内科学-肝硬化课件.ppt

并发症Complications6.肝肾综合征Hepatorenalsyndrome(HRS):少尿(oliguria)氮质血症(azotemia)低血压(hypotension)稀释性低钠血症(dilutionalhyponatremia)低钠尿(lowurinarysodium)*并发症Complications7.肝肺综合征（hepatopulmonarysyndrome）----低氧血症（anoxemia）----呼吸困难（dyspnea）8.肝癌9.肝性脑病

*实验室检查Laboratoryfindings血尿常规Bloodandurineroutines肝功能检测Liverfunctiontests----评估肝功能不良的程度toestimatetheseverityofliverdysfunction：ALT,AST,AKP,GGT,血清总胆红素serumtotalbilirubin,血清白蛋白serumalbumin,凝血酶原时间prothrombintime，球蛋白globulin,胆固醇cholesterol.---todifferentialdiagnosis鉴别诊断:Alcoholic:AST/ALT=2;PBC:AKP,GGTALT,AST---torefecthepaticfibrosis:PIIIP、HA、laminin(层粘连蛋白)---toquanlityliverfunction*实验室检查Laboratoryfindings?免疫学Immunology----细胞免疫Cellularimmune?,激素hormonal----免疫性肝病immune?autoimmuneliverdisease:IgG?,globulin?ANA(+),SMA(+)原发性胆汁性肝硬化PBC:IgM?,AMA(+)病毒标志物Markerofvirus甲胎蛋白AFP*实验室检查Laboratoryfindings?腹水穿刺Ascitesparacentesis:routine,culture,ADA,LDH,SAAG(serumascitesalbumingradient)(血清腹水白蛋白梯度)11g/L?B超(Ultrasonography),CT扫描(CTscanning)：胆道梗阻biliaryobstruction,肝脏肿块livermasses,脾大splenomegaly,腹水ascites?内镜检查Endoscopy:食道胃底静脉曲张(thenumber,appearance,andsizeofanyesophageal/gastricvarix)门脉高压性胃病(PHGportalhypertensivegastropathy)*实验室检查Laboratoryfindings?放射性核素Radionuclide:99mTC-MIBI,H/L?肝活检具有确诊价值liverbiopsy:toconfirmthediagnosis?腹腔镜检查Laparoscopy?肝静脉压力梯度HVPG(hepaticveinpressuregradient)()(wedged-free)hepaticvenouspressureNormal:5-6mmHg10mmHg:varices12mmHg:rupture破裂*****诊断Diagnosis1、确定有无肝硬化2、病因(Etiologyofcirrhosis)3、评估肝功能Evaluatingofliverfunction:Child-Pughclassification(Child分级)?寻找并发症Searchingforcomplications*诊断Diagnosis?病史有助于确定诊断(thehistoryofdiseasecontributestoidentifyingthecauseofcirrhosis)病毒感染史(historyofviralhepatit