Chiwindi cha Fibrosis

Zamkati

• Kodi magawo a chiwindi fibrosis ndi ati?
• Kodi zizindikiro za chiwindi fibrosis ndi ziti?
• Kodi zimayambitsa chiwindi fibrosis ndi chiyani?
• Njira zothandizira
• Matendawa
• Chiwindi chiwindi
• Zosintha zazitali
• Mayeso osavomerezeka
• Zovuta
• Chiwonetsero

Chidule

Chiwindi cha fibrosis chimachitika pomwe minofu yabwinobwino ya chiwindi imayamba kukhala ndi zipsera motero sichitha kugwira ntchito. Fibrosis ndiye gawo loyamba la mabala a chiwindi. Pambuyo pake, chiwindi chochuluka chikakhala ndi zipsera, chimadziwika kuti chiwindi cha chiwindi.

Ngakhale maphunziro ena azinyama awonetsa kutha kwa chiwindi kudzichiritsanso kapena kudzichiritsa yokha, chiwindi cha chiwindi chikachitika mwa anthu, chiwindi sichichira nthawi zambiri. Komabe, mankhwala ndi kusintha kwa moyo kumathandiza kuti fibrosis isawonongeke.

Kodi magawo a chiwindi fibrosis ndi ati?

Pali masikelo angapo osiyanasiyana a chiwindi cha fibrosis, pomwe dokotala amadziwitsa kukula kwa chiwindi. Popeza kupanga masitepe kumatha kukhala kokhazikika, sikelo iliyonse ili ndi malire ake. Dokotala wina angaganize kuti chiwindi chimakhala ndi zipsera pang'ono kuposa china. Komabe, madokotala nthawi zambiri amapatsa chiwindi fibrosis gawo chifukwa zimathandiza wodwalayo ndi madotolo ena kumvetsetsa momwe chiwindi cha munthu chimakhudzidwira.

Imodzi mwa machitidwe odziwika bwino kwambiri ndi METAVIR system. Njirayi imapereka mphotho ya "ntchito" kapena kuneneratu momwe fibrosis ikuyendera, komanso mulingo wa fibrosis womwewo. Madokotala amatha kugawa izi pokhapokha atatenga chidutswa cha chiwindi. Magawo osiyanasiyana kuyambira A0 mpaka A3:

• A0: palibe ntchito
• A1: ntchito yofatsa
• A2: zochitika zochepa
• A3: ntchito yayikulu

Magawo a fibrosis amachokera ku F0 mpaka F4:

• F0: palibe fibrosis
• F1: portal fibrosis yopanda septa
• F2: portal fibrosis yokhala ndi septa yochepa
• F3: septa yambiri yopanda chiwindi
• F4: matenda a chiwindi

Chifukwa chake, munthu yemwe ali ndi matenda oopsa kwambiri akhoza kukhala ndi mphotho ya A3, F4 METAVIR.

Njira ina yolembera ndi Batts ndi Ludwig, yomwe imalemba ma fibrosis pamlingo wa grade 1 mpaka grade 4, pomwe grade 4 imakhala yovuta kwambiri. International Association of the Study of the Liver (IASL) imakhalanso ndi magawo anayi omwe amachokera ku chiwindi chochepa kwambiri mpaka chiwindi chachikulu.

Kodi zizindikiro za chiwindi fibrosis ndi ziti?

Madokotala samazindikira kawirikawiri chiwindi cha fibrosis pang'onopang'ono. Izi ndichifukwa choti chiwindi cha fibrosis sichimayambitsa zizindikilo mpaka chiwindi chambiri chiwonongeka.

Munthu akamadwala matenda a chiwindi, amatha kukhala ndi zizindikilo monga:

• njala
• kuvuta kuganiza bwino
• madzi mumiyendo kapena m'mimba
• jaundice (pomwe khungu ndi maso zimawoneka zachikasu)
• nseru
• kuonda kosadziwika
• kufooka

Malinga ndi a, pafupifupi 6 mpaka 7 peresenti ya anthu padziko lapansi ali ndi chiwindi cha chiwindi ndipo samadziwa chifukwa alibe zizindikilo.

