Liver Diseases

Dr. Avnish Upadhyay

Clinical Research Scientist
Department of Clinical Research
Patanjali Yog Peeth, Divya Yog Mandir Trust, Haridwar
(An Recognized R & D Institution by DSIR)
1. Introduction
a. anatomical Position and weight- weighing
between 3-4 pounds (Approximately 1.5 Kg). Your
Liver is the largest internal organ in the body. It is
located on the right side of your abdomen, just
beneath your lower ribs.
b. Functions- Processing most of the nutrients
absorbed from the intestine.
c. Removing drugs, Alcohol and other harmful
substances from the blood stream.
d. Manufacturing bile, its storage in GB.
e. Produces cholesterol- Blood clotting factors and
certain other Proteins.
Introduction contd….
f. It needs to be stressed that the liver may be
Palpable after deep inspiration in the right
hypochondriam in normal healthy adults, 10
to 12% are such cases. The incidence of
palpability of the left lobe in the epigastrium is
still more but in small children this part is
sometimes difficult to feel, Again the
incidence of palpability is still higher, because
in infants, the relative size of liver is bigger for
the size of the abdomen.
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
 Because of the complexity of the liver and
its exposure to so many potentially toxic
substances, it would seem specially
valnerable to disease. But the liver has an
amazing capacity for regeneration- it can
heal itself by replacing or repairing injured
cells. In cirrhosis healing process seems
to go slightly wrong. In response to
chronic injury, cells called stellate cells
increase dramatically in size and number.
This lead to formation of excess scar
tissue that interferes with the liver’s ability
to function. And although group of cells
may continue to regenerate , the pattern of
regeneration is not normal.
Causes
1. Some people have cirrhosis
without an obvious cause
(Cryptogenic cirrhosis)
2. Major cause is drinking excessive
amount of Alcohol over many in
years.
3. Having certain forms of viral
hepatitis.
2. Examination of Liver
1. On inspection if one sees
a. swelling in the Rt. Hypochondrium which on
palpation seems to be in the liver the
common conditions are
1. Amoebic Liver Abscess.
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.
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 hypochondrium (Right) and /or
epigastrium 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 specially in
cases who have developed chest complications; often
there is fever.
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 favors 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 sub costal area after a deep
inspiration. Rarely tenderness may be only in the
epigastrium 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 given 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
or 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 intestinal amoebiasis.
 If pain, fever and tenderness of the liver persists
even 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,
neighbour 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. These patients 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. The disease 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 in 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 hepatitis.
Three stages
Stage 1
Complete loss of appetite, 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 coloured urine.
In viral hepatitis patient does not complain of
pain in the liver area, may complain vague
discomfort on questioning. Patient 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 improves weight gains.
Jaundice clears up by the end of third
week.
 90-95% patients 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 Behaviour
3. Irritability
4- Tremors

Better to hospitalize

nothing can be done at this stage.

Signs of Infective hepatitis
 Jaundice
 Tender liver
 may or may not be 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, though they are very costly but
should ideally be given to all family
members.
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