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

Functions of the Liver

Metabolism of ingested carbohydrates, protein Fat delivered through the portal circulation Synthesis of proteins

plasma proteins Coagulation proteins

Functions of the Liver

Storage of vitamin B12 and other materials Detoxification and excretion of various substances

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

Liver, basic lobule, or acini

Bile

Bile pigment is derived from the breakdown of red blood cells Bile pigment is conjugated and excreted by the liver

Bile

An aqueous solution containing various dissolved substances

Conjugated bilirubin, bile salts, lecithin, cholesterol, water, minerals

Functions as a biologic detergent

Liver Injury

Manifestations

Cell necrosis Immune cell infiltration Fatty change Mixed necrosis and fatty change Later, fibrosis

Common Types of Liver Injury

Viral hepatitis

Hep A, B, C, etc

Alcoholic hepatitis Cirrhosis

Scarring, which is end result of acute injury

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

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

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

Alcoholic Liver Disease

Three stages of progression

fatty liver reversible Hepatitis - reversible The above two can lead to cirrhosis - irreversible

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

Manifestations of Cirrhosis of the Liver

Liver failure Liver unable to inactivate estrogen in males

Testicular atrophy, loss of sex drive, breast hypertrophy Ascites, collateral circulation formation

Portal hypertension

Manifestations of Cirrhosis of the Liver

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

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

Cholecystitis

Chronic disease common Gallstones may predispose to cholecystitis Impaction of a stone in the neck of the gallbladder may precipitate acute cholecystitis

Tumors of the Liver

Benign adenomas Primary carcinoma

Called Hepatocellular Carcinoma, related to Hep B Spread from primary sites most common type of tumors, Colonic cancer is common primary tumor

Metastatic carcinoma