Ukungasebenzi kakuhle kwe-Coagulation yinxalenye yesifo sesibindi kunye neyona nto iphambili kumanqaku amaninzi abikezelwayo.Utshintsho kwibhalansi ye-hemostasis ikhokelela ekuphumeni kwegazi, kwaye iingxaki zokopha bezisoloko ziyingxaki enkulu yeklinikhi.Izizathu zokopha zinokwahlulwa ngokulinganayo (1) kwi-portal hypertension, engenanto yakwenza ne-hemostatic mechanism;(2) i-mucosal okanye i-puncture inxeba ukopha, ngokuphindaphindiweyo ngokuchithwa kwangaphambili kwe-thrombus okanye i-fibrinolysis ephezulu, ebizwa ngokuba yi-accelerated intravascular coagulation kunye ne-fibrinolysis kwisifo sesibindi sokunyibilika (AICF).Indlela ye-hyperfibrinolysis ayicacanga, kodwa ibandakanya utshintsho kwi-intravascular coagulation kunye ne-fibrinolysis.Ukuqina okungaqhelekanga kubonwa kwi-portal vein thrombosis (PVT) kunye ne-mesenteric vein thrombosis, kunye ne-deep vein thrombosis (DVT).Ezi meko zonyango zihlala zifuna unyango lwe-anticoagulation okanye uthintelo.I-Microthrombosis esibindini ebangelwa yi-hypercoagulability kaninzi ibangela i-atrophy yesibindi.
Ezinye iinguqu eziphambili kwindlela ye-hemostasis ziye zacaciswa, ezinye zivame ukukhupha igazi kwaye ezinye zivame ukuvala (Umfanekiso 1).Kwi-cirrhosis yesibindi esizinzile, inkqubo iya kulungelelaniswa ngenxa yezinto eziphazamisayo, kodwa le bhalansi ayizinzile kwaye iya kuchaphazeleka kakhulu ngezinye izinto, ezifana nesimo somthamo wegazi, ukusuleleka kwenkqubo, kunye nokusebenza kwezintso.I-Thrombocytopenia inokuba lolona tshintsho luqhelekileyo lwe-pathological ngenxa ye-hypersplenism kunye nokuncipha kwe-thrombopoietin (TPO).Ukungasebenzi kakuhle kwePlatelet kuye kwachazwa, kodwa olu tshintsho lwe-anticoagulant lwacinywa kakhulu kukwanda kwe-endothelial-derived von Willebrand factor (vWF).Ngokufanayo, ukuncipha kwezinto ze-procoagulant eziphuma kwisibindi, ezifana ne-V, VII, kunye ne-X, zikhokelela kwixesha elide le-prothrombin, kodwa oku kutshatyalaliswa kakhulu ngokuhla kwe-anticoagulant ephuma kwisibindi (ingakumbi iprotheni C).Ukongezelela, i-endothelial-derived factor VIII ephakamileyo kunye ne-protein C ephantsi ikhokelela kwisimo se-hypercoagulable.Olu tshintsho, ludityaniswe ne-venous stasis kunye nomonakalo we-endothelial (i-Virchow's triad), ikhokelele ekuqhubekeni kwe-synergistic ye-PVT kunye ne-DVT ngamaxesha athile kwizigulane ezine-cirrhosis yesibindi.Ngamafutshane, iindlela ze-hemostatic ze-cirrhosis zesibindi zihlala zilungelelaniswa ngendlela engazinzanga, kwaye ukuqhubela phambili kwesifo kunokunyanzeliswa kuyo nayiphi na indlela.
Isalathiso:O'Leary JG, uGreenberg CS, uPatton HM, uCaldwell SH.AGA uHlaziyo lweKlinikhi yokuSebenza: Ukudibanisa kwiCirrhosis.Gastroenterology.2019,157(1):34-43.e1.doi:10.1053/j.gastro.2019.03.07. .
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