Kei te mamae tō puku anō hoki? He mate pāwera pea!

I ētahi wā ka pāngia koe e te mamae rerekē e tīmata ana i te puku o raro ka toro atu ki te tuara? Kāore rānei koe e mākona ana, e kore rānei e pai ki a koe i muri i te kai? Tērā pea kei muri i ēnei mea he raruraru kei tētahi okana tino nui kāore tātou e kōrero nui ana, engari tera pea. I tēnei rā, me kōrero tātou mō te repe taiaki me tōna mumura, arā, te (Pancreatitis).

He aha tēnei repeure? Ka ahatia ia?

He kupu ngāwari, he okana iti tō repe taiaki, engari he tino hira i roto i tō puku. Ki te whakatakoto koe i tō ringa matau ki runga i tō puku, koinā te rahi o tō repe taiaki, i muri i tō puku, ā, i mua paku i tō tuaiwi. E rua ngā mahi nui a tēnei okana iti: 1. Te āwhina i te nakunaku: Ka hangaia e ia he whākōkī motuhake (pērā i te amylase) hei āwhina i tō tinana ki te mimiti i ngā matūkai i roto i te kai e kainga ana e koe. Ka haere ēnei whākōkī ki raro i te awa repe taiaki ki roto i te whekau iti, te wāhi e rongoa ai te kai e kainga ana e koe. 2. Te whakahaere i ngā taumata huka toto: Kua rongo pea koe i te insulin. Ka hangaia e te repe taiaki ngā homoni hei āwhina i te pupuri i ngā taumata huka toto.

Na, he aha te pancreatitis?

Ko te mate pāwera he mumura, he pupuhi rānei o tō repe taiaki. He rite ki te wā ka whara tātou i tētahi wāhi o tō tātou tinana, ka pupuhi, ka mamae. Ko tēnei mumura te take o te mamae o te puku i kōrerotia i mua ake nei. Whakaarohia, ina ngana te pūnaha ārai mate o tō tātou tinana ki te whakaora i tētahi wāhi kua whara, ka puta te mumura. Ka puta tēnei mumura ina whara, ina pakaru rānei te repe taiaki. I te nuinga o te wā, ka puta tēnei i te aukati i te awaawa repe taiaki nā ngā kōhatu o te puku, nā te nui rawa rānei o te inu waipiro.

He momo pēnei kei reira?

Ae, e rua ngā momo matua o te pancreatitis:

1. Te Pancreatitis Whakapeka

He momo rangitahi tēnei. Ka puta mai i te wā e ngana ana te repe taiaki ki te whakaora i muri i tētahi whara iti, poto noa iho. Ka ora katoa te nuinga o te tangata i roto i ētahi rā. Heoi, me whai maimoatanga tika , pērā i te okiokinga, te inu i te nui o ngā wai, me te tango i ngā rongoā whakamamae . Heoi, i ētahi wā ka tino kino tēnei mate "Acute pancreatitis" ā, ka arahi pea ki ngā raruraru morearea .

2. Te mate pāwera mau tonu

Koinei te momo roa, e ahu whakamua ana . Kāore e pai haere noa, engari ka kino haere i roto i te wā. Ka puta tēnei āhuatanga ina haere tonu te kino o te repe taiaki. Ka puta he kiriuhi ((Fibrosis)) o te kiko repe taiaki, ka tīmata te iti o ngā whākōkī me ngā homoni e hiahiatia ana hei hanga. Ka roa pea tēnei i mua i te tupu.

He pēhea te noa o tēnei mate?

I tētahi whenua pērā i Amerika, neke atu i te 200,000 ngā tāngata e noho hōhipera ana i ia tau nā te mate pāwera nui. I roto i ēnei, e kiia ana kei roto i te āhua kino te 20%. He iti ake te kitea o te mate pāwera mau tonu, engari e 86,000 tonu ngā tāngata e noho hōhipera ana i ia tau. Kei te kitea haeretia hoki tēnei āhua i Sri Lanka.

He aha ngā tohu? Kei te pēhea ōu kare ā-roto?

Ko te tohu matua o te pancreatitis ko te mamae o te puku . Heoi anō, tera pea ka puta mai ētahi atu tohu.

Ngā tohumate whawhati tata:

• Tērā pea ka pā te whakapairuaki me te ruaki .
• Kei te piki haere te tere o te manawa .
• Ka tere, ka papaku te manawa .
• Tērā pea ka pāngia koe e te kirika .

