资源简介

(共33张PPT)
第八章 消化系统疾病
Alimentary system
慢性肝损伤的终末改变
不可逆
弥漫分布 affects the entire liver
纤维化和结节再生 characterized by fibrosis and nodular regeneration
特征：纤维化和结节再生
肝硬化 Liver cirrhosis
CIRRHOSIS
PORTAL-to-PORTAL (bridging) FIBROSIS
The “normal” hexagonal “ARCHITECTURE” is replaced by NODULES
BLIND MAN’s LIVER
Blind Man’s Diagnosis
Clause
病毒性肝炎：70%～80%，HBV,HCV
药物及化学物质中毒：砷、黄磷、四氯化碳等
慢性酒精中毒：
营养缺乏：甲硫氨酸、光氨酸、蛋白质、胆硷等
胆道阻塞、胆汁淤积：结石、肿瘤、总胆管囊肿，先天性狭窄等慢性非化脓性破坏性胆管炎
寄生虫：血吸虫等
黄曲霉素
Liver's regeneration
肝细胞损伤但是小叶结构保留
If individual hepatocytes are destroyed but the architecture of the lobule is not destroyed…
整个小叶结构损害
If whole lobules are destroyed…
瘢痕组织改建肝脏血流
If scar tissue alters the flow of blood through the liver…
The liver's ability to regenerate is legendary.
(The Greek titan Prometheus had his liver devoured each day by a monster bird, but it always grew right back.)
Regeneration
Fibrosis
网状纤维支架塌陷，融合，胶原化
成纤维细胞增生
Stellate cells (Ito cells) 转型合成胶原
Activated by factors (eg. TGF-β) released by hepatocytes, Kupffer cells, and sinusoidal endothelium following liver injury.
N
O
FIBROUS
TISSUE
BETWEEN
PORTAL
AREAS
Scars
Nodules

Pseudolobule 假小叶
TRICHROME
CIRRHOSIS, TRICHROME STAIN
CIRRHOSIS, TRICHROME STAIN
micronodular （ d ≤ 3 mm)
macronodular （ d ＞ 3 mm)
Mixed
不全分隔型 （ 早期 ）
肝硬化分类 Classification
形态分类（结节大小）
小结节肝硬化
小结节肝硬化伴有脂肪变性
坏死后性硬化： The nodules seen here are larger than 3 mm and, 大结节硬化

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