The Treatment of Alcoholic Cirrhosis
Chikamu cheMaddrey chinozivikanwa nemazita akawanda, kusanganisira Maddrey Discrimination Function, MDF, DF kana DFI. Icho chinhu chinoshandiswa nevatsigiri vehutano kuti vaone rudzi rwakakodzera rwekutarisira murwere ane chirwere chakasiyana chechiropa chinonzi kudhakwa kwechirhosis .
Nzvimbo yekushandisa zvigaro inowanzoshandiswa munzvimbo yezvipatara, sezvo vanhu ava vanowanzorwara pavanosvika kuhutano hwehutano hunoda kushandiswa kweMardirey Madhigiri.
Muchidimbu, chikwata cheMaddrey chinobatsira kuona kuti zvakakanganiswa sei nechiropa, kuitira kuti urongwa hwekuchengetedza hugadziridzwe.
Ndiani Anoda Maddrey Score?
Vanhu vane doro rinokonzera hepatitis ndivo varwere vanoita kuti Maddrey Score ishandiswe. Ava ndivo varwere vanokanganisa chiropa chavo chinokonzerwa nekudhakwa, kana kudhakwa kudhakwa doro, uye vanowanzoona zviratidzo zvisinganzwisisiki kune zviratidzo zvakaoma apo chikwata cheMaddrey chinoshandiswa.
Vamwe vevanhu ava vacharamba vari muchipatara, vamwe vachaonekwa pamusana pekupedzisira. Muzviitiko zvose izvi, vanofanira kunge vari kugamuchira kutarisirwa kubva kumudzidzisi anonyanya kugadzirisa gastroenterology kana hepatology. Gastroenterologists anotarisira nzvimbo yose yekudya, kusanganisira chiropa, nepo hepatologist inofunga pachiropa.
Chii Chinodhaka Zvokudhakwa?
Kunwisa doro ndechirwere chechiropa chinokonzerwa nokunwa doro zvakanyanya. Inogona kubva kubva kune unyoro kusvika kune yakaoma uye inogona kukonzera matambudziko akawanda-kusanganisira kufa.
Kurwisana kunokonzera kusingaperi kuputika kwechiropa, mafuta anowedzera uye zvinogona kukonzera kuora kwezviviri zvinoita kuti zvive nyore kuti chiropa chishande zvakanaka. Mune zvimwe zviitiko, chiropa chinonyanya kuwedzera.
Zviratidzo Zvinozivikanwa Nezviratidzo zveSyrhosis
Kune marudzi akawanda e-cirrhosis, iyo inogona kana kuti ingasakonzerwa nekudhakwa kunwa.
Pasinei nechinokonzera, varwere vane cirrhosis vane zviratidzo zvakafanana , izvo zvinowanzova zvishoma muzvikamu zvekutanga zvechirwere uye zvinowedzera kuwedzera muhosha yakaoma.
- Kurwisana kwepamuviri kumakumbo: Chiropa chiri munharaunda yepamusoro yepamusoro uye vamwe varwere vanotaura kuti vanonzwa kunzwa kusuruvara pamusoro pechiropa chinowedzera nehuwandu hwechirwere.
- Nausea: vamwe varwere vanoona kushambidzika, asi kusuruvara kunowanzoonekwa uye kunoda mishonga kubvumira murwere kudya zvokudya nguva dzose.
- Kudengenyeka nyore: chiropa chinotora basa rinokosha pakubatsira ropa clot mushure mekuvadzwa kana kukuvara. Sezvo kuvhiringidzika kunowedzera, kuputika kunoitika nyore nyore uye mune dzimwe nguva, kubuda ropa kunoitika zvisingatarisirwi, pasina kukuvadza semusana.
- Kushungurudzika kwepfungwa / fogginess : Kana chiropa chisakwanisi kuita basa rayo, ammonia inogona kuvaka muropa, iyo inotungamirira mukuvhiringidzika, kuneta, kufungisisa kwepfungwa, nekushaya kukwanisa kutarisira mabasa ezuva nezuva.
- Kukanganwa: Kana chiropa chiri chirwere kusvika pakasachagoni kuita basa racho zvachose, zviratidzo zvichaonekwa uye zvinowedzera sezvinoita chirwere chacho. Mishonga inogona kushandiswa kuvandudza zviratidzo.
