Izimbangela, Izimpawu, kanye Nokuphathwa
Isithasiselo siyisakhiwo esincane, esinjengeshubhu esifakwe engxenyeni yokuqala yamathumbu amakhulu (okubizwa nangokuthi ikholoni). Ngenkathi isithasiselo sitholakala engxenyeni engezansi kwesisu, ayinawo umsebenzi owaziwayo nokususwa kwayo kubonakala ingenzi ushintsho emsebenzini wokugaya ukudla.
Sibutsetelo
I-appendicitis ukuvuvukala kwesithasiselo. Uma iqala, ayikho yokwelashwa okwelapha okuphumelelayo, ngakho-ke uhlelo lokusebenza lwe-appendicitis lubhekwa njengesimo esiphuthumayo sezokwelapha.
Lapho siphathwa ngokushesha, iziguli eziningi zilula ngaphandle kobunzima. Uma ukwelashwa kubambezelekile, isithasiselo singaphula, sibangele ukutheleleka ngisho nokufa.
Ngisho noma ubani angathola i-appendicitis, kwenzeka kaningi phakathi kweminyaka engu-10 no-30.
Izimbangela
Isizathu se-appendicitis sibhekisela ekuvinjweni kwangaphakathi kwesithasiselo, esaziwa njenge-lumen. Ukuvinjelwa kuholela ekucindezelweni okukhudlwana, ukugeleza kwegazi okungaphelele, nokuvuvukala. Uma ukuvinjelwa kungaphathwa, ukuhlukunyezwa nokuphuka (ukuphula noma ukukhipha) kwesithasiselo kungabangela.
Ngokujwayelekile, udoti luvimbela ngaphakathi kwesithasiselo. Kanti futhi, ukutheleleka kwamagciwane noma ama-virus emgodini wokugaya kungadala ukuvuvukala kwama-lymph nodes, okufakela isithasiselo bese kubangela ukuvinjelwa. Ukulimala okubuhlungu emathunjini kungase kuholele ekusebenziseni i-appendicitis, ngenani elincane labantu.
Ungase umangale uma uzwa ukuthi izakhi zofuzo zingase zibe yimbangela kulabo abathola i-appendicitis. Ngamanye amazwi, ukufakwa komzimba okusebenza emindenini kungase kubangele ukuhlukahluka kofuzo okubeka umuntu ithuba lokuvinjelwa kwe-appendiceal lumen.
Izimpawu
Izimpawu ze-appendicitis zingabandakanya:
- Ubuhlungu esiswini , kuqala kuzungeze inkinobho yesisu, bese uhamba endaweni engezansi kwesokudla-lokhu kuthiwa ubuhlungu besisu esisuka emathunjini
- Ukulahlekelwa kwesifiso
- I-nausea nokuhlanza
- Ukuqokwa noma isifo sohudo
- Ukungakwazi ukudlula igesi noma ukudlula kwegesi njalo
- Umkhuhlane ophansi oqala ngemva kwezinye izimpawu
- Ukuvuvukala kwesisu
- Ukuzithoba
Ngokuhlukunyezwa kwesisu kwe-appendicitis (isibonakaliso esivame kakhulu futhi esivela ngaso sonke isikhathi), ubuhlungu bukhulu bukhula futhi bubuhlungu uma kuthutha, ukuthatha ukuphefumula okujulile, ukukhwehlela noma ukukhipha. Indawo ebuhlungu iba yithenda kakhulu kunoma yikuphi ukucindezelwa.
Abantu bangase babe nokuzwa okubizwa ngokuthi "ukunciphisa phansi," okubizwa nangokuthi "tenesmus," okuwukuthi umuzwa wokuthi ukunyakaza kwamathumbu kuzokwenza ukuba kunciphise ukuhlukumeza kwabo. Lokhu kuthiwa, ama-laxatives akufanele athathwe kulesi simo.
Kubalulekile ukuqonda ukuthi akuwona wonke umuntu onokufaka ama-appendicitis anezibonakaliso ezingenhla. Yingakho kubalulekile ukubona udokotela ngokushesha uma unenkinga noma noma yiziphi izimpawu ezingenhla ngezinhlungu zomzimba.
