Post-Tonsillectomy Kutaya Magazi: Tsiku 5 mpaka 10 Kuthamanga kwa Mkhosa ndi Kuthamanga kwa Kutaya kwa Airway¶

Tonsillectomy (yokhala kapena popanda adenoidectomy) ndi imodzi mwama opaleshoni omwe amachitidwa kawirikawiri kwa ana ndi achinyamata padziko lonse lapansi, komabe imakhala ndi chiopsezo chodziwika, chomwe chingakhale chowopsa cha kuchedwa kwa kutuluka kwa magazi kwa mpweya mpaka masabata awiri athunthu wodwala kubwerera kwawo. Chifukwa matani a palatine amakhala pakhosi lapakhosi lomwe limaperekedwa ndi nthambi zisanu zothamanga kwambiri za mtsempha wamagazi wakunja wa carotid, komanso chifukwa mabala opangira opaleshoni kumbuyo kwa mkamwa sangasokedwe kutsekedwa kwathunthu kapena kuphimbidwa ndi bandeji, fossae yaiwisi ya tonsillar imachiritsa popanga zipsera zazikulu, zoyera-chikasu za fibrinous.eschars). Pakati pa opareshoni Masiku 5 mpaka 10, pamene khungu latsopano la mucosal limakula pansi, zipsera zotetezazi zimamasuka ndikuchoka. Ngati nkhanambo yapatukana nthawi isanakwane kapena ikang'ambika mtsempha wamkati, kutuluka magazi mwachangu kumachitika pamwamba pa khomo la m'mphepete mwake.trachea). Magazi aliwonse ofiira owoneka bwino kuchokera mkamwa kapena mphuno, kumeza mobwerezabwereza mwana akugona, kapena kusanza kwa magazi akuda a khofi pambuyo pa tonsillectomy ndi opaleshoni yadzidzidzi. Imbani foni kwanuko manambala angozi nthawi yomweyo ndipo funsani malangizo athu okhudzana nawo kutsokomola magazi ndi kukha mwazi kwa mpweya, kusanza magazi ndi magazi m'mimba,ndi hypovolemic mantha.

Chitani izi tsopano¶

1. Imbani 911, 112, kapena 999 nthawi yomweyo chifukwa chotuluka magazi ofiira owala, kutsekeka kwa magazi, kapena kusanza kwamagazi pambuyo pa tonsillectomy: Osadikirira kunyumba kuti muwone ngati magazi a post-tonsillectomy asiya okha, ndipo musamayendetse mwana yemwe akutuluka magazi mwachangu kuchipatala kumpando wakumbuyo wagalimoto yapayekha pomwe palibe amene angamve pompopompo kapena kutaya mtima.
2. Mukhazikitseni mowongoka ndi kutsamira mutu ndi chiuno patsogolo pa mbale kapena chopukutira choyera: Musalole kuti munthu amene akutuluka magazi kukhosi agone chagada. Kukhala mowongoka kumachepetsa kuthamanga kwa magazi m'mitsempha ndi mtsempha wamagazi m'khosi, pomwe kutsamira kutsogolo kumapangitsa magazi kutuluka mkamwa kulowa m'beseni kuti asasunthike pamitsempha ya mawu kapena kutsika m'mimba.
3. Mukhale ndi mwana wamkulu kapena wamkulu wogwirizira mozama ndikulavulira madzi ozizira oundana: Ngati wodwala ali maso, watcheru, ndipo amatha kutsata malangizo osatsamwitsidwa, kusuntha pang'onopang'ono madzi oundana kumbuyo kwa kamwa ndikuwalavulira mu sinki yoyera kapena mbale kumayambitsa reflex vasoconstriction ya zotengera zazing'ono zokhala ndi ma tonsillar ndikuchotsa kutuluka magazi. Musati **mumakakamize zamadzimadzi kwa mwana yemwe akulira, khanda, kapena wodwala tulo.
4. Ikani kolala ya ayezi kapena paketi yozizira kutsogolo ndi m'mbali mwa khosi ndikuyamwa madzi oundana: Kugwira paketi ya ayezi yokulungidwa ndi nsalu pakhosi lam'mbali mwa khosi (pansi pa ngodya ya nsagwada) kumathandiza kuziziritsa nthambi zakunja za carotid zomwe zimadyetsa tonsillar fossa podikirira azachipatala.
5. Muuze wodwala kulavula dontho lililonse la magazi ndi malovu m'malo mowameza: Kumeza magazi kumabisa kuchuluka kwa kukha mwazi kwa makolo ndi madokotala, kumakwiyitsa m'mimba kwambiri, ndipo kumayambitsa kusanza kwadzidzidzi.hematemesis) zomwe zimatha kusefukira munjira ya mpweya ndikung'amba bedi lamachiritso lotseguka.
6. Konzekerani kuchira ngati wodwala akuwodzera, wotumbululuka, kapena kukomoka: Ngati mwana amene akutuluka magazi kapena wachikulire wafooka, wotsimphina, kapena wosalabadira pamene akudikirira chithandizo chamwadzidzidzi, mutembenuzireni nthawi yomweyo kumbali yake pamalo ochira* nkhope yopendekeka pang'ono pansi kotero kuti magazi amatuluka pakona ya mkamwa m'malo momira m'mapapo.

