Omanyi embeera ey’akabi ey’obulwadde bw’olubuto obuyitibwa necrotizing pancreatitis?

Wali owuliddeko embeera ey'amaanyi ng'ekitundu ky'olubuto kifa ? Kino kye tuyita mu by'obujjanjabi ``Necrotizing Pancreatitis''. Teebereza engeri gye kibeera eky’amaanyi okufiirwa ekitundu ky’ekitundu ekikulu mu mubiri gwaffe. Kino kibaawo ng'embeera eyitibwa ``Acute Pancreatitis '' efuuse ya maanyi nnyo . Leero, tugenda kwogera ku nsonga eno mu bujjuvu, nga tulinga ayogera ne mukwano gwaffe.

Kiki ddala kye ki ``(Necrotizing Pancreatitis)``?

Mu ngeri ennyangu, ``Necrotizing Pancreatitis`` kwe kufa kw'ekitundu kya ``Pancreas`` yo (Necrosis). Kino kibaawo ng’embeera ya ``Pancreatitis`` efuuse ya maanyi nnyo. Obulwadde bw’olubuto bwe buzimba, okumyufu, n’okulumwa olw’obuvune oba ekintu ng’obutwa. Singa okuzimba kuno kufuuka kwa maanyi nnyo, okutambula kw’omusaayi mu bitundu by’olubuto kuyinza okutaataaganyizibwa ``Ischemia``. Olwo ebitundu ebyo tebifuna mukka gwa oxygen n'ebiriisa bye byetaaga ne bitandika okufa . Kino kiyitibwa ``Necrosis``. Eno embeera ya bulabe ddala.

Kino bwe kibaawo, ttiimu yo ey’abasawo ejja kukukuumira mu ddwaaliro okumala akaseera era ekulondoole nnyo okulaba oba waliwo ebizibu ebirala byonna . Ekisinga obukulu okwegendereza kwe kukwatibwa yinfekisoni . Teebereza singa obuwuka butandika okulya ebitundu ebifu, busobola okweyongera amangu ne busaasaana mu mubiri gwo gwonna. Singa ekyo kibaawo, kiyinza okuvaako embeera ez’amaanyi ng’okulemererwa kw’ebitundu by’omubiri , ekiyinza okutta omuntu. Mu mbeera ng’ezo, abasawo bayinza okuggyibwako ebitundu ebifu nga balongoosebwa .

Embeera eno ya bulijjo etya?

Mu ngeri ey’obukambwe, abantu nga 20% abafuna obulwadde bw’olubuto obw’amaanyi bajja kufuna obulwadde bw’olubuto obuyitibwa necrotizing pancreatitis. Mu nsi nga Amerika, kigambibwa nti abantu kumpi emitwalo bisatu be baweebwa ebitanda buli mwaka olw’obulwadde bw’olubuto. Kale, 20% muwendo gwa maanyi, nedda?

Bubonero ki obwa `(Necrotizing Pancreatitis)`?

Obubonero obusooka okulabika bwe bwa acute pancreatitis. Bbo bali:

• Obulumi obw’amaanyi mu lubuto olwa waggulu. Obulumi buno era buyinza okubumbulukuka okutuuka ku mugongo.
• Olubuto okugaziwa oba okuzimba.
• Okuziyira n’okusiiyibwa.

Obulwadde bw’olubuto bwe bweyongera, obubonero nga buno era buyinza okulabika:

• Omusujja n’okuziyira.
• Omutima gweyongera okukuba (Tachycardia).
• Ennyonta ey’amaanyi oba okuggwaamu amazzi mu mubiri.

Biki ebivaako obulwadde bwa ``Necrotizing Pancreatitis''?

Kino kibaawo mu mitendera egiwerako. Ekisooka, okuzimba okwa bulijjo okw’olubuto (Acute Pancreatitis) kufuuka kwa maanyi. Olwo, omusaayi gutaataaganyizibwa (Ischemia), era ku nkomerero, okufa kw’ebitundu by’omubiri (Necrosis) kubaawo. Waliwo ebintu eby’enjawulo ebivaako buli kimu ku bintu bino.

Obulwadde bw’olubuto bwa maanyi butya?

Ekisinga okuvaako obulwadde bw’olubuto obw’amaanyi bwe bulwadde bw’amayinja mu nnyindo . Kino kibaawo ng’ejjinja ly’omu nnyindo liyingidde mu nnywanto ne liziba omukutu gw’olubuto. Kino era kiyitibwa gallstone pancreatitis . Ekisinga okuvaako ekyokubiri kwe kunywa omwenge ekisusse .

