Raunin Rashin Hanta (Hepatic Encephalopathy) da Jini na Variceal¶

Marasa lafiya da ke zaune tare da cututtukan hanta na yau da kullun, cirrhosis, ko gazawar hanta mai tsanani suna fuskantar bala'i guda uku masu barazanar rayuwa waɗanda zasu iya fashewa ba tare da faɗakarwa ba a gida: ** ruptured gastroesophageal varices ** (m babba gastrointestinal hemorrhage inda engorged veins a cikin ƙananan esophagus fashe bude), ** hepatic enfusion neuropsychic rawar jiki, da kuma coma wanda ammonia da gut neurotoxins ke haifar da hanta mai tabo da kumburin kwakwalwa), da ** bacterial peritonitis (SBP)** (mai saurin kamuwa da kamuwa da cutar kwayan cuta daga cikin ruwa mai kumbura).

Ayyukanku na gaggawa lokacin kula da majinyacin hanta a cikin rikici shine kiran sabis na gaggawa na gaggawa nan da nan, kare hanyar iska ta hanyar mirgina mai amai ko mara lafiya mai barci a gefen su a cikin ** matsayin farfadowa ** (kamar yadda nutsewa a cikin jinin da aka sha shi ne babban dalilin mutuwar kwatsam a cikin fashewar variceal), tilasta NPO mai tsanani (babu wani abu da baki) idan zubar jini mai aiki ko mai tsanani ya nuna rashin jin dadi " (asterixis)** don gano ciwon hanta na farko, kuma a guji ba da magungunan barci, magungunan kwantar da hankali, ibuprofen/NSAIDs, ko wuce haddi na acetaminophen.

Yi wannan yanzu¶

1. Kira ma'aikatan kiwon lafiya na gaggawa nan da nan: Kira lambar gaggawa ta gida (911 a Amurka da Kanada, 112 a cikin Tarayyar Turai, 999 a Burtaniya, 000 a Ostiraliya) ko duba kundin adireshi na mu lambobin gaggawa. Faɗa a fili cewa majiyyaci yana da ciwo ko ciwon hanta kuma ko dai yana amai da jini, yana wucewa baƙar fata stools, yana yin dimuwa/rashin tashin hankali, ko kuma yana fama da zazzaɓi tare da ciwon ciki.
2. Idan amai jini ko barci, sanya a gefen-kwance wurin warkewa nan take: Kada majinyacin da ke amai da jini ko barci daga ciwon hanta ya kwanta a bayansa. Mirgine su a gefen hagunsu ** tare da karkatar da haɓinsu kaɗan zuwa ƙasa don haka jini yana gudana, duhu "ƙasa kofi", amai "ƙasa-kofi", ko ɗigon ruwa yana fita kai tsaye daga baki maimakon shaƙe huhu.
3. Kaddamar da NPO mai tsauri (babu komai da baki) yayin zubar jini ko matsanancin bacci: Kada a ba da ruwa, madara, abinci, ko magungunan baka idan majiyyaci yana amai da jini, yana wucewa ta stool baƙar fata, ko kuma ya yi barci sosai don ya tashi zaune yana tattaunawa sosai. Likitocin gastroenterologists na asibiti za su buƙaci babu komai a ciki don yin gaggawar endoscopic variceal band ligation cikin sa'o'i na isowa.
4. Duba don "flapping hand tremor" (asterixis) idan majiyyacin ya gamu da rude ko kuma ya fusata: Tambayi mara lafiyan da ya farka ya miqe hannuwansa biyu a gabansu, su karkata wuyan hannu a baya ("kamar jami'in zirga-zirga da ke dakatar da zirga-zirga"), sa'annan su yada yatsunsu a waje na 15 zuwa 30 seconds. Idan hannayensu da wuyan hannu ba da gangan ba suna jujjuya gaba kuma suna jujjuyawa a cikin motsi mai motsi kamar fuka-fukin tsuntsu, suna cikin ** m hepatic encephalopathy**.
5. Kada a taba ba da maganin barci, abubuwan kwantar da hankali, opioids, ko magungunan kashe jijiyoyi na NSAID: Kada a taɓa ba da benzodiazepines maras natsuwa, rashin barci, ko tashin hankali hanta benzodiazepines (lorazepam, alprazolam, diazepam), kayan bacci (zolpidem, diphenhydramine), opioids painkillers, ko ibuprofen NSAIDs. Magungunan kwantar da hankali suna nutsar da majiyyaci mai ciwon hanta kai tsaye zuwa cikin suma mara kyau, yayin da NSAIDs ke haifar da zubar da jini mai saurin mutuwa da kuma rufewar koda nan da nan (** ciwon hanta**).
6. Ki sa majiyyaci dumi sannan a tattaro dukkan magungunan hanta: Rufe mara lafiya da busassun barguna masu dumi don hana ciwon kai (wanda ke kara gurguntar da jini a cikin cirrhosis), sannan a tattara kwalaben su na lactulose, rifaximin, beta-blockers (propranolol, nadolol, carvedilol), da (Furomediromiol).

