内科学教学课件：Hepatic Cirrhosis
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• loss of the normal lobular liver architecture
• Liver failure and portal hypertension 是各种慢性肝病的终末阶段
2020/11/6
2
Etiology
1. Chronic viral hepatitis：typeB, typeC
2020/11/6
18
2020/11/6
19
门脉高压症
• 侧支循环 • 脾大及脾功能亢进 • 腹水
2020/11/6
20
Pathophysiology
(Ascites )
• Mechanism 1. Portal hypertension主要原因 2. Dilation of visceral artery: sodium and water retention最终原因 3. Plasmatic Colloid osmotic pressure 重要因素: Hypoalbumin 4. Others : atrial natriuretic hormone, ADH, secondary aldosteronism • Postulates 1. underfilling theory, 2. overflow theory 3. Arterial vasodilatation • Spontaneous bacterial peritonitis , SBP
4. Drugs and toxic substances
2020/11/6
5
Etiology
6. Circulation disturbance of liver
2020/11/6
6
Etiology
7. Metabolic disease：
Haemochromatosis， Wilson‘s disease， 1-antitrypsin deficiencyin
8. Autoimmune hepatitis,AIH • Others
2020/11/6
7
pathogenesis
Activation of Hepatic stellate cell （HSC） cytokines extracellular matrix, ECM
2020/11/6
8
2020/11/6
2020/11/6
13
正常肝脏
肝纤维化
肝硬化
2020/11/6
14
normal
fibrosis
cirrhosis
2020/11/6
15
Pathology (liver )
• micro nodular cirrhosis regenerative nodules size of 3 mm
• macro nodular cirrhosis nodules show marked differences in size,
5-10y
10-15y
单纯性脂肪肝
NASH
17%
15-25%
10y
肝硬化
肝病相关死亡
30-40%
亚急性肝衰竭
HCC
肝移植后复发
2020/11/6
Shneider 2006
பைடு நூலகம்
Etiology
4. Cholestasis
Primary biliary cirrhosis，PBC; Primary sclerosing cholangitis，PSC ; Secondary biliary cirrhosis
2020/11/6
21
Mechanism of ascites formation
activation
11
2020/11/6
12
pathogenesis
• widespread death of liver cells • formation of regenerative nodules • formation of pseudo-lobules • derangement of hepatic circulation
(Portal-hypertension)
Portal pressure>10mmHg Ohm’s law: Hepatic vein pressure gradient(HVPG)=
blood flow ×vascular resistance collateral circulations, varices bleeding
3mm~5cm • intermediate mixed forms
2020/11/6
16
Pathology
(others)
• Gastrointestinal tract varices of esophagus and gastric
. fundus, Congestive gastropathy
Hepatic Cirrhosis
肝硬化
outline
• variety causes, chronic, progressive and widespread , end stage liver disorder.
• Hepatic fibrosis ，regenerative nodules & pseudo-lobules
• Kidneys: HBV related renal disease; insufficient irrigation of
renal arteries; bilirubin thrombin
• Spleen • Endocrine organs
2020/11/6
17
Pathophysiology
乙肝携带率由1992年的9.75% 降至2006年的7.18%
2. Alcoholic liver disease, ALD，长期大量80g/d > 10年
2020/11/6
3
Etiology
3. Nonalcholic fatty liver disease, NAFLD/ Nonalcholic steatohepatitis, NASH
9
2020/11/6
10
Degeneration hepatocyte
Kupffer cell
PDGF TGF
Platelet
ECM
（collagen I、III）
HGF
silence
2020/11/6
TGF-R PDGF-R
flt-1
transforming
TGF
TGF-R PDGF-R flt-1
• Liver failure and portal hypertension 是各种慢性肝病的终末阶段
2020/11/6
2
Etiology
1. Chronic viral hepatitis：typeB, typeC
2020/11/6
18
2020/11/6
19
门脉高压症
• 侧支循环 • 脾大及脾功能亢进 • 腹水
2020/11/6
20
Pathophysiology
(Ascites )
• Mechanism 1. Portal hypertension主要原因 2. Dilation of visceral artery: sodium and water retention最终原因 3. Plasmatic Colloid osmotic pressure 重要因素: Hypoalbumin 4. Others : atrial natriuretic hormone, ADH, secondary aldosteronism • Postulates 1. underfilling theory, 2. overflow theory 3. Arterial vasodilatation • Spontaneous bacterial peritonitis , SBP
4. Drugs and toxic substances
2020/11/6
5
Etiology
6. Circulation disturbance of liver
2020/11/6
6
Etiology
7. Metabolic disease：
Haemochromatosis， Wilson‘s disease， 1-antitrypsin deficiencyin
8. Autoimmune hepatitis,AIH • Others
2020/11/6
7
pathogenesis
Activation of Hepatic stellate cell （HSC） cytokines extracellular matrix, ECM
2020/11/6
8
2020/11/6
2020/11/6
13
正常肝脏
肝纤维化
肝硬化
2020/11/6
14
normal
fibrosis
cirrhosis
2020/11/6
15
Pathology (liver )
• micro nodular cirrhosis regenerative nodules size of 3 mm
• macro nodular cirrhosis nodules show marked differences in size,
5-10y
10-15y
单纯性脂肪肝
NASH
17%
15-25%
10y
肝硬化
肝病相关死亡
30-40%
亚急性肝衰竭
HCC
肝移植后复发
2020/11/6
Shneider 2006
பைடு நூலகம்
Etiology
4. Cholestasis
Primary biliary cirrhosis，PBC; Primary sclerosing cholangitis，PSC ; Secondary biliary cirrhosis
2020/11/6
21
Mechanism of ascites formation
activation
11
2020/11/6
12
pathogenesis
• widespread death of liver cells • formation of regenerative nodules • formation of pseudo-lobules • derangement of hepatic circulation
(Portal-hypertension)
Portal pressure>10mmHg Ohm’s law: Hepatic vein pressure gradient(HVPG)=
blood flow ×vascular resistance collateral circulations, varices bleeding
3mm~5cm • intermediate mixed forms
2020/11/6
16
Pathology
(others)
• Gastrointestinal tract varices of esophagus and gastric
. fundus, Congestive gastropathy
Hepatic Cirrhosis
肝硬化
outline
• variety causes, chronic, progressive and widespread , end stage liver disorder.
• Hepatic fibrosis ，regenerative nodules & pseudo-lobules
• Kidneys: HBV related renal disease; insufficient irrigation of
renal arteries; bilirubin thrombin
• Spleen • Endocrine organs
2020/11/6
17
Pathophysiology
乙肝携带率由1992年的9.75% 降至2006年的7.18%
2. Alcoholic liver disease, ALD，长期大量80g/d > 10年
2020/11/6
3
Etiology
3. Nonalcholic fatty liver disease, NAFLD/ Nonalcholic steatohepatitis, NASH
9
2020/11/6
10
Degeneration hepatocyte
Kupffer cell
PDGF TGF
Platelet
ECM
（collagen I、III）
HGF
silence
2020/11/6
TGF-R PDGF-R
flt-1
transforming
TGF
TGF-R PDGF-R flt-1