Ngā tohu o te mate pūmau:

• Te mamae me te koretake o te kai i muri i te kai.
• Te ngaronga o te hiahia kai me te taumaha .
• He tūtae hinuhinu (he rite ki te paninga hinu i runga i te wharepaku).
• Te pōuriuri (nā te iti o te toto toto ).

Ko te tikanga o tēnei kei te ngoikore haere tō repe taiaki.

He aha te āhua o tēnei mamae?

Ka rerekē te mamae o te mate pāwera i waenga i te ngawari ki te kino . He maha ngā wā ka rite ki te mea e horapa ana mai i te puku ki waho . Ko te mate pāwera nui he kino ake, ā, ka rite ki te mamae wero . Ka mamae anō hoki ina pā koe ki tō puku. Ka rerekē te mamae o te mate pāwera mau tonu i ia tangata, i ia tangata. I ētahi wā ka puta mai, ka ngaro atu, engari kāore e memeha rawa. He mea noa i muri i te kai. Mō ētahi tāngata, he pumau te mamae. Ina kino haere te mamae:

• Ina okioki koe ki muri.
• Ina maremare.
• I te wā e whakakorikori tinana ana.
• Ina nui rawa tāu kai.

Ka taea te whakaiti i te mamae ina:

• Ina noho tika koe.
• Ina piko koe ki mua.
• Ina piko koe pērā i te pōro.
• Ina iti iho tāu kai.

Me pēhea te mōhio mēnā kāore te pancreas e mahi tika ana?

Ina mutu te mahi tika a te repe taiaki nā te mate pāwera mau tonu, ka kite pea koe i ngā panonitanga o tō pūnaha nakunaku. Ina kore e taea e te repe taiaki te whakaputa i ngā whākōkī nakunaku me te tuku atu ki ngā whekau, kāore e taea e te tinana te mimiti tika i ngā matūkai o te kai, inā koa ngā ngako. Ka pāngia pea koe e te mamae i muri i te kai, ā, ka taea e ngā ngako kāore anō kia nakunaku te haere mā roto i tō tūtae. I roto i te wā, ka tīmata pea koe ki te whakaiti i tō taumaha.

He aha ngā take matua?

Ko ngā tino take e rua o te pancreatitis ko: 1. Ngā kohatu o te pūhā (Gallstones) 2. Te inu nui i te waipiro. Ina honoa ēnei take e rua, tata ki te 80% o ngā tūroro pancreatitis te take.

1. Te mate pāwera o te kōhatu o te kāpia

Ka uru te au o roto i tō pūkahukahu ki roto i ō whekau mā te awaawa au noa. Ka tuwhera tēnei awaawa me te awaawa repeure ki roto i ō whekau i te wā kotahi. Whakaarohia te aha ka tupu mēnā ka mau te kōhatu repeure ki taua hononga? Kāore e taea e ngā wai repeure te puta, ka mau ki roto i te repeure. Kātahi ka piki ake te pēhanga, ā, ka tīmata aua whākōkī ki te mahi i roto i te repeure, ā, ka tīmata rātou ki te nakunaku i te repeure tonu. Koinei te take o tēnei mumura.

2. Te nui rawa o te inu waipiro

Ko te nui rawa o te inu waipiro tētahi tino take o te pancreatitis. Ahakoa kāore anō kia tino mārama ngā kaipūtaiao me pēhea te puta, e whakaarohia ana ko ngā wāhanga paitini o te waipiro te take o te mumura o te pancreas, te whakahohenga matū rānei o ngā whākōkī nakunaku. Tata ki te haurua o ngā take katoa o te pancreatitis whakapeka me te mau tonu e kiia ana nā te nui rawa o te inu waipiro.

Ētahi atu take

Haunga ēnei take matua e rua, tera atu anō ētahi take, engari he iti ake te kitea.

• Ngā mate urutā maha, hei tauira, ngā huaketo.
• Ka whakaekea e te pūnaha ārai mate o te tinana te repe taiaki ((Pankreatitis Autoimmune)).
• Ngā whakarerekētanga ira e tukuna iho ana i roto i ngā whakatipuranga ((Hereditary pancreatitis)).
• Ngā raruraru o ngā āhuatanga pēnei i te cystic fibrosis.
• Te nui o te ngako (triglycerides) i roto i te toto ((Hypertriglyceridemia)).
• Te nui o te konupūmā i roto i te toto (Hypercalcemia).
• Te whakahekenga o te rere o te toto ki te repe taiaki ((Ischemia)).
• Te tūnga o te mate pukupuku.
• Ngā whara ki te pancreas.
• He kino ētahi rongoā ki te pancreas.

