Download - NÝBURAGULA
![Page 1: NÝBURAGULA](https://reader031.vdocumento.com/reader031/viewer/2022020921/568157ad550346895dc53a51/html5/thumbnails/1.jpg)
NÝBURAGULANÝBURAGULA
BARNALÆKNISFRÆÐI
HÁSKÓLI ÍSLANDS
Atli Dagbjartsson
![Page 2: NÝBURAGULA](https://reader031.vdocumento.com/reader031/viewer/2022020921/568157ad550346895dc53a51/html5/thumbnails/2.jpg)
Nýburagula
GULAGULA
• Myndun bilirubins úr hemoglobulíni • Flutningur bilirubins frá reticuloendotheial vef til lifrar• Bynding bilirubins (conjugation) við glucuronylsýru í
lifrarfrumum• Útskilnaður bilirubins í þvagi og saur• Óconjugerað bilirubin getur valdið heilaskemmdum
(Kernicterus)
![Page 3: NÝBURAGULA](https://reader031.vdocumento.com/reader031/viewer/2022020921/568157ad550346895dc53a51/html5/thumbnails/3.jpg)
Nýburagula
BILIRUBINBILIRUBIN
![Page 4: NÝBURAGULA](https://reader031.vdocumento.com/reader031/viewer/2022020921/568157ad550346895dc53a51/html5/thumbnails/4.jpg)
Nýburagula
GULAGULA
• Myndun bilirubins úr hemoglobulíni • Flutningur bilirubins frá reticuloendotheial vef til lifrar• Bynding bilirubins (conjugation) við glucuronylsýru í
lifrarfrumum• Útskilnaður bilirubins í þvagi og saur• Óconjugerað bilirubin getur valdið heilaskemmdum
(Kernicterus)
![Page 5: NÝBURAGULA](https://reader031.vdocumento.com/reader031/viewer/2022020921/568157ad550346895dc53a51/html5/thumbnails/5.jpg)
Nýburagula
BILIRUBINBILIRUBIN
![Page 6: NÝBURAGULA](https://reader031.vdocumento.com/reader031/viewer/2022020921/568157ad550346895dc53a51/html5/thumbnails/6.jpg)
Nýburagula
FYSIOLOGISK GULAFYSIOLOGISK GULA
• Aukin þéttni óconjugeraðs bilirubins
í subcutam fitu
• Hátt bilirubin í sermi
![Page 7: NÝBURAGULA](https://reader031.vdocumento.com/reader031/viewer/2022020921/568157ad550346895dc53a51/html5/thumbnails/7.jpg)
Nýburagula
FYSIOLOGISK GULA FYSIOLOGISK GULA (óconjugerað bilirubin)(óconjugerað bilirubin)
• 1. Aukin framleiðsla bilirubins:– Há hct. við fæðingu– Stuttur líftími rbk.– Upptaka bilirubins frá görnum
(enterohepatic circulation)
![Page 8: NÝBURAGULA](https://reader031.vdocumento.com/reader031/viewer/2022020921/568157ad550346895dc53a51/html5/thumbnails/8.jpg)
Nýburagula
FYSIOLOGISK GULAFYSIOLOGISK GULA
• 2. Léleg upptaka bilirubins frá plasma
Skortur á Y próteinum• 3. Léleg „conjugation“
Skert starfsemi glucuronyl transferasa• 4. Lélegur útskilnaður bilirubins
• 5. Brjóstamjólkurgula
![Page 9: NÝBURAGULA](https://reader031.vdocumento.com/reader031/viewer/2022020921/568157ad550346895dc53a51/html5/thumbnails/9.jpg)
Nýburagula
PATHOLOGISK GULA PATHOLOGISK GULA (óconjugerað bilirubin)(óconjugerað bilirubin)
• 1. HemolysaIsoimmunisation
Erfðagallar í rbk.
