Mishonga Inogona Kubatanidza Kudya, Kudya Kwemviri, Mishonga, uye Kuvhiya
Muchidimbu chirwere chemuviri (SBS) chirwere chinogona kuitika kana yakawanda yemukati yakabviswa kana kuti isingadyi mishonga sezvinofanira. Mavitamine nemaminera ayo muviri unoda kunotorwa kubva pakudya sezvo ichipfuura nepamuviri mudumbu. Kana chirwere chiduku chiri chiduku zvokuti hachina kuwana zvakakwana kubva pakudya, kana kana zvikamu zvayo zvisingakwanisi kuwana mishonga, zvinogona kukonzera kushaya zvokudya zvinovaka muviri.
SBS inogona kuva chirwere chisingaperi chinoda kutarisirwa nguva dzose, asi pane dzimwe nguva ichinguva chechiitiko icho chichapindura kurapwa.
Maererano neCrohn's and Colitis Foundation , pakati pe10 000 ne20 000 vanhu muUnited States vanogara neSBS. Zvirwere zveSBS zvakapfuura mumakore achangobva kupfuura, kuvandudza hupenyu hwevanhu vanorarama nemamiriro acho ezvinhu. Mune zvimwe zviitiko, kurapwa kunogona kubatsira kuwedzera basa rehutachidzo zvakare kuitira kuti iwane zvinodhaka zvakawanda. Kusadya kwakakwana, mishonga, uye kuvhiwa kunogona kushandiswa kubata vanhu vane SBS. Vanhu vane chirwere cheCrohn avo vane maitiro akawanda ekuvhiya uye vangasara pedyo nehafu kana yakawanda yemukati wavo muduku vanogona kuvaka SBS.
Kukosha kweMucheche Muduku
Basa guru remukati mudumbu, iyo iri chikamu chekudya kwekudya , ndeyekudya mavitamini nemaminera kubva pakudya. Utumbo hudiki hwakafanana nebhubhu, uye inowanzova mamita makumi maviri pakureba.
Inowanikwa mudumbu iyo inogadzirirwa iri pakati pemudumbu uye mumukati mukuru mudumbu rekudya. Zvokudya zvinosiya mudumbu uye zvinopfuurira kusvika mumukati muduku umo mavhithamini anotorwa, zvisati zvapfuura zvichienda kumucheto uko mvura inotora.
Utumbi hudiki hunorondedzerwa seine zvikamu zvitatu zvakanyanya uye zvikamu zvakasiyana-siyana zvinotorwa mune rimwe nerimwe chikamu.
Nokuda kwechikonzero ichi, zvakakosha kune varwere vane SBS kuziva kuti zvikamu zvipi zvemukati mudumbu zvakabviswa kuburikidza nekuvhiyiwa kana kusashanda pamwe uye zvinofanira kunge zviri. Siri inoputirwa muchikamu chekutanga, duodenum, shuga, amino acids, uye mafuta acids muchikamu chechipiri, jejunum, uye B12, bile acids, uye mamwe mavitamini anoshandiswa muchikamu chechitatu uye chekupedzisira, the ileum.
Mazinyamu anobatsira kugadzira zvokudya anogadzirwa mupakreas uye akapinda mumukomana muduku. Zvokudya zvinoputsika nemakemikari uye michina inotorwa nezvivako zvakadanwa zvinonzi villi zviripo mukati memadziro emukati emudumbu muduku.
Zvinokonzera Short Short Chiwel Syndrome
Kuva nechirwere cheCrohn uye mitambo yakawanda pamatumbo maduku kunogona kuisa munhu pangozi yeSBS. SBS inogonawo kuitika apo musikana muduku hahushandi zvakanaka uye kwete chete kana huwandu hwahwo husiripo (hwakafanana nevaya vanozvarwa vane tumukaka kadiki) kana kuti vakabviswa. Mamwe mamiriro ezvinhu anosangana neSBS anosanganisira:
- Kubvuma: ruvara rwechivara rwakaumbwa mushure mekuvhiyiwa mumimba
- Cancer
- Kurwara kusingaperi-kuvhara: hutumbu hudiki hunoita sekuti pane kuvhara
- Chirwere cheCrohn ine multiple resection
- Maitiro eC Congenital akadai sepenital short bowel syndrome, gastrochischisis, Hirschspring's disease, meconium ileus, microvilius inclusion chirwere, midgut volvulus, uye omphalocele.
