Ukopha kwe-Post-Tonsillectomy: Usuku 5 ukuya ku-10 Ulwelwesi lwe-Sloughing kanye ne-Airway Hemorrhage Triage¶

I-tonsillectomy (ene-adenoidectomy noma ngaphandle kwayo) ingenye yezinqubo zokuhlinzwa okwenziwa njalo ezinganeni nakubantu abadala emhlabeni wonke, nokho inengozi ehlukile, engase ibeke ukuphila engozini yokubambezeleka ngokopha emoyeni kuze kube amasonto amabili agcwele ngemva kokuba isiguli sibuyele ekhaya. Ngenxa yokuthi amathoni e-palatine ahlala embhedeni womphimbo onemisipha ohlinzekwa amagatsha amahlanu anomfutho ophezulu wesistimu ye-carotid yangaphandle, futhi ngenxa yokuthi amanxeba okuhlinzwa angemuva komlomo awakwazi ukuthungwa avalwe ngokuphelele noma ambozwe ngebhandeshi, i-fossae eluhlaza ye-tonsillar iyaphola ngokwenza uqweqwe lwe-fibrinous oluwugqinsi olumhlophe-ophuzi (eschars). Phakathi kwe-post-operative Izinsuku ezingu-5 no-10, njengoba isikhumba esisha se-mucosal sikhula ngaphansi, lezi zinhlayiya ezivikelayo ziyaxega futhi zihambe kancane. Uma utwayi luhlukana ngaphambi kwesikhathi noma lukhala luvula umthambo ongaphansi, ukopha ngokushesha ngenhla komnyango woqhoqhoqho (trachea). Noma yiliphi igazi elibomvu elikhanyayo elivela emlonyeni noma ekhaleni, ukugwinya okuphindaphindiwe enganeni elele, noma ukuhlanza igazi elimnyama eligaywe ngekhofi ngemva kokuhlinzwa kwe-tonsillectomy kuyisimo esiphuthumayo sokuhlinzwa. Shayela indawo yangakini izinombolo eziphuthumayo ngokushesha futhi uxhumane nabaqondisi bethu abahlobene ukukhwehlela igazi kanye nokopha emoyeni, ukuhlanza igazi kanye nokopha emathunjini, futhi ukushaqeka kwe-hypovolemic.

Yenza lokhu manje¶

1. Shayela u-911, 112, noma u-999 ngokushesha ukuze uthole noma yikuphi ukopha okubomvu okukhanyayo, amahlule egazi, noma ukuhlanza igazi ngemva kwe-tonsillectomy: Ungalokothi ulinde ekhaya ukuze ubone ukuthi ukopha kwe-post-tonsillectomy kuzima ngokwakho yini, futhi ungalokothi ushayele ingane eyopha ngokushesha esibhedlela esihlalweni esingemuva semoto yangasese lapho kungekho muntu ozwa khona umoya noma ukulahlekelwa umoya.
2. Hlalisa isiguli siqonde bese uncikisa ikhanda nomzimba wayo phambili phezu kwesitsha noma ithawula elimhlophe: Ungalinge uvumele umuntu owopha emphinjeni alale afulathele. Ukuhlala uqondile kunciphisa umfutho wegazi we-venous kanye ne-arterial entanyeni, kuyilapho ukuncika phambili kuvumela igazi ukuthi liphume emlonyeni lingene endishini ukuze lingahlangani phezu kwezintambo zezwi noma lehlele esiswini.
3. Yiba nengane endala noma umuntu omdala obambisane naye ukuthi abhukule bese ekhafula amanzi abandayo eqhweni: Uma isiguli siphapheme ngokuphelele, siqaphile, futhi sikwazi ukulandela iziqondiso ngaphandle kokuklinywa, ukusunduza ngobumnene amanzi eqhwa ngemuva komlomo bese uwakhafulela kusinki omhlophe noma endishini kubangela i-reflex vasoconstriction yemithambo emincane yamathoni futhi kususe amahlule ukuze ubone ukuthi kuyaxebuka yini. Ungaphoqi u-** uketshezi kungane encane ekhalayo, usana, noma esigulini esozelayo.
4. Faka i-ice collar noma iphakethe elibandayo ngaphambili nasemaceleni entamo bese uncela i-ice pop: Ukubamba iphakethe leqhwa eligoqwe ngendwangu ulibhekise enhla nentamo engemuva (ngezansi nje kwe-engeli yomhlathi) kusiza ukupholisa amagatsha e-carotid angaphandle afunza i-tonsillar fossa ngenkathi ulinde abezimo eziphuthumayo.
5. Yala isiguli ukuba sikhafule wonke amaconsi egazi namathe kunokuba sikugwinye: Ukugwinya igazi kufihla umthamo wangempela wokopha kubazali nodokotela, kucasula ulwelwesi lwesisu ngamandla, futhi kubangele ukuhlanza okungazelelwe (hematemesis) okungagcwala umzila womoya futhi kudabuke umbhede opholile womphimbo uvuleke ngokuqhubekayo.
6. Lungiselela indawo yokululama uma isiguli sisozela, siphaphatheka, noma siquleke: Uma ingane esophayo noma umuntu omdala eba buthakathaka, exhuga, noma engasabeli ngesikhathi elinde usizo lwezempilo oluphuthumayo, mgingqe ngokushesha ohlangothini lwaso lapho esesimweni sokululama ngemuva ubuso butshekele phansi kancane ukuze igazi liphume ekhoneni lomlomo kunokuminza amaphaphu.

