M Ischemia mai tsanani, Ciwon hanji, da kuma Gaggawa Gut Gut¶

M ischemia mai tsanani (AMI) wani bala'i ne na gaggawa na jijiyoyin jini da na ciki wanda jini ke gudana ta manyan arteries ko veins masu samar da ƙananan hanji da manyan hanji (mafi yawanci ** mafi girma mesenteric artery [SMA]) an yanke shi da sauri ta hanyar bugun jini na jijiya ( embolism) ko rashin ƙarfi na jini. mesenteric ischemia**), ko kuma venous clot (** mesenteric venous thrombosis**). Kamar yadda toshewar jijiyar kwakwalwa ke haifar da bugun jini kuma toshewar jijiyar kafa yana haifar da ischemia mai tsanani, toshewar jijiyar hanji yana haifar da " bugun jini / bugun zuciya na hanji" wanda lallausan ciki (mucosa) na karamar hanjin ya fara mutuwa cikin mintuna 30 zuwa 60.* (** ciwon hanji mai jujjuyawa**) cikin awanni 6 zuwa 12**. Idan balagagge (musamman duk wanda ke da fibrillation na atrial, bugun zuciya na baya-bayan nan, raunin zuciya, ko cututtukan jijiyoyin jini) ya taso kwatsam, matsanancin zafi na tsakiyar ciki tare da amai na gaggawa ko gudawa, kira yankin ku. lambobin gaggawa nan da nan. Yayin da ake jiran ma'aikatan jinya, duba abubuwan da suka shafi jijiyoyin jini da jagororin gaggawa na ciki dissection aortic da ruptured na ciki aortic aneurysm, toshewar hanji, ƙwanƙwasa hernia, da volvulus, kuma m pancreatitis da gallbladder gaggawa.

Domin ciwon hanji mara magani yana ɗauke da adadin mace-macen kashi 60 zuwa 80 cikin ɗari**, rayuwa ta dogara ne akan ɗaukar gaggawa a lokacin taga farkon juyawar sa'o'i (sa'o'i 6 na farko) ta hanyar gane alamarta guda ɗaya da ta fi shahara a asibiti:

Yi wannan yanzu¶

1. **Kira lambar gaggawa ta gida nan da nan kuma nemi jigilar zuwa asibiti tare da iyawar Vascular da Gabaɗaya. lambobin gaggawa. Yi magana a fili: "Waɗanda ake zargin m mesenteric ischemia / gut jini gudan jini: kwatsam zafin ciki mai raɗaɗi daidai gwargwado ga majiyyaci mai fibrillation (ko cututtukan zuciya / zuciya)."
2. Gane "Tarkon Ciki Mai Lalauci" (Ciwo Mafi Girma zuwa Jarrabawar Jiki) A cikin sa'o'i 1 zuwa 6 na farko bayan gudan jini ya toshe babban jijiya na mesenteric, majiyyaci yana yin baƙin ciki da nishi a cikin 10/10 na ciki na tsakiya, duk da haka lokacin da kai ko likitan kwantar da hankali a hankali ya danna cikin ciki, ** mai gadi yana jin dadi gaba daya ba tare da jin dadi ba. tausayi**. Kada ku taɓa ɗauka cewa ciwon "Gas ne kawai, rashin narkewar abinci, ko ƙwayar cuta ta ciki" saboda cikin yana jin laushi; Lokacin da ciki ya yi tauri da tauri, hanjin ya riga ya mutu ya huda.
3. Kada majiyyaci nisantar baki da baki (NPO: ruwan sifiri, abinci sifiri, sifiri antacids, sifiri mai zafi). Na farko, narkar da abinci ko ruwa yana tilasta wa hanjin da ke fama da yunwar iskar oxygen yin aiki tuƙuru da buƙatar ƙarin iskar oxygen, yana haɓaka mutuwar mucosal. Na biyu, majiyyaci na buƙatar gaggawa gaggawa ** CT Angiography (CTA) tare da catheter thrombectomy ko laparotomy-ɗakin aiki a ƙarƙashin maganin sa barci na gabaɗaya.
4. ** Sanya mara lafiya a kwance ko a wurin hutawa mai daɗi (ƙuƙuwa kaɗan) a sa su ɗumi.** Rashin hawan jini da sanyi mai sanyi yana ƙara shaƙewar jini ta hanyar celiac da ƙananan arteries na mesenteric.
5. ** Bayar da rahoton duk wani tarihin Atrial Fibrillation (musamman abubuwan da aka rasa na jini), bugun zuciya na baya-bayan nan, ko "tsoron abinci" (jin zafi na yau da kullun) ga likitocin gaggawa nan da nan. warfarin. Faɗa wa ma'aikatan jinya ainihin suna da lokacin ƙayyadaddun kashi na ƙarshe na duk magungunan zuciya da na jini.
6. Kada a yi amfani da kumfa mai zafi a cikin ciki ko kuma ba da maganin laxative ko enemas. Zafin waje yana ɗaga buƙatun iskar oxygen na bangon gut ɗin ischemic, yayin da laxatives ko enemas ke ta da peristalsis da ƙarfi kuma yana iya ratsa ƙwayar ischemic colon ko ƙananan hanji.

