(肝硬化)重点培训.ppt

Clinical presentation There may be no abnormal clinical or biochemical features of liver disease in initial times Features of hepatocellular failure, portal hypertension, or both may appear in advanced times. CirrhosisClinical Features Symptoms of advanced cirrhosis Fatique, weakness Nausea, vomiting and loss of appetite Weight loss, muscle wasting Jaundice, dark urine Spider naevi, caput Medusae Bloody, black stools or unusually light-colored stools Vomiting of blood Abdominal swelling Swollen feet or legs Liver palms Gynecomastia Loss of sex drive Menstrual changes in women Generalized itching Sleep disturbances, confusion,desorientation,tremor, asterixis Clinical Features Hepatocellular failure. Malnutrition, low albumin clotting factors, bleeding. Hepatic encephalopathy. Portal hypertension. Ascites, Porta systemic shunts, varices, splenomegaly. Gynecomastia Ascites Caput Medusae Umbilical hernia Visible signs of advanced liver cirrhosis Complications Complications Upper gastrointestinal hemorrhage Hepatic encephalopathy Infection Hepatorenal syndrome Hepatopulmonary Syndrome Primary carcinoma of the liver Disturbance of electrolyte and acid-base balance Laboratory tests and investigations  laboratory tests and investigations Blood-RT anaemia；hypersplenia:WBC ，Plt Urine-RT urine bilirubin，urobilinogen；sometimes albumen，haematuria Stool-RT melena laboratory tests and investigations liver function tests Compensation normal or abnormal slightly Decompensation transaminase ： ALT AST cholesterol albumin and globulin prothrombin time bilirubin PⅢP, and so on Quantitation- liver function tests IGG laboratory tests and investigations Biochemistry can be surprisingly normal but some abnormality will often be present with slightly raised transaminases and alkaline phosphatases