I-Fistula inokuba yintlungu, kodwa iqheleke yonyango ngaphandle kokuhlinzwa
I-fistula ichazwa njengexhamlwano olungavumelekanga lwimizimba emibini yomzimba (njenge- rectum kunye nesondo), okanye ukuxhamla komzimba kwesikhumba (njenge-rectum kwesikhumba). Enye indlela i-fistula inokwenza isuka kwi- abscess -a pocket of pus emzimbeni. I-abscess ingasoloko izaliswa ngamanzi omzimba njengesihlalo okanye umchamo, obangela ukuphulukiswa.
Ekugqibeleni liphululela eluswini, omnye umzimba, okanye iqumrhu, ukudala i-fistula.
I-Fistula yinto eqhelekileyo kwisifo sikaCrohn kunokuba isifo sezilonda zesisu. Phantse ama-25 ekhulwini labantu abanesifo sikaCrohn bahlakulela i-fistula. I-Fistula iphathwa ngokuphethwe okanye ngokunyamekelwa kwilonda.
Iintlobo
I-fistula isoloko ivela kwindawo ejikeleze izitho zangasese kunye ne-anus (eyaziwa ngokuba yi-perineum). Iintlobo ezine ze-fistula zi:
- I-Enterocutaneous : Olu hlobo lwe-fistula luvela emathunjini ukuya kwesikhumba. I-fistula engena kwi-intanethi ingaba yinkxalabo yokuhlinzwa. Inokuthi ichazwe njengendlela ehambayo esuka emathunjini ukuya kwisayithi yokuhlinzwa kwaye kwesikhumba.
- I-Enteroenteric okanye i-Enterocolic : Le fistula equka intumbo enkulu okanye encinci .
- Ukungena kwinqanaba : Le fistula eya ebomini.
- I-enterovesicular : Olu hlobo lwe-fistula luya kwisitya. Ezi fistula zingabangela ukusulelwa kwezigulane zamanzi, okanye ukuhamba kwegesi kwi-urethra ngexesha lokuchama.
Iimpawu
Iimpawu zesifo se-fistula zingabandakanya intlungu, umkhuhlane, ukunyamezela, ukubetha, kwaye ngokuqhelekileyo uzive kakubi. I-fistula inokukhupha i-pus okanye inkunkuma epholileyo. Ezi zimpawu ziyahlukahluka ngokusukelana nobunzima kunye nendawo ye-fistula.
Ukuxilongwa
I-Fistula ivame ukuxilongwa ngokusetyenziswa kovavanyo lomzimba, i- computed tomography (CT) yokukhangela , kwaye, xa kuyimfuneko, ezinye iimvavanyo ezifana ne- barium enema , i- colonoscopy , i- sigmoidoscopy , i- endoscopy ephezulu okanye i-fistulogram.
Ngexesha le-fistulogram, idayi ifakwe kwi-fistula, kwaye i-X-ray iyathathwa. Idayi inceda i-fistula ukuba ibonise ngcono kwi-X ray. Idayi ifakwe kwi-rectum, efana ne- enema , ye-fistula esecaleni. Idayi kufuneka 'ibanjwe' ngaphakathi ngaphakathi kwenkqubo. Nge-fistula engaphandle komzimba, idayi ifakwe kwisithuba kunye ne-tube encinane. I-ray-ray iya kuthathwa kwii-angles ezahlukeneyo, ngoko isigulane kufuneka sitshintshe izikhundla kwitheyibhile ye-X. Njengoko naluphi na uhlobo oluthile lwe-X-ray, kusala kubalulekile.
Xa kucingelwa ukuba isigulane sinesifo se-fistula (i-bladder) ye-fistula, i-pyelogram ye-intravenous (IVP), enye uhlobo lwe-X-ray, inokwenziwa. Ukumisela oku kuhlolwa kungabandakanya ukutya okucacileyo okanye ukutya ukutya, kuba isitonti kwikoloni sinokuthiphazamisa imbono yesikhumba. Idayi (izinto ezifaniyo) zifakwe kwisandla, kunye ne-X-rays ithathwa.
Iingxaki ezinokwenzeka
I-fistula ingabangela iingxaki. Kwezinye iimeko, i-fistula ayinakuphulukisa, kwaye ingapheliyo. Ezinye iingxaki ezinokuthi zibandakanya i-fistula, i-sepsis, kunye ne-peritonitis. I-Sepsis isifo esisongela ubomi esiphumela kwisiphumo somzimba kwisifo sobhaktheriya.
Iimpawu ze-sepsis zibandakanya ukukhawuleza, ukukhulelwa komkhuhlane, ukuphazamiseka, ukudideka, ukuphazamiseka, nokuphefumula ngokukhawuleza kunye nentliziyo. I-Peritonitis kukuvuvukala okanye usulelo lwe-peritoneum, iisisu kwisalathisi sangaphakathi esisisu esithwala izitho zangasese. Iimpawu ze-peritonitis ziquka intlungu yesisu kunye nesisa, isifo somkhuhlane, ukubola, iintlungu ezihlangeneyo, isisongela kunye nokuhlanza.
Unyango
Iipilisi ze-fistula ziyahluka ngokuxhomekeka kwindawo yazo kunye nobukhulu beempawu. Unyango lwezonyango luquka i- Flagyl (i-antibiotic), i -MP-6 (i-immunosuppresant), okanye iiphilisi ezithile ze-biologic (kuquka i- Remicade ne- Humira ).
Ukutya okunokungeniswa kwempahla kunokumiselwa i-fistula, i-enterocutaneous, ne-enterovesicular fistula.
Ukutya okunomsoco kungumlinganiselo wesondlo esithathwa ngomlomo okanye unikezwa nge-tube yokutya. Ezi zifomula zondlobongela zibuyisela ukutya okuqinileyo kwaye ziqulethe izondlo ezibalulekileyo. Ngaphandle kokutya okuqinileyo kukho isona esingaphantsi esidlulayo kwi-anus, esinceda ukuphilisa i-fistula kwaye mhlawumbi isondele.
Uninzi lwe-fistula aluyi kuphendulwa naluphi na olu luhlobo lwezonyango olungentla kwaye luya kufuna ukunakekelwa kunye / okanye ukunakekelwa kwilonda. Ukuba i-fistula inxalenye ephilileyo yamathumbu, ingasuswa ngaphandle kokuthatha nayiphi na inxalenye yamathumbu. Ukuba i-fistula isesifo esiyinkathazo yesibilini, kufuneka kuqhutywe i- resection .
I-resection ingabangela i- ileostomy yesikhashana. I-Stool ichithwa nge-ileostomy, inika inxalenye yengathumbu ngexesha le-fistula lokuphilisa. Olu hlobo lotyando ludla ngokuphindwa lwenziwa kwi-ftotuliki okanye kwi-fistula e-enterovesicular.
Prognosis
Indawo kunye nobunzima be-fistula badlala indima enkulu ekumiseni unyango. I-fistula ngumqondiso wesifo esibangeleko sesibindi (IBD), kwaye ngaphandle kokunyamekela okufanelekileyo, kunokukhokelela kwiimeko ezinzima. Ukubona i-gastroenterologist rhoqo kwaye ukuthatha amayeza njengoko kuchazwe kubalulekile ekulawuleni nasekukhuselweni kweengxaki ze-IBD.
Imithombo:
UBuckmire M. "Ukungabikho kunye neFistula kwandisa ulwazi." I-American Society of Colon kunye nee-Rectal Surgeons. Feb 2015.
Crohn's and Colitis Foundation of America. "Ukunyanga kwi-Crohn's Disease & Ulcerative Colitis." CCFA 31 Agasti 2010.