Utanaðkomandi þættir
![Page 10: NÝBURAGULA](https://reader031.vdocumento.com/reader031/viewer/2022020921/568157ad550346895dc53a51/html5/thumbnails/10.jpg)
Nýburagula
PATHOLOGISK GULA PATHOLOGISK GULA (óconjugerað bilirubin)(óconjugerað bilirubin)
• 2. Blæðingar og marblettir
• 3. Blóð í meltingarvegi• 4. Enterohepatiska hringrásin• 5. Hypothyroidismus• 6. Hypopituitarismus• 7. „Familial nonhemolytisk“ gula
Crigler-Najar
Gilberts
![Page 11: NÝBURAGULA](https://reader031.vdocumento.com/reader031/viewer/2022020921/568157ad550346895dc53a51/html5/thumbnails/11.jpg)
Nýburagula
GULAGULA
• Myndun bilirubins úr hemoglobulíni • Flutningur bilirubins frá reticuloendotheial vef til lifrar• Bynding bilirubins (conjugation) við glucuronylsýru í
lifrarfrumum• Útskilnaður bilirubins í þvagi og saur• Óconjugerað bilirubin getur valdið heilaskemmdum
(Kernicterus)
![Page 12: NÝBURAGULA](https://reader031.vdocumento.com/reader031/viewer/2022020921/568157ad550346895dc53a51/html5/thumbnails/12.jpg)
Nýburagula
ÁHÆTTUÞÆTTIRÁHÆTTUÞÆTTIRfyrir heilaskemmdumfyrir heilaskemmdum
• 1. Fyrirburar• 2. Hemolysa• 3. Súrefnisskortur• 4. Acidosis• 5. Þurrkur• 6. Lágt albumen• 7. Sýkingar• 8. Lyf
![Page 13: NÝBURAGULA](https://reader031.vdocumento.com/reader031/viewer/2022020921/568157ad550346895dc53a51/html5/thumbnails/13.jpg)
Nýburagula
RANNSÓKNIRRANNSÓKNIR
• 1. Blóðstatus
skoða blóðstrokið sérstaklega• 2. Coombs próf• 3. Blóðflokkun• 4. Bilirúbin
direct reacting
indirect reacting
• 5. Byndigeta blóðsins
![Page 14: NÝBURAGULA](https://reader031.vdocumento.com/reader031/viewer/2022020921/568157ad550346895dc53a51/html5/thumbnails/14.jpg)
Nýburagula
MEÐFERÐMEÐFERÐ
![Page 15: NÝBURAGULA](https://reader031.vdocumento.com/reader031/viewer/2022020921/568157ad550346895dc53a51/html5/thumbnails/15.jpg)
Nýburagula
MEÐFERÐMEÐFERÐ
• 1. Vökvun
• 2. Flýta hægðalosun• 3. Ljósameðferð• 4. Blóðskipti
![Page 16: NÝBURAGULA](https://reader031.vdocumento.com/reader031/viewer/2022020921/568157ad550346895dc53a51/html5/thumbnails/16.jpg)
Nýburagula
BLÓÐSKIPTIBLÓÐSKIPTI
• TILGANGUR:
• FJARLÆGJA EFNI ÚR BLÓÐINU SVO SEM
• antibodies
• bilirubin
• lyf
• toxin
• o.fl.
![Page 17: NÝBURAGULA](https://reader031.vdocumento.com/reader031/viewer/2022020921/568157ad550346895dc53a51/html5/thumbnails/17.jpg)
Nýburagula
BLÓÐSKIPTIBLÓÐSKIPTI
• BLÓÐSKIFTABLÓÐIÐ:
• sermið samrýmist blóðkornum barnsins
• blóðkornin samrýmist sermi barnsins
![Page 18: NÝBURAGULA](https://reader031.vdocumento.com/reader031/viewer/2022020921/568157ad550346895dc53a51/html5/thumbnails/18.jpg)
Nýburagula
BLÓÐSKIPTIBLÓÐSKIPTI
• FRAMKVÆMDIN:
• ÚT - INN
• 5 - 10 % AF BLÓÐMAGNI BARNSINS Í EINU
• Samtals notað u.þ.b. 2 x blóðmagn barnsins,
• sem er 90 - 100 ml á kg líkamsþunga þess
![Page 19: NÝBURAGULA](https://reader031.vdocumento.com/reader031/viewer/2022020921/568157ad550346895dc53a51/html5/thumbnails/19.jpg)
Nýburagula
BLÓÐSKIPTINBLÓÐSKIPTIN
• FRAMKVÆMDIN
Rusl
BlóðpokiBlóð
barnsins
![Page 20: NÝBURAGULA](https://reader031.vdocumento.com/reader031/viewer/2022020921/568157ad550346895dc53a51/html5/thumbnails/20.jpg)
Nýburagula
BLÓÐSKIFTINBLÓÐSKIFTIN
• Árangur blóðskiftanna
![Page 21: NÝBURAGULA](https://reader031.vdocumento.com/reader031/viewer/2022020921/568157ad550346895dc53a51/html5/thumbnails/21.jpg)
Nýburagula
BLÓÐSKIPTIBLÓÐSKIPTI
• HÆTTUR:• rangt blóð• blóðkornin setjast í pokanum• sýkingarhætta• jóniserað calcíum lækkað• blóðrásarálag - truflanir• electrolytatruflanir• lár blóðsykur eftir blóðskiftin