讲授内主要容和要求 1、病因和发病机制 2、临床表现 3、辅助检查 4、诊断与鉴别诊断、并发症 5、治疗
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
Pathogenesis 病因 肝炎症、坏死二 再生 胶原沉积、纤维增生 生长因子 激活引to 肝细胞↓ 一◆纤维 肝 假小叶形成 肝内血流阻力 化
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