Kev puas tsuaj rau lub siab yog nkag siab tias yog cov qauv kev hloov pauv hauv cov ntaub so ntswg (rov qab thiab hloov tsis tau) raws li kev cuam tshuam ntawm cov tshuaj phem. Tus lej ICD 10 rau tus kab mob toxic yog K71.
Etiology
Qhov ua rau mob siab mob siab yog: tshuaj, cawv, tsev neeg, zaub thiab tshuaj lom.
- Tshuaj mob lub siab puas tsuaj. Cov tsos mob tuaj yeem tshwm sim nrog ib koob tshuaj loj lossis siv sijhawm ntev ntawm cov tshuaj me me ntawm qee cov tshuaj. Piv txwv li, thaum siv Tetracycline, Paracetamol. Qee cov tshuaj muaj peev xwm inhibit hepatocyte enzymes. Cov no yog, piv txwv li: "Erythromycin", "Rifampicin", "Clarithromycin", cawv, haus luam yeeb, tshuaj tua kab mob thiab tshuaj tua kab mob, penicillins. Tsis tas li ntawd, cov tshuaj tiv thaiv kab mob no muaj cov tshuaj lom: "Oxacillin", "Flucloxacillin", "Amoxicillin", "Clavulonate"("Amoxiclav"), sulfonamides, "Co-trimaxazole", "Sulfosalazine", "Nifurantoin", "Isoniaid", "Tubazid", "Ftivazid", anticonvulsants. Txoj cai dav dav rau ICD 10 rau tshuaj lom kab mob siab ntawm tshuaj genesis yog K71. Tsis tas li ntawd, nws raug xaiv nyob ntawm qhov hloov pauv ntawm lub cev.
- Cawv, tshuaj. Txoj cai dav dav rau ICD 10 rau tshuaj lom kab mob siab ntawm cawv yog K70.
- Industrial tshuaj lom. Cov tshuaj tua kab, arsenic, phosphorus, tshuaj tua kab, phenols, aldehydes, chlorinated hydrocarbons, thiab lwm yam.
- Nroj tshuaj lom. Gorchak, ragwort, fungus lom, thiab lwm yam. Qhov dav dav ICD 10 code rau kab mob siab mob siab tshwm sim los ntawm cov tshuaj lom lossis zaub tshuaj lom kuj yog K71.
Pathogenesis
Ib yam ntawm lub siab ua haujlwm yog qhov thaiv. Nws neutralizes tshuaj lom mus rau hauv ib qho inactive daim ntawv.
- Thaum cov tshuaj hepatotoxic nkag mus rau hauv lub cev, cov tshuaj metabolites nquag tsim nyob rau hauv daim siab, uas tuaj yeem ua rau muaj kev cuam tshuam ncaj qha rau ntawm tes lossis lub cev tiv thaiv kab mob (txiav txim siab los ntawm cov txheej txheem ntawm hypersensitivity). Ob leeg ntawm cov txheej txheem no ua rau cytolysis, necrosis ntawm hepatocyte. Kab mob siab mob siab los yog mob ntev.
- Tsis tas li, cov tshuaj thiab lawv cov metabolites tuaj yeem txo qis mitochondrial oxidation hauv cell thiab hloov cov metabolism hauv nws mus rau txoj hauv kev anaerobic. Kev sib xyaw ntawm cov lipoproteins tsawg ntom ntom yog cuam tshuam, thiab triglycerides khaws cia hauv hepatocyte. Tus neeg mob tsim fatty degenerationdaim siab. Ib tug loj tus naj npawb ntawm fatty inclusions nyob rau hauv lub cell ua rau nws steatonecrosis.
- Kev ua haujlwm ntawm cov enzymes thiab thauj cov proteins hauv lub cell kuj tuaj yeem cuam tshuam yam tsis muaj kev puas tsuaj rau hepatocyte nws tus kheej, hyperbilirubinemia thiab nce hauv gamma-glutamyl transferase tshwm sim. Lwm yam kev kuaj lub siab ua haujlwm tsis hloov.
- Thaiv kev thauj cov enzymes, kev puas tsuaj rau hepatocytes ua rau cholestasis, impaired synthesis lossis thauj cov kua tsib. Cov kua tsib yog tsim nyob rau hauv hepatocyte los ntawm cov kua tsib acids, bilirubin, thiab cov cholesterol. Tom qab ntawd nws nkag mus rau hauv cov kua tsib. Intrahepatic cholestasis yog intralobular thiab extralobular. Tseem muaj extrahepatic cholestasis, uas tshwm sim los ntawm kev cuam tshuam ntawm cov kua tsib nyob rau hauv cov kab mob extrahepatic bile ducts.
Yog li, cov tshuaj lom tuaj yeem ua rau mob siab rau lub siab nrog kev tuag loj ntawm hepatocytes thiab ntev - nrog rov qab noj me me ntawm cov tshuaj lom.
- Nrog necrosis ntawm hepatocytes yam tsis muaj qhov tshwm sim ntawm cov txheej txheem autoimmune thiab cholestasis, AST, ALT yuav nce ntxiv.
- Yog tias hepatocellular cholestasis koom nrog, ces muaj qhov nce mus rau 2 tus qauv ntawm alkaline phosphatase, ALT, AST, GGTP.
