Xa siva ilizwi elithi "i- hepatitis ," sivame ukudibanisa ne- cirrhosis nezinye izifo ezichaphazela isibindi. Kodwa akusoloko kunjalo. Njengokunye okuqhubekayo, izifo ezingapheliyo, i-hepatitis inokuchaphazela ngqo inkqubo yelungu elinye (kule meko, isibindi) ngelixa lichaphazela ngokungathanga ngqo ezinye iinkqubo zesebe, ngokunjalo.
Enye inkqubo echaphazelekayo ngokungathanga ngqo ngesifo sesibindi yinkqubo yesantya ephakathi, kwaye ingakumbi ingqondo.
Ngethuba lokusuleleka kwintsholongwane engapheliyo okanye engapheliyo, isifo esinobungozi esibusweni singakwazi ukuqokelela kwigazi kunye nokusasazeka (okanye ukusasazeka) kuwo wonke umzimba. Xa ezi zinto zingena kwingqondo, zingabangela imeko ye-neurological ebizwa ngokuba yi- hepatitis encephalopathy .
I-encephalopathy ye-Hepatic ibonisa ngokudideka, ukunyenga, kunye namaxesha amaninzi utshintsho kwizinto zokuziphatha nezakhono. Ukuba ishiywe ingakhange ilandelwe, isifo sinokuthi senze inkqubela phambili kwi-coma (coma hepaticum) okanye nokufa.
Yonke into echazwe, phakathi kwama-30 no-45 ekhulwini kwabantu abane-cirrhosis baya kuphuhlisa imiqondiso ye-encephalopathy ye-hepatic, nokuba ingaba zizinto ezintle zokulibala okanye izinto ezinzima zokubamba i-amnesia okanye ukuthatha.
Iimbangela ze-Hepatic Encephalopathy
Nangona i-encephalopathy i-hepatic ihambelana nokungafezeki kwesibindi , ngokuqhelekileyo kukho ezinye izinto ezibangela umdla. Uninzi lwezi zinto alinanto enxulumene nesibindi okanye ingqondo; bavele babonakale ukuba bangabangela ukuhlaselwa okanye baqhubekisele phambili ukwandisa isiqendu esele sikhona.
Phakathi kwezinto ezinokubambisana ezinobunzima bebindi:
- Ukusetyenziswa ngokweqile kotywala
- Ukuhluleka kweengso
- Ukutyunjwa, okwandisa umthambo we-ammonia
- Pneumonia
- Ukuphuma kwegazi, okuqhelekileyo kubakho kwisifo sesibindi esilandelayo
- I-british peritonitis ngokuqhelekileyo, ngokuqhelekileyo isiphumo se-cirrhosis yesibindi
- Usulelo lwe-Urinary tract
- I-potassium ephantsi kunye / okanye amanqanaba e-sodium, ngokuqhelekileyo kubangelwa i-diuretics esetyenziselwa ukunyuka kwi-ascites kwisifo esilandelayo
- I-Benzodiazepines, i-sedative edlalwa rhoqo ukuba ilawule ukutsalwa kotywala
- Izidakamizwa kunye nezidakamizwa ezichasayo
- Ukusetyenziswa kwezigodo (ezaziwa nge-transjugular intrahepatic portosystemic shunt, okanye i-TIPS), zisetyenziselwa ukulungisa ukuhamba kwegazi kwisibindi
Ngokuchonga izizathu ezisisiseko sezidakamizwa ze-hepatic encephalopathy, oogqirha banako ukunyanga ngokuthe ngempumelelo ngolu hlobo ngokunciphisa izinto ezinokuthi zithintele okanye zihlasele ukuhlaselwa.
Indlela ukungaphumeleli kwesibindi kuthinta ngayo ubuchopho
I-hepatic encephalopathy iyenzeka xa isibindi singasakwazi ukwenza imisebenzi yaso yesiqhelo.
Kubantu abanomsebenzi wesibindi, i-nitrojeni ene-nitrogen ephuma emathunjini athunyelwa esibindi, apho iqhutyelwa khona kwaye ikhutshwe emzimbeni. Xa umsebenzi wesibindi ungasebenzi, i-nitrogen-containing containing compounds iqala ukukhula ngokukhawuleza, okubangela ukwanda kwamazinga e-ammonia.
Ezi ngqungquthela ze-ammonia zisasazeka kulo lonke igazi kwaye zigqithise umlenze ongenakunyamelekayo ojikeleze ingqondo. Kukho, bangela ukuba ukuvuvukala kweeseli zobuchopho kuthiwa yi-astrocytes, ekugqibeleni igxotha imveliso ye-neurotransmitters ebalulekileyo ekucingeni ingqiqo.
Iimpawu kunye neempawu ze-Hepatic Encephalopathy
I-hepatic encephalopathy ivame ukuba nzima ukuxilonga kwizigaba zokuqala zesifo. Ukulibaleka, ukucaphuka, ukuxhalaba kunye nokudideka ngokuqhelekileyo kukho impawu zokuqala, ezininzi zazo ezilahleka kalula nakubantu abanezifo zesibindi.
Mhlawumbi isibonakaliso sokuqala siza kuba yinto ebizwa ngokuba yindlela yokulala yokulala, apho umntu elala ngokulala emini aze ahlale ephaphile ebusuku. Oku kuvame ukulandelwa ngoluhlu lweempawu zamanqanaba ezizayo, ezingabandakanya:
- Lethargy
- Ukuguqulwa komntu
- Ukwanda kokudideka
- Iingxaki ngokubhala nokuhamba kakuhle
- Izandla ezithintekayo okanye "ukungena" kwezandla
- Ukugubungela ngamalungu
- Ukuziphatha okungenakuvinjelwa
- Amnesia
- Ukuphazamiseka kwegag reflex
Iziganeko ezinzima zingakhokelela ekuhlaleni ukukhathazeka, ngokuqhelekileyo ukuqhubela phambili ekutshatyalaliswa kogonyamelo kunye ne-coma. Ukufa kufuthi kubangelwa ukuvuvukala okukhulu kwengqondo (ebizwa ngokuba yi-edema ye-cerebral).
Izigaba ze-Hepatic Encephalopathy
Izigaba ze-encephalopathy ze-hepatic zifakwe kwizinga elibizwa ngokuba yi-West Haven Criteria, ekwahlukanisa ubunzima beempawu ezisekelwe kumgangatho wokukhubazeka kwegazi:
- Okuncinci: utshintsho kwisantya seemoto ngaphandle kwempawu zenguqu zengqondo
- Ibanga 1: ukungabi ncinane kokuqonda, ukunyamezela okanye ukuxhalabisa, ukufutshane nokujonga ixesha, ukuguqula isigqi sokulala
- Ibanga lesi-2: ukunyaniseka okanye ukunganaki, ukuphazamiseka, ukuguquka komntu, ukuziphatha okungalunganga, iingxaki zezithuthi, ukuthungatha "kwezandla" zezandla
- Ibanga lesi-3: i-state-stupor state, ukudideka, ukuphazamiseka okukhulu, ukuziphatha okumangalisayo
- Bakala 4: i-coma
Uvavanyo lwezonyango luyenziwa ngokuhlenga isisiseko esiyimbangela, nokuba sisenokungaphumeleli kwesibindi (Tshintsha A), inkqubo ye-TIPS (Uhlobo B), okanye i-cirrhosis (Uhlobo C). Ngalunye lwezi zigaba zisiza ekuqaliseni ikhondo elifanelekileyo lezenzo zokunyanga le meko.
Ukuxilongwa
Ukuxilongwa kwe-encephalopathy ye-hepatic kungenziwa kuphela phambi kobungozi obuqinisekisiweyo besibindi okanye kubantu abaye bafumana inkqubo ye-TIPS. Ukuxilongwa kwenziwa ngokungabandakanyi zonke ezinye izizathu ezibangelwa ukukhubazeka kwegazi.
Ubungcali bonyango luyadingeka ukuze kwenziwe uvavanyo lokuhlula ; akukho vavanyo lwayo oluya kuqinisekisa ngokupheleleyo okanye ukungabandakanyi imeko. Ukuba u-suspect encephalopathy uyangqatshulwa, oogqirha baya kuqhuba ibhetri yeemvavanyo, ezinokubandakanya:
- Ukuvavanywa kwezakhono ezibonakalayo, izithuthi kunye nezetetho
- I-CT icinga ukuba ingabandakanyi okanye iqinisekise ubuchopho
- I-Electroencephalogram (i-EEG) xa kukhankanywa ingozi
- Ukuhlolwa kwegazi ukujonga i-serum ammonia
- Iisampuli zamanzi ezivela kwisithwathwa se-peritoneal (esihlula isisu esiswini ukusuka eludongeni lwesisu) ukuba singabandakanyi okanye siqinisekise ukusuleleka kwe-bacterial
- Ezinye iimvavanyo, kubandakanywa ne-X-rays kunye ne-urinalysis, ukukhupha ezinye izizathu ezinokwenzeka
Unyango
I-hepatic encephalopathy iyaphathwa. Unyango lujoliswe ekuxazululeni nayiphi na imeko engaphantsi kwimeko enokubangela okanye iqhube ukuhlaselwa. Kwezinye iimeko (njengabantu abaye bafumana inkqubo ye-TIPS), imeko ingasombulula ngokukhawuleza kwaye ayifuni ukungenelela. Ngamanye amaxesha, ukupheliswa kwesichengiselwano esithile okanye unyango lokuqhawulwa kunokuphucula kakhulu iimpawu ze-neurological.
Kwiimeko apho usuleleko olunefuthe luye lwafunyaniswa, i-antibiotics iya kubhalwa ngokukodwa ngendlela ye- rifaximin . Ukongezelela, i- lactulose ifakwe ngokuqhelekileyo njengonyango lokuqala lokunciphisa umveliso we-ammonia emathunjini.
Ukugxekwa komntu onokukhupha i-hecatic encephalopathy kungahluka kakhulu. Ukuxilongwa kwe-encephalopathy, kunye nebhetri yeemvavanyo zesibindi, kuya kusetyenziswa ngokuqhelekileyo ukuba kuqinisekiswe ukuba umntu uya kufuna ukufakelwa kwesibindi . Kubantu abanesifo esiphambili sesibindi, njenge-cirrhosis ekhutshelweyo okanye umdlavuza wesibindi, ukutsalwa kwesibindi kudlalwa rhoqo.
> Imithombo:
> Vilstrup, H .; Amodio, P .; Bajaj, J .; okqhubekayo. "I- Hepatic Encephalopathy kwiSifo esiSigxina esingasigxina: Izikhokelo ze-Practice 2014 ezivela kwi-AASLD ne-EASL." I-AASLD Yenza Isikhokelo. 2014: 3-67.
> I-Conn, H. "I-hepatic encephalopathy." Schiff, L kunye neSchiff, E., eds. Izifo zesibindi . Wesi-7. Philadelphia, PA: Lippicott; 1993: 1036-1060.