王吉耀-肝硬化.ppt

Hepatic Cirrhosis
Professor Wang Ji-yao
Department of Internal Medicine
Division of Gastroenterology,
Zhongshan hospital , Fu Dan university.
Cirrhosis---definition
chronic, progressed, diffuse hepatocellular injury fibrosis
nodular regeneration
Incidence: 17/100000/y
Age: 20-50 yr.
Hepatic cirrhosis
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Etiology
Liver function Injury,Portal hypertension
Diffuse, chronic liver injury
Hepato-cellular
necrosis, collapse of
hepatic lobules
regenerative
nodules formation
Formation of
diffuse
fibrous septa
Complations: Upper GI Bleeding,
a, infections, primary liver cancer,
Functional renal failure
viral hepatitis (慢性病毒性肝炎):
[HBV,HCV,HBV+HDV]
2. Long-term alcoholism(慢性酒精中毒)
[80g/d, 10 yr.]
3. Prolonged cholestasis(长期胆汁郁积), intra-and extra-hepatic: [primary biliary cirrhosis, PBC] /[secondary biliary cirrhosis]
4. Drugs and toxins(药物和毒物)
[toxic hepatitis---chronic active hepatitis---cirrhosis]
5. Nonalcoholic steatohepatitis (NASH)(非酒精性脂肪性肝炎)
Etiology of cirrhosis(I)
Etiology of cirrhosis(II)
6. Hepatic venous outflow obstruction(肝血液循环障碍)
veno-occlusive disease, Budd-Chiari syndrome, constrictive pericarditis
7. Metabolic disorders (遗传代谢性疾病)
hemochromatosis(血色病); Wilson‘s disease(肝豆状核变性);
8. Autoimmune hepatitis (AIH)(自身免疫性肝炎)
9. Schistosomiasis (血吸虫病)
10. Cryptogenic (隐原性)
11. Mixed: alcohol+virus , HBV+HCV, HBV+schistosomiasis
Hepatic stellate cell activation
Liver fibrosis
accumulation of
extracellular matrix in liver
synthesis of matrix proteins
degradation of matrix proteins
Collagens type I and III constitute more than 95% of the total content of increased collagen in fibrotic liver
Pathogenesis: chronic, progressed, diffuse
Hepatocyte injury leading to necrosis.
Chronic inflammation - (hepatitis).
Capillarization (肝窦毛细血管化) of the space of Disse is a key event.
Bridging fibrosis.
Regeneration of remaining hepatocytes proliferate as round nodules surrounded by fibrous septa.
Loss of vascular arrangement results in re