The liver is the largest gland in the body and performs many critical metabolic functions like carbohydrate and protein metabolism. It also plays an important role in hormone regulation, bile production, and blood clotting factor synthesis. Chronic liver disease can lead to liver fibrosis and cirrhosis over many years. Cirrhosis is characterized by liver scarring and nodule formation, resulting in loss of liver function. Common causes include alcohol abuse, viral hepatitis, and non-alcoholic fatty liver disease. Complications arise due to portal hypertension and liver failure. Diagnosis involves liver biopsy or lab tests showing abnormalities in liver enzymes and clotting factors.
The document provides information about Hepatitis A and Hepatitis B viruses including:
1. Hepatitis A virus is transmitted through the fecal-oral route while Hepatitis B can be transmitted through contact with infected blood or bodily fluids.
2. Hepatitis A infection causes an acute illness that does not lead to chronic infection or liver disease. Hepatitis B can result in either an acute or chronic infection, with chronic infection putting one at risk of serious liver diseases.
3. Diagnosis of Hepatitis A is usually based on detecting IgM antibodies in serum while Hepatitis B involves blood tests to detect hepatitis B surface antigen and specific antibodies.
This document provides an overview of liver diseases. It begins with an introduction to liver anatomy and functions. It then discusses signs and symptoms of liver problems. The main types of liver diseases covered are hepatitis, cirrhosis, fatty liver diseases, and liver cancer. Diagnostic tests for liver function are also mentioned. The document concludes with some dietary recommendations for supporting liver health.
This document provides an overview of liver anatomy, functions, and diseases. It describes the liver's structure including liver cells, bile drainage system, and blood supply. The liver's key functions are metabolism, protein synthesis, storage, detoxification, and bile production. Investigation of liver diseases includes blood tests, imaging, and biopsy. Common liver diseases discussed are jaundice, cholestasis, liver failure, and cirrhosis. Cirrhosis is the end-stage of chronic liver disease and can result from infections, toxins, autoimmune conditions, and other etiologies.
The document discusses the anatomy, histology, functions and common pathologies of the liver. Key points include:
- The liver has four lobes and receives dual blood supply from the hepatic artery and portal vein. It performs many metabolic and synthetic functions.
- Common liver diseases include viral hepatitis, alcoholic liver disease and cirrhosis. Cirrhosis results from chronic liver injury and scarring that disrupts the liver architecture.
- Primary liver cancers like hepatocellular carcinoma often arise in the setting of chronic liver disease and cirrhosis. Treatment options are limited but may include transplantation or resection in early stages.
The liver is the largest organ in the body
It is located below the diaphragm in the right upper quadrant of the abdominal cavity and extended approximately from the right 5th rib to the lower border of the rib cage.
This document discusses jaundice and hyperbilirubinemia. It defines jaundice as a yellow discoloration from bile pigment deposition. Jaundice can be detected when serum bilirubin is above 2-2.5 mg/dL. Bilirubin is produced from the breakdown of hemoglobin and exists in unconjugated and conjugated forms. Elevated bilirubin can be caused by overproduction, impaired hepatic uptake or excretion, or biliary obstruction. Evaluation involves liver and biliary imaging and lab tests of liver and biliary function. Stable patients may be discharged with follow up, while those with signs of failure or obstruction typically need admission.
This document discusses diabetic nephropathy, which is kidney damage caused by diabetes. It begins with an introduction on the increasing prevalence of diabetes in India and how about 25-40% of diabetics develop end stage renal disease or chronic kidney disease. The natural history of kidney disease progression through 5 stages is described from early increased filtration to end stage requiring dialysis or transplant. Risk factors, screening methods, management including controlling blood glucose and blood pressure, and treatment options like dialysis and transplant are covered.
The document provides information about Hepatitis A and Hepatitis B viruses including:
1. Hepatitis A virus is transmitted through the fecal-oral route while Hepatitis B can be transmitted through contact with infected blood or bodily fluids.
2. Hepatitis A infection causes an acute illness that does not lead to chronic infection or liver disease. Hepatitis B can result in either an acute or chronic infection, with chronic infection putting one at risk of serious liver diseases.
3. Diagnosis of Hepatitis A is usually based on detecting IgM antibodies in serum while Hepatitis B involves blood tests to detect hepatitis B surface antigen and specific antibodies.
This document provides an overview of liver diseases. It begins with an introduction to liver anatomy and functions. It then discusses signs and symptoms of liver problems. The main types of liver diseases covered are hepatitis, cirrhosis, fatty liver diseases, and liver cancer. Diagnostic tests for liver function are also mentioned. The document concludes with some dietary recommendations for supporting liver health.
This document provides an overview of liver anatomy, functions, and diseases. It describes the liver's structure including liver cells, bile drainage system, and blood supply. The liver's key functions are metabolism, protein synthesis, storage, detoxification, and bile production. Investigation of liver diseases includes blood tests, imaging, and biopsy. Common liver diseases discussed are jaundice, cholestasis, liver failure, and cirrhosis. Cirrhosis is the end-stage of chronic liver disease and can result from infections, toxins, autoimmune conditions, and other etiologies.
The document discusses the anatomy, histology, functions and common pathologies of the liver. Key points include:
- The liver has four lobes and receives dual blood supply from the hepatic artery and portal vein. It performs many metabolic and synthetic functions.
- Common liver diseases include viral hepatitis, alcoholic liver disease and cirrhosis. Cirrhosis results from chronic liver injury and scarring that disrupts the liver architecture.
- Primary liver cancers like hepatocellular carcinoma often arise in the setting of chronic liver disease and cirrhosis. Treatment options are limited but may include transplantation or resection in early stages.
The liver is the largest organ in the body
It is located below the diaphragm in the right upper quadrant of the abdominal cavity and extended approximately from the right 5th rib to the lower border of the rib cage.
This document discusses jaundice and hyperbilirubinemia. It defines jaundice as a yellow discoloration from bile pigment deposition. Jaundice can be detected when serum bilirubin is above 2-2.5 mg/dL. Bilirubin is produced from the breakdown of hemoglobin and exists in unconjugated and conjugated forms. Elevated bilirubin can be caused by overproduction, impaired hepatic uptake or excretion, or biliary obstruction. Evaluation involves liver and biliary imaging and lab tests of liver and biliary function. Stable patients may be discharged with follow up, while those with signs of failure or obstruction typically need admission.
This document discusses diabetic nephropathy, which is kidney damage caused by diabetes. It begins with an introduction on the increasing prevalence of diabetes in India and how about 25-40% of diabetics develop end stage renal disease or chronic kidney disease. The natural history of kidney disease progression through 5 stages is described from early increased filtration to end stage requiring dialysis or transplant. Risk factors, screening methods, management including controlling blood glucose and blood pressure, and treatment options like dialysis and transplant are covered.
Cirrhosis of the liver is a chronic disease characterized by the replacement of normal liver tissue with scar tissue. Once cirrhosis develops, the damage to the liver is irreversible and can lead to liver failure, complications, liver cancer and death. Cirrhosis has many causes, including chronic alcohol abuse, viral hepatitis, fatty liver disease, and genetic or autoimmune conditions. Treatment focuses on managing symptoms, avoiding alcohol, treating the underlying cause if possible, and monitoring for complications of liver failure.
