西安交通大学医学院消化系统疾病课件 cirrhosis21.pptVIP

Liver cirrhosisxue hui Ⅴ Complications * Upper gastrointestinal tract bleeding may occur from varices; portal hypertensive gastropathy; portal enteropathy or gastroduodenal ulcer. Esophageal varices  * Hepatic encephalopathy results from failure of the liver to detoxify noxious agents of gut origin because of hepatocellular dysfunction and portosystemic shunting. * Primary hepatic carcinoma  * Spontaneous bacterial peritonitis leading to abdominal pain, fever, increasing ascites, progressive HE. Paracentesis reveals the character of ascites with a total white cell count between 100-300 cells/ml but neutro-phils predominant, and a protein concentration below 25g/L. Hepatorenal syndrome- preterminal event characterized by oliguria, hyponatremia, low urinary sodium ,high BUNand hypotension. It results from reflecting activationof renin angiotension due to splanchnic vasodilators and to make renal artery contract . Histologically the kidneys are normal.  Acid-base imbalance and electrolyte imbalance  due to use of diuretics and restriction of sodium in take.   Ⅵ Investigations a. Laboratory findings Latent cirrhosis: absent or minimal Anemia: Suppression of erythro- poiesis; hypersplenism ;  blood loss from GI. Leucocyte: dependent on hyper- splenism or infection. Thrombocytopenia: marrow suppre- ssion, folate deficiency Liver function test: AST,ALT,TB,DB elevated; Serum albumin decreased; Gamma globulin elevated.Liver biopsy : is of value in cirrhosis with no specific  features(fibrosis with  regenerative nodules)  b. Imaging Barium studies:  revealing presence of varices Ultrasound together with Doppler: assessing liver size,acites,Hcc,