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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.
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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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