Bishiyar yanke shawara: ba zato ba tsammani mai tsanani ciwon ciki da m mesenteric ischemia triage¶

flowchart TD
    Start["Ciwon Ciki Mai Tsanani Mai Tsanani/Cikin Wuta a Majiyyaci Tare da Fibrillation, Ciwon Zuciya na Kwanan nan, Rashin Zuciya, PAD, ko Ciwon Ciki"] --> ClassicTriad{"Mataki na 1: Bincika Triad Embolic Classic: Ƙaunar 10/10 zafi Fiye da GIDA zuwa jarrabawar ciki mai laushi, zubar da ciki mai karfi (Amai / zawo), ko sananne AFib / kafin abinci tsoro?"}

    ClassicTriad -->|"YES don Raɗaɗin Ƙarfafawa ko Ƙaddamarwa"| Emergency["WANDA AKE TSOKACI MESENTERIC ISCHEMIA (WINDOW NA TSIRA HOUR): Kira Sabis na Gaggawa (911/112/999) Nan take."]

    ClassicTriad -->|"Tuni yana da ƙaƙƙarfan ciki kamar ciki, duhun stool mai jini, ruɗe, saurin numfashi, ko ƙarancin hawan jini"| Infarction["RASHIN CIWON HANJI DA MAGANGANCI: Rikicin Tiyata Mai Barazana Rayuwa; Kira 911 Nan da nan"]

    Emergency --> Prehospital["1. Taimakon Farko na Asibiti: Ƙuntataccen NPO (babu ruwa, abinci, antacids, ko magunguna na baka), kwanta a cikin kwanciyar hankali, dumi, kuma bayar da rahoton AFib ko raguwar jini"]
    Infarction --> Prehospital

    Prehospital --> HospitalCTA["2. Binciken Asibiti na gaggawa & Bundle Resuscitation: STAT Biphasic CT Angiography (CTA) na Abdomen / Pelvis ba tare da jiran lactate, IV crystalloids, IV Heparin drip, da Broad-spectrum IV maganin rigakafi"]

    HospitalCTA --> Revasc["3. Hybrid OR Endovascular & Surgical Bowel Ceto: Endovascular Aspiration Thrombectomy / Stenting or Surgical Embolectomy, resectly necrotic bowel, and Planned Second-Look Laparotomy in 24 to 48 hours"]

Anatomy da pathophysiology: dalilin da yasa Babban Maganin Jijiya (SMA) shine "bulseye" don bugun zuciya¶

Kututturan arterial guda uku da ba a haɗa su da juna ba, reshe a gaban gaban aorta na ciki don samar da gabaɗayan sashin gastrointestinal na ɗan adam:

