Ingabe amatshe akho enyongo nawo anamathele emgudwini wenyongo ovamile? (I-Choldocholithiasis) Ake sifunde ngakho!

Ingabe ngezinye izikhathi uzizwa ubuhlungu obukhulu engxenyeni ephezulu kwesokudla yesisu sakho ngemva kokudla? Ingabe uzizwa unesicanucanu noma uzizwa sengathi uhlanza? Ingabe ngezinye izikhathi uzizwa sengathi amehlo akho nesikhumba sakho kuyashintsha kube phuzi? Lezi akuzona izimpawu ezinhle zokungazinaki nje. Lokhu kungabonisa ukuthi itshe linamathele 'emgudwini wakho we-Common Bile' . Namuhla, sizoxoxa ngalesi simo esibizwa ngokuthi 'i-Choledocholithiasis'.

Kalula nje, kuyini lokhu (i-choledocholithiasis)?

I-Choledocholithiasis yisimo lapho itshe elilodwa noma ngaphezulu linamathela khona emgudwini wakho we-bile ovamile . Igama elithi "Choldocho" yigama lesiLatini le-common bile duct. Igama elithi "Lithiasis" lisho itshe. Amatshe enyongo ayizingcezu zenyongo eziqinile, ezifana namatshe amancane. Lawa matshe angakheka noma kuphi emzimbeni wethu lapho kugeleza khona inyongo.

Manje ungase uzibuze ukuthi iyini le nyongo nokuthi iyini imibhobho yenyongo. Kulula kakhulu. Isibindi sethu sikhiqiza le nyongo. Le nyongo isisiza ukugaya ukudla esikudlayo, ikakhulukazi amafutha. Le nyongo iqoqana enyongweni. Ukusuka lapho, ihamba ngepayipi elincane iye emgudwini wenyongo ovamile, ohlangana namathumbu amancane. Ngakho-ke, uma itshe lakheka ndawana thize kulolu hambo, inkinga iwukuthi.

Ngakho-ke ingabe (i-Choldocholithiasis) kanye (i-Cholelithiasis) zizinto ezimbili ezihlukene?

Yebo, kunomehluko omncane. Kungenzeka ukuthi uke wezwa igama elithi 'cholelithiasis'. Lisho ukuba namatshe enyongweni . Amatshe enyongweni angakheka enyongweni ngokwayo, emigudwini yenyongo, noma kokubili. Ngisho netshe elakheka enyongweni lingangena kamuva enyongweni evamile yenyongo.

Kalula nje, 'i-Cholelithiasis' isho amatshe enyongo. 'i-Choldocholithiasis' isho amatshe (elilodwa noma ngaphezulu) aphume enyongo futhi abhajwe emgudwini wenyongo ovamile. Uyaqonda?

Uyini umehluko phakathi kwe-Choledocholithiasis ne-Biliary Colic?

Uma une-choledocholithiasis, kusho ukuthi okungenani unetshe elilodwa emgudwini wakho we-bile ovamile. Uma itshe lincane kakhulu , ungase ungabi nazinkinga. Lingase lidlule ngisho namathumbu akho liphume emzimbeni wakho. Kodwa uma itshe likhula futhi livimba umgudwini we-bile ovamile, ungase ube nobuhlungu obukhulu, obuqhubekayo besisu kanye ne-jaundice.

I-biliary colic yisimo esenzeka lapho itshe lihlala ohlelweni lwe-biliary. Sivame kakhulu kubantu abanamatshe enyongo. Kodwa-ke, uma itshe elisemgudwini wenyongo ovamile lihlala futhi livala umgudwini, umuntu one-choledocholithiasis angaphinde abe ne-biliary colic. Cabanga ngakho njengetshe elibhajwe epayipini lamanzi, ngezinye izikhathi amanzi ayageleza, ngezinye izikhathi awagelezi.

Ingabe lokhu kuyisimo esiphuthumayo? Ingabe ngidinga ukwelashwa ngokushesha?

Ukuba netshe noma amatshe emgudwini wenyongo ovamile akuyona into ephuthumayo ngaso sonke isikhathi. Kodwa-ke, kukhona ingozi . Njengoba kushiwo ngaphambili, amatshe amancane angaphuma emzimbeni. Kodwa-ke, ingozi iwukuthi amatshe angabhajwa lapho, akhule abe makhulu ngokuhamba kwesikhathi, futhi avale ngokuphelele umgudwini.

