Indlela inkinga yesibindi ethinta ngayo izinso ngqo: Ake sifunde ngqo nge-Hepatorenal Syndrome!

Wake wacabanga ukuthi inkinga enkulu ngesibindi sakho ingabangela ukuthi izinso zakho zombili eziphilile kahle ziyeke ukusebenza ngesikhathi esisodwa? Kungumcabango owesabekayo, akunjalo? Namuhla sizokhuluma ngesimo esibi, esisongela ukuphila esingase senzeke uma isibindi sihluleka ukusebenza. Yilokhu odokotela abakubiza ngokuthi i-Hepatorenal Syndrome (HRS) . Ake sibheke ukuthi iyini, kungani yenzeka, nokuthi yini enye esingayenza.

Iyini i-Hepatorenal Syndrome?

Kalula nje, i-hepatorenal syndrome (i-HRS) yisimo lapho isibindi sakho singasebenzi kahle, inkinga enkulu kakhulu eyenzeka ezigabeni zokugcina zokwehluleka kwesibindi. Okwenzekayo kulokhu ukuthi izinso zakho zilahlekelwa ukusebenza kwazo ngokuzumayo ngenxa yezinkinga zesibindi. Okukhethekile ukuthi lokhu kubhekwa njengokwehluleka kwezinso okubukhali kwangaphambi kwezinso . Lokhu kusho ukuthi ungaba nalesi simo noma ngabe awunaso isifo sezinso sangaphambilini futhi akukho zinguquko zomzimba noma umonakalo ezinso zakho. Izinso zakho zingase zibe ziphilile ngokuphelele, kodwa ngenxa yenkinga yesibindi, ukunikezwa kwegazi kuzo kuyaphazamiseka, futhi azikwazi ukwenza umsebenzi wazo.

Cabanga ngakho njengephampu yamanzi esebenza kahle, kodwa uma ipayipi lamanzi eliya ethangini lamanzi livaliwe, amanzi ngeke aphume. Izinso zilungile, kodwa izinkinga zesibindi zibangela ukuthi imithambo yegazi ethwala igazi ezinso ivaleke futhi inciphe. Ngemuva kwalokho, izinso azitholi igazi ezilidingayo, futhi ukusebenza kwazo kwehla kancane kancane. Lokhu kubhekwa njengesimo esiphuthumayo , futhi ezimweni eziningi, ukwelashwa okuwukuphela kwaso okuhlala njalo kwalokhu ukufakelwa kwesibindi .

Ubani othinteka kakhulu yilesi simo?

Lesi simo, esibizwa ngokuthi i-hepatorenal syndrome (HRS), sithinta kakhulu abantu abanesifo sesibindi esibi kakhulu . Ikakhulukazi, abantu abanesifo sesibindi esingamahlalakhona, esiqhubekayo , isibindi sabo esiye saba buthaka kancane kancane ngokuhamba kwesikhathi, basengozini enkulu yalesi simo. Ubuwazi ukuthi ngenxa yalesi sifo sesibindi sesikhathi eside, izicubu zesibindi ziba nezibazi futhi isibindi siba nzima. Lokhu sikubiza ngokuthi i-cirrhosis . Ngenxa yalesi simo, ukunikezwa kwegazi esibindini kuyashintsha, futhi ngokuhamba kwesikhathi, isibindi siyayeka ukusebenza.

Futhi, uma kwenzeka ukwehluleka kwesibindi okukhulu okwenzeka ngokuzumayo ngenxa yesizathu esithileKodwa-ke, i-HRS ingenzeka. Izifundo zibonise ukuthi i-HRS ingenzeka kubantu abangafika ku-40% abanesifo sesibindi esisesigabeni sokugcina. Nakuba ingenzeka kunoma yimuphi ubudala nobulili, ivame kakhulu kubantu abasengxenyeni yesibili yokuphila kwabo. Iphinde ivele kubantu abangaba ngu-10% abalaliswe esibhedlela ngenxa yokwehluleka kwesibindi okungapheli noma okubukhali. Nakuba kunezimbangela ezingaphezu kweyodwa zokwehluleka kwezinso ngenxa yesifo sesibindi, i-HRS ihlukile ngoba iyenzeka kubantu abangenaso isifo sezinso ngaphambilini.

I-cirrhosis ibangela kanjani i-hepatorenal syndrome?

Lokhu kuyinkinga eyinkimbinkimbi kancane. Kusenemibono ehlukene phakathi kwabacwaningi mayelana nokuthi isifo sesibindi sibangela kanjani i-hepatorenal syndrome (HRS), okungukuthi, i-pathophysiology yaso.

Kwenzeka kanjani lokhu ngempela? (I-Pathophysiology)

Njengoba sazi, ukwehluleka kwezinso kwenzeka lapho imithambo yegazi ezinso incipha, ivaleka, futhi ukugeleza kwegazi kuyo kuncipha. Abacwaningi bakholelwa ukuthi lokhu kuncipha kwemithambo yegazi kubangelwa yinhlanganisela yezici ezihlobene nesifo sesibindi kanye nokwehluleka kwesibindi. Imbangela enkulu yalokhu umfutho wegazi ophezulu we-portal .

Umfutho wegazi ophezulu we-portal yisimo lapho umfutho wegazi ku-portal vein, umthambo oyinhloko odlula esibindini sakho, kanye nemithambo exhuma kuyo futhi inwebeka kulo lonke uhlelo lwakho lokugaya ukudla, ukhuphuka khona. Imbangela evame kakhulu yalokhu yi -cirrhosis . I-cirrhosis ingabangela nesimo esibizwa ngokuthi i-cirrhosis cardiomyopathy , esibangela ukuthi eminye yemithambo yegazi emzimbeni wakho ibe mikhulu ngendlela engavamile. Lokhu kushintsha kokugeleza kwegazi okuyinkimbinkimbi kubangela ukuthi eminye imithambo yegazi ivuleke kanti eminye (ikakhulukazi leyo esezinso zakho) imincane. Cabanga ngakho njengokuminyana kwezimoto ohlangothini olulodwa lomgwaqo, okuthinta nezinye izinhlangothi.

Yiziphi izinto ezibangela lesi simo sibe sibi kakhulu?

Kunezinye izinto ezihlotshaniswa nesifo sesibindi ezingaba "yimbangela" noma isici esibangela i-HRS. Evame kakhulu kulezi yi-Spontaneous Bacterial Peritonitis (SBP) . Lokhu ukutheleleka kwebhaktheriya kolwelwesi lwesisu sakho (i-peritoneum). I-SBP iyinkinga ye -ascites , okuyiqoqo loketshezi esiswini. I-Ascites ibangelwa ukuvuza koketshezi oluvela emithanjeni esiswini ngenxa yomfutho wegazi ophezulu we-portal.

Cabanga nje, uma isisu sakho sigcwele amanzi (ama-ascites), amagciwane angangena kalula lapho futhi abangele ukutheleleka. Yilokho okubizwa ngakho le peritonitis yebhaktheriya ezenzakalelayo (i-SBP).

Futhi, umfutho wegazi ophezulu we-portal ungabangela ukuthi imithambo yakho iqhume futhi yophe igazi esiswini sakho.Ukulahlekelwa igazi okukhulu ngenxa yokopha kwamathumbu kungenye into ebangela lokho. Akukhona lokho kuphela, kodwa ukusetshenziswa ngokweqile kwemithi yokukhipha isisu , noma "amaphilisi amanzi," nakho kungaba yimbangela. Ama-diuretics asebenza ngokukhipha uketshezi oluningi emzimbeni. Abantu abanesifo sesibindi esithuthukile bangase bathathe la maphilisi amanzi ngenxa ye-ascites noma i-edema , okuyisifo sokuvuvukala komzimba.

Ziyini izimpawu?

Abantu abane-hepatorenal syndrome (HRS) bavame ukuqala ngokuzwa umuzwa ongaqondakali nojwayelekile wokugula. Izimpawu zifaka:

• Ukukhathala
• Isicanucanu
• Isisu esibuhlungu
• Ukunambitheka okubi emlonyeni

Ngaphezu kwalokho, bangase babe nezimpawu zesifo sesibindi esithuthukile noma ukwehluleka kwesibindi. Lokhu kufaka phakathi:

• I-jaundice (ukuphuzi kwamehlo amhlophe)
• Ukuphuka okulula nokopha
• Indle enombala okhanyayo kanye nomchamo omnyama
• Ukuvuvukala kwesisu (ngenxa ye-ascites, isibindi esikhulu noma i-spleen)
• Isikhumba esilumayo
• Ukudideka, ukulahlekelwa inkumbulo, noma ukozela (i-Hepatic Encephalopathy)

Uma ukwehluleka kwezinso kuba kubi kakhulu, ungase uqaphele ukuthi inani lomchamo owukhiqizayo lehle kakhulu .

Ukubona kanjani lokhu?

I-Hepatorenal syndrome (i-HRS) uhlobo lokwehluleka kwezinso okwenzeka lapho kukhona isifo sesibindi esibi futhi kungekho esinye isizathu sokwehluleka kwezinso. Ngakho-ke, odokotela baxilonga lokhu ngokuqinisekisa kuqala isifo sesibindi kanye nokwehluleka kwezinso, bese bekhipha ezinye izimbangela ezingaba khona zokwehluleka kwezinso. Ukuze benze lokhu, basebenzisa izivivinyo ezahlukene zezithombe , njengezikena, ukuhlolwa kwegazi, kanye nokuhlolwa komchamo, ukuhlola ukuthi isibindi sakho kanye nezinso zisebenza kanjani.

Iphathwa kanjani?

Nakuba i-HRS iyisimo esibi kakhulu esibangelwa ukwehluleka kwezinso, impande yenkinga isesibindini . I-Hepatorenal syndrome (i-HRS) ihlukaniswa njengohlobo "lwangaphambi kwezinso" lokwehluleka kwezinso okubukhali ngoba izinso zakho ziphilile ngenye indlela. Eqinisweni, uma izinso zakho zithathwa futhi zifakwe emzimbeni womunye umuntu, zizosebenza kahle. Ngokufanayo, uma ukusebenza kwesibindi sakho kubuyela esimweni esijwayelekile, kunethuba elihle lokuthi izinso zakho zizoqala ukusebenza futhi.

Abanye abantu abanenkinga yesibindi ebukhali bangase balulame kokubili ukusebenza kwesibindi kanye nezinso zabo. Kodwa wonke umuntu uzodinga ukufakelwa isibindi . Bangase badinge ukufakelwa isibindi ngesinye isikhathi noma kunjalo, kodwa i-HRS yenza isidingo sibe siphuthumayo nakakhulu. Kodwa-ke, akuwona wonke umuntu ofanelekela ukufakelwa isibindi, futhi noma ngabe kunjalo, kufanele alinde aze athole esinye.

Ngesikhathi esinjengalesi, ukwelashwa okusheshayo kanye nokuphathwa okufanele yizinto ezibaluleke kakhulu.

Okwamanje, udokotela wakho noma umhlengikazi uzozama ukulondoloza ukusebenza kwezinso zakho ngangokunokwenzeka futhi anciphise izimpawu nemiphumela emibi yalesi simo. Lezi zinyathelo zingathuthukisa impilo yakho iyonke futhi zikusize ukulungiselela ukufakelwa isibindi. Zingasiza futhi ekuthuthukiseni umphumela wokufakelwa isibindi uma unaso. Kodwa-ke, lokhu akuzona izindlela zokwelapha . Lezi zindlela zokwelapha zingafaka:

• Uketshezi lwe-IV , olufana nosawoti, lunikezwa ukulungisa ukungalingani kwama-electrolyte emzimbeni nokusiza ukugeleza kwegazi ezinso.
• Ukuyeka imithi ethile, njengemithi yokukhipha isisu (amaphilisi amanzi).
• Ukunikeza ama-antibiotic ezifweni ezihlobene nawo.
• I-Paracentesis yenziwa ukuze kususwe uketshezi oluningi oluqongelelwe ngenxa yama-ascites.
• Ukunikeza imithi ebizwa ngokuthi ama-vasoconstrictors . Lokhu kusebenza ngokunciphisa imithambo yegazi yakho ebanzi ngendlela engavamile nokwandisa ukugeleza kwegazi ezinso.
• I-Hemodialysis , okuyi-blood dialysis, iyindlela yokwelapha izinso zakho ezicindezelekile.

Ingabe kungavinjelwa?

Indlela engcono kakhulu yokuvimbela i-hepatorenal syndrome (HRS) ukuphatha isifo sesibindi ngaphambi kokuba siqhubekele ekubeni yi-cirrhosis . Isifo sesibindi esingamahlalakhona yisimo esikhula kancane eminyakeni eminingi. Abantu abaziyo ukuthi banalesi simo bangalawula futhi ngezinye izikhathi babuyisele emuva ukuqhubeka kwalesi sifo ngokwenza izinto ezifana nokunciphisa utshwala, ukwehlisa isisindo, nokuthuthukisa ukudla kwabo. Kodwa-ke, ngenxa yokuthi abantu abaningi ababonisi izimpawu, kungase kungatholakali ngaphandle kokuhlolwa okuvamile kwezokwelapha.

Uma usuvele une-cirrhosis, ayikho indlela yokubikezela noma yokuvimbela i-HRS ukuthi ingakhuli. Kodwa-ke, i-Spontaneous Bacterial Peritonitis (SBP)Nokho, ungagwema "into ebangela" lokhu evame kakhulu. I-SBP ibangela cishe ama-25% amacala e-HRS kubantu abane-cirrhosis. Ngakho-ke, uma udokotela wakho ecabanga ukuthi usengozini enkulu ye-SBP, ukuthatha ama-antibiotic njengendlela yokuvimbela kunganciphisa lesi sizathu futhi kunciphise amathuba akho okuthuthukisa i-HRS.

Ingabe lokhu kungelapheka? Ingabe kusongela ukuphila?

Ngaphandle kokufakelwa isibindi, abantu abaningi basesimweni esibucayi kakhulu. Uma i-HRS iba yimbi ngokuzumayo futhi ukufakelwa kungatholakali, isikhathi sokusinda esimaphakathi singamasonto amabili kuphela. Nge-HRS engapheli, isikhathi sokusinda esimaphakathi ngaphandle kokufakelwa siyizinyanga ezintathu kuya kweziyisithupha . Kuye ngokuthi ukwehluleka kwesibindi kukhulu kangakanani, isimo singaba sibi kakhulu ngokushesha. Futhi, uma isimo siba sibi kakhulu ngokushesha, ungase ugule kakhulu ukuthi ungafakelwa ukufakelwa, okungaba nzima.

Kodwa-ke, uma ufakwa isibindi, isimo sakho sizothuthuka kakhulu . Abantu abane-HRS banethuba elingu-60% lokusinda eminyakeni emithathu ngemva kokufakelwa isibindi. Lokhu kuphansi kancane kunesilinganiso sokusinda seminyaka emithathu kubantu abavame ukuthola ukufakelwa isibindi (75%). Ukusebenza kwezinso zabantu abaningi kuzobuyela esimweni esijwayelekile phakathi namasonto ambalwa. Inani elincane kakhulu (cishe u-5%) kungadingeka liqhubeke nokuhlanza igazi .

Kungakhathaliseki ukuthi ungumuntu onesifo sokwehluleka kwesibindi esiwohlokayo kancane kancane noma ukuqala ngokuzumayo kwe-hepatorenal syndrome (HRS) okusheshise isikhathi sakho, ukuba sohlwini lokulinda lwabanikeli besibindi akuwona umqondo omuhle. Ngoba azikho isibindi esanele sabantu abakulolo hlu. Kodwa-ke, uma ungathola umnikeli wesibindi ophilayo , kungase kungadingeki ukuthi ube sohlwini, futhi imiphumela yakho yezempilo iyonke ingathuthuka.

Abanikeli abaphilayo bangabavolontiya abanempilo, ngokuvamile abathandekayo bakho, abafanela uhlobo lwegazi lakho kanye nosayizi womzimba wakho. Ngisho nengxenye encane yesibindi ethathwe komunye umuntu ophilayo ingakhula ibe yisibindi esiphelele kuwe nakulowo onikelayo. Futhi, isibindi esiphilayo cishe sisesimweni esingcono kunesibindi esithathwe kubanikeli abashonile. Odokotela abahlinzayo benza yonke imizamo yokwenza ukuhlinzwa kwalaba banikeli abaphilayo abanesibindi kungeneke kakhulu ngangokunokwenzeka.

Okokugcina, izinto okufanele uzikhumbule

Ngakho-ke, cishe usuyaqonda manje ukuthi i-hepatorenal syndrome yisimo esibi esidinga ukunakekelwa ngoba sithinta izinso ngenxa yezinkinga zesibindi.

• Impilo yesibindi ibaluleke kakhulu:Uma unesifo sesibindi, kubaluleke kakhulu ukusiphatha kahle, ikakhulukazi ukuvimbela ukuthi singadluleli ezimweni ezifana ne-cirrhosis.
• Naka izimpawu: Uma unezimpawu ezihlobene nesifo sesibindi noma umuzwa ojwayelekile wokungaphatheki kahle, bona udokotela ngokushesha.
• Cabanga ngezinso zakho: Uma unezinkinga zesibindi, udinga nokunakekela izinso zakho. Uma unezimpawu ezifana nokuncipha kokuchama, tshela udokotela wakho.
• Kukhona ukwelashwa: Nakuba i-HRS iyisimo esibucayi, ukwelashwa okufana nokufakelwa isibindi kungasindisa izimpilo. Ngakho ungalilahli ithemba.
• Indlela yokuphila ibalulekile: Izinto ezifana nendlela yokuphila enempilo, ukudla okulinganiselayo, nokugwema utshwala kusiza ekugcineni isibindi siphilile.

Ngiyethemba ukuthi lolu lwazi luzokusiza. Uma wena noma othile omaziyo ebhekene nalolu hlobo lwenkinga, into engcono kakhulu ongayenza ukufuna iseluleko sezokwelapha ngokushesha.

Isifo sesibindi, isifo sesibindi, ukwehluleka kwezinso, i-cirrhosis, ukufakelwa kwesibindi, umfutho wegazi ophakeme we-portal, ama-ascites