Isinqumo okumelwe sihlolwe ngokucophelela
Uma unesifo esibi kakhulu sesibindi, njengokuthi isifo sesibindi sokudakwa noma u- hepatitis B noma C kanye nokuhlinzwa okungahambisani nesibindi, izinto zingaba nzima. Isinqumo sokuqhubeka nokuhlinzwa kulokhu akuthathwa kalula. Odokotela bakho kudingeka bacabangele izici eziningana lapho benquma ingozi yakho yokusebenza nokuthi ngabe uzobhekana nezinkinga ezinkulu noma ukufa okubangelwa ukuhlinzwa.
Ngokukhethekile, kulabo abanesifo somzimba sebesevele sithinteka ngenxa yokugula okunzima noma okungapheli, ukuhlinzwa kungase kube nesisindo esikhwameni sokuxoshwa kwesibindi, noma ukuwohloka kwesibindi, ukuhluleka kwesibindi nokufa. Ngakho-ke, ukuhlinzekwa kufanele kucatshangelwe ngokucophelela uma unesifo sesibindi.
Izinto ezihlolwe kulabo abazokwazi ukuhlinzeka ngokuhlinzwa ngezifo zesibindi zihlanganisa okulandelayo:
- ubuqili, imbangela nokuqina kwesifo sesibindi
- uhlobo lokuhlinzwa
- ukuphuthuma kokuhlinzwa
- uhlobo lwe- anesthesia
- i-intraoperative yehla e-blood pressure
Ake sibheke izici ezihlukahlukene izibhedlela, odokotela abahlinzayo, abahlinzeki bama-hepatologists (ochwepheshe bezinyosi) kanye namanye amalungu eqembu elibhekele ezempilo acabange ngaphambi kokunquma ukuthi umuntu onesifo sesibindi ungumuntu obhekene nokuhlinzwa.
Ukuhlolwa Kwemvelo
Ukuthi ubhekene nomuntu ohlinzekwa kanjani, noma isethulo somtholampilo ngaphambi kokuba ahlinzekwe yingxenye ebalulekile yokuhlola ingozi yokuhlinzeka kulabo abanesifo sebindi.
Ngokujwayelekile, udokotela uzobheka izibonakaliso nezimpawu ezilandelayo ezibonisa ukuthi u-hepatitis oyingozi:
- isiyaluyalu
- i-jaundice
- ukuhlanza
- ukuthuka ebusuku
- i-pruritis (itchiness)
- ukulahlekelwa isisindo
Kubantu abane- cirrhosis , eziningi zezibonakaliso ezilandelayo zenzeka kancane ukuze zifake isifo somfutho wegazi ophezulu futhi zibonise ukuhlushwa okuncane kakhulu futhi ziphakamise ukuthi i-cirrhosis evuliwe.
- ukwandisa ebhinceni lomzimba (okubonisa ukuthi i- ascites )
- inzuzo yesisindo (okubonisa ukuthi i-ascites)
- ukuguqulwa kwememori (okubonisa ukukhathazeka okukhulu kwe- hepatic )
- ukuphuma kwegazi kwamanje nje (okubonisa ukuthi i-variceal yegazi)
- ushintsho ekujikelezeni kokulala
- i-jaundice (ukuphuka kwamehlo, isikhumba, nezinye izitho zomzimba)
Abantu abaningi abanesipiliyoni se-cirrhosis bashintsha emaphethini okulala. Lezi zinguquko ziye zavezwa ngokuyinhloko nge-encephalopathy ecindezelekile futhi i-hepatic melatonin metabolism eyingozi ; Kodwa-ke, akukafaneli sikwazi ukucacisa ukuphikisana kwezinto eziqondile zokuphazamiseka kokulala.
Ukuqina kwesifo senhliziyo
Abantu abane-hepatitis enzima noma i-cirrhosis ehlukumezekile, kanye nokwehluleka kwesibindi, akufanele bahlinzekwe. Lokhu kunengqondo ngoba awufuni isiguli sibe nokusebenza kabi kwesibindi ngesikhathi sokuhlinzwa. Ngokuvamile, ukuba khona kwe-cirrhosis kuthonya imiphumela yokuhlinzwa. Ukukhethwa okungcono kokuhlinzekwa kubandakanya abantu abane-hepatitis engapheli futhi abangasebenzi ngaphandle kwesibindi.
