Blood supply презентация

body mass
- held in place by ligamentous attachments to diaphragm, peritoneum, great vessels and upper GI organs

2001;322:477-480

Couinaud’s segmental anatomy of the liver

= portal vein: nutrient rich
cell majority (2/3 of liver mass): hepatocytes
other cell types: Kupffer cells
stellate (Ito or fat-storing) cells bile ductular structures supporting structures

Syndrome 85% due to indirect
fractions
No bilirubinuria

Acute Hepatocellular Both fractions may Elevated, often
necrosis (viral and be elevated > 500 IU
drug hepatitis , Peak usually follows ALT > AST
hepatotoxins, acute aminotransferase
heart failure) Bilirubinuria

Chronic hepatocellular Both fractions may Elevated, usually
disorders be elevated < 300 IU
Bilirubinuria

Encephal Ascites
(mg/dl) (gm/dl)

1 < 2 > 3.5 1 - 4 None None

2 2 - 3 2.8 - 3.5 4 – 6 1 - 2 Mild

3 > 3 < 2.8 > 6 3 – 4 Severe



Child class:
A: 5 – 6
B: 7 – 9
C: > 9.

FIBROSIS
EARLY PRIMARY BILIARY CIRRHOSIS
CHRONIC ACTIVE HEPATITIS
MYELOPROLIFERATIVE DISORDER
GRAFT VS HOST DISEASE

theme is injury, repair, regeneration and scarring
NOT a localized process; involves entire liver
Primary histologic features:
Marked fibrosis
Destruction of vascular & biliary elements
Regeneration
Nodule formation

characteristics of the hepatic nodules
Micronodular
Macronodular
Mixed

angioma, splenomegaly, palmar erythema, fetor hepaticus, purpura etc.
Elevated LFTs, thrombocytopenia,

end- stage liver disease, including recurrent GI bleeding due to severe portal hypertension,

orthotopic liver transplantation.

Since the presence of a surgical portacaval or mesocaval shunt greatly complicates the transplantation procedure, we have generally abandoned these types of shunting operations in patients with cirrhosis.

Management

# primary in Child’s C
2- SHUNT PROCEDURE

3- DEVASCULARIZATION

devasc. Stomach, esopsophagus, transect the esoph with reanastamosis, ligate all collaterals