I-Splenomegaly

Ubende, isitho esingangenqindi engxenyeni engenhla kwesokunxele yesisu ngaphansi koqweqwe lwesokunxele, sisebenza njengengxenye ebalulekile ye-lymphatic futhi amasosha omzimba. I-Splenomegaly yenzeka lapho lesi sitho sikhuliswa ngaphezu kobukhulu baso obujwayelekile.

Ubende olunempilo ngokuvamile lufinyelela ku-12 cm ubude futhi lunesisindo esiphakathi kuka-70 kuya ku-200 amagremu. Ubukhulu bobende ngokuvamile buhlotshaniswa nezici zomzimba zomuntu ngamunye, ezinobukhulu obukhulu obuvame ukubonwa kwabesilisa uma kuqhathaniswa nabesifazane nakubantu abade noma abasindayo.

Ubende benza imisebenzi eminingana ebalulekile ekugcineni impilo yomzimba. Ngokuyinhloko, ihlunga igazi, ikhiphe ukungcola, futhi ikhiqize amangqamuzana amhlophe egazi ukuze alwe nezifo. Ukwengeza, i-spleen igcina cishe ingxenye eyodwa kwezintathu yama-platelet omzimba futhi ihlanganise ama-peptide abalulekile amasosha omzimba, okuhlanganisa i-properdin ne-tuftsin.

Ukuqonda i-splenomegaly kudinga ukuqashelwa kwemvelo yayo eguquguqukayo. Lesi simo singase senzeke ngendlela ehlukile kubantu ngabanye, kuthonywa izici ezihlukahlukene zomzimba kanye ne-pathological. Ukuqapha njalo kanye nokuhlolwa okufanele kwezokwelapha kusalokhu kubalulekile ekulawuleni lesi simo ngempumelelo.

Izimpawu ze-Spleen Esikhulisiwe (Splenomegaly)

Ukubona izimpawu nezimpawu ze-splenomegaly kubangela inselele eyingqayizivele ngoba abantu abaningi bangase bangaziboni izimpawu ezisheshayo. 

• Ubuhlungu noma ukungaphatheki kahle kuyinkomba eyinhloko, ikakhulukazi engxenyeni engenhla kwesokunxele yesisu.
• Ubende luyazwakala. 
• Ukulahlekelwa kwesifiso
• Ukungakhululeki kwesisu ngenxa yokucindezela kwesitho esikhulisiwe
• Isitho esikhulisiwe singasusa amangqamuzana egazi abomvu ngokweqile ekujikelezeni kwegazi, okungase kubangele i-anemia
• Ukukhathala okuqhubekayo
• Ubuthakathaka obujwayelekile
• Ukwanda kokungenwa yizifo
• Ukuvela kaningi kwemikhuhlane evamile
• Ukulinyazwa okulula
• Ukuthambekela ukopha okuthuthukisiwe
• Ukuhlunga kwegazi okusengozini

Izinkinga ze-Splenomegaly 

Izimo eziningi ezingaphansi zingavusa i-splenomegaly, kusukela ekuthelelekeni kuya ekuphazamisekeni kwegazi. 

• Amagciwane:  
  • Ukutheleleka ngegciwane, ikakhulukazi i-mononucleosis ne-HIV 
  • Ukutheleleka kwamagciwane, ikakhulukazi isifo sofuba kanye ne-endocarditis
  • Izimo ze-parasitic ezifana ne-malaria kanye ne-toxoplasmosis
• Izifo zesibindi, okuhlanganisa isifo sokusha kwesibindi sokuqina kwesibindi nesifo sokusha kwesibindi kohlobo, kudala umfutho ophakeme emithanjeni yegazi egijima kukho kokubili isibindi nobende, okuholela ekuhlanganeni kwegazi futhi kamuva kubangele ukwanda kobende.
• Izifo ezihlobene negazi zifaka isandla kakhulu ku-splenomegaly:
  • Izimo ezihlobene nomdlavuza:
    • I-leukemia
    • I-Lymphomas
    • Izinkinga ze-Myeloproliferative
  • Izinkinga zemithambo yegazi:
    • I-Portal vein thrombosis
    • I-Hepatic vein thrombosis
• Izimo ze-autoimmune ezifana ne-Systemic lupus erythematosus (SLE), isifo samathambo, ne-sarcoidosis 
• Izifo ze-metabolic ezizuzwe njengefa, okuyi-Niemann-Pick disease kanye nesifo sikaGaucher
• Izilonda ezigxile ngaphakathi kwe-spleen, okuhlanganisa i-hemangiomas, amathumba, ama-cysts, nokukhula kwe-metastatic 

Izinkinga ze-Splenomegaly

Uma ishiywe ingalashwa, i-spleen ekhulisiwe ingaholela ezinkingeni ezinkulu zezempilo ezithinta imisebenzi ehlukahlukene yomzimba, njenge:

Ukuphazamiseka kokugeleza kwegazi kugqama njengento eyinhloko ekhathazayo. Njengoba i-spleen ikhula, iqala ukucindezela izitho ezingomakhelwane, okuthinta ukuhamba kwegazi. Lokhu kucindezela kukhinyabeza ikhono lobende lokuhlunga igazi ngokuphumelelayo. Umsebenzi wokuhlunga osengozini ubangela ukukhishwa okunganele kwamaseli alimele nezinye izinto egazini.

