1. LIVER & GALLBLADDER DISEASES AND DISORDERS

3. JAUNDICE ► PHYSIOLOGICAL CHANGES –  Yellowness of skin and sclera  Destruction of RBC - HAEMOLYTIC  Defective uptake or transport of bilirubin - HEPATOCELLULAR  Obstruction in bile duct passage - OBSTRUCTIVE

5. MAJOR CAUSES ► INFECTIVE – HEPATITIS A, B, C, E ► CIRRHOSIS ► TUMORS ► VASCULAR OBSTRUCTION ► POISONING ► ABCESS – PARASITES ► HEREDITARY DISEASES

6. SYMPTOMS- SYMPTOMS- anorexia fatigue non-specific abdominal pain ► ACUTE  Fever  Nausea, vomiting  Diarrhoea  Jaundice  Bleeding  Hepatomegaly  Rt hypochondria tenderness ► CHRONIC  Portal HT – O varices, piles, ascites, splenomegaly  Hepatomegaly – immune deficiencies  Palmar erythema  Dupuytren’s contracture  Spider naevi

7. Major Remedies ► Nux vom – a/f over indulgence ► Bry – great nausea and heaviness with splitting headache ► Podo – vomitting of bile, constipation and light stools ► Merc sol – simple, pain in liver, <lying on rt ► Chel – yellow stools, pain under rt scapula ► China – congested liver and white stools ► Crot h – from blood disorganisation

8. HEPATITIS ► INFECTIOUS  VIRUS – A TO G, CYTOMEGALOVIRUS, YELLOW FEVER, EPSTEIN-BARR  PARASITES ► NON- INFECTIOUS  DRUGS  TOXINS  AUTO-IMMUNE REACTIONS  ALCOHOLIC

9. Infectious Hepatitis ► A, E, F, - ingestion of contaminated food or water ► Usually acute ► E - severe ► B, C, D, G – Transmitted by blood or bodily fluids, sexual contact or exposure to contaminated blood. ► D only occurs in association with B ► B,C,D – lead to chronic Hepatitis

11. Hepatitis symptoms ► ► Flu like symptoms - nausea, vomiting, abdominal pain, fever, fatigue, loss of appetite, less commonly, rash and joint pain. ► ► Jaundice ► ► The acute symptomatic phase of viral hepatitis lasts from a few days to many weeks; the period of jaundice that may follow can persist from one to three weeks. ► ► Complications of acute viral hepatitis include fulminant hepatitis & chronic hepatitis

12. Hepatitis B ► Severe and long lasting ► 40 days to 6 months after exposure ► RISK –IV drug users, sexual partners of infected people, unprotected healthcare workers, organ transplants, blood transfusions ► 100 times more likely to develop liver cancer

13. Major Remedies ► Chelidonium – all liver diseases with pale stools, pain under right scapula, >hot drinks ► China – all liver disorders with fevers, weakness, hard pressure ► Bryonia - lying painful side ► Merc sol - <lying painful side, offensive perspiration

14. CIRRHOSIS ► Irreversible change resulting in degeneration of functional liver cells and their replacement with fibrous connecting tissue – scarring of liver tissue ► Excessive and chronic alcohol abuse – common cause ► Early stages – can be stabilised by abstaining from alcohol + good diet

16. Pathology ► Early stages – enlarging – outer capsule smooth and stretched  Becomes more yellow, fibrous tissue and more bile ducts form ► Enlarged/ Granular stage with more fibrous tissue  Blood vessels thicken and obstruct channels ► Advanced stage  Shrinking with loss of lobes and rough

18. Cirrhosis ► Other causes – Hep B or C infection, Cystic fibrosis, Auto-immune disorders, ► Heamochromotosis – inc Fe absorption and deposition in liver ► Wilson’s – inc Copper, making liver green ► COMPLICATIONS – portal venous pressure – haemorrhages, hepatic coma, jaundice, oedema, ascites.

19. Major Remedies ► Phos ► Ars iod ► China ► Aur mur ► Hydrocot (from Clarke’s Prescriber)

20. LIVER CANCER ► PRIMARY OR SECONDARY SPREAD ► RISK – chronic liver infection, cirrhosis, aflatoxins, males, family history, old age ► Symptoms – Pain Rt side abdomen extending to back/ shoulder, Swelling, Wt Loss, Anorexia, nausea & vomiting, Weakness, Yellowness (jaundice), fever, Bloating

21. GALL STONES ► Composed of crystalline substances – Cholesterol, Bile pigments, calcium ► Common – cholesterol saturated bile with low bile salts and phospholipids. ► CHOLELITHIASIS

22. RISKS TO GET STONED ► INFLAMMATION AND STAGNATION  Liver damage  Chronic GB disease  Obesity  Hereditary blood disorders (sickle-cell A)  Ca of biliary tract

23. Symptoms ► No clinical symptoms ► Acute inflammation – CHOLECYSTITIS ► Obstruction by stone in duct – severe pain – Biliary Colic and Cholangitis ► Recovery  Pass thru spontaneously  Surgical removal – stones or GB  Medication to dissolve

26. Major remedies ► Colocynth – colic >bending double ► Dios – colic >bending backwards ► Calc carb – acute & chronic ► Cardus mar (Q) – left lobe pain ► Berberis (Q) – every 15 min ► Chel (Q) – 5 drops tds after food for several weeks, Can be used with china ► China 6 – for prevention