Izinhlobonhlobo ze-Oesophageal

Imithambo ye-oesophageal imelela isimo esinzima sezempilo esingaholela ekopheni okusongela ukuphila epayipini lokudla. Lesi simo sidinga ukunakekelwa kwezokwelapha ngokushesha lapho izimpawu zivela, njengoba ukopha okuvela emithanjeni yomthombo kungaba kubi futhi kungase kubulale. Lo mhlahlandlela obanzi uchaza konke okudingwa yiziguli mayelana nemithambo yomphimbo, kusukela ekuboneni izimpawu eziyisixwayiso kusenesikhathi kuya ekuqondeni izindlela zokwelapha. 

Yiziphi Izinhlobonhlobo ze-Oesophageal?

Isimo sezempilo esaziwa ngokuthi yi-esophageal varices senzeka lapho imithambo yegazi engxenyeni engezansi yomminzo ikhula futhi ivuvukale. Le mikhumbi itholakala olwelweni lomgudu womphimbo. Leli shubhu elinemisipha lixhumanisa umlomo nesisu.

Lapho ukunikezwa kwegazi esibindini kuvaleka, ngokuvamile ngenxa yezibazi noma amahlule, kudala isimo esibizwa ngokuthi i-portal. nomfutho wegazi ophezulu. Lokhu kucindezela okwandayo kuphoqa igazi ukuthi lithole ezinye izindlela ngemithambo emincane yomminzo. Le mikhumbi enezindonga ezincane yayingaklanyelwe ukuphatha igazi eliningi kangaka, okubangela ukuba libe nebhaluni futhi libe buthaka.

Ubukhulu besifo se-esophageal varices bungahluka kakhulu, nezici ezibalulekile ezihlanganisa:

• Izinhlobonhlobo zingahluka kusuka ezincane kuye ezinkulu
• Izindonga zale mikhumbi ziba ntekenteke
• Basengozini enkulu yokuqhekeka noma ukuvuza
• Kufika ku-50% wezigameko zokopha
• Isimo siba sibi kakhulu njengoba isifo sesibindi siqhubeka

Izimpawu ze-Esophageal Varices

Iziguli eziningi ezine-esophageal varice azinazo izimpawu eziphawulekayo kuze kube yilapho kuvela izinkinga. Kodwa-ke, odokotela bavame ukubona lesi simo ngesikhathi sokuhlolwa okujwayelekile kwabantu abanesifo sesibindi esingamahlalakhona.

Lapho izimpawu zivela, zivame ukuhambisana nezinye izimpawu zezinkinga zesibindi. Iziguli zingase zibe:

• jaundice - ukuphuzi kwesikhumba namehlo
• I-Ascites - ukunqwabelana koketshezi esiswini
• Ubuhlungu besisu phezulu
• Ukuluma ngaphandle kokuqubuka okubonakalayo
• Ukudideka noma ukudideka
• Imilenze nezinyawo ezivuvukele

Uphawu olubi kakhulu lwenzeka lapho imithambo yegazi igqabuka futhi yopha. Iziguli zingase ziqaphele ukuhlanza igazi, okungase kubonakale kubomvu bhá noma kufane nenkundla yekhofi. Indle emnyama, efana netiyela ngokuvamile ibonisa ukopha, nakuba ezinye iziguli zingase zibona igazi elibomvu elikhanyayo esitulweni sazo phakathi nokopha ngokushesha.

Izimbangela Zokuhlukana Kwe-Oesophageal

Ukuthuthukiswa kwe-oesophageal varices kuqala ngokuyinhloko ku-portal hypertension, okwenzeka lapho umfutho wegazi ukhuphuka ohlelweni lwe-portal venous. Lokhu kucindezela okwandayo kuphoqa igazi ukuthi lifune ezinye izindlela ngemithambo emincane yomminzo.

I-Cirrhosis: I-cirrhosis kwesibindi kuyimbangela eyinhloko evame kakhulu. Izimo ezihlukahlukene zingabangela lesi sibazi sezicubu zesibindi, njengesifo sesibindi esidakayo, isifo sokusha kwesibindi kohlobo olungapheli, nesifo sesibindi esinamafutha angenatshwala. Izicubu ezinezibazi zivimba ukugeleza kwegazi okuvamile, okuholela ekwakhekeni kwama-varice.

