Ama-Ascites

I-Ascites yisimo sezokwelapha esenzeka lapho uketshezi oluningi lunqwabelana esiswini, okubangela izinkinga zempilo ezingaba khona. Ukuqonda ama-ascites, izimbangela zawo, kanye nokwelashwa okutholakalayo kubalulekile kulabo abathintekayo kulesi simo.

Ama-ascites angavela ezinkingeni ezihlukene zezempilo, kanti isifo sesibindi siyimbangela evamile. Izimpawu ze-ascites zingahluka kusukela ekuphathekeni okuncane kuya ebuhlungu obukhulu kanye nobunzima bokuphefumula. Lesi sihloko sizohlola izimbangela ze-ascites, izimpawu zayo nokuthi odokotela baxilonga futhi basiphathe kanjani lesi simo. 

Iyini i-Ascites?

I-Ascites yisimo esibonakala ngokunqwabelana koketshezi oluningi esiswini. Lokhu kunqwabelana kwenzeka phakathi kwezingqimba ezimbili ze-peritoneum, ishidi lethishu elimboze izitho zesisu. Lesi simo sivame ukuvela kubantu abane i-cirrhosis, okuyizibazi zesibindi. Njengoba uketshezi lunqwabelana, lungabangela isisu sikhukhumale, okuholela ekuphathekeni kabi kanye nohlu lwezimpawu. Lokhu kungase kuhlanganise ubuhlungu besisu, ukuvuvukala, ukuqunjelwa, Futhi ukuphelelwa umoya. Ama-ascites angabangelwa ukwanda kwengcindezi ku-portal vein (Lo mthambo usuka ezithweni zokugaya uye esibindini). Lokhu kuphakama komfutho kungaphazamisa ukusebenza kwezinso nesibindi, kubangele ukunqwabelana koketshezi. Nakuba ama-ascites ngokwawo ngokuvamile engafaki ukuphila engozini, angase abonise isimo esibucayi kakhulu.

Izigaba ze-Ascites

Ama-ascites anomthelela omkhulu ezigulini ze-cirrhosis yesibindi, cishe ama-60% aqala lesi simo phakathi neminyaka eyishumi. Ukuhlukaniswa kwe-ascites kusekelwe kumthamo woketshezi emgodini wesisu. 

• Ibanga loku-1: Ama-ascites amaphakathi, atholakala kuphela ngokuhlolwa kwe-ultrasound. 
• IBanga lesi-2: Ama-ascites amaphakathi, abangela ukungezwani kwesisu okuthambile. 
• IBanga lesi-3: Ama-ascites amakhulu, okuholela ekuphumeni okuphawulekayo kwesisu. 

Ukuvela kwe-ascites kubonisa ukubikezela okubi, ngezinga lokufa elibalelwa ku-40% ngemva konyaka owodwa. Iziguli ezinama-ascites angeyona inkimbinkimbi zinamathuba angu-85% okusinda onyaka owodwa. Kodwa-ke, lokhu kwehla kakhulu kulabo abanezinkinga ezifana ne-hyponatremia, i-refractory ascites, noma i-hepatorenal syndrome. 

Izinkinga ze-Ascites

I-Ascites inezimbangela ezihlukahlukene, njenge:

• I-cirrhosis yesibindi ivame kakhulu. 
• Esinye isifo sofuba esiswini. 
• Umdlavuza esiswini, njenge-ovarian, pancreatic, noma umdlavuza wesibindi, nawo ungaholela kuma-ascites. 
• Izimo zenhliziyo, ikakhulukazi ukwehluleka kwenhliziyo eqinile, kungase kubangele ukunqwabelana koketshezi esiswini. 
• Izifo zezinso, izifo, i-renal dialysis, namazinga aphansi amaprotheni angabangela ukuthuthukiswa kwe-ascites. 
• I-Portal vein thrombosis, ebandakanya amahlule egazi emithanjeni yesibindi, kanye ne-pancreatitis ngezinye izimbangela ezingase zibe khona. 

Ukuqonda lezi zimbangela kubalulekile ekwelapheni okusebenzayo kwe-ascites nokuphatha izimo ezingaphansi.

