Zimene muyenera kudziwa zokhudza matenda a Hepatopulmonary Syndrome!

Ngati inuyo kapena munthu amene mumamudziwa ali ndi matenda a chiwindi, kapena ngati inunso muli ndi vutoli, ndikofunikira kudziwa za vutoli lomwe nthawi zina lingayambitse mavuto opuma. Timalitcha kuti Hepatopulmonary Syndrome. Dzinali lingamveke ngati lovuta pang'ono, koma tiyeni tipitirizebe kulimvetsa, sichoncho? Chifukwa ndi vuto lomwe limayambira pachiwindi kupita ku mapapo.

Kodi matenda a Hepatopulmonary Syndrome ndi chiyani kwenikweni?

Mwachidule, matenda a chiwindi ndi vuto losowa koma lalikulu la matenda a chiwindi lomwe lingakhudze mapapo. Mawu oti "hepato" amatanthauza "zokhudzana ndi chiwindi." "pulmonary" amatanthauza "zokhudzana ndi mapapo." Kodi mukudziwa kuti chiwindi ndi mapapo athu zimalumikizidwa ndi mitsempha yamagazi?

Tangoganizirani, munthu akakhala ndi matenda a chiwindi, makamaka matenda monga cirrhosis, pomwe chiwindi chimakhala cholimba ndikuchepa, mitsempha ina yamagazi yolumikizidwa ndi mapapo imakula mosafunikira. Monga baluni ikuphulika. Mu zamankhwala, timatcha izi "Vasodilation" . Mitsempha yamagazi ikakula motere, njira yabwinobwino yoyendera magazi m'mapapo imasintha. Nthawi zina, magazi sasakanikirana bwino ndi mpweya m'mapapo, koma m'malo mwake amadutsa mwachindunji. Kuyenda kwa magazi kosakhazikika kumeneku kumatchedwa "Shunts" . Kukulira kwa mitsempha yamagazi m'mapapo kumachitika chifukwa cha "Vasodilation", ndipo kuchuluka kwa mpweya m'magazi kumachepa chifukwa cha "Shunts" amenewo. Timatcha izi "Hypoxemia" . Kodi mukumvetsa?

Kodi vutoli limakukhudzani bwanji? Kodi mukuvutika kupuma?

Tsopano mwina mukuganiza kuti, "Chabwino, izi zikundikhudza bwanji?" Chinthu chachikulu chomwe chimakhudza izi ndi kuvutika kupuma (Dyspnea) . Izi sizibwera mwadzidzidzi, koma pang'onopang'ono zimawonjezeka. Anthu ena sangazindikire kwambiri poyamba. Koma pakapita nthawi, vutoli likhoza kukhala lalikulu kwambiri kotero kuti limakhala lovuta kupuma ngakhale mutayimirira.

Anthu ena amavutika kupuma akakhala pansi kapena atayimirira, koma amamva bwino akagona. Kwa ena, ndi zosiyana; amavutika kupuma akagona, ndipo amamva bwino akakhala pansi. Komabe, chifukwa kupuma movutikira kumeneku kumakula pakapita nthawi, timatcha Chronic Respiratory Failure. Izi zikutanthauza kuti chilichonse sichimaima mwadzidzidzi, koma pang'onopang'ono ziwalo ndi minofu ya thupi lanu sizimalandira mpweya wokwanira. Timatcha izi hypoxia .

Uwu ndi vuto loopsa kwambiri. Kodi mukudziwa chiyani? Mpweya wa okosijeni ndi wofunikira m'matupi athu. Ukatayika kwathunthu, ukhoza kuwononga ziwalo zofunika kwambiri monga ubongo ndi mtima. Ngati sunachiritsidwe bwino, vutoli likhoza kukhala pachiwopsezo chachikulu.

Ndani amene ali ndi mwayi waukulu wopeza matenda a hepatopulmonary syndrome?

Kafukufuku wapeza kuti pafupifupi kotala, kapena 25%, ya anthu omwe ali ndi matenda a chiwindi osatha amakhala ndi matenda a hepatopulmonary syndrome. Zitha kuchitikanso ngati chiwindi chagwa mwadzidzidzi, chomwe chimatchedwa acute liver failure, koma sizichitika kawirikawiri.

Nthawi zambiri, izi ndi zomwe zimachitika: Matenda a chiwindi amachititsa kuti mitsempha yamagazi yolumikizidwa ndi chiwindi ichuluke. Mu zamankhwala, timatcha kuti "Portal Hypertension" . Vuto la "Portal Hypertension" ndi lomwe limapangitsa kuti mitsempha yamagazi m'mapapo ikule mwa anthu ena, zomwe zimayambitsa matenda a hepatopulmonary syndrome. Komabe, nthawi zambiri, "Portal Hypertension" imatha kuchitika chifukwa cha zifukwa zina, monga magazi kuundana, ndipo matendawa amathanso kuchitika chifukwa cha zimenezo.

