jaundice

I-Jaundice, eyaziwa nangokuthi i-icterus, i-pigmentation ephuzi yesikhumba kanye ne-sclera yamehlo kanye nolwelwesi lwamafinyila ngenxa yamazinga aphezulu e-bilirubin emzimbeni.

Igama elithi Jaundice lisuselwa egameni lesiFulentshi elithi "jaunisse", okusho ukuthi "isifo esiphuzi". Ukushintsha kombala okuphuzi kungenxa ye-Bilirubin (uketshezi oluphuma esibindini). Ukuhlukaniswa kwama-RBC's, kuholela ekwakhekeni kwe-Bilirubin emzimbeni wethu. I-Bilirubin ivame ukugaywa esibindini futhi ikhishwe ku-bile emzimbeni wethu. Ukuphazamiseka kwemetabolism, ukukhiqizwa noma ukuphuma kwe-Bilirubin kuholela ekufakweni kwenani eleqile le-bile emzimbeni, okubangela jaundice. Ngenxa yokuqukethwe kwawo okuphezulu kwe-elastin, umhlophe weso unokuhlobana okuthile ne-Bilirubin. I-Serum bilirubin ingaba okungenani ngu-3 mg/dL ku-scleral icterus.

I-jaundice ibangelwa amazinga aphezulu e-bilirubin emzimbeni aziwa ngokuthi i-hyperbilirubinemia. Egazini, amazinga ajwayelekile e-Bilirubin angaphansi kuka-1.0 mg/dL futhi amazinga angaphezu kuka-2–3 mg/dL abangela iJaundice.

I-Bilirubin ingaba yizinhlobo ezi-2:

1) I-BILIRUBIN ENGAHLANGANISIWE (INDIRECT): Ngokuvamile kubonakala ku-Jaundice esanda kuzalwa, ukuphazamiseka kwegilo, ukuzila ukudla isikhathi eside, nasezimeni zeGenetic njenge-Gilbert's Syndrome.

2) I-BILIRUBIN EHLANGANISIWE (DIRECT): Ivame ukubonakala kumagciwane isifo sofuba kanye ne-cirrhosis (izifo zesibindi), ukuvaleka komgudu we-bile (okubangelwa amatshe enyongo avala imigudu ye-hepatic kanye ne-pancreatitis), izifo zesibindi nemithi.

 Ngokuvamile i-jaundice ibangelwa ukuphazamiseka okuhlukahlukene okudinga ukwelashwa, njenge:

1) I-Pre-hepatic Imbangela (ngaphambi kokuba i-bile ikhiqizwe yisibindi): Izimo ezibangela ukwenyuka kokuwohloka kwamangqamuzana abomvu egazi kunenqubo evamile njenge-sickle cell crisis, umalaleveva, i-thalassemia, izidakamizwa nobunye ubuthi.

2) I-Hepatocellular Cause: Ukuthuthwa kweBilirubin kuma-hepatocyte (amangqamuzana esibindi) kuyaphazamiseka nganoma isiphi isikhathi phakathi kokuthathwa kwamaselula kwe-Bilirubin engahlanganisiwe kanye nokuthuthwa kwe-Bilirubin ehlanganisiwe iye kuma-bile ducts. Ibangelwa yi-Hepatitis, isifo sesibindi esidakayo, umdlavuza wesibindi kanye ne-paracetamol overdose.

3) I-Post-Hepatic Cause (ngemuva kokuba isibindi sikhiqize i-bile): Ukugeleza okujwayelekile kwe-bile (i-conjugated Bilirubin) kusuka esibindini kuya emathunjini kuyaphazamiseka kuJaundice evimbelayo. Izimo ezibangela ukuthi kube ne-Jaundice evimbelayo amatshe enyongo emiseleni yenyongo, umdlavuza wesinye/i-bileduct, i-cholangitis (izifo ze-bile duct), i-pancreatitis(amagciwane kumanyikwe), ukukhulelwa kanye ne-Jaundice esanda kuzalwa. Lokhu kuvame ukuhlotshaniswa nomchamo onombala omnyama, indle ephaphathekile (indle enombala wobumba) kanye Nokuluma komzimba. Ukulunywa Kakhulu kubonakala kaningi ezigulini ezinamazinga e-serum cholesterol aphezulu.

