Diseases of liver Dr. Mohamed. A. Mahdi Mob: 0123002800 4/2/2019
Cirrhosis Cirrhosis is a complication of many liver disease. Permanent scarring of the liver. A late-stage liver disease. The inflammation and repair that is associated with the dying liver cells causes scar tissue to form. Normal liver cells are replaced by scar tissue that cannot perform any liver function.
Causes There are many causes of cirrhosis; they include chemicals (such as alcohol, fat, and certain medications), viruses, toxic metals (such as iron and copper that accumulate in the liver as a result of genetic disease, and autoimmune liver disease in which the body's immune system attacks the liver.
Symptoms: Yellowing of the skin (jaundice) due to the accumulation of bilirubin in the blood Fatigue Weakness Loss of appetite Itching
Complications: Edema and ascites Spontaneous bacterial peritonitis (SBP) Hepatorenal syndrome (This syndrome is a serious complication in which the function of the kidneys is reduced. It is a functional problem in the kidneys, that is, there is no physical damage to the kidneys. Instead, the reduced function is due to changes in the way the blood flows through the kidneys themselves. The hepatorenal syndrome is defined as progressive failure of the kidneys. Liver cancer (hepatocellular carcinoma) Hypersplenism (rise of blood pressure in portal vein)
Diagnosis and evaluation: The single best test for diagnosing cirrhosis is biopsy of the liver. Jaundice (yellowness of the skin and of the whites of the eyes due to elevated bilirubin in the blood) is common among patients with cirrhosis. Advanced cirrhosis leads to a reduced level of albumin in the blood and reduced blood clotting factors due to the loss of the liver's ability to produce these proteins.
Abnormal elevation of liver enzymes in the blood (such as ALT and AST) Patients with elevated levels of iron in their blood may have hemochromatosis. Auto-antibodies (antinuclear antibody, anti-smooth muscle antibody and anti-mitochondrial antibody) sometimes are detected in the blood and may be a clue to the presence of autoimmune hepatitis or primary biliary cirrhosis, both of which can lead to cirrhosis
Hemochromatosis (iron overload) Inherited disease. Metabolic disorder that leads to abnormally elevated iron stores in the body. The excess iron may be found in the tissues of the liver, pancreas, and heart and Can lead to inflammation, cirrhosis, liver cancer, and liver failure.
Diagnosis Iron. TIBC. Transferrin. Ferritin. liver biopsy
Wilson's Disease Inherited disease that affects the body's ability to metabolize copper. Copper is normally transported from intestine to liver, but cannot be transported to bile. So accumulate in liver and brain May lead to cirrhosis and liver failure.
Diagnosis serum ceruloplasmin (low <.2 g/l). Serum copper (low) 24hr urine for copper (high > 100 µg/24 hr). liver biopsy. Kayser-Fleischer rings
Gilbert's Disease Abnormality in bilirubin metabolism in the liver. Affects up to 7% of the North American population. No symptoms, usually diagnosed incidentally when an elevated bilirubin level is found on routine blood tests. Benign condition and no treatment is necessary.
Specific liver function blood tests include: AST and ALT ( transaminase chemicals released with liver cell inflammation). GGT and alkaline phosphatase (chemicals released by cells lining bile ducts). Bilirubin. Protein. albumin levels.
Other blood tests Complete blood count (CBC), patients with end stage liver disease may have bone marrow suppression and low RBCs, WBCs and platelets; Lipase to check for pancreas inflammation; electrolytes, BUN and creatinine to assess kidney function; and Ammonia blood level assessment is helpful in patients with mental confusion.
Imaging studies May be used to visualize, not only the liver, but other organs nearby that may be diseased. CT scan (computerized axial tomography), MRI (magnetic resonance imaging), and Ultrasound (sound wave imaging, which is especially helpful in assessing the gallbladder and bile ducts. Liver biopsy (Under local anesthetic)may be considered to confirm a specific diagnosis for liver disease.
HEPATOSIS Hepatosis is disease with injuring of the liver with predominance of degeneration (dystrophy) and necrosis of hepatic hepatocytes. There are acute and chronic hepatosis according to clinical course Acute hepatosis is termed one as massive hepatic necrosis. Chronic hepatosis is termed one as hepatic steatosis
Etiology (causes): 1- Poisons can be mushroom, phosphorus, drugs 2 - endogenic intoxication can be gestosis, thyreotoxicosis 3 - viral hepatitis (fulminate form)
Hepatocellular Carcinoma Patients with cirrhosis have a markedly increased risk of developing hepatocellular carcinoma Incidence in well compensated cirrhosis is approximately 3 percent per year
Symptoms are largely due to mass effect from the tumor Pain, obstructive jaundice. Serum AFP greater than 500 micrograms/l in a patient with cirrhosis are virtually diagnostic