Mtengo wosankha: Kuyeserera kwa post-tonsillectomy ndi kuyankha kwapanjira¶

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Pathophysiology: Chifukwa chiyani nkhanambo za tonsillectomy zimatuluka magazi sabata yathunthu pambuyo pa opaleshoni¶

Makolo ndi odwala akuluakulu nthawi zambiri amadabwa pamene magazi akutuluka pakhosi patatha masiku 7 kapena 8 atachitidwa opaleshoni, pamene wodwalayo akuyamba kumva bwino kapena kuyambiranso ntchito zake zonse. Kumvetsetsa njira yochiritsa mabala a magawo atatu a oropharynx kumafotokoza chifukwa chake zenera lochedwali ndi nthawi yachiwopsezo chachikulu.

1. Kuchuluka kwa mitsempha yamtundu wa tonsillar fossa¶

Thupi la palatine limakhala pamimba yozama ya katatu pakati pa nsanamira yam'mbuyo (palatoglossus muscle) ndi nsanamira yapambuyo tonsillar (palatopharyngeus muscle), kupumula mwachindunji pa pamwamba pharyngeal constrictor minofu . Nthambi zisanu zothamanga kwambiri za mtsempha wakunja wa carotid zimabowoleza bedi la minyewa iyi kuti lidyetse mphuno:

• Nthambi ya tonsillar ya mtsempha wakumaso (chomwe chimakhala chachikulu kwambiri komanso chodziwika bwino cha kukha magazi kotsika kwambiri).
• **Nthambi yokwera ya palatine ya mtsempha wakumaso **.
• **Nthambi za chilankhulo cha dorsal za mtsempha wa chinenero ** (kupereka mtengo wotsika pafupi ndi tsinde la lilime).
• Mtsempha wokwera wa pharyngeal (wopereka khoma lakumbuyo).
• Mtsempha wotsika wa palatine (nthambi ya mtsempha wapakati womwe umapereka mtengo wapamwamba).

Komanso, mtsempha waukulu wa paratonsillar (vein of Denis Browne) imayenda molunjika pansi pa bedi la lateral tonsillar pansi pa khoma lopyapyala, ndipo thunthu lalikulu la mitsempha yamkati ndi yakunja ya carotid imadutsa ma 1.5 mpaka 2.5 centimita (0.6 mpaka 1.0 inchi) motsatira kapisozi wakuya wa tonsillar.

