Liver Disease: Types, Symptoms, Causes, Diagnosis, Treatment

Liver Disease

The liver weighs up to 1500g in adults and as such is one of the largest organs in the body. The main functions of the liver include protein synthesis, storage, and metabolism of fats and carbohydrates, detoxification of drugs and other toxins, excretion of bilirubin and metabolism of hormones,

Liver Disease

Liver Disease


Acute Liver Disease

It is a self-limiting episode of hepatocyte damage which in most cases resolves spontaneously without clinical sequelae. This is a rare condition in which there is a rapid deterioration in liver function with associated encephalopathy (altered mentation) and coagulopathy. It may result in Acute liver failure which carries a significant morbidity and mortality and may require emergency liver transplantation.

The Chronic Liver Disease

It occurs when permanent structural changes within the liver develop secondary to long-standing cell damage, with the consequent loss of normal liver architecture. In many cases, this progresses to cirrhosis, where fibrous scars divide the liver cells into areas of regenerative tissue called nodules. The conventional wisdom is that this process is irreversible, but therapeutic intervention in hepatitis B and hemochromatosis has now repeatedly documented cases of reversal of cirrhosis. Once the patient reaches this stage they are at risk of developing liver failure, portal hypertension or hepatocellular carcinoma.

Symptoms of Liver Disease

The common symptoms of liver disease are the weakness, increased fatigue, and general malaise. Weight loss and anorexia are more commonly seen in chronic liver disease and loss of muscle bulk is a characteristic of the very advanced disease. Abdominal discomfort may be seen in patients with an enlarged liver or spleen while distension with ascites is usually the cause of more advanced disease. Abdominal pain is common in hepatobiliary disease, frequently localized to the right upper quadrant. This mostly results in rapid or gross enlargement of the liver when the pain is thought to be a consequence of capsular stretching. There is Tenderness over the liver in case of acute hepatitis, hepatic abscess or hepatic malignancy.

liver

liver


Causes of Liver Disease

Viral Infections

Viruses are the common causative agents which the affect liver, resulting in a transient and innocuous hepatitis.Five human viruses have been well described to date, including hepatitis A (HAV), B (HBV), C (HCV), D (HDV) and E (HEV). Each type of viral hepatitis causes similar symptoms with acute inflammation of the liver.

Alcohol:

Alcohol is the single most significant cause of liver disease throughout the Western world accounting for between 40% and 60% of cases of cirrhosis in different countries. About 20% of alcohol abusers develop progressive liver fibrosis, which can eventually lead to alcoholic cirrhosis, typically after a period of 10–20 years of heavy indulgence

Non-Alcohol Related Fatty Liver Disease:

Liver pathology that is very similar to alcohol-induced disease is now well recognized in a number of settings including obesity, diabetes mellitus, and the metabolic syndrome.

Immune Disorder:

Autoimmune disease can affect the hepatocyte or bile duct and is characterized by the presence of autoantibodies and raised immunoglobulin levels. It includes Autoimmune Hepatitis (AIH), Primary biliary cirrhosis (PBC), Primary sclerosing cholangitis (PSC).

Vascular Abnormalities:

The Budd–Chiari syndrome (BCS) is a rare, heterogeneous and potentially fatal condition related to the obstruction of the hepatic venous outflow tract.

Metabolic and Genetic Disorders:

There are various inherited metabolic disorders that can affect the functioning of the liver. Hemochromatosis, Wilson’s disease, α1-Antitrypsin deficiency, Glycogen storage disease, Gilbert’s syndrome.

Drugs:

Drugs are an important cause of abnormal liver function tests and acute liver injury, including ALF (DILI drug induced liver injury).

Diagnosis of Liver Disease

All patients with liver disease must undergo a comprehensive and thorough assessment to ascertain the underlying etiology. Although causes of acute and chronic liver disease may differ, a similar approach is used to investigate both patient groups to ensure no primary cause or cofactor is overlooked.

  • Biochemical tests
  • Imaging Techniques
  • Liver Biopsy
  • Lab Investigation Of Aetiology

Treatment for Liver Disease

Several pharmacological agents are available for the emergency control of variceal bleeding. Most act by lowering portal venous pressure. They are generally used to control bleeding in addition to balloon tamponade and emergency endoscopic techniques.

  • Vasopressin was the first vasoconstrictor used to reduce portal pressure in patients with actively bleeding varices. However, its associated systemic vasoconstrictive adverse effects limited its use.
  • The synthetic vasopressin analog, terlipressin, is highly effective in controlling bleeding and in reducing mortality. It can be administered in bolus doses every 4–6h and has a longer biological activity and a more favorable side effect profile.
  • Once a diagnosis of variceal bleeding has been established, a vasoactive drug infusion (usually terlipressin) should be started without further delay and continued for 2–5 days. Somatostatin and the somatostatin analog, octreotide, are reported to cause selective splanchnic vasoconstriction and reduce portal pressure.
  • Although they are reported to cause less adverse effects on the systemic circulation, terlipressin remains the agent of choice.

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