Kei te kōrero tātou mō te toto toto tiketike o te tomokanga?

Kua rongo kē koe i tēnei mate e kiia nei ko te `(Portal Hypertension)`? Tērā pea he ahua rerekē, he uaua hoki ki te mārama ki te ingoa. Engari he mate tēnei ka puta i roto i tō tātou ate, me āta tiaki, ā, ka taea te kino. Me kōrero noa tātou mō tēnei i tēnei rā, i roto i tētahi huarahi e mārama ai koe, me te mea nei kei te whakamāramahia e tētahi e tata ana ki a koe, āe?

He aha te toto toto tiketike o te tomokanga?

Ki te whakarāpopototanga, ko te "Portal Hypertension" ko te pikinga o te toto i roto i te uaua toto matua ('portal vein') e hono ana ki tō ate me te pūnaha o ngā uaua iti ('portal venous system') e peka mai ana i reira, ki runga ake i te taumata noa. Whakaarohia he uaua nui kei roto i tō puku e kohi ana i te toto paru mai i ngā whekau pēnei i tō puku, whekau, pancreas, me te whēkau, ka kawe ki tō ate. Koinei te mea e kiia nei e tātou ko te "portal vein" ko te portal vein rānei. Ko te pūnaha i hangaia e ngā uaua iti maha e hono ana ki tēnei uaua matua e kiia nei ko te "portal venous system" ko te portal venous system rānei.

He tino okana nui tō tātou ate. Ko te ate te mea e horoi ana i te toto kua kohia, e wehewehe ana i ngā matūkai e tika ana, ā, e whakahoki ana ki te ngākau kia tohatohahia puta noa i te tinana.

Nā, ki te āraia te rere o te toto ki te ate mā tēnei `(uaua tomokanga)`, ki te puhoi rānei taua haerenga, ka piki haere te pēhanga i roto i taua pūnaha uaua katoa. Pērā i te aukatinga o tētahi paipa wai i waenganui, ka piki ake te pēhanga o te wai i roto i te paipa. Koinei te mea e kiia nei e tātou ko te `(Portal Hypertension)` ina piki te pēhanga.

Kātahi ka ngana tō tātou tinana ki te aro atu ki tēnei pēhanga kua piki ake. Nō reira, ka tīmata te tuku toto ki ētahi atu uaua, he iti ake te rere o te toto, me te mea nei kei te karo i te ara matua kua āraia. Engari ina uru atu taua toto tāpiri, kāore e taea e aua uaua iti te aro atu, te totoro, te nui haere, ā, ka ngoikore haere ō rātou pakitara. I ētahi wā ka taea e ēnei uaua ngoikore te 'tātari' wai ki roto i te puku, ka pakaru rānei ngā uaua, ka totohu ohorere. Koinei te mea tino morearea.

Ko wai te mea ka nui ake te tūponotanga ka pāngia e te "Portal Hypertension"?

I ngā whenua o te Hauāuru, ko te tino take o tēnei mate he mate e kiia nei ko te cirrhosis o te ate. Ko te cirrhosis he mate e pakaru ai te ate i roto i te wā, ā, ka whakakapia ngā pūtau ate hauora e te kiko whara (he kiko mārō, he kiko muka). Ka puta he aukati nui i te rere o te toto i roto i te ate mā te uaua portal. He rite ki te kōhatu e ārai ana i te huarahi.

I ētahi atu wāhi o te ao, hei tauira i ētahi whenua o Āwherika me Āhia, he mea noa anō hoki nā te mate pirinoa e kiia nei ko te "schistosomiasis." Ka pakaru ngā oko toto o te ate i tēnei pirinoa. E ai ki te World Health Organization, neke atu i te 230 miriona tāngata puta noa i te ao kua pangia e tēnei mate.

He pēhea te kino o tēnei āhuatanga?

Ka taea e ngā raruraru e puta mai ana i te `(Portal Hypertension)` te whakararu i te ora i ētahi wā., inā koa te toto o roto. Kāore te katoa e pāngia e ēnei raruraru, engari ka piki ake te mōrearea i te pikinga o te pēhanga i roto i te pūnaha uaua. Ka nui ake te pēhanga, ka nui ake te tūponotanga ka nui haere, ka ngoikore, ka pakū hoki ngā uaua.

