重庆医科大学：《内科学》课程教学课件（PPT讲稿）CIRRHOSIS of LIVER

CIRRHOSIS/of LIVER Xiaohong Tao The First Affiliated Hospital Chongqing University of Medical Sciences

CIRRHOSIS of LIVER Xiaohong Tao The First Affiliated Hospital Chongqing University of Medical Sciences

Introduction 种或几种病因长期或反复作用引起的慢性进行性肝 病的后期阶段。(t's the end result of hepatocellular injury resulted from different causes,ERLD 病理—有广泛肝细胞变性坏死、肝细胞结节性再生、 结缔组织增生及纤维化，正常肝小叶结构破坏和假小 叶形成、肝逐渐变形、变硬。The histologic feature is degeneration,regeneration(nodular)and fibrosis. According to the following sequence: INJURY DEGENERATION and necrosis regeneration FIBROSIS FORMATION OF FIBRO-VASCULAR MEMBRANES PARENCHYMAL DISSECTION INTO NODULES REARRANGEMENT OF BLOOD CIRCULATION CIRRHOSIS REARRANGEMENT OF BLOOD CIRCULATION CIRRHOSIS

Introduction 一种或几种病因长期或反复作用引起的慢性进行性肝 病的后期阶段。(It’s the end result of hepatocellular injury resulted from different causes, ERLD ) • 病理—有广泛肝细胞变性坏死、肝细胞结节性再生、 结缔组织增生及纤维化，正常肝小叶结构破坏和假小 叶形成、肝逐渐变形、变硬。The histologic feature is degeneration, regeneration(nodular) and fibrosis. • According to the following sequence: INJURY DEGENERATION and necrosis regeneration FIBROSIS FORMATION OF FIBRO-VASCULAR MEMBRANES PARENCHYMAL DISSECTION INTO NODULES REARRANGEMENT OF BLOOD CIRCULATION CIRRHOSIS REARRANGEMENT OF BLOOD CIRCULATION CIRRHOSIS

Introduction 临床一肝功能损害和门脉高压为主、晚期常出现消 化道出血、肝性脑病等并发症。(The clinical manifestations can be broadly classified into those resulting from hepatocellular dysfunction,such as jaundice and coagulopathy and portal hypertension. The complication often appear in late phase,such as hemmorrage,hepatic encephalopathy. 世界性疾病，所有种族、不论国籍、年龄或性别、 均可罹患。 年龄35~48岁最多，男：女为3.6~8：1

Introduction • 临床— 化道出血、肝性脑病等并发症。(The clinical manifestations can be broadly classified into those resulting from hepatocellular dysfunction, such as jaundice and coagulopathy and portal hypertension. The complication often appear in late phase, such as hemmorrage, hepatic encephalopathy. • 世界性疾病，所有种族、不论国籍、年龄或性别、 均可罹患。 • 年龄35～48岁最多，男：女为3．6～8：1

Introduction Cirrhosis is the third most common cause of death,after heart disease and cancer.killing about 25,000 people each year

Cirrhosis is the third most common cause of death, after heart disease and cancer. killing about 25,000 people each year. Introduction

HISTORY In 1761,This peculiar transformation of the liver was identified by the first anatomic pathologist,Gianbattista Morgagni in his 500 autopsies

HISTORY In 1761, This peculiar transformation of the liver was identified by the first anatomic pathologist, Gianbattista Morgagni in his 500 autopsies

HISTORY In 1826 (65years latter),the name of cirrhosis was given by Laennec because of the yellowish-tan color of the cirrhotic liver."cirrhosis" (greek=orange color)

HISTORY In 1826 (65years latter), the name of cirrhosis was given by Laennec because of the yellowish-tan color of the cirrhotic liver. "cirrhosis" (greek=orange color)

HISTORY Only in 1930,one hundred years later, the first theory as to the pathogenesis of this disorder was advanced by Roessle: parenchymal degeneration, regeneration and scarring which is now understood according to the following sequence:

HISTORY Only in 1930, one hundred years later, the first theory as to the pathogenesis of this disorder was advanced by Roessle: parenchymal degeneration, regeneration and scarring which is now understood according to the following sequence:

HISTORY INJURY DEGENERATION FIBROSIS FORMATION OF FIBRO-VASCULAR MEMBRANES PARENCHYMAL DISSECTION INTO NODULES REARRANGEMENT/OF BLOOD CIRCULATION CIRRHOSIS REARRANGEMENT OF BLOOD CIRCULATION CIRRHOSIS

HISTORY INJURY DEGENERATION FIBROSIS FORMATION OF FIBRO-VASCULAR MEMBRANES PARENCHYMAL DISSECTION INTO NODULES REARRANGEMENT OF BLOOD CIRCULATION CIRRHOSIS REARRANGEMENT OF BLOOD CIRCULATION CIRRHOSIS

其他病因 病因 。寄生虫感染血吸虫、华枝睾 吸虫 ·胆汁淤积肝内淤胆或肝外胆 管梗阻 循环障碍慢性充血性心力衰 病毒性肝炎 我 国 竭、 缩窄性心包炎 BD),C 。HBV携带者 酒精性 其它病因 20,000,000 ·肝静脉和（或）下腔静脉梗阻 慢性乙肝患者 30.000,000 ·工业毒物四氰化碳、磷、砷、 慢性病 。肝硬化 双醋酚丁、四环素 >7,000,000 每年死亡率 。 代谢障碍血色病（铁质沉 >300,000 积)、肝豆状核变性（铜沉积） 肝纤维化 ·营养障碍慢性炎症性肠病、 腹水 门脉高压（出血） 食物中缺乏蛋白质、维生素、抗 肝硬化 脂肝物质 肝癌 肝性脑病 。 原因不明

其他病因 • 寄生虫感染 血吸虫、华枝睾 吸虫• 胆汁淤积 肝内淤胆或肝外胆 管梗阻 • 循环障碍 慢性充血性心力衰 竭、缩窄性心包炎 • 肝静脉和（或）下腔静脉梗阻 • 工业毒物 四氰化碳、磷、砷、 双醋酚丁、四环素 • 代谢障碍 血色病（铁质沉 积）、肝豆状核变性（铜沉积） • 营养障碍 慢性炎症性肠病、 食物中缺乏蛋白质、维生素、抗 脂肝物质 • 原因不明 病因

ETIOLOGY (CAUSES) Drugs Viruses Unknown Alcohol Abuse Heredity Causes of Cirrhosis

ETIOLOGY (CAUSES)