《臨床診斷學(xué)》黃疸課件

Jaundice(黃疸)PanLiDepartmentofGastroenterology,FirstAffiliatedHospitalofChongqingMedicalUniversity《臨床診斷學(xué)》黃疸Jaundice(黃疸)PanLiDepartmentofGastroenterology,FirstAffiliatedHospitalofChongqingMedicalUniversity1.DEFINITIONJaundice(icterus):Whatisjaundicemeansthesclera(鞏膜),SkinandmucousmembraneCai)turnedyellowduetoascentofbilirubin(膽紅素)InserumSerumtotalbilirubin(normal1.7-17.1umol/LConjugatedbilirubin:0-3.42umol/LUnconjugatedbilirubin:1.7-13.68umol/LOccultjaundice(隱性黃疸):17.1umol/L<TotalBilirubin(TBIL)<34.2umol/LJaundice(黃疸):TotalBilirubin(TBIL)>34.2umol/LJaundice(黃疸)《臨床診斷學(xué)》黃疸Jaundice(11.DEFINITIONJaundice(icterus):Whatisjaundicemeansthesclera(鞏膜),SkinandmucousmembraneCai)turnedyellowduetoascentofbilirubin(膽紅素)InserumSerumtotalbilirubin(normal1.7-17.1umol/LConjugatedbilirubin:0-3.42umol/LUnconjugatedbilirubin:1.7-13.68umol/L1.DEFINITION2Occultjaundice(隱性黃疸):17.1umol/L<TotalBilirubin(TBIL)<34.2umol/LJaundice(黃疸):TotalBilirubin(TBIL)>34.2umol/LOccultjaundice(隱性黃疸):32.BILIRUBINMETABNISM(膽紅素的代謝)2.BILIRUBINMETABNISM4Importantconceptions1)TBIL(totalbilirubin:總膽紅素2)UCB(unconjugatedbilirubin,非結(jié)合膽紅素)Cannotbefiltratedthroughglomerulusbecauseitdoesnotdissolveinwater,soitwontshowinurine.(不溶于水,故不能從腎小球濾過,因此不出現(xiàn)在尿液中)3)CB(conjugatedbilirubin,結(jié)合膽紅素water-soluble,canbefiltratedthroughglomerulusandwillshowInurine.(溶于水,能通過腎小球從尿中排出)TBIL=UCB+CBImportantconceptions5OriginsofUCB(非結(jié)合膽紅素的來源):1)Majororigin(80-85%)mononuclearphagocyte(單核吞噬細(xì)胞)oldredbloodcellsbilirubin,iron,globin(膽紅素,鉄和珠蛋白)2)Anotherorigin(15-20%):bypassbilirubin(旁路膽紅素)Immatureredbloodcellsinmarrow(骨髓)Proteininliverwhichcontainferroheme(亞鐵血紅素)OriginsofUCB(非結(jié)合膽紅素的來源):6OriginsofCB(結(jié)合膽紅素的來源UCBcombinedwithserunalbumin(UCB與血清清蛋白結(jié)合)glucuronyltransferase(葡萄糖醛酸轉(zhuǎn)移酶)LiverCBtestinaltract←BiliarytractUrobilinogen(尿膽原)portalveinofliverstercobilin(糞膽素)urine膽紅素的肝腸循環(huán)(Bilirubinenterohepaticcirculation)OriginsofCB(結(jié)合膽紅素的來源7求求Bilirubinenterohepaticcirculation:膽紅素的肝腸循環(huán)CBistransportedfromlivertobileduct,andexcretedintointestinaltract,whichisdeoxidizedtourobilinogenbythedehydrogenationofintestinalbacteria.themajorityofurobilinogenisexcretedinfeces,andTheminorityofurobilinogenisabsorbedintoliverthroughportalvein,thenconvertedintoCBandexcretedintointestinaltract結(jié)合膽紅素經(jīng)過肝臟轉(zhuǎn)運(yùn)至膽管,隨膽汁排入腸道,在腸道細(xì)菌脫氫作用下還原為尿膽原,尿膽原的大部分氧化為尿膽素從糞便中排出,又稱為糞膽素,小部分在腸內(nèi)被吸收,經(jīng)肝門靜脈回到肝內(nèi),其中的大部分再轉(zhuǎn)變?yōu)榻Y(jié)合膽紅素,又隨膽汁排入腸內(nèi)。