Aklã ƒe Dɔmawɔmawɔ ƒe Tɔtɔ (Aklã ƒe Tagbɔdɔ) Kple Ʋu si Dona le Variceal¶

Dɔnɔ siwo le aklãdɔléle si nɔa anyi didi, aklãdɔléle, alo aklã ƒe dɔmawɔmawɔ nyuie sesẽ la dzea ŋgɔ decompensation kpata etɔ̃ siwo ate ŋu ado mo ɖa nuxlɔ̃ame manɔmee le aƒeme: gastroesophageal varices si gbã (ʋu si dona le dɔgboa ƒe akpa si le etame si me ʋuka siwo me ʋu sina tona le nuɖuɖutome ƒe akpa si le ete la gbãna le), aklã ƒe tagbɔdɔ (acute ahɔhɔ̃mekawo ƒe tɔtɔ, amenyenye ƒe tɔtrɔ, asiʋuʋu si le ʋuʋum, kple alɔ̃madɔmadɔ si amonia kple dɔgbo me ahɔhɔ̃mekawo ƒe aɖi siwo to aklã si ŋu abi le ŋu eye ahɔhɔ̃a vuvu), kple dɔlékui ƒe peritonitis (SBP) (dɔlékui si xɔa tsi si le ƒodo si vuvu me kabakaba, si dea ame ƒe agbe afɔku me) hena vɛ.

Wò agbanɔamedziwo enumake ne èle aklãdɔléla si le xaxa me dzi kpɔm enye be nàƒo ka na atikewɔƒe kpatawo enumake, akpɔ yaƒoƒomɔ̃a ta to dɔnɔ si le ʋuʋum alo alɔ̃ dɔm la ʋuʋu ɖe woƒe axadzi le haya ƒe nɔnɔme me (abe alesi tsinyenye le ʋu si wogbɔ me nye nu vevi si hea ku kpata vɛ le variceal rupture me ene), nàzi NPO sesẽ dzi (naneke mele nu me o) ne ʋu si le dodom alo alɔ̃dɔdɔ sesẽe nye present, do telltale "flapping hand tremor" (asterixis) kpɔ be nàde dzesi aklã ƒe tagbɔdɔ kaba, eye nàƒo asa na alɔ̃dɔdɔ ƒe atikewo, atike siwo naa ame ƒe dzi dzea eme, ibuprofen/NSAIDs, alo acetaminophen si sɔ gbɔ nana vevie.

Wɔ esia fifia¶

1. Ƒo ka na atikewɔƒe siwo kpɔa nudzɔdzɔ kpatawo gbɔ enumake: Ƒo ka na wò nutoa me xexlẽdzesi kpata (911 le United States kple Canada, 112 le Europa Dukɔwo ƒe Habɔbɔ bliboa me, 999 le United Kingdom, 000 le Australia) alo nàlé ŋku ɖe míaƒe nyatakakadzraɖoƒe si nye xexlẽdzesi siwo wozãna kpata. Gblɔe kɔte be cirrhosis alo aklãdɔ le dɔnɔa ŋu eye wòle ʋu ƒom, le aɖuɖɔ si me aŋɔ yibɔ le la tom, le nu wɔm tɔtɔ/meʋãna o, alo asrã le du dzi kple ƒodo ƒe vevesese.
2. Ne ʋu le ʋuʋum alo le alɔ̃ dɔm la, tsɔe da ɖe axadzi ƒe hayahaya ƒe nɔnɔme me enumake: Mègana dɔnɔ si le ʋu ƒom alo le alɔ̃ dɔm le aklã ƒe ahɔhɔ̃medɔ ta la namlɔ anyi ɖe woƒe akɔta gbeɖe o. Mia wo ɖe woƒe miame dzi eye woƒe asike nabɔbɔ ɖe anyi vie ɖo ta anyigba ale be ʋu si le dodom, "kɔfi-tu" ƒe ʋuʋudedi viviti, alo aɖuɖɔ nado tso nu me tẽ tsɔ wu be wòami lãkusiwo.
3. Mizi NPO sesẽ dzi (naneke to nu me) dzi le ʋu si le dodom alo alɔ̃dɔdɔ sesẽ me: Mègana tsi, notsi, nuɖuɖu, alo atikekui siwo woano ne dɔnɔa le ʋu ƒom, le aɖuɖɔ si me aŋɔ yibɔ le tom, alo le alɔ̃ dɔm akpa be wòanɔ anyi aɖo dze eme nakɔ o. Kɔdzi dɔgboŋutinunyalawo ahiã dɔgbo ƒuƒlu hafi woate ŋu awɔ dɔgbo ƒe ʋuka si me ʋu sina tona kpata le gaƒoƒo ʋɛ aɖewo me tso esime wova ɖo.
4. Kpɔ "asi ƒe ʋuʋu" (asterixis) ɖa ne edze abe dɔnɔa tɔtɔ alo do dziku ene: Bia dɔnɔ si le ŋudzɔ be wòakeke eƒe abɔ eveawo tẽ ɖe wo ŋgɔ, abɔbɔ woƒe asibidɛwo ɖe megbe ("abe ʋukula si tɔ ʋuwo ƒe zɔzɔ ene"), eye wòakeke woƒe asibidɛwo ɖe wo nɔewo ŋu hena sɛkɛnd 15 va ɖo 30. Ne woƒe asiwo kple asibidɛwo ɖiɖi yi ŋgɔ le wo ɖokui si eye wogaʋuʋu yi dzi le ɣeyiɣi ƒe didime ƒe ʋuʋu me abe xevi ƒe aʋala ene la, ke wole aklã ƒe ahɔhɔ̃medɔ sesẽ me.
5. Mègana alɔ̃dɔdɔtike, dzimaɖitsitsinutsitike, opioid, alo NSAID vevesesenutsitike gbeɖe o: Mègana aklãdɔléla si meɖea dzi ɖi o, alɔ̃madɔmadɔ, alo si tɔtɔ benzodiazepines (lorazepam, alprazolam, diazepam), alɔ̃dɔdɔ ƒe atikewo (zolpidem, diphenhydramine), opioid vevesesenutsitikewo, alo NSAIDs gbeɖe o (ibuprofen, naproxen, aspirin) ƒe atike. Atike siwo naa ame ƒe susu dzea akɔ anyi nana dɔnɔ si ŋu aklã ƒe tagbɔdɔléle le la dea alɔ̃madɔmadɔ si womate ŋu anyɔ o me tẽ, gake NSAID ya nana ʋu sina le ʋukawo me si wua ame eye ayikua tsina enumake (aklã ƒe dɔléle).
6. Na dzoxɔxɔ nanɔ dɔnɔa ŋu eye nàƒo aklãtikewo katã nu ƒu: Tsɔ avɔ ƒuƒu siwo me dzo le tsyɔ dɔnɔa dzi be wòaxe mɔ ɖe dzoxɔxɔ si nu sẽ (si gagblẽa ʋu ƒe sisi le ʋumenugbagbeviɣidɔ me nu), eye nàƒo woƒe lactulose, rifaximin, beta-blockers (propranolol, nadolol, carvedilol), kple diuretics (spironolactone, ) ƒe aŋetuwo nu ƒu. furosemide) na kpekpeɖeŋunalawo.

