Zakudya ndi kuchuluka bilirubin

Kufotokozera kogwirizana ndi 29.06.2017

Kuchita bwino: kuchiritsa pambuyo 21 masiku
Madeti: kuyambira miyezi itatu ndi kupitilira
Mtengo Wogulitsa: 1300-1400 rubles pa sabata

Malamulo onse

Bilirubin opangidwa ndi kuwola hemoglobin mu maselo ofiira amwaziOmaliza moyo wawo (owonongedwa Pambuyo pa masiku 120). Nthawi zambiri, 80-85% ya bilirubin imapangidwa patsiku. Plasma bilirubin ali womangika kwambiri ku albumin. Chiwindi chimagwira gawo lofunikira pakusinthanitsa kwa mitundu ya bile. Imazilandira ndikudziunjikira mkati mwa khungu, ndimanga (kapena conjugates ndipo izi zimalepheretsa kutulutsa kwa bilirubin m'magazi) ndikuchotsa mu bile. Ndilo gawo lotsiriza lino lomwe limasokonezeka ma cell a chiwindi atawonongeka - bilirubin yomangidwa imalowa mu ndulu pang'ono ndipo bilirubin yosasunthika imachokera ku maselo a chiwindi kupita kumagazi, komwe imakhalapo yochulukirapo (hyperbilirubinemia).

Mawonekedwe owonetsa a hyperbilirubinemia ndi jaundice. Pali pafupifupi ma syndromes ndi matenda 50 omwe amatsatana ndi kufalikira kwa pakhungu komanso mucous nembanemba. Akuluakulu, madontho a khungu amadziwika pamlingo wa bilirubin wopitilira 34 μmol / L. Ndi bilirubin yochulukirapo, kuwonjezera pa chizindikiro ichi, odwala amawoneka mutukubweza kugona, khungu loyenda, kutopa.

Zomwe zimapangitsa kuchuluka kwa bilirubin:

matenda a chiwindi (pachimake komanso aakulu) chiwindikuchepa kwamafuta, intrahepatic cholestasis, matenda amatsengaautoimmune chiwindi, chidakwa ndi mankhwala oopsa a hepatitis) ndi bile ducts,
hemolytic anemia,
matenda kapamba
ntchito hyperbilirubinemia (cholowa m'mabanja Kriegler-Nayyar syndromes, Dabin Jones, Zoyota, Gilbert).

Yotsirizirayi imakhala pamalo oyamba pafupipafupi pakati pazobadwa nazo zothandizira bilirubinemia. At Matenda a Gilbert (cholowa m'magazi hepatosis) mwa odwala, kuchuluka kwa bilirubin kosakhazikika kumakwezedwa chifukwa cha kuwonongeka kwa khungu la chiwindi ndikumanga kwa glucuronic acid mkati mwake (chomalizirachi chikufotokozedwa ndi kusowa kwa enzyme). Bilirubin yosasunthika imasungunuka mosavuta m'mafuta, imalumikizana ndi ma phospholipids a membrane wama cell a ubongo, motero amakhala ndi vuto la neurotoxic. Nthawi zambiri odwala amadandaula za kufooka, kugona pang'ono, kukhumudwa, kusokonezedwa.

Odwala nthawi ndi nthawi amawonekera kuwonjezeka kwa sclera ndi khungu losiyanasiyana. Izi zimadziwika kwambiri pankhope, makona atatu a nasolabial, miyendo ndi manja, mabowo a axillary. Komanso nkhawa bradycardia komanso zomaliza hypotension.

Jaundice amakhala woipa kwambiri ndi mowa, kuchuluka kwa thupi, atachitidwa opaleshoni, kumwa sulfonamideskulera kwamlomo salicylates ndi matenda opatsirana (nthawi zina matendawa amayambika ndi chiwindi A) Matendawa ndi abwino, ngakhale hyperbilirubinemia imapitilira moyo. Kuzindikira kwakukulu kwa odwalawa kumayambitsa hepatotoxic (mankhwala, mowa, mankhwala amkati) amadziwika.

Kuti mudziwe zomwe zimayambitsa matendawa (organic pathology kapena zinchito), kuyeza ndi kudya ndikofunikira. Zakudya zokhala ndi bilirubin yambiri m'magazi ziyenera kupulumutsa chiwindi ndi ziwalo zina zam'mimba. Izi ndi Zakudya nambala 5analimbikitsa matenda osiyanasiyana a chiwindi ndi ndulu.

Amapereka kuteteza chiwindi moyenera, kusintha kwamafuta ndi pigment, komanso kutuluka kwa bile. Muli ndi mafuta ochepa (chifukwa chakuchepa kwa omwe amakankhira kumbuyo), mchere wa tebulo, umaletsa kudya zakudya zamafuta ambiri (chiwindi cha nyama, nyama ya mbalame yamphaka, nyama zosuta, sardines, yisiti yophika mkate, tuna, zikwangwani, hering'i, nsomba ya salmon, bowa wa porcini wowuma, shrimps , ma mussels).

Zakudya zomwe zili ndi bilirubin wokwera ziziphatikizanso zokwanira pectin ndi fiber (masamba, zipatso, zipatso). Kuyambitsa kutulutsa kwa bile, zopangidwa ndi choleretic zilipo m'zakudya: mafuta a masamba, chinangwa, timadziti (kabichi, beetroot). Zakudyazi ndizopezeka mu lipotropic zinthu (ng'ombe, nsomba zamafuta ochepa, tchizi tchizi, soya, Whey, Buckwheat), zomwe zimateteza chiwindi kuti chisawonongeke mafuta ndikuchepetsa chiopsezo cha miyala ya cholesterol. CHIKWANGWANI chamafuta ndi polyunsaturated mafuta acids (mafuta amasamba ali ndizambiri mwa iwo) amakhalanso ndi lipotropic.

Kuteteza kwa chiwindi kwamankhwala kumapangidwa ndi mbale zowiritsa, zophika kapena zophika. Pazakudya, kugwiritsa ntchito zakudya yokazinga ndizoletsedwa, koma mbale sizingathe kupukutidwa. Mfundo za zakudya zopatsa chidwi m'magawo ang'onoang'ono ndizofunikira - izi sizidzaza chiwindi ndi ziwalo zina zam'mimba, komanso zimathandizira kutuluka kwa bile. Zofunikira pazakudya ndizamasamba ndipo kapangidwe kake ndizosiyanasiyana. Iwo, komanso zipatso ndi zipatso, amathanso kudyedwa mwa mtundu uliwonse.

Kusankhidwa kwa nyama kumakhalanso kosiyanasiyana - ng'ombe, nyama yamwana wamkaka ndi nyama ya nkhumba yopanda mafuta, komanso nkhuku ndi nkhuku. Ndikofunika kuti muzikonda nsomba zamafuta ochepa, zomwe zimayenera kudyedwa katatu pa sabata. Mwambiri, chakudya chimakhala chokwanira komanso chopatsa thanzi (mapuloteni amakhala ndi 100 g, chakudya - 400 g, mafuta - 80-90 g). Zakumwa zoledzeretsa ziyenera kukhala zochulukirapo - mpaka malita 2.5 patsiku. Chakumwa chizikhala madzi patebulo popanda gasi, zakumwa za zipatso, zopindika, zotupa za zitsamba.

Zosaloledwa kugwiritsa ntchito:

malonda okhala ndi zoteteza, utoto,
nyama yamafuta, zakudya yokazinga, chiwindi, ubongo, zakudya zamzitini, nyama zosuta, impso, mphodza (zokhala ndi zochulukirapo), masoseji, mafuta anyama, mafuta ophika,
mphamvu yampweya yolimbitsa (ma nyemba, mapira, nthawi zina - kabichi yoyera, ngati kulekerera kwake kulibe bwino),
zotupa zam'mimba zamatumbo zolimbikitsira (mafuta am'madzi, viniga, masamba osazidwa, mpiru, zonunkhira, bowa, zakudya zowuma ndi mchere),
zopangidwa ndi mafuta ofunikira (anyezi wobiriwira, adyo, ma turnips, mitundu yonse ya radara, radara),
broth kuchokera ku nyemba, nsomba, bowa, nyama,
kirimu, wowawasa wowawasa, tchizi chamafuta,
zipatso zowawasa (plums, cranberries, zipatso za malalanje),
cocoa, zakumwa za gasi, khofi, chokoleti, ayisikilimu, confectionery ya zonona.

Zakudya liti Matenda a Gilbert sizosiyana ndi zomwe tafotokozazi, koma ndi matendawa, monga mulibe ena, ndikofunikira kwambiri kuti musalole nthawi yayitali kudya zakudya. Mwa odwalawa, njala imatsagana ndi kuwonjezeka kwa mulirubin wosakwaniritsidwa. Kuti adziwe matendawa, amachitanso mayeso othamanga. Pakadutsa masiku awiri, wodwalayo amalandila zakudya zama calorie ochepa (400 kcal). Pambuyo pa masiku awiri, bilirubin imatsimikiziridwa ndikufanizira ndi zisonyezo musanayambe kuphunzira. Zoyesedwa zimawoneka zabwino ngati mulingo wa bilirubin ukwera ndi 50-100%. Kuphatikiza apo, odwala omwe ali ndi matendawa amafunikira kuwona kuchuluka kwa madzi, komwe ndiko kupewa kupewa kwa bile. Ma Microelements ndi mavitamini osungunuka mafuta monga mitundu ya mankhwala amathandizidwanso mu chakudya.

Mkulu bilirubin m'magazi mwa akulu: zoyambitsa ndi zamankhwala

Mwazi uli ndi zinthu zambiri zosiyanasiyana. Iliyonse ya iyo ili ndi mfundo zake. Kuchulukitsa zizindikiro zomwe zakhazikitsidwa kumawonetsa kukhalapo kwa ma pathologies kapena zovuta zina. Chimodzi mwazinthu izi ndi bilirubin. Imagwira ntchito yofunika ndipo, pomwe magazi ake ndiwochuluka, njira zochiritsira zimafunikira.

Bilirubin ndi mtundu wa bile womwe umapangidwa chifukwa cha kuphulika kwa hemoglobin

M'maselo ofiira a magazi ndi hemoglobin, yomwe imanyamula mpweya kuchokera m'mapapu kupita kuzinthu zonse za thupi. Koma pamene maselo amwazi sangathenso kuchita ntchito zawo, amawonongeka mu chiwindi, ndulu ndi mafuta m'mafupa. Hemoglobin imamasulidwa ndikusinthidwa kukhala bilirubin.

