The Treatment of Alcoholic Cirrhosis
I-Maddrey Score iyaziwa ngamagama amaningi, kuhlanganise noMaddrey Discrimination Function, MDF, DF noma iDFI. Ithuluzi elisetshenziselwa abahlinzeki bezempilo ukunquma uhlobo olufanele lokunakekela isiguli esinomonakalo othize wesibindi esibizwa ngokuthi i- cirrhosis yotshwala.
Ithuluzi lokufaka amagoli livame ukusetshenziswa esiteshini esibhedlela, njengoba laba bantu bevame ukugula lapho befinyelela esifundazweni sesifo esidinga ukusetshenziswa kweMardrey Score.
Ngamafuphi, amaphuzu aseMaddrey asisiza ukuthi banqume ukuthi ubonakaliso obunobungozi bunjani, ukuze kwenziwe uhlelo lokunakekelwa.
Ubani Okudingayo I-Maddrey Score?
Abantu abanesifo sofuba esibangelwa yi-alcoholic hepatitis yiziguli okusetshenziselwa i-Maddrey Score. Lawa yiziguli ezilimaza isibindi sezibangelwa ukuphuza utshwala, noma ukuphuza utshwala ngokweqile, futhi ngokuvamile zibhekana nezibonakaliso ezinzima lapho kusetshenziswa amaphuzu aseMaddrey.
Abanye balaba bantu bazoba esibhedlela, abanye bazobonakala ngesikhathi sokugula. Kuzo zombili izimo, kufanele bathole ukunakekelwa kusuka kumhlinzeki ogxile kwi-gastroenterology noma i-hepatology. I-Gastroenterologists inakekele yonke indlela yokugaya, kuhlanganise nesibindi, kuyilapho izimbangi ze-hepatologists zigxila esibindi.
Iyini i-cirrhosis eyingozi?
I-cirrhosis enobudlova uhlobo lwesifo sesibindi esibangelwa ukusetshenziswa kotshwala ngokweqile. Ingahluka ukusuka komnene kuze kube nzima futhi ingabangela izinkinga eziningi-kuhlanganise nokufa.
I-cirrhosis ibangela ukuvuvukala okungapheli kwesibindi, amafutha anemali futhi kungabangela ukuhluleka kwezicubu ezenza kube nzima isibindi ukusebenza kahle. Kwezinye izimo, isibindi siyabonakala ngokucacile.
Izimpawu Ezivamile Nezibonakaliso Ze-Cirrhosis
Kunezinhlobo eziningi ze-cirrhosis, okungenzeka noma kungabangelwa ukuphuza utshwala.
Kungakhathaliseki imbangela, iziguli ezine-cirrhosis zinezibonakaliso kanye nezimpawu ezifanayo , ezivame ukungena ezimweni zokuqala zesifo futhi zibhebhetheke kakhulu ezifweni ezinzima.
- Ubuhlungu besisu esiswini: Isibindi sisekugcineni kwesisu esisodwa kanti ezinye iziguli zibika ukuthi zizwa umuzwa odabukile phezu kwesibindi esanda ngesifo esibucayi.
- I-nausea: ezinye iziguli zithola ukuhlanza, kodwa isicanucanu sivame kakhulu futhi singadinga imithi yokuvumela isiguli ukuba sidle ukudla okuvamile.
- Ukugqwala kalula: isibindi sidlala indima ebalulekile ekusizeni i-clot yegazi ngemva kwelonda noma ukulimala. Njengoba i-cirrhosis ikhula, ukulimala kwenzeka kalula futhi kwezinye izimo, ukuphuma kwegazi kwenzeka ngokungalindelekile, ngaphandle kokulimala njengenhloko.
- Ukudideka kwengqondo / ubungqingili : Uma isibindi singakwazi ukwenza umsebenzi wawo, i-ammonia ingakha egazini, eholela ekudidekeni, ekukhathaleni, ekufakeni kwengqondo, nokungakwazi ukuzinakekela imisebenzi elula yansuku zonke.
- Ukukhohlwa: Uma isibindi sigula kuze kube yilapho singasakwazi ukwenza umsebenzi wayo ngokuphelele, izimpawu zizovela futhi zibi kakhulu njengoba isifo senza. Imithi ingasetshenziselwa ukuthuthukisa izimpawu.
