Liver Disease - What I will learn …… <ul><li>Some basic liver anatomy, function and histology </li></ul><ul><li>What are t...
Functions of the Liver <ul><li>Metabolism of ingested carbohydrates, protein </li></ul><ul><li>Fat delivered through the p...
Functions of the Liver <ul><li>Storage of vitamin B 12  and other materials </li></ul><ul><li>Detoxification and excretion...
Liver Structure <ul><li>Has a double blood supply from the hepatic artery and portal vein </li></ul><ul><li>Portal tracts ...
Liver, basic lobule, or acini
Bile <ul><li>Bile pigment is derived from the breakdown of red blood cells </li></ul><ul><li>Bile pigment is conjugated an...
Bile <ul><li>An aqueous solution containing various dissolved substances </li></ul><ul><ul><li>Conjugated bilirubin, bile ...
Liver Injury <ul><li>Manifestations </li></ul><ul><ul><li>Cell necrosis </li></ul></ul><ul><ul><li>Immune cell infiltratio...
Common Types of Liver Injury <ul><li>Viral hepatitis </li></ul><ul><ul><li>Hep A, B, C, etc </li></ul></ul><ul><li>Alcohol...
Hepatitis A <ul><li>RNA virus </li></ul><ul><li>Fecal-oral method of transmission, ie eating at the wrong place </li></ul>...
Hepatitis B <ul><li>DNA containing virus </li></ul><ul><li>Blood or body fluid method of transmission </li></ul><ul><li>30...
Hepatitis C <ul><li>RNA containing virus </li></ul><ul><li>Blood and body fluids method of transmission </li></ul><ul><li>...
Alcoholic Liver Disease <ul><li>Three stages of progression </li></ul><ul><ul><li>fatty liver – reversible  </li></ul></ul...
Cirrhosis of the Liver <ul><li>Diffuse scarring (Cirrhosis) of the liver from any cause </li></ul><ul><ul><li>Alcoholic li...
Manifestations of Cirrhosis of the Liver <ul><li>Liver failure </li></ul><ul><li>Liver unable to inactivate estrogen in ma...
Manifestations of Cirrhosis of the Liver
Cholelithiasis (Gallstones) <ul><li>Incidence </li></ul><ul><ul><li>Higher in women than men </li></ul></ul><ul><ul><li>Hi...
Cholelithiasis <ul><li>Cholesterol stones </li></ul><ul><li>Cholesterol is soluble when mixed with water soluble bile salt...
Cholecystitis <ul><li>Chronic disease common </li></ul><ul><li>Gallstones may predispose to cholecystitis </li></ul><ul><l...
Tumors of the Liver <ul><li>Benign adenomas </li></ul><ul><li>Primary carcinoma </li></ul><ul><ul><li>Called Hepatocellula...
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Liver

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Liver

  1. 1. Liver Disease - What I will learn …… <ul><li>Some basic liver anatomy, function and histology </li></ul><ul><li>What are the common viral infections of the liver </li></ul><ul><li>An understanding of Cirrhosis </li></ul><ul><li>How gallstones are formed </li></ul>
  2. 2. Functions of the Liver <ul><li>Metabolism of ingested carbohydrates, protein </li></ul><ul><li>Fat delivered through the portal circulation </li></ul><ul><li>Synthesis of proteins </li></ul><ul><ul><li>plasma proteins </li></ul></ul><ul><ul><li>Coagulation proteins </li></ul></ul>
  3. 3. Functions of the Liver <ul><li>Storage of vitamin B 12 and other materials </li></ul><ul><li>Detoxification and excretion of various substances </li></ul>
  4. 4. Liver Structure <ul><li>Has a double blood supply from the hepatic artery and portal vein </li></ul><ul><li>Portal tracts travel together </li></ul><ul><ul><li>Hepatic artery </li></ul></ul><ul><ul><li>Portal vein </li></ul></ul><ul><ul><li>Bile ducts </li></ul></ul><ul><ul><li>Lymphatic vessels </li></ul></ul>
  5. 5. Liver, basic lobule, or acini
  6. 6. Bile <ul><li>Bile pigment is derived from the breakdown of red blood cells </li></ul><ul><li>Bile pigment is conjugated and excreted by the liver </li></ul>
  7. 7. Bile <ul><li>An aqueous solution containing various dissolved substances </li></ul><ul><ul><li>Conjugated bilirubin, bile salts, lecithin, cholesterol, water, minerals </li></ul></ul><ul><li>Functions as a biologic detergent </li></ul>
