Ganewar Cututtukan da ke Dauke da Cututtukan Kai-tsaye a Asibiti
Cututtukan garkuwar jiki rukuni ne na cututtuka inda tsarin garkuwar jiki - wanda ake tsammanin zai kare jiki daga kamuwa da cuta - ke kai hari ga kyallen jiki. Wannan yana haifar da kumburi na yau da kullun wanda zai iya shafar kusan kowace gabobi: fata, gidajen abinci, jini, gland, huhu, koda, har ma da tsarin jijiyoyi. Misalan sanannun cututtukan garkuwar jiki sun haɗa da systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), autoimmune thyroid disease (Graves' and Hashimoto's), nau'in ciwon suga na 1, multiple sclerosis, psoriasis, cutar celiac, da cututtukan hanji kamar Crohn's da ulcerative colitis. Saboda alamun galibi ba su da takamaiman takamaiman kuma suna iya kwaikwayon cututtuka ko wasu cututtuka, ganewar asali na cututtukan garkuwar jiki yana buƙatar kulawa da tsari, da zaɓin gwaje-gwaje masu dacewa.
Me yasa ganewar asali na autoimmune yakan zama ƙalubale?
Babban ƙalubalen shine bambancin alamomi da yanayin da cutar ke canzawa (ƙumburi da sassauci). Wani majiyyaci na iya fuskantar gajiya mai ɗorewa da ciwon haɗin gwiwa mai sauƙi, yayin da wani kuma na iya fuskantar kuraje a fata, zazzabi, raguwar nauyi, ko kuma mummunan aikin gabobi kamar nephritis. Bugu da ƙari, wasu cututtukan da ke haifar da garkuwar jiki suna da alamun da ke haɗuwa; misali, cutar Sjögren na iya kasancewa tare da SLE ko scleroderma. Wasu marasa lafiya kuma suna da ƙwayoyin rigakafi masu kyau waɗanda ba su da alamun bayyanar cututtuka, don haka dole ne a fassara sakamakon dakin gwaje-gwaje koyaushe a cikin mahallin asibiti.
Matakan farko: an shirya aikin gyaran yanayi
Ganewar cutar a asibiti yawanci tana farawa ne da cikakken tarihi. Likitan zai buƙaci ya binciki babban ƙorafin, tsawon lokacin da ya ɗauka, yanayin sake dawowa, abubuwan da ke haifar da matsala, da kuma tasirin ayyukan yau da kullun. Gajiya mai tsanani wadda ba ta inganta ba tare da hutawa, zazzabi mai tsanani, da kuma raguwar kiba ba tare da wani dalili ba alamu ne da ya kamata a lura da su.
Alamomin da suka shafi gabobi suna taimakawa wajen jagorantar zato. Ciwon gaɓoɓi mai kama da juna a hannuwa tare da taurin safe wanda ya wuce mintuna 30-60 na iya nuna RA. Kurajen fuska mai siffar malam buɗe ido wanda ke ƙara ta'azzara bayan rana ta bayyana, ciwon baki mai yawan dawowa, asarar gashi mai yaɗuwa, da ciwon gaɓoɓi na iya zama abin zargi ga SLE. Busasshen idanu da baki na yau da kullun na iya nuna ciwon Sjögren. Gudawa mai yawan jini ko ciwon ciki mai ɗorewa na iya nuna cututtukan hanji. Korafe-korafen suma, rauni a ƙafafu, ko matsalolin gani na baya-bayan nan ya kamata su haifar da tambayar wata cuta ta jijiyoyi kamar sclerosis mai yawa.
Tarihin iyali ma yana da mahimmanci, domin yanayin kwayoyin halitta yana taka rawa a cikin cututtuka da yawa na garkuwar jiki. Bugu da ƙari, tarihin wasu cututtuka, shan miyagun ƙwayoyi, shan taba, damuwa, ɓacin rai bayan haihuwa, da yanayin hormonal na iya alaƙa da fara ko ƙara ta'azzara cututtukan garkuwar jiki a wasu marasa lafiya.
Binciken jiki: neman alamun kumburi da shigar gabobi
Gwajin jiki yana da nufin gano alamun kumburi, tantance shigar gabobin jiki, da kuma kawar da bambance-bambancen ganewar asali. Likitan zai tantance alamun mahimmanci (zazzabi, hawan jini), ya nemi kuraje (misali, kurajen fuska, purpura), gyambon baki, manyan ƙwayoyin lymph, da kuma alamun rashin jini kamar fatar jiki.
