{"id":7193,"date":"2022-05-02T00:00:12","date_gmt":"2022-05-01T15:00:12","guid":{"rendered":"https:\/\/wp.meccari.jp\/?p=7193"},"modified":"2023-12-25T12:14:36","modified_gmt":"2023-12-25T03:14:36","slug":"menu_38","status":"publish","type":"post","link":"https:\/\/wp.meccari.jp\/eigocafe\/menu_38\/","title":{"rendered":"Menu 38\u3000\u9ec4\u75b8\u306b\u95a2\u3059\u308b\u82f1\u8a9e\u8868\u73fe"},"content":{"rendered":"\"\"\r\n\r\n

\u3053\u3093\u306b\u3061\u306f\u3002\u300c\u533b\u5b66\u82f1\u8a9e\u30ab\u30d5\u30a7<\/strong><\/span>\u300d\u306b\u3088\u3046\u3053\u305d\uff01<\/span><\/p>\r\n\r\n

\u3053\u3053\u306f\u300c\u30b3\u30fc\u30d2\u30fc1\u676f\u5206\u300d\u306e\u6642\u9593\u3067\u3001\u533b\u5b66\u82f1\u8a9e\u306b\u307e\u3064\u308f\u308b\u8a71\u3092\u6c17\u8efd\u306b\u697d\u3057\u3093\u3067\u3044\u305f\u3060\u304f\u30b3\u30fc\u30ca\u30fc\u3067\u3059\u3002<\/span><\/p>\r\n\r\n

\u672c\u65e5\u306e\u30c6\u30fc\u30de\u306f\u300c\u9ec4\u75b8\u306b\u95a2\u3059\u308b\u82f1\u8a9e\u8868\u73fe<\/strong><\/span>\u300d\u3002<\/span><\/p>\r\n

\u300c\u9ec4\u75b8<\/strong>\u300d\u306f\u533b\u5b66\u6559\u80b2\u30e2\u30c7\u30eb\u30fb\u30b3\u30a2\u30fb\u30ab\u30ea\u30ad\u30e5\u30e9\u30e0\u306b\u3042\u308b\u7fd2\u5f97\u3059\u3079\u304d37\u75c7\u5019\u306e\u4e00\u3064\u3067\u3059\u304c\u3001\u300c\u773c\u7403\u7d50\u819c\u9ec4\u67d3<\/strong>\u300d\u3084\u300c\u80c6\u7ba1\u7d50\u77f3\u75c7<\/strong>\u300d\u306a\u3069\u306e\u82f1\u8a9e\u8868\u73fe\u3068\u306a\u308b\u3068\u3001\u96e3\u3057\u3044\u3068\u611f\u3058\u308b\u65b9\u3082\u591a\u3044\u306e\u3067\u306f\u306a\u3044\u3067\u3057\u3087\u3046\u304b\uff1f<\/span><\/p>\r\n

\u305d\u3053\u3067\u4eca\u6708\u306f\u3001\u300c\u9ec4\u75b8\u306b\u95a2\u3059\u308b\u82f1\u8a9e\u8868\u73fe<\/strong>\u300d\u3092\u3054\u7d39\u4ecb\u3057\u305f\u3044\u3068\u601d\u3044\u307e\u3059\u3002<\/span><\/p>\r\n

\u300c\u773c\u7403\u7d50\u819c\u9ec4\u67d3<\/strong>\u300d\u3063\u3066\u82f1\u8a9e\u3067\u4f55\u3068\u8a00\u3046\uff1f<\/strong><\/span>
\r\n\u300c\u9ec4\u75b8<\/strong>\u300d\u306f\u82f1\u8a9e\u3067\u306f jaundice<\/strong><\/span><\/span> \u3068\u306a\u308a\u307e\u3059\u3002\u3053\u308c\u306f\u30d5\u30e9\u30f3\u30b9\u8a9e\u3067\u300c\u9ec4\u8272<\/strong>\u300d\u3092\u610f\u5473\u3059\u308b jaune<\/strong> \u304b\u3089\u751f\u307e\u308c\u305f\u8868\u73fe\u3067\u3059\u3002<\/span><\/p>\r\n

