He aha tēnei (te mate pukupuku a Boerhaave)?
Ki te kī māmā noa, ko tēnei `(Boerhaave's Syndrome)` he āhua e pakaru ohorere ai te pakitara o tā tātou paipa kai, arā, te `(esophagus),`. Ka puta tēnei ina he nui te pēhanga e kore e taea te whakaaro, arā, he pana, ki roto i te paipa kai. Hei whakamārama, ko te mea pea ka puta tēnei ina ruaki kaha koe , ina whakapau kaha rānei koe i tētahi atu huarahi. Ka karangahia hoki tēnei e ngā tākuta ko te `(effort rupture)`, ko te `(spontaneous rupture)` rānei, nā te mea ehara tēnei i te mea e pā tika ana ki te paipa kai. He tino onge tēnei āhua, arā, e pā ana ki te 0.0003% o te taupori. Heoi, 15% o ngā aituā paipa kai katoa nā tēnei `(Boerhaave's Syndrome)`.He aha te rerekētanga i waenganui i te (Syndrome a Boerhaave) me te (Syndrome Mallory Weiss)?
Inaianei kei te whakaaro pea koe, 'Koinei te mea kua rongo ahau i taku rongonga mō te haehae i roto i te korokoro?' He rerekētanga iti kei waenganui i ngā mea e rua. Ko te haehae Mallory Weiss he haehae e puta ana ina ruaki kaha koe, ina pēhi rānei koe. He haehae i roto i te arai o te korokoro. He mea noa ēnei e rua i roto i te hunga e inu nui ana i te waipiro . Ka ruaki toto pea te tangata whai roimata Mallory Weiss. Heoi, kāore te korokoro e pakaru katoa. Heoi, he kino ake te mate o Boerhaave. He haehae tēnei e toro atu ana puta noa i te matotoru katoa o te pakitara korokoro. Ka kiia hoki e ngā tākuta he haehae whakawhiti. Ina pakaru katoa, me whakatika mā te pokanga ohorere . Ka taea te waiho hei āhuatanga ora, mate rānei.Ka ahatia ina pahū te ngongo kai?
Whakaarohia te mea ka tupu ina pahū tō tātou korokoro. He āhuatanga ohorere tūturu tēnei, ā, ki te kore e rongoatia wawetia , ka mate pea . E mōhio ana koe he aha? Ko tō tātou korokoro he wāhanga o tō tātou pūnaha nakunaku (ara nakunaku). Nō reira, ina pahū te korokoro, ka turuturu ngā matūkai, ngā huakita, me ngā matū nakunaku ki roto i te kōhao o tō tātou uma, ki te kōhao puku rānei. Ki te tupu tēnā, ka pā mai ngā mate huakita kino .Ki te uru tēnei mate ki roto i te toto o tō tātou tinana katoa, ka puta pea ngā āhuatanga e kiia nei ko te "septicemia" me te "sepsis". He tauhohenga morearea tēnei "sepsis". Ka taea e ia te arahi ki te "oho ohorere", te ngoikore o ngā okana maha, ā, i te mutunga ka mate.
Ko wai te mea tino pāngia e tēnei?
Ka taea e te tangata katoa te pāngia e tēnei `(Boerhaave's Syndrome). Heoi anō,He mea tino noa tēnei i roto i ngā tāne me te hunga neke atu i te 50 tau te pakeke. Tata ki te 80% o te hunga e pāngia ana he tāne waenga-pakeke. He mea noa anō hoki tēnei i roto i te hunga e inu nui ana i te waipiro .He aha ngā tohu o te mate Boerhaave?
Āe, kia tirohia tātou he aha ngā tohu o te `(Boerhaave's Syndrome)`. He mea tino nui kia mōhio ki ēnei.- Te mamae ohorere, te mamae nui o te uma. Koinei te tohu matua.
- Whakapairuaki me te ruaki . I ētahi wā ka puta te toto i roto i te ruaki.
