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Anatomy and the Complications Associated with Liver Diseases!

 LIVER AND THE COMPLICATIONS ASSOCIATED WITH THE PROGRESSION OF DISEASE!


Liver:

  • The liver weighs up to 1.5kg in adults and is the 2nd largest organ in the body. Hepatocytes are the functioning unit of liver.
  • Impairment of liver may lead to:

  1. Acute liver diseases
  2. Chronic liver diseases
  3. Liver cirrhosis



Acute Liver Disease (ALD):

  • ALD is a self-limiting episode of hepatocyte damage which in most cases spontaneously without clinical sequelae, but acute liver failure (ALF) may develop. This is a rare condition in which there is a rapid deterioration in liver function with associated encephalopathy and coagulopathy.
  • ALF carries significant morbidity and mortality and may require emergency liver transplant.


Chronic Liver Disease (CLD):

  • CLD occurs when the longstanding cell damage causes permanent structural changes within the liver, with the loss of normal liver structure and functions.
  • In many cases, this may lead to cirrhosis where fibrosis sears divide the liver cells into areas of regenerative tissues called Nodules. It is usually irreversible but therapeutic interventions in Hepatitis B Virus (HBV)and Hepatitis C Virus (HCV), and hemochromatosis has demonstrated the ability to reverse cirrhosis.
  • CLD can progress to:

  1. Liver failure
  2. Portal hypertension
  3. Hepatocellular carcinoma


Causes of Liver Disease/ Etiology:

  1. Viral infections
  2. Hepatitis
  3. Alcohol
  4. Immune disease
  5. Vascular abnormalities
  6. Genetic and metabolic disorders


Clinical Features of Acute Infection:

Non-specific features include;

  1. Headache
  2. Nausea
  3. Development of jaundice within 2 weeks
  4. Vomiting
  5. Diarrhea
  6. Dark urine
  7. Pale stools
  8. Myalgia
  9. Arthralgia
  10. Anorexia
  11. Abdominal discomfort

Physical signs include;

  1. Liver tenderness
  2. Mild splenomegaly

  • Symptoms last longer than 3-6 weeks


Complications:

  1. Acute Liver failure (ALF)
  2. Chronic liver disease (CLD)
  3. Liver cirrhosis (HBV &HCV)
  4. Cholestatic hepatitis (HAV)
  5. Aplastic anemia


Investigations:

  1. Liver Function Test: Low serum transaminase, Plasma bilirubin exceeds twice of normal.
  2. Serological test: Confirms the cause of infection.


General Management:

  • Most patients do not need hospital care.
  • Drugs metabolized in liver (sedatives, narcotics) should be stopped.
  • Avoid alcohol consumption.
  • No specific dietary modification required.
  • Increase fluid intake.


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