Kodi zimayambitsa chiwindi fibrosis ndi chiyani?

Chiwindi cha fibrosis chimachitika munthu akavulala kapena kutupa pachiwindi. Maselo a chiwindi amalimbikitsa kuchira kwa mabala. Pakachilitsidwe ka chilondachi, mapuloteni owonjezera monga collagen ndi ma glycoprotein amakhala mchiwindi. Pambuyo pake, pambuyo podzikonza nthawi zambiri, maselo a chiwindi (omwe amadziwika kuti hepatocytes) sangathe kudzikonza okha. Mapuloteni owonjezera amapanga minofu yofiira kapena fibrosis.

Pali mitundu ingapo ya matenda a chiwindi omwe angayambitse fibrosis. Izi zikuphatikiza:

• matenda a chiwindi
• biliary kutsekeka
• chitsulo chochulukirapo
• Matenda a chiwindi osakhala mowa, omwe amaphatikizapo chiwindi chamafuta osagwiritsa ntchito mowa (NAFL) komanso nonatoxic steatohepatitis (NASH)
• matenda a chiwindi a B ndi C
• mowa chiwindi matenda

Malinga ndi, chifukwa chofala kwambiri cha chiwindi cha fibrosis ndimatenda a chiwindi (NAFLD), pomwe chachiwiri ndi matenda a chiwindi chifukwa chakumwa mowa mopitirira muyeso.

Njira zothandizira

Njira zochiritsira chiwindi cha fibrosis nthawi zambiri zimadalira chomwe chimayambitsa fibrosis. Dokotala amachiza matendawa, ngati zingatheke, kuti achepetse zovuta za matenda a chiwindi. Mwachitsanzo, ngati munthu amamwa mowa mopitirira muyeso, adokotala angauze pulogalamu yothandizira kuti amuthandize kusiya kumwa. Ngati munthu ali ndi NAFLD, adokotala angalimbikitse kusintha zakudya kuti muchepetse thupi komanso kumwa mankhwala olimbikitsira kuwongolera shuga. Kuchita masewera olimbitsa thupi ndi kuonda kungathandizenso kuchepetsa matendawa.

Dokotala amathanso kupereka mankhwala otchedwa antifibrotics, omwe awonetsedwa kuti achepetse mwayi woti zilonda za chiwindi zitha kuchitika. Ma antifibrotic omwe amaperekedwa nthawi zambiri amatengera matenda omwe amabwera. Zitsanzo za mankhwalawa ndi monga:

• matenda aakulu a chiwindi: ACE inhibitors, monga benazepril, Lisinopril, ndi ramipril
• Vuto la hepatitis C: a-Tocopherol kapena interferon-alpha
• mopanda mowa steatohepatitis: PPAR-alpha agonist

Ngakhale ofufuza akuchita mayeso ambiri kuti ayesetse kupeza mankhwala omwe angasinthe zotsatira za chiwindi cha fibrosis, palibe mankhwala aliwonse omwe angakwaniritse izi pakadali pano.

Ngati chiwindi cha munthu chifikira kumene chiwindi chake chili ndi zipsera zambiri ndipo sichikugwira ntchito, chithandizo chokhacho cha munthu nthawi zambiri chimalandiridwa ndi chiwindi. Komabe, mndandanda wa oyembekezera ndiwotalikirako mitundu yokhazikitsirayi ndipo sikuti munthu aliyense ndiwosankhidwa pa opaleshoni.

Matendawa

Chiwindi chiwindi

Pachikhalidwe, madotolo adaganizira zotenga chiwindi "choyesa cha golide" choyesera chiwindi cha fibrosis. Iyi ndi njira yochitira opaleshoni pomwe dokotala amatenga zitsanzo za minofu. Katswiri wodziwika kuti ndi wodwala matenda amafufuza minofu ngati ilipo khungu kapena fibrosis.

