Ukuphulukana nokusebenza kwengqondo-isifo sesibindi

Ukuphulukana nokusebenza kwengqondo kwenzeka xa isibindi singakwazi ukususa ityhefu egazini. Oku kubizwa ngokuba yi-hepatic encephalopathy (HE). Le ngxaki inokwenzeka ngesiquphe okanye inokukhula kancinci ngokuhamba kwexesha.

Umsebenzi obalulekileyo wesibindi kukwenza izinto eziyityhefu emzimbeni zingenabungozi. Ezi zinto zinokwenziwa ngumzimba (i-ammonia), okanye izinto ozithathayo (amayeza).

Xa isibindi sonakele, ezi "tyhefu" zinokwakha egazini kwaye zichaphazele ukusebenza kwenkqubo yemithambo-luvo. Iziphumo zinokuba ngu-HE.

UNGENZA ngesiquphe kwaye unokugula ngokukhawuleza.Izizathu ze-HE zingabandakanya:

• Usulelo lwe-Hepatitis A okanye u-B (akuqhelekanga ukwenzeka ngale ndlela)
• Ukuvalelwa kwegazi esibindini
• Ityhefu yityhefu eyahlukileyo okanye amayeza
• Ukuqunjelwa
• Ukopha okuphezulu emathunjini

Abantu abanomonakalo omkhulu wesibindi bahlala benengxaki ye-HE. Iziphumo zokugqibela zomonakalo ongapheliyo wesibindi yi-cirrhosis. Izizathu eziqhelekileyo zezifo ezingapheliyo zesibindi zi:

• Usulelo olunamandla lwe-hepatitis B okanye lwe-C
• Ukusetyenziswa gwenxa kotywala
• Ngokuzimela hepatitis
• Ukuphazamiseka kwendlela yokubila
• Amanye amayeza
• Isifo sesibindi esinamafutha se-Nonalcoholic (NAFLD) kunye ne-nonalcoholic steatohepatitis (NASH)

Nje ukuba ube nomonakalo wesibindi, iziqendu zokuba nzima kokusebenza kwengqondo zinokubangelwa ngu:

• Amanzi amancinci omzimba (ukomisa)
• Ukutya kakhulu protein
• I-potassium ephantsi okanye amanqanaba e-sodium
• Ukopha emathunjini, isisu, okanye ipayipi yokutya (isisu)
• Usulelo
• Iingxaki zezintso
• Amanqanaba eoksijini asezantsi emzimbeni
• Ukubekwa ngokukhawuleza okanye iingxaki
• Ugqirha
• Intlungu ye-narcotic okanye amayeza okuthomalalisa

Ukuphazamiseka okunokubonakala kufana ne-HE kunokubandakanya:

• Utywala butywala
• Ukurhoxiswa kotywala
• Ukopha phantsi kokakayi (i-hematoma yangaphantsi)
• Ukuphazamiseka kwengqondo okubangelwa kukungabikho kwe-vitamin B1 (Isifo seWernicke-Korsakoff)

Ngamanye amaxesha, HE yingxaki yexesha elifutshane enokulungiswa. Inokwenzeka kwakhona njengenxalenye yeengxaki zexesha elide (ezingapheliyo) kwisifo sesibindi esiba mandundu ngokuhamba kwexesha.

Iimpawu ze-HE zihlelwe kwinqanaba le-1 ukuya kwi-4. Zingaqala kancinci kwaye zisiba mandundu ngokuhamba kwexesha.

Iimpawu zokuqala zinokuba mnene kwaye zibandakanya:

• Ukuphefumla nge-musty okanye iphunga elimnandi
• Utshintsho kwiipateni zokulala
• Utshintsho kwindlela yokucinga
• Ukudideka okuphakathi
• Ukulibala
• Ubuntu okanye imo iyatshintsha
• Uxinzelelo olubi kunye nokugweba
• Ukuphakama kokubhala ngesandla okanye ukulahleka kwezinye iintshukumo ezincinane zezandla

Iimpawu ezinzima zingabandakanya:

• Iintshukumo ezingaqhelekanga okanye ukuxhawulana kwezandla okanye iingalo
• Ukuxhalaba, ukonwaba, okanye ukuxhuzula (kwenzeka kunqabile)
• Ukudideka
• Ukozela okanye ukudideka
• Ukuziphatha okanye utshintsho kubuntu
• Intetho egudileyo
• Ukuhamba kancinci okanye ukonqena

Abantu abane-HE banokungazi, bangaphenduli, kwaye banokungena kwi-coma.