flowchart TD
    Start["Marasa lafiya Tare da Ciwon Hanta ko Ciwon Hanta Yana Tabarbarewa a Gida"] --> Triage{"1. Gano Gaggawar Rage Rarraba"}
    Triage -->|Vomiting Bright Red Blood, Clots, Coffee Grounds, or Passing Black Tarry Stools| Varices["Ruptured Esophageal Varices: Kira 911/112/999 Nan da nan, Ciwon Haihuwar Mutuwa"]
    Triage -->|New Confusion, Reversed Sleep-Wake Cycle, Irritability, Slurred Speech, or Flapping Hands| HE["Ciwon Hanta na Hanta: Kira 911/112/999 ko Likitan Hanta, Bincika Ƙoyayyun Ƙaruwa (Jini, Kamuwa, Ƙunƙarar Maƙarƙashiya)"]
    Triage -->|Swollen Ascites Belly With New Fever, Chills, Belly Tenderness, or Low Blood Pressure| SBP["Kwatsam Peritonitis Bacterial (SBP) / Sepsis: Kira 911/112/999 Nan da nan don maganin rigakafi na IV"]
    Varices --> Airway["2. Mirgine Mara lafiya A Gefe (Matsayin Farfadowa) Nan da nan don haka Jini Ya Fito Daga Baki, Kada Ka Taɓa Bar Baki A Baya."]
    Airway --> NPO["3. Kiyaye Tsantsan NPO (Babu Komai ta Baki), Yi Dumi tare da Bargo, Shirya don Endoscopy na Gaggawa"]
    HE --> CheckAwake{"4. Shin marar lafiyan da ya ruɗe ya farka kuma yana iya hadiye lami lafiya?"}
    CheckAwake -->|No: Drowsy, Stuporous, or Slurring| Airway
    CheckAwake -->|Yes: Alert Grade 1 or 2 Encephalopathy| Lactulose["Bi Shirin Lactulose na Rana na Likita idan An umarce shi, Kada a Ba da Magungunan Magunguna ko Magungunan Barci, jigilar zuwa Asibiti"]
    SBP --> NPO

Ruptured gastroesophageal varices: dalilin da ya sa cirrhosis yana haifar da zubar da jini¶

A cikin lafiyayyan jiki, duk wani jinin da ke fitowa daga ciki, hanji, pancreas, da kuma sai ya bi ta wata katuwar babban jirgin ruwa mai suna ** portal vein** zuwa cikin hanta mai laushi, spongy don a tace kafin a dawo cikin zuciya. Lokacin da cututtukan hanta na yau da kullun (daga barasa, hepatitis B ko C, tabarbarewar rayuwa mai alaƙa da steatohepatitis / MASH, ko cututtukan autoimmune) ya maye gurbin hanta mai laushi tare da wuya, ƙwayar fibrous tabo (**cirrhosis ***), jini ba zai iya gudana cikin sauƙi ta cikin hanta ba.