- Kuneta / kusava nesimba: Kuneta kunowanzoshamisa uye kazhinji ndiko kunotungamirira kuongororwa kwechirrhosis.
- Jaundice (kuchena kweganda): Kana chiropa chisisakwanise kuchenesa ropa zvakanaka ganda nemamwe matukiti emuviri anogona kutora maitiro ekuchena. Izvi zvinowanzotanga kuonekwa pakati pevatsvene vemaziso, uko kuchinja kusina kunyanya kuoneka pachena.
- Zviri pachena kuwedzera mutsvo mumudumbu: Yakakonzerwa nekuwedzerwa kweropa uye kusanganiswa mumidziyo yeropa pedyo nechiropa, mishonga yeropa mumudumbu inokura uye inowoneka pasi peganda.
- Kuwedzerwa mitsipa mu-esophagus (esophageal varices): Mukuwedzera kumaketani ari mudumbu akanyonganiswa uye akawedzerwa muhukuru, zvakafanana zvinogona kuitika kune midziyo iri mumhara. Apo mishonga iyi yakawedzerwa zvakanyanya kune njodzi yekuisa upenyu kutyisa, saka kurapwa kunowanzodiwa kuderedza dambudziko iri.
- Kushushikana kwakaipa, kuora kurasikirwa: Vatengi vazhinji vanozoremerwa nehuwandu hwehutachiwana, asi vamwe vanoona kuti vari kurasikirwa nehutoro nekuda kwekushaya nzara uye kuneta. Nausea inogonawo kutungamirira kukurasikirwa.
- Chibereko chekuwedzera muvarume nevakadzi: Kunyange zvazvo chikonzero chaicho cheicho chisingazwisiswi zvakajeka, chirwere chetrhosis chinotungamirira kusina kufanana kwehommone izvo zvinotungamirira kuchinja chemazamu.
- Gesi (flatulence)
- Kusviba: Ropa rakatsvuka rinogona kana risingaoneki. Mune zvimwe, kubuda ropa kunogona kuuya se "nzvimbo yekofi" iyo inoonekwa apo kurutsa. Vamwe vanogona kuona kuti zvigaro zvavo hazvisvi tsvuku asi zvinosviba kana kuti zvakasviba, uye zvinotarisa kana seti. Zvose izvi zviratidzo zvekubuda ropa mumagetsi uye inofanira kuudzwa kune mupi wehutano.
- Kuchengetwa kwemvura ( ascites ): Vamwe varwere vanochengetedza mvura yakanyanya, kunyanya mudumbu, mamiriro ezvinhu anogona kutungamirira kudiwa yekuita nzira yekubvisa mvura.
- Itching: Ichi chinogona kuva chiratidzo chokuti chiropa hachina kuchenesa ropa rakanaka iro rinogona kuonekwa sekuita.
- Kukurira mumakumbo, makumbo, uye tsoka: Chimwe chiratidzo chekuchengetedza kwemvura, kupfugama mumucheto wakadzika kunogona kuva chiratidzo chezvinhu zvine chiropa mune vamwe vanhu.
- Kusuruvara kwemweya: Kufema kwekufema kunogona kuva nharo kana kuchengetedza kwemuviri mumvura kuchiita kuti zvive nyore kutora kufema kwakanyanya kana kuwedzerwa kunetseka mudumbu.
Kuti Chikamu cheMaddrey Chinoratidzwa sei
Chikoro cheMaddrey chinoshandisa kuongororwa kweropa maviri kuti chione kuti chiyero chechiropa chakaipa sei, bilirubin uye prothrombin nguva.
Bilirubin inonzi orange pigment iyo chiropa inogadzira iyo inoputsa hemoglobin (chikamu cheropa) uye inobva yanyongedzwa mu bile. Kazhinji, izvi zvinobviswa pamuviri asi kana pane chiropa chinopararira bilirubin inogona kuvaka muropa rinokonzera jaundice.
Prothrombin nguva ndiyo imwe nzira yekutsvaga kwekuvhara ropa kwemaawa mashoma. Imwe yemabasa echiropa ndeyokubatsira ropa clot, saka nguva yakareba nguva inotarisirwa kana chiropa ichikuvara.
