Casharka 52aad

 Habdhiska dheefshiidka (Digestive system).

Casharka 52aad

Ascites

Waxa dheecaan ku urura godadka  xubnaha caloosha, waxa uu ka yimadaadaa beerka oo adkaada, xaalado kale sida wadnaha,  kelyaha.

Sidee ayuu Ku yimadaadaa. Waxa uu ka dhashaa xaalado adag sida in ay xididdada dhib ka jirto, kelyaha,  xaalado beerka la xidhiidha.

 

1:Portal Hypertension: waa kacsanaanta cadaadiska arooraha beerka.  Siyaaditaanka cadaadiska qulqulka dhiigga ee beerka waa barta ay ka curaneyso sameysanka dheecanka. Taasi waxay siyaadineysaa  cadaadiska habdhiska arooraha beerka,  waxa uu sababayaa dheecanka olol ka yimid xiddidada  gododka caloosha.  Kacsanaanta cadaadiska xiddidada beerka waxay keenayaan in dhiigga dib ugu soo laabto xiddidada quudsha xubnaha caloosha. Cadaadiska ka jirra xiddidada beerka  waxay keenayaan in hooraha ku ururo unug hoore u dhexeeyaha (interstitial space), taasina waxay keeneysaa in uu sameyso dheecanka caloosha.

2: Hypoalbuminemia:  Waxa yaraanaya sameysanka  borotiinka albumin.  Waxa keeni kara xaalado badan sida adkaanshaha beerka(cirrhosis), beerka ma awooddayo inuu sameysto borotiinka(albumin). Albumin waa Borotiinka  muhiim ah kaasoo isku dheellitira cadaadiska xiddidada dhexdiisa isku haya hooraha(oncotic pressure). Haddii uu yaraado xaddiga borotiinka  dhiiga dhexdiisa cadaadiska xiddidada hoora ku celsha hoos ayuu dhacayaa, waxa meesha ka baxeysa awooddii xakameyn ay xakameyn lahaayeen xiddidada hooraha. Waxa qalqal ku imanaya hooraha xiddidada dhexdiisa, hoore unug u dhexeeyaha( interstitial space). 

 Hooraha waxa uu soo aadi doonaa banaanka qulqulka dhiigga, taasoo uu keenayo mugga dhiigga inuu yaraado, waxa uu carinayaa hannaanka magdhabaha(compensatory mechanism) ee jirka taasina waxay keeneysaa in hooraha dib loo celsho. Yaraanshaha wareega dhiigga taasoo ugu wacan tahay liigga hooraha(leakage) taasina waxay carineysaa hormoonka(Raas)  waxa la soo deyn doonnaa lidiga hormoonka hooraha celsha(aldosterone).Hormoonkan waxa uu siyaadinayaa cusbada iyo biyaha in jirka dib loogu soo celsho, taasina waxay keeneysaa inuu siyaado mugga hooraha, taasina waxay qeyb ka noqoneysaa ku ururka hooraha xubnaha caloosha  ama gododka caloosha. Taasina waxay sahleysaa inuu yimaado sameynka dheecaanka caloosha(ascites). Haddii uu yaraado borotiinka albumin , jirka ma awooddayo inuu isku nidaamsho baahitaanka hooraha, taasina waxay keeneysaa inuu soo socdo habitaanka hooraha ,taasoo ka imanayo xiddidada una gudbaya gododka caloosha.

3:Splanchnic Vasodilation:  kala baxa xiddidada quudsha xubnaha caloosha, waxa  la soo dooneyayaa maadooyinka xiddidada kala baxsha( nitric oxide, glucagon, prostaglandin)  waxay keenayaan in xiddidada kala baxaan( ballaartaan) gaar ahaan xiddidka quudsha dheefshiidka,  ganaca, xameetida, beerka. Waxay ka qeyb qaadaneysaa kala baxa xiddidka  inuu yaraado mugga dhiigga, tanina waxay sahleysaa inuu hoore Ku ururo gododka caloosha.

Maxaa keenna

1:Cirrhosis (80% of cases): adkaansha beerka 80% waa waxa keenna inuu dheecaanka ku ururo gododka caloosha. Adkaanshaha beerka waxa uu keenayaa inuu siyaado cadaadiska arooraha beerka, inuu yaraado borotiinka beerka soo saaro(albumin), inuu si guud u balaadhiyo xiddidada si markaasi mugga dhiigga u yaraaddo, dhammaan waxay sahlayaan inuu sameyso dheecaanka caloosha.

2:Heart Failure: Fashillanka wadnaha gaar ahaan qeybta midig( right side heart failure)waxay keeneysaa inuu siyaado cadaadiska xiddidada,  taasina waxay keeneysaa inuu  hooraha ku ururo gododka caloosha.

