I-Steatohepatitis

ngu-Stephanie Reid, MD FRCPC
Kwangathi 19, 2022


Iyini i-steatohepatitis?

I-Steatohepatitis wuhlobo lwesifo sesibindi esinamafutha. Ihlotshaniswa ne ukuvuvukala kanye nokwakheka kwamafutha ngaphakathi kwamangqamuzana esibindi akhethekile abizwa ngokuthi ama-hepatocyte.

Yiziphi izinhlobo ze-steatohepatitis?

Kunezinhlobo ezimbili ezinkulu ze-steatohepatitis: engeyona utshwala neyotshwala. I-alcohol steatohepatitis yenzeka ngenxa yokusetshenziswa kotshwala. I-steatohepatitis engeyona utshwala ingabangelwa izimo ezihlukahlukene ezihlanganisa ukukhuluphala okuphakathi nendawo, isifo sikashukela, nezici zokudla. Uma ubheka isampula yezicubu zesibindi ngaphansi kwesibonakhulu, akwenzeki ukutshela umehluko phakathi kwe-steatohepatitis edakayo nengaphuzi, futhi ngokuvamile umehluko udinga ukwenziwa abanye odokotela eqenjini lakho lokunakekelwa kwezempilo ngemva kokucabangela kokubili umlando wakho, izimpawu. , kanye nemiphumela ye-pathological.

Yiziphi izimpawu ze-steatohepatitis?

I-Steatohepatitis ingavela ngezindlela ezihlukahlukene. Ezinye iziguli azinazo izimpawu futhi lesi sifo sitholakala ngokuzenzakalelayo lapho kwenziwa isithombe se-radiological (i-CT scan noma i-ultrasound) yesisu. Kungase futhi kutholakale lapho ukuhlolwa kwegazi kubonisa ama-enzyme esibindi aphakeme. Iziguli ezine-steatohepatitis zingase futhi zizwe ubuhlungu besisu noma isimo sezempilo esibi esibizwa ngokuthi 'ukwehluleka kwesibindi'. Kuzo zonke lezi zimo, udokotela wakho angase ayale isibindi i-biopsy ukunquma ukuthi i-steatohepatitis ikhona yini.

Izazi ze-pathologists zikwenza kanjani ukuxilongwa kwe-steatohepatitis?

Ukuxilongwa kwe-steatohepatitis kudinga isibindi i-biopsy. Isazi sakho sezifo sizobheka izici ezine ezinkulu ezingabonakali ukuze kutholakale ubukhona kanye nobukhulu be-steatohepatitis: i-steatosis, i-hepatocyte ebhaluni, ukuvuvukala kwe-lobular portal, kanye ne-fibrosis. Lezi zici zichazwe kabanzi ezigabeni ezingezansi.

Izici ezincane ze-steatohepatitis

I-Steatosis

I-Steatosis yigama elisetshenziselwa ukuchaza ukuba khona kwamaconsi amafutha ngaphakathi kwe-hepatocytes. I-Steatosis ingaba ukuxilongwa ngokwayo, noma ingaba yingxenye ye-steatohepatitis. Ku-steatosis, ama-hepatocyte aqukethe izindawo ezicacile zamaconsi amafutha lapho ebhekwa ngesibonakhulu.

Izazi zezifo zisebenzisa isikali ukuchaza inani lamafutha esibindi nge-steatosis. Isilinganiso sisekelwe kumaphesenti amaseli esibindi aqukethe amaconsi amafutha:

Isikali esisetshenziswa iningi lama-pathologists sihlanganisa:

  • Imnene Amaconsi amafutha abonakala ngaphansi kwama-33% we-hepatocyte ku-biopsy.
  • Lokulingene Amaconsi amafutha abonakala ku-33 - 66 % we-hepatocyte ku-biopsy.
  • ezinzima Amaconsi amafutha abonakala ngaphakathi kwama-hepatocyte angaphezu kwama-66% ku-biopsy.
Ama-hepatocyte ajwayelekile

Ibhaluni igama elithi pathologists elisetshenziswa ukuchaza amahepatocyte alimele noma afayo. Abizwa ngokuthi 'i-balloon' ngoba i-hepatocyte ikhukhumala izikhathi eziningana ngobukhulu bayo obujwayelekile futhi umzimba weseli uyacaca. I-hepatocyte ebhaluni kufanele ibe khona ukuze kutholakale ukuxilongwa kwe-steatohepatitis. Inombolo ye-hepatocyte ebhaluni ekhona izochazwa njengemnene, emaphakathi, noma eqinile.

Ukuvuvukala kwe-Lobular noma i-portal

Isibindi sakhiwe izingxenye ezintathu eziyinhloko:

  1. Lobule I-lobule iyingxenye yesibindi eyakhiwe amangqamuzana esibindi akhethekile abizwa ngokuthi ama-hepatocytes.
  2. Ipheshana lephothali - I-portal tract iqukethe izingxenye ezintathu: i-vein, i-artery, kanye ne-bile duct.
  3. Umthambo ophakathi – I-central vein ingumkhumbi wegazi ongenisa igazi esibindini.

