He aha nā Petechiae? Nā Hōʻailona, ​​Nā Kumu, & Lapaʻau ma ka Home

ʻO nā Petechiae nā kiko liʻiliʻi ʻulaʻula, poni, a i ʻole ʻeleʻele e ʻike ʻia ma kou ʻili ke haki a i ʻole ke kahe ʻana o nā kīʻaha koko liʻiliʻi i kapa ʻia he capillaries ma lalo o ka ʻili. ʻO kēia mau kiko liʻiliʻi e like me ka pine, he palahalaha maʻamau a ʻaʻole e mae ke kaomi ʻoe iā lākou, e hoʻokaʻawale iā lākou mai nā ʻōpala maʻamau a i ʻole nā ​​ʻeha.

ʻOiai hiki i nā petechiae ke nānā aku i ka weliweli i ka wā e ʻike mua ʻia ai, ʻaʻole lākou e hōʻeha a pili pinepine i nā pilikia liʻiliʻi e like me ka ʻuʻu ikaika a i ʻole ka hoʻoikaika kino. Eia naʻe, ʻo ka hoʻomaopopo ʻana i ke kumu o lākou a i ka manawa e ʻimi ai i ka lāʻau lapaʻau hiki ke kōkua iā ʻoe e manaʻoʻiʻo i ka mālama ʻana i kēia ʻike ʻili maʻamau.

He aha nā Petechiae?

ʻO nā Petechiae nā kiko liʻiliʻi ʻulaʻula a poni paha e ana i lalo o 2 millimeters ma ke anawaena, ma kahi o ka nui o ka pine. Hoʻokumu lākou i ka wā e haki ai nā kīʻaha koko liʻiliʻi ma lalo o kou ʻili a kahe i nā mea liʻiliʻi o ke koko i loko o ka ʻiʻo a puni.

ʻO kēia mau kiko e ʻike maʻamau ʻia he palahalaha i kou ʻili a ʻaʻole e mae a keʻokeʻo paha ke kaomi ʻoe iā lākou me kou manamana lima. Kōkua kēia ʻano e hoʻokaʻawale i nā petechiae mai nā ʻano ʻōpala ʻē aʻe e mae paha ma lalo o ke kaomi.

Hiki iā ʻoe ke ʻike i nā petechiae ma nā wahi a pau o kou kino, akā ʻike pinepine lākou ma kou mau wāwae, nā lima, ka umauma, ka maka, a i loko o kou waha. Hiki iā lākou ke ʻike wale a i ʻole i nā pūʻulu, e hana ana i kahi ʻano speckled ma ka wahi i hoʻopilikia ʻia.

Pehea ka manaʻo o Petechiae?

ʻAʻole hana maʻamau nā Petechiae i nā manaʻo kino. ʻAʻole ʻoe e ʻeha, ʻaʻole ʻoe e ʻeha, a i ʻole ke kuni ʻana mai nā kiko iā lākou iho no ka mea he mau wahi liʻiliʻi wale nō o ke koko i kahe ma lalo o kou ʻili.

He maʻalahi a palahalaha nā kiko ke holo ʻoe i kou manamana lima ma luna o lākou, ʻaʻole like me nā puʻupuʻu a i ʻole nā ​​pahu. ʻO lākou nā ʻeha liʻiliʻi i liʻiliʻi loa e hana i nā loli ʻano ma ka ʻili o kou ʻili.

Akā naʻe, inā ʻike ʻia nā petechiae me nā hōʻailona ʻē aʻe, hiki iā ʻoe ke ʻike i nā manaʻo hou e like me ka luhi, ke kuni, a i ʻole ka hōʻoluʻolu e pili ana i ke kumu ma mua o nā kiko ponoʻī.

He aha ke kumu o Petechiae?

Hoʻomohala ʻia nā Petechiae i ka wā e haki ai nā kīʻaha koko liʻiliʻi ma muli o nā ʻano kaomi a i ʻole ka pōʻino. ʻO nā kumu mai nā hana o kēlā me kēia lā a hiki i nā maʻi olakino koʻikoʻi e pili ana i kou koko a i ʻole ke kahe.

