Chapter 17 Hepatic failure 一一一--二二-一二-一-一一-一
1 Chapter 17． Hepatic Failure
Section 1 Concept of hepatic failure 一一一--二二-一二-一-一一-一 2
2 Section 1. Concept of hepatic failure
1. Definition of hepatic failure →--1--1-÷----1-1------4 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
3 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
2. Classification and causes Severe, extensive degeneration and necrosis of hepatic cells Acute(fulminant) hepatic failure Late stage of cirrhosis or carcinoma of the liver Chronic hepatic failure
4 Severe, extensive degeneration and necrosis of hepatic cells → Acute (fulminant) hepatic failure Late stage of cirrhosis or carcinoma of the liver → Chronic hepatic failure 2. Classification and causes
3. Effects of hepatic failure on the body (1) Disturbance of metabolism carbohydrate protein electrolyte (2)Obstacle of bile secrete and excrete hyperbilirubinemia, intrahepatic cholestasis (3)Disorder of coagulation generation or consumption clotting factor→>bd ng tendency (4)Dysfunction of bioconversion drug metabolism; detoxication of toxin, inactivation of hormone (5)Dysfunction of immune(Kuppfer cells bacterial infection, bacteremia, intestinal endotoxemia
5 (1) metabolism: (2) bile secrete and excrete: (3) coagulation: (4) bioconversion (5) immune Disturbance of metabolism: carbohydrate, protein, electrolyte Obstacle of bile secrete and excrete: hyperbilirubinemia, intrahepatic cholestasis Disorder of coagulation: generation↓ or consumption↑ → clotting factor↓→ bleeding tendency Dysfunction of bioconversion drug metabolism; detoxication of toxin; inactivation of hormone Dysfunction of immune (Kuppfer cells) bacterial infection, bacteremia, intestinal endotoxemia 3. Function of normal liver 3. Effects of hepatic failure on the body
Section 2 Hepatic Encephalopathy 一一一--二二-一二-一-一一-一 6
6 Section 2. Hepatic Encephalopathy
A. Concept and classification Acute or chronic liver disease A serial of Neuropsychical symptoms hepatic encephalopathy Hepatic coma ultimate clinical manifestation of HE
7 A serial of Neuropsychical symptoms hepatic encephalopathy A. Concept and classification Acute or chronic liver disease Hepatic coma ultimate clinical manifestation of HE
Classification →-+-------1-1----4 According to the nic course Acute, subacute and chronic types Clinical neuropsychical symptoms 1st stage(prodromal period) 2nd stage(pre-coma period) 3rd stage (lethargy period) 4th stage(coma period Etiolog Virus infection or drug intoxication extensive hepatocyte necrosis → acute( fulminant) hepatitis→; endogenous he Portal or Schistosome hepatic cirrhosis ->exogenous HE usually with obvious inducing factors)
8 Classification: According to the Clinic course Clinical neuropsychical symptoms Etiology Acute, subacute and chronic types 1 st stage (prodromal period) 2nd stage (pre-coma period) 3 rd stage (lethargy period) 4th stage (coma period) Virus infection or drug intoxication → extensive hepatocyte necrosis → acute (fulminant) hepatitis → endogenous HE Portal or Schistosome hepatic cirrhosis → exogenous HE ( usually with obvious inducing factors)
B. Pathogenesis of HE hE is a neuropsychical disturbance The following features may Imply hE is mainly caused by the metabolic and functional disturbance of the brain Reversibility of symptoms 2) Dissemination of disease region 3)No clear evidence of morphologic alteration 4) Accompanied with biochemical abnormalit
9 B. Pathogenesis of HE 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 Theory of ammonia intoxication False neurotransmitter hypothesis Theory of amino acid imbalance Theory of GABA(gamma-aminobutyric acid) None of them is necessarily exclusive a conservative and conventional view of he is Almost certainly the etiology is multifactorial
10 Theory of ammonia intoxication False neurotransmitter hypothesis Theory of amino acid imbalance Theory of GABA(gamma-aminobutyric acid) 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