Kodi mulinso ndi kutupa mu 'thumba' lanu? Tiyeni tikambirane za pouchitis!

Kodi munachitapo opaleshoni ya thumba la ileal? Kapena kodi pali munthu amene mumamudziwa amene adachitapo opaleshoniyi? Anthu omwe amachita opaleshoni ya thumba la ileal nthawi zina amatha kukhala ndi vuto lotchedwa pouchitis. Ngakhale kuti lingakhale lokhumudwitsa pang'ono, palibe chodetsa nkhawa nacho. Tiyeni tikambirane za izi m'njira yosavuta yomwe mungamvetse.

Kodi Pouchitis ndi chiyani kwenikweni?

Mwachidule, pouchitis ndi kutupa kwa thumba lanu la ileal . Tiyeni tiwone tanthauzo la thumba la ileal. Mwachitsanzo, anthu ena ali ndi vuto lalikulu la matumbo lomwe limafuna kuti matumbo awo onse ndi rectum achotsedwe. Timatcha opaleshoni iyi kuti ndi proctocolectomy yonse. Kenako, amafunika kupanga njira yatsopano yoti zinyalala, kapena ndowe, zituluke m'thupi lawo. Pamenepo ndi pomwe thumba la ileal limalowa. Madokotala amagwiritsa ntchito kumapeto kwa matumbo anu ang'onoang'ono, ileum, kuti apange thumba ili, lomwe lili ngati thumba laling'ono. Ili ndi matumbo anu ang'onoang'ono ndi rectum yanu yochotsedwa, zomwe zikutanthauza kuti imasonkhanitsa ndikusunga ndowe kwa kanthawi. Kenako thumba ili limalumikizidwa komwe ndowe imatuluka. Nthawi zina imalumikizidwa ku anus yanu, kaya ngati J-pouch kapena S-pouch, kapena ngati K-pouch, yomwe imalumikizidwa ndi dzenje lapadera m'mimba mwanu, lotchedwa stoma. Mwanjira ina, gawo la matumbo anu ang'onoang'ono tsopano likugwira ntchito ngati matumbo anu aang'ono. Choncho, pouchitis ndi yofanana ndi colitis - kutupa kwa m'matumbo - kapena proctitis - kutupa kwa rectum - koma kumachitika mwa anthu omwe ali ndi thumba la ileal. Zizindikiro zake ndi zofanana kwambiri. Zizindikiro zake zitha kuphatikizapo kupweteka m'mimba komanso kufunikira kupita kuchimbudzi mwachangu komanso pafupipafupi. Anthu ambiri amakhala ndi 'acute pouchitis', yomwe ndi kutupa komwe kumabwera ndikutha kwa kanthawi kochepa. Komabe, kwa ena, ikhoza kukhala vuto lotchedwa 'chronic pouchitis', lomwe limakhalapo nthawi zonse kapena limabwera ndikutha.

Kodi pouchitis ndi yofala bwanji?

Akuti pakati pa 25% ndi 45% ya anthu omwe adachitidwa opaleshoni ya ileal pouchitis adzadwala pouchitis nthawi ina m'miyoyo yawo . Pafupifupi 40% ya anthu adzadwala matendawa koyamba chaka chilichonse. Komanso, pakati pa 10% ndi 20% adzadwalanso.

Kodi zizindikiro za Pouchitis ndi ziti?

Ngati muli ndi pouchitis, mungakumane ndi zizindikiro ngati izi.

• Kupweteka m'mimba ndi kupunduka.
• Kufunika kupita kuchimbudzi mwachangu komanso pafupipafupi.
• Kudzuka kuti ndikapite kuchimbudzi usiku.
• Kuvuta kulamulira mayendedwe a m'mimba (kusadziletsa m'mimba), zomwe zikutanthauza kutuluka pang'ono.
• Kuvuta kutulutsa ndowe, kupsinjika (dyschezia).
• Kumva ngati ukufunika kupita kuchimbudzi, koma sungathe kupita (tenesmus).
• Magazi pang'ono mu ndowe.
• Malungo kapena kumva kuzizira.

Kodi zimayambitsa pouchitis ndi ziti?

