Hepatic purpura
Introduction
Introduction to hepatic purpura Hepatic purpura is rare and has been reported in recent years and may be associated with chemical cytotoxic drugs, gamma rays, bacterial or viral infections, and immunodeficiency. It is characterized by a cavity that is randomly distributed in the liver and filled with blood. basic knowledge The proportion of illness: 0.005% Susceptible people: no specific population Mode of infection: non-infectious complication:
Cause
Causes of hepatic purpura
Disease factor (30%):
The cause is not clear, and may be associated with diseases such as severe tuberculosis, malignant tumors, acquired immunodeficiency syndrome (AIDS), taking certain drugs (such as steroids, azathioprine, tamoxifen), long-term hemodialysis, organs The application of immunosuppressive drugs after transplantation is related.
Pathogen infection (30%):
It has been reported that a human or immunodeficiency virus (HIV)-positive population may have a liver or spleen of bacillary peliosis (BP), which is associated with the infection of the genus R. henselae and belongs to animal-borne parasitic diseases. Close contact with cats or infection with R. henselae and related pathogens.
pathology:
The connection between the hepatic sinus and the central venous connection causes the hepatic sinus to dilate, or the hepatocytes are first necrotic or the hepatic sinus barrier is destroyed, the endothelial cells are damaged, and the red blood cells enter the gap of the Disse from the hepatic sinus cavity to form a cyst filled with red blood cells. It is also believed that hepatic purple spot disease, hepatic venular occlusive disease, hepatic sinus dilatation and perihepatic fibrosis are the same pathological process, which shows that endothelial cells in different parts are damaged, and various pathogenic factors can cause defects in the immune system, such as Immunoglobulin IgA, IgG, IgM deficiency, complement system defects, T cell and B cell defects or combined immunodeficiency; secondary immunodeficiency disease, can be seen in all age groups, the incidence is higher than the original These immunodeficiencies can be clinically manifested in a variety of manifestations, such as the spread of infection, aggravation or recurrent attacks; protein, calorie malnutrition; diarrhea and nutrient absorption disorders; diabetes, rapid deterioration of uremia; rapid spread of malignant tumors and Exacerbation, the above performance can occur simultaneously or sequentially with hepatic purpura.
The liver is swollen, and there are purple-blue or blue-black plaques on the surface. The lesions are randomly distributed, limited to one leaf or diffuse whole liver. The liver section is honeycomb-shaped, with cysts of different sizes and full of blood. From millimeters to several centimeters, the cystic dilatation of the hepatic sinus is seen under the microscope. The endothelial cells lining the cystic cavity are extensively damaged. The lumen is filled with red blood cells. These cysts can communicate with the normal hepatic sinus or central vein. The gap can be seen to expand, and the endothelial cell barrier between the hepatic sinus is destroyed. Occasionally, red blood cells pass through, endothelial cells and Kupffer cells proliferate, fibrosis around the hepatic sinus and hepatic venules, and hepatocyte atrophy can be seen around the lesion cavity. Liver, kidney, bone marrow, and lymph nodes can also be affected.
Prevention
Hepatic purpura prevention 1. Pay attention to whether there is suspicious food before the rash, contact with foreign body causes allergies, and avoid contact again. Avoid eating foreign proteins such as seafood to prevent re-allergies and aggravate the condition. 2. Should pay attention to cold and warm, prevent colds, pay attention to exercise, enhance physical fitness, improve the body's disease resistance. 3. After getting sick, rest in bed, avoid overwork, avoid eating alcohol and tobacco. The diet is easy to be nutritious, easy to digest, and eats more fresh vegetables and fruits. Should not eat spicy, fragrant and stimulating and seafood. Should pay attention to make up too much to eat high quality protein diet. Care should be taken to catch a cold. Pay attention to whether there is suspicious food before the rash, foreign matter contact causes allergies, and avoid contact again. Avoid eating foreign proteins such as seafood to prevent re-allergies and aggravate the condition. 4. Pay attention to anti-infection.
Complication
Hepatic complication Complication
Abdominal hemorrhage caused by spontaneous rupture of the cyst is the main complication.
Symptom
Symptoms of hepatic purpura common symptoms hepatosplenomegaly liver enlargement liver failure spleen purpura abdominal pain diarrhea anorexia bloating purpura
Most patients are asymptomatic, a small number of patients with hepatomegaly and mild transaminase elevation, occasionally accompanied by spleen purpura, in rare cases due to massive liver cell damage, severe complications and extensive diffuse hepatic purpura caused by liver failure, bacilli Patients with purpura may have fever, weight loss, anorexia, diarrhea, abdominal pain, abdominal distension, hepatosplenomegaly, and various types of blood cell reduction.
Examine
Examination of hepatic purpura
If accompanied by secondary immunodeficiency disease, immunoglobulin IgA, IgC, IgE and IgM decreased, complement and lymphocyte reduction, but mostly limited to the theory, clinical practical application and promotion remains to be studied, usually see anemia, Hematopoiesis, serum aminotransferase, alkaline phosphatase and gamma glutaminase may be moderately elevated, and most patients may have increased bilirubin.
1. Imaging examination
B-mode ultrasound can detect uneven hypoechoic areas, but there is no characteristic change. CT can be seen in the liver with limited or diffuse low-density or high-density lesions, and it is not characteristic. When hepatic venography, if the contrast agent directly enters The cystic cavity is a powerful basis for the diagnosis of hepatic purpura. Selective hepatic angiography, from the late arterial phase to the venous phase, can be seen in the accumulation of contrast agents, but not characteristic, with hepatocellular adenomas and regenerative nodules Not easy to distinguish.
2. Histological examination
Laparoscopic liver is swollen, with purple-blue or purple-black plaque on the surface. Under a direct acupuncture biopsy, it is highly targeted, and it can be used to stop the hemorrhage of the needle. It is a simple method. Safety, small trauma examination method, when exploratory laparotomy, liver tissue wedge cutting can be sent for pathological examination, for patients with limited lesions and bleeding, the corresponding hemostasis or partial hepatectomy, and then sent for pathological examination.
Diagnosis
Diagnosis and identification of hepatic purpura
diagnosis
Symptoms are concealed and difficult to diagnose. Most of them are accidental findings. Hepatic angiography is helpful when the lesions are widely distributed. When the lesions are diffuse, CT, B-ultrasound and MRI are also helpful, and histological examination is the method of diagnosis. A needle biopsy can cause bleeding and should be avoided.
Differential diagnosis
Identification with various liver damage.
