hepatic artery occlusion
Introduction
Introduction to hepatic artery occlusion Due to the dual blood supply of the liver, liver infarction caused by hepatic artery occlusion is rare. Hepatic artery occlusion can be caused by atherosclerosis, embolism, thrombosis, vasculitis, or hypotensive shock, and occasionally hepatic artery thrombosis can occur after pregnancy or oral contraceptives. The disease is rapidly onset and the condition is dangerous. Unless the diagnosis and treatment is early, the mortality rate is high. Hepatic artery occlusion is extremely rare, and the disease is rarely diagnosed before death. basic knowledge The proportion of illness: 0.001% Susceptible people: good for middle-aged and elderly Mode of infection: non-infectious Complications: paralytic ileus
Cause
Cause of hepatic artery occlusion
Causes:
Hepatic artery occlusion can be caused by embolism, thrombosis, external compression, thickening of blood vessel wall and iatrogenic factors, nodular polyarteritis, embolism of subacute endocarditis; inflammation, tumor infiltration and liver Thrombosis in the arteries; external invasion and compression of malignant tumors; thickening of the vessel wall during arteriosclerosis, destruction of the intima, hyperplasia or shedding, secondary thrombosis, and inadvertent ligation during surgery can cause liver Arterial occlusion, in recent years, with the popularization of interventional techniques, in the catheterization or interventional embolization treatment, the hepatic artery embolism has an upward trend, so strict selection of indications, strict technical operation rules, in order to minimize accidents and adverse consequences .
Pathogenesis:
The consequence of hepatic artery occlusion is hepatic infarction. If portal vein obstruction occurs at the same time, it is often fatal. The mortality of hepatic artery occlusion occurs in normal liver is higher than that in patients with cirrhosis. The size of liver infarction depends on the category of collateral artery circulation. The central part is pale, and it is surrounded by bloody hemorrhage: a large number of hepatocyte necrosis is seen in the central area, although there is hepatocyte necrosis around, but there is no major change in the portal area, and the liver cells in the infarct area are disordered and irregular.
Prevention
Hepatic artery occlusion prevention
There is no effective preventive measure for this disease, and it is the most effective prevention and treatment measure to actively treat the primary disease. Once the disease occurs, it must be actively rescued, and absolutely rest in bed to ensure nutritional supply.
Complication
Hepatic artery occlusion complications Complications paralytic ileus
Patients often have paralytic ileus, oliguria, azotemia, coma, and die in a short period of time. Simultaneous or sequential multiple organ artery embolization can be seen.
Symptom
Hepatic artery occlusion symptoms Common symptoms Pale pale pain, jaundice, blood pressure drop, no urinary intestinal paralysis, nervous coma, oliguria, renal ischemia
Most cases of middle-aged and elderly patients, sudden onset, sudden pain in the right upper quadrant, sweating, pale, rapid pulse, blood pressure, liver pain and sneezing pain, muscle tension, jaundice rapidly deepened with fever, liver function damage Prothrombin time is prolonged sharply, and non-vitamin K treatment can be recovered, often accompanied by intestinal paralysis, oliguria, shock and coma, and soon died. If the patient passes the acute phase, attention should be paid to the visceral function of each system. Changes and corresponding symptoms and signs, such as splenomegaly, pancreatic swelling, intestinal ischemic manifestations, renal ischemia caused by oliguria, no urine or uremia.
Examine
Hepatic artery occlusion
1. The number of white blood cells in blood is increased.
2. Liver function test Alanine aminotransferase, aspartate aminotransferase increased significantly.
3. Prothrombin time is significantly prolonged, but not vitamin K can be recovered.
4, Doppler ultrasound examination can be seen in the interruption of hepatic artery blood flow, there may be collateral compensation, but rare, there may be liquefaction in the liver parenchyma, CT can be seen in the liver parenchyma concentrated or scattered density reduction area, celiac angiography The diagnosis is most meaningful. It can be seen that the hepatic artery is truncated or conical, and there may be collateral formation around it.
Diagnosis
Diagnosis and diagnosis of hepatic artery occlusion
diagnosis
The disease is a rare disease, so it lacks clinical description. In addition to the primary disease, the patient suddenly has a sudden onset of pain in the right upper abdomen, followed by collapse, blood pressure, tenderness in the right upper abdomen and liver, muscle tension, and deepening of jaundice. , fever, poor spirit.
Differential diagnosis
The disease is difficult to diagnose before birth. Only on the basis of the original disease, when the above clinical manifestations are present, the disease can be associated. Common primary diseases are cellular endocarditis, nodular polyarteritis, or difficult upper abdominal surgery. In view of this, the sudden onset of abdominal pain should be differentiated from the following diseases: 1. biliary colic; 2. acute abdomen; 3. acute peritonitis.
