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肝硬化 Cirrhosis of liver

肝硬化 Cirrhosis of liver. 浙江大学医学院附属第一医院 厉有名 zlym@zju.edu.cn. Introduction. Cirrhosis is the END result of hepatocellular injury that leads to both fibrosis and nodular regeneration through the liver. Irreversible!. Introduction.

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肝硬化 Cirrhosis of liver

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  1. 肝硬化 Cirrhosis of liver 浙江大学医学院附属第一医院 厉有名 zlym@zju.edu.cn

  2. Introduction • Cirrhosis is the ENDresult of hepatocellular injury that leads to both fibrosis and nodular regeneration through the liver. Irreversible!

  3. Introduction • The clinical features of cirrhosis result from hepatic cell dysfunction, portosystemic shunting and portal hypertension. • 临床表现为单一脏器病变、多系统受累; 以肝功能损害和门脉高压为主要表现。

  4. Etiology • Hepatitis virus (HBV, HCV, HDV) • Alcohol abuse • Biliary Cirrhosis • Toxic/Drug induced • Autoimmune diseases • Genetic/metabolic diseases • Venous outflow obstruction • Chronic right-sided heart failure • Cryptogenic (隐原性） ……

  5. Pathology & pathophysiology Histologic Classification • Micronodular (小结节性) alcoholic liver disease 3~5mm, ≯10mm • Macronodular (大结节性) viral liver disease 10~50mm • Mixed forms (混合性)

  6. Pathology & pathophysiology Liver 再生结节 肝内血液 循环紊乱 门静脉高压 广泛肝细胞 变性坏死 肝内纤维化

  7. Mechanisms of hepatic fibrosis • 肝细胞炎症坏死→单核巨噬细胞系统→细胞因子→贮脂细胞→肌成纤维细胞样细胞→分泌细胞外基质(ECM)→弥漫性肝纤维化

  8. Pathology & pathophysiology SPLEEN Portal hypertension Chronic congestion fibrogenesis Splenomegaly • 慢性淤血、脾索纤维组织增生——脾肿大

  9. Pathology & pathophysiology Gastrointestinal Tract 门脉高压 消化道粘膜淤血 水肿、静脉曲张 门脉高压性 胃粘膜病变

  10. Pathology & pathophysiology KIDNEY • 轻者：肾小动脉痉挛性收缩; • 重者：肾小管变性坏死，急性肾功能衰竭。

  11. Pathology & pathophysiology Endocrine System • 睾丸、卵巢、甲状腺、肾上腺皮质等多种内分泌腺萎缩和退行性变。

  12. Pathphysiology: portal hypertension • Pressure of portal vein＞20cm H2O • Portosystemic shunting • Ascites • Endocrinal changes • Hepatic encephalopathy

  13. Pathphysiology: portal hypertension

  14. Pathphysiology: ascites Mechanisms of Ascites • Portal hypertension 门静脉压力增高 • Low plasma colloid osmotic pressure 血浆胶体渗透压降低 • Disequilibrium of recycle of lymph fluid 肝脏淋巴液失平衡 • Renal factors 肾性原因 • Endocrinal factors 内分泌性原因

  15. Clinical Manifestation • Symptoms & Signs • Lab Findings • Imaging Studies • Special Studies

  16. Symptoms & Signs • Compensation stage (代偿期): Symptoms are insidious & nonspecific • Decompensation stage (失代偿期)： • Deterioration of liver function • Portal hypertension • Systemic symptoms

  17. Symptoms of Complications • Upper GI Bleeding • Hepatic encephalopathy • Spontaneous bacterial peritonitis • Primary carcinoma of the liver • Hepatorenal syndrome • Water-electrolyte disturbance

  18. Lab Findings • Blood chemical studies • Albumin, globulin • AST/ALT • r-GT

  19. Lab findings • Indicators for liver fibrosis • PⅢP（Ⅲ型前胶原氨基末端肽） • Type IV collagen (IV型胶原) • laminin (层粘蛋白) • Hyaluronic acid (透明质酸)

  20. Imaging Studies • Barium(钡) study • BUS • CT • MRI

  21. Special Examination • Endoscopy • Laparoscopy • Liver biopsy

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