Ngenxa yale ngozi, odokotela bavame ukwelapha amatshe e-bile duct avamile ngokushesha nje lapho etholakala. Bavame ukuncoma ukusebenzisa i-endoscopy ukuhlola nokususa amatshe. Lokhu kusho ukuthi udokotela we-gastroenterologist usebenzisa ithubhu elincane (i-catheter) elifakwa emphinjeni wakho ukuze lifinyelele emapayipini e-bile bese lisusa amatshe. Ungakhathazeki, lokhu kwenziwa ngaphansi kwe-anesthesia, ngakho ngeke uzizwe ungakhululekile kangako.

Kwenzekani uma lesi simo (i-choledocholithiasis) siba sibi kakhulu?

Uma itshe libhajwa emgudwini wenyongo ovamile futhi limise ukugeleza kwenyongo, kuthinta lonke uhlelo lwenyongo. Okungukuthi, zonke ezinye izitho kanye nemigudu lapho inyongo igeleza khona. Lokhu kungabangela ukuvuvukala, izifo , ngisho nezinkinga ezisongela ukuphila.

Into ebaluleke kakhulu ukufuna iseluleko sezokwelapha ngokushesha uma unezimpawu ezinjengalezi, ngaphandle kokuzishaya indiva.

Sivame kangakanani lesi simo?

Ngokwesilinganiso, cishe abantu abayi-10 kwabayi-100 banamatshe enyongo. Kodwa-ke, iningi lalawo matshe akheka enyongo. Cishe abantu abayi-15% abanamatshe enyongo bakha amatshe emgudwini wenyongo ovamile. Iningi labantu alikaze libe nezinkinga ngala matshe. Cishe abantu abayi-20% kuphela abanamatshe enyongo abakha izinkinga ezidinga ukwelashwa.

Ziyini izimpawu ze-Choledocholithiasis?

Ungase ungabi nazo izimpawu. Uma inyongo yakho ingavinjiwe ngamatshe enyongo, ungase ungazi nokuthi unazo. Kodwa-ke, uma unezimpawu, kusho ukuthi inyongo yakho evamile ivinjiwe yitshe. Izimpawu zokuqala ezenzeka lapho inyongo ivinjiwe zibizwa ngokuthi i-biliary colic. Zihlanganisa:

• Ubuhlungu besisu: Lobuhlungu buvela ngemva kokudla. Bungathatha ihora elilodwa kuya kwamane. Ubuhlungu bunamandla kakhulu imizuzu engama-20 yokuqala, bese buphela kancane kancane. Iningi labantu libuzwa engxenyeni ephezulu kwesokudla yesisu. Kodwa ngezinye izikhathi ubuhlungu bungasakazekela ohlangothini lwesokudla noma ehlombe.
• Isicanucanu nokuhlanza: Kuvamile ukuba nesicanucanu nokuhlanza nge-biliary colic. Kodwa-ke, uzoqaphela ukuthi, ngokungafani nezinye izifo ezibangelwa yikhanda elibuhlungu, ubuhlungu abupheli ngemva kokuhlanza. Uma i-biliary colic ingeyona embi kakhulu, ungase uzizwe ulahlekelwe yisifiso sokudla.
• I-Jaundice:Uma inyongo ingagelezi kahle futhi ibuyela egazini, isikhumba sakho kanye namehlo amhlophe angase abe phuzi. Umchamo wakho nawo ungase ube mnyama. I-jaundice, njenge-biliary colic, iyafika futhi ihambe. Kodwa ingafika iphinde ihambe kuze kube yilapho ukuvaleka komsele kususiwe.
• Umkhuhlane: Uma unokuvuvukala okukhulu ohlelweni lwenyongo, ungase ube nomkhuhlane. Umkhuhlane ungaba uphawu lokutheleleka. Uma imisele yenyongo ivaliwe, amabhaktheriya awakwazi ukuphuma emzimbeni ngendlela efanele, okwenza kube lula ukuthi izifo zikhule.

Yiziphi ezinye izinkinga ezingabangelwa yilokhu?

