Te pānga tika o te mate ate ki ngā whatukuhu: Me ako tātou mō te Hepatorenal Syndrome!

Kua whakaaro koe i mua ka mutu te mahi a ō whatukuhu hauora e rua i te wā kotahi nā te raruraru nui o tō ate? He whakaaro whakamataku tēnei, kāore? I tēnei rā ka kōrero tātou mō tētahi mate kino, mōrearea hoki ka pā mai i te ngoikore o te ate. Koinei te ingoa o ngā tākuta ko te Hepatorenal Syndrome (HRS) . Me titiro tātou ki te aha, te take e puta ai, me ētahi atu mea ka taea e tātou te mahi.

He aha te Mate Hepatorenal?

I te whakarapopototanga, ko te mate hepatorenal syndrome (HRS) he āhuatanga e kore ai tō ate e mahi tika, he raruraru tino kino e puta ana i ngā wāhanga whakamutunga o te ngoikore o te ate. Ko te mea ka tupu i tēnei take ko te ngaro ohorere o te mahi a ō whatukuhu nā ngā raruraru ate. Ko te mea motuhake ko te whakaaro he ngoikore whatukuhu ūkui tēnei i mua i te whatukuhu . Ko te tikanga ka pāngia koe e tēnei āhuatanga ahakoa kāore he mate whatukuhu o mua, ā, kāore he huringa tinana, he kino rānei ki ō whatukuhu. Ahakoa he tino hauora ō whatukuhu, engari nā te raruraru ate, ka pakaru te rere o te toto ki a rātou, ā, kāore e taea e rātou te mahi i tā rātou mahi.

Whakaarohia he rite ki te papu wai e mahi pai ana, engari ki te aukatia te paipa wai ki te tāke wai, e kore te wai e puta. Kei te pai ngā whatukuhu, engari nā ngā raruraru o te ate ka aukatia, ka whaiti hoki ngā oko toto e kawe ana i te toto ki ngā whatukuhu. Kātahi, kāore ngā whatukuhu e whiwhi i te toto e hiahiatia ana e rātou, ā, ka heke haere te mahi a tā rātou mahi. E kiia ana tēnei he āhuatanga ohorere , ā, i te nuinga o te wā, ko te rongoā tuturu anake mō tēnei ko te whakawhitinga ate .

Ko wai te mea tino pāngia e tēnei āhuatanga?

Ko tēnei mate, e kiia nei ko te hepatorenal syndrome (HRS), ka pā nui ki te hunga e mate kino ana ki te ate . Ina koa, ko te hunga e mate ana i te mate ate mau tonu, e whanake haere ana, ā, kua ngoikore haere te ate i roto i te wā, ko rātou te hunga tino mōrearea ki tēnei mate. I mōhio koe nā tēnei mate ate roa, ka pakaru te kiko o te ate, ka mārō te ate. Ka kiia tēnei ko te cirrhosis . Nā tēnei mate, ka rerekē te rere o te toto ki te ate, ā, i roto i te wā, ka mutu te mahi a te ate.

Waihoki, mēnā he ngoikore o te ate ka puta ohorere mai i tētahi takeHeoi, ka taea te puta te HRS. Kua whakaatuhia e ngā rangahau ka taea te puta te HRS i roto i te 40% o te hunga e pāngia ana e te mate ate mutunga-wāhanga. Ahakoa ka taea te puta i ngā tau katoa me ngā ira tangata katoa, he nui ake te kitea i roto i te hunga i te haurua tuarua o ō rātou oranga. Ka puta hoki i roto i te 10% o te hunga e noho ana ki te hōhipera nā te ngoikore o te ate mau tonu, whakapeka rānei. Ahakoa he maha atu i te kotahi ngā take o te ngoikore o te whatukuhu nā te mate ate, he ahurei te HRS nā te mea ka puta i roto i te hunga kāore he mate whatukuhu o mua.

He aha te take o te mate hepatorenal i te cirrhosis?

He take uaua tēnei. He rerekē tonu ngā whakaaro o ngā kairangahau mō te āhua o te mate ate e puta ai te mate hepatorenal syndrome (HRS), arā, tōna pathophysiology .

