{"id":11950,"date":"2020-05-05T23:16:15","date_gmt":"2020-05-05T21:16:15","guid":{"rendered":"https:\/\/www.synevo.ro\/shop\/analiza-calculi-biliari\/"},"modified":"2025-01-31T16:50:21","modified_gmt":"2025-01-31T14:50:21","slug":"analiza-calculi-biliari","status":"publish","type":"product","link":"https:\/\/old.synevo.md\/ru\/shop\/analiza-calculi-biliari\/","title":{"rendered":"\u0410\u043d\u0430\u043b\u0438\u0437 \u0436\u0435\u043b\u0447\u043d\u044b\u0445 \u043a\u0430\u043c\u043d\u0435\u0439"},"content":{"rendered":"

Informa\u021bii generale<\/span><\/i><\/b><\/span><\/p>\n

Litiaza biliar\u0103 se define\u0219te ca prezen\u021ba calculilor \u00een tractul biliar. Calculii se pot forma \u00een orice segment al tractului biliar, dar mai frecvent \u00een vezicula biliar\u0103. <\/span><\/div>\n
Litiaza este semnificativ mai frecvent\u0103 la femei dec\u00e2t la b\u0103rba\u021bi \u0219i la v\u00e2rst\u0103 avansat\u0103. Majoritatea persoanelor cu litiaz\u0103 vezicular\u0103 (70-80%) sunt asimptomatice. Litiaza devine o boal\u0103 propriu-zis\u0103 \u00een prezen\u021ba durerilor \u0219i a complica\u021biilor. <\/span><\/div>\n
Calculii \u00een calea biliar\u0103 principal\u0103 sunt prezen\u021bi la 10-15% dintre persoanele cu calculi veziculari, mai ales la v\u00e2rsta avansat\u0103.<\/span><\/div>\n
Litiaza biliar\u0103 este o condi\u021bie medical\u0103 a c\u0103rei prevalen\u021b\u0103 este \u00een cre\u0219tere, posibil datorat\u0103 cre\u0219terii speran\u021bei de via\u021b\u0103 \u0219i a modific\u0103rilor de diet\u0103. In Europa \u0219i America procentul persoanelor afectate este de 10-20%;\u00a0\u00een Romania se raporteaza o prevalen\u021b\u0103 de 10%, ajustat\u0103 dup\u0103 v\u00e2rst\u01031<\/sup>.<\/span><\/div>\n
\u00cen ultimul deceniu s-au \u00eenregistrat progrese semnificative \u00een ceea ce prive\u0219te biologia molecular\u0103 a excre\u021biei biliare \u0219i mecanismele care conduc la formarea calculilor. <\/span><\/div>\n
Un element patogenic important pentru procesul de formare a calculilor este suprasaturarea bilei \u00een anumite substan\u021be care vor precipita \u0219i vor genera cristale microscopice. Aceste cristale vor fi ancorate \u00een mucusul din vezicula biliar\u0103 produc\u00e2nd noroiul biliar. \u00cen timp, cristalele vor cre\u0219te \u00een dimensiuni, vor agrega \u0219i vor conduce la calculi macroscopici.<\/span><\/div>\n

Se descriu dou\u0103 mari categorii de calculi biliari:<\/span><\/p>\n

– Calculi de colesterol (85%);<\/span><\/p>\n

– Calculi pigmentari (15%).<\/span><\/p>\n

Factorii principali care contribuie la formarea calculilor de colesterol sunt urm\u0103torii:<\/span><\/p>\n

-propor\u021bia inadecvat\u0103 \u00eentre colesterol, lecitin\u0103 \u0219i s\u0103ruri biliare (compu\u0219i secreta\u021bi de ficat) \u00een favoarea colesterolului;<\/span><\/p>\n

