内科学 肝硬化-张顺财【荐】.ppt

Hepatic Cirrhosis Professor Wang Ji-yao,Zhang Shuncai Department of Internal Medicine Division of Gastroenterology, Zhongshan hospital , Fu Dan university. Cirrhosis---definition chronic, progressed, diffuse hepatocellular injury fibrosis nodular regeneration Incidence: 17/100000/y Age: 20-50 yr. Etiology of cirrhosis(I) 1.Chronic viral hepatitis (慢性病毒性肝炎): [HBV,HCV,HBV+HDV] 2. Long-term alcoholism(慢性酒精中毒) [80g/d, 10 yr.] 3. Prolonged cholestasis(长期胆汁郁积), intra-and extra-hepatic: [primary biliary cirrhosis, PBC] /[secondary biliary cirrhosis] 4. Drugs and toxins(药物和毒物) [toxic hepatitis---chronic active hepatitis---cirrhosis] 5. Nonalcoholic steatohepatitis (NASH)(非酒精性脂肪性肝炎) Etiology of cirrhosis(II) 6. Hepatic venous outflow obstruction(肝血液循环障碍) veno-occlusive disease, Budd-Chiari syndrome, constrictive pericarditis 7. Metabolic disorders (遗传代谢性疾病) hemochromatosis(血色病); Wilson‘s disease(肝豆状核变性); 8. Autoimmune hepatitis (AIH)(自身免疫性肝炎) 9. Schistosomiasis (血吸虫病) 10. Cryptogenic (隐原性) 11. Mixed: alcohol+virus , HBV+HCV, HBV+schistosomiasis Pathogenesis: chronic, progressed, diffuse Hepatocyte injury leading to necrosis. Chronic inflammation - (hepatitis). Capillarization (肝窦毛细血管化) of the space of Disse is a key event. Bridging fibrosis. Regeneration of remaining hepatocytes proliferate as round nodules surrounded by fibrous septa. Loss of vascular arrangement results in regenerating hepatocytes ineffective. Cirrhosis may lead to liver failure, portal hypertension, or development of hepatocellular carcinoma Histopathologic classification micronodular uniformly small nodules ( 3 mm in diameter) and regular bands of connective tissue macronodular nodules that vary in size (3 mm to 5 cm in diameter) mixed macro and micronodular (incomplete septal cirrhosis) combines elements of micronodular and macronodular cirrhosis. Consequences of portal hypertension[I] 1.Splenomegaly (脾肿大) 2.Formation and open