Amaraso ava inyuma yo gukuraho amatonsi: Umusi wa 5 gushika ku wa 10 Gukuraho ibisebe no gutoranya amaraso ava mu nzira y’impwemu¶

Gukuraho amatonsillectomy (harimwo canke ata adenoidectomy) ni kimwe mu bikorwa bikoreshwa cane mu kubaga abana n’abakiri bato kw’isi yose, yamara rero birafise ingorane idasanzwe, ishobora gutuma umuntu apfa, iyo umuntu atevye kuva amaraso mu nzira y’impwemu gushika inyuma y’indwi zibiri zuzuye umurwayi asubiye i muhira. Kubera ko amatonsille palatine yicaye mu gitanda c’imitsi y’umuhogo gihabwa n’amashami atanu afise umuvuduko munini w’umutsi w’inyuma w’akanwa, be n’uko ibikomere vyo kubagwa inyuma y’akanwa bidashobora kudogwa bipfutse bimwe bishitse canke ngo bipfukwe n’umugozi, amatonsille atagiramwo ibinure arakira, mu guhingura thickye fibri-eschars). Hagati y’inyuma y’ugukorwa Imisi ya 5 n’iya 10, uko urukoba rushasha rw’umubiri rukura munsi, ivyo bikoko bikingira birarekura bigaca bivaho. Iyo igisebe gitandukanye imbere y’igihe canke kigafungura umutsi uri munsi yaho, amaraso arasohoka vyihuta hejuru cane y’ubwinjiriro bw’umutsi w’umuyaga (trachea). Amaraso yose aboneka atukura cane ava mu kanwa canke mu zuru, gusubiramwo kenshi umwana asinziriye, canke guruka amaraso y’umwirabura yasezwe n’ikawa inyuma yo kubagwa amatonsille, ni ikintu gikomeye co kubagwa. Hamagara aho uba inomero z'ivyihutirwa ubwo nyene maze urabe uburongozi bwacu bujanye n’ivyo kuri . gukorora amaraso no kuva amaraso mu nzira y'impwemu, guruka amaraso no kuva amaraso mu nda, na guhungabana.

Ivyo ubikore ubu¶

1. Hamagara 911, 112, canke 999 ubwo nyene ku bijanye n’amaraso atukura cane, amaraso atera, canke amaraso atera inyuma yo gukura amatonsi: Ntukigere urindira i muhira kugira ngo urabe nimba amaraso ava inyuma yo gukugwa amatonsi ahagarara ubwayo, kandi ntukigere utwara imodoka iva amaraso mu bitaro aho umwana wiwe ashobora gusubira mu bitaro inzira y’impwemu iyo bahumekera canke bagatakaza ubwenge.
2. Icara umurwayi ahagaze maze ushire umutwe n’umubiri imbere hejuru y’igikombe canke igitambaro cera: Ntukigere wemera ko umuntu afise amaraso ava mu muhogo aryama ku mugongo. Kwicara ugororotse bigabanya umuvuduko w’amaraso mu mitsi no mu mitsi yo mu ijosi, mu gihe kwiheka imbere bituma amaraso asohoka mu kanwa akaja mu gitereko kugira ngo ntaterere hejuru y’imitsi y’ijwi canke ngo amanuke aja mu nda.
3. Ugire umwana mukuru canke umuntu akuze akorana n’abandi, akure amazi akanye nk’urubura: Iyo umurwayi ari maso, ari maso, kandi ashobora gukurikiza amabwirizwa ataco aniha, gutera amazi y’urubura mu kanwa inyuma y’akanwa akayasuka hanze mu gitereko c’amazi canke mu gitereko cera, bishobora gutuma ugira ububabare bw’imitsi y’amaraso. urabe nimba amaraso ariko arava. Ntu guhatira amazi mu mwana muto arira, uruyoya, canke umurwayi asinziriye.
4. Shira ice collar canke cold pack imbere n’inyuma y’izosi hanyuma wonke ice pop: Gufata ice pack izingiwe n’impuzu ku ijosi ryo hejuru ry’inyuma (munsi y’umwanya w’urwaya gusa) birafasha gukonjesha amashami y’inyuma y’urusaya agaburira tonsillar fossa mu gihe urindiriye paramedics.
5. Itegeke umurwayi guca amacandwe yose y’amaraso n’amacandwe aho kuyamira: Gumira amaraso bihisha umubare nyawo w’amaraso ava mu bavyeyi n’abaganga, birababaza cane urukoba rwo mu nda, kandi bituma umuntu atera umutwe mu buryo butunguranye (hematemesis) bishobora gusesagura inzira y’impwemu maze bikarushiriza gutabura igitanda c’umuhogo gikira.
6. Itegure gukira iyo umurwayi asinziriye, apfutse, canke acitse intege: Iyo umwana canke umuntu akuze ava amaraso acitse intege, akagira ububabare, canke akabura ico yishura mu gihe arindiriye ubuvuzi bwihutirwa, uce umuzunguruka ubwo nyene ku ruhande rwiwe mu hantu yo gukira hasi mu maso n’umuco akanwa aho kuroha amahaha.