E 20% pea te tapeke o ēnei take katoa. I ētahi wā, kāore e kitea he take.

He rite tonu ngā mumura whakapeka me ngā mumura mau tonu?

I te nuinga o te wā, ka puta ohorere te pancreatitis, ā, ka memeha haere mō te wā poto ((Acute)). Heoi, ki te mea he take tonu, pērā i ngā mate tuku iho, ka puta pea te pancreatitis mō tētahi wā ((Chronic pancreatitis)). Waihoki, ki te puta tonu te pancreatitis acute, ka taea hoki te noho hei mate mō te wā roa.Whakaarohia, ina pēhia tonutia te repe taiaki e te pēhanga me te kino, ka taunga te tinana ki taua mea, ā, ka mau tonu pea te mumura ahakoa kua mutu te kino.

Ka taea e tēnei te arahi ki te mate?

Ae, ki te tino kino te mate pāwera nui, ka taea e ngā raruraru te arahi ki te mate. Mō te hunga tokoiti, ka taea e te mate pāwera nui te whakaputa i tētahi tauhohenga ka pā ki te tinana katoa. Ka taea e tēnei te arahi ki te ohorere me te ngoikore o ngā okana maha. Ki te kore e rongoatia wawe, ka taea te whakararu i te ora. He pai ake te haere ki te hōhipera nā te mea he uaua ki te mārama ki te kino o te mate ina pāngia koe e ngā tohu.

He aha ngā raruraru ka pā mai?

Ko te nuinga o ngā mate pāwera nui kāore e puta he raruraru. Engari tata ki te 1 i roto i te 5 ngā mate ka kino rawa atu. Kāore anō kia mārama he aha i pēnei ai te kino o ētahi tāngata. Ka taea e ngā mate kino te arahi ki te mate. Ka taea hoki e te pāwera nui te puta he raruraru, engari ka āta haere te tipu, ā, kāore e tere tonu te mōrearea ki te ora. Ka taea te whakahaere i te nuinga o ngā raruraru mā te rongoā.

Ngā Pōrearea o te Pancreatitis Whakapeka:

• Te mate o ngā kiko ((Necrosis)) me te mate pāwera: Mō te 1 i roto i te 3 o ngā take o te pancreatitis nui, ka pupuhi te repe taiaki, ka motuhia te rere o te toto ki reira. Kātahi ka mate te kiko i ētahi wāhanga o te repe taiaki. He wāhi pai tēnei kiko mate mō ngā huakita. Mēnā ka pangia ngā huakita, ka tere te horapa ka uru ki roto i te toto. He āhuatanga ohorere te mate i roto i te toto ((Septicemia)). Ka urupare te tinana ki tēnei āhuatanga e kiia nei ko te (Systemic Inflammatory Response Syndrome). Ka nui haere ngā oko toto, ka heke te toto ((Septic shock)) me te heke o te toto ki ngā whekau nui, ka arahi pea ki te (Multiple organ failure).
• Ngā pūkahukahu rūpahu: Ka ārai pea te mumura o te pūkahukahu i te awa e kawe ana i te wai pūkahukahu ki te whekau. Ka turuturu te wai huri noa i te pūkahukahu, ka puta te mumura ki ngā kiko e karapoti ana. I roto i te wā, ka puta he pēke mārō me te wai huri noa i te wāhi mumura, e kiia nei ko te pūkahukahu rūpahu. I te nuinga o te wā, kāore ēnei pūkahukahu e puta he tohu, kāore hoki e hiahiatia he maimoatanga. Heoi, i ētahi wā ka pangia, ka nui rānei, ka puta he raruraru. He onge noa iho, ka uru he oko toto ki roto i te pūkahukahu ka toto. I tēnei wā, me tango pea e ngā tākuta te wai, me whakamutu rānei te toto.
• Te mate pāwera pūmau: Ina puta pinepine te mate pāwera pūmau, ka taea te noho pūmau. Ina mumura tonu te repe taiaki, ka puta he kiriuhi (fibrosis) i roto i te kiko. Ka ārai tēnei i te mahi a te repe taiaki hei repe. I roto i te wā, ka heke haere te kaha o te tinana ki te whakaputa i ngā whākōkī me ngā homoni, ka arahi atu ki ngā raruraru anō.

