Apo isu tinonzwa shoko rokuti " hepatitis ," tinowanzotaurirana naro ne- cirrhosis nezvimwe zvinetso zvinokonzera chiropa. Asi haisi nguva dzose. Sezvimwe nezvimwe zvinoramba zvichirwara, zvirwere zvisingaperi, hepatitis inogona kuchinja zvakananga imwe nhengo yehutano (munyaya iyi, chiropa) asi isina kukanganisa zvimwe zvirongwa zvenhengo, zvakare.
Imwe nzira isina kusimbiswa inokonzerwa nehupachivwere chirwere chepakati yenheyo, uye kunyanya uropi.
Munguva yakaoma kana isingaperi yehepatitis, utachiona hunobva pachiropa hunogona kuunganidza muropa uye hupararira (kana kuparadzira) mumuviri wose. Apo izvozvi zvinhu zvinopinda muuropi, zvinogona kukonzera chirwere chepfungwa chinonzi hepatic encephalopathy .
Hepatic encephalopathy inowanzopa nekuvhiringidzika, kunetseka, uye dzimwe nguva kuchinja kunoshamisa mune mufambiro uye unyanzvi hwemotokari. Kana isina kusiya, chirwere ichi chinogona kuwedzera zvishoma nezvishoma kusvika ku coma (coma hepaticum) kana kunyange rufu.
Zvose zvinotaurwa, pakati pe30 ne45 muzana yevanhu vane cirrhosis vachaita zvimwe zviratidzo zvehupenzi hwekudzivirira, zvisinei kuti zviri zvinyoro zvekukanganwa kana kuti zvakanyanya kuoma kwemamnesia kana kukanganisa.
Zvinokonzera Hepatic Encephalopathy
Kunyange zvazvo hepatic encephalopathy inobatanidza nehutachiona hwekushaya simba , pane kazhinji zvimwe zvinokonzera kutamba. Zvakawanda zvezvinhu izvi hazvina chokuita nechoropa kana uropi; zvinongoratidzika sekuti zvinokonzera kurwisa kana kuwedzera kuwedzera chiitiko chiripo.
Pakati pezvinhu zvinogona kuwirirana muvanhu vane chiropa chakakundikana:
- Kunyanyisa doro kushandisa
- Kuora kweiyo
- Kuvhara, izvo zvinoita kuti mucheche upiwe muAmmonia
- Pneumonia
- Kubuda kwepachiviri ropa, izvo zvinowanzowanzoitika mushure mekupedzisira-chirwere chechiropa
- Kunokonzerwa nebhakitiriya peritonitis , kazhinji kunokonzerwa nechiropa chinonzi cirrhosis
- Urinary tract infection
- Low potassium uye / kana sodium mizinga, kazhinji inokonzerwa ne diuretics inoshandiswa kurapa ascites munguva inotevera-chirwere chechirwere
- Benzodiazepines, sedative inowanzorongerwa kuti irore doro rekusiya
- Narcotics uye anti-psychotic zvinodhaka
- Kushandiswa kwekuvhara (inozivikanwa pa transjugular intrahepatic portosystemic shunt, kana mazano), yakashandiswa kururamisa ropa mukati meropa
Nokuziva zvikonzero zvinokonzerwa nehepatic encephalopathy, vanachiremba vanokwanisa kurapa chirwere ichi kubudirira kuburikidza nekuderedza zvinhu zvinogona kunge zvakapinda kana kuwedzera kukurudzira.
Iyo Kusakundikana Kwechiropa kunobata Bongo
Hepatic encephalopathy inowanzoitika apo chiropa hachikwanisi kuita zvinowanzogadzirisa mashizha.
Muvanhu vane chiropa chinoshanda, nitrogen-ine makemikari kubva mumatumbo inotakurirwa kuenda kuchiropa, iyo inoshandiswa uye inobudiswa kubva mumuviri. Apo chiropa chinoshanda hachina simba, zvinokonzerwa ne nitrogen zvinotanga kuwedzera zvishoma nezvishoma, izvo zvinokonzera kuwedzera kwemaammonia.
Aya ammonia particles akapararira muropa rose uye achipfuura nepamuviri unotenderera unopoteredza uropi. Iko, inokonzera kubwinya kwemasero europi anonzi astrocytes, izvo zvinopedzisira zvichitadzisa kubudiswa kwevanhu vanoziva nezvemaurotransmitter anokosha pakufunga kwemafungiro.
Zviratidzo uye Zviratidzo zveHematic Encephalopathy
Hepatic encephalopathy inowanzoomerwa kuongororwa mumatanho ekutanga echirwere. Kukanganwa, kusagadzikana, kuzvidya mwoyo, uye kuvhiringidzika kazhinji kazhinji zviratidzo zvekutanga, zvizhinji zvacho zvisingakanganwiki kunyange kune vanhu vane chirwere chinonzi chiropa.