Disorders of the renal functions, including anatomy and physiology, acute kidney injury, chronic kidney disease, glomerular disease, nephrolithiasis, polyuria, renal acidosis and HIV-associated nephropathy (HIVAN).
This document discusses the functions and tests used to assess the liver. It outlines the excretory, synthetic, metabolic, detoxification and storage functions of the liver. It then describes various tests used to evaluate the excretory function including serum bilirubin levels, urine and fecal tests. Liver enzymes are discussed to assess hepatic injury including AST, ALT, ALP, GGT and 5'NT. Tests of synthetic and metabolic functions include total serum proteins, albumin and PT. Causes and significance of changes in these tests are summarized.
This document defines various components of the biliary system including bile, bile salts, and bile acids. It describes bile acid metabolism and the enterohepatic circulation. It discusses cholestasis, approaches to diagnosing a patient with cholestasis, and various causes of cholestasis including gallstones. It describes the pathophysiology, risk factors, clinical features, diagnosis, and treatment of gallstone disease. It also discusses other biliary diseases and conditions such as primary sclerosing cholangitis, biliary strictures, and biliary dyskinesia.
The document discusses liver function tests and bilirubin metabolism. It describes that liver function tests are useful for diagnosing and monitoring liver diseases. A battery of tests are needed since the liver has diverse functions including excretion, metabolism, protein and plasma synthesis, and storage. Specific tests mentioned include liver enzymes, albumin, prothrombin time, tumor markers, bilirubin, and dye excretion tests. The types of jaundice - hemolytic, obstructive, and hepatic - are distinguished based on conjugated and unconjugated bilirubin levels as well as other factors. Various inborn errors affecting bilirubin metabolism are also outlined.
The liver performs many vital functions including filtering and storing blood, metabolizing carbohydrates, proteins and fats, forming bile, storing vitamins and iron, and forming blood clotting factors. It is composed of lobules made up of hepatic plates and sinusoids that filter blood from the gastrointestinal tract and hepatic artery. The liver regulates blood glucose, produces cholesterol and proteins, and detoxifies drugs and hormones before excretion. Bilirubin is formed from hemoglobin breakdown and conjugated in the liver before excretion in bile and intestines.
Fatty liver, or hepatic steatosis, refers to excess triglyceride accumulation in liver cells. This can be caused by increased fatty acid mobilization from adipose tissue, excess fatty acid synthesis in the liver, or reduced removal of fat from the liver. Common causes include obesity, uncontrolled diabetes, high-fat diet, alcoholism, and deficiencies in lipotropic factors like choline, betaine, and inositol. Untreated, fatty liver can progress to non-alcoholic steatohepatitis and fibrosis or cirrhosis of the liver.
The document summarizes renal physiology and kidney function. It discusses:
1) The structure of the kidney including nephrons, collecting ducts, and microvasculature. Nephron number is established prenatally and cannot be replaced if lost.
2) Urine formation through selective retention and elimination of solutes and water by different nephron segments including the glomerulus, proximal tubule, loop of Henle, and collecting ducts.
3) Causes, types (prerenal, intrarenal, postrenal), phases, prevention and management of acute renal failure and end-stage renal disease where dialysis or transplantation is needed for survival.
This document discusses liver function tests (LFTs), which assess the liver's metabolic, synthetic, excretory and detoxification functions. LFTs include tests of bilirubin, bile salts, aminotransferases, alkaline phosphatase, lactate dehydrogenase, ammonia, cholesterol and coagulation factors. Elevations in aminotransferases generally indicate liver injury, while alkaline phosphatase and gamma-glutamyl transferase indicate cholestasis or bile duct injury. Interpretation of LFTs can help diagnose liver diseases and assess disease severity. Limitations include lack of specificity and inability to fully assess liver function.
Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions, such as hepatitis and chronic alcoholism.
This document provides information on liver pathology and disease. It begins with the anatomy and functions of the liver. It then discusses various liver diseases including hepatic injury, cirrhosis, hepatitis, and tumors. It also provides in-depth descriptions of jaundice, portal hypertension, and hepatic encephalopathy - discussing their causes, signs/symptoms, investigations, and treatments. The document is an informative overview of liver conditions and diseases.
The document discusses various liver function tests that can help evaluate liver health. Tests that detect liver cell injury include alanine transaminase (ALT) and aspartate transaminase (AST), which are released when the liver cell membrane is damaged. Elevated levels of these enzymes suggest hepatocellular damage. Tests that indicate cholestasis and obstruction of bile flow include alkaline phosphatase, 5' nucleotidase, and leucine aminopeptidase. The ratio of AST to ALT can help differentiate conditions such as alcoholic liver disease. Together these tests provide insight into liver synthetic, metabolic and detoxification functions.
Renal hypertension is high blood pressure caused by kidney disease. It can be caused by renal stenosis where the renal arteries narrow, decreasing blood flow to the kidneys, or chronic glomerulonephritis where inflammation damages the glomeruli. This causes increased renal vascular resistance and decreased glomerular filtration, stimulating the renin-angiotensin system which increases blood pressure. Investigations include blood and urine tests, ultrasound, CT scan, and biopsy. Treatments depend on the cause but may include angioplasty, stenting, medications, or controlling blood pressure and protein intake.
This document provides an overview of liver disease, including the anatomy and blood flow of the liver, histology, cirrhosis, and complications of liver disease such as portal hypertension, ascites, and hepatocellular carcinoma. It also discusses the evaluation and scoring of liver disease severity, as well as nutrition recommendations for patients with liver disease. Key points covered include maintaining adequate protein intake while limiting salt and, in some cases, fat and carbs depending on the stage of liver disease.
1) The document discusses the pathophysiology of diarrhea including the 6 main mechanisms: secretory, osmotic, decreased motility, infection, decreased surface area, and mucosal invasion.
2) It provides examples of specific causes of infectious diarrhea by various viral, bacterial and parasitic organisms and their virulence properties.
3) Oral rehydration therapy is described as the most effective treatment for diarrhea to prevent dehydration. The improved reduced osmolarity ORS formula introduced in 2004 by WHO/UNICEF is highlighted for its additional clinical benefits over the original ORS solution.
The document discusses diseases of the liver. It begins by describing the liver's location and functions, including producing bile to aid digestion and regulating biochemical reactions. It then discusses the liver's blood supply, biliary flow, synthesis, breakdown, detoxification, protein synthesis, and glycogen regulation. Key clinical diseases are then outlined, such as alcoholic liver disease, hepatotoxicity from drug overdoses, and hepatic failure. Guidelines for ICD-10-CM coding of various liver diseases are provided.
This document discusses the clinical evaluation of liver disease through history, examination, and liver function tests. It describes taking a thorough history including risk factors. Physical exam may reveal non-specific findings or signs of liver dysfunction. Liver function tests can detect hepatocellular injury, assess protein synthesis, and evaluate cholestatic disorders through standard lab tests, quantitative tests, blood flow measurements, and radiologic/endoscopic methods. Normal ranges are provided for common liver enzymes and proteins.
Gastro esophageal Reflux Disease (GERD) and its managementDr. Ankit Gaur
In this presentation I have tried to explain in brief about gastro esophageal Reflux Disease (GERD), its etiology, risk factors, diagnosis, and its management via pharmacotherapy.