flowchart TD
    Start["Dɔnɔ Si Ŋu Aɖuɖɔtoedɔ alo Aklãdɔléle Le Gbegblẽna Le Aƒeme"] --> Triage{"1. De dzesi Acute Decompensation Emergency"}
    Triage -->|Vomiting Bright Red Blood, Clots, Coffee Grounds, or Passing Black Tarry Stools| Varices["Nuɖuɖutome ƒe Ʋuʋudedi Siwo Gã: Ƒo ka na 911/112/999 Enumake, Ʋu si Doa Ame Siwo Kuna Wu"]
    Triage -->|New Confusion, Reversed Sleep-Wake Cycle, Irritability, Slurred Speech, or Flapping Hands| HE["Aklã ƒe Tagbɔdɔléle: Ƒo ka na 911/112/999 alo Aklãŋutinunyala, Kpɔe ɖa be Nusi ɣla si hea dɔléle vɛ hã (Ʋu, Dɔlékui, Dɔmeɖui) ."]
    Triage -->|Swollen Ascites Belly With New Fever, Chills, Belly Tenderness, or Low Blood Pressure| SBP["Dɔlékuiwo ƒe Dɔlékuiwo ƒe Dɔléle (SBP) / Sepsis: Ƒo ka na 911/112/999 Enumake nàxɔ Dɔlékuiwutikewo le IV me"]
    Varices --> Airway["2. Mia Dɔnɔa Ðe Axadzi (Recovery Position) Enumake ale be Ʋu Nado le Nu Me, Mègagblẽe Ðe Akɔta Gbadzaa Gbeɖe O"]
    Airway --> NPO["3. Na Strictly NPO (Naneke to Nu me), Na Dzoxɔxɔ Kple Avɔwo, Dzra Ðo Ðe Emergency Endoscopy Ŋu"]
    HE --> CheckAwake{"4. Ðe Dɔnɔ Si Tɔtɔ La Nyɔ Bliboe Eye wòte ŋu Mia nu Dediea?"}
    CheckAwake -->|No: Drowsy, Stuporous, or Slurring| Airway
    CheckAwake -->|Yes: Alert Grade 1 or 2 Encephalopathy| Lactulose["Wɔ ɖe Ðɔkta ƒe Dɔnɔ Ŋkeke Lactulose Ðoɖo dzi ne Woŋlɔe, Mègana Atike Siwo Faa Alɔ̃ alo Alɔ̃dɔtikewo Gbeɖe O, Tsɔe Yi Kɔdzi"]
    SBP --> NPO

--- .

Dɔgbo ƒe ʋuka siwo me ʋu sina tona: nusita ʋu ƒe sisi na ʋu sina toa ʋuka me si gblẽa nu le ame ŋu¶

Le ŋutilã si le lãmesẽ me me la, ʋu si me nunyiame sɔ gbɔ ɖo siwo katã dona tso dɔgbo, dɔgbo, dɔgbo, kple dɔgbo me la sina toa ʋuka gã gã aɖe si woyɔna be portal vein me yia aklã falɛfalɛ si le abe ƒumebɔbɔ ene me be woaɖee hafi atrɔ ayi dzia me. Ne aklãdɔléle si nɔa anyi didi (tso aha sesẽ, dɔlékui ƒe aklãdɔléle B alo C, lãmenugbagbeviwo ƒe dɔwɔwɔ ƒe dɔmawɔmawɔ nyuie si do ƒome kple steatohepatitis / MASH, alo autoimmune disease) tsɔ abi sesẽ siwo me ka le (cirrhosis) ɖɔ li aklã ƒe lãkusi falɛfalɛwo la, ʋu megate ŋu sina to aklãa me bɔbɔe o.

