9月26日 非感染性肝病及CBL2012.ppt

非感染性肝病Non-infective Liver Disease GI department Peking University First HospitalCheng Hong CONTENTS Alcoholic liver disease Nonalcoholic fatty liver disease Autoimmune liver disease Drug-induced liver injury Metabolic liver disease Others Alcoholic Liver Disease (A L D) DEFINITION Alcoholic liver disease: A spectrum of clinical syndromes and pathologic changes in the liver caused by alcohol (ethanol). Fatty liver Alcoholic hepatitis Alcoholic fibrosis/cirrhosis Fatty liver Fatty liver (hepatic steatosis) Risk Factors The quantity and years of alcohol consumed The patients nutritional status Genetic trait Metabolic trait Pathology The liver is large; the cut surface, yellow. Hepatocyte steatosis Fat accumulates in zones 3 (centrizonal) and 2 (midzonal). Fat droplets tend to coalesce Fatty cysts probably represent late stages of the fatty change. Pathology ballooning degeneration of hepatocytes necrosis of hepatic cell diffuse inflammatory cell infiltrate Mallory hyaline (alcoholic hyaline) in zones 3 (centrizonal) Pathology The liver shrinks and becomes small. Micronodular cirrhosis is evident. May be a lingering feature of fatty liver and alcoholic hepatitis. The cirrhosis may slowly progress to a nonspecific macronodular pattern. Clinical Manifestation chronic drinker Usually asymptomatic In 33%, the liver is enlarged, smooth, and occasionally tender. Routine biochemical studies are often within normal limits; GGT is often elevated. Vascular spiders and features of hyperestrogenism and hypoandrogenism from the alcoholism per se may be evident. Clinical Manifestation The patient is usually a chronic drinker with a recent episode of exceptionally heavy consumption. fever, jaundice right upper quadrant pain Acute liver failure(ALF) tender hepatomegaly Clinical Manifestation Developing in 10 to 20% of those who are chronically heavy drinkers. can occur in patients who have never had evidence of alcoholic hepatitis May be relativel