Ka nalowale ʻana o ka hana lolo - maʻi ate

Loaʻa ka nalowale o ka hana o ka lolo ke hiki ʻole i ke ake ke wehe i nā toxins mai ke koko. Kapa ʻia kēia hepatic encephalopathy (HE). Kū koke paha kēia pilikia a ulu lohi paha i ka holo ʻana o ka manawa.

ʻO kahi hana nui a ke akepaʻa ka hana ʻole i nā mea ʻona i ke kino. Hana ʻia kēia mau mea e ke kino (amonia), a i ʻole nā ​​mea e lawe ai i (nā lāʻau).

Ke hōʻino ʻia ke akepaʻa, hiki i kēia mau "ʻawahia" ke kūkulu i ke kahe o ke koko a hoʻopili i ka hana o ka ʻōnaehana nūhou. ʻO ka hopena paha ʻo HE.

Hiki iā HE ke kū koke a maʻi koke ʻoe.Nā kumu o HE e komo pū paha:

• ʻO ka maʻi Hepatitis A a ʻo B paha (ʻike ʻole ʻia e like me kēia)
• Ka paʻa ʻana o ke koko i ke ake
• ʻOihana ʻona e nā lāʻau ʻona like ʻole a i ʻole nā ​​lāʻau
• Konipōpō
• ʻO ke kahe o ka gastrointestinal o luna

ʻO ka poʻe me ka ʻino nui o ka ate ke ʻeha pinepine iā HE. ʻO ka hopena o ka hōʻino ʻia o ke ake mau ʻo cirrhosis. ʻO nā kumu maʻamau o ka maʻi ate mau:

• ʻO ka maʻi hepatitis B a ʻo C paha
• ʻIno ʻino
• ʻO ka hepatitis autoimmune
• Nā maʻi maʻi o ka bile
• ʻO kekahi mau lāʻau
• ʻO ka maʻi akepaʻa momona momona ʻole (NAFLD) a me ka steatohepatitis nonalcoholic (NASH)

I ka manawa e loaʻa iā ʻoe ka hōʻino o ke ake, e hoʻomaka ʻia nā ʻāpana o ka ʻino o ka hana lolo e:

• ʻOi aku ka wai o ke kino (dehydration)
• ʻO ka ʻai ʻana i ka protein
• Nā pae potassium haʻahaʻa a i ʻole sodium
• Kahe mai ka ʻōpū, ʻōpū, a i ʻole ka paipu ʻai (esophagus)
• Nā maʻi ʻino
• Nā pilikia ʻiʻo
• Nā pae oxygen haʻahaʻa i ke kino
• Hoʻonohonoho Shunt a i ʻole nā ​​pilikia
• ʻOki kino
• ʻO kaʻeha narcotic a i ʻole nā ​​lāʻau hoʻohiamoe

Hiki i nā pilikia i kū like ke ʻano me HE ke hoʻopili pū ʻia:

• ʻOna ʻona
• ʻO ka haʻalele ʻana i ka ʻalekohola
• Kahe i lalo o ka iwi poʻo (hematoma subdural)
• ʻO ka maʻi lolo ke kumu o ka loaʻa ʻole o ka wikamina B1 (Wernicke-Korsakoff Syndrome)

I kekahi mau hihia, HE pilikia pilikia pōkole ʻo ia i hiki ke hoʻoponopono ʻia. Hiki ke hana ʻia ma ke ʻano he ʻāpana o kahi pilikia lōʻihi (mau loa) mai ka maʻi ate a ʻoi aku ka maikaʻi o ka hala ʻana o ka manawa.

Helu ʻia nā ʻōuli o HE ma ka pālākiō o nā māka 1 a 4. Hoʻomaka paha lākou e lohi a hoʻomāhuahua i ka hala ʻana o ka manawa.

Mālie paha nā ʻōuli mua a hoʻokomo pū ʻia:

• E hanu me kahi ʻino a ʻala paha
• Hoʻololi i nā hiʻohiʻona hiamoe
• Hoʻololi i ka noʻonoʻo
• Huikau ʻaʻano
• Poina ʻole
• Hoʻololi ke ʻano a i ʻole ke ʻano
• Ka noʻonoʻo maikaʻi ʻole a me ka hoʻokolokolo
• Hoʻonui i ka kākau lima a i ʻole nalo ʻana o nā neʻe lima liʻiliʻi ʻē aʻe

Pākuʻi ʻia paha nā ʻōuli koʻikoʻi:

• Nā neʻe maʻamau a haʻalulu paha o nā lima a lima paha
• Hoʻonāukiuki, pīhoihoi, a i ʻole ka hopu ʻana (ʻaʻole loaʻa pinepine)
• Hoʻohuli manaʻo
• Hiamoe a huikau paha
• Hoʻololi ka hana a i ʻole ke ʻano pilikino
• ʻLelo lohi
• Holo mālie a lohi paha

Hiki i ka poʻe me HE ke lilo i noʻonoʻo ʻole, pane ʻole, a komo paha i kahi koma.

ʻAʻole hiki i ka poʻe ke mālama iā lākou iho no kēia mau ʻōuli.