Nyaƒoɖeamenu si le ʋuka si le ʋɔtrua nu me la trɔna ɖe megbe abe ʋu siwo le mɔ gã aɖe si woxe megbe ene, si nye nɔnɔme si woyɔna be ʋuka si me ʋu sina tona le agbo nu. Esi ʋu si wotsɔ nya ɖe wo ŋu le agbo nu la di vevie be yewoakpɔ mɔ si dzi woato atrɔ ayi dzia gbɔ ta la, ʋuka suesuesue siwo mebɔbɔ o, siwo ƒe gliwo le tsɛ, siwo le nuɖuɖumɔ̃ (mimimɔ̃) ƒe gɔme kple dɔgbo tame. Le ɣleti geɖe megbe la, ʋuka siawo siwo le bɔbɔe la va zua ka siwo tro, siwo ƒe nyaƒoɖeamenu sesẽ siwo woyɔna be esophageal and gastric varices.

Susu eve siwo tae ʋu si dona le ʋukawo me wua ame wu dɔgbo me ʋu si dona le lãme na ame sã¶

1. Venous pressure si lolo le agbo nu: To vovo na peptic ulcer sue la, esophageal varix le hydrostatic pressure si yia edzi me; ne eƒe gli tsɛ la gbã la, ʋu sina yia nuɖuɖutome kple dɔgbo me le agbɔsɔsɔ si nye mililita 100 va ɖo 500 le miniti ɖeka me.
2. Coagulopathy kple thrombocytopenia le aklã ƒe dɔmawɔmawɔ nyuie me: Aklã si le lãmesẽ me wɔa ŋutilã ƒe ʋu ƒe sisi ƒe protein (prothrombin, fibrinogen, Factors V, VII, IX, X) esime ʋuka si lolo ɖe enu le portal hypertension me léa ʋu platelets eye wòtsrɔ̃nɛ. Eyata ne ʋumenugbagbeviɣidɔ aɖe gbã le dɔnɔ si ŋu ʋusɔgbɔdɔ le ŋu la, ʋumenugbagbevi dzĩwo kple ʋumenugbagbeviɣidɔlékui siwo hiã be woatsɔ axe doa le eɖokui si siaa menɔa ʋua me o.

Nuxlɔ̃amedzesiwo le ʋuka siwo me ʋu sina tona ŋu (Hafi ʋu nado gɔ̃ hã) .¶

Menye ɣesiaɣie dɔnɔ meɖea ʋu dzĩ si le keklẽm enumake ne varix dze dodo gɔme ɖe dɔgboa me o:

• Hematemesis (Ʋu si le ʋuʋum): Agbagbadzedze manɔmee, ʋu si nye ʋu si nye tsi dzĩ si le keklẽm, ʋu si ƒe amadede nye maroon dzĩ si do viviti si lolo abe plum ene, alo nu si ƒe amadede nye aŋutiɖiɖi si le abe kɔfi ƒuƒu ƒuƒu ene (ʋu si dona le dɔgboa me).
• Melena (Black, tarry, foul-smelling stools): Ʋu si ƒoa ƒu ɖe dɔgboa me eye wòtoa dɔgbowo me la, dɔgbo me acid kple dɔgbo me dɔlékuiwo ɖunɛ wòzua jet-black, sticky, shiny stools siwo le abe mɔdzi tar ene eye woƒe ʋeʋẽ lilili si nye ga si ŋu ɖikeke mele o, si le ʋeʋẽm. Aɖuɖɔ yibɔ siwo me tarry le ƒe toto le dɔnɔ si ŋu cirrhosis le ŋu nye ʋu si dona le GI ƒe akpa si le etame si le dɔ wɔm, zi geɖe la, eya ɖeka kolia si hea tɔtɔ kpata alo alɔ̃dɔdɔ vɛ ne ʋuʋudedi zero medzɔ o gɔ̃ hã.
• Hematochezia (Maroon alo ʋu dzĩ si le keklẽm tso dɔgbo me): Ne ʋu si dona le ʋukawo me kabakaba ŋutɔ (si wu mililita 1,000) la, ʋu sina toa dɔgbo bliboa me kabakaba ale gbegbe be wòdona le dɔgboa me wògakpɔtɔ le dzedzem abe aŋutiɖiɖi alo maroon ene, eye taɖuame kple dzidziƒoame sesẽ kpena ɖe eŋu.
• Vevesese manɔmee ƒe alɔ̃madɔmadɔ kpata (Syncope) kple fifia fafɛ: Esi ʋu si yɔa dɔgboa me wɔa dɔ abe ʋuʋudedi sesẽ aɖe ene ta la, kasia dɔnɔ geɖe sena le wo ɖokui me be ehiã kpata be yewoazã nugododeƒe, azɔ ayi tsileƒe, eye yewoadze anyi le tsileƒe ƒe anyigba manyamanyae hafi ame aɖeke nakpɔe be ʋu le dodom le yewo me le ememe.

