肝性脑病bppt课件

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1、Hepaticencephalopathy肝性脑病DepartmentofGastroenterologyThirdXiangyaHospitalWANGXiaoyan,MD,PhD.OverviewEtiologyandPathogenesisPathologyClinicalmanifestationLaboratoryexaminationDiagnosisandDifferentialdiagnosisManagementContentsoftheseclasses:Overview（概述）Definitionaseriesofreversibleneurologicalandp

2、sychopathicsyndromecausedbysevereliverdiseaseandPortosystemicshunt,andmetabolicdisorderisunderlyingchange.Disturbanceofconsciousness/ComaRelativeterms（相关概念）Minimalhepaticencephalopathy（MHE,轻微肝性脑病）Thepatientinthisstagelacksymptoms,whichcanbediagnosedbysubtlePsychometrictest.Portosystemicencephalop

3、athy(门体分流性脑病)EtiologyandPathogenesisEtiologyandPathogenesisVariouskindsoflivercirrhosis,portosystemicshunting(TIPS)aremostcommon.Severehepatitis,acutehepaticfailure,primarylivercancer,gestationrelatedfattyliverandseverebiliarytractinfectionarealsotheetiologicalfactors.InducementUppergastrointesti

4、nalhemorrhage(上消化道出血）Potentdiuresis（强利尿剂）Ascitesexclusion（排放腹水）Proteinmeal（高蛋白饮食）InducementTakingsedativeorsimilardrug（服用镇静药）Constipation（便秘）Uremia（尿毒症）InfectionPathogenesis（发病机制）CommonpathophysiologicchangeNeurotoxinhypothesisAmmoniaintoxicationChangeofneurotransmitterγ-Amino-butyricacidhypothes

5、isFalseneurotransmitterhypothesisTryptophanPathogenesis（发病机制）IntestinekidneyMuscleNH3NH4+LiverurineBrain,liver,kidneyGlutaminOrnithinecycleATPbloodintestinePH>6PH<6KidneyandlungMuscleproductionandclearanceofAmmoniaNeurotoxinhypothesis--Ammonia氨中毒学说Howdoesammoniacauseneurologicdysfunction?Interfe

6、rewithtricarboxylicacidcycleIncreaseconcentrationofaromaticaminoacidIncreaseconcentrationofglutamine(Hypertonic)EnergymetabolismAmmoniaintoxicationHypothesis氨中毒学说γ-Amino-butyricacidhypothesisGABA/BZ复合体学说（三）GABA/BZco-receptorcanbindtobarbiturateandbenzodiazepine,soenhancetheinhibitoryeffectofGABA.

7、GABA-receptorFalseneurotransmitterHypothesis假性神经递质Excitatoryneurotransmitterinbrain：noradrenaline(去甲肾）/dopamine（多巴胺）AromaticaminoacidTyrosine/phenylalanineTyramine(酪胺）andBenzol-Ethylamine（苯乙胺）inintestineBeclearedhydrox