Pākuʻi ʻia paha nā ʻōuli o ka ʻōnaehana ʻōnaehana:

• Ke hoʻoluliluli nei i nā lima ("flapping tremor") ke hoʻāʻo nei e hoʻopaʻa i nā lima i mua o ke kino a hāpai i nā lima
• Nā pilikia me ka noʻonoʻo a hana ʻana i nā hana noʻonoʻo
• Nā hōʻailona o ka maʻi akepaʻa, e like me ka ʻili melemele a me nā maka (jaundice) a me ka hōʻiliʻili wai i loko o ka ʻōpū (ascites)
• ʻAla Musty i ka hanu a me ka mimi

Hiki i nā hoʻokolohua i hana ʻia ke:

• Helu piha ke koko a i ʻole hematocrit e nānā i ka anemia
• CT scan o ke poʻo a i ʻole MRI
• ʻEELE
• Nā hoʻāʻo hana ate
• Prothrombin manawa
• ʻĀpana amonia serum
• ʻO ka pae sodium ma ke koko
• ʻO ka pae potassium i ke koko
• ʻO BUN (nitrogen urea koko) a me ka creatinine e ʻike pehea ka hana ʻana o nā puʻupaʻa

Pili ka mālama ʻana iā HE ma ke kumu.

Inā nui nā loli i ka hana o ka lolo, pono paha kahi noho ma ka haukapila.

• Pono e hoʻopau i ka holo ʻana o ka toto i loko o ka digestive tract.
• ʻO nā maʻi, nā kōpaʻa ʻole, a me nā loli i ka pae sodium a me potassium e pono e mālama ʻia.

Hāʻawi ʻia nā lāʻau e kōkua i ka pae amonia haʻahaʻa a hoʻonui i ka hana o ka lolo. Hāpai ʻia nā lāʻau i hāʻawi ʻia:

• Lactulose e pale aku i nā koʻohune i loko o nā ʻōpū mai ka hoʻokumu ʻana i ka amonia. Hiki paha ke diarrhea.
• ʻO ka neomycin a me ka rifaximin e hoʻoliʻiliʻi hoʻi i ka nui o ka amonia i hana ʻia i loko o nā ʻōpū.
• Inā hoʻomaikaʻi ʻo HE i ka lawe ʻana i ka rifaximin, pono ia e hoʻomau mau loa ʻia.

Pono ʻoe e hōʻalo:

• ʻO nā mea hoʻomaluhia a pau, nā tranquilizers, a me nā lāʻau ʻē aʻe i wāwahi ʻia e ke ake
• Nā lāʻau i piha i ka amonium (me kekahi mau antacids)

Hōʻike paha kāu mea mālama ola i nā lāʻau a me nā lāʻau ʻē aʻe. He mau hopena ʻokoʻa paha kēia.

Aia ka nānā o HE ma ka mālama ʻana i ke kumu o HE. ʻO nā ʻano maʻi o ka maʻi pinepine e hoʻomau i ka ʻino a hoʻi mai.

ʻO nā pae mua ʻelua o ka maʻi he prognosis maikaʻi. ʻO ke kahua ʻekolu a me ʻehā he prognosis maikaʻi ʻole.

Kāhea i kāu mea hāʻawi inā ʻike ʻoe a i ʻole nā ​​poʻe a puni ʻoe i nā pilikia me kāu kūlana noʻonoʻo a i ʻole ka ʻōnaehana ʻōnaehana. He mea nui kēia no ka poʻe i loaʻa i ka maʻi ate. Hiki iā HE ke lilo i mea ʻāwīwī wikiwiki a lilo i kūlana pilikia.

ʻO ka mālama ʻana i nā pilikia o ke akepaʻa e pale aku iā HE. ʻO ka pale ʻana i ka waiʻona a me nā lāʻau lapaʻau intravenous hiki ke pale i nā maʻi o ke ake.

Koma Hepatic; Encephalopathy - hepatic; Hepatic encephalopathy; ʻO ka encephalopathy Portosystem

Ferri FF. Hepatic encephalopathy. I: Ferri FF, hoʻoponopono. ʻO Ferri's Clinical Advisor 2020. Piladelapia, PA: Elsevier; 2020: 652-654.

Garcia-Tsao G. Cirrhosis a me kona hopena. I: Goldman L, Schafer AI, eds. ʻO ka lāʻau lapaʻau Goldman-Cecil. 26th ed. Piladelapia, PA: Elsevier; 2020: chap 144.

Nevah MI, Fallon MB. Hepatic encephalopathy, hepatorenal syndrome, hepatopulmonary syndrome, a me nā ʻōnaehana ʻōnaehana o nā maʻi ate. I: Feldman M, Friedman LS, Brandt LJ, eds. ʻO Sleisenger a me Fordtran's Gastrointestinal a me ka maʻi ate. 10 o ka lā. Piladelapia, PA: Elsevier Saunders; 2016: chap 94.

Wong MP, Moitra VK. Hepatic encephalopathy. I: Fleisher LA, Roizen MF, Roizen JD, eds. ʻO ke kumu o ka hoʻomaʻamaʻa Anesthesia. ʻEhā ed. Piladelapia, PA: Elsevier; 2018: 198-198.

Woreta T, Mezina A. Hoʻokele o ka hepatic encephalopathy. I: Cameron AM, Cameron JL, eds. ʻO ke kaʻoki lāʻau lapaʻau o kēia manawa. 13th ed. Piladelapia, PA: Elsevier; 2020: 428-431.