Hepatic Faiure分析课件.ppt

Chapter 17． Hepatic Failure Section 1. Concept of hepatic failure 1. Definition of hepatic failure Various harmful factors ↓ parenchymal cells and Kupffer cells damadged severely and extensively ↓ severe disturbance of liver function in metabolism, secretion, synthesis, detoxication and immunity ↓ jaundice, bleeding, infection, renal dysfunction and encephalopathy ↓ “Hepatic insufficiency” ↓ (late stage) “Hepatic failure” hepatorenal syndrome and hepatic encephalopathy Severe, extensive degeneration and necrosis of hepatic cells → Acute (fulminant) hepatic failure Late stage of cirrhosis or carcinoma of the liver → Chronic hepatic failure (1)??metabolism: (2)??bile secrete and excrete: (3)??coagulation: (4)? bioconversion (5)? immune Section 2. Hepatic Encephalopathy A. Concept and classification A serial of Neuropsychical symptoms hepatic encephalopathy According to the Clinic course Clinical neuropsychical symptoms Etiology HE is a neuropsychical disturbance. The following features may imply HE is mainly caused by the metabolic and functional disturbance of the brain: l ) Reversibility of symptoms 2) Dissemination of disease region 3) No clear evidence of morphologic alteration 4) Accompanied with biochemical abnormality Several hypotheses of the pathogenesis of HE have been proposed: None of them is necessarily exclusive. A conservative and conventional view of HE is Almost certainly the etiology is multifactorial 1. Theory of ammonia intoxication Ammonia is wildly believed to play a role in the pathogenesis of HE. However, a precise role for ammonia in the pathogens of HE has yet to be clearly defined. Evidences supporting ammonia in