I-ordination ejwayelekile kanye nama-painkillers angaphezu kwe-counter angenza izilonda.
Isilonda se-peptic yisigama esisetshenziselwa isifo esibuhlungu esenzeka emgodini we-mucosal wesisu, amathumbu amancane, noma isisu. Uma isilonda sisesiswini singase sibizwe ngokuthi isilonda esiswini. Ama-ulcers engxenyeni yokuqala yamathumbu amancane (i-duodenum) angase abizwe ngokuthi i-duodenal ulcer. Isizathu esivame kakhulu sesilonda sesilonda uhlobo lwama-bacterium okuthiwa i- Helicobacter pylori (H pylori) .
Okwesibili, okungajwayelekile, kodwa okwandayo ngokubaluleka, imbangela yezilonda zamapulisi kuyindlela yokusebenzisa imishanguzo engeyona i-steroidal anti-inflammatory (NSAIDs) .
Ukusebenzisa ama-NSAID angaphezu kwe-counter, okufana ne- aspirin noma ibuprofen ngenxa yesifo sekhanda esithile noma ukubuyela emuva ngeke kubangele isilonda se-peptic. Esikhundleni salokho, isifo sesilonda se-peptic yinto engenzeka ngezinga eliphakeme lama-NSAID asetshenziselwa isikhathi eside, njengokubuhlungu okungapheli okuhambisana nesifo samathambo noma ezinye izimo zokuvuvukala. Abantu abanezinkinga mayelana nokusetshenziswa kwama-NSAID nokuthi indlela yokugaya izithinteka kanjani kufanele ikhulume nodokotela.
Kungani ama-NSAID enza i-Ulcers
Ama-NSAID afana ne-aspirin, ibuprofen, ne- naproxen , angabangela izilonda ngokuphazamisa ikhono lomzimba lokuzivikela ezigulini zesisu. Nakuba izidakamizwa zesisu zibalulekile ekugayeni, zingabangela umonakalo uma izithiyo zokuzivikela zesisu zishintshwa.
Ngokuvamile, isisu sinokuvikela okuyisithathu ngokumelene ne-asidi esiswini:
- I-Mucus eyenziwa ngamaseli e-foveolar ahamba ngesisu
- I-bicarbonate ekhiqizwa ngamaseli e-foveolar esiza ekunciphiseni isisu esiswini
- Ukusakazwa kwegazi okusiza ekwakheni nasekuvuseleleni amaseli esiswini se-mucosal esiswini
Ama-NSAID anciphisa ukukhiqizwa kombukiso wokuzivikela futhi ashintshe isakhiwo sakhe.
Iklasi le-lipids elenziwe ngumzimba okuthiwa i- prostaglandin linomthelela wezinkinga ezibuhlungu. Ama-NSAID asebenza ukunciphisa ubuhlungu ngokuvimbela ama-enzyme ahilelekile ekukhiqizeni ezinye ze-prostaglandin. I-Prostaglandins nayo ivikela emgqeni we-mucosal wesisu, futhi uma isiphelile, kungase kube nokuphumula kulowo ungqimba. Ukunciphisa ukuzivikela kwemvelo ngokumelene ne-gastric acids kungaholela ekuvukeni kwesisu esiswini. Ngokuhamba kwesikhathi, lokhu kungabangela ukuqhuma kwesitsha segazi se-capillary, kubangele ukuphuma kwegazi kanye nokuthuthukiswa kwesifo sokuvuvukala nesilonda esiswini.
Izimpawu ze-Ulcer Peptic
Isilonda se-peptic singase sibangele izimpawu emgatsheni wokugaya kodwa abanye abantu abanalo izimpawu nhlobo. Isibonakaliso esivame kakhulu kakhulu ubuhlungu besisu esiswini (lapho isisu sitholakala khona) esingase sibe nomuzwa omuhle noma ovuthayo. Ubuhlungu bubukeka bunzima, abanye babhekana nokukhathazeka okuncane nabanye bebuhlungu obukhulu. Esikhathini esiningi ubuhlungu buyokwenzeka emva kokudla kodwa kwabanye abantu kungenzeka futhi ebusuku. Ingaqhubeka nanoma yikuphi ukusuka emaminithini ambalwa kuya emahoreni ambalwa.
Ezinye izimpawu azitholakali kodwa zingabandakanya igesi, i-nausea, ukuhlanza, ukulahlekelwa isifiso, ukulahlekelwa isisindo, nokuzwa okugcwele emva kokudla okuncane.
