Konke Okudingeka Ukwazi Nge-Hepatorenal Syndrome

by Veeraish Chauhan, MD, udokotela oqinisekiswe yibhodi

Lokhu kunzima kwezifo zesibindi kungabangela ukwehluleka kwezinso

Sibutsetelo

Izitho zomuntu azikwenzi umsebenzi wazo ngokuzihlukanisa. Baxhumana nomunye nomunye. Baxhomeke komunye nomunye. Ukuqonda umsebenzi wendikimba kudinga ukuthi umuntu aqonde indima yezinye izitho. Umzimba womuntu ufana ne-orchestra enzima kakhulu. Uma ngabe uvele ulalele abaculi ngabanye, ungase ungabongi i-symphony.

Uma sesiyiqonda lo mqondo obalulekile, kuba lula ukuqonda ukuthi izinkinga zomsebenzi owodwa zingathinta omunye.

Incazelo yeHepatorenal Syndrome (HRS)

Njengoba leli gama lisikisela, igama elithi "hepato" libhekisela esibindi, kanti "ukuqothulwa komzimba" kubhekisela ezinso. Ngakho-ke, i-hepatorenal syndrome isho isimo lapho isifo sesibindi siholela esibhedlela sezinso noma ezimweni ezimbi kakhulu, ukwehluleka kwezinso .

Kodwa, kungani sidinga ukwazi nge-hepatorenal syndrome? Isifo sesibindi isakhiwo esivamile (cabanga nge-Hepatitis B noma C, utshwala, njll). Futhi endaweni yonke yesifo sesibindi, i-hepatorenal syndrome akuyona into engavamile. Ngokusho kwesinye isibalo, amaphesenti angama-40 weziguli ezine-cirrhosis (eboshiwe, isibindi se-shrunken) kanye ne-ascites (ukuqoqwa kwamanzi esiswini esiswini esiphezulu kwesifo sesibindi) kuzokwandisa i-hepatorenal syndrome engakapheli iminyaka emihlanu.

Isici Sengozi

Isici sokuqala ku-hepatorenal syndrome njalo uhlobo lwesifo sesibindi.

Lokhu kungaba konke okusuka ku-hepatitis (kusuka kuma-virus afana ne-Hepatitis B noma i-C, izidakamizwa, isifo sokuzimela, njll), kuya kwezicubu zesibindi, ukuya e-cirrhosis, noma ngisho nesimo esesabekayo sesifo sesibindi esihambisana nokuncipha okusheshayo kwesibindi, okuthiwa ukwehluleka kwesibindi se-fulminant. Zonke lezi zimo zingadala isifo sezinso nokuhluleka kwezinso zamanqanaba ahlukene obukhulu emlonyeni we-hepatoreal.

Kodwa-ke, kunezici ezithile ezicacile ezicacile nezingozi ezikhulisa kakhulu amathuba okuba umuntu ehluleka ukuhluleka kwezinso ngenxa yesifo sesibindi.

Ukwelashwa kwesisu esiswini (okungase kwenzeke ngezinye izikhathi kubantu abane-cirrhosis), okuthiwa yi-bacterial peritonitis (SBP)
Ukukhipha igazi ku-gut, okuyinto evamile ezigulini ze-cirrhosis ezivela emithanjeni yegazi ezikhukhulayo zibe yisibonelo (izinyathelo zokuqapha)

Amaphilisi amanzi (izidakamizwa ezinjenge-furosemide noma i-spironolactone) ezinikezwa iziguli ezine-cirrhosis nokugqithisa oketshezi azifakeli i-hepatorenal syndrome (nakuba zingalimaza izinso ngezindlela).

Ukunyuka kwezifo

Izindlela izifo zesibindi ezibangela izinkinga ngezinso zezinso kucatshangwa ukuthi zihlobene "nokunciphisa" kokunikezwa kwegazi kude nezinso nakuzo zonke izitho zomzimba zesisu (okuthiwa " ukusabalalisa kwe-splanchnic ").

Esinye isici esiyinhloko esinquma ukuhlinzeka ngegazi kunoma yisiphi isici ukuphikiswa okuhlangene negazi eligeleza kulolo sigaba. Ngakho-ke, ngokusekelwe emithethweni ye-physics, isinciphisi se-sitsha segazi, ukuphakama okungaphezu kwalokho kuzokwenza ukuthi kuqhume igazi .

Isibonelo, ucabange ukuthi ngabe uzama ukupompa amanzi ngamapulangwe amabili ahlukene egadidi usebenzisa isilinganiso esilinganayo sokucindezela (okusemzimbeni womuntu okwenziwe yinhliziyo).

Uma zombili lezi zibambo zinezibani ezilingana nobukhulu / caliber, umuntu angalindela inani elilinganayo lamanzi ukugeleza kuzo. Manje, kwenzekani uma enye yalezi zinduku yayivulekile kakhulu (ukulinganisa okukhulu) kunomunye? Amanzi amaningi azohamba ngokuphambene phakathi kwephasi elibanzi ngenxa yokumelana okuncane lapho amanzi ehlangana khona.

