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PATOMEKANISME

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Blood transmission Body fluid TransmisionRISK FACTOR FORHBV INFECTION

H!atitis B "irus ntr

#lood $ir$ulation

!ntration to li"r $llEarly sta% in"ol"in%

&umoral immun

rs!ons

Viral a$ti"ity indu$dlymfosit T a$ti"ation

S$rtion of %ama

Intrfron

In"ol"in% C'( and C')

a$ti"ation

Vrti$al s!radin% form

mot&r to $&ild

Anti"iral ff$t

H!ato$yt in*ury

Ta+ t& form of diffuss,llin% - #alloonin%

d%nration.

Cytoto/i$ ff$t dama%& ato$ t

Indu$d inflammatory

infiltrat

A!o!toti$ $ll s&rin+ and#$om intnsly

osinofili$

Im!aird #il flo,

Cssation of &!ato$yt

$ontra$til a$ti"it

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Continous inflammatory

ra$tion in & ato$ t

Portal tra$+ infiltratd#y

lymfosit0ma$ro!&a%s 1!lasma $ll

Cll n$rosis

'!otition of fi#roustissu

Brid%in% n$rosis and

#rid%in% fi#rosis

2ymfoid

a%%r%at

Bil du$t dama%

Continous loss of& ato$ t and fi#rosis

Formation of fi#rous

s!ta and &!ato$ytr%nrati" nodul

Cirr&osis &!ati$

Im!aird #il flo,Im!aird

"as$ular3sinusoidal$ir$ulation

Massi" lost of

& ato$ t fun$tion

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MASSIVE 2OST OF

HEPATOC5TE F6NCTION

Protin mta#olism Fat mta#olism Car#o&ydrat Mta#olism Bil s$rtion Stora% "it B8

Synt&sis of!lasma !rotin

Synt&sis of

$oa ulation fa$tor

Synt&sis of

al#umin

Im!aird

$oa%ulation

!ro$ss

9 total !lasma

rotin

Im!aird nutrint

trans ort

Fati%u 1

im!aird tissu

mta#olism

9 Al#umin

$on$ntration

Formation urafrom amonia

Blood

/tra"asation

'$rasd

$oa%ulant

fa$tor

As$its and an+l

odma

Im!aird osmoti$

rssur

: ammonia

$on$ntration

Cir$ulatd

Amonia

Cytoto/i$ to

rnal $ll

2ad to

n$!&alo!at&y

Foul odor

#rat&

Rnal failur

Im!aird rnal

fun$tion

9 #il salt

$on$ntration

9 Amont

of #il salt

s$rtd to

duodnum

Im!aird$&olstrol

synt&sis

2a$+ ofmm#ran

$ll

arran%mnt

Im!aird

$on"rsion

of

$&olstrol

to #il salt

Im!aird

mta#olism

and s$rtion

of stroid

&ormon

Im!aird

di%stion of

ft

Im!aird%lu$ono%nsis

Im!airdsynt&sis 1

#ra+do,n of

%ly$o%n

2a$+ of nr%y

sour$

6nr%ulat

#lood %lu$os

C&roni$ fati%u

and ,a+nss

Im!aird

#ra+do,n

%ly$o%n;

%lu$os

Im!aird

formation

%lu$os;

%ly$o%n

aftr mal

C&roni$ fati%u

Mus$l ,astin%

Im!aird

!rodu$tion of

#il salt

Im!aird

limination of

#iliru#in

: #iliru#in

indir$t

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)>

IMPAIRE' INTRA HEPATICVASC62AR CIRC62ATION

: Intra &!ati$ "as$ularrsistan$

Portal Hy!rtntion

: intra"nous!rssur on

osofa%al "in

: intra"nous!rssur on

?astri$ "in

: intra"nous!rssur on

r$tall "in

: intra"nous!rssur on

!ri um#ili$al

"in

9 IVC#a$+flo,

Im!airds!lni$ "in

$ir$ulation

As in$rasin% of !ortal

& rtntion

Vnous rsistan$ ra$& t& limit

Ca!utmdusa

R$tal#ldin%

?astri$#ldin%

Osofa%al#ldin%

Vas$ular ru!tur

Tarrry s!ot

Hmats@siaMlnaHmatmsis

9 rnal$laran$

9 rnal

$ir$ulationHy!otntion0

ta$&y$ardia0ta$&i!na0

!rs!iration

Hy!o"olmi$

s$&o$+

Massi" #lood

lost

Mta#oli$

al+alosis

: B6N

9 Cardia$out ut

9 $ardia$rload

RAA !at&,aya$ti"ation

Na rtntionVaso$onstri$tion

of #lood "ssl

Ma+ ,orst

!ortal&y!rtntion s!lnom%ali

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V

)

In$ras #il $anali$ular !rssur

Cir$ulatd systmi$ly

Con*u%atd #iliru#in la+ tosinusoid

Flo, to $ntral "in

Im!aird intra &!ati$ #il flo,

C&olstasis

Bound to $llmm#ran

Con*u%atd #iliru#in $annot ntr#il du$t

'issol" in ,atr In$ras dir$t#iliru#in in #lood tst

E/$rtd ,it& urin

Biliru#inuria