肝疾病与门静脉高压症 Liver diseases and Portal hypertension 授课人：普外科六病房 姜明山 1 of 67 www.hrbmush.edu 第三十八章 肝疾病 第一节 解剖生理概要 (Anatomy and physiology) General Description and Topography 2 of 67 www.hrbmush.edu 第三十八章 肝疾病 第一节 解剖生理概要 (Anatomy and physiology) Functional Anatomy 3 of 67 www.hrbmush.edu 第三十八章 肝疾病 第一节 解剖生理概要 (Anatomy and physiology) Functional Anatomy and Surgery 4 of 67 www.hrbmush.edu 第三十八章 肝疾病 第一节 解剖生理概要 (Anatomy and physiology) Functional Anatomy and Imaging 5 of 67 www.hrbmush.edu 第三十八章 肝疾病 第一节 解剖生理概要 (Anatomy and physiology) Hepatic Microcirculation Microvilli Hepatocytes in plates Bile canaliculus SPACE OF DISSE Fenestrated Endothelial cells SINUSOID Kupffer cell STELLATE CELL HEPATOCYTE ENDOTHELIAL CELL KUPFFER CELL STELLLATE CELL 7 of 67 www.hrbmush.edu 第三十八章 肝疾病 第一节 解剖生理概要 (Anatomy and physiology) Blood Flow 1500 mL/minute 25% of the cardiac output Hepatic A.: Blood 25~30%, Oxygen 46~60% Portal v.: Blood 70~75% 8 of 67 www.hrbmush.edu 第三十八章 肝疾病 第一节 解剖生理概要 (Anatomy and physiology) Function Energy Functional heterogeneity Bile formation Enterohepatic circulation Bilirubin metabolism Carbohydrate metabolism Lipid metabolism Protein metabolism Vitamin metabolism Coagulation Metabolism of drugs and toxin Regeneration 9 of 67 www.hrbmush.edu 第三十八章 肝疾病 第一节 解剖生理概要 (Anatomy and physiology) Assessment of Liver Function Variable 1 Point 2 Points 3 Points Bilirubin level <2 mg/dL 2–3 mg/dL >3 mg/dL Albumin level >3.5 g/dL 2.8–3.5 g/dL <2.8 g/dL International normalized ratio <1.7 1.7–2.2 >2.2 Encephalopathy None Controlled Uncontrolled Ascites None Controlled Uncontrolled Child-Pugh class: Class A = 5–6 points; Class B = 7–9 points; Class C = 10–15 points Child-Pugh Score