Ngokufanayo, esimweni se-hepatorenal syndrome, ukukhulisa (ukuhlanjululwa) kwemithambo ethile yegazi emjikelezweni we-splanchnic esiswini kususa igazi kude nezinso (imithwalo yegazi layo ivinjelwe). Nakuba lokhu kungaqhubeki ukuqhubekela ezinyathelweni ezihlukile, ukuze ukwazi ukuqonda, nansi indlela esingayibonisa ngayo lokhu:

Isinyathelo 1- I-trigger yokuqala yinto okuthiwa i- portal hypertension (ukwanda kwengcindezi yegazi emithanjeni ethile egazini igazi kusukela esiswini, i-pleen, i-pancreas, emathunjini), evamile kwiziguli eziphethwe yisifo senhliziyo. Lokhu kuguqula ukugeleza kwegazi emzimbeni wesisu esiswini ngokuphucula imithwalo yegazi ye-splanchnic ngenxa yokukhiqizwa kwekhemikhali ebizwa ngokuthi " nitric oxide ". Lokhu kukhiqizwa imithwalo yegazi ngokwabo futhi yiyo yikhemikhali efanayo abayisosayensi abayifake ekwenzeni imithi efana ne-Viagra.
Isinyathelo sesibili - Nakuba izitsha zegazi ezingenhla zihlanza (futhi ngaleyo ndlela zithatha igazi elingaphezu kwegazi), kunezitsha zegazi ezintsheni eziqala ukuvimbela (ngaleyo ndlela ukunciphisa ukuhlinzeka ngegazi). Izinqubo eziningiliziwe zalokhu zingaphezu kwalesi sihloko, kodwa kucatshangwa ukuthi zihlobene nokuqaliswa kwesistimu okuthiwa i-renin-angiotensin.

Lezi zinguquko zegazi zizophela futhi zenze ukwehla okusheshayo emsebenzini wezinso.

Ukuxilongwa

Ukuxilongwa kwe-hepatorenal syndrome akuyona ukuhlolwa kwegazi okuqondile. Ngokuvamile odokotela babiza ukuxilongwa kokuxoshwa . Ngamanye amazwi, omunye wayezobukeka ngesethulo semitholampilo yesiguli sesifo sesibindi esethula ngokuhluleka kwezinso ezingachaziwe. Okudingekayo ukuxilongwa kungaba ukuthi udokotela uzodinga ukukhipha ukuthi ukuhluleka kwezinso akuyona imbangela yanoma yiyiphi enye imbangela (ukungcola, umphumela wemithi ongalimaza izinso njengezindleko zobuhlungu be-NSAID , umphumela wokuzivikela omzimba we-Hepatitis B noma i-virus, i-autoimmune izifo, ukuvinjelwa, njll). Uma leso simo sesifinyelelwe, siqala ngokuqinisekisa ukwehla kwemisebenzi yezinso ngokubheka izici ezithile nokuhlolwa:

Izinga eliphezulu le-creinine egazini, elihambisana nokunciphisa izinga lokuhlunga izinso (GFR)
Yehla ekukhipha umchamo
Izinga eliphansi le-sodium elikhona emcinini
I-ultrasound yezinso, ezingeke zibonise noma yini, kodwa ingabandakanyeka ezinye izimbangela zokuhluleka kwezinso kumguli ocatshangwa ukuthi une-hepatorenal syndrome
Ukuvivinya igazi noma amaprotheni kumchamo. Amazinga angekho / amancane ayesekela ukuxilongwa kwe-hepatorenal syndrome
Impendulo yokwelapha isetshenziselwa njengesivivinyo "sokuhlolwa kwesifo" sokuthola ukuxilongwa. Ngamanye amazwi, uma umsebenzi wezinso uphuthukisa ngokuphawulekayo ngemuva kokuthi "i-hydration" (okungase ihilele ukunikeza isiguli esiswini somzimba noma ukumnika amaprotheni we-albin), cishe akunakwenzeka ukuba kube yi-hepatorenal syndrome. Eqinisweni, ukumelana nalezi zindlela zokwelashwa ezivame ukuveza ukusola nge-hepatorenal syndrome okwamanje

Ngifuna ukugcizelela ukuthi ngisho nokuhlola ukwehluleka kwezinso kungase kungabi njalo ngqo esigulini esinesifo esiyinhloko sesibindi noma isifo se-cirrhosis. Lokhu kungenxa yokuthi ukuhlolwa okuvame kakhulu esikuthembele ekuhloleni umsebenzi wezinso, izinga le-serum creatinine, ngeke liphakamise kakhulu iziguli ze-cirrhosis endaweni yokuqala. Ngakho-ke, ukubheka izinga le-serum creatinine kungadukisa isifo sokuthola izifo ngoba kuyoholela ekubhekiseni ukuqina kwezinso ezinzima. Ngakho-ke, ezinye izivivinyo ezinjenge-24-hour urine creinine imvume zingase zidingeke ukusekela noma ukuphikisa izinga lokuhluleka kwezinso.