Kanema (dinani kusewera).

Koma ma cell omwe amapangidwa amakhala owopsa kwa thupi ndipo amakhala ndi vuto loyipa. Ichi ndichifukwa chake umalowa m'chiwindi, momwe umasinthidwa ndi zinthu zosiyanasiyana. Chifukwa chake, mtundu wosadziwika wa chinthu umapezedwa, womwe umatsitsidwa ndi ndulu, ndikuwuchotsa m'thupi limodzi ndi mkodzo.

Kusintha kwa chinthu ndichinthu chovuta kwambiri kupangira mankhwala.

Kuphwanya pamitundu yosiyanasiyana ya kutembenuka kwa hemoglobin kukhala bilirubin wosalunjika kumayambitsa kusintha pamlingo wake. Zizindikiro zimawerengedwa kuti ndizofunika kwambiri pakuwonetsa matenda osiyanasiyana.

Mankhwala, chinthu chimagawika m'magulu awiri:

Zachindunji. Imasungunuka m'mafuta okha ndipo imapangidwa ndi kuphulika kwa hemoglobin. Amawonedwa kuti ndi owopsa mthupi, popeza imalowa mosavuta m'maselo, ndikusokoneza kugwira ntchito kwa ziwalo zina.
Zowongolera. Amapangidwa m'chiwindi. Imasungunuka m'madzi, ndipo sikuti ndiwowopsa m'thupi. Amapukusidwa mwachilengedwe ndi bile.

Direct mtundu wa bilirubin ndiotetezeka kwathunthu kwa thupi, popeza kale sizimasinthidwa ndi michere ya chiwindi. Thupi silikhudzana ndi ntchito ya machitidwe ndi ziwalo zosiyanasiyana, limamasulidwa mosavuta m'thupi. Mukazindikiritsa, mulingo wa bilirubin mwachindunji komanso osadziwika umatsimikiziridwa.

Kuti mudziwe mulingo wa bilirubin, magazi amayenera kuperekedwa kuti aunike zamankhwala am'thupi

Bilirubin ali m'magazi a munthu. Ichi ndichifukwa chake magazi amatengedwa kuti akhazikitse gawo la zomwe zili. Kuti zisonyezo zikhale zodalirika, wodwalayo ayenera kutsatira malamulo angapo.

Choyamba, muyenera kusiya zakudya osachepera maola 12 musanachitike njirayi. Ndikofunikanso kupatula nthawi yovuta komanso yolimbitsa thupi. Maola awiri musanatenge magazi kuti muunikirane, osavomerezeka kuti musute.

Kusanthula kumawonetsa zizindikiro zitatu:

Chizindikiro Chambiri. Sayenera kukhala wotsika kuposa 5.1 mmol / l, koma osapitilira 17 mmol / l.
Zachindunji. Zomwe zimadziwika kuti zimachokera ku 3.4 mpaka 12 mmol / l.
Zowongolera. Chizindikirochi chikhoza kusiyana kuchokera pa 1.7 mpaka 5.1 mmol / L.

Zizindikiro za chinthucho malinga ndi jenda sizothandiza ndipo sizisintha pakati pa zaka zapakati pa 18 ndi 60.

Mukamayang'ana zotsatira za phunziroli, katswiriyo samangotengera kuchuluka kwa bilirubin, komanso mwachindunji komanso m'njira zina.

Kuwonjezeka kwa kuchuluka kwa bilirubin mwachindunji kumachitika chifukwa cha kusintha kwa kutuluka kwa bile, chifukwa chomwe amalowa m'matumbo osasunthidwira m'mimba, koma amayenda limodzi ndi magazi.

Dziwitsani bilirubin imakuthandizani kuti muwone momwe chiwindi chimagwirira ntchito komanso momwe amagwirira ntchito

Zomwe zimayambitsa kuphwanya izi ndi matenda otsatirawa:

The pachimake mawonekedwe a chiwindi hepatitis, mwachitsanzo, hepatitis A, B kapena matenda mononucleosis.
Hepatitis yachilengedwe.
Mankhwala otupa chiwindi obwera chifukwa cha kugwiritsa ntchito mankhwalawa kwa magulu osiyanasiyana (zotupa, chifuwa kapena kutupa).
Autoimmune hepatitis.
Hepatitis yoyambitsidwa ndi poyizoni ndi zinthu zapoizoni kapena bowa wapoizoni.
Matenda a Gallstone.
Khansa m'chiwindi, kapamba kapena chikhodzodzo.
Dabin-Johnson kapena Rotor Syndrome.

Pozindikira, kuwonjezeka kwa kuchuluka kwa bilirubin yosawerengeka kumawonedwanso. Vutoli limayambitsidwa ndi matenda otsatirawa:

Matenda opatsirana. Ambiri omwe amapezeka ndi sepsis, typhoid fever ndi malungo.
Congenital hemolytic magazi m'thupi. Matenda ofanana ndi omwe ali ndi matenda a Markyafavi-Michele, osakhala spherocytic, thalassemia ndi ena.
Syndromes of Lucy-Driscola, Krigler-Nayyar, Gilbert.
Kuperewera kwa magazi m'thupi komwe kumayambitsidwa ndi kulumidwa ndi njoka zapoizoni, poyizoni ndi poyizoni ndi ziphe zingapo, zitsulo zolemera, lead, arsenic.
Anemia opatsirana pogwiritsa ntchito mankhwala a NSAIDs, insulin kapena aspirin nthawi yayitali.

Zomwe zimawonjezera kuchuluka kwa bilirubin yosalunjika m'magazi imatha kupezeka ndi autoimmune hemolytic anemia, yomwe imachitika motsutsana ndi maziko a nyamakazi, lupus erythematosus, ndi matenda ena.

Bilirubin wokwera ili ndi mawonekedwe ake osiyana, malinga ndi momwe mungakayikire kukhalapo kwa kuphwanya popanda kuyezetsa magazi. Kusanthula ndi umboni chabe wakuwonjezeka kwazinthu zachilengedwe m'magazi.

Kutupa kwa khungu ndi mucous nembanemba ndi zizindikiro za bilirubin wokwera

Ndi kuchuluka kwa bilirubin, zizindikiro zazikulu ndi:

Matenda a dyspeptic, omwe amawoneka ngati chosangalatsa pambuyo pake mkamwa ndi mseru.
Mutu.
Maonekedwe mu chilankhulo cha imvi kapena choyera. Ili ndi mawonekedwe osinthika
Chizungulire
Khungu loyera.
Kutopa
Kulankhula kwa mucous nembanemba mkamwa ndi khungu.
Ndowe zopanda utoto.
Mthunzi wakuda wa mkodzo.

Palinso kumachitika kosasangalatsa mu hypochondrium yoyenera, yomwe imayambitsidwa ndi kukula kwamphamvu kwa chiwindi. Mukatha kudya zakudya zamafuta ndi zolemera, kutentha kwadzidzidzi ndi kuyamwa kumachitika. Vuto la Stool lingachitike. Mu milandu yomwe chifukwa chopitilira muyeso wa bilirubin ndi chiwindi cha hepatitis, kuwonjezereka kwa kutentha kwa thupi kumadziwikanso.

Milingo yodziwika yokwanira ya bilirubin chifukwa cha njira zamakono zamankhwala imatha kukhala popanda zotsatirapo zakepi. Koma pokhapokha ngati palibe chithandizo chamankhwala, matendawa atha kubweretsa mavuto ambiri, omwe ndi awa:

Kuphwanya ntchito kwa zida zonse ndi ziwalo.
Encephalopathy
Aakulu mawonekedwe a cholecystitis.
Mapangidwe amiyala yamiyala.
Viral mawonekedwe a chiwindi.
Matenda a chiwindi.

Poyerekeza ndi maziko apamwamba kwambiri kuposa bilirubin yokhazikika, kusintha kwa njira zomwe sizingasinthike zimawonedwa. Vutoli limathanso kudwala.

Chithandizo cha mankhwalawa ndicholinga chothetsa chomwe chinayambitsa kuchuluka kwa pigment

Kubwezeretsa kuchuluka kwa bilirubin m'magazi, ndikofunikira kukhazikitsa chomwe chimayambitsa kusintha. Nthawi zambiri ntchito kulowetsedwa, zomwe zimaphatikizira mtsempha wamagazi ndi njira zamchere. Izi zimathandiza kuchotsa zizindikiritso za kuledzera ndikuchotsa zinthu za metabolic m'thupi.

Nthawi zina, Phototherapy imagwiritsidwanso ntchito. Njirayi imaphatikizira kuwirira ndi nyali zapadera. Mothandizidwa ndi ma ray, kutembenuka kwa bilirubin yosalunjika kukhala bilirubin mwachindunji kumayang'aniridwa, komwe kumachotsedwa m'thupi.

Mankhwala amathandizidwa kusintha matenda a bile, komanso omwe bilirubin amawachotsanso. Njira zimagwiritsidwanso ntchito pothandiza kuchepetsa kuledzera. Nthawi zambiri, odwala amatumizidwa kukonzanso kaboni.

Muzochitika zomwe kuchuluka kwa bilirubin m'magazi kumayamba chifukwa cha hepatitis, ndiye kuti chithandizo chamankhwala chothetsa kachilomboka ndi mankhwala.

Kugwiritsa ntchito mankhwala opangidwa kuti ateteze chiwindi ku zotsatira zoyipa ndikupewa kuchitika kwa cirrhosis akuwonetsedwa. Pozindikira matenda a Gilbert ndi mavuto ena, chithandizo chiyenera kuyikidwa kokha ndi katswiri malinga ndi momwe wodwalayo alili, mtundu wake, mawonekedwe ake ndi kuchuluka kwake kwa matendawo.

Hepatoprotectors amagwiritsidwa ntchito pakuwonongeka kwa chiwindi. Ma immunomodulating, antibacterial ndi antiviral nawo amadziwikanso. Kugwiritsa ntchito maphikidwe a mankhwala achilengedwe kuti muchepetse kuchuluka kwa bilirubin m'magazi ndizoletsedwa.Izi ndichifukwa choti pamakhala zinthu zambiri zoyambitsa vutoli ndipo kulandira chithandizo mosayenera kumabweretsa zotsatirapo zoyipa.