Futhi, abantu abanezimo ezikhethekile bangase bangabi neqoqo lezimpawu ezingenhla futhi bangase babe nomuzwa ojwayelekile wokungahlali kahle. Iziguli ezinalezi zimo zihlanganisa:
- Abantu abasebenzisa i-immunosuppressive therapy njenge-steroids
- Abantu abaye bathola isici sokufakelwa kabusha
- Abantu abanegciwane lesandulela ngculaza
- Abantu abanesifo sikashukela
- Abantu abanomdlavuza noma abathola i- chemotherapy
- Abantu abakhulu kakhulu
Abesifazane abakhulelwe
Ubuhlungu besisu, isicanucanu, nokuhlanza kuvame kakhulu ngesikhathi sokukhulelwa futhi kungenzeka noma kungabi yizibonakaliso zokufakwa kwesisu.
Abesifazane abaningi abahlakulela i-appendicitis ngesikhathi sokukhulelwa abatholi izimpawu zakudala, ikakhulukazi ku-trimester yesithathu. Kubalulekile ukuthi owesifazane okhulelwe ozwa ubuhlungu ngakwesokudla sokuxhumana nesisu ngesidakamizwa.
Izinsana Nezingane
Izinsana nezingane ezincane ngokuvamile azikwazi noma zinganiselwe ekukhulumeni ubuhlungu kubazali noma odokotela babo. Ngaphandle komlando ocacile, odokotela kumele bathembele ekuhloleni ngokomzimba kanye nezimpawu ezingacacile, njengokuhlanza nokukhathala. Ngezinye izikhathi izingane ezinenkinga ye-appendicitis zinenkathazo yokudla futhi zingase zibonakale zilele ngokungajwayelekile. Izingane zingase zibe nokuqothulwa, kodwa zingase zibe nezitshalo ezincane eziqukethe i-mucus.
Ngamafuphi, izimpawu ziyahlukahluka phakathi kwezingane futhi azifani nezezidala njengalabo abadala (ikakhulukazi ezinganeni ezincane). Ngakho uma ucabanga ukuthi ingane yakho ine-appendicitis, xhumana nodokotela ngokushesha.
Abantu abadala
Iziguli ezindala zivame ukuba nezinkinga eziningi zezokwelapha kunabantu abasha. Abantu asebekhulile bavame ukuzwa umkhuhlane omncane futhi ubuhlungu obukhulu kakhulu besisu kunabanye abagulayo abenza nge-appendicitis. Abantu abadala asebekhulile abazi ukuthi banenkinga enkulu kuze kube yilapho isithasiselo sesisondele ekukhuliseni. Umkhuhlane omncane kanye nobuhlungu besisu ngesinye ngakwesokudla kukhona izizathu zokubiza udokotela ngokushesha.
Yiqiniso, bonke abantu abanezinkinga ezikhethekile zezempilo nemindeni yabo kudingeka baqaphele ngokuphawulekayo ushintsho ekusebenzeni okujwayelekile kanye neziguli kufanele babone odokotela babo ngokushesha, kunokuba kamuva, uma kwenzeka ushintsho.
Ukuxilongwa
Umlando Wezokwelapha
Ukubuza imibuzo ukuze ufunde umlando wezimpawu kanye nokuhlolwa okucophelela ngokomzimba kuyisihluthulelo ekutholeni ukufakwa kwesicelo. Udokotela uzobuza imibuzo eminingi-njengokungathi intatheli-ezama ukuqonda uhlobo, isikhathi, indawo, iphethini, nobukhulu bezinhlungu nezimpawu. Noma yiziphi izimo zezokwelapha zangaphambilini kanye nokuhlinza, umlando womndeni, imithi, kanye nokwelapha kuyinto ebalulekile kudokotela. Ukusetshenziswa kotshwala, ugwayi kanye nezinye izidakamizwa kufanele kukhonjiswe. Lolu lwazi lubhekwa njengeyimfihlo futhi alukwazi ukwabiwa ngaphandle kwemvume yesiguli.
Ukuhlolwa Kwemvelo
Ngaphambi kokuqala ukuhlolwa ngokomzimba, umhlengikazi noma udokotela uzovame ukulinganisa izimpawu ezibalulekile: izinga lokushisa, izinga lokushisa, izinga lokuphefumula, nokucindezelwa kwegazi. Ngokuvamile, ukuhlola ngokomzimba kuvela ekhanda kuya enzwaneni. Izimo eziningi ezifana ne-pneumonia noma isifo senhliziyo zingabangela ubuhlungu besisu. Izimpawu ezijwayelekile ezifana nomkhuhlane, ukuqhuma, noma ukuvuvukala kwama-lymph nodes kungase kubhekisele ezifweni ezingadingi ukuhlinzwa.
