Definition 定义 一种或多种病因长期或反复作用于肝脏,导致肝细胞反复 炎性变性、坏死、凋亡、纤维结缔组织增生、假小叶和再 生结节形成以及肝内血液循环紊乱(血管异常增值,肝窦 毛细血管化)的病理阶段。最终造成肝功损害和门脉高压, 晚期可出现严重并发症(complications)而导致死亡。 Hepatocellular injury肝细胞损伤 Fibrosis纤维化 Nodular regeneration再生结节 Pseudolobule假小叶 Hepatic dysfunction肝功能损害 Portal hypertension门静脉高压
Etiology and Pathogenesis 病因和病机 Etiology l.Chronic viral hepatitis(慢性病毒性肝炎): (HBV,HCV,HBV+HDV) 2.Long-term alcoholism(慢性酒精中毒) 3.Nonalcoholic steatohepatitis (NASH))非酒精性脂肪性肝炎) 4.Prolonged cholestasis(长期胆汁郁积),intra--and extra--hepatic: [primary biliary cirrhosis,PBC]/[secondary biliary cirrhosis,SBC] 5.Hepatic venous outflow obstruction(肝血液循环障碍) Chronic right--sided congestive heart failure(慢性充血性心力衰 竭);Budd-Chiari syndrome(肝静脉阻塞综合症); Constrictive pericarditis(缩窄性心包炎)
Etiology 6.letabolic disorders(遗传代谢性疾病) Hemochromatosis(血色病); Wilson's disease(肝豆状核变性); a1-抗胰蛋白酶(a1-antitripsin)缺乏症等。 7.Drugs and toxins(药物和毒物) &.Autoimmune hepatitis(AIHD(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
Pathology病理学 大体分型(General classification): 1.micronodular(小结节性肝硬化):最常见。D3 mm) 3.mixed macro and micronodular(混合性肝硬化):combines elements of micronodular and macronodular cirrhosis. 4.incomplete septal cirrhosis(不完全分隔型肝硬化)
组织学Histology 1.广泛肝细胞变性坏死(degeneration and necrosis、肝小叶纤维支架塌 (fibrous framework collapse) 2.不规则再生结节(regeneration nodule) 3.纤维结缔组织增生(desmoplasia) 4.假小叶(pseudolobule)形成 5.血管床(vascular bed)改变、肝内血循环紊乱(circulatory disturbance) (血管异常增值,肝窦毛细血管化)
练习题1: ·男,50岁,乙肝病史30年,腹胀、乏力、双下肢水肿伴少尿1月。消化系彩 超提示肝脏回声增粗,不均匀,中等量腹水。该患者肝脏病理最可能的表现 是: A.肝细胞脂肪变性 B.假小叶形成 C淤血性改变 D淋巴细胞浸润 E小胆管普遍淤胆
Clinical Manifestations 临床表现 Compensation Stagef代偿期:Many people experience few symptoms at the onset of cirrhosis,The signs and symptoms of cirrhosis are nonspecific and frequently related to the complications. -Fatigue and loss of energy乏力、虚弱 -Loss of appetite食欲减退 --Nausea恶心 -Splenomegaly脾脏肿大 ---Liver function may be normal 肝功能基本正常
Clinical Manifestation Decompensation Stage失代偿期 Hepatic dysfunction portal hypertension Dysfunction of liver: 肝功能减退 L.malnutrition营养不良 Fatigue(疲劳) Lethargy(精神不振) Weakness(乏力力) weight loss(消瘦) 2. Fever发热 3.Jaundice黄疸 4.Digest system symptoms Diarrhea腹泻 Constipation便秘 Dull abdominal pain Indigestioni消化不良 Nauseai恶心