Ina hoki, ko te toto toto tiketike me ōna raruraru te tino take o te whakaurunga ki te hōhipera, ā, i ētahi wā, te mate mō te hunga e pāngia ana e te cirrhosis o te ate.

He aha ngā tohu matua e 5 o te `(Portal Hypertension)`?

Ko tētahi raruraru o tēnei, i roto i te nuinga o ngā wā, kāore pea he tohu o waho kia puta rā anō ngā raruraru. Whakaarohia ko te 90% o te hunga whai mate ate ka puta te toto toto tiketike i roto i ō rātou tinana i mua i te whakaatu i ngā tohu. Waihoki, tata ki te 40% kua nui kē ngā uaua e kiia nei ko te varices, kāore he whakatūpato.

Ko ngā tohu tuatahi e puta mai ana e pā ana ki ngā uaua hou, kua nui, kua turuturu, kua totohu hoki. Koia ēnei:

• Te ruaki toto (tērā pea he rite te tae ki te paura kawhe).
• He toto kei roto i te tūtae (he maha ngā wā he mangu pouri, he parauri pouri, he whero rānei i ētahi wā).
• Ka nui haere te puku, ka kī tonu, me te piki tere o te taumaha. (Nā te kīnga o te puku i te wai te take o tēnei).
• Te pupuhi o ngā waewae, inā koa ngā pona waewae (edema) .
• Te pōhēhē, te ngaro o te māramatanga, te wareware i ētahi wā ko wai koe, kei hea hoki koe (te pōhēhē hinengaro) .

He aha ngā raruraru pea ka pā mai i te `(Portal Hypertension)`?

Ka taea e tēnei āhuatanga te arahi ki ngā raruraru maha. Me titiro takitahi tātou ki ēnei:

• ``Ascites``: `` Ascites`` te kohikohinga o te wai rite ki te wai i roto i te puku mai i ngā uaua kua nui haere, kua ngoikore, ka turuturu ki roto i te kōhao puku (``peritoneal cavity``). Ka pupuhi te puku, ka pupuhi, ka ngaro te hiahia kai me te uaua ki te nakunaku. I ētahi wā kino, ka piki ake tēnei wai ki te uma, ka uaua ai te manawa. Ka piki ake hoki te mōrearea o te mate i roto i te puku (``peritonitis``).

• Te toto o te puku: Ka pakaru, ka toto hoki ngā uaua kua whakanuia i roto i te ara kai (esophagus, puku, whekau) (varices). Ko ngā mea tino kitea ko ngā varices esophageal . Koinei ngā uaua e tata ana ki te kiri, ā, he angiangi rawa ō rātou pakitara, nō reira ka tere te pakaru. Ka pupuhi hoki ngā uaua i roto i ngā pakitara o te puku (e kiia ana tēnei ko te portal hypertensive gastropathy) ā, i ngā wā kino, ka toto. Ki te haere tonu tēnei toto , ka puta te anemia , te kore toto rānei i roto i te tinana.

• `Te Hipersplenism`:Ina whakaitihia te rere o te toto i roto i te ate, ka pupuhi te ate me te nui ake o te toto, ā, ka tupu ake ngā uaua toto hou hei whakauru i tēnei toto tāpiri. Ka nui rawa te mahi a te ate kua nui haere, ā, ka tīmata ki te tango i ngā pūtau nui ake i roto i te toto o te tinana (hei tauira, ngā pereti toto , e āwhina ana ki te toto totoka, me ngā pūtau toto mā , he mea nui mō te ārai mate). Ka taea e tēnei te arahi ki te hekenga o te toto totoka (he māmā ake te toto), me te ngoikore o te pūnaha ārai mate (he māmā ake te pāngia e te mate).

• Te iti o te hāora i roto i te toto: Mō ētahi tāngata, ka whānui rawa ngā oko toto i roto i ngā pūkahukahu nā tēnei "Portal Hypertension". Kātahi ka kore e taea e ngā pūkahukahu te whakawhiti tika i te hāora ki te toto. Ko te mutunga mai he iti ngā taumata hāora i roto i te toto "(hypoxemia)" . Ka kiia hoki tēnei āhuatanga ko te "(hepatopulmonary syndrome)" .

• Te ngoikore o te whatukuhu: Ka taea e ngā oko toto kua whānuitia e te toto toto tiketike te whakawhāiti i ngā oko toto i ētahi atu wāhi o te tinana (ina koa ko ērā e tuku toto ana ki ngā whatukuhu). Mēnā ka puta tēnei i roto i ngā whatukuhu, ka heke te tuku toto ki ngā whatukuhu, ka puta te ngoikore o te whatukuhu . He raruraru onge tēnei engari he tino kino, e mōhiotia ana ko te mate hepatorenal .

