肝硬化(Hepatic Cirrhosis.英文).ppt
http://www.100md.com
参见附件(3992kb)。
Hepatic Cirrhosis
Cirrhosis---definition
chronic, progressed, diffuse hepatocellular injury fibrosis
nodular regeneration
Incidence: 17/100000/y
Age: 20-50 yr.
Etiology of cirrhosis(I)
Etiology of cirrhosis(II)
6. Hepatic venous outflow obstruction(肝血液循环障碍)
veno-occlusive disease, Budd-Chiari syndrome, constrictive pericarditis
7. Metabolic disorders (遗传代谢性疾病)
hemochromatosis(血色病); Wilson's disease(肝豆状核变性);
8. Autoimmune hepatitis (AIH)(自身免疫性肝炎)
9. Schistosomiasis (血吸虫病)
10. Cryptogenic (隐原性)
11. Mixed: alcohol+virus , HBV+HCV, HBV+schistosomiasis
Pathogenesis: chronic, progressed, diffuse
? Hepatocyte injury leading to necrosis.
? Chronic inflammation - (hepatitis).
? Capillarization (肝窦毛细血管化) of the space of Disse is a key event.
? Bridging fibrosis.
? Regeneration of remaining hepatocytes proliferate as round nodules surrounded by fibrous septa.
? Loss of vascular arrangement results in regenerating hepatocytes ineffective.
? Cirrhosis may lead to liver failure, portal hypertension, or development of hepatocellular carcinoma
Histopathologic classification
? micronodular
uniformly small nodules (< 3 mm in diameter) and regular bands of connective tissue
? macronodular
nodules that vary in size (3 mm to 5 cm in diameter)
? mixed macro and micronodular
(incomplete septal cirrhosis) combines elements of micronodular and macronodular cirrhosis.
Consequences of portal hypertension[I]
1.Splenomegaly (脾肿大)
2.Formation and open of portal-systemic collateral's (门体侧支循环开放)--Esophageal/gastric varices (食管/胃静脉曲张) (short gastric/coronary veins)--Rectal collateral's(痔静脉丛) (Suphemorrhoidal/middle & inf. hemorrhoidal)--Caput medusae(水母头)( umbilical/epigastric)--abdominal wall varices (腹壁静脉曲张)--Portal system and left renal
Consequences of portal hypertension[II]
3. Ascites (腹水)
Theories of ascites formation
? Underfilling theory (灌注不足假说)
? Overflow theory (泛溢假说)
? Arterial vasodilation theory (动脉扩张假说)
Ascites
? Sodium retention---Renin angiotension aldosterone system(RAAS)?---sympathetic nerve system ?,norepinephrine?--- Intrarenal factors: Kallikrein-kinin system, Adenosine .
? Water retention---Antidiuretic hormone(ADH)?---Impaired renal synthesis of PGs (PGE2?)
? Renal vasoconstriction--- RAAS, AngiotensionII?---SNS---ADH?---ET?
Endocrine system
(gynecomastia(男性乳房发育),telangiectases (毛细血管扩张症),spider nevi(蜘蛛痣),palmar erythema(肝掌)
testicular atrophy(睾丸萎缩)
menstrual irregularities (月经失调)
Pulmonary manifestations
?Hepatic hydrothorax (肝性胸水)
?Hepatopulmonary syndrome
(HPS, 肝肺综合征)
HRS is characterized clinically by the triad of pulmonary vascular dilatation causing arterial hypoxemia in the setting of advanced liver disease.
HRS(Hepatorenal syndrome, 肝肾综合征)
( Occurred in the setting of:---chronic liver disease---advanced hepatic failure---portal hypertension ......
Hepatic Cirrhosis
Cirrhosis---definition
chronic, progressed, diffuse hepatocellular injury fibrosis
nodular regeneration
Incidence: 17/100000/y
Age: 20-50 yr.
Etiology of cirrhosis(I)
Etiology of cirrhosis(II)
6. Hepatic venous outflow obstruction(肝血液循环障碍)
veno-occlusive disease, Budd-Chiari syndrome, constrictive pericarditis
7. Metabolic disorders (遗传代谢性疾病)
hemochromatosis(血色病); Wilson's disease(肝豆状核变性);
8. Autoimmune hepatitis (AIH)(自身免疫性肝炎)
9. Schistosomiasis (血吸虫病)
10. Cryptogenic (隐原性)
11. Mixed: alcohol+virus , HBV+HCV, HBV+schistosomiasis
Pathogenesis: chronic, progressed, diffuse
? Hepatocyte injury leading to necrosis.
? Chronic inflammation - (hepatitis).
? Capillarization (肝窦毛细血管化) of the space of Disse is a key event.
? Bridging fibrosis.
? Regeneration of remaining hepatocytes proliferate as round nodules surrounded by fibrous septa.
? Loss of vascular arrangement results in regenerating hepatocytes ineffective.
? Cirrhosis may lead to liver failure, portal hypertension, or development of hepatocellular carcinoma
Histopathologic classification
? micronodular
uniformly small nodules (< 3 mm in diameter) and regular bands of connective tissue
? macronodular
nodules that vary in size (3 mm to 5 cm in diameter)
? mixed macro and micronodular
(incomplete septal cirrhosis) combines elements of micronodular and macronodular cirrhosis.
Consequences of portal hypertension[I]
1.Splenomegaly (脾肿大)
2.Formation and open of portal-systemic collateral's (门体侧支循环开放)--Esophageal/gastric varices (食管/胃静脉曲张) (short gastric/coronary veins)--Rectal collateral's(痔静脉丛) (Suphemorrhoidal/middle & inf. hemorrhoidal)--Caput medusae(水母头)( umbilical/epigastric)--abdominal wall varices (腹壁静脉曲张)--Portal system and left renal
Consequences of portal hypertension[II]
3. Ascites (腹水)
Theories of ascites formation
? Underfilling theory (灌注不足假说)
? Overflow theory (泛溢假说)
? Arterial vasodilation theory (动脉扩张假说)
Ascites
? Sodium retention---Renin angiotension aldosterone system(RAAS)?---sympathetic nerve system ?,norepinephrine?--- Intrarenal factors: Kallikrein-kinin system, Adenosine .
? Water retention---Antidiuretic hormone(ADH)?---Impaired renal synthesis of PGs (PGE2?)
? Renal vasoconstriction--- RAAS, AngiotensionII?---SNS---ADH?---ET?
Endocrine system
(gynecomastia(男性乳房发育),telangiectases (毛细血管扩张症),spider nevi(蜘蛛痣),palmar erythema(肝掌)
testicular atrophy(睾丸萎缩)
menstrual irregularities (月经失调)
Pulmonary manifestations
?Hepatic hydrothorax (肝性胸水)
?Hepatopulmonary syndrome
(HPS, 肝肺综合征)
HRS is characterized clinically by the triad of pulmonary vascular dilatation causing arterial hypoxemia in the setting of advanced liver disease.
HRS(Hepatorenal syndrome, 肝肾综合征)
( Occurred in the setting of:---chronic liver disease---advanced hepatic failure---portal hypertension ......
您现在查看是摘要介绍页，详见PPT附件(3992kb)。