Kodi chifukwa chenicheni cha izi n'chiyani?

Ndipotu, asayansi sakudziwabe chifukwa chake vutoli, lotchedwa portal hypertension, limapangitsa kuti mitsempha yamagazi m'mapapo ikule (vasodilation) mwa anthu ena. Pali malingaliro ndi malingaliro ambiri okhudza izi. Sizikudziwika bwino chifukwa chake sizichitika kwa aliyense, koma kwa anthu ena okha. Zikuoneka kuti sizikugwirizana mwachindunji ndi kuopsa kwa matenda a chiwindi.

Koma chinthu chimodzi n’chodziwikiratu. Kuchuluka kwa mpweya m’mapapo kumayambitsa kuchepa kwa mpweya m’magazi (Hypoxemia). Mwachidule, pali kusalingana pakati pa kuchuluka kwa mpweya wolowa m’mapapo ndi kuchuluka kwa magazi odutsa m’mapapo. Ichi ndichifukwa chake thupi sililandira mpweya wochuluka womwe limafunikira.

Kodi zizindikiro zake ndi ziti? Kodi tingazizindikire bwanji izi?

Ngati vuto la Hepatopulmonary Syndrome silili lalikulu kwambiri, simungazindikire zizindikiro zilizonse. Chizindikiro choyamba chomwe anthu ambiri amamva, monga tafotokozera kale , ndi kuvutika kupuma (Dyspnea) . Komabe, pali zifukwa zambiri zomwe kupuma kungakhale kovuta. Munthu amene ali ndi matenda a chiwindi amatha kukumana ndi vuto lopuma m'njira zosiyanasiyana. Chifukwa chake, nthawi zina odwala ndi madokotala sangazindikire nthawi yomweyo izi ngati chizindikiro cha Hepatopulmonary Syndrome.

Pamene vutoli likuipiraipira, mungakumanenso ndi zizindikiro zina monga:

• Platypnoea: Izi zimachitika pamene mukuvutika kupuma mukakhala pansi kapena mukuyimirira, koma mumamva mpumulo pang'ono mukagona.
• Orthopnea: Izi ndi zosiyana. N'zovuta kupuma mukagona, koma zimakhala bwino mukakhala pansi.
• Cyanosis: Kusanduka kwa mtundu wa buluu wa milomo, misomali, ndipo nthawi zina khungu chifukwa cha kusowa kwa mpweya m'thupi. Ichi ndi chizindikiro chooneka.
• Zala zokhala ndi zibonga:Nsonga za zala kapena zala zakumanja zimaoneka zotupa komanso zotupa, ngati nsonga za ndodo ya ng'oma. Ichi ndi chizindikiro china cha kuchepa kwa madzi m'thupi.

Kuwonjezera pa zizindikiro izi, mungakhalenso ndi zizindikiro zomwe zimafanana ndi matenda a chiwindi ndi/kapena kuthamanga kwa magazi kwa portal. Mwachitsanzo:

• Angiomas ya kangaude: Mitsempha yamagazi yaying'ono, yofiira, yofanana ndi kangaude yomwe imawonekera pansi pa khungu.
• Mitsempha ya Varicose: Mitsempha yamagazi yokulirapo imawonekera m'mimba kapena m'mero.
• Mbiri yakale ya kutuluka magazi m'mimba .
• Ascites (kutupa kwa mimba)

Kodi madokotala amazindikira bwanji izi?

Madokotala amazindikira matenda a chiwindi ndi mapapo pamene zizindikiro zitatu zazikulu zimachitika pamodzi:

1. Kuthamanga kwa magazi kwa m'mimba: Izi zimachitika nthawi zambiri ndi matenda a chiwindi.

2. Kutambasuka kwa mitsempha ya m'mapapo: Izi zikutanthauza kuti mitsempha yamagazi mkati mwa mapapo imatambasuka.

3. Kuchepa kwa mpweya m'magazi (Hypoxemia) .

Nthawi zambiri, mukakhala ndi `(Hepatopulmonary Syndrome)`, madokotala anu apeza kale kuti muli ndi matenda a chiwindi `(Matenda a Chiwindi)` kapena `(Matenda Othamanga Kwambiri a Portal).` Kupanda kutero, gulu lanu lachipatala lidzachita kaye ma scan osiyanasiyana ndi mayeso a magazi kuti lione ngati pali kuwonongeka kwa chiwindi. Kenako adzayang'ana mitsempha m'mapapu anu ndikuyeza kuchuluka kwa mpweya m'magazi mwanu. Mayesowa angasonyeze bwino kuti mitsempha yamagazi m'mapapu mwanu ikukulirakulira `(Vasodilation)`, zomwe zikuchititsa kuti mpweya ukhale wochepa m'magazi mwanu `(Hypoxemia).`

Ndi mayeso apadera ati omwe amachitidwa pa izi?

