《黄疸》-09级一系-老年-麻醉-救援-心理-陶小红-12-04-18.ppt

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1、Jaundice(黄疸)DepartmentofGastroenterology,FirstAffiliatedHospitalofChongqingMedicalUniversityXIAOHONGTAO(陶小红)Jaundiceoricterus:Whatisjaundice?ClinicallyitistheyellowdiscolorationoftheSclera(巩膜)SkinMucousmembraneduetodepositionofbilepigment(bilirubin胆红素)Se

2、rumtotalbilirubin(normal1.7-17.1umol/lit)Conjugatedbilirubin:0-3.42μmol/l，Unconjugatedbilirubin:1.7-13.68μmol/l.1.DEFINITION2.BILIRUBINMETABNISMHemeDegradationHEMEBILIVERDINO2Fe+3NADPHNADP+(openstheporphyrinring)BILIRUBINNADPHNADP+BILIRUBINdiglucuronideB

3、ILETheFateofBilirubin…Alb=albuminB=bilirubinGST=glutathione-S-transferaseUDPGA=uridinediphosphoglucuronicacid;CB=conjugatedbilirubinUGT1A1=UDP-glucuronosyltransferase1A1MRP2=Multi-drugResistanceProtein2AdaptedfromHarrison’s15thEd.“PrinciplesofInternalMed

4、icine”,2001.MRP2B+GSTCBPlasmaHepaticCellBileAlbBAlb?:GSTBsERB+UDPGAUGT1A1BilirubinExcretionIntestinesLiverBCBCBBUrobilinogenB-glucoronidasebacteriabacteriaBileEnterohepaticcirculationKidneyUrobilinoxUrobilinogenUrobilinStercobilinStercobilingogenfecesUri

5、neoxLiverAlbuninHemeFerrohemetransferaseBilirubinConjugatedbilirubinKidneyUrobilinStercobilinogenUrobilinogenIntestinesAlbuminBilirubinreductaseHemeGlobinHemoglobinoxidaseBiliverdinMarrowInfantilityErythrocyteFerrohemeEnzyme15%~20%Bilirubin

6、AlbuminErythr

7、ocyte80%~85%UDPUDPGABilirubinglucuronolactoneurobilinogenEnterohepaticcirculationY/ZproteincathepsinErythrocyteBiochemicalchangeofNormalbilirubinmetabolism3.CLASSFICATION1.DependingonEtiologyHemolyticJaundice（溶血性黄疸）HepatocellularJaundice（肝细胞性黄疸）Cholestat

8、icJaundice（胆汁淤积性黄疸）Congenitaljaundice（先天性黄疸）2.DependingonbilirubinUnconjungatedbilirubinincreasedjaundiceConjungatedbilirubinincreasedjaundiceEtiology1.Congenitalhemolyticanemia(thalassemia(海洋性贫血),hereditaryspherocytosis(遗传性球形红细胞增多症)).2.Posteriorityacqui

9、redhemolyticanemia(autoimmunityhemolyticanemia,hemolyticdiseaseofnewborn,posttransfusionhemolytic,Favism(蚕豆病).MechanismAlargenumberoferythrocytedestroyedrapidlyAnemia,hypoxiaandtoxityoferythocytemetabolismproducts3.1.Hemol