Ezimweni ezingavamile, abantu abanezilonda zamapulisi bangabona igazi esitokisini sabo noma babe nezitshalo ezimnyama ngoba ziqukethe igazi. Igazi elivela kwesilonda esisodwa noma ngaphezulu se-peptic singase sibonakale ekuhlanzeni.
Ukuhlonza Ulcers Peptic
Uma izimpawu zesilonda se-peptic sezikhona, udokotela angalawula ukuhlolwa okuningiliziwe ukuze abone imbangela futhi aqinisekise ukuxilongwa. Kulabo abamukela ama-NSAID ngobuhlungu obungapheli, udokotela angase abe nokusola okuphezulu ukuthi lokhu kuyimbangela, noma kubangela, isifo sesilonda se-peptic. Ngenxa yokuthi yiyona imbangela evamile kakhulu yezilonda zamapulpress, ukutheleleka ngeHl pylori kuvame ukulawulwa ngaphandle kokuhlolwa kokuphefumula noma ukuhlolwa kwesibalo.
Uchungechunge oluphezulu lwe-GI noma i- endoscopy engenhla ingasetshenziswa ukubuka ngaphakathi kwegciwane lokugaya eliphezulu futhi libheke izilonda. Ku-GI engenhla, iziguli ziphuza into ebizwa nge- barium futhi uchungechunge lwe-x-ray lithathwe. I-barium iyasiza izitho zangaphakathi zibonise kwi-x ray. Ngesikhathi i-endoscopy engenhla ithubhu eguquguqukayo nekhamera isetshenziselwa ukubheka ngaphakathi kwesisu, isisu, ne-duodenum. Iziguli ziyadluliswa phakathi nale nqubo futhi izingcezu ezincane zezicubu (i- biopsy ) zingathathwa emgqeni wegciwane lokugaya ukuze kuhlolwe okuqhubekayo.
Izingozi Zezingozi
Wonke ama-NSAID anakho okubangela ukuhlukumezeka, ukuphuma kwegastric, nezilonda. Kodwa-ke, abanye abantu bangakwazi ukuthuthukisa isifo sofuba sesilonda kunabanye. Ngokwesibonelo, ngenkathi uphando lubonisa ukuthi amaphesenti angama-25 abantu abathola ama-NSAID aphezulu-dose azokwakha isilonda, amaphesenti amancane kuphela alabo abazoqhubeka nokuthuthukisa izinkinga ezinkulu.
Izinkinga ezinkulu ezivela ezilonda zamapulpus ezibangelwa ama-NSAID cishe kungenzeka kubantu:
- Bangabantu abadala kunama-65
- Futhi uthathe i-corticosteroids
- Usebenzise ama-NSAID okungaphansi kwenyanga
- Yiba nemlando yezilonda
- Thatha ama-NSAID omthamo ophezulu
- Yiba nesifo ngeHl pylori
- Sebenzisa i-aspirin nsuku zonke (kufaka phakathi i -aspirin encane ephansi yezinhloso zezinhliziyo)
- Futhi uthathe igazi elincane
Ukwelapha Ulcers Peptic
Manje sekuyaziwa ukuthi ukudla okubabayo nokucindezeleka akubangeli izilonda. Kodwa-ke, kunezinye izinguquko zokuphila ezingase zinconywe ukuze kusize ukuphulukisa izilonda zamaphilisi . Udokotela angase ancome ukuthi isiguli esinesifo sesilonda se-peptic sigweme ukubhema, ugweme utshwala, ugweme i-caffeine, unqabe ama-NSAID, futhi ugweme noma yiziphi ezinye izinhlobo zokudla eziyimpawu ezimbi kakhulu.
Kwesinye isikhathi izidakamizwa zingase zinikezwe iziguli ezithatha ama-NSAID ukuze zivimbele izilonda zamapulitiki ukuba zingabonakali kuqala. Izilonda ezibangelwa i-NSAID zivame ukuphulukisa kanye ukwelashwa nge-NSAID imisiwe. Ukusheshisa inqubo yokuphulukisa, udokotela angase ancoma ukuthatha imithi ethile ye-prescription. I-antacid, engatholakala ngaphandle kwemithi kadokotela, ingahle ibekiwe ngoba iyasiza ekunciphiseni isisu esiswini. Kwezinye izimo i-bismuth subsalicylate (njenge -Pepto-Bismol noma i-Kaopectate ) ingasetshenziswa futhi.