Madokotala amachita mayeso angapo kuti atsimikizire vutoli. Ena mwa iwo ndi awa:

• Kuyeza kwa pulse oximetry: Mwina munachitapo izi kale. Ndi mayeso osavuta komanso osapweteka. Chipangizo chaching'ono chonga clip chimalumikizidwa ku nsonga ya chala chanu. Chimaunikira kuwala kudzera mu chala chanu ndikuyesa kuchuluka kwa kuwala komwe kukubwera mbali inayo, komwe kumagwiritsidwa ntchito poyesa kuchuluka kwa mpweya m'magazi anu (Oxygen Saturation). Iyi ndi mayeso oyambira.
• Mpweya wa Magazi a M'mitsempha (ABG): Ngati kugunda kwa mtima kukuwonetsa kuti mpweya m'magazi mwanu ndi wochepa, mayeso otsatira omwe muchita ndi ABG. Izi ndi zatsatanetsatane pang'ono. Chitsanzo chaching'ono cha magazi chimatengedwa kuchokera ku mtsempha womwe uli m'dzanja lanu. Chitsanzo cha magazi chimayesedwa kuti adziwe kuchuluka kwa mpweya womwe umasungunuka m'magazi mwanu (PaO2). Ichi ndi muyeso wa momwe mapapu anu amayamwitsira mpweya m'magazi mwanu.
• Kusiyana kwa Echocardiography:Iyi ndi njira yabwino kwambiri yopezera mitsempha ya m'mapapo yotambasuka. Echocardiogram ndi ultrasound. Imagwiritsa ntchito mafunde amphamvu kwambiri kuti ijambule zithunzi za mtima wanu ndi mitsempha m'mapapo anu. Mu ultrasound yowonjezereka, choyezera chosiyanitsa, madzi apadera, amalowetsedwa mumtsempha kuti mitsempha iwonekere bwino. Mukalandira contrast echocardiogram, katswiri amalowetsa saline solution m'mitsempha yanu. Iyi ndi yankho lopangidwa powonjezera thovu laling'ono la mpweya m'madzi amchere. Kenako amawayang'anira kuti awone ngati thovu laling'onoli limayenda kuchokera kumanja kwa mtima wanu kupita kumanzere pakapita nthawi (kumanja kupita kumanzere cardiac shunt). Izi zitha kuwadziwitsa ngati muli ndi `(Hepatopulmonary Syndrome)` kapena ayi.

Kodi izi zimachiritsidwa bwanji?

Chithandizo chokhacho chomwe chimagwiritsidwa ntchito pakali pano cha matenda a chiwindi ndi mpweya wowonjezera . Chithandizo cha mpweya chimaphatikizapo kupuma mpweya 100% kuti muthandize thupi lanu. Mungafunike kupeza mpweya kuchokera ku chipinda chopanikizika m'chipatala, chotchedwa hyperbaric oxygen therapy. Kapena, mungapatsidwe chipangizo chomwe mungapite nacho kunyumba, monga chigoba cha mpweya. Mpweya ungathandize kuchepetsa zizindikiro, makamaka kupuma movutikira, ndikusunga minofu ya thupi lanu ikugwira ntchito bwino powapatsa mpweya womwe amafunikira.

Kodi matenda a chiwindi ndi mapapo amabwereranso? ​​Kodi angathe kuchiritsidwa kwathunthu?

Chithandizo chokhacho chochiritsira matenda a chiwindi ndi kuikidwa chiwindi . Inde, mwandimva bwino. Pambuyo poikidwa chiwindi bwino, kukulirakulira kwa mitsempha yamagazi m'mapapo (vasodilation) ndi kusowa kwa mpweya m'magazi (hypoxemia) pang'onopang'ono kumabwerera m'mbuyo. Izi zikutanthauza kuti zimakhala bwino. Zimatenga miyezi isanu ndi umodzi mpaka khumi ndi iwiri kuti mapapu anu abwerere mwakale.

Komabe, si aliyense amene ali woyenera kuikidwa chiwindi. Pali zifukwa zosiyanasiyana za izi. Ngakhale atakhala oyenerera, nthawi zina amafunika kudikira nthawi yayitali kuti chiwindi chilandire. Choncho kuchira kumeneku kuli ngati mpikisano wopikisana ndi nthawi.

Kodi izi ndi zoopsa? Nanga bwanji za nthawi yopulumuka?

