Ka maʻi ʻaʻai ate

Anter

• He aha ka maʻi ʻaʻai ate?
• He aha nā ʻano ʻano like ʻole o ka maʻi ʻaʻai mua?
• ʻO ka maʻi maʻi hepococularular
• Cholangiocarcinoma
• ʻO angiosarcoma ate
• Hepatoblastoma
• He aha nā hōʻailona o ka maʻi ʻaʻai ate?
• ʻO wai ka makaʻu no ka maʻi ʻaʻai ate?
• Pehea e ʻike ʻia ai ka maʻi ʻaʻai ate?
• ʻO ka biopsy ate
• Pehea e mālama ʻia ai ka maʻi ʻaʻai ate?
• Hepatectomy
• Ka hoʻoliʻiliʻi ate
• Hoʻomaha
• ʻO Chemotherapy
• Lapaʻau hoʻomākala
• Pahuhopu kau ʻia
• Embolization a me ka chemoembolization
• Pehea e pale ai i ka maʻi ʻaʻai ate?
• Loaʻa i ka lāʻau hoʻomaʻi hepatitis B
• E hana i nā hana e pale aku ai i ka maʻi hepatitis C
• E hoʻemi i kou makaʻi i ka cirrhosis
• E inu wale ʻoe i ka waiʻona me ke kaulike
• Mālama i kahi kaupaona olakino
• Ke kū ʻana i ka maʻi ʻaʻai ate

Nā kiʻi Cavan / kiʻi kiʻi Getty

He aha ka maʻi ʻaʻai ate?

ʻO ke kanesa maʻi ʻaʻai ka maʻi ʻaʻai e kū i ke ake. ʻO ke akepaʻa ka mea nui glandular i loko o ke kino a hana i nā hana koʻikoʻi e mālama i ke kino me ka ʻole o nā lāʻau make a me nā mea ʻino.

Aia ke akepaʻa ma ka quadrant luna pono o ka ʻōpū, ma lalo pono o nā iwi ʻaoʻao. ʻO ia ke kuleana no ka hana ʻana i ka bile, kahi mea kōkua e hōʻolo i nā momona, nā wikamina, a me nā meaola ʻē aʻe.

Mālama pū kēia meaola nui i nā meaola e like me ka glucose, i mālama pono ai ʻoe i nā manawa ke ʻai ʻole ʻoe. Uhaʻi nō hoʻi ia i nā lāʻau a me nā lāʻau make.

Ke hoʻomohala ʻia ka maʻi ʻaʻai i ke ake, hoʻopau ia i nā hunaola ate a keʻakeʻa i ka hiki o ke ake ke hana maʻamau.

Hoʻokaʻawale ʻia ka maʻi ʻaʻai ate ma ke ʻano he kula mua a ʻelua paha. Hoʻomaka ka maʻi maʻi ate mua i nā hunaola o ke ake. Hoʻolālā ka maʻi ʻaʻai ʻelua i ka wā e laha ana nā hunaola maʻi maʻi mai kahi mea ʻē aʻe i ke akepaʻa.

ʻAʻole like me nā hunaola ʻē aʻe i loko o ke kino, hiki i nā hunaola maʻi ʻoki ke hemo mai ka pūnaewele mua, a kahi i hoʻomaka ai ka maʻi ʻaʻai.

Hele nā ​​pūnaewele i nā wahi ʻē aʻe o ke kino ma o ke kahe o ke koko a i ʻole ka lymphatic system. E ʻohiʻohi nā hunaola maʻi ʻaʻai i loko o ke kino ʻē aʻe a hoʻomaka e ulu ma laila.

Kuhi kēia ʻatikala i ka maʻi ʻaʻai mua. Inā loaʻa ʻoe i ka maʻi ʻaʻai i loko o kahi lālā ʻē aʻe ma mua o kou hoʻomohala ʻana i ka maʻi ʻaʻai ate, e ʻoluʻolu e ʻike i kā mākou ʻatikala e pili ana i ka metastasis ate e aʻo hou aʻe e pili ana i ke kanesa maʻi ʻelua.

He aha nā ʻano ʻano like ʻole o ka maʻi ʻaʻai mua?

ʻO nā ʻano ʻokoʻa o ka maʻi ʻaʻai akekake mua mai nā ʻano like ʻole i kūkulu i ke ake. Hiki ke hoʻomaka ka maʻi ʻaʻai ate ma ke ʻano he puʻupuʻu hoʻokahi e ulu ana i ke ake, a i ʻole hiki ke hoʻomaka i nā wahi he nui i loko o ke akepaʻa i ka manawa like.