Isihlahla sesinqumo: I-post-tonsillectomy triage kanye nempendulo yomzila womoya¶

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I-Pathophysiology: Kungani i-tonsillectomy scabs yopha isonto eligcwele ngemva kokuhlinzwa¶

Abazali neziguli ezingabantu abadala bavame ukushaqeka lapho ukopha emphinjeni kwenzeka ezinsukwini ezingu-7 noma ezingu-8 ngemva kokuhlinzwa, lapho nje isiguli sasiqala ukuba ngcono kancane noma siqale kabusha imisebenzi evamile. Ukuqonda inqubo yokupholisa amanxeba enezigaba ezintathu ze-oropharynx kuchaza ukuthi kungani leli windi elibambezelekile kuyinkathi yengozi enkulu.

1. Ukunikezwa kwe-arterial okucebile kwe-tonsillar fossa¶

I-Palatine tonsil ihlala endaweni ejulile yemisipha engunxantathu phakathi kwensika yethoni yangaphambili (palatoglossus muscle) kanye nensika yethoni yangemuva (palatopharyngeus muscle), ephumula ngqo phezu kwe-*superior pharyngeal constrictor muscle **. Amagatsha amahlanu we-arterial egeleza kakhulu i-carotid artery yangaphandle abhoboza lo mbhede onemisipha ukuze ondle ithoni:

• Igatsha le-tonsillar lomthambo wobuso (umthombo omkhulu kunayo yonke futhi ovame kakhulu okopha kakhulu komthambo ophansi we-low-pole).
• Igatsha elikhuphukayo le-palatine lomthambo wobuso.
• Amagatsha e-Dorsal lingual of the lingual artery (ihlinzeka ngesigxobo esingaphansi eduze kwesisekelo solimi).
• Umthambo we-pharyngeal okhuphukayo (uhlinzeka ngodonga lwangemuva).
• I-palatine artery eyehlayo (igatsha lomthambo omkhulu ohlinzeka ngesigxobo esiphezulu).

Ngaphezu kwalokho, i-paratonsillar vein enkulu (vein of Denis Browne)* yehla iqonde phansi kumbhede we-lateral tonsillar ngaphansi nje kodonga oluncane lwemisipha, futhi isiqu esiyinhloko semithambo ye-carotid yangaphakathi nengaphandle idlula kuphela amasentimitha angu-1.5 kuya ku-2.5 (0.6 kuya ku-1.0 amayintshi) eceleni kuya ku-capsule ye-tonsillar ejulile.

2. Okuyinhloko vs. ukopha kwe-post-tonsillectomy yesibili¶

Odokotela bahlukanisa ukopha kwe-post-tonsillectomy (PTH) zibe izigaba ezimbili ezihlukene ngokusekelwe esikhathini kanye nendlela:

3. Yini utwayi lomphimbo omhlophe (eschar) kukhona nokuthi kungani ukuphelelwa amanzi emzimbeni kuwenza ophe¶

Phakathi namahora angu-12 kuya kwangu-24 ngemva kokuhlinzwa, imigodi eluhlaza lapho amathonsi ayekhishwe khona imbozwa ngengubo ewugqinsi, ephuzi, empunga-mhlophe noma ephuzi-tan eyakhiwe i-fibrin, ama-platelet, amangqamuzana egazi amhlophe namangqamuzana angaphezulu.

