胆汁淤积症的诊断治疗.ppt

JHepatol2007;46:365–371po第64页,共66页，星期六，2024年，5月骨质疏松症的治疗脂溶性维生素缺乏Hepatology2009;40:291第65页,共66页，星期六，2024年，5月感谢大家观看第66页,共66页，星期六，2024年，5月**根据其发生部位的差异分为肝内胆汁淤积和肝外胆汁淤积，肝外胆汁淤积最常见的原因是机械性阻塞；肝内胆汁淤积的原因则更为复杂，包括感染性、药物性、自身免疫性、妊娠性等，但有时两者可有交叉，如原发性硬化性胆管炎（PSC）可同时有肝外和肝内部分的病变。**In1989,apanelof12EuropeanandAmericanexperts7byconsensusdefinedliverinjuryasanincreaseofmorethantwicetheupperlimitofthenormalrangeinthelevelsofserumalanineaminotransferaseorconjugatedbilirubin,oracombinedincreaseinthelevelsofaspartateaminotransferase,alkalinephosphatase,**totalanalanineaminotransferaselevelofmorethanthreetimestheupperlimitofnormalandatotalbilirubinlevelofmorethantwicetheupperlimitbeusedasacombinedtesttodefineclinicallysignificantabnormalitiesonlivertests,withfurtherverificationthroughtheanalysisofadditionalclinicaldata.8Elevationsinserumenzymelevels(alanineaminotransferase,aspartateaminotransferase,andalkalinephosphatase)weretakenasindicatorsofliverinjury,whereasincreasesinbothtotalandconjugatedbilirubinlevelsweremeasuresofoverallliverfunctionbilirubin,**PanelCshowscholestaticinjuryduetotrimethoprim–sulfamethoxazoleina42-year-oldwoman.Thisportaltractshowsaseverelydamagedbileductsurroundedbylymphocytesandeosinophils.Thepercentageofeosinophilsintheperipheralbloodreached42percent(hematoxylinandeosin,20).InPanelD,afollow-upbiopsyspecimenfromthesamepatienteightmonthslaterdemonstratesthelossofbileducts(vanishingbileductsyndrome).Thisportaltractshowsanormalarteryandveinwithnoevidentbileductremaining(Massontrichrome,?60).**高度可能8 可能3-5Excluded≤0可能性大6-8 不可能Unlikely1-2**Herbalifeisaproductsoldforpromoting‘wellness’andweightreduction;thecompanyreportssalesof1.6billion$in60countries(/phoenix.zhtml?c=183888p=irol-irh