1. Tsarin Celiac: Yana ba da ciki, hanta, gallbladder, saifa, pancreas, da duodenum na sama (embryonic ** foregut**).
2. Mafi Girman Jijiya (SMA): Yana ba da ** gaba ɗaya ƙananan hanji ** (ƙananan duodenum, jejunum, da ileum) tare da ** gaba ɗaya rabin dama na babban hanji ** (cecum, hawan hawan hanji, da kashi biyu bisa uku na madaidaicin hanji, ciki midgut).
3. The Inferior Mesenteric Artery (IMA): Supplies the descending colon, sigmoid colon, and upper rectum (the embryonic hindgut).

Me yasa kashi 85 cikin 100 na ɗigon jini na visceral na jijiyoyi ke kwana a cikin Babban Jijiya na Mesenteric¶

Lokacin da gudan jini ya karye daga zuciya (misali, daga gefen hagu na hagu a lokacin fibrillation ko kashe bangon ventricular na hagu bayan ciwon zuciya na baya) kuma ya harba aorta na ciki, kusan koyaushe yana tashi kai tsaye zuwa ** Superior Mesenteric artery (SMA)** maimakon gandun daji na celiac ko ƙananan ƙwayoyin cuta. Me yasa? - Gangar jikin Celiac daga cikin aorta a wani kaifi, kusan ** 90-digiri perpendicular kwana **, kuma ƙananan jijiyar mesenteric yana kunkuntar a cikin caliber. - Sabanin haka, Superior Mesenteric Artery yana da faffadan baki da reshe a gaban gaban aorta a wani yanayi mai laushi, mai gangara zuwa kasa ** 45-digiri madaidaicin kusurwa ***, kusan daidai da babban rafi na aortic. Jinin jini da ke raunata aorta yana bin hanyar mafi ƙarancin juriya kai tsaye zuwa gangaren digiri 45 zuwa cikin SMA, yawanci masauki ** 3 zuwa santimita 8 da suka wuce asalin *** bayan cirewar jijiya colic na tsakiya.

Me yasa ciki ke jin laushi yayin da majiyyaci ke kururuwa cikin azaba (Visceral vs. Somatic Pain)¶

Fahimtar samar da jijiya mai nau'i biyu na ciki yana bayyana mahimmin mahimmancin asibiti guda ɗaya a cikin maganin gaggawa, "ciwo daga gwargwadon gwajin jiki":

1. Sa'o'i 0 zuwa 6 (Mucosal Ischemia da Visceral Nerve Agony - MATAKIN CIKI MAI LAUKI):
2. Rufin ciki na hanji ( ** mucosa da submucosa **, wanda miliyoyin villi na microscopic sinadari mai shayarwa) ke cinye ** 70 bisa dari na jimlar jini ** na bangon hanji kuma shine mafi yawan nama mai aiki a cikin ciki.
3. A cikin ** 15 zuwa 30 minutes *** na SMA blockage, mucosal villi fara shaƙa da kuma sughing kashe, yayin da santsi na tsoka Layer na gut bango shiga cikin tashin hankali, tetanic ** ischemic spasm ** (wanda ya sa mai haƙuri ya yi amai da zawo don zubar da ciki).
4. Wannan spasm na ischemic yana ƙone sigina masu zafi ta hanyar ** autonomic visceral C-fibers ** tafiya tare da jijiyoyi na mesenteric zuwa kashin baya.T8-T11), haifar da matsananciyar zafi, rashin gurɓataccen wuri, zurfin ciki mai zurfi.
5. Duk da haka, saman hanjin (serosa) na waje yana raye, don haka ba ya kunna bangon bangon ciki na waje (** the parietal peritoneum**). Don haka idan likita ko ma’aikacin jinya ya danna wajen cikin mara lafiya, tsokar bangon ciki ba ta karewa ko kau da kai ko kadan: Majinyacin yana cikin azabar 10/10, duk da haka cikin yana jin taushi sosai.
6. Sa'o'i 6 zuwa 12+ (Transmural Necrosis da Somatic Peritonitis - MAZAN CIKI):
7. Bayan sa'o'i 6 zuwa 12 na zubar jini na sifili, mutuwar kwayar halitta tana konewa ta hanyar bangon tsoka zuwa waje ** serosal surface ** na hanji (** infarction transmural / gangrene**).
8. Bacteria, endotoxin, da necrotic fluid suna zubowa ta mataccen bangon hanji sannan su taba parietal peritoneum mai rufin cikin bangon ciki, wanda aka yi masa waya da kaifi somatic nerves.
9. Sai kawai cikin ya juya ** katako mai ƙarfi, mai ƙarfi, da daɗi mai daɗi ga ɗan taɓawa ko kumbura na shimfidar wuri (maimaita taushi da peritonitis)**, tare da ƙamshi mai duhu mai duhu mai ƙamshi ("currant-jelly" stool), girgiza septic, da gazawar gabbai da yawa.