Matsi a cikin jijiyar portal yana dawowa kamar motoci a bayan hanyar da aka toshe, yanayin da ake kira ** hauhawar jini na portal **. Cikin matsananciyar neman hanyar komawa cikin zuciya, karfin jini na portal da aka matse ya bude kanana, rarrauna, jijiyoyi masu sirara da suka lullube gindin *esophagus (bututun hadiye) da saman ciki. A tsawon watanni, waɗannan ƙaƙƙarfan balloon jijiyoyi zuwa murɗaɗɗen igiyoyi masu ƙarfi da ake kira ** esophageal da varices na ciki ***.

Dalilai biyu na zub da jini na varice ya fi kisa fiye da jinin ciki na yau da kullun¶

1. Matsi na venous na portal: Ba kamar ƙaramin ciwon peptic ulcer ba, varix na esophageal yana ƙarƙashin matsin lamba mai ƙarfi na hydrostatic; idan siririn bangon sa ya tsage, sai jini ya shiga cikin hajiyar haji da ciki a daidai lokacin da ya kai mil 100 zuwa 500 a minti daya**.
2. Coagulopathy da thrombocytopenia na gazawar hanta: Hanta mai lafiya tana ƙera sunadaran da ke zubar da jini a jiki (prothrombin, fibrinogen, Factors V, VII, IX, X) yayin da ya kara girma a cikin tarkon hawan jini na portal kuma yana lalata jini ** platelets **. Saboda haka, lokacin da varix ya fashe a cikin majiyyaci na cirrhotic, jinin ya rasa duka biyun platelets da abubuwan da ke damun jini da ake buƙata don toshe ramin da kansa.

Alamomin gargadi na ruptured varices (Ko kafin jini ya yi amai)¶

Mara lafiya ba koyaushe yake yin amai ja mai haske nan take ba lokacin da varix ya fara zubowa cikin ciki:

• Hematemesis (jinin amai): Rashin qoqari, amai mai girma na jini mai haske ja mai haske,yankakken jinin jajayen jajayen maroon girman plums, ko duhu mai duhun granular mai kama da ruwan kofi (zubar jini na ciki).
• Melena (Baƙar fata, tari, stool mai ƙamshi): Jinin da ke taruwa a ciki ya ratsa cikin hanji yana narkar da shi da acid ɗin ciki da ƙwayoyin hanji a cikin jet-black, m, stools mai sheki mai kama da kwalta ta hanya kuma tana da ƙamshin ƙarfe mara misaltuwa. Cutar stool baƙar fata a cikin majiyyaci mai ciwon cirrhosis shine zubar jini na sama na GI mai aiki, galibi shine dalilin ruɗarwa kwatsam ko suma koda lokacin da amai babu.
• Hematochezia (Maroon ko jajayen jini mai haske daga duburar):* Idan jinin variceal ya yi saurin wuce gona da iri (sama da milliliters 1,000), jini ya ratsa cikin gaba dayan hanjin cikin sauri har ya fita daga duburar har yanzu yana kama da ja ko maroon, tare da dizziness da kaduwa.
• Rashin suma ba zato ba tsammani ( Syncope) da gumi mai sanyi: Domin jinin da ke cika ciki yana aiki a matsayin mai ƙarfi mai ƙarfi, da yawa marasa lafiya kwatsam sun ji buƙatar gaggawar amfani da bayan gida, shiga banɗaki, kuma sun faɗi a sume a falon banɗaki kafin kowa ya gane cewa zubar jini a ciki.