Kpekpeɖeŋu gbãtɔ afɔɖeɖe ɖesiaɖe na ʋu si dona le ʋukawo me si le dɔ wɔm¶

1. Yɔ kpekpeɖeŋunalawo enumake eye nàʋu ŋgɔgbe ʋɔtrua: Aɖabaƒoƒo ɖesiaɖe le vevie; kɔdzi ƒe agbetsitsi nɔ te ɖe atike siwo doa ʋukawo me (octreotide alo terlipressin be woaɖe ʋuka ƒe ʋukawo ƒe nyaƒoɖeamenu dzi akpɔtɔ), dɔlékuiwutike siwo wotsɔ xea mɔ na ʋuka me (ceftriaxone), ʋudodo ŋuɖɔɖɔɖotɔe, kple endoscopic variceal band ligation kpata xɔxɔ le gaƒoƒo 12 me dzi.
2. Takpɔ yaƒoƒomɔ̃a le Miame ƒe Axadzi Gbugbɔgadzɔ ƒe Nɔnɔme:
3. Mia dɔnɔa ɖe woƒe miame dzi le anyigba alo aba dzi.
4. Do woƒe mo ɖe anyi vie ɖe tsize alo afɔkpa dzi ale be ʋu kple ʋuʋudediwo nakɔ tẽ tso ŋgonu si le ete.
5. Zã asibidɛ si ŋu asigɛ le si woxatsa ɖe avɔ me nàtsɔ atutu ʋu gã siwo le abe jelly ene la ado goe le nu ƒe ŋgɔgbe ne wole nu ƒom. Mègatsɔ dɔnɔ si le ʋu ɖum la da ɖe woƒe akɔta gbadzaa gbeɖe o, eye mègaɖo kpe wo dzi gbeɖe be woanɔ anyi ɖe tsitrenu ne woƒe ta le ʋuʋum alo woƒe tagbɔ le gbegblẽm o, elabena anyinɔƒe dzɔdzɔe nana ahɔhɔ̃mekawo me ʋu sina fũu akpa eye wòtsia dzodzodzoe zi ɖeka kple yaƒoƒo.
6. Na dɔnɔa naxɔ dzo kple avɔ ƒuƒu: Xatsa akɔta kple afɔwo ɖe avɔ dzodzoewo me. Dzoxɔxɔ si mede Celsius dzidzenu 36.0 o (Fahrenheit dzidzenu 96.8) nana ʋumenugbagbeviɣidɔ kple ʋumenugbagbevi dzĩ ʋɛ siwo susɔ siwo dɔnɔa gblẽ ɖi la megawɔa dɔ o.
7. Mègana tsi, tsikpe ƒuƒu, antacids, alo ʋu ƒe sisi ƒe atikekuiwo to nu me gbeɖe o: Ne dɔnɔa ɖe kuku be tsi naklɔ ʋu ƒe vivi le woƒe nu me hã la, avɔ xɔdzo koe nàtsɔ atutu woƒe nuyiwo. Tsi nana nana tsi si doa viviti ɖe dɔgboŋutinunyala ƒe fotoɖemɔ̃ si wotsɔ léa ŋku ɖe dɔgboa ŋu la yɔa dɔgboa me fũ eye wòʋãa ame be wòagaɖe aɖuɖɔ eye wòagbɔ ya ake.

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Aklãdɔ (HE): nusita aklã ƒe dɔmawɔmawɔ nyuie hea tɔtɔ kple alɔ̃madɔmadɔ vɛ¶

Le lãmesẽ gome la, dɔlékui siwo le dɔgboa me gblẽa nuɖuɖu me protein me eye wowɔa nitrogen gbeɖuɖɔ siwo me aɖi le, vevietɔ ammonia (\(NH_3\)), tsɔ kpe ɖe mercaptans, ami siwo ƒe kɔsɔkɔsɔ kpuiwo, kple manganese ŋu. Zi geɖe la, ʋu si woyɔna be portal vein ʋu tsɔa amoniaka sia katã yia aklã me tẽ, afisi aklãmenugbagbevi siwo le lãmesẽ me (aklãmenugbagbevi) trɔa aɖi ammonia wòzua urea si me afɔku mele o to urea ƒe tsatsam dzi ale be ayikuawo nate ŋu akɔe ado goe le aɖuɖɔ me.

Le aklã ƒe dɔmawɔmawɔ nyuie alo aklã ƒe dɔmawɔmawɔ nyuie me la, nu eve gblẽna: aklãmenugbagbevi siwo ŋu abi le la bu woƒe ŋutete be woaɖe amoniaka ɖa ƒe alafa memama 80, eye ʋusɔgbɔdɔ si le agbo nu zi dɔgbo ƒe ʋu dzi be wòato aklãa ŋu keŋkeŋ to collateral shunts (alo amekoko ƒe TIPS stent: transjugular intrahepatic portosystemic shunt) dzi. ammonia si womeɖe o la tsia ɖe ʋuka siwo le ɖoɖo nu me tẽ eye wòtsoa ʋu kple ahɔhɔ̃ ƒe mɔxenu. Le ahɔhɔ̃a me la, ahɔhɔ̃menugbagbevi siwo doa alɔe siwo woyɔna be astrocytes dzea agbagba be yewoaɖe aɖi ɖa le amonia me to glutamate tɔtrɔ wòazu glutamine me. Glutamine wɔa dɔ abe osmotic sponge ene le astrocytes me, hea tsi yia ahɔhɔ̃menugbagbeviwo me eye wòhea diffuse cerebral edema (ahɔhɔ̃ ƒe vuvu) kple neurochemical inhibition sesẽ (hepatic encephalopathy) vɛ.

West Haven ƒe Dzesidede Dzesidede: aklã ƒe tagbɔdɔléle ƒe dzesidede tso Dzeside 1 vaseɖe Dzeside 4¶

Ƒomea me tɔ siwo le aklãdɔléla gbɔe nyea ame gbãtɔ siwo kpɔa Aklãdɔ ƒe Dzeside 1 alo Dzeside 2 ɣesiaɣi, ɣeyiɣi didi aɖe hafi amedzro aɖe nade dzesi naneke si gblẽ. Zã dukɔwo dome West Haven Criteria nàtsɔ akpɔ dɔnɔa ƒe afɔɖeɖe tututu eye nàgblɔe:

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Alesi woawɔ abadzivɔ "Asterixis" (Flapping Tremor) dodokpɔ¶

Asterixis menye lãmeka siwo le ʋuʋum ƒe ʋuʋu ŋutɔŋutɔ o; le ahɔhɔ̃mekawo ƒe dɔwɔwɔ gome la, enye negative myoclonus, si nye elektrikŋusẽ ƒe tɔtɔ (nutsitsi) si xɔa milisekɔnd 50 va ɖo 200 kpata le motor cortex ƒe titina siwo léa nɔnɔme ɖe te ɖe nuheŋusẽ ŋu, si aɖi si nye ammonia hena vɛ.

