Me ako tātou mō ō awa au. He mea tino nui tēnei!

Kia ora! Kua whakaarohia e koe te hiranga o ngā awaawa iti rawa i roto i ō tātou tinana? Ko tētahi mea nui, engari kāore pea tātou e kōrero nui ana mōna, ko te awaawa au. Nō reira, i tēnei rā ka kōrerohia e tātou tēnei awaawa au i roto i ngā kupu māmā noa iho, he aha te mea, he aha te mea ka pā ki a ia, he aha ngā mate e pā mai ana, me pēhea te tiaki i a ia.

He aha te awa waikura? He aha tāna mahi?

Ki te kī māmā noa, ko te awaawa au he pūnaha ngongo angiangi e hono ana i ētahi okana i roto i tā tātou pūnaha nakunaku. He rite ki te paipa e kawe ana i te wai. Ko tana mahi matua he kawe i tētahi matū e kiia nei ko te 'au' i waenganui i ēnei okana. Ko tō tātou ate, ko te pūkahukahu, me te whekau iti, me ēnei awaawa au, e hanga ana i te pūnaha au . Nā, he aha i hiahiatia ai ēnei awaawa au? Me whai au tō tātou tinana mō ngā mahi maha. Ka āwhina ngā awaawa au ki te kawe haumaru i tēnei au mai i tētahi wāhi ki tētahi wāhi. He mea nui tēnei pūnaha ngongo mō te kawe i te au ki te tinana i ngā wā katoa, i ngā wāhi katoa, me te kore e pokanoa ki tētahi atu mea, me te kore hoki e whara i ētahi atu okana. Inaianei tirohia, ko tēnei au he wai i hangaia e tō tātou ate. Kei roto he momo matū e kiia nei ko ngā waikawa au . Koinei ngā mea e āwhina ana i a tātou ki te nakunaku i ngā ngako me ngā pūmua i roto i te kai e kainga ana e tātou. Engari he paku kaha ēnei waikawa au, ā, ka kino pea ki ngā okana kāore i te taunga ki a rātou. Waihoki, ka haere ētahi whākōkī nakunaku mai i tā tātou repeure mā roto i ēnei awaawa au. Waihoki, ki te kore e haere ki te wāhi tika, ka puta pea ngā raruraru.

He aha te hononga o tēnei awa au ki ō tātou whekau?

Whakaarohia he rite ki te rākau manga. Ka tīmata i tō tātou ate. Kei te taha matau o runga o tō tātou puku te ate. Kei roto i te ate he tino kikokore, he manga ngā awaawa aukume. Ka kiia ēnei ko ngā awaawa aukume intrahepatic . Ina hanga aukume te ate, ka kohia e ia mā roto i ēnei awaawa. Kātahi, ka honoa ēnei awaawa iti i roto i te ate hei hanga i ngā awaawa ate matau me te maui he nui ake. Ka puta mai ēnei awaawa e rua i te ate ka honoa hei hanga i te awaawa ate noa . Ko ngā awaawa i waho o te ate ka kiia ko ngā awaawa extrahepatic . Ināianei, ka honoa tēnei awaawa ate noa ki te awaawa cystic e puta mai ana i tō tātou pūkahukahu hei hanga i te awaawa aukume noa.Ka waihanga. Tata ki te haurua o te au e puta mai ana i te ate ka haere tika ki roto i tēnei awa au noa. Ko te haurua ka haere ki te pūkahukahu. Kei raro tonu i te ate te pūkahukahu. He rite ki tētahi putea iti e pupuri ana i te au. Ka rongoa i te au kāore e whakamahia ana i taua wā. Ka rongoa e te pūkahukahu kia tae rā anō ki te wā e hiahiatia ana e tō tātou whekau iti. Ina rongo tō tātou whekau iti kei reira ngā ngako me ngā pūmua hei nakunaku, ka tukuna he tohu ki te pūkahukahu. Kātahi ka whakawhāiti te pūkahukahu ka tukuna te au i te taha o te awa cystic ki te awa au noa. Mai i reira, ka haere te au ki te whekau iti. Ko tēnei awa au noa te awa au nui rawa atu kei a tātou. Tata ki te 10 henimita te roa. Ka peka mai ngā awa au katoa mai i tēnei. Ka hono atu hoki tō tātou awa pancreatic ki te wāhi kotahi e tuwhera ai tēnei awa au noa ki roto i te whekau iti, engari he awa motuhake. Kua mārama?

He aha ngā āhuatanga e pā ana ki ngā awaawa o te ate?

Āe, kia tirohia tātou he aha ngā momo mate ka pā ki tēnei pūnaha awaawa nui.