Taimakon farko na mataki-mataki don zubar jini mai aiki na variceal¶

1. A tara ma'aikatan lafiya nan da nan kuma a buɗe ƙofar gida: Kowane minti yana ƙidaya; Rayuwar asibiti ya dogara da karɓar magungunan vasoactive na ciki (** octreotide ko terlipressin ** don sauke matsa lamba na portal), maganin rigakafi na prophylactic na ciki (** ceftriaxone **), ƙarin ƙarin jini, da ** gaggawar endoscopic variceal band ligation ** a cikin awanni 12.
2. Kare hanyar iska a Matsayin Farfadowa na gefen hagu:
3. Mirgine mara lafiyar a kan ** gefen hagu ** a kasa ko gado.
4. Mayar da fuskar su ƙasa kaɗan a kan kwano ko tawul don haka jini da gudan jini suna zuba kai tsaye daga kunci na ƙasa.
5. Yi amfani da yatsan safofin hannu da aka naɗe a cikin wani zane don share manyan gudan jini kamar jelly daga gaban baki idan suna haƙarƙari. Kada ka sanya majiyyaci mai amai ya kwanta a bayansa, kuma kada ka tada zaune tsaye idan sun yi kasala ko suma, domin zama a tsaye yana haifar da zubar da jini da kuma kwatsam tare da buri.
6. Ki sa majiyyaci dumi da busassun barguna: Ku nannade gangar jikin da kafafu a cikin bargo masu dumi. Hypothermia da ke ƙasa da digiri 36.0 Celsius (digiri 96.8 Fahrenheit) yana kashe ƴan ragowar enzymes clotting da platelets mai haƙuri ya bari.
7. Kada a ba da ruwa, ice chips, antacids, ko maganin hawan jini da baki: Ko da majiyyaci ya roki ruwa ya wanke bakinsa, sai kawai ya goge lebbansa da danshi. Bayar da ruwa yana cika ciki da ruwa wanda ke rufe kyamarar endoscopy na likitan gastroenterologist kuma yana haifar da maimaita amai da buri.

Hepatic encephalopathy (HE): dalilin da yasa gazawar hanta ke haifar da rudani da suma¶

A cikin lafiya, ƙwayoyin cuta da ke zaune a cikin hanji suna rushe furotin na abinci kuma suna samar da kayan sharar nitrogen masu guba, da farko ** ammonia ($ NH_3$)**, tare da mercaptans, acid fatty gajere, da manganese. A al'ada, portal vein jini yana ɗaukar duk wannan ammonia kai tsaye zuwa cikin hanta, inda lafiyayyen ƙwayoyin hanta (hepatocytes) ke canza ammonia mai guba zuwa mara lahani ** urea ** ta hanyar zagayowar urea don haka koda za su iya fitar da shi a cikin fitsari.

A cirrhosis ko m hanta gazawar , abubuwa biyu ba daidai ba: hanta tabo Kwayoyin rasa har zuwa 80 bisa dari na ikon share ammonia, da kuma portal hauhawar jini ya tilasta jini na hanji ya kewaye hanta gaba daya ta hanyar lankwasa shunts (ko wani tiyata sanya ** TIPS stent: transjugular intrahepatic portosystemic shunt). Ba a tace ba ammonia ambaliya kai tsaye zuwa cikin jijiyoyi na tsarin kuma ya ketare shingen jini-kwakwalwa. A cikin kwakwalwa, masu tallafawa ƙwayoyin kwakwalwa da ake kira ** astrocytes ** suna ƙoƙarin lalata ammonia ta hanyar canza glutamate zuwa ** glutamine . Glutamine yana aiki kamar soso osmotic a cikin astrocytes, yana jawo ruwa zuwa cikin ƙwayoyin kwakwalwa kuma yana haifar da ** yaduwa edema na kwakwalwa (ƙwaƙwalwar ƙwaƙwalwa) da kuma hanawa neurochemical mai tsanani ( encephalopathy hepatic**).

Sikelin Grading na West Haven: Gane ciwon hanta daga Grade 1 zuwa Grade 4¶

'Yan uwa da ke zaune tare da mai hanta koyaushe su ne farkon don gano Grade 1 ko Grade 2 hepatic encephalopathy, tun kafin baƙo ya lura da wani abu ba daidai ba. Yi amfani da ƙa'idodin ** West Haven na duniya don waƙa da bayar da rahoton ainihin matakin mara lafiya:

Yadda ake yin gwajin "Asterixis" (Flapping Tremor) a gefen gado¶

Asterixis ba a zahiri girgizar tsokoki ba ce; neurophysiologically, shi ne ** myoclonus mara kyau , ɗan taƙaitaccen, kwatsam 50-to-200-milli daƙiƙa na lantarki ** dakatarwa (kashewa) a cikin cibiyoyi masu motsi waɗanda ke kula da matsayi akan nauyi, wanda guba ammonia ya haifar.

