Ngā mea me mōhio koe mō te Mate Pukupuku Hepatopulmonary!

Mena kei a koe, kei tētahi atu rānei e mōhio ana koe he mate ate, he mea nui rānei kia mōhio koe ki tēnei mate, ka uaua ai te manawa i ētahi wā. Ka kiia e mātou ko te Hepatopulmonary Syndrome. Tērā pea he ahua uaua te ingoa, engari kia māmā noa iho, me pēhea? Nā te mea he raruraru tēnei e haere ana mai i te ate ki ngā pukahukahu.

He aha rawa te Mate Pukupuku Hepatopulmonary?

Ki te whakarapopoto, he raruraru onge engari he kino te mate ate hepatopulmonary syndrome ka pā ki ngā pūkahukahu. Ko te tikanga o te kupu "hepato" he "e pā ana ki te ate." Ko te tikanga o te "pūkahukahu" he "e pā ana ki ngā pūkahukahu." I mōhio koe he hononga o te ate me ngā pūkahukahu e ngā uaua toto?

Whakaarohia, ina pāngia te tangata e te mate ate, inā koa he mate pēnei i te cirrhosis, ka pakari, ka mimiti te ate, ka whānui haere ētahi o ngā oko toto e hono ana ki ngā pukahukahu, kāore e tika. Pēnei i te pupuhi o te poihau. I roto i te rongoā, ka kiia tēnei ko te "Vasodilation" . Ina whānui haere ngā oko toto pēnei, ka rerekē te āhua noa o te rere o te toto i roto i ngā pukahukahu. I ētahi wā, kāore te toto e uru tika ki te hāora i roto i ngā pukahukahu, engari ka tika te haere mā roto i aua oko. Ko ēnei rere toto koretake ka kiia ko te "Shunts" . Ko te whānui haere o ngā oko toto i roto i ngā pukahukahu nā te "Vasodilation", ā, ka heke te taumata hāora i roto i te toto nā aua "Shunts". Ka kiia tēnei ko te "Hypoxemia" . Kei te mārama koe?

He aha te pānga o tēnei mate ki a koe? He uaua ki a koe te manawa?

Inaianei pea kei te whakaaro koe, "Āe, he aha te pānga o tēnei ki ahau?" Ko te mea nui e pā ana ki tēnei ko te uaua ki te manawa (Dyspnea) . Kāore tēnei e puta ohorere mai, engari ka piki haere. Kāore pea ētahi e tino kite i te tīmatanga. Engari i roto i te wā, ka tino kino rawa atu tēnei āhuatanga, ā, ka uaua ki te manawa ahakoa e tū tonu ana.

He uaua ki ētahi te manawa i a rātou e noho ana, e tū ana rānei, engari ka pai ake te ahua ina takoto. Mō ētahi atu, he rerekē te āhua; he uaua ki a rātou te manawa ina takoto, ā, ka pai ake te ahua ina noho. Heoi, nā te mea ka kino haere tēnei poto o te manawa i roto i te wā, ka kiia e mātou ko te Chronic Respiratory Breakdown. Ko te tikanga o tēnei, kāore ngā mea katoa e mutu ohorere, engari ka āta haere, kāore e nui te hāora e whiwhihia ana e ngā whekau me ngā kiko o tō tinana. Ka kiia e mātou tēnei ko te hypoxia .

He tino morearea tēnei āhuatanga. E mōhio ana koe ki te aha? He mea nui te hāora mō ō tātou tinana. Ina ngaro rawa, ka pā he kino tuturu ki ngā whekau nui pērā i te roro me te ngākau. Ki te kore e rongoatia tika, ka tūpono tēnei āhuatanga ki te ora.

Ko wai te mea ka nui ake te tūponotanga ka pāngia e te mate pūkahukahu?

Kua kitea e ngā rangahau tata ki te hauwhā, ara 25%, o te hunga whai mate ate mau tonu ka pāngia e te mate hepatopulmonary syndrome. Ka pā anō hoki tēnei ki ngā take o te ngoikore o te ate ohorere, e kiia nei ko te ngoikore o te ate whakapeka, engari he iti ake te kitea.

I te nuinga o te wā, koinei te mea ka tupu: Ka piki ake te pēhanga i roto i ngā oko toto e hono ana ki te ate nā te cirrhosis o te ate. I roto i te rongoā, ka kiia e mātou ko te "Portal Hypertension" . Ko te mate "Portal Hypertension" te mea e whānui ai ngā oko toto i roto i ngā pukahukahu i roto i ētahi tāngata, ka puta ai tēnei mate hepatopulmonary. Heoi, he tino onge, ka puta te "Portal Hypertension" nā ētahi atu take, pērā i te toto totoka, ā, ka puta anō hoki tēnei mate mā roto i tēnā.