A cikin tsarin tsokar jiki, duba laushi, kumburin gaɓoɓi, ƙarancin motsi, nakasa, ko kumburin rheumatoid yana taimakawa wajen bambance kumburin gaɓoɓi da ciwon inji. A cikin glandar thyroid, faɗaɗawa, rawar jiki, ko bradycardia na iya nuna cututtukan thyroid na autoimmune. Gwaje-gwajen huhu, zuciya, da ciki suna da mahimmanci saboda cututtukan autoimmune na iya haifar da zubar jini na pleural, pericarditis, hepatosplenomegaly, ko ciwon ciki mai kumburi. Gwajin jijiyoyi yana tantance ƙarfi, motsin rai, jin daɗi, da daidaitawa, musamman idan akwai alamun cututtukan jijiyoyi.
Gwaje-gwajen dakin gwaje-gwaje na asali: tantance kumburi da tasirinsa
Da zarar an yi zargin akwai wata matsala ta garkuwar jiki, gwaje-gwajen farko na dakin gwaje-gwaje galibi sun haɗa da gwajin jini, ƙimar sedimentation erythrocyte (ESR) ko furotin C-reactive (CRP), gwaje-gwajen aikin koda da hanta, gwajin fitsari, da kuma yanayin metabolism. Rashin jini, leukopenia, ko thrombocytopenia na iya kasancewa a cikin SLE ko wasu cututtukan jini na autoimmune. Ƙara ESR/CRP na iya nuna kumburi, kodayake wasu yanayin autoimmune na iya samun ƙaramin CRP duk da aikin da ake yi.
Gwajin fitsari yana da mahimmanci don gano furotin ko hematuria wanda zai iya nuna kamuwa da koda, kamar lupus nephritis. Gwajin rabon furotin/creatinine na fitsari ko kuma tarin fitsari na awanni 24 na iya zama dole don tantance matakin furotin.
Gwajin rigakafi na Autoantibodies da gwajin rigakafi: mabuɗin amma ba kawai ba
Gwajin ƙwayoyin cuta na autoantibody muhimmin ɓangare ne na ganewar asali, amma dole ne a fahimci iyakokinsa. Ana amfani da ƙwayoyin cuta na antinuclear antibodies (ANA) sau da yawa azaman gwaje-gwajen tantancewa don zargin SLE, cutar Sjögren, cututtukan haɗin gwiwa, da scleroderma. ANA mai kyau ba ya nuna cutar autoimmune ta atomatik, kamar yadda ake iya samunta a wasu mutane masu lafiya, musamman a ƙananan matakan jini. Akasin haka, ANA mara kyau yana sa wasu cututtuka, kamar SLE, su yi ƙasa da yuwuwar faruwa, kodayake bai kawar da yiwuwar hakan ba.
Ƙarin takamaiman ƙwayoyin cuta na autoantibodies suna taimakawa wajen tabbatar da ganewar asali, kamar anti-dsDNA da anti-Sm a cikin SLE; anti-CCP da rheumatoid factor a cikin RA; anti-Ro/SSA da anti-La/SSB a cikin Sjögren's; anti-centromere ko anti-Scl-70 a cikin scleroderma; da ANCA a cikin wasu ƙwayoyin cuta. Gwajin ƙari (C3, C4) yana da amfani, musamman a cikin SLE, domin yana iya raguwa yayin cutar mai aiki.
Duk da haka, fassarar dole ne koyaushe ta yi la'akari da alamomi, binciken jiki, da sauran abubuwan da ke tallafawa. Kwayoyin rigakafi na iya zama "alama," amma bai kamata a gano cutar bisa ga sakamako ɗaya ba.
Gwaje-gwajen hoto da hanyoyin musamman
Hoto yana taimakawa wajen tantance lalacewar gabobi da kuma bambance kumburi da sauran yanayi. Hotunan X-ray, na'urar daukar hoton gaɓoɓi, ko MRI na iya tantance synovitis, zaizayar ƙashi, da kuma raunin nama mai laushi a cikin kumburin amosanin gabobi. Don shiga cikin huhu, gwajin CT na ƙirji zai iya tantance cututtukan huhu na interstitial, wanda zai iya faruwa a cikin scleroderma, RA, ko myositis. Ana iya buƙatar echocardiography idan ana zargin pericarditis ko hawan jini na huhu.