Ngokuqondene nokuhlinzwa okukhethiwe, i-cirrhosis ne-hepatitis enamandla yizizathu ezicacile zokugwema ukuhlinzwa. Uma unesifo esibi kakhulu sesibindi, kufanele ugweme ukuhlinzeka uma kungenzeka.
Izindlela ezintathu zokufaka izilinganiso ezisekelwe ebufakazini zisetshenziselwa ukwenza inqubo yokunquma ukuthi umuntu onesibindi isifo esihle sokuhlinzwa: i-Child-Pugh score, isiqephu se-Model for End-Stage Liver Disease (MELD) nesilinganiso se-hepatic i-veous pressure gradient (HVPG).
Inothi, i-HVPG isetshenziselwa izikhungo zezokwelapha ezinkulu futhi ayitholakali yonke indawo. Noma kunjalo, kuhle kakhulu ngokubikezela ukubikezela noma imiphumela yomtholampilo.
Ukuphuma kwegazi eHepatic
Kungenzeka into ebaluleke kunazo zonke engenzeka ngesikhathi sokuhlinzwa kulabo abanesifo sesibindi isinciphisa ukugeleza kwegazi okwenziwe nge-oksijeni esibindi. Lokhu kwehlisa ukugeleza kwegazi kuholela e-ischemia ye-hepatic necrosis (ukufa kwamangqamuzana wesibindi), okungaholela ekuqedeni kwesibindi noma ukwehluleka, kanye nokukhululwa kwezimbangi ezivuthayo ezingaholela ekuhlulekeni kwezitho eziningi.
Ngokuvamile, imishanguzo ihlinzeka ngegazi okwenziwe umoya okwenziwa izitho.
Kodwa-ke, esibindi, ukuhlinzeka ngegazi okwenziwe nge-oksijeni kuvela kokubili umthambo we-hepatic kanye ne-portal vein. Eqinisweni, i-veal portal inikeza ingxenye enkulu yegazi okwenziwe nge-oxygen eningi labantu.
Ngesikhathi sokuhlinzwa, ukucindezelwa kwegazi kanye nokwehla kwenhliziyo. Amaconsi anciphisa ukugeleza kwegazi okwenziwe nge-oksijeni esibindi. Ngokujwayelekile, umcibisholo we-hepatic uhamba noma ukhula ukuze uthathe ukusikhipha futhi ukhokhele ukugeleza kwegazi okwenziwe nge-oksijeni esibindi ngesidumbu se-portal. Kodwa-ke, kubantu abane-cirrhosis, izinguquko ezingapheliyo ezakhiweni zesibindi, ezifana ne-fibrosis ne-nodularity, ukuthungatha ikhono lomthambo we-hepatic ukuze lihlanza futhi likhulise ukugeleza kwegazi okwenziwe nge-oxygen esibindi. Ukwengeza, i-anesthetics iphinde iphazamise ukuhlanjululwa kokubuyisela komshini we-hepatic okwenza kanjalo kube nenkinga.
Ngamanye amazwi, abantu abane-cirrhosis banenkinga yokukhokhela amaconsi ekugezeni kwegazi kuya esibindi, okubangelwa ukuhlinzwa kanye ne-anesthesia kanye nokuhlelwa kwezakhiwo zesibindi. Ngaphandle kokugeleza okwanele kwegazi okwenziwe nge-oksijeni esibhedlela ngesikhathi sokuhlinzwa, umuntu angabhekana nokulimala okukhulu kwesibindi nokuhluleka.
Uhlobo Lokuhlinzwa
Ngaphambi kokuba umuntu onezifo zesibindi asebenze, kubalulekile ukucabangela ukuthi uhlobo oluthile lohlinzekwa olwenziwe luzobeka umuntu ngisho engozini enkulu yezinkinga.
Phakathi nokuhlinzwa kwesisu (cabanga laparotomy), noma yikuphi ukuxhumana okuqondile nemithambo yegazi yesibindi kungabangela ukulimala okunye nokulimala kwesibindi. Ngaphezu kwalokho, ukuphenya ngalezi zingxube zegazi kunganciphisa ukugeleza kwegazi kuya esibindi ngesikhathi sokuhlinzwa.
Abantu abanezifo ezinzulu zesibindi, njenge-cirrhosis, abadinga ukwelashwa okuphuthumayo ngenxa yokuhlambalaza kwegazi, njenge-sepsis noma i-trauma, basengozini enkulu yokufa ngemva kwenqubo.
