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Liver
Normal liver has smooth brown surface
Weight: 1200-1600 g
Maintaining body metabolic homeostasis: Lipid and carbohydrate metabolism: production and secretion of glucose Protein synthesis: albumin, coagulation factors Detoxification and drug metabolism Excretion of bilirubin Synthesis and excretion of bile salts
Steatosis
Alcohol, Obesity, Diabetes Hyperlipidemia
Clinical picture:
Silent, or fatigue, malaise, right upper quadrant discomfort
Liver cirrhosis
Definition: bridging fibrous septa and parenchymal nodules with disruption of architecture.
Decrease detoxification capacity leading to: Hyperammonemia and increase toxic metabolites: Encephalopathy (altered behavior and consciousness that may lead to deep coma and death)
Splenomegaly
Hemorrhoids Malignancy on top of cirrhosis
Jaundice
Accumulation of bilirubin in tissue leading to yellow
Bilirubin
Conjugation is a function of the liver by adding glucuronic acid to bilirubin
Hepatocyte injury (enzymes normally present inside the hepatocytes and released with injury):
Serum aspartate aminotransferase (AST) Serum alanine aminotransferase (ALT) Serum lactate dehydrogenase
Drug-induced hepatitis
Autoimmune hepatitis
Alcoholic hepatitis
Hemochromatosis
Wilson disease
Neoplasms of the liver
Hepatitis A virus
RNA virus Mode of transmission: contaminated water and food Incubation period: 2-6 weeks Virus shedding: 2-3 weeks before and 1 week after appearance of jaundice No carrier state No increase risk for chronic hepatitis, or carcinoma Because viremia is transient, no need to screen donated blood
Hepatitis B virus
Ds-DNA virus
Hepatitis C
Ss-RNA virus Mode of transmission: parenteral, sexual, 40% unknown source. It is present in the saliva.
disease
Outcomes of infection:
Hepatitis D
Defective RNA virus that needs Hep B capsule to replicate Mode of transmission: Parenteral Coinfection of B and D: mild disease with recovery in most cases, <5% chronic hepatitis Superinfection by D after B: accelerated more severe
Hepatitis E
ssRNA virus
Drug-indued hepatitis
Predictable or unpredictable (idiosyncrasy) Mechanisms: direct toxicity, conversion of drug to an active toxin, immune-mediated A long list of drugs can cause different forms of injury: hepatitis, fibrosis, granulomas, necrosis, cholestasis, vascular disorders and neoplasia
Autoimmune hepatitis
More in females (70%) The absence of serologic markers for viral hepatitis Elevated serum IgG levels High titers of autoantibodies (antinuclear, anti-smooth
10% cirrhosis
Hereditary hemochromatosis
Autosomal recessive disease characterized by increased body iron, most of which is deposited in the liver and pancreas.
Wilson disease
Autosomal recessive disorder characterized by accumulation of copper in liver, brain and eyes, among other organs
Biliary disease
Secondary biliary cirrhosis: secondary to extrahepatic
Hepatotoxins
Clinical picture:
Often patient already has liver cirrhosis, with rapid increase in liver size, worsening ascites, fever and pain; elevated serum alpha fetoprotein levels
Median survival is 7 months (death from bleeding, liver failure, or profound cachexia)
Metastatic carcinoma
The most common malignant tumors in the liver Usually multiple lesions The most common primary sites are colon, lung, breast, pancreas and stomach
The Pancreas
The Pancreas
85% exocrine: enzymes for digestion Acute and chronic pancreatitis Cystic fibrosis Tumors 15% endocrine: insulin, glucagon and others Diabetes Tumors
Acute pancreatitis
Acute pancreatitis
Clinical presentation: abdominal pain radiating to the
Chronic pancreatitis
Progressive destruction of pancreatic parenchyma and its replacement by fibrosis Predisposing factors: alcohol, hypercalcemia or idiopathic
Pancreatic adenocarcinoma
The 5th most frequent cause of death from cancer Risk factors: smoking CP: symptoms are late; pain and jaundice Prognosis is poor: 5% survive for 5 years
Gallbladder
Gallstones
Afflict 10% of adult population in Western countries Costs of management: $6 billion a year 20 million patients are estimated to have gallstones totalling several tons Made of cholesterol, bilirubin and calcium salts with different concentrations Two types: cholesterol and pigmented stones
Gall stones
Cholesterol
Western > others Advancing age Female sex Obesity Hyperlipidemia and bile stasis
Pigmented
Asian > Western Hemolytic anemia Biliary infection
Acute cholecystitis
Calculous: acute inflammation of a gallbladder that has
Chronic cholecystitis