Izinhlobo ze-jaundice

-Delile

• Yiziphi izinhlobo ezahlukahlukene ze-jaundice?
• Konke mayelana ne-jaundice yangaphambi kwesibindi
• Konke mayelana ne-jaundice ye-hepatic
• Konke mayelana ne-jaundice ye-post-hepatic
• Konke mayelana ne-jaundice ebelethayo
• Umbono

Yiziphi izinhlobo ezahlukahlukene ze-jaundice?

I-jaundice yenzeka lapho i-bilirubin eningi yakha egazini lakho. Lokhu kwenza isikhumba sakho futhi abamhlophe bamehlo akho babonakale bephuzi ngokumangazayo.

I-Bilirubin i-pigment ephuzi eyenziwe njengoba i-hemoglobin - ingxenye yamaseli abomvu egazi - idilizwa.

Imvamisa, i-bilirubin ihanjiswa isuka egazini iye esibindini sakho. Ngemuva kwalokho, idlula kumashubhu abizwa ngokuthi ama-bile ducts. Le mibhobho ithwala into ebizwa nge-bile emathunjini akho amancane. Ekugcineni, i-bilirubin idluliselwa emzimbeni wakho ngomchamo noma esitulweni.

Izinhlobo ze-jaundice zihlukaniswe lapho zenzeka khona phakathi kwenqubo yesibindi yokungenisa nokuhlunga i-bilirubin:

• pre-hepatic: ngaphambi kwesibindi
• i-hepatic: esibindini
• oku-post-hepatic: ngemuva kwesibindi

Konke mayelana ne-jaundice yangaphambi kwesibindi

I-jaundice yangaphambi kwesibindi ibangelwa yizimo eziphakamisa izinga legazi lakho le-hemolysis. Le yinqubo lapho kuhlelwa khona amangqamuzana abomvu egazi, kukhipha i-hemoglobin bese kuguqulwa kube yi-bilirubin.

Ngoba isibindi sikwazi ukucubungula i-bilirubin engaka ngasikhathi sinye, i-bilirubin ichichima izicubu zomzimba.

I-jaundice yangaphambi kwesibindi yilezi:

• umalaleveva, ukutheleleka ngegazi okubangelwa yisimuncagazi
• i-sickle cell anemia, isimo sezakhi zofuzo lapho amangqamuzana abomvu egazi eba okwakheke okomklamo kunesimo sediski esijwayelekile
• i-spherocytosis, isimo sezakhi zofuzo se-membrane yegazi elibomvu elibangela ukuba babe nesimo se-sphere kunokuba babe njenge-disc
• i-thalassemia, isimo sezakhi zofuzo esidala ukuthi umzimba wakho wenze uhlobo olungajwayelekile lwe-hemoglobin olukhawulela inani lamaseli abomvu egazi anempilo egazini lakho

Izimpawu ezivamile ze-jaundice yangaphambi kwesibindi zifaka:

• ubuhlungu besisu
• umkhuhlane, kufaka phakathi amakhaza noma ukujuluka okubandayo
• ukulahleka kwesisindo okungavamile
• ukuzwa ukulunywa
• umchamo omnyama noma indle ephaphathekile

Ezinye zezinto ezinobungozi zalolu hlobo lwe-jaundice zifaka:

• ukusetshenziswa kwezidakamizwa
• ukuba nelungu lomndeni elinenkinga yegazi
• ukuhambela izifunda ezikhungethwe umalaleveva

Ukuthola i-jaundice yangaphambi kwesibindi, udokotela wakho kungenzeka a-oda izivivinyo ezilandelayo:

• ukuhlolwa komchamo ukukala inani lezinto ezithile emchameni wakho
• ukuhlolwa kwegazi, njengokubala okuphelele kwegazi (i-CBC) noma ukuhlolwa kokusebenza kwesibindi ukukala i-bilirubin nezinye izinto ezisegazini
• ukuhlolwa kwe-imaging, njenge-MRI noma i-ultrasound, ukuhlola isibindi sakho, i-gallbladder, ne-bile ducts ukukhipha ezinye izinhlobo ze-jaundice
• ukuskena kwe-HIDA ukusiza ukuthola ukuvinjelwa noma ezinye izingqinamba esibindini, enyongweni, emigudwini yenyongo, nasemathunjini amancane

Udokotela wakho kungenzeka akuhlolisise nge-jaundice yangaphambi kwesibindi uma kungekho zinkinga nge-bilirubin eqhutshwa isibindi sakho noma ngaphakathi kwe-gallbladder kanye ne-biliary ducts.

