1. Chronic liver disease

2. 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

3. Etiology Infection Alcohol Autoimmune Cholestatic Infiltrative
Metabolic
Vascular
Drugs
Cryptogenic

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

5. 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)

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

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

8. 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

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

10. 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

11. 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

12. 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

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

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

15. Complication
Ascites
GI bleed
SBP
Edema
Hepatoma