Igiti c'ingingo: Inyuma yo gukuraho amatonsil n'inyishu y'inzira y'impwemu¶

flowchart TD
    PostOp["Umurwayi amaze gukurwako amatonsille (Umusi wa 0 gushika ku musi wa 14)"] --> SignCheck{"Hari Amaraso Atukura Akeye, Amacandwe Afise Amaraso, Igikoko Gitukura, Canke Amarura y’Ikawa?"}
    SignCheck -->|"Ego, Gusohoka Gukora, Gutera Amaraso, Gusesa Amaraso, canke Gutukura"| CallEMS["HAMAGARE 911 / 112 / 999 UBWO nyene: Usabe Ambulance ifasha ubuzima"]
    CallEMS --> Conscious{"Umurwayi yoba ari maso kandi akagenzura inzira y’impwemu yiwe?"}
    Conscious -->|"Ego"| Upright["Icara Ugororotse Uhevye Imbere; Tuka Amaraso Yose Mu Kinogo; Ice Pack ku Izosi; Amazi y'urubura Swish iyo ari umuburo"]
    Conscious -->|"Oya, Ucumbagira, Ugusinzira, canke Ugutontomera"| Lateral["Gutemba Ku Ruhande (Ikibanza co Gukira) Ukanwa Kari Hasi; Ivyuma Biboneka Bigaragara; Gutegura CPR"]
    SignCheck -->|"Ego, Agace Gatoyi k’Amaraso Kahagaze (‘Herald Bleed’)"| GoToER["NTURINDERE MU RUGO: Ugutwara abantu mu gisata c’ivyihutirwa kugira ngo basuzume kandi bavyitegereze"]
    SignCheck -->|"Nta maraso aboneka"| SubtleCheck{"Gusubiramwo kenshi, Gutera umuhogo, Tachycardie nshasha canke Guhagarika umutima mu buryo butunguranye?"}
    SubtleCheck -->|"Ego"| TorchLook["Shine Flashlight in Mouth: Rondera Amaraso Atemba Hasi ku Ruhome rw’Inyuma y’Umuhogo canke Igipfunsi mu Fossa"]
    TorchLook -->|"Amaraso canke Igipfunsi Bibonetse"| GoToER
    TorchLook -->|"Ibisebe vyera/umuhondo vyonyene nivyo vyabonetse"|HydrationCheck{"Ububabare bukomeye bwo mu gutwi/mu muhogo, Kwanka kunywa amasaha 12+, canke umuriro mwinshi > 38.9 C (102 F)?"}
    HydrationCheck -->|"Ego"| UrgentContact["Baza umuganga w'amatwi canke umuganga w'abana kugira ngo ubone amazi n'ububabare/indwara"]
    HydrationCheck -->|"Oya"| NormalCare["ESCHAR YO GUKIZA BIsanzwe: Bandanya Ufata Amazi, Acetaminophen, n’Ivyokurya Bisanzwe"]

Pathophysiology: Kubera iki ibisebe vy’amatonsillectomy biva amaraso indwi yose inyuma yo kubagwa¶

Abavyeyi n’abarwayi bakuze baratangara kenshi iyo amaraso ava mu muhogo haciye imisi 7 canke 8 abazwe, igihe nyene uwo murwayi yariko atangura kwumva ameze neza gatoyi canke agasubira gukora ibikorwa bisanzwe. Gutahura ingene ibikomere bikira mu ntambwe zitatu vyo mu kanwa, birasigura igituma iryo dirisha ricerezwa ari co gihe c’akaga gakomeye cane.

