Iyini i-Pseudomembranous Colitis? Izimpawu, Izimbangela, Nokwelapha

I-Pseudomembranous colitis iwukuvuvukala okukhulu kwamathumbu akho amakhulu (ikholoni) okwenza amaqatha amhlophe, afana ne-yellowish, abizwa ngokuthi ama-pseudomembranes odongeni lwamathumbu. Lokhu kwenzeka lapho ibhaktheriya eliyingozi lithatha isikhala esimathumbini akho ngemuva kokuba ibhaktheriya elihle liqediwe, ngokuvamile ngokusetshenziswa kwe-antibiotic.

Cabanga ngekholoni lakho njengoba linelaphethi lokuvikela lebhaktheriya elihle elikugcina konke kuqondene. Uma ama-antibiotic ebulawa la ma-microorganism amahle, ibhaktheriya eliyingozi njenge-Clostridioides difficile (C. diff) lingakhula ngokushesha futhi likhiphe izinto ezibuhlungu ezilimaza ukugqoka kwamathumbu akho.

Ziyini izimpawu ze-pseudomembranous colitis?

Isilwane sokuqala esivamile yisifuba samanzi esivelela ngesikhathi noma ngokushesha ngemuva kokuthatha ama-antibiotic. Ungase uqaphele ukuthi lesi sifo sinuka kabi futhi senzeka izikhathi eziningi ngosuku.

Nawa izimpawu okufanele uzilinde, uqale ngezivamile kakhulu:

• Isifo samanzi esivamile (izikhathi ezingama-3 noma ngaphezulu ngosuku)
• Ubuhlungu nobuhlungu besisu
• Ukuqunjelwa nokuthandaza
• Ukuphefumula nokwehluleka kokudla
• Igazi noma ukhuni emathunjini
• Izimpawu zokulahlekelwa amanzi njengokukhungatheka noma umlomo owomile

Ezimweni ezinzima kakhulu, ungase uhlangabezane nesilinganiso sokubetha kwenhliziyo, ukukhula okukhulu kwesisu, noma izimpawu zokulahlekelwa amanzi okukhulu. Lezi zimpawu zivame ukuvela ezinsukwini ezimbalwa kuya emavikini ambalwa ngemuva kokuqala ama-antibiotic, nakuba ngezinye izikhathi zingase zenzeke ngemuva kwezinyanga.

Yini ebangela i-pseudomembranous colitis?

Imbangela eyinhloko ukukhula okukhulu kwe-Clostridioides difficile ibhaktheriya ekholoni lakho ngemuva kokuba ibhaktheriya yakho yamathumbu evamile iphazamiseke. Lokhu kuphazamiseka kuvame kakhulu lapho uthatha ama-antibiotic abulala kokubili ibhaktheriya eliyingozi nelihle.

Ake sibheke izici eziyinhloko ezingabangela le meko:

• Ukusetshenziswa kwe-Antibiotic (ikakhulukazi i-clindamycin, i-fluoroquinolones, i-cephalosporins, ne-penicillins)
• Imithi ye-Chemotherapy
• I-Proton pump inhibitors ye-acid reflux
• Ukungeniswa esibhedlela samuva noma ukuhlala isikhathi eside ezindaweni zokunakekelwa kwesikhathi eside
• Izimo zangaphambili zokutheleleka kwe-C. diff

Ezimweni ezingavamile, i-pseudomembranous colitis ingase ivele ngaphandle kokubekwa kwe-antibiotic. Lokhu kungase kwenzeke ngenxa yesifo esinzima, isifo samathumbu esivuvukayo, noma imithi ethile ecindezela isimiso sakho sokugcina. Isici esiyinhloko sihlala siyi-disruption ethile ekuqondeni kwakho okungavamile kwesilinganiso sebhaktheriya yamathumbu.

Nini okufanele ubheke udokotela nge-pseudomembranous colitis?

Kufanele uxhumane nodokotela wakho ngokushesha uma uthola isifo samanzi esiqhubekayo ngenkathi uthatha ama-antibiotic noma phakathi nezinyanga ezimbili ngemuva kokuphela kwawo. Ungalindi ukubona uma izimpawu ziphucuka zodwa.

Funani ukunakekelwa okusheshayo uma uhlangabezana nobuhlungu besisu obukhulu, ukushisa okuphezulu ngaphezulu kuka-101.3°F (38.5°C), izimpawu zokulahlekelwa amanzi, noma igazi emathunjini akho. Lezi zimpawu zingabonisa izinkinga ezinzima ezidinga ukwelashwa okusheshayo.

Ngisho nezimpawu ezilula zifanele ukunakekelwa kwezokwelapha ngoba i-pseudomembranous colitis ingase ibe mbi ngokushesha. Ukuxilongwa kwasekuqaleni nokwelashwa kuphucuka kakhulu umphumela wakho futhi kuvimbele izinkinga ezingozi.

