Ingabe imithambo yegazi esemqaleni wakho, ipayipi elithwala ukudla kusuka emlonyeni wakho liye esiswini sakho, iyavuvukala futhi ikhule? Kungenzeka ukuthi awukaze uzwe ngalokhu. Kodwa lesi simo, esibizwa ngokuthi ama-Esophageal Varices, singathula futhi ngokuzumayo sibe yingozi. Ngakho-ke namuhla, ake sifunde konke ngakho kalula, njengokungathi sikhuluma nomngane.
Kalula nje, ziyini izifo zomphimbo?
Cabanga nje, ngezinye izikhathi imilenze yethu inemithambo evuvukele, ejiyile? Siyibiza ngokuthi 'imithambo ye-varicose'. Into efanayo yenzeka ngaphakathi komphimbo wethu. Izindonga zale mithambo zibuthakathaka kakhulu. Ngakho-ke kunethuba elikhulu lokuthi igazi lizophuma kuyo, noma ukuthi lizoqhuma ngokuzumayo futhi liphume igazi. Lokhu kuphuma kwegazi emzimbeni kungaba ngokuzumayo, kube kubi, futhi kusongela nokuphila.
Lesi simo sivame ukubangelwa ukwanda kwengcindezi emthanjeni wegazi oyinhloko odlula esibindini nakweminye imithambo exhunywe kuso (i-Portal Hypertension). Lokhu kucindezeleka okungajwayelekile kubangela ukuthi imithambo emincane esibindini ivuvuke futhi ibe mikhulu. Lesi simo sivame ukubonakala kubantu abanesifo sesibindi.
Sibi kangakanani lesi simo?
Ingozi eyingozi kakhulu ye-portal vein thrombosis ukopha . Akuwona wonke umuntu opha igazi, kodwa cishe abantu abangu-50% basengozini. Uma umfutho wegazi ophezulu we-portal uphezulu, kulapho ingozi yokopha ikhula khona. Lokhu kucindezela kuyanda ngesifo sesibindi, ikakhulukazi i-cirrhosis .
Abantu abane-cirrhosis yesibindi esibi bangase babe nezinye izinkinga ngaphezu kwale mithambo evuvukele. Kodwa-ke, isizathu esiyinhloko sokulaliswa esibhedlela nokufa ukuqhekeka kwale mithambo nokopha. Uma wopha kanye ngale ndlela, ingozi yokufa icishe ibe ngu-20%. Futhi, ukopha kungaphindeka njalo.
Ziyini izimpawu zalesi simo?
Ngenxa yokuthi le mithambo ingaphakathi emzimbeni, ayibonakali njengomthambo emlenzeni. Ungase ungayizwa ngisho nalapho ugwinya ukudla. Eqinisweni, ingase ingakhombisi zimpawu kuze kube yilapho iqala ukuphuma igazi .
Kodwa-ke, uma udokotela ebona ezinye izimpawu ezibonisa ukuthi unesifo sesibindi noma umfutho wegazi ophakeme we-portal, angase asole nalokhu.