Izimpawu ze-Ascites

Izimpawu ze-ascites zingakhula kancane kancane noma ngokuzumayo, kuye ngokuthi imbangela eyinhloko. Izimpawu eziyinhloko zihlanganisa ukuvuleka kwesisu kanye nokuzuza kwesisindo ngokushesha. Umuntu ngamunye angase abe nobuhlungu besisu, ukuqunjelwa, nokungakhululeki njengoba uketshezi lunqwabelana. Uketshezi oluningi olunqwabelanayo lungaholela ekuphefumuleni kanzima njengoba i-diaphragm idudulelwa phezulu, icindezela amaphaphu aphansi. Ezinye izimpawu zihlanganisa: 

• Ukuvuvukala emaqakaleni
• Izinkinga zokugaya ukudla njenge ukulahlekelwa ukudla kanye nokuqunjelwa
• Ukuhlungu obusemhlane
• Ukukhathala. 
• Ngezinye izikhathi, i-peritonitis yebhaktheriya ezenzakalelayo ingase ivele, ibangele imfiva, isicanucanu, nokuthamba kwesisu. 

Ubukhulu bezimpawu ngokuvamile buhambisana nenani loketshezi olungaphakathi kwesisu.

Ukuxilongwa kwe-Ascites

Odokotela basebenzisa izindlela ezihlukahlukene zokuxilonga i-ascites. 

• Ukuhlolwa Komzimba: Udokotela uzohlola ukuthukuthela okuguquguqukayo noma ama-bulging flanks, angasiza ekuboneni ama-ascites. 
• Ukuhlolwa Kwegazi: Odokotela bangase benze uphenyo lwegazi oluhlukahlukene (ukuhlolwa kokusebenza kwesibindi (LFT), ukuhlolwa kokusebenza kwezinso (RFT)) kanye nezifo & nezimpawu zomdlavuza ukuze kutholakale ama-ascites.
• I-Abdominal Ultrasonography: Ingakwazi ukubona ngisho nenani elincane loketshezi. 
• Ukuhlolwa Kwezithombe: Kwezinye izimo, odokotela benza i-computed tomography, i-laparoscopy, noma i-MRI ukuze bathole ukuxilongwa okuqondile, ikakhulukazi uma kusolakala ukuthi kukhona okulimazayo.
• I-Diagnostic Paracentesis: Le nqubo ibhekwa njengokuhlolwa kwegolide okujwayelekile kokuxilonga, lapho odokotela bezokhipha khona isampula yoketshezi lwe-ascitic. Lolu ketshezi luhlaziywa ukuze kutholakale inani lamaseli, amazinga e-albumin, nesiko ukuze kutholakale imbangela. I-serum-ascites albumin gradient (SAAG) ukuhlolwa okubalulekile, okuneleveli engu-1.1 g/dL noma ngaphezulu ekhombisa umfutho wegazi ophakeme ephothali. 

Ukwelashwa kwe-Ascites

Ukwelashwa kwe-ascites ngokuvamile kuhilela inhlanganisela yezindlela: 

• Imithi: I-Diuretics iyinsika yokwelapha. Ngezinye izikhathi odokotela banikeza ama-antibiotics uma imbangela ye-ascites ingukutheleleka.
• Ukudla okune-sodium ephansi: Kunconywa ukuthi ukhawule usawoti wokudla ufike ku-90 mmol/usuku. 
• I-Paracentesis: Odokotela bavame ukusebenzisa i-paracentesis yokwelapha ezigulini ezinama-ascites amakhulu noma aphikisayo. Le nqubo ihlanganisa ukukhipha uketshezi lwe-ascitic ngokunwetshwa kwevolumu kusetshenziswa i-albumin uma ngaphezu kwamalitha angu-5 kukhishwa. 
• I-Shunt Placement: Ngezinye izikhathi, odokotela baphakamisa ukubekwa kwe-transjugular intrahepatic portosystemic shunt (TIPS) ezigulini ezidinga i-paracentesis njalo.