Ziyini izici ezingozi ze-pseudomembranous colitis?

Ingozi yakho iyakhuphuka kakhulu uma usanda kuthatha ama-antibiotic, ikakhulukazi ama-broad-spectrum abulala izinhlobo eziningi zebhaktheriya. Ubudala buphinde bube nomthelela, ngabantu abangaphezu kweminyaka engama-65 ubudala ababhekene nengozi enkulu ngenxa yokushintsha emsebenzini wokugcina nokuqondana kwesibhaktheriya samathumbu.

Izici eziningi zingakwenza ube lula ukukhula kule meko:

• Ukwelashwa kwe-Antibiotic samuva (ngaphakathi kwezinyanga ezingu-2-3)
• Ubudala obungaphezu kweminyaka engama-65
• Ukungeniswa esibhedlela noma ukuhlala endlini yokunakekelwa kwabaqaphi
• Isimiso sokugcina esibuthakathaka
• Ukutheleleka kwe-C. diff kwangaphambili
• Isifo samathumbu esivuvukayo
• Isifo sezinso esiqhubekayo
• Ukusetshenziswa kwe-proton pump inhibitors

Abasebenzi bezempilo nabantu abavakashela izibhedlela ngokuvamile nabo babhekene nengozi enkulu yokubekwa. Ukuba nezici eziningi zengozi akusho ukuthi uzokhula kule meko, kodwa kusho ukuthi kufanele uqaphele kakhulu izimpawu uma uthatha ama-antibiotic.

Ziyini izinkinga ezingase zenzeke ze-pseudomembranous colitis?

Ngenkathi abantu abaningi bephulukana ngokuphelele ngokwelashwa okufanele, i-pseudomembranous colitis ingabangela izinkinga ezinzima uma ingalashwa. Indaba ephambili yilahlekelwa amanzi okukhulu ngenxa yesifo samanzi esiqhubekayo.

Nawa izinkinga ezingase zikhule, kusukela ekuvamile kakhulu kuya kwezingavamile kodwa ezinzima:

• Ukushonelwa amanzi okukhulu nokungaqondani kwama-electrolyte
• Izinkinga zezinso ezivela ekushonelweni amanzi
• I-Toxic megacolon (ukukhula okubi kwekholoni)
• Ukugqwala kwekholoni (umgodi odongeni lwamathumbu)
• I-Sepsis (ukutheleleka okubulalayo okusakazwayo)
• Ukufa ezimweni ezinzima, ezingalashwanga

Ukutheleleka okuphindaphindayo kuchaphazela cishe u-20-25% wabantu, okusho ukuthi le meko ingabuya ngisho nangemuva kokwelashwa okuphumelelayo. Lokhu kwenzeka ngoba ama-spores e-C. diff ibhaktheriya angaphila emathunjini akho futhi aphinde asebenze kamuva. Ukubuyela kabusha kuvame ukuphendula kahle ekwelapheni, nakuba abanye abantu bengase badinge ukwelashwa okukhethekile.

I-Pseudomembranous colitis ixilongwa kanjani?

Udokotela wakho uzoqala ngokubuza ngokusetshenziswa kwakho kwamuva kwe-antibiotic nezimpawu, bese u-oda ukuhlolwa kwamathumbu ukubheka ibhaktheriya le-C. diff nezinhlanzi zalo. Lezi zivivinyo ngokuvamile yisinyathelo sokuqala nesibaluleke kakhulu ekuxilongweni.

Inkqubo yokuxilonga ngokuvamile ihlanganisa izindlela eziningi zokuqinisekisa isimo nokulinganisela ubukhulu balo. Umhlinzeki wakho wezempilo angase aqoqe izibonelo eziningi zamathumbu ngoba ibhaktheriya le-C. diff nezinhlanzi zalo azikho njalo kuzo zonke izibonelo.

Ukuhlolwa okwengeziwe kungase kuhlanganise umsebenzi wegazi ukuhlola izimpawu zokutheleleka nokushonelwa amanzi. Ezimweni ezinzima, udokotela wakho angase acebise i-CT scan yesisu lakho ukubheka izinkinga njengokukhula kwekholoni noma ukugqwala.

Ngezinye izikhathi i-colonoscopy iyadingeka ukubona ngqo amaqatha amhlophe, afana ne-yellowish (ama-pseudomembranes) odongeni lwekholoni lakho. Le nqubo ikusiza ukuqinisekisa ukuxilongwa lapho ukuhlolwa kwamathumbu kungacaci noma lapho kukhona izinkinga ezithathwe.

Ukuphathwa kwe-pseudomembranous colitis kuyini?

