Izifo zesibindi kanye ne-Bile duct

Ukwelashwa kwe-Bile Duct Disease e-Hyderabad, e-India

Izifo Zesibindi

Abantu bahlome ngezindlala eziningi ezibalulekile emzimbeni, kuhlanganise nesibindi. Imisebenzi eminingi ilawulwa isibindi, okuhlanganisa ukugaya, ukugcinwa kwamandla, ukulawulwa kwama-hormone, nokukhululwa kwamakhemikhali nezakhi emzimbeni. Nokho, izifo zesibindi zingakhinyabeza inqubo yemvelo ethinta izinga lokuphila komuntu. 

Izinhlobo zezifo zesibindi

Izifo zesibindi ezilandelayo zingahlukaniswa ngokubanzi:

• Izifo ezibangelwa igciwane: I-Hepatitis A, B, C & E

• Ezinye izifo: Ithumba lesibindi, isifo sofuba esivuthayo

• Isifo sesibindi esinamafutha kanye ne-cirrhosis yesibindi yizifo ezibangelwa ukusebenzisa kabi utshwala

• Umdlavuza wesibindi: I-Hepatocellular carcinoma kanye ne-cholangiocarcinoma (umdlavuza we-bile duct).

• Izifo ze-metabolism: i-jaundice kanye ne-neonatal jaundice

• Isifo sesibindi esitholwa ngumuntu ngamunye: i-hemochromatosis, isifo sikaWilson

Izimpawu nezimpawu

Kuvamile ukuthi izifo zesibindi zingabonisi zimpawu ekuqaleni. Kukhona nokho izimpawu ezimbalwa ezisobala nezibonakala kalula zezifo zesibindi:

• Ukuvuvukala nobuhlungu esiswini.

• Ukushintsha umbala ophuzi kwesikhumba kanye ne-sclera.

• Ukukhathala

• Ukulahlekelwa kwesifiso

• Isikhumba esinamahloni

• Umbala omnyama womchamo kanye nendle ephuzile

• Ukwehla kwesisindo

Ukuxilongwa kwezifo zesibindi

Xhumana nodokotela uma uhlangabezana nanoma yiziphi izimpawu zesifo sesibindi. Udokotela uzoncoma ukuthi wenze uchungechunge lokuhlolwa ukuze uhlole ukusebenza kwesibindi sakho.

Ukuhlolwa kokusebenza kwesibindi:

Ukuhlolwa kokusebenza kwesibindi kwenziwa ngokuthatha isampula yegazi nokuhlaziya ama-enzyme esibindi, amaprotheni, njll. ukuze kuhlolwe ukuthi isibindi sisebenza kanjani. Ukuhlola ukusebenza kwesibindi okujwayelekile kufaka:

Ukuhlolwa kwe-Alanine Transaminase (ALT): 

Amaprotheni aphulwa yi-enzyme yesibindi i-ALT. Ezimweni lapho ubuhlungu besisu, ukukhathala okukhulu, i-jaundice, umchamo omnyama noma indle enombala okhanyayo kubonakala, i-ALT izoyalelwa. Igazi lesiguli liqoqwa umhlinzeki wezempilo bese lithunyelwa elabhorethri ukuze lihlaziywe. Umphumela we-ALT ojwayelekile usukela kumayunithi ayi-7 kuye kwangama-55 ilitha. Amazinga e-ALT angase abe phezulu ngenxa:

• Isimila esibindini

• Ukuphuza utshwala

• Ukufa kwezicubu zesibindi

• I-Mononucleosis

• I-cirrhosis

Ukuhlolwa kwe-Aspartate aminotransferase (AST): 

I-AST nayo iyi-enzyme yesibindi futhi ibizwa nangokuthi i-serum glutamic-oxaloacetic transaminase (SGOT). Ukuhlolwa kunconywa uma unezimpawu zesifo sesibindi. Amazinga aphezulu e-AST abonisa ukuthi isibindi asisebenzi.

