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胆结石:病因,症状及诊疗方法

Gallstones (cholelithiasis) - causes, symptoms, diagnosis, treatment & pathology

When you eat some real fatty foods, like say some delicious french fries,
当你进食一些富含高脂肪的食物 比如说美味的薯条
they make their way to through the stomach and into the small intestine.
它们会通过胃进入小肠
At this point they aren’t really french fries anymore,
此时它们就不是真正意义上的薯条了
but since they’re high in fat,
但由于它们脂肪含量高
they’re still a little more difficult to absorb,
吸收起来还是有点困难的
and that’s where your gallbladder comes in.
这时便轮到胆囊闪亮登场了
This high fat food stimulates the gallbladder to
这类高脂肪食物会刺激胆囊分泌胆汁
squeeze out some bile into the small intestine
并将胆汁排入到小肠中
that bile emulsifies the fat,
胆汁会乳化脂肪
or basically mixes the fat up, and makes it easier to absorb.
基本上就是混合脂肪 使其更容易吸收
This is pretty much your gallbladder’s job-
这差不多就是胆囊的用武之地:
store and concentrate bile until the time comes to send it to the small intestine.
储存并浓缩胆汁 直至将胆汁排入小肠
It’s not the most glamorous of jobs, but hey,
这并非是胆囊最神奇的地方
got ta start somewhere.
不过 我们总得有个开始吧
If we take a closer look at this magical substance,
如果我们仔细看一看这神奇的胆汁
we’d get a rough breakdown that’s something like the following:
就会明白它的成分大致可分为:
~70 % bile salts and acids,
70%的胆盐和胆汁酸
~10 % cholesterol, ~5 % phospholipids,
10%的胆固醇 5%的磷脂
~5 % proteins, and 1 % conjugated bilirubin,
5%的蛋白质 1%的结合胆红素
and the rest are small amounts of other things like water, electrolytes, and bicarbonate.
还有少量的其他物质 比如水 电解质 碳酸氢盐
Bile salts and acids are mostly a product of cholesterol metabolism,
胆盐和胆汁酸是胆固醇代谢的主要产物
so an acid might look something like this
胆汁酸的分子结构是这样的
and its salt is the anionic form, something like this.
胆盐呢 是阴离子形式 类似于这样
These acids and their salts have both hydrophobic and hydrophilic sides,
胆汁酸和胆盐同时具备疏水基团和疏水基团
making them amphiphilic,
使其具有两亲性
which help them make cholesterol and fat in the gut more soluble in bile.
得益于此 肠道中的胆固醇和脂肪更易溶于胆汁
The phospholipids are mostly lecithin,
磷脂 主要是卵磷脂
also amphiphilic, and also help make cholesterol and fats more soluble in bile.
也具有两亲性 同样有助于胆固醇和脂肪更易溶于胆汁
Gall-stones are these round and solid stones you can find inside your gallbladder,
胆结石就是你可以在胆囊里找到的圆形实心结石
and they’re made from the components of bile,
由胆汁的成分构成
and so they’re categorized depending on what they’re made of,
因此可以根据它们的成分来分类
the most common ones are cholesterol stones,
最常见的就是胆固醇结石
but there’s also bilirubin stones, which are sometimes called pigmented stones.
但也有胆红素结石 有时也被称为胆色素结石
The first type, as you might guess, are made mostly of cholesterol
你可能已经猜到了 第一种胆固醇结石主要由胆固醇构成
that has precipitated out of the bile as a solid and formed these solid stones.
胆固醇以固体的形式从胆汁中沉淀出来 形成了这些固体的结石
These account for around 75 to 90% of cases.
这类结石约占胆结石的75%到90%
This cholesterol precipitation can happen in a couple ways,
胆固醇可以以多种形式沉淀出来
first, the bile can become supersaturated with cholesterol,
首先 胆汁中的胆固醇过饱和
meaning that the bile has so much cholesterol
也就是说胆汁中含有过量的胆固醇
that the bile salts and acids or phospholipids
导致胆盐 胆汁酸 以及磷脂
can’t hold any more in solution,
不能再维持在溶液中的相对含量
because remember that these all help make the cholesterol more soluble in bile,
因为所有的这些物质都有助于让胆固醇更易溶于胆汁
and so the cholesterol comes out of solution as a solid or precipitates.
从而使胆固醇以固体或沉淀的形式从溶液中析出
