Chisarudzo chinofanirwa kunyatsoongororwa
Kana uine chirwere chakakomba chechiropa, zvakadai sechirwere chechirwere chechiropa kana hepatitis B kana C uye chirwere chinoshaiwa chisingaenderani nechiropa, zvinhu zvinogona kuoma. Chisarudzo chekuenderera mberi nekuvhiyiwa munyaya iyi hachina kutorwa zvishoma. Vanachiremba vako vanofanira kuongorora zviverengeka zvikonzero kana uchitarisa dambudziko rako rekushanda uye kana iwe uchange uine zvinetso zvakakomba kana rufu nekuda kwekuvhiyiwa.
Kunyanya zvakanyanya, kune avo vane chiropa chinenge chave chichigadziriswa kana chirwere chakaoma kana chisingaperi, kuvhiyiwa kunogona kukwidza zviyero zvichienderana nechirwere chekushaya chiropa, kana kuwedzera kwechiropa chechiropa, kukundikana kwechiropa, nekufa. Nokudaro, kuvhiyiwa kunofanirwa kunyatsoonekwa kana iwe une chirwere chechiropa.
Zviitiko zvinongororwa kune vanogona kuvhiyiwa vane chirwere chechiropa vanosanganisira zvinotevera:
- acuity, chinokonzera uye kuoma kwechiropa cheropa
- rudzi rwekuvhiya
- kukurumidzira kwekuvhiyiwa
- rudzi rweaneshesia
- madonhera emvura muropa
Ngatitarisei pane zvakasiyana-siyana izvo zvipatara, vanachiremba, vanachipatara (nyanzvi dzechiropa) uye nhengo dzakasiyana-siyana dzeboka rehutano hwezvehutano dzinofunga zvisati zvaitika kana munhu ane chirwere chechiropa ari mukana wokuvhiya.
Kuongorora Kwepanyama
Kuti munhu anosarudzwa anotarisa sei, kana kliniki yako kutaura asati avhiyiwa chikamu chinokosha chekuongorora njodzi yekuvhiya kune avo vane chirwere chechiropa.
Kazhinji, chiremba achatsvaka zviratidzo nezviratidzo zvinotevera zvinoratidza kurwara kwehepatitis:
- nausea
- jaundice
- kurutsa
- usiku sweats
- pruritis (itchiness)
- kuonda
Muvanhu vane cirrhosis , zviratidzo zvizhinji zvinotevera zvinowanikwa pachidimbu kusvika kuhutachiona hwehutachiona uye kuratidzira kusarudzwa kwevarombo uye kuratidza kuvhiringidzwa kwepirhosis.
- kuwedzera mubhandi bomuviri (chiratidzo che ascites )
- kuwedzera pfuma (inoratidza ye ascites)
- chiyeuchidzo chinoshanduka (chinoratidza chekudzivirira kwepfungwa)
- kubuda kwepamuviri kubuda ropa (chiratidzo chevariceal ropa)
- kuchinja mukurara-kupera
- jaundice (kusvibira kwemaziso, ganda, uye mamwe mutsara)
Vanhu vazhinji vane ruzivo rwechirwere chinoshandura muitiro dzekurara. Iko kushandurwa kwakave kunongororwa kunonzi kunetseka kwakanyanya uye kushaya simba kunokonzera melatonin metabolism; zvisinei, isu tisati tinyatsojekesa pathophysiology chaiyo yezvivhiringidzi zvehope.
Kuoma kwechiropa Chirwere
Vanhu vane hepatitis yakaoma kana kuti vakaremara kushaya chiropa, pamwe nekushaya simba kwechiropa, havafaniri kuvhiyiwa. Izvi zvinonzwisisika nokuti haudi kuti murwere ave nechiropa chakanyanya kusina simba panguva yekuvhiyiwa. Muzhinji, kuvapo kwe-cirrhosis kunokanganisa maitiro ekuvhiya. Vaya vanogona kuvhiyiwa vanovhiya vanosanganisira vanhu vane chirwere chisingaperi chehepatitis uye vasina kubhadhara chiropa basa.
