Momwe vuto la chiwindi limakhudzira impso mwachindunji: Tiyeni tiphunzire bwino za Hepatorenal Syndrome!

Kodi munayamba mwaganizapo kuti vuto lalikulu la chiwindi chanu lingayambitse impso zanu zonse ziwiri zomwe zili ndi thanzi labwino kusiya kugwira ntchito nthawi imodzi? Ndi lingaliro loopsa, sichoncho? Lero tikambirana za vuto lalikulu, lomwe lingawononge moyo lomwe lingachitike chifukwa cha kulephera kwa chiwindi. Izi ndi zomwe madokotala amatcha Hepatorenal Syndrome (HRS) . Tiyeni tiwone chomwe chili, chifukwa chake chimachitika, ndi zina zomwe tingachite.

Kodi Hepatorenal Syndrome ndi chiyani?

Mwachidule, matenda a hepatorenal syndrome (HRS) ndi vuto lomwe chiwindi chanu sichikugwira ntchito bwino, vuto lalikulu kwambiri lomwe limachitika kumapeto kwa kulephera kwa chiwindi. Chomwe chimachitika pankhaniyi ndikuti impso zanu zimataya ntchito yawo mwadzidzidzi chifukwa cha mavuto a chiwindi. Chapadera ndichakuti izi zimaonedwa ngati kulephera kwa impso kwa prerenal acute . Izi zikutanthauza kuti mutha kukhala ndi vutoli ngakhale mutakhala kuti mulibe matenda a impso kale ndipo palibe kusintha kwa thupi kapena kuwonongeka kwa impso zanu. Impso zanu zitha kukhala zathanzi, koma chifukwa cha vuto la chiwindi, magazi omwe amaperekedwa kwa izo amasokonekera, ndipo sangathe kuchita ntchito yawo.

Taganizirani ngati pampu yamadzi yomwe ikugwira ntchito bwino, koma ngati chitoliro cha madzi chopita ku thanki la madzi chatsekedwa, madziwo sadzatuluka. Impso zili bwino, koma mavuto a chiwindi amachititsa kuti mitsempha yamagazi yomwe imanyamula magazi kupita ku impso ikhale yotsekeka komanso yopapatiza. Kenako, impso sizilandira magazi omwe zimafunikira, ndipo ntchito yawo imachepa pang'onopang'ono. Izi zimaonedwa ngati zadzidzidzi , ndipo nthawi zambiri, chithandizo chokhacho chokhazikika cha izi ndi kuyika chiwindi .

Ndani amene akukhudzidwa kwambiri ndi vutoli?

Matendawa, otchedwa hepatorenal syndrome (HRS), amakhudza kwambiri anthu omwe ali ndi matenda aakulu a chiwindi . Makamaka, anthu omwe ali ndi matenda a chiwindi osatha , omwe chiwindi chawo chakhala chikufooka pang'onopang'ono pakapita nthawi, ali pachiwopsezo chachikulu cha matendawa. Kodi mukudziwa kuti chifukwa cha matenda a chiwindi a nthawi yayitali, minofu ya chiwindi imakhala ndi zipsera ndipo chiwindi chimakhala cholimba? Timatcha matenda a chiwindi . Chifukwa cha vutoli, magazi opita ku chiwindi amasintha, ndipo pakapita nthawi, chiwindi chimasiya kugwira ntchito.

Komanso, ngati chiwindi chalephera kugwira ntchito mwadzidzidzi chifukwa cha zifukwa zinaKomabe, HRS ikhoza kuchitika. Kafukufuku wasonyeza kuti HRS imatha kuchitika mwa anthu okwana 40% omwe ali ndi matenda a chiwindi omwe amafika pachimake. Ngakhale kuti imatha kuchitika pa msinkhu uliwonse komanso jenda, imapezeka kwambiri mwa anthu azaka zilizonse. Imapezekanso mwa anthu pafupifupi 10% omwe ali m'chipatala omwe ali ndi vuto la chiwindi losatha kapena loopsa. Ngakhale kuti pali zifukwa zingapo zomwe zimayambitsa kulephera kwa impso chifukwa cha matenda a chiwindi, HRS ndi yapadera chifukwa imapezeka mwa anthu omwe alibe matenda a impso kale.

Kodi cirrhosis imayambitsa bwanji matenda a hepatorenal?

Nkhaniyi ndi yovuta pang'ono. Ofufuza akadali ndi maganizo osiyanasiyana okhudza momwe matenda a chiwindi amayambitsira matenda a hepatorenal syndrome (HRS), kutanthauza kuti, matenda ake.

