Hepatorenal maʻi maʻi

ʻO ka maʻi Hepatorenal kahi kumu kahi i kūleʻa ʻole ai ke kōkō i loko o ke kanaka me ka cirrhosis o ke ake. He pilikia paʻakikī ia e hiki ai i ka make.

Hana ʻia ka maʻi Hepatorenal ke pau ka hana maikaʻi ʻana o nā puʻupaʻa i ka poʻe me nā pilikia koʻikoʻi o ke ake. Lawe ʻia ka mimi liʻiliʻi mai ke kino, no laila nā huahana ʻōpala i loaʻa ka nitrogen e kūkulu ʻia i ke kahe o ke koko (azotemia).

Kū ka maʻi a hiki i 1 i 10 mau kānaka i ka haukapila me ka holo pono ʻole o ke ake. Ke alakaʻi nei ia i ka maikaʻi ʻole o ka puʻupaʻa i ka poʻe me:

• Hoka kō ake akea
• ʻO ka hepatitis ʻalekohola
• Cirrhosis
• Pā ka maʻi ʻōpū i loaʻa

ʻO nā kumu pilikia me:

• ʻO ke kaomi koko e hāʻule i ka wā e ala aʻe ke kanaka a i ʻole hoʻololi koke i kahi kūlana (orthostatic hypotension)
• Hoʻohana i nā lāʻau i kapa ʻia he diuretics ("nā wai wai")
• Kahe ʻana o ka gastrointestinal
• Maʻi kīnā
• ʻO ka hemo ʻana o ka wai ʻōpū hou (paracentesis)

ʻO nā hōʻailona me:

• Pahu ʻōpū ma muli o ka wai (i kapa ʻia ascites, kahi ʻōuli o ka maʻi ate)
• Huikau o ka noʻonoʻo
• ʻAno mākala
• Mimi ʻeleʻele-ʻeleʻele (kahi ʻōuli o ka maʻi ate)
• Hoʻoemi i ka puka mimi
• ʻO Nusea a me ka luaʻi
• Kaumaha hoʻonui
• ʻIli melemele (jaundice, kahi ʻōuli o ka maʻi ate)

Kuhi ʻia kēia ʻano ma hope o ka hoʻāʻo ʻana e kāpae i nā kumu ʻē aʻe o ka holo pono ʻole ʻana o ka hakuʻala.

ʻAʻole ʻike ʻia kahi hoʻokolohua kino i ka ʻole pono ʻole o ka hakuʻala. Eia nō naʻe, hōʻike pinepine ka hoʻokolohua i nā hōʻailona o ka maʻi ake luhi, e like me:

• Huikau (pinepine ma muli o ka hepatic encephalopathy)
• ʻO ka nui o ka wai i loko o ka ʻōpū (ascites)
• ʻO Jaundice
• Nā hōʻailona ʻē aʻe o ka holo pono ʻole o ke ake

ʻO nā hōʻailona ʻē aʻe:

• Nā reflexes maʻamau
• Hōʻike liʻiliʻi
• Kani kani i ka ʻōpū o ka ʻōpū ke kāʻei ʻia me nā wēlau o nā manamana
• Hoʻonui i kaʻiʻo o ka umauma (gynecomastia)
• Nā maʻi ʻeha (lesions) ma ka ʻili

ʻO nā mea aʻe paha nā ʻōuli o ke kōpaʻa ʻole:

• Liʻiliʻi loa a ʻaʻohe puka mimi
• ʻO ka paʻa ʻana o ka wai i loko o ka ʻōpū a i ʻole nā ​​ʻaoʻao
• Hoʻonui i ka BUN a me nā pae kine kine
• Hoʻonui i ka umekaumaha kikoʻī a me ka osmolality
• Sodium paʻakai haʻahaʻa
• Haʻahaʻa loa ka mimī sodium

ʻO nā mea aʻe paha nā hōʻailona o ka hōʻino ʻole o ke ake:

• Ka manawa prothrombin maʻamau (PT)
• Hoʻonui i ka pae amonia koko
• Albumin koko haʻahaʻa
• Hōʻike ka paracentesis i ka ascites
• Nā hōʻailona o ka hepatic encephalopathy (e hana ʻia kahi EEG)

ʻO ka pahuhopu o ka mālama ʻana e kōkua i ke ake e hana ʻoi aku ka maikaʻi a e hōʻoia i ka naʻau e hiki ke pauma i ke koko i ke kino.

Hoʻohālikelike ka mālama ʻana e like me ka ʻole o ke kōkō mai nā kumu āpau. Loaʻa iā ia:

• Ke kū nei i nā lāʻau pono ʻole a pau, ʻo ka ibuprofen a me nā NSAID ʻē aʻe, kekahi mau lāʻau antibiotic, a me nā diuretics ("nā wai wai")
• Loaʻa i ka dialysis e hoʻomaikaʻi ai i nā ʻōuli
• Lawe i nā lāʻau e hoʻomaikaʻi ai i ke koko a kōkua i kāu mau puʻupaʻa e hana ʻoi aku ka maikaʻi; Kōkua pū paha ka hoʻokomo ʻana o albumin
• Ke kau nei i kahi shunt (ʻike ʻia ʻo TIPS) e hōʻoluʻolu i nā ʻōuli o ka ascites (hiki i kēia ke kōkua i ka hana o ka hakuʻala, akā hiki ke makaʻala i ke kaʻina hana)
• Ke ʻoki kino e waiho i kahi shunt mai kahi o ka ʻōpū a i ka aa jugular e hoʻopakele ai i kekahi mau ʻōuli o ke kōpaʻa ʻole (he mea weliweli kēia hana a ʻaʻole hana pinepine ʻia)

Hune pinepine ka hopena. Kū pinepine ka make ma muli o kahi maʻi a i ʻole ke kahe koko nui (hemorrhage).

Komo pū nā pilikia:

• Kahena
• Poino i, a me ka holo pono ʻole o, nā ʻōnaehana ʻōnaehana he nui
• ʻO ka maʻi hōʻeha hope loa
• ʻO ka nui o ka wai a me ka maikaʻi ʻole o ka puʻuwai
• ʻO Coma ka hopena o ke ake
• Nā maʻi ʻelua

ʻIke pinepine ʻia kēia maʻi maʻi i ka haukapila i ka wā e hoʻomaʻamaʻa ʻia ana no kahi maʻi akepaʻa.

Cirrhosis - hepatorenal; Hewa kōpaʻa - hepatorenal

ʻO Fernandez J, ʻo Arroyo V. Hepatorenal maʻi. I: Feehally J, Floege J, Tonelli M, Johnson RJ, eds. Nā Nephrology Haumāna piha. ʻElua huaʻōlelo Piladelapia, PA: Elsevier; 2019: chap 73.

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.

Mehta SS, 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. 11th hua. Piladelapia, PA: Elsevier; 2021: chap 94.