肝硬化cirrhosisofliver-浙江大学.ppt

肝硬化 Cirrhosis of liver 浙江大学医学院附属第一医院 厉有名 zlym@zju.edu.cn Introduction Cirrhosis is the END result of hepatocellular injury that leads to both fibrosis and nodular regeneration through the liver. Introduction The clinical features of cirrhosis result from hepatic cell dysfunction, portosystemic shunting and portal hypertension. 临床表现为单一脏器病变、多系统受累; 以肝功能损害和门脉高压为主要表现。 Etiology Hepatitis virus (HBV, HCV, HDV) Alcohol abuse Biliary Cirrhosis Toxic/Drug induced Autoimmune diseases Genetic/metabolic diseases Venous outflow obstruction Chronic right-sided heart failure Cryptogenic (隐原性） …… Pathology pathophysiology Micronodular (小结节性) alcoholic liver disease 3~5mm, ≯10mm Macronodular (大结节性) viral liver disease 10~50mm Mixed forms (混合性) Pathology pathophysiology Mechanisms of hepatic fibrosis 肝细胞炎症坏死→单核巨噬细胞系统→细胞因子→贮脂细胞→肌成纤维细胞样细胞→分泌细胞外基质(ECM)→弥漫性肝纤维化 Pathology pathophysiology Pathology pathophysiology Pathology pathophysiology 轻者：肾小动脉痉挛性收缩; 重者：肾小管变性坏死，急性肾功能衰竭。 Pathology pathophysiology 睾丸、卵巢、甲状腺、肾上腺皮质等多种内分泌腺萎缩和退行性变。 Pathphysiology: portal hypertension Pressure of portal vein＞20cm H2O Portosystemic shunting Ascites Endocrinal changes Hepatic encephalopathy Pathphysiology: portal hypertension Pathphysiology: ascites Portal hypertension 门静脉压力增高 Low plasma colloid osmotic pressure 血浆胶体渗透压降低 Disequilibrium of recycle of lymph fluid 肝脏淋巴液失平衡 Renal factors 肾性原因 Endocrinal factors 内分泌性原因 Clinical Manifestation Symptoms Signs Lab Findings Imaging Studies Special Studies Symptoms Signs Compensation stage (代偿期): Symptoms are insidious nonspecific Decompensation stage (失代偿期)： Deterioration of liver function Portal hypertension Systemic symptoms Symptoms of Complications Upper GI Bleeding Hepatic encephalopathy Spontaneous bacterial peritonitis Primary carcinoma of the liver Hepatorenal syndrome Water-electrolyte disturbance L