Chakudya chizikhala pafupipafupi (nthawi 5-6 patsiku) komanso kupindika, osamadya kwambiri

Bilirubin yayikulu m'magazi imafunikanso kukonza zakudya. Zakudya zimathandizira kuchepetsa katundu pa chiwindi. Odwala ayenera makamaka kuchepetsa kuchuluka kwa mchere womwe umatha. Zakudya zimalimbikitsidwa kuti ziphike popanda izo. Amaloledwa kugwiritsa ntchito zosaposa 10 magalamu patsiku.

Ndikofunikanso kuthetseratu kugwiritsa ntchito ma pickles, marinade, nyama zosuta, komanso nyama ndi nsomba zam'chitini. Odwala amaletsedwa kudya msuzi wamafuta, bowa, mizimu, zipatso zosapsa ndi zipatso. Mukamaphika, musagwiritse ntchito zonunkhira.

Ndi kuchuluka bilirubin mu zakudya muyenera kulowa:

Zinthu zamkaka zokhala ndi mafuta ochepa.
Zotsekemera zotsekemera.
Shuga ndi uchi.
Nyama yotsika.
Porridge pamadzi.
Mafuta ophikira.

Ndikofunikira kuwona boma lakumwa, ndikugulitsa zinthu zonse kuti zitheke. Chizindikiro chowonjezeka cha bilirubin m'magazi chimadziwika ndi zizindikiro zowopsa, zomwe zimakupatsani mwayi wodziwa kuphwanya panthawi. Ndikofunika kukhazikitsa chomwe chimayambitsa matendawa ndikuwapatsa chithandizo.

Zambiri zokhudzana ndi bilirubin zimapezeka mu kanema:

Odwala sayenera kumwa mankhwala okhawo omwe amamwa, komanso kutsatira zakudya. Kuperewera kwa chithandizo chamankhwala kapena chithandizo chosayenera kungayambitse zotsatirapo zoyipa kwambiri. Chifukwa chake simuyenera kusiya kupita kwa dokotala.

Kufotokozera kogwirizana ndi 29.06.2017

Kuchita bwino: kuchiritsa pambuyo 21 masiku
Madeti: kuyambira miyezi itatu ndi kupitilira
Mtengo Wogulitsa: 1300-1400 rubles pa sabata

Zomwe zimapangitsa kuchuluka kwa bilirubin:

matenda a chiwindi (pachimake komanso aakulu) chiwindikuchepa kwamafuta, intrahepatic cholestasis, matenda amatsengaautoimmune chiwindi, chidakwa ndi mankhwala oopsa a hepatitis) ndi bile ducts,
hemolytic anemia,
matenda kapamba
ntchito hyperbilirubinemia (cholowa m'mabanja Kriegler-Nayyar syndromes, Dabin Jones, Zoyota, Gilbert).

Odwala nthawi ndi nthawi amawonekera kuwonjezeka kwa sclera ndi khungu losiyanasiyana. Izi zimadziwika kwambiri pankhope, makona atatu a nasolabial, miyendo ndi manja, mabowo a axillary. Komanso nkhawa bradycardia komanso zomaliza hypotension.

Zosaloledwa kugwiritsa ntchito:

malonda okhala ndi zoteteza, utoto,
nyama yamafuta, zakudya yokazinga, chiwindi, ubongo, zakudya zamzitini, nyama zosuta, impso, mphodza (zokhala ndi zochulukirapo), masoseji, mafuta anyama, mafuta ophika,
mphamvu yampweya yolimbitsa (ma nyemba, mapira, nthawi zina - kabichi yoyera, ngati kulekerera kwake kulibe bwino),
zotupa zam'mimba zamatumbo zolimbikitsira (mafuta am'madzi, viniga, masamba osazidwa, mpiru, zonunkhira, bowa, zakudya zowuma ndi mchere),
zopangidwa ndi mafuta ofunikira (anyezi wobiriwira, adyo, ma turnips, mitundu yonse ya radara, radara),
broth kuchokera ku nyemba, nsomba, bowa, nyama,
kirimu, wowawasa wowawasa, tchizi chamafuta,
zipatso zowawasa (plums, cranberries, zipatso za malalanje),
cocoa, zakumwa za gasi, khofi, chokoleti, ayisikilimu, confectionery ya zonona.

Kodi bilirubin yokwera imatanthawuza chiyani: zoyambitsa, chithandizo ndi zakudya mwa akulu

Bilirubin ndi mtundu wapadera wachikasu wachikasu ndi utoto wonyezimira wobiriwira. Amapangidwa chifukwa chakuwonongeka kwa hemoglobin. Thupi laumunthu limakhala ndi bilirubin m'malo momwe magazi ndi bile. Kusunga izi munthawi yofananira kumapangitsa phindu la ntchito ya chiwindi. Njira ya metabolic ya enzyme yomwe ili pamfunso ndi zovuta zamachitidwe amakanidwe: zimachitika mosalekeza mthupi la munthu wathanzi. Kuphwanya njirayi munthawi iliyonse kukuwonetsedwa mu mawonekedwe a magazi seramu, omwe angayambike mosavuta chifukwa cha maphunziro a biochemical of samples a chiwindi.

Kodi nchifukwa chiyani bilirubin yathunthu imakwera munthu wamkulu?

Enzyme ndi chidziwitso chofunikira cha magwiridwe antchito a machitidwe angapo amthupi nthawi imodzi. Kwa munthu wamkulu, chizindikiro chokhazikika ndi 5.2-17 mmol / L - bilirubin, 3.5-12 mmol / L - osadziwika komanso 1.8-5.2 mmol / L - bilirubin mwachindunji.

Thupi limapukusidwa ndi thupi kudzera mu ndowe - ndiye michere ya chiwindi yomwe imapatsa chopondacho mthunzi wake.

Kuwonjezeka kwakukulu kwa chinthu cha bilirubin m'magazi kumachitika chifukwa cha kuchuluka kwa maselo ofiira a magazi. Kuwonongeka kwa minofu ya chiwindi kumayambitsa kuphwanya kwake kwa ntchito yake yowonekera. Zotsatira zake, kutuluka kwa ndulu kumachitika m'matumbo, zomwe zimakhala zopindulitsa pakupanga matenda ambiri.

Pali matenda angapo pakadutsa pomwe munthu adakweza ma enzymes a chiwindi m'magazi.

Pali zambiri zomwe zimayambitsa kuchuluka kwa bilirubin, ndipo popeza mawonekedwe ake ndiwambiri, ndikofunikira kudziwa koyambirira, komwe kudakhala maziko a izi.

Kukhazikika kuwonjezeka kwa kuchuluka kwa bilirubin mwa munthu wamkulu ndikosavuta: izi zitha kuchitika popanda kuyezetsa magazi, ndipo kuwunikaku kungatsimikizire kuti koyambirira kwawonekera.

Zizindikiro zazikulu za kukhathamiritsa kwa chiwindi mwa munthu wamkulu ndizomwe zidzachitike:

mutu
mavuto a dyspeptic (nseru, kulawa koyipa mkamwa, makamaka m'mawa),
imvi kapena zoyera kumaso;
chizungulire
kuyabwa pakhungu,
kutopa,
kuvunda kwakhungu kwa pakhungu ndi mucous nembanemba
mkodzo wakuda, ndowe zopanda utoto,
kusokonezeka mu hypochondrium yoyenera chifukwa cha kuchuluka kwa chiwindi, mafuta ndi zakudya zambiri zimayambitsa kusokonezeka, kupindika, nthawi zina kutentha mtima kapena kukhumudwa.

Ngati kuwonjezereka kwa bilirubin kumachitika motsutsana ndi kachilombo ka hepatitis komwe kali koyambira, chizindikiritso chofunikira kwambiri chidzakhala kutentha kwa thupi mpaka kuchuluka kwambiri.

Kuti adziwitse chomwe chiri chifukwa chakuwonongeka kwa thanzi, wochita zamatsenga ayenera poyamba. Kuyendera kumakuthandizani kuzindikira kusintha kwa mtundu wa sclera ndi khungu, kupezeka kwa zokutira kwamaso pamalilime, kuwonjezeka kwa chiwindi, komwe kumatha kugwiritsidwa ntchito, popeza limba lomwe limatupa limafotokoza momveka bwino.

Ngati zikutsimikiziridwa kuti vutoli ndi matenda a chiwindi, wodwalayo amatumizidwa kwa katswiri wa matenda a gastroenterologist kapena matenda opatsirana. Ngati pa nthawi ya chithandizo ndizodziwika kale pang'onopang'ono panjira yotupa, a oncologist amathandizidwa. Perekani kuyezetsa magazi a biochemical kuti mupeze kuchuluka kwa bilirubin mwachindunji komanso osadziwika, komanso AST ndi ALT (zitsanzo za chiwindi).

Kuphatikizika kwina kwa chiwindi kumachitika - izi zimakupatsani mwayi kuwona m'maganizo momwe mumakhalira parenchyma, ducts ya bile, mabwalo a ziwalo ndi malo ake.

Kayezetsa magazi mwatsatanetsatane adalembedwa - mwanjira imeneyi dokotala azitha kumvetsetsa bwino lomwe mkhalidwe wamthupi: leukocytosis imawonetsa kukhalapo kwa kutupa, pomwe kuchepa kwa hemoglobin kumawonetsa kukula kwa kuchepa kwa magazi. Njira yothandizirana imatha kukonzedwa pokhapokha pa mbiri yachipatala ya wodwalayo komanso chidziwitso chokwanira chomwe chimapezeka kudzera mu matenda othandizira odwala komanso othandizira.

