Anatomy , Histology and Function of the liver. Hepatitis C: Signs, Symptoms, Complication and Management.

1. Hepatitis C

2.  Anatomy of the liver
 Second largest organ
 In adults, the liver can weigh up to 1.5 kg
 It is in the upper-right abdomen, just under the rib cage and below the diaphragm
 The liver consists of 4 distinct lobes – the left, right, caudate, and quadrate lobes.
 The left and right lobes are the largest lobes and are separated by the
falciform ligament.
 The small caudate lobe extends from the posterior side of the right lobe and
wraps around the inferior vena cava.
 The small quadrate lobe is inferior to the caudate lobe and extends from the
posterior side of the right lobe and wraps around the gallbladder.

4.  Blood vessels
 The liver has 2 major sources of blood:
 The portal vein carries blood from the digestive system, which removes most of the oxygen in the blood, to the
liver. About 75% of the liver’s blood supply comes from the portal vein. This blood has nutrients from the digestive
system.
 The hepatic artery supplies the liver with oxygen-rich blood from the heart.
 Bile ducts
 Liver cells (called hepatocytes) make bile.
 Bile is a yellow-green fluid that helps the body digest fat. Bile travels through a series of tubes, or
ducts, in the liver to the small intestine or to the gallbladder for storage
 Liver ducts:
 The hepatic ducts collect bile from the liver. Two hepatic ducts leave the liver and join to form the
common hepatic duct.
 The cystic bile duct leaves the gallbladder and joins the common hepatic duct to form the
common bile duct.
 The common bile duct empties bile into the duodenum (the first part of the small intestine).

6.  Histology of liver
 Hepatocytes are the main tissue cell of the liver, making up 70-80% of the liver's
cytoplasmic mass
 Hepatocytes contain large amounts of rough endoplasmic reticulum and free
ribosomes
 Hepatocytes are involved in protein synthesis; protein storage; transformation of
carbohydrates, synthesis of cholesterol, bile salts and phospholipids; and
detoxification, modification, and excretion of exogenous and endogenous
substances
 Hepatocytes are unique in that they are one of the few types of cell in the
human body that are capable of regeneration
 Hepatocyte nuclei are distinctly round, with one or two prominent nucleoli. A
majority of cells have a single nucleus, but binucleate cells are common

8.  Function of the liver
1. Metabolic
1) Synthesis
2) Breakdown
3) Detoxification.
2. Excretion of waste products from bloodstream into bile
3. Storage – storage of blood, storage of fat soluble vitamin and vitaminB12
4. Immune & inflammatory function

9. 1) Metabolic function:
 Carbohydrate metabolism
 Gluconeogenesis
 Glycogenesis
 Protein metabolism
 Synthesis of amino acids
 Deamination of amino acids
 Formation of urea for removal of ammonia from the body fluid
 Synthesis of proteins (Transferrin, Ferritin) involved in iron transport & metabolism.
 Production of coagulation factors I, II, V, VII, IX, X and XI, and antithrombin
 Produces insulin-like growth factor 1 (IGF-1),
 Production of trombopoetin (Thrombopoietin is a glycoprotein hormone that regulates the
production of platelets by the bone marrow)
 Breaks down insulin and other hormones
 Breaks down of hemoglobin
Lipid metabolism
Cholesterol synthesis
Lipogenesis
Oxidation of fatty acids
Primary bile acids.

10. 2) Excretory function:
 bile acids, urea synthesis
 Liver also has the ability to detoxify or excrete into the bile many drugs, including
sulfonamides, penicillin, ampicillin, and erythromycin
3) Liver as a Storage Organ:
 The vitamin stored in greatest quantity in the liver is vitamin A, but large quantities of vitamin
D and vitamin B12 are normally stored as well
 Iron as Ferritin:
 The hepatic cells contain large amounts of a protein called apoferritin, which is capable of combining
reversibly with iron.
 Therefore, when iron is available in the body fluids in extra quantities, it combines with apoferritin to
form ferritin and is stored in this form in the hepatic cells until needed elsewhere
4) Immune & inflammatory function
 Kuffer cells protect against foreign agents, degrade toxins, process antigens, and phagocytose
bacteria.
 Induce & intensify inflammation by recruiting neutrophils
 Release proinflammatory mediators