1. Na dɔnɔa nanɔ anyi ɖe aba dzi alo zikpui dzi (alo mlɔ anyi ɖe edzi) eye nàdo eƒe abɔ eveawo ɖe woƒe akɔta ŋgɔ tẽ eye woƒe abɔta nanɔ dzɔdzɔe.
2. Mifia wo be woabɔbɔ asibidɛ eveawo ɖe megbe sesĩe (dorsiflexion, asibidɛwo dze ŋgɔ ŋgɔgbe abe ɖe wole tutum ɖe gli si womekpɔna o ŋu ene) eye woakeke woƒe asibidɛwo ɖe wo nɔewo ŋu gbadzaa.
3. Gblɔ na wo be miã ŋku eye woalé nɔnɔme ma tututu me ɖe asi madzudzɔmadzudzɔe hena sɛkɛnd 30.
4. Alesi dodokpɔ nyui aɖe le: Le sɛkɛnd 5 va ɖo 15 ƒe ɣeyiɣi aɖe megbe la, asibidɛwo kple asibidɛwo ɖiɖina yia ŋgɔ kasia sentimeta ʋɛ aɖewo esime lãmekawo ƒe gbeɖiɖi nu yina hena sɛkɛnd ɖeka ƒe akpa ɖeka, emegbe enumake wogaʋuʋuna yia dzi esi dɔnɔa lée, eye wogbugbɔna gbugbɔna le ɣeyiɣi ƒe didime nu abe xevi si le eƒe aʋalawo ƒom ene ("aklã ƒe ʋuʋu").
5. Dodokpɔ bubu na dɔnɔ siwo gbɔdzɔ: Ne dɔnɔa gbɔdzɔ akpa be wòate ŋu alé abɔ eveawo ɖe dzi le yame la, na woƒe ŋgɔgbe abɔwo nanɔ anyi ɖe mattress la dzi gbadzaa eye nàkɔ woƒe asiwo ɖe dzi le asibidɛa gbɔ sɛkɛnd 20 ko, alo nàbia tso wo si be woamimi wò asibidɛ eve madzudzɔmadzudzɔe ("milkmaid's grip").

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Nu 6 siwo ɣla siwo hea aklãdɔléle vɛ kabakaba¶

Aklã me tagbɔdɔléle medzena le ya tsɛ aɖe me gbeɖe le dɔnɔ si ƒe ʋumenugbagbeviɣidɔ nɔa te tsã la me gbeɖe o; le ame siwo wu 80 le alafa me siwo woxɔna ɖe kɔdzi me la, atikewɔwɔ me vlododo kpata aɖe koŋ ye he amonia ƒe dzidziɖedzi vɛ. Atikewɔla siwo kpɔa nudzɔdzɔ kpatawo gbɔ dia six classic precipitants siawo enumake (eye ele be dɔnɔdzikpɔlawo nagblɔ wo dometɔ siwo dzɔ le gaƒoƒo 72 siwo va yi me na kpekpeɖeŋunalawo):

1. Silent Gastrointestinal Bleeding (Ʋu ƒe "protein nuɖuɖu" gã aɖe): Ʋu yɔ fũ kple hemoglobin protein (protein dzadzɛ si ade gram 15 va ɖo 20 le ʋu mililita 100 me). Ne varix alo dɔgbo me abi aɖe ʋu le nuɖuɖumeŋusẽ me kpoo la, dɔgbo me dɔlékuiwo ɖua ʋu me protein si woɖu la eye wotrɔnɛ wòzua amonia ƒe ƒutsotsoe gã aɖe. Lé ŋku ɖe nugododeƒea ŋu ɣesiaɣi alo nàbia nu tso aɖuɖɔ yibɔ, si me aŋɔ le (melena) ŋu ɣesiaɣi si aklãdɔléla aɖe tɔtɔ.
2. Dɔlékui (Vevietɔ Dɔlékuiwo ƒe Dɔlékuiwo ƒe Dɔlékuiwo, UTI, alo Aklãdɔ): Dɔlékuiwo ƒe dɔdzẽ kple dɔlékuiwo ƒe aɖi nana ʋu kple ahɔhɔ̃ ƒe mɔxenu la tsina eye wòdzia ​​ammonia ƒe ahɔhɔ̃mekawo ƒe aɖi ɖe edzi zi gbɔ zi atɔ̃.
3. Aɖuɖɔtoe kple Lactulose ƒe agbɔsɔsɔ si to: Ne aɖuɖɔ bɔbɔ nɔ dɔgboa me gaƒoƒo 24 va ɖo 48 le esi teƒe be woaɖee ɖa zi 2 va ɖo 3 gbesiagbe la, dɔgbo me dɔlékuiwo wɔa amonia geɖe ŋutɔ eye woxɔa wo.
4. Tsikuɖiɖi, Aɖuɖɔtoe si gbɔ eme, Ʋuʋudedi, alo Aɖuɖɔtoe (Electrolyte & Kidney Crisis): Tsitike siwo woŋlɔ na ame (furosemide kple spironolactone) ƒe agbɔsɔsɔ fũ akpa nono, fifia le dzoxɔxɔ me, alo dɔgbo me dɔlékui aɖe ƒe amesinɔnɔ hea ayiku ƒe abi sesẽ, hypokalemia (ʋu me potassium si mebɔ o), kple lãmenugbagbeviwo ƒe dɔwɔwɔ vɛ alkalosis ƒe dɔléle. Potassium si le ʋu me si mesɔ gbɔ o ʋãa ayikuawo tẽ be woawɔ amonia bubu, gake alkalosis ya trɔa ammonium ions (\(NH_4^+\), si mate ŋu atso ayi ahɔhɔ̃a me o) wozua amonia gas si me dzoxɔxɔ mele o (\(NH_3\), si tsoa ahɔhɔ̃a me tẽ).
5. Titina Lãmetsiŋusẽ ƒe Blanuilélenutsitikewo: Benzodiazepine (lorazepam, diazepam, clonazepam), alɔ̃dɔdɔtike (zolpidem), atike si naa ame ƒe dzi dzea eme (diphenhydramine, hydroxyzine), alo opioid vevesesenutsitike (oxycodone, morphine, tramadol) ƒe agbɔsɔsɔ ɖeka gɔ̃ hã nono.
6. Acute Portal Vein Thrombosis alo New TIPS Shunt: Ʋu yeye si xea mɔ na portal vein alo aklã ƒe ʋuka si woda nyitsɔ laa.

