Cholangite Biliaire Primitive

Udukoresho tw'inzira y'umusemburo utwara umusemburo uva mu mwijima ujya mu ruhago rw'amara mato. Iyo udukoresho tw'inzira y'umusemburo twangiritse, umusemburo ushobora gusubira inyuma mu mwijima, ukangiza uturemangingo tw'umwijima. Iyo mwangirika ishobora gutera gucika intege kw'umwijima.

Cholangite ya biliaire y'ibanze ni indwara y'ubudahangarwa aho inzira y'umusemburo iba yanduje kandi ihora yangizwa buhoro buhoro. Mbere yaho yitwaga cirrhose ya biliaire y'ibanze.

Umusemburo ni umusemburo ukorerwa mu mwijima. Ufasha mu gusya ibiryo no kunywa vitamine zimwe na zimwe. Ufasha kandi umubiri kunywa amavuta no kwirukana cholesterol, uburozi n'uturemangingo tw'amaraso dutukura twasazwe. Kugira umuriro uhoraho mu mwijima bishobora gutera kubyimba no kwangirika kw'inzira y'umusemburo bizwi nka cholangite. Rimwe na rimwe, ibi bishobora gutera ibikomere by'ibihe byose mu mwijima, bizwi nka cirrhose. Bishobora kandi gutera gucika intege kw'umwijima.

Nubwo bikora ku bagabo n'abagore bombi, cholangite ya biliaire y'ibanze ikunda kwibasira abagore. Ifatwa nk'indwara y'ubudahangarwa, bisobanura ko ubudahangarwa bw'umubiri bugaba igitero ku turemangingo n'imiterere y'umubiri muzima. Abashakashatsi batekereza ko ihuriro ry'ibintu by'umurage n'ibidukikije ari byo bitera iyi ndwara. Ikunze gutera buhoro buhoro. Kuri ubu, nta muti wa cholangite ya biliaire y'ibanze, ariko imiti ishobora kugabanya kwangirika kw'umwijima, cyane cyane iyo ubuvuzi butangiye hakiri kare.

Abantu barenga ½ bafite indwara ya primary biliary cholangitis nta bimenyetso bigaragara bagira igihe bayimenye. Iyi ndwara ishobora kumenyekana igihe bipimishije amaraso kubera izindi mpamvu, nko gupima buri gihe. Ibimenyetso birangira bigaragara mu myaka 5-20 iri imbere. Abagira ibimenyetso igihe bayimenye, ubusanzwe bagira ibizavamo bibi.

Ibimenyetso bya mbere bisanzwe birimo:

• Umunaniro.
• Kwishima kw’uruhu.

Ibindi bimenyetso n’ibigaragara nyuma birimo:

• Umuhondo ku ruhu no mu maso, bita ikirere.
• Amaso n’akanwa yumye.
• Kubabara mu gice cy’iburyo hejuru y’inda.
• Kubyimba kw’ijisho, bita splenomegaly.
• Kubabara mu gufata, ijosi cyangwa mu ngingo.
• Kuvimba kw’ibirenge n’amaguru.
• Kwirundira kw’amazi mu nda bitewe n’uko umwijima utakora neza, bita ascites.
• Ibinure by’umweru, bita xanthomas, ku ruhu hafi y’amaso, ku gice cy’amaso cyangwa mu mivimbo y’intoki, ibirenge, amavi cyangwa amavi.
• Kwimika kw’uruhu bidakomoka ku zuba, bita hyperpigmentation.
• Amagufwa adakomeye kandi adafite imbaraga, bita osteoporosis, bishobora gutera amagufwa kuvunika.
• Cholesterol nyinshi.
• Impiswi ishobora kuba irimo amavuta menshi, bita steatorrhea.
• Gukora nabi kwa thyroid, bita hypothyroidism.
• Kugabanuka k’uburemere.

Ntabwo birasobanutse icyateza cholangite ya biliaire y'ibanze. Impuguke nyinshi zibona ko ari indwara y'umubiri ubwe aho umubiri wihangana n'uturemangingabo twawu. Abashakashatsi bizera ko iyi réaction y'umubiri ubwe ishobora guterwa n'ibintu byo mu kirere n'iby'umurage.

