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Mechanism of ascites formation
8. Autoimmune hepatitis,AIH • Others
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pathogenesis
Activation of Hepatic stellate cell （HSC） cytokines extracellular matrix, ECM
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3mm~5cm • intermediate mixed forms
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Pathology
(others)
• Gastrointestinal tract varices of esophagus and gastric
. fundus, Congestive gastropathy
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正常肝脏
肝纤维化
肝硬化
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normal
fibrosis
cirrhosis
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Pathology (liver )
• micro nodular cirrhosis regenerative nodules size of 3 mm
• macro nodular cirrhosis nodules show marked differences in size,
• loss of the normal lobular liver architecture
• Liver failure and portal hypertension 是各种慢性肝病的终末阶段
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Etiology
1. Chronic viral hepatitis：typeB, typeC
Hepatic Cirrhosis
肝硬化
outline
• variety causes, chronic, progressive and widespread , end stage liver disorder.
• Hepatic fibrosis ，regenerative nodules & pseudo-lobules
9
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10
Degeneration hepatocyte
Kupffer cell
PDGF TGF
Platelet
ECM
（collagen I、III）
HGF
silence
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TGF-R PDGF-R
flt-1
transforming
TGF
TGF-R PDGF-R flt-1
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18
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门脉高压症
• 侧支循环 • 脾大及脾功能亢进 • 腹水
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Pathophysiology
(Ascites )
• Mechanism 1. Portal hypertension主要原因 2. Dilation of visceral artery: sodium and water retention最终原因 3. Plasmatic Colloid osmotic pressure 重要因素: Hypoalbumin 4. Others : atrial natriuretic hormone, ADH, secondary aldosteronism • Postulates 1. underfilling theory, 2. overflow theory 3. Arterial vasodilatation • Spontaneous bacterial peritonitis , SBP
5-10y
10-15y
单纯性脂肪肝
NASH
17%
15-25%
10y
肝硬化
肝病相关死亡
30-40%
亚急性肝衰竭
HCC
肝移植后复发
பைடு நூலகம்2020/11/6
Shneider 2006
Etiology
4. Cholestasis
Primary biliary cirrhosis，PBC; Primary sclerosing cholangitis，PSC ; Secondary biliary cirrhosis
4. Drugs and toxic substances
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Etiology
6. Circulation disturbance of liver
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Etiology
7. Metabolic disease：
Haemochromatosis， Wilson‘s disease， 1-antitrypsin deficiencyin
• Kidneys: HBV related renal disease; insufficient irrigation of
renal arteries; bilirubin thrombin
• Spleen • Endocrine organs
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Pathophysiology
(Portal-hypertension)
Portal pressure>10mmHg Ohm’s law: Hepatic vein pressure gradient(HVPG)=
blood flow ×vascular resistance collateral circulations, varices bleeding
乙肝携带率由1992年的9.75% 降至2006年的7.18%
2. Alcoholic liver disease, ALD，长期大量80g/d > 10年
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Etiology
3. Nonalcholic fatty liver disease, NAFLD/ Nonalcholic steatohepatitis, NASH
activation
11
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pathogenesis
• widespread death of liver cells • formation of regenerative nodules • formation of pseudo-lobules • derangement of hepatic circulation