Kodi izi zimachitika bwanji kwenikweni? (Pathophysiology)

Monga tikudziwa, kulephera kwa impso kumachitika pamene mitsempha yamagazi mu impso imachepa, kutsekeka, ndipo magazi opita kumeneko amachepa. Ofufuza amakhulupirira kuti kuchepa kwa mitsempha yamagazi kumeneku kumachitika chifukwa cha zinthu zosiyanasiyana zokhudzana ndi matenda a chiwindi ndi kulephera kwa chiwindi. Chifukwa chachikulu cha izi ndi kuthamanga kwa magazi kwa portal .

Matenda a magazi otchedwa portal hypertension ndi matenda omwe kuthamanga kwa magazi mu mtsempha wa portal, mtsempha waukulu womwe umadutsa m'chiwindi, ndi mitsempha yomwe imalumikizana nayo ndikufalikira m'mimba mwanu, imawonjezeka. Chifukwa chofala kwambiri cha izi ndi matenda a cirrhosis . Matenda a cirrhosis amathanso kuyambitsa matenda otchedwa cirrhosis cardiomyopathy , omwe amachititsa kuti mitsempha ina m'thupi lanu ikhale yayikulu kwambiri. Kusintha kwa kayendedwe ka magazi kovuta kumeneku kumapangitsa kuti mitsempha ina yamagazi ikule pomwe ina (makamaka yomwe ili mu impso zanu) imachepa. Taganizirani ngati kuchuluka kwa magalimoto mbali imodzi ya msewu, komwe kumakhudzanso mbali zina.

Kodi ndi zinthu ziti zomwe zikuwonjezera vutoli?

Pali zinthu zina zomwe zimagwirizanitsidwa ndi matenda a chiwindi zomwe zingakhale "choyambitsa" kapena choyambitsa HRS. Chofala kwambiri mwa izi ndi Spontaneous Bacterial Peritonitis (SBP) . Ichi ndi matenda a bakiteriya omwe amafalikira m'mimba mwanu (peritoneum). SBP ndi vuto la ascites , lomwe ndi kuchuluka kwa madzi m'mimba. Ascites imayamba chifukwa cha madzi kutuluka m'mitsempha ya m'mimba chifukwa cha kuthamanga kwa magazi kwa portal.

Tangoganizirani, ngati mimba yanu yadzaza ndi madzi (ascites), majeremusi amatha kulowa mosavuta m'mimbamo ndikuyambitsa matenda. Ndicho chimene chimatchedwa bacterial peritonitis (SBP) iyi.

Komanso, kuthamanga kwa magazi m'mimba kungayambitse kuphulika kwa mitsempha yanu ndikutuluka magazi m'mimba mwanu.Kutaya magazi mwachangu chifukwa cha kutuluka magazi m'mimba ndi chinthu china chomwe chimayambitsa vutoli. Sikuti zimenezo zokha, komanso kugwiritsa ntchito kwambiri mankhwala okodzetsa , kapena "mapiritsi amadzi," kungayambitsenso vutoli. Mankhwala okodzetsa amagwira ntchito pochotsa madzi ochulukirapo m'thupi. Anthu omwe ali ndi matenda a chiwindi omwe akukula amatha kumwa mapiritsi amadzi awa chifukwa cha ascites kapena edema , yomwe ndi kutupa kwa thupi.

Kodi zizindikiro zake ndi ziti?

Anthu omwe ali ndi matenda a hepatorenal syndrome (HRS) nthawi zambiri amayamba kumva kudwala kosamveka bwino komanso kosamveka bwino. Zizindikiro zake ndi izi:

• Kutopa
• Kusanza
• Kuwawa kwam'mimba
• Kukoma koipa mkamwa

Kuphatikiza apo, angakhalenso ndi zizindikiro za matenda a chiwindi kapena kulephera kwa chiwindi. Izi zikuphatikizapo:

• Jaundice (kuyera kwa maso)
• Kutupa ndi kutuluka magazi mosavuta
• Chimbudzi chowala komanso mkodzo wakuda
• Kutupa m'mimba (chifukwa cha ascites, chiwindi chokulirapo kapena ndulu)
• Khungu loyabwa
• Kusokonezeka, kuiwala zinthu, kapena kugona (Hepatic Encephalopathy)

Impso zikalephera kugwira ntchito bwino, mungazindikire kuti kuchuluka kwa mkodzo womwe mumatulutsa kwachepa kwambiri .

Kodi mumazindikira bwanji izi?