Wasu lokuta suna buƙatar gwajin biopsy don tabbatar da ganewar asali ko tantance girman lalacewar, kamar gwajin koda a cikin waɗanda ake zargi da cutar lupus nephritis, gwajin biopsy na fata a cikin vasculitis ko cutar fata, da kuma gwajin biopsy na hanji a cikin cutar celiac ko cututtukan hanji. Waɗannan hanyoyin suna da mahimmanci saboda sakamakon zai iya tantance zaɓuɓɓukan magani da hasashen cutar.
Ka'idojin rarrabuwa da ganewar asali daban-daban
Ga wasu cututtuka, akwai sharuɗɗan rarrabuwa na ƙasashen duniya (misali, ACR/EULAR) don sauƙaƙe daidaitawa, musamman a cikin bincike da aikin asibiti. Duk da cewa ba "kayan aikin gano cuta" ɗaya ba ne, waɗannan sharuɗɗan na iya jagorantar likitoci wajen tantance haɗuwar alamun, gwajin jiki, ƙwayoyin rigakafi na autoantibodies, da kuma abubuwan da aka gano.
Ya kamata a yi la'akari da bambance-bambancen ganewar asali koyaushe. Cututtuka na yau da kullun (tarin fuka, hepatitis, HIV), cututtukan jini, halayen magunguna, matsalolin endocrine, har ma da fibromyalgia na iya kwaikwayon alamun cututtukan autoimmune. Saboda maganin autoimmune sau da yawa yana amfani da magungunan rage garkuwar jiki, kawar da kamuwa da cuta da sauran yanayi waɗanda za su iya ta'azzara tare da rage garkuwar jiki yana da mahimmanci.
Ƙayyade ayyukan cututtuka da shigar gabobin jiki
Baya ga tantance nau'in cutar, likitoci yawanci suna tantance matakin aiki da kuma waɗanne gaɓoɓi ne ke da hannu. Wannan yana tasiri ga gaggawa da ƙarfin magani. Misali, ana magance ciwon amosanin gabbai mai sauƙi a cikin SLE ta hanyoyi daban-daban fiye da lupus nephritis ko shiga cikin tsarin jijiyoyi na tsakiya. Kimanta ayyuka na iya amfani da takamaiman maki (misali, don SLE ko RA), tare da sigogin dakin gwaje-gwaje kamar su complement, anti-dsDNA, CRP, da binciken asibiti.
Matsayin haɗin gwiwa da bin diddigin aiki
Gane cututtukan da ke da alaƙa da garkuwar jiki sau da yawa yana buƙatar haɗin gwiwa tsakanin fannoni daban-daban: maganin ciki - rheumatology, dermatology, neurology, nephrology, gastroenterology, da hematology. Ba sabon abu ba ne cewa ganewar asali ta bayyana ne kawai bayan an ci gaba da sa ido akai-akai, domin da farko wasu marasa lafiya ba su nuna alamun kaɗan ba. Saboda haka, bin diddigin da aka tsara, takardun alamun, da sake kimanta gwaje-gwajen dakin gwaje-gwaje na iya zama wani ɓangare na tsarin ganewar asali.
Penutup
Ganewar cutar da ke haifar da cutar kansa ta hanyar asibiti tsari ne mai matakai da yawa wanda ya haɗa da tarihi mai zurfi, cikakken bincike na jiki, kimantawa ta dakin gwaje-gwaje, gwajin rigakafi na autoantibody, da kuma daukar hoto da biopsy idan ya cancanta. Babban ƙalubalen yana cikin yanayin alamun da ba su da takamaiman takamaiman, yanayin cututtuka masu canzawa, da yuwuwar haɗuwa tsakanin cututtukan. Maɓallan nasara sune fassara kowane sakamakon gwaji a cikin yanayin asibiti na majiyyaci, kawar da ganewar asali mai yuwuwar cutarwa, da kuma yin bibiya na dogon lokaci. Tare da ganewar asali daidai, ana iya tsara magani don rage kumburi, hana lalacewar gabobi, da inganta rayuwar majiyyaci.