1. Ka sa majiyyaci ya zauna a tsaye a kan gado ko kujera (ko ya kwanta a sama) kuma ya miƙe hannayensa biyu a gaban ƙirjinsu tare da madaidaicin gwiwar hannu.
2. Ka umurce su da ** lanƙwasa wuyan hannu biyu da ƙarfi da baya** (ƙwaƙwalwa, tafin hannu suna fuskantar gaba kamar suna tura bangon da ba a gani) da ** yada yatsunsu a waje.
3. Fada musu su rufe idanuwansu* sannan su rike daidai wannan matsayi na tsawon dakika 30**.
4. Kamar yadda tabbataccen gwajin ya yi kama: Bayan jinkirin daƙiƙa 5 zuwa 15, yatsu da wuyan hannu ba zato ba tsammani su faɗi gaba 'yan santimita kaɗan yayin da sautin tsoka ke ɓacewa na tsawon daƙiƙa guda, sannan nan da nan ya ja da baya sama yayin da majiyyaci ya kama shi, yana maimaitawa a cikin rhythmically kamar tsuntsu yana kada fuka-fukinsa ("harkar hanta").
5. Gwajin madadin marasa lafiya: Idan majiyyaci ya yi rauni sosai don riƙe hannayensa biyu sama a iska, bari hannayensu su kwanta a kan katifa su ɗaga hannuwansu sama a wuyan hannu na tsawon daƙiƙa 20, ko kuma a ce su matse yatsunsu biyu a hankali ("mƙar madara").

Abubuwan da ke ɓoye 6 waɗanda ke haifar da encephalopathy na hanta¶

Hepatic encephalopathy kusan bai taba fitowa daga bakin sirara ba a cikin mara lafiyar cirrhosis na baya; a cikin ** fiye da kashi 80 cikin 100 na masu shiga asibiti ***, wani takamaiman zagi na likita ya haifar da hawan ammonia. Likitocin gaggawa suna bincika nan da nan don waɗannan ** abubuwan hazo shida na yau da kullun ** (kuma masu kulawa yakamata su gaya wa ma'aikatan jinya waɗanda suka faru cikin awanni 72 da suka gabata):

1. Zubar da Jini na Gastrointestinal Silent (Babban "abincin furotin" na jini):** Jini yana cike da furotin na haemoglobin (milili 100 na jini ya ƙunshi kusan gram 15 zuwa 20 na furotin mai tsabta). Lokacin da varix ko ciwon ciki ya zubar da jini a hankali a cikin sashin narkewar abinci, ƙwayoyin cuta na hanji suna cin abinci a kan furotin na jini da aka narkar da su kuma suna mayar da shi zuwa babban igiyar ammonia. Koyaushe duba bayan gida ko tambaya game da black, tarry stools (melena) duk lokacin da mai hanta ya rikice.
2. Kamuwa da cuta (Musamman Kwayoyin Kwayoyin cuta Peritonitis, UTI, ko Pneumonia): Kumburi na tsari da gubobi na ƙwayoyin cuta suna sa shingen jini-kwakwalwa ya zube kuma ya ninka ammonia neurotoxicity sau biyar.
3. Maƙarƙashiya da rashin amfani da allurai na Lactulose: Idan stool yana zaune a cikin hanji na tsawon awanni 24 zuwa 48 maimakon a zubar da shi sau 2 zuwa 3 a kullum, ƙwayoyin cuta na colonic suna samar da ammonia da yawa.
4. Rashin ruwa, Over-Diuresis, Amai, ko gudawa (Electrolyte & Kidney Crisis): Shan maganin da aka rubuta na ruwa mai yawa (furosemide da spironolactone), gumi a cikin zafi, ko ciwon ciki yana haifar da ** matsanancin rauni na koda *, * hypokalemia (ƙananan potassium na jini), da **kalosis. Ƙananan potassium na jini yana motsa koda kai tsaye don samar da karin ammonia, yayin da alkalosis ke canza ions ammonium ($ NH_4 ^ + \(, wanda ba zai iya shiga cikin kwakwalwa ba) zuwa gas ammonia maras caji (\) NH_3 $ , wanda ke ƙetare kai tsaye zuwa cikin kwakwalwa).
5. Magungunan Magance Maganin Jijiya na Tsakiya: Shan ko da kashi ɗaya na benzodiazepine (lorazepam, diazepam, clonazepam), kwayar barci (zolpidem), maganin antihistamine (diphenhydramine, hydroxyzine), ko maganin kashe zafi na opioid (oxycodone, morphine, tramadol).
6. Cutar Portal Vein Thrombosis ko Sabbin TIPS Shunt: Wani sabon gudan jini yana toshe jijiyar portal ko shunt hanta da aka sanya kwanan nan.

