【正文】 the abdomen or extremities Increased BUN (Azotemia) and creatinine levels 實(shí)驗(yàn)室及特殊檢查 一、 實(shí)驗(yàn)室檢查 (Lab Test) 1．血常規(guī) 貧血、脾亢時(shí)白細(xì)胞和血小板減少。 Nosebleed, bleeding gums , Decreased number of red blood cells (anemia) ,Gastrointestinal bleeding from varices ： 蜘蛛痣、肝掌、皮膚顏面色素沉著、男性乳房發(fā)育、睪丸萎縮及女性月經(jīng)失調(diào)。 ：納差、惡心、腹脹 Abdominal fullness, gaseous及腹瀉。肝功能正?；蜉p度異常?？捎蟹α?、納差、惡心、上腹不適、腹脹、腹瀉等，查體見一般情況較好，肝臟輕度腫大，質(zhì)地結(jié)實(shí)或偏硬。 病理 4．不完全分隔型 肝小葉由纖維圍成結(jié)節(jié)，纖維間隔可向小葉延伸，但分隔小葉不完全，再生結(jié)節(jié)不明顯 。多見于肝炎后肝硬化。常見于酒精性肝硬化。s disease) 7. Autoimmune diseases (including autoimmune chronic hepatitis) 12 8. Schistosoma hematobium CAUSES Iron overload (hemochromatosis) 9. Unknown ( NASH, Cryptogenic) 發(fā)病機(jī)制 Stellate cell, extracellular matrix PATHOLOGY Classification of cirrhosis According to World Health Organization (Anthony . et al. . 31:395,1978) MORPHOLOGIC: Macronodular Micronodular Mixe HISTOLOGIC: Portal, Postnecrotic, Post Hepatitic, Biliary, Congestive ETIOLOGIC AGENTS: Geic, Toxic, Infectious, Biliary, Vascular, Cryptogenic MACRONODULAR CIRRHOSIS: Larger nodules separated by wider scars and irregularly distributed throughout the liver usually due to an infectious agent such as viral hepatitis which does not diffuse uniformly throughout the liver. DISSECTION NODULES: ?contain remnants of portal tracts an central veins. ?are separated by wide scars but contain thin fibrous septa. ?contain dilated sinusoids especially at their periphery looking like multiple central veins obviously produced by the inflow of arterial blood ing from the surrounding wide scars. ?the portal tracts within large nodules may be hypoplastic containing portal venule and arteriole but no bile ducts giving the impression of a disappearing bile duct disorder. ?within wide scars regenerative nodules may develop. REGENERATIVE NODULES: ?these occur in micro and macro nodular cirrhosis. ?they arise in the midst of scars favored by the rich arterial blood of scar tissue. ?they are round nodules with a fibrous pseudo capsule with bile ductules due to obstruction of bile flow. ?they have embryonal type of cell plates. ?they often show focal cholestasis. ?they may undergo dysplastic and malignant changes. ?they press the vessels of the capsule contributing to the perpetuation of the cirrhosis. 大體形態(tài) 肝逐漸變形、變硬變小、包膜增厚、結(jié)節(jié)出現(xiàn)而致肝硬化。 ? 年齡 35～ 48歲最多，男：女為 3． 6～ 8： 1。 The histologic feature is degeneration, regeneration(nodular) and fibrosis. ? According to the following sequence: INJURY DEGENERATION and necrosis regeneration FIBROSIS FORMATION OF FIBROVASCULAR MEMBRANES PARENCHYMAL DISSECTION INTO NODULES REARRANGEMENT OF BLOOD CIRCULATION CIRRHOSIS REARRANGEMENT OF BLOOD CIRCULATION CIRRHOSIS Introduction ? 臨床 —化道出血、肝性腦病等并發(fā)癥。CIRRHOSIS of LIVER Xiaohong Tao The First Affiliated Hospital Chongqing University of Medical Sciences Introduction 一種或幾種病因長期或反復(fù)作用引起的慢性進(jìn)行性肝病的后期階段。 (It’s the end result of hepatocellular injury resulted from different causes, ERLD ) ? 病理 — 有廣泛肝細(xì)胞變性壞死、肝細(xì)胞結(jié)節(jié)性再生、結(jié)締組織增生及纖維化，正常肝小葉結(jié)構(gòu)破壞和假小葉形成、肝逐漸變形、變硬。 (The clinical manifestations can be broadly classified into those resulting from hepatocellular dysfunction, such as jaundice and coagulopathy and portal hypertension. The plication often appear in late phase, such as hemmorrage, hepatic encephalopathy. ? 世界性疾病，所有種族、不論國籍、年齡或性別、均可罹患。 Cirrhosis is the third most mon cause of death, after heart disease and cancer. killing about 25,000 people each year. Introduction HISTORY In 1761, This peculiar transformation of the liver was identified by the first anatomic pathologist, Gianbattista Magni in his 500 autopsies. HISTORY In 1826 (65years latter), the name of cirrhosis was given by Laennec because of the yellowishtan color of the cirrhotic liver. cirrhosis (greek=orange color). HISTORY Only in 1930, one hundred years later, the first theory as to the pathogenesis of this disorder was advanced by Roessle: parenchymal degeneration, regeneration and s