Itshe elivimba umsele we-bile ovamile libangela ukuthi i-bile ibuye emuva. Lokhu kungathinta eminye imisele exhunywe kuyo, kanye nezitho ezifana ne-gallbladder, i-pancreas, nesibindi. Lokhu kungabangela ukuvuvukala, ukutheleleka, kanye nomonakalo wezicubu wesikhathi eside. Izinkinga ezingaba khona zifaka:

• Ukutheleleka: Umsele wenyongo ovalekile uyindawo elula yokungena kwezifo ezibangelwa amagciwane. Ukutheleleka ohlelweni lwenyongo kuyingozi kakhulu . Kungasakazekela esibindini nasegazini. Uma ukutheleleka kusakazekela egazini (septicemia), kungaholela esimweni esibi nesisongela ukuphila (sepsis).
• I-Cholangitis: Imbangela eyinhloko yokuvuvukala kanye nokutheleleka kwe-common bile duct yi-'Choledocholithiasis'. I-bile duct iyavuvukala ngenxa yokuqongelela emuva kwe-bile, futhi ukugeleza kwe-bile kuba kancane nakakhulu. Lokhu kuvuvukala kanye nokutheleleka kungasakazeka kusuka ku-common bile duct kuya kwamanye amagatsha, okungukuthi, kuya emigudwini edlula esibindini. Lokhu kungabangela futhi ukuthi isibindi sivuvuke.
• I-Cholecystitis: Lokhu ukuvuvukala kwenyongo. Uma inyongo ibuyela emuva enyongweni, iyavuvukala. Lokhu kubuhlungu. Kungaphazamisa nokusebenza kwenyongo futhi, ngokuhamba kwesikhathi, kuyilimaze. Lena imbangela eyinhloko yesifo senyongo.
• I-Gallstone Pancreatitis: I-bile duct yakho kanye ne-pancreas kokubili kuvula emathunjini amancane (amathumbu amancane). Uma le ndlela evamile ivinjiwe amatshe enyongo, ukukhishwa kwe-pancreatic kungayeka ukunyakaza. Lokhu kukhishwa kuqukethe ama-enzyme anamandla kakhulu, angabuyela enyongo, okubangela ukuvuvukala okukhulu kanye nomonakalo wezitho zomzimba. Lokhu kubizwa ngokuthi i-pancreatitis. Amatshe enyongo ayimbangela ehamba phambili ye-pancreatitis engeyona utshwala.

Kungani lokhu (i-choledocholithiasis) kwenzeka?

Isibindi sethu senza i-bile ngezinto esizihlunga egazini lethu. Lezi zinto zifaka i-cholesterol, i-bilirubin, usawoti we-bile, kanye ne-lecithin. Amatshe enyongo akheka lapho enye yalezi zinto - ngokuvamile i-cholesterol, ngezinye izikhathi i-bilirubin - iba yiningi kakhulu. Bese, lezi zinto ezingeziwe ziqongelela njengodaka.

Lokhu okufana nodaka kuqoqwa phansi kwenyongo noma emgudwini wenyongo ovamile bese kuqina kancane kancane. Njengoba udaka oluningi lugeleza phezu kwayo, la matshe akhula kancane kancane. Lokhu kungathatha iminyaka. Amatshe amaningi enyongo akheka enyongweni. Bese ehamba phansi emgudwini wenyongo bese egcina esemgudwini wenyongo ovamile.

Yiziphi izinto eziyingozi ezithinta lokhu?

Ungase ube namathuba amaningi okuthuthukisa amatshe e-bile duct avamile ngenxa yezizathu ezilandelayo:

• Ukuba ne-cholangitis engapheli: I-Choledocholithiasis iyimbangela eyinhloko ye-cholangitis. Kodwa ingase yenzeke ngenye indlela. Uma imisele yakho ye-bile ivuvukele ngesinye isizathu, ukugeleza kwe-bile kungancipha, kubangele ukwakheka kwamatshe emimiseleni ye-bile.
• Amatshe enyongo angaphambilini: Iningi labantu abanamatshe enyongo ababi nezinkinga. Kodwa-ke, abantu abake baba namatshe enyongo ngaphambili banamathuba amaningi okuphinde bawathole. Ngisho noma inyongo yakho isusiwe njengendlela yokwelapha amatshe enyongo, ezimweni ezingavamile, kungakheka amatshe amasha emigudwini yakho yenyongo.

Ezinye izici eziyingozi ezivame ukufaka isandla ekwakhekeni kwamatshe enyongo zifaka:

• Amazinga E-Cholesterol Aphezulu: Amatshe enyongo amaningi (cishe angu-75%) akhiwa yi-cholesterol eningi egazini. Ezinye izingxenye zenyongo (usawoti wenyongo kanye ne-lecithin) kuthiwa ziyayincibilikisa le cholesterol. Kodwa uma kukhona ukungalingani phakathi kwalokhu, ngeke kusebenze kahle.
• Ama-hormone abesifazane: I-estrogen inyusa i-cholesterol. I-progesterone inciphisa ukufinyela kwenyongo futhi inyusa ukugeleza kwenyongo. Womabili la ma-hormone ngezinye izikhathi ayanda ngesikhathi sokuzala kwabesifazane. Ukwelashwa kokufaka esikhundleni sama-hormone nakho kungandisa amazinga e-cholesterol.

