Uma sizwa igama elithi " isifo sofuba ," sivame ukuzihlanganisa nge- cirrhosis nezinye izifo ezihlasela isibindi. Kodwa akusiyo njalo indaba. Njengokunye okuphikisanayo, izifo ezingapheli, isifo sofuba singaphazamisa ngqo uhlelo olulodwa lomzimba (kulokhu, isibindi) ngenkathi kuthinta ngokuqondile ezinye izinhlelo zomzimba, futhi.
Uhlelo olulodwa olungathinteki ngokuqondile ngesifo sesibindi yisimiso sezinzwa eziphakathi, futhi ikakhulukazi ubuchopho.
Ngesikhathi isifo sesifo sofuba esiyingozi noma esingapheli, izinto ezinobuthi ezivela esibindi zingabuthelela egazini futhi zisakaze (noma zisakaze) kuwo wonke umzimba. Lapho lezi zinto zingena ebuchosheni, zingabangela isimo sezinzwa esibizwa ngokuthi i- hepatic encephalopathy .
Ukuxilongwa kwe-hepatic ngokuvamile kuveza ukuguquguquka, ukuguquka kwesinye isikhathi, futhi ngezinye izikhathi izinguquko ezimangalisayo ekuziphatheni nasekuthuthukiseni amakhono. Uma ishiywe ingalashwa, lesi sifo singahamba kancane kancane siye ku-coma (coma hepaticum) noma ngisho nokufa.
Konke okushiwo ukuthi, phakathi kwamaphesenti angu-30 no-45 abantu abane-cirrhosis bazokwakha ezinye izibonakaliso ze-encephalopathy enobungozi, kungakhathaliseki ukuthi yizinhlobo ezibucayi zokukhohlwa noma izinkinga ezinzima ze-amnesia noma ukuwayeka.
Izimbangela ze-Hepatic Encephalopathy
Ngenkathi i-encephalopathy ye-hepatic ihlotshaniswa nokuhluleka kwesibindi esiningi , ngokuvamile kunezinye izinto ezibangela ukudlala. Eziningi zalezi zici azihlangene nesibindi noma ubuchopho; babonakala sengathi bangabangela ukuhlaselwa noma baqhubekisele phambili isiqephu esikhona.
Phakathi kwama-co-factors angaba khona kubantu abanokuhluleka kwesibindi esikhulu:
- Ukusetshenziswa ngokweqile kotshwala
- Ukuhluleka kwezinso
- Ukuqothulwa, okwandisa ukukhiqizwa kwamathumbu emathunjini we-ammonia
- I-pneumonia
- Ukuphuma kwamagciwane, okuvame ukwenzeka esikhathini esizayo kwesifo sesibindi
- I-peritonitis ye-bacterial ejwayelekile, ngokuvamile iwumphumela wesibindi sesibindi
- Ukutheleleka kwe-Urinary tract
- I-potassium ephansi kanye / noma amazinga e-sodium, evame ukubangelwa yi-diuretics esetshenziselwa ukwelapha ama-ascites esikhathini esizayo
- I-benzodiazepines, i-sedative ejwayele ukuqondiswa ukuphatha ukuphuza utshwala
- Izidakamizwa nezidakamizwa ezilwa no-psychotic
- Ukusetshenziswa kokugwema (okuyaziwa nge-transjugular intrahepatic portosystemic shunt, noma i-TIPS), esetshenziselwa ukulungisa ukugeleza kwegazi esibindi
Ngokukhomba izimbangela eziyinhloko zokucindezeleka okungenangqondo, odokotela bayakwazi ukuphatha kahle lesi sifo ngokunciphisa izici ezingase zenze noma zihlasele ukuhlaselwa.
Ukuthi ukwehluleka kwesibindi kuthinta ubuchopho
Ukuphelelwa yisifo esiphundu ngokuvamile kwenzeka lapho isibindi singasakwazi ukwenza imisebenzi yaso evamile yokusebenzisa umzimba.
Kubantu abanesifo esijwayelekile sesibindi, ama-nitrogen aqukethe amathumbu asuka emathunjini athunyelwa esibindi, lapho asetshenziselwa khona futhi agxiliwe emzimbeni. Uma umsebenzi wesibindi ungasebenzi, ama-nitrogen aqukethe ama-nitrogen aqala kancane kancane ukwakha, okwenza ukwanda kwamazinga e-ammonia.
Lezi zinhlayiyana ze-ammonia zisakazeka kulo lonke igazi futhi zidlulise isigqebhezana esingenakulinganiswa esingazungeza ubuchopho. Lapho, kubangela ukuvuvukala kwamangqamuzana obuchopho okuthiwa ama-astrocytes, okugcina ekunciphiseni ukukhiqizwa kwama-neurotransmitters okubalulekile ekucabangeni kwengqondo.
Izimpawu Nezibonakaliso Ze-Encephalopathy Hepatic
Ngokuvamile ukucindezeleka kwe-hepatic kuyinkimbinkimbi ukuxilonga ngezigaba zokuqala zesifo. Ukukhohlwa, ukucasula, ukukhathazeka nokudideka ngokuvamile kuyimpawu zokuqala, eziningi zazo ezingabanjwanga kalula ngisho nabantu abanezifo zesibindi esaziwayo.
