fa برخورد با بیماری کلستاتیک کبدی عمومى General پژوهشي Research <span style="font-size:10.0pt;">کلستاز</span> <span style="font-size:10.0pt;">کبدی</span> <span style="font-size:10.0pt;">به</span> <span style="font-size:10.0pt;">صورت</span> <span style="font-size:10.0pt;">افزایش</span> <span style="font-size:10.0pt;">آلکالن</span> <span style="font-size:10.0pt;">فسفاتاز</span> <span style="font-size:10.0pt;">و</span> <span style="font-size:10.0pt;">گاماگلوتامیل</span> <span style="font-size:10.0pt;">ترانس</span> <span style="font-size:10.0pt;">پپتیداز</span> <span style="font-size:10.0pt;">و</span> <span style="font-size:10.0pt;">بدنبال</span> <span style="font-size:10.0pt;">آن</span> <span style="font-size:10.0pt;">هیپربیلی</span> <span style="font-size:10.0pt;">روبینمی</span> <span style="font-size:10.0pt;">کونژوگه</span> <span style="font-size:10.0pt;">مشخص</span> <span style="font-size:10.0pt;">می</span> <span style="font-size:10.0pt;">شود</span><span dir="LTR"><span style="font-size:10.0pt;">. </span></span><span style="font-size:10.0pt;">کلستاز</span> <span style="font-size:10.0pt;">به</span> <span style="font-size:10.0pt;">دو</span> <span style="font-size:10.0pt;">دسته</span> <span style="font-size:10.0pt;">داخل</span> <span style="font-size:10.0pt;">کبدی</span> <span style="font-size:10.0pt;">و</span> <span style="font-size:10.0pt;">خارج</span> <span style="font-size:10.0pt;">کبدی</span> <span style="font-size:10.0pt;">تقسیم</span> <span style="font-size:10.0pt;">بندی</span> <span style="font-size:10.0pt;">می</span> <span style="font-size:10.0pt;">گردد</span><span dir="LTR"><span style="font-size:10.0pt;">. </span></span><br> <span style="font-size:10.0pt;">کلستاز</span> <span style="font-size:10.0pt;">داخل</span> <span style="font-size:10.0pt;">کبدی</span> <span style="font-size:10.0pt;">نشانگر</span> <span style="font-size:10.0pt;">اختلال</span> <span style="font-size:10.0pt;">عملکرد</span> <span style="font-size:10.0pt;">هپاتوسلولار</span> <span style="font-size:10.0pt;">یا</span> <span style="font-size:10.0pt;">وجود</span> <span style="font-size:10.0pt;">ضایعه</span> <span style="font-size:10.0pt;">انسدادی</span> <span style="font-size:10.0pt;">مجاری</span> <span style="font-size:10.0pt;">صفراوی</span> <span style="font-size:10.0pt;">داخل</span> <span style="font-size:10.0pt;">کبدی</span> <span style="font-size:10.0pt;">دیستال</span> <span style="font-size:10.0pt;">به</span> <span style="font-size:10.0pt;">کانالیکول</span> <span style="font-size:10.0pt;">های</span> <span style="font-size:10.0pt;">صفراوی</span> <span style="font-size:10.0pt;">می</span> <span style="font-size:10.0pt;">باشد</span><span dir="LTR"><span style="font-size:10.0pt;">.</span></span><br> <span style="font-size:10.0pt;">اولین</span> <span style="font-size:10.0pt;">قدم</span> <span style="font-size:10.0pt;">برای</span> <span style="font-size:10.0pt;">بررسی</span> <span style="font-size:10.0pt;">کلستاز،</span> <span style="font-size:10.0pt;">افتراق</span> <span style="font-size:10.0pt;">کلستاز</span> <span style="font-size:10.0pt;">داخل</span> <span style="font-size:10.0pt;">کبدی</span> <span style="font-size:10.0pt;">از</span> <span style="font-size:10.0pt;">خارج</span> <span style="font-size:10.0pt;">کبدی</span> <span style="font-size:10.0pt;">است</span><span dir="LTR"><span style="font-size:10.0pt;">. </span></span><span style="font-size:10.0pt;">سونوگرافی</span> <span style="font-size:10.0pt;">شکم،</span> <span style="font-size:10.0pt;">برای</span> <span style="font-size:10.0pt;">رد</span> <span style="font-size:10.0pt;">وجود</span> <span style="font-size:10.0pt;">دیلاتاسیون</span> <span style="font-size:10.0pt;">مجاری</span> <span style="font-size:10.0pt;">صفراوی</span> <span style="font-size:10.0pt;">خارج</span> <span style="font-size:10.0pt;">و</span> <span style="font-size:10.0pt;">داخل</span> <span style="font-size:10.0pt;">کبدی</span> <span style="font-size:10.0pt;">حساس</span> <span style="font-size:10.0pt;">و</span> <span style="font-size:10.0pt;">اختصاصی</span> <span style="font-size:10.0pt;">است</span><span dir="LTR"><span style="font-size:10.0pt;">. </span></span><span style="font-size:10.0pt;">اگر</span> <span style="font-size:10.0pt;">اختلال</span> <span style="font-size:10.0pt;">مجاری</span> <span style="font-size:10.0pt;">صفراوی</span> <span style="font-size:10.0pt;">وجود</span> <span style="font-size:10.0pt;">داشته</span> <span style="font-size:10.0pt;">باشد،</span> <span style="font-size:10.0pt;">قدم</span> <span