1. Mumura

Ka taea e ētahi mate me ētahi atu āhuatanga mumura te whakararu i ngā awaawa o te ate. Ka taea tēnei te noho mō te wā poto, te noho roa rānei. I te wā poto, ka taea e te mumura whakapeka te aukati i ngā awaawa me te aukati i te rere o te ate. Heoi, i te wā roa, ka taea e te mumura mau tonu te whakararu i te kiko i roto i ngā awaawa o te ate. Ka whakawhāitihia ngā awaawa e tēnei kiko whakapeka – ka kiia tēnei he stricture . I te mutunga, ka motuhia te rere o te toto, ā, ka pakaru ngā awaawa o te ate. Ka kiia tēnei mumura o ngā awaawa o te ate ko te cholangitis . Ka taea e ngā mate me ngā aukati te whakararu i te cholangitis whakapeka . Waihoki, ka taea e ngā mate pūnaha ārai mate te whakararu i te cholangitis mau tonu . Ko te Primary Biliary Cholangitis (PBC) me te Primary Sclerosing Cholangitis (PSC) ētahi o aua āhuatanga mau tonu.

2. Te aukati

Ko te tino take o ngā raruraru o te awaawa au ko te aukati . Ko tētahi o ngā mea tino noa ko ngā kōhatu au . He tioata ēnei kōhatu e puta mai ana i roto i te auawa au, i ngā awaawa au rānei. Ka āta tipu haere i roto i ngā tau maha. He maha ngā wā ka pakaru ngā kōhatu au ka haere ki roto i te awaawa au noa. Ka kiia tēnei mate ko te choledocholithiasis.Ki te nui haere ēnei kōhatu i roto i ngā awaawa o te ate, ka ārai pea i te rere o te ate. Waihoki, ko te whakawhāiti i ngā awaawa o te ate , arā, ko te whakawhāiti i ngā awaawa o te ate, ka ārai pea i te rere o te ate. Ka taea e te mumura roa te hanga kiko whara i roto i ngā awaawa o te ate, ka whakawhāiti i a rātou. Ko ētahi mate whānau – hei tauira , ko te atresia biliary me te Alagille Syndrome – ka taea hoki te whakaputa i tēnei mate.

3. Matepukupuku

Ko te mate pukupuku o te awaawa aukume e kiia ana ko te cholangiocarcinoma . Ka taea te whanake i roto i ngā awaawa o waho o te ate – koinei ngā mea tino kitea – i roto rānei i ngā awaawa o roto i te ate (ngā awaawa intrahepatic). He rerekē tēnei i te mate pukupuku ate. Heoi, ki te whanake te mate pukupuku ate, ka taea hoki e ia te kino i ngā awaawa aukume i roto i te ate mā te mumura, te aukati rānei.

Ka aha mēnā ka āraia te awaawa o te ate?

Pērā i te waikeri kua purua, ki te kore e taea e te au te rere i roto i ngā awa au, ka hoki whakamuri, ka tīmata te kohikohi ki roto i ngā whekau. Ka taea e tēnei te mumura me te kino ki aua whekau. Hei tauira, te mumura o te pūkahukahu ( cholecystitis ), te mumura o te pancreas ( gallbladder pancreatitis ), me te mumura o te ate me ngā awa au tonu. Ina mutu te rere o te au ( cholestasis ), ka nui ake te tūponotanga o ngā mate. He tino mamae, he morearea hoki ngā mate i roto i te pūnaha au. Ki te horapa ki te ate, ka taea e rātou te uru ki te toto ka puta te septicemia puta noa i te tinana, ka arahi ki tētahi āhuatanga morearea e kiia nei ko te sepsis .

He mea nui: He āhuatanga ohorere e morearea ana te mate o te Sepsis.

Waihoki, ina tīmata te turuturu o te aukume kua pūmau ki roto i te toto, ka pā mai he maha ngā mate. Ka pā mai pea te jaundice – he kōwhai o te kiri me ngā kanohi – te whakapairuaki, te mākūkū, ā, i ētahi wā he ngoikore te hinengaro (hepatic encephalopathy) . Kāore e taea e ngā awa aukume kua āraia te tuku tika i te aukume ki roto i te whekau iti. Ka pā mai pea ngā raruraru nakunaku. He uaua ki tō pūnaha nakunaku te nakunaku i ngā ngako me te mimiti i ngā huaora wairewa-ngako. Ka taea hoki e tēnei mimiti koretake te arahi ki te kore kai pai .

Me pēhea koe e mōhio ai mēnā he raruraru tō te awaawa o tōu?

He maha ngā wā ka āta haere te whanaketanga o ngā mate pūmau i roto i ngā tau maha. Nō reira, kāore pea koe e kite i tētahi tohu tae noa ki te pakaru nui o ō awaawa au. Heoi, ki te mea he mate whakapeka tōu, pērā i te aukati, te mate rānei, ka pāngia koe e ngā tohu e kiia nei ko te biliary colic . He aha te biliary colic?

• He mamae puku tēnei.
• He maha ngā wā ka haere tahi mai me te whakapairuaki , ā, i ētahi wā ka ruaki .
• Ka puta tēnei i muri i te kai i tētahi kai momona .
• Ka tīmata mārire te mamae, ka piki haere te kaha i roto i te haora, kātahi ka memeha anō i roto i tētahi atu haora, e rua rānei.

