Nsi nri, nnukwu gastroenteritis, na akpịrị ịkpọ nkụ siri ike¶

Ọrịa gastroenteritis siri ike na ọrịa sitere na nri na-eme mgbe nje bacteria, nje, nje nje, ma ọ bụ nsị microbial a haziri ahazi na-akpasu iwe ma kpasuo mkpuchi nke afọ na eriri afọ gị ọkụ. Ọ bụ ezie na ọtụtụ ndị toro eto nwere ahụike na-agbake site na flu afọ dị nro ma ọ bụ nsị nri n'ime awa 24 ruo 72 na-eji mmiri ọnụ ọnụ, oke mmiri na-efunahụ site na vomiting na-adịghị agwụ agwụ na afọ ọsịsa mmiri nwere ike ịkpalite ujo hypovolemic, nnukwu akụrụ akụrụ, adịghị mma electrolyte na-egbu egbu, ma ọ bụ nsogbu usoro na-eyi ndụ egwu n'ime awa.

Ụfọdụ nje na-ebute nri na-ahapụkwa neurotoxins dị ike ma ọ bụ nsị na-ebibi akụrụ ebe nlekọta ụlọ na-ezughị ezu. Ịmara ka esi amata ọdịiche dị n'etiti gastroenteritis viral na-emekarị site na botulism, hemolytic uremic syndrome, ma ọ bụ akpịrị ịkpọ nkụ siri ike, otu esi agwakọta ihe ngwọta rehydration nke Òtù Ahụ Ike Ụwa (WHO) n'ụlọ, na ọgwụ mgbochi afọ ọsịsa nwere ike n'ezie ọnyà na-egbu egbu n'ime ahụ gị na-echebe ndụ gị na ndụ nke ụmụaka na-adịghị ike na ndị okenye.

Mee nke a ugbu a¶

1. ** Lelee ọkọlọtọ uhie na-eyi ndụ egwu wee kpọọ ndị ọrụ mberede ma ọ dị.** Kpọọ nọmba mberede mpaghara gị (911 na United States na Canada, 112 gafee European Union, 999 na United Kingdom, ma ọ bụ hụ ha niile. nọmba mberede) ma ọ bụrụ na onye ahụ na-egosi ihe ịrịba ama nke oké akpịrị ịkpọ nkụ ma ọ bụ ujo (mgbagwoju anya, oké ike ọgwụgwụ, dizziness ma ọ bụ ịda mbà mgbe ọ na-eguzo, ngwa ngwa obi ọnụego karịrị 110 iti kwa nkeji, anya dara ụda, ma ọ bụ enweghị urination maka 8 ruo 12 awa n'ime ndị okenye ma ọ bụ 6 awa n'ime ụmụ ọhụrụ), vomits ọbara ma ọ bụ ọchịchịrị ihe dị ka mmiri kọfị ogige, na-agafe maroon ma ọ bụ na-akpụ akpụ n'olu, ọbara na-erute ngwa ngwa. ọhụụ na-agbanwe, ma ọ bụ oke mgbu mpaghara na ala ala aka nri.
2. ** Wetuo afọ n'ime obere oge mgbe ọgbụgbọ, wee malite micro-sips of Oral Rehydration Solution (ORS)** Akụnyela nnukwu iko mmiri dị larịị ozugbo ọ gbachara, n'ihi na ịgbatị afọ na-ere ọkụ na-akpalite gag reflex ọzọ. Chere nkeji 15 ruo 30 mgbe a gbasịrị, wee nye milimita 5 (1 teaspoon) nke ngwọta rehydration nke ọnụ kwa nkeji 2 ruo 5 na-eji ngaji, iko ọgwụ, ma ọ bụ sirinji ọnụ, jiri nwayọọ nwayọọ na-abawanye ruo obere sips ka afọ na-edozi.
3. ** Kwadebe ihe ngwọta nnu na shuga nke WHO mere n'ụlọ ma ọ bụrụ na ọ dịghị ngwugwu ORS na-ere ọgwụ.** Naanị mmiri nkịtị adịghị edochi sodium na potassium furu efu, na ihe ọṅụṅụ mkpụrụ osisi na-adịghị edozi ma ọ bụ soda nkịtị na-adọtakwu mmiri n'ime eriri afọ site na nrụgide osmotic, na-eme ka afọ ọsịsa ka njọ. Gwakọta teaspoons ọkwa 6 (milimita 30) nke shuga okpokoro ọcha na teaspoon 0.5 larịị (2.5 milliliters) nke nnu n'ime 1 liter (iko 4.2 US) nke mmiri ọṅụṅụ dị ọcha ma dị mma ruo mgbe agbazere kpamkpam.
4. Enyela ọgwụ mgbochi afọ ọsịsa n'ụlọ ọgwụ ma ọ bụrụ na ahụ ọkụ dị elu ma ọ bụ stool na-agbapụta ọbara. Ejila ọgwụ ndị na-ebelata ike nke motility dị ka loperamide ma ọ bụ bismuth subsalicylate ma ọ bụrụ na ị nwere ahụ ọkụ karịa 38.5 degrees Celsius (101.3 degrees Fahrenheit) ma ọ bụ ọbara a na-ahụ anya na stool gị. Ibelata eriri afọ na-ejide nje bacteria na-emerụ ahụ na Shiga toxins megide mgbidi eriri afọ, na-abawanye ohere nke megacolon na-egbu egbu na ọdịda akụrụ.
5. ** Chekwaa ma kpọọ nri a na-enyo enyo n'enweghị nsogbu ọ bụla.** Ọ bụrụ na ị na-enyo enyo otu nri ụlọ oriri na ọṅụṅụ, ngwaahịa a na-adịghị ahụkebe, ero anụ ọhịa, ma ọ bụ ite nwere fụrụ akpụ n'ụlọ kpatara ọrịa siri ike n'ọtụtụ mmadụ, mechie nri fọdụrụnụ n'ime akpa rọba nke ọma n'ime friji (anaghị ajụ oyi ma ọ gwụla ma a gwara ya) ka ndị na-enyocha ahụike ọha ma ọ bụ ndị dọkịta toxicology nwere ike ịnwale.
6. ** Wepụ ihe ndị emetọworo n'elu ya na ịcha ọcha chlorine, ọ bụghị mmanya.** Ọ bụrụ na norovirus ma ọ bụ afọ ọsịsa na-efe efe na-agbasa n'ụlọ gị, ihe nchacha aka na-aba n'anya na ihe mkpochapụ ammonium quaternary agaghị egbu nje virus. Jiri ncha na mmiri na-ekpo ọkụ saa aka nke ọma maka sekọnd 20, yiri gloves nwere ike ịpụpụ mgbe ị na-ehicha vomit ma ọ bụ stool, wee kpochapụ ihe ndị siri ike site na mmiri ịcha ọcha chlorine ezinụlọ agwakọtara ọhụrụ nke hapụrụ mmiri maka opekata mpe nkeji 5 ruo 10.

