Isigqibo esimele sihlolwe ngokucophelela
Ukuba unesifo esiqinileyo sesibindi, njengesifo sesibindi sokunxila okanye u- hepatitis B okanye uC kunye nokuhlinzwa okungahambelani nesibindi, izinto zinokuba nzima. Isigqibo sokuqhubeka nokuhlinzwa kulo mzekelo asithathwa lula. Amagqirha akho kufuneka aqwalasele izinto ezininzi xa uqikelela umngcipheko wakho wokusebenza kwaye nokuba uya kuba neengxaki ezinzulu okanye ukufa ngenxa yokuhlinzwa.
Ngokukodwa, kulabo abanesifo somlenze esele sanyanzeliswe ngukugula okanye sisifo esingapheliyo, utyando lunokuthi lithinte isikali ngenxa yokuxhatshazwa kwesibindi, okanye ukugqithisa kwesifo sesibindi, ukuhluleka kwesibindi kunye nokufa. Ngoko ke, utyando kufuneka uqwalaselwe ngenyameko ukuba unesifo sesibindi.
Izinto ezihlolwe ngabaviwa abathintekayo abanezifo zesibindi ziquka oku kulandelayo:
- ubunzima, imbangela kunye nobuhlungu besifo sesibindi
- uhlobo lotyando
- ngokukhawuleza kokuhlinzwa
- uhlobo lwe- anesthesia
- Ukungena kwi-intraoperative kwegazi
Makhe sijonge kwizinto ezahlukahlukeneyo zezibhedlele, oogqirha, ii-hepatologists (iingcali zesibindi) kunye namanye amalungu athile eqela elijongene nokunakekelwa kwempilo ngaphambi kokuba aqinisekise ukuba umntu onesifo sesibindi ngumviwa wokuhlinzwa.
Uvavanyo lweMvelo
Indlela umgqatswa ogqitywa ngayo, okanye inkcazo yekliniki phambi kokuba utyando luyingxenye ebalulekileyo yokuvavanya umngcipheko ophezulu kubantu abanesifo sesibindi.
Ngokuqhelekileyo, ugqirha uya kukhangela iimpawu kunye neempawu ezilandelayo ezibonakalisa i-hepatitis enzima:
- isicaphulelo
- jaundice
- ukuhlanza
- ukukhupha ebusuku
- pruritis (itchiness)
- ukuhla ukusinda
Kubantu abane- cirrhosis , ezininzi izibonakaliso ezilandelayo zivela kwinqanaba lokushushumbisa umfutho wegazi kwaye zibonise ukunyanzeliswa komntu osweleyo kwaye zicebise i-cirrhosis.
- ukwanda kwindandatho yesisu (umqondiso we- ascites )
- inzuzo yesisindo (ebonisa ukunyuka kwama-ascites)
- ukuguqulwa kweememori (okubonisa ukunyuka kwengqondo )
- ukuphuma kwamanzi okutshatyalaliswa kwangoku (ukubonisa ukuphuma kwamagciwane)
- utshintsho kwimijikelezo yokulala
- i-jaundice (ukuluphuka kwamehlo, isikhumba kunye nezinye iimbumba ze-mucus)
Abantu abaninzi abanamava e-cirrhosis batshintshwa kwiindlela zokulala. Olu tshintsho luye lwalubizwa ngokuba yi-hepatic encephalopathy kunye nokukhubazeka kwe- melatonin metabolism ye-hepatic; Nangona kunjalo, asikafaneli ukucacisa ngokuthe ngqo ukuphazamiseka kwezifo zokulala.
Ubunzima beSifo seNtsholongwane
Abantu abane-hepatitis enobuhlungu okanye i-cirrhosis ehlukumezayo, kunye nokuhluleka kwesibindi, akafaneleki ukuhlinzwa. Oku kunengqiqo kuba awufuni isigulane sibe nesifo esinobungozi obukhulu ngexesha lotyando. Ngokuqhelekileyo, ubukho be-cirrhosis buchaphazela kakhulu iziphumo zokuhlinzwa. Abagqatswa abangcono kwi-operesheni babandakanya abantu abane-hepatitis engapheliyo kwaye bengabikho emsebenzini onesibindi.
Ngokuphathelele ukuhlinzwa okhethwayo, i-cirrhosis kunye ne-hepatitis enamandla zizathu ezicacileyo zokuphepha ukuhlinzwa. Ukuba unesifo esiqinileyo sesibindi, kufuneka ugweme ukuhlinzwa xa kunokwenzeka.
Izindlela ezintathu ezahlukeneyo zokufaka ubungqina obungqina obusetyenzisiweyo ukwenzela ukwenza inkqubo yokumisela ukuba umntu onesifo sesibindi ngumviwa ofanelekileyo wokuhlinzwa: i-Child-Pugh, umzekelo weMode for End-Stage-Stage Disease (MELD) umlinganiselo kunye nokulinganisa kwe-hepatic i-gravent pressure (i-HVPG).
Ingqalelo, i-HVPG isetyenziselwa kuphela kumaziko amakhulu eziko lemfundo kwaye ayifumanekanga kuyo yonke indawo. Nangona kunjalo, kukuhle ngokucacileyo ekuqikeleleni ukuhlaziya okanye iziphumo zeklinikhi.
Ukuphuma kwegazi eHepatic
Into enzima kakhulu into eyenzekayo ngexesha lotyando kulabo abanesifo sesibindi kunciphisa ukuhamba kwegazi le-oxygen kwisibindi. Oku kunciphisa ukuhamba kwegazi kubangela i-hepatic ischemia ne-necrosis (ukufa kweeseli zesibindi), ezinokubakhokelela ekuphelelweni kwesibindi okanye ukungaphumeleli, kunye nokukhululwa kwabalamli abavuthayo abangabangela ukungaphumeleli kwamalungu amaninzi.
Ngokuqhelekileyo, imirhobho inikezela ngegazi okwenziwe ngegazi.
Nangona kunjalo, kwisibindi, ukunikezelwa kwegazi oksijini kuvela kumbindi we-hepatic kunye ne-veal vein. Enyanisweni, i-portal vein inika ininzi yegazi e-oxygen kwininzi yabantu.
Ngethuba lokuhlinzwa, uxinzelelo lwegazi kunye nokuphuma kwenhliziyo. La matonsi anciphisa ukuhamba kwegazi le-oxygen kwisibindi. Ngokuqhelekileyo, umthambo we-hepatic uhluma okanye ukhula ukuze uqoke i-slack kwaye uhlawule ukuhla kwegazi le-oksijeni kwisibindi ngokusebenzisa i-veal vein. Nangona kunjalo, kubantu abane-cirrhosis, utshintsho olungapheliyo kwi-architecture yesibindi, ezifana ne-fibrosis kunye ne-nodularity, ukungcola ngekhono lomthi we-hepatic ukunyusa nokunyusa ukuhamba kwegazi oksijini ukuya esibindi. Ukongezelela, i-anesthetics iphinde iphazamise ukuhlengahlengiswa kwembuyekezo ye-hepatic artery edibanisa ingxaki.
Ngamanye amazwi, abantu abane-cirrhosis banenkathazo yokuhlawulela amaconsi ekuphumeni kwegazi kwisibindi, esibangelwa utyando kunye ne-anesthesia kunye nokuchitshiyelwa kwezakhiwo zesibindi. Ngaphandle kokuhamba okwaneleyo kwegazi le-oksijeni kwisibindi ngexesha lotyando, umntu unokufumana umonakalo omkhulu wesibindi nokuhluleka.
Uluhlobo lweNyango
Ngaphambi kokuba umntu onesifo sesibindi aqhutywe kuyo, kubalulekile ukuqwalasela ukuba uhlobo oluthile lotyando olwenziwayo luya kumbeka umntu umngcipheko omkhulu kunzima.
Ngexesha lokuhlinzwa kwesisu (cinga i-laparotomy), nayiphi na inxibelelwano ngokuthe ngqo kunye nemithambo yegazi yesibindi ingabangela ukwanda komonakalo kunye nomonakalo wesibindi. Ngaphezu koko, ukuphengulula le mijelo yegazi kunokunciphisa ukuhamba kwegazi ukuya esibindi ngexesha lotyando.
Abantu abanezifo ezinzulu zesibindi, ezifana ne-cirrhosis, abadinga ukuhlinzwa ngokukhawuleza ngenxa yokuhlambalaza, njenge-sepsis okanye i-trauma, basengozini enkulu yokufa emva kwenkqubo.
Utyando lwe-cardiovascular further uphazamisa ukuhamba kwegazi kwisibindi kunye nokwandisa ingxaki. Ukongezelela, abaxinzezeli (amachiza anikwe ukunyusa uxinzelelo lwegazi ngelixesha lokuphelisa ixesha) kunye ne-cardiopulmonary bypass ingabangela ukonakalisa ukulimala kwesibindi.
Njengoko kukhankanywe ngaphambili, i-anesthetics inokunciphisa uxinzelelo lwegazi kunye nokuhamba kwegazi kwisibindi kwaye iqhubeke negalelo kumonakalo wesibindi. Ngaphezu koko, kubantu abanesifo sesibindi, i-anesthetics inokuthi ihlale ijikeleze ixesha elide kwaye ingabonakali ngokukhawuleza ngoko kubangele ixesha elide lezenzo.
Isiphelo
Okokuqala, ukuba i- enzyme yakho yesibindi iphakanyisiwe nje kodwa isifo sakho sesibindi silawulwa ngenye indlela, unokuba ngumviwa ofanelekileyo wokuhlinzwa. Okwesibini, ukuba une-hepatitis engapheliyo enobungozi obuhle kakhulu, usenokuba ngumviwa ofanelekileyo wokuhlinzwa. Okwesithathu, ukuba une-hepatitis yotywala kwaye ushiye ukusela ixesha elide kwaye ungenasifo esithile kwisifo, unokuba ngumviwa ogqityiweyo.
Nceda ugcine ukhumbule ukuba nje ngokuba unesifo se-cirrhosis asisho ukuba awukwazi ukuhlinzwa. Nangona kunjalo, ubukho be-cirrhosis buchaphazela ngokuqinisekileyo iziphumo kwaye ke akufanele kuhlawulwe ngexesha lokuhlinzwa (cinga i-jaundice, ascites, isisu, okanye i-variceal, ukuphuma kwegazi kunye nokunye).
Ukuba une-hepatitis okanye i-cirrhosis ekhutshiwe, utyando luyinto engalunganga. Kungcono ukucinga ngesibindi kubantu abanesifo esibindileyo sesibindi njenge-hepatitis okanye i-cirrhosis njengeqhekeza elilele. Okubaluleke kakhulu, oogqirha basebenza ngeenxa yokulala kakhulu, kunye ne-flare-ups okanye ukuvinjelwa kwesibindi umsebenzi osisondeza kwi-cirrhosis ehlawulisiwe yenza ukuba le ntokazi ilele kakhulu.
Imiphumo yokuhlinzwa kwalabo abaneesifo sesibindi ingaba nzima kakhulu. Abanye abantu bafumana ukuhluleka kwesibindi baze bafe emva kokuhlinzwa okunjalo. Ngaloo ndlela, isincomo sokwenza utyando kubantu abanesifo sesibindi kuqwalaselwa ngenyameko yecandelo lakho lezempilo. Ukongezelela, njengesigulane, kufuneka unikeze imvume enolwazi, okanye uvumelane nenkqubo.
Kufuneka ucelwe ukuba unikeze imvume enolwazi kuphela emva kokuba ugqirha wakho kunye neqela lezempilo lichaze ngokupheleleyo iingozi, iintlawulo kunye nemiphumo yenkqubo. Khumbula ukuba utyando kunye nesigqibo owenzayo.
Imithombo
Bacon BR. I-Cirrhosis kunye neengxaki zayo. Ku: Kasper D, Fauci A, Hauser S, uLongo D, Jameson J, Loscalzo J. eds. Iinqununu zeHarrison ze-Internal Medicine, 19e . New York, NY: McGraw-Hill; 2015.
Abahleli. Ukusebenza kweMithi. Ku: Kasper D, Fauci A, Hauser S, uLongo D, Jameson J, Loscalzo J. eds. Iinqununu zeHarrison ze-Internal Medicine, 19e . New York, NY: McGraw-Hill; 2015.
Montagnese S, De Pitta C, De Rui M, et al. Ukulala-Vuka ukungahambi kakuhle kwezigulane nge-Cirrhosis. Hepatology . 2014; 59 (2): 705-712.
Qamar AA, Grace ND. Isahluko 53. UkuVavanywa kwangaphambili kwezifo zesifo. Ku: McKean SC, Ross JJ, Dressler DD, Brotman DJ, Ginsberg JS. eds. Imigaqo kunye nokuSebenza kweMithi yoBhedlele . New York, NY: McGraw-Hill; 2012.