1. Liver disease Prepared by: Siti Norhaiza Bt Hadzir

2. Liver disease Diagnosis of liver disease depends on: –complete history –complete physical examination –evaluation of liver function tests –further invasive and non-invasive tests In liver disease there are crossovers between purely biliary disease and hepatocellular disease To interpret these, the physician will look at the entire picture of the hepatocellular disease and biliary tract disease to determine which is the primary abnormality Acute liver disease Chronic liver disease

3. Acute liver disease Causes of hepatocellular damage: - poisoning - infection - inadequate perfusion

4. Poisoning Source: paracetamol and carbon tetrachloride. Cause destruction of hepatocytes with massive release of enzymes. Some plant and fungal toxins can also cause catastrophic and fatal liver damage within 48h. Some toxins give rise to acute hepatocellular failure only in certain individuals who are susceptible. Important examples include sodium valproate (anticonvulsant) – toxic to some children.

6. Liver infection Both bacteria and virus can give rise to infective hepatitis. virus (hepatitis A,B,C,D,E) Epstein Barr virus (infectious mononucleosis) Cytomegalovirus Herpes simplex virus Varicella Zoster infection

8. Diagnosis of viral hepatitis HBsAg appears first, late in the incubation period. Followed by HBeAg. The presence of HBeAg and hepatitis B-DNA indicate infectivity. The first antibody to appear is anti-HBc during the acute illness Followed by anti-HBe and anti-HBs. The presence of anti-HBe in the blood indicate absence of infectivity. Liver biopsy

10. Outcome of acute liver disease It may resolve It may progress to acute hepatic failure It may lead to chronic hepatic damage.

11. Acute liver failure Results from acute massive liver cell necrosis ( viral hepatitis, toxic drug and chemicals) May also follow acute fatty change of the liver. Characterization: 1)Jaundice 2)Hypoglycemia 3)Bleeding tendency due to DIC 4)Electrolyte and acid base disturbance 5)Hepatic encephalophaty 6)Hepatorenal syndrome 7)Elevation of serum enzymes (LDH,AST, ALT)

12. Biochemical finding in hepatic failure

13. Chronic liver disease Three forms of chronic liver damage are: - alcoholic fatty liver - chronic active hepatitis - primary biliary cirrhosis. All of these conditions may progress to cirrhosis.

14. Cirrhosis It is an irreversible and progressive disease that ultimately causes death. The rate of progressive is variable. It is manifested clinically by features of chronic liver failure. Cirrhosis is a pre-malignant lesion. The risk of hepatocellular carcinoma is greatest in cirrhosis caused by hemochromatosis, virus induced cirrhosis, cryptogenic cirrhosis and alcoholic cirrhosis.

16. Chronic liver failure The effect of chronic liver failure: - decrease synthesis of albumin, leading to serum albumin levels, edema and ascites. - decrease levels of prothrombin and of factors VII,IX and X resulting in bleeding tendency. - Portal hypertension - Hepatic encephalopathy - Hepatorenal syndrome - Endocrine changes - Fetor Hepaticus

17. Thank You