Kutayika kwa ubongo - matenda a chiwindi

Kutaya kwa ubongo kumachitika pomwe chiwindi sichitha kuchotsa poizoni m'magazi. Izi zimatchedwa hepatic encephalopathy (HE). Vutoli limatha kuchitika mwadzidzidzi kapena limayamba pang'onopang'ono pakapita nthawi.

Ntchito yofunika kwambiri m'chiwindi ndikupanga zinthu zapoizoni mthupi kukhala zopanda vuto lililonse. Zinthu izi zimatha kupangidwa ndi thupi (ammonia), kapena zinthu zomwe mumamwa (mankhwala).

Chiwindi chitawonongeka, "ziphe" izi zimatha kukhazikika m'magazi ndikukhudza magwiridwe antchito amanjenje. Zotsatira zake zitha kukhala IYE.

IYE akhoza kuchitika modzidzimutsa ndipo ukhoza kudwala msanga kwambiri.Zomwe zimayambitsa HE zitha kuphatikiza:

• Matenda a Hepatitis A kapena B (omwe siwodziwika ngati awa)
• Kutsekedwa kwa magazi kwa chiwindi
• Kupha poizoni ndi poizoni kapena mankhwala osiyanasiyana
• Kudzimbidwa
• Kutuluka m'mimba m'mimba

Anthu omwe ali ndi vuto lalikulu la chiwindi nthawi zambiri amavutika ndi HE. Chotsatira chomaliza cha kuwonongeka kwa chiwindi ndi chiwindi. Zomwe zimayambitsa matenda a chiwindi ndi awa:

• Matenda owopsa a hepatitis B kapena C
• Kumwa mowa kwambiri
• Matenda a hepatitis
• Matenda osokoneza bongo
• Mankhwala ena
• Matenda a chiwindi cha Nonalcoholic fatty (NAFLD) ndi nonalcoholic steatohepatitis (NASH)

Mukakhala ndi kuwonongeka kwa chiwindi, magawo owonjezeka aubongo amatha kuyambitsidwa ndi:

• Madzi ochepa amthupi (kusowa madzi m'thupi)
• Kudya kwambiri mapuloteni
• Potaziyamu wotsika kapena milingo ya sodium
• Kutulutsa magazi kuchokera m'matumbo, m'mimba, kapena chitoliro cha chakudya (kum'mero)
• Matenda
• Mavuto a impso
• Magulu otsika a oxygen mthupi
• Kusungidwa kwa Shunt kapena zovuta
• Opaleshoni
• Kupweteka kwa mankhwala osokoneza bongo kapena mankhwala osokoneza bongo

Zovuta zomwe zingawoneke ngati HE zitha kuphatikizira izi:

• Kuledzera
• Kuchotsa mowa
• Magazi pansi pa chigaza (subdural hematoma)
• Matenda aubongo omwe amayamba chifukwa chosowa vitamini B1 (matenda a Wernicke-Korsakoff)

Nthawi zina, HE ndimavuto akanthawi kochepa omwe amatha kukonza. Zitha kupezekanso ngati gawo la vuto lalitali (losatha) kuchokera ku matenda a chiwindi omwe amawonjezeka pakapita nthawi.

Zizindikiro za HE zimagawidwa pamakalasi 1 mpaka 4. Amatha kuyamba pang'onopang'ono ndikuipiraipira pakapita nthawi.

Zizindikiro zoyambirira zitha kukhala zofatsa ndikuphatikizira:

• Mpweya wokhala ndi fungo labwino kapena lokoma
• Kusintha kwa magonedwe
• Kusintha kalingaliridwe
• Kusokonezeka pang'ono
• Kuiwala
• Umunthu kapena zosintha
• Kuzindikira molakwika komanso kuweruza
• Kukulira pakulemba pamanja kapena kutayika kwa mayendedwe ena ang'onoang'ono amanja

Zizindikiro zazikulu zitha kuphatikiza:

• Kusuntha kosazolowereka kapena kugwirana chanza kapena mikono
• Kusokonezeka, chisangalalo, kapena kugwidwa (kumachitika kawirikawiri)
• Kusokonezeka
• Kusinza kapena kusokonezeka
• Khalidwe kapena kusintha kwa umunthu
• Mawu osalankhula
• Kuyenda pang'onopang'ono kapena kwaulesi

Anthu omwe ali ndi HE amatha kukhala opanda chidziwitso, osayankha, ndipo mwina amatha kukomoka.

Nthawi zambiri anthu samatha kudzisamalira chifukwa cha zizindikilozi.