Amaseli okuvuvukala ingangena kunoma iyiphi yalezi zindawo futhi ithathe isikhathi eside ukuvuvukala ingalimaza isibindi. Uma amangqamuzana okuvuvukala ebonakala esicutshini sakho, udokotela wakho wezifo uzochaza indawo akuyo kanye nezinhlobo zamangqamuzana okuvuvukala akhona. Inani lokuvuvukala lizobuye lichazwe ngesilinganiso esithambile, esimaphakathi, noma esinzima. Ukuvuvukala kwe-lobular kuvame ukubonakala ku-steatohepatitis.

I-Fibrosis

I-Fibrosis wuhlobo lwezicubu ezibomvu ezakha esibindini ngemva kokulimala. Ngenxa yokuthi i-steatohepatitis ilimaza isibindi, kunengozi yokuba ne-fibrosis. Imibiko eminingi ye-pathology iphawula ngenani le-fibrosis futhi izoyinikeza 'isiteji'. Isiteji sincike ezintweni eziningi ezihlanganisa izinga lokulimala kokuqala, ubude besikhathi sokulimala okwenzeka, nokuthi yiziphi izingxenye zesibindi ezilimele. I-fibrosis eningi iphazamisa ukwakheka kwesibindi futhi isivimbele ekusebenzeni kahle.

Kunezinhlelo eziningana zokuhlukanisa ezisetshenziselwa ukwenza i-fibrosis kodwa zonke zihlanganisa uhlobo nenani le-fibrosis ebonwayo. I-Cirrhosis yisigaba sokugcina se-fibrosis futhi ibonakala ngamabhande amakhulu anemicu akha amaqhuqhuva esibindini. Lawa maqhuqhuva avimbela isibindi ekwenzeni imisebenzi yaso evamile futhi angaholela esimweni sezempilo esibizwa ngokuthi 'ukwehluleka kwesibindi'.

Ezinye izici ezingase zichazwe embikweni wakho we-steatohepatitis

Ukwenela

Isibindi sihlukaniswe 'amazoni' futhi phakathi nendawo ngayinye kunesakhiwo esibizwa ngokuthi 'ipheshana le-portal'. Amapheshana e-portal abalulekile ngoba aqukethe imithambo yegazi kanye nemigudu ehambisa ezinye izinto ezifana ne-bile ngaphakathi nangaphandle kwesibindi.

Lapho uhlola isibindi i-biopsy, udokotela wakho wezifo kufanele aqale anqume ukuthi isampula liqukethe inani elincane lamapheshana ephothali adingekayo ukuze kuhlolwe isifo esinembile. Ukwanela kwe-biopsy kungase kubikwe ngokuthi “yebo” noma “cha”, noma inani lamapheshana ephothali abonisiwe lingashiwo.

Ukuhlukaniswa

Isimo sesibindi i-biopsy lapho kubukwa ngaphansi kwesibonakhulu ngokuvamile kuchazwa. Uma i-biopsy yesibindi ishwabene futhi ihlukene phakathi lokhu kuzochazwa, njengoba kungase kube umkhondo ezimweni ezithile zesibindi.

Imizimba ye-Mallory

Imizimba ye-Mallory yakha ngenxa yokulimala kwama-hepatocyte. Uma zibukwa ngesibonakhulu, zibukeka njengezinto eziminyene ezibomvana ngaphakathi kwamaseli. Izidumbu ze-mallory zivame ukutholakala ku-steatohepatitis futhi zizochazwa embikweni wakho uma zibonwa.

Imigudu yebile

Isibindi sikhiqiza into ebizwa ngokuthi i-bile esetshenziselwa ukukhipha ubuthi emzimbeni nokugaya ukudla. I-bile ekhiqizwa esibindini idonsa ngemigudu ebizwa ngokuthi ama-bile ducts emathunjini amancane. I-portal tract ngayinye iqukethe i-bile duct eyodwa. Ezinye izifo zesibindi zithinta ama-bile ducts. Ngalesi sizathu, udokotela wakho wezifo uzohlola imigudu ye-bile kusampula yezicubu zakho ukuze abone ukuthi inani elivamile lamapayipi e-bile likhona yini nokuthi noma imaphi ama-bile ducts alimele.

I-Cholestasis

I-Cholestasis igama elithi pathologists elisetshenziswa ukuchaza i-bile evaleleke esibindini. I-bile evalelwe ibalulekile ngoba ingabangela ukulimala kwesibindi. Uma i-cholestasis ibonakala, udokotela wakho wezifo uzochaza indawo yayo ngaphakathi kwesibindi futhi inani le-bile evalelekile lizochazwa ngokuthi limnene, elilinganiselwe, noma elinzima.

Iron

I-ayoni ingakheka esibindini ngenxa yokuwohloka kwe-iron ngendlela engavamile, i-iron eyengeziwe emzimbeni (njengasemva kokumpontshelwa igazi izikhathi eziningi), noma lapho isibindi singasebenzi kahle (njengaku-cirrhosis yesibindi). Le iron eyeqile ingabonakala ngaphakathi kwama-hepatocyte noma ngaphakathi kwamaseli omzimba abizwa ngokuthi ama-macrophages. Uma i-iron ikhona esicutshini sakho, udokotela wakho wezifo uzobika indawo yayo kanye nobukhulu bayo.

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