Diseases of the Liver pdf - د. زينة

Diseases of the Liver

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Objectives of this lecture is to:



List the major functions of the liver.



Define Jaundice & Identify its types.



Enumerate diseases affecting the structure and

functions of the liver.

Functions of the liver

1) General Metabolism of :       a. Carbohydrates.
              b. Fat.
2) Synthetic functions:             a. Plasma proteins.
                          b. Coagulation factors.
3) Excretion& detoxification of:   a. Steroid hormones.

b. Drugs.

4) Storage of: a. Vitamins
b. Iron.
5) Metabolism & excretion of bilirubin.

Formation of bile

Cholesterol 7-α-Hydroxycholesterol

Primary bile acids Cholate Chenodeoxycholate

Taurine/glycine conjugate

Deconjugation by intestinal bacteria

Secondary bile acids deoxycholate Lithocholate

Efficient excretion of the end products of
metabolism and of bilirubin depends on:

1. Normally functioning liver cells.

2. Normal blood flow to/through the liver.

3. Patent biliary ducts.

Jaundice

Yellowish discoloration of skin, nail bed and sclera

due to increase bilirubin level in the blood.

1. Unconjugated:

i. Hemolytic.

ii. Neonatal:

physiological

2. Conjugated: obstruction.

i. Intra-hepatic.

ii. Extra-hepatic.

Types of Hyperbilirubinemia:

Diseases of the Liver

1) Hepatitis:

i. Acute Hepatitis:

1. Viral hepatitis (A,B,C,D,& E)

2. Toxins (alcohol & drugs)

ii. Chronic hepatitis: hepatic inflammation persisting

for more than six months.

Infection (hepatitis B & C)

Autoimmune hepatitis

Toxins (alcohol).

Diseases of the Liver

2) Hepatic failure:

i. Acute Fulminant hepatic failure.

ii. Chronic : (Cirrhosis) fibrosis causing permanent

damage to hepatic tissue.

3) Cholestasis:

i. Intra-hepatic: caused by infection.

ii. Extra-hepatic: obstruction of bile duct by

(gallstone or tumor).

Diseases of the Liver

4) Fatty liver diseases:

i. Alcoholic liver disease.

ii.Non-alcoholic steatotic hepatitis (NASH) caused

by DM and/or obesity.

5) Tumors:

i. Primary (hepatocellular Carcinoma).



α-fetoprotein would be positive in 70% of cases.

ii. Secondary (metastatic deposits).

Diseases of the Liver

6) Inherited diseases:

i. Gilbert's disease: present in 5-7% of normal

population.

ii. Criggler-Najjar syndrome.

7) Uncommon liver diseases:

i. Wilson's disease.

ii. Hemochromatosis.

Diseases of the Liver

8) Liver diseases in children: Neonatal jaundice:

i. Physiological.

ii. Pathological.

9) Liver diseases in Pregnancy:

i. Hyperemesis gravidarum.

ii. Pre-eclampsia/Eclampsia:

(HELLP syndrome).

References

1. Clinical chemistry & Metabolic medicine by Martin

A. Crook; 7th edition 2008. Chapter 17.

2. Clinical Chemistry by Michael L. Bishop and

colleagues; 4th edition 2005. Part III, chapter 22.

3. Clinical Chemistry by William J Marshall & Stephen

K Bangert; 6th edition 2008. Chapter 5.