- Kāore he aha te mamae i te wā e horomia ana, e maremare ana rānei.
- Ka poto ake, ka tere ake te manawa .
- Ka kī ngā kiko o te uma i te hau, i te wai rānei, ka pupuhi.
- Kei te piri tōku puku, pērā i te toka.
- Ngā tohu o te mate pāwera pērā i te kirika me te werawera .
Mena ka puta ohorere mai tētahi, ētahi rānei o ēnei tohu, inā koa i muri i te ruaki nui, he mea tino nui kia rapu tohutohu hauora tonu atu .
He aha te āhua o te mamae?
He pēhea te kaha o te mamae o te `(Boerhaave's Syndrome)`? E ai ki ētahi he mamae tino kore e taea te manawanui. Ka pā te mamae ki te wāhi i pakaru ai. I te nuinga o te wā, ka puta tēnei pakaru ki te tuatoru o raro o tō tātou korokoro. Arā, i waenganui i te kōhao o raro o te uma me te kōhao o runga o te puku. Heoi anō, ka taea hoki te teitei ake i tērā. Ka taea hoki e tēnei mamae te horapa ki te tuara, ki ngā pakihiwi rānei .He aha ngā raruraru ka pā mai?
He maha ngā pānga taha ka pā mai mēnā kāore tēnei mate e whakahaeretia tika ana:- Te mumura me te pupuhi i roto i te kōhao o tō uma.
- Te kohikohinga o te pūkahukahu i roto i te uma (empyema)
- Te hau kua mau i roto i te uma, i roto rānei i ngā kiko i raro i te kiri.
- Te rerenga wai i roto i te uma ( te pupūnga wai i roto i te uma)
- Te Mate Pōuri Manawa Whakapeka ( ARDS )
- Te mate pāwera, te mate pāwera, me te ohorere. Ka taea e ēnei te whakararu i te ora.
He aha ngā take o te mate Boerhaave?
He aha i puta ai te Mate Pukupuku a Boerhaave? E rua ngā take matua mō tēnei. Ko tētahi , ka piki ake te pēhanga i roto i te korokoro nā te taumahatanga rerekē, te taumahatanga rānei . Ko tētahi, ina kore te uaua cricopharyngeus i te tihi o tō tātou korokoro (te sphincter esophageal o runga) e whakangāwari hei whakautu ki tēnei pēhanga, ka puta he pēhanga kino i waho o te korokoro .Ko te tino take o tēnei `(Boerhaave's Syndrome)` ko te ruaki nui, te ruaki tonu rānei . Hei tāpiri, ko te whānautanga, ko te wiri, ko te hiki taumaha, me te horomi i ngā matū whakakā, whakakino rānei. I te nuinga o te wā, i roto i ēnei āhuatanga, me whakangāwari ngā tohu io i te `(cricopharyngeus muscle)` me te tuku i te pēhanga ki roto. Heoi, i roto i te `(Boerhaave's Syndrome)`, mō ētahi take kāore tēnei taunga io `(neuromuscular coordination)` e mahi tika ana.Ka pāngia te whakamahinga o te waipiro?
Ka taea e te inu waipiro te pakaru o te korokoro? He take mōrearea te inu nui i te waipiro . Ko te momo tino noa o te Mate Boerhaave ko te ruaki i muri i te kai nui, i muri rānei i te inu waipiro. Ko te mate whakamahi waipiro, te kai nui, me te bulimia he take mōrearea. Ko ētahi atu take mōrearea ko ngā mate hauora kei roto i te korokoro, pērā i te esophagitis me te eosinophilic esophagitis, te esophagus a Barrett, me te mate pukupuku peptic. Heoi, ko te nuinga o te hunga e pāngia ana e te Mate Boerhaave he korokoro noa iho.He pehea te mate o Boerhaave's Syndrome?
