CLINICAL CHEMISTRY-2 (MLT 302) LIVER FUNCTION AND THE BILIARY TRACT LECTURE FIVE - PowerPoint PPT Presentation

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CLINICAL CHEMISTRY-2 (MLT 302) LIVER FUNCTION AND THE BILIARY TRACT LECTURE FIVE

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CLINICAL CHEMISTRY-2 (MLT 302) LIVER FUNCTION AND THE BILIARY TRACT LECTURE FIVE Dr. Essam H. Aljiffri * * LIVER DISEASES Acute Viral Hepatitis Hepatitis occurs as a ... – PowerPoint PPT presentation

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Title: CLINICAL CHEMISTRY-2 (MLT 302) LIVER FUNCTION AND THE BILIARY TRACT LECTURE FIVE


1
CLINICAL CHEMISTRY-2 (MLT 302) LIVER FUNCTION AND
THE BILIARY TRACT LECTURE FIVE
  • Dr. Essam H. Aljiffri

2
LIVER DISEASES
  • Acute Viral Hepatitis
  • Hepatitis occurs as a complication of many viral
    infections, the term viral hepatitis usually
    refers to three types of infection (A, B and C).
  • Hepatitis A is transmitted by the oro-faecal
    route while
  • hepatitis B and C are transmitted by
  • blood products or other body fluids.
  • Attacks vary in severity and may be asymptomatic
    with only a transient rise in transaminases.

3
Acute Viral Hepatitis
  • The basic pathology of these infections is
    similar
  • acute inflammation, and
  • hepatic necrosis occurs.
  • Symptoms are often nonspecific at presentation,
    including
  • Anorexia, and
  • Nausea.

4
Acute Viral Hepatitis
  • Serum transaminases may be elevated
    significantly, sometimes exceeding 20 times the
    upper limit of normal.
  • Serum transaminase activities usually peak before
    the onset of jaundice which occurs typically 34
    days following the onset of symptoms,
  • the urine often becoming dark and the feces pale.

5
Acute Viral Hepatitis
  • Impaired excretion of bilirubin from hepatocytes
    is often the major cause of hyperbilirubinaemia
    which is therefore mainly conjugated.

6
Acute Viral Hepatitis
  • Bilirubinuria is common.
  • Modest increases in alkaline phosphatase greater
    than three times the upper limit of normal.

7
Chronic Hepatitis
  • Chronic persistent hepatitis may follow acute
    viral hepatitis.
  • Transaminase activities often being abnormal
    biochemical finding.

8
Chronic Hepatitis
  • Chronic active hepatitis may result from
    persisting
  • hepatitis B infection,
  • other viral infections,
  • auto-immune hepatitis,
  • drug reactions,
  • alpha1-antitrypsin deficiency,
  • alcohol abuse.

9
Chronic Hepatitis
  • Jaundice with very high serum transaminase
    activities is common
  • immunoglobulin levels are often high.
  • Serum albumin concentrations may fall as the
    disease progresses.

10
Hepatic Cirrhosis
  • Cirrhosis is a diffuse process in which fibrosis
    and nodule formation follows
  • hepatocellular necrosis.
  • There are many causes

11
Causes of liver cirrhosis
  • Chronic alcohol abuse
  • Viral hepatitis
  • Inherited metabolic disorders
  • Haemochromatosis
  • Wilsons disease
  • Galactosaemia
  • a-Antitrypsin deficiency
  • Tyrosinaemia
  • Type IV glycogen storage disease
  • Prolonged cholestasis
  • Hepatic venous outflow obstruction
  • Heart failure
  • Toxins, drugs

12
Hepatic Cirrhosis
  • The normal architecture of the liver is disrupted
    in cirrhosis, with changes in the blood supply
    resulting in portal hypertension.
  • Slight increases in transaminases, particularly
    AST and GGT, are the commonest abnormalities

13
Hepatic Cirrhosis
  • Jaundice is accompanied by increased urobilinogen
    and bilirubin excretion in urine.
  • Increases in serum immunoglobulins may occur.
  • Patients with cirrhosis are at increased risk of
    developing
  • hepatocellular carcinoma, indicated by
  • ( high alpha-fetoprotein concentrations
  • in serum).

14
Hepatocellular and Acute (Fulminant) Hepatic
Failure
  • Hepatocellular failure may result from almost all
    causes of liver disease including
  • viral hepatitis,
  • cirrhosis,
  • drug overdoses, e.g. paracetamol, and
  • prolonged cholestasis.
  • Jaundice is often progressive and transaminases
    are usually raised.

15
Hepatocellular and Acute (Fulminant) Hepatic
Failure
  • Changes in nitrogen metabolism occur, including
  • reduced urea synthesis and
  • Blood levels of ammonia may rise.
  • Hypoglycaemia may occur owing to impaired
    gluconeogenesis.
  • Abnormalities in oestrogen and androgen
    metabolism occur and a degree of feminization is
    common in male patients.

16
Hepatocellular and Acute (Fulminant) Hepatic
Failure
  • Testicular atrophy is common, with reduced
    testosterone level, particularly in
  • alcoholic patients.
  • Fulminant hepatic failure is caused by
  • sudden massive necrosis, or
  • severe impairment of liver function.

17
Hepatic Malignancy
  • The liver is a common site for secondary
    carcinoma.
  • Increases in serum alkaline phosphatase and GGT
    due to
  • tumours causing cholestasis in parts of the liver
    are common abnormalities of liver function tests.

18
Toxic Liver Damage
  • Liver injury may follow exposure to a number of
  • pharmacological,or
  • chemical agents.
  • With some, toxic effects are predictable and
    dose-related.

19
Gallstones
  • Most gallstones, unlike renal stones, do not
    contain calcium and are
  • radiotranslucent.
  • The main constituent of gallstones in Western
    countries is cholesterol.
  • Cholesterol gallstone formation due to
  • supersaturation of the bile with cholesterol.
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