- •LIVER DISEASES
- •LIVER DISEASES
- •Do you know that …
- •Liver structure v. portae system
- •Liver
- •Liver functions
- •Major risk factors for liver disease
- •Symptoms of liver disorders
- •Fatigue
- •Jaundice
- •Jaundice or icterus
- •Jaundice: major types
- •Causes of jaundice
- •Darkening of the Urine
- •Pale (light) Stools
- •Liver Pain
- •Ascites
- •Ascites, umbilical hernia
- •Ascites
- •Симптомы и синдромы заболеваний печени
- •ПОРТАЛЬНАЯ ГИПЕРТЕНЗИЯ
- •Possible levels of block in portal hypertension
- •Hepatocellular cytolisis
- •Stigmata of chronic liver disease
- •Cholestasis syndrom
- •CHOLESTASIS
- •Etiology of Dupuitren contracture
- •Etiologic factors of gynecomastia
- •polyneuropathia
- •ПРИЧИНЫ ПОРТАЛЬНОЙ ГИПЕРТЕНЗИИ
- •Расширенные вены передней стенки живота, асцит
- •ЭГДС.
- •Расширение v. рortae и vv. hepaticae
- •ПЕЧЕНОЧНОКЛЕТОЧНАЯ
- •ПРИЧИНЫ ПЕЧЕНОЧНОЙ НЕДОСТАТОЧНОСТИ
- •Синдром печеночно-клеточной недостаточности
- •Печеночная энцефалопатия
- •ГЕПАТОРЕНАЛЬНЫЙ СИНДРОМ I и II тип
- •Патогенеза гепаторенального синдрома
- •Типы гепаторенального синдрома
- •ФАКТОРЫ, ПРОВОЦИРУЮЩИЕ РАЗВИТИЕ ГЕПАТОРЕНАЛЬНОГО СИНДРОМА (на фоне поражения печени)
- •Желтуха, ксантелазмы
- •ГИПЕРСПЛЕНИЗМ
- •Маркеры хронической алкогольной интоксикации
- •Классификация тяжести поражения печени по Чайлд-Пью
- •ЭГДС – расширенные вены пищевода
- •Пункционная биопсия печени под контролем УЗИ (цирроз)
- •Мелкоочаговое поражение печени при остром гепатите
- •Асцит, расширенная v.portae, неровность контуров при циррозе печени
- •Сцинтиграфия печени с метастазами
- •Сцинтиграфия мелкоузлового цирроза
- •Лапароскопия – крупноузловой цирроз
- •Передняя стенка живота при синдроме портальной гипертензии
- •Компьютерная томография
- •FibroScan®
- •Выраженность фиброза при фибросканировании печени
- •Stages of Liver Disease
- •Progression of Hepatitis B Infection
- •Healthy Liver
- •Healthy Liver
- •Types of Hepatitis
- •Hepatitis B is a Devastating Global Healthcare Issue
- •Hepatitis – Disease Terminology
- •How Hepatitis B is Acquired?
- •How the Infection is Acquired in the West?
- •Hepatitis B – Diagnosis Terminology
- •Diagnosis of Chronic Hepatitis B
- •Signs and Symptoms of HBV Infection
- •Universal Hepatitis B Vaccination
- •Global Control of Hepatitis B
- •Types of viral Hepatitis
- •Healthy Liver
- •Liver biopsy
- •Detection of serologic markers of hepatitis B virus (HBV) infection, as a function
- •Lamivudine is a Potent Inhibitor of HBV Replication
- •Lamivudine has an Excellent Pharmacokinetic Profile
- •Patient Entry Criteria
- •One Year of Lamivudine - Conclusions
- •Resistance to Anti-Viral Drugs
- •Prevention of Hepatitis B
- •Universal Hepatitis B Vaccination
- •Recommendations for Pre-exposure Vaccination
- •Recommendations for Post-exposure Vaccination
- •Global Control of Hepatitis B
- •Concurrent immunologic diseases in type 2 autoimmune hepatitis.