Daban-daban nau'ikan asibiti guda 4 na m mesenteric ischemia¶

Dangane da **WSES da jagororin ESVS ***, m mesenteric ischemia yana faruwa ne ta hanyoyi daban-daban guda huɗu, kowannensu yana da nasa bayanan haƙuri, saurin farawa, da magani na asibiti:

Bambance-bambancen m mesenteric ischemia daga ischemic colitis da sauran rikice-rikice na ciki¶

Akwai nau'ikan ischemia daban-daban guda biyu, kuma rikitar da su yana haifar da jinkiri mai haɗari: Mraunin Mesenteric Ischemia (AMI) yana shafar kananan hanji (SMA) kuma yana saurin mutuwa ba tare da sake dawo da hanzarin gaggawa ba, yayin da ** Ischemic Colitis** yana shafar wuraren wuraren ruwa na babban hanji (magudanar ruwa) ba tare da kulawa da kulawa ba.

Me yasa matakin lactate na jini na al'ada baya kawar da m ischemia mesenteric¶

Ɗaya daga cikin tatsuniyoyi mafi muni a cikin ɗakunan gaggawa yana jiran hawan jini ** matakin lactate na jini (lactic acidosis)** kafin yin odar CT angiogram don zargin ischemia na mesenteric.

Matsakaicin gwajin gwajin asibiti na asibiti da aikin tiyata / endovascular ceto¶

Lokacin da kuka isa sashin gaggawa kuma ku faɗakar da ƙungiyar game da mummunan ischemia na mesenteric, kowane minti yana ƙidaya zuwa taga ceton hanji na awa 6 **:

1. Nan take Biphasic Computed Tomography Angiography (CTA)¶

Hasken X-ray na ciki da daidaitattun duban gani na ciki ba za su iya kawar da ischemia na mesenteric ba (a lokacin da X-ray ya nuna kumfa gas a cikin bangon hanji, wanda ake kira ** pneumatosis intestinalis **, ko gas a cikin portal vein, hanji ya riga ya mutu). - Gwajin tilas guda ɗaya shine STAT Biphasic (Arterial + Portal Venous Phase) Multidetector CT Angiogram (CTA) na Ciki da ƙashin ƙugu tare da bambanci na cikin jini (da ** BABU bambanci na baka **, wanda ke jinkirta binciken da awa ɗaya kuma yana ɓoye tasoshin jini). - **Ko da majiyyaci yana da haɓakar creatinine ko cututtukan koda na yau da kullun, jagororin sun ba da umarnin ba da bambanci na IV nan da nan **, saboda rashin ischemia mai saurin gaske yana kusan mutuwa a duk duniya, yayin da ana iya sarrafa nephropathy tare da hydration na IV.