1. Ubutunzi bw'imitsi y'amaraso y'amatonsille¶

Igihimba c’umubiri citwa palatine kiri mu gitereko c’imitsi y’inkomoko itatu kiri hagati y’inkingi y’imbere y’igihimba c’umubiri (palatoglossus muscle) n’inkingi y’inyuma y’amatonsille (palatopharyngeus muscle), iruhukira ataco ihinduye hejuru y’umutsi w’umuhogo wo hejuru. Amashami atanu y’imitsi y’amaraso atemba cane y’umutsi w’inyuma w’umutwe atobora iki gitanda c’imitsi kugira ngo agaburire amatonsille:

• Ishami ry’amatonsi ry’umutsi wo mu maso (ni ryo rituma umutsi wo hasi uva amaraso cane kandi ukaba usanzwe).
• Ishami ry’umutsi wo mu maso riduga ryitwa palatine.
• Amashami y’ururimi yo mu mugongo y’umutsi w’ururimi (atanga igiti co hasi kiri iruhande y’ishingiro ry’ururimi).
• Umutsi w’umuhogo uduga (utanga uruhome rw’inyuma).
• Umutsi w’amaso umanuka (ishami ry’umutsi w’amaso utanga umutsi w’imbere).

Ikindi kandi, umutsi munini paratonsillaire (vein of Denis Browne) igenda ihagaze imanuka mu gitanda c’amatonsille co mu ruhande munsi gato y’uruhome rw’imitsi yoroshe, kandi umubiri nyamukuru w’imitsi y’amatonsile yo mu mutima n’iyo hanze uca gusa ku masentimetero 1,5 gushika kuri 2,5 (0,6 gushika ku 1,0 inch) mu ruhande rw’igice c’amatonsille kiri mu bwimbike.

2. Ugusohoka amaraso kw’intango n’ukwa kabiri inyuma yo gukura amatonsille¶

Abaganga bashira mu migwi amaraso ava inyuma yo gukura amatonsille (PTH) mu mice ibiri itandukanye ishingiye ku gihe n’uburyo:

3. Ivyo umuhogo mweru utera (eschar) ni n’igituma ukubura amazi mu mubiri bituma bava amaraso .¶

Mu masaha 12 gushika kuri 24 inyuma y’aho umuntu abazwe, izo nzira z’imitsi zidasanzwe aho bakuye amatonsille zica zipfukwa n’igitambaro gikomeye, gifise ubwoya, gifise ibara ry’umweru canke ry’umuhondo, kikaba gifise utugingo ngengabuzima twitwa fibrine, utugingo ngengabuzima twera, utugingo ngengabuzima twera be n’utugingo ngengabuzima two hejuru.

• Igishushanyo gisanzwe (Si infection): Abavyeyi baraba mu kanwa k’umwana wabo ku musi wa 3 kenshi barahagarika umutima iyo babonye ibice bibiri vy’umuhondo vyera bikomeye kandi bimota nabi bipfutse inyuma y’umuhogo, bakavyihendako ko ari ibisebe bikomeye vy’umuhogo canke ibisebe vy’umuhondo. Iyi fibrinous eschar ni igisebe gisanzwe, gikingira, kandi ni umunuko mubi ukomeye (halitosis) bitezwe ko bimara imisi 10 gushika kuri 14.
• Uko gusenyuka bishika (Imisi ya 5 gushika ku ya 10): Munsi y’ico gipfukisho c’amafibrine, igihimba gishasha c’umubiri gifise ibara ry’agahama (pink squamous mucosal epithelium) kiragenda kigenda kija imbere buhoro buhoro kivuye ku nkengera z’inkingi z’amatonsille. Hagati y’Imisi ya 5 n’iya 10, umubiri urasenyura ubufatanye buri hagati y’urukoba rushasha n’igisebe c’umubiri gipfuye kiri hejuru kugira ngo ico gisebe gishobore guca mu bice bitobito bitobito maze kigamirwa n’amacandwe ata wubibona.
• Igituma ukubura amazi mu mubiri bitera amaraso: Bitandukanye n’igisebe co ku ivi gikira neza mu kirere c’umye, eschar yo mu muhogo itegerezwa kuguma iguma itose kandi ikomeye. Iyo umwana yanse kunywa amazi kubera ububabare bwo mu muhogo no mu gutwi, umuhogo urakama (pharyngeal desiccation). Eschar yumye iragabanya, igakomera ikaba igihimba c’umubiri gikomeye, maze igakwega cane imitsi y’amaraso ivura iri munsi yayo igihe cose imitsi y’umuhogo ipfutse kugira ngo imere canke ikorere. Aho gusenyuka neza, iyo nkoko yumutse iratabura mu gice kimwe, igatabura uruhome rw’umutsi w’amaraso wari munsi yawo wari waragoyagoye kubera ubushuhe.