- Ukukhathala / ubuthakathaka: Ukukhathala kuvame kakhulu futhi ngokuvamile kuholela ekuxilongweni kwe-cirrhosis.
- I-jaundice (i-yellowing yesikhumba): Uma isibindi singasakwazi ukuhlunga igazi kahle isikhumba nezinye izicubu zomzimba zingathatha ukubukeka okuphuzi. Lokhu kuvame ukubonwa okokuqala kulabo abamhlophe bamehlo, lapho ukuguqulwa okucashile kubonakala khona.
- Izindwangu ezandisiwe ezibonakalayo esiswini: Okubangelwa ukunyuka kwengcindezi yegazi nokuxubana emithanjeni yegazi eduze kwesibindi, imithwalo yegazi esiswini isaba sikhulu futhi ibonakale ngaphansi kwesikhumba.
- Izindwangu ezikhulisiwe ezithandweni (okuyi-esophageal varices): Ngaphandle kwemithanjeni esesiswini esisindayo futhi sikhulisiwe ngosayizi, okufanayo kungenzeka ezitsheni ezisendlini. Uma lezi zindlala zikhuliswa kakhulu kukhona ingozi yokuguga impilo, ngakho-ke ukwelashwa kuyadingeka ukunciphisa lo mngcipheko.
- Ukudla okubi, ukulahlekelwa isisindo: Iziguli eziningi ziyokwenyuka ngenxa yokugcinwa kwamanzi, kodwa abanye bathola ukuthi basweleka ngenxa yokuntuleka kwesidlo nokukhathala. I-nausea ingaholela ekulahlekeni kwesisindo.
- Ukwandiswa kwebele kwabesilisa nabesifazane: Nakuba isizathu esiqondile salokhu singacaciswanga ngokucacile, i-cirrhosis iholela ekungalingani kwe-hormone okuholela ekuguqulweni kwesayizi sebele.
- Igesi (flatulence)
- Ukuphuza: Igazi elibomvu lingabonakala noma lingabonakali. Kwamanye, ukuphuma kwamanzi kungabonisa ngokuthi "izizathu zekhofi" ezibonakala lapho zihlanza. Abanye bangabona ukuthi izitshalo zabo azisebhakabhaka kodwa ziba mnyama noma zibe mnyama, futhi zibukeka sengathi zinamathele noma zifana ne-tar. Zombili lezi zibonakaliso zokuphaphaza ohlelweni lokugaya futhi kumele zibikwe kumhlinzeki wezempilo.
- Ukugcinwa kwamanzi ( ascites ): Ezinye iziguli zigcina uketshezi oluphawulekayo, ikakhulukazi esiswini, isimo esingabangela isidingo sokuba nenqubo yokukhipha uketshezi.
- Ukubamba: Lokhu kungaba isibonakaliso sokuthi isibindi asihlungi kahle igazi elingase lihlangane njengokubamba.
- Ukuvuvukala emilenzeni, emaqaqweni, nasezinyaweni: Okunye ukubonakaliswa kokugcinwa kwamanzi, ukuvuvukala emaphethelweni angaphansi kungaba uphawu lwezinkinga ngesibindi kwabanye abantu.
- Ukuphefumula: Ukuphefumula kungaba yinkinga uma ukugcinwa kwamanzi emzimbeni kwenza kube nzima ukuthatha umoya ojulile noma ukwandisa ukucindezeleka esiswini.
Indlela iMardrey Score Ebalwa ngayo
Isiqephu se-Maddrey sisebenzisa ukuhlolwa kwegazi ezimbili ukucacisa ubukhulu bokulimala kwesibindi, isikhathi se-bilirubin ne-prothrombin.
I-Bilirubin iyi-pigment yama-orange eyenziwa yisibindi uma iphula i-hemoglobin (ingxenye yegazi) futhi isuke ibhekwa nge-bile. Ngokujwayelekile, lokhu kususwe emzimbeni kodwa uma kwenzeka isibindi esonakalisiwe i-bilirubin ingakha egazini elidala i-jaundice.
Isikhathi se-prothrombin sinesilinganiso sokuthi ama-clots wegazi asheshe alinganiswe kanjani ngemizuzwana. Omunye wemisebenzi yesibindi ukusiza i-clot yegazi, izikhathi ezide kakhulu zokulinda zilindeleke lapho isibindi sonakalisiwe.
