HEPATOMEGALIA

consistenta, forma, sensibilitate

- cu margine inferioara rotunjita, inflamatie/infectie
suprafata neteda, sensibil la palpare congestie venoasa ICD

- ferma, suprafata regulata + icter icter obstructiv

- ferma/dura, cu margine/ suprafata neregulata ciroza

+ durere neplasm

- pulsatilitate insuficienta tricuspidiana

- auscultatie
HEPATOMEGALIA
aparenta – lob Riedel
inflamatorie/infectioasa
afectiuni tropicale
chistica
afectiuni metabolice
afectiuni hepatice cronice
obstructie biliara
congestie venoasa: ICD, pericardita constrictiva, boala venoocluziva
tumori
primare
secundare: sin, plamin, ovar, tract gastrointestinal
boli hematologice
SCHISTOSOMIAZA KALA – AZAR
Schistosoma Mansoni forma viscerala a leishmaniozei
Schistosoma Japonicum febra,
adenopatie,
Hepatosplenomegalie + hepatosplenomegalie
HP presinusoidala

MALARIE
Plasmodium falciparum
anemie, trombocitopenie
hepatosplenomegalie
tulburari neurologice
cefalee, delir, hemoragii retiniene
abces hepatic piogen abces amoebian

- stare de rau, febra, greata - stare de rau precedata de diaree

- soc toxico septic cu
germeni gram – hepatomegalie dureroasa
- Escherichia colli, sindrom lichidian pleural
Streptococus faecalis,
Staphylococus aureus,
Proteus vulgaris
boala fibrochistica chist hidatic boala Caroli

- asimptomatic sau - mai frecvent in = dilatatie saculara

jena in hipocondrul hipocondrul drept a ductelor biliare
drept - se poate palpa intra / extrahepatice
- la auscultatie - febra,
- asociata cu chiste freamatul veziculelor dureri abdominale,
pancreatice, renale colangita, septicemie

amiloidoza
hemocromatoza - material amorf, hialin primara
- peste 50 ani - hepatosplenomegalie secundara
- pigmentare - IC
tegumentara infectii
- sindrom nefrotic inflamatii cronice
- hepatomegalie
-insuficienta viscerala: mielom multiplu
boala Hodgkin
DZ, IC,
insuf.gonadala,
artropatie
- cancer hepatic
 Infectia VHC
Manifestari extrahepatice
Hematologice Oculare
Crioglobulinemia mixta Ulcer cornean
Anemia aplastica Uveita
Trombocitopenie
Limfom cu celule B non-Hodgkin
Vasculare
Dermatologice Vasculita necrozanta
Porphyria cutanea tarda Poliarterita nodoasa
Lichen planus Fibroza pulmonara
Vasculita cutanata necrozanta Neuromusculare
Mialgii
Renale Neuropatie periferica
Glomerulonefrita Artrita/artralgii
Sindrom nefrotic
Fenomene autoimune
Endocrine Sindrom CREST
Anticorpi anti-tiroidieni Granuloame
Diabet zaharat Autoanticorpi

Salivare
Sialadenita Hadziyannis. J Eur Acad Dermatol Venereol. 1998.
obezitate adipocitokine VHC

SOCS3
(semnal citokinic
supresor)

scaderea
raspunsului rezistenta la insulina fibroza
la terapie hepatica
activare celule stelate
hipercoagulabilitate Mota M Medica- a Journal of Clinical Medicine 2008;3(2):100-108
Persico M Gut 2008;57:507-517
Fumio M Liver International 2008: 28(1): 355-362
Alcool
ficat gras +
greata, varsaturi, diaree
hepatomegalie
hepatita alcoolica Deficit α1 antitripsina
simptome putine la nastere icter colestatic
icter moderat tinar hepatita cronica +
ciroza alcoolica emfizem pulmonar
dureri abdominale
febra prin necroza hepatica

Boala Wilson
degenerescenta hepatolenticulara
copii boala hepatica
tineri suferinta neurologica
Adipocyte-macrophage interaction
leading to dysfunction

Gideon R.Hajer, Timon W. van Haeften, and Frank L.J.Visseren

Adipose tissue dysfunction in obesity, diabetes, and vascular diseases
European Heart Journal(2008) 29,2959-2971
Seung Hwan,MD, PhD, Michael J.Quon,MD,PhD,Jeong-a Kim, PhD, Kwang kon, MD, PhD,FACC
Adiponectin and Cardiovascular Disease
JACC vol.49, No.5, 2007
Antiatherogenic Effects of Adiponectin

