Hnub no muaj ntau yam kab mob uas tib neeg tsis ntsib ntau zaus. Txawm li cas los xij, koj tseem yuav tsum paub txog lawv tsawg kawg me ntsis. Tom qab tag nrho, nyob rau hauv txoj kev no, piv txwv li, nws muaj peev xwm tiv thaiv tau qhov tshwm sim ntawm cov teeb meem zoo li no. Tias yog vim li cas tam sim no kuv xav tham kom meej txog cov kab mob xws li parenchymal jaundice.
Terminology
Ua ntej yuav tiv thaiv tus kab mob nws tus kheej, nws yog ib qho tsim nyog los txheeb xyuas cov ntsiab lus uas yuav siv tau rau hauv kab lus no. Yog li, parenchymal jaundice yog ib yam kab mob, los yog ntau, tshwj xeeb cov tsos mob complex, uas yog yus muaj los ntawm staining nyob rau hauv icteric xim tsis tau tsuas yog ntawm daim tawv nqaij, tab sis kuj ntawm mucous daim nyias nyias (sclera ntawm lub qhov muag). Tag nrho cov no tshwm sim vim qhov tseeb tias bilirubin (ib cov kua tsib xim) maj mam pib sau rau hauv tus neeg mob lub cev. Nws tseem ceeb heev uas yuav tsum nco ntsoov tias cov tsos mob no qhia tau hais tias tus neeg mob muaj teeb meem daim siab uas yuav tsum tau kho sai li sai tau.
Nws yog qhov nthuav tias hauv cov tshuaj kuj muaj lub tswv yim ntawm qhov tsis tseeb jaundice. ATNyob rau hauv cov ntaub ntawv no, nws tsis yog bilirubin uas accumulates nyob rau hauv tib neeg lub cev, tab sis carotene, ib tug natural khoom vim hais tias ntawm daim tawv nqaij xim tshwm sim. Yog li, qhov no tuaj yeem tshwm sim yog tias koj noj carrots, taub dag, txiv kab ntxwv, thiab beets ntau dhau thiab ntau heev. Ib qho teeb meem zoo sib xws tuaj yeem tshwm sim yog tias koj noj picric acid ntev, nrog rau qee yam tshuaj.
daim duab kho mob
Cov kab mob zoo li parenchymal jaundice ua li cas? Lub pathogenesis ntawm tus kab mob yog raws li nram no. Yog li, thawj zaug nws yuav tsum tau muab sau tseg tias thaum lub sij hawm ib txwm ua hauj lwm, bilirubin, ib tug kua tsib xim, yog tawm los ntawm lub cev lawm. Yog tias muaj qee yam teeb meem hauv daim siab, nws pib maj mam nce hauv lub cev, qhia qhov no los ntawm yellowing ntawm daim tawv nqaij, nrog rau cov mucous membranes. Saib los ntawm cov ntaub ntawv hais txog dab tsi parenchymal jaundice yog, nws tseem ceeb heev uas yuav tau hais tias qhov teeb meem no muaj peb theem tseem ceeb ntawm kev loj hlob.
- thawj theem. Hauv qhov no, muaj qhov txo qis hauv kev ua haujlwm enzyme, hepatocyte daim nyias nyias raug puas ntsoog, ncaj qha bilirubin tsis raug tsim tawm ib txwm.
- Nyob rau theem thib ob ntawm tus kab mob, cov neeg mob muaj teeb meem xws li hyperfermentation, permeability ntawm hepatocyte daim nyias nyias nce. Mob nyob rau sab tshwm sim vim yog nyem ntawm cov capillaries.
- Nyob rau theem thib peb, muaj kev ua txhaum ntawm cov txheej txheem ntawm bilirubin glucuronization, daim siab tsis ua haujlwm tshwm sim. Tsis tas li ntawd, cov zis dhau los ua qhov sib sib zog nqus, mob tas li nyob rau sab.
