Hloov cov xim ntawm daim tawv nqaij lossis cov mucous daim nyias nyias yog ib qho ntawm lub cev cov tshuaj tiv thaiv kab mob. Feem ntau nws qhia txog kev hloov hauv daim siab lossis kev tawg ntawm cov qe ntshav. Cov kab mob zoo li no tshwm sim los ntawm jaundice. Qhov no yog ib qho ntawm feem ntau cov kev kho mob syndromes. Jaundice tuaj yeem loj hlob ntawm txhua lub hnub nyoog thiab qhia txog ntau yam pathologies. Qee zaum, nws raug suav hais tias yog qhov qub. Txawm li cas los xij, nyob rau hauv cov kab mob, qhov syndrome no yog qhov qhia tau tias muaj mob loj heev tau tshwm sim hauv lub cev. Yog li ntawd, nws yog ib qho tseem ceeb los txheeb xyuas qhov ua rau ntawm daim tawv nqaij tsis zoo thiab tshem tawm sai li sai tau.
Lub tswvyim ntawm jaundice syndrome
Jaundice tsis yog hom kab mob, raws li ntau tus neeg xav. Qhov no tsuas yog ib qho ntawm cov cim qhia ntawm pathology. Ntxiv mus, nws tuaj yeem txhim kho nrog ntau yam kab mob. Ntawm lawv yog kab mob, mob qog noj ntshav, kab mob parasitic invasion, kab mob caj ces, ntshav poob. Txhawm rau kom nkag siab tias dab tsi yog qhov ua rau ntawm qhov tshwm sim no, ib qho kev faib tawm pathogenetic ntawm jaundice tau tsim. Nws yog ua raws li cov txheej txheem ntawm kev loj hlob ntawm tus mob no. Los ntawm kev nkag siab yuav ua li cas qhov teeb meem tshwm sim, nws yooj yim dua rau cov kws kho mob kom pom qhov tshwm sim ntawm cov kab mob.
Jaundice yog nrog tsis yog los ntawm kev tshwm sim sab nraud, tab sis kuj los ntawm kev hloov pauv hauv kev kuaj ntshav biochemical. Qhov teeb meem no hu ua hyperbilirubinemia. Nrog rau kev hloov pauv ntawm cov xim ntawm cov mucous daim nyias nyias thiab daim tawv nqaij, theem ntawm qhov ntsuas no nce ntau ntau zaus. Qib ntawm bilirubin kuj yog lub hauv paus rau kev faib tawm ntawm jaundices. Qhov no yog lwm qhov kev ntsuas uas pab cov kws kho mob ua qhov kev kuaj mob sib txawv rau tus mob no. Jaundice kuj raug cais raws li qhov hnyav thiab etiology. Tsuas yog nrhiav kom paub qhov ua rau ntawm qhov kev hloov ntawm cov xim ntawm daim tawv nqaij, tus kws kho mob thiaj li yuav tau txais kev kho mob txaus.
Kev faib tawm ntawm tus menyuam yug tshiab jaundice los ntawm etiology
Cov niam txiv feem ntau nco ntsoov tias lawv tus menyuam daim tawv nqaij thaum yug los muaj xim daj me ntsis. Tom qab ob peb hnub, qhov no dhau mus thiab tus me nyuam tig liab. Qhov no yog ib qho tshuaj tiv thaiv tag nrho ntawm lub cev rau kev hloov hauv ib puag ncig. Tus mob no hu ua physiological jaundice nyob rau hauv cov me nyuam mos. Nws tshwm sim los ntawm qhov ua tsis tiav ntawm daim siab thiab kev tawg ntawm hemoglobin hauv plab, uas hloov mus rau bilirubin. Neonatal jaundice thaum tsis muaj cov kab mob ploj mus rau hnub 10-14th. Txawm li cas los xij, yog tias tsis muaj qhov hloov pauv ntawm cov xim ntawm daim tawv nqaij, koj yuav tsum xav txog qhov muaj cov kab mob pathology thiab sab laj tus kws kho mob.
Hmoov tsis zoo, kab mob jaundice syndrome feem ntau pom hauv cov menyuam yaus hauv thawj lub hlis ntawm lub neej. Etiological yam yuav ua tau raws li nram no:
- Ntxhais hluas.