Madokotala amaganiza kuti chifukwa chachikulu cha pouchitis ndi kusintha kwa mitundu ya mabakiteriya a m'matumbo omwe amakhala m'thumba lanu. Taganizirani izi, pamene gawo la matumbo anu ang'onoang'ono likugwira ntchito ngati matumbo akulu, limakumana ndi mitundu yatsopano ya mabakiteriya. Mabakiteriya atsopanowa amapikisana ndi mabakiteriya omwe analipo kale. Izi zimapangitsa chitetezo chanu cha mthupi kuganiza kuti, "O, pali matenda apa," kenako chimayankha poyambitsa kutupa. Anthu ena ali ndi kachilombo. Mitundu ina ya mabakiteriya m'matumbo mwathu, ngati atapatsidwa mwayi, amayesa kulamulira ena ndikukhala mfumu. Izi zimatchedwa "mabakiteriya opatsirana." Kawirikawiri, kukhala ndi mabakiteriya ena m'matumbo mwathu ndibwino, chifukwa mabakiteriya ena abwino amawaletsa. Koma pambuyo pa opaleshoni ya thumba la ileal, kulinganiza kumeneku kumasintha, ndipo mabakiteriya "oipa" amenewo amakhala ndi mwayi watsopano wofalitsa mphamvu zawo. Ndizachilendo kukhala ndi pouchitis kwa kanthawi kochepa pambuyo pa opaleshoni ya thumba la ileal. Izi zimatchedwa pouchitis yoyambirira, ndipo zimaonedwa ngati zotsatira zoyipa za opaleshoniyo. Nthawi zambiri zimakhala bwino ndi maantibayotiki. Koma zimatha kubwereranso. Kwa anthu ena, zimabwereranso. Izi zili choncho chifukwa mitundu ina ya mabakiteriya imapitirira kulamulira ena. Mutha kukhala ndi matenda a acute pouchitis kangapo, ndipo nthawi iliyonse mutha kuchira ndi maantibayotiki. Vutoli limakhala lovuta pang'ono mukakhala ndi matenda ochulukirapo pachaka. Anthu ena amadalira maantibayotiki - izi zimatchedwa chronic antibiotic-dependent pouchitis (CADP). Kwa ena, maantibayotiki amasiya kugwira ntchito pang'onopang'ono. Izi zimatchedwa Chronic Antibiotic-Resistant Pouchitis (CARP).

Ndi zinthu ziti zomwe zimakhudza pouchitis yosatha komanso yosagwiritsa ntchito maantibayotiki (CARP)?

Pali zifukwa zingapo zomwe zingayambitse vuto la 'CARP'. Zina mwa zifukwazi ndi izi:

• Matenda Otupa a M'mimba ( IBD ): Anthu omwe adachitidwa opaleshoni ya proctocolectomy chifukwa cha IBD, monga ulcerative colitis kapena matenda a Crohn, ali pachiwopsezo chachikulu chotenga pouchitis. Zinthu zomwezo zomwe zidayambitsa vuto lawo loyamba zimatha kukhudza thumba.
• Mabakiteriya osamva maantibayotiki : EnaMatenda a bakiteriya , monga C. difficile, sagonjetsedwa ndi maantibayotiki. Pogwiritsa ntchito maantibayotiki mosalekeza, mabakiteriya omwe nthawi zambiri samayambitsa matenda amatha kukhala osagonjetsedwa ndi maantibayotiki. Izi zingayambitsenso kusalingana kwa mabakiteriya m'thumba.
• Matenda ena: Nthawi zina matenda opatsirana ndi mavairasi, monga cytomegalovirus, kapena matenda a bowa, monga candidiasis, angayambitsenso kutupa kwa thumba.
• Kuchepetsa chitetezo chamthupi: Chitetezo chamthupi chanu chikhoza kufooka chifukwa cha matenda enaake omwe mudakumana nawo kale kapena mankhwala omwe mumamwa, zomwe zimakupangitsani kuti musamathe kulimbana ndi matenda.
• Kugwiritsa ntchito mankhwala oletsa kutupa otchedwa 'NSAIDs' (mankhwala oletsa kutupa omwe si a steroidal) monga 'Aspirin' ndi ' Ibuprofen ' pafupipafupi komanso mopitirira muyeso kungawononge matumbo anu ndi thumba la 'thumba'.
• Kuchepa kwa magazi (Ischemia): Ngakhale kuti sizichitika kawirikawiri, kutupa kungachitikenso chifukwa cha kuchepa kwa magazi kupita ku gawo la thupi. Izi zitha kukhala chifukwa cha kutsekeka kwa mitsempha yamagazi yomwe imapereka magazi.
• Matenda Oyamba a Sclerosing Cholangitis (PSC): Uwu ndi matenda omwe amayambitsa chitetezo chamthupi, zomwe zikutanthauza kuti chitetezo chamthupi chimaukira maselo ake. Chimayambitsa kutupa kosatha m'njira yanu ya ndulu. Monga IBD, njira zomwe zimayambitsa kutupa kosatha kumeneku zimathanso kukhudza thumba. Anthu omwe ali ndi matendawa ali pachiwopsezo chachikulu chotenga pouchitis.