2. Primary vs sekondale post-tonsillectomy kukha magazi¶

Madokotala amagawa magazi pambuyo pa tonsillectomy (PTH) m'magulu awiri osiyana kutengera nthawi ndi makina:

3. Zomwe zipsera zapakhosi (eschar) ndi chifukwa chiyani kutaya madzi m'thupi kumawapangitsa kuti azitaya magazi¶

Pasanathe maola 12 mpaka 24 pambuyo pa opaleshoni, ziboliboli zokhala ndi minyewa yomwe anachotsedwamo zimakutidwa ndi bulangete lokhuthala, lotuwa, lotuwa kapena lachikasu lopangidwa ndi fibrin, mapulateleti, maselo oyera a magazi, ndi maselo a pamwamba otsetsereka.

• Maonekedwe anthawi zonse (Osati matenda): Makolo amene amayang'ana mkamwa mwa mwana wawo pa Tsiku 3 nthawi zambiri amachita mantha akaona zigamba ziwiri zokhuthala, zonunkha zoyera ndi zachikasu zotsekera kukhosi, zomwe zimawapangitsa kukhala ndi mafinya owopsa. Fibrinous eschar imeneyi ndi yachibadwa, yoteteza nkhanambo yonyowa, komanso mpweya woipa kwambiri.halitosis) akuyembekezeka kwa masiku 10 mpaka 14.
• Mmene kutsetsereka kumachitikira (Masiku 5 mpaka 10): Pansi pa bulangeti la fibrin ili, epithelium yatsopano ya pinki ya squamous mucosal epithelium imalowa mkati pang'onopang'ono kuchokera m'mphepete mwa zipilala za tonsillar. Pakati pa masiku 5 mpaka 10, thupi limasungunula zomwe zili pakati pa khungu latsopano ndi nkhanambo yakufayo kuti nkhanamboyo ituluke m'tizidutswa ting'onoting'ono tating'onoting'ono ndikumezedwa mosazindikira ndi malovu.
• Chifukwa chiyani kutaya madzi m'thupi kumayambitsa kukha mwazi: Mosiyana ndi nkhanambo yapabondo yomwe imachira bwino mukamauma, eschar yapakhosi iyenera kukhala yonyowa mosalekeza komanso yokhazikika. Mwana akakana kumwa madzi chifukwa cha kukhosi komanso kupweteka kwa khutu, kukhosi kumauma.pharyngeal desiccation). Eschar youma imafota, imalimba kukhala kutumphuka kolimba, ndipo imakoka mwamphamvu pamitsempha yochiritsa yomwe ili pansi nthawi zonse pamene minofu yapakhosi imagwira kapena kumeza. M'malo mosungunuka bwino, nkhanambo yowumayo imang'amba pang'onopang'ono ndikung'amba khoma la arteriole yofooka kwambiri yomwe ili pansi pake.

Kuzindikira magazi obisika mwa makanda, makanda, ndi ana ogona¶

Pamene wamkulu kapena wachinyamata nthawi yomweyo amalowa m'khitchini ndikukuuzani kuti amamva kutentha, magazi achitsulo kumbuyo kwa mmero wawo, ana aang'ono (makamaka osakwana zaka 6) ndi ana omwe ali ndi zilema zachitukuko pafupifupi ** samalavula magazi**. M'malo mwake, reflex yawo yodziwikiratu ndikumeza chilichonse chomwe chimalowa m'mphuno mwawo.

Zizindikiro zosaoneka bwino za kutaya magazi kwapakhosi mwa mwana¶

Mwana akhoza kumeza mwakachetechete 20 mpaka 30 peresenti ya magazi ake onse ozungulira m’mimba mwake dontho limodzi la magazi lisanatulukire pa pillowcase kapena milomo yake. Yang'anani mwachidwi izi zowunikira zamakhalidwe ndi zakuthupi:

1. **Kumeza pafupipafupi, mobwerezabwereza pamene akugona kapena kupumula **: Yang'anani kutsogolo kwa khosi la mwanayo. Ngati mwana wogona kapena kupumula akumeza masekondi 5 mpaka 15 aliwonse osamwa chilichonse, magazi amadzimadzi amayenda mwachangu kuchokera pa bedi la tonsillar kapena bedi la adenoid.nasopharynx) kuseri kwa mmero wawo.
2. Kukantha konyowa, kutulutsa pakhosi, kapena kutsokomola mwadzidzidzi kwausiku kumafika: Magazi osakanikirana mu hypopharynx amakokera polowera m'kholingo, kumapangitsa kuti pakhale phokoso lonyowa, lomveka popuma kapena kudzuka mwadzidzidzi ndi chifuwa chovuta.
3. Kusakhazikika kwadzidzidzi, kuda nkhawa, kapena khungu lotumbululuka: M'maganizo a ana omwe ali ndi vuto la hypovolemic, ana amakhalabe ndi kuthamanga kwa magazi mwachinyengo kufikira atataya 25 mpaka 30 peresenti ya kuchuluka kwa magazi awo. Kugwedezeka koyambirira kumawonekera ngati kuthamanga kwa mtima (tachycardia), zala zotumbululuka zoziziritsa kukhosi, mkamwa zoyera zotumbululuka ndi zikope zamkati, ndi kunjenjemera kwadzidzidzi kapena kusachita bwino.
4. Mseru wadzidzidzi ndi kusanza kwa zinthu zakuda za "khofi" kapena zozungulira za maroon: Magazi akamezedwa amasakanikirana ndi hydrochloric acid (HCl) m'mimba, chitsulo cha hemoglobini chimapangidwa ndi okosijeni kukhala hematin wakuda wakuda. Mkati mwa mphindi 15 mpaka 45 mutameza mwakachetechete, m’mimba mumatuluka ndi kukwiya, zomwe zimachititsa mwanayo kusanza mwadzidzidzi madzi ochuluka a khofi woderapo woderapo wosanganikirana ndi mikwingwirima yofiira kwambiri kapena magazi oundana ngati odzola.

Kuchitapo kanthu mwachangu podikirira ambulansi¶

Mukaitana 911, 112, kapena 999, zomwe mumayika patsogolo pa mphindi 5 mpaka 15 asanafike odwala opaleshoni ndi ** kulepheretsa kupuma kwa magazi m'mapapo **, kulepheretsa kumeza kwa magazi **, ndi ** kulimbikitsa vasoconstriction yakomweko **.

1. Kuyimirira bwino kwa msewu wapamlengalenga: Kuwongoka ndi kutsamira kutsogolo¶

• Khalani mwana kapena wamkulu wowongoka pampando, pabedi, kapena pamiyendo ya makolo ndi mutu wawo ndi pachifuwa chapamwamba akutsamira patsogolo pa 30-to-45-degree angle.
• Gwirani ** mbale yoyera, beseni lapulasitiki loyera, kapena chopukutira choyera ** pansi pa chibwano chawo. Kugwiritsa ntchito chidebe choyera kumakulolani inu ndi obwera kuchipatala kuti aweruze molondola zonse ** voliyumu** ya magazi otayika ndi mtundu (wofiira wonyezimira wonyezimira motsutsana ndi madontho akuda a venous vs. pinki malovu).
• Lankhulani ndi mawu abata, achete, odekha. Kulira, kukuwa, ndi mantha kukwera kugunda kwa mtima ndi systolic kuthamanga kwa magazi, kutulutsa magazi m'chiwiya chotseguka cha tonsillar.