Me pēhea tēnei e tupu ai? (Pathophysiology)

E mōhio ana tātou, ka puta te ngoikore o te whatukuhu ina whaiti, ka ārai, ka heke te rere o te toto ki roto i ngā whatukuhu. E whakapono ana ngā kairangahau ko te whaiti o ngā oko toto nā te huinga o ngā āhuatanga e pā ana ki te mate ate me te ngoikore o te ate. Ko te tino take o tēnei ko te toto toto tiketike .

Ko te toto toto tiketike o te tomokanga he āhuatanga e piki ake ai te toto i roto i te uaua tomokanga, te uaua matua e rere ana i roto i tō ate, me ngā uaua e hono ana ki reira, e toro atu ana puta noa i tō pūnaha nakunaku. Ko te tino take o tēnei ko te cirrhosis . Ka taea hoki e te cirrhosis te whakaputa i tētahi āhuatanga e kiia nei ko te cirrhotic cardiomyopathy , e whānui haere ai ētahi o ngā uaua o tō tinana. Nā tēnei huringa uaua o te rere o te toto ka whānui haere ētahi o ngā uaua toto, ko ētahi (ina koa ko ērā o roto i ō whatukuhu) ka whaiti. Whakaarohia he rite ki te waka i tetahi taha o te rori, ka pā ki ngā taha kē atu.

He aha ngā āhuatanga e whakanui ana i tēnei āhuatanga?

Tērā atu anō ngā mea e pā ana ki te mate ate, ka taea te waiho hei " whakaoho " i te HRS. Ko te mea tino noa ko te Spontaneous Bacterial Peritonitis (SBP) . He mate huakita tēnei o te arai o tō puku (peritoneum). Ko te SBP he raruraru o te ascites , he pupū wai i roto i te puku. Ka puta te ascites i te turuturu o te wai mai i ngā uaua o te puku nā te portal hypertension.

Whakaarohia, ki te kī tonu tō puku i te wai (ascites), ka taea e ngā iroriki te tomo ngāwari ki reira ka pangia. Koinei te ingoa o tēnei peritonitis huakita ohorere (SBP).

Waihoki, ka taea e te toto toto tiketike te pakaru me te toto ki roto i tō puku. Pēnei i tēnei:Ko te toto tere i puta mai i te toto puku tētahi atu take e whai wāhi ana. Ehara i te mea koinā anake, engari ko te whakamahinga nui o ngā rongoā diuretic , arā, ngā "pire wai" rānei, ka taea hoki te waiho hei take. Ka mahi ngā rongoā diuretic mā te tango i te wai nui mai i te tinana. Ko te hunga whai mate ate kua whanake haere ka tango pea i ēnei pire wai mō te ascites, te edema rānei, arā, he pupuhi o te tinana.

He aha ngā tohu?

Ko te hunga e pāngia ana e te mate hepatorenal (HRS) ka pāngia tuatahitia e te ahua ngoikore, āhua koretake. Ko ngā tohu ko:

• Ngenge
• Whakapairuaki
• Mamae puku
• Te reka kino i roto i te mangai

Hei tāpiritanga, tera pea ka pāngia rātou e ngā tohu o te mate ate kua horapa haere, te ngoikore rānei o te ate. Kei roto i ēnei ko:

• Te kōwhai o ngā kanohi (te mā o ngā kanohi)
• Ngāwari te maru me te toto
• Ngā tūtae mārama me te mimi pouri
• Te pupuhi o te puku (nā te ascites, te ate nui, te whēkau rānei)
• Kiri mākūkū
• Te pōhēhē, te ngaronga o te mahara, te hiamoe rānei (Hepatic Encephalopathy)

Ina kaha haere te ngoikore o te whatukuhu, ka kite pea koe kua tino heke te nui o te mimi e whakaputaina ana e koe .

Me pēhea koe e mōhio ai ki tēnei?

Ko te mate Hepatorenal (HRS) he momo ngoikore o te whatukuhu e puta ana i te aroaro o te mate ate kino, kāore he take kē atu o te ngoikore o te whatukuhu. Nō reira, ka tātaritatia tēnei e ngā tākuta mā te whakaū tuatahi i te mate ate me te ngoikore o te whatukuhu, kātahi ka whakakore i ētahi atu take pea o te ngoikore o te whatukuhu. Hei mahi i tēnei, ka whakamahia e rātou ngā whakamātautau whakaahua maha, pērā i te matawai, ngā whakamātautau toto, me ngā whakamātautau mimi, hei tirotiro i te mahi a tō ate me ō whatukuhu.

