annanaliketil acalesia

annanaliketil acalesia, jyala sahasa fakt acalesia mhanoon sambodhale jaate, heey gulgulit snayu tantunche aaram karnyat apayash aahe, jyamule annanaliketil khalcha sphinktar bund rahoo shakato. badal naan karata, "achalesia" haah samanyatah annanalikechya achalesiyacha sandarbh deto. jatharantramargatil vividh bindunvar acalesia houu shakato; udaharanarth, gudashayache acalesia hirshasprangchya aajarat houu shakate. khalcha annanalika sphinktar haah annanalika aanee pooat yanchyatil snayu aahe joou ann aat aalyavar ughadato. potache aaml punha varr yeu naye mhanoon teey bund hote. rogache purnapane samajale gelele kaaran adnyat aahe, tasech tyache swaroop vadhavinare ghatak dekhil aahet. achalasiachya anuvanshikaritya sankramit sankramit swarupachya soochana astitvat aahet, parantu heey purnapane samajale jaat nahee kinwa tyavar sahmati nahee.
annanaliketil acalesia haah annanaliketil halchalincha vikar aahe jyamadhye annanalikecha gulgulit snayu thurr aanee annanaliketil khalchya sphinctorcha (leesa) samavesh asato. karkarog kinwa tantumay rogasarkhya itar spashtikarananchya anupasthitit apoorn shithilata, vadhiv leesa toone aanee annanalikechya peristalsischa abhav (annanalikechya khalee ann halvinyas gulgulit snayuchi asamarthata) heey tyache vaishishtya aahe.
gilanyat adchan, punarujjivan aanee kadhikadhi chhatit dukhane heey acalesiache vaishishtya aahe. annanaliketil manometry aanee berrium gilalelya radiographic abhyasadvare nidan kele jaate. vividh upchar upalabdh aahet, jaree konihi hii sthitee burry karat nahee. kahee prakarananmadhye vishisht aushadhe kinwa botoxcha vapar keela jaau shakato, parantu annanalikeche vistar aanee snayunchya shastrakriyedvare (heller myotomy kinwa kavita) adhik kayamswarupi aaram midato.
prathamik acalesia haah sarvat samanya prakar aahe, jyache konatehi dnyat mool kaaran nahee. heey durastha annanalika avarodhak neuronschya apayshamule hote. tathapi, annanalikecha karkarog, chagas rog (dakshin americet samanya asalela sansargjanya rog) kinwa tripple-aii syndrome yasarkhya itar paristhitinpeksha eka lahan praman duyyam asate. acalesia darr varshi 100,000 paiki sumare eka vyaktila prabhavit karato. rogachya pradurbhavasathi konatehi ling varchasva nahee. hii sandnya 'aaa-' + '-chalesia' pasoon aalee aahe, jyamadhye konatihi shithilata nahee."
achalasia microcephalisarkhya durmil lakshansamuchchay mhanoon achalasia itar rogambarobarach prakat houu shakato.
chinhe aanee lakshane.
dysphasia (gilanyat adchan), pachat nasalele ann punha pachane, chhatichya pathimage vedna hone aanee vajan qamee hone hii acalesiachi mukhya lakshane aahet. dysphagea kalantarane haloohaloo bighadat jaato aanee tyat drav aanee ghan donhi samavisht hotat. aadvya sthiteet padalyavar kahee lokanna khokala dekhil yeu shakato.
chhatitil vedna, jyala cardiospasm aanee hriday-nasaleli chhatichi vedna asehi mhanatat, anekada hrudayavikaracha zatka mhanoon chukun olakhale jaau shakate. kahee rugnanmadhye heey atyant vednadayak asoo shakate. lalesah ann aanee drav annanaliket rakhoon thewale jaatat aanee fuffusanmadhye shvasadvare aat takale jaau shakatat (aakanksha).