2. Njira yosinthira madzi oundana ndi malovu (odwala ogwirizana okha)¶

Ngati wodwala ndi wamkulu, wachinyamata, kapena mwana wazaka zakusukulu (nthawi zambiri wazaka 7 kapena kuposerapo) yemwe ali watcheru, wodekha, komanso wosatsamwitsidwa:

• Lembani chikho ndi madzi ozizira ndi wosweka ayezi.
• Muuzeni wodwalayo kuti amwe madzi ozizira pang'ono, kupendekera mutu pang'ono kuti madzi ozizira asambe kumbuyo kwa kamwa kwa masekondi 3 mpaka 5, ndi ** kulavulira madziwo pang'onopang'ono ** mu beseni (osagwedezeka mwamphamvu, monga kugwedezeka kwapakhosi kungathe kugwedeza zotayirira kuchokera m'chombo).
• Bwerezani masekondi 30 mpaka 60 aliwonse. Madzi ozizira amadziwonetsera poyera mucosal arterioles ndi capillaries mu tonsillar fossa pamene akutsuka ma enzymes a fibrinolytic mkati mwa magazi otayirira.

3. Kuzizira kwa khosi lakunja¶

• Manga thumba la ayezi wophwanyidwa kapena nandolo zowumitsidwa mu chopukutira chonyowa, chonyowa ndikuchiyika mofatsa pambali ya khosi lakumtunda pansi pa nsagwada (submandibular triangle), kapena kumbuyo kwa khosi.
• Osakulunga chilichonse mwamphamvu pakhosi kapena kukanikiza mwamphamvu pamphepo yamkuntho kapena kugunda kwa carotid.

4. Zomwe OSATI kuchita panthawi yochotsa tonsillectomy kutulutsa magazi¶

• Osamatira zala, zopyapyala, mipira ya thonje, kapena zida zasiliva kuseri kwa kamwa kunyumba kuyesa kukanikiza bedi la tonsil: Kukankhira gauze mwakhungu mu pharynx wa mwana kumayambitsa chiwawa champhamvu komanso kusanza, kukwapula chotsalira chotsalira pa bedi loyang'anizana ndi tonsil, ndikuyika pachiwopsezo chotaya magazi.
• Musamapatse aspirin, ibuprofen (pokhapokha mutayezedwa momveka bwino, komanso osapereka magazi), naproxen, kapena mankhwala ochepetsa magazi azitsamba: Mankhwala oletsa kutupa (Nonsteroidal anti-inflammatory drugs)NSAIDsmonga aspirin imalepheretsa kuphatikizika kwa mapulateleti (COX-1). Ngakhale madokotala ena ochita opaleshoni amalola ibuprofen yokonzekera pamodzi ndi acetaminophen kuti athetse ululu wa post-op, ** kusiya ma NSAID onse nthawi yomweyo ** ngati magazi atuluka.
• Musamapatse wodwala chilichonse choti adye kapena kumwa (kupatulapo madzi oundana osambira ndi kulavulira omwe sanamezedwe): Wodwala angafunikire opaleshoni yadzidzidzi m'chipinda chopangira opaleshoni mkati mwa ola limodzi, ndipo m'mimba modzaza kwambiri kumawonjezera ngozi ya pulmonary aspiration panthawi ya intubation yofulumira.

Chipatala ndi kasamalidwe ka opaleshoni: Zomwe mungayembekezere mu ER¶

Kudziwa momwe madotolo azadzidzidzi, opaleshoni, ndi otolaryngologists (ENT surgeons) Kusamalira kutaya magazi pambuyo pa tonsillectomy kumathandiza mabanja kukonzekera akafika kuchipatala.

Kuwerengera kuopsa kwa post-tonsillectomy hemorrhage (Stammberger / Windfuhr Classification)¶

Kupewa kukhetsa magazi kwachiwiri pawindo la masiku 14 lochira¶

Ngakhale kukhetsa magazi kwachiwiri kumachitika mosasamala kanthu za chisamaliro choyenera chapakhomo, kutsatira malamulo okhwima ochira pambuyo pa opaleshoni mkati mwa masiku 14 athunthu opaleshoniyo imachepetsa kwambiri chiopsezo cha eschar sloughing.