• Ukubonakala okuvamile (Akukona ukutheleleka): Abazali ababheka emlonyeni wengane yabo ngoSuku 3 bavame ukwethuka lapho bebona amabala aphuzi amhlophe anuka kabi amboze ngemuva emphinjeni, okubenza bacabange ukuthi i-strep pus noma i-thrush. Le fibrinous eschar iwutwayi olumanzi olujwayelekile, oluvikelayo, kanye nomoya omubi onamandla (halitosis) kulindeleke izinsuku eziyi-10 kuye kweziyi-14.
• Indlela ukuyehlisa okwenzeka ngayo (Izinsuku 5 kuya kwezingu-10): Ngaphansi kwale ngubo ye-fibrin, i-epithelium entsha ephinki e-squamous ingena ngaphakathi isuka emaphethelweni ezinsika zamathoni. Phakathi Kwezinsuku 5 kanye Nezi-10, umzimba uncibilikisa okunamathiselwe phakathi kwesikhumba esisha kanye notwayi lwefibrin oludlulele ukuze uqweqwe luqubuke zibe izingcezu ezincane ezingabonakali futhi zigwinywe kungabonakali ngamathe.
• Kungani ukuphelelwa amanzi emzimbeni kubangela ukopha: Ngokungafani notwayi edolweni oluphola kangcono emoyeni owomile, i-eschar yomphimbo kufanele ihlale imanzi ngokuqhubekayo futhi ithambile. Uma ingane yenqaba ukuphuza uketshezi ngenxa yomphimbo kanye nobuhlungu bendlebe, umphimbo uyakoma (pharyngeal desiccation). I-eschar eyomile iyashwabana, iqine ibe uqweqwe oluqinile, futhi idonsa ngamandla emithanjeni yegazi epholayo engaphansi njalo lapho imisipha yomphimbo ifinyela ukuze igwinye noma ikhwehlele. Esikhundleni sokuncibilika kahle, utwayi olomile luklebhula ingxenye eyodwa, luvule udonga lwe-arteriole ebuthaka ngaphansi.

Ukuqaphela ukopha okucashile ezinsaneni, ezisacathula, nasezinganeni ezilele¶

Ngenkathi umuntu omdala noma osemusha ezongena ngokushesha ekhishini futhi akutshele ukuthi banambitha igazi elifudumele, elinensimbi ngemuva komphimbo wabo, izingane ezincane (ikakhulukazi ezingaphansi kweminyaka engu-6) kanye nezingane ezinokukhubazeka kokukhula cishe azilokothi zikhafule igazi. Kunalokho, i-reflex yabo ezenzakalelayo iwukugwinya yonke into engena epharynx yabo.

Izimpawu ezicashile eziyisixwayiso sokopha emphinjeni buthule enganeni¶

Ingane ingagwinya buthule amaphesenti angu-20 kuya kwangu-30 esamba segazi elizungezayo esiswini sayo ngaphambi kokuba kuvele iconsi elilodwa legazi kumcamelo noma ezindebeni zayo. Bukisisa lezi zinkomba zokuziphatha nezomzimba:

1. Ukugwinya kaningi, okuphindaphindayo ngenkathi ilele noma iphumule: Buka ingaphambili lentamo yengane. Uma ingane elele noma ephumule igwinya njalo emizuzwaneni emi-5 kuya kweyi-15 lapho ingaphuzi lutho, igazi eliwuketshezi ligeleza ngamandla lisuka embhedeni wamathoni noma embhedeni we-adenoid (nasopharynx) phansi ngemuva komphimbo.
2. Ukugedla okumanzi, ukususa umphimbo, noma ukukhwehlela okuzumayo kwasebusuku kungena: Ukuhlangana kwegazi ku-hypopharynx kukitaza i-laryngeal inlet, okubangela umsindo omanzi, onamagwebu ngesikhathi sokuphefumula noma ukuvuka kungazelelwe ngokukhwehlela okuklinywayo.
3. Ukungahlaliseki okungazelelwe okungachazeki, ukukhathazeka, noma isikhumba esiphaphazelayo esiphaphathekile: Ekushaqekeni kwe-hypovolemic yezingane, izingane zigcina umfutho wegazi ovamile ngokukhohlisa kuze kube yilapho zehle ngamaphesenti angu-25 kuya kwangu-30 omthamo wegazi lazo. Ukushaqeka kwangaphambi kwesikhathi kubonakala njengokushaya kwenhliziyo okugijima (tachycardia), iminwe epholile ephaphathekile nezinzwani, izinsini ezimhlophe ngokuphaphathekile nezinkophe zangaphakathi, nokuyaluza okungazelelwe noma ukungabi naluzwelo.
4. Isicanucanu esingazelelwe nokuhlanza kwezinto ezimnyama "ze-coffee-ground" noma amahlule: Lapho igazi eligwinywe lihlangana ne-hydrochloric acid (HCl) esiswini, insimbi eku-hemoglobin ifakwa nge-oxidized ibe i-hematin ene-acid ensundu. Phakathi nemizuzu engu-15 kuya kwengu-45 yokugwinya buthule, isisu siyaxebuka futhi siyacasuka, okubangela ukuba ingane ivele ihlanze inqwaba yoketshezi lwekhofi olunsundu ngokumnyama oluxutshwe nemivimbo ebomvu ngokugqamile noma amahlule anjengejeli.

Izenzo zosizo lokuqala ezisheshayo ngenkathi ulinde i-ambulensi¶

Uma usushayele u-911, 112, noma 999, izinto eziza kuqala kuwe phakathi nemizuzu emi-5 kuya kweyi-15 ngaphambi kokuba abezimo eziphuthumayo bafike ukuvimbela ukulangazelela kwegazi emaphashini, ukuvimbela ukugwinya kwegazi, kanye nokukhuthaza i-vasoconstriction yendawo.

1. Ukuma kahle kwendlela yomoya: Imile futhi incike phambili¶

• Hlalisa ingane noma umuntu omdala aqonde esihlalweni, esofeni, noma emathangeni omzali ikhanda lakhe nesifuba esingenhla sincike phambili nge-engeli engu-30-to-45-degree.
• Bamba isitsha esimhlophe, indishi yepulasitiki emhlophe, noma ithawula elimhlophe ngaphansi kwesilevu sabo. Ukusebenzisa isiqukathi esimhlophe kukuvumela kanye nabezimo eziphuthumayo ukuthi bahlulele ngokunembile kokubili ivolumu yegazi elilahlekile kanye nombala umbala walo (ubomvu obukhanyayo obuqhathaniswa namahlule e-venous amnyama vs. amathe aphinki).
• Khuluma ngezwi elipholile, elinokuthula, eliqinile. Ukukhala, ukuklabalasa, nokwethuka kwesilinganiso senhliziyo nomfutho wegazi we-systolic, ukupompa igazi emkhunjini ovulekile wamathoni ngokushesha okukhulu.

2. Indlela ye-ice-water swish-and-spit (iziguli ezisebenzisanayo kuphela)¶

Uma isiguli singumuntu omdala, osemusha, noma ingane endala esesikoleni (imvamisa eneminyaka engu-7 nangaphezulu) eqaphe ngokuphelele, ezolile, futhi engaklinyiwe:

• Gcwalisa inkomishi ngamanzi abandayo kanye neqhwa elichotshoziwe.
• Cela isiguli siphuze kancane amanzi abandayo eqhweni, sitshekise ikhanda kancane ukuze amanzi abandayo ageze ingemuva lomlomo imizuzwana emi-3 kuya kwemi-5, futhi akhafule amanzi ngobumnene akhiphe endishini (ungalokothi ugoqe ngamandla, njengoba ukuvevezela komphimbo okunamandla kunganyakazisa amahlule axegayo asuke emkhunjini).
• Phinda njalo emizuzwaneni engama-30 kuye kwengama-60. Ukuncishiswa kwamanzi abandayo kuveza ama-mucosal arterioles nama-capillaries ku-tonsillar fossa ngenkathi kuhlanzwa ama-enzyme e-fibrinolytic ngaphakathi kwamahlule egazi axegayo.