Isitho esikhulisiwe singase sisebenze ngokweqile, isimo esaziwa ngokuthi yi-hypersplenism. Lo msebenzi owengeziwe uholela ekukhishweni ngokweqile kwamangqamuzana egazi ekujikelezeni kwegazi, okubangela izinkinga eziningana ezihlobene negazi:

• I-anemia ekukhishweni kwamaseli abomvu egazi amaningi
• Ukwanda kokungenwa yizifo ngenxa yokuncipha kwenani lamaseli amhlophe egazi
• Ukuthambekela ukopha okuthuthukisiwe kusuka kumazinga ancishisiwe weplatelet

Ubende olukhulisiwe lungase ludlule umthamo wegazi, luvimbele umoya-mpilo owanele ukuthi ungafinyeleli kuzo zonke izingxenye zesitho. Ngaphandle kokugeleza kwegazi okwanele, izicubu ezithintekile ziyayeka ukusebenza futhi ekugcineni ziyafa.

Nakuba kungavamile, ubende olukhulisiwe lungase luqhamuke noma luphuke ngokuzenzakalelayo kulandela umthelela oqondile, njengokuwa noma ukushaywa. I-spleen ephukile ibangela ukopha okukhulu kwangaphakathi, okwenza isimo esingase sibe yingozi esidinga ukunakekelwa kwezokwelapha ngokushesha.

Ukuxilongwa Kwe-Spleen Enwetshiwe

Ukuhlola umzimba kuyisinyathelo sokuqala, nakuba ukuthola i-spleen ekhulisiwe kudinga amasu anembile.

I-Ultrasound yesisu iyisinqumo sokuqala somugqa wokuqinisekisa ukuvuvukala okusolwayo kobende. 

Ukuhlolwa kwegazi kwakha ingxenye ebalulekile yokuxilongwa. Odokotela bavame ukucela:

• Gcwalisa inani legazi
• Ukuvivinya kokusebenza kwesibindi
• Umkantsha ukuhlaziywa ezimweni ezithile

Izikena ze-CT ezithuthukisiwe zibonakala zibalulekile lapho kudingeka ukuhlolwa kwesitho okunemininingwane. Lezi zikena zisiza ukukhomba izizathu eziqondile zokukhuliswa kwe-spleen, njenge:

• Ithumba le-splenic
• Izilonda ezinkulu
• Ukungajwayelekile kwemithambo
• Cysts
• Izinguquko ezivuthayo

Ukuskena kwe-MRI kulandelela ukugeleza kwegazi ku-spleen, kunikeze imininingwane enemininingwane ngamaphethini wemithambo. Le ndlela ibonakala iwusizo ikakhulukazi lapho kuhlolwa:

• I-Portal vein thrombosis
• Izinkinga ze-Cirrhosis
• Izilonda ezigxile

Inkomba ye-splenic, ebalwa ngokuphindaphinda ubude, ububanzi, nobude, inikeza ukuhlolwa kwevolumu. Ibanga elijwayelekile liwela phakathi kuka-160-440 cubic centimeter. Amanani adlula lobu bubanzi abonisa i-splenomegaly.

Ukwelashwa

Ubende luvame ukubuyela esimeni saso esivamile uma isimo esingaphansi siba ngcono. 

Izimo ezithile, njengokutheleleka kwesikhashana, zingaxazulula ngokuzimela ngaphandle kokungenelela okuqondile. 

Odokotela banikeza ama-antibiotic ahlosiwe okutheleleka ngamagciwane, kuyilapho izifo ezibangelwa amagciwane ngokuvamile zidinga ukunakekelwa okusekelayo kunokwelashwa ngama-antibiotic.
Lapho ukwelapha okuvamile kubonakala kungasebenzi, odokotela bacabangela ukungenelela okunolaka. Lokhu kubandakanya:

• Ukwelashwa ngemisebe enedosi ephansi ukuze kuncishiswe usayizi wobende
• Ukususwa kokuhlinzwa (splenectomy) ezimweni ezimbi kakhulu

Ezigulini ezinobende olungaguquki kodwa olukhulisiwe, izinyathelo zokuvimbela zibaluleka. Laba bantu kumele:

• Gwema imidlalo yokuxhumana efana nebhola, ibhola likanobhutshuzwayo, nehokhi
• Gqoka amabhande ezihlalo njalo ukuze uvikeleke ekuhlukumezekeni
• Gcina isimo samanje sokugoma, ikakhulukazi isibhamu saminyaka yonke somkhuhlane

