肝性脑病英文课件.ppt

1、Hepatic FailureTao Wang,PH.D.,Associated professorPathophysiology departmentAnhui Medical University1nIntroduction and ConceptionnEtiologynHepatic insufficiencynHepatic failure Hepatic encephalopathy(focal point)Hepatorenal syndromeHepatic Failure2PART I Introduction and ConceptionLiverThe largest a

2、nd most metabolically complex organ1.The liver32.The liver anatomyThe liver is divided into 2 main lobes,each consisting of many lobules.These lobules are surrounded by branches of the hepatic artery,which supplies the liver with oxygenated blood.The portal vein supplies nutrient-rich blood.Deoxygen

3、ated blood from the liver drains into the hepatic veins.A network of ducts carries bile from the liver to the gallbladder and the small intestine43.The functions of the liver Substance metabolism immune function Hemostasis regulation production and secretion of bile Bio-transformation(detoxification

4、)54.Hepatic insufficiencySevere damage in liver cells will result in serious condition,manifesting as jaundice,bleeding,infection,renal dysfunction or encephalopathy,termed all together these syndromes of hepatic insufficiency.Acute Hepatic insufficiency Chronic Hepatic insufficiency 65.Hepatic fail

5、ureTerminal stage of hepatic insufficiencyHepatic encephalopathy(focal point)Hepatorenal syndromePrimary clinical manifestations7PART II Etiology1.Biological2.Physical and chemical 3.Inherited conditions 4.Immune 5.Nutritional causesHepatitis virus(such as HBV),bacteria,parasites,etc.Industrial toxi

6、ns,some drugs,alcohol,etc.Idiopathic hemochromatosis,Wilsons disease,etc.Extent of inflammation and necrosis 8PART III Hepatic insufficiencyLiverVarious etiology causeshepatocytesNon-parenchymalcellsdamagedamage Kupffer cells,hepatic satellite cells,lipocytes,liver associated lymphocytes,hepatic sin

7、usoid endothelial cellsHepatic insufficiency9Syndromes of Hepatic insufficiency1.Metabolic disorders2.Water and electrolytes imbalance3.Disorders in production of bile salts and elimination of bilirubin4.Impaired kupffer cells functionCarbohydrate Metabolic DisordersLipid Metabolic DisordersProtein

8、Metabolic DisordersHepatic AscitesElectrolytic Metabolic Disorders101.Metabolic disorders1)Carbohydrate Metabolic DisordersCarbohydrate Metabolism of liverTo maintain concentrations of glucose in blood within a narrow,normal range.insulinA hormone produced by the pancreas that regulates glucose leve

9、ls in the blood.It is normally produced in response to raised glucose levels following a meal and promotes glucose absorption into the liver and muscle cells(where it is converted into energy).Excess glucose entering the blood after a meal is rapidly taken up by the liver and sequestered as the larg

10、e polymer,glycogenglycogenesis11glyconeogenesisglycogenolysiswhen blood concentrations of glucose begin to decline,the liver activates other pathways which lead to depolymerization of glycogenWhen hepatic glycogen reserves become exhaused,as occurs when an animal has not eaten for several hours,the

11、hepatocytes,recognize the problem and activate additional groups of enzymes that begin synthesizing glucose out of such things as amino acids and non-hexose carbohydrates.12Severe liver diseaseHypoglycemiaHyperglycemiaCaused by a decrease in functional hepatocyte mass.When glucogen reserves are depl

12、eted:gluconeogenensis impared;inactivation of insulin weakenCaused by portal-to-systemic shuntingDecrease the postprandial extraction of glucose from protal bloodSome patients may suffer abnormal glucose tolerance131.Metabolic disorders2)Lipid Metabolic DisordersLiver is the center of lipid metaboli

13、smManufacturing 80%of the cholesterolSynthesizing,storing and exporting triglyceridesAssembling,secreting and taking up lipoprotein particle,such as VLDL,LDL,and HDL.14Severe liver diseaseDisturbance of lipid metabolismSyndromes of fat accumulation(fatty liver)In certain chronic liver diseasePrimary

14、 biliary cirrhosisDestruction of bile ductsBile flow decreaseDecrease lipid clearance via bilehyperlipidemiaThese patients often develop xanthomas accumulation of cholesterol 151.Metabolic disorders3)Protein Metabolic DisordersThe liver manufactures and secretes many of the protein found in plasmaal

15、buminSome clotting factorsSome binding proteinsSome hormone precursorsTo maintain plasma oncotic pressureTo regulate hemostasisSteroid and thyroid hormone-binding protein to regulate metabolismangiotensinogen to regulate blood pressureInsulin like growth factor-1 to regulate growth16Other roles of t

16、he liver in protein metabolismProcesses of oxidative deamination and transaminationThe urea cycle allows nitrogen to be excreted in the form of urea17Severe liver diseaseDisturbance of protein metabolismDecreased conversion of ammonia to ureaPlasma proteins decreaseElevated ammonia levelalbuminClotting factorsHepatic encephalopathyEdema and ascitesBleeding tendancy182.Water and electrolytes imbalance1)Hepatic AscitesAscties is the presence of the excess fluid in the peritoneal cavityIt is a late