- Nyob rau hauv ductular cholestasis nrog cell necrosis, daim duab zoo ib yam, tab sis ALP nce ntau dua 2 tus qauv.
- Nyob rau hauv cov txheej txheem autoimmune, nce hauv immunoglobulins ntau dua 1.5 npaug ntxiv.
Clinic
Yog tias lub siab mob toxicity tshwm sim, cov tsos mob tuaj yeem tshwm sim ob qho tib si thiab maj mam (hloov ntev). Tus neeg mob yws ntawm qhov mob thiab hnyav nyob rau hauv txoj cai hypochondrium, xeev siab, tsis muajqab los noj mov, tsis muaj zog. Tej zaum yuav khaus ntawm daim tawv nqaij, cov quav xoob, los ntshav. Tus neeg mob yog retarded. Thaum kuaj xyuas, daim tawv nqaij thiab sclera yog icteric. Nrog cholestasis, xim ntawm cov zis darkens, cov quav ua lub teeb. Muaj qhov loj ntawm daim siab thiab tus po. Ua tau ascites, kub taub hau. Cov tsos mob ntawm tus kab mob siab thiab kev kho mob yog nyob ntawm qhov kev ua ntawm cov txheej txheem inflammatory.
Diagnosis
Yog xav tias muaj kab mob siab mob siab, qhov kev kuaj mob yog tsim los ntawm kev soj ntsuam, tshuaj anamnestic, kuaj, thiab cov ntaub ntawv ntsuas. Kev kuaj ntshav thiab zis dav dav, kev tshuaj xyuas biochemical tau sau tseg: kuaj lub siab, qib protein, coagulation system, lipidogram raug kuaj. Kev tshuaj xyuas rau immunoglobulins, ultrasound ntawm lub plab hnyuv plab, endoscopy, MRI, daim siab biopsy kuj tau sau tseg.
Kev kho mob
Cov tshuaj tseem ceeb siv los kho daim siab puas muaj xws li:
- Ursodeoxycholic acid UDCA ("Ursofalk", "Ursosan", "Ursodez"). Nws txo cov cholestasis (cov kua tsib stasis), txhim kho cov kua tsib kua qaub, muaj cov kab mob ua kom ruaj khov (tiv thaiv phab ntsa ntawm tes los ntawm kev raug co toxins), nrog rau hepatoprotective, immunomodulatory, anti-inflammatory (prednisolone-zoo li), hypocholesterolemic., anti-apoptotic (txo qis kev laus ntawm hepatocytes), litholytic (dissols cov roj cholesterol). nrog cholelithiasis), antifibrotic (slows down the progress of cirrhosis, tiv thaiv nws tshwm sim), cardioprotective, tsub kom insulin rhiab heev, txhim kho metabolism.lipids thiab qabzib nyob rau hauv daim siab, ua raws li vasodilator.
- Qhov tseem ceeb phospholipids ("Essentiale") rov ua kom muaj kev ncaj ncees ntawm cov cell membranes, muaj cov nyhuv antifibrotic.
- S-ademeteonin ("Heptral") nce cov tshuaj hauv cov cell uas tawm tsam co toxins, txo cholestasis thiab lipid peroxidation.
- Npaj "Alpha" lipoic acid ("Berlition", "Thioctacid") tawm tsam kev loj hlob ntawm daim siab steatosis.
- Artichoke npaj muaj cov nyhuv choleretic.
- Silymarin npaj ("Karsil", "Legalon") muaj cov nyhuv antifibrotic ncaj qha.
Kev ua haujlwm algorithm
Yog li cas yog tus kab mob siab mob siab? Cov tsos mob thiab kev kho mob yog dab tsi? Cia peb ntxiv qee qhov kev qhia meej. Raws li cov kws kho mob pom zoo rau cov kab mob siab, yog tias GGTP, alkaline phosphatase nce siab (muaj cholestasis), thiab AST thiab ALT yog qhov qub lossis nce tsis siab tshaj ob qhov kev cai, ces UDCA raug tshuaj ntawm koob tshuaj 15 mg ib kg (750 - 1000 mg ib hnub rau ob koob) rau peb lub hlis lossis ntau dua. Yog tias ntau tshaj ob qhov kev cai (3 - 5), ces "Heptral" yog ntxiv rau hauv cov hlab ntsha ntawm 400 - 800 mg ib hnub rau 10 - 15 hnub.
Nrog rau qib ib txwm muaj alkaline phosphatase (tsis muaj cholestasis) thiab nce hauv ALT thiab AST mus txog 5 tus qauv, UDCA 10 mg ib kg yog sau. Teem sijhawm 2-3 lub hlis "Essentiale", "Berlition" nyob ntawm seb qhov ua rau tus kab mob.
YYog AST, ALT, bilirubin ntau duantau dua 5 cov qauv, tom qab ntawd ntxiv glucocorticoids. "Prednisolone" yog txhaj tshuaj intravenously txog 300 mg ib hnub twg mus txog 5 hnub, nrog rau kev hloov mus rau cov ntsiav tshuaj thiab maj mam txo cov koob tshuaj. UDCA thiab "Geptral" raug sau tseg raws li lub tswv yim saum toj no (qhov twg alkaline phosphatase nce). Ntxiv rau cov vitamins B1, B12, B6, PP yog xav tau.
