Prehepatic jaundice yog tus cwj pwm los ntawm kev nce qib ntawm bilirubin hauv cov ntshav, tom qab ntawd daj ntawm daim tawv nqaij, mucous daim nyias nyias thiab pob qhov muag. Tus kab mob no provoked los ntawm ib tug malfunction ntawm lub erythrocyte system, nyob rau hauv uas cov kev puas tsuaj ntawm erythrocytes yog pom, uas ua rau kom nce nyob rau hauv bilirubin.
Lub siab tsis muaj sijhawm los ua thiab tshem tawm daim siab pigment, uas thawj zaug nkag mus rau hauv cov kua tsib thiab cov hnyuv thiab tom qab ntawd rov mus rau hauv lub cev. Tus kab mob no feem ntau tshwm sim tawm tsam keeb kwm ntawm kis kab mob, kab mob autoimmune, lom thiab tej zaum yuav muaj cov caj ces.
Ntxhais kab mob
Ntau zaus, cov tawv nqaij daj yog tshwm sim los ntawm cov teeb meem ntawm cov kab mob biliary thiab daim siab, thaum cov kabmob no tsis tuaj yeem khi cov bilirubin tso tawm thiab tshem tawm ntawm lub cev. Txawm li cas los xij, nws kuj tshwm sim tias cov kab mob no ua haujlwm ib txwm ua, tab sis bilirubin tseem khaws ntau ntau.
Ib yam mob zoo sib xws yog ua tau nrog suprahepatic jaundice. Qhov no pathology yog characterizedKev puas tsuaj ntau dhau ntawm cov qe ntshav, thaum cov qe ntshav liab tawg, thiab hemoglobin hloov mus rau bilirubin, uas tsis muaj sijhawm los ua tiav thiab nkag mus rau hauv cov ntshav. Lub pathogenesis ntawm suprahepatic jaundice tuaj yeem cuam tshuam nrog malaria, lobar pneumonia, thiab lwm yam kab mob uas ua rau muaj kev tawg ntawm cov qe ntshav liab.
Cov tawv nqaij ua txiv qaub daj, cov neeg mob daj ntseg heev, tab sis tsis muaj qhov khaus ntawm lwm hom jaundice. Kev kuaj ntshav tsis qhia txog qib siab ntawm bilirubin. Ntawm cov tsos mob ntawm suprahepatic jaundice, o ntawm tus po yuav tsum paub qhov txawv, uas tuaj yeem kuaj pom los ntawm palpation, tab sis lub siab tseem nyob ntawm qhov loj. Tus kab mob tuaj yeem yog los yog kis tau.
Congenital suprahepatic jaundice yog ib yam kab mob uas tshwm sim los ntawm cov teeb meem ntawm cov qe ntshav liab, thaum muaj cov qe ntshav liab raug rhuav tshem, thiab cov hlwb tshiab tsis tsim txaus. Feem ntau, erythrocytes nyob li ntawm 4 lub hlis, thiab nrog rau cov kab mob no - ntau tshaj 3 lub lis piam. Hauv qhov no, kev puas tsuaj ntawm cov qe ntshav liab hauv lub siab, cov hlab ntsha, cov pob txha pob txha, spleen.
Nyob rau hauv qhov kis tau tus kab mob suprahepatic jaundice, cov qe ntshav liab raug rhuav tshem hauv tus po. Hauv cov menyuam yaus, qhov kev ua txhaum cai no feem ntau yog los ntawm kev hloov mus rau qhov chaw txawv txawv. Hauv cov neeg laus, tus kab mob tshwm sim thaum muaj kab mob ntshav lossis lwm yam teeb meem kev noj qab haus huv.
mob rau menyuam mos
Suprahepatic thiab subhepatic jaundice ntawm cov menyuam yug tshiab tau muab faib ua physiologic althiab pathological. Daim ntawv physiological ntawm tus kab mob daws nws tus kheej hauv 1-1.5 lub lis piam. Txawm li cas los xij, yog tias lub sijhawm no cov tsos mob ntawm tus kab mob tsis ploj mus lossis lwm yam cim koom nrog, qhov no yuav qhia txog cov kab mob pathology. Hauv qhov no, koj yuav tsum tau mus ntsib kws kho mob sai. Thawj cov tsos mob ntawm jaundice tshwm sim hauv tus menyuam hnub ob tom qab yug me nyuam.