ʻO ka poʻe me ka hōʻino nui o ke ake e loaʻa pinepine i nā wahi ulu maʻi ʻaʻai. ʻO nā ʻano nui o ka maʻi ʻaʻai mua:

ʻO ka maʻi maʻi hepococularular

ʻO Hepatocellular carcinoma (HCC), ʻo ka hepatoma kekahi, ʻo ia ke ʻano o ka maʻi ʻaʻai ate, no ka 75 pākēneka o nā maʻi maʻi ate āpau.

Kūkulu kēia ʻano i nā hepatosit, ʻo ia nā hunaola ate nui. Hiki ke pālahalaha ʻia mai ke ake a i nā ʻāpana ʻē aʻe o ke kino, e like me ka pancreas, nā ʻōpū, a me ka ʻōpū.

ʻOi aku paha ka HCC i ka poʻe i loaʻa ka ʻeha o ke ake ma muli o ka hōʻino ʻana i ka ʻalekohola.

Cholangiocarcinoma

ʻO Cholangiocarcinoma, ka mea i ʻike pinepine ʻia e like me ka maʻi ʻaʻai bile duct, ulu i loko o nā liʻiliʻi, e like me nā paipu e like me ka paipu i ke ake. Hāpai kēia mau aniani i ka lāʻau i ka gallbladder e kōkua ai i ka digestion.

Ke hoʻomaka ka maʻi ʻaʻai i ka ʻāpana o nā duct i loko o ke ake, ua kapa ʻia ʻo intrahepatic bile duct cancer. Ke hoʻomaka ka maʻi ʻaʻai i ka ʻāpana o nā duct i waho o ke ake, ua kapa ʻia ʻo ka maʻi kanal o ke aʻa extrahepatic.

ʻO ka maʻi ʻaʻai ʻo Bile duct no kahi 10 a 20 paha pākēneka o nā maʻi maʻi ate.

ʻO angiosarcoma ate

ʻO ka angiosarcoma ate he ʻano laha ʻole o ka maʻi ʻaʻai ate e hoʻomaka i loko o nā kīʻaha koko o ke ake. ʻO kēia ʻano maʻi ʻaʻai e holomua me ka wikiwiki, no laila ʻike pinepine ʻia i kahi pae holomua.

Hepatoblastoma

Hepatoblastoma kahi ʻano laha ʻole loa o ka maʻi ʻaʻai ate. ʻAneʻane loaʻa mau ia i nā keiki, ʻo ka mea hoʻi ma lalo o ka makahiki 3.

Me ke ʻoki a me ka chemotherapy, hiki ke maikaʻi loa ka nānā aku no nā poʻe me kēia ʻano maʻi ʻaʻai. Ke ʻike ʻia ka hepatoblastoma i nā wā mua, ʻoi aku ka kiʻekiʻe o ke ola ma mua o 90 pākēneka.

He aha nā hōʻailona o ka maʻi ʻaʻai ate?

ʻAʻole ʻike ka poʻe he nui i nā ʻōuli i ka wā mua o ka maʻi ʻaʻai mua. Ke ʻike ʻia nā ʻōuli, pili pū paha lākou:

• hōʻoluʻolu o ka ʻōpū, ʻeha, a me ka palupalu
• melemele o ka ʻili a me nā keʻokeʻo o nā maka, i kapa ʻia he jaundice
• keʻena keʻokeʻo, chalky
• nausea
• ka luaʻi
• ʻūpī a hoʻokahe wale paha
• nāwaliwali
• luhi

ʻO wai ka makaʻu no ka maʻi ʻaʻai ate?