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Lactulose Kple Rifaximin Gɔmesese (Eye ne MELE be woana Lactulose si woano GBEÐE o) .¶

Woŋlɔa atike eve na dɔnɔ siwo ŋu aklãdɔléle kple aklãdɔléle do ŋgɔ le edziedzi be woatsɔ aɖe amoniaka ɖa le dɔgboa me:

• Lactulose (alo Lactitol): Sukli si wotsɔ lãgbalẽ wɔe si le ʋeʋẽm, vivina, si mexɔna o. Ne lactulose ɖo dɔgboa me la, dɔgbo me dɔlékui siwo ɖea vi la ʋãnɛ wòzua lactic acid kple acetic acid. Acidification sia ɖea pH si le dɔgboa me dzi kpɔtɔna, si toa atikewo léa ammonia si kaka (\(NH_3\)) to hydrogen ion dede eme be wòatrɔe wòazu ammonium (\(NH_4^+\)) si me dzo le. Esi wònye be ammonium si me dzo le mate ŋu ato dɔgboa ƒe gli me ayi ʋukawo me o ta la, egatsia aɖuɖɔa me eye lactulose ƒe osmotic laxative action si dona le ŋutilãa me. Ðɔktawo trɔa lactulose ƒe agbɔsɔsɔme gbesiagbe ale be dɔnɔa toa aɖuɖɔ falɛfalɛ 2 va ɖo 3 gbesiagbe.
• Rifaximin: Dɔlékuiwutike si wonona si mexɔna o si nɔa dɔgboa me tututu eye wòɖea dɔgbo me dɔlékui siwo wɔa amonia ƒe xexlẽme dzi kpɔtɔna.

Dedienɔnɔ ƒe se vevi aɖe le tagbɔdɔléle sesẽ ƒe kuxi aɖe me le aƒeme¶

• Ne dɔnɔa le Dzeside 1 ƒe gɔmedzedze alo Dzeside 2 HE si nu mesẽ o (wònyɔa goglo, bɔbɔ nɔ anyi, ekɔa akɔta le mɔ si sɔ nu, eye wòte ŋu noa tsi evɔ metsi o) eye woƒe lactulose to eŋu alo eƒe dɔgbo le ƒoƒom la, yɔyɔ na woƒe aklãdɔdala alo amedɔdɔ kpata ate ŋu alɔ lactulose ƒe agbɔsɔsɔme si woŋlɔ na wo si woŋlɔ na wo le dɔléle ŋkeke me esime wole ɖoɖo wɔm ɖe atikewɔlawo ƒe dodokpɔ ŋu.
• MÈGAKƆ lactulose (alo tsi aɖeke) si woano ɖe nu me ɖe dɔnɔ si le Grade 3 (stuporous/drowsy) alo Grade 4 (comatose) ƒe nu me GBEÐE o: Ne dɔnɔa nya dɔ alɔ̃, le ɣli dom vevie, alo esesẽ be wòanyɔ ko la, woƒe gag reflex la nu yina. Lactulose-tsi si le ʋeʋẽm si léna ɖe nu me kɔklɔ ɖe woƒe nu me nana aklã me ʋuʋu yia lãkusi me enumake. Dɔnɔdzikpɔlawo kple kɔdzi dɔnɔdzikpɔlawo tsɔa lactulose retention enemas alo nasogastric tube si wokpɔ ta na la daa dɔ na dɔnɔ siwo le Dzeside 3 kple Dzeside 4 dedie le yaƒoƒomɔ̃a ƒe dedienɔnɔ vɔ megbe.

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Dɔlékuiwo ƒe Dɔlékuiwo ƒe Dɔléle (SBP) si dzɔna le wo ɖokui si kple ascites si me teteɖeanyi le ƒe nɔnɔme kpatawo¶

Dɔnɔ geɖe siwo ŋu decompensated cirrhosis le la ƒoa tsi si ƒe amadede nye gbe lita geɖe nu ƒu ɖe woƒe ƒodo me (ascites), si wɔnɛ be ƒodoa xaxa, vuvu, eye wòkekena. Esi wònye be dɔlélenutsiŋutete ƒe protein siwo kpɔa ame ta (kpeɖeŋutɔ) mesɔ gbɔ kura le ascitic tsi me o ta la, dɔlékui nyui siwo tso dɔnɔa ŋutɔ ƒe dɔgbo me ate ŋu aʋu to nusuekpɔmɔ̃ me to dɔgbo ƒe gli me (dɔlékui ƒe ʋuʋu) eye woaxɔ dɔlékui le ƒodo me tsia me evɔ dɔgbo ƒe ʋuʋu aɖeke madzɔ o. Woyɔa dɔlékui sia si ate ŋu ade ame ƒe agbe afɔku me be Spontaneous Bacterial Peritonitis (SBP) eye wòhea ku ƒe alafa memama 20 va ɖo 30 ne dɔlékuiwutike siwo wodona ɖe ʋuka me tsi megbe gaƒoƒo ʋɛ aɖewo gɔ̃ hã.