upchar naan kelyas, madhya-tappyatil acalesia jawaljawal konatyahi ann kinwa dravachya margat purnapane adthala aanoo shakato-gilalelya vastuche mothe prushthbhagache kshetra anekada leesa/losses (khalche annanalikeche sphinktar) paar karane adhik katheen asate. asha tappyavar, ann gilalyanantar, teey purnapane annanaliket rahate, teey vadhat jaate aanee megaesophagus mhanoon olakhalya prakriyetoon ghatanemadhye teey atyant mothya aakaraparyant pasarate. jarr purese ann sathale tarr teey gilalelya vastoo shuddha karanyachi garaj nirman karate, jyache varnan anekada malmal naan hone asey kele jaate, parantu annanalikemadhye jeey tayar jhaale hote teey ulatanyachi tivra-kadhikadhi aniyantrit garaj, annanalikechya bhintinchya jaast tanamule, sahajpane galatee naan karata sodale jaate. heey chakr asey aahe qee lahan aatadyanmadhye poshakdravye raktpravahat shoshun ghenyasathi qamee teey vyavharikdrushtya konatehi ann pohochat nahee, jyamule haloohaloo vajan qamee hone, bhook naan lagane, shevati upasamar aanee mrutyu hoto, jyapaiki antim nehmi 'acalesiamule mrutyu' mhanoon soochibaddha kele jaau shakat nahee, jyamule rogamule jhalelya mrutyunchi aadhich chukichi aanee/kinwa anirnit ganana hote, itar vaidyakeey ghatakanchya chalancha ullekh naan karata jeey acalesia rugnachya aadhich kamkuvat jhalelya sharirachya mrutyula gatee deu shakatat.
shevatchya tappyatil achalesia.
mothya pramanat pasarlelya aanee trasdayak annanalika dware darshavilele antim tappyatil acalesia, purvi upchar kelelya rugnanmadhye houu shakate parantu jethe aanakhi vistar kinwa myotomy dysphagea door karnyat kinwa poshanatil bighad rokhanyat ayashasvi hote aanee annanalikachhedan haah ekmev paryay asoo shakato. vayaveey vistar aanee shastrakriyedvare kelelya myotomis sampoorn paramparik upcharpaddhati asoonahi, antim tappyatil acalesia aanee poshanvishayak apayash asalelya done rugnanche aamhi varnan karato. donhi rugnanna utkrusht lakshanyukt niyantran aanee jivanacha darja sudharun, transhital annanalikachhedan aanee grivetil jathar-annanalika anastomosisdware yashasviritya vyavasthapit kele gele. yaa prakarananvar charcha kelee jaate aanee sahityacha aadhava ghetala jaato.
antim tappyatil rog, jyache vaishishtya lakshaniyaritya vistarlele aanee trasdayak annanalika aanee varanvar varanvar avarodhak lakshananmule aahe, tyala jatharantra-aantr karya punarsanchayit karnyasathi, poshanvishayak kamatarata ulatavanyasathi aanee aakanksha pneumoniacha dhoka qamee karnyasathi annanalikeche vichhedan aavashyak asoo shakate.
sahityacha aadhava asha prakriyetoon prakriyetoon 75-100% rugnanmadhye nondavalelya changlya lakshan niyantranasah samaan parinam darshavito. tathapi, annanalikechi shastrakriya hii dhokyashivay nahee aanee pratyek rugnala sambandhit serve jokhaminchi purnapane mahitee asane aavashyak aahe. nondavalelya 5-10% chya mrutyudarache varnan kele aahe, tarr 50 takkyanparyantche rugnatva darr nondavale gele aahet aanee 10-20% rugnanmadhye anastomotic galatee nondavali gelee aahe. rugnanna dirghakalin guntaguntibaddal dekhil mahitee dilee pahije. 20 takke rugnanmadhye nondavalelya, shastrakriyenantarchya follow-up.11 dumping syndromechya lambinusar, 50 takkyanparyant rugnanmadhye anastomotic kadakpana nondavala gela aahe, 16 swayam-maryadit asatat aanee aavashyak asalyas vaidyakiyadrushtya vyavasthapit kele jaau shakatat aanee vegal-bachav annanalikachhedan haah dhoka qamee karoo shakate.
yantrana.
achalasiyachya bahutansh prakarananche kaaran adnyat aahe. daab aanee vishranti uttejit karoon niyantrit kelee jaate (udaa.jee., acetylcholine, padarth pii) aanee avarodhak (udaa.jee., nitrick auxide, vasoactive aatadyansambandhi peptide) neurotransmitter. acalesia asalelya lokanmadhye noradrenergic, noncolinergic, inhibitory ganglian peshincha abhav asato, jyamule uttejak aanee inhibitory neurotransmissionmadhye asantulan hote. parinam mhanje uchch raktadab nasalela annanalika sphinktar.
