Kulephera kwa coagulation ndi gawo la matenda a chiwindi komanso chinthu chofunikira kwambiri pazambiri zodziwika bwino.Kusintha kwa mlingo wa hemostasis kumayambitsa magazi, ndipo vuto la kutaya magazi nthawi zonse lakhala vuto lalikulu lachipatala.Zomwe zimayambitsa kutuluka kwa magazi zimatha kugawidwa motere (1) portal hypertension, zomwe sizikugwirizana ndi njira ya hemostatic;(2) mucosal kapena puncture bala magazi, nthawi zambiri ndi kutha msanga kwa thrombus kapena mkulu fibrinolysis, wotchedwa inapita patsogolo intravascular coagulation ndi fibrinolysis mu chiwindi matenda Sungunulani (AICF).Limagwirira wa hyperfibrinolysis si bwino, koma kumafuna kusintha intravascular coagulation ndi fibrinolysis.Kutsekeka kosadziwika bwino kumawonedwa mu portal vein thrombosis (PVT) ndi mesenteric vein thrombosis, komanso deep vein thrombosis (DVT).Izi zachipatala nthawi zambiri zimafuna chithandizo cha anticoagulation kapena kupewa.Microthrombosis m'chiwindi yoyambitsidwa ndi hypercoagulability nthawi zambiri imayambitsa chiwindi kufoka.
Kusintha kwina kwakukulu kwa njira ya hemostasis kwadziwika bwino, ena amakonda kukhetsa magazi ndipo ena amaundana (Chithunzi 1).Mu chiwindi chokhazikika cha chiwindi, dongosololi lidzasinthidwanso chifukwa cha zinthu zowonongeka, koma izi sizikhazikika ndipo zidzakhudzidwa kwambiri ndi zinthu zina, monga kuchuluka kwa magazi, matenda a systemic, ndi ntchito ya impso.Thrombocytopenia ikhoza kukhala kusintha kofala kwambiri kwa pathological chifukwa cha hypersplenism ndi kuchepa kwa thrombopoietin (TPO).Kusagwira ntchito kwa mapulateleti kwafotokozedwanso, koma kusintha kwa anticoagulant kumeneku kunathetsedwa kwambiri ndi kuwonjezeka kwa endothelial-derived von Willebrand factor (vWF).Momwemonso, kuchepa kwa zinthu zomwe zimachokera ku chiwindi, monga V, VII, ndi X, kumabweretsa nthawi yayitali ya prothrombin, koma izi zimachepetsedwa kwambiri ndi kuchepa kwa zinthu zomwe zimachokera ku chiwindi (makamaka mapuloteni C).Kuphatikiza apo, kukwezeka kwa endothelial-derived factor VIII ndi kutsika kwa protein C kumapangitsa kuti pakhale hypercoagulable state.Kusintha kumeneku, kuphatikiza ndi kuwonongeka kwa venous stasis ndi kuwonongeka kwa endothelial (Virchow's triad), zidapangitsa kuti PVT ipite patsogolo komanso nthawi zina DVT mwa odwala omwe ali ndi vuto la chiwindi.Mwachidule, njira za hemostatic za chiwindi cha cirrhosis nthawi zambiri zimasinthidwa mosakhazikika, ndipo kufalikira kwa matendawa kumatha kupendekeka mbali iliyonse.
Buku: O'Leary JG, Greenberg CS, Patton HM, Caldwell SH.AGA Clinical Practice Update: Coagulation inCirrhosis.Gastroenterology.2019,157(1):34-43.e1.doi:10.1053/j.gastro.2019.03.07. .
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