Liver disease Prepared by: Siti Norhaiza Bt Hadzir
Liver disease • Diagnosis of liver disease depends on: • 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 • Results from acute massive liver cell necrosis ( viral hepatitis, toxic drug and chemicals) • May also follow acute fatty change of the liver. • Characterization: • Jaundice • Hypoglycemia • Bleeding tendency due to DIC • Electrolyte and acid base disturbance • Hepatic encephalophaty • Hepatorenal syndrome • Elevation of serum enzymes (LDH,AST, ALT)
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