.
- Olubuto lwange mpulira nga lunywezeddwa, ng’olwazi.
- Obubonero bw'okukwatibwa obulwadde nga omusujja n'okutuuyana .
Singa obubonero buno obumu oba obusingawo bulabika mu bwangu naddala oluvannyuma lw’okusesema ennyo, kikulu nnyo okugenda mu basawo amagezi amangu ddala .
Obulumi buli butya?
Obulumi bwa `(Boerhaave's Syndrome)` bwa maanyi butya? Abantu abamu bagamba nti ddala bulumi obutagumiikiriza . Obulumi buwulirwa wennyini we waali okukutuka. Ebiseera ebisinga, okukutuka kuno kubaawo mu kitundu eky’okusatu ekya wansi eky’omusuwa gwaffe. Kwe kugamba, wakati w’ekifuba ekya wansi n’olubuto olwa waggulu. Kyokka era kiyinza okuba waggulu okusinga ekyo. Obulumi buno era busobola okusaasaana mu mugongo oba ebibegabega .Bizibu ki ebiyinza okuvaamu?
Waliwo ebizibu ebiwerako ebiyinza okubaawo singa embeera eno teddukanyizibwa bulungi:- Okuzimba n’okuzimba mu kifuba kyo.
- Okukunganya amasira mu kifuba (empyema) .
- Empewo esibiddwa mu kifuba oba mu bitundu ebiri wansi w’olususu.
- Pleural effusion ( okukuŋŋaanyizibwa kw’amazzi mu lining y’ekifuba) .
- Obulwadde bw'okusannyalala mu kussa ( ARDS ) .
- Septicemia, sepsis, n’okusannyalala. Bino biyinza okutta omuntu.
Biki ebivaako obulwadde bwa Boerhaave?
Lwaki obulwadde bwa Boerhaave’s Syndrome bubaawo? Waliwo ensonga bbiri enkulu eziviirako kino. Ekimu kiri nti puleesa munda mu nnywanto yeeyongera olw'okunyigirizibwa oba okunyigirizibwa okutali kwa bulijjo . Ekirala kiri nti ekinywa kya cricopharyngeus ekiri waggulu ku mumiro gwaffe (ekitundu eky’okungulu eky’omumwa gwa nnabaana) bwe kitawummulamu nga kiddamu puleesa eno, puleesa embi ebaawo ebweru w’omumwa gwa nnabaana .. Ekisinga okuvaako kino `(Boerhaave's Syndrome)` kwe kusesema okw'amaanyi oba okutambula obutasalako . Okugatta ku ekyo, okuzaala, okukonziba, okusitula ebintu ebizito, n’okumira ebintu ebiwunya oba ebiwunya nabyo bisobola okubireeta. Mu budde obwabulijjo, mu mbeera ng’ezo, obubonero bw’obusimu bulina okuwummuza `(cricopharyngeus muscle)` ne bufulumya puleesa munda. Naye mu `(Boerhaave's Syndrome)`, olw'ensonga ezimu okukwatagana kuno okw'obusimu `(neuromuscular coordination)` tekola bulungi.Okunywa omwenge kikosa?
Okunywa omwenge kuyinza okuvaako omumwa gwa nnabaana okukutuka? Okunywa omwenge ekisusse kiyinza okuvaako akabi . Ekika ekisinga okutawaanya obulwadde bwa Boerhaave’s Syndrome kwe kusesema oluvannyuma lw’okulya emmere ennene oba ng’omaze okunywa omwenge. Obuzibu mu kunywa omwenge, okulya ennyo, n’obulwadde bwa bulimia bye biyinza okuvaako akabi. Ebirala ebiyinza okuvaako akabi mulimu embeera z’obujjanjabi ezisibuka mu nnywanto, gamba ng’obulwadde bw’omumwa gwa nnabaana n’obulwadde bw’omumwa gwa nnabaana obuyitibwa eosinophilic esophagitis, omusuwa gwa Barrett, n’obulwadde bw’amabwa mu lubuto. Wabula abantu abasinga abalina obulwadde bwa Boerhaave’s Syndrome balina omumwa gwa nnabaana ogwa bulijjo.Obulwadde bwa Boerhaave’s Syndrome buzuulibwa butya?
Boerhaave's Syndrome eyinza okuba enzibu okuzuula , naye kikulu okubufuna amangu ddala . Kyangu okuzuula ng’olina obubonero busatu, obumanyiddwa nga Mackler triad. Bino bye bino: 1. Okusesema okw’amaanyi oba okuddirira. 2. Obulumi mu kifuba okutandika amangu. 3. Obulwadde bw’okusannyalala wansi w’olususu. Akabonero kano akasembayo naddala kalaga nti omumwa gwa nnabaana gukutuse. Wabula si buli muntu nti ajja kuba n’obubonero buno obwa kalasi. Singa okukutuka kubaawo mu kifo ekitali kya bulijjo, oyinza okulumwa mu kifo ekitali kya bulijjo, gamba ng’ensingo oba amagumba g’omu bulago. Kiyinza okuba nga kiva ku kintu ekirala okuggyako okusesema, oba kiyinza okuwerekerwako ebizibu ebitali bya bulijjo. X-ray ennyangu ey’ekifuba eyinza okukuwa ekisumuluzo, naye kyetaagisa okukebera ebifaananyi mu ngeri esingako obulungi okusobola okuzuula embeera eno.Ebigezo bya radiological ebikozesebwa okuzuula obulwadde
Bikebere ki eby'amasannyalaze ebikozesebwa okuzuula obulwadde bwa ``Boerhaave's Syndrome''?`(Ekifaananyi ky'omumwa gwa nnabaana)` (Ekifaananyi ky'omumwa gwa nnabaana) .
Omusawo bw’ateebereza obulwadde bwa Boerhaave’s Syndrome, ekintu kye batera okusooka okukola kwe kukwata X-ray. Bakozesa langi ya ‘contrast dye’. Kino era kiyitibwa esophagram. Kino kigezo kya mangu, ekitali kya kuyingirira era nga kituufu nnyo. Ku kukebera kuno, onywa eddagala eririmu langi ya ‘contrast dye’ etabulwa mu mazzi. Kino kifuula munda mu payipu yo ey’emmere okulabika ku X-ray. Singa wabaawo okukutuka, basobola okulaba langi ya contrast gy’ekulukuta.(CT scan)
Bw’oba tosobola kukola esophagogram, oba omusawo wo bw’aba ayagala okumanya ebisingawo ku bitundu ebikwetoolodde, oyinza okukolebwa CT scan. Wadde nga tesobola kulaga kifo kituufu amaziga we gakutuse, esobola okuzuula langi entonotono oba empewo efuukuuse mu bitundu ebigyetoolodde okuva mu nnywanto. Era esobola okukozesebwa okuzuula amazzi agakuŋŋaanyiziddwa mu kifuba oba mu lubuto ageetaaga okufuluma.Obulwadde bwa Boerhaave’s Syndrome bujjanjabwa butya?
Okay, kati ka tulabe engeri y'okujjanjaba `(Boerhaave's Syndrome)`. Wano waliwo emitendera gy’olina okugoberera:- Okuwa amazzi mu misuwa (amazzi aga IV): Abantu bangi tebalina mazzi mu mubiri, n’olwekyo amazzi aga IV geetaaga okuweebwa amangu.
- Eddagala eritta obuwuka : Eddagala eritta obuwuka erya broad-spectrum liweebwa mu misuwa okusobola okufuga yinfekisoni.
- Okwebuuza ku balongoosa: Ku bantu abasinga obungi, okulongoosa bwe bujjanjabi obwa bulijjo. Abantu abamu abalina ebizimba ebitonotono ebisangibwa mu kitundu bayinza okujjanjabibwa awatali kulongoosebwa, nga batunuuliddwa n’eddagala eritta obuwuka mu IV oba okukebera endoscopy. Wabula ne mu mbeera zino, abasawo bulijjo bajja kuba n’enteekateeka y’okulongoosebwa mu bwangu.
- Okuddaabiriza ng’olongoosa: Kirungi okuddaabiriza ekifo ekikutuse mu ssaawa 24 okuva lwe kyakutuse. Okusinziira ku mbeera gy’olimu, omusawo ayinza okukozesa okulongoosa okutali kwa maanyi nnyo. Ng’ekyokulabirako, okulongoosa ekifuba nga bayambibwako vidiyo (VATS). Mu mbeera ezimu ez’amangu, kiyinza okwetaagisa okusala ekifuba ekiggule okusobola okufuna amangu era mu bujjuvu mu kisenge ky’ekifuba.
- Okufulumya amazzi/okusalako: Ng’oggyeeko okuddaabiriza amaziga, amazzi gonna agalina obuwuka agakuŋŋaanyiziddwa mu kisenge kyetaaga okufulumizibwa n’okutta obuwuka. Ekitundu kyonna ekirimu obuwuka oba ekifudde (necrotic) nakyo kirina okuggyibwamu. Mu mbeera ezimu ez’amaanyi, ekitundu ky’omusuwa gwo kiyinza okwetaagisa okuggyibwamu.
- Enzirukanya ey’omulembe: Singa okulongoosa tekisoboka mu ssaawa 24 oluvannyuma lw’okukutuka, okuddaabiriza obutereevu kuyinza obutaba bulungi. Empenda z’ekiwundu ziyinza okuba nga zaatandika okukaluba oba okwonooneka. Kino bwe kibaawo, omusawo ayinza okwetaaga okuggyako ekitundu oba kyonna eky’omumwa gwa nnabaana (esophagectomy). Bw’oba weetaaga okukyusa omusulo, kino osobola okukikola oluvannyuma lwa wiiki mukaaga.
- Enkola endala ez’okuliisa: Okutuusa nga payipu yo ey’emmere ewonye, tojja kusobola kumira mmere mu yo, n’olwekyo ojja kwetaaga okufuna ebiriisa mu ngeri endala. Kino kiyinza okuyita mu ttanka oba okuyita mu musuwa.
Kiki ekisuubirwa okuwona?
Kiki ekitegeeza omuntu alina obulwadde bwa ``Boerhaave's Syndrome''? Okuzuula amangu n’okujjanjaba bye bintu ebikulu by’osobola okukola okutangira ebizibu omuli n’okufa olw’okukwatibwa obulwadde.. Abo abafuna obujjanjabi mu ssaawa 24 basobola okusuubira okuwona obulungi, nga balina emikisa 75% okuwona. Oluvannyuma lw’essaawa 24, emikisa gy’okufa gisukka ebitundu 50%, ate oluvannyuma lw’essaawa 48 giba 90%. Okutwalira awamu, omuwendo gw’abafa guli nga 35%. Abo abafuna obujjanjabi mu budde era obulungi basobola okuwona mu bujjuvu, naye kiyinza okutwala emyezi egiwerako. `(Boerhaave's Syndrome)` mbeera etali ya bulijjo naye nga si ya bulijjo nnyo ereka bingi eby'okulowoozaako . Kiyinza okujja mu bwangu, awatali kabonero konna ka kulabula – naye okunywa ennyo omwenge obutawona kabonero akalaga okulabula ke tusobola okuziyiza. Tetumanyi buli kimu ku `(Boerhaave's Syndrome)`. Tetumanyi lwaki omusulo gulemererwa okwekuuma obutayonoonebwa mu mbeera zino. Naye tukimanyi nti kiyinza okutta omuntu singa tekitegeerekese era ne kijjanjabwa nga bukyali.Ebintu ebikulu by’olina okujjukira
Okay, kale kati olina okutegeera okulungi ku bye tubadde twogerako, ``Boerhaave's Syndrome.'' Bino bye bimu ku bintu ebikulu by'olina okujjukira:- Boerhaave’s Syndrome mbeera ya mangu ey’obujjanjabi evudde ku nnywanto okukutuka.
- Kino kitera okubaawo oluvannyuma lw'okusesema n'amaanyi .
- Obubonero obukulu bwe bulumwa obw’amangu, obw’amaanyi mu kifuba, okusiiyibwa, n’okukaluubirirwa okumira .
- Abantu abanywa ennyo omwenge bali mu bulabe bwa maanyi.
- Bw'oba olaba obubonero , genda mangu omusawo amagezi . Gy’okoma okutandika amangu obujjanjabi, emikisa gyo egy’okuwona gye gikoma okubeera emirungi.
- Ebiseera ebisinga kyetaagisa okulongoosebwa ng’obujjanjabi.
Kikulu okumanya embeera eno. Singa ggwe oba omuntu gw’omanyi afuna obubonero buno bwonna, tobubuusa maaso. Laba omusawo amangu ago.
` Borrego syndrome, okukutuka kw’omumwa gwa nnabaana, okulumwa mu kifuba, okusiiyibwa, omwenge, okukutuka kw’omumwa gwa nnabaana, Meckler triad, sepsis, okulongoosa omumwa gwa nnabaana
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