I-Physiological Jaundice, i-jaundice yobisi lwebele, ukuncelisa ibele i-jaundice, i-cephalohematoma kanye nokungahambisani kweqembu legazi likaMama-lengane nakho kuyizimbangela ezimbalwa zeJaundice.

• I-Physiological Jaundice: Ivame ukubonakala ezinganeni ezisanda kuzalwa futhi ivela evikini lokuqala lokuphila. Ukuwohloka okusheshayo kwamangqamuzana egazi abomvu okwenzeka kule minyaka akukwazi ukucutshungulwa isibindi esingavuthiwe sosana olusanda kuzalwa. I-Bilirubin ihlala emzimbeni ibangela i-Jaundice kodwa ayinangozi futhi iyancipha kancane kancane phakathi namasonto amabili okuqala okuphila.
• Ubisi lwebele jaundice: Uhlobo olungenabungozi lweJaundice esenzeka ekupheleni kwesonto lokuqala lokuphila ngemva kokuzalwa. Kukholakala ukuthi kudalwa amakhemikhali athile akhona obisini lwebele. Ukuncelisa ibele kufanele kuyekwe izinsuku eziyi-1-3. I-Phototherapy inganikezwa. Kungase kungavamile ukuholela ku-Kernicterus.
• I-jaundice yokuncelisa ibele: Kubonwa ezinganeni ezisanda kuzalwa ezinganceliswa kahle ubisi lukamama. Ukungatholi ngokwanele ubisi lwebele osanda kuzalwa kuholela ekunyakazeni okuncane kwamathumbu okubangela ukwehla kokuphuma kwe-bilirubin emzimbeni.
• I-Cephalohematoma: Kubangelwa ukulimala ekhanda lomntwana ngesikhathi ebeletha. Igazi liqoqwa ngaphansi kwesikhumba futhi ukuwohloka ngokushesha kwala maseli abomvu egazi kungabangela ukwanda kwamazinga e-bilirubin emzimbeni, okubangele i-Jaundice.

4) Ukungahambisani kweqembu legazi likaMaternal-fetal (ABO, Rh): Ukuwohloka ngokushesha kwamangqamuzana egazi abomvu egazi lengane ngenxa yokungahambelani phakathi kwamaqembu egazi kamama kanye ne-fetus kubangela i-Jaundice ibe amazinga aphezulu e-bilirubin emzimbeni.

Ezinye izimo ezingabangela i-jaundice zihlanganisa

1) I-DUBLIN-JOHNSON SYNDROME: Lesi sifo se-Jaundice esingelapheki esizuzwe njengefa siphumela ku-conjugated hyperbilirubinemia yesibili ngemva kwesici ekuthuthweni kwe-canalicular of organic anion. Amazinga e-serum bilirubin angase akhuphuke aze afike ku-30 ​​mg/dL. Ngokuvamile, akukho ukwelashwa okudingekayo.

2) CRIGLER-NAJJAR SYNDROME: Kuphinde kube ukuphazamiseka okuzuzwe njengefa okubangelwa ukushoda okuncane kwe-enzyme ye-UDPGT. Amazinga e-bilirubin e-serum engahlanganisiwe asebangeni lika-6-25mg/dl. Ukwelashwa kuhlanganisa ukusetshenziswa kwe-phenobarbitone, ukukhanya kwe-UV kanye nokufakelwa kwesibindi.

3) I-PSEUDO-JAUNDICE: Ngokuvamile kubangelwa ukusetshenziswa ngokweqile kwe-beta-carotene equkethe ukudla okufana nesanqante, ithanga, noma amakhabe. Ngokuvamile ayinangozi futhi iholela ekushintsheni kombala ophuzi kwesikhumba.

Izimpawu ezivamile zihlanganisa isikhumba esinombala ophuzi kanye ne-sclera, ngokuvamile eqala kusukela ekhanda futhi isakazeka phansi emzimbeni (i-sclera isondelene kakhulu ne-Bilirubin), umchamo omnyama noma onsundu, indle (indle enobumba ngenxa yokungabikho kwe-bile pigments esitokisini), ukulunywa (i-pruritisi kanye ne-excoriation kubonakala ezimweni ezimbi kakhulu ezibangelwa usawoti we-bile okhona ku-bile). Ezinye izimpawu zihlanganisa ubuhlungu besisu, ukukhathala kanye ne-myalgia, ukuncipha kwesisindo, imfiva nokuhlanza.