Imithi ye-prescription engase iphakanyiswe ihlanganisa i-H2-blocker (histamine receptor blocker), okuvimbela ukukhiqizwa kwesisu esiswini ngokuvimbela i-histamine, kanye / noma i- proton pump inhibitor (PPI) , ehlisa inani le-asidi esiswini. Amagciwane okuvikela i-Mucosal (ama-MPAs) elinye iklasi lemithi kadokotela engase isetshenziswe, futhi le mithi isebenza ukugcina umzimba uveza ungqimba omucosal oluzuzayo esiswini ..
Inkinga enkulu kubantu ababhekene nesifo sesilonda se-peptic ngenxa yemithi yokwelapha nge-NSAID yindlela yokuphatha ubuhlungu lapho leyo mithi ishiywe. Uma kwenzeka ubuhlungu obungapheli, lokhu kungadinga usizo lweqembu labachwepheshe, kuhlanganise nodokotela wokuphathwa ubuhlungu. Isigaba semithi ebizwa nge- COX-inhibitors (i-cyclooxygenase inhibitors) ingasetshenziswa ukulawula ubuhlungu kwabanye abantu. I-COX-inhibitors eye yaboniswa ukuthi isebenze ukusizwa ubuhlungu futhi ihlotshaniswa nemiphumela emibi yocala yokugaya kunezinye izinhlobo ze-NSAID. Lezi zidakamizwa ziye zaboniswa ukuthi zinemiphumela emibi ye-cardiovascular, Nokho, ngakho-ke kuvame ukunconywa ukuba zisetshenziswe kumthamo ophansi kakhulu.
Izilonda eziningi ziphulukisa uma ama-NSAID emiswa kodwa kwezinye izimo kungenzeka ukuthi kudingeke ukuba kuhlinzekwe. Lokhu kuvame ukwenzeka uma kunezinkinga ngenxa yesilonda, njengokungena kwegazi okujulile, i- perforation (umgodi esiswini noma emathunjini amancane), noma ukuvinjelwa (ukuvinjelwa kwamathumbu).
Izwi elivela
Iningi labantu abathatha ama-NSAID ngeke balithole isifo sesilonda se-peptic. Kodwa-ke, abantu abanobuhlungu obungapheli futhi abathola amanani aphezulu ala mithi kufanele bazi ukuthi kungenzeka izilonda. Kwezinye izimo, kungase kube kuhle ukubuza udokotela uma kunezindlela zokuvimbela izilonda futhi uma lezo zinyathelo kufanele zenziwe ngenkathi zithola amanani aphezulu ama-NSAID. Ngenxa yokuthi izilonda ezingelashwa zingabangela izinkinga, kubalulekile ukuthola ukuxilongwa nokuthola ukwelashwa ngokushesha uma isilonda sikholelwa. Ezimweni eziningi izilonda zizopholisa ngokuma ama-NSAID nezimpawu zingaphathwa ngezinguquko zendlela yokuphila, kodwa imishanguzo engaphezu kwe-counter and prescription ingasetshenziswa ukusheshisa inqubo. Uma ubuhlungu obungapheliyo buqhubeka buyinkinga futhi kukhona ingozi yokuthuthukisa izilonda ezihlobene ne-NSAID, ukubhekana nomthombo wobuhlungu nokusebenza nobuchwepheshe bokuphatha ubuhlungu ukuthola ezinye izindlela zokusiza izinhlungu kungaba yindlela engcono kakhulu yokukhetha.
> Umthombo:
> Lanza, F, Chan F, Quigley E, et al. "Iziqondiso zokuvimbela izinkinga zesilonda ezihlobene ne-NSAID." Amer J Gastroenterol. 2009; 104: 728-38. I-DOI: 10.1038 / ajg.2009.115.
> Larkai EN, Smith JL, uLidsky MD et al. I-gastroduodenal mucosa kanye nezibonakaliso zesifo se-dyspeptic kwiziguli ze-arthritic ngesikhathi sokusetshenziswa kwezidakamizwa ezingapheliyo zokuvuvukala izidakamizwa. Am J Gastroenterol .1987; 82: 1153-1158.
> Isikhungo seNational Diabetes and Digestive and Kidney Diseases (NIDDK). "Izimpawu Nezimbangela Zama-Ulcers E-Peptic (Izilonda Zesisu)" Izikhungo Zikazwelonke Zempilo NgoNovemba 2014.