\u3053\u306e\u3088\u3046\u306b jaundice \u81ea\u4f53\u306b\u300c\u9ec4\u8272<\/strong>\u300d\u3068\u3044\u3046\u610f\u5473\u304c\u3042\u308b\u308f\u3051\u3067\u3059\u304b\u3089\u3001\u300c\u9ec4\u75b8<\/strong>\u300djaundice<\/strong> \u306e\u5b9a\u7fa9<\/strong>\u306f abnormal yellowing of the skin and\/or conjunctiva caused by a high level of bilirubin<\/strong> \u3068\u306a\u308a\u307e\u3059\u3002\u3053\u306e conjunctiva<\/strong> \u306f\u300c\u7d50\u819c<\/strong>\u300d\u306e\u3053\u3068\u3067\u3059\u3002\u7686\u3055\u3093\u3082 OSCE \u306a\u3069\u3067\u300c\u773c\u7403\u7d50\u819c\u304c\u9ec4\u8272\u306b\u306a\u3063\u3066\u3044\u308b\u5834\u5408\u3001\u300e\u9ec4\u75b8\u300f\u3067\u306f\u306a\u304f\u300e\u9ec4\u67d3<\/strong>\u300f\u3068\u3044\u3046\u8868\u73fe\u3092\u4f7f\u3044\u306a\u3055\u3044\u300d\u3068\u7fd2\u3063\u305f\u3053\u3068\u3068\u601d\u3044\u307e\u3059\u3002\u540c\u3058\u3088\u3046\u306b\u82f1\u8a9e\u3067\u3082\u300c\u773c\u7403\u7d50\u819c\u9ec4\u67d3<\/strong>\u300d\u306b\u306f jaundice \u3067\u306f\u306a\u304f\u3001\u30e9\u30c6\u30f3\u8a9e\u3067\u300c\u9ec4\u8272<\/strong>\u300d\u3092\u610f\u5473\u3059\u308b ictericus \u304b\u3089\u751f\u3058\u305f icterus<\/strong><\/span> \u3068\u3044\u3046\u82f1\u8a9e\u3092\u4f7f\u3044\u3001conjunctival icterus<\/strong><\/span> \u3068\u8868\u73fe\u3057\u307e\u3059\u3002\u5b9f\u306f\u3053\u306e icterus \u306b\u3082\u300c\u9ec4\u75b8\u300d\u3068\u3057\u3066\u306e\u610f\u5473\u304c\u3042\u308b\u306e\u3067\u3059\u304c\u3001\u5b9f\u969b\u306b\u306f\u82f1\u8a9e\u3067\u3082\u300c\u9ec4\u75b8<\/strong>\u300d\u3068\u3057\u3066\u306f jaundice \u304c\u4f7f\u308f\u308c\u3001\u540d\u8a5e\u306e icterus \u3084\u5f62\u5bb9\u8a5e\u306e icteric<\/strong><\/span> \u306f\u300c\u9ec4\u67d3<\/strong>\u300d\u3068\u3057\u3066\u4f7f\u308f\u308c\u3066\u3044\u307e\u3059\u3002\u307e\u305f\u4ee5\u524d\u306f\u300c\u9ec4\u67d3\u3057\u3066\u3044\u308b\u90e8\u4f4d\u306f\u5f37\u819c\u3067\u3042\u308b\u300d\u3068\u8003\u3048\u3089\u308c\u3066\u3044\u305f\u305f\u3081\u306b\u3001\u300c\u773c\u7403\u5f37\u819c\u9ec4\u67d3\u300dscleral icterus \u3068\u3044\u3046\u8868\u73fe\u3082\u4f7f\u308f\u308c\u3066\u3044\u307e\u3057\u305f\u304c\u3001\u73fe\u5728\u3067\u306f\u300c\u9ec4\u67d3\u3057\u3066\u3044\u308b\u90e8\u4f4d\u306f\u7d50\u819c\u3067\u3042\u308b<\/strong>\u300d\u3068\u8003\u3048\u3089\u308c\u3001conjunctival icterus<\/strong> \u3068\u3044\u3046\u8868\u73fe\u3092\u4f7f\u3046\u3053\u3068\u304c\u63a8\u5968\u3055\u308c\u3066\u3044\u307e\u3059\u3002<\/span><\/p>\r\n

\u3053\u306e jaundice \u306e\u5b9a\u7fa9\u306b \u201ccaused by a high level of bilirubin\u201d<\/strong> \u3068\u3042\u308b\u3088\u3046\u306b\u3001\u76ae\u819a\u306e\u8272\u304c\u9ec4\u8272\u3068\u306a\u3063\u305f\u3060\u3051\u3067\u306f jaundice \u3068\u306f\u306a\u308a\u307e\u305b\u3093\u3002\u8aad\u8005\u306e\u7686\u3055\u3093\u3082\u3088\u304f\u3054\u5b58\u77e5\u306e\u3088\u3046\u306b\u3001carrots \u3084 oranges \u306a\u3069\u3092\u98df\u3079\u904e\u304e\u305f\u5834\u5408\u306b\u3082\u76ae\u819a\u306e\u8272\u304c\u9ec4\u8272\u306b\u306a\u308a\u307e\u3059\u3002\u3053\u308c\u306f carotene<\/strong><\/span> \u300c\u30ab\u30ed\u30c1\u30f3<\/strong>\u300d\u306e\u904e\u5270\u6442\u53d6\u306b\u3088\u308b carotenemia<\/strong><\/span> \u300c\u30ab\u30ed\u30c1\u30f3\u8840\u75c7\u30fb\u67d1\u76ae\u75c7<\/strong>\u300d\u306b\u3088\u308b\u3082\u306e\u3067\u3059\u3002\u305f\u3060\u3057 carotene<\/strong> \u306f\u300c\u30ab<\/strong>\u30e9\u30c6\u30a3\u30fc\u30f3\u300d\u3068\u3001carotenemia<\/strong> \u306f\u300c\u30ab\u30ed\u30c6\u30a3\u30cb\u30a3<\/strong>\u30df\u30a3\u30a2\u300d\u306e\u3088\u3046\u306a\u767a\u97f3\u3068\u306a\u308b\u306e\u3067\u6ce8\u610f\u3057\u3066\u304f\u3060\u3055\u3044\u306d\u3002<\/span><\/p>\r\n