Fahimtar Lactulose da Rifaximin (Kuma lokacin da ba a taɓa ba da Lactulose na baka)¶

Marasa lafiya da ke da cirrhosis da kafin hanta encephalopathy ana ba da su akai-akai magungunan kulawa guda biyu don share ammonia daga gut:

• ** Lactulose (ko Lactitol):** Kauri, mai zaki, wanda ba za a iya sha ba. Lokacin da lactulose ya kai ga hanji, ƙwayoyin cuta masu amfani suna tada shi cikin lactic acid da acetic acid. Wannan acidification yana sauke pH a cikin hanji, wanda ke kama tarko mai yaduwa ** ammonia ($ NH_3\()** ta hanyar ƙara ion hydrogen don juya shi zuwa cajin ** ammonium (\) NH_4 ^ + $)**. Saboda cajin ammonium ba zai iya wucewa ta bangon hanji cikin jini ba, ya kasance a cikin tarko a cikin stool kuma ana fitar da shi daga jiki ta hanyar lactulose's osmotic laxative action. Likitoci suna ba da allurai na lactulose na yau da kullun don haka majiyyaci ya wuce ** 2 zuwa 3 motsin hanji mai laushi kowace rana.
• Rifaximin: Kwayoyin cuta na baka da ba sa sha wanda ke tsayawa a cikin hanji sosai kuma yana rage yawan kwayoyin cutar ammonia masu samar da gut.

Muhimmin ƙa'idar aminci yayin mummunan rikicin encephalopathy a gida¶

• ** Idan majiyyaci yana farkon aji na 1 ko matsakaicin aji na 2 HE** (fadi a farke, zaune, tari akai-akai, kuma yana iya shan ruwa ba tare da shaƙa ba) kuma ya rasa lactulose ɗinsu ko yana da maƙarƙashiya, kiran likitan hanta ko aika gaggawar gaggawa na iya haɗawa da ba da maganin lactulose da aka umarce su na ranar rashin lafiya.
• Kada a zuba lactulose na baka (ko duk wani ruwa) a cikin bakin majinyata mai daraja ta 3 (mai ban tsoro) ko na 4 (comatose) maras lafiya: Da zarar majiyyaci ya yi barci, ya yi kasala, ko kuma da wuya ya tashi, sai gag reflex dinsa ya bushe. Zuba ruwan sifar lactulose mai kauri mai kauri a cikin bakinsu yana haifar da burin huhu cikin huhu nan take. Ma'aikatan jinya da ma'aikatan jinya na asibiti suna kula da marasa lafiya na aji 3 da na 4 lafiya ta hanyar amfani da lactulose retention enemas ko kuma ** nasogastric tube** mai kariya bayan sun tsare hanyar iska.

