Kusashanda zvakanaka kweropa muropa ndicho chikamu chechirwere chechiropa uye chinhu chikuru muhuwandu hwezviratidzo zvekufanotaura. Kuchinja kwehuwandu hweropa muropa kunotungamira mukubuda ropa, uye matambudziko ekubuda ropa agara ari dambudziko guru rekurapa. Zvikonzero zvekubuda ropa zvinogona kukamurwa kuita (1) portal hypertension, iyo isina chekuita ne hemostatic mechanism; (2) mucosal kana puncture wound bleeding, kazhinji nekunyungudika kwe thrombus nguva isati yakwana kana high fibrinolysis, iyo inonzi accelerated intravascular coagulation uye fibrinolysis mu liver disease Melt (AICF). Maitiro e hyperfibrinolysis haana kujeka, asi anosanganisira shanduko mu intravascular coagulation uye fibrinolysis. Abnormal coagulation inoonekwa mu portal vein thrombosis (PVT) uye mesenteric vein thrombosis, pamwe ne deep vein thrombosis (DVT). Aya mamiriro ekurapa anowanzoda kurapwa kana kudzivirira anticoagulation. Microthrombosis muchiropa inokonzerwa ne hypercoagulability inowanzo kukonzera liver atrophy.
Dzimwe shanduko huru munzira ye hemostasis dzakajekeswa, dzimwe dzinowanzo buda ropa uye dzimwe dzinowanzo vhara (Mufananidzo 1). Muchirwere chechiropa chakagadzikana, hurongwa huchagadziriswazve nekuda kwezvinhu zvisina kurongeka, asi chiyero ichi hachina kugadzikana uye chichakanganiswa zvakanyanya nezvimwe zvinhu, zvakaita sehuwandu hweropa, hutachiona hwemuviri, uye mashandiro eitsvo. Thrombocytopenia inogona kunge iri shanduko inonyanya kuitika nekuda kwe hypersplenism uye kudzikira kwe thrombopoietin (TPO). Kusashanda zvakanaka kwemaplatelet kwakatsanangurwawo, asi shanduko idzi dze anticoagulant dzakaderedzwa zvakanyanya nekuwedzera kwe endothelial-derived von Willebrand factor (vWF). Saizvozvowo, kudzikira kwe procoagulant factors dzinobva muchiropa, dzakadai se factors V, VII, uye X, kunotungamira kune prothrombin time yakareba, asi izvi zvinoderedzwa zvakanyanya nekudzikira kwe anticoagulant factors dzinobva muchiropa (kunyanya protein C). Pamusoro pezvo, endothelial-derived factor VIII yakakwira uye protein C yakaderera zvinotungamira kune hypercoagulable state. Kuchinja uku, pamwe chete nekusagadzikana kwetsinga uye kukuvara kwe endothelial (Virchow's triad), kwakaita kuti PVT ienderere mberi pamwe chete uye dzimwe nguva DVT ivepo muvarwere vane cirrhosis yechiropa. Muchidimbu, nzira dze hemostatic dze cirrhosis yechiropa dzinowanzo gadziriswa nenzira isina kugadzikana, uye kufambira mberi kwechirwere kunogona kutsauswa kune chero divi.
Referensi: O'Leary JG, Greenberg CS, Patton HM, Caldwell SH.AGA Kuvandudzwa kweKushanda Kwekiriniki: Kuvhara Mutsinga muCirrhosis.Gastroenterology.2019,157(1):34-43.e1.doi:10.1053/j.gastro.2019.03.070.
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