Bilirubin \u3063\u3066\u3069\u3046\u767a\u97f3\u3059\u308b\u306e\uff1f<\/strong><\/span>
\r\n\u524d\u8ff0\u3057\u305f\u3088\u3046\u306b\u300c\u9ec4\u75b8\u300djaundice \u306e\u5b9a\u7fa9\u306f\u3001 abnormal yellowing of the skin and\/or conjunctiva caused by a high level of bilirubin<\/strong> \u3068\u306a\u308a\u307e\u3059\u3002\u65e5\u672c\u8a9e\u3067\u306f\u300c\u30d3\u30ea\u30eb\u30d3\u30f3<\/strong>\u300d\u3068\u8868\u8a18\u3055\u308c\u308b bilirubin<\/strong><\/span> \u3067\u3059\u304c\u3001\u591a\u304f\u306e\u8f9e\u66f8\u3067\u306f\u300c\u30d3\u30ea\u30eb<\/strong>\u30a5\u30d3\u30f3\u300d\u306e\u3088\u3046\u306a\u30a2\u30af\u30bb\u30f3\u30c8\u3067\u8a18\u8f09\u3055\u308c\u3066\u3044\u307e\u3059\u3002\u3057\u304b\u3057\u82f1\u8a9e\u570f\u306e\u533b\u7642\u73fe\u5834\u3067\u306f\u300c\u30d3<\/strong>\u30ea\u30eb\u30a5\u30d3\u30f3\u300d\u306e\u3088\u3046\u306a\u30a2\u30af\u30bb\u30f3\u30c8\u3067\u767a\u97f3\u3055\u308c\u308b\u3053\u3068\u304c\u591a\u304f\u3042\u308a\u307e\u3059\u3002\u3053\u306e\u3088\u3046\u306b\u3001\u82f1\u8a9e\u570f\u306e\u533b\u7642\u8005\u304c\u533b\u5b66\u7528\u8a9e\u3092\u8f9e\u66f8\u3067\u7d39\u4ecb\u3055\u308c\u3066\u3044\u308b\u901a\u308a\u306b\u767a\u97f3\u3057\u306a\u3044<\/strong>\u5834\u5408\u3082\u5b9f\u969b\u306b\u306f\u591a\u304f\u3042\u308a\u307e\u3059\u3002\u3057\u305f\u304c\u3063\u3066\u533b\u5b66\u7528\u8a9e\u306e\u767a\u97f3\u3092\u78ba\u8a8d\u3057\u305f\u3044\u5834\u5408\u306b\u306f\u3001YouTube\u306a\u3069\u306e\u52d5\u753b\u3067\u305d\u306e\u7528\u8a9e\u3092\u691c\u7d22\u3057\u3001\u305d\u306e\u7528\u8a9e\u304c\u82f1\u8a9e\u570f\u306e\u533b\u7642\u8005\u306b\u3088\u3063\u3066\u3069\u306e\u3088\u3046\u306b\u767a\u97f3\u3055\u308c\u3066\u3044\u308b\u306e\u304b\u3092\u78ba\u8a8d\u3059\u308b<\/strong>\u3053\u3068\u3092\u304a\u52e7\u3081\u3044\u305f\u3057\u307e\u3059\u3002<\/span><\/p>\r\n

\u300c\u30b0\u30eb\u30af\u30ed\u30f3\u9178\u62b1\u5408<\/strong>\u300d\u3063\u3066\u82f1\u8a9e\u3067\u4f55\u3068\u8a00\u3046\uff1f<\/strong><\/span>
\r\n\u300c\u9ec4\u75b8\u300djaundice \u306e\u8a3a\u65ad\u306b\u304a\u3044\u3066\u3001\u3053\u306e\u300c\u30d3\u30ea\u30eb\u30d3\u30f3\u306e\u4ee3\u8b1d<\/strong>\u300dbilirubin metabolism<\/strong><\/span> \u3092\u7406\u89e3\u3059\u308b\u3053\u3068\u306f\u6975\u3081\u3066\u91cd\u8981\u3067\u3059\u3002\u305d\u306e\u8a73\u7d30\u306f\u300c\u751f\u7406\u5b66<\/strong>\u300dphysiology<\/strong> \u3067\u5b66\u3076\u3053\u3068\u3068\u601d\u3044\u307e\u3059\u306e\u3067\u3001\u3053\u3053\u3067\u306f\u305d\u306e\u6700\u5c0f\u9650\u306e\u5185\u5bb9\u306e\u307f\u3092\u4e0b\u8a18\u306b\u793a\u3057\u307e\u3059\u3002<\/span><\/p>\r\n

Bilirubin Metabolism<\/strong>
\r\n\u2022<\/strong> Bilirubin comes from RBC breakdown<\/strong>
\r\n\u2022<\/strong> Unconjugated<\/strong> bilirubin is NOT<\/strong> water soluble
\r\n\u2022<\/strong> Conjugation<\/strong> occurs in the liver<\/strong>
\r\n\u2022<\/strong> Conjugated<\/strong> bilirubin is water soluble<\/strong>
\r\n<\/span>
\r\n\u7686\u3055\u3093\u3054\u5b58\u77e5\u306e\u901a\u308a\u3001bilirubin \u306e\u4ee3\u8b1d\u306f\u300c\u8d64\u8840\u7403<\/strong>\u300d red blood cells<\/strong> (RBC<\/strong>)\/erythrocytes<\/strong> \u304b\u3089\u59cb\u307e\u308a\u307e\u3059\u3002\u3053\u306e\u6bb5\u968e\u3067\u306e bilirubin \u306f\u307e\u3060\u300c\u30b0\u30eb\u30af\u30ed\u30f3\u9178\u62b1\u5408<\/strong>\u300dglucuronic acid conjugates<\/strong><\/span>\/ glucuronide conjugates<\/strong><\/span>\/conjugation with glucuronic acid<\/strong><\/span> \u3092\u53d7\u3051\u3066\u3044\u306a\u3044\u306e\u3067\u300c\u975e\u62b1\u5408\u578b\u30d3\u30ea\u30eb\u30d3\u30f3<\/strong>\u300dunconjugated bilirubin<\/strong><\/span>\u3001\u3082\u3057\u304f\u306f\u300c\u9593\u63a5\u30d3\u30ea\u30eb\u30d3\u30f3<\/strong>\u300dindirect bilirubin<\/strong><\/span> \u3068\u547c\u3070\u308c\u307e\u3059\u3002\u305d\u3057\u3066\u3053\u306e unconjugated\/indirect bilirubin \u306f\u6c34\u306b\u6eb6\u3051\u306a\u3044\u300c\u8102\u6eb6\u6027<\/strong>\u300dfat soluble<\/strong> \u3068\u306a\u308a\u307e\u3059\u3002<\/span><\/p>\r\n