shavavichedan aanee myotomichya namunyanmadhye, hystological tapasanivar, see. dii. 3/see. dii. 8-positive cytotoxic tii lymphocytes, eosynophils aanee mast peshinchi badalanari sankhya, ganglian peshinchi haanee aanee neurophybrosis yancha samavesh asalela dahak pratisad disun aala aahe; yaa ghatana acalesiamadhye lavkar ghadatat asey disate. asha prakare, asey disate qee echalesiacha svayampratikar sandarbh aahe, joou bahudha vishanujanya triggersmule hoto. itar abhyas aanuvanshik, neurodegenerative, anuvanshik aanee sansargjanya yogdan suchavatat.
nidan.
lakshananmadhye samya asalyamule, gastroesophageal refluxes rog (jee. aar. dii.), antaral antargrahan aanee agadi manodaihik vikar yasarkhe adhik samanya vikar mhanoon acalesiachi chook kelee jaau shakate.
berrium swallo aanee annanalikechi manometry yaa acalesiasathichya vishisht chachanya aahet. yavyatirikt, annanalika, pooat aanee duodenumchi (annanalika-granthi-prajanana-granthi kinwa ii. jee. dii.) endoscopy samanyatah endoscopic ultrasounds kinwa tyashivay kelee jaate, jyamule karkarogachi shakyata nakarta yete. annanalikechi antargat ootee samanyatah endoscopymadhye samanya disate, jaree kahee adchaninsah aaram naan naan khalchya annanalikechya sphinctormadhun vyapti paar kelee jaat asalyane 'popp' pahile jaau shakate aanee annache avashesh lesachya varr aadhalu shakatat.
berrium gilato.
annanaliketun drav pravah nirikshan karnyasathi rugna satat fluoroscopy (ksh-kiran nond) karoon berrium dravan gilato. annanalikechi samanya peristaltic halchal disun yet nahee. khalchya annanalikechya sphinctorvar tivra aakunchan hote aanee jathar-annanalikechya junctionver sankuchit hote, jyamule "pakshyachi chanch" kinwa "undaranchi shepati" disate. annanalika kalantarane haloohaloo tanali jaat asalyane arund honyachya varchya annanalikecha vistar anekada vegvegalya pramanat keela jaato (vadhavala jaato). peristalsischya abhavamule berrium stambhavar havah-drav margine anekada disun yete. paach minitancha velevar berrium gilane haah upcharachi parinamkarakta mojanyasathi eka upayukt mapdand pradan karoo shakato.
annanalikechi manometry.
tyachya sanvedansheelatemule, manometry (annanaliketil halchal abhyas) hii nidan sthapit karnyasathichi pramukh chachani manali jaate. nakadvare eka catheter (patal nalee) ghatale jaate aanee rugnala anek vela gilanyachya soochana dilya jaatat. gilanyachya krutidarmyan annanalikechya vegvegalya bhaganmadhil snayunche aakunchan tapasate. manometrymule gilanyane leesa aaram karnyat ayashasvi jhalyache aanee gulgulit snayu annanalikemadhye karyatmak peristalsischa abhav disun yeto.
vaishishtyapurn manometric nishkarsh asey aaheth
biopsy.
biopsy, endoscopy darmyan uutincha namuna kadhoon takane, heey samanyatah acalesiamadhye aavashyak nasate parantu jarr kele tarr hypertrophid snayu aanee myenteric plexeschya vishisht majjatantu peshinchi anupasthiti disun yete, jeey annanalikechya peristalsisvar niyantran thevanare majjatantu tantunche jaale aahe. keval bayopsidware acalesiache nidan karane shakya nahee.
upchar.
saumya kinwa madhyam aajaar asalelya 75 takke lokanmadhye sublingual nifedipinamule parinam lakshaniyaritya sudharatat. shastriyadrushtya asey manale jaat hote qee vaidyakeey vyavasthapanamadhye ayashasvi jhalelyanmadhye botulinum vish kinwa vistarapeksha shastrakriyedvare kelelya myotomimule adhik fayda hoto. tathapi, alikadil yadruchchik niyantrit chachanimadhye neumatic dialation heey laparoscopic heller myotomipeksha qamee nasalele asalyache aadhalun aale.
jivanshailimadhye badal.
