Cholangitis Yokuqina Okukhulu
Uhlolojikelele
Izitho zebile zithwala ibile evela ethisini lakho ziye esibindini sakho esincane. Uma izitho zebile zilimele, ibile ingabuyela ethisini, okubangela ukulimala kwamangqamuzana ethisini. Lolu limale lungabangela ukuhluleka kwesibindi.
I-cholangitis esclerosing eyinhloko (skluh-ROHS-ing) (koh-lan-JIE-tis) yisifo sezitho zebile. Izitho zebile zithwala ibile eliswidi lokugaya ukudla evela ethisini lakho liye esibindini sakho esincane. Ku-cholangitis esclerosing eyinhloko, ukuvuvukala kubangela amabala ngaphakathi kwezitho zebile. La mabala enza izitho ziqine futhi zibe nzima kancane kancane zibangele ukulimala okukhulu kwesibindi. Iningi labantu abane-cholangitis esclerosing eyinhloko banesifo sokuvuvukala sesibindini, njenge-ulcerative colitis noma i-Crohn's disease.
Kubantu abaningi abane-cholangitis esclerosing eyinhloko, isifo siqhubeka kancane kancane. Ekugcineni singabangela ukuhluleka kwesibindi, ukutheleleka okuphindaphindayo, kanye nezinhlungu zesitho sebile noma isibindi. Ukuhlinzwa kwesibindi yilona kuphela ukwelapha okuyaziwayo kwe-cholangitis esclerosing eyinhloko ephambili, kodwa isifo singabuya esibindini esitshalwe kubantu abambalwa.
Izimpawu
I-Primary sclerosing cholangitis ivame ihlonishwa ngaphambi kokuba izimpawu zivele uma ukuhlolwa kwengqondo okuvamile noma i-X-ray ethathwe ngenxa yesimo esingaxhunyiwe kubonisa ukungasebenzi kahle kwesibindi. Izimpawu zokuqala nezimpawu zivame ukufaka: Ukukhathala Ukukhahlela Amehlo nekhala ephuzi (ukukhala) Ubuhlungu besisu Abantu abaningi abaxilongwe nge-primary sclerosing cholangitis ngaphambi kokuba babe nezimpawu baqhubeka bezizwa bephilile iminyaka eminingana. Kodwa-ke, ayikho indlela ethembekile yokubikezela ukuthi isifo siyoqhubeka ngokushesha kangakanani noma kancane kangakanani kumuntu oyedwa. Izimpawu nezimpawu ezingase zivele njengoba isifo siqhubeka zifaka: Ukuvuvukala Ukubanda Ukushisa ebusuku Isibindi esikhulu Umphunga omkhulu Ukulahlekelwa isisindo Yenza i-aphoyintimenti nodokotela wakho uma une-itching eqinile, engachazwanga emzimbeni wakho wonke - ukukhahlela okuqhubeka kungakhathaliseki ukuthi ukhukhumala kangakanani. Bheka futhi udokotela wakho uma uzizwa ukhathele kakhulu ngaso sonke isikhathi, kungakhathaliseki ukuthi wenzani. Kubaluleke kakhulu ukuletha ukukhathala okungachazwanga nokukhahlela ekunakekelweni kwodokotela wakho uma une-ulcerative colitis noma i-Crohn's disease, kokubili okuyizinhlobo zesifo sokuvuvukala sezisu. Iningi labantu abane-primary sclerosing cholangitis banesinye salezi zifo.
Isikhathi sokubona udokotela
Yenza i-aphoyintimenti nodokotela wakho uma une-itching eqinile, engachazwanga emzimbeni wakho omningi—ukukroba okuqhubeka kungakhathaliseki ukuthi ukhroba kangakanani. Bheka nodokotela wakho uma uzizwa udiniwe kakhulu ngaso sonke isikhathi, kungakhathaliseki ukuthi wenzani. Kubaluleke kakhulu ukuletha ukudinwa okungachazwanga nokusikroba ekunakekelweni kwodokotela wakho uma une-ulcerative colitis noma i-Crohn's disease, zombili lezi yizinhlobo ze-inflammatory bowel disease. Iningi labantu abane-primary sclerosing cholangitis banesinye salezi zifo.