Mpempe akwụkwọ mkpebi ihe mberede na akpịrị ịkpọ nkụ¶

Jiri osisi mkpebi ụlọ ọgwụ a chọpụta ma onye nwere nnukwu vomiting na afọ ọsịsa nwere ike ijikwa ya n'ụlọ site na iji rehydration ọnụ ma ọ bụ na-achọ ọgwụgwọ intravenous n'ụlọ ọgwụ ozugbo.

flowchart TD
    Start["Ọgbụgbọ, ọgbụgbọ mmiri, ma ọ bụ afọ mgbu"] --> NeuroCheck{"Ọ bụla akara akwara ozi?<br/>Ọhụụ abụọ, nkuanya na-ada ada, <br/>okwu na-adịghị mma, nsogbu ilo, ka ọ bụ ọgbụgbọ?"}

    NeuroCheck -->|"Ee"| Call911Neuro["Kpọọ Ọrụ Mberede ozugbo<br/>Botulism ma ọ bụ Neurotoxin mmiri a na-enyo enyo<br/>Na-eme ka onye ọrịa kwụ ọtọ ma lelee iku ume."]
    NeuroCheck -->|"Mba"| RedFlags{"Lelee ọkọlọtọ na-acha uhie uhie nke sistemu: <br/> stool ọbara ma ọ bụ oji, ọgbụgbọ ala kọfị, <br/> mgbagwoju anya, nkụda mmụọ, afọ siri ike, ma ọ bụ enweghị mmamịrị> awa asatọ?"}

    RedFlags -->|"Ee, 1 ma ọ bụ karịa ugbu a"| ERVisit["Gaa na Ngalaba Mberede Ụlọ Ọgwụ Ugbu a<br/>Na-achọ IV Crystalloids, Electrolyte Panel,<br/>Stool Culture, and Surgical or Renal Evaluation"]
    RedFlags -->|"Mba"| HighRiskCheck{"Onye ọrịa ọ bụ nwa ọhụrụ <6 ọnwa, <br/> okenye na-esighị ike>65, dị ime,<br/> ọrịa shuga, ma ọ bụ immunocompromised?"}

    HighRiskCheck -->|"Ee"| SameDayEval["Kpọtụrụ Dọkịta ma ọ bụ nlekọta ngwa ngwa taa<br/>Malite micro-sips nke WHO ORS ozugbo<br/> Ọnụ ala ala maka hydration IV"]
    HighRiskCheck -->|"Mba"| TrialORS["Start Home Oral Rehydration Protocol<br/>5 mL (1 tsp) ORS kwa nkeji 2 ruo 5<br/>Zere ọgwụ mgbochi motility ma ọ bụrụ na ahụ ọkụ dị"]

    TrialORS --> ToleranceCheck{"Onye ọrịa nwere ike idowe obere sips <br/> maka awa 4 ruo 6 n'enweghị ihe ka njọ?"}
    ToleranceCheck -->|"Ee"| RecoveryDiet["Ọga n'ihu na inye nri n'oge dị ka anabatara<br/>Dochie stool ọ bụla rụrụ arụ na 200 ruo 250 ml ORS<br/> Lelee akara akụrụ HUS na-egbu oge maka ụbọchị iri na anọ."]
    ToleranceCheck -->|"Mba, vomiting na-adịgide adịgide"| ERVisit

Usoro iheomume mmalite: ịchọpụta nje ahụ site na elekere incubation¶

Mgbe ọtụtụ mmadụ daa ọrịa mgbe ha risịrị nri, ndị dọkịta mberede na ndị na-ahụ maka toxicologists na-ebu ụzọ leba anya n'oge nnabata (ọnụọgụ awa ma ọ bụ ụbọchị n'etiti iri nri a na-enyo enyo na akara nke mbụ) n'akụkụ akara ngosi kachasị. Mgbaàmà ngwa ngwa na-amalite n'ime awa 1 ruo 6 ọ fọrọ nke nta ka ọ bụrụ mgbe niile na-arụtụ aka na kemịkalụ ma ọ bụ nje bacteria nke na-anọdụ ala na nri tupu ị ilo ya, ebe igbu oge nke ụbọchị 1 ruo 5 na-egosi nje bacteria, nje, ma ọ bụ nje nje na-amụba n'ime tract intestinal gị.