| Uhlobo lwesibonakaliso | Incazelo |
|---|---|
| Izimpawu ezibonisa isifo sesibindi | |
| I-Jaundice | Isikhumba sakho namehlo akho aphenduka aphuzi. |
| Ama-Ascites | Ukuvuvukala kwesisu ngenxa yokuqongelela koketshezi esiswini (esiswini). |
| Ukuvuvukala | Ukuvuvukala kwemilenze nezinyawo. |
| Ubuhlungu besisu esingaphezulu | Ubuhlungu obubangelwa ukuvuvukala kwesibindi noma i-spleen. |
| Umuzwa wokuphelelwa yithemba | I-hepatic encephalopathy yisimo lapho isibindi singasebenzi kahle, okuthinta ubuchopho. |
| Izimpawu zokuphuma kwegazi emthanjeni | |
| Ukuhlanza igazi | Uma ukopha kuhamba kancane, ukuhlanza kungase kubukeke njengokugcotshwa kwekhofi. Uma umthambo uqhuma ngokuzumayo, igazi elisha elibomvu lizohlanzwa. |
| Igazi esitulweni | Uma igazi lihamba ngendlela yokugaya ukudla, lingabangela ukuthi indle ibe mnyama okwesibhakabhaka, njenge-tar (melena). Ezimweni zokopha ngokushesha, igazi elibomvu elisha lingadluliselwa. |
| Ubumpunga | Ukubukeka okukhanyayo njengokungathi igazi seliphumile ebusweni. |
| Ukukhathala kanye nesiyezi | Ukuzizwa ukhathele, ubuthakathaka, futhi unesiyezi ngenxa yomfutho wegazi ophansi. |
Kubaluleke kakhulu: Uma uba nezimpawu zokushaqeka kwe-hypovolemic ngenxa yokopha ngokweqile, iya ekamelweni lezimo eziphuthumayo esibhedlela (ETU) ngokushesha. Lezi zimpawu zifaka: ukushaya kwenhliziyo okusheshayo, ukuphefumula okusheshayo, ukujuluka okubandayo, kanye nokulahlekelwa ukwazi.
Kungani le mithambo ivuvukala? Iyini imbangela?
Njengoba sixoxile ngaphambili, imbangela eyinhloko yisimo esibizwa ngokuthi "i-Portal Hypertension." Ake sikuqonde lokhu kalula.
Cabanga ngesibindi sethu njengesihlungi esikhulu. Igazi elivela ekudleni esiswini lidlula esibindini, lapho lihlanzwa khona bese liya enhliziyweni. Umthambo oyinhloko oletha leli gazi esibindini ubizwa ngokuthi ``i-Portal Vein``.
Manje, uma isibindi sinamanxeba futhi siqinile ngenxa yesifo esifana ne-cirrhosis , lelo gazi alikwazi ukudlula kalula esibindini. Kunjengokungathi kukhona ukuminyana okukhulu kwezimoto emgwaqweni. Lokhu kubangela ukuthi umfutho wegazi ngaphakathi kwe-portal vein ukhuphuke kakhulu.
Umzimba uzama ukuvala lesi sikhala sokucindezela okukhulu ngokuphambukisa igazi ngemithambo emincane (imithambo emincane). Imithambo ese-ureter iyimithambo emincane kakhulu. Kodwa le mithambo emincane ayikwazi ukusingatha inani elikhulu legazi kanye nokucindezela. Ngenxa yalokho, iyavuvukala, ibe mikhulu, futhi ingaqhuma nganoma yisiphi isikhathi.
Izimbangela eziyinhloko ze-cirrhosis yesibindi yilezi:
- Ukuphuza utshwala ngokweqile.
- Isibindi esinamafutha (i-Non-alcoholic Steatohepatitis).
- Ukutheleleka kwe-hepatitis okubangelwa yigciwane isikhathi eside.
- Amasosha omzimba ahlasela isibindi (i-Autoimmune Hepatitis).
- Ezinye izimbangela ezifana nokuqhekeka kwegazi, izifo ezibangelwa yizinambuzane (i-Schistosomiasis) njll.
Wazi kanjani ukuthi unalesi simo?
Esikhathini esiningi, uthola lokhu kuphela ngemva kokuba udokotela ekuhlolile. Uma usuvele une-cirrhosis yesibindi, udokotela wakho uvame ukuncoma ukuthi uhlolwe lolu hlobo lokuvuvukala kwemithambo yegazi.
Ukuhlolwa okuyinhloko ukuhlolwa kwe-Upper Endoscopy noma i-EGD .
Lokhu kuhilela ukufaka ipayipi elincane neliguquguqukayo elinekhamera exhunywe ngomlomo wakho bese uhlola umphimbo wakho, isisu, kanye nokuqala kwamathumbu akho amancane. Lokhu kuvumela udokotela wakho ukuthi abone ngokucacile ukuthi imithambo yakho ivuvukele yini, inkulu kangakanani, nokuthi ingabe isengozini yokopha.
Yiziphi izindlela zokwelapha lokhu?
