Duk abin da kuke buƙatar sanin game da ciwo na cututtukan

Wannan rikitarwa na cutar hanta zai iya haifar da gazawar koda

Bayani

Sassan jikin mutum ba su cika nauyin da suke da su ba. Suna sadarwa tare da juna. Suna dogara da juna. Yin fahimtar aiki na kwaya yana buƙatar fahimtar muhimmancin sauran kwayoyin. Jikin jikin mutum yana kama da ƙungiyar makaɗaici mai wuya. Idan kun kasance kawai ku saurari masu kiɗa guda ɗaya, kuna iya jin dadin taron.

Da zarar mun fahimci wannan muhimmin mahimmanci, zai zama mafi sauƙin fahimtar cewa matsalolin da aikin daya zai iya rinjayar wani.

Ma'anar cututtukan cututtukan cututtuka (HRS)

Kamar yadda kalmar ta nuna, kalman "hepato" ya shafi hanta, yayin da "koda" yana nufin koda. Saboda haka, ciwo mai cututtuka yana haifar da yanayin da cutar ta hanta take kaiwa ga cututtukan koda ko a cikin matsanancin hali, cikakkiyar gazawar koda .

Amma, me ya sa muke bukatar mu san game da ciwo na cutar hepatorenal? Labaran cutar shi ne wani abu mai mahimmanci (tunanin Hepatitis B ko C, barasa, da dai sauransu). Kuma a cikin yanayin ciwon hanta, rashin lafiyar hepatorenal ba wani abu ba ne. Ifact, bisa ga wani kididdiga, kashi 40 cikin dari na marasa lafiya da cirrhosis (ƙwaƙwalwa, hanta mai yalwace) da ascites (ruɗar ruwa a cikin ciki wanda ke faruwa a cikin cutar ciwon hasara) zai inganta ciwo mai cutar hepatorenal cikin shekaru 5.

Factor Factor

Sakamakon farawa a cikin ciwo na hepatorenal shine ko da yaushe wani irin cutar hanta.

Wannan zai iya zama duk abin da ke faruwa daga hepatitis (daga ƙwayoyin cuta kamar Hepatitis B ko C, kwayoyi, cututtukan kwayoyin cuta, da dai sauransu), zuwa ciwon sukari a cikin hanta, zuwa cirrhosis, ko kuma mafi nau'i na cutar hanta da ke haɗuwa da saurin hawan aikin hanta, ake kira cikewar hanta fulminant. Duk waɗannan ka'idoji zasu iya haifar da cututtukan koda da kuma gazawar koda na matakan bambanci a cikin rashin lafiya na hepatorenal.

Duk da haka, akwai wasu alamun da aka gano a fili da kuma wasu lamurran da ke da muhimmanci wanda ya inganta yawan sauƙin wanda ya tasowa gazawar koda saboda cututtukan hanta.

• Kamuwa da ƙananan ɓangaren (wanda wani lokaci yakan faru a mutanen da ke da cirrhosis), da ake kira kwayar cutar bacteria peritonitis (SBP)
• Buga cikin ƙuƙumi, wanda yake a cikin marasa lafiya cirrhosis daga jini wanda ya bullo a cikin esophagus misali (bambancin jinsi)

Kwayoyin ruwa (litattafai irin su furosemide ko spironolactone) da aka ba marasa lafiya tare da cirrhosis da kuma karuwar ruwa bazai dame cutar ciwon daji ba (ko da yake suna iya cutar da kodan a wasu hanyoyi).

Ci gaba da ciwo

Hanyoyin da abin da cututtukan hanta suka haifar da matsaloli tare da aikin koda anyi zaton zasu kasance da alaka da "raguwa" na samar da jini daga kodan kuma cikin sauran ɓangaren gado na ciki (abin da ake kira " splanchnic circulation ").

Ɗaya daga cikin mahimman factor da ke ƙayyade samar da jini ga kowane kwaya shine juriya da jini ke gudana zuwa gawar. Saboda haka, bisa ga ka'idojin kimiyyar lissafi, mafi ƙarancin jirgi mai jini, mafi girman juriya zai haifar da yaduwar jini .

Alal misali, yi tunani idan kuna ƙoƙari su sha ruwa ta hanyoyi biyu daban-daban ta hanyar amfani da matsin lamba (wanda a zuciyar mutum ke haifar da zuciya).

Idan duka hossan suna da lumensan da suke da nau'i mai yawa, wanda zai yi tsammanin yawan ruwan zai gudana ta wurinsu. Yanzu, menene zai faru idan daya daga cikin waɗannan shingen ya fi girma (mafi girma) fiye da ɗayan? Da kyau, mafi yawan ruwa zai fi dacewa ta hanyar rassan fadi saboda ƙananan juriya da matsalolin ruwa a can.

Hakazalika, a cikin yanayin ciwo na cutar hepatorenal, ƙaddamarwa (dilatation) na wasu tasoshin jini a cikin ƙwayar katako na ciki yana kawar da jini daga kodan (wanda jini yake da shi). Kodayake wannan ba dole ba ne a ci gaba da matakan jeri, don sake fahimtar juna, ga yadda za mu iya tsara wannan:

1. Mataki na farko- Sakamakon farko shine wani abu da ake kira karfin jini na jini (karuwa a cikin karfin jini a cikin wasu kwayoyin da ke zub da jinin daga ciki, yalwatawa, pancreas, intestines), wanda yake cikin marasa lafiya marasa lafiya. Wannan ya canza jini yana gudana a cikin jikin jiki wanda yake rarrabawa ta hanyar dilating jini na kashin jini saboda samar da sinadaran da ake kira " nitric oxide ". Wannan samfurin ya samar da kansu da kuma irin wannan kwayar da masana kimiyya suka shiga don samar da magunguna kamar Viagra.
2. Mataki na 2 - Yayinda jiragen sama na sama suna dilating (sabili da haka sunada jinin ƙarin jinin jini ta hanyar su), akwai tasoshin jini a cikin kodan da zasu fara ƙuntatawa (don haka rage karfin jini). Hanyoyi masu mahimmanci akan wannan bai wuce wannan labarin ba, amma ana tsammanin za'a danganta shi da farawa da tsarin da ake kira renin-angiotensin.

Wadannan canje-canje na jini sun ƙare kuma suna samar da ƙananan gudu cikin aikin koda.

Sanin asali

Bincike na ciwo na hepatorenal ba wata gwajin jini ne mai sauƙi ba. Yawanci likitoci suna kiran ganewar asali na wariya . A wasu kalmomi, wanda zai yi la'akari da bayyanar likitancin ciwon hanta na haƙuri tare da inganci rashin gazawar koda. Abinda ake bukata don ganewar asali shine likita zai buƙaci rashin cin nasara koda ba sakamakon wani dalili ba (jin dadi, sakamako na magunguna wanda zai iya cutar da koda kamar nauyin ciwon NSAID , rashin ciwon cutar Hepatitis B ko C, autoimmune cuta, hanawa, da dai sauransu). Da zarar an cika wannan yanayin, za mu fara da tabbatar da ƙwanƙwasa aikin aikin koda ta hanyar duban wasu siffofin asibitoci da gwaje-gwaje:

• Wani nau'i na hakar creatinine a cikin jini, hade da raguwa a cikin kididdigar kidneys (GFR)
• Drop a cikin fitattun kayan aiki
• Matsanancin sodium da ke cikin fitsari
• Kwayar dan tayi, wadda ba dole ba ne ya nuna wani abu, amma zai iya ware wasu ƙananan cututtuka na koda a cikin wani mutum da ake zaton yana da ciwo mai cututtukan
• Jaraba ga jini ko furotin a cikin fitsari. Babu matakan mahimmanci / matakan da zasu taimaka wajen ganewar asibiti na ciwon hepatorenal
• An yi amfani da maganin farfadowa a matsayin gwajin "jarrabawa" don ganewar asali. A wasu kalmomi, idan aikin aikin koda ya inganta bayan "hydration" (wanda zai iya haifar da ruwa mai kwakwalwa ko ƙwayar sinadarin proteinin albumin), to lallai ya zama rashin lafiyar hepatorenal. A gaskiya ma, tsayayya da wadannan magungunan na ra'ayin mazan jiya zai haifar da zato game da ciwo na hepatorenal kasancewa

Ina son in jaddada cewa har ma da bincikar gazawar koda ba zai kasance mai sauƙi ba a cikin mai haƙuri da ciwo mai hanta ko cirrhosis. Wannan shi ne saboda gwajin mafi yawan da muke dogara a kan tantance aikin ƙwayar kodawa, ƙwayar halittar halittar creatinine, bazai yi girma sosai a marasa lafiya cirrhosis a farkon wuri ba. Saboda haka, kawai kallon kwayar halitta creatinine zai iya ɓatar da ƙwararrun tun lokacin da zai haifar da rashin fahimta akan rashin karfin koda. Saboda haka, wasu gwaje-gwajen kamar hurewa na huxu 24 haɓakar halittar halitta na iya zama wajibi don tallafawa ko gurɓata matakin gazawar koda.

Iri

Da zarar an tabbatar da ganewar asali ta amfani da ka'idojin da ke sama, likitoci za su rarraba ciwo na hepatorenal zuwa Type-I ko Type-II. Bambanci ya ta'allaka ne cikin tsananin da kuma rashin lafiya. Rubuta ni ne mafi tsanani irin, dangantaka da sauri da kuma zurfin (fiye da 50%) ƙi aikin koda a cikin ƙasa da makonni 2.

Jiyya

Yanzu dai mun fahimci cewa cutar rashin ciwon daji ta tashi daga cututtukan hanta (tare da tasirin hauhawar tashar jini kamar wakili ne), yana da sauƙin fahimtar abin da ya sa zalunta cutar cutar cike take da fifiko da mahimmancin magani. Abin takaici, wannan ba zai yiwu ba. A gaskiya ma, akwai ƙwayoyin da ba'a samu magani ko kuma, kamar yadda ya faru game da rashin cin zarafin hanta, inda magunguna (wanin hawan hanta zai iya aiki). A ƙarshe, akwai dalilin lokaci. Musamman a Type-I HRS. Saboda haka, yayin da cutar hanta zai iya zama mai tasowa, mai yiwuwa ba zai yiwu ya jira magani ba a cikin mai haƙuri da kodan da ya kasa cinyewa. A wannan yanayin, magunguna da dialysis sun zama dole . Ga wasu zabi kaɗan da muke da:

• A cikin 'yan shekarun nan, akwai wasu shaidu masu kyau game da muhimmancin sabon magani da ake kira terlipressin. Abin takaici, ba a samuwa a Amurka ba, ko da yake ana amfani da ita a mafi yawancin duniya don maganin ciwo na rashin lafiya. Abin da muka samu ta wurin nan, shine magani ne da ake kira norepinephrine (magani na yau da kullum da aka yi amfani da shi a cikin ICU don tada matsa lamba daga jini a cikin mutanen da ke dauke da karfin jini daga damuwa), da kuma tsarin "cocktail regime" wanda ya hada da kwayoyi 3, da ake kira octreotide, midodrine da albumin (manyan sunadaran dake cikin jini).
• Idan waɗannan magunguna ba su aiki ba, hanyar da ake kira TIPS (ƙaddarar hanyar ƙwaƙwalwar ƙwayoyin cuta) zai zama mai amfani, ko da yake wannan yazo tare da matsala na kansa.
• A ƙarshe, idan komai ya kasa kuma kodan baya warkewa, zane na iya zama wajibi ne a matsayin "gadar gada" har sai cutar ta hanta za a iya magance shi sosai.

Yawanci, idan magunguna da aka bayyana a sama ba su aiki a cikin makonni biyu ba, ana iya daukar magani a banza kuma hadarin mutuwar ya tashi.

Rigakafin

Ya dogara. Idan mai hakuri yana da ciwon hanta da halayyar hanta da aka gane masu haɓaka (kamar yadda aka bayyana a sama a cikin ɓangaren marasa lafiya marasa lafiya) na ciwo na hepatorenal, wasu hanyoyin rigakafi na iya aiki. Alal misali, marasa lafiya da cirrhosis da ruwa a cikin ciki (da ake kira ascites), zasu iya amfana daga kwayoyin da ake kira norfloxacin. Marasa lafiya za su iya amfana daga cikewar magungunan albumin.

> Sources:

> Tashin hankali, abubuwan da suka faru, da kuma alamar cutar ciwon hawan na hepatorenal a cikin cirrhosis tare da ascites. Gines et al. Gastroenterology. 1993 Yuli; 105 (1): 229-36.

> Lafiya a cikin cutar ciwon hepatorenal: Shaida ga alamun nunawa yanzu. Rajekar et al.J Gastroenterol Hepatol. 2011 Jan; 26 Samar 1: 109-14. Doi: 10.1111 / j.1440-1746.2010.06583.x

> Labaran farko na kwayoyin cutar marasa lafiya wanda ba tare da wata sanadiyar cututtukan da ke ciwo ba, kuma yana inganta zaman lafiya a cirrhosis. Fernández J. Gastroenterology. 2007 Sep; 133 (3): 818-24. Afrilu 2007 Yuli 3.