\u305d\u3057\u3066\u3001\u3053\u306e\u300c\u30b0\u30eb\u30af\u30ed\u30f3\u9178\u62b1\u5408<\/strong>\u300dglucuronic acid conjugates<\/strong>\/ glucuronide conjugates<\/strong>\/conjugation with glucuronic acid<\/strong> \u306f\u300c\u809d\u81d3<\/strong>\u300dliver<\/strong> \u3067\u884c\u308f\u308c\u3001\u3053\u3053\u3067\u30b0\u30eb\u30af\u30ed\u30f3\u9178\u62b1\u5408\u3055\u308c\u305f\u30d3\u30ea\u30eb\u30d3\u30f3\u306f\u300c\u62b1\u5408\u578b\u30d3\u30ea\u30eb\u30d3\u30f3<\/strong>\u300d conjugated bilirubin<\/strong><\/span>\u3001\u3082\u3057\u304f\u306f\u300c\u76f4\u63a5\u30d3\u30ea\u30eb\u30d3\u30f3<\/strong>\u300d direct bilirubin<\/strong><\/span> \u3068\u547c\u3070\u308c\u307e\u3059\u3002\u305d\u3057\u3066\u3053\u306e conjugated bilirubin \u306f\u3001\u6c34\u306b\u6eb6\u3051\u308b\u300c\u6c34\u6eb6\u6027<\/strong>\u300d water soluble<\/strong><\/span> \u3068\u306a\u308b\u306e\u3067\u3059\u3002<\/span><\/p>\r\n

\u300c\u9ec4\u75b8<\/strong>\u300d\u306e\u8a3a\u65ad\u306f\u3069\u3046\u8003\u3048\u308c\u3070\u3044\u3044\u306e\uff1f<\/strong><\/span>
\r\n\u3067\u306f\u300c\u9ec4\u75b8\u300djaundice \u306e\u60a3\u8005\u3055\u3093\u304c\u6765\u9662\u3057\u305f\u5834\u5408\u3001\u305d\u306e\u8a3a\u65ad\u306f\u3069\u306e\u3088\u3046\u306b\u8003\u3048\u308c\u3070\u3088\u3044\u306e\u3067\u3057\u3087\u3046\u304b\uff1f<\/span><\/p>\r\n

\u3053\u3053\u3067\u91cd\u8981\u306b\u306a\u308b\u306e\u304c water soluble \u3067\u3042\u308b conjugated<\/strong>\/direct bilirubin<\/strong> \u306e\u7279\u5fb4\u3067\u3059\u3002water soluble \u3067\u3042\u308b\u3053\u306e conjugated\/direct bilirubin \u304c\u8840\u6db2\u5185\u3067\u4e0a\u6607\u3059\u308b\u3068\u3001\u305d\u308c\u304c\u305d\u306e\u307e\u307e\u5c3f\u306b\u6392\u6cc4\u3055\u308c\u308b\u3053\u3068\u3067\u300c\u6fc3\u3044\u8272\u306e\u5c3f<\/strong>\u300d dark urine<\/strong><\/span> \u304c\u751f\u3058\u307e\u3059\u3002\u305d\u3057\u3066\u82f1\u8a9e\u570f\u306e\u60a3\u8005\u3055\u3093\u306f\u3053\u306e dark urine \u3092 \u201ctea-colored<\/strong> urine\u201d \u3084 \u201ccola-colored<\/strong> urine\u201d \u306e\u3088\u3046\u306b\u8868\u73fe\u3057\u307e\u3059\u3002<\/span><\/p>\r\n

\u307e\u305f\u8a73\u3057\u3044\u6a5f\u5e8f\u306f\u3088\u304f\u308f\u304b\u3063\u3066\u3044\u307e\u305b\u3093\u304c\u3001\u3053\u306e conjugated\/direct bilirubin \u304c\u4e0a\u6607\u3059\u308b\u3068\u3001\u76ae\u819a\u306e\u300c\u75d2\u307f<\/strong>\u300d itchiness<\/strong><\/span> \u3082\u751f\u3058\u307e\u3059\u3002\u305d\u3057\u3066\u3001\u3053\u306e itchiness \u306f\u533b\u5b66\u82f1\u8a9e\u3068\u3057\u3066\u306f pruritus<\/strong><\/span> \u300c\u63bb\u75d2<\/strong>\uff08\u305d\u3046\u3088\u3046<\/strong>\uff09\u300d\u3068\u8868\u73fe\u3055\u308c\u307e\u3059\u3002\u307e\u305f\u3053\u306e pruritus \u304c\u3042\u308b\u5834\u5408\u3001\u76ae\u819a\u3092\u63bb\u304f\u3053\u3068\u306b\u3088\u3063\u3066 scratch marks<\/strong><\/span> \u304c\u76ae\u819a\u306b\u751f\u3058\u307e\u3059\u304c\u3001\u305d\u306e\u533b\u5b66\u82f1\u8a9e\u306f excoriation<\/strong><\/span> \u300c\u8868\u76ae\u5265\u96e2<\/strong>\u300d\u3068\u306a\u308a\u307e\u3059\u3002<\/span><\/p>\r\n

\u3067\u3059\u304b\u3089 jaundice \u306e\u8a3a\u65ad\u3092\u8003\u3048\u308b\u5834\u5408\u3001\u3053\u306e dark urine<\/strong> \u3068 pruritus<\/strong> \u306e\u6709\u7121\u3092\u5c0b\u306d\u308b\u3053\u3068\u3067\u3001\u305d\u306e\u60a3\u8005\u3055\u3093\u306e\u300c\u9ad8\u30d3\u30ea\u30eb\u30d3\u30f3\u8840\u75c7<\/strong>\u300dhyperbilirubinemia<\/strong><\/span> \u304c unconjugated<\/strong> \/indirect hyperbilirubinemia<\/strong><\/span> \u306a\u306e\u304b\u3001\u305d\u308c\u3068\u3082 conjugated<\/strong>\/direct hyperbilirubinemia<\/strong><\/span> \u306a\u306e\u304b\u3092\u5224\u65ad\u3059\u308b\u3053\u3068\u304c\u3067\u304d\u308b\u306e\u3067\u3059\u3002<\/span><\/p>\r\n