Odokotela bagcizelela ukufuna ukunakekelwa okuphuthumayo kulezi zimo:

• Ubuhlungu obukhulu besisu, ikakhulukazi endaweni engaphezulu kwesokunxele
• Ukuqinisa ukungakhululeki ngenkathi uphefumula kakhulu
• Ubuhlungu obuphuma bubheke ehlombe langakwesokunxele
• Ubuthakathaka obungachazeki noma ukukhathala
• Izimpawu zokutheleleka kanye nokungakhululeki okuhlobene ne-spleen

Isiphetho

I-Splenomegaly iveza isimo sezokwelapha esiyinkimbinkimbi esidinga ukunakekelwa ngokucophelela nokuphathwa okufanele kwezokwelapha. Nakuba kuvame ukutholakala phakathi nokuhlolwa okuvamile, ama-spleen akhulisiwe angabonisa izinkinga ezihlukahlukene zezempilo ezisukela ekuthelelekeni kuye ekuphazamisekeni kwegazi.

Odokotela manje banikeza izindlela zokwelapha eziningi ezisekelwe ezimbangela ezithile namazinga obunzima. Nakuba ezinye izimo zixazulula ngokwemvelo ngemva kokwelapha isimo esiyisisekelo, ezinye zingadinga ukungenelela kokuhlinzwa nge-splenectomy. Iziguli ezibona ubuhlungu besisu obungachazeki, ikakhulukazi endaweni engaphezulu kwesokunxele, kufanele zifune usizo lwezokwelapha ngokushesha. Ukwengeza, labo abaye benza i-splenectomy badinga ukugadwa njalo futhi kufanele bahlale benolwazi ngemigomo enconywayo.

Imibuzo Evame Ukubuzwa

1. Ingabe ubende olukhulisiwe lubucayi?

Ubende olukhulisiwe ludinga ukunakwa ngokucophelela njengoba lubonisa izinkinga zempilo ezicashile. I-splenomegaly engalashwa ingase ibangele ukungasebenzi kahle kwezitho. Ezimweni ezimbi kakhulu, i-spleen ingaqhuma, kubangele ukopha kwangaphakathi okudinga ukungenelela kwezokwelapha ngokushesha.

2. Ingabe kukhona ukudla okukhethekile okufanele ukugweme nge-spleen ekhulisiwe?

Ngempela, ukukhetha kokudla kudlala indima ekulawuleni i-splenomegaly. Odokotela batusa ukugwema ukudla okucutshungulwe kakhulu, okuhlanganisa:

• Izinto zokudla okusheshayo
• Ukudla okulula okupakishiwe
• Iziphuzo ezinoshukela
• Ukudla okufakiwe

3. Bunjani ubuhlungu be-spleen?

Ubuhlungu be-spleen bubonakala njengokungakhululeki kwesisu esingenhla kwesokunxele, ngokuvamile kuhambisane nokuzwela ngemuva kwezimbambo zangakwesokunxele. Ezinye iziguli zithola ubuhlungu obudluliselwe ehlombe lesokunxele. Indawo ingase izwekale lapho ithintwa, eduze nezimpawu zokuqunjelwa kanye nokusutha kwangaphambi kwesikhathi.

4. Ingabe i-spleen ekhulisiwe ingabuyela esimweni esivamile?

Yebo, i-spleen ingabuyela kubukhulu bayo obujwayelekile uma isimo esingaphansi sithole ukwelashwa okufanele. Umugqa wesikhathi uyahlukahluka kuye ngembangela nokusebenza kwezinqubo zokwelapha.

5. Ibuhlungu kangakanani i-splenomegaly?

Amandla obuhlungu ayahluka phakathi kwabantu. Ngokuvamile, iziguli zibika ukungaphatheki kahle kwesisu okungacacile. Ukunyakaza okuthile noma ukuphefumula okujulile kungase kukhulise ukungakhululeki, ikakhulukazi uma ubende lukhula kakhulu.

6. Yikuphi ukudla okubangela ukwanda kobende?

Nakuba kungekho ukudla okuthile okubangela ngokuqondile i-splenomegaly, amaphethini athile okudla angase andise izici eziyingozi. Ukusetshenziswa okuphezulu kokudla okucutshungulwe kakhulu kanye nokuphuza utshwala ngokweqile kungaholela ezimweni ezifana ne-cirrhosis, okungenzeka kube nomthelela ekwandeni kobende.

7. Ingabe isibindi esinamafutha singadala ubende olukhulisiwe?

Ucwaningo lubonisa ukuthi ukukhula ubende kuvame ukwenzeka ezigulini ezinamafutha esibindini angewona utshwala, okubonisa ukuhlobana okubalulekile phakathi kwalezi zimo.

UDkt. Mohit Jain

MBBS, MD (General Medicine), DNB (Gastroenterology)
Izibhedlela ze-CARE CHL, e-Indore

Ukuze Ubhukhe Isikhathi, shayela:

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