肝硬化（英文版）知识介绍.ppt

Palmar erythema As the liver becomes fibrotic, there is obstruction of the blood flow through the liver. This results in portal hypertension, an increase in blood pressure within the portal vein and its tributaries. The obstructed hepatic blood flow also causes congestion of the spleen, leading to a markedly enlarged spleen (splenomegaly). Also, most people with cirrhosis eventually develop fluid in their abdomen (ascites) and are at an increased risk of developing a spontaneous intraabdominal infection. Ascites Ascites Legs edema Cirrhosis of Liver Spleen enlarges Cirrhosis of Liver Portal hypertension results from the abnormal blood flow pattern in liver created by cirrhosis. The increased pressure is transmitted to collateral venous channels. Sometimes these venous collaterals are dilated. Seen here is caput medusae which consists of dilated veins seen on the abdomen of a patient with cirrhosis of the liver. A much more serious problem produced by portal hypertension results when submucosal veins in the esophagus become dilated. These are known as esophageal varices. Varices are seen here in the lower esophagus as linear blue dilated veins. There is hemorrhage around one of them. Such varices are easily eroded, leading to massive gastrointestinal hemorrhage Abdomen varices Esophageal varices Esophageal varices Red spot Gastric varices Complications Esophageal and gastric variceal bleeding 　Hepatic encephalopathy 　Infection 　Hepatocellular carcinoma 　Hepatorenal syndrome 　Hepatopulmonary syndrome 　Portal vein thrombus Esophageal variceal bleeding Hepatocellular carcinoma Hepatocellular carcinoma Portal vein stenosis Portal vein thrombus Lab findings Aminotransferases - AST and ALT are moderately elevated, with AST ALT. However, normal aminotransferases do not preclude cirrhosis. Alkaline phosphatase - usually slightly elevated. GGT -- correlates with AP levels. Typically much higher in chronic liver disease from alcohol. Bilirubin - may elevate as ci