Ngā raruraru o te pancreatitis mau tonu:

Ka puta haere ēnei i te āta haere:

• Te ngoikore o te repe taiaki (EPI), te koretake o te ngongo, me te kore kai: I te mea ka pakaru te repe taiaki, ka iti ake ngā whākōkī e whakaputaina ana e ia e hiahiatia ana hei nakunaku i te kai. Nā tēnei ka uaua ki te tinana te ngongo i ngā matūkai , inā koa ngā ngako me ngā huaora wairewa-ngako. Ka tukuna te ngako nui ki roto i te tūtae, ka puta he tūtae hinuhinu, ā, i muri mai, he mate korere. Ina kore koe e whiwhi i te nui o te matūkai mai i tō kai, ka hiroki koe, ka tīmata te rongo i ngā pānga o te korenga o ngā matūkai.
• Te huka toto iti ((Hypoglycemia)), te huka toto tiketike ((Hyperglycemia)), me te mate huka momo 1 ((Hyperglycemia)): Ka whakaitihia hoki e te mumura roa o te repeure te hanga o ngā homoni e whakahaere ana i te huka toto. I runga i te homoni e pāngia tuatahitia ana, ko te ngaronga o te glucagon ka hua ake te huka toto iti ((Hypoglycemia)) ka hua ake rānei te huka toto teitei ((Hyperglycemia)) i te ngaronga o te insulin. Ā tōna wā, ka ngaro ngā homoni e rua, ā, ka puta te mate huka.
• Mamae tonu: Ahakoa ka kitea e ētahi te whakaoranga mai i ō rātou mamae, ka kitea e ētahi ka kaha haere te mamae, ka roa hoki. He uaua pea tēnei ki te whakahaere, ahakoa he rongoā, ā, ka pā pea ki tō hauora hinengaro.
• Te pikinga ake o te mōrearea o te mate pukupuku repeure: Mā te mumura tonu i ngā wāhi katoa ka piki ake te mōrearea o te mate pukupuku. Ko te hunga kua roa e pāngia ana e te pancreatitis, he 1% ki te 2% te mōrearea ki te whakawhanake i te mate pukupuku repeure (pancreatic adenocarcinoma). Nā te mea he rite ngā tohu ki ngā tohu o te mumura mau tonu, kāore e kitea i ētahi wā. E taunaki ana ngā tākuta kia tirotirohia te hunga whai mate pukupuku i ia wā, i ia wā.

Me pēhea te tautuhi i te mate?

Mena kei a koe ngā tohu o te pancreatitis, ka tirohia e tō tākuta tō pancreas mā te whakamahi i ngā whakamātautau toto me ngā whakamātautau whakaahua. Ka tirohia e te whakamātautau toto ngā taumata teitei o ngā whākōkī pancreatic i roto i tō toto. Mena he nui ake i te toru ngā wā i te mea noa, e whakapaetia ana he pancreatitis. Kātahi ka mahia he matawai CT, he MRI rānei hei whakaū i te mate. Ka taea e ēnei matawai te whakaatu i ngā tohu o te pupuhi me te hanga wai i roto i te pancreas. Mena ka whakapae rātou he pancreatitis mau tonu tōu, ka mahia pea ētahi atu whakamātautau:

• Whakamātautau huka (hei tirotiro mēnā kei te tika te hanga o te insulin e te repe taiaki).
• Whakamātautau elastase tūtae (hei tirotiro mēnā kei te nui ngā whākōkī nakunaku e whakaputaina ana e te repe taiaki).
• Te tātaritanga ngako paru (tirohia mēnā he nui te ngako i roto i te paru, he tohu tēnei kāore i te pai te mimiti o te ngako).
• Ngā whakamātautau toto (hei tirotiro i tō āhua kai me te tirotiro mēnā he nui ngā huaora wairewa-ngako i roto i ō toto).

Me pēhea te rongoā?