• Te ngoikore o te hinengaro: I a tātou e ngana ana ki te urutau ki te toto toto tiketike, ka hangaia e rātou he uaua toto hou (ngā shunt) e karo ana i te ate. Engari ina karo te toto i te ate, ka haere tika ki roto i te tohanga toto, kāore e horoia ngā paitini e tika ana kia horoia e te ate. Kātahi ka kohia ēnei paitini ki roto i te toto, ā, ka pā kino haere ki te mahi a te roro. Tērā pea ka pāngia koe e ngā tohu wā poto pēnei i te pōhēhē, te kōrero pōturi, me te ngaro o te māramatanga. Ka kiia tēnei ko te encephalopathy hepatic .

He aha ngā tino take o te toto toto tiketike o te whare?

E ai ki tā tātou i kōrero ai i mua ake nei, e toru ngā take matua:

• Te mate ate: Koinei te tino take. Ko te mate ate te wāhanga whakamutunga o te mate ate roa. Ko te nuinga o te wā ka puta mai i ngā mate huaketo pērā i te mate hepatitis C huaketo, te mate hepatitis i puta mai i te waipiro , me te mate ate momona kore-waipiro . Ka āraihia e tēnei kiko whara te rere o te toto i roto i te ate.

• 'Ngā Granuloma o te ate':Ko ngā granuloma he kohinga pūtau mumura e puta mai ana i roto i ngā mate urutā (hei tauira, te schistosomiasis) me ngā mate mumura. He rite ki ngā pukupuku iti, ā, ka taea te aukati i te pūnaha uaua tomokanga. He maha ngā wā ka puta ko te whanaketanga o te fibrosis ate i muri mai.

• Ngā toto totoka (Thrombosis): Mena ka puta he toto totoka (thrombosis) ki hea i roto i te pūnaha uaua tomokanga, ka ārai i te rere o te toto ki te ate, mā roto i te ate, ki waho rānei i te ate. He maha ngā take o tēnei, tae atu ki ētahi mate toto tuku iho.

Me pēhea koe e mōhio ai mēnā kei a koe te `(Portal Hypertension)`?

Hei tino mōhio mēnā koinei te āhua, me ine koe i te pēhanga i roto i ngā uaua o te ate. Ko te tikanga o tēnei ko te whakauru i tētahi ngongo iti (catheter) ki roto i te uaua. Heoi, he whakamātautau uaua, ā, kāore i te ngāwari te mahi, ā, ehara i te mea e hiahiatia ana e te katoa.

Waimarie, ka taea e ngā tākuta te tātaritanga i tēnei mate (Portal Hypertension) i runga i ngā tohu me ngā āhuatanga haumanu. Arā, ko tāu e kōrero ana me tā rātou e kite ana i a koe e tirotirohia ana. Ka taea e ngā matawai me ngā whakamātautau toto te whakaū i tēnei whakapae.

He aha ngā tohu e whakapaetia ana e te tākuta kei te pāngia koe e te toto toto tiketike (portal hypertension)?

• Ngā uaua kua nui haere (varices) (ina koa ka kitea i te wā endoscopy).
• He whēkau kua rahi (i te pā atu, i te karapa rānei).
• He tohu mō te rere o te toto i roto i te ara nakunaku.
• He wai kei roto i te puku (ascites).
• Ngā tohu o te iti o te hekenga o te mahi a te roro (e ai ki te kōrero i mua ake nei, ngā tohu o te 'hepatic encephalopathy').
• Mena ka whakaatuhia e te whakamātautau toto he iti te maha o ētahi momo pūtau i roto i te toto (hei tauira, ngā pereti toto, ngā pūtau toto mā).
• Ko ngā tohu ko te ngawari o te marutanga me te toto nui.

He aha ngā whakamātautau e mahia ana hei whakaū i tēnei āhuatanga?