Eia nā kumu maʻamau e ʻike ʻia ai nā petechiae ma kou ʻili:

• Kaomi kino: ʻO ka ʻuʻu nui, ka luaʻi ʻana, ka uē ʻana, a i ʻole ke kaomi ʻana i ka wā o ka neʻe ʻana o ka ʻōpū hiki ke hoʻonui i ke kaomi i loko o kou mau kīʻaha koko
• Nā ʻeha liʻiliʻi: Nā lole paʻa, ka holoi ʻana, a i ʻole ka trauma liʻiliʻi i ka ʻili
• Nā lāʻau lapaʻau: Nā mea lahilahi koko, aspirin, a i ʻole kekahi mau lāʻau antibiotic e pili ana i ka hoʻopaʻa ʻana o ke koko
• Nā maʻi viral: Nā anu maʻamau, ka maʻi flu, a i ʻole nā maʻi ʻē aʻe e pili ana i kou mau kīʻaha koko
• Ka ʻelemakule: Hiki i nā mākua kahiko ke hoʻomohala i nā petechiae maʻalahi i ka wā e lilo ai nā kīʻaha koko i palupalu
• Pōʻino o ka lā: Hiki i ka ʻike ʻana i ka lā ke hoʻonāwaliwali i nā kīʻaha koko i ka manawa

ʻO ka hapa nui o nā hihia o petechiae mai kēia mau kumu maʻamau e hoʻoponopono iā lākou iho i loko o kekahi mau lā a i ʻole mau pule. Hoʻopili maoli kou kino i ke koko i kahe ʻia, a e mae mālie nā kiko.

He aha nā Petechiae he hōʻailona a hōʻailona paha o?

ʻOiai ʻo petechiae e hōʻike pinepine i nā pilikia liʻiliʻi, hiki iā lākou ke hōʻailona i nā kūlana e pili ana i kou koko, ke kahe, a i ʻole ka ʻōnaehana pale. ʻO ka hoʻomaopopo ʻana i kēia mau mea hiki ke kōkua iā ʻoe e ʻike i ka wā e pono ai ka loiloi olakino ʻoihana.

ʻO nā kūlana maʻamau e hiki ke kumu i ka petechiae me:

• Nā maʻi platelet: Hoʻemi ʻia ka helu platelet (thrombocytopenia) e pili ana i ka hiki ʻana o kou koko ke kūpono
• Nā maʻi kūpono o ke koko: Nā kūlana e hoʻopilikia i nā hana kūpono o ke koko
• Nā maʻi autoimmune: Nā maʻi kahi e pili ai kou ʻōnaehana pale i nā kīʻaha koko a i ʻole nā platelet
• Maʻi ate: Hiki ke hoʻemi i ka hana ʻana o nā mea clotting e pono ai no ka clotting koko kūpono
• Maʻi kīkī: Hiki ke pili i ka hana platelet a me ke olakino o nā kīʻaha koko
• Nā maʻi maʻi maʻi: Hiki i ka leukemia a i ʻole nā maʻi maʻi koko ʻē aʻe ke pili i ka hana ʻana o nā cell koko maʻamau

ʻO nā kūlana maʻamau ʻole akā ʻoi aku ka koʻikoʻi e hiki ke kumu i ka petechiae e komo pū ana:

• Endocarditis: Maʻi o ka uhi o loko o ka puʻuwai e hiki ke hōʻino i nā kīʻaha koko liʻiliʻi
• Meningitis: Hoʻāhu o nā membrane lolo a me ke kuamoʻo e hiki ke hana i ka petechiae ākea
• Sepsis: Maʻi koʻikoʻi e pili ana i ke kahe koko ma ke kino holoʻokoʻa
• Hantavirus: Maʻi viral maʻamau e hiki ke kumu i ke kahe ʻana a me ka petechiae
• Rocky Mountain spotted fever: Maʻi i lawe ʻia e ka tick e pili ana i nā kīʻaha koko

E hoʻomanaʻo ʻaʻole ia he manaʻo maʻalahi ka loaʻa ʻana o ka petechiae he maʻi koʻikoʻi kou. Nui ka poʻe e hoʻomohala i kēia mau kiko mai nā kumu maikaʻi loa a ʻaʻole loa e ʻike i nā pilikia.

Hiki i ka Petechiae ke hele wale aku?

