Total bilirubin kordhay. Sababaha bilirubin kacsantahay ee dhiigga. Cuntada la bilirubin kordhay

Waayo-shiid caadiga ah iyo tamarta ee jirka ku jira waa in sahayda joogta ah muhashada ka baxsan, taas oo ah, cunto, biyo iyo hawo. Ay maaddooyinka lagama maarmaan yihiin xeryahooda organic, fitamiinada iyo qaybaha macdanta - potassium, magnesium, sodium, copper, bir iyo kuwo kale oo badan. The ee la soo dhaafay ka mid ah ayaa qayb ka ah unugyada dhiigga cas, sidayaal-hal unug of ogsijiin ku jira dhiigga, oo sidaas daraaddeed shiid bir ah waa sidaa muhiim u ah jidhka. Oo markii xadgudubyada si kasta uu yeesho icteric syndrome, in lagu gartaa in bilirubin guud kiciyey. Haddaba bal aynu eegno dhammaan qodobada muhiim ah.

dheef-birta

Man helo bir gaar cunto. Its fiirsashada ugu sareeya fiirsanayo in beerka xayawaanka, qaar ka mid ah nuts (lows, lawska, geed, kaashuuga), digiraha (digir, digir), cereals (kaleh, oo sarreen ah, miro, oo shaciir ah), isbinaajka, galley ah. Xaaladdan oo kale marka hore waa buuxsameen la qadar lagama maarmaanka u ah heme dhismaha ku saleysan erythrocyte ah, ka dibna kaliya qaadataa meel dhigaalka ee birta ay saldhig ee jirka, taas oo ku saabsan 3.4 grams, waxay ka dhigan tahay udhigo, inta badan la xiriira borotiinada plasma iyo falgalka (birta, transferrin, oxidase xanthine, ferroflavoproteiny, succinate iyo NADH-dehydrogenase, iyo kuwo kale). Laakiin waxaa sida caadiga ah dhacdaa, laakiin hadda aynu eegno khasaaraha uu, iyo qaar ka mid ah xaaladda cudurada.

Sababaha khasaaraha ka mid ah macdan muhiim ah

Mid ka mid ah geeddi-jir taas oo ay jirto khasaaro bir ah tahay caadada iyo uurka ee haweenka. Si kastaba ha ahaatee, laga yaabaa in xaaladaha ugu muhiimsan yihiin dhiig la'aan, sumowga, anemia ee asal ahaan kala duwan, cudurada gudaha daran, neoplasms malignant. Haddii khasaare ma uu taaban karo, waa wakhti ku habboon in la buuxsameen in wakhti yar oo gaaban, oo ay dhacdo in this bukaanka ma laha calaamadaha deficiency (sideropenic syndrome). Si kastaba ha ahaatee, waxaa jira cudurro qabtay oo lacagta birta la hadhay, laakiin beddelayba waa aad bay u wareersan. Xaaladaha noocaas ah waxaa ka mid ah icteric syndrome Bilowgii kasta, marka la ogaado sida midhaha metabolite ugu weyn - bilirubin. Si aad u bilawdo, isku day inaad fahanto uu dheef in jidhka iyo sababaha bilirubin Qolol in dhiigga, waxaa muhiim u ah fahamka ee pathogenesis ee cuduradan.

hemoglobin Exchange, wajiga koowaad

Bilirubin la xidhiidha pigments muhiim ah ka mid ah in Halabuurka ee bile iyo raaca ka jidhku waa at its kharashka. Waxaa shaki waddo dheer iyada oo weelasha oo weli qaab hemoglobin, ka dhigaysa isbedel muhiim ah in hepatocytes oo ugu dambeyntii ku qarisay galay xiidmaha sii daayo deegaanka saxarada. Sayidka, walax this waxaa la aasaasay by suuska ee unugyada dhiigga cas oo markiiba qabsadeen borotiinada side gaadiidka shaybaarka ugu weyn - beerka. jajab Tan waxaa lagu magacaabaa dadban ama aan la xidhiidhin, maxaa yeelay, bilirubin ku dhex jira waa iska beddelin. Tani waxay dhacdaa sababtoo ah qaab xor ah, waxa ay si fudud u geli karo xuub of gacanta kasta, iyo waxay leedahay saamayn sun ah xoog ugu horeyn ku neurons. Sidaas darteed, ay xajin tahay ficil daafaca caadiga ah.

