CHRONIC LIVER DISEASE

DR. AMIT WAZIB

FCPS (MEDICINE), MD (NEUROLOGY)
ASSSOCIATE PROFESSOR & HEAD
DEPARTMENT OF MEDICINE
SHAHABUDDIN MEDICAL COLLEGE
CHRONIC LIVER DISEASE

CHRONIC HEPATITIS

CIRRHOSIS OF LIVER
 CHRONIC HEPATITIS
HEPATITIS LASTING FOR ≥ 6 MONTHS.

CAUSES
 HEPATITIS VIRUS B/C/E
 AUTOIMMUNE HEPATITIS
 ALCOHOLIC HEPATITIS
 NON ALCOHOLIC STEATOHEPATITIS
CHRONIC CIRRHOSIS OF HEPATOCELLULAR
HEPATITIS LIVER CARCINOMA
 CIRHOSIS OF LIVER

CHRONIC LIVER DISEASE CHARACTERIZED BY

PROGRESSIVE HEPATOCYTE LOSS AND
FIBROSIS LEADING TO DISORGANIZATION OF
HEPATIC ARCHITECTURE AND DEVELOPMENT
OF PORTAL HYPERTENSION.
 CIRHOSIS OF LIVER
DISORGANIZATION CHANGE IN
CHRONIC
OF LIVER HEPATIC
INFLAMMATION
ARCHITECTURE CIRCULATION

MACROPHAGES
PORTAL
RELEASE FIBROSIS
HYPERTENSION
CYTOKINES

ACTIVATION OF SYSTHESIS OF
STELLATE CELLS COLLAGEN
 CIRHOSIS OF LIVER

ALTERATION
OF HEPATIC
LOSS OF CIRCULATION
HEPATOCYTES

HEPATIC PORTAL
FAILURE HYPERTENSION
 CIRHOSIS OF LIVER
HEPATIC FAILURE COMBINED EFFECT PORTAL HYPERTENSION

JAUNDICE ASCITES SPLENOMEGALY

SPIDER NAEVI HEPATIC ENCEPHALOPATHY CAPUT MEDUSA
PALMAR ERYTHAEMA ESOPHAGEAL VARICES
HEPATIC FACE
 CIRHOSIS OF LIVER
HEPATIC FACE
 JAUNDICE
 HOLLOW CHEEKS
 PROMINENT ZYGOMA
 PINCHED NOSE
 MUDDY COMPLEXION
 CIRHOSIS OF LIVER
INVESTIGATIONS

 LIVER FUNCTION TESTS : SGPT, SERUM ALBUMIN,

PROTHROMBIN TIME

 VIRAL MARKERS : HBsAg, ANTI-HCV

 CIRHOSIS OF LIVER
INVESTIGATIONS (CONT.)

 ULTRASONOGRAM OF ABDOMEN : SMALL LIVER

WITH CORASE AECHITECTURE, SPLENOMEGALY,
ASCITES.

 ENDOSCOPY OF UPPER GIT : ESOPHAGEAL VARICES

 ACUTE COMPLICAIONS
OF
CIRRHOSIS OF LIVER
 HEPATIC ENCEPHALOPATHY
 RUPTURE OF ESOPHAGEAL VARICES
 HEPATORENAL SYNDROME
 HUGE ASCITES
 SPONTANEOUS BACTERIAL PERITONITIS
 ASCITES IN CIRRHOSIS OF LIVER
PATHOGENESIS
1. PORTAL HYPERTENSION

2. REDUCED ALDOSTERONE METABOLISM

3. SPLANCHNIC VASODILATATION CAUSING

RENAL HYPOPERFUSION AND SALT
RETENTION
 ASCITES IN CIRRHOSIS OF LIVER
TREATMENT
 RESTRICTION OF FLUID AND SALT
 SPIRONOLACTONE
 ADDITION OF FRUSEMIDE IN INADEQUATE
RESPONSE
 PARACENTESIS IN REFRACTORY ASCITES
[ALBUMIN INFUSION IF >1 LITRE ASPIRATED]
 HEPATIC ENCEPHALOPATHY

BRAIN DYSFUNCTION CAUSED BY HEPATIC

INSUFFICIENCY AND/OR PORTO-SYSTEMIC

SHUNT.
 HEPATIC ENCEPHALOPATHY
TYPE CAUSE

A ACUTE HEPATIC FAILURE

B PORTO-SYSTEMIC SHUNT

C CIRRHOSIS OF LIVER
 HEPATIC ENCEPHALOPATHY
PRECIPITATING FACTORS
 RUPTURED ESOPHAGEAL VARICES
 DIURETIC OVERDOSE
 CONSTIPATION
 EXCESSIVE PARACENTESIS
 INFECTION
 ELECTROLYTE IMBALANCE
 HEPATIC ENCEPHALOPATHY
GRADE CLINICAL FEATURES

I ALTERED SLEEP PATTERN

II AGGRASIVE BEHAVIOUR, FLAPPING TREMOR

III DROWSINESS

IV COMA
 HEPATIC ENCEPHALOPATHY
TREATMENT
 CORECTION OF PRECIPITATING FACTOR
 GUT STERILIZATION WITH RIFAXIMINE
 LACTULOSE TO ENSURE ≥ 2 BOWEL
MOVEMENTS/ DAY

REFRACTORY CASE : LIVER TRANSPLANTATION

RUPTURED ESOPHAGEAL VARICES
PRESENTATION
 HAEMATEMESIS & MELAENA
 SHOCK

INVESTIGATIONS
 BLOOD GROUPING
 HAEMOGLOBIN
 SERUM CREATININE
 SERUM ELECTROLYTES
 ENDOSCOPY OF UPPER GIT
RUPTURED ESOPHAGEAL VARICES
MANAGEMENT
MEDICAL EMERGENCY, HOSPITAL ADMISSSION
IS MANDATORY
 OXYGEN
 IV ACCESS
 SENDING BLOOD FOR GROUPING,
HAEMOGLOBIN, SERUM CREATININE, SERUM
ELECTROLYTES
RUPTURED ESOPHAGEAL VARICES
MANAGEMENT
 IV CRYSTALLOID
 BLOOD TRANSFUSION
 UPPER GI ENDOSCOPY FOR DETECTION AND
CONTROL OF BLEEDING [LIGATION].
 PROPRANOLOL TO REDUCE PORTAL
HYPERTENSION TO PREVENT RECURRENT
BLEEDING.
 THANKS
FOR THE PATIENCE HEARING