Liver and Biliary Tract Disease

Liver diseases Liver disease is any disturbance of liver function that causes illness. Acute liver failure may be reversible,there is a treatable cause and the liver may be able to recover and resume its normal functions

Liver

The causes of liver disease The liver can be damaged in a variety of ways: Cells can become inflamed (such as in hepatitis: hepar =liver + itis=inflamation) Bile flow can be obstructed (such as in cholestasis: chole=bile+stasis=standing) Cholesterol or triglycerides can accumulate (such as in steatosis; steat=fat+osis=accumulation) Blood flow to the liver may be compromised Liver tissue can be damaged by chemicalsand minerals, or infiltrated by abnormal cells

The causes of liver disease Alcohol abuse Cirrhosis Drug-induced liver disease Infectious hepatitis Other viruses Non-Alcoholic fatty liver disease Hemochromatosis Wilson’s Disease Gilbert’s Disease Cancers Blood flow abnormalities Other disease and conditions

Alcohol abuse Alcohol abuse is the most common cause of liver disease. Alcohol is directly toxic to liver cells and can cause liver inflammation, referred to as alcoholic hepatitis. In chronic alcohol abuse, fat accumulation

Alcoholic liver abuse Alcoholic liver disease is a term that encompasses the hepatic manifestations of alcohol over consumption, including fatty liver, alcoholic hepatitis, and chronic hepatitis with hepatic fibrosis or cirrhosis.[1] It is the major cause of liver disease in Western countries. Although steatosis (fatty liver) will develop in any individual who consumes a large quantity of alcoholic beverages over a long period of time, this process is transient and reversible. Of all chronic heavy drinkers, only 15–20% develop hepatitis or cirrhosis, which can occur concomitantly or in succession.

Fatty liver Fatty change, or steatosis is the accumulation of fatty acids in liver cells. These can be seen as fatty globules under the microscope. Alcoholism causes development of large fatty globules (macro vesicular steatosis) throughout the liver and can begin to occur after a few days of heavy drinking.[5] Alcohol is metabolized by alcohol dehydrogenase (ADH) into acetaldehyde, then further metabolized by aldehyde dehydrogenase (ALDH) into acetic acid, which is finally oxidized into carbon dioxide (CO2) and water ( H2O).[6] This process generates NADH, and increases the NADPH/NADP+ ratio. A higher NADH concentration induces fatty acid synthesis while a decreased NAD level results in decreased fatty acid oxidation. Subsequently, the higher levels of fatty acids signal the liver cells to compound it to glycerol to form triglycerides. These triglycerides accumulate, resulting in fatty liver.

Symptoms General symptoms include: Abdominal pain and tenderness Dry mouth and increased thirst Fatigue Jaundice Loss of appetite Nausea Swelling or fluid buildup in the legs (edema) and in the abdomen (ascites) when cirrhosis is present Weight loss Skin changes include: Abnormally dark or light skin Redness on feet or hands Small, red spider-like blood vessels on the skin Yellow color in the skin, mucus membranes, or eyes (jaundice)

Symptoms Abnormal bleeding: Bloody, dark black, or tarry bowel movements (melena) Nosebleeds or bleeding gums Vomiting blood or material that looks like coffee grounds Brain and nervous system symptoms: Agitation (being stirred up, excited, or irritable) Changing mood Confusion (encephalopathy) - Periods of decreased alertness or awareness - Hallucinations - Impaired short- or long-term memory Pain, numbness, or tingling in the arms or legs Problems paying attention or concentrating Poor judgment Slow, sluggish movements

Treatment Stop using alcohol completely Vitamins (B-coplex, folic acid) Liver transplant (complications of cirrhosis)

Cirrhosis Cirrhosis is scarring of the liver and poor liver function. It is the final phase of chronic liver disease.

Causes Hepatitis C infection (long-term infection) Long-term alcohol abuse (see alcoholic liver disease) Other causes of cirrhosis include: Autoimmune inflammation of the liver Disorders of the drainage system of the liver (the biliary system), such as primary biliary cirrhosis and primary sclerosing cholangitis Hepatitis B (long-term infection) Medications Metabolic disorders of iron and copper (hemochromatosis and Wilson's disease) Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH)

Symptoms Confusion or problems thinking Impotence, loss of interest in sex, and breast development (gynecomastia) in men Loss of appetite Nausea and vomiting Nosebleeds or bleeding gums Pale or clay-colored stools Small, red spider-like blood vessels on the skin Swelling or fluid buildup of the legs (edema) and in the abdomen (ascites) Vomiting blood or blood in stools Weakness Weight loss Yellow color in the skin, mucus membranes, or eyes (jaundice)

Symptoms

Spider naevi

Palmar erythema

Caput meduse

Physical examination An enlarged liver or spleen Excess breast tissue Expanded (distended) abdomen, as a result of too much fluid Reddened palms Red spider-like blood vessels on the skin Small testicles Widened (dilated) veins in the abdomen wall Yellow eyes or skin (jaundice)

Diagnosis Tests can reveal liver problems including: Anemia (detected on a complete blood count test) Clotting problems Liver function problems (detected on liver function tests) Low blood albumin The following tests may be used to evaluate the liver: Computed tomography (CT) of the abdomen Magnetic resonance imaging (MRI) of the abdomen Endoscopy to check for abnormal veins in the esophagus or stomach Ultrasound of the abdomen Liver biopsy confirms cirrhosis.

Treatment Lifestyle changes, including: Stop drinking alcohol. Limit salt in the diet. Eat a nutritious diet. Get vaccinated for influenza, hepatitis A and hepatitis B, and pneumococcal pneumonia (if recommended by your doctor). Tell your doctor about all prescription and nonprescription medications, and any herbs and supplements you take now or are thinking of taking. Other treatment options are available for the complications of cirrhosis: Bleeding varices -- upper endoscopy with banding and sclerosis Excess abdominal fluid (ascites) -- take diuretics, restrict fluid and salt, and remove fluid (paracentesis) Coagulopathy -- blood products or vitamin K Confusion or encephalopathy -- lactulose medication and antibiotics Infections -- antibiotics A procedure called transjugular intrahepatic portosystemic shunt (TIPS) is sometimes needed for bleeding varices or ascites. A liver transplant - when cirrhosis progresses to end-stage liver disease

Hepatocellular carcinoma Hepatocellular carcinoma accounts for most liver cancers. This type of cancer occurs more often in men than women. It is usually seen in people age 50 or older. However, the age varies in different parts of the world. The disease is more common in parts of Africa and Asia than in North or South America and Europe. Hepatocellular carcinoma is not the same as metastatic liver cancer, which starts in another organ (such as the breast or colon) and spreads to the liver.

In most cases, the cause of liver cancer is usually scarring of the liver (cirrhosis). Cirrhosis may be caused by: Alcohol abuse (the most common cause in the United States) Autoimmune diseases of the liver Hepatitis B or C virus infection Inflammation of the liver that is long-term (chronic) Iron overload in the body (hemochromatosis) Patients with hepatitis B or C are at risk for liver cancer, even if they have not developed cirrhosis.

Symptoms Abdominal pain or tenderness, especially in the upper-right part Easy bruising or bleeding Enlarged abdomen Yellow skin or eyes (jaundice)

Diagnosis Physical examination may show an enlarged, tender liver. Tests include: Abdominal CT scan Abdominal ultrasound Liver biopsy Liver enzymes (liver function tests) Liver MRI Serum alpha fetoprotein

Ultrasonography

tomography