Izinkinga

I-Ascites ingaholela ezinkingeni ezinkulu uma ishiywe ingalashwa, okuhlanganisa: 

• Ukutheleleka: Okuvame kakhulu yi-bacterial peritonitis ezenzakalelayo, ukutheleleka kwe-ascitic fluid. Lesi simo sibangela imfiva nobuhlungu besisu, okudinga ukunakekelwa ngokushesha kwezokwelapha kanye nokwelashwa ngama-antibiotic. 
• I-Hepatic Hydrothorax: Kulesi simo, uketshezi lunqwabelana emaphashini, lubangele ubunzima bokuphefumula kanye nokungakhululeki kwesifuba. 
• I-Hernia: Ukwanda kwengcindezi yesisu kusuka ku-ascites kungaholela i-hernias, ikakhulukazi izinhlobo ze-umbilical kanye ne-inguinal. 
• Ukukhubazeka Kwezinso: Ukwehluleka kwezinso, okwaziwa ngokuthi i-hepatorenal syndrome, kungenzeka uma i-cirrhosis iba yimbi. 

Uzoyibona Nini Udokotela

Uma une-ascites, ukufuna usizo lwezokwelapha kubalulekile uma kuvela izimpawu ezithile. Xhumana nodokotela wakho ngokushesha uma uhlangabezana: 

• Ukushisa ngaphezu kuka-38.05°C 
• Ubuhlungu besisu
• Igazi endle noma ekuhlanzeni kwakho
• Ukulimala kalula noma ukopha 
• Imilenze evuvukele noma amaqakala
• Izinkinga zokuphuza
• Izimpawu zengqondo, njengokudideka 
• Ukushintsha umbala ophuzi esikhumbeni nasemehlweni akho (i-jaundice)
• Ukuzuza kwesisindo kungazelelwe, ngokuphawulekayo ngaphezu kwamakhilogremu angu-10 noma amaphawundi amabili ngosuku izinsuku ezintathu ezilandelanayo.

Prevention

Ukuvimbela ama-ascites noma ukuphatha ukuqhubeka kwawo, abantu ngabanye bangenza izinguquko ezimbalwa zokuphila: 

• Ukudeda otshwaleni kubaluleke kakhulu, njengoba kungalimaza isibindi futhi kwandise nengozi ye-cirrhosis. 
• Ukunciphisa ukudla kukasawoti ku-2,000-4,000 mg nsuku zonke kusiza ukunciphisa ukugcinwa koketshezi. 
• Isisindo esinempilo sibalulekile, njengoba ukukhuluphala kuyisici esiyingozi sama-ascites. 
• Ukuhlolwa kwesisindo njalo kubalulekile; yazisa udokotela wakho uma uzuza ngaphezu kuka-5 kgs noma 0.9 kg nsuku zonke izinsuku ezintathu zilandelana. 
• A Ukudla okunazo zonke, ukuvivinya umzimba njalo nokugwema ugwayi kunomthelela empilweni yonke. 
• Ukwenza ucansi oluphephile kunciphisa ingozi yesifo sokusha kwesibindi, okungaholela ekulimaleni kwesibindi kanye nama-ascites.
• Ukusetshenziswa okulinganiselwe kwezidakamizwa ezilwa nokuvuvukala (ama-NSAID) nakho kuyafaneleka, njengoba kungaphazamisa ukusebenza kwezinso nokugcinwa koketshezi.

Isiphetho

Ama-ascites athinta kakhulu labo abathintekile, ngezimbangela zabo nezimpawu ezihlukahlukene eziletha izinselele ezinkulu ezigulini nakodokotela ngokufanayo. Kusuka ku-cirrhosis yesibindi kuya ezimweni zenhliziyo, izinkinga eziholela ku-ascites zidinga ukuphathwa nokwelashwa ngokucophelela. Ukuxilongwa ngokushesha kanye nokungenelela okufanele kubalulekile ukuze kuvinjwe izinkinga futhi kuthuthukiswe izinga lempilo. Lesi simo asithinti nje kuphela impilo engokomzimba kodwa futhi nempilo engokomzwelo, sigcizelela isidingo sokunakekelwa okuphelele.

Inhlanganisela yezindlela zokwelapha, izinguquko zokuphila, nezinyathelo zokuvimbela kunikeza ithemba lokuphathwa kangcono kwalesi simo. Ukutholwa kusenesikhathi nokunakekelwa kwezokwelapha okufika ngesikhathi kuyisihluthulelo sokubhekana nama-ascites kanye nezinkinga zawo ezingaba khona.

