2013酒精性肝炎的诊断与处理（天坛）ppt课件.pptVIP

曾留学日本4年.在国内外发表论文170余篇，其中1篇文章被Am J gastroenterol 推荐为2010年CME教材。主编或参编了《消化病手册》、《脂肪性肝病》、《消化内科门诊手册》等8部著作 兼任《实用肝脏杂志》共同主编,《中国实用乡村医学杂志》副主编，《Hepatobiliary Pancreatic Diseases International》、《WJG》、《国际消化病杂志》等十数家杂志的编委;王炳元（中国医大第一医院消化科）;Main Point：;1. Excessive alcohol intake ;Continuum of Risk Associated with Alcohol Use and Possible Clinical Responses.;Etiology of Mortality in ALD;2. Spectrum of ALD ;Alcoholic cirrhosis (39%);Natural history of alcoholic liver disease (ALD). The spectrum of ALD is comprised of steatosis, steatohepatitis, ?brosis, cirrhosis, and superimposed hepatocellular carcinoma. Both environmental and genetic factors are known to modify the progression of ALD (adapted from [2] with permission from the American Gastroenterological Association).;3. Who develop ALD?;4. What’s the clinical diagnosis of alcoholic hepatitis?;Checklist of DSM-IV-TR Criteria for Alcohol-Use Disorders.;AUDIT questionnaire. To score the AUDIT questionnaire, sum the scores for each of the 10 questions. ;Differential diagnosis of alcoholic hepatitis;The Alcoholic Liver Disease/Nonalcoholic Fatty Liver Disease Index (ANI);5. Prognostic assessment;Novel histological grading systems for alcoholic hepatitis;Fibrosis stage – None/portal: 1 – Expansive fibrosis: 2 – Bridging ?brosis or cirrhosis: 3 Bilirubinostasis – None: 1 – Hepatocellular bilirubinostasis: 2 – Canalicular/ductular: 3 – Hepatocellular and canalicular/ductular: 4 Neutrophil in?ltration – None/mild: 0 – Severe: 1 Megamitochondria – None: 0 – Present: 1;Prognostic models in severe alcoholic hepatitis;Comparison of the elements that constitute 5 prognostic instruments in alcoholic hepatitis;6. Major therapeutic measures;（1） Abstinence;250ml X 50% X 0.8 X 7 = 700 cal (2000cal/d 35%);General recommendations for screening and management of complications of cirrhosis should be applied to patients with alcoholic cirrhosis (Recommendation A1) No specific pharmacological therapy for alcoholic cirrhosis has demonstrated unequiv