ʻAʻole maopopo i nā kauka ke kumu e loaʻa ai i kekahi poʻe ka maʻi ʻaʻai ate akā ʻaʻole nā ​​poʻe ʻē aʻe. Eia nō naʻe, aia kekahi mau mea i ʻike ʻia e hoʻonui i ka makaʻu o ka hoʻomohala ʻana i ka maʻi ʻaʻai ate:

• ʻOi aku ka maʻi o ka maʻi ʻaʻai ma nā poʻe ma mua o 50 mau makahiki.
• Hiki i kahi maʻi hepatitis B a C lōʻihi loa ke hoʻopōʻino i kou ake. Hoʻolahalaha ʻia ka Hepatitis mai ke kanaka a ke kanaka ma o ka pili pololei ʻana me nā wai o ke kanaka i loaʻa i ka maʻi, e like me ko lākou koko a i ʻole ka semen. Hoʻohui ʻia nō hoʻi mai ka makuahine a ke keiki i ka wā hānau hānau. Hiki iā ʻoe ke hoʻohaʻahaʻa i kou makaʻi no ka hepatitis B a me C ma ka hoʻohana ʻana i ka pale i ka wā o ka moekolohe. Aia kekahi lāʻau lapaʻau i hiki ke pale iā ʻoe i ka maʻi hepatitis B.
• ʻO ka loaʻa ʻana o nā mea inu ʻona ʻelua a ʻoi paha i kēlā me kēia lā i nā makahiki he nui e hoʻonui i kou makaʻu no ka maʻi ʻaʻai ate.
• ʻO ka Cirrhosis kahi ʻano o ka hōʻino o ke akepaʻa kahi i hoʻololi ʻia ai nā mea olakino e nāʻiʻo makaʻu. ʻAʻole hiki i ke ake kuni ke hana pono a alakaʻi hope paha i nā pilikia he nui, me ka maʻi ʻaʻai ate. ʻO ka hōʻino waiona wā lōʻihi a me ka hepatitis C nā kumu maʻamau o ka cirrhosis i United States. ʻO ka hapanui o ʻAmelika me ka maʻi ʻaʻai ate he cirrhosis ma mua o ka hoʻomohala ʻana i ka maʻi ʻaʻai ate.
• Hōʻike i ka aflatoxin kahi mea pilikia. ʻO ka Aflatoxin kahi mea ʻona i hana ʻia e kekahi ʻano o ka pala i hiki ke ulu ma nā pī, nā hua, a me nā kulina. Ma ʻAmelika Hui Pū ʻIa, ʻo nā kānāwai mālama lima i ka palena i hōʻike ākea i ka aflatoxin. Ma waho o ka ʻāina, eia nō naʻe, hiki ke kiʻekiʻe ke ʻike ʻana i ka aflatoxin.
• ʻO ka maʻi diabetes a me ka momona ka pilikia pū kekahi. ʻO ka poʻe me ka maʻi diabetes e mālama i ka momona a i ʻole ka momona, kahi e pilikia ai ka ate a hoʻonui i ka makaʻu no ka maʻi ʻaʻai.

Pehea e ʻike ʻia ai ka maʻi ʻaʻai ate?

Hoʻomaka ka hōʻailona o ka maʻi ʻaʻai ate me ka mōʻaukala olakino a me ka hoʻokolokolo kino. E ʻike pono e haʻi aku i kāu kauka inā loaʻa iā ʻoe ka mōʻaukala o ka wā ʻino lōʻihi a i ʻole ka maʻi hepatitis B a me C maʻi maʻi paha.

ʻO nā hōʻoia diagnostics a me nā kaʻina hana no ka maʻi ʻaʻai ate me kēia mau mea:

• ʻO nā hoʻokolohua hana ate e kōkua i kāu kauka e hoʻoholo i ke olakino o kou ake ma ke ana ʻana i nā pae o nā protein, nā ʻenema ate, a me bilirubin i kou koko.
• ʻO ke kū ʻana o ka alpha-fetoprotein (AFP) i loko o ke koko he hōʻailona no ka maʻi ʻaʻai ate. Hana wale ʻia kēia protein i ke akepaʻa a me ka ʻeke yolk o nā pēpē ma mua o ko lākou hānau ʻia ʻana. Kū ka hana a ka AFP ma hope o ka hānau ʻana.
• Hana nā scans Abdominal CT a i ʻole MRI i nā kiʻi kikoʻī o ke ake a me nā mea ʻē aʻe i loko o ka ʻōpū. Hiki iā lākou ke ʻae i kāu kauka e kuhikuhi i kahi e ulu ai kahi tumo, hoʻoholo i kona nui, a nānā inā ua pālahalaha ʻia i nā meaola ʻē aʻe.

ʻO ka biopsy ate

ʻO kekahi hōʻike diagnostic i loaʻa he biopsy ate. Hoʻopili kahi biopsy ate i ka hemo ʻana i kahi ʻāpana ake o ke ake ake. Hana mau ʻia ia me ka hoʻohana ʻana i ka anesthesia e pale aku ai iā ʻoe i ka ʻehaʻeha i ke kaʻina hana.