ʻAe, pinepine ka petechiae e nalowale wale nō ke kumu ʻia e nā mea liʻiliʻi e like me ke kaumaha kino a i ʻole nā ʻeha liʻiliʻi. Hoʻopili maoli kou kino i ke koko i kahe ʻia i ka manawa, e hana ana i nā kiko e mae mālie.

No ka petechiae i hana ʻia e nā hana o kēlā me kēia lā e like me ka ʻū a i ʻole ke kaumaha, hiki iā ʻoe ke manaʻo e hoʻomaka ana lākou e mae i loko o kekahi mau lā a i hoʻokahi pule. Hoʻololi maʻamau nā kiko mai ka ʻulaʻula ʻālohilohi i ka poni, a laila ʻeleʻele, ma mua o ka nalowale loa ʻana.

Eia naʻe, inā pili ka petechiae i kahi maʻi olakino, hiki iā lākou ke hoʻomau a i ʻole e hoʻomau i ka ʻike ʻana a hiki i ka wā e mālama pono ʻia ai kēlā maʻi. ʻO ia ke kumu e hiki ai i ka nānā ʻana i ke ʻano a me ka lōʻihi o ka petechiae ke hāʻawi i ka ʻike waiwai e pili ana i ko lākou kumu.

Pehea e mālama ʻia ai ka Petechiae ma ka home?

No ka petechiae i hana ʻia e nā mea liʻiliʻi, hiki i nā hana mālama ponoʻī ke kōkua i ke kākoʻo ʻana i ke kaʻina hana hoʻōla maoli o kou kino. Eia naʻe, he mea nui e hoʻomanaʻo ʻaʻole pono ka petechiae i ka mālama pololei ʻana no ka mea he hōʻailona wale nō lākou o ka pōʻino o nā kīʻaha koko liʻiliʻi.

Eia kekahi mau ʻano mālama kākoʻo hiki iā ʻoe ke hoʻāʻo ma ka home:

• Hoʻomaha a pale i ke kaumaha: Hāʻawi i kou kino i ka manawa e hoʻōla ai ma ka pale ʻana i nā hana e hiki ke hōʻeha hou i nā kīʻaha koko
• Mālama ʻili mālie: E hoʻohana i nā mea hoʻomaʻemaʻe maʻalahi, ʻaʻala ʻole a pale i ka holoi ʻana i nā wahi i hoʻopilikia ʻia
• Nā compresses ʻoluʻolu: E hoʻopili i kahi lole maʻemaʻe, ʻoluʻolu i nā wahi me ka petechiae no 10-15 mau minuke e kōkua i ka hōʻemi ʻana i ka pehu pili
• E noho hydrated: E inu nui i ka wai e kākoʻo i ke kahe a me ka hoʻōla
• E pale i nā mea e hoʻoheheʻe ai ke koko: E kaupalena i ka waiʻona no ka manawa a pale i ka aspirin ke ʻole i kauoha ʻia e kāu kauka

He mea nui e hoʻomaopopo i ka mālama ʻana i ka home he kūpono wale nō no ka petechiae i ʻike ʻia e nā mea liʻiliʻi e like me ke kaumaha kino. Inā ʻaʻole ʻoe maopopo i ke kumu a i ʻole ʻike i nā hōʻailona ʻē aʻe e pili ana, ʻo ka ʻimi ʻana i ka loiloi olakino ke koho palekana.

He aha ka lāʻau lapaʻau no Petechiae?

ʻO ka mālama ʻana i ka lāʻau lapaʻau no ka petechiae e kālele ana i ka hoʻoponopono ʻana i ke kumu ma lalo o ka ʻili ma mua o nā kiko ponoʻī. E hana kāu kauka e ʻike i ka mea e hana nei i kou mau kīʻaha koko e haki a e hoʻomohala i kahi hoʻolālā lapaʻau e like me ia.

Inā pili kāu petechiae i nā hopena ʻaoʻao o ka lāʻau lapaʻau, hiki i kāu kauka ke hoʻoponopono i kāu dosage a i ʻole e hoʻololi iā ʻoe i kahi lāʻau lapaʻau ʻē aʻe. No nā maʻi e hana ana i ka petechiae, hiki ke kuhikuhi ʻia nā lāʻau antibiotic a i ʻole antiviral kūpono.