Ntụle akpịrị ịkpọ nkụ n'ụlọ ọgwụ n'afọ niile¶

akpịrị ịkpọ nkụ na nnukwu gastroenteritis abụghị naanị ịkpọ nkụ; ọ bụ mbelata nke oke mmiri mmiri intravascular na intracellular electrolytes (sodium, potassium, chloride, na bicarbonate). Ka olu plasma na-agbada, obi ga-akụrịrị ngwa ngwa na arịa ọbara na akpụkpọ ahụ na akụrụ na-akpachi iji chekwaa ọbara mgbali n'ụbụrụ na obi.

Ndị dọkịta na Òtù Ahụ Ike Ụwa na-ekewa akpịrị ịkpọ nkụ n'ime ụzọ atọ a pụrụ ịrụ ọrụ: ** Mba ma ọ bụ ntakịrị akpịrị ịkpọ nkụ** (ihe na-erughị pasenti atọ n'ịdị arọ nke anụ ahụ), ** akpịrị ịkpọ nkụ dị nro ruo na-agafeghị oke ** (pasent 3 ruo 9 ọnwụ anụ ahụ), na ** nkụnwụ mmiri siri ike ** (pasent 10 ma ọ bụ oke ibu ahụ, nke na-eme ka hypovolemic shock).

Otu esi agwakọta na inye Ngwọta Rehydration Oral (ORS)¶

N'ime narị afọ nke 20, nchọpụta ** sodium-glucose cotransport method (SGLT1)** n'ime obere eriri afọ mmadụ gbanwere ọgwụ mberede. Ọbụlagodi mgbe ọgbụgbọ ọgbụgbọ, rotavirus, ma ọ bụ * Salmonella * nsị na-eme ka eriri afọ na-awụsa lita mmiri n'ime afọ, protein na-ebuga SGLT1 na oke ahịhịa eriri afọ na-adịgide kpamkpam. Agbanyeghị, protein ndị a nwere ike ịmịnye sodium na mmiri n'ofe mgbidi eriri afọ ma ọ bụrụ na **glucose (sugar) na sodium (nnu) dị ọnụ na nha nha nha 1 ruo 1.

• Ọ bụrụ na ị na-aṅụ ** mmiri nkịtị ** na nnukwu mpịakọta n'oge oké vomiting na afọ ọsịsa, ọ na-agafe nke ọma n'ofe eriri afọ na-egbuke egbuke ma na-agbaze sodium fọdụrụ n'ime ọbara gị, na-etinye ihe ize ndụ ** hyponatremia ** (ọzịza ụbụrụ, mgbagwoju anya, na ọdịdọ).
• Ọ bụrụ na ị na-a drinkụ ** ihe ọ juiceụụ appleụ apụl na-edochaghị anya, kola mgbe niile, ihe ọṅụṅụ egwuregwu na-atọ ụtọ, ma ọ bụ tii ụtọ , ha nwere nnukwu shuga (oke osmolality) na obere sodium. Mfefe shuga a na-enwetabeghị na-anọdụ n'ime eriri afọ wee na-eme dị ka sponge, na-adọta ọbụna karịa mmiri n'ọbara gị n'ime eriri afọ gị ( osmotic afọ ọsịsa**).

1. Azụmahịa WHO-formula ORS ngwugwu (nhọrọ mbụ)¶

Mgbe ọ bụla o kwere mee, jiri ngwungwu nnu rehydration nke ọnụ eburu ụzọ tụọ nke sitere na ụlọ ahịa ọgwụ (dị ka WHO/UNICEF Reduced Osmolarity ORS, Pedialyte, Dioralyte, Hydralyte, ma ọ bụ CeraLyte), agwakọta ya na oke mmiri dị ọcha nke ebipụtara na ngwugwu ahụ. Ejikọtala ngwugwu ORS na mmiri ara ehi, ofe, ma ọ bụ ihe ọṅụṅụ mkpụrụ osisi, ọ dịghịkwa mgbe ị ga-esi nri * mgbe ị gbakwụnye nnu (ọ bụrụ na mmiri gị chọrọ esi, buru ụzọ sie mmiri ahụ, hapụ ya ka ọ dị jụụ kpamkpam, wee gbanye na ngwugwu ahụ).

2. Ezi ihe mberede emere n'ụlọ WHO ORS uzommeputa¶

Ọ bụrụ na ịnweghị ike iru ebe a na-ere ọgwụ, kwadebe usoro nri a na-azọpụta ndụ nke Òtù Ahụ Ike Ụwa na Project Rehydration kwadoro. Jiri ngaji na-atụ ihe (ọ bụghị ngwa ọlaọcha na-eri nri oge niile) nụrụ ụtọ mmiri ikpeazụ tupu inye ya nwata: ** ọ gaghị atọ ụtọ nnu karịa anya mmiri nke mmadụ.