The document discusses the anatomy, physiology, and various disorders that can affect the small intestine, including Crohn's disease, intestinal tuberculosis, intestinal ameobiasis, Campylobacter infection, Salmonellosis, diverticula, mesenteric ischemia, intestinal fistulas, Celiac disease, bacterial overgrowth, and neoplasms. It provides details on the pathogenesis, clinical features, investigations, and management of these small intestinal disorders. The document also compares ulcerative and hyperplastic forms of intestinal tuberculosis and discusses conditions like Meckel's diverticulum, intestinal tumors, and Peutz-Jeg
Cirrhosis of the liver is a chronic, progressive disease characterized by widespread scarring (fibrosis) and nodule formation in the liver. It occurs when normal blood flow and bile production in the liver are disrupted by scarring. Common causes include chronic alcohol use, hepatitis B/C, autoimmune disorders, and genetic conditions. Symptoms include fatigue, abdominal pain, jaundice, easy bruising, and fluid retention. Diagnosis involves blood tests, imaging, and liver biopsy. Treatment focuses on managing complications through diet, medications, procedures, and potentially transplantation.
Fulminant hepatic failure is an acute condition characterized by a rapid loss of liver function over a period of less than 8 weeks. It can result from viral infections, drug toxicity, autoimmune conditions, and other etiologies. Clinically, it presents with jaundice, coagulopathy, encephalopathy, and multi-organ dysfunction as the liver loses its ability to carry out important functions like metabolizing toxins and producing proteins. Treatment focuses on managing complications, reversing precipitating factors, and potentially liver transplantation if the liver fails to recover.
Cirrhosis of the liver is a chronic disease characterized by the replacement of normal liver tissue with scar tissue. Once cirrhosis develops, the damage to the liver is irreversible and can lead to liver failure, complications, liver cancer and death. Cirrhosis has many causes, including chronic alcohol abuse, viral hepatitis, fatty liver disease, and genetic or autoimmune conditions. Treatment focuses on managing symptoms, avoiding alcohol, treating the underlying cause if possible, and monitoring for complications of liver failure.
Disorders of the renal functions, including anatomy and physiology, acute kidney injury, chronic kidney disease, glomerular disease, nephrolithiasis, polyuria, renal acidosis and HIV-associated nephropathy (HIVAN).
This document discusses the functions and tests used to assess the liver. It outlines the excretory, synthetic, metabolic, detoxification and storage functions of the liver. It then describes various tests used to evaluate the excretory function including serum bilirubin levels, urine and fecal tests. Liver enzymes are discussed to assess hepatic injury including AST, ALT, ALP, GGT and 5'NT. Tests of synthetic and metabolic functions include total serum proteins, albumin and PT. Causes and significance of changes in these tests are summarized.
This document defines various components of the biliary system including bile, bile salts, and bile acids. It describes bile acid metabolism and the enterohepatic circulation. It discusses cholestasis, approaches to diagnosing a patient with cholestasis, and various causes of cholestasis including gallstones. It describes the pathophysiology, risk factors, clinical features, diagnosis, and treatment of gallstone disease. It also discusses other biliary diseases and conditions such as primary sclerosing cholangitis, biliary strictures, and biliary dyskinesia.
The document discusses liver function tests and bilirubin metabolism. It describes that liver function tests are useful for diagnosing and monitoring liver diseases. A battery of tests are needed since the liver has diverse functions including excretion, metabolism, protein and plasma synthesis, and storage. Specific tests mentioned include liver enzymes, albumin, prothrombin time, tumor markers, bilirubin, and dye excretion tests. The types of jaundice - hemolytic, obstructive, and hepatic - are distinguished based on conjugated and unconjugated bilirubin levels as well as other factors. Various inborn errors affecting bilirubin metabolism are also outlined.
The liver performs many vital functions including filtering and storing blood, metabolizing carbohydrates, proteins and fats, forming bile, storing vitamins and iron, and forming blood clotting factors. It is composed of lobules made up of hepatic plates and sinusoids that filter blood from the gastrointestinal tract and hepatic artery. The liver regulates blood glucose, produces cholesterol and proteins, and detoxifies drugs and hormones before excretion. Bilirubin is formed from hemoglobin breakdown and conjugated in the liver before excretion in bile and intestines.
Fatty liver, or hepatic steatosis, refers to excess triglyceride accumulation in liver cells. This can be caused by increased fatty acid mobilization from adipose tissue, excess fatty acid synthesis in the liver, or reduced removal of fat from the liver. Common causes include obesity, uncontrolled diabetes, high-fat diet, alcoholism, and deficiencies in lipotropic factors like choline, betaine, and inositol. Untreated, fatty liver can progress to non-alcoholic steatohepatitis and fibrosis or cirrhosis of the liver.
The document summarizes renal physiology and kidney function. It discusses:
1) The structure of the kidney including nephrons, collecting ducts, and microvasculature. Nephron number is established prenatally and cannot be replaced if lost.
2) Urine formation through selective retention and elimination of solutes and water by different nephron segments including the glomerulus, proximal tubule, loop of Henle, and collecting ducts.
3) Causes, types (prerenal, intrarenal, postrenal), phases, prevention and management of acute renal failure and end-stage renal disease where dialysis or transplantation is needed for survival.
This document discusses liver function tests (LFTs), which assess the liver's metabolic, synthetic, excretory and detoxification functions. LFTs include tests of bilirubin, bile salts, aminotransferases, alkaline phosphatase, lactate dehydrogenase, ammonia, cholesterol and coagulation factors. Elevations in aminotransferases generally indicate liver injury, while alkaline phosphatase and gamma-glutamyl transferase indicate cholestasis or bile duct injury. Interpretation of LFTs can help diagnose liver diseases and assess disease severity. Limitations include lack of specificity and inability to fully assess liver function.
Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions, such as hepatitis and chronic alcoholism.
This document provides information on liver pathology and disease. It begins with the anatomy and functions of the liver. It then discusses various liver diseases including hepatic injury, cirrhosis, hepatitis, and tumors. It also provides in-depth descriptions of jaundice, portal hypertension, and hepatic encephalopathy - discussing their causes, signs/symptoms, investigations, and treatments. The document is an informative overview of liver conditions and diseases.
The document discusses various liver function tests that can help evaluate liver health. Tests that detect liver cell injury include alanine transaminase (ALT) and aspartate transaminase (AST), which are released when the liver cell membrane is damaged. Elevated levels of these enzymes suggest hepatocellular damage. Tests that indicate cholestasis and obstruction of bile flow include alkaline phosphatase, 5' nucleotidase, and leucine aminopeptidase. The ratio of AST to ALT can help differentiate conditions such as alcoholic liver disease. Together these tests provide insight into liver synthetic, metabolic and detoxification functions.
Renal hypertension is high blood pressure caused by kidney disease. It can be caused by renal stenosis where the renal arteries narrow, decreasing blood flow to the kidneys, or chronic glomerulonephritis where inflammation damages the glomeruli. This causes increased renal vascular resistance and decreased glomerular filtration, stimulating the renin-angiotensin system which increases blood pressure. Investigations include blood and urine tests, ultrasound, CT scan, and biopsy. Treatments depend on the cause but may include angioplasty, stenting, medications, or controlling blood pressure and protein intake.
This document provides an overview of liver disease, including the anatomy and blood flow of the liver, histology, cirrhosis, and complications of liver disease such as portal hypertension, ascites, and hepatocellular carcinoma. It also discusses the evaluation and scoring of liver disease severity, as well as nutrition recommendations for patients with liver disease. Key points covered include maintaining adequate protein intake while limiting salt and, in some cases, fat and carbs depending on the stage of liver disease.
