Liver Disease - What I will learn …… Some basic liver anatomy, function and

histology What are the common viral infections of the

liver An understanding of Cirrhosis How gallstones are formed

Functions of the Liver

Metabolism of ingested carbohydrates, protein

Fat delivered through the portal circulation Synthesis of proteins

plasma proteins Coagulation proteins

Functions of the Liver

Storage of vitamin B12 and other materials Detoxification and excretion of various

substances

Liver Structure

Has a double blood supply from the hepatic artery and portal vein

Portal tracts travel together Hepatic artery Portal vein Bile ducts Lymphatic vessels

Liver, basic lobule, or acini

Bile

Bile pigment is derived from the breakdown of red blood cells

Bile pigment is conjugated and excreted by the liver

Bile

An aqueous solution containing various dissolved substances Conjugated bilirubin, bile salts, lecithin,

cholesterol, water, minerals Functions as a biologic detergent

Liver Injury

Manifestations Cell necrosis Immune cell infiltration Fatty change Mixed necrosis and fatty change Later, fibrosis

Common Types of Liver Injury Viral hepatitis

Hep A, B, C, etc Alcoholic hepatitis Cirrhosis

Scarring, which is end result of acute injury

Hepatitis A

RNA virus Fecal-oral method of transmission, ie eating

at the wrong place Self-limiting disease with no carriers and no

chronic liver disease Hep A antibody appears at the time of

symptoms Prevention after exposure Immunization available

Hepatitis B

DNA containing virus Blood or body fluid method of transmission 300 million carriers worldwide Most shed the virus, however, 10% become

carriers and may develop chronic liver disease

Prevention after exposure Immunization available

Hepatitis C

RNA containing virus Blood and body fluids method of transmission Most important cause of transfusion associated

hepatitis 75% become carriers and many develop chronic

liver disease HCV RNA detected for 1-3 weeks, but may persist No prevention of disease after exposure No immunization available

Alcoholic Liver Disease

Three stages of progression fatty liver – reversible Hepatitis - reversible The above two can lead to cirrhosis - irreversible

Cirrhosis of the Liver

Diffuse scarring (Cirrhosis) of the liver from any cause Alcoholic liver disease Chronic hepatitis An episode of severe liver necrosis Other drugs and chemicals Longstanding bile duct obstruction

Manifestations of Cirrhosis of the Liver Liver failure Liver unable to inactivate estrogen in males

Testicular atrophy, loss of sex drive, breast hypertrophy

Portal hypertension Ascites, collateral circulation formation

Manifestations of Cirrhosis of the Liver

Cholelithiasis (Gallstones)

Incidence Higher in women than men Higher in women who have borne several children Twice as high in women who use contraceptive pills Higher in obese women

Cholelithiasis

Cholesterol stones Cholesterol is soluble

when mixed with water soluble bile salts and insoluble lecithins

Once cholesterol exceeds the solubilizing capacity of bile, cholesterol crystalizes

Cholecystitis

Chronic disease common Gallstones may predispose to cholecystitis Impaction of a stone in the neck of the

gallbladder may precipitate acute cholecystitis

Tumors of the Liver

Benign adenomas Primary carcinoma

Called Hepatocellular Carcinoma, related to Hep B

Metastatic carcinoma Spread from primary sites most common type of

tumors, Colonic cancer is common primary tumor