Okuzimba mu butuufu y’engeri omubiri gye guddamu obuvune, nga gugezaako okuddaabiriza ebyonoonese. Naye oluusi okuddamu kuno okw’okuzimba kufuuka kwa maanyi nnyo ne kutandika okuleeta okwonooneka.

Tekinnaba kutegeerekeka lwaki okuddamu kuno okw’okuzimba kwa maanyi nnyo mu bantu abamu okusinga abalala. Naye kyeyoleka bulungi nti kino kireeta `` snowball effect`` munda mu pancreas.

Puleesa enkulu ereetebwa okuzimba okw’amaanyi ekola enziyiza z’olubuto munda mu bitundu by’olubuto. Mu budde obwabulijjo, enziyiza zino ezigaaya emmere zikola oluvannyuma lw’emmere okuyingira mu nkola y’okugaaya emmere. Naye singa zitandika okukola nga bukyali, zitandika okugaaya olubuto lwennyini. Teebereza, okugaaya ekitundu kyo n’enziyiza zo!

Okukendeera kw'omusaayi kivaako ``Ischemia`` n'okufa kw'ebitundu by'omubiri ``Necrosis``

Okwonooneka kuno okugenda mu maaso ku pancreas kuleetera obulwadde bw’olubuto okweyongera. Oluvannyuma okuzimba kw’olubuto kuleetera emisuwa okugaziwa, ekikendeeza ku muwendo gw’omusaayi ogukulukuta mu bitundu by’omubiri.

Ensonga endala eyinza okukosa kino ye Systemic Inflammatory Response Syndrome (SIRS). Eno mbeera ya kuzimba ebeerawo mu mubiri gwonna. Kino kiyinza okuvaako puleesa okutwalira awamu n’okutambula kw’omusaayi okukendeera.

Okufiirwa omusaayi (ischemia) kivaako ebitundu by’omubiri okufa (necrosis). Okugaaya olubuto olw’enziyiza z’olubuto nakyo kiyinza okuvaako okufa kuno okw’ebitundu by’omubiri.

Bizibu ki ebiyinza okuva mu `(Necrotizing Pancreatitis)`?

Embeera eno esobola okuleeta ebizibu eby’enjawulo mu bbanga ettono n’ery’ewala.

Ebizibu ebiva mu bbanga ettono:

• Yinfekisoni: Kino kye kisinga okuba eky’obulabe eri obulwadde bwa Necrotizing Pancreatitis. Kino kiyinza okubaawo mu balwadde nga 20%. Ebitundu ebifu bifaanana ng’ekifo ekirungi obuwuka obutaayaaya we buliisa. Kizibu okufuga yinfekisoni ng’oli mulwadde dda. Singa busaasaana mu musaayi, buyinza okutta obulamu. Yinfekisoni mu musaayi esobola okuleeta sepsis , ekiyinza okuvaako ebitundu by'omubiri ebingi okulemererwa . Kino kye kisinga okutta abantu abalina obulwadde bwa Necrotizing Pancreatitis.
• Necrotic Fluid Collections: Mu bulwadde bw’olubuto obw’amaanyi, enziyiza z’olubuto ezikola zisobola okukulukuta okuva mu lubuto ne zoonoona ebitundu ebikyetoolodde. Ekikuta ky’ebitundu ebigonvu kikola okwetooloola amazzi g’olubuto. Singa kkapu eno ebaamu ebitundu ebifu ne bakitiriya, yinfekisoni esobola bulungi okutandika n’okusaasaana. Tekitera kubaawo, kkapu eno esobola okugaziwa n’enyigiriza ebitundu ebiriraanyewo, gamba ng’olubuto, emisuwa oba emikutu gy’entuuyo.
• Okuvaamu omusaayi: Obulwadde bw’olubuto obuva mu musaayi tebutera kubaawo, naye buyinza okutta omuntu singa bubaawo. Obulwadde bw’olubuto obuyitibwa necrotizing pancreatitis byongera obulabe bw’okuvaamu omusaayi guno. Engeri emu kino gye kiyinza okubaawo kwe kuba nti okuzimba oba amazzi agali mu lubuto gasaasaana ne gatuuka ku musuwa oguli okumpi, ne kwonoona ekisenge ky’emisuwa ne kivaamu omusaayi. Engeri endala eri nti singa enziyiza z’olubuto zimenya bbugwe w’omusuwa, ne zikola ekizimba ekiyitibwa pseudoaneurysm , ekikutuka ne kivaamu omusaayi.
• Obdominal Compartment Syndrome: Okuzimba, okuvaamu omusaayi, n’amazzi amalala agakuŋŋaanyizibwa ebikwatagana n’obulwadde bw’olubuto obuyitibwa necrotizing pancreatitis bisobola okuleeta puleesa ey’amaanyi munda mu lubuto. Kino kisinga kulabibwa mu balwadde abali mu mbeera embi. Kino kiyinza okuvaako omusaayi okukendeera mu bitundu by’omubiri, ekiyinza okuvaako omusaayi okuzimba , okukendeera kw’omusaayi, n’obutaba na mukka gwa mukka . Kino era kiyinza okuvaako ebitundu by’omubiri ebingi okulemererwa.

