Chronic liver disease.

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Presentation transcript:

Chronic liver disease

Definition Pathologic Etiology Clinical Liver biopsy showing features of chronic inflammation or cirrhosis (Metavir, Knodell’s Scoring…) Etiology Clinical Features of chronic liver stigmata, complications including portal hypertension

Etiology Infection Alcohol Autoimmune Cholestatic Infiltrative Metabolic Vascular Drugs Cryptogenic

Viral Hepatitis Over View Virus Transmission Chronicity A Feco-oral No B Percutanous per mucosal Yes C D E

Diagnosis Medical history (parenteral risk factors) Investigations Biochemical Serology( HBsAg, HBeAg, HCV Ab, HDV Ab, PCR) LFT,CBC,PT Radiologic imaging (Ultrasound, CT/MRI abdomen) Pathology (Liver biopsy with features of chronic hepatitis or cirrhosis)

Alcohol Alcoholic liver disease: Steatosis Acute alcoholic steatohepatitis cirrhosis Depends on: Consumed alcohol Duration Genetic predisposition

Autoimmune Hepatitis Diagnosis Autoantibody (ANA, SMA, LKM1 Ab..) IgG (Increased) Liver biopsy (interface hepatitis)

Cholestatic liver disease Primary biliary cirrhosis AMA positive, increased Ig M & ALP Sclerosing cholangitis Increased ALP, association with IBD ERCP showing beading of biliary ducts

Hepatic vascular disorder Budd-Chiari syndrome (triad of tender hepatomegaly, ascites & spleenomegaly) Portal vein thrombosis Veno-occlusive disease

Drug induced liver disease Cholestatic Antidepressant, ant seizure, anti fungal agents Granulomas Allopurinol, pheytoin Fibrosis Methotrexate, organic solvents Phospholipidosis Amiodarone, TPN, septrin Steatosis Tetracycline, glucocorticoids Vascular Estrogens, azathioprine Adenomas Estrogens

Metabolic liver disease NASH Risk factors : insulin resistance primary: (obesity, type II diabetes, dyslipidemia) secondary: (drugs, short bowel syndrome, TPN, metabolic) Stages: I: Steatosis (macro vesicular) II: Steatosis + inflammation (centrilobular) III: Steatosis + inflammation + ballooning (degeneration & necrosis) IV: Steatosis + inflammation + ballooning + fibrosis +/- Mallory bodies

Metabolic liver disease Alpha 1-Antitrypsin Deficiency Liver and lung involvement Diagnosis using quantitative serum alpha 1-antitrypsin & liver biopsy (PAS+, diastase resistant globules in periportal hepatocytes) Hereditary Hemochromatosis Increased iron absorption & deposition in liver, pancreas, skin, joints & heart Increased transferrin saturation & Ferritin. HFE mutation analysis & liver biopsy ( increased hepatic iron index >1.5 with >+2 Perls’ Prussian blue stain) Wilson’s Disease Autosomal recessive with copper accumulation in liver, brain, cornea, RBCs, kidneys & joints due to defective copper transport and excretion. Serum ceruloplasmin is decreased with increased urinary & hepatic copper

Signs & Symptoms Encephalopathy Jaundice Pallor KF ring Xanthelasma Parotid swelling Fetor hepaticus

Bleeding gums Clubbing Leukonychia Palmer erythema Dupetryns contracture Asterexis Gynecomastia Scratch marks

Complication Ascites GI bleed SBP Edema Hepatoma