1. Kuthira madzi mosalekeza ("Mkangano wonyowa uchiritsa; nkhanambo zimatuluka magazi")¶

• Uzani mwana kapena wamkulu kuti amwe madzi pang'ono, madzi a apulo osungunuka, electrolyte solution, kapena madzi oundana pakadutsa mphindi 15 mpaka 30 zilizonse.
• Thamangani chinyontho choziziritsa kukhosi pafupi ndi bedi la wodwalayo usiku uliwonse kwa masiku 14. Chifukwa kutupa m'kamwa ndi adenoid bedi kukakamiza odwala pambuyo opaleshoni kugona ndi kukamwa motsegula, youma m'chipinda mpweya desiccates nkhanambo pakhosi usiku wonse, kufotokoza chifukwa ambiri pambuyo tonsillectomy magazi kumachitika pakati 2:00 AM ndi 6:00 AM.

2. Kuwongolera, kuwongolera kupweteka kwa mawotchi kuti wodwala apitirize kumwa¶

• Kupweteka kwapakhosi ndi **kupweteka kwa khutu ** (kuyambitsidwa ndi nthambi zogawana za mitsempha ya glossopharyngeal, Cranial Nerve IXndi vagus mitsempha, Cranial Nerve X, zomwe zimapereka bedi la matonsi ndi khutu lapakati) nthawi zambiri zimafika poipa pa Masiku 4 mpaka 8 pamene nkhanambo zimayamba kulekana.
• Kuwongolera kulemera kwa acetaminophen (paracetamol) (ndipo dokotala wa opaleshoni amavomereza alternating ibuprofen ngati atalamulidwa, ngakhale **osati aspirin ** ndi ** konse codeine kapena tramadol **, zomwe zimakhala ndi FDA/EMA zotsutsana ndi bokosi lakuda mwa ana pambuyo pa tonsillectomy chifukwa chachangu kwambiri CYP2D6 kagayidwe kake kukhala mlingo wakupha wa morphine) mokhazikika usana ndi usiku m'malo modikirira mpaka mwana akulira ndi ululu ndikukana kumeza zakumwa.

3. Kupewa zoyambitsa makina ndi magazi kwa masiku 14 athunthu¶

• Palibe zakudya zofunkha, zakuthwa, zokanda, kapena zotentha kwa masiku 14: Pewani tchipisi ta tortilla, ma crisps a mbatata, chotupitsa chowotcha, chimanga chouma, zophika, pitsa, mtedza, ma popcorn, maapulo/kaloti zosaphika, ndi soups wotentha kapena madzi a citrus. Mphepete zakuthwa za chakudya zimachotsa eschar yoyera kuchokera pa bedi la matonsi misempha ya pansi isanatseke.
• Kupumula kotheratu kwa masiku 14: Ngakhale mwana atakhala wanyonga pa Tsiku 6, letsani kuthamanga, kudumpha pa trampolines, roughhousing, masewera okhudzana, masewera olimbitsa thupi, kunyamula katundu, kapena kulimbitsa thupi mwamphamvu mpaka chizindikiro chonse cha masiku 14 chitatha ndipo chigamba chilichonse cha nkhanambo chasowa pakhosi. Ntchito iliyonse yomwe imapangitsa kugunda kwa mtima komanso kuthamanga kwa magazi kwa systolic kumatha kutulutsa chotengera chochiritsa.

Nambala zangozi zachigawo ndi ndondomeko za bungwe¶

Nthawi zonse sungani nambala yanu ya foni** ya maola 24 ya opaleshoni ya ENT** ndi nambala yanu ya ambulansi yadzidzidzi yadziko lonse yosungidwa mu foni yanu kwa masiku 14 mutatha opaleshoni:

Mafunso omwe amafunsidwa pafupipafupi¶

Chifukwa chiyani khosi la mwana wanga linayamba kutuluka magazi pa Tsiku la 7 pamene opaleshoniyo inali sabata yathunthu?¶