Ndikosatheka kuchepetsa kuchuluka kwa bilirubin popanda kuthetsa matenda oyambitsidwa. Poletsa zomwe zimayambitsa, mutha kusintha kuchuluka kwa kuchuluka kwa magazi. Katswiri wazachipatala kapena wa matenda opatsirana okha ndi omwe ayenera kukonzekera njira yochizira, kutengera matendawo. Iliyonse ya njira zamankhwala yokhala ndi zidziwitso, ma contraindication ndi zovuta zingapo zoyipa. Munthu wopanda maphunziro oyenera amadzivulaza poyesa kugwiritsa ntchito mankhwala osokoneza bongo komanso njira zina. Njira zazikulu zochepetsera milingo ya bilirubin ndi izi:

Palinso unyinji wa mankhwala achikhalidwe - decoctions, infusions, koma kuyenera kwake ndi chitetezo chogwiritsa ntchito ziyenera kukambidwa ndi dokotala. Zina mwazitsamba ndi zomerazo zimakhala ndi mavuto, kuphatikiza palpitation, nseru, kusanza, chikumbumtima, kufooka, komanso kugona. Kuphatikiza ndi matenda omwe amayambitsa, sikuti nthawi zonse zimakhala zoyenera kugwiritsa ntchito maphikidwe a mankhwala achikhalidwe - izi zimatha kupotoza chithunzi chenicheni cha chipatala.

Kuchuluka kwa bilirubin m'magazi kumatsimikizika ndi momwe amagwirira ntchito mokwanira magawo onse a unyolo wa kupanga, kagayidwe ndi kutulutsa kwa bilirubin kuchokera mthupi. Njira yakuyeretsera kuchokera ku zinthu zowola zomaliza ziyenera kuchitika motsatizanatsatizana, osati mwachangu, mokwanira, popanda zolephera paliponse. Kusanthula kwa Laborator kumathandizira kuwunikira izi. Kupanda kutero, ndizosatheka kuzindikira kuwonjezeka kwa kuchuluka kwa chiwindi, kupanga matenda ndikuyamba kulandira chithandizo. Sichosavomerezeka kunyalanyaza zizindikilo zambiri za bilirubin: muyenera kufunafuna chithandizo choyenerera.

Bilirubin yathunthu mwa munthu wamkulu imakwezedwa: zimatanthawuza chiyani, matenda omwe angakhale omwe amayambitsa

Bilirubin ndi utoto wa lalanje ndi chikasu. Amapangika pakuphwanya kwachilengedwe kwa maselo ofiira a m'magazi (maselo ofiira am'magazi), kenako amatulutsidwa mu ndulu ndikutulutsidwamo. Bilirubin imatha kulembedwa ngati bilirubin yosalunjika (mawonekedwe aulere, osakhudzidwa kapena osalunjika), mtundu womwe ma pigment a bile samasungunuka m'madzi, umazungulira m'magazi momwe umalowera m'chiwindi, komwe umatenga mawonekedwe osungunuka (bilirubin mwachindunji). Ma bilirubin onse omwe amayenderera m'matumba pamodzi ndi madzi ofiira amatchedwa bilirubin yonse.

Kufotokozera mwatsatanetsatane bilirubin ndi njira zofananira

Bilirubin m'thupi imawonekeranso munthawi yomwe hemoglobin (puloteni yokhala ndi chitsulo) m'magazi ofiira amphongo aphulika. Kuwonongeka kwa maselo akale ndi njira yabwino, yathanzi. Pambuyo pakuzungulira m'magazi, bilirubin imatumizidwa ku chiwindi. Mu chiwindi, bilirubin imalumikizidwa, yosakanikirana ndi bile ndikupakidwa mu ducts ya bile ndipo imakhala kwakanthawi mu ndulu yanu. Mapeto ake, bile limatulutsidwa m'matumbo ang'onoang'ono kuti athandize kugaya mafuta, pambuyo pake limatuluka m'thupi lanu.

Mulingo wokwezeka wamtunduwu wa bile umatchedwa hyperbilirubinemia (Gilbert syndrome).Sikuti aliyense amadziwa kuti matendawa amafalikira kuchokera kwa bambo ndi mayi kupita kwa mwana, mwatsoka ndi matenda, msambo umakhala wokwera m'moyo wonse wamunthu.

Bilirubin yosavomerezeka imatha kuvulaza dongosolo lamkati lakhanda lomwe likubadwa kumene (mpaka masabata 2-4), silikuwopseza unyamata ndi akulu. Mu achinyamata ndi achikulire, "chotchinga cha magazi" ndichopangidwa kwambiri ndipo chimalepheretsa bilirubin kulowa maselo aubongo. Komabe, kuchuluka kwambiri kwa bilirubin kumaonetsa kukhalapo kwa machitidwe kapena matenda m'thupi omwe amafunikira kuzindikiridwa ndi kuthandizidwa.

Bilirubin nthawi zambiri samapezeka mkodzo. Komabe, conjugated (mawonedwe achindunji) samasungunuka madzi ndipo amatha kusiya thupi kudzera mkodzo ngati singathe kulowa mu ndulu. Kupezeka kwa pigment mumkodzo kumawonetsa kusagwira bwino ntchito kwa chiwindi kapena ducts ya hepatitis, kapena njira ina iliyonse yokhudzana ndi chiwalochi ndipo imatha kuwoneka koyambirira kwamatenda.

Madokotala azindikira bilirubin wokwera limodzi ndi mayeso ena a labotale (alkaline phosphatase, aspartate aminotransferase (AST), alanine aminotransferase (ALT) yokhudzana ndi mavuto a chiwindi. Laboratory matenda a bilirubin ikuchitika ndi:

Jaundice (matenda a Gospel)
Wodwala akamaledzera kapena akamwa kwambiri mowa,
Ngati mukukayikira kumwa mankhwala osokoneza bongo a mankhwalawa komanso oopsa,
Munthu akapatsidwa kachilombo ka hepatitis.

Kuyesedwa kwa magazi m'magazi kumatha kuthandizidwanso ngati mukukayikira hemolytic anemia monga chifukwa cha kuchepa kwa magazi (chikhalidwe chodziwika ndi hemoglobin wochepa kapena maselo ofiira amwazi m'magazi). Pankhaniyi, maphunziro owonjezera nthawi zambiri amalembedwa kuti ayese hemolysis (kuchuluka kwa magazi, kuwunika kwa reticulocyte, haptoglobin ndi lactate dehydrogenase (LDH)).

Zomwe zimakhudza magwiridwe ake osayenera:

Zifukwa zomwe simunakwaniritsire mayeso kapena chifukwa chomwe zotsatira zake sizingakhale zolondola zikuphatikiza:

Kumwa khofi kapena zinthu zopangidwa ndi khofi, zomwe zimachepetsa mulingo wa bile.
Kudziletsa pazakudya kwanthawi yayitali (kusala), komwe nthawi zambiri kumakulitsa kuchuluka kwa bilirubin yosalunjika.

Kuyeza magazi kwathunthu kwa bilirubin kukuwonetsa kuchuluka kwa bilirubin m'magazi anu onse: mwachindunji, mwachindunji komanso kwathunthu. Pansipa pali zikhalidwe zonse zitatu mwa munthu wamkulu:

Makhalidwe abwinobwino achindunji a bilirubin amachokera ku 1.8-5.2 mmol / L.
Makhalidwe abwinobwino a bilirubin wosiyanasiyana amasiyana m'njira zosiyanasiyana za 3.5-12 mmol / L.
Bilirubin yathunthu (yolunjika komanso yosalunjika) imasiyana m'magawo a 5.2-17 mmol / l.

Kodi zizindikiro za bilirubin yayikulu mwa akulu ndi ziti?

Akuluakulu, jaundice (matenda omwe amaphatikizidwa ndi chikasu cha khungu kapena sclera yamaaso) ndi kuyimitsidwa ndi zizindikiro zazikulu ndi zizindikiro zapamwamba za bilirubin m'magazi.

Izi ndi zina mwazomwe zimayambitsa kuchuluka kwa bilirubin ndi zizindikiritso zake (iyi ndi mndandanda wachidule, osati mndandanda wathunthu):

Zizindikiro zake komanso kuchepa kwa magazi m'thupi (monga zomwe zimayambitsa maselo ofiira am'magazi) zimaphatikizapo:

Zizindikiro zake za hepatitis yapakhungu ndi monga:

Kutopa
Matenda ofatsa
Kupweteka kwa minofu
Kusanza ndi kusanza
Chiellon

Zizindikiro zake ndi kutupa kwa biliary thirakiti ndi monga:

Mpando wopepuka
Mkodzo wakuda
Kuyabwa
Ululu kumanja kwamimba
Kusanza, kusanza,
Kuteteza khungu.

Zizindikiro za matenda opatsirana (mwachitsanzo, malungo):

Kutentha kwapakati / kuzizira,
Zofooka.

Matenda obadwa nawo (mwachitsanzo odwala matenda am'mimba komanso cholowa cholumikizira chiberekero) ali ndi zizindikiro zotsatirazi:

Kupweteka kwam'mimba
Kupuma pang'ono
Kutopa
Zofooka
Maselo ofiira samakhazikika.

Zizindikiro ndi zizindikiro za kulephera kwa chiwindi (zomwe zimayambitsa zingaphatikizepo cirrhosis, khansa ya chiwindi, uchidakwa, mankhwala osokoneza bongo, matenda a Gilbert ndi Krigler-Najar syndromes):

Mavuto a chiwindi osagwira bwino ntchito.

Komanso, mankhwalawa monga sulfonamides ndi nitrofurantoin (mankhwala omwe ali ndi antimicrobial effect) amatha kukulitsa kuchuluka kwa bilirubin, ndikuwonjezera kuchepa kwa maselo ofiira am'magazi. Ndipo mankhwala ngati atazanavir amachulukitsa bilirubin wosatsungula.

Monga lamulo, kuchuluka kwa ma bile kwa amuna ndi okwera kwambiri kuposa azimayi. Ku maamerika aku Africa, kuchuluka kwa zinthuzi kumakhala kotsika. Komanso, kulimbikira kapena kuchita masewera olimbitsa thupi kumatha kukulitsa kuchuluka kwa bilirubin m'magazi.

Kuika magazi - Zotsatira za kafukufuku komanso mayesero azachipatala omwe adachitika ku China akuwonetsa kuti njira iyi yochepetsera milingo yayitali ya bilirubin yokhala ndi zovuta zochepa ndi njira imodzi yothandiza kwambiri.

Mankhwala - kuchotsa mthupi ndikuchepetsa bilirubin, mutha kugwiritsa ntchito mankhwala osokoneza bongo monga salicylates, furosemide, ampicillin ndi ceftriaxone, (ena mwa mankhwalawo ndi owopsa, muyenera kufunsa dokotala).