Sitholakala kanjani lesi sifo (i-choledocholithiasis)?

Amatshe emigudwini yenyongo avame ukutholakala ngemva kokuba izimpawu zivele. Uma ufuna usizo lwezokwelapha ngezimpawu ezifana ne-biliary colic noma i-jaundice, udokotela wakho uzokwenza ukuhlolwa kwegazi kanye nokuhlolwa kwezithombe . Ukuhlolwa kwegazi kungabonisa ukuthi ingakanani inyongo eqongelelekile. Ukuhlolwa kwezithombe kungasiza ekunqumeni ukuthi ukuvaleka kukuphi.

Yiziphi izivivinyo ezenziwayo ngalokhu?

Ukuhlolwa kwegazi:

• Inani eliphelele legazi (i-CBC)
• Ukuhlolwa kwe-Bilirubin
• Ukuhlolwa kokusebenza kwe-pancreas
• Ukuhlolwa kokusebenza kwesibindi

Njengokuhlolwa kwezithombe:

• I-ultrasound yesisu:Lokhu ukuhlolwa okulula, okungenabuhlungu. Kungakunikeza umbono wokuqala ngesimo sakho. Kungabonisa ukuthi kukhona amatshe yini enyongweni yakho. Nakuba kungabonakali kahle ukuthi i-duct evamile ye-bile ivulekile yini, kungabonisa ukuthi i-duct ivulekile yini. Lokhu kubonisa ukuthi kukhona ukuvaleka. Ukuvaleka kungase kubukeke njengesithunzi.
• I-ultrasound ye-Endoscopic: Lokhu kuhlola kuhlanganisa ubuchwepheshe be-ultrasound ne-endoscopy ephezulu ukuze kukhiqizwe izithombe ezicacile zemibhobho ye-bile. Lokhu kuhilela ukufaka ithubhu elincane elifakwe ikhamera (i-endoscope) phansi emphinjeni wakho nasesiswini sakho nasemathunjini amancane angaphezulu. Idivayisi ye-ultrasound ekugcineni kwe-endoscope isebenzisa amaza omsindo ukudala izithombe zesistimu ye-bile.
• I-MRCP (i-Magnetic Resonance Cholangiopancreatography): Lolu uhlobo lwe-MRI (i-Magnetic Resonance Imaging). Ithatha izithombe zemibhobho yenyongo ngqo. Ayilimazi umzimba. Ingathatha izithombe ezicacile kakhulu zesistimu yonke yenyongo, okuhlanganisa ne-common bile duct. Udokotela angenza lolu vivinyo kuqala uma esola ukuthi kukhona itshe emgudwini wenyongo ovamile. Kodwa-ke, uma kunethuba elikhulu lokuthi kukhona itshe, angaya ngqo ku-ERCP.
• I-ERCP (i-Endoscopic Retrograde Cholangiopancreatography): Lokhu kuhlolwa kuhlasela kakhulu kunezinye. Kodwa kuyasiza kakhulu ekutholeni amatshe enyongo. Kungasusa namatshe. Kusebenzisa kokubili i-X-ray kanye ne-endoscopy. Uma i-endoscope isiphezulu emathunjini amancane, uchwepheshe ufaka enye ithubhu encane ngayo bese eyiqondisa emigudwini yenyongo. Ngemuva kwalokho, kufakwa uketshezi olukhethekile (udayi) ngethubhu, bese kuthathwa i-video X-ray (fluoroscopy) njengoba udayi uhamba emigudwini. Uma kutholakala amatshe, angelashwa.

Odokotela bawasusa kanjani amatshe emgudwini we-bile ovamile?

Lawa matshe avame ukususwa ngesikhathi senqubo ye-ERCP. Odokotela bangasebenzisa amathuluzi akhethekile axhunywe ekugcineni kwe-endoscope ukuze baphule futhi basuse amatshe lapho etholakala. Ngezinye izikhathi, kwenziwa ukusikeka okuncane emisipheni yomsele (sphincterotomy) ukuze kwandiswe umsele futhi kuvunyelwe itshe ukuthi lidlule.

Ingabe ukuhlinzwa kuyadingeka nge-Choledocholithiasis?

I-Endoscopic retrograde cholangiopancreatography (ERCP) ayidingi ukusikwa kwesisu ukuze ifinyelele emigudwini yenyongo. Kodwa-ke, ngemva kokususa amatshe emigudwini yenyongo, odokotela bavame ukuncoma ukuhlinzwa kokususwa kwenyongo . Isizathu salokhu ukuvimbela amatshe ukuthi angaphinde aphume enyongweni futhi abangele i-choledocholithiasis.

