病理学-第八章 消化系统疾病.ppt

４、结 局 ④肝癌 （１）稳定，代偿状态 （２）死因 ①肝性脑病 ②出血 ③感染 三、肝硬化（liver cirrhosis） （一）概述 （二）常见类型肝硬化 一）门脉性肝硬化 二）坏死后性肝硬化（postnecrotic cirrhosis) １、病 因 （１）肝炎Ｖ感染（亚重肝，慢活肝） （２）药物和化学物质中毒 2、病 变 变小： 变硬： 变形： 二）坏死后性肝硬化（postnecrotic cirrhosis) 1、病 因 2、病 变 （1）肉 眼 大小不等的粗大结节，Ｄ0.5~1cm、6cm （2)光 镜 ①肝Ｃ变性、坏死明显 ②ｆＣＴ明显增生，形成大小不等的假小叶，且纤维间隔宽窄不一。 ③纤维间隔炎Ｃ浸润及小胆管增生较显。 （2）癌变率高（１３.1%） （１）肝性脑病 （２）出血 （３）感染 （４）肝癌 二）坏死后性肝硬化（postnecrotic cirrhosis) 1、病 因 2、病 变 ３、临 床 （1）肝机能不全明显 4、结 局 三）胆汁性肝硬化（billisy cirrhosis) 三、肝硬化（liver cirrhosis） （一）概述 （二）常见类型肝硬化 一）门脉性肝硬化 二）坏死后性肝硬化（postnecrotic cirrhosis) Here is an example of intrahepatic obstruction with a small stone in an intrahepatic bile duct. This could produce a localized cholestasis, but the serum bilirubin would not be increased, because there is plenty of non-obstructed liver to clear the bilirubin from the blood. However, the serum alkaline phosphatase is increased with biliary tract obstruction at any level. This 3 month old child died with extrahepatic biliary atresia, a disease in which there is inflammation with stricture of hepatic or common bile ducts. This leads to marked cholestasis with intrahepatic bile duct proliferation, fibrosis, and cirrhosis. This liver was rock hard. The dark green color comes from formalin acting on bile pigments in the liver from marked cholestasis, turning bilrubin to biliverdin. This is a case of primary biliary cirrhosis, a rare autoimmune disease (mostly of middle-aged women) that is characterized by destruction of bile ductules within the triads of the liver. Antimitochondrial antibody can be detected in serum. Seen here in a portal tract is an intense chronic inflammatory infiltrate with loss of bile ductules. Micronodular cirrhosis ensues. Microscopically, extrahepatic biliary atresia leads to this appearance in the liver, with numerous brown-green bile plugs, bile duct proliferation (seen at lower center), and extensive fibrosis. If a large enough bile duct can be found to anastomose and provide bile dr