Ukuhlolwa kwesisu kusiza ukuxilongwa. Indawo yobuhlungu nobubele kubalulekile-ubuhlungu kube uphawu oluchazwa umuntu kanye nesisa ngokuba impendulo ekuthintweni.
Izimpawu ezimbili, ezibizwa ngokuthi izibonakaliso ze-peritoneal, ziphakamisa ukuthi ukwelulwa kwesisu kuvuvukala futhi kungenziwa ukuhlinzwa:
- ithenda eliphindaphindiwe
- ukuqapha
Ukwethembeka okuphindaphindiwe yilapho udokotela ecindezela engxenyeni yesisu futhi lowo muntu uzizwa ethandeka kakhulu uma ingcindezi ikhishwa ngaphandle kokuthi isetshenziswe.
Ukuqapha kubhekisela ekutheni imisipha ishaxa ngokuphendula.
Udokotela angase futhi athuthe imilenze yesiguli ukuze avivinye ubuhlungu ekujuleni kwe-hip (ebizwa ngokuthi isibonakaliso se-psoas), ubuhlungu ekujikelezweni kwangaphakathi kwesibindi (okubizwa ngokuthi uphawu lwe-obturator), noma ubuhlungu ngakwesokudla uma ucindezela ngakwesokunxele (ukubiza Uphawu lukaRovsing). Lezi zibonakaliso ezibalulekile zokuvuvukala kodwa akuzona zonke iziguli ezinezifo.
Izivivinyo zeLebatho
Ukuhlolwa kwegazi kusetshenziselwa ukuhlola izimpawu zokutheleleka, njengokubalwa kwamangqamuzana egazi. Amakhemikhali egazi aphinde akhombise ukukhulelwa kwamanzi noma ukuphazamiseka kwamanzi kanye ne-electrolyte. Ukuhlolwa kwe-urinal kusetshenziselwa ukulawula ukutheleleka kwe-urinary tract. Odokotela bangase bahlele ukuhlolwa kokukhulelwa kwabesifazane abaneminyaka yobudala yokubeletha noma benze ukuhlolwa kwe-pelvic ukulawula izimbangela zesisu zokuhlunguphaza.
Ukuhlolwa kwezilingo
Imisindo ye-X, i-ultrasound, ne-computed tomography (CT) ingaveza izithombe zesisu. Imifula x enhle ingabonisa izimpawu zokuvimbela, i-perforation (imbobo), izidumbu zangaphandle, futhi ezimweni ezingavamile, i-appendicolith, okuyi-stool enzima esihlokweni.
I-Ultrasound ingabonisa ukuvuvukala kwesithasiselo futhi ingahlola isifo se- gallbladder nokukhulelwa.
Ngokwevivinyo oluvame kakhulu ukusetshenziswa, noma kunjalo, yi-CT scan. Lokhu kuhlolwa kunikeza uchungechunge lwezithombe zomzimba ezihamba phambili futhi kungabona izimo eziningi zesisu futhi kube lula ukuxilongwa lapho ukuphazamiseka komtholampilo kungabaza. Ngezinye izikhathi, i-imagery ye-resonance magnetic (MRI) isetshenziselwa ukusiza ekuhloleni kukadokotela nge-appendicitis kwabesifazane abakhulelwe (njengoba imisebe inikezwa ngesikhathi se-CT kodwa hhayi i-MRI).
Ezimweni ezikhethiwe, ikakhulukazi kwabesifazane uma imbangela yezimpawu zingase zibe isithasiselo noma i-ovary noma i-fallopian tube, i-laparoscopy ingadingeka. Le nqubo igwema imisebe kodwa idinga i-anesthesia ejwayelekile. I-laparoscope iyi-tube encane enekhamera ehlanganiswe efakwe emzimbeni ngokusebenzisa ukusika okuncane, okuvumela odokotela ukuba babone izitho zangaphakathi. Ukwelashwa kungenziwa lapho i-laparoscopically uma isimo samanje sidinga khona.