Kumenya amaraso yihishije mu bana b'inzoya, abakiri bato, n'abana basinziriye¶

Mu gihe umuntu akuze canke umuyabaga azoca yinjira mu gikoni akubwira ko asongora amaraso asusurutse, y’icuma inyuma y’umuhogo, abana batoyi (na cane cane abari munsi y’imyaka 6) n’abana bafise ubumuga bwo mu bijanye n’iterambere hafi ntibashobora guca amaraso hanze. Ahubwo, ikintu gikora ubwaco ni ukumira ikintu cose cinjira mu rwara rwabo.

Ibimenyetso vy'imburi vy'amaraso ava mu muhogo mu mwana¶

Umwana arashobora kumira mu gacerere ibice 20 canke 30 kw’ijana vy’amaraso yose agendagenda mu nda yiwe imbere y’uko n’itonde rimwe ry’amaraso riboneka ku gipfukisho c’umusego canke ku minwa yiwe. Raba neza ibi bimenyetso vy’inyifato n’ivy’umubiri:

1. Gumira kenshi, gusubiramwo igihe umuntu asinziriye canke ariko araruhuka: Raba imbere y’izosi ry’umwana. Iyo umwana asinziriye canke aruhutse ariko aramira buri masegonda 5 canke 15 igihe ata co anywa, amaraso y’amazi aratemba cane avuye mu gitanda c’amatonsille canke mu gitanda c’amatonsi (nasopharynx) bimanuka inyuma y’umuhogo wabo.
2. Gugukorora gutose, gukorora umuhogo, canke gukorora bukwi na bukwi mw’ijoro: Amaraso atera mu nzira y’umuhogo atera umutwe, bigatuma umuntu agira ijwi ry’amazi, ry’ibibumbano mu gihe umuntu ariko arahumeka canke akavyuka bukwi na bukwi afise igikomere gikomeye.
3. **Uguhagarika umutima mu buryo butunguranye, amaganya, canke urukoba rwo mu bwoko bwa hypovolemic shock y’abana, abana baguma bafise umuvuduko w’amaraso usanzwe mu buryo buhenda gushika batakaje 25 canke 30 kw’ijana vy’umubare w’amaraso yabo. Guhungabana hakiri kare bigaragara nk’ugutera kw’umutima (tachycardia), intoke n’amano bikonje vyera, amano n’ibipfunsi vy’imbere vyera, be n’uguhungabana bukwi na bukwi canke ukubura umutima.
4. Ugusesa amaraso n'ugusesa amaraso bitunguranye bivuye ku bintu vyirabura "vyakozwe mu kafe" canke amaraso y'umutuku: Iyo umuntu amize amaraso avanga n'aside hydrochlorique (HCl) mu nda, icuma kiri muri hemoglobine kirahinduka aside y’umuhondo yirabura yitwa hematine. Mu minota 15 gushika kuri 45 umuntu amaze kumira ata co avuga, inda iravyimba kandi igashavura, ivyo bikaba bituma umwana atera bukwi na bukwi amazi menshi y’umuhondo w’agahama y’ikawa avunganye n’imirongo itukura cane canke n’ibihimba bimeze nk’ibitoke.

Ibikorwa vy'ubutabazi bwa mbere vyihuse mu gihe urindiriye imodoka itwara abarwayi¶

Umaze guhamagara 911, 112, canke 999, ivyo ushira imbere mu minota 5 gushika kuri 15 imbere y’uko abaganga bashika ni kubuza amaraso gushika mu mahaha, kubuza amaraso kumira, no guhimiriza amaraso mu karere.

1. Gushiramwo neza inzira y’impwemu: Guhagarara no kwiheka imbere¶

• Nimwicare umwana canke umuntu akuze ahagaze ku ntebe, ku ntebe canke ku bibero vy’umuvyeyi, umutwe wiwe n’igifu co hejuru bikaba vyemeje imbere mu mfuruka y’amadegre 30 gushika kuri 45.
• Fata igikombe cera, igikombe c’ipulasitike cera, canke igitambaro cera munsi y’ikibuno cabo. Gukoresha igikoresho cera bituma wewe n’abaganga bashika mushobora guca urubanza neza ku ubunini bw’amaraso yatakaye be n’ibara ryayo** (umutuku ukeye w’imitsi n’amacandwe y’umuhondo).
• Vuga mw’ijwi ritekanye, ritekanye kandi ridahinduka. Kurira, gusemerera no gutera ubwoba bituma umutima utera cane be n’umuvuduko w’amaraso, ivyo bikaba bituma amaraso asohoka mu mutsi w’amatonsile wuguruye vyihuta cane.