Lub cev nqaij daim tawv tsis txaus ntshai, vim nws tshwm sim raws li cov tshuaj tiv thaiv ntawm lub cev rau kev tawg ntawm hemoglobin thaum lub siab ua haujlwm tsis zoo, uas tsis tuaj yeem tiv nrog nws txoj haujlwm tseem ceeb. Lub pathogenesis ntawm suprahepatic jaundice nyob rau hauv cov me nyuam yog tib yam li cov neeg laus. Cov kab mob pathological tuaj yeem tshwm sim los ntawm yam xws li:
- cov teeb meem thyroid;
- -Conggenital Patenologies;
- lub siab tsis paub qab hau;
- Rhesus teeb meem ntawm niam thiab menyuam;
- kab mob siab;
- mob ntshav qab zib thaum cev xeeb tub.
Feem ntau qhov laj thawj tseem ceeb ntawm suprahepatic jaundice yog Rh tsis sib haum, raws li cov hlwb ntawm leej niam lub cev thaum cev xeeb tub tawm tsam cov hlwb ntawm tus menyuam hauv plab, lees paub tias lawv yog kab mob. Feem ntau, thawj cov cim qhia ntawm tus kab mob tshwm sim txawm nyob hauv tsev kho mob, uas ua rau muaj kev pheej hmoo ntawm qhov tshwm sim zoo thiab pab tiv thaiv kev txhim kho ntawm cov teeb meem.
Suprahepatic jaundice yog tus yam ntxwv ntawm cov tsos mob xws li:
- jaundice ntawm sclera ntawm lub qhov muag thiab tawv nqaij;
- pallor;
- kev nyuaj siab.
Muaj ntau yam sib txawvhemolytic jaundice nyob rau hauv tus me nyuam mos, xws li:
- anemic;
- edematous;
- icteric.
Tus kab mob anemic yog qhov yooj yim zam los ntawm tus menyuam, vim nws tsuas yog lub sijhawm luv ntawm kev ua phem ntawm leej niam cov tshuaj tiv thaiv rau tus menyuam hauv plab. Nyob rau tib lub sijhawm, cov cim qhia xws li daj ntseg ntawm daim tawv nqaij, anemia, nce qhov loj ntawm tus po thiab daim siab tau sau tseg.
Yeej, qhov kev loj hlob ntawm suprahepatic jaundice yog tshwm sim los ntawm kev raug rau niam cov tshuaj tiv thaiv kab mob ntev ntev ntawm tus menyuam. Daim ntawv edematous yog suav tias yog qhov txaus ntshai heev thiab tuaj yeem ua rau tus menyuam tuag. Tib lub sijhawm, muaj cov tsos mob ntawm suprahepatic jaundice xws li:
- mob hnyav anemia;
- daim siab, spleen, plawv;
- ua rau lub siab ua haujlwm tsis zoo;
- teeb meem plawv;
- puffiness;
- ntim cov kua hauv lub plab thiab plab.
Vim edema, qhov hnyav ntawm tus menyuam yug tshiab tshaj li 2 zaug. Tsis tas li ntawd, qhov tshwm sim ntawm ascites, tseem ceeb bruising yog yam ntxwv. Feem ntau muaj pericarditis thiab pleurisy, uas kuj tshwm sim vim o loj.
Daim ntawv icteric ntawm tus kab mob tshwm sim thaum cov tshuaj tiv thaiv pib los tua cov hlwb ntawm cov kab mob uas twb muaj lawm. Nyob rau tib lub sij hawm, tus me nyuam mos noj qab nyob zoo. Cov tsos mob nce zuj zus, thiab qhov tshwm sim ntawm tus kab mob nce mus txog qhov siab tshaj li 4 hnub tom qab yug me nyuam. Nws yog ib qho tsim nyog sau cia tias cov tsos mob ua ntej ntawm jaundice pib tshwm, qhov chaw kho mob nyuaj dua. Tom qab ib pliag tus me nyuamdaim tawv nqaij pib daj, thiab tus po, daim siab thiab cov qog ntshav nce ntxiv.
Cov tsos mob ntawm jaundice thiab bilirubin nce ntxiv kom tom qab ib ntus ntawm daim tawv nqaij ua daj daj, yuav luag xim av los yog xim ntsuab me ntsis, thiab qib bilirubin hauv cov ntshav tau loj hlob sai. Qhov tseeb, tus kab mob no kav ntev li ib hlis.
Nrog suprahepatic jaundice, bilirubin accumulates hauv lub cev thiab cuam tshuam rau kev ua haujlwm ntawm lub plawv, daim siab thiab lub paj hlwb. Tus me nyuam tsaug zog heev thiab tsis kam noj mov. Qee zaus qaug dab peg thiab ua tsis taus pa yuav tshwm sim.