Me pēhea te rongoā?

Ahakoa he mate tino kino te HRS nā te ngoikore o te whatukuhu, ko te pūtake o te raruraru kei roto i te ate . Ko te mate Hepatorenal (HRS) e kiia ana he momo ngoikore whatukuhu "prerenal" nā te mea he hauora ō whatukuhu. Inaa, ki te tangohia ō whatukuhu ka whakatōkia ki te tinana o tētahi atu, ka pai te mahi. Waihoki, ki te hoki te mahi o tō ate ki te āhua noa, he nui te tūponotanga ka tīmata anō ō whatukuhu ki te mahi.

Tērā pea ka ora ake te mahi a te ate me te whatukuhu o ētahi tāngata e pāngia ana e te ngoikore o te ate. Engari me whai whakawhitinga ate te katoa. Tērā pea ka hiahia rātou ki te whakawhitinga ate i tētahi wā, engari ka nui ake te hiahia mā te HRS. Heoi, kāore te katoa e tika ana mō te whakawhitinga ate, ā, ahakoa ka pērā, me tatari rātou kia whiwhi rā anō i tētahi.

I tēnei wā, ko te mea nui ko te tere me te tika o te maimoatanga.

I tēnei wā, ka ngana tō tākuta, tō nēhi rānei ki te tiaki i te mahi a tō whatukuhu i te mea ka taea, me te whakaiti i ngā tohu me ngā pānga taha o tēnei mate. Ka taea e ēnei mahi te whakapai ake i tō hauora whānui, me te āwhina i a koe ki te whakarite mō te whakawhitinga ate. Ka taea hoki e rātou te āwhina ki te whakapai ake i te putanga o te whakawhitinga ate mēnā kei a koe tētahi. Heoi, ehara ēnei i te rongoā . Kei roto pea i ēnei maimoatanga:

• Ko ngā wai IV , pērā i te tote, ka hoatu hei whakatika i ngā kore taurite o ngā electrolytes i roto i te tinana, hei āwhina hoki i te rere o te toto ki ngā whatukuhu.
• Te whakamutu i ētahi rongoā, pērā i ngā rongoā whakaheke toto (ngā pire wai).
• Te hoatu i ngā paturopi mō ngā mate pāwera e pā ana.
• Ka mahia te paracentesis hei tango i te wai nui i kohia mai i te ascites.
• Te hoatu i ngā rongoā e kiia nei ko ngā vasoconstrictors . Mā ēnei e whaiti ai ō oko toto e whānui rawa ana, e whakanui ai hoki i te rere o te toto ki ngā whatukuhu.
• Ko te hemodialysis , arā, ko te dialysis toto, he maimoatanga hei āwhina i ō whatukuhu e taumaha ana.

Ka taea te ārai?

Ko te huarahi pai hei ārai i te mate hepatorenal (HRS) ko te whakahaere i te mate ate i mua i te horapa ki te cirrhosis . Ko te mate ate mau tonu he mate e tupu puhoi ana i roto i ngā tau maha. Ko te hunga e mōhio ana kei a rātou te mate ka taea te whakahaere, ā, i ētahi wā ka whakakore i te haere whakamua o te mate mā te mahi i ngā mea pēnei i te whakaiti i te waipiro, te whakaiti i te taumaha, me te whakapai ake i tā rātou kai. Heoi, nā te mea he maha ngā tāngata kāore e whakaatu i ngā tohu, kāore pea e kitea me te kore he tirotiro hauora noa.

Mena kua pāngia koe e te cirrhosis, kāore he huarahi hei matapae, hei ārai rānei i te whanaketanga o te HRS. Heoi, ko te Spontaneous Bacterial Peritonitis (SBP)Ahakoa rā, ka taea e koe te karo i te "mea e tino kitea ana" mō tēnei. Ko te SBP te take mō te 25% o ngā take o te HRS i roto i te hunga whai mate cirrhosis. Nō reira, ki te whakaaro tō tākuta he nui te mōrearea o te SBP ki a koe, mā te tango i ngā paturopi hei ārai ka taea te whakaiti i tēnei mea e whakaoho ana, ā, ka whakaiti hoki i ō tupono ki te whakawhanake i te HRS.