Umuvuduko w'umwijima uboneka muri cholangite ya biliaire y'ibanze utangira igihe bimwe mu bwoko bw'uturemangingabo tw'amaraso yera twitwa T cells, bizwi kandi nka T lymphocytes, bitangiye guterana mu mwijima. Ubusanzwe, utu turemangingabo tw'umubiri tumenya kandi tugatabara ibyorezo, nka bagiteri na virusi. Ariko muri cholangite ya biliaire y'ibanze, birangiza amagira y'utugingo twiza dukingira imiyoboro mito y'umusemburo mu mwijima.

Umuvuduko mu miyoboro mito cyane urakaze kandi amaherezo urangiza utundi turemangingabo mu mwijima. Uko utugingo dupfa, gasimburwa n'umusemburo, uzwi kandi nka fibrosis, ushobora gutera cirrhose. Cirrhose ni ugukomera kw'uturemangingabo tw'umwijima bigatuma umwijima wawe utakora neza.

Ibintu bikurikira bishobora kongera ibyago byo kurwara cholangite ya biliaire y'ibanze:

• Ibitsina. Abantu benshi barwaye cholangite ya biliaire y'ibanze ni abagore.
• Imyaka. Bisanzwe bibaho cyane mu bantu bafite imyaka iri hagati ya 30 na 60.
• Uruhererekane rw'ababyeyi. Bishoboka cyane ko wabirwara niba ufite umuntu wo mu muryango wawe wabirwaye cyangwa wari warabirwaye.
• Aho ukomoka. Bibaho cyane mu bantu bakomoka mu majyaruguru y'Uburayi, ariko cholangite ya biliaire y'ibanze ishobora kwibasira amoko yose n'amoko yose.

Abashakashatsi batekereza ko ibintu by'umurage bifatanije n'ibindi bintu by'ibidukikije ari byo bitera cholangite ya biliaire y'ibanze. Ibyo bintu by'ibidukikije bishobora kuba birimo:

• Indwara zandura, nka kanseri y'inzira z'umuyoboro w'inkari.
• Kunywa itabi, cyane cyane igihe kirekire.
• Kuhura n'ibintu byangiza, nko mu mirimo imwe na imwe.

Uko ikibazo cyo kwangirika k'umwijima gikomeza kuba kibi, cholangite ya biliaire primaire ishobora gutera ibibazo bikomeye by'ubuzima, birimo:

• Udukoba mu mwijima, twitwa cirrhose. Cirrhose bituma umwijima wawe utakora neza kandi bishobora gutera gucika intege kw'umwijima. Bisobanura icyiciro cya nyuma cya cholangite ya biliaire primaire. Abantu bafite cholangite ya biliaire primaire na cirrhose bafite ibibazo byinshi by'ubuzima. Nanone bafite ibyago byinshi byo kugira ibindi bibazo.
• Uruhago rwaguka, twitwa splenomegaly. Uruhago rwawe rushobora kubyimba rufite utunyangingo tw'amaraso yera n'utunyangingo tw'amaraso duto. Ibi biterwa n'uko umubiri wawe utakiri gukuramo uburozi mu maraso nkuko bikwiye.
• Amabuye mu gifu n'amabuye mu muyoboro w'inzira y'umusemburo. Niba umusemburo udashobora kunyura mu muyoboro w'inzira y'umusemburo, ushobora gukomera ukaba amabuye muri iyo muyoboro. Ayo mabuye ashobora gutera ububabare n'indwara.
• ** Kanseri y'umwijima.** Udukoba mu mwijima byongera ibyago byo kurwara kanseri y'umwijima. Niba ufite udukoba mu mwijima, uzakenera gupimwa kanseri buri gihe.
• Amagufa adakomeye, twita osteoporosis. Abantu bafite cholangite ya biliaire primaire bafite ibyago byinshi byo kugira amagufa adakomeye, adafite imbaraga, kandi ashobora kuvunika byoroshye.
• Kubura vitamine. Kudafata umusemburo uhagije bigira ingaruka ku bushobozi bw'igogorwa ryawe bwo kunywa amavuta na vitamine zikunzwe mu mavuta, A, D, E na K. Kubera ibyo, bamwe mu bantu bafite cholangite ya biliaire primaire ikomeye bashobora kugira izi vitamine nke. Kugira izi vitamine nke bishobora gutera ibibazo bitandukanye by'ubuzima, birimo ubuhumbu bw'ijoro n'indwara zo kuva amaraso.
• Kolesterol nyinshi. Abantu bagera kuri 80% bafite cholangite ya biliaire primaire bafite kolesterol nyinshi.
• ** Kugabanuka kw'imikorere y'ubwonko, twita hepatic encephalopathy.** Bamwe mu bantu bafite cholangite ya biliaire primaire ikomeye na cirrhose bahindura imico. Nanone bashobora kugira ibibazo byo kwibuka no gutekereza.
• Ibyago byiyongereye byo kurwara ibindi ndwara. Cholangite ya biliaire primaire ifitanye isano n'izindi ndwara, harimo izibasira umwijima, uruhu n'ingingo. Nanone ishobora kuba ifitanye isano n'amaso yumye n'akanwa, indwara yitwa Sjogren's syndrome.