Ukuphathwa kugxile ekuyekezeni i-antibiotic yamanje (uma usalithatha) nokuqala imithi ekhethekile ehlose ibhaktheriya le-C. diff. Ukwelashwa okuvamile kakhulu okuqokiwe yi-oral vancomycin noma i-fidaxomicin.

Udokotela wakho uzokhetha imithi engcono kakhulu ngokuya ngobunzima besimo sakho kanye nomlando wakho wezokwelapha. I-Vancomycin ngokuvamile iyisinqumo sokuqala sezimo ezimnene kuya ezinkulu, ngenkathi i-fidaxomicin ingase ikhethwe uma usunokutheleleka kwangaphambili.

Ezimweni ezilula, abanye odokotela bangase baqokomise i-metronidazole, nakuba lokhu kungavamile manje. Ukwelashwa kuvame ukuhlala izinsuku ezingu-10-14, futhi kufanele uqale ukuzizwa kangcono ezinsukwini ezimbalwa ngemuva kokuqala imithi.

Ezimweni ezinzima ngezinkinga, ungase udinga ukungeniswa esibhedlela ngezinsimbi ze-IV, ukulandelela eduze, futhi ngezinye izikhathi ukuhlinzwa. Ukudluliswa kwe-microbiota ye-Fecal (FMT) kuyisinqumo esisha sokwelapha abantu abanezikhathi zokutheleleka ezingaphenduli kuma-antibiotic ajwayelekile.

Ungazinakekela kanjani ngesikhathi sokwelashwa kwe-pseudomembranous colitis?

Ukugcina amanzi kuyinto yakho ephambili ngoba isifo samanzi singabangela ukushonelwa amanzi ngokushesha. Phuza amanzi amaningi acacile njengamanzi, i-broth, noma izixazululo zama-electrolyte usuku lonke.

Ukuphumula kubalulekile ekubuyiseleni kwakho, ngakho ungazicindelisi ukugcina imisebenzi yakho evamile ngenkathi uphulukana. Umuthi wakho udinga amandla okulwa nokutheleleka nokulungisa ukugqoka kwamathumbu akho.

Dla ukudla okulula, okulula ukuqeda lapho uzizwa ukhululekile ukudla. Ukudla kwe-BRAT (amabhanana, irayisi, i-applesauce, i-toast) kungaba mnandi esiswini sakho, kodwa ungazivimbeli kuphela kulezi zokudla uma ungakhuthazeleli ukwahluka okukhulu.

Gwema imikhiqizo yobisi, ukudla okunemafutha, nokudla okuphezulu kwefayibha kuze kube yilapho izimpawu zakho ziphucuka, njengoba lokhu kungase kube mbi isifo samanzi. Ama-probiotics awanconywa ngesikhathi sokwelashwa okusebenzayo ngoba angase ahlanganyele nama-antibiotic akho aqokiwe.

I-Pseudomembranous colitis ingavikeleka kanjani?

Iqhinga eliphumelelayo kakhulu lokuvimbela ukusebenzisa ama-antibiotic kuphela lapho kudingeka ngempela futhi ngokuqondile njengoba kuqokiwe umhlinzeki wakho wezempilo. Ungagcini ama-antibiotic asale noma uwabelane ngawona nabanye.

Ukuhlanzeka kwezandla kuhle kakhulu, ikakhulukazi ezindaweni zezempilo lapho ama-spores e-C. diff angaphila khona emaphethelweni izinyanga. Geza izandla zakho ngokuphelele ngesepha namanzi kunokuthembela kuphela kuma-sanitizers asekelwe e-alcohol, angabulali ama-spores e-C. diff.

Uma usesibhedlela noma esikhungweni sokukhathalela isikhathi eside, qiniseka ukuthi abasebenzi bezempilo begeza izandla zabo ngaphambi nangemuva kokunakekela wena. Ungangabazi ukubakhumbuza ngomusa uma uqaphela ukuthi bakhohlwe.

Gcina indlela yokuphila enempilo ngokudla okuhle nokuzivocavoca okuvamile ukuze usekele isimiso sakho sokugcina nempilo yamathumbu. Nakuba ungakwazi ukuvimbela ngokuphelele ukubekwa kwe-C. diff, isimiso sokugcina esinamandla sisiza umzimba wakho ukuba ulwe nokutheleleka.

Kufanele uzilungiselele kanjani i-aphoyintimenti yakho yodokotela?

Bhala zonke izimpawu zakho, kufaka phakathi ukuthi zaqala nini nokuthi zivele kangaki. Yiba uchwepheshe ngokuvamile nokubonakala kwesifo sakho samanzi, njengoba lolu lwazi lusiza udokotela wakho ukulinganisela ubukhulu.