dhexdhexaadnimada Wajiga iyo go'doomin ee bilirubin

Si kastaba ha ahaatee, borotiinada, kuwaas oo isaga ma raaci karaan si ay xiidmaha, sababtoo ah waxaa weli loo baahan yahay by jirka ah ee hawlaha kale oo badan, oo sidaas bilirubin waa in la hoos geliyey wax isbadal noocan oo kale ah, in hantida baas uu ka lumay galay unugyada. Ujeedada this, hepatocytes ah (unugyada beerka parenchyma dhismaha) waa ay ereyada, in uu yahay, ku qabanaya of acid glucuronic, taas oo, fudud, waxa ay sii xumaysaa. Sidaas darteed, ka yar tallaabada of eulayska UDP-glucuronyl-diglucuronide bilirubin sameeyay. Next, ka hepatocytes ka soo galo bile iyo gudahood waxaa la sii daayay in mindhicirka lagu jiro dheefshiidka. Haddaba maraya jidka la bolusdose koowaad dhuuban, ka dibna si xiidanka, saamayn ku flora bakteeriyo, waxaa mar kale la sii daayay iyo diinta urobilinogen, ka dibna urobilin stercobilin in si toos ah raaca saxarada ah. Laakiin lacagta had iyo jeer aad u yar oo bilirubin in xididka portal ku soo laabtay waxaana la qabtaa kelyaha, meesha ay kaadidu waa lagaa saarayaa.

xadka ah ee caadiga ah

Ku xadgudubka sarrifka this Midabka muhiim ah ku dhici kara saddex marxaladood oo waaweyn: wareegga dhiigga ee bololka ee erythrocytes, ka qabashada iyo go'doon ah ee bile cagaarshowga. Si kastaba ha ahaatee, in embodiments oo dhan, waxaa la ogaan doonaa dhiigga, wadarta bilirubin waxaa Qolol, la doorbidayo ama si toos ah ama aan toos ahayn by jajab ay. Sidaas darteed, ay fiirsashada caadiga ah ee plasma waxaa loo arkaa inay ku saabsan 8,5-20,5 micromoles halkii litir. Haddii tiraduna way sii kordhaysaa in 85, ka dibna xaalad ah hyperbilirubinemia khafiif ah, ka 86 si ay 169 - dhexe iyo ugu dambeyntii in ka badan 170 mmol / l - daran. Waxay ku saabsan tahay kiiska, haddii aad kaliya shaaca ka qaaday in bilirubin total kacsantahay. Si kastaba ha ahaatee, si gooni gooni ah xeerka ka jira ee u taagan jajab: si toos ah - si 5.1, furan - 16.5 pmol / l.

nooca Suprarenal jooniska

Sidaas daraaddeed, xadgudub ku ah marxaladda ugu horeysa ee bilirubin total ee dhiigga la sara kiciyaa ugu horayn iyada oo jajab aan toos ahayn. Tan waxaa loo sharxay by etiology ee gobolka, kuwaas oo kala diridda sare ee unugyada dhiigga cas ee dhiigga. Tani waxay dhici kartaa xaaladaha foomamka lagu dhasho ee anemia hemolytic (cilladaha heer hidaha ee unugyada dhiigga cas naftooda, falgalka ay, haemoglobin) ama helay (weerar difaaca cudurka la erythrocytes u gaar ah, gaadhista sunta iyo sunta, fayrusyada, bakteeriyada iyo noolaha kale). Sayidka, pathogenesis waxaa kor u formation of bilirubin sabab u ah unugyada beerka oo si fudud aadan haysan waqti ay ku qabsadaan sida tiro aad u badan waxaa ka mid ah, oo waxay ku ururayaa in maqaarka iyo xabka xuubka, ka dibna ee xubnaha gudaha, iyaga keenaya dhaawac halis ah. Sayidka sameeyay nooca suprarenal jooniska.