Umuhanga wawe wita ku buzima azakubaza amateka yawe y'ubuzima n'amateka y'ubuzima bw'umuryango wawe, kandi akore isuzuma ngaruka mubuzima. Ibizamini n'ibikorwa bikurikira bishobora gukoreshwa mu kumenya indwara ya cholangite ya biliaire y'ibanze. Ibizamini by'amaraso: Ibizamini by'umwijima. Ibi bizamini by'amaraso bireba urwego rw'imiti runaka ishobora kugaragaza indwara y'umwijima no kwangirika kw'inzira y'umusemburo. Ibizamini bya antijeni byerekana ibimenyetso by'indwara ziterwa na système immunitaire. Ibizamini by'amaraso bishobora gukorwa kugira ngo harebwe antikorps za anti-mitochondrial, bizwi kandi nka AMAs. Ibi bintu ntibigaragara na gato mu bantu badafite iyo ndwara, nubwo bafite izindi ndwara z'umwijima. Kubwibyo, ikizamini cya AMA cyiza gifatwa nk'ikimenyetso cyizewe cyane cy'indwara. Ariko, umubare muto w'abantu bafite cirrhose ya biliaire y'ibanze ntabwo bafite AMAs. Ikizamini cya kolesterol. Abantu barenga ½ bafite cholangite ya biliaire y'ibanze bagira izamuka rikabije ry'amavuta yo mu maraso, harimo n'urwego rwa kolesterol rusanzwe. Ibizamini byo kubona amashusho bishobora gufasha itsinda ryawe ryita ku buzima kwemeza uburwayi cyangwa guhakana izindi ndwara zifite ibimenyetso n'ibimenyetso bisa. Ibizamini byo kubona amashusho byo kureba umwijima n'inzira y'umusemburo bishobora kuba birimo: Ultrasound. Ultrasound ikoresha amaseseme y'amajwi yo hejuru kugira ngo ikore amashusho y'ibintu biri mu mubiri wawe. FibroScan. Ukoresheje igikoresho gisa na ultrasound, iki kizamini gishobora kumenya uburyo umwijima waguye. Magnetic resonance cholangiopancreatography, izwi kandi nka MRCP. Iyi MRI idasanzwe ikora amashusho arambuye y'imigongo yawe n'inzira y'umusemburo. Magnetic resonance elastography, izwi kandi nka MRE. MRI ifatanije n'amaseseme y'amajwi kugira ngo ikore ikarita y'amashusho y'imigongo yo imbere, yitwa elastogram. Iki kizamini gikoreshwa mu kumenya ukubira kw'umwijima bishobora kuba ikimenyetso cya cirrhose. Niba uburwayi bukiri butunguranye, umuhanga wawe wita ku buzima ashobora gukora biopsie y'umwijima. Igice gito cy'umwijima gikurwaho binyuze mu gikomere hakoreshejwe umugozi mwinshi. Hanyuma kigezwa muri laboratwari, kugira ngo yemeze uburwayi cyangwa kumenya ubukana bw'indwara. Kwitabwaho muri Mayo Clinic Itsinda ryacu ryita ku buzima ry'inzobere za Mayo Clinic rishobora kugufasha mu bibazo byawe by'ubuzima bifitanye isano na cholangite ya biliaire y'ibanze. Tangira hano Amakuru y'inyongera Kwitabwaho kwa cholangite ya biliaire y'ibanze muri Mayo Clinic CT scan Biopsie y'umwijima MRI Garagaza amakuru afitanye isano

