Ukwelashwa Kungabandakanya Ukudla, Ukusekelwa Kwemithi, Imithi, Nokuhlinzwa
I-short-bowel syndrome (i-SBS) yisimo esingaba khona uma isisu esincane kakhulu sisusiwe noma singenakuthola izakhi njengoba kufanele. Amavithamini namaminerali okudinga isidumbu esivela ekudleni njengoba sidlula emathunjini amancane. Uma intombazane encane imfushane kakhulu ukuze ingatholi ngokwanele ukudla, noma uma izingxenye zayo zingenakuthola izakhi, zingabangela ukungondleki.
I-SBS ingaba yisimiso esingapheli esidinga ukuphathwa okujwayelekile, kodwa kwezinye izimo kuyisimo sesikhashana esiphendula ukwelashwa.
Ngokusho kweCrohn's and Colitis Foundation , abantu abaphakathi kuka-10 000 no-20 000 e-United States bahlala ne-SBS. Ukwelashwa kwe-SBS kuye kwaqhubeka eminyakeni yamuva, kuthuthukisa izimpilo zabantu abaphila nesimo. Kwezinye izimo, ukwelashwa kungasiza ukwandisa umsebenzi wesilonda futhi ukuze uthathe izakhi eziningi. Ukudla okunomsoco, imithi, kanye nokuhlinzwa kungasetshenziswa ukuphatha abantu abane-SBS. Abantu abanesifo sikaCrohn abaye baba nokuhlinzekwa ngokuphindaphindiwe kokuphindaphindiwe futhi okungase baswele eduze kwesigamu noma ngaphezulu emathunjini abo amancane bangakha iSBS.
Ukubaluleka Kwamathambo Omncane
Umsebenzi oyinhloko wamathumbu amancane, okuyingxenye yesimiso sokugaya ukudla , ukuthola amavithamini namaminerali ekudleni. Amathumbu amancane afana nethubhu, futhi ivame ukuhamba ngamamitha angu-20 ubude.
Itholakala esiswini lapho isethwe khona phakathi kwesisu nomathumbu omkhulu endaweni yokugaya. Ukudla kushiya isisu bese kudlulela emathunjini amancane lapho kutholakala khona amavithamini, ngaphambi kokuba udlulele emgodini lapho amanzi agxila khona.
Umathumbu omncane uchazwa ukuthi unezigaba ezintathu eziyinhloko kuwo futhi izakhi ezihlukahlukene zithathwa esigabeni ngasinye.
Ngenxa yalesi sizathu, kubalulekile ukuthi iziguli ezine-SBS zikwazi ukuthi yiziphi izingxenye zamathumbu amancane ezikhishwe ngukuhlinzwa noma azisebenzi ngendlela efanele. I-iron itholakala esigabeni sokuqala, i-duodenum, ushukela, ama-amino acids, nama-fatty acids esigabeni sesibili, i-jejunum, ne-B12, i-bile acid, namanye amavithamini afakwa esigabeni sesithathu nesokugcina, i-ileum.
Ama-enzyme azisiza ukugaya ukudla adalwa ama-pancreas futhi adluliselwa emathunjini amancane. Ukudla kuphulwa yi-enzyme kanye nezakhiwe ezithathwa yizakhiwo ezikhethekile ezibizwa ngokuthi i-villi ezitholakala ezindongeni zangaphakathi zamathumbu amancane.
Izimbangela ze-Short Bowel Syndrome
Ukuba nesifo sikaCrohn nemikhakha eminingana emathunjini amancane kungafaka umuntu engozini ye-SBS. I-SBS ingenzeka futhi lapho intombazane encane ingasebenzi kahle futhi hhayi nje kuphela lapho ingekho kakhulu (njengalabo abazalwa ngamathumbu amancane) noma isusiwe. Ezinye izimo ezihlotshaniswa ne-SBS zihlanganisa:
- Ukuxhaswa: izicubu ezibomvu ezakhiwe emva kokuhlinzwa kwesisu
- I-Cancer
- Ukwelashwa okungahambi kahle: umathumbu omncane uziphatha njengokungathi kukhona ukuvinjelwa
- Isifo sikaCrohn esinezixazululo eziningi
- Izimo ezibangelwa ukubola njenge-congenital short bowel syndrome, i-gastroschisis, isifo se-Hirschspring, i-meconium ileus, i-microvilius isifo esifakiwe, i-midgut volvulus, ne-omphalocele.