Ukwelashwa kwe-jaundice yangaphambi kwesibindi kungafaka:

Okomalaleveva:

• imithi yokusiza ukubhubhisa amagciwane nokuvikela ama-parasites ekutheleleni kwesibindi sakho futhi

Nge-sickle cell anemia:

• ukumpontshelwa igazi okuvela kumuphi onempilo
• ukuvuselela amanzi nge-intravenous (IV) fluid
• imithi yanoma yikuphi ukutheleleka okungadala inkinga yeseli

Okwe-spherocytosis:

• izithako ze-folic acid
• ukumpontshelwa igazi ngenxa yokushoda kwegazi
• ukuhlinzwa kokukhipha ubende ukusiza ukukhulisa impilo yeseli elibomvu nokunciphisa amathuba ama-gallstones

Okwe-thalassemia:

• ukumpontshelwa igazi
• ukufakelwa umnkantsha
• ubende noma ukuhlinzwa okususa i-gallbladder

Konke mayelana ne-jaundice ye-hepatic

I-hepatic jaundice yenzeka lapho izicubu zakho zesibindi zibolile (ezaziwa njenge-cirrhosis), zonakalisiwe noma zingasebenzi. Lokhu kwenza kungasebenzi kahle ekuhluzeni i-bilirubin egazini lakho.

Njengoba ingeke yahlungwa ohlelweni lwakho lokugaya ukudla ukuze isuswe, i-bilirubin yakha ize ifike emazingeni aphezulu egazini lakho.

I-jaundice ye-hepatic yilezi:

• i-cirrhosis yesibindi, okusho ukuthi izicubu zesibindi zinesibazi ngokuvezwa isikhathi eside ezifweni noma ezintweni ezinobuthi, njengamazinga aphezulu otshwala
• i-hepatitis yegciwane, ukuvuvukala kwesibindi okubangelwa elinye lamagciwane amaningi angangena emzimbeni wakho ngokudla okuthelelekile, amanzi, igazi, isitulo noma ukuxhumana ngokocansi.
• i-cirrhosis eyinhloko ye-biliary, eyenzeka lapho amapayipi e-bile elimele futhi engakwazi ukucubungula i-bile, okudala ukuthi yakhe esibindini sakho futhi ilimaze izicubu zesibindi
• i-hepatitis enotshwala, lapho izicubu zakho zesibindi zifikelwa yisilonda ngenxa yokuphuza utshwala obunzima, besikhathi eside
• i-leptospirosis, ukutheleleka kwamagciwane okungasakazwa yizilwane ezinegciwane noma umchamo wesilwane noma igciwane lesilwane elinegciwane
• umdlavuza wesibindi, lapho amangqamuzana anomdlavuza akhula futhi ande ngaphakathi kwezicubu zesibindi

Izimpawu ezivamile ze-jaundice ye-hepatic zifaka:

• ukulahlekelwa isifiso sokudla
• impumulo enegazi
• ukulunywa kwesikhumba
• ubuthakathaka
• ukulahleka kwesisindo okungavamile
• ukuvuvukala kwesisu noma imilenze yakho
• umchamo omnyama noma isitulo esiphaphathekile
• ubuhlungu emisipheni yakho noma emajoyintini
• isikhumba esimnyama
• imfiva
• ngizizwa ngigula
• ukuphosa

Ezinye zezinto ezinobungozi zalolu hlobo lwe-jaundice zifaka:

• ukusetshenziswa kwezidakamizwa
• ukuphuza utshwala obuningi isikhathi eside
• ukusetshenziswa kwemithi engadala ukulimala kwesibindi, njenge-acetaminophen noma imithi ethile yenhliziyo
• ukutheleleka kwangaphambilini okuthinte isibindi sakho

Ukuthola i-jaundice ye-hepatic, udokotela wakho kungenzeka a-oda izivivinyo ezilandelayo:

• ukuhlolwa komchamo ukukala amazinga ezinto ezisemchameni wakho ezihlobene nokusebenza kwesibindi sakho
• ukuhlolwa kwegazi, njengokubala okuphelele kwegazi (i-CBC) nokuhlolwa kwama-antibody, noma ukuhlolwa kokusebenza kwesibindi ukukala i-bilirubin egazini nasemazingeni ezinto ezibonisa ukuthi isibindi sakho kungenzeka asisebenzi kahle i-bilirubin
• ukuhlolwa kwe-imaging, njenge-MRI noma i-ultrasound, ukuhlola isibindi sakho uma sinomonakalo noma ubukhona bamangqamuzana anomdlavuza
• i-endoscopy, okubandakanya ukufaka ishubhu elincane, elikhanyisiwe emgodini omncane ukuze ubheke isibindi sakho futhi uthathe isampula lesicubu (i-biopsy) uma kunesidingo sokuhlolela umdlavuza noma ezinye izimo

