2012-9-27 Endocrine system Pulmonary manifestations Hepatic hydrothorax(肝性胸水 Telangiectases(毛细血管扩张症 nary syndrome(HPs,肝肺综合征) Spider nevi(嶼蛛痣 riad of pulmonary vascular dilatation Palmar erythema(肝掌) arterial hypoxemia Testicular atrophy(睾丸委缩 in the setting of advanced liver disease Menstrual irregularities(月经失调) Hepatorenal syndrome( HRs) Mechanisms of HRS Hypotension due to Arterial vasodilation AAS. AVP endothelin advanced hepatic failure Reduced cardiac Portal Reduced ked abnormalities in arterial circulation hypertension sensitivity to nous vasoactive system ↓ HRS ction of LTC4 gressive Often results in mild renal insufficiency causing LTD4 and F2 oprostane PGI2 and PGE2 Symptoms and signs Clinical Features Compensated cirrhosis Decompensated cirrhosis brosis itself does not cause distinct symptoms. Symptoms may develop secondary to the primary disorder with splenomegaly is often ss complications, such as variceal GI d loss of e bleeding. portal-systemic encephalopath develop. gastro-esophageal varices, Splemegaly, ascit2012-9-27 9 Endocrine system Gynecomastia (男性乳房发育), Telangiectases (毛细血管扩张症) Spider nevi (蜘蛛痣) Palmar erythema (肝掌) Testicular atrophy (睾丸萎缩) Menstrual irregularities (月经失调) Pulmonary manifestations Hepatic hydrothorax (肝性胸水) Hepatopulmonary syndrome (HPS, 肝肺综合征) triad of pulmonary vascular dilatation arterial hypoxemia in the setting of advanced liver disease Hepatorenal syndrome ( HRS) Occurred in the setting of: -- chronic liver disease -- advanced hepatic failure -- portal hypertension characterized by: -- impaired renal function -- marked abnormalities in arterial circulation -- activation of endogenous vasoactive system Classified into 2 different types: -- Type I: Rapidly progressive -- Type II: Not rapidly progressive Often results in mild renal insufficiency causing diuretic resistant ascites Mechanisms of HRS Renal cortical ischemia HRS Hypotension due to: Arterial vasodilation, Reduced cardiac output Portal hypertension Increased local production of LTC4, LTD4 and F2 isoprostane Activation of SNS, RAAS, AVP, endothelin and neuropeptide Y Reduced sensitivity to NO and ANP  renal production of PGI2 and PGE2 Symptoms and Signs Hepatic fibrosis itself does not cause distinct symptoms. Symptoms may develop secondary to the primary disorder or to portal hypertension. Portal hypertension with splenomegaly is often asymptomatic unless complications, such as variceal GI bleeding, ascites, or portal-systemic encephalopathy, develop. Eventually, cirrhosis supervenes. Clinical Features Compensated cirrhosis Many people experience few symptoms at the onset of cirrhosis, symptoms are typically vague and nonspecific. -- Fatigue and loss of energy -- Loss of appetite and nausea -- Spider angiomas -- liver function is normal Decompensated cirrhosis  Hepatocellular insufficiency Symptoms caused by loss of functioning liver cells --- System： fatigue, weakness, weight loss, malnutrition --- Digestive System: Loss of appetite, nausea, diarrhea  Portal hypertention gastro-esophageal varices, Splemegaly, ascites…