山东大学：肝功能不全（PPT课件讲稿）Hepatic insufficiency（肝衰竭）

Hepatic insufficiency Wang Jing-jing Esophagus Pancreas stomach Transvers Department of Descending colon Duodenum Pathophysiology Ascending Colon sigmoid colon Shandong University

Hepatic insufficiency Wang Jing-jing Department of Pathophysiology Shandong University

■ ntroduction ■ Concept a etiology and classification a The functional and metabolic changes a Hepatic encephalopathy

◼ Introduction ◼ Concept ◼ Etiology and classification ◼ The functional and metabolic changes ◼ Hepatic encephalopathy 2

☆ Introduction Blood Supply antenor vona cava Portal vein 3/4 of the hepatic voin blood flow(which drains the stomach, intestine nes to stvo tract spleen, and pancreas Hepatic artery: 1/4 of pota vein the blood flow

3 ❖ Introduction 1. Blood Supply: Portal vein: 3/4 of the blood flow (which drains the stomach, intestine, spleen, and pancreas) Hepatic artery: 1/4 of the blood flow

2. Internal Structure: Liver lobule Liver Lobule a Acentral vein(coalesce into hepatic veins, which empty Detail of Lobule into the vena cava) Branch of 04-6 portal triad(branches of hepatic artery, hepatic portal Bile duct vein and bile duct) Branch of hepatic portal vein

2. Internal Structure: Liver lobule ❑ A central vein (coalesce into hepatic veins, which empty into the vena cava) ❑ 4-6 portal triad (branches of hepatic artery, hepatic portal vein and bile duct)

Rows of liver cells(Hepatocytes, hepatic stellate cells, sinusoidal endothelial cells Kupffer cells and liver- associated lymphocytes which are in close contact with blood-filled sinusoids Sinusoidal Endothelial Cell Kuppfer Cell Sinusoid - Stellate Cell Central vein P°° hepatocyte Liver hepatic lobule

Rows of liver cells (Hepatocytes, hepatic stellate cells, sinusoidal endothelial cells, Kupffer cells and liver￾associated lymphocytes which are in close contact with blood-filled sinusoids

Hepatic cirrhosis: pseudolobuli 肝细胞变性坏死、纤维组织 增生及肝细胞结节状再生这 三种改变反复交替进行 解缺化假小叶形成

Hepatic cirrhosis: pseudolobule 肝细胞变性坏死、纤维组织 增生及肝细胞结节状再生这 三种改变反复交替进行

3. Functions a EXcretion bile(help the absorption of vitamin K) a Clearing the blood of particles and infections including bacteria a Synthesis: albumin, lipoproteins, coagulation factors, as well as protein C, s and antithrombin a Metabolism: protein, lipid, carbohydrate a Neutralizing and destroying drugs and toxins a Manufacturing, breaking down and regulating numerous hormones including sex hormones

3. Functions ◼ Excretion: bile (help the absorption of vitamin K) ◼ Clearing: the blood of particles and infections including bacteria ◼ Synthesis: albumin, lipoproteins, coagulation factors, as well as protein C, S and antithrombin. ◼ Metabolism: protein, lipid, carbohydrate ◼ Neutralizing and destroying drugs and toxins ◼ Manufacturing, breaking down and regulating: numerous hormones including sex hormones

Concept of Hepatic insufficiency Severe damage in liver cells result in degeneration, necrosis, fibrosis and cirrhosis, manifesting as jaundice, bleeding, infection, renal dysfunction or encephalopathy, termed all together the syndrome of Hepatic insufficiency

❖ Concept of Hepatic insufficiency Severe damage in liver cells result in degeneration, necrosis, fibrosis and cirrhosis, manifesting as jaundice, bleeding, infection, renal dysfunction or encephalopathy, termed all together the syndrome of Hepatic insufficiency 8

☆ Etiology 1. Infections: hepatitis virus(HB), bacteria, parasites 它 我国乙 肝感染 者9300 万!肝 Has Ag rates (s) 感染者 High Hepatoma 1000万! neiden areas

9 ❖Etiology 1. Infections : hepatitis virus (HBV), bacteria, parasites 我国乙 肝感染 者9300 万 !丙肝 感染者 1000万!

外膜 核心 ①结合,侵人 内质网 Dane粒 ③包装,排出 DNA (+)DNA HBsAg )DNA ④基因复非 arodOOcecDNA 转录 AAA HBSAg ③转译 AAA HBc/HBeAg 细胞核 细胞浆 Pol蛋白 X蛋白 HBV感染细胞的过程 HBV→入侵肝细胞→受染细胞表达 HbsAg、 HbeAg HBCAg→T细胞识别、致敏→杀伤受染肝细胞:清除病毒 肝细胞损伤

10 HBV →入侵肝细胞→受染细胞表达 HbsAg 、 HbeAg 、 HBcAg → T 细胞识别、致敏→杀伤受染肝细胞：清除病毒 肝细胞损伤