3:Peritoneal Carcinomatosis: kansarrada sida kan makaanka, caloosha, ganaca, xiidmaha waa wayn. Waxay keenayaan  xirranka habdhiska liinfaha(lymphatic system)iyo in uu siyaado cadaadiska xiddidada kaddib uu hooraha ku ururo  caloosha.

4:Pancreatitis: ololka gacana kiisa dad daga ah ama waqtiga dheer qaata, waxa uu keenayaa inuu dheecaanka gacana liig sameeyo  kaddib uu ku ururo gododka caloosha taasina waxay keeneysaa inuu sameysmo hooraha caloosha.

5:Tiibeyda ku dhacda caloosha: tiibeyda waxay keeneysaaa caabuq raagga ee xuub xaleedka dahaara xubnaha caloosha,  waxay sababeysaa inuu siyaado borotiinka iyo unugyada dhiigga  cad waxay keeneysaa inuu ku ururo dheecanka caloosha.

6: Abdominal cancer:

Calaamadaha. 

1:Abdominal Distention: weynaanta caloosha waa calaamada ugu muhiimsan ee lagu arko bukaanka.

2: Shortness of Breath:  neefshada oo adkaata, taasoo ugu wacan cadaadiska caloosha oo siyaaday, kaasoo riixaya muruqaha ka masuulka ah neefshada, taasina waxay yareneysaa  awoodda sambabada. 

3: Poor Appetite: siyaaditaanka cadaadiska caloosha waxa uu keenayaa qofka inuu dareemo inuu dharagsan yahay uu waxba cunni waayo.

4:Abdominal Pain: waxa ugu wacan  kala baxa murqaha caloosha. 

5:Peripheral Edema: barar ku yimaada lugaha, badanaa waxa caan ku ah xanuunnada beerka.

6: Fatigue and Weakness:  Daal iyo tabbar yari  badanaa waxay la xidhiidhaan fashillanka wadnaha, adkaanshaha beerka.

Baadhitaanka. 

1:Ultrasound: waa midka ugu fiican markaasi lagu ogaado hooraha caloosha.

2:CT Scan/MRI: waxaa loo isticmaalayaa xaaladaha qar haddii ay jiraan kansar, ama xaalado kale beerka la xidhiidha 

3:Paracentesis: waa hab lagu gaaro go'aan si markaasi loo ogaado waxa keenay hooraha, dheecaan ayaa laga soo qaadayaa godadka caloosha si markaasi falaqeyn loogu sameeyo, lagana ogaado sababtii keentay.

Daaweynta. 

1:Dietary Sodium Restriction: qofka waa inuu qataa sodium 2 gram maalinkii,  waxay innaga caawineysaa in hoora  jirka ku harro. Qofka waxa uu ka fogaanayaa cunnooyinka cusbada ku badan tahay.

2:Diuretics: bukaanka waxa la siinayaa dawooyinka kaadi badiyaasha, si markaasi looga hortago celinta biyaha jirka uu ceshanaya hormoonka aldosterone, sida dawada:Spironolactone,Furosemide.

3:Paracentesis: waxa laga soo nuugayaa hooraha ku jirra gododka caloosha,  haddii uu badan yahay hooraha. 

4:Fluid Restriction: bukaanka waxa la siinayaa hoore haddii ay soodiyamka hoos u dhacdo(hyponatremia)

5:Management of Underlying Causes: waxa la saxayaa waxyaabaha keenay. Haddii uu yahay fashilka wadnaha, ama adkaansha(Liver Cirrhosis).

6:Antibiotic prophylaxis: bukaanka waxa la siinayaa qalajiye ka hortag ah waxa uu qatar ugu jiraa in ololka xuub xaleedka ay ee keenta bakteeriyada,  ka hor inta aan la siin waa in bukaanka laga qaadaa dheecaanka caloosha, si markaasi loo helo go'aan sax ah. Daawada waxay keeni kartaa iska caabin. Waxa la siinayaa:norfloxacin

7: Transjugular intrahepatic portosystemic shunt (TIPS):  waa qalab lagu yareynayo cadaadiska arooraha beerka(portal hypertension) si markaasi loo daweeyo hooraha caloosha. 

8:Albumin infusion: bukaanka waxa faleebo loogu darayaa borotiinka albuminka  si markaasi looga hortago shaqo gab wareega dhiigga marka laga soo saaro xaddi badan oo hoora ah qofka.

 

Tixraaca. 

Books:

Harrison's Principles of Internal Medicine, 21st Edition: Provides a detailed discussion on ascites, especially in the context of cirrhosis and liver disease.

Current Medical Diagnosis and Treatment, 2024: Offers an updated approach to diagnosing and managing ascites.

Websites:

Amboss: Comprehensive articles on the pathophysiology and management of ascites, including diagnostic criteria and treatment options.

Medscape: Provides clinical guidelines on the evaluation and treatment of ascites, focusing on cirrhotic and malignant ascites.

National Library of Medicine (NIH): Research articles and reviews on the latest advances in ascites management and outcomes

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