2. Uburyo bwo gutera amazi y’urubura (Abarwayi bakorana gusa)¶

Nimba umurwayi ari umuntu akuze, umuyabaga, canke umwana akuze w’imyaka y’ishure (mu bisanzwe afise imyaka 7 n’irenga) ari maso rwose, atuje, kandi adaniha:

• Uzuza igikombe amazi akanye n’urubura rwajanjaguritse.
• Reka umurwayi afate akacupa gatoyi k’amazi akanye nk’urubura, azunguze umutwe gatoyi kugira ngo ayo mazi akanye yoge inyuma y’akanwa mu masegonda 3 gushika kuri 5, hanyuma acire amazi hanze mu gitereko (ntiwigere ukaraba cane, kuko guhungabana kw’umuhogo gukomeye gushobora guhungabanya utugingo ngengabuzima tw’imitsi).
• Usubiremwo buri masegonda 30 gushika kuri 60. Amazi akanye arafunga imitsi y’amaraso n’imitsi y’amaraso iri mu mfuruka y’amatonsille mu gihe asukura intungamubiri zitera amaraso mu maraso zidakomeye.

3. Gukonjesha izosi ryo hanze¶

• Zingira umufuko w’urubura canke ibitunguru vyakonje mu gitambaro c’amasahani gitose kandi gitose maze ugishire ku ruhande rw’izosi ryo hejuru munsi y’umurongo w’urwaya (submandibular triangle), canke ukajabuka inyuma y’izosi.
• Ntukigere uzingira ikintu na kimwe mw’izosi canke ngo ukande cane ku nzira y’umuyaga canke ku nzira y’umutsi w’umutima.

4. Ivyo UTAKORA mu gihe umuntu avuye amaraso inyuma yo gukura amatonsille¶

• Ntukigere ushiramwo intoke, ibipande vy’impuzu, imipira y’ipampa, canke ibikoresho vy’ifeza inyuma y’akanwa muhira kugira ngo ugerageze gukanda ku gitanda c’amatonsille: Gusunika impuzu mu kanwa k’umwana ataco ubona bituma umwana agira ububabare bukomeye kandi akaruha, bica bitera ingorane y’amaraso asigaye, gaze pad igororotse mu muhogo.
• Ntukigere utanga aspirine, ibuprofen (kiretse iyo uyisuzumye neza, kandi ntukigere utanga mu gihe umuntu ariko arasohoka amaraso), naproxen, canke imiti igabanya amaraso y’ibimera: Imiti igabanya umururumba idakoreshwa n’ibimera (NSAIDs) nk’uko aspirine ibuza ata gusubira inyuma kwirundanira kw’utugingo ngengabuzima (COX-1). Naho abaganga bamwebamwe bemera ko umuntu afata imiti yitwa ibuprofen hamwe n’imiti yitwa acetaminophen kugira ngo umuntu ashobore guhangana n’ububabare busanzwe inyuma yo kubagwa, hagarike imiti yose y’ibitera ububabare ubwo nyene iyo hari amaraso ava.
• Ntukigere uha umurwayi ico arya canke co kunywa (uretse amazi y’urubura y’ugusuka n’amacandwe atamira): Umurwayi ashobora gukenera guterwa umuti w’ububabare rusangi mu gihe c’isaha imwe, kandi iyo umuntu afise inda yuzuye, yongera cane ingorane zo guhumeka mu mahaha mu gihe c’ugutera umuti w’amahaha mu buryo bwihuta.

Uburongozi bw’ibitaro n’ubuvuzi bwo kubaga: Ivyo wokwitega muri ER¶

Kumenya ingene abaganga bavura indwara zihutirwa, abaganga batera umuti wo gutera umutima be n’abaganga bavura indwara z’amatwi n’amatwi (ENT surgeons) gucungera amaraso ava inyuma y’uguca amatonsille bifasha imiryango kwitegura iyo ishitse mu bitaro.

Gupima uburemere bw’amaraso ava inyuma yo guca amatonsille (Stammberger / Windfuhr Classification)¶

Gukingira amaraso ava mu gihe c'imisi 14 yo gukira¶

Naho amaraso amwe amwe ashobora kuva naho umuntu yitaho neza mu rugo, gukurikiza amategeko akomeye yo gukira inyuma yo kubagwa mu misi 14 yose inyuma yo kubagwa biragabanya cane ingorane zo gusenyuka kw’amaraso mbere y’igihe.