upcharapurvi aanee nantar, echalesiachya rugnanna haloohaloo khane, khoop changle chavane, jevanabarobar bharpur paanee pine aanee zopanyachya velejaval khane talhane aavashyak asoo shakate. bedvaroon doke varr uchalane kinwa fatcher ushee gheuun zopane gurutvakarshanadvare annanalika rikami honyas protsahan dete. shastrakriya kinwa vayaveey vistaranantar, gastric aesidchya srawala pratibandh karoon refluxche nuksan talhanyasathi proton pump avarodhak aavashyak asatat aanee kechap, limbuvargiy, chocolate, alcohole aanee caffeen yasah refluxes vadhavu shakanare padarth talhane aavashyak asoo shakate. upchar naan kelyas kinwa visheshtah aakramak asalyas, aamlanmule honari jaljal aanee ganj yamule barretchya annanalika houu shakate.
aushadhopachar.
daab qamee karnari aushadhe upayukt aahet. yamadhye niphedipin sarkhya calcium vahini avarodhak aanee isosorbide dynitrate aanee nitroglycerine sarkhya nitratescha samavesh aahe. tathapi, anek rugnanna dokedukhi aanee sujalele paay yasarkhe apriy dushparinam anubhavayala yetat aanee hii aushadhe anekada anek mahinyanantar madat karane bund karatat.
botulinum toxin (botox) bund thevalelya snayunna ardhangvayu denyasathi khalchya annanalikechya sphinctormadhye injection dile jaau shakate. cosmetic botoxchya babatit, parinam keval tatpurata asato aanee sumare 6 mahine tikato. botoxchya injectionmule sphinctorvar daag padatat jyamule nantarchya heller myotomichi adchan vadhu shakate. yaa upcharachi shifaras keval asha rugnansathi kelee jaate jyanna shastrakriyecha dhoka nahee, jase qee kharab aarogyatil vruddha lock. vayaveey vistar haah botoxpeksha dirghkalasathi adhik prabhavi asato.
vayaveey vistar.
phuga (vayaveey) vistar kinwa vistaramadhye, khalchya annanalikechya sphinctormadhye thevalelya fugachya jordar fuganyane snayu tantu tanale jaatat aanee kinchit fatatat. chhidra honyacha nehmich eka lahansa dhoka asato jyasathi tatkal shastrakriyedvare durusti aavashyak asate. vayaveey vistaramule kahee daag padatat jyamule nantar shastrakriyechi aavashyakta bhasalyas heller myotomychi adchan vadhu shakate. anek rugnanmadhye vayaveey vistaranantar gastroesophageal refluxes (jee. aar. dii.) hoto. 40 varshanpeksha jaast vayachya rugnanvar dirghkalasathi vayaveey vistar sarvat prabhavi asato; sharirachya aaghatatun barey honyachya uchch daramule tarun rugnanmadhye fayade qamee kaal tikatat, parinami jastit jaast parinamkarakta prapt karnyasathi mothya fugyansah varanvar prakriya hotat. vayaveey vistar vaparoon anek vela ayashasvi jhalyanantar, tyaeivaji adhik satatyapurn yashasvi hellerchya myotomisarkhya shastrakriyancha prayatna keela jaau shakato.
shastrakriya.
heller myotomimule 90 takke acalesia rugnanna madat hote. heey sahasa keeholchya drushtikonatun kinwa laparoscopic paddhatine kele jaau shakate. myotomy hii annanalikechya bajoone lambinusar kapani aahe, jee lesachya varr suru hote aanee potaparyant thodya pramanat khalee vistarte. annanalika anek tharanni banaleli asate aanee myotomy keval snayunchya bahereel tharanmadhunach kapate, jeey teey daboon bund karatat, jyamule aateel shleshmal thurr abadhit rahato.
aanshik phandoplication kinwa "rapp", jethe fundus (potacha bhag joou annanalikechya jodanichya varr latakato) khalchya annanalikebhovati gundalala jaato aanee swatashi shivla jaato, myotominantar sphinctorvar dabav nirman karnyasathi diaframmadhye surakshit keela jaato, samanyatah atee refluxes talhanyasathi jodala jaato, jyamule annanalikeche kalantarane gambhir nuksan houu shakate. shastrakriyenantar, rugnanni anek aathvade teey eka mahina saumya aahar ghetala pahije, refluxes vadhavu shakanare padarth talhale pahijet.
