Download Chronic liver disease

Chronic liver disease
Definition
• Pathologic
o Liver biopsy showing features of chronic inflammation or
cirrhosis (Metavir, Knodell’s Scoring…)
• Etiology
• Clinical
o Features of chronic liver stigmata, complications
including portal hypertension
Etiology
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Infection
Alcohol
Autoimmune
Cholestatic
Infiltrative
Metabolic
Vascular
Drugs
Cryptogenic
Viral Hepatitis
Over View
Virus
Transmission
Chronicity
A
Feco-oral
No
B
Percutanous
per mucosal
Yes
C
Percutanous
per mucosal
Yes
D
Percutanous
per mucosal
Yes
E
Feco-oral
No
Diagnosis
• Medical history (parenteral risk factors)
• Investigations
o Biochemical
 Serology( HBsAg, HBeAg, HCV Ab, HDV Ab, PCR)
 LFT,CBC,PT
o Radiologic imaging (Ultrasound, CT/MRI abdomen)
o Pathology (Liver biopsy with features of chronic hepatitis or
cirrhosis)
Alcohol
Alcoholic liver disease:
• Steatosis
• Acute alcoholic steatohepatitis
• cirrhosis
Depends on:
o Consumed alcohol
o Duration
o Genetic predisposition
Autoimmune Hepatitis
• Diagnosis
o Autoantibody (ANA, SMA, LKM1 Ab..)
o IgG (Increased)
o Liver biopsy (interface hepatitis)
Cholestatic liver disease
• Primary biliary cirrhosis
o AMA positive, increased Ig M & ALP
• Sclerosing cholangitis
o Increased ALP, association with IBD
o ERCP showing beading of biliary ducts
Hepatic vascular disorder
• Budd-Chiari syndrome
(triad of tender hepatomegaly, ascites & spleenomegaly)
• Portal vein thrombosis
• Veno-occlusive disease
Drug induced liver disease
• Cholestatic
Antidepressant, ant seizure, anti fungal agents
• Granulomas
Allopurinol, pheytoin
• Fibrosis
Methotrexate, organic solvents
• Phospholipidosis
Amiodarone, TPN, septrin
• Steatosis
Tetracycline, glucocorticoids
• Vascular
Estrogens, azathioprine
• Adenomas
Estrogens
Metabolic liver disease
• NASH
o Risk factors : insulin resistance
primary: (obesity, type II diabetes, dyslipidemia)
secondary: (drugs, short bowel syndrome, TPN, metabolic)
o Stages:
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I: Steatosis (macro vesicular)
II: Steatosis + inflammation (centrilobular)
III: Steatosis + inflammation + ballooning (degeneration & necrosis)
IV: Steatosis + inflammation + ballooning + fibrosis +/- Mallory
bodies
Metabolic liver disease
• Alpha 1-Antitrypsin Deficiency
o Liver and lung involvement
o Diagnosis using quantitative serum alpha 1-antitrypsin & liver biopsy (PAS+,
diastase resistant globules in periportal hepatocytes)
• Hereditary Hemochromatosis
o Increased iron absorption & deposition in liver, pancreas, skin, joints &
heart
o Increased transferrin saturation & Ferritin. HFE mutation analysis & liver
biopsy ( increased hepatic iron index >1.5 with >+2 Perls’ Prussian blue
stain)
• Wilson’s Disease
o Autosomal recessive with copper accumulation in liver, brain, cornea, RBCs,
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kidneys & joints due to defective copper transport and excretion.
Serum ceruloplasmin is decreased with increased urinary & hepatic copper
Signs & Symptoms
• Encephalopathy
• Jaundice
• Pallor
• KF ring
• Xanthelasma
• Parotid swelling
• Fetor hepaticus
• Bleeding gums
• Clubbing
• Leukonychia
• Palmer erythema
• Dupetryns contracture
• Asterexis
• Gynecomastia
• Scratch marks
Complication
• Ascites
• GI bleed
• SBP
• Edema
• Hepatoma