1. Gutera amazi mu mubiri ("Ibisebe vy'amazi birakira; ibisebe vyumye birava amaraso")¶

• Nimubwire umwana canke umuntu akuze anywe utuvunji dutoduto tw’amazi, umutobe w’ipome, umutobe w’amazi canke ice pops buri minota 15 canke 30 mu masaha yose umuntu ariko aravyuka.
• Gukoresha igikoresho co gutonyanga umuyaga gikonje iruhande nyene y’igitanda c’umurwayi ijoro ryose mu kiringo c’imisi 14. Kubera ko ukuvyimba hirya no hino y’ururimi n’igitanda c’ama adenoide bituma abarwayi bamaze kubagwa baryama bafunguye akanwa, umuyaga wumye wo mu cumba co kuraramwo uratuma ibisebe vyo mu muhogo vyuma ijoro ryose, ivyo bikaba bisigura igituma amaraso menshi cane ava inyuma yo kubagwa amatonsil aba hagati ya 2:00 z’ijoro n’isaha zitandatu z’ijoro.

2. Gutegekanya, gucungera ububabare nk'isaha kugira ngo umurwayi agume anywa¶

• Ububabare bwo mu muhogo n’ububabare bwo mu gutwi buvugwa** (buterwa n’amashami y’ugutahura asangira y’umutsi w’amajambo, Cranial Nerve IX, n’umutsi w’umubiri, . Cranial Nerve X, zitanga igitanda c’amatonsi n’ugutwi kwo hagati) kenshi birakomera ku misi ya 4 gushika ku ya 8 nk’uko nyene ibisebe bitangura gutandukana.
• Gutanga umuti ushingiye ku buremere acetaminophene (paracetamol) (n’ibuprofen yemejwe n’umuganga iyo itegetswe, naho ntiwigere ufata aspirin na ntiwigere ufata codeine canke tramadol, zifise ibimenyetso vy’ububisha vya FDA/EMA ku bana bamaze gukurwako amatonsille kubera ko zifata vuba cane CYP2D6 metabolism into lethal morphine doses) ku rutonde rukomeye rw’amasaha yose aho kurindira gushika umwana ariko ararira kubera ububabare kandi yanse kumira amazi.

3. Kwirinda ibintu bitera umuvuduko w’amaraso mu misi 14 yuzuye¶

• Nta vyo kurya bishaje, bisongoye, bishaje, canke bishushe mu misi 14: Irinde ibitoke vy’ibitoke, ibitoke vy’ibitoke, ibitoke vy’ibitoke bikomeye, ibitoke vyumye, ibitoke vy’ibitoke, ibitoke vy’ibitoke vy’ibitoke, inyama z’ingurube, ibitoke vy’ibitoke, amapome/ibitoke bitagiramwo ibinure, n’amasupu ashushe cane canke amasupu y’ibitoke vy’ibitoke vy’aside. Ivyokurya bisongoye bica bikura ku mubiri eschar yera ku gitanda c’amatonsille imbere y’uko imitsi y’amaraso iri munsi yayo ipfuka.
• Ikiruhuko c’umubiri gikomeye imisi 14: Naho umwana yoba yumva afise inguvu ku musi wa 6, mubuze kwiruka, gusimbuka ku bitanda, gukora imyimenyerezo y’umubiri, gukora imyimenyerezo y’umubiri, guterura ibintu bikomeye, canke gutera inguvu nyinshi gushika ikimenyetso c’imisi 14 yose kirangiye kandi akamenyetso kose k’umubiri kavuye mu bikorwa vy’umubiri. Igikorwa cose cotuma umutima utera cane be n’umuvuduko w’amaraso utera cane, gishobora gutuma umutsi w’amaraso ukira.