Aflaga dzĩ siwo nye Spontaneous Bacterial Peritonitis (SBP) ƒe aflaga dzĩwo .¶

To vovo na amekoko ƒe ƒunukpeƒetetedɔ si dona tso ƒunukpeƒetetedɔ si gbã (si nana ƒodoa sesẽna abe ʋuƒo ene) la, tsi si wotsɔna tsia ascites le ʋumenugbagbeviɣidɔléla me xea mɔ na ƒodo ƒe lãmekawo be woase le wo ɖokui me be yewosesẽ o. Di nuxlɔ̃amedzesi siawo siwo menya kpɔna dzea sii bɔbɔe o dometɔ ɖesiaɖe** le dɔnɔ si ŋu ascites le ŋu:

• Asrã ɖesiaɖe si ƒe kɔkɔme wu Celsius 37.8 (100.0 degrees Fahrenheit) alo dzoxɔxɔ si nu sẽ wu 36.0 degree Celsius (96.8 degrees Fahrenheit), alo vuvɔ si le ʋuʋum si womenya o.
• Ƒodo ƒe vevesese yeye si kaka, ƒoƒo, vevesese, alo vevesese ne wole tetem blewuu ɖe ƒodo si vuvu la dzi, alo ƒodo si kasia wòsena le eɖokui me be yesẽ eye wòtena ɖe edzi wu alesi wònɔna ɖaa.
• Tɔtɔ yeye alo esi le sesẽm ɖe edzi / aklã ƒe tagbɔdɔ si me nusi gbɔ wòtso si dze ƒã o (le SBP dɔnɔ siwo ade 30 le alafa me me la, tɔtɔ nye ɖeka si dzena le gota, dzoxɔxɔ aɖeke mele eme o eye ƒodo mevea ame hã o).
• Ʋu ƒe sisi ƒe ɖiɖi si womeɖe o, taɖuame, alo aɖuɖɔ ƒe dodo kpata (aklã ƒe dɔléle, afisi SBP dɔlékui ʋãa ayikuwo be woatɔ keŋkeŋ).
• Afɔɖeɖe enumake: Yi dɔwɔƒe si kpɔa nudzɔdzɔ kpatawo gbɔ tẽ. Kɔdzi ɖɔktawo azã aŋe tsɛ aɖe le ultrasound ƒe mɔfiafia te atsɔ aɖe ƒodo me tsi sue aɖe (diagnostic paracentesis) atsɔ axlẽ ʋumenugbagbevi ɣiwo (>250 polymorphonuclear cells per cubic millimeter confirms SBP) eye woado dzidzime etɔ̃lia ƒe cephalosporin dɔlékuiwutike siwo wodona ɖe ʋuka me kpe ɖe albumin si wodona ɖe ʋuka me ŋu enumake be woaɖe ayikuawo.

Nusi woawɔ ne tsi do tso vidzidɔ ƒe ʋuʋu me ("Tsiɖɔɖɔ ƒe Dɔléle") .¶

Le dɔnɔ siwo ŋu ascites sesẽ si tena ɖe ame ŋu le gome la, zi geɖe la, nyaƒoɖeamenu si le ƒodoa me ƒoa ƒodoa doa goe wòzua umbilical hernia si ƒe ŋutigbalẽ le tsɛ. Ne ŋutigbalẽ si le ƒodoa dzi la xɔ abi alo abi si do viviti eye kasia vuvu la, ascitic tsi ɣi si me kɔ lita geɖe ate ŋu ado ɖe awuawo dzi (Tsiɖɔɖɔ ƒe dɔléle).

• Kpekpeɖeŋunana gbãtɔ enumake na ascitic umbilical hernia si gbã:
• Ƒo ka na wò nutoa me xexlẽdzesi kpata alo tsɔ ʋu yi dɔwɔƒe si kpɔa nudzɔdzɔ kpatawo gbɔ enumake (ne dɔlékuiwo ge ge ɖe do ma me la, peritonitis si wua ame kplɔnɛ ɖo le gaƒoƒo ʋɛ aɖewo ko me, eye tsi si bu kabakaba la nana ʋu ƒe sisi dzi ɖena kpɔtɔna).
• Na dɔnɔa namlɔ anyi ɖe woƒe akɔta alo wòabɔbɔ vie ale be teƒe si tsi le dodom le la nafia ta dzi.
• Tsɔ gauze dressing si me dɔlékui mele o alo afɔkpa dzadzɛ si woklɔ yeyee si wotsɔ tape bla nyuie (mègatutu naneke ɖe doa me o) tsyɔ ʋɔtru si le dodom la dzi, eye nàlé asibidɛ ƒe gotagome nyaƒoɖeamenu blewu vaseɖe esime kɔdzidɔwɔlawo nate ŋu ana dɔlékuiwutike siwo wodona ɖe ʋuka me, albumin, kple amekoko ƒe ɖɔɖɔɖo.