Kodi mavuto omwe angakhalepo chifukwa cha pouchitis ndi ati?

Matenda a pakhosi otchedwa acute pouchitis nthawi zambiri samayambitsa mavuto akuluakulu. Komabe, matenda a pakhosi otchedwa pouchitis osachiritsika amatha kuyambitsa mavuto. Izi zingaphatikizepo:

• Kusintha kwa zizolowezi za m'mimba: Kutupa kwa thumba kungapangitse kuti zikhale zovuta kusunga ndowe mkati, ndipo kutupa kungapangitse kuti zikhale zovuta kutulutsa ndowe. Izi zingakhudze zizolowezi zanu za m'mimba kwa nthawi yayitali.
• Moyo wochepa: Kukhala ndi mavuto nthawi zonse kupita kuchimbudzi kungakhale kovuta kukhala nawo. Kungayambitse kupsinjika maganizo ndi thupi, komanso kungasokoneze kusangalala ndi moyo wocheza ndi anthu ena.
• Chikwama cholimba:Kutupa kosatha kungayambitse zipsera m'thumba. Zipsera zimenezi zimatha kutsekereza kutsegula kwa thumba. Zingathenso kuchepetsa kuyenda kwa magazi kupita ku thumba, zomwe zingalepheretse kuchira.
• Kukokoloka kwa nthaka: Kutupa kwa nthawi yayitali kungayambitse kuti mkati mwa thumbalo muwonongeke, zomwe zimapangitsa zilonda. Zilondazi zimathanso kutuluka magazi. Mitundu ina ya mabakiteriya opatsirana imathanso kuwononga khoma la m'mimba.
• Kusamwa madzi ndi kusowa zakudya m'thupi: Pamene gawo lamkati la thumba lawonongeka, mphamvu yoyamwa michere kuchokera muzakudya zomwe zili mkati mwake imachepa (malabsorption), zomwe zingayambitse kusowa zakudya m'thupi.
• Kulephera kwa thumba: Ngati mavuto ndi thumbalo akupitirira, pamapeto pake limatha kusagwiritsidwa ntchito. Izi zingafunike opaleshoni kuti lichotse thumbalo ndikulowetsa matumbo mu ileostomy.

Kodi matenda a Pouchitis amawapeza bwanji?

Kuzindikira matenda a pouchitis kumayamba ndi kukambirana za zizindikiro zanu ndi mbiri ya thanzi lanu. Kenako, dokotala wanu adzayang'ana mkati mwa thumba lanu. Adzagwiritsa ntchito chida chotchedwa endoscope . Ichi ndi chubu chopyapyala chokhala ndi kamera kakang'ono kolumikizidwa nacho. Adzachidutsa m'thumba kuti aone kutupa kapena zolakwika zina. Adzatenganso chitsanzo cha minofu (biopsy) kudzera mu endoscope ndikuchiyang'ana kuti adziwe chomwe chingayambitse vutoli. Dokotala wanu angagwiritsenso ntchito mayeso ena ojambula kuti aone kunja kwa thumba ndi kapangidwe kake kolumikizidwa nalo. Izi zimachitika kuti apeze ngati pali matenda ena omwe angayambitse vutoli. Mayeso ena omwe angachitike ndi awa:

• Kujambula zithunzi zosiyana (pouchogram): Uwu ndi mtundu wa X-ray. Madzi osiyanitsa amalowetsedwa m'thumba kuti liwonekere bwino. Ndi ofanana ndi barium enema, koma izi zimachitika pa thumba la ileal.
• Kujambula kwa CT.
• Kujambula kwa MRI (MRI).