Ukwelapha
Ukuhlinzwa
I-appendicitis enhle iphathwa ngokuhlinzwa ukuze isuse isithasiselo . Ukusebenza kungenziwa ngokuvuleka ngokucubungula okuncane okujwayelekile kwesisu, noma kungenziwa ngokusebenzisa i-laparoscope, edinga ukuboniswa okuncane kwezintathu noma ezine. Uma ezinye izimo zisolakala ngaphezu kwe-appendicitis, zingase zikhonjwe ngokusebenzisa i-laparoscopy. Kwezinye iziguli, i-laparoscopy inenzuzo yokuvula ukuhlinzeka ngoba ukuhlunga kuyinkimbinkimbi, isikhathi sokuphumula siyashesha, futhi imithi yokuhlungu ubuhlungu iyadingeka. Isihlomelo sisuswe ngaso sonke isikhathi, ngisho noma sitholakala sijwayelekile. Ngokususwa okuphelele, noma yiziphi iziqephu zamuva zobuhlungu ngeke zibhekiswe ku-appendicitis.
Ukubuyiswa okuvela ku-appendectomy kuthatha amasonto ambalwa. Odokotela ngokuvamile banikeza imithi ebuhlungu futhi babuze iziguli ukuba zilinganise ukusebenza komzimba. Ukubuyiswa okuvela ku-appendectomy laparoscopic ngokuvamile kuyasheshisa, kodwa umsebenzi okhungathekayo ungase udingeke izinsuku ezingu-3 kuya kwezingu-5 ngemuva kokuhlinzwa okuyisifo se-laparoscopic nezinsuku ezingu-10 kuya kwezingu-14 emva kokuhlinzwa okuvulekile. Iningi labantu eliphathekayo ukuze lisebenzise i-appendicitis libuyele kahle futhi lingavamile ukuba lenze izinguquko ekudleni, ekuzivocavoca, noma endleleni yokuphila.
I-Antibiotic Therapy
Uma ukuxilongwa kungaqiniseki, abantu bangabuka futhi ngezinye izikhathi baphathwe ngama-antibiotic. Le ndlela ithathwa uma udokotela esolwa ukuthi izimpawu zesiguli zingase zibe nezizathu ezingelapheki noma ezikwelapha ngokwelapha. Uma imbangela yobuhlungu isifo esithathelwanayo, izimpawu zixazulula ngama-antibiotiki anesifo sangaphakathi kanye namanzi aphethwe yi-intravenous fluids.
Kodwa-ke, ngokuvamile, ukufakwa kwesilwane kungaphathwa kuphela ngokuhlinzwa-kuphela kubantu abathile noma kubantwana kuyindlela yokwelapha yokwelashwa yedwa okubhekwa njengendlela yokwelapha yokwelapha.
Ngezinye izikhathi umzimba uyakwazi ukulawula i-perforation yokwengeza ngokwenza i-abscess. I-abscess iyenzeka uma ukutheleleka kuvinjelwe endaweni eyodwa yomzimba. Udokotela angase akhethe ukukhipha isikhwama sakhe bese eshiya isikhwama samathambo amasonto ambalwa. I-appendectomy ingase ihlelwe ngemuva kokuba i-abscess isheshiwe.
Izinkinga
Inkinga enkulu kakhulu ye-appendicitis iphuka. Isithasiselo siqhuma noma izinyembezi uma i-appendicitis ingatholakali ngokushesha futhi ingaphathwa kabi. Izinsana, izingane ezincane, nabantu abadala asezikhungweni eziphezulu. Isithasiselo esiphunduwe singaholela ku-peritonitis ne-abscess. I-Peritonitis iyisifo esithathelwanayo esiyingozi uma kwenzeka uma amabhaktheriya kanye nokunye okuqukethwe kwe-appendix ehlanjulwe kuvuza ngaphakathi esiswini. Kubantu abane-appendicitis, i-abscess ngokuvamile ithatha isimo sesisindo sokuvuvukala esigcwele uketshezi namagciwane. Eziguli ezimbalwa, izinkinga ze-appendicitis zingaholela ekuhlulekeni komzimba nokufa.
> Imithombo:
> I-American College of Odokotela. (Kubukeziwe ngo-2014. I-Appendectomy: Ukususwa Okuhlinzekwa kwesithasiselo.
> Martin RF. (Novemba 2016). I-appendicitis enhle kubantu abadala: ukubonakaliswa kwemitholampilo nokuxilongwa ngokungafani. Ku: UpToDate, Weiser M (ed), UpToDate, Waltham, MA.
> Isikhungo Sikazwelonke Sesifo Sikashukela kanye Nezifo Zokugula Nezinso Zokugaya. I-Appendicitis.
> Wilms IM, de Hoog DE, de Visser DC, uJanzing HM. I-Appendectomy ngokumelene nokwelashwa kwama-antibiotic we-appendicitis enzima. I-Cochrane Database Syst Rev. 2011 Nov 9; (11): CD008359.