• Ubulili
• Ibanga elijwayelekile
• Abesilisa - 10 kuya ku-40 amayunithi / L
• Abesifazane - 9 kuya ku-32 amayunithi / L

Ukuhlolwa kwe-alkaline phosphatase (ALP): 

Isibindi, i-bile duct, namathambo aqukethe i-enzyme ALP. Amazinga e-ALP kufanele abe phakathi kuka-44 no-147 IU/L. Kwezinye izimo, amazinga e-ALP aphakeme kunokuvamile ngenxa yokulimala kwesibindi, ukuvinjelwa kwemigudu ye-bile, noma izifo zamathambo njenge-Paget's disease noma ama-rickets. Kungenzeka ukuthi amazinga e-ALP abe phansi ngenxa yokuntuleka kwamaprotheni, isifo sikaWilson, ukungondleki kahle, noma i-hypophosphatemia.

Ukuhlolwa kweBilirubin: 

Isibindi sikhiqiza i-bilirubin, umbala ophuzi lapho amangqamuzana abomvu egazi ephuka. Ukuhlolwa kwe-bilirubin kusetshenziselwa ukuthola ukuthi ingakanani i-bilirubin ekhona egazini. Amazinga e-bilirubin emzimbeni abangela ukuphuzi kwesikhumba kanye ne-sclera. Ngokusebenzisa imiphumela yelebhu unikezwa inani le-bilirubin ehlanganisiwe nengahlanganisiwe, kanye nenani eliphelele le-bilirubin. Isilinganiso esivamile se-bilirubin kubantu abadala singamamiligremu angu-0.2 - 1.2 ngedesilitha ngayinye (mg/dl). Izinga le-bilirubin ehlanganisiwe kufanele libe ngaphansi kuka-0.3 mg/dl. Izinga le-bilirubin egazini lingakhuphuka ngenxa ye-viral hepatitis, i-cirrhosis, isifo sesibindi esidakayo, i-anemia, ukusabela ekumpontshelwe igazi, noma i-Gilbert syndrome.

I-albumin kanye nokuhlolwa okuphelele kwamaprotheni: 

Phakathi kwamaprotheni enziwa isibindi kukhona i-albumin neglobulin. Egazini, izinga elivamile le-serum albumin lingamagremu angu-3.4 kuya ku-5.4 idesilitha ngayinye. Kunezimbangela eziningana zamazinga aphansi e-albhamuin, okuhlanganisa ukulimala kwesibindi, ukungondleki, i-nephrotic syndrome, isifo sikaCrohn, noma isifo se-celiac.

Ukwelashwa:

Ngokuya ngokuxilongwa kwakho, uzothola ukwelashwa okuhlukene kwesifo sesibindi. Izifo zesibindi zangaphambili zitholwa, anciphisa amathuba okuhluleka kwesibindi. Ngokukhetha indlela yokuphila enempilo, njengokuyeka utshwala nokugcina isisindo esinempilo, singanciphisa ingozi yezifo ezithile. Uma singelashwa ngesikhathi, lesi sifo singase siholele ekuhlulekeni kwesibindi okungamahlalakhona okungase kudingeke ukuthi kufakwe isibindi.

• Uhlobo olungapheli lwe-Hepatitis B lungelashwa ngemithi elwa namagciwane

• Ukuhlinzwa noma ukwelashwa ngemisebe kungasetshenziswa ukwelapha izimila zesibindi esiyingozi.

• Umdlavuza wesibindi awuvamile ukulawulwa ngezidakamizwa eziqondise izicubu eziqondiwe.

• Iziguli ezihlushwa isifo sokusha kwesibindi kotshwala esinamandla zingandisa izinga lokusinda kwazo ngokuthatha ama-corticosteroids.

Ukuvimbela izifo zesibindi ngokushintsha indlela yokuphila

• Ukudla okunomsoco- Abantu abanokukhuluphala ngokweqile basengozini yokuthola isifo sesibindi esinamafutha angenaso utshwala. Ungakwazi ukuzuza isisindo esinempilo ngokudla ukudla okunothe nge-fiber namafutha aphansi agcwele. Kunokuba udle ukudla okune-asidi, okunamafutha amaningi, kufanele ukugweme ukuze uvimbele inyongo.

• Nciphisa uphuzo oludakayo- Ukuphuza ngokweqile kungaholela ku-cirrhosis yesibindi.