- Kab mob ntawm cov kab mob endocrine hauv niam lossis tus menyuam yug tshiab.
- Heredity.
- Fetal hypoxia thaum cev xeeb tub lossis yug menyuam.
- kab mob Hemolytic cuam tshuam nrog Rhesus teeb meem hauv niam thiab menyuam.
- Kev siv qee yam tshuaj uas cuam tshuam rau tus menyuam lub cev.
Nyob ntawm qhov ua rau muaj qhov tshwm sim, tshuaj, keeb kwm, hypoxic thiab lwm yam kab mob jaundice yog qhov txawv. Txawm hais tias qhov ua rau ua rau muaj kev txhim kho ntawm tus mob no, pathological hyperbilirubinemia yuav tsum tau kho. Txwv tsis pub, ntau dhau ntawm cov kua tsib xim tuaj yeem ua rau lub hlwb puas. Txhawm rau tiv thaiv qhov no tshwm sim, yuav tsum tau ua tib zoo saib xyuas hauv tsev kho mob.
Ntshav daj daj daj: kev faib tawm los ntawm thaj chaw
Koj tuaj yeem taug qab qib kev puas tsuaj tsis yog los ntawm kev kuaj ntsuas, tab sis kuj los ntawm cov ntaub ntawv kho mob. Nws kuj tseem muaj txiaj ntsig zoo rau kev ntsuas qhov ua tau zoo ntawm kev kho tsis tu ncua. Rau lub hom phiaj no, pediatrics siv cov kev faib tawm ntawm jaundice raws li 5-point system (raws li Cramer). Nws yog raws li nyob rau hauv lub localization ntawm lub pathological syndrome. Tus kws kho mob tshuaj xyuas tus menyuam thiab khiav raws nws daim tawv nqaij, qhia meej tias qhov twg muaj jaundice. Yog hais tias nws yog nyob rau hauv lub mucous daim nyias nyias ntawm lub qhov muag thiab lub ntsej muag, ces qhov no yog suav hais tias yog 1 point raws li Cramer. Qhov no txhais tau tias thawj qib ntawm qhov hnyav. Nrog rau kev sib kis ntawm yellowness ntawm lub cev, 2 cov ntsiab lus tau teeb tsa. Cov qib tom ntej yog kev hloov xim ntawm daim tawv nqaij mus rau lub luj tshib thiab lub hauv caug ntawm tus menyuam. Ntawm 4 cov ntsiab lus, jaundice txuas mus rau cov ceg ntawm tus menyuam. Qhov siab tshaj plaws yog suav tias yog kev hloov pauv ntawm cov xim ntawm daim tawv nqaijnpog xib teg thiab ko taw.
Cov ntsiab lus ntau, qhov siab dua ntawm bilirubin hauv cov ntshav. Ua tsaug rau Kramer qhov kev faib tawm, nws yooj yim dua rau tus kws kho mob los ntsuas qhov ua tau zoo ntawm kev ntsuas kev kho mob lub sijhawm. Qhov no yuav pab kom tsis txhob nqus cov ntshav tawm ntawm tus menyuam txhua hnub.
Yam jaundice hauv cov neeg laus
Rau cov neeg laus, muaj kev faib tshwj xeeb ntawm jaundice. Nws yog nyob ntawm qhov pathogenesis ntawm tus mob no. Raws li cov txheej txheem ntawm txoj kev loj hlob, cov nram qab no hom jaundice yog txawv:
- Suprahepatic. Nws pathogenesis zoo ib yam li transient neonatal syndrome. Kev loj hlob ntawm suprahepatic jaundice yog txuam nrog kev ua kom nrawm ntawm cov qe ntshav liab. Yog li ntawd, nyob rau hauv lwm txoj kev nws yog hu ua hemolytic.
- Hepatic (parenchymal) jaundice. Nws cuam tshuam nrog kev puas tsuaj rau hepatocytes hauv cov txheej txheem mob hnyav thiab mob ntev. Nyob rau tib lub sijhawm, lub siab tsis tuaj yeem tiv nrog kev thauj mus los thiab kev ntes ntawm bilirubin tsim hauv lub cev.
- Mechanical jaundice. Nws tshwm sim vim muaj ntau yam pathologies. Ntawm lawv - calculous cholecystitis, pancreatic cancer, kab mob. Hauv lwm txoj kev, nws yog hu ua subhepatic thiab obstructive. Nws tshwm sim los ntawm stagnation ntawm cov kua tsib.