cagaarshow nooca cagaarshowga

Haddii xadgudubku ka dhacdaa on marxaladda labaad ugu weyn, hepatocytes ku aadan waqti kor u soo qaado oo loo farsameeyo xataa lacagta caadiga ah iyaga inay metabolite haemoglobin, iyo ugu dambeyntii at kharashka labada kooxood Qolol total bilirubin. Sababaha this - isbedel burbur culus ee beerka. Waxaa ka mid ah hepatitis of Bilowgii kala duwan (sun ah, khamri, viral) iyo cirrhosis. Sayidka, sababaha bilirubin kacsantahay been dhiigga ee xaqiiqda ah in hepatocytes laga yaabaa in aan si ku filan u shaqeeyaan, ama barar aan iyaga ku jiro, sidoo kale sabab u tahay tiradooda aan ku filnayn. Sababta ugu badan, dabcan, waa hepatitis nooca-A, B, C, Delta, E ama PP. Sayidka yeesho nooca cagaarshowga (parenchymal) jooniska syndrome, kaas oo la Ulasocto calaamadaha dhalaalaya oo caabuq mesenchymal iyo gepatotsiliarnoy failure.

nooca cagaarshow obstructive

Iyo, dabcan, xadgudub shiid bilirubin sidoo kale dhici karaan masraxa weyn ee saddexaad, waa in marka Digo ee bile. Anyway, la habkan waxaa hor istaagay waddooyinku ku soo saarka ama beerka, ama xitaa ka vesicafellea. Sababtoo ah oo ka mid ah isbedel ku bile ururayaa in kaadiheysta iyo siyaabaha, ay cadaadis si tartiib tartiib ah u kordhiyaa, iyo ugu danbeyn ay soo noqoto (this ifafaale waxaa lagu magacaabaa regurgitation) in marinnada intrahepatic, ka dibna - in xididdada dhiigga, taas oo ah sababta kacsantahay bilirubin total. Isla mar ahaantaana, dabcan, waxaa jira isbedel kale in assays lagmamaarmaanna. Sayidka, dhiigga ku dhacdaa cholehemia, i.e. hesho u galay acids bile iyo ensaymes, iyo in xididada u isu sameeyay cholestasis, i.e. dheecaanka fadhiya. sclera Caafimaad ahaan, waxa lagu muujiyay doonaa cagaarshow, xub-axaleedka iyo maqaarka (midab huruud ah leh towns cagaaran), iyo falanqayn lahaa ma aha oo kaliya wadarta bilirubin oo si toos ah u kordhay, laakiin sidoo kale acids bile, kolestaroolka, heerka phosphatase xumadoodu, triglycerides, waxqabadka of transferase gamma-glutamyl .

sababaha

etiology ee obstructive ama, iyada waxaa loo yaqaan cagaarshow obstructive, waa arrin ballaaran. Sababta ugu badan waa xannibaad ah dhagaxa mareenka biliary ee cholecystitis calculous ama cholelithiasis raagay iyo helminthic dhagax weyn marka dirxi ku kooban gudaha laga shido ama ka muujiyay cholangitis, iyo marka ay Lumen bararaan occlusive ama ay sabab u tahay barar derbiyada, ama ay sabab u tahay dhexgalka iyaga ka mid ah. Iyo, dabcan, waxay sharaxeysaa xaqiiqda ah in bilirubin tooska ah iyo guud ahaan korodhay. Sababaha ka heley kale kiis kasta, waxaa sababa riixo ee ka baxsan. Inta badan waxa ay ka dhacdaa sababtoo ah sii kordhaysa ee burada, oo caadi ahaan saameeya madaxa beeryarada. Laakiin sidoo kale, xaaladda this laga yaabaa inuu dhaco cirrhosis markii biliary, marka laga shido waa la tuujiyaa si uu u koro sirqoollada iyo qaybood of unugyo.

joonis dhalaanka

Si kastaba ha ahaatee, joonis oo dhan ma yihiin xaaladaha cudur ee u shaqeeyo. Sidaas darteed haddii wadarta bilirubin waxaa Qolol in ilmaha si deg deg ah marka ay dhashaan ama dhowr saacadood ka dib, iyo maqaarka iyo xub-axaleedka leeyihiin joonis dhalaalaya, waa in aad si degdeg ah oo aan qaylodhaan. Ka dib markii dhasha waa xaalad jir yeedhay transient sababtoo ah waa waddada. Dabcan, su'aasha soo baxdo ka hooyadiis ku faraxsan kuwaas oo u barto in bilirubin ilmahaagu Qolol, "Maxaa habboon in aan sameeyo?" Jawaabtu waa mid fudud: sugaan. Marka ay tani run ahaantii muujinaysaa maamulka uurka leh oo kaliya, tan iyo muddo dhowr maalmood (sida caadiga ah saddex ilaa shan) jaalle si tartiib tartiib ah u baaba'aa. Oo kaliya waa haddii dib loo dhigo, xaaladda ilmaha xumaatay iyo guud ahaan bilirubin la Qolol, daaweynta waxaa lagu fuliyaa si deg deg ah, kuwaas oo therapy naanin loo isticmaalo iyo cindiga ultraviolet. Haddaba aynu ka fiirsan pathogenesis ee xaaladan.