2. Bundle Resuscitation Medical¶

Kafin majiyyaci ya mirgina cikin ɗakin aiki ko ɗakin shiga tsakani, ƙungiyar gaggawa ta fara magunguna guda huɗu: 1. Rikin Jiki na Crystalloid Mai Mutuwa: Ruwan Isotonic (Ringer's lactate ko Saline na al'ada) don dawo da ƙarar jini na jini wanda ya ɓace cikin bangon hanji mai kumbura. 2. ** Heparin Bolus da Ba a Karɓar Jiki nan take:** Yana hana gudan jini a cikin SMA ko SMV daga yadawa zuwa ƙananan rassan arcade. 3. Maganin rigakafi na Ciki mai Faɗaɗi: Saboda mucosal villi ya fara mutuwa a cikin mintuna 30, ƙwayoyin cuta na gut (* E. coli , Klebsiella, Bacteroides) nan da nan suna jujjuya shingen gut ɗin da ya lalace zuwa cikin jini; Jagororin sun ba da umarnin maganin rigakafi na IV nan da nan wanda ke rufe Gram-negative bacilli da anaerobes (misali, ** ceftriaxone ko cefepime + metronidazole, ko ** piperacillin-tazobactam). 4. ** Gujewa Alpha-Adrenergic Vasoconstrictors:* Idan hawan jini ya ragu bayan ruwa, likitoci sunyi ƙoƙari su guje wa norepinephrine mai girma ko vasopressin (wanda ke danne ginshiƙan arteries) kuma sun fi son inotropes kamar dobutamine ko ƙananan ƙwayar vasopressor goyon bayan da zarar ƙarar ya cika.

3. Revascularization, Lalacewar-Control Resection, da "Laparotomy-Look Na Biyu"¶

A cikin dakin aiki na zamani Hybrid Operating Room, likitocin jijiyoyin jini da na gaba ɗaya suna aiki kafada da kafada: 1. Mayar da kwararar jini NA FARKO: Duk lokacin da kowane hanji zai iya samun ceto, ana dawo da kwararar jini ta farko ta hanyar ** endovascular catheter aspiration thrombectomy, injin thrombectomy, ko SMA stenting**, ko ta hanyar budewa Fogarty balloon embolectomy / aorto-mesenteric bypass. Yawancin madaukai na dusky, bluish-purple hanji suna juya launin ruwan hoda mai haske kuma su fara yin kwangila a cikin mintuna 15 na dawo da bugun jini. 2. Yanke hanjin gaskia wanda ya mutu (baki/baki/baki) BA TARE da an dinke karshen tare ba tukuna (Lalacewar-Tsarin tiyata): Duk wani yanki na hanji wanda ya riga ya zama baki, siririn takarda, ko mai tokali, ana yin tiyata a cire shi. 3. Wajibi na 24-zuwa-48-hour "Laparotomy na biyu-Look": Domin sau da yawa ba zai yiwu ba a lokacin aikin farko don gaya ko madaukai-dusky na ƙananan hanji za su warke bayan da jini ya dawo ko ci gaba zuwa necrosis, likitocin da gangan sun bar hanji ya ƙare a cikin ciki a karkashin wani abu na wucin gadi na ABCUta (bude ciki) a cikin majiyyaci na wucin gadi. 24 zuwa 48 hours, sannan a dawo da majiyyaci dakin tiyata domin Laparotomy na biyu don duba kowane centimita na sauran hanjin kafin dinka lafiyayyen hanjin ya kare tare. Wannan dabarar tana adana santimita masu mahimmanci na ƙananan hanji kuma tana hana tsawon rayuwa ** Short Ciwon hanji**.

