Category Archives: Liver biliary tract and pancreatic diseases

Drugs and the liver

that can be excreted in the urine or bile. This metabolismv of drugs is mediated by a group of mixed-function enzymes, including cytochrome, located on the smooth endoplasmic reticulum of the liver cell. It takes place in two stages: PHASE I METABOLISM involves oxidation, reduction or demethylation of the drug. PHASE II METABOLISM involves the conjugation of the derivatives produced in Phase I with glucuronid

Miscellaneous conditions of the liver

Reye’s syndrome This syndrome is of unknown aetiology but has been associated with aspirin consumption in childhood. It consists of an acute encephalopathy with cerebral oedema and diffuse microvesicular fatty infiltration of the liver. It occurs mainly in children and the mortality rate is 50%. Benign recurrent intrahepatic cholestasis This condition often presents in children and consists of bouts o

Liver tumours

The commonest liver tumour is a secondary (metastatic) tumour , particularly from the gastrointestinal tract, breast or bronchus. Clinical features are variable but usually include hepatomegaly. MRI is comparable to CT at detecting metastases. However, ultrasound is cheaper and more readily available. Primary liver turn ours may be benign or malignant. The commonest are malignant. MRI scan showing liver metas

Jaundice In pregnancy

Liver function is not impaired in pregnancy. Any liver disease from whatever cause can occur incidentally and coincide with pregnancy. For example, viral hepatitis accounts for 40% of all cases of jaundice during pregnancy. Pregnancy does not necessarily exacerbate established liver disease, but it is uncommon for women with advanced liver disease to conceive. The following changes take place: Plasma and bloo

Other infections of the liver

Schistosomiasis Schistosoma mansoni and S. japonicum affect the liver, but S. haematobium rarely does so. During their life-cycle the ova reach the liver via the venous system and obstruct the portal branches, producing granulomas, fibrosis and inflammation but not cirrhosis. Clinically there is hepatosplenomegaly and presinusoidal portal hypertension, which is particularly severe with S. mansoni. Investigati

Liver abscess

Pyogenic abscess These abscesses are uncommon, but may be single or multiple. The commonest cause used to be a portal pyaemia from intra-abdominal sepsis, e.g. appendicitis or perforations, but now in many cases the aetiology is not known. Biliary sepsis, particularly in the elderly, is a common cause. Other causes include trauma, bacteraemia and direct extension from, for example, a perinephric abscess. The

Budd-Chiari syndrome

In this condition there is obstruction to the venous outflow of the liver owing to occlusion of the hepatic vein. In one-third of patients the cause is unknown, but specific causes include hypercoagulability states, such as polycythaemia vera, taking the contraceptive pill, or leukaemia. Other causes include occlusion of the hepatic vein owing to posterior abdominal wall sarcomas, renal or adrenal tumours, HCC

Alcoholic liver disease

This section gives the pathology and clinical features of liver disease. The amounts needed to produce liver damage, alcohol metabolism, and other clinical effects of alcohol are described. Ethanol is metabolized in the liver by two pathways  resulting in an increase in the NADH/NAD ratio. The altered redox potential results in increased hepatic fatty acid synthesis with decreased fatty acid oxidation, bot

INVESTIGATION

Homozygotes SERUM IRON is elevated (>30/-Lmol Iitre=’}, with a reduction in the TIBC and complete or almost complete transferrin saturation (>60%). SERUM FERRITIN is elevated (usually >500 /-Lglitre-lor 240 nmollitre -I). LIVER BIOCHEMISTRY is often normal, even with established cirrhosis. Heterozygotes Heterozygotes may have normal biochemical tests or modest increases in serum iron transferri

Types of cirrhosis

Alcoholic Primary biliary cirrhosis (PBC) This is a chronic disorder in which there is a progressive destruction of bile ducts, eventually leading to cirrhosis. It predominantly affects women aged 40-50 years (female to male ratio 6 : 1). It used to be considered rare but is now being diagnosed more frequently in its milder forms. PBe has been called ‘chronic non-suppurative destructive cholangitis̵