Nekukuvhiya kwakasarudzwa, cirrhosis uye acute hepatitis zvikonzero zvikonzero zvekurega kuvhiyiwa. Kana uine chirwere chakakomba chechiropa, iwe unofanirwa kudzivisa kuvhiyiwa kana zvichibvira.
Nzira dzakasiyana-siyana dzakasiyana-siyana-based based scoring dzinoshandiswa kuita chirongwa chekuziva kana munhu ane chirwere chechiropa ari mukana wakanaka wokuvhiya: chikwata cheChild-Pugh, chikamu cheMuenzaniso wekupedzisira-Stage Chiver Disease (MELD) chikamu uye chiyero chehepatic zvinotyisa zvinoshungurudza (HVPG).
Nenzira, HVPG inoshandiswa chete muzvikoro zvepamusoro zvezvidzidzo uye hazviwaniki kwose kwose. Kunyange zvakadaro, zvinoshamisa chaizvo pakufanotaura kwekutsvaga kana zvirwere zvekuchipatara.
Hepatic Blood Flow
Zvichida chinhu chinonyanya kukosha chinogona kuitika panguva yekuvhiyiwa kune avo vane chirwere cheropa chinoderera kuderera kwemuviri weoksijeni kusvika pachiropa. Izvi zvakaderera ropa rinotungamirira ku hepatic ischemia uye necrosis (kufa kwechiropa chemasero), izvo zvinogona kutungamirira kuchiropa chekuvhiringidza kana kukundikana, pamwe nekusunungurwa kwevhiringidzi vanopisa zvinogona kukonzera kukundikana kwenhengo dzakawanda.
Kazhinji, mishonga inopa ropa rinogadziriswa kune nhengo.
Zvisinei, muropa, kupa kwemhepo yakakonzerwa nemhepo kunobva kune zvose zvinonzi hepatic artery uye portal vein. Muzvokwadi, mutezo wepasiporesi unopa akawanda eropa rinokonzerwa nemhepo muzhinji rwevanhu.
Panguva yokuvhiyiwa, kuwedzera kweropa uye kubuda kwemwoyo kunokonzera. Madonhwe aya anoderedza kubuda kweioksijeni ropa kune chiropa. Kazhinji, arteri yakanyanyisa inowedzera kana inowedzera kutora slack uye inobhadhara kuderera kwekuwedzerwa kweropa re okisijeni kusvika kuchiropa kuburikidza nehutachiona chemukova. Zvisinei, kune vanhu vane cirrhosis, zvisingaperi zvinoshandiswa mumapuranga eropa, zvakadai se fibrosis uye zvinogunun'una, kusvibiswa nekukwanisa kweyeri yepamusoro kuti iwedzere uye kuwedzera kuerera kweropa reoksijeni kuchiropa. Uyezve, anesthetics inopindirawo nekugadziriswa kwekodzero kweyeri yepamusoro saka inokonzera dambudziko racho.
Mune mamwe mazwi, vanhu vane chirwere chetrhosis vane dambudziko rekugadzirisa madonhwe muropa ruchiyerera kusvika kuchiropa, chinokonzerwa nekuvhiyiwa uye aneshesia pamwe nekushandurwa kwemapukisi eropa. Pasina kufamba kwakakwana kweropa reoksijeni kusvika kuchiropa panguva yekuvhiyiwa, munhu anogona kukuvara zvakakomba zvechiropa nekukundikana.
Type of Surgery
Munhu asati ane chirwere chechiropa anoshandiswa, zvakakosha kuongorora kana chirwere chaiyo chekuvhiyiwa chinoita kuti munhu atove mukana mukuru wezvinetso.
Panguva yekuvhiyiwa kwepamuviri (funga laparotomy), chero kusangana zvakananga nemidziyo yeropa yeropa kunokonzera kushungurudzika kwepamusoro uye kuora kwechiropa. Uyezve, kupoteredza mutsara iyi yeropa kunogona kuderedza kuderera kweropa kuchiropa panguva yekuvhiyiwa.