- Ukulimala emathunjini amancane kusuka emithanjeni yemisebe (ukungena kwe-radiation)
- Ukulimala ngezifo noma ukulimala emithanjeni yegazi (ukulimala kwamagciwane)
- I-Ischemia: ukuntuleka kwegazi noma isitsha segazi esivinjiwe
- Intussusception: uma ingxenye yamathumbu igoqa njenge-telescope
- Ukungena kwe-entocolitis: isimo esingase senzeke ezinsana ezingakabiphi
- I-Volvulus: ukuphikisana kwesigaba samathumbu amancane
- Ukuhlinzwa kokulahlekelwa kwesisindo
- I-Trauma
Izimpawu Ze-Short Bowel Syndrome
Uma kukhona okungahambi kahle, mhlawumbe ngenxa yokuthi akusikho okwanele emathunjini amancane ashiywe noma ngenxa yokuthi uyeke ukusebenza ngendlela efanele, ukudla akuphuli futhi kusetshenziswe ngendlela efanele ngendlela efanele, futhi kungaba khona izimpawu nezimpawu ze-SBS kokubili ipheshana lokugaya futhi kulo lonke umzimba. I-diarrhea ngokuvamile yinye yezimpawu ezivame kakhulu futhi, ngokuqondakalayo, ingabangela ukulahlekelwa isisindo nokuphelelwa amandla kwamanzi.
Ezinye izibonakaliso ezingase zibe khona kanye nezimpawu zesikhumba esifushane samathumbu zingabandakanya:
- Ukugubha
- Ukuvimbela
- Uhudo
- I-Edema (ukuvuvukala) emilenzeni
- Ukukhathala
- Ukuguquka kwenhliziyo
- Ukungondleki
- Ukungabi namandla
- Ukulahlekelwa kwesisindo
Ukungondleki kuyisibonakaliso se-SBS esizoba umphumela wokungatholi izakhi ezanele ekugayeni kokudla. Ukungondleki kungathinta umzimba wonke futhi ngeke nje kubangele umuzwa jikelele wokungahambi kahle nezimpawu ezifana nokukhathala nokuphefumula, kodwa kungaholela kwezinye izinto ezikhathazayo ezifana nokulahlekelwa izinwele kanye nesikhumba esomile kanye nezinkinga ezinkulu ezifana nokuvuvukala (i-edema) ukulahlekelwa isisindo somzimba.
Ukwehla kwe-Vitamin
Ukuntuleka kwe-Vitamin kungenzeka nge-SBS kuye ngokuthi yisiphi isitho samathumbu amancane esithintekile yilo mqathango. Ukwehluleka okuthile kwe-vitamin kungabangela izimpawu nezimpawu ezihlukahlukene. Uma kukhona ukungabi khona kwamavithamini okuthize ngenxa yokuthi ayitholakali, ithimba lezokunakekelwa kwezempilo lingaphatha lokho okwehluleka ngama-supplement ukuze kutholakale lelozinga le-vitamin emzimbeni.
Ezinye zeziphene ezivame kakhulu ezibandakanya:
- I-Iron : I- Iron ithathwa kwi-duodenum, ngakho-ke uma leso sigaba samathumbu amancane sithintekile, umphumela ungase ube ukuntuleka kwesimbi. Ukuntuleka kwensimbi eyanele kungaholela ekudleni kwegazi, okungaholela ekukhatheni.
- I-Vitamin A: I- Vitamin A idlala indima ekugcineni kokubili amehlo nesikhumba kuphilile, okusho ukuthi ukungabi nalesi sakhi kungabangela izinkinga zamehlo (njengokungathi ubumpumputhe ubusuku) nezimpikiswano zesikhumba ezinjengezinsalela. Izimo ezinzima kakhulu zingabangela ukuntuleka okukhulu, kuhlanganise nokuguguleka kwe-cornea, izifo zokuphefumula, nokuqina kwesikhumba. I-Vitamin A izothathwa ku-jejunum, ngakho-ke uma leyo ngxenye yamathumbu ingasebenzi kahle, ukungabi khona kwe-vitamin A kungenzeka.
- I-Vitamin B: B amavithamini B afakwe kwi-jejunum ne-vitamin B12 ibanjwe engxenyeni yokugcina ye-ileum, okuthiwa i-leum esibulalayo. Ukuntuleka kwevithamini B kungabangela izimpawu nezimpawu ezifana ne-edema, ukushaya kwenhliziyo okungavamile, nokulimala kwamanyo (ukushaya kwegazi).
