Ho se sebetse hantle ha ho kopanya mali le sebete ke karolo ea lefu la sebete 'me ke ntlha ea bohlokoa lintlheng tse ngata tsa ho bolela esale pele. Liphetoho tekanyong ea hemostasis li lebisa ho tsoe mali, 'me mathata a ho tsoa mali esale e le bothata bo boholo ba bongaka. Lisosa tsa ho tsoa mali li ka aroloa ka mokhoa o batlang o lekana ka (1) khatello e phahameng ea mali ea portal, e sa amane le mokhoa oa hemostatic; (2) ho tsoa mali leqebeng la mucosal kapa ho phunya, hangata ka ho qhibiliha pele ho nako ha thrombus kapa fibrinolysis e phahameng, e bitsoang accelerated intravascular coagulation le fibrinolysis lefung la sebete Melt (AICF). Mokhoa oa hyperfibrinolysis ha o hlake, empa o kenyelletsa liphetoho ho kopaneng ha mali le fibrinolysis ka har'a vascular. Ho kopana ho sa tloaelehang ho bonoa ho thrombosis ea methapo ea portal (PVT) le thrombosis ea methapo ea mesenteric, hammoho le thrombosis ea methapo e tebileng (DVT). Maemo ana a bongaka hangata a hloka kalafo kapa thibelo ea thibelo ea ho kopana ha mali le ho ruruha. Microthrombosis sebeteng e bakoang ke hypercoagulability hangata e baka ho putlama ha sebete.
Liphetoho tse ling tsa bohlokoa tseleng ea hemostasis li hlakisitsoe, tse ling li na le tšekamelo ea ho tsoa mali 'me tse ling li na le tšekamelo ea ho hoama (Setšoantšo sa 1). Ho cirrhosis ea sebete e tsitsitseng, tsamaiso e tla leka-lekana hape ka lebaka la mabaka a sa laoleheng hantle, empa tekano ena ha e tsitse 'me e tla angoa haholo ke mabaka a mang, joalo ka boemo ba bophahamo ba mali, tšoaetso ea tsamaiso, le ts'ebetso ea liphio. Thrombocytopenia e ka ba phetoho e atileng haholo ea pathological e bakoang ke hypersplenism le ho fokotseha ha thrombopoietin (TPO). Ho se sebetse hantle ha platelet le hona ho hlalositsoe, empa liphetoho tsena tsa anticoagulant li ile tsa fokotsoa haholo ke keketseho ea von Willebrand factor (vWF) e nkiloeng ho endothelial. Ka mokhoa o ts'oanang, phokotso ea lintlha tsa procoagulant tse nkiloeng ho sebete, joalo ka lintlha tsa V, VII, le X, e lebisa ho nako e telele ea prothrombin, empa sena se fokotsoa haholo ke phokotso ea lintlha tsa anticoagulant tse nkiloeng ho sebete (haholo-holo protheine ea C). Ho phaella moo, endothelial-derived factor VIII e nkiloeng ho endothelial le protheine e tlase ea C li lebisa boemong ba hypercoagulant. Liphetoho tsena, hammoho le ho se tsitse ha methapo le tšenyo ea endothelial (Virchow's triad), li lebisitse ho tsoeleng pele ha PVT le DVT ka linako tse ling ho bakuli ba nang le cirrhosis ea sebete. Ka bokhutšoanyane, litsela tsa hemostatic tsa cirrhosis ea sebete hangata li leka-lekana ka tsela e sa tsitsang, 'me tsoelo-pele ea lefu lena e ka sekamela ka lehlakoreng lefe kapa lefe.
Referense: O'Leary JG, Greenberg CS, Patton HM, Caldwell SH.AGA Ntlafatso ea Tloaelo ea Bongaka: Ho Kopana ha Mafu a Mafu a Mafu a Mafu.Gastroenterology.2019,157(1):34-43.e1.doi:10.1053/j.gastro.2019.03.070.
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