Nws tsim nyog sau cia tias nws tseem ceeb heev uas yuav tsum pib tawm tsam parenchymal jaundice ntawm thawj theem ntawm qhov pib ntawm tus kab mob. Tom qab tag nrho, nyob rau hauv cov ntaub ntawv no, kev daws teeb meem yuav ua tau yooj yim dua thiab sai dua. Yog tias koj "txiav" qhov pib ntawm cov txheej txheem rov qab mus rau theem thib peb, ces nws yuav nyuaj heev kom rov zoo los ntawm tus kab mob no.
Cas ntawm teeb meem
Vim li cas parenchymal jaundice tshwm sim, dab tsi yog qhov ua rau nws tshwm sim?
- Ua ntej tshaj plaws, nws yuav tsum raug sau tseg tias qhov teeb meem tseem ceeb hauv qhov no yog cov kab mob sib kis: cov no yog cov kab mob, kab mob, co toxins. Feem ntau, qhov no, peb tab tom tham txog kab mob xws li malaria, syphilis, toxoplasmosis, thiab lwm yam.
- Kev swb ntawm hepatocides nrog tshuaj lom, ob qho tib si organic thiab inorganic. Cov tshuaj lom ntawm lub cev tuaj yeem tshwm sim vim yog siv cov nceb tshuaj lom, cawv tsis zoo, tom qab noj arsenic lossis ib tus nab tom.
- Kev siv qee yam tshuaj uas muaj cov nyhuv hepatotoxic tuaj yeem ua rau muaj teeb meem no. Hauv qhov no, feem ntau peb tab tom tham txog cov tshuaj xws li Paracetamol lossis tshuaj tua kab mob.
Xav txog qhov ua rau parenchymal jaundice, nws kuj yuav tsum tau hais tias tus kab mob no kuj muaj qhov cuam tshuam los ntawm keeb kwm. Qhov ntawd yog, nws tuaj yeem kis tau los ntawm poj niam txiv neej los ntawm ib tus neeg hauv tsev neeg mus rau lwm tus.
- Tej zaum yuav tsis muaj ligandin tshwj xeeb cov proteins uas nyob raulub siab.
- Yog vim li cas tej zaum yuav yog ib qho kev tsis txaus ntawm cov enzyme tshwj xeeb hu ua UDP-glucuronyltransferase.
- Wilson-Konovalov tus kab mob kuj yog los ntawm keeb kwm, thaum tooj liab sib sau hauv hepatocytes, vim yog qhov tsis xws ntawm caj ces, lub luag haujlwm ntawm lub cev no cuam tshuam.
Cov tsos mob tseem ceeb
Xav txog tus kab mob xws li parenchymal jaundice, cov tsos mob - yog qhov yuav tsum tau qhia. Yog li, dab tsi tshwm sim ntawm tus kab mob no?
- Ua ntej ntawm tag nrho cov, qhov teeb meem no tshwm sim los ntawm yellowing ntawm daim tawv nqaij, nrog rau cov mucous daim nyias nyias, feem ntau cov sclera ntawm lub qhov muag.
- Tus neeg mob kuj yuav khaus me ntsis.
- mob taub hau, kub taub hau, migraine.
- Cov neeg mob feem ntau yws yws ntawm qhov tsis qab los ua rau poob phaus.
- Tseem muaj mob nqaij thiab tsis muaj zog.
Tus nqi ntsuas kuj hloov pauv.
- Feces dhau los ua lub teeb, xim me ntsis. Qhov no yog vim qhov poob ntawm stercobilin, lwm cov kua tsib xim.
- zis kuj hloov xim. tuaj yeem yog lub teeb dhau los lossis tsaus dhau.
- Nyob rau hauv cov ntshav ntawm cov neeg mob, cov ntsiab lus ntawm ncaj qha thiab tsis ncaj bilirubin nce.
Diagnosis
Koj tuaj yeem nkag siab li cas tias ib tus neeg muaj tus kab mob parenchymal jaundice? Diagnostics - yog dab tsi yuav qhia rau koj txog lub hav zoovtus kab mob no. Rau qhov no koj xav tau:
- Ua ib qho kev soj ntsuam dav dav ntawm cov zis, quav, thiab ntshav.
- Kev soj ntsuam ntawm daim duab kho mob tag nrho.
- kuaj ntshav biochemical.