1) The document discusses the pathophysiology of diarrhea including the 6 main mechanisms: secretory, osmotic, decreased motility, infection, decreased surface area, and mucosal invasion.
2) It provides examples of specific causes of infectious diarrhea by various viral, bacterial and parasitic organisms and their virulence properties.
3) Oral rehydration therapy is described as the most effective treatment for diarrhea to prevent dehydration. The improved reduced osmolarity ORS formula introduced in 2004 by WHO/UNICEF is highlighted for its additional clinical benefits over the original ORS solution.
The document discusses diseases of the liver. It begins by describing the liver's location and functions, including producing bile to aid digestion and regulating biochemical reactions. It then discusses the liver's blood supply, biliary flow, synthesis, breakdown, detoxification, protein synthesis, and glycogen regulation. Key clinical diseases are then outlined, such as alcoholic liver disease, hepatotoxicity from drug overdoses, and hepatic failure. Guidelines for ICD-10-CM coding of various liver diseases are provided.
This document discusses the clinical evaluation of liver disease through history, examination, and liver function tests. It describes taking a thorough history including risk factors. Physical exam may reveal non-specific findings or signs of liver dysfunction. Liver function tests can detect hepatocellular injury, assess protein synthesis, and evaluate cholestatic disorders through standard lab tests, quantitative tests, blood flow measurements, and radiologic/endoscopic methods. Normal ranges are provided for common liver enzymes and proteins.
Gastro esophageal Reflux Disease (GERD) and its managementDr. Ankit Gaur
In this presentation I have tried to explain in brief about gastro esophageal Reflux Disease (GERD), its etiology, risk factors, diagnosis, and its management via pharmacotherapy.
The document discusses the anatomy, physiology, and various disorders that can affect the small intestine, including Crohn's disease, intestinal tuberculosis, intestinal ameobiasis, Campylobacter infection, Salmonellosis, diverticula, mesenteric ischemia, intestinal fistulas, Celiac disease, bacterial overgrowth, and neoplasms. It provides details on the pathogenesis, clinical features, investigations, and management of these small intestinal disorders. The document also compares ulcerative and hyperplastic forms of intestinal tuberculosis and discusses conditions like Meckel's diverticulum, intestinal tumors, and Peutz-Jeg
Cirrhosis of the liver is a chronic, progressive disease characterized by widespread scarring (fibrosis) and nodule formation in the liver. It occurs when normal blood flow and bile production in the liver are disrupted by scarring. Common causes include chronic alcohol use, hepatitis B/C, autoimmune disorders, and genetic conditions. Symptoms include fatigue, abdominal pain, jaundice, easy bruising, and fluid retention. Diagnosis involves blood tests, imaging, and liver biopsy. Treatment focuses on managing complications through diet, medications, procedures, and potentially transplantation.
Fulminant hepatic failure is an acute condition characterized by a rapid loss of liver function over a period of less than 8 weeks. It can result from viral infections, drug toxicity, autoimmune conditions, and other etiologies. Clinically, it presents with jaundice, coagulopathy, encephalopathy, and multi-organ dysfunction as the liver loses its ability to carry out important functions like metabolizing toxins and producing proteins. Treatment focuses on managing complications, reversing precipitating factors, and potentially liver transplantation if the liver fails to recover.
This document defines and describes cirrhosis of the liver. It is a chronic, progressive disease characterized by extensive scarring and destruction of liver tissue. There are four types classified by etiology: alcoholic, postnecrotic, biliary, and cardiac. Symptoms range from mild gastrointestinal issues to later complications of liver failure like jaundice, edema, and encephalopathy. Diagnosis involves liver function tests, biopsy, and imaging. Treatment focuses on managing complications through dietary changes, diuretics, banding of varices, and sometimes shunt procedures. Nursing care addresses symptoms, nutrition, skin integrity, and risk for bleeding.
The document provides information on the anatomy, physiology, and pathologic conditions of the spleen. It discusses the spleen's development, location, vasculature, and functions including filtering blood and immune roles. Secondary hypersplenism is defined as being caused by an underlying disease like disorders of splenic blood flow, hematopoietic disorders, immune disorders, infiltrative disorders, infections, or neoplasms. Specific conditions discussed in detail include hereditary spherocytosis, idiopathic thrombocytopenic purpura, myeloid metaplasia, and splenic abscess.
This document discusses the anatomy, functions, and disorders of the liver and biliary system. It provides details on:
- The liver's role in producing bile to aid digestion, regulating blood clotting factors, filtering toxins, and storing vitamins and minerals.
- The structure of the liver including lobules, hepatocytes, blood supply from the hepatic artery and portal vein, and bile duct network.
- Common liver disorders like hepatitis, cirrhosis, cancer, and how they impact liver function and cause symptoms like jaundice, abdominal pain, and fatigue.
- Tests used to evaluate liver function such as albumin, prothrombin time, and transaminase levels.
The document provides an overview of liver disease, including:
1) Jaundice and cholestasis which can occur due to increased bilirubin production, decreased uptake by hepatocytes, or impaired excretion.
2) Liver failure which can be acute or chronic, and results in hepatic encephalopathy, coagulopathy, and other systemic effects.
3) Cirrhosis, defined as diffuse liver scarring leading to regenerative nodules and altered vasculature, with complications including liver failure, portal hypertension, ascites, and hepatocellular carcinoma.
The document provides information about cirrhosis of the liver. It defines cirrhosis as a chronic, progressive disease characterized by diffuse damage to liver cells with fibrosis and nodular regeneration. Cirrhosis results in the loss of the liver's normal lobular architecture and the formation of scar tissue and regenerative nodules. Common causes include alcohol abuse, viral hepatitis, and other conditions that result in chronic liver inflammation. Patients may experience complications such as ascites, variceal bleeding, jaundice, and hepatic encephalopathy as the disease progresses. Diagnosis involves clinical examination, lab tests, imaging and sometimes liver biopsy. Treatment focuses on managing complications and the underlying cause.
Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions, such as hepatitis and chronic alcoholism
The pancreas is a glandular organ that produces hormones and digestive enzymes. It is located behind the stomach and connected to nearby organs. Under a microscope, it contains clusters of endocrine cells that produce hormones like insulin and clusters of exocrine cells that produce digestive enzymes. The enzymes help digest carbohydrates, proteins, and lipids in the small intestine. Diseases like chronic pancreatitis, cystic fibrosis, and pancreatic cancer can impair the pancreas's functioning and cause digestive issues. Treatment involves enzyme supplements, diet changes, and surgery in some cases.
The document discusses the anatomy, physiology, and common diseases of the liver. It begins with a brief history of liver surgery and anatomy including liver innervation and lymph drainage. It then covers liver physiology including metabolism of nutrients, proteins, and drugs. Common liver diseases are summarized such as viral hepatitis, alcohol-related disease, cirrhosis, portal hypertension, and liver cancer. Specific conditions like fatty liver disease, jaundice, acute liver failure, and infections are also reviewed. Imaging findings and treatments for various benign and malignant liver lesions are mentioned.