Ukuhlinzeka ngokuhlinzwa kwengqondo kuphazamisa ukugeleza kwegazi kwesibindi futhi kukhulisa inkinga. Ngaphezu kwalokho, izingcindezi (imithi enikezwe ukwandisa umfutho wegazi phakathi nenkathi yokusebenza kwesikhathi) kanye ne-cardiopulmonary bypass ingadala ukulimala kwesibindi.
Njengoba kukhulunywe ngaye ngaphambili, i-anesthetics nayo inganciphisa ukucindezelwa kwegazi nokugeleza kwegazi kwesibindi futhi kuqhubekisele phambili ekulimazeni kwesibindi. Ngaphezu kwalokho, kubantu abanesifo sesibindi, ama-anesthetics anganamathela isikhathi eside futhi angatholi ukuhlanganiswa kalula kalula ngaleyo ndlela kubangele isikhathi eside.
Isiphetho
Okokuqala, uma izakhi zakho ze- enzyme zesibindi ziphakanyiswa nje kuphela kodwa isifo sakho sesibindi silawulwa ngenye indlela, ungase ube ngumuntu omele ukuhlinzwa. Okwesibili, uma une-hepatitis engapheli enomsebenzi omuhle wesibindi, ungase ube ngumuntu omele ukuhlinzwa. Okwesibili, uma une-hepatitis ephuza utshwala futhi uyeke ukuphuza okwesikhashana futhi ungenaso isifo esibhedlela, ungase ube ngumfundi ohlinzayo omuhle.
Sicela ugcine engqondweni ukuthi ngenxa yokuthi une-cirrhosis ayisho ukuthi awukwazi ukuhlinzwa. Kodwa-ke, ukuba khona kwe-cirrhosis kuphazamisa ngempela imiphumela ngakho-ke akufanele kukhishwe imali ngesikhathi sokuhlinzwa (cabanga nge-jaundice, ascites, emathunjini, noma ku-variceal, ukuphuma kwegazi nokunye).
Uma une-hepatitis enomsoco noma i-cirrhosis ehlukumezekile, ukuhlinzeka cishe kungumqondo omubi. Kungcono ukucabanga ngesibindi kubantu abanezifo ezinamandla zesibindi njenge-hepatitis noma i-cirrhosis njenge-giant elele. Ngokuyinhloko, odokotela abahlinzayo basebenza ngokuzungeze i-giant elele, futhi ama-flare-ups noma umsebenzi wesibindi ovinjelwe okwesibili kuya kwe-cirrhosis ekhokhelwe ukwenza le giant yokulala iphumule kakhulu.
Imiphumela yokuhlinzekwa kulabo abanesifo sesibindi ingaba yingozi kakhulu. Abanye abantu bathola ukuhluleka kwesibindi futhi bafe emva kokuhlinzwa okunjalo. Ngakho-ke, isincomo sokwenza ukuhlinzwa kubantu abanezifo zesibindi kucatshangwa ngokucophelela yiqembu lakho lezempilo. Ngaphezu kwalokho, njengesiguli, kufanele unikeze imvume evumisekile, noma uvumele inqubo.
Kufanele uceliwe ukuba unikeze imvume enolwazi kuphela ngemuva kokuba udokotela wakho kanye nethimba lezokunakekela impilo lichaze ngokuphelele izingozi, izinzuzo, nemiphumela yenqubo. Khumbula ukuthi ukuhlinzwa kunesinqumo osenzayo.
Imithombo
I-Bacon BR. I-cirrhosis nezinkinga zayo. Ku: Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. eds. I-Harrison's Principals of Internal Medicine, 19e . ENew York, NY: McGraw-Hill; 2015.
Abahleli. I-Practice of Medicine. Ku: Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. eds. I-Harrison's Principals of Internal Medicine, 19e . ENew York, NY: McGraw-Hill; 2015.
Montagnese S, De Pitta C, De Rui M, et al. Ukulala-Ukulimaza Okungajwayelekile Emaphileni Ane-Cirrhosis. I-Hepatology . 2014; 59 (2): 705-712.
I-Qamar AA, uGrace ND. Isahluko 53. Ukuhlolwa Okubalulekile Kwesifo Sezinguquko. Ku: McKean SC, Ross JJ, Dressler DD, Brotman DJ, Ginsberg JS. ama-eds. Izimiso Nemikhuba Yezokwelapha Isibhedlela . ENew York, NY: McGraw-Hill; 2012.