Ib qho ntawm pathologies uas tuaj yeem cuam tshuam rau cov kab mob biliary ntawm dev yog cholestasis. Qhov kev hloov pauv no muaj qhov txawv txav ntawm cov kua tsib nyob rau hauv daim siab, cov ducts los yog lub gallbladder uas tshwm sim los ntawm kev thaiv los yog cuam tshuam ntawm cov kua tsib. Kev txiav txim siab txog qhov ua rau cholestasis yuav ua rau nws raug cais tawm thiab qhov kev kho mob tsim nyog tshaj plaws yuav tsum tau tsim nyob rau hauv txhua rooj plaub.
cholestasis hauv dev yog dab tsi?
-COLESTASIS tau txhais raws li lub siab nyob hauv lub siab, kua txiv ntoo, lossis cov kua tsib ua haujlwm ntawm cov kua txiv muaj qhov thaiv los yog ua rau cov kua tsib ntws tawm, uas tag nrho lossis ib nrab tiv thaiv kev tuaj txog ntawm cov kua tsib mus rau txoj hnyuv.
Kom nkag siab zoo dua li cas cholestasis tshwm sim, peb yuav piav qhia luv luv txog nws cov kab mob. Lub hepatocytes yog cov hlwb parenchymal ntawm lub siab uas ua haujlwm feem ntau ntawm lub cev noNtawm lwm yam, hepatocytes yog lub luag haujlwm tsim cov khoom ntawm cov kua tsib thiab zais cia rau hauv cov kua tsib canaliculus (qhov chaw nruab nrab ntawm ob lub hepatocytes uas nyob ib sab). Thaum nyob rau hauv lub canaliculus, cov kua tsib nkag mus rau hauv cov kua tsib intrahepatic ducts (uas yog, cov nyob rau hauv lub siab nws tus kheej), ces mus rau hauv lub extrahepatic bile ducts, thiab thaum kawg mus rau hauv lub gallbladder qhov twg nws yog khaws cia. Thaum tus dev noj pluas mov nrog cov protein thiab rog, kev cog lus ntawm lub gallbladder tshwm sim thiab cov kua tsib ntws mus rau hauv cov hnyuv me, uas tso cai rau kev zom zaub mov kom zoo thiab nqus cov rog. Thaum, vim muaj ib qho intra los yog extrahepatic ua rau, cov kua tsib tsis txaus los ntawm cov kua tsib ducts, cholestasis tshwm sim.
Thaum cholestasis khaws cia dhau sijhawm, hepatocytes kawg raug mob, vim cov kua tsib acids uas muaj nyob rau hauv cov kua tsib muaj tshuaj ntxuav tes. phab ntsa cell ntawm hepatocytes.
Types of cholestasis in dogs
Nyob ntawm qhov ua rau ntawm qhov txawv txav ntawm cov kua tsib nyob rau hauv daim siab, cholestasis tau muab faib ua ob hom:
- Intrahepatic cholestasis: thaum ua rau cholestasis pom hauv daim siab nws tus kheej thiab cuam tshuam rau cov kab mob intrahepatic bile ducts.
- Extrahepatic cholestasis: thaum ua rau cholestasis sab nraum lub siab, cuam tshuam rau cov kab mob hauv lub siab.
Nyob rau ntu nram qab no, peb piav qhia txog qhov sib txawv uas tuaj yeem ua rau intrahepatic thiab extrahepatic cholestasis hauv dev.
Ua rau cholestasis hauv dev
Raws li peb tau piav qhia, qhov ua rau cholestasis sib txawv nyob ntawm seb nws puas yog intrahepatic lossis extrahepatic cholestasis.
Intrahepatic cholestasis
Lub ntsiab ua rau intrahepatic cholestasis hauv dev yog:
- Intrahepatic bile duct obstruction: vim muaj kab mob parasites, thick bile syndrome, inflammatory bile ducts (cholangitis) los yog hlav ntawm cov kua tsib. ducts (cholangiocarcinoma).
- Inflammation or fibrosis at the level of the portal space: the portal spaces are tubular structures that cross the liver. Los ntawm lawv hla cov hlab ntsha, lymphatic hlab ntsha thiab cov kua tsib ducts. Thaum cov chaw no ua rau mob los yog fibrotic, lawv compress cov qauv hauv lawv, nrog rau cov hlab ntsha lymphatic.
