I-sclerosing cholangitis

I-sclerosing cholangitis isho ukuvuvukala (ukuvuvukala), ukusikeka, nokubhujiswa kwemigudu ye-bile ngaphakathi nangaphandle kwesibindi.

Imbangela yalesi simo ayaziwa ezimweni eziningi.

Lesi sifo singabonakala kubantu abane:

• Isifo samathumbu esivuthayo (IBD) esifana ne-ulcerative colitis nesifo sikaCrohn
  
• Ukuphazamiseka okuzenzakalelayo
• I-pancreatitis engapheli (ama-pancreas avuthayo)
• I-Sarcoidosis (isifo esidala ukuvuvukala ezingxenyeni ezahlukahlukene zomzimba)

Izici zofuzo nazo zingaba nomthelela. I-sclerosing cholangitis yenzeka kaningi emadodeni kunabesifazane. Lesi sifo asivamile ezinganeni.

I-sclerosing cholangitis nayo ingabangelwa:

• I-Choledocholithiasis (ama-gallstones emgodini we-bile)
• Ukutheleleka kwesibindi, i-gallbladder, ne-bile ducts

Izimpawu zokuqala imvamisa:

• Ukukhathala
• Ukulunywa
• Ukuphuzi kwesikhumba namehlo (i-jaundice)

Kodwa-ke, abanye abantu abanazo izimpawu.

Ezinye izimpawu zingafaka:

• Isibindi esandisiwe
• Ubende obukhulisiwe
• Ukwehla kwesifiso sokudla nokuncipha
• Phinda iziqephu ze-cholangitis

Noma abanye abantu bengenazo izimpawu, ukuhlolwa kwegazi kukhombisa ukuthi banokusebenza kwesibindi okungajwayelekile. Umhlinzeki wakho wokunakekelwa kwezempilo uzobheka:

• Izifo ezidala izinkinga ezifanayo
• Izifo ezivame ukwenzeka ngalesi simo (ikakhulukazi i-IBD)
• Amatshe amatshe amade

Ukuhlolwa okubonisa i-cholangitis kufaka:

• Iskena se-CT esiswini
• I-ultrasound yesisu
• I-Endoscopic retrograde cholangiopancreatography (ERCP)
• I-biopsy yesibindi
• Imagnetic resonance cholangiopancreatography (MRCP)
• I-Percutaneous transhepatic cholangiogram (PTC)

Ukuhlolwa kwegazi kufaka ama-enzyme wesibindi (ukuhlolwa kwesibindi).

Imithi engasetshenziswa ifaka phakathi:

• I-Cholestyramine (efana ne-Prevalite) yokwelapha ukulunywa
• I-Ursodeoxycholic acid (ursodiol) yokuthuthukisa ukusebenza kwesibindi
• Amavithamini ancibilika ngamafutha (D, E, A, K) ukuze abuyisele okulahlekile kulesi sifo uqobo
• Imithi elwa namagciwane yokwelapha ukutheleleka emithanjeni yenyongo

Lezi zinqubo zokuhlinza zingenziwa:

• Ukufaka ithubhu ende, ezacile ngebhaluni ekugcineni ukuvula ukuncipha (i-endoscopic balloon dilation of strictures)
• Ukubekwa kukadreyini noma ithubhu yokunciphisa kakhulu (ukuqina) kwamapayipi enyongo
• I-Proctocolectomy (ukususwa kwe-colon ne-rectum, kulabo abane-ulcerative colitis kanye ne-sclerosing cholangitis) akuthinti ukuqhubeka kwe-primary sclerosing cholangitis (PSC)
• Ukufakelwa kwesibindi

Abantu benza kahle kangakanani kuyehluka. Lesi sifo sivame ukuba sibi ngokuhamba kwesikhathi. Kwesinye isikhathi abantu bayathuthuka:

• Ama-Ascites (uketshezi oluningi esikhaleni esiphakathi kolwelwesi lwesisu kanye nezitho zesisu) kanye nama-varices (imithambo ekhulisiwe)
• I-cirrhosis ye-biliary (ukuvuvukala kwemibhobho yenyongo)
• Ukuhluleka kwesibindi
• I-jaundice eqhubekayo

Abanye abantu baba nezifo zemibhobho yenyongo eqhubeka ibuya.

Abantu abanalesi simo basengozini enkulu yokuba nomdlavuza wamadolo enyongo (cholangiocarcinoma). Kufanele zihlolwe njalo ngokuhlolwa kwe-imaging yesibindi nokuhlolwa kwegazi. Abantu abane-IBD bangaba nengozi eyengeziwe yokuthola umdlavuza we-colon noma i-rectum futhi kufanele babe ne-colonoscopy ngezikhathi ezithile.

Izinkinga zingafaka:

• Ukopha i-varices esophageal varices
• Umdlavuza emathangeni e-bile (cholangiocarcinoma)
• Ukuhluleka kwesibindi nokuhluleka kwesibindi
• Ukutheleleka kohlelo lwe-biliary (cholangitis)
• Ukuncipha kwamapayipi enyongo
• Ukushoda kwamavithamini

I-primary sclerosing cholangitis; I-PSC

• Uhlelo lokugaya ukudla
• Indlela yeBile

I-Bowlus C, i-Assis DN, i-Goldberg D. I-cholangitis yamabanga aphansi nasesekondari. Ku: Sanyal AJ, Boyer TD, Lindor KD, Terrault NA, abahleli. I-Hepatology kaZakim neBoyer. Umhla wesi-7. IPhiladelphia, PA: Elsevier; 2018: isahluko 43.

URoss AS, uKowdley KV. I-primary sclerosing cholangitis kanye ne-pyogenic cholangitis ephindaphindayo. Ku: Feldman M, Friedman LS, Brandt LJ, ama-eds. ISleisenger neFordtran's Gastrointestinal and Liver Disease: IPathophysiology / Diagnosis / Management. Umhlaka 10. IPhiladelphia, PA: Elsevier Saunders; 2016: isahluko 68.

IZyromski NJ, iPitt HA. Ukuphathwa kwe-primary sclerosing cholangitis. Ku: UCameron JL, uCameron AM, ama-eds. Ukwelashwa Kwamanje. Umhla ka-12. IPhiladelphia, PA: Elsevier; 2017: 453-458.