icterul

tipuri

• Cresterea BI
– Productie crescuta
– Captare hepatica redusa
– Anomalii de conjugare
• Cresterea BI si BD
– Afectare hepatocelulara
– Excretie redusa
– Recaptare redusa a BD
– Obstructie biliara
 Cresterea B indirecte
• Productie crescuta
• degradare excesiva a hemului
– Hemoliza
• Extravasculara – splina, maduva osoasa, hepatocit
• Intravasculara – haptoglobina scazuta – metHb – hem legat de
hemopexina si albumina distruse in ficat
– Extravazare in tesuturi/seroase
• E fagocitate de macrofage si degradate – hem transf in biliverdina si
bilirubina (hematoame)
– Diseritropoieza
• Anemii megaloblastice, sideroblastice, Feprive, porfirie – hem
incorporat deficitar in E
 Cresterea B indirecte
• Productie crescuta
– Boli hepatice ce afecteaza excretia canaliculara
• Captare hepatica scazuta
– Internalizarea B in hepatocit
– Transport scazut la B la ficat – flux sg redus (IC) / sunturi
porto-sistemice (CH)
• Anomalii de conjugare
– Sdr genetice (Gilbert, Criegler-Najar)
 Cresterea B directe
• Obstructie biliara (colestaza extrahepatica)
– Litiaza, tumori intrinseci/extrinseci, colangita sclerozanta,
infectii, pancreatita acuta/cronica
• Colestaza intrahepatica
– Hepatite, sepsis, boli infiltrative, siclemie
• Leziuni hepatocitare
– Neoplasm, metastaze, boli metabolice, fibroza, infectii,
toxice, boli imune
– Eliberare proteine intracelulare in sg
– Asociaza cresterea enzimelor hepatice, hipoalbuminemie
 diagnostic clinic
• Urgenta
– Hemoliza masiva
– Colangita severa
– Insuficienta hepatica fulminanta

• Anamneza
– Medicamente, suplimente, alcool, droguri
– FR pt hepatita – tratamente iv
– Interventii chirurgicale (+ colecistectomie)
– Boli ereditare hepatice / hemolitice
– HIV
– Expunere la toxice
– Simptome asociate
 Simptome asociate
• Febra, frison, durere hipocondrul drept + chirurgie
biliara = colangita
• Anorexie, mialgii, astenie = hepatita
• Durere cadran superior drept = obstructie biliara
extrahepatica
• Scaun acolic = hepatita vs (colestaza acuta) /
obstructie duct biliar principal (tumori cap pancreas,
T ampula Vater
 Examen fizic
• Semn Courvoisier (obstructie tumorala distala – canal
cistic)
• Semne de insuficienta hepatica / HT portala – ascita,
splenomegalie, stelute vasculare, ginecomastie
• Semne specifice
– Hiperpigmentare – hemocromatoza
– Inele Kayser-Fleischer – b. Wilson
– Xantoame – colangita biliara primara