hepatic failure分析课件

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1、Chapter17．HepaticFailure1Section1.Conceptofhepaticfailure21.DefinitionofhepaticfailureVariousharmfulfactors↓parenchymalcellsandKupffercellsdamadgedseverelyandextensively↓severedisturbanceofliverfunctioninmetabolism,secretion,synthesis,detoxicationandimmunity↓jaundice,bleeding,infection,ren

2、aldysfunctionandencephalopathy↓“Hepaticinsufficiency”↓(latestage)“Hepaticfailure”hepatorenalsyndromeandhepaticencephalopathy3Severe,extensivedegenerationandnecrosisofhepaticcells→Acute(fulminant)hepaticfailureLatestageofcirrhosisorcarcinomaoftheliver→Chronichepaticfailure2.Classificationan

3、dcauses4(1)metabolism:(2)bilesecreteandexcrete:(3)coagulation:(4)bioconversion(5)immuneDisturbanceofmetabolism:carbohydrate,protein,electrolyteObstacleofbilesecreteandexcrete:hyperbilirubinemia,intrahepaticcholestasisDisorderofcoagulation:generation↓orconsumption↑→clottingfactor↓→bleedingt

4、endencyDysfunctionofbioconversiondrugmetabolism;detoxicationoftoxin;inactivationofhormoneDysfunctionofimmune(Kuppfercells)bacterialinfection,bacteremia,intestinalendotoxemia3.Functionofnormalliver3.Effectsofhepaticfailureonthebody5Section2.HepaticEncephalopathy6AserialofNeuropsychicalsympt

5、omshepaticencephalopathyA.ConceptandclassificationAcuteorchronicliverdiseaseHepaticcomaultimateclinicalmanifestationofHE7Classification:AccordingtotheCliniccourseClinicalneuropsychicalsymptomsEtiologyAcute,subacuteandchronictypes1ststage(prodromalperiod)2ndstage(pre-comaperiod)3rdstage(let

6、hargyperiod)4thstage(comaperiod)Virusinfectionordrugintoxication→extensivehepatocytenecrosis→acute(fulminant)hepatitis→endogenousHEPortalorSchistosomehepaticcirrhosis→exogenousHE(usuallywithobviousinducingfactors)8B.PathogenesisofHEHEisaneuropsychicaldisturbance.Thefollowingfeaturesmayimpl

7、yHEismainlycausedbythemetabolicandfunctionaldisturbanceofthebrain:l)Reversibilityofsymptoms2)Disseminationofdiseaseregion3)Noclearevidenceofmorphologicalteration4)Accompaniedwithbiochemicalabnormality9TheoryofammoniaintoxicationFalseneurotransmitterhypothesisT