\u305d\u3057\u3066\u3001\u3053\u306e conjugation with glucuronic acid \u306f\u809d\u81d3\u3067\u884c\u308f\u308c\u308b\u305f\u3081\u3001\u305d\u306e\u524d\u5f8c\u306b\u3088\u3063\u3066 jaundice \u306f\u300c\u809d\u524d\u6027\u9ec4\u75b8<\/strong>\u300d pre-hepatic jaundice<\/strong><\/span>\u3001\u300c\u809d\u6027\u9ec4\u75b8<\/strong>\u300d hepatic jaundice<\/strong><\/span>\u3001\u300c\u809d\u5f8c\u9ec4\u75b8<\/strong>\u300d post-hepatic jaundice<\/strong><\/span> \u306e\u4e09\u3064\u306b\u5206\u3051\u3089\u308c\u307e\u3059\u3002<\/span><\/p>\r\n

Approach to Jaundice
\r\nDark Urine & Pruritus:<\/strong> (–<\/strong>)
\r\n= Unconjugated\/Indirect Hyperbilirubinemia
\r\n\u2022<\/strong> Pre-Hepatic<\/strong> Jaundice: Hemolysis<\/strong><\/span>
\r\n\u2022<\/strong> Hepatic<\/strong> Jaundice: Decreased Conjugation<\/strong><\/span>
\r\n<\/span>
\r\nDark Urine & Pruritus<\/strong>: (+<\/strong>)
\r\n= Conjugated (Direct) Hyperbilirubinemia
\r\n\u2022<\/strong> Hepatic<\/strong> Jaundice: Intra-Hepatic Obstruction<\/strong><\/span>
\r\n\u2022<\/strong> Post-Hepatic<\/strong> Jaundice: Extra-Hepatic Obstruction<\/strong><\/span><\/span><\/p>\r\n

\u809d\u81d3\u3067 conjugation \u304c\u884c\u308f\u308c\u308b\u524d\u306e unconjugated\/indirect hyperbilirubinemia \u304c\u751f\u3058\u308b\u300c\u809d\u524d\u6027\u9ec4\u75b8<\/strong>\u300d pre-hepatic jaundice<\/strong><\/span> \u306f\u3001\u8d64\u8840\u7403\u304c\u7834\u58ca\u3055\u308c\u308b\u300c\u6eb6\u8840<\/strong>\u300d hemolysis<\/strong><\/span> \u304c\u539f\u56e0\u3067\u751f\u3058\u307e\u3059\u3002\u540c\u69d8\u306b conjugation \u304c\u884c\u308f\u308c\u305f\u5f8c\u306e conjugated\/direct hyperbilirubinemia \u304c\u751f\u3058\u308b\u300c\u809d\u5f8c\u6027\u9ec4\u75b8<\/strong>\u300d post-hepatic jaundice<\/strong><\/span> \u306f\u3001\u300c\u80c6\u6c41<\/strong>\u300dbile<\/strong> \u304c\u8840\u6db2\u4e2d\u306b\u9006\u6d41\u3057\u3066\u3057\u307e\u3046\u300c\u809d\u5916\u80c6\u7ba1\u9589\u585e<\/strong>\u300d extra-hepatic obstruction<\/strong><\/span> \u304c\u539f\u56e0\u3067\u751f\u3058\u307e\u3059\u3002<\/span><\/p>\r\n

\u3053\u3053\u3067\u6ce8\u610f\u304c\u5fc5\u8981\u306a\u306e\u304c\u3001 unconjugated & conjugated hyperbilirubinemia \u306e\u4e21\u65b9\u304c\u751f\u3058\u308b \u300c\u809d\u6027\u9ec4\u75b8<\/strong>\u300d hepatic jaundice<\/strong><\/span> \u3067\u3059\u3002<\/span><\/p>\r\n

\u3082\u3057\u305d\u306e hepatic jaundice \u304c\u809d\u81d3\u5185\u3067\u306e conjugation \u304c\u5341\u5206\u306b\u884c\u308f\u308c\u306a\u3044 decreased conjugation<\/strong> \u306b\u3088\u308b\u3082\u306e\u3067\u3042\u308c\u3070\u3001unconjugated<\/strong>\/indirect hyperbilirubinemia<\/strong> \u3068\u306a\u308a\u307e\u3059\u304c\u3001\u305d\u308c\u304c\u809d\u81d3\u5185\u306e\u80c6\u7ba1\u304c\u9589\u585e\u3057\u3066\u8d77\u3053\u308b\u300c\u809d\u5185\u80c6\u7ba1\u9589\u585e<\/strong>\u300d intra-hepatic obstruction<\/strong><\/span> \u306b\u3088\u308b\u3082\u306e\u3067\u3042\u308c\u3070\u3001\u305d\u308c\u306f conjugated<\/strong>\/direct hyperbilirubinemia<\/strong> \u3068\u306a\u308b\u306e\u3067\u3059\u3002<\/span><\/p>\r\n

Self-limiting \u3063\u3066\u3069\u3046\u3044\u3046\u610f\u5473\uff1f<\/strong><\/span>
\r\n\u3067\u306f\u3001\u3053\u306e decreased conjugation \u306b\u3088\u308b hepatic jaundice \u306e\u539f\u56e0\u3068\u3057\u3066\u306f\u3069\u306e\u3088\u3046\u306a\u3082\u306e\u304c\u3042\u308b\u306e\u3067\u3057\u3087\u3046\u304b\uff1f<\/span><\/p>\r\n