- Kukuvadza kumucheto muduku mukati mekurapwa kwemazizi (radiation enteritis)
- Kukuvara nehosha kana kukuvara kumidziyo yeropa (kukuvara kwevascula)
- Ischemia: kushaikwa kweropa kunopera kana kuti yakadzivirirwa mudziyo weropa
- Kutanga: apo chikamu chemukati chinopinda se telescope
- Necrotizing enterocolitis: mamiriro ezvinhu anogona kuitika mumwana asati azvarwa
- Volvulus: kuchinja kwechikamu chemukati mudumbu
- Kurasikirwa nekurasikirwa kwekureruka
- Trauma
Zviratidzo zveKfupi Bowel Syndrome
Kana chimwe chinhu chichienda chisina kumira, zvichida nokuti hachina kukwana kamumbu kaduku kakasara kana nokuti yakamira kushanda zvakanaka, zvokudya hazvina kuputswa uye zvinoshandiswa zvakajeka sezvazvingafanira kuva, uye zvinogona kuva zviratidzo nezviratidzo zveSBS zvose chirwere chekudya uye mune imwe muviri wose. Diarrhea inowanzova imwe yezviratidzo zvinowanzozivikanwa uye, zvinonzwisisika, inogona kutungamirira kukurasikirwa kwemazivi uye kupera simba.
Zvimwe zvezviratidzo zvinogona kuitika uye zviratidzo zvemukati madiki chirwere chinogona kusanganisira:
- Cramping
- Bloating
- Diarrhea
- Edema (kurira) mumakumbo
- Kuneta
- Kushungurudza
- Kusadya zvakakwana
- Kushaya simba
- Kuonda
Kusagadzikana kwechingwa chiratidzo cheSBS icho chichava chigumisiro chekusawana mishonga yakakwana kubva mukudya kwezvokudya. Kusagadzikana kwezvokudya zvinovaka muviri kunogona kukanganisa muviri wose uye hakungokonzeri manzwiro evanhu ekusava nehana zviratidzo zvakadai sokuneta uye kushaya simba, asi zvinogona kutungamirira kune zvimwe zvinetso zvakadai sekuora bvudzi uye ganda rakaoma pamwe nezvinetso zvakakomba zvakadai sokuputika (edema) uye kurasikirwa nemisasa mashoma.
Vitamin Deficiencies
Vitamini zvakakundikana zvinogona kuitika neSBS zvichienderana nechikamu chipi chemukati mutsva chinokanganiswa nemamiriro aya. Humwe hutachiona hwehutachiona hunoita kuti zviratidzo zvakasiyana-siyana zviratidze. Kana paine kushaya kwevamwe vitamini nokuti haisi kunyanya, boka rehutano rinogona kutora kushayikwa kwacho nemazana ekuwedzera kuitira kuti uwedzere mavitamini aya mumuviri.
Zvimwe zvezvakawanda zvinowanzoita mavitamini zvinosanganisira:
- Iron : Iron inoputirwa mu duodenum, saka kana chikamu ichocho chemukati mudumbu chikabatwa, chigumisiro chacho chingava kushayikwa kwesimbi. Kushaya kwesimbi yakakwana kunogona kutungamirira kumapembudzi, izvo zvinogona kukonzera kuneta.
- Vitamini A: Vitamin A inobatsira mukuchengeta maziso ose uye ganda rehutano, izvo zvinoreva kuti kushayikwa kwemuviri uyu kunogona kutungamirira kumatambudziko eziso (zvakadai sehupofu hweusiku) uye nyaya dzeganda dzakadai semashes. Mimwe mitemo yakakomba inogona kukonzerwa nokushayikwa kwakanyanya, kusanganisira kudengenyeka kwekromaa, zvirwere zvokuputika, uye kuoma kweganda. Vitamini A ichaendeswa mu jejunum, saka kana chikamu ichocho chemukati chiri kushanda zvakanaka, chirwere chevitamini A chinogona kuitika.
- Vitamini B: B mavhithamini anoshandiswa mu jejunum uye vitamini B12 inowanikwa muchikamu chekupedzisira cheiyoum, chinonzi terminal terminal. Kushaikwa kwevhitamini B kunogona kutungamirira kune zviratidzo nezviratidzo zvakadai sedhemema, kusagadzikana kwepfungwa, uye kuora kwehuipi (neuropathy).