Koj tuaj yeem txiav txim siab hom kab mob pathological siv kev kuaj ntshav biochemical. Los ntawm theem ntawm dawb thiab conjugated (direct) bilirubin. Xws li kev faib tawm ntawm jaundice pab tus kws kho mob kom taug qab thiab nqaim lub voj voog ntawm cov kab mob nrog rau tus mob no. Ntxiv nrog rau kev kuaj ntshav biochemical, lawv ua CBC, kawm txog quav thiab zis, nrog rau kev kuaj ultrasound.hepato-duodenal zone.
Lub tswvyim ntawm suprahepatic jaundice
Prehepatic jaundice yog qhov tshwm sim ntawm daim siab tsis muaj sijhawm los tiv thaiv nws txoj haujlwm thiab metabolize tag nrho cov bilirubin tsim hauv ntau. Yog vim li cas rau nws ntau lawm yog hemolysis ntawm cov qe ntshav liab, uas yog, lawv puas. Feem ntau, qhov no tshwm sim vim cov kab mob congenital ntawm hematopoietic system. Hauv particular, nrog hemolytic anemia. Qhov no pathology yog nrog los ntawm kev tsim cov tshuaj tiv thaiv rau cov qe ntshav, raws li qhov tshwm sim ntawm cov qe ntshav liab raug rhuav tshem. Lwm yam ua rau hemolytic jaundice tuaj yeem yog: kev raug mob loj heev, ua rau muaj ntau yam tshuaj lom. Tag nrho cov no ua rau kev puas tsuaj ntawm cov qe ntshav.
Hemolytic jaundice tuaj yeem xav tau los ntawm cov txiv qaub xim ntawm daim tawv nqaij. Feem ntau, cov neeg mob no daj ntseg vim muaj ntshav liab. Cov tawv nqaij khaus thiab hepatomegaly tsis tuaj. Qee cov neeg mob muaj tus po loj. Cov zis thiab quav ua cov xim tsaus nti vim muaj cov ntsiab lus ntawm cov xim (uro- thiab stercobilinogen).
Ua rau kab mob siab jaundice
Parenchymal jaundice yog ib qho ntawm cov tsos mob tseem ceeb qhia txog kev puas siab puas ntsws. Nws yog txuam nrog kev puas tsuaj los yog kev puas tsuaj ntawm hepatocytes. Ua rau ntawm tus mob no muaj xws li:
- Kab mob pathologies. Ntawm lawv yog kab mob siab, mononucleosis, leptospirosis, sepsis.
- Cirrhosis ntawm daim siab.
- tshuaj lom rau lub cev. Tshwj xeeb, kev siv yeeb tshuaj ntev ntev thiab cawv cawv.
Intrahepatic cholestasis syndrome tshwm sim hauv cov kab mob mus ntev. Nws yog tus cwj pwm los ntawm kev cuam tshuam ntawm cov ducts me me. Hauv qhov no, dawb bilirubin nkag mus rau lymphatic thiab circulatory system. Qhov no yog nrog los ntawm cov zis tsaus. Cov quav hauv cov neeg mob nrog parenchymal jaundice, ntawm qhov tsis sib xws, ua tsis muaj xim. Qhov no tseem ceeb heev rau kev kuaj mob.
yam ntxwv ntawm obstructive jaundice
Prehepatic jaundice tshwm sim vim qhov thaiv ntawm cov kua dej hauv plab zom mov. Cov qog nqaij hlav, cov kab mob loj lossis cov lej ua haujlwm ua rau muaj kev cuam tshuam. Yog li ntawd, stagnation ntawm cov kua tsib thiab digestion tshwm sim. Tus kab mob no nrog rau ntawm daim tawv nqaij khaus, xeev siab thiab quav quav. Kev faib tawm ntawm cov kab mob jaundice raws li Halperin suav nrog cov txheej txheem xws li tag nrho cov protein thiab cov ntshav bilirubin, nrog rau cov teeb meem uas tshwm sim los ntawm cov kab mob hauv qab. Cov ntsiab lus tau txais txiaj ntsig raws li qhov no. Qhov no tso cai rau koj los ntsuas qhov kev ntsuas rau obstructive jaundice. Qhov kev faib tawm tau tsim rau qhov muaj peev xwm ntawm kev teeb tsa chav kawm ntawm qhov hnyav. Qhov yooj yim tshaj yog degree A, nyob rau hauv uas mus txog 5 cov ntsiab lus tau qhab nia. Nyob rau hauv lub xub ntiag ntawm cov teeb meem, prognosis zuj zus. Chav B sib raug rau 6-12 ntsiab lus. Tus neeg mob qhov mob hnyav zuj zus tuaj. Nyob rau hauv lub xub ntiag ntawm ntau yam teeb meem thiab deterioration ntawm cov ntshav suav, ntau tshaj 15 cov ntsiab lus tau qhab nia. Chav kawm C sib raug mus rau qib hnyavgravity.