He uaua te tautuhi i te Mate Boerhaave, engari he mea nui kia kitea tonutia . He māmā ake te tautuhi ina toru ngā tohu, e mōhiotia ana ko te Mackler triad. Ko ēnei: 1. Te ruaki nui, te ruaki tonu rānei. 2. Te tīmatanga ohorere o te mamae o te uma. 3. Te emphysema i raro i te kiri. Ko tēnei tohu whakamutunga he tohu nui mō te pakaru o te esophagus. Heoi, ehara i te katoa ka pāngia e ēnei tohu tawhito. Mena ka puta te pakaru i tētahi wāhi rerekē, ka pāngia pea koe e te mamae i tētahi wāhi rerekē, pērā i te kaki, i ngā wheua kaki rānei. Tērā pea nā tētahi mea ehara i te ruaki, ka haere tahi rānei me ngā pānga taha rerekē. Mā te hihi-X o te uma ka kitea pea he tohu, engari me whai whakamātautau whakaahua tairongo ake hei tautuhi i te mate.Ngā whakamātautau hihi-X e whakamahia ana mō te tautuhi mate
He aha ngā whakamātautau hihi-X e whakamahia ana hei tautuhi i te "Boerhaave's Syndrome"?`(Esophagram)` (Esophagram)
Ina whakapae te tākuta kei te mate a Boerhaave, ko te mea tuatahi ka mahia e rātou ko te tango i te hihi-X. Ka whakamahia e rātou he tae rerekē. Ka kiia hoki tēnei he esophagram. He whakamātautau tere tēnei, kāore e pokanoa, ā, he tino tika. Mō tēnei whakamātautau, ka inu koe i tētahi otinga kei roto he tae rerekē wairewa-wai. Mā tēnei ka kitea te roto o tō paipa kai i runga i te hihi-X. Mena he haehae, ka taea e rātou te kite i te wāhi e turuturu ana te tae rerekē.(Matawai CT)
Mena kāore e taea te whai i tētahi esophagogram, ki te hiahia rānei tō tākuta i ētahi atu kōrero mō ngā whekau e karapoti ana, ka taea te mahi i tētahi matawai CT. Ahakoa kāore e taea te whakaatu i te wāhi tika o te roimata, ka taea e ia te kite i ngā tae rerekē, i te hau rānei kua turuturu ki roto i ngā kiko e karapoti ana mai i te esophagus. Ka taea hoki te whakamahi hei kimi i te wai e pupū ake ana i roto i te uma, i te puku rānei e hiahia ana kia ringihia.Me pēhea te rongoā i te Mate Boerhaave?
Āe, me titiro tātou me pēhea te rongoā i te `(Boerhaave's Syndrome)`. Anei ngā mahi hei whai:- Te hoatu wai i roto i te uaua (wai IV): He tokomaha ngā tāngata e matewai ana, nō reira me hoatu wawetia ngā wai IV.
- Paturopi : Ka hoatu ngā paturopi whānui-ahu ki roto i te uaua hei whakahaere i ngā mate pāwera.
- Kōrero mō te pokanga: Mō te nuinga o te tangata, ko te pokanga te maimoatanga paerewa. Ko ētahi tāngata he iti noa ngā whewhe, ā-rohe, ka taea te rongoā me te kore pokanga, mā te tirotiro me ngā paturopi IV, te endoscopy rānei. Heoi, ahakoa i roto i ēnei take, ka whai mahere ā-tau ngā tākuta mō te pokanga.
- Whakatikatika pokanga: He pai ake te whakatika i te pakaru i roto i ngā haora 24 o te pakaru. I runga i tō āhua, ka whakamahia pea e tō tākuta he pokanga iti rawa te whakaekenga. Hei tauira, he pokanga thoracoscopic ataata-āwhina (VATS). I ētahi āhuatanga ohorere, ka hiahiatia pea he thoracotomy tuwhera kia tere ai te uru atu ki te kōhao o te uma.