Izimpawu ze-Jaundice ziyahlukahluka kuye ngembangela kanye nezifo eziwumsuka kusuka kumuntu ngamunye kuye kumuntu ngamunye.

• Izimbangela Ze-Pre-Hepatic: Iziguli ziba nobuhlungu besisu, ukuncipha komzimba kanye nokukhathala ngenxa yokwanda kokuqhekeka kwamangqamuzana egazi abomvu ezifweni ezinjengomalaleveva, i-sickle cell crisis kanye thalassemia. Ku-hemolytic Jaundice, kubonakala i-spleen ekhulisiwe.
• I-Hepatocellular Imbangela: Izimpawu ezifana nomchamo onombala omnyama, indle ephaphathekile kanye nokuluma zibonakala ezimeni ze-Hepatitis ebangelwa yigciwane. Ngesifo sesibindi esidakayo, isiguli singase sibe nobuhlungu obukhulu besisu nokungahambi kahle, i-gastritis nokukhathala. Emidlavuza yesibindi kanye nokweqisa kwe-paracetamol, izimpawu zingahluka kuye ngokuthi isiguli siphethwe yini. Ku-cirrhosis noma izibazi zesibindi, isiguli sizoba ne-portal nomfutho wegazi ophezulu.
• I-Post-Hepatic Cause (ngemuva kokuba isibindi sikhiqize i-bile): Izimpawu ezifana nokushintsha umbala ophuzi kwesikhumba, indle ephaphathekile, ubuhlungu besisu, ukwehla kwesisindo somzimba, ukugula komzimba kubonakala ku-Obstructive Jaundice ebangelwa isifo senyongo emiseleni yenyongo, umdlavuza wenyongo/ bileduct, cholangitis (infection of the bileduct), pancreatitis(infection of the bileduct). amanyikwe), ukukhulelwa kanye ne-Jaundice esanda kuzalwa. Ezimweni ze-choledocholithiasis, umkhuhlane kanye nesisa esiswini kukhona. I-Jaundice engenabuhlungu ibonakala ekuvinjweni okuyingozi kwe-biliary.

I-Jaundice yenzeka ngenxa ye-hyperbilirubinemia (amazinga aphezulu e-Bilirubin egazini). Ngokuvamile izifo ezicashile noma iziyaluyalu ziyimbangela enkulu. Lokhu kuvimbela isibindi ekukhipheni i-Bilirubin emzimbeni futhi ifakwa ezicutshini.

Ezinye zezinkinga ezivamile ezidinga ukwelashwa ukuvinjelwa kwe-bile duct (amazinga e-Bilirubin akhuphuka emzimbeni ngenxa yokuvinjelwa kwesibindi), i-Gilbert's Syndrome (Ukuphuma kwe-bile emzimbeni konakala njengoba kuthinteka ama-enzyme abandakanyeka kule nqubo. isifo sofuzo), i-Hemolytic I-anemia (lapho ama-RBC ehlehlisiwe ngobuningi, khona-ke ukukhiqizwa kwe-Bilirubin emzimbeni kuyakhuphuka), I-Bile duct Ukuvuvukala kanye nokuvuvukala okukhulu kwesibindi. Ku-cholestasis, ukugeleza kwe-bile kusuka esibindini kuyaphazamiseka yingakho i-bilirubin ehlanganisiwe ihlala emzimbeni.

Uma kusolakala ukuthi i-Hepatitis enegciwane, izici eziyingozi zihlanganisa ukusebenzisa kabi izidakamizwa emithanjeni, ukumpontshelwa igazi, ukuchayeka egazini noma oketshezini lomzimba lomuntu onaleli gciwane kanye nabalingani bobulili abaningi.

Izinto eziyingozi zihlanganisa ukumunca ubuthi obungase bube khona okungukuthi izidakamizwa ezithile njenge-paracetamol (izimbangela zokweqisa izidakamizwa ukwehluleka kwesibindi), izinyibilikisi (amakhemikhali) namakhowe asendle.

