I-Short Bowel Syndrome: Ukunyangwa okufanelekileyo kunye nokutya

Unyango lunokubandakanya isidlo, inkxaso yeZondlo, iMithi kunye noPhephelo

Isifo esifutshane samathumbu (SBS) yimeko eyenzekayo xa isisu esincinci sisusiwe okanye singabonakali izondlo ngendlela efanele. Amavithamini kunye neemaminerali ukuba umzimba udinga ukunyuka ekudleni njengoko udlula emathunjini amancinci. Ukuba umathumbu omncinci uphelele kakhulu ukuba ungathathi ngokwaneleyo ukutya, okanye ukuba iinxalenye zawo azikwazi ukufumana izondlo, zingakhokelela ekungondlekeni.

I-SBS ingaba yimeko engapheliyo efuna ukuphathwa rhoqo, kodwa kwezinye iimeko yimeko yesikhashana eya kuphendula unyango.

Ngokutsho kweCrohn's and Colitis Foundation , phakathi kwabantu abayi-10 000 no-20,000 e-United States bahlala ne-SBS. Unyango lwe-SBS luye lwaqhubeka kwiminyaka yamuva, ukuphucula ubomi babantu abahlala nalo mqathango. Kwezinye iimeko, unyango lunokukunceda ukwandisa umsebenzi wesibilini kwakhona ukuze uthathe ezinye izondlo. Ukutya okunomsoco, unyango, kunye nokuhlinzwa kungasetyenziselwa ukuphatha abantu abane-SBS. Abantu abanesifo sikaCrohn abaye bahlinzwa ngokuphindaphindiweyo kwaye banokulahleka kufuphi nesiqingatha okanye ngaphezulu kwamathumbu abo amancinci bangavelisa i-SBS.

Ukubaluleka kwe-Intestine encinci

Umsebenzi oyintloko wamathumbu amancinci, okuyinxalenye yenkqubo yokutya , ukufumana amavithamini kunye neemaminerali ekudleni. Amathumbu amancinci anjengobhubhe, kwaye ngokuqhelekileyo malunga neenyawo ezili-20 ubude.

Itholakala kwisisu esisetyenziselwayo phakathi kwesisu kunye nomathumbu omkhulu kumgudu wokugaya. Ukutya kushiya isisu kwaye kudlulele emathunjini amancinci apho kuthathwa khona amavithamini, ngaphambi kokuba udlulele kwiqoloni apho amanzi anqamle khona.

Amathumbu amancinci achazwa njengamacandelo amathathu aphezulu kwaye izondlo ezahlukeneyo zithathwa kwicandelo ngalinye.

Ngenxa yoko, kubalulekile ukuba izigulane nge-SBS zikwazi ukuba ziphi na izitho zamathumbu amancinci zisuswe ngokuhlinzwa okanye azisebenzi kunye nokuba zifanele. Insimbi ifakwe kwicandelo lokuqala, i-duodenum, ishukela, i-amino acid, kunye ne-acids e-acids kwicandelo lesibini, i-jejunum, kunye ne-B12, i-bile acid, kunye namanye amavithamini athathwe kwicandelo lesithathu kunye lokugqibela, i-ileum.

Ama-enzyme anceda ukugaya ukutya akhiwa kwi-pancreas aze adlulisele emathunjini amancinci. Ukutya kuphulwa yi-enzymes kunye nezondlo zithathwa yizakhiwo ezizodwa ezibizwa ngokuba yi-villi ezifumaneka kwiindonga zangaphakathi zesisu esincinci.

Iimbangela ze-Short Bowel Syndrome

Ukuba nesifo sikaCrohn kunye nemigangatho emininzi emathunjini amancinci kunokubeka umntu engozini kwiSBS. I-SBS iyakwenzeka kwakhona xa isisu esincinci singasebenzi kakuhle kwaye kungekhona kuphela xa kuninzi kakhulu ekhoyo (njengaleyo ezalwe ngumathumbu omncinci) okanye isusiwe. Ezinye iimeko ezinxulumene ne-SBS ziquka:

• I-Adhesions: izicubu ezibomvu ezenziwe emva kokuhlinzwa kwesisu
• Cancer
• Ingxaki engapheliyo-ingxaki: isisu esincinci siziphatha njengokuba kukho ukucinywa
• Isifo sikaCrohn kunye nokuthengiswa kwamanani amaninzi

• Izimo ezinjenge-congenital short-circular syndrome, i-gastroschisis, isifo se-Hirschspring, i-ileus ye-meconium, isifo esifakwe kwi-microvilius, i-midgut volvulus kunye ne-omphalocele.
• Ukulimala emathunjini amancinci ukususela kwimithi yonyango (i-radiation enteritis)
• Ukulimala ngesifo okanye ukulimala kwimithambo yegazi (ukulimala kwe-vascular)
• I-Iskemia: ukungabikho kokuphuma kwegazi okanye umkhumbi wegazi ovalwe
• Intuthuko: xa isahlulo somathumbu sithatha njenge-telescope
• Ukungena kwe-entocolitis: iimeko ezingenzeka kwiintsana ezingekafiki
• I-Volvulus: ukuguquka kwecandelo lomathumbu omncinci
• Isisindo sokulahlekelwa ngumzimba

• I ngxaki

Iimpawu zeMfutshane yeBilwel Syndrome

Xa into ehamba phambili, mhlawumbi ngenxa yokuba ayinelanga ngokwamathumbu amancinci okanye ngenxa yokuba eyekile ukusebenza ngokufanelekileyo, ukutya akupheli kwaye kusetyenziswe ngempumelelo njengoko kufanelekile, kwaye kukho impawu kunye neempawu zeSBS zombini umzila wokutya kunye nomzimba wonke. I-diarrhea ngokuqhelekileyo yenye yezona ziimpawu eziqhelekileyo kwaye, ngokuqondakalayo, kunokukhokelela ekulahlekelweni kwesisindo nokuphelelwa ngumzimba.

Ezinye zezibonakaliso kunye neempawu zesifo esifutshane samathumbu angabandakanya:

• Ukuqhawula
• Ukuqhawula
• Uhudo
• I-Edema (ukuvuvukala) kwimilenze
• Ukukhathala
• Ukuguquka
• Ukungondleki
• Ubuthathaka
• Ukuhla ukusinda

Ukungondleki kungumqondiso we-SBS oza kuba ngumphumo wokungafumani izondlo ezaneleyo zokutya kokutya. Ukungondleki kungathintela umzimba wonke kwaye akusayi kubangela ukuba uhlale ungenasifo kunye neempawu ezifana nokukhathala nokunyaniseka, kodwa kunokukhokelela kwezinye izinto ezifana nokulahleka kweenwele kunye nekhumba elomileyo kunye neengxaki ezinzulu ezifana nokuvuvukala (i-edema) kunye ukulahlekelwa ubunzima bemisipha.

Ulwaphulo lweVitamin

Ukungaphumeleli kwe-Vitamin kungenzeka nge-SBS kuxhomekeke kwiliphi iqela lentlungu elincinci elichaphazelekayo le meko. Ezinye iimpazamo ze-vitamin zingabangela iimpawu kunye neempawu ezahlukahlukeneyo. Xa kukho ukungabikho kwevithamini ethile ngenxa yokuba ingabonakali, iqela lezempilo lingajongana nokusilela kunye neendleko zokuza kuvelisa i-vitamin level kumzimba.

Ezinye zezona zinto zixhaphake kakhulu zibandakanya:

• Intsimbi : Insimbi ifakwa kwi-duodenum, ngoko ukuba loo nxalenye yesisu esincinci isichaphazelekayo, umphumo unokuba yintlupheko yensimbi. Ukungabikho kwesebe eyaneleyo kunokukhokelela ekudleni kwegazi, leyo leyo ingabangela ukukhathala.
• I-Vitamin A: I- Vitamin A idlala indima ekugcinweni kokubonakala kwesikhumba kunye nesikhumba sempilweni, oko kuthetha ukuba ukungabikho kwesi sondlo kunokubangela iingxaki zamehlo (njengobungaboni bobusuku) kunye nemiba yesikhumba efana ne-rashes. Izimo ezinzulu ngakumbi zingabangela ukusilela kakhulu, kubandakanywa nokukhukuliseka kwe-cornea, izifo zokuphefumula kunye nokuqina kwesikhumba. I-Vitamin A iya kuthathwa kwi-jejunum, ngoko ke ukuba loo nxalenye yamathumbu ayisebenzi kakuhle, i-vitamin A isweleka.
• I-Vitamin B: ii- vithamini B zixutywe kwi-jejunum kunye ne-vithamini B12 ibanjwe kwingxenye yokugqibela ye-ileum, ebizwa ngokuba yi-leum terminal. Ukungabikho kwe-vitamin B kunokukhokelela kwiimpawu kunye neempawu ezinjenge-edema, intliziyo engavumelekanga, kunye nomonakalo wemisipha (i-neuropathy).
• I-Vitamin D : I- Vitamin D i-vitamin D iyinqobo ye-vitamin D ukuze i-vitamin D ingapheli ixesha elide likhokelela kwiingxaki ngamathambo afana ne-osteoporosis. Amanqanaba aphantsi e-vitamin D anokubangela ukuba i-muscle spasms kunye nokubetha okanye izikhonkwane kunye neenaliti zengqondo (paresthesias). Ijjunum apho i-vitamin D ithathwa khona ngumzimba kwisisu esincinane.
• I-Vitamin E: Ukungaphumeleli kwe-Vitamin E akuqhelekanga ngaphandle kwehlabathi eliphuhlisayo, kodwa kubantu abane-SBS apho i-jejunum ichaphazelekayo, ukungabi nalutho kwala mavithamini. Ukungabikho kwe-vitamin E kunokukhokelela kwizikhonkwane kunye neenaliti zengxaki kunye neengxaki zombono, kunye neengxaki ze-muscle ezinjengezoxinzelelo.
• I-Vitamin K: I- Vitamin K inceda i-clot yegazi, ngoko ukungabikho kwale vithamini kunokukhokelela kwiingxaki ngokubetha ngokulula kunye nokuphuma kwamanzi. Ngaphandle kwamanye amavithamini, i-vitamin K ithathwa kwi-jejunum, ngoko ukusilela kungenzeka ukuba loo nxalenye yesisu esincinci ichaphazeleka yi-SBS.
• I-Zinc: Ukusilela kwe-Zinc akuqhelekanga kubantu abaphilileyo kodwa ukungabi nalesi simbiwa kungenzeka xa i-SBS ichaphazela ukuxhamla kwayo. Ukunqongophala kwe-Zinc kunzima ukuxilonga kodwa kungabangela ukulahleka kwesondlo nokunciphisa umzimba (oko kunokuthetha ukuba kubekho amathuba okubamba ubushushu okanye umkhuhlane).

Ukuchonga i-Short Bowel Syndrome

Kwezinye iimeko, i-SBS iya kuba ngumngcipheko etafileni ngenxa yokuhlinzwa kwi-intestine encinci (njengabantu abanesifo sikaCrohn abanesifo esiphakamileyo sokuhlinzwa), ngoko ke ukuxilongwa akunakuthetha ukuba uninzi lovavanyo. Kwezinye iimeko, kunokuba kuyimfuneko ukuba ugqirha kunye / okanye iingcali ukuba zijonge iziphumo zemvavanyo eyahlukeneyo ukuze kuqinisekiswe ukuba i-SBS ingxaki.

Iimvavanyo zegazi zihlala zisetyenziselwa ukuxilonga nokujonga i-SBS. Inani elipheleleyo le-cell (CBC) lingabonisa ukuba kukho i-anemia, i-enzyme yesibindi ingabonisa ukuba umonakalo wesibindi ungabakho, kwaye amazinga okudala angabonisa ukuba kukho ingxaki ngeentliziyo. Iimvavanyo zegazi nazo zingasetyenziselwa ukufumanisa ukuba kukho i-vitamin certain deficiency.

Ezinye zeemvavanyo ezingasetyenziselwa ukuxilonga i-SBS ziquka:

• Ukucwaninga kwe-axial tomography (CAT) : Uvavanyo olwenziwe ngombala owenziwe nge-IV onokubonisa iingxaki ngesibindi kunye nezibilini.
• Iskripthi yeTompography (CT) yekhompyutha : Ukukhangela kwesisu esisinika isigxina esiphambanweni somzimba.
• I-imagery resonance imagination (MRI) : Izixhobo zamagnetic zisetyenziselwa ukwenza umfanekiso wesisu kwaye ingakumbi emathunjini amancinci.
• I-Ultrasound: I-ultrasound yesisu isetyenziswe ukujonga imiba nge-bile ducts okanye gallbladder.
• Uchungechunge oluphezulu lwe-GI : Uhlobo lwe-x-ray ethathwa kwisisu emva kokusela isisombululo se-barium esinceda sibone oko kwenzekayo kwinkqubo yokutya yokutya.
• I-X-ray : I-x-rays yesisu ingasetyenziselwa ukukhangela izithintelo okanye ezinye iingxaki emathunjini.

Unyango

Unyango lwe-SBS lunokubandakanya ukutya okunomsoco, imichiza, utshintsho lokutya, i-vitamin supplement, kunye nokuhlinzwa. Uhlobo lonyango olusetyenzisiweyo luya kuba ngumntu ngamnye ngenxa yokuba isigulane esineSBS siya kuba neemfuno ezahlukeneyo ngokubhekiselele kwiyeza. Kukho ezinye izinto ekusebenzeni ngokunjalo ekukhetheni unyango, ezifana nokukhethwa kwezigulane, ezinye iimeko ezigulane nesigulane, nokuba ingaba isigulane singumntu omdala okanye umntwana.

Ukutya

Kwiimeko ezinzima ze-SBS, utshintsho ekudleni kunye nokudibanisa kwezinye izithako ze-vithamine kunye nezamaminerali kunokunceda ukuqinisekisa ukuba izondlo ezininzi zixutywa ngumzimba. Izigulane zicetyiswa ukuba zidle ukutya ezahlukeneyo njengokuba zinyamezelekile, kodwa ukutya kunokukwenziwa ngumculi wezilwanyana ukugxila ngokukhethekileyo kwizondlo ezifunekayo. Ukutya ukutya okuncinci ngemini emininzi kunokuba kunokutya okumbalwa kunokuba kube lula kwisigulane ngeSBS. Isisombululo sokuvuselelwa ngomlomo (ORS) singasetyenziselwa ukugcina ukulinganisela okufanelekileyo kwamanzi kunye ne-electrolyte emzimbeni.

Ulungelelaniso lwamazinyo

Amathumbu amancinci anakho ukulungelelanisa ixesha elide kwaye angaqala ukufumana izondlo ezingaphezulu kokutya, okwenziwe ngamacandelo angasebenzi kakuhle okanye alahlekile. Ezinye iindlela zonyango zingancedisa le nkqubo kunye, kwaye ngelixa ixesha elifunekayo lokulungelelaniswa kwamathumbu asemathunjini liyakwazi ukuqonda, lingahamba naliphi na leenyanga ezintandathu ukuya kwi-2 ukuya kwiminyaka emithathu.

Isondlo sePerrenal Total (TPN)

Kwiimeko ezininzi ze-SBS, izigulane zifakwa kwifom ye-TPN, eyona isondlo esinikezwa nge-IV. Ngenxa yokuba le fom yesondlo ayifuni kumathumbu amancinci, ivumela izondlo ezifana noshukela, iiprotheni, amafutha, iivithamini kunye neemaminerali ukuya ngqo kwigazi kwaye zisetyenziswe ngumzimba. Ukusetyenziswa kwe-TPN kusenokuba yisesigxina okanye ingasigxina, kuxhomekeke kwindlela iSBS echaphazela ngayo umzimba.

Kwezinye iimeko, isondlo sinikezwa nge-tube ekhethekileyo efakwe kwisisu okanye emathunjini amancinci, okubizwa ngokuba yi-tubeal feed. Abantu abafumana isondlo se-IV banakho okanye abanako ukutya ukutya ngomlomo. I-TPN inokunika izigulane xa zibhedlele kwaye zinganikwa kwakhona ekhaya xa isigulane sisisigxina ngokwaneleyo ukuba sikhululwe.

Amachiza

Iindidi ezahlukeneyo zamachiza zisetyenziselwa ukuphatha i-SBS ukwenzela ukuba uncedise isilwane sithatha izondlo ezingaphezulu, unciphise urhudo, kwaye unciphise imveliso yesisu esiswini. Iimpawu zokurhoxisa ezingasetyenziselwa ziquka i-diphenoxylate / i-atropine, i-loperamide, i-somatostatin, kwaye, ngokungaqhelekanga, ikhodiyini kunye ne-tincture ye-opium. Kucinga ukuba isisu esiswini esikhulu sinokunciphisa ukuguqulwa kwamathumbu emathunjini, kunye nokubangela ukungonakali, kunye nokunciphisa i-acid esiswini (i-histamine-2 blockers blockers kunye neproton pump inhibitors ) ezinokunciphisa okanye zokuthintela ukuveliswa kwesisu sase-acid zisenokusetyenziswa, kuquka i-famotidine, i-lansoprazole, i-omeprazole, kunye ne-ranitidine.

I-hormone yokukhula komntu, i-somatropin, xa idibene kunye nokutya kwe-carbohydrates edibeneyo, inokunyusa ukondla komthamo emathunjini amancinci kwaye ingasetyenziselwa kwizigulane ezifumana i-TPN. Iibil ze-acid ezibophayo ezifana ne- cholestyramine zingasetyenziselwa ukunciphisa i-bile acid, ezinokuthi zinciphise urhudo. Iimvumi ze-Pancreatic zingaphinde zinikezelwe ukwandisa ukuphuka kwamafutha, amaprotheni kunye ne-carbohydrate yokutya njengoko ihamba emathunjini amancinci. I-peptide efana ne-glucagon 2, i-teduglutide, inokunikezwa ngabantu abadala abafumana i-TPN kuba iboniswe ukuba yandisa ukwenziwa kwe-mucosa kumathumbu amancinci, kwaye ngaloo ndlela uncede izondlo ezininzi zifakwe.

Ukuhlinzwa

Nangona kungabonakala kungenakuphikisa, utyando ngamanye amaxesha kusetyenziswa ukuphatha iSBS. Iintlobo ezimbalwa zokuhlinzwa zingasetyenziselwa ukwandisa ubude besilwanyana esincinci, esibandakanya inkqubo yeBianchi kunye ne-enteroplasty ye-serial transverse (STEP). Kuzo zombini kwezo zonyango, isiphumo sithuba esele sihlala sisisigxina, kodwa ukutya kuya kuchitha ixesha elidlulileyo, kwaye izondlo ezingaphezulu ziyakunqandwa.

Olunye ukhetho oluqhekezayo aluqhelekanga kwaye ludla kuphela kulabo abaneengxaki ezivela kwi-SBS-njengokwehluleka kwesibindi kunye nokusuleleka-isisu sokufakelwa emathunjini. Kule nqubo, umthambo omncinci omncinci uphathwe kwisigulane ngeSBS. Olu hlobo lotyando ngelishwa ludityaniswe kunye neengxaki ezibandakanya ukukhutshwa. Abantu abafumana ukutshintshwa kwezilwanyana ezincinci baya kufuna kwakhona ukuthatha izidakamizwa ezingenayo i-immunosuppressant ukunciphisa imiphumo yokulahlwa.

Ukunyuka kwamaBetina amancinci amancinci

Umathumbu omncinci awunalo iibhaktheriya ezininzi, kodwa abanye abantu abaneSBS bangakhula ngokugqithiseleyo kwale bhaktheriya, ebizwa ngokuba yintsholongwane yebhakteria encinci . Le meko ingabangela iimpawu zokuqhaqha, isifo sohudo, isisongela, kunye nokuhlanza. Le meko inokubangela ukuba i-SBS ibe nzima kwaye inqande inkqubo yokulungiswa kwamathumbu emathunjini. Unyango lunokubandakanya ama-antibiotics ukuba ayeke ukukhula kweebhaktheriya kwisilwanyana esincinci kunye nokujongana naziphi na ezinye izinto ezinokuba negalelo kwingxaki. Iiprobiotiki zingaphinde zinikezelwe ukukhuthaza ukubhaliswa kweebhaktheriya ezincedo emva kokunyanga ngamayeza.

ILizwi

I-SBS yimeko echaphazela kuphela zonke iinxalenye zomzimba, kodwa zonke iindawo zobomi bomguli. Unyango olukhoyo luyakwazi ukunciphisa ukuchaphazeleka kwe-SBS emzimbeni nokufumana umgangatho obuninzi wobomi kwizigulane. Nangona i-TPN inokuyenza ngaphandle kwesibhedlele, kwaye nangona ephuma ngaphandle kwendlu ngosuku okanye xa ehamba.

Nangona kunjalo, le meko ihamba nemingeni ebalulekileyo kwaye ibeka iqela elibanzi elinenkxaso kwindawo ezayo liya kubaluleka ekulawuleni. Akunjalo nje iingcali ezifana ne-gastroenterologist, ugqirha ogqithisileyo kunye nodokotela wezilwanyana, kodwa kunye nenethiwekhi yabahlobo, intsapho, ezinye izigulane kunye neengcali zempilo yengqondo. Umntu onokufumana i-SBS unokufumana ubuninzi obuphezulu bemigangatho kunye neemeko kunye nemeko yabo, elindelekileyo. Ukufikelela ekuncedeni uncedo nenkxaso kunye nokuhlala esondelelene kunye nenethiwekhi yenkxaso iya kunika ithuba elihle lokonyango olufanelekileyo kunye nokuphila ubomi obulungileyo obunokwenzeka ngeSBS.

> Imithombo:

> Crohn's and Colitis Foundation. "I-Short Bowel Syndrome kunye neSifo seCrohn." CrohnsColitisFoundation.org Jul 2013.

> Johnson LE. "Ukunqongophala kwamaVitham, ukuxhomekeka, kunye noTyhefu: iVithamini A." I-Merck Manual.

> Johnson LE. "Ukunqongophala kweVithamini, ukuxhomekeka, kunye noTyhefu: i-Vitamin E." I-Merck Manual.

> Johnson LE. "Ukunqongophala kweVithamini, ukuxhomekeka kunye noTyhefu: i-Vitamin K." I-Merck Manual. Ngo-Septemba 2016.

> Isizwe seSizwe seSifo seswekile kunye neeNtsholongwane zeNtsholongwane kunye neNtsholongwane (iNIDDK). "I-Short Bowel Syndrome." ISikole kaZwelonke seSifo seswekile kunye neSigestive kunye neZifo zeNtsholongwane yeZiko lezeMpilo.