Fahimtar Magana da Kula da Biliary Obstructions
MRCP zuwa ERCP don Biliary Obstruction
Don fahimtar abin da Magnetic Resonance Cholangio-Pancreatography (MRCP) da Endoscopic Retrograde Cholangio-Pancreatography su ne, dole ne ka fahimci abin da biliary obstruction yake da kuma abin da yawanci sa wannan irin matsala.
Duk da yake gallstones sau da yawa yakan haifar da biliary obstruction, akwai dalilai da yawa dalilin da zai sa biliary obstruction zai iya faruwa da kuma hanyoyi da dama don magance waɗannan al'amurran da suka shafi da zai dogara da shekaru da haƙuri, overall kiwon lafiya, jiki, tarihin kwayoyin halitta al'amurran da suka shafi da sauran sharudda da zai iya bambanta daga mutum zuwa mutum.
An Bayyana Ma'anar Biliary
Bari mu fara da yadda tsarin tsarin narkewa yake aiki. Don samun iyakar abincin da za a iya samarwa daga abinci, abinci ya kamata a rushe ta hanyar wurin narkewa don haka dukkanin bitamin, ma'adanai, sunadarai, fats, da carbohydrates za su iya tunawa da ƙananan hanji. Wannan tsari yana farawa tare da cin nama, sannan ciki ya biyo baya ta amfani da albarkatun da kuma shinging abinci a kusa don taimakawa ya karya shi. Bayan haka, an ƙara bile zuwa abincin don karya kashi mai kyau na abinci.
Bile ne ruwan 'ya'yan itace mai narkewa wanda aka yi a cikin hanta kuma za'a iya amfani da shi nan da nan ko adana don amfani da baya. Idan ana amfani da bile daga bisani, zai yi tafiya daga hanta zuwa gallbladder ta hanyar daya daga cikin tubin bile ducts wanda ke daukar nauyin bile daga hanta zuwa inda ake amfani dasu don taimakawa wajen narkewa.
Idan ana amfani da bile nan da nan bayan barin hanta, zai gudana daga hanta kai tsaye zuwa kashi na farko na ƙananan ƙwayar (duodenum) ta hanyar dabarar bile.
Kimanin kashi hamsin na bile ana amfani da su nan da nan a cikin wannan hanya yayin da sauran rabi ke jira a cikin gallbladder, inda aka kawar da yawancin ruwan kuma ana bi da bile.
Idan bile ba zai iya motsa ta cikin ɗayan bile ducts ba daga hanta ko gallbladder saboda matsala tare da ducts, ana kiran wannan biliary obstruction.
Mafi yawan nau'in biliary shi ne gallstone, wanda shine ball na bile wanda yake da wuyar gaske a lokacin aiwatar da cire ruwan daga bile, wanda shine daya daga cikin ayyukan da ake yiwa gallbladder. Wadannan ƙananan duwatsu sukan kama su a cikin gallbladder ko a cikin ductenum wanda ke dauke da bile daga gallbladder.
Dalili na Musamman na Biliary Obstruction
- Gallstones (wannan shi ne dalilin da ya fi dacewa na biliary obstruction)
- Hanyoyin da ba su dace ba ne a cikin ɗayan bile ducts, wanda ake kira biliary stenosis
- Bile duct ƙonewa
- Halittar wani cyst a daya daga cikin ducts
- Cire kumburi na Lymph wanda ya tara rufin daga waje
- Pancreatitis, musamman maimaita ko na kullum
- Rauni / cuta da ke tattare da hanta, gallbladder, pancreas ko bile ducts
- Tumors, cancerous ko benign
- Kamuwa da cuta na gallbladder, bile ducts ko pancreas
- Cutar cutar
Dalili na Rashin Gida don Biliary Obstruction
Akwai wasu dalilai da yawa da ya sa mutum zai fuskanci hani na biliary, wasu daga cikin abubuwan da ke tattare da su shine:
- Tarihin gallstones
- Tarihin tiyata wanda ke shafar ƙwayar bile
- Tarihin ciwon daji na biliary
- Tarihin ciwon daji ko cutar
- Tarihi na ciwon daji na pancreatic ko cuta
- Tarihin matsalolin gallbladder
- Tarihin kwanan nan na tiyata don cire gallbladder
- Hanyar kwanciyar hankali
- Kiba
- Raƙarin nauyi mai nauyi
Alamai da cututtukan cututtuka na Biliary Obstruction
Alamun da alamun bayyanar cututtuka na biliary zai bambanta daga mutum zuwa mutum, amma yawanci sun hada da ɗaya ko fiye da haka:
- Abun ciki na ciki, yawanci a cikin ƙananan ƙananan ciki
- Itching
- Jaundice (yellowing fata)
- Nausea da Vomiting
- Clay ko launin fari masu launin hanyoyi
- Dark fitsari
Binciken Biliary Obstruction
Idan ana tsammanin cewa an hana biliary obstruction, akwai gwaje-gwajen jini, nazarin nazari, da hanyoyin da za a iya yi don tabbatar da ganewar asali.