I-jaundice ivame ukutholakala ngezimpawu, umlando onikezwa isiguli kanye nokuhlolwa komzimba.

1) Ukuhlolwa komzimba kuvame ukwenziwa ukuze kubhekwe izimpawu nezimpawu zeJaundice. Ukuvuvukala kwesibindi, amaqakala kanye nezinyawo okubonisa i-Cirrhosis noma Ukuqubuka kwesibindi. Isibindi sizwakala sinzima lapho sihlolwa ngudokotela (nge-palpation).

• Emidlavuza yesibindi, isibindi siqinile lapho sithinta.
• Nge-hemolytic jaundice, I-Splenomegaly (ubende olukhulisiwe) luzwakala ku-palpation.
• Ezimeni ezimbi kakhulu zokuvinjelwa kwamathumbu, isiguli asinabo ubuhlungu besisu noma ukuzwela futhi ngokuvamile saziwa ngokuthi i-Jaundice engenabuhlungu.
• I-excoriation ibonakala ku-cholestasis kanye nokuvinjelwa kwe-biliary yebanga eliphezulu.
• I-Greenish Hue (ngenxa ye-biliverdin) ingabonakala ezimeni ezimbalwa eziphakamisa izimo zesibindi ezihlala isikhathi eside njenge-biliary cirrhosis, i-sclerosing cholangitis, i-Hepatitis engapheli noma ukuvinjelwa okuyingozi isikhathi eside.
• Uma imfiva nokuzwela esiswini kukhona khona kuphakamisa i-cholestasis, choledocholithiasis.
• I-Palmar Erythema (Ubomvu ezintendeni zezandla) ingase iphakamise ukungenwa kwe-ethanol okungapheli.
• Ku-viral Hepatitis, izimpawu ezinjengomkhuhlane zingabonakala ngisho nangaphambi kokuba i-Jaundice yenzeke esigulini.

2) Umlando wezokwelapha wesiguli kufanele uhlanganise ukuthi isiguli siye sahamba muva nje siye kunoma yiliphi izwe noma isifunda lapho i-Hepatitis noma umalaleveva idlange khona uma isiguli siwumlutha wotshwala noma kukhona ukusetshenziswa kotshwala kwakamuva kwesiguli, noma yimuphi umlando wakamuva wezidakamizwa. ukuhlukunyezwa okufana ne-paracetamol kanye nobungozi emsebenzini (ukuthi ngabe ubhekene nanoma imaphi amakhemikhali ayingozi angathinta isibindi endaweni yakhe yokusebenza).

Uvivinyo

I-BILIRUBIN TEST: Amazinga e-Bilirubin ekuhlolweni kwegazi abizwa ngokuthi ukuhlolwa kwe-bilirubin. Ikala amazinga e-bilirubin angaqondile noma angahlanganisiwe emzimbeni.

Egazini, Amazinga Ajwayelekile e-Bilirubin angaphansi kuka-1.0 mg/dL (17 µmol/L) futhi amazinga angaphezu kuka-2–3 mg/dL (34-51 µmol/L) aphumela ku-Jaundice.

Ku-Haemolytic Jaundice, amazinga aphezulu e-Bilirubin engahlanganisiwe ayabonakala. Ukwenyuka kwe-Heme metabolism kungabonakala futhi amazinga anyukile omchamo-urobilinogen (> amayunithi ama-2) angabonwa ngaphandle kwe-bilirubin. I-Bilirubin engahlanganisiwe ayincibiliki emanzini, ngakho-ke ayikwazi ukubonakala emchameni kodwa ibonakala ku-serum kuphela. Okuhlukile kuphela izingane ezisanda kuzalwa nezinsana njengoba i-gut flora ingakathuthuki.

IZIVIVINYO ZOKUSEBENZA KWESIBINDI: Ukuhlolwa kwe-ALP (alkaline phosphatase), i-GGT ne-ALT, i-AST (aminotransferase) kungenziwa.

Amazinga ajwayelekile yi-ALP (10–45 IU/L), GGT (18–85IU/L), AST (12–38 IU/L) kanye ne-ALT (10–45 IU/L).