Ngati muli ndi Hepatopulmonary Syndrome, mwina muli kale ndi Matenda a Chiwindi Osatha. Matenda a chiwindi otsiriza ndi vuto lomwe lingathe kupha popanda kuikidwa chiwindi. Hepatopulmonary Syndrome ndi imodzi mwa zotsatirapo zake komanso mavuto omwe amabwera chifukwa cha matendawa. Anthu ambiri samwalira ndi Hepatopulmonary Syndrome, yomwe ndi kusowa kwa mpweya (hypoxemia), komanso imathandizira thanzi lawo lonse ndikufupikitsa moyo wawo.

Kutalika kwa nthawi yomwe mungakhale ndi Hepatopulmonary Syndrome kumadalira zinthu zambiri. Izi zikuphatikizapo kuopsa kwa matenda anu a chiwindi, thanzi lanu lonse, komanso ngati muli ndi matenda ena. Pa avareji, munthu amene ali ndi matenda a chiwindi koma alibe Hepatopulmonary Syndrome akhoza kukhala ndi moyo kwa zaka pafupifupi zisanu ndi ziwiri osamuika chiwindi. Komabe, kwa munthu amene ali ndi matenda a chiwindi ndi Hepatopulmonary Syndrome, nthawi yapakati yokhala ndi moyo popanda kumuika chiwindi imatha kuchepetsedwa kufika pa zaka ziwiri.

Anthu ena akhoza kukhala ndi matenda a chiwindi ofooka, omwe si oopsa ngati matenda a chiwindi. Akhoza kukhala ndi moyo wautali ndi chithandizo chothandizira. Komanso, anthu ena sangapulumuke ataikidwa chiwindi ngati matenda awo ndi aakulu. Chiwerengero cha anthu omwe ali ndi matenda a chiwindi opitirira muyeso omwe apulumuka zaka zisanu omwe achita bwino ataikidwa chiwindi ndi pafupifupi 70%. Izi ndi zochepa pang'ono kuposa chiwerengero chonse cha anthu omwe apulumuka ataikidwa chiwindi (75%).

Matenda a chiwindi amakhudza aliyense mosiyana. Matenda a Hepatopulmonary Syndrome ndi matenda osowa komanso omwe angaphe anthu ambiri omwe angachitike. Mwina simunamvepo za matendawa mpaka atakuchitikirani kapena munthu wina amene ali pafupi nanu.

Anthu ambiri ali ndi zizindikiro zochepa kapena alibe zizindikiro. Koma kwa ena, makamaka omwe ali kale ndi thanzi lofooka, izi zimatha kumveka ngati "udzu womaliza." Monga matenda a chiwindi, matenda a hepatopulmonary syndrome (HPS) amakula pakapita nthawi. Ngati muli kale pamndandanda woyembekezera kuikidwa chiwindi, mudzakwezedwa pamndandanda mukapezeka ndi HPS. Izi zili choncho chifukwa madokotala amadziwa kuti vutoli lingafupikitse nthawi yanu yoyembekezera moyo ndikuchepetsa moyo wanu - ndipo amadziwa kuti kuikidwa chiwindi kungathe kuchichiza. Pakadali pano, kupitiriza kuchiza ndi mpweya kungakuthandizeni kupeza mpumulo ndikukuthandizani kukhala ndi moyo wautali.

Pomaliza, zinthu zofunika zomwe muyenera kukumbukira

Kotero, ndikukhulupirira kuti mwamvetsa bwino zomwe takambirana zokhudza Hepatopulmonary Syndrome. Kumbukirani mfundo izi:

• Ichi ndi vuto losowa koma lomwe lingakhale lalikulu chifukwa cha matenda a chiwindi .
• Chizindikiro chachikulu ndi kuvutika kupuma (kulephera kupuma mokwanira) , makamaka kwa munthu amene ali ndi matenda a chiwindi.
• Ngati munthu amene ali ndi matenda a chiwindi akuvutika kupuma, ayeneranso kukayikiridwa kuti ali ndi vutoli (Hepatopulmonary Syndrome) ndipo dokotala ayenera kuuzidwa za vutoli.
• Kuika chiwindi ndi njira yokhayo yochiritsira yomwe ilipo pakadali pano.
• Mpaka chithandizocho chitapezeka, chithandizo cha okosijeni chingathandize kuchepetsa zizindikiro ndikusunga moyo.
• Ngati inu kapena munthu amene mumamudziwa ali ndi zizindikirozi, ndikofunikira kwambiri kupita kwa dokotala nthawi yomweyo kuti akakupatseni upangiri. Chifukwa, ngati zadziwika msanga, zimakhala zosavuta kuzisamalira ndikukonzekera chithandizo china. Musachite mantha, koma ndi bwino kudziwa.

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