Matenda a Hepatorenal (HRS) ndi mtundu wa kulephera kwa impso komwe kumachitika ngati pali matenda oopsa a chiwindi ndipo palibe chifukwa china chilichonse cholephera kwa impso. Chifukwa chake, madokotala amazindikira izi poyesa kaye matenda a chiwindi ndi impso, kenako n’kuchotsa zina zomwe zingayambitse kulephera kwa impso. Kuti achite izi, amagwiritsa ntchito mayeso osiyanasiyana ojambulira zithunzi , monga kusanthula, kuyezetsa magazi, ndi kuyezetsa mkodzo, kuti awone momwe chiwindi ndi impso zanu zikugwirira ntchito.

Kodi imachiritsidwa bwanji?

Ngakhale kuti HRS ndi vuto lalikulu kwambiri chifukwa cha kulephera kwa impso, muzu wa vutoli uli m'chiwindi . Hepatorenal syndrome (HRS) imatchulidwa kuti ndi "prerenal" ya kulephera kwa impso chifukwa impso zanu zimakhala zathanzi. Ndipotu, ngati impso zanu zitengedwa ndikuikidwa m'thupi la munthu wina, zimagwira ntchito bwino. Mofananamo, ngati chiwindi chanu chibwerera mwakale, pali mwayi waukulu kuti impso zanu ziyambiranso kugwira ntchito.

Anthu ena omwe ali ndi vuto lalikulu la chiwindi amatha kuchira bwino ntchito yawo ya chiwindi ndi impso. Koma ena onse adzafunika kuikidwa chiwindi . Angafunike kuikidwa chiwindi nthawi ina, koma HRS imapangitsa kufunikako kukhala kofunika kwambiri. Komabe, si aliyense amene ali woyenera kuikidwa chiwindi, ndipo ngakhale atatero, ayenera kudikira mpaka atalandira.

Pa nthawi ngati iyi, chithandizo chachangu ndi kasamalidwe koyenera ndiye zinthu zofunika kwambiri.

Pakadali pano, dokotala wanu kapena namwino adzayesetsa kusunga ntchito ya impso zanu momwe angathere ndikuchepetsa zizindikiro ndi zotsatirapo zake. Njira izi zingathandize thanzi lanu lonse ndikukuthandizani kukonzekera kuikidwa chiwindi. Zingathandizenso kukonza zotsatira za kuikidwa chiwindi ngati muli nacho. Komabe, izi si machiritso . Mankhwalawa angaphatikizepo:

• Madzi a m'mitsempha ya m'magazi , omwe ndi zinthu monga saline, amaperekedwa kuti akonze kusalinganika kwa ma electrolyte m'thupi ndikuthandizira kuyenda kwa magazi kupita ku impso.
• Kusiya mankhwala ena, monga diuretics (mapiritsi amadzi).
• Kupereka mankhwala opha mabakiteriya pa matenda opatsirana.
• Paracentesis imachitika kuti ichotse madzi ochulukirapo omwe amasonkhana chifukwa cha ascites.
• Kupereka mankhwala otchedwa vasoconstrictors . Mankhwalawa amagwira ntchito pochepetsa mitsempha yanu yamagazi yotakata kwambiri ndikuwonjezera kuyenda kwa magazi kupita ku impso.
• Hemodialysis , yomwe ndi dialysis ya magazi, ndi njira yothandizira impso zanu zomwe zili ndi nkhawa.

Kodi zingatheke kupewedwa?

Njira yabwino yopewera matenda a chiwindi (HRS) ndikuwongolera matenda a chiwindi asanayambe kukula kwa cirrhosis . Matenda a chiwindi osatha ndi vuto lomwe limakula pang'onopang'ono kwa zaka zambiri. Anthu omwe amadziwa kuti ali ndi vutoli amatha kulamulira komanso nthawi zina kusintha kufalikira kwa matendawa mwa kuchita zinthu monga kuchepetsa kumwa mowa, kuchepetsa thupi, komanso kukonza zakudya zawo. Komabe, chifukwa anthu ambiri sasonyeza zizindikiro, sizingadziwike popanda kuyezetsa dokotala nthawi zonse.

Ngati muli kale ndi matenda a cirrhosis, palibe njira yodziwira kapena kuletsa HRS kuti isakule. Komabe, Spontaneous Bacterial Peritonitis (SBP)Komabe, mutha kupewa "choyambitsa" chofala kwambiri cha izi. SBP ndiye amachititsa pafupifupi 25% ya milandu ya HRS mwa anthu omwe ali ndi matenda a chiwindi. Chifukwa chake, ngati dokotala wanu akuganiza kuti muli pachiwopsezo chachikulu cha SBP, kumwa maantibayotiki ngati njira yopewera kungathandize kuchepetsa vutoli ndikuchepetsa mwayi wanu wopeza HRS.