I ka hapanui o nā hihia, hana ʻia kahi biopsy nila. I loko o kēia kaʻina hana, e hoʻokomo kāu kauka i kahi kui kele ma o kou ʻōpū a i loko o kou ake e loaʻa i kahi hōʻailona kiko. Nānā ʻia ka laʻana ma lalo o ka microscope no nā ʻōuli o ke kanesa.

E hana ʻia paha kahi biopsy ate me ka hoʻohana ʻana i ka laparoscope, kahi paipu lahilahi a maʻalahi me kahi kāmela i hoʻopili ʻia. ʻAe ka pahu paʻi kiʻi i kāu kauka e ʻike i ke ʻano o ke ake a hana i kahi biopsy kikoʻī.

Hoʻokomo ʻia ka laparoscope ma o kahi ʻoki liʻiliʻi i loko o ka ʻōpū. Inā makemake ʻia nā laʻana kikoʻī mai nā mea ʻē aʻe, e hana nui kāu kauka. Kapa ʻia kēia he laparotomy.

Inā loaʻa ka maʻi ʻaʻai ate, e hoʻoholo kāu kauka i ka pae o ka maʻi ʻaʻai. Hōʻike ke kahua i ka paʻakikī a i ʻole ka nui o ka maʻi ʻaʻai. Hiki iā ia ke kōkua i kāu kauka e hoʻoholo i kāu koho lapaʻau a me kāu nānā. ʻO ka pae 4 ka pae kiʻekiʻe loa o ka maʻi ʻaʻai ate.

Pehea e mālama ʻia ai ka maʻi ʻaʻai ate?

ʻOkoʻa ka mālama ʻana no ka maʻi ʻaʻai ate. Aia ia i:

• ka helu, ka nui, a me kahi o nā tumors i ke akepaʻa
• pehea ka maikaʻi o ka hana a ke ake
• inā aia ka cirrhosis
• inā ua pālahalaha ka tumo i nā ʻōpala ʻē aʻe

E hoʻokumu ʻia kāu papa hana lapaʻau e pili ana i kēia mau kumu. Hiki i nā ʻano maʻi maʻi ʻaʻai ke komo i kēia mau mea:

Hepatectomy

Hana ʻia kahi hepatectomy e hoʻoneʻe i kekahi ʻāpana o ke ake a i ʻole nā ​​ake āpau. Hana pinepine ʻia kēia ʻokiʻoki ke paʻa ʻia ka maʻi ʻaʻai i ke ake. I ka hala ʻana o ka manawa, e hōʻuluʻulu hou nā mea olakino i koe i ka ʻāpana i nalo.

Ka hoʻoliʻiliʻi ate

Hoʻopili kahi pepeke ake i ke akepaʻa maʻi me ke ake olakino mai kahi mea hāʻawi kūpono. Hiki ke hana i kahi transplant inā ʻaʻole pāhola ka maʻi ʻaʻai i nā meaola ʻē aʻe. Hāʻawi ʻia nā lāʻau e pale ai i ka hōʻole ma hope o ke transplant.

Hoʻomaha

Hoʻohui ʻo Ablasi i ka hoʻohana ʻana o ka wela a i ʻole nā ​​ethanol injection e hōʻino ai i nā hunaola maʻi ʻaʻai. Hana ʻia ia me ka hoʻohana ʻana i ka anesthesia kūloko. Hoʻomaʻomaʻa kēia i ka wahi e pale ai iā ʻoe mai ka ʻeha ʻana. Hiki i ka Ablasi ke kōkua i ka poʻe i ʻole moho no ke ʻoki a i ʻole ke transplant.

ʻO Chemotherapy

ʻO Chemotherapy kahi ʻano hakakā o ka lāʻau lapaʻau e hōʻino ana i nā hunaola maʻi ʻaʻai. Hoʻokomo pinepine ʻia nā lāʻau i loko, a i ʻole ma o ka aa. I ka hapanui o nā hihia, hiki ke hāʻawi ʻia i ka chemotherapy ma ke ʻano he lāʻau lapaʻau i waho.

