Download Liver disease

Liver disease
Prepared by: Siti Norhaiza Bt Hadzir
Liver disease
• Diagnosis of liver disease depends on:
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complete history
complete physical examination
evaluation of liver function tests
further invasive and non-invasive tests
• In liver disease there are crossovers between purely
biliary disease and hepatocellular disease
• To interpret these, the physician will look at the entire
picture of the hepatocellular disease and biliary tract
disease to determine which is the primary
abnormality
• Acute liver disease
• Chronic liver disease
Acute liver disease
• Causes of hepatocellular damage:
- poisoning
- infection
- inadequate perfusion
Poisoning
• Source: paracetamol and carbon tetrachloride.
• Cause destruction of hepatocytes with massive
release of enzymes.
• Some plant and fungal toxins can also cause
catastrophic and fatal liver damage within 48h.
• Some toxins give rise to acute hepatocellular failure
only in certain individuals who are susceptible.
• Important examples include sodium valproate
(anticonvulsant) – toxic to some children.
Liver infection
• Both bacteria and virus can give rise to infective
hepatitis.
• virus (hepatitis A,B,C,D,E)
• Epstein Barr virus (infectious mononucleosis)
• Cytomegalovirus
• Herpes simplex virus
• Varicella Zoster infection
Diagnosis of viral hepatitis
• HBsAg appears first, late in the incubation period.
• Followed by HBeAg.
• The presence of HBeAg and hepatitis B-DNA indicate
infectivity.
• The first antibody to appear is anti-HBc during the acute
illness
• Followed by anti-HBe and anti-HBs.
• The presence of anti-HBe in the blood indicate absence of
infectivity.
• Liver biopsy
Outcome of acute liver disease
• It may resolve
• It may progress to acute hepatic failure
• It may lead to chronic hepatic damage.
Acute liver failure
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Results from acute massive liver cell necrosis
( viral hepatitis, toxic drug and chemicals)
May also follow acute fatty change of the liver.
Characterization:
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Jaundice
Hypoglycemia
Bleeding tendency due to DIC
Electrolyte and acid base disturbance
Hepatic encephalophaty
Hepatorenal syndrome
Elevation of serum enzymes (LDH,AST, ALT)
Biochemical finding in hepatic failure
Chronic liver disease
• Three forms of chronic liver damage are:
- alcoholic fatty liver
- chronic active hepatitis
- primary biliary cirrhosis.
All of these conditions may progress to
cirrhosis.
Cirrhosis
• It is an irreversible and progressive disease that
ultimately causes death.
• The rate of progressive is variable.
• It is manifested clinically by features of chronic liver
failure.
• Cirrhosis is a pre-malignant lesion.
• The risk of hepatocellular carcinoma is greatest in
cirrhosis caused by hemochromatosis, virus induced
cirrhosis, cryptogenic cirrhosis and alcoholic
cirrhosis.
Chronic liver failure
• The effect of chronic liver failure:
- decrease synthesis of albumin, leading to serum
albumin levels, edema and ascites.
- decrease levels of prothrombin and of factors
VII,IX and X resulting in bleeding tendency.
- Portal hypertension
- Hepatic encephalopathy
- Hepatorenal syndrome
- Endocrine changes
- Fetor Hepaticus
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