Hloov pauv hauv qhov ntsuas ntsuas rau jaundice
Ntsuas tus neeg mob tus mob siv cov qauv kuaj. Kev faib tawm ntawm jaundice los ntawm qib ntawm bilirubin pab tsis tau tsuas yog ntsuas qhov hnyav ntawm tus kab mob, tab sis kuj ua rau kev kuaj mob sib txawv. Nws yog feem ntau siv nyob rau hauv pediatrics. Kev kuaj mob thiab kev kuaj mob ntawm cov menyuam yaus jaundice raug soj ntsuam hauv Cramer system. Ib qib me me sib raug rau qhov kev hloov ntawm cov xim ntawm tawv taub hau thiab sclera. Hauv qhov no, bilirubin tsawg dua 80 μmol / l. Qhov siab dua cov xim xim, qhov siab dua cov qhab nia Cramer. Nrog yellowness ntawm lub cev, qib ntawm bilirubin yog 80-150 µmol / l. Qhov no sib raug rau 2 ntsiab lus. Qhov thib peb ntawm jaundice tshwm sim yog tias qib ntawm bilirubin yog los ntawm 150 txog 200 µmol / l. Clinically, qhov no sib haum mus rau ib tug discoloration ntawm daim tawv nqaij mus txog rau lub hauv caug thiab lub luj tshib. Nrog rau qhov mob hnyav heev, qib ntawm bilirubin nce siab dua 250 µmol / l.
Cov teeb meem ntawm icteric syndrome
Feem ntau, cov ntsiab lus siab ntawm bilirubin tsis hem lub cev. Cov xim tsis ua mob rau daim tawv nqaij thiab cov kab mob hauv nruab nrog cev. Cov ua rau tus neeg mob qhov mob hnyav yog: hemolysis ntawm erythrocytes, daim siab puas thiab impaired bile outflow. Cov teeb meem ncaj qha ntawm hyperbilirubinemia tau pom thaum cov xim nkag mus rau hauv lub hlwb. Cov mob no hu ua nuclear jaundice. Nws raug pom thaum theem ntawm indirect bilirubin nce ntau pua zaus. Nuclear jaundice tshwm sim vim muaj kab mob hemolytic ntawm tus menyuam mos thiab ntau yamcongenital pathologies ntawm hematopoietic system. Nws hem muaj mob loj heev.
Differential Diagnosis for Jaundice Syndrome
Yuav kom paub qhov ua rau mob daj ntseg, ua tib zoo saib cov xim ntawm daim tawv nqaij (txiv qaub, txiv kab ntxwv) thiab muaj lwm yam tsos mob. Lub siab thiab tus po yog palpated. Nws yog ib qho tseem ceeb los txiav txim siab qib ntawm bilirubin. Yog tias tsuas yog cov xim dawb tau nce siab, erythrocyte hemolysis yog qhov ua rau. Hauv kev ua txhaum ntawm daim siab, theem ntawm ob qho tib si unconjugated thiab ncaj qha bilirubin hloov. Cov zis yuav darker thiab feces sib zog. Qib ntawm stercobilinogen hauv cov ntshav nce. Subhepatic jaundice yog nrog los ntawm khaus thiab deterioration ntawm tus mob. Kev nce hauv conjugated bilirubin tau sau tseg hauv cov ntshav. Txhawm rau kom paub qhov ua rau mob daj ntseg, kev sim ntau yam, ultrasound thiab CT ntawm lub plab kab noj hniav yog ua.