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Atikewo ƒe dedienɔnɔ ŋuti se sesẽwo na amesiame si ŋu ʋumenugbagbeviɣidɔ le¶

Aklã si ŋu abi le la trɔa asi le atikewo ŋu vivivi, gake ʋusɔgbɔdɔ si le agbo nu nana dɔgboa ƒe lãkusi kple ayikuwo te ŋu gblẽna le mɔ tɔxɛ aɖe nu. Ele be amesiame si kpɔa ʋumenugbagbeviɣidɔléla dzi nawɔ ɖe aƒeme atikewɔwɔ ŋuti se etɔ̃ siawo dzi:

1. Mɔxexe ɖe NSAID-tikewo katã nu keŋkeŋ (Ibuprofen, Naproxen, Aspirin, Meloxicam, Diclofenac): Ibuprofen alo naproxen ƒe atikekui ʋɛ aɖewo gɔ̃ hã nono le ʋumenugbagbeviɣidɔ me ɖea prostaglandin siwo kpɔa ame ta la ɖa le dɔgboa ƒe ʋukawo me (si hea afɔku gã aɖe vɛ le dɔgbo ƒe ʋuka me ʋu ƒe sisi alo ʋuka me ʋu ƒe sisi le agbo nu) kple ayiku ƒe ʋukawo me (si hea acute, zi geɖe la, ewua ame aklã ƒe dɔléle).
2. Acetaminophen (Paracetamol) ƒe agbɔsɔsɔme ƒe seɖoƒe sesẽ: Togbɔ be acetaminophen ƒe agbɔsɔsɔ gã (>4,000 mg/ŋkeke) hea aklã ƒe dɔmawɔmawɔ nyuie vɛ hã la, aklãŋutinunya ƒe mɔfiamewo (AASLD kple EASL) de dzesii be le aklãdɔléle si nɔa anyi didi siwo menoa aha o gome la, acetaminophen ƒe agbɔsɔsɔ sue ƒe seɖoƒe sesẽ na mewu 2,000 o miligram (ene 500 mg regular-strength tablets) katã le gaƒoƒo 24 ɖesiaɖe me na nuɖuɖu kpuiwo le nyateƒe me la, ele dedie wu NSAIDs, negbe ɖe dɔnɔa le aklã ƒe dɔmawɔmawɔ nyuie me, aha nom vevie, alo nunyuimakpɔɖui/nutsitsidɔ, le nɔnɔme sia me la, ele be woana zero acetaminophen ɖɔkta ƒe sedede tẽ manɔmee.
3. Lé aɖuɖɔtoemetikewo ("tsitikewo") ɖe asi le ʋuʋudedi, aɖuɖɔtoe, alo tɔtɔ me: Mègana spironolactone alo furosemide ƒe ŋdi me agbɔsɔsɔme gbeɖe ne dɔnɔa ƒe ta le ʋuʋum, tɔtɔ, eƒe ʋuʋudedi, alo eƒe aɖuɖɔ >4 le ʋuʋum gbesiagbe vaseɖe esime atikewɔla nalé ŋku ɖe woƒe ʋu me sodium, potassium, kple creatinine ŋu.

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Nya siwo wobiaa amewo enuenu¶

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Wolé ŋku ɖe dzɔtsoƒewo ŋu¶

• Amerika Habɔbɔ si Kpɔa Aklãdɔlélewo Ŋuti Nusɔsrɔ̃ Gbɔ (AASLD) kple Europa Habɔbɔ si Kpɔa Aklã Ŋuti Nusɔsrɔ̃ Gbɔ (EASL): Dɔdaƒe ƒe Mɔfiamewo le Aklãdɔléle Ŋuti Mɔfiamewo le Aklãdɔléle Si Nɔa Anyi Me (West Haven Criteria), Ascites kple Dɔlékuiwo ƒe Dɔlékui Siwo Dzɔna le Wo ɖokui Si ƒe Dɔlélewo Dzikpɔkpɔ, kple Portal Hypertensive Bleeding in Cirrhosis.
• Baveno VII ƒe Nubabla ƒe Dɔwɔƒe (Dukɔwo Dome Portal Hypertension Consensus): Baveno VII, Nubabla yeye wɔwɔ le Portal Hypertension kple Acute Variceal Hemorrhage Resuscitation me.
• Dukɔa ƒe Lãmesẽnyawo Kple Belélename Ŋuti Nusrɔ̃ƒe (NICE) kple Britaintɔwo ƒe Dɔgbomeŋutinunya Habɔbɔ (BSG, United Kingdom): Adɔgbo ƒe Dɔléle le ƒe 16 kple edzivɔ me: Dzodzro kple edzikpɔkpɔ (NG50) kple Acute Upper Gastrointestinal Bleeding in Cirrhosis Mɔfiamewo.
• Xexeame ƒe Dɔgboŋutinunya Habɔbɔ (WGO, Dukɔwo Dome): Xexeame Katã ƒe Mɔfiamewo le Nuɖuɖutome ƒe Vovototowo Kple Aklã ƒe Tagbɔdɔléle ƒe Vovototo Me.

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Mɔfiame siwo do ƒome kplii¶

• Ʋu si dona le dɔgboa me, ʋu si dona le lãme na ame, kple kpekpeɖeŋunadɔ gbãtɔ si nye melena
• Sepsis kple septic shock ƒe dzesidede kple kpekpeɖeŋunana gbãtɔ
• Kpekpeɖeŋu gbãtɔ si nana ame ƒe dzi gbãna kple ʋu ƒe sisi ƒe gbagbã
• Ahanono ƒe ahamumu, ahamumu, kple ʋu si woatsɔ ahaya dedie
• Xexlẽdzesi siwo woxɔna kpata le dukɔwo nu