Ko te maimoatanga e whakawhirinaki ana ki te take, ahakoa he mate pāwera, he mate mau tonu rānei, me tōna kaha. I te nuinga o te wā, ki te whai tohu koe o te pancreatitis, me toro atu koe ki te tākuta. Ka taea te whakahaere i ētahi mate pāwera i a rātou anō, engari e whakawhirinaki ana tēnei ki te take me te kaha. I tēnei wā, he maha ngā tāngata e hiahia ana ki ngā rongoā whakamamae hei āwhina i te whakahaere i te mamae. Me whiwhi maimoatanga ohorere ētahi tāngata. Ko ētahi pea me tiaki nui nā te mea he raruraru.

Te rongoā mō te mate pāwera nui:

Manaaki Tautoko

Mena kua whakatauhia te take, ā, kāore i te kino te āhua, ko te huarahi pai ko te āwhina i te tinana kia ora i a ia anō. Ko te tikanga kei roto i tēnei:

• Te hoatu i te tote (wai IV): Ka matewai te tangata nā te mate pāwera, ā, he mea tino nui te makuku mō te oranga.
• Whāngai mā te ngongo: Ki te kore e taea e koe te kai mā te waha, ka hoatu he kai māu mā te ngongo ka tukuna mā tō ihu, ki roto rānei i tō puku.
• Kai whāngai: I ngā wā tino kino, ka taea te hoatu tika i te kai mā roto i tētahi uaua.
• Ngā rongoā mamae: Ka hoatu ngā rongoā mamae mā te uaua, mā te waha rānei.

Te Tango i te Kōhatu Auaha

Mena he mate pāwera tōu nā te kōhatu o te pūkahukahu, me tango pea he kōhatu mai i tō awaawa au. Tērā pea ka tūtohutia kia tangohia tō pūkahukahu (pokanga tango pūkahukahu) hei ārai i tēnei raruraru kei puta anō. Anei ngā mea ka taea e koe te mahi:

• Ko te Endoscopic retrograde cholangiopancreatography (ERCP): Kei roto i tēnei ko te whakauru i tētahi endoscope (he ngongo angiangi, ngāwari me te kāmera e piri ana) ki roto i ngā awaawa o te ate. He maha ngā kōhatu ka taea te tango mā tēnei ara. Ka whakaurua te ngongo ki raro i te korokoro, ka tukuna mā roto i te puku ki roto i ngā awaawa o te ate.
• Te pokanga tango i te pūkahukahu: Kia tae koe ki te hōhipera mō ngā kōhatu pūkahukahu, ka nui ake te tūponotanga ka pāngia anō koe e ngā raruraru. Nō reira, he maha ngā wā ka tangohia te pūkahukahu. Ko te tikanga ka mahia tēnei mā te laparoscopic ((Laparoscopic cholecystectomy)), arā, ka taea te mahi mā roto i ētahi tapahi iti.

Tautoko Tāpiri

Mena he raruraru, ka hiahiatia pea ēnei:

• Ngā rongoā paturopi.
• He pokanga hei tango i te wai, i te kiko mate rānei.
• Te tiaki nui.

Te maimoatanga mō te pancreatitis mau tonu:

Mena kei a koe tēnei mate, ka tukuna koe e tō tākuta whānui ki tētahi tohunga (he tohunga puku). Ka tīmata te maimoatanga mā te whakahaere mamae me te whakarerekē i te āhua noho hei ārai i te kino haere o te mate. I roto i te wā, me tango pea koe i ngā rongoā o waho hei whakakapi i ngā whākōkī me te insulin kāore e hangaia ana e tō repeure.

Ngā Huringa Āhua Noho

He mea tino nui tēnei. Me mutu rawa te inu waipiro me te momi hikareti.He nui te pānga o ēnei e rua ki te mate pāwera, ā, ka tere te kino haere o te mate. Mā tō tākuta koe e kī atu ki hea koe e whiwhi āwhina ai hei whakamutu i ēnei. He mea nui anō hoki kia taunga koe ki te kai iti te ngako, nui ngā huawhenua me ngā hua, me te inu wai nui i te roanga o te rā .

Te Whakahaere Mamae

He uaua pea te whakahaere i te mamae mau tonu. Me whakamātau pea koe i ngā rongoā me ngā tikanga rerekē kia kitea ai te mea e pai ana mōu. Kia mahara ki te kōrero ki tō tākuta mō tō mamae me te aha ka taea e koe te mahi mēnā kāore ngā mea e āwhina. Tērā pea ka tukuna koe e ia ki tētahi tohunga whakahaere mamae (he tohunga mamae mau tonu). I ētahi wā, ka taea e te tango endoscopic o te kiko whara, o ngā kōhatu pancreatic rānei te āwhina ki te whakaiti i ngā tohu. Ko te werohanga i te anesthesia ki roto i ngā io o te pancreas (he aukati celiac plexus) tētahi atu kōwhiringa mō ētahi tūroro.