Nrog rau txoj kev loj hlob ntawm daim ntawv nuclear ntawm jaundice, tus me nyuam txoj kev noj qab haus huv pib deteriorate heev sharply. Nyob rau hauv cov ntaub ntawv ntawm intoxication heev thiab tsis muaj kev kho kom raug thiab raws sij hawm, convulsions ua ntau zaus, trembling tshwm sim nyob rau hauv cov ceg. Tsis tas li ntawm cov cim qhia yuav tsum tau muab sau tseg tias nro thiab nruj ntawm cov leeg ntawm caj dab. Tus me nyuam yuav luag tsis muaj zog, nws tsis muaj lub ntsej muag qhia, nws ob lub qhov muag dov, thiab nws tsuas yog squeaks raws li cov tshuaj tiv thaiv rau sab nraud stimuli.
Kev kho cov menyuam mos yuav tsum tam sim. Lub hauv paus ntawm kev kho yog qhov normalization ntawm tus po thiab daim siab nyob rau hauv cov txheej txheem ntawm kev khi thiab neutralizing bilirubin. Txhawm rau txhim kho kev noj qab haus huv ntawm tus menyuam yuav tsum tau siv cov kev kho mob nyuaj. Thaum kho, cov tshuaj thiab cov txheej txheem physiotherapy yog siv. Tej zaum koj kuj yuav tau txhaj ntshav.
Nws yog txwv tsis pub muab tshuaj rau tus menyuam me. Thaum xub thawj tshwm simsuprahepatic jaundice nyob rau hauv cov me nyuam mos, koj yuav tsum tau hu rau ib tug pediatric neonatologist. Kev txhim kho yuav luag tam sim tom qab pib kho.
Ib txoj hauv kev kho cov menyuam mos yog lub teeb fluorescent nrog lub teeb tshwj xeeb. Nws pab hloov bilirubin mus rau hauv cov khoom muaj kev nyab xeeb uas tawm hauv lub cev los ntawm kev ua kom lub plab zom mov. Kev kho mob tsuas yog ua hauv tsev kho mob xwb. Hauv qhov no, nws yog ib qho tsim nyog los xyuas kom meej tag nrho cov xwm txheej rau kev nyab xeeb ntawm cov txheej txheem. Lub ntsiab lus ntawm cov txheej txheem yog tias tus menyuam tau muab tso rau hauv lub thawv tshwj xeeb lossis tsuas yog hauv qab lub teeb. Thaum kho, yuav tsum pub niam mis ntau zaus, vim tias cov bilirubin ntau dhau tau tawm nrog cov khoom noj.
Yog tias qib ntawm bilirubin nce siab dhau qhov qauv, nws yuav ua rau muaj kev phom sij heev rau kev noj qab haus huv thiab lub neej ntawm tus menyuam. Nyob rau hauv cov ntaub ntawv no, nws yog qhia ib tug ntshav. Ua li no, cov ntshav pub ntshav yog txhaj los ntawm txoj hlab ntaws, uas pab ntxuav lub cev ntawm cov khoom txaus ntshai. Qhov no yog qhov kev ntsuas hnyav tshaj plaws, vim nws tau nrog ntau yam kev phiv, yog li cov txheej txheem no tau ua nyob rau hauv cov xwm txheej uas lwm txoj kev kho tsis tuaj yeem nqa qhov xav tau.
Kev tshwm sim
Txhua yam kab mob jaundice tsis yog ib qho kab mob ywj pheej, tab sis tsuas yog qhia tau tias muaj qee yam kev hloov pauv lossis kev cuam tshuam hauv kev ua haujlwm ntawm lub cev. Yog li ntawd, yellowing ntawm lub qhov muag thiab tawv nqaij yog cov yam ntxwv tsis tsuas yog rau kab mob siab, tab sis kuj rau ntau lwm yam kab mob. Qhov laj thawj tseem ceeb ntawm suprahepatic jaundice yog kev dhia nrawm hauv qibbilirubin rau qhov siab tshaj plaws. Tus mob no provokes ib tug loj tawg ntawm cov qe ntshav liab.
Lub etiology thiab pathogenesis ntawm suprahepatic jaundice nyob rau hauv cov neeg laus yog txuam nrog:
- kis mob ua rau;
- tiv thaiv kab mob;
- tshuaj lom;
Nyob rau hauv keeb kwm ntawm ntshav qab zib, ib qho anomaly nyob rau hauv cov qauv ntawm cov qe ntshav liab raug pom tawm tsam keeb kwm ntawm qhov tshwm sim ntawm cov lipids txawv txav thiab cov proteins. Lawv pom kev hloov pauv, thiab tseem muaj kev tiv thaiv qis rau kev hloov pauv hauv qhov kub thiab txias.