Ku-Jaundice evimbelayo, zozine zazo ziphakeme kakhulu. Ezimeni zokulimala okukhulu kwe-hepatocellular, amazinga e-AST aphindwe izikhathi ezingu-15 kunevelu evamile futhi amanani amancane abonisa izimbangela ezivimbelayo. Amazinga e-ALP aphindwe izikhathi ezingu-10 kunevelu evamile abonakala ku-CMV (CYTOMEGALOVIRUS) noma izifo zesibindi ezingelapheki. Ku-Acute Hepatitis, amazinga e-ALT kanye ne-AST angaphezulu (1000 IU/L). Amazinga e-ALT ne-AST azungeze (1500-2250 IU/L) kubuthi be-Acetaminophen. Amaleveli e-GGT aphindwe izikhathi ezi-5 kunevelu evamile abonisa ubuthi bezidakamizwa.

1. c) CBC (Qedela Isibalo Segazi): Ikhombisa izinga lamangqamuzana egazi abomvu, amangqamuzana egazi amhlophe, namaPlatelet egazini.
2. d) Ukuhlolwa kokubona izifo zesibindi nakho kungenziwa njengalokhu I-hepatitis A, B, C & E izivivinyo.
3. e) Ukuhlolwa komchamo kungenziwa ukukala amazinga e-urobilinogen. Amazinga aphansi e-urobilinogen aphakamisa izimbangela ze-post-hepatic futhi amazinga aphezulu aphakamisa izimbangela zangaphambili noma ze-intrahepatic.
4. f) Ezimweni ezisolekayo ze-Obstruction, Ukufanekisa kungenziwa njengalokhu I-MRI, i-CT scan, ne-Ultrasound. ULTRASound ingasetshenziswa ukuhlonza Ukuvinjelwa kwamapayipi eBile kanye nesinye.
5. g) Isibindi Biopsy (inaliti ishuthekwa esibindini bese kukhishwa isampula yethishu ehlolwa ngaphansi kwesibonakhulu) kuphakanyiswa ezimweni zesibindi esinamafutha, umdlavuza, isifo sokusha kwesibindi, nokuvuvukala.

• Imbangela ewumsuka ye-Jaundice kumele ilashwe kuqala. Ukuphathwa kwezokwelapha kwenziwa ezimweni eziningi ezibandakanya ukwelapha izifo ezikhona njenge-Hepatitis, i-leptospirosis kanye nomalaleveva.
• Ezimweni ze-Hepatitis ebangelwa i-Jaundice, imishanguzo ye-Anti-viral ikhethwa. Umalaleveva ungelashwa ngama-antibiotics kanye ne-hydroxychloroquine nama-quinolones. Ama-antiviral amasha ayatholakala ekwelapheni I-hepatitis B & C.
• Kunconywa ukuphumula kombhede, Ukudla Okunomsoco, ushukela neziphuzo zezithelo. Izinguquko ezithile endleleni yokuphila zingenziwa njengokuzivocavoca njalo.
• Ukudla okukhethekile okugwema ukudla okuthile kungathathwa ezigulini ezinokuntula kwe-G6PD.
• Izidakamizwa ezifana ne-Hypnotics, Sedatives kanye ne-Alcohol kumele zigwenywe. Amaphilisi Okuvimbela Inzalo Asetshenziswa ngabesifazane kufanele ayekwe kuze kunciphe izimpawu.
• I-Corticosteroids isiza ukuthuthukisa izimpawu ze-autoimmune hemolytic anemia. IHydroxyurea imiselwe iziguli ezine i-sickle cell anemia.
• Ukumpontshelwa igazi kunikezwa iziguli ezine-hemolytic anemia enzima. Uma zonke ezinye izindlela zokwelapha zehlulekile, i-plasmapheresis iphakanyiswa esigulini.
• Izithasiselo ze-Iron kanye nokudla okunothe nge-Iron kufanele kuthathwe ezimeni ze-anemia ebangelwa i-Jaundice.
• ukuhlinzwa kwe-Gall Bladder kunganciphisa ukuluma emzimbeni ezimeni ezinzima.
• Ezinganeni Ezisanda kuzalwa, i-Jaundice ingelashwa nge-PHOTOTHERAPY (Ukwelashwa Okukhanyayo lapho ingane ibekwe ngaphansi kwesibani sokwenziwa esiluhlaza okwesibhakabhaka noma ingane ingavezwa ngokuqondile ngaphansi kokukhanya kwelanga lasekuseni imizuzu embalwa) KANYE NOKUSHINTSHA UKUTSHINTSHWA uma amazinga e-bilirubin engaphezulu kuka-421mg/dL.
• Abantu abanezifo ze-hepatitis A, B, no-C bayelulekwa ukuthi bavikele ubulili.
• I-immunoglobulin emithanjeni kanye nokufakelwa komnkantsha kwenziwa njengoba kudingekile ezinkingeni ezimbalwa zofuzo ezibangela i-Jaundice.
• I-ERCP (I-Endoscopic retrograde cholangiopancreatography) indlela yokwelapha ekhethwayo ekuvinjweni kwe-Extrahepatic Bileduct (I-Gallstones; I-bileduct Malignancy; I-Pancreatic Malignancy).
• Ezimweni ezimbi kakhulu, njengokuvinjwa kwe-Bile duct, ukuphathwa kokuhlinzwa kukhethwa ngaphezu kokuphathwa kwezokwelapha. Ingxenye yesibindi enesifo iyasuswa ngaphandle kokuphazamisa ukusebenza kwesibindi.
• Ezimweni ezimbi kakhulu lapho kungekho ukwelashwa okungenhla okuhlulekile, ukufakelwa kwesibindi kungenziwa.