Another, somewhat similar way,
此外 同理
is if you don’t have enough of these bile acids or salts and
如果没有足够的胆盐 胆汁酸 磷脂
phospholipids to help keep the cholesterol in solution,
帮助维持溶液中胆固醇的相对含量
so the less you have,
那么它们的含量越少
the less cholesterol can be in solution and the more precipitates out.
溶液中的胆固醇就越少 析出的胆固醇就越多
Gallbladder stasis, or inactivity,
胆囊淤积 或胆囊收缩功能不良
has also been linked to forming stones,
也与结石的形成有关
if the bile just sits there,
如果胆汁还停留在胆囊
it can cause the cholesterol to separate and basically precipitate out as a solid,
就会导致胆固醇以固体的形式沉淀析出
kind of like when the oil in your peanut butter jar separates from the peanuts
就像花生酱罐放置太久
if it just sits too long.
里面的油就会分离出来
Stones that’re made of cholesterol can’t be seen on x-ray,
胆固醇结石在X光下是不可见的
but rarely are the stones only cholesterol,
但结石很少只含胆固醇
and usually you’ll see a bit of a mixed composition;
通常可以看到一些混合成分
if they have enough calcium carbonate they might be able to be seen on x-ray.
如果结石含有足量的碳酸钙 在X光片上也是可见的
Remember that we said there’s a small amount of electrolytes and bicarbonate?
还记得我们有说过胆汁中还有少量的电解质和碳酸氢盐吗?
Well some of those electrolytes are calcium ions,
有些电解质是钙离子
and calcium ions tend to form insoluble precipitates
钙离子易与碳酸氢盐结合
with bicarbonate as calcium carbonate,
形成不溶性沉淀物碳酸钙
which would be radio-opaque, and visible on x-ray,
碳酸钙不可穿透X射线 在X光下可见
but usually there’s not enough calcium carbonate
但通常没有足量的碳酸钙
and the cholesterol stones will be radiolucent
胆固醇结石是可穿透X射线的
and on x-ray you won’t be able to see them.
因此在X光下看不到它们
Alright, so the other type is bilirubin or pigmented gallstones.
另一种胆结石类型是胆红素结石 也叫胆色素结石
These ones, again, are pretty self-explanatory
这类结石 顾名思义
and are made mostly of bilirubin and therefore are pigmented.
主要由胆红素组成 因此是有颜色的
These are made when there’s too much bilirubin in the bile
当胆汁中的胆红素过量时就会产生这类结石
and it has combined with calcium to form the solid precipitate calcium bilirubinate.
胆红素与钙结合形成固体沉淀物胆红素钙
Since they’re made partly of calcium, they’ll usually be radiopaque,
因为胆红素结石部分是由钙组成的 所以它们是不可穿透X射线的
meaning you can see them on x-ray,
这就意味着可以在X光下看到它们
here’s an example showing pigmented gallstones on x-ray.
这有一个胆色素结石在X光下显影的例子
Since it’s the bilirubin in bile,
因为胆色素结石的胆汁中存在着胆红素
we’d maybe assume that they’re made of conjugated bilirubin, right?
我们可能会认为胆色素结石是由结合胆红素构成的 对吗?
Well, actually pigmented gallstones are made of unconjugated bilirubin.
事实上 胆色素结石是由非结合胆红素构成的
What?
什么?
I thought there was only conjugated bilirubin in bile?
我还以为胆汁中只有结合胆红素呢?
Well the vast majority is conjugated,
其实胆汁中绝大多数是结合胆红素
but there is a small amount of unconjugated bilirubin in bile as well,
但仍有少量的非结合胆红素
only about 1-2 % of total bilirubin,
非结合胆红素仅占总胆红素的1到2%
which is only 1 % of bile.
占胆汁的1%
Although the exact mechanism is unclear,
尽管确切的机制尚不清楚
this tiny tiny amount of unconjugated bilirubin is thought to
但这些非常微量的非结合胆红素被认为是
form from nonbacterial and nonenzymatic hydrolysis of conjugated bilirubin,
由结合胆红素经非细菌和非酶水解形成的
so through a reaction in the chemical environment of bile
所以胆汁里的整个反应过程中的化学环境
that doesn’t involve enzymes or bacteria.
并未涉及到酶或者细菌
OK quick breakdown of the structure of conjugated vs. unconjugated bilirubin:
好了 我们来快速分析一下结合胆红素和 非结合胆红素的结构:
the conjugated form has this R-group, glucuronic acid,
结合胆红素有R-基团和葡萄糖醛酸
that makes it water soluble,
这使得它可以溶于水