Qhov etiology ntawm suprahepatic jaundice tuaj yeem sib txawv heev, tab sis feem ntau cov txheej txheem yog vim cov txheej txheem biochemical. Yog li ntawd, nrhiav pom ntawm overt jaundice tsis yooj yim. Nws yog qhov nyuaj dua los txiav txim siab qhov ua rau mob daj ntseg, raws li lawv tau pom nyob rau hauv ntau yam kab mob tsis sib kis thiab kis kab mob. Kev loj hlob ntawm suprahepatic jaundice yog qhov tshwm sim ntawm:
- kab mob gallstone;
- pab dej paug tawm;
- thaiv lub siab ducts;
- cholecystitis thiab lwm yam kab mob ntawm lub gallbladder;
- pancreatitis thiab kev puas tsuaj ntawm pancreas.
Daim ntawv no ntawm tus kab mob no cuam tshuam nrog hemolysis thiab tsub zuj zuj hauv cov ntshav ntawm cov seem ntawm cov kua tsib xim - bilirubin. Nws yog ib qho tseem ceeb heev uas yuav tsum paub txog tus kab mob raws sij hawm thiab kho nws.
Cov tsos mob tseem ceeb
Txawm hais tias qhov etiology ntawm suprahepatic jaundice, qhov tshwm sim ntawm tus kab mob yog qhov zoo ib yam. Ntawm cov cim tseem ceeb, nws yog qhov yuav tsum tau ua kom pom qhov staining ntawm cov mucous daim nyias nyias thiab daim tawv nqaij daj. MainCov tsos mob yog ib qho kev hloov pauv ntawm biochemical tsis nyob rau hauv suprahepatic jaundice, uas yog, nce qib ntawm cov kua tsib xim (bilirubin) hauv cov ntshav cov ntshav, uas ua rau icteric staining ntawm cov ntaub so ntswg.
Nws tsim nyog xav tias qhov daj ntawm daim tawv nqaij yuav yog vim lwm yam. Qhov no yuav yog vim muaj qee yam khoom hauv cov ntaub so ntswg, tshwj xeeb tshaj yog thaum ua haujlwm hauv kev lag luam phom sij lossis noj quinacrine.
Suprahepatic jaundice yog tus yam ntxwv los ntawm cov tsos mob xws li:
- loj ntawm daim siab, uas tuaj yeem kuaj pom los ntawm palpation thiab ultrasound;
- xim dawb ntawm ob lub qhov muag thiab tawv nqaij daj;
- -dilation ntawm cov leeg ntawm txoj hlab pas;
- mob mob sab xis hauv qab tav;
- qhov tshwm sim ntawm venous network ntawm daim tawv nqaij ntawm lub plab;
- hloov pauv hauv qhov muaj pes tsawg leeg thiab xim ntawm cov quav thiab zis.
Ntxiv rau, muaj qhov nce ntawm tus po, mob hnyav, nce cov qe ntshav liab hauv cov pob txha. Ntawm cov yam ntxwv tshwm sim ntawm suprahepatic jaundice, nws yog ib qho tsim nyog los qhia txog cov xim khaus ntawm cov quav. Lub siab tsis tuaj yeem tiv taus qhov loj ntawm bilirubin tsim thaum lub sijhawm ua haujlwm ntawm cov qe ntshav liab. Nyob rau hauv cov ntaub ntawv no, cov tsos mob tseem ceeb yog nrog los ntawm ib tug rub mob nyob rau hauv lub poov xab cheeb tsam, ua daus no, ib tug ntse txo nyob rau hauv hemoglobin.
Kev txhim kho mechanism
Lub txheej txheem ntawm suprahepatic jaundice tuaj yeem yog vim muaj kev puas tsuaj ntau ntawm cov qe ntshav liab, cov kua tsib stasis, daim siab puas, lossis kev sib xyaw ua ke ntawm tag nrho cov xwm txheej no. Thaum ua qhov kev kuaj mob, nws yuav tsum tau coj mus rau hauv tus account lub peculiarity ntawm kev ua txhaum ntawm pigment metabolism. Daim ntawv no ntawm tus kab mobyog vim qhov tseeb hais tias nyob rau hauv ib tug neeg noj qab nyob zoo li 1% ntawm cov qe ntshav liab lwj txhua hnub. Nrog rau kev tawg ntawm hemoglobin hauv cov ntshav, bilirubin yog tsim nyob rau hauv cov hlwb, uas tsis yaj hauv dej thiab tsis tawm nrog cov zis. Txawm li cas los xij, tib lub sijhawm, nws dissolves zoo nyob rau hauv cov rog, yog li nws accumulates nyob rau hauv cov ntaub so ntswg subcutaneous rog. Nyob rau tib lub sijhawm, bilirubin, txav mus los ntawm cov hnyuv thiab tsub zuj zuj hauv cov hnyuv loj, hloov mus rau hauv cov xim uas ua rau cov quav xim av. Qhov no tuaj yeem txiav txim siab thaum lub sijhawm kev soj ntsuam.
