Kunzwisisa Kuongororwa uye Kurapa Kwezvibvumirano zveBiliary
MRCP Versus ERCP yeBiliary Disstruction
Kunyatsonzwisisa zvinonzi Magnetic Resonance Cholangio-Pancreatography (MRCP) uye Endoscopic Retrograde Cholangio-Pancreatography ndeyako, iwe unofanira kutanga unonzwisisa kuti chii chinokanganisa bhaariary uye chinowanzokonzera rudzi urwu rwechinetso.
Kunyange zvazvo zvipembenene zvinowanzotadzisa kubhadharwa, kune zvikonzero zvakawanda nei chibharo chinogona kuitika uye nzira dzakawanda dzokurapa nyaya idzodzo dzinotarisana nezera remurwere, hutano hwehutano, hutachiona, nhoroondo yezvokudya zvekudya uye zvimwe zvingaita zvinogona kusiyana munhu kumunhu.
Kugadziriswa kweBiliary Kunotsanangurwa
Ngatitangei nekugadzirisa kunoita chirwere chekudya. Kuti uwane huwandu hwakawanda hwezvinhu zvinobva kune zvokudya, zvokudya zvinofanira kuputswa nepuropa rekudya kuitira kuti mavhithamini, mineral, mapuroteni, mafuta, uye makhahydrates zvinogona kubatwa nemukati muduku. Izvi zvinotanga nekutsvaira zvokudya, zvinoteverwa nedumbu rinoshandisa acid uye rinomesa chikafu chinopoteredza kuti chibatsire kuputsa. Mushure meizvozvo, bile yakawedzerwa kune zvokudya kuti iparadze chikamu chemafuta chekudya.
Bhiri ibisi rekudya rinogadzirwa muchiropa uye rinogona kushandiswa pakarepo kana kuchengetwa kuti rizoshandiswa gare gare. Kana iyo bile ichishandiswa gare gare, inofamba ichibva pachiropa ichienda mu gallbladder kuburikidza nechimwe che bile ducts-tubes dzinotakura bile kubva kuchiropa kuenda kunoshandiswa kubatsira rubatsiro.
Kana iyo bile inoshandiswa pakarepo mushure mokusiya chiropa, ichayerera ichibva pachiropa ichienda kune chikamu chokutanga chemukati mudumbu (the duodenum) kuburikidza nehana yakawanda bhute.
Inenge makumi mashanu kubva muzana yebhati inoshandiswa pakarepo nenzira iyi apo imwe hafu inomira mumvura, apo mvura zhinji inobviswa uye bile inowedzera kuwedzera.
Kana bile isina kukwanisa kudarika imwe yeblue ducts kubva pachiropa kana gallbladder nemhaka yechinetso nematavi, izvi zvinonzi biliary obstruction.
Rudzi rwakanyanya kunyanya kubviswa kwebiliary ndiyo gorosi, iyo ibhola ye bile iyo inomesa panguva yekubvisa mvura kubva kune bile, iyo imwe yemabasa e gallbladder. Aya mabwe maduku akabatanidzwa mukati meguruva kana mumudhaini unotora bile kubva ku gallbladder kusvika ku duodenum.
Zvinowanzokonzera Kuvhara Biliary
- Gallstones (ichi ndicho chikonzero chinonyanya kukanganisa chekuvhara biliary)
- Kubata zvishoma kuderedza imwe ye bile ducts, inowanzonzi biliary stenosis
- Bhiri duct kupisa
- Maumbirwo e cyst mune imwe yematope
- Lymph node kuwedzera kunomesa duct kubva kunze
- Pancreatitis, kunyanya ichidzoka kana kusingaperi
- Injury / trauma inosanganisira chiropa, gallbladder, pancreas kana bile ducts
- Tumha, kenza kana bhendi
- Kuvharirwa kwegurubladder, bile ducts kana pancreas
- Chiropa chechiropa
Dambudziko rekuvhara Biliary
Pane zvikonzero zvakawanda nei munhu achizoona kubviswa kwebhaariary, zvimwe zvezvinowanzokonzera ndezvi:
- Nhoroondo yemakondomu
- Nhoroondo yekuvhiya iyo inobata bile ducts
- Nhoroondo yekenza yebriary
- Nhoroondo yekenza yeropa kana chirwere
- Nhoroondo yekenza yepancreatic kana chirwere
- Nhoroondo yezvinetso zvebongozi
- Nguva ichangopfuura nhoroondo yekuvhiya kubvisa nduru
- Chronic pancreatitis
- Kuwedzera muviri
- Kukurumidza kuora kurasikirwa
Zviratidzo nezviratidzo zvekudziviswa kweBiliary
Zviratidzo nezviratidzo zvekuvhara bhaariary zvichasiyana kubva kune mumwe munhu kune mumwe munhu, asi zvinowanzobatanidza chimwe kana zvimwe zvezvinotevera:
- Mumuviri wepamuviri, kazhinji ari mucheche kumusoro kwemuviri
- Itching
- Jaundice (kuchena kweganda)
- Nausea uye Kuedza
- Mutsvuku kana machena machena mahara
- Mvura yakasviba
Kuongorora Kuvhara Biliary
Kana kuvhara kwebhaariary kuchifungidzirwa, pane kuongororwa kweropa, zvidzidzo zvekufungidzira, uye nzira dzinogona kuitwa kuti dzigone kuonekwa.