Ka puta tēnei momo mate pāwera o te ate ina ngana tō pūnaha ate ki te tuku i te ate ki roto i tō whekau iti hei āwhina i te nakunaku kai. Kātahi ka whakawhāiti te pūkahukahu, ka piki ake te pēhanga i roto i ngā awaawa ate. Mena kua pangia, kua āraia rānei ō awaawa ate, ko taua pēhanga te take o te mamae.

Kia maumahara: Ki te pāngia koe e ngā tohu o te mate biliary colic, ahakoa kāore i te tino kino, haere tonu ki te hōhipera . Mā ngā whakamātautau hauora ka taea te whakatau wawe i te raruraru. Ki te kore koe e pāngia e te mamae nui, engari he tohu kē atu e pā ana ki te pūnaha biliary, pērā i te jaundice , he tohu pea tēnei mō tētahi mate mau tonu.

Me pēhea te rongoā i te awaawa kōpū kua āraia?

He maha ngā tikanga e whakamahia ana e ngā tākuta hei kimi me te tango i ngā aukati i roto i ngā awaawa o te ate. Ko te tikanga e taunakitia ana māu ka whakawhirinaki ki tō āhua, ahakoa he roa, he tere rānei, me te tere o tōna mate.

• Te Kōparapara Retrograde Endoscopic (ERCP): He tikanga kore-pokanga tēnei. Ka whakauruhia he ngongo roa me te kāmera e piri ana (endoscope) mā te waha, ka tukuna ki te ara GI. Ka taea e te tākuta te mahi i ngā mea e tika ana mā tēnei endoscope.
• Te tūhura i ngā awaawa au: He tikanga pokanga tēnei. He maha ngā wā ka taea te mahi mā te whakamahi i ngā tikanga iti rawa te whakaekenga . Arā , ko te pokanga laparoscopic, e uru ana ki te hanga i tētahi, i ētahi rānei tapahi iti i roto i te puku. I ētahi wā ka mahia i te wā pokanga hei tango i te aukume mō ngā kōhatu aukume.

Ka taea e te tākuta te tapahi i te awaawa o te ate hei tango i te mea i aukatia, te whakauru rānei i tētahi stent hei pupuri i te tuwhera. I ētahi wā ka mahia ngā mea e rua. Mena he whānui rawa (kua whānui) ngā awaawa o te ate nā te mea kua pāngia, kua piko rānei, ka taea hoki e rātou te tango i ētahi wāhanga o ngā awaawa.

Me pēhea taku tiaki i aku awaawa waikura?

Ko te mōrearea nui rawa atu ki ō awaawa au ko ngā kōhatu . Ko te tino take o ngā kōhatu au ko te nui o te cholesterol i roto i te toto. Ka taea e te cholesterol tāpiri i roto i te toto te hanga i roto i ngā awaawa au, ka whakapakeke, ka hanga kohatu cholesterol. Ka taea e koe te whakaiti i tēnei mōrearea mā te whakaiti i te cholesterol i roto i tō kai . Ko te tuarua o ngā mōrearea nui ko te mate ate . Mena he mate ate mau tonu tōu, ka taea e koe te whakaiti i te kino ki tō ate me tō pūnaha au mā te whai i tētahi momo noho hauora.

• Whakakorikori tinana .
• Whakaitihia te nui o ngā ngako i roto i tō kai.
• Āta karohia te waipiro me ngā raau taero.

Ka nui te āwhina o ēnei.

He iti rawa ngā awaawa au, engari he tino pai te mahi a ēnei awaawa au mō ō tātou tinana. I ia rā, he maha ngā okana me ngā tukanga tinana e whakawhirinaki ana ki ēnei awaawa au. Ki te kore e taea e te au te tae ki te wāhi e tika ana, ka taea e ia te turuturu ki roto i te toto, ka pā ki te tinana katoa.

Ka pā pea ngā mate o te awaawa waikura ki ētahi atu okana o te pūnaha biliary. Nā reira, ka pā pea ngā raruraru o aua okana ki ngā awaawa waikura. Nō reira, ki te mea he tohu kei a koe e pā ana ki te pūnaha biliary, pērā i te kōroke biliary, te jaundice rānei, rapua tonutia he tohutohu hauora . Ka āwhina tēnei ki te tiaki i tō pūnaha biliary ngāwari, tae atu ki ngā awaawa waikura.

Nā, he aha ngā mea tino nui hei maumahara mā tātou i roto i ngā kōrero o te rā nei?

• He pūnaha iti engari he mea tino nui te awaawa au e kawe ana i te au i waenganui i te ate , te pūkahukahu, me te whekau iti.
• Ko ngā kōhatu o te pūkahukahu me te mumura ngā raruraru matua e pā ana ki ngā awaawa au.
• Kia tūpato mēnā ka pāngia koe e ngā tohu pēnei i te mamae o te puku (biliary colic) me te jaundice i muri i te kai i ngā kai momona.
• He mea tino nui te pupuri i tētahi kai hauora me te noho ora mō te hauora o ngā awaawa o te ate.
• Ki te puta mai ētahi tohu, mā te toro atu ki te tākuta me te rapu tohutohu tonu ka āwhina i a koe ki te karo i ngā raruraru nui.