Ebiyinza okuvaamu mu bbanga eggwanvu:

• Obutamala mu lubuto: Singa ebitundu by’olubuto bingi bibula, ebimu ku bikolwa by’olubuto biyinza okubula. Exocrine Pancreatic Insufficiency bwe butakola enzymes zimala okugaaya emmere. Kino kiyinza okuvaako obutanywa mmere nnungi n'endya embi . Endocrine Pancreatic Insufficiency bwe buzibu bw’olubuto obutakola busimu bumala obufuga ssukaali mu musaayi. Kino kiyinza okuvaako sukaali omungi ne sukaali .
• Disconnected Pancreatic Duct Syndrome: Okuzimba ennyo, okuvaamu omusaayi, okufa kw’ebitundu by’omubiri, n’ebizibu ebirala ebiva mu bulwadde bw’olubuto obuyitibwa necrotizing pancreatitis bisobola okuvaako omukutu gw’olubuto okwekutula ekitundu oba ku kyenda oba ekyenda ekitono. Kino kiyinza okuvaako enziyiza z’olubuto okugenda mu maaso n’okukulukuta. Okukulukuta kuno kuyinza okuvaako okukuŋŋaanyizibwa kw’amazzi okumala ebbanga eddene ne/oba obulwadde bw’olubuto obutawona.
• Okukaluba kw’omusaayi:Okuzimba okw’amaanyi n’okumala ebbanga eddene kuyinza okuleeta enkovu mu mikutu gyonna egigatta olubuto ku nkola y’okugaaya emmere (omukutu gw’olubuto, omukutu gw’omusaayi, duodenum - entandikwa y’ekyenda ekitono). Enkovu eno ereetera omukutu okufunda mu ngeri etaali ya bulijjo (stricture). Kino kikendeeza ku kutambula kw’entuuyo, era entuuyo zitandika okudda emabega mu nkola y’omusulo.
• Splanchnic Vein Thrombosis: Emisuwa gyo egy’okusannyalala gibeera wansi w’olubuto lwo. Obulwadde bw’olubuto obw’amaanyi buyinza okubaleetera okuzimba. Kino kiyinza okuvaako omusaayi okuzimba (thrombosis) mu misuwa gino. Emisuwa gino mulimu omusuwa gw’ennywanto, omusuwa gw’omu lubuto, omusuwa gw’ekibumba n’omusuwa gw’omulyango. Singa omusaayi gukola mu kimu ku bino, ebizibu eby’enjawulo bisobola okubaawo, gamba nga puleesa ey’omu mulyango , okuzimba mu lubuto, okuvaamu omusaayi mu lubuto, obulwadde bw’olubuto obuyitibwa ischemic colitis, ne mesenteric ischemia.

Obulwadde bwa Necrotizing Pancreatitis buzuulibwa butya?

Abasawo bazuula embeera eno `(Necrotizing Pancreatitis)` oluvannyuma lw'okusooka okuzuula `(Acute Pancreatitis).` Obubonero obweyoleka obw'okufa kw'ebitundu by'omubiri `(Necrosis)` tebulabika okutuusa nga wayise ennaku ssatu ku ttaano oluvannyuma lw'okutandika obulwadde bw'olubuto. Bw’oba ​​olina obubonero bw’obulwadde bw’olubuto obw’amaanyi oluvannyuma lw’ennaku ntono oluvannyuma lw’okuzimba okusooka, omusawo wo ajja kukozesa CT scan ng’erina langi ya fluorescent `(Contrast-enhanced CT scan)` oba MRI.` (MRI - Magnetic Resonance Imaging)` okunoonya okufa kuno okw’ebitundu by’omubiri. Era bajja kunoonya ebizibu ebirala, gamba ng’amazzi okukuŋŋaanyizibwa.

Bujjanjabi ki obukolebwa ku kino?