3. Ukupholisa intamo kwangaphandle¶

• Gcoba isikhwama seqhwa elichotshoziwe noma uphizi oqandisiwe ngethawula lesitsha elincanyana, elimanzi bese ulibeka kahle eceleni kwentamo engenhla ngaphansi nje komhlathi (submandibular triangle), noma ngaphesheya kwentamo.
• Ungalokothi ubophe noma yini uyiqinise entanyeni noma ucindezele ngamandla uqhoqhoqho noma i-carotid pulse.

4. OKUMELE ukwenze ngesikhathi sokukhishwa kwe-tonsillectomy ukopha¶

• Ungalokothi unamathisele iminwe, amaphedi e-gauze, amabhola kakotini, noma izinto zesiliva ngemuva komlomo ekhaya ukuze uzame ukucindezela umbhede we-tonsil: Ukuphushela i-gauze ngobumpumputhe emhlumeni wengane kubangela i-gag enobudlova kanye ne-reflex yokuhlanza, kuklebhula i-eschar esele iwususe komunye umbhede wethonsi, futhi kubeke engcupheni yokuphonsa ipayipi legazi.
• Ungalokothi unikeze i-aspirin, ibuprofen (ngaphandle kwalapho kucaciswe-kuhlolwe, futhi ungalokothi unikeze phakathi nokopha okusebenzayo), i-naproxen, noma i-herbal blood thiners: Izidakamizwa ezingezona ukuvuvukala (nonsteroidal anti-inflammatory drugs)NSAIDsnjenge-aspirin ivimbela ngokungenakuguquleka ukuhlangana kweplatelet (COX-1). Ngisho noma abanye odokotela abahlinzayo bevumela ibuprofen ehleliwe eceleni kwe-acetaminophen yokulawula ubuhlungu be-post-op, misa wonke ama-NSAID ngokushesha uma kwenzeka noma yikuphi ukopha.
• Ungalokothi unikeze isiguli okuthile okudliwayo noma okuphuzwayo (ngaphandle kwamanzi eqhwa e-swish-and-spit angagwinywa): Isiguli singase sidinge i-anesthesia evamile egunjini lokuhlinzela phakathi nehora, futhi isisu esigcwele siyayinyusa kakhulu ingozi yokulangazelela kwamaphaphu phakathi ne-intubation elandelanayo ngokushesha.

Isibhedlela nokuphathwa kokuhlinzwa: Ongakulindela ku-ER¶

Ukwazi ukuthi odokotela bezimo eziphuthumayo, i-anesthesiologists, kanye ne-otolaryngologists (ENT surgeons) ukuphatha ukopha kwe-post-tonsillectomy kusiza imindeni ukuthi izilungiselele lapho ifika esibhedlela.

Ukulinganisa ubulukhuni be-post-tonsillectomy hemorrhage (Stammberger / Windfuhr Classification)¶

Ukuvimbela ukopha kwesibili phakathi newindi lokululama lezinsuku eziyi-14¶

Nakuba ukopha okuthile kwesibili kwenzeka naphezu kokunakekelwa okufanele kwasekhaya, ukulandela imithetho eqinile yokululama ngemva kokuhlinzwa phakathi nezinsuku eziyi-14 ezigcwele ngemva kokuhlinzwa kwehlisa ngokuphawulekayo ingozi yokwehliswa kwe-eschar ngaphambi kwesikhathi.

1. I-hydration engapheli ("Utwayi olumanzi luyapholisa; ukopha utwayi olomile")¶

• Cela ingane noma umuntu omdala aphuze amanzi amancane, ijusi ye-apula ehlanjululwe, isixazululo se-electrolyte, noma ama-ice pops njalo emizuzwini engu-15 kuya kwengu-30 phakathi namahora angavuki.
• Sebenzisa umswakamo we-cool-mist eduze kombhede wesiguli njalo ebusuku izinsuku eziyi-14. Ngenxa yokuthi ukuvuvukala okuzungeza ulwanga kanye nombhede we-adenoid kuphoqa iziguli ngemuva kokuhlinzwa ukuthi zilale imilomo yazo ivulekile, umoya omile wekamelo lokulala ususa utwayi lomphimbo ngobusuku obubodwa, kuchaza ukuthi kungani ukopha okuningi kangaka kwangemva kwe-tonsillectomy kwenzeka phakathi kuka-2:00 AM no-6:00 AM.