• Umuthi wokugoma kusenesikhathi- Ukuze uzivikele ku-hepatitis A noma B, qiniseka ukuthi uthola umjovo wokusha kwesibindi ngokushesha ngangokunokwenzeka.

• Izinyathelo zokuphepha- Thatha izinyathelo zokuphepha lapho uthola ukubhobozwa noma ama-tattoo ukuze ugweme ukutheleleka.

Isifo seBile duct (esingenamdlavuza)

Imigudu yenyongo, esiza ekugayeni amafutha ngokuthwala inyongo isuke esibindini iye ethunjini elincane, ingavinjwa umdlavuza. Kubalulekile ukuqaphela ukuthi kunezinhlobo eziningana zokuphazamiseka kwemigudu yenyongo engenamdlavuza ezingase zidale izinkinga. Ukuphazamiseka kwe-bile duct okungenayo umdlavuza kungase kuhlanganise okulandelayo.

• I-Cholangitis (ukutheleleka kwe-bile duct)

• Ukutheleleka okubangelwa ukuvuza kwe-bile duct kungenzeka ngemva kokuhlinzwa okuthile

• Ukuqina kwe-biliary (ukuncipha okungavamile komgudu wenyongo)

• Amatshe ahlangene (i-choledocholithiasis, ukwakheka kwe-gallstones ku-bile duct evamile)

• Izinguquko emiseleni yenyongo ngemva kokufakelwa kwesibindi (njengokuvuza noma ukuncipha).

Kungcono ukuba nethimba lochwepheshe elisingatha ukuxilonga nokwelashwa kwesifo se-bile duct. Ochwepheshe bethu bemigudu ye-bile banesipiliyoni esibanzi sokwelapha ukuphazamiseka kwe-bile duct besebenzisa izindlela zokuhlinzwa nezithuthukisiwe ze-endoscopic ukukhulula imigudu evimbile kanye nokwenza ngcono izinga lempilo yeziguli.

Izimpawu Zezifo Ze-Bile

Lapho ama-bile ducts engakwazi ukusebenza kahle, angabangela izimpawu ezihlukahlukene, kuhlanganise:

• jaundice

• I-nausea nokuhlanza

• Isikhumba esinamahloni

• Ubuhlungu

Ukuxilongwa Kwe-Bile Duct Disorders

Ukuze kutholwe ukuvinjwa nokunye ukuphazamiseka kwe-bile ducts, lezi zivivinyo zokuxilonga ezilandelayo zingenziwa:

• Ukuhlola ukuhlolwa: Ama-CT scan kanye ne-magnetic resonance imaging (MRI).

• I-Endoscopic ultrasound (EUS): Le nqubo isebenzisa i-endoscope eklanywe ngokukhethekile namaza omsindo onamandla amakhulu ukuze ibone ngeso lengqondo umgudu wokugaya ukudla nezitho ezizungezile.

• I-confocal endomicroscopy esekwe ku-Probe: I-CADC ingesinye sezikhungo ezimbalwa ezinikeza le ndlela ekhetheke kakhulu yokuhlola ukuncipha emiseleni ye-bile kusetshenziswa isibonakhulu esincane.

• Isithombe se-Narrowband: Kusetshenziswa uhlelo olukhethekile kule nqubo ye-endoscopic yokuthwebula izithombe ngaphandle kokusetshenziswa kodayi bemibhobho ye-bile. I-NBI isebenza ngesimiso sokuthi amaza ahlukene okukhanya angena ezicutshini ekujuleni okuhlukene. Amaza okukhanya ahlukene avumela odokotela ukuthi bahlole ulwelwesi lwama-bile ducts (mucosa).

Ukwelashwa Kokuphazamiseka Kwe-Bile Duct

Ochwepheshe bethu abaningana banolwazi olunzulu lokuhlonza nokwelapha ukuphazamiseka kwemigudu ye-bile. Ukuze kuhlinzekwe isiguli ngasinye ngokunakekelwa okudidiyelwe, okuthuthukisiwe, nokuqondene nomuntu ngamunye, ithimba lezinhlaka eziningi lochwepheshe be-endoscopy, i-radiology, nokuhlinzwa lisebenza ndawonye.