Kuongororwa kweropa kwakawanda kunogona kuratidza kuti zvinokonzerwa neB bile duct chinetso zvinosanganisira kuwedzera alkaline phosphatase level, yakakwirira yebilirubin, uye yakakura enzyme yeropa.
Dambudziko rinokonzera bheri kuti ridzoke muchiropa rinokonzera kuchinja kunoshamisa mukuongorora kweropa kunotarisa chiropa basa.
Mimwe miedzo inogona kuitwa kuti iongorore bhiaryary obstruction inosanganisira:
- Ultrasound yedumbu
- CT kuongorora mimba
- Percutaneous transhepatic cholangiogram (PTCA)
- Magnetic Resonance Cholangio-Pancreatography (MRCP)
- Endoscopic Retrograde Cholangio-Pancreatography (ERCP)
Mishonga inogona kuitwa kuitira kurapwa kwebhaari inobva pane chinokonzera uye nzvimbo yechinetso. Chinonyanya kukonzera nduru, uye kurapwa kunosanganisira Endoscopic Retrograde Cholangio-Pancreatography (ERCP) uye kuvhiyiwa kubvisa gallbladder (cholecystectomy).
Kana chikonzero chekudzivirira chiri chimwe chinhu kunze kwegorosi, kurapa kunogona kusiyanisa kubva kune munhu kumunhu. Semuenzaniso, munhu ari kunetseka kwebhaariary nekuda kwekenza ichabatwa zvakasiyana zvakasiyana nemunhu ari kutarisana nedambudziko rimwe chete nekuda kwehutachiona. Murembera akwegura ane zvironda zveguru angagamuchira kurapwa kwakasiyana kune mukadzi wemakore makumi matatu nemakumi matatu ari kutarisana nezviratidzo nezviratidzo, sezvo murwere mukuru angave asingakwanisi kubvumira kurapa kumwechete.
Kazhinji, nzira inonyanya kushandiswa yekuongorora uye yekurapa ndiyo yekutanga yekuedzwa-yakadai seM MRC-asi imwe nzira inopesana yakafanana neE ERCP kana chirwere chenguruve chinowanikwa chete kana zvichidikanwa. Izvozvo zvakati, chirwere chenduru, chinonziwo cholecystectomy, chimwe chekuvhiya kunowanzoitwa muUnited States.
Chii Chinonzi Magnetic Resonance Cholangio-Pancreatography (MRCP)
Magnetic Resonance Cholangio-Pancreatography, inowanzozivikanwa seMRCP, isiri yomuedzo isingasviki yakaita seMRI yakafanana. Uyu muedzo unoshandiswa kuongorora chiropa, pancreas, gallbladder, uye bile ducts kuti uone kana kuvharwa kuripo. Chiyero chinogona kubatsira kuongorora kugadziriswa, uye kunogona kubatsira kubvisa chikonzero chekudzivirira, izvo zvinogona kugadzirisa kuti nyaya yacho inofanira kurapwa sei.
Rini MRCP Rwakaitwa?
An MRCP inoitwa kana pane kusafungidzirwa kuti bongo duct kudzivisa iripo uye zvinokonzera dambudziko. Kwete izvi chete zvinogona kuongororwa kuti kana bhodhi inokonzera kudzivirirwa iripo, ichi chiyero chinowanzotarisa chinokonzera dambudziko. Zvinosuruvarisa, nepo MRCP iyo nzira yakanakisisa yekuongorora chirwere ichi, chiyero ichi chinogona kungobatsira kuziva kuti unganyatsopindura sei nyaya-iyo MRCP pachayo inogona kusabata kubviswa.
Chii Chinoitika MuMRCP?