Obujjanjabi bwo bujja kusinziira ku oba olina yinfekisoni oba ebizibu ebirala. Singa obulwadde bw’olubuto buba tebulina buwuka era nga tewali bubonero, abasawo bajja kubujjanjaba n’obujjanjabi obuwagira . Singa obubonero bw’obulwadde oba ebizibu ebirala bibaawo, abasawo bajja kuyingira mu nsonga nga bwe kyetaagisa. Bajja kugezaako okuggyawo ebitundu ebifu nga bakozesa enkola ezitayingira mu mubiri nga tebannaddukira mu kulongoosebwa.

Enzirukanya y’emirimu mu ngeri ey’okukuuma

Obulabirizi obuwagira obulwadde bwa ``Sterile Necrotizing Pancreatitis`` obutasiigibwa mulimu:

• Eddagala eriweweeza ku bulumi.
• Amazzi agayingira mu misuwa `(IV Fluids)`.
• Endya y’omu byenda.

Emisango egisinga obungi egitalina buzibu gijja kugonjoolwa n‟okulabirira kwokka. Mu kiseera kino, ttiimu yo ey’abasawo ejja kulondoola nnyo embeera yo. Bajja kulondoola obubonero bwo obukulu , puleesa y’olubuto, n’omuwendo gw’omusaayi gwonna.Balondoola ebintu nga Complete Blood Cell Count (CBC) ne batunuulira ebizibu ebiyinza okuvaamu. Singa ekintu nga yinfekisoni oba okulemererwa kw’ebitundu by’omubiri kibaawo, bajja kuwa obuyambi bw’obulamu oba okuyingira mu nsonga endala nga bwe kyetaagisa.

Okufulumya amazzi n’okuggyamu amazzi

Kasita otandise okulaba obubonero obulaga nti olina obulwadde, ttiimu yo ey’abasawo ejja kukutandika ku ddagala eritta obuwuka era eteekateeka okuggyamu ebitundu byonna ebifu bwe kiba kisoboka. Bajja kutandika n’enkola etali ya kuyingirira nnyo, olwo mpolampola bongere ku maanyi bwe kiba kyetaagisa.

Enkola zino mulimu:

• Okufulumya amazzi mu lususu: Okufulumya amazzi mu lususu kitegeeza okuyita mu lususu. Omusawo akola ku by’okukuba ebifaananyi (interventional radiologist) akozesa obukodyo bw’okukuba ebifaananyi (emirundi mingi ultrasound oba CT scans) okuzuula ekitundu ky’ebitundu ebifu era n’ayingiza ttanka okuyita mu lususu lwo. Tubu eno erekebwa mu kifo kyayo n’efuumuulwa n’omunnyo emirundi egiwerako olunaku okusobola okufulumya amazzi. Eno y’enkola yokka eri abalwadde nga kimu kya kusatu. Ku balala, kiyamba okufuga yinfekisoni okutuusa ng’enkola endala ez’okusalako zisobodde okukolebwa awatali bulabe.
• Endoscopic Debridement: Enkola eyitibwa endoscopy esobozesa omusawo w’omu lubuto okutuuka ku bitundu ebifu munda mu mubiri gwo nga tasala lususu lwo. Ajja kuyisa ekyuma ekikebera endoscope, ekirimu ekyuma ekikebera amaloboozi, okuyita mu nkola yo ey’okungulu ey’olubuto okuzuula ekitundu ky’olubuto. Oluvannyuma, ebikozesebwa biyisibwa mu endoscope okukola omukutu wakati w’ebitundu ebifu n’enkola yo ey’omu lubuto. Ekitundu ekifu kiggyibwamu nga kiyita mu mukutu ogwo.
• Video-assisted Retroperitoneal Debridement (VARD): Eno era nkola ya kulongoosa etali ya kuyingirira nnyo. Kino kizingiramu okuyingiza ebikozesebwa mu kulongoosa ng’oyita mu kitundu kye kimu ky’olina edda mu lususu lwo ekiyitibwa Percutaneous Drainage Portal n’ogenda mu kitundu awali ekitundu ekifu. Omusawo alongoosa akozesa ebyuma ebiyitibwa forceps, okufukirira n’okusonseka okuggyamu ebitundu ebifu ng’ayita mu kifo we batemye. Bwe kiba kyetaagisa, ekifo ekisaliddwa kiyinza okugaziwa ne bateekamu ttanka eriko kkamera eyitibwa laparoscope. Oluvannyuma ebitundu ebisigaddewo biggyibwamu nga bakozesa enkola ya laparoscopic eyitibwa laparoscopic surgery.
• Open Surgery - Necrosectomy: Necrosectomy kwe kuggyawo ebitundu ebifu. Okulongoosa mu lwatu kizingiramu okuggulawo ekituli ky’olubuto n’okuzuula ebitundu ebifu (Laparotomy). Eno y’engeri esinga okwangu ey’okuzuula n’okujjanjaba ebizibu eby’amangu. Wadde ng’okulongoosa kuleeta akabi akamu, kye kisembayo mu mbeera ez’amangu n’enkola ezitayingirira nnyo bwe ziremye.