求求Bilirubinenterohepaticcir83.CLASSFICATIONDependingonEtiologyDependingonbilirubinHemolyticJaundiceUnconjugatedbilirubin(溶血性黃疸)increasedjaundiceaHepatocellularJaundiceConjugatedbilirubin(肝細(xì)胞性黃疸)increasedjaundice■CholestaticJaundic(膽汁淤積性黃疸)aCongenitalnon-hemolyticaundice(先天性非溶血性黃疸)3.CLASSFICATION93.1.HemolyticJaundiceEtiology:1Congenitalhemolyticanemia(先天性溶血性黃疸)l)thalassemia(海洋性貧血)2hereditaryspherocytosis(遺傳性球形紅細(xì)胞增多癥)Posteriorityacquiredhemolyticanemia(F性溶血性黃渲)l)autoimmunityhemolyticanemia(自身免疫性溶血性貧血)2)hemolyticdiseaseofnewborn(新生兒溶血)3Posttransfusionhemo(輸血后溶血)4Favism(蠶豆病)MechanismAlargenumberoferythrocytes(2IzBHE)destroyedrapidly,thenformedUCBwhichexceededhepaticcapacityofabsorbing,combiningandexcretingaNemia,hypoxiaandtoxityoferythocytesmetabolismproductscanweakenedmetabolicfunctionofliver3.1.HemolyticJaundice10《臨床診斷學(xué)》黃疸課件11《臨床診斷學(xué)》黃疸課件12《臨床診斷學(xué)》黃疸課件13《臨床診斷學(xué)》黃疸課件14《臨床診斷學(xué)》黃疸課件15《臨床診斷學(xué)》黃疸課件16《臨床診斷學(xué)》黃疸課件17《臨床診斷學(xué)》黃疸課件18《臨床診斷學(xué)》黃疸課件19《臨床診斷學(xué)》黃疸課件20《臨床診斷學(xué)》黃疸課件21《臨床診斷學(xué)》黃疸課件22《臨床診斷學(xué)》黃疸課件23《臨床診斷學(xué)》黃疸課件24《臨床診斷學(xué)》黃疸課件25《臨床診斷學(xué)》黃疸課件26《臨床診斷學(xué)》黃疸課件27《臨床診斷學(xué)》黃疸課件28《臨床診斷學(xué)》黃疸課件29《臨床診斷學(xué)》黃疸課件30《臨床診斷學(xué)》黃疸課件31《臨床診斷學(xué)》黃疸課件32《臨床診斷學(xué)》黃疸課件33《臨床診斷學(xué)》黃疸課件34《臨床診斷學(xué)》黃疸課件35《臨床診斷學(xué)》黃疸課件36《臨床診斷學(xué)》黃疸課件37Jaundice(黃疸)PanLiDepartmentofGastroenterology,FirstAffiliatedHospitalofChongqingMedicalUniversity《臨床診斷學(xué)》黃疸Jaundice(黃疸)PanLiDepartmentofGastroenterology,FirstAffiliatedHospitalofChongqingMedicalUniversity1.DEFINITIONJaundice(icterus):Whatisjaundicemeansthesclera(鞏膜),SkinandmucousmembraneCai)turnedyellowduetoascentofbilirubin(膽紅素)InserumSerumtotalbilirubin(normal1.7-17.1umol/LConjugatedbilirubin:0-3.42umol/LUnconjugatedbilirubin:1.7-13.68umol/LOccultjaundice(隱性黃疸):17.1umol/L<TotalBilirubin(TBIL)<34.2umol/LJaundice(黃疸):TotalBilirubin(TBIL)>34.2umol/LJaundice(黃疸)《臨床診斷學(xué)》黃疸Jaundice(381.DEFINITIONJaundice(icterus):Whatisjaundicemeansthesclera(鞏膜),SkinandmucousmembraneCai)turnedyellowduetoascentofbilirubin(膽紅素)InserumSerumtotalbilirubin(normal1.7-17.1umol/LConjugatedbilirubin:0-3.42umol/LUnconjugatedbilirubin:1.7-13.68umol/L1.DEFINITION39Occultjaundice(隱性黃疸):17.1umol/L<TotalBilirubin(TBIL)<34.2umol/LJaundice(黃疸):TotalBilirubin(TBIL)>34.2umol/LOccultjaundice(隱性黃疸):402.BILIRUBINMETABNISM(膽紅素的代謝)2.BILIRUBINMETABNISM41Importantconceptions1)TBIL(totalbilirubin:總膽紅素2)UCB(unconjugatedbilirubin,非結(jié)合膽紅素)Cannotbefiltratedthroughglomerulusbecauseitdoesnotdissolveinwater,soitwontshowinurine.(不溶于水,故不能從腎小球濾過,因此不出現(xiàn)在尿液中)3)CB(conjugatedbilirubin,結(jié)合膽紅素water-soluble,canbefiltratedthroughglomerulusandwillshowInurine.(溶于水,能通過腎小球從尿中排出)TBIL=UCB+CBImportantconceptions42OriginsofUCB(非結(jié)合膽紅素的來源):1)Majororigin(80-85%)mononuclearphagocyte(單核吞噬細(xì)胞)oldredbloodcellsbilirubin,iron,globin(膽紅素,鉄和珠蛋白)2)Anotherorigin(15-20%):bypassbilirubin(旁路膽紅素)Immatureredbloodcellsinmarrow(骨髓)Proteininliverwhichcontainferroheme(亞鐵血紅素)OriginsofUCB(非結(jié)合膽紅素的來源):43OriginsofCB(結(jié)合膽紅素的來源UCBcombinedwithserunalbumin(UCB與血清清蛋白結(jié)合)glucuronyltransferase(葡萄糖醛酸轉(zhuǎn)移酶)LiverCBtestinaltract←BiliarytractUrobilinogen(尿膽原)portalveinofliverstercobilin(糞膽素)urine膽紅素的肝腸循環(huán)(Bilirubinenterohepaticcirculation)OriginsofCB(結(jié)合膽紅素的來源44求求Bilirubinenterohepaticcirculation:膽紅素的肝腸循環(huán)CBistransportedfromlivertobileduct,andexcretedintointestinaltract,whichisdeoxidizedtourobilinogenbythedehydrogenationofintestinalbacteria.themajorityofurobilinogenisexcretedinfeces,andTheminorityofurobilinogenisabsorbedintoliverthroughportalvein,thenconvertedintoCBandexcretedintointestinaltract結(jié)合膽紅素經(jīng)過肝臟轉(zhuǎn)運(yùn)至膽管,隨膽汁排入腸道,在腸道細(xì)菌脫氫作用下還原為尿膽原,尿膽原的大部分氧化為尿膽素從糞便中排出,又稱為糞膽素,小部分在腸內(nèi)被吸收,經(jīng)肝門靜脈回到肝內(nèi),其中的大部分再轉(zhuǎn)變?yōu)榻Y(jié)合膽紅素,又隨膽汁排入腸內(nèi)。求求Bilirubinenterohepaticcir453.CLASSFICATIONDependingonEtiologyDependingonbilirubinHemolyticJaundiceUnconjugatedbilirubin(溶血性黃疸)increasedjaundiceaHepatocellularJaundiceConjugatedbilirubin(肝細(xì)胞性黃疸)increasedjaundice■CholestaticJaundic(膽汁淤積性黃疸)aCongenitalnon-hemolyticaundice(先天性非溶血性黃疸)3.CLASSFICATION463.1.HemolyticJaundiceEtiology:1Congenitalhemolyticanemia(先天性溶血性黃疸)l)thalassemia(海洋性貧血)2hereditaryspherocytosis(遺傳性球形紅細(xì)胞增多癥)Posteriorityacquiredhemolyticanemia(F性溶血性黃渲)l)autoimmunityhemolyti