-gradul de concentrare a bilei \u0219i staza din vezicul\u0103.<\/span><\/p>\n

Suprasaturarea bilei \u00een colesterol nu poate explica\u00a0\u00een totalitate procesul de formare a calculilor. Nuclea\u021bia<\/i> \u2013 etapa ini\u021bial\u0103 \u00een formarea calculilor \u2013 este procesul de tranzi\u021bie a colesterolului din stare solubil\u0103 \u00een stare solid\u0103 cristalizat\u0103. \u00cen interiorul veziculei biliare anumi\u021bi compu\u0219i pot favoriza acest proces, iar al\u021bii \u00eel pot inhiba. Spre exemplu, mucusul favorizeaz\u0103 nuclea\u021bia \u00een timp ce glicoproteinele specifice bilei se opun acestui fenomen. Hipersecre\u021bia de mucin\u0103 de c\u0103tre mucoasa veziculei biliare creeaz\u0103 un gel vascoelastic favorabil nuclea\u021biei. Arahidonil-lecitina ce este absorbit\u0103 din tractul digestiv \u0219i secretat\u0103 \u00een bil\u0103 determin\u0103 hipersecre\u021bie de mucus prin stimularea sintezei de prostanoizi de c\u0103tre mucoasa veziculei biliare; inhibitorii de prostaglandin\u0103 exercit\u0103 un efect negativ asupra produc\u021biei de mucus. <\/span><\/p>\n

Un alt factor implicat \u00een formarea calculilor \u00eel constituie hipomotilitatea veziculei biliarei cu staz\u0103 consecutiv\u0103. Aceast\u0103 condi\u021bie poate fi \u00eent\u00e2lnit\u0103 \u00een sarcin\u0103, dup\u0103 administrarea de contraceptive orale precum \u0219i la pacien\u021bii afla\u021bi \u00een unit\u0103\u021bile de terapie intensiv\u0103 ce primesc alimenta\u021bie parenteral\u0103.<\/span><\/p>\n

\u00cen func\u021bie de compozi\u021bia chimic\u0103, calculii de colesterol sunt \u00eemp\u0103r\u021bi\u021bi \u00een dou\u0103 categorii:<\/span><\/p>\n

–calculi de colesterol pur<\/i> ce con\u021bin 90-100% colesterol; sunt adesea unici, de culoare albicioas\u0103, av\u00e2nd diametrul >2.5 cm;<\/span><\/p>\n

–calculi micst<\/i>i cu un con\u021binut \u00een colesterol de 50-90%; sunt cel mai adesea multipli, de dimensiuni mai mici, cu varia\u021bii de form\u0103 \u0219i culoare; pot prezenta o structur\u0103 laminar\u0103, \u00een care stratul albicios de colesterol alterneaz\u0103 cu un strat sub\u021bire de pigment \u00eenchis la culoare av\u00e2nd o dispozi\u021bie concentric\u0103 \u00een jurul unui centru pigmentat.<\/span><\/p>\n

Factorii ce confer\u0103 un risc crescut de dezvoltare a calculilor de colesterol sunt urm\u0103torii:<\/span><\/p>\n

    \n
  • obezitatea;<\/span><\/li>\n
  • dietele hipercalorice;<\/span><\/li>\n
  • terapia cu clofibrat;<\/span><\/li>\n
  • fibroza chistic\u0103 asociat\u0103 cu insuficien\u021b\u0103 pancreatic\u0103;<\/span><\/li>\n
  • sexul feminin.<\/span><\/li>\n<\/ul>\n

    Calculii pigmentari sunt la r\u00e2ndul lor de dou\u0103 tipuri:<\/span><\/p>\n

    –calculi bruni<\/i> ce con\u021bin bilirubinat de calciu \u0219i s\u0103punuri de calciu; \u00een formarea acestora sunt implicate bacterii (prin producerea de beta-glucuronidaza \u0219i fosfolipaza); se asociaz\u0103 frecvent cu diverticuli duodenali periampulari; tind s\u0103 se formeze \u00een ductele biliare;<\/span><\/p>\n