Kudzora kuri kuverenga iyo lab inoshandisa kutsanangura kuti "zviitiko" zvakadini zviri pane imwe nzvimbo, uye haisi yebasa inoguma kubva muropa remurwere.
Iyo equation inoshandiswa kuverenga Maddrey Score ndeyokuti:
- Bilirubin (mg / dL) + 4.6 nguva (prothrombin nguva mumaminitsi mashoma kutora)
Chikamu cheMaddrey chinoshandiswa sei?
Apo murwere ane doro rinokonzera doro rinorwara, Chikamu cheMaddrey chinoshandiswa kuziva kana vangabatsirwa nekushandisa steroids sechikamu chemishonga yavo yemishonga. Iyo inogonawo kufanotaura mukana wekupona, kunyanya mumwedzi mitatu inotevera chikero ichiverengwa.
Kana chikwata cheMaddrey chiri pasi pemakumi maviri nembiri, murwere anoonekwa seine nyoro kusvika pakuenzanisa doro rinodhaka uye haazobatsiri nekushandisa steroid. Inenge 90 kubva muzana yevarwere vane chikwata ichi vachararama kwemwedzi inotevera ichitevera kana mapeji acho apera.
Zvinosuruvarisa, mapeji anopfuura makumi matatu anoratidza chirwere chinodhaka chechiropa, zvinoreva kuti chiropa chakanyangadza zvakanyanya nedoro. Muzviitiko izvi, anenge 60-65 muzana yevarwere vari vapenyu mwedzi mitatu mushure mekupihwa. Ndivo varwere avo ndivo vanonyanya kutsvaga kushandisa steroids sechikamu chemishonga yavo. Kune avo vanorwara, njodzi dzekutsamwisa dzinopfurikidza nemubairo unogona kuponeswa kwenguva refu.
Zvakakosha kuyeuka kuti Maddrey Score isiri, kwete mhedziso. Izvi zvinoreva kuti chikamu chinhu chimwe chete chiremba kana chiremba wezvehutano anotarisa paanoona nzira yakanakisisa yekuita. Nokuda kwechikonzero ichi, unogona kuona murwere ane zvikamu makumi matatu zvinogamuchira steroid uye iwe unogona kuona murwere akasiyana ane mapeji anopfuura makumi matatu 32 asingaiti. Steroidhi ine zviremera zvakakosha, zvakadai sokusimudza shuga yeropa, izvo zvingada kudziviswa mune vamwe varwere.
Nzira yekuvandudza Madhirey Chikamu
Nhamba yeMaddrey haina kuiswa mumatombo, uye haisi shoko rekupedzisira pamusoro pekuti chirwere chemurwere chichapindura sei kurapwa. Nhamba yacho inoshandiswa kufanotaura zviitiko, asi murwere angave achiri kukwanisa kuchinja chirwere chavo pane dzimwe nguva.
Kune vanorwara vane zvirwere zvishoma, kuchinja mune mararamiro evanhu kunogona kusimbisa kuchinja kwakanaka mukukwanisa kwechiropa kushanda uye kunogona kuchinja kuoma kwechirwere chacho. Mune vamwe varwere vane zvirwere zvishoma zvinomisa doro rekudhakwa kunogona kutungamirira kuchinjwa chechirwere chetachiona. Kune vanorwara vane chirwere chinotyisa kusvika kune zvakanyanya, zvinokwanisika kuona chirwere chechiropa chiri nani kune vamwe. Kune vamwe, mararamiro emararamiro haatungamiri mukuvandudza asi inodzivirira chirwere ichi kuti chirege kuwedzera-zvingava zvakaoma kufanotaura kuti huchavandudzi huchaitika sei.
- Rega kunwa doro. Kana munhu wacho achienderera mberi kunwa doro, iyo nzira yakaratidza kuti inogadzirisa kuwedzera kwezvirwere uye zvichida kuve nekuvandudzwa muropa rechiropa basa rekurega kunwa doro zvakakwana. Izvi hazvirevi zvachose doro, kwete kunyange kazhinji nguva isina waini kana doro. Kuparara zvachose doro kunogona kuva kwakaoma zvikuru, asi kuchave kwakakosha zvikuru kuponeswa kwemurwere, sekuenderera mberi kwekushandisa doro mushure mekunyatsoonekwa kwechirwere chechirwere kunongowedzera kukurumidza kwokuti murwere anowedzera kusvika pamagariro ekupedzisira e-cirrhosis uye pakupedzisira rufu.
