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1、《黄疸》-09级一系-老年-麻醉-救援-心理-陶小红-12-04-18(1)Jaundiceoricterus:Whatisjaundice?ClinicallyitistheyellowdiscolorationoftheSclera(巩膜)SkinMucousmembraneduetodepositionofbilepigment(bilirubin胆红素)Serumtotalbilirubin(normal1.7-17.1umol/lit)Conjugatedbilirubin:0-3.42μmol/l，Unconjuga
2、tedbilirubin:1.7-13.68μmol/l.1.DEFINITION2.BILIRUBINMETABNISMLiverAlbuninHemeFerrohemetransferaseBilirubinConjugatedbilirubinKidneyUrobilinStercobilinogenUrobilinogenIntestinesAlbuminBilirubinreductaseHemeGlobinHemoglobinoxidaseBiliverdinMarrowInfantilityErythrocyteF
3、errohemeEnzyme15%~20%Bilirubin
4、AlbuminErythrocyte80%~85%UDPUDPGABilirubinglucuronolactoneurobilinogenEnterohepaticcirculationY/ZproteincathepsinErythrocyteBiochemicalchangeofNormalbilirubinmetabolism3.CLASSFICATION1.DependingonEtiologyHemolyticJaundice（溶血性黄疸）Hepatoce
5、llularJaundice（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),hereditaryspherocytosis(遗传性球形红细胞增多症)).2
6、.Posteriorityacquiredhemolyticanemia(autoimmunityhemolyticanemia,hemolyticdiseaseofnewborn,posttransfusionhemolytic,Favism(蚕豆病).MechanismAlargenumberoferythrocytedestroyedrapidlyAnemia,hypoxiaandtoxityoferythocytemetabolismproducts3.1.HemolyticJaundiceHemolyticJaundi
7、cemechanismClinicalManifestationMildjaundice,lightlemon,noskinitch(痒).Acutehemolysis:fever,chill,headache,vomit,backache,anemia,hemoglobinuria(血红蛋白尿),acuterenalfailure.Chronichemolysis:anemiaandsplenomegaly(脾大).LaboratoryExamination1.SerumTB↑,UCB↑,CBnormal.2.UCB↑→int
8、estinalCB↑→faecalcolordeepen.3.IntestinalUrobilinogen(尿胆原)↑→urinaryUrobilinogen↑.4.Acutehemolytis,occultbloodtest(+).5.Bloodtest:anemia,reticulocyte(网织红细胞)↑,erythrocyteproliferation↑.3.2.HepatocellularJaundiceEtiologyHepatocytedamage.MechanismImpairhepatocyteuptakein
9、g,conjugatingandexcretingbilirubin,UCB↑CBrefluxintoblood,serumCB↑→jaundice.HepatocellularJaundicemechanismClinicalManifestationSkin