FAQ sika

1. Ingabe ama-ascites angelapheka?

Ama-ascites angaphathwa ngempumelelo, kodwa ukwelapha okuphelele kuncike ekwelapheni okuyimbangela. Ezimweni ezihambisana notshwala isifo sofuba, ama-ascites angase axazulule ngokuthuthukiswa kokusebenza kwesibindi. Ezigulini ezine-cirrhosis, imithi yokwelapha efana ne-diuretics, i-paracentesis, noma i-TIPS ingasiza ekulawuleni ama-ascites. Kodwa-ke, ukufakelwa kwesibindi kuvame ukuba ukuphela kwendlela yokwelapha ezimweni ezinzima.

2. Ingabe kufanele ngiphuze amanzi amaningi ane-ascites?

Ukuphuza uketshezi ezigulini ezine-ascites kufanele kulawulwe ngokucophelela. Nakuba ukuvinjelwa kwamanzi ngokweqile ngokuvamile kunganconywa, iziguli ezine-hyponatremia enzima zingase zidinge ukunciphisa ukuphuza kwazo amanzi. Ukulandela iseluleko sikadokotela wakho mayelana nokuphuza uketshezi kubalulekile, njengoba izidingo zomuntu ngamunye zingase zihluke ngokusekelwe ebukhulwini be-ascites nezinye izinkinga.

3. Ingabe ama-ascites angasuswa?

Yebo, inqubo ye-paracentesis ingakhipha ama-ascites. Inaliti ifakwa esiswini ukuze kukhishwe uketshezi oluningi phakathi nale nqubo. Nge-paracentesis yevolumu enkulu, ukumnika kwe-albumin kungase kudingeke ukuze kuvinjelwe izinkinga. Nakuba le nqubo inikeza ukukhululeka kwesikhashana, ayixazululi imbangela eyinhloko yama-ascites, futhi uketshezi lungase lunqwabelene ngaphandle kokwelashwa okwengeziwe.

4. Ungawahlola kanjani ama-ascites?

Ukuxilongwa kwe-ascites ngokuvamile kuhlanganisa ukuhlolwa ngokomzimba, ukuhlolwa kwe-imaging, nokuhlaziya uketshezi. Udokotela wakho angase ahlole izimpawu ezifana nokuvuvukala kwesisu noma ukuba buthuntu okushintshashintshayo. I-ultrasound yesisu iqinisekisa ukuthi kukhona uketshezi. Kwezinye izimo, odokotela bangenza i-paracentesis yokuxilonga ukuze bahlaziye i-ascitic fluid futhi banqume imbangela yayo.

5. Yikuphi ukudla okulungele ama-ascites?

Ezigulini ezine-ascites, ukudla okuphansi kwe-sodium kunenzuzo. Ukudla okunconyiwe kwesodium ngokuvamile kungaphansi kwamamiligremu angu-2,000 kuya kwangu-4,000 ngosuku. Uchwepheshe wezokudla angasiza ekwakheni uhlelo olufanele lokudla. Ukudla okunesodium ephansi, njengezithelo ezintsha, imifino, namaprotheni amancane, ngokuvamile kuyatuswa.

6. Yisiphi isikhathi sokululama sama-ascites?

Isikhathi sokuphumula se-ascites siyahlukahluka futhi sincike kumbangela kanye nendlela yokwelapha. Ngokuphathwa okufanele, ezinye iziguli zingase zibone ukuthuthuka phakathi namaviki. Nokho, kulabo abanayo isifo sesibindi esingamahlalakhona, ukuphatha ama-ascites kungase kube inqubo eqhubekayo. 

7. Ingabe ama-ascites angabuya?

Yebo, ama-ascites angaphinde avele, ikakhulukazi uma imbangela eyinhloko iphikelela. Ngemva kokwelashwa ngempumelelo, uketshezi lungase lunqwabelene futhi uma ukusebenza kwesibindi kungathuthuki noma iziguli zinganamatheli emigomeni yokudla nemithi. Ukulandelela njalo nodokotela kubalulekile ukuze kuqashwe ukuphindeka futhi kulungiswe ukwelashwa njengoba kudingeka. Kwezinye izimo, i-paracentesis ephindaphindiwe noma ukucatshangelwa kwezinye izindlela zokwelapha ezifana nama-TIPS kungase kudingeke.

UDkt Akash Chaudhary

I-MBBS, MD, i-DM
CARE Hospitals, Banjara Hills, Hyderabad

Ukuze Ubhukhe Isikhathi, shayela:

+ 91 40-68106529

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