unconjugated just has this OH group,
非结合胆红素有OH-基团
which at the pH of bile, is in anionic form
在胆汁的pH值下 它呈负离子形式
that’d probably really like to bind with calcium.
很可能会与钙结合
Usually though, bile salts bind up the calcium ions
通常情况下 胆盐会与钙离子结合
and keep them from binding with and precipitating unconjugated bilirubin.
以防钙离子与非结合胆红素结合 沉淀
With extravascular hemolysis, we have macrophages eating up red blood cells
血管外溶血时 巨噬细胞吞噬红细胞的量
more than normal and unconjugated bilirubin production is ramped up, right?
比正常时还要多 从而加速了非结合胆红素的产生 不是吗?
Which is conjugated by the liver and sent to the gallbladder.
非结合胆红素由肝脏转化 并输送至胆囊
These situations where there’s a lot of hemolysis and unconjugated bilirubin production,
在这种有大量溶血和非结合胆红素产生的情况下
there’s going to eventually be more conjugated bilirubin produced, right?
最终会产生更多的结合胆红素 不是嘛?
And it’s thought that when there’s more conjugated bilirubin in the bile,
于是人们普遍认为 当胆汁中的结合胆红素增加时
there’s also more unconjugated bilirubin,
非结合胆红素也会增加
to the point where it can now bind calcium instead of the bile salts,
直到非结合胆红素结合钙离子而非胆盐
and precipitate out to form black pigmented stones.
然后沉淀析出 形成黑色的胆色素结石
If the gallstone is brown pigmented,
如果胆结石是褐色的
it’s often a sign of gallbladder or biliary tract infection,
通常是胆囊或胆道感染的征兆
and often the stones have even ventured outside gallbladder and into the bile ducts.
并且通常情况下 这类结石甚至会有可能脱出胆囊 进入胆管
These brown gallstones are also made of the calcium salts of unconjugated bilirubin,
这些褐色胆结石也是由非结合胆红素的钙盐组成
what’s different, though, is how the unconjugated bilirubin forms:
不同的是 非结合胆红素的形成方式
what happens is that a bacteria that causes gallbladder infection,
事实上 引起胆囊感染的某种细菌
like E coli., for example,
比如 大肠杆菌
brings about hydrolytic enzymes
产生水解酶
that hydrolyze both conjugated bilirubin and phospholipids,
水解结合胆红素和磷脂
that again combine with calcium ions,
再与钙离子结合
which then precipitates out to form stones.
然后沉淀析出结石
The brownness is due to this mix of unconjugated or hydrolyzed bilirubin and phospholipids.
胆结石的褐色源自这种未结合的或者水解的胆红素和磷脂的混合物
Some other common gallbladder infections are Ascitris lumbricoides
另外一些常见的胆囊感染是由蛔虫和
and clonorchis sinesis—
华枝睾吸虫引起的
the second of which is endemic to China, Korea, and Vietnam,
其中华枝睾吸虫是中国 韩国和越南所特有的
so brown-pigmented stones are commonly seen in Asian populations.
所以褐色的胆结石常见于亚洲人群
Also women are typically more at risk than men,
而且 女性患胆结石的风险通常比男性更大
because estrogen increases cholesterol stone formation,
因为雌激素会促进胆固醇结石的形成
which is also why use of oral contraceptive pills
这也就是为什么使用含雌激素的口服避孕药
that contain estrogen increase the risk of cholesterol stones.
会增加患胆固醇结石的风险
Also though, obesity is often associated with increased levels of cholesterol, right?
此外 肥胖通常也与胆固醇水平的升高有关 对吗?
Meaning that it’s also associated with increased risk of cholesterol stones.
这也意味着它与增加胆固醇结石形成的风险有关
Finally, rapid weight-loss that decreases lipids
最后 快速减肥降脂会导致胆汁成分失衡
can create an imbalance in bile composition that increases the chances of gallstone formation.
从而增加胆结石形成的可能

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视频概述

简单介绍胆结石的病因,症状及其诊疗方法

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收集自网络

翻译译者

长安小盆友

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审核员1024

视频来源

https://www.youtube.com/watch?v=UPw3ot1M_o0

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