肝脏疾病医学ppt演示课件

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肝脏疾病医学ppt演示课件

. 1 LIVER DISEASE . 2 HISTORICAL PERSPECTIVE Francis Glisson 1654 J. Hogarth Pringle 1908 ---modern era of liver surgery--------- Lortat-Jacob 1952 anatomic liver resection Couinaud 1957 segment Blumgart, Bismuth, Longmire, Fortner, Schwartz, Starzl, Ton . . 3 Contents ANATOMY AND PHYSIOLOGY INFECTIOUS DISEASES NEOPLASMS . 4 ANATOMY AND PHYSIOLOGY Gross Anatomy . 5 ANATOMY AND PHYSIOLOGY . 6 ANATOMY AND PHYSIOLOGY . 7 ANATOMY AND PHYSIOLOGY . 8 ANATOMY AND PHYSIOLOGY Couinaud (French 1957) . 9 Microscopic Anatomy Functional Unit of the Liver . 10 Microscopic Anatomy Hepatic Microcirculation . 11 Child-Pugh Classification No. of Points Factor 1 2 3 Bilirubin (mg/dL) 2 23 3 Albumin (g/dL) 3.5 2.83.5 2.8 Prothrombin time (increased seconds) 13 46 6 Ascites None Slight Moderate Encephalopathy None Minimal Advanced * Grade A, 56 points; Grade B, 79 points; Grade C, 1015 points. Assessment of Liver Function . 12 Bacterial Liver Abscess 病

因和病理临床表现诊断鉴别诊断治疗细菌入肝途径

胆道肝动脉门静脉淋巴管

直接侵入 . 13 细菌性肝脓肿病因和病理临床表现诊断

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鉴别诊断治疗致病菌：

大肠杆菌，葡萄球菌，厌氧链球菌，类杆菌等。

脓腔：

单个或多个 . 14 细菌性肝脓肿病因和病理临床表现诊断鉴别诊断治疗多继发于一感染性先驱疾病毒血症菌血症表现体征实验室和影像学检查并发症 . 15 细菌性肝脓肿病因和病理临床表现诊断鉴别诊断治疗病史查体实验室及影像学检查 . 16 细菌性肝脓肿病因和病理临床表现诊断鉴别诊断治疗阿米巴性肝脓肿膈下脓肿胆道感染肝癌 . 17 Features of Amebic Versus Pyogenic Liver Abscess Clinical Features Amebic Abscess Pyogenic Abscess Age (yr) 2040 50 Male:female ratio 10 : 1 1.5 : 1 Solitary vs. multiple Solitary 80% Solitary 50% Location Usually right liver Usually right liver Travel in endemic area Yes No Diabetes Uncommon (approx. 2%) More common (approx. 27%) Alcohol use Yes Yes Jaundice Rare Common Elevated bilirubin Uncommon Common Elevated alkaline phosphatase Common Common Positive blood culture No Common Positive amebic serology Yes No * In acute amebic abscess 50% are solitary. . 18 Amebic Abscess . 19 细菌性肝脓肿病因和病理临床表现诊断鉴别诊断治疗全身性支持疗法抗生素应用切开引流经皮穿刺置管引流中医

---------------------------------------------------------------最新资料推荐------------------------------------------------------ 中药 . 20 percutaneous drainage . 21 percutaneous drainage ( B 超辅助引导下 ) . 22 Primary Liver Cancer 概述病因病理临床表现诊断与鉴别诊断治疗我国常见肿瘤中位年龄40-50 岁男性女性年死亡率第二位 . 23 原发性肝癌概述病因病理临床表现诊断与鉴别诊断治疗病毒性肝炎亚州肝癌患者 70 ～ 90 ％为 HBV携带者，国内肝癌患者 HBV 携带者超过 85 ％。

. 24 . 25 . 26 概述病因病理临床表现诊断与鉴别诊断治疗肝硬化 70 ～ 85% 的肝癌发生于肝硬化时肝细胞代偿增生的基础上 . 27 概述病因病理临床表现诊断与鉴别诊断治疗化学致癌剂黄曲霉素亚硝胺类化合物有机氯杀虫剂。

. 28 原发性肝癌概述病因病理临床表现诊断与鉴别诊断治疗大体病理分型组织分型临床分类肝癌的播散途径 . 29 结节型最常见，多伴肝硬化，常为多个结节，大小不一，分布广泛，有半数以上病例波及全肝。

. 30 巨块型多为单个癌结节或多个癌结节融合而成，较少肝硬化，切除机会多。

. 31 弥漫型少见，为广泛分布的小结节癌灶，肉眼下难与结节性肝硬化区分。

. 32 组织分型肝细胞型胆管细胞型混合型 . 33 临床

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