ПОРТАЛЬНАЯ ГИПЕРТЕНЗИЯ

Клинические проявления

Развитие коллатерального венозного кровообращения (портокавальные анастомозы)

-варикозно расширенные вены пищевода

-«голова медузы»

-расширение верхних геморроидальных вен

Асцит

Гепатоспленомегалия , возможно только спленомегалия

Расширение v. рortae при УЗИ (более 12мм.)

Possible levels of block in portal hypertension

Hepatocellular cytolisis

•Enzymes that Reflect Damage to Hepatocytes

•The aminotransferases (transaminases) are sensitive indicators of liver cell injury and are most helpful in recognizing acute hepatocellular diseases such as hepatitis.

•They include the aspartate aminotransferase (AST) and the alanine aminotransferase (ALT).

•AST is found in the liver, cardiac muscle, skeletal muscle, kidneys, brain, pancreas, lungs

•продолжение

Stigmata of chronic liver disease

•spider nevi,

•palmar erythema

•dilated superficial abdominal veins

•Gynecomastia

•parotid gland enlargement

•Dupuytren’s contracture

•white nails (leukonychia)

Cholestasis syndrom

•Cholestatic Conditions

•When the pattern of the liver tests suggests a cholestatic disorder, the next step is to determine whether it is intra- or extrahepatic cholestasis.

•Distinguishing intrahepatic from extrahepatic cholestasis may be difficult

•Ultrasonography rarely identifies the site or cause of obstruction because of overlying bowel gas

•Appropriate next tests include computed tomography and endoscopic retrograde cholangiopancreatography

•Extrahepatic cholestasis

•Intrahepatic cholestasis

CHOLESTASIS

•Intrahepatic cholestasis

•drugs (phenothiazines)

•primary billiary cirrhosis

•primary sclerosing cholangitis

•Extrahepatic cholestasis

•bile duct stricture (benign and malignant)

•common duct stone

•cancer of the head of the pancreas

Etiology of Dupuitren contracture

•Chronic alcohol intoxication

•Manual labor

•Trauma

•Diabetes mellitus

•Epilepsy (drugs?)

•Elderly persons