Thaum lub siab ua haujlwm tsis zoo, qib ntawm bilirubin hauv cov ntshav nce ntxiv. Cov txheej txheem ntawm kev loj hlob ntawm suprahepatic jaundice tshwm sim yog tias cov xim tsis nkag mus rau hauv cov kua tsib capillaries, tab sis rov qab mus rau qhov chaw hauv daim siab, thiab tom qab ntawd mus rau hauv cov ntshav. Txawm li cas los xij, lwm qhov kev hloov pauv kuj tseem ua tau. Tsis tas li ntawd xwb, tus kab mob no kuj ua tau.
Npaj daj tuaj yeem tshwm sim los ntawm kev cuam tshuam ntawm cov ducts, xws li txhaws los ntawm pob zeb. Nyob rau tib lub sijhawm, cov kua tsib xim, bilirubin, accumulates hauv cov ntshav. Yog li, raws li cov txheej txheem ntawm kev loj hlob, suprahepatic, subhepatic thiab hepatic jaundices txawv. Nws hom tau txiav txim siab hauv kev kuaj mob sib txawv.
Pathophysiology
Kev puas tsuaj loj rau hepatocytes yog tus yam ntxwv ntawm suprahepatic jaundice. Hom kab mob no tuaj yeem tshwm sim hauv kab mob siab ntawm ntau yam etiologies, cirrhosis ntawm daim siab, nrog rau lwm yam kab mob uas tshwm sim nrog necrosis ntawm cov hlwb ntawm lub cev. Nyob rau tib lub sijhawm, muaj cov yam ntxwv zoo heev ntawm kev txhim kho thiab cov txheej txheem ntawm tus kab mob. Nyob rau hauv qhov kev tshwm sim ntawm pronouncedCov tsos mob xav tau kev kuaj mob.
Diagnosis
Kev kuaj mob tseem ceeb ntawm suprahepatic jaundice, uas yog kev kuaj pom pom tau ua tiav los txiav txim siab qhov muaj daj ntawm daim tawv nqaij thiab sclera ntawm lub qhov muag. Tom qab ntawd, txhawm rau paub meej qhov kev kuaj mob, cov txheej txheem xws li:
- tso zis thiab kuaj ntshav;
- antiglobulin test;
- pob txha pob txha puncture;
- kuaj mob lub siab thiab lub plab biliary.
Nrog suprahepatic jaundice, ntshav biochemistry yog thawj zaug, vim qhov kev soj ntsuam no tso cai rau koj los txiav txim siab qib ntawm bilirubin. Kev kuaj ntshav biochemical yog ua los ntawm kev noj ntshav los ntawm cov hlab ntsha thaum sawv ntxov nruj ntawm lub plab khoob. Yog tias cov ntshav hloov pauv, ces tus neeg mob tau txais kev kuaj mob ntxiv rau daim siab, uas yuav ua rau pom kev sib txawv txaus ntshai hauv kev ua haujlwm ntawm daim siab. Kev kuaj antiglobulin tso cai rau koj los txiav txim siab muaj cov tshuaj tiv thaiv rau cov qe ntshav liab. Yog tias muaj kev xav tias muaj kab mob ntawm daim siab, ces kuaj ntshav kuaj kab mob siab.
Nws tsim nyog sau cia tias nws yog daim ntawv suprahepatic ntawm jaundice uas yooj yim tshaj plaws los kuaj. Qhov no tau piav qhia los ntawm qhov tseeb tias cov tsos mob ntawm tus kab mob no tau hais meej heev. Cov tawv nqaij yog xim txiv qaub xim nrog lub zog pallor, thiab tsis muaj khaus uas yog yam ntxwv ntawm lwm hom jaundice.
Hauv kev kuaj ntshav, cov ntsiab lus nce ntxiv ntawm kev tsis ncaj ncees bilirubin tau sau tseg, thaum ncaj qha bilirubin tseem zoo li qub. Cov qib roj cholesterol thiab kev kuaj lub siab kuj tseem nyob hauv cov kev txwv ib txwm. Tsuas yog complexDiagnostics tso cai rau koj los txiav txim qhov peculiarity ntawm cov chav kawm ntawm tus kab mob, nrog rau muab ib tug kev kho mob.