- Vitamini D : Vitamini D inobatsira vitamini yegamisiyamu kuitira kuti nguva yakareba kusagadzikana kwevhitamini D kunogona kutungamirira kumatambudziko nemapfupa akaita seansteoporosis. Low vitamin D maitiro anogonawo kukonzera misi miviri uye kusungirira kana pini uye nenyuchi kunzwa (paresthesias). Ijjunamu ndiko uko vitamini D inotorwa nemuviri mudumbu duku.
- Vitamin E: Vitamin E kusimba hazviwanzoitiki kunze kwenyika dzichiri kusimukira, asi kune vanhu vane SBS umo jejunum inobatwa, kusakwana kwevhitamini iyi kunogona kuitika. Kushaikwa kwevhitamini E kunogona kutungamirira kumapini uye nenyuchi kunzwa uye zvinetso zvekuona, uyewo nenyaya dzemasumbu dzakadai sekugumburwa.
- Vitamin K: Vitamin K inobatsira ropa clot, saka kushayikwa kwevhitamini iyi kunogona kutungamirira kumatambudziko nekupwanya nyore uye kubuda ropa zvikuru. Pamwe pamwe nemamwe mavitamini, vitamini K inotorwa mu jejunum, saka kushayikwa kunogona kuitika kana chikamu ichocho chemucheche chiduku chakakanganiswa neSBS.
- Zinc: Kushaiwa kweZinc hazviwanzoonekwa nevanhu vane hutano asi kusava kwemugodhi uyu kunogona kuitika apo SBS inoshandisa kuwanikwa kwayo. Kushaya kweZinc kwakaoma kuongorora asi kunogona kukonzera kurasikirwa kwechido uye kuderedza zvirwere zvekudzivirira muviri (izvo zvinogona kureva kuva mukana wekubata hove kana chirwere).
Kurondedzera Short Bowel Syndrome
Mune zvimwe zviitiko, SBS ichava pangozi iyo iri patafura nekuda kwekuvhiyiwa pamutsipa muduku (sevanhu vane chirwere cheCrohn vane maitiro akawanda ekuvhiya kwepamusoro), uye nokudaro kuongororwa hakungareve kutarisana nekuongororwa kwakawanda. Mune mamwe mamiriro ezvinhu, zvingave zvakakosha kune chiremba uye / kana nyanzvi kutarisa migumisiro yechiratidzo zvakasiyana-siyana kuti aone kuti SBS idambudziko.
Ropa rega rinowanzoshandiswa kuongorora nekuongorora SBS. Nhamba yakazara yeropa (CBC) inogona kuratidza kana pane chirwere chemaemia, zvirwere zveropa zvinogona kuratidza kana kukuvara kwechiropa kungave kuripo, uye mazinga ezvisikwa anokwanisa kuratidza kana kune dambudziko nemishonga. Kuyera ropa kunogona kushandiswawo kuziva kana kune humwe hutachiona husina kukwana.
Zvimwe zvezviedzo zvinogona kushandiswa kutsvaga SBS dzinosanganisira:
- Computerized axial tomography (CAT) scan : Muedzo wakaitwa nekusiyana dye yakapiwa kuburikidza ne IV inogona kuratidza zvinetso nechiropa uye mumatumbo.
- Computerized tomography (CT) scan : A scan of the pregnancy that gives a cross section of the body.
- Magnetic resonance imaging (MRI) : Magnetic masimi anoshandiswa kuita chifananidzo chemuviri uye kunyanya mumukati muduku.
- Ultrasound: An ultrasound yedumbu inogona kushandiswa kutsvaga nyaya ne bile ducts kana gallbladder.
- Kumusoro GI mutsara : Chimiro che x-ray iyo inotorwa mudumbu mushure mekunwa sarudzo yebasium inobatsira kuona zviri kuitika mumugwagwa wepamusoro.
- X-rays : Muviri x-rays inogona kushandiswa kutarisa mabheji kana zvimwe zvinetso mumatumbo.
Mishonga
Zvirwere zveSBS zvinogona kusanganisira kudya kwakakwana, mishonga, kudya kunochinja, vitamini kuwedzera, uye kuvhiyiwa. Mhando yemishonga inoshandiswa ichave yakasiyana-siyana nokuti murwere wese ane SBS achava nezvimwe zvakasiyana nezvinodiwa kurapwa. Panogona kunge pane zvimwe zvinhu zvinoshandawo pakusarudza kurapa, zvakadai sezvido zvevarwere, mamwe mamiriro ayo murwere angave nawo, uye kana murwere ari munhu mukuru kana mwana.
