cirrosis hepatica
TRANSCRIPT
![Page 1: Cirrosis hepatica](https://reader035.vdocuments.us/reader035/viewer/2022062405/556b62dbd8b42a280c8b4d76/html5/thumbnails/1.jpg)
CIRROSIS HEPATICA
FEDERICO FAILACH NAVARRO
RESIDENTE II AÑO MEDICINA INTERNA
UNIVERSIDAD DEL SINÚ
![Page 2: Cirrosis hepatica](https://reader035.vdocuments.us/reader035/viewer/2022062405/556b62dbd8b42a280c8b4d76/html5/thumbnails/2.jpg)
CONCEPTO
CIRROSIS
HEPATICA
ALTERACION DE LA ARQUITECTURA
HEPATICA
TABIQUES FIBROSOS
NODULOS PARENQUIMATOSO
S
Med Clin N Am 93 (2009) 787–799. www.thelancet.com vol 371, march 8, 2008
![Page 3: Cirrosis hepatica](https://reader035.vdocuments.us/reader035/viewer/2022062405/556b62dbd8b42a280c8b4d76/html5/thumbnails/3.jpg)
FISIOPATOLOGIA
Med Clin N Am 93 (2009) 787–799 www.thelancet.com vol 371, march
8, 2008
FIBROSISCEL. ITO
1.AUTOINMUNE2.CICATRIZACION3.FIBROGENESIS
TNF ª
TGFb
IL 1 MIOFIBROBLASTOS
COLAGENO TIPO I Y III
![Page 4: Cirrosis hepatica](https://reader035.vdocuments.us/reader035/viewer/2022062405/556b62dbd8b42a280c8b4d76/html5/thumbnails/4.jpg)
FISIOPATOLOGIA
Fisiopatologia medica Mc phee y Ganong 5ed. cap 14; www.thelancet.com vol 371, march 8, 2008
![Page 5: Cirrosis hepatica](https://reader035.vdocuments.us/reader035/viewer/2022062405/556b62dbd8b42a280c8b4d76/html5/thumbnails/5.jpg)
EPIDEMIOLOGIA
Med Clin N Am 93 (2009) 787–799. www.thelancet.com vol 371, march
8, 2008
Se estima la prevalencia en 0.5 % la población mundial25.000 muertes y 373.000 altas hospitalarias en 1998
350.000 VHB cronica 15-40% cirrosis (2008)
![Page 6: Cirrosis hepatica](https://reader035.vdocuments.us/reader035/viewer/2022062405/556b62dbd8b42a280c8b4d76/html5/thumbnails/6.jpg)
Patología estructural y funcional; Robbins; cap19,889-891. www.thelancet.com vol 371, march 8, 2008
EPIDEMIOLOGIA
40-50% DE CAUSA ALCOHOLICA
![Page 7: Cirrosis hepatica](https://reader035.vdocuments.us/reader035/viewer/2022062405/556b62dbd8b42a280c8b4d76/html5/thumbnails/7.jpg)
Patología estructural y funcional; Robbins; cap19,889-891. www.thelancet.com vol 371, march 8, 2008
ETIOLOGIA CRIPTOGENIC
A (10%)
MEDICAMENTOS (5%)
BILIAR (7%)
AUTOINMUNE (5-10%)
VIRAL (25%)
ALCOHOLISMO (40-50%)
![Page 8: Cirrosis hepatica](https://reader035.vdocuments.us/reader035/viewer/2022062405/556b62dbd8b42a280c8b4d76/html5/thumbnails/8.jpg)
Patología estructural y funcional; Robbins; cap19,889-891. www.thelancet.com vol 371, march 8, 2008
MANIFESTACIONES CLINICAS
CIRROSIS COMPENSADA
• Asintomatico• anorexia• perdida de peso• astenia y
adinamia• Hepatomegalia• Esplenomegalia• Arañas vasculares• Eritema palmar • Otras ….
CIRROSIS DESCOMPENSADA
• Ascitis• Hemorragia por
varices• Encefalopatía
hepática• Ictericia
![Page 9: Cirrosis hepatica](https://reader035.vdocuments.us/reader035/viewer/2022062405/556b62dbd8b42a280c8b4d76/html5/thumbnails/9.jpg)
DIAGNOSTICO
MARCADORES BIOQUIMICOS• AST/ALT• ALBUMINA• TIEMPO DE
PROTROMBINA• FOSFATASA
ALCALINA• PLAQUETAS• GGT
IMAGENES • ECOGRAFIA• DOPPLER• TAC• RM
PRUEBAS ESPECIFICAS• SEROLOGIA ENF.
VIRALES.• ANA, ASMA, AMA,
ANCA.• CERULOPLASMINA,
CU ORINA 24, .• FERRITINA, SA Fe,
GEN HFE• FIBRO TEST, FIB4.
Patología estructural y funcional; Robbins; cap19,889-891. www.thelancet.com vol 371, march 8,
BIOPSIA
![Page 10: Cirrosis hepatica](https://reader035.vdocuments.us/reader035/viewer/2022062405/556b62dbd8b42a280c8b4d76/html5/thumbnails/10.jpg)
ESTADIOS DE LA CIRROSIS
Patología estructural y funcional; Robbins; cap19,889-891. www.thelancet.com vol 371, march 8, 2008
COMPENSADA
Estadio 1
No varices- no ascitis
Mortalidad 1%
Estadio 2
Varices- no ascitis
Mortalidad 3%
Estadio 4
Sangrado variceal + ascitis
Mortalidad 57%
DESCOMPENSADA
Estadio 5
Sepsis > 60%
Estadio 3
Varices + ascitis
Mortalidad 20%
![Page 11: Cirrosis hepatica](https://reader035.vdocuments.us/reader035/viewer/2022062405/556b62dbd8b42a280c8b4d76/html5/thumbnails/11.jpg)
Patología estructural y funcional; Robbins; cap19,889-891. www.thelancet.com vol 371, march 8, 2008
PRONOSTICO
Clase Puntaje Sobrevida 1 año Sobrevida 2 años
A 5-6 100 85
B 7-9 80 60
C 10-15 45 35
![Page 12: Cirrosis hepatica](https://reader035.vdocuments.us/reader035/viewer/2022062405/556b62dbd8b42a280c8b4d76/html5/thumbnails/12.jpg)
SCORE MELD
• R=10 x {0,957 x log (creatinina en mg/dl) +
0,38 x log (bilirrubina en mg/dl) + 1,120 x
log (INR) + 0,643}
Patología estructural y funcional; Robbins; cap19,889-891. www.thelancet.com vol 371, march 8, 2008,
1-6% 10-40% 50-70%
![Page 13: Cirrosis hepatica](https://reader035.vdocuments.us/reader035/viewer/2022062405/556b62dbd8b42a280c8b4d76/html5/thumbnails/13.jpg)