Download AH LIVER & GALLBLADDER

LIVER & GALLBLADDER
DISEASES AND DISORDERS
JAUNDICE
► PHYSIOLOGICAL
CHANGES –
 Yellowness of skin and sclera
 Destruction of RBC - HAEMOLYTIC
 Defective uptake or transport of bilirubin HEPATOCELLULAR
 Obstruction in bile duct passage OBSTRUCTIVE
MAJOR CAUSES
► INFECTIVE
– HEPATITIS A, B, C, E
► CIRRHOSIS
► TUMORS
► VASCULAR
OBSTRUCTION
► POISONING
► ABCESS – PARASITES
► HEREDITARY DISEASES
SYMPTOMSanorexia fatigue non-specific abdominal pain
► ACUTE







Fever
Nausea, vomiting
Diarrhoea
Jaundice
Bleeding
Hepatomegaly
Rt hypochondria
tenderness
► CHRONIC
 Portal HT – O varices,
piles, ascites,
splenomegaly
 Hepatomegaly –
immune deficiencies
 Palmar erythema
 Dupuytren’s contracture
 Spider naevi
Major Remedies
► Nux
vom – a/f over indulgence
► Bry – great nausea and heaviness with splitting
headache
► Podo – vomitting of bile, constipation and light
stools
► Merc sol – simple, pain in liver, <lying on rt
► Chel – yellow stools, pain under rt scapula
► China – congested liver and white stools
► Crot h – from blood disorganisation
HEPATITIS
► INFECTIOUS
 VIRUS – A TO G ,
CYTOMEGALOVIRUS,
YELLOW FEVER,
EPSTEIN-BARR
 PARASITES
► NON-
INFECTIOUS
 DRUGS
 TOXINS
 AUTO-IMMUNE
REACTIONS
 ALCOHOLIC
Infectious Hepatitis
► A,
E, F, - ingestion of
contaminated food or
water
► Usually acute
► E - severe
► B,
C, D, G –
Transmitted by blood
or bodily fluids, sexual
contact or exposure to
contaminated blood.
► D only occurs in
association with B
► B,C,D – lead to chronic
Hepatitis
Hepatitis symptoms
► Flu
like symptoms - nausea, vomiting,
abdominal pain, fever, fatigue, loss of
appetite, less commonly, rash and
joint pain.
► Jaundice
► The acute symptomatic phase of viral
hepatitis lasts from a few days to many
weeks; the period of jaundice that may
follow can persist from one to three weeks.
► Complications of acute viral hepatitis include
fulminant hepatitis & chronic hepatitis
Hepatitis B
► Severe
and long lasting
► 40 days to 6 months after exposure
► RISK –IV drug users, sexual partners of
infected people, unprotected healthcare
workers, organ transplants, blood
transfusions
► 100 times more likely to develop liver
cancer
Major Remedies
► Chelidonium
– all liver diseases with pale
stools, pain under right scapula, >hot drinks
► China – all liver disorders with fevers,
weakness, <touch >hard pressure
► Bryonia - <touch >lying painful side
► Merc sol - <lying painful side, offensive
perspiration
CIRRHOSIS
► Irreversible
change resulting in
degeneration of functional liver cells and
their replacement with fibrous connecting
tissue – scarring of liver tissue
► Excessive and chronic alcohol abuse –
common cause
► Early stages – can be stabilised by
abstaining from alcohol + good diet
Pathology
► Early
stages – enlarging – outer capsule
smooth and stretched
 Becomes more yellow, fibrous tissue and more
bile ducts form
► Enlarged/
tissue
Granular stage with more fibrous
 Blood vessels thicken and obstruct channels
► Advanced
stage
 Shrinking with loss of lobes and rough
Cirrhosis
► Other
causes – Hep B or C infection, Cystic
fibrosis, Auto-immune disorders,
► Heamochromotosis – inc Fe absorption and
deposition in liver
► Wilson’s – inc Copper, making liver green
► COMPLICATIONS – portal venous pressure –
haemorrhages, hepatic coma, jaundice,
oedema, ascites.
Major Remedies
► Phos
► Ars
iod
► China
► Aur mur
► Hydrocot
(from Clarke’s Prescriber)
LIVER CANCER
► PRIMARY
OR SECONDARY SPREAD
► RISK – chronic liver infection, cirrhosis,
aflatoxins, males, family history, old age
► Symptoms – Pain Rt side abdomen
extending to back/ shoulder, Swelling, Wt
Loss, Anorexia, nausea & vomiting,
Weakness, Yellowness (jaundice), fever,
Bloating
GALL STONES
► Composed
of crystalline substances –
Cholesterol, Bile pigments, calcium
► Common – cholesterol saturated bile with
low bile salts and phospholipids.
► CHOLELITHIASIS
RISKS TO GET STONED
► INFLAMMATION





AND STAGNATION
Liver damage
Chronic GB disease
Obesity
Hereditary blood disorders (sickle-cell A)
Ca of biliary tract
Symptoms
► No
clinical symptoms
► Acute inflammation – CHOLECYSTITIS
► Obstruction by stone in duct – severe pain –
Biliary Colic and Cholangitis
► Recovery
 Pass thru spontaneously
 Surgical removal – stones or GB
 Medication to dissolve
Major remedies
► Colocynth
– colic >bending double
► Dios – colic >bending backwards
► Calc carb – acute & chronic
► Cardus mar (Q) – left lobe pain
► Berberis (Q) – every 15 min
► Chel (Q) – 5 drops tds after food for several
weeks, Can be used with china
► China 6 – for prevention