Deseases of the
liver
Balaka Sviatoslav Nikolaevich
Kharkov National Medical University
Department of surgery №2
Anatomy
3
5
1
2
4
1 - falciform ligament
2 - round ligament
3 - coronary ligament
4 - triangular ligament
5 - diaphragm
3
...
Liver location types
(by Didanski)
Segments of liver
(by Couinaud)
Venous inflow and outflow
1
1 – The Rex-Kantli line
2 – Fissure line
2
I
II
III
IV
V
VI
VII
VIII
Blood
supply of
the liver
Portacaval shunts
1.cardiac region
2.umbilical region
3.rectal region
4.renal region
Lymphatic system
1) l.n. of posterior
mediastinum
2) l.n. of anterior
mediastinum
3) portal l.n.
4) suprapancreatic l.n.
Functions of the liver
Synthesis
Further information: Proteins produced and secreted by the liver
A CT scan in which the l...
Diagnostic imaging
 ultrasonography
 scintigraphy
 CT
 MRI
 laparoscopy
 arteriography
 portografphy
Ultrasonography
Computed tomography
Nuclear magnetic
resonance diagnostics
Percutaneous transhepatic
portography
Cut-down
approache
s
Sutures of liver
Liver trauma
Liver trauma
Liver trauma
Liver trauma
Liver trauma
Liver trauma
Liver trauma
Liver trauma
Liver trauma
Liver trauma
Liver trauma
Cirrhosis
Picture of Cirrhosis
• Ascites
• Asterixis
• Spider angiomas
• Palmer erythema
• Gynecomastia
• Caput medusa
• Splenomegaly
Child-Pugh Classification
Points
1 2 3
Bilirubin (mg/dL) < 2 2 – 3 > 3
Albumin (g/dL) > 3.5 2.8 – 3.5 < 2.8
Prothrombin ti...
Portal hypertension
Portal
hypertension
- a complex of
changes arising at
difficulty of a blood
flow in portal
system, cau...
Portal hypertension
syndrome
1. High portal pressure
2. Decrease of portal blood flow
3. Enlargement of the spleen
4. Esop...
CLASSIFICATION
Mortality from the first
esophago-gastric bleeding
Esophageal and stomach varicose veins
dilatation
Frequency of relapses ...
The reasons of portal
hypertension
Extrahepatic
portal
hypertensia
Cirrhosis of
liver
The reasons of a portal
hypertension
Extrahepatic portal hypertension
In children In adults
- Congenital defect
(anomaly) ...
Segmental portal
hipertension
Total portal hypertension Segmental portal hypertension
Portal Hypertension
and Varices
• major cause of
morbidity and mortality
• 50% of cirrhosis
develops varices
• 15-20% of v...
Hemorrhage
Mortality (bleeding from
esophageal varices)
– 23% one year
– 34% two year
– 58% three years
Most bleeding with...
42
The stage of varicose
1st
The stage of varicose
2nd
The stage of varicose
3d
VARICOSE VEINS OF STOMACH
The stage of varicose
Sengstaken-
Blakemor Tube
Treatment
drugs
Endoscopic
treatment
Sclerotherapy
T I P S
Surgical treatment
Treatment
1.Vasopressin
2.Terlipressin
3.Somatostatin
4.Sandostatin
Treatment– 5-7 days
drugs
Sengstaken-
Blakemor Tube
En...
Sengstaken-Blakemor Tube
drugs
Sengstaken-
Blakemor Tube
Endoscopic
treatment
Sclerotherapy
T I P S
Surgical
treatment
Endoscopic
Banding
drugs
Sengstaken-
Blakemor Tube
Endoscopic
treatment
Sclerotherapy
T I P S
Surgical
treatment
perivascular
Endoscopic variceal ligation
drugs
Sengstaken-
Blakemor Tube
Endoscopic
treatment
Sclerotherapy
T I P S
Surgi...
Отделение экстренной хирургии и
портальной гипертензии 51
Endoscopic variceal ligation
Transjugular
Inrahepatic
Portasystemic Shuntdrugs
Sengstaken-
Blakemor Tube
Endoscopic
treatment
Sclerotherapy
T I P S
Sur...
Transjugular
Inrahepatic
Portasystemic Shunt
54
Patsiora's operation
TIPS
Surgical
treatment
drugs
Sengstaken-
Blakemor Tube
Endoscopic
treatment
Sclerotherapy
Patsiora's operation
Surgical treatment
Отделение экстренной хирургии и
портальной гипертензии 57
Surgical treatment
Surgical
treatment
drugs
Sengstaken-
Blakemor...