- I-Vitamin D : I- Vitamin D iyinvithamini eyisizayo ye-calcium ngakho isikhathi eside isikhathi sokuntula u-vitamin D kungabangela izinkinga ngamathambo afana ne-osteoporosis. Amazinga aphansi e-vitamin D nawo angabangela ukuqhuma kwemisipha nokuxubha noma izikhonkwane nezinaliti zokuzwa (ama-paresthesias). I jejunum yilapho i-vitamin D ithathwa khona ngumzimba emathunjini amancane.
- I-Vitamin E: Ukuntuleka kwe-Vitamin E akuvamile ngaphandle kwezwe elisathuthuka, kodwa kubantu abane-SBS lapho i-jejunum ithinteka khona, ukungabi nalutho kwaleli vithamini kungenzeka. Ukuntuleka kwevithamini E kungabangela izikhonkwane nezinaliti izinzwa kanye nezinkinga zombono, kanye nezinkinga zemisipha ezifana nokuhlukunyezwa.
- I-Vitamin K: I- Vitamin K isebenzisa i-clot yegazi, ngakho-ke ukungabi nalutho kwaleli vithamini kungabangela izinkinga ngokulimaza kalula nokuphuza kakhulu. Kanye namanye amavithamini, i-vitamin K ithathwa ku-jejunum, ngakho-ke kunokonakala okungenzeka uma leyo ngxenye yamathumbu amancane ihlaselwa yi-SBS.
- I-Zinc: Ukuntuleka kwe-Zinc akuvamile kubantu abanempilo kepha ukungabi nalesi sitshalo semaminerali kungenzeka uma i-SBS ithinta ukukhipha kwayo. Ukuntuleka kwe-Zinc kunzima ukuyihlolisisa kodwa kungabangela ukulahlekelwa kwesidlo nokunciphisa amandla omzimba (okusho ukuthi kungenzeka ukuthi ubambe umkhuhlane noma umkhuhlane).
Ukuthola i-Short Bowel Syndrome
Kwezinye izimo, i-SBS izoba ingozi etafuleni ngenxa yokuhlinzwa emathunjini amancane (njengabantu abano-Crohn's disease abanokuhlinzwa okuphindaphindiwe), ngakho-ke ukuxilongwa kungase kungasho ukuthi uhlolwa okuningi. Kwezinye izimo, kungase kudingeke ukuthi udokotela kanye / noma ochwepheshe babheke imiphumela yezivivinyo eziningana ezahlukene ukuze banqume ukuthi i-SBS yinkinga.
Ukuhlolwa kwegazi kuvame ukusetshenziselwa kokubili ukuhlola nokuqapha i-SBS. Ukubalwa okuphelele kwe-cell cell (CBC) kungabonisa ukuthi kukhona i-anemia, ama-enzyme yesibindi angabonisa ukuthi ukulimala kwesibindi kungase kube khona, futhi amazinga okudala angabonisa ukuthi kunenkinga yokusebenza kwezinso. Ukuhlolwa kwegazi kungasetshenziswa futhi ukuthola ukuthi kunezinkinga ezithile zamavithamini.
Ezinye zezivivinyo ezingase zisetshenziselwe ukuxilonga i-SBS zihlanganisa:
- Ukuskena kwe-computerized axial tomography (CAT) : Isivivinyo esenziwe ngokuhlukile kodayi owanikwa nge-IV ongabonisa izinkinga ngesibindi namathumbu.
- Ukuskena kwe- computerized tomography (CT) : Ukuskena kwesisu esisinikeza isigaba esinqunyiwe somzimba.
- Ukufaneka kwe-magnontic resonance (MRI) : Amasimu omhlaba asetshenziselwa ukwenza isithombe sesisu futhi ikakhulukazi emathunjini amancane.
- I-Ultrasound: I-ultrasound yesisu ingasetshenziselwa ukubheka izinkinga nge-bile ducts noma gallbladder.
- Uchungechunge oluphezulu lwe-GI : Uhlobo lwe-ray ray oluthathwa ngesisu ngemuva kokuphuza isisombululo se-barium esiza ukubona ukuthi kwenzekani ohlelweni lokugaya.
- I-X-ray : I-x-ray yama-esiswini ingase isetshenziselwe ukubuka amabhulogi noma ezinye izinkinga emathunjini.
Ukwelapha
Ukwelashwa kwe-SBS kungabandakanya ukudla okunomsoco, imithi, izinguquko zokudla, ama-vitamin supplement, kanye nokuhlinzwa. Uhlobo lwezokwelapha ezisetshenzisiwe luzobekwa ngabanye ngoba zonke iziguli ezine-SBS zizoba nezidingo ezihlukene ngokuphathelene nokwelapha. Kungase kube nezinye izici emsebenzini lapho ukhetha ukwelashwa, njengokuthandwa kwesiguli, nezinye izimo isiguli esingase sibe nayo, nokuthi ngabe isiguli singumuntu omdala noma ingane.
