Lefu la Hepatorenal

Hepatorenal syndrome ke boemo boo ho nang le ho hloleha ha liphio ho tsoelang pele ho hlahang ho motho ea nang le lefu la ho thatafala ha sebete. Ke bothata bo tebileng bo ka lebisang lefung.

Hepatorenal syndrome e etsahala ha liphio li khaotsa ho sebetsa hantle ho batho ba nang le mathata a tebileng a sebete. Ho tlosoa moroto o fokolang 'meleng, ka hona litšila tse nang le naetrojene lia bokellana maling (azotemia).

Boloetse bona bo hlaha ho motho a le mong ho ba leshome ba sepetlele ba nang le ho hloleha ha sebete. E lebisa ho hloleha ha liphio ho batho ba nang le:

• Ho hloleha ho matla ha sebete
• Joala ba lefu la sebete
• Cirrhosis
• Mokelikeli oa mpa o tšoaelitsoeng

Mabaka a kotsi a kenyelletsa:

• Khatello ea mali e oang ha motho a phahama kapa a fetoha ka tšohanyetso (orthostatic hypotension)
• Ts'ebeliso ea meriana e bitsoang diuretics ("lipilisi tsa metsi")
• Ho tsoa mali ka mpeng
• Tšoaetso
• Ho tlosoa ha metsi ka mpeng haufinyane (paracentesis)

Matšoao a kenyelletsa:

• Ho ruruha ka mpeng ka lebaka la mokelikeli (o bitsoang ascites, letšoao la lefu la sebete)
• Pherekano ea kelello
• Mesifa jerks
• Moroto o mmala o lefifi (letšoao la lefu la sebete)
• Ho fokotsa tlhahiso ea moroto
• Ho nyekeloa le ho hlatsa
• Boima ba 'mele
• Letlalo le mosehla (jaundice, letšoao la lefu la sebete)

Boemo bona bo fumanoa kamora ho etsa liteko ho felisa lisosa tse ling tsa ho hloleha ha liphio.

Tlhahlobo ea 'mele ha e fumane ho hloleha ha liphio ka kotloloho. Leha ho le joalo, tlhahlobo hangata e tla bontša matšoao a lefu le sa foleng la sebete, joalo ka:

• Pherekano (hangata ka lebaka la ho ts'oaroa ke lefu la sebete)
• Mokelikeli o feteletseng ka mpeng (ascites)
• Jaundice
• Matšoao a mang a ho hloleha ha sebete

Lipontšo tse ling li kenyelletsa:

• Maikutlo a sa tloaelehang
• Mabele a manyane
• Molumo o lerootho ka mpeng ha o kokotsoa ka malebela a menoana
• Ho eketseha ha lisele tsa matsoele (gynecomastia)
• Liso (liso) letlalong

Tse latelang e ka ba matšoao a ho hloleha ha liphio:

• Ho tsoa moroto o monyane haholo kapa ha o eo
• Ho boloka metsi ka mpeng kapa lipheletsong
• Ho eketseha ha BUN le maemo a mali a creatinine
• Keketseho ea khoheli e khethehileng ea moroto le osmolality
• Low sodium sodium
• Motsoako o tlase haholo oa sodium

Tse latelang e ka ba matšoao a ho hloleha ha sebete:

• Nako e sa tloaelehang ea prothrombin (PT)
• Ho eketsa boemo ba ammonia ea mali
• Albumin e tlaase ea mali
• Paracentesis e bonts'a li-ascites
• Matšoao a hepatic encephalopathy (EEG e kanna ea etsoa)

Morero oa kalafo ke ho thusa sebete ho sebetsa hantle le ho etsa bonnete ba hore pelo e khona ho pompa mali a lekaneng 'meleng.

Kalafo e batla e tšoana le ea ho hloleha ha liphio ka lebaka lefe kapa lefe. E kenyeletsa:

• Ho emisa meriana eohle e sa hlokahaleng, haholo-holo ibuprofen le li-NSAID tse ling, lithibela-mafu tse itseng, le diuretics ("lipilisi tsa metsi")
• Ho ba le dialysis ho ntlafatsa matšoao
• Ho noa meriana ho ntlafatsa khatello ea mali le ho thusa liphio tsa hau hore li sebetse hantle; Ho tšeloa albumin le hona ho ka thusa
• Ho beha shunt (e tsejoang ka hore ke LITLHAHISO) ho fokotsa matšoao a ascites (hona ho ka thusa ho sebetsa ha liphio, empa mokhoa ona o ka ba kotsi)
• Ho buoa ho beha shunt ho tloha ka mpeng ho ea mothapong o jugular ho fokotsa matšoao a ho hloleha ha liphio (ts'ebetso ena e kotsi ebile ha e etsoe hangata)

Phello hangata ha e ntle. Lefu hangata le hlaha ka lebaka la ts'oaetso kapa ho tsoa mali haholo (hemorrhage).

Mathata a ka kenyelletsa:

• Ho tsoa mali
• Tšenyo le ho hloleha ha litsamaiso tse ngata tsa litho
• Boloetse ba liphio qetellong
• Ho tlala mokelikeli le ho hloleha ha pelo
• Coma e bakoang ke ho hloleha ha sebete
• Matšoao a bobeli

Boloetse bona hangata bo fumanoa sepetlele nakong ea kalafo ea lefu la sebete.

Ho thatafala ha sebete - hepatorenal; Ho hloleha ha sebete - hepatorenal

Fernandez J, Arroyo V. Hepatorenal lefu. Ho: Feehally J, Floege J, Tonelli M, Johnson RJ, bangoli. Kakaretso ea Nephrology ea Kliniki. La 6th. Philadelphia, PA: Elsevier; 2019: khaolo ea 73.

Garcia-Tsao G. Cirrhosis le sequelae sa eona. Ka: Goldman L, Schafer AI, li-eds. Phekolo ea Goldman-Cecil. La 26th. Philadelphia, PA: Elsevier; 2020: khaolo ea 144.

Mehta SS, Fallon MB. Hepatic encephalopathy, hepatorenal syndrome, hepatopulmonary syndrome, le mathata a mang a amanang le lefu la sebete. Ka: Feldman M, Friedman LS, Brandt LJ, bahlophisi. Sleisenger le Fordtran's Mpeng le Mafu a Sebete. 11th ed. Philadelphia, PA: Elsevier; 2021: khaolo ea 94.