Ngā tāpiringa kai

I roto i te wā, he tokomaha te hunga ka pāngia e te ngoikore o te repe taiaki (EPI). Me tango e rātou ngā whākōkī repe taiaki mai i ngā pūtake o waho. Me tango hoki e rātou ngā tāpiringa kai hei whiwhi i te nui o ngā kaora me ngā matūkai (ngā huaora me ngā kohuke). Ka kore e taea e ētahi te aro atu ki te hukahuka, ā, ka mutu ka pāngia e te mate huka, ka whakawhirinaki ki te insulin.

Pokanga

Mena he iti noa te mumura nui ki tētahi wāhanga motuhake o te repe taiaki, ā, kei te puta he mamae, he raruraru rānei i taua wāhanga, ka tūtohu pea tō tākuta kia tangohia taua wāhanga ((Resection)). I ngā take tino matatau, ki te tino pakaru te repe taiaki, ā, kei te mau tonu te mamae nui, ka taea te tango i te repe taiaki katoa ((Total pancreatectomy)).

He aha te momo āhuatanga ka taea te tumanako i roto i te wā roa?

Ko te nuinga o te tangata ka ora katoa mai i te pancreatitis acute. Mēnā kāore i te kino rawa, ka ora i roto i ngā rā 5-10. Mēnā he kino rawa, he raruraru rānei, me noho pea koe ki te hōhipera mō ētahi wiki. Mēnā ka taea e koe te rongoā i te take, ka taea te ārai i te hokinga mai. Mō te hunga tokoiti e pāngia ana e te ngoikore o ngā okana, tata ki te 20% te ōrau mate. He mate puhoi te whanaketanga o te pancreatitis mau tonu. Mā te rapu awhina hauora me te aroturuki i tōna ahunga whakamua, ka taea e koe te ārai i ngā raruraru i mua i te puta mai. He wero pea te whakahaere mamae mō ētahi tāngata, ā, ka pā hoki ki te hauora hinengaro me te kounga o te oranga. Tērā pea ka whakaarohia te pokanga. Ka taea te ora me te kore he pancreas, engari me whakawhirinaki pea koe ki te insulin.

Ka taea te ārai i tēnei?

Kāore e taea te ārai i ngā take katoa. Engari ka taea e koe te whakaiti i tō mōrearea mā te whakawhāiti i tō inu waipiro . Ko tētahi atu tino take o ngā kōhatu pūkahukahu ko te whakaheke i tō cholesterol . Mena kua pāngia koe e te pancreatitis acute, ka āwhina te whakamutu i te waipiro me te momi hikareti.He āwhina ki te ārai i te hokinga mai. Mena nā ngā kōhatu i puta mai i te pūkahukahu, mā te tango i te pūkahukahu ka ārai i te hokinga mai.

Kāore pea koe e tino whakaaro ki tō repe taiaki tae noa ki tētahi rā ka mamae. He huarahi whakamataku, he huarahi ahotea hoki tēnei hei kukume i tō aro.

Hei whakamutunga, ngā mea hei maumahara

Ki te mea kei a koe ngā tohu o te pancreatitis, kaua e warewarehia. Tirohia he tākuta tonu. Ko te nuinga o ngā take o te pancreatitis acute ka pai ake i roto i ētahi rā. Ki te taea e koe te kimi i te take, kaua e mangere ki te rongoā. Ka taea e te pancreatitis mau tonu te tīmata āta, ā, kāore e kitea i te wā e mōhio ana koe. Ahakoa he mea matapae ētahi take, pērā i te waipiro, ko ētahi he mea rerekē ake, he mea ohorere hoki. Kāore pea koe i whakaaro kei te tūpono koe ki te whakawhanake i tēnei mate mō te wā roa. Heoi, he uaua pea te ako ki te noho tahi me tēnei mate. Me hiahia koe ki tētahi tākuta e whakawhirinaki ana koe hei āwhina i a koe ki te whakahaere i a ia mō te toenga o tō oranga. Ko tō hauora tō kawenga, nō reira kia tiakina. Pancreatitis, Pancreatitis, Mamae Puku, Kohatu Au, Waipiro, Nakunaku