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ID:38318594
大小:1.62 MB
页数:36页
时间:2019-06-10
《黄疸》-09级一系-老年-麻醉-救援-心理-陶小红》由会员上传分享,免费在线阅读,更多相关内容在教育资源-天天文库。
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
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