Phototherapy (Phototherapy, opepuka mankhwala) - Hyperbilirubinemia yoyambitsidwa ndi jaundice imatha kuthandizidwa mosavomerezeka kapena popanda zotsatirapo zochepa mothandizidwa ndi Phototherapy (mankhwalawa ndi kuwala kwa dzuwa kapena kuwala kochita kupanga, ma ray). Kuchita bwino kwa Phototherapy kumadalira zinthu zambiri (zomwe zafotokozedwazi zikhala zothandiza mukamayankhula ndi dokotala):

Pafupifupi thupi lawonekera
Kuwonekera kwa gwero lowala: nthawi zambiri kuti mugwiritse ntchito bwino, machubu abuluu apadera omwe ali ndi chizindikiro F20T12 / BB m'malo mwa F20T12 / B amagwiritsidwa ntchito, pomwe njira zamagetsi kapena zotulutsa zimatha kuwonjezeredwa mu chipangizo cha Phototherapy, ndikuchepetsa mtunda kwa munthu yemwe ali mumataulo a 15-20 cm.
Kupitiliza Phototherapy kopitilira kumakhala kwabwinoko kuposa kukhala patapangidwe kenthawi pang'ono.

Magawo ochiritsira kapena othandizirana a fiber optic Phototherapy angagwiritsidwe ntchito, pokhapokha ngati jaundice si hemolytic kapena kupita patsogolo kwake.

M'mikhalidwe ya hemolytic jaundice, kuwonjezereka mwachangu kwa bilirubin kapena kusakwanira kwa chipika chachilendo, kugwiritsa ntchito kwambiri Phototherapy kumakhala kolondola.

Mitundu ya bilir bin ndi tanthauzo lake

Bilirubin ndi mtundu wa bile womwe umapangidwa chifukwa cha kuphulika kwa hemoglobin

Kusintha kwa chinthu ndichinthu chovuta kwambiri kupangira mankhwala.

Mankhwala, chinthu chimagawika m'magulu awiri:

Zachindunji. Imasungunuka m'mafuta okha ndipo imapangidwa ndi kuphulika kwa hemoglobin. Amawonedwa kuti ndi owopsa mthupi, popeza imalowa mosavuta m'maselo, ndikusokoneza kugwira ntchito kwa ziwalo zina.
Zowongolera. Amapangidwa m'chiwindi. Imasungunuka m'madzi, ndipo sikuti ndiwowopsa m'thupi. Amapukusidwa mwachilengedwe ndi bile.

Kuzindikira ndi zizolowezi

Kuti mudziwe mulingo wa bilirubin, magazi amayenera kuperekedwa kuti aunike zamankhwala am'thupi

Bilirubin ali m'magazi a munthu. Ichi ndichifukwa chake magazi amatengedwa kuti akhazikitse gawo la zomwe zili. Kuti zisonyezo zikhale zodalirika, wodwalayo ayenera kutsatira malamulo angapo.

Kusanthula kumawonetsa zizindikiro zitatu:

Chizindikiro Chambiri. Sayenera kukhala wotsika kuposa 5.1 mmol / l, koma osapitilira 17 mmol / l.
Zachindunji. Zomwe zimadziwika kuti zimachokera ku 3.4 mpaka 12 mmol / l.
Zowongolera. Chizindikirochi chikhoza kusiyana kuchokera pa 1.7 mpaka 5.1 mmol / L.

Zizindikiro za chinthucho malinga ndi jenda sizothandiza ndipo sizisintha pakati pa zaka zapakati pa 18 ndi 60.

Zoyambitsa Bilirubin

Mukamayang'ana zotsatira za phunziroli, katswiriyo samangotengera kuchuluka kwa bilirubin, komanso mwachindunji komanso m'njira zina.

Dziwitsani bilirubin imakuthandizani kuti muwone momwe chiwindi chimagwirira ntchito komanso momwe amagwirira ntchito

Zomwe zimayambitsa kuphwanya izi ndi matenda otsatirawa:

The pachimake mawonekedwe a chiwindi hepatitis, mwachitsanzo, hepatitis A, B kapena matenda mononucleosis.
Hepatitis yachilengedwe.
Mankhwala otupa chiwindi obwera chifukwa cha kugwiritsa ntchito mankhwalawa kwa magulu osiyanasiyana (zotupa, chifuwa kapena kutupa).
Autoimmune hepatitis.
Hepatitis yoyambitsidwa ndi poyizoni ndi zinthu zapoizoni kapena bowa wapoizoni.
Matenda a Gallstone.
Khansa m'chiwindi, kapamba kapena chikhodzodzo.
Dabin-Johnson kapena Rotor Syndrome.

Pozindikira, kuwonjezeka kwa kuchuluka kwa bilirubin yosawerengeka kumawonedwanso. Vutoli limayambitsidwa ndi matenda otsatirawa:

Matenda opatsirana. Ambiri omwe amapezeka ndi sepsis, typhoid fever ndi malungo.
Congenital hemolytic magazi m'thupi. Matenda ofanana ndi omwe ali ndi matenda a Markyafavi-Michele, osakhala spherocytic, thalassemia ndi ena.
Syndromes of Lucy-Driscola, Krigler-Nayyar, Gilbert.
Kuperewera kwa magazi m'thupi komwe kumayambitsidwa ndi kulumidwa ndi njoka zapoizoni, poyizoni ndi poyizoni ndi ziphe zingapo, zitsulo zolemera, lead, arsenic.
Anemia opatsirana pogwiritsa ntchito mankhwala a NSAIDs, insulin kapena aspirin nthawi yayitali.

Zizindikiro zophatikiza

Kutupa kwa khungu ndi mucous nembanemba ndi zizindikiro za bilirubin wokwera

Ndi kuchuluka kwa bilirubin, zizindikiro zazikulu ndi:

Matenda a dyspeptic, omwe amawoneka ngati chosangalatsa pambuyo pake mkamwa ndi mseru.
Mutu.
Maonekedwe mu chilankhulo cha imvi kapena choyera. Ili ndi mawonekedwe osinthika
Chizungulire
Khungu loyera.
Kutopa
Kulankhula kwa mucous nembanemba mkamwa ndi khungu.
Ndowe zopanda utoto.
Mthunzi wakuda wa mkodzo.

Kodi chiwopsezo cha bilirubin yayikulu ndi chiani?

Kuphwanya ntchito kwa zida zonse ndi ziwalo.
Encephalopathy
Aakulu mawonekedwe a cholecystitis.
Mapangidwe amiyala yamiyala.
Viral mawonekedwe a chiwindi.
Matenda a chiwindi.

Poyerekeza ndi maziko apamwamba kwambiri kuposa bilirubin yokhazikika, kusintha kwa njira zomwe sizingasinthike zimawonedwa. Vutoli limathanso kudwala.

Momwe mungasinthire miyeso ya bilirubin?

Chithandizo cha mankhwalawa ndicholinga chothetsa chomwe chinayambitsa kuchuluka kwa pigment

Muzochitika zomwe kuchuluka kwa bilirubin m'magazi kumayamba chifukwa cha hepatitis, ndiye kuti chithandizo chamankhwala chothetsa kachilomboka ndi mankhwala.

Hepatoprotectors amagwiritsidwa ntchito pakuwonongeka kwa chiwindi. Ma immunomodulating, antibacterial ndi antiviral nawo amadziwikanso. Kugwiritsa ntchito maphikidwe a mankhwala achilengedwe kuti muchepetse kuchuluka kwa bilirubin m'magazi ndizoletsedwa. Izi ndichifukwa choti pamakhala zinthu zambiri zoyambitsa vutoli ndipo kulandira chithandizo mosayenera kumabweretsa zotsatirapo zoyipa.

Malangizo azabwino

Chakudya chizikhala pafupipafupi (nthawi 5-6 patsiku) komanso kupindika, osamadya kwambiri

Ndi kuchuluka bilirubin mu zakudya muyenera kulowa:

Zinthu zamkaka zokhala ndi mafuta ochepa.
Zotsekemera zotsekemera.
Shuga ndi uchi.
Nyama yotsika.
Porridge pamadzi.
Mafuta ophikira.

Zambiri zokhudzana ndi bilirubin zimapezeka mu kanema:

Kodi mwazindikira kulakwitsa? Sankhani ndikusindikiza Ctrl + Lowanikutiuza.

Zizindikiro zakuwonjezeka kwa bilirubin

Ngati kuchuluka kwa bilirubin m'magazi kukwera kwambiri, wodwalayo amakhala ndi kamvekedwe ka khungu lachikaso ndi mkodzo wakuda. Izi zikusonyeza kuti kuchuluka kwa bilirubin komwe kwatupa m'matupi amunthu, ndikuwasunga mtundu wa imvi.

Komanso, momwe mulingo wa bilirubin ukuwonjezekera, munthu amatha kumva kusasangalala kumanzere kwa hypochondrium atatha kuchita masewera olimbitsa thupi, chifukwa chomwe wodwalayo angavutike, kufooka komanso kutentha thupi.

Ngati munthu ali ndi zizindikiro zotere, izi zikutanthauza kuti ndikofunikira kuchitira ziwalo zamkati. Muyenera kufunsa dokotala yemwe akamakuyezeni magazi kuti adziwe kuchuluka kwa bilirubin komanso kupereka chithandizo. Ngati mulingo wambiri wazinthuzi ndi wokwera kwambiri, izi zikusonyeza kuti pali zifukwa zina zothandizira matenda zomwe zimafunikira kuthandizidwa.

Nthawi zina, kuchuluka kovuta kwa bilirubin kumatha kuchuluka mpaka magawo 300, omwe ndi owopsa paumoyo ndipo amafunika chithandizo cham'tsogolo. Monga lamulo, zizindikiro za 300 μmol / lita zimatha kuyang'aniridwa mu makanda, madokotala amatcha izi chodwala jaundice, chomwe chimazimiririka patatha masiku ochepa.

Poganizira zisonyezozo, adotolo adzalembera kuyesedwa kwa magazi kuti adziwe kuchuluka kwa bilirubin. Kusanthula kwa bilirubin okwera kwathunthu kumachitika m'mawa pamimba yopanda kanthu.

Musanapenda kusanthula, simumatha kumwa kwa maola anayi. Ngati malamulo onse atsatiridwa, zotsatira zolondola za kafukufuku zipezeka.