Inomero z'ivyihutirwa zo mu karere n'amategeko y'ibigo¶

Imisi yose uzigame muri telefone yawe **inomero yawe ya telefone y’amasaha 24 y’abaganga b’amatwi n’inomero yawe y’igihugu y’ubuvuzi bw’ivyihutirwa imisi 14 inyuma yo kubagwa:

Ibibazo bikunda kubazwa¶

Ni kuki umuhogo w’umwana wanje watanguye kuva amaraso ku musi wa 7 kandi haciye indwi yose abazwe?¶

Igihe umuganga abaga amatonsille, arafunga imitsi y’amaraso iri mu gitanda c’umuhogo, maze mu masaha 24 ya mbere umubiri ugapfuka ivyuho vy’imitsi bitagiramwo ibinure n’igikoko gikomeye c’umuhondo w’umweru gikingira citwa fibrinous eschar. Hagati y’imisi ya 5 n’iya 10 inyuma yo kubagwa, urukoba rushasha rw’ibara ry’agahama rurakura munsi maze ivyo bikoko bikingira birarekura mu buryo busanzwe bigaca bivaho. Iyo igisebe cyumye canke kigatandukana imbere y’uko umutsi w’amaraso uri munsi yawo ukira neza, canke iyo ivyokurya bikomeye biwukaraba, uwo mutsi uri munsi yawo urafunguka maze ugatuma amaraso ava ateba (“secondaire”) indwi yose inyuma y’aho umuntu abazwe.

Umwana wanje yaraturiye akagingo ngengabuzima gatoyi k’amaraso kangana n’ica kane, ubu hakaba haciye iminota 10, ubu amacandwe yabo araboneka neza. None vy’ukuri turakeneye kuja mu cumba c’abarwayi vyihutirwa?¶

Egome, utegerezwa guca uja mu bitaro vy’abagwayi bihutirwa naho amaraso yoba asa n’aho ahagaze burundu. Mu vy'amatwi n'amatwi, igihe gitoyi kandi gitoyi c'amaraso hagati y'imisi ya 5 n'iya 10 kizwi kw'izina rya "amaraso y'umumenyeshamakuru" canke amaraso y'umurinzi. Bisigura ko umutsi w’amaraso canke w’imitsi iri mu gitanda c’amatonsille wasenyutse uko igisebe cagenda kiratandukana kandi ubu kikaba gipfutse gusa n’igice c’amaraso gishobora gusenyuka kandi c’igihe gito. Iyo ata n’umwe asuzumye mu bitaro, ata n’umwe ayisuzumye canke ngo ayisuzume ijoro ryose, iyo nkoko y’igihe gito irakunda gusohoka haciye amasaha menshi hagati mw’ijoro, igatuma umuntu ava amaraso ashobora gutuma apfa.

Ni kuki umwana wanje agira ububabare bukomeye mu gutwi imisi 5 amaze gukugwa amatonsille, kandi ivyo bisigura ko bafise indwara y’ugutwi canke amaraso?¶

Ububabare bukomeye bwo mu gutwi bushika ku rwego rwo hejuru hagati y'imisi 4 n'umunani inyuma yo gukuraho amatonsille hafi y'igihe cose ni "ububabare burungitswe" aho kuba indwara y'ugutwi canke ikimenyetso c'amaraso. Uwo mutsi nyene w’umutwe (umutsi w’amajambo, umutsi w’umutwe IX) utanga inyiyumvo ku nyuma y’umuhogo no ku gutwi kwo hagati biciye ku mutsi wa Jacobson. Iyo imitsi y’umuhogo ipfutse maze ibisebe bigatangura gusenyuka ku musi wa 5, ubwonko burasobanura nabi ivyo bimenyetso vy’ububabare bwo mu muhogo ko biva imbere cane mu matwi. Uhe umuti w’ububabare utegekanijwe, ushireko igipapuro gishushe canke gikonje ku matwi, kandi uremeshe gutafuna canke kunywa amazi kugira ngo imitsi y’urwaya n’iy’umuhogo irekure.

Nomenya gute itandukaniro riri hagati y’ibisebe vyera bisanzwe bikira n’indwara y’umuhogo inyuma yo gukuraho amatonsille?¶

Ivyiyumviro bisanzwe biva ku gukuraho amatonsille (eschars) bisa n’ibikomeye, bifise ubwoya, vyera nk’ibara ry’agahama, vy’imvi canke nk’umuhondo, biguma mu mifuko ibiri aho amatonsille yahora ari, kandi bituma umuntu agira umwuka mubi cane (`halitosis`) gushika mu ndwi zibiri. Si indwara kandi ntibisaba imiti irwanya indwara. Ushobora guhamagara umuganga w’amatwi n’amatwi kugira ngo umenye ko yoba yanduye canke akabura amazi mu mubiri gusa iyo umurwayi afise umuriro mwinshi uhoraho uri hejuru ya degre 38,9 Celsius (102,0 degrees Fahrenheit), ugakwiragiza umutuku ukeye n’ukuvyimba mu rurimi rworoshe no mw’izosi, canke akabura ubushobozi bwo kumira amazi.