12. Hepatitis C

13. Hepatitis C
 Hepatitis is an inflammation of the liver. The condition can be self-limiting or can progress to fibrosis
(scarring), cirrhosis or liver cancer. Hepatitis viruses are the most common cause of hepatitis in the
world but other infections, toxic substances (e.g. alcohol, certain drugs), and autoimmune diseases
can also cause hepatitis
 Hepatitis C is an infection caused by the hepatitis C virus (HCV) FLAVIVIRUS that attacks the liver
and leads to inflammation.
 the virus can cause both acute and chronic hepatitis infection, ranging in severity from a mild illness
lasting a few weeks to a serious, lifelong illness.
 Transmission
 The hepatitis C virus is a bloodborne virus. It is most commonly transmitted through:
 injecting drug use through the sharing of injection equipment
 the reuse or inadequate sterilization of medical equipment, especially syringes and needles in healthcare
settings
 the transfusion of unscreened blood and blood products.
 HCV can also be transmitted sexually and can be passed from an infected mother to her baby; however
these modes of transmission are much less common.
 Hepatitis C is not spread through breast milk, food, water or by casual contact such as hugging, kissing and
sharing food or drinks with an infected person.

14.  Signs and symptoms
 Initial symptoms of hepatitis C are often extrahepatic, most commonly involving the joints, muscle, and skin.
Examples include the following:
 Arthralgias / Paresthesias
 Myalgias / Pruritus
 Sicca syndrome / Sensory neuropathy
 Symptoms characteristic of complications from advanced or decompensated liver disease are related to
synthetic dysfunction and portal hypertension, such as the following:
 Mental status changes (hepatic encephalopathy)
 Ankle edema and abdominal distention (ascites)
 Hematemesis or melena (variceal bleeding)
 Physical findings usually are not abnormal until portal hypertension or decompensated liver disease develops.
Signs in patients with decompensated liver disease include the following:
 Palmar erythema, clubbing
 Icteric sclera, temporal muscle wasting, enlarged parotid gland, cyanosis
 Gynecomastia, small testes
 Ankle edema
 Scant body hair
 Spider nevi, excoriations due to pruritus

15. Complications of Hepatitis C
 Cirrhosis
 Cirrhosis is a slowly progressing disease in which healthy liver tissue is replaced with scar tissue,
eventually preventing the liver from functioning properly. The scar tissue blocks the flow of blood
through the liver and slows the processing of nutrients, hormones, drugs, and naturally produced
It also slows the production of proteins and other substances made by the liver.
 There are usually few symptoms in the early stages. But as your liver loses its ability to function
you may experience:
 tiredness and weakness
 loss of appetite
 weight loss
 very itchy skin
 tenderness or pain in your tummy
 jaundice
 Portal hypertension (leads to varices)

17.  Liver failure
 In severe cases of cirrhosis, the liver loses most or all of its functions. This is known as liver failure
 Each year, around 1 in every 20 people with hepatitis-associated cirrhosis will develop liver failure.
 Symptoms of liver failure include:
 hair loss
 build-up of fluid in the legs, ankles and feet (oedema)
 build-up of fluid in your tummy (ascites)
 dark urine
 black, tarry stools or very pale stools
 frequent nosebleeds and bleeding gums
 a tendency to bruise easily
 vomiting blood
 Liver cancer
 It's estimated that around 1 in every 20 people with hepatitis-associated cirrhosis will develop liver
cancer each year.

18. Management of Hepatitis C
 Hepatitis C medications
 Pegylated interferon: a medication that encourages the immune system to attack the
virus
 Ribavirin: an antiviral medication that stops the virus reproducing
 Lifestyle measures
 Eating a healthy and balanced diet
 Exercising regularly
 Cutting out alcohol
 Keeping personal items, such as toothbrushes or razors, for your own use
 Not sharing any needles or syringes with others