2. Ukulawula ubuhlungu obuhleliwe, bewashi ukuze isiguli siqhubeke siphuza¶

• Ubuhlungu bomphimbo kanye nobuhlungu bendlebe obubhekiselwe (okubangelwa amagatsha ezinzwa okwabelwana ngawo we-glossopharyngeal nerve, Cranial Nerve IXkanye ne-vagus nerve, Cranial Nerve X, enikeza kokubili umbhede wethoni kanye nendlebe ephakathi) ngokuvamile ** iba mbi kakhulu ngezinsuku 4 kuya ku-8** njengoba nje utwayi luqala ukuhlukana.
• Lawula isisindo esisekelwe i-acetaminophen (paracetamol) (kanye ne-ibuprofen egunyazwe udokotela ohlinzayo uma kunqunyiwe, nakuba ingalokothi i-aspirin futhi ingalokothi i-codeine noma i-tramadol, ephethe ukungqubuzana kwebhokisi elimnyama kwe-FDA/EMA ezinganeni zangemuva kwe-tonsillectomy ngenxa yokushesha kakhulu CYP2D6 i-metabolism ibe imithamo ebulalayo ye-morphine) ngesimiso esiqinile sasemini newashi kunokulinda kuze kube yilapho ingane ikhale ngobuhlungu futhi yenqabe ukugwinya uketshezi.

3. Ukugwema izibangeli zemishini nezomfutho wegazi izinsuku eziyi-14 ezigcwele¶

• Akukho ukudla oku-crunchy, okubukhali, okuklwejwayo, noma okushisayo izinsuku eziyi-14: Gwema amashiphu e-tortilla, ama-potato crisps, ama-hard toast crusts, okusanhlamvu okomile, ama-crackers, uqweqwe lwe-pizza, amantongomane, u-popcorn, ama-apula/izaqathi eziluhlaza, kanye nesobho elishisayo noma i-citrus ene-acidic. Imiphetho ebukhali yokudla ikhuhla i-eschar emhlophe embhedeni we-tonsillar ngaphambi kokuba imithambo yegazi engaphansi ivaleke.
• Ukuphumula okuqinile ngokomzimba izinsuku eziyi-14: Ngisho noma ingane izizwa inamandla ngoSuku lwesi-6, yenqabela ukugijima, ukugxumela kuma-trampoline, ukugebenga, imidlalo yokuxhumana, ikilasi lokuvocavoca umzimba, ukuphakamisa izinto ezisindayo, noma ukuzivivinya ngamandla kuze kudlule uphawu olugcwele lwezinsuku eziyi-14 futhi wonke umkhondo wotwayi olumhlophe unyamalele emphinjeni. Noma yimuphi umsebenzi okhuphula izinga lokushaya kwenhliziyo kanye nomfutho wegazi we-systolic ungaqhumisa isitsha esiphulukisayo se-tonsillar.

Izinombolo zezimo eziphuthumayo zesifunda kanye nezinqubomgomo ze-ejensi¶

Ngaso sonke isikhathi gcina kokubili inombolo yakho yocingo yokuhlinza ye-ENT** yamahora angu-24 kanye nenombolo yakho ye-ambulensi kazwelonke yezimo eziphuthumayo ilondolozwe ocingweni lwakho izinsuku eziyi-14 ngemva kokuhlinzwa:

Imibuzo ejwayelekile ukubuzwa¶

Kungani umphimbo wengane yami waqala ukopha ngoSuku 7 lapho ukuhlinzwa kwakuyisonto lonke elidlule?¶

Ngesikhathi sokuhlinzwa kwe-tonsillectomy, udokotela ohlinzayo uvala imithambo yegazi embhedeni womphimbo, futhi emahoreni okuqala angu-24 umzimba uvala imigodi yemisipha eluhlaza ngotwayi oluvikelayo olumhlophe oluphuzi olubizwa ngokuthi i-fibrinous eschar. Phakathi kwezinsuku ezi-5 neziyi-10 ngemva kokuhlinzwa, isikhumba esisha esiphinki siyakhula ngaphansi futhi utwayi oluvikelayo luyaxega futhi luyaxebuka. Uma utwayi loma noma luhlukana ngaphambi kokuba umthambo wegazi ongaphansi uphole ngokuphelele, noma uma ukudla okumaholoholo kuwukhuhla, umkhumbi ongaphansi uyavuleka bese ubangela ukubambezeleka ("kwesibili") ukopha isonto eligcwele ngemva kokuhlinzwa.

