Tabel Date Laborator Afectiuni Hepatice Alcoolice
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Transcript of Tabel Date Laborator Afectiuni Hepatice Alcoolice
Boala Anatomie patologica
Manifestari clinice
Examen clinic
Laborator ElementeParaclinice
Diagnostic pozitiv
Diagnostic diferential
Tratament
Ficatul gras alcoolic
Picaturi lipidice macroveziculareLipogranulom (macrofage cu grasime)
75% hepatomegalia asimptomaticaContracturi dupuytren likeAtrofie testicularaEritem palmarStelute vasculare
25%HyperbilirubinemieAST<300AlT/AST >2PAS <300GGT crescutGGT/PAS >5
Ecografie:Hiperecogenitate uniforma a parenchimului
Pseudodilatatii vasculare
Ecostructura omogena
Atenuarea undelor ultrascurte posterior
Doar la biopsie
Tulb.Nutritionale-Inanitie-Obezitate-Deficit de -carnitinaFicat de sarcinaMalnutritie
MEdicamente:-Metrorexat-Corticosteroizi-HIdrocarbonate -halogenateSalicilati la copiiAcid valproic
Boli ereditare :Boala volmanBoala tangier
INfectii:Sindrom ureeic Sindrom de soc toxic
1.Abstinenta-(stetoza revers.in cateva saptamani)
2.Nutritional:1g /kg2000 /ziEnteral sau paraenteral
3.MEdicatieCorticosteroizi:Actiune:-imunosupressivaAntinflamatorieAntifibroticaAdministrate: 40mg/zi 32(IV)28 de zile
PEntofixinil:IPDraza400 mg 3/zi<TNF alfaINfliximab<TNFVit ESilimarina
•Hepatita ALcoolica
Degenerare vaculoara(necroza)
Corpii Mallory(hialin)
INfiltra
Asimptomatici.Dispeptici:Anorexie ,Astenie fizica,fatigabilitat
Clare:encefalop
HmegalieHtPort(cap de meduza splenomegalieIcterFebra
Semne de boala
ASAT/ALAT ^Gglob^Gama gtb^ALKP^Colesterol^BT^Creatinina^URee^
Halbumine<<
DZBUlimie Rezectii masive LipodistrofieHiperlipidemiiChirurgie bypass
t inflamator(neutro)
atieHemoragie digestivaAscita
alcoolica:EchimozaStelute vasculareLeuconichieEritem palmar
Fibrinogen<<Na<<K<<
Ciroza Hepatica
Depunere de colagen in jurul hepatocitelor cu regenerare nodulara(1-3 mm mici pe langa lobul)
!10.20% asimptomaticiRestul tablou clasic cu complicatii...splenomegalie
Tablocu clinicclasic
AST ALT^ moderatIGa,IGg^ crescutAlbumina <<APTT^TrombocitopenieAnemie
Elemente de tensiune hiperportalaBiopsie hepatica
HTPO idiopaticaPEricardita constrictiva