• Ngā whakamātautau toto: Ka taea e ngā whakamātautau toto te whakaatu i ngā āhuatanga o roto i ō whekau, inā koa tō ate me ō whatukuhu. Ka taea e tētahi tātaritanga pākia whānui te tirotiro i ngā raruraru o ō whatukuhu me tō ate. Ka taea e te tatau toto katoa (CBC) te tirotiro i tētahi whēkau e kaha rawa ana te mahi e tango ana i te nui rawa o ngā toto toto mā, ngā pereti toto rānei. Ka taea hoki te tirotiro i ētahi mate toto ka puta ai te toto toto tiketike, te anemia rānei i puta mai i te toto o roto.

• Ngā whakamātautau whakaahua: Ka taea e ngā matawai ultrasound me ngā matawai CT te āwhina ki te whakatau mēnā kei te kitea te cirrhosis, kei te kitea te ascites, kua nui haere ngā whekau pēnei i te whēkau, kua nui haere te pūnaha uaua portal, ā, kua puta he uaua hou. He tino whai hua te ultrasound Doppler .Ka taea te tango pikitia o te toto e rere ana i roto i ngā uaua. Ka taea te kite mārama i ngā aukati i roto i te rere o te toto, me te kite mēnā he whānui rawa, he whaiti rawa rānei ngā uaua.

• Endoscopy: Mena kei a koe ngā tohu o te toto mai i tō ara nakunaku (toto i roto i tō ruaki, toto i roto i tō tūtae), me mahi pea e tō tākuta he endoscopy. Ko te endoscopy o runga ko te whakauru i tētahi ngongo roa, angiangi (endoscope) me tētahi kāmera mā roto i tō waha hei tirotiro i tō esophagus, tō puku, me te wāhanga tuatahi o tō whekau iti (duodenum). Ka rapu te tākuta i ngā uaua kua nui ake e kiia nei ko ngā varices, mena kei te toto, me te mea kei reira ētahi wāhi toto e tata ana. Ko te mea pai rawa atu, ki te kite koe i te toto, ka taea e rātou te whakauru i ngā taputapu motuhake mā roto i te endoscope hei whakamutu i te toto.

He aha ngā maimoatanga mō te `(Portal Hypertension)`?

Ko te rongoā mō te Totoka Ārai Mate ka whakawhirinaki ki te pūtake o te mate. Hei tauira, mēnā he mate pāwera, he toto totoka rānei te pūtake, ka taea pea e tō tākuta te rongoā i te pūtake o te mate mā te rongoā, ā, ka āta pai haere tō Totoka Ārai Mate, ā, i ētahi wā ka memeha rawa atu.

Heoi, ki te mea he nui ngā whara o te ate, pērā i te cirrhosis, kāore e memeha. Ko te tikanga o tēnei, kāore e memeha te whara. Nō reira, ka mau tonu pea te toto toto tiketike. I te nuinga o te wā, ko te maimoatanga he whakahaere i ngā raruraru kino o te toto toto tiketike me te whakaiti i te kino e puta mai ana. Ka ngana tuatahi ngā tākuta ki te whakahaere i ngā āhuatanga ohorere (hei tauira, te toto toto) kātahi ka neke atu ki ngā otinga roa.

Te maimoatanga tuatahi hei aukati i te toto mai i te ara kai:

• Whakaora endoscopic: Ka rongoāhia e te tākuta te toto ohorere mā te endoscopy. Kei roto i ēnei tikanga ko te sclerotherapy (te werohanga i tētahi rongoā motuhake ki roto i ngā uaua toto hei whakaiti i a rātou, hei whakahaere hoki i te toto) me te here ( te here i ngā uaua toto ki ngā here rapa iti hei whakamutu i te toto).
• Rongoā: Tērā pea ka tohua e tō tākuta he rongoā, me te rongoā endoscopic rānei, hei whakaiti i te pēhanga i roto i ō uaua varicose me te whakaiti i te tūponotanga o te toto anō. Ka taea e ngā rongoā e kiia nei ko ngā beta-blockers te āwhina ki te whakaiti i te pēhanga portal, ko ngā vasoconstrictors ka āwhina ki te whakawhāiti i ngā uaua kua nui haere me te whakaiti i te toto.

Te maimoatanga tuatahi mō ētahi atu raruraru:

• Mena he `(hepatopulmonary syndrome)` (te korenga o te hāora i roto i te toto), ka hoatu he `(Oxygen therapy)` .
• Te dialysis mēnā he mate hepatorenal (te ngoikore o te whatukuhu).
• Mena kei te pāngia koe e te encephalopathy hepatic (ngā raruraru mahi roro), tera ētahi rongoā hei āwhina.
• Ko te paracentesis te tango i te wai nui mai i te puku nā te ascites (te kohi wai i roto i te puku) ā, ka tangohia he tauira o taua wai hei tirotiro mō te peritonitis (te mate o te puku).