He aha te tino take mō tēnei?

Ina hoki, kāore anō kia tino mōhiotia e ngā kaipūtaiao he aha i whānui ai ngā oko toto i roto i ngā pukahukahu (vasodilation) i roto i ētahi tāngata i tēnei āhuatanga, e kiia nei ko te portal hypertension. He maha ngā ariā me ngā whakaaro mō tēnei mea. Kāore anō hoki i te tino mārama he aha kāore e pā ki te katoa, engari ki ētahi tāngata anake. Te āhua nei kāore e pā tika ana ki te kaha o te mate ate.

Engari kotahi te mea e mārama ana. Ko te whakanui i te toto i roto i ngā pūkahukahu ka heke te nui o te hāora i roto i te toto (Hypoxemia). He kupu ngāwari noa iho, he kore taurite i waenga i te nui o te hau e tomo ana ki ngā pūkahukahu me te nui o te toto e rere ana i roto i ngā pūkahukahu. Koinei te take kāore te tinana e whiwhi i te nui o te hāora e hiahiatia ana.

He aha ngā tohu? Me pēhea tātou e mōhio ai ki tēnei?

Mena kāore te āhua o te Hepatopulmonary Syndrome i te tino kino, tērā pea kāore koe e kite i tētahi tohu. Ko te tohu tuatahi e pāngia ana e te tini tāngata, e ai ki te kōrero i mua ake nei, ko te uaua ki te manawa (Dyspnea) . Heoi, he maha ngā take e uaua ai te manawa. Ka pāngia te tangata whai mate ate e te uaua ki te manawa i ngā huarahi maha. Nō reira, i ētahi wā, kāore pea ngā tūroro me ngā tākuta e mōhio tonu he tohu tēnei o te Hepatopulmonary Syndrome.

I te kino haere o te āhua, ka pāngia pea koe e ētahi atu tohu pēnei i:

• Platypnoea: Koinei te wā e uaua ai koe ki te manawa ina noho, ina tū rānei koe, engari ka rongo koe i te marino ina takoto koe.
• Orthopnea: Koinei te ritenga kē. He uaua te manawa ina takoto, engari he pai ake ina noho ake.
• Cyanosis: He tae kikorangi o ngā ngutu, o ngā maikuku, me te kiri i ētahi wā nā te korenga o te hāora ki te tinana. He tohu kitea tēnei.
• Ngā matihao e piri ana ki te karapu:He ahua pupuhi, he pūkohu hoki ngā pito o ngā maihao me ngā matimati, pērā i ngā pito o te rākau pahu. He tohu anō tēnei o te koretake o te toto.

Haunga ēnei tohu, tera pea ka pāngia koe e ngā tohu e rite ana ki te mate ate me/ranei te toto toto tiketike. Hei tauira:

• Ngā angiomas pungawerewere: He iti, he whero, he rite ki te pungawerewere ngā oko toto e puta mai ana i raro i te kiri.
• Ngā uaua varicose: Ka kitea ngā oko toto kua nui haere i roto i te puku, i te korokoro rānei.
• He hītori o te toto puku o mua.
• Ascites (pupuhi o te puku)

Me pēhea te tautuhi a ngā tākuta i tēnei?

Ka kitea tēnei mate pūkahukahu e ngā tākuta ina puta ngātahi ngā tohu matua e toru:

1. Te Toto Toto Nui: Ka puta pinepine tēnei me te mate ate.

2. Te whakawhanuitanga o ngā uaua o roto i te pūkahukahu: Ko te tikanga o tēnei kua whakawhanuitia ngā uaua toto i roto i ngā pūkahukahu.

3. Te hekenga o te taumata hāora i roto i te toto (Hypoxemia) .

I te nuinga o te wā, ina pāngia koe e tēnei `(Hepatopulmonary Syndrome)`, kua kitea kētia e ō tākuta he mate ate `(Liver Disease)`, `(Portal Hypertension)` rānei tōu. Ki te kore, ka mahi tuatahi tō tīma hauora i ngā matawai me ngā whakamātautau toto hei tirotiro mēnā he kino te ate. Kātahi ka tirohia e rātou ngā uaua i roto i ō pukahukahu, ka ine i te nui o te hāora i roto i ō toto. Ka taea e ēnei whakamātautau te whakaatu mārama kei te whānui haere ngā uaua toto i roto i ō pukahukahu `(Vasodilation)`, e hua ai te iti o te hāora i roto i ō toto `(Hypoxemia).`

He aha ngā whakamātautau motuhake e mahia ana mō tēnei?