Abantu bahlala bengakwazi ukuzikhathalela ngenxa yezi mpawu.

Iimpawu zotshintsho lwenkqubo yemithambo luquka:

• Ukuxhawulana kwezandla ("ukungcangcazela") xa uzama ukubamba iingalo phambi komzimba nokuphakamisa izandla
• Iingxaki ngokucinga nokwenza imisebenzi yengqondo
• Iimpawu zesifo sesibindi, ezinje ngesikhumba esimthubi kunye namehlo (jaundice) kunye nokuqokelelwa kolwelo esiswini (ascites)
• Ivumba elimyoli lokuphefumla kunye nomchamo

Uvavanyo olwenziwe lunokubandakanya:

• Gcwalisa ubalo lwegazi okanye ihemmatocrit ukujonga i-anemia
• Ukuskena i-CT kwentloko okanye iMRI
• I-EEG
• Uvavanyo lomsebenzi wesibindi
• Ixesha leprothrombin
• Inqanaba le-serum ammonia
• Inqanaba lesodium egazini
• Inqanaba lePotassium egazini
• BUN (igazi urea nitrogen) kunye ne-creatinine ukubona ukuba zisebenza njani izintso

Unyango lwe-HE luxhomekeke kwisizathu.

Ukuba utshintsho ekusebenzeni kwengqondo lubukhali, ukuhlala esibhedlele kungafuneka.

• Ukopha kwindawo yokugaya kufuneka kuyekwe.
• Usulelo, ukusilela kwezintso, kunye notshintsho kumanqanaba esodiyam kunye nepotassium kufuneka anyangwe.

Amayeza anikwa ukunceda inqanaba eliphantsi le-ammonia kunye nokuphucula ukusebenza kwengqondo. Amayeza anikiweyo anokubandakanya:

• I-Lactulose ukukhusela ibhaktheriya emathunjini ekudaleni i-ammonia. Ingabangela urhudo.
• I-Neomycin kunye ne-rifaximin nayo iyanciphisa inani le-ammonia eyenziwe emathunjini.
• Ukuba i-HE iyaphucuka ngelixa ithatha i-rifaximin, kufuneka iqhubeke ngokungapheliyo.

Kuya kufuneka uphephe:

• Nawaphi na amayeza okuthomalalisa, okuzola kunye nawo nawaphi na amanye amayeza aphulwe sisibindi
• Amayeza aqukethe i-ammonium (kubandakanya ezinye ii-antacids)

Umboneleli wakho wezempilo unokucebisa amanye amayeza kunye nonyango. Ezi zinokuba neziphumo ezahlukeneyo.

Imbonakalo ye-HE ixhomekeke kulawulo lwezizathu ze-HE. Iifom ezingapheliyo zesifo esihlala siqhubeka ukuba mandundu kwaye zibuye.

Amanqanaba amabini okuqala esi sifo anezigulo ezifanelekileyo. Isigaba sesithathu nesine sinesifo esingalunganga.

Fowunela umboneleli wakho ukuba wena okanye abantu abakungqongileyo bakho naziphi na iingxaki ezikwimo yakho yengqondo okanye kwinkqubo yovalo. Oku kubalulekile kubantu esele benesifo sesibindi. UNOKUYA mandundu ngokukhawuleza kwaye abe yimeko engxamisekileyo.

Ukunyanga iingxaki zesibindi kunokuthintela i-HE. Ukuphepha utywala kunye neziyobisi ezifakwe ngaphakathi kungenza kuthintele ukuphazamiseka kwesibindi.

Isiqaqa seHepatic; Encephalopathy - hepatic; Ecephalopathy yesibindi; Inkqubo yesifo seengcongconi

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I-Woreta T, iMezina A.Ulawulo lwe-hepatic encephalopathy. Ku: ICameron AM, uCameron JL, ii-eds. Unyango lwangoku lonyango. Umhla we-13. IPhiladelphia, PA: Elsevier; Ngo-2020: 428-431.