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Liver
Liver
Liver
Liver
Liver
Liver
Liver
Liver
Liver
Liver
Liver
Liver
Liver
Liver
Liver
Liver
Liver
Liver
Liver
Liver
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Liver

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

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