Extrahepatic cholestasis
Extrahepatic cholestasis tshwm sim thaum muaj ib qho obstruction Extrahepatic cholestasis tshwm sim thaum muaj tus kab mobNyob rau hauv lem, qhov kev cuam tshuam no tuaj yeem tshwm sim los ntawm:
- Gallstones, parasites, or clots uas cuam tshuam lub lumen ntawm cov kab mob siab ntxiv.
- Thick bile Syndrome: thaum cov kua tsib tuab heev ua rau nws ntws tsis zoo thiab thaiv cov kua tsib.
- Tumors (cholangiocarcinoma) los yog cov txheej txheem inflammatory (cholangitis) uas cuam tshuam rau phab ntsa ntawm cov kua tsib.
- External compression of the bile ducts: vim yog pancreatitis lossis lymphadenitis ntawm lub portal lossis mesenteric nodes. Thaum cov kabmob no loj tuaj, lawv tuaj yeem ua rau cov ducts ntawm sab nraud thiab cuam tshuam rau lawv.
Cov tsos mob ntawm cholestasis hauv dev
Cov cim tseem ceeb ntawm cholestasis yog jaundice, uas muaj cov xim daj uas pom nyob rau theem ntawm daim tawv nqaij thiab mucous daim nyias nyias. Raws li qhov tshwm sim ntawm bilirubin deposition. Feem ntau, bilirubin raug tso tawm los ntawm cov kua tsib, txawm li cas los xij, nyob rau hauv cov ntaub ntawv ntawm cholestasis, cov xim no accumulates hauv daim siab thiab nkag mus rau hauv cov ntshav, ua rau hyperbilirubinemia (nce qib ntawm bilirubin hauv cov ntshav). Thaum cov qib bilirubin hauv cov ntshav siab dua 2 mg / dl, nws tau tso rau hauv cov ntaub so ntswg, ua rau mob daj ntseg. Hauv cov dev, jaundice pom tau yooj yim dua ntawm qib ntawm sclera, txawm hais tias nws tuaj yeem pom nyob rau hauv qhov ncauj mucosa, qhov chaw mos mucosa thiab txawm nyob rau hauv daim tawv nqaij thaum bilirubin qib siab heev.
Ntxiv nrog rau jaundice, thaum tag nrho cov kab mob ntawm cov ducts tshwm sim, cov tsos mob hauv qab no yuav raug soj ntsuam:
- Maldigestion/malabsorption syndrome: cov kua tsib ntsev uas muaj nyob rau hauv cov kua tsib yog qhov tseem ceeb rau kev zom thiab nqus cov rog. Thaum cov kua tsib tsis tuaj yeem ncav cuag txoj hnyuv, ib qho maldigestion/malabsorption syndrome tshwm, uas tshwm sim los ntawm cov tsos mob ntawm osmotic-type raws plab.
- Steatorrhea: muaj cov rog nyob hauv cov quav. Thaum cov kua tsib ntsev tsis ncav cuag txoj hnyuv, cov rog tsis zom los yog nqus tau, yog li lawv raug tshem tawm nrog cov quav.
- Faeces tsis muaj xim (acholic): xim ntawm cov quav yog vim muaj cov stercobilinogen, metabolite tau los ntawm bilirubin. Hauv cov neeg mob cholestasis, bilirubin uas muaj nyob rau hauv cov kua tsib tsis ncav cuag txoj hnyuv, uas txhais tau hais tias stercobilinogen tsis tsim thiab cov quav tsis muaj xim.
- Bleeding tendency: Thaum lub sij hawm cholestasis, malabsorption ntawm vitamin K tshwm sim. los ntshav.
- Bacterial Cholangitis: Thaum qhov kev cuam tshuam tiav lawm, cov kab mob ntawm txoj hnyuv tuaj yeem nce mus rau cov kab mob bile thiab colonize cov ducts, ua rau muaj kab mob. cholangitis
Thaum muaj ib qho mob ntxiv uas ua rau lub sijhawm dhau mus, cov ducts los yog lub gallbladder nws tus kheej tuaj yeem tawg. Thaum cov kua tsib poob mus rau hauv lub plab kab noj hniav, nws tsim ib tug peritonitis uas tuaj yeem septic lossis aseptic, nyob ntawm seb puas muaj kab mob kis tau.
Diagnosis of cholestasis in dogs
Thaum peb tau piav qhia txog cov laj thawj tseem ceeb thiab cov tsos mob cuam tshuam nrog cholestasis, peb yuav piav qhia nws qhov kev kuaj mob.