    –calculi de culoare neagr\u0103<\/i> ce con\u021bin bilirubinat de calciu rezultat \u00een urma polimeriz\u0103rii bilirubinei\u00a0\u00een exces ce p\u0103trunde\u00a0\u00een bil\u0103; apar predominant la pacien\u021bi cu anemii hemolitice cronice, ciroz\u0103 alcoolic\u0103 precum \u0219i la persoanele de varst\u0103 \u00eenaintat\u0103; tind s\u0103 se formeze\u00a0\u00een vezicula biliar\u01032;3<\/sup>.<\/span><\/p>\n

    Tratamentul litiazei biliare depinde de stadiul bolii. De obicei, dac\u0103 pacientul este asimptomatic se r\u0103m\u00e2ne \u00een expectativ\u0103. Pe de alt\u0103 parte, la persoanele simptomatice este necesar s\u0103 se recurg\u0103 la interven\u021bie chirugical\u0103 (colecistectomie). Exist\u0103 \u00eens\u0103 unele situa\u021bii\u00a0 \u00een care colecistectomia comport\u0103 anumite riscuri pentru pacient fiind necesar un tratament medical efectuat \u00een mod obi\u0219nuit cu acid ursodeoxicolic. Trebuie men\u021bionat \u00eens\u0103 c\u0103 acest tratament se aplic\u0103 numai\u00a0\u00een cazurile\u00a0\u00een care calculii con\u021bin colesterol3<\/sup>.<\/span><\/p>\n

    Recomand\u0103ri pentru analiza calculilor biliari <\/i><\/b>– <\/b><\/i>stabilirea compozi\u021biei chimice a calcului \u00een vederea unui tratament adecvat la pacien\u021bii cu risc operator crescut; calculul este extirpat\u00a0\u00een cursul unei ERCP (colangiopancreatografie endoscopic\u0103 retrograd\u0103) sau prin colecistolitotomie percutan\u01034<\/sup>. <\/span><\/p>\n

    Recipient de transport <\/i><\/b>\u2013 dup\u0103 extirpare calculul trebuie l\u0103sat s\u0103 se usuce dup\u0103 care este introdus \u00eentr-un recipeint curat; nu se vor ad\u0103uga alte substan\u021be \u0219i nu se va fixa cu scotch5<\/sup>.<\/span><\/p>\n

    Metoda <\/i><\/b>- <\/i>analiza chimic\u0103 a calculior dup\u0103 mojararea p\u00e2n\u0103 \u00een stadiul de pulbere<\/span>; va fi analizat\u0103 prezen\u021ba urm\u0103torilor compu\u0219i: colesterol, pigmen\u021bi biliari, calciu, magneziu, fosfa\u021bi, carbona\u021bi5<\/sup>.<\/span><\/p>\n

    Interpretarea rezultatelor<\/span><\/i><\/b><\/span><\/div>\n
    Prezen\u021ba unui con\u021binut crescut de colesterol \u00een calculii biliari ofer\u0103 informa\u021bii asupra procesului de formare a acestora \u0219i permite instituirea unui tratament corespunz\u0103tor4<\/sup>.<\/span><\/div>\n

    \u0411\u0438\u0431\u043b\u0438\u043e\u0433\u0440\u0430\u0444\u0438\u044f<\/span><\/strong><\/span><\/p>\n

    1. Litiaza biliar\u0103. www.ms.ro. Reference Type: Internet Communication.<\/span><\/span><\/div>\n
    2. Annie T Chemmanur. Biliary Disease. http:\/\/emedicine.medscape.com. Update: May 2013. Reference Type: Internet <\/span>Communication.<\/span><\/span><\/div>\n
    3. Douglas M Heuman. Cholelithiasis. http:\/\/emedicine.medscape.com. Update: May 2013. Reference Type: Internet <\/span>Communication.<\/span><\/span><\/div>\n
    4. Mayo Clinic, Mayo Medical Laboratories. Gallstone Cholesterol Content. www.mayomedicallaboratories.com. Update: 2013. Reference Type: Internet Communication.<\/span><\/div>\n
    5. Laborator Synevo. Referin\u021be specifice tehnologiei de lucru utilizate 2013. Ref Type: Catalog.<\/span><\/div>","protected":false},"excerpt":{"rendered":"

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