Ingane yami ikhafule ihlule legazi elincane elingangekota emizuzwini eyi-10 edlule, futhi manje amathe ayo asecwebile. Ingabe ngempela sidinga ukuya ekamelweni lezimo eziphuthumayo?¶

Yebo, kufanele uye emnyangweni wezimo eziphuthumayo esibhedlela ngokushesha ngisho noma ukuphuma kwegazi kubonakala kumile ngokuphelele. Ku-otolaryngology, isiqephu esifushane, esincane sokopha phakathi kwezinsuku ezi-5 no-10 saziwa ngokuthi "i-herald bleed" noma ukopha komlindi. Kusho ukuthi umkhumbi we-arterial noma we-venous embhedeni we-tonsil ugugulekile njengoba utwayi luhlukana futhi okwamanje luxhunywe kuphela ihlule legazi elintekenteke, lesikhashana. Ngaphandle kokuhlolwa kwesibhedlela, i-cauterization, noma ukubonwa ebusuku, lelo hlule lesikhashana livame ukufutheka ngemva kwamahora ambalwa phakathi nobusuku, libangele ukopha okusongela ukuphila.

Kungani ingane yami inezinhlungu ezindlebeni ezinzima ezinsukwini ezingu-5 ngemva kokukhishwa kwe-tonsillectomy, futhi ingabe lokho kusho ukuthi ine-infection yendlebe noma yopha?¶

Ubuhlungu obukhulu ezindlebeni bukhuphuka phakathi kwezinsuku ezi-4 no-8 ngemuva kokuhlinzwa kwe-tonsillectomy cishe njalo "ubuhlungu obudluliselwe" kunokuba ukutheleleka kwendlebe noma uphawu lokopha. Inzwa efanayo ye-cranial (inzwa ye-glossopharyngeal, i-Cranial Nerve IX) inikeza ukuzwa kuyo yomibili ingemuva lomphimbo kanye nendlebe emaphakathi ngomthambo ka-Jacobson. Lapho imisipha yomphimbo inyakaza kanye notwayi luqala ukuxebuka ngoSuku 5, ubuchopho buchaza ngokungeyikho lezo zimpawu zobuhlungu bomphimbo njengezivela ekujuleni kwezindlebe. Nikeza imithi yezinhlungu ehleliwe, gcoba iphakethe elifudumele noma elipholile ezindlebeni, futhi ukhuthaze ukuhlafuna ushingamu noma ukudonsa uketshezi ukuze uphumuze imisipha yomhlathi nomphimbo.

Ngingawubona kanjani umehluko phakathi kokhwekhwe olumhlophe olujwayelekile lokuphulukisa kanye nesifo somphimbo ngemva kwe-tonsillectomy?¶

Utwayi olujwayelekile lwe-post-tonsillectomy (ama-eschars) lubukeka luwugqinsi, olushaqile, olumhlophe qwa, olumpunga, noma oluphuzi ngokuphuzi, luhlala luvaleleke emaphaketheni amabili lapho amathoni kade ekhona, futhi lubanga umoya omubi onamandla (`halitosis`) kuze kube amasonto amabili. Akuwona ukutheleleka futhi awadingi ama-antibiotics. Kufanele uxhumane nodokotela we-ENT ukuze uthole ukutheleleka okungenzeka noma ukuphelelwa amanzi emzimbeni kuphela uma isiguli siba nemfiva ephezulu engapheli engaphezu kuka-38.9 degrees Celsius (102.0 degrees Fahrenheit), sisakaza ububomvu obukhanyayo nokuvuvukala kulwanga oluthambile nentamo, noma ukungakwazi ukugwinya uketshezi.