No nā kūlana e pili ana i ke koko, hiki i nā koho lapaʻau ke komo:

• Nā hoʻoili platelet: No nā helu platelet haʻahaʻa koʻikoʻi e hōʻike ana i nā pilikia koko
• Nā lāʻau immunosuppressive: No ka mālama ʻana i nā kūlana autoimmune e pili ana i nā kīʻaha koko
• Corticosteroids: No ka hōʻemi ʻana i ka mumū e hōʻino ana i nā kīʻaha koko
• Nā lāʻau lapaʻau kūikawā: Nā lapaʻau kikoʻī no nā kūlana ma lalo o ka ʻili e like me ka maʻi ate a i ʻole ka maʻi kīkī

E nānā pū kāu kauka i kāu pane ʻana i ka lapaʻau a e hoʻoponopono i ke ala e like me ka mea e pono ai. Kōkua nā manawa hālāwai maʻamau e hōʻoia i ka mālama pono ʻia ʻana o ke kumu ma lalo o ka ʻili a ʻaʻole e ulu ana nā petechiae hou.

I ka manawa hea e ʻike ai au i ke kauka no ka Petechiae?

Pono ʻoe e ʻimi i ka lāʻau lapaʻau inā ʻike koke ʻia ka petechiae me ka ʻole o ke kumu maopopo e like me ka ʻuʻu a i ʻole ke kaumaha. ʻOiai he mea ʻole ka nui o nā hihia, pono nā ʻano hana a i ʻole nā ​​hōʻailona e hele pū ana i ka loiloi ʻoihana.

E hoʻokaʻaʻike koke i kāu kauka inā ʻike ʻoe:

• Petechiae laulaha: Nā kiko e uhi ana i nā wahi nui o kou kino a i ʻole e ʻike ʻia ma nā wahi he nui
• Nā hōʻailona e hele pū ana: ʻĀwela, luhi, maʻalahi ka ʻeha, a i ʻole ke kahe koko ʻano ʻē mai nā ʻāʻī a i ʻole ka ihu
• Nā kiko paʻa: ʻAʻole e mae nā Petechiae ma hope o hoʻokahi pule a i ʻole e hoʻomau i ka ʻike mau ʻana
• Nā hōʻailona ʻē aʻe e pili ana: Nā puʻupuʻu lymph i pehu, ka ʻeha hui, a i ʻole nā loli i ka mimi

E ʻimi koke i ka mālama olakino inā ʻike ʻia nā petechiae me:

• ʻĀwela nui: ʻOi loa me nā anu a i ʻole ke poʻo nui
• Paʻakikī ka hanu ʻana: Pōkole ka hanu a i ʻole ka ʻeha o ka umauma
• Ke kahe koko nui: Nā kahe koko ihu nui, ke koko i loko o ka mimi, a i ʻole ke kahe koko nui o ka menstrual
• Nā hōʻailona neurological: Huikau, poʻo nui, a i ʻole ka ʻoʻoleʻa o ka ʻāʻī
• Nā hōʻailona o ka maʻi: Ka wikiwiki o ka puʻuwai, ke koko haʻahaʻa, a i ʻole ka maikaʻi ʻole

E hilinaʻi i kou mau manaʻo e pili ana i kou kino. Inā hewa kekahi mea a i ʻole e hopohopo ana ʻoe e pili ana i kāu mau hōʻailona, ​​ʻoi aku ka maikaʻi o ka loaʻa ʻana o kahi loea mālama ola e loiloi i kou kūlana.

He aha nā mea pilikia no ka hoʻomohala ʻana i nā Petechiae?

Hiki i kekahi mau mea ke hoʻonui i kou hiki ke hoʻomohala i nā petechiae, ʻoiai hiki i kekahi ke ʻike i kēia mau kiko liʻiliʻi ma lalo o nā kūlana kūpono. ʻO ka hoʻomaopopo ʻana i kāu mau mea pilikia hiki ke kōkua iā ʻoe e ʻike i ka wā e hiki ai ke hana pinepine ʻia nā petechiae.