Izimbangela
Akuqondakali ukuthi yini ebangela i-primary sclerosing cholangitis. Ukusebenza kwesistimu yokukhulula umzimba ekuthelelekeni noma e-toxin kungase kuqalise lesi sifo kubantu abanezindlela ezihlukaniswe ngokufanayo. Iningi labantu abane-primary sclerosing cholangitis banesifo sokuvuvukala kwesisu, igama elihlanganisa izifo eziningi ezihlanganisa i-ulcerative colitis ne-Crohn's disease. I-primary sclerosing cholangitis nesifo sokuvuvukala kwesisu aziveli ngaso sonke isikhathi ngesikhathi esifanayo. Ezimweni ezithile, i-primary sclerosing cholangitis ivela iminyaka ngaphambi kokuba kube khona isifo sokuvuvukala kwesisu. Uma kukhona i-primary sclerosing cholangitis, kubalulekile ukubheka isifo sokuvuvukala kwesisu ngoba kunengozi enkulu yomdlavuza wesisu. Ngokuvamile, abantu abaphathwa ngesifo sokuvuvukala kwesisu bathola ukuthi bane-primary sclerosing cholangitis. Futhi kancane, abantu abane-primary sclerosing cholangitis bathuthukisa isifo sokuvuvukala kwesisu kuphela ngemuva kokuthola ukutshalwa kwesibindi.
Izici eziyingozi
Izici ezingase zikhulise ingozi ye-primary sclerosing cholangitis zifaka:
- Ubudala. I-primary sclerosing cholangitis ingahle ibonakale kunoma yiliphi iminyaka, kodwa ivame ukuxilongwa phakathi kweminyaka engama-30 nama-40.
- Ubulili. I-primary sclerosing cholangitis ivame kakhulu kubantu besilisa.
- Isifo sokuvuvukala sezisu. Ingxenye enkulu yabantu abane-primary sclerosing cholangitis banesifo sokuvuvukala sezisu.
- Indawo yomhlaba. Abantu abavela eYurophu enyakatho banengozi enkulu ye-primary sclerosing cholangitis.
Izingqinamba
Izinkinga ze-primary sclerosing cholangitis zingafaka:
- Ukugula nokungasebenzi kwesibindi. Ukuvuvukala okuqhubekayo kwezinsimbi zebile kulo lonke isibindi kungabangela ukwenziwa kwe-scarring (cirrhosis), ukufa kwamaselula esibindi, futhi ekugcineni, ukulahleka komsebenzi wesibindi.
- Ukutheleleka okuphindaphindayo. Uma ukwenziwa kwe-scarring kwezinsimbi zebile kunciphise noma kuyeke ukusabela kobile oluvela esibindini, ungaba nokutholakala kokutheleleka okuphindaphindayo ezimbindi zebile. Ingozi yokutheleleka iphakeme kakhulu ngemuva kokuba uthole inqubo yokucubungula ukuze wandise insimbi ye-bile eyonakele kakhulu noma ukususa itshe elivala insimbi ye-bile.
- Amathambo abuthakathaka. Abantu abane-primary sclerosing cholangitis bangaba namathambo abuthakathaka (osteoporosis). Udokotela wakho angakuncoma ukuhlolwa kobunzima lwamathambo ukuze ahlole i-osteoporosis eminyakeni embalwa. Izithasiselo zekhalsiyam ne-vitamin D zingabhalwa ukuze zisize ekuvimbeni ukulahleka kwamathambo.
- Umgqonyo we-bile duct. Uma une-primary sclerosing cholangitis, unezingozi eziphezulu zokuthuthukisa umdlavuza ezimbindi zebile noma e-gallbladder.
- Umgqonyo wekoloni. Abantu abane-primary sclerosing cholangitis ehlotshaniswe nesifo sokuvuvukala sezisu banengozi ephakeme yomdlavuza wekoloni. Uma utholakala une-primary sclerosing cholangitis, udokotela wakho angakuncoma ukuhlolwa sesifo sokuvuvukala sezisu, ngisho noma ungenawo ama-signs noma izimpawu, njengoba ingozi yomdlavuza wekoloni iphakeme uma unawo omabili lawo ma-diseases.
Ukuqina kwe-portal hypertension kungabangela ukuba amanzi esibindini aphumele esiswini (ascites). Kungabuye kuqondanise igazi elivela e-portal vein kuya kwezinye izinsimbi, kubangele ukuthi lezi zinsimbi zibe bukhulu (varices). I-Varices yizinsimbi ezibuthakathaka futhi zithambekele ekopha kalula, okungaba yingozi eyingozi.
Ukuxilongwa
I-Endoscopic retrograde cholangiopancreatography (ERCP) isebenzisa umbala ukuqokomisa izitho zokukhipha ubisi ezihlotsheni ze-X-ray. Umphako omncane, ophethe ikhamera ekupheleni, obizwa ngokuthi yi-endoscope, uya ngomlomo bese uya esibindini esincane. Umbala ungena ezithweni ngomphumela omncane ongaxhunyiwe, obizwa ngokuthi yi-catheter, edluliselwe yi-endoscope. Amathuluzi amancane adluliselwe yi-catheter angasetshenziswa futhi ukususa amatshe e-gallstones.