Cirrhosis is scarring of the liver caused by long-term liver damage and inflammation. It is irreversible and can develop from conditions like hepatitis, alcoholism, and genetic disorders. As fibrosis worsens and liver tissue is replaced by scar tissue, it loses its normal structure and function. Late-stage cirrhosis complications include jaundice, ascites, bleeding, and liver failure. While cirrhosis cannot be cured, treatments focus on managing complications and underlying causes through lifestyle changes and medications. In some severe cases, liver transplantation may be required to survive.
Cirrhosis is scarring of the liver caused by long-term liver damage and injury. It is characterized by the replacement of liver tissue with fibrous scar tissue and regenerative nodules, leading to loss of liver function. Common causes include alcoholism, hepatitis B/C infection, and non-alcoholic fatty liver disease. Symptoms may include abdominal pain, jaundice, easy bruising, fluid retention, and hepatic encephalopathy. Treatment focuses on managing complications, treating the underlying cause if possible, and liver transplantation for end-stage disease. Homeopathic remedies like Nux Vomica, Phosphorus, and Bryonia can help manage symptoms in some cases.
Medical Surgical Nursing - I
UNIT: IV -Nursing Management of Patients With Disorder of Digestive System "Cirrhosis of liver"
the topic covers
- the stages, Pathophysiology and clinical manifestation of Cirrhosis of liver
- diagnostic evaluation and complication of Cirrhosis of liver
- medical, surgical and nursing management of patient with Cirrhosis of liver
The liver performs many vital functions: (1) It filters blood from the digestive system and removes toxins. (2) It regulates carbohydrate and fat metabolism, storing glucose and producing cholesterol. (3) It synthesizes proteins and aids in protein metabolism, forming urea to remove ammonia from the body. The liver's high blood flow and unique lobule structure enable these diverse metabolic roles.
lungs ,their structure, diseases,diagnoaiS and treatmentShivaDeepak3
The liver is a vital organ located in the upper right side of the abdomen. It performs over 500 functions including detoxification, protein synthesis, and production of biochemicals and bile. The liver filters blood from the digestive tract and breaks down toxins. Heavy alcohol use can lead to fatty liver, inflammation, and cirrhosis as the liver breaks down ethanol into toxic compounds. Chronic alcohol consumption is a major risk factor for liver disease.
The document provides information on liver anatomy, physiology, and functions. It also discusses causes of liver disease including dietary deficiencies, infectious agents like hepatitis viruses, toxic agents like alcohol and drugs, and inborn errors of metabolism. Specific conditions discussed include fatty liver disease (NAFLD), hepatitis, gallbladder conditions like cholecystitis, and bile duct inflammation (cholangitis). Diet and lifestyle factors are presented for managing conditions like NAFLD and viral hepatitis.
It was one of my presentation for my master's in pharmacy. It assisted me in better understanding the many pharmacy research fields as well as what to do before, during, and following a research project. I am hoping that it will also provide the readers a better understanding of the fascinating world of research.
It was an assignment of mine when i was undergraduate, studying at Gono Bishwabidyalay. this assignment contains:
Introduction, Definitions, Unique characteristics, categories, routes, advantages and dis-advantages.
On insulin part i focused on:
Introduction, different formulations of insulin, injectable insulin preparation, methods of insulin preparation, quality control of insulin, quality control parameter, common quality control tests, packaging and packaging materials..
COVID-19:
Introduction
immunosenescence, ARDS,
Hyperinflammation and mortality
Cytokine storm , Inflammatory storm,
Treatment of COVID-19,
Acalabrunitib, Tocilizumab, Anakinra and Itolizumab,
Roleof itolizumab in suppressing the cytokine storm.
Approval status of Itolizumab.
Treatment with the anti-CD6 MAb Itolizumab.
Current status of itolizumab in the treatment of COVID-19,
Common side effects of itolizumab.
Expert opinion
Biopharmaceutics & Pharmacokinetics (Ultimate final note)MdNazmulIslamTanmoy
Intravenous Infusion (IV): Define intravenous infusion. Write down advantages and disadvantages of intravenous infusion,
Write down the pharmacokinetics of IV infusion, Calculate the plasma drug concentration at steady-state after IV infusion, Determine the half life (t1/2) by IV infusion method, Show that in case of IV infusion the time to reach 99% steady-state is 6.65 t1/2.
Multiple-Dosage Regimens: Write a short note on Multiple-Dosage Regimens. What are the basic considerations for multiple dosage regimen?, What are the purposes of multiple-dosage regimens (MDR)? Write down the importance of MDR, Write short note on repetitive intravenous injections, Prove that C∞av is not arithmetic average of C∞max and C∞min, Give brief description on superposition principle and Plateau principle?.
Individualization: Write down about individualization of drug dosing regimen? What are the advantages of individualization? How will you optimizing dosage regimen?, What are the sources of variability in drug response? What are the causes of Inter subject Pharmacokinetics Variability? Write down the steps involved in individualization of dosage regimen?, Write short note on – dosing of drug in obese patient and also discuss about dosing of drug in neonates, infants and children?, Write down about dosing of drug in elderly and hepatic disease? Give some examples of drugs who's conc. Changes due to hepatic impairment?, Explain some clinical experience with individualization and optimization based on plasma drug levels?
NON-linear pharmacokinetics: Derive the Michaelis-Menten Equation or Non-Liner pharmacokinetic and Linear pharmacokinetic model, Define non-linear pharmacokinetics. Why it is called dose dependent pharmacokinetics?, Why Michaelis-Menten equation is termed as mixed order kinetics?, A given drug is metabolized by capacity-limited pharmacokinetics. Assume KM is 50훍g/mL, Vmax is 20훍g/mL per hour and apparent VD is 20 L/kg, Differentiate between linear & non-linear Pharmacokinetics.
Non-compartment model: Briefly describe compartment model?, Briefly describe non-compartment model?, What is MRT? Write down the importance of MRT?, What is MAT? Write down the importance of MAT?, Compare between compartment model and non-compartment models.
Carcinogenesis
Theories of carcinogenesis
Hallmarks of cancer
Important Oncogenes
RB & p53 genes
Metastasis
Aetiology and Pathogenesis of cancer
Tests for carcinogenicity
How to repair damaged DNA?
Basic DNA repair mechanism
Repair of double stranded break
Hydrogels,
introduction,
historical background,
properties,
classification,
difference between chemical and physical hydrogels,
common uses,
pharmaceutical applications,
preparation methods,
list of monomers used,
analytical machines,
advantages,
disadvantages,
conclusion
Spermatogenesis steps, hormonal regulation and abnormalitiesMdNazmulIslamTanmoy
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E. Salt form of the drug
F. Lipophilicity of the drug
pH partition theory
Assumption of PH partition theory
Diagram showing the transfer of drug across the membrane
Limitations of pH-partition hypothesis
(Q.U): Mathematical problem
Formulation factors affecting drug availability
First pass effect
Gastric emptying time
Gastrointestinal motility
Short note on Gastric emptying and motility
Physicochemical factors affecting drug absorption
A. Drug solubility and dissolution rate
B. Particle size and surface area of drugs
C. Polymorphism and amorphism
D. Hydrate or solvates
Biopharmaceutical classification system of drug
This document introduces physiological factors influencing drug availability, including the circulatory system and mechanisms of drug absorption across membranes. The circulatory system transports nutrients, oxygen, and wastes through the heart, blood, and vessels. There are three types of circulation: systemic circulation carries oxygenated blood from the heart to cells and back, pulmonary circulation moves deoxygenated blood between the heart and lungs, and portal circulation transports blood from the intestines to the liver. Drug absorption is influenced by membrane physiology, with mechanisms including carrier-mediated transport like active transport against gradients and facilitated diffusion, as well as non-carrier mediated simple diffusion down concentration gradients.
