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1、HepaticCirrhosisProfessorWangJi-yaoDepartmentofInternalMedicineDivisionofGastroenterology,Zhongshanhospital,FuDanuniversity.Cirrhosis---definitionchronic,progressed,diffusehepatocellularinjuryfibrosisnodularregenerationIncidence:17/100000/yAge:20-50yr.Hepaticcirrhosis》EtiologyLiverfunctionIn
2、jury,PortalhypertensionDiffuse,chronicliverinjuryHepato-cellularnecrosis,collapseofhepaticlobulesregenerativenodulesformationFormationofdiffusefibrousseptaComplations:UpperGIBleeding,Hepaticcoma,infections,primarylivercancer,Functionalrenalfailure1.Chronicviralhepatitis(慢性病毒性肝炎):[HBV,HCV,HBV
3、+HDV]2.Long-termalcoholism(慢性酒精中毒)[80g/d,10yr.]3.Prolongedcholestasis(长期胆汁郁积),intra-andextra-hepatic:[primarybiliarycirrhosis,PBC]/[secondarybiliarycirrhosis]4.Drugsandtoxins(药物和毒物)[toxichepatitis---chronicactivehepatitis---cirrhosis]5.Nonalcoholicsteatohepatitis(NASH)(非酒精性脂肪性肝炎)Etiologyofci
4、rrhosis(I)Etiologyofcirrhosis(II)6.Hepaticvenousoutflowobstruction(肝血液循环障碍)veno-occlusivedisease,Budd-Chiarisyndrome,constrictivepericarditis7.Metabolicdisorders(遗传代谢性疾病)hemochromatosis(血色病);Wilson‘sdisease(肝豆状核变性);8.Autoimmunehepatitis(AIH)(自身免疫性肝炎)9.Schistosomiasis(血吸虫病)10.Cryptogenic(隐原性)
5、11.Mixed:alcohol+virus,HBV+HCV,HBV+schistosomiasisHepaticstellatecellactivationLiverfibrosisaccumulationofextracellularmatrixinliversynthesisofmatrixproteinsdegradationofmatrixproteinsCollagenstypeIandIIIconstitutemorethan95%ofthetotalcontentofincreasedcollageninfibroticliverPathogenesis:chr
6、onic,progressed,diffuseHepatocyteinjuryleadingtonecrosis.Chronicinflammation-(hepatitis).Capillarization(肝窦毛细血管化)ofthespaceofDisseisakeyevent.Bridgingfibrosis.Regenerationofremaininghepatocytesproliferateasroundnodulessurroundedbyfibroussepta.Lossofvasculararrangementresultsinregeneratinghep
7、atocytesineffective.Cirrhosismayleadtoliverfailure,portalhypertension,ordevelopmentofhepatocellularcarcinomaHistopathologicclassificationmicronodularuniformlysmallnodules(<3mmindiameter)andregularbandsofconnectivetissuemacronodularnodulesthatvaryin
