Category Archives: Liver biliary tract and pancreatic diseases

Parenchymal liver disease

The most common cause worldwide is viral hepatitis. Parenchymal liver disease can be divided into acute and chronic forms. Acute Acute parenchymal liver damage can be caused by many agents (Fig. 5.10). If there is widespread damage of hepatocytes, the normal liver architecture may collapse. The extent of hepatocellular damage may be extremely variable. PATHOLOGY Although some histological features are suggesti

NVESTIGATION

Jaundice is not a diagnosis and the cause should always be sought. The two most useful tests are the viral markers and an ultrasound examination. The liver biochemistry confirms the jaundice and may help in the diagnosis. Investigations include: 1 Viral markers for HAV and HBV (antibodies to ncv develop late). Causes of hepatomegaly. 2 An ultrasound should always be performed to exclude an extrahepatic obstru

Jaundice

Jaundice (icterus) is detectable when the serum bilirubin is greater than 30-60 /-Lmollitre-I (3 mg dl'”). The usual division of jaundice into prehepatic, hepatocellular and obstructive (cholestatic) is an oversimplification as in hepatocellular jaundice there is invariably cholestasis and the clinical problem is whether the cholestasis is intrahepatic or extrahepatic. Jaundice will therefore be consid

Signs of liver disease

Acute liver disease There may be few signs apart from jaundice and an enlarged liver. Jaundice is a yellow coloration of the skin and mucous membranes and is best seen in the conjunctivae. In the cholestatic phase of the illness, pale stools and dark urine are seen. Spider naevi and liver bpalms usually indicate chronic disease but they can occur in severe acute disease. Physical signs in chronic liver diseas

Symptoms of liver disease

Acute liver disease Acute liver disease may be asymptomatic and anicteric. For example, an abnormality such as raised aminotransferases may be found during a routine biochemical screen. Symptomatic acute liver disease, which is often viral, produces generalized symptoms of malaise, anorexia and fever. Jaundice may appear as the illness progresses. Chronic liver disease Patients may be asymptomatic or complain

Cholecystogram

This has now been replaced in most centres by ultrasound. Oral iopanoic acid is absorbed from the gut, conjugated in the liver, secreted in bile and concentrated in the gallbladder, which opacifies homogeneously. A fatty meal is given to make the gall bladder contract. The dye is excreted by the liver via the same mechanism as bilirubin, so that non-visualization will occur in the jaundiced patient and in th

Imaging techniques

The main aim of these investigations is to delineate the anatomy and to look for any abnormality in the liver or biliary tree. Plain X-rays of the abdomen These are rarely requested but may show: GALLSTONES -10% contain enough calcium to be seen AIR IN THE BILIARY TREE owing to its recent instrumentation, surgery or to a fistula between the intestine and the gallbladder PANCREATIC CALCIFICATION CALCIFICATION OF

Functions of the liver

Protein metabolism Synthesis The liver is the principal site of synthesis of all circulating proteins apart from y-globulins, which are produced in the reticuloendothelial system. It receives amino acids from the intestine and muscles and, by controlling the rate of gluconeogenesis and transamination, regulates levels in the plasma. Plasma contains 60-80 g litre-I of protein, mainly in the form of albumin, gl

THE LIVER AND BILIARY TRACT

Structure Liver The liver, the largest internal organ in the body, is situated in the right hypochondrium. Its upper border lies between the fifth and sixth ribs and its lower border can sometimes be palpated below the right costal margin on inspiration. The liver is divided into two main lobesright and left. The right is larger and also contains the quadrate and caudate lobes. Riedel’s lobe is an exten

Introduction

In the Western World alcohol is the major cause of liver disease, whilst elsewhere the hepatitis B virus is still a significant factor. The longer term clinical consequences of hepatitis C are now being increasingly recognized. Health education and the improvement of social conditions should help stop the spread of viral infections. Imaging techniques now enable the liver and biliary tree to be visualized wi