Sarilikli hastaya yaklasim @ Dr Huseyin Koseoglu BILIRUBIN METABOLIZMAS: Raiyesiiee Org vers rete Far deki WMinbin dineg! ehioce oy Bilirubin metabolizmast Bilirubin metabolizmast + Unkonjuge bilirubin. ~ Suda etnmes,draragegmer ve sara leatlimaz. > Coro Aslosy« — Uposolubldurs membranlaréanholayikiagegerekdokulare fize a lai -y ag de wan incr i Soene ~ Dolasimda albdmine nonkovalent batlanarak aracere taginir- =< aaers = Gtinde 250-350 me olsur = Stokrom by = Diazo rea le direkt reaksyon verme ancak%80 tana), kafein = Stolrom ps9 veya Ue le isleren sonra reaklyan veri Indira) WBN. an Bape boynogs Hh ve diger aaadeaaee Y + By eluson bilintic enkenjvge bibnbirair Bilirubin metabolizmasi Bilirubin metabolizmast + Konjuge bilirubin. Ce d= Longuge eal’ Zz @2a => ~ Suda gbrnive sata le ati. er i _/ ~ Normalde kanda bulunmaz veya ¢ok az bulunur. onda iz 15m aed ide septa Van den Berghreasynunds dao rei et eaten ent tbwetd a> Eo E Binion band iladgpimit Fatal bil den indicat rin atecce die ogee nae te inbull BN 4 DAIL Tool ek :Bilirubin metabolizmasi a Segeo gpllenadan Sebren Lartette fortaiyer Mewede gok Temliah olse felrer Bee ener erg. gia Eo Nteminl rypis hematenter + 1vBilirubin asindretimi. — -} Travmna , Korcme , hemoboom eet { <-eatmamnin, |, eme tons eo 24s ohn 2 stnmasen = Kein wptate sftainar aor = sepsis, ~~ — SARILIK NEDENLERI ~ Gaberic tons forsier AST BG dae ae 7 fortis, ttle ober) > Theda iis seater satay By Chae gn” Srila. pane Peagestral th tipertioiiem . = Dugve Kantoat hater COS) 9 rtrediel nOaheafen + Popgashenn icuren Wout antlen Aitet Ge Gilbert 84.» 'y! Crigler-Najar Sendromu + 925, 00/08 rer To + UDP-GTizoform 1A aktvtesi ;bazen hepatik uptake azalma + Neon idea + conrad ot + Sree @ ee agent tress etre gmat Soo : ase ne + Sotnniaomaeli. + KGET veKChistolgjsinormal — @Eiindin genelde. SmylMly* + fespoeatceanyad + moe net je | Sse tim, + fenoberbtalyentor © Preanse ti QUEL, ping to penbie | pea See * Tedowihvaciyole y painstenp e792 dpha heyella sf Lpitie BP ; Bit bakager tHe S44 gin dalene bial _ : tele bere. depleting ' int, Feeber bile SR ee hope Aornakse thet tants. le cernmnn aL} vyhe vette Pe Bas pistol Paap ssa ae ae eae= Kolede cinta SE hokyhl kaebs)= PSX. 9 Rintrahepatikkolestar ) so yreye alake ver o> =e ~ Keslanjiebesion = Pekampullen bey > ScHepatoseldlerhasar Y Saoye atmads skank vor inh eds @ewrat Gu. mgl dt neste 2 geet > lndireld Bil, te 7 gaundet ttane, beat, bitledan ae i ee doin Koledokolitiazis tSapco. soap, bagh + Ana satrtanaindatas oimase) “SNA Mons Eines + Safra ese tag olanlarn %5-20snde vrai + Safra kesesinden gelen tas/primer koledok tas Hapelestt haenads kl 20-25 malldige wskor JMSPRLE COT olader yichclmen Bil. SSfeu Verdin abides a> Kemah mide e Lb Lge Hope don Koledokolitiazis- komplikasyon.. otedet. + Portrait. Lana = Ampslaae ray Keoynw peclrens eminis il ese tafe BAT, a tol he, + Akut Pankseatit. -} + Akut Kolanjit. * Sehonderbiliesitox.—> Yruy sirati konto Sel cae je tal A Taam dndisi AP gyobilecgy gh pOFERCE saranr db "At gpliecbiic tee ee tn 1. Bilie See We vier Eihenaa, © secier Ls ertcans Baier Leese atee Lotedol. Valedsie Learatl, feetr yerrsere este yelees Seb Koledokolitiazis EROS eine: bMalinds Alf ve GGT Sxelliule yiksetir. ALTE Age fabits burn ee Ber @ Ace ve GOT ikisi becber yokedic wt keane GET Gt: Hawmalbole bls He Se eee Geeta tate pent Thee 3 wtovlanedt, tuitetenttyal te TALE 4 shoplente ain - VLR. Koma ASE ks Se plerde gbieic aan alamo age des cade So fate eben TE dbwelidee dagete- Wielees norm gene Koledokolitazis-Tani. + Uscsenivitr spite non FBS, My dees + EUS: 9698,%95. > Erigi inten Famanna Layne MRCP: 693,994. 