• ** Mmiri ọṅụṅụ dị ọcha, adịghị mma ***: ** 1 lita *** (ihe dị ka iko US 4.2, ma ọ bụ iko 200-milimita ise).
• ** sugar granulated na-acha ọcha (sucrose) ***: ** teaspoons ọkwa 6 ** (milimita 30, ma ọ bụ gram 25.2).
• ** Nnu tebụl ọkọlọtọ (sodium chloride) ***: ** 0.5 (otu ọkara) teaspoon ọkwa *** (2.5 milliliters, ma ọ bụ gram 2.9).

Mee nke ọma maka sekọnd 60 ruo mgbe kristal nnu na shuga gbazere. Chekwaa mkpuchi n'ebe dị mma ma tụfuo akụkụ ọ bụla a na-ejighị ya mgbe awa 24 gachara, na-akwadebe ogbe ọhụrụ kwa ụbọchị.

3. Ezi ntụziaka mmiri ụlọ ọzọ mgbe shuga adịghị¶

• ** ORS nke ọka starch (Ọ dị irè nke ukwuu maka afọ ọsịsa mmiri siri ike)**: Starch mgbagwoju anya na osikapa na-agbaji nwayọọ nwayọọ banye glucose n'ime afọ na-ebulighị osmolity eriri afọ, na-ebelata mmepụta stool ruo pasent 30 ma e jiri ya tụnyere shuga dị mfe. Obụpde ** 50 ruo 60 grams (ihe dị ka iko 0.5) nke osikapa ọcha ma ọ bụ osikapa na-esi ísì ụtọ ** na ** 1.1 lita mmiri ** maka nkeji 5 ruo 7 ruo mgbe ọ na-eme ka ọ dị nro, mmiri mmiri, hapụ ya ka ọ dị jụụ na ọnụ ụlọ, tinye ** 0.5 ọkwa teaspoon nke tebụl nnu **, ma chọpụta na olu ikpeazụ hà nhata 1 liter.
• Ihe ọṅụṅụ mkpụrụ osisi diluted tinyere salted cracker fallback (Maka ndị dị nro na ụmụaka na ndị okenye) ***: Ọ bụrụ na nwatakịrị nwere nkụda mmụọ ma ọ bụ okenye ajụ ọkọlọtọ ORS, ndị nchọpụta egosiwo na ịgbanye ** 1 akụkụ apple unsweetened apple juice na 4 akụkụ mmiri ** (1: 4 dilution) ma ọ bụ ọzọ sips nke diluted egwuregwu ọṅụṅụ (1 akụkụ nke nnu nwere ike ịnọgide na-aṅụ mmiri na mmiri mmiri na mmiri ara ehi). n'oge viral gastroenteritis. Ejila ọdịda a maka ụmụ ọhụrụ ma ọ bụ akpịrị ịkpọ nkụ na-agafeghị oke ruo nke siri ike.

4. Nzọụkwụ-site-nzọụkwụ olu lekwasịrị anya na mgbochi vomiting Usoro¶

Mgbe mmadụ na-agbọ agbọ, ndị nne na nna na ndị na-elekọta ya na-echekarị na rehydration n'ọnụ dara ada n'ihi na onye ọrịa na-atụfu otu iko mmiri zuru ezu. N'ihe mberede ụmụaka nọ n'ọnọdụ mberede, rehydration nke ọnụ na-aga nke ọma karịa pasent 90 nke oge a na-enye ya site na ** sirinji ma ọ bụ ngaji pacing ***:

1. **Iwu 5-milliter ***: Iji sirinji ọgwụ 5-milliter (1-teaspoon) ọgwụ sirinji ma ọ bụ ngaji, squirt ma ọ bụ ngaji 5 milliliters nke ORS dị jụụ n'akụkụ ọnụ kwa nkeji 3 ọ bụla. N'oge a, onye ahụ na-amịkọrọ 100 milliliters (3.4 ounces) kwa elekere ozugbo site na afọ na duodenum dị elu na-enweghị mgbe ọ bụla na-agbakọta oke mmiri mmiri zuru oke n'ime afọ iji kpalite vomiting reflex.
2. ** Ọ bụrụ na ha na-agbọ agbọ n'oge rehydration ***: Chere nkeji 15 ruo 20 ka ọ kwụsịlata spasms nke esophageal na gastric, wee malitegharịa na milliliters 5 kwa nkeji ise ọ bụla.
3. ** Ebumnuche nkwụghachi mmiri nke awa 4 maka akpịrị ịkpọ nkụ dị nro na nke na-agafeghị oke *: Ebumnuche inye ihe dị ka ** 50 ruo 75 milliliters nke ORS kwa kilogram nke ịdị arọ ahụ (ihe dị ka 1 ounce kwa paụnd) gbasaara nke ọma n'ime awa anọ mbụ:
4. ** Nwa ọhụrụ na-eru kilogram 6 (paụnd 13)**: 300 ruo 450 milliliters (10 ruo 15 ounces) ngụkọta karịrị awa anọ.
5. ** Nwata na-eto eto na-eru kilogram 12 (paụnd 26)**: 600 ruo 900 milliliters (20 ruo 30 ounces) ngụkọta karịrị awa anọ.
6. Nwata na-eru kilogram 25 (paụnd 55)**: 1.25 ruo 1.8 lita (42 ruo 60 ounces) ngụkọta karịrị awa anọ.
7. ** Onye dị afọ iri na ụma ma ọ bụ okenye (60+ kilogram / 132+ pound) ***: 2.0 ruo 3.5 lita (68 ruo 118 ounces) ngụkọta karịrị awa 4 ruo 6.
8. ** Ndochi mmezi na-aga n'ihu ***: Ozugbo akpịrị ịkpọ nkụ na akpịrị ịkpọ nkụ na-akawanye mma, nyekwuo ** 60 ruo 120 milliliters (2 ka 4 ounces) nke ORS maka stool ọ bụla ma ọ bụ ịgba agbọ na ụmụaka.