Zvichida chiratidzo chokutanga chakajeka chaizova chimwe chinhu chinonzi chivhiringidziro chekurara-mufananidzo, umo munhu acharara nemasikati ndokuramba akamuka usiku. Izvi zvinowanzoteverwa nehuwandu hwezviratidzo zvekupedzisira-chekutanga, zvinogona kusanganisira:
- Lethargy
- Unhu hunochinja hunochinja
- Kuwedzera kukanganiswa
- Matambudziko nekunyorera uye nemaoko akanaka
- Shaky maoko kana kusazvipira "kuputika" kwemaoko
- Kubvongodza kwemakumbo
- Uninhibited behavior
- Amnesia
- Kutadza kwegag reflex
Zviitiko zvakakomba zvinogona kutungamirira kumamiriro ezvinhu anowedzera kuwedzera kwekuziva, kazhinji kuenderera mberi kukundwa kwechisimba uye coma. Rufu runowanzokonzerwa nekudzivirira kukuru kweuropi (inonzi cerebral edema).
Nhanho dzeHepatic Encephalopathy
Zvikamu zve hepatic encephalopathy zvakanamirwa pamwero unonzi West Haven Criteria, iyo inoratidzira kuoma kwezviratidzo zvichienderana nehutano hwehutachiona hwehutano:
- Minimal: kuchinja mu motor speed pasina zviratidzo zvekuchinja kwepfungwa
- Bhuku 1: kusakosha kwekuziva, kufara kana kushungurudzika, kuderedza nguva yekucherechedza, kuchinja kurara rhythm
- Chikoro chechipiri: kusava nehanya kana kusava nehanya, kusavhiringidzika, unhu hwakajeka hunoshanduka, mufambiro usina kukodzera, matambudziko emagetsi, unodedera ne "kuputika" kwemaoko
- Chikoro chechitatu: nhengo-yakadzika, mhirizhonga, kuvhiringidzika kukuru, mufambiro unoshamisa
- Bhuku 4: coma
Zvirwere zvekupikira hutachiona zvinoshandiswa nekugadzirisa chinokonzera chinokonzera, kana chiri chiropa chakakundikana (Type A), nzira yeTIPS (Type B), kana kuti cirrhosis (Type C). Chimwe nechimwe chezvikamu izvi zvinobatsira mukugadzira nzira yakakodzera yekuita mukurapa mamiriro acho.
Kuziva
Kuonekwa kwehepatic encephalopathy kunogona kungoitwa chete pakuvapo kwechirwere chechiropa chakasimba kana kuti kune vanhu vakawana maitiro eTIPS. Kuongororwa kunoitwa nekusaisa zvimwe zvimwe zvinokonzera kukanganisa kwepfungwa.
Unyanzvi hwekliniki hunodiwa kuitira kuti kuve nekusiyanisa kuongororwa ; hapana kuongororwa kunogona kujekesa kana kubvisa zvakakwana mamiriro acho ezvinhu. Kana hepatic encephalopathy inenge ichifungidzirwa, vanachiremba vachawanzoita bhatiri rekuedzwa, iro rinogona kusanganisira:
- Kuongororwa kwemaziso anoona, motokari uye nemashoko
- CT inotsvaga kuti irege kubvisa kana kusimbisa uropi humorrhage
- Electroencephalograms (EEG) kana kugumburwa kuchionekwa
- Ropa kuedza kuongorora serum ammonia mazinga
- Zvirwere zvakasvibiswa kubva ku-peritoneal cavity (iyo inoparadzanisa chikamu chemuviri kubva mudumbu remukati) kuti irege kubvisa kana kuratidza hutachiona hwehutachiona
- Mimwe miedzo, kusanganisira chifukidzo X-rays uye urinalysis, kusabvisa zvimwe zvinokonzera
Kurapa
Hepatic encephalopathy inoporesa. Mishonga inowanzoenderera pakugadzirisa chero mamiriro ezvinhu akadai angangodaro akanganisa kana kuwedzera kukurwisa. Mune zvimwe zviitiko (zvakadai sevanhu vakagadzirirwa maitiro eTIPS), mamiriro acho anogona kugadzirisa pakarepo uye haadi kuti awedzere kupindira. Pane dzimwe nguva, kuguma kweimwe chirwere kana kurapwa kwekudzivirira kunogona kuchinja zvikuru zviratidzo zvehutano.
Mumamiriro ezvinhu apo chirwere chinoshanda chave chichiongororwa, antibiotics inowanzorongedzerwa nenzira ye rifaximin . Uyezve, lactulose inowanzogadziriswa semushonga wekutanga-mutsara kuderedza kubudisa ammonia mumatumbo.
Kufanirwa kwemunhu ane hepatic encephalopathy kunogona kusiyanisa zvikuru. Kuongororwa kwe encephalopathy, pamwe nebheteri yekuongororwa kwechiropa, kuchawanzoshandiswa kusarudza kana munhu achingoda chiropa chekuisa . Mune vanhu vane chirwere chakakomba chechiropa, zvakadai seprhosis decompensed kana kenza yeropa , chiropa chekuputika chinonyanya kuratidzwa.
> Sources:
> Vilstrup, H .; Amodio, P .; Bajaj, J .; et al. " Hepatic Encephalopathy muHurwere Hwezvirwere Hwakachengetedzwa: Mazano Ekubatsira a2014 kubva kuAASLD neEASL." IAASLD Dzidzira Mutungamiri. 2014: 3-67.
> Conn, H. "Hepatic encephalopathy." Schiff, L uye Schiff, E., eds. Zvirwere zveChiropa . 7th ed. Philadelphia, PA: Kubvunzwa; 1993: 1036-1060.