Ingabe ngizodinga ezinye izindlela zokwelapha?

Kuye ngesimo sakho, ungadinga ezinye izindlela zokwelapha ngaphambi kokususwa kwamatshe akho enyongo. Isibonelo:

• Uma kukhona ukutheleleka , kunikezwa ama-antibiotic .
• Izindlela zokukhipha inyongo ukuze kususwe inyongo eqongelelekile.

Yiziphi izinkinga ezingaba khona ngemva kokwelashwa?

Izinkinga ezilandelayo zingase zenzeke esikhathini esifushane ngemva kokususwa kwamatshe e-endoscopic:

• Ukopha
• Ukutheleleka
• I-Pancreatitis

Lokhu okulandelayo kungenzeka esikhathini eside ngemva kokwelashwa:

• Ukuphinda kwe-Gallstone: Ngisho noma wonke amatshe asezimbotsheni ze-bile esusiwe, amatshe amasha angakheka kamuva. Abantu abake baba namatshe ngaphambili banamathuba amaningi okuphinde bawathole.
• I-Bile duct fibrosis: Izicubu zezibazi zingakheka lapho i-bile duct isikiwe. Ngezinye izikhathi lezi zicubu zezibazi zingabangela ukuthi i-duct ibe mncane (i-biliary stricture). Lokhu kungabangela uhlobo oluhlukile lokuvaleka kwe-bile duct evamile. Kungadinga ukwelashwa okuhlukile.

Ingabe ukuthuthukiswa kwe-choledocholithiasis kungavinjelwa?

Amatshe amaningi enyongo abangelwa yi-cholesterol, futhi ungawehlisa amazinga e-cholesterol egazini lakho ngokwenza izinguquko ekudleni kwakho nasendleleni ophila ngayo. Lokhu kungasiza ekunciphiseni ingozi yakho. Odokotela bathi gwema ukudla okuthi "yo-yo", okuwukwehlisa isisindo ngesikhathi esisodwa bese usiphinda usithole. Uma wehlisa isisindo, kwenze kancane kancane . Ukwehlisa isisindo esiningi ngesikhathi esisodwa kwandisa ingozi yakho yokuthola amatshe enyongo.

Sinjani isimo ngemva kokwelashwa?

Kwabaningi, ukwelashwa kulula futhi kuyaphumelela. Esimweni esingavamile lapho umuntu eba nezinkinga ngemva kokwelashwa, lezo zinkinga zingelashwa. Esikhathini esiyiminyaka eyi-10 kuya kwengama-20, abantu abaphakathi kwaba-5 no-25 kwabayi-100 bazokhula amatshe amasha emigudwini yenyongo. Le ngozi iphansi uma inyongo isusiwe.

Ukuhlaselwa yi-gallstone kungaba yinto ebuhlungu kakhulu futhi eyesabekayo, ikakhulukazi uma ubungazi ukuthi unamatshe ngaphambili. Uma uthola ukwelashwa ngokushesha, uzozizwa ungcono ngokushesha. I-biliary colic, noma ngabe iyafika futhi ihambe, futhi ingabi yingozi kakhulu, akufanele neze inganakwa. Izoba yimbi kakhulu kuze kube yilapho ukuvaleka kwe-bile duct kususiwe.

Izinto ezibaluleke kakhulu okufanele uzikhumbule (Umyalezo Wokuya Ekhaya)

Kulungile, ngakho-ke ngithemba ukuthi usuyaqonda kangcono 'i-choledocholithiasis' esikhulume ngayo namuhla.

Into ebaluleke kakhulu ukuthi uma unezimpawu ezifana nobuhlungu obukhulu ohlangothini oluphezulu kwesokudla lwesisu sakho, isicanucanu, ukuhlanza, kanye nokuphuzi kwamehlo, ungamane nje ungakunaki bese ubona udokotela ngokushesha.

Kunezindlela zokwelapha ezinhle zalesi simo. Uma sitholakale kusenesikhathi, singelapheka ngaphambi kokuba kuvele izinkinga ezinkulu. Ungesabi, landela iseluleko sikadokotela wakho. Futhi nakekela ukudla kwakho nendlela yakho yokuphila. Khona-ke ungahlala uphephile kakhulu ezinkingeni ezinjalo.

Amatshe enyongo, i-common bile duct, i-choledocholithiasis, i-jaundice, ubuhlungu besisu, i-endoscopy, i-ERCP