Nsogbu na-egbu egbu ị ga-elele¶

Ọbụlagodi mgbe a na-achịkwa oke mfu mmiri, nsogbu ahụike anọ na-eyi ndụ egwu nwere ike ibilite n'ime ma ọ bụ n'ime izu abụọ na-esochi ọrịa sitere na nri.

1. Nri na-eri nri na botulism nwa ọhụrụ (Na-agbadata ahụ mkpọnwụ neurotoxic)¶

Clostridium botulinum na-emepụta otu n'ime ihe ndị na-egbu egbu egbu egbu mara. N'adịghị ka Salmonella ma ọ bụ norovirus, botulism anaghị ebute ahụ ọkụ ma mee ka onye ọrịa mara nke ọma ma nwee uche dị nkọ ma na-eji nwayọọ nwayọọ na-ebipụ ihe mgbaàmà akwara na akwara afọ ofufo.

• ** botulism nri ndị okenye na nwata ***: Lelee "4 Ds": ** D *** iplopia (ọhụụ abụọ ma ọ bụ nke na-adịghị mma), ** D *** ysarthria (slurred, oké okwu), ** D *** ysphonia (olu siri ike ma ọ bụ nke na-adịghị ike), na ** D *** ysphagia (ihe isi ike sroovaping) na mmiri na-agbapụta mmiri (ihe isi ike salivaping) na mmiri nku anya mmiri. ụmụ akwụkwọ na-adịghị egbochi n'ìhè na-egbuke egbuke. Adịghị ike na-esikwa n'olu na ogwe aka gbadaa ala ruo n'ọkpụkpụ obi na ụkwụ.
• ** botulism nwa ọhụrụ (afọ otu izu ruo ọnwa iri na abụọ): Ihe kpatara ya bụ ilo C. botulinum spores (nke a na-ahụkarị na raw ma ọ bụ pasteurized ** mmanụ aṅụ, yana ájá na ala) na-eto n'ime akụkụ eriri afọ nwata na-etobeghị. Ihe ịrịba ama mbụ bụ ihe fọrọ nke nta ka ọ bụrụ mgbe ọ bụla ** afọ ntachi ọhụrụ ** (ụbọchị 3 ma ọ bụ karịa na-enweghị stool), na-esote adịghị ike, nke dị larịị, mkpu dị jụụ, ịṅụ ara na ara ma ọ bụ karama na-adịghị mma, nkwụsị isi (" floppy baby" hypotonia), na mmiri mmiri.
• ** Ihe omume ozugbo ***: Gaa na ngalaba mberede ụlọ ọgwụ kacha nso ozugbo. Nlekọta mbụ nke Botulinum Antitoxin intravenous (BAT maka ndị okenye/ụmụaka, ma ọ bụ BabyBIG human botulism immuno globulin maka ụmụ ọhụrụ) na-akwụsị ahụ mkpọnwụ akwara ọzọ, n'agbanyeghị na njedebe akwara kpọnwụrụ akpọnwụ na-ewe izu iji pulite njikọ ọhụrụ ebe ikuku na-akwado iku ume.

2. Hemolytic Uremic Syndrome (HUS) na ọdịda akụrụ¶

Ihe dị ka pasent 5 ruo 10 nke ndị mmadụ (na ihe ruru pasentị 15 nke ụmụaka nọ n'okpuru afọ 5) butere Shiga toxin na-emepụta E. coli * (STEC O157: H7) ma ọ ụ higella dysenteriae* na-etolite*hemolytic Uremic Syndrome (HUS)**. N'ụzọ na-emegide onwe ya, HUS na-adakarị ** 5 ruo ụbọchị 10 mgbe afọ ọsịsa ahụ malitere, na-abụkarị mgbe afọ ọsịsa ahụ ọ na-akawanye mma.

Shiga toxins na-agafe mgbidi colon mebiri emebi banye n'ọbara ma jikọta ozugbo na arịa ọbara microscopic n'ime akụrụ. N'ebe ahụ, nsi na-akpasa mkpụrụ ndụ ọbara uhie dị iche iche (** microangiopathic hemolytic anaemia**), na-eri platelet ọbara (thrombocytopenia), ma na-akụnye ihe nzacha akụrụ (** nnukwu ọdịda akụrụ**).

• ** Ihe ịrịba ama ịdọ aka ná ntị nke HUS ***: A na-ahụ anya pallor (ịcha ọbara ọbara, akpụkpọ ahụ na-egbuke egbuke na nku anya ime ma ọ bụ chịngọm), oke ike ọgwụgwụ ma ọ bụ mgbakasị ahụ, ọnyá na-enweghị nkọwa ma ọ bụ obere ntụpọ odo odo na akpụkpọ ahụ (petechiae), ọbara ọgbụgba site na imi ma ọ bụ chịngọm, ọzịza nfụkasị anya n'anya, nkwonkwo ụkwụ, na nkwụsịtụ na mberede. (ma ọ bụ mmamịrị na-acha pink/cola) ụbọchị 5 ruo 14 ka afọ ọsịsa na-agba ọbara ma ọ bụ nke na-egbuke egbuke.
• ** Ihe mberede ***: Were nwata ma ọ bụ okenye gaa ụlọ ọgwụ mberede ozugbo; HUS chọrọ ọgwụgwọ ọbara ngwa ngwa na nlekọta nephrology ụmụaka, mmịnye ọbara, na dialysis akụrụ nwa oge.