Letha uhlu oluphelele lwemithi yonke oyithathe ezinyangeni ezintathu ezedlule, kufaka phakathi ama-antibiotic, imithi yokuthengwa ngaphandle komthetho, nezinhlanganisela. Faka amagama, izilinganiso, nezinsuku oyithathe.

Lungiselela imibuzo mayelana nezinketho zakho zokwelapha, isikhathi esilindelekile sokubuyisela, nokuthi kufanele ulandele nini. Buza ngezimpawu zezexwayiso ezizodinga ukunakekelwa kwezokwelapha okusheshayo.

Cabanga ngokuletha ilungu lomndeni noma umngani ongakusiza ukukhumbula ulwazi olubalulekile, ikakhulukazi uma uzizwa ungaphili kahle. Bangaphinda banikeze ukwesekwa futhi basize ukukhuthaza ukunakekelwa kwakho uma kudingeka.

Yini eyinhloko mayelana ne-pseudomembranous colitis?

I-Pseudomembranous colitis iyimo elibi kodwa eliphulukiswayo elivela ngokuvamile ngemuva kokusetshenziswa kwe-antibiotic. Ukubona kwasekuqaleni nokwelashwa kuholela emiphumeleni emihle kakhulu kubantu abaningi.

Into ebaluleke kakhulu okumele uyikhumbule ukuthi isifo samanzi esiqhubekayo ngesikhathi noma ngemuva kokwelashwa kwe-antibiotic akuvamile futhi sidinga ukulinganiswa kwezokwelapha. Musa ukuzama ukumelana nakho noma ucabange ukuthi sizoxazulula zodwa.

Ngokwelashwa okufanele, abantu abaningi baphulile ngokuphelele phakathi kweviki elilodwa kuya kwezimbili. Ukulandela imiyalo yodokotela wakho ngokuphelele nokunakekela wena ngesikhathi sokubuyisela kuzokunika ithuba elihle kakhulu lokululama okuphelele, okungenazo izinkinga.

Imibuzo evamile ebuzwayo mayelana ne-pseudomembranous colitis

Q1. Ngingathola i-pseudomembranous colitis ngaphandle kokuthatha ama-antibiotic?

Yebo, nakuba kungavamile kakhulu. Ungase ukhule le meko kusuka emithini ye-chemotherapy, imithi ethile ye-acid yesisu, noma isifo esinzima esiphazamisa ibhaktheriya yakho yamathumbu. Noma kunjalo, cishe u-90% wezimo zihlanganiswe nokusetshenziswa kwamuva kwe-antibiotic.

Q2. Kuthatha isikhathi esingakanani ukubuyela ekuphileni okuvamile ngemuva kwe-pseudomembranous colitis?

Abantu abaningi baqala ukuzizwa kangcono ezinsukwini ezingu-2-3 ngemuva kokuqala ukwelashwa, ngokubuyela okuphelele okuthatha i-1-2 weeks. Noma kunjalo, ukugqoka kwamathumbu akho kungase kudinge amaviki ambalwa ukuze kululame ngokuphelele, ngakho-ke ukululama kwamathumbu kungase kuqhubeke ngisho nangemuva kokuba ezinye izimpawu ziphulukile.

Q3. Ingabe i-pseudomembranous colitis iyadluliseka?

Ibhaktheriya le-C. diff ebangela le meko lingasakazeka kusuka kumuntu kuya kumuntu ngemaphethini angcolile nokungcolile kwezandla. Noma kunjalo, cishe uzokhula izimpawu kuphela uma ibhaktheriya yakho yamathumbu isivele iphazamisekile yi-antibiotic noma ezinye izici.

Q4. Ingabe i-pseudomembranous colitis ingabuya ngemuva kokwelashwa?

Ngeshwa, yebo. Cishe u-20-25% wabantu bahlangabezana nokubuyela kabusha, ngokuvamile phakathi kweviki ezingu-2-8 ngemuva kokuphela kokwelashwa. Lokhu kwenzeka ngoba ama-spores e-C. diff angaphila emathunjini akho futhi abe sebenza futhi. Izimo ezibonakala kabusha ngokuvamile ziphendula kahle kuma-antibiotic afanayo noma ahlukile.

Q5. Ingabe kukhona imiphumela yesikhathi eside ye-pseudomembranous colitis?

Abantu abaningi baphulile ngokuphelele ngaphandle kwemiphumela ehlala njalo. Noma kunjalo, abanye bangase bahlangabezane nokuhlala kwesikhashana kwemikhuba yamathumbu noma ukululama okukhulu kokudla okuthile izinyanga ezimbalwa. Ngokungavamile, izimo ezinzima zingabangela izinkinga zamathumbu ezikhathi elide, kodwa lokhu akuvamile ngokwelashwa okufanele.