Ni kuki umuganga yatubwiye ko tutazokwigera duha codeine canke aspirine inyuma yo gukura amatonsille?¶

Aspirine irabuza ubudasiba utugingo ngengabuzima two mu maraso gufatanya mu kiringo cose c’ubuzima bw’utugingo ngengabuzima tw’amaraso kuva ku misi 7 gushika ku 10, ivyo bikaba bituma umuntu agira ingorane nyinshi zo kuva amaraso menshi inyuma yo guca amatonsille. Codeine (na tramadol) birabujijwe cane inyuma y’uguca amatonsille y’abana kubera ko hariho uguhinduka kw’ivy’uruvyaro mu bihimba vy’igitigu (`CYP2D6 ultra-rapid metabolizers`) bituma abana bamwebamwe bahindura imiti isanzwe y’imiti yitwa codeine bakayigira imiti myinshi cane iteye akaga yitwa morphine iri mu maraso yabo, ivyo bikaba bishobora guhagarika guhema kwabo igihe basinziriye, canecane ku bana bakuweko amatonsille kubera ububabare bwo guhema neza iyo basinziriye.

Guruka amazi y'umuhondo mwiza "y'ikawa" bisobanura iki inyuma yo gukuraho amatonsille?¶

Guruka ibintu vy’umuhondo mwiza bisa n’ibitoke vy’ikawa, canke guruka ibice vy’umuhondo vyirabura bimeze nk’ibitoke vy’umukara, ni ikintu gikomeye c’ubuvuzi gisobanura ko umurwayi yariko arasohoka amaraso mu muhogo canke mu zuru mu gacerere, akamira ayo maraso akaja mu nda. Iyo amaraso yicaye mu aside yo mu nda iminota 15 gushika kuri 45, iyo aside irahindura icuma gitukura cane kiri mu maraso kikagira umuhondo w’agahama, kigatera umubabaro mu gipfukisho c’inda gushika umurwayi arutse. Hamagara 911, 112 canke 999 ubwo nyene, naho woba utabonye amaraso atukura cane atonyanga mu kanwa imbere y’aho.

Inyobora zifitaniye isano¶

• Gukorora amaraso (hemoptyse) no kuva amaraso menshi mu nzira y’impwemu
• Guruka amaraso (hematemesis), melena, n’amaraso ava mu nda
• Igisebe co mu rubavu, angina ya Ludwig, n’indwara zikomeye zo mw’izosi
• Amaraso ava mu zuru (epistaxis) n’amaraso ava mu zuru inyuma
• Kumenya uguhungabana kw'amaraso n'ugusohoka kw'amaraso

Amasoko n'ubuyobozi buzwi¶

• Ishure ry’Amerika ry’Ivy’Amatwi n’Amatwi - Kubaga Umutwe n’Izosi (AAO-HNS, Leta Zunze Ubumwe za Amerika): Ingingo ngenderwako y’ubuvuzi: Gukura amatonsi mu bana (Ivugurura) - Gukurikirana amaraso ava inyuma yo kubagwa, Gucungera ububabare, no Gukingira Codeine.
• ENT UK & Royal College of Surgeons y'Ubwongereza (Ubwongereza): Igenzura ry'Igihugu ry'Ivyerekeye Gukura Amatonsi n'Ivyihutirwa vy'Amabwirizwa y'Amaso Ava Amatonsi.
• Ishirahamwe ry'abaganga b'abana bo mu Bwongereza no muri Irlande (APAGBI): Ingingo ngenderwako y'ubumwe ku bijanye n'ugutera umuti w'ibihe vyihutirwa be n'ugufata amaraso mu gihe c'impwemu (Bleeding Tonsil).
• Ibitaro vy’abana vy’Ubwami vy’i Melbourne (Ostraliya): Ingingo ngenderwako y’ubuvuzi: Gukuraho amatonsille n’ugukuraho adenoidectomy inyuma yo kubagwa no gupima amaraso.
• TWEBWE. Ishirahamwe ry’Ibifungurwa n’Imiti (FDA, Leta Zunze Ubumwe za Amerika) & Ishirahamwe ry’Uburayi ryitaho imiti (EMA): Itangazo ryerekeye umutekano w’imiti: Imburi iri mu gasandugu ivuga ko Codeine na Tramadol zidashobora gukoreshwa mu gufasha abana gukira ububabare buva ku gukuraho amatonsille.