Kodi mungachiritse bwanji pouchitis?

Chithandizo choyamba cha matenda a pouchitis oyambitsidwa ndi acute pouchitis ndi mankhwala opha tizilombo toyambitsa matenda a masabata awiri . Anthu ambiri amachira ndi izi. Ngati simuchira ndi izi, dokotala wanu adzayesa mankhwala ena opha tizilombo toyambitsa matenda, kapena kuphatikiza maantibayotiki, kwa nthawi yayitali. Ngati mudakali ndi zizindikiro patatha milungu inayi, mutha kukhala ndi matenda a pouchitis osagonjetsedwa ndi maantibayotiki. Dokotala wanu adzafunika kuchita mayeso ambiri kuti apeze zifukwa zina zomwe zingachitike asanasankhe chithandizo chabwino kwambiri.

Kodi mankhwala a pouchitis yobwerezabwereza ndi ati?

Ngati matenda a pacute pouchitis atha ndi chithandizo kenako n’kubwereranso, dokotala wanu apitiliza chithandizo chomwecho. Ngati chithandizocho chikugwira ntchito ndipo zizindikiro sizibwereranso kawirikawiri, chithandizo chomwecho chimagwiritsidwa ntchito. Komabe, ngati chibwerezabwereza katatu pachaka, madokotala amaona kuti ndi matenda a pacuitis osachiritsika omwe amadalira maantibayotiki. Amachiritsidwa ndi chithandizo chosamalira kwa nthawi yayitali kuti apewe kubwereranso. Chithandizo chosamalira chingaphatikizepo:

• Mankhwala Opha Majeremusi: Kumwa mankhwala opha majeremusi pa mlingo wochepa kungathandize kupewa kubwereranso kwa matendawa.
• Ma Probiotics: Izi ndi zowonjezera zomwe zili ndi mabakiteriya opindulitsa omwe amakhala m'matumbo mwathu. Zingathandize kubwezeretsa mabakiteriya omwe ali m'thumba ndikumenyana ndi mabakiteriya opatsirana.

Kodi mankhwala a pouchitis yosagwira maantibayotiki (CARP) ndi ati?

Ngati matenda a pouchitis anu sanachiritsidwepo ndi maantibayotiki, kapena ngati achira kale koma sakuchira tsopano, madokotala amatcha kuti chronic antibiotic-resistant pouchitis (CARP). Pankhaniyi, dokotalayo choyamba adzayang'ana zifukwa zilizonse zomwe zimayambitsa, monga matenda ena, matenda a autoimmune, kapena vuto la kapangidwe kake m'thumba. Ngati palibe chifukwa chomveka chomwe chingapezeke, adzachiza chronic pouchitis mofanana ndi momwe amachitira matenda otupa m'matumbo (IBD). Nazi njira zina zomwe zingathandize:

• Mankhwala a Mesalamine: Mesalamine, yomwe imadziwikanso kuti 5-aminosalicylic acid (5-ASA), ndi mankhwala oyamba a matenda a zilonda zam'mimba. Imabwera ngati mankhwala oyeretsera omwe mumayika m'thumba.
• Bismuth enemas: Bismuth subsalicylate, yomwe ndi chinthu chogwira ntchito mu Pepto Bismol®, imabweranso ngati foam enema (bismuth carbomer). Izi zingathandize kuchepetsa zizindikiro zanu.
• Corticosteroids: Awa ndi mtundu wa mankhwala oletsa kutupa omwe amagwiritsidwa ntchito pochiza kutupa kosatha.
• Mankhwala oletsa chitetezo chamthupi: Mankhwalawa amachepetsa mphamvu ya chitetezo chamthupi chanu. Madokotala amalemba mankhwalawa pamene chitetezo chamthupi chanu chikuyambitsa kutupa kosatha.
• Ma antibodies a monoclonal (biologics): Ma antibodies a monoclonal ndi mapuloteni opangidwa ndi anthu omwe amagwira ntchito ngati ma antibodies a anthu, kukulitsa chitetezo chanu chachilengedwe motsutsana ndi matenda.
• Mamolekyu ang'onoang'ono: Awa ndi mankhwala atsopano omwe amagwira ntchito ngati ma antibodies a monoclonal, koma amapangidwa mwa kupanga.
• Kusamutsa tizilombo toyambitsa matenda m'chimbudzi: Mankhwalawa avomerezedwa ndi US Food and Drug Administration (FDA) kuti athandize matenda a C. diff osagwiritsa ntchito maantibayotiki. Komabe, angagwiritsidwenso ntchito pochiza matenda osagwiritsa ntchito maantibayotiki, ngakhale kuti sanayambitsidwe ndi C. diff. Amathandiza kubwezeretsa tizilombo toyambitsa matenda m'matumbo.

Kodi zimatenga nthawi yayitali bwanji kuti pouchitis ichiritse?

Zizindikiro za matenda a pakhosi nthawi zambiri zimayamba kuchira patangopita masiku ochepa kuchokera pamene mwayamba kulandira mankhwala opha tizilombo toyambitsa matenda. Komabe, ndikofunikira kumaliza kumwa mankhwala opha tizilombo kwa milungu iwiri, ngakhale mutamva bwino. Muyenera kuonana ndi dokotala wanu mankhwalawo atatha. Adzafunanso kuyang'ana mkati mwa thumba lanu kuti atsimikizire kuti kutupa kwatha.

Kodi matenda a Pouchitis angapewedwe?

Umboni wina umasonyeza kuti ma probiotic angathandize kupewa pouchitis kuti isakule pambuyo pa opaleshoni kapena kuti isabwererenso mutalandira chithandizo chabwino. Sizigwira ntchito nthawi zonse, koma zingagwire ntchito kwa inu. Nthawi zina madokotala amakulemberani mankhwala apadera osakaniza ma probiotic (monga DeSimone formula). Mtundu wa ma probiotic omwe mumamwa ndi wofunikira, choncho ndikofunikira kulankhula ndi dokotala wanu.

Kodi mungayembekezere chiyani ngati mutayamba matenda a pouchitis?

Ngati muyamba kudwala pouchitis mutachita opaleshoni ya ileal pouchitis - ngakhale zitachitika kangapo - pali mwayi waukulu woti idzachiritsidwa bwino ndi maantibayotiki. Anthu ena angafunike mankhwala opha tizilombo nthawi yayitali kuposa ena. Ngati mumakhala ndi nthawi zambiri, mungafunike chithandizo cha nthawi yayitali ndi maantibayotiki kapena ma probiotics. Kwa anthu ochepa omwe ali ndi pouchitis, palibe njira iliyonse yomwe ingagwire ntchito. Ngati mupitiliza kukhala ndi pouchitis ndipo siiyankha chithandizo cha maantibayotiki, dokotala wanu adzafufuza zomwe zimayambitsa kutupa, monga ischemia, kugwiritsa ntchito NSAID, kapena matenda odziteteza okha. Ngati sangapeze chifukwa china, adzachizindikira ngati pouchitis yosagonjetsedwa ndi maantibayotiki (CARP). Madokotala adzapereka njira zosiyanasiyana zochizira CARP. Adzagwira nanu ntchito kuti apeze yomwe ili yoyenera kwa inu.

Nthawi zina, ngati mavuto a thumbalo akuposa ubwino wake, mungasankhe kuchotsa thumbalo kuti mukhale moyo wopanda matenda. Imeneyo ndi njira inanso.

Kodi chakudya ndi zakumwa zimakhudza pouchitis?