heller myotomila purak honyasathi sarvat shifaras kelele phandoplication mhanje dorr phandoplication, jyamadhye annanalikebhovati 180 teey 200 anshanchya agravarti gundalalela asato. nisenchya phandoplication tulanet heey utkrusht parinam pradan karate, jeey shastrakriyenantarchya dysphagiachya uchch ghatananshi sambandhit aahe.
laparoscopic annanalika myotomichi kamatarata mhanje phandoplication garaj aahe. ekikade, myotomy annanalika ughadate, tarr dusarikade, phandoplicationmule adthala nirman hoto. jathar-annanalika virodhi pravah adthala/zadap yanchya alikadil samjamule myotominantar refluxchya ghatanechya karanavar prakash padala aahe. annanalikechya antarane annanalikechya aatalya aat bharr padanyacha parinam mhanje jatharanalikecha zadap. yaa infoldingmule eka zadap tayar hote jee annanalikechya parighajaval 7 teey 4 vajeparyant (270 ansh) vistarte. laparoscopic myotomimule 12 vajanyachya sthiteet snayu kapatat, parinami zadap aanee refluxchee akshamata hote. alikadil robotic laparoscopic malikanni annanalikevar zadapapasun door 5 vajanyachya sthiteet myotomicha prayatna keela aahe. robotic parshviy annanalika myotomy annanalika zadap jatan karate aanee parinami refluxes hott nahee, jyamule phandoplication garaj door hote. refluxshivay khanyachya kshamatechya babatit robotic parshva grassonalic myotomiche aataparyantche sarvottam parinam jhaale aahet.
endoscopic myotomy.
2008 madhye japanmadhye acalesia vyavasthapanasathi eka naveen endoscopic upchar vikasit karnyat aala. prati-maukhik endoscopic myotomy kinwa kavita haah naisargik chhidra transluminal endoscopic shastrakriyecha eka kiman aakramak prakar aahe joou heller myotomeepramanech tattvanche palan karato. annanalikechya shleshmalavar eka lahan chhed keela jaato jyadvare endoscope ghatala jaato. annanalikecha sarvat aateel golakar snayu thurr vibhajit keela jaato aanee lesmadhun sumare 2 seen. mea. paryant jathar snayumadhye vistarit keela jaato. hii prakriya purnapane rugnachya tondadvare kelee jaat asalyane, rugnachya shariravar konatehi daag disat naheet.
rugna sahasa sumare 1 teey 4 divas rugnalayat ghalavatat aanee samadhankarak tapasaninantar tyanna gharee sodanyat yete. rugnanna purn aaharavar sodanyat yete aanee samanyatah kamavar parat yenyas aanee discharge midalyanantar lagechach purn kriyakalap karnyas saksham asatat. kavitenantar mothya guntagunt durmil asatat aanee samanyatah hastakshep naan karata hatalalya jaatat. manak laparoscopic heller myotomichya tulanet dirghakalin rugna samadhan khaleel kavitesarkhech aahe.
japanmadhye 1,200 hoon adhik rugnanvar kavita sadar karnyat aalee aahe aanee acalesiachya rugnanmadhye pratham-ola upchar mhanoon aantarrashtriy staravar tee adhikadhik lokpriy hott aahe.
dekhrekh.
achalesiyachya yashasvi upcharanantarhi, gilane kalantarane bighadu shakate. annanalikechi tapasani darr eka-done varshanni velevar berrium gilalyane kelee pahije kaaran kahinna vayaveey vistar, punaravrutti myotomy kinwa anek varshannantar annanalikechi shastrakriya dekhil karavi lagoo shakate. yavyatirikt, kahee doctor refluxche nuksan tapasanyasathi ph chachani aanee endoscopychi shifaras karatat, jyamule barretchya annanalika mhanoon olakhali jaanari purv-rognivarak sthitee houu shakate kinwa upchar naan kelyas kadak houu shakate.
mahamarishastra.
kahee loksankhyanmadhye achalasiyache praman prati 100,000 madhye andaje 1.6 paryant vadhale aahe. haah rog mukhytah 30 teey 50 vayogatatil praudhanna hoto.
ullekhaneey rugna.
grahiy shastradnya carl sagan yanna vayachya 18 vya varshapasoon aaklesiya hota.
zambian sarkarne jaheer kele qee zambia edgar lunguchya adhyakshanna achelasia aahe, jyat kadhikadhi adhikrut sahbhagadarmyan, visheshtah dokedukhichi lakshane disun yetat.

