Matenda a hepatorenal

Matenda a Hepatorenal ndimavuto a impso omwe amapita patsogolo mwa munthu wodwala matenda a chiwindi. Ndi vuto lalikulu lomwe lingayambitse imfa.

Matenda a Hepatorenal amapezeka pamene impso zimasiya kugwira ntchito bwino mwa anthu omwe ali ndi vuto lalikulu la chiwindi. Mkodzo wocheperako umachotsedwa mthupi, chifukwa chake zinyalala zomwe zimakhala ndi nayitrogeni zimakhazikika m'magazi (azotemia).

Matendawa amapezeka mwa anthu 1 mwa 10 ali mchipatala omwe ali ndi vuto la chiwindi. Zimayambitsa kulephera kwa impso mwa anthu omwe ali ndi:

• Kulephera kwa chiwindi
• Mowa wa chiwindi
• Matenda a chiwindi
• Matenda am'mimba opatsirana

Zowopsa ndi izi:

• Kuthamanga kwa magazi komwe kumagwa munthu akamakwera kapena mwadzidzidzi asintha malo (orthostatic hypotension)
• Kugwiritsa ntchito mankhwala otchedwa diuretics ("mapiritsi amadzi")
• Kutuluka m'mimba
• Matenda
• Kuchotsa kwaposachedwa kwam'mimba (paracentesis)

Zizindikiro zake ndi izi:

• Kutupa m'mimba chifukwa chamadzi (otchedwa ascites, chizindikiro cha matenda a chiwindi)
• Kusokonezeka kwamaganizidwe
• Minofu ikugwedezeka
• Mkodzo wamtundu wakuda (chizindikiro cha matenda a chiwindi)
• Kuchepetsa mkodzo
• Nseru ndi kusanza
• Kulemera
• Khungu lachikaso (jaundice, chizindikiro cha matenda a chiwindi)

Matendawa amapezeka atayesedwa kuti athetse zina zomwe zimayambitsa impso.

Kuyesedwa kwakuthupi sikuwona kulephera kwa impso mwachindunji. Komabe, mayeso nthawi zambiri amawonetsa zizindikiro za matenda a chiwindi, monga:

• Chisokonezo (nthawi zambiri chifukwa chodwala matenda encephalopathy)
• Mavitamini owonjezera m'mimba (ascites)
• Jaundice
• Zizindikiro zina za kulephera kwa chiwindi

Zizindikiro zina ndizo:

• Maganizo osazolowereka
• Machende ang'onoang'ono
• Phokoso lakumimba m'mimba mukamayimbidwa ndi nsonga zala
• Kuchuluka kwa minofu ya m'mawere (gynecomastia)
• Zilonda pakhungu

Zotsatirazi zikhoza kukhala zizindikiro za impso kulephera:

• Kutulutsa mkodzo pang'ono kapena ayi
• Kusungidwa kwamadzimadzi pamimba kapena kumapeto
• Kuchuluka kwa BUN ndi milingo ya creatinine
• Kuchulukitsa kwamphamvu kwamkodzo ndi osmolality
• Magazi otsika
• Mkodzo wotsika kwambiri wa sodium

Izi ndi izi:

• Nthawi yachilendo ya prothrombin (PT)
• Kuchuluka kwa magazi ammonia
• Magazi otsika magazi
• Paracentesis akuwonetsa ma ascites
• Zizindikiro za hepatic encephalopathy (EEG itha kuchitidwa)

Cholinga cha chithandizo ndikuthandizira chiwindi kugwira ntchito bwino ndikuonetsetsa kuti mtima ukupopera magazi okwanira mthupi.

Chithandizo chake ndichofanana ndi kufooka kwa impso pazifukwa zilizonse. Zimaphatikizapo:

• Kuyimitsa mankhwala onse osafunikira, makamaka ibuprofen ndi ma NSAID ena, maantibayotiki ena, ndi okodzetsa ("mapiritsi amadzi")
• Kukhala ndi dialysis yothetsera zizindikiro
• Kumwa mankhwala othandizira kuthamanga kwa magazi ndikuthandizira impso zanu kugwira ntchito bwino; kulowetsedwa kwa albin kungathandizenso
• Kuyika shunt (yotchedwa MALANGIZO) kuti muchepetse zisonyezo za ascites (izi zitha kuthandizanso kugwira kwa impso, koma njirayi ikhoza kukhala yowopsa)
• Kuchita opaleshoni kuti muike shunt kuchokera m'mimba kupita kumtunda kuti muchepetse zizindikilo za impso (njirayi ndi yowopsa ndipo siyichitika kawirikawiri)

Zotsatira zake sizikhala zabwino. Imfa imachitika kawirikawiri chifukwa cha matenda kapena kutuluka magazi kwambiri (kukha magazi).

Zovuta zingaphatikizepo:

• Magazi
• Kuwonongeka, ndi kulephera kwa, ziwalo zambiri zamagulu
• Matenda omaliza a impso
• Kuchulukanso kwamadzimadzi komanso kulephera kwa mtima
• Coma chifukwa cha kulephera kwa chiwindi
• Matenda achiwiri

Matendawa nthawi zambiri amapezeka mchipatala akamalandira chithandizo cha matenda a chiwindi.

Matenda enaake - hepatorenal; Chiwindi kulephera - hepatorenal

Fernandez J, Arroyo V. Matenda a Hepatorenal. Mu: Feehally J, Floege J, Tonelli M, Johnson RJ, olemba. Chachikulu Chachipatala Nephrology. Lachisanu ndi chimodzi. Philadelphia, PA: Elsevier; 2019: mutu 73.

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.

Mehta SS, 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. 11th ed. Philadelphia, PA: Elsevier; 2021: mutu 94.