黄疸》-09级一系-老年-麻醉-救援-心理-陶小红

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1、Jaundice(黄疸)DepartmentofGastroenterology,FirstAffiliatedHospitalofChongqingMedicalUniversityXIAOHONGTAO(陶小红)Jaundiceoricterus:Whatisjaundice?ClinicallyitistheyellowdiscolorationoftheSclera(巩膜)SkinMucousmembraneduetodepositionofbilepigment(bilirubin胆红素)Serumtotalbilirubin(normal1.7-17.1umo

2、l/lit)Conjugatedbilirubin:0-3.42μmol/l，Unconjugatedbilirubin:1.7-13.68μmol/l.1.DEFINITION2.BILIRUBINMETABNISMHemeDegradationHEMEBILIVERDINO2Fe+3NADPHNADP+(openstheporphyrinring)BILIRUBINNADPHNADP+BILIRUBINdiglucuronideBILETheFateofBilirubin…Alb=albuminB=bilirubinGST=glutathione-S-transfer

3、aseUDPGA=uridinediphosphoglucuronicacid;CB=conjugatedbilirubinUGT1A1=UDP-glucuronosyltransferase1A1MRP2=Multi-drugResistanceProtein2AdaptedfromHarrison’s15thEd.“PrinciplesofInternalMedicine”,2001.MRP2B+GSTCBPlasmaHepaticCellBileAlbBAlb?:GSTBsERB+UDPGAUGT1A1BilirubinExcretionIntestinesLive

4、rBCBCBBUrobilinogenB-glucoronidasebacteriabacteriaBileEnterohepaticcirculationKidneyUrobilinoxUrobilinogenUrobilinStercobilinStercobilingogenfecesUrineoxLiverAlbuninHemeFerrohemetransferaseBilirubinConjugatedbilirubinKidneyUrobilinStercobilinogenUrobilinogenIntestinesAlbuminBilirubinreduc

5、taseHemeGlobinHemoglobinoxidaseBiliverdinMarrowInfantilityErythrocyteFerrohemeEnzyme15%~20%Bilirubin

6、AlbuminErythrocyte80%~85%UDPUDPGABilirubinglucuronolactoneurobilinogenEnterohepaticcirculationY/ZproteincathepsinErythrocyteBiochemicalchangeofNormalbilirubinmetabolism3.CLASSFICATION1.Dep

7、endingonEtiologyHemolyticJaundice（溶血性黄疸）HepatocellularJaundice（肝细胞性黄疸）CholestaticJaundice（胆汁淤积性黄疸）Congenitaljaundice（先天性黄疸）2.DependingonbilirubinUnconjungatedbilirubinincreasedjaundiceConjungatedbilirubinincreasedjaundiceEtiology1.Congenitalhemolyticanemia(thalassemia(海洋性贫血),hereditarysph

8、erocytosis(遗传性球形红细胞增多症)).2.Posteriorityacquiredhemolyticanemia(autoimmunityhemolyticanemia,hemolyticdiseaseofnewborn,posttransfusionhemolytic,Favism(蚕豆病).MechanismAlargenumberoferythrocytedestroyedrapidlyAnemia,hypoxiaandtoxityoferythocytemetabolismproducts3.1.Hemol