Kudya
Pamatambudziko akakura eSBS, kuchinja kwezvokudya uye kuwedzerwa kwevhitamini uye mineral supplement zvinogona kubatsira kuchengetedza kuti zvimwe zvibereko zviri kuwedzerwa nemuviri. Varwere vanowanzorayirwa kuti vadye zvokudya zvakasiyana-siyana zvakadai sekuregererwa, asi kudya kunogona kugadziriswa nemudzidzisi wekare kuti aise zvakanyanya kuzvinhu zvinowanikwa zvakanyanya. Kudya zvishomanana kudya zviduku pazuva pane pane zvishomanana kudya kukuru kunogona kuva nyore kune murwere ane SBS. Shanduro yekugadzirisa mvura mumuromo (ORS) inogona kushandiswawo kuitira kuchengetedza kukodzera kwemvura uye electrolyte muviri.
Intestinal Adaptation
Utumbo hudiki hunokwanisa kugadzirisa kwenguva yakawanda uye hunogona kutanga kutora mishonga yakawanda kubva pakudya, kugadzira zvikamu zvisingashande zvakanaka kana zviripo. Mimwe mishonga inogona kubatsira iyi nzira pamwe chete, uye apo nguva inoda kubatwa kwemukati ichiri kunzwisiswa, inogona kutora chero ipi zvayo kubva pamwedzi 6 kusvika pamakore maviri kusvika ku3.
Total Parenteral Nutrition (TPN)
Muzviitiko zvakawanda zveSBS, varwere vanoiswa mufananidzo we TPN, iyo inogadziriswa inopiwa kuburikidza ne IV. Nemhaka yekuti chimiro chekudya chikafu hachidari mumukati muduku, inobvumira mishonga yakadai sehuga, mapuroteni, mafuta, mavitamini, uye maminera kuti apinde muropa rega uye kushandiswa nemuviri. Kushandiswa kweTPN kunogona kuva kwenguva pfupi kana kunogona kuva kusingagumi, zvichienderana nokuti SBS inobata sei muviri.
Mune zvimwe zviitiko, kudya kwakapiwa kunopiwa kuburikidza nehuwandu hutachiona hunoiswa mudumbu kana musikana muduku, unonzi inalidal feed tube. Vanhu vanogamuchira zvokudya zvekudya zvega zvinogona kana kuti havagoni kudya zvokudya nemuromo. TPN inogona kupiwa kuvarwere pavanenge vari muchipatara uye inogona kupiwawo kumba kana murwere akasimba zvakakwana kuti asunungurwe.
Mishonga
Mhando dzakasiyana dzakasiyana dzemishonga inoshandiswa kurapa SBS kuitira kuti ibatsiro riwane mishonga yakawanda, kunonoka kurara, uye kuderedza kubudiswa kwemuviri acid. Anti-diarrheals inogona kushandiswa inosanganisira diphenoxylate / atropine, loperamide, somatostatin, uye, kazhinji, codeine uye tincture ye opium. Zvinofungidzirwa kuti muviri wakawanda weAidam unogona kuderedza chirwere chemuviri, uyewo chinokonzera kusagadzikana, uye saka gastric acid reducers (histamine-2 receptor blockers uye proton pump inhibitors ) iyo inogona kuderedza kana kurambidza kugadzirwa kwemuviri acid inogona kushandiswa, kusanganisira famotidine, lansoprazole, omeprazole, uye ranitidine.
Kuwedzera kwevanhu hormone, somatropin, kana pamwe nekudya kwezvinhu zvakakombhedzwa, zvinogona kuwedzera kuwedzera kwekudya mumutsipa muduku uye kunogona kushandiswa kune varwere vari kugamuchira TPN. Bile acid kusungira resin yakadai sa cholestyramine inogona kushandiswa kuderedza bile acids, iyo inogonawo kubatsira kuderedza chirwere. Pancreatic enzyme inogonawo kupiwa kuwedzera kuputsika kwemafuta, mapuroteni, uye mahydrohydrates ezvokudya sezvaanenge achifamba nomukati muduku. Glucagon-like peptide 2, teduglutide, inogona kupiwa kuvanhu vakuru vanogamuchira TPN nokuti yakaratidzwa kuti iwedzere kugadziriswa kwemucosa mumucheche muduku, uye nokudaro kubatsira mamwe mishonga kuti iwane.