ʻO nā mea pili i ka makahiki e hoʻonui ai i kou pilikia e pili ana:

• Nā mākua kahiko: Lilo nā kīʻaha koko i mea palupalu me ka makahiki, e maʻalahi ai lākou i ka haki
• Nā pēpē a me nā keiki ʻōpio: Hiki ke hoʻomohala i nā petechiae me ka maʻalahi ma muli o ka uē ikaika a i ʻole ka ʻuʻu ʻana
• Hāpai: Hiki i nā loli hormonal a me ka nui o ke koko ke hoʻopilikia i ka palupalu o nā kīʻaha koko

ʻO nā maʻi olakino e hoʻonui ai i kou pilikia, e komo pū ana:

• Nā maʻi koko: Nā maʻi e pili ana i ka helu platelet a i ʻole ka hana ʻana o ke koko
• Nā maʻi autoimmune: Nā maʻi e hiki ke hoʻopilikia i nā kīʻaha koko a i ʻole ka hana ʻana o nā keʻena koko
• Maʻi ate a i ʻole maʻi kīkī: Nā maʻi e keakea i nā hana maʻamau o ke koko
• Nā maʻi puʻuwai: ʻO kekahi mau pilikia o ka puʻuwai e pili ana i ke kahe ʻana o ke koko
• Nā lapaʻau maʻi ʻaʻai: ʻO ka chemotherapy a i ʻole ka radiation e hiki ke hoʻopilikia i ka hana ʻana o nā keʻena koko

ʻO nā mea ola e hiki ke kōkua i ka ulu ʻana o ka petechiae e komo pū ana me ka lawe ʻana i nā lāʻau e lahilahi ai ke koko, ka inu nui ʻana i ka waiʻona, a i ʻole ka hana ʻana i nā hana e hana ai i ke kaomi ʻana i nā kīʻaha koko. Eia naʻe, ʻo ka loaʻa ʻana o nā mea pilikia ʻaʻole ia he manaʻo e loaʻa ana iā ʻoe ka petechiae.

He aha nā pilikia e hiki ke loaʻa mai i ka Petechiae?

ʻAʻole pinepine ka petechiae i nā pilikia no ka mea he mau wahi liʻiliʻi wale nō o ke koko i kahe ma lalo o kou ʻili. Eia naʻe, hiki i nā maʻi e hana ai i ka petechiae ke alakaʻi i nā pilikia olakino koʻikoʻi inā ʻaʻole i mālama ʻia.

Hiki ke hilinaʻi ʻia nā pilikia i ka mea i hana ai a hiki ke komo pū:

• Hoʻonui ʻia ka pilikia o ke kahe ʻana: Inā hana ʻia ka petechiae e nā maʻi e pili ana i ke koko, hiki iā ʻoe ke pilikia i ke kahe nui ʻana
• Nā pilikia o ka maʻi: Inā loaʻa ka petechiae mai nā maʻi koʻikoʻi, hiki i ka mālama ʻana i ka lohi ke alakaʻi i ka maʻi koʻikoʻi
• Poino o nā ʻōkana: Hiki i nā maʻi e like me ka maʻi ate a i ʻole ka maʻi kīkī ke holomua me ka ʻole o ka mālama kūpono
• Anemia: Hiki i ke kahe ʻana o ke koko a i ʻole nā maʻi koko ke alakaʻi i ka helu haʻahaʻa o nā keʻena koko ʻulaʻula

ʻO ka nūhou maikaʻi, hiki ke pale ʻia ka hapa nui o nā pilikia e pili ana i ka petechiae me ka mālama olakino kūpono. Hiki i ka ʻike mua a me ka mālama ʻana i nā kūlana e waiho nei ke kōkua iā ʻoe e pale i nā pilikia olakino koʻikoʻi.

ʻO ke kamaʻilio mau ʻana me kāu mea mālama ola e pili ana i nā hōʻailona hou a i ʻole nā loli e kōkua i ka hōʻoia ʻana e ʻike mua ʻia nā pilikia a mālama pono ʻia.

He aha nā mea hiki ke kuhi hewa ʻia no Petechiae?

Hiki ke huikau ʻia ʻo Petechiae me nā kūlana ʻili ʻē aʻe e hana ana i nā kiko liʻiliʻi ʻulaʻula a poni paha. ʻO ka hoʻomaopopo ʻana i kēia mau ʻokoʻa hiki ke kōkua iā ʻoe e wehewehe maikaʻi i kāu mau hōʻailona i nā mea mālama ola.