Lissafin rigakafi: gane "Angina na hanji" da kuma kariya daga ƙumburi na AFib¶

• Kada ka yi watsi da "Intestinal Angina" (Chronic Mesenteric Ischemia): Idan wani dattijo mai tarihin shan taba, cututtukan jijiya, ko cututtukan zuciya ya haifar da ciwon ciki mai cike da damuwa ** 15 zuwa 60 mintuna bayan cin abinci ** (tsawon sa'o'i 1 zuwa 2 har sai narkewar abinci ya ƙare), ya fara cin abinci kaɗan. yana rasa nauyi ba da gangan ba, nemi buƙatar gaggawar aikin tiyata na jijiyoyin jini don duban dan tayi na mesenteric ko CTA. Ƙirƙirar asalin SMA mai kunkuntar da zaɓi yana hana mummunan rauni na thrombotic.
• Kiyaye tsananin riko da magungunan da aka tsara na jini a cikin Atrial Fibrillation: Kar a taɓa tsayawa ko dakatar da apixaban, rivaroxaban, edoxaban, dabigatran, ko warfarin ba tare da ƙayyadadden jagorar likita ba.
• Ku kasance da ruwa sosai a lokacin zafin zafi ko ciwon ciki idan kuna da cututtukan jijiyoyin jini mai tsanani ko tarihin zubar jini na venous.

Bayanin da za a tattara don ƙungiyar jijiyoyin jini da na asibiti¶

Yayin jiran motar asibiti, shirya mahimman mahimman bayanai guda huɗu na tarihin likita yana adana mintuna masu mahimmanci a cikin sashin gaggawa:

1. Ainihin lokacin da ciwon ciki ya fara: Kamar yadda ake kula da bugun jini ko bugun zuciya, likitocin jijiyoyi suna amfani da daidai sa'ar alamar farawa don auna yadda hanjin ya kusa kusa da madaidaicin necrosis na sa'o'i 6.
2. ** Cikakkun lissafin bugun zuciya da cututtukan jijiyoyin jini:** Rubuta ko majiyyaci yana da paroxysmal ko na dindindin na atrial fibrillation, bawul ɗin zuciya na prosthetic, ciwon zuciya na baya-bayan nan, bugun jini na gefe, ko duk wani tarihin thrombosis mai zurfi ko embolism na huhu.
3. ** Canje-canjen magunguna na baya-bayan nan ko allurai da aka rasa:** Kawo duk kwalabe na magani, ba da kulawa ta musamman ga duk wani mai sisin jini da aka gudanar kwanan nan don ziyarar haƙori, colonoscopy, ko tiyata, ko duk wani sabon diuretic (kwayar ruwa) ko digoxin.
4. Bayan aikin koda ko bambancin tarihin rashin lafiyar: Bayar da likitan gaggawa ya san aikin koda na majiyyaci yana taimaka musu su shirya hydration na ciki bayan-scan yayin da suke ci gaba da sauri tare da biphasic CT angiogram mai ceton rai.

Lambobin gaggawa na yanki da ka'idojin hukumar¶

M ischemia mai tsanani yana buƙatar jigilar motar asibiti nan da nan zuwa babban asibiti tare da ** 24-hour CT Angiography, Vascular Surgery, Interventional Radiology, da Janar/Trauma Surgery ***:

• Amurka da Kanada: Dial 911. Nemi jigilar zuwa cibiyar kiwon lafiya ta manyan makarantu ko asibitin matakin ½ (kada ku taɓa zuwa asibitin kulawa da gaggawa don tsananin ciwon ciki kwatsam).
• United Kingdom: Kiran gaggawa 999 don gaggawar motar daukar marasa lafiya ko kuma kai tsaye zuwa babban asibitin gaggawa ** Sashen Gaggawa (A&E)** tare da Cibiyar Jijiyoyin Jijiyoyin Jijiyoyi da Babban Tiyatar Gaggawa.
• ** Tarayyar Turai:** Kiran Kira 112. Managed under the European Society for Vascular Surgery (ESVS) Clinical Practice Guidelines on the Management of Diseases of the Mesenteric Arteries and Veins and WSES Guidelines.
• ** Ostiraliya da New Zealand:** Kiran kira 000 a Ostiraliya ko 111 a New Zealand.
• Indiya da Asiya-Pacific:* Dial 112 (ko 108 a Indiya),995* a Singapore,119* a Japan da Koriya ta Kudu, ko kuma 999 a Malaysia da Hong Kong. Ci gaba kai tsaye zuwa babban asibiti tare da angiography na MDCT na awa 24 da tiyatar jijiyoyin jini/GI.