Omuwendo gw’abafa n’omuwendo gw’okuwona olw’obulwadde bwa `(Necrotizing Pancreatitis)` guli gutya?

Omukisa gw’okuwona gusinziira ku bungi bw’olubuto lwo lwe lufudde, oba ofuna yinfekisoni oba ebitundu by’omubiri ebilemererwa, n’engeri gy’okwatamu obujjanjabi. Singa ebitundu ebitakka wansi wa 30% eby’olubuto lwo bikosebwa, omuwendo gw’abafa guba wansi wa 15% . Bwe wabaawo okufa kw’ebitundu by’omubiri byokka nga tewali yinfekisoni, ekyo kirungi. Naye singa ebitundu ebisukka mu 50% eby’olubuto lwo bikosebwa, n’ofuna yinfekisoni oba ebitundu by’omubiri ebilemererwa, omuwendo gw’abafa gweyongera okutuuka ku bitundu ebisukka mu 30% .

Totya olw’ebibalo bino. Bino mawulire ga bulijjo gokka. Ttiimu y’abasawo yokka ekujjanjaba y’esobola okukubuulira obulungi embeera yo n’emikisa gyo egy’okuwona.

Kiki ekibaawo oluvannyuma lw’okujjanjabwa?

Ku ssaawa yo ey’okugoberera oluvannyuma lw’okujjanjabwa, omusawo ajja kukubuuza ku bubonero bwonna obugenda mu maaso oba obupya. Obulwadde bw’olubuto obuyitibwa Necrotizing Pancreatitis buyinza okuba n’ebizibu ebiwangaala ne bwe buba bujjanjabiddwa. Bw’oba ​​olina obubonero, oyinza okusabibwa okwekebeza omusaayi, okukeberebwa mu laabu oba okukeberebwa mu bifaananyi okusobola okubukebera. Ebizibu ebiyinza okubaawo biyinza okwetaagisa obujjanjabi obw’enjawulo, obuyinza okuba obw’ekiseera ekitono oba obw’ekiseera ekiwanvu.

Obulwadde bw’olubuto obuyitibwa Necrotizing pancreatitis buzibu bwa maanyi nnyo obuva ku bulwadde bw’olubuto obw’amaanyi. Wadde ng’abantu abasinga bawona obulwadde bw’olubuto obw’amaanyi nga bayambibwako bwokka, abo abafuna obulwadde bw’olubuto obw’amaanyi n’okufa beetaaga obujjanjabi obw’amaanyi obw’ekiseera ekiwanvu. Ojja kwetaaga ttiimu y’abasawo ab’enjawulo okulondoola embeera yo n’ebizibu byonna ebiyinza okuvaamu. Oyinza okwetaaga okuyingira mu nsonga oba okulongoosebwa, era nga kiyinzika okuba nga n’okulabirira okugoberera.

Ebintu ebikulu bye twetaaga okujjukira okuva mu mboozi eno (Take-Home Message)

• Necrotizing Pancreatitis mbeera ya maanyi nnyo ng’ekitundu ky’olubuto kifa.
• Kino kitera okuva ku bulwadde bw’olubuto obw’amaanyi. Ebisinga okuvaako kwe kuzimba amayinja mu nnyindo n'okunywa omwenge omungi .
• Bw’oba ​​olina obubonero ng’okulumwa ennyo mu lubuto, omusujja, okuziyira, n’okusesema, funa amagezi mu bwangu omusawo.
• Obulwadde buno bwe buzibu obusinga era obw’obulabe obuva mu mbeera eno.
• Enkola z’obujjanjabi zaawukana okusinziira ku mbeera y’omulwadde. Waliwo obujjanjabi obw'enjawulo okuva ku kulabirira okuwagira okutuuka ku kulongoosa .
• Wadde ng’embeera eno ya maanyi, abantu bangi bawona nga bajjanjabiddwa bulungi era nga balabirirwa bulungi . Kale toggwaamu ssuubi.

Bw’oba ​​ggwe oba omuntu gw’omanyi alina obubonero buno, nsaba olabe omusawo mu bwangu. Obujjanjabi nga bukyali busobola okutaasa obulamu!

` Necrotizing Pancreatitis, Pancreatitis, Okufa kw’olubuto, Okulumwa olubuto, Obulwadde bw’olubuto, Pancreatitis Sinhala, Endwadde z’olubuto