Zomwe zimapangitsa Kuchulukitsa kwa Bilirubin

Zomwe zimapangitsa kuchuluka kwa bilirubin m'magazi kumatha kuchitika chifukwa cha matenda a chiwindi komanso dongosolo la magazi. Pali zosankha zingapo chifukwa chake ndikuphwanya kugwiritsidwa ntchito kwa zinthu m'thupi.

Chifukwa cha kubadwa kwa magazi m'thupi kapena kupezeka kwa magazi m'thupi la munthu, njira yowonongera maselo ofiira m'magazi imathandizira, zomwe zimapangitsa kuchuluka kwa bilirubin. Vutoli limayamba chifukwa cha kuchuluka kwa zinthu izi. Komanso, chifukwa cha kuchepa kwa magazi m'thupi, bilirubin yosalunjika imakwera.
Chifukwa china chimagwirizanitsidwa ndi kupunduka kwa bilirubin mwachindunji. Matenda odziwika bwino monga hepatitis, cirrhosis, khansa ndi mitundu ina ya matenda atha kubweretsa izi. Kuphatikiza pazifukwa zowonjezera kuchuluka kwa bilirubin kukhoza kukhala cholowa. Mwachitsanzo, matenda a Gilbert's syndrome amabweretsa kuphwanya kapangidwe ka michere ya chiwindi.
Chifukwa chachitatu chitha kukhala mavuto a gallbladder. Chifukwa chophwanya kutuluka kwa bile kuchokera ku chikhodzodzo cha choleretic, kuchuluka kwa bilirubin mthupi kumachulukana.
Kuphatikiza pazomwezi zitha kuphatikizidwa ndikugwiritsa ntchito mankhwala aliwonse. Izi zikutanthauza kuti musanayambe chithandizo, muyenera kudziwa bwino za contraindication zomwe zimayikidwa mu malangizo.
Nthawi zambiri, chifukwa chokulira kwa bilirubin imakhala mukupatsirana kwa thupi ndi helminths. Helminthiasis ikapezeka, ndikofunikira kaye kulandira chithandizo chofunikira, kenako ndikuwunika magazi ndikuwunikanso mfundo za bilirubin.
Ndi kuchepa kwa vitamini B12, milingo ya bilirubin ingakulenso. Izi zikutanthauza kuti, musanalandire chithandizo chamankhwala, muyenera kubwezeretsanso thupi ndi zinthu zopanda phindu.

Kutsitsa Miyezo Ya Bilirubin M'mwazi

Musanayambe chithandizo, ndikofunikira kudziwa zomwe zimayambitsa matendawa. Njira zomwe zikupezeka mu zamakono zamankhwala zimakupatsani mwayi wothandizira kuphwanya malingana ndi zomwe mukuwonetsa. Pazifukwa izi, ndi dokotala yekha yemwe angatchule kuchepa kwa milingo ya bilirubin.

Mothandizidwa ndi kulowetsedwa, glucose ndi mankhwala opatsirana amathandizira jekeseni wamkati.

Mankhwalawa amakulolani kuyeretsa thupi la kuchuluka kwa bilirubin. Njira yofananayo imagwiritsidwa ntchito ngati wodwala ali ndi vuto lalikulu.

Phototherapy imagwiritsidwa ntchito kuchepetsa milingo ya bilirubin osati mwa akulu okha komanso kwa makanda. Njira imakhudzira wodwalayo mothandizidwa ndi nyali zapadera, mothandizidwa ndi momwe bilirubin yosalunjika imasinthidwa kukhala mawonekedwe owonekera, pambuyo pake imatha kusiya thupi.

Ngati chifukwa chowonjezereka cha bilirubin chikugona ndikuphwanya chimbudzi cha ndulu kuchokera m'thupi, dokotala amakupatsani chithandizo choyenera ndi mankhwala apadera. Choyambirira, ndimankhwala a choleretic omwe amakhala ndi kukhuthala kwa bile.

Zakudya zochiritsira zimathandizanso kuchepetsa kuchuluka kwa bilirubin m'magazi. Kuphatikiza apo, chithandizo chimayendera limodzi ndi kugwiritsa ntchito makala ophatikizika, mankhwala oyeretsa komanso ma gels ochotsa poizoni. Kuphatikiza mafuta, yokazinga, zokometsera zokometsera ndi zakumwa zozizilitsidwa ndi kaboni sizimachotsedwa muzakudya za wodwalayo.

Ngati wodwala wapezeka ndi matenda a chiwindi, chinthu choyamba chomwe wodwalayo adalandira ndi chithandizo cha matendawa, omwe amachepetsa bilirubin. Kuphatikiza ndi adotolo amatipatsa mankhwala oteteza chiwindi.

Ndi matenda a Gilbert komanso matenda ena a chiwindi, Phenobarbital ndi mankhwala.

Popewa zovuta, chithandizo ndi mankhwala ziyenera kutumizidwa ndi dokotala pambuyo pakuwunika ndi kuwunika.

Matenda Akuluakulu a Bilirubin

Bilirubin mwachindunji imachuluka ngati pali zifukwa zotsatirazi:

Kuchuluka kwa bilirubin m'mwazi,
Pachimake hepatitis A, B, chiwindi ndi matenda mononucleosis,
Matenda a hepatitis C, autoimmune hepatitis,
Brucellosis ndi leptospirosis bacteria hepatitis,
Poizoni ndi zinthu zapoizoni kapena bowa,
Kugwiritsa ntchito njira zakulera za mahomoni, NSAIDs, mankhwala oletsa chifuwa ndi zotupa,
Jaundice pa nthawi yoyembekezera
Chotupa
Biliary cirrhosis,
Heredational jaundice - Rotor syndrome, Dabin-Johnson.

Bilirubin yosalozera m'magazi chifukwa cha zinthu zotsatirazi:

Congenital hemolytic anemia, kuphatikizapo spherocytic, non-spherocytic, matenda odwala maselo, thalassemia, matenda a Markyafa-Michele,
Anapeza hemolytic anemia, yomwe imayamba motsutsana ndi maziko a systemic lupus erythematosus, nyamakazi yamitsempha yamitsempha yam'mimba, lymphagranulomatosis.
Sepsis, typhoid fever, malungo ndi matenda ena opatsirana,
Mankhwala hemolytic anemia chifukwa chotenga insulin, cephalosporins, aspirin, NSAIDs, chloramphenicol, penicillin, levofloxacin,
Poizoni wa hemolytic anemia wopezeka ndi poyizoni wa chiphe, bowa, arsenic, mkuwa sulphate, kulumidwa ndi tizilombo tapoizoni.
Syndromes of Gilbert, Krigler-Nayyar, Lucy-Driscola.

Kodi bilirubin ndi chiyani, ndipo amachokera kuti?

Kodi ndichifukwa chiyani munthu wamkulu amapezeka ndi bilirubin yowonjezereka, ndipo izi zikutanthauza chiyani? Hemoglobin imapezeka m'magazi ofiira - maselo ofiira a munthu, imanyamula mpweya kupita nawo kumaselo a m'mapapu. Maselo ofiira owonongeka ndi akale amawonongeka ndulu, chiwindi ndi mafuta m'mafupa. Mwanjira imeneyi, hemoglobin imamasulidwa ndikusintha kukhala bilirubin.

Bilirubin yomwe yangopangidwa kumeneyo siyolunjika, poizoni m'thupi la munthu, makamaka kwamkati wamanjenje. Chifukwa chake, chiwindi sichimasinthidwa ndi zinthu zina. Wophatikizidwa - bilirubin mwachindunji imachotsedwa pamodzi ndi chiwindi cha bile ndipo imachoka m'thupi mwachilengedwe. Mtundu wakuda wa ndowe nthawi zambiri umawonetsa kusintha pamlingo wa bilirubin.

Gulu

Kagayidwe ka Bilirubin ndimapangidwe ovuta a makemikolo omwe amapezeka mthupi lathu nthawi zonse, ngati asokonezedwa nthawi iliyonse, kusintha kwa zinthuzi mu seramu yamagazi kumawonekera. Chifukwa chake, bilirubin ndi chofunikira chidziwitso cha ntchito ya machitidwe angapo a thupi.

Kutengera mtundu, bilirubin mwachindunji komanso yosalunjika imakhala yokhayokha.

Molunjika - imodzi yomwe imapangidwa chifukwa cha kuphulika kwa hemoglobin. Imasungunuka m'mafuta, chifukwa chake imawonedwa ngati yoopsa. Imatha kulowa mosavuta m'maselo, ndikuphwanya ntchito zawo.
Direct ndi yomwe imapanga chiwindi. Imasungunuka m'madzi, motero, imawerengedwa ngati ya poizoni. Bilirubin mwachindunji amachotsedwa m'thupi limodzi ndi bile.

Bilirubin yachindunji ndiotetezeka ku thupi, popeza kale idalibe ziwalo za chiwindi. Zinthu zotere zimachoka m'thupi modekha ndipo sizibweretsa mavuto ambiri. Ma bilirubin osaneneka ndi oopsa kwambiri, adapangidwa posachedwa kuchokera ku hemoglobin ndipo samamangidwa ndi ma enzymes a chiwindi.

Muyezo wa bilirubin m'magazi

Kwa munthu wamkulu wazaka zosakwana 60, zotsatira zoyesedwa za bilirubin zidzakhala:

5.1-17 mmol / l - bilirubin yathunthu,
3.4-12 mmol / l - osalunjika,
1.7-5.1 mmol / L - molunjika.

Matebulo a bilirubin abwinobwino m'magazi onse ali ofanana. Komabe, asayansi atsimikizira kuti abambo nthawi zambiri amakhala ndi vuto la Gilbert kuposa azimayi.

Kuchulukitsa bilirubin mwa wakhanda

Bilirubin okwera - izi zikutanthauza chiyani mwa munthu wamkulu?

Pazifukwa ziti mwa akulu, kuchuluka kwa bilirubin m'magazi kumachuluka, ndipo izi zikutanthauza chiyani? Kodi ndi zinthu ziti zomwe zimapangitsa izi?

Akuluakulu, zifukwa zingapo zazikulu ndizodziwika:

kuchuluka kwa maselo ofiira a m'magazi,
chachikulu biliary cirrhosis,
matenda a ndulu
zinthu zina zomwe zimayambitsa kuphwanya kwa mapangidwe a bile,
helminthiases ndi majeremusi m'thupi,
intrahepatic cholestasis,
mimba jaundice
zotupa za chiwindi
zovuta pakupanga ma enzyme omwe ali ndi vuto la kupanga ma bilirubin mwachindunji,
mavairasi, mabakiteriya, poizoni, mankhwala, matenda a autoimmune komanso hepatitis - pomwe chiwindi chimalephera kuyambitsa bilirubin.

