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SHS.420 Lec-10: Dr. M.Nauman
SHS.420 Lec-10: Dr. M.Nauman
420 Lec-10
Dr. M.Nauman
Diseases of Liver
Liver Function tests
Normal Values
• Conjugated (Direct).
• Unconjugated (Indirect).
Unconjugated Hyperbilirubinemia
(Causes)
• Water insoluble; cannot be excreted in urine.
• Causes include:
a. Overproduction – Haemolysis.
b. Impaired uptake – Drugs, ischemia.
c. Impaired conjugation – Glibert’s syndrome, Crigler-
Najjar syndrome.
d. Physiological – In neonates.
Conjugated Hyperbilirubinemia
(Causes)
• Water soluble; changes the urine colour.
• Causes include:
a. Hepatocellular dysfunction – Viruses, drugs, alcohol, cirrhosis,
liver metastases, haemochromatosis, autoimmune hepatitis,
septicemia, alpha-1 antitrypsin deficiency, Budd-Chiari syndrome,
Wilson’s disease, right heart failure, toxins.
b. Cholestasis due to impaired drainage of bile – Diseases of biliary
tree, carcinoma of pancreas.
Ascites
Definition
• Ultrasonography.
• Ascitic tap for biochemistry and cytology.
• LFTs.
Serum-Ascitic Albumin Gradient
(SAAG Ratio)
• Cirrhosis.
• Right heart failure.
• Hypoproteinemia – Nephrotic syndrome, protein-losing
enteropathy.
Causes (Exudative)
• Malignancy.
• Infections (spontaneous bacterial peritonitis (SBP), TB).
Management
• Sodium restriction.
• Diuretics – Spironolactone.
• Therapeutic ascitic tap.
• TIPSS (transjugular intrahepatic portosystemic stent shunt).
Portal Hypertension
Definition
• Splenomegaly.
• Caput medusa (visible blood vessels on anterior abdominal
wall).
• Esophageal varices.
• Rectal varices (resemble haemorrhoids).
• Ascites.
Investigations
• Upper GI endoscopy.
• Ultrasonography.
• CT or MRI angiography.
• Decreased platelet count (due to splenomegaly).
Complications
• Esophageal Varices:
a. Prevention in non-bleeding varices – Beta blockers.
b. Management of acute variceal bleed:
i. Resuscitation (ABC, IV fluids, PPI, prophylactic antibiotics,
terlipressin).
ii. Endoscopic band ligation or sclerotherapy or balloon tamponade.
iii. Secondary prevention – Beta blockers.
Cirrhosis
Pathophysiology
• May be asymptomatic.
• Non-specific symptoms like weakness, fatigue, muscle
cramps, weight loss, nausea etc. may be present.
• Hepatomegaly – Most commonly present in alcoholic
cirrhosis.
• Features of portal hypertension or ascites may be
seen in advanced cases.
Other Features
(Stigmata of Chronic Liver Disease)
• Clubbing.
• Palmar erythema.
• Spider nevi (telangiectasia).
• Gynecomastia.
Management
• Constipation.
• High protein load (e.g., protein rich diet, GI bleeding).
• Drugs.
• Trauma.
• Infections.
Management