Ukudla
Ezimweni ezinzima ze-SBS, ushintsho ekudleni kanye nokwengezwa kwamanye amavithamini nezamaminerali angasiza ekuqinisekiseni ukuthi izakhi eziningi zithathwa ngumzimba. Iziguli ngokuvamile ziluleka ukuba zidle ukudla okuhlukahlukene njengoba zibekezelela, kepha ukudla kungenziwa kube ngumculi wezilwane ukugxila ngokukhethekile ezakhiweni ezidinga kakhulu. Ukudla ukudla okuncane ezincane ngosuku kunokuba kunciphise ukudla okuncane kungase kube lula ngesiguli nge-SBS. Isixazululo sokuvuselelwa ngomlomo (ORS) singase sisetshenziswe futhi ukuze silondoloze ibhalansi elungile le-electrolyte emzimbeni.
Ukuguquguquka kwamathumbu
Amathumbu amancane anekhono lokuzivumelanisa ngokuhamba kwesikhathi futhi angase aqale ukuthatha izakhi ezingaphezulu kokudla, okwenzela izigaba ezingasebenzi kahle noma ezingekho. Ezinye zokwelapha zingasiza lolu hlelo, futhi ngenkathi isikhathi esidingekayo sokujwayela amathumbu namanje kuqondwa, kungathatha noma yikuphi kusukela ezinyangeni ezingu-6 kuya eminyakeni emibili kuya kweyesi-3.
Ukudla okuphelele kwama-Parenteral (TPN)
Ezimweni eziningi ze-SBS, iziguli zifakwe efomini ye-TPN, okuyisondlo esinikezwa nge-IV. Ngenxa yokuthi le ndlela yokudla ayihambi emathunjini amancane, ivumela izakhi ezifana noshukela, amaprotheni, amafutha, amavithamini, kanye namaminerali ukuba angene ngqo egazini futhi asetshenziswe ngumzimba. Ukusetshenziswa kwe-TPN kungase kube okwesikhashana noma kungase kuhlale kunomphela, kuye ngokuthi iSBS ithinta kanjani umzimba.
Kwezinye izimo, ukudla okunomsoco kunikezwa nge-tube ekhethekile efakwe esiswini noma emathunjini amancane, okuthiwa i-tube yokudla yokungena. Abantu abathola ukungondleki kwe-IV bangakwazi noma bangakwazi nokudla ukudla ngomlomo. I-TPN ingase inikezwe iziguli lapho izibhedlela futhi inganikwa futhi ekhaya lapho isiguli sisezinzile ngokwanele ukuba sikhululwe.
Imithi
Izinhlobo eziningi zemithi zisetshenziswa ukuphatha i-SBS ukuze kusize isilwane sithatha izakhi eziningi, sinciphise isifo sohudo, futhi sinciphise ukukhiqizwa kwesisu esiswini. Ama-anti- diarrals angasetshenziswa afaka i-diphenoxylate / atropine, i-loperamide, i-somatostatin, futhi, ngokungajwayelekile, i-codeine ne-tincture ye-opium. Kucatshangwa ukuthi isisu esiswini esikhulu singanciphisa ukujwayela kwamathumbu emathunjini, futhi kungabangela ukungahambi kahle, ngakho-ke ama-acid reducers (i-histamine-2 receptor blockers kanye ne- proton pump inhibitors ) enganciphisa noma enqabela ukukhiqizwa kwesisu esiswini angasetshenziswa, kufaka phakathi i-famotidine, i-lansoprazole, i-omeprazole, ne-ranitidine.
I-hormone yokukhula yomuntu, i-somatropin, uma ihambisana nokudla kwe-carbohydrate eyinkimbinkimbi, ingandisa ukondla komzimba emathunjini amancane futhi ingasetshenziselwa iziguli ezitholayo i-TPN. Izinhlayiya ze-acid ezibophayo ezifana ne- cholestyramine zingasetshenziswa ukunciphisa i-bile acid, okungase kube usizo ekunciphiseni isifo sohudo. Ama-enzyme angama-pancreatic anganikwa futhi ukwandisa ukuwohloka kwamafutha, amaprotheni, kanye nama-carbohydrate wokudla njengoba ehamba emathunjini amancane. I-peptide efana ne-glucagon-2, i-teduglutide, inganikezwa kubantu abadala abathola i-TPN ngoba iboniswe ukwandisa ukujwayela kwe-mucosa emathunjini amancane, futhi ngaleyo ndlela kusize izakhi ezingaphezulu zifakwe.