\u305d\u306e\u4ee3\u8868\u4f8b\u304c\u300c\u4f53\u8cea\u6027\u9ec4\u75b8<\/strong>\u300d constitutional hyperbilirubinemia<\/strong><\/span>\uff08\u300c\u4f53\u8cea\u6027\u9ec4\u75b8\u300d\u306f \u82f1\u8a9e\u3067\u306fconstitutional jaundice \u3067\u306f\u306a\u304f\u3001constitutional hyperbilirubinemia \u3068\u8868\u73fe\u3059\u308b\u3053\u3068\u304c\u4e00\u822c\u7684\u3067\u3059\uff09\u3067\u3042\u308a\u3001\u305d\u306e\u4e2d\u3067\u3082\u6700\u3082\u983b\u5ea6\u304c\u9ad8\u3044\u306e\u304c\u300c\u30b8\u30eb\u30d9\u30fc\u30eb\u75c7\u5019\u7fa4<\/strong>\u300d Gilbert Syndrome<\/strong><\/span> \uff08\u82f1\u8a9e\u3067\u306f\u300c\u30b8\u30eb\u30d9\u30fc\u30eb\u300d\u3067\u306f\u306a\u304f\u300c\u30ae<\/strong>\u30eb\u30d0\u30a1\u300d\u306e\u3088\u3046\u306b\u767a\u97f3\u3055\u308c\u307e\u3059\uff09\u3067\u3059\u3002\u3053\u308c\u306f\u591a\u304f\u306e\u5834\u5408\u300c\u7121\u75c7\u72b6<\/strong>\u300d asymptomatic<\/strong> \u3067\u3042\u308a\u3001\u9ec4\u75b8\u3082 mild jaundice<\/strong> \u3067\u3042\u308b\u3053\u3068\u304c\u4e00\u822c\u7684\u3067\u3059\u3002\u307e\u305f\u3053\u306e\u75be\u60a3\u306f \u201cGilbert’s syndrome is usually self-limiting<\/strong>, and treatment is not necessary.\u201d \u306e\u3088\u3046\u306b\u8a18\u8f09\u3055\u308c\u307e\u3059\u304c\u3001\u3053\u3053\u3067\u4f7f\u308f\u308c\u3066\u3044\u308b self-limiting<\/strong><\/span> \u3068\u3044\u3046\u306e\u306f\u300c\u6cbb\u7642\u3092\u3057\u306a\u3044\u3067\u3082\u81ea\u7136\u306b\u8efd\u5feb\u3059\u308b<\/strong>\u300d\u3068\u3044\u3046\u610f\u5473\u3067\u3059\u306e\u3067\u3001\u77e5\u3089\u306a\u304b\u3063\u305f\u65b9\u306f\u3053\u308c\u3092\u6a5f\u4f1a\u306b\u662f\u975e\u899a\u3048\u3066\u304a\u3044\u3066\u304f\u3060\u3055\u3044\u306d\u3002<\/span><\/p>\r\n

