Ukungasebenzi kakuhle kwe-coagulation yinxalenye yesifo sesibindi kwaye yinto ephambili kumanqaku amaninzi okuxela kwangaphambili. Utshintsho kwibhalansi ye-hemostasis lukhokelela ekuphumeni kwegazi, kwaye iingxaki zokopha bezisoloko ziyingxaki enkulu yezonyango. Izizathu zokopha zingahlulwahlulwa zibe (1) i-portal hypertension, engenanto yakwenza nendlela yokwenza i-hemostatic; (2) ukopha kwenxeba kwi-mucosal okanye kwi-puncture, rhoqo ngokunyibilika kwe-thrombus ngaphambi kwexesha okanye i-fibrinolysis ephezulu, ebizwa ngokuba yi-accelerated intravascular coagulation kunye ne-fibrinolysis kwisifo sesibindi I-Melt (AICF). Indlela yokwenza i-hyperfibrinolysis ayicacanga, kodwa ibandakanya utshintsho kwi-intravascular coagulation kunye ne-fibrinolysis. I-abnormal coagulation ibonakala kwi-portal vein thrombosis (PVT) kunye ne-mesenteric vein thrombosis, kunye ne-deep vein thrombosis (DVT). Ezi meko zeklinikhi zihlala zifuna unyango okanye uthintelo lwe-anticoagulation. I-Microthrombosis kwisibindi ebangelwa yi-hypercoagulability idla ngokubangela i-liver atrophy.
Ezinye iinguqu ezibalulekileyo kwindlela yokugaya igazi zicacisiwe, ezinye zidla ngokuphuma igazi kwaye ezinye zidla ngokujiya (Umfanekiso 1). Kwi-cirrhosis yesibindi ezinzileyo, inkqubo iya kulungelelaniswa kwakhona ngenxa yezinto ezingasebenzi kakuhle, kodwa olu lungelelwaniso aluzinzanga kwaye luya kuchaphazeleka kakhulu zezinye izinto, ezifana nesimo somthamo wegazi, usulelo lwenkqubo, kunye nokusebenza kwezintso. I-Thrombocytopenia isenokuba lolona tshintsho luqhelekileyo lwe-pathological ngenxa ye-hypersplenism kunye nokuncipha kwe-thrombopoietin (TPO). Ukungasebenzi kakuhle kweplatelet nako kuchaziwe, kodwa olu tshintsho lwe-anticoagulant luncitshiswe kakhulu kukwanda kwe-von Willebrand factor (vWF) ephuma kwi-endothelial. Ngokufanayo, ukwehla kwezinto ze-procoagulant eziphuma kwisibindi, ezifana nezinto V, VII, kunye no-X, kukhokelela kwixesha elide le-prothrombin, kodwa oku kuncitshiswe kakhulu kukuncipha kwezinto ze-anticoagulant eziphuma kwisibindi (ingakumbi iproteni C). Ukongeza, i-endothelial-derived factor VIII ephezulu kunye neproteni C ephantsi kukhokelela kwimeko ye-hypercoagulable. Olu tshintsho, kunye nokuxinana kwemithambo yegazi kunye nomonakalo we-endothelial (i-Virchow's triad), kukhokelele ekuqhubekeni kwe-PVT kunye ne-DVT ngamanye amaxesha kwizigulane ezine-cirrhosis yesibindi. Ngamafutshane, iindlela ze-hemostatic ze-cirrhosis yesibindi zihlala zilungelelaniswa ngendlela engaguqukiyo, kwaye ukuqhubela phambili kwesi sifo kunokuthambekela nakweyiphi na indlela.
Isalathiso: O'Leary JG, Greenberg CS, Patton HM, Caldwell SH.AGA Uhlaziyo lweKlinikhi: Ukuxinana kwemithambo kwiCirrhosis.Gastroenterology.2019,157(1):34-43.e1.doi:10.1053/j.gastro.2019.03.070.
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