Kutengera ndondomeko iti ikuphwanyidwa, kuwonjezeka kwa gawo limodzi la bilirubin kumaonedwa m'magazi. Ngati kuwonjezeka kwa bilirubin kwathunthu ndi zigawo zamtundu wapezeka, ndiye kuti matenda a chiwindi ndi ofanana kwambiri.

Zoyambitsa Elevated Direct Bilirubin

Mlingo wa bilirubin mwachindunji m'magazi umakwera chifukwa cha kuphwanya kwa mapangidwe a bile. Zotsatira zake, bile limatumizidwa ku magazi, osati m'mimba. Zomwe zimachitika nthawi zambiri zimakhala zotsatirazi:

pachimake viral hepatitis (hepatitis A, B, yokhala ndi mononucleosis),
hepatitis ya bakiteriya etiology (leptospirosis, brucellosis),
aakulu a chiwindi
autoimmune hepatitis,
hepatitis ya mankhwala osokoneza bongo (chifukwa cha mankhwala omwe amachitika ndi mahomoni, mankhwala osapweteka a antiidal, antitumor ndi anti-tuberculosis),
hepatitis ya poizoni (poyizoni ndi chiphe cha mafangasi, zinthu za poizoni).
khansa ya ndulu, chiwindi, kapamba,
matenda a ndulu
biliary cirrhosis,
syndromes of Rotor, Dabin-Johnson.

Kuchulukitsa kwakukulu kwa bilirubin mwachindunji. Maziko ndikuphwanya kutuluka kwa bile.

Zomwe Zikuwonjezera Bilirubin

Matenda omwe ma bilirubin osalunjika amadzuka:

Syndromes of Gilbert, Krigler-Nayyar, Lucy-Driscola.
Matenda opatsirana - typhoid fever, sepsis, malungo.
Congenital hemolytic anemia - spherocytic, non-spherocytic, sickle cell, thallasemia, Markyafavi-Michele matenda.
Toxic hemolytic anemia - poyizoni ndi ziphe, kulumidwa ndi tizirombo, njoka, poyizoni wa bowa, mtovu, arsenic, mchere wamkuwa (vitriol). Mankhwala hemolytic anemia - wokwiyitsidwa ndi kutenga cephalosporins, insulin, aspirin, NSAIDs, chloramphenicol, penicillin, levofloxacin, etc.
Acquid autoimmune hemolytic anemia - chitani motsutsana ndi maziko a systemic lupus erythematosus (Zizindikiro, mankhwala), nyamakazi, lymphocytic leukemia, lymphagranulomatosis (Zizindikiro, mankhwala), ndi zina zambiri.

Kuchulukitsa kwakukulu kwa bilirubin yosalunjika. Maziko ndikuwonongeratu kwakukulu kwa maselo ofiira amwazi.

Mavuto a chiwindi

Chiwindi ndichofunikira kwambiri pakupanga njira za bilirubin. Ndi ma pathologies a chiwalochi, njira yokhazikika yosinthira ma bilirubin aulere ndikusintha kupita ku boma mwachindunji kumakhala kosatheka. Mwa zina mwa matenda a chiwindi momwe kagayidwe ka bilirurin kamasokonezekera, pali matenda enaake, chiwindi, hepatitis A, B, C, B ndi E, mowa komanso mankhwala osokoneza bongo a chiwindi.

Mlingo wa mitundu yonse iwiri ya bilirubin ukuwonjezeka, womwe umawonetsedwa ndi zizindikiro zotere:

kusasangalala ndi kulemera kumbali yakumanja chifukwa cha chiwindi chokulirapo.
Final French ndi mdima - mkodzo,
kuwala kwapang'onopang'ono, kupaka chakudya mutatha kudya, makamaka kusapeza bwino zamafuta ndi zakudya zamafuta,
kutaya mphamvu, chizungulire, kusilira,
kuchuluka kwa kutentha kwa thupi (ndi hepatitis yamtundu wamavalidwe).

Titha kuwulula zina zoyambitsa kuchuluka kwa bilirubin. Izi zimaphatikizira kuchepa kwa chibadwa cha michere ya chiwindi, matenda awa amatchedwa Gilbert syndrome. Odwala, kuchuluka kwa bilirubin m'magazi kumachulukitsidwa kwambiri, motero khungu ndi sclera ya khungu nthawi zambiri imakhala yotuwa.

Kulakwila kwa kutuluka kwa ndulu

M'matenda a biliary system, mwachitsanzo, matenda a gallstone, wodwalayo amakhala ndi zizindikiro zotsatirazi:

kusamala khungu ndi sclera,
kupweteka mu hypochondrium yoyenera (yokhala ndi hepatic colic kwambiri),
kutulutsa, kusokonezeka kwazimbudzi (kutsekula m'mimba kapena kudzimbidwa),
Kusintha kwa ndowe ndi kuda kwa mkodzo,
Khungu.

Mosiyana ndi matenda amwazi ndi chiwindi, munthawi imeneyi kuchuluka kwa ma bilirubin mwachindunji (omwe amamangidwa kale) amawonjezereka.

Zoyambitsa zazikulu

Kukula kwa suprahepatic jaundice kumachitika chifukwa cha kuwonongeka kowonjezereka kwa maselo ofiira amwazi. Pankhaniyi, gawo lalikulu laulere limatuluka. Mwa matenda kusiyanitsa:

hemolytic ndi B12 kuchepera magazi,
kutalika kwa hematomas
kuchuluka kwa poizoni wama cell m'magazi,
Kutenga magazi kapena kuwayika ziwalo zakunja,
thalassemia.

Ndikuphwanya kagayidwe ka bilirubin, ziwonetsero zake zingapo m'magazi zitha kukhala zazikulu. Amawonetsedwa ndi jaundice, kapena mwa kukonza ma mucous nembanemba ndi khungu chikaso.

Ngati ndende ya bile ya m'magazi ya seramu ifika 85 micromol / l, ndiye kuti amalankhula mtundu wowonjezera.
Jaundice yokhala ndi zisonyezo za 86-169 mmol / L imawerengedwa kuti ndi yocheperako, yoopsa - yomwe ili ndi ziwerengero pamwamba pa 170 μmol / L.

Kutengera mtundu wa jaundice, mawonekedwe ake ali amtundu wina. Khungu limatha kukhala ndi chikasu chowoneka chikasu, zobiriwira, kapena safironi. Kuphatikiza apo, ndi bilirubin yowonjezereka, mkodzo wamdima umadziwika (imakhala mtundu wa mowa wamdima), kuyabwa kwambiri pakhungu.

Zizindikiro zina zimaphatikizapo:

kuwawa mkamwa
mkodzo wakuda
khungu loyera la ndowe,
kufooka wamba
kukumbukira kwamisala ndi luntha,
kukulitsa chiwindi mu kukula kwake komanso kulemera kwake mu hypochondrium yoyenera.

Matenda a Gilbert

Momwe mungachitire bilirubin wokwera m'magazi

Bilirubin imatha kuchepetsedwa pokhapokha yokhazikitsa chomwe chikuwonjezera. Izi zikutanthauza kuti muyenera kukayezetsa matenda a chiwindi a hepatitis, kuyezetsa kwa chiwindi (kutsimikiza kwa ntchito ya ast, alkaline phosphatase, ndi zina zambiri), kuyesedwa ndi ultrasound ya chiwindi ndi maphunziro ena apadera.

Pankhaniyi, kulandira chithandizo kwa achikulire makamaka ndi etiotropic, ndiye kuti, kumakhudza matenda omwe akuwatsogolera. Mwachitsanzo, ngati pakuphwanya patency ya biliary thirakiti, ndikofunikira kuchititsa kuti miyala ichotse kapena zotupa, nthawi zina kununkha kwa ma ducts kumakhala kothandiza.

Ndi bilirubin yowonjezereka chifukwa chotchedwa hemolysis yamaselo ofiira am'magazi, kulowetsedwa ndi kuyambitsa shuga, albin, komanso plasmapheresis, akusimbidwa. Ndi jaundice wa akhanda, Phototherapy imagwira kwambiri, momwe ma ultraviolet walitsa khungu limathandizira kusintha bilirubin ya poizoni kukhala yolumikizika, yochotseka mosavuta m'thupi.

Chifukwa chiyani kuchuluka kwa bilirubin kuli koopsa?

Jaundice, kapena bilirubinemia, ndimatenda ogwirira ntchito, chizindikiritso chowoneka cha chikasu cha zotupa za mucous lotseguka (mapuloteni amaso, lilime), komanso m'malo omwe amatulutsa ma lymph node (axillae, manja).

Chomwe chimapangitsa ndikuwonetsa kuchuluka kwa bilirubin m'magazi, chifukwa chomwe amayikika m'malo ena amthupi, kuphatikiza khungu. Zizindikiro zimawonekeranso m'mutu, nseru, kutopa, khungu loyabwa, kuwawa mkamwa, kutentha pa mtima.

Bilirubin ndi tanthauzo lenileni kuchokera ku Latin "red bile" (bilis - bile ndi ruber - red) - gawo lalikulu la bile mwa anthu ndi nyama. M'malo mwake, ndimankhwala oopsa kwambiri omwe amachitika pakuwonongeka kwa zinthu zomanga (ma protein) omwe amapezeka m'chiwindi, komanso m'maselo a m'mafupa, ndulu, ndi ma lymph node. Zinthu zowola zomaliza zimachotsedwa m'thupi pogwiritsa ntchito biliary system.

Kuchuluka kwa pigment kumapangidwa ndi bilirubin yaulere komanso yomangidwa. Zabwinobwino mwa akazi achikulire ndi amuna chizindikiro ichi sichikuyenera kupitirira 20.5 μmol pa lita imodzi yamagazi, pomwe gawo la bilirubin mwachindunji sayenera kupitirira 5 μmol.

