LIVER DISEASE

Vinci Mizranita, S.Farm., M.Pharm., Apt.

LIVER DISEASE IN THE WORLD
 2. England – Liver disease mortality
trend dramatic increase relative
to other major disease groups

1. International – UK has now overtaken

France & Italy – which used to have much
higher rates but now have a reducing trend
 The Liver
∗ Organ terbesar dalam
tubuh manusia
∗ Pada orang dewasa,
beratnya mencapai 1,5 kg
∗ Lokasi: Atas sebelah kanan
abdomen
Microscopic Anatomy
 Blood and Bile Flow in Opposite
Directions
∗ Blood Flow ∗ Bile Flow

∗ Darah (Deoxygenated ) dari perut ke

usus kecil Hepatic
PortalVeinvenulessinusoidsce ∗ Bile diproduksi di hepatocytesbile
ntral veinhepatic veinvena cava ductulescommon ductgall
bladderbile ductsmall intestine
 What does the liver do?
Multi-function, blood-processing “factory”

• Penyimpanan sementara bagi nutrisi

(glucose-glycogen)
• Remove toxins from blood
• Remove old/damaged RBC’s
• Regulate nutrient or metabolite levels
in blood—keep constant supply of
sugars, fats, amino acids, nucleotides
(including cholesterol)

Liver Physiology, Larry Frolich, Yavapai College, March 10, 2006

 Functions
∗ The liver has more than 200
functions, including:

∗ Storage of Nutrients
∗ Breakdown of erythrocytes
∗ Bile Secretion
∗ Synthesis of plasma Proteins
∗ Synthesis of cholesterol
Cholesterol—one example of liver processing

∗ Our body needs cholesterol for

∗ Cell membranes
∗ Vitamin D
∗ Hormones—progesterone and testosterone
∗ Myelin (neuron axonal “wrapping”)
∗ Component of bile salts
∗ 85% of cholesterol in our blood is “endogenous” or
manufactured by our own cells (mostly liver)
∗ 15% comes from the food we eat
∗ So, is zero-cholesterol good…or even healthy?

Liver Physiology, Larry Frolich, Yavapai College, March 10, 2006

 LIVER DISEASE
CAUSES & RISKS
 Anatomy details
NORMAL LIVER vs LIVER DISEASE

1. The Lobule
2. The biliary tracts
3. The portal circulation
LIVER DISEASE

NORMAL LIVER
 INTERPRETASI LFTs
 Enzim → kerusakan
ALT/AST
ALP

 Fungsi (tes)
Albumin- Signifikansi:
- Pola
Prothrombin / INR - Tren
Bilirubin - Penyerta
- Review
Glukosa
 STEPS PADA LIVER DISEASE

STEP TESTS ACTION

0 Lihat faktor resiko :

Alkohol, BB
Akses LFTs, Hep C

I Liver enzim (albumin normal), Intervensi gaya hidup,

tes bilirubin, platelets monitor reguler

II Hep B atau Hep C, Ferritin Konfirmasi hasil

Liver enzim dengan ↓

III Albumin, timbul gejala capek,
Perawatan Sekunder
(secondary care)
kuning
 PRIMARY CARE
1. Identifikasi pasien dengan resiko (e.g obesitas, DM)
2. Test kerusakan fungsi liver (enzim liver)
3. Tes fungsi liver : Albumin, bilirubin, INR, glukosa,
urea
4. Tes liver fibrosis : platelets
5. Menawarkan pasien informasi dan gaya hidup
6. Monitoring progres dari penyakit liver
7. Perhatian! Untuk komplikasi : kuning, encephalopati
8. Saran tentang pengobatan
Alcohol and obesity
Making every contact count
All the resources from this lecture
Will be available to download at:

www.liver.nhs.uk