  8. 8. Liver Injury <ul><li>Manifestations </li></ul><ul><ul><li>Cell necrosis </li></ul></ul><ul><ul><li>Immune cell infiltration </li></ul></ul><ul><ul><li>Fatty change </li></ul></ul><ul><ul><li>Mixed necrosis and fatty change </li></ul></ul><ul><ul><li>Later, fibrosis </li></ul></ul>
  9. 9. Common Types of Liver Injury <ul><li>Viral hepatitis </li></ul><ul><ul><li>Hep A, B, C, etc </li></ul></ul><ul><li>Alcoholic hepatitis </li></ul><ul><li>Cirrhosis </li></ul><ul><ul><li>Scarring, which is end result of acute injury </li></ul></ul>
  10. 10. Hepatitis A <ul><li>RNA virus </li></ul><ul><li>Fecal-oral method of transmission, ie eating at the wrong place </li></ul><ul><li>Self-limiting disease with no carriers and no chronic liver disease </li></ul><ul><li>Hep A antibody appears at the time of symptoms </li></ul><ul><li>Prevention after exposure </li></ul><ul><li>Immunization available </li></ul>
  11. 11. Hepatitis B <ul><li>DNA containing virus </li></ul><ul><li>Blood or body fluid method of transmission </li></ul><ul><li>300 million carriers worldwide </li></ul><ul><li>Most shed the virus, however, 10% become carriers and may develop chronic liver disease </li></ul><ul><li>Prevention after exposure </li></ul><ul><li>Immunization available </li></ul>
  12. 12. Hepatitis C <ul><li>RNA containing virus </li></ul><ul><li>Blood and body fluids method of transmission </li></ul><ul><li>Most important cause of transfusion associated hepatitis </li></ul><ul><li>75% become carriers and many develop chronic liver disease </li></ul><ul><li>HCV RNA detected for 1-3 weeks, but may persist </li></ul><ul><li>No prevention of disease after exposure </li></ul><ul><li>No immunization available </li></ul>
  13. 13. Alcoholic Liver Disease <ul><li>Three stages of progression </li></ul><ul><ul><li>fatty liver – reversible </li></ul></ul><ul><ul><li>Hepatitis - reversible </li></ul></ul><ul><ul><li>The above two can lead to cirrhosis - irreversible </li></ul></ul>
  14. 14. Cirrhosis of the Liver <ul><li>Diffuse scarring (Cirrhosis) of the liver from any cause </li></ul><ul><ul><li>Alcoholic liver disease </li></ul></ul><ul><ul><li>Chronic hepatitis </li></ul></ul><ul><ul><li>An episode of severe liver necrosis </li></ul></ul><ul><ul><li>Other drugs and chemicals </li></ul></ul><ul><ul><li>Longstanding bile duct obstruction </li></ul></ul>
  15. 15. Manifestations of Cirrhosis of the Liver <ul><li>Liver failure </li></ul><ul><li>Liver unable to inactivate estrogen in males </li></ul><ul><ul><li>Testicular atrophy, loss of sex drive, breast hypertrophy </li></ul></ul><ul><li>Portal hypertension </li></ul><ul><ul><li>Ascites, collateral circulation formation </li></ul></ul>
  16. 16. Manifestations of Cirrhosis of the Liver
  17. 17. Cholelithiasis (Gallstones) <ul><li>Incidence </li></ul><ul><ul><li>Higher in women than men </li></ul></ul><ul><ul><li>Higher in women who have borne several children </li></ul></ul><ul><ul><li>Twice as high in women who use contraceptive pills </li></ul></ul><ul><ul><li>Higher in obese women </li></ul></ul>
  18. 18. Cholelithiasis <ul><li>Cholesterol stones </li></ul><ul><li>Cholesterol is soluble when mixed with water soluble bile salts and insoluble lecithins </li></ul><ul><li>Once cholesterol exceeds the solubilizing capacity of bile, cholesterol crystalizes </li></ul>
  19. 19. Cholecystitis <ul><li>Chronic disease common </li></ul><ul><li>Gallstones may predispose to cholecystitis </li></ul><ul><li>Impaction of a stone in the neck of the gallbladder may precipitate acute cholecystitis </li></ul>
  20. 20. Tumors of the Liver <ul><li>Benign adenomas </li></ul><ul><li>Primary carcinoma </li></ul><ul><ul><li>Called Hepatocellular Carcinoma, related to Hep B </li></ul></ul><ul><li>Metastatic carcinoma </li></ul><ul><ul><li>Spread from primary sites most common type of tumors, Colonic cancer is common primary tumor </li></ul></ul>
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