Udokotela wakho uzokuxilonga nge-jaundice ye-hepatic uma ebona ukulimala kwezicubu zesibindi kumphumela wokuhlolwa kwe-imaging noma abone amazinga angajwayelekile wezinto ezithile zesibindi, njenge-albin, noma amasosha omzimba wezifo noma umdlavuza.

Ukwelashwa kwe-jaundice ye-hepatic kungafaka:

Okwe-cirrhosis yesibindi:

• ukuyeka ukuphuza
• beta-blocker
• imishanguzo elwa nemithambo yegazi (IV)
• ukudla okunamaprotheni amancane

Nge-hepatitis yegciwane:

• imishanguzo yokulwa namagciwane
• ukugoma i-hepatitis
• ukuphumula okuningi namanzi

Nge-cirrhosis eyinhloko ye-biliary:

• i-bile acids ukusiza ngokugaya
• imithi yokwehlisa i-bile
• ama-antihistamine afana ne-diphenhydramine (iBenadryl) yokulunywa

Nge-hepatitis yotshwala:

• ukuyeka utshwala
• izakhamzimba
• ukufakelwa kwesibindi, ezimweni ezinzima

Nge-leptospirosis:

• ama-antibiotic okutheleleka
• umshini wokuphefumula wenkinga yokuphefumula
• dialysis yokulimala kwezinso

Ngomdlavuza wesibindi:

• i-chemotherapy noma i-radiation ukubulala amangqamuzana omdlavuza
• ukuthengiswa kwesibindi okuyingxenye
• ukufakelwa kwesibindi

Konke mayelana ne-jaundice ye-post-hepatic

I-post-hepatic, noma i-jaundice evimbelayo, yenzeka lapho i-bilirubin ingenakudonswa kahle emithonjeni ye-bile noma umgudu wokugaya ukudla ngenxa yokuvaleka.

I-jaundice ye-post-hepatic yilezi:

• ama-gallstones, ama-hard calcium deposits ku-gallbladder engavimba amapayipi enyongo
• umdlavuza wepancreatic, ukukhula nokusabalala kwamangqamuzana omdlavuza kumanyikwe, isitho esisiza ukukhiqiza izinto zokugaya ukudla
• umdlavuza we-bile duct, ukukhula nokwanda kwamangqamuzana omdlavuza emibhobho yakho ye-bile
• i-pancreatitis, ukuvuvukala noma ukutheleleka kwamanyikwe akho
• , isimo sezakhi zofuzo lapho unemigudu emincane noma engekho ye-bile

Izimpawu ezivamile ze-jaundice post-hepatic zifaka:

• ngizizwa ngigula
• ukuphosa
• umchamo omnyama noma indle ephaphathekile
• ubuhlungu besisu
• isifo sohudo
• ukulahleka kwesisindo okungavamile
• ukulunywa kwesikhumba
• ukuvuvukala kwesisu
• imfiva

Ezinye zezinto ezinobungozi zalolu hlobo lwe-jaundice zifaka:

• ukukhuluphala ngokweqile
• ukudla ukudla okunamafutha amaningi, okune-fiber encane
• ukuba nesifo sikashukela
• ukuba nomlando womndeni wama-gallstones
• ukuba ngowesifazane
• ukuguga
• ukubhema imikhiqizo kagwayi
• ukuphuza utshwala obuningi
• ukuba nokuvuvukala kwamanyikwe kwangaphambili noma ukutheleleka
• ukuvezwa amakhemikhali ezimboni

Ukuthola i-jaundice ye-post-hepatic, udokotela wakho kungenzeka a-oda izivivinyo ezilandelayo:

• ukuhlolwa komchamo ukukala amazinga wezinto emchameni wakho
• ukuhlolwa kwegazi, njengokubala okuphelele kwegazi (i-CBC) nokuhlolwa kwamagciwane omdlavuza, noma ukuhlolwa kokusebenza kwesibindi ukukhipha i-jaundice ye-hepatic
• ukuhlolwa kwe-imaging, njenge-MRI noma i-ultrasound, ukuhlola isibindi sakho, i-gallbladder, ne-bile ducts ukuvinjelwa okunjengamatshe enyongo noma izicubu
• i-endoscopy, okubandakanya ukufaka ishubhu elincane, elikhanyisiwe phansi kwesisu ukuze ubheke isibindi sakho, i-gallbladder, noma i-bile ducts bese uthatha isampula lezicubu uma kunesidingo sokuhlaziya umdlavuza noma ezinye izimo

Uma udokotela wakho abona ukuvinjelwa kumphumela wokuhlolwa kwe-imaging noma ethola amazinga ama-antibodies athile angakhombisa ukutheleleka noma umdlavuza, kungenzeka ahlolisise i-jaundice yakho njenge-post-hepatic.

