1. Las hepatitis virales y sus diagnósticos diferenciales más importantes en la práctica clínica Fernando Bessone Universidad Nacional Rosario
2. El hígado fue siempre misterioso… Desde tiempos primitivos se lo consideró como el órgano más poderoso del reino animal y la base donde se asentaba la vida Modelo de higado en arcilla que data de 1700 años AC Lugar de los sentimientos, deseos y potencia sexual
3. El hígado como asiento de emociones internas… “ Four vessels lead to the liver, supplying it with air and water, and, being overfilled with blood, influence the occurrence of all sorts of illness”; or: “The wrath of the heart results from ebullition of parts of the liver and rectum.” (Papiro egipcio 1550 AC) Modelo Etrúsco de higado de carnero en bronce - 300 años AC
4. La mitología y Prometeus… El primer registro de la capacidad regenerativa del hígado Prometeus atado en las montañas del Cáucaso - 525 años AC
10. De transmisión enteral De transmisión parenteral VIRUS A y E VIRUS B, C y D Hepatitis virales
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13. Diferenciar otras causas de aumento de transaminasas que pueden confundirse con hepatitis virales por virus hepatototrópicos Cuales son las dos primeras funciones del clínico frente a una hepatitis aguda ?
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29. El diagnóstico de hepatitis autoinmune es la combinación de anormalidades clínicas y de laboratorio sugestivas de enfermedad y la exclusión de otras causas de enfermedad hepática
35. Biochemical liver test results in 140 adult patients with histologically severe type 1 AIH McFarlane Clin Liver Dis 2002
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38. Reacciones hepatotóxicas Metabolitos reactivos Conducto biliar Sinusoide Célula endotelial Célula estrellada Inmuno- reactividad Toxicidad a Organelas y membranas DROGA
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46. SEVERA INJURIA HEPATOCELULAR EN CORTO PERÍODO DE TIEMPO Definición de hepatitis fulminante
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48. ETIOLOGÍA DE LA HEPATITIS FULMINANTE INDETERMINADA VIRAL TOXICOS DROGAS MAS FRECUENTES Hepatitis Isquémica Budd Chiari Wilson -Autoinmune Linfoma MENOS FRECUENTES Higado graso agudo del Embarazo
49. Enfermedad hepática aguda fulminante PLANTEA TRES SITUACIONES DIFERENTES Hepatitis de novo Enfermedad hepática crónica reagudizada - HAI - Wilson - Hepatitis B Enfermedad hepática crónica + Noxa
50. De transmisión enteral De transmisión parenteral VIRUS A y E VIRUS B, C y D Hepatitis virales
71. Cuantos virus m á s me seguir á n atacando ?.... H, I, J, K .....??? Y HBV HAV HDV HCV HGV HEV
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Notas do Editor
Evidently, priests and fortune-tellers at that time became interested primarily in the liver and thus great mantic-religious significance was attributed to this organ. For the Babylonians and Assyrians, the inspection of entrails, in reality inspection of the liver, was the most important method of foretelling events . This “hepatoscopy” was based on the premise that the god to whom the sacrifice was offered would show his pleasure by revealing the future through variations in the appearance of the sacrificial animal’s liver. The sacrificial priests of Mesopotamia had acquired a precise knowledge of the size, colour and external structure of the animal liver, especially that of the sheep
They assigned specific names to the individual parts of the liver and gall bladder and to their different variations in form and appearance, reflecting similarities to everyday objects such as mountains, rivers, roads, nose, ear, tooth, hand, finger , etc. Hepatoscopy was carried out in accordance with stipulated ceremonial rites and in the face of an image of a god. It was limited to assessing the outer appearance of the liver; the organ itself was not dissected. The Babylonian sacrificial priests taught the art of hepatoscopy Clearly recognizable on the concave surface are 2 lobes: the coniform gall bladder with the cystic duct and the caudate lobe with the pyramidal process and the smaller papillary process (). Carved lines divide the lower surface into approximately 40 small, rectangular fields, which contain cuneiform inscriptions of sacral symbols and mantic readings, one of the recurrent themes being “May your liver be smooth” . • Many of the rectangles show small holes, presumably used to insert tiny wooden pins according to the variations in form observed in the animal liver. Such a topographical fixation of findings facilitated a more accurate prophecy.
