Kulephera kugwira ntchito bwino kwa magazi m'chiwindi ndi gawo lalikulu la matenda a chiwindi ndipo ndi chinthu chofunikira kwambiri pa ziwerengero zambiri zamtsogolo. Kusintha kwa kuchuluka kwa magazi m'chiwindi kumabweretsa kutuluka magazi, ndipo mavuto otuluka magazi nthawi zonse akhala vuto lalikulu lachipatala. Zomwe zimayambitsa kutuluka magazi zitha kugawidwa m'magulu awiri: (1) kuthamanga kwa magazi m'chiwindi, komwe sikukhudzana ndi njira yolumikizira magazi m'chiwindi; (2) kutuluka magazi m'chilonda cha mucous kapena puncture, nthawi zambiri ndi kusungunuka msanga kwa magazi m'chiwindi kapena fibrinolysis yambiri, yomwe imatchedwa accelerated intravascular coagulation ndi fibrinolysis mu matenda a chiwindi Melt (AICF). Njira ya hyperfibrinolysis si yomveka bwino, koma imaphatikizapo kusintha kwa magazi m'chiwindi ndi fibrinolysis. Kutseka magazi kosazolowereka kumawoneka mu portal vein thrombosis (PVT) ndi mesenteric vein thrombosis, komanso deep vein thrombosis (DVT). Matendawa nthawi zambiri amafunikira chithandizo kapena kupewa kutseka magazi m'chiwindi. Kutsekeka kwa magazi m'chiwindi komwe kumachitika chifukwa cha kuchuluka kwa magazi m'chiwindi nthawi zambiri kumayambitsa kufooka kwa chiwindi.
Kusintha kwakukulu kwa njira yochotsera magazi m'magazi kwafotokozedwa momveka bwino, kwina kumayamba kutuluka magazi ndipo kwina kumaundana (Chithunzi 1). Mu matenda a chiwindi okhazikika, dongosolo lidzasinthidwanso chifukwa cha zinthu zosakhazikika, koma kukhazikika kumeneku sikukhazikika ndipo kudzakhudzidwa kwambiri ndi zinthu zina, monga kuchuluka kwa magazi, matenda amthupi, ndi ntchito ya impso. Kutupa kwa magazi m'magazi kungakhale kusintha kofala kwambiri chifukwa cha hypersplenism ndi kuchepa kwa thrombopoietin (TPO). Kusagwira ntchito bwino kwa ma platelet kwafotokozedwanso, koma kusintha kumeneku kwa anticoagulant kunachepetsedwa kwambiri ndi kuwonjezeka kwa endothelial-derived von Willebrand factor (vWF). Mofananamo, kuchepa kwa zinthu zomwe zimachokera ku chiwindi, monga zinthu V, VII, ndi X, kumabweretsa nthawi yayitali ya prothrombin, koma izi zimachepetsedwa kwambiri ndi kuchepa kwa zinthu zomwe zimachokera ku chiwindi (makamaka mapuloteni C). Kuphatikiza apo, kuchuluka kwa endothelial-derived factor VIII ndi mapuloteni otsika C kumabweretsa mkhalidwe wovuta kwambiri wa hypercoagulant. Kusintha kumeneku, pamodzi ndi kukhazikika kwa mitsempha yamagazi ndi kuwonongeka kwa endothelial (Virchow's triad), kunapangitsa kuti PVT ipitirire limodzi komanso nthawi zina DVT ichitike mwa odwala omwe ali ndi matenda a chiwindi. Mwachidule, njira zoyendetsera magazi m'chiwindi nthawi zambiri zimakhala zokhazikika, ndipo kupita patsogolo kwa matendawa kumatha kupendekeka mbali iliyonse.
Buku Lothandizira: O'Leary JG, Greenberg CS, Patton HM, Caldwell SH.AGA Zosintha Zachipatala: Coagulation inCirrhosis.Gastroenterology.2019,157(1):34-43.e1.doi:10.1053/j.gastro.2019.03.070.
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