Panthawi yochotsa tonsillectomy, dokotalayo amamata mitsempha yapakhosi, ndipo kwa maola 24 oyambirira thupi limaphimba minyewa yaiwisi ya minofu ndi nkhanambo yotchinga yoyera-yachikasu yoteteza yomwe imatchedwa fibrinous eschar. Pakati pa Masiku 5 mpaka 10 pambuyo pa opaleshoni, khungu latsopano la pinki limakula pansi ndipo zipsera zoteteza zimamasuka ndikuphwanyidwa. Ngati nkhanambo yawuma kapena kupatukana mtsempha wamagazi usanachire, kapena ngati chakudya chachabechabe chitakula, chotengeracho chimatseguka ndikupangitsa kuti magazi achedwe ("wachiwiri") patatha sabata yathunthu opareshoni itachitika.

Mwana wanga analavulira kagawo kakang'ono ka magazi ka kotala mphindi 10 zapitazo, ndipo tsopano malovu awo ayera. Kodi tiyeneradi kupita kuchipinda chodzidzimutsa?¶

Inde, muyenera kupita ku dipatimenti yachipatala mwamsanga ngakhale magazi akuwoneka kuti asiya kwathunthu. Mu otolaryngology, kachigawo kakang'ono ka magazi pakati pa Masiku 5 ndi 10 amadziwika kuti "herald bleed" kapena sentinel bleed. Zimatanthawuza kuti chotengera chamtsempha kapena venous mu bedi la tonsil chakokoloka pamene nkhanambo imalekanitsidwa ndipo pakali pano imalumikizidwa ndi magazi osalimba, osakhalitsa. Popanda kuyang'ana m'chipatala, kutsekereza, kapena kuyang'anitsitsa usiku wonse, magazi omwe ali ndi kanthaŵi kaŵirikaŵiri amaphulika maola angapo pambuyo pake pakati pausiku, kuchititsa kutaya magazi koopsa.

Chifukwa chiyani mwana wanga akumva kupweteka kwambiri m'makutu patatha masiku asanu atachotsa tonsillectomy, ndipo kodi izi zikutanthauza kuti ali ndi matenda a khutu kapena kutuluka magazi?¶

Kupweteka kwakukulu kwa khutu komwe kumamveka pakati pa Masiku 4 ndi 8 pambuyo pa tonsillectomy nthawi zonse kumakhala "kupweteka kwapadera" osati matenda a khutu kapena chizindikiro cha magazi. Mitsempha ya cranial yomweyo (mitsempha ya glossopharyngeal, Cranial Nerve IX) imapereka kumva kuseri kwa mmero ndi khutu lapakati kudzera mumisempha ya Jacobson. Minofu yapakhosi ikayamba kusweka ndipo zipsera zikayamba kusuluka pa Tsiku 5, ubongo umatanthawuza molakwika zizindikiro za ululu wa pakhosi ngati zikuchokera mkati mwa makutu. Perekani mankhwala opweteka omwe mwakonzekera, ikani paketi yotentha kapena yoziziritsa m'makutu, ndipo limbikitsani kutafuna chingamu kapena kumwa zakumwa kuti muchepetse nsagwada ndi zapakhosi.

Kodi ndingadziwe bwanji kusiyana pakati pa nkhanambo zoyera zochiritsa ndi matenda apakhosi pambuyo pa tonsillectomy?¶

Mkangano wanthawi zonse wa post-tonsillectomy (eschars) umawoneka wokhuthala, wonyezimira, woyera choko, wotuwa, kapena wachikasu, umakhala wokhazikika m'matumba awiri omwe kale panali zotupa, ndipo zimayambitsa mpweya woipa kwambiri.`halitosis`) mpaka milungu iwiri. Iwo si matenda ndipo safuna mankhwala. Muyenera kuonana ndi dokotala wa opaleshoni ya ENT kuti mutenge matenda kapena kutaya madzi m'thupi pokhapokha ngati wodwala ayamba kutentha thupi kosalekeza kupitirira madigiri 38.9 Celsius (102.0 degrees Fahrenheit), kufalitsa kufiira kowala ndi kutupa m'kamwa lofewa ndi khosi, kapena kulephera kumeza zamadzimadzi.

