Liver Diseases

Dr. Avnish Upadhyay

Senior Research Scientist, Patanjali Yog
Peeth, Haridwar
1. Introduction
a. anatomical Position and weight.
b. Functions- Processing most of the nutrients
absorbed from the intestine.
c. Removing drugs, Alcohol and harmful
substances from the blood stream.
d. Manufacturing bile, its storage in GB.
e. Produces cholesterol- Blood clotting factors
and certain other Proteins.
f. The liver may be Palpable in normal healthy
adult, 10 to 12% are such cases.
Healthy Liver
 This is what a healthy
liver is supposed to
look like:
Damaged Liver
 This is what a
damaged liver looks
like:
Damaged liver Continuation
2. Examination of Liver
1. On inspection if one sees
a. swelling in the Rt. Hypochondria which on
palpation seems to be in the liver the
common conditions are
1. Amoebic Liver Abscesses.
2. A malignancy
b. First palpate Right and then Lt Lobe of Liver.
c. Edge whether thin or thick, firm or soft.
d. Surface- smooth or nodular.
e. Pulsatile Tricuspid Regurgitation.
2. Examination of Liver Contd.
2. Look for Tenderness- it is very important Point to
consider. it is tender in 3 conditions.
a. Infective hepatitis.
b. Amoebic Hepatitis and Amoebic Abscess.
c. CCF
 Exclude CCF by the presence of dyspnoea,
enlarged heart, engorged neck veins, edemas of
feet.
 Now there remain 2 common causes
1. Hepatic Amoebiasis or Amoebic Liver Abscess.
2. Infective Hepatitis
3. Hepatic Amoebiasis
 It includes Amoebic Hepatitis and Amoebic Liver
Abscess
a. main symptom is pain in hypochondria (Right) and /or
epigastria rarely in Rt Shoulder
b. it may be of dull ache or as severe as biliary colic
c. The duration of pain Could be from a few days to few
weeks.
d. The pain in increased on turning on the side, more on the
Rt Side.
e. The pain is increased on deep breathing.
f. Nausea. Vomiting, lose of appetite, jaundice are absent.
g. alcoholic are more prone to get disease.
h. Past history of dysentery may or may not be present
however a recent attack of diarrheas or dysentery if
present would favour the diagnosis very much.
4. Physical sign is Tenderness of the Liver

a. May be elicited by hammering over the liver area Or

by pressure on subcostal area after a deep
inspiration. Rarely tenderness may be only in the
epigastria in the area of left lobe. The liver may not
be enlarged or may be enlarged, slightly, moderately
or markedly, Therefore more time should be give in
eliciting tenderness than size of the liver.
b. A lump in the liver area is a rarity.
c. No investigations are required. The may be normal
raised.
d. The Rt dome of diaphragm may be raised or
immobile. Immobility is more important. It can be
seen on screening of the chest (Fluoroscopy)
e. Best is Therapeutic test with emetine Injection.
Treatment
1. Emetine 60 mg 1M for 8-10 days - Rest if Possible
2. Chloroguin or Metronidazole- 2 Tabs twice daily
for 2 days. After then 1 Tab twice daily for 21
days (May cause slight nausea)
 Flagyl (Metronidazole):- 400 to 800 mg TD for 8
days may cause nausea and loss of appetite but
this is the effective dose, Dose of 200 mg TD is
only for infantile amoebiasis.
 If pain, fever and tenderness of the liver persists
ever after emetine Tapping must not be delayed
finally, if an obvious lump is seen in the liver
area, it would always need aspiration.
 INFECTIVE HEPATITIS
 It is due to virus and therefore a single case can
infect many others, So it should be taken
seriously.
 Incubation Period is about 3-4 weeks, history of
jaundice in any family member or any friend,
neighbor or locality during past one month is an
important point to be elicited in history taking.
 One can get 2-3 attacks of viral hepatitis during
the life time
 Disease is common in small children and young
adults, It is rare after the age of 45-50 yrs.
 Dot Call This disease "Jaundice" because
 Many People may suffer and recover without
jaundice. The patient get loss of appetite, slight
nausea and do not generally feel well for a week
or two. The only way to diagnose will be, by
eliciting history of jaundice in the family or
neighborhood during previous 3-4 weeks. An the
same time, in that particular patient, it is
impossible whether he is going to develop
jaundice or whether he would recover without
developing jaundice. Jaundice without jaundice
is called anicteric jaundice.
 Fever with complete loss of appetite.
 Surgical jaundice will have to be excluded,
surgical jaundice means jaundice caused by the
disease which produce obstruction the flow of
bile and the treatment is mainly surgical such as
bile duct obstruction due to stones.
 Carcinoma head pancreas (leading to
obstructing common bile ducts) Presence of
one or more severe upper abdominal pain, while
colored stool and excessive pruritis would
favour for surgical jaundice.
 Prolonged administration of hormones or
promazine group of drugs will favour the
diagnosis of drug hepatits.
Three stages
Stage 1
Complete loss of appetites, Patient does not
want even to see food. Nausea, vomiting,
Fever, body ache, general malaise. In the 1st
week there is no evidence of jaundice.
Towards the end of 1st week the patient
might notice very high colored urine.
In viral hepatitis patient don’t complain of pain
in the liver area, may complain vague
discomfort on questioning. Patient to may
lose 2-3 kg body weight.
Stage 2
 Patient's relatives see jaundice.

 As Jaundice deepens, the temperature

starts coming down and appetite starts
improving, So that by the end of 2nd week
the patient is left with deep Jaundice but
good appetite and no fever.
Stage 3
 Recovering to normal. Resume his work
Appetite improve weight gains. Jaundice
clears up by the end of third week.
 90-95% behave the above manner, 5 to 10
PC would die after going to hepatic coma
(specially Pregnant women)
Symptoms of Prehepatic coma
1. Presence of Drowsiness
2. Abnormal Behavior
3. Irritability
4- Tremors

Better to hospitalize

nothing can be done at this stage.

Signs of Infective hepatitis
 Jaundice
 Tender liver
 may be enlarged and may bends
 Enlarged.
Investigations
SGPT
SGOT
Serum Billirubin
Treatment
1. Inj Gamma Globulin .06 cc/LB body weight
should be given to all family members as
prophylaxis, but they are very costly but
should ideally be give to all family.
2. Tonics for appetite, Inj glucose 25 pc Iv. Cal.
gluconate iv, Inj B comp., vit c, vit k,
Antibiotics, Prednisolone 1 BD or TD, Inj.
liver ext., two drugs are harmful as they can
precipitate hepatic coma. only glucose iv or
orally is useful along with rest.
Drugs
Antihistaminic and IV glucose is sufficient.

In severe case prednisolone 40 to 60 mg/day

gradually tapered off very slowly

danger signals
 The following are the danger signals, the
presence of any of them indicates on coming
hepatic coma and death
1. Drowsiness
2. Reversal of sleep rhythm
3. Irritability
4. Tremors
Deep Jaundice is not a sign of danger.
Thanks