山东大学基础医学院：《病理生理学 Pathophysiology》课程PPT教学课件（7年制）12 hepatic insufficiency 肝衰竭（肝功能不全）

Hepatic insufficiency Zhang xiao-ming Dept pathophysiology

Hepatic insufficiency Zhang Xiao-ming Dept. pathophysiology

Clinical Example 患者,男,62岁,20年前患过肝炎,后治愈 10年前因上腹部不适伴隐痛及食欲不振入院 检查肝大肋下lcm,肝功能异常,经治疗后症 状好转出晚。5年前上述症状加重,进食附上 腹部不适感加重,有时伴恶心、呕吐,症状反 复持姎至今。1d前在饭店进食大量肉类后出 现恶心、呕吐,进而出现神志恍惚、烦躁不安 遂急诊入院

Clinical Example 患者，男，62岁，20年前患过肝炎，后治愈。 10年前因上腹部不适伴隐痛及食欲不振入院， 检查肝大肋下1cm，肝功能异常，经治疗后症 状好转出院。5年前上述症状加重，进食时上 腹部不适感加重，有时伴恶心、呕吐，症状反 复持续至今。1d前在饭店进食大量肉类后出 现恶心、呕吐，进而出现神志恍惚、烦躁不安。 遂急诊入院

Clinical Example 查体:神志恍惚,步履失衡,烦躁不安,皮肤 巩膜黄染,颈静脉怒张,面部及前胸有蜘蛛痣。 腹稍隆,肝可触及,质硬,边缘较钝。脾大在肋 下3横指,质硬。叩诊移动性浊音(+)。心肺无 异常。食道钡餐显示食道下段静脉曲张。 化验:胆红素34.2μmoL,SGPT120u,血氨 120μg/dl

Clinical Example 查体：神志恍惚，步履失衡，烦躁不安，皮肤、 巩膜黄染，颈静脉怒张，面部及前胸有蜘蛛痣。 腹稍隆，肝可触及，质硬，边缘较钝。脾大在肋 下3横指，质硬。叩诊移动性浊音（+）。心肺无 异常。食道钡餐显示食道下段静脉曲张。 化验：胆红素34.2mol/L，SGPT120u，血氨 120 g/dl

LEFT LOBE RIGHT LOBE FALCIFORM LIGAMENT ANTERIOR VIEW OF LIVER

HEPATIC VEIN B MESEN TERIC HEPATIC ARTERY ARTERY PORTA VEIN

Function of the liver gestion excretion synthesizing detoxification metabolic immune

Function of the liver ◼ Digestion ◼ excretion ◼ synthesizing ◼ detoxification ◼ metabolic ◼ immune

Causes of liver disease Biological Factors Physical and chemical Factors Genetic Factors Immunity Factors Nutritional Factors:

Causes of Liver Disease – Biological Factors: – Physical and Chemical Factors: – Genetic Factors: – Immunity Factors: – Nutritional Factors:

Hepatic insufficiency Jaundice bleeding Severe Causes infection damage in liver cells renal dysfunction encephalopathy hepatic failure

Hepatic insufficiency Jaundice Bleeding infection renal dysfunction encephalopathy Severe damage in liver cells hepatic failure Causes

hepatic encephalopathy Neuropsychiatric symptoms occuring in patients with severe liver diseases are usually summarized as hepatic encephalopathy (He)

Neuropsychiatric symptoms occuring in patients with severe liver diseases are usually summarized as hepatic encephalopathy (HE) hepatic encephalopathy

Classification Endogenous HE 25%o Fulminant hepatic failure Exogenous HE 75% Portal-systemic encephalopathy Plasma level of ammonia

Endogenous HE 25% Fulminant hepatic failure Exogenous HE 75% Portal-systemic encephalopathy Plasma level of ammonia↑ Classification