Ukuhlinzwa
Yize kungase kubonakale kungaqondakali, ukuhlinzwa ngezinye izikhathi kusetshenziselwa ukuphatha iSBS. Izinhlobo ezimbalwa zokuhlinzwa zingasetshenziselwa ukwandisa ubude besilwane esincane, okubandakanya inqubo ye-Bianchi ne-serial enteroplasty ehamba phambili (STEP). Kuzo zombili lezi zindlela zokuhlinza, umphumela uyisigaba esidelele sesilonda esibuye sinciphise, kodwa ukudla kuzochitha isikhathi esiningi, futhi izakhi ezingaphezulu zingangena.
Enye indlela yokukhetha engavamile futhi evame kuphela kulabo abanezinkinga ezivela ku-SBS-njengokuhluleka kwesibindi nokutheleleka-ukuguqulwa kwamathumbu. Kule nqubo, umathumbu omncane we-donor usetshenziselwa isiguli nge-SBS. Lolu hlobo lohlinzekwa ngeshwa lubuye luhlotshaniswe nezinkinga eziningi ezibandakanya okusemandleni okulahlwa. Abantu abathola ukufakelwa okuncane kwamathumbu kuzodinga futhi ukuthatha izidakamizwa ze-immunosuppressant ukunciphisa imiphumela yokwenqatshwa.
Ukukhukhulwa kwamabhaktheriya amancinci amancane
Umathumbu omncane awunawo ama-bacteria amaningi, kodwa abanye abantu abane-SBS bangase bahlakulele ukukhudlwana kwala mabhaktheriya, okuthiwa yi- overgrowth encane yamagciwane emathumbu . Lesi simo singabangela izimpawu zokuvimbela, isifo sohudo, isicanucanu, nokuhlanza. Lesi simo singathinteka i-SBS futhi sivimbele inqubo yokujwayela emathunjini. Ukwelashwa kungabandakanya ama-antibiotic ukuvimbela ukukhula kwamabhaktheriya emathunjini amancane kanye nokubhekana nanoma yiziphi ezinye izici ezingase zibe negalelo kule nkinga. Ama-probiotics anganikwa futhi ukukhuthaza ukuphindwa kwamabhaktheriya awusizo emva kokwelashwa ngama-antibiotic.
Izwi elivela
I-SBS yisimo esithinta hhayi kuphela izingxenye zomzimba, kodwa zonke izingxenye zempilo yesiguli. Izindlela zokwelashwa ezitholakalayo zinganciphisa izimpikiswano ze-SBS emzimbeni futhi zithengise izinga eliphezulu lokuphila kweziguli. Ngisho ne-TPN manje ingenziwa ngaphandle kwesibhedlela, ngisho nalapho ephuma endlini usuku noma ngenkathi ehamba.
Noma kunjalo, lesi simo sihlangabezana nezinselele eziqakathekileko futhi ukubeka ithimba lokusekela eliphelele endaweni lizobaluleka ekulawuleni. Akukhona nje ochwepheshe abanjengo-gastroenterologist, udokotela ohlinzayo, nomhlengikazi, kodwa futhi nenethiwekhi yabangani, umndeni, ezinye iziguli, kanye nomsebenzi wezempilo yengqondo. Umuntu onesifo se-SBS angase athole inani eliphakeme lemikhawulo nemigqa ngesimo sabo, okumele kulindeleke. Ukuzama ukuthola usizo nokusekelwa nokuhlala eduze noxhumano lwenethiwekhi kuzonikezela ithuba elihle lokwelashwa okuphumelelayo nokuphila impilo engcono kakhulu ngeSBS.
> Imithombo:
> Crohn's and Colitis Foundation. "I-Short Bowel Syndrome ne-Crohn's Disease." I-CrohnsColitisFoundation.org Jul 2013.
> Johnson LE. "Ukwehla Kwevithamini, Ukuthembela, Nokudakayo: I-Vitamin A." I-Merck Manual. Sept 2016.
> Johnson LE. "Ukwelashwa kweVithamini, Ukuthembela, Nokudakayo: I-Vitamin E." I-Merck Manual.
> Johnson LE. "Ukwehla kwe-Vitamin, Dependency, and Toxicity: Vitamin K." I-Merck Manual.
> Isikhungo seNational Diabetes and Digestive and Kidney Diseases (NIDDK). "I-Short Bowel Syndrome." I-National Institute of Diabetes kanye ne-Digestive and Kidney Diseases Health Information Centre.