Ukungasebenzi kahle kokuqina kwemithambo yegazi kuyisici esiyinhloko sesifo sesibindi futhi kuyisici esibalulekile emazingeni amaningi okubikezela. Izinguquko ekulinganisweni kwe-hemostasis ziholela ekuphumeni kwegazi, futhi izinkinga zokuphuma kwegazi bezilokhu ziyinkinga enkulu yezokwelapha. Izimbangela zokuphuma kwegazi zingahlukaniswa cishe zibe (1) umfutho wegazi ophezulu we-portal, okungenalo nhlobo uhlobo lwe-hemostatic mechanism; (2) ukuphuma kwegazi enxebeni le-mucosal noma le-puncture, ngokuvamile ngokuqedwa kwe-thrombus ngaphambi kwesikhathi noma i-fibrinolysis ephezulu, okubizwa ngokuthi i-accelerated intravascular coagulation kanye ne-fibrinolysis kwisifo sesibindi i-Melt (AICF). Indlela ye-hyperfibrinolysis ayicaci, kodwa ihilela izinguquko ekuqineni kwemithambo yegazi kanye ne-fibrinolysis. Ukuqineka okungajwayelekile kubonakala ku-portal vein thrombosis (PVT) kanye ne-mesenteric vein thrombosis, kanye ne-deep vein thrombosis (DVT). Lezi zimo zezokwelapha zivame ukudinga ukwelashwa noma ukuvimbela ukuqina kwemithambo yegazi. I-Microthrombosis esibindini ebangelwa ukuqineka kwemithambo yegazi ngokuvamile ibangela ukuqina kwesibindi.
Ezinye izinguquko ezibalulekile endleleni yokungena kwegazi emzimbeni sezicacisiwe, ezinye zivame ukopha kanti ezinye zivame ukujiya (Isithombe 1). Ku-cirrhosis yesibindi esizinzile, uhlelo luzophinde lulinganiswe ngenxa yezici ezingasebenzi kahle, kodwa lokhu kulinganisela akuzinzile futhi kuzothinteka kakhulu ezinye izici, njengesimo sevolumu yegazi, ukutheleleka kwesistimu, kanye nokusebenza kwezinso. I-Thrombocytopenia ingaba ushintsho oluvame kakhulu lwe-pathological ngenxa ye-hypersplenism kanye nokwehla kwe-thrombopoietin (TPO). Ukungasebenzi kahle kweplatelet nakho kuchazwe, kodwa lezi zinguquko ze-anticoagulant zilinganiswe kakhulu ngokwanda kwe-von Willebrand factor (vWF) etholakala e-endothelial. Ngokufanayo, ukwehla kwezici ze-procoagulant ezitholakala esibindini, njengezici V, VII, kanye no-X, kuholela esikhathini eside se-prothrombin, kodwa lokhu kulinganiswe kakhulu ngokuncipha kwezici ze-anticoagulant ezitholakala esibindini (ikakhulukazi iphrotheni C). Ngaphezu kwalokho, i-endothelial-derived factor VIII ephezulu kanye nephrotheni C ephansi kuholela esimweni sokujiya ngokweqile. Lezi zinguquko, ezihambisana nokuma kwemithambo yegazi kanye nomonakalo we-endothelial (i-Virchow's triad), ziholele ekuqhubekeni kwe-PVT kanye ne-DVT ngezikhathi ezithile ezigulini ezine-cirrhosis yesibindi. Ngamafuphi, izindlela ze-hemostatic ze-cirrhosis yesibindi zivame ukulinganiswa kabusha ngendlela engazinzile, futhi ukuqhubeka kwesifo kungatshekiswa kunoma iyiphi indlela.
Inkomba: O'Leary JG, Greenberg CS, Patton HM, Caldwell SH.AGA Isibuyekezo Sokusebenza Kwezokwelapha: Ukuqina Kwegazi ku-Cirrhosis.Gastroenterology.2019,157(1):34-43.e1.doi:10.1053/j.gastro.2019.03.070.
Ikhadi lebhizinisi
I-WeChat yesiShayina