Ukuhlolwa kwe-liver biopsy inqubo yokususa isampula encane yethishu ye-liver ukuze kuhlolwe elabhoratri. Ukuhlolwa kwe-liver biopsy kuvame ukwenziwa ngokufaka unhlangothi oluthambile ngesikhumba bese uya e-liver.
Amathethhu nezinqubo ezisetshenziswa ukuthola i-primary sclerosing cholangitis afaka:
- Ukuhlolwa kwegazi lomsebenzi we-liver. Ukuhlolwa kwegazi ukuhlola umsebenzi wakho we-liver, kufaka phakathi amazinga e-enzymes yakho ye-liver, kungamnika udokotela wakho izinkomba mayelana nokutholakala kwakho.
- I-MRI yezitho zakho zokukhipha ubisi. I-Magnetic resonance cholangiopancreatography (koh-lan-jee-o-pan-cree-uh-TOG-ruh-fee) isebenzisa i-magnetic resonance imaging (MRI) ukwenza izithombe ze-liver yakho nezitho zakho zokukhipha ubisi futhi kuyivivinyo lokukhetha ukuthola i-primary sclerosing cholangitis.
- Ukuhlolwa kwe-liver biopsy. Ukuhlolwa kwe-liver biopsy inqubo yokususa ingxenye yethishu ye-liver ukuze kuhlolwe elabhoratri. Udokotela wakho ufake unhlangothi ngesikhumba sakho bese uya e-liver yakho ukukhipha isampula yethishu.
Ukuhlolwa kwe-liver biopsy kungasiza ekuqondeni ubunzima bomonakalo e-liver yakho. Ivivinyo lisetshenziswa kuphela uma ukutholakala kwe-primary sclerosing cholangitis kusazungezile ngemuva kokuhlolwa okungenawo ubunzima.
Izithombe ze-X-ray zezitho zakho zokukhipha ubisi. Uhlobo lwe-X-ray yezitho zokukhipha ubisi ebizwa ngokuthi yi-endoscopic retrograde cholangiopancreatography (ERCP) ngaphezu kwalokho, noma esikhundleni se-MRI kungadingeka. Kodwa-ke leli viyivo alisetshenziswa kaningi ekutholeni ngenxa yengozi yezinkinga.
Ukuqokomisa izitho zakho zokukhipha ubisi ku-X-ray, udokotela wakho usebenzisa umphako ophethe owa ngomlomo wakho ukufaka umbala endaweni yesibindini sakho esincane lapho izitho zakho zokukhipha ubisi zikhulula khona.
I-ERCP yivivinyo lokukhetha uma izimpawu nezimpawu ziqhubeka naphezu kokungabi khona kwezinto ezingavamile ku-MRI. I-ERCP ivame ukuba yivivinyo lokuqala uma ungakwazi ukuba ne-MRI ngenxa yokuhlanganiswa kwensimbi emzimbeni wakho.
Ukuhlolwa kwe-liver biopsy. Ukuhlolwa kwe-liver biopsy inqubo yokususa ingxenye yethishu ye-liver ukuze kuhlolwe elabhoratri. Udokotela wakho ufake unhlangothi ngesikhumba sakho bese uya e-liver yakho ukukhipha isampula yethishu.
Ukuhlolwa kwe-liver biopsy kungasiza ekuqondeni ubunzima bomonakalo e-liver yakho. Ivivinyo lisetshenziswa kuphela uma ukutholakala kwe-primary sclerosing cholangitis kusazungezile ngemuva kokuhlolwa okungenawo ubunzima.
Ukwelashwa
Ukwelapha i-primary sclerosing cholangitis kugxile ekuphatheni izinkinga nokubheka ukulimala kwesibindi. Imithi eminingi iye yahlolwa kubantu abane-primary sclerosing cholangitis, kodwa kuze kube manje ayikho ebonwe ukuthi iyanciphisa noma ibuyisela umonakalo wesibindi ohambisana naleli gciwane.
- Abaphuthumi be-bile acid. Imithi ebotha ama-bile acid — izinto ezicatshangwa ukuthi zibangela ukukhahlela esifweni sesibindi — yiyona yokwelapha yokuqala yokukhahlela ku-primary sclerosing cholangitis.
- Ama-antibiotics. Uma unesikhathi esinzima sokubekezelela umuthi obopha i-bile acid noma uma awusizi, udokotela wakho angase alotshe i-rifampin (Rifadin, Rimactane, nabanye), umuthi wokulwa nezifo zebhaktheriya. Indlela i-rifampin eyanciphisa ngayo ukukhahlela ayaziwa, kodwa ingase ivinje impendulo yengqondo ezinto ezikhuthazayo ezikukujikelezo lwakho.