Vanhu vane chirwere chakakomba chechiropa, kufanana ne-cirrhosis, avo vanoda kuvhiyiwa nekukurumidzira nekuda kwekutukwa kwepakati, sekushungurudza kana kushungurudzika, vari pangozi yekufa mushure mekuita.
Kuvhiyiwa kwepfungwa kunowedzera kupindira kweropa ruchienda kuchiropa uye rinowedzera dambudziko racho. Uyezve, mapurisa (mishonga inopiwa kuwedzerwa ropa mukati me periopative period) uye cardiopulmonary bypass inogona kuwedzera kukuvara kwechiropa.
Sezvambotaurwa, anesthetics inogonawo kuderedza kuwedzera kweropa uye kubuda kweropa kuchiropa uye zvinowedzera kuwedzera kukuvadza kwechiropa. Uyezve, kune vanhu vane chirwere chechiropa, anesthetics inogona kuramba yakananga kwenguva refu uye isingazogadziriswi zvishoma nezvishoma zvichiita kuti iite nguva yakareba yekuita.
Mhedziso
Chokutanga, kana chiropa chako chechiropa chinongokurudzirwa asi chirwere chako cheropa chinenge chichidzorwa, unogona kunge uri mukana wakanaka wokuvhiya. Chechipiri, kana iwe une chirwere chisingaperi chine hepatitis ine chiropa chakasimba chebasa, unogona kunge uchiri mukana wakanaka wokuvhiya. Chechitatu, kana uine doro rehapatitis uye urega kunwa kwechinguva uye usingaregi kurwara, unogona kunge uri mukana wakanaka wokuvhiya.
Ndapota ramba uchifunga kuti nekuda kwekuti iwe une cirrhosis hazvirevi kuti iwe haugone kuvhiyiwa. Zvisinei, kuvapo kwe-cirrhosis kunobatsira chaizvo zvinokonzera uye saka hazvifanirwe kubhadharwa panguva yekuvhiyiwa (funga jaundice, ascites, masimba, kana variceal, kubuda ropa nezvakadaro).
Kana iwe une acute hepatitis kana decompensated cirrhosis, chirwere chinogona kunge chakaipa. Zvakanakisisa kufunga nezvechiropa mukati mevanhu vane chirwere chakakomba chechiropa se hepatitis kana cirrhosis sehope huru. Chaizvoizvo, vanachiremba vanovhiya vachipoteredza chirume chikuru chinorara, uye mirre-ups kana inhibited chiropa chinoshanda sechipiri kusvika kune cheprhosis yakagadziriswa inoita chigunwe ichi chekurara chisingazorori.
Migumisiro yekuvhiyiwa kune avo vane chirwere cheropa chinogona kuwana zvakanyanya kunaka. Vamwe vanhu vane chiropa chokukundikana uye vanofa mushure mekuvhiyiwa kwakadaro. Nokudaro, kukurudzirwa kuita chirwere muvanhu vane chirwere chechiropa kunonyatsoongororwa neboka rako rehutano hwehutano. Uyezve, semurwere, iwe unofanirwa kupawo chibvumirano chakanaka, kana kubvumirana nenzira.
Iwe unofanirwa kukumbirwa kupa mvumo yakagadziriswa chete mushure mekunge chiremba wako neboka rehutano hwezvehutano vakatsanangura zvakakwana ngozi, mazano, nemigumisiro yechirongwa. Yeuka kuti kuva nekuvhiyiwa ichisarudzo chaunoita.
Sources
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The Editors. Mhizha yeMishonga. Muna: Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 19e . New York, NY: McGraw-Hill; 2015.
Montagnese S, De Pitta C, De Rui M, et al. Kurara-Kuvhara Kuipa Kwevarwere NeCirrhosis. Hepatology . 2014; 59 (2): 705-712.
Qamar AA, Grace ND. Chitsauko 53. Kuongorora kuongororwa kwehutachiona hwechiropa. Mu: McKean SC, Ross JJ, Dressler DD, Brotman DJ, Ginsberg JS. eds. Nheyo uye Maitiro echipatara Mushonga . New York, NY: McGraw-Hill; 2012.