Kuvura indwara Nta muti uwo ari wo wose ukiriho wo gukiza indwara ya cholangite ya biliaire y'ibanze, ariko hari imiti iboneka ifasha kugabanya uburyo iyi ndwara itera imbere no gukumira ingaruka mbi. Amahitamo arimo: Ursodeoxycholic acid. Uyu muti, uzwi kandi nka UDCA cyangwa ursodiol (Actigall, Urso), ni wo ukunze gukoreshwa mbere. Ufasha mu gutuma umusemburo uca mu mwijima wawe. UDCA ntikiza cholangite ya biliaire y'ibanze, ariko isa n'igira uruhare mu kunoza imikorere y'umwijima no kugabanya ibikomere by'umwijima. Ntibishoboka ko byafasha mu kwishima no kunanirwa. Ingaruka mbi zishobora kuba harimo kwiyongera k'uburemere bw'umubiri, kugwa kw'imisatsi no kuribwa. Obeticholic acid (Ocaliva). Ubushakashatsi bwerekana ko iyo obeticholic acid ihawe yonyine cyangwa ikavangwa na ursodiol mu mezi 12, ishobora gufasha kunoza imikorere y'umwijima no kugabanya uburibwe bw'umwijima. Ariko, ikoreshwa ryayo rikunze kugabanuka kuko rishobora gutera kwiyongera kwishima. Fibrates (Tricor). Abashakashatsi ntibabona neza uko uyu muti ufasha mu kugabanya ibimenyetso bya cholangite ya biliaire y'ibanze. Ariko, iyo ufashe hamwe na UDCA, wagabanije kubabara kw'umwijima no kwishima muri bamwe. Hari ubushakashatsi bwinshi bukenewe kugira ngo hamenyekane inyungu zayo mu gihe kirekire. Budesonide. Iyo ivangwa na UDCA, budesonide ya corticosteroid ishobora kugira akamaro kuri cholangite ya biliaire y'ibanze. Ariko, uyu muti ufitanye isano n'ingaruka mbi ziterwa na steroide ku bantu barwaye indwara ikomeye. Hari ibizamini byinshi bikenewe mu gihe kirekire mbere y'uko budesonide ishobora gusabwa mu kuvura iyi ndwara. Kubaga umwijima. Iyo imiti itakijyana cholangite ya biliaire y'ibanze kandi umwijima utangiye kunanirwa, kubaga umwijima bishobora gufasha mu kubaho igihe kirekire. Kubaga umwijima bimara umwijima urwaye ukawusimbuza uwuzuye uturutse ku muntu utanga. Kubaga umwijima bifitanye isano n'ibisubizo byiza cyane mu gihe kirekire ku bantu barwaye cholangite ya biliaire y'ibanze. Ariko, rimwe na rimwe iyi ndwara isubira inyuma nyuma y'imyaka myinshi mu mwijima wasimbuwe. Kuvura ibimenyetso itsinda ryawe ry'ubuvuzi rishobora kugutegurira uburyo bwo kugenzura ibimenyetso bya cholangite ya biliaire y'ibanze no kugutera amahoro. Kuvura kunanirwa Cholangite ya biliaire y'ibanze itera kunanirwa. Ariko imigenzo yawe ya buri munsi, indyo yuzuye nimyitozo ngororamubiri, nibindi bibazo byubuzima bishobora kugira ingaruka kumuntu wumva afite umunaniro. Ni ngombwa kandi gupimwa kugira ngo habeho gukumira indwara ya thyroid kuko igaragara cyane mubantu barwaye cholangite ya biliaire y'ibanze. Kuvura kwishima Antihistamines ikoreshwa cyane kugirango igabanye kwishima. Bishobora gufasha gusinzira niba kwishima bikubuza gusinzira. Antihistamines ishobora kuba irimo diphenhydramine, hydroxyzine hydrochloride na loratadine. Cholestyramine ni ifu ishobora guhagarika kwishima. Igomba kuvanganwa nibiribwa cyangwa amazi. Rifampin ni antibiyotike ishobora guhagarika kwishima. Uburyo ibikora ntabwo bizwi. Abashakashatsi batekereza ko bishobora guhagarika uburyo ubwonko bwumva ibintu byatera kwishima mumaraso. Abahangana na opioid nka naloxone na naltrexone bashobora gufasha kwishima bifitanye isano nindwara y'umwijima. Kimwe na rifampin, iyi miti isa nkaho igabanya uburibwe bwo kwishima binyuze mu gukora ku bwonko bwawe. Sertraline ni umuti wiyongera serotonin mubwonko, witwa selective serotonin reuptake inhibitor, cyangwa SSRI. Ishobora gufasha kugabanya kwishima. Kuvura amaso yumye numunwa wumye Amarira y'imiti n'ibindi bisimbuza amarira bishobora gufasha kugabanya amaso yumye numunwa wumye. Bishobora kuboneka bifite cyangwa bidafite amabwiriza. Gukoresha umuti cyangwa kunywa ibinyobwa bikomeye bishobora kandi kugufasha gukora amarira menshi no kugabanya umunwa wumye. Kuvura ingaruka mbi Zimwe mu ngaruka mbi zikunze kugaragara zifitanye isano na cholangite ya biliaire y'ibanze. Itsinda ryawe ry'ubuvuzi rishobora kugutegurira: Ibinyobwa by'imiti n'imyunyu ngugu. Niba umubiri wawe udakusanya imiti cyangwa izindi ntungamubiri, ushobora kuba ukeneye gufata vitamine A, D, E na K. Ushobora kandi kuba ukeneye calcium, acide folique cyangwa ibinyobwa by'ibyuma. Imiti igabanya cholesterol. Niba ufite cholesterol nyinshi mu maraso yawe, itsinda ryawe ry'ubuvuzi rishobora kugutegurira imiti izwi nka statin kugira ngo igabanye urwego rwayo. Imiti yo kuvura ibyago by'amagufwa. Niba ufite amagufwa adakomeye cyangwa yoroheje, bizwi nka osteoporosis, ushobora guhabwa imiti cyangwa ibinyobwa, nka calcium na vitamine D, kugira ngo ugabanye ibyago by'amagufwa kandi unonosore ubucucike bw'amagufwa. Imikino nko kugenda no gukoresha ibiremereye byoroheje iminsi myinshi mu cyumweru bishobora gufasha kongera ubucucike bw'amagufwa yawe. Kuvura umuvuduko mwinshi mu mwijima, bizwi nka portal hypertension. Itsinda ryawe ry'ubuvuzi rishobora kukumenya no kukukurikirana kuri portal hypertension n'imitsi minini niba ufite ibikomere byinshi by'indwara y'umwijima. Amazi mu nda yawe ni ingaruka mbi isanzwe ya portal hypertension. Ku maziko make mu nda, itsinda ryawe ry'ubuvuzi rishobora kugutegurira kugabanya umunyu mu mirire yawe. Ibibazo bikomeye bishobora gusaba imiti izwi nka diuretics cyangwa uburyo bwo gukuraho amazi bizwi nka paracentesis. Amakuru y'inyongera Kwita kuri cholangite ya biliaire y'ibanze muri Mayo Clinic Kubaga umwijima Gusaba gahunda