3. Ọrịa Guillain-Barre (GBS) mgbe Campylobacter gasịrị¶

Campylobacter jejuni (nke a na-enwetakarị site na anụ ọkụkọ na-esighi esi ma ọ bụ mmiri ara ehi a na-esighị ya) bụ otu ihe na-ebute ọrịa na-efe efe n'ụwa niile maka Guillain-Barre Syndrome, nnukwu ọrịa akwara autoimmune nke na-amalitekarị 1 ruo izu atọ mgbe mgbake site na afọ ọsịsa.

• **Otu o si dị iche na botulism ***: Ebe botulism na-amalite n'isi wee kwaga * ala , ọrịa Guillain-Barre na-emepụta ** adịghị ike na-arị elu ** nke na-amalite n'ụkwụ na-ebuli * elu. Lezienụ anya maka ịgbatị "mkpọ na agịga" na mkpịsị ụkwụ na mkpịsị aka, mfu nke nkwụghachi ụkwụ ụkwụ, mkpọda mberede ma ọ bụ enweghị ike ịga n'elu steepụ, na adịghị ike na-arịgoro ụkwụ n'akụkụ ogwe na iku ume. Akwụsị ụkwụ ọ bụla na-aga n'ihu mgbe flu afọ na-achọ nyocha ụlọ mberede ozugbo.

4. Sepsis ọbara na-emerụ ahụ na megacolon na-egbu egbu¶

N'ime ụmụ ọhụrụ nọ n'okpuru ọnwa 3, ndị okenye karịa 65, ndị dị ime, ndị nwere nje HIV, ndị na-agwọ ọrịa chemotherapy, na ọbụna ndị mmadụ na-aṅụ ihe mgbochi proton-pump kwa ụbọchị (nke na-egbochi ihe mgbochi afọ nke na-echebe afọ), nje bacteria dị ka * Salmonella *, * Listeria *, * Campylobacter * na * Vibrio vulnificus * nwere ike ịkpalite mgbidi ahụ, na-agbaji n'ọbara. sepsis na ujo septic.

Ọ bụrụ na afọ ọsịsa nke onye ọrịa na mberede ** akwụsị *** mgbe afọ ya na-aza elu dị ka ịgbà siri ike, na-enwe mmetụta dị nro na mmetụ dị nro, na-esonyere ya na pulse ịgba ọsọ na nnukwu ahụ ọkụ ma ọ bụ hypothermia, onye a na-enyo enyo ** megacolon na-egbu egbu ** ma ọ bụ ** perforation intestinal **, nke chọrọ nyocha ịwa ahụ mberede.

Iwu ọgwụ dị mma: ihe na-enyere aka na ihe na-emerụ ahụ¶

Ọtụtụ ndị na-elekọta ndị nwere ezi ebumnuche na-eme ka ọrịa na-ebute nri ka njọ site na iru maka ọgwụgwọ kabinet ọgwụ ezinaụlọ. Soro ntuziaka ụlọ ọgwụ nke ọma:

• ** Mgbe ị ga-ezere Loperamide (Imodium) na Diphenoxylate *: Ngwọta mgbochi motility ndị na-ere ahịa na-arụ ọrụ site na ijikọ ndị na-anabata opioid na mgbidi eriri afọ, na-eme ka ahụ kpọnwụrụ akpọnwụ nke muscular rhythmic (peristalsis) nke na-achụpụ stool. ** Ya adịla mgbe ọ bụla enyela loperamide ụmụaka nọ n'okpuru afọ 6 ** (ma ọtụtụ ndị ọrụ ụmụaka na-enye ndụmọdụ megide ya na ụmụaka niile na-erubeghị afọ 12 ruo 18 n'ihi ihe ize ndụ nke ileus paralytic, iro ụra, na megacolon na-egbu egbu). N'ime ndị okenye, ** ejila loperamide ma ọ bụrụ na ị nwere ahụ ọkụ, stool ọbara ma ọ bụ mucoid, ma ọ bụ nnukwu mgbu afọ. Ndị okenye nwere ahụike nwere ike iji ya jiri nlezianya mee ya naanị maka obere mmiri, mmiri, enweghị ọbara, afọ ọsịsa na-enweghị ahụ ọkụ mgbe ị na-eme njem ma ọ bụ na-arụ ọrụ.
• ** Mgbe a ga-ezere Bismuth Subsalicylate (Pepto-Bismol, Kaopectate)**: Bismuth subsalicylate nwere ngwakọta salicylate nke metụtara aspirin. Ọ dịghị mgbe ọ bụla enyela bismuth subsalicylate nye ụmụ ọhụrụ, ụmụaka, ma ọ bụ ndị nọ n'afọ iri na ụma na-erubeghị afọ 18 na-agbake na gastroenteritis viral n'ihi ihe ize ndụ nke Reye's syndrome (oke imeju imeju na ọzịza ụbụrụ na-egbu egbu). Marakwa na bismuth na-emeghachi omume na sọlfọ trace n'ime mmiri gị na stool iji mepụta bismuth sulfide, nke na-atụgharị ma ire gị na stool gị nwa oge jet ojii; Nke a nwere ike ikpuchi ma ọ bụ gosipụta ezi ọbara ọgbụgba nke eriri afọ (melena).
• ** Zere NSAIDs (Ibuprofen, Naproxen, Aspirin) mgbe mmiri gwụchara *: ọgwụ mgbochi mkpali na-abụghị nke na-egbochi prostaglandins nke na-eme ka arịa ọbara na-abanye n'akịrị gị gbasaa n'oge mfu mmiri. Inwe ibuprofen ma ọ bụ naproxen maka ahụ ọkụ ma ọ bụ ahụ mgbu mgbe mmiri gwụchara site na vomiting na afọ ọsịsa bụ ihe na-ebutekarị ** nnukwu mmerụ ahụ akụrụ na-ebute ọgwụ ọjọọ (AKI). Ọ bụrụ na achọrọ ihe na-ebelata ahụ ọkụ mgbe mmiri ọnụ na-agbadata, paracetamol (acetaminophen) dị mma maka akụrụ, ma ọ bụrụ na ọ nweghị ọrịa imeju.
• ** Ndenye Ondansetron (Zofran) na Zinc supplementation ***: Na nlekọta ngwa ngwa na ngalaba mberede, otu dose dabere na ịdị arọ nke mgbaze ọnụ ondansetron na-akwụsị ọgbụgbọ na-adịghị agwụ agwụ n'ime ụmụaka karịa ọnwa 6 na ndị okenye, na-ekwe ka rehydration nke ọnụ nwee ihe ịga nke ọma n'achọghị eriri IV. Maka ụmụaka nọ n'ọnọdụ dị ala ma ọ bụ nwere afọ ọsịsa ogologo oge, Healthtù Ahụ Ike Worldwa na-atụ aro ** 10 ruo 20 milligrams nke zinc elemental nke ọnụ kwa ụbọchị maka ụbọchị 10 ruo 14 **, nke na-edozi mkpụrụ ndụ eriri afọ ma na-ebelata ma ịdị njọ nke ihe omume ugbu a yana nlọghachi n'ọdịnihu n'ime ọnwa 3 na-abịa.

Nnyeghachi n'oge: kedu ihe kpatara "nri nri BRAT" siri bụrụ ihe ochie¶

Ruo ọtụtụ iri afọ, a gwara ezinụlọ ka ha rie agụụ maka afọ 24 ruo 48 wee rie naanị nri ** BRAT ** (Bananas, Rice, Applesauce, na Toast). Ntuziaka ugbu a sitere na Òtù Ahụ Ike Ụwa, American Academy of Pediatrics (AAP), na European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) kwadoro na ** ibu ọnụ ogologo oge na ihe mgbochi BRAT-naanị nri na-ebelata ọgwụgwọ eriri afọ ** n'ihi na sel intestinal enterocyte chọrọ luminal luminal iji nwetaghachi na protein, protein na nri nri siri ike.

1. **Gaa n'ihu na-enye nwa ara na usoro nwa ọhụrụ mgbe niile na-enweghị nkwụsịtụ **: Akwụsịla inye nwa ọhụrụ nwere nnukwu gastroenteritis ara; Mmiri ara ara nwere ọgwụ mgbochi nzuzo nke IgA na ihe mgbochi mgbe a na-agbari ya ngwa ngwa. Ụmụ ọhụrụ na-eri karama kwesịrị ịlaghachi n'ụdị siri ike, nke a na-agbanyeghi ngwa ngwa ngwa ngwa nke oge nhazi mmiri nke ORS nke dị awa 4 (usoro iji mmiri gbakwunyere na-eme ka agụụ na-agụ nwa nke calorie na electrolytes).
2. ** maliteghachi nri siri ike dabara na afọ n'ime awa 4 ruo 6 nke rehydration ***: Ozugbo vomiting kwụsịrị ma dochie mperi ORS nke awa 4 nke mbụ, nye obere nri ugboro ugboro kwa awa 3 ruo 4.
3. ** Nri kachasị mma ị ga-eri n'oge mgbake ***: Họrọ carbohydrates dị mgbagwoju anya jikọtara ya na protein ndị na-adịghị ala ala na potassium nkịtị: osikapa ọcha, sie ma ọ bụ poteto a kpụkọrọ akpụ na ntụtụ nnu, oatmeal, crackers plain, noodles na ọkụkọ doro anya ma ọ bụ broth akwukwo nri, anụ ọkụkọ ma ọ bụ ara toki, àkwá esichara, banana chara acha, applesauce, na omenala dị ndụ na-enye yogọt nkịtị na nje bacteria bara uru.
4. Ihe oriri ndị a ga-ezere maka ụbọchị 3 ruo 5 ***: Zere nri abụba, e ghere eghe, ma ọ bụ nnukwu abụba buru ibu (nke na-egbu oge ịpụta afọ na-ebute ọgbụgbọ), ose chili na-esi ísì ụtọ, caffeine na mmanya (nke na-akpali motility gut ma na-eme dị ka diuretics), candies na-enweghị shuga ma ọ bụ chịngọm nwere *sorbitol, xylitol, mannich nke siri ike na-akpata Mmiri ara ehi mmiri mmiri na-ekoghị eko ma ọ bụrụ na nwa oge mgbe ọrịa lactose ekweghị ekwe na-akpata bloating na gas.