Zizindikiro zosintha kwamanjenje zimatha kuphatikiza:

• Kugwirana chanza ("kugwedeza kugwedezeka") poyesa kugwira mikono patsogolo pa thupi ndikukweza manja
• Mavuto akuganiza komanso kuchita ntchito zamaganizidwe
• Zizindikiro za matenda a chiwindi, monga khungu lachikaso ndi maso (jaundice) ndi kusonkhanitsa madzi m'mimba (ascites)
• Kununkhira koyenera kwa mpweya ndi mkodzo

Mayeso omwe adachitika atha kukhala:

• Kuchuluka kwa magazi kapena hematocrit kuti muwone kuchepa kwa magazi
• Kujambula kwa CT pamutu kapena MRI
• EEG
• Kuyesa kwa chiwindi
• Nthawi ya Prothrombin
• Mlingo wa seramu ammonia
• Mulingo wa sodium m'magazi
• Potaziyamu m'magazi
• BUN (magazi urea nayitrogeni) ndi creatinine kuti muwone momwe impso zikugwirira ntchito

Chithandizo cha HE chimadalira chifukwa.

Ngati kusintha kwa magwiridwe antchito a ubongo kuli kovuta, kukafunika kupita kuchipatala.

• Magazi am'magazi amayenera kuyimitsidwa.
• Matenda, kulephera kwa impso, komanso kusintha kwa magawo a sodium ndi potaziyamu amafunika kuthandizidwa.

Mankhwala amaperekedwa kuti athandize kutsitsa ammonia ndikusintha magwiridwe antchito aubongo. Mankhwala omwe amaperekedwa atha kuphatikiza:

• Lactulose yoletsa mabakiteriya m'matumbo kuti asapangitse ammonia. Zitha kuyambitsa kutsekula m'mimba.
• Neomycin ndi rifaximin amachepetsanso kuchuluka kwa ammonia wopangidwa m'matumbo.
• Ngati HE ikukula pamene akutenga rifaximin, iyenera kupitilizidwa kwamuyaya.

Muyenera kupewa:

• Mankhwala amtundu uliwonse, opeputsa, ndi mankhwala ena aliwonse omwe awonongeka ndi chiwindi
• Mankhwala okhala ndi ammonium (kuphatikiza ma antacids ena)

Wothandizira zaumoyo wanu akhoza kupereka mankhwala ndi mankhwala ena. Izi zitha kukhala ndi zotsatirapo zosiyanasiyana.

Maganizo a HE amatengera kasamalidwe ka zifukwa za HE. Matenda osachiritsika nthawi zambiri amapitilira kukulira ndikubwerera.

Magawo awiri oyamba a matendawa amakula bwino. Gawo lachitatu ndi lachinayi silimadziwika bwino.

Itanani omwe akukuthandizani ngati inu kapena anthu omwe akuzungulirani akuwona zovuta zilizonse zamaganizidwe anu kapena dongosolo lamanjenje. Izi ndizofunikira kwa anthu omwe ali kale ndi vuto la chiwindi. MUNTHU amatha kukulirakulira mwachangu ndikukhala wadzidzidzi.

Kuchiza mavuto a chiwindi kumatha kuteteza HE. Kupewa kumwa mowa komanso kugwiritsa ntchito mankhwala osokoneza bongo kumatha kupewa mavuto ambiri a chiwindi.

Chikomokere; Encephalopathy - chiwindi; Kusokonezeka kwa chiwindi; Matenda osokoneza bongo

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Garcia-Tsao G. Cirrhosis ndi sequelae yake. Mu: Goldman L, Schafer AI, olemba. Mankhwala a Goldman-Cecil. 26 wa. Philadelphia, PA: Elsevier; 2020: chap 144.

Nevah MI, Fallon MB. Hepatic encephalopathy, hepatorenal syndrome, hepatopulmonary syndrome, ndi zovuta zina zamatenda a chiwindi. Mu: Feldman M, Friedman LS, Brandt LJ, olemba. Sleisenger ndi Matenda a Mimba ndi a Fordtran Amatenda a Chiwindi. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016: chap 94.

Wong MP, Moitra VK. Kusokonezeka kwa chiwindi. Mu: Fleisher LA, Roizen MF, Roizen JD, olemba., Eds. Makhalidwe a Anesthesia Practice. Wolemba 4. Philadelphia, PA: Elsevier; 2018: 198-198.

Woreta T, Mezina A. Kuwongolera kwa encephalopathy ya hepatic. Mu: Cameron AM, Cameron JL, olemba., Eds. Chithandizo Chamakono Cha Opaleshoni. Wolemba 13. Philadelphia, PA: Elsevier; 2020: 428-431.