Munguva yeMRCP murwere anodikanwa kuti arambe ari pamubhedha unopinda mukati uye kunze kwebhuku-seMRI machine. Chiyero hachisi chisingadi, zvinoreva kuti hapana chakaiswa pane kana mumuviri. Sezvakaita x-ray, mishonga haifaniri kukubata iwe kuti uongorore mukati memuviri. Muedzo uyu unofadza uye unotora maawa akawanda.
Ngozi dzeMMCP
Ngozi dzeMMC dzakanyanya. Varwere vanoona claustrophobia kana vakaremera zvikuru vanogona kudai miviri yakawanda isina kuzarura yeMRI mhando yekudzidza kwavo panzvimbo yegadziriro yemagetsi-semashini, asi hapana zviitiko zvakakosha nemhando iyi yekudzidza. Kana kushandiswa kwemasikirwo kunoshandiswa, kune ngozi shoma yekugadzirisa zvirwere, uye kusiyana kunofanira kushandiswa nekuchenjerera kune varwere vane zvinetso zvepvo.
Varwere vane tsvina yesimbi vanogona kunge vane MRCP kana kupinza kwavo kuri MRI kuchengeteka, sezvo nzira inoshandisa magnetti yakasimba kuti iumbe mifananidzo yemuviri. Hapana majekesheni anowanikwa mukati meMRI.
ERCP Inotsanangurwa
Endoscopic Retrograde Cholangio-Pancreatography, inowanzozivikanwa se ERCP, inoparadzanisa nzira iyo endoscope inopenya inowanikwa mumuromo uye inonyatsokonzera kupinda mukati mudumbu, uye kusvika muchikamu chekutanga chemukati muduku unonzi duodenum.
Endoscope ine zvose chiedza uye kamera pamagumo, iyo inobvumira chiremba kutarisa kuongorora mukati memutsetse wekudya. Izvi zvinokwanisika nokuti iyo yakawanda bile buct inopinda mu duodenum, uye kana gorosi kana chimwe chigadziro chiripo mu bile buct, gastroenterologist ane unyanzvi anogona kubvisa dombo racho achishandisa tsinga, tswanda kana bhoti kusungirirwa pa endoscope.
Apo ERCP Inoitwa?
IE ERCP inoitwa kune chimwe chezvikonzero zviviri. Chikonzero chekutanga ndechokuita kuti uongororwe-kuti uone kana kuvhara kwebhaariary kunovapo nekuona zviri kuongorora duct. Chikonzero chechipiri icho ERCP inoshandiswa ndeye apo dzimwe dzidzo, dzakadai sekuongorora ropa kana MRCP, dzinoratidza kuti kushandiswa kwebhaariary hakusipo chete, asi dambudziko rinogona kugadziriswa nekuisa stent kana kubvisa gorosi kubva kune bile duct.
Kusiyana neRMCP, iyo inopa mifananidzo yezvinoitika mumuviri, ERCP inogona kunyatsopedza dambudziko.
Ngozi dze ERCP
Kunyange zvazvo ERCP inofungidzirwa kuti yakanyanya kuipa, nenzira ipi neipi inopesana nayo inogona kunge yakaoma iyo inofanira kukurukurwa. Mukuwedzera kune njodzi dzinosangana neanesthesia , ERCP inogona kukonzera pancreatitis, hosha, uye kubuda ropa.
Dambudziko rakaoma zvikuru rinowanzosvibisa-nekukanganisa kugadzira gomba-mumatumbo kana dzimwe nzvimbo apo ERCP iri kuongorora. Dambudziko rekugadziriswa kwakaderera mumaoko ejagroenterologist ane unyanzvi, asi zvisinei zvakadaro.
Anesthesia uye ERCP
Iro chirongwa che ERCP chinoitwa nemurwere anogamuchira anesthesia mukuru kuitira kuti varege kuziva nzira iri kuitwa. Murwere achabviswa uye akaiswa pavhenekeri uye akarara nokuda kwenzira yose.
Kana iyo nzira yapera, mishonga ichapiwa kuti idzikise sedation uye murwere achangomuka zvishoma nezvishoma. Kana mumwe murwere achikwanisa kufema ari oga, endotracheal tube inobviswa uye murwere anowanzoendeswa kuPost Anesthesia Care Unit ( PACU ) kana kuti chipinda chechipatara kuti chidzoke.
Iyi nzira inogona kuitwa sechirwere chepfungwa kana chirwere chekurapa. Kana murwere asina kurwara zvakanyanya, vangazodzoka kumba musi iwoyo, apo varwere vanorwara vangada kudzoka muchipatara.
> Kwakabva:
> Bhiri Duct Kubviswa. Yakasvika muna February, 2017. http://www.nytimes.com/health/guides/disease/bile-duct-obstruction/overview.html