Seung Hwan,MD, PhD, Michael J.Quon,MD,PhD,Jeong-a Kim, PhD, Kwang kon, MD, PhD,FACC
Adiponectin and Cardiovascular Disease
JACC vol.49, No.5, 2007
 Interaction among the mechanisms involved
on blood pressure elevation,in the presence
of the metabolic syndrome

Journal of Hypertension 2009, Vol 27 No3

Mecanisms of hypertensions in the cardiometabolic syndrome
Josep Redon, Ranata Cifkova, Stephane Laurent, Peter Nilsson, Krzysztof Narkiewicz,
Serap Erdine and Giuseppe Mancia
HIPERCOAGULABILITATEA
IN STEATOHEPATITA SI SM

disfunctie endoteliala

hipercoagulare

rezistenta la insulina + CD36

PAI1
Progresia bolii hepatice
factor von Willebrand
Risc crescut arterial
factor tisular - coronarian
- cerebrovascular
factor VII
Risc tromboembolic venos

Northup GP Thromb.Haemost 2008;6: 2-9

 fibroza si regenerare
CIROZA HEPATICA modificari functionale

idiopatica
alcoolica
post hepatita
altele
ciroza biliara
Ciroza biliara
hemocromatoza prurit

boala Wilson icter colestatic pigmentare

boala polichistica xantelasme, xantoame
medicamentoasa hepatomegalie
congestie venoasa hepatica
celule hepatice
celule endoteliale
celule Kupffer
celule Ito
perisinusoidal
stocheaza lipide
depoziteaza vitamina A
rol in fibroza hepatica
celule fenestrate LK
 CLASIFICARE CHILD -TURCOTTE –PUGH

bilirubinemie
albuminemie
TP
ascita
hipertensiune
portala starea de nutritie
encefalopatie port sistemica
icter insuficienta
ciroza hepatica
hepatica
SPLENOMEGALIA

moale infectie, septicemie

ferma congestie, infiltrat

dura fibroza, scleroza

 Splenomegalii
infectii
afectiuni infiltrative
- virale
- parazitare - boala Gaucher
- bacteriene - boala Niemann-Pick
- fungice - amiloidoza
- hematopoieza extramedulara
inflamatie
- P.R.
- sarcoidoza hipertensiune portala
- LES
- Dializa
boli endocrine
- tiroidita Hashimoto
neoplasm
- leucemii
- limfoame altele
- slndrom mieloproliferare cronica - limfadenopatia angioimunoblastica
- metastaze
• PTI
hemoliza • anemie hemolitica
- sferocitoza
- talasemie majora SPLENECTOMIE • boala Hodgkin
- HPN • hipertensiune portala
• posttraumatic
HEPATOMEGALIE

inflamatie/infectie
afectiuni metabolice
afectiuni hematologice
boli hepatice

SPLENOMEGALIE
TUMORI MASIVE ABDOMINALE
ficat tumoral primitiv/metastatic
splenomegalie
rinichi polichistic
adenopatie + splenomegalie
pseudochist pancreatic

cancer gastric
adenopatie+
splenomegalie

chist mezenteric
anevrism aorta
chist ovar
Apendicita acuta
- febra, greata, varsaturi,
- dureri initial in epigastru si periombilical, apoi in fosa iliaca dreapta
- iritatie peritoneala
- durere la compresia pe psoas

Diagnostic diferential in apendicita acuta

Boala Crohn
Adenita mezenterica
Diverticuli colon drept
Diverticul Meckel
Adenocarcinom colon drept peforat
Colica renala dreapta
Chist ovarian torsionat
Sarcina extrauterina rupta
 CLASIFICARE CHILD -TURCOTTE –PUGH

bilirubinemie
albuminemie
TP
ascita
hipertensiune
portala starea de nutritie
encefalopatie port sistemica
icter insuficienta
ciroza hepatica
hepatica
ecografie abdominala
CT
aprecierea functiei hepatice
SaO2
ecocardiografie
SINDROM BUDD CHIARI
obstructie a venelor suprahepatice

cresterea presiunii sinusoidale

staza si congestia hepatica duc la lezare hepatica

necroza hepatica centrolobular

tabloul clinic depinde de brutalitatea instalarii obstacolului

ASPECT ECOGRAFIC IN HP
VS >
VP >
prezenta sunturilor porto cave
tromboza vena porta,
transformare cavernoasa a venei porte