Njikwa ọrịa n'ụlọ: ịkwụsị norovirus na mgbasa nje¶

Ọ bụrụ na otu onye ezinaụlọ na-amalite ịgba agbọ ma ọ bụ nwee afọ ọsịsa na-efe efe, iwere usoro mgbochi iche na mkpochapụ ozugbo na-egbochi ezinụlọ dum ịda n'otu oge:

• **Jiri ncha na mmiri saa aka maka nkeji iri abụọ zuru ezu ***: gels mmanya na-aba n'anya (ọbụlagodi na 70% ethanol) anaghị adabere na nje virus na-abụghị enveloped dị ka norovirus ma ọ bụ nje spores dị ka Clostridioides difficile. Jiri ncha na mmiri sachaa aka nke ọma mgbe ọ bụla nleta ụlọ ịsa ahụ gasịrị, mgbanwe diaper, na tupu imetụ nri aka.
• ** Yiri uwe aka na ihe nkpuchi tupu ihicha vomit ***: Ọgbụgbọ na-apụta site na norovirus na-ebunye ọtụtụ nde ụmụ irighiri mmiri na-efe efe n'ikuku na-adaba na brọsh eze, counter na aka ọnụ ụzọ dị nso. Yiri nitrile ma ọ bụ uwe mkpuchi latex na mkpuchi ịwa ahụ ma ọ bụ N95, jiri akwa nhicha akwụkwọ hichapụ ihe mmiri mmiri (ọ dịghị mgbe ọ bụla vacuum ma ọ bụ zachaa vomit kpọrọ nkụ), ma mechie ihe mkpofu n'ime akpa rọba ekechiri tupu etinye ya na ahịhịa dị n'èzí.
• ** Wepu ihe ngwọta 1,000 ruo 5,000 ppm chlorine bleach solution ***: Mix ** 5 ruo 25 tablespoons (75 ka 375 milliliters) nke ịcha ọcha ụlọ na-esi ísì ụtọ (5 ruo 6% sodium hypochlorite) kwa 3.8 lita (1 galọn) mmiri **, na-etinye aka na nnukwu efere na-adịghị edozi ahụ. Ala tile, na mkpịsị ọnụ ụzọ), hapụ mmiri ka ọ dị ọcha ma ọ dịkarịa ala ** 5 nkeji ruo 10 **, wee jiri mmiri dị ọcha sachaa.
• Sachaa akwa akwa akwa na oke ọkụ ozugbo: Wepu akwa akwa, akwa akwa na uwe metọsịrị nke ọma na-amanyeghị ha n'ikuku. Jiri ncha sachaa ha na okirikiri kacha ogologo na mmiri kachasị elu nke ** opekata mpe 60 degrees Celsius (140 degrees Fahrenheit)** na nchacha, wee daa nkụ na ebe okpomọkụ kachasị elu ruo mgbe akpọnwụchara kpamkpam.
• Mee ka usoro mkpochapụ kichin nke awa 48 sie ike ***: Onye ọ bụla na-agbake site na nnukwu ọgbụgbọ na-efe efe ma ọ bụ afọ ọsịsa agaghị akwadebe nri maka ndị ọzọ, jikwaa ice ma ọ bụ arịa, igwu mmiri n'ọdọ mmiri ọha, ma ọ bụ laghachi ọrụ nri, nlekọta ahụike, ma ọ bụ ọrụ nlekọta ụmụaka ruo opekata mpe ** 48 ruo 72 awa mgbe njedebe ikpeazụ nke vomiting ma ọ bụ afọ ọsịsa gasịrị.

Ajụjụ a na-ajụkarị¶

enyochara isi mmalite¶

• ** Òtù Ahụ Ike Ụwa (WHO) na UNICEF:** * Ọgwụgwọ afọ ọsịsa: akwụkwọ ntuziaka maka ndị dibịa bekee na ndị ọrụ ahụike ndị ọzọ* (nhazi nke akpịrị ịkpọ nkụ n'ụlọ ọgwụ, mbelata-osmolarity ORS, ngwọta nnu-sugar nke arụrụ n'ụlọ, na usoro mgbakwunye zinc ụmụaka).
• ** Ọrịa na-efe efe Society of America (IDSA, United States):** * Ntuziaka omume nlekọta ahụike maka nchọpụta na njikwa nke ọrịa afọ ọsịsa na-efe efe* (tebụl incubation pathogens, STEC ọgwụ nje na mgbochi motility contraindications, na njirisi nyocha stool).
• ** Centers for Disease Control and Prevention (CDC, United States):** Germs na ọrịa ndị sitere n'ihe oriri, Nchịkwa Ọrịa Norovirus na Ngwọta Ngwọta Ọrịa, na Nduzi ahụike maka botulism na Hemolytic Uremic Syndrome (HUS).
• ** National Institute for Health and Care Excellence (NICE, United Kingdom) na National Health Service (NHS, United Kingdom):**
• ** European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN):** * Ntuziaka dabere na njikwa nke nnukwu ọrịa gastroenteritis na ụmụaka na Europe* (usoro mgbazigharị mmalite na ondansetron/probiotic akaebe).

Ntuziaka emetụtara¶

• Nsi
• Sepsis na ujo septic
• Nri emebiri emebi na ike ngwa nju oyi
• Nchekwa mmiri na ọkwa obụpde