Ukulawulwa ukubala ukuthi irebhu isebenzisa ukucacisa ukuthi yimiphi imiphumela "evamile" kuleyo ndawo ethile, futhi akuyona umphumela webhu ebusweni legazi.
I-equation esetshenziselwa ukubala i-Maddrey Score yilezi:
- I-Bilirubin (mg / dL) + izikhathi ezingu-4.6 (isikhathi se-prothrombin ngemizuzwana engaphansi kokulawula)
Ithimba le-Maddrey lisetshenziswe kanjani?
Uma isiguli esine-cirrhosis yohlobo oludakayo sagula, i-Score Maddrey isetshenziselwa ukuthola ukuthi ingazuza yini ekusebenziseni i-steroids njengengxenye yomuthi wabo wemithi. Kungabuye kusho ukuthi amathuba okuphila, ikakhulukazi ezinyangeni ezintathu ezilandelwayo.
Uma isiqephu seMaddrey singaphansi kweminyaka engu-32, isiguli sibhekwa ukuthi sinomdlandla we-cirrhosis ophuza ngokweqile futhi cishe ngeke sizuze ekusebenziseni i-steroids. Cishe amaphesenti angu-90 weziguli abenele score azosinda ezinyangeni ezilandelayo ngokushesha lapho amaphuzu enziwe.
Ngeshwa, amaphuzu aphezulu kunama-32 akhombisa izifo zesibindi esibi kakhulu, okusho ukuthi isibindi sonakaliswe kabi ngotshwala. Kulezi zimo, amaphesenti angaba ngu-60 kuya kwangu-65 kwalezi ziguli aphila ezinyangeni ezintathu ngemuva kokufaka amagoli. Yilezi ziguli ezikhethwa kakhulu ekusetshenzisweni kwe-steroids njengengxenye yokwelashwa kwazo. Kulezi ziguli, izingozi zokwelashwa okunonya zikhulu kakhulu ngemiphumela engaba khona yokuhlala isikhathi eside.
Kubalulekile ukukhumbula ukuthi iMardrey Score iyithuluzi, hhayi eliphelele. Lokhu kusho ukuthi amaphuzu ayinto eyodwa kuphela udokotela noma uchwepheshe wezempilo obukayo lapho ekhetha inkambo engcono kakhulu yezenzo. Ngenxa yalesi sizathu, ungabona isiguli esinamaphesenti angama-30 owamukela i-steroids futhi ungabona isiguli esithile sinamaphuzu angaphezu kuka-32 ongenayo. I-Steroids inezimpikiswano ezibalulekile, ezifana nokuphakamisa ushukela wegazi ngokuphawulekayo, okungase kudingeke kugwenywe kwezinye iziguli.
Indlela Yokuthuthukisa I-Score Maddrey
Isaphulelo seMaddrey asisetshenziswanga ngamatshe, futhi akuyona izwi lokugcina ukuthi isifo sesiguli sizosabela kanjani ekwelapheni. Isibalo siyithuluzi elisetshenziselwa ukubikezela imiphumela, kodwa isiguli singase sikwazi ukushintsha inqubo yabo yesifo kwezinye izimo.
Kulezi ziguli ezinezifo ezincane, ukuguquka endleleni yokuphila kungenza ushintsho oluhle kakhulu ekusebenzeni kwesibindi ukusebenza futhi empeleni kungabuyisa ubukhulu besifo. Kwezinye iziguli ezinezifo ezincane ezivimba ukuphuza utshwala zingaholela ekuguqulweni okuphelele kwezifo. Kulezi ziguli ezinezifo ezivame ukubhekana nezifo ezinzima, kungenzeka ukubona ukuthi izifo zesibindi zithuthukisa abanye. Kwabanye, izinguquko zendlela yokuphila azikhombisi ekuthuthukiseni kodwa zivimbela lesi sifo ukuba singabe siphuthuma-kungaba nzima ukubikezela ukuthi kuzokwenziwa ngcono kangakanani.
- Yeka konke ukungenisa utshwala. Uma lowo muntu eqhubeka ephuza utshwala, indlela eyodwa eqinisekisiwe yokuvimbela ukuguga kwesifo futhi mhlawumbe uhlangabezana nokuthuthukiswa kwesibindi umsebenzi ukuyeka ukuphuza utshwala ngokuphelele. Lokhu akusho neze utshwala, ngisho nokuphuza iwayini noma ubhiya. Ukuqeda ukuphuza utshwala kungase kube nzima kakhulu, kodwa kuyobaluleka kakhulu ekusindeni kwesiguli, njengokusetshenziswa kokusetshenziswa kotshwala okuqhubekayo emva kokuxilongwa kwe-cirrhosis yotshwala kuyokwandisa nje ijubane lapho isiguli sithuthuka khona kuya ezigabeni zokugcina ze-cirrhosis futhi ekugcineni ukufa.