2-Beve'in alhindhks tealen gicemeyi + Tntraabdominal kolanjiografi%660-100, %100 «Seay Tae Wer” gs Aerts teh esa Sn rt ee amouk ek eatlendmerKoledokolitazis Tas rape vase ehtine, Endoscopic Retrograde Cholangio Pancreatograph Te tna Wan or seg a fa MRCE dn Bin legate at ELt AL AL fouledie fen ustoromgersen shee bays p droses Koledokolitiazis-tedavi_ + Komplikasyon tedavisi + Rep + Cerra % Tedoviss ERCP, baroramugersan Garohi UL “ERCP endikasyon. Pothop. bon + Bilier obstrilksiyon oldugu digindlen sani hasta* + Safra yolu hastali/pankreas hastaligi digndlen sariigy ‘olmayan hasta @ Yang teausl amos ELCR oldelue, nadic 3 Sajra tusalindeti hehangi bic pateleys (4a title, poroster enh) ; seneoss Cath. boeaQe worm oe ieee co riesAkut Kolanjit (AX) Kolanjit-patogenez~ ‘enfesyonusut + Portal van le hematojen yay nad Berlon Ugly gan, atemn £.Col,Klabsila, Enterobacter s aengndaic | Bee EY ee ey. entercoeeus= + Malan dark reaper Gans Kelnflainon gC eee resin a Abud Rolongid adil midohale gore Lier Q® AK tan biter 9 Chercol Trade sate, oShst so tagned tenkods aoe FEES ag Uvide hale de ilmab . Hala ERCP eda eden i eis true aoe f : state devas \it-Klinik Akut kolanjit-Tant > Ghaseeioituennectapasctemaaeamaii. “ebhe 2 TINTON sagt oracles 4 a z da ‘fever on sai ie 22 tabrary da ene of fates a Giese + Montaite-—) morhaldir 32 Lito da sac enon es "= Siddetli A kolanjit %20-30 bm C1 Bley ation (C2, Even the etlogy an imap (stir sen, sete) Suspected diagno: on em in A+ one em a tir Bor © Datinte diagnose one ia A oe tema Bardon ei C = Genel mortalte 10 = 1970 erde mortalite>50 Akut kolanjit-siddet (se) : Poihu, ea cba lainl fan i ——— x ake: 4 fitrane + snk” lee yarp dong igh seeAkut kolanjit-tedavi + Yeterlihidrasyon, elektrolit bozukiugunun izeltilmesi, analjezk tedavi + Organ yetmezlif ve sepsis igin yalun takip + Antibiot tedavi + Bier dren} ——_ re = Cerrahi nae CPerkvhon “Torah r TK yapslie HERE yopilameyinco FT yer Kolenjiogrops ) ws bateter + T= 19 teilyer ithe, drew; Safra Uaraling dewey ile Betagga yo diac afer PCH olawese eeerohi NQabn soln son Parazit EE + Ascaris lumbricoides + Echinococeus granulosus + Clonorchis sinensis AF facolahepatica safc tardive year, Whe HATH Le Nie, ERCP Ve « foconttler Koledeiy kayel' " Jeninlene : patel gate Walgh ts ai Se ie NS, roe a Tiplen vers 1, Tip? tip) ) Bevilon ERCP Moyle goer Gas afirtdened "bates Sop, BN yibeckti giles aLatrabagell atest satin fede otnstle sles. Ly te Sob hott gutageie” 20 = yt de ole Eade geek Cate pe tat serty Kolanjiokarsinom (cc) intra- ve ekstra-hepatiksfrayollanepitelyal hicrelerden kaynakianan tm. reg Insite 12/1000 NOL areliitle youte hosters chee ce adRt, deel Enystor ¥ Tedave ceroF Koledol ote -UsK geislemls , distalde besink vordse ¥ Pantress bess koledaga boss yeper WSient boyep Whe dee ve carahi ge vite Whiptle iain. 2. intrahe == a Meater 2 AY 1 Eater (Wick) + Tres laglar. + Akutholestaz— Again) ~ Amolsislin-Mawolanat, Amiodaron, ACEIpanabolik