Hiki ke maikaʻi ka Chemotherapy i ka mālama ʻana i ka maʻi ʻaʻai ate, akā nui ka poʻe i ʻike i nā hopena i ka wā o ka mālama ʻana, e like me ka luaʻi, hoʻemi i ka makemake, a me nā haʻalulu. Hiki i ka Chemotherapy ke hoʻonui i kāu makaʻu o ka maʻi.

Lapaʻau hoʻomākala

Hoʻopili ka radiation radiation i ka hoʻohana ʻana i nā kaola kukuna uila ikaika e pepehi i nā hunaola maʻi ʻaʻai. Hiki ke hāʻawi ʻia e ka radiation radiation i waho a i ʻole i ka radiation internal.

I ka radiation radiation waho, pili ka radiation i ka ʻōpū a me ka umauma. Pili ka pāhawewe kūloko i ka hoʻohana ʻana o ka catheter e hoʻokomo i nā ʻāpana radioactive liʻiliʻi i loko o ke aʻa hepatic.

Luku ka pāhawewe i ke aʻa hepatic, kahi kīʻaha koko e hāʻawi i ke koko i ke ake. Hoʻoiho kēia i ka nui o ke kahe o ke koko i ka tumo. Ke pani ʻia ke aʻa hepatic, hoʻomau ka portal vein i ka hānai i ke ake.

Pahuhopu kau ʻia

Hoʻopili ka lāʻau hoʻomōhala ʻia i ka hoʻohana ʻana i nā lāʻau i hoʻolālā ʻia e pā i nā hunaola maʻi ʻaʻai ma kahi e nāwaliwali ai. Hoʻoemi lākou i ka ulu ʻana o ka tumora a kōkua i ka hoʻopau ʻana i ka lako o ke koko i ka tumo.

Ua ʻae ʻia ʻo Sorafenib (Nexavar) e like me ka mea i hoʻomākaukau ʻia no ka poʻe me ka maʻi ʻaʻai ate. Hiki ke kōkua i ka lāʻau i hoʻomākaukau ʻia no nā poʻe ʻaʻole moho no ka maʻi hepatectomy a i ʻole ke ake.

Hiki i nā mea i hoʻolālā ʻia ke loaʻa nā hopena ʻaoʻao nui.

Embolization a me ka chemoembolization

ʻO ka Embolization a me ka chemoembolization he mau hana ʻoki. Pau lākou e ālai i ke aʻa hepatic. E hoʻohana kāu kauka i mau ʻanuʻu liʻiliʻi a i ʻole nā ​​ʻāpana ʻē aʻe e hana i kēia. Hoʻoemi kēia i ka nui o ke kahe o ke koko i ka tumo.

I ka chemoembolization, hoʻokuʻi kāu kauka i nā lāʻau chemotherapy i loko o ke aʻa hepatic ma mua o ka hoʻopili ʻia ʻana o nā huna. Mālama ka blockage i mālama i nā lāʻau chemotherapy i ke akepaʻa no kahi wā lōʻihi.

Pehea e pale ai i ka maʻi ʻaʻai ate?

ʻAʻole hiki ke pale ʻia ka maʻi ʻaʻai akepaʻa. Eia nō naʻe, hōʻemi ʻoe i kou makaʻi no ka maʻi ʻaʻai ate ma ke lawe ʻana i nā ʻanuʻu e pale ai i ka hoʻomohala ʻana o nā kūlana e hiki ai i ka maʻi ʻaʻai ate.

Loaʻa i ka lāʻau hoʻomaʻi hepatitis B

Aia kekahi lāʻau lapaʻau no ka maʻi hepitis B e loaʻa i nā keiki āpau. ʻO nā mākua i makaʻu nui i ka maʻi (e like me ka poʻe e hōʻino ana i nā lāʻau lapaʻau intravenous) pono nō hoʻi e wailana ʻia.

Hāʻawi pinepine ʻia ka lāʻau lapaʻau i loko o ke kaʻina o ʻekolu injection i loko o 6 mau mahina.