- I-fat fat / sodium yokudla. Ukudla kungasiza ukulawula i-cirrhosis. Ukudla okunamafutha amaningi kanye ne-sodium kungasiza ekunciphiseni ukwanda kwezifo futhi kunganciphisa ukugcinwa kwamanzi okubangelwa yisibindi. Kubantu abadinga ukususwa kwamanzi asemzimbeni, inqubo ebizwa ngokuthi i-paracentesis, ukudla kungathinta indlela inqubo edingeka ngayo ngokunciphisa ukugcinwa kwamanzi.
- Ukwengezwa. Abanye abantu abane-cirrhosis yotshwala badla ngokweqile futhi bazobona ngcono esimweni sabo ngokufaka amavithamini namaminerali okungeziwe ekudleni njengoba kunqunywe umhlinzeki wezempilo. Umthombo wokungondleki kungase kube ukuntuleka kwama-kilojoule ngendlela yokudla, njengoba abanye abantu abanomlutha wotshwala obunzima badla kancane futhi bathatha amakholori amaningi ngobunjalo bokuphuza utshwala. Kwabanye, ukudla okungalungile kwekhwalithi noma ezinye izinkinga kungabangela ukungondleki.
- Amakholori afanele. Kulezi ziguli ezinezifo ezinzima kanye nesifiso esibi, kungase kudingekile ukufaka ukudla okuneziphuzo ezifana nokuqinisekisa noma ukuqinisa. Uma isiguli singakwazi ukudla ama-kilojoule okwanele ukuze ukwanelise izidingo zomzimba, ngokuvamile ama-calories angu-2 000 noma ngaphezulu, zingadinga ukondla kwe-tube ukuze ukwandise inani lamakhalori abatholayo. Ngokuvamile, ukudla okuphelele okunempilo kukhethwa ngaphezu kweziphuzo zokuphuza, kodwa kwezinye iziguli noma yikuphi ukudla okungamukelekile uma behluleka ukuthatha amakholori anele.
- Ukufakelwa kwesibindi. Ukwelashwa okuyiqiniso kwe-cirrhosis, kungakhathaliseki imbangela, ukufakelwa kwesibindi. Ukutshala izitshalo kunzima kakhulu kubantu abane-cirrhosis yotshwala ngoba kufanele baphuze utshwala isikhathi esithile - ngokuvamile izinyanga eziyisithupha noma ngaphezulu - ukuze bafanelekele ukufakelwa. Lokhu kungaba nzima kakhulu, futhi abantu abaningi abakwazi ukufaneleka ukufakelwa ngoba abakwazi ukuyeka ukuphuza utshwala.
Isiguli kumele futhi sigweme utshwala ngemva kokuthola isibindi esisha, njengoba isitho esisha singonakaliswa utshwala ngisho ngokushesha kunobindi bokuqala ngenxa yemithi edingekayo ukuvimbela ukwenqatshwa.
Izwi elivela
I-Maddrey Score iyithuluzi elilodwa abahlinzeki abasebenzisa ekunakekeleni iziguli ezitholakala ukuthi banezifo zesibindi sokudakwa. Amaphuzu asiza ukucacisa ubukhulu be-cirrhosis futhi inikeza inkomba yokuthi ngabe i-steroids kufanele isetshenziswe yini kumuntu ngamunye. Nakuba lena yingxenye ebalulekile yokunakekelwa okuhlinzekwe, ezinye izici zibaluleke kakhulu noma zibaluleke nakakhulu, njengokuthi isiguli siyaqhubeka yini ukuphuza utshwala, sizimisele kangakanani ukulandela imiyalelo nezinye izinto ezingeke zishintshe, njengezinhlelo zabo ubudala.
> Imithombo:
> I-cirrhosis. I-Medscape. https://emedicine.medscape.com/article/185856-kubukezwa kabusha
> Iyini i-cirrhosis? I-NIDDK. https://www.niddk.nih.gov/health-information/liver-disease/cirrhosis