Tambayoyin da ake yawan yi¶

Menene ma'anar "ciwo daidai gwargwado" a cikin matsanancin ischemia mai tsanani?¶

A mafi yawan lokuta na gaggawa na ciki (kamar appendicitis ko gyambon ciki), murfin waje na rami na ciki (parietal peritoneum) yana ƙonewa nan da nan, don haka danna cikin mara lafiya yana haifar da ciwo mai tsanani da kuma taurin tsoka (tsaro). A cikin matsanancin ischemia na mesenteric, gudan jini yana fara jin yunwa ga rufin hanji a farkon yayin da saman waje ya kasance a cikin sa'o'i 4 zuwa 6 na farko. Wannan yana haifar da ciwo mai zurfi 10/10 na visceral mai zurfi wanda ke sa majiyyaci ya yi fushi cikin ɓacin rai, duk da haka lokacin da likita ya danna waje na ciki, ciki yana jin taushi da annashuwa. Gane wannan rashin daidaituwa a cikin sa'o'i 6 na farko shine abin da ke ceton rayuwar majiyyaci.

Me yasa mutanen da ke da fibrillation na atrial suke cikin irin wannan babban haɗari ga kwatsam jini na gut?¶

A cikin fibrillation (AFIb), ɗakunan na sama na zuciya suna yin rawar jiki ba bisa ka'ida ba maimakon matsewa da kyau, ba da damar jini mara nauyi ya taru ya toshe cikin ƙaramin jaka da ake kira appendage na hagu. Idan majiyyaci ya rasa allurai na bakin jini (ko kuma yana da AFib wanda ba a gano shi ba), wani yanki na wannan gudan jini zai iya karyewa, fitar da zuciya daga cikin aorta, kuma ya zamewa kai tsaye zuwa kusurwar digiri 45 na babban jijiya na mesenteric, yana yanke jini zuwa dukan ƙananan hanji a cikin bugun zuciya ɗaya.

Menene "tsoron abinci" (sitophobia) ko "angina na hanji," kuma me yasa alamar gargadi?¶

Kamar yadda kunkuntar arteries na zuciya ke haifar da ciwon kirji (angina) a lokacin motsa jiki lokacin da tsokar zuciya ke buƙatar ƙarin jini, ƙwayoyin hanji masu rage cholesterol suna haifar da ciwon ciki na tsakiya 15 zuwa 60 mintuna bayan cin abinci, lokacin da hanji ya buƙaci ƙarin jini don narkar da abinci. A cikin makonni ko watanni, marasa lafiya sun koyi cewa cin abinci yana haifar da ciwo, don haka suna jin tsoron ci (sitophobia) kuma sun rasa 10 zuwa 30 fam ba da gangan ba. Kimanin kashi 70 cikin dari na marasa lafiya da ke fama da mummunar cutar tabarbarewar jijiyoyin jini suna da waɗannan alamun gargaɗin tun da farko; kamawa da stenting ɗigon jijiya da wuri yana hana ciwon hanji.

Shin gwajin lactic acid na jini na al'ada (lactate) zai iya kawar da katange jijiyar hanji?¶

A'a, taba. A cikin sa'o'i 2 zuwa 6 na farko na ischemia mai tsanani na mesenteric, lactic acid wanda hanjin mai yunwar iskar oxygen ke samarwa ko dai ya makale a cikin jijiyar hanjin da ba ta da kyau ko kuma hanta ta tace gaba daya kafin ya kai ga veins a hannu inda aka ja jini. A lokacin da matakin lactate na jini ya hau sama, bangon hanji ya riga ya sami gangrene wanda ba zai iya jurewa ba. Likitoci dole ne su ba da umarnin angiogram na CT bambanci nan da nan dangane da zato na asibiti ba tare da jiran lactate ya tashi ba.