steroid, ‘Rzothioprin,Klopidogre} Ketokorazol, Naproksen, fifampin, + Kronik kolestaz = Ampisln,Amiipiin,Amokssiin-Rawulanat, arabollk steroid, Karbamazepin, Eritromisin, OKS,fnitin, TMP-SMX, TCA ee ee a . Konjuge hiperbilirubinemi + Biller obstrUksiyon -eee PelaeabenatiebnleaE Tey ES Fate Sle, + 3, Hepatoselaler hasar s it Total Parenteral. Nutrisyon. > keri A > inteahapsE rolutet + steatoz + Kolestaz + Safragamuru olusumu + Uzun sirede midahale edilmezse siroza f Tedovisl otlral beslenmeye geais+ Aralikl kolestatik ataklar + Safra asiti sekresyonunda defekt olan bir grup hastalik + Hepatoseluler hasar bulgusu olmadan kolestaz bulgulan olmasi + Sirozasikhkailerler 7 + ATP8B1, ABCBI1 mutasyoniari + KC ral + Siroza genelde ierlemez PBC. Gebeligin intrahepatik kolestazi_ Cciwe) + PBS= primer bilierkolonjit + ABCB4 gen mutasyonu rettceseeuke + Kigak intralobuler sara kanallarinin lenfost isl hasan + Kasint, sail + ALP ve bil yiksek, ASTIALT yksek- ‘Serum safra-asit viksck A Geta. We besbede dale ASCO ALT git JERE BeetRlEY ate ALE Sut ae SENG crete see Te ata 7 UNE giloakmae Fhe agine 1BC Oteimerin , a Y PBC Tedavies UDCA (Vobdestsi ; tree at. Fi T)GINES BK ve Ue gikactie - Roliade Bi nadiren gerebic aafee ttle BQO we Tednide UDCA eae lean feet WE ae ete LN she Konjuge hiperbilirubinemi + 1.ailler obstruksiyon + 2. Intrahepatik kolestaz ‘ Nealon. ‘B.Hlepatosolilerhasar 5 = Rever Att vical hepa (ay yasvilicus tiny, HEY) Had aw yeBV Aeonica, CMY) ¥ Hew ve Master teh . . = ke iebamia 2 oiW ote Sond > Gheelag Konjuge Hiperbilirubinemi-genetik Tom 83, + Aka hasar me hastaliklatr- ~Atarbor, Asetaminote, Allopurinol eens, Fuse, Haltan ev=bar™ on a a ‘etlGor, Roi, Satine teas, valestowt Sracem + ene itn ina + owner ier overs lass) : + anoles muspesicSiganicamjon * BE? ponent ‘tasiyici molekil defekt (safraya atim + idrar kaproperfirin dizeyi normalin 3 = Dilfer, inp, mins, Salforamide,Teoksen py oe + io + learner doi etna ‘aoe . Erde yorka half obseblitle bulgy vere » Oykii- > ilagebithisel drier diyet destek rtnlari a Bes > Hepatitis faktorleri > Diyas hahas Konjenitalhastalk(Karacier veya hemoltk) YAKLASIM HIV Gebelik~ Eslieden semptam (kasint, ates, karin ag kilo kayb,- hls, myali) Eslik eden hastalik (UK, tiroidit, KY) — Cheadighae i rlerolt poeta aa eet a Or ae gt © Tore Gi = OH + viele O15 9 Bayle clear zo = IS + Sates. ae i P jo BIL yiksatie QdeIL habinigess voae DAIL yobs Laboratuar Teserbcant gotew > Alb ve AST/ALT normals hepatichasar veya bllec hasta ihtimali cok az. Konjenital hastaliklari digtinmek lazim “> Onplanda ALP yiksek: Biller obstrlisivan veva intrahenatik. ‘elestar— => ASTIATTOnplandayoksetchepstoselernasr, fe : : ————— LEH pak Hr oy verye Ke simes vm aime WG Gag galas, BAL Be3 mplaty NR AF CUD — : Ores ite, OL NSN Ne coe oe ee tary We Ma ae, Me lle ieee Uimerse | Ke sinter dork chu abic Mepatesdicler boson 7 Abed Ke yee” gash ensGériintileme ; Ee Giintilemde USG UL Heh. ~ieeerch sagen yolten Alebe ise + Safrayollonnin genislemedifi; “J bx La: Sets gelvm fer fore cate F Sonlitle guldi BIL qDELIIGh ver. Orta ya Hr rye og AM REN Oo Konjuge hiperbilirubinemi Castano andce de to ot oahigated Snulncornaaea yperseainen + ferrin > \emabra maton + Seruloplazmin — Wilson + ALAT + TF adrenal etme testi + Tm markerlan? + Coliak testleri + Kardiak inceleme Unkonjuge hiperbilirubinemi