Ijaundice ingavinjelwa ngu

• Ukugwema uphuzo oludakayo kanye nezidakamizwa ezilalisayo njenge-hypnotics, ne-paracetamol.
• Ukudla okunomsoco kubalulekile ukuvimbela i-Jaundice (Ukudla okunothe nge-iron kufanele kuthathwe abantu abane-Jaundice ebangelwa i-anemia).
• Ukuzivocavoca Okujwayelekile kufanele kwenziwe.
• Ezigulini ezinomlando womndeni we-Crigler-Najjar syndrome, ukwelulekwa ngofuzo kunganikezwa.
• Iziguli namalungu omndeni kufanele bafundiswe ngezimpawu nezimpawu ezingase zibonwe esigulini futhi babike noma yiziphi izinguquko ngokushesha.
• Ukuya ocansini okuvikelekile kuyelulekwa kubantu abanezifo ze-hepatitis A,B,C.
• Ukuya kunoma yiliphi izwe noma isifunda lapho i-Hepatitis noma umalaleveva kwande khona kufanele kugwenywe.
• Ukuchayeka kunoma yimaphi amakhemikhali ayingozi angathinta isibindi kufanele kugwenywe.

1) Ingabe i-jaundice ingelapheka?

Yebo, i-Jaundice ingelapheka. Uma kubangelwa ukutheleleka okucashile, udokotela wakho angase asikisele ukuphathwa kwezokwelapha. Kodwa ezimweni ezimbi kakhulu futhi uma kwenzeka ngenxa yokuvinjelwa, khona-ke ukuhlinzwa kuyaphakanyiswa.

2) Ingabe i-jaundice iyingozi?

I-jaundice iyingozi kuphela lapho amazinga e-bilirubin ephezulu kakhulu emzimbeni futhi ingase ibangele izinkinga ezifana nokuhluleka kwesibindi, i-sepsis nokufa.

3) Kuzothatha isikhathi esingakanani ukwelapheka i-jaundice?

Ukwelashwa kwe-jaundice kuncike ezimweni eziyisisekelo. Ezinganeni ezisanda kuzalwa, liyanyamalala ngemva kwamasonto ama-2 empilo.

I-Apollo Hospitals ine-Best Gastroenterologist e-India. Ukuze uthole odokotela be-gastroenterologist abahamba phambili edolobheni lakho eliseduze, vakashela izixhumanisi ezingezansi:

• I-Gastroenterologist eBangalore
• I-Gastroenterologist e-Chennai
• I-Gastroenterologist e-Hyderabad
• I-Gastroenterologist eDelhi
• I-Gastroenterologist eMumbai
• I-Gastroenterologist e-Kolkata