style="font-size:10.0pt;">بعدی</span> <span style="font-size:10.0pt;">می</span> <span style="font-size:10.0pt;">تواند</span><span dir="LTR"><span style="font-size:10.0pt;"> (MRCP) </span></span><span dir="LTR"><span style="font-family:minion pro,serif;"><span style="font-size:10.0pt;">Magnetic</span></span></span><span dir="LTR"><span style="font-size:10.0pt;"> Resonance Cholangiopancreatography </span></span><span style="font-size:10.0pt;">یا</span><span dir="LTR"><span style="font-size:10.0pt;"> (EUS) </span></span><span dir="LTR"><span style="font-family:minion pro,serif;"><span style="font-size:10.0pt;">Endoscopic</span></span></span> <span dir="LTR"><span style="font-family:minion pro,serif;"><span style="font-size:10.0pt;">Ultrasound</span></span></span> <span style="font-size:10.0pt;">باشد</span><span dir="LTR"><span style="font-size:10.0pt;">. </span></span><span style="font-size:10.0pt;">در</span> <span style="font-size:10.0pt;">صورتیکه</span> <span style="font-size:10.0pt;">در</span> <span style="font-size:10.0pt;">تصویربرداری</span> <span style="font-size:10.0pt;">شواهد</span> <span style="font-size:10.0pt;">انسداد</span> <span style="font-size:10.0pt;">خارج</span> <span style="font-size:10.0pt;">کبدی</span> <span style="font-size:10.0pt;">وجود</span> <span style="font-size:10.0pt;">نداشته</span> <span style="font-size:10.0pt;">باشد،</span> <span style="font-size:10.0pt;">تشخیص</span> <span style="font-size:10.0pt;">کلستاز</span> <span style="font-size:10.0pt;">داخل</span> <span style="font-size:10.0pt;">کبدی</span> <span style="font-size:10.0pt;">مطرح</span> <span style="font-size:10.0pt;">می</span> <span style="font-size:10.0pt;">شود</span> <span style="font-size:10.0pt;">که</span> <span style="font-size:10.0pt;">جهت</span> <span style="font-size:10.0pt;">بررسی</span> <span style="font-size:10.0pt;">آن،</span> <span style="font-size:10.0pt;">ابتدا</span><span dir="LTR"><span style="font-size:10.0pt;"> (</span></span><span dir="LTR"><span style="font-family:minion pro,serif;"><span style="font-size:10.0pt;">AMA</span></span></span><span dir="LTR"><span style="font-size:10.0pt;">) </span></span><span dir="LTR"><span style="font-family:minion pro,serif;"><span style="font-size:10.0pt;">Antimitochondrial</span></span></span> <span dir="LTR"><span style="font-family:minion pro,serif;"><span style="font-size:10.0pt;">Antibody</span></span></span> <span style="font-size:10.0pt;">چک</span> <span style="font-size:10.0pt;">می</span> <span style="font-size:10.0pt;">شود</span> <span style="font-size:10.0pt;">و</span> <span style="font-size:10.0pt;">اگر</span> <span dir="LTR"><span style="font-size:10.0pt;">AMA </span></span><span style="font-size:10.0pt;">منفی</span> <span style="font-size:10.0pt;">باشد،</span> <span style="font-size:10.0pt;">بیوپسی</span> <span style="font-size:10.0pt;">کبد</span> <span style="font-size:10.0pt;">مدنظر</span> <span style="font-size:10.0pt;">قرار</span> <span style="font-size:10.0pt;">می</span> <span style="font-size:10.0pt;">گیرد</span><span dir="LTR"><span style="font-size:10.0pt;">.</span></span> Hepatic cholestasis is characterized by elevated alkaline phosphatase and gama - glutamyl transpeptidase levels which is then followed by conjugated hyperbilirubinemia. It is classified into intrahepatic and extrahepatic cholestasis.<br> Intrahepatic cholestasis indicates hepatocellular dysfunction or the presence of an obstructive lesion in intrahepatic bile ducts distal to biliary canalicular system.<br> The first step in evaluating cholestasis is to distinguish intrahepatic from extrahepatic cholestasis. Abdominal sonography is a sensitive and specific modality to rule out intra- and extrahepatic biliary dilatation. If abnormal biliary tract is present, the next step is to perform Magnetic Resonance Cholangiopancreatography (MRCP) or Endoscopic Ultrasound (EUS). If there was not any evidence of biliary system obstruction in imaging, intrahepatic cholestasis is suggested and to evaluate this condition, initially Antimitochondrial antibody (AMA) should be checked and if the result was negative, liver biopsy should be considered. کلستاز, هیپربیلی روبینمی, سونوگرافی Cholestasis, Hyperbilirubinemia, Sonography 131 138 http://jmciri.ir/browse.php?a_code=A-10-1-2612&slc_lang=fa&sid=1 ناصر ابراهیمی دریانی 10031947532846005631 10031947532846005631 Yes گروه گوارش ، دانشگاه علوم پزشکی تهران محمد طاهر 10031947532846005632 10031947532846005632 No گروه گوارش ، دانشگاه علوم پزشکی تهران