Kev kho mob
Kev kho yog ua nyob rau hauv ib qho nyuaj thiab tuaj yeem ua tau zoo lossis ua haujlwm. Thaum xaiv cov txheej txheem thiab muab tshuaj, cov ntsuas bilirubin thiab qhov hnyav ntawm cov kab mob tau muab rau hauv tus account.
Kev kho mob ntawm suprahepatic (hemolytic) jaundice yog ua raws li kev tshem tawm ntawm qhov ua rau ua rau tus kab mob no. Conservative therapy txhais tau tias:
- siv tshuaj tua kab mob;
- Yglucocorticoids;
- nqa tawm phototherapy.
txhawm rau txo cov tsos mob ntawm qaug dab peg, qabzib lossis saline yog infused. Yog hais tias tus kab mob no provoked los ntawm ntau yam autoimmune txheej txheem, ces cov kev taw qhia ntawm glucocorticosteroids, tshwj xeeb tshaj yog xws li Dexamentasone los yog Prednisolone, yog qhia. Tsis tas li ntawd, cov tshuaj tiv thaiv kab mob tau sau tseg.
Qee zaum, cov ntshav ib leeg tuaj yeem hloov pauv. Cov txheej txheem no yog siv tsis tshua muaj, thaum qib ntawm bilirubin siab heev. Direct transfusion yog xyaum tsis siv. Nyob rau tib lub sijhawm, nrog rau kev siv cov ntshav, kev kho tshuaj kho mob tau sau tseg, uas pab hloov pauv bilirubin tsis ncaj rau hauv cov tshuaj tsis muaj tshuaj lom. Irradiation yog ua los ntawm cov xim dawb lossis xiav fluorescent teeb. Nyob rau hauv cov ntaub ntawv loj ntawm tus kab mob vim biochemical tsis xws luag nyob rau hauv cov ntshav liab, yuav tsum tau tshem tawm tus po.
Vim tias qhov nce hauv bilirubin hauv cov ntshav tuaj yeem tshwm simob peb yam sib txawv, kev kho mob yog nqa tawm los ntawm ob peb tus kws kho mob ib zaug. Cov kab mob hemolytic feem ntau cuam tshuam nrog cov kab mob ntshav, yog li kev sab laj nrog tus kws kho mob hematologist yuav tsum tau ua. Kev kuaj mob los ntawm tus kws kho mob toxicologist kuj tseem yuav tsum tau, vim jaundice tuaj yeem tshwm sim los ntawm kev lom nrog hepatotropic toxins. Txawm li cas los xij, daim ntawv subhepatic ntawm tus kab mob xav tau kev sab laj ntawm tus kws phais lossis tus kws kho mob oncologist.
Etiotropic therapy kuj yog qhov yuav tsum tau ua, txhawm rau tshem tawm cov laj thawj tseem ceeb uas ua rau muaj kev cuam tshuam. Yog hais tias cov dej ntws tawm ntawm cov kua tsib yog cuam tshuam los ntawm lub gallstone, tom qab ntawd kev kho mob yuav tsum muaj kev ua haujlwm thaum lub cev txawv teb chaws raug tshem tawm. Txawm li cas los xij, nws tsim nyog nco ntsoov tias kev kho etiotropic tsis yog ib txwm ua tau. Txawm hais tias qhov ua rau muaj kab mob ntshav qab zib tau tshwm sim ib txwm paub, tsis muaj kev kho mob uas tuaj yeem kho cov kab mob uas twb muaj lawm hauv cov noob uas ua rau kev puas tsuaj ntxov ntxov ntawm cov qe ntshav liab.
Kev kho kab mob yog tsom rau ntawm tus kheej txuas ntawm cov txheej txheem uas ua rau muaj qhov tshwm sim ntawm tus kab mob lossis kev puas tsuaj rau tus neeg mob txoj kev noj qab haus huv. Tshwj xeeb, kev kho infusion yuav ua tau, nyob rau hauv uas infusions infusions ntawm saline los yog lwm yam detoxification agents yog siv los pab tshem tawm ntau tshaj bilirubin los ntawm ob lub raum.