Surgical treatment
T I P S
Surgical
treatment
drugs
Sengstaken-
Blakemor Tube
Endoscopic
treatment
Sclerotherapy
проксимальный спленоренальный
анастомоз с удалением селезенки
дистальный спленоренальный
анастомоз
Main types of portocava...
Thanks for your attention!
Deseases of the liver
Deseases of the liver
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Deseases of the liver

  1. 1. Deseases of the liver Balaka Sviatoslav Nikolaevich Kharkov National Medical University Department of surgery №2
  2. 2. Anatomy 3 5 1 2 4 1 - falciform ligament 2 - round ligament 3 - coronary ligament 4 - triangular ligament 5 - diaphragm 3 4 2
  3. 3. Liver location types (by Didanski)
  4. 4. Segments of liver (by Couinaud)
  5. 5. Venous inflow and outflow 1 1 – The Rex-Kantli line 2 – Fissure line 2 I II III IV V VI VII VIII
  6. 6. Blood supply of the liver
  7. 7. Portacaval shunts 1.cardiac region 2.umbilical region 3.rectal region 4.renal region
  8. 8. Lymphatic system 1) l.n. of posterior mediastinum 2) l.n. of anterior mediastinum 3) portal l.n. 4) suprapancreatic l.n.
  9. 9. Functions of the liver Synthesis Further information: Proteins produced and secreted by the liver A CT scan in which the liver and portal vein are shown. A large part of amino acid synthesis The liver performs several roles in carbohydrate metabolism: Gluconeogenesis (the synthesis of glucose from certain amino acids, lactate or glycerol) Glycogenolysis (the breakdown of glycogen into glucose) Glycogenesis (the formation of glycogen from glucose)(muscle tissues can also do this) The liver is responsible for the mainstay of protein metabolism, synthesis as well as degradation The liver also performs several roles in lipid metabolism: Cholesterol synthesis Lipogenesis, the production of triglycerides (fats). A bulk of the lipoproteins are synthesized in the liver. The liver produces coagulation factors I (fibrinogen), II (prothrombin), V, VII, IX, X and XI, as well as protein C, protein S and antithrombin. In the first trimester fetus, the liver is the main site of red blood cell production. By the 32nd week of gestation, the bone marrow has almost completely taken over that task. The liver produces and excretes bile (a yellowish liquid) required for emulsifying fats. Some of the bile drains directly into the duodenum, and some is stored in the gallbladder. The liver also produces insulin-like growth factor 1 (IGF-1), a polypeptide protein hormone that plays an important role in childhood growth and continues to have anabolic effects in adults. The liver is a major site of thrombopoietin production. Thrombopoietin is a glycoprotein hormone that regulates the production of platelets by the bone marrow. Breakdown The breakdown of insulin and other hormones The liver glucoronidates bilirubin, facilitating its excretion into bile. The liver breaks down or modifies toxic substances (e.g., methylation) and most medicinal products in a process called drug metabolism. This sometimes results in toxication, when the metabolite is more toxic than its precursor. Preferably, the toxins are conjugated to avail excretion in bile or urine. The liver converts ammonia to urea (urea cycle) Other functions The liver stores a multitude of substances, including glucose (in the form of glycogen), vitamin A (1–2 years' supply), vitamin D (1–4 months' supply), vitamin B12 (1–3 years' supply), iron, and copper. The liver is responsible for immunological effects—the reticuloendothelial system of the liver contains many immunologically active cells, acting as a 'sieve' for antigens carried to it via the portal system. The liver produces albumin, the major osmolar component of blood serum. The liver synthesizes angiotensinogen, a hormone that is responsible for raising the blood pressure when activated by renin, an enzyme that is released when the kidney
  10. 10. Diagnostic imaging  ultrasonography  scintigraphy  CT  MRI  laparoscopy  arteriography  portografphy
  11. 11. Ultrasonography
  12. 12. Computed tomography
  13. 13. Nuclear magnetic resonance diagnostics
  14. 14. Percutaneous transhepatic portography
  15. 15. Cut-down approache s
  16. 16. Sutures of liver
  17. 17. Liver trauma
  18. 18. Liver trauma
  19. 19. Liver trauma
  20. 20. Liver trauma
  21. 21. Liver trauma
  22. 22. Liver trauma
  23. 23. Liver trauma
  24. 24. Liver trauma
  25. 25. Liver trauma
  26. 26. Liver trauma
  27. 27. Liver trauma
  28. 28. Cirrhosis
  29. 29. Picture of Cirrhosis • Ascites • Asterixis • Spider angiomas • Palmer erythema • Gynecomastia • Caput medusa • Splenomegaly
  30. 30. Child-Pugh Classification Points 1 2 3 Bilirubin (mg/dL) < 2 2 – 3 > 3 Albumin (g/dL) > 3.5 2.8 – 3.5 < 2.8 Prothrombin time (seconds ↑) 1 – 3 4 – 6 > 6 Ascites None Slight Moderate Encephalopathy None Minimal Advanced •Grade A – 5-6 points. •Grade B – 7-9 points. •Grade C – 10-15 points.
