肝硬化（英文版）课件

Hepatic Cirrhosis Definition Hepatic cirrhosis is a chronic, degenerative disease in which normal liver cells are damaged and are then replaced by scar tissue. Description Hepatic Cirrhosis changes the structure of the liver and the blood vessels that nourish it. The disease reduces the livers ability to manufacture proteins and process hormones, nutrients, medications, and poisons. Cirrhosis gets worse over time and can become potentially life injury. This disease can cause: 1. Excessive bleeding (hemorrhage) 2. Impotence 3. Liver cancer 4. Coma due to accumulated ammonia and body wastes (liver failure) 5. Death Long-term alcoholism is the primary cause of cirrhosis in the United States. Men and women respond differently to alcohol. Although most men can safely consume two to five drinks a day, one to two drinks a day can cause liver damage in women. Individual tolerance to alcohol varies, but people who drink more and drink more often have a higher risk of developing cirrhosis. In some people, one drink a day can cause liver scarring. Chronic liver infections, such as hepatitis B and particularly hepatitis C, are commonly linked to cirrhosis. People at high risk of contracting hepatitis B include those exposed to the virus through contact with blood and body fluids. This includes healthcare workers and intravenous (IV) drug users. In the past, people have contracted hepatitis C through blood transfusions. As of 2003, cirrhosis resulting from chronic hepatitis has emerged as a leading cause of death among HIV-positive patients; in Europe, about 30% of HIV-positive patients are coinfected with a hepatitis virus. Liver injury, reactions to prescription medications, certain autoimmune disorders, exposure to toxic substances, and repeated episodes of heart failure with liver congestion can cause cirrhosis. A family history of diseases can genetically predispose a person to develop cirrhosis. Cirrhosis is the seventh leading cause of disease related death in the United States. It is twice as common in men as in women. The disease occurs in more than half of all chronic alcoholics and kills about 25,000 peoples a year. It is the third most common cause of death in adults between the ages of 45 and 65. Hepatitis is the first leading cause of disease related death in the China. So far, HBsAg+ peoples are about 1200 million (1, 200, 000, 000), and peoples who are infected HCV are about 38 million (38, 000, 000). Types of cirrhosis Portal or nutritional cirrhosis is the form of the disease most common in the United States. About 3050% of all cases of cirrhosis are this type. Nine out of every 10 people who have nutritional cirrhosis have a history of alcoholism. Biliary cirrhosis is caused by intrahepatic bile-duct diseases that impede bile flow. Bile is formed in the liver and is carried by ducts to the intestines. Bile then helps digest fats in the intestines. Biliary cirrhosis can scar or block these ducts. It represents 15 20% of all cirrhosis. Various types of chronic hepatitis, especially hepatitis B and hepatitis C, can cause postnecrotic cirrhosis. This form of the disease affects up to 40% of all patients who have cirrhosis. Chronic hepatitis B and C Alcoholic liver disease Cardiac cirrhosis Drugs or toxins Certain parasitic infections (such as schistosomiasis) Primary biliary cirrhosis Autoimmune hepatitis Primary sclerosing cholangitis Other: such as Wilsons disease, Hereditary hemochromatosis, Alpha 1-antitrypsin deficiency, Galactosemia, Cystic fibrosis In China, the chronic hepatitis is common cause, but not the alcoholic liver disease. Risk factors of Hepatic cirrhosis Worldwide Prevalence of HBV and Incidence of HCC World prevalence of HBV carriers HBsAg carriers-prevalence 8% Poorly documented Annual incidence of primary HCC Cases/100,000 population 13 310 10150 Poorly documented WHO 2003 Hepatitis B Related Death in China Cause of death No. of Deaths MortalityPercentage of total death Rank order Per 100,000 person/yr Chronic liver diseases* Total30621.31.58 Men19326.71.78 Women11316.01.310 * 85% related to HBV infection He et al. NEJM 2006 1. Hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic disease. 2. The virus is transmitted through contact with the blood or other body fluids of an infected person - not through casual contact. 3. About 2 billion peoples worldwide have been infected with the virus and about 350 million live with chronic infection. An estimated 600 000 persons die each year due to the acute or chronic consequences of hepatitis B. 4. About 25% of adults who become chronically infected during childhood later die from liver cancer or cirrhosis (scarring of the liver) caused by the chronic infection. 5. The hepatitis B virus is 50 to 100 times more infectious than HIV. 6. Hepatitis B virus is an important occupational hazard for health workers. 7. Hepatitis B is preventable with a safe and effective vaccine. from WHO Hepatocytes necrosis Hepatocytes regeneration Fibrotic scar tissue Regenerative nodules form VirusAlcoholOther This liver is slightly enlarged and has a pale yellow appearance, seen both on the capsule and cut surface. This uniform change is consistent with fatty metamorphosis (fatty change). Here are seen the lipid vacuoles within hepatocytes. The lipid accumulates when lipoprotein transport is disrupted and/or when fatty acids accumulate. Alcohol, the most common cause, is a hepatotoxin that interferes with mitochondrial and microsomal function in hepatocytes, leading to an accumulation of lipid. Fatty Liver H it is unlikely to completely replace liver biopsy in the diagnosis of cirrhosis. Prevention Eliminating alcohol abuse could prevent 7580% of all cases of cirrhosis. Other preventive measures include: Maintaining a healthy diet that includes whole foods and grains, vegetable, and fruits Obtaining counseling or other treatment for alcoholism Taking precautions (practicing safe sex, avoiding dirty needles) to prevent hepatitis Getting immunizations against hepatitis if a person is in a high-risk group receiving appropriate medical treatment quickly when diagnosed with hepatitis B or hepatitis C Having blood drawn at regular intervals to rid the body of excess iron from hemochromatosis Using medicines (chelating agents) to rid the body of excess copper from Wilsons disease Wearing protective clothing and following product directions when using toxic chemicals at work, at home, or in the garden The therapy of cirrhosis is aimed primarily at preventing or reducing the complications. Bleeding esophageal varices (collateral venous channels) are a frequent serious complication of cirrhosis. Various techniques are used to control the bleeding. In some individuals with severe portal hypertension, vascular shunts are made to reduce the pressure in the portal vein by bypassing the liver. Most frequently the portal vein is surgically connected to the inferior vena cava so that some of the blood in the portal vein does not pass through the liver. Treatment 1.Common treatment: Rest, nutritional and supportable therapy. 2. Treating underlying causes: Alcoholic cirrhosis caused by alcohol abuse is treated by abstaining from alcohol. Treatment for hepatitis-related cirrhosis involves medications used to treat the different types of hepatitis, such as interferon for viral hepatitis and corticosteroids for autoimmune hepatitis. Cirrhosis caused by Wilsons disease, in which copper builds up in organs, is treate