Pakakhala vuto, ziwalo zofunika monga chiwindi, ndulu, ubongo zili pachiwopsezo, ndipo kunyalanyaza vutoli kumapatsa imfa. Phokoso lachiberekero chatsopano mwa ana akhanda ndi njira yachilengedwe, yomwe nthawi zambiri safuna kulowerera kuchipatala ndipo imachitika pakatha masiku angapo poyamwitsa kapena kudyetsa ndi zosakaniza zapamwamba kwambiri.

Mfundo zoyambirira za zakudya

Cholinga cha chakudya chapadera chokhala ndi bilirubin yayikulu ndikutsitsa chiwindi momwe mungathere, zithandizira kusinthana ndi mitundu ndi mafuta, komanso kutuluka kwa nthawi ya bile kuchokera mthupi. Zakudya zoyambirira zimayenderana mokwanira ndi Zakudya Na. 5, zomwe nthawi zonse zimalembedwa kwa iwo omwe ali ndi matenda a chiwindi komanso chikhodzodzo. Malongosoledwe ake amapezeka m'buku lililonse lazachipatala pa zakudya.

Mwayi wosakayikitsa chakudyachi ndi mitundu yosiyanasiyana yazinthu zovomerezeka komanso zachilengedwe zomwe zimapezeka m'zakudya zonse, kotero zimatha kuonedwa ngati chakudya chopatsa thanzi.

Pafupifupi, kufalitsa kofunikira kwa zida zama mankhwala kuyenera kukhala motere:

100 g mapuloteni
400 g chakudya
80-90 g mafuta

Makamaka chidwi ayenera kulipidwa kwa madzi mu zakudya, omwe ayenera kukhala malita 2.5 patsiku. Ndi madzi apatebulo opanda mipweya ndi utoto. Ma compotes amitundu yosiyanasiyana ya zipatso ndi zipatso, ma decoctions ndi infusions azitsamba, tiyi ofooka, zobiriwira zingakhale zothandiza kwambiri.

Zoletsa zazikulu zili pazinthu zamchere ndi mchere - amaphatikizidwa m'gawo loletsedwa kotheratu. Mndandandawo umapitilira ndi mowa, komanso zakumwa zilizonse za kaboni. Suzi zonse - komanso zinthu zopanda yisiti, komanso zokhala ndi mafuta ambiri okhala ndi mafiyamu, omwe amakhala ndi mafuta ambiri osiyanasiyananso mafuta.

Chofunikira kwambiri pakudzazidwa kwa chakudya ndi chilichonse chomwe chimathandizira kuchepetsa kuchuluka kwa pigment m'magazi komanso mafuta a metabolism, kumalepheretsa chiwindi kuwonongeka, kuyeretsa mitsempha yamagazi, kuchepetsa chiopsezo cha kupezeka kwa cholesterol, komanso kuchotsa bile kuchokera mthupi.

Chifukwa chake, ndikofunikira kuti muphatikizire mndandanda wazakudya za tsiku ndi tsiku zomwe zimakhala ndi fiber, pectins ndi lipotropic. Izi zikutanthauza pafupifupi ndiwo zamasamba (kupatula zonunkhira, zowawa komanso zokhala ndi oxalic acid), zipatso (kupatula zipatso za zipatso za asidi) ndi zipatso zokoma. Zomwe zimakhazikitsidwa ndi zakudya ndizophatikiza, komabe, kupezeka kwa kuchuluka kwama protein komanso polyunsaturated m'menemo kumapangitsa kuti ndizovomerezeka kuti muzisunga kwa nthawi yayitali.

Mbali inanso yofunika kwambiri yazakudya ndi chakudya chamitundu ing'onoing'ono. Izi zimathandizira kutuluka kwa ndulu kawirikawiri mthupi, komanso kupewa chiwindi chochuluka, chomwe chimachitika pakudya kwambiri. Mitundu yololedwa ya kutentha: kuphika, kuwotcha ndi kuphika.

Kuchotsa moto sikulimbikitsidwa., chifukwa izi zimapangitsa kuti pakhale zinthu zochulukirapo zochuluka zowononga chiwindi. Kutentha kwa chakudya chotsirizidwa kuyenera kutentha nthawi zonse, ndipo osazizira, kuti tisatseke njira za ndulu.

Ambiri tsiku lililonse caloric kudya pafupifupi 2500 kcal. Kukhudza komaliza kosangalatsa pachakudya ndi kutsika kwake. Chifukwa chake, ngati mumamatira ku pafupifupi pafupifupi menyu omwe aperekedwa munkhaniyi, zolipirira sabata iliyonse sizingadutse ma ruble 1,500 pa munthu aliyense.

20 zakudya zoletsedwa

mowa
zakumwa zoziziritsa kukhosi
mchere ndi zinthu zamchere, marinade, kabichi wowawasa,
fodya wosuta, sardine, nsomba, zikopa, hering'i, nsomba za salimoni, shrimp, mussels,
bowa, makamaka ceps
zofufumitsa, makeke, mkate watsopano wa woyamba, makamaka kuchokera ku ufa wa ufa woyamba,
nyama iliyonse yamafuta, makamaka yokhala ndi zigawo zamafuta owoneka, chiwindi, ubongo, nyama yam'chitini, impso, nyama ya mbalame yaying'ono, nyama ndi mafuta ophikira,
dzira lachikasu
nyama zosuta, masoseji, masoseji, mafuta anyama,
tchizi zolimba, zamchere, zowola ndi zowawa,
zonse zokhala ndi zoteteza komanso utoto,
mpiru, zonunkhira zokometsera, mahatchi, ma marinade, mayonesi,
sorelo, sipinachi, makoswe ndi ma turnips, chives, adyo,
msuzi wadzadza (woyamba),
misuzi yamafakitale, viniga,
Zipatso wowawasa, zipatso ndi zipatso,
Zakudya zokazinga, kuphatikiza msuzi wophika (zipatso sizikulimbikitsidwanso),
nyemba, mapira, komanso kabichi iliyonse, yosagwirizana bwino ndi izi,
mafuta amkaka amkaka: tchizi chamafuta, kirimu wowawasa, batala,
khofi, koko, chokoleti, ayisikilimu, zonona zophika.

Zosintha zamasabata sabata

Kutsatira mndandanda womwe uli pamwambapa sikofunikira konse ayi. Mutha kusintha m'malo mwa mbale zomwe zimapangidwa ndi zomwe zimapangidwa ndi mankhwala. Chachikulu ndikupanga chakudya chopatsa thanzi, chokhala ndi zofunika tsiku lililonse zopatsa mphamvu, mapuloteni, ndi mafuta. Ndikofunikira kwambiri kupatula zakudya zoletsedwa muzakudya, komanso njira zophikira.

Makina omwe akupangidwawo ndiwonsekonse, makamaka thanzi lathu pothana ndi zotupa za bile. Komabe, matenda ena, omwe chizindikiro chake ndi jaundice, amafunika kusintha kwapadera pakudya, ndipo milandu ina amaletsa kugwiritsa ntchito zinthu molingana ndi chiwembu. Chifukwa chake, onetsetsani kuti mwakumana ndi dokotala musanayambe zakudya zilizonse.

Njira zina zotsimikiziridwa

Mankhwala achikhalidwe amadziwa njira zochizira jaundice. Chofunika koposa, musanasankhe aliyense wa iwo, muyenera kufunsa dokotala, kukayezetsa kuti mupeze zomwe zimapangitsa kuti pakhale zambiri zowonjezera, komanso chothandizanso pakudya.

Madzi a Beetroot. Chida ichi chimatha kupangitsa magazi kukhala ndi hemoglobin ndikuyeretsa thupi la poizoni, zimathandizira kuchotsa mwachangu kwa bile kuchokera mthupi. Mutha kupanga madzi madzulo. Kuti muchite izi, beets yoboola komanso yokhazikika uyenera kupukutidwa pa pulasitiki ya pulasitiki, ndipo misayo iyenera kudzazidwa ndi shuga (kapu - supuni ziwiri). M'mawa, misa yomwe idapatsa msuziyo ikuyenera kumanizidwa bwino ndikuwotenga m'chigawo chachitatu cha galasi pamimba yopanda kanthu.
Milandu yoyesedwa. Wothandiza kwambiri okodzetsa komanso choleretic odana ndi kutupa. Supuni ziwiri za stigmas za chimanga zimathiridwa ndi madzi otentha ndikulimbikitsidwa kuti musatenge nthawi yogona (mlingo - theka lagalasi).
Infusions wa choleretic zitsamba. Wort wa St. John, chamomile, timbewu ali ndi zofunikira zochizira. Ndalama zapadera za pharmacy ziyenera kugwiritsidwa ntchito. Njira yovomerezeka yokonzera decoction ndi kusamba kwamadzi. Njira ina yopepuka ndi tiyi wowerengeka wazitsamba, yemwe amafunikanso kugulidwa ku pharmacy. Imwani kapu imodzi ya kulowetsedwa kawiri pa tsiku. Zotsatira ziziwonekera m'masabata awiri kapena atatu.
Tsamba la Birch. Kusakaniza kouma kumathiridwa ndi madzi otentha ndikuyamba kukonzekera kusamba kwamadzi. Tengani theka chikho musanakagone.

Pomaliza

Zakudya zomwe zafotokozedwazo ndi mankhwala azikhalidwe zimangofunika kuwonjezera pa mankhwala okhazikitsidwa ndi katswiri, ngati pakufunika kutero. Pali zifukwa zopitilira 50 zokulitsa kuchuluka kwa bilirubin, chifukwa chake pali njira zambiri zochiritsira zomwe zitha kutsimikiziridwa ndi dokotala pambuyo pa mayeso apadera a biochemistry, komanso ndowe ndi mkodzo.

Komabe, zikuwonekeratu kuti ngati muli m'gulu la odwala omwe ali ndi vutoli, simungapewe malamulo onse azakudya omwe alembedwa pamwambapa kuti achire. Lezani mtima, phunzirani maphikidwe osiyanasiyana azakudya zamagulu ogwiritsira ntchito zakudya zomwe zololedwa, chifukwa zakudyazo zimayenera kutsatiridwa kwa miyezi yambiri.

Ngati mumatsatira malamulo onse ndipo simukupunthwa panjira yodziletsa, ndiye kuti simusangalala ndi kusanthula bwino, komanso kuchepa thupi ndikuwadabwitsa aliyense ndi mawonekedwe anu achichepere. Tikukufunirani zabwino ndi thanzi labwino!