Izindlela ezihlukahlukene zokuhlinza, kanye nezinqubo ze-endoscopic, zingasetshenziswa ukwelapha ukuqina kwemigudu ye-bile, ukuvimbela, nokuvuza. Kulezi zimo, i-endoscopic retrograde cholangiopancreatography (ERCP) isetshenziselwa ukufaka i-stent ngaphakathi kwendawo ewumngcingo noma evinjiwe. Ku-ERCP, i-endoscope isetshenziswa kanye nama-x-ray ngenqubo ethuthukisiwe. Ku-ERCP noma i-ERCP eqondiswa yi-EUS, odokotela bethu abangenelelayo bafaka ama-stents ukuze baphinde bavule imigudu yenyongo evinjiwe, babuyisele ukusebenza, futhi banciphise izimpawu zeziguli.

Amatshe e-Bilateral Bilateral duct angasuswa nge-ERCP kanye ne-sphincterotomy (ukusikwa okwenziwe ngaphakathi kwemisipha emhubheni). Ngokusebenzisa indlela yokuhlasela kancane, odokotela bethu abangenelelayo bangaphinde basuse amatshe e-biliary besebenzisa i-laser lithotripsy noma i-mechanical lithotripsy.

• Imithi:
  • Ama-antibiotics: Asetshenziselwa ukwelapha izifo emiseleni yenyongo.
  • I-Ursodeoxycholic Acid: Ingancibilikisa izinhlobo ezithile zamatshe enyongo futhi ithuthukise ukugeleza kwe-bile.
• Izinqubo ze-Endoscopic:
  • I-ERCP (Endoscopic Retrograde Cholangiopancreatography): Isetshenziselwa ukususa amatshe enyongo noma ukubeka ama-stents ukuvula imigudu emincane.
  • I-Endoscopic Balloon Dilation: Ukufutha ibhaluni ukuze kunwetshwe imigudu yenyongo emincane.
• Ukuhlinzwa:
  • Ukususwa kwe-Gallbladder: Ezimeni zamatshe enyongo abangela ukuvinjelwa kwemigudu yenyongo.
  • Ukwakhiwa kabusha kwe-Bile duct: Ukulungiswa kokuhlinzwa kwamapayipi e-bile alimele.
  • Ukufakelwa Kwesibindi: Kucatshangelwa ezimeni ezinzima lapho isibindi sithinteka kakhulu ukuphazamiseka kwe-bile duct.
• I-Percutaneous Transhepatic Cholangiography (PTC): Isebenzisa izithombe ukuze iqondise ukubekwa kwe-drainage catheter ukuze kukhululwe ukuvaleka kwemigudu ye-bile.
• I-Photodynamic Therapy: Ihilela ukujova umuthi ozwela ukukhanya egazini, obese ucushwa ngokukhanya ukuze ucekele phansi amangqamuzana omdlavuza.
• I-Radiation Therapy: Isetshenziselwa ukuncipha noma ukulawula ukukhula kwezimila ezithinta imigudu yenyongo.
• Ukufakwa kwe-Biliary Stent: Kubandakanya ukufaka i-stent ukugcina i-bile duct ivulekile nokwenza lula ukugeleza kwe-bile.
• Ukuguqulwa kwendlela yokuphila:
  • Izinguquko Zokudla: Ukudla okunamafutha aphansi kungase kunconywe ukuphatha izimpawu.
  • Ukuqedwa kotshwala: Kubalulekile kulabo abanesifo sesibindi sotshwala.
• Ukulawulwa Kwezinkinga: Ukubhekana nezinkinga ezinjengokungenwa izifo ngokushesha ukuze kuvinjwe omunye umonakalo.
• Ukunakekelwa Kokulandelela: Ukuqapha njalo kanye nokuqokwa kokulandelela ukuze kuhlolwe ukusebenza kokwelashwa nokulawula noma yikuphi ukuphindeka noma ukuthuthukiswa okusha.

Le ndlela ebanzi iqinisekisa ukuthi iziguli ezinokuphazamiseka kwe-bile duct zithola ukunakekelwa kwesimanjemanje, okusebenzisana okubhekana nezinkinga zesakhiwo kanye nezimpawu ezihambisana nazo.