Maimoatanga tuarua (mēnā ka mau tonu te toto, ētahi atu raruraru rānei):

I ētahi wā, ki te kore e taea te aukati i te toto, ki te mau tonu rānei ētahi atu raruraru, ka huri ngā tākuta ki ngā maimoatanga tuarua. Ko ngā tikanga matua e rua ko ngā pokanga "shunt". Ka whakamahia ēnei hei whakarerekē i te ara o te rere o te toto i roto i te "pūnaha uaua portal" me te whakaiti i te pēhanga.

• Te shunt portosystemic intrahepatic transjugular (TIPS): He tikanga kore-pokanga tēnei. Mā te whakamahi i ngā whakaahua hihi-X, ka whakanohoia e te tohunga hihi-X he stent (he ngongo mata iti) ki roto i tō ate. Ka whakamahia e rātou he ngira hei hanga i tētahi kauhanga mā roto i te ate, ka hono tika i te uaua portal ki tētahi uaua i roto i te ate (te uaua hepatic). Mā tēnei ka taea te rere o te toto mā roto i te kauhanga, ka whakaiti i te pēhanga. Ka whakanohoia te stent kia noho tuwhera tonu te kauhanga. He tikanga tino whai hua tēnei, engari i roto i te wā, ka āraia pea te stent, ā, me whakatika anō pea (he tikanga tukurua).

• Te shunt splenorenal distal (DSRS): He tikanga pokanga tēnei. Mō ētahi tāngata, he pai ake pea tēnei i te TIPS. Heoi, me hauora koe kia taea ai te pokanga me te wā whakaora. Heoi, tera pea ka whai hua ake ki te whakahaere i te mate i te wā roa. Ko tēnei tikanga ko te tango i tō uaua splenic mai i tō ate ka hono atu ki te uaua whatukuhu maui. Ka whakaitihia te rere o te toto me te pēhanga ki te ate me te whēkau.

Hei whakamutunga, mō te hunga he tino kino te mate ate e kore e taea te whakahaere mā ētahi atu maimoatanga, ka whakaarohia pea he whakawhitinga ate .

He aha te momo tiaki whai muri ka hiahiatia e au?

I muri i ēnei maimoatanga katoa , he mea nui kia noho tonu koe i raro i te tirotiro a te taote. Me aro nui koe ki tō āhua. Me toro atu koe ki tō tākuta i ia wā mō te tau tuatahi i muri i te maimoatanga kia kite ai mēnā kei te whai hua tonu te maimoatanga, ā, mēnā kua puta mai ētahi raruraru hou. Whai muri i tēnā, me toro atu koe ki tō tākuta i te iti rawa kia rua ngā wā i te tau kia tirohia te ate me ngā whakamātautau toto hei tirotiro i te mahi a tō ate. He rite tēnei ki te ratonga waka, me tiaki tonu e koe.

He aha taku e tumanako atu ai mō tēnei āhuatanga?

Ko tō matapae me tō whakaoranga ka whakawhirinaki ki te kaha o tō toto toto tiketike, mēnā he toto varicose tōu, me mēnā he raruraru kē atu āu.Ina hoki, ko te mōrearea o te mate mai i te toto tuatahi ka eke ki te 40%. Mēnā ka toto anō koe i muri i te maimoatanga, ko te mōrearea o te mate mai i te toto e whai ake nei e tata ana ki te 30%. Ka nui ake te mōrearea mēnā he kino tō cirrhosis. Heoi, mēnā kei te taea tonu te whakahaere i te mate ate i ōna wāhanga tōmua, ā, ka tere te maimoatanga, ka taea te whakaiti i te mōrearea.

Me pēhea te ārai i te `(Portal Hypertension)`?

Ko te huarahi pai hei ārai i tēnei "(Portal Hypertension)" ko te ngana ki te aukati i te whanaketanga o te mate ate mō te wā roa mēnā ka taea. Kāore e taea te whakahaere i ngā take katoa, engari ko ētahi o ngā take tino noa ka taea te whakahaere mēnā ka kitea wawe.