He maha ngā whakamātautau ka mahia e ngā tākuta hei whakaū i tēnei mate. Ko ētahi o aua whakamātautau ko:

• Te ine i te manawa: Kua oti pea tēnei i a koe i mua. He whakamātautau tino māmā, kāore he mamae. Ka tāpirihia he taputapu iti, he rite ki te topenga, ki te pito o tō maihao. Ka whiti te mārama mā roto i tō maihao, ka ine i te nui o te mārama e puta mai ana i tērā taha, e whakamahia ana hei ine i te nui o te hāora kei roto i tō toto (Te Matūkai Hāora). He whakamātautau taketake tēnei.
• Hau Toto Arteri (ABG): Mena ka whakaatuhia e te pulse oximetry he iti te hāora o roto i tō toto, ko te whakamātautau e whai ake nei ko te ABG. He taipitopito ake tēnei. Ka tangohia he tauira toto iti mai i te uaua i roto i tō ringaringa . Ka whakamatautauria te tauira toto hei whakatau i te nui o te hāora kua rewa i roto i tō toto (PaO2). He ine tēnei mō te pai o te mimiti o te hāora e ō pūkahukahu ki roto i ō toto.
• Te Echocardiography rerekē:Koinei te tikanga hihi-X pai rawa atu hei kimi i ngā uaua pūkahukahu kua whānui. He ultrasound te echocardiogram. Ka whakamahia ngā ngaru oro auau-teitei hei tango pikitia o tō ngākau me ngā uaua i roto i ō pūkahukahu. I roto i te ultrasound whakarei-whakawhitinga, ka werohia he kaihoko whakawhitinga, he wai motuhake, ki roto i te uaua kia kitea ake ai ngā uaua. Ina whiwhi koe i te echocardiogram whakawhitinga, ka werohia e te tohunga hangarau he otinga tote kua whakaohokia ki roto i tō uaua. He otinga tēnei mā te tāpiri i ngā mirumiru hau iti ki te wai tote. Kātahi ka mātakitaki rātou mēnā ka neke ēnei mirumiru iti mai i te taha matau o tō ngākau ki te taha maui i roto i te wā (cardiac shunt matau ki maui). Mā tēnei ka taea e rātou te kī atu mēnā kei a koe te `(Hepatopulmonary Syndrome)` kāore rānei.

Me pēhea te rongoā mō tēnei?

Ko te hāora tāpiri anake te rongoā o nāianei mō te mate pūkahukahu. Ko te whakaora hāora ko te manawa i te hāora 100% hei āwhina i tō tinana. Me tiki hāora pea koe mai i tētahi rūma pēhanga i roto i te hōhipera, e kiia nei ko te whakaora hāora hyperbaric. Mēnā rānei, ka hoatu pea he taputapu ka taea e koe te kawe ki te kāinga, pērā i te kopare hāora. Ka taea e te hāora te āwhina i te whakaiti i ngā tohu, inā koa ko te poto o te manawa, me te pupuri i te mahi tika o ngā kiko o tō tinana mā te whakarato i te hāora e hiahiatia ana e rātou.

Ka hoki anō te mate pūkahukahu? Ka taea te whakaora katoa?

Ko te rongoā anake mō tēnei mate pūkahukahu hepato ko te whakawhitinga ate . Ae, i tika tāu i rongo ai. I muri i te whakawhitinga ate angitu, ka huri haere te whānui o ngā oko toto i roto i ngā pūkahukahu (vasodilation) me te kore o te hāora i roto i te toto (hypoxemia). Ko te tikanga ka pai ake. E ono ki te tekau mā rua marama te roa ka hoki anō te mahi a ō pūkahukahu ki te āhua noa.

Heoi, kāore te katoa e āhei ki te whakawhitinga ate. He maha ngā take mō tēnei. Ahakoa e āhei ana rātou, tera pea ētahi wā me tatari roa rātou kia whiwhihia he ate. Nō reira, he rite tēnei whakaoranga ki te whakataetae ki te wā.

He mea whakamate tēnei? Ā, me pēhea te wā ora?

