ERCP

He pōkole ʻo ERCP no ka endoscopic retrograde cholangiopancreatography. He hana ia e nānā i nā dile o ka bile. Hana ʻia ia ma o ka endoscope.

• ʻO nā kaha bile nā ​​paipu e halihali i ka bile mai ke akepaʻa a i ka huahuā a me ka ʻōpū liʻiliʻi.
• Hoʻohana ʻia ʻo ERCP e mālama i nā pōhaku, nā tumors, a i ʻole nā ​​wahi liʻiliʻi o nā aʻa o ka bile.

Hoʻokomo ʻia kahi laina intravenous (IV) i kou lima. E moe ʻoe ma kou ʻōpū a ma kou ʻaoʻao hema no ka hoʻāʻo.

• Hāʻawi ʻia nā lāʻau i loko o ka IV.
• I kekahi manawa, hoʻohana ʻia kahi ʻehu e hoʻopōpō i ka ʻāʻī. E hoʻonoho ʻia kahi kiaʻi waha i kou waha e pale aku ai i kou mau niho. Pono e hemo nā niho.

Ma hope o ka hopena o ka sedative, hoʻokomo ʻia ka endoscope ma o ka waha. Hele ia i loko o ka esophagus (paipu meaʻai) a me ka ʻōpū a hiki i ka duodenum (ka ʻāpana o ka ʻōpū liʻiliʻi kokoke i ka ʻōpū).

• ʻAʻole pono ʻoe e hōʻoluʻolu, a hoʻomanaʻo iki paha i ka hōʻike.
• Hiki paha iā ʻoe ke gag i ka wā e hoʻoiho ʻia ka paipu i kāu esophagus.
• ʻIke paha ʻoe i ke kau ʻana o nā kuʻina i kau ʻia ka laulā i kahi.

Hoʻomoe ʻia kahi paipu lahilahi (catheter) ma o ka endoscope a hoʻokomo ʻia i loko o nā paipu (ducts) e alakaʻi ai i ka pancreas a me ka gallbladder. Hoʻokomo ʻia kahi kala kūikawā i loko o kēia mau ʻūlū, a lawe ʻia nā kukuna x. Kōkua kēia i ke kauka e ʻike i nā pōhaku, nā tumors, a me nā wahi āpau e lilo i ʻiki.

Hiki ke kau ʻia i nā mea kani kūikawā ma o ka endoscope a i loko o nā kahe.

Hoʻohana ʻia ke kaʻina hana no ka mālama ʻana a hōʻoia ʻana paha i nā pilikia o ka pancreas a i ʻole nā ​​aʻa o ka bile e hiki ai ke hōʻeha i ka ʻōpū (ʻo ka pinepine i ka ʻākau a i ʻole ka waena o ka ʻōpū) a me ka melemele o ka ʻili a me nā maka (jaundice).

E hoʻohana ʻia paha ʻo ERCP i:

• E wehe i ke komo ʻana o nā duct i loko o ka ʻōpū (sphincterotomy)
• E kīloi i nā ʻāpana kūiki (ka paʻa ʻana o ka bile duct)
• Wehe a wāwahi paha i nā pōhaku ʻaʻa
• ʻIke i nā kūlana e like me biliary cirrhosis (cholangitis) a i ʻole sclerosing cholangitis
• Lawe i nā laʻana kikoʻī e ʻike pono i kahi tumera o ka pancreas, nā aʻa o ka bile, a me ka gallbladder
• Hoʻomaʻemaʻe i nā wahi

Nānā: E hana maʻamau nā hoʻokolohua kiʻi ʻana e ʻike pono i ke kumu o nā hōʻailona ma mua o ka pau ʻana o kahi ERCP. Hoʻopili kēia i nā hōʻike ultrasound, scan CT, a me ka scan MRI.

ʻO nā pōʻino mai ke kaʻina hana nā:

• Ka hopena i ka anesthesia, kala, a i ʻole lāʻau i hoʻohana ʻia i ke kaʻina hana
• Kahena
• Hole (perforation) o ka ʻōpū
• ʻO ka hoʻohaunaele o ka pancreas (pancreatitis), hiki ke koʻikoʻi loa

ʻAʻole ʻoe e ʻai a inu paha ma kahi o 4 mau hola ma mua o ka hoʻāʻo. E kau inoa ʻoe i kahi palapala ʻae.

Wehe i nā mea hoʻonaninani āpau iʻole e hoʻopilikia i ka x-ray.

E haʻi i kāu mea mālama ola inā loaʻa nā maʻi āpau iā iodine a i ʻole loaʻa iā ʻoe nā hopena i nā kala ʻē aʻe i hoʻohana ʻia e lawe i nā kukuna.

Pono ʻoe e hoʻonohonoho i kahi holo i ka home ma hope o ke kaʻina hana.

Pono kekahi e hoʻokele iā ʻoe i ka home mai ka haukapila.

Hoʻohana ʻia ka ea e hoʻonui ai i ka ʻōpū a me ka ʻōpū i ka wā o ka ERCP hiki ke hoʻoulu i kekahi bloating a i ʻole ke kinoea no 24 mau hola. Ma hope o ke kaʻina hana, loaʻa paha iā ʻoe kahi ʻehaʻeha no ka lā mua. Hiki ke ʻeha a hiki i 3 a 4 mau lā.

Hana wale i ka hana māmā i ka lā mua ma hope o ke kaʻina hana. Hōʻalo i ka hāpai hāpai kaumaha no nā hola 48 mua.

Hiki iā ʻoe ke mālama i ka ʻeha me ka acetaminophen (Tylenol). Mai lawe i ka aspirin, ibuprofen, a i ʻole naproxen. Ke kau nei i kahi pale hoʻomehana ma luna o kou ʻōpū e hōʻoluʻolu i ka ʻeha a me ka momona.

E haʻi ka mea hāʻawi iā ʻoe i ka mea e ʻai ai. ʻO ka pinepine, e makemake ʻoe e inu i nā wai a ʻai wale i ka ʻai māmā i ka lā ma hope o ke kaʻina hana.

Kāhea i kāu mea hāʻawi inā loaʻa iā ʻoe:

• ʻEha o ka ʻōpū a i ʻole bloating koʻikoʻi
• Kahe mai ka pololei a i ʻole nā ​​noho ʻeleʻele
• Fever ma luna o 100 ° F (37.8 ° C)
• Nausea a i ʻole ka luaʻi

ʻO endoscopic retrograde cholangiopancreatography

• ERCP
• ERCP
• Endoscopic retrograde cholangio pancreatography (ERCP) - moʻo

Lidofsky SD. ʻO Jaundice. I: Feldman M, Friedman LS, Brandt LJ, eds. ʻO Sleisenger a me Fordtran's Gastrointestinal a me ka maʻi Liver: Pathophysiology / Diagnosis / Management. 10 o ka lā. Piladelapia, PA: Elsevier Saunders; 2016: chap 21.

ʻO Pappas TN, ʻo Cox ML. Ka mālama ʻana i ka cholangitis huehue. I: Cameron JL, Cameron AM, eds. ʻO ke kaʻoki lāʻau lapaʻau o kēia manawa. 12th ed. Piladelapia, PA: Elsevier; 2017: 441-444.

ʻO Taylor AJ. ʻO endoscopic retrograde cholangiopancreatography. I: Gore RM, Levine MS, hoʻoponopono. Puke puke o Gastrointestinal Radiology. ʻEhā ed. Piladelapia, PA: Elsevier Saunders; 2015: chap 74.