Nws kuj pom zoo kom siv cov tshuaj diuretics, saline daws, colloids. Cov tshuaj no pab ntxuav cov ntshav. Txhawm rau rov ua kom lub siab, hepatoprotectors yuav tsum tau siv, uas yog siv los ua ib feem ntawm txoj kev kho mob. los ntawm feem ntauFeem ntau txhais tau tias yog qhov tseem ceeb phospholipids, uas pab txhawb kev rov ua haujlwm ntawm lub cev. Cov kua tsib yog diluted nrog cov tshuaj choleretic, thiab cov vitamins yog qhia kom ntxiv dag zog rau phab ntsa ntawm cov hlab ntsha.
Kev kho mob ntawm daim ntawv suprahepatic ntawm theem pib yuav tsum tau ua hauv tsev kho mob. Nws yog ib qho tseem ceeb uas yuav tsum tau nyob rau hauv kev saib xyuas ntawm tus kws kho mob tas li kom cov kab mob hloov pauv hauv qib bilirubin, nrog rau kev ua haujlwm ntawm lub siab, tuaj yeem tshawb pom raws sijhawm.
Kev cuam tshuam kev phais mob tsis tshua muaj thaum muaj kev puas tsuaj ntawm cov ntaub so ntswg ntau. Rau kev kho mob, lwm txoj hauv kev kuj tuaj yeem siv tau, uas yog pab thiab siv ua ke nrog cov tshuaj ib txwm siv. Qhov nrov tshaj plaws yog cov zaub mov txawv raws li kelp, burdock, sorrel, mis thistle thiab lwm yam tshuaj uas tau npaj los ntawm decoctions. Raws li tus neeg sawv cev choleretic, dandelion cov hauv paus hniav thiab paj, cov kua txiv hmab txiv ntoo tshiab tau siv. Kev siv lwm txoj kev kho yuav tsum tau pom zoo nrog tus kws kho mob.
Dieting
Tus neeg mob jaundice yuav tsum ua raws li tus kws kho mob cov lus pom zoo txog kev noj zaub mov, uas yuav pab tshem tawm lub siab. Tsiaj txhu thiab cov roj refractory yog qhov nyuaj tshaj plaws rau zom. Nws yog nruj me ntsis txwv tsis pub noj ntsim, kib, ntsev, rog, haus luam yeeb. Txhua hom dej cawv raug txwv nruj heev.
Nws yog qhov zoo tshaj yog tias lub hauv paus ntawm kev noj haus yog oatmeal lossisbuckwheat, tsawg-rog ntau hom ntses los yog nqaij, thermally ua zaub, crackers. Nws tseem muaj peev xwm hais tias durum nplej nplej zom, nrog rau cov khoom noj muaj roj tsawg, muaj nyob hauv cov khoom noj. Cov zaub mov yuav tsum muaj ntau cov vitamins thiab minerals. Tsis tas li ntawd, yog tias tsim nyog, tus kws kho mob yuav sau cov tshuaj vitamin complexes.
Nws yog qhov yuav tsum tau ua kom noj zaub mov zoo. Nws raug nquahu kom noj 5-6 zaug hauv ib hnub hauv qhov me me. Cov zaub mov yuav tsum tau chew kom huv si. Kev noj haus kev kho mob occupies ib qho tseem ceeb heev nyob rau hauv kev kho mob ntawm cov kab mob ntawm lub siab thiab biliary ib ntsuj av. Lub hom phiaj tseem ceeb ntawm kev noj haus yog kom txo cov load ntawm daim siab. Nws raug pom zoo kom haus dej ntau ntxiv yog tias tsis muaj contraindications.
Kev kuaj mob tom qab kev kho mob
Kev kuaj mob tom qab kho cov neeg laus yog qhov zoo heev. Yog hais tias tus kab mob no provoked los ntawm intoxication ntawm lub cev, ces tom qab ib tug ua tiav purification ntawm cov ntshav, tag nrho cov uas twb muaj lawm cov cim yuav ploj tam sim ntawd. Nrog autoimmune ua rau mob jaundice subhepatic, kev kho mob nrog glucocorticosteroids muab cov txiaj ntsig zoo heev.
Qhov kev pom zoo tshaj plaws yuav yog yog tias kev kho mob tau pib thaum pib ntawm tus kab mob. Kev rov tshwm sim ntawm jaundice yog ua tau nrog kev txhim kho ntawm cholelithiasis, yog li ib qho ntawm qhov tseem ceeb ntawm kev kho mob yuav yog qhov normalization ntawm cov metabolism. Nws yog ib qho tseem ceeb heev uas yuav tau ua raws li kev noj zaub mov noj thiab tag nrho cov kws kho mob cov tshuaj.