Mena kei a koe te Mate Hepatopulmonary, tera pea kua pāngia koe e te Mate Ate Mau tonu. Ko te mate ate mutunga-wāhanga he mate ka mate pea mēnā kāore he whakawhitinga ate. Ko te Mate Hepatopulmonary tētahi o ngā pānga taha me ngā raruraru e pā mai ana. He tokomaha te hunga kāore e mate i te Mate Hepatopulmonary, arā, te kore o te hāora (hypoxemia), engari ka whai wāhi atu hoki ki tō rātou hauora whānui, ā, ka whakapoto i ō rātou oranga.

Ko te roa o te oranga me te Mate Hepatopulmonary e whakawhirinaki ana ki ngā mea maha. Kei roto i tēnei ko te kaha o tō mate ate, tō hauora whānui, me te mea kei a koe ētahi atu mate hauora. I te toharite, ko te tangata e pāngia ana e te cirrhosis o te ate engari kāore he Mate Hepatopulmonary ka ora mō te whitu tau me te kore he whakawhitinga ate. Heoi, mō te tangata e pāngia ana e te cirrhosis me te Mate Hepatopulmonary, ka taea te whakaiti i te roanga o te oranga toharite me te kore he whakawhitinga ate ki te rua tau.

Tērā pea ka pāngia ētahi tāngata e te mate pūkahukahu ngawari, kāore i te tino kino pērā i te mate ate. Tērā pea ka roa ake tō rātou oranga mā te rongoā tautoko. Waihoki, tērā pea kāore ētahi tāngata e ora i te whakawhitinga ate mēnā he kino rawa tō rātou mate. Ko te toharite o te oranga mō ngā tau e rima mō te hunga whai mate pūkahukahu kua angitu te whakawhitinga ate he 70%. He iti ake tēnei i te whānui o te oranga i muri i te whakawhitinga ate (75%).

He rerekē te pānga o te mate ate ki te katoa. He mate onge, he mate whakamate pea te Hepatopulmonary Syndrome, ā, ka pā pea ki a koe. Kāore pea koe i rongo mō tēnei mate tae noa ki te pā ki a koe, ki tētahi rānei e tata ana ki a koe.

He iti noa iho, kāore rānei he tohu o te tokomaha. Engari mō ētahi, inā koa ko te hunga kua ngoikore kē te hauora, ka rite pea tēnei ki te "kōrere whakamutunga." Pērā i te mate ate, ka kino haere te mate pūkahukahu (HPS) i te roanga o te wā. Mena kei te rārangi tatari koe mō te whakawhitinga ate, ka piki ake tō rārangi ina kitea he HPS koe. Nā te mea e mōhio ana ngā tākuta ka taea e tēnei mate te whakapoto i tō roanga oranga me te whakaiti i tō kounga oranga - ā, e mōhio ana rātou ka taea e te whakawhitinga ate te whakaora. I tēnei wā, mā te haere tonu o te rongoā hāora ka āwhina i a koe kia whiwhi i te whakamarie me te āwhina i a koe kia roa ake te ora.

Hei whakamutunga, ko ētahi mea nui me maumahara koe

Nō reira, ko tāku tumanako kua mārama ake ki a koe ngā kōrero kua kōrerotia e tātou mō te Hepatopulmonary Syndrome. Kia maumahara ki ēnei kōrero:

• He āhuatanga onge tēnei engari he āhuatanga kino pea o te mate ate .
• Ko te tohu matua ko te uaua ki te manawa (dyspnea) , inā koa mō te tangata he mate ate tōna.
• Mena ka uaua te manawa o te tangata he mate ate tōna, me whakapae hoki ki tēnei mate (Hepatopulmonary Syndrome), ā, me whakamōhio atu ki te tākuta.
• Ko te whakawhitinga ate anake te maimoatanga whakaora e wātea ana i tēnei wā.
• Kia tae rā anō ki te wā e wātea ai taua maimoatanga, ka taea e te hāora whakaora te āwhina i te whakahaere i ngā tohu me te pupuri i te ora.
• Mena kei a koe, kei tētahi rānei e mōhio ana koe, he mea nui kia toro atu koe ki te tākuta tonu mō ētahi tohutohu. Nā te mea, ki te kitea wawe, ka māmā ake te whakahaere me te whakarite mō ētahi atu maimoatanga. Kaua e mataku, engari he pai ake te tūpato.

Te mate ate, te mate pūkahukahu, te uaua ki te manawa, te kore o te hāora, te cirrhosis, te whakawhitinga ate