- Low fat / sodium diet. Zvokudya zvinogona kubatsira kudzora cirrhosis. Zvokudya zvakaderera mumafuta uye sodium zvinogona kubatsira kuderedza kuwedzera kwezvirwere uye kunogona kuderedza kuchengetedza kwemvura inokonzerwa nechiropa. Kune vanhu vanoda kuti kubviswa kwemvura kunobva mudumbu, chirongwa chinonzi paracentesis, kudya kunogona kukanganisa kuti kazhinji nzira yacho inodikanwa sei nekuderedza kushandiswa kwemvura.
- Supplementation. Vamwe vanhu vane doro rekudhakwa vane nzara uye vanoona kuvandudzwa mumamiriro avo nehuwandu hwevhitamini nemaminerari akawedzerwa kuzvokudya sezvazvakatemerwa nemupi wehutano wehutano. Izvo zvinokonzerwa nekushaikwa kwezvokudya zvinovaka muviri kungave kushaikwa kwekoriki nenzira yezvokudya, sezvo vamwe vanhu vane doro rinodhaka vanodya zvishoma uye vanotora zvakawanda zvemaoriro avo nenzira yewaini. Kune vamwe, kudya kwakashata kwakanaka kana zvimwe zvinhu zvinogona kutungamirira mukushaya zvokudya zvinovaka muviri.
- Yakakwana makorikori. Kune varwere vane chirwere chakakomba uye chido chisina kunaka, zvingave zvakakosha kuwedzera kudya pamwe nekumwa zvakadai seKuvimbisa kana Kuwedzera. Kana murwere asingakwanisi kudya zvakakwana makorikiti kuti agutse zvido zvemuviri, kazhinji 2 000 makorikori kana kupfuura, vanogona kutora hutachiwana kudya kuti kuwedzere huwandu hwemaoriji avo vari kutora. Muzhinji, utano hwakakwana hwakanaka hunoshandiswa pakuwedzera zvinwiwa, asi kune vamwe varwere chero chikafu chero chikafu chinogamuchirwa kana vari kutambura kutora makarikori akakwana.
- Liver transplant. Imwe mushonga wechokwadi wekushongedza, zvisinei nokuti chii chinokonzera, chiropa chokuwedzerwa. Kudyara kunonyanya kuoma kune vanhu vane dorosiro rekudhakwa nokuti vanofanira kurega doro kwenguva yakati - kazhinji mwedzi mitanhatu kana kupfuura - kuti vakwanise kukohwa. Izvi zvinogona kunge zvakaoma zvikuru, uye vanhu vakawanda havakwanisi kukodzera kuwedzerwa nokuti havagone kubudirira kurega kunwa doro.
Murwere anofanirawo kurega doro mushure mekugamuchira chiropa chitsva, sezvo nhengo itsva inogona kuderedzwa newaini kunyange nekukurumidza kudarika chiropa chepakutanga nekuda kwemishonga inotarisirwa kudzivisa kurambwa.
Shoko Rinobva
Chikamu cheMaddrey chinongova chinhu chimwe chete chinoshandiswa nevatengi mukuchengetwa kwevarwere vanoonekwa kuti vane chirwere chinodhaka chechiropa. Nhamba yacho inobatsira kuona kuoma kwechirwere ichi uye inopa chiratidzo chekuti kana kwete steroid inofanira kushandiswa kune munhu uyu. Kunyange zvazvo ichi chiri chikamu chinokosha chekuchengetedzwa kwakapiwa, zvimwe zvikonzero zvinokosha zvakanyanya kana zvakanyanya kukosha, zvakadai sekunge murwere achienderera mberi kunwa doro, kuti vanoda sei kutevera mirairo nezvimwe zvinhu zvavasingagoni kuchinja, zvakadai se age.
> Sources:
> Cirrhosis. Medscape. https://emedicine.medscape.com/article/185856-overview
> Chii chinonzi cirrhosis? NIDDK. https://www.niddk.nih.gov/health-information/liver-disease/cirrhosis