Kubaho ufite indwara y'umwijima idakira bishobora gutera umunabi. Umunaniro ubwawo ushobora kugira ingaruka zikomeye ku mibereho yawe. Buri wese ashaka uburyo bwo guhangana n'umunaniro uterwa n'indwara idakira. Mu gihe, uzabona icyakubereye. Dore uburyo bwo gutangira: Menya ibyerekeye uburwayi bwawe. Uko wumva neza ibyerekeye cholangite ya biliaire y'ibanze, ni ko uzaba ufite uruhare mu kwita ku buzima bwawe. Uretse kuvugana n'abaganga bawe, shaka amakuru muri Bibliotheque ya komini yawe no kuri website z'imiryango izwi cyane nka American Liver Foundation. Fata umwanya wawe. Kurya neza, gukora imyitozo ngororamubiri no kuruhuka bihagije bishobora kugufasha kumva umeze neza. Gerageza gutegura igihe uzaba ukeneye kuruhuka cyane. Fata ubufasha. Niba inshuti cyangwa umuryango wawe bashaka kugufasha, reka bagufashe. Cholangite ya biliaire y'ibanze ishobora gutera umunaniro, bityo wemere ubufasha niba hari umuntu ushaka kugufasha kugura ibintu, gukaraba imyenda cyangwa guteka ifunguro ryawe. Bwira abagufasha icyo ukeneye. Shaka inkunga. Imibanire myiza ishobora kugufasha kugumana imitekerereze myiza. Niba inshuti cyangwa umuryango wawe bagorwa no gusobanukirwa uburwayi bwawe, ushobora kubona ko itsinda ry'abantu bahuje ibibazo rishobora kugufasha.