Chifukwa chiyani adokotala anatiuza kuti tisamapatse codeine kapena aspirin pambuyo pa tonsillectomy?¶

Aspirin imatsekereza mapulateleti kuti asamamatirane kwa masiku onse 7 mpaka 10 a moyo wa kupatsidwa zinthu za m'mwazi, zomwe zimawonjezera chiopsezo cha kutaya kwambiri kwa magazi pambuyo pa tonsillectomy. Codeine (ndi tramadol) ndi yoletsedwa kwambiri pambuyo pa tonsillectomy ya ana chifukwa kusintha kwa majini mu chiwindi cha enzyme (`CYP2D6 ultra-rapid metabolizers`) kumapangitsa ana ena kusintha mlingo wokhazikika wa codeine kukhala woopsa kwambiri wa morphine m’mwazi wawo, umene umatha kuletsa kupuma kwawo pamene akugona, makamaka kwa ana amene anachotsedwako matani awo chifukwa cha vuto lobanika kutulo.

Kodi kusanza kwakuda "kokhala pansi pa khofi" kumatanthauza chiyani pambuyo pa tonsillectomy?¶

Kusanza zinthu za bulauni zakuda zomwe zimawoneka ngati khofi wonyowa, kapena kusanza zokhala ngati zotsekemera za maroon, ndizovuta zachipatala zomwe zikutanthauza kuti wodwalayo wakhala akutuluka mwakachetechete kukhosi kapena mphuno ndikumeza magazi m'mimba mwake. Magazi akakhala m’mimba ya asidi kwa mphindi 15 mpaka 45, asidiyo amatembenuza chitsulo chofiyira chonyezimira m’mwazi woderapo ndi kukwiyitsa m’mimba mpaka wodwalayo asanze. Imbani 911, 112, kapena 999 nthawi yomweyo, ngakhale simunawone magazi ofiira owala akuchucha mkamwa.

Maupangiri ogwirizana¶

• Kutsokomola magazi (hemoptysis) ndi kukha mwazi kwakukulu kwa mpweya
• Kusanza kwa magazi (hematemesis), melena, ndi kutuluka kwa m'mimba
• Kutupa kwa peritonsillar, angina ya Ludwig, ndi matenda a m'khosi
• Kutuluka magazi m'mphuno (epistaxis) ndi kutuluka kwa m'mphuno kumbuyo
• Hypovolemic ndi hemorrhagic kuzindikira mantha

Magwero ndi malangizo ovomerezeka¶

• American Academy of Otolaryngology - Opaleshoni ya Mutu ndi Nkhongo (AAO-HNS, United States): *Chitsogozo Chothandizira Zachipatala: Tonsillectomy mu Ana (Kusintha) - Kuwunika Kutaya kwa Kutaya kwa M'mbuyo, Kupweteka Kwambiri, ndi Codeine Contraindication *.
• ENT UK & Royal College of Surgeons of England (United Kingdom): National Prospective Tonsillectomy Audit and Emergency Management of Post-Tonsillectomy Haemorrhage Guidelines.
• Association of Pediatric Anesthetists of Great Britain and Ireland (APAGBI): Consensus Guideline on the Emergency Anesthetic and Airway Management of Post-Tonsillectomy Haemorrhage (Bleeding Tonsil).
• Chipatala cha Royal Children's Hospital Melbourne (Australia): Malangizo Othandizira Zachipatala: Tonsillectomy ndi Adenoidectomy Post-Operative Care and Hemorrhage Grading.
• U.S. Food and Drug Administration (FDA, United States) & European Medicines Agency (EMA): Kulankhulana pa Chitetezo cha Mankhwala: Chenjezo la Boxed Contraindicating Codeine ndi Tramadol for Post-Tonsillectomy Pain Management in Children.