Bacterial Peritonitis (SBP) da gaggawa na gaggawa na ascites¶

Yawancin marasa lafiya da ke fama da cutar cirrhosis suna tara lita na ruwa mai launin bambaro a cikin rami na ciki (ascites), yana haifar da matsatsi, kumbura, ruɗewar ciki. Saboda ruwan ascitic yana da ƙananan matakan kariya na rigakafi (masu cikawa), ƙwayoyin cuta na yau da kullun daga hanjin majiyyaci na iya yin ƙaura ta microscopically ta bangon hanji (** canjin ƙwayar cuta **) kuma suna cutar da ruwan ciki ba tare da wani faɗuwar hanji ba. Wannan cuta mai barazana ga rayuwa ana kiranta Spontaneous Bacterial Peritonitis (SBP) kuma tana ɗaukar adadin mace-macen kashi 20 zuwa 30 cikin ɗari idan an jinkirtar da maganin rigakafi na cikin ko da ƴan awoyi kaɗan.

Jajayen Tutocin Kwayoyin Kwayoyin Kwayoyin cuta (SBP)¶

Ba kamar peritonitis na tiyata ba daga fashe appendix (wanda ke sa allon ciki ya yi tauri), matashin ruwa na ascites a cikin majinyacin cirrhosis yana hana tsokoki na ciki su ji tsauri. Nemo ** kowane ɗayan waɗannan alamun gargaɗin a hankali a cikin mara lafiya tare da ascites:

• Duk wani zazzabi sama da digiri 37.8 ma'aunin celcius (digiri 100.0 Fahrenheit) ko hypothermia ƙasa da digiri 36.0 ma'aunin celcius (digiri 96.8 Fahrenheit)**, ko sanyin rawan jiki da ba a bayyana ba.
• Sabon ciwon ciki mai yaɗuwa, kumburin ciki, rashin jin daɗi, ko tausasawa lokacin da ake latsawa a hankali akan kumbura cikin ciki, ko cikin da yake jin ƙara da ƙarfi fiye da yadda aka saba.
• **Sabuwa ko damuwa rikicewa / ciwon hanta na hanta ** tare da dalili na fili (a cikin kashi 30 cikin dari na lokuta na SBP, rudani shine * kawai * alamar waje, ba tare da zazzaɓi ba kuma babu ciwon ciki).
• ** Rashin saukar da hawan jini, dizziness, ko raguwar fitowar fitsari kwatsam** (** ciwon hanta**, inda ciwon SBP ke haifar da kodan don rufewa gaba ɗaya).
• Mataki na gaggawa: Kai tsaye zuwa sashin gaggawa. Likitocin asibiti za su yi amfani da allura na bakin ciki a karkashin jagorancin duban dan tayi don zana wani karamin samfurin ruwan ciki (diagnostic paracentesis) don kirga fararen jini (> 250 polymorphonuclear cell per cubic millimeters tabbatar da SBP) kuma nan da nan ya ba da ** maganin rigakafi na cephalosporin na ƙarni na uku na ciki ** da ** albumin na ciki *** don ceton kodan.

Abin da za a yi idan ruwa ya fita daga hernia na cibiya ("Ciwon Ruwa")¶

A cikin marasa lafiya masu tsanani, matsananciyar ascites, matsa lamba a cikin ciki sau da yawa yana tura maɓallin ciki zuwa cikin siririn fata ** Ciwon ciki **. Idan fatar jikin ciki ta fito da scab mai duhu ko gyambo kuma ba zato ba tsammani ruptures, ruwan ruwan ascitic mai launin rawaya mai haske zai iya zubowa a cikin tufafin (Ciwon ambaliya).

• Taimakon farko na gaggawa don karyewar cibical hernia:
• Kira lambar gaggawa ta gida ko kai zuwa sashin gaggawa nan da nan (idan kwayoyin cuta sun rarrafe ciki ta wannan rami, peritonitis mai mutuwa yana biyo baya cikin sa'o'i, kuma saurin zubar ruwa yana sauke hawan jini).
• Ka sa majiyyaci ya kwanta a bayansa ko ya karkata kadan don haka tabo mai yoyon ya nuna sama.
• Rufe budewar da ** kauri, rigar gauze mara kyau ko sabon tawul mai tsabta da aka wanke da kyau tare da tef (kada a tura komai cikin rami), sannan a rike matsin dabino a hankali har sai ma'aikatan asibiti za su iya ba da maganin rigakafi na ciki, albumin, da gyaran tiyata.