Zosintha zazitali

Njira ina ndiyeso yojambula yotchedwa elastography yopitilira. Ichi ndi mayeso omwe amayesa momwe chiwindi chimakhalira cholimba. Munthu akamakhala ndi chiwindi cha fibrosis, maselo ofiirawo amapangitsa chiwindi kukhala cholimba. Kuyesaku kumagwiritsa ntchito mafunde amawu otsika pafupipafupi kuti athe kuyeza momwe minofu ya chiwindi ilimba. Komabe, ndizotheka kukhala ndi malingaliro abodza pomwe minofu ya chiwindi imatha kuwoneka yolimba, koma biopsy sikuwonetsa mabala a chiwindi.

Mayeso osavomerezeka

Komabe, madokotala atha kugwiritsa ntchito mayeso ena omwe safuna kuchitidwa opaleshoni kuti adziwe kuti munthu akhoza kukhala ndi chiwindi cha chiwindi. Kuyezetsa magazi kumeneku kumangosungidwa kwa omwe ali ndi matenda a chiwindi a C omwe amadziwika kuti ali ndi chiwindi chifukwa cha matenda awo. Zitsanzo ndi serum hyaluronate, matrix metalloproteinase-1 (MMP), ndi minofu inhibitor ya matrix metalloproteinase-1 (TIMP-1).

Madokotala amathanso kugwiritsa ntchito mayeso omwe amafunika kuwerengera, monga aminotransferase-to-platelet ratio (APRI) kapena kuyesa magazi kotchedwa FibroSURE komwe kumayesa zizindikiro zisanu ndi chimodzi za chiwindi ndikugwiranso ntchito musanapereke mphotho. Komabe, dokotala samakonda kudziwa gawo la chiwindi cha fibrosis potengera mayesowa.

Mwachidziwikire, dokotala adzazindikira munthu yemwe ali ndi chiwindi cha fibrosis koyambirira pomwe matendawa amachiritsidwa. Komabe, chifukwa vutoli nthawi zambiri silimayambitsa zizindikilo koyambirira, madokotala samazindikira matendawa koyambirira.

Zovuta

Vuto lalikulu kwambiri la chiwindi cha fibrosis limatha kukhala chiwindi cha chiwindi, kapena mabala owopsa omwe amachititsa chiwindi kuwonongeka kwambiri munthu amadwala. Nthawi zambiri, izi zimatenga nthawi yayitali kuti zichitike, monga kupitilira zaka chimodzi kapena ziwiri.

Munthu amafunika chiwindi kuti apulumuke chifukwa chiwindi chimayang'anira zosefera magazi m'magazi ndikupanga ntchito zina zambiri zofunika mthupi. Pomaliza, ngati fibrosis ya munthu imayamba kudwala matenda a chiwindi ndi chiwindi, atha kukhala ndi zovuta monga:

• ascites (madzi owonjezera m'mimba)
• hepatic encephalopathy (zinyalala zambiri zomwe zimayambitsa chisokonezo)
• matenda a hepatorenal
• matenda oopsa
• magazi a variceal

Zonsezi zitha kupha munthu amene ali ndi matenda a chiwindi.

Chiwonetsero

Malinga ndi, chiwindi cha chiwindi ndi chimodzi mwazomwe zimayambitsa kufa padziko lonse lapansi. Chifukwa chake, ndikofunikira kuti munthu azindikire ndikuchiritsidwa chiwindi cha fibrosis mwachangu asadafike pachimake cha chiwindi. Chifukwa chiwindi fibrosis sichimayambitsa zizindikiro nthawi zonse, izi ndizovuta kuchita. Nthawi zina madokotala amayenera kuganizira zoopsa za munthu, monga kukhala wonenepa kwambiri kapena womwa mowa kwambiri, kuti apeze matenda a fibrosis ndikuvomereza chithandizo.