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Disorders of the Liver.pptx
- 1. Bett SK
- 2. Yellow discoloration of tissues due to accumulation of bilirubin Clinical jaundice occurs when bilirubin exceed 3mg/dL Scleral tissue have higher affinity for bilirubin It is not a diagnosis; rather etiology should be sought.
- 3. Bilirubin is a product of RBC breakdown ◦ Hemoglobin → heme+ globin By heme oxygenase ◦ Heme → biliverdin + CO+ iron By bilirubin reductase ◦ Biliverdin → bilirubin By blrubin reductase Bilirubin lipid soluble ◦ Bilirubin conjugated in the liver To make it water soluble
- 4. Hyperbilirubinemia classified as ◦ Conjugated ◦ Unconjugated Also classifed as ◦ Prehepatic ◦ Hepatocellular ◦ Post hepatic
- 5. Unconjugated hyperbilirubinemia ◦ Caused by Increased bilirubin production Hemolysis Decreased conjugation in the liver Criglar najar Gilbert syndrome Cirrhosis Hepatitis Drugs and toxins
- 6. Extra hepatic cholestasis Intrahepatic cholestasis/damage Gall stones Tumors Sclerosing cholangitis Parasitic infections Pancreatitis Strictures Hepatitis Primary biliary cirhosis Drugs and toxins Autoimmine disorders Dubin jonson syndrome Rotor syndrome Granulomatous diseases Alcohol
- 7. Unconjugated ◦ Jaundice ◦ Normal stool and urine color ◦ Features of underlying etiology Conjugated ◦ Jaundice ◦ Pruritus ◦ Pale stool ◦ Dark colored urine ◦ Signs of underlying etiology ◦ Steatorhoea ◦ Bleeding
- 8. Bilirubin levels Liver enzymes Serum proteins Complete blood count Reticulocyte count Abdominal ultrasound Abdominal CT
- 9. Treat underlying cause Cholestyramine for pruritus Surgery ◦ To unblock the biliary tree
- 10. Ascites derived from the word askos than means a bag or a sac Accumulation of fluid within the peritoneal cavity Small accumulation produces no symptoms Healthy males have little or no fluid normally Females have up to 20 ml of fluid in the peritoneal cavity Not a diagnosis; look for etiology
- 12. Under filling theory ◦ Splanchnic sequestration of fluid Overflow theory ◦ Inappropriate retention of sodium and water Peripheral vasodilation theory ◦ Combination of above 2
- 13. Transudative ascites ◦ No intrinsic problem to the peritoneal membrane ◦ SAAG more than 11g/L Exudative ascites ◦ There is an intrinsic problem to the peritoneal membrane ◦ SAAG less than 11g/L
- 14. Abdominal distension Everted umbilicus Respiratory distress positive shifting dullness Positive fluid thrill Features of underlying etiology
- 15. Paracentesis ◦ Appearance ◦ Biochemistry Albumin amylase ◦ Micrsospy G-staining, Z-N staining ◦ Gene expert for TB ◦ Culture ◦ Cytology WBCs, malignant cells
- 16. LFTs ◦ Liver enzymes ◦ Coagulation profile ◦ Blirubin ◦ Serum proteins UECs CBC Abdominal ultrasound Abdominal CT
- 18. Treat the cause Sodium and fluid restriction Diuretics Spironolactone or amiloride Therapeutic paracentesis (ascitic tap) Infusion of albumin Trans Jugular Intrahepatic Portosystemic Stent Shunt. Peritoneo-venous shunt
- 19. Spontaneous bacterial peritonitis Hepato-renal syndrome
- 20. Neuropsychiatric disorder due to liver disease Caused by nitrogenous toxins that bypasses the liver and reaches the CNS This follows inability of the liver to metabolize these toxins Toxins implicated include ammonia, GABA, etc. Presents with psychiatric symptoms, altered level of conciousness, convulsion, etec. Treatment ◦ Lactulose ◦ Rifaximin, neomycin for gut sterilization
- 21. Characterised by diffuse hepatic fibrosis and nodule formation Caused by recurrent/chronic hepatocyte damage Normal liver tissue replaced by fibrous tissue Occurs at any age Significant cause of premature death
- 22. Alcohol Chronic viral hepatitis (B or C) Non-alcoholic fatty liver disease Immune ◦ Primary sclerosing cholangitis ◦ Autoimmune liver disease Biliary ◦ Primary biliary cirrhosis ◦ Cystic fibrosis Genetic ◦ Haemochromatosis ◦ Wilson's disease ◦ α1-antitrypsin deficiency Cryptogenic (unknown-15%) Chronic venous outflow obstruction
- 23. Chronic inflammation and hepatocyte damage ◦ Cytokines from kupfer cells transform stalete cells into myofibroblast ◦ Myofroblast are converted to collagen ◦ Collagen together with cytokines worsen injury Replacement of normal liver tissue by fibrous tissue ◦ Micronodular or ◦ Macronodular Progressive loss of liver function Portal hypertension
- 24. Assymptomatic Upper abdominal discormfort Anorexia nausea vomiting, weight loss Weakness and fatigue Hepatomegally, splenomegally Features of portal hypertension Features of hepatic insufficiency
- 25. Features portal hypertension ◦ Splenomegally ◦ Oesophageal varices ◦ Rectal varices ◦ Dilated anterior abdominal wall veins ◦ Feto-hepaticus ◦ Ascites
- 26. Features of hepatic insufficiency ◦ Oedema and ascites ◦ Jaundice ◦ Hepatic encephalopathy ◦ Bleeding ◦ Hypoglycemia ◦ Loss of libido, hair loss ◦ Men: gynaecomastia, testicular atrophy, impotence ◦ Women: breast atrophy, irregular menses, amenorrhoea
- 27. Other features ◦ Spider telangiectasia, ◦ Palmar erythema, ◦ Digital clubbing, ◦ Dupuytren's contracture
- 28. Treat the underlying cause Avoid precipitants Nutritional support Treatment of complications ◦ Ascites Tapping Diuretics ◦ Encephalopathy Shunting Gut sterilisation; aminosidine, neomycin ◦ Variceal bleeding Sclerotherapy Nifedipine ◦ Coagulopathy Vitamin K
- 30. Thanks