Inde, mpaka pamlingo wina. Umboni wina umasonyeza kuti ngati zakudya zanu zili ndi ma antioxidants ochepa, mungakhale pachiwopsezo chachikulu chotenga pouchitis. Ma antioxidants amapezeka mwachilengedwe mu zipatso ndi ndiwo zamasamba zambiri. Mankhwalawa amathandiza kuthetsa mankhwala m'thupi lathu otchedwa ma free radicals. Pamene ma free radicals asonkhana m'thupi, amatha kuwononga maselo ndikuthandizira kutupa. Ma antioxidants ochokera ku chakudya ndi othandiza kwambiri kuposa zowonjezera. Kumbali ina, ngati mukuvutika ndi zizindikiro za pouchitis, kuchepetsa kuchuluka kwa ulusi muzakudya zanu kungathandize. Madokotala amalimbikitsa kudya zakudya zopanda FODMAP . Izi zimachepetsa kuchuluka kwa zakudya zomwe mabakiteriya anu am'mimba amakonda kudya, kuphatikizapo ulusi. Kusiya zakudya izi kwakanthawi kungathandize kuchepetsa zizindikiro za m'matumbo mwanu. Koma pamapeto pake, muyenera kuyesa kuwonjezera zakudya zosiyanasiyana muzakudya zanu.

Zakudya zomwe zimathandiza kupewa pouchitis:

Onetsetsani kuti mukupeza ma antioxidants okwanira. Mutha kupeza izi mwa kudya zipatso ndi ndiwo zamasamba zosiyanasiyana. Zina mwa zakudya zabwino kwambiri zomwe zili ndi ma antioxidants ambiri ndi izi:

• apulosi
• Zipatso (monga sitiroberi, mabuloberi)
• Mphesa
• Ma plum ouma (Prunes)
• Mitundu ya nyemba
• Artichokes
• Mbatata za Russet
• Ndiwo zamasamba zobiriwira zakuda (monga sipinachi, kale)

Kuwonjezera zakudya zonse ku zakudya zanu, makamaka zakudya zochokera ku zomera, ndi mfundo yofunika kwambiri pa zakudya zotsutsana ndi kutupa. Ma antioxidants ndi chifukwa chimodzi chokha.

Zakudya zomwe simuyenera kudya mukakhala ndi pouchitis (kuchepetsa zizindikiro):

Pofuna kuchepetsa zizindikiro za pouchitis, madokotala amalimbikitsa kudya zakudya zopanda FODMAP zambiri, mpaka mutadziwa kuti ndi ma FODMAP ati omwe muli ndi vuto la chifuwa. Ma FODMAP wamba ndi awa:

• Fructose (shuga mu zipatso)
• Lactose (shuga mu mkaka)
• Anyezi
• Anyezi woyera
• Mitundu ya nyemba
• Tirigu

Zakudya zopanda FODMAP zambiri ndi zakudya zomwe zimachotsa zakudya zina m'zakudya zanu kwa kanthawi kochepa. Mumachotsa zakudya zina muzakudya zanu, mumapeza chomwe chimaziyambitsa, kenako pang'onopang'ono mumazibwezeretsanso motsogozedwa ndi dokotala.

Pomaliza, uthenga wopita nawo kunyumba

Ngati muli ndi thumba la ileal, nthawi zina mungakhale ndi pouchitis. Si aliyense amene amalipeza, koma amene amalipeza angalipeze kangapo. Zingakhale zokhumudwitsa kukhala ndi mavuto a m'mimba ngakhale mutachotsa m'matumbo ambiri. Nkhani yabwino ndi yakuti kwa anthu ambiri, pouchitis ndi vuto la nthawi zina, ndipo n'zosavuta kuchiza kuposa matenda a m'matumbo omwe mwina anali nawo kale. Pouchitis yosagwiritsa ntchito maantibayotiki (CARP) ndi yovuta pang'ono. Nthawi zina, ikhoza kukhala yogwirizana ndi vuto la m'matumbo lomwe linalipo kale. Kuchiza kungakhale kovuta mofanana. Koma ndi kuyesa pang'ono, mutha kupeza njira zosiyanasiyana zomwe zimagwira ntchito kwa anthu ambiri. Kumbukirani, simuli nokha. Lankhulani momasuka ndi dokotala wanu ndikufunsa mafunso aliwonse omwe muli nawo. Ndi malangizo oyenera komanso chithandizo, mutha kukhala bwino ndi vutoli.