- Ama-antihistamines. Lolu hlobo lomuthi lungasiza ekuqedeni ukukhahlela okuncane okubangelwa yi-primary sclerosing cholangitis. Akukaziwa ukuthi le miuthi isebenza yini kuleli gciwane. Ama-antihistamines angenza izimpawu zesifo sesibindi zibi kakhulu zamehlo omile nomlomo omile. Ngakolunye uhlangothi, ama-antihistamines angasiza ngokulala uma ukukhahlela kukugcina uvukile.
- Abaphikisi be-opioid. Ukukhahlela okuhlobene nesifo sesibindi kungase futhi kuphendule kumithi yabaphikisi be-opioid, njenge-naltrexone. Njenge-rifampin, le miuthi ibonakala iyanciphisa imizwa yokukhahlela ngokusebenza ebuchosheni bakho.
- I-Ursodeoxycholic acid (UDCA). Eyaziwa nangokuthi yi-ursodiol, i-UDCA iyibhile acid eyenzeka ngokwemvelo engasiza ekuqedeni izimpawu zokukhahlela ezibangelwa yisifo sesibindi ngokwandisa ukufunwa kwe-bile. Ama-antihistamines. Lolu hlobo lomuthi lungasiza ekuqedeni ukukhahlela okuncane okubangelwa yi-primary sclerosing cholangitis. Akukaziwa ukuthi le miuthi isebenza yini kuleli gciwane. Ama-antihistamines angenza izimpawu zesifo sesibindi zibi kakhulu zamehlo omile nomlomo omile. Ngakolunye uhlangothi, ama-antihistamines angasiza ngokulala uma ukukhahlela kukugcina uvukile. Ibhile ebuyela emuva emikhondweni ecindezelwe noma evaliwe ibangela ukutheleleka kwezibhaktheriya okuvamile. Ukuvimbela nokuphatha le miheleleko, abantu abane-primary sclerosing cholangitis bangase bathathe izifundo eziphindaphindwayo zama-antibiotics noma baqhubeke nokuthatha ama-antibiotics isikhathi eside. Ngaphambi kwanoma iyiphi inqubo engabangela ukutheleleka, njengokuhlinzwa kwe-endoscopic noma sokugaya ukudla, uzodinga futhi ukuthatha ama-antibiotics. I-Primary sclerosing cholangitis yenza kube nzima emzimbeni wakho ukufunwa kwezithako ezithile. Ngisho noma ungadla ukudla okunempilo, ungase uthole ukuthi awukwazi ukuthola zonke izondlo ozidingayo. Udokotela wakho angase akukhuthaze ukuba uthathe izithako zevithamini ozithatha njengezithako noma ozithola njengokuqothulwa ngomqondo esiphundu sakho. Uma isifo sibuthakathaka amathambo akho, ungase uthathe izithako zekhalsiyam ne-vitamin D futhi. Ukuvimba okuvela emikhondweni yakho ye-bile kungase kube ngenxa yokuthuthuka kwesifo kodwa kungaba uphawu lomdlavuza womkhondo we-bile. I-Endoscopic retrograde cholangiopancreatography (ERCP) ingasiza ekutholeni imbangela, futhi ukuvimba komkhondo we-bile kungaphathwa ngokuthi:
- Ukukhululwa kwe-balloon. Le nqubo ingavula ukuvimba emikhondweni emikhulu ye-bile ngaphandle kwesibindi. Ekukhululweni kwe-balloon, udokotela wakho uqhuba i-tube encane enebhaluni ephumula ekupheleni kwayo (i-balloon catheter) nge-endoscope angene emkhondweni we-bile ovimbile. Uma i-balloon catheter isikhona, i-balloon iphumula.
- Ukubekwa kwe-stent. Kule nqubo, udokotela wakho usebenzisa i-endoscope nezinto ezihlanganisiwe ukuze afake i-tube encane yepulasitiki ebizwa nge-stent emkhondweni we-bile ovimbile ukuze ugcine umkhondo uvulekile. Ukuhlinzwa kwesibindi yiyona kuphela ukwelapha okuaziwayo kokwelapha i-primary sclerosing cholangitis. Ngesikhathi sokuhlinzwa kwesibindi, ochwepheshe bokuhlinzwa basusa isibindi sakho esigula bese besifaka esinempilo esivela kumnikelo. Ukuhlinzwa kwesibindi kugcinelwe abantu abanesifo sesibindi noma ezinye izinkinga ezinzima ze-primary sclerosing cholangitis. Nakuba kungavamile, kungenzeka ukuthi i-primary sclerosing cholangitis ibuye emuva ngemuva kokwelashwa kwesibindi.
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