外科-门静脉高压症PPT.pptVIP

Measurement of Hepatic Functional Reserve. The time-honored method of assessing hepatic functional reserve is Child’s classification. In most clinical series, operative mortality rates for : Childs Class A -----0% to 5%, B -----10% to 15%, C ------greater than 25%. Section II / Chapter 7 - Hepatic Failure Table - Child-Turcotte-Pugh Scoring System Points 1 2 3 Encephalopathy None State I or II Stage III or IV Ascites Absent Slight (or controlled??by diuretics) Moderate despite??diuretic treatment Bilirubin (mg/dl)??Patients with PBC????or PSC 2 4 2-34-6 3 6 Albumin (g/L) 3.5 2.8-3.5 2.8 PT (prolonged sec)??INR 4 1.7 4-61.7-2.3 6 2.3 PBC---primary biliary cirrhosis??PSC---primary sclerosing cholangitis ? 2001 WebMD Corp. All Rights Reserved. Child’s classification. Hepatic Hemodynamic Assessment portal pressure can be indirectly estimated by measurement of hepatic venous wedge pressure. A complete angiographic study generally consists of selective injections of radiographic contrast medium into the superior mesenteric and splenic arteries followed by late venous phase films to define splenic, superior mesenteric, and portal veins. Sections:1~5 ANATOMY, PHYSIOLOGY, AND PATHOPHYSIOLOGY OF PORTAL HYPERTENSION CLASSIFICASION OF PORTAL HYPERTENSION EVALUATION OF THE PATIENT WITH CIRRHOSIS COMPLICATION OF PORTAL HYPERTENSION VARICEAL HEMORRHAGE PORTOSYSTEMIC ENCEPHALOPATHY ASCITES Section 4 COMPLICATION OF PORTAL HYPERTENSION Variceal bleeding Portal hypertensive gastropathy Ascites Spontaneous bacterial peritonitis Spontaneous shunts Encephalopathy Hypersplenism Sections:1~6 ANATOMY, PHYSIOLOGY, AND PATHOPHYSIOLOGY OF PORTAL HYPERTENSION HISTORICAL REVIEW CLASSIFICASION OF PORTAL HYPERTENSION EVALUATION OF THE PATIENT WITH CIRRHOSIS COMPLICATION OF PORTAL HYPERTENSION VARICEAL HEMORRHAGE PORTOSYSTEMIC ENCEPHALOPATHY ASCITES Section 5: VARICEAL HEMORRHAGE Bleeding from esophago