- •Probabilities of clinical, biochemical, and histologic remission during corticosteroid therapy.
- •Clinical features of type 2 autoimmune hepatitis.
- •Liver transplantation for autoimmune hepatitis.
- •Survival expectations and probability of developing cirrhosis during and after corticosteroid treatment.
- •liver biopsy
- •Detection of serologic markers of hepatitis B virus (HBV) infection, as a function
- •The Efficacy and Safety of Lamivudine in HBeAg-positive Chronic Hepatitis B
- •Lamivudine is a Potent Inhibitor of HBV Replication
- •Lamivudine has an Excellent Pharmacokinetic Profile
- •What Patient Populations Have Been Studied
- •Key Lamivudine Clinical Studies (1)
- •Key Lamivudine Clinical Studies (2)
- •Patient Entry Criteria
- •Lamivudine Rapidly Suppresses
- •One Year of Lamivudine - Conclusions
- •Resistance to Anti-Viral Drugs
- •Concurrent immunologic diseases in type 1 autoimmune hepatitis.
- •Probabilities of clinical, biochemical, and histologic remission during corticosteroid therapy.
- •Clinical features of type 2 autoimmune hepatitis.
- •Liver transplantation for autoimmune hepatitis.
- •Survival expectations and probability of developing cirrhosis during and after corticosteroid treatment.
- •ALCOHOLIC LIVER DISEASE
- •Principal alcohol-induced hepatic lesions
- •Alcohol-induced hepatic lesions
- •Pathogenesis of liver injury secondary to chronic ethanol ingestion
- •Equivalents of pure alcohol
- •Alcoholic fatty liver
- •Two-Hit Model of the Progression of Fatty Liver Disease
- •Alcoholic fatty liver
- •Similarities between Alcoholic and Nonalcoholic Fatty Liver Diseases
- •Alcoholic hepatitis
- •This figure depicts a laparoscopic view of a patient with chronic active hepatitis
- •Percutaneous liver biopsy with or without ultrasonic guidance
- •Alcoholic hepatitis: liver biopsy
- •Treatment of severe alcoholic hepatitis
- •Причины смерти при алкогольном гепатите
- •Alcoholic cirrhosis
- •Alcoholic cirrhosis
- •Alcoholic cirrhosis: clinical manifestations
Лапароскопия – крупноузловой цирроз
Передняя стенка живота при синдроме портальной гипертензии
Компьютерная томография
FibroScan®
•Нет необходимости голодать
• Продолжительность исследования 5 минут
•10 успешных замеров
•Срединное значение = истинное значение
•Результат выражается в кПа
•Противопоказание: асцит
Выраженность фиброза при фибросканировании печени
Скорость волны связана с эластичностью печени и уровнем фиброза Эластичность = 3×плотность×скорость2
(мм) Глубина
Stages of Liver Disease
Inflammation |
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Fibrosis Thickening and accumulation of |
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scar tissue in the liver |
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Cirrhosis Extensive destruction of liver cells |
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associated scarring |
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Liver Cancer |
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Progression of Hepatitis B Infection
Resolution Resolution |
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Silent |
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Cirrhosis |
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Short-term |
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Long-term |
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Cirrhosis |
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Liver |
Death |
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Infection |
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Hepatitis |
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Cancer |
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Long-term Cirrhosis Death
Carrier
30 - 50 Years
Healthy Liver |
Hepatic Fibrosis |
Cirrhosis |
Liver Cancer |
Healthy Liver |
Hepatic Fibrosis |
Cirrhosis |
Liver Cancer |
Types of Hepatitis
Hepatitis How is it acquired?
A Oral via contaminated food or water B Blood/body fluids and mother-to-child C Blood/body fluids and mother-to-child
D Blood/body fluids (only found with hepatitis B virus)
E Oral via contaminated water G Blood
Hoofnagle 1994; Linnen et al. 1996