Me yasa likitocin fiɗa suke yin "Laparotomy-Look Laparotomy" awanni 24 zuwa 48 bayan tiyatar daskarewar hanji?¶

Lokacin da likitocin fiɗa suka dawo da kwararar jini zuwa hanjin ischemic kuma suna cire duk wani ɓangaren da ke bayyana baƙar fata kuma ya mutu, tsayin daka na sauran ƙananan hanjin yakan yi duhu da kururuwa, yana sa ba za a iya sanin tabbas a cikin sa'a na farko ko waɗannan madaukai za su warke ko kuma su mutu. Idan likitocin tiyata sun yanke duk hanjin kan iyaka nan da nan, ana iya barin majiyyaci da Short Bowel Syndrome (ba zai iya sha abinci ba). Madadin haka, likitocin tiyata suna barin ciki na ɗan lokaci suna yin ado, suna tallafa wa mara lafiya a cikin ICU na tsawon sa'o'i 24 zuwa 48 don barin hanjin da ya sake dawowa ya warke, sa'an nan kuma sake duba hanjin a cikin dakin tiyata kafin sake haɗa ƙarshen lafiyayyen.

Menene bambanci tsakanin m mesenteric ischemia da ischemic colitis?¶

M ischemia mesenteric shine toshewar babban jijiya mai barazanar rai (mafi girman jijiya) wanda ke ba da duka ƙananan hanji da hanji na dama; yana haifar da ciwon tsakiya na 10/10 kuma yana kashe kashi 60 zuwa 80 na marasa lafiya sai dai idan an dawo da jini ta hanyar tiyata a cikin sa'o'i. Ischemic colitis wani abu ne da ya fi kowa yawa, yawanci raguwa na wucin gadi a cikin jini na microvascular zuwa "ruwa" na lanƙwasa na babban hanji na hagu (colon), yana haifar da ciwon ciki mai matsakaicin gefen hagu wanda ya biyo baya a cikin sa'o'i 24 ta hanyar maroon ko jini mai haske a cikin stool; sama da kashi 80 cikin 100 na cututtukan ischemic colitis suna warkewa cikin ƴan kwanaki tare da ruwan jijiya da hutun hanji.

Tushen da jagorar hukuma¶

• World Society of Emergency Surgery (WSES, International): Acute Mesenteric Ischemia: Updated Guidelines of the World Society of Emergency Surgery (Bala et al., World Journal of Emergency Surgery, 2022/2023 update: immediate CTA without waiting for lactate, anticoagulation, broad-spectrum antibiotics, endovascular-first revascularization, and damage-control duban laparotomy na biyu).
• European Society for Vascular Surgery (ESVS, Europe): Editor's Choice - Management of the Diseases of Mesenteric Arteries and Veins: Clinical Practice Guidelines of the European Society for Vascular Surgery (Björck et al., European Journal of Vascular and Endovascular Surgery).
• ** Kwalejin Gastroenterology na Amirka (ACG) & Ƙungiyar Gastroenterological ta Amirka (AGA, Amurka): ** * ACG Jagoran Clinical: Epidemiology, Risk Factors, Tsarin Gabatarwa, Bincike, da Gudanar da Colon Ischemia da M Ischemia mai tsanani *.
• Al'umma don Tiyatar Jijiyoyin Jiji (SVS, Amurka): Sharuɗɗa na Ayyukan Asibiti don Ciwon Jiki na Tsawon Jiki da Ciwon Jiki.
• ** Cibiyar Kula da Lafiya ta Kasa (NICE) & Royal College of Surgeons of England (United Kingdom):** *Babban Tiyata na Gaggawa da Babban Hatsarin Ciwon Ciki Mai Girma.

Jagora masu alaƙa¶

• Kwatsam sanyi mara motsin hannu da matsananciyar rufewar jijiya
• Toshewar hanji, ƙwanƙwasawa, da alamun gaggawa
• Ragewar aortic da ruptured aortic aneurysm na ciki
• Appendicitis, ruptured appendix, peritonitis, da kuma m ciwon ciki
• Zubar da jini na hanji, amai jini, da melena