Ka taea te rongoā i tēnei? He mate mōrearea rānei?

Ki te kore he whakawhitinga ate, he tokomaha te hunga kei roto i tētahi āhuatanga tino kino. Mēnā ka kino haere te HRS, ā, kāore e taea te whakawhitinga, e rua wiki noa iho te roa o te oranga. Mēnā he HRS mau tonu, e toru ki te ono marama te roa o te oranga me te kore he whakawhitinga. I runga i te kaha o te ngoikore o te ate, ka tere te kino o te āhua. Waihoki, ki te tere te kino o te āhua, tera pea ka tino mate koe, kāore e taea te whakawhitinga, ka uaua pea tēnei.

Heoi, ki te whiwhi koe i te whakawhitinga ate, ka tino pai ake tō āhua. Ko te hunga whai HRS he 60% te tūponotanga ka ora i roto i ngā tau e toru i muri i te whakawhitinga ate. He iti iho tēnei i te reiti oranga mō ngā tau e toru mō te hunga e whiwhi ana i te whakawhitinga ate (75%). Ka hoki te mahi tākihi o te nuinga o te tangata ki te noho noa i roto i ētahi wiki. He iti noa iho pea te tokomaha (tata ki te 5%) me haere tonu te dialysis .

Ahakoa he tangata koe e pāngia ana e te ngoikore o te ate i te wāhanga whakamutunga, he mate hepatorenal syndrome (HRS) rānei i tere ai tō wā, ehara i te mea pai te noho ki te rārangi tatari mō te kaituku ate. Nā te mea kāore i te nui ngā kaituku ate e wātea ana mō te hunga kei runga i taua rārangi. Heoi, ki te kitea e koe he kaituku ate ora , kāore pea koe e hiahiatia kia noho ki te rārangi, ā, tera pea ka pai ake ngā putanga hauora whānui.

Ko ngā kaituku ora he tūao hauora, ko ō whanaunga te nuinga, he rite ki tō momo toto me te rahi o tō tinana. Ahakoa he wahi iti o te ate i tangohia mai i tētahi atu tangata ora, ka taea e ia te tipu anō hei ate katoa i roto i a koe me te kaituku. Waihoki, tera pea kei te pai ake te āhua o ngā ate ora i ngā ate i tangohia mai i ngā kaituku kua mate. Ka whakapau kaha ngā taote pokanga ki te whakaiti i te kaha o te pokanga ki ēnei kaituku ora toa.

Hei whakamutunga, ngā mea hei maumahara

Nō reira, kua mārama pea koe ināianei he mate kino te mate hepatorenal e hiahia ana kia arohia nā te mea ka pā ki ngā whatukuhu nā ngā raruraru ate.

• He mea tino nui te hauora o te ate:Mena he mate ate tōu, he mea tino nui kia tika te whakahaere, ina koa kia kore ai e huri hei mate pēnei i te cirrhosis.
• Kia tūpato ki ngā tohu: Mena kei a koe ngā tohu e pā ana ki te mate ate, ki te māuiui rānei koe, me toro atu ki te tākuta tonu.
• Whakaarohia ō whatukuhu: Mēnā he raruraru ate tōu, me tiaki hoki ō whatukuhu. Mēnā he tohu pēnei i te iti o te mimi, kōrero ki tō tākuta.
• He rongoā kei reira: Ahakoa he mate kino te HRS, ka taea e ngā maimoatanga pēnei i te whakawhitinga ate te whakaora i ngā oranga. Nō reira kaua e mutu te tumanako.
• He mea nui te āhua noho: Ko ngā mea pēnei i te āhua noho hauora, te kai taurite, me te karo i te waipiro ka āwhina i te ate kia ora.

Ko tāku tumanako ka whai hua ēnei mōhiohio ki a koe. Mena kei te pāngia koe, tetahi atu rānei e mōhio ana koe e tēnei momo raruraru, ko te mea pai ko te rapu tohutohu hauora tonu atu.

` Te mate ate, te ngoikore o te whatukuhu, te cirrhosis, te whakawhitinga ate, te toto toto tiketike, te ascites