- Kev ntsuas ntsuas qee yam yuav raug txiav txim.
kuaj mob
Yog tias tus neeg mob tau kuaj cov quav thiab zis, ces qhov no, nrog tus kab mob no, qib ntawm bilirubin thiab urobilin nce ntau, thiab tus nqi ntawm stercobilin ntog, uas ua rau muaj xim tsis muaj zog ntawm tib neeg excrement.
Koj tseem yuav tau kuaj ntshav. Hauv qhov no, leukocytosis thiab anemia tuaj yeem tshwm sim. Yog tias tus neeg mob muaj parenchymal jaundice, ntshav biochemistry tseem ceeb heev. Ntawm no, cov cim qhia ntawm kev khi thiab tsis muaj kev cuam tshuam bilirubin thiab urobilin yuav nce ntxiv.
Qee zaum, tus neeg mob yuav raug sau rau lwm yam kev tshawb fawb ntxiv. Nws tuaj yeem yog:
- Kev txiav txim siab qib ntawm folic acid thiab vitamin B12 hauv cov ntshav.
- Kev txiav txim siab ntawm cov qog nqaij hlav.
- Coprogram: tsom xam rau cov kab mob parasites thiab helminths.
Instrumental Study
Tus kws tshaj lij uas paub txog tuaj yeem paub qhov txawv ntawm parenchymal jaundice syndrome los ntawm tus kab mob tag nrho yam tsis muaj teeb meem. Txawm li cas los xij, qee zaum, txawm tias cov luminaries uas muaj txiaj ntsig zoo tshaj plaws ntawm cov tshuaj xav tau kev tshawb fawb ntxiv kom paub meej tias qhov kev kuaj mob. Hauv qhov no, tus neeg mob yuav raug xaiv:
- X-ray. Txhawm rau txheeb xyuas cov teeb meem nrog lub plab, txoj hlab pas thiab txoj hnyuv.
- Cholecystography. Qhov no yog qhov tsim nyog kom nkag siab yog tias muaj pob zeb hauv lub gallbladder.
- Ultrasound tuaj yeem muab cov ntaub ntawv hais txog lub xeev ntawm lub siab thiab lwm yam kabmob tseem ceeb.
- CT lossis MRI.
Nws tsis tshua muaj rau cov neeg mob uas muaj daim siab biopsy.
Kev kho mob
Nws yuav tsum tau muab sau tseg tias cov kab mob no muaj ntau txoj hauv kev kom tshem tau nws. Nws tag nrho yog nyob ntawm qhov kev tsis saib xyuas ntawm tus kab mob hauv qab. Feem ntau, cov kws kho mob sau cov tshuaj uas tshem tawm cov bilirubin ntau dhau ntawm lub cev. Txawm li cas los xij, tshuaj tsis tas yuav pab tau. Hauv qhov no, cov kws kho mob yuav sau cov txheej txheem xws li phototherapy. Thiab tag nrho vim hais tias ultraviolet muaj peev xwm sai sai zom bilirubin molecules thiab pab kom tshem tawm sai li sai tau. Nrog rau tus kab mob no, nws tseem ceeb heev kom noj cov vitamins complex, thiab tshwj xeeb tshaj yog B thiab C, lipoic acid thiab amino acids.
Kev Tiv Thaiv thiab Teebmeem
Vim tias parenchymal jaundice yog cov tsos mob tshwm sim tawm tsam keeb kwm ntawm lwm yam kab mob (tus kab mob siab B thiab C, zais zis pob zeb, thiab lwm yam), nws yog ib qho tseem ceeb heev uas yuav tau pib tshem tawm cov kab mob hauv lub sijhawm. Tom qab tag nrho, peb yuav tsum nco ntsoov tias yog tias tus neeg mob tsis tau txais kev pab hauv lub sijhawm, qhov no tuaj yeem ua rau muaj qee yam teeb meem. Namely: tus neeg mob tuaj yeem cuam tshuam kev ua haujlwm ntawm lub siab thiab lub gallbladder. Nyob rau tib lub sijhawm, kev nce siab ntawm bilirubin ua rau qaug zog ntawm lub cev, uas muaj kev cuam tshuam tsis zoo rau kev ua haujlwm ntawm tag nrho nws lub cev thiab lub cev.