\u307e\u305f intra-hepatic obstruction<\/strong> \u306b\u3088\u308bhepatic jaundice<\/strong> \u306e\u539f\u56e0\u306f\u6570\u591a\u304f\u3042\u308a\u3001\u305d\u306e\u4ee3\u8868\u7684\u306a\u3082\u306e\u306f\u4e0b\u8a18\u306e\u901a\u308a\u3067\u3059\u3002<\/span>
\r\n
\r\nHepatic Jaundice: Intra-Hepatic Obstruction<\/strong><\/span>
\r\n\u2022<\/strong> Viral Hepatitis\u300c\u30a6\u30a4\u30eb\u30b9\u6027\u809d\u708e\u300d
\r\n\u2022<\/strong> Alcoholic Hepatitis\u300c\u30a2\u30eb\u30b3\u30fc\u30eb\u6027\u809d\u708e\u300d
\r\n\u2022<\/strong> Drug-Induced Hepatitis\u300c\u85ac\u5264\u6027\u809d\u708e\u300d
\r\n\u2022<\/strong> Cirrhosis\u300c\u809d\u786c\u5909\u300d
\r\n\u2022<\/strong> Hepatocellular Carcinoma (HCC)\u300c\u809d\u7d30\u80de\u764c\u300d
\r\n<\/span>
\r\n\u3053\u3053\u3067\u6ce8\u610f\u304c\u5fc5\u8981\u306a\u306e\u304c\u3001\u3053\u3046\u3044\u3063\u305f hepatic jaundice \u306e\u4e2d\u306b\u306f decreased conjugation \u3082\u5f15\u304d\u8d77\u3053\u3059\u5834\u5408\u3082\u3042\u308b\u305f\u3081\u3001unconjugated<\/strong>\/indirect hyperbilirubinemia \u3068\u306a\u308b\u3082\u306e\u3082\u3042\u308b<\/strong>\u3068\u3044\u3046\u3053\u3068\u3067\u3059\u3002\u3088\u304f\u300c\u30a6\u30a4\u30eb\u30b9\u6027\u809d\u708e\u306f\u9593\u63a5\u30d3\u30ea\u30eb\u30d3\u30f3\u304c\u4e0a\u6607\u3059\u308b\u5834\u5408\u3068\u76f4\u63a5\u30d3\u30ea\u30eb\u30d3\u30f3\u304c\u4e0a\u6607\u3059\u308b\u5834\u5408\u306e\u4e21\u65b9\u304c\u3042\u308b<\/strong>\u300d\u3068\u8a00\u3044\u307e\u3059\u304c\u3001\u305d\u308c\u306f decreased conjugation \u304c\u512a\u4f4d\u304b\u3001\u305d\u308c\u3068\u3082 intra-hepatic obstruction \u304c\u512a\u4f4d\u304b\u306e\u9055\u3044\u3068\u3044\u3046\u308f\u3051\u3067\u3059\u3002
\r\n<\/span>
\r\n\u77e5\u3063\u3066\u304a\u304d\u305f\u3044<\/strong>\u300c\u80c6\u77f3<\/strong>\u300d\u306b\u95a2\u3059\u308b\u82f1\u8a9e\u8868\u73fe<\/strong><\/span>
\r\n\u3067\u306f\u6700\u5f8c\u306b\u3001\u300c\u809d\u5916\u80c6\u7ba1\u9589\u585e<\/strong>\u300dextra-hepatic obstruction<\/strong> \u306b\u3088\u308b post-hepatic jaundice \u306e\u539f\u56e0\u3092\u8003\u3048\u3066\u3044\u304d\u307e\u3057\u3087\u3046\u3002
\r\n<\/span>
\r\n\u3053\u308c\u306f\u57fa\u672c\u7684\u306b bile duct \u304c\u9589\u585e\u3059\u308b\u75be\u60a3\u306a\u3089\u3070\u4f55\u3067\u3082\u751f\u3058\u308b\u306e\u3067\u3001\u300c\u81b5\u982d\u90e8\u764c<\/strong>\u300dpancreatic head adenocarcinoma<\/strong><\/span> \u306a\u3069\u3067\u3082\u751f\u3058\u307e\u3059\u3002<\/span>
\r\n
\r\n\u3057\u304b\u3057\u4f55\u3068\u8a00\u3063\u3066\u3082\u3053\u306e extra-hepatic obstruction \u3068\u3057\u3066\u6700\u3082\u591a\u3044\u306e\u304c\u3001\u300c\u80c6\u77f3\u75c7<\/strong>\u300d gallstones<\/strong><\/span> \uff08\u300c\u30b4\u30a9<\/strong>\u30a5\u30b9\u30c8\u30a5\u30f3\u30ba\u300d\u306e\u3088\u3046\u306b\u767a\u97f3\uff09\u3067\u3059\u3002
\r\n<\/span>
\r\n\u3053\u306e gallstones \u306e risk factors \u3068\u3057\u3066\u6709\u540d\u306a\u306e\u304c 4Fs<\/strong><\/span> \u3067\u3059\u3002\u3053\u308c\u306f F<\/strong>emale\/F<\/strong>orty\/F<\/strong>at\/F<\/strong>ertile \u306e\u982d\u6587\u5b57\u3067\u3059\u304c\u3001\u305d\u308c\u305e\u308c\u300c\u5973\u6027<\/strong>\u300d\u300c40\u4ee3<\/strong>\u300d\u300c\u80a5\u6e80<\/strong>\u300d\u300c\u7d4c\u7523\u5a66<\/strong>\u300d\u3092\u610f\u5473\u3057\u3066\u3044\u307e\u3059\u3002\u307e\u305f 5Fs<\/strong> \u3068\u3059\u308b\u5834\u5408\u306b\u306f\u3001\u3053\u308c\u3089\u306b F<\/strong>air skin\u300c\u767d\u4eba<\/strong>\u300d\u304c\u52a0\u308f\u308a\u307e\u3059\u3002<\/span>
\r\n
\r\n\u3053\u306e gallstones \u304c\u3069\u3053\u306b\u3042\u308b\u304b\u306b\u3088\u3063\u3066\u305d\u306e\u533b\u5b66\u82f1\u8a9e\u306f\u7570\u306a\u308a\u307e\u3059\u3002\u80c6\u77f3\u304c\u80c6\u56a2\u5185\u306b\u3042\u308b\u5834\u5408\u306b\u306f cholelithiasis<\/strong><\/span> \u300c\u80c6\u56a2\u80c6\u77f3\u75c7<\/strong>\u300d\u3068\u306a\u308a\u3001\u80c6\u77f3\u304c\u80c6\u7ba1\u5185\u306b\u3042\u308b\u5834\u5408\u306b\u306f choledocholithiasis<\/strong><\/span> \u300c\u80c6\u7ba1\u80c6\u77f3\u75c7<\/strong>\u300d\u3068\u306a\u308a\u307e\u3059\u3002
\r\n<\/span>
\r\n\u305d\u3057\u3066 cholelithiasis \u306f\u300c\u80c6\u56a2\u708e<\/strong>\u300d cholecystitis<\/strong><\/span> \u3092\u5f15\u304d\u8d77\u3053\u3057\u3001choledocholithiasis \u306f\u300c\u80c6\u7ba1\u708e<\/strong>\u300d cholangitis<\/strong><\/span> \u3092\u5f15\u304d\u8d77\u3053\u3057\u307e\u3059\u304c\u3001jaundice \u3068\u306e\u95a2\u4fc2\u306b\u304a\u3044\u3066\u306f\u4e0b\u8a18\u306e\u5185\u5bb9\u304c\u6975\u3081\u3066\u91cd\u8981\u3068\u306a\u308a\u307e\u3059\u3002
\r\n<\/span>
\r\nCholelithiasis<\/strong> does NOT<\/strong><\/span> lead to jaundice!
\r\nCholedocholithiasis<\/strong><\/span> can cause jaundice!<\/strong><\/span>
\r\n
\r\n\u3064\u307e\u308a\u3001\u80c6\u56a2\u306e\u4e2d\u306b\u77f3\u304c\u3042\u308b\u3060\u3051\u306e cholelithiasis<\/strong> \u306f extra-hepatic obstruction \u3092\u8d77\u3053\u3055\u305a\u3001\u80c6\u9053\u306e\u4e2d\u306b\u77f3\u304c\u3042\u308b choledocholithiasis<\/strong> \u304c extra-hepatic obstruction \u3092\u5f15\u304d\u8d77\u3053\u3059\u306e\u3067\u3059\u3002<\/span>
\r\n
\r\n\u307e\u305f\u80c6\u77f3\u3068\u8a00\u3048\u3070\u3001 \u201cPainless jaundice with a palpable gallbladder is unlikely to be due to gallstones.<\/strong><\/span>\u201d \u3068\u3044\u3046 Courvoisier\u2019s Law<\/strong><\/span> \u3082\u6709\u540d\u3067\u3059\u304c\u3001\u3053\u308c\u306f\u82f1\u8a9e\u3067\u306f\u300c\u30af\u30a5\u30f4\u30ef\u30a1<\/strong>\u30b8\u30a3\u30a8\u30a3\u300d\u306e\u3088\u3046\u306a\u767a\u97f3\u3068\u306a\u308a\u307e\u3059\u3002<\/span>
\r\n
\r\n\u3055\u3066\u3001\u305d\u308d\u305d\u308d\u30ab\u30c3\u30d7\u306e\u30b3\u30fc\u30d2\u30fc\u3082\u6b8b\u308a\u308f\u305a\u304b\u3067\u3059\u3002\u6700\u5f8c\u306b\u4eca\u56de\u6700\u521d\u306b\u3054\u7d39\u4ecb\u3057\u305f Approach to Jaundice \u3092\u3082\u3046\u4e00\u5ea6\u307e\u3068\u3081\u3066\u304a\u304d\u307e\u3059\u3002<\/span>
\r\n
\r\nApproach to Jaundice<\/strong>
\r\nDark Urine & Pruritus:<\/strong> (–<\/strong>)
\r\n= Unconjugated\/Indirect Hyperbilirubinemia
\r\n\u2022<\/strong> Pre-Hepatic<\/strong> Jaundice: Hemolysis<\/strong>
\r\n\u2022<\/strong> Hepatic<\/strong> Jaundice: Decreased Conjugation<\/strong> (Gilbert Syndrome<\/strong>)
\r\n<\/span>
\r\nDark Urine & Pruritus:<\/strong> (+)
\r\n= Conjugated (Direct) Hyperbilirubinemia
\r\n\u2022<\/strong> Hepatic<\/strong> Jaundice: Intra-Hepatic Obstruction<\/strong> (Hepatitis<\/strong>\/Cirrhosis<\/strong>\/HCC<\/strong>)
\r\n\u2022<\/strong> Post-Hepatic<\/strong> Jaundice: Extra-Hepatic Obstruction<\/strong> (Choledocholithiasis<\/strong>)
\r\n<\/span><\/p>\r\n