ʻO nā kūlana maʻamau e like me ka petechiae:

• Cherry angiomas: Nā kiko liʻiliʻi, ʻulaʻula ʻālohilohi i hoʻokiʻekiʻe iki ʻia a i hana ʻia e nā kīʻaha koko i hoʻonui ʻia
• Purpura: Nā kiko poni nui (ʻoi aku ka nui ma mua o ka petechiae) i hana ʻia e ke koko ma lalo o ka ʻili
• Eczema a i ʻole dermatitis: Nā pā ʻulaʻula, ʻāʻī e loaʻa paha nā kiko ʻulaʻula liʻiliʻi akā maʻamau ka ʻāʻī
• Heat rash: Nā puʻupuʻu ʻulaʻula liʻiliʻi i hoʻokiʻekiʻe ʻia a hiki ke ʻano ʻoi a ʻāʻī paha
• Insect bites: Nā kiko ʻulaʻula i hoʻokiʻekiʻe ʻia, ʻāʻī, a ʻike ʻia ma nā wahi i hōʻike ʻia
• Allergic reactions: Nā kiko ʻulaʻula a i ʻole nā hives e ʻāʻī maʻamau a hiki ke hele mai a hele

ʻO ka hiʻohiʻona nui o ka petechiae ʻaʻole lākou e blanch (huli keʻokeʻo) ke kaomi ʻoe iā lākou, palahalaha loa lākou, a ʻaʻole lākou e ʻāʻī a ʻeha paha. Inā ʻaʻole ʻoe maopopo i ke ʻano o nā kiko āu e ʻike nei, hiki i ka lawe ʻana i nā kiʻi ke kōkua iā ʻoe e nānā i nā loli a kaʻana like i ka ʻike me kāu mea mālama ola.

Nā nīnau i nīnau pinepine ʻia e pili ana iā Petechiae

Hōʻike mau ʻo Petechiae i kahi maʻi olakino koʻikoʻi?

ʻAʻole, ʻaʻole hōʻailona mau nā petechiae i nā pilikia olakino koʻikoʻi. Nui nā hihia i loaʻa mai nā kumu liʻiliʻi e like me ka ʻuʻu ikaika, ka hoʻoikaika kino, a i ʻole nā ​​ʻeha liʻiliʻi. Eia naʻe, hiki i kekahi mau hiʻohiʻona a i ʻole nā ​​hōʻailona e hele pū ana ke hōʻike i nā kūlana e pono ai ka lāʻau lapaʻau.

Pehea ka lōʻihi o ka noho ʻana o nā petechiae?

ʻO nā petechiae mai nā kumu liʻiliʻi e mae maʻamau i loko o kekahi mau lā a i ʻelua pule. Hoʻololi mālie nā kiko i ke kala mai ka ʻulaʻula a i ka poni a i ka ʻeleʻele ma mua o ka nalowale ʻana i ka wā e hoʻopili hou ai kou kino i ke koko i kahe. Hiki i nā petechiae mau ke hōʻike i nā kūlana e pono ai ka loiloi.

Hiki i ke kaumaha ke hana i nā petechiae?

ʻAʻole i hana pololei ke kaumaha i nā petechiae, akā hiki i nā hana e pili ana i ke kaumaha ke kōkua i ko lākou ulu ʻana. Hiki i ka ʻuʻu ikaika mai ke kaumaha e pili ana i ka ʻāʻī a i ʻole ka uē nui ke hana i ke kaomi e haki ai nā kīʻaha koko liʻiliʻi.

He maʻi paha nā petechiae?

ʻAʻole maʻi nā petechiae iā lākou iho no ka mea he mau wahi liʻiliʻi wale nō o ke koko i kahe ma lalo o kou ʻili. Eia naʻe, inā i hana ʻia nā petechiae e kahi maʻi maʻi, hiki ke maʻi ka maʻi e pili ana i ke kūlana.

Hiki iaʻu ke uhi i nā petechiae me ka make-up?

ʻAe, hiki iā ʻoe ke uhi palekana i nā petechiae me ka make-up inā i hana ʻia e nā mea liʻiliʻi a ʻaʻole ʻoe e ʻike i nā hōʻailona ʻē aʻe. E hoʻohana i nā huahana mālie, ʻaʻole hoʻonāukiuki a pale i ka holoi ʻana i ka wahi. Eia naʻe, ʻaʻole pono ka uhi ʻana iā lākou e pani i ka ʻimi ʻana i ka loiloi olakino inā hopohopo ʻoe e pili ana i ke kumu.