Ezinye izimo eziningana zingabangela ukuthuthukiswa kwe-varices ye-oesophageal:
Amahlule egazi ku-portal noma splenic vein

• Ukutheleleka nge-parasitic, ikakhulukazi i-schistosomiasis
• I-cardiovascular izifo, ikakhulukazi ukuhluleka kwenhliziyo ohlangothini lwesokudla
• Ubende olukhulisiwe lwakha imithambo yegazi emisha
• I-Granulomas yesibindi

Izingozi Zezingozi

Ingozi yokopha kusuka emithanjeni yomqala ikhula kakhulu ngezici ezithile. Lokhu kubandakanya:

• Ukuqhubeka nokuphuza utshwala
• Ukucindezela okuphezulu kwe-portal vein
• Ukuba khona kwezinhlobonhlobo ezinkulu ezinamamaki abomvu. 
• Abantu abane-cirrhosis enzima 
• Labo abake bahlangabezana neziqephu zokopha ezedlule 

Izinkinga

Inkinga enzima kakhulu yemithambo yomphimbo ukopha ngaphakathi, okuthinta cishe ingxenye yeziguli. Lapho le mithambo ekhulisiwe igqabuka, ingabangela ukopha okukhulu kwegazi okudinga ukwelashwa ngokushesha. Kubantu abane-cirrhosis abopha, izinga lokusinda lonyaka owodwa limi ku-50%.

Ngaphandle kokungenelela kodokotela ngokushesha, ukopha okuvela emithanjeni yommizo kungaholela ekushaqekeni kwe-hypovolemic. Kuyisimo esisongela ukuphila lapho umzimba ungakwazi ukugcina ukutholakala kwegazi okwanele ezithweni ezibalulekile. Ezimweni ezingu-40%, ukopha kungase kume ngokuzenzakalelayo, kodwa ukwelashwa kuhlala kubalulekile ukuze kuvinjelwe ukuphindeka futhi kulawule izinkinga ezingase zibe khona.

Sifo

Odokotela bangasebenzisa amathuluzi amaningana okuxilonga:

• I-Endoscopy Engenhla (EGD): Isebenza njengezinga eligolide lokuxilongwa. Phakathi nale nqubo, i-gastroenterologist idlula ishubhu elincanyana neligobekayo elinekhamera encane exhunywe emphinjeni wesiguli. Lokhu kubenza bakwazi ukuhlola umminzo ngokuqondile futhi balinganise noma yimiphi imithambo ekhulisiwe.
• I-CT Scans: Ibonisa izithombe ezinemininingwane yemithambo yegazi
• I-Doppler Ultrasound: Ihlola ukugeleza kwegazi emithanjeni ye-portal kanye ne-splenic
• I-Elastography yesikhashana: Ikala izibazi zesibindi
• I-MRA (I-Magnetic Resonance Angiogram): Idala izithombe ezinemininingwane yemithambo yegazi

Ukwelashwa kwe-Esophageal Varices

Izinketho zokwelapha ze-esophageal varices zigxila ezinhlosweni ezimbili eziyinhloko: ukuvimbela ukopha kokuqala nokulawula iziqephu zokopha okusebenzayo. 

Ukwelapha Okuvimbela:

• Ama-Beta-blockers asiza ukwehlisa umfutho wegazi emthanjeni we-portal.
• I-Endoscopic band ligation isonga amabhande amancane okunwebeka azungeze imithambo ukuze kunqandwe ukugeleza kwegazi.
• Ukuhlolwa okuvamile kanye nokuqokwa kokulandelela ukuze kuqashwe isimo

Ezigulini ezopha kakhulu, kudingeka ukwelashwa okuphuthumayo. Odokotela bavame ukusebenzisa inhlanganisela yezindlela, okuhlanganisa:

• Imithi efana ne-octreotide noma i-vasopressin yokunciphisa ukugeleza kwegazi emthanjeni we-portal
• Izinqubo ze-endoscopic eziphuthumayo zokumisa ukopha.
• I-Transjugular intrahepatic portosystemic shunt (TIPS) ezimeni ezinzima lapho ezinye izindlela zokwelapha zibonisa ukuthi zingasebenzi kudala ukuxhumana okusha phakathi kwemithambo yegazi esibindini ukuze kuncishiswe ingcindezi emithanjeni yegazi. 

Uzoyibona Nini Udokotela

Izimo eziphuthumayo ezidinga ukunakwa ngokushesha zihlanganisa:

• Ukuhlanza igazi (kungaba okusha noma ukubukeka kwekhofi)
• Indle emnyama, efana netiyela
• Izitulo ezinegazi
• Ubuthakathaka obukhulu noma isiyezi
• Ukushaya kwenhliziyo okusheshayo ngesikhumba esibandayo, esicwebezelayo

Ukuvimbela

Ukuvimbela izinkinga ezivela ku-esophageal varices kudinga indlela ebanzi ehlanganisa ukudla okufanele, imithi, kanye nokuguqulwa kwendlela yokuphila. 