  31. 31. Portal hypertension Portal hypertension - a complex of changes arising at difficulty of a blood flow in portal system, caused by various diseases.
  32. 32. Portal hypertension syndrome 1. High portal pressure 2. Decrease of portal blood flow 3. Enlargement of the spleen 4. Esophageal and stomach varicose veins dilatation with a bleeding 5. Ascites 6. Hemorrhoids.
  33. 33. CLASSIFICATION
  34. 34. Mortality from the first esophago-gastric bleeding Esophageal and stomach varicose veins dilatation Frequency of relapses bleedings within the first year 90 % 50 % 60 % 30 %Mortality from relapse bleedings within the first year GIT bleeding 25-35 % 90 %
  35. 35. The reasons of portal hypertension Extrahepatic portal hypertensia Cirrhosis of liver
  36. 36. The reasons of a portal hypertension Extrahepatic portal hypertension In children In adults - Congenital defect (anomaly) of portal vein - Thrombosis after umbilical sepsis -Myeloproliferation diseases -Thrombophilia -Traumas -Inflammatory diseases of abdominal cavity
  37. 37. Segmental portal hipertension Total portal hypertension Segmental portal hypertension
  38. 38. Portal Hypertension and Varices • major cause of morbidity and mortality • 50% of cirrhosis develops varices • 15-20% of varices bleed • 1/3 of deaths from bleeds
  39. 39. Hemorrhage Mortality (bleeding from esophageal varices) – 23% one year – 34% two year – 58% three years Most bleeding within 1-2 y. 30% rebleed within 6 weeks 60- 70% rebleeding rate within 1 year
  40. 40. 42 The stage of varicose 1st
  41. 41. The stage of varicose 2nd
  42. 42. The stage of varicose 3d
  43. 43. VARICOSE VEINS OF STOMACH The stage of varicose
  44. 44. Sengstaken- Blakemor Tube Treatment drugs Endoscopic treatment Sclerotherapy T I P S Surgical treatment
  45. 45. Treatment 1.Vasopressin 2.Terlipressin 3.Somatostatin 4.Sandostatin Treatment– 5-7 days drugs Sengstaken- Blakemor Tube Endoscopic treatment Sclerotherapy T I P S Surgical treatment
  46. 46. Sengstaken-Blakemor Tube drugs Sengstaken- Blakemor Tube Endoscopic treatment Sclerotherapy T I P S Surgical treatment
  47. 47. Endoscopic Banding drugs Sengstaken- Blakemor Tube Endoscopic treatment Sclerotherapy T I P S Surgical treatment
  48. 48. perivascular Endoscopic variceal ligation drugs Sengstaken- Blakemor Tube Endoscopic treatment Sclerotherapy T I P S Surgical treatment intravascular
  49. 49. Отделение экстренной хирургии и портальной гипертензии 51 Endoscopic variceal ligation
  50. 50. Transjugular Inrahepatic Portasystemic Shuntdrugs Sengstaken- Blakemor Tube Endoscopic treatment Sclerotherapy T I P S Surgical treatment drugs Sengstaken- Blakemor Tube Endoscopic treatment Sclerotherapy T I P S
  51. 51. Transjugular Inrahepatic Portasystemic Shunt
  52. 52. 54 Patsiora's operation TIPS Surgical treatment drugs Sengstaken- Blakemor Tube Endoscopic treatment Sclerotherapy
  53. 53. Patsiora's operation
  54. 54. Surgical treatment
  55. 55. Отделение экстренной хирургии и портальной гипертензии 57 Surgical treatment Surgical treatment drugs Sengstaken- Blakemor Tube Endoscopic treatment Sclerotherapy TIPS
  56. 56. Surgical treatment T I P S Surgical treatment drugs Sengstaken- Blakemor Tube Endoscopic treatment Sclerotherapy
  57. 57. проксимальный спленоренальный анастомоз с удалением селезенки дистальный спленоренальный анастомоз Main types of portocaval anastomosis кавамезентериальный анастомоз мезентерикокавальныйанастомозспленоренальный анастомоз Н-типабок в бок Н-типабок в бок
  58. 58. Thanks for your attention!
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