Approach to liver disease
•Download as PPTX, PDF•
43 likes•20,322 views
The document provides an overview of liver anatomy and functions, clinical features of liver disease, causes of jaundice, signs of alcohol-related liver damage, common tests used to evaluate liver function, and investigations for liver disease. Key points include that the liver performs important roles in metabolism, detoxification, and protein and hormone synthesis. Clinical features can vary depending on the type of liver disease and include fatigue, jaundice, abdominal pain, and bleeding issues. Biochemical tests and imaging help diagnose and characterize liver injury.
More Related Content
What's hot
What's hot (20)
Similar to Approach to liver disease
Similar to Approach to liver disease (20)
Recently uploaded
Recently uploaded (20)
Approach to liver disease
- 1. APPROACH TO LIVER DISEASE Dr Anoop R Prasad
- 2. ANATOMY
- 3. 30% 70%
- 10. Glucose metabolism • The liver performs several roles in carbohydrate metabolism: • Gluconeogenesis • Glycogenolysis • Glycogenesis • Glucogenesis • Glucose buffer function
- 11. Protein Lipids • Amino acid synthesis • Protein metabolism, • Cholesterol synthesis (synthesis as well as • Lipogenesis, the degradation) production of triglycerides (fats). • Lipoprotein synthesis • Beta oxidation
- 12. Synthesis of plasma proteins Albumin Acute phase proteins Clotting factors Steroid binding and other hormone binding proteins HORMONES Erythropoietin IGF-1 Thrombopoietin Angiotensinogen 25 hydrxoy choolecalciferol
- 13. Hematopoesis Extramedullary hemopoiesis during first trimester of gestation • STORAGE: Vitamins Glycogen Iron Copper • Immunity Kupffer cells
- 14. Detoxification toxins steroids other hormones drugs Bilirubin Urea formation
- 15. CLINICAL FEATURES OF h DISEASE • Fatigue • Nausea • Vomiting • Jaundice • Right upper quadrant pain • Bleeding manifestation(echymosis, easy bruising,hematemesis,malena) • Colicky pain • Pruritus Obstructive • Clay colored stools jaundice • Abdominal distension • Muscle wasting • Altered sensorium
- 16. Cholestatic disease • fatigue, malaise • anorexia, nausea • Biliary colic • Deep jaundice • +++ pruritus • +++ abdominal pain and pancreatitis • +++ gray or clay-colored stools
- 17. CIRRHOSIS • Fatigue • Muscle wasting • Hematemesis • Ascites • Easy bruising • Edema
- 18. Other points in history • Fever, prodrome (anorexia,vomiting,nausea) – which disappears with onset of jaundice – acute viral hepatitis • Joint pain, diabetes, pigmentation, jaundice – • Young individual with extrapyramidal symptoms, neuropsychiatric manifestation, anemia • Colicky abd pain, jaundice, fever- gall stones • Rash, arthritis • Drug history
- 19. Acute onset jaundice • Viral hepatitis • Alcoholic liver disease • Autoimmune hepatitis • Ischemic hepatitis • Medication-induced liver disease • Common bile duct stones • Pancreatic cancer • Primary Biliary Cirrhosis (PBC) • Primary Sclerosing Cholangitis (PSC)
- 20. Jaundiced Emergencies • Acetaminophen Toxicity • Fulminant Hepatic Failure • Ascending Cholangitis
- 21. Jaundice Unrelated to Intrinsic Liver Disease • Hemolysis (usually T. bili < 4) • Massive Transfusion • Resorption of Hematoma • Ineffective Erythropoesis • Disorders of Conjugation • Gilbert’s syndrome • Intrahepatic Cholestasis • Sepsis, TPN, Post-operation
- 23. Alcohol • A standard drink is any drink that contains about 14 grams of pure alcohol (about 0.6 fluid ounces or 1.2 tablespoons) • One "Standard Drink" equals = one 30ml nip of whisky or other basic spirit = 60ml fortified wine = 150ml table wine = 250ml beer = 425ml low alcohol beer • Strength (ABV) x Volume (ml) ÷ 1000 = No. of units. • 40–80 g/d of ethanol produces fatty liver; 160 g/d for 10–20 years causes hepatitis or cirrhosis. Only 15% of alcoholics develop alcoholic liver disease.
- 26. Signs Alopecia Pigmentation of face Jaundice KF ring Parotid swelling Gynaecomastia Spider naevi Palmar erythema Dupyutren’s contracture Half and half nail Asterixis
- 27. Testicular atrophy Scratch marks Echymotic patches Muscle wasting Pallor Clubbing Edema Leuconychia Hepatomegaly ….. Splenomegaly Ascites
- 28. • Dilated veins • Caput medusae
- 31. Biochemical tests in liver disease • The true tests of liver function: • INR, PT, Albumin,Bilirubin • Tests of hepatic injury/inflammation: • Aspartate aminotransferase (AST) • Alanine aminotransferase (ALT) • Alkaline phosphatase (ALP) • Gamma-glutamyl transpeptidase (GGT) • Hepatocellular – AST/ALT elevation twice that of ALP • Cholestatic – AST/ALT elevation less than twice ALP
- 33. INVESTIGATIONS • AST-ALT-ALP • Ammonia • Bilirubin – total/indirect • Viral serologies • Albumin • ANA-ASMA- • INR AMA • Glucose • Quantitative Ig • Na-K-PO4, acid-base • Ceruloplasmin • Acetaminophen level • Iron profile • CBC/plt • Blood cultures
- 34. Hepatocellular Cholestatic • AST/ALT >> ALP • ALP>>AST/ALT • Unconjugated bil >> • Conjugated bil>> conjugated unconjugated • USG – BILE DUCTS • ↑GGT, 5’nucleotidase NORMAL • USG- Intrahepatic biliary duct dilation
- 35. Non hepatic cause of elevated transaminases • Muscle disease • Thyroid diseases • Bone disease - ALP
- 39. THANK YOU QUESTIONS??