Tshwj xeeb, txoj kev kuaj mob rau cholestasis hauv dev yuav tsum ua raws li cov ntsiab lus hauv qab no:
- : Raws li peb tau piav qhia nyob rau hauv tshooj dhau los, cov dev uas muaj cholestasis feem ntau muaj jaundice, txawm tias lawv tuaj yeem saib rau plab zom mov (zaub, steatorrhea, thiab cov quav tsis xim), nrog rau mob plab.
- Ntshav tsom xam nrog daim siab profile: cov yam ntxwv tshaj plaws ntawm cholestasis yog qhov nce hauv ob lub siab enzymes, alkaline phosphatase thiab GGT (gamma- glutamyl transpeptidase). Qhov nce hauv cov enzymes no tshwm sim ua ntej qhov pib ntawm jaundice. Tsis tas li ntawd, kev nce qib ntawm bilirubin hauv cov ntshav tuaj yeem pom.
- Abdominal ultrasound: Thaum muaj qhov txhaws ntawm cov ducts, cov kua tsib tsis tuaj yeem ncav cuag txoj hnyuv, yog li nws khaws cia hauv cov ducts. Raws li qhov tshwm sim, muaj qhov nthuav dav ntawm cov kua tsib thiab / lossis lub gallbladder uas tuaj yeem pom los ntawm ultrasound. Txawm li cas los xij, lub gallbladder yuav tsuas yog dilated vim anorexia (vim yog tias tus tsiaj tsis noj, qhov stimulus rau nws qhov khoob tsis tsim). Yog li ntawd, txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau, nws yog ib qho tsim nyog yuav tsum ua kom pom tsis yog tsuas yog dilatation xwb, tab sis kuj yog qhov ua rau obstructive. Nyob rau hauv cov ntaub ntawv ntawm lub gallbladder rupture, ib tug tsis zoo lub gallbladder cheeb tsam thiab muaj cov kua dej dawb nyob rau hauv lub plab yuav pom.
- MRI: Qhov kev kuaj pom zoo no tuaj yeem pab tshawb pom qhov muaj kev cuam tshuam ntawm qib ntawm cov kab mob biliary extrahepatic.
- Exploratory laparotomy: thaum lub ultrasound qhia txog qhov dilation ntawm cov ducts, tab sis tsis pom qhov ua rau ntawm qhov kev cuam tshuam, kev tshawb nrhiav kev phais ntawm lub cev. plab kab noj hniav tej zaum yuav tsim nyog los soj ntsuam cov causal.
Tshuaj rau cholestasis hauv dev
Kev kho tus mob cholestasis hauv dev yuav tsum yog qhia txog qhov ua rau nws, thiab tej zaum yuav muaj xws li kev kho mob, kev kho mob phais lossis ob qho tib si. ntawm lawv.
Kev kho mob yuav txawv nyob ntawm qhov ua rau cholestasis, thiab tej zaum yuav raug muab tshuaj hepatoprotectors (xws li ursodeoxycholic acid lossis silymarin), tshuaj tua kab mob, vitamin supplements (xws li vitamin K, E lossis D),kho kua dej thaum lub cev qhuav dej, thiab lwm yam. Tsis tas li ntawd, nws yog ib qho tseem ceeb kom txwv tsis pub muaj roj cov ntsiab lus ntawm cov khoom noj kom txog thaum cov kua tsib ntws mus rau txoj hnyuv rov qab los. Yog li, cov khoom noj uas txwv tsis pub rau cov dev uas muaj cholestasis yog cov rog rog.
Kev kho mob phais feem ntau yog tsim nyog thaum cholestasis tshwm sim los ntawm kev cuam tshuam ntawm lub siab. Cov kev xaiv phais yuav suav nrog:
- The Gallbladder tshem tawm (cholecystectomy), vim tus dev tsis muaj lub gallbladder tseem tuaj yeem muaj lub neej zoo.
- qhib lub gallbladder los yog cov kua tsibtshem tawm pob zeb, txhaws, los yog lwm yam uas thaiv cov kua tsib.
- Placing bile duct stents kom lawv qhib rau cov kua tsib.
- Thov tshem cov qog uas sab nraud compress cov ducts.
Raws li peb tau pom, tsis muaj kev kho mob cholestasis hauv cov dev, dhau ntawm kev hloov cov zaub mov, yog li yuav tsum tau mus ntsib kws kho tsiaj kom tau txais kev kuaj mob thiab kho kom raug.
