2005年4月10日上午8点44分，陈逸飞在上海华山医院去世，据有关媒体报道，陈逸飞的死因为胃出血所致，也有部分媒体报道，他的死因是肝功能衰竭。那么，究竟是什么病残酷地折断了这位在绘画、服装、电影、模特经纪等诸多领域处于旺盛阶段的年轻“长者”的生命？原来陈逸飞先生真正的死是因为肝硬化导致食管胃底静脉曲张破裂而大出血。,浔阳遗韵 Lingering Melodies from the Xunyang River,1991,首都医科大学宣武医院消化科 胡水清 2006.5,肝硬化,Cirrhosis,Cirrhosis,Classification,Overview,Clinical Manifestations,Pathology and Pathophysiology,Complications,Laboratory Findings and other examinations,Prognosis,Treatment,Diagnosis and Differential Diagnosis,Case report,History : A 43 year old man was admitted with a history of high alcohol intake for 20 years. For six months prior to admission there had been an increase in weight, jaundice (yellow skin) and several episodes of melaena (black, tarry motions due to bleeding from the oesophagus, stomach or duodenum). Four days before admission, he developed pneumonia. Examination: He was jaundiced, with flapping tremor of the hands (a sign of brain injury due to acute liver failure), testicular shrinkage (resulting from chronic liver damage), enlarged spleen, fluid in the abdominal cavity (ascites) and swelling of the legs.,（1）本病的病因是什么？ （2）为明确诊断需做哪些检查？ （3）本病的诊断是什么？,Pathology (Liver biopsy ): The liver shows a reddish-grey fibrous tissue is seen in contrast to the yellowish nodules of remaining liver cells. The yellow colour suggests that there has been fatty degeneration of these cells.,Case report,谢谢!,Overview,Definition Clinical manifestations,Definition,Cirrhosis consists of fibrosis (纤维化）of hepatic parenchyma resulting in nodule （结节）formation .It represents the consequences of a sustained wound-healing response（损伤-修复反应） to chronic liver injury from a variety of causes (alcohol ,chronic viral infection, metabolic disorders and etc ).,Clinical Manifestations,Impaired hepatocellular function,Portal hypertension,Clinical Manifestations,Impaired hepatocellular function,Jaundice（黄疸）,Coagulopathy （凝血异常）,Clinical Manifestations,Portal hypertension,Ascites（腹水）,Clinical Manifestations,Portal hypertension,Gastroesophageal varices,An 83 year-old, non-alcoholic female that had an upper gastrointestinal hemorrhage. Large tortuous varices with red color sign.Cherry red spots are signs of imminent hemorrhage.,Clinical Manifestations,Portal hypertension,Gastroesophageal varices,This 72 year old female with a recurrent episode of bleeding from gastric varices. Seen on retroflexion are pendulous varices in the gastric cardia and fundus.“ String of Pearls ”,Classification,Morphology classification,Etiologic classification,Classification,Micronodular cirrhosis :The regenerative nodules 3mmIrregular in size and shape,Morphology classification,Classification,Micronodular cirrhosis,Morphology classification,The regenerative nodules The size and shape,Macronodular cirrhosis,Chronic viral hepatitis: viral B、C infection. Alcohol: 80g/d for 20 years Drugs Metabolic disease (Wilsons disease, alpha1-antitrypsin deficiency ) Biliary obstructive diseases Venous outflow obstruction (Budd-chiari syndrome) Cryptogenic cirrhosis,Classification,Etiologic classification,?,Venous outflow obstruction (Budd-chiari syndrome),Pathology and Pathophysiology,Histology of normal liver tissue,Histology of cirrhotic liver tissue,Pathology and Pathophysiology,Pathology,Pathology and Pathophysiology,Pathology and Pathophysiology,Pathophysiology,Venous Collaterals Abdominal Wall,Esophageal Varices,Pathology and Pathophysiology,Pathophysiology,Clinical Manifestations,Dysfuntion of hepatocytes Portal hypertension,Clinical Manifestations,Weakness, fatigability, weight loss Anorexia, nausea, occasional vomiting, abdominal pain,Dysfuntion of hepatocytes,Clinical Manifestations,Impaired hepatocellular function,Jaundice,Coagulopathy,Clinical Manifestations,Jaundice Coagulopathy :Nosebleed ,bleeding gums Decreased libido :males : feminization of the pattern of body hair ; breast enlargement; spider angioma;palmar erythema. (increased estrogen,decreased androgen),Dysfuntion of hepatocytes,Clinical Manifestations,Enlargement of spleen Large collateral veins Ascites,Portal hypertension,Clinical Manifestations,Enlargement of spleen: thrombocytopenia,Portal hypertension,Clinical Manifestations,Large collateral veins,Portal hypertension,Clinical Manifestations,Large collateral veins,Portal hypertension,varices in esophagus/stomach(most common) Varices in rectum Varices on the abdomen,Clinical Manifestations,Ascites,Portal hypertension,How does the ascites happen?,Complications:,Upper gastrointestinal bleeding（上消化道出血）,Spontaneous bacterial peritonitis (SBP)（原发性腹膜炎）,Hepatorenal syndrome (functional renal failure)（肝肾综合征）,Hepatic Encephalopathy （肝性脑病）,Primary carcinoma of liver （原发性肝癌）,Laboratory Findings and Other Examinations,Laboratory Findings,Imaging,Special examinations,Laboratory Findings,Blood routine Blood chemical studies,Anemia（贫血）, hemolysis（溶血）The white blood cell count ：low ,elevated or normalThrombocytopenia（血小板减少症）,Blood routine,Modest elevation of ALT and alkaline phosphatase（碱性磷酸酶） Progressive elevation of the bilirubin Serum albumin is low Gamma globulin is creased and may be as high as in autoimmune hepatitis Prolongation of the prothrombin time（凝血酶原时间） Elevated serum alpha-fetoprotein（甲胎蛋白） levels,