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Chronic liver disease

Chronic liver disease. Definition. Pathologic Liver biopsy showing features of chronic inflammation or cirrhosis (Metavir, Knodell ’ s Scoring … ) Etiology Clinical Features of chronic liver stigmata, complications including portal hypertension. Etiology. Infection Alcohol Autoimmune

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Chronic liver disease

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  1. Chronic liver disease

  2. Definition • Pathologic • Liver biopsy showing features of chronic inflammation or cirrhosis (Metavir, Knodell’s Scoring…) • Etiology • Clinical • Features of chronic liver stigmata, complications including portal hypertension

  3. Etiology • Infection • Alcohol • Autoimmune • Cholestatic • Infiltrative • Metabolic • Vascular • Drugs • Cryptogenic

  4. Viral HepatitisOver View

  5. Diagnosis • Medical history (parenteral risk factors) • Investigations • Biochemical • Serology( HBsAg, HBeAg, HCV Ab, HDV Ab, PCR) • LFT,CBC,PT • Radiologic imaging (Ultrasound, CT/MRI abdomen) • Pathology (Liver biopsy with features of chronic hepatitis or cirrhosis)

  6. Alcohol Alcoholic liver disease: • Steatosis • Acute alcoholic steatohepatitis • cirrhosis Depends on: • Consumed alcohol • Duration • Genetic predisposition

  7. Autoimmune Hepatitis • Diagnosis • Autoantibody (ANA, SMA, LKM1 Ab..) • IgG (Increased) • Liver biopsy (interface hepatitis)

  8. Cholestatic liver disease • Primary biliary cirrhosis • AMA positive, increased Ig M & ALP • Sclerosing cholangitis • Increased ALP, association with IBD • ERCP showing beading of biliary ducts

  9. Hepatic vascular disorder • Budd-Chiari syndrome (triad of tender hepatomegaly, ascites & spleenomegaly) • Portal vein thrombosis • Veno-occlusive disease

  10. Drug induced liver disease • Cholestatic Antidepressant, ant seizure, anti fungal agents • Granulomas Allopurinol, pheytoin • Fibrosis Methotrexate, organic solvents • Phospholipidosis Amiodarone, TPN, septrin • Steatosis Tetracycline, glucocorticoids • Vascular Estrogens, azathioprine • Adenomas Estrogens

  11. Metabolic liver disease • NASH • Risk factors : insulin resistance primary: (obesity, type II diabetes, dyslipidemia) secondary: (drugs, short bowel syndrome, TPN, metabolic) • Stages: • I: Steatosis (macro vesicular) • II: Steatosis + inflammation (centrilobular) • III: Steatosis + inflammation + ballooning (degeneration & necrosis) • IV: Steatosis + inflammation + ballooning + fibrosis +/- Mallory bodies

  12. Metabolic liver disease • Alpha 1-Antitrypsin Deficiency • Liver and lung involvement • Diagnosis using quantitative serum alpha 1-antitrypsin & liver biopsy (PAS+, diastase resistant globules in periportal hepatocytes) • Hereditary Hemochromatosis • Increased iron absorption & deposition in liver, pancreas, skin, joints & heart • Increased transferrin saturation & Ferritin. HFE mutation analysis & liver biopsy ( increased hepatic iron index >1.5 with >+2 Perls’ Prussian blue stain) • Wilson’s Disease • Autosomal recessive with copper accumulation in liver, brain, cornea, RBCs, kidneys & joints due to defective copper transport and excretion. • Serum ceruloplasmin is decreased with increased urinary & hepatic copper

  13. Signs & Symptoms • Encephalopathy • Jaundice • Pallor • KF ring • Xanthelasma • Parotid swelling • Fetor hepaticus

  14. Bleeding gums • Clubbing • Leukonychia • Palmer erythema • Dupetryns contracture • Asterexis • Gynecomastia • Scratch marks

  15. Complication • Ascites • GI bleed • SBP • Edema • Hepatoma

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