Kungani udokotela asitshela ukuthi singalokothi sinikeze i-codeine noma i-aspirin ngemva kwe-tonsillectomy?¶

I-Aspirin iwavimba unomphela ama-platelet egazi ukuthi anganamathelani kukho konke ukuphila kwezinsuku eziyi-7 kuya kweziyi-10 ze-platelet, okwandisa kakhulu ingozi yokopha okukhulu kwangemva kwe-tonsillectomy. I-Codeine (ne-tramadol) ivinjelwe ngokuqinile ngemuva kwe-tonsillectomy yezingane ngenxa yokuhlukahluka kofuzo kuma-enzyme esibindi (`CYP2D6 ultra-rapid metabolizers`) kubangela ukuthi ezinye izingane ziguqule imithamo evamile ye-codeine ibe amazinga aphezulu e-morphine egazini lazo, okungamisa ukuphefumula kwazo lapho zilele, ikakhulukazi ezinganeni ezikhishwe amathonsi azo ngenxa yokuphefumula kokuphefumula okuphazamisayo.

Kusho ukuthini ukuhlanza okunsundu okumnyama "okuphansi kwekhofi" uketshezi ngemuva kokuhlinzwa kwe-tonsillectomy?¶

Ukuhlanza okokusebenza okunsundu okufana nesisekelo sekhofi esimanzi, noma ukuhlanza amahlule amnyama afana nejeli e-maroon, kuyisimo esiphuthumayo sezokwelapha okusho ukuthi isiguli besilokhu sopha buthule emphinjeni noma emakhaleni futhi sigwinya igazi esiswini saso. Lapho igazi lihlezi esiswini se-asidi imizuzu engu-15 kuya kwengu-45, i-asidi iphendula insimbi ebomvu egqamile esegazini ibe nsundu ngokumnyama futhi icunule ulwelwesi lwesisu kuze kube yilapho isiguli siphalaza. Shayela ku-911, 112, noma ku-999 ngokushesha, ngisho noma ungazange ubone igazi elibomvu elikhanyayo liphuma emlonyeni ngaphambili.

Iziqondiso ezihlobene¶

• Ukukhwehlela igazi (i-hemoptysis) kanye nokopha okukhulu emoyeni
• Ukuphalaza kwegazi (i-hematemesis), i-melena, nokopha kwamathumbu
• Ithumba le-Peritonsillar, i-angina ka-Ludwig, kanye nezifo ezijulile zentamo
• Ukuphuma kwegazi ekhaleni (i-epistaxis) kanye nokopha kwamakhala ngemuva
• Ukuqashelwa kokushaqeka kwe-Hypovolemic kanye ne-hemorrhagic

Imithombo neziqondiso ezisemthethweni¶

• I-American Academy of Otolaryngology - Ukuhlinzwa Kwekhanda Nentamo (AAO-HNS, United States): Isiqondiso Sokuzilolonga Emtholampilo: I-Tonsillectomy Ezinganeni (Ukubuyekeza) - Ukuqapha Kokopha Kwegazi Kwangemva Kokuhlinzwa, Ukulawula Ubuhlungu, kanye Ne-Codeine Contraindication.
• ENT UK & Royal College of Surgeons of England (United Kingdom): National Prospective Tonsillectomy Audit and Emergency Management of Post-Tonsillectomy Haemorrhage Guidelines.
• Inhlangano Yama-Anesthetists Ezingane zase-Great Britain nase-Ireland (APAGBI): Isiqondiso Sokuvumelana Ngokuphathelene Nesimo Esiphuthumayo Sokubulala Nezinzwa Nokuphathwa Komoya We-Post-Tonsillectomy Haemorrhage (Bleeding Tonsil).
• Royal Children's Hospital Melbourne (Australia): Isiqondiso Sokuzilolonga Emtholampilo: I-Tonsillectomy ne-Adenoidectomy Ukunakekelwa Kwangemva Kokuhlinzwa kanye Nokulinganisa Kokopha Kwegazi.
• I-U.S. Ukuphathwa Kokudla Nezidakamizwa (i-FDA, United States) kanye Nenhlangano Yemithi YaseYurophu (EMA): Ukuxhumana Ngokuphepha Kwezidakamizwa: Isexwayiso Esinebhokisi Esiphikisana ne-Codeine ne-Tramadol yokulawulwa kobuhlungu be-Post-Tonsillectomy Ezinganeni.