Tom qab tshem tawm qhov tseem ceeb ntawm tus kab mob thiab kho cov khoom noj khoom haus, cov txheej txheem tsim thiab tshem tawm bilirubin los ntawm lub cev tau rov qab los. Nrog txoj cai thiabTxoj kev kho mob txwv tsis pub cov qe ntshav liab tawg thiab nce qib ntawm bilirubin hauv cov ntshav. Yog tias mob daj ntseg tau tshwm sim los ntawm Gilbert's syndrome, ces tsis tas yuav muaj kev kho mob tshwj xeeb, vim nws tsis ua rau muaj kev phom sij rau tib neeg kev noj qab haus huv.
Muaj Teeb Meem
Yog jaundice tshwm sim tom qab 29 lub lim tiam ntawm cev xeeb tub, muaj kev pheej hmoo siab nchuav menyuam lossis tuag hauv plab. Nrog kev pab tsis raws sijhawm, tus menyuam tuag. Yog tias koj pib kho raws sijhawm thiab tsis ua raws li cov lus pom zoo ntawm tus kws kho mob, feem ntau yuav, tus kab mob yuav kov yeej tag nrho thiab yuav tsis tso tseg lwm yam kab mob thiab teeb meem. Yog hais tias tus me nyuam raug kev txom nyem bilirubin encephalopathy, thiab nws tsis tau muab kev pab kho mob, ces qhov tshwm sim tej zaum yuav yog ib feem los yog tag tsis hnov lus, kev loj hlob qeeb, tuag tes tuag taw.
Hauv cov neeg laus, qhov teeb meem ntawm jaundice tuaj yeem ua rau muaj ntau yam kab mob sib txawv, tshwj xeeb xws li:
- pancreatitis;
- sepsis;
- cholangitis;
- cirrhosis ntawm daim siab;
- raum tsis ua haujlwm.
Ntxiv rau, cov teeb meem tuaj yeem cuam tshuam nrog cov kab mob uas ua rau muaj tus kab mob daj ntseg. Cholangitis, tshwj xeeb tshaj yog hom kab mob purulent, feem ntau tshwm sim los ntawm kab mob gallstone.
prophylaxis
Yuav kom txo tau txoj kev pheej hmoo ntawm jaundice, kev tiv thaiv yuav tsum tau ua. Raws li kev tiv thaiv, koj yuav tsum noj tsuas yog cov tshuaj uas tau muab los ntawm koj tus kws kho mob. Nws yog ib qho tsim nyog yuav tsum tau kuaj xyuas yog tias muaj kev hloov ntshavThiab tom qab ntawd, yellowing ntawm daim tawv nqaij tshwm.
Thaum cev xeeb tub, koj yuav tsum ua raws li tag nrho cov kws kho mob cov tshuaj, noj kom zoo thiab tshem tawm cov cwj pwm phem. Yog tias, thaum sau npe, tus poj niam muaj qhov tsis zoo Rh ntshav, ces nws yuav tsum tau suav nrog tam sim ntawd rau hauv pab pawg muaj kev pheej hmoo. Hauv qhov no, kev kuaj mob hauv computer thiab saib xyuas qib ntawm cov tshuaj tiv thaiv kab mob hauv cov ntshav tau ua tiav.
Txoj kev kuaj mob tseem ceeb yog ultrasound, txij li kev pab ntawm cov txheej txheem no tuaj yeem txiav txim siab qhov tuab ntawm cov placenta, qib ntawm nws txoj kev loj hlob, qhov mob ntawm tus po thiab daim siab. Kev txiav txim siab ntawm qhov ua tau ntawm tus menyuam hauv plab hypoxia kuj tseem xav tau. Txhua lub trimester, tus poj niam cev xeeb tub yuav tsum tau kuaj cov tshuaj tiv thaiv. Hauv qhov no, muaj txhua txoj hauv kev los yug tus menyuam noj qab haus huv nrog lub cev tsim tau zoo. Tus me nyuam lub cev yooj yim tiv nrog kev nce hauv bilirubin, thiab cov tsos mob ntawm jaundice yog me me los yog tsis muaj kiag li.
Nyob rau hauv thawj lub lim tiam tom qab yug me nyuam, nws raug nquahu kom teem caij sunbathing rau nws. Hnub ob, koj yuav tsum muab tus menyuam tso rau hauv qhov chaw tshav ntuj rau 10 feeb thiab ua cov txheej txheem zoo sib xws 1-2 zaug hauv ib hnub. Txawm li cas los xij, koj yuav tsum ua txhua yam kom zoo zoo, tiv thaiv koj ob lub qhov muag ntawm lub hnub ci ci, thiab koj cov tawv nqaij los ntawm kev kub hnyiab.