Ukwelashwa kwe-jaundice ye-post-hepatic kuzoxazulula imbangela. Lokhu kufaka:

Okwezinyongo:

• ukushintsha indlela odla ngayo uyeke ukukhiqiza amatshe enyongo
• ukususa ama-gallstones noma i-gallbladder yakho ngokuphelele
• ukuthatha imishanguzo noma imishanguzo yokuqeda inyongo

Ngomdlavuza we-pancreatic:

• ukuhlinzwa ukuze kususwe izicubu ezinomdlavuza noma wonke amanyikwe
• imisebe noma i-chemotherapy ukuqeda amangqamuzana omdlavuza

Ngomdlavuza we-bile duct:

• ukuhlinzwa ukuze ususe amapayipi enyongo nezingxenye zesibindi namanyikwe
• imisebe noma i-chemotherapy ukuqeda amangqamuzana omdlavuza
• ukufakelwa kwesibindi

Nge-pancreatitis:

• ukuphumula
• uketshezi olufakwa emithanjeni (IV) noma umuthi wezinhlungu
• ukuhlinzwa ukuze kususwe noma yiziphi izimbangela zokuvuvukala (njengamatshe enyongo)

Okwe-biliary atresia:

• inqubo yeKasai yokususa nokufaka esikhundleni samapayipi
• ukufakelwa kwesibindi

Konke mayelana ne-jaundice ebelethayo

I-jaundice yeNonatal uhlobo oluvamile lwe-jaundice olwenzeka ezinganeni ezisanda kuzalwa.

Iningi lezingane lizalwa linamaseli amaningi abomvu, futhi ngenxa yokuthi isibindi asikakhuli ngokugcwele, i-bilirubin ayikwazi ukucubungulwa ngokushesha. Ngenxa yalokho, ingane yakho ingaba nezimpawu ze-jaundice ezinsukwini ezimbalwa ngemuva kokuzalwa kwayo.

Izinhlobo ze-jaundice ebelethayo zifaka:

• Kwemvelo. Lokhu kwenzeka ngoba isibindi asikakheki ngokugcwele okwamanje.
• Ngaphambi kokuvuthwa. Lokhu kubangelwa ukuthi ingane izalwe kusenesikhathi futhi ingakwazi ukukhipha i-bilirubin kahle.
• Ukuncelisa ibele. I-jaundice yobisi lwebele ivela enganeni enenkinga yokuncelisa ibele noma ingatholi ubisi lwebele olwanele.
• Uhlobo lwegazi olungahambelani. Lokhu kubangelwa ukuthi ingane nomama banezinhlobo ezahlukene zegazi, ezingadala ukuthi umama enze amasosha omzimba adiliza amangqamuzana egazi abomvu engane yakhe.

I-jaundice yeNonatal ayiyona imbangela yokukhathazeka. Kepha uma i-bilirubin yakhela emazingeni aphezulu ngokwedlulele, ingane yakho ingathola ukulimala kobuchopho (okwaziwa njenge-kernicterus) kusuka ku-bilirubin ingena ezicutshini zobuchopho.

Funa usizo oluphuthumayo uma ubona ukuthi ingane yakho inalezi zimpawu ezilandelayo:

• isikhathi eside sokukhala okuphezulu
• ukugoqa kwentamo yabo nangemuva
• imfiva
• ukuphosa
• unenkinga yokondla

Umbono

I-jaundice isho ngokusobala ukuthi kune-bilirubin eningi egazini lakho, kodwa imbangela eyimbangela ingahluka kakhulu.

Bheka udokotela wakho ngokushesha uma ubona ukuphuzi kwesikhumba sakho noma okumhlophe kwamehlo akho. Ezinye izimbangela zingelashwa ngoshintsho ekudleni noma endleleni ophila ngayo, kepha ezinye zingadinga ukwelashwa ngokushesha noma ukwelashwa kwesikhathi eside.