Professional Documents
Culture Documents
Cardic cirrhosis
liver
Liver
Congestion
Systemic congestion
Right side heart
Right side heart failure
Tricuspid stenosis
Tricuspid regurge
Pericardia effusion
Constrictive pericarditis
Liver
congestion
liver
jaundice ?????cardic patient
cardic cirrhosis -1
hepatitis
Hemochromatosis
)(Bronze diabetes
4
hemosidrosis
hemochromatosis Organs
Organ liver
liver
hemochromatosis carcinogenic
intestine Mucosal
block
deficit mucosal block
6 clinical picture of
hemochromatosis
mental disturbances
hemochromatosis
-1 Liver liver cirrhosis
-2 heart cardio myopathy
-4 -3 hemochromatosis bronzed diabetes
diabetes diabetes
pigmentation
stimulation of the melanocytes
-5 mental disturbances
-6 testicular atrophy
Investigations
1-investigation for the cause
Binding capacity
2- Investigation for the liver cell failure
3-investigation of portal hypertension
Treatment
500 250
250
hemochromatosis
60
56
56 12
repeated venesection iron chelator
desferal
hemochromatosis highly carcinogenic
hepatoma %30 hemochromatosis
Investigations
Liver
liver ceruloplasmin
Treatment
chelating
Liver L C F
-2
-3
end stage
-1
Infection chronic hepatitis
chemical DHPI
L C F DDT, Halothane, Paracetamol,INH
physical sever burn
-4
Clinical pictures
Manifestions
11
f
1-fatigue,anorexia and loss of weight
fever -2 Low grade fever prolonged
fever jaundice hepatitis
fever fever jaundice L C F
chronic fever prolonged jaundice
???????fever
fever
manifestation Liver intestine
toxins Liver portal vein Liver
liver LCF liver
intestine Manifestation fever
intestine
toxins bacteremia
fever
fever
liver pyrogens
Manifestations
fetor hepatica -3
?????fetor hepatica
Intestine toxins toxins methyl
)mercaptan (which is normally absorbed from intestine
liver liver
saliva
manifestations specific LCF
Jaundice, Ascites and Encephalopathy
Liver
Ascites
Ascites
Ascites
hypoalbuminaemia
hypoalbuminaemia edema
2 portal hypertension
portal hypertension hypoalbuminaemia Ascites
-3 Liver aldosterone
Liver
liver salt and water
retention edema
portal hypertension
aldosterone mechanism 2
Liver Liver aldosterone
hypoalbuminaemia hypovoluemia
renal blood flow kidney rennin rennin
aldosterone
-4 ADH Liver liver
ADH water retention edema
-5 liver weeping lymph
lymphatic obstruction lymph ) (Lymphorrhea
associated factors -6 TB peritonitis
Liver recurrent infection
TB peritonitis
infection immunity
Ecoli peritoneum Spontaneous
)bacterial peritonitis (SBP
prognosisvery bad
aspiration of peritoneal white blood cells
WBCs 250 cells/mm3 clinical manifestations
liver cirrhosis complicated e' SBP Liver
cirrhosis
* aspiration 1000 WBCs SBP
clinical manifestations
Treatment
Cefotaxime: 2gm 3t.d.s IV or Ciprofloxacin 400mg/12h for 5-10days.
WBCs 250
liver cirrhosis
SBP
Clinical fever and abdominal pain
-1
SBP Ascites
Ascites Refractory Ascites Ascites
Ascites
6
1 2 s
Salt restriction
Spirnolactone diuretics
aldosterone antagonist drug of choice
Ascites
aspiration
encephalopathy
Ascites
aspiration Ascites
lung fluid
Ascites urine
diuretics diuretics kidney
Ascites kidney
aspiration Ascites
-1 sampling
-2 relieve respiratory compression
-3 relieve renal compression
albumin
Ascites hypoalbuminaemia
.
aspiration
Ascites inferior
vena cava Peritoneum vein
Ascites
infection circulation
Liver Liver
Ascites
aspiration sampling
investigation cause
cultures cell count WBCs
250 SBP
amylase pancreatitis
Ascites
Encephalopathy
-1 Encephalopathy
-2 clinical picture coma
-3
liver
Encephalopathy
It's a neuropsychiatric syndrome that is seen in patients with acute or
chronic liver cell failure or protosystemic shunting.
Encephalopathy
Encephalopathy
Encephalopathy
Ammonia
creb's cycle
glutamic acid glutamine
CNS inhibition
10
) intestine
Intestine
liver
Liver
Encephalopathy
high ptn in diet
-1
-2 bleeding
bleeding
Encephalopathy
liver GIT
bleeding
liver
liver
-3 old blood transfusion very very
very fresh blood transfusion
Encephalopathy
Encephalopathy
hypoglycemic coma
-1 Spirnolactone
Hypokalemia
-2
-3 aspiration Ascites
Encephalopathy clinical pictures
precoma coma irritable
coma neuro
11
-1
-1
-2
Treatment
-1 ICU endoscope
encephalopathy
bleeding endoscope bleeding
12
encephalopathy
-6 liver transplant
Diet -2 Fats
liver
Pre coma
Diabetes
pre coma
fat fat
fat nausea
Enema -3
-4 Enema Antibiotic
oral
IV
lactulose -5 laxative
lactulose H ions H ions
NH3 NH4 Ammonium
-1
-2
-3
-4
-5
Skin manifestation
)Cardiovascular manifestations (VDM
Endocrinal manifestations
Hematological manifestations
Hepato-renal Syndrome
skin cardic
skin cardic
)(VDM skin
VDM VDM Vaso Dilator material
13
liver Liver
vasodilatation
skin manifestation cardic manifestations
skin
palmar erythema -1 root of metacarpal
thennar hypothennar
Spider naevi -2 arteriole
radiating capillaries arteriole capillaries
VDM
arteriole capillaries
nipple line
nipple line
White nail: white zone at the tip of the nail. -3
paper money skin -4
liver
numerous
small vessels scattered in skin over bony areas. Dorsum of foot,
hand, forehead and chest
varicose vein
-1
-2
cardic
Hyper dynamic circulation
liver
VDM
Cyanosis& clubbing
Cyanosis
liver
Cyanosis
cyanosis
cyanosis VDM A.V fistula
lung intra pulmonary A.V. shunt artery vein
shunt VDM
cyanosis
14
-1
-2
Breast atrophy libido
Amenorrhea & sterility
Blood manifestations
bleeding
Anemia
-1
Microcytic chronic blood loss
Normocytic Toxins inhibition of bone marrow
hypersplenism portal hypertension
Macrocytic Vit.B12 deficiency 12
liver
Bleeding tendency
-2
platelets hypersplenism portal
hypertension
15
16