• Ko te mate ate i puta mai i te inu waipiro, te mate ate rānei i puta mai i te mate pākia o te tinana (hei tauira, te mate ate momona kore-waipiro), ka taea te whakapai ake mā te kai me ngā huringa oranga hauora (pēnei i te whakakori tinana).
• Ka taea te rongoā i te mate Hepatitis C mā roto i ngā rongoā ārai huaketo hou. Nō reira, he mea tino nui kia whakamātauria koe mō te mate Hepatitis C i te iti rawa i te kotahi i roto i tō oranga.

Me pēhea taku tiaki i a au anō i a au e noho tahi ana me te `(Portal Hypertension)`?

He haerenga uaua pea tēnei, engari kāore koe i te mokemoke.

• Kia mau tonu te whakapā atu ki tō rōpū hauora, tae atu ki ō tākuta me ō nēhi. Whakarongo pai ki ā rātou kōrero, ā, whai i tā rātou e kōrero nei.
• Me haere koe ki te tirotiro hauora i te wā tika, me tango ō rongoā kia rite ki tā te tākuta i tohutohu ai, i te wā e tohutohu ai rātou. Kaua e mahue tetahi rā.
• Me kōrero tonu ki tō tākuta i mua i te tango i tētahi rongoā hou (ahakoa mō tētahi atu mate, mō tētahi huaora rānei).
• Kati rawa te inu waipiro, whakaitihia rānei te nui e taea ana. Koinei tētahi o ngā painga nui ki te ate.
• Me whai pea koe i tētahi kai iti-konutai , inā koa mēnā kei te pupuhi koe. Me whai pea rānei koe i tētahi mahere kai kua hangaia mōu. He mea pai kia rapu tohutohu mai i tētahi tohunga kai.
• Tērā pea kei a koe ētahi atu mate e pā ana ki tēnei mate (hei tauira, te mate huka, te cholesterol tiketike). Āwhina ki te whakahaere i ēnei mate mā te whakarerekē i te kai me te noho ora.

Nā te mea he maha ngā okana e pāngia ana e tēnei āhuatanga, e kiia nei ko te "Portal Hypertension," ka rite te rongoā ki te tineia he ahi e mura ana i ngā wāhi rerekē. Tērā pea ka ohorere koe, ka mataku rānei, ki te mōhio ka pā te mate ate ki ngā uaua o tō puku, te korokoro, ngā pukahukahu, me ngā whatukuhu. He ohorere nui tēnei, inā koa mēnā kāore anō kia kitea he tohu o te mate ate. Engari ko te mea nui, ki te kite wawe koe, ā, ka rongoatia tika, ka nui te painga ki a koe ki te whakahaere i te "Portal Hypertension," me ōna raruraru. Nō reira kaua e mataku, ā, ki te mea he ruarua āu, tirohia he tākuta mō ētahi tohutohu.

Karere Whakamutunga mō te Tango ki te Kāinga

Āe, mai i ngā mea kua kōrerotia e tātou, ko te tumanako kua mārama ake koe ki te `(Portal Hypertension)`. Anei ngā mea matua hei maumahara māu:

• Ko te toto toto tiketike o te tomokanga he pikinga o te pēhanga i roto i ngā uaua e hono ana ki te ate. He mate kino tēnei.
• Ko te mate ate cirrhosis te tino take. Nō reira, he mea tino nui te tiaki i te ate.
• He maha ngā wā, kāore pea ngā tohu e puta i ngā wāhanga tōmua. Nō reira, ki te mea he āhuatanga mōrearea tōu (hei tauira, te mate ate mau tonu, te mate hepatitis), me tirotiro hauora koe i ia wā.
• Ki te pāngia koe e ngā tohu pēnei i te ruaki toto, te tūtae mangu, te puku pupuhi rānei , me toro atu ki te tākuta tonu.
• He maimoatanga kei reira, engari he pai ake te kite wawe i te mate, kātahi ka tīmata te maimoatanga.
• Me whai i ngā tohutohu a tō tākuta, me tango tika i tāu rongoā, ā, me huri i te āhua noho e tika ana.

Mena he pātai anō āu mō tēnei, kaua e mangere ki te kōrero ki tō tākuta. Kia ora tonu koe!

` Te Toto Toto Nui o te Kūaha, Ate, Te Pēhanga o te Uaua Kūaha, Te Ānini, Te Hematemesis, Te Ascites, Te Mate Ate, (Cirrhosis), (Varices), (Ascites)