Surgery
Kunyange zvazvo zvingaratidzika kunge zvisinganzwisisiki, kuvhiyiwa dzimwe nguva kunoshandiswa kubata SBS. Mhando shomanana yekuvhiya inogona kushandiswa kuwedzera urefu hwemukoko muduku, unosanganisira nzira yeBianchi uye serial transverse enteroplasty (STEP). Muzviviri zvekuvhiya uku, mugumisiro ndeye chikamu chakareba chemuviri wechipfuva chinowedzerawo, asi chikafu chichapedza nguva yakawanda ichifamba nayo, uye mimwe michina inogona kuwedzerwa.
Imwe nzira yekuvhiya iyo isingawanzoitiki uye inongowanikwa kune avo vane matambudziko kubva kuSBS-zvakadai sekushaya simba kwechiropa uye kutapurirwa-inhengo yekutapira. Mune nzira iyi, mupiro wemukati muduku unoiswa mumurwere neSBS. Iyi nzira yekuvhiya inosuruvarisa zvakare inobatanidza nehuwandu hwezvinetso zvinosanganisira kukwanisa kukanganisa. Vanhu vanogamuchira zvinyorwa zvishoma zvekuchera zvinodawo kutora mishonga yemuviri kunoderedza migumisiro yekuramba.
Kudukuka kweBhakiteriya Muduku
Utumbo muduku hahuna mabhakitiriya mazhinji, asi vamwe vanhu vane SBS vanogona kuwedzera kukura kwebhakitiriya, iyo inonzi kuduku kwebhakitiriya yebhakitiriya . Izvi zvinogona kukonzera zviratidzo zvekuvhara, kurarisa, kushungurudza, uye kurutsa. Izvi zvinogona kukonzera SBS uye kudzivisa kushandiswa kwemukumbo kuchinjwa. Kurapa kunogona kusanganisira mishonga inorwisa mabhakitiriya kuti irege kukura kwebhakitiriya muhomwe duku uye kutarisa chero zvimwe zvikonzero zvingangodaro zvinokonzera dambudziko racho. Zvirongwa zvebioti zvinogonawo kupiwa kukurudzira regrowth mabhakitiriya anobatsira mushure mekurapa nemishonga inorwisa mabhakitiriya.
Shoko Rinobva
SBS imamiriro ezvinhu asingabatanidzi zvikamu zvose zvemuviri, asi zvikamu zvose zvehupenyu hwomurwere. Mishonga inowanika inogona kuderedza kusvibiswa kweSBS pamuviri uye kupa hutano hwepamusoro hwehupenyu kuvarwere. Kunyange TPN inogona kuitika ikozvino kunze kwechipatara, uye kunyange paunenge uchibuda mumba kwezuva kana uchifamba.
Kunyangwe zvakadaro, iyi mamiriro ezvinhu anouya nematambudziko makuru uye kuisa sangano rinotsigira rutsigiro panzvimbo ino richave rakakosha kuti riitungamirire. Kwete vadzidzisi bedzi vakadai se gastroenterologist, chiremba, uye chiremba, asiwo ruzhinji rwevamwe, mhuri, vamwe varwere, uye nyanzvi yehutano hwepfungwa. Munhu ane SBS anogona kuwana huwandu hwakawanda hwehutsika nehutsika nemamiriro avo, izvo zvinofanira kutarisirwa. Kuedza kuwana rubatsiro uye kutsigirwa uye kuramba uri pedyo nemusangano unotsigira huchapa mukana wakanakisisa wekurapa kwakanaka uye kurarama hupenyu hwakanakisisa huripo neSBS.
> Sources:
> Crohn's uye Colitis Foundation. "Short Bowel Syndrome uye Crohn's Disease." CrohnsColitisFoundation.org Jul 2013.
> Johnson LE. "Vitamin Defence, Dependency, uye Toxicity: Vitamini A." Merck Manual Sept 2016.
> Johnson LE. "Vitamin Defence, Dependency, uye Toxicity: Vitamin E." Merck Manual Sept Septembre 2016.
> Johnson LE. "Kushaya Vitamini, Kuvimba, uye Inonyangadza: Vitamin K." Merck Manual Sept Septembre 2016.
> National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). "Short Bowel Syndrome." National Institute of Diabetes uye Digestive uye Kidney Diseases Health Information Centre.