This document introduces concepts related to biopharmaceutics including Fick's first law of diffusion, gastrointestinal physiology, and the relationship between drug products and their pharmacological action. It defines key terms such as absorption, distribution, metabolism, and excretion. Fick's first law states that the rate of diffusion across a membrane is proportional to the difference in drug concentration on each side. The document also describes the anatomy and protective mucous layer of the gastrointestinal tract, and explains that orally administered drugs must dissolve before being absorbed and distributed throughout the body, where they may act, be stored, metabolized, or excreted.
ADRs
Classifications of ADRs
Thompson and DoTS system classification
Factors: age, gender, Co-morbidities, ethnicity, Pharmacogenetics,G6PD deficiency, porphyrias
Immunological reactions
Classifications
Epidemiology and pharmacovigilance of ADRs
Yellow card scheme,
Thalidomide tragedy
Factors that may raise or suppress suspicion of a drug
HPLC
Chromatography
Mobile Phase & Stationary Phase
CLASSIFICATION OF CHROMATOGRAPHY
Characteristics of HPLC
Purpose
Superiority of HPLC
TYPES OF HPLC TECHNIQYES
Principle
PHASING SYSTEM & (normal vs reversed phase)
INSTRUMENTATION
Flow diagram of HPLC instrument
Advantages of HPLC
Healthy Eating Habits:
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Benefits of Regular Exercise:
Physical Benefits: Discusses how exercise aids in weight management, muscle and bone health, cardiovascular health, and flexibility.
Mental Benefits: Explains the psychological advantages, including stress reduction, improved mood, and better sleep.
Tips for Staying Active:
Encourages consistency, variety in exercises, setting realistic goals, and finding enjoyable activities to maintain motivation.
Maintaining a Balanced Lifestyle:
Integrating Nutrition and Exercise: Suggests meal planning and incorporating physical activity into daily routines.
Monitoring Progress: Recommends tracking food intake and exercise, regular health check-ups, and provides tips for achieving balance, such as getting sufficient sleep, managing stress, and staying socially active.
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Stem Cell Solutions: Dr. David Greene's Path to Non-Surgical Cardiac Care
Liver & Liver Diseases
1. 1
LIVER
• It is the largest gland in the body (about 2.5% of the body mass in adults).
i.e. 1500 gm
• Receives blood 25% of cardiac output.
• In the late fetus in which it also serves as a hematopoietic organ, it is
proportionately twice as large (5% of body weight). From early childhood
onward, it occupies almost all of the right hypochondrium and epigastrium.
• In adults: the liver lies in the right hypochondrium, epigastrium, and left
hypochondrium.
• In normal individuals, it should not be palpable below the right costal
margin.
Functions of the Liver:
• Metabolic
• Storage
• Excretory / Secretory
• Protective
• Circulatory
• Coagulation
Metabolic Functions:
➢ Carbohydrate metabolism
• Gluconeogenesis (the synthesis of glucose from certain amino acids,
lactate or glycerol)
• Glycogenolysis and glycogenesis (breakdown of glycogen to glucose /
formation of glycogen from glucose)
➢ Hormone metabolism
➢ Synthesis of fatty acids, lipoproteins, cholesterol
➢ Ketogenesis (breakdown of keytones to fats)
➢ Protein Metabolism
➢ Synthesis of plasma proteins (albumin, globulin, fibrinogen)
➢ Urea synthesis (ammonia to urea)
➢ Red blood cell production (In the first trimester of the fetus)
2. 2
Storage Functions:
• Glycogen
• Vitamins A, D, E, K (fat soluble) B12 (water soluble)
• Iron
• Copper
Excretory / Secretory:
• Bile
- Water
- Cholesterol
- Bile pigments (Bilirubin and Biliverdin)
- Anions of the Bile acids
- Phospholipids (mainly lecithin)
- Bicarbonate and other ions
• Insulin-like Growth Factor 1 (IGF-1)
• Most blood proteins (save antibodies) are synthesis and therefore
secreted by the liver
• Cholesterol, fatty acids (via lipoproteins)
Protective Function
• Purification, Transformation, and Clearance - The liver removes harmful
substances (such as ammonia and toxins) from the blood and then breaks
them down or transforms them into less harmful compounds. In addition,
the liver metabolizes most hormones and ingested drugs to either more or
less active products.
• Kupffer cells - ingest bacteria or other foreign material from the blood
Circulatory Function
• While the liver is technically part of the gastrointestinal system, it also plays
an important role in blood circulation. The liver has been called the
"antechamber of the heart" because it collects and processes all of the
gastrointestinal blood through the portal vein and delivers it to the right
3. 3
side of the heart. The liver receives blood through two vascular systems,
the portal vein and hepatic artery.
Coagulator Functions
➢ Production and secretion of coagulation factors
- fibrinogen I
- prothrombin II
- Factors (V, VII, IX, X, XI)
- protein C
- protein S
- antithrombin.
Common causes of liver disease:
• Alcoholic liver disease
• Chronic viral hepatitis- C or B
• Non-alcoholic steatohepatitis (NASH)
• Autoimmune diseases: autoimmune hepatitis.
• Cholestatic liver disease: PBC & PSC
• Metabolic and genetic:
- Wilson disease
- hemochromatosis,
- alpha 1- antitrypsin deficiency
• Cystic fibrosis
Liver fibrosis: Fibrosis is the formation of an abnormally large amount of scar
tissue in the liver. It occurs when the liver attempts to repair and replace
damaged cells. Many conditions can damage the liver. Fibrosis itself causes no
symptoms, but severe scarring can result in cirrhosis, which can cause symptoms.
Liver Cirrhosis
• Cirrhosis of liver is a chronic, progressive disease characterized by
widespread fibrosis (scarring) and nodule formation.
• The development of cirrhosis is. insidious, prolonged course, usually
after decades of chronic liver disease.
4. 4
• Cirrhosis is a consequence of. chronic liver disease, characterized by
replacement of liver tissue by fibrosis, scar tissue and regenerative
nodules leading to loss of liver function.
Causes:
- Chronic alcohol abuse
- Chronic viral hepatitis ( Hep B, Hep C)
- Non-alcoholic fatty liver disease
Types of Cirrhosis:
a. Alcoholic Cirrhosis (Laennec's Cirrhosis)
- micronodular, portal cirrhosis.
- Men are more likely to have alcoholic cirrhosis.
- Fibrosis occurs mainly around central veins and portal areas.
- It is associated with chronic alcoholic abuse.
- Small nodules forms as a result of some offending agent.
b. Post-necrotic cirrhosis
- Late result of a previous bout of acute viral hepatitis
- Macronodular cirrhosis, toxin-induced cirrhosis.
- Most common worldwide form.
- Broad bands of scar tissue.
- Caused by post-acute viral B, C hepatitis, Post intoxication with
industrial chemicals.
- More common in women.
c. Biliary cirrhosis
- Scaring around bile ducts and lobes of the liver.
- It results from chronic biliary injury and obstruction of the intrahepatic
or extrahepatic biliary system.
