Ko te ngoikoretanga o te coagulation tetahi waahanga o te mate ate me tetahi take nui i roto i te nuinga o nga tohu tohu.Ko nga huringa i roto i te toenga o te hemostasis ka arahi ki te whakaheke toto, a ko nga raruraru whakaheke toto he raruraru haumanu nui tonu.Ka taea te wehewehea nga take o te toto ki te (1) te takawhita o te tomokanga, kaore he hononga ki te tikanga hemostatic;(2) te mucosal, te werohanga ranei o te marutanga o te toto, i te nuinga o te wa ka memeha wawe te thrombus, te fibrinolysis teitei ranei, e kiia nei ko te tere o te whakakoi toto me te fibrinolysis i te mate ate Melt (AICF).Kaore i te maarama te tikanga o te hyperfibrinolysis, engari ka uru ki nga huringa o te coagulation intravascular me te fibrinolysis.Ka kitea te paheketanga ohorere i roto i te thrombosis vein portal (PVT) me te thrombosis vein mesenteric, me te thrombosis vein hohonu (DVT).Ko enei ahuatanga haumanu e hiahia ana ki te maimoatanga anticoagulation, te aukati ranei.Ko te Microthrombosis i roto i te ate na te hypercoagulability he maha nga wa ka paheke te ate.
Ko etahi o nga huringa matua o te ara hemostasis kua whakamaramatia, ko etahi ka whakaheke toto, ko etahi ka pupuhi (Whakaahua 1).I roto i te cirrhosis ate pumau, ka whakatauritehia te punaha na te mea kua kore te whakarite, engari he koretake tenei toenga, ka tino pa ki etahi atu mea, penei i te mana o te toto, te mate o te punaha, me te mahi whatukuhu.Ko te thrombocytopenia pea te huringa pathological tino noa na te hypersplenism me te heke o te thrombopoietin (TPO).Kua korerohia ano te paheketanga o te platelet, engari ko enei huringa anticoagulant i tino whakahekehia e te pikinga o te take von Willebrand (vWF) i ahu mai i te endothelial.Waihoki, ko te whakahekenga o nga huanga procoagulant i ahu mai i te ate, penei i nga mea V, VII, me X, ka arahi ki te wa prothrombin roa, engari ka tino paheketia tenei e te hekenga o nga huanga anticoagulant i ahu mai i te ate (ina koa ko te pūmua C).I tua atu, ko te teitei o te endothelial-i takea VIII me te iti o te pūmua C ka arahi ki te ahua hypercoagulable.Ko enei huringa, i honoa atu me te tatai o te venous me te kino endothelial (Virchow's triad), i arahi ki te ahu whakamua o te PVT me te DVT i etahi wa i roto i nga turoro me te cirrhosis ate.I te poto, ko nga huarahi hemostatic o te cirrhosis ate he maha tonu te whakatikatika i roto i te ahua kore, a ka taea te haere o te mate ki tetahi huarahi.
Tohutoro:O'Leary JG, Greenberg CS, Patton HM, Caldwell SH.AGA Whakahoutanga Mahi Haumanu: Coagulation inCirrhosis.Gastroenterology.2019,157(1):34-43.e1.doi:10.1053/j.gastro.2019.03.070 .
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