dhallaanka Gaar ahaan wareegga dhiigga

Xaqiiqada ah in wareegga uurjiifka uurka si weyn uga duwan in lagu arkay carruur horay u dhashay. Inta lagu guda jiro uurka, ilmaha la Hawiyaha ee xumbada leh dheecaanka amniotic, iyo sababtoo ah sambabada uu aan weli aqoon u leh hawada iyo waxaa waanuu gobolka, sida oonay. Laakiin ilmaha waa mid muhiim u ah socodka joogtada ah ee ogsijiin si unugyada uu ay formation, koritaanka iyo kaladuwan. Taasi waa sababta uu dhiiggiisu waa sidaas si dhow ula xiriiro waalidka. In si faahfaahsan, unugyada dhiigga cas kid kaliya daraan oxygen ka unugyada dhiigga cas naagtii, oo taas waxay u baahan yihiin Karanka oo xoog awoodiisa. Sidaa darteed, waxaa wakiil nooca F-hemoglobin, taas oo macnaheedu yahay Uur. Waxa uu si fudud u helo oksijiin oo xanbaarsan in unugyada ilmaha caloosha ku.

natiijooyinka

Si kastaba ha ahaatee, ka dib dhalashada awood noocan oo kale ah waa loo baahnayn, sababtoo ah markaas ka on sambabada uu shaaca ka qaaday in uu neefsanayo on iyaga u gaar ah iyo kasban ay oxygen u gaar ah. Oo haddii hemoglobin isku sii joogi doonaa, ma noqon doonto awood u siin unugyada. Sidaa darteed, ka dib markii neefta ugu horeysay ee uu bilaabo inuu si firfircoon uga bedeli protein ugu weyn this ee unugyada dhiigga cas ka uurjiifka qof weyn - nooca A. Tan waxa u sabab hemolysis kordhay ee unugyada dhiigga cas iyo horumarka degdeg ah oo cusub, sax ah, ka dhuuxa lafta. Sidaas darteed, waxaa jira joonis ee hore oo kale, nooca suprarenal, oo istaago sida ugu dhakhsaha badan dhammaan unugyada jirka dhiigga cas waa la wada baabbi'iyey iyo kuwo cusub buuxin dhiigga.

therapy

tallaabada ugu muhiimsan ee daaweynta bilirubin kacsantahay waa, dabcan, daawaynta cudurka sababaya, xanuunada keena sarrifka sida, i.e. antibiotics in hepatitis viral, naanin xaaladaha sunta lagu sumoobo, shubo dhiig iyo unugyada cas ka buuxaan ama hemolysis inta lagu guda jiro xubin badalida beerka wareega daran ee cirrhosis. Si kastaba ha ahaatee, waa in la xoojiyo daaweynta dabiiciga ah, gepatoprotektory, hab-nololeedka midig, oo aan halista ah iyo cunto gaar ah bilirubin kacsantahay. Si arrintan loo sameeyo, marka hore, waa in aad kor u siin sigaarka iyo khamriga, baruurta xad-dhaaf ah, kolestaroolka, basbaas iyo cuntooyinka la shiilay. Waa arin mamnuuc ah in la cuno pickles iyo waxyaabaha pickled. Waxaa lagama maarmaan ah in la xaddido qaadashada cusbo iyo shaaha iyo kafeega waa in aysan cabbin oo dhan. Taas bedelkeeda, cunto la bilirubin kacsantahay waxaa ka mid ah cunto yar soo noqnoqda la tirada meatless cereals kulul, compotes midhaha, bedelida kibis cad in Bula. Indeed, in daawada mahad bilaabi doonaan isbeddel togan iyo ugu dambeyntii cudur aad ka tagi doono.