LIVER DISEASES

By: Ricaneth Imeldaine Taan

Liver Disease
• The right upper quadrant of the abdomen is
dominated by the liver and its companion biliary tree
and gallbladder.
• Residing at the crossroads between the digestive
tract and the rest of the body, the liver has the
enormous task of maintaining the metabolic
homeostasis.
Liver Diseases: VIRUSES
• Hepatitis A
• Hepatitis B
• Hepatitis C
Hepatitis A (Description)
• Hepatitis A is a highly contagious liver infection caused by
the hepatitis A virus. The virus is one of several types of
hepatitis viruses that cause inflammation and affect your
liver's ability to function.
You're most likely to get hepatitis A from contaminated
food or water or from close contact with a person or
object that's infected. Mild cases of hepatitis A don't
require treatment. Most people who are infected recover
completely with no permanent liver damage.
Hepatitis A (Pathopyshiology)
• HAV is a single-stranded, positive-sense, linear
RNA enterovirus of the Picornaviridae family. In
humans, viral replication depends on hepatocyte
uptake and synthesis, and assembly occurs
exclusively in the liver cells. Virus acquisition
results almost exclusively from ingestion (eg,
fecal-oral transmission), although isolated cases
of parenteral transmission have been reported.
Hepatitis A (Treatment)
• There are no specific medicines to cure infection with
hepatitis A. Most people require no treatment except to
relieve symptoms. However, if symptoms become severe
or dehydration develops, the person should seek medical
care emergently.
• There is a vaccine for it. If you have been exposed to
someone who is infected with HAV, a treatment called
immune serum globulin is available and may prevent you
from becoming infected. Immune serum globulin is more
likely to be effective when given within 2 weeks of
exposure.
Hepatitis B (Description)
• Hepatitis B infection is a worldwide healthcare
problem, especially in developing areas. The
hepatitis B virus (HBV) is commonly transmitted
via body fluids such as blood, semen, and
vaginal secretions.
Hepatitis B (Pathophysiology)
• Hepatitis B virus (HBV) is a hepadnavirus, with
the virion consisting of a 42-nm spherical,
double-shelled particle composed of small
spheres and rods and with an average width of
22 nm. It is an exceedingly resistant virus,
capable of withstanding extreme temperatures
and humidity. HBV can survive when stored for
15 years at –20°C, for 24 months at –80°C, for 6
months at room temperature, and for 7 days at
44°C.
Hepatitis B (Treatment)
• An injection of immunoglobulin (an antibody) given within 12 hours of
exposure to the virus may help protect you from getting sick with hepatitis B.
Because this treatment only provides short-term protection, you also should
get the hepatitis B vaccine at the same time, if you never received it.
• People diagnosed with chronic hepatitis B infection need treatment for the
rest of their lives. Treatment helps reduce the risk of liver disease and
prevents you from passing the infection to others.
Hepatitis C (Description)
• Hepatitis C is an infection caused by the
hepatitis C virus (HCV) that attacks the liver and
leads to inflammation.
Hepatitis C (Pathophysiology)
• Hepatitis C virus (HCV) is a spherical, enveloped, single-stranded RNA virus
belonging to the family Flaviviridae, genus Flavivirus. Lauer and Walker
reported that HCV is closely related to hepatitis G, dengue, and yellow fever
viruses.
• The natural targets of HCV are hepatocytes and, possibly, B lymphocytes.
Viral clearance is associated with the development and persistence of
strong virus-specific responses by cytotoxic T lymphocytes and helper T
cells.
• In most infected people, viremia persists and is accompanied by variable
degrees of hepatic inflammation and fibrosis. Findings from studies suggest
that at least 50% of hepatocytes may be infected with HCV in patients with
chronic hepatitis C.
Hepatitis C (Treatment)
• Hepatitis C infection is treated with antiviral
medications intended to clear the virus from your
body.
Liver Diseases: ALCOHOL & DRUGS
• Fatty Liver Disease
• Cirrhosis
Fatty Liver Disease (Description)
• Fatty liver is also known as hepatic steatosis. It
happens when fat builds up in the liver. Having small
amounts of fat in your liver is normal, but too much
can become a health problem.
Fatty Liver Disease (Pathophysiology)
Potential pathophysiologic mechanisms for fatty
liver include the following:
• Decreased mitochondrial fatty acid beta-
oxidation
• Increased endogenous fatty acid synthesis or
enhanced delivery of fatty acids to the liver
• Deficient incorporation or export of triglycerides
as very low-density lipoprotein (VLDL)
Fatty Liver Disease (Treatment)
• The first line of treatment is usually weight loss
through a combination of a healthy diet and
exercise.
• Vitamin E
• Coffee
Cirrhosis (Description)
• Cirrhosis is a late stage of scarring (fibrosis) of the liver
caused by many forms of liver diseases and conditions,
such as hepatitis and chronic alcoholism. Each time your
liver is injured — whether by disease, excessive alcohol
consumption or another cause — it tries to repair itself.
Cirrhosis (Classification)
• Biliary cirrhosis
• Post necrotic cirrhosis
• Alcoholic cirrhosis
Bilary Cirrhosis
• It is due to an intra hepatic block that obstructs the
excretion of bile or it may occur secondary to
obstruction of the bile ducts.
• The obstruction in one area of biliary passage
• results in bile stasis; that causes injury and scarring
• around the hepatocytes with evidence of fibrosis.
Post Necrotic Cirrhosis
• It follows massive liver necrosis and involves the
destruction of lobules and even lobes of the liver.
• It may occur after hepatitis or after exposure to
hepato-toxins such as certain drugs.
Alcoholic Cirrhosis
• The most common cause of cirrhosis is excessive
alcohol consumption
• At least 75% of alcohol related deaths are attributed
to cirrhosis.
Cirrhosis (Treatment)
• Stop drinking
• Weight Loss
Liver Diseases: INHERITANCE
• Hemochromatosis
• Wilson Disease
Hemochromatosis (Description)
• Hereditary hemochromatosis causes your body
to absorb too much iron from the food you eat.
Excess iron is stored in your organs, especially
your liver, heart and pancreas. Too much iron
can lead to life-threatening conditions, such as
liver disease, heart problems and diabetes.
Hemachromatosis (Phatophysiology)
• Inappropriately decreased expression of the iron-
regulatory hormone hepcidin. Hepcidin serves to
decrease the export of iron from reticuloendothelial
cells and absorptive enterocytes. Thus, HH patients
demonstrate increased iron release from these cell
types, elevated circulating iron, and iron deposition in
vulnerable tissues.
Hemachromatosis (Treatment)
• Removing blood from your body.
Wilson Disease (Description)
• Wilson disease is a rare genetic disorder
characterized by excess copper stored in
various body tissues, particularly the liver, brain,
and corneas of the eyes. The disease is
progressive and, if left untreated, it may cause
liver (hepatic) disease, central nervous system
dysfunction, and death.
Wilson Disease (Pathophysiology)
• Wilson disease is an autosomal recessive inherited
disorder of copper metabolism resulting in pathological
accumulation of copper in many organs and tissues.
• ATP7B is the gene product of the Wilson disease gene
located on chromosome 13 and resides in hepatocytes in
the trans-Golgi network, transporting copper into the
secretory pathway for incorporation into
apoceruloplasmin and excretion into the bile. Mutations
of the gene result in impaired trafficking of copper in and
through the hepatocytes.
Wilson Disease (Treatment)
• Liver Transplant