Wali obaddeko olubuto oluluma mu ngeri etategeerekeka, n’owulira ng’ojjudde, n’owulira ng’oziyira mu bwangu? Mpozzi kino kya mangu. Leero tugenda kwogera ku hemoperitoneum, evaamu omusaayi munda mu lubuto. Kino si kyangu okukola, n’olwekyo kikulu okuwuliriza obulungi.
Mu ngeri ennyangu, Hemoperitoneum kwe kukuŋŋaanyizibwa kw’omusaayi mu kifo ekyerere munda mu lubuto lwo, ekituli ky’olubuto. ‘Hemo’ kitegeeza omusaayi, ate ‘peritoneum’ kitegeeza oluwuzi olukola layini y’olubuto luno. Kale, omusaayi munda mu mubiri bwe guti (era tuguyita omusaayi ogw’omunda oba okuvaamu omusaayi) kya bulabe nnyo era kyetaagisa okuweebwa ekitanda mu ddwaaliro mu bwangu.
Lwaki kino kya maanyi nnyo?
Teebereza, kiki ekibaawo singa omusaayi mu mubiri gwaffe gukulukuta okuva mu misuwa ne gukuŋŋaanyizibwa awalala? Omuwendo gw’omusaayi ogutuuka mu bitundu byaffe ebikulu n’ebitundu byaffe ebikulu gukendeera. Omusaayi bwe guba gukulukuta munda mu mubiri, tetulaba musaayi bwe gukulukuta n’okutambula ku sipiidi. Naddala mu lubuto luno, omusaayi mungi gusobola okukuŋŋaanyizibwa. Singa omusaayi teguyimirizibwa mu ngeri eno, wabaawo akabi k’okufiirwa omusaayi ogumala okutuuka ku ssa ly’okutta omuntu. Y’ensonga lwaki kino kya maanyi nnyo.
Obubonero bwe buliwa?
Obubonero bw’obulwadde bwa hemoperitoneum busobola okwawukana okusinziira ku muntu okusinziira ku kivaako.
- Oyinza okulumwa ennyo mu lubuto oba okulumwa ekisambi mu bwangu.
- Naye olw’ensonga ezimu, obulumi buyinza okukendeera ng’ojja.
- Olubuto lwo luyinza okuwulira nga lugaziye era nga luluma ng'okwatako .
- Singa omusaayi gugenda mu maaso, obubonero bw’okukendeera kw’omusaayi okw’amaanyi bujja kutandika okulabika mpolampola.
- Oyinza okuwulira ng’oziyira, ng’omutwe guzirika, era ng’oziyira .
- Oyinza n'okuwulira ng'omutima gwo gweyongera okukuba .
Bw’ofuna obubonero buno, mazima ddala olina okugenda mu basawo amagezi mu bwangu.
Ensonga eziyinza okuba nga ze ziruwa?
Waliwo ebintu bingi ebiyinza okuvaako obulwadde bwa hemoperitoneum, naye ebimu bye bisinga okubeerawo. Abasawo bagabanyaamu ebivaako bino mu biti bisatu:
1. Okulumwa ennyo
2. Ebikolebwa mu ngeri ey’okwekolako
3. Nga ekizibu ekiva mu bujjanjabi (Iatrogenic) .
Ku bino, obuvune obuva ku bubenje n’embuto ezitali za nnabaana bye bisinga okuvaako omusaayi (hemoperitoneum).
1. Hemoperitoneum ewunyiriza
Kino kibaawo singa ekitundu ky’omubiri oba omusuwa gw’omusaayi mu lubuto lwo gufuna obuvune. Ebitundu ebisinga okukosebwa bye kibumba n’ennywanto.Ebitundu bino ebibiri bisobola okuvaamu omusaayi mungi. Kiyinza okubaawo okuva ku kukubwa okw’amaanyi (blunt trauma) oba okuva ku kintu ekifumita munda (penetrating trauma) mu kiseera ky’akabenje.