• Ukudla okuhlelwe kahle kudlala indima ebalulekile ekuvimbeleni. Iziguli kufanele zilandele lezi ziqondiso zokudla:
  • Yidla ukudla okuthambile okungokwemvelo njengobhanana ovuthiwe nemifino ephekiwe
  • Yidla ukudla okuncane okuhlanu usuku lonke esikhundleni sokudla okukhulu
  • Faka ukudla okunothe nge-fibre engancibilikiyo ukuze uvimbele ukuqunjelwa
  • Gwema ukudla okuqinile njengezaqathi eziluhlaza namagobolondo e-taco
  • Khetha ongakhetha kukho okunamafutha aphansi njengeyogathi namaprotheni angenalutho
• Ama-Beta-blockers asebenza njengesisekelo sokuvimbela kwezokwelapha, ehlisa amathuba okopha aze afike ku-50% ezigulini ezifanele. 
• Odokotela bangase batuse i-endoscopic band ligation njengendlela yokuvimbela yalabo abangakwazi ukuthatha ama-beta-blockers.
• Ukugcina indlela yokuphila enempilo kunomthelela omkhulu ekuvimbeleni. Lokhu kuhlanganisa ukugwema ngokuphelele ukusetshenziswa kotshwala nokugcina isisindo esinempilo ukuvikela ukusebenza kwesibindi. 

Isiphetho

Imithambo ye-oesophageal idinga ukunakwa okujulile nokunakekelwa okufanele kwezokwelapha ukuze kuvinjelwe izinkinga ezisongela ukuphila. Ukuhlolwa kwezokwelapha kusiza ukuhlonza le mithambo ekhulisiwe kusenesikhathi, kuyilapho ukwelashwa okufanele kunciphisa ingozi yeziqephu zokopha eziyingozi. Iziguli ezinesifo sesibindi zibhekene nengozi enkulu yokuba nalesi simo.

Isenzo esisheshayo sisindisa izimpilo lapho ukopha kwenzeka. Noma ubani onezimpawu ezinjengokuhlanza igazi noma indle emnyama kufanele ashayele abezimo eziphuthumayo ngokushesha. Ukuhlolwa njalo, ukuthobela imithi, kanye noshintsho endleleni yokuphila kusiza ukuvimbela izinkinga ezinkulu.

Inhlanganisela yokwelashwa kanye nokukhetha kwendlela yokuphila enempilo kunikeza isivikelo esingcono kakhulu ezikhathini zokopha. Iziguli ezilandela iseluleko sikadokotela, ukuthatha imithi enqunyiwe futhi zigcine ukudla okufanele zithuthukise kakhulu amathuba azo okuphatha lesi simo ngempumelelo.

Imibuzo Evame Ukubuzwa

1. Iyiphi imbangela evame kakhulu yemithambo yomphimbo?

I-cirrhosis yesibindi iyimbangela eyinhloko ye-varices ye-oesophageal. Lesi simo siqala lapho izicubu zesibindi ezinempilo zithathelwa indawo yizicubu ezibomvu, ngokuvamile ezibangelwa ukulimala kwesibindi isikhathi eside. Isibazi siholela ekwenyukeni kwengcindezi ku-portal vein, okuphoqa igazi ukuthi lithole ezinye izindlela ngemithambo yomminzo.

2. Ungakwazi yini ukululama emithanjeni yomthombo?

Ukululama emigudwini yomeso kuncike kakhulu esimweni sesibindi esingaphansi nokuthi sisabela kahle kangakanani ekwelashweni. Nakuba isimo ngokwaso singeke selapheke ngokuphelele, ukuphathwa ngendlela efanele kungavimbela ukopha futhi kunciphise izinkinga. Izinqubo ze-variceal banding zibonisa izinga lempumelelo lika-85-94% ekuvimbeleni ukuqhekeka.

3. Yini okufanele uyigweme ngemithambo ye-osophageal?

Iziguli ezine-esophageal varices kufanele zigweme izinto ezimbalwa ukuze zinciphise ingozi yazo yezinkinga:

• Ukuphakamisa kanzima (noma yini engaphezu kwamakhilogremu angu-30-40)
• ama-NSAID
• Ukuphuza utshwala
• Ukudla okunamafutha nokudla okuthosiwe
• Indlela yokuphila yama-sedentary

4. Yiziphi izimpawu eziyisixwayiso zemithambo yomphimbo?

Abantu kufanele babheke lezi zimpawu eziyisixwayiso ezibucayi:

• Ukuhlanza igazi (ukubukeka okusha okubomvu noma okuphansi kwekhofi)
• Okumnyama, indle ephuzile
• Ikhanda elikhanyayo noma ukuquleka
• Ukushaya kwenhliziyo okusheshayo
• Isikhumba esibandayo, esicwebezelayo
• Ukukhathala okukhulu nobuthakathaka

UDkt. Saurabh Lanjekar

CARE Medical Team