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:
Ngā tohu o te mate pūmau:
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
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