Dokokin aminci na magani ga duk wanda ke da cirrhosis¶

Hanta mai tabo tana daidaita magunguna sannu a hankali, yayin da hauhawar jini na portal ke sa rufin ciki da kodan su yi rauni sosai. Kowane mai kula da majinyacin cirrhosis ya kamata ya tilasta waɗannan ka'idodin maganin gida guda uku:

1. ** Cikakken haramci akan duk NSAIDs (Ibuprofen, Naproxen, Aspirin, Meloxicam, Diclofenac):** Shan ko da 'yan allunan ibuprofen ko naproxen a cikin cirrhosis yana cire prostaglandins masu kariya daga duka rufin ciki (yana haifar da catastrophic variceal ko portal hypertensive gastrnal arteacute). ** ciwon hanta**).
2. ** Ƙaƙƙarfan ƙwayar ƙwayar cuta akan Acetaminophen (Paracetamol):** Yayin da babban adadin acetaminophen (> 4,000 mg / day) yana haifar da gazawar hanta, jagororin hanta (AASLD da EASL) lura cewa ga marasa lafiya na cirrhosis na yau da kullun waɗanda ** ba sa shan barasa **, ƙarancin kashi acetaminophen ya rufe daidai gwargwado a ** ba fiye da 2000 mg na yau da kullun ba. Allunan) duka a cikin sa'o'i 24 *** don gajeren kwasa-kwasan hakika ya fi aminci fiye da NSAIDs, ** sai dai in *** mai haƙuri yana cikin ** m hanta gazawar **, yana shan barasa sosai, ko rashin abinci mai gina jiki / azumi, a cikin wannan yanayin ** zero acetaminophen ** yakamata a ba shi ba tare da umarnin likita kai tsaye ba.
3. • Rike maganin diuretics ("kwayoyin ruwa") yayin amai, gudawa, ko rudani:** Kada a ba da allurai na safe na spironolactone ko furosemide idan majiyyaci yana da hayaniya, rikicewa, amai, ko kuma yana da 4 sako-sako da stools kowace rana har sai likita ya duba jininsa sodium, potassium, da creatinine.

Tambayoyin da ake yawan yi¶

An duba tushe¶

• ** Ƙungiyar Amirka don Nazarin Ciwon Hanta (AASLD) da Ƙungiyar Ƙasa ta Turai don Nazarin Hanta (EASL): ** * Ka'idodin Ayyukan Clinical akan Ciwon Hanta a Ciwon Hanta na Ciwon Hanta (Sharuɗɗan Yammacin Yammacin Yamma)*, * Gudanar da Ascites da Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Kwayoyin Halitta )
• Baveno VII Consensus Workshop (International Portal Hemorrhage Consensus): Baveno VII, Sabunta Yarjejeniya A Cikin Hawan Jini na Portal da Mummunan Ciwon Jini Na Farko.
• ** Cibiyar Kula da Lafiya ta Kasa (NICE) da Ƙungiyar Gastroenterology ta Biritaniya (BSG, United Kingdom):** Cirrhosis a cikin Sama da 16s: Assessment and Management (NG50) da Babban Ciwon Gastrointestinal Bleeding a Cirrhosis Guidelines.
• Ungiyar Ciwon Gastroenterology ta Duniya (WGO, International): Sharuɗɗa na Duniya game da varices na Esophageal da Cutar Hanta Hanta.

Jagora masu alaƙa¶

• Zubar ciki na ciki, amai jini, da melena taimakon farko
• Sepsis da Septic shock ganewa da taimakon farko
• Girgiza kai da rugujewar jini na taimakon gaggawa
• Barasa buguwa, shaye-shaye, da safarar murmurewa lafiya
• Lambobin gaggawa ta ƙasa