Mhlawumbe isibonakaliso sokuqala esicacile siyoba yinto ebizwa ngokuthi i-pattern-sleep pattern, lapho umuntu eyolala khona emini futhi ahlale ephapheme ebusuku. Lokhu kuvame ukulandelwa yizinhlobo zezibonakaliso zesikhathi esilandelayo, ezingabandakanya:
- I-Lethargy
- Ukushintsha komuntu okuphawuliwe
- Ukwandisa ukudideka
- Izinkinga ngokubhala kanye nokunyakaza kwesandla esihle
- Izandla ezithintekayo noma "ukungena" kwezandla
- Ukuqhaqha ngamagatsha ngamalungu
- Ukuziphatha okungavinjelwe
- Amnesia
- Ukungasebenzi kwe-gag reflex
Amacala ahlukumezayo angabangela isimo esibucayi sokuqaphela, ngokuvamile ukuqhubekela phambili ekuqothulweni kobudlova kanye ne-coma. Ukufa kubangelwa ukuvuvukala okukhulu kobuchopho (okuthiwa i-cerebral edema).
Izinyathelo ze-Hepatic Encephalopathy
Izigaba ze-encephalopathy ye-hepatic zihanjiswe esikalini esibizwa ngokuthi i-West Haven Criteria, ehlukanisa ubunzima bezimpawu ezisuselwe ezingeni lokukhubazeka kwegazi:
- Okuncane kakhulu: izinguquko ezisheshayo ngesivinini ngaphandle kwezibonakaliso zenguquko yengqondo
- Ibanga 1: ukungabi nandaba okuncane kokuqwashisa, ukukhathazeka noma ukukhathazeka, ukunciphisa isikhathi sokunakekelwa, ukuguqula isigqi sokulala
- Ibanga lesi-2: ukungahambi kahle noma ukunganakwa, ukuphazamiseka, ukuguquka komuntu obonakalayo, ukuziphatha okungalungile, izinkinga zekhono zamakhono, ukuthuthumela nge "ukukhwabanisa" kwezandla
- Ibanga lesi-3: isimo se-semi-stupor, ukudideka, ukuphazamiseka okukhulu, ukuziphatha okungavamile
- Ibanga lesi-4: i-coma
Izifo zokuxilongwa kwemitholampilo nazo zenziwa ngokuhlukanisa imbangela eyinhloko, kungaba ukuhluleka kwesibindi (Uhlobo A), inqubo ye-TIPS (Thayipha B), noma i-cirrhosis (Thayipha C). Ngalunye lwalezi zigaba zisiza ekunqumeni inkambo efanele yokusebenza ekuphatheni isimo.
Ukuxilongwa
Ukuxilongwa kwe-encephalopathy ye-hepatic kungenziwa kuphela phambi kwesifo esiqinisekisiwe sesibindi noma kubantu abaye bahlangabezana nenqubo ye-TIPS. Ukuxilongwa kwenziwa ngokungafaki zonke ezinye izimbangela zokukhubazeka kwegazi.
Ubuchwepheshe bezokwelapha buyadingeka ukuze kutholakale ukuhlonza okuhlukile ; akukho ukuhlolwa okukodwa okungaqinisekisa noma ukukhipha ngokugcwele isimo. Uma kucatshangwa ukuthi i-encephalopathy i-hepatic, odokotela bayovame ukuhlela ukuhlolwa kwebhethri, okungabandakanya:
- Ukuhlaziywa kwamakhono okubukwa, ama-motor kanye namazwi
- I-CT ihlola ukuthi ingabandakanyi noma iqinisekise ukubola kwesisu
- I-Electroencephalograms (EEG) uma kutholakala ukuhlukunyezwa
- Ukuhlolwa kwegazi ukuhlola amazinga we-serum ammonia
- Amasampuli e-Fluid avela emgodini we-peritoneal (ohlukanisa umthambo wesisu kusuka odongeni lwesisu) ukuze ungafaki noma uqinisekise ukutheleleka kwebhaktheriya
- Ezinye izivivinyo, kufaka phakathi i-X-rays yesifuba ne-urinalysis, ukukhipha ezinye izimbangela ezikhona
Ukwelapha
Ukuphelelwa yisifo sofuba kunokwelapha. Ukwelashwa kuvame ukugxila ekuxazululeni noma yisiphi isimo esincane esingase senze noma siphuthumise ukuhlaselwa. Kwezinye izimo (njengabantu abaye bahlangabezana nenqubo ye-TIPS), isimo singasombulula ngokuzenzekelayo futhi asidingi ukungenelela okunye. Ngezinye izikhathi, ukuqedwa kwesinye isidakamizwa noma ukwelashwa kokuqothulwa kungaba ngcono kakhulu izimpawu ze-neurological.
Ezimweni lapho kutholakala khona ukutheleleka okusebenzayo, ama-antibiotics ayobekwa ngendlela efana ne- rifaximin . Ukwengeza, i- lactulose ivame ukushiwo njengendlela yokwelapha lokuqala ukunciphisa ukukhiqizwa kwe-ammonia emathunjini.
Isibikezelo somuntu one-encephalopathy ye-hepatic singahluka kakhulu. Ukuxilongwa kwe-encephalopathy, kanye nebhethri yokuhlolwa kwesibindi, kuzovame ukusetshenziswa ukuze kutholakale ukuthi umuntu uzodinga ukufakelwa kwesibindi . Kubantu abanesifo esiqhamuka esibindi, njenge-cirrhosis ekhulelwe noma umdlavuza wesibindi , ukufakelwa kwesibindi kuvame ukuboniswa.
> Imithombo:
> Vilstrup, H .; I-Amodio, i-P .; I-Bajaj, J .; et al. " Incephalopathy Hepatic in Chronic Liver Disease: Iziqondiso Zokuziphatha Zika-2014 ezivela ku-AASLD ne-EASL." I-AASLD Yokusebenzisa Isiqondiso. 2014: 3-67.
> Conn, H. "Ukucindezeleka kwe-Hepatic." Schiff, L no-Schiff, E., ama-eds. Izifo zesibindi . I-7th ed. Philadelphia, PA: Lippicott; 1993: 1036-1060.