8. Liver Disease

recommended weekly alcohol limit

• 14 units per week

• best to spread evenly over 3 or more days

principle functions of the liver

• cholesterol metabolism

• drug metabolism

• carbohydrate metabolism

• fatty acid metabolism

• ammonia metabolism

• protein synthesis

• bile formation

functions of bile

• cholesterol/ phospholipid homeostasis

• electrolyte balance

• conjugated bilirubin excretion

• functional bile acid circulation

• drug excretion

common clinical situations of hepatic disease

• acute hepatitis

• chronic liver disease

• extrahepatic biliary obstruction

• fatty liver disease

hepatitis A virus

• RNA virus

• faecal-oral transmission

• replicates in hepatocytes

• lymphocyte infiltration

symptoms of hepatitis A

• jaundice

• dark urine

• pale stools

• malaise

• anorexia

• abdo. pain

• nausea/vomiting

• fever

clinical features of hepatitis A

• jaundice

• hepatomegaly

• splenomegaly

• rash

chronic liver disease

• permanent and usually progressive pathological change throughout the liver

• lobular architecture deranged

• fibrosis and nodular regeneration (cirrhosis)

causes of cirrhosis

• alcohol

• fatty liver disease

• hepatitis B and C

• primary biliary cirrhosis

• primary sclerosing cholangitis

• auto-immune liver disease

morphological results of cirrhosis

• hepatocytes damaged and function poorly

• sinusoidal/canalicular pathways disturbed

• disrupted intrahepatic biliary drainage

• disturbed vascular perfusion

clinical effects of cirrhosis

• jaundice

• ascites

• encephalopathy

• portal hypertension

• splenomegaly

• bleeding tendency

• endocrine abnormalities

• renal failure

• hepatocellular carcinoma

physical signs of liver disease

• kayser-fleischer rings

• parotid swelling

• hepatomegaly

• bruising

• jaundice, anaemia

• hepatic fetor, central cyanosis

• ascites

biliary obstruction

• obstruction of extrahepatic biliary system

• commonly due to gallstones or pancreatic cancer

• decreased excretion bile

clinical effects of biliary obstruction

• jaundice

• dark urine

• pale stools

• itching

• pain

• steatorrhoea

• weight loss

• vitamin deficiencies

• disturbed lipid metabolism

fatty liver disease

• multiple causes e.g. drugs, diabetes, obesity

• increasing incidence and prevalence

• increasing public health problem

deadly quartet of metabolic syndrome

• abdominal obesity

• hypertension

• diabetes mellitus

• dyslipidaemia