肝疾病与门静脉高压症LiverdiseasesandPortalhypertension授课人：普外科六病房姜明山1of67www.hrbmush.edu.cn第三十八章肝疾病第一节解剖生理概要(Anatomyandphysiology)GeneralDescriptionandTopography2of67www.hrbmush.edu.cn第三十八章肝疾病第一节解剖生理概要(Anatomyandphysiology)FunctionalAnatomy3of67www.hrbmush.edu.cn第三十八章肝疾病第一节解剖生理概要(Anatomyandphysiology)FunctionalAnatomyandSurgery4of67www.hrbmush.edu.cn第三十八章肝疾病第一节解剖生理概要(Anatomyandphysiology)FunctionalAnatomyandImaging5of67www.hrbmush.edu.cn第三十八章肝疾病第一节解剖生理概要(Anatomyandphysiology)HepaticMicrocirculationMicrovilliHepatocytesinplatesBilecanaliculusSPACEOFDISSEFenestratedEndothelialcellsSINUSOIDKupffercellSTELLATECELLHEPATOCYTEENDOTHELIALCELLKUPFFERCELLSTELLLATECELL7of67www.hrbmush.edu.cn第三十八章肝疾病第一节解剖生理概要(Anatomyandphysiology)BloodFlow1500mL/minute25%ofthecardiacoutputHepaticA.:Blood25~30%,Oxygen46~60%Portalv.:Blood70~75%8of67www.hrbmush.edu.cn第三十八章肝疾病第一节解剖生理概要(Anatomyandphysiology)FunctionEnergyFunctionalheterogeneityBileformationEnterohepaticcirculationBilirubinmetabolismCarbohydratemetabolismLipidmetabolismProteinmetabolismVitaminmetabolismCoagulationMetabolismofdrugsandtoxinRegeneration9of67www.hrbmush.edu.cn第三十八章肝疾病第一节解剖生理概要(Anatomyandphysiology)AssessmentofLiverFunctionVariable1Point2Points3PointsBilirubinlevel<2mg/dL2–3mg/dL>3mg/dLAlbuminlevel>3.5g/dL2.8–3.5g/dL<2.8g/dLInternationalnormalizedratio<1.71.7–2.2>2.2EncephalopathyNoneControlledUncontrolledAscitesNoneControlledUncontrolledChild-Pughclass:ClassA=5–6points;ClassB=7–9points;ClassC=10–15pointsChild-PughScore10of67www.hrbmush.edu.cn第三十八章肝疾病第二节偶发肝脏肿块的诊断与鉴别诊断（Occasionallivermass）11of67www.hrbmush.edu.cn第三十八章肝疾病第三节肝脓肿（Liverabscess）细菌进入肝的途径胆道肝动脉门静脉淋巴系统开放性肝损伤12of67www.hrbmush.edu.cn第三十八章肝疾病第三节肝脓肿（Liverabscess）致病菌及病理致病菌多为大肠杆菌、金黄色葡萄球菌、厌氧链球菌、类杆菌属等...
