慢性肝病－进程与诊断.ppt

Normal正常 Congenital先天性 Acquired后天性 Acquired portosystemic shunts 后天性门脉分流 Coeliotomy 剖腹探查 Small liver architectural distortion 肝脏缩小/結構變形 Acquired PVA 後天性門脈吻合枝 Biopsy活检 “Jenny” Liver biopsy 肝脏活检 Only way to diagnose most conditions 大多数病例是唯一的诊断方法 Indications 适应症 Persistently elevated liver enzymes 肝酶持续上升 Altered liver size 肝脏大小改变 Progressive liver disease 进行性肝病 Acquired portosystemic shunts 后天性门静脉分流 Diagnosis 诊断 Severe chronic hepatopathy ± cirrhosis 严重慢性肝病（部分肝硬化） “Jenny” Diagnosis History 病史 Physical examination 全身检查 Laboratory evaluation 实验室评估 Diagnostic imaging 影像诊断 Liver biopsy 肝脏活检 Chronic Hepatic Disease:Approach Investigation慢性肝病－进程与诊断 Introduction 介绍 Understanding the Liver 熟悉肝脏解剖 Case example 病例 “Jenny” Understanding the Liver熟悉肝脏解剖 1 Hepatic functions 肝脏功能 Intermediate metabolism 代谢功能 Storage function 储存功能 Protein synthesis 蛋白質合成 Production of bile 生成胆汁 Detoxification 解毒 Others ! 其他 Hepatic dysfunction 肝功能不全 Enormous functional reserve 强大的代偿能力 massive and widespread acute lesions 大量、广泛的急性损伤 or widespread chronic liver damage 广泛的慢性肝损伤 Enormous capacity for regeneration 强大的再生能力 some diseases are reversible有些疾病是可逆的 disorganised repair may ? cirrhosis 修复不良会导致硬变 Consequences of liver disease Intermediate metabolism 介导代谢 Storage function 储存功能 Protein synthesis 蛋白合成 Production of bile 生成胆汁 Detoxification 解毒 Others ! 其他 Clinical signs 临床症状 Jaundice 黄疸 Ascites 腹水 Vomiting and diarrhoea 呕吐，腹泻 Polyuria polydipsia 尿频，烦渴 Bleeding problems 出血 Hepatic encephalopathy 肝性脑病 Non-specific signs 非特异性征象 anorexia, weight loss, weakness 食欲减退，体重减轻，虚弱 Jaundice黄疸 There can be severe hepatic dysfunction without jaundice 无黄疸时可能有严重的肝功能不全 Ascites腹水 Bleeding problems 出血 Hepatic Detoxification 肝脏解毒 Leads to hepatic encephalopathy*肝性脑病 Hepatic encephalopathy肝性脑病 Signs – largely CNS 症状－主要在中枢神经系统 Anorexia 食欲减退 Vomiting diarrhoea 呕吐，腹泻 Polyuria polydipsia 尿频，烦渴 Dullness, aggression, staggering 迟钝，攻击性（狂躁不