Ngenhlanhla, kunezindlela zokwelapha ezahlukahlukene ezitholakalayo zokulawula ukopha nokuvimbela ukopha kabusha. Izinhloso eziyinhloko zokwelashwa yilezi:
- Lawula ukopha okusebenzayo uma kukhona.
- Ukuvimbela ukopha esikhathini esizayo.
- Uma kungenzeka, nciphisa isimo se-`(Portal Hypertension)`.
1. Lawula ukopha (okuphuthumayo)
Lesi yisimo esiphuthumayo sezokwelapha. Esibhedlela, uzonikezwa uketshezi lwe-IV, ukumpontshelwa igazi uma kudingeka, kanye ne-endoscopy ngemuva kokuba isimo sakho sesizinzile. Lapho:
- I-Varicose Band Ligation: Ithuluzi elincane lidluliselwa nge-endoscope bese kubekwa ibhande elincane lerabha lizungeze umthambo we-varicose. Lokhu kumisa ukugeleza kwegazi emithanjeni futhi kulawula ukuphuma kwegazi.
- Imithi: Imithi ehlisa umfutho wegazi futhi inciphise imithambo yegazi (i-Octreotide, i-Vasopressin) inikezwa ngemithambo yegazi.
2. Ukuvimbela ukopha kabusha
Kungakhathaliseki ukuthi kukhona ukopha noma cha, uma kukhona ingozi yokopha, udokotela uzoqala ukwelashwa kokuvimbela.
- Ama-Beta-blocker: Lolu hlobo lomuthi, olunikezwa umfutho wegazi ophakeme, lunganciphisa ingozi yokopha cishe ngo-50%.
- Ukubopha Amabhande: Le ndlela isetshenziswa futhi njengendlela yokuvimbela kwabanye abantu.
3. Ukwelapha imbangela eyisisekelo
Uma ukwelashwa okungenhla kunganciphisi ingozi yokopha, udokotela wakho angase asikisele ezinye izindlela zokunciphisa ngqo isimo "se-Portal Hypertension."
- I-Transjugular Intrahepatic Portal-Systemic Shunt (AMACEBISO): Lena akuyona inqubo yokuhlinzwa. Kule nqubo, kufakwa ithubhu elincane (i-stent) emthanjeni ongaphakathi kwesibindi othwala igazi lisuka emthanjeni we-portal, okwakha uxhumano olusha, noma "indlela emfushane." Lokhu kunciphisa kakhulu ingcindezi.
- Ukuhlinzwa: Izinqubo zokuhlinzwa ezifana ne-"Distal Splenorenal Shunt (DSRS)" nazo zinciphisa ingcindezi ngokuguqula ukugeleza kwegazi.
Ungakhohlwa: Into ebaluleke kakhulu ukwelapha imbangela eyinhloko yokulimala kwesibindi. Ukuyeka utshwala, ukwehlisa isisindo, nokwelapha izimo ezifana ne-hepatitis C kungasiza ekunciphiseni ukulimala kwesibindi nokuvimbela lesi sifo ukuthi singabi sibi kakhulu.
Umlayezo Wokuya Nawe Ekhaya
- Izifo zomphimbo ziyisimo esibi kakhulu esivame ukungabi nazimpawu kuze kube yilapho kuvela ukopha.
- Imbangela eyinhloko yalokhu umfutho wegazi ophakeme we-portal obangelwa yisifo sesibindi, ikakhulukazi i-cirrhosis.
- Uma unesifo sesibindi, kubaluleke kakhulu ukukhuluma nodokotela wakho futhi uthole ukuhlolwa njalo.
- Uma ubona izimpawu ezifana nokuhlanza igazi noma ukuphuma kwendle emnyama, kuyisimo esiphuthumayo. Yiya eMnyangweni Wezimo Eziphuthumayo wesibhedlela (ETU) ngokushesha.
- Ukushintsha indlela yokuphila, njengokuyeka utshwala nokugcina indlela yokuphila enempilo, kwenza lukhulu ekugcineni impilo yesibindi nokuvimbela lesi simo ukuba singabi sibi kakhulu.
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