Isifo seHepatorenal

I-Hepatorenal syndrome yimeko apho kukho ukusilela kwezintso okuqhubekayo okwenzeka kumntu one-cirrhosis yesibindi. Ingxaki enkulu enokubangela ukufa.

I-Hepatorenal syndrome yenzeka xa izintso ziyeka ukusebenza kakuhle kubantu abaneengxaki zesibindi. Umchamo omncinci uyasuswa emzimbeni, ngenxa yoko iimveliso zenkunkuma eziqukethe initrogen ziyakha kwigazi (azotemia).

Esi sifo senzeka kubantu abali-1 kwabali-10 abasesibhedlele ngenxa yokusilela kwesibindi. Kukhokelela ekusileleni kwezintso kubantu abane:

• Ukungaphumeleli kwesibindi
• Utywala hepatitis
• Isibindi
• Ulwelo olusulelayo lwesisu

Izinto zomngcipheko zibandakanya:

• Uxinzelelo lwegazi oluwayo xa umntu ephakama okanye ngequbuliso etshintsha isikhundla (orthostatic hypotension)
• Ukusetyenziswa kwamayeza abizwa ngokuba ngumchamo ("iipilisi zamanzi")
• Ukopha emathunjini
• Usulelo
• Ukususwa kolwelo lwamva esiswini (paracentesis)

Iimpawu zibandakanya:

• Ukudumba kwesisu ngenxa yolwelo (olubizwa ngokuba zii-ascites, uphawu lwesifo sesibindi)
• Ukudideka kwengqondo
• Izihlunu zemisipha
• Umchamo omnyama-mnyama (uphawu lwesifo sesibindi)
• Ukuncipha kwemveliso yomchamo
• Isicaphucaphu nokugabha
• Ukutyeba kwakho
• Ikhumba eliphuzi (i-jaundice, uphawu lwesifo sesibindi)

Le meko ifunyaniswa emva kovavanyo ukulawula ezinye izizathu zokungaphumeleli kwezintso.

Uvavanyo lomzimba alukufumani ukusilela kwezintso ngqo. Nangona kunjalo, uvavanyo luza kuhlala lubonisa iimpawu zesifo esinganyangekiyo sesibindi, ezinje:

• Ukudideka (rhoqo ngenxa ye-hepatic encephalopathy)
• Ulwelo oluninzi esiswini (ascites)
• I-jaundice
• Eminye imiqondiso yokusilela kwesibindi

Ezinye iimpawu zibandakanya:

• Ingqondo engaqhelekanga
• Amatyhalarha amancinci
• Isandi esimdaka kwindawo yesisu xa ucofe iincam zeminwe
• Ukwanda kwamathambo ebele (gynecomastia)
• Izilonda (izilonda) kulusu

Ezi zilandelayo zingabonakalisa ukusilela kwezintso:

• Kancinci kakhulu okanye akukho mveliso yokuchama
• Ukugcinwa kolwelo kwisisu okanye emacaleni
• Ukonyusa i-BUN kunye ne-creatinine amanqanaba egazi
• Ukonyusa umchamo othile kunye ne-osmolality
• Isodiyam yegazi esezantsi
• Umchamo ophantsi kakhulu we-sodium

Ezi zilandelayo zingabonakalisa ukusilela kwesibindi:

• Ixesha elingaqhelekanga leprothrombin (PT)
• Ukunyuka kwenqanaba le-ammonia yegazi
• I-albhamuin yegazi ephantsi
• IParacentesis ibonisa ii-ascites
• Iimpawu ze-hepatic encephalopathy (i-EEG inokwenziwa)

Injongo yonyango kukunceda isibindi sisebenze ngcono kunye nokuqinisekisa ukuba intliziyo iyakwazi ukumpompa igazi elaneleyo emzimbeni.

Unyango lufana ngokufanayo nokusilela kwezintso nangasiphi na isizathu. Ibandakanya:

• Ukuyekisa onke amayeza angafunekiyo, ngakumbi ibuprofen kunye nezinye ii-NSAID, ii-antibiotics ezithile, kunye ne-diuretics ("iipilisi zamanzi")
• Ukuba ne-dialysis ukuphucula iimpawu
• Ukuthatha amayeza ukuphucula uxinzelelo lwegazi kunye nokunceda izintso zakho zisebenze ngcono; Ukufakwa kwe-albin kunokuba luncedo
• Ukubeka i-shunt (eyaziwa ngokuba yi-TIPS) ukunciphisa iimpawu ze-ascites (oku kunokunceda ukusebenza kwezintso, kodwa inkqubo inokuba yingozi)
• Utyando lokubekwa kwindawo esiswini ukuya emthanjeni wejugular ukunciphisa ezinye iimpawu zokusilela kwezintso (le nkqubo iyingozi kwaye ayifane yenziwe)

Iziphumo zihlala zimbi. Ukufa kuhlala kwenzeka ngenxa yosulelo okanye ukopha kakhulu (ukopha).

Iingxaki zinokubandakanya:

• Ukopha
• Ukonakala nokungaphumeleli kweenkqubo ezininzi zomzimba
• Isifo sokugqibela sezintso
• Ulwelo oluninzi kunye nokusilela kwentliziyo
• Isifo esibangelwa kukusilela kwesibindi
• Usulelo lwesibini

Esi sifo sihlala sifunyaniswa esibhedlele ngexesha lonyango lwesifo sesibindi.

Ukuqina - hepatorenal; Ukungaphumeleli kwesibindi - hepatorenal

UFernandez J, uArroyo V. Isifo seHepatorenal. Ku: Feehally J, Floege J, Tonelli M, Johnson RJ, ii-eds. I-Clinical Nephrology epheleleyo. Umhla wesi-6. IPhiladelphia, PA: Elsevier; I-2019: isahluko 73.

UGarcia-Tsao G. Cirrhosis kunye nokulandelelana kwayo. Ku: IGoldman L, iSchafer AI, ii-eds. Amayeza eGoldman-Cecil. Ngomhla wama-26. IPhiladelphia, PA: Elsevier; 2020: isahluko 144.

Mehta SS, Fallon MB. I-hepatic encephalopathy, i-hepatorenal syndrome, i-hepatopulmonary syndrome, kunye nezinye iingxaki zesifo sesibindi. Ku: UFeldman M, uFriedman LS, uBrandt LJ, ii-eds. Sleisenger kunye neFordtran's Gastrointestinal and Liver Disease. Ngomhla we-11. IPhiladelphia, PA: Elsevier; 2021: isahluko 94.