肝功能衰竭.ppt

Hepatic Failure
1
Section 1.
Concept of hepatic failure
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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
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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
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(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
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Section 2.
Hepatic Encephalopathy
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A serial of
Neuropsychical symptoms
hepatic encephalopathy
A. Concept and classification
Acute or chronic liver disease
a
ultimate clinical manifestation of HE
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Classification:
According to the
Clinic course
Clinical neuropsychical symptoms

Etiology
Acute, subacute and chronic types
1st stage (prodromal period) 2nd stage (a period)
3rd 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)
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B. Pathogene