- Primary biliary cirrhosis and Primary Sclerosing Cholangitis are biliary
causes of cirrhosis.
d. Cardiac cirrhosis
- It is rare.
- It is chronic liver disease associated with long term severe right sided
heart failure.
5. 5
- It is caused by AV valve disease, constrictive pericarditis
Stages of liver Cirrhosis:
Formatin of fibrosis :
Fibrosis is the prosses mediated by these special cells called Stellate cell that sites
betwwen sinusoid and Hepatocytes known as the perisinusoidal space. At the
basic layout of the basic functional unit of the liver portal vain and hepatic artery
that combine into sinusoid which then goes into central vein and these are all line
with hepatocytes. Along these there’s bile duct (central vein+ hepatocytes+ bile
duct= Portal triad). In healthy tissue stellate cell store Vitamin-A and dormant
quiescent. When hepatocytes are injured, they secrete factors that activates and
sort of change stellate cells. When activated these cells loss Vitamin-A and start
secreting Transforming growth factor beta-1 Which then causes them to produce
collagen which is the main ingredient in extra cellular matrix gradually fibrosis
then Scar tissues. As these fibrotic tissues builds up it start to compress the
central vein in Sinusoid.
Complications:
6. 6
• Portal hypertension: Coagulopathy
• Gastroesophageal varices: Factor deficiency
• Portal hypertensive gastropathy: Fibrinolysis
• Splenomegaly, hypersplenism: Thrombocytopenia
• Ascites disease: Bone disease
• Spontaneous bacterial peritonitis: Osteopenia
• Hepatorenal syndrome: Osteoporosis
- Type 1: Osteomalacia
- Type 2 Hematologic abnormalities
• Hepatic encephalopathy Anemia
• Hepatopulmonary syndrome: Hemolysis
• Portopulmonary hypertension: Thrombocytopenia
• Malnutrition: Neutropeni
Signs and symptoms
➢ Some of the following signs and symptoms may occur in the presence of
cirrhosis or as a result of the complications of cirrhosis. Many are
nonspecific and may occur in other diseases and do not necessarily point to
cirrhosis. Likewise, the absence of any does not rule out the possibility of
cirrhosis.
➢ Spider angiomata or spider nevi.
Vascular lesions consisting of a central arteriole surrounded by many
smaller vessels due to an increase in estradiol. These occur in about 1/3 of
cases.
➢ Palmar erythema
Exaggerations of normal speckled mottling of the palm, due to altered sex
hormone metabolism.
➢ Gynecomastia
Benign proliferation of glandular tissue of male breasts presenting with a
rubbery or firm mass extending concentrically from the nipples. This is due
to increased estradiol and can occur in up to 66% of patients.
➢ Hypogonadism
7. 7
Manifested as impotence, infertility, loss of sexual drive, and testicular
atrophy due to primary gonadal injury or suppression of hypothalamic or
pituitary function.
➢ Liver size. Can be enlarged, normal, or shrunken.
➢ Splenomegaly
(increase in size of the spleen). Due to congestion of the red pulp as a
result of portal hypertension.
➢ Ascites
Accumulation of fluid in the peritoneal cavity giving rise to flank dullness
(needs about 1500 mL to detect flank dullness). It may be associated with
hydrocele and penile flomation (swelling of the penile shaft) in men.
➢ Caput medusa
In portal hypertension, the umbilical vein may open. Blood from the portal
venous system may be shunted through the periumbilical veins into the
umbilical vein and ultimately to the abdominal wall veins, manifesting as
caput medusa.
➢ Cruveilhier-Baumgarten murmur
Venous hum heard in epigastric region (on examination by stethoscope)
due to collateral connections between portal 'system and the remnant of
the umbilical vein in portal hypertension.
➢ Fetor hepaticus
Musty odor in breath due to increased dimethyl sulfide.
➢ Jaundice
Yellow discoloring of the skin, eye, and mucus membranes due to increased
bilirubin (at least 2-3 mg / dL or 30 mmol / L). Urine may also appear dark.
➢ Asterixis
Bilateral asynchronous flapping of outstretched, dorsiflexed hands seen in
patients with hepatic encephalopathy.
➢ Other Weakness, fatigue, anorexia, weight loss.
Diagnosis
• The gold standard for diagnosis of cirrhosis is a liver biopsy
8. 8
• Histologically cirrhosis can be classified as micronodular, macronodular, or
mixed, but this classification has been abandoned since it is nonspecific to
the etiology
• Diagnosis Lab findings: The following findings are typical in cirrhosis:
➢ Aminotransferases - AST and ALT are moderately elevated, with
AST> ALT. However, normal aminotransferases do not preclude
cirrhosis.
➢ Alkaline phosphatase - usually slightly elevated.
➢ GGT - correlates with AP levels. Typically much higher in chronic liver
disease from alcohol.
➢ Bilirubin - may elevate as cirrhosis progresses.
➢ Albumin - levels fall as the synthetic function of the liver declines
with worsening cirrhosis since albumin is exclusively synthesized in
the liver
➢ Prothrombin time- increases since the liver synthesizes clotting
factors.
➢ Globulins - increased due to shunting of bacterial antigens away from
the liver to lymphoid tissue.
➢ Serum sodium - hyponatremia due to inability to excrete free water
resulting from high levels of ADH and aldosterone.
➢ Thrombocytopenia - due to both congestive splenomegaly as well as
decreased thrombopoietin from the liver. However this rarely results
in platelet count <50,000 / mL.
➢ Leukopenia and neutropenia- due to splenomegaly with splenic
margination. •
➢ Coagulation defects - the liver produces most of the coagulation
factors and thus coagulopathy correlates with worsening liver
disease.
• Liver biopsy.
• Liver scan.
• Upper GI barium swallow.
• Computed tomography (CT) of the abdomen
• Magnetic resonance imaging (MRI) of the abdomen
• Ultrasound of the abdomen.
9. 9
Treatment
• All patients with cirrhosis can benefit from certain lifestyle changes,
including:
• Stop drinking alcohol.
• Limit salt in the diet.
• Get vaccinated for influenza, hepatitis A and hepatitis B, and pneumococcal
pneumonia (if recommended by doctor).
• Generally, liver damage from cirrhosis cannot be reversed, but treatment
could stop or delay further progression and reduce complications.
• A healthy diet is encouraged, as cirrhosis may be an energy-consuming
process.
• Antibiotics will be prescribed for infections, and various medications can
help with itching.
• Laxatives, such as lactulose, decrease risk of constipation.
• Alcoholic cirrhosis caused by alcohol abuse is treated by abstaining from
alcohol.
• Treatment for hepatic cirrhosis involves medications used to treat the
different types of hepatitis, such as interferon for viral hepatitis and
corticosteroids for autoimmune hepatitis.
• Liver transplant.
Viral Hepatitis
➢ Viral hepatitis is a systemic disease with primary inflammation of the liver
by any one of a heterogeneous group of hepatotropic viruses.
➢ The most common causes of viral hepatitis are the five unrelated
hepatotropic viruses Hepatitis A, Hepatitis B, Hepatitis C, Hepatitis D, and
Hepatitis E. among them Hep B & C are most common
➢ In addition to the nominal hepatitis viruses, other viruses that can also
cause liver inflammation include Herpes simplex, Cytomegalovirus, Epstein-
Barr virus, or Yellow fever.
