Steatoza Hepatica + Hemangiom
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Transcript of Steatoza Hepatica + Hemangiom
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STEATOZA HEPATICAHEMANGIOMUL
BY N.A. DALIKO
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I.STEATOZA HEPATICA
Definitie:Steatoza hepatica este o acumulare de trigliceride cu cresterea absoluta intracelular si aparitia de vacuole clare(grasimi) care in timp si in cantitate excesiva duc la ciroza.
Etiologie este sistematizata dupa localizarea predominanta a celulelor distrofice:
Steatoza centrolobulara:in anorexie;anemie;dupa agresiuni de factori toxici(ex:etanol,benzen,etc.)
Steatoza periportala:carente proteice Steatoza mediolobulara:staza hepatica cronica.
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PATOGENEZA Aport excesiv de acizi grasi liberi(A.G.L)in ficat.
Pe fondul cresterii sintezei si a reducerii oxidarii de A.G.L(alcoolism cronic,diabet zaharat,agresiuni toxice)
Cresterea esterificarii AGL in trigliceride datorita cresterii de alfa-glicero-fosfat(otravire cu etanol)
Scaderea sintezei de apoproteine(in malnutritia protein-calorica) Scaderea secretiei de apoproteine din ficat(etanol,carente proteice
globale- Sindrom Kwashiorkor=edeme,anorexia,iritabilitatea,steatoza hepatica,tulburari psihomotori,balonarea abdominala,leziuni cutanate,atrofia musculara si intarzierea cresterii)
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MACROSCOPIC
Ficat cu volum si greutate crescut
Marginea anterioara rotunjita
Consistenta scazuta
Culoarea galben-lutoasa
La jet de apa:parenchimul dilacereaza;iar la sectiune raman picaturi de grasime pe lama de cutit.
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MICROSCOPIC
Coloratii: Sudan III:portocaliu Acid osmic:negru Scharlach-Roth:rosu Albastru de Neel:Albastrui Hepatocite cu volum crescut Vacuole in citoplasma-picaturi lipidice;initial in zona
centrolobulara Fuzionarea vacuolelor impingerea nucleului la
periferie(aspect de inel cu pecete)
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SIMPTOME
In stadiile incipiente:ficat gras nu prezinta semne sau simptome;dar pot exista simptome cu manifestare vag si nespecific(oboseala,durere abdominala,febra)
In fazele avansate:steatoza hepatica se manifesta prin: Hemoragie gastrointestinala,oboseala,slabiciune Insuficienta hepatica,icter Starea de greata,edeme,pierdere in greutate Inapetenta,tulburari mentale,prurit In timpul sarcinii determina:starea de
greata,varsaturi,lipsa poftei de mancare si dureri abdominale.
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TRATAMENT + PROFILAXIE
Profilaxie:consta in adoptarea unei alimentatii sanatoase,restrictionarea consumului de alcool.
Tratament: Se face in functie de cauze Daca nu a condus la alte complicatii,ficatul gras nu
necesita tratamentul medicamentos;se recomanda:pierdere in greutate;restrictia consumului de grasimi,de alcool si de zahar;un program de exercitii fizice si suplimentarea dietei cu vitamine si minerale.
Diagnosticata si tratata la timp,steatoza hepatica este o afectiune reversibila;daca apar leziuni hepatice severe poate necesita un transplant de ficat.
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II.HEMANGIOMUL.
Definitie:Hemangiomul este o tumora benigna cu punct de plecare la nivelul vaselor sangvine.
De regula este congenital si poate sa dispara spontan. Hemangiomul pielii la nou-nascut(hemangiom
juvenil),care creste rapid in cateva luni,incepe sa regreseze la 1-3 ani si dispare la 5 ani in proportie de 80%
Presupune proliferarea de: Vase sangvine capilare-hemangiom capilar Vase adulte-hemangiom cavernos Apare subcutanat,pe mucoase,pe buze,in cavitatea
orala sau in viscere(ficat,splina,rinichi)
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MACROSCOPIC
Tumora poate fi reliefata,proieminenta,cu suprafata neregulata sau poate fi plana
Culoare rosie-violet;se decoloreaza la vitropresiune
Consistenta moale si dimensiuni variabile de la cativa mm la cm
Epiteliul de acoperire este de obicei intact Daca tumora este la suprafata pielii arata ca o capsuna
coapta iar daca este doar sub piele se prezinta ca o umflatura albastruie.
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MICROSCOPIC
Epidermul este subtire
In derm:numeroase vase cu perete subtire(capilare),dimensiuni diferite,grupate
Celule endoteliale turtite
Hematii in lumenele vasculare
Limitele nu sunt bine definite
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TRATAMENT
Corticoterapie: topic, intralezional sau oral.
Laserterapie adaptata
Chirurgical
Terapie orala diferita
Combinatia diferitelor terapii este recomandata pentru a obtine cele mai bune rezultate