Liver disease

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Liver disease

• Prepared by Siti Norhaiza Bt Hadzir

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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

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Acute liver disease

• Causes of hepatocellular damage
• - poisoning
• - infection
• - inadequate perfusion

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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.

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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

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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

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Outcome of acute liver disease

• It may resolve
• It may progress to acute hepatic failure
• It may lead to chronic hepatic damage.

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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)

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Biochemical finding in hepatic failure
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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.

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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.

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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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Thank You