- Te tango wai/te tango i te wai: Haunga te whakatika i te roimata, me tango wai, me te patu huakita te wai pangia kua kohia ki roto i te kōhao. Me tango atu hoki ngā kiko pangia, mate rānei (necrotic). I ētahi wā kino, me tango pea tētahi wāhanga o tō korokoro.
- Te whakahaere matatau: Ki te kore e taea te pokanga i roto i ngā haora 24 o te pakaru, tērā pea kāore e angitu te whakatika tika. Tērā pea kua tīmata te pakeke, te kino rānei o ngā taha o te patunga. Ki te tupu tēnei, me tango pea e tō tākuta tētahi wāhanga, tō esophagus katoa rānei (esophagectomy). Ki te hiahia koe ki tētahi whakakapinga esophagus, ka taea tēnei i muri i ngā wiki e ono.
- Ngā tikanga whāngai rerekē: Kia ora rā anō tō paipa kai, e kore e taea e koe te horomi kai mā roto, nō reira me whiwhi koe i te kai mā tētahi atu ara. Mā te ngongo, mā te uaua rānei tēnei.
He aha te tūmanako mō te whakaoranga?
He aha te āhua o te mate mō te tangata e pāngia ana e te "Syndrome Boerhaave"? Ko te tautuhi me te maimoatanga wawe ngā mea tino nui ka taea e koe te mahi hei ārai i ngā raruraru, tae atu ki te mate, mai i te mate.. Ko te hunga e whiwhi maimoatanga i roto i ngā haora 24 ka taea te tumanako ka ora pai, me te 75% te tūponotanga ka ora. I muri i ngā haora 24, ko te tūponotanga o te mate he neke atu i te 50%, ā, i muri i ngā haora 48 he 90%. I te katoa, ko te reiti mate he tata ki te 35%. Ko te hunga e whiwhi maimoatanga wā tika me te angitu ka taea te ora katoa, engari ka roa pea ētahi marama. He mate onge engari he tino rerekē te `(Boerhaave's Syndrome)` e waiho ana he maha ngā mea hei whakaaroaro . Ka puta ohorere mai, me te kore he tohu whakatūpato - engari ko te inu nui tonu he tohu whakatūpato mārama ka taea e tātou te ārai. Kāore mātou e mōhio ki ngā mea katoa mō te `(Boerhaave's Syndrome)`. Kāore mātou e mōhio he aha te korenga o te korokoro e tiaki i a ia anō mai i te kino i roto i ēnei take. Engari e mōhio ana mātou ka taea te whakamate mena ka kore e kitea me te rongoatia wawe.Ngā mea tino nui me maumahara koe
Āe, kua mārama ake koe ināianei ki tā tātou i kōrero ai, arā, te "Boerhaave's Syndrome". Anei ētahi o ngā mea nui hei maumahara māu:- Ko te Mate a Boerhaave he āhuatanga ohorere hauora e hua mai ana i te pakaru o te korokoro.
- Ka puta pinepine tēnei i muri i te ruaki nui .
- Ko ngā tohu matua ko te mamae ohorere, te mamae nui o te uma, te ruaki, me te uaua ki te horomi .
- He nui ake te mōrearea o te hunga e inu nui ana .
- Ki te pāngia koe e ngā tohu , rapua tonutia he tohutohu hauora . Ko te wawe o te tīmatanga o te maimoatanga, ko te nui ake o te tūponotanga ka ora koe.
- He maha ngā wā e hiahiatia ana te pokanga hei maimoatanga.
He mea nui kia mōhio koe ki tēnei mate. Mēnā ka pāngia koe, tētahi atu rānei e mōhio ana koe, kaua e warewaretia. Me toro atu ki te tākuta tonu.
Te mate Borrego, te pakaru o te korokoro, te mamae o te uma, te ruaki, te waipiro, te pakaru o te korokoro, te toru o ngā Meckler, te sepsis, te pokanga korokoro
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