ʻO ke keʻakeʻa aʻa bili

ʻO ke kahakaha ʻana o ka bile duct blockage i nā paipu e lawe i ka bile mai ke ake a i ka gallbladder a me ka ʻōpū liʻiliʻi.

ʻO ka bile kahi wai i hoʻokuʻu ʻia e ke ake. Loaʻa iā ia ka kolesterol, nā paʻakai bile, a me nā huahana neoneo e like me ka bilirubin. Kōkua nā paʻakai ʻoi i kou kino e wāwahi (ʻai) nā momona. Holo ʻo Bile mai ke akepaʻa ma o nā dule o ka bile a mālama ʻia i ka gallbladder. Ma hope o kahi pāʻina, hoʻokuʻu ʻia i loko o ka ʻōpū liʻiliʻi.

Ke ālai ʻia nā aʻa o ka bile, kūkulu ka bile i ke ake, a ulu ka jaundice (kala melemele o ka ʻili) ma muli o ka piʻi ʻana o ka nui o ka bilirubin i loko o ke koko.

ʻO nā kumu kūpono o ke kahe o ka bile i kāpae ʻia me:

• ʻO nā cist o ke kēpau bile maʻamau
• Hoʻonui ʻia nā lymph node ma ka porta hepatis
• Nā Pohaku
• ʻO ka hoʻowahāwahā o nā aʻa aʻa
• Hoʻopili ʻia o nā kaha bile mai ka scarring
• ʻO ka ʻeha mai ke kaha ʻana o ka gallbladder
• Nā tumors o nā aʻa aʻa a i ʻole pancreas
• ʻO nā tumors i palahalaha aʻe i ka ʻōnaehana biliary
• Hānai a me nā ʻalalā duct worm (flukes)

ʻO nā kumu pilikia me:

• ʻO ka mōʻaukala o nā gallstones, pancreatitis mau, a me ka maʻi ʻaʻai pancreatic
• Ka hōʻeha i ka wahi ʻōpū
• ʻOki kino biliary hou loa
• ʻO ka maʻi ʻaʻai biliary hou (e like me ka maʻi ʻaʻai bile duct)

Hiki ke hoʻopili ʻia i ka blockage e nā maʻi. ʻOi aku ka maʻamau o kēia i nā poʻe me nā ʻōnaehana pale nawaliwali.

Pākuʻi ʻia paha nā ʻōuli:

• ʻO ka ʻeha o ka ʻōpū ma ka ʻaoʻao ʻākau ma luna
• Mimi ʻeleʻele
• Fiva
• Kāwili
• Jaundice (melemele kala kala)
• ʻO Nusea a me ka luaʻi
• Nā noho Pale-kala

E nānā kāu mea mālama ola iā ʻoe a ʻike i kou ʻōpū.

ʻO nā hopena hoʻokolohua koko aʻe ma muli o kahi hiki ke paʻa.

• Hoʻonui i ka pae bilirubin
• Hoʻonui i ka pae alkaline phosphatase pae
• Hoʻonui ʻia nā ʻenema ate

Hiki ke hoʻohana ʻia nā hoʻokolohua aʻe e hoʻokolokolo ai i kahi kahena bile i ālai ʻia.

• ʻO ke ultrasound ʻōpū
• Scanner CT ʻōpū
• Endoscopic retrograde cholangiopancreatography (ERCP)
• ʻO cholangiogram transhepatic transutanputan (PTCA)
• Mākēneki resonance cholangiopancreatography (MRCP)
• Endoscopic ultrasound (EUS)

Hiki paha i kahi palaka bile i hoʻopaʻa ʻia ke hoʻololi i nā hopena o nā hōʻike aʻe:

• Hōʻike koko Amylase
• ʻO ke kiʻi ʻana o Gallbladder radionuclide scan
• Hōʻike koko lipase
• Ka manawa Prothrombin (PT)
• Urine bilirubin

ʻO ka pahuhopu o ka mālama ʻana e hoʻomāmā i ka poloka. Hiki ke hemo ʻia nā pōhaku me ka hoʻohana ʻana i ka endoscope i ka wā o kahi ERCP.

I kekahi mau hihia, koi ʻia ke ʻoki e kāpae i ka paʻa. Lawe ʻia ka gallbladder i kahi oʻokiʻoki ke hana ʻia ka palaka e nā gallstones. Kauoha paha kāu mea hāʻawi i nā lāʻau antibiotic inā kuhi ʻia kahi maʻi.

Inā kumu ʻia ka blockage e ka maʻi ʻaʻai, pono e hoʻonui ʻia ke duct. Kapa ʻia kēia kaʻina hana he endoscopic a i ʻole percutaneile (ma o ka ʻili e pili ana i ke ake ake) hoʻonui. Pono e hoʻokomo i kahi paipu e ʻae i ka hoʻokahe.

Inā ʻaʻole i hoʻoponopono ʻia ka poloka, hiki iā ia ke alakaʻi i ka maʻi hoʻoweliweli a me kahi kūkulu weliweli o bilirubin.

Inā lōʻihi ka lōʻihi o ka paʻa ʻana, hiki i ka maʻi maʻi ate ke hopena. Hiki ke mālama ʻia ka hapa nui o nā ālai me ka endoscopy a i ʻole ke ʻoki kino. ʻO nā āla i hoʻokumu ʻia e ka maʻi ʻaʻai he hopena hopena maikaʻi ʻole.

ʻAʻole i mālama ʻia, nā pilikia kūpono e pili ana i nā maʻi, sepsis, a me nā maʻi ate, e like me ka biliary cirrhosis.

Kāhea i kāu mea hāʻawi inā ʻoe:

• E nānā i kahi loli i ke kala o kāu mimi a me nā noho
• Hoʻomohala jaundice
• Loaʻa kaʻeha o ka'ōpū i ka heleʻole a hoʻomau i ka hana hou

E makaʻala i nā ʻano pilikia i loaʻa iā ʻoe, i hiki ai iā ʻoe ke loaʻa koke i ka hōʻailona a me ka mālama ʻana inā paʻa ʻia kahi kaila bile. ʻAʻole hiki ke pale ʻia ka paʻa ʻana.

Pāpale Biliary

• ʻŌnaehana Digestive
• Nānā Endocrine
• Ala hele bile
• Pale Biliary - moʻo

ʻO Fogel EL, Sherman S. Nā maʻi o ka gallbladder a me nā dile bile. I: Goldman L, Schafer AI, eds. ʻO ka lāʻau lapaʻau Goldman-Cecil. 26th ed. Piladelapia, PA: Elsevier; 2020: chap 146.

Lidofsky SD. ʻO Jaundice. I: Feldman M, Friedman LS, Brandt LJ, eds. ʻO Sleisenger a me Fordtran's Gastrointestinal a me ka maʻi ate. 11th hua. Piladelapia, PA: Elsevier; 2021: chap 21.