\u3067\u306f\u3001\u307e\u305f\u306e\u3054\u6765\u5e97\u3092\u304a\u5f85\u3061\u3057\u3066\u304a\u308a\u307e\u3059\u3002<\/span><\/p>\r\n

\u300cDr. \u62bc\u5473\u306e\u533b\u5b66\u82f1\u8a9e\u30ab\u30d5\u30a7\u300d\u3067\u306f\u7686\u3055\u3093\u304b\u3089\u6271\u3063\u3066\u6b32\u3057\u3044\u30c8\u30d4\u30c3\u30af\u3092\u52df\u96c6\u3044\u305f\u3057\u307e\u3059\u3002\u3053\u3061\u3089\u306e\u30ea\u30f3\u30af<\/strong><\/span><\/a>\u304b\u3089\u3053\u306e\u30ab\u30d5\u30a7\u3067\u6271\u3063\u3066\u6b32\u3057\u3044\u3068\u601d\u3046\u533b\u5b66\u82f1\u8a9e\u306e\u30c8\u30d4\u30c3\u30af\u3092\u3054\u81ea\u7531\u306b\u8a18\u8f09\u304f\u3060\u3055\u3044\u3002<\/span><\/p>\r\n

\u56fd\u969b\u533b\u7642\u798f\u7949\u5927\u5b66\u533b\u5b66\u90e8 \u533b\u5b66\u6559\u80b2\u7d71\u62ec\u30bb\u30f3\u30bf\u30fc \u6559\u6388\u3000\u62bc\u5473 \u8cb4\u4e4b<\/p>","protected":false},"excerpt":{"rendered":"\u3053\u3093\u306b\u3061\u306f\u3002\u300c\u533b\u5b66\u82f1\u8a9e\u30ab\u30d5\u30a7\u300d\u306b\u3088\u3046\u3053\u305d\uff01 \u3053\u3053\u306f\u300c\u30b3\u30fc\u30d2\u30fc1\u676f\u5206\u300d\u306e\u6642\u9593\u3067\u3001\u533b\u5b66\u82f1\u8a9e\u306b\u307e\u3064\u308f\u308b\u8a71\u3092\u6c17\u8efd\u306b\u697d\u3057\u3093\u3067\u3044\u305f\u3060\u304f\u30b3\u30fc\u30ca\u30fc\u3067\u3059\u3002 \u672c\u65e5\u306e\u30c6\u30fc\u30de\u306f\u300c\u9ec4\u75b8\u306b\u95a2\u3059\u308b\u82f1\u8a9e\u8868\u73fe\u300d\u3002 \u300c\u9ec4\u75b8\u300d\u306f\u533b\u5b66\u6559\u80b2\u30e2\u30c7\u30eb\u30fb\u30b3\u30a2\u30fb\u30ab\u30ea\u30ad\u30e5","protected":false},"author":15,"featured_media":6865,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"onecolumn-960.php","format":"standard","meta":{"_acf_changed":false,"_jin_ogp_image_url":"","_jin_last_featured_id":0,"footnotes":""},"categories":[63],"tags":[],"class_list":["post-7193","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-eigocafe"],"acf":[],"_links":{"self":[{"href":"https:\/\/wp.meccari.jp\/api\/wp\/v2\/posts\/7193","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/wp.meccari.jp\/api\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/wp.meccari.jp\/api\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/wp.meccari.jp\/api\/wp\/v2\/users\/15"}],"replies":[{"embeddable":true,"href":"https:\/\/wp.meccari.jp\/api\/wp\/v2\/comments?post=7193"}],"version-history":[{"count":1,"href":"https:\/\/wp.meccari.jp\/api\/wp\/v2\/posts\/7193\/revisions"}],"predecessor-version":[{"id":7194,"href":"https:\/\/wp.meccari.jp\/api\/wp\/v2\/posts\/7193\/revisions\/7194"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/wp.meccari.jp\/api\/wp\/v2\/media\/6865"}],"wp:attachment":[{"href":"https:\/\/wp.meccari.jp\/api\/wp\/v2\/media?parent=7193"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/wp.meccari.jp\/api\/wp\/v2\/categories?post=7193"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/wp.meccari.jp\/api\/wp\/v2\/tags?post=7193"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}