Kodi izi zingathe kuchiritsidwa? Kodi zikuika moyo pachiswe?

Popanda kuikidwa chiwindi, anthu ambiri amakhala ndi vuto lalikulu kwambiri. Ngati HRS yakula mwadzidzidzi ndipo palibe choika chiwindi, nthawi yopulumuka imakhala milungu iwiri yokha. Ndi HRS yosatha, nthawi yopulumuka yopanda choika chiwindi ndi miyezi itatu mpaka isanu ndi umodzi . Kutengera ndi momwe chiwindi chikulephera kugwira ntchito bwino, vutoli likhoza kukulirakulira mofulumira. Komanso, ngati vutoli likukulirakulira mofulumira, mungadwale kwambiri kuti musachite choika chiwindi, zomwe zingakhale zovuta.

Komabe, ngati mutapatsidwa chiwindi, vuto lanu lidzakula kwambiri . Anthu omwe ali ndi HRS ali ndi mwayi wa 60% wopulumuka zaka zitatu mutapatsidwa chiwindi. Izi ndi zochepa pang'ono poyerekeza ndi zaka zitatu zomwe anthu omwe nthawi zambiri amapatsidwa chiwindi (75%) amakhala nazo. Ntchito ya impso ya anthu ambiri idzabwerera mwakale mkati mwa milungu ingapo. Chiwerengero chochepa kwambiri (pafupifupi 5%) chingafunike kupitiliza ndi dialysis .

Kaya ndinu munthu amene chiwindi chanu chikulephera kugwira ntchito bwino pang'onopang'ono kapena mwayamba mwadzidzidzi matenda a hepatorenal syndrome (HRS) omwe akukuchititsani kuti muchedwetse nthawi yanu, kukhala pamndandanda wodikira anthu opereka chiwindi si lingaliro labwino. Chifukwa palibe chiwindi chokwanira cha anthu omwe ali pamndandandawo. Komabe, ngati mungapeze munthu wopereka chiwindi wamoyo , simungafunike kukhala pamndandandawu, ndipo thanzi lanu lonse likhoza kukhala bwino.

Opereka moyo ndi odzipereka athanzi, nthawi zambiri okondedwa anu, omwe ali ofanana ndi mtundu wa magazi anu ndi kukula kwa thupi lanu. Ngakhale chidutswa chaching'ono cha chiwindi chotengedwa kuchokera kwa munthu wina wamoyo chingakulirenso kukhala chiwindi chathunthu mwa inu ndi wopereka. Komanso, chiwindi chamoyo chimakhala bwino kuposa chiwindi chotengedwa kuchokera kwa opereka moyo omwe anamwalira. Madokotala ochita opaleshoni amayesetsa kuti opaleshoni ya opereka moyo olimba mtima awa ikhale yochepetsera kuwononga momwe angathere.

Pomaliza, zinthu zoti muzikumbukira

Kotero, mwina tsopano mukumvetsa kuti matenda a hepatorenal ndi vuto lalikulu lomwe limafuna chisamaliro chifukwa limakhudza impso chifukwa cha mavuto a chiwindi.

• Thanzi la chiwindi ndi lofunika kwambiri:Ngati muli ndi matenda aliwonse a chiwindi, ndikofunikira kwambiri kuwasamalira bwino, makamaka kuti asapitirire kukhala matenda monga cirrhosis.
• Samalani ndi zizindikiro: Ngati muli ndi zizindikiro zokhudzana ndi matenda a chiwindi kapena kumva kuti simuli bwino, pitani kwa dokotala nthawi yomweyo.
• Ganizirani za impso zanu: Mukakhala ndi vuto la chiwindi, muyeneranso kusamalira impso zanu. Ngati muli ndi zizindikiro monga kuchepa kwa mkodzo, uzani dokotala wanu.
• Pali chithandizo: Ngakhale kuti HRS ndi vuto lalikulu, chithandizo monga kuyika chiwindi chingapulumutse miyoyo. Choncho musataye mtima.
• Moyo ndi wofunika: Zinthu monga moyo wathanzi, kudya zakudya zoyenera, komanso kupewa kumwa mowa zimathandiza kuti chiwindi chikhale ndi thanzi labwino.

Ndikukhulupirira kuti izi zikuthandizani. Ngati inu kapena munthu amene mumamudziwa akukumana ndi vuto lamtunduwu, chinthu chabwino kuchita ndikupempha upangiri wa dokotala nthawi yomweyo.

Matenda a chiwindi , matenda a chiwindi, kulephera kwa impso, cirrhosis, kusamutsidwa kwa chiwindi, kuthamanga kwa magazi m'mapapo, ascites