Hepatitis B V
10. 10
• Hepatitis B (formerly known as "serum" hepatitis) is an acute systemic
infection with major pathology in the liver, caused by hepatitis B virus.
• Transmitted by the Parenteral route.
• The acute illness causes liver inflammation, vomiting, jaundice, and, rarely,
death. Chronic hepatitis B may eventually cause cirrhosis and liver cancer.
• Hepatitis B is endemic throughout the world, especially in tropical &
developing countries.
Epidemiology Determinants
➢ Agent factor
a) AGENT: Hepatitis B Virus (HBV)
- It is a complex, 42 nm double-shelled DNA virus originally known as
"Dane Particle".
- It replicates in liver cell.
HBV occurs in 3 morphology form in serum:
I. Small spherical particles with an average Diameter of 22nm.
II. Filamentous or Tubules of varying length & of 22 nm diameter.
III. Dane particle. Out of 3 morphology forms, only the Dane particle is
considered infectious, other circulating morphology forms are not
infectious.
b) RESERVOIR OF INFECTION: -Men is the only reservoir of infection which
can be spread either from carriers or from cases.
c) Infective material:
- Contaminated blood is the main source,
- Virus has been found in body secretion such as saliva, vaginal secretion &
Semen in infected material.
d) Resistance: -Readily destroyed by sodium hypochlorite, as is by heat
sterilization in an autoclave for 30-60 min.
➢ Host factor
a) AGE: -
1. Acute hepatitis B 2. Chronic hepatitis
is B
11. 11
b) High Risk Group:
- People from endemic regions
- Babies of mothers with chronic HBV
- Intravenous drug abusers
- People with multiple sex partners
- Hemophiliacs and other patients requiring blood and blood product
treatments
- Health care personnel who have contact with blood v Patients who
are immunocompromised.
c) Humoral and cellular response:
- HBV has 3 distinct antigen:
i. HBSAG, also known as "Australian antigen,
ii. HBCAG antigen (core antigen)
iii. HBeAg envelope antigen They stimulate production of corresponding
antibody.
* Incubation Period 45-180 days (usually 60-90 days)
Mode of Transmission
90% resolve by themselves;
<1% develop fulminant
hepatic failure. - occurs in
approx
2-10% progress to chronic
state. -occur in approx.
Perinatal - 1% - Perinatal -95%
Childhood - 10% (1-5 yr. Age) - Childhood -80%
Late infection - 30% (> 5 yr.
Age)
- After 5 yr. of age -5-10%
12. 12
- Parenteral- IV drug abusers, health workers are at increased risk.
- Sexual- sex workers and homosexuals are particular at risk.
- Perinatal (Vertical) mother (HBEA9 +) -infant. Mothers who are
HBeAg positive are much more likely to transmit to their offspring
than those who are not. Perinatal transmission is the main means of
transmission in high prevalence populations
Diagnosis : - Serology ;
-Liver Chemistry tests AST, ALT, ALP, and total Bilirubin
-Histology : Immunoperoxidase staining
-HBV Viral DNA : Most accurate marker of viral DNA and detected by PCR
- Liver Biopsy - to determine grade (Inflammation) and stage (Fibrosis) in chronic
Hepatitis
Prevention
➢ Vaccination - highly effective recombinant vaccines
➢ Hepatitis B Immunoglobulin (HBIG) -exposed within 48 hours of the
incident / neonates whose mothers are HBSAg and HBeAg positive.
➢ Other measures -screening of blood donors, blood and body fluid
precautions.
Treatment I
Interferon Alfa (Intron A) Response rate is 30 to 40%.
Lamivudine (Epivir HBV) (relapse, drug resistance)
Adefovir dipivoxil (Hepsera)
Hepatitis C V
➢ Hepatitis C is an infectious disease affecting primarily the liver, caused by
the hepatitis C virus (HCV). V
➢ The infection is often asymptomatic, but chronic infection can lead to
scarring of the liver and ultimately to cirrhosis, which is generally apparent
after many years.
13. 13
➢ It is estimated that 150-200 million people, or -3% of the world's
population, are living with chronic hepatitis C.
Incubation Period: 40-120 days
Mode of Transmission
• Intravenous Drug Use
• Healthcare Exposure: Blood Transfusion, transfusion of Blood products,
Organ Transplant without HCV screening carry significant risk of infection.
• Hemodialysis
• Accidental injuries with needles / sharps
• Sexual / household exposure to anti-HCV-positive contact
• Multiple sex partners
• Vertical Transmission: Vertical transmission of hepatitis C from an infected
mother to her child
Diagnosis
• HCV antibody - ELISA used to diagnose hepatitis C infection. Not useful in
the acute phase as it takes at least 4 weeks after infection before antibody
appears.
• HCV-RNA - various techniques are available eg PCR and branched DNA.
May be used to diagnose HCV infection in the acute phase. However, its
main use is in monitoring the response to antiviral therapy.
• HCV-antigen - an EIA for HCV antigen is available. It is used in the same
capacity as HCV-RNA tests but is much easier to carry out.
Prevention: Only General Prophylaxis, such as blood, tissue, organ screening, is
possible. No specific active or passive immuntizing agent is available.
Treatment: Interferon may be considered for patients with chronic active
hepatitis. The response rate is around 50% but 50% of responders will relapse
upon withdrawal of treatment.
Ribavirin - there is less experience with ribavirin than interferon. However,
recent studies suggest that a combination of interferon and ribavirin is more
effective than interferon alone.
14. 14
Alcoholic Liver Disease
Alcoholic liver disease (ALD) is a disease that goes through the hepatic
manifestations of alcohol, fatty liver, alcoholic hepatitis, and chronic hepatitis. In
other words it is cirrhosis.
Symptoms: General symptoms include: R Abdominal pain and tendemess ,Dry
mouth and increased thirst ,Loss of appetite (food),Swelling or fluid buildup in the
legs and in the abdomen when cirrhosis is present ,Weight loss
Pathology: Alcohol can produces a wide spectrum of liver disease from fatty
change to hepatitis and cirrhosis.
Treatment
Abstinence: 1) Leads to reversal of liver disease and improvement in survival.
2)Less than 20% of patients will demonstrate progression of liver disease after
abstinence. 3) 5 years survival improves from 34% to 60% for those with
decompensated liver disease. 4)Patients with chronic HCV infection should
abstain from any alcohol intake due to the risk for rapid acceleration of liver
disease.
Nutrition:
A) Alcoholism is associated with nutritional deficiencies. B) Enteral as well as tube
feeding found to be associated with decreased mortality. C)Continued entral
nutrition support after hospitalization also improves long tem morbidity.
Corticosteroids:
A) Only five studies have shown benefit in survival mostly in rural populations the
remaining studies have been wrong.
B) Corticosteroid therapy is beneficial in improving 30 and 60 days mortality only
in patients with severe acute alcoholic hepatitis and an MDF> 32 in the absence
of acute GI bleeding, renal failure, acute infection or pancreatitis.
C) 2months survival is about 80% but up to 40% of patients still die in 6 months.
D) Significant improvement in LFTS is evident at 7 day after initiation of therapy
and may be present up to 1 year.
15. 15
E) Patients with a score> 0.45 using lille model had a mortality rate of 76% at 6
months.
F) Prednisolone given at a dose of 40mg daily for 4 wks followed by rapid 4 wks
taper.