Bilirubin. Ponseponse ya wokhutira. mitundu ya matenda a chikasu ndiyo

anthu onse ndi kuchuluka kwa munali bilirubin m'magazi. Wakudziko zikhale osapitirira 17,1 mmol / L. Nthawi zina zoterezi uka pamene bilirubin mu thupi kamapangikira ochuluka kuposa kungachititse chiwindi wathanzi ntchito bwinobwino. Tauka bilirubin zili mulole komanso chifukwa kuwonongeka chiwindi, amene akhoza kusokoneza excretion wa bilirubin. Komanso, pamene plugging Biliary chiwindi pang'onopang'ono zedi yaing'ono anachokera bilirubin. Ponseponse wa wokhutira mwa magazi ndiko kuposa. Matenda amatchedwa hyperbilirubinemia. Mu bilirubin izi atasunga thupi ndende anakonzeratu, kenako likulowerera minofu, kuwapatsa iwo mtundu wachikasu. Matenda amatchedwa matenda a chikasu ndiyo.

Kuti zambiri ndi bwino kudziwa matenda a chikasu ndiyo kumachitika chifukwa chilichonse, muyenera choyamba muganize momwe kuchita nzeru bilirubin. Bilirubin amachokera heme, zomwe thupi makamaka napeza monga hemoprotein. Hemoglobin anamasulidwa pa oipa a okhwima maselo ofiira, ndiye gwero lofunika kwambiri pa bilirubin (70-80%). Yotsala ya bilirubin m'madera pafupifupi wofanana anapangidwa kuchokera erythrocytes hemoglobin mwana ndi zofunika zawo m'mafupa ndi michere heme munali monga catalase, cytochrome, etc. Pankhaniyi, 250-400 mg -. Kodi chiwerengero amene ali inkakhazikitsidwa tsiku lililonse othyoka anthu bilirubin. Normal pa nthawi ya kusanthula - Mndandanda wa 0.2-1.0 mg / DL.

Ngati bilirubin ali plasma kuposa munthu pakhomo, ndiye matenda a chikasu ndiyo. Izi zimachitika chifukwa bilirubin, amene kwambiri kuposa ponseponse, akuyamba kulankhula ndi ulusi zotanuka wa khungu ndi conjunctiva. Malinga limagwirira mapangidwe matenda a chikasu ndiyo ake ndi a mitundu itatu:

1. Hemolytic (kapena suprarenal).
2. kuwonongeka chiwindi parenchymal chifukwa cha (hepatocellular).
3. Anachititsa biliary thirakiti kutsekeka (obstructive kapena makina).

Hemolytic matenda a chikasu ndiyo yodziwika ndi mawonekedwe zambiri unconjugated bilirubin, kapena stagnation mu thupi. The madzi okwana bilirubin limatuluka chifukwa unconjugated. Mkodzo bilirubin palibe konse. Zimenezi zalongosoledwa ndi kulephera kwa bilirubin unconjugated kudutsa mu Fyuluta aimpso, amene si kuonongeka. Hemolytic matenda a chikasu ndiyo bwino zimayamba hemolytic mavuto, malungo, intravascular hemolysis kanthu za poizoni, kuperewera kwa mavitamini B12, ndi magazi a atakwatirana. Kuchuluka kaperekedwe ka bilirubin unconjugated akhale ndi matenda Gilbert a. Anthu amene ali ndi matenda izi pafupifupi nthawi zonse taonera mucous wake chikasu ndi khungu. Chifukwa cha ichi kwagona kuti chiwindi sangathe kugwila, kuonetsetsa ndi conjugated ya ndulu capillaries bilirubin.

Pamene parenchymal matenda a chikasu ndiyo amayamba onse bilirubin conjugated ndi unconjugated. Chifukwa ambiri imeneyi akhoza kukhumudwa ndi chilolezo kuchokera ku magazi a unconjugated bilirubin excretion mu ya ndulu akusokoneza capillaries conjugated bilirubin ku maselo chiwindi komanso ingress wa conjugated bilirubin kwa chiwindi ya ndulu tikulephera capillaries magazi, mwa maselo kuonongeka chiwindi. Pa nthawi yomweyo kukwezeka kaperekedwe ka bilirubin mu seramu magazi limodzi ndi kuwonjezeka mu excretion ake mu mkodzo. Komabe, mu magawo oyambirira a matenda mkodzo bilirubin pafupifupi mtima, kotero ngati mayeso sitinganene kuti matenda oyambirira.

Matenda a chikasu ndiyo anachititsa kwa chiwindi biliary thirakiti kutsekeka, mkhutu outflow ya ndulu kapena kutseka kwathunthu njira ndulu (chotupa, kutupa, Stone neri Al.). Ndi mtundu uwu wa capillaries matenda a chikasu ndiyo kwa chiwindi anatambasula chifukwa amasonkhana ya ndulu chiwindi, hepatocytes akuyamba Finyani muyende mu capillaries magazi conjugated bilirubin. Ponseponse mu magazi ukuwonjezeka plasma, ndipo ngati ine olumpha chovomerezeka aimpso pakhomo (pafupifupi 30 mmol / l), ndi bilirubin limapezeka mu mkodzo.