Izinhlobo

Lapho ukuxilongwa kuqinisekiswa ngokusebenzisa izindlela ezingenhla, odokotela bazohlukanisa i-hepatorenal syndrome ibe yi-Type-I noma i-Type-II. Umehluko ukhona ebucayi nasenkathini yokugula. Uhlobo Iluhlobo olunamandla kakhulu, oluhambisana nokuncipha okusheshayo nokujulile (okungaphezu kwe-50%) emsebenzini wezinso ezingaphansi kwamasonto amabili.

Ukwelapha

Manje ukuthi siyaqonda ukuthi i-hepatorenal syndrome isuswe yisifo sesibindi (nge-portal hypertension ibe yinkampani yokugqugquzela i-agent), kulula ukuqonda ukuthi kungani ukwelapha izifo zesibindi ezingaphansi kwesibindi kuyona okubaluleke kakhulu kanye ne-crux yokwelapha. Ngeshwa, lokho akunakwenzeka ngaso sonke isikhathi. Eqinisweni, kungase kube nezinhlangano ezingekho ukwelashwa noma, njengoba kwenzeka ekuhlulekeni kwesibindi, lapho ukwelashwa (ngaphandle kokufakelwa kwesibindi) kungase kungasebenzi ngisho. Ekugcineni, kukhona isici sesikhathi. Ikakhulukazi ngohlobo lwama-HRS. Ngakho-ke, nakuba isifo sesibindi singase siphathwe, kungenzeka ukuthi akunakwenzeka ukulinda ukwelashwa kwakhe esigulini ngezinso eziphuthumayo ngokushesha. Uma kunjalo, imithi kanye ne- dialysis ziyadingeka . Nazi izinketho ezimbalwa esinaso:

Eminyakeni yamuva, kuye kwaba nobufakazi obuhle mayelana nendima yemithi entsha ebizwa ngokuthi i-terlipressin. Ngeshwa, ayitholakali kalula e-United States, nakuba ukusetshenziswa kwayo kunconywa emhlabeni wonke ngokuphathwa kokwelashwa kwesifo se-hepatorenal syndrome. Lokho esikutholayo lapha, kungukuthi, imithi ebizwa ngokuthi i-norepinephrine (imithi ejwayelekile esetshenziswa ku-ICU ukuphakamisa ukucindezelwa kwegazi kubantu abanomfutho wegazi ophansi ngokweqile), kanye "ne-cocktail regimen" ehlanganisa izidakamizwa ezintathu, okuthiwa i-octreotide, i-midodrine ne-albin (iphrotheni enkulu ekhona egazini).
Uma le mithi ingasebenzi, inqubo yokungenelela ebizwa ngokuthi i-TIPS (ukufakwa kwe-transjugular intrahepatic portosystemic shunt) ingase ibe nenzuzo, nakuba ifika nezinkinga zayo siqu.
Ekugcineni, uma konke kungaphumeleli futhi izinso zingabuyiselwa, i-dialysis ingadingeka njenge "bridge bridge" kuze kube yilapho isibindi sesibindi singasetshenziswa ngokubhekiselwe.

Ngokuvamile, uma imithi echazwe ngenhla ingasebenzi phakathi kwamasonto amabili, ukwelashwa kungabhekwa njengento engenamsebenzi futhi ingozi yokufa ikhuphuka kakhulu.

Ukuvimbela

Kuya ngesimo. Uma isiguli sinesifo sesibindi esaziwa ngezinkinga ezibonakalayo eziqhamukayo (njengoba kuchaziwe ngenhla esigabeni esineziguli ezingozi kakhulu) ze-hepatorenal syndrome, ezinye izindlela zokwelashwa zokuzivikela zingasebenza. Ngokwesibonelo, iziguli ezine-cirrhosis nezikhukhula esiswini (okuthiwa i-ascites), zingase zizuze ku-antibiotic ebizwa ngokuthi i-norfloxacin. Iziguli zingase zizuze ngokuphindaphindiwe kwe-albinini.

> Imithombo:

> Ukukhubazeka, izici zokubikezela, nokubikezelwa kwe-hepatorenal syndrome ku-cirrhosis ene-ascites. Gines et al. I-Gastroenterology. 1993 Jul; 105 (1): 229-36.

> Terlipressin ku-hepatorenal syndrome: Ubufakazi bezinkomba zamanje. Rajekar et al.J Gastroenterol Hepatol. 2011 Jan; 26 Suppl 1: 109-14. i-doi: 10.1111 / j.1440-1746.2010.06583.x

> I- prophylaxis eyinhloko ye-bacterium peritonitis ephuza i-hepatorenal syndrome iphinde ithuthukise ukusinda ku-cirrhosis. UFernández J. Gastroenterology. 2007 Sep; 133 (3): 818-24. I-Epub 2007 Jul 3.