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Liver Disease

Liver disease can be classified as acute or chronic, with common causes including viral hepatitis, alcohol-related cirrhosis, and hepatocellular carcinoma. Clinical signs of chronic liver disease include jaundice, hepatomegaly, and signs of portal hypertension, while laboratory investigations focus on liver function tests and enzyme levels. Alcoholic liver disease ranges from reversible fatty liver to potentially irreversible cirrhosis, with acute liver failure characterized by severe liver function decline and coagulation abnormalities.

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24 views5 pages

Liver Disease

Liver disease can be classified as acute or chronic, with common causes including viral hepatitis, alcohol-related cirrhosis, and hepatocellular carcinoma. Clinical signs of chronic liver disease include jaundice, hepatomegaly, and signs of portal hypertension, while laboratory investigations focus on liver function tests and enzyme levels. Alcoholic liver disease ranges from reversible fatty liver to potentially irreversible cirrhosis, with acute liver failure characterized by severe liver function decline and coagulation abnormalities.

Uploaded by

ilkelambrechts101
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

Liver disease

Definition
Classify by duration of abnormalities:
 Acute (< 6 months)
 Chronic (>6 months)
 Common causes include:
o Viral hepatitis
o Cirrhosis secondary to alcohol
o HCC (hepatocellular carcinoma)

Functions of the liver


1. Metabolism
a. Proteins, carbohydrates, fats and vitamins
2. Storage
a. Glycogen, vitamins, minerals
3. Detoxification and inactivation of endogenous/exogenous substances
4. Bile secretion
5. Synthesis of coagulation factors (Protein C&S)

Clinical presentation of chronic liver disease


 Signs of cirrhosis
o Hands
 Leukonychia
 Clubbing
 Palmar erythema
 Bruising
 Asterixis
o Face
 Jaundice
o Chest
 Gynaecomastia
 Spider naevi
 Bruising
o Abdomen
 Hepatomegaly AND/OR Splenomegaly
 Ascites
 Signs of portal HT
 Testicular atrophy
o Legs
 Oedema
 Bruising

1
 Signs of portal hypertension
o Splenomegaly
o Haematamesis (from gastric/oesophageal varices)
o Ascites
o Caput medussae

Types of liver injury (causes)

Pre- Sepsis (infection)


HUS (haemolytic ureamic syndrome)

hepatic
Malaria
Haemolysis

Viral hepatitis (B, C)

Hepatic Alcoholic hepatitis


Vascular/Cogenstive hepatitis
DILI

Biliary Primary biliary cirrhosis (autoimmune)


Primary sclerosing cholangitis (autoimmune)

Alcoholic liver disease (alcoholic cirrhosis)


 Usually an acute exacerbation of symptoms in a patient with chronic and excessive
alcohol ingestion
 Clinical features
o Symptoms
 Nausea/vomiting
 Low grade fever
 RUG pain
o Signs
 Dupuytren’s contracture
 Parotid gland enlargement (bilateral)
 Jaundice
 Hepatomegaly
 (Other signs of cirrhosis)

2
Vascular hepatitis
 Ischemic hepatitis: “shock liver” from severe hypotension (low cardiac output state)
from septic shock
 Congestive hepatitis: from any cause of right sided heart failure  Passive
congestion leading to ischemia and necrosis of liver

DILI
 Paracetomol (> 10g)
 TB  Isoniazid, Rifampicin
 HIV medication  Zidovudine, Nevirapine
 All statins

Laboratory investigations
1. Liver function tests
a. PTT (INR)
b. Bilirubin
c. Albumin  Marker for liver protein synthesis. Decreases in chronic liver
disease
2. Liver enzymes (inflammation/injury)
a. ALT/AST
i. Intracellular enzymes released secondary to necrosis/inflammation.
ALT more specific for liver than AST
ii. ALT > AST more likely viral hepatitis or fatty liver
iii. AST: ALT ratio > 2:1  Alcoholic hepatitis
b. ALP/GGT  Obstruction

Patterns of liver disease


 Hepatocellular: Marked increase in AST and ALT
 Cholestasis: Increased ALP/GGT and +/- mild increases in AST and ALT
o Jaundice: A clinical sign when bilirubin levels are high > 2.5 mg/dl, if
hyperbilirubinaemia is conjugated, should see increase in urine bilirubin
 Acute liver failure: High AST/ALT, alk phos, bilirubin, PT with hepatic
encephalopathy

Alcoholic liver disease

Definition
→ Fatty liver (all alcoholics): always reversible if alcohol stopped
→ Alcoholic hepatitis (35% of alcoholics): usually reversible if alcohol stopped
→ Cirrhosis (10-15% of alcoholics): potentially irreversible
3
Liver complications of alcohol abuse

Acute Liver Failure

Definition
 Severe decline in liver function characterized by coagulation abnormality (INR>1.5)
and encephalopathy
o In setting of previously normal liver
o Rapid (< 26 wk duration)

Pathology (most common)


 Drugs (NB paracetomol)
 Hepatitis B
 Hepatitis A

Cirrhosis (Chronic liver disease)

Definition
 Liver damage characterized by diffuse distortion of the basic architecture and
replacement with scar tissue and formation of regenerative nodules
o Stage 1 cirrhosis is compensated and asymptomatic, can last for 10-20 yr with
almost normal life expectancy
o Stage 2 cirrhosis is the onset of first decompensation, typically development
of ascites (most common), variceal bleeding, encephalopathy

4
Pathology
 Fatty liver disease (alcohol)
 Hepatitis
o Chronic viral hepatitis
o Autoimmune hepatitis
 Infiltrative
o Hemochromatosis
 Biliary
o Primary biliary cirrhosis
 Chronic hepatic congestion (congestive hepatitis)
o Cardiac cirrhosis

Investigations
I. Bloods
a. LFT, enzymes
II. Imaging
a. U/S (expect decreased size)
b. CT (for complications)
c. Gastroscopy (bleeds)
III. Biopsy (definitive)

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