E hana i nā hana e pale aku ai i ka maʻi hepatitis C

ʻAʻohe lāʻau lapaʻau no ka maʻi hepatitis C, akā hiki iā ʻoe ke hōʻemi i kou makaʻu i ka loaʻa ʻana o ka maʻi i ka hana ʻana i kēia mau mea:

• E hoʻohana i ka pale. Hoʻomaʻamaʻa mau i ka moekolohe me ka hoʻohana ʻana i ka pale pale me kāu poʻe hoa kolohe āpau.ʻAʻole loa ʻoe e komo i ka moekolohe pale ʻole ke ʻole ʻoe e ʻike ʻaʻole maʻi kāu maʻi i ka maʻi hepitis a i ʻole nā ​​maʻi ʻino e lawe ʻia i ka moekolohe.
• Mai hoʻohana i nā lāʻau kū ʻole. Hōʻalo i ka hoʻohana ʻana i nā lāʻau kū ʻole i ke kānāwai, keu hoʻi i nā mea i hiki ke injected, e like me heroin a cocaine. Inā hiki ʻole iā ʻoe ke hōʻoki i ka hoʻohana ʻana i nā lāʻau, e hōʻoia e hoʻohana i kahi nila kuʻikuʻu i kēlā me kēia manawa e hoʻokomo ʻoe iā lākou. Mai hoʻokaʻawale i nā nila me nā poʻe ʻē aʻe.
• E akahele e pili ana i ka honu a me ke ʻō. E hele i kahi hale kūʻai hilinaʻi i kēlā me kēia manawa inā loaʻa iā ʻoe i ke kui a me ka peʻa. E noi i nā limahana e pili ana i kā lākou hana palekana a e hōʻoia e hoʻohana lākou i nā nila kele.

E hoʻemi i kou makaʻi i ka cirrhosis

Hiki iā ʻoe ke hoʻohaʻahaʻa i kou makaʻi o ka cirrhosis ma ka hana ʻana i kēia mau mea:

E inu wale ʻoe i ka waiʻona me ke kaulike

ʻO ka palena ʻana i ka nui o ka waiʻona āu e inu ai hiki ke pale i ka hōʻino ʻana o ke ake. ʻAʻole pono nā wahine e inu ma mua o hoʻokahi inu i kēlā me kēia lā, a ʻaʻole pono nā kāne e inu i nā mea inu ma mua o ʻelua mau inu i kēlā me kēia lā.

Mālama i kahi kaupaona olakino

ʻO ka hoʻoikaika kino no 30 mau minuke ma ka liʻiliʻi ʻekolu mau manawa i kēlā me kēia pule hiki ke kōkua iā ʻoe e mālama i kou kaupaona.

He mea nui ka ʻai ʻana i ka papaʻai kaulike no ka mālama ʻana i ke kaumaha. E nānā pono i ka hoʻopili ʻana i nā protein momona, nā kīʻaha holoʻokoʻa, a me nā mea kanu a hua paha i ka hapa nui o kāu mau meaʻai.

Inā pono ʻoe e lilo i ka paona, e hoʻonui i ka nui o ka hoʻoikaika kino āu e hana ai i kēlā me kēia lā a hoʻēmi i ka helu o nā calories āu e ʻai ai.

Hiki paha iā ʻoe ke noʻonoʻo e hui pū me kahi nutrististist. Hiki iā lākou ke kōkua iā ʻoe e hana i kahi papa ʻaina a hoʻoikaika i ka papa hana e ʻae iā ʻoe e hoʻokō wikiwiki i kāu mau pahu hopu.

Inā loaʻa iā ʻoe kekahi o kēia mau ʻano a hopohopo ʻoe i kou makaʻu no ka maʻi ʻaʻai ate, e kamaʻilio me kāu kauka e pili ana i ka loiloi ʻana o ka maʻi ʻaʻai ate.

Ke kū ʻana i ka maʻi ʻaʻai ate

Hiki ke loli ke kuhi maʻi ʻaʻai ate. He mea nui ka loaʻa ʻana o kahi pūnaewele kākoʻo ikaika i hiki ke kōkua iā ʻoe e hana me nā pilikia a me nā hopohopo āu e manaʻo nei.

Makemake paha ʻoe e ʻike i kahi kākāʻōlelo e hiki ke kōkua iā ʻoe e hana ma waena o kou naʻau. E makemake paha ʻoe e noʻonoʻo i ka hui ʻana i kahi hui kākoʻo maʻi maʻi kahi e hiki ai iā ʻoe ke kūkākūkā i kāu mau hopohopo me nā poʻe ʻē aʻe i hiki ke pili i nā mea āu e hele nei.

E noi i kāu kauka e pili ana i nā hui kākoʻo i kou wahi. Hiki iā ʻoe ke ʻike i ka ʻike e pili ana i nā pūʻulu kākoʻo ma nā pūnaewele ʻo ʻAmelika ʻAmelika.