Lowooza ku bintu nga bino:
- Okugwa okuva waggulu.
- Obubenje bw'emmotoka.
- Okutomeragana nga bazannya.
- Okukuba obutereevu mu lubuto.
- Okufumita n’akambe.
- Essasi ly’emmundu.
Bw’ofuna obulumi mu lubuto n’obubonero obulala oluvannyuma lw’akabenje ak’amaanyi nga kano, ekisinga obulungi kwe kugenda mu ddwaaliro mu bwangu.
2. Hemoperitoneum eyeetongodde
Kino kiyitibwa Spontaneous oba Nontraumatic Hemoperitoneum. Kino kwe kuvaamu omusaayi mu ngeri eyeetongodde, nga tewali bulabe bwonna. Kiyinza okuva ku bulwadde oba enkola endala munda mu mubiri. Oluusi ekitundu ky’omubiri oba omusuwa guyinza okukutuka munda, olw’okuzimba okuva munda, oba olw’obuvune obwaliwo emabega. Okukula kw’ebitundu ebitali bya bulijjo (nga ebizimba) nakyo kisobola okubaawo munda mu lubuto ne kivaamu omusaayi.
Ka tulabe ensonga ntono:
- Omusuwa ogukutuse (Ruptured Aneurysm).
- Okukutuka kw’obuzibu bw’emisuwa (AVM).
- Ensigo z’omu lubuto ezikutuse.
- Okukutuka kw’omusaayi (Hematoma rupture).
- Ebizimba bibutuka.
- Ekizimba ky’enkwaso ekyakutuse.
- Olubuto olukutuse ebweru w’olubuto - kino kikwata ku bakyala.
- Okukutuka kw’omugongo mu ngeri ey’okwekolako.
- Okukutuka mu lubuto oba ekyenda (Gastrointestinal Perforation).
- Ennyindo erimu ebituli.
- Obulwadde bw’olubuto obuva mu musaayi.
3. Nga ekizibu ekiva mu bujjanjabi (Iatrogenic Hemoperitoneum) .
Kino kibaawo ng’ekizibu ekiva mu bujjanjabi obumu. Kino tekitera kubaawo nnyo, naye kiyinza okubaawo. Kino kibaawo singa ekitundu ky’omubiri oba omusuwa gw’omusaayi gwonoonese mu butanwa nga bajjanjabwa.
Ebimu ku byokulabirako:
- Okulongoosa olubuto, gamba nga laparoscopy, okulongoosa okuggyamu ekitundu ky’omubiri oba ng’omwana azaaliddwa mu kulongoosa.
- Okukebera okutwala sampuli y’ebitundu by’omubiri (Biopsy), okugeza okuva mu kibumba (Liver Biopsy) oba ekibumba (Kidney Biopsy).
- Enkola z’okuyingiza ttanka (catheter) okuyita mu lubuto, kwe kugamba, ng’okola PEG oba Paracentesis.
- Okukebera endoscopy, okugeza, endoscopy eya waggulu oba colonoscopy.
Bw’ofuna obubonero bwonna obutali bwa bulijjo oluvannyuma lw’ekintu nga kino, kikulu okubuulira omusawo eyakujjanjaba.
Kikwata kitya mu ngeri ey’enjawulo ku bakyala?
Ebitundu by’enkola y’okuzaala kw’omukazi nabyo bibeera munda mu kisenge kino eky’olubuto. Kale, era zisobola okuvaamu omusaayi mu lubuto mu ngeri eno. Ng’ekyokulabirako, ebintu ng’ebizimba by’enkwaso (enkwaso ezikutuse) n’olubuto olutali mu nnabaana bisobola okubaawo . Zino mbeera za mangu nnyo.
Obulabe bw’okulwala hemoperitoneum ng’oli lubuto buyinza okweyongera mu ngeri eziwerako. Ebika by’ebizimba by’ekibumba ebimu bisobola okukula amangu ne bikutuka ng’oli lubuto. Ekirala, omusaayi guyinza okuvaamu ng’ozaala, oba mu ngeri eyeetongodde oba olw’ensonga z’obujjanjabi.
Kiba kya bulabe obw’enjawulo ng’oli lubuto? (Hemoperitoneum eyeetongodde mu lubuto - SHiP)
Spontaneous Hemoperitoneum in Pregnancy (SHiP) mbeera etali ya bulijjo ebaawo ng’oli lubuto. Kitera okubaawo mu lubuto olw’okubiri oba olw’okusatu. Ekituufu ekivuddeko tekimanyiddwa. Ebiseera ebisinga, guba musuwa gwa musaayi ogwakutuse. Wabula abasawo n’okutuusa kati tebamanyi lwaki kibaawo. Obujulizi obumu bulaga nti kiyinza okuba nga kyekuusa ku bulwadde bwa endometriosis obwaliwo edda oba okuzaala mu kisenge (IVF) .
Waliwo ebintu ebirala ebiyinza okuleeta akabi?
Yee, ebintu ebirala ebimu bisobola okwongera ku bulabe buno.
- Bw’oba olina obuzibu bw’okuvaamu omusaayi oba obutazimba musaayi, okutwalira awamu otera okuvaamu omusaayi. Kino kiyinza okuli okuvaamu omusaayi mu ngeri eyeetongodde oba okuvaamu omusaayi omungi olw’obuvune obutonotono. Oyinza n’okuvaamu omusaayi omungi okusinga abalala.
- Ku bantu abalina endwadde ezimu ezitawona, singa obulwadde buno bweyongera era ekitundu ne kikutuka, basobola okuvaamu omusaayi mu lubuto mu ngeri eyeetongodde. Kyokka kino si kya bulijjo nnyo.
Bizibu ki ebiyinza okuvaamu?
Okuvaamu omusaayi munda mu lubuto kya maanyi kubanga kiba kintu ekigenda mu maaso munda mu mubiri era w’okitegeera kiyinza okuba eky’amaanyi ennyo. Ebizibu bibaawo singa ofiirwa omusaayi omungi amangu. Omuwendo gw’omusaayi gw’ovaamu n’engeri gye gutambulamu kisinziira ku kisookera ddala (obuvune oba obulwadde), obungi bw’otera okuvaamu omusaayi, n’engeri gy’ofunamu amangu obujjanjabi.
Singa omusaayi guba gwa maanyi, kiyinza okuvaako embeera eyitibwa Hypovolemic Shock. Okusukka awo, okulemererwa kw’ebitundu by’omubiri n’okufa n’okufa kuyinza okubaawo. N’olwekyo, eno embeera ya mangu nnyo, era si sekondi n’emu erina okwonooneka.
Kino okisanga otya? (Okuzuula obulwadde)
Bw’oba olina omusaayi ogw’omunda, kikulu okuguzuulibwa amangu. Abasawo bwe beetaaga okulaba amangu ebigenda mu maaso munda mu mubiri gwo, batera okutandika n’okukeberebwa amangu ebifaananyi.
- Ekyo kitegeeza okukola ultrasound.Ekintu nga CT scan.
- FAST Ultrasound kigezo ku kitanda ekikoleddwa mu ngeri ey’enjawulo okukebera oba omusaayi guvaamu munda mu lubuto lwo. FAST kifupi kya Focused Assessment nga kiriko Sonography for Trauma.
Ebiseera ebisinga abasawo basobola okukozesa okukebera kuno okw’ebifaananyi okulaba oba olina hemoperitoneum ne omusaayi gye guva. Naye oluusi, ebifaananyi tebitegeerekeka bulungi. Bayinza okwetaaga okuggya sampuli y’amazzi okuva mu lubuto lwo n’empiso oba ttanka (paracentesis). Bw’oba mulwadde nnyo, bayinza okwetaaga okukutwala mu kifo we bakulongoosa okunoonyereza, nga kino kwe kulongoosa okuzuula ekizibu n’okukitereeza amangu ago.
Obujjanjabi bwe buruwa?
Omusawo bw’amala okuzuula obulwadde bwa hemoperitoneum, bajja kutunula okulaba omusaayi gye guva n’okumanya oba gukyajja. Bwe wabaawo okuvaamu omusaayi, kyetaaga okuyimirizibwa mu bwangu. Engeri kino gye kinaakolebwamu ejja kusinziira ku mbeera gy’olimu.
- Mu mbeera ey’amangu, kiyinza okwetaagisa okulongoosebwa mu bwangu okuddaabiriza ekiwundu oba okuggala omusuwa.
- Singa embeera yo ebeera nnywevu, oyinza obutakola kintu kinene n’omala kugiddukanya mu ngeri ey’okukuuma.
Obujjanjabi buyinza okuli:
- Okuddukanya obulumi.
- Okuteekebwamu omusaayi.
- Okusengula abantu/Okufulumya amazzi amangi.
- Okujjanjaba embeera evuddemu.
- Embolization bujjanjabi obuziyiza omusuwa.
- Enkola za endoscopy okuziba ekiwundu.
- Laparoscopy nkola ya kulongoosa okuzuula ekizibu ne/oba okuddaabiriza ekiwundu nga bakozesa enkola y’emu.
- Exploratory laparotomy okuzuula ekizibu ne/oba okuddaabiriza ekiwundu nga bayita mu kulongoosa olubuto.
Essuubi ly’okudda engulu liri litya?
Okuwona kwo kujja kusinziira ku ngeri gy’ofunamu obujjanjabi amangu n’engeri omusaayi gwo gye gukulukutamu. Bw’oba olina obuzibu bw’okuzimba omusaayi oba embeera endala ezitawona ezikosa obulamu bwo okutwalira awamu, embeera yo eyinza okuba ey’amaanyi ennyo. Okufuna obujjanjabi amangu ddala kiyinza okuyamba okuziyiza ebizibu ebiva mu kufiirwa omusaayi ennyo. Bw’oba osobola okuziyiza ebizibu ebyo, olina emikisa mingi okuwona mu bujjuvu.
Hemoperitoneum mbeera ya mangu ebaawo mu bwangu era nga tosuubira. Bw’oba ofunye akabenje, oyinza okuba nga wafuna dda obujjanjabi. Naye bwe kitaba ekyo, oyinza obutamanya kigenda mu maaso ng’obubonero bulabika.Ekisinga obukulu si butabuusa maaso bubonero bwo n’onoonya amagezi g’abasawo nga tebunnagenda kweyongera. Bw’okwata obulwadde buno nga bukyali n’ofuna obujjanjabi, emikisa gyo egy’okuwona giba mirungi.
N’ekisembayo, ebintu by’olina okujjukira
Hemoperitoneum mbeera ya mangu eyinza okutta omuntu ng’omusaayi guvaamu munda mu lubuto.
- Bw’ofuna obubonero ng’okulumwa ennyo olubuto mu bwangu, okuzimba, okuziyira, oba okuwulira ng’olina obunafu , tokitwala nga kitono.
- Kino kiyinza okubaawo ng’ebiva mu bubenje, endwadde ezimu, ebizibu ebiva ku lubuto, n’obujjanjabi.
- Ekisinga obukulu kwe kuzuula obulwadde n’okubujjanjaba amangu. Bw’okola bw’otyo, osobola okuziyiza ebizibu eby’amaanyi n’owona mu bujjuvu.
- Bw’oba olina obubonero buno, laba omusawo mu bwangu oba genda mu ddwaaliro erikuli okumpi. Ebiseera bye bikulu wano. Teweeraliikiriranga naye mwangu.
` Hemoperitoneum, okuvaamu omusaayi mu lubuto, okuvaamu omusaayi munda, omusaayi mu lubuto, okulumwa mu lubuto, okulongoosebwa, okulabirira mu bwangu











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