Gwaje-gwajen jini na yau da kullum wanda zai nuna matsala ta hanyar ƙwayar ruwa kamar yadda ya kamata ya hada da ƙananan matakan phosphatase, wani nauyin bilirubin mai girma, kuma ya haɓaka hanta enzymes.
Matsalar da ke haifar da bile don dawowa cikin hanta zai haifar da canje-canje mai zurfi cikin gwaje-gwajen jini wanda ya duba aikin hanta.
Ƙarin gwaje-gwaje da za a iya yi don tantance hanyar haɓaka biliary sun hada da:
- Duban dan tayi na ciki
- CT scan daga cikin ciki
- Hanyoyin bishiyoyi na ƙwayar cututtuka (PTCA)
- Magnetic Resonance Cholangio-Pancreatography (MRCP)
- Endoscopic Retrograde Cholangio-Pancreatography (ERCP)
Jiyya da za a iya yi don magance biliary obstruction suna dogara ne akan hanyar da kuma wurin da matsalar ta kasance. Dalilin da ya fi dacewa shi ne wani gallstone, kuma jiyya sun haɗa da Endoscopic Retrograde Cholangio-Pancreatography (ERCP) da kuma tiyata don cire gallbladder (cholecystectomy).
Idan dalili na hani shine wani abu banda gallstone, magani zai iya bambanta daga mutum zuwa mutum. Alal misali, mutumin da ke fama da ciwon gine-gine saboda ciwon daji za a bi shi da bambanci fiye da mutumin da ke fama da wannan matsala saboda kamuwa da cuta. Matukar tsofaffi da gallstones zai iya samun magani dabam dabam fiye da mace mai shekaru 30 da ke fuskantar alamu da alamun alamun, kamar yadda mazan farko ba zai iya jurewa irin wannan magani kamar ƙarami ba.
Yawancin lokaci, hanyar da za a iya yadawa ta hanyar ganowa da zalunta shi ne na farko da za a yi ƙoƙari-irin su MRCP-yayin da hanya mafi mahimmanci kamar aikin ERCP ko tilasta yin amfani da gallbladder kawai idan ya cancanta. Wannan ya ce, aikin tiyata, wanda aka fi sani da cholecystectomy, yana daya daga cikin magungunan da aka fi sani da su a Amurka.
Mene ne Maganin Cholangio-Pancreatography (Magnetic Resonance Cholangio-Pancreatography (MRCP)
Magnetic Resonance Cholangio-Pancreatography, wanda aka fi sani da MRCP, wani gwaji ne mai ban sha'awa kamar yadda misali MRI ta dace. Ana amfani da wannan gwajin don bincika hanta, haukara, gallbladder, da kuma bile ducts don sanin idan akwai hani. Jarabawar zata iya taimakawa wajen bincikar ƙyama, kuma zai iya taimakawa wajen ƙayyade dalilin ƙyama, wanda zai iya ƙayyade yadda za'a bi da batun.
Yaushe aka yi MRCP?
An yi MRCP lokacin da ake tuhuma cewa ƙwarewar ƙwayar bile yana samuwa kuma yana haifar da batu. Ba wai kawai wannan gwajin zata ƙayyade idan ƙwarewar ƙwayar bile ba ta kasance ba, wannan gwajin zai iya sanin abin da ke haddasa matsalar. Abin takaici, yayin da MRCP hanya ce mai kyau don tantance matsalar, wannan jarrabawar zata iya taimakawa wajen ƙayyade yadda za a magance matsalar ta musamman - MRCP kanta ba zai iya magance matsalar ba.
Abin da ke faruwa A lokacin MRCP?
A lokacin MRCP an buƙatar mai haƙuri don kasancewa a kan gado da yake motsawa cikin kuma daga cikin na'ura mai kamar MRI. Jarabawar ba ta da nakasa, ma'anar cewa babu abin da aka sanya akan ko cikin jiki. Kamar na'urar x-ray, injin ba zata taɓa ka ba don bincika ciki. Jarabawar ita ce mai daɗaɗɗiya kuma yawanci yana ɗaukar sa'o'i da yawa.
Risks na MRCP
Rashin lafiyar MRCP kadan ne. Marasa lafiya da ke fama da kwarewa ko matsanancin nauyi na iya buƙatar motsi na MRI wanda ba a san shi ba don nazarin su maimakon na'ura mai kama da kamfanoni, amma babu matsala masu yawa da irin wannan binciken. Idan an yi amfani da matsakaicin matsakaici, akwai karamin haɗari na rashin lafiyar, kuma ya kamata a yi amfani da bambanci da hankali a cikin marasa lafiya da matsaloli na koda.
Marasa lafiya tare da ƙwararrun ƙarfe na iya samun MRCP kawai idan abin da suke da shi shine MRI lafiya, kamar yadda tsarin ke amfani da magnet mai karfi don ƙirƙirar hotunan jikin. Babu radiation a cikin lokacin MRI.
An bayyana bayanin ERCP
Endoscopic Retrograde Cholangio-Pancreatography, wanda aka fi sani da suna ERCP, wani hanya ne mai banƙyama inda aka saka wani katakon haske a cikin bakin kuma a tura shi cikin hanzari cikin cikin ciki, sa'an nan kuma zuwa kashi na farko na ƙananan hanji da ake kira duodenum.
Ƙaƙidar ƙarshe tana da haske da kyamara a ƙarshen, wanda ya ba da damar likita don duba ido a ciki a cikin ɓangaren magani. Wannan yana yiwuwa ne saboda ƙwayar bile na yau da kullum ya shiga cikin duodenum, kuma idan wani gallstone ko wani ƙyama ya kasance a cikin ƙwayar bile, wani mai ilimin gastroenterologist wanda zai iya cire dutse ta hanyar amfani da waya, kwando ko abin da aka makala a kan ƙarshen katako.
Yaushe aka yi ERCP?
An yi ERCP don ɗaya daga dalilai biyu. Dalilin farko shi ne tabbatar da ganewar asali - don sanin idan akwai hanzari na biliary ta wurin duba ido a kan ido. Dalili na biyu da aka sa ERCP shi ne lokacin da wasu nazarin, irin su gwaje-gwajen jini ko MRCP, sun nuna cewa ƙyama biliary ba kawai ba ne kawai, amma matsalar za a iya gyara ta wurin sanya wani yatsa ko cire wani gallstone daga kogin bile.
Ba kamar MRCP ba, wanda ya ba da hotunan abin da ke faruwa a jiki, ERCP zai iya magance matsalar.
Risks na ERCP
Yayinda ake la'akari da ERCP wata hanya mai ƙananan haɗari, kamar kowane ɓarna ƙwayar cuta akwai matsaloli da za'a tattauna. Bugu da ƙari ga haɗarin da ake haɗuwa da maganin rigakafi , ERCP na iya haifar da pancreatitis, kamuwa da cuta, da zub da jini.
Ƙafin da ya fi tsanani shine yawan haɗari-da gangan yin rami-a cikin hanji ko wasu yankunan da ERCP yake nema. Rashin haɗari da ƙananan ƙwayar yana da rauni a hannun wani gastroenterologist gwani, amma duk da haka zai yiwu.
Anesthesia da ERCP
Ana aiwatar da tsarin ERCP tare da mai karɓa na karbar warkar da ƙwayar cuta don kada su san yadda ake aiwatar da su. Mai haɗuri za a yi fushi kuma a sanya shi a kan wani mai kwakwalwa kuma yana barcin dukan hanya.
Lokacin da aka kammala aikin, za'a ba da magani don dakatar da fitarwa kuma mai haƙuri zai sannu a hankali. Da zarar mai haƙuri ya iya numfasawa a kan kansa, an kawar da bututun endotracheal kuma an yi amfani da mai daukar hankali zuwa Ƙungiyar Kulawa da Ƙwararren Ƙwararren Ƙwallo ( PACU ) ko ɗakin asibitin su warkewa.
Wannan hanya za a iya yi a matsayin mai kula da inpatient ko hanya mai fita. Idan marasa lafiya ba su da lafiya, za su iya